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Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 

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United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued September 19, 2003 Decided January 13, 2004

No. 02–5312

JOAN S. BUTLER,

APPELLANT

v.

JO ANNE B. BARNHART,

COMMISSIONER, SOCIAL SECURITY ADMINISTRATION,

APPELLEE

Appeal from the United States District Court

for the District of Columbia

(No. 99cv00488)

Stephen F. Shea argued the cause for the appellant.

Fred E. Haynes, Assistant United States Attorney, argued

the cause for the appellee. Roscoe C. Howard, Jr., United

States Attorney, and R. Craig Lawrence, Assistant United

States Attorney, were on brief. Mark E. Nagle, Assistant

United States Attorney, entered an appearance.

 Bills of costs must be filed within 14 days after entry of judgment.

The court looks with disfavor upon motions to file bills of costs out

of time.

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Before: HENDERSON, TATEL and GARLAND, Circuit Judges.

Opinion for the court filed by Circuit Judge HENDERSON.

KAREN LECRAFT HENDERSON, Circuit Judge: Joan Butler

appeals from the district court’s judgment affirming the

denial by the Social Security Administration (SSA) Commissioner (Commissioner) of her application for disability insurance benefits under Title II of the Social Security Act (Act),

42 U.S.C. §§ 401 et seq., and supplemental security income

under Title XVI of the Act, 42 U.S.C. §§ 1381 et seq. On

appeal Butler maintains that the decision of the Administrative Law Judge (ALJ) who evaluated her case is not supported by substantial evidence in the record and was reached

by the incorrect application of relevant legal standards. We

agree; therefore, we reverse the judgment of the district

court and remand to that court with instructions to remand in

turn to the Commissioner for further proceedings.

I. FACTUAL BACKGROUND

Joan Butler is today a 50–year-old woman with a tenthgrade education and no additional training, vocational or

otherwise. From 1990 through part of 1995, Butler worked

as an Environmental Services Technician (EST) at Greater

Southeast Community Hospital (GSCH) in Washington, D.C.;

in this capacity she performed such tasks as making beds,

mopping floors and cleaning. In early August 1995 Butler

suffered a severe migraine headache and was admitted to

GSCH. She stayed for four days, during which time she was

treated by a neurologist, Dr. William Lightfoote. His notes

indicate that Butler experienced three similar ‘‘episodes’’

during the past five years. Joint Appendix (JA) 163. He

placed her on medication (Inderal) and scheduled diagnostic

tests. The results of the tests were normal and Lightfoote

scheduled additional tests, including magnetic resonance imaging (MRI). On August 22, 1995 Butler attempted to return

to work but suffered another migraine; the following day she

saw Lightfoote who counseled her to remain off-duty for the

next five days.

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On August 29, 1995 Lightfoote reported that while Butler’s

headaches had subsided, she was experiencing ‘‘low back pain,

with radiation into the lateral aspect of both legs.’’ Id. 209.

Lightfoote noted that the pain prevented Butler from getting

out of bed. He ordered an MRI of the lumbar spine, an

electromyogram (EMG) and nerve conduction tests of both

lower extremities. The MRI found ‘‘narrowing and degeneration at L5–S1 TTT with a very small, subligamentous herniation of nuclear material to the right of midline that minimally

flattens the thecal sac. Narrowing and degeneration at L4–5

TTT with a diffusely bulging annulus TTT [and] mild dextroscoliosis.’’ Id. 156. Butler suffered another migraine on September 6, 1995 and the next day Lightfoote noted that she

should remain off-duty until additional medical opinions could

be obtained. Lightfoote also indicated that he would obtain a

second neurological opinion from Dr. Taghi Asadi.

On Lightfoote’s referral, Butler saw Dr. Alfred Pavot, who

performed an electroneurodiagnostic study. On September

11, 1995 Pavot reported that the results of the study were

consistent with lumbrosacral facet syndrome. Butler saw

Asadi later that week. Asadi’s report noted that Butler had

‘‘a history of low back pain’’ but was referred to him regarding the ‘‘diagnosis and management of her headaches.’’ Id.

207. He described her headaches as having ‘‘a character of

becoming cluster-like with more frequent attacks for a couple

of weeks’’ and noted that his physical examination revealed

‘‘no limitation of the cervical spine.’’ Id. Asadi concluded

that she suffered migraines with ‘‘aura’’ and started her on

Elavil, as she was already ‘‘receiving the maximum dose of

Inderal.’’ Id.

On October 17, 1995 Lightfoote observed that Butler continued to suffer lower back pain and diagnosed a herniated

inverterbral disc and lubrosacral facet syndrome. He noted

that when she returned to work she would ‘‘not be able to do

any lifting, bending, or stooping,’’ ‘‘no lifting greater than 10

pounds’’ and that this limitation would ‘‘have to be written in

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her ‘return-to-work contract.’ ’’1

 Id. 188. Later that month

Lightfoote completed a disability form for Butler, in which he

stated that he could not determine when she would be able to

return to work and described her condition as ‘‘severe limitation of functional capacity; incapable of minimal (sedentary)

activity.’’ Id. 101.

On November 16, 1995 Lightfoote reported that while

Butler’s headaches were ‘‘subsiding,’’ she continued to experience ‘‘significant’’ pain in her lower back. Id. 187. He noted

that Butler ‘‘can hardly get out of bed, without rolling over

first and rolling herself out of the bed to the floor,’’ ‘‘has

difficulty standing up’’ and suffers ‘‘severe pain radiating into

the lower extremities.’’ Id. He stated that he doubted she

would be able to return to her position at GSCH. On

December 9, 1995 Lightfoote described Butler’s condition as

‘‘migraine with visual fortification spectra, lumbar disc herniation and lumbar facet syndrome.’’ Id. 176. Based on this

diagnosis, he concluded that Butler was capable of performing

sedentary, clerical or administrative work with certain restrictions. Specifically, he noted that Butler could not sit or

stand for more than one hour at a time or lift objects heavier

than 10 pounds and that she should never climb, bend or

stoop. On a disability form completed around the same time,

Lightfoote noted these restrictions on Butler’s future work

activities but characterized her prognosis as ‘‘good.’’ Id. 153.

He further identified Butler as a candidate for rehabilitation

services, job modification and vocational counseling.

On January 23, 1996 Lightfoote opined that Butler’s headaches had become infrequent and concluded that she ‘‘is now

ready’’ to return to work in a capacity consistent with the

restrictions identified in his earlier reports. Id. 204. On

April 16, 1996 Lightfoote again observed that Butler’s head1 Although it appeared at this point that Lightfoote believed

Butler capable of lifting at most 10 pounds, his later reports plainly

found Butler incapable of lifting as part of any work activity. E.g.,

JA 125 (July 16, 1996 report), 126–28 (July 9, 1996 report and

disability form).

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aches were ‘‘very infrequent’’ but noted that her lumbar spine

problems persisted. Id. 203. He stated that she had a

herniated disk at two levels ‘‘at least’’ and some days could

not get out of bed. Id. He also referred her to Dr. Lavern

Bentt for lumbar epidural steroid injections.

In a report dated May 6, 1996 Bentt stated that during the

previous six months Butler’s back pain had progressively

worsened ‘‘to the point where she cannot sit up and stand out

of bed and needs to roll herself out of bed in order to avoid

excruciating pain.’’ Id. 148. Bentt also remarked that aside

from the moderate relief provided by physical therapy ‘‘there

has been nothing that [Butler] has tried so far which has

improved her pain.’’ Id. Bentt noted the results of a CT

myelogram, ‘‘which demonstrated mild anterior extradural

defects of the thecal sac at L4–5 and L5–S1.’’ Id. He

performed a therapeutic lumbar epidural injection and proposed a series of additional injections in the event the first

provided Butler ‘‘some degree of relief.’’ Id. Butler subsequently received two additional lumbar epidural injections.

At the time Butler received her third epidural injection, Bentt

noted that the previous two had succeeded in easing her pain;

each injection provided two weeks of complete relief but the

pain eventually returned, ‘‘although not to the same intensity

and degree.’’ Id. 132. His report also noted that her MRI

and CT myelogram showed ‘‘nerve root pathology at both L4–

5 and L5–S1.’’ Id. Bentt planned for Butler to return in two

to three weeks for diagnostic lumbar L4–5 and L5–S1 facet

joint injections. The record is silent on whether Butler

received the additional injections.

According to Lightfoote’s July 9, 1996 report, he completed

disability forms for Butler in which he recommended that her

job be modified to accommodate her back pain and headache

disorder and that she receive vocational counseling and/or

retraining. On the disability form, Lightfoote classified Butler’s physical impairments as ‘‘severe,’’ signifying that she is

‘‘incapable of minimal activity or sedentary work.’’ Id. 128.

Although he indicated that a job modification would enable

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Butler to work with her impairments, he explained that

Butler could not lift, bend, stoop, push or pull and characterized her prognosis for recovery as good to poor. Id. In his

July 16, 1996 report Lightfoote stated that Butler should

consider retirement on total disability or ‘‘cross-training with

Vocational Rehabilitation, so that she can get a job that does

not entail any lifting, bending, stooping or reaching.’’ Id.

125. In a November 3, 1996 report Lightfoote stated that

Butler was ‘‘continuing in a stable situation’’ but needed a

transcutaneous electrical nerve stimulator (TENS) unit—a

small device used to produce electroanalgesia—from GSCH.2

On November 19, 1996 Dr. James Yan, a neurologist,

evaluated Butler at the request of the Disability Determinations Division of the District of Columbia Rehabilitation Services Administration (Disability Determinations Division).

Yan noted that for the past three years, Butler’s ‘‘main

problem’’ had been ‘‘severe disk disease over the lumbosacral

area’’ but that she also was hospitalized as a result of her last

migraine headache, during which she experienced ‘‘a strokelike syndrome.’’ Id. 106. After finding that Butler ‘‘has

severe pain which causes inability to get up easily,’’ ‘‘cannot

stand up for too long,’’ ‘‘cannot lift heavy objects,’’ and suffers

‘‘complex migraine headaches, which come on almost once

every two months TTT [and] compromise her performance at

work,’’ Yan concluded that her examination was ‘‘otherwise

TTT basically within normal limits.’’ Id. 107. He also opined

that Butler’s spinal disks appeared to be within ‘‘normal

limits.’’ Id. On November 18, 1996 the Disability Determinations Division referred Butler to Dr. Harry Press for a

radiology study. Two days later, Press performed a lumbar

spine examination which revealed a ‘‘mild’’ scoliosis and atherosclerosis but was ‘‘otherwise negative.’’ Id. 104.

From December 1996 to March 1997, Lightfoote issued his

last set of reports contained in the record. On December 17,

2 Shortly thereafter, on November 5, 1996, Lightfoote reported

that Butler suffered an episode of migraine headaches.

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1996 Lightfoote stated that Butler received a TENS unit for

her lower back pain and that he added lithium carbonate to

her prescribed medications to combat her ‘‘lingering’’ headache disorder. Id. 198. On March 17, 1997 Lightfoote

opined that Butler continued to experience lower back pain

and ‘‘pounding in the head’’ and again adjusted her prescription regimen. Id. 196. On the same day he stated that

Butler had evidence of herniated nucleus pulposus (HNP) in

her lumbar region, that an independent medical examination

(IME) disclosed a possible herniated disc in the cervical

region and that she had severe migraine headaches. He

concluded that ‘‘at the present time[ ] [Butler] is 100% disabled from any gainful employment.’’ Id. 197.

The last report contained in the record is a residual functional capacity assessment completed on March 30, 1997 by

Dr. Hall, a medical consultant to the Disability Determinations Division. Hall’s evaluation of Butler’s exertional limitations found that she could occasionally lift and carry 20

pounds, frequently lift and carry 10 pounds, stand and/or

walk at least two hours in an eight-hour workday, sit for

about six hours in an eight-hour workday and had an unlimited ability to push and/or pull. With respect to her postural

limitations, Hall concluded that Butler was capable of occasionally climbing, balancing, stooping, kneeling and crouching,

but could never crawl or climb a ladder, rope or scaffold.

Hall also concluded that Butler must avoid concentrated

exposure to vibration. Hall acknowledged that his findings

regarding Butler’s limitations differed significantly from

those of her treating physician, Dr. Lightfoote.

II. STATUTORY FRAMEWORK

To qualify for disability insurance benefits and supplemental security income under Titles II and XVI of the Act, Butler

must establish that she is ‘‘disabled.’’ 42 U.S.C.

§§ 423(a)(1)(D), 1382(a)(1). ‘‘Disability’’ means the ‘‘inability

to engage in any substantial gainful activity by reason of any

medically determinable or mental impairment which can be

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expected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12

months.’’ Id. §§ 423(d)(1)(A), 1382c(a)(3)(A). With certain

exceptions not relevant here, an individual is disabled ‘‘only if

[her] physical or mental impairment or impairments are of

such severity that [she] is not only unable to do [her] previous

work but cannot, considering [her] age, education, and work

experience, engage in any other kind of substantial gainful

work which exists in the national economy.’’ Id.

§§ 423(d)(1)(A), 1382c(a)(3)(B).

The Commissioner has established a five-step sequential

evaluation process for assessing a claimant’s alleged disability. See 20 C.F.R. §§ 404.1520, 416.920. The claimant carries

the burden of proof on the first four steps. Id. §§ 416.1520,

416.920. First, the claimant must demonstrate that she is not

presently engaged in ‘‘substantial gainful’’ work. Id.

§§ 404.1520(b), 416.920(b). Second, a claimant must show

that she has a ‘‘severe impairment’’ that ‘‘significantly limits

[her] physical or mental ability to do basic work activities.’’

Id. §§ 404.1520(c), 416.920(c). Third, if the claimant suffers

from an impairment that meets the duration requirement and

meets or equals an impairment listed in Appendix 1 to the

Commissioner’s regulations, she is deemed disabled and the

inquiry is at an end. Id. §§ 404.1520(d), 416.920(d). If the

claimant does not satisfy step three, the inquiry proceeds to

the fourth step, which requires her to show that she suffers

an impairment that renders her incapable of performing ‘‘past

relevant work.’’ Id. §§ 404.1520(e), 416.920(e). Once a claimant has carried the burden on the first four steps, the burden

shifts to the Commissioner on step five to demonstrate that

the claimant is able to perform ‘‘other work’’ based on a

consideration of her ‘‘residual functional capacity’’ (RFC),

age, education and past work experience. Id. §§ 404.1520(f),

416.920(f). It is the ALJ’s application of this analytical

sequence that prompted Butler’s appeal.

III. PRIOR PROCEEDINGS

Butler applied for disability insurance benefits and supplemental security income on October 10, 1996 and September

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12, 1996, respectively, claiming that she had become disabled

and unable to work on August 7, 1995 as the result of back

pain and migraine headaches. Her applications were rejected

at every stage of the administrative process. The SSA

denied Butler’s claims initially and upon reconsideration. At

Butler’s request, an ALJ subsequently held a hearing, after

which he also denied Butler’s claims in a decision dated

January 29, 1998. In performing the five-step evaluation

process outlined above, the ALJ found in Butler’s favor on

the first two steps: he concluded that she had not engaged in

substantial gainful employment since August 1995 and that

her headaches and back problems constituted severe impairments. At step three, the ALJ concluded that Butler’s

impairments did not meet or equal an impairment listed in

Appendix 1.

Turning to step four, the ALJ determined that while Butler

was incapable of performing her past relevant work as an

EST, she retained the RFC ‘‘to perform sedentary work so

long as she can sit or stand at her own option, where the

work does not involve lifting more than four pounds or

involve more than minimal stress.’’ JA 32. As support for

his conclusion, the ALJ referenced the reports of Drs. Asadi,

Press, Yan and Lightfoote. The ALJ’s explanation of how

the medical reports supported his finding was limited to the

observations that Yan’s report ‘‘noted that [Butler] could not

perform stressful work or lift heavy objects but otherwise her

examination was basically within normal limits’’ and that

Lightfoote’s December 9, 1995 report found Butler ‘‘capable

of sedentary, clerical or administrative work but she could not

sit or stand for more than one hour or ever climb, bend, or

stoop.’’ Id.

In evaluating Butler’s allegations of pain, the ALJ concluded that her pain did not preclude her from engaging in the

limited range of sedentary work of which he found her

capable. He explained that ‘‘there is no evidence of any

underlying conditions which could be producing pain of the

intensity which she has alleged.’’ Id. 33. The ALJ noted

that Butler had not undergone or contemplated surgery to

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alleviate her pain, nor had she been hospitalized, and that her

medication had brought her a measure of relief. He also

found that the simple functions of daily living that she

continued to perform—washing dishes, making her bed, laundering her clothes, using a car to shop for groceries once a

week—were consistent with the residual functional capacity

he assigned her. The ALJ therefore concluded that, insofar

as Butler’s daily activities were consistent with his RFC

assessment, her allegations of pain were ‘‘only credible to that

extent.’’ Id.

Because the ALJ determined that Bulter’s RFC nevertheless prevented her from performing her past relevant work,

he proceeded to the final step, which obligated the Commissioner to demonstrate the existence of a significant number of

jobs in the economy that someone with Butler’s RFC could

perform. The ALJ explained that at the hearing Leonard

Perlman, an independent vocational expert, testified that

someone with Butler’s RFC would be able to perform approximately 20 per cent of the 200 sedentary, ‘‘unskilled occupations administratively noticed by the Commissioner’’ in the

Medical–Vocational guidelines. Id. Perlman offered the occupations of film development assistant, visual inspector of

small items and bindery worker as examples. Because someone with Butler’s ‘‘credible limitations’’ was able to perform a

significant number of jobs in the economy, the ALJ concluded

that Butler was not disabled under the Act. Id.

The SSA Appeals Council affirmed the ALJ’s decision on

January 6, 1999. Butler then petitioned for review of the

Commissioner’s decision in district court under 42 U.S.C.

§ 405(g); she fared no better there. On August 2, 2002 the

district court granted the Commissioner’s motion for affirmance, concluding that, while the ALJ’s finding of nondisability was ‘‘certainly spare,’’ it rested on substantial evidence contained in the record. JA 14–19. The district court

stated that the ALJ rejected Lightfoote’s opinion that Butler

can never stoop because ‘‘this finding contradicted the assessment of other physicians that he found credible.’’ Id. 14.

The district court further explained that ‘‘the ALJ considered

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all of Dr. Lightfoote’s reports—some of which agreed that

[Butler] can perform sedentary work—alongside the other

medical evidence and concluded that [Butler] can stoop occasionally.’’ Id. 15. Moreover, according to the district court,

the ALJ’s opinion ‘‘reveals his consideration of each evidentiary source, and the reviewing court can discern his logic

without difficulty and without post hoc explanation.’’ Id. 19.

The district court therefore concluded that remanding Butler’s case to the agency ‘‘would be both inefficient and unreasonable.’’ Id. 16. Now, more than five years after the ALJ

found that Butler was not disabled, her case has made its way

to us.

IV. DISCUSSION

‘‘In a disability proceeding, the ALJ ‘has the power and the

duty to investigate fully all matters in issue, and to develop

the comprehensive record required for a fair determination of

disability.’ ’’ Simms v. Sullivan, 877 F.2d 1047, 1050 (D.C.

Cir. 1989) (quoting Diablo v. Sec’y of HEW, 627 F.2d 278, 281

(D.C. Cir. 1980)). The Commissioner’s ultimate determination will not be disturbed if it is based on substantial evidence

in the record and correctly applies the relevant legal standards. 42 U.S.C. §§ 405(g), 1383(c)(3); Craig v. Chater, 76

F.3d 585, 589 (4th Cir. 1996); Brown v. Bowen, 794 F.2d 703,

705 (D.C. Cir. 1986). Substantial evidence is ‘‘ ‘such relevant

evidence as a reasonable mind might accept as adequate to

support a conclusion.’ ’’ Richardson v. Perales, 402 U.S. 389,

401 (1971) (quoting Consol. Edison Co. v. NLRB, 305 U.S.

197, 229 (1938)). The test ‘‘requires more than a scintilla, but

can be satisfied by something less than a preponderance of

the evidence.’’ Fla. Mun. Power Agency v. FERC, 315 F.3d

362, 365–66 (D.C. Cir.) (internal quotation omitted), cert.

denied, 124 S. Ct. 386 (2003). Although we must carefully

scrutinize the entire record, Brown, 794 F.2d at 705, we are

not to determine ourselves whether Butler is disabled; we

assess only whether the ALJ’s finding that she is not is based

on substantial evidence and a correct application of the law.

We conclude that the ALJ’s decision fails this review.

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Butler raises four challenges to the ALJ’s decision. She

claims that the ALJ failed to properly (1) account for her

physical limitations in his RFC assessment; (2) weigh the

opinions of her treating physician, Dr. Lightfoote; and (3)

assess her allegations of pain. Because of these errors,

Butler claims, the ALJ’s reliance on the vocational expert’s

testimony to support his no disability decision was misplaced.

The Commissioner counters that the ALJ reached his determination based upon a proper consideration of all the record

evidence. The district court agreed with the Commissioner,

finding that ‘‘the ALJ’s opinion makes it clear that there is

substantial evidence in the record and that his opinion rests

upon that evidence.’’ JA 18. But the substantial evidence

standard requires the court to review the record itself to

determine whether it substantiates the story the agency

would have it tell. Granted, this level of review is a deferential one but it is no less thoroughgoing for being so. See

Brown, 794 F.2d at 705. On a correct application of the

standard, the ALJ’s decision cannot stand. Accordingly, we

reverse and remand to the district court with instructions to

remand to the Commissioner for further proceedings. See id.

at 709.

A. BUTLER’S RESIDUAL FUNCTIONAL CAPACITY

Butler asserts that in assessing her RFC the ALJ failed to

properly consider her inability to meet certain physical demands of work activity—namely, her inability to lift, which is

an exertional limitation, as well as her inability to reach and

stoop, which are both postural limitations. We agree. The

ALJ’s RFC assessment bears on Butler’s ability to perform

past relevant work (step four) and her ability to do ‘‘other

work’’ (step five). 20 C.F.R. §§ 404.1520(e)-(f), 416.920(e)-(f);

id. §§ 404.1545(a)(5)(i)-(ii), 416.945(a)(5)(i)-(ii). It is designed

to determine the claimant’s uppermost ability to perform

regular and continuous work-related physical and mental

activities in a work environment. Id. §§ 404.1545(a)(1),

416.945(a)(1); see also Social Security Ruling (SSR) 96–8p,

Assessing Residual Functional Capacity in Initial Claims,

1996 WL 374184, at *2–*3 (SSA July 2, 1996). In effect, it is

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a ‘‘function-by-function’’ inquiry based on all of the relevant

evidence of a claimant’s ability to do work and must contain a

‘‘narrative discussion’’ identifying the evidence that supports

each conclusion. SSR 96–8p, 1996 WL 374184, at *3, *7; see

20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). In performing the

RFC assessment, the ALJ must explain how he considered

and resolved any ‘‘material inconsistencies or ambiguities’’

evident in the record, as well as the reasons for rejecting

medical opinions in conflict with the ultimate RFC determination. SSR 96–8p, 1996 WL 374184, at *7.

Here the ALJ found that Butler’s physical impairments

prevented her from performing her past relevant work but

did not preclude her from engaging in a limited range of

sedentary work. He concluded that Butler ‘‘retains the residual functional capacity to perform sedentary work so long as

she can sit or stand at her own option, where the work does

not involve lifting more than four pounds or involve more

than minimal stress.’’3

 JA 32. In so concluding, the ALJ

was required to consider the nature and extent of any limit on

her ability to ‘‘perform certain physical demands of work

activity,’’ such as lifting, reaching or stooping, that affect her

ability to perform past relevant or other work. Id.

§§ 404.1545(b), 416.945(b). Social Security Ruling 96–9p

gives the ALJ additional guidance regarding the erosive

effect any physical limitations may have on the ‘‘unskilled

sedentary occupational base’’—the occupational base to which

the ALJ concluded Butler’s impairments limited her. See

SSR 96–9p, Determining Capability to Do Other Work—

Implications of a Residual Functional Capacity for Less

Than a Full Range of Sedentary Work, 1996 WL 374185, at

*5 (SSA July 2, 1996). The Ruling explains that ‘‘[a]n accu3 Sedentary work requires ‘‘lifting no more than 10 pounds at a

time and occasionally lifting or carrying articles like docket files,

ledgers, and small tools.’’ 20 C.F.R. §§ 404.1567(a), 416.967(a).

‘‘Although a sedentary job is defined as one which involves sitting, a

certain amount of walking and standing is often necessary in

carrying out job duties. Jobs are sedentary if walking and standing

are required occasionally and other sedentary criteria are met.’’ Id.

§§ 404.1567(a), 416.967(a).

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rate accounting of [a claimant’s] abilities, limitations, and

restrictions is necessary to determine the extent of erosion of

the occupational base, the types of sedentary occupations an

individual might still be able to do, and whether it will be

necessary to make use of a vocational resource.’’ Id. at *6.

With respect to an exertional limitation on lifting, the Ruling

notes that ‘‘[t]he extent of erosion will depend on the extent

of the limitations’’ and that ‘‘an inability to lift TTT more than

1 or 2 pounds would erode the unskilled sedentary occupational base significantly.’’ Id. The Ruling also addresses

postural limitations, explaining that ‘‘[a] complete inability to

stoop would significantly erode the unskilled sedentary occupational base and a finding that the individual is disabled

would usually apply, but restriction to occasional stooping

should, by itself, only minimally erode the unskilled occupational base of sedentary work.’’ Id. at *8. Additionally, a

Social Security Program Policy Statement observes that a

‘‘[s]ignificant limitation[ ] of reaching,’’ which is ‘‘required in

almost all jobs,’’ ‘‘may eliminate a large number of occupations a person could otherwise do’’ and a vocational specialist

may be needed to determine the effects of the limitation.

SSR 85–15, Capability to Do Other Work—The Medical–

Vocational Rules as a Framework for Evaluating Solely

Nonexertional Impairments, 1985 WL 56857, at *7 (SSA

1985).

In light of this ruling and statement, it is clear that to

arrive at his RFC assessment for Butler, the ALJ failed to

properly consider the opinion of her treating physician, Dr.

Lightfoote, who repeatedly opined that she could not lift,

reach or stoop.4

 The district court found, and the Commis4 As detailed earlier, Lightfoote’s myriad reports are replete with

references to Butler’s serious physical limitations. On October 17,

1995, Lightfoote stated that ‘‘when’’ Butler returns to duty, she

‘‘will not be able to do any lifting, bending or stooping.’’ JA 103.

On December 9, 1995 Lightfoote noted that Butler ‘‘should never

climb, bend or stoop.’’ Id. 176. On January 23, 1996 Lightfoote

stated that Butler was able to return to work subject to the

limitations he noted in December 1995. On July 9, 1996 Lightfoote

recommended that Butler ‘‘have some job modifications to enable

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sioner agrees, that the ALJ rejected Lightfoote’s conclusion

that Butler was unable to stoop by referring to the (apparently) contrary opinions of other medical experts. JA 31–32;

see, e.g., id. 104, 106–07, 207. But the other medical opinions

on which the ALJ purportedly relied do not address Butler’s

ability to stoop. (The ALJ cited the views of doctors Asadi,

Press and Yan; Hall’s opinion, which did address Butler’s

ability to stoop, was not cited by the ALJ.) In his November

19, 1996 report Yan noted that Butler’s examination was

‘‘otherwise’’ within ‘‘normal limits,’’ after having stated that

Butler complained that she had disk disease over her lumbosacral area, had severe pain which prevented her from getting up easily, could not stand for too long and could not lift

heavy objects. Id. 106–07. Yan, however, did opine that

Butler’s disks appeared to be ‘‘within normal limits.’’ Id.

Asadi’s report acknowledged that Butler had a history of

lower back pain, but that ‘‘there is no limitation of movement

of [her] cervical spine.’’ Id. 185. Butler was referred to

Asadi, however, only for a second opinion on the diagnosis

and treatment of her headaches. The ALJ also noted Press’s

lumbar spine examination that revealed mild scoliosis but was

otherwise ‘‘negative.’’ Id. 104. It is not apparent to us how

these three one-time, generalized medical reports conflict

with Lightfoote’s continuous, specific opinion that Butler cannot stoop on the job. The ALJ’s conclusionary attempt to

justify his RFC finding that Butler was capable of engaging

in a limited range of sedentary work inexplicitly cited Lightfoote’s opinion that Butler could not perform work that

required her to stoop. Id. 32, 176.

The same goes for Lightfoote’s conclusions regarding Butler’s inability to lift and reach. In concluding that Butler was

capable of performing work that requires lifting of no more

her to work with her impairment of low back pain.’’ Id. 126. On

July 16, 1996 Lightfoote stated that Butler ‘‘should consider crosstraining with Vocational Rehabilitation, so that she can get a job

that does not entail any lifting, bending, stooping or reaching.’’ Id.

125. And on March 11, 1997 Lightfoote concluded that Butler was

‘‘100% disabled from any gainful employment’’ because of her back

pain and migraine headaches. Id. 180.

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than four pounds, the ALJ apparently relied on Butler’s

testimony that she can lift a half-gallon of milk (which,

according to the ALJ, weighs approximately four pounds)

‘‘with reasonable comfort.’’ Id. 60. In so finding, however,

he failed to explain away, or even acknowledge, Lightfoote’s

three specific opinions that Butler could not perform work

that required any lifting. Id. 125, 128, 188. The ALJ may

have discounted these opinions in view of Lightfoote’s earlier

notations indicating that Butler was capable of lifting up to 10

pounds. The ALJ, however, did not cite these opinions at all;

rather, he relied exclusively on Butler’s own testimony at the

hearing. Id. 32. But the ALJ does not tell us how Butler’s

occasional lifting a half-gallon of milk conflicts with Lightfoote’s opinion that Butler could not lift as part of her regular

and continuous work-activity. As to Butler’s second alleged

postural limitation, it appears that the ALJ ignored Lightfoote’s opinion that Butler could not perform work that

requires any reaching. Id. 125. Nowhere in the ALJ’s

opinion is reaching mentioned, and none of the other medical

opinions he references touches on it in the least.

In sum, we cannot discern from the record the ALJ’s basis

for rejecting Lightfoote’s opinions regarding these limitations

nor from his mere references to the other physicians’ reports.

The ALJ’s reasoning is not simply ‘‘spare’’—as the district

court described it—in crucial particulars it is missing. Nor

did he ‘‘note[ ] the contradictory evidence in the record, which

record supplie[d] the reason’’ for his decision. Williams v.

Shalala, 997 F.2d 1494, 1499 (D.C. Cir. 1993). This simply

will not do. ‘‘The judiciary can scarcely perform its assigned

review function, limited though it is, without some indication

not only of what evidence was credited, but also whether

other evidence was rejected rather than simply ignored.’’

Brown, 794 F.2d at 708.

The Commissioner contends that the ALJ must have interpreted Lightfoote’s opinion that Butler should never stoop to

mean that she should stoop ‘‘very little’’ or ‘‘only occasionally.’’ Appellee’s Br. at 22. While this interpretation may have

some intuitive appeal, the ALJ did not articulate this view in

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his decision5

 and Lightfoote’s multiple opinions are not easily

susceptible of such an interpretation. Despite his hopeful

statements regarding Butler’s capacity to perform some gainful activity, Lightfoote consistently opined that any job Butler

performed had to accommodate her inability to stoop. JA

103, 125, 126, 176, 180, 204. The Commissioner also directs

our attention to Hall’s RFC assessment, which found Butler

capable of lifting 10 pounds frequently and stooping occasionally. Although Hall’s assessment conflicts with Lightfoote’s

opinions, the ALJ apparently did not rely on Hall’s assessment as that assessment was not cited in the ALJ’s order.

Id. 31–32. And in view of Lightfoote’s consistent opinions to

the contrary, Hall’s report, without more, does not constitute

substantial evidence that Butler is capable of frequently

lifting 10 pounds and stooping occasionally.6

 We are therefore at a loss to locate in the lengthy record substantial

evidence supporting the ALJ’s determination that Butler is

capable of lifting four pounds, reaching and occasionally

stooping on the job.

B. LIGHTFOOTE’S MEDICAL OPINIONS

Butler argues that the ALJ failed to properly evaluate

Lightfoote’s medical opinions. Lightfoote’s opinions, as those

of Butler’s treating physician, are entitled to ‘‘controlling

weight’’ if they are not inconsistent with other substantial

record evidence and are well-supported by medically acceptable clinical and laboratory diagnostic techniques. 20 C.F.R.

§§ 404.1527(d)(2), 416.927(d)(2). Indeed ‘‘when all of the

5 See SEC v. Chenery Corp., 332 U.S. 194, 196 (1947) (‘‘[A] simple

but fundamental rule of administrative law TTT is to the effect that a

reviewing court, in dealing with a determination or judgment which

an administrative agency alone is authorized to make, must judge

the propriety of such action solely by the grounds invoked by the

agency.’’).

6 We note that Hall prepared his RFC assessment by checking

boxes on a pre-printed administrative form and offered little or no

explanation for his choices.

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factors are satisfied[ ]7

 the adjudicator must adopt a treating

source’s medical opinion irrespective of any finding he or she

would have made in the absence of the medical opinion.’’

SSR 96–2p, Giving Controlling Weight to Treating Source

Medical Opinions, 1996 WL 374188, at *2 (SSA July 2, 1996).

As the regulations assure claimants, ‘‘[w]e will always give

good reasons in our notice of TTT decision for the weight we

give your treating source’s opinion.’’ 20 C.F.R.

§§ 404.1527(d)(2), 416.927(d)(2).

We have a ‘‘treating physician rule’’ of our own. ‘‘Because

a claimant’s treating physicians have great familiarity with

[her] condition, their reports must be accorded substantial

weight.’’ Williams, 997 F.2d at 1498 (internal quotation

omitted). A treating physician’s report is ‘‘binding on the

fact-finder unless contradicted by substantial evidence.’’ Id.

(internal quotation omitted). We thus require an ALJ ‘‘who

rejects the opinion of a treating physician [to] explain his

reasons for doing so.’’ Id. Here, however, the ALJ offered

little more than the bare statement that ‘‘the record is

consistent with claimant retaining a residual functional capacity to perform the range of sedentary work notedTTTT’’ JA

32. The ALJ’s passing references to the other medical

opinions are insufficient to override the substantial weight

due Lightfoote’s opinion. Furthermore, Lightfoote’s opinions

were confirmed by the results of an MRI, a CT myelogram,

an EMG, an IME, and an electroneurodiagnostic study. We

thus cannot conclude, as did the district court, that ‘‘credible

medical opinions undermine Dr. Lightfoote’s opinion’’ or that

the ALJ’s ‘‘logic’’ can be understood ‘‘without difficulty.’’ Id.

19.

Relying on our decision in Williams, the Commissioner

argues that the ALJ’s acknowledgment of contrary evidence

alone supplies an adequate basis for his decision. This case is

7 The ALJ is to consider the following six factors when evaluating

a treating physician’s medical opinion: (1) length of the treating

relationship and frequency of examination; (2) nature and extent of

the treating relationship; (3) supportability; (4) consistency; (5)

specialization; and (6) other factors that tend to support or contradict the medical opinion. 20 C.F.R. §§ 404.1527(d)(2)-(6),

416.927(d)(2)-(6).

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not analogous to Williams, however, because the ALJ here

did not acknowledge the contradictory evidence in the record,

‘‘which record supplie[d] the reason’’ for rejecting the treating

physician’s opinion. 997 F.2d at 1499. Our decision in

Simms, in which we remanded to the Commissioner for the

ALJ to explain the weight he attached to one of the claimant’s

treating physicians’ opinions, supplies the more fitting analogue. 877 F.2d at 1052–53. In Simms the ALJ offered no

reason for rejecting the claimant’s treating physician’s view in

favor of those of consulting physicians. Id. at 1052. We held

that upon remand, ‘‘the ALJ should explain what weight he

attaches to [the treating physician’s] conclusions, or if he

attaches none, his reason therefor.’’ Id. at 1053. We believe

we should impose the same directive here.

C. EVIDENCE OF PAIN

Butler asserts that the ALJ failed to properly assess her

credibility in rejecting her claim that she suffers disabling

back pain.8

 We conclude that the ALJ’s analysis here suffers

from the same shortcoming that undermined his RFC assessment and rejection of Lightfoote’s opinions; namely, he did

not properly consider Butler’s physical limitations. The applicable regulations prescribe a two-step process to determine

whether a claimant suffers from symptoms (including pain)

that affect her ability to perform basic work activities. 20

C.F.R. §§ 404.1529, 416.929. First, the claimant must adduce

‘‘medical signs or laboratory’’ findings evidencing a ‘‘medically

determinable impairment that could reasonably be expected

to produce’’ the alleged pain. Id. §§ 404.1529(a)-(b),

416.929(a)-(b); see also 42 U.S.C. §§ 423(a)(5)(A), 1382(H)(i).

The objective evidence must confirm the existence of an

impairment ‘‘reasonably expected to produce,’’ 20 C.F.R.

§§ 404.1529(b), 416.929(b), ‘‘the actual pain, in the amount

and degree, alleged by the claimant.’’ Craig, 76 F.3d at 594.

8 In her brief, Butler appeared to argue that the ALJ also failed

to assess her credibility in rejecting her allegations of pain caused

by her migraine headaches. Appellant’s Br. at 27. At oral argument, however, Butler’s counsel clarified that she challenges the

ALJ’s credibility determination only in relation to her back pain.

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Once the claimant crosses this threshold, the second step

assesses the persistence and intensity of the claimant’s pain

as well as the extent to which it impairs her ability to work.

20 C.F.R. §§ 404.1529(c)(1), 416.929(c)(1).

The latter evaluation entails not only the claimant’s statements about her pain but also ‘‘all the available evidence,’’

including the claimant’s medical history, medical signs and

laboratory findings; objective medical evidence of pain; the

medical opinions of the claimant’s treating physician; and any

other evidence that bears on the severity of the pain. Id.

§§ 404.1529(c)(1)-(3), 416.929(c)(1)-(3); Craig, 76 F.3d at 594–

95. As to other evidence bearing on the severity of pain, the

regulations provide that because pain is ‘‘subjective and difficult to quantify,’’ the Commissioner takes account of ‘‘any

symptom-related functional limitations and restrictions’’ reported by the claimant and her treating physician ‘‘which can

reasonably be accepted as consistent with the objective medical evidence and other evidence.’’ 20 C.F.R.

§§ 404.1529(c)(3), 416.929(c)(3). Factors the Commissioner

considers as relevant to assessing a claimant’s pain are: the

claimant’s daily activities; the ‘‘location, duration, frequency,

and intensity of’’ the claimant’s pain; ‘‘precipitating and

aggravating factors’’; ‘‘the type, dosage, effectiveness, and

side effects of any medication’’ for pain relief; treatment the

claimant receives or has received, other than medication, for

pain relief; ‘‘any measures’’ the claimant uses to relieve pain;

and ‘‘other factors concerning [the claimant’s] functional limitations and restrictions due to pain.’’ Id. §§ 404.1529(c)(3)(i)-

(vii), 416.929(c)(3)(i)-(vii).

In considering the extent to which the claimant’s pain

interferes with her capacity to engage in basic work activities,

the regulations provide that the ALJ evaluates the claimant’s

‘‘statement in relation to the objective medical evidence and

other evidence,’’ id. §§ 404.1529(c)(4), 416.929(c)(4), including

‘‘whether there are any inconsistencies in the evidence and

the extent to which there are any conflicts between your

statements and the rest of the evidence, including your

medical history, the medical signs and laboratory findings,

and statements by your treating or examining physician or

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psychologist or other persons about how your symptoms

affect you.’’ Id. And a claimant’s allegations of pain will be

‘‘determined to diminish [her] capacity for basic work activities’’ only insofar as her ‘‘alleged functional limitations and

restrictions due to TTT pain TTT can reasonably be accepted as

consistent with the objective medical evidence and other

evidence.’’ Id.

Social Security Ruling 96–7p supplies further guidance to

the ALJ on how to evaluate pain. Once an underlying

impairment that could reasonably be expected to generate the

alleged pain has been established, the intensity, persistence

and limiting effects of the pain must be evaluated ‘‘to determine the extent to which the symptoms affect the individual’s

ability to do basic work activities.’’ SSR 96–7p, Evaluation of

Symptoms in Disability Claims: Assessing the Credibility of

An Individual’s Statements, 1996 WL 374186, at *1 (SSA

July 2, 1996). This determination in turn requires ‘‘the

adjudicator to make a finding about the credibility of the

individual’s statements about the symptom(s) and its functional effects.’’ Id. In determining the individual’s credibility,

the ALJ ‘‘must consider the entire case record’’ and may not

disregard the individual’s statements about the intensity and

persistence of her pain ‘‘solely because they are not substantiated by objective medical evidence.’’ Id. The ALJ’s decision

‘‘must contain specific reasons for the finding on credibility,

supported by the evidence in the case record, and must be

sufficiently specific to make clear to the individual and to any

subsequent reviewers the weight the adjudicator gave to the

individual’s statements and reasons for that weight.’’ Id. at

*2.

Applying step one (and perhaps step two) of the analysis,

the ALJ concluded that ‘‘there is no evidence of any underlying conditions which could be producing pain of the intensity

which [Butler] has alleged.’’ JA 33. His conclusion that ‘‘no

evidence’’ supports her allegations once again reflects his

failure to properly evaluate Lightfoote’s opinions. Moreover,

Lightfoote is not alone in concluding that Butler suffers from

lumbar disk herniations and lumbosacral facet syndrome—

diagnoses which the ALJ appears to have credited. Id. 82,

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104, 116, 132. Pavot’s electroneurodiagnostic study diagnosed lumbar facet syndrome, while Press’s lumbar spine

examination revealed scoliosis and atherosclerosis. Bentt

also noted that Butler’s MRI and CT myelogram indicated

‘‘nerve root pathology at both L4–5 and L5–S1.’’ Id. 132.

And even Hall’s RFC assessment lists Butler’s primary diagnosis as herniated disk disease. Id. 82. The ALJ may have

thought that these diagnosed conditions could not produce the

degree of pain Butler claimed to suffer but such a conclusion

would be near impossible to understand without some explanation, if for no other reason than that the diagnoses are

consistently accompanied by descriptions of incapacitating

pain. See, e.g., Id. 132, 148–49, 203. The ALJ may have

rejected these evaluations by inferring from Yan’s and

Press’s reports that Butler’s condition could not produce

severe pain; however, he has not articulated this position and,

given all of the evidence to the contrary, the record cannot do

it for him.

D. VOCATIONAL EXPERT’S TESTIMONY

Butler asserts that at step five the ALJ improperly relied

on the vocational expert’s testimony to establish that she is

capable of performing ‘‘other work.’’ We agree. If the ALJ

looks to a vocational expert in assessing a claimant’s ability to

do other work, the ALJ ‘‘must accurately describe the claimant’s physical impairments in any question posed to the

expert.’’ Simms, 877 F.2d at 1050; see also Williams, 997

F.2d at 1499; Diablo, 627 F.2d at 283. Deficiencies in the

ALJ’s description of the claimant’s condition ‘‘undermine the

foundation for the expert’s ultimate conclusion that there are

alternative jobs’’ that the claimant is capable of performing.

Simms, 877 F.2d at 1053; see also Williams, 997 F.2d at

1499.

We cannot say that the hypothetical question the ALJ

posed to the vocational expert accurately reflected Butler’s

physical limitations. The ALJ asked whether work exists in

the economy for someone of ‘‘claimant’s age, education, and

work background’’ who can perform a limited range of sedenUSCA Case #02-5312 Document #796586 Filed: 01/13/2004 Page 22 of 23
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tary work. JA 68. The ALJ qualified the hypothetical by

adding that the work available must allow her to sit or stand

at her own option, not require her to lift more than four

pounds and involve only minimal stress. The vocational

expert answered affirmatively, concluding that such a person

would be able to find gainful employment in 20 per cent of the

200 sedentary, unskilled occupations significantly represented

in the economy that the Commissioner has ‘‘administratively

noticed,’’ and offered as examples of such jobs, film development assistant, visual inspector and bindery worker. Id. 68–

69.

In Simms, we found the hypothetical question the ALJ

posed to the vocational expert fatally defective because it

omitted significant aspects of the claimant’s condition. 877

F.2d at 1053. We explained there that the ALJ failed to

apprise the expert that the claimant complained of pain; that

the claimant’s medication made him drowsy; that the claimant might have had to rely on a medical device that compromised the use of his remaining arm; and that the claimant

had a limited ability to hold and carry the objects he could

lift. Id. We therefore remanded the case to the Secretary9

‘‘to rule anew (at step five) on [the claimant’s] ability to

perform ‘other work.’ ’’ Id. We do likewise here because the

ALJ’s hypothetical question failed to include Butler’s physical

limitations regarding lifting, reaching and stooping. Id.

* * *

For the foregoing reasons, we reverse the judgment of the

district court and remand the case to that court with instructions to remand to the Commissioner for further proceedings

consistent with this opinion.

So ordered.

9 The duties of the Secretary of the Department of Health and

Human Services in social security cases were transferred to the

SSA Commissioner as of March 31, 1995. See 42 U.S.C. §§ 901,

902.

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