Full Opinion

United States Court of Appeals For the Eighth Circuit ___________________________ No. 25-2081 ___________________________ Rachael Michelle Post Plaintiff - Appellant v. Frank Bisignano, Commissioner of Social Security Administration Defendant - Appellee ____________ Appeal from United States District Court for the Eastern District of Missouri - St. Louis ____________ Submitted: April 15, 2026 Filed: August 28, 2026 ____________ Before KELLY, GRASZ, and KOBES, Circuit Judges. ____________ KOBES, Circuit Judge. The Commissioner of the Social Security Administration denied Rachael Post’s application for disability insurance benefits. The district court1 affirmed the Commissioner’s decision, and Post appeals. We affirm. 1 The Honorable Rodney W. Sippel, United States District Judge for the Eastern District of Missouri. I. Post suffered from pain, numbness, and tingling in both hands. She stopped working her retail job on June 3, 2016 after Dr. Grant Kleiber operated on her right hand and forearm and restricted her from working or lifting more than five pounds. Dr. Kleiber performed the same surgery on her left hand and forearm in early July. He recommended she remain off work until September 19. But the pain in her left hand persisted, and she did not return to work as planned. Dr. Kleiber operated on her left elbow and wrist on September 30, but the surgery did not resolve her symptoms. In February 2017, Dr. Kleiber diagnosed Post with thoracic outlet syndrome2 and referred her to Dr. Robert Thompson, a vascular surgeon. Dr. Thompson performed thoracic outlet release surgery on Post’s left shoulder in March, and on discharge, Registered Nurse Katherine Kolster told Post she should not lift more than five pounds with her left arm for the next two weeks. A month after her surgery, Post applied for disability insurance benefits. In the function report she submitted to the Social Security Administration, Post said that she could not lift more than five pounds and that her hands would lock up when she did repetitive motions. She acknowledged that she could do her own personal care, drive, prepare meals, do the dishes, shop for groceries, and do laundry. In June 2017, Dr. Thompson said that Post could return to work with the following restrictions: (1) no sustained overhead activities with her left upper extremity; (2) no prolonged repetitive activities with her left arm or hand; and (3) no lifting, pushing, or pulling more than five pounds with her left upper extremity. Post’s physical therapy records indicate that, although the range of motion and strength in her arms and hands were somewhat impaired, she was improving and had met six of her seven long-term goals. 2 A condition where nerves or blood vessels in the area between the collarbone and first rib are compressed, causing pain, numbness, and tingling in the upper extremities. -2- On August 8, Dr. John Marshall Jung, an ophthalmologist, reviewed Post’s medical records for the Social Security Administration. He concluded that she could do more than she said in her function report and that she could frequently lift up to ten pounds and had no limitations when it came to reaching, handling, or fingering. Although the symptoms in her left arm continued to improve, the symptoms in her right arm were becoming worse. On September 29, Dr. Thompson performed thoracic outlet release surgery on Post’s right shoulder. Nurse Practitioner Melissa Snyder-Rodgers followed up with Post in November and noted that she had recovered to the point that she had full range of motion and normal grip strength. In March 2018, Post was assessed by Dr. Michael Bonnette at the Washington University Pain Management Center. He reported that Post had normal range of motion and 5/5 strength in her upper extremities. Despite this, at an exam later that month, Nurse Practitioner Snyder-Rodgers said that Post should not lift anything over five pounds. Dr. Thompson examined Post in October. He said she had full range of motion and normal grip strength but still imposed a five-pound lifting restriction. During a January 2019 exam, Dr. Thompson noted that Post was again experiencing pain, numbness, and tingling, so he operated on both of her shoulders three months later. By the time of her follow-up exam in September, she had full range of motion and normal grip strength and could take classes online and walk her dog. But Dr. Thompson still recommended that she not return to work or lift anything over five pounds. Post continued to improve, so at a December exam, he raised her lifting limitation to ten pounds. But in February 2020, Post was experiencing muscle spasms, so he lowered her lifting restriction back to five pounds. Come July, Post had either met or partially met all of her physical therapy goals, and she had reported that she could throw a nerf football with her son, take care of her family while her brother was in the hospital, help clean her nephew’s apartment, and frequently do housework. And in September, she had full strength and range of motion in her shoulders and no longer needed physical therapy. On -3- August 5, 2021, Dr. Thompson said that she could return to work if she didn’t lift more than five pounds. Post returned to work on August 13 as a cafeteria cashier. An administrative law judge considered Post’s application for disability insurance benefits for the closed period of June 3, 2016 to August 5, 2021. Relying on Post’s 2017 function report, her physical therapy records, her examination records, and the various medical opinions, the ALJ determined that Post had the residual functional capacity to perform sedentary work—meaning “lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools”—as long as she avoided climbing. 20 C.F.R. § 404.1567(a) (defining sedentary work). The ALJ also found that she could frequently handle, finger, and reach for things. A vocational expert testified that there were a significant number of jobs in the national economy for individuals with those limitations, so the ALJ concluded that Post was never disabled. II. “We review de novo a district court’s decision upholding the Commissioner’s denial of [disability insurance] benefits and will affirm the ALJ’s decision if it is ‘supported by substantial evidence on the record as a whole.’” Andrews v. Colvin, 791 F.3d 923, 928 (8th Cir. 2015) (citation omitted). “Substantial evidence is less than a preponderance but enough that a reasonable mind would find it adequate to support the conclusion.” Id. (cleaned up). We may not reverse just because “we would have decided the case differently.” Krogmeier v. Barnhart, 294 F.3d 1019, 1022 (8th Cir. 2002). Rather, we can only disturb the ALJ’s decision if it “f[ell] outside the available zone of choice.” Bonham v. Bisignano, 177 F.4th 934, 942 (8th Cir. 2026) (citation omitted). To be entitled to benefits, Post must have been disabled. Halverson v. Astrue, 600 F.3d 922, 929 (8th Cir. 2010). Disabled means unable to “engage in any other kind of substantial gainful work which exists in the national economy” for at least twelve continuous months. 42 U.S.C. § 423(d)(1)(A) and (d)(2)(A); accord -4- Barnhart v. Walton, 535 U.S. 212, 218 (2002). To determine whether Post could do that, the ALJ first had to determine her residual functional capacity—“the most [she could] do despite [her] limitations.” Hensley v. Colvin, 829 F.3d 926, 931 (8th Cir. 2016) (citing 20 C.F.R. § 404.1545(a)). That must be “based on all of the relevant evidence, including [her] medical records, observations of treating physicians and others, and [her] own description of [her] limitations.” Id. at 932 (citation omitted). Post argues that the ALJ’s finding that she had the residual functional capacity to perform sedentary work was not supported by substantial evidence. She claims that the ALJ should not have relied on Dr. Jung’s opinion and says that without it, the evidence shows that she could lift only five pounds, meaning she could not perform sedentary work and was disabled. At oral argument, she conceded that if the ALJ properly relied on Dr. Jung’s opinion, her claim for disability insurance benefits fails. The ALJ did not err in relying on Dr. Jung’s opinion. “ALJs evaluate the persuasiveness of medical opinions by considering (1) whether they are supported by objective medical evidence, (2) whether they are consistent with other medical sources, (3) the relationship that the source has with the claimant, (4) the source’s specialization, and (5) any other relevant factors.” Bowers v. Kijakazi, 40 F.4th 872, 875 (8th Cir. 2022) (citing § 404.1520c(c)). Supportability and consistency are the most important factors. Id. (citing § 404.1520c(a)). Under the substantial evidence standard, our review on this issue is limited to “whether the ALJ adequately analyzed persuasiveness[,] not whether we agree with the ALJ’s evaluation of the record evidence.” Bonham, 177 F.4th at 944 (citation omitted). “Accordingly, we uphold ALJ decisions that weigh conflicting medical evidence and reach a conclusion that does not comport with all the medical evidence.” Id. at 944–45. The ALJ thoroughly evaluated Dr. Jung’s opinion, finding that it was consistent with (1) Post’s reports that she drove, walked her dog, did dishes, helped to clean out her nephew’s apartment, and was busy with housework, and (2) medical records showing that she had normal upper extremity strength, full range of motion, -5- and normal grip strength. The ALJ also evaluated the opinions from Dr. Kleiber, Registered Nurse Kolster, Dr. Thompson, and Nurse Practitioner Snyder-Rodgers but did not find them persuasive because they were inconsistent with the same evidence. Post argues that the ALJ erred in finding that her reported activities supported Dr. Jung’s opinion because “the ability to do activities such as light housework” does not support “[a] finding that [she could] perform full-time competitive work.” Hogg v. Shalala, 45 F.3d 276, 278 (8th Cir. 1995). But Post did more than just “light housework.” She drove, walked her dog, threw a nerf football, and frequently did housework. It was reasonable for the ALJ to find that these activities supported Dr. Jung’s conclusion that she could lift more than five pounds and undermined contrary medical opinions. See Ross v. O’Malley, 92 F.4th 775, 780 (8th Cir. 2024) (“[T]estimony of performing small repairs, brief work riding a lawn mower, and driving short distances, combined with his monthly trips to stores and his ability to fish, contradicts his testimony that his head, neck, and back disabilities completely prevent him from working in the national economy.”); cf. Swarthout v. Kijakazi, 35 F.4th 608, 612 (8th Cir. 2022) (“While ‘daily activities alone do not disprove disability, they are a factor to consider in evaluating subjective complaints of pain.’” (citation omitted)). And even if Post’s reported daily activities weren’t inconsistent with a five-pound lifting restriction, the ALJ reasonably relied on her medical records, which showed that she had normal strength and full range of motion in her upper extremities. See Bonham, 177 F.4th at 944 (ALJ’s decision supported by substantial evidence where he relied on medical records “show[ing] 5/5 motor strength and normal muscle groups and good range of motion in all limbs”); see also § 404.1529(c)(2) (“[E]vidence of reduced joint motion, muscle spasm, sensory deficit or motor disruption . . . is a useful indicator to assist [ALJs] in making reasonable conclusions about the intensity and persistence of [a claimant’s] symptoms.”). Post also argues that the ALJ should not have relied on Dr. Jung’s opinion because, after Dr. Jung performed his evaluation, she had additional surgeries and -6- received four more years of treatment. New evidence “after the medical source made his or her medical opinion” may make the medical opinion “less persuasive.” § 404.1520c(c)(5). But it doesn’t necessarily make the ALJ’s reliance on the opinion an error. The ALJ acknowledged the limitations of Dr. Jung’s opinion but relied on it nonetheless because she found that it was consistent with the medical evidence. Dr. Thompson performed a thoracic outlet release on Post’s right shoulder about a month and a half after Dr. Jung’s August 8 evaluation, but by March 2018, Post had full range of motion and full strength in her arms. Dr. Thompson then performed an additional surgery on Post’s shoulders in April 2019, but she also recovered well from this operation to the point that Dr. Thompson himself raised Post’s lifting restriction to ten pounds in December. By September 2020, she had full range of motion and full strength in her shoulders and no longer required physical therapy. Although the subsequent surgeries indicate Post continued to suffer from thoracic outlet syndrome, her subsequent recoveries are consistent with Dr. Jung’s opinion that she could lift up to ten pounds. We will not disturb an ALJ’s decision to rely on a medical opinion “merely because there is evidence supporting two inconsistent conclusions.” Bonham, 177 F.4th at 945 (citation omitted). “The weighing of evidence is ultimately reserved to the ALJ.” Id. (cleaned up). The ALJ’s analysis complied with § 404.1520c, and it was not improper to rely on Dr. Jung’s opinion. Accordingly, the ALJ’s finding that Post could lift up to ten pounds was within the zone of choice, and her conclusion that Post was not disabled was supported by substantial evidence. III. Affirmed. ______________________________ -7-