NO T R EC OM M EN DE D F OR F UL L- TEX T P UB LIC AT ION File Na me: 09a0162n.06 Filed: F ebrua

ry 24, 2009 No. 08-1586 UN ITED STA TES C OU RT OF AP P EA LS F OR THE SI XT H C IR CU IT
ADDI SON WHI TE, J R., P laintif f-App ellant,
v. COMMI SSI ONER OF SOCI AL SECURI TY, Defendan t-Appellee.

_______________________________________ ) ) ) ) ) ) ) ) ) ) ) ON AP P EAL FROM THE UN I TE D ST AT ES D I STR I CT CO UR T F OR

TH E WE STE RN DI STRI CT OF MI CHI GAN
O P I N I O N

Be for e : M ER RI TT, M OORE, a nd C OLE, Ci r c uitJudg e s. KA REN NELSO N MOORE, Circ uit Jud ge. Plaintiff -A p p el l ant Addison Whit e, Jr., appea ls from the di s t ri ct court’s judgment a ffirming the dec ision of the Commi ssioner of Social Security , which d en i ed his claim for disa bility insurance benef

its under 42 U.S.C. §§ 416(i), 423. Whit e make s five ar g uments on appea l: (1) the Administrative L aw Judge (“A L J ”) er re d by not proper ly considering the opinions of Whit e’s treating phy sicians; (2) the AL J err ed by failing to find that Whit e had a

signific ant mental impairment de spite clea r evide nce othe rwise; (3) the AL J did not h av e s u b s tantial evidenc e to support the finding that Whit e could have per formed a limit ed ra

nge of lig ht w or k; ( 4) the AL J er

re d b y fa ili ng to fo llo w t

he vo c a tio na l e xpe rt ’s te sti mony in r e sp on se to hy pothetical questions t hat accurately portray ed W hite’s i mpairments; and (5) the district court
err ed by failing to a dopt the Report and Recommendation of the mag istrate judge
. For the re asons2

discussed below, w e RE VE RSE the judgme nt of the district c ourt upholding the Commiss ioner’s decision and REMAND with i n structions to return the c laim to the Comm issioner for f urther proce eding s consistent with this opi nion. I. BACKG ROUND A. F ac tu al B ac kgr ound Be fore claiming disability in 2003, Whit e consistently had been employ ed as an elec trician since 1986, a

nd previously

had wor ked as a die ca st operator s i n ce 1 9 7 6
. Since 1997, White has suffe red f rom pain in his rig ht thigh due to “mer alg ia paresthetica c aused by entra pment of the late ral fe mor a l c uta

ne ou s n e rv e .” Ad

min istrativ e Re c or d ( “ A. R.” ) a t 1 4 4 ( E M G/

N C T S t u d y 9/2 /97 ). Whit e be g an s e e inga

pa in s pe c ia lis t, D r. Th oma s Ba sc h, wh o start e d admin ist e ri ngne rv e blo c ks to Wh ite in 2001. I n May 2002, Dr. B asch note d that the ner ve blocks “ help [W hite] for a month or two but then t he pain returns” and that W hite’s “job as a n elec trician is g etting ha

rder and har der be cause of the pa in. ” A
. R
. a t 2 3 5 ( B a s c h P a i n C ar e R e p o rt 5 / 3 / 2 0 0 2 )
. L a t e r i n 2 0 0 2 , W h i t e u n d e r we nt a
c ryoa blatio n p ro c e dure , b ut the pr oc e dure and re c ov e ry we re se ve re ly pa inf ul, and a ff or de d h im o nly
one we ek of r elief. I n J anuar y 2003, Whit e re ported to Dr. B asch that his leg remained “numb and painf ul,” and Dr. B as ch n o ted that ner ve blocks have “be en a hit or miss proposition” and that surg ical intervention may

be appr opriate. A .R. at 236 (B asch P ai n C ar e Report 1/21/2003). The surg eon wi t h whom Whit e consulted, how ever , rec ommended ag ainst surg ery . Whit e also tried phy sical the ra py wi th n o s uc c e ss, and Dr
. B a sc h wa s h e sit ant t o p re sc ri be str on g e r p a in m e dic a tio n b e c a us e the side ef

fec ts would interfer e with White’s job a s an ele ctricia n. Dr. B asch e ventually

noted that Whit e may

have to a pply for disability
. Whit e continued with the nerve blocks, but also noted that3

his pain was wor sening and that the injec tions only g ave te m p o ra ry

relief . On May

7, 2003, Dr. Ba sch noted, At thi s p oin t I

sim ply do n’ t ha ve muc h e lse to o ff

er [ W hi te ]. H e is s e ri ou sly consideringapplying f

or disability

and I think the t i m e has come to do this. The work he does as an electricia n involves sitti ng , squatting, twisti ng and simply place s pressure and torsion ac ross this branch of the inguina l ne rve. I n the patients I have seen w ith this problem, it seems like we ’ve e ither been able to “hit a home run” or have be en unable to treat it well at a ll and unfortunate ly [W hite] i s falling into the l a t t e r c a t e g o r y. A.R. at 230 (B asch Pain Car e Report 5/7/2003). Dr . Ba sch subsequently “took [W hite] off work.” A.R. at 229 (B asch O ffice Notes 9/15/2003). Dr. B asch note d that W h i t e would be helped by
wa lki ngmor e , b ut fo un d tha t whe n White did inc re a se his wa lki ng a s instru c te d, the pa in b e c a me unbear able. White continued to re ceive injections, but the relief lasted only

betwee n three to seven
wee ks. I n J uly

2004, Whit e’s pr imary car e phy sician, Dr. Mervy n Smit h, also put White off w ork

“ ind e fi nit e ly ” du e to his “ [ri g ht] le g ne rv e dama g e .” A. R. a t 24 2 (D isa bil ity Ce rt if

ic a te ). I n Apr il 2005, Dr. B asch note d that Whit e “did quite we ll” with the most rece nt ne rve block but also noted that “as he become s more ac tive with the improving w eathe r, there are times that his g roin pain and anter ior thigh pa in rea lly flare s” and that “there are , unfortunate ly , no cure s for thi s sort of condition.” A.R. at 250 (B asch O ffice Notes 4/26/2005). D u r i n g t h i s t i m e , W h i t e a l s o w a s t r e a t e d f o r d e p r e s s i o n , b o t h b y D r . B a s c h an d b y a counseling psy cholog ist, Dr . McDowe ll. W hite beg an see ing D r. McDow ell in May 2003, and she diag nosed him with adjustment disorder and depre ssion, finding that he had a global asse ssment of functioning (“G AF”) s co re o f 55, indicating moderate sy mptoms. W hite beg an see ing D r. McDowe ll freque ntly , three times a month, but by J une 2005 he w as going for counseling only ever y tw o o r t hr e e mon ths . D r. B a sc h a lso wa s tr e a tin g Whit e fo r d e pres si on and pr e sc ri be d a

nti

-4

depre ssant medication upon finding that Whit e “is becomingdepre ssed and discour ag ed. His wife
c on c ur s. . . . T he c hr on ic pa in p lus wh a t a pp e ars to b e an im

pe nd ingdis a

bil ity is w e ig hin g he a vil y upon him.” A.R. at 229 (B asch O ffice Notes 9/15/2003). At a late r visit, Dr. Ba sch incre ased the do sa g e be c a

us e Whit e “ fe e ls o ve rw he lmi ng ly de pr e sse d b e c a

us e of the c omb inatio n o f t

he c hr on ic pain and inability

to sleep bec ause of

pain.” A.R. at 252 (Ba sch Off ice Note s 1/21/2005). On June 16 , 2 00 3, Whit e a

pp lie d f or dis a bil ity ins ur anc e be ne fi ts und e r 4 2 U .S. C. § § 4 16 (i ) and 423, alleg ing that he bec ame disable d on May 7, 2003. A state a g ency phy sician, who did not
e xami ne Whit e , co mpl e te d a re sid ua l fun c tio na l ca

pa c ity (“ RF C” ) a sse ssm e nt, and fo un d th a t Whi te
was not disa

bled. The phy sician noted that this c onclusion differ ed from the tho s e o f W hite’s treating phy sicians bec au s e t h eir stateme nts were not supported by the evidenc e and f

indings, but elabor ated no f

urther. T he state a g ency

denied his cla im in Decembe r 2003. B. A dm inis tr at ive He ar ing After the state a g ency denied his claim, W hite reque sted a he aringbefor e an a dminist rative law j u d ge (“ ALJ ”) , and a he aringwas he ld on May 12, 2005. At the hea

ring , the AL J hear d te sti mony fr om Wh ite and

fr om a vo c a tio na l e xpe rt
. Reg arding his daily activities, Whit e testified that he drove ve ry littl e bec ause of

his pain and the e ff e c t of his pa in m e dic a tio ns , th a t he su pe rv ise d h is s on s in

do ingy ard

wo rk be c a us e he c ou ld
no lon g e r d o it

him se lf , a nd that he c ou ld no lon g e r he lp his c hil dr e n g e t r e a dy in t he mor nin g or he lp the m w ith t h e i r h o m e w o r k
. H e t e s t i f

i e d t h a t h e e xp e r i e n c e d f a t i g u e an d f

o r g e t f u l n e s s w i t h his medication, which c aused him to take fre quent naps, a nd preve nted him from beingable to play car d g ames. Reg ardinghis phy sical capa cities, he testified that he can sit for only about thirty minutes without medication, but when he takes medication his head is not clea r. He could stand in one plac e5

for only ten to fiftee n m i n utes, both beca use of the pa in and bec ause of dizz iness from the
me dic a t i o n . H e a l s o t e s t i f i e d t h a t h e c o u l d w a l k p e r h a p s a b l o c k w i t h o u t h i s m e d i c a t i o n . Whit e noted that Dr. B asch ha d planned to wr ite him a presc ription for a c ane, but White had alr eady obtained one. With reg ard to the nerve blocks, Whit e testified that they g ive him two or three w eeks of re lief but also leave his leg swollen. He a lso noted that he st ill has pain and mus t take medication
e ve n a ft e r t

he ne rv e blo c ks
. The AL J then questioned a vocational e x pert. The AL J posed three hy pothetical questions to the vocational e x pert. The third question, upon which the AL J relied in his decision, aske d the vocational e x pert to assume an individual the same ag e as the claimant, same educational backg round and wi th the jou

rn e y man’ s card and same pa st wo rk y ou de sc ri be d. Th is p e rs on

is limit ed to doing light exerti onal work w ith occasiona l postural movement, and oc c a sio na l pu sh ingand pu ll ing wi th t he ri g ht l ow e r e xtre mity

and a lso ne e din g to alternate sitting and standingat will, so I ’ll call that a sit/stand at will option. A. R. at 31 5- 16 (H r’ g Tr . at 46 -4 7) . In r e sp on se , th e vo c a tio na l e xp ert state d th a t jo bs wi th t

he se restric tions included “[i] nspector, te ster, sorter , stamper, we ighe r,” “ca shier,” and “ticke t sales,” a nd that the number of

jobs in each that would acc ommodate a sit/st and option wer e 4500, 16,000, and 30 00 , r e sp e c tiv e ly . A .R. a t 31 6 ( Hr ’gTr . at 47 ). Th e e xpe rt la te r a g re e d, ho we ve r, that a ll o f t he se jobs would be eliminated if the pe rson dozes off duringthe day or has mental confusion and fo rg e tf uln e ss. C. ALJ Dec ision On Dec ember

18, 2005, the AL J issued a dec ision finding that White was not disabled. The AL J revie wed Whit e’s claim under the five-ste p analy sis se t f orth in 20 C.F. R
. § 4 0 4.1520. Although the AL J foun d t h at W hite’s “ne uropathic pa in in the rig ht thigh fr om latera l femora l6

cutane ous nerve entra

pment” wa s a seve re impairme nt, A.R. at 18 (AL J Dec ision at 5), and preve nted White from doing his pa st releva nt work, the AL J fo u n d t h at W hite was not disabled beca use he w as ca

pable of perf orming other wor

k that exis ts in signific ant numbers in the national
e c o n o m y. Th e AL J dec ide d n ot t o “ g ive g re a t w e ig ht t o th e op ini on s of Dr. Basch an d D r. Smith
re g ard ingthe c la ima

nt’ s a bil ity to pe rf

or m wo rk -r e la te d a c tiv iti e s be c a us e tho se op ini on s take int o
c on sid e ratio n o nly

the c la ima

nt’ s p a st w or

k wh ic h wa s a t th e me dium and he a vy e xer tio na l le ve l; and n o t ‘o t h er work.’” A.R. at 17-18 (A L J Dec ision at 4-5). The A L J further discounted Dr. Ba sch’s opinion beca

use it “is inconsistent with his own office note s that indicate the c laimant
r e c e i v e s g o o d

p a i nr e l i e f

f o r f o u r t o s e v e nw e e k s f

r o m n e r v e b l o c k i n j e c t i o n s . ” A
. R
. a t1 8 ( A LJ Dec ision at 5). The AL J went on to find that W h i t e’s “neuropathic pain in the rig ht thigh fr om latera l femora l cutaneous ne rve e ntrapment” is a “seve re” impairment, but found that his other impairments, including his menta l impairme n t, were not “seve re.” Id . I n discussing the mental imp a ir me nt, the AL J found

tha t Whi te wa s dia g no se d w ith“ a dju stm e nt d iso rd e r” by Dr . M c Do we ll but takes anti-depre ssants “more for pain relief and slee p than for de pressive sy mptoms,” “does not pa rt ic ipate in m e nta l he a lth c ouns e lin g on a c on sis te nt ba sis and ha s on ly mil d to no lim itatio ns in his activities of dail y l i v i n g, social func tioning and c oncentr ation, persistenc e and pa ce due to a mental hea lth impairment.” Id
. The AL J went on to deter mine Whit e’s RF C, defined a s “the most an individual can still do afte r consider ing the eff

ects of phy sical and/or me ntal limit ations that aff ect the ability to perfor

m
wo rk -r elated tasks.” Id
. T h e A L J d is c u s s e d s o me o f Wh it e ’ s te s ti mo n y

a b o u t t h e a c ti v it ie s he perf orms, noting that White “wa s teac hing his so n h o w to do y ard w ork, drove , used a c omputer,7

went to the store with his family , and handled the f amily financ es.” A .R. at 19 (AL J Dec ision at 6). He a lso noted Whi te’s testimony “that he e x per ie n c e d

fatig ue and f

org etfulness fr om his medications but stil l drove a

vehicle” and that, des p i t e W h i t e’ s testimony that he we nt to counseling once a month, “[t ]he recor ds clea rly show that the cla imant does not see his counse lor once a month.” Id
. After discussing White’s testimony that he wa s “limited to si t t i n g thirty minutes, standing f

ifteen minutes with a cane , walking one block with a cane , and lifting a g allon of milk,” the AL J found “no evidenc e in the re cord that the claiman t wa s p re s cr ibed a c ane or has any difficulty walking .” Id
. B e c a us e of the se a pp are nt i nc on sis te nc ie s, the AL J found that “ [t]he c la ima

nt’ s d e sc ri pti on

of his limit ations exceeds medica l substantiation, is not consistent with other evidenc e and is not credible.” Id . Acc ording ly , the AL J found that White “reta ins the following r esidual func tional capa city : light work with a sit/st and option; occ asional pushing and pulling with [rig ht lowe r extr em i t y ] ; and
occa sional bending , kneeling , squatting, c rouching , and cra wling.” Id . T he A L J fou ndth at t hi s R FC preve nted White from perf orming his past releva

nt work as a

n elec trician. Be cause the AL J found t hat t he R FC included “ additional exertional and/or non-e x ertional lim itat i o n s , ” t h e A L J l o o k e d t o t h e h y

p o t h e t i c a l qu e s t i o n s p o s e d t o t h e v o c a t i o n a l e xp e rtto de te rm ine wh e the r t

he re we re a sig nif

ic ant numbe r of

job s in the natio na l e c on omy

tha t Whi te c ou ld perf orm g iven his RFC, ag e, educa tion, a nd past work experience
. A.R. at 20 (AL J Dec ision at 7). B e c a us e the vo c a tio na l e xpe rt

te sti fi e d th a t th e re we re 23 ,5 00 job s in th e re g ion fo r s ome on e of

thi s RFC and other

vocational f

actor s, the AL J conclude d that there wer e a sig nificant number of other jobs a vailable to White, and that he was there fore not disa bled. Whit e timely

filed an a ppeal to the Soc ia l Se c ur ity

Ad min istratio n Ap pe a ls Counc il, bu t the Ap pe a ls Counc il d e nie d Wh ite ’s re qu e st for r eview.8

D. Distric t Court P roce edings On Novembe r 6, 2006, White f iled a civil a ction for judicial revie w of the Commissioner’s decision, and the mag istrate judge issued a repor t a nd rec ommendation on J anuar y 17, 2008. The
ma g istrate jud g e c on c lud e d th a t th e AL J’s de c isi on , spe c if ic a lly the de te rm inatio n of Wh ite ’s RF C, was not supported by substantial e vidence
. First, the mag istrate judge conclude d that, while it was appropr iate for

the AL J to discount Dr. B asch’ s opinion that Whit e wa s disabled, the AL J should not h av e ign o re d Dr
. Ba s ch ’s m ed i ca l co n cl u s i o n t h at W h i t e’ s i mp ai rm en t i s ex ac er b a t e d b y s i t t i n g, squatting, a

nd twisting, bec ause that conclusion was not c ontradicte d by any evidenc e in the rec ord. Next, the mag istrate judge conclude d that the AL J should ha ve taken into c onsidera t i o n W h i te’s t es t i m o n y t h at h i s m ed i ca t i o n s ad v er s el y af fe ct ed h i s ab i l i t y t o p er fo rm wo rk
. T h e ma gi s t ra t e j u d ge fu rt he r c on c lud e d th a t, b e c a

us e Whit e ’s te stimo ny regard inghis lim itatio ns wa s c on sis te nt w ith objective medic al evidenc e and be cause Whit e’s c redibility was bolstere d by

his ex tensive work history , the AL J ’s decision was not supported by substantial evidenc e to t he extent Whi te “testified that he wa s impaired to an e x tent bey ond that rec og nized by the AL J .” Report & Recommendation at 10-11. F or these r easons, “ the hy pothetical questions, the response to w hich the AL J relied upon to support his decision, [ wer e] based upon an imprope r RFC dete rmination.” Id . at 11. Al tho u g h t h e m a g i s t r a t e j u d g e c o n c l u d e d t h a t t h e A L J’ s d e t e r m i n a t i o n “ t h a t t h e r e e xi s t s a sig nif ic ant numbe r of job s wh ic h Pla int if f c an p e rf or m de sp ite his lim itatio ns , is su pp or te d b y le ss than substantial evidenc e,” id
. at 11, the m ag istrate judg e did not find that there exis ted compelling
ev i d en ce t h at W h i t e is d i s ab l ed s u ch t h at t h e co u rt co u l d aw ar d b en ef i t s . T h e m a g i s t r a t e j u d ge there fore rec ommended that the Commissioner’s dec ision be reve rsed a nd the case be re manded f or further fac tual finding s. Id

at 12.9

Th e Com mis sio ne r f

ile d o bje c tio ns to t

he Re po rt and Re c omm e nd a tion, to wh ic h Wh ite responde d. On Fe bruar

y 29, 2008, the district

court e ntere d a judg ment g ranting the Commiss ioner’s
o b j ec t i o n s, rejec ting the Re port and Rec ommendation, and af firming the dec ision of the Social Security Ad m i n istration. The district court c oncluded that the A L J ’s dec ision was supported by substantial evidence beca use (1) Dr. Basc h’s opi nion that Whi te’s impairment wa s exacerbated by
cer tain activities was c ontradicte d by Dr. B asch’ s own finding s that Whit e’s pa in was controlled by
nerve block injections an d b y the state a g ency

phy sician’s finding s and (2) substantial evidence “supports the AL J ’s discounting of Plaintiff’s s el f-diagnose s since Plaintiff drives a vehicle, g oes sh op pin g , w a lks fr e qu e ntl y , hand le s the fa mil y fi na nc e s, and c arr ie s o ut o the r d a ily

a c tiv iti e s. ” Di st. Ct. J . at 3. Ultim ately , the district court c oncluded that “ althoug h it may disag ree with the AL J ’s deter mination, the AL J has ac ted within his ‘zone of choice .’” Id
. II. AN AL YSI S A. Standard of

Review

“ Th is c ourt ’s re vie w o f t

he Com mis sio ne r’ s d e c isi on is lim ite d to de te rm ini ng wh e the r it i s supported by

substantial evidence and wa s made pursua nt to proper leg al standar ds.” Ro g er s v. Comm’r of Soc. Se c. , 486 F.3d 234, 2 4 1 (6 t h Cir. 2007). “Substantial evidenc e is ‘such r eleva nt evidenc e as a re as o n ab l e mi nd might ac cept a s adequate to support a conc lusion.’” Howard v. Comm’r of Soc. Se c. , 2 7 6 F. 3 d 2 3 5 , 2 3 7 -3 8 (6 t h C i r. 2 0 0 2 ) ( qu o t i n g Richardson v. Pe rales , 4 02 U. S. 389, 401 (1971))
. A social sec urity

disability deter

mination is made in ac corda nce w ith the five-step se quential analy sis set forth in 20 C.F.R. § 404.1520:10 F ir st, [White ] mus t de mon str a te that [he ] is n ot c ur rent ly e ng a g e d in su bs tanti a l g a inf

ul e mpl oy

me nt at the tim e of

the dis a bil ity a pp lic a tio n. 20 C.F .R. § 404. 1 5 2 0 (b ). Second, [W hite] m ust show that [ he] suffer s from a se vere impairment. 20 C.F.R. § 404.1520(c) . Third, if [W hite] i s not eng ag ed in substantial g a inf ul e mpl oy me nt an d ha s a sev e re imp a ir me nt wh ic h is e xpe c te d to la st f or a t le a st twelve months , which meets or equals a li sted impairment, [he] will be considere d dis a ble d without r e g ard

to a g e , e du c a tio n, and wo rk e xpe ri e nc e . 2 0 C. F .R. § 404.1520(d). F ourth, if the Commissi oner c annot mak e a deter mination of dis a bil ity ba se d on med ic a l eva luatio ns and c ur re nt w or k a c tiv ity and [White ] ha s a sever e impairment, the Commi ssioner will then r eview [Whit e’s] residual func tional capa city (RFC) a nd rele vant past work to de termine if [he] can do past work; if so, [he] is not disabled. 20 C.F.R. § 404.1520(e). Ho war d , 276 F.3d at 238. I n Whit e’s c ase, Th e AL J det e rm ine d th a t th e fi rst fou r par ts d id n ot e nti tle [White ] to d isa bil ity benef its, so thi s case turns on the fifth: if [W hite’s] im pairment pre vents [him ] from do ingpa st w or

k, the Com mis sio ne r w ill c on sid e r [h is] RF C, a g e , e du c a tio n a nd pa st work e x perie nce to de termine if [ he] can perfor m other wor

k. I f [he] cannot perf

orm other work , th e Co mm is s io n e r w il l f in d [h im ] d is a

b le d
. 2 0 C. F
. R. § 4 0 4
. 1 5 2 0 (f)
. The Com missioner has t he burden of proof only on “the f ifth step, proving that there is work available in the economy that the claimant c an per form.” Her v . Comm’r of Soc. Sec

. , 203 F.3d 388, 391 ( 6th Cir. 1999). To me e t th e burd e n o f s ho wi ngtha t [Whit e ] co uld

pe rf or m wor k th a t is available in the national ec onomy , the Commiss ioner must make a finding
“ su pp or te d b y su bs tanti a l e vid e nc e that [White ] ha s th e vo c a tio na l qu a lif ic a tio ns to perf orm specif

ic jobs.” Va rle

yv . S e c ’y of H e alt h &Hu ma n S

ervs. , 820 F.2d 777, 7 7 9 (6 t h C i r. 1 9 8 7 ). T h i s k i n d o f “ [ s ] u b s t an t i al ev i d en ce m ay

b e p ro d u ce d t h ro u gh re lia nc e on the te sti mony

of a vo c a tio na l e xpe rt

(V E) in r e sp on se to a

‘hy po the tic a l’ question, but only

‘if the question acc urate ly portray s [W hite’s] indi vidual phy sical and mental impairme nts.’” Id . (citations omitted). Id. Af te r c on sid e ri ngWhit e ’s a g e , e du c a tio n, pa st re le va nt w or k e xpe ri e nc e , a

nd RF C, a lon g wi th the testim o n y o f the vocational expert, the AL J deter mined that Whit e wa s able to per form other work a n d w a s n o t d is a

b le d
. Wh it e ar g u e s th a t t h is d e te r mi n a ti o nis n o t s u

p p o rte d b y s u b s ta n tial evidenc e.11

B. Whether the A LJ’s Dec ision Is Su pported by S ubs tantial Evid ence Whit e ar g ues that the AL J ’s dec ision was not supported by substantial evidence for thre e
rea sons. First, White arg ues that t he AL J did not properly consider the opinions of Whi te’s tre ating phy sicians, Dr. B asch a

nd Dr. Smith. S econd, White ar g ues that t he AL J err ed by not finding that Whit e had a si g nificant mental impairment. Finally , Whit e arg ues t hat s ubstantial evidenc e does not
s u p p o rtt h e f

i n d i n g t h a t W h i t e c o u l d h a v e p e r f o r m e d a l i m i t e d

r an g e o f l i g h tw o r k an d t h a tt h e A LJ fa ile d to fo llo w the vocat iona l e xpe rt ’s re sp on se s to the hy po the tic a l qu e sti on s th a t a c c ur a te ly portray ed White’s phy sical and me ntal state. We f irst disc uss w hether the AL J ’s RFC deter mination that Whit e could perf

orm a limit ed rang e of lig ht work wa s supported by substantial evidence and then discuss whether the vocational expert’s testimony in response to the A L J ’s hy pothetical question provides substantial evidenc e to support the AL J ’s finding that Whit e could pe rfor m other work. We conc lude that bot h t h e ALJ ’s RFC deter mination and the AL J ’s finding of other w ork
wer e not supported by

substantial evidence
. 1. RF C Det erm ination A claimant’ s “RFC is an assessment of an individual’s ability to do sustained work-r elated phy sical and me ntal activities in a work setting on a regular and continuing basis,” which is de fined as “8 hour s a day , for 5 da y s a we ek, or an equivalent wor k schedule .” Soc. Sec. Rul. 96-8p, 1996 WL 374184, at *1 (July

2, 1996) (Policy

I nterpre tation Ruling Tit les I Iand XVI : Assessing Re sidual Func tional Cap ac i t y i n I nitial Cl aims). The A L J found that White “reta ins the following r esidual functional capac ity : light work with a si t/stand option; occa sional pushing a nd pulling with [right l o wer ext remity ]; and occ asional bending , kneeling , squatting, c rouching , and cr awling .” A.R. at 19 (A L J De c isi on

a t 6) . Wh ite argue s th a t th e AL J er re d in makin g thi s f

ind ingby no t pr op e rl y12

consideringthe opinions of Whit e’s tre ating phy sicians, by n o t co nsidering Whit e’s sig nificant
me nta l im

pa ir me nt, and by no t c re dit ingWhit e ’s te sti mony , p art icularl y on the e ff e c ts o f h is p a in and his pain medication.

a. Tr e at ing P hys ic ian s’ Opini ons Under the “tre ating source ” rule , the AL J must “‘g ive g ood rea sons’ for not givingweig ht to a t reating phy sician i n the contex t of a disability deter mination.” W

ilson v. Comm’r of Soc. Sec

. , 37 8 F .3 d 5 41 , 5 44 (6 th C ir . 2 00 4) (q uo tin g 20 C.F .R. § 4 04 .1 52 7( d) (2 )) . Purs ua nt t o th is r

ule , “ if the op ini on

of the tr e a tin g ph y sic ian as to the natur e and se ve ri ty of a c la ima nt’ s c on dit ion s is ‘we ll-supported b y m ed i cally acc eptable c linical and labor atory diag nostic techniques a

nd is not inconsistent with other substantial e vidence in [the] c ase rec ord,’ then it will be acc orded c ontrolling weig ht.” Ro ge rs , 4 8 6 F. 3 d at 2 4 2 (q u o t i n g W

ilson , 378 F.3d at 544). “When the treating phy sician’s opinion is not controlling , the AL J , in deter mining how much weight is appropr iate, must consider
a host of fac tors, including the leng th, f reque ncy , nature , and extent of the treatment re l at i onship; the supportability

and consistenc y

of th e phy sician’s c onclusions; the specialization of the phy sician; and any other re levant fa ctors.” Id . “ Ho we ver, in all ca se s th e re re ma ins a pr e su mpt ion , a lbe it a
re bu tta ble on e , th a t th e op ini on of a tr e a tin g ph y si cia n is e nti tle d to g re a t de fe re nc e , it s non-controlling status notwithst anding .” Id . “I t is true, howeve r, that t h e ultimate decision of disability rests with the administrative lawjudge .” W alk e r v . Se c ’y

of H e alt h &Hu ma n S

e rv s. , 980 F.2d 1066, 1070 ( 6th Cir. 1992). Whit e argues that, beca use his treating phy sicians, Dr. B asch a nd Dr. Smith, advised him not to r eturn to w ork, the AL J err ed by discounting their opinions reg arding Whit e ’s dis a

bil ity wh e n the re wa s noth ing in the re c or d, e xce pt t he state a g e nc y

ph y sic ian’ s r e po rt , that supported a c onclusion that Whi te could perf orm limit ed light work. The Commissioner argues13

that a tre ating phy si ci an ’s o p i nion that a claimant c annot re turn to work is not conclusive on the ultimate issue of di sability and that the AL J g ave the requisite “good rea sons” for discounting the op ini on s o f t

he tr e a tin g ph y sic ians . We conclude that the AL J did not g ive suffic ient rea sons for discounting the opinion of Dr. Ba sch as to White’s limit ations. Although the AL J was c orre ct that the opinions of Dr. B asch a nd Dr . Sm ithwe re no t c on c lus ive on dis a bil ity , p art ic ula

rl y be c a us e the y re fe rr e d to Whit e ’s a

bil ity to pe rf or m hi s c ur re nt j ob rathe r t

ha n o the r j ob s, the AL J doe s n ot g ive g oo d r e a so ns fo r e nti re ly discounting the rema inder of D r. B asch’ s opinions. The AL J stated that he did not g ive Dr. B asch’ s opinion gr eat we ight “ beca use his opinion is i nconsistent with his own office notes that indicate the claimant re ceive s g ood pain re lief for four to seve n wee ks from ner ve block injec tions.” A.R. at 18 (AL J Dec ision at 5). Howeve r, althoug h Dr. Bas ch d i d fi n d that Whit e obtained te mporary relief fr om t he ne rv e blo c ks , the ke y is that th is r e lie f w a s te mpo ra ry , la sti ngfo r o nly

thr e e to s e ve n w e e ks
. Dr . B a sc h’ s no te s re pe a te dly state that, a sid e fr om the te mpo ra ry re lie f f ro m th e inj e c tio ns , n o v ia

ble tr e a tme nts are wo rk ing

and the re is n oth ing mor e tha t c an be do ne to r e lie ve Whit e ’s pa in. Th is i s in n o w ay inc on sis te nt w iththe c on c lus ion that Whi te ’s pa in w ou ld p re ve nt h im f ro m c on sis te ntl y holding a job and there fore is not a go o d rea son for e ntirely discounting D r. B asch’ s opinion as internally inconsistent. As we have pre viously stated, a doc tor’s re po rt is not inconsistent with a finding of disability mere ly beca use it states that the cla imant’s phy sical impairment has improve d. W alker , 980 F.2d at 1071. As the mag istrate judg e noted, Dr . Ba sch found that White could not perf orm work involving sitti ng , squatting, or twisting, because it place s too much pressure on his nerve . This is inconsist ent with the RFC, which allows for occa sional pushing a

nd pulling with the rig ht l eg and occasional14

bending , kneeling , sq u at t i n g, crouching , and cr awling . Although, a s the district court noted, Dr
. Ba sch found that White should walk more, he also foun d t hat when White did walk more as instructed, the pa in beca

me unbearable
. The AL J stated t hat Dr. Ba sch’s re cent of fice notes repor

ted that Whit e wa s becoming more a ct i v e, but the AL J failed to note that in that same sentenc e Dr
. Ba sch re ported that the inc rea sed ac tivity was incr easingWhit e’s pa in. As we have noted, “the fa ct that a patient is encourag ed to rema in active does not refle ct the manne r in which such a ctivities may ag g ravate the patient’ s sy mptoms.” Ro ge rs , 486 F.3d at 249. b. Si gni fic antM e nt al I m pai r m e nt Whit e also a

rg ues that the AL J err ed by failing to find that Whi te had a signific ant mental impairment even though Dr. McDowe ll diag nosed W hite with adjustment disorder a nd depre ssion, g iving him a GA F of

score of 55, indicating moderate sy mptoms. I n d i s cu ssing White’s mental imp a ir me nt, the AL J fou nd that it w a s n ot s e ve re be c a

us e , a lth ou g h h e wa s d ia g no se d w ith “adjustment disorder ” and w as pre scribed an anti -depr essant medica tion, the anti-depre ssant was

“ mor e fo r p a in r e lie f a

nd sle e p th an f

or de pr e ssi ve sy

mpt oms ,” and

Whit e “ do e s no t pa

rt ic ipate in mental hea lth counseling on a consistent basis and has onl y mild to no limit ations in his activities . . . due to a menta l health impairment.” A .R. at 18 (AL J Dec ision at 5). Although the AL J did not err in finding that Whit e’s menta l impairment was not seve re, the AL J g ave no e x planation for totally discounting the objective e vidence of White’s mental impairment in determining Whit e’s RF C. Once one sever e impairment is found, the combined e ffe ct of all impairments must be consider ed, eve n if other impairme nts would not be sever e. See 20 C.F.R. §§ 404.1523, 404.1545(a) (2). The Commi ssioner cor rec tly states that Dr. Mc Dowell did not note any limit ations cause d by

Whit e’s menta l impairment and th at t h e AL J was ther efor e not15

require d to include the GAF finding in the RFC. Ho war d , 276 F.3d at 241. The AL J ’s total discounting of

Whit e’s menta l impairments, h oweve r, is not supported by substantial evidence , beca use the AL J mischara cter izes the evidence and misstat es Dr
. Ba sch’s re asons for pr escr ibing anti-depr essants. When f

irst pr escr ibing them, Dr. Ba sch stated “[W hite] i s becoming depre ssed and dis c oura g e d. Hi s w if

e c on c ur s. . . . Th e c hr on ic pa in plu s wh a t a pp e ars to be an im

pe nd ingdis a

bil ity is w eig hing heavily upon him.” A.R. at 229 (B asch O ffice Notes 9/15/2003). At a late r visit, Dr. Ba sch incre ased t h e d o s ag e bec ause White “fe els overw helmingly depre ssed bec ause of

the combination of the c hronic pa in and inability to sle ep beca use of pain.” A.R. at 252 (B asch O ffice Notes 1/21/2005 ). C ontrary to the AL J ’s statement, the a nti-depre ssants were not prescr ibed for “pain r elief a

nd sleep,” A.R. at 18 (AL J Dec ision at 5), but beca use t he pain and lack of sleep w ere
c a us ingde pr e ssi on . B e c a

us e the AL J doe s n ot ac c ur a te ly state the e vid e nc e us e d to su pp or t hi s finding , his total discounting of the me ntal impairment is not supported by substantial evidence
. c. White’s C redibility Whit e ar g ues that substantial evidenc e does not supp o rt t h e AL J ’s discounting of White’s testimony about his impairments. We rec ently discussed t he two-part ana ly sis “used in eva luating complaints of disabling pain”: F ir st, the AL J will a sk

wh e the r t

he the re is a

n und erl y ingme dic a lly

de te rm ina

ble phy sical impairment that could r easonab ly be expected to pr oduce the claimant’s sy mptoms. 20 C .F.R. § 416.929(a ). Second, if the AL J find s t h at s uch an impairment exist s, then he must evaluate the intensity , p ersist ence , and limiting eff ects of the sy

mptoms on t he individual’s ability to do basic wo rk activit ies. Id
. Relevant fa ctors for

the AL J to consider in his evaluation of sy mptoms i nclude the claim an t’ s d a il y

a c ti v it ie s ; t

h e lo c a ti o n , d

u r a ti o n , f r e qu e n c y , an d

in te n s it y of sy mptoms; fac tors that prec ipitate and aggrav ate sy mptoms; the ty

pe, dosag e, effect iven e ss, and

sid e e ff e c ts o f a ny me dic a tio n ta

ke n to a lle viate the sy

mpt oms ; other tre atment under

taken to re li ev e s y

m ptoms; ot her me asure s taken to re lieve16

sy mptoms, such as ly ing on one ’s bac k; and any other fa ctors bea

ring on the limit ations of the cla imant to perfor m basic func tions. Id
. Ro ge rs , 4 86 F .3 d at 24 7; se e als o 20 C.F.R. § 404.1529(a) . Although it is “for the AL J , and not the
r e v i e w i n g c o u rt , t o e v a l u a t e t h e c r e d i b i l i t y o f w i t n e s s e s , i n c l u d i n g t h a to f t h e c l a i m an t , ” “ t h e A LJ is not free to make cr edibility deter minat ions based solely

upon an ‘intang ible or intuitive notion about an individual’s cr edibility .’” Ro ge rs , 4 8 6 F
. 3 d a t 2 4 7 ( qu o ti n g So c . Se c . Ru l. 9 6

- 7 p , 1 9 9 6 WL 374186, at *4 (July

2, 1996) (Policy

I nterpre tation Ruli ng Titles I Iand XVI : Evaluation of S y mp t o m s i n D i s a

b i l i t y C l a i m s : A s s e s s i n g t h e C r e d i b i l i t y o f anIn d i v i d

u a l ’ s S t a t e m e n t s ) )
. In Ro ge rs , the claimant asserted disabilit y based on pain caused by fibromy alg ia, and we r ever sed and
rema nded the AL J ’s dec ision, in part beca use the AL J failed to e valuate p ro p er l y t h e cla imant’s
cre dibilit y

by over- emphasizing objec tive fin d i ng s, mischara cter izi ng the scope of the c laimant’s da ily a c tiv iti e s, and

pla c ingun wa

rr ante d s ig nif

ic anc e on a ph y sic ian’ s te sti mony

that th e be st treatment was re gular e x erc ise. Id . at 248-49. Her e, the AL J found that White’s “desc ription of his lim itations ex cee ds medical substantiation, is not c onsistent with other evidenc e and is not cre dible.” A.R. at 19 (AL J Dec ision at 6). The ALJ s t ated that he “conside red a ll sy mptoms, i ncluding pain, and the e x tent to which these sy mptoms can rea sonably

be ac cepte d as consistent with the objec tive medical evidence and other e vidence based on the require ments of 20 C FR § 404.1529, and S ocial S ecur ity Ruling 96-7p”
an d rele vant medica l opinions, id
. , b u t h e d id n o t e xp la in h o w th e o b je c ti v e e v id e n c e wa s inc on sis t e n tw i t h W h i t e ’ s t e s t i m o n y . H e s e e m s t o h a v e b a s e d t h i s f i n d i n g o nt h e f

a c tt h a tW hit e testified that “[h]e is able to drive, handle the family financ es, help c are for six children, and use a computer” and that he “was t eac hing his son how t o do y ard work.” Id . But this “mischar acte rizes17

[W hite’s] testim ony

reg ardingthe scope of [his] daily activities [and] fails to e x amine the phy sical eff ects c oextensive with their perfor mance .” Ro ge rs , 486 F.3d at 248-49. Whit e testified, f or
e xamp le , th a t he dr ov e ve ry lit tle be c a

us e of pa in and his me dic a tio ns , that he wa s su pe rv isi nghis
so ns in d oin g y ard

wo rk be c a us e he c ou ld no lon g e r d o it him se lf , a nd that he c ou ld n o lo ng e r h e lp his c hil dr e n g e t r e a dy in the mor nin g or he lp wi th the ir ho me wo rk
. Whit e ’s su bje c tiv e c omp la int s
are c on sis te nt w iththi s te sti mony and wi th t he a c tiv iti e s q

ue sti on na ir e s h e c omp le te d as part of his
a pp lic a tio n. F ur

the r, Whit e ’s e xten siv e wo rk his tor y and a tte mpt s to c on tin

ue wo rk ingde sp ite his disability support his credibility , a factor not eve n considere d by the AL J
. See Sc haal v. Apfel , 134 F.3d 496, 502 ( 2d Cir. 1998) (“[A] good wor k history may be deeme d probative of cre dibilit y . . . .”); Soc. Sec. Rul. 96-7p, 1996 WL 374186, at *5. Mu c h o f Whit e’s tes tim on y wo uld a ff e c t hi s RF C de te rm inatio n. F or e xamp le , Wh ite testified that he e x perie nced f atig ue and forg etfulness with his medication. The AL J also found no
e vid e nc e that Whi te ha d tr ou ble wa lki ngbe c a

us e he ha d n ot b e e n p re sc ri be d a c ane , b ut Wh ite testified that he alre ady had obtained one without a prescription. As in Ro ge rs , we c onclude that the AL J ’s dec ision “fails to ‘contain spe cific r ea sons for the f inding on c redibility , supported by the
e vid e nc e in t

he c a se re c or d’ ” and

is no t “ ‘s uf

fi c ie ntl y sp e c if

ic to make c le ar t o th e ind ivi du a l and to any subsequent reviewe rs the we ight the a djudicator g ave to [Whi te’s] statements and the re asons for that weig ht.’” Ro ge rs , 486 F.3d at 248-49 (quoting Soc. Sec. Rul. 96-7p, 1996 WL 374186, at *4).18

2. Vo c at ion al E xpe r t T e st im ony Whit e ar g ues that, bec ause the AL J did not have substantial e vidence to suppor t the finding that Whit e could perf

orm limit ed light work, the hy pothetical question posed to the vocational e x pert was inac curate, and the A L J should not have re lied on the answer i n finding that there wer e other jobs that W hite could per form. White argues that later h y p o t h etical que stions asked of the vocational e x pert by

Whit e’s attorney

acc urate ly

portray ed White’s limit ati o n s . T h e A L J p o sed three hy po the tic a l qu e sti on s to the vo c a tio na l e xpe rt and re lie d on the ans we r to the thi rd qu e stion in deter mining that White could perf orm other wor

k. That question aske d the vocational expert to assume an individual the same ag e as the claimant, same educational backg round and wi th t he jou rn e y man’ s card and same pa st wo rk y ou de sc ri be d. Th is p e rs on is limit ed to doing light ex ertional wor k with occa sional postural movement, and oc c a sio na l pu sh ingand

pu lli ng wi th the ri g ht l ow e r e xtre mity and a lso ne e din g to alternate sitting and standingat will, so I ’ll call that a sit/stand at will option. A.R. at 315-16 (Hr’gTr. at 46- 47). B eca use the hy pothetical question simply restate s the RFC, and beca use, as discusse d above, the RFC does not ac curately portray Whit e’s limitations, the hy pothetical question suffe rs from the sa me problems as the RFC, and thus the AL J err ed in re ly ing on the answe r to this question. Moreove r, we have expl ained that the purpose of a hy pothetical question is differ ent than that of an RF C: “while the RFC should focus on [Whi te’s] abiliti es or, in othe r words, what [ Whit e] can
and c ann ot do, the hy

po the tic a l qu e sti on

sh ou ld f oc us on [White ’s ] ove ra ll s ta te inc lud ing[White ’s ] mental and phy sical maladie s.” Ho war d , 276 F.3d at 239. T h e “R FC i s to be an ‘ assessment of [W hite’s] remaining capa city for wor k’ once [hi s] limitations have been taken into ac count.’” Id
. (quoting 20 C.F.R. § 416.945). I n other wor ds, the RFC “is an a ssessment of what [ Whit e] can a nd cannot do, not what [ he] doe s and does not suf fer from.” Id . “ Th e hy

po the tic a l qu e sti on

po se d to19

a [vocational expert] for purposes of deter mining whe ther [Whi te] can per form other work, on the oth e r h and , s ho uld

be a more co mp let e asse ssm e nt o f [h is] p hy sic a l and me nta l st a te and

sh ou ld include an ‘ acc urate [ ] portray [al] [of his] individual phy sical and me ntal impairment[s] .’” Id
. (q u o t i n g Va rle

yv . S e c ’y of Health & Hu ma n S

e rv s. , 8 20 F .2 d 7 77 , 7 79 (6 th C ir . 1 98 7) ; Mye rs v. W einberge r , 514 F.2d 293, 294 ( 6th Cir. 1975)). I n Ho war d , we f ound that the vocational expert’s testimony was not sufficie nt evidenc e to support the AL J ’s findi ng that the claimant c ould perfor m “other work,” beca

use t h e q u es t i o n did not include the AL J ’s finding s on the claimant’s phy sical ailments and diag noses and be cause the question did not acc urate ly p o rt ra y the claimant’ s mental state. 276 F .3d at 241. Her e, the AL J ’s re liance on the answe r to the hy pothetical question is further flawe d to the extent that it did not accur ately portray Whit e’s phy sical and me ntal impairments. Specifica lly , the qu e sti on ma de no me nti on of Whit e ’s me nta l state
. Dr . M c Do we ll, Whit e ’s tr e a tin g ps y c ho log ist , diag nosed him with adjustment di s o rd er an d d epre ssion and g ave him a G AF sc ore of 55, which i n d i ca t es m o d er at e s y

mp t o m s o r m o d er at e d i ff

i cu l t i es i ns o ci al , o cc u

p at i o n al , o r s ch o o l fu n ct i o n i n g. As discussed above, the AL J did not have to include this finding in the RFC. Ho war d , 276 F.3d at 241. Howeve r, Ho war

d does direc t the AL J to include the diag nosis of mental impairment in the hy pothetical question. Fur ther, the que stion did n o t ac co u n t for the side eff ects of the pain medication. W hen questioned by

Whit e’s at t o rn ey , the vocational expert admitted that the listed jobs would be eliminated if the pe rson dozes off duringthe day or has m ental confusion and forg etfulness. The Commi ssioner ar g ues that these sy mptoms correc tly

wer e not included in the question bec ause the AL J found that White’s testimony was not cr edible. As discussed above, there was not substantial20

evidenc e to discount Whit e’s testimony that the pain medication left him drowsy and fat igue d. Whit e ha s b e e n o n s e ve ra l po te nt p a in m e dicatio ns , in c lud ingVa lium, V ic od in, and a Dura g e sic patc h, wh ic h a

re kn ow n to have po we rf

ul sid e e ff e c ts suc h as dr ow sin e ss, fatigue , li g ht- he a de dn e ss,
and we a kn e ss. F ur

the r, Dr
. B a sc h’ s of

fi c e no te s ind ic a te that, fa r fr om a bu sin g the se me dic a tio ns , Whit e wa s conce rned a

bout the side eff

ects a nd at times asked to have hi s dosag e decre ased. The AL J ’s deter

mination is thus not entitled to substantial weig ht to the extent that it di scounted the side
e ff e c ts o f Wh ite ’s me dic a tio ns . C. Award of

Benefits “I f a cou rt

de te rm ine s th a t su

bs tanti a l e vid e nc e do e s n ot s up po rt the [Comm iss ion e r’ s] decision, the c ourt ca

n re v er s e the de cision and immediately awa rd bene fits only

if all essential fa c tua l is su e s h a ve be e n r e so lve d a nd the re c or d a de qu ate ly e sta bli sh e s a pla int if f' s e nti tle me nt t o benef its.” Fa uc he r v. Sec’

y of He alt

h &Hu ma n S

e rv s. , 17 F.3d 171, 176 ( 6th Cir. 1994). Otherw ise, the cour

t should remand to the C ommissi oner f or fur ther c onsideration. Althoug h the AL J did n ot p ro vid e su

bs tanti a l e vid e nc e to sup po rt his c on c lus ion s, we c ann ot s ay tha t th e re is compelling evidenc e that White is entitl ed t o benef its. W e ther efor e must remand f or fur ther consideration. III . C ON CL USI ON Be cause we c onclude that the A L J ’s deter mination that W hite is able to perf orm a substantial number of othe r jobs was not supported by substantial evidence and did not confor m to the proper leg al standar ds, we RE VE RSE the judg ment of the d i s t ri ct court upholding the Commiss ioner’s decision and REMAND with instructions to return the cla im t o the Commiss ioner for further proce eding s consistent with this opi nion.