[DO NOT PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 22-13807

Non-Argument Calendar

____________________

ELISHA L. GRESHAM, 

Plaintiff-Appellant,

versus

COMMISSIONER OF SOCIAL SECURITY, 

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Middle District of Florida

D.C. Docket No. 8:21-cv-00601-MRM

____________________

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2 Opinion of the Court 22-13807

Before WILSON, JORDAN, and BRANCH, Circuit Judges.

PER CURIAM:

Elisha Gresham, proceeding pro se, appeals a magistrate 

judge’s order affirming the Social Security Administration (“SSA”) 

Commissioner’s decision denying her application for disability 

insurance benefits (“DIB”) under 42 U.S.C. § 405(g).1 She raises 

several issues on appeal, but only one of these issues is preserved 

for review—whether the administrative law judge (“ALJ”) properly 

weighed the medical opinion evidence.2 After careful review, we 

affirm. 

1 Gresham consented to the magistrate judge conducting all proceedings in 

the district court and issuing the final order. 

2 Gresham raises a number of issues for the first time on appeal. Specifically, 

she asserts that (1) she cannot do the jobs the ALJ found existed for someone 

with her limitations in the national economy; (2) the ALJ ignored that she was 

terminated from her last job because she was never medically cleared to return 

to work and she routinely missed work for doctor’s appointments; (3) the ALJ 

omitted and failed to consider the vocational expert’s written report; (4) the 

ALJ created a conflict of interest by asking Dr. Meltzer to review her file; and 

(5) the magistrate judge who issued the order was not the same one who 

presided over an earlier case conference in the underlying proceedings, which 

calls into question the validity of the underlying order. We decline to consider 

these issues as she raises them for the first time on appeal. See Access Now, Inc. 

v. Sw. Airlines Co., 385 F.3d 1324, 1331 (11th Cir. 2004) (“This Court has 

repeatedly held that an issue not raised in the district court and raised for the 

first time in an appeal will not be considered by this court.” (quotation 

omitted)); Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999) (declining to 

consider an issue raised before the district court and presented for the first time 

on appeal in a social security case); Kelley v. Apfel, 185 F.3d 1211, 1215 (11th Cir. 

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22-13807 Opinion of the Court 3

I. Background

In August 2015, at age 47, Gresham applied for DIB, 

asserting that she was unable to work due to disabling conditions, 

that started on May 20, 2015, including “spinal bifida, sciatica, [a] 

stroke [in the] last year, high blood pressure, depression, work and 

medical related stress, obesity, and right knee problems.” An 

agency consultant for the state reviewed the medical records 

Gresham submitted3 and opined that she was not disabled. She 

sought reconsideration, and a second agency consultant conducted 

an independent review and similarly concluded that Gresham was 

not disabled. Accordingly, the agency denied her application at the 

reconsideration level. 

Thereafter, Gresham requested and received a hearing 

before an ALJ. Initially, the ALJ denied her application. Thereafter, 

the Appeals Council granted Gresham’s request for review and 

remanded the case to the ALJ for further development of the 

record on certain issues. On remand, the agency’s Office of

1999) (declining to reach appellant’s argument that the ALJ should not have 

relied on the vocational expert’s testimony because the appellant failed to raise 

the argument “before the administrative agency or the district court”).

3

Gresham submitted records from her primary care physician, Dr. David 

Krasner, along with records from several other medical entities where she 

received treatment for various conditions. These records are discussed in 

detail later in the opinion.

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4 Opinion of the Court 22-13807

Hearing Operations ordered a second hearing, at which Gresham 

proceeded pro se.4 

A. The Relevant Medical Evidence

The relevant medical evidence before the ALJ at the time of 

the second hearing was as follows.5 Gresham’s medical records 

from her primary care physician, Dr. David Krasner, revealed that 

she had a history of high blood pressure, obesity, transient ischemic 

attacks (“TIA”), and anxiety, and that she was prediabetic. 

In December 2014, Gresham experienced pain in her right 

knee for several weeks. Imaging of the knee identified no 

abnormalities and that the knee was “normal.” On January 19, 

2015, Gresham visited “First State Orthopaedics,” complaining of 

continued right knee pain. She described the pain, which was 

aggravated by physical activity, as “aching, piercing and sharp.” 

She also reported a history of left-side sciatica. Dr. Michael Axe 

aspirated her knee, gave her an injection to help with the knee pain, 

and ordered physical therapy for both her knee pain and sciatica. 

Dr. Axe also completed an “ADA Medical Questionnaire” stating 

Gresham had leg pain and required a desk job with the 

accommodation of being allowed to get up, stretch, and walk 

“every hour or two” to relieve the pain. Dr. Axe identified 

4 A different ALJ presided over this second hearing. 

5 In addition to the medical records, Gresham submitted three letters from her 

family, all dated in September 2019, in which they talked about the pain she 

experienced and the difficulty she had completing tasks. 

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Gresham’s limitations as temporary and he expected the duration 

to be six months or less. 

On February 5, 2015, at a general medical exam with her 

primary care physician, Dr. Krasner, Gresham reported that she felt 

“well with minor complaints” and had a “good energy level.” She 

denied being in any pain. Dr. Krasner’s exam indicated that her 

musculoskeletal system had normal strength and tone. 

That same day, Gresham began physical therapy, and she 

continued therapy throughout the month of February for a total of 

nine sessions. Initially, she reported lower back pain that radiated 

down her left side and right knee pain. She also reported difficulty 

lifting objects, sitting or standing for more than one hour, and 

walking. She indicated that she could perform most of her job 

duties and home activities, but pain prevented her from doing the 

more physically demanding tasks. At her second, third, and fourth 

physical therapy sessions, Gresham reported her back was fine with 

no pain and significant improvement in her right knee. At her fifth 

and sixth visit, however, she indicated some lower back pain from 

sitting. On her seventh visit, she reported her back was feeling 

better, but she indicated that she continued to have right knee pain. 

At her eighth visit, she reported feeling better and that she believed 

she was “ready to go to a gym and continue this on [her] own.” At 

her ninth and final visit on March 4, 2015, the progress notes 

indicated that “Gresham ha[d] gained range of motion and strength 

in both of her knees and her complaints of back pain [were] 

infrequent.” The progress notes further indicated that she still 

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6 Opinion of the Court 22-13807

experienced pain with weightbearing activities. Because her back 

pain worsened with increased sitting, the therapist recommended 

that Gresham rise hourly and do extension exercises, as well as 

continue her strengthening work on her own. 

Meanwhile, on February 27, 2015, Dr. Axe (from First State 

Orthopaedics) completed a Family Medical Leave Act (“FMLA”)

form for Gresham, in which he indicated that she would need to 

work on a reduced schedule because of her medical condition.6 

However, he left blank the section for estimating the treatment 

schedule and did not specify any reduced set of hours Gresham 

should work. He also indicated that if Gresham had a flare-up, it 

would prevent her from performing her job functions. 

On May 4, 2015, Gresham returned to First State 

Orthopaedics for a follow-up concerning her right knee. Dr. Axe 

found that Gresham’s “knee [had] resolved nicely with therapy,” 

and that she had good reflexes and no gross instability. He 

concluded that her current problem was her back—an issue for 

which she would see a different doctor—and that he no longer 

needed to see her for the knee issue. 

That same day, Gresham saw Dr. Krasner for radiating 

“back pain [that] has been occurring in an intermittent pattern for 

6 In March 2015, Gresham requested Dr. Krasner’s assistance with FMLA 

forms “due to stress at work.” At that time, she reported feeling well, sleeping 

well, and having good energy levels, but that she also had back and joint pain. 

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22-13807 Opinion of the Court 7

years.” She also reported fatigue, neck pain and stiffness, back and 

joint pain, and paresthesia (tingling/numbness) in her legs. She 

indicated that the back pain was “aggravated by bending, twisting, 

lifting, sitting, standing and walking,” and was relieved by bed rest, 

elevating her legs, taking Tylenol, applying heat or ice, and physical 

therapy. Upon a physical examination, Dr. Krasner noted no leg 

weakness but observed tenderness, spasms, and decreased range of 

motion in “L/S areas” of the spine and tenderness in Gresham’s left 

hip. He diagnosed her with sciatica and prescribed her physical 

therapy. He also noted that Gresham “decline[d] injections due to 

[a history of] spina bifida.” He instructed her to avoid pushing,

pulling, and lifting anything over 10 pounds for the next six 

months. Dr. Krasner gave Gresham a sick note, indicating that she 

could return to work on May 6, 2015. 

Three days later, on May 7, 2015, Dr. Krasner completed an 

FMLA form for Gresham, stating that she had “sciatica [and] 

difficulty walking,” which had existed from September 1998 to 

present, and that these conditions would require absences from 

work during flare-ups, limited activity, and bedrest. He noted that 

Gresham could not “lift, push or pull objects over 10 [pounds]” and 

“may not be able to perform [her] job comfortably during flareups.” He wrote that Gresham’s condition would worsen with “fast 

pace or quick [and] sudden physical movement” and that she 

should avoid those type of movements during a flare-up. He also 

stated that Gresham should not “over exert” herself and should rest 

as much as possible during flare-ups, including lying “flat [with] 

leg[s] [and] back elevated.” In terms of leave needed from her job, 

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8 Opinion of the Court 22-13807

Dr. Krasner indicated that she would require intermittent leave as 

needed. 

On May 20, 2015, Gresham returned to Dr. Krasner for a 

“recheck” of her back pain. Gresham reported that the pain in her 

lower back had increased in frequency and intensity “due to stress 

at work.” She maintained that the pain was “aggravated by 

bending, twisting, lifting, sitting, standing and walking” and 

relieved by bed rest, changing positions, medication, the 

application of heat and ice, and both massage and physical therapy. 

Dr. Krasner’s examination revealed tenderness, spasm, and 

decreased range of motion in the lumbar sacral area. Dr. Krasner 

again diagnosed Gresham with sciatica and ordered physical 

therapy. He further noted that Gresham indicated that the stress 

at work caused her back pain and that she wanted to take “a leave 

of absence” until July 8, 2015. Dr. Krasner indicated that she should 

“see [him] prior to then.”7 

Gresham returned to physical therapy on May 27, 2015, 

reporting back, left leg, and buttock pain. Gresham attended eight 

therapy sessions between May 27, 2015 and July 22, 2015, during 

which she indicated she made some progress, although still 

7 The next day, Dr. Krasner filled out FMLA paperwork stating that Gresham 

would need leave from work until July 18, 2015, due to sciatica and “stress” 

and would need “good ergonomics and the freedom to move around during 

the work day” once she returned. A few weeks later, Dr. Krasner also 

completed short term disability paperwork indicating that Gresham was 

temporarily unable to work due to sciatica and stress at work with an expected 

return to work date of July 8, 2015. 

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experienced some occasional pain, particularly after doing 

housework, standing for an extended period of time, and going to 

the beach. On her final visit on July 22, 2015, however, Gresham 

reported feeling better with no back pain and that her doctor felt 

that she was ready to be discharged. 

Meanwhile, Gresham saw Dr. Krasner on July 1, 2015, for “a 

recheck of [s]tress” stemming from her job. At that time, she did 

not report any back pain and denied any joint pain or muscle 

cramps. Dr. Krasner’s physical examination revealed “mild 

tenderness” in the lumbar region.8 Dr. Krasner saw Gresham again 

on July 21, 2015, for another “recheck of [s]tress.” At that time, his 

progress notes indicated that Gresham “stated that ‘she fe[lt]

‘physically’ better, but [she was] still anxious about returning to 

work on an emotional level’” and she wanted additional leave until 

September 21, 2015. 

As noted previously, Gresham applied for DIB benefits on 

August 18, 2015. That same day, she saw Dr. Krasner complaining 

of back pain. At that time, Gresham self-reported that she had

spina bifida and that she was diagnosed with spina bifida in 1988–

1989 when she was 21 years old. Dr. Krasner’s notes indicated that 

the medical files related to that diagnosis had been requested in 

8 The next day, Dr. Krasner completed additional FMLA paperwork indicating 

that Gresham was temporarily unable to work due to sciatica, stress at work, 

and a “sprain/strain” in the lumbar region of her back. He indicated that she 

would be incapacitated until August 2, 2015, and that she would require “good 

ergonomics” and “the freedom to move around during the work day once she 

return[ed]” to work. 

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10 Opinion of the Court 22-13807

order to confirm the diagnosis. Dr. Krasner also ordered x-rays of 

Gresham’s spine. An x-ray showed Gresham’s spine was of normal 

height and alignment. No “vertebral anomal[ies]” were present. 

Mild degenerative changes were noted in the lumbar region, as 

well as a “questionable small linear lucency at the midline S1 

[vertebrae] possibly from artifact or from spina bifida occulta, 

which is typically of no clinical significance.”9 

Gresham returned to Dr. Krasner’s office on September 15, 

2015, reporting back, joint, hip, and muscle pain, as well as “all over 

body pain.” Dr. Krasner diagnosed her with “stress at work,” and 

his progress notes indicated that Gresham expressed a desire not to 

return to work.10 In November and December 2015, Gresham 

returned to Dr. Krasner for assistance in completing disability 

forms and to further discuss her back pain, hip pain, and leg 

9 Shortly thereafter, Dr. Krasner completed updated short-term disability 

paperwork stating that Gresham’s restrictions “[were] psychological not 

physical.” 

10 That same day, Dr. Krasner wrote a letter certifying that Gresham had “been 

under [his] care for work-related stress, and it [was his] opinion that she could 

not return to work . . . until further notice.” He stated that “[h]er condition 

[was] permanent.” Thereafter, in October 2015, Dr. Krasner completed more 

short-term disability paperwork stating that Gresham had ongoing sciatica, 

that was aggravated by work stressors; that she had been diagnosed with spina 

bifida and therefore surgery was not suggested; and that she could not do 

extended sitting, walking, or standing. Although Dr. Krasner saw Gresham in 

October 2015 for other medical related issues, she did not report any back pain, 

other types of pain, or stress at her October visit. 

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22-13807 Opinion of the Court 11

weakness.11 While Dr. Krasner’s treatment notes measured her 

vitals, they did not discuss an examination or make any objective 

findings.12 

Gresham’s employer, the State of Delaware, terminated her 

employment in January 2016. The State also denied her 

unemployment benefits, as she did not certify that she was ready 

and able to work. 

In February 2016, Dr. Krasner opined that Gresham could 

return to work part-time with limitations. Specifically, Dr. Krasner 

stated that Gresham could work for no more than 25-hours per 

week with no lifting, no bending, no squatting, no pulling/pushing 

heavy items, no steps, no extended sitting, no extended standing, 

no extended driving or traveling, and “flexibility to accommodate 

[her] condition as needed.” 

That same month, Gresham saw Dr. David Sowa, at First 

State Orthopaedics for a mass on her left wrist causing wrist pain, 

as well as radiating neck pain. An x-ray of her cervical spine

showed a small bone spur at one vertebra, but “no significant 

11 At her December visit, Gresham also complained of headaches and neck 

pain. 

12 At that time, Dr. Krasner completed updated short-term disability forms for 

Gresham. Notably, Dr. Krasner opined that Gresham’s “sciatica [was] not 

preventing her from returning to work. It’s the stress.” Gresham also 

obtained a note from psychologist, Dr. Mary Kennedy, who had seen Gresham 

four times between April and November 2015. She opined that due to 

Gresham’s psychological distress and self-reported “continuing medical 

problems,” Gresham should not return to work. 

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abnormalities.” She received a referral for physical therapy for the 

neck pain. At a follow-up visit in April 2016, following additional 

testing, Dr. Sowa noted that Gresham had “persistent 

deQuervain’s tenosynovitis of her left wrist” and scheduled outpatient surgery for the wrist.13 He referred her to a spine center for 

her neck issues. 

In March 2016, in connection with her DIB application, 

Gresham was examined by SSA’s consultative examiner, Dr. Irwin 

Lifrak. At that time, Gresham’s chief complaints were back pain 

radiating to both of her hips and legs, hypertension, neck pain 

radiating to both of her shoulders and arms, and depression. Dr. 

Lifrak found that Gresham was adequately developed and 

nourished, was in no acute distress, and walked without an assistive 

device “with a minimal degree of limp favoring the left [side].” Her 

extremities, including her legs, had full muscle strength and tone, 

and intact reflexes and sensation, but she had paravertebral spasms 

and reduced range of motion in her lumbar spine and hips. Dr. 

Lifrak’s diagnostic impression was that Gresham had 

“[d]egenerative joint disease” with possible disc damage, 

hypertension that was under control at the time of the 

examination, and depression. He determined that within an eighthour day with customary breaks and without any assistive device 

Gresham could perform activities requiring her to walk, either 

13 Following the wrist surgery, Gresham had limited range of motion in her 

left wrist and sensitivity at the scar site. Dr. Sowa recommended hand 

therapy. 

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22-13807 Opinion of the Court 13

indoors or outdoors; climb stairs; sit for a total of six hours out of 

an eight-hour day; stand for a total period of six hours out of an 

eight-hour day; and lift weights of up to ten pounds with each hand 

on a regular basis. 

In September 2016, Gresham returned to Dr. Krasner, 

complaining of back pain. His notes indicated that Gresham stated 

that she was unable to perform her job duties due to the pain and 

she requested that Dr. Krasner give her a letter for her work. Dr. 

Krasner wrote a formal medical letter, stating that Gresham was 

under his care for sciatica, that she should “avoid excessive 

bending, squatting, sitting, and standing,” and that she should not 

lift, push, or pull more than 20 pounds. Dr. Krasner’s notes were 

similar when Gresham returned in February 2017, complaining of 

worsening back pain, pain in her neck, left hip, and left wrist, and 

requesting Dr. Krasner “certify that she [was] unable to work.” Dr. 

Krasner ordered an MRI of Gresham’s lumbar spine, an x-ray of her 

cervical spine, and physical therapy. He also completed paperwork 

stating that Gresham was expected to be unable to work for 6 to 9 

months due to her sciatica, cervical pain, and lumbar pain. The xray of Gresham’s cervical spine revealed some straightening, which 

was “nonspecific” and “often associated with muscle spasms.” No 

other abnormalities were observed. The MRI of the spine revealed 

that the alignment was normal, but there was mild joint 

arthropathy in the lumbar region. 

In March 2017, Gresham resumed physical therapy,

reporting her back pain level as a 7 out of 10, and a 10 out of 10 on 

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bad days. Although she continued to report some back pain 

throughout the course of her six-week treatment, she self-reported 

some improvements in her back pain and demonstrated improved 

functionality. 

On April 26, 2017, Gresham returned to Dr. Krasner for a 

recheck of her back pain and stress. In terms of her back pain, 

Gresham indicated that physical therapy helped the pain (which 

she rated as a 3 out of 10) and that she was interested in getting a 

transcutaneous electrical nerve stimulation (“TENS”) unit, which 

is a medical device that sends low-voltage electric currents to 

nerves and helps with pain. She reported that her stress, however, 

had been increasing. Dr. Krasner again diagnosed her with sciatica 

and prescribed additional physical therapy.14 

Gresham returned to physical therapy a few months later in 

July 2017, reporting a resting back pain level of 3 out of 10, and a 

10 out of 10 with physical activity. During the course of her 

treatment between July 27 and October 9, 2017,Gresham gradually

14 Approximately a week later, Gresham went to the emergency room for left 

hip and groin pain, but imaging of her pelvis and left hip revealed “no evidence 

of acute fracture or dislocation,” and “no evidence of any arthritic changes.” 

The emergency room physician noted that Gresham’s pain was “suggestive of 

suspect musculoskeletal etiology,” such as a “muscle strain, tendinitis, or 

injury” and “less consistent with sciatica or [a] lumbar source.” A few days 

after her emergency room visit, Gresham returned to Dr. Krasner for the left 

hip pain, rating it as a 5 out of 10. Dr. Krasner’s notes indicated that, at that 

time, Gresham indicated that she “want[e]d to hold off on [physical therapy.” 

Dr. Krasner referred her to an orthopedic surgeon for the hip pain and 

prescribed some medication. 

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reported improvement in her symptoms. Although at times

Gresham indicated she felt worse, particularly after weekend 

activities such as “walking in Ocean City” or doing “a lot of” 

shopping, cooking, and cleaning. The physical therapist’s 

assessments indicated that Gresham showed an improvement in

her range of motion and functional limitations. 

On September 6, 2017, Gresham visited Dr. Anne Mack, 

M.D., based on a referral from Dr. Krasner for lower back pain and 

hip pain, which she rated as an 8 out of 10.15 On examination, Dr. 

Mack noted that Gresham had a reduced range of motion in the

cervical and lumbosacral areas of the spine, and a normal range of 

motion in the thoracic area of the spine. Gresham also had full 

range of motion and strength in her extremities. Dr. Mack 

recommended that Gresham continue with physical therapy. 

On September 18, Dr. Krasner completed a document 

entitled “Treating Source Statement—Physical Conditions” related 

to Gresham’s disability claim in which he opined that Gresham

likely would be off task for more than 25% of a typical workday 

and miss more than four days of work per month as a result of her 

ailments, which included “sciatica, severe stress, left hip pain, spinal 

dysplasia, [and] TIA.” Dr. Krasner further opined that Gresham 

could continuously lift or carry items lighter than 10 pounds; could 

frequently lift or carry items that were 10 pounds; could never lift 

or carry items 20 pounds or heavier; could sit, stand, and walk for 

15 Notably, on this same day, Gresham had a physical therapy visit at which 

she reported “feeling better” and that he was “starting to feel better overall.” 

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only 1 hour in an 8-hour workday; required the option to sit/stand 

at will; and occasionally required the use of a cane or other assistive 

device. He indicated that Gresham could occasionally reach 

overhead and push/pull; frequently reach in all other directions; 

continuously perform handling, fingering, and feeling; 

continuously use foot controls; never balance, crawl, or climb 

ladders; rarely climb stairs and ramps, stoop, kneel, or crouch; and 

could frequently rotate her head and neck. Turning to 

environmental limitations, Dr. Krasner stated that Gresham could 

never be around unprotected heights, moving mechanical parts, 

dust/odors/fumes/pulmonary irritants, and extreme cold; 

occasionally be around humidity, wetness, extreme heat, and 

vibrations; and could frequently operate a vehicle. 

On October 6, 2017, Gresham returned to Dr. Mack, 

reporting lower back and hip pain with radiating pain down her 

legs. She described the pain as “moderate” and “constant,” rating 

it as a 6 out of 10. Upon examination, Gresham again had 

decreased range of motion in her cervical and lumbosacral areas of 

the spine and a full range of motion in her extremities. She also 

exhibited pain in her left ankle with certain movements. Dr. Mack 

ordered an x-ray of the ankle, which did not reveal any abnormal 

findings. She recommended that Gresham return for a recheck in 

approximately 6 weeks. 

Three days later, on October 9, 2017, Gresham completed 

her last physical therapy visit. During this visit, Gresham reported 

that she felt “about 40% better,” and she rated her back pain a 2 out 

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22-13807 Opinion of the Court 17

of 10 at rest, and a 7 out of 10 during activity. The physical therapist 

reported that Gresham had “shown objective improvement with 

lumbar [range of motion] and subjectively report[ed] improvement 

with functional activities and independent management of 

symptoms. She [also] present[ed] with improvement in gait 

mechanics with no noted deficits pre and post session.” 

Two days later, Gresham saw Dr. Krasner for a pre-op 

evaluation related to a scheduled hysterectomy.16 Dr. Krasner 

noted that Gresham reported “feel[ing] well with minor 

complaints” and that she was not currently in pain. As part of the 

physical examination, he noted that her gait and posture were 

normal and that she was not in any acute distress. 

In March 2018, Dr. Mack ordered an MRI of Gresham’s 

lumbar spine. The MRI indicated that Gresham had “[l]ower 

lumbar degenerative disc disease and facet arthritis” with 

“moderate to severe bilateral foraminal stenosis” and a disc bulge 

abutting a nerve root in the lower lumbosacral region of the spine. 

In April 2018, shortly before her hysterectomy, Gresham 

returned to Dr. Krasner’s office seeking help with completing 

disability related forms. At that time, she reported “feel[ing] well 

16 Gresham needed a hysterectomy to resolve issues related to numerous 

fibroids, which doctors also thought could possibly be contributing to her back 

pain. The surgery, however, was delayed, and Gresham had a second pre-op 

evaluation performed in March 2018, that included nearly identical findings. 

The medical records indicate that the hysterectomy was performed 

successfully in mid-April 2018. 

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with no complaints,” “sleeping well,” and “ha[ving] [a] good 

energy level.” She denied currently being in pain. Gresham 

indicated to the nurse practitioner in Dr. Krasner’s office that she 

“needed [a] permanent disability form for her back” and that Dr. 

Mack told her that the MRI revealed arthritis in her neck. The 

nurse practitioner’s physical examination indicated that Gresham 

had full range of motion in her neck with some discomfort. She 

instructed Gresham to consult with Dr. Mack about the disability 

forms. 

In October 2018, Gresham again visited Dr. Mack for pain in 

her lower back, hip, and left knee. She reported the back pain as 

an 8 out of 10. On examination, Dr. Mack noted a reduced range 

of motion in Gresham’s cervical and lumbar spine, an antalgic gait, 

evidence of swelling in the knee, and a full range of motion in the 

ankle (but accompanied by pain), but otherwise no abnormalities, 

noting full strength in all muscles.17 She ordered a CT scan of 

Gresham’s lumbar spine, x-rays of her left knee and right foot, and 

a straight cane due to knee pain. The CT scan confirmed 

“[d]egenerative changes” of Gresham’s lumbar spine at two levels. 

In June 2019, Gresham had an operation to treat a hernia. In 

August 2019, Dr. Wynn, the surgeon who treated Gresham for the 

hernia, opined that Gresham could not return to work until 

September 23, 2019, and when she returned she could not push, 

17 Subsequent examinations performed by Dr. Mack in November 2018, 

August 2019, September 2019, and October 2019 contained substantially 

similar results to that of the October 2018 examination. 

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22-13807 Opinion of the Court 19

pull, or lift anything over 10 pounds. Dr. Wynn lifted these 

restrictions in late September 2019, stating that Gresham was 

allowed “to perform normal duties up to her capacity.” 

In October 2019, an unnamed individual at Thrive Physical 

Therapy completed a one-time “Functional Assessment Report” 

for Gresham’s disability application. The report indicated that 

Gresham experienced right knee and lower back pain with all of 

the physical function tests, but that it was difficult to fully assess 

her abilities and strengths or barriers to her ability to work due to 

restrictions that she was under from hernia surgery. In terms of 

Gresham’s ability to work, the report indicated that the “[o]nly 

option that would work per discussion with client is part time light 

duty with a flexible schedule that [could] allow for frequent call 

outs for doctors visits or if having a bad day with pain or 

limitations.” The therapist recommended that Gresham could 

perform “[p]art time light duty” work. The report further opined 

that Gresham could occasionally stand or walk; could constantly 

sit; rarely lift any weight less than 10 pounds; never lift any weight 

more than 10 pounds; frequently use her arms and hands; would 

never need to recline or elevate feet; could never crouch or climb 

a ladder; could rarely bend, walk, kneel or crouch; and occasionally

stand, sit, or work while standing. 

Finally, records indicated that in November 2019, Gresham 

applied for a handicap parking placard, and Lindsay Kelly, a family 

nurse practitioner, completed the necessary forms, certifying that 

Gresham could not walk more than 200 feet without stopping for 

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20 Opinion of the Court 22-13807

rest and required a cane as an assistive device, and that Gresham 

had no prognosis for improvement. 

B. Testimony Before the ALJ

At the second hearing on her disability application, Gresham 

provided testimony concerning her prior occupations and her 

physical ailments and associated pain. Regarding her prior 

occupations, she previously worked as a behavioral therapist for 

mentally and physically disabled residents in a group home. Next, 

she worked as a preschool teacher, which involved writing up 

various lesson plans and reports. Then she worked as a customer 

service representative in the collections department of a financial 

company for a year, which involved mainly “sit down” work. 

Finally, she worked as an administrator (and later as the purchasing 

services coordinator) in the procurement unit of a state agency in 

Delaware, where she was responsible for a wide variety of 

administrative tasks and frequently traveled between offices. In 

this role, she was responsible for handling phones, transporting 

large boxes of documents weighing over 20 pounds, and writing 

and editing contracts. 

Turning to her impairments, Gresham testified that, in May 

2015, she became disabled after she experienced “a stress 

breakdown and the pain became intolerant to where [she] 

could . . . barely move [her] left leg.” She also suffered “memory 

setbacks” around this time. Gresham explained that she had been 

using a cane prescribed by Dr. Mack as a mobility assistive device 

for the last year. She stated that she lived with her husband and 

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22-13807 Opinion of the Court 21

her two daughters, ages 26 and 17, and that they helped her cook 

and do things around the house like cleaning and laundry. She 

explained that sometimes she gets “the tinglys” in her legs and that 

pain medications, her TENS unit, physical therapy, massages and a 

heating pad helps. She confirmed that she had never had any 

surgery on her back and that she was still recovering from the 

hernia repair. 

When asked to describe the problems that have prevented

her from working since 2015, Gresham stated it was: her constant 

back, right knee, and ankle pain; hip pain for which she went to the 

emergency room in 2017; her hysterectomy, during which 

cancerous cells were discovered and removed successfully; neck 

issues that developed in 2018; shoulder pain; and her hernia. She 

explained that, in 2016, she felt capable of at least doing part-time 

work, and she completed 200 job applications, but was unable to 

find work. She stated that she also suffers from TIA strokes, high 

blood pressure, and diabetes. 

A vocational expert (“VE”) then testified in response to three 

hypotheticals from the ALJ. The ALJ’s first hypothetical involved 

an individual of Gresham’s age and skills who could occasionally 

lift 20 pounds; frequently lift 10 pounds; stand or walk for six hours 

out of an eight-hour workday; sit for six hours out of an eight-hour 

workday; frequently climb ramps and stairs; occasionally climb 

ladders, ropes, and scaffolds; frequently balance; occasionally 

stoop, kneel, crouch, and crawl; and tolerate occasional exposure 

to vibration and hazards. The VE testified that a person with these 

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22 Opinion of the Court 22-13807

limitations could perform three of Gresham’s prior jobs, namely,

her work as a purchasing agent, secretary, and collection clerk. 

Additionally, the VE testified that the hypothetical individual could 

work as a file clerk, as a general clerk, or in a wide range of 

sedentary positions available in the national economy. 

The ALJ next reduced the lift limit to 10 pounds and the time 

standing or walking to two hours out of an eight-hour day, keeping 

the remainder of the limitations the same. The VE testified that 

such an individual could perform two of Gresham’s prior jobs, 

namely, that of a collection clerk and secretary. The VE further 

testified that such limitations would limit an individual to 

sedentary work, identifying a data entry clerk, an information 

clerk, and a data clerk as additional positions such a person could 

fill. 

For the third and final hypothetical, the ALJ added to the 

limitations that the individual would require a cane to balance and 

would be off-task 25 percent of the workday. The VE testified that 

such an individual could not perform any of Gresham’s prior 

positions or any other position in the workforce. The ALJ then

removed the limitation of being off-task for 25 percent of the 

workday, but still required the use of a cane. The VE testified that 

such an individual would be able to perform the same positions 

identified in the second hypothetical. 

Finally, at the request of Gresham, the VE next considered 

an individual with the same limitations who needed to miss work 

on average four days a month due to an ailment or to see a doctor. 

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22-13807 Opinion of the Court 23

The VE testified that such a limitation would be work preclusive, 

even if further limited to only missing part of the day once a month 

for a doctor’s appointment. 

Gresham then explained that “it’s not that [she] can’t do 

work,” she just needs flexibility. The ALJ explained that because 

Gresham had various ailments, he was going to have an 

independent doctor review Gresham’s complete file, look at 

everything collectively, and then write up a report. The ALJ would 

then review that report along with all the other evidence in the 

record and make a determination. 

C. Post-Hearing Evidence

In February 2020, at the request of the ALJ, Dr. Seth Meltzer 

reviewed Gresham’s file. Dr. Meltzer identified Gresham as 

suffering from the following impairments: sciatica, DeQuervian’s 

tenosynovitis, stroke, and hypertension. He then explained that 

none of these impairments met or equaled any impairment in the 

agency’s Listing of Impairments.18 

He next opined that, with her ailments, Gresham could 

continuously lift or carry up to 10 pounds; frequently lift or carry 

up to 20 pounds; occasionally carry, but never lift between 20 and 

50 pounds; sit two hours at a time and up to four hours per 

18 In particular, he explained that Gresham’s back issues did not meet the 

listing of impairments for disorders of the spine because although the MRI 

showed evidence of facet arthritis, degenerative disc disease, and stenosis in 

the lumbar region, “there [was] no evidence of neuroanatomic motor loss, 

motor weakness, loss of reflex, or positive SLR.” 

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24 Opinion of the Court 22-13807

workday; stand and walk for 30 minutes at a time and up to two 

hours per workday. Dr. Meltzer further opined that Gresham 

could frequently reach, handle, finger, feel, push, and pull; 

continuously use foot controls; occasionally climb stairs, ramps, 

ladders, and scaffolds; frequently balance; never stoop, kneel, 

crouch, or crawl; occasionally be exposed to heights and moving 

mechanical parts; and be exposed to very loud noises. Meltzer 

cited to specific documents in the record in support of hisfindings.19 

Following the second hearing, Gresham submitted 

additional medical evidence, which included a cardiologist report 

from January 2020 that stated that Gresham reported feeling great 

with no back or joint pain. Upon examining Gresham, the 

cardiologist reported that her extremities, motor strength, and 

reflexes were normal. And a February 2020 “medical statement of 

ability to do work-related activities” from a nurse practitioner in 

Dr. Krasner’s office, indicated that, due to a history of “spinal 

dysplasia, TIA[,] [and] arthritis,” Gresham had the following 

physical limitations: she could frequently lift or carry up to 10 

19 After Dr. Meltzer completed his report, the ALJ requested that the VE 

complete an updated interrogatory on Gresham’s ability to work. The 

interrogatory asked the VE to consider whether a hypothetical person of 

Gresham’s age, education, and skill, could perform any of her prior positions 

or other positions in the workplace if they had limitations identical to those 

found by Dr. Meltzer. The VE certified that such an individual could perform 

two of the Gresham’s prior positions, namely, a purchasing agent and an 

administrative assistant. The VE also certified that such an individual could 

perform as a general clerk, administrative clerk, purchasing clerk, receptionist, 

payroll clerk, router, fingerprint clerk, or microfilm mounter. 

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22-13807 Opinion of the Court 25

pounds; occasionally lift or carry up to 20 pounds; sit for one hour 

at a time and up to eight hours a day; stand for less than 5 minutes 

at a time and up to 1 hour in a day; walk for less than 30 minutes 

and up to 1 hour in a day; required a cane to ambulate; could 

occasionally reach with her hands; could continuously handle, 

finger, feel, and push/pull with each hand; could continuously 

operate foot controls; could never climb stairs, ramps, ladders, or 

scaffolds; could never balance, stoop, kneel, crouch, or crawl; could 

never be exposed to unprotected heights, moving mechanical 

parts, humidity/wetness, dust, odors, fumes, pulmonary gases, 

extreme cold, extreme heat, or vibrations; could occasionally 

operate a motor vehicle; and could be exposed to moderate noise 

levels. The nurse practitioner further opined that Gresham’s 

impairments met or equaled an impairment on the agency’s Listing 

of Impairments, though she did not specify which one or ones were 

met and did not specify any evidence that supported this finding. 

D. The ALJ’s Decision

Employing the SSA’s five-step sequential evaluation process 

for determining whether a claimant is disabled, the ALJ denied 

Gresham’s application.20 The ALJ found that Gresham had not 

20 The evaluation process involves the following five determination steps: 

(1) whether the claimant is engaged in substantial gainful activity; (2) if not, 

whether she “has a severe impairment or combination of impairments”; (3) if 

so, whether that impairment, or combination of impairments, meets or equals 

the medical listings in the regulations; (4) if not, whether the claimant can 

perform her past relevant work in light of her RFC; and (5) if not, whether, 

based on her age, education, and work experience, she can perform other 

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26 Opinion of the Court 22-13807

engaged in substantial gainful activity since May 20, 2015, and was 

severely impaired from “obesity, degenerative disc disease of the 

lumbar spine, and left DeQuervain’s tenosynovitis.” At step three, 

the ALJ determined that Gresham’s impairments did not meet or 

medically equal any listed impairment under the relevant Social 

Security regulations.21 At step four, the ALJ then determined that 

Gresham had:

the residual functional capacity to perform light work 

as defined in 20 CFR [§] 404.1567(b) except she can lift 

and carry 20 pounds frequently and 50 pounds 

occasionally, sit for 2 hours at a time for a total of 4 

hours out of an 8-hour workday, stand 30 minutes at

a time for a total of 2 hours out of an 8-hour workday, 

and walk 30 minutes at a time for a total of 2 hours in 

an 8-hour workday. The claimant can frequently 

reach in all directions bilaterally with the upper 

extremities. She can occasionally climb stairs and 

ramps, occasionally climb ladders or scaffolds, 

frequently balance, and never stoop, kneel, crouch, or 

crawl. The claimant can tolerate occasional exposure 

to unprotected heights and moving mechanical parts. 

She can tolerate very loud noise.

work found in the national economy. Winschel v. Comm’r of Soc. Sec., 631 F.3d 

1176, 1178 (11th Cir. 2011).

21 A claimant bears the burden of showing her impairments meet or equal a 

listing. Barron v. Sullivan, 924 F.2d 227, 229 (11th Cir. 1991). 

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22-13807 Opinion of the Court 27

In reaching this conclusion, the ALJ found that Gresham’s 

medically determinable impairments could reasonably be expected 

to cause the alleged symptoms, but that Gresham’s “statements 

concerning the intensity, persistence and limiting effects of [her] 

symptoms [were] not entirely consistent with the medical evidence 

and other evidence in the record.” For instance, the ALJ noted that 

the objective evidence in the record indicated that Gresham’s back 

issues improved with physical therapy and she frequently reported 

feeling better, such that Gresham’s “allegations of disabling 

symptoms and limitations are inconsistent with and unsupported 

by the evidence.” 

As for the medical opinion evidence, the ALJ gave little to 

no weight to the opinions provided by Dr. Krasner, Dr. Wynn, Dr. 

Lifrak, and the Thrive Physical Therapy Functional Assessment 

Report. The ALJ explained that Dr. Krasner’s opinions as to 

Gresham’s limitations and her inability to work were not 

supported by the objective medical evidence or constituted 

findings on an issue reserved to the Commissioner. Similarly, “the 

evidence as a whole, including the physical examination findings, 

[did] not support such restrictive limitations” as those indicated in 

Dr. Wynn’s medical opinion. The ALJ explained that he gave little 

weight to the agency examiner Dr. Lifrak’s 2016 consultative 

examination because “the weight of the evidence, including the 

mostly normal strength findings, do not support limiting lifting and 

carrying to 10 pounds bilaterally.” The ALJ also explained that it 

gave little weight to the Functional Assessment Report completed 

by Thrive “because the examiner was unable to fully assess 

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28 Opinion of the Court 22-13807

[Gresham’s] ability” due to restrictions that Gresham was still 

under after her hernia surgery. On the other hand, the ALJ gave 

great weight to Dr. Meltzer’s opinion, because he had the 

opportunity to review Gresham’s entire file and the RFC he 

provided (which the ALJ adopted) was supported by the record. 

In light of Gresham’s RFC, the ALJ determined that 

Gresham could perform past relevant work as a purchasing agent 

and an administrative assistant. Alternatively, the ALJ proceeded 

to step five and determined that Gresham could perform other jobs 

in the national economy such as a router, fingerprint clerk, and 

microfilm mounter. Consequently, the ALJ found that Gresham 

was not disabled. 

Gresham requested discretionary review of the ALJ’s 

decision by the SSA Appeals Council, and her request was denied. 

Gresham then obtained counsel and filed a complaint in the district 

court, raising two issues: (1) whether the ALJ failed to properly 

evaluate and weigh the medical opinion evidence—in particular 

the opinions of Dr. Krasner, Dr. Wynn, and Dr. Lifrak, and the 

Thrive Physical Therapy Functional Assessment—as required 

under “SSA policy and Eleventh Circuit precedent”; and 

(2) whether the ALJ and Appeals Council judges were properly 

appointed, and, if not, whether remand was necessary. A 

magistrate judge, acting on behalf of the district court, affirmed the 

ALJ’s decision and rejected Gresham’s appointments challenge. 

Gresham, proceeding pro se, appealed the decision. 

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22-13807 Opinion of the Court 29

II. Standard of Review

“When, as in this case, the ALJ denies benefits and the 

[Appeals Council] denies review, we review the ALJ’s decision as 

the Commissioner’s final decision.” Doughty v. Apfel, 245 F.3d 1274, 

1278 (11th Cir. 2001). “[W]e review de novo the legal principles

upon which the Commissioner’s decision is based,” and “we 

review the resulting decision only to determine whether it is 

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

1208, 1211 (11th Cir. 2005); see also Simon v. Comm’r, Soc. Sec. 

Admin., 7 F.4th 1094, 1103 (11th Cir. 2021) (“Substantial evidence is 

less than a preponderance, and thus we must affirm an ALJ’s 

decision even in cases where a greater portion of the record seems 

to weigh against it.” (quotation omitted)). “We may not decide the 

facts anew, reweigh the evidence, or substitute our judgment for 

that of the [Commissioner].” Winschel v. Comm’r of Soc. Sec., 631 

F.3d 1176, 1178 (11th Cir. 2011) (alteration in original) (quotation 

omitted). “Even if the evidence preponderates against the 

Commissioner’s findings, we must affirm if the decision reached is 

supported by substantial evidence.” Crawford v. Comm’r of Soc. Sec., 

363 F.3d 1155, 1158–59 (11th Cir. 2004) (quotation omitted).

III. Discussion

Gresham challenges the ALJ’s weighing of medical opinions, 

asserting that the ALJ erred in giving more weight to Dr. Meltzer’s 

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30 Opinion of the Court 22-13807

opinion than the “independent medical professional experts who 

actually worked with [her].”22

To obtain social security disability benefits, the applicant 

must prove she is disabled. See Barnhart v. Thomas, 540 U.S. 20, 21 

(2003). “Disability” is defined as the “inability to engage in any 

substantial gainful activity by reason of any medically determinable 

physical or mental impairment which can be 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). The impairment must be “of such severity that [the 

person] is not only unable to do [her] previous work but cannot, 

considering [her] age, education, and work experience, engage in 

any other kind of substantial gainful work which exists in the 

national economy.” Id. § 423(d)(2)(A).

When making the disability assessment, the ALJ must give 

special attention to the medical opinions, particularly those of the 

treating physician. SSA regulations in force at the time Gresham 

filed her application required an ALJ to give “controlling weight” 

to a treating physician’s opinion if it was “well-supported by 

medically acceptable clinical and laboratory diagnostic techniques” 

and “not inconsistent with the other substantial evidence in [the] 

22 Gresham does not state to which of the treating “independent medical 

professional experts” she is referring. Nevertheless, we assume for purposes 

of this opinion that she is referring to the same treating physician opinions that 

she took issue with in the district court, namely, those of Dr. Krasner, Dr. 

Wynn, and Dr. Lifrak, and the Thrive Physical Therapy Functional 

Assessment. Therefore, we focus on those opinions.

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22-13807 Opinion of the Court 31

case record.” 20 C.F.R. § 404.1527(c)(2).

23 Good cause to discount 

a treating physician’s opinion exists “when the: (1) treating 

physician’s opinion was not bolstered by the evidence; (2) evidence 

supported a contrary finding; or (3) treating physician’s opinion 

was conclusory or inconsistent with the doctor’s own medical 

records.” Winschel, 631 F.3d at 1179 (quotation omitted). 

“[T]he ALJ must state with particularity the weight given to 

different medical opinions and the reasons therefor.” Id. There are 

no magic words to state with particularity the weight given to the 

medical opinions. Rather, the ALJ must “state with at least some 

measure of clarity the grounds for his decision.” Id. (quotation 

omitted). “We will not second guess the ALJ about the weight the 

treating physician’s opinion deserves so long as [the ALJ] articulates 

a specific justification for it.” Hunter v. Soc. Sec. Admin., Comm’r, 808 

F.3d 818, 823 (11th Cir. 2015).

State agency medical consultants, like Dr. Lifrak and Dr. 

Meltzer, are considered experts in social security disability 

evaluations, and the ALJ must consider and assign weight to their 

opinions in the same manner as other medical sources. See 20 

C.F.R. §§ 404.1527(e), 404.1513a(b). The weight to be given to a 

non-examining physician’s opinion depends on, among other 

considerations, the extent to which it is consistent with other 

23 In 2017, the SSA amended its regulations and removed the “controlling 

weight” requirement for all applications filed after March 27, 2017. See 20 

C.F.R. §§ 404.1527, 404.1520c. Because Gresham filed her DIB application in 

2015, the former regulations apply.

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32 Opinion of the Court 22-13807

evidence. See id. § 404.1527(c)(4). When reviewing the report of a 

consultative examiner, the ALJ considers whether the report 

“provides evidence [that] serves as an adequate basis for 

decision-making,” “is internally consistent,” and “is consistent with 

the other information available.” Id. § 404.1519p(a)(1)-(3). 

In this case, the ALJ provided good cause for not giving 

controlling weight to the opinions of Dr. Krasner, Dr. Wynn, Dr. 

Lifrak, and the functional assessment prepared by Thrive Physical 

Therapy. For instance, the ALJ explained that he gave little to no 

weight to Dr. Krasner’s numerous opinions between 2015 and 2020 

because Dr. Krasner’s opinions as to Gresham’s limitations and her 

inability to work were not supported by the objective medical 

evidence. The ALJ’s conclusion is reinforced by the record. Dr. 

Krasner’s opinions were not supported by many of the objective 

medical findings, including the physical therapy progress reports. 

Furthermore, although Dr. Krasner opined in 2020 that Gresham 

had impairments that met the agency’s Listing of Impairments and 

was therefore disabled, a medical source’s opinion that a claimant 

is “disabled” or “unable to work” is not dispositive of a disability 

claim because that determination is reserved to the agency. 20 

C.F.R. § 404.1527(d)(1); Walker v. Soc. Sec. Admin., Comm’r, 987 F.3d 

1333, 1339 (11th Cir. 2021). 

Turning to the opinions of Dr. Wynn, the surgeon who 

treated Gresham for her hernia, the ALJ explained that he gave 

limited weight to Dr. Wynn’s opinion—namely, that Gresham was 

unable to work between August and September 2019 and that 

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22-13807 Opinion of the Court 33

Gresham should be restricted from pushing, pulling, prolonged 

sitting, standing, or walking, and lifting more than 10 pounds—

because the evidence as a whole did not support these restrictive 

limitations. Similarly, the ALJ explained that he gave no weight to 

Dr. Wynn’s opinion that, as of September 23, 2019, Gresham could 

perform her normal duties “up to her capacity” because the 

opinion provided no specific functional limitations. Where, as 

here, the ALJ provides a specific justification for affording lesser 

weight or otherwise discounting a treating physician’s opinion, we 

will not second guess the ALJ’s decision. See Hunter, 808 F.3d at 

823.

Next, the ALJ provided good cause for giving only limited 

weight to the opinion of the consulting doctor, Dr. Lifrak, who 

opined in 2016 that Gresham could lift or carry weights of up to 10 

pounds and could perform activities requiring her to walk, either 

indoors or outdoors; climb stairs; sit for a total of six hours out of 

an eight-hour day; stand for a total period of six hours out of an 

eight-hour day.24 Specifically, the ALJ found that the lift and carry 

capacity proposed by Lifrak was unsupported by the mostly 

normal strength findings in the medical records. The ALJ’s 

statement is supported by the collective medical evidence and 

24 Notably, aside from the lift/carry restriction, Dr. Lifrak’s restrictions were 

less restrictive than those found by the ALJ. Thus, even if the ALJ had given 

Dr. Lifrak’s opinion controlling weight, it would not have changed the 

outcome. 

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34 Opinion of the Court 22-13807

provides good cause for giving only limited weight to Dr. Lifrak’s 

opinion.

Likewise, the ALJ explained that he gave limited weight to 

the Thrive Physical Therapy Functional Assessment Report which 

limited Gresham to part-time light duty work with a flexible 

schedule because the unidentified examiner indicated that he or 

she was unable to fully assess Gresham’s abilities and limitations 

due to restrictions that Gresham was still under from her hernia 

surgery. The ALJ’s statement provides good cause for giving the 

assessment limited weight, and is consistent with the examiner’s 

statement in the report. See Winschel, 631 F.3d at 1179. 

Furthermore, the assessment was prepared for purposes of 

Gresham’s disability application, and, therefore, it was not a 

“treating source” and not entitled to controlling weight. See 20 

C.F.R. § 404.1527(a)(2) (“We will not consider an acceptable 

medical source to be your treating source if your relationship with 

the source is not based on your medical need for treatment or 

evaluation, but solely on your need to obtain a report in support of 

your claim for disability.”).

Finally, the ALJ explained that he gave great weight to Dr. 

Meltzer’s opinion because Dr. Meltzer “had the opportunity to 

review [Gresham’s] entire file” and he provided an RFC supported 

by the objective medical evidence in the record. The ALJ’s 

statement is supported by substantial evidence in the record. 

Accordingly, the ALJ provided specific justifications for 

giving less than controlling weight to Gresham’s the challenged 

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22-13807 Opinion of the Court 35

opinions and for giving greater weight to Dr. Meltzer’s opinion. 

Thus, the ALJ satisfied the good cause standard, and we will not 

second guess the ALJ’s decision. See Hunter, 808 F.3d at 823; see also 

Crawford, 363 F.3d at 1158–59 (“Even if the evidence preponderates 

against the Commissioner’s findings, we must affirm if the decision 

reached is supported by substantial evidence.” (quotation 

omitted)). Consequently, we affirm. 

AFFIRMED.

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