Renstrom v. Astrue

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

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No. 11-2975

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Rodney Alan Renstrom, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the

* District of Minnesota.

Michael J. Astrue, Commissioner of *

Social Security *

*

Appellee. *

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Submitted: May 17, 2012

Filed: June 12, 2012

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Before RILEY, Chief Judge, BYE and MELLOY, Circuit Judges.

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BYE, Circuit Judge.

Rodney Renstrom sought disability insurance benefits for his ongoing back

pain, lower extremity problems, neck pain, sleep apnea, and anxiety. An

Administrative Law Judge (ALJ) upheld the Commissioner’s denial of benefits after

concluding Renstrom maintained the residual functional capacity (RFC) to perform

light work. The district court1 affirmed. After careful review, we conclude the

Commissioner’s decision was supported by substantial evidence, and we affirm.

1

The Honorable Franklin L. Noel, United States Magistrate Judge for the

District of Minnesota.

I

Renstrom was born on November 21, 1959. He has a high school education and

previously worked as a hydraulics valve machinist from 1979 to 2002. In 1993,

Renstrom sustained an on-the-job injury—an L4-L5 disc herniation with surgical

intervention superimposed on a pre-existing underlying degenerative disc

disease—resulting in worker’s compensation payments from that point until 2006.

Renstrom underwent physical therapy, medical examination and evaluation, pain

medication, IV injections, and surgeries due to his injury. Renstrom filed an

application for disability insurance benefits on November 15, 2006, claiming he had

been disabled since September 13, 2002, as a result of ongoing back pain, lower

extremity problems, neck pain, sleep apnea, and anxiety.

A. Medical Evidence

On April 5, 2002, Renstrom participated in a sleep study, which resulted in a

diagnosis of sleep apnea. Renstrom was consequently fitted for the use of a CPAP

monitor.

From May 2002 through January 2006, Renstrom saw Dr. James Schwender for

his back pain. In October 2002, Dr. Schwender diagnosed Renstrom with

degenerative disc disease at L5-S1. Dr. Schwender ordered further studies to

determine the cause of Renstrom’s pain and restricted Renstrom to no work from

October 9, 2002, through December 31, 2002. In January 2003, Dr. Schwender

assessed Renstrom as having discogenic back pain, with disc degeneration at L5-S1

confirmed through MRI results.

Renstrom returned to see Dr. Schwender in July 2003 with complaints of

worsening symptoms. As a result, Dr. Schwender performed a minimally invasive

spinal fusion at L5-S1 on Renstrom on August 25, 2003. On September 9, 2003,

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Renstrom reported deep sharp pain radiating into his right hip, leg, knee, calf, and

ankle, and was provided with an epidural steroid injection. However, Dr. Schwender

noted satisfactory progress at Renstrom’s post-operative visits in October and

December, and Renstrom reported minimal pain at both visits. Dr. Schwender ordered

a physical therapy regimen to allow Renstrom to return to work by early 2004,

although he continued Renstrom’s no-work restriction through January 31, 2004. The

work restrictions were later continued until March 31, 2004. In March 2004,

Renstrom reported he was “overall doing quite well” and his “back pain [was]

essentially resolved,” although Dr. Schwender described some occasional swelling

and L5-type symptoms on Renstrom’s right side.

On June 23, 2004, Renstrom complained of symptoms into his right lower

extremity, although Dr. Schwender noted he had good strength without motor deficits

and he was able to return to work on that date with lifting and motion restrictions.

Renstrom was assessed as having ongoing symptoms, with improved low back pain

but symptoms into the right lower extremity. Renstrom underwent a right-sided

lumbar nerve root injection at L5 on that date.

On July 20, 2004, Renstrom underwent an independent medical examination

with Dr. Loren Vorlicky, at the request of his employer’s worker’s compensation

insurance carrier. Renstrom reported a decrease in low back pain, but the

development of right leg pain. Dr. Vorlicky manipulated Renstrom’s spine, and

opined that Renstrom required work restrictions due to his surgery, although his MRI

results did not show any ongoing nerve root impingement.

On September 15, 2004, Renstrom described improvements in his back and leg

symptoms in a follow-up exam with Dr. Schwender, but also a flare-up of some pain

after he had seen Dr. Vorlicky. Dr. Schwender diagnosed Renstrom with neuritis or

radiculitis thoracic or lumbar, and ordered four more weeks of physical therapy. Once

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again, Dr. Schwender noted Renstrom was able to work with restrictions from

September 30, 2004, to December 31, 2004.

On April 20, 2005, Renstrom complained of worsening back pain, particularly

on his right side, with symptoms into his right lower extremity into the buttocks,

thigh, and calf. After being presented with various options, Renstrom wished to

consider removal of the surgical instrumentation and a revision decompression. Dr.

Schwender also ordered additional physical therapy and reinstated a no-work

restriction from June 24, 2005, through July 31, 2005.

On August 3, 2005, Renstrom reported continued back pain with occasional

symptoms into his lower extremities. Dr. Schwender indicated the MRI showed mild

disc degeneration of the L4-L5 level with central protrusion and mild foraminal

stenosis at L5-S1. Renstrom agreed to proceed with surgery for instrumentation

removal at L5-S1 and decompression, which was performed on August 8, 2005. Dr.

Schwender again noted Renstrom was unable to work from July 31 through November

30, 2005.

Renstrom reported overall slow progress in a follow-up visit on October 12,

2005, although his strength was improving in the right lower extremity. Renstrom’s

no-work restriction was ultimately continued through January 31, 2006. On January

11, 2006, Renstrom reported continued back pain and right lower extremity pain. Dr.

Schwender diagnosed Renstrom with spinal stenosis of the lumbar region and referred

him to Dr. Mark Agre for further back pain treatment.

In addition to overseeing Renstrom’s physical therapy, Dr. Agre authored

several documents for Renstrom, including an October 2006 worker’s compensation

letter stating Renstrom was “for all practical purposes, permanently totally disabled.”

The letter stated Renstrom was “able to do sporadic, light, intermittent, part time work

with frequent position change, but the nature of the severity of his pain, particularly

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the neuropathic pain of his right leg which has been unremitting to surgery,

intervention or therapy, will not allow him to work beyond sporadic and light.” Dr.

Agre also completed some medical assessment forms wherein he opined that

Renstrom was capable of light work with some restrictions; the second form he

completed in January 2009 noted Renstrom could sit for two to four hours a day and

regularly work four to six hours per day.

On November 6, 2006, Renstrom saw Dr. Patricia Kline for his neck pain. An

MRI revealed Renstrom’s vertebrae were intact and in normal alignment with some

spurring, but he had no other appreciable abnormalities. Renstrom reported continued

neck pain at future appointments on June 14, 2007, and July 29, 2008; on the latter

date, Dr. Paul Westling noted Renstrom’s neck pain was exacerbated by movement,

and he prescribed prednisone and Flexeril and physical therapy. Renstrom had

another MRI on August 11, 2008, which showed mild to moderate degeneration at C5-

6 and slight changes with underlying disc degeneration at T6-7.

Renstrom also saw Dr. Westling and Dr. Randall Chadwick for shoulder

problems beginning in 2005. After reports of pain, a June 7, 2005, MRI showed

Renstrom’s coracoacromial arch configuration would mildly increase his risk of

impingement, but the exam was otherwise negative. Dr. Chadwick diagnosed

Renstrom with left shoulder chronic impingement on June 22, 2005, for which

Renstrom underwent two physical therapy sessions. Renstrom returned on October

9, 2005, when he reported intermittent soreness and nighttime discomfort with his

shoulder, and Dr. Chadwick reiterated a finding of a mildly positive impingement

sign. Renstrom received a cortisone shot and additional physical therapy sessions.

On January 31, 2007, a state agency reviewing physician, Dr. Gregory Salmi,

conducted an assessment of Renstrom, concluding Renstrom could occasionally lift

twenty pounds and frequently carry ten pounds, and he could stand, walk, or sit for

six hours in an eight-hour work day. Dr. Salmi further opined Renstrom could

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occasionally climb, bend, balance, stoop, kneel, crouch, and crawl, but his reaching

was restricted. Dr. Salmi prohibited Renstrom from frequent bilateral overhead

reaching and throwing due to his neck and shoulder problems.

B. Renstrom’s Claim for Benefits

Renstrom’s application was initially denied on February 1, 2007, and again

after reconsideration on March 30, 2007. In a hearing before the ALJ, Renstrom

testified he had last worked as a machinist in 2000 or 2001, and had stopped working

because of his back and neck pain. Renstrom indicated he was only able to walk for

fifteen minutes, and stand and sit for ten to fifteen minutes at a time, with assistance

in his car from a TENS unit. He stated he was prescribed a cane to assist with

walking, but he was able to walk without it. Renstrom also noted the most he lifted

was ten pounds, and he could not raise his left arm overhead. He testified he had bad

headaches lasting all day, and he spent a lot of time in home therapy for his neck.

Combined with his physical limitations, Renstrom stated the time he spent laying

down prevented him from performing a job where he could change positions. On a

typical day, Renstrom indicated he showered, ate breakfast, drove himself to therapy

or performed therapy at home, and cared for his personal needs.

The ALJ also heard testimony from a medical expert, Dr. Andrew Steiner, who

concluded Renstrom was not subject to any impairment that met the listings. Dr.

Steiner discussed work-related limitations Renstrom would be subject to, pointing

toward a “light” RFC with respect to lifting twenty pounds occasionally, ten pounds

frequently, and being on his feet six out of eight hours in a work day with a brief

position change hourly. Dr. Steiner also noted there were no neurological symptoms

or signs in the record to document a foot drop.

Finally, a vocational expert, Steven Bosch, testified in response to hypothetical

questions posed by the ALJ. Considering an individual impaired by a number of

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conditions such as anxiety disorder, blurred vision, degenerative disc disease in the

cervical, thoracic and lumbar spine, fusion in the lumbar spine, bilateral shoulder

impingement, obstructive sleep apnea, and allegations of pain and fatigue, with the

above restrictions and education and work experience similar to Renstrom, Bosch

opined an individual would be unable to perform Renstrom’s past work, but would be

able to perform other jobs existing in the national economy such as bench assembler

and parking attendant. Considering an individual with the same restrictions who was

limited to sedentary work, Bosch indicated a person could serve as a security monitor,

or perform assembly work. If the person was unable to use his hands for handling for

up to four hours, had difficulty seeing for up to two hours, or would miss work once

a week or more, Bosch testified such restrictions would not be consistent with

competitive work. Moreover, Bosch stated a requirement of a position change and

walking every fifteen minutes would eliminate a person’s ability to perform most jobs,

as would the need to lie down for an hour or more each day.

The ALJ ultimately denied Renstrom’s application. First, the ALJ found

Renstrom had the following impairments: (1) degenerative disc disease of the lumbar

spine with past L5-S1 fusion and subsequent instrument removal and revision and

decompression; (2) degenerative disc disease of the cervical and thoracic spine; (3)

bilateral shoulder impingement; (4) obstructive sleep apnea; and (5) anxiety. After

concluding these impairments were not severe enough to meet any listed impairment,

the ALJ found Renstrom had the RFC to perform light work, with the additional

requirement of a brief change of position after one hour. Moreover, the ALJ found

Renstrom was restricted from overhead work, frequent reaching beyond eighteen

inches, frequent bending and twisting, and skilled work. Accordingly, the ALJ found

Renstrom was unable to perform his past relevant work as a machinist. However, the

ALJ concluded Renstrom’s account of the intensity, persistence, and functionally

limiting effects of pain was not consistent with the objective medical evidence, and

Renstrom could control the severity of his symptoms through prescription medications

and other treatment options. Giving significant weight to the testimony of Dr. Steiner,

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and little weight to Dr. Agre’s opinion, the ALJ concluded Renstrom was not disabled

because he could perform a significant number of other light and sedentary jobs in the

national economy.

Renstrom’s appeal to the Appeals Council was denied, making the ALJ’s

determination the final decision of the Commissioner. Renstrom thereafter appealed

to the district court, which affirmed after concluding substantial evidence on the

record as a whole supported the ALJ’s decision. Renstrom now appeals to this court.

II

“We review de novo the District Court’s determination of whether substantial

evidence on the record as a whole supports the ALJ’s decision.” Gonzales v.

Barnhart, 465 F.3d 890, 894 (8th Cir. 2006). Substantial evidence “is less than a

preponderance, but enough that a reasonable mind might accept as adequate to support

a conclusion.” Moore v. Astrue, 572 F.3d 520, 522 (8th Cir. 2009) (internal quotation

marks and citation omitted). We consider “both evidence that supports and evidence

that detracts from the Commissioner’s decision,” Pate-Fires v. Astrue, 564 F.3d 935,

942 (8th Cir. 2009) (internal quotation marks and citation omitted), but “[w]e do not

reweigh the evidence presented to the ALJ, and we defer to the ALJ’s determinations

regarding the credibility of testimony, as long as those determinations are supported

by good reasons and substantial evidence.” Gonzales, 465 F.3d at 894 (internal

quotation marks and citation omitted).

Renstrom argues the ALJ’s determination is not supported by substantial

evidence because the ALJ improperly determined his RFC by rejecting the opinions

of his long-term physician, improperly discounted the credibility of his subjective

complaints, erroneously relied on the vocational expert, and improperly determined

that he engaged in substantial gainful activity.

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A. The ALJ’s RFC Determination

In her determination, the ALJ stated she gave significant weight to Dr. Steiner’s

opinion, which was supported by the record. The ALJ indicated Dr. Steiner’s opinion

was “generally consistent” with the opinions of Dr. Schwender and Dr. Vorlicky.

However, while the ALJ noted she considered Dr. Agre’s opinion, she stated she did

not give that opinion controlling weight because it was largely based on Renstrom’s

subjective allegations of pain, which the ALJ found not to be fully credible, and not

supported by objective evidence. Specifically, the ALJ concluded that despite

Renstrom’s “allegations of leg weakness and foot drop, physical examinations

consistently demonstrate normal strength, no associated neurological loss, no

objective findings to support the loss of propioception reported by Dr. Agre, and the

claimant demonstrates the ability to use foot controls based on his reported ability to

drive.”

On appeal, Renstrom contends the RFC determination was incorrect because

the ALJ failed to properly weigh the opinions of his treating physicians, Dr.

Schwender and Dr. Agre, and discount the opinions of the Social Security medical

experts. Renstrom further asserts Dr. Schwender’s opinion was not consistent with

Dr. Steiner’s, and the ALJ provided no specific basis to show otherwise. Moreover,

Renstrom challenges the ALJ’s reliance on Dr. Vorlicky’s opinion, who only saw

Renstrom twice—once in 2004 and once in 2006.

Generally, “[a] treating physician’s opinion is given controlling weight if it is

well-supported by medically acceptable clinical and laboratory diagnostic techniques

and is not inconsistent with the other substantial evidence.” Perkins v. Astrue, 648

F.3d 892, 897 (8th Cir. 2011) (internal quotation marks and citation omitted).

However, “[a] treating physician’s opinion does not automatically control, since the

record must be evaluated as a whole.” Id. (internal quotation marks and citation

omitted). “An ALJ may discount or even disregard the opinion of a treating physician

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where other medical assessments are supported by better or more thorough medical

evidence, or where a treating physician renders inconsistent opinions that undermine

the credibility of such opinions.” Id. at 897-98 (internal quotation marks and citation

omitted).

After careful review, we conclude the ALJ properly decided to give Dr. Agre’s

opinion non-controlling weight. First, the ALJ noted Dr. Agre’s opinion was largely

based on Renstrom’s subjective complaints. See Teague v. Astrue, 638 F.3d 611, 616

(8th Cir. 2011) (concluding the ALJ properly discounted a doctor’s report, in part,

because it “cited only limitations based on [the claimant’s] subjective complaints, not

his own objective findings”). Second, the ALJ found Dr. Agre’s opinion was not

consistent with the other medical experts, who determined Renstrom could perform

light work within a modified RFC. “Because [Dr. Agre’s] determination contradicted

other objective evidence in the record, the ALJ’s decision to give less weight to [Dr.

Agre’s] determination was reasonable.” Partee v. Astrue, 638 F.3d 860, 864 (8th Cir.

2011). See also Martise v. Astrue, 641 F.3d 909, 925 (8th Cir. 2011) (“[W]hen a

treating physician’s opinions are inconsistent or contrary to the medical evidence as

a whole, they are entitled to less weight.”) (internal quotation marks and citation

omitted); Halverson v. Astrue, 600 F.3d 922, 931 (8th Cir. 2010) (“The ALJ noted the

conflicting opinions regarding [the claimant’s] ability to perform work activities and

chose not to give controlling weight to [the treating psychiatrist’s] opinion.”).

Finally, Dr. Agre’s finding that Renstrom was “totally disabled” “gets no

deference because it invades the province of the Commissioner to make the ultimate

disability determination.” Perkins, 648 F.3d at 898. Accordingly, “the ALJ was

permitted to disregard [Dr. Agre’s] conclusory statement, unsupported by the

objective medical evidence, that [Renstrom] is disabled.” Choate v. Barnhart, 457

F.3d 865, 870 (8th Cir. 2006).

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As for Dr. Schwender’s opinion, we agree with the district court that the ALJ

only mentioned this particular opinion in passing by noting Dr. Schwender’s opinion

was generally consistent with the other medical experts. Nonetheless, while the ALJ

was required to develop the record fully, she was not required to provide an in-depth

analysis on each piece of evidence. See Craig v. Apfel, 212 F.3d 433, 436 (8th Cir.

2000) (“Although required to develop the record fully and fairly, an ALJ is not

required to discuss all the evidence submitted, and an ALJ’s failure to cite specific

evidence does not indicate that it was not considered.”). This is particularly true here,

because the ALJ found Dr. Schwender’s opinion to be generally consistent with the

other medical experts—who the ALJ did discuss in more depth. Like the other

experts, Dr. Schwender’s notes indicate Renstrom was improving with treatment, and

that he could work with lifting restrictions, position changes, occasional reaching

overhead and bending and twisting, and occasional kneeling, squatting, and climbing.

In sum, “[i]t is the ALJ’s function to resolve conflicts among the opinions of

various treating and examining physicians.” Pearsall v. Massanari, 274 F.3d 1211,

1219 (8th Cir. 2001). While it may have been more preferable for the ALJ to discuss

Dr. Schwender’s opinion in more depth, there is substantial evidence in the record

supporting the ALJ’s finding because four out of five medical sources were consistent

with the ALJ’s RFC finding for a restricted range of light work. Therefore, we affirm

the ALJ’s determination with respect to the medical experts.

B. The ALJ’s Credibility Determination

Next, Renstrom contends the ALJ improperly found his subjective complaints

not credible. “If an ALJ explicitly discredits the claimant’s testimony and gives good

reason for doing so, we will normally defer to the ALJ’s credibility determination.”

Juszczyk v. Astrue, 542 F.3d 626, 632 (8th Cir. 2008) (internal quotation marks and

citation omitted). In Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984), this court set

forth a number of factors an ALJ must consider in assessing a claimant’s credibility:

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“(1) the claimant’s daily activities; (2) the duration, intensity, and frequency of pain;

(3) the precipitating and aggravating factors; (4) the dosage, effectiveness, and side

effects of medication; (5) any functional restrictions; (6) the claimant’s work history;

and (7) the absence of objective medical evidence to support the claimant’s

complaints.” Moore, 572 F.3d 524. “When rejecting a claimant’s complaints of pain,

the ALJ must make an express credibility determination, detailing the reasons for

discounting the testimony, setting forth the inconsistencies, and discussing the Polaski

factors.” Dipple v. Astrue, 601 F.3d 833, 837 (8th Cir. 2010). “[A]n ALJ may not

discount a claimant’s subjective complaints solely because the objective medical

evidence does not fully support them.” Wiese v. Astrue, 552 F.3d 728, 733 (8th Cir.

2009).

In this case, the ALJ concluded Renstrom’s impairments could be expected to

cause the alleged symptoms, but Renstrom’s statements about the intensity,

persistence, and limiting effects of the symptoms were not credible to the extent they

were inconsistent with the RFC assessment. The ALJ found the severity of

Renstrom’s impairments was not consistent with the objective medical evidence in the

record. Notably, the ALJ concluded “there have been no findings of neurological

losses, no objective radicular findings such as hypoflexia or nerve specific muscle

weakness, there was no documentation of EMG abnormalities, there was full shoulder

range of motion during an examination in October 2006 and the treatment note

indicates the claimant had been last seen for his shoulder a year earlier, indicating the

condition did not require ongoing treatment.” Moreover, the ALJ noted Renstrom’s

symptoms improved with treatment, and thus, despite Renstrom’s allegations of

disabling levels of pain, the record showed he could use treatment to control the

severity of the symptoms.

The ALJ also discussed the inconsistencies between Renstrom’s allegations as

it pertained to his anxiety and his daily living. After reciting the various activities

Renstrom performed, the ALJ concluded the activities were consistent with the ability

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to work within the RFC and did not support a disability finding. Finally, the ALJ

found there was not a strong motivation for Renstrom to return to the workplace

because he was involved in worker’s compensation litigation, and while this was

pending, he did not receive any vocational or rehabilitation services to assist with

employment.

On appeal, Renstrom contends the ALJ could not reject his claims regarding

pain, symptoms, or the effects of symptoms on his ability to work based solely on the

lack of objective medical evidence. Renstrom also argues the fact that he could

perform some chores and limited activities was not sufficient to discredit his

subjective complaints of pain. Indeed, Renstrom asserts he testified he experiences

pain daily, which affects his ability to walk and stand, among other things.

We reject Renstrom’s arguments because the record shows the ALJ considered

a multitude of factors in assessing Renstrom’s credibility. First, the ALJ noted the

severity of Renstrom’s reported impairments was not consistent with the medical

evidence in the record and his course of treatment. See, e.g., Teague, 638 F.3d at 615

(“Given that none of [the claimant’s] doctors reported functional or work related

limitations due to her headaches, there was a basis to question [the claimant’s]

credibility.”). The ALJ proceeded to discuss how Renstrom improved with treatment,

including physical therapy, a TENS unit, and pain medications, which showed

Renstrom’s level of pain was controllable. “If an impairment can be controlled by

treatment or medication, it cannot be considered disabling.” Brown v. Astrue, 611

F.3d 941, 955 (8th Cir. 2010) (internal quotation marks and citation omitted). The

ALJ also cited Renstrom’s failure to obtain treatment for certain symptoms and for

certain periods of time.

Next, the ALJ considered Renstrom’s daily activities, including his multiple

vacations, daily chores, and ability to provide self care. The ALJ found these

activities indicated a lesser impairment than Renstrom claimed in his testimony. “We

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have held that acts which are inconsistent with a claimant’s assertion of disability

reflect negatively upon that claimant’s credibility.” Halverson, 600 F.3d at 932

(internal quotation marks and citation omitted). Finally, the ALJ discussed

Renstrom’s work history, finding Renstrom had a possible disincentive to return to

work because of his worker’s compensation litigation. Together, these inconsistencies

in the record as a whole undermined the credibility of Renstrom’s allegations.

In sum, the ALJ discussed many Polaski factors in discrediting Renstrom’s

credibility in a detailed and prolonged discussion. “The ALJ is not required to discuss

methodically each Polaski consideration, so long as he acknowledged and examined

those considerations before discounting a claimant’s subjective complaints.” Partee,

638 F.3d at 865 (internal quotation marks and citation omitted). Because the ALJ

gave good reasons for discounting Renstrom’s credibility, we defer to the ALJ’s

credibility findings. See Perkins, 648 F.3d at 900 (“If the ALJ discredits a claimant’s

credibility and gives a good reason for doing so, we will defer to its judgment even

if every factor is not discussed in depth.”) (internal quotation marks and citation

omitted); Medhaug v. Astrue, 578 F.3d 805, 816-17 (8th Cir. 2009) (concluding the

ALJ properly discredited the claimant’s testimony after considering his own

statements and his physicians’ opinions that his pain was controlled with medication;

the claimant maintained work after his onset date; and the claimant performed daily

activities and chores that were inconsistent with his complaints of pain).

C. The ALJ’s Reliance on the Vocational Expert

Next, Renstrom contends the ALJ failed to incorporate all limitations,

restrictions, and subjective complaints into the hypothetical posed to the vocational

expert. “Testimony based on hypothetical questions that do not encompass all

relevant impairments cannot constitute substantial evidence to support the ALJ’s

decision. Hypothetical questions should set forth impairments supported by

substantial evidence on the record and accepted as true and capture the concrete

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consequences of those impairments.” Jones v. Astrue, 619 F.3d 963, 972 (8th Cir.

2010) (internal quotation marks and citation omitted).

“The ALJ’s hypothetical question to the vocational expert needs to include only

those impairments that the ALJ finds are substantially supported by the record as a

whole.” Martise, 641 F.3d at 927 (internal quotation marks and citation omitted). As

noted above, the ALJ properly discounted Renstrom’s subjective complaints and

allocated more weight to certain medical opinions than others. Accordingly, the

hypothetical question to the vocational expert did not need to incorporate the

additional limitations the ALJ had properly disregarded. See Wildman v. Astrue, 596

F.3d 959, 969 (8th Cir. 2010) (“[T]he ALJ was not obligated to include limitations

from opinions he properly disregarded.”). “Based on our previous conclusion . . . that

the ALJ’s findings of [Renstrom’s] RFC are supported by substantial evidence, we

hold that the hypothetical question was therefore proper, and the [vocational expert’s]

answer constituted substantial evidence supporting the Commissioner’s denial of

benefits.” Martise, 641 F.3d at 927 (internal quotation marks and citation omitted).

D. The ALJ’s Determination of Substantial Gainful Activity

Finally, Renstrom challenges the ALJ’s determination that he engaged in

substantial gainful activity after September 13, 2002. Citing documents indicating

Renstrom earned $24,002.09 in 2002, and $12,330.00 in 2003, the ALJ stated there

was no indication this work was not substantial gainful activity, and thus the ALJ

concluded Renstrom engaged in substantial gainful activity through 2003. Renstrom

claims these earnings were not as a result of work activity, but were from a retirement

source and worker’s compensation benefits. Therefore, Renstrom asserts these

earnings cannot be considered for purposes of determining whether he engaged in

substantial gainful activity.

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We need not decide whether Renstrom engaged in substantial gainful activity

in 2002 and 2003 because the ALJ found Renstrom “was not under a disability . . . at

any time from September 13, 2002, the alleged onset date, through December 31,

2008, the date last insured[.]” Therefore, any error regarding Renstrom’s substantial

gainful activity was harmless, because the ALJ explicitly found Renstrom was not

disabled from his alleged onset date through the date he was last insured—including

the challenged 2002 and 2003 time periods. See Van Vickle v. Astrue, 539 F.3d 825,

830 (8th Cir. 2008) (“There is no indication that the ALJ would have decided

differently . . . and any error by the ALJ was therefore harmless.”).

III

We conclude substantial evidence in the record as a whole supported the ALJ’s

denial of disability insurance benefits. Accordingly, we affirm.

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