Bekkem v. Wilkie , 915 F.3d 1258 ( 2019 )


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  •                                                                             FILED
    United States Court of Appeals
    Tenth Circuit
    PUBLISH                       February 12, 2019
    Elisabeth A. Shumaker
    UNITED STATES COURT OF APPEALS                    Clerk of Court
    TENTH CIRCUIT
    ANUPAMA BEKKEM,
    Plaintiff - Appellant,
    v.                                                        No. 17-6186
    ROBERT WILKIE, Secretary, U.S.
    Department of Veterans Affairs,*
    Defendant - Appellee.
    APPEAL FROM THE UNITED STATES DISTRICT COURT
    FOR THE WESTERN DISTRICT OF OKLAHOMA
    (D.C. No. 5:14–CV–00996–HE)
    Amber L. Hurst (Mark Hammons with her on the reply brief), of Hammons, Gowens &
    Hurst, Oklahoma City, Oklahoma, for Plaintiff-Appellant.
    Scott Maule, Assistant U.S. Attorney (Robert J. Troester, Acting U.S. Attorney, and Tom
    Majors and Daniel J. Card, Assistant U.S. Attorneys, with him on the brief), Oklahoma
    City, Oklahoma, for Defendant-Appellee.
    Before LUCERO, McKAY, and MATHESON, Circuit Judges.
    McKAY, Circuit Judge.
    *
    Current Secretary Robert Wilkie has been automatically substituted for the prior
    Secretary pursuant to Rule 43(c)(2) of the Federal Rules of Appellate Procedure.
    Plaintiff Anupama Bekkem brought this action against her employer, the
    Department of Veterans Affairs, based on numerous instances of discrimination and
    retaliation she allegedly experienced while working as a primary care physician for the
    VA in the Oklahoma City area. The district court dismissed some of her claims under
    Rule 12(b)(6) and granted summary judgment in favor of Defendant on the remaining
    claims. On appeal, Plaintiff seeks reversal of the district court’s ruling as to four of her
    claims, all of which arise under Title VII of the Civil Rights Act of 1964: (1) gender
    discrimination based on unequal pay; (2) retaliation based on the VA’s choice of a
    different physician to fill a medical director position after Plaintiff had made protected
    complaints of discrimination; (3) retaliation based on a written reprimand she received
    after sending an email complaining of discrimination in physician pay; and (4)
    discrimination because of race, sex, color, national origin, and/or religion based on the
    same written reprimand. The first three of these claims were disposed of on summary
    judgment; the final claim was dismissed under Rule 12(b)(6) for failure to state a
    plausible claim for relief.
    I.
    Because Plaintiff raises a claim regarding her pay, it is necessary as an initial
    matter to briefly describe how VA physicians’ pay is calculated. The salaries of VA
    physicians are “governed by a complex scheme of statute, regulation, VA handbooks, and
    internal agency guidance and rules.” (Appellant’s App. at 366.) A VA physician’s
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    annual salary includes three components: (1) base pay, which is determined solely by “the
    physician’s length of service with the VA”; (2) market pay, which is based on an
    individualized assessment of several factors including the physician’s experience and
    accomplishments, the needs of the facility where the physician is assigned, and the
    applicable healthcare labor market for the physician’s specialty or assignment; and (3)
    performance pay, which is based on the achievement of performance objectives set by
    management and may not exceed the lower of $15,000 or 7.5% of the physician’s
    combined base pay and market pay. (Id. at 367.) See 38 U.S.C. § 7431. A physician may
    also receive an additional discretionary payment of retention pay, relocation pay, and/or
    recruitment pay in certain circumstances. (Appellant’s App. at 367-68.)
    Under the applicable statute and VA policy, a physician’s market pay should be
    reviewed at least once every two years by a compensation panel, which makes salary
    recommendations to the medical director of the regional VA healthcare system.
    38 U.S.C. § 7431(c)(5); (Appellant’s App. at 368-69). The regional medical director is
    the ultimate decisionmaker on the question of physician pay and may thus accept, reject,
    or alter the compensation panel’s recommendations. Compensation panels are composed
    of a diverse group of men and women from different medical services. These panels meet
    weekly, and the particular panel members participating in each week’s review may vary.
    Compensation panels do not review all VA physicians’ market pay at the same time, but
    rather conduct individual pay reviews that “tend to be spread out due to scheduling
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    demands, efficiency, and need.” (Appellant’s App. at 369.)
    Plaintiff began working for the VA healthcare system in 2006. Following a
    compensation panel review, she received a market pay increase in May 2009. On
    January 1, 2011, the federal government instituted a pay freeze that would last for three
    years. Due to the freeze, VA officials were instructed that market pay adjustments to
    physicians’ salaries could only be granted “under exceptional circumstances.” (Id. at
    565.) Given this guidance, the regional Oklahoma City VA network “did not always
    conduct pay panel reviews within the obligatory two-year period, because management
    felt there was no reason if there could effectively be no change to market salaries.” (Id. at
    370.) Both male and female doctors from various medical services did not receive timely
    biennial compensation panel reviews during the pay freeze. The VA presented evidence
    that, due to the staggered nature of the biennial compensation reviews, “those physicians
    who received a compensation panel review closest to the implementation of the pay
    freeze tended to have higher market pay,” while those—like Plaintiff—whose last review
    had occurred further before the pay freeze “tended to have their lower pre-review salary
    locked in for the full three years of the pay freeze, which resulted in some pay
    discrepancies in all of the various services.” (Id.) Moreover, the competitive labor
    market and the fact that newly hired physicians were not locked in to an existing salary
    meant that newly hired physicians were sometimes brought in at salaries that exceeded
    many of the longer-term physicians’ salaries, contributing to the pay discrepancies across
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    the various medical services. According to the VA’s uncontested expert evidence,
    “[t]here [wa]s no statistically significant difference in the . . . market pay of female and
    male primary care physicians” employed in the regional VA healthcare system throughout
    the relevant time period. (Id. at 378.)
    Plaintiff’s supervisor—a physician who supervised Plaintiff first as the Medical
    Director of Primary Care and then as the Chief of Ambulatory Care—initiated a pay
    review for Plaintiff in 2012, during the pay freeze. He did not participate in her
    compensation panel review, which occurred in July 2012 and recommended only an
    increase in base pay. In accordance with the compensation panel’s recommendation and
    the guidance given to VA management officials regarding implementation of the pay
    freeze, the regional medical director approved an increase of $3,267 in Plaintiff’s base
    pay but did not adjust her market pay.
    In September 2012, Plaintiff transferred from the main VA clinic in Oklahoma
    City to a satellite clinic office that the parties refer to as the North May clinic. In early
    2013, Plaintiff began having problems with a registered nurse who had recently been
    assigned to her four-person team at the North May clinic. Their relationship deteriorated
    to the point that each of them contacted an Equal Employment Opportunity counselor in
    May 2013 to complain of a hostile work environment. In her May 2013 contact with the
    EEO, Plaintiff asserted that she had been subjected to a hostile work environment and
    discrimination based on her “sex (female), National Origin (India), race (Asian-Indian),
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    color (Brown), [and] religion (Hindu).” (Id. at 72.)
    On August 8, 2013, Plaintiff’s supervisor sent an email to several VA physicians,
    including Plaintiff, about the shifts they needed to fill at a regional clinic that had recently
    lost two primary care physicians. The attached schedule indicated that Plaintiff’s
    supervisor was scheduled to spend four days working at the clinic, while Plaintiff was
    scheduled for a single day there. Plaintiff responded to her supervisor’s email with her
    own lengthy email, sent on August 19, 2013, in which she asserted that she should not be
    required to “cover at [the clinic] because you in the physician management[] couldn’t do
    your jobs right.” (Id. at 485.) She stated, “You all can fix your mess-ups by going to [the
    clinic] yourself and taking care of the patients there. . . . Since I didn’t get a $50,000 raise
    like you did, I don’t think I should be the one to fix your mistakes.” (Id.) She further
    stated that she had “turned down an extra $13,000 for weekend ER coverage” and was
    unwilling to now accept an increase in her work load with no compensation. (Id.)
    Plaintiff copied several VA health-care providers in her response to her supervisor and
    then forwarded her response to numerous other VA employees as well.
    Plaintiff continued to have problems with the nurse assigned to her team at the
    North May clinic, and on August 27, 2013, her supervisor sent her an email informing her
    that the physician management had decided to separate her from the “dysfunctional
    environment” in her team by transferring her back to the main VA facility in Oklahoma
    City as of August 29, 2013. (Id. at 490.) Plaintiff responded with an email, also sent on
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    August 27, 2013, which she again forwarded to numerous other VA employees. In this
    email, she complained about the way her supervisor and other management officials had
    handled the conflict between Plaintiff and the nurse on her team. She complained that
    this nurse was “lazy and vindictive,” described her as an insubordinate liar, and accused
    VA managers, particularly her supervisor, of various types of wrongdoing. (Id. at
    489–90.) Plaintiff then stated that she would be proceeding with a formal EEO
    complaint.
    Approximately thirty minutes after sending this email, still on the evening of
    August 27, 2013, Plaintiff sent another email to numerous VA employees, including her
    supervisor and other management officials. This email was entitled “Information
    received by filing a FOIA request related to my EEO action related to Ambulatory Care
    Physic[i]ans’ pay.” (Id. at 492.) In this email, Plaintiff explained that she had filed a
    Freedom of Information Act request to obtain the salary data of physicians employed by
    the VA regional network in Oklahoma City, which she was attaching to her email for her
    colleagues to consider. She suggested that the other physicians review this data and draw
    their own conclusions, and she listed some of the conclusions she had drawn. For
    instance, she had concluded that “[f]emales seem to be paid less than males” and, “[i]n
    general, Foreign Born or non-white physicians make less than white physicians.” (Id.)
    She also observed that one male doctor had apparently been paid for two years while he
    was away pursuing a fellowship, and she asked: “I wonder how we too can get this
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    awesome deal? Maybe some money changed hands to make this happen?” (Id.) She
    advised her colleagues to “[r]eview the data at your leisure and figure out your worth to
    the organization.” (Id.)
    In a letter dated August 27, 2013, Plaintiff’s supervisor informed her that he was
    proposing a reprimand for inappropriate conduct. He specified three reasons for the
    proposed reprimand:
    Specification 1: On or about August 27, 2013 you exhibited inappropriate
    conduct in an email that you sent to me and multiple other employees. In
    the email you stated to me, among other things, “I was already a US citizen
    the day I started at this job, unlike you who used the VA to get your visa
    paperwork done. . . . [The nurse] is lazy and vindictive. . . . The physician
    management has no backbone, and all you are interested in is dumping
    work on the rank and file, and padding your paychecks. . . .”
    Specification 2: On or about August 19, 2013 you exhibited inappropriate
    conduct in an email that you sent to me and multiple other employees. In
    the email you stated to me, among other things, “So we have to cover at [the
    other clinic] because you in the physician management, couldn’t do your
    jobs right. . . . So how come you need us to help you now, with something
    you and the rest or [sic] leadership team messed up? You all can fix your
    mess-ups by going to [the clinic] yourself and taking care of the patients
    there. . . .”
    Specification 3: On or about August 27, 2013 you sent an inappropriate
    email to several employees who you labeled “Colleagues.” In the email you
    alleged various complaints regarding the pay of physicians at this facility.
    In your email you made an allegation by stating, “Maybe some money
    changed hands to make this happen?”
    (Id. at 483 (most alterations in original).) On September 30, 2013, after considering
    Plaintiff’s response to the proposed reprimand, the Chief of Staff—Plaintiff’s second-line
    supervisor—issued a reprimand for the same reasons stated in the proposed reprimand.
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    Plaintiff was informed that a copy of the reprimand would be placed in her electronic
    Official Personnel Folder and that “any future offenses or violations of rules for which
    disciplinary action would be appropriate could result in a more severe penalty, up to and
    including removal.” (Id. at 495.)
    Plaintiff filed a formal EEO complaint on September 5, 2013, and an amended
    complaint on November 21, 2013. In her amended EEO complaint, she not only
    reiterated her previous complaints of discrimination and a hostile work environment, but
    also claimed retaliation on numerous grounds, including her receipt of a reprimand while
    her informal EEO complaint was pending.
    The pay freeze ended on December 31, 2013, and Plaintiff’s supervisor soon
    thereafter recommended a compensation panel review and pay raise for Plaintiff. The
    compensation panel reviewed her pay in March and April of 2014 and recommended two
    different raises that together increased Plaintiff’s market pay (and thus her total pay) by
    more than $20,000. Plaintiff’s supervisor participated in both of these favorable
    compensation panel reviews. The regional director approved the compensation panel’s
    recommendations, and thus Plaintiff received the recommended increase of more than
    $20,000 to her total salary soon after the pay freeze ended.
    Plaintiff filed this federal lawsuit in September 2014, alleging discrimination and
    retaliation based on numerous allegedly improper actions taken by her employer. As
    pertinent here, she alleged that her pay was lower than other comparable physicians’ pay
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    because of her gender and/or other protected characteristics and that the reprimand she
    received in September 2013 was based on discriminatory and/or retaliatory motives.
    In November 2014, the VA posted a job opening for a position as the medical
    director of the North May clinic where Plaintiff had worked from September 2012
    through August 2013. The clinic had not previously had an official medical director, but
    a primary care physician who worked at this clinic had been volunteering as a liaison or
    lead physician, carrying out all the responsibilities that the new medical director position
    would entail, since September 2012. Plaintiff’s supervisor was responsible for making
    the hiring decision for this position, and he received applications from only two
    applicants who met the minimal qualifications required to serve as the medical director
    for the North May clinic: the physician who had already in essence been acting as the
    medical director of the clinic for the past two years in his volunteer role as lead physician,
    and Plaintiff. In January 2015, each candidate was interviewed by a panel of medical
    providers. Each member of the panel scored the North May clinic lead physician higher
    than Plaintiff. Plaintiff afterwards complained to her supervisor that the panel members
    had asked her about her prior EEO activity. He accordingly disregarded the results of
    these interviews and requested a second panel to be constituted of “four individuals (men
    and women) who were not believed to have knowledge of Plaintiff’s EEO complaint, and
    an H.R. representative.” (Id. at 361; 584–85.) This second panel interviewed both
    candidates, and again each panel member gave the lead physician higher scores than
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    Plaintiff. Plaintiff’s supervisor then conducted his own interviews of each candidate and
    selected the North May lead physician to fill the new medical director position. Plaintiff
    was informed that she had not been selected for this position on March 23, 2015.
    Also in March 2015, the district court dismissed several of the discrimination
    claims in Plaintiff’s complaint under Rule 12(b)(6) for failure to state a claim upon which
    relief could be granted. The court held that the only claim of discrimination which stated
    a plausible claim for relief was Plaintiff’s claim of unequal pay based on her gender. All
    of Plaintiff’s other claims of discrimination, including her claim of race, sex, color,
    national origin, and/or religious discrimination based on the reprimand she received,
    failed to state a plausible claim for relief because “‘there is nothing other than sheer
    speculation to link’” the complained-of acts “‘to a discriminatory motive.’” (Id. at 94
    (quoting Khalik v. United Air Lines, 
    671 F.3d 1188
    , 1194 (10th Cir. 2012) (ellipsis
    omitted)).) With the exception of her gender pay claim, Plaintiff’s complaint simply
    “contain[ed] no facts from which it c[ould] be inferred that defendants [discriminated
    against her] because of a protected characteristic.” (Id.)
    Plaintiff filed an amended complaint to attempt to address these deficiencies, but
    the district court held that her conclusory assertion that “[o]ther physicians, who did not
    share in [her] protected characteristics” were treated differently was insufficient to
    support the inference that the VA discriminated against her based on her membership in a
    particular protected class. (Id. at 194.)
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    In October 2015, Plaintiff filed a second amended complaint, adding a new claim
    of retaliation based on the VA’s decision not to hire her for the medical director position
    at the North May clinic.
    The district court ultimately granted summary judgment in favor of Defendant on
    each claim raised in the second amended complaint, holding that the facts, taken in the
    light most favorable to Plaintiff, demonstrated that Defendant was entitled to judgment as
    a matter of law on each claim.
    Plaintiff appeals the district court’s entry of summary judgment as to three of the
    claims included in her second amended complaint: (1) gender discrimination under Title
    VII of the Civil Rights Act based on unequal pay; (2) retaliation under Title VII based on
    her non-selection for the North May medical director position; and (3) retaliation under
    Title VII based on the September 2013 reprimand. She also appeals the district court’s
    earlier dismissal of her claim of Title VII discrimination based on the same reprimand.
    II.
    We review the district court’s entry of summary judgment de novo, applying the
    same standards as the district court. Adler v. Wal-Mart Stores, Inc., 
    144 F.3d 664
    , 670
    (10th Cir. 1998). We also review de novo the district court’s dismissal of a claim under
    Rule 12(b)(6). 
    Khalik, 671 F.3d at 1190
    . “Our review of each of the district court’s
    rulings requires us to view the allegations and evidence in the light most favorable to
    [Plaintiff as] the non-movant.” Witt v. Roadway Express, 
    136 F.3d 1424
    , 1428 (10th Cir.
    -12-
    1998).
    To survive summary judgment on a Title VII claim of discrimination based on
    race, color, religion, sex, or national origin, a plaintiff must present either direct evidence
    of discrimination or indirect evidence that satisfies the burden-shifting framework of
    McDonnell Douglas Corp. v. Green, 
    411 U.S. 792
    (1973). See 
    Khalik, 671 F.3d at 1192
    .
    Under the McDonnell Douglas framework, a plaintiff must first “raise a genuine issue of
    material fact on each element of the prima facie case, as modified to relate to differing
    factual situations.” Morgan v. Hilti, Inc., 
    108 F.3d 1319
    , 1323 (10th Cir. 1997) (citation
    omitted). The burden then “shifts to the employer to offer a legitimate nondiscriminatory
    reason for its employment decision.” 
    Id. If the
    employer does so, “the burden then
    reverts to the plaintiff to show that there is a genuine dispute of material fact as to
    whether the employer’s proffered reason for the challenged action is pretextual—i.e.,
    unworthy of belief.” 
    Id. (internal quotation
    marks omitted).
    A claim of Title VII retaliation can likewise be proven either by direct evidence or
    by reliance on the McDonnell Douglas framework. 
    Khalik, 671 F.3d at 1192
    . To state a
    prima facie Title VII retaliation claim, “a plaintiff must show (1) that she engaged in
    protected opposition to discrimination, (2) that a reasonable employee would have found
    the challenged action materially adverse, and (3) that a causal connection existed between
    the protected activity and the materially adverse action.” 
    Id. at 1193
    (internal quotation
    marks and brackets omitted).
    -13-
    We begin by addressing Plaintiff’s claim of gender discrimination based on
    unequal pay. As an initial matter, it is important to note the scope of this claim. First,
    this claim is based solely on the time period between September 2011 and March 2014, a
    period which corresponds with the federal pay freeze for all but the last three months.
    Second, this claim is limited to the market pay component of Plaintiff’s total salary and
    does not include any claims relating to base pay, performance pay, or any other aspects of
    her compensation. Finally, Plaintiff’s claim of pay discrimination is based entirely on the
    actions of her supervisor, who she alleges held discriminatory bias against women.
    Specifically, she contends that her supervisor caused her to receive lower pay than male
    VA physicians by failing to recommend an earlier compensation panel review of her
    salary during the pay freeze and/or by failing to recommend that her market pay be
    increased during this time period. She does not allege—and has presented no evidence to
    suggest—any discrimination on the part of the compensation panel that reviewed her pay
    in 2012 or any of the regional directors who were the ultimate decisionmakers on the
    question of her pay.
    Because Plaintiff has presented no direct evidence of discrimination, we analyze
    her claim under the burden-shifting McDonnell Douglas framework. At the first step of
    this analysis, we assume without deciding that Plaintiff has presented sufficient evidence
    to establish a prima facie case of pay discrimination. At the second stage of this analysis,
    the VA has come forward with a legitimate, non-discriminatory reason that Plaintiff’s pay
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    was lower during the relevant time period than many other VA physicians (both male and
    female) with comparable experience—due to the timing of the federal pay freeze in
    conjunction with the biennial pay review process, the market pay component of Plaintiff’s
    salary was frozen at an amount fixed in May 2009, while many other physicians’ pay was
    frozen at a higher amount that had been fixed at a later date. The VA has also explained
    that there were two exceptions to the freeze in market pay increases: (1) some physicians
    received a market pay increase, with a corresponding increase in their total salary,
    because they took on additional duties during the pay freeze; and (2) a new accounting
    policy caused certain other types of pay (specifically, relocation, recruitment, and
    retention pay) to be recharacterized as market pay, thus increasing the market pay
    component of some physicians’ salaries without affecting the total compensation they
    received. Neither of these exceptions was applicable to Plaintiff—or to a number of other
    VA physicians—because she did not take on additional job duties during the pay freeze,
    and she had not been receiving any of the types of pay that were recharacterized as
    “market pay” during the freeze. Finally, the VA has explained that, because market pay
    could not be increased during the pay freeze unless one of these two exceptions applied,
    VA officials “did not always conduct pay panel reviews within the obligatory two-year
    period, because management felt there was no reason if there could effectively be no
    change to market salaries,” and thus “[b]oth males and females, in many different services
    . . . , did not receive timely [biennial] compensation panel review.” (Appellant’s App. at
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    370.) The VA’s proffered evidence of these non-discriminatory reasons for the pay
    situation during the federal pay freeze is sufficient to meet its “exceedingly light burden,”
    Montes v. Vail Clinic, Inc., 
    497 F.3d 1160
    , 1173 (10th Cir. 2007) (internal quotation
    marks omitted), at the second stage of the McDonnell Douglas analysis.
    Thus, the burden now reverts back to Plaintiff to establish pretext. To show that
    the VA’s proffered gender-neutral reasons for Plaintiff’s delayed compensation panel
    review and lack of a market pay increase during the pay freeze were pretextual, Plaintiff
    must show that the proffered reasons “were so incoherent, weak, inconsistent, or
    contradictory that a rational factfinder could conclude the reasons were unworthy of
    belief.” Young v. Dillon Cos., 
    468 F.3d 1243
    , 1250 (10th Cir. 2006) (quoting Stover v.
    Martinez, 
    382 F.3d 1064
    , 1076 (10th Cir. 2004)). “Mere conjecture that the employer’s
    explanation is a pretext for intentional discrimination is an insufficient basis for denial of
    summary judgment.” 
    Morgan, 108 F.3d at 1323
    (internal quotation marks and brackets
    omitted).
    Plaintiff first argues that the VA’s explanation is false because male physicians
    received market pay increases during the pay freeze even when they did not take on
    additional job duties or have other components of their pay recharacterized as market pay.
    Plaintiff’s only evidence in support of this argument is the pay stub of one male physician
    who she contends did not fall into either of the VA’s asserted exceptions to the pay freeze
    because his pay stub shows that he received an increase in both market pay and total
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    salary despite the fact that he remained assigned to general internal medicine at the time
    of the salary increase. Notably, however, this pay stub in fact indicates that this physician
    received a “change in assignment” warranting a pay increase even though he kept
    working in general internal medicine (Appellant’s App. at 711), which appears to be
    entirely consistent with the Chief of Ambulatory Care’s explanation that this physician
    received higher market pay because, “in addition to and outside his Monday through
    Friday primary care working hours,” he “performs specialized duties such as
    compensation and pension exams and environmental exams for Agent Orange patients”
    (id. at 364). Plaintiff has presented no other evidence to support her contention that male
    physicians received market pay increases outside the two exceptions identified by the VA,
    and we are persuaded that the pay stub is insufficient to create a material dispute of fact
    on this point.
    Second, Plaintiff argues that a jury could find pretext because the VA’s
    explanations have been inconsistent. She contends that the VA first stated that market
    pay could only be increased if physicians took on additional job duties, but later added a
    new purported reason for market pay increases by mentioning that other components of
    pay were recharacterized as market pay during the pay freeze. This argument is based
    solely on Plaintiff’s mischaracterization of the evidence. In fact, the VA’s explanation
    has been entirely consistent throughout this litigation. In discussing physicians’
    “salaries,” of which market pay is only one component part, Plaintiff’s supervisor
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    explained that physicians could only obtain salary increases during the pay freeze by
    taking on additional job duties. (Id. at 620.) He also explained that some apparent salary
    increases had not actually been increases to the physician’s salary, but simply reflected a
    recharacterization of the component parts of their salary for accounting purposes. The
    VA has never deviated from this explanation, which is supported by contemporaneous
    records that Plaintiff has done nothing to refute.
    Third, Plaintiff argues that the jury could find the VA’s explanation to be
    pretextual because the VA prepared a table showing individual physicians’ pay from 2009
    to 2014 that Plaintiff argues is “inaccurate and misleading” because it “overstat[es]
    female pay and leav[es] out other kinds of pay components.” (Appellant’s Opening Br. at
    22.) Plaintiff does not further elaborate on these accusations. To the extent she is
    attempting to re-assert the argument she made below that the chart is inaccurate because it
    does not include performance pay as a component of the physicians’ total compensation,
    we note that Plaintiff’s claim of discrimination is limited solely to the issue of market pay,
    and we are not persuaded that a reasonable jury could find the VA’s explanation for the
    market pay freeze to be pretextual simply because the VA’s chart does not include a
    comparison of a category of physician pay that is not at issue in this case. Moreover,
    Plaintiff has waived this and any other challenge to the accuracy of this evidence by
    failing to adequately brief or support her argument. See 
    Adler, 144 F.3d at 679
    .
    -18-
    Fourth, Plaintiff contends that the jury could find pretext because her supervisor
    demonstrated bias towards women by allegedly selecting male physicians over female
    physicians for positions of authority and later expressing dissatisfaction with Plaintiff’s
    filing of an EEO complaint. However, even assuming the jury could draw some inference
    of gender bias from these purported facts, in order to establish pretext Plaintiff “must still
    show some nexus,” Shorter v. ICG Holdings, Inc., 
    188 F.3d 1204
    , 1210 (10th Cir. 1999),
    between her supervisor’s discriminatory statements or actions and the adverse
    employment action at issue in this case. Even when a decisionmaker has made
    discriminatory statements, this is insufficient to establish such a nexus; rather, something
    in the decisionmaker’s statements must link them to the adverse employment action at
    issue in the case. 
    Id. Plaintiff has
    shown no such nexus. The adverse employment action
    at issue here is the VA’s failure to increase Plaintiff’s market pay from September 2011
    until March 2014. She contends her supervisor caused this adverse action by failing to
    recommend her for a compensation panel review during the federal pay freeze. However,
    her supervisor in fact recommended her for a compensation panel review in mid-2012,
    and it was the compensation panel and the regional director, not Plaintiff’s supervisor,
    who decided not to increase her market pay. Plaintiff has presented no evidence—nor has
    she even argued or alleged—that the compensation panel or regional director held any
    discriminatory animus, and she has likewise presented no evidence that her supervisor
    affected their decision to follow the VA’s guidelines for market pay increases during the
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    pay freeze. Nor has Plaintiff presented any evidence suggesting that she would have
    received an increase in market pay during the pay freeze if her supervisor had
    recommended her for a compensation panel review at any point between September 2011
    and July 2012, while the same pay freeze policies were in effect. Thus, she has not
    shown that her supervisor even affected her market pay during the pay freeze, much less a
    nexus between the pay she received and her supervisor’s hiring practices or his attitude
    toward her subsequent filing of an EEO complaint. Finally, we note that Plaintiff does
    not address the short period of time that elapsed between the end of the federal pay freeze
    on December 31, 2013, and her next compensation panel review—recommended by her
    supervisor—in mid-March 2014. The record reflects that Plaintiff was in India on FMLA
    leave when the pay freeze ended, and, to the extent any argument regarding this time
    period was not waived by Plaintiff’s failure to specifically address it, we are not
    persuaded that the jury could find pretext based on the timing of her compensation panel
    review after her return.
    Fifth, Plaintiff argues that a rational factfinder could find the VA’s explanation to
    be pretextual simply because her pay was lower than several male physicians’ pay during
    the relevant time period. However, where the VA came forward with a non-
    discriminatory explanation for this apparent disparity in pay, the existence of the apparent
    disparity does not in itself prove that the VA’s explanation must be a pretext for
    discrimination. See E.E.O.C. v. Flasher Co., 
    986 F.2d 1312
    , 1319 (10th Cir. 1992)
    -20-
    (“Title VII does not make unexplained differences in treatment per se illegal nor does it
    make inconsistent or irrational employment practices illegal. It prohibits only intentional
    discrimination based upon an employee’s protected class characteristics.”). To hold
    otherwise would eviscerate the McDonnell Douglas framework by allowing a plaintiff to
    establish pretext simply by reiterating her prima facie case. Cf. Reeves v. Sanderson
    Plumbing Prods., Inc., 
    530 U.S. 133
    , 148 (2000) (“[A] plaintiff’s prima facie case,
    combined with sufficient evidence to find that the employer’s asserted justification is
    false, may permit the trier of fact to conclude that the employer unlawfully
    discriminated.” (emphasis added)). The mere fact that Plaintiff’s pay was lower than
    several of her male colleagues’ pay is insufficient to show that the VA’s proffered
    explanation for her lower pay was unworthy of belief.
    Finally, Plaintiff points out that in evaluating pretext we do not “look at each piece
    of evidence in isolation,” but rather consider all of the plaintiff’s evidence “in its totality,”
    Orr v. City of Albuquerque, 
    531 F.3d 1210
    , 1215 (10th Cir. 2008), and she contends that
    the district court erred in analyzing each of her arguments on pretext separately rather
    than considering her arguments and evidence as a whole. We see no such error in the
    district court’s analysis, and we further note that, while we here address Plaintiff’s
    arguments sequentially for ease of analysis, we have considered her evidence in its
    totality and find all of her evidence, taken as a whole, insufficient to permit an inference
    -21-
    of pretext. We accordingly affirm the district court’s entry of summary judgment in favor
    of Defendant on Plaintiff’s claim of gender discrimination based on unequal pay.
    We turn then to Plaintiff’s claim of retaliation based on her supervisor’s selection
    of a male physician instead of Plaintiff for the position of North May medical director.
    As previously noted, to establish a prima facie case of Title VII retaliation, Plaintiff must
    show “(1) that she engaged in protected opposition to discrimination, (2) that a reasonable
    employee would have found the challenged action materially adverse, and (3) that a
    causal connection existed between the protected activity and the materially adverse
    action.” 
    Khalik, 671 F.3d at 1193
    (internal quotation marks and brackets omitted).1 We
    hold that Plaintiff has failed to establish a prima facie case of retaliation because she has
    not established a causal connection between any protected activity and her non-selection
    for the medical director position.
    To establish a causal connection, a plaintiff must “present evidence of
    circumstances that justify an inference of retaliatory motive.” Ward v. Jewell, 
    772 F.3d 1
              Like the district court, we note that it is not entirely clear whether Plaintiff, as a federal
    employee, can bring a retaliation claim against the VA. See Green v. Brennan, 
    136 S. Ct. 1769
    ,
    1774 n.1 (2016) (assuming without deciding that such a claim could be brought); see also 
    id. at 1792
    n.2 (Thomas, J., dissenting) (arguing that federal employees may not bring Title VII
    retaliation claims because “Title VII’s federal-sector provision incorporates certain private-sector
    provisions related to discrimination but does not incorporate the provision prohibiting retaliation
    in the private sector”). Because neither the parties nor the district court have addressed this
    argument, we will likewise assume without deciding that such a claim is available to Plaintiff.
    We express no opinion as to whether the district court should address this issue on remand of the
    second retaliation claim, nor do we express any opinion as to what the correct resolution of this
    issue would be.
    -22-
    1199, 1203 (10th Cir. 2014) (internal quotation marks omitted). “If the protected conduct
    is closely followed by the adverse action, courts have often inferred a causal connection.”
    
    Id. However, a
    three-month gap between protected activity and an adverse action is too
    long to support an inference of causation on its own. Anderson v. Coors Brewing Co.,
    
    181 F.3d 1171
    , 1179 (10th Cir. 1999). Thus, where a gap of three months or longer has
    occurred, a plaintiff must present other evidence—“‘more than mere speculation,
    conjecture, or surmise’”—to establish that her protected activity was a but-for cause of
    the adverse employment action. 
    Ward, 772 F.3d at 1203
    (quoting Bones v. Honeywell
    Int’l, Inc., 
    366 F.3d 869
    , 875 (10th Cir. 2004)); see also Univ. of Tex. Sw. Med. Ctr. v.
    Nassar, 
    570 U.S. 338
    , 352 (2013).
    It is undisputed in this case that Plaintiff’s last protected activity occurred more
    than three months before the VA decided not to select her for the medical director
    position. (See Appellant’s Opening Br. at 30 (“[Plaintiff’s] most recent protected activity
    was her Sept. 16, 2014, filing of a federal gender discrimination lawsuit.”); see also
    Appellant’s App. at 361 (stating that the first set of interviews occurred in January 2015);
    
    id. at 691
    (indicating that Plaintiff’s non-selection for the position occurred on March 23,
    2015).) Plaintiff argues that she presented other evidence of causation in the form of her
    testimony that in 2013 her supervisor expressed anger regarding her filing an EEO
    complaint and said he did not want her to continue with the complaint. We note that her
    testimony was rather ambiguous on this point. Although she said, “Yes,” when asked
    -23-
    whether her supervisor ever expressed anger at her filing the complaint, her own
    explanation of the situation was:
    He was angry at me complaining about [the nurse assigned to her team at
    North May] and he was angry about revealing all the stuff what is going on
    in the primary care to the chief of staff and the medical director. And he
    would nitpick on small administrative stuff and comment on those. . . . So
    he was very upset.
    (Appellant’s App. at 664–65.) Despite being asked to elaborate, Plaintiff never described
    a single conversation in which her supervisor’s alleged anger was directed at her EEO
    complaint of discrimination rather than personnel problems. Likewise, although Plaintiff
    testified broadly that her supervisor “didn’t want [her] to continue with the EEO
    complaint,” when she was asked to elaborate on any conversations in which her
    supervisor told her not to continue with the complaint, she responded:
    It was before I formally complained to the EEO, just around the time when I
    met with [another VA physician manager]. Also when he dropped by one
    time, he said this is not right, you are not supposed to do these things
    and—but I cannot reassign [the North May nurse], but you have to suck it
    up and just do it. You don’t have a choice, if you want to, we can send you
    back to the main VA to be punitive in that sense.
    (Id. at 665.) On cross-examination, Plaintiff clarified that she did not remember exactly
    what her supervisor said, but she inferred that he meant she should not be pursuing an
    EEO complaint. (Id. at 817.)
    Even viewing this ambiguous testimony in the light most favorable to Plaintiff, we
    still are not persuaded that a reasonable jury could find a non-speculative link between
    Plaintiff’s supervisor’s alleged attitude towards her EEO complaint in 2013 and
    -24-
    Plaintiff’s non-selection for the position as North May medical director in 2015. First, we
    note that any link between Plaintiff’s supervisor’s vague alleged comments in 2013 and
    his hiring decision in 2015 is attenuated in both time and subject. Plaintiff has presented
    no evidence that her supervisor ever mentioned her discrimination action after she filed
    her formal EEO complaint in the fall of 2013. She argues that a jury could infer that her
    supervisor was still angry about the discrimination action in 2015 because he told her at
    that time that he would make sure she did not get the medical director position. However,
    Plaintiff’s own testimony clarifies that her supervisor said he would not hire her for this
    position specifically because of her acrimonious “history with [the nurse] at the North
    May clinic,” not for any other reason. (Id. at 669.) On appeal, Plaintiff asks us to
    speculate that her supervisor was instead motivated by the same anger he had allegedly
    expressed towards her EEO complaint in 2013, but none of her evidence supports this
    speculation. Moreover, Plaintiff’s supervisor’s alleged statements in 2013 were centered
    around her relationship with the nurse at the North May clinic, not the EEO complaint,
    and the only action he allegedly threatened to take against her was to transfer her back to
    the main office in Oklahoma City. He did not threaten her with any other consequences
    for either her personnel complaints or her EEO complaint, and in fact the intervening year
    saw him recommending and participating in two compensation panel reviews in which
    Plaintiff received a salary increase of more than $20,000, contrary to Plaintiff’s
    -25-
    speculative assertion that he continued making adverse employment decisions against her
    because of lingering retaliatory animus.
    Additionally, any possible connection that could be drawn between Plaintiff’s
    complaint of discrimination and her later non-selection for the position as North May
    medical director is further negated by the uncontested record evidence regarding the
    relative merits of the two applicants for this position. It is undisputed that the other
    applicant had in essence already been acting as the medical director of the North May
    clinic for the past two years in a volunteer capacity, carrying out all of the responsibilities
    that this new position would now entail. In contrast, Plaintiff had been transferred away
    from the North May clinic in 2013 because of the dysfunctional relationship she had with
    a nurse who was employed there. As we held in Ward, “[a] reasonable fact-finder could
    not infer retaliation from the decision to keep another employee in his job rather than
    replace him with someone who had admittedly experienced ‘interaction issues’ with other
    
    employees.” 772 F.3d at 1204
    . Plaintiff has presented no evidence of any way in which
    she was objectively more qualified than the North May clinic lead physician to fill the
    position of North May clinic medical director; to the contrary, the uncontested record
    evidence reflects that the other physician had significantly more experience than Plaintiff
    both in the medical profession generally and with the VA specifically, and Plaintiff has
    not shown that she had any additional certifications or qualifications that he lacked.
    Additionally, the panel of medical directors who interviewed Plaintiff and the North May
    -26-
    clinic lead physician unanimously scored him higher than Plaintiff. In her deposition,
    Plaintiff not only conceded this fact, but also conceded that the other applicant “should
    score higher” because of his two years of experience acting as the North May clinic
    liaison. (Appellant’s App. at 463.) Even taken in the light most favorable to Plaintiff, the
    facts of this case simply do not “‘justify an inference of retaliatory motive,’” 
    Ward, 772 F.3d at 1203
    (quoting Williams v. W.D. Sports, N.M., Inc., 
    497 F.3d 1079
    , 1091 (10th Cir.
    2007)), in the VA’s decision to hire the North May clinic lead physician instead of her for
    the position of North May medical director. Plaintiff has failed to meet her burden of
    showing that “the desire to retaliate was the but-for cause of the challenged employment
    action,” 
    Nassar, 570 U.S. at 352
    , and we thus affirm the district court’s grant of summary
    judgment in favor of Defendant on this claim of retaliation.
    Nevertheless, we reach the opposite conclusion on Plaintiff’s second claim of
    retaliation, which is based on the written reprimand she received for sending three emails
    that her supervisor found objectionable, including an August 27 email she entitled
    “Information received by filing a FOIA request related to my EEO action related to
    Ambulatory Care Physic[i]ans’ pay,” which discussed the data allegedly supporting her
    claim of discrimination. (Appellant’s App. at 492.) The VA does not dispute that the
    reprimand, recommended on the same day Plaintiff sent this email, is sufficient to
    establish a prima facie case of retaliation, but it contends that Plaintiff has not come
    forward with sufficient evidence of pretext to rebut the VA’s legitimate non-retaliatory
    -27-
    reason for the reprimand. However, taking all of the evidence and the inferences to be
    drawn therefrom in the light most favorable to Plaintiff, we are persuaded that Plaintiff’s
    evidence is sufficient for a jury to find the VA’s proffered explanation to be pretextual,
    and we therefore reverse the district court’s ruling.
    The proposed reprimand included the following paragraph, which was
    incorporated by reference into the actual reprimand issued in September 2013:
    Specification 3: On or about August 27, 2013 you sent an inappropriate
    email to several employees who you labeled “Colleagues.” In the email you
    alleged various complaints regarding the pay of physicians at this facility.
    In your email you made an allegation by stating, “Maybe some money
    changed hands to make this happen?”
    (Appellant’s App. at 483.) The VA asserts that it had a legitimate, non-retaliatory reason
    to reprimand Plaintiff for sending this email: as noted in the last sentence of Specification
    3, Plaintiff made an accusation of bribery in her email, and this accusation of criminal
    behavior warranted a reprimand. The VA acknowledges that the reprimand also mentions
    Plaintiff’s “alleg[ation of] various complaints regarding the pay of physicians at [the
    VA].” (Id.) However, the VA contends that the reprimand mentioned these allegations
    merely to clarify which August 27 email was the subject of Specification 3, while the
    reprimand itself was based only on the accusation of bribery described in the third
    sentence of the specification. This may be a plausible explanation of the reprimand, but it
    is not the only plausible explanation. Although a jury might ultimately agree with the
    VA’s explanation, the facts taken in the light most favorable to Plaintiff are sufficient to
    -28-
    support a reasonable inference that the reprimand actually mentioned Plaintiff’s
    allegations of discrimination for the simple reason that Plaintiff’s supervisor wanted to
    punish her for sending her colleagues an email that alleged the VA was discriminating
    against female, foreign-born, non-white physicians. Given the timing and the wording of
    the reprimand, we are persuaded that Plaintiff has met her burden of showing that a
    reasonable jury could find the VA’s explanation to be “‘pretextual—i.e., unworthy of
    belief,’” 
    Morgan, 108 F.3d at 1323
    (quoting Randle v. City of Aurora, 
    69 F.3d 441
    , 451
    (10th Cir. 1995)). We therefore reverse the entry of summary judgment in favor of
    Defendant on this claim and remand this claim for further proceedings.
    Finally, we address the district court’s Rule 12(b)(6) dismissal of Plaintiff’s claim
    of race, sex, color, national origin, and/or religious discrimination based on the
    reprimand. In her original complaint, Plaintiff alleged that the reprimand was
    discriminatory simply because “[o]ther physicians had sent similar emails on similar
    issues of concern and have not been reprimanded for those actions.” (Appellant’s App.
    at 7.) After the district court held that this allegation failed to state a plausible claim of
    discrimination, Plaintiff amended her complaint to allege that “[o]ther physicians, who
    did not share in [Plaintiff’s] protected characteristics and who had not engaged in
    protected activity, had sent similar emails on similar issues of concern and had not
    received reprimands or similar discipline for having done so.” (Id. at 108.) Her
    complaint then asserted, “It appeared that the reprimand was issued, because of her
    -29-
    protected characteristics, specifically female, from India, brown, Asian-Indian, and/or of
    the Hindu religion, and/or as reprisal for her having engaged in protected activity.” (Id. at
    108–09.) Her amended complaint contained no other allegations to support this claim of
    discrimination.
    A complaint raising a claim of discrimination does not need to conclusively
    establish a prima facie case of discrimination, but it must contain more than
    “‘[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory
    statements.’” 
    Khalik, 671 F.3d at 1193
    (quoting Ashcroft v. Iqbal, 
    556 U.S. 662
    , 678
    (2009)). “While we do not mandate the pleading of any specific facts in particular,” a
    plaintiff must include enough context and detail to link the allegedly adverse employment
    action to a discriminatory or retaliatory motive with something besides “sheer
    speculation.” 
    Id. at 1194.
    “[A] plaintiff should have”—and must plead—“at least some
    relevant information to make the claims plausible on their face.” 
    Id. at 1193
    . Thus, it is
    insufficient for a plaintiff to allege, for instance, that she did not receive an employment
    benefit that “similarly situated” employees received. Hwang v. Kan. State Univ., 
    753 F.3d 1159
    , 1164 (10th Cir. 2014). A plaintiff’s assertion that she is “similarly situated” to
    other employees is “just a legal conclusion—and a legal conclusion is never enough.” 
    Id. Rather, a
    plaintiff must allege “some set of facts”—not just legal conclusions—“that
    taken together plausibly suggest differential treatment of similarly situated employees.”
    
    Id. “Pleadings that
    do not allow for at least a reasonable inference of the legally relevant
    -30-
    facts are insufficient.” Burnett v. Mortg. Elec. Registration Sys., Inc., 
    706 F.3d 1231
    ,
    1236 (10th Cir. 2013) (internal quotation marks omitted).
    Plaintiff’s amended complaint fails to satisfy this standard. Although she asserts
    that other, non-reprimanded physicians were similarly situated because they “sent similar
    emails on similar issues of concern,” (Appellant’s App. at 108), this is too conclusory to
    permit a reasonable inference of “differential treatment of similarly situated employees,”
    
    Hwang, 753 F.3d at 1164
    . Most notably, “[f]or all we know from [Plaintiff’s]
    complaint,” 
    id., these other
    physicians addressed their “similar issues of concern,”
    (Appellant’s App. at 108), without launching into the string of insults and accusations that
    Plaintiff included in each of the emails for which she was reprimanded; lacking any facts,
    we cannot assume that these physicians were similarly situated simply because Plaintiff
    has asserted that they were so. See 
    Hwang, 753 F.3d at 1164
    . Her lack of any details also
    makes it impossible to parse out her numerous theories of discrimination, because she
    fails to identify or describe the other physicians who sent purportedly similar emails, but
    simply alleges that these physicians “did not share in [her] protected characteristics” and
    then makes the conclusory assertion that the reprimand “appeared” to be based on “her
    protected characteristics, specifically female, from India, brown, Asian-Indian, and/or of
    the Hindu religion.” (Appellant’s App. at 108–09 (emphasis added).) With no additional
    details, her conclusory assertion that physicians who did not share in one or more of her
    protected characteristics went unpunished for sending “similar” emails is insufficient to
    -31-
    “indicate that racial [or other] discrimination was the plausible, rather than just the
    possible reason” for her reprimand. McCoy v. Wyoming, 683 F. App’x 662, 665 (10th
    Cir. 2017); see also 
    Iqbal, 556 U.S. at 678
    (“Where a complaint pleads facts that are
    merely consistent with a defendant’s liability, it stops short of the line between possibility
    and plausibility of entitlement to relief.” (internal quotation marks omitted)). Plaintiff’s
    complaint thus fails to give rise to a reasonable inference of discrimination relating to the
    reprimand, and we affirm the district court’s dismissal of this claim.
    Plaintiff argues in the alternative that the district court should have granted her a
    second chance to amend her complaint so she could add factual allegations regarding the
    purportedly similarly situated physicians whose emails went unpunished. “We review the
    district court’s decision to deny leave to amend a complaint for an abuse of discretion.”
    Wilkerson v. Shinseki, 
    606 F.3d 1256
    , 1267 (10th Cir. 2010). The district court denied
    leave to amend in this case because Plaintiff—with the benefit of counsel—had already
    been granted one opportunity to amend her complaint to include facts which would give
    rise to a reasonable inference of discrimination. District courts have the discretion to
    deny leave to amend for “‘failure to cure deficiencies by amendments previously
    allowed,’” 
    id. (quoting Duncan
    v. Manager, Dep’t of Safety, Denver, 
    397 F.3d 1300
    ,
    1315 (10th Cir. 2005)), and Plaintiff has not shown that the district court abused its
    discretion here. We therefore affirm the district court’s discretionary decision to deny
    leave to further amend this claim.
    -32-
    III.
    For the foregoing reasons, we AFFIRM the district court’s entry of summary
    judgment in favor of Defendant on Plaintiff’s claims of discrimination based on unequal
    pay and retaliation based on her non-selection for the position as North May clinic
    medical director. We also AFFIRM the district court’s dismissal of her claim of
    discrimination based on the reprimand she received, as well as the district court’s denial
    of her request for a second chance to amend this claim. We REVERSE the district
    court’s entry of summary judgment on Plaintiff’s claim of retaliation relating to the
    reprimand, and we REMAND this claim for further proceedings before the district court.
    -33-