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Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 

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[DO NOT PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 22-13913

Non-Argument Calendar

____________________

LEE LOWERY, 

Plaintiff-Appellant,

versus

ACTING COMMISIONER, SOCIAL SECURITY

ADMINISTRATION, 

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Northern District of Georgia

D.C. Docket No. 1:21-cv-02420-JEM

____________________

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22-13913 Opinion of the Court 2

Before WILSON, JORDAN, and LUCK, Circuit Judges.

PER CURIAM:

Lee Lowery appeals the district court’s order affirming the 

Social Security Administration’s denial of his claim for disability 

insurance benefits (“DIB”) pursuant to 42 U.S.C. § 1383(c)(3). First, 

Mr. Lowery argues that the administrative law judge (“ALJ”) 

improperly omitted his emotional support dog from her residual 

functional capacity (“RFC”) finding. Second, he contends that the 

ALJ failed to adequately account for a limitation in his treating 

psychologist’s opinion in the RFC because she omitted the 

psychologist’s opinion that he struggles with multi-step directions. 

Third, he asserts that the ALJ erred in finding that he could perform 

light-exertion work despite his limitations. 

For the reasons which follow, we agree with Mr. Lowery on 

the first two points, and reverse and remand for further 

proceedings before the ALJ.

I

Mr. Lowery filed an application for DIB in January of 2017, 

alleging a disability onset of October of 2013, later amended to 

December of 2016. In his initial disability report, he claimed to be 

suffering from PTSD, as well as knee and ear conditions, which 

limited his ability to work since October of 2012. When disability 

examiners denied his application initially and on reconsideration, 

Mr. Lowery requested a hearing before an ALJ.

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The ALJ held a hearing in February of 2019. At the hearing, 

the ALJ acknowledged that Mr. Lowery was accompanied by his 

emotional support dog, Beano. Before the ALJ, Mr. Lowery 

argued that the bilateral degenerative joint disease in his knees and 

his PTSD, stemming from his service in the Gulf War, affected his 

ability to concentrate, get along with others, and hold a full-time 

job. 

The ALJ presented two hypothetical scenarios to the 

vocational expert (“VE”) to assess what jobs Mr. Lowery could 

perform. The VE testified that an individual with Mr. Lowery’s 

physical, psychological, and interpersonal limitations could work 

as an office cleaner, photocopy operator, and garment sorter, for 

which there were 177,000, 45,400 and 28,700 jobs, respectively, in 

the national economy. Next, the ALJ presented the same scenario 

with the additional limitation of requiring a cane to ambulate. The 

VE stated that this individual could work as a photocopy operator 

and as a garment sorter, but not as an office cleaner. 

The ALJ then asked how the need for an emotional support

dog in close proximity to the individual would affect his ability to 

hold a job. The VE said that if an employee needed an emotional 

support dog nearby throughout the workday, the employer might 

have to provide an accommodation if it met the requisite ADA 

standards and if the dog were required for psychiatric reasons. But 

the ALJ did not pose a hypothetical scenario to the VE which 

includes the use of an emotional support dog. 

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In May of 2019, the ALJ issued a decision denying Mr. 

Lowery’s application, concluding that he was not disabled and thus 

did not qualify for DIB. Although the ALJ found that Mr. Lowery 

had three severe impairments (PTSD, major joint dysfunction, and 

obesity), she concluded that he retained the RFC to perform light 

work as set out in 20 C.F.R. § 404.1567(b).

To reach these conclusions, the ALJ relied on and 

summarized Mr. Lowery’s medical treatment records from 2016 to 

2018. The ALJ highlighted the opinion of Dr. John Whitley, PhD, 

a psychologist who evaluated Mr. Lowery in December of 2017, 

and opined that he had moderate difficulties interacting with others 

and would do better with “solitary, simple work with simple 

changes.” The ALJ acknowledged Dr. Whitley’s observation that 

Mr. Lowery would struggle with multi-step and complex 

directions.

The ALJ determined that although Mr. Lowery could not 

perform his past relevant work as a tubing inspector, there were a 

significant number of jobs in the national economy that he could 

perform. In particular, the ALJ concluded that, based on his RFC 

and the VE’s answers to the hypothetical questions, Mr. Lowery 

could work as an office cleaner, a photocopy operator, or a 

garment sorter. Because Mr. Lowery qualified for those 

occupations, which collectively accounted for 251,100 jobs in the 

national economy, he was not disabled for DIB purposes.

The Appeals Council declined to review the ALJ’s decision. 

Mr. Lowery subsequently sought judicial review of the agency’s 

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decision in federal court. The district court affirmed, concluding

that the ALJ’s findings were supported by substantial evidence. Mr. 

Lowery timely appealed.

II

We review de novo the ALJ’s application of legal principles,

and we review the ALJ’s resulting decision “to determine whether 

it is supported by substantial evidence.” Moore v. Barnhart, 405 F.3d 

1208, 1211 (11th Cir. 2005). “Substantial evidence is more than a 

scintilla and is such relevant evidence as a reasonable person would 

accept as adequate to support a conclusion.” Crawford v. Comm’r of 

Soc. Sec. 363 F.3d 1155, 1158 (11th Cir. 2004). We will affirm the 

ALJ’s decision if it is supported by substantial evidence, even if the 

preponderance of evidence weighs against it. See id. at 1158-59. But

we will not “affirm simply because some rationale might have 

supported the ALJ’s conclusion.” Owens v. Heckler, 748 F.2d 1511, 

1516 (11th Cir. 1984).

III

Before addressing in detail Mr. Lowery’s assignment of 

error, we set out some background information about the 

administrative process used to evaluate a DIB claim.

Eligibility for DIB requires that a claimant be disabled. See 

42 U.S.C. § 423(a)(1)(E). A claimant is disabled if he cannot engage 

in substantial gainful activity due to a medically determinable 

impairment expected to last for a continuous period of at least 12 

months. See § 423(d)(1)(A).

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The SSA sets out a five-step, sequential evaluation process 

for determining whether a claimant is disabled for DIB purposes. 

See 20 C.F.R. § 404.1520(a)(2), (4). An ALJ must evaluate whether 

(1) the claimant is presently engaged in substantial gainful activity, 

(2) the claimant has a medically severe impairment, (3) the 

impairment is equivalent to one of those listed in the appendix of 

the relevant disability regulation, (4) the impairment prevents the 

claimant from performing his or her past work, and (5) the claimant 

possesses the RFC to perform other work in the national economy, 

considering their age, education, and work experience. See § 

404.1520(a)(4)(i)–(v). 

Importantly, the claimant bears the burden of proof for the 

first four steps. At step five, the burden temporarily shifts to the 

Commissioner to prove that the claimant will be able to perform 

other jobs in the national economy despite the claimant’s

limitations. See Buckwalter v. Acting Comm’r of Soc. Sec., 5 F.4th 1315 

(11th Cir. 2021).

A

Mr. Lowery first contends that the ALJ erred at step five by 

(1) omitting his need for his emotional support dog, Beano, in his 

RFC, and (2) failing to include his need for Beano in the 

hypothetical questions presented to the VE.

In order to help analyze the step-five requirement—whether 

there are enough jobs in the national economy that the claimant 

can perform—the SSA has created Medical–Vocational Guidelines 

(“the grids”). See 20 C.F.R. § 404.1567. Five degrees of RFC are 

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outlined in the grids by general exertional level: sedentary, light, 

medium, heavy, and very heavy exertion. See 20 C.F.R. § 

404.1569(a). These RFC levels reflect the maximum degree to 

which “an individual is still able to do despite the limitations caused 

by his or her impairments.” Phillips v. Barnhart, 357 F.3d 1232, 1238 

(11th Cir. 2004). If the ALJ finds that a claimant’s exertional 

capacity, education, age, and skills fit precisely within a particular 

grid level, the ALJ may conclude that the claimant is not disabled. 

See Haddock v. Apfel, 196 F.3d 1084, 1088 (10th Cir. 1999).

Exclusive reliance on the grids is not appropriate when a 

claimant “is unable to perform a full range of work at a given 

functional level or when a claimant has non-exertional 

impairments that significantly limit basic work sills.” Walker v. 

Bowen, 826 F.2d 996, 1002–03 (11th Cir. 1987). “When the grids are 

not controlling, the preferred method of demonstrating job 

availability is through expert vocational testimony.” Id. at 1003. 

We have held that where a hypothetical question posed to a 

VE does not comprehensively account for impairments found by 

the ALJ, the VE’s answer does not qualify as substantial evidence 

to support the ALJ’s decision. See Pendley v. Heckler, 767 F.2d 1561, 

1563 (11th Cir. 1985). Here, the ALJ found Mr. Lowery capable of 

light work, but this finding was qualified by many additional 

physical restrictions, including limits on climbing ramps and stairs; 

on understanding and carrying out simple instructions; on 

maintaining concentration, persistence, and pace for more than 

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two-hour periods; on interacting with the public; and on 

performing team-based work. 

After acknowledging that this restrictive RFC precluded Mr. 

Lowery’s return to his past work as a tubing inspector, the ALJ 

determined that based on his RFC and the VE’s answers to the two 

hypothetical questions, Mr. Lowery could work as an office 

cleaner, photocopy operator, or garment sorter. 

In reaching this conclusion, the ALJ failed to account for an 

additional mental restriction that she found qualified Mr. Lowery’s 

RFC: his need for Beano, the emotional support dog that he 

received as part of a clinical study for veterans suffering from 

PTSD. One of the reasons provided by the ALJ for the RFC 

assigned to Mr. Lowery was that Beano was performing his 

intended function: Mr. Lowery “was getting beneficial support 

from his emotional support dog” and it helped mitigate his PTSD 

symptoms.

As a result, the ALJ’s hypotheticals posed to the VE were not 

complete. By failing to include Mr. Lowery’s need for Beano by 

his side during the workday, the factual assumptions underlying 

the hypothetical scenario posed to the VE did not fully account for 

Mr. Lowery’s limitations. Accordingly, we conclude that the ALJ’s 

decision is not supported by substantial evidence.

The district court concluded that the ALJ’s decision was

supported by substantial evidence because it viewed Mr. Lowery’s 

dog as not being medically necessary. This rationale, however, was 

not carried into the ALJ’s findings. The ALJ never excluded Beano 

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from her RFC finding because it was not medically necessary, or 

for any other reason. Instead, the ALJ failed to acknowledge the 

VE’s testimony that the dog “would be considered an 

accommodation,” which only “some employers might consider” 

accommodating. The district court’s rationale was thus a post hoc 

rationalization of the ALJ’s decision, which we cannot affirm. See 

generally S.E.C. v Chenery Corp., 332 U.S. 194, 196 (1947). 

In any event, the reconstructed version of the ALJ’s decision 

ultimately flounders. In evaluating a record for DIB purposes, an 

ALJ may consider, in addition to objective medical evidence, any 

“treatment other than medication” and “any measures that the 

claimant used to relieve his pain or symptoms.” 20 C.F.R. § 

404.1529(c)(3). This is exactly what the ALJ did: she factored Beano 

into Mr. Lowery’s RFC as a measure for him to alleviate his PTSD.

By failing to account for Mr. Lowery’s need for his dog during the 

workday in the RFC and hypotheticals, the ALJ issued a decision 

which lacked substantial evidence. The Commissioner thus failed 

to meet its burden of showing that Mr. Lowery could perform 

other gainful employment in the national economy.

Next we consider whether the ALJ’s error can be deemed 

harmless. As a general proposition, reviewing courts apply the 

harmless error doctrine in reviewing a decision of the 

Commissioner denying a DIB claim. See Diorio v. Heckler, 721 F.2d 

726, 728 (11th Cir. 1983). But reviewing courts will not affirm on 

harmless error grounds “[w]here an insufficient record precludes a 

determination that substantial evidence support[s] the ALJ’s denial 

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of benefits.” Patterson v. Comm’r of Soc. Sec. Admin., 846 F.3d 656, 

658 (4th Cir. 2017).

Assuming that the harmless error doctrine applies in these 

circumstances, we conclude that a remand is required. First, the 

Commissioner waived any harmless error argument by failing to 

present it in her submission to this Court. See United States v. Hall, 

858 F.3d 254, 280 n.8 (4th Cir. 2017) (explaining that the

government may waive a harmless error argument). Second, 

notwithstanding the Commissioner’s waiver, we are unable to 

conclude that the ALJ’s errors are harmless in this case. The 

administrative record does not clearly demonstrate that, needing a 

dog by his side, Mr. Lowery can actually perform the three 

occupations identified by the VE and relied on by the ALJ at step 

five. And we cannot assume that the VE would have answered in 

a similar manner had the ALJ instructed her to consider the added 

limitation of needing an emotional support dog nearby at work. 

Accordingly, a remand is appropriate for the ALJ to properly make 

this factual determination.

B

With respect to his second argument, Mr. Lowery claims 

that the ALJ erred by assigning great weight to Dr. Whitley’s 

opinion—stating that Mr. Lowery struggled with complex and 

multi-step directions—and not including the latter limitation in his 

RFC.

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For claims filed before March 27, 2017—like Mr. Lowery’s—

the ALJ must give a treating physician’s opinion “substantial or 

considerable weight unless there is good cause to discount [it].” 

Simon v. Comm’r of Soc. Sec., 7 F.4th 1094, 1104 (11th Cir. 2021)

(quotation marks omitted). A “treating source” is a physician or 

other medical source who has provided the claimant with medical 

treatment and has, or previously had, an ongoing treatment 

relationship with the claimant. See 20 C.F.R. § 404.1527(a)(2).1

The weight to be given to a physician’s opinion depends on 

several factors, including (1) the length of treatment and frequency 

of evaluation; (2) the nature and extent of the treatment 

relationship; (3) the medical evidence supporting the opinions; 

(4) its consistency with the record as a whole; (5) whether there is 

specialization in the medical area at issue: and (6) any other factors 

tending to support or contradict the opinion. See § 404.1527(c); see 

also Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1260 (11th Cir. 

2019). 

When a VE provides evidence about a job’s requirements, 

the ALJ has an affirmative duty to inquire about any “apparent 

conflicts” between that evidence and information provided in the 

Dictionary of Occupational Titles (“DOT”). See Buckwalter, F.4th 

at 1321. A conflict is apparent if it is “apparent to an ALJ who has 

1 For claims filed on or after March 27, 2017, the SSA does not give “any specific 

evidentiary weight” to any medical opinion. See 20 C.F.R. § 404.1520c. For 

claims filed before March 27, 2017, however, the rule regarding treating 

physicians’ opinions still applies. See § 404.1527. 

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ready access to and a close familiarity with the DOT.” Washington 

v. Comm’r of Soc. Sec., 906 F.3d 1353, 1366 (11th Cir. 2018). If the 

“conflict is reasonably ascertainable or evident,” the ALJ must 

identify it. See id. Apparent means “seeming real or true, but not 

necessarily so.” Id. (quotation marks omitted). Where the VE’s 

evidence is inconsistent with the information in the DOT, the ALJ 

must resolve the conflict before relying on the VE’s evidence to 

support a determination that a claimant is or is not disabled. See 

Buckwalter, 5 F.4th at 1321. According to SSR 00-4P, neither the 

VE’s testimony nor the DOT automatically trumps when the two

conflict. See id. Although SSR 00-4P is not binding on us, the SSA 

is nevertheless bound to follow it. See id.

In Buckwalter, we explained that the difference between jobs 

with level one and level two reasoning is the length of the 

instructions, not their complexity. See id. at 1323. Although level 

one is limited to instructions with only one or two steps, the 

instructions in level two are not limited in length. See id. Simple 

instructions under level one and uninvolved instructions under 

level two are not in conflict because “simple” and “uninvolved” are 

similarly defined. Id.

As noted, if there is an apparent conflict between the RFC 

and requirements for the jobs identified by the ALJ, the ALJ must 

address the conflict. See Viverette v. Comm’r of Soc. Sec., 13 F.4th 

1309, 1317 (11th Cir. 2021). If she fails to address the conflict, then 

the remaining question is whether the failure is harmless. See id. 

In Viverette, we ruled that the ALJ’s failure to address the conflict 

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between the RFC and one of the identified jobs was not harmless. 

See id. at 1318. We noted that the ALJ identified three possible 

occupations that the claimant could perform and cumulatively 

determined that those occupations existed in significant numbers 

in the national economy. See id. Because around eighty percent of 

the named jobs conflicted with the RFC, we could not conclude 

that the error was harmless. See id. at 1318.

As an initial matter, the ALJ properly assigned great weight 

to Dr. Whitley’s opinion. Because Mr. Lowery filed his DIB claim 

in January of 2017, Dr. Whitley’s opinion was still subject to the 

treating physician rule. See Simon, 7 F.4th at 1104. But the ALJ is 

not required to refer to every piece of evidence provided by a 

claimant in a decision, so long as the decision does not broadly 

reject the claimant’s position or disregard the claimant’s whole 

medical condition. See Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th 

Cir. 2005). 

Turning to Mr. Lowery’s claim, the ALJ failed to address an 

apparent conflict between Lowery’s RFC and the requirements of 

the garment sorter and photocopy operator jobs. Dr. Whitley

opined that Mr. Lowery would struggle with multi-step directions. 

Yet, an individual working as a photocopy operator or garment 

sorter must be able to carry out detailed but uninvolved 

instructions and level two reasoning. See DOT §§ 207.685-014, 

222.687-014. As we held in Buckwalter, 5 F.4th at 1321, jobs 

requiring level two reasoning do not possess a limit in the length 

of instructions. This conflicts with Dr. Whitley’s opinion—to 

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which the ALJ assigned great weight—that Mr. Lowery would 

struggle with multi-step directions. As a result, the ALJ based her 

finding of fact on the VE’s testimony about a total number of 

251,100 jobs, without considering an apparent conflict that affected 

74,100 of those jobs. 

Although the number of jobs generally available to Mr. 

Lowery is greater than that available to the claimant in Viverette, 

we remain hesitant to make any factual determinations ourselves. 

“[W]here additional (or more specific) agency fact-finding is 

needed, remand is the appropriate disposition.” Viverette, 13 F.4th

at 1318. Because the ALJ did not find that the remaining office 

cleaner jobs alone exist in significant numbers and, again, because 

the Commissioner has waived any harmless error argument, we 

decline to determine this question ourselves.

C

We turn to Mr. Lowery’s third and final argument, which is 

that the ALJ’s RFC finding does not reasonably account for 

Lowery’s cane, knee brace, shoe lift, or obesity. Five degrees of 

RFC are outlined in the grids by general exertional level: sedentary, 

light, medium, heavy, and very heavy exertion. See 20 C.F.R. § 

404.1569(a). 

“The ALJ has a basic obligation to develop a full and fair 

record.” Welch v. Brown, 854 F.2d 436, 440 (11th Cir. 1988). This 

obligation ensures that the ALJ fulfills her duty and allows us to 

determine whether the ALJ’s findings are supported by substantial 

evidence. See id. 

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Here, there is substantial evidence in the record to support 

the ALJ’s finding that Mr. Lowery could perform light work 

because his medical records stated that his knee pain was managed 

through medication and physical therapy, his pain diminished after 

he warmed up, his knee brace and shoe lift helped him walk better, 

and he primarily used his cane in the mornings. Accordingly, the 

ALJ adequately considered Mr. Lowery’s knee condition and his 

various ambulatory devices and determined that he could perform 

light work.

IV

The judgment of the district court is reversed and the matter 

is remanded with instructions to remand to the Commissioner for 

further proceedings before the ALJ.

AFFIRMED IN PART; REVERSED AND REMANDED IN 

PART.

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