Pаtricia Casey’s applications for disability insurance benefits and supplemental security income benefits were denied by the Social Security Administration (SSA). Casey sought review before an administrative law judge (ALJ), who, after conducting a hearing, concluded that Casey was not disabled and denied the benefits. The SSA Appeals Council denied review, thereby rendering the ALJ’s decision the final agency determination. Casey sought review in the District Court, 2 which affirmed the decision of the agency. Casey appeals, and we affirm.
I.
Casey’s applications for benefits alleged that she became disabled and unable to work on June 11, 2002, due to fibromyal-gia, back pain, leg pain, depression, and other impairments. On the alleged onset date, she was 40 years old, had a 12th-grade education, and had completed a secretarial training course. She had previously worked as an administrative assistant, employment clerk, program manager, cashier, and waitress.
The ALJ evaluated Casey’s disability claim under the sequential analysis prescribed by the Social Security regulations.
See
20 C.F.R. § 404.1520. First» the ALJ found that Casey was not engaged in substantial gainful activity. Second, the ALJ concluded that Casey was severely impaired by the combination of “fibromyal-gia, status post left knee surgery, back pain secondary to past compression fracture and depression.” J.A. at 9. At the third step, the ALJ determined that Ca
II.
On appeal, Casey contends that the District Court committed reversible error in affirming the ALJ’s decision because the ALJ (1) gave improper weight to medical opinions in the record, (2) improperly discredited Cаsey’s subjective complaints of pain, and (3) erred in determining Casey’s RFC. We review de novo the District Court’s decision affirming the agency’s denial of benefits.
Travis v. Astrue,
A.
Casey first contends that the ALJ improperly weighed the medical evidence in determining that she was not disabled. In particular, Casey argues that the ALJ gave too little weight to the opinions of physicians that treated and examined her and too much weight to the opinion of a physician who performed a paper reviеw of the medical records.
The ALJ had a duty to evaluate the medical evidence as a whole.
See Hogan v. Apfel,
According to Casey, the ALJ’s “most оutrageous error” was the failure to credit the testimony of Lawrence Rettenmaier, M.D., the rheumatologist who treated Casey’s fibromyalgia. Appellant’s Br. at 25. Initially, it is important to note that contrary to Casey’s suggestion, the ALJ did not reject all of Dr. Rettenmaier’s opinions. The ALJ discussed and gave weight to Dr. Rettenmaier’s treatment records of December 2001 to May 2004. The ALJ only refused to give weight to Dr. Rettenmaier’s opinion expressed in a Fi-bromyalgia RFC Questionnaire completed in July 2004. In the RFC Questionnaire, Dr. Rettenmaier simply discussed his ultimate conclusions about Casey’s limitations, specifically, that Casey could sit for fifteen to twenty minutes at a time, for a total of less than two hours in an eight-hour day; could stand for five to ten minutes at a time, for a total of less than two hours in an eight-hour day; would need unscheduled breaks during the workday; and would miss three or more days of work per month due to the severity of her symptoms. The ALJ characterized this opinion as “quite conclusory, providing very little explanation of the evidence relied on in forming the opinion as to why the claimant was so limited.” J.A. at 12. The ALJ further found that although Dr. Retten-maier did have a treating relationship with Casey, the record revealed that the actual treatment visits were infrequent.
We will discuss the ALJ’s determination of Casey’s RFC in Part II.C of this opinion. At this point, however, we note that substantial evidence supports the ALJ’s refusal to give the opinion of Dr. Retten-maier controlling weight. As we have stated, a treating physician’s opinion is entitled to controlling weight only to the extent that it is consistent with medically acceptable clinical or laboratory diagnostic data.
See Pena,
Casey began seeing Scott Meyer, M.D., for knee pain in April 2003. On August 14, 2003, Dr. Meyer performed osteotomy surgery on Casey’s left knee. On February 13, 2004, Casey reported that she was “much improved from where she was prior to her surgery” and “overall happy with the results of the surgery”; she reported only occasional soreness in her knee from using stairs or being bumped by her Saint Bernard. J.A. at 196. A physical examination on that date showed that Casey’s “[pjatella tracking appears to be good,” and that she could “do a straight leg raise without difficulty.” Id. Casey had “a little bit of quad atrophy present,” whiсh Dr. Meyer attributed to Casey “not being real consistent with her exercises” due to other health problems. Id. Significantly, Dr. Meyer cleared Casey to “return to her activities” without restriction. Id. We also note that an x-ray taken of Casey’s knees on July 3, 2002, showed “[njormal knees,” with no “effusion, fracture or dislocation.” Id. at 136.
In addition to contrasting Dr. Retten-maier’s opinion with the medical records of other treating physicians, the ALJ appears to have discounted the opinion based on the infrequent nаture of the treatment visits.
See
20 C.F.R. § 404.1527(d)(2)(i). Dr. Rettenmaier saw Casey for the first time in “several years” on December 7, 2001. J.A. at 174. Thereafter, he treated her far less frequently than one would expect based on the pain that Casey alleges.
See Comstock v. Chater,
Next, Casey challenges the limited weight that the ALJ gave to the opinion of consulting examiner Shawn Richmond, M.D. Dr. Richmond examined Casey in September 2002. He noted in his report that Casey complained of neck, shoulder, and knee pain аnd that she reported experiencing “much discomfort in her back” when she performed work that required her to “sit in one place or do any kind of lifting.” J.A. at 138. Dr. Richmond’s physical examination of Casey revealed some reduced range of motion in her shoulders, left cervical spine, and hips, but normal range of motion overall. Dr. Richmond opined that Casey’s fibromyalgia and chronic back problems “would inter
Casey also takes issue with the ALJ’s reliance on the report of John May, M.D., an Iowa Disability Determination Services physician who reviewed the medical evidence in October 2002. Dr. May noted: “MRI of the thoracic spine reveals no evidence of spinal stenosis. She has end of range of motion restriction of the cervical and lumbar spinе.... She has generalized tenderness in both recognized tender points and control points.” Id. at 195. He concluded, however, that “her alleged level of impairment is not supported by significant positive physical findings.” Id. Although Dr. May found Casey’s impairments to be severe, he believed that she was capable of working within limits that he outlined in an RFC. Casey complains that Dr. May’s review was “premature” because he did not have access to later diagnoses by Drs. Retten-maier and Richmond. Appellаnt’s Br. at 24. Our review of the record shows that Dr. May’s October 23, 2002, report was consistent with the medical evidence as of that date. The later reports of Dr. Ret-tenmaier and Dr. Richmond were not entitled to significant weight, as we discussed above. The ALJ did not err in considering the opinion of Dr. May along with the medical evidence as a whole. 4
Finally, Casey challenges the ALJ’s interpretation of a consultative psychological evaluation performed by Dr. Jerald Catron, Ph.D., in September 2002. Dr. Catron noted that Casey was “preoccupied with physical symptoms” of pain, but found that she had no other psychological problems or evidence of a psychopathological condition. J.A. at 144. He stated that “[h]er history and behavior indicate that she has the ability to remember and understand instruction, procedures, and locations”; that she displayed “no indication of problems with attention, concentration, and pace”; that she “displayed adequate sociаl skills”; and that “[t]he intensity of her affective display was not congruent with her statements about depression.”
Id.
He noted, however, that Casey “regards her physical problems as making her unable to work because of pain.”
Id.
Dr. Catron ultimately diagnosed Casey with “pain disorder associated with both psychological factors and her general medical condition” and concluded that “[i]t is very
B.
Casey’s second argument on appeal is that the ALJ erred in finding her statements about the intensity and severity of her symptoms “not fully credible.” J.A. at 14. In
Polaski v. Heckler,
we noted several factors that an ALJ must consider in evaluating a claimant’s subjective complaints.
The ALJ properly identified the Polaski factors and considered evidence relevant to those factors. The ALJ ultimately found that Casey’s subjective complaints' of pain were inconsistent with medically objective evidence and the observations of third parties. The ALJ’s analysis of the medical evidence has been discussed above. Regarding the observations of third parties, the ALJ began by considering a Third Party Adaptive Functioning Questionnaire completed by Casey’s mother. In it; Casey’s mother indicated that Casey had good communication and social skills, had good functional academic skills, and engaged in significant independent activity. The ALJ found this report inconsistent with Casey’s allegations of disabling pain, difficulty with concentration, and limited activities. Casey does not challenge the truth of her mother’s answers in the questionnaire but, rather, argues that the questionnaire does not address all of her subjective complaints. While Casey’s assertion may be correct, it is of no consequence. It was certainly within the ALJ’s discretion to consider the questionnaire in аddition to other evidence in the record.
The ALJ also considered a Work Performance Assessment from Casey’s former employer. In it, the employer stated that he considered Casey’s performance ade
With regard to daily activities, the ALJ noted that Casey prepared supper for her family, drove locally, visited her parents’ house several times weekly, attended a bible study, and worked on the computer. Casey also testified that she was able to camp with her husband, swim, and paint ceramics. Moreover, the medical recоrds frequently reference Casey’s active lifestyle.
See, e.g.,
J.A. at 125 (noting that Casey dropped a heavy ceramic tile on her foot while she was remodeling), 129 (noting that Casey reported back pain and headache that began after “helping to lay carpet”), 135 (Casey reported spending “hours on the internet” at home), 174 (noting that Casey’s knee pain had flared up, possibly because she had been “laying carpet and doing some other physical activities at home”), 185 (diagnosing “sсiatica with low back pain” after Casey “lift[ed] something heavy”), 205 (reporting that Casey’s knees were bothering her after she rode a jet ski). While Casey’s ability to perform these activities does not disprove disability as a matter of law, “[i]nconsis-tencies between subjective complaints of pain and daily living patterns may ... diminish credibility.”
Pena,
The ALJ is responsible for deciding questions of fact, including the credibility of a claimant’s subjective testimony about her limitations.
Gregg v. Barnhart,
C.
Casey’s final argument is that the ALJ erred in determining her RFC. “The RFC is a function-by-function assessment of an individual’s ability to do work-related activities based upon all of the relevant evidence.”
Harris v. Barnhart,
The ALJ determined that Casey had the RFC to perform work with the following limitations: “occasionally lift ten pounds, frequently lift less than ten pounds, sit a total of six hours in an eight hour day, stand/walk at least two hours in an eight hour day and occasionally climb, balance, stoop, kneel, crоuch and crawl.” J.A. at 15. The ALJ stated that this determination was based generally on the report of Dr. May and “other subjective evidence of record.” Id. at 13. The ALJ further stated that Dr. May’s opinion was well supported and not inconsistent with the medical evidence in the record as a whole.
Casey argues that the ALJ’s RFC determination is inconsistent with her testimony, daily activity report, and medical evidence. According to Casey, if the ALJ had fully credited the opinions of Drs. Rettenmaier, Catron, and Richmond, аnd had not discounted Casey’s testimony and subjective complaints of pain, then the ALJ would have determined Casey’s RFC to be incompatible with the ability to work. As we discussed above, however, the ALJ did not err in her evaluation of the medical evidence or in discounting Casey’s subjective complaints. Casey challenges the ALJ’s reliance on Dr. May’s RFC opinion, directing us to
Nevland v. Apfel
where we reversed an ALJ’s decision because he relied on the opinions of nontreating, nonex-amining physicians in determining thе claimant’s RFC.
Our review of the record shows that the ALJ’s RFC determination is supported by Dr. May’s report, other medical evidence, and the subjective reports of Casey’s mother and former employer. We thus affirm the ALJ’s determination of Casey’s RFC.
III.
Overall, substantial evidence in the record supports the ALJ’s determination that Casey’s impairments did not inhibit her ability to perform her past relevant work and that Casey therefore was not disabled. Accordingly, we affirm.
Notes
. The Honorable Ronald E. Longstaff, United States District Judge for the Southern District of Iowa.
. RFC is defined as the most an individual can do despite the combined effects of her impairments. 20 C.F.R. § 494.1545.
. To the extent that Casey argues that the ALJ's denial of disability was based solely on Dr. May's report, her argument is not supported by the record.
. Casey also suggests that Dr. May might have been unaware of the fibromyalgia tender points identified by Drs. Rettenmaier and Richmond. Dr. May’s report acknowledges, however, that Casey suffers from fibromyalgia and "has generalized tenderness in both recognized tender points and control points.” J.A. at 195.
