United States Court of Appeals

FOR THE EIGHTH CIRCUIT

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No. 08-3537

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Jill Tilley, *

*

Appellant, * Appeal from the United States 

* District Court for the

v. * Eastern District of Arkansas.

*

Michael J. Astrue, Commissioner *

of Social Security Administration, *

*

Appellee.

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Submitted: April 15, 2009

Filed: September 1, 2009

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Before WOLLMAN, MELLOY, and GRUENDER, Circuit Judges.

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WOLLMAN, Circuit Judge.

Jill Tilley appeals from the district court’s judgment affirming the denial of her

application for disability insurance benefits pursuant to Title II of the Social Security

Act, 42 U.S.C. § 401, et seq. We reverse and remand.

I. Background

To qualify for disability insurance benefits, Tilley was required to establish that

she was disabled before her insurance expired on September 30, 1998. See 42 U.S.C.

§ 416(i) (defining the terms “disability” and “period of disability”); § 423(a)
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(describing who is entitled to disability insurance benefits); see also Moore v. Astrue,

572 F.3d 520, 522 (8th Cir. 2009) (Claimant must “establish her being disabled prior

to the expiration of her insurance to be entitled to disability insurance benefits”). Thus

the relevant time period is from her alleged disability onset date, March 1, 1998, until

the date her insured status expired, September 30, 1998. 

A. Personal History

Tilley was born on March 21, 1944. She is a high school graduate and has

completed some college courses. From 1978 to 1991, Tilley worked in food services

as a cafeteria worker. She was fired when she was no longer physically able to

perform her job. Tilley has not engaged in substantial gainful activity since her

alleged disability onset date, though she worked from 2001 through 2003 as a product

demonstration person, handing out samples to customers at a Walmart store. In that

position, Tilley worked either one day a week or every other weekend for six hours

on Saturday and six hours on Sunday. She testified that after working her weekly

shift, “it’d take me nearly another week to get healed up to go back and do that one

Saturday.” Admin. R. at 728.

Tilley alleges that she became disabled due to fibromyalgia, hypoglycemia,

hypertension, and degenerative changes of the cervical and lumbar spines. In 1983

and 1991, Tilley underwent surgery of the cervical spine. The first surgery was

successful and alleviated her left upper extremity pain. Her second surgery was less

so, and Tilley continued to suffer from back, neck, and right arm pain.

Tilley completed Social Security Disability Supplemental Interview Outlines

in October 2002 and August 2003. She reported that her pain was located in her lower

back, her neck, and her right side (shoulder, arm, and leg) and that it would subside

only when her medications took effect. She could not engage in activities that

required repetitive motion or heavy lifting. Tilley’s ability to complete household
1

Darvocet is a narcotic pain medication indicated for the relief of mild to

moderate pain. Physician’s Desk Reference 3497 (60th ed. 2006).

2

Tilley testified that she became diabetic after losing weight.

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chores was limited, but she could launder clothes, wash dishes, change sheets, prepare

simple meals, and complete short errands. Even though she was able to complete

those household tasks, things like cleaning, cooking, standing, driving, and working

caused pain or other symptoms. Other than attending church, Tilley’s recreational

activities were solitary and sedentary; she no longer visited friends or family. 

At her 2005 hearing before an administrative law judge (ALJ), Tilley testified

that her condition was about the same as it was in 1998, although in 1998 she was

taking more pain medication—four to six Darvocet1

 each day—and receiving trigger

point injections in her lower back, neck, shoulder, and arm. She testified that she felt

“real tired and draggy” and that her medications upset her stomach and some made her

“a little woozy.” Admin. R. at 737, 730. Tilley’s hypoglycemia was troubling her in

1998, and she “was throwing up, dizzy, couldn’t stand up straight.”2

 Id. at 736. Tilley

also testified that she has suffered hearing loss, that she has pain from fibromyalgia,

and that she takes medication to manage her high blood pressure. 

Tilley’s testimony concerning her daily activities was consistent with the

information she provided in the interview outline. She explained that she does light

housework and that her husband does the vacuuming, sweeping, and mopping.

Tilley’s husband also makes breakfast, while she might microwave something for

lunch and make a sandwich or a bowl of cereal for supper. Tilley testified that she

goes to bed around 11:00 p.m. because being in bed for too long causes pain and she

often is unable to sleep through the night, despite being on medication to assist her in

doing so. Once a week, Tilley teaches a children’s Bible study class at the church she

attends. She rarely drives, and when she does, it is for a short distance (three to four
3

Trilisate is a nonsteroidal, anti-inflammatory preparation and is prescribed for

osteoarthritis, rheumatoid arthritis, and acute painful shoulder. Physicians’ Desk

Reference 2846-48 (58th ed. 2004).

4

Soma is prescribed to relieve discomfort associated with acute, painful

musculoskeletal conditions. Physicians’ Desk Reference 1931-33 (63d ed. 2009).

Soma may have sedative properties. Id. at 1931.

5

Flexeril is prescribed to relieve skeletal muscle spasms associated with acute,

painful musculoskeletal conditions. Physicians’ Desk Reference 1832-33 (60th ed.

2006). 

6

Trazodone is prescribed for treatment of depression. Physicians’ Desk

Reference 520-22 (49th ed. 1995).

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miles). She watches television and reads short magazine articles, but she no longer

has any hobbies.

B. Medical History

In February 1991, Randy Roberts, M.D., diagnosed Tilley with fibromyalgia

and osteoarthritis. Tilley had been having problems sleeping due to back and neck

pain on her right side. Dr. Roberts found that her neck had lost about ten degrees

rotation on either side, and a cervical spine x-ray revealed significant osteoarthritis.

Despite repeated treatment for pain in her back and neck, Tilley’s condition did not

improve, and she underwent the second surgery on her cervical spine. Dr. Roberts

continued to treat Tilley for pain and hypoglycemia through 1996. Darrell Ragland,

M.D., began treating Tilley in 1994. 

Throughout 1997 and 1998, Dr. Ragland and William Hurst, D.O., treated

Tilley repeatedly for fibromyalgia and for pain in her back, neck, joints, and right side.

Her treatment included trigger point injections, Darvocet and Trilisate3

 for pain, either

Soma4

 or Flexeril5 for muscle relaxation and sleep, Trazodone6 for sedation, either
7

Tenex and Hyzaar are indicated for the treatment of hypertension. Mosby’s

2002-2003 Medical Drug Reference 477-78 (2002) (Tenex); Physicians’ Desk

Reference 1996-2001 (64th ed. 2008) (Hyzaar). 

8

Premarin is prescribed for hormone replacement. Physicians’ Desk Reference

3221-28 (63d ed. 2009).

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Tenex or Hyzaar7

 for hypertension, and Premarin8 for hormone replacement. In July

1997, Dr. Hurst treated Tilley for “persistent fibromyalgia type pain that has been very

debilitating” and adjusted her medications to try to find a more effective treatment.

Admin. R. at 447. Tilley had hung wallpaper a few days earlier, and Dr. Hurst

remarked that the activity “could cause some of this soreness” that Tilley was

experiencing in her right arm, right leg, and neck. Id. 

In his treatment notes following an office visit in January 1999, Dr. Ragland

noted that Tilley had been working in the deli at Walmart, but was resigning that day

because the work was too difficult.

By letter dated January 4, 2008, Dr. Ragland opined that Tilley could no longer

work:

Jill Tilley is a patient that I have followed for many years who carries the

diagnosis of degenerative arthritis, fibromyalgia, diabetes type 2,

hypertension, and generalized anxiety. These conditions have worsened

to the point that I believe that she is unable to continue to work. She is

maintained on several different medications, and these medications have

been adjusted in an attempt to control her pain better, but without much

success. She is maintained on glucophage, flexeril, maxide, actonal,

trazadone, lotension, glucotrol, and some prn darvocet.

Id. at 200.
9

The five steps are: (1) whether the claimant is engaged in any substantial

gainful activity; (2) whether the claimant has a severe impairment; (3) whether the

impairment meets or equals an impairment listed in 20 C.F.R. Pt. 404, Subpt. P, App.

1; (4) whether the claimant can return to her past relevant work; and (5) whether the

claimant can adjust to other work in the national economy. 20 C.F.R. §

404.1520(a)(5)(i)-(v).

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Dr. Ragland also completed a medical source statement assessing Tilley’s

physical capabilities from 1998 to June 2004. He opined that she could frequently and

occasionally lift and/or carry less than ten pounds; that she could stand and/or walk

for a total of two hours, continuously for fifteen minutes; and that she could sit for a

total of eight hours, continuously for one hour. He reported that she had a limited

ability to use hand or foot controls; that she should never climb, balance, or crouch;

and that she could occasionally stoop, kneel, and bend. Her reaching, fingering,

feeling, hearing, and speaking were unlimited, but her handling and sight were

limited. Dr. Ragland remarked that Tilley “drops items due to [range of motion] neck

loss.” Id. at 199.

C. Administrative History

Tilley filed for disability insurance benefits in August 2003, and her claim was

denied initially and on reconsideration. A vocational expert testified at the 2005

hearing that Tilley’s past relevant work in food service constituted light, semi-skilled

work. 

The ALJ undertook the familiar five-step test to determine whether Tilley was

disabled as of September 30, 1998.9

 The ALJ found that Tilley met the first two steps

of the analysis: she had not engaged in substantial gainful activity since the alleged

onset of disability date, and her impairment was severe. Because her impairment did

not meet or equal those listed in the Social Security regulations, the ALJ proceeded

to the fourth step, which asks whether Tilley could perform her past relevant work.
10The Social Security regulations state: 

Light work involves lifting no more than 20 pounds at a time with

frequent lifting or carrying of objects weighing up to 10 pounds. Even

though the weight lifted may be very little, a job is in this category when

it requires a good deal of walking or standing, or when it involves sitting

most of the time with some pushing and pulling of arm or leg controls.

To be considered capable of performing a full or wide range of light

work, you must have the ability to do substantially all of these activities.

20 C.F.R. § 404.1567(b). 

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The ALJ found that Tilley had the residual functional capacity to perform light work10

as of the date last insured and thus could have returned to her work in food services.

Accordingly, the ALJ determined that she did not meet the Social Security Act’s

definition of disabled and denied her claim for benefits. 

In concluding that Tilley could perform her past relevant work, the ALJ rejected

Dr. Ragland’s opinion, discrediting it based on Tilley’s activities prior to and

immediately following the last date of insurance coverage. 

II. Analysis

We review de novo the district court’s decision affirming a denial of Social

Security benefits. Minor v. Astrue, No. 08-3375, 2009 WL 2244597 at *1 (8th Cir.

July 29, 2009). We affirm the denial of such benefits when the substantial evidence

on the record as a whole supports the ALJ’s decision. Id. This standard requires a

more searching review than the substantial evidence standard, and we take into

account record evidence that fairly detracts from the ALJ’s decision. Id. “[T]he court

must also take into consideration the weight of the evidence in the record and apply

a balancing test to evidence which is contradictory.” Id. (citations omitted).

“Reversal is not warranted, however, ‘merely because substantial evidence would
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have supported an opposite decision.’” Reed v. Barnhart, 399 F.3d 917, 920 (8th Cir.

2005) (quoting Shannon v. Chater, 54 F.3d 484, 486 (8th Cir. 1995)). 

The issue before us is whether there is substantial evidence based on the record

as a whole to support the ALJ’s conclusion that Tilley could have performed her past

relevant work in food services as of September 30, 1998. The answer turns on

whether it was appropriate to discredit the opinion of Tilley’s treating physician, Dr.

Ragland.

Tilley argues that the ALJ’s failure to give controlling weight to the opinion of

her treating physician contradicted the rules established in 20 C.F.R. § 404.1527 and

SSR 96-2p. A treating physician’s opinion is given controlling weight if it “is wellsupported by medically acceptable clinical and laboratory diagnostic techniques and

is not inconsistent with the other substantial evidence in [a claimant’s] case record.”

20 C.F.R. § 404.1527(d)(2); see also SSR 96-2p, 1996 WL 374188, at *2 (Social

Security Administration, July 2, 1996) (When a treating source renders a medical

opinion that is well supported by medically acceptable diagnostic techniques and

consistent with the other substantial evidence in the claimant’s record, “the

adjudicator must adopt a treating source’s medical opinion irrespective of any finding

he or she would have made in absence of the medical opinion.”). The record must be

evaluated as a whole to determine whether the treating physician’s opinion should

control. Reed, 399 F.3d at 920. The regulations require the ALJ to “always give

good reasons” for the weight afforded to the treating source’s opinion. 20 C.F.R. §

404.1527(d)(2).

Dr. Ragland’s opinion that Tilley cannot perform light work is consistent with

the evidence in the administrative record. Tilley testified that she was first diagnosed

with fibromyalgia by Dr. Miller, who performed Tilley’s cervical spine surgery in

1983. Tilley’s medical records indicate that Dr. Roberts, Dr. Ragland, and Dr. Hurst

diagnosed and treated her for fibromyalgia and degenerative spine issues. The records
11In 2003, state agency physician Steve Owens, M.D., completed a residual

functional capacity assessment, concluding that Tilley had the ability to perform

medium work activity. Dr. Robert Redd affirmed Dr. Owen’s assessment. The ALJ

assigned little weight to the assessment because “the formulation was reached without

benefit of testimony and current medical documentation.” Admin. R. at 16. 

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from the relevant time period document her repeated reports of pain, much of which

the doctors attributed to fibromyalgia, as well as her back and neck problems. Both

Dr. Ragland and Dr. Hurst prescribed trigger point injections, narcotic pain

medications (including Darvocet), and sleep aides and muscle relaxers (including

Soma and Flexeril). Tilley’s substantial pain management medications lend further

support to Dr. Ragland’s opinion. 

The ALJ did not rely on conflicting or inconsistent medical assessments to

discredit Dr. Ragland’s opinion. This is not a case in which different treating doctors

have offered varied opinions. See Hamilton v. Astrue, 518 F.3d 607, 611-12 (8th Cir.

2008) (treating doctor’s opinion conflicted with another doctor’s treatment notes);

Casey v. Astrue, 503 F.3d 687, 692-93 (8th Cir. 2007) (treating rheumatologist’s

opinion inconsistent with other doctors’ treatment notes). Dr. Hurst’s treatment notes

are fully consistent with Dr. Ragland’s opinion. For example, in 1997, Dr. Hurst

diagnosed Tilley with hypertension (controlled), dyspepsia, fibromyalgia, and right

lumbar strain, noting that “there is some exquisite tenderness and a couple of

triggerpoints noted in the lower thoracic muscles in the right paravertebral

musculature. The patient can heel walk and toe walk well but there is persistent right

hip and right lumbar pain at examination.” Admin. R. at 454. Moreover, the ALJ did

not rely on a consultative physician’s assessment to discount Dr. Ragland’s opinion.11

Cf. Hamilton, 518 F.3d at 611-12 (concluding that the findings of consultative doctor

served as some evidence to discredit the opinion of the treating doctor’s opinion); see

also Moore, 572 F.3d at 523-24 (concluding that one consulting physician’s residual

functional capacity assessment supported the ALJ’s finding when claimant provided

no contrary assessment). The only substantiated medical opinion in this case is Dr.
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Ragland’s, and his opinion is consistent with Tilley’s medical records from the

relevant time period. Cf. Stormo v. Barnhart, 377 F.3d 801, 806 (8th Cir. 2004)

(treating physicians’ conclusory and inconsistent opinions properly discounted);

Hogan v. Apfel, 239 F.3d 958, 961 (8th Cir. 2001) (inconsistent and unsupported

portions of the treating physician’s medical source statements properly discounted).

We disagree with the Commissioner’s argument that the facts in Tilley’s case

are comparable to those in Krogmeier v. Barnhart, 294 F.3d 1019 (8th Cir. 2004). In

Krogmeier, the treating psychiatrist rendered an opinion in 1997 that the claimant was

disabled prior to his date last insured, December 31, 1994. Id. at 1023. The

psychiatrist’s treatment notes from the relevant time period, however, told a different

story, stating that the claimant “was ‘1000% better,’ ‘back to his old self,’ and ‘wellmaintained.’” Id. After considering the medical records, the opinion of a consulting

physician, the claimant’s lack of motivation to return to work, and his testimony

regarding his daily activities, the ALJ determined that the claimant was capable of

some work. Id. at 1024. We concluded that substantial evidence in the record

supported the ALJ’s decision. Id. Like the treating physician’s opinion in Krogmeier,

Dr. Ragland rendered his opinion that Tilley was disabled years after her date last

insured. Unlike the facts in Krogmeier, however, Dr. Ragland’s treatment notes from

the relevant time period were entirely consistent with his 2004 opinion and medical

source statement. 

An incomplete description of Tilley’s activities provided the sole basis for the

ALJ’s dismissal of Dr. Ragland’s opinion. The decision stated that Tilley “was able

to hang wall paper in 1997, work at Wal-Mart in 1999 and as a census taker in 2000;

and care for her husband who was ill in 2003.” Admin. R. at 15. Notably, Tilley’s

medical records disclosed these activities, as each resulted in a visit to the doctor’s

office. Following Tilley’s activity of hanging wallpaper, Dr. Hurst treated her for

persistent, debilitating fibromyalgia pain in her right arm, right leg, and neck and

adjusted her medication in an attempt to find an effective treatment. Similarly, Dr.
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Ragland’s medical notes indicate that Tilley’s ailments forced her to resign from her

short-lived employment at the Walmart deli in 1999. Tilley returned to Dr. Ragland

after her brief stint as a census taker and was administered trigger point injections for

shoulder pain and numbness in her fingers on her right hand. And after the stress of

caring for her ailing husband in 2003 left Tilley feeling tired with pain in her neck and

shoulders, Dr. Ragland increased her prescribed dosage of Flexeril. This history,

when viewed in its full context, supports Dr. Ragland’s conclusion that Tilley was

unable to perform light work, and her unsuccessful attempts to engage in gainful

employment do not discredit his opinion. 

Tilley’s ability to engage in some life activities, despite the pain it caused her,

does not mean she retained the ability to work as of the date last insured. See

Forehand v. Barnhart, 364 F.3d 984, 988 (8th Cir. 2004) (“[W]e have held, in the

context of a fibromyalgia case, that the ability to engage in activities such as cooking,

cleaning, and hobbies, does not constitute substantial evidence of the ability to engage

in substantial gainful activity.” (quoting Brosnahan v. Barnhart, 336 F.3d 671, 677

(8th Cir. 2003))). The ALJ’s decision did not address the difficult diagnoses of

fibromyalgia and degenerative spine changes, nor did it acknowledge Tilley’s physical

limitations. Fibromyalgia is an elusive diagnosis; “[i]ts cause or causes are unknown,

there’s no cure, and, of greatest importance to disability law, its symptoms are entirely

subjective.” Sarchet v. Chater, 78 F.3d 305, 306 (7th Cir. 1996). Tilley has been

diagnosed with fibromyalgia repeatedly, and her complaints correspond directly with

the disorder’s characteristics: “chronic widespread aching and stiffness, involving

particularly the neck, shoulders, back, and hips, which is aggravated by the use of the

affected muscles.” Stedman’s Medical Dictionary 725 (28th ed. 2006). Her limited

ability to complete light housework and short errands does not mean she has “the

ability to perform the requisite physical acts day in and day out, in the sometimes

competitive and stressful conditions in which real people work in the real world.”

McCoy v. Schweiker, 683 F.2d 1138, 1147 (8th Cir. 1982) (en banc). 
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We conclude that the treating physician’s opinion was improperly discredited

and that the finding that Tilley can perform her past work as a food service worker is

not supported by substantial evidence on the record as a whole. We thus vacate the

judgment and remand to the district court with instructions to remand the case to the

Social Security Administration for further consideration consistent with this opinion.

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