McCoy v. Astrue

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 10-3555

___________

Steve L. McCoy, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the

* District of Nebraska.

Michael J. Astrue, Commissioner of *

the Social Security Administration, *

*

Appellee. *

*

___________

Submitted: May 11, 2011

Filed: August 4, 2011

___________

Before MURPHY, BEAM, and COLLOTON, Circuit Judges.

___________

BEAM, Circuit Judge.

Appellant Steve McCoy challenges the district court's1 affirmance of the Social

Security Administration's (SSA) denial of McCoy's claim for disability benefits. We

affirm.

1

The Honorable Laurie Smith Camp, United States District Judge for the

District of Nebraska.

I. BACKGROUND

McCoy alleges he is disabled as a result of Post Traumatic Stress Disorder

(PTSD), Parkinson's disease, Attention Deficit Disorder (ADD), and peripheral

neuropathy. McCoy contends that the mental and physical limitations he has as a

result of these conditions, combined with his advanced age and limited job skills,

render him unable to perform any work available in the national economy.

McCoy, born on April 25, 1949, was 53 years old at the time of his alleged

disability-onset date and 56 years old on his date last insured. McCoy has a general

equivalency diploma, which he earned while serving in the military. McCoy's three

years of military service included a deployment to Vietnam. His service ended with

a dishonorable discharge, leaving him ineligible for veterans benefits. McCoy failed

to provide the Administrative Law Judge (ALJ) with a complete and detailed

overview of his post-military work history. However, it appears McCoy worked

intermittently in a number of unskilled jobs, including in positions as an automatic

machine attendant, a product tester, and a packer. The record indicates McCoy

worked as a heavy general laborer between 1987 and 1993 and worked other short-

term temporary jobs between 1993 and March 2001. McCoy has not worked outside

the home since March 2001.

On October 26, 2004, McCoy filed an application for benefits, alleging

disability beginning on September 15, 2000. After McCoy's claim was denied

initially and on reconsideration, he requested a hearing, which was held on January

17, 2007. At the hearing, McCoy amended his alleged disability-onset date to

February 1, 2003. McCoy stopped working in March 2001, and his date last insured

was March 31, 2006. Thus, to qualify for disability benefits, McCoy is required to

prove that he was disabled between February 2003 and March 2006. See Tilley v.

Astrue, 580 F.3d 675, 676 (8th Cir. 2009).

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On October 28, 2002, four months before his alleged disability-onset date,

McCoy saw his primary care physician, Steven Saathoff, M.D., complaining of hand

tremors, trouble sleeping, intrusive thoughts, depression, and anxiety. Upon

examining McCoy, Dr. Saathoff noted that McCoy retained normal muscle strength

and gait, but observed a fine tremor in McCoy's hands. Dr. Saathoff prescribed

McCoy medicine for his PTSD symptoms, but did not prescribe any medication for

McCoy's tremor at that time.

Over the next three years, McCoy made a series of visits to various healthcare

providers. This series included several trips back to Dr. Saathoff, visits with

neurologist John Puente, M.D., and, beginning in 2004, weekly visits with a licensed

mental health practitioner Janet Waage Lingren, Ed. D. Dr. Saathoff continued to

treat McCoy's PTSD symptoms with medication, and monitored his hand tremor,

eventually prescribing medication for that as well. In 2004, Dr. Saathoff referred

McCoy to Dr. Puente for further evaluation and treatment of his hand tremor. Dr.

Puente concluded that McCoy's tremor likely was partially caused by his PTSD but

that it also seemed to have an "essential" neurological component. Eventually, Dr.

Puente diagnosed McCoy with "likely" Parkinson's disease and treated him

accordingly. Starting in 2004, McCoy also had weekly sessions with Dr. Lingren,

who provided general counseling and "neurofeedback" to treat McCoy's PTSD

symptoms. In addition to regularly visiting these treating physicians, McCoy

underwent a number of consultative disability evaluations between 2003 and 2007,

visiting Ruilin Wang, M.D., psychologist William R. Stone, Ph.D., agency

psychologist Linda Schmechel, Ph. D., psychiatrist Mohammad S. Kamal, M.D., and

neuropsychologist Robert Arias, Ph.D. The administrative record contains extensive

documentation of these medical visits.

The healthcare providers who treated and examined McCoy came to somewhat

varied conclusions about the severity of McCoy's condition and the significance of

his resulting limitations during his insured period. McCoy's counselor, Dr. Lingren,

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expressed the most significant concerns about the limitations that McCoy's condition

would impose on his ability to work. Ultimately, she concluded in a 2005 report

prepared in conjunction with McCoy's disability application that McCoy's "ability to

do work related activities such as sitting, standing, lifting, carrying, and handling

objects has been dramatically compromised because of the tremors" and that his

ability to concentrate and sustain social interactions was "very limited" because of his

PTSD and Parkinson's-related symptoms. At one point, Dr. Puente also indicated that

McCoy had significant cognitive limitations; in a 2005 Residual Functioning

Capacity (RFC) assessment, Dr. Puente noted "marked" limitations in areas related

to memory and concentration.

On the other hand, a number of the healthcare providers who treated McCoy

during this same period concluded that his physical and mental limitations were

minor and that his most significant limitations were social and emotional. During a

July 2004 exam, Dr. Saathoff noted that, despite McCoy's tremor, McCoy retained

muscle strength rated at "5/5" in his upper and lower extremities and a "normal" gait.

In 2004, Dr. Stone, who performed multiple consultative exams on McCoy, noted that

McCoy did not display "any remarkable involuntary movements [or] gross

peculiarities of posture or gait" and that, despite a diagnosis of PTSD, McCoy was

generally capable of performing mental work-related functions. Dr. Stone did note

that, as a result of his PTSD and personality disorder, McCoy had some prohibitive

social limitations that undermined his ability to engage in ongoing interaction with

the public or cooperative work with supervisors or coworkers. Similarly, in 2005, Dr.

Kamal saw McCoy for a consultative exam and concluded that McCoy had the ability

to concentrate on and complete tasks and to follow and complete instructions, but that

he may have a limited ability to relate to coworkers and supervisors because of his

PTSD-related symptoms. Neuropsychological testing conducted by Dr. Stone in 2005

also revealed no significant memory or cognitive impairment. After reviewing the

test results, Dr. Stone concluded McCoy was "generally capable of sustaining

concentration and attention" with only brief periods of "decreasing frequency" where

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intrusive thoughts reduced his attention capacity to "low average" and that his social

impairments would not "be prohibitive in the kinds of relatively superficial

relationships typical for jobs." Similarly, a neuropsychological exam conducted by

Dr. Arias in January 2007–after McCoy's insured status had expired–indicated

moderate memory-retrieval impairment but noted otherwise normal cognitive

performance with perceptual-organization skills in the "superior" range.

In addition to the voluminous medical evidence, the ALJ also considered

evidence of McCoy's daily activities during his insured period. In 2003, McCoy

filled out a Daily Activities and Symptoms Report. He indicated that his activities

included gardening, mowing the lawn, watching television, and visiting his family.

McCoy's wife filled out a Supplemental Information Form at the same time,

indicating that McCoy helped with childcare and pet care and that he "independently

and appropriately" assisted with home-schooling his autistic daughter. In a December

2004 Supplemental Disability Report, McCoy continued to indicate he did yard work,

gardened, and drove three times per week. As late as July 2006, McCoy reported

mowing the lawn in the high heat. However, at his disability hearing, McCoy

indicated that he could not do "anything" at home because of his inability to focus

and because of his neuropathy. Upon further questioning, McCoy admitted that he

helped get his children ready for school, helped home-school his daughter,

occasionally drove, and helped with the children once they got home from school.

However, he maintained that he was not able to focus on any of this because of

intrusive thoughts. McCoy also said that he used a cane all the time because he was

in significant pain, but that he did not have the cane with him that day because it was

broken. McCoy further indicated that he could only walk about fifty feet and that he

could not wear shoes.

After considering the medical evidence and McCoy's testimony, the ALJ

examined Michael McKeeman, a vocational expert (VE). Based on the ALJ's

evaluation of the evidence, the ALJ posed a hypothetical to McKeeman about

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whether someone in McCoy's position would be able to find work in the national

economy.2 The ALJ asked what jobs would be available to a worker with McCoy's

age, education, and work experience who: (1) could do only routine repetitive

unskilled work with ordinary supervision; (2) could not set goals or deal with job

changes; (3) could have only brief or superficial interactions with coworkers,

supervisors, and the public; and (4) was limited to occasional fingering due to a mild

tremor. The VE said a person in that position could perform approximately fifty

percent of light or medium jobs and would have a "wide range" of employment

options. The VE noted, however, that if he took McCoy's testimony at the hearing

as fully credible–including his claims that he could only walk fifty feet and could not

wear shoes–McCoy would likely not be able to find work in the national economy.

On July 19, 2007, the ALJ issued a written opinion finding that McCoy was not

disabled within the meaning of the Social Security Act. The Appeals Council denied

McCoy's request for review. McCoy filed a complaint in federal district court

challenging the denial of his claim. The district court affirmed, and McCoy appeals.

II. DISCUSSION

We review de novo a district court decision upholding a denial of Social

Security disability benefits. Bowman v. Barnhart, 310 F.3d 1080, 1083 (8th Cir.

2002). However, we review the underlying ALJ decision under a deferential

"substantial evidence" standard, and will affirm if, based on the record as a whole, a

reasonable mind could accept the ALJ's decision. Juszczyk v. Astrue, 542 F.3d 626,

631 (8th Cir. 2008). "If, after review, we find it possible to draw two inconsistent

positions from the evidence and one of those positions represents the Commissioner's

2

Because the details of McCoy's work history were unclear, the ALJ assumed

McCoy could not perform relevant past work.

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findings, we must affirm the denial of benefits." Wiese v. Astrue, 552 F.3d 728, 730

(8th Cir. 2009) (quotation omitted).

The SSA has established a five-step sequential process for evaluating disability

claims. In step one, the ALJ decides whether the claimant is currently engaging in

substantial gainful activity; if the claimant is working, he is not eligible for disability

insurance benefits. 20 C.F.R. § 404.1520(b). In step two, the ALJ determines

whether the claimant is suffering from a severe impairment. If the claimant is not

suffering a severe impairment, he is not eligible for disability insurance benefits. 20

C.F.R. § 404.1520(c). At the third step, the ALJ evaluates whether the claimant's

impairment meets or equals one of the impairments listed in Appendix 1 of the

regulations (the "listings"). 20 C.F.R. § Pt. 404, Subpt. P, App. 1. If the claimant's

impairment meets or equals one of the listed impairments, he is entitled to benefits;

if not, the ALJ proceeds to step four. 20 C.F.R. § 404.1520(d). At step four, the ALJ

determines whether the claimant retains the "residual functional capacity" (RFC) to

perform his or her past relevant work. If the claimant remains able to perform that

past relevant work, he is not entitled to disability insurance benefits. 20 C.F.R. §

404.1520(f). If he is not capable of performing past relevant work, the ALJ proceeds

to step five and considers whether there exist work opportunities in the national

economy that the claimant can perform given his or her medical impairments, age,

education, past work experience, and RFC. 20 C.F.R. § 404.1520(g). If the

Commissioner demonstrates that such work exists, the claimant is not entitled to

disability insurance benefits. Id.

Here, the ALJ applied the proper legal framework and found that McCoy (1)

was not engaged in gainful activity; (2) did have severe impairments–Parkinson's

disease, PTSD, and a personality disorder; (3) did not meet the requirements of any

"listing" condition; (4) could not perform relevant past work; and (5) was capable of

performing jobs available in the national economy. Based on these findings, the ALJ

concluded that McCoy was not entitled to benefits.

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McCoy argues that the ALJ's analysis was erroneous in two respects. First,

McCoy argues the ALJ erred at step three by concluding that McCoy did not meet the

requirements of the Parkinson's disease listing. Second, McCoy argues the ALJ erred

in its RFC determination and its conclusion that McCoy is capable of performing

work in the national economy. We reject both arguments because the ALJ's findings

at each step were supported by substantial evidence.

A. Step Three

McCoy's first argument is that the ALJ erred at step three of the sequential

evaluation by deciding that McCoy's impairments did not meet or exceed the criteria

of the presumptively disabling Parkinson's disease listing. To qualify for disability

under a listing, a claimant carries the burden of establishing that his condition meets

or equals all specified medical criteria. Marciniak v. Shalala, 49 F.3d 1350, 1353 (8th

Cir. 1995). Merely being diagnosed with a condition named in a listing and meeting

some of the criteria will not qualify a claimant for presumptive disability under the

listing. "An impairment that manifests only some of [the listing] criteria, no matter

how severely, does not qualify." Sullivan v. Zebley, 493 U.S. 521, 530 (1990). The

listing criteria for establishing "Parkinsonian syndrome" are "[s]ignificant rigidity,

brady kinesia, or tremor in two extremities, which, singly or in combination, result

in sustained disturbance of gross and dexterous movements, or gait and station." 20

C.F.R. Pt. 404, Subpt. P, App. 1, § 11.06. There is substantial evidence supporting the

ALJ's step three conclusion that, prior to the expiration of his insured status, McCoy

did not meet or equal these criteria.

The ALJ concluded that McCoy did not satisfy the section 11.06 listing

requirement because there was no evidence that, during his insured period, McCoy

had a sustained disturbance in either dexterous and gross movement, or gait and

station. Even assuming, as McCoy argues, that the ALJ's finding that McCoy is

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limited to only occasional fingering because of his tremor implies that McCoy has

a sustained disturbance in dexterous movement, this is not enough to support a

finding of disability under section 11.06. There is substantial evidence supporting

the ALJ's finding that McCoy has failed to establish any sustained disturbance in

either gross movement or gait and station.

Dr. Puente–the neurologist who diagnosed McCoy with Parkinson's disease–

repeatedly noted that McCoy's gait was relatively normal. There is no indication in

any of Dr. Puente's notes that McCoy's tremor was having a sustained effect on

anything other than his fine-motor movements. Dr. Puente's observation that McCoy

suffered from a "very small degree of cogwheel rigidity" does not compel a finding

that McCoy had a sustained disturbance in gross movement, especially given his

conclusion that McCoy's movement was "essentially intact." Only a month before

McCoy's insured status expired, Dr. Puente noted that McCoy's Parkinson's was at a

"pretty mild stage" and was "not affecting his activities of daily living to a significant

degree." This kind of evidence does not compel a finding of disability under the

listings, which are designed to identify claimants who–regardless of age, education,

or work history–are incapable of performing "any gainful activity, not just 'substantial

gainful activity.'" Zebley, 493 U.S. at 532. The ALJ's conclusion that McCoy did not

meet this very high standard is supported by substantial evidence.

McCoy also argues that the ALJ erred by failing to develop the record on

whether McCoy did, in fact, have a sustained disturbance in gross movement or gait

and station. However, this argument mischaracterizes the ALJ's burden. While an

ALJ does have a duty to develop the record, this duty is not never-ending and an ALJ

is not required to disprove every possible impairment. Barrett v. Shalala, 38 F.3d

1019, 1023 (8th Cir. 1994). The ALJ is required to order medical examinations and

tests only if the medical records presented to him do not give sufficient medical

evidence to determine whether the claimant is disabled. Conley v. Bowen, 781 F.2d

143, 146 (8th Cir.1986). Here there was voluminous evidence documenting the

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effects of McCoy's Parkinson's disease and the ALJ's decision that McCoy had no

sustained disturbance in gross movement or station and gait was supported by

substantial evidence.

B. RFC Determination and Step Five

After finding that McCoy did not have a listing impairment, the ALJ went on

to determine McCoy's RFC. Relying in part on the testimony of a VE, the ALJ

concluded that McCoy was capable of performing work available in the national

economy. McCoy argues the ALJ erred by failing to account for all of McCoy's

limitations when determining McCoy's RFC and by determining that, given McCoy's

RFC, he was capable of performing work in the national economy. Specifically,

McCoy alleges: (1) the ALJ erred by not finding him presumptively disabled under

the medical-vocational guidelines contained in 20 C.F.R. Pt. 404, Subpt. P, App. 2

("the grids"); (2) the ALJ failed to consider some relevant evidence when determining

McCoy's functional limitations and improperly discredited other evidence; and (3) the

ALJ improperly relied on testimony from the VE about jobs that McCoy is not

actually capable of doing. We reject each of these arguments.

First, McCoy argues that the ALJ should have found him presumptively

disabled under the grids. The grids are a set of charts listing certain vocational

profiles that warrant a finding of disability or non-disability. 20 C.F.R. Pt. 404,

Subpt. P, App. 2. In this case, McCoy argues that the ALJ should have found him

capable of only light work and, thus, given his demographic profile, should have

found him conclusively disabled as of his 56th birthday. While McCoy is correct that

if he were restricted to light work he would have been conclusively disabled as of his

56th birthday, he is incorrect to suggest that the ALJ erred by finding him capable of

performing medium work.

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The grids take into account only exertional limitations and certain demographic

features; they do not account for non-exertional limitations. Reynolds v. Chater, 82

F.3d 254, 258-59 (8th Cir. 1996). McCoy's primary argument is he should have been

placed in the light category because he is limited to occasional stooping, which

renders him incapable of performing medium-level work. We reject this argument

because–as we discuss below–the ALJ did not find that McCoy had a stooping

limitation. Further, even if the ALJ had accepted McCoy's argument that he is limited

to occasional stooping, a stooping limitation is a nonexertional limitation and, thus,

is not part of the grids analysis. Lounsburry v. Barnhart, 468 F.3d 1111, 1115 (9th

Cir. 2006). The ALJ correctly considered only exertional limitations when

determining that McCoy was capable of medium-level work. 20 C.F.R. Pt. 404,

Subpt. P, App. 2, § 200.00(e)(2) ("[W]here an individual has an impairment or

combination of impairments resulting in both strength limitations and nonexertional

limitations, the rules in this subpart are considered in determining first whether a

finding of disabled may be possible based on the strength limitations alone."). The

only doctor to fill out a physical RFC evaluation about McCoy indicated that he was

capable of lifting fifty pounds occasionally and up to twenty-five pounds frequently.

This meets the exertional requirements for medium work. 20 C.F.R. § 416.967(c).3

Thus, under the grids, there was no conclusive presumption of disability. Because

McCoy also claimed nonexertional impairments, the correct procedure was to have

a VE testify about the effect of McCoy's nonexertional limitations on his ability to

3

McCoy argues that under the Social Security regulations, a limitation to

stooping occasionally automatically undermines a claimant's ability to do the lifting

required for medium work. While lifting strength and stooping posture may often be

related, Social Security regulations treat them as factors that are to be examined

separately. Here, the only physician who indicated McCoy had a stooping limitation

also indicated he was capable of meeting all exertional requirements for medium

work. McCoy's argument erroneously blurs the distinction between the role of

exertional and nonexertional limitations in the disability analysis.

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find jobs in the national economy, which the ALJ appropriately did here. See Fenton

v. Apfel, 149 F.3d 907, 911 (8th Cir. 1998).

Second, McCoy argues that, even if it was proper for the ALJ to move past the

grids and consider VE testimony, the ALJ gave the VE an improper hypothetical that

was based on a determination of McCoy's RFC that failed to account for all of

McCoy's limitations because the ALJ ignored some evidence and improperly

discredited other evidence. A claimant's RFC represents the most he can do despite

the combined effects of all of his credible limitations and must be based on all

credible evidence. Flynn v. Astrue, 513 F.3d 788, 792 (8th Cir. 2008). Here, the ALJ

made a thorough and well-reasoned evaluation of the voluminous evidence related

to McCoy's impairments. McCoy raises a number of objections to the ALJ's analysis,

but none of them convince us that the ALJ's RFC determination was not supported

by substantial evidence.

McCoy argues that the ALJ erred by discrediting McCoy's complaints of

disabling pain and of physical impairments that limited his ability to walk, sit, stand,

reach, handle, and stoop. However, the ALJ's decision not to fully credit McCoy's

testimony on these matters was proper. In assessing a claimant's credibility, an ALJ

must consider all of the evidence related to the subjective complaints, the claimant's

daily activities, observations of third parties, and the reports of treating and

examining physicians. Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984). If

an ALJ explicitly discredits a claimant's testimony and gives good reasons for doing

so, we will normally defer to the ALJ's credibility determination. Gregg v. Barnhart,

354 F.3d 710, 713-14 (8th Cir. 2003). That is exactly what the ALJ did here; the ALJ

identified and summarized McCoy's complaints, described evidence of his daily

activities, identified inconsistencies between McCoy's testimony and record evidence,

and considered the reports of both treating and consultative physicians.

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Based on all of these factors, we believe the ALJ's conclusion that McCoy's

self-reported symptoms were not "entirely credible" is supported by substantial

evidence. "The ALJ may disbelieve subjective complaints if there are inconsistencies

in the evidence as a whole." Strongson v. Barnhart, 361 F.3d 1066, 1072 (8th Cir.

2004). McCoy's complaints of disabling pain are inconsistent with repeated

observations from treating and consultative physicians that McCoy was not in acute

pain or distress. See Guilliams v. Barnhart, 393 F.3d 798, 802 (8th Cir. 2005)

(discrediting claimant's claim of disabling pain where, inter alia, claimant's treating

physician repeatedly noted claimant "appeared to be in no significant distress.").

Similarly, McCoy's reports that he gardened, drove, and helped his children get ready

for school are inconsistent with his reports of disabling pain. Medhaug v. Astrue, 578

F.3d 805, 817 (8th Cir. 2009) ("[A]cts such as cooking, vacuuming, washing dishes,

doing laundry, shopping, driving, and walking, are inconsistent with subjective

complaints of disabling pain."). Further, McCoy's testimony that he could walk only

fifty feet because of acute pain was inconsistent with record evidence indicating that,

as late as July 2006, McCoy told the doctor he was mowing the lawn in the high heat.

The ALJ did not err by discrediting some of McCoy's reported symptoms.

McCoy also argues that the ALJ erred by failing to make explicit findings

regarding McCoy's ability to stoop, stand, walk, handle, and reach. We review the

record to ensure that an ALJ does not disregard evidence or ignore potential

limitations, but we do not require an ALJ to mechanically list and reject every

possible limitation. See Depover v. Barnhart, 349 F.3d 563, 567 (8th Cir. 2003)

("Here, however, the ALJ did not simply describe the RFC in 'general terms.' He

made explicit findings and, although we would have preferred that he had made

specific findings as to sitting, standing, and walking, we do not believe that he

overlooked those functions."). Based on the administrative record here, we conclude

that the ALJ did not overlook any of McCoy's alleged limitations. The ALJ identified

the proper legal framework, noting she had to take into account all credible

nonexertional limitations when determining McCoy's RFC. During the hearing and

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in her written opinion, the ALJ considered evidence that was relevant to whether

McCoy suffered from postural or manipulative limitations. Ultimately, the ALJ did

not define McCoy's RFC in "general terms," but rather affirmatively made clear

which of McCoy's alleged nonexertional limitations she found credible by including

them in the hypothetical she gave to the VE. In this context, we conclude the ALJ

implicitly made a finding that McCoy did not suffer from postural or manipulative

limitations, and we "do not see any reason to remand to make [that finding] explicit."

Depover, 349 F.3d at 568.

McCoy further argues that, even if the ALJ did make an implicit finding that

McCoy had no stooping limitation, that finding was improper because it failed to

account for medical evidence suggesting McCoy is limited to occasional stooping.4

Specifically, McCoy contends that the finding fails to account for a physical RFC

evaluation completed by agency physician A.R. Hohensee, M.D., in February of

2004, which indicated McCoy was limited to only occasional stooping, climbing,

balancing, kneeling, crouching, and crawling. However, we conclude there were

significant reasons for the ALJ to discredit this evaluation.

First, this 2004 evaluation of McCoy's postural limitations was: (1) given by

a doctor who did not examine McCoy; (2) in a checklist format with no narrative

discussion in the postural-limitation section; and (3) was not based on all relevant

medical evidence. Each of these factors was a reason for the ALJ to discredit Dr.

Hohensee's findings. "[T]he opinions of nonexamining sources are generally . . .

given less weight than those of examining sources." Wildman v. Astrue, 596 F.3d

959, 967 (8th Cir. 2010) (quotation omitted) (affirming decision to discredit

4

McCoy's arguments regarding the other alleged limitations rest almost

exclusively on McCoy's own subjective complaints, which, as discussed above, the

ALJ properly discredited because they were inconsistent with medical evidence and

with McCoy's daily activities during his insured period. Thus, we conclude the ALJ's

implicit rejection of those alleged limitations was supported by substantial evidence.

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evaluation of agency psychologist who did not examine plaintiff). That is especially

true when, like here, the nonexamining expert's opinion is given in checklist format.

"[T]he checklist format, generality, and incompleteness of the assessments limit [the

assessments'] evidentiary value." Holmstrom v. Massanari, 270 F.3d 715, 721 (8th

Cir. 2001). Relevant here, although Dr. Hohensee provided a narrative discussion on

other parts of the evaluation, question seven in the postural-limitations section,

which asked Dr. Hohensee to "explain how and why the evidence supports your

conclusions in items 1 through 6. Cite the specific facts upon which your conclusions

are based," was left completely blank. Finally, the opinion of a nonexamining

consulting physician is afforded less weight if the consulting physician did not have

access to relevant medical records, including relevant medical records made after the

date of evaluation. See Wildman, 596 F.3d at 968. In this case, Dr. Hohensee did not

have access to the records of Dr. Puente, which as discussed below, indicate that

McCoy did not have significant postural limitations.

Second, Dr. Hohensee's finding that McCoy had a stooping limitation is

inconsistent with the record as a whole. Although Dr. Hohensee did not indicate what

evidence he was using to make his finding about postural limitations, at oral argument

McCoy indicated it was based on objective medical evidence provided by Dr. Wang

during a December 2003 consultative examination. McCoy emphasizes that Dr.

Wang noted that McCoy's spinal cord flexion was only 90 degrees. However, at the

same evaluation, Dr. Wang noted "cervical spine, flexion, extension, and lateral

flexion all normal" that McCoy was "stable and balanced" and that he found no

"neurological impairments." Thus, it is not clear that this is the medical evidence that

supported Dr. Hohensee's finding of a stooping limitation. Further, in 2006, Dr.

Puente–who regularly treated McCoy for several years–explicitly found he had "[n]o

postural troubles." The ALJ correctly noted that, although McCoy regularly visited

doctors during his insured period, he rarely mentioned any pain or limitation in

movement of his back, and none of the doctors McCoy visited prior to 2006 reported

treating McCoy for limitations imposed by back pain. Notably, in July 2006, three

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months after McCoy's insured status expired, McCoy visited a new doctor at Family

Physicians Group, complaining of "relatively new" and mild lower back pain, which

the treatment notes indicate had only been going on a "few days." Similarly, in 2006,

Dr. Puente noted that McCoy had not "focused on" his leg and back pain during their

previous visits. McCoy is responsible for establishing a limitation that occurred

before his insured status expired in March 2006. Thus, symptoms first reported and

observed during these visits are unhelpful to McCoy. See Davidson v. Astrue, 501

F.3d 987, 989 (8th Cir. 2007). Further, as the ALJ noted, the record indicates that

during his insured period McCoy was engaging in day-to-day activities, such as

gardening, that were inconsistent with McCoy's claimed limitations, including his

stooping limitation. See Ellis v. Barnhart, 392 F.3d 988, 995 (8th Cir. 2005) (proper

to consider evidence of daily activities when discounting physician's opinion of

claimant's limitations). Thus, we conclude that the ALJ's implicit finding that McCoy

had no stooping limitation was supported by substantial evidence.

McCoy also argues the ALJ erred by discrediting some of Dr. Puente's findings

about McCoy. Specifically, McCoy argues the ALJ erred by discrediting parts of a

mental RFC evaluation filled out by Dr. Puente in 2004 where he noted that McCoy

had "marked" limitations in areas of understanding and memory as well as

concentration and persistence. The ALJ explicitly referenced and discounted Dr.

Puente's findings in this area. An ALJ may reject a treating physician's opinion if it

is inconsistent with the record as a whole. Finch v. Astrue, 547 F.3d 933, 936 (8th

Cir. 2008). Here, the ALJ properly found Dr. Puente's mental RFC findings were

inconsistent with the record as a whole. Dr. Puente's report was filled out before Dr.

Stone performed objective testing at Dr. Puente's request. After conducting the

cognitive testing, Dr. Stone produced a report suggesting that McCoy retained an

average level in most areas of cognitive functioning and noting that the results of the

test were "inconsistent with the presence of a significant memory or cognitive

impairment." In 2007, Dr. Arias concluded that McCoy had only "moderate" memory

impairments and that the rest of his cognitive performance was within or above

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normal limits. Finally, the ALJ noted that Dr. Puente's evaluation appeared to be

based, at least in part, on McCoy's self-reported symptoms and, thus, insofar as those

reported symptoms were found to be less than credible, Dr. Puente's report was

rendered less credible. For these reasons, we conclude that the ALJ's decision to

partially discredit Dr. Puente's RFC was based on substantial evidence.

McCoy further argues that all of the above findings are nevertheless improper

because the ALJ did not apply the proper legal standard. Namely, McCoy argues the

ALJ failed to consider two critical elements: the sustainability of McCoy's ability to

function and McCoy's ability to function in a real world work environment. McCoy

is correct that an RFC determination must be based on a claimant's ability to "perform

the requisite physical acts day in and day out, in the sometimes competitive and

stressful conditions in which real people work in the real world." Coleman v. Astrue,

498 F.3d 767, 770 (8th Cir. 2007). Here, the ALJ recognized and applied this

standard. The ALJ explicitly noted that McCoy's RFC should include only activities

McCoy could do on a "sustained basis," and the opinion clearly contemplates the

effect that a particular work environment would have on McCoy's ability to function,

including limitations on the type of supervision, pace, required adaptability, and

amount of public interaction that McCoy could handle. We conclude that, in

determining McCoy's RFC, the ALJ properly engaged in a "realistic evaluation of his

abilities to work." Juszczyk, 542 F.3d at 633.

Finally, McCoy argues that the ALJ improperly relied on incorrect VE

testimony about the jobs McCoy would be capable of performing. Specifically

McCoy argues that the VE testified that McCoy could perform jobs, as a building

cleaner and as a laborer, which are inconsistent with McCoy's limitation to occasional

fingering. However, some of the jobs in these categories that the VE referenced

require either no fingering or only occasional fingering. See, e.g., Dictionary of

Occupational Titles § 411.687-018 (poultry farm laborer); § 381.687-018 (industrial

cleaner) (4th ed. 1991). The VE did not suggest McCoy would be able to perform

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each and every job in the categories he mentioned, nor was he required to identify a

category in which McCoy could perform all of the jobs. Thus, McCoy has not

undermined the evidentiary value of the VE's testimony by identifying some jobs in

those categories that require more-than-occasional fingering. McCoy's argument that

he cannot do any of the jobs in those categories is based on his assumption of other

limitations (i.e., stooping limitations), which the ALJ properly did not find credible

and which, therefore, cannot be used to undermine the VE's analysis. See Davis v.

Apfel, 239 F.3d 962, 966 (8th Cir. 2001). Because the VE was presented with a

proper hypothetical, his testimony that there were jobs in the national economy that

McCoy could perform constituted substantial evidence. Tucker v. Barnhart, 363 F.3d

781, 784 (8th Cir. 2004).

III. CONCLUSION

For the foregoing reasons, we affirm.

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