The Hon. N ancy G. Edmunds, United States District Judg e for the Easter

n Di s tri ct of * Michig an, sitting by

designation. NO T RE CO MM EN DE D FO R FU LL -T EXTPU BL IC A TI ON Fi le N ame: 08a0677n .06 Fi led : N ovemb er 5 , 200 8

07- 3168 UNITED STA

TES COURT OF A PPE A LS FO R TH E SI XTH C IR CU IT
KAREN GERMANY-JOHN SON, Pl ain ti ff-A ppel lan t,
v. C O M M ISSI O N E R O F SOC IAL SE CUR IT Y, Defendant -A ppel lee

. ) ) ) ) ) ) ) ) ) ) ON APP EAL F RO M THE UN ITED ST AT ES DIST RICT COURT F O R THE NO RTH ER N DI STRIC T OF OH IO

Before: D AU GH TREY and GILM AN , C ircui t J udg es; ED MU ND S, D is tr ict J udg e. *
PERC UR IAM

. In t his app e a l chal len g ing the deni al of Soci al Secu ri ty di sabi li ty benefits , c lai mant Ka re n Ger many -J ohnso n as si g ns as er ro r the “sec o n d step” r uli ng by the a dmini strati v e l aw

j udg e ( ALJ)thather

medi cal co ndi ti on w as n o t se vere enoug h to adv ance the s eq uenti al ev alu ati on proces s, as w ell as the ALJ’ s fai lure to g iv e appropr iat e deferenc e to the opi nio n of he r treati ng physi ci an. Den ial of benefits w as aff ir med by the Appeal s C ounci l and by the dis tr ict c our

t. W e co n clu d e t h a t the ALJ er re d as a l eg al matter by ( 1) appl y ing the w ro ng st andard of rev iew at the s e co n d st ep of the fiv e- ste p evaluation process an d (2) fa iling to com ply w ith the Social Secu rity Adm inistration ’s rule07-3168

Germ an y -J oh ns on v . Co mm iss ion e r o f So c ial Se c urity

- 2 - that a dec is ion deny ing benefit s must inc lud e spec ific re asons for re jecti ng the opi nio n of
a treati ng physi ci an, a req uirement reit erated in our opi nio n i n W

il son v. Com m is si

oner of Soci al Secu rity, 378 F .3d 5 41 ( 6th C ir . 200 4)

. As a resul t, thi s c ase must be remanded t o the A LJ for furt her

co nsi derati on.
I. FACTUA L A ND PROCEDUR A L BACKGROUND
After w or ki ng st eadi ly

from 196 9 to 1996, w it h a four-y ear break in the e ar ly

1980s to s tar t a family , G er many -J ohnso n w as inv olv ed i n an automobi le acc iden t in 1996 t hat apparentl y

caused neck

and back

pain, w hic h in turn ex acer bated ner v e damage she had
ex per ien ced as the r e su lt of three s urg er ies on h er l ow er sp ine dati ng bac k t o 1972. Una ble to maint ain full -t ime wor k, she hel d s ev eral par t- ti me or sh ort- ter m jo bs ov er

the
next s ix y ears, w hil e s he w as in the care of her pr imar y physi ci an, D r. M ar k M eacha m. I n 1998, she w as seen by an o rt hopedi c spec ial is t, Dr

. John Col li s, w ho di ag nosed her w it h chron ic should er and neck pa in due to arthritic disc disea se and sev ere pa in due to C5 disc her nia ti on and extr usi on. Her efforts at ph y si cal therapy resul ted i n the ons et of v erti g o,
w hic h w as ser iou s e nough t o req uire hos pit ali z ati on. In 20 00, G er many -J ohnso n develope d an ulcer due to taking me dicatio n for her neck a nd low back pain. Tw o y ears lat er , D r. M eacha m referred Germany-J ohnso n to Dr . Ray nor , a rh eumatol og is t, w ho found that she w as “l ik ely” sufferin g from fibromy alg ia.
In N ov ember

2002, the cl aimantw as als o referred by D r. M eacha m to D r. Gardz iol a, a ne urologist. Dr. Gardziola recogniz e d thatshe w as the v ictim of chronic pa in butsaid07-3168

Germ an y -J oh ns on v . Co mm iss ion e r o f So c ial Se c urity

- 3 - tha t he cou ld noteasilyident if y its sou rce b ecau se it d id notf it a n euro pat hic pat tern. He
ne v er th el es s n ot ed t ha t Ge r ma ny- J oh ns on h ad a lo ng hi s to r y of mu s c l e pa i n an d s pa s m.
Germ any-Johnso n ap plied for disability be nef its in 2 002

. I n Decem ber of thaty ear, she w as seen by

D r. Al ok K. Bhaiji , a cons ult ing physi ci an c hosen by the Soci al Secu ri ty Admin is trati on. He found that the c lai mant had v erti g o and her nia ted d is cs and ordered an M RI

. It re v eal ed Ge rmany-J ohnso n had a n n u lar bul g ing at the L 4- L5 area and leftsi ded di scher nia ti on atL5- S1. Anot her M RI tak en of the cer

v ic al spi ne rev eal ed bony degenerat i v e c ha ng es i n he r n ec k

. O th er

d i ag no s es i nc l ud ed s po nd y l os i s a nd l ordot ic
re v ersal , sc oli osi s w it h pel v ic ti lt , and a pepti c ulc er caus ed by the v ar iou s pai n medi cat ion s that Ger many -J ohnso n w as tak ing

. In F ebr uar

y 2003, D r. M each a m l ist ed di ag noses of my osi ti s, cer v ic al sy ndrome, and my alg ia and not ed th at t he c lai mant’ s p ain w as at a lev el si x out of ten. That month Dr

. Ga rd ziol a found tha t t he c lai mant’ s c ondi ti on remaine d unc hang ed and that she cont inu ed to hav e pai n and w eakne ss . By the end of F ebr uar

y , D r. M eacha m had w ri tten a l etter to the cl aimantex pla ini ng that he had trea ted her for sev eral y ears a nd th at he had “N O dou bts that the combinat ion of medi cal di ag noses y ou hav e c ontr ibu te t o s ig nific ant dif f iculty w ith ma intain ing g ainf ul em ploymen t.” A y ear la t er, on Ja nua ry 2, 200 4, Dr. Me acham w ro te another letter , noti ng thatthe cl aimanthad been hi s p ati ent s inc e the mid
1990' s a nd had underg one ex haust iv e ev alu ati ons of her phy si cal sy mptoms by many speci a li sts, w ithou t any resolu tion o f her neck pa in and f ibrom y algia sy mp tom s. He07-3168

Germ an y -J oh ns on v . Co mm iss ion e r o f So c ial Se c urity

- 4 - conclu ded thatGerma ny- John son was unab le to susta in w ork and thather sy mp tom s w ere d e b ili ta ti n g. In ap plyi ng fo r disability ben ef its in 2002 , Germ any-Johnso n de scribed ne rv e pa in in her bac k a nd nec k, pai nful mus cl e s pasms , and numbnes s i n her co ccyx , s ay ing thatthe p a in m a d e itd if

f ic u ltt o p e rfo rm n o rm a l t a s k s li k e wa lk in g, s it t in g, s t a n d in g, d o in g l a u n d ry, lift ing cookw are, an d grocery shop ping, am ong oth ers. S he also said th at she nee ded help f rom h e r fa m il y

in prepa ring me als and hou se-clean ing and tha t she was l argely house bound. H er

appl ic ati on w as deni ed i nit ial ly and als o upon re cons ide ra ti on.
Ger many -J ohnso n the n req uest ed a hear ing before an admi nis trati v e l aw judg e, at
w hich she app eare d w ith cou nsel an d test if ied. A m edica l expert and a v ocat iona l ex pert als o tes ti fied. The ALJ determi ned that Ger many -J ohnso n w as not d is abl ed, fin din g that she “d [i d] no t hav e any i m p air ment or i mpair ments [that] s ig nific antl y l imi t her abi li ty to per form bas icwor k- re lat ed acti v it ies ” and, therefore, “d [i d] no t hav e a sev ere i mpair ment.” The Appeal s C ounci l deni ed th e c lai mant’ s req uestfor rev iew an d a mag is trate j udg e, si tti ng by ag re ement as the dis tr ict c our t, found that there w as su b st a nti al ev ide nce to suppo rtthe deci si on of the admini strati v e l aw j udg e and uphel d tha t dec is ion

. II. D ISC US SION
A . St and ard o f Rev iew07-3168

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- 5 - W e ex erci se de n ovorev iew of dis tr ict cour

t deci si ons in Soci al Secu ri ty ca ses . See Valley v. Comm ’

r of Soc. Se c. , 42 7 F. 3 d 3 8 8 , 39 0 (6 th Cir. 20 0 5 ). Th e un d e rlyin g f in d in gs of t he admini strati v e law jud g e are rev iewed for subs tanti al suppo rt ing ev ide nce. See42 U. S.C . § 405( g ). Subs tanti al ev ide nce is “‘s uch re lev ant ev ide nce as a reason abl e mi nd might accep t as ade quate to supp ort a conclu sion.’” Richar dson v. Per

ale s , 402 U .S. 389, 4 0 1 (19 7 1 )(qu o ti n g Conso lidate d Ediso n Co. v. NLRB , 305 U .S. 197, 229 ( 1938) ).
Unde r applicab le S ocial Secu rity regulations, th e me rit of a disability claim is deter mined by

foll ow ing a s eq uenti al fiv e- ste p anal y si s. See20 C .F .R . § 404.152 0. The ALJ must deter mine, first, w hether the cl aimanti s wor ki ng ; s econd , w hether the all eg ed impai rmenti s s ev ere; t hird, w hether the impai rment meets or eq ual s a li ste d i mpair ment and hen ce ha s a certain level of sev erity ; fourth , w h e t h er the claim antcan still do past relevant w ork; and , f inally, w hen conside ring the claiman t’s age, edu cation , w ork
ex per ien ce, and re si dual functi onal ca paci ty , w hether the cl aimantca n do other wor k. See 20 C.F.R. § 40 4.1 520 (a)(4). T he burden is on the cl aim ant to satisf y the f irst fo ur steps. See Longwor

th v . C om m ’ r Soc. Sec . Ad

m in. , 40 2 F .3 d 59 1, 59 5 ( 6t h C i r . 20 05 )

. In this
cas e, t he ALJ foll ow ed the req uired ev alu ati on only throug h the second step , findi ng that the claiman t w as no t disab led be cause her impa irmen ts w ere no t “sev ere.”
B. Sev erity

of Impair ment07-3168

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- 6 - The st ep- two s ev er ity

dete rmi nati on i s p hrased in the n eg ati v e: i f a clai mant doe s n o t h a ve a s e ve re m e d ic a ll y d e t e rm in a b le p h ys ic a l o r m e n t a l i m p a ir m e n t , fo r a tle a s ttwe lve months , or

a c ombina ti on of impai rment s that is sev ere, the c lai mant i s n ot di sabl ed. 20 C. F. R. § 404.1520. In thi s c ircui t, the c lai mant’ s b urden of proof at s tep tw o “ has been
cons tr ued as a de mi nim is hurdle i n the di sabi li ty dete rmi nat io n proces s . . . [A]n impai rmentca n be cons id e re d not sev ere onl y i f it is a s li g ht ab nor mali ty that m inim ally af fects w ork a bility

regardless of

age, edu cation , and ex perien ce.” Hi ggs v. Bowen , 880 F. 2 d 86 0 , 8 6 2 (6t h Cir. 19 8 8 ) (e m p h a sis a d d e d ) (ci ti n g Far ri s v . Se c’ y o f Health an d Hum an Serv. , 773 F .2d 8 5, 89 -9 0 ( 6th C ir . 198 5) ). See also Bowen v. Yu ckert , 482 U .S. 137, 158- 59 ( 1987) ( “O nly

thos e clai mants w it h s li g ht ab nor mali ti es that do notsi g nific antl y l imi t any ‘basic w ork activi ty’ can be den ied be nef its w ithou t und ertakin g this v ocat iona l analysis.”) (O ’ C o n n o r , J

. , c o n c u r r i n g )

. F u rt h e r mo re , s t e p - tw o s e v e r i ty re v i e w i s u s e d p r i ma ri lyto “screen ou t tota lly

g roun dless claim s.” Farris , 773 F .2d a t 89.
Cl ear ly , G er many -J ohnso n’s impai rment s w ere not g ro undl ess under 20 C .F .R . § 404.152 1, be caus e the record establ is hes that, w it hout q uest ion , t hey i nter fered w it h her basi c wor k a cti v it ies

. Basi c wor k a cti v it ies a re d e f ined as “ the a bil it ies and apti tudes
n e ce ss a ryto do mos t j obs” su ch as “( 1) physi cal functi ons suc h as w alk ing , s tandi n g, sit ti n g, li f ti n g, p u sh in g, p u lli n g, re a ch in g, ca rryin g, o r ha n d l in g; (2 ) ca p a cit ie s fo r se e in g, h e a r i n g a n d s p e a k i n g ; ( 3 ) und erstan ding, carry ing out, an d re m e m b e ri ng simple instructio ns; (4) use of

judgmen t; (5) resp ond ing ap prop riately to sup erv ision, co-workers and us u a l w or k s it uati ons; and (6 ) deal ing w it h c hang es in a routi ne wor k s etti ng .” 2007-3168

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- 7 - C. F. R. § 40 4.1521. The record rev eal s t o our sa ti sfacti on th at t h e c la im a n t’s b ack and neck pai n and fibromy alg ia li mite d her abil ity to w or k. Bey ond the personal anec dotes from G e rm a n y-J o h n s o n li s t e d a b o ve , Dr

. B h a ij i fo u n d f ro m h e r s ym p t o m s t h a tsh e co u ld h a ve difficul ty w alk ing and li fting , and Dr. Meach am, the clai mant’ s treati ng physi ci an, d esc ri bed her as tot all y

di sabl ed from wor ki ng . T he quest ion in this ap pea l thus be com es w het her the re is also substa ntial ev iden ce to s uppor

t t he oppos it e conc lus ion – that the c lai mant’ s i mpair ments are s o s li g ht t hat t hey hav e l ittl e, i f any , i mpact on her w or k c apaci ty

. If subs tanti al ev ide nce suppo rt s t he decision of

the ad min istrativ e law

judge, “this Co urt w ill de fer t o tha t f inding ‘even if there is substa ntial evidence in the record thatwould h ave su ppo rted an o ppo site con clusion. ’” Longwor th , 4 0 2 F.3 d at59 5 (quo ti n g W arne r v. C om m ’

r of Soc. Se c. , 375 F .3d 3 87, 3 90 (6 th C ir . 200 4 ))

. See also Cutlip v. Sec’ y of Health and

Hum an Se rv. , 25 F. 3d 284, 286 (6th Cir. 1994 ) ( “If

the Se cretary’s decision is su p p o rt ed b y substa ntial evidence , it must be aff ir med ev en if the re v iew ing cour t w oul d deci de the m a tt e r di fferentl y , see Kin sella
v. Schwei

ker , 708 F.2d 105 8, 1059 (6th Cir. 1983 ), and e v en if substa ntial evidence also suppo rt s t he oppo si te c oncl usi on, see Mullen v . Bo wen , 800 F. 2d 535, 545 (6 th C ir . 198 6) (e n banc ). ”)

. In t his ci rc uit , “ subs tanti al ev ide nce means more than a s cintil la of ev ide nce. I t
me ans su ch relevant evidence as a reaso nab le min d w ould accep t as ade quate to supp ort
a con clusion. ” Mo wery v. Heck ler , 7 7 1 F.2 d 96 6 , 9 7 0 (6t h Cir. 19 8 5 ) (qu o ti n g Lash ley v.07-3168

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- 8 - Se c ’ y o f Hea ltha nd

Hum anS er

v. , 7 0 8 F.2d 10 48, 105 3 (6th Cir. 198 3). Moreover,

“ [d ]i s ab i l i ty

ma y b e es ta bl i s he d by a c l ai ma nt s uffer i ng from a v ar i ety of m ed i c al p rob l em s no one of w hic h mi g ht be su ff ic ien tl y di sabl ing to prev ent s ubst anti al g ain ful empl oy ment, b u twhen ta ken to gether ha v e tha t result.” Mowe ry, 771 F .2d a t 971

. As in Mowe ry , alt h oug h the ALJ and the d is tr ict c our t g av e w hat c an bes t be desc ri bed as “ li p s er v ic e” to th is principle, w e con clude thatboth courts cam e to t h e wron g conclu sion w ith regard to t his cl aimant

. Id.
The ALJ ac know led g ed i n hi s o rd er that“ the record i ndi cat es cl aimanthas dia g noses of fibromy alg ia wit h deg enerati v e di scdi seas e of the cer v ic al and l umbar spi nes. ” H e c oncl uded, how ev er , t hat the re cord als o “e sta bli shes that thes e i mpair ments
are no t severe impairm ent s,” based upo n w hathe iden tif ie d a s t h e cla ima nt’s “norm al” chara cteristics. F or example , af ter describin g diagnose s of ann ular bulging, disc her nia ti on, c er

v ic al dis c d is ease , and bon y deg enerati on, t he ALJ poi nted to t he “e ss enti all y

nor mal” EM G and ner

v e c onducti on. Howev er , he neg lected t o menti on th at the report also su gg este d tha t f urthe r ev alua tion b y M RI wa s d ictate d by “ ma rkedly p ro lo n ge d p e ro n e a l a n d p o s t e ri o r ti b ia l F wa ve s . ” T h e a d m in is t ra t ive la w ju d g e n e xt all uded t o physi cal ex aminat ion s t hat hav e “noted normal rang e of m oti on of the cer

v ic al spi ne, lumbar

spine, as w ell as normal ra ng e of moti on of the upper and lower

extremit ies .” But , t h e s o u rc e o f t h e s e fi n d i n g s , a l t h o u g h n o tc i t e d , w a s t h e p h y s i c a l e x a mi n a t i on condu cte d by

D r. Bhaiji , t he c onsul ti n g physi ci an hi re d by the Soci al Secu ri ty Ad m in ist ra ti o n , who al so no te d t h e c la im a n t co u ld h a ve d if f icu lt y with wa lki n g a n d lif ti n g,07-3168

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- 9 - tw o bas icwor k a cti v it ies under 20 C .F .R . § 404.152 1, a n d wh o r e commended a furt her
neurolo g ic al ev alu ati on of Ger many -J ohnso n.
Poin ting to the claim ant ’s “normal sen sation , norm al ref lexes, and no rmal m uscle streng th. . . [and als o] no rmal g ait ,” the ALJ conc lud ed th at “ w hil e the cl aimantal leg es that
s h e is d is a b le d b y h e r p a in [ , ] h e r c o m p la in t s a re n o tsu p p o rt e d b y t h e o ve ra ll o bje c t ive
me dical evidence in the record w hich is norm al.” How ever, one of the ba ses for these “n or mal” findi ng s was the repor t of D r. Gardz iol a tha t al so desc ri bed t he c lai mant’ s “ lon g history of m uscle pa in and spasm . . . [fro m] pinchin g in her ne ck, w hich creat es a cha in reactio n to pin ching and pain in he r butto ck, legs, fe et, sh ould ers, and neck.”
Altho ugh the adm inistrative law judge focuse d on w hathe pe rceiv ed to be “norma l” findi ng s by

the medic al ex per

ts, the cav eats prov ide d bythose same doctors indi cat e tha t

–ta kin g th e rec o rd as a who le an d in clu d in g bo th th e d o ct o rs w h o pro vide d no rm a l f in d in gs and thos e w ho found th e c lai mant had a s ev ere di sabi li ty

–t h e re i s n ot s ubst anti al
ev ide nce to suppo rt the admini strati v e law j udg e’s findi ng thatthe cl aimant ’s i mpair ments
are not “sev ere,” at lea st for purpos es of ste p- two analy si s. See Hur st v. Sec’ y o f Health and Hu m an Se rv. , 753 F.2d 517 , 519 (6th Ci r. 1985 ) ( “failure to co nside r the record as a
w hole und ermin es the Secret ary ’s conclu sion”). Ind eed , in our j udgm ent the ev iden ce in the record th at can be con sidered to esta blish Germ any-Johnso n’s cond ition as “no rmal” is min imal and is offsetby the not- nor mal findi ng s i n the sa me repor ts.07-3168

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- 10 - T he a dm inistrative law

judge also ba sed h is fin ding thatthe claiman t’s disability is notsev ere on the na ture of her prescribed med ication s, not ing that the y are com mo nly used to t re at mi ld sy mptoms and c oncl uded fro m thatfact “ that the c lai man t [h ]as an imp airme nt w hich is so slight, it would notb e expected t o interfere w ith her ability to work
or a non -sev ere i mp airme nt.” But this obse rv ation w holly overlooks evidence in th e record that Ger many -J ohnso n too k t hese medic ati ons in suc h l arg e doses that she dev elo ped an ulc er and had t o sto p tak ing them. I ndeed, Dr . C ain found the cl aimanthad an ul cer due to “a n t i- in f lam ma tory drug use.” Moreover, as noted byher treatin g physician, Dr. Me a c h a m , t h e p re s c ri p t io n d ru gs V io xx a n d Ce le b re x we re in e f fe c t ive t o co n t ro l G e rm a n yJohns on’ s p ain sy mptoms, as w as Ty len ol. Al thoug h the use of rela ti v ely mil d medi cat ion s maybe t aken to i n d ica te t h at t he c lai mant does not s uffer from “ sev ere di sabl ing pai n,” Ma h er v. Sec’

y of Health and

Hum an Se rv. , 8 9 8 F

. 2 d 1 1 0 6 , 1 1 0 9 ( 6 t h C i r . 1 9 8 9 ) ( ci ti ng Kim brou gh v. Se c’

y of Health and

Hum an Se rv. , 801 F .2d 7 94, 7 97 ( 6th C ir . 198 6) ), the T ent h C i rc ui t ha s he l d th at w he n th e c l ai ma nt s uffers from th e s i de effects of us i ng pain
re li ev ers, an ALJ ca nnot re ly on t he non- use of t hose same pai n re li ev ers t o ev alu ate t he cl aimant ’s impair ment. See F rey v . Bo wen , 816 F. 2d 508, 517 (1 0th Ci r. 1987) ( “U nrefuted tes ti mony

by both [doctors] ind ic ated that anti- infla mmator y and anti -p ain medi cat ion appropr iat e for [the cl aimant ’s ] deg enerati v e ar thr it icco ndi ti on w as cont ra ind ic ated beca use o f

the side ef

fects of stom ach ir ritation

. Althou gh pain ab ate me nt w ould enh ance [the cl aimant ’s ] abi li ty

to per form se dentary wo rk, the si de effects w oul d i nter fere w it h
re sto ra ti on of hi s a bil ity to w or k.” ).07-3168

Germ an y -J oh ns on v . Co mm iss ion e r o f So c ial Se c urity

- 11 - T he AL J also focuse d on the te stimo ny of Dr. Hershel Gore n, on e of the agen cy ’s medic al ex per

ts, but Dr . G oren ex amined onl y the cl aimant ’s medi cal fil e, no t t he c lai mant herse lf , in prep aratio n for testim ony regarding the v alidity of the ot her expert’s diagnose s, the degree of

the claim ant ’s dy sf unct ion, a nd b oth h er m ent al and her physical capa cities. Dr . G ore n c oncl uded t hat t he c lai mant’ s s y mptoms did not eq ual any Soc ial Sec ur ity Adm inistration listing s, tha t she would not be impaired in a w ork settin g, and thatshe w ould have no restr ic t io n s on he r fu nction al capa city . He based his conclusion s on his d e t e rm in a t ion th at he r sy mp tom s did notnece ssarily correlate wi th an y

of the MRI abnor mali ti es and, therefore, that thos e abnor mali ti es thus co uld no t be cons ide re d obj ect iv e findi ng s.
Our rev iew co nv inc es us that, ev en after exte n d in g appropr iat e defere nce to t he ALJ’ s d eci si on, t he deni al of reli ef at ste p tw o w as not suppo rt ed by subs tanti al ev ide nce. Fi rs t, the o pin ion of a non- ex amini ng physi ci an s u ch a s Dr. G oren s houl d be g iv en re lat iv ely l ittl e w eig ht “ if i t is co n trar y t o the opi nio n of the cl aimant ’s treati ng physi ci an.” Shel m an v . Heck ler , 821 F.2d 316, 321 (6th Ci r. 1987) (“ [t] he testi mony of [non- ex amini ng phy si ci an] canno t prov ide a suffici ent basi s for re jecti ng the o pin ion s o f plai nti ff ’s treati ng p h ysici a n s . . . ”) (cit in g Br oughtonv. Heck

ler , 776 F .2d 9 60, 9 62 ( 11th Ci r. 1985)

. See also Cohe n v. Sec’

y Health and Hum an Se rv. , 964 F .2d 5 24, 5 28 ( 6th C ir . 199 2) ( “medi cal opin ions an d diagno ses of treating physicians are ent itled to g reat we ight, and if
u n co n tra d ict e d , are e n ti tl e d to co m p le te de fe re n ce ”) (ci ti n g Ki ng v . Heck ler , 742 F .2d 9 68, 973 (6th Ci r. 198 4)). In this case, Dr. Goren ’s opin ion contradicts that o f t h e cla ima nt’s07-3168

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- 12 - treati ng physi ci an, D r. M eacha m, w hose opi nio n w as larg ely , i f not c omplet ely , ov er loo ked by both the ALJ and t he di str ict c our t. In g iv ing co ntroll ing w eig ht t o D r. Goren’ s o pin ion and to only selecti v e por

ti ons of repo rts by

the agency ’s oth er consu lting phy sician, Dr. Bhaiji, an d the claiman t’s secon dary phy si ci an, D r . G a rd z i o l a , t h e A L J fa i l e d t o g i v e e ffe c tt o t h e a g e n cy ’ s “ t re a t i n g s o u rc e”
re gul a ti o n , 2 0 C.F .R

. § 4 0 4 .1 5 2 7 (d )(2 ). T h a t p ro visio n requ ire s a n ad m in ist ra ti ve la w ju d ge to giv e mo re w eight to op inions f rom treating source s if th e treat ing phy sician’s opin ion is “well -s uppor

ted b y medi cal ly

ac cept abl e c li nic al and laborato ry di ag nost ictec hni q ues. ” Mo re ov er , t he reg ula tio n also re q uires the j udg e to sta te “ g ood” reason s for the w eig ht g iv en th e opi nio n of a c lai mant’ s t re ati ng physi ci an. 20 C.F .R . § 404.152 7( d) (2 ). H ence, a dec isio n deny ing benefit s “ must cont ain sp eci fic reason s for the w eig ht g iv en to the treat ing sou rce’s med ical opinio n, sup porte d by the evi den ce in the case record, and must be s uff ic ien tl y

sp eci fic t o make cl ear to any su bseq uen t re vi ew ers t he w eig ht t he adj udi cat or

gav e to the treati ng sourc e’s m edi cal opi nio n and the reason s for thatw eig ht.” Soc. Sec . R ul. 96- 2p 1996 W L 374188 at *5 ( 1996)

. See also W ilson v. Com m ’

r of Soc. Sec. , 378 F .3d 5 41, 5 44 ( 6th C ir . 200 4)

. The subs tanti v e ar m of the reg ula ti on, referred to i n thi s c ircui t as th e “ treati ng p h y s i c i a n r u l e , ” c re a t e s “ a p re s u mp t i o n , a l b e i ta re b u t t a ble one, thatt h e o p i n i o n o f a treati ng physi ci an i s e nti tl ed to g re at deference , its non-c ontroll ing st atus notw it hst andi ng .” Roge rs v. C om m ’

r of Soc. Se c. , 4 8 6 F

. 3 d 2 3 4 , 2 4 2 ( 6 t h C i r . 2 0 0 7 )

. Eve n if th e tre ati ng07-3168

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- 13 - physician’s opinio n is not giv en co ntrolling w eight, the adm inistr a t iv e law judge mu st still deter mine how

much w eig ht i s a ppropr iat e for the o pin io n , co n sid er ing : ( 1) the len g th, freq uency , nat u re , and extent of the treatment re lat ion shi p; ( 2) co nsi ste ncy of the phy si ci an’ s c oncl usi ons and the ev ide nce to s uppor t t hem; and ( 3) the spec ial iz ati on of the treati ng physi ci an. See id.
Onc e the w eig ht t o b e gi ven t h e opi nio n i s d eter mined, the procedu ra l ar m of the regulation requires the ALJ to “provi de good reaso ns for discoun ting treating physici ans’ opin ions, rea sons th at are su f f iciently specif ic to ma ke clear to any subse quent review ers the weig ht t he adj udi cat or g av e to the treati ng sourc e’s m edi cal opini on and the reason s for thatweight.” Id. (internal quota t io n m arks om itted ). The se reaso ns are pa rticularly impor tantw hen t he treati ng physi ci an has di ag nosed the cl aimantas di sabl ed. See id. As w e hel d i n W

il son , “A cour

t canno t ex cus e the deni al of a mandator y proc edural protecti on s impl y becau se, as the C ommis si oner urg es, there i s s uff ic ien t ev ide nce in the
rec ord for

t he A LJ t o di s c ou ntt he t rea ti ng s ou rc e’ s o pi ni on a nd , th us , a di fferen t ou tc om e on remand i s u nli kel y .” 3 7 8 F .3d a t 546

. Ul ti matel y , “ a fail ure to follo w the procedu ra l
re q uirement of i denti fyi ng the re asons for dis co u nti ng the opi nio ns and for ex pla ini ng preci sel y how thos e reason s a ffect ed th e w eig ht ac corded t he opi nio ns denotes a lac k o f subs tanti al ev ide nce, ev en w here the co ncl usi on of the ALJ maybe j ust ified bas ed upon the record.” Roge rs , 486 F .3d a t 243

.07-3168

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- 14 - Here, the only evidence th at th e ALJ cite d to ref ute t h e s e verityof the claim ant ’s dia g noses w a s t he “ nor mal” findi ng s o f tw o non- treati ng doctors. But , t he j udg e w as sel ect iv e i n parsi ng the v ar iou s medic al repor ts and si mply

fail ed al tog ether

to address the findi ng s o f Dr . M eacha m, the physi ci an w ho had been t re ati ng the cl aimant for al most ten y ears, bey ond merely

se tti ng them out i n nar ra ti v e fashi on. He apparentl y did not gi v e any
w eig ht t o the m, nor

di d he ex pla in w hy

he h ad di sc ounted the t re ati ng physi ci an’ s o pin ion that the c lai mant w as dis abl ed from wor ki ng , bey ond say ing that“ her co mplai nts are not suppo rt ed by the ov erall obj ect iv e medic al ev ide nce in the record w hic h i s n or mal. ” The
re cord thu s e sta bli shes as a ma tt e r o f l aw thatthe cas e mustbe remanded t o the admini strati v e l aw

co urt for further

co nsi derati on. See W il son , 378 F .3d a t 544

. O n re m a n d , t h e a d m in is t ra t ive la w ju d ge is f u rt h e r d ir e c t e d t o e va lu a t e G e rm a n yJohns on’ s cl aims under the sta ndard appropr iat e for cl aims of fibromy alg ia. I n g eneral, an “i mpair ment mus t resul t from anatomical , physi olo g ic al, or ps y chol og ic al abnor mali ti es
w hich can be sho w n by medica lly accep tab le clinical and laborat orydiagnostic tech niques. A physi cal or

mental i mpair ment mus t be e sta bli shed by medi cal ev ide nce cons is ti ng of si g ns, sy mptoms, and lab orator y findi ng s, not o nly

by [ th e c lai mant’ s] sta tement of sy mp tom s.” 20 C.F.R. § 416 .90 8. Fibrom y algia, howev er, can b e con f irmed as a severe impai rmentw it hout obj ect iv e te st in g. See Rogers , 486 F .3d a t 243 ( “O n at lea st one occasio n, we ha v e recognized thatf ibrom y algia can be a sev ere imp airme nt th at, u nlike medic al condi ti ons that can be c onfir med by obj e ct i v e t e sti ng , fibromy lag ia pati ents present
no o bjectively a la rm in g signs.”). In fact, p erson s suf fering from f ibrom y algia “manifest07-3168

Germ an y -J oh ns on v . Co mm iss ion e r o f So c ial Se c urity

- 15 - nor mal musc le streng th an d neurolo g ic al re act ion s a nd h a ve a full rang e of moti on.” Pr es to n v . Se c ’ y of Hea lth an d H um an Se rv. , 8 54 F.2 d 81 5, 82 0 (6th Cir. 198 8). As a
re sul t, w e hav e pre viou sly conc lud ed th at “ [t] here are no obj ect iv e tes ts w hic h c an conclu siv ely conf irm the disease .” Id. at 81 8. Ins tead , t he s tandard for dia g nosi ng fibromy alg ia in thi s c ircui t i nv olv es tes ti ng a s er ies of focal poi nts for t ender ness and ru li ng out other pos si ble co ndi ti ons throug h obj ect iv e medi cal and cl ini cal tr ial s. See Roge rs , 486 F. 3d at244.
As i n Roge rs , the ALJ in this case did n ot discu ss, let alon e ap ply, the correct sta ndard for ass ess ing a di ag nosi s o f f ibrom ya l g i a i n hi s d eci si on, i nst ead emphas iz ing and basi ng hi s d eni al of benefits on “ nor mal” ph y si cal findi ng s, i. e. , nor mal musc le streng th,
norm al range of

m otion , and norm al gait. But for obvious reason s, the se f indings bore little
re lev ance to D r. M eacha m’s di ag nosi s o f f ibromy alg ia. See Roge rs , 486 F.3d at 245 (“in li g ht of the uni q ue ev ide nti ar y di ff ic ult ies as soc iat ed w it h t h e diag nosi s a nd treatment of f ibrom y algia, opin ions that focu s solely upo n obje ctiv e evidence are not p a rt icularly
re lev ant” ).
Fi nal ly , w e not e the Commis si oner ’s contenti on that remandi ng this ca se for furt her
cons ide ra ti on woul d be futil e i f, as t he C ommis si oner i nsi sts , t he c lai mant w il l fail at a lat er poin t in the se quent ia l d e t e rm in ation of disability. How ever, w e ha v e he ld tha t it is “i nappropr iat e” to spec ula te conc er nin g the ult imat e out come w hen an admini strati v e l aw judge stop ped his or he r evaluat ion at a prem atu re st ep in the sequent ial ana ly sis, beca use07-3168

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- 16 - the remaini ng st eps are for the a dmini strati v e l aw j udg e to cons ide r in the first ins tanc e. See Farris , 773 F .2d at 90 ( “S inc e the ALJ st opped a t t he s ev er ity st ag e i n the ev alu ati on proces s a nd di d notreach the q uest ion of w hether M rs . F ar ri s’ [s] di sorder

met o r ex ceede d the s ev er ity

of a l is ted i mpair ment, iti s i nappropr iat e for us to cons ide r thes e q uest ion s a t thi s j unct ure i n the ca se, al thoug h the y mustbe d eter mined by the ALJ on remand.” ).
III . CO NC LU SION
For the re asons set out abov e, w e RE VER SE the jud g ment of the di str ict c our t and RE MA N D t h i s c a s e t o t h e a d mi n i s t ra t i v e l a w c o u rtfo r

fu rt h e r c o n s i d e ra t i o n o f t he claima nt’s ap plication for disability ben ef its.07-3168

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- 17 - RONA LD LEE GILMA N, Circuit Judge, concurri ng. I co ncur i n the maj or ity opi nio n, bu t w ri te separat ely bec ause I di sag re e w it h the maj or ity ’s co ncl usi on th at t he
re cord l ack s s ubst anti al ev ide nce to s uppor t t he ALJ ’s findi ng that Ger many -J ohnso n i s n ot dis abl ed. Nev erthel ess , I ag re e tha t t h e A L J erred i n fail ing to ex pla in the d imi nis hed
w eig ht th a t he attr ibu ted t o the opi nio n of Ger many -J ohnso n’s treati ng physi ci an, a nd
w oul d the re fore r e m a n d the ca se for furt her co nsi derati on, b ut on ly on t his nar ro w er g ro und. I ag re e w it h the maj or ity t h a t the record i s repl ete w it h ev ide nce that Ger many -J ohnso n has i mpair ments. Indeed, thi s conc lus ion is not dis puted by any of the phy si ci ans w ho ei ther

ex amined Ger many -J ohnso n or re v iewed her fil e, i ncl udi ng the Soci al Secu ri ty

Admi nis trati on’ s ( SSA’ s) ow n D r. Goren. Ev en the ALJ ack now led g ed th at Ge r ma ny- J oh ns on s uffers from t he i mp ai r me nt s o f “ fi brom y al g i a w i th d eg en erat i v e disc dis ease of the c er

v ic al and l umbar

sp ine s.” ( JA 23) Bu t he ult imat ely co ncl uded t hat “t hese impai rment s a re not sev ere i mpair ments. ” ( JA 23)
T he m ajo ri ty conclu des th at “the ev iden ce tha t can be conside red to e stab lish Ger many -J ohnso n’s co ndi ti on as ‘ nor mal’ i s mi nimal and is l arg ely rebut te d b y t he not
norm al f indings in the sa me reports.” (Maj. op. 9 ) Yet the m edica l docum ent s on record show th at the various tests cond ucte d on Germa ny- John son rep eat edly and con sistent ly showed “no rmal ” re sul ts. An d w here abnor mali ti es w ere i denti fied, t he record l ack s a ny in fo rm a t io n a s t o t h e ir

se ve ri ty.07-3168

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- 18 - Dr . R ay nor , for

ex ample, as the cl aimant ’s treat ing r heumatol og is t, found that her g aitand musc le streng th were “ nor mal” and that her phy si cal ex am w as “u nremark abl e.” (J A 109)An other

ex amini ng physi ci an, D r. Bhaj i, f o u n d , among othe r thi ng s, that her
re flex es and t he rang e of moti on i n her upper and lower

extremit ies w ere “ nor mal. ” (J A 118) He als o conc lud ed that she w oul d hav e no difficul ty w it h wor k- re lat ed acti v it ies
suc h as si tti ng , s tandi ng , and ca rr y ing obj ect s, but that she mayhav e di ff ic ulty w alk ing and li fting

. (J A 119)Dr . Gard z iol a, G er many -J ohnso n’s treati ng neurolo g is t, document ed th e fact th at s he ex per ien ced pin chi ng and numbness , butsa id that she ex hib it ed full st re ng th and t hat h e c oul d noteas il y i denti fy her

ch ro nicpai n. He did not come t o any furth er co n clu sio n s a b o u t t h e se veri ty of he r im p a irm e n t s , a n d r e co m m e n d e d th a t s h e un d e rgo MR I and ner

v e- condu ct io n tests

. (J A 141)D r. Burdette , w ho di d the ner v e- condu cti on stu die s, conc lud ed th at t he resul ts w ere “w it hin the broad li mits of no rmal for a pat ien t of thi s a g e.” ( JA 132) The radi olo g is t, Dr . R osenfel d, ran a seri es of MR I tests and found the
re sul ts to be al most enti re ly “ nor mal, ” w it h t he ex cept ion of a her nia ted d is c, “a nnul ar bul g ing ,” “d iffuse dis tr ibu ti on,” and “b ony deg enerati v e chang es. ” (J A 125- 29) H e di d not , howev er, chara cteriz e the ef fect or severity

of these problem s. ( J A125 -29) And Dr. G o re n , t h e S S A ’s m e d ic a l e xp e rt , t e s t if ie d t h a tG e rm a n y-J o h n s o n d id n o th a ve “o bje c t ive findi ng s t o s uppor

t her co mplai nts .” ( JA 23) Altho ugh “not-no rmal” f indings in Germ any-Johnso n’s me dical record m ight in fa ct esta blish tha tsh e ha s impa irmen ts, this cou rt has he ld tha t the ex istence of such impai rment s d oes not a lon e lead to the concl usi on th at t hey are ( or are not ) sev ere. See07-3168

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- 19 - Hi ggs v. Bowen , 880 F .2d 8 60, 8 63 ( 6th C ir . 198 8) ( “[ T ]h e m e re di ag nosi s o f [an impai rment], of course, sa y s n othi ng aboutthe sev er ity of the c ondi ti on.” ). W here, as here, a c lai mant i s found t o hav e i mpair ments, but the t est s c ome bac k eit her neg ati v e or

i n the
norm al range, I do notb elieve th at the reco rd su ppo rts a f inding tha t the impa irmen ts are
sev ere. See , e.g ., Crady v. Sec’ y of Hea lth & Hum an Se rvs ., 835 F.2d 617, 6 20- 21 ( 6th Ci r. 1987) (h old ing that the ALJ w as jus ti fied i n det er mini ng thatthe cl aimant ’s co mplai nedof k n e e c o n d i t i o n w a s “ n o t a s e v e re i mp a i r me n t ” w h e re p o s t
- o p e ra t i v e t e s t s s how ed no
re str icti on of moti on and “o nly min or dege n e ra ti ve joi nt c hang es” i n tha t k nee, and x-ray re su l t s “ w e re e s s e n t i a l l y w i t h i n n o r ma l l i mi t s ” )

. I b e l i e v e t h a t t h e t e s t re s u l t s p ro v i d e the
m o s tre li a b le a n d o bje c t ive b a s is fo r d e t e rm in in g t h e d e g re e t o wh ic h a n y o f G e rm a n yJohn son’s imp airme nts imp acts th e claima nt’s physical a bilities or a ctiv ities. And th e test results in this case indicate thatshe ha s “norma l” fun ction, desp ite he r impairm ent s. To be sure, Dr

. Me acham, Ger many -J ohnso n’s treati ng physi ci an, s ent a l etter to her i n 2003 sta ti ng thathe h ad no doubts thatsh e woul d face “ si g nific ant d ifficul ty w it h maint ain in g g ain ful empl oy ment,” and senther anot her l etter i n 2004 sta ti ng thather sy mptoms w ere “ debi li tati ng .” ( JA 145) The SSA’ s so- cal led “ treati ng so urce” reg ula ti on, 20 C .F .R . § 404.152 7( d) (2 ), “ re q uires an admi nis trati v e l aw j udg e to g iv e more w eig ht t o o p in io n s f rom trea ting sources if the tr eati ng phy sici an’ s opin ioni

s ‘ well -s uppor ted by m edical ly acc eptable cl

ini cal and lab or

ator y dia g n o stic techni

ques .’ ” ( Ma

j. op. 12 (e mph a sis a d d ed) ). Thus the opi nio n of a treati ng physi ci an i s g enerall y g iv en g re ater
w eig ht t han t hat o f other ex amini ng physi ci ans. Al lenv. C ali

fano , 613 F.2d 139 , 145 ( 6th07-3168

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- 20 - Ci r. 1980)

. But “s uch opi nio ns rec eiv e great w eig ht only i f they are s uppor

ted b y su ff ic ien t clinical f indings and are consiste nt w ith the ev iden ce.” Bog le v. Su lli van , 998 F .2d 3 42, 347 -348 (6th Cir. 1 9 9 3 ). An ALJ “is not bou nd b y concluso ry

state me nts of

docto rs, par ti cul ar ly w here the y

are uns uppor

ted b y deta il ed obj ect iv e c ri ter ia and doc umentati on.” Buxton v . Halter , 246 F .3d 7 62, 7 73 ( 6th C ir . 200 1) ( ci tati on omi tted)

. T h e m e d ic a l d o c u m e n t a t io n t h a tDr

. Me a c h a m su b m it t e d p ro vid e s li t t le , if a n y, suppo rtfor h is concl usi ons. Hi s rec ord of each of Germany -J ohnso n’s off ic e v is it s c onsi sts onl y of one or

two pag es of not- v er

y -d etai led note s in w hic h he document s h er co mplai nts
as she describe d he r sym pto m s to him , and si mply li sts his dia g noses w it hout ela borati on. But he mak es no menti on of any method or

tes t he used to dia g nose her sy mptoms, or to ind ependent ly

co nfir m or

obj ect iv ely

ev alu ate t he s ev er ity

of those sy mptoms. (J A 145- 56, 172- 75, 1 83) I n one cas e, he e xpli cit ly n o ted “no cl ini cal ev ide nce on ex am.” ( JA 149) Nev erthel ess , t he ALJ fail ed to co mply w it h the req uirement th a t he “ alway s g iv e g ood
re asons i n [hi s]

. . . decis io n for the w eig ht [ he g iv es to t he] t re ati ng so urce’ s o pin ion .” 20 C.F .R . § 404.152 7( d) (2 ). This alone is g ro unds for rev ersal

. See W il son v. Com m ’

r of Soc. Sec ., 378 F. 3d 541, 544 (6 th Ci r. 2004) (c it ing 20 C. F. R. § 404.152 7( d) (2 ) and hol din g that “[ a]l thoug h s ubst anti al ev ide nce other w is e s uppor

ts the d eci si on of the Commi ss ion er in thi s c ase, rev ersal i s req uired because the a g ency fail ed to foll ow

i ts ow n procedu ra l
re g ula tio n ” that mandates a di sc uss ion of the weig ht g iv en to the treati ng phy si ci an’ s o pin ion ).07-3168

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- 21 - Germ any -J ohnso n ul ti matel y bears t he burden of prov ing the sev er ity of her impai rment s. S ee Murphy v. Se c’ y of Health & Hum an Se rvs. , 801 F.2d 18 2, 18 5 (6th Cir. 198 6). Altho ugh I am sy mp ath etic to he r situation , I cann ot say on the basis of this record that she has met th at bu rd en, o r that the A LJ er re d i n findi ng thather i mpair ments are not
sev ere. But becaus e the ALJ fail ed to st ate h is reason s for the decreased w eig ht t hat h e attr ibu ted t o the opi nio n of Ger many -J ohnso n’s treati ng physi ci an, I co ncur in the maj or ity opi nio n’s dec is ion to re v erse the dis tr ict cour t’ s jud g ment and re mand the cas e to the A LJ for furt her

co nsi derati on.