NOT RECOMMENDED F OR F ULL-TEXT PUBLICATION File Na me: 11a0489n.06 No. 09-5924 UNITED STAT ES COURT OF AP P EALS F OR THE S IXTH CIRCUIT WYVONNI A B ROOKS, Plaintiff-Appellant,

v. SOCI AL SECURI TY ADMI NI STRATI ON, Def endant - Appellee

.

_______________________________________ ) ) ) ) ) ) ) ) ) ) ) O N A P P E A L F R O M T H E UNI TED STATES DI STRI CT COU R T FOR THE MI DDL E DI STRI CT OF TEN

NESSEE

O P I N I O N

Before: G ILMAN and WHIT E, Circuit Judges; and WAT SON , District Judge. *
HELE NE N. WHITE , Circuit Judge

. Plaintiff-Appellant Wy vonnia Br ooks appea ls from the district-court o rd er aff irming the decision of the Commi ssioner of Social Security deny ing
Br ooks’s claim for disability insurance benef its and supplemental secur ity income. For the rea sons
set forth below, we REVERS E the judg ment of the district cour t and REMAND to the ag ency for thoroug h consideration of the entire r ecor d.

F ACTS AND P ROCEDURAL BACK GR OUND I n May 2004, Br ooks filed applications for disability in s uranc e benef its and supplemental

secur ity income pay

ments for the period beg inning Dec ember 20, 2003, based o n s ev er e car pal tunnel sy ndrome in both hands and de g ener ative disc disea se in her ne ck.

The Honor able Micha el H. Watson, United States District Judge for the Souther n District * of Ohio, sitting by

desig nation.A. Medic al Records

I n S ep t ember 2003, Br ooks was working as a certified nurse t echnic ian when she i nj u re d herse lf moving a patient. Br ooks was trea ted at the Ba ptist Hospital emer g ency room for pain and numbn es s i n h er left shoulder, wrist, and hand. A cer vical spine x -ra

y showed “deg ener ative chang es” at the C5-6 level with “disc space narr owing and anter ior osteophy te formation.” Ten day s later, Br ooks underw ent an MRI , which reve aled “minimal centr al posterior disc bulge s at C4-5 and C5-6.” The MRI repor

t conclude d that Br o o ks had “[m] inimal spondy lotic chang e at C4-5 and C5-6.” Although Br ooks appar entl y did not complain about her neck, shoulder, or back to her primary car e phy sician, Dr. Salil Roy , during a Dec ember 2003 visit, Br ooks had been seeing another phy sician, Dr. Kar l Four nier, during that time for “nec k pain and numbness of b o t h u pper extremiti es.” O n J anuar

y 20, 2004, Dr. F ournier note d that “She has not improved ve ry well with her ce rv i ca l s p i n e. I told her there is no[t ] much else we can [do] as far as her neck pain. She is
g oing to ha

ve to le arn to live with it be cause there is not enoug h to do surg ery and I decide d not to do any discog ram of he r ce rvica l spine beca use I do not think she will do well with surge ry which might involve up to three levels if we do it beca use she has deg ener ative discs in her cer vical spine like a lot of people in her a g e ra ng e.” Dr. Four nier also diag nosed Br ooks with car pal tunnel sy

ndrome in both upper extremiti es, noting (base d on nerve conduction studies) that it was more sever e on the rig ht side, but that Br ooks had more sy

mptoms on t he lef

t. Dr. F ournier ha d Br ooks wea r splints at night and w ork “on lig ht duty with no lifting more than 20 pounds, no repe titive twisting, no repe titive bending .” The splints

-2-did not work well and in F ebrua ry 2004 Dr. F ournier r efe rre d Br ooks to a hand-sur g ery specia list, Dr. B arr y Callahan. Dr . Four

nier maintaine d Br ooks’s work r estrictions. Dr. Callahan saw Br ooks in Fe bruar y 2004. I n his phy sical-e x am notes, Dr. Callahan wrote that Br ooks had a positive Phalen’s test, p o sitive Tinel’s test, and a positive median-ne rve- rootcompre ssion test on both her left and rig ht hand and wrist. Dr. Callahan also noted that Br ooks was 1 obese. He rec ommended that Br ooks underg o car pal-tunnel rele ase surg ery on both sides. I n April 2004, Dr. Callaha

n examined Brooks a

nd ag ain re commended sur g ical re lease

. Br ooks s o u gh t an addit ional opinion with reg ard to her sy mptoms, and saw Dr. Doug las Weikert in May 2004. Acc ording to Dr. Weikert’s notes, Br ooks repor ted pain in her left and rig ht

arms and discomfort in he r back and neck. Dr. Weikert diag nosed her with “ bilatera l r ight g rea ter than left, chronic advanc ed car pal tunnel sy

ndrome” and, like Dr. Callahan, rec ommended surg ical rele ase. Dr. Weikert opined that Br o o k s ’s car pal-tunnel sy

ndrome develope d g radua lly over the
y ear s and that her “morbid obesity ” wa s a ri s k fac tor in the development of the disease. He restric ted Brooks to lifting no more than ten pound s an d as k ed her to limit repe titive pushing and pulling.
Br ooks underw ent a surg ical car pal-tunnel rele ase on her rig ht hand on J une 3, 2004, and on her left hand on J une 29, 2004. I n an Aug ust 2004 visit to Dr. Weikert, Br ooks complained of left shoulder pain and some lockin g o f h er ri g ht ring fing er, along with “some g ener alized pain,

A Tinel’s Sign is “a tingling sensation [‘pins and needle s’] in the distal end of a limb when 1 perc ussion is made over the site of a divided n erve” that is indicative of “a partial lesion or the beg inning reg ener ation [si c] o f t h e n erve ,” and a Phalen’s test “involves reduc ing the siz e of the car pal tunnel b y holding the hand straig ht, with the wrist fully flexed or extended, for 30 to 60 seconds.” C

r ee ch v. UNUM Life Ins. Co. of North America , 162 F. App’x 445, 450 n.8 (6th Cir. 2006). -3-numbness and tingling in her fing ers.” Dr. Weikert noted that Br ooks had well-he aled incisions, and

“g ood capillar

y ref ill, intact light touch sensation, and a neg ative Phalen’s test in both hands.” Dr. Wei k er t re s t ri cted Br ooks to lifting 10 pounds or less occa sionally , but noted that “she should be

near ing a point where she ca

n work without restric tions soon.” O n Se p te mb er 12, 2004, Dr. Celia Gulbenk, a non-examining medical consultant fo r th e St a te Disability Deter mination Services (D DS), assesse d Br ooks’s phy sical re sidual functional capa city (RFC). Dr. Gulbenk listed morbid obesity as her primary diag nosis and car pal-tunnel sy

ndrome as her seconda

ry diag nosis. I n the section of the RFC assessment form entitled “Exertional
L imitations ,” Gulbenk c hecke d box es denoting t hat Brooks could 1) occasionally lift and/or ca

rry 50 pounds, 2) fre quently lift and/or car ry 25 pounds, 3) stand and/or walk about 6 hours in an 8-hour work day , 4) sit about 6 hours in a n 8-hour work day , and 5) push and/or pull without limit ations. Dr. Gulbenk rec ommended no postural, environmenta l, or manipulativ e l i m i tations. “No manipulative limit ations” means Br ooks is not limit ed i n 1 ) rea ching in all direc tions (including overhe ad), 2) handling , 3) fing ering , and 4) f eeling . I n the section of the form wher e Dr. Gulbenk

was direc ted to explain how the evidenc e supports her conclusions, she noted Br ooks’s September 2003 MRI as s h o wi ng minor spondy litis and “no other abnorma lities.” Dr. Gulbenk also noted “Sever e CTS [carpal- tunnel sy ndrome], e xp e c te d to improve to nonsever e by 12 months [after] AOD [allege d onset date]; pain is expected to subside.” Dr. Gulbenk also noted “No evi dence of any

sever e nec k D/O [disorder].”
Br ooks saw Dr. Weikert on Se p t em b er 2 0 , 2004. He noted that Br ooks complained of “intermittent numbness and ti ng ling, wrist pain as we ll as neck a nd shoulder pain.” Br ooks had a
neg ative elbow-f

lexi on test and a neg ative Phal en’s test. Dr. Weikert order ed a repe at nerve -

-4-conduction study and g ave B rooks work r estrictions limit ing any lifting to 20 pounds and limiti ng g rasping and pushing and pulling to less than 50% of the da y . On October 26, 2004, Br ooks underw ent the repe at nerve -conduc tion study order ed by Dr. Weikert. I n the conc lusions section of the re port, Dr. Rober t Clendenin stated: Abnormal study

. There is elec trodiag nostic evidenc e of m o d era te car pal tunnel sy ndrome bilatera lly . There is no acute dener vation prese nt. The median latencie s are much improved on compar ison w ith the pre- op studies. The persistent slowing is most likely a remna

nt from the previous cts [carpal tun n el s y n d ro me] and not a new acute sy

ndrome. I f her sy

mptoms per sist re peat median conductions would be useful to rule out a

worsening or ac ute cts. Br ooks next saw Dr. Weikert on November 1, 2004. Dr. Weikert noted that Br oo k s “i s complaining today of some left upper extremity , neck, and shoulder pain.” Dr. Weikert compar ed
Br ooks’s pre- surg ery nerve study with her October 2004 stud y : “P re o pera tively , her elec trical studies reve aled a motor latency of 9 on t he rig ht and 5 on the l eft. Postoperatively , her electric al studies are 4.92 on the rig ht and 4.45 on the left.” After examining Br ooks, Dr. Weikert opined that

s h e had rea ched maxi mum medical improvement and reta ined 4% impairments to both u p p er extremiti es. Wit h reg ard to work restric tions, Dr. Weikert limit ed Br o o k s to occa sionally lifting betwee n 11 and 25 pounds, and direc ted that she should abide by that restric tion until her next visit three months later. Dr. Weikert wrote that he “would exp ec t t h i s we i gh t-lifting limit to be not
perman en t afte r the next visit,” and “sug g ested that if her neck and shoulder pain appea rs to be worsening , then she should consider having this evaluated.”
Br ooks saw Dr. Weikert ag ain on Fe bruar y 7, 2005. Br ooks complained that her left shoulder

was “killing” her. Br ooks also complai n ed that her rig ht ring fing er would g et “stuck” while straig htened and that she had pain in both wrists, di s co mfort in her fore arms, and intermittent

-5-tingling

. Dr. Weikert noted that Br ooks had a neg ative Phalen’s test, but also noted that she had left

shoulder pain during a supraspinatus stress test, and that her AC [acromioclavicula r] joint was tender and her trape zium was painful along the anter ior marg in. Dr. Weikert conclude d ag ain that Br ooks had rea ched maxi mum medical improvement as to her car pal-tunnel r e le a s e s , a

n d r e mo ved the lifting limit ati o n s he had previously put in place , leaving Br ooks with no restric tions. Dr. Weikert discharg ed B rooks, stating , “I have nothing further

to add to her c are .” On Fe bruar

y 22, 2005, Br ooks returne d to her primary car e phy sician, Dr. Roy

. Dr. Roy noted “tende rness cer

vical spine (C5 – C7); pain left shoulder – spasm; pain both wrists.” Dr. Roy also noted that Br o o k s was “not working now” and was “running out of TennCar e.” Dr. Roy continued to be trea t Br ooks throug h at least May 2006; the rec ord shows that Br ooks saw Dr. Roy 17 time s . I n those visits, Br ooks complained of left shoulder pain at least eig ht times, and of restric ted movement of her left shoulder seven times. Dr. Roy also noted that Br ooks repor ted pain and sometimes stiffness in both hands and wrists, a we ak g rip with her left hand, and pain in her neck. Dr. Roy at one point ref err ed to Br ooks’s left-a

rm pain as “bursitis,” and co n s i s t entl y presc ribed 800 milli g rams of ibuprofen. At one point, Br ooks appar ently experience d relief with the ibuprofen. Howeve r, notes from later appointments show that she subsequently complained of pain in her l ef t shoulder and wrist. I n a Marc h 2006 appointment, Br ooks’s left shoulder rang e of
movement was a

ppare ntly “improved.” Howeve r, in April 2006 she c omplained of “drawing ” of

-6-her left arm. By May 2006, Roy noted an “incr ease d rang e of movement.” He also discontinued the

ibuprofen a

nd substitut ed Ty lenol. 2
On April 24, 2006, Dr. Roy filled out a form entitled “Medic al Source Statement of Ability
to Do W ork-Rela ted Activit ies (Phy sical).” Under the categ ory of exertional limitations , Dr. Roy
repor ted that 1) Br ooks could occa sionally lift less than ten pounds, 2) Br ooks could stand or walk less than 2 hours in an 8-hour work day , 3) Br ooks could sit less than 6 hours in an 8-hour work day , and 4) Br ooks was limit ed in upper extremiti es in that she could only push or pull up to 90 deg ree s with her lef

t shoulder. I n support of these c onclusions, Dr. Roy wrote, “ Has bursitis aff

ecting left shoulder; L imit ed m o v em ent of t he left shoulder; Neuropathic pain left shoul der[.]” Wit h reg ard
t o postural limit ations, Dr. Roy chec ked box es indicating that Br ooks could never climb, kneel,

crouc h, or crawl. Wit h reg ard to manipulative l imitations , Dr. Roy chec ked box es i ndicating that
Br ooks was limit ed in the cate g ories of rea ching in a ll dire ctions and fing ering /fine manipulation.
I n support of these conclusions, Dr. Roy wrote, “Sever e p ai n aff ecting the left shoulder and left
upper a rm.” 3
B. Administrati ve H

earing The administrative law judge (AL J ) held a hear ing on Aug ust 9, 2006, at which Br ooks and

a vocational expert testified. Br ooks testified that she was still having trouble with both her hands and the left side of her neck and shoulder. Despite her car pal-tunnel surg ery , she still experience d

I t appea rs the signific ant amounts of ibuprofen had an adver se aff ect on Br ooks’s stomach. 2 Br ooks herse lf t es t i fi ed to this at the hear ing, and in the same notes in which Dr. Roy chang ed Br ooks’s painkiller, he note d that a re cent e ndoscopy had re veale d “antr al g astritis.” Dr. R o y also conclude d that Br ooks had environmenta l limit ations in the are as of 3 humidity /wetness, hazar ds, and fumes, odor s, chemica ls and g ases. -7-wrist pain and her fing ers “dra wing up” or bending and stiffening , and it was extremely painful for her to lift. When asked if she would be able to pick up paper clips on a table in front of her, she testified that she might be able to, but that her hands might draw up, and that she continually dropped things. Br ooks stated that she almost br oke her denture s the morning of the hear ing when she was try ing to brush them and her hands “re lease [d] .” She testified that her sy mptoms wer e worse on her left side, that she slept in wr ist brace s and wore a neck brac e continuously while in the house, that she ex perie nced pain on the l eft side from her hand all the way t o her neck and shoulder, and that she had slight continuous heada ches. She further testified that her left shoulder ache d constantly and that the only way she could slee p was whe n she took 800 milli g rams of ibuprof en, but sta ted as of the time of the hear ing that she just “tr[ies] to take ” t h e p ai n b ec ause “nothing else ease s it and
I buprofe n messes my stomach up.” Br ooks cut her hair short beca use t h e p ai n in her left arm preve nted her

from re aching above he r hea d to fix it. As for her daily activities, Br ooks testified that she had to start at 4:30 or 5:00 in the morning beca use it took her a long time to bathe and dress, and that she require d her 17-y ear -old daug hter’s assistance to shave under her arms or apply deodora nt and sometimes to put on her pajamas. Br ooks estimated that she spent approximately 30 minutes to an hour per day doing chore s. Br ooks said she did not pick up the laundry basket, but was sometimes able to do the laundry by picking up one piece
at a time; other times he r daug hter did it while Br ooks told he r what to do. Br ooks also stated that

s h e swept, althoug h with a lot of difficulty beca use her shoulder “g ives [her] a fit” and her hands lock around the handle of the broom. She testified that she and her daug hter made the beds toge ther and that her daug hter did most of the cooking and washing the dishes. Br ooks stated that a neig hbor took car e of her y ard for her. She testified that she went g roce ry shopping about once a wee k, taking

-8-her daug hter or someone else who would “put the stuff in a basket and come out with me and bring

it to the house.”
Br ooks testified that she had to lay d o wn t wo or three times in a ty pical day , and that she could stand for 10-15 minutes befor e she neede d to sit down and rest. She estimated that she could walk for 5-10 minutes befor e being short of brea th and needing to rest, and that sh e co u l d lift no more than 5 or 10 pounds. She stated t hat t here wer e day s she st ay ed in bed b ec au s e s h e was too stiff to move; this happene d two or three times a month in the summer, and about four day s a wee k in the winter.
Br ooks testified that she was able to dr ive and did so ever y day

. She drove her daug hter to school during the school y ear and also during summer school. She descr ibed participa ting in churc h activities including choir on Saturday s (for about an hour); worship and Bible study on Wednesday s (for two hours); overse eing y o u t h Bi b l e study on Thursday s (for an hour); and Sunday School, churc h service s, and other prog rams on Sunday s (for approximately 2-4 hours). When asked if her phy sical p ro b l em s g ave her difficulties in her churc h activities, she explained that she mostly sat during churc h activities, including choir re hear sal. The voc ational expert (VE) explained that Br ooks’s past rele vant work w as as a cer tified

nurse technicia

n, a medium, semi-skilled occupation. I n response to the AL J ’s question whether Dr. Gulbenk’s RFC finding s – occa sionally lifting 50 pounds, fre quently lifting 25 pounds, standing 6 hours per day , sitti ng 6 hours per day , and no other limit ations – allowed Br ooks’s past work, the VE stated that they did. The AL J then asked about an individual “ca pable of lifting less than ten pounds

occa sionally , no indication for f reque nt lifting, standing , walking less than two hours out of e ight, sitti ng for less than six

. L imitations in the use of the upper extremiti es, no postural activities except

-9-for occa sional balanc ing, limit ed in the ability to rea ch and handle g ross manipulation, limit ed in the

ability to tolerate vibrations, humidity , wetness, hazardous machiner y , fumes, odors, g as, dust.” The VE responde d that the capa biliti es of such a person wer e “l es s t h an a ful l rang e of work at any exertional level, it’s like less than a f ull rang e of se dentar

y .” C. ALJ Dec ision On October 24, 2006, the AL J issued his decision concluding that Br ooks was not disabled. The decision followed the sequential five-ste p analy sis explained in 20 C.F.R. § 404.1520. The AL J found that Br ooks had three sever e impairments 1) cer vical spine sp ondy losis, 2) obesity , and 3) “status post bilatera l car

pal tunnel rele ase.” The AL J considere d Br ooks’s shoulder pain separ ately fr o m t h e above impairments and conclude d that it was not sever e, whether taken alone or i n combination with other impairments. The A L J explained: [Brooks] testified her left shoulder pain is constant but ref ers to this pain in rela tion to her ne ck pain. Thr oug hout the rec ord she a lleg ed shoulder pain multipl e times. Howeve r, she complained of more neck and hand pain. On numerous occa sions she failed to mention any difficulty with her left shoulder. The rec ord lacks appropr iate rad i o l o gi cal or diag nostic techniques that would support a medical deter minable impairment. The AL J further conclude d that Br ooks was capa ble of perf

orming her past rele v an t wo rk as a

cer tified nurse te chnician, a

nd thus was not disabled for purposes of the Social Security Act.
I n rea ching this decision, the AL J deter mined that Br ooks’s testi m o n y conce rning the “intensity , persistenc e, and limit ing eff ects” of the sy

mptoms of her medical impairments was “not entirely cre dible.” The AL J conclude d that Br ooks’s subjective alleg ations wer e not suppor ted by either the objective medical evidenc e or her established daily activities. The AL J cited the fac t that
Br ooks alleg ed constant debilitating pain, but had not been presc ribed muscle rela x ants or narc otic

-10-pain medication. He also cited the fac t that, despite rec eiving trea tment for shoulder pain, “ther e [i s]

no corr elating testing such [as a] radiolog ical test or a specific diag nosis.” The AL J rejected
Br ooks’s testimony

about needing fre quent rests due to shor tness of brea th a s “not consistent with participa tion in church a ctivities including c hoir.” Wit h reg ard to B rooks’s RFC, the AL J stated: [Brooks] has the residual functional capa city to perf orm medium work (lift/car ry 50 pounds occa sionally and 25 pounds fre quently , stand/walk or sit for 6 hours out of an 8-hour workda

y ) without additional limit ations prior to Dec ember 2004. Following Dec ember 2004 the claimant had no sever e impairments t h at woul d prec lude her from perf

orming her past rele vant work as she had obtained maxi mum medical improve ment. The phy sical functional l imitations the AL J found wer e the same as those rec ommended by Dr. Gulbenk. The AL J stated th at Dr. Gulbenk’s assessment in her September 2004 non-examining consult “we re we l l supported and consistent with the daily activities, and thus acc orded g rea t weig ht.” I n contra st, the AL J g ave “no we ight” to D r. Roy ’s April 2006 medical source statement beca use it “lac k[ed] objective finding s for upper left extremity impairments and limit s.” The AL J also found that Br ooks’s daily activities “dire ctly ref ute” limit ations to the deg ree sug g ested by Dr. Roy , and that Dr . Roy ’s own tre atment re cords did not support his opinion. The Appea ls Council denied Br ooks’s reque st for revie w of the AL J ’s decision on Marc h 1, 2007. D. District Court

Procee dings
I n May 2007, Br ooks filed a civil action to revie w the ag ency decision. S he moved for judgme nt on the rec ord, arg uing among other things that the AL J err ed in aff ording no weig ht to Dr. Roy ’s assessment and controlling weig ht to Dr. Gulbenk’s, that the AL J failed to g ive g ood rea sons

-11-for disag ree ing with Br ooks’s primary car e phy s i ci an , an d that her left shoulder condition was a

sever e impairment. The mag istrate judge denied the motion in a brief order , adopting the arg uments made in the Social Se cu ri t y Administration’s response to the motion. I n a single -pag e order , the district court adopted the mag istrate judge ’s repor t and rec ommendation over Br ooks’s objections.
I t explained its reje ction of Br ooks’s arg ument that the AL J improperly g ave no weig ht to Dr. Roy as follows: The Plaintiff is incorre ct[]

. The Administrative L aw J udg e found the opinion of Dr. Roy to be unsupported by his own trea tment rec o rd , i n consistent with Plaintiff’s daily activities, and inconsistent with the rec ord as a whole. Dr. Roy ’s trea tment notes did not contain any radiologi ca l o r diag nostic techniques such as observe d swelling , withdrawa l of sy novial fluid. His trea tment was conser vative presc ribing only Tylenol and ibuprofen. Fa ilure to c onsider or use such techniques or steroidal injection or surg ery sug g ests the shoulder injury was much milder than Dr. Roy opined. [] I n contra diction to Dr. Roy ’s opinion, the Administrative L aw J udg e considere d the opinion and diag noses of Drs. Weikert, Dulbenik, and Gulbenk. The 4 Administrative L aw J udg e considered these and the whole rec ord i n g iving gr eate r weig ht to their opi nions than to those of Dr. Roy

. The deter mination of the Administrative L aw Judge is amply supported by

the evidenc e. Br ooks timely

appea led.

DISCUSSIO N A. Legal Standards
T his court revie ws district-court decisions in social secur ity case s de novo . See Jordan v. C o mm ’r o f Soc. Sec. , 548 F.3d 417, 422 (6th Cir. 2008). Howeve r, appellate review is limit ed t o

The order incorre ctly implies that “Dr

. Dulbenik” and Dr. Gulben k ar e t wo separ ate 4 phy sicians. “D r. Dul benik” does not exis t; court documents submitt ed by the Commi ssioner misspelling Dr. G ulbenk’s name are the likely source of the c onfusion. -12-deter

mining whether the Commi ssioner’s decision “is supported by substantial evidenc e an d was made pursuant to proper le g al standar ds.” Rogers v. Comm’ r of Soc. Sec

. , 486 F.3d 234, 241 ( 6th Cir. 2007)

. “Substantial evidenc e is ‘ such rele vant evidenc e as a rea sonable mind mig ht a cce pt a s adequate t o support a conclusion.’” Lindsl ey v. C omm’r of Soc. Sec. , 560 F.3d 601, 604 (6th Cir. 2009) (quoting Richardson v. Perales , 402 U.S. 389, 401 (1971))

. I f the Commi ssioner’s decision is based upon substantial evidenc e, this court must aff irm, even if substantial evidenc e exis ts in the

rec ord supporting a diffe rent c onclusion. Id . at 604-05. A social secur ity disability deter mination is made acc ording to the five-ste p analy sis set out in 20 C.F.R. § 404.1520: First, [Brooks] must demonstrate that she is not curr ently eng ag ed in subs t an t i al g ainful employ

ment at t h e time of the disability application. 20 C.F.R. § 404.1520(b). S ec ond, [Brooks] must show that she suffe rs from a sever e impairment. 20 C.F.R. § 4 0 4

. 1 5 2 0 (c). Third, if [Brooks] is not eng ag ed in substantial g ainful employ ment and has a sever e impairment which is expecte d to la st for at least twelve months, which meets or equ al s a listed impairment, she will be considere d disabled without reg ard to ag e, education, and wo rk ex p er ience

. 20 C.F.R. § 404.1520(d). Four th, if the Commi ssioner cannot make a deter mination of disability based on medical e valuations and c urre nt work ac tivity and [Brooks] ha s a sever e impairment, the Commi ssioner will th en re v i ew [Brooks’s] residual functional capa city (R FC ) and rele vant past work to deter mine if she can do past work; if so, she is not disabled. 20 C.F.R. § 404.1520(e ). Howard v. Comm’r of Soc. S ec
. , 2 7 6 F.3d 235, 238 (6th Cir. 2002). I f, under the fourth step, Br ooks’s impairment preve nts her from doing past work, the analy sis proce eds to the fifth step: the “Commissi oner will consider her RFC, ag e, education and past work experience to deter mine if she

can perf orm other work. I f she cannot perf orm other work, the Commi ssioner will find her disabled. 20 C.F.R. § 404.1520(f) .” Id

.

-13-For t h e fifth step, the burden of proof shifts to the Commi ssioner. See McClanahan v.

Comm’r of Soc. Se c ., 474 F.3d 830, 836 ( 6th Cir. 2006). To meet this burden, the Commi ssione r m ust make a finding “supported by substantial evidenc e that [Brooks] has the vocational qualifica tions to perf orm specific jobs.” Varley v. Sec’ y of Health & Human Servs., 820 F.2d 777, 779 (6th Cir. 1987). This kind of “[s ] u b s t an t i al evidenc e may be produce d throug h relianc e on the testimony of a vocational expert (VE) in res ponse to a ‘hy pothetical’ question, but only ‘if the question acc urate ly portray s [Brooks’s] individual phy sical and mental impairments.’” Id . (citations omitted). Howard , 276 F.3d a t 238. The Social Security Adm inistration g ener ally g ives the most weig ht to opinions from a claimant’s trea

ting source . See 20 C.F.R. § 404.1527(d)( 1)-( 2). I f a trea ting source ’s opinion is wellsupported by medically acc eptable clinical and labor at o ry d i ag nostic techniques and is not inconsistent with other rec ord evidenc e, it is entitled to controlling weig ht. See id. § 404.1527(d)( 2). When the t rea ting source’ s opinion is not g iven controlli ng weig ht, the age ncy considers th e set of fac tors that apply in deter mining the proper weig ht to g ive any medical opinion. See i d

. § 404.1527(d) & (d )( 2 ). These include the leng th of the trea tment rela tionship and the fre quency of examination, the nature and extent of the trea tment rela tionship, the amount of rele vant evidenc e the medical source provides, how consistent the medical source ’s opinion is with the rec ord as a whole, and whether the medical source is a specia list. See id. § 404.1527(d). I n any case , the AL J is require d
to “g ive g ood rea sons in [i ts] notice of dete rm i nation or decision for the weig ht [i t g ives the claimant’s] trea t i n g s o u rc e’s opinion.” Smith v. Comm’r of Soc. Sec ., 482 F.3d 873, 875 (6th Cir. 2007) (quoting 20 C.F.R. § 404.1527(d)( 2)). Good rea sons are rea sons that are “s u p p o rt ed by the evidenc e in the case rec ord, and must be sufficie ntly s p ec ific to make clea r to any subsequent

-14-revie wer s the weig ht the adjudicator g ave to the trea ting source ’s medical opinion and the rea sons for that weig ht.” Blakley

v. Comm’r of Soc . Sec ., 581 F.3d 399, 406- 07 (6th Cir. 2009).

B. Analysis On appe al, B rooks contends that the AL J did not give g ood rea sons for g iving no we ight to
trea ting phy sician Dr. Roy ’s assessment. Specifica lly , she arg ues that the rationale s g iven by the AL J

– that 1 ) on numerous occa sions Br ooks failed to mention any difficulty with her left shoulder, 2) there was no testing or other objective evidenc e of a left-shoulder conditi o n , 3 ) Brooks’s daily 5 activities ref

ute the limit ations assig ned by Dr. Roy , and 4) Dr. Roy ’s own medical rec ords fail to support his assessment – are faulty

. Br ooks also arg ues that it was improper for the AL J to base his RFC finding on Dr. Gulbenk’s rec ommendation beca use Dr. Gulbenk’s September 2004 assessment

nece ssarily did not consider the signific ant medi ca l ev ents and rec ords that occur red afte rwa

rd. Finally , Br ooks arg ues that the AL J failed to proper ly cre dit Br ooks’s sy mptoms, including pain, and that Br ooks’s testimony

is supported by

the evidenc e. 1. Whether the AL J g ave g ood rea sons for g iving no we ight to Dr . Roy ’s opinion.

a. Br ooks’s failure to mention difficulties with her lef t shoulder The AL J ’s asser

tion that “[o] n numerous occa sions [Brooks] failed to mention any difficulty with her left shoulder” is problematic. The AL J ’s opi nion states a mere two sente nces before that, “[t] hroug hout the rec ord she alleg ed shoulder pain multipl e times.” Fur ther, Br ooks’s alleg ations of

The AL J did not expli citly list this as a rationale for g iving no weig ht to Dr. Roy ’s opinion. 5 T h e ALJ ci ted this point in rela tion to his evalua tion at step two (dete rmining Br ooks’s seve re impairments) rathe r than at step five (eva luation of Br ooks’s RFC and consideration o f m ed i cal source statements on the issue). Reg ardle ss, beca u se Dr. Roy ’s RFC conclusion depende d upon Br o o k s ’s left shoulder injury /pain, the AL J ’s reje ction of Br ooks’s shoulder trouble as a sever e impairment is an implicit reason for g iving no we ight to Dr . Roy ’s opinion.

-15-shoulder difficulty are well documented in her medical rec ords. She initially complained of shoulder

pain at the time of her 2003 work injury

. She then complained of left- shoulder pain to Dr. Weikert in Aug ust 2004, September 2004, November 2004, and Fe bruar y 2005, four out of the five visits to Dr. Weikert in the r ecor d. I n her 17 visits total to D r. Roy (16 of them betwe en F ebrua ry 2005 and May 2006), Br ooks was trea ted by Dr. Roy and specific ally compl ai ned of left-shoulder pain or restric ted movement 10 or 11 times. I t also appea rs that Br ooks complained about her shoulder when she soug ht c hiroprac tic trea tment in Fe bruar

y 2006. On the whole, Br ooks complained of shoulder problems more often than not. That Br ooks did not complain of shoulder problems ever y single time she saw a doctor is not a g ood rea son to discount the numerous times she did complain. Relatedly , the AL J discounts the num ber of times that Brooks c omplained of shoulder pain beca use she of ten complained a

bout it in conjunction with her neck a nd/or hand pa in. See A.R. 17 (“She testified her left shoulder pain is constant, but re fer s to this pain in relation to her neck pain. Throug hout the rec ord she alleg ed shoulder pain multipl e times. Howeve r, she complained of more neck and hand pain.”)

. But it makes sense that Br ooks’s shoulder complaints often overla pped with

co m p l ai n t s conce rning her neck, hand and wrist. When Br ooks was first injured, she complained 6 of pain and numbness in all of those locations – shoulder, wrist, neck, and hand. The AL J failed to explain how Brooks’s c oncurr ent experienc e of ne ck or wrist or hand pain along with her shoulder pain cuts ag ainst the alleg ation of shoulder pain. Acc ording ly , the AL J ’s rationale that Br ooks failed

I t is not the case , as the AL J asser ted, that Br ooks “complaine d [] more” of neck and hand 6 pain. Br ooks complained ab o u t n ec k , s houlder, and hand pain roug hly the same amount befor e Fe bruar y 2005. After Fe bruar

y 2005, she complained of shoulder pain numerous times, wrist/hand pain twice, a

nd neck pa in once. -16-to mention difficulties with her left shoulder is not sup p orted by substantial evidenc e and is not a

“g ood rea son” to aff

ord no we ight to Dr . Roy

. b. No testing or other obje ctive evide nce of a lef t-shoulder c ondition The AL J rea soned, “Althoug h[] the trea ting rec ord ref lects trea tment for shoulder pain, there [i s] no corr elating testing such [as a] radiolog ical test or a specific diag nosis. The prese nce of a medically deter

minable impairment must be supported by objective medical evidenc e and cannot rest solely upon a claimant’s subjective alleg ations. 20 [C .F.R. §] 404.1508.” The AL J conclude d, “The April 24, 2006, opinion of Dr. Roy lacks objective finding s for upper left extremity impairments and limit s. There fore his opinion i s g iven no weig ht.” (A.R. 20.) 20 C.F.R.§ 404.1508 states: What is needed to show an impair ment. . . . Your impairment must result from anatomica l, phy siolo gi cal, or psy cholog ical abnorma lities which can be show n b y me d ically acceptable clinical and laboratory diagnostic techniques

. A phy sical or mental impairment must be established by medical evidenc e consisting of signs, symptoms, and laboratory findings , not only by y our statement of sy

mptoms (see § 404.1527). (See § 404.1528 for further information about wha t we mea n by sy mptoms, si g ns, and laboratory finding s.) (Emphasis adde d.) 20 [C.F.R.§] 404.1528 states in part: Sy mptoms, si g ns and laboratory finding s.

. . . (b) Signs are anatomica l, phy siologica l, or psy cholog ical abnorma lities which can be observe d, apar

t from y our statements (sy mptoms). Signs must be shown by medically acce ptable clinical diagnostic techniques

. . . . (c) L abora tory finding s are anatomica l, phy siologica l, or psy cholog ical phenomena which can b e s h own by the use of medically acce ptable laboratory diagnostic techniques

. Some of these diag nostic techniques include chemica l tests, electrophy siologica l studies (ele ctroc ardiog ram, elec troenc ephalog ram, etc.) , roentg enolog ical studies (X- ray s), and psy cholog ical tests.

-17-(Emphasis adde d.) F inally , 20 C.F.R. § 404.1529 states in rele vant par t: How we evalua te sy

mptoms, i ncluding pain. (a) Gene ral. I n determ i n i n g whether y ou are disabled, we consider all y our sy mptoms, including pain, and the extent to which y our sy mptoms can rea sonably be acc ept ed as consistent with the objective medical evidenc e and other evidenc e. By objective medical evide nce, we mean medical signs and laboratory fi n d in g s a s defined in § 404.1528 (

b) and ( c)

. (Emphasis adde d.)
I n more than one place , the reg ulations state that objective medical evidenc e is medical signs and labora

tory find i n gs as define d in § 404.1528(b) and (c)

. See 20 C.F.R. §§ 404.1512(b)( 1), 404.1529(a) ; see also id. § 404.1508

. Since Dr. Roy did not conduct any lab tests, the only issue is whether Dr Roy employ ed any “m edica lly acc eptable clinical diag nostic techniques” under § 404.1528(b). On this rec ord, we need not specific ally define “clinica l diag nostic techniques” in order
to observe that it would be difficult to conclude that Dr. Roy employ ed any . Even if simply observing
Br ooks’s shoulder would be a sufficie nt “tec hnique,” Dr. Roy ’s notes ref err ing to reduc ed motion and muscle spasm do not indicate whether he observe d these aspec ts about Br ooks’s shoulder or whether she repor ted them. Thus, we conclude that the AL J ’s conclusion that Dr. Roy di d not perf orm specific testing or show other objective medical evidenc e of a left-shoulder condition is supported by substantial evidence

. The que stion that nece ssarily follows is whether this is a “g ood rea son” to aff ord Dr. Roy ’s conclusions no weig ht. Whil e it is rea sonable to g ive l ess weight to an opini o n t h at l ac k s m edica l signs and lab finding s to suppor t it, the rec ord does contain objective medical evidenc e of Br ooks’s shoulder impair ment. I n Fe bruar y 2005, Dr. Weikert’s medical rec ords state that Br ooks’s “lef t

-18-shoulder reve als pain with supraspinatus stress test.” Fur ther, there ar e n u merous tests and other clinical diag nostic information in the rec ord supporting Br ooks’s car pal-tunnel sy

ndrome and

cer vical-spine spondy losis; ag ain, tw o i m pairments that the AL J acknow ledg ed wer e sever e. And there is no indication that the doctors who trea ted Br ooks for those conditions reg arde d her shoulder pain (of w hich B rooks complained at the time) as re sulting fr om a sepa rate condition. 7 Under other c ircumstance s, the AL J ’s lack- of-testing -or- objective- evidenc e ra tionale could be a g ood rea son to dismiss Dr. Roy ’s opinion. Howeve r, on this rec ord, we cannot conclude that
Br ooks’s shoulder pain was distinct from her other well-doc umented and fu l l y d i agnosed impairments. Thus, the AL J did not articulate a g ood rea son.

c. Br ooks’s daily

activities ref

ute the limitations assigned by Dr. Roy The AL J ’s opinion char acte rized Br ooks’s daily activities as follows: Her daily activities consist o f d ri ving her daug hter to school ever y day , g oing to the library , go i ng to choir prac tice for 1 hour once a wee k, attending worship service ever y Wednesday , conducts y outh bible study o n Thursday , Sunday she g oes to churc h

The Commi ssioner would respond that the ca rpal-tunne l and spondy losis record e vidence 7 cannot shore up Dr. Roy ’s m edical rec ords because Dr. R oy himself chose the alterna te di ag nosis “bursitis” (but did not perf orm ty pical diag nostic tests for bursitis, and only trea ted it conser vatively with ibuprofen and Ty len o l ). T h is is true in part – in his medical- source statement, Dr. Roy does note that Br ooks “[h] as bursitis aff ecting left shoulder.” Howeve r, in the same document, Dr. Roy wrote “[n] e u

r o p a th ic pain left shoulder,” an indication that he had deter mined that Br ooks’s shoulder pain was rela ted to her prior nerve injuries, the car pal-tunnel sy

ndrome and cer

vica l-spine spondy losis. See The Merc k Manuals Online Medica l L ibrary : The Merc k Manual for Hea lthcare P r o f e s s i o n a l s , a v a i l a b l e a t h t t p : / / w w w . m e r c k

. c o m / m m p e / s e c 1 6 / c h 2 0 9 / c h 2 0 9 c . h t m l ? q t = n e u r o p a t h i c % 2 0 p a i n & a l t = s h (“N europa thic pain results from damage to or dysfunction of the periphera l or central nervous system

. . . . Neur opathic pain is sug g ested by its ty pical sy mptoms when nerve injury is known or s u s p e c t e d

. ” ) ( E m p h a s i s a d d e d )

. s e e a l s o ht tp://www.merck.c om/mmpe/sec04/ch042/ch042f.html#sec 04-ch042- ch042f- 992 (ca rpal tunnel s y n d r o m e i s a n e r v e c o m p r e s s i o n s y n d r o m e ) ; http:// www.mer ck.com/mmpe/ s ec 1 6 / ch 2 2 4 / ch 2 2 4d.html? qt=ce rvica l%20spine%20spondy losis& alt=sh (c ervic al spondy losis categ orized as a “ neurolog ic disorder ”). -19-from 10:00 to 12:30 and 3:00 to 5:00, an d d u ring holiday s she attends churc h

additionally

.
The AL J conclude d t h at t h o s e ac tiviti es “dire ctly ref ute” the limit ations Dr. Roy found. These limit ations included only occa sionally lifting less than t en poun d s ; s t an d i ng or walking less than 2 hours in an 8-hour work day ; sitti ng less than 6 hours in an 8-hour work day ; no climbing, kneeling ,

crouc hi n g, or cra

wling; being limit ed in rea ching (including overhe ad) and handling (g ross manipulation); and being limit ed in exposure to v ib r a ti on, humidity , wetness, machiner y , heig hts, and fumes. The AL J did n o t ex p l ai n how Br ooks’s daily activities direc tly ref uted Dr. Roy ’s stated limit ations. Br ooks’s activities mostly involve sitti ng inside, and trave ling by car to place s wher e one g ener ally sits inside. None of her daily activities nece ssarily involve the lifting, extended standing , extended walking or sitti ng , climbing or crouc hing from which she was restric ted. Acc ording ly , the rationale that Br ooks’s activities “dire ctly ref ute” Dr. Roy ’s limit ations is not well supported by the

rec ord, and thus is not a g ood rea son to devalue D r. Roy ’s assessment.

d. Dr. Roy ’s own medica l rec ords fa il to support his assessment We have alrea dy discussed Dr. Roy ’s record entries depicting Brooks’s pain and l i m itation of movement and his lack of rec ord entries demonstrating testing or clinical techniques. The only signif i cant point on this topic not y et addre ssed conce rns Dr. Roy ’s rec ommended environmenta l limit ations. Dr. Roy chec ked box es indicating that Br ooks should limit her exposure to 1) vibrations, 2) humidity and wetness, 3) hazards (mac hinery , heig hts, etc.) , and 4) fumes, odors, chemica ls, a nd
g ases. The AL J ’s conclusion that the assessment is unsupported is corr ect as to the environmenta llimit ation portion of Dr. Roy ’s assessment. Dr. Roy wrote “Rec urre nt upper [r] espirator y trac t

-20-infec tions and allerg y ” as the explanation for his assig ned limit ations. But Dr. Roy ’s medical rec ords

show only

a sing le occ urre nce of

a re spiratory -trac t infection, and ma ke no mention of a llerg ies. The fact that Dr . Roy ’s re cords f ail to support his environmental limitations is undoubtedly

a g ood rea son to aff

ord no weig ht to that part of Dr. Roy ’s assess m en t

. However, this limit ed defic iency

is not sufficient re ason to g ive no weig ht to any portion of Dr. Roy ’s assessment. Of the fo u r “g ood rea sons” t hat t he AL J can be understood to have offer ed for his decision
to aff ord no weig ht to Dr. Roy ’s assessment, two are not supported by the rec ord. Another, althoug h technica lly supported by the rec ord, is not a leg itimate rationale for dismiss ing Dr. Roy ’s assessment. The final rea son justifies aff ording no weig ht only to Dr. Roy ’s sug g ested environmenta l limit ations.

2. Whether the AL J proper ly g ave “g rea t weig ht” to D r. Gulbenk’s RFC deter mination Dr. Gulbenk conclude d that Br o o ks could perf orm medium work (which involves lifting/ca rry ing 50 pounds occa sionally and 25 pounds fre quently , and standing , walking or sitti ng for 6 hours out of an 8-hour workda y ), that she was unlimit ed in her ability to push and pull, and that she had no manipulative or postural limit ations. The AL J g ave Dr. Gulbenk’s RFC assessment “g rea t weig ht” and ultimately assig ned Br ooks the exact same RFC as Dr. Gulbenk did. Of the three ty pes of medical source s (non-e x ami n i n g source s, examining source s, and trea ting source s), a nonex amining, non-trea

ting phy sician is g ener ally g iven the least weig ht. See 20 C.F.R

. § 404.1527(d)( 1)-( 2). Howe ver, it is not alway s illegitimate for an AL J to decide to a ccor d g rea ter weig ht to an ag ency phy sician over a trea ting source : “I n appropr iate circ umstances, opinions from State ag ency medical

. . . consultant s . . . may be entitled to g rea ter weig ht than the opinions of
trea ting or examining source s.” Blakl ey , 581 F.3d at 409 (citing Soc. Sec. Rul. 96-6p, 1996 WL

-21-374180, at *3 (Jul y 2, 1996)). “One s u ch ci rc umstance may occur , for example, when the ‘State

ag ency m ed i ca l

. . . consultant’s opinion is based on a revie w of a complete case rec ord that

. . . provides more detailed and compre hensive information than what wa s available to the individual’s
trea ting sourc e.’” Id

. Her e, though, the AL J g ave i n ad eq u at e rea sons for aff ording Dr. Gulbenk’s opinion g rea t weig ht. Dr. Gulbenk’s September 2004 assessment was necessa rily limit ed in the m edica l rec ords he revie wed, since many of Br ooks’s medical rec ords are from afte r that date. This is espec ially signific ant beca

use when Dr. Gulbenk examined Br ooks’s rec ords, Br ooks had just completed car pal tunnel rele ase surg ery on both hands and was seeing Dr. Weikert for follow up. At that time,
Br ooks’s most rec ent doctor visit (Aug ust 2004) had been optimis tic – althoug h Br ooks complained of left shoulder pain, locking of her rig ht ring fing er and some gen er al i z ed pain, numbness, and tingling in her fing ers, she had o n l y re ce n t ly completed her second surg ery on J une 29, 2004. Dr. Weikert noted that her

incisions had heale d well and that she had “g ood capillar y ref ill, int act lig ht touch sensation, and a

neg ative Phalen’ s test in both hands.” He a nticipated a thor oug h rec overy – “she should be near ing a point where she ca n work without restric tions soon.” Thus, in September 200 4 , Dr. Gulbenk’s assessment reg arde d Br ooks’s car pal-tunnel sy

ndrome as “seve re . . . [but ] expected to improve to nonsever e by 12 mos [after alleg ed onset date]; pain is expected to subside.” But subsequent medical rec ords show that Dr. Gulbenk’s predic tion proved inacc urate

. Br ooks continued to complain of pain to Dr. Weikert in visits leading up t o an d afte r the date 12 months af

t er the alleg ed onset of her impairment (De cembe r 20, 2004). Eig hteen day s afte r Dr. Gulbenk’s determination t h at Br o o ks could occasionally lift and/or carr y 50 pounds, and push and pull without limit ations, Dr. Weikert order ed a repe at nerve -conduc tion study and limit ed Br ooks to

-22-lifting 20 pounds and to g rasping , pushing and pulling less t h an 5 0 % of the day

. The nerve conduction study was conducte d October 26, 2004, and noted abnorma l results, likely from Br ooks’s previous car

pal-tunn el sy

ndrome. The repor

t portion of the study conclude d that “if [Brooks’s]
sy mptoms persist repe at median conductions would be useful to rule out a worsening or acute cts.” Thus, the medical evidenc e indicated continuing car pal-tunnel sy

mptoms inconsistent wi t h Dr

. Gulbenk’s prior estimations. Fur ther, Br ooks saw her trea ting phy sician, Dr. Roy , 16 times afte r Dr. Gulbenk’s Septembe r 2004 asse ssment. These r ecor ds document B rooks’s complaints of shoulder pain, wrist pain, re stricted shoulder move ment, wea k hand g rip, and va

rious other sy

mptoms. Acc ording ly , in aff

ording Dr. Gulbenk g rea t weig ht, the AL J relied upon a non-treating, nonexamining source who revie wed Br ooks’s rec ords a y ear and a half befor e Dr. Roy ’s assessment, and who did not have acc ess to signific ant medical rec ords from the p er i o d afte r her assessment that contained evidenc e of continuing problems with a rele vant impairment. The AL J could perha ps have relied on Dr. Gulbenk’s dated assessment if the AL J made clea r that he had considere d the eff ect of the subsequent medical rec ords on the reliability of that assessment. S ee Blakley , 581 F.3d at 409 (“[W] e require some indication that the AL J at lea s t co n s i d ere d [t he subsequent medical rec ords] befor e g iving g rea ter weig ht to an opinion that is not based on a revie w of a complete case rec ord.” (interna l citations and quotation marks omitted)). The AL J did not do this here , howeve r. The AL J ’s opinion only acknow ledg es Br ooks’s first and last visits to Dr. Roy , and neg lects to m ention the numerous other

documented visits. As we have noted above, the AL J ’s opinion mischara cter izes Br ooks’s com p la ints of shoulder problems to Dr. Roy , and only selec tively descr ibes Br ooks’s subsequent visits to Dr. W ei k er t

. Thoug h the opinion mentions that Dr. Weikert conclude d that Br ooks had rea ched maxi mum medical

-23-improvement in November 2004 and rele ased the temporar y lifting restric tions he had imposed in Fe b ru ar y 2005, the AL J g ave no indication that he considere d Dr. Weikert’s November 2 0 0 4
sug g estion that “if [Brooks’s] neck and shoulder pain appea r[] to be worsening , then she should consider ha

ving this eva luated,” a

nd his nota tion on Fe bruar y 2005 that Br ooks’s left shoulder w as “killing” her. The opinion also ignor es Br ooks’s October 2004 repe at nerve -conduc tion study

. Whil e the opinion does state that Gulbenk’s limit ations wer e consistent with Br ooks’s later acc ount of her daily activities, this does not substitut e for the AL J ’s fa ilure to demonstrate consideration of all of the re levant subseque nt medical re cords. Be cause there is no indication that the AL J separ ately considere d all of the rele vant medical

rec ords t hat pos t-dated Dr. Gulbenk’s assessment when deciding to aff ord i t g rea t we ight, the AL J impermissibly

violated the ag ency ’s rules, wa rra nting r emand.

3. Whether the AL J failed to prope rly cre dit Brooks’s sy

mptoms, i ncluding pain The AL J conclude d that Br ooks’s testimony conce rning the intensity , persistenc e and limit ing eff ects of he r sy

mptoms was “not entirely cre dible.” On the whole, the AL J ’s conclusion is supported by substantial evidenc e. Br ooks’s testimony portray ed someone with very debilitating limit ations – she testified that she was in constant pain, that during the winter she could not leave bed an aver ag e of four day s per wee k, and that she could walk only about 5 to 10 minutes or stand 10 to 15 minutes beca use of being short of brea th. The AL J cited
Br ooks’s daily driving , signific ant involvement in churc h activities, and pe rfor mance of household chore s as conf

licting with B rooks’s ac count of her s y mptoms. The AL J may

consider a

claimant’s daily activities in deter

mining the cre dibilit y of her complaints of pain. See Vance v. Comm’r of Soc.

-24-Sec ., 260 F. App’x. 801, 805 (6th Cir. 2008) (unpublished); Cruse v. Comm’r of Soc. Sec ., 502 F.3d

532, 542 (6th Cir. 2007). I n particula r, the AL J found Br ooks’s shortness-of- brea t h t es t i m o n y inconsistent with participa ti o n i n h er ch urch choir. The AL J also noted t hat “[ d]espite her alleg ed
constant debilitating pain, she has not been presc ribed muscle rela x ants or narc otic pain medication.”
Br ooks raises sever al arg uments in response , including that she stopped taking the ibuprofen for pain beca

use it upset her stomach, that she had been presc ribed ox y codone, Percoc et, and Ultrac et, and that the AL J did not acknow ledg e the other steps she took to avoid pain such as g etting her hair

cu t short so she would not have to rea ch for it, and having her daug hter apply her undera rm deodora nt. Whil e some of these arg uments ar e l egi t i mate, none undermine the valid substantial evidenc e the AL J cited to support his conclusion. S ee B l a kl ey , 581 F.3d at 407 (“[I ]f substantial evidenc e supports the AL J ’s decision, this Court defe rs to that finding ‘eve n if t h er e i s substantial evidenc e in the rec ord that would have supported an opposite conclusion.’” ) (citing Key v. Callahan , 109 F.3d 270, 273 ( 6th Cir. 1997)). The AL J ’s conclusion that the Br ooks’s own acc ount of the intensity , persistenc e and limit ing eff ects of her sy

mptoms was less than wholly cre dible is there fore supported by substantial evidenc e.

CONCLUSION Despite the fac t that the ALJ ’s p ar tial reje ction of Brooks’s hearing testimony is supported by substantial evidenc e, the AL J did not g ive g ood rea sons for g iving no weig ht to Br ooks’s trea ting phy sician’s assessment of her limit ations and g iving g rea t weig ht to the asses s ment of an ag ency consulting phy sician. Severa l of the rea sons the AL J g ave for discounting Br ooks’s trea t i n g phy sician’s opinion wer e not supported by the record, and the two that wer e did not provide “ g ood

-25-rea son” to reje ct the entirety of Dr

. R o y ’s o pinion. And, there is no indication that the AL J

considere d signific ant m ed i ca l rec ords g ener ated afte r the ag ency phy sician’s September 2004
assessment. Treating- phy sician opinions t h at are well-supporte d by medically acc eptable clinical and l ab oratory diag nostic techniques and not inconsistent with other rec ord evidenc e are enti t l ed t o controlling weight

. See 20 C.F.R. § 404.1527(d)( 2). I n the event that a trea ting phy sician’s opinion is not entitled to that high level of defe renc e, an AL J must prese nt good rea sons, as articula ted in the applicable reg ulations, not only for the lack of controlling weig ht aff orded the trea ting phy sician, but for the w eig ht affor ded to the ag ency phy sician or other

competing opinion. See id. After car eful revie w of the rec ord befor e us, we are convince d that this standard was not met here

. Acc ording ly , we REVERSE the opinion of the district court and REMAND to the ag ency for thoroug h consideration of the entire r ecor d.

-26-