UNITED STATES COURT OF APPEALS 

FOR THE TENTH CIRCUIT 

_________________________________ 

PAULA J. CRAMPTON, 

 Plaintiff - Appellant, 

v. 

COMMISSIONER, SSA, 

 Defendant - Appellee. 

No. 18-5075 

(D.C. No. 4:17-CV-00074-GBC) 

(N.D. Okla.) 

_________________________________ 

ORDER AND JUDGMENT*

_________________________________ 

Before HARTZ, MATHESON, and CARSON, Circuit Judges. 

_________________________________ 

Paula J. Crampton, formerly known as Paula Jo Sams, applied for disability 

insurance benefits (DIB) and supplemental security income (SSI). The 

Commissioner of the Social Security Administration (SSA) denied her application, 

and the district court affirmed the denial of benefits. Exercising jurisdiction under 

28 U.S.C. § 1291 and 42 U.S.C. § 405(g), we affirm. 

 * After examining the briefs and appellate record, this panel has determined 

unanimously that oral argument would not materially assist in the determination of 

this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is therefore 

ordered submitted without oral argument. This order and judgment is not binding 

precedent, except under the doctrines of law of the case, res judicata, and collateral 

estoppel. It may be cited, however, for its persuasive value consistent with 

Fed. R. App. P. 32.1 and 10th Cir. R. 32.1. 

FILED 

United States Court of Appeals 

Tenth Circuit 

July 11, 2019

Elisabeth A. Shumaker 

Clerk of Court
2 

I. BACKGROUND 

Ms. Crampton was employed as a nurse until May 2009. She asserts that she 

has been unable to work since August 9, 2011, due to health problems. Ms. Crampton 

filed for DIB and SSI in 2013 and 2014, respectively, at the age of 39. She alleged the 

following physical and mental impairments: degenerative disc disease and issues with 

her lumbar and cervical spine, bone spurs, shoulder and neck pain, migraine headaches, 

left arm and elbow pain, knee pain and swelling, ankle swelling, numbness in her hands 

and fingers, asthma, obesity, and anxiety and depression. 

 In evaluating her application for benefits, the Administrative Law Judge (ALJ) 

and the district court painstakingly recounted Ms. Crampton’s medical history and 

treatment for the relevant time period, 2011 to 2015, see R., Vol. 1 at 15-23, 913-19.1

 

We incorporate those accounts herein. 

Three doctors assessed Ms. Crampton’s physical limitations: (1) Benjamin 

Roberts, D.O., an agency doctor who performed a consultative examination on August 

30, 2014; (2) Karl K. Boatman, M.D., an agency doctor who reviewed Ms. Crampton’s 

medical records and rendered an opinion on September 9, 2014, that she can perform 

light work; and (3) Brent W. Laughlin, M.D., a treating physician and primary care 

provider who completed a medical source statement during an office visit on October 8, 

2015. Drs. Boatman and Laughlin also opined about Ms. Crampton’s ability to work 

 1

 Some of the pages in the record contain two different page numbers. We 

refer to the smaller numbers on the bottom right. 
3 

given her physical limitations. We incorporate the district court’s careful summaries of 

these opinions as well. See id. at 919-21. 

The Commissioner denied Ms. Crampton’s application for benefits, both 

initially and on reconsideration. Ms. Crampton then obtained a hearing before an ALJ, 

at which both she and a vocational expert testified. The ALJ issued a written decision 

in November 2015. He applied the familiar five-step sequential evaluation process used 

to assess social security claims, see 20 C.F.R. § 404.1520(a)(4), and found that 

Ms. Crampton was not disabled during the relevant time period. 

At step one, the ALJ stated that Ms. Crampton has not engaged in substantial 

gainful activity since August 9, 2011, her alleged onset date. The ALJ then found the 

following severe impairments at step two: “Degenerative Disc Disease lumbar and 

cervical spine post 2011 lumbar fusion, migraine headaches, asthma, knee pain primarily 

left post surgery, left elbow and shoulder pain post-surgery, obesity, anxiety and 

depression.” R., Vol. 1 at 12. At step three, the ALJ concluded these impairments are 

not presumptively disabling. 

At step four, the ALJ found Ms. Crampton has the following residual functional 

capacity (RFC): 

[T]he claimant has the [RFC] to perform a full range of 

sedentary work . . . except as follows: Stooping and 

crouching can be done only occasionally. No overhead 

reaching left side. Handling and fingering limited to frequent. 

Avoid exposure to concentrated levels of fumes, dusts, 

gasses, odors, poor ventilation, or other respiratory irritants. . 

. . 
4 

Due to mental impairments, claimant can understand, 

remember, and carryout simple or intermediate level 

instructions, and perform simple and some tasks of 

intermediate level difficulty under routine supervision, such 

that she is capable of doing simple or at most semi-skilled 

work. Claimant can relate to supervisors and coworkers on a 

superficial and work related basis, and can adapt to a work 

situation. Occasional incidental contact with the public is 

allowed. 

Id. at 14-15. Applying these limitations, the ALJ determined that Ms. Crampton cannot 

return to her past relevant work as a highly skilled nurse. 

Finally, at step five, the ALJ considered Ms. Crampton’s age, education, work 

experience, and RFC and found she can perform unskilled, sedentary jobs existing in 

significant numbers in the national economy—namely, clerical mailer, assembler, and 

stuffer. Because Ms. Crampton can adjust to other work, the ALJ did not deem her to be 

disabled under the SSA. 

The SSA’s Appeals Council denied Ms. Crampton’s request for review, making 

the ALJ’s determination the final decision for purposes of judicial review. See Krauser v. 

Astrue, 638 F.3d 1324, 1327 (10th Cir. 2011). The district court affirmed the ALJ’s 

decision.2

 Ms. Crampton filed this timely appeal. 

II. DISCUSSION 

A. Standard of Review 

We review de novo the district court’s ruling in a social security case and 

“independently determine whether the ALJ’s decision is free from legal error and 

 2

 The parties agreed to proceed before a magistrate judge under 28 U.S.C. 

§ 636(c). 
5 

supported by substantial evidence.” Wall v. Astrue, 561 F.3d 1048, 1052 

(10th Cir. 2009) (internal quotation marks omitted). “Substantial evidence is such 

relevant evidence as a reasonable mind might accept as adequate to support a 

conclusion.” Id. (internal quotation marks omitted). “In reviewing the ALJ’s 

decision, we neither reweigh the evidence nor substitute our judgment for that of the 

agency.” Vigil v. Colvin, 805 F.3d 1199, 1201 (10th Cir. 2015) (internal quotation 

marks omitted). 

B. Preservation of Issues for Appeal 

Although Ms. Crampton was represented by counsel through the district court 

proceedings, she is now proceeding pro se. Because Ms. Crampton appears pro se, 

we afford her filings a liberal construction. See Garza v. Davis, 596 F.3d 1198, 1201 

n.2 (10th Cir. 2010). Even so, we “cannot take on the responsibility of serving as 

[her] attorney in constructing arguments and searching the record.” Garrett v. Selby 

Connor Maddux & Janer, 425 F.3d 836, 840 (10th Cir. 2005). 

Ms. Crampton’s arguments on appeal are difficult to follow because she does 

not comply with Federal Rule of Appellate Procedure 28, which requires an 

appellant’s opening brief to “contain . . . appellant’s contentions and the reasons for 

them, with citations to the authorities and parts of the record on which the appellant 

relies.” Fed. R. App. P. 28(a)(8)(A). She seems to make two separate arguments: 

(1) she was brought up “to smile [her] way through [her] pain” and not to complain, 

Aplt. Opening Br. at 3, so it was unfair for the ALJ to focus on her external 

appearance while ignoring her subjective complaints of disabling symptoms; and 
6 

(2) the ALJ did not give appropriate weight to the opinion of her treating physician, 

Dr. Laughlin. 

Only the second argument is properly before us because the sole error that 

Ms. Crampton identified in district court was the ALJ’s “fail[ure] to properly 

consider the opinion of the treating physician.” R., Vol. 1 at 895. This court will 

“consider issues not raised or argued in the district court only in the most unusual 

circumstances, which may include issues regarding jurisdiction and sovereign 

immunity, instances where public interest is implicated, or where manifest injustice 

would result,” Bylin v. Billings, 568 F.3d 1224, 1231 (10th Cir. 2009) (internal 

quotation marks omitted). Not one of those circumstances is present here, and 

Ms. Crampton has not offered a compelling reason to excuse her failure to raise the 

first issue before the district court. She makes only generalized statements about 

ineffective assistance of counsel. 

C. Weight Assigned to Treating Physician’s Opinion 

We turn to Ms. Crampton’s argument that the ALJ failed to give the opinion of 

her treating physician, Dr. Laughlin, “proper weight.” Aplt. Opening Br. at 4; see also

Aplt. Reply Br. at 8 (“While the ALJ may have followed the five step sequential 

evaluation for assessing disability, I do not believe he gave the proper weight to . . . Dr. 

Laughlin’s medical opinion.”). She states generally that the ALJ should not have 

“discredited a [doctor] who treated [her] for over 10 years,” Aplt. Opening Br. at 4, and 
7 

“given more weight to Dr. Boatman’s findings after just one visit,” Aplt. Reply Br. at 

12.3

 For the reasons that follow, this argument is not persuasive.

1. Dr. Laughlin’s Opinion 

We start by examining the substance of Dr. Laughlin’s opinion. On October 8, 

2015, he completed a medical source statement regarding Ms. Crampton’s ability to do 

physical work-related activities. See R., Vol. 1 at 873-76. It is unclear whether he 

understood the evaluation would be used for social security purposes, as his treatment 

notes for that day reference the “FMLA” (the acronym for the Family and Medical 

Leave Act) as the “[c]hief [c]omplaint,” id. at 869. 

Dr. Laughlin opined that Ms. Crampton did not have mental limitations, but his 

opinion included the following physical limitations: 

 Ms. Crampton can occasionally lift and/or carry less than ten pounds; 

 she can stand and/or walk less than two hours in an eight-hour workday 

because standing more than ten minutes exacerbates her back pain; 

 she must periodically alternate between sitting and standing to relieve pain or 

discomfort; 

 she is limited in pushing and pulling due to problems with her left shoulder and 

left knee; 

 although she can frequently feel and finger, she can only occasionally reach in 

all directions and handle due to shoulder bursitis and carpal tunnel syndrome; 

 she can occasionally balance and stoop but can never climb, kneel, crouch, or 

crawl due to aggravation of the low back and knee pain; 

 3

 Ms. Crampton seems to be confusing Dr. Boatman (who reviewed her medical 

records) with Dr. Roberts (who conducted a consultative examination). 
8 

 her ability to maintain attention and concentration on work tasks throughout an 

eight-hour day is significantly compromised because she takes narcotic 

medications; 

 she should limit exposure to hazards because her balance is affected by her 

back and knee and she could fall; and 

 she should limit exposure to dust, humidity and wetness, fumes, odors, 

chemicals, and gases due to her asthma. 

In formulating these limitations, Dr. Laughlin relied on Ms. Crampton’s decreased range 

of motion, observed pain, and evidence of previous surgery. 

2. Background Law 

A treating physician’s opinion usually receives more weight than other 

physicians’ opinions “since these sources are likely to be the medical professionals 

most able to provide a detailed, longitudinal picture of [the claimant’s] medical 

impairment(s) and may bring a unique perspective to the medical evidence.” 

20 C.F.R. § 404.1527(c)(2). But this is not always the case. 

In evaluating a treating physician’s opinion, “the ALJ must complete a 

sequential two-step inquiry, each step of which is analytically distinct.” Krauser, 

638 F.3d at 1330. First, the ALJ must consider whether the opinion is entitled to 

controlling weight. A treating physician’s opinion is entitled to controlling weight if 

it is both “well-supported by medically acceptable clinical or laboratory diagnostic 

techniques” and “[]consistent with other substantial evidence in the record.” Id.; 

accord 20 C.F.R. § 404.1527(c)(2). An ALJ may discount the opinion if it is 

inconsistent with the weight of the evidence or if it assesses restrictions without 

explanation or support. See, e.g., Allman v. Colvin, 813 F.3d 1326, 1332 
9 

(10th Cir. 2016) (inconsistent with record); White v. Barnhart, 287 F.3d 903, 907-08 

(10th Cir. 2002) (no explanation for new restrictions). 

Second, if the opinion is not entitled to controlling weight, “the ALJ must 

make clear how much weight the opinion is being given (including whether it is 

being rejected outright) and give good reasons, tied to the factors specified in 

[20 C.F.R. §§ 404.1527 and 416.927] . . . for the weight assigned.” Krauser, 

638 F.3d at 1330. Those factors are: 

(1) the length of the treatment relationship and the frequency 

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

relationship, including the treatment provided and the kind of 

examination or testing performed; (3) the degree to which the 

physician’s opinion is supported by relevant evidence; 

(4) consistency between the opinion and the record as a 

whole; (5) whether or not the physician is a specialist in the 

area upon which an opinion is rendered; and (6) other factors 

brought to the ALJ’s attention which tend to support or 

contradict the opinion. 

Id. at 1331 (internal quotation marks omitted). The ALJ need not explicitly discuss 

all six factors if he otherwise provides good reasons for the weight given to the 

treating source’s opinion—e.g., if he cites contrary, well-supported medical evidence 

and shows the treating source “did not have the opportunity to see or did not give 

weight to contrary evidence showing the [claimant’s] greater functional capacity.” 

Oldham v. Astrue, 509 F.3d 1254, 1258 (10th Cir. 2007). 

3. Analysis 

In determining Ms. Crampton’s RFC, the ALJ afforded “little weight” to 

Dr. Laughlin’s opinion, R., Vol. 1 at 21. The ALJ characterized Dr. Laughlin’s opinion 
10 

as “inconsistent with the other evidence of record” and found that “the limitations 

provided by Dr. Laughlin are extreme and not supported by the overall evidence of 

record.” Id. He provided numerous examples, including Ms. Crampton’s improved 

condition at appointments with Tulsa Pain Consultants on May 18, 2015, and June 15, 

2015; an internal inconsistency within Dr. Laughlin’s own opinion; results in the 

normal range at the examination by Dr. Roberts and at earlier appointments with other 

doctors; an evaluation by Eric Edgar, M.D., at Neurology L.L.P.C., who concluded that 

Ms. Crampton was exaggerating her symptoms; and Ms. Crampton’s own inconsistent 

statements. 

For substantially the same reasons set forth in the district court’s order, see R., 

Vol. 1 at 926-28, we agree that substantial evidence supports the ALJ’s allocation of 

“light weight” to Dr. Laughlin’s medical opinion and his reliance on Dr. Boatman’s 

opinion. The ALJ discussed the totality of the medical record and gave “good 

reasons” why Dr. Laughlin’s opinion was inconsistent with that record. See id. at 

1330; see also Haga v. Astrue, 482 F.3d 1205, 1208 (10th Cir. 2007) (acknowledging 

that “the ALJ is entitled to resolve any conflicts in the record”). He also carefully 

explained why he relied on Dr. Boatman’s opinion “to the extent it stands for the 

proposition that claimant is capable of at least sedentary work” yet also “provided 

some additional limitation[s] based on more recent medical records,” R., Vol. 1 at 24. 

Of the opinions rendered, Dr. Boatman’s was the most comprehensive. 

Dr. Boatman also reviewed Dr. Roberts’ report, Dr. Laughlin’s medical records, 

and the medical records of several specialists (including James L. Griffin, M.D., and 
11 

Antoine I. Jabbour, M.D., at Tulsa Bone and Joint and Andrew F. Revelis, M.D., Martin 

L. Martucci, M.D., and Brad Helton, PA-C, at Tulsa Pain Consultants). Moreover, as 

the district court explained, Ms. Crampton did not present any evidence that she 

experienced a significant deterioration of symptoms after Dr. Boatman rendered his 

opinion. See id. at 927-28.4

 

III.CONCLUSION

The ALJ’s decision to give the treating physician’s opinion little weight was 

supported by substantial evidence. We affirm the district court’s order upholding the 

Commissioner’s denial of benefits. 

Entered for the Court 

Scott M. Matheson, Jr. 

Circuit Judge 

 4

 In challenging the ALJ’s assessment of the medical opinions, Ms. Crampton 

disagrees with certain statements in the doctors’ reports (e.g., that she had been on a 

cruise). But the ALJ relied on the record presented to him, and Ms. Crampton had the 

opportunity to contest the reports in the administrative proceedings. Moreover, even if 

we could accept the alleged discrepancies in her favor, “no reasonable administrative 

factfinder, following the correct analysis, could have resolved the factual matter in any 

other way.” Allen v. Barnhart, 357 F.3d 1140, 1145 (10th Cir. 2004). Ms. Crampton 

also provides details about what tasks and activities she is currently capable of 

performing, but we cannot consider new evidence on appeal. See Selman v. Califano, 

619 F.2d 881, 884-85 (10th Cir. 1980) (“We must decide the appeal on the record made 

below.”).