c determination and that includes the want to just heard arguments and that involves also the step for findings as to whether a claimant with that r f c can perform his or her past work and any other work that exist severe impairment or a severe combination of impairments that more than minimally impact her ability to work so i have a question for you i take it that your response to that finding is that the record shows that she has fibro miles yes and i want to know what the record is going to tell me about the onset date of the fibro my allergies she applies in tw benefits before the application yes over the course of two thousand and ten and two thousand and eleven these doctors documented her repeated manifestation of the some magic symptoms and over the course of two thousand one and haven't tried to rule out other conditions that were causing these disorders and eventually dr blankenship concluded that she suffers from fibromyalgia so say a little bit more about the ruling out because one of the things that concerns  doing that how did that happen the ale jay actually did not discuss whether other conditions were ruled out that was the basis for the district court affirming the decision and the district of the ale j reasoned that conditions the record shows that beginning in two thousand and ten dr blinken stein reviewed multiple imaging studies that returned largely were normal results this and what was he looking for it is the records show that he was looking for i think a cause of her widespread pain she complained of pain in her nerve compression or describable it was one of her complaints sorry one of her complaints was pain in her neck and in her shoulders and in her upper extremities so he conducted he reviewed a c t scan of her neck and early two thousand and ten that was reviewing for degenerative changes he didn't find any she was also so you're basically saying that means he's ruling out degenerative changes in the cervical spinal area yes yes as has two thousand and ten and two thousand and eleven progress she notes her complaints of nausea abdominal pain and cramping as well as fatigue he orders laboratories to studies to assess for room and logical conditions which return normal results he reviews ultrasound of her abdomen that was performed in the emergency room that he referred to as stone cold normal at in two thousand eleven and again you know what what might he have sounder g t s does he reveal actually that's the real question does he indicate what might have been wrong is he looking for something in particular just something that doesn't look right to him i think well it's not a stomach problem because it looks fine he's looking and some of those laboratory studies he orders a rheumatoid factor test this is a test that doctors order to assess for information r because the claim that one of the claimants symptoms fatigue and weakness as well as widespread pain those tests were normal the complete blood counts that he did to assess for anemia were probably intended to review for some kind of gastrointestinal bleeding disorder that could have caused fatigue or could have caused her abdominal pain so what the record shows is that dr blinken stein and dr rashid over the course of two years were documenting repeated manifestations of sematic symptoms ruling out other conditions and eventually diagnosing fibromyalgia and the state agency consultants who reviewed the claim in early two thousand and eleven did not consider evidence of this diagnosis they did not review the medical evidence showing that other disorders were excluded over the course of time why wasn't the file i did they just not asked for it i don't understand why they didn't get the full file a lot of this is due to the chronological nature of these cases when  claimant applies at the agency they're evaluated within six months and a state agency consultant makes a determination and then when the claimant appeals that determination additional medical evidence is the pain before the agency's administrative law judge issues a decision sometimes eighteen months later so in this case the state agency doctors didn't see a diagnosis of fibromyalgia the claimant treating physicians ruled out other disorders which necessarily takes time and then diagnosed my alj of the commissioners adjudicator rejected that diagnosis because there was no examination showing tender points that rationale is not sufficient in light of the facts of this case and the relevant medical and legal authority and the commissioner effectively concedes that the able date and evaluate this condition this diagnosis under the two thousand and ten a c r criteria and that's enough to remain in this case the claimant if the claimant has one medically determinable severe impairment she's entitled to have a claim that evaluated in light of her hour of c and because she's of advanced age she would be entitled to a disability under the medical vocational guidelines for the finding that she can only perform well at work and that's consistent with dr rashid's opinion and without also  methodology it's true that the you know like she fits the two thousand and ten methodology so it's prejudicial while as the district court found there was not evidence that other disorders that could have caused those symptoms were excluded but actually mr browder has just spent the last five minutes telling us that that is completely wrong well plenty of evidence that there was rule out process there was a blood worked out in february of two thousand and ten when the doctor said it was tough to say if her symptoms the neither the l j nor the district court does they're obsessed about tender points i'm looking at page six of the just reports opinion in the district court also seems to think that only a specialist will do narrows it down to fibro my ocean it's responding to the lyrica which is another sign and he rules out other stuff i would say that even when he noted that the lyrica was improving he said she almost certainly has  two because if we were to think that that was error obviously there are more steps to go through you know there's step three step four and conceivably step five plus an r f c determination  think that's good enough because the i j of course is not a doctor and if there are two physicians who have said we've looked at this package of symptoms and we think they add up to fibro my all should there are two doctors who said that  then the l j has to proceed on that basis maybe there's another agency doctor often there is who says you know i've looked at the same package of system symptoms and i don't think so but we don't have evidence like that in this record that she sent for disability services at a college he only functional limitation and she noted it wasn't an ability to lift more than twenty pounds but but the the problem is fiber miles's is a severe disability and i think you're you're jumping ahead in the process if there is an r f c and she can live twenty pounds and maybe the agency shows that she's not entitled to benefits and step for step five because there are jobs at such a person could thank you very much anything further mr browder the commissioner takes credit a great pair makes great pains to qualify dr blank and starnes diagnosis of fibromyalgia but kind of overlooks that dr rashid also reached this diagnosis and from what the record shows it seems that these two were kind of treating the claimant together and the commissioner argues that this error should be excused because the a considered the claim and symptoms associated with fibromyalgia but the commissioner's policy rulings require that if an ale j does not find that an impairment is a medically determinable impairment under the regulations they cannot account for limitations associated with that impairment and finally i would point out that the commissioner is arguing that this error is kind of harmless because dr rashid said the claimant can lift twenty pounds under the medical vocational guidelines if she has an r f c where she cannot perform more than light work which requires her to stand and walk for six hours each day and lift twenty pounds occasionally if she can perform that work she's disabled under the