1

 The Honorable Jerry W. Cavaneau, United States Magistrate Judge for the

Eastern District of Arkansas.

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

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No. 06-2142

___________

Sharon Travis, *

*

Plaintiff – Appellant, *

* Appeal from the United States

v. * District Court for the

* Eastern District of Arkansas.

Michael J. Astrue, Commissioner, *

Social Security Administration, *

*

Defendant – Appellee. *

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Submitted: November 16, 2006

Filed: February 28, 2007

___________

Before MURPHY, ARNOLD, and BENTON, Circuit Judges.

___________

BENTON, Circuit Judge.

Sharon Y. Travis appeals the dismissal of her disability-insurance and

supplemental-security-income claims. The district court1

 dismissed for lack of subject

matter jurisdiction or, alternatively, on the merits. Having authority under 28 U.S.C.

§ 1291, this court affirms on the merits.
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I.

In 1995, Travis applied for disability-insurance benefits and supplementalsecurity income under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 423,

1382(c). She alleged inability to work beginning November 14, 1994, due to high

blood pressure, diabetes, arthritis, kidney problems, back problems, memory lapses,

a nervous condition, and the need for oral surgery. Her application was denied

initially and upon reconsideration. After a hearing, the ALJ denied her application,

finding she could return to past work. 

Travis requested review by the appeals council, submitting additional evidence.

The council remanded for review. After a second hearing, the ALJ again found that

Travis could return to past work. The council denied her request for review. 

Travis then sought judicial review by the district court. In April 2000, on the

Commissioner's motion, the district court remanded back to the council for

consideration of additional evidence on mental impairments. The council then

remanded the case to the ALJ.

Travis filed a second application for benefits in February 1998, alleging

disability as of July 9, 1997, based on high blood pressure, diabetes, arthritis, irritable

bowel syndrome, Alzheimer's disease, depression, hypothyroidism, obesity, and

problems with her memory and kidneys. Her claims were granted upon initial review,

but with an onset date of May 20, 1999. 

Travis then filed a third application in January 2000, re-alleging an onset date

of July 9, 1997. A hearing was held before the ALJ in October 2000, on her first and

third applications, pursuant to the district court's April 2000 remand. The ALJ

determined that Travis was not disabled from November 14, 1994 (the date claimed

in her first application) to May 20, 1999 (the onset date granted in her second
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application). The ALJ concluded that she could return to her past work as a cashier.

Travis appealed to the district court.

The district court dismissed the complaint, without prejudice, for lack of subject

matter jurisdiction or, alternatively, on the merits. Travis appeals, claiming the district

court had jurisdiction to review the Commissioner's denial of her claims, and that the

Commissioner's decision is not supported by substantial evidence.

II.

The district court ruled that it lacked subject matter jurisdiction because Travis

failed to exhaust her administrative remedies by not seeking review by the council on

her first and third applications. Both Travis and the government agree that the district

court maintained subject matter jurisdiction.

The "exclusive methods" for district courts to remand to the Commissioner are

in sentences four and six of 42 U.S.C. § 405(g). Pottsmith v. Barnhart, 306 F.3d 526,

527 (8th Cir. 2002), quoting Shalala v. Schaefer, 509 U.S. 292, 296 (1993).

Sentences four and six provide:

[4] The [district] court shall have power to enter, upon the pleadings and

transcript of the record, a judgment affirming, modifying, or reversing

the decision of the Commissioner of Social Security, with or without

remanding the cause for a rehearing.

. . . . [6] The [district] court may, on motion of the Commissioner of

Social Security made for good cause shown before the Commissioner

files the Commissioner's answer, remand the case to the Commissioner

of Social Security for further action by the Commissioner of Social

Security, and it may at any time order additional evidence to be taken

before the Commissioner of Social Security, but only upon a showing

that there is new evidence which is material and that there is good cause

for the failure to incorporate such evidence into the record in a prior

proceeding; and the Commissioner of Social Security shall, after the case
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is remanded, and after hearing such additional evidence if so ordered,

modify or affirm the Commissioner's findings of fact or the

Commissioner's decision, or both, and shall file with the court any such

additional and modified findings of fact and decision, and a transcript of

the additional record and testimony upon which the Commissioner's

action in modifying or affirming was based.

42 U.S.C. § 405(g).

 Remand under sentence four terminates the court's jurisdiction, while remand

under sentence six does not. See Schaefer, 509 U.S. at 301. Under sentence six, "the

district court does not affirm, modify, or reverse the Secretary's decision; it does not

rule in any way as to the correctness of the administrative determination." Melkonyan

v. Sullivan, 501 U.S. 89, 98 (1991). 

The motion to remand here requested a "sentence four remand" to "further

evaluate Plaintiff's possible mental impairment, to include a mental status consultative

examination with psychological testing to assist in delineating the nature and severity

of said impairment." In its order, the district court found that "if remand is to be

granted, it should come under sentence six" because "the Court is not making any

ruling based on the correctness of the Commissioner's decision." The district court

ordered a "sentence six remand."

As the district court did not affirm, modify, or reverse the Commissioner's

decision and instead granted a “sentence six remand,” the court retained subject matter

jurisdiction, and thus improperly dismissed her case on those grounds .
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III.

This court reviews de novo a district court's decision to uphold the ALJ's denial

of benefits. Hacker v. Barnhart, 459 F.3d 934, 936 (8th Cir. 2006); Maresh v.

Barnhart, 438 F.3d 897, 898 (8th Cir. 2006). This court decides "whether the

Commissioner's findings are supported by substantial evidence on the record as a

whole." Dunahoo v. Apfel, 241 F.3d 1033, 1037 (8th Cir. 2001). Substantial

evidence is "less than a preponderance," but "enough that a reasonable mind would

find it adequate to support the Commissioner's conclusions." Id., quoting Prosch v.

Apfel, 201 F.3d 1010, 1012 (8th Cir. 2000); McKinney v. Apfel, 228 F.3d 860, 863

(8th Cir. 2000); Reutter v. Barnhart, 372 F.3d 946, 950 (8th Cir. 2004). In

determining whether there is substantial evidence on the record to support the

Commissioner's decision, this court considers "evidence that detracts from the

Commissioner's decision as well as evidence that supports it." Singh v. Apfel, 222

F.3d 448, 451 (8th Cir. 2000), quoting Warburton v. Apfel, 188 F.3d 1047, 1050 (8th

Cir. 1999). If substantial evidence supports the Commissioner's conclusions, this

court does not reverse even if it would reach a different conclusion, or merely because

substantial evidence also supports the contrary outcome. See Reutter, 372 F.3d at

950. 

A.

Travis contends that the ALJ’s determination that she was "not disabled" from

1994 to 1999 is not supported by substantial evidence on the record as a whole. She

argues that (1) the ALJ improperly discounted the opinions of her doctors, (2) the ALJ

improperly discounted her subjective complaints, and (3) the vocational expert's

response did not support the ALJ's conclusion.

A disability is "the inability to engage in any substantial gainful activity by

reason of any medically determinable physical or mental impairment which can be
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expected to result in death or which has lasted or can be expected to last for a

continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A). To

determine disability, the ALJ followed the five-step process, considering whether: (1)

Travis was employed; (2) she was severely impaired; (3) her impairment was, or was

comparable to, a listed impairment; (4) she could perform past relevant work; and if

not, (5) whether Travis could perform any other kind of work. See 20 C.F.R. §

404.1520(a)(4); 20 C.F.R. § 416.920(a); Hacker, 459 F.3d at 936, quoting Cox v.

Barnhart, 345 F.3d 606, 608 n.1 (8th Cir. 2003).

If the ALJ "cannot make a determination or decision at the first three steps of

the sequential evaluation process, [it] will compare [the] residual functional capacity

assessment . . . with the physical and mental demands of past relevant work." 20

C.F.R. § 404.1520(f); 20 C.F.R. § 416.920(f). If the claimant can still perform that

work, the claimant is not disabled. Id. 

The ALJ found that Travis was not disabled at the fourth step – holding that she

had the residual functional capacity (RFC) to perform her past work as a cashier.

"Residual functional capacity is what a claimant can do despite her limitations, and

it must be determined on the basis of all relevant evidence, including medical records,

physician's opinions, and claimant's description of her limitations." Dunahoo, 241

F.3d at 1039. The ALJ concluded that Travis had RFC to perform the demands of

light work. Travis argues that the Commissioner mischaracterized her RFC,

erroneously finding she could return to past relevant work, by discounting the

opinions of her doctors and her subjective complaints, and by relying on vocational

expert testimony that was inconsistent.

B.

Travis's medical record includes reports from several physicians, including Drs.

Fowler, Hollis, Lyon, and Chan. In August 1996, Dr. Fowler diagnosed Travis with
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pre-senile dementia, Alzheimer's type, with depressed mood. In December 1996, he

indicated that she was disabled from her condition. In a letter of December 1998, he

stated, "Because of her illness, she is disabled to work at any job." 

Dr. Hollis was treating Travis as early as February 1996. In a March 1998

letter, he opined that Travis "would not be able to hold down a job in a productive

manner including driving a truck." In January 1999, he restated her multiple chronic

medical problems and reiterated his opinion that Travis could not work. Travis

contends that the ALJ did not give the opinions of Drs. Fowler and Hollis the

appropriate weight.

The ALJ is required to assess the record as a whole to determine whether

treating physicians' opinions are inconsistent with substantial evidence on the record.

20 C.F.R. § 404.1527(d)(2). "A treating physician's opinion is generally given

controlling weight, but is not inherently entitled to it." Hacker, 459 F.3d at 937. See

20 C.F.R. § 404.1527(d)(2). An ALJ may elect under certain circumstances not to

give controlling weight to treating doctors opinions. A physician's statement that is

"not supported by diagnoses based on objective evidence" will not support a finding

of disability. Edwards v. Barnhart, 314 F.3d 964, 967 (8th Cir. 2003). If the doctor’s

opinion is "inconsistent with or contrary to the medical evidence as a whole, the ALJ

can accord it less weight." Id.; see also Hacker, 459 F.3d at 937; 20 C.F.R. §

404.1527(d)(2). It is the ALJ's duty to resolve conflicts in the evidence. See Hacker,

459 F.3d at 936. 

While recognizing the "considerable" weight given the opinion of treating

physicians, the ALJ found that their opinions were inconsistent with the record as a

whole. In a March 1998 letter, Dr. Hollis wrote that Travis could not hold down a job

in a productive manner, but two months later wrote that she "feels great." The ALJ

noted that in 1996 Dr. Fowler wrote that Travis stopped driving a truck when she and

her husband went bankrupt and that Travis had "no impairment of intellectual
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functioning." Her treatment from Dr. Fowler included supportive and cognitive

therapy, which requires she intellectually participate in the therapy. The ALJ found

that Dr. Lyon's conclusion that Travis had moderate to severe depression, beginning

stages of a global dementia syndrome, and possible Alzheimer's disease "were

inconsistent" with "all the other evidence on the record." Dr. Chan determined Travis

suffered from "possible dementia" and "very marked impairment" in memory, but his

"dementia lab workup" was normal. 

Travis argues that a one-time medical evaluation does not provide substantial

evidence for the ALJ's decision. See Cox v. Barnhart, 345 F.3d 606, 610 (8th Cir.

2003). Here, however, the ALJ's determination to grant Travis's treating physicians'

opinions less weight is supported by more than a one-time medical evaluation and is

supported by medical evidence. This court will not reverse merely because evidence

also points to an alternate outcome. See Reutter, 372 F.3d at 950. As there is

conflicting evidence on the record, the ALJ's determination that the physicians'

opinions were not supported by objective medical evidence does not lie outside the

available zone of choice. See Hacker, 459 F.3d at 938. 

C.

Travis asserts that the ALJ improperly discounted her subjective complaints.

A claimant's complaints of pain or symptoms "shall not alone be conclusive evidence

of disability . . . there must be medical signs and findings, established by medically

acceptable clinical or laboratory diagnostic techniques." 42 U.S.C. § 423(d)(5)(A).

An ALJ may not disregard subjective complaints merely because there is no evidence

to support the complaints, but may disbelieve subjective reports because of "inherent

inconsistencies or other circumstances." Eichelberger v. Barnhart, 390 F.3d 584, 589

(8th Cir. 2004). 
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Little medical evidence supports her allegations of pain. However, "the absence

of an objective medical basis which supports the . . . subjective complaints is just one

factor to be considered in evaluating the credibility of the . . . complaints." Polaski

v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984). The ALJ must also consider (1) the

claimant’s daily activities, (2) the duration, frequency and intensity of pain, (3)

precipitating and aggravating factors, (4) dosage, effectiveness and side effects of

medication, (5) and functional restrictions. Id. The ALJ need only acknowledge and

consider the factors, not explicitly discuss each one. Eichelberger, 390 F.3d at 590.

Here, applying the Polaski factors, the ALJ acknowledged Travis's complaints,

but concluded she could perform light, nonstressful physical or mental tasks. The ALJ

noted that Travis maintained her Class "C" commercial driver’s license, and that her

husband admitted she could manage professional driving close to home in 1997. She

continued to do laundry, some housework, cooking and shopping, and sought and

gained custody of her twin granddaughters. Travis counters that her driver's license

was automatically renewed, she did not perform household activities, she only

shopped for a short period of time, and she had to give up custody of her

grandchildren in 1997. The ALJ determined that the record as a whole does not

support Travis's allegations of pain that is constant, unremitting, or disabling. Where

there are two inconsistent reports, with one supporting the ALJ's determination, this

court must affirm the ALJ's denial of benefits. See Eichelberger, 390 F.3d at 589.

This court will not substitute its opinion for the ALJ’s, who is in a better position to

gauge credibility and resolve conflicts in evidence. See id.; Hacker, 459 F.3d at 936.

D.

Determining that Travis was not disabled at the fourth step, the ALJ relied on

vocational expert testimony that Travis could perform her past work as a cashier.
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Travis objects that the expert's response does not support the ALJ's finding that she

could return to her past work as a cashier. 

Responding to a question approximating Travis’s case, the vocational expert

testified that Travis could perform her past duties as a cashier. In a follow-up question

to a second hypothetical, the ALJ asked, "Would the fact that she had a poor ability

to follow work rules . . . affect [her ability to perform the job of a cashier]?" The

expert stated "normally I would say yes except she has fair ability to follow simple

instructions and it's an unskilled job." He then stated that the job would require a

"level of attention and concentration . . . . I guess there could be an issue there if that

in and of itself would be enough to keep a person from performing that job." 

Travis contends that the response was equivocal, undermining the ALJ's

finding. An ALJ's reliance on a vocational expert's testimony is improper if the expert

substantially changes the hypothetical beyond the ALJ's instructions. See Penn v.

Sullivan, 896 F.2d 313, 317 (8th Cir. 1990). Here, however, the vocational expert

stated his opinion and then raised an issue for the ALJ's consideration. The expert did

not change the hypothetical question or rely on criteria not mentioned by the ALJ. As

the ALJ did not find that Travis suffered those attention and concentration limits, the

expert's equivocal response does not contradict his prior response to the ALJ's

hypothetical question. Cf. Clay v. Barnhart, 417 F.3d 922, 931 (8th Cir. 2005) (the

ALJ did not err in omitting additional restrictions not supported by evidence).
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According to the vocational expert, the physical and mental demands of a

cashier are limited and do not entail duties beyond light exertion. There is substantial

evidence to support the ALJ's decision that Travis had the RFC to return to past work.

IV.

The judgment of the district court is affirmed.

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