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 suppl emental security income (SSI) . The Commissioner of the Social Secur ity Administration (SSA) denied her application, and the district court affirmed the denial of benefits. Exerci sing 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 ha s determined unanimously that oral argument would not materially assist in t he determination of this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is t herefore ordered submitted without oral ar gument. This order and judgme nt is not binding precedent, except under the doctr ines of law of the case, res j udicata, and collateral estoppel. It may be cited, howev er, for its persuasive value c onsistent with Fed. R. App. P. 32.1 a nd 10th Cir. R. 32.1. FILED United States Court of Appeals Tenth Circuit 

### July 11, 2019
Elisabeth A. Shumaker Clerk of Court2 I. BACKGROUND Ms. Crampton was emplo yed as a nurse until May 2009. She asser ts that she has been unable to work since August 9, 2011, due to health pro blems. Ms. Crampton filed for DIB and SS I in 2013 and 2014, resp ectively, at the ag e of 39. She alleged the following physical and mental imp airments: degenerative disc d isease and issues with her lumbar and cervical spine, bone spurs, should er and neck pa in, migraine headaches, left arm and elbow pain, knee pain and swelling, ankle swelling , numbness in her hands and fingers, asthma, obesity, a nd anxiety and depression. In evaluating her application for benefits, the Administrative Law Judge (ALJ) and the district court painstakingly recounted Ms. Crampton’s m edical history and treatment for the relevan t time period, 2011 to 2015, see R., Vol. 1 at 15-23, 913-19. 1 We incorporate those accounts herein. Three doctors a ssessed Ms. Crampton’s phy sical limitations: (1 ) Benjamin Roberts, D.O., an agency doctor who performed a consultative ex amination on August 30, 2014; (2) Karl K. Boatman, M.D., an agen cy doctor who revie wed Ms. Crampton’s medical records and rendered an opinion on September 9, 2014, t hat she can perform light work; and (3) Brent W. La ughlin, M.D., a treating physici an and primary care provider who completed a medica l source statement during an off ice visit on October 8, 2015. Drs. Boatman and Laughlin a lso opined abou t Ms. Crampton ’s ability to work

1 Some of the pages in the reco rd contain two different page num bers. We refer to the smaller num bers on the bottom right.3 given her physical lim itations. We incorpo rate the district co urt’s careful summaries of these opinions as well. See id. at 919-21. The Commissioner denied Ms. Cram pton’s application for benefits , both initially and on reconsideration . Ms. Crampton t hen obtained a hearing before an ALJ, at which both she and a vocationa l expert testified. The ALJ i ssued a writte n 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 d isabled during the r elevant time period. At step one, the ALJ stated that M s. Crampton has not engaged i n substantial gainful activity since August 9, 2011, her alleged onset date. The ALJ then found the following severe impairments at step two: “Degenerative Disc D isease lumbar and cervical spine post 2011 lumbar fu sion, migraine headaches, ast hma, knee pain primarily left post surgery, left elbow and shoulder pain post-surgery, o besity, anxiety and depression.” R., Vol. 1 at 12. A t step three, the ALJ conclud ed these impairments are not presumptively disabling. At step four, the ALJ found Ms. C rampton has the following resi dual 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, o r 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 s imple or at most semi-skilled work. Claimant can relate to s upervisors and coworkers on a superficial and work related ba sis, and can adapt to a work situation. Occasional incident al contact with the public is allowed. Id. at 14-15. Applying these limita tions, the ALJ determined that Ms. Crampton cannot return to her past relevant w ork as a highly skilled nurse. Finally, at step five, the ALJ considered Ms. Crampton’s age, e ducation, work experience, and RFC and found she can perform unskilled, sedent ary jobs existing in significant numbers in the national economy—namely, clerical ma iler, assembler, and stuffer. Because Ms. Crampton ca n adjust to other work, the AL J did not deem her to be disabled under the SSA. The SSA’s Appeals Co uncil denied Ms. Crampton’s request for rev iew, making the ALJ’s determination the fi nal decision for purposes of judi cial review. See Krauser v.
Astrue , 638 F.3d 1324, 1327 (10th Cir. 20 11). The district court aff irmed the ALJ’s decision. 2 Ms. Crampton filed this timely appeal.
II. DISCUSSION
A. Standard of Review We review de novo the district c ourt’s ruling in a social secur ity case and “independently determi ne whether the ALJ’s decision is free fro m legal error and

2 The parties agreed to proceed b efore a magistrate judge under 28 U.S.C. § 636(c).5 supported by substan tial evidence.” Wall v. Astrue , 561 F.3d 1048, 1052 (10th Cir. 2009) (internal quota tion marks omitted). “Substant ial evidence is such relevant evidence as a reasonabl e mind might accept as adequate to support a conclusion.” Id. (internal quotation marks omitted). “In reviewing the ALJ’s decision, we neither r eweigh the evidence nor substitute our ju dgment 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 repres ented by counsel through the di strict court proceedings, she is now proceeding pro se. Because Ms. Crampto n 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, w e “cannot take on the responsi bility of serving as [her] attorney in constructing arguments and searching the reco rd.” Garrett v. Selby Connor Maddux & Janer , 425 F.3d 836, 840 ( 10th Cir. 2005). Ms. Crampton’s arguments on app eal are difficult to follow beca use she does not comply with Federal Rule of Appellate Procedure 28, which r equires an appellant’s opening brief to “co ntain . . . appellant’s content ions and the reasons for them, with citations to the au thorities and parts of the record on which the appellant relies.” Fed. R. App. P. 28(a)(8 )(A). She seems to make two s eparate 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 o n her external appearance while ignoring her s ubjective complaints of disablin g symptoms; and6 (2) the ALJ did not give appropr iate weight to the opinion of h er treating physician, Dr. Laughlin. Only the second argument is prop erly before us because the sole error that Ms. Crampton identified in distric t court was the ALJ’s “fail[u re] to properly consider the opinion of the treating physic ian.” R., Vol. 1 at 895. This court will “consider issues not raised or a rgued in the district court onl y in the most unusual circumstances, which may include issues regarding jurisdiction and sovereign immunity, instances where public interest is implicated, or whe re manifest injustice would result,” Bylin v. Billings , 568 F.3d 1224, 1231 (10t h Cir. 2009) (internal quotation marks omitted). Not one of those circumstances is pr esent here, and Ms. Crampton has not offered a co mpelling reason to excuse her failure to raise the first issue before the district court. She makes only generali zed statements about ineffective assistance of counsel.
C. Weight Assigned to Trea ting Physician’s Opinion We turn to Ms. Crampton’s argumen t that the ALJ failed to give the opinion of her treating physician, Dr. Laugh lin, “proper wei ght.” Aplt. O pening Br. at 4; see also Aplt. Reply Br. at 8 (“ While the ALJ may hav e followed the five step sequential evaluation for assessing disabilit y, I do not beli eve he gave t he proper weight to . . . Dr. Laughlin’s medica l opinion.”). She states generally t hat the A LJ should not have “discredited a [doctor] who treated [her] for over 10 years,” A plt. Opening Br. at 4, and7 “given more weight to Dr. Boatman’s findings after just one vis it,” Aplt. Reply Br. at
12. 3 For the reasons that follow, thi s argument is not persuasive.
1. Dr. Laughlin’s Opinion We start by examining the substa nce of Dr. Laugh lin’s opinion. On October 8, 2015, he completed a medical sourc e statement regarding Ms. Cra mpton’s ability to do physical work-rel ated activities. See R., Vol. 1 at 873-76. It is unclear whether he understood the evaluati on would be used for social security pur poses, as his treatment notes for that day reference the “FMLA” (the acr onym for the Fa mily and Medical Leave Act) as the “[c] hief [c]omplaint,” id. at 869. Dr. Laughlin opined that Ms. Crampton did not have mental limit ations, but his opinion included the followi ng physical limitations:

 Ms. Crampton can occasionally lif t and/or carry less than ten p ounds;

 she can stand and/or walk less th an two hours in an eight-hour workday because standing more than ten minutes exacerbates her back pai n;

 she must periodically alternat e 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 occas ionally reach in all directions and handle due t o shoulder bursitis and carpal t unnel syndrome;

 she can occasionally balance and stoop but can never climb, kne el, crouch, or crawl due to aggravation of the low back and knee pain;

3 Ms. Crampton seems to be confusing Dr. Boatman (who reviewed h er medical records) with Dr. Robe rts (who conducted a c onsultative examina tion).8  her ability to maintain attention and concentration on work tas ks throughout an eight-hour day is significantly com promised because she takes n arcotic medications;

 she should limit exposure to ha zards because her balance is aff ected by her back and knee and she could fall; and

 she should limit exposure to dus t, humidity and wetness, fumes, odors, chemicals, and gases due to her asthma. In formulating these limitations , Dr. Laughlin relied on Ms. Cr ampton’s decreased range of motion, observed pain, and ev idence of previous surgery.
2. Background Law A treating physician’s opinion us ually receives more weight tha n other physicians’ opinions “since these sources are likely to be the medical professionals most able to provide a detailed , longitudinal picture of [the c laimant’s] medical impairment(s) and may bring a un ique perspective to the medical evidence.” 20 C.F.R. § 404.1527(c)(2). But this is not always the case. In evaluating a treating physic ian’s opinion, “the ALJ must com plete 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 opi nion is entitled to controlling weight. A treating physician’s opinion is entitled to controlling weight if it is both “well-supported by me dically acceptable clinical or laboratory diagnostic techniques” and “[]cons istent with other substantial evidence i n 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, 13329 (10th Cir. 2016) (inc onsistent with record); White v. Barnhart , 287 F.3d 903, 907-08 (10th Cir. 2002) (no explana tion for new restrictions). Second, if the opinion is not e ntitled to controlling weight, “ the ALJ must make clear how much weight the opinion is being gi ven (includin g whether it is being rejected outri ght) and give good r easons, tied to the fac tors specified in [20 C.F.R. §§ 404.1527 and 416. 927] . . . for the weight assign ed.” 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 trea tment provided and the kind of examination or testing performed ; (3) the degree to which the physician’s opinion is suppor ted by relevant evidence; (4) consistency between the opinion and the record as a whole; (5) whether or not the phys ician is a specialist in the area upon which an opinion is re ndered; and (6) other factors brought to the ALJ’s attention which tend to support or contradict the opinion. Id. at 1331 (internal quotation mark s omitted). The ALJ need not explicitly discuss all six factors if he otherwis e provides good reasons for the w eight given to the treating source’s opinion— e.g. , if he cites contrary, well- supported medical evidence and shows the treating source “d id not have the opportunity to see or did not give weight to contrary evidence show ing the [claimant’s] greater fu nctional capacity.” Oldham v. Astrue , 509 F.3d 1254, 1258 (10th Cir. 2007)

. 3. Analysis In determining Ms. Crampton’s RFC, the ALJ aff orded “little wei ght” to Dr. Laughlin’s opinion, R., Vol. 1 at 21. The ALJ characterize d Dr. Laughli n’s opinion10 as “inconsistent with the other evidence of reco rd” and found t hat “the limitations provided by Dr. Laugh lin are extreme and not supported by the o verall evidence of record.” Id. He provided numerous examples, including Ms. Crampton’s improve d condition at appointments with Tul sa Pain Consulta nts on May 18 , 2015, and June 15, 2015; an internal inconsistency wi thin Dr. Laughli n’s own opini on; results in the normal range at the examination by Dr. Roberts and at earlier a ppointments with other doctors; an evaluation by Eric Edgar, M.D., at Neurology L.L.P. C., who concluded that Ms. Crampton was exaggerating he r symptoms; and Ms. Crampton’s own inconsistent

statements. For substantially the s ame reasons set forth in the district co urt’s order, see R., Vol. 1 at 926-28, we agree that s ubstantial evidence supports t he ALJ’s allocation of “light weight” to Dr. Laughlin’s medical opinion and his relian ce on Dr. Boatman’s opinion. The ALJ discussed the to tality of the medical record and gave “good reasons” why Dr. Laughlin’s opini on 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 res olve any conflicts in the recor d”). He also carefully explained why he relied on Dr. B oatman’s opinion “to the extent it stands for the proposition that claimant is capab le of at least sedentary work ” yet also “provided some additional limita tion[s] based on more recent medical reco rds,” R., Vol. 1 at 24. Of the opinions rendered, Dr. Boatman’s was the most comprehens ive. Dr. Boatman also reviewed Dr. Roberts’ report, Dr. Laughlin’s m edical records, and the medical records of sever al specialists (including James L. Griffin, M.D., and11 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 Consult ants). Moreover, as the district court exp lained, Ms. Crampton did not present any evidence that she experienced a significant deterioration of symptoms after Dr. B oatman rendered his opinion. See id. at 927-28. 4
III. CONCLUSION The ALJ’s decision to give the treating physician’s opinion lit tle weight was supported by substantial eviden ce. We affirm the district cour t’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 assess ment of the medical opinions, M s. Crampton disagrees with certain statement s in the doctors’ reports (e.g. , that she had been on a cruise). But the ALJ relied on the record presented to him, an d Ms. Crampton had the opportunity to contest the repor ts in the administrative procee dings. Moreover, even if we could accept the alleged disc repancies in her favor, “no rea sonable administrative factfinder, following the correct analysis, could have resolved the factual matter in any other way.” Allen v. Barnhart , 357 F.3d 1140, 1145 (10t h Cir. 2004). Ms. Crampton also provides details about wha t tasks and activities she is cu rrently capable of performing, but we cannot con sider new evidence on appeal. See Selman v. Califano , 619 F.2d 881, 884-85 (10th Cir. 1980) (“We m ust decide the appe al on the record made below.”).