Bonnie Giles v. Michael Astrue, Commissioner , 433 F. App'x 241 ( 2011 )


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  •      Case: 10-31006     Document: 00511542858         Page: 1     Date Filed: 07/18/2011
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT  United States Court of Appeals
    Fifth Circuit
    FILED
    July 18, 2011
    No. 10-31006                        Lyle W. Cayce
    Clerk
    BONNIE GILES,
    Plaintiff – Appellant
    v.
    MICHAEL J. ASTRUE, Commissioner of Social Security
    Defendant – Appellee
    Appeal from the United States District Court
    for the Western District of Louisiana
    USDC No. 5:09-CV-00685
    Before JONES, Chief Judge, and HIGGINBOTHAM and SOUTHWICK, Circuit
    Judges.
    PER CURIAM:*
    For well over a decade, Plaintiff Bonnie Giles has been seeking disability
    insurance benefits under Title II of the Social Security Act. Giles asserts she
    became disabled on February 7, 1992, resulting from the onset of multiple
    impairments including scoliosis, temporal lobe epilepsy, headaches, Graves
    disease, depression, fibromyalgia, diabetes, and a later onset of cardiac disease.
    Giles first filed for disability benefits in 1996 and her claim has since been heard
    *
    Pursuant to 5TH CIR. R. 47.5, the court has determined that this opinion should not
    be published and is not precedent except under the limited circumstances set forth in 5TH CIR.
    R. 47.5.4.
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    No. 10-31006
    by four administrative law judges (“ALJs”). All four denied benefits. The first
    three decisions were remanded by the Social Security Appeals Council or by the
    federal district court. The district court affirmed the most recent ALJ decision
    and Giles timely appealed. For the reasons stated below, we AFFIRM.
    I. Factual Background
    Giles was born in 1950 and has a high school education. She worked for
    Mobil Oil in Dallas from 1977 until the alleged onset of her disability in
    February 1992. During her time at Mobil, she was promoted several times,
    eventually becoming a computer analyst, which she did for about a year until
    she became sick. Giles claims she was terminated for missing too much work,
    a problem caused by her illness. After being terminated, Giles moved to her
    hometown in Louisiana to be closer to family.
    Although Giles states her disability began in February 1992, the medical
    records provide limited insight into the treatment she received before 1996,
    showing only that she was seen by a psychiatrist for a few months and an
    endocrinologist for a few years. The records also show that Giles has a 43 degree
    lumbar curvature, but most doctors agreed that scoliosis is the lesser of her
    problems. In October 1996, Giles started seeing Mairus McFarland for family
    practice medicine, whose regular notes are throughout the record.
    Giles’s medical history is complex, likely in part due to the challenges
    inherent in treating Graves disease, an autoimmune disorder that causes
    hyperthyroidism. Treatment of Graves disease may lead to hypothyroidism,
    which can cause depression, mental and physical sluggishness, and weight
    gain—conditions appearing in Giles’s medical history. Giles’s thyroid condition
    had been treated successfully with medication in September 1995, but
    physicians later altered her medications because of negative side effects. In
    April 1996, the endocrinologist noted that Giles’s Graves disease was seemingly
    2
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    under control, but he expressed concerns that it may be over-controlled. In
    February 1997, the record indicates Giles had normal thyroid function without
    medication, but she still relied on medication intermittently during the next
    several years.
    Throughout Giles’s illness, she has struggled with depression. Some
    examining physicians also suggested she be assessed for bipolar disorder.
    Several doctors noted that Giles was crying during examinations.
    Much of Giles’s physical pain during 1996 and 1997 involved her temporal
    lobe seizures which were likely causing severe migraine headaches. However,
    medical records suggest that the prescription medication Tegretol was generally
    effective in assisting Giles with her seizures, and Giles’s complaints about the
    headaches were limited from 1999 to 2006.
    In early 1997, Giles was admitted to the hospital and ultimately diagnosed
    with diabetes. Her gallbladder was removed and she started insulin therapy.
    There is no indication that her diabetes was an impairment until late 2004,
    when she was admitted to the hospital with chest pain and the emergency room
    physician noted that her diabetes was poorly controlled.
    Despite Giles’s numerous health problems, there are very few medical
    records from 1998 through 2005, other than regular notes from her primary care
    physician. In 2005, Giles’s cardiac issues arose, and she was diagnosed with
    mitral valve prolapse and later received a pacemaker.
    Giles has not been employed since 1992, and her insured status expired
    on December 31, 1998. Accordingly, she must establish disability on or before
    that date.
    II. Procedural Background
    Four ALJs have denied Giles’s claim. In May 1998, ALJ Morton J. Gold
    denied the claim, which was later remanded for failure to consider updated
    3
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    medical evidence. ALJ Thomas Bundy was the second to review the case in
    November 2001, and his decision was remanded because of an insufficient
    examination of the claimant’s mental impairment and credibility. ALJ Nancy
    J. Griswold took the case on the next appeal in May 2004, and the district court
    remanded her decision because of insufficient consideration of the claimant’s
    severe headaches and whether an underlying medical impairment could have led
    to Giles’s alleged symptoms. Finally, ALJ Charles R. Lindsay issued a decision
    in August 2008, which serves as the basis for this appeal. All ALJs incorporated
    the previous ALJ’s opinion in their decision.
    ALJ Lindsay found that Giles had severe impairments of thyroid disease,
    depression, cardiac disease, epilepsy, diabetes, and a history of migraine
    headaches. He found that these conditions and others limited Giles’s residual
    functional capacity (RFC) to the performance of light work1 except for no more
    than frequent postural activities (and no climbing ladders); an inability to work
    at unprotected heights or around dangerous moving machinery; no more than
    frequent reaching, handling, and fingering; moderately reduced ability to
    understand, remember, and carry out detailed instructions; moderately reduced
    ability to maintain attention and concentration, deal with the public, and set
    goals independently; the need to sit and stand at will; and an inability to work
    in high stress situations. ALJ Lindsay concluded that these limitations did not
    preclude Giles from performing her past relevant work as a computer analyst
    and that she could also perform three alternative jobs recommended by the
    vocational expert: cashier II, telephone information clerk, and document
    preparer.
    1
    Light work is defined as work involving “lifting no more than 20 pounds at a time with
    frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted
    may be very little, a job is in this category when it requires a good deal of walking or standing,
    or when it involves sitting most of the time with some pushing and pulling of arm or leg
    controls.” 
    20 C.F.R. § 404.1567
    (b).
    4
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    The Appeals Council rejected the ALJ’s conclusion that Giles could have
    performed her prior job. Giles only worked as a computer analyst for one year,
    and the vocational expert testified that two years of experience were required to
    acquire skills at that level. Moreover, the Appeals Council found that “[i]n light
    of the numerous, moderate mental limitations that are contained in the
    established residual functional capacity,” Giles was unable to perform her past
    work. The Council agreed that the vocational expert’s testimony provided
    sufficient support to conclude that Giles could perform the alternate jobs ALJ
    Lindsay listed, and the Council affirmed the denial of benefits. The district court
    affirmed, and Giles timely appealed.
    III. Applicable Laws
    This court reviews the Commissioner’s denial of social security benefits
    only to ascertain (1) whether the final decision is supported by substantial
    evidence and (2) whether the Commissioner used the proper legal standards to
    evaluate the evidence.2 Substantial evidence is that which a reasonable mind
    might accept to support a conclusion.3 “It is more than a mere scintilla and less
    than a preponderance.”4 When we apply the substantial evidence standard, “we
    scrutinize the record to determine whether such evidence is present. We may
    not reweigh the evidence, try the issues de novo, or substitute our judgment” for
    that of the Commissioner.5
    2
    Newton v. Apfel, 
    209 F.3d 448
    , 452 (5th Cir. 2000).
    3
    Richardson v. Perales, 
    402 U.S. 389
    , 401 (1971).
    4
    Ripley v. Chater, 
    67 F.3d 552
    , 555 (5th Cir. 1995) (internal quotation marks omitted).
    5
    Greenspan v. Shalala, 
    38 F.3d 232
    , 236 (5th Cir. 1994) (citation omitted), cert. denied,
    
    514 U.S. 1120
     (1995); see Newton, 
    209 F.3d at 452
    .
    5
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    In order to be eligible for disability benefits, the claimant must prove that
    she has a medically determinable physical or mental impairment, or
    combination of impairments, lasting at least twelve months that prevents her
    from engaging in a substantial gainful activity.6 Substantial gainful activity is
    defined as work involving significant physical or mental abilities that is usually
    done for pay or profit.7 The ALJ engages in a five-step sequential evaluation
    process for determining whether an individual is disabled: (1) whether the
    claimant is presently engaging in substantial gainful activity; (2) whether the
    claimant has a medically determinable severe impairment, as defined by
    regulations; (3) whether the claimant’s impairment or combination of
    impairments meets the criteria of an impairment listed in Appendix 1 of the
    regulations; (4) whether the impairment prevents the claimant from doing her
    past relevant work; and (5) whether the impairment prevents the claimant from
    doing any other work.8
    Before considering the fourth and fifth steps, the Commissioner must
    determine the claimant’s residual functional capacity (RFC).9 The RFC is the
    individual’s ability to do physical and mental tasks on a sustained basis despite
    limitations from her impairments. In determining the RFC, the Commissioner
    must consider all of a claimant’s impairments, including those that are not
    severe.10
    The claimant bears the burden of proof on the first four steps and then the
    burden shifts to the Commissioner for the fifth step. If the claimant shows she
    6
    
    42 U.S.C. § 423
    (d)(1)(A).
    7
    
    20 C.F.R. § 404.1572
    (a) and (b).
    8
    
    Id.
     § 404.1520(a).
    9
    Id. § 404.1520(e).
    10
    Id. § 404.1545.
    6
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    is no longer capable of performing her previous jobs, the Commissioner must
    show that the claimant is capable of engaging in some type of alternative work
    that exists in the national economy.11                  Giles does not challenge the
    Commissioner’s conclusions in the first four steps. Rather, the sole basis for this
    appeal involves the RFC limitations and Giles’s ability to perform alternative
    work.
    IV. Discussion
    A. Consideration of the Combined Effects of Giles’s Multiple Impairments
    Giles argues that the ALJ did not properly consider the combined effects
    of her multiple impairments. This claim generally is without merit, as ALJ
    Lindsay specifically incorporated “the combination” of Giles’s diabetes, cardiac
    disease, and migraine headaches into his RFC.                  Additionally, he included
    limitations resulting from Giles’s epilepsy and depression. However, Giles
    contends that neither the ALJ nor the Appeals Council considered the effects of
    her scoliosis and fibromyalgia in combination with the other impairments listed.
    Neither of these two conditions was listed as a severe impairment or explicitly
    included in the RFC. However, the RFC included a specification allowing Giles
    to sit or stand at will to assist with back pain.
    In challenging ALJ Lindsay’s failure to list scoliosis as a severe
    impairment, Giles points to several physician reports that label the scoliosis as
    “severe.” However, a conclusion that the degree of curvature is medically
    “severe” differs from a finding that the ailment was “severe” for purposes of
    disability determination. A non-severe impairment under the Social Security
    regulations is one that “does not significantly limit [the claimant’s] physical or
    11
    Chaparro v. Bowen, 
    815 F.2d 1008
    , 1010 (5th Cir. 1987).
    7
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    mental ability to do basic work activities.”12 The plaintiff has the burden of
    proving that her medical condition qualifies as severe.13 Giles points to no
    documents in the record to support her assertion that scoliosis significantly
    limited her physical work ability.
    Further, the medical history does not support including any specific
    limitation in Giles’s RFC because of her fibromyalgia. Medical records from
    1997 and 1998 indicate that Giles was experiencing joint pain, which may have
    been related to fibromyalgia. However, after Giles received a Celestone injection
    in December 1998, there are no records to suggest fibromyalgia caused Giles
    difficulty. Giles herself did not raise this condition in her most recent ALJ
    hearing. ALJ Lindsay did not err when failing to list fibromyalgia as severe nor
    does the medical history support an additional RFC limitation to account for the
    effects of fibromyalgia.
    B. Consideration of Treating and Examining Physicians’ Opinions
    Disability cases typically involve three types of physicians: 1) a treating
    physician who regularly provides care to the claimant; 2) an examining
    physician who conducts a one-time physical exam of the claimant; and 3) a
    reviewing or non-examining physician who has never examined the claimant,
    but read the claimant’s files to provide guidance to an adjudicator.14 Because the
    treating physician is most familiar with the claimant’s impairments, his opinion
    should be accorded great weight in determining disability.15 If a treating
    physician’s opinion is “well-supported by medically acceptable clinical and
    12
    
    20 C.F.R. § 404.1521
    .
    13
    See Perez v. Barnhart, 
    415 F.3d 457
    , 461 (5th Cir. 2005).
    14
    See generally 
    20 C.F.R. § 404.1527
    (d).
    15
    Newton, 
    209 F.3d at 455
    .
    8
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    laboratory diagnostic techniques and is not inconsistent with the other
    substantial evidence in [the] case record, [the Commissioner] will give it
    controlling weight.”16 Likewise, when a treating physician has reasonable
    knowledge of the impairment, his opinion is given more weight than an opinion
    from a non-treating physician.17 By contrast, the Commissioner may give less
    weight to a treating physician’s opinion about a condition outside his area of
    expertise.18 Treating physicians’ opinions also receive greater weight “[w]hen
    the treating source has seen [the claimant] a number of times and long enough
    to have obtained a longitudinal picture of [the claimant’s] impairment.”19 The
    weight given to opinions from nonexamining physicians depends on “the degree
    to which they provide supporting explanations for their opinions.”20
    An ALJ is free to reject a physician’s opinion when good cause exists.21
    “Good cause may permit an ALJ to discount the weight of a treating physician
    relative to other experts where the treating physician’s evidence is conclusory,
    is unsupported by medically acceptable clinical, laboratory, or diagnostic
    techniques, or is otherwise unsupported by the evidence.”22
    Social Security regulations provide that the Administration “will always
    give good reasons in [the] notice of determination or decision for the weight [it]
    16
    
    20 C.F.R. § 404.1527
    (d)(2).
    17
    
    Id.
    18
    
    Id.
     The regulation provides the example of an ophthalmologist who notes that the
    patient complains of neck pain during an eye exam. The ophthalmologist’s assessment of the
    neck pain would be given limited weight, even though he is a treating physician, because the
    pain is outside his specialty.
    19
    
    Id.
    20
    
    Id.
     § 404.1527(d)(3).
    21
    Newton, 
    209 F.3d at 455
    .
    22
    
    Id. at 456
    .
    9
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    give[s the claimant’s] treating source’s opinion.”23 Further, Social Security
    Ruling 96-2p instructs that an ALJ should not reject the treating physician’s
    opinion simply because it is not well-supported by the record.24               In those
    instances, the opinion is not given controlling weight, but the treating source
    opinion is “still entitled to deference and must be weighed using all of the factors
    provided in [the regulations].”25
    Giles alleges that the Commissioner did not adequately weigh the opinions
    of treating and examining physicians and over-relied on a reviewing physician’s
    report. ALJ Lindsay’s decision included a description of interrogatory responses
    by a reviewing physician, neurologist Dr. Woodrow W. Janese. As noted above,
    this opinion may only be weighted according to the value of its supporting
    explanations. If ALJ Lindsay had heavily relied on Dr. Janese’s testimony, such
    reliance would have been in error because Dr. Janese’s responses to the
    interrogatories were conclusory and without explanations.               However, ALJ
    Lindsay did not rely exclusively upon Dr. Janese—the medical record as a whole
    supports ALJ Lindsay’s conclusions.                 Further, ALJ Lindsay’s decision
    incorporated the preceding ALJ opinions, which together adequately address
    why some physician reports were given greater or lesser consideration.
    i. Disability Determinations Reserved for the Commissioner
    Although some determinations, such as disability and RFC, are legally
    reserved for the Commissioner, Social Security guidelines require adjudicators
    making these determinations to consider the opinions of medical sources and
    “apply the applicable factors” denoted in the regulations when weighing the
    23
    
    20 C.F.R. § 404.1527
    (d)(2).
    24
    Social Security Ruling 96-2p, Titles II and XVI: Giving Controlling Weight to
    Treating Source Medical Opinions, 
    61 Fed. Reg. 34,490
     (July 2, 1996).
    25
    
    Id. at 34,491
    .
    10
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    opinions.26 These factors are: 1) the physician’s length of treatment of the
    claimant; 2) the frequency of examination; 3) the nature and extent of the
    treatment relationship; 4) the extent to which the physician’s opinion is
    supported by the medical record; 5) the consistency of the opinion with the
    record as a whole; and 6) the specialization of the treating physician.27 With
    regards to a disability determination, the guidelines note that medical opinions
    “must not be disregarded. However, even when offered by a treating source,
    they can never be entitled to controlling weight or special significance.”28
    Several physicians—Dr. McFarland, Dr. Rogers, and Dr. Russell—
    indicated at various points in time that they considered Giles to be disabled. In
    the second administrative review of this case, ALJ Bundy specifically addressed
    these statements and found that they need not be attributed great weight based
    on the above-listed factors. His conclusions are supported by the record as a
    whole.
    ii. Mental Health Conditions
    The district court remanded ALJ Bundy’s decision back to the
    administration for his failure to address the severity of Giles’s mental
    impairment. Thus, ALJ Griswold, the third administrative reviewer, focused on
    Giles’s mental health claims, and ALJ Lindsay incorporated Griswold’s findings
    into his decision. Both ALJs noted that Giles’s mental health treatment had
    been sporadic over the years. One mental health specialist opined that Giles
    was mentally impaired to the point that she was not functional at work, but ALJ
    Griswold adequately explained why this opinion was given limited weight. The
    26
    Social Security Ruling (SSR) 96–5p, Titles II and XVI: Medical Source Opinions on
    Issues Reserved to the Commissioner, 
    61 Fed. Reg. 34,471
    , 34,473 (July 2, 1996).
    27
    
    20 C.F.R. § 404.1527
    (d).
    28
    61 Fed. Reg. at 34,474.
    11
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    physician had only treated Giles for five months and a subsequent examining
    physician’s report found fewer impairments. More importantly, there is no
    evidence that Giles sought mental health treatment after November 1996.
    Although Giles did not seek professional psychological help, she did follow
    up with her family practice physician, Dr. McFarland, who continues to
    prescribe anti-anxiety medication.            Giles asserts that the Commissioner’s
    decision did not properly weigh Dr. McFarland’s assessment of Giles’s mental
    limitations. However, ALJ Griswold adequately explained why she gave limited
    weight to Dr. McFarland’s assessment. For example, Dr. McFarland said that
    Giles had a poor ability to maintain concentration, but his opinion was not
    consistent with the record as a whole; several other physicians denoted that
    Giles’s memory and concentration were intact. Moreover, Dr. McFarland is not
    a mental health specialist, so his opinions regarding the claimant’s mental
    impairments are entitled to lesser weight.29
    To the degree Dr. McFarland’s opinion was consistent with the record, the
    Commissioner’s decision adequately takes it into consideration. For example,
    Dr. McFarland opined that Giles has a poor ability to deal with work stress, and
    the vocational expert testified that the recommended alternate jobs were
    appropriate for an employee who could not handle high stress job environments.
    Although ALJ Lindsay concluded that Giles’s mental health limitations
    would not impair her from performing her prior work, the Appeals Council
    reversed that portion of his decision. The Council’s conclusion that Giles could
    perform the alternative jobs listed by ALJ Lindsay, even with her mental
    limitations, is supported by substantial evidence in the record.                    The
    Commissioner’s final decision adequately considered the testimony of treating
    and examining physicians in determining Giles’s mental health limitations.
    29
    See 
    20 C.F.R. § 404.1527
    (d).
    12
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    iii. Physical Limitations
    Giles further claims that ALJ Lindsay’s RFC assessment failed to
    acknowledge the full extent of her reduced physical capacity. Specifically, Giles
    cites to Dr. McFarland’s finding that Giles could only occasionally lift up to 10
    pounds. Dr. McFarland also found that Giles’s condition prohibited her from
    sitting for more than an hour or standing for more than an hour during an eight
    hour work day. ALJ Lindsay, however, concluded that Giles could sit or stand
    for a full eight hours as long as she had the option to alternate between the two
    postures at will. Giles contends that this RFC determination improperly ignored
    Dr. McFarland’s expert opinion.
    While Dr. McFarland’s conclusions are relevant, they are not controlling.
    The record does not reflect why Giles would be limited to the degree asserted by
    Dr. McFarland. Moreover, even if Giles could only occasionally lift up to 10
    pounds, as Dr. McFarland concluded, Giles would still be capable of performing
    two of ALJ Lindsay’s alternative jobs—the telephone information clerk and the
    document preparer—both of which are sedentary positions, requiring lifting of
    no more than ten pounds. Likewise, Dr. McFarland limited Giles to only
    occasional postural maneuvers, and while ALJ Lindsay did not incorporate that
    into his RFC, the vocational expert testified that none of the three recommended
    jobs would be affected if the claimant was limited in that manner. Therefore,
    ALJ Lindsay adequately considered Dr. McFarland’s overall diagnosis, even if
    the ALJ did not follow the precise guidance Dr. McFarland suggested with
    respect to Giles’s RFC limitations.
    C. Claimant’s Credibility
    Giles’s third claim is that ALJ Lindsay’s credibility finding is not based
    upon substantial evidence.     She asserts that ALJ Griswold’s decision was
    remanded in part to address the credibility issue and that ALJ Lindsay failed to
    13
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    follow the Appeals Council instructions. The Appeals Council had remanded so
    the ALJ would “consider the following factors in evaluating the intensity,
    persistence and limiting effects of the alleged symptoms: objective medical
    evidence; medical opinions; prior work record; daily activities; the location,
    duration, frequency and intensity of pain or other symptoms; precipitating and
    aggravating factors; the type, dosage, effectiveness and side effects of
    medication, including headaches and drowsiness; treatment other than
    medication and other measures used to relieve symptoms.”
    ALJ Lindsay noted that he was evaluating the intensity and persistence
    of Giles’s pain based on the medical record. He summarized her full medical
    record and concluded that her statements were not entirely reliable. He did not
    discuss each factor listed by the Appeals Council, but his decision need not do so.
    The Social Security Ruling on credibility determinations denotes the “kinds of
    evidence,” including the above factors, that must be considered, but there is no
    instruction that every factor must be discussed in detail in the determination.30
    Of course the ALJ’s determination decision cannot simply make conclusory
    statements regarding credibility and “must contain specific reasons for the
    finding on credibility, supported by the evidence in the case record,”31 but ALJ
    Lindsay satisfied this burden by discussing the medical record and opinions.
    While the record supports Giles’s assertions regarding her diagnoses, the
    extent of the symptoms she described in the hearing exceed what the record
    supports. For example, Giles testified she has severe migraine headaches two
    to three times a week, while the record only supports that Giles experienced
    30
    Social Security Ruling 96-7p, Titles II and XVI: Evaluation of Symptoms in Disability
    Claims: Assessing the Credibility of an Individual’s Statements, 
    61 Fed. Reg. 34,483
    , 34,485
    (July 2, 1996); see also Clary v. Barnhart, 214 Fed. App’x 479 (5th Cir. 2007) (“The ALJ is not
    required to mechanically follow every guiding regulatory factor in articulating reasons for
    denying claims or weighing credibility.”).
    31
    61 Fed. Reg. at 34,486.
    14
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    intermittent headaches, which diminished in frequency with her seizure
    medication. In short, there is sufficient evidence in the record to support ALJ
    Lindsay’s determination to give the claimant limited credibility.
    Finally, ALJ Lindsay did not ignore Giles’s testimony entirely. He found
    that Giles “has established a lengthy history of complaints of headaches, and it
    is reasonable to conclude that she did experience occasional headaches that,
    alone or in combination with her seizure disorder, depression, and other
    impairments, could have resulted in moderate limitations.” He included these
    limitations in his RFC.
    D. Burden of Proving the Availability of Alternative Work
    At step five in the disability benefits determination, the Commissioner has
    the burden of proof to show that there is other gainful employment the claimant
    is capable of performing in spite of her limitations. Giles first argues that she
    is not capable of performing the cashier II or telephone information clerk jobs
    because she has a moderate limitation in dealing with the public.                         The
    Dictionary of Occupational Titles does not explicitly state that persons with such
    moderate limitations are incapable of performing these jobs.32 Although the
    record suggests that Giles has some limitations in social contexts, there is an
    adequate basis for the ALJ to conclude that Giles could sustain some social
    32
    See D.O.T. 211.462-010 Cashier II (“Receives cash from customers or employees in
    payment for goods or services . . . .”); D.O.T. 237.367-046 Telephone Quotation Clerk (“Answers
    telephone calls from customers requesting current stock quotations . . . .”). The Appellant
    notes that the vocational expert’s citation to D.O.T. 237.367-046 was in error because the
    formal name is Telephone Quotation Clerk, rather than Telephone Information Clerk as stated
    by the vocational expert. Appellant suggests that the vocational expert intended to refer to
    D.O.T. 237.367-022, the listing for information clerk. However, the D.O.T. number originally
    cited by the vocational expert is the proper listing—the alternative name for Telephone
    Quotation Clerk is listed as “Telephone-Information Clerk,” which is distinct from the regular
    information clerk listing.
    15
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    interaction in a work environment.33 The vocational expert testified that Giles
    could perform these tasks, even if she had a moderate limitation in her ability
    to interact with the general public and a marked limitation in dealing with
    detailed instructions.
    To overcome the vocational expert’s testimony, Giles argues that the
    expert did not properly understand the term “moderate.” The ALJ defined
    moderate to mean “that there are more than slight limitations but the person
    can still perform the task satisfactorily.”34 The vocational expert testified that
    a person with moderate limitations in maintaining concentration, carrying out
    detailed instructions, and setting goals independently could perform Giles’s past
    skilled work as well as the recommended unskilled alternate jobs. However, the
    Appeals Council disagreed and found that Giles’s multiple moderate
    impairments prohibited her from performing her prior skilled work.
    Giles asserts that the Appeals Council decision undermines the vocational
    expert’s conclusion because, in order to reach opposing positions about Giles’s
    capacity to perform her prior skilled work, the vocational expert must have
    relied on a different interpretation of multiple “moderate” impairments than the
    Appeals Council endorsed. Given the facts of this case, we do not find this
    argument persuasive. First, the Appeals Council based part of its decision on
    the fact that Giles had not performed her prior job as a computer analyst for long
    enough to retain transferable skills. Second, the vocational expert also testified
    33
    See Carey v. Apfel, 
    230 F.3d 131
    , 146 (5th Cir. 2000) (finding that the ALJ may rely
    on the vocational expert’s testimony if the record reflects an adequate basis for doing so even
    if the vocation expert’s testimony conflicts with the DOT). Further, Giles admits that the third
    alternate job identified by the vocational expert, document preparer, does not require
    significant interaction with the general public.
    34
    In an unpublished opinion, this court affirmed the use of a similar definition for
    “moderate,” which is not defined by the regulations. Cantrell v. McMahon, 227 Fed. App’x 321,
    322 (5th Cir. 2007) (finding the vocational expert understood the degree of limitation at issue
    when the ALJ defined “moderate” to mean “there are some limitations, but the person can still
    perform the task satisfactorily”).
    16
    Case: 10-31006         Document: 00511542858       Page: 17   Date Filed: 07/18/2011
    No. 10-31006
    that a prohibition on high stress environments would prevent the claimant from
    performing the computer analyst position. The ALJ’s RFC denoted that Giles
    could not work in high-stress environments, yet he still included her past prior
    work in his recommendation. The Appeals Council properly reversed this
    portion of his decision. Yet this reversal does not mean that the remainder of
    the vocational expert’s testimony was irrelevant or unpersuasive. The vocational
    expert had a satisfactory understanding of the multiple moderate limitations in
    Giles’s RFC, and both she and the Appeals Council found that Giles could
    adequately perform the alternate unskilled jobs, even with her multiple
    limitations. The Commissioner may rely upon the vocational expert’s testimony
    to satisfy his burden of proof that the claimant is capable of performing alternate
    jobs in the national economy.35
    V. Conclusion
    “Procedural perfection in administrative proceedings is not required. This
    court will not vacate a judgment unless the substantial rights of a party have
    been affected.”36 Giles has noted several occasions where the ALJ did not
    thoroughly address each aspect of the record. Yet when dealing with such an
    extensive and multi-faceted record, there will always be some evidence that is
    not specifically discussed in the Commissioner’s decision. Our review is limited
    to examining whether the decision to deny benefits is supported by substantial
    evidence in the record, and it is here. Likewise, the Commissioner used the
    proper legal standards to evaluate the evidence, and the ALJ adequately
    resolved inconsistencies in the record. The decision below is AFFIRMED.
    35
    See, e.g., Carey, 
    230 F.3d at 145
    .
    36
    Mays v. Bowen, 
    837 F.2d 1362
    , 1364 (5th Cir. 1988) (per curiam); see Anderson v.
    Sullivan, 
    887 F.2d 630
    , 634 (5th Cir. 1989) (quoting Mays).
    17