United States Court of Appeals FOR THE EIGHTH CIRCUIT

___________ No. 97-2142

___________ Nancy Kelley, *
* Appellant, *
* Appeal from the United States
v. * District Court for the Southern
* District of Iowa. John J. Callahan, Acting Commissioner, * Social Security Administration, *
* Appellee. *

___________ Submitted: October 23, 1997 Filed: January 7, 1998

___________ Before MCMILLIAN, FLOYD R. GIBSON, and BEAM, Circuit Judges.

___________ BEAM, Circuit Judge. Nancy Kelley appeals the district court's affirmance of a denial of Soc ial Security benefi ts. Because the record does not contain substantial evidence to support th e findings of the Administrative Law Judge (ALJ), we reverse and remand for furthe r proceedings.Lupus, also known as systemic lupus erythematosus (SLE) is "a chronic , 1
rem itting, relapsing, inflammatory, and often febrile multisystemic disorder o f connective tissue, acute or insidious in onset, characterized principally by involvement of the skin, joints, kidneys, and serosal membranes." See Dor land's Illustrated Medical Dictionary 964 (28th ed. 1994) (Dorland's). Fibr omyalgia is muscle pain in fibrous tissues. Stedman's Medical Dictionary 2 222 (4th ed. 1976). It is a degenerative disease which results in symptoms such a s achiness , stiffness, and chronic joint pain. See Cline v. Sullivan , 939 F.2d 560, 56 7 (8th Cir. 1991).
-2- I. BACKGROUND
Kelley is fifty-three years old. She was previ ously employed as a telephone line repair person and a telephone repair dispatcher. She has one year of junior college

. She suffers from a history of lupus, fibromyalgia, chest pain, ulcers, irritable bowel 1 2 syndrome, high cholesterol, pain due to a pronated ankle, and atypical heart pain.

In November 1992, Kelley's employer downsized and Kelley's position as a dispatcher was eliminated. At that time, several people w ere offered positions with the company in another town. Kelley was not offered a job. She was told that he r excessive absenteeism w as the reason. She had missed twenty-seven days of work in about five m onths. Kelley testified that these absences were due to illness and he r emplo yer did not dispute that fact. Before her job was eliminated, Kelley's employer had accommodated her health problems by allowing her to lie down sev eral times a day on a cot that had been p rovided for her. Kelley testified that she would have received a pension if she had been able to continue working for three more years.

On Ma y 20, 1993, Kelley applied for disability benefits alleging that she ha s been disabled since November 20, 1992. Her applicat ion was denied both initially and on reconsideration. She then requested a hearing before an ALJ.Pleu risy is an inflammation of the pleura, the serous membrane investing th e 3 lungs and lining the thoracic cavity. Dorland's at 1306-07. A NA stands for antinuclear antibodies. Antinuclear antibodies are directe d 4 against nuclear antigens; ANA are almost invariably found in systemic lupu s erythematosus and are frequently found in rheumatoid arthritis, scleroderma, and mixed connective tissue diseases. Dorland's at 93 Arthralgia is pain in a joint. Dorland's at 140. 5
-3- At the hearing, Kelley testified that she is in almost constant pain in her shoulders, back and legs. She also suffers from exha ustion. She can only walk about half a block because of pain

in her foot and ankle and cannot stand for very long. She testified that she can sometimes drive an hour and a half from her home to Des Moines for doctors' appointments, but that sh e has to stop and rest on the way. She usually stays overnight in Des Moines because she is unabl e to drive both ways in one day. She stated she can rarel y sleep through the night because of pain. She has had to hire housecleaning help and is unable

to do any gardening. Her adult children help her with the shopping. She is unable to handle the stress of having her grandchildren a round. Several times a month she suffers from stomach sick ness and vomiting as a result of an esophageal ulcer. She also suf fers from a hiatal hernia that causes heartburn and loss of sleep. She testifie d that she has chest pain about six times a month. She also testified that she would b e unable to sit for an hour without a break, an d that even with a break, it would be painful for her to do so.

The medical evidence shows that Kelley has been treated for many years by five physicians: Dr. Dale J. Andringa, a general practitioner; Dr. M.G. Parks, a genera l pract itioner; Dr. Theodore W. Rooney, a rheumatologist; Dr. Joel A. From, a cardiologist; and Dr. Bernard I. Leman, a gastroenterologist. Kelley first sought medical treatment for lupus in 1981. Her sympt oms then included darkening of the palms of her hands, pleurisy-like chest pains, joint aches, and r ashes. At that time she had a positive 3 ANA test, and was treated for arth ralgia and left-sided pleuritic chest pain. She either 4 5 contacted or was examined by Drs. Andringa and Parks, for variousMyalgia is pain in a muscle or muscles. Dorland's at 1085. 6
-4- compla ints, including myalgia and back pain, over one hundred additional time s 6 between 1980 and 1992. Dr. Parks stated in 1993 that Kelley's "physical capacity i s limited," and suggested environmental limitations, particularly avoidance of cold or damp conditions. He stated she was "unable to stand or walk for long periods of time due to the legs hurting." He also found that "[w]hen she attempts t o sit, she has significant pain in her back and [is] unable to sit due to the pain." He further found her unable to stoop, crawl, or kneel due to pain in her lower extremity joints and found that she had difficulty in handling objects because of significant joint pain in her hands.
Kelley v isited Dr. Rooney numerous times beginning in 1987. At that time h e repor ted a "longstanding history of upper and low back pain" and a "history of SL E (sys temic lupus erythematosus) without evidence of significant target orga n involvement." He noted that the SLE had been ina ctive for six years. His findings were "suggestive with the periarticular trigger points of fibromyalgia and soft ti ssue myofascial strain." In 1990, he wrote tha t Kelley could not "walk 200 feet without assistance" and that this was a permanent condition. In 1992, he again noted fibromyalgia, wit h radicular right leg pain. In 1993, he wro te that, due to multiple tender points, Kelley "is going to be somewhat limited in her ability to perform certain activities." An MRI o f Kelle y's back showed mild degeneration of the L5 and S1 discs, probable mil d arthropathy, and noncompressive central p rotrusion. Dr. Rooney completed a disability checklist and indicated that Kelley would not be able to work more than a four-hour day.
Dr. From, a cardiologist, wrote in 1993 that it would be difficult for Kelley "to do standing, walking, sitting, stooping, climbing, kneeling, and crawling due t o her leg brace and be coming fatigued attempting to do these different positions." He further stated , "[d]ue to her continual angina symptoms, it would not be advisable for her to-5-

be in very cold or very warm temperatures or ex posed to dust, fumes, or other hazards." Dr. From advised Kelley to stop smoking.
Kelley's records were reviewed by several consulta tive physicians, none of whom examined Kelley. Those doctors questi oned Kelley's SLE diagnosis and concluded that she was not disabled.
A vocational expert

also testified at the hearing. He was asked in a hypothetical questi on to assume a worker had possible lupus erythematosus, fibromyalgia, ches t discomfort and a braced le ft foot. He was also asked to assume she could occasionally lift twenty pounds, frequently lift ten pounds, could stand for one hour and sit for two hours, cou ld walk one hour, could occasionally climb, bend, stoop, squat, twist, kneel, and crawl, but that she could not use left foot contro ls or be exposed to extremes of heat

or col d. He testified this person could perform the duties of a telephone repai r dispatcher. In

a second hypothetical, he was asked whether a person with a ten-pound weight limitation and a half-hour limitation on sitting could perform the functions of a dispatch er

and he answered "no." Similarly, he stated that a person with a four-hou r workday limitation could not perform the dispatcher functions.
After the hearing, the ALJ found that Kelle y was not under a disability as defined in the Social Security Act and denied her application. The ALJ discounted Kelley' s complaints of pain and fatigue as inconsistent with objective findings. She found Kelley

was n ot credible, noting "[i]t is anyone's guess whether [Kelley's] absences wer e medically necessary or just job 'burnout.' Lack of motivation does not qualify one for disability. There is no supp ort that this claimant's absences were medically necessary." She concl uded, "[t]he undersigned can only conclude that Ms. Kelley failed to go t o work whenever she did not 'feel' like it" and "[ w]hether or not the absenteeism is related to her illness or a lackadaisical na ture has not been established." She found the opinion of Dr. Rooney, Kelley's treating rheu matologist, was not persuasive, in part because he had not hospitalized Kelley. The ALJ also put great weight on Kelley's-6-

failure to quit smoking, although d octors had advised her to do so. The ALJ thus found that Ke lley's impairments would not prevent her from returning to her past work as a dispatcher. The Appeals Council affirmed the decision, as did the district court.

II. DISCUSSION

We wi ll affirm the ALJ's findings if supported by substantial evidence on th e record as a whole. See Matthews v. Bowen , 879 F.2d 422, 423-24 (8th Cir. 1989)

. Substantial evidence is less than a preponderance, but enough that a reasonable min d might accept as adequate to support a decisio n. See Lawrence v. Chater , 107 F.3d 674, 676 (8th Cir. 1997). The review we undertake is more than an examina tion of the record for the existence

of substantial evidence in support of the Commissioner's decision, we also take into account whatever in the record fairly detracts from t he decision. See Cline v. Sullivan , 939 F.2d 560, 564 (8th Cir. 1991).
To receive disability benefits, Kelley must es tablish a physical impairment lasting at least one year that prevents her from engaging in any gainful activity. See Ingram v. Chater , 107 F.3d 598, 600 (8th Cir. 1997). The Commissioner utilizes the familiar fivestep sequential evaluation to determine disability under which he det ermines: 1) whether the c laimant is presently engaged in a "substantial gainful activity;" 2) whether th e claimant has a severe impairment--one tha t significantly limits the claimant's physical or menta l ability to perform basic work activities; 3) whether the claimant has a n impairm ent

that meets or equals a presumptively disabling impairment listed in th e regu lations (if so, the claimant is disabled without regard to age, education, and work experience); 4) whether t

he claimant has the residual functional capacity to perform his

or her past r elevant work; and 5) if the claimant cannot perform the past work, th e burden shift s to the Commissioner to prove that there are other jobs in the nationa l economy that the claimant can perform. See id.-7-

The ALJ found that Kelley suffered from severe impairments including a history of lupus, fibromyalgia, chest discomfort, and a need to wear a brace on her left foot, but that she did not have an impairment that met the presumptively disabling listings. She found "the testimony of the claimant, her son and daughter could not be afforded ful l credibility due to numerous inconsistencies in the record as a whole." She thus found Kelley retained the residual functional capacity to perfor m work-related activities except for work involving lifting more than twenty pounds occasionally or ten pound s repea tedly. She found Kelley could stand for one hour and sit for one hour with th e usual breaks and that she should be able to move if needed. She als o found Kelley could occasionally cli mb, bend and stoop. The ALJ limited Kelley's exposure to extremes of heat or cold. With those restrictions, the ALJ found that Kelley could return to he r former work, n oting that her past relevant work did not require the performance of any activities precluded by the limitations.
In arriving at that conclusion, the ALJ discredited Kelley's testi mony regarding the extent of her pain. Wh en assessing the credibility of a claimant's subjective allegations of pain, th e ALJ must consider the claimant's prior work history; daily activities ; duration, frequency, and intensity of pain; dosage, effectiveness and side effects o f medicati on; precipitating and aggravating factors; and functional restrictions. Se e Polask i v. Heckler , 739 F.2d 1320, 1322 (8th Cir. 1984). When an ALJ rejects a claimant's complaints of pa in, he or she must make an express credibility determination d e tailing reasons for discrediting the testimony, must set forth the inconsistencies, and must discuss the Pola ski factors. See Cline , 939 F.2d at 565. In this case, the ALJ did not a dequately detail the inconsistencies that she relied upon to disbelieve Kelley' s testimony.

The ALJ first stated that Kelley had not provided documentation for her man y absences and speculated that she "failed to go to work whenever she did not 'feel' like it." Ke lley was not required to document her absences. She testified that she misse d work because she was sick and there is nothing in the record to suggest that this was-8-

not the case. Her employer conceded that her absences were legitimate. The record is replete with evidence of her many illnesses and doctor visits.

The ALJ also discredited Kelle y's complaints of pain because she had continued working for several ye ars in spite of her limitations. Kelley testified that she continued working for as long as she could in an effort to be eligible for her pension. Th e presumpt ion that a claimant is not disabled merely because the claimant had a lenien t employer, a high tolerance for pain, or no other means of support wou ld unfairly shift the burd en of proof back onto the claimant at a point in the proceedings when the burde n rightfully belongs on the Commissioner. See C line , 939 F.2d at 566. The record shows that Kelley's continued emp loyment was only through the good graces of her employer. The accom modations that the employer offered Kelley serve to corroborate he r testimony regardi ng her pain and fatigue. Her largely passive work responsibilities are not inconsistent with her testimony regarding her pain and with the medi cal evidence that describes a degenerative condition.

We find that Kelley's daily activities are also consistent with her complaints o f disabling p ain. Uncontroverted evidence shows that Kelley is unable to perform many of the daily activities she once enjoyed. She testified that although she is able to take

care of her daily needs, she needs help with housework and shopping. This court has repeatedly stated that a person's abi lity to engage in personal activities such as cooking, cleaning, and hobbies does not constitute substantial evidence that he or she has th e functi onal capacity to engage in substantial gainful activity. See Hogg v. Shalala , 4 5 F.3d 276, 278 (8th Cir. 1995).
Although a claimant's allegations of disabling pain may also be discredited b y eviden ce that the claimant has received minimum medical treatment and/or has take n only occasional pain medications, such is no t the case with Kelley. See Cline , 939 F.2d at 568. Again, the record shows numerous visits to doctors. She testified that sheThese include Premarin, Zocor, Tagamet, Lozol, Dilacor, Amitriptyline , 7 Metoclopramide, Ketoprofen, and Nitrostat.
-9- takes many prescription medications. She has availed herself of many pain treatment 7 modalities, including a TENS unit, physical therapy, trigger point injections of cortisone, chiropractic treatments, and nerve blocks. In addition, s he has had several surgeries and many diagnostic te sts, including X-rays, CT scans, DNA tests, MRIs, and blood work.

In a ddition to discrediting Kelley's complaints, the ALJ also disregarded th e opinions of Kelley's treating physicians and in stead credited the opinions of consultative physic ians who had not examined Kelley. A treating physician's opinion is generall y entitled to substantial weight, although it is not conclusive and must be supported b y medically acceptab le clinical or diagnostic data. See Pena v. Chater , 76 F.3d 906, 908 (8th Cir. 1996). The Commissioner is encouraged to give more weight to the opinio n of a spec ialist about medical issues related to his or her area of specialty than to th e opinion of a source who i s not a specialist. See Metz v. Shalala , 49 F.3d 374, 377 (8th Cir. 1995). The opinion of a consult ing physician who examines a claimant once or not at all does not ge nerally constitute substantial evidence. See id. at 378. Here, Kelley's treating physicians' diagnoses are amply supported by clinical data. Kelley's principal diagnosis a t present is fibromyalgia and that diagnosis is clinically supported by th e trigger point injections. Fibromyalgia, which is pain in the fibrous connective tissu e components of mus cles, tendons, ligaments, and other white connective tissues, can be disa bling. See Cline , 939 F.2d at 567. It often leads to a distinct sleep derangemen t

w h ich often contributes to a general cycle of daytime fatigue and pain. See id. at 563.

The ALJ also rejected Kelley's treating ph ysician's four-hour day restriction. The assumpt ion that physicians cannot opine as to the hours a claimant can work is wrong. See Smallwood v. Chater , 65 F.3d 87, 89 (8th Cir. 1995). Physicians regularly make-10-

such assessments. See id. In fact, medical opinions on how much work a claimant can do are not only allowed, but encouraged. See id. A vocational expert must then tak e into account medical limitations, including opinions on work time limits, and offer a n opi nion on the ultimate question whether a claimant is capable of gainful employment. See id. The opinio n of a treating specialist controls if it is well supported by medically

acce ptable diagnostic techniques and is not inconsistent with the other substantia l evidenc e. See id. As noted above, Dr. Rooney's recommendation is supported b y medically acceptable diagnostic techniques and is not inconsistent wi th the other medical testimony or Kelley's testimony.

The A LJ also emphasized Kelley's failure to quit smoking as a reason to den y benefits. Impairments that are controllable or amenable to treatment do not support a finding of disability, and failure to foll ow a prescribed course of treatment without good

reason can be a ground for denying an application for benefits. See Kisling v. Chater , 105 F.3d 1255, 1257 (8th Cir. 1997). Although Kelley's cardiologist advised her to quit smoking , he did not state that her smoking was the cause of her problems or that he r complaints would be relieved by quitting smoking. Although she would undoubtedl y improve her general health and well-being by doing so, there is no evidence that he r musculoskeletal complaints would be affected. Under the circumstanc es of this case, we are reluctant to deny benefits solely because of Kelley's failure to quit smoking.

III. CONCLUSION

Th e ALJ improperly evaluated Kelley's subjective complaints of pain and failed to give pr oper weight to the opinions of her treating physicians. Accordingly, w e reverse the judgment. However, because the ALJ concluded that Kelley could return to her prior work, no proper record was developed regarding whether the Commissioner

can me et his burden of showing that there are other jobs in the national economy tha t Kelley can perform. Accordingly, the judgment is reversed and this case-11-

is remanded t o the district court with directions to remand it to the Commissioner fo r further proceedings consistent with this opinion.

A true copy.

ATTEST:

CLERK, U.S. COURT OF APPEALS, EIGHTH CIRCUIT