Johnson v. O'Malley

U.S. District Court, District of Minnesota

Johnson v. O'Malley

Trial Court Opinion

                UNITED STATES DISTRICT COURT                             
                    DISTRICT OF MINNESOTA                                


Jacqueline M. J.,                       No. 23-cv-1154 (DLM)             

               Plaintiff,                                                


v.                                                                       

ORDER

Martin J. O’Malley,                                                      
Commissioner of Social Security                                          
Administration,                                                          

               Defendant.                                                



    Pursuant to 
42 U.S.C. § 405
(g), Plaintiff Jacqueline M. J. seeks judicial review of 
the final decision of the Commissioner of Social Security (“Commissioner”) denying her 
benefits. This matter is before the Court on the parties’ briefs seeking judgment on the 
administrative  record.  (Docs.  11–12  (Plaintiff’s  motion  and  memorandum),  14 
(Commissioner’s motion and memorandum).) Both parties have voluntarily consented to 
the undersigned magistrate judge’s review of this matter. For the reasons below, the Court 
denies Plaintiff’s motion and grants Defendant’s motion.                  
                         BACKGROUND                                      
    On December 4, 2020, Plaintiff applied for Disability Insurance Benefits (“DIB”), 
alleging that she had been disabled since April 1, 2020, which she later amended to October 

1, 2020. (Tr.1 at 232–38, 259.) The Social Security Administration (“SSA”) denied her 
claim initially (Tr. at 124–26), and upon reconsideration (Tr. at 131–32). Plaintiff then 
timely requested a hearing before an Administrative Law Judge (“ALJ”), and the ALJ held 
a hearing by telephone on the matter on May 11, 2022. (Tr. at 140–41 (request for hearing), 
36–69 (hearing transcript).) Counsel represented Plaintiff at the hearing, and Plaintiff also 

testified on her own behalf. (Tr. at 48–51, 57–74.) A vocational expert also testified, 
opining that if Plaintiff were limited to light, unskilled positions with some postural and 
environmental limitations, she could still perform work available in the national economy 
even though she could no longer perform her past relevant work. (Tr. at 75–79.) Plaintiff’s 
counsel had no questions for the vocational expert during the hearing. (Tr. at 79.) 

    On May 27, 2022, the Commissioner sent his notice of an unfavorable decision to 
Plaintiff. (Tr. at 10–12 (notice), 13–41 (decision).) The ALJ recognized that Plaintiff 
suffered from several severe impairments, including “degenerative disc disease; migraine 
headaches; obesity; obstructive sleep apnea; generalized anxiety disorder; and depressive 
disorder.” (Tr. at 16.)                                                   



1 The Commissioner filed the consecutively paginated transcript of the administrative 
record on June 23, 2023. (Docs. 6–6-2.) For ease of reference, the citations to the transcript 
will identify the page number listed on the lower right corner of the document as though 
all three parts were combined into one document, rather than the docket page number. 
    Despite Plaintiff’s mental and physical impairments, the ALJ found that she did not 
qualify for benefits. (Tr. at 18.) First, the ALJ considered whether Plaintiff had impairments 
that,  either  singly  or  in  combination,  met  the  criteria  of  a  listed  impairment2  that 

automatically demonstrates an individual qualifies as  disabled. (Tr. at 16–22.) As to 
Plaintiff’s physical impairments, the ALJ determined that she did not meet the criteria for 
Listings for disorders of the skeletal spine, lumbar spinal stenosis impacting the spinal 
nerves, or headaches. (Tr. at 17–20.) As to her mental impairments, the ALJ determined 
that Plaintiff did not meet the criteria for Listings for depressive, bipolar, and related 

disorders, or for anxiety and obsessive-compulsive disorders. (Tr. at 20.) 
    The ALJ also considered areas of mental functioning that may result in a finding of 
disability when an individual has either one extreme or two marked limitations, using a 
five-point scale that includes none, mild, moderate, marked, and extreme.3 He concluded 
that  the  record  showed  Plaintiff  had  a  mild  limitation  in  her  ability  to  understand, 

remember, or apply information, and at-most moderate limitations in her ability to interact 

2 Listed impairments, or “Listings,” are impairments for each major body system severe 
enough that a person would be prevented from engaging in any gainful activity. See 20 
C.F.R. pt. 404, subpt. P, app. 1.                                         
3 In evaluating the limitations a claimant’s mental impairments impose, an ALJ is directed 
to consider four broad functional areas: (1) the claimant’s ability to understand, remember, 
or apply information; (2) the claimant’s ability to interact with others; (3) the claimant’s 
ability to concentrate, persist, or maintain pace; and (4) the claimant’s ability to adapt or 
manage oneself. 
20 C.F.R. § 404
.1520a(c)(3). As noted above, the ALJ must rate the 
degree of a claimant’s impairment in each functional area based on a five-point scale: none, 
mild, moderate, marked, and extreme. 
20 C.F.R. § 404
.1520a(c)(3); see also SSA POMS 
DI 24583.005(D), https://perma.cc/J22E-T8XN (last visited Sept. 13, 2024) (describing the 
distinctions between each point on the severity scale in the Social Security Administration 
Program  Operations  Manual  System  (“POMS”));  SSA  POMS  DI  34001.032(F)(2), 
https://perma.cc/V86P-LTDF (last visited Sept. 13, 2024) (same).          
with others, to concentrate, persist, or maintain pace, and to adapt or manage oneself. (Tr. 
at  20–21.)  Finding  no  criteria  for  an  automatic  finding  of  disability,  the  ALJ  next 
determined that Plaintiff retained the residual functional capacity (“RFC”) to perform light 

work as defined by 
20 C.F.R. § 404.1567
(b), provided the job included additional postural 
and environmental limitations to account for Plaintiff’s impairments. (Tr. at 22.) 
    Next, the ALJ credited the testimony of the vocational expert that, considering 
Plaintiff’s age, education, work experience, and RFC, she could still perform work in 
representative  jobs  in  the  national  economy,  including  as  a  marker  (Dictionary  of 

Occupational Titles (“DOT”) No. 209.587-034) and a mail sorter (DOT No. 209.687-026).4 
(Tr. at 40–41, 78.) Because Plaintiff could still perform work, the ALJ found her not 
disabled under the evaluative process set forth in 
20 C.F.R. § 404.1520
(g). (Id.) Plaintiff 
appealed the ALJ’s decision, but the SSA’s Appeals Council denied her request for further 
review, making the ALJ’s decision the final decision of the Commissioner. (Tr. at 1–3.) 

    Plaintiff then filed this federal action seeking judicial review of the Commissioner’s 
decision. (Doc. 1.) Plaintiff raises six challenges to the ALJ’s determination that she is not 
disabled: 1) the ALJ improperly evaluated medical opinion evidence by failing to explain 
the provider relationships to Plaintiff and by substituting the ALJ’s own unqualified 
opinion for theirs; 2) the ALJ’s conclusion that Plaintiff did not meet Section 12.04 of the 

Listing of Impairments is not supported by substantial evidence because the ALJ based it 


4 The vocational expert also identified a third representative job as a label coder (DOT No. 
920.587-014), although the ALJ does not reference this occupation in his ultimate decision. 
(Tr. at 40–41, 78.)                                                       
on  improperly  evaluated  medical  opinion  evidence;  3)  substantial  evidence  does  not 
support Plaintiff’s RFC because the ALJ based it on improperly evaluated medical opinion 
evidence; 4) the hypothetical questions posed by the ALJ to the vocational expert were 

inaccurate because Plaintiff’s RFC is not supported by substantial evidence; 5) the ALJ 
failed to resolve the conflict between the testimony of the vocational expert and the DOT 
according to Social Security Ruling (“SSR”) 00-4p; and 6) the ALJ failed to meet his 
burden to show that there were a significant number of jobs in Plaintiff’s geographical 
region, or in several regions of the national economy, that Plaintiff could perform. Based 

on these errors, Plaintiff asks the Court to reverse the Commissioner’s decision and remand 
the matter for both a reevaluation of Plaintiff’s RFC and for additional vocational expert 
testimony.                                                                
                           ANALYSIS                                      
    This Court reviews an ALJ’s denial-of-benefits decision to determine whether it is 

supported by substantial evidence in the record as a whole, and whether the decision is 
infected by legal error. 
42 U.S.C. § 405
(g); Austin v. Kijakazi, 
52 F.4th 723, 728
 (8th Cir. 
2022). Substantial evidence means “such relevant evidence as a reasonable mind might 
accept as adequate to support a conclusion.” Biestek v. Berryhill, 
139 S. Ct. 1148, 1154
 
(2019) (internal quotations omitted); see also Nash v. Comm’r, Soc. Sec. Admin, 
907 F.3d 1086, 1089
  (8th  Cir.  2018)  (characterizing  “substantial  evidence”  as  “less  than  a 
preponderance, but enough that a reasonable mind would find it adequate to support the 
Commissioner’s conclusions”). Courts reviewing ALJ decisions must look to the entire 
administrative record to ascertain whether it contains sufficient evidence to support the 
ALJ’s conclusion. Grindley v. Kijakazi, 
9 F.4th 622, 627
 (8th Cir. 2021). When substantial 
evidence supports the ALJ’s decision, the Court will not reverse, even if substantial 
evidence also supports a contrary outcome. Nash, 
907 F.3d at 1089
. But if an ALJ fails to 

explain their evaluation of the persuasiveness of the record’s prior administrative medical 
findings, that is a legal error subject to de novo review. Joel M. B. v. Kijakazi, No. 21-cv-
1660 (PAM/ECW), 
2022 WL 1785224
, at *2 (D. Minn. June 1, 2022) (citing Collins v. 
Astrue, 
648 F.3d 869, 871
 (8th Cir. 2011)); Michael B. v. Kijakazi, No. 21-cv-1043 
(NEB/LIB), 
2022 WL 4463901
, at *1 (D. Minn. Sept. 26, 2022).              

    Plaintiff does not contest that the ALJ followed the five-step sequential process laid 
out in 
20 C.F.R. § 404.1520
(a)(4)5 for evaluating DIB claims. Rather, Plaintiff asserts that, 
because the ALJ failed to follow the appropriate analyses at several steps under the 
applicable regulations and rules, the decision issued contains legal errors and reaches a 
conclusion that is not substantially supported by the record. The Court will take each of 

Plaintiff’s challenges in turn.                                           



5 Step one of this process involves determining whether a claimant is engaged in substantial 
gainful activity. 
20 C.F.R. § 404.1520
(a)(4)(i). If not, the ALJ must next decide (in step 
two)  whether  the  claimant’s  impairments  are  severe,  and  of  a  duration  of  least  12 
continuous months. 
Id.
 § 404.1520(a)(4)(ii). At step three, the ALJ determines whether the 
claimant’s impairments are severe enough to equal a listed impairment under Appendix 1 
to Subpart P of Part 404. Id. § 404.1520(a)(4)(iii). If so, the claimant is considered disabled 
without further inquiry. If not, the ALJ must determine the claimant’s RFC, and decide (at 
step  four)  whether  the  claimant  can  still  do  their  past  work  given  their  limitations. 
Id. § 404.1520(a)(4)(iv). Finally, if the ALJ concludes a claimant cannot perform their 
prior work, step five requires the ALJ to determine whether they can do other work 
considering their RFC, age, education, and work experience. Id. § 404.1520(a)(4)(v). 
I.   THERE IS NO ERROR IN THE ALJ’S DISCUSSION OR CONCLUSIONS             
    ABOUT   PLAINTIFF’S  TREATING    PSYCHOLOGIST’S    MEDICAL           
    OPINION EVIDENCE.                                                    

    Plaintiff’s first two arguments challenge the ALJ’s consideration of the opinion of 
Amy Strait, Psy.D., Plaintiff’s treating psychologist. Plaintiff makes two claims about this 
error: first, that the ALJ’s conclusions about Dr. Strait’s opinion lack substantial evidence 
in the record, and second, that the ALJ’s discussion amounts to a legal error because it does 
not discuss all of the required factors set forth by regulation in 
20 C.F.R. § 404
.1520c. 
    As to her substantial evidence argument, Plaintiff claims that Dr. Strait found 
Plaintiff  had  marked  limitations  in  her  ability  to  interact  with  others,  to  maintain 
concentration, persistence, or pace, and to adapt and manage oneself. Dr. Strait based these 
findings on her evaluation of Plaintiff as lacking interest in activities, showing decreased 
energy and signs of psychomotor agitation or retardation, expressing feelings of guilt or 
worthlessness, and showing difficulty in thinking or concentrating. Plaintiff argues that Dr. 

Strait’s evaluation is supported by other evidence in the record that demonstrated Plaintiff 
suffered from consistently severe depression impacting her activities of daily living. Had 
the ALJ properly accounted for Dr. Strait’s opinion rather than giving it cursory attention, 
Plaintiff argues that the ALJ would have concluded that Plaintiff met the criteria of Listing 
12.04 related to depressive and bipolar disorders in the Listing of Impairments. 

    Plaintiff also argues that the ALJ’s discussion of Dr. Strait’s opinion amounts to 
legal  error  because  the  ALJ  failed  to  discuss  factors  required  by  
20 C.F.R. § 404
.1520c(3)(i)–(v), and in particular, Dr. Strait’s examining and treating relationship 
with  Plaintiff.  Plaintiff  also  argues  that  the  ALJ  wrongly  found  Dr.  Strait’s  opinion 
unpersuasive because the ALJ found it inconsistent with Plaintiff’s essentially normal 
mental status examinations and activities of daily living when in fact Dr. Strait’s opinion 
aligned with other record evidence.                                       

    The  Commissioner  disagrees,  arguing  that  substantial  evidence  in  the  record 
supports the ALJ’s conclusions that Plaintiff’s impairments did not match all of the criteria 
required for Listing 12.04. He also contends that the ALJ properly evaluated Dr. Strait’s 
medical opinion according to the required regulatory factors.             
A.   Substantial  evidence  in  the  record  supports  the  ALJ’s  conclusions  that 
    Plaintiff’s mental function limitations do not meet the criteria for Listing 12.04. 

    “The burden of proof is on the plaintiff to establish that his or her impairment meets 
or equals a listing.” Johnson v. Barnhart, 
390 F.3d 1067
, 1070 (8th Cir. 2004) (citing 
Sullivan v. Zebley, 
493 U.S. 521
, 530–31 (1990)). A plaintiff must satisfy all of a listing’s 
criteria to meet that listing. 
Id.
 The criteria for Listing 12.04 regarding depressive, bipolar, 
and  related  disorders  include  impairments  “characterized  by  an  irritable,  depressed, 
elevated, or expansive mood, or by a loss of interest or pleasure in all or almost all 
activities, causing a clinically significant decline in functioning.” 20 C.F.R. pt. 404, subpt. 

P, app. 1, Listing 12.04. Listing 12.04 requires a person to have either one “extreme” or 
two “marked” limitations in their ability to understand, remember, or apply information, 
interact with others, concentrate, persist, or maintain pace, and adapt or manage oneself, as 
well as evidence for at least two years that a person’s mental disorder is “serious and 
persistent.” 
Id.
 Underlying symptoms and signs that typically cause such serious and 

persisting limitations “may include, but are not limited to, feelings of hopelessness or guilt, 
suicidal  ideation,  a  clinically  significant  change  in  body  weight  or  appetite,  sleep 
disturbances, an increase or decrease in energy, psychomotor abnormalities, disturbed 
concentration, pressured speech, grandiosity, reduced impulse control, sadness, euphoria, 

and social withdrawal.” 
Id.
 Here, the ALJ found that “[t]he severity of the claimant’s 
mental impairments, considered singly and in combination, did not meet or medically equal 
the criteria of listing[] 12.04.” (Tr. at 20.)                            
    Plaintiff claims that Dr. Strait’s medical opinion showed that she met Listing 
12.04’s criteria. Dr. Strait completed two mental impairment questionnaires, the first on 

March 19, 2021, and the second about six months later. (Tr. at 836–41, 1180–85.) Dr. Strait 
based her medical opinion on biweekly treatment appointments with Plaintiff beginning on 
February 4, 2021, amounting to a period of less than one year even by the time she 
submitted the second questionnaire. (Tr. at 836, 1180.) Dr. Strait opined that Plaintiff had 
diagnoses of generalized anxiety, major depressive, dysthymic, and chronic pain disorders 

for which she received psychotherapy and medications without improvement during Dr. 
Strait’s period of treatment. (Id.) She rated Plaintiff’s functional limitations as moderate in 
understanding, remembering, or applying information, and marked in interacting with 
others, concentration, persistence, or pace, and adapting or managing oneself. (Tr. at 837, 
1181.) Her notes describe Plaintiff as so depressed she often could not get out of bed or 

leave her house, and as suffering from extreme panic. (Id.) As a result, Dr. Straight found 
that Plaintiff could not meet any of the required mental abilities and aptitudes to sustain 
work because of her symptoms and noted that Plaintiff would be absent from work for two 
to three days each week due to her severe depression. (Tr. at 839–40, 1183–84.) However, 
Dr. Strait did not check the box defining Plaintiff’s disorder as “serious and persistent” 
because  she  noted  that  she  had  not  been  treating  Plaintiff  for  long  enough  to  draw 
conclusions about Plaintiff’s disorder “over a period of at least 2 years.” (Tr. at 837, 1181.)  

    The ALJ reviewed Dr. Strait’s opinion, finding it unpersuasive because it was 
inconsistent with other record evidence that Plaintiff had essentially normal mental status 
examinations. (Tr. at 38.) The ALJ also cited Plaintiff’s activities of daily living  as 
evidence that Plaintiff’s functional abilities exceeded the type of limitations that would 
meet a work-preclusive mental impairment like the impairments that would meet the 

criteria  of  Listing  12.04.  (Id.)  These  activities  included  caring  for  her  one-year-old 
grandson, tending to animals on the farm, helping manage her adult sons’ finances, and 
assisting a brother suffering from schizophrenia. (Id.)                   
    When substantial evidence supports the ALJ’s decision, the Court will not reverse, 
even if substantial evidence also supports a contrary outcome. Nash, 
907 F.3d at 1089
. 

Here, there is substantial evidence in the record supporting the ALJ’s finding that Plaintiff 
did not meet Listing 12.04. First, contrary to Dr. Strait’s opinion that Plaintiff had a marked 
limitation in interacting with others, the ALJ found only a moderate limitation based on 
evidence that while Plaintiff endorsed preferring to be alone, she also said that she got 
along well with others, had friends and a boyfriend, and worked on setting boundaries with 

family members during psychotherapy sessions. (Tr. at 20 (citing Tr. at 311, 798–99, 817, 
1353, 1371–72).) Likewise, the ALJ found Plaintiff had an at-most moderate limitation in 
concentrating, persisting, or maintaining pace because she could attend to a task for 10 to 
15  minutes,  had  no  concentration  issues  during  her  February  2021  psychological 
examination, and performed within the normal range on psychometric testing. (Tr. at 20–
21 (citing Tr. at 330, 797–800, 817).) As to Plaintiff’s ability to adapt or manage oneself, 
the ALJ again found moderate limitations because, despite her subjective reports of anxiety 

and need for control, she could manage her mental impairments with a conservative course 
of treatment (psychotherapy and medications), could function independently in self-care, 
spent time out in her community, performed household chores, and cared for her infant 
grandchild. (Tr. at 21 (citing Tr. at 59–74, 305–13, 325–33, 817, 879–80).) Without one 
extreme or two marked impairments, Plaintiff fails to meet the criteria for Listing 12.04. 

See 20 C.F.R. pt. 404, subpt. P, app. 1, Listing 12.04.                   
    Second, the ALJ reviewed the record and found that while the record supported that 
Plaintiff’s mental impairments could produce her symptoms, her statements about the 
intensity, persistence, and limiting effects of her symptoms were not borne out by the 
medical and other evidence in the record. (Tr. at 23.) The Court has reviewed the record 

citations that the ALJ considered above and finds that the record contains substantial 
evidence that supports the ALJ’s conclusions.                             
    The Court therefore finds, after a careful review of the ALJ’s decision and the record 
before him, that substantial evidence in the record supports the ALJ’s determination that 
Plaintiff did not meet all of the criteria for Listing 12.04, including meeting the criteria of 

one extreme or two marked areas of mental functioning. Because substantial evidence in 
the record supports this conclusion, the Court finds no basis for reversal on this point. 
B.   The ALJ did not legally err in his discussion finding Dr. Strait’s opinion 
    unpersuasive.                                                        

    Plaintiff also claims that the ALJ should have given Dr. Strait’s medical opinion as 
Plaintiff’s  treating  psychologist  greater  weight  when  considering  Plaintiff’s  mental 
impairment limitations. According to Plaintiff, the ALJ’s discussion of Dr. Strait’s opinion 
is infected by legal error because the ALJ failed to discuss the factors required by 
20 C.F.R. § 404
.1520c(3)(i)–(v)—specifically, Dr. Strait’s examining and treating relationship with 
Plaintiff.  Plaintiff  also  argues  that  the  ALJ  wrongly  found  Dr.  Strait’s  opinion 
unpersuasive.                                                             
    The governing regulations do not require that an ALJ defer or give specific weight 
to  any  medical  opinion  or  findings.  See  Austin,  
52 F.4th at 728
  (citing  
20 C.F.R. § 404
.1520c(a)). This reflects a change to the regulations that once required an ALJ to give 
a treating medical professional’s opinion deference and controlling weight. See 
20 C.F.R. § 404.1527
. As of March 27, 2017, ALJs are under the updated requirements found at 
20 C.F.R. § 404
.1520c. Compare 
20 C.F.R. § 404.1527
 (applicable to claims filed before 
March 27, 2017) with 
20 C.F.R. § 404
.1520c (applicable to claims filed after March 27, 

2017).  According  to  these  updated  regulations,  an  ALJ  must  now  consider  the 
persuasiveness of medical opinions and findings and explain how they reached their 
conclusions according to certain factors. See  
20 C.F.R. § 404
.1520c(c)(1)–(5). These 
factors  require  that  an  ALJ  “evaluate  the  persuasiveness  of  medical  opinions  by 
considering (1) whether they are supported by objective medical evidence, (2) whether they 

are consistent with other medical sources, (3) the relationship that the source has with the 
claimant, (4) the source’s specialization, and (5) any other relevant factors.” Austin, 
52 F.4th at 728
 (quoting Bowers v. Kijakazi, 
40 F.4th 872, 875
 (8th Cir. 2022)). The first two 
factors of supportability and consistency are the most important and are the only two 

factors that an ALJ must explain in their decision, even though all of the factors must be 
considered. 
20 C.F.R. § 404
.1520c(a); see also Violet G. v. Kijakazi, No. 21-cv-2105 
(TNL), 
2023 WL 2696594
, at *6 (D. Minn. Mar. 29, 2023) (collecting cases concluding 
that an ALJ’s failure to address and explain supportability and consistency warranted 
remand). In short, an ALJ’s allocation of persuasive value will be considered legally 

sufficient  upon  court  review  for  legal  error  where  they  explain  supportability  and 
consistency in their decision.                                            
    Turning to its review, the Court first finds that the ALJ did not address the factor of 
Plaintiff’s examining relationship with Dr. Strait. Yet this “examining relationship” factor 
falls under the factors that the SSA “may, but [is] not required to, explain” in making its 

determination, unlike the mandatory factors of “supportability” and “consistency” which 
an ALJ must discuss. 
20 C.F.R. § 404
.1520c(b)(2). In other words, courts assume that an 
ALJ considered the “examining relationship” when evaluating the persuasiveness of an 
opinion or finding.                                                       
    Considering the two factors that an ALJ must address under § 404.1520c, the Court 

finds that the ALJ discussed his reasons for finding that Dr.  Strait’s opinion lacked 
consistency with, and support from, the record. (Tr. at 38.) The ALJ opined that, although 
Dr. Strait opined that Plaintiff had three areas of mental function that showed marked 
limitations, this position was inconsistent with, and unsupported by, record evidence. (Tr. 
at 38.) The ALJ then discussed conflicting record evidence of essentially normal mental 
status examinations and engagement in daily living activities that suggested Plaintiff’s 
limitations were not as severe as she subjectively reported. (Id.) Although Plaintiff may 

disagree with this analysis and its conclusions, the Court finds that this analysis is sufficient 
under 
20 C.F.R. § 404
.1520c. The Court also finds it is supported by substantial evidence 
in the record as a whole, as discussed above. The Court thus finds no basis for reversal as 
to the ALJ’s discussion of Dr. Strait’s opinion.                          
II.  SUBSTANTIAL EVIDENCE IN THE RECORD AS A WHOLE SUPPORTS               
    THE  ALJ’S  RFC  LIMITATIONS  TO  ACCOMMODATE   PLAINTIFF’S          
    BACK PAIN AND MIGRAINE HEADACHES.                                    

    Plaintiff’s next argument is that substantial evidence in the record does not support 
the physical limitations of her RFC, which she claims should reflect the greater limitations 
found in the opinions of Plaintiff’s primary care physician, Jennifer Hart, PA-C, and Dr. 
Strait. Specifically, Plaintiff argues that her back pain and migraine headaches result in 
work-preclusive limitations, but that the ALJ ignored persuasive opinion evidence on this 
point and instead substituted his own  medically-unqualified  judgment that Plaintiff’s 
limitations were not severe enough to preclude work.                      
    The  Commissioner  argues  that  while  Plaintiff  may  disagree  with  the  ALJ’s 
conclusions, the ALJ’s decision is supported by substantial evidence in the record and 

contains no legal error. The Commissioner asserts that Plaintiff bears the burden to prove 
greater restrictions are required in her RFC, and that she has not met that burden. 
    A plaintiff’s RFC is the measure of the “the most [they] can still do despite [their] 
limitations.” 
20 C.F.R. § 404.1545
(a)(1). An ALJ must consider all relevant evidence in 
the record to fashion a plaintiff’s RFC, “including medical records, observations of treating 
physicians and others, and [the plaintiff’s] own description of [their] limitations.” Anderson 
v. Shalala, 
51 F.3d 777, 779
 (8th Cir. 1995); see also 
20 C.F.R. § 404.1545
(e) (providing 

that the ALJ “will consider the limiting effects of all [a plaintiff’s] impairment(s), even 
those that are not severe, in determining [their] residual functional capacity”). “[T]o find a 
[plaintiff] has the residual functional capacity to perform a certain type of work, the 
[plaintiff] must have the ability to perform the requisite acts day in and day out, in the 
sometimes competitive and stressful conditions in which real people work in the real 

world.” Reed v. Barnhart, 
399 F.3d 917, 923
 (8th Cir. 2005) (citing Thomas v. Sullivan, 
876 F.2d 666, 669
 (8th Cir. 1989)).                                       
A.   Substantial  evidence  in  the  record  supports  the  ALJ’s  RFC  concerning 
    Plaintiff’s back pain and migraine headaches.                        

    Here, Plaintiff’s RFC contains limitations to account for her physical impairments, 
including, for example, a limitation to light work with no climbing of ladders, occasional 
climbing of stairs, occasional balancing, occasional bending down, occasional reaching 
overhead, and frequent reaching side to side. (Tr. at 22.) The ALJ discussed the record 
evidence, including opinion evidence, on Plaintiff’s back pain and migraine headaches. 
(Tr.  at  22–29.) Such  evidence  included Plaintiff’s  spinal  pain,  imaging of  her  spine 
showing mild to moderate narrowing of her discs, and treatments including physical 
therapy, branch blocks, and radiofrequency ablation. (E.g., Tr. at 24 (citing Tr. at 902), 25 
(citing Tr. at 785), 26–27 (citing Tr. at 901), 28 (citing Tr. at 1387, 1396–98).) As to her 

migraine  headaches,  the  ALJ  found  that  Plaintiff’s  treatment  records  were  generally 
preventative after 2020, employing medications, Botox injections, nerve block injections, 
and  physical  and  chiropractic  therapies  to  reduce  the  frequency  and  severity  of  her 
migraines. (Tr. at 29.) Here again, the ALJ discussed the record evidence on Plaintiff’s 

migraines when reaching this conclusion. (E.g., Tr. at 23 (citing Tr. at 59–74, 307–12, 325–
32), 24 (citing Tr. at 425–27, 483, 503), 25 (citing Tr. at 921–24), 26 (citing Tr. at 863–
64), 27 (citing Tr. at 979), 27–28 (citing Tr. at 1437), 28 (citing Tr. at 1417, 1425, 1439), 
29 (citing Tr. at 1419).) After reviewing the evidence on her back pain and migraine 
headaches, the ALJ concluded that her RFC required adjustments to accommodate her 

limitations:                                                              
    The  undesigned  found  the  claimant’s  migraine  headaches  and  back 
    impairments limit the claimant to light exertional work (i.e., lifting, carrying, 
    pulling, and pushing up to 10 pounds frequently and 20 pounds occasionally, 
    and sitting, standing, and walking 6 hours each in an 8-hour workday with 
    normal breaks). The claimant was capable of that level of work activity as 
    long as she occasionally balanced, crawled, crouched, kneeled, stooped, and 
    climbed ramps and stairs but never ladders, ropes, or scaffold nor exposure 
    to hazards. The undersigned further found the claimant was capable of 
    occasionally reaching overhead with the bilateral upper extremities, and 
    frequently,  but  not  constantly,  reaching  in  all  other  directions  with  the 
    bilateral upper extremities. Additionally, the claimant was able to tolerate 
    occasional exposure to extreme heat, extreme cold, and humidity; light and 
    noise equivalent to that of an office setting; work environment where the 
    noise intensity level did not exceed “moderate” as that term was defined in 
    the Selected Characteristics of Occupations; and no exposure to vibration, 
    such as vibratory tools or machinery.                                

(Tr. at 29.)                                                              
    Plaintiff argues that the ALJ based his decision on his own conclusions rather than 
on medical evidence. But considering the ALJ’s lengthy discussion of record evidence 
discussed  above  on  Plaintiff’s  back  and  headache  impairments—including  objective 
medical evidence—the Court respectfully disagrees with Plaintiff’s argument. 
B.   The ALJ did not legally err in his discussion finding the opinions of Ms. Hart 
    and Dr. Strait unpersuasive.                                         

    Plaintiff also contends that if the ALJ had properly considered the medical opinion 
evidence from Ms. Hart and Dr. Strait according to the requirements of the relevant 
regulatory  standard,  the  RFC  would  have  reflected  Plaintiff’s  actual,  more  severe 
limitations. However, the Court finds that the ALJ followed the requirements of 
20 C.F.R. § 404
.1520c  when  he  found  the  opinions  of  Ms.  Hart  and  Dr.  Strait  only  partially 
persuasive.                                                               
    As to Ms. Hart’s opinion, she submitted a number of physician’s statements about 

Plaintiff’s symptoms that contained updates on the status of Plaintiff’s conditions and 
limitations between September 2020 and June 2021. (E.g., Tr at 1319, 1327, 1332, 1336.) 
These statements noted that Plaintiff’s migraines were so severe she could not return to 
work until June 2021. (Id.) Ms. Hart also submitted letters on Plaintiff’s behalf from 
October 2020 through March 2022 excusing Plaintiff from work based on her medical 

conditions. (E.g., Tr. at 1052, 1160, 1220–34, 1319, 1389.) Finally, Ms. Hart submitted an 
RFC questionnaire in December 2020 in which she assessed Plaintiff’s limitations as 
follows: can lift less than 10 pounds rarely, sit 10 minutes at a time and for a total of less 
than two hours in an eight-hour workday, stand 10 minutes, walk zero blocks, stand and 
walk for less than two hours in an eight-hour workday, walk around for 10 minutes, change 

positions at will, be able to lie down, take unscheduled 10- to 15-minute breaks every one 
to two hours, never move her head and neck, rarely perform postural movements, and limit 
her handling and reaching. (Tr. at 443–48.)                               
    The ALJ reviewed Ms. Hart’s submissions and found them unpersuasive. As to her 

physician’s statements and letters, the ALJ found they provided only temporary, short-term 
evidence that lacked persuasive value under 
20 C.F.R. § 404
.1520b(c).6 As to Ms. Hart’s 
RFC assessment, the ALJ pointed out that Ms. Hart’s clinic notes show Plaintiff filled out 


6 The Court understands the ALJ’s conclusion to be that Ms. Hart’s opinions reach matters 
reserved for the Commissioner under 
20 C.F.R. § 404
.1520b(c)(3):          

 (3) Statements on issues reserved to the Commissioner. The statements listed in 
    paragraphs (c)(3)(i) through (c)(3)(viii) of this section would direct our 
    determination or decision that you are or are not disabled or blind within the 
    meaning of the Act, but we are responsible for making the determination or 
    decision about whether you are disabled or blind:                    
      (i)  Statements that you are or are not disabled, blind, able to work, or 
           able to perform regular or continuing work;                   
      (ii)  Statements about whether or not you have a severe impairment(s); 
      (iii)  Statements about whether or not your impairment(s) meets the 
           duration requirement (see § 404. 1509);                        
      (iv)  Statements about whether or not your impairment(s) meets or  
           medically equals any listing in the Listing of Impairments in Part 
           404, Subpart P, Appendix 1;                                   
      (v)  Statements about what your residual functional capacity is using 
           our programmatic terms about the functional exertional levels in 
           Part  404,  Subpart  P,  Appendix  2,  Rule  200.00  instead  of 
           descriptions about your functional abilities and limitations (see § 
           404. 1545);                                                    
      (vi)  Statements about whether or not your residual functional capacity 
           prevents you from doing past relevant work (see § 404. 1560);  
      (vii)  Statements that you do or do not meet the requirements of a 
           medical-vocational rule in Part 404, Subpart P, Appendix 2; and 
      (viii)  Statements about whether or not your disability continues or ends 
           when we conduct a continuing disability review (see § 404. 1594). 

20 C.F.R. § 404
.1520b(c)(3).                                              
her own questionnaire for her disability application, eroding its persuasive value versus a 
physician’s own opinion. (Tr. at 36 (citing Tr. at 480).) The ALJ found that most of Ms. 
Hart’s conclusions appeared to be supported by Plaintiff’s subjective reports but not by 

objective medical evidence. (Tr. at 36.) Specifically, Ms. Hart observed that Plaintiff 
reported her symptoms—including her back pain and headaches—would not permit her to 
work. (Tr. at 480.) In contrast, Ms. Hart’s physical findings about Plaintiff included that 
she was alert, oriented, spoke normally, had appropriate affect, showed organized thoughts, 
had an anxious mood, appeared well-developed and nourished, showed no distress, had 

normal musculoskeletal and neurological exams, and had no unusual findings during a neck 
exam. (Id.) The ALJ concluded that on such generally normal evaluative findings except 
for her mood, the degree of limitations that Ms. Hart then endorsed for Plaintiff lacked 
support. (Tr. at 36.)                                                     
    Plaintiff disagrees with the ALJ’s assessment, arguing that his discussion did not 

comply with the regulations because he did not address the required factors, including Ms. 
Hart’s  treating  relationship  with  Plaintiff.  Yet  as  discussed  above,  the  governing 
regulations do not require that an ALJ defer or give specific weight to any medical opinion 
or findings. See Austin, 
52 F.4th at 728
 (citing 
20 C.F.R. § 404
.1520c(a)). Rather, an ALJ 
must consider all five factors found at 
20 C.F.R. § 404
.1520c(c)(1)–(5), and must explain 

the first two factors—supportability and consistency—when assessing a medical opinion’s 
persuasive value. 
20 C.F.R. § 404
.1520c(b)(2); see also Violet G., 
2023 WL 2696594
, at 
*6. Here, the ALJ explained why he found Ms. Hart’s opinion on Plaintiff’s limitations 
unpersuasive: because she opined on areas reserved for the Commissioner under 
20 C.F.R. § 404
.1520b(c), and because her assessment lacked consistency with, and support from, 
her own objective medical findings on the severity of Plaintiff’s symptoms. 
    The same holds true for the ALJ’s evaluation of Dr. Strait’s opinion on Plaintiff’s 

RFC. Dr. Strait treated Plaintiff for her mental impairments, and this included treating her 
for migraines and chronic pain. (Tr. at 836–37, 1180.) Dr. Strait opined that, as previously 
noted, Plaintiff’s impairments were work-preclusive. (Tr. at 836–841, 1181–85.) The ALJ 
concluded, also as previously noted, that the record evidence did not support the degree of 
limitations from her mental impairments that Dr. Strait identified, as borne out by evidence 

of Plaintiff’s daily living activities. (Tr. at 38.) This analysis remains sufficient under 
20 C.F.R. § 404
.1520c, as discussed above, and the Court again finds no basis for reversal as 
to the ALJ’s discussion of Dr. Strait’s opinion.                          
III.  THE  VOCATIONAL     EXPERT’S    TESTIMONY     CONSTITUTES           
    SUBSTANTIAL EVIDENCE IN THE RECORD SUPPORTING THE ALJ’S              
    CONCLUSION THAT PLAINTIFF IS NOT DISABLED.                           

    Plaintiff’s next argument is that substantial evidence in the record fails to support 
the ALJ’s conclusion that Plaintiff is not disabled because the vocational expert gave 
inaccurate  testimony  that  could  not  provide  a  reliable  basis  for  any  conclusions. 
Specifically, Plaintiff contends that because the RFC hypotheticals posed to the vocational 
expert  did  not  include  all  of  Plaintiff’s  limitations,  the  vocational  expert  could  not 
accurately assess whether jobs existed which Plaintiff could perform.     
    The Commissioner disagrees, arguing that the ALJ’s hypothetical questions were 
grounded in record evidence and resulted in accurate responses that provided a basis for 
the ALJ’s disability determination. The Commissioner further contends that, if the Court 
finds Plaintiff’s RFC determination is supported by substantial evidence in the record and 
is not infected by legal error, then Plaintiff’s arguments about the hypothetical questions 
fail because they depend on the Court finding an unsupported, legally insufficient RFC 

determination.                                                            
    “A vocational expert’s testimony constitutes substantial evidence when it is based 
on a hypothetical that accounts for all of the claimant’s proven impairments.” Hulsey v. 
Astrue, 622, F.3d 917, 922 (8th Cir. 2010) (citing Grissom v. Barnhart, 
416 F.3d 834, 837
 
(8th Cir. 2005)). As discussed above, the Court has already concluded that the ALJ 

appropriately tailored Plaintiff’s RFC to accommodate limitations substantially supported 
by the record.                                                            
    Building on this conclusion, the Court also finds that the ALJ accurately described 
the exertional, postural, and environmental limitations in Plaintiff’s RFC to the vocational 
expert during the hearing. (Tr. at 76–78.) In response, the vocational expert testified that, 

if  limited  to  light  and  unskilled  positions,  a  person  with  Plaintiff’s  postural  and 
environmental limitations could still perform work available in the national economy even 
though she could no longer perform her past relevant work. (Tr. at 75–79.) Plaintiff’s 
counsel did not question the vocational expert. (Tr. at 79.) The ALJ then relied on the 
expert’s testimony. (Tr. at 41.)                                          

    The Court concludes that the vocational expert gave accurate testimony that the ALJ 
reasonably relied on to find that Plaintiff is not disabled. Because the Court finds no error 
in the ALJ’s assessment of Plaintiff’s RFC, and because the hypothetical questions posed 
to the vocational expert accurately reflected the limitations of that RFC, the Court finds no 
basis for remand here.                                                    
IV.  THE ALJ’S DECISION COMPLIED WITH SSR 00-4P.                          

    Plaintiff’s next argument is that the ALJ failed to meet his duty to resolve conflicts 
between the testimony of the vocational expert and the DOT. Plaintiff claims that although 
the ALJ asked the vocational expert to consider a hypothetical person who could perform 
only  simple,  routine  tasks  and  simple  work-related  decisions,  the  vocational  expert 
identified two representative jobs that do not match such limitations. Rather than resolving 

this conflict, Plaintiff argues that the ALJ failed to elicit a reasonable explanation for the 
conflict by the vocational expert as required of him by SSR 00-4p. Plaintiff contends that 
this constitutes reversible error.                                        
    The Commissioner argues that the ALJ properly relied on the vocational expert’s 
testimony that no conflict existed between her testimony and the DOT. He contends that 

the identified representative occupations required a reasoning level of two or three, and 
that the DOT definitions for such jobs do not require more than performing work on simple, 
routine tasks and simple work-related decisions.                          
    When receiving a vocational expert’s testimony, an ALJ must ask whether their 
testimony conflicts with the DOT and, if so, must follow the procedure provided by SSR 

00-4p. See SSR 00-4p, 
2000 WL 1898704
, at *2–4 (Dec. 4, 2000); see also Moore v. 
Colvin, 
769 F.3d 987
, 989–90 (8th Cir. 2014). Under SSR 00-4p, “[w]hen there is an 
apparent unresolved conflict between [vocational expert] . . . evidence and the DOT, the 
adjudicator must elicit a reasonable explanation for the conflict before relying on the 
[expert] evidence to support a determination or decision about whether the claimant is 
disabled.” 
2000 WL 1898704
, at *2. When there is a conflict, neither the DOT nor the 
expert testimony automatically takes priority; instead, the ALJ “must resolve the conflict 

by determining if the explanation given by the [expert] is reasonable and provides a basis 
for relying on the [expert] testimony rather than on the DOT information.” 
Id.
 “The 
adjudicator must explain the resolution of the conflict.” 
Id. at *4
.      
    During the May 2022 hearing for Plaintiff here, the ALJ posed a hypothetical 
question about what jobs would be available to a person limited to, among other things, 

“simple and routine tasks performed in a work environment free of fast-paced production 
requirements, i.e., no work on an assembly line,” and “low stress work . . . involving only 
simple work-related decisions and routine workplace changes.” (Tr. at 77.) The vocational 
expert testified that, based on the ALJ’s hypothetical limitations, such a person could still 
perform work in representative jobs in the national economy. (Tr. at 76–79.) The expert 

identified three jobs, including a marker (DOT No. 209.587-034), a mail sorter (DOT No. 
209.687-026), and a label coder (DOT No. 920.587-014). (Tr. at 78.) The expert did not 
offer testimony about the regional location(s) of such jobs. After receiving her testimony, 
the ALJ pointed out that the DOT does not cover some aspects of functional limitations, 
including “time off task, absenteeism, pace work, work in proximity to others, low-stress 

work, work in proximity to hazards, distinction between reaching overhead, reaching in all 
other directions, distinction between climbing ladders versus stairs, and use of vibratory 
tools.” (Tr. at 78–79.) The ALJ thus asked upon what source the vocational expert based 
her testimony on these limitations, and she answered “[t]hirty-seven years professional 
experience in job placement.” (Tr. at 79.) The ALJ then asked, “[a]nd has your testimony 
been consistent with the DOT and SCO?”7 to which the vocational expert responded, 
“Yes.” (Id.)                                                              

    The ALJ ultimately adopted an RFC that limited Plaintiff to “simple and routine 
tasks performed in a work environment free of fast-paced production requirements (i.e. no 
work on an assembly line)” and “low stress work, which is defined as involving only 
simple, work-related decisions and routine work place changes.” (Tr. at 22.) The ALJ cited 
two of the vocational expert’s examples of representative jobs that Plaintiff could still 

perform with such limitations, including the occupations of marker (DOT No. 209.587-
034) and mail sorter (DOT No. 209.687-026). (Tr. at 40.) He also concluded that the 
vocational expert’s testimony was consistent with the DOT. (Tr. at 41.) In doing so, he 
noted that the DOT does not provide information on “pace work” or “low stress work,” 
among other things, and that he relied on the vocational expert’s testimony based on her 

37 years of professional experience in job placement to reach conclusions on these areas 
where the DOT is silent. (Id.)                                            
A.   There is no conflict between the vocational expert’s testimony related to pace 
    and stress levels and the DOT.                                       

    The Court finds that the ALJ fulfilled the requirements of SSR 00-4p. First, the ALJ 
asked whether the vocational expert’s testimony conflicted with the DOT and received the 
expert’s confirmation no conflict existed. Even though an ALJ is not absolved of their duty 

7  The  “SCO”  refers  to  the  DOT’s  supplement  entitled  Selected  Characteristics  of 
Occupations  Defined  in  the  Dictionary  of  Occupational  Titles,  which  elaborates  on 
exertional RFC classifications. See SSR 83-14, 
1983 WL 31254
, at *1 (Jan. 1, 1983). 
to ensure that the vocational expert’s testimony is consistent with the DOT just because the 
expert testifies that the two are consistent, see Moore, 
769 F.3d at 990
, at the very least, it 
is clear from the vocational expert’s testimony here that the DOT could not conflict with 

areas on which it was silent—the DOT does not offer guidance on pace work or low stress 
work. Thus, to the extent that Plaintiff challenges the vocational expert’s testimony about 
the pace and stress levels of work for the representative occupations, there can be no 
conflict between the expert’s testimony and the DOT, and thus, no conflict that the ALJ 
failed to resolve.                                                        

B.   There is no conflict between the Worker Functions ratings in the representative 
    occupations of marker and mail sorter and an RFC limiting Plaintiff to “simple 
    and routine tasks” and “simple and work related decisions.”          

    For the sake of thoroughness, the Court next considers whether there are any non-
pace or stress-level related job characteristics specific to the jobs identified that would still 
conflict with the DOT. Plaintiff challenges whether a marker or mail sorter involves more 
than “simple and routine tasks” and “simple and work related decisions.” (Tr. at 22.) A 
“marker”                                                                  
    [m]arks and attaches price tickets to articles of merchandise to record price 
    and identifying information: Marks selling price by hand on boxes containing 
    merchandise, or on price tickets. Ties, glues, sews, or staples price ticket to 
    each article. Presses lever or plunger of mechanism that pins, pastes, ties, or 
    staples ticket to article. May record number and types of articles marked and 
    pack them in boxes. May compare printed price tickets with entries on 
    purchase order to verify accuracy and notify supervisor of discrepancies. 

DICOT 209.587-034, 
1991 WL 671802
. A “mail sorter”                        
    Sorts incoming mail for distribution and dispatches outgoing mail: Opens 
    envelopes by hand or machine. Stamps date and time of receipt on incoming 
    mail. Sorts mail according to destination and type, such as returned letters, 
    adjustments, bills, orders, and payments. Readdresses undeliverable mail 
    bearing  incomplete  or  incorrect  address.  Examines  outgoing  mail  for 
    appearance and seals envelopes by hand or machine. Stamps outgoing mail 
    by hand or with postage meter.                                       

DICOT 209.687-026, 
1991 WL 671813
.                                        
    These  “DOT  definitions  are  simply  generic  job  descriptions  that  offer  the 
approximate maximum requirements for each position, rather than their range.” Page v. 
Astrue, 
484 F.3d 1040, 1045
 (8th Cir. 2007) (quoting Wheeler v. Apfel, 
224 F.3d 891, 897
 
(8th Cir. 2000)). “The middle three digits of the DOT occupational code are the Worker 
Functions ratings of the tasks performed in the occupation” and relate to the degree of 
demand on a worker as to “data, people, and things.” DICOT, Parts of the Occupational 
Definition, 
1991 WL 645965
. “As a general rule, Worker Functions involving more 
complex responsibility and judgment are assigned lower numbers in these three lists while 
functions which are less complicated have higher numbers.” 
Id.
 “It is assumed that, if the 
job requires it, the worker can generally perform any higher numbered function listed in 
each of the three categories.” 
Id.
 Thus, if the representative jobs identified only involve 
“simple and routine tasks” and “simple and work related decisions” according to the DOT, 

the Court would expect the three middle digits would have a higher number, signaling the 
functions are less complicated.                                           
    First the Court will consider the initial Worker Functions rating digit concerning 
data. A job can have a rating between one and six for the first digit related to data. See 
DICOT, Appendix B – Explanation of Data, People, and Things, 
1991 WL 688701
. 

Reviewing a marker’s first Worker Functions rating—five—a worker would need to do no 
more than “copy” data, which involves “[t]ranscribing, entering, or posting data.” DICOT, 
Parts  of  the  Occupational  Definition,  
1991 WL 645965
;  DICOT,  Appendix  B  – 
Explanation of Data, People, and Things, 
1991 WL 688701
; DICOT 209.587-034, 
1991 WL 671802
. Reviewing a mail sorter’s first middle digit—six—a worker would need to do 
no more than “compare” data, which involves “[j]udging the readily observable functional, 
structural, or compositional characteristics (whether similar to or divergent from obvious 
standards) of data, people, or things.” DICOT, Parts of the Occupational Definition, 
1991 WL 645965
; DICOT, Appendix B – Explanation of Data, People, and Things, 
1991 WL 688701
; DICOT 209.687-026, 
1991 WL 671813
. Both jobs have ratings at the higher end 
of the Worker Functions rating at five and six, respectively, and the Court finds that these 
ratings and their descriptions do not conflict with an RFC limiting Plaintiff to “simple and 
routine tasks” and “simple and work related decisions.” See, e.g., Melsha v. Colvin, No. 
14-cv-3 (JSS), 
2014 WL 5858561
, at *6–7 (N.D. Iowa Nov. 12, 2014) (affirming an ALJ’s 

decision finding a plaintiff limited to simple, routine tasks could perform the representative 
jobs of a marker and mail clerk); Weckherlin v. Berryhill, No. 4:16-cv-1487 (AGF), 
2017 WL 3873167
, at *1, 4 (E.D. Mo. Sept. 5, 2017) (affirming an ALJ’s decision finding a 
plaintiff limited to simple, routine, repetitive work without a fast pace could perform 
representative jobs of mail room clerk and merchandise marker).           

    Next,  the  Court  will  consider  the  second  two  Worker  Functions  rating  digits 
concerning people and things. The final two digits in both the marker and mail sorter jobs 
are the same—an eight in relation to people, and a seven in relation to things. DICOT 
209.587-034, 
1991 WL 671802
; DICOT 209.687-026, 
1991 WL 671813
. Both numbers 
represent the highest (and therefore least complicated) category of job in relation to people 
(with ratings from one through eight) and things (with ratings from one through seven). 
See DICOT, Appendix B – Explanation of Data, People, and Things, 
1991 WL 688701
. As 

to people, both jobs require a worker to do no more than take “instructions” from and 
“help” people, which involves “[a]ttending to the work assignments instructions or orders 
of supervisors” with no immediate response required or expectation of learning. DICOT, 
Parts  of  the  Occupational  Definition,  
1991 WL 645965
;  DICOT,  Appendix  B  – 
Explanation of Data, People, and Things, 
1991 WL 688701
; DICOT 209.587-034, 
1991 WL 671802
; DICOT 209.687-026, 
1991 WL 671813
. As to things, both jobs require a 
worker to do no more than “handle” things, which involves “[u]sing body members, 
handtools,  and/or  special  devices  to  work,  move,  or  carry  objects  or  materials”  and 
“[i]nvolves little or no latitude for judgment with regard to attainment of standards or in 
selecting  appropriate  tool,  object,  or  materials.”  DICOT,  Parts  of  the  Occupational 

Definition, 
1991 WL 645965
; DICOT, Appendix B – Explanation of Data, People, and 
Things, 
1991 WL 688701
; DICOT 209.587-034, 
1991 WL 671802
; DICOT 209.687-026, 
1991 WL 671813
. The Court again finds that these ratings and their descriptions do not 
conflict with an RFC limiting Plaintiff to “simple and routine tasks” and “simple and work 
related decisions.” See, e.g., Melsha, 
2014 WL 5858561
, at *6–7. Weckherlin, 
2017 WL 3873167
, at *1, 4.                                                        
C.   There is no conflict between the general educational development rating on 
    reasoning in the representative occupations of marker and mail sorter and an 
    RFC limiting Plaintiff to “simple and routine tasks” and “simple and work 
    related decisions.”                                                  

    Along with these functional ratings in the middle three digits of each job, the DOT 
also assigns jobs a rating on a scale of one through six for general educational development 
in  three  areas:  reasoning,  math,  and  language  development.  DICOT,  Appendix  C  – 
Components of the Definition Trailer, 
1991 WL 6887702
. The lower the rating, the less 
complicated reasoning is involved in a job. The reasoning component is relevant here to 
consider whether the occupations of marker and mail sorter in the DOT involve more than 
“simple and routine tasks” and “simple and work related decisions.” (Tr. at 22.) 
    Here, the job of a marker is rated a “Level 2” for reasoning, which requires a worker 
to  do  no  more  than  “[a]pply  commonsense  understanding  to  carry  out  detailed  but 
uninvolved written or oral instructions” and to “[d]eal with problems involving a few 
concrete variables in or from standardized situations.” DICOT, Appendix C – Components 
of the Definition Trailer, 
1991 WL 6887702
; DICOT 209.587-034, 
1991 WL 671802
. The 
role of a mail sorter is rated a “Level 3” for reasoning, which requires a worker to do no 

more than “[a]pply commonsense understanding to carry out instructions furnished in 
written, oral, or diagrammatic form” and to “[d]eal with problems involving several 
concrete variables in or from standardized situations.” DICOT, Appendix C – Components 
of the Definition Trailer, 
1991 WL 6887702
; DICOT 209.687-026, 
1991 WL 671813
. 
    Considering  the  characteristics  of  jobs  like  marker  or  mail  sorter  in  relation 

reasoning, the Court finds no conflict between the DOT and the vocational expert’s 
testimony that a person limited to “simple and routine tasks” and “simple and work related 
decisions” could perform these roles. Accord Murphy v. Berryhill, No. 18-cv-61 (LRR), 
2019 WL 1140235
, at *16 (N.D. Iowa Mar. 12, 2019) (“[T]he Eighth Circuit has held that 

a claimant who could follow ‘simple, concrete instructions’ could do a job requiring level 
3 reasoning and a claimant who was limited to unskilled work could do jobs requiring level 
3 reasoning.”) (citing Hillier v. Soc. Sec. Admin., 
486 F.3d 359, 367
 (8th Cir. 2007); 
Renfrow v. Astrue, 
496 F.3d 918
, (8th Cir. 2007)); see also, Galloway v. Kijakazi, 
46 F.4th 686, 690
 (8th Cir. 2022) (“We previously have found no direct conflict between carrying 

out simple job instructions for simple, routine and repetitive work activity, and a vocational 
expert’s  identification  of  occupations  involving  instructions  that,  while  potentially 
detailed, are not complicated or intricate.”) (quoting Moore v. Astrue, 
623 F.3d 599, 604
 
(8th Cir. 2010)) (cleaned up); Nicolas J. v. Kijakazi, No. 20-cv-1340 (WMW/ECW), 
2022 WL 1109810
, at *25 (D. Minn. Jan. 20, 2022) (affirming an ALJ’s decision finding a 

plaintiff limited to simple, routine tasks at a nonproduction pace could perform work 
requiring Level 3 reasoning), R. & R. adopted sub nom. Nicholas C. J. v. Kijakazi, 
2022 WL 807605
 (D. Minn. Mar. 17, 2022).                                       
    In sum, because the hypotheticals presented to the vocational expert were based on 
substantial evidence in the record, and because there is no conflict between the expert’s 

testimony and the DOT, the Court finds that the ALJ properly relied on the vocational 
expert’s testimony to conclude Plaintiff was not disabled. Wagner v. Astrue, 
499 F.3d 842, 854
 (8th Cir. 2007).                                                      
V.   THE  ALJ  PROPERLY  RELIED  ON  THE  VOCATIONAL    EXPERT’S          
    IDENTIFICATION  OF  ENOUGH  JOBS  NATIONALLY   TO  INDICATE          
    REGIONAL JOBS IN SIGNIFICANT NUMBERS ALSO EXIST.                     

    Plaintiff’s final argument is that the ALJ erred in concluding that the record proves 
there are a significant number of jobs that she could still perform despite her limitations. 
While  the  ALJ  relied  on  the  vocational  expert’s  identification  of  143,200  total 
representative jobs available in the national economy, Plaintiff contends the record lacks 
required evidence on these jobs. Specifically, the record contains no evidence on how many 
of those jobs are in the state or region where Plaintiff lives, or are in several other regions 
in the nation, as required by regulation under 
20 C.F.R. § 404.1566
. Because the burden is 
on the Commissioner at step five to show a claimant can perform other work and is not 
disabled,  Plaintiff  contends  that  this  failure  to  identify  the  regional  locations  of  the 
representative jobs merits reversal of the Commissioner’s decision.       
    The Commissioner responds that the jobs of marker and mail sorter identified by 

the vocational expert are not the type of jobs that are geographically specific, “such as a 
shrimp-boat worker or tobacco farmer.” (Doc. 14 at 21.) He also argues that the prehearing 
notice provided by the ALJ put the vocational expert on notice that they would be asked if 
Plaintiff could perform work in the national economy existing in “significant numbers 
either in the region where the claimant lives or in several other regions of the country.” (Id. 

at 22 (citing Tr. at 198).) The Commissioner also contends that Plaintiff’s counsel could 
have asked more probing questions about job locations at the hearing had he believed the 
expert’s testimony was deficient, but did not do so.                      
    To begin with, there is no dispute that the vocational expert’s identification of 
143,200 total representative jobs is a sufficient number. The dispute lies, instead, in 
whether the record must show where in the nation such jobs exist. At step five in the 

sequential evaluation, to demonstrate that a claimant is not disabled, the Commissioner 
must prove that “substantial gainful work . . . exists in the national economy, regardless of 
whether such work exists in the immediate area in which [a plaintiff] lives, or whether a 
specific job vacancy exists for [them], or whether [they] would be hired if [they] applied 
for work.” 
42 U.S.C. § 423
(d)(2)(A). The regulations define “work which exists in the 

national economy” as “work which exists in significant numbers either in the region where 
such  individual  lives  or  in  several  regions  of  the  country.”  Id.;  see  also  
20 C.F.R. § 404.1566
(a) (“We consider that work exists in the national economy when it exists in 
significant numbers either in the region where you live or in several other regions of the 
country.”).                                                               

    The Eighth Circuit has created no rubric by which courts measure whether the 
identified representative jobs in a case meet the regulatory requirements. See Karen E. v. 
Kijakazi, No. 21-cv-3015 (CJW/MAR), 
2022 WL 17548642
, at *7 (N.D. Iowa Sept. 15, 
2022) (“The Eighth Circuit has never held that an ALJ must specifically identify whether 
jobs exist in the claimant’s region or several regions as opposed to simply identifying jobs 

in the entire national economy.”). Instead, this question is left “to the trial judge’s common 
sense” based on the particular facts of the case. Hall v. Chater, 
109 F.3d 1255, 1259
 (8th 
Cir. 1997). One court in this District recently summarized the different ways that courts in 
this Circuit exercise that common sense, noting that the District of South Dakota’s courts 
require that an ALJ rely on evidence that representative jobs exist in a claimant’s region or 
in several regions, while the District of Missouri’s courts accept that jobs that exist 
nationally exist in several regions of the country absent evidence that they are jobs peculiar 

to particular regions. See Shari B. v. Kijakazi, No. 22-cv-1539 (DJF), 
2023 WL 6130679
, 
at *8 (D. Minn. Sept. 19, 2023) (collecting cases).                       
    Shari B. is instructive. There, the court determined that while a sufficient number of 
national jobs likely indicates job availability in several regions, too few jobs nationally 
could require evidence of a regional breakdown. 
Id. at 9
. Applying this rule, the Shari B. 

court found 18,000 jobs in the national economy provided insufficient evidence of an 
adequate number of jobs at regional levels, and the court remanded the case with directions 
for the Commissioner to supplement the record as to the locations of the representative jobs 
identified. 
Id.
                                                           
    There is a significant difference between the 18,000 representative jobs in Shari B. 

and the 143,200 here. It is true that the vocational expert provided no regional breakdown 
on which the ALJ could rely. (See Tr. at 40–41, 77–78.) Even so, considering the number 
of jobs, the broad definitions of a marker or mail sorter discussed above, and the fact that 
there appears to be nothing peculiar to any region about either of these occupations, the 
Court finds that these national numbers are sufficient to show that representative jobs exist 

without requiring evidence of regional breakdowns. Therefore, the Court finds that the ALJ 
met his burden at step five to show that a sufficient number of representative jobs are 
available to Plaintiff and that, consequently, she is not disabled.       

ORDER

    Based on the above, as well as the files, records, and proceedings in this case, IT 
IS ORDERED that:                                                          

    1.   Plaintiff’s Motion (Doc. 11) is DENIED; and                     

    2.   Defendant’s Motion (Doc. 14) is GRANTED.                        


    LET JUDGMENT BE ENTERED ACCORDINGLY.                                 


DATED:  September 19, 2024           s/Douglas L. Micko                   
                                  DOUGLAS L. MICKO                       
                                  United States Magistrate Judge         

Trial Court Opinion

                UNITED STATES DISTRICT COURT                             
                    DISTRICT OF MINNESOTA                                


Jacqueline M. J.,                       No. 23-cv-1154 (DLM)             

               Plaintiff,                                                


v.                                                                       

ORDER

Martin J. O’Malley,                                                      
Commissioner of Social Security                                          
Administration,                                                          

               Defendant.                                                



    Pursuant to 
42 U.S.C. § 405
(g), Plaintiff Jacqueline M. J. seeks judicial review of 
the final decision of the Commissioner of Social Security (“Commissioner”) denying her 
benefits. This matter is before the Court on the parties’ briefs seeking judgment on the 
administrative  record.  (Docs.  11–12  (Plaintiff’s  motion  and  memorandum),  14 
(Commissioner’s motion and memorandum).) Both parties have voluntarily consented to 
the undersigned magistrate judge’s review of this matter. For the reasons below, the Court 
denies Plaintiff’s motion and grants Defendant’s motion.                  
                         BACKGROUND                                      
    On December 4, 2020, Plaintiff applied for Disability Insurance Benefits (“DIB”), 
alleging that she had been disabled since April 1, 2020, which she later amended to October 

1, 2020. (Tr.1 at 232–38, 259.) The Social Security Administration (“SSA”) denied her 
claim initially (Tr. at 124–26), and upon reconsideration (Tr. at 131–32). Plaintiff then 
timely requested a hearing before an Administrative Law Judge (“ALJ”), and the ALJ held 
a hearing by telephone on the matter on May 11, 2022. (Tr. at 140–41 (request for hearing), 
36–69 (hearing transcript).) Counsel represented Plaintiff at the hearing, and Plaintiff also 

testified on her own behalf. (Tr. at 48–51, 57–74.) A vocational expert also testified, 
opining that if Plaintiff were limited to light, unskilled positions with some postural and 
environmental limitations, she could still perform work available in the national economy 
even though she could no longer perform her past relevant work. (Tr. at 75–79.) Plaintiff’s 
counsel had no questions for the vocational expert during the hearing. (Tr. at 79.) 

    On May 27, 2022, the Commissioner sent his notice of an unfavorable decision to 
Plaintiff. (Tr. at 10–12 (notice), 13–41 (decision).) The ALJ recognized that Plaintiff 
suffered from several severe impairments, including “degenerative disc disease; migraine 
headaches; obesity; obstructive sleep apnea; generalized anxiety disorder; and depressive 
disorder.” (Tr. at 16.)                                                   



1 The Commissioner filed the consecutively paginated transcript of the administrative 
record on June 23, 2023. (Docs. 6–6-2.) For ease of reference, the citations to the transcript 
will identify the page number listed on the lower right corner of the document as though 
all three parts were combined into one document, rather than the docket page number. 
    Despite Plaintiff’s mental and physical impairments, the ALJ found that she did not 
qualify for benefits. (Tr. at 18.) First, the ALJ considered whether Plaintiff had impairments 
that,  either  singly  or  in  combination,  met  the  criteria  of  a  listed  impairment2  that 

automatically demonstrates an individual qualifies as  disabled. (Tr. at 16–22.) As to 
Plaintiff’s physical impairments, the ALJ determined that she did not meet the criteria for 
Listings for disorders of the skeletal spine, lumbar spinal stenosis impacting the spinal 
nerves, or headaches. (Tr. at 17–20.) As to her mental impairments, the ALJ determined 
that Plaintiff did not meet the criteria for Listings for depressive, bipolar, and related 

disorders, or for anxiety and obsessive-compulsive disorders. (Tr. at 20.) 
    The ALJ also considered areas of mental functioning that may result in a finding of 
disability when an individual has either one extreme or two marked limitations, using a 
five-point scale that includes none, mild, moderate, marked, and extreme.3 He concluded 
that  the  record  showed  Plaintiff  had  a  mild  limitation  in  her  ability  to  understand, 

remember, or apply information, and at-most moderate limitations in her ability to interact 

2 Listed impairments, or “Listings,” are impairments for each major body system severe 
enough that a person would be prevented from engaging in any gainful activity. See 20 
C.F.R. pt. 404, subpt. P, app. 1.                                         
3 In evaluating the limitations a claimant’s mental impairments impose, an ALJ is directed 
to consider four broad functional areas: (1) the claimant’s ability to understand, remember, 
or apply information; (2) the claimant’s ability to interact with others; (3) the claimant’s 
ability to concentrate, persist, or maintain pace; and (4) the claimant’s ability to adapt or 
manage oneself. 
20 C.F.R. § 404
.1520a(c)(3). As noted above, the ALJ must rate the 
degree of a claimant’s impairment in each functional area based on a five-point scale: none, 
mild, moderate, marked, and extreme. 
20 C.F.R. § 404
.1520a(c)(3); see also SSA POMS 
DI 24583.005(D), https://perma.cc/J22E-T8XN (last visited Sept. 13, 2024) (describing the 
distinctions between each point on the severity scale in the Social Security Administration 
Program  Operations  Manual  System  (“POMS”));  SSA  POMS  DI  34001.032(F)(2), 
https://perma.cc/V86P-LTDF (last visited Sept. 13, 2024) (same).          
with others, to concentrate, persist, or maintain pace, and to adapt or manage oneself. (Tr. 
at  20–21.)  Finding  no  criteria  for  an  automatic  finding  of  disability,  the  ALJ  next 
determined that Plaintiff retained the residual functional capacity (“RFC”) to perform light 

work as defined by 
20 C.F.R. § 404.1567
(b), provided the job included additional postural 
and environmental limitations to account for Plaintiff’s impairments. (Tr. at 22.) 
    Next, the ALJ credited the testimony of the vocational expert that, considering 
Plaintiff’s age, education, work experience, and RFC, she could still perform work in 
representative  jobs  in  the  national  economy,  including  as  a  marker  (Dictionary  of 

Occupational Titles (“DOT”) No. 209.587-034) and a mail sorter (DOT No. 209.687-026).4 
(Tr. at 40–41, 78.) Because Plaintiff could still perform work, the ALJ found her not 
disabled under the evaluative process set forth in 
20 C.F.R. § 404.1520
(g). (Id.) Plaintiff 
appealed the ALJ’s decision, but the SSA’s Appeals Council denied her request for further 
review, making the ALJ’s decision the final decision of the Commissioner. (Tr. at 1–3.) 

    Plaintiff then filed this federal action seeking judicial review of the Commissioner’s 
decision. (Doc. 1.) Plaintiff raises six challenges to the ALJ’s determination that she is not 
disabled: 1) the ALJ improperly evaluated medical opinion evidence by failing to explain 
the provider relationships to Plaintiff and by substituting the ALJ’s own unqualified 
opinion for theirs; 2) the ALJ’s conclusion that Plaintiff did not meet Section 12.04 of the 

Listing of Impairments is not supported by substantial evidence because the ALJ based it 


4 The vocational expert also identified a third representative job as a label coder (DOT No. 
920.587-014), although the ALJ does not reference this occupation in his ultimate decision. 
(Tr. at 40–41, 78.)                                                       
on  improperly  evaluated  medical  opinion  evidence;  3)  substantial  evidence  does  not 
support Plaintiff’s RFC because the ALJ based it on improperly evaluated medical opinion 
evidence; 4) the hypothetical questions posed by the ALJ to the vocational expert were 

inaccurate because Plaintiff’s RFC is not supported by substantial evidence; 5) the ALJ 
failed to resolve the conflict between the testimony of the vocational expert and the DOT 
according to Social Security Ruling (“SSR”) 00-4p; and 6) the ALJ failed to meet his 
burden to show that there were a significant number of jobs in Plaintiff’s geographical 
region, or in several regions of the national economy, that Plaintiff could perform. Based 

on these errors, Plaintiff asks the Court to reverse the Commissioner’s decision and remand 
the matter for both a reevaluation of Plaintiff’s RFC and for additional vocational expert 
testimony.                                                                
                           ANALYSIS                                      
    This Court reviews an ALJ’s denial-of-benefits decision to determine whether it is 

supported by substantial evidence in the record as a whole, and whether the decision is 
infected by legal error. 
42 U.S.C. § 405
(g); Austin v. Kijakazi, 
52 F.4th 723, 728
 (8th Cir. 
2022). Substantial evidence means “such relevant evidence as a reasonable mind might 
accept as adequate to support a conclusion.” Biestek v. Berryhill, 
139 S. Ct. 1148, 1154
 
(2019) (internal quotations omitted); see also Nash v. Comm’r, Soc. Sec. Admin, 
907 F.3d 1086, 1089
  (8th  Cir.  2018)  (characterizing  “substantial  evidence”  as  “less  than  a 
preponderance, but enough that a reasonable mind would find it adequate to support the 
Commissioner’s conclusions”). Courts reviewing ALJ decisions must look to the entire 
administrative record to ascertain whether it contains sufficient evidence to support the 
ALJ’s conclusion. Grindley v. Kijakazi, 
9 F.4th 622, 627
 (8th Cir. 2021). When substantial 
evidence supports the ALJ’s decision, the Court will not reverse, even if substantial 
evidence also supports a contrary outcome. Nash, 
907 F.3d at 1089
. But if an ALJ fails to 

explain their evaluation of the persuasiveness of the record’s prior administrative medical 
findings, that is a legal error subject to de novo review. Joel M. B. v. Kijakazi, No. 21-cv-
1660 (PAM/ECW), 
2022 WL 1785224
, at *2 (D. Minn. June 1, 2022) (citing Collins v. 
Astrue, 
648 F.3d 869, 871
 (8th Cir. 2011)); Michael B. v. Kijakazi, No. 21-cv-1043 
(NEB/LIB), 
2022 WL 4463901
, at *1 (D. Minn. Sept. 26, 2022).              

    Plaintiff does not contest that the ALJ followed the five-step sequential process laid 
out in 
20 C.F.R. § 404.1520
(a)(4)5 for evaluating DIB claims. Rather, Plaintiff asserts that, 
because the ALJ failed to follow the appropriate analyses at several steps under the 
applicable regulations and rules, the decision issued contains legal errors and reaches a 
conclusion that is not substantially supported by the record. The Court will take each of 

Plaintiff’s challenges in turn.                                           



5 Step one of this process involves determining whether a claimant is engaged in substantial 
gainful activity. 
20 C.F.R. § 404.1520
(a)(4)(i). If not, the ALJ must next decide (in step 
two)  whether  the  claimant’s  impairments  are  severe,  and  of  a  duration  of  least  12 
continuous months. 
Id.
 § 404.1520(a)(4)(ii). At step three, the ALJ determines whether the 
claimant’s impairments are severe enough to equal a listed impairment under Appendix 1 
to Subpart P of Part 404. Id. § 404.1520(a)(4)(iii). If so, the claimant is considered disabled 
without further inquiry. If not, the ALJ must determine the claimant’s RFC, and decide (at 
step  four)  whether  the  claimant  can  still  do  their  past  work  given  their  limitations. 
Id. § 404.1520(a)(4)(iv). Finally, if the ALJ concludes a claimant cannot perform their 
prior work, step five requires the ALJ to determine whether they can do other work 
considering their RFC, age, education, and work experience. Id. § 404.1520(a)(4)(v). 
I.   THERE IS NO ERROR IN THE ALJ’S DISCUSSION OR CONCLUSIONS             
    ABOUT   PLAINTIFF’S  TREATING    PSYCHOLOGIST’S    MEDICAL           
    OPINION EVIDENCE.                                                    

    Plaintiff’s first two arguments challenge the ALJ’s consideration of the opinion of 
Amy Strait, Psy.D., Plaintiff’s treating psychologist. Plaintiff makes two claims about this 
error: first, that the ALJ’s conclusions about Dr. Strait’s opinion lack substantial evidence 
in the record, and second, that the ALJ’s discussion amounts to a legal error because it does 
not discuss all of the required factors set forth by regulation in 
20 C.F.R. § 404
.1520c. 
    As to her substantial evidence argument, Plaintiff claims that Dr. Strait found 
Plaintiff  had  marked  limitations  in  her  ability  to  interact  with  others,  to  maintain 
concentration, persistence, or pace, and to adapt and manage oneself. Dr. Strait based these 
findings on her evaluation of Plaintiff as lacking interest in activities, showing decreased 
energy and signs of psychomotor agitation or retardation, expressing feelings of guilt or 
worthlessness, and showing difficulty in thinking or concentrating. Plaintiff argues that Dr. 

Strait’s evaluation is supported by other evidence in the record that demonstrated Plaintiff 
suffered from consistently severe depression impacting her activities of daily living. Had 
the ALJ properly accounted for Dr. Strait’s opinion rather than giving it cursory attention, 
Plaintiff argues that the ALJ would have concluded that Plaintiff met the criteria of Listing 
12.04 related to depressive and bipolar disorders in the Listing of Impairments. 

    Plaintiff also argues that the ALJ’s discussion of Dr. Strait’s opinion amounts to 
legal  error  because  the  ALJ  failed  to  discuss  factors  required  by  
20 C.F.R. § 404
.1520c(3)(i)–(v), and in particular, Dr. Strait’s examining and treating relationship 
with  Plaintiff.  Plaintiff  also  argues  that  the  ALJ  wrongly  found  Dr.  Strait’s  opinion 
unpersuasive because the ALJ found it inconsistent with Plaintiff’s essentially normal 
mental status examinations and activities of daily living when in fact Dr. Strait’s opinion 
aligned with other record evidence.                                       

    The  Commissioner  disagrees,  arguing  that  substantial  evidence  in  the  record 
supports the ALJ’s conclusions that Plaintiff’s impairments did not match all of the criteria 
required for Listing 12.04. He also contends that the ALJ properly evaluated Dr. Strait’s 
medical opinion according to the required regulatory factors.             
A.   Substantial  evidence  in  the  record  supports  the  ALJ’s  conclusions  that 
    Plaintiff’s mental function limitations do not meet the criteria for Listing 12.04. 

    “The burden of proof is on the plaintiff to establish that his or her impairment meets 
or equals a listing.” Johnson v. Barnhart, 
390 F.3d 1067
, 1070 (8th Cir. 2004) (citing 
Sullivan v. Zebley, 
493 U.S. 521
, 530–31 (1990)). A plaintiff must satisfy all of a listing’s 
criteria to meet that listing. 
Id.
 The criteria for Listing 12.04 regarding depressive, bipolar, 
and  related  disorders  include  impairments  “characterized  by  an  irritable,  depressed, 
elevated, or expansive mood, or by a loss of interest or pleasure in all or almost all 
activities, causing a clinically significant decline in functioning.” 20 C.F.R. pt. 404, subpt. 

P, app. 1, Listing 12.04. Listing 12.04 requires a person to have either one “extreme” or 
two “marked” limitations in their ability to understand, remember, or apply information, 
interact with others, concentrate, persist, or maintain pace, and adapt or manage oneself, as 
well as evidence for at least two years that a person’s mental disorder is “serious and 
persistent.” 
Id.
 Underlying symptoms and signs that typically cause such serious and 

persisting limitations “may include, but are not limited to, feelings of hopelessness or guilt, 
suicidal  ideation,  a  clinically  significant  change  in  body  weight  or  appetite,  sleep 
disturbances, an increase or decrease in energy, psychomotor abnormalities, disturbed 
concentration, pressured speech, grandiosity, reduced impulse control, sadness, euphoria, 

and social withdrawal.” 
Id.
 Here, the ALJ found that “[t]he severity of the claimant’s 
mental impairments, considered singly and in combination, did not meet or medically equal 
the criteria of listing[] 12.04.” (Tr. at 20.)                            
    Plaintiff claims that Dr. Strait’s medical opinion showed that she met Listing 
12.04’s criteria. Dr. Strait completed two mental impairment questionnaires, the first on 

March 19, 2021, and the second about six months later. (Tr. at 836–41, 1180–85.) Dr. Strait 
based her medical opinion on biweekly treatment appointments with Plaintiff beginning on 
February 4, 2021, amounting to a period of less than one year even by the time she 
submitted the second questionnaire. (Tr. at 836, 1180.) Dr. Strait opined that Plaintiff had 
diagnoses of generalized anxiety, major depressive, dysthymic, and chronic pain disorders 

for which she received psychotherapy and medications without improvement during Dr. 
Strait’s period of treatment. (Id.) She rated Plaintiff’s functional limitations as moderate in 
understanding, remembering, or applying information, and marked in interacting with 
others, concentration, persistence, or pace, and adapting or managing oneself. (Tr. at 837, 
1181.) Her notes describe Plaintiff as so depressed she often could not get out of bed or 

leave her house, and as suffering from extreme panic. (Id.) As a result, Dr. Straight found 
that Plaintiff could not meet any of the required mental abilities and aptitudes to sustain 
work because of her symptoms and noted that Plaintiff would be absent from work for two 
to three days each week due to her severe depression. (Tr. at 839–40, 1183–84.) However, 
Dr. Strait did not check the box defining Plaintiff’s disorder as “serious and persistent” 
because  she  noted  that  she  had  not  been  treating  Plaintiff  for  long  enough  to  draw 
conclusions about Plaintiff’s disorder “over a period of at least 2 years.” (Tr. at 837, 1181.)  

    The ALJ reviewed Dr. Strait’s opinion, finding it unpersuasive because it was 
inconsistent with other record evidence that Plaintiff had essentially normal mental status 
examinations. (Tr. at 38.) The ALJ also cited Plaintiff’s activities of daily living  as 
evidence that Plaintiff’s functional abilities exceeded the type of limitations that would 
meet a work-preclusive mental impairment like the impairments that would meet the 

criteria  of  Listing  12.04.  (Id.)  These  activities  included  caring  for  her  one-year-old 
grandson, tending to animals on the farm, helping manage her adult sons’ finances, and 
assisting a brother suffering from schizophrenia. (Id.)                   
    When substantial evidence supports the ALJ’s decision, the Court will not reverse, 
even if substantial evidence also supports a contrary outcome. Nash, 
907 F.3d at 1089
. 

Here, there is substantial evidence in the record supporting the ALJ’s finding that Plaintiff 
did not meet Listing 12.04. First, contrary to Dr. Strait’s opinion that Plaintiff had a marked 
limitation in interacting with others, the ALJ found only a moderate limitation based on 
evidence that while Plaintiff endorsed preferring to be alone, she also said that she got 
along well with others, had friends and a boyfriend, and worked on setting boundaries with 

family members during psychotherapy sessions. (Tr. at 20 (citing Tr. at 311, 798–99, 817, 
1353, 1371–72).) Likewise, the ALJ found Plaintiff had an at-most moderate limitation in 
concentrating, persisting, or maintaining pace because she could attend to a task for 10 to 
15  minutes,  had  no  concentration  issues  during  her  February  2021  psychological 
examination, and performed within the normal range on psychometric testing. (Tr. at 20–
21 (citing Tr. at 330, 797–800, 817).) As to Plaintiff’s ability to adapt or manage oneself, 
the ALJ again found moderate limitations because, despite her subjective reports of anxiety 

and need for control, she could manage her mental impairments with a conservative course 
of treatment (psychotherapy and medications), could function independently in self-care, 
spent time out in her community, performed household chores, and cared for her infant 
grandchild. (Tr. at 21 (citing Tr. at 59–74, 305–13, 325–33, 817, 879–80).) Without one 
extreme or two marked impairments, Plaintiff fails to meet the criteria for Listing 12.04. 

See 20 C.F.R. pt. 404, subpt. P, app. 1, Listing 12.04.                   
    Second, the ALJ reviewed the record and found that while the record supported that 
Plaintiff’s mental impairments could produce her symptoms, her statements about the 
intensity, persistence, and limiting effects of her symptoms were not borne out by the 
medical and other evidence in the record. (Tr. at 23.) The Court has reviewed the record 

citations that the ALJ considered above and finds that the record contains substantial 
evidence that supports the ALJ’s conclusions.                             
    The Court therefore finds, after a careful review of the ALJ’s decision and the record 
before him, that substantial evidence in the record supports the ALJ’s determination that 
Plaintiff did not meet all of the criteria for Listing 12.04, including meeting the criteria of 

one extreme or two marked areas of mental functioning. Because substantial evidence in 
the record supports this conclusion, the Court finds no basis for reversal on this point. 
B.   The ALJ did not legally err in his discussion finding Dr. Strait’s opinion 
    unpersuasive.                                                        

    Plaintiff also claims that the ALJ should have given Dr. Strait’s medical opinion as 
Plaintiff’s  treating  psychologist  greater  weight  when  considering  Plaintiff’s  mental 
impairment limitations. According to Plaintiff, the ALJ’s discussion of Dr. Strait’s opinion 
is infected by legal error because the ALJ failed to discuss the factors required by 
20 C.F.R. § 404
.1520c(3)(i)–(v)—specifically, Dr. Strait’s examining and treating relationship with 
Plaintiff.  Plaintiff  also  argues  that  the  ALJ  wrongly  found  Dr.  Strait’s  opinion 
unpersuasive.                                                             
    The governing regulations do not require that an ALJ defer or give specific weight 
to  any  medical  opinion  or  findings.  See  Austin,  
52 F.4th at 728
  (citing  
20 C.F.R. § 404
.1520c(a)). This reflects a change to the regulations that once required an ALJ to give 
a treating medical professional’s opinion deference and controlling weight. See 
20 C.F.R. § 404.1527
. As of March 27, 2017, ALJs are under the updated requirements found at 
20 C.F.R. § 404
.1520c. Compare 
20 C.F.R. § 404.1527
 (applicable to claims filed before 
March 27, 2017) with 
20 C.F.R. § 404
.1520c (applicable to claims filed after March 27, 

2017).  According  to  these  updated  regulations,  an  ALJ  must  now  consider  the 
persuasiveness of medical opinions and findings and explain how they reached their 
conclusions according to certain factors. See  
20 C.F.R. § 404
.1520c(c)(1)–(5). These 
factors  require  that  an  ALJ  “evaluate  the  persuasiveness  of  medical  opinions  by 
considering (1) whether they are supported by objective medical evidence, (2) whether they 

are consistent with other medical sources, (3) the relationship that the source has with the 
claimant, (4) the source’s specialization, and (5) any other relevant factors.” Austin, 
52 F.4th at 728
 (quoting Bowers v. Kijakazi, 
40 F.4th 872, 875
 (8th Cir. 2022)). The first two 
factors of supportability and consistency are the most important and are the only two 

factors that an ALJ must explain in their decision, even though all of the factors must be 
considered. 
20 C.F.R. § 404
.1520c(a); see also Violet G. v. Kijakazi, No. 21-cv-2105 
(TNL), 
2023 WL 2696594
, at *6 (D. Minn. Mar. 29, 2023) (collecting cases concluding 
that an ALJ’s failure to address and explain supportability and consistency warranted 
remand). In short, an ALJ’s allocation of persuasive value will be considered legally 

sufficient  upon  court  review  for  legal  error  where  they  explain  supportability  and 
consistency in their decision.                                            
    Turning to its review, the Court first finds that the ALJ did not address the factor of 
Plaintiff’s examining relationship with Dr. Strait. Yet this “examining relationship” factor 
falls under the factors that the SSA “may, but [is] not required to, explain” in making its 

determination, unlike the mandatory factors of “supportability” and “consistency” which 
an ALJ must discuss. 
20 C.F.R. § 404
.1520c(b)(2). In other words, courts assume that an 
ALJ considered the “examining relationship” when evaluating the persuasiveness of an 
opinion or finding.                                                       
    Considering the two factors that an ALJ must address under § 404.1520c, the Court 

finds that the ALJ discussed his reasons for finding that Dr.  Strait’s opinion lacked 
consistency with, and support from, the record. (Tr. at 38.) The ALJ opined that, although 
Dr. Strait opined that Plaintiff had three areas of mental function that showed marked 
limitations, this position was inconsistent with, and unsupported by, record evidence. (Tr. 
at 38.) The ALJ then discussed conflicting record evidence of essentially normal mental 
status examinations and engagement in daily living activities that suggested Plaintiff’s 
limitations were not as severe as she subjectively reported. (Id.) Although Plaintiff may 

disagree with this analysis and its conclusions, the Court finds that this analysis is sufficient 
under 
20 C.F.R. § 404
.1520c. The Court also finds it is supported by substantial evidence 
in the record as a whole, as discussed above. The Court thus finds no basis for reversal as 
to the ALJ’s discussion of Dr. Strait’s opinion.                          
II.  SUBSTANTIAL EVIDENCE IN THE RECORD AS A WHOLE SUPPORTS               
    THE  ALJ’S  RFC  LIMITATIONS  TO  ACCOMMODATE   PLAINTIFF’S          
    BACK PAIN AND MIGRAINE HEADACHES.                                    

    Plaintiff’s next argument is that substantial evidence in the record does not support 
the physical limitations of her RFC, which she claims should reflect the greater limitations 
found in the opinions of Plaintiff’s primary care physician, Jennifer Hart, PA-C, and Dr. 
Strait. Specifically, Plaintiff argues that her back pain and migraine headaches result in 
work-preclusive limitations, but that the ALJ ignored persuasive opinion evidence on this 
point and instead substituted his own  medically-unqualified  judgment that Plaintiff’s 
limitations were not severe enough to preclude work.                      
    The  Commissioner  argues  that  while  Plaintiff  may  disagree  with  the  ALJ’s 
conclusions, the ALJ’s decision is supported by substantial evidence in the record and 

contains no legal error. The Commissioner asserts that Plaintiff bears the burden to prove 
greater restrictions are required in her RFC, and that she has not met that burden. 
    A plaintiff’s RFC is the measure of the “the most [they] can still do despite [their] 
limitations.” 
20 C.F.R. § 404.1545
(a)(1). An ALJ must consider all relevant evidence in 
the record to fashion a plaintiff’s RFC, “including medical records, observations of treating 
physicians and others, and [the plaintiff’s] own description of [their] limitations.” Anderson 
v. Shalala, 
51 F.3d 777, 779
 (8th Cir. 1995); see also 
20 C.F.R. § 404.1545
(e) (providing 

that the ALJ “will consider the limiting effects of all [a plaintiff’s] impairment(s), even 
those that are not severe, in determining [their] residual functional capacity”). “[T]o find a 
[plaintiff] has the residual functional capacity to perform a certain type of work, the 
[plaintiff] must have the ability to perform the requisite acts day in and day out, in the 
sometimes competitive and stressful conditions in which real people work in the real 

world.” Reed v. Barnhart, 
399 F.3d 917, 923
 (8th Cir. 2005) (citing Thomas v. Sullivan, 
876 F.2d 666, 669
 (8th Cir. 1989)).                                       
A.   Substantial  evidence  in  the  record  supports  the  ALJ’s  RFC  concerning 
    Plaintiff’s back pain and migraine headaches.                        

    Here, Plaintiff’s RFC contains limitations to account for her physical impairments, 
including, for example, a limitation to light work with no climbing of ladders, occasional 
climbing of stairs, occasional balancing, occasional bending down, occasional reaching 
overhead, and frequent reaching side to side. (Tr. at 22.) The ALJ discussed the record 
evidence, including opinion evidence, on Plaintiff’s back pain and migraine headaches. 
(Tr.  at  22–29.) Such  evidence  included Plaintiff’s  spinal  pain,  imaging of  her  spine 
showing mild to moderate narrowing of her discs, and treatments including physical 
therapy, branch blocks, and radiofrequency ablation. (E.g., Tr. at 24 (citing Tr. at 902), 25 
(citing Tr. at 785), 26–27 (citing Tr. at 901), 28 (citing Tr. at 1387, 1396–98).) As to her 

migraine  headaches,  the  ALJ  found  that  Plaintiff’s  treatment  records  were  generally 
preventative after 2020, employing medications, Botox injections, nerve block injections, 
and  physical  and  chiropractic  therapies  to  reduce  the  frequency  and  severity  of  her 
migraines. (Tr. at 29.) Here again, the ALJ discussed the record evidence on Plaintiff’s 

migraines when reaching this conclusion. (E.g., Tr. at 23 (citing Tr. at 59–74, 307–12, 325–
32), 24 (citing Tr. at 425–27, 483, 503), 25 (citing Tr. at 921–24), 26 (citing Tr. at 863–
64), 27 (citing Tr. at 979), 27–28 (citing Tr. at 1437), 28 (citing Tr. at 1417, 1425, 1439), 
29 (citing Tr. at 1419).) After reviewing the evidence on her back pain and migraine 
headaches, the ALJ concluded that her RFC required adjustments to accommodate her 

limitations:                                                              
    The  undesigned  found  the  claimant’s  migraine  headaches  and  back 
    impairments limit the claimant to light exertional work (i.e., lifting, carrying, 
    pulling, and pushing up to 10 pounds frequently and 20 pounds occasionally, 
    and sitting, standing, and walking 6 hours each in an 8-hour workday with 
    normal breaks). The claimant was capable of that level of work activity as 
    long as she occasionally balanced, crawled, crouched, kneeled, stooped, and 
    climbed ramps and stairs but never ladders, ropes, or scaffold nor exposure 
    to hazards. The undersigned further found the claimant was capable of 
    occasionally reaching overhead with the bilateral upper extremities, and 
    frequently,  but  not  constantly,  reaching  in  all  other  directions  with  the 
    bilateral upper extremities. Additionally, the claimant was able to tolerate 
    occasional exposure to extreme heat, extreme cold, and humidity; light and 
    noise equivalent to that of an office setting; work environment where the 
    noise intensity level did not exceed “moderate” as that term was defined in 
    the Selected Characteristics of Occupations; and no exposure to vibration, 
    such as vibratory tools or machinery.                                

(Tr. at 29.)                                                              
    Plaintiff argues that the ALJ based his decision on his own conclusions rather than 
on medical evidence. But considering the ALJ’s lengthy discussion of record evidence 
discussed  above  on  Plaintiff’s  back  and  headache  impairments—including  objective 
medical evidence—the Court respectfully disagrees with Plaintiff’s argument. 
B.   The ALJ did not legally err in his discussion finding the opinions of Ms. Hart 
    and Dr. Strait unpersuasive.                                         

    Plaintiff also contends that if the ALJ had properly considered the medical opinion 
evidence from Ms. Hart and Dr. Strait according to the requirements of the relevant 
regulatory  standard,  the  RFC  would  have  reflected  Plaintiff’s  actual,  more  severe 
limitations. However, the Court finds that the ALJ followed the requirements of 
20 C.F.R. § 404
.1520c  when  he  found  the  opinions  of  Ms.  Hart  and  Dr.  Strait  only  partially 
persuasive.                                                               
    As to Ms. Hart’s opinion, she submitted a number of physician’s statements about 

Plaintiff’s symptoms that contained updates on the status of Plaintiff’s conditions and 
limitations between September 2020 and June 2021. (E.g., Tr at 1319, 1327, 1332, 1336.) 
These statements noted that Plaintiff’s migraines were so severe she could not return to 
work until June 2021. (Id.) Ms. Hart also submitted letters on Plaintiff’s behalf from 
October 2020 through March 2022 excusing Plaintiff from work based on her medical 

conditions. (E.g., Tr. at 1052, 1160, 1220–34, 1319, 1389.) Finally, Ms. Hart submitted an 
RFC questionnaire in December 2020 in which she assessed Plaintiff’s limitations as 
follows: can lift less than 10 pounds rarely, sit 10 minutes at a time and for a total of less 
than two hours in an eight-hour workday, stand 10 minutes, walk zero blocks, stand and 
walk for less than two hours in an eight-hour workday, walk around for 10 minutes, change 

positions at will, be able to lie down, take unscheduled 10- to 15-minute breaks every one 
to two hours, never move her head and neck, rarely perform postural movements, and limit 
her handling and reaching. (Tr. at 443–48.)                               
    The ALJ reviewed Ms. Hart’s submissions and found them unpersuasive. As to her 

physician’s statements and letters, the ALJ found they provided only temporary, short-term 
evidence that lacked persuasive value under 
20 C.F.R. § 404
.1520b(c).6 As to Ms. Hart’s 
RFC assessment, the ALJ pointed out that Ms. Hart’s clinic notes show Plaintiff filled out 


6 The Court understands the ALJ’s conclusion to be that Ms. Hart’s opinions reach matters 
reserved for the Commissioner under 
20 C.F.R. § 404
.1520b(c)(3):          

 (3) Statements on issues reserved to the Commissioner. The statements listed in 
    paragraphs (c)(3)(i) through (c)(3)(viii) of this section would direct our 
    determination or decision that you are or are not disabled or blind within the 
    meaning of the Act, but we are responsible for making the determination or 
    decision about whether you are disabled or blind:                    
      (i)  Statements that you are or are not disabled, blind, able to work, or 
           able to perform regular or continuing work;                   
      (ii)  Statements about whether or not you have a severe impairment(s); 
      (iii)  Statements about whether or not your impairment(s) meets the 
           duration requirement (see § 404. 1509);                        
      (iv)  Statements about whether or not your impairment(s) meets or  
           medically equals any listing in the Listing of Impairments in Part 
           404, Subpart P, Appendix 1;                                   
      (v)  Statements about what your residual functional capacity is using 
           our programmatic terms about the functional exertional levels in 
           Part  404,  Subpart  P,  Appendix  2,  Rule  200.00  instead  of 
           descriptions about your functional abilities and limitations (see § 
           404. 1545);                                                    
      (vi)  Statements about whether or not your residual functional capacity 
           prevents you from doing past relevant work (see § 404. 1560);  
      (vii)  Statements that you do or do not meet the requirements of a 
           medical-vocational rule in Part 404, Subpart P, Appendix 2; and 
      (viii)  Statements about whether or not your disability continues or ends 
           when we conduct a continuing disability review (see § 404. 1594). 

20 C.F.R. § 404
.1520b(c)(3).                                              
her own questionnaire for her disability application, eroding its persuasive value versus a 
physician’s own opinion. (Tr. at 36 (citing Tr. at 480).) The ALJ found that most of Ms. 
Hart’s conclusions appeared to be supported by Plaintiff’s subjective reports but not by 

objective medical evidence. (Tr. at 36.) Specifically, Ms. Hart observed that Plaintiff 
reported her symptoms—including her back pain and headaches—would not permit her to 
work. (Tr. at 480.) In contrast, Ms. Hart’s physical findings about Plaintiff included that 
she was alert, oriented, spoke normally, had appropriate affect, showed organized thoughts, 
had an anxious mood, appeared well-developed and nourished, showed no distress, had 

normal musculoskeletal and neurological exams, and had no unusual findings during a neck 
exam. (Id.) The ALJ concluded that on such generally normal evaluative findings except 
for her mood, the degree of limitations that Ms. Hart then endorsed for Plaintiff lacked 
support. (Tr. at 36.)                                                     
    Plaintiff disagrees with the ALJ’s assessment, arguing that his discussion did not 

comply with the regulations because he did not address the required factors, including Ms. 
Hart’s  treating  relationship  with  Plaintiff.  Yet  as  discussed  above,  the  governing 
regulations do not require that an ALJ defer or give specific weight to any medical opinion 
or findings. See Austin, 
52 F.4th at 728
 (citing 
20 C.F.R. § 404
.1520c(a)). Rather, an ALJ 
must consider all five factors found at 
20 C.F.R. § 404
.1520c(c)(1)–(5), and must explain 

the first two factors—supportability and consistency—when assessing a medical opinion’s 
persuasive value. 
20 C.F.R. § 404
.1520c(b)(2); see also Violet G., 
2023 WL 2696594
, at 
*6. Here, the ALJ explained why he found Ms. Hart’s opinion on Plaintiff’s limitations 
unpersuasive: because she opined on areas reserved for the Commissioner under 
20 C.F.R. § 404
.1520b(c), and because her assessment lacked consistency with, and support from, 
her own objective medical findings on the severity of Plaintiff’s symptoms. 
    The same holds true for the ALJ’s evaluation of Dr. Strait’s opinion on Plaintiff’s 

RFC. Dr. Strait treated Plaintiff for her mental impairments, and this included treating her 
for migraines and chronic pain. (Tr. at 836–37, 1180.) Dr. Strait opined that, as previously 
noted, Plaintiff’s impairments were work-preclusive. (Tr. at 836–841, 1181–85.) The ALJ 
concluded, also as previously noted, that the record evidence did not support the degree of 
limitations from her mental impairments that Dr. Strait identified, as borne out by evidence 

of Plaintiff’s daily living activities. (Tr. at 38.) This analysis remains sufficient under 
20 C.F.R. § 404
.1520c, as discussed above, and the Court again finds no basis for reversal as 
to the ALJ’s discussion of Dr. Strait’s opinion.                          
III.  THE  VOCATIONAL     EXPERT’S    TESTIMONY     CONSTITUTES           
    SUBSTANTIAL EVIDENCE IN THE RECORD SUPPORTING THE ALJ’S              
    CONCLUSION THAT PLAINTIFF IS NOT DISABLED.                           

    Plaintiff’s next argument is that substantial evidence in the record fails to support 
the ALJ’s conclusion that Plaintiff is not disabled because the vocational expert gave 
inaccurate  testimony  that  could  not  provide  a  reliable  basis  for  any  conclusions. 
Specifically, Plaintiff contends that because the RFC hypotheticals posed to the vocational 
expert  did  not  include  all  of  Plaintiff’s  limitations,  the  vocational  expert  could  not 
accurately assess whether jobs existed which Plaintiff could perform.     
    The Commissioner disagrees, arguing that the ALJ’s hypothetical questions were 
grounded in record evidence and resulted in accurate responses that provided a basis for 
the ALJ’s disability determination. The Commissioner further contends that, if the Court 
finds Plaintiff’s RFC determination is supported by substantial evidence in the record and 
is not infected by legal error, then Plaintiff’s arguments about the hypothetical questions 
fail because they depend on the Court finding an unsupported, legally insufficient RFC 

determination.                                                            
    “A vocational expert’s testimony constitutes substantial evidence when it is based 
on a hypothetical that accounts for all of the claimant’s proven impairments.” Hulsey v. 
Astrue, 622, F.3d 917, 922 (8th Cir. 2010) (citing Grissom v. Barnhart, 
416 F.3d 834, 837
 
(8th Cir. 2005)). As discussed above, the Court has already concluded that the ALJ 

appropriately tailored Plaintiff’s RFC to accommodate limitations substantially supported 
by the record.                                                            
    Building on this conclusion, the Court also finds that the ALJ accurately described 
the exertional, postural, and environmental limitations in Plaintiff’s RFC to the vocational 
expert during the hearing. (Tr. at 76–78.) In response, the vocational expert testified that, 

if  limited  to  light  and  unskilled  positions,  a  person  with  Plaintiff’s  postural  and 
environmental limitations could still perform work available in the national economy even 
though she could no longer perform her past relevant work. (Tr. at 75–79.) Plaintiff’s 
counsel did not question the vocational expert. (Tr. at 79.) The ALJ then relied on the 
expert’s testimony. (Tr. at 41.)                                          

    The Court concludes that the vocational expert gave accurate testimony that the ALJ 
reasonably relied on to find that Plaintiff is not disabled. Because the Court finds no error 
in the ALJ’s assessment of Plaintiff’s RFC, and because the hypothetical questions posed 
to the vocational expert accurately reflected the limitations of that RFC, the Court finds no 
basis for remand here.                                                    
IV.  THE ALJ’S DECISION COMPLIED WITH SSR 00-4P.                          

    Plaintiff’s next argument is that the ALJ failed to meet his duty to resolve conflicts 
between the testimony of the vocational expert and the DOT. Plaintiff claims that although 
the ALJ asked the vocational expert to consider a hypothetical person who could perform 
only  simple,  routine  tasks  and  simple  work-related  decisions,  the  vocational  expert 
identified two representative jobs that do not match such limitations. Rather than resolving 

this conflict, Plaintiff argues that the ALJ failed to elicit a reasonable explanation for the 
conflict by the vocational expert as required of him by SSR 00-4p. Plaintiff contends that 
this constitutes reversible error.                                        
    The Commissioner argues that the ALJ properly relied on the vocational expert’s 
testimony that no conflict existed between her testimony and the DOT. He contends that 

the identified representative occupations required a reasoning level of two or three, and 
that the DOT definitions for such jobs do not require more than performing work on simple, 
routine tasks and simple work-related decisions.                          
    When receiving a vocational expert’s testimony, an ALJ must ask whether their 
testimony conflicts with the DOT and, if so, must follow the procedure provided by SSR 

00-4p. See SSR 00-4p, 
2000 WL 1898704
, at *2–4 (Dec. 4, 2000); see also Moore v. 
Colvin, 
769 F.3d 987
, 989–90 (8th Cir. 2014). Under SSR 00-4p, “[w]hen there is an 
apparent unresolved conflict between [vocational expert] . . . evidence and the DOT, the 
adjudicator must elicit a reasonable explanation for the conflict before relying on the 
[expert] evidence to support a determination or decision about whether the claimant is 
disabled.” 
2000 WL 1898704
, at *2. When there is a conflict, neither the DOT nor the 
expert testimony automatically takes priority; instead, the ALJ “must resolve the conflict 

by determining if the explanation given by the [expert] is reasonable and provides a basis 
for relying on the [expert] testimony rather than on the DOT information.” 
Id.
 “The 
adjudicator must explain the resolution of the conflict.” 
Id. at *4
.      
    During the May 2022 hearing for Plaintiff here, the ALJ posed a hypothetical 
question about what jobs would be available to a person limited to, among other things, 

“simple and routine tasks performed in a work environment free of fast-paced production 
requirements, i.e., no work on an assembly line,” and “low stress work . . . involving only 
simple work-related decisions and routine workplace changes.” (Tr. at 77.) The vocational 
expert testified that, based on the ALJ’s hypothetical limitations, such a person could still 
perform work in representative jobs in the national economy. (Tr. at 76–79.) The expert 

identified three jobs, including a marker (DOT No. 209.587-034), a mail sorter (DOT No. 
209.687-026), and a label coder (DOT No. 920.587-014). (Tr. at 78.) The expert did not 
offer testimony about the regional location(s) of such jobs. After receiving her testimony, 
the ALJ pointed out that the DOT does not cover some aspects of functional limitations, 
including “time off task, absenteeism, pace work, work in proximity to others, low-stress 

work, work in proximity to hazards, distinction between reaching overhead, reaching in all 
other directions, distinction between climbing ladders versus stairs, and use of vibratory 
tools.” (Tr. at 78–79.) The ALJ thus asked upon what source the vocational expert based 
her testimony on these limitations, and she answered “[t]hirty-seven years professional 
experience in job placement.” (Tr. at 79.) The ALJ then asked, “[a]nd has your testimony 
been consistent with the DOT and SCO?”7 to which the vocational expert responded, 
“Yes.” (Id.)                                                              

    The ALJ ultimately adopted an RFC that limited Plaintiff to “simple and routine 
tasks performed in a work environment free of fast-paced production requirements (i.e. no 
work on an assembly line)” and “low stress work, which is defined as involving only 
simple, work-related decisions and routine work place changes.” (Tr. at 22.) The ALJ cited 
two of the vocational expert’s examples of representative jobs that Plaintiff could still 

perform with such limitations, including the occupations of marker (DOT No. 209.587-
034) and mail sorter (DOT No. 209.687-026). (Tr. at 40.) He also concluded that the 
vocational expert’s testimony was consistent with the DOT. (Tr. at 41.) In doing so, he 
noted that the DOT does not provide information on “pace work” or “low stress work,” 
among other things, and that he relied on the vocational expert’s testimony based on her 

37 years of professional experience in job placement to reach conclusions on these areas 
where the DOT is silent. (Id.)                                            
A.   There is no conflict between the vocational expert’s testimony related to pace 
    and stress levels and the DOT.                                       

    The Court finds that the ALJ fulfilled the requirements of SSR 00-4p. First, the ALJ 
asked whether the vocational expert’s testimony conflicted with the DOT and received the 
expert’s confirmation no conflict existed. Even though an ALJ is not absolved of their duty 

7  The  “SCO”  refers  to  the  DOT’s  supplement  entitled  Selected  Characteristics  of 
Occupations  Defined  in  the  Dictionary  of  Occupational  Titles,  which  elaborates  on 
exertional RFC classifications. See SSR 83-14, 
1983 WL 31254
, at *1 (Jan. 1, 1983). 
to ensure that the vocational expert’s testimony is consistent with the DOT just because the 
expert testifies that the two are consistent, see Moore, 
769 F.3d at 990
, at the very least, it 
is clear from the vocational expert’s testimony here that the DOT could not conflict with 

areas on which it was silent—the DOT does not offer guidance on pace work or low stress 
work. Thus, to the extent that Plaintiff challenges the vocational expert’s testimony about 
the pace and stress levels of work for the representative occupations, there can be no 
conflict between the expert’s testimony and the DOT, and thus, no conflict that the ALJ 
failed to resolve.                                                        

B.   There is no conflict between the Worker Functions ratings in the representative 
    occupations of marker and mail sorter and an RFC limiting Plaintiff to “simple 
    and routine tasks” and “simple and work related decisions.”          

    For the sake of thoroughness, the Court next considers whether there are any non-
pace or stress-level related job characteristics specific to the jobs identified that would still 
conflict with the DOT. Plaintiff challenges whether a marker or mail sorter involves more 
than “simple and routine tasks” and “simple and work related decisions.” (Tr. at 22.) A 
“marker”                                                                  
    [m]arks and attaches price tickets to articles of merchandise to record price 
    and identifying information: Marks selling price by hand on boxes containing 
    merchandise, or on price tickets. Ties, glues, sews, or staples price ticket to 
    each article. Presses lever or plunger of mechanism that pins, pastes, ties, or 
    staples ticket to article. May record number and types of articles marked and 
    pack them in boxes. May compare printed price tickets with entries on 
    purchase order to verify accuracy and notify supervisor of discrepancies. 

DICOT 209.587-034, 
1991 WL 671802
. A “mail sorter”                        
    Sorts incoming mail for distribution and dispatches outgoing mail: Opens 
    envelopes by hand or machine. Stamps date and time of receipt on incoming 
    mail. Sorts mail according to destination and type, such as returned letters, 
    adjustments, bills, orders, and payments. Readdresses undeliverable mail 
    bearing  incomplete  or  incorrect  address.  Examines  outgoing  mail  for 
    appearance and seals envelopes by hand or machine. Stamps outgoing mail 
    by hand or with postage meter.                                       

DICOT 209.687-026, 
1991 WL 671813
.                                        
    These  “DOT  definitions  are  simply  generic  job  descriptions  that  offer  the 
approximate maximum requirements for each position, rather than their range.” Page v. 
Astrue, 
484 F.3d 1040, 1045
 (8th Cir. 2007) (quoting Wheeler v. Apfel, 
224 F.3d 891, 897
 
(8th Cir. 2000)). “The middle three digits of the DOT occupational code are the Worker 
Functions ratings of the tasks performed in the occupation” and relate to the degree of 
demand on a worker as to “data, people, and things.” DICOT, Parts of the Occupational 
Definition, 
1991 WL 645965
. “As a general rule, Worker Functions involving more 
complex responsibility and judgment are assigned lower numbers in these three lists while 
functions which are less complicated have higher numbers.” 
Id.
 “It is assumed that, if the 
job requires it, the worker can generally perform any higher numbered function listed in 
each of the three categories.” 
Id.
 Thus, if the representative jobs identified only involve 
“simple and routine tasks” and “simple and work related decisions” according to the DOT, 

the Court would expect the three middle digits would have a higher number, signaling the 
functions are less complicated.                                           
    First the Court will consider the initial Worker Functions rating digit concerning 
data. A job can have a rating between one and six for the first digit related to data. See 
DICOT, Appendix B – Explanation of Data, People, and Things, 
1991 WL 688701
. 

Reviewing a marker’s first Worker Functions rating—five—a worker would need to do no 
more than “copy” data, which involves “[t]ranscribing, entering, or posting data.” DICOT, 
Parts  of  the  Occupational  Definition,  
1991 WL 645965
;  DICOT,  Appendix  B  – 
Explanation of Data, People, and Things, 
1991 WL 688701
; DICOT 209.587-034, 
1991 WL 671802
. Reviewing a mail sorter’s first middle digit—six—a worker would need to do 
no more than “compare” data, which involves “[j]udging the readily observable functional, 
structural, or compositional characteristics (whether similar to or divergent from obvious 
standards) of data, people, or things.” DICOT, Parts of the Occupational Definition, 
1991 WL 645965
; DICOT, Appendix B – Explanation of Data, People, and Things, 
1991 WL 688701
; DICOT 209.687-026, 
1991 WL 671813
. Both jobs have ratings at the higher end 
of the Worker Functions rating at five and six, respectively, and the Court finds that these 
ratings and their descriptions do not conflict with an RFC limiting Plaintiff to “simple and 
routine tasks” and “simple and work related decisions.” See, e.g., Melsha v. Colvin, No. 
14-cv-3 (JSS), 
2014 WL 5858561
, at *6–7 (N.D. Iowa Nov. 12, 2014) (affirming an ALJ’s 

decision finding a plaintiff limited to simple, routine tasks could perform the representative 
jobs of a marker and mail clerk); Weckherlin v. Berryhill, No. 4:16-cv-1487 (AGF), 
2017 WL 3873167
, at *1, 4 (E.D. Mo. Sept. 5, 2017) (affirming an ALJ’s decision finding a 
plaintiff limited to simple, routine, repetitive work without a fast pace could perform 
representative jobs of mail room clerk and merchandise marker).           

    Next,  the  Court  will  consider  the  second  two  Worker  Functions  rating  digits 
concerning people and things. The final two digits in both the marker and mail sorter jobs 
are the same—an eight in relation to people, and a seven in relation to things. DICOT 
209.587-034, 
1991 WL 671802
; DICOT 209.687-026, 
1991 WL 671813
. Both numbers 
represent the highest (and therefore least complicated) category of job in relation to people 
(with ratings from one through eight) and things (with ratings from one through seven). 
See DICOT, Appendix B – Explanation of Data, People, and Things, 
1991 WL 688701
. As 

to people, both jobs require a worker to do no more than take “instructions” from and 
“help” people, which involves “[a]ttending to the work assignments instructions or orders 
of supervisors” with no immediate response required or expectation of learning. DICOT, 
Parts  of  the  Occupational  Definition,  
1991 WL 645965
;  DICOT,  Appendix  B  – 
Explanation of Data, People, and Things, 
1991 WL 688701
; DICOT 209.587-034, 
1991 WL 671802
; DICOT 209.687-026, 
1991 WL 671813
. As to things, both jobs require a 
worker to do no more than “handle” things, which involves “[u]sing body members, 
handtools,  and/or  special  devices  to  work,  move,  or  carry  objects  or  materials”  and 
“[i]nvolves little or no latitude for judgment with regard to attainment of standards or in 
selecting  appropriate  tool,  object,  or  materials.”  DICOT,  Parts  of  the  Occupational 

Definition, 
1991 WL 645965
; DICOT, Appendix B – Explanation of Data, People, and 
Things, 
1991 WL 688701
; DICOT 209.587-034, 
1991 WL 671802
; DICOT 209.687-026, 
1991 WL 671813
. The Court again finds that these ratings and their descriptions do not 
conflict with an RFC limiting Plaintiff to “simple and routine tasks” and “simple and work 
related decisions.” See, e.g., Melsha, 
2014 WL 5858561
, at *6–7. Weckherlin, 
2017 WL 3873167
, at *1, 4.                                                        
C.   There is no conflict between the general educational development rating on 
    reasoning in the representative occupations of marker and mail sorter and an 
    RFC limiting Plaintiff to “simple and routine tasks” and “simple and work 
    related decisions.”                                                  

    Along with these functional ratings in the middle three digits of each job, the DOT 
also assigns jobs a rating on a scale of one through six for general educational development 
in  three  areas:  reasoning,  math,  and  language  development.  DICOT,  Appendix  C  – 
Components of the Definition Trailer, 
1991 WL 6887702
. The lower the rating, the less 
complicated reasoning is involved in a job. The reasoning component is relevant here to 
consider whether the occupations of marker and mail sorter in the DOT involve more than 
“simple and routine tasks” and “simple and work related decisions.” (Tr. at 22.) 
    Here, the job of a marker is rated a “Level 2” for reasoning, which requires a worker 
to  do  no  more  than  “[a]pply  commonsense  understanding  to  carry  out  detailed  but 
uninvolved written or oral instructions” and to “[d]eal with problems involving a few 
concrete variables in or from standardized situations.” DICOT, Appendix C – Components 
of the Definition Trailer, 
1991 WL 6887702
; DICOT 209.587-034, 
1991 WL 671802
. The 
role of a mail sorter is rated a “Level 3” for reasoning, which requires a worker to do no 

more than “[a]pply commonsense understanding to carry out instructions furnished in 
written, oral, or diagrammatic form” and to “[d]eal with problems involving several 
concrete variables in or from standardized situations.” DICOT, Appendix C – Components 
of the Definition Trailer, 
1991 WL 6887702
; DICOT 209.687-026, 
1991 WL 671813
. 
    Considering  the  characteristics  of  jobs  like  marker  or  mail  sorter  in  relation 

reasoning, the Court finds no conflict between the DOT and the vocational expert’s 
testimony that a person limited to “simple and routine tasks” and “simple and work related 
decisions” could perform these roles. Accord Murphy v. Berryhill, No. 18-cv-61 (LRR), 
2019 WL 1140235
, at *16 (N.D. Iowa Mar. 12, 2019) (“[T]he Eighth Circuit has held that 

a claimant who could follow ‘simple, concrete instructions’ could do a job requiring level 
3 reasoning and a claimant who was limited to unskilled work could do jobs requiring level 
3 reasoning.”) (citing Hillier v. Soc. Sec. Admin., 
486 F.3d 359, 367
 (8th Cir. 2007); 
Renfrow v. Astrue, 
496 F.3d 918
, (8th Cir. 2007)); see also, Galloway v. Kijakazi, 
46 F.4th 686, 690
 (8th Cir. 2022) (“We previously have found no direct conflict between carrying 

out simple job instructions for simple, routine and repetitive work activity, and a vocational 
expert’s  identification  of  occupations  involving  instructions  that,  while  potentially 
detailed, are not complicated or intricate.”) (quoting Moore v. Astrue, 
623 F.3d 599, 604
 
(8th Cir. 2010)) (cleaned up); Nicolas J. v. Kijakazi, No. 20-cv-1340 (WMW/ECW), 
2022 WL 1109810
, at *25 (D. Minn. Jan. 20, 2022) (affirming an ALJ’s decision finding a 

plaintiff limited to simple, routine tasks at a nonproduction pace could perform work 
requiring Level 3 reasoning), R. & R. adopted sub nom. Nicholas C. J. v. Kijakazi, 
2022 WL 807605
 (D. Minn. Mar. 17, 2022).                                       
    In sum, because the hypotheticals presented to the vocational expert were based on 
substantial evidence in the record, and because there is no conflict between the expert’s 

testimony and the DOT, the Court finds that the ALJ properly relied on the vocational 
expert’s testimony to conclude Plaintiff was not disabled. Wagner v. Astrue, 
499 F.3d 842, 854
 (8th Cir. 2007).                                                      
V.   THE  ALJ  PROPERLY  RELIED  ON  THE  VOCATIONAL    EXPERT’S          
    IDENTIFICATION  OF  ENOUGH  JOBS  NATIONALLY   TO  INDICATE          
    REGIONAL JOBS IN SIGNIFICANT NUMBERS ALSO EXIST.                     

    Plaintiff’s final argument is that the ALJ erred in concluding that the record proves 
there are a significant number of jobs that she could still perform despite her limitations. 
While  the  ALJ  relied  on  the  vocational  expert’s  identification  of  143,200  total 
representative jobs available in the national economy, Plaintiff contends the record lacks 
required evidence on these jobs. Specifically, the record contains no evidence on how many 
of those jobs are in the state or region where Plaintiff lives, or are in several other regions 
in the nation, as required by regulation under 
20 C.F.R. § 404.1566
. Because the burden is 
on the Commissioner at step five to show a claimant can perform other work and is not 
disabled,  Plaintiff  contends  that  this  failure  to  identify  the  regional  locations  of  the 
representative jobs merits reversal of the Commissioner’s decision.       
    The Commissioner responds that the jobs of marker and mail sorter identified by 

the vocational expert are not the type of jobs that are geographically specific, “such as a 
shrimp-boat worker or tobacco farmer.” (Doc. 14 at 21.) He also argues that the prehearing 
notice provided by the ALJ put the vocational expert on notice that they would be asked if 
Plaintiff could perform work in the national economy existing in “significant numbers 
either in the region where the claimant lives or in several other regions of the country.” (Id. 

at 22 (citing Tr. at 198).) The Commissioner also contends that Plaintiff’s counsel could 
have asked more probing questions about job locations at the hearing had he believed the 
expert’s testimony was deficient, but did not do so.                      
    To begin with, there is no dispute that the vocational expert’s identification of 
143,200 total representative jobs is a sufficient number. The dispute lies, instead, in 
whether the record must show where in the nation such jobs exist. At step five in the 

sequential evaluation, to demonstrate that a claimant is not disabled, the Commissioner 
must prove that “substantial gainful work . . . exists in the national economy, regardless of 
whether such work exists in the immediate area in which [a plaintiff] lives, or whether a 
specific job vacancy exists for [them], or whether [they] would be hired if [they] applied 
for work.” 
42 U.S.C. § 423
(d)(2)(A). The regulations define “work which exists in the 

national economy” as “work which exists in significant numbers either in the region where 
such  individual  lives  or  in  several  regions  of  the  country.”  Id.;  see  also  
20 C.F.R. § 404.1566
(a) (“We consider that work exists in the national economy when it exists in 
significant numbers either in the region where you live or in several other regions of the 
country.”).                                                               

    The Eighth Circuit has created no rubric by which courts measure whether the 
identified representative jobs in a case meet the regulatory requirements. See Karen E. v. 
Kijakazi, No. 21-cv-3015 (CJW/MAR), 
2022 WL 17548642
, at *7 (N.D. Iowa Sept. 15, 
2022) (“The Eighth Circuit has never held that an ALJ must specifically identify whether 
jobs exist in the claimant’s region or several regions as opposed to simply identifying jobs 

in the entire national economy.”). Instead, this question is left “to the trial judge’s common 
sense” based on the particular facts of the case. Hall v. Chater, 
109 F.3d 1255, 1259
 (8th 
Cir. 1997). One court in this District recently summarized the different ways that courts in 
this Circuit exercise that common sense, noting that the District of South Dakota’s courts 
require that an ALJ rely on evidence that representative jobs exist in a claimant’s region or 
in several regions, while the District of Missouri’s courts accept that jobs that exist 
nationally exist in several regions of the country absent evidence that they are jobs peculiar 

to particular regions. See Shari B. v. Kijakazi, No. 22-cv-1539 (DJF), 
2023 WL 6130679
, 
at *8 (D. Minn. Sept. 19, 2023) (collecting cases).                       
    Shari B. is instructive. There, the court determined that while a sufficient number of 
national jobs likely indicates job availability in several regions, too few jobs nationally 
could require evidence of a regional breakdown. 
Id. at 9
. Applying this rule, the Shari B. 

court found 18,000 jobs in the national economy provided insufficient evidence of an 
adequate number of jobs at regional levels, and the court remanded the case with directions 
for the Commissioner to supplement the record as to the locations of the representative jobs 
identified. 
Id.
                                                           
    There is a significant difference between the 18,000 representative jobs in Shari B. 

and the 143,200 here. It is true that the vocational expert provided no regional breakdown 
on which the ALJ could rely. (See Tr. at 40–41, 77–78.) Even so, considering the number 
of jobs, the broad definitions of a marker or mail sorter discussed above, and the fact that 
there appears to be nothing peculiar to any region about either of these occupations, the 
Court finds that these national numbers are sufficient to show that representative jobs exist 

without requiring evidence of regional breakdowns. Therefore, the Court finds that the ALJ 
met his burden at step five to show that a sufficient number of representative jobs are 
available to Plaintiff and that, consequently, she is not disabled.       

ORDER

    Based on the above, as well as the files, records, and proceedings in this case, IT 
IS ORDERED that:                                                          

    1.   Plaintiff’s Motion (Doc. 11) is DENIED; and                     

    2.   Defendant’s Motion (Doc. 14) is GRANTED.                        


    LET JUDGMENT BE ENTERED ACCORDINGLY.                                 


DATED:  September 19, 2024           s/Douglas L. Micko                   
                                  DOUGLAS L. MICKO                       
                                  United States Magistrate Judge         

Reference

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