Th e Ho no ra ble Th oma s A. Wise man, Jr., Se nio r Un ite d Stat e s Dist ri c t J ud g e fo r t

he Mid dle * District of Tenne ssee, sitting by desig nation. NO T R EC OM M EN DE D F OR F UL L- TEX T P UB LIC AT ION F ile Nam e: 11a0018n.06 No. 09-2076 UN ITED STA TES C OU RT OF AP P EA LS F OR THE SI XT H C IR CU IT TERRI L . KAL MBACH, Pla int if f- Ap pe lla nt,
v. COMMI SSI ONER OF SOCI AL SECURI TY, Def endant- Appellee
. ) ) ) ) ) ) ) ) ) ) ON APPEALFROM THE U NI TED STATES DI STRI CT COURT FOR THE EASTERN DI STRI CT OF MI CHI GAN

Be fore : BOG GS and CL AY, Circuit J udg es; and WI SEMAN, District J udg e. * WI SEMAN , Di s t ri ct J u d ge. P l ai n t i ff -A p p el l an tT erri Ka l mb ac h ap p ea l s a district cour t order aff irming a n administrative law judg e’s de nial of Ka lmbach’s a pplication for Disa

bility I nsuranc e B e ne fi ts ( DI B ). Ka lmb a c h p re se nts tw o is su e s f or re vie w: (1 ) wh e the r the Com mis sio ne r p ro pe rl y evaluated t he medical evidenc e in the record, and (2) whether the Commi ssioner prope rly evaluated Kalmbac h’s s ubjective complaints. Be cause we f ind that the AL J failed to provide g ood rea sons for reje cting the opi nions of Kalmbach’s treating phy sicians, that his rejec tion of Kalmbac h’s subjective complaints is not supported by substantial evidence , and further that proof of disability is strong a

nd the re e ff e c tiv e ly is n o o pp os inge vid e nc e , w e re ve rs e and re mand fo r a n a wa rd of be ne fi ts. I. P ROCEDURAL BACK GR OUNDNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-2- Ka lmb a c h a

pp lie d f or DI B on July 26 , 2 00 5, a lle g ing that sh e ha d be c ome dis a ble d o n Apr il 27, 2005, by fibromy alg ia, arthritis, and ca rpal tunnel sy

ndrome. He r cla im was denied initially . She reque sted a he aringbefor e an a dminist rative la w judg e (A L J ), which w as conduc ted on Novembe r 8, 2007. Kalmbac h, who was r epre sented by an attorne y , appea

red a nd testified at the he aring . A vocational e x pert a lso testified. On Fe bruar y 7, 2008, the ALJ , Bennett S. Enge lman, issued a de c isi on fi nd ingtha

t K a lmb a c h wa s no t dis a

ble d. Th e Ap pe a ls C ounc il d e nie d K a lmb a c h’ s r e qu e st for r eview on June 11, 2008, rende ring the AL J ’s dec ision the final decision of the Commiss ioner. Kalmbac h soug ht reviewof the Commissioner’s dec ision in t he United States District Court for the Easter n District of Mi chig an. After briefing by the parties, the mag istrate judg e re commended that judgme nt be enter ed in favor of the C ommissi oner. Over Ka lmbach’s objec tions, the district court adopted the ma g istrate judg e’s r eport a nd rec ommendation and af firmed the Commissioner’s fina l decision, finding that the AL J had applied the correc t leg al standar ds and his decision wa s supported by substantial evidence in the rec ord. This appe al followed. II. THE ADMINISTRATIVE RE CORD A. The Medical Evidence Upon re fer

ral fr om Kalmb ach’ s long- time family phy sician, Dr. Richa

rd B eison, Dr. Vladimir Og nenovski, a spec ialist i n rh eumatolog y , beg an tre ating Kalmbac h in May 2001 for complaints of prog ressive fatig ue and joint pain. (AR 297.) At the t ime she wa s forty -three y ear s old , h a d r e c e ntl y

be e n d ia g no se d w ithno n- ins uli n- de pe nd e nt d ia be te s me lli tu s, was “ mod e rate lyNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

By Aug ust 2001, she was descr ibed in the Sleep Disorde rs Clinic notes as morbidly obese. 1 (AR 304.) -3- ov e rw e ig ht, ” and

wa s a lso be ing

tr e a te d f or hy po thy ro idi sm. On he r fi rs t vis it wi th Dr . O g ne no vs ki, 1 Kalmbac h descr ibed a one -y ear history of prog ressive f

atig ue, with d i s t urbed slee p and excessive day -time somnolence, a s well as a ten-y ear history of progr essive pain aff ecting all of her

joints, and morning stiffness. He r m ajor complaint was fatigue ; althoug h she worked full -time, she indicate d she wa s inc a

p a b le o f d o in g mu c h a f

te r w o r k
. ( A R 2 9 7
. ) D r . O g n e n o v s k i’ s im p r e s s io n was fibromy alg ia, and he also ref err ed her to a sleep clinic for evaluation a nd treatment of possible sleep apnea . He pr escr ibed a tria l of non-steroida l medication on an a s-nee ded basis and r ecommende d
an exerc ise prog ram. (A R 298–99.) I n Aug ust 2001, Dr. Og nenovski observe d that Kalmbac h’s medica l history was notable for hy perte nsion, diabetes, asthma, hy pothy roidism, TMJ , car

pal tunnel sy

ndrome, g astroesopha g eal
re fl ux, a nd ob e sity , a s w e ll a s su sp e c te d s le e p a pn e a . Ka lmb a c h re po rt e d that sh e wa s e ng a g ingin ph y sic a l th e ra

py and wate r a e ro bic s a

nd wa s f e e lin g “ le ss s tif

f a nd mo re mob ile ” and , d e sp ite continued ar

thralg ia and m y al gi a p ain, was “more f unctional and c omfortable.” (AR 307.) She continued to w ork full time, but occa sionally took da y s off when she was more sy mptomatic. She ha d ful l rang e of mot ion and str e ng th, bu t a “f oc us e d muc ulo sk e le ta l exam ” re ve a le d “ mul tip le so ft

tis su e te nd e r p oin ts, ” a

tot a l of 18 ou t of 18 . D r. Og ne no vs ki’ s a sse ssm e nt w a s “ fi br omya lg ia wi th ong oing a rthralg ia at base line” and probable sleep apnea. (AR 307.) He re commended c ontinuedNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-4- use of muscle rela x ants and non-ste roidal anti-inflammatory medications (NSAI Ds) ( i.e. , Celebre x and Vioxx ) as ne eded, a s well as ca rdiovascula

r exercise
. Over the next seve ral y ear s, Kalmbac h saw Dr. Og nenovski two or more times per y ear for fo llo w- up tr e a tme nt of he r fi br omya lg ia
. I n Oc tob e r 20 01 , Dr
. Og ne no vs ki dis c us sed wi th Kalmbac h the pos sibili ty of reducing her hour s at work “ as a w ay of copingwith her [fibromy alg ia] sy mpt oms and

fa tigue .” (A R 30 9. ) I

n F e br ua ry 20 02 he no ted t

hat sh e ha d b e e n d ia g no se d w ith sle e p a pn e a , h a d b e g un

us inga Con tinuo us Pos iti ve Ai rw ay Pr e ssu re (C PAP ) m a c hin e , a

nd , a s a result, she wa s sleeping somewhat be tter and f eelingless fatig ued. He also n o t ed t h at s h e wa s workingreduc ed hours, a nd that her f

ibromy alg ia sy

mptoms were much improve d as a r esult of be tte r s le e p a

nd le ss wo rk , tho ug h sh e “ of c ours e ” c on tin

ue d to take NSA I Ds and

mus c le re la xan ts. I n J uly 2002, she was still working reduc ed hours, was sleeping better, and her ener g y level
r e ma in e d “ s ta b le
. ” S h e w a s “ l e s s s y

mp to mati c , ” b u t D r . O g n e n o v s k i r e c o mm e n d e d in c r e a s e d V io xx
and Ul tr a m f or thr e e to fi ve day s at thos e tim e s w he n s he wa s su ff e ri ngfl are -u

ps of mor e int e ns e pain. (AR 314.) In May

2003, Dr. Og nenovski noted Kalmbac h did “not fee l too bad,” but that her
ener g y level fluc tuated and she continued to have arthra lgia and st iffness in the morning , as we ll as
occa sional day -time arthr alg ias and “ occa sionally fee ling in a fog ,” which a ffe cted he r per formanc e. He a lso noted she tended to be “more sy mptomatic in the winter mo n t h s .” (A R 320.) She was
c on c e rn e d a t that ti me a

bo ut t he po ssi bil ity

of los inghe r j ob . D r. Og ne no vs ki b e lie ve d th a t, “ ov e ra ll, she would ben ef

it by rema ining f

unctional,” a

nd encour ag ed her

to continue workingif possible.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-5- (AR 320.) In Septem b er 2004, he noted that he r fibromy alg ia was at “base line” and that she “re main[ed] fairly

functional” and continued to wor k part-time. ( AR 388.) I n J une 2005, Dr . Og nenovski noted Ka lmbach had lost her job, had not been a

ble to find
new e mploy

ment, and wa s “looking into the possibility of pursuing medical disability .” (A R 331.) She complained of

new lef t- k n ee p ai n. Her

fibroy my alg ia was “ unchang ed,” w ith ongoing g ener alized arthra lgia

and my alg ia, morning stiffness, and fatig ue. (A R 331–32.) I n October 2005, Dr . O g ne no vs ki n ote d th a t in a dd iti on to f ibr omya lg ia

Ka lmb a c h h a d o ste oa

rt hr iti s in bo th k ne e s,
mor bid ob e sity and sle e p a pn e a . K a lmb a c h c on tin

ue d to re po rt

g e ne ra lize d pa in and

fatigue , a s w e ll
as m orning stiffness. Dr. Ogne novski’s impression was “[f]ibromy alg ia with ong oing sy mptoms.” He noted: “I rea listi cally did not expect a signific ant chang e in he r sy mptoms given the numbe r of comorbid conditions that could contribute to the sy mptoms of fibrom y al gi a,” in pa rticular, he r obesity . He noted on that day that she had r equeste d a for mal statemen t fr o m him reg ardingher disability , and he believed that, at t hat poi nt, she wa s “totally disabled fr om any

ty pe of w ork.” ( AR 211.) Kalmbac h’s condition was ba sically unchang ed throug h 2006 and 2007, except she w as dia g no se d w ithos te oa

rt hr iti s in he r l e ft kn ee and tend e rn e ss o ve r t he late ra l e pic on dr

y le s o f b oth
e lbo ws a s w e ll a s b ur sit is i n h e r h ips . Sh e c on tin ue d to have so ft -t iss ue te nd e rn e ss t hr ou g ho ut,
c on sis te nt wi th fi br omya lg ia
. Dr
. Og ne no vs ki c on tin ue d to pr e sc ri be NSA I Ds and mus c le re la xan ts. Dr. Ogn en o v s k i filled out a “Me dical Statement” f orm in Dec ember

2005 in which he indicated that, be g inning in Apr il 2005, Kalmbach wa s limi ted in her a bility to work as a

result ofNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-6- pain and fatig ue as well as difficulty conce ntrating as a result of fibromy alg ia and sleep a pnea. ( AR 154.) Dr. Og nenovski com p l et ed an “I mpairment Que stionnaire” r elated to Ka lmbach’s fibromy alg ia in Marc h 2006 and ag ain in October 2007. On both dates he noted that he had tre ated plaintiff for f

ibromy alg ia two to three times a y ear since May 2 0 01; that she met the Amer ican Rheumatolog ical cr iteria for fibromy alg ia; and tha t h er p rog nosis was “fa ir.” (A R 235, 97.) He de sc ri be d th e c lin ic a l f

ind ing s r e late d to fib ro my a lg ia a s “ [g ]en e ra lize d s of t- tis su e pa in, e sp e c ia lly hips, knees and shoulde rs,” besides “morbid obesity and deconditioning.” (AR 235, 97.) He listed Kalmbac h’s sy

mptoms as including fatigue , joint and muscle pain, day time somnolence, g e n e r alized
weakness, stiffness, a

nd difficulty

conce ntrating . (AR 236, 98.) He descr ibed the fr equenc y of the pa in a s “ da ily

& c on sta

nt ” wi th a

se ve ri ty le ve l of 7– 8, and a ve rr e d th a t th e patie nt w a s n ot a malinge rer . (AR 237, 99.) He assessed he r as c apable of sitting one t o t wo h o u rs p er day , and standing or wa lking up to one hour a day
. He indicated Kalmbac h should not sit continuously in a
wo rk se tti ng , a nd that sh e ne e de d to mov e aro un d f or te n to fi ft e e n min

ute s e ve ry tw o ho ur s. He a lso indicated she would need to r est two to four hours daily , that she would have “g ood and bad da y s,” and that she w as likely

t o b e ab s en t from wor

k more than thre e day s a month as a r esult of her impairments. He e stimated she could lift and c arr y up to ten pounds occa sionally . Dr. Og nenovski al s o i ndicated that Kalmbach w as inca pable of workingeven a

“low stress” job as a re sult of her difficulties conc entrating a nd difficulties with computati on. (AR 238–39, 100–11.) Unde r “additional comments,” Dr. Og nenovski noted t h at Kalmbach was “ totally incapa citated in herNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-7- a bil ity to p e rf or m at he r us ua l jo b d

ue to c on sta

nt p a in, fatigue & dif

fi c ult y c on c e ntr a tin g ” ; he a lso noted that “the e arliest date ” to which his de scription of her sy mptoms and lim itations applied was 2000. (AR 240, 102.) Plaintiff’s primary

car e phy sician, Dr. Robe rt Be ison, filled out a “Multiple I mp ai rment Questionnaire ” in Octobe r 2007, in which he list e d K a lm b a c h ’ s diag noses as includingfibromy alg ia, GERD, diabete s, asthma, rig ht hip piriforma sy ndrome, a nd bilatera l car

pal tunnel sy

ndrome. He identified the c linical finding s associate d with these conditi o n s as i n cluding extremity pain and numbness, difficulty

walking , loss of manual dexterity , occa sional diz ziness and loss of balance , difficulty thinking/conc entrating, a nd fatig ue, amongothers. (A R 111.) Dr. B eison assesse d Kalmbac h as havingconstant, daily “c omplete body ” pain, r ating an “8” in severity on a 10-point
sc a le , a nd fatigue a t le ve l 6 o n a

10 -p oin t sc a le . H e ind ic a te d s tr e ss a nd anxie ty e xac e rb a te d p a in and fatigue , and that her

sy mptoms wer e li kely to incre ase if she was plac ed in a c ompetitive work environment. He opined that she wa s not capa ble of wor

king a full-time co m p et i t i v e j ob that require d activity

on a sustained ba sis, or of workinga low-stres s job. L ike Dr. O g nenovski, Dr. Be ison indicated Ka lmbach wa s not a maling ere r. (AR 113–16.) H e also indicated she would ne ed to take daily

rest bre aks of one to two hours, that she would have “g ood day s” and “ bad day s,” but
w o u l d l i k e l y b e r e qu i r e d

t o b e a b s e n tf r o m w o r k a s a r e s u l to f h e r s ymp t o m s m o r e t h an t h r e e d ays a month. (AR 117.) Finally , Dr. Beison not ed that he agr eed with Dr. Og nenovski that Kalmbac h
was una ble to perf

orm any ty pe of w ork due pri m ar i ly to her fibr omy g alg ia, osteoar thritis, sl eep apnea , morbid obesity

and ca rpal tunnel sy

ndrome.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-8- B. The He ar ing be for e th e AL J At the hea

ring conducte d on November 8, 2007, Kalmbac h testified that she wa s forty -nine y e ars old , h a d g ra du a te d f ro m hi g h s c ho ol a

nd ha d c omp le te d s e ve ra l c ours e s at a c omm un ity colleg e. She had not wor

ked since her stated disability date of April 27, 2005. Prior to that date, she had wor ked for eleve n y ear s doing c lerica l and administrative wor k for the sa

me employ er, until the company was sold a n d she beg an wor king f or the succ essor c ompany . Duringthe last y ear she worke d, she primar ily

was a nsweringt h e p h one. She stated she stopped workingin April 2005 be c a us e the ne w ow ne rs mov e d the of fi c e to a loc a tio n fu

rt he r awa y fr om he r ho me , a

nd sh e c ou ld not drive that fa

r bec ause of

her c arpa l tunnel sy

ndrome, by

which she w as limited to thi rty miles per day . She was initially

awa rded une mploy

ment benef

its but t hen had to r epa y it six months later beca use it was dete rmined that her doctor said she was unable to work full-tim e, so unemploy ment benef its should not have be en appr oved. She also testified that during the last couple of y ear s she worke d, she did not work a full eig ht-hour day . She was pa id around $20,000 pe r y ear throug h 2001, and her ear

nings decre ased after that as her hours dec rea sed. She stated that he r hours de cre ased a s “the fibromy alg ia s tarted coming in and I started ge tting worse and worse.” (AR 448.) In 2004, she made $10,799. In 2005, she made $4,500. She testified that her employ er was ver

y lenient and that she wa s not require d to w ork ver y hard at her job, par

ticularly during the last couple of

y ear s. I n her
wr itt e n mate ri a ls, Ka lmb a c h n ote d th a t du ri ngthe la st f

our ye ars a t wor

k, sh e c a lle d in si c k thre e to four da y s per month and wa s fre quently late bec ause of

her f ibromy alg ia sy

mptoms. (AR 73.)No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-9- Kalmbac h testified t

h a t t h e s y mp to ms that preve nted her from wor king w ere pain and f

atig ue,
and sh e de sc ri be d th e pa in a s “ a ll ov e r” bu t pr ima ri ly in he r arm s and ba c k, and to a le sse r e xten t in her le g s. (AR 442.) She rated the pain as gene rally betwee n five and eig ht on a ten-point sca le. She
n o t e d t h a tt h e C P A P m a c h i n e h a d h e l p e d w i t h h e r s l e e p b u ts h e s t i l l f

e l tf a t i g u e d f o r m o s to f t h e d ay. As for he r o the r m e dic a l c on dit ion s, sh e ind ic a te d h e r d ia be te s w a s b a sic a lly

un de r c on tr ol w ith
m ed i ca t i o nan d

t h at b ra ce s h ad h el p ed wi t h h er ca rp al tu n n el s y

n dro m e w h ens h e w as s t i l l wo rk i n g. She also testified that she had diff iculty conce ntrating and that re petitive motions i ncre ased he r pain. Wit h respe ct to h e r d a il y a c ti v it ie s a s o f th e d a te o f th e h e ar in g , K a lm b a c h s tate d th a t she g e ne ra lly wo ke up aro un d 9 :00 and sp e nt a ha lf -h our s tr e tc hin g in b e d a s th a t ma de it “eas ier to
m o v e . ” ( A R

4 5 1
. ) H e r m o t h e r , w i t h w h o m s h e l i v e s , s o m e t i m e s h a d t o h e l p h e r dr e s s . S o m e d ays she hurt so much that she did not g et dresse d; the se day s occur red two to thr ee times pe r month. She testified that, most d ay s , s h e woul d make he r own bre akfa st and spend the morningrea ding or watchingtelevision. She would occa sionally take he r mother to the g rocery store, g o to the pharma cy to pick up presc riptions, or attend chur ch, but had lea rned s h e co u ld only

do one such
a c tiv ity ou tsi de the ho me pe r d ay . I f s he did mor e tha n th a t, sh e became to o f

a tigue d a nd wo uld

“ hurt fo r t wo or thr e e da

y s af te rw ard s. ” (A R 452. ) She tho ug ht she c ou ld p ro ba bly wa lk t he le ng th of one f ootball field but it would hur t; she could not walk two football fie ld leng ths at one time. She
e sti mate d s he c ou ld s tand fo r tw e nty to thi rt y min ute s a t a tim e , sit fo r an ho ur be fo re sh e ne e de d to g et up and move, a

nd lift up to ten or fifteen p o u nds. She spent most of her da y s in a L azy

Boy
rec lining cha ir with her f

eet e levated pa

rallel to the g round, which took pre ssure off her ba ck.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-10- Kalmbac h testified that she is five f eet two inche s tall and at the ti me of the hearingweig hed 3 5 0 p o u n d s . S h e h adt ri edu n s u cc es s fu l l y t o l o s e w ei gh an d

h add i ff i cu l t y ex er ci s i n g. A vocational expert also testified at the hea ring . She had pre pare d a re port prior to the hear ing in whic h she opined that t h e p l aintiff’s position as offic e mana g er w as skilled sedenta ry work. Af ter hearing Kalmbac h’s t estimony , she concluded that the position was more a kin to that of se c re tary , a

nd th en rec e pti on

c le rk , b oth

of wh ic h w e re se mi- sk ill e d s e de nta ry job s. She a lso testified that a person could be absent for rea sons r elated to a medical impairment a maximum of two day s per month and still maintain a rec eption cler k job as it is ty

pically perf ormed. C. The ALJ’s Decision I n his written decision issued Fe bruar y 7, 2008 the AL J found that Ka lmbach had e stablished that she had “ sever e impairments” inc luding obe sity , asthma, diabetes, and slee p apnea . (AR 16.) Despite the f

act that Kalmbac h’s entire disability application was ba sed upon the sy mptoms arising from fibromy alg ia, he did not find her fibromy alg ia, or the sy

mptoms relat ed to it, to be a sever e impairment. The AL J noted that Kalmbac h had been treated by Dr. Og nenovski on J une 15, 2005 “for fibromy alg ia complaints.” (A R 1 6
. ) T he AL J stated that on that day , Dr. Og nenovski had ob se rv e d th a t a lth ou g h K a lmb a c h w a s morbi dly ov e rw e ig ht a

nd ha d s of t- tis su e te nd e rn e ss i n multipl e ar eas, she was in “n o d i s t ress,” had “f ull mobil ity ,” had no sig nificant objec tive skeletal finding s, and was treated with ove r-the- counter Napr osy n. (AR 17.) The AL J noted that the followup exam in October 2005 wa s basically the same.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-11- Th e AL J re c og nize d th a t bo th D r. B e iso n a nd Dr . O g ne no vs ki h a d c omp le te d f or ms indicating their opinions that the plaintiff was inc apable of workinga full-time job. W i t h respe ct t o t h e M ar c h 2 0 0 6 an d

O c t o b e r 2 0 0 7 qu e s t i o n n a i r e s c o mp l e t e d b y D r . O g n e n o v s k i , t h e A LJ observe d that Dr. Og nenovski opined that Ka lmbach met the Americ an Rheumatolog ical criter ia for fibromy alg ia, and r eporte d that the plaintiff “c laimed constant da ily pain,” a nd that he asse ssed her
as ca pable of sitti ng for up to one to two hours in a day and wa lking f

or less than one hour, and that
s h e w a s i n c a

p a b l e o f p e r f o r m i n ge v e na

l o w - s t r e s s j o b
. Inr e v i e w i n g t h e s e qu e s t i o n n a i r e s , t h e A LJ emphasized Dr. Og

n e n o v s k i’ s f

in d in g s th a

t K a lm bach ha d “ normal ” bioche mical profile, CB C, bone scan, MRI

and x-ray s, and only

minimal dege nerative chang es. (AR 18 (e mphasis in origina l).) The AL J found, purpor

tedly “[a]fter ca

ref ul cons ideration of the entire r ecor d,” that Kalmbac h h a d

th e r e s id u a l f u n c ti o nal ca

pacity to perfor m sedentar

y work involving a sit/stand option and occ asional use of

the hands, a

nd permitting absenc e fr om work up to two day s per month. The AL J found

that th e pla int if

f’ s me dic a lly

de te rm ina

ble imp a ir

me nts c ou ld r e a so na

bly be e xpe c te d to produce her a lleged s y

mptoms, but that her “ statements conc erningthe intensity , persistenc e and lim iti nge ff

e c ts o f t he se sy mpt oms are no t e nti re ly

c redib le .” (A R 21 .) He ba se d h is c re dib ili ty deter mination larg ely

upon the fa ct that Kalmbac h “eng ag e[d] in essentially normal daily and socia l
ac t i v i t i es , ” i nt h at s h e a dm i t t eds h e “ dri v es h er ca r t o ru nerra n d s an d s h o p fo r gro ce ri es an d cl o t h i n g. She s p e n d s ti me w a

tc h ingtelevision, rea ding, ta lking on the te lephone, a nd attending churc h service s and ac tiviti es.” ( AR 21.) He a lso noted she had not required hospitalization or surg ical interve ntion or other a g g ressive tre atments. He c ontinued:No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-12- The medic al re cord c ontains no signific ant complaints of m edication side eff ects or ineffe ctiveness that mig ht rea sonably preve nt [ her] from completing an e ight- hour workda y . There is no indication th at h er diabetes, a sthma, acid re flux and hy pothy roidism a re n o t u n d er g ood control with medication. The use of a CPAP he lps he r s le e p a

pn e a . Sh e ha s f

ull mob ili ty . L a

bo rator y resul ts are e sse nti a lly normal and h er bone scan, MRI , and x-ray s were neg ative with only minimal deg ener ative cha

ng es. Ther e ar e no cu rr en t EEG re sults showing the c laimant has more than mild ca

rpal tunnel. Whil e the undesig ned does not doubt that the c laimant experience s some discomfort, the a lleg ations of a pain level that pr eclude s all ty pes of work a re inc onsistent with the o bjective medic al evidenc e, the a bsence of more a g g re ssi ve tr e a me nt, the c la ima nt’ s o rd ina

ry a c tiv iti e s, and

wi th t he e vid ence as a whole. (AR 21.) Th e AL J als o s tate d th a t he ha d c on sid ered th e me dic a l qu e sti onna ir e s su bmi tte d b y

Dr s. Be ison and Og nenovski indicating that Kalmbac h’s conditi on signific antly reduc ed her ability for substantial g ainful activity , but that he g ave these opinions “ minimal we ight as they ar e n ot sup p o rt ed by

the objective f

indings a nd appea r to be ba sed entire ly

on the claimant’ s subjective complaints. Furthe r, it [presumably , a dete rmination of disabi l i t y ] i s a conc lusion reserve d to the Commi ssioner.” ( AR 22.) III . THE ST AN DA RD OF RE VI EW We r e vie w d istri c t c ourt de c isi on s in

c a se s invo lving Soc ia l Se c ur ity dis a bil ity de te rm inatio ns de novo
. Ealy v. Comm’r of Soc. Sec

. , 594 F.3d 504, 512 (6th Cir. 2010). Under the Social S ecu

ri ty Ac t, h ow e ve r, the AL J we ig hs the e vid e nc e , r e so lve s any c on fl ic ts, and

make s a d e te r mi n a ti o n o f d is a

b il it y . T h e A c t p r o v id e s th a t th e “ f in d in g s o f th e Co mm is s io n er of Social Secur i t y as to any

fac t, if supported by

substantial evidence , shall be conc lusive.” 42 U.S.C. § 405(g ). Our r eview is a ccor dingly limit ed to de termining whether substantial e vidence supports theNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-13- Comm is sioner’s f

indings a nd whether

the Commiss ioner a

pplied the cor

rec t leg al standar ds. Ro ge rs v. Comm’r of Soc . Sec. , 486 F.3d 234, 241 ( 6th Cir. 2007). “Substantial evidenc e is ‘such r eleva nt evidenc e as a

rea sonable mind might a cce pt as ade quate to su p port a c onclusion.’” Lindsl ey v . Comm’r of Soc. Se c. , 5 6 0 F. 3 d 6 0 1 , 6 0 4 (6 t h C i r. 2 0 0 9 ) ( qu o t i n g Richardson v. Pe rales , 4 02 U. S. 389, 401 (1971))
. Substantialit y is ba sed on the re cord taken as a whole. Ho us ton v . S

e c ’y of H e alt h & Hu ma n S

e rv s. , 736 F.2d 365, 366 ( 6th Cir. 1984). I f substantial evidenc e supports the AL J ’s conclusion and the AL J applied the c orre ct leg al sta nd ard s, we are no t at li be rt y to r e ve rs e the AL J’s de c isi on e ve n if su bs tanti a l e vid e nc e e xists in the re cord t h at woul d have suppor ted an opposite c onclusion. Y oughiogheny &Ohio Coal Co. v. W ebb , 49 F.3d 244, 246 (6th Cir. 1995). Conversely , howeve r, we must reve rse a nd rema nd if the AL J applied incorre ct leg al standards, even if the fac tual deter minations a

re othe rwise supporte d by substantial evidence and the outcome on rema nd is unlikely

to be diffe rent. S

ee , e.g. , W

ilson v. Comm’r of Soc. Se c. , 378 F.3d 541, 545–46 ( 6th Cir. 2004) (finding that reve rsal wa s require d even though the Commi ssioner’s de cision was other wise supported by

substantial ev i d en ce , wher e the AL J failed to g ive g ood rea sons f or not g iving weig ht to the opinion of a trea ting phy sician, there by violating the a g ency ’s own re g ulations). IV . AN AL YSI S A. The ALJ’s Evalu ation of the Me dical Evi dence Severe impairments are impairments that signific antly limit a cla imant’s “phy sical or menta l ability to do basic work a ctivities.” 20 C.F. R
. § 4 0 4
. 1 5 20(c) . Although the AL J mentionedNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

F ibr omya lg ia , a lso c a lle d f ibr os iti s, “ is a

me dic a l c on dit ion

mark e d b y ‘chro nic dif

fu se 2 widespre ad aching and stiffness of muscles and soft tissues.’ Stedman’s Medica l Dictionary for the He a lthPr of

e ssi on s and

Nurs inga t 54 1 (5 th e d. 20 05 ). We no te a lso that ours is no t the on ly c ir c uit to r e c og nize the me dic a l di a g no sis of fi br omya lg ia

a s w e ll a s th e di ffi c ult ie s a sso c iate d w iththi s diag nosis and the treatment for this condition.” Rogers v. Comm’r of Soc. Sec

. , 486 F.3d 234, 244 n.3 (6th Cir. 2007) (most internal c itations omi tted).
-14- Kalmbac h’s diag nosis of fibromy alg ia in the cour se of discussing the medica l evidence , he neither identified it as a se vere impairment nor explained why he believed it wa s not one. That over sight is ga ping g iven that Kalmbac h’s disability application is p remised pr imarily upon the pain and fatig ue she e x perie nces a s a re sult of her fibr omy alg ia, and in light of the fa ct that she wa s diag nosed with t h e co n d i tion by

a spec ialist in rheumatology , and both the spec ialist and her pr imary car e ph y sic ian a g re e d th a t K a lmb a c h’ s fi br omya lg ia sy mpt oms are the pr ima

ry c a us e of he r i na bil ity to
e ng a g e in s us ta ine d w or

k a c tiv ity . M or e ov e r, thi s Ci rc uit ha s e xpre ssl y

re c og nize d th a t f

ibr omya lg ia can be a “se vere impairment.” Ro ge rs , 4 86 F .3 d at 24 3; Pr esto n v. Se c ’y of He alt h & Hu ma n S

e rv s. , 2 854 F.2d 815, 820 ( 6th Cir. 1998). I n t h at rega

rd, Dr. O g nenovski, Kalmbac h’s treating r heumatolog ist since May 2001, has
c on sis te ntl y op ine d that Ka lmb a c h ha s be e n un a ble to pe rf

or m su sta ine d w or

k a c tiv ity sin c e Ap ri l 2005 due to her

fibromy alg ia and its attenda nt chronic pa in and fatigue , compl i ca t ed b y other c omorbid fac tors including obe sity and slee p apnea . Dr. B eison, the plaintiff’s pr imary car e phy sician, ag ree d with Dr. Og nenovski’s asses s m en t that Kalmbac h is incapable of per forming any ty pe of substantial ga inful activity as a r esult of the sy

mptoms associated with fibromy alg ia.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-15- I n assessing the medica l evidence supporting a claim for disa

bility benef its, the AL J is bound by the s o-ca lled “tre ating phy sician rule,” which g ener ally require s the AL J to give g reater de fer ence to the opinions of treatingphy sicians than to the opinions of non-tre ating phy sicians. Blakley v. Comm’r of Soc. Se c. , 581 F.3d 399, 406 (6th Cir. 2009)
. The rationale behind the rule is that treating phy sicians
are likely to be the medical profe ssionals most able to provide a de tailed, long itudinal picture of [t he cla imant’s] m edica l impairment(s) and ma y bring a uniqu e p e r s pective t o t h e m ed i ca l ev i d en ce t h at ca n n o tb e o b t ai n edfr o m t h e o b j ec t i v e m ed i ca l fi n d i n gs alone or from repor

ts of individual ex aminations, such as c onsultative examinations or br ie f h os pit a lizatio ns . 20 C.F .R. § 4 04 .1 52 7( d) (2 ). Th e AL J must g ive a tr e a tin g so ur c e op ini on

“ c on tr oll ingwe ig ht” if the treating sourc e o p i nion is “well-supported by medically

acc eptable c linical and labor atory dia g no sti c te c hn iqu e s and is n ot i nc on sis te nt w iththe oth e r s ub sta nti a l e vid e nc e in [the ] ca se
rec ord.” Id. Even if the AL J does not g ive controlling weig ht to a treating phy sician’s opinion, he must sti ll consider ho w m u ch we i gh t t o g ive it; in doing so, the AL J must take into acc ount the leng th of the treatment r elationship, fre quency of examination, the extent o f t h e p hy sician’s know le d g e o f

th e im p a ir me nt( s ) , the amount of re levant evide nce suppor ting the phy sician’s opinion, the extent to which the opinion is consistent with the record as a whole, whether or not the phy sician is a sp e c ia lis t, a

nd any oth e r re le va

nt fa c tor s ten din g to sup po rt or c on tr a dic t the op ini on . 20 C.F .R. § 404.1527(d)( 2)–(6)
. The AL J ’s dec ision as to how much weig ht to accor d a medica l opinion m u st be
acc ompanied by

“g ood rea sons” t hat are “supported by the evidenc e in the ca se re cord, a nd must beNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-16- su ff ic ie ntl y sp e c if ic to m a ke c le ar t o a

ny su bs e qu e nt r e vie we rs the we ig ht t he a djudi cat or ga

ve to the treating source ’s medical opinion a nd the rea sons for that we ight.” Soc. Sec. Rul. 96-2p, 1996 WL 374188, at *5. This proce dural “g ood rea son” rule serve s both to ensure a dequac y of re view and to permit the claimant to under stand the disposition of her ca se. Ro ge rs , 486 F.3d at 242. We w ill re ve rs e and

re man d a d e n i a l o f be ne fi ts, e ve n th ou g h “ su

bs tanti a l e vid e nc e oth e rw ise supports the dec ision of the Commi ssioner,” w hen the AL J fails to g ive g ood rea sons for discounting the opinion of the cla imant’s treating phy sician. W ilson , 378 F.3d at 543–46. A failure to fol low the proc edura l require ment “of iden tify ing the rea sons for discounting the opinions and for explaining pre cisely

how t hose reasons affec ted t he weight accor ded the opinions denotes a lac k of substantial evidence , even wher e the conc lusion of the AL J may be justified base d upon the re cord.” Ro ge rs , 4 8 6 F
. 3 d

a t2 4 3 ; s ee also W

ilson , 378 F.3d at 546 (a re viewing court “ cannot e x cuse the denial of a

mandatory

proce dural prote ction s imply beca use . . . there is sufficient evide nce in the
rec ord of the A L J to disc ount the treating source ’s opinion a nd, thus, a diffe rent outcome on rema nd is unlikely ”). Thus, w hile a “la ck of c ompatibilit y with other r ec o rd ev i dence is ge rmane to the
we ig ht [a c c or de d] a

tr e a tin g ph y sic ian’ s opin ion , an AL J c ann ot simp ly inv ok e the c ri te ri a se t f or th in the reg u lati o n s if

d o in gs o w o u ld

n o t b e ‘ s u f

f ic ie n tl y s p e c if ic ’ to me e t t

h e g o a ls o f

th e ‘ g ood
rea son’ rule.” Friend v. Comm’r of Soc. Sec

. , 375 F. App’ x 543, 551 (6th Cir. 2010). I n this case, the A L J ’s entire rationale for discountingthe opinions of Drs. Og nenovski and Be ison was summed up succinc tly in two sentenc es : “[ T ] h ey are not supported by

the objective finding s and appea

r to be based entirely on the claimant’s subjective complaints. Fur ther , [ t heNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-17- deter mination of disability ] i s a conc lusion reserve d to the Commi ssioner.” ( AR 22.) As a matter of la w , th e s e d o n o t qu a li f

y a s “ g o o d r e a s o n s ” an d th e r e f o r e d o n o t c o mp o rt w it

h th e proce dural require ment embodied in 20 C.F.R. § 404.1527(d)( 2). F irst, the fac t that the ultimate determination of disability , pe r se , is reser ved to the Commissi oner, 20 C.F.R. § 404.1527(e) , did not supply the AL J with a le g iti mate ba si s to di sreg ard the ph y sic ians ’, and

pa rt ic ula rl y Dr . O g ne no vs ki’ s,
as s es s m en to f K al mb ac h ’s ab i l i t i es t o p er fo rm wo rk -r el at ed ac t i v i t i es , i n cl u d i n g s t an d i n g, wa l k i n g, sitti ng , using he r hands, a

nd so forth. Dr. O g nenovski did not opine i n a vac uum that Kalmbach w as disabled. Rather , he opined that she was incapa citated by pain and f atig ue fr om perfor

ming workre la te d a c tiv iti e s o n a

su sta ine d b a sis . M or e ov e r, bo th D r. Og ne no vs ki and Dr . B e iso n a ff ir mativ e ly stated that they

di d n o t believe the ir patient wa s a maling ere r or someone who exag g erated her sy mpt oms . Fur ther, the AL J ’s reje ction of the treating phy sicians’ opinions as unsupported by objective evidenc e in the re cord ob v i o u s l y s t ems from his fundamental misunderstandingof the nature of f ib r o mya lg ia. Cf. Ro ge rs , 4 8 6 F
. 3 d a t 2 4 3 ( o b s e r

v in g th a t t

h e A L J’ s f

a il u r e to r e c o g n iz e fibromy alg ia as a “ sever e impairment” “influenc ed the AL J ’s consider ation of the medic al evidenc e in t he pr e se nt c a se ” ). I n h is d isc us sio n o f Dr
. Og ne no vs ki’ s tr e a tme nt n ote s and me dic a l f ind ing s, the AL J repe atedly

emphasized the i ndications that Kalmbac h reta ined mobility in her joints and had normal blood tests, bone, sca ns and MRI s with only

minima l deg ener ative cha ng es; he ha

rkene d back to the se objective finding s in a sserting that Dr. Og nenovski’s assessment o f t h e p l ai ntiff’s abilities was not supported by the objective medical e vidence . We have r ecog nized on more thanNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-18- one occ asion, howeve r, that fib r o my a lg ia patients g ener ally

“pre sent no objectively

alar ming sig ns.” Ro ge rs , 4 8 6 F. 3 d at 2 4 3 (c i t i n g Pr esto n v . S e c ’y of H e alt h &Hu ma n S

e rv s. , 85 4 F .2 d 8 15 , 8 20 (6 th Cir. 1988) (per

curiam) (noting that objective tests ar e of little rele vance in determining the exist ence
or se ve ri ty of fi br omya lg ia ); Swain v. Comm’r of Soc. Sec

. , 29 7 F
. Sup p. 2d 98 6, 99 0 (N .D. Ohio 2003) (obse rving that “[f]i bromy alg ia i s an ‘e lusive’ and ‘ my sterious' disease” which ca uses “se vere
mus c ulo sk e le ta l pa in” ). Ra the r, fi br omya lg ia patie nts , li ke Ka lmb a c h h e re , ty pi cal ly “ manif e st normal muscle streng th a nd neurolog ical rea ctions and have a full ra ng e of motion.” Preston , 854 F.2d at 820. I n t h e absence of othe r objec tively asce rtainable manifestations, the proc ess of diag nosing f

ibromy alg ia includes (1) the testing of a series of foca l points for tenderne ss and (2) the ruling out of other possible c onditions t hroug h objective medic al and c linical trials. Id. ; Swa in , 297 F. Supp. 2d at 990. Dr. Ogne novski noted on multipl e occasions t hat Kalmbac h tested positive for tender ness at 18 of 18 f

ocal points, and he ruled out the possibili ty of other cause s for Ka lmbach’s sy mptoms. Thus, t he AL J ’s contention that the tre ating phy sicians’ a ssessments and opinions were
un su pp or te d b y oth e r o bje c tiv e me dic a l e vid e nc e wa s si mpl y be sid e the po int
. Nor c an i t b e said that the A L J ’s fa ilure to g ive g ood rea sons—a leg al er ror—wa s in any sense ha rmless, bec ause hi s re

j ec t i on of the tre ating phy sicians’ opinions is not supported by substantial evidenc e in the record either. I n particula r, there are no counter

vailing or contra dictory medical opinions in the rec ord to which the A L J pointed in support of his wholesale reje ction of the treating phy sicians’ opinions. As indicated a b o v e, an AL J must accor d “contr olling we ight” to a treating phy sician’s opinion if t hat opinion is “well-supported by medically

acc eptable c linical andNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-19- laboratory

diag nostic techniques a

nd is not inconsist ent with the other substantial evide nce in [the]
c a se r e c o r d
. ” 2 0 C
. F
. R
. § 4 0 4
. 1 5 2 7 ( d ) ( 2 )
. H e r e , D r . O g n e n o v s k i ’ s d i a g n o s i s o f f i b r omy a lg iais
su pp or te d b y me dic a lly

a c c e pta ble c lin ic a l and

dia g no sti c te c hn iques th a t pe rt a in t o th e dia g no sis for that p articula

r condition, and his opinion reg ardingthe plaintiff’s c apac ity to perform workrelated ac tiviti es as a

result of the sy

mptoms she suffere d in connec tion with her fibromy alg ia is not inconsistent with the other evide nce in the r ecor d. There eff ectively is no other evide n ce i n the
rec ord, besides the plaintiff’s own testimony , discussed in g reater de tail below. I n su m , t h e A L J’ s f

a i l u r e t o g i v e g o o d

r e a s o n s f o r h i s r e j e c t i o no f t h e t r e a t i n g p h y s i c i a ns ’ opinions constitut ed leg al er ror, a ppare ntly stemming fr om his failure to re cognize the plaintiff’s fibromy alg ia as a “se vere impairment.” Cf. Preston , 854 F.2d at 820 (finding reve rsible er ror whe re the AL J failed to c redit the plainti ff ’s t re ating phy sician’s fibr omy alg ia diag nosis based on the absenc e of obje ctive medica l evidence to support it). Finally , the AL J ’s fa ilure to ac cord
c on trol li ng—o r i nd e e d a ny —w e ig ht t o D r. Og ne no vs ki’ s a sse ssm e nt o f K a lmb a c h’ s a bil ity to perf orm work- related activities was err or in light of the fac t that the medical opinion was c onsistent with the overw helming weig ht of t he evidence in this case , and not contra dicted by any other medic al evidenc e in the re cord. The s e e r r o r s a lo n e w ar

r an t r e ma

n d , b u t th e y ar e f

u rth e r c o mp o u n d e d b y th e AL J ’s inadequately

supported asse ssment of Kalmbac h’s cr edibility , as discussed be low. B. The ALJ’s Evalu ation of Kalm bach’s CredibilityNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

Th e AL J state d that “th e c la ima nt’ s med ic a lly de te rm ina

ble imp a ir

me nts c ou ld r e a so na

bly 3 be expected to pr oduce the alleg ed sy mptoms” (AR 21) but, beca use he did not list fibromy alg ia as a seve re impairme nt, it is unclear whether he took that c ondition int o consideration in assessing Ka lmb a c h’ s p a in a lle g a tio ns . -20- The AL J found that Ka lmbach’s state ments reg arding the eff ect of her impairments on her ability to work we re not fully

cre dible. We have r ecog nized that disabili ty claims related to fibromy alg ia ar e re lated to the symptoms
a sso c ia te d w iththe c on dit ion —in c lud ingc omp la int s o f p a in , st if fn e ss, fatigue , a

nd ina bil ity to
conce ntrate—r ather than t he underly ing condition its elf. Ro ge rs , 48 6 F .3 d a t 24 7 (c iti ng 20 C.F .R. § 4 16 .9 29 ); W

y att v . S e c ’y of H e alt h &Hu ma n S

e rv s. , 974 F.2d 680, 686 (6th Cir. 1992) (noting that subjective c omplaints of pain may support a claim for disabili ty). Where the sy mptoms and not the
un de rl yingc on dit ion

fo rm the ba sis of

the dis a bil ity cla im, we e mpl oy

a tw o- pa rt ana ly sis in
e va luatin g c omp la int s o f d isa bli ngpa in. 20 C.F .R. § 4 16 .9 29 (a ); Ro ge rs , 4 86 F .3 d at 24 7; Felisky v. Bowen , 35 F.3d 1027, 1038-39 (6th Cir.1994). First, the AL J should a sk whether the there is an
un de rl yingme dic a lly

de te rm ina

ble ph y sic a l im

pa ir me nt t hat c ou ld r e a so na

bly be e xpe c te d to produce the claimant’ s sy mptoms. 20 C .F.R. § 416.929(a ). Second, if the AL J finds that such an 3 impairment exist s, then he must evaluate the intensity , persistenc e, a n d l i m i t ing e ffe cts of the sy mptoms on t he individual’s ability to do basic work activities. Id. R e l e v an tf a c t o r s f o r t h e A LJ to consider in his eva luation of sy mptoms i nclude the c laimant’s daily activities; the location, duration, fr equenc y , and int ensity of sy mptoms; fac tors that prec ipitate and ag g ravate sy mptoms; the ty pe, dosag e, ef

fec tiveness, and side e ffe cts of any medication take n to alleviate the sy mptoms; otherNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-21- treatment undertake n to relieve sy mptoms; other measures take n to relieve sy mptoms, such as ly ing
on on e ’s ba c k; a

nd any oth e r f a c tor s b e ari ngon

the lim itatio ns of th e claima nt t o p e rf or m ba sic functions. Id. ; se eals o Soc. Sec. Rul. 96-7p, 1996 WL374 1 8 6 , at * 2 -3 (Jul y 2, 1996) (Policy I nterpre tation Ruli ng Titles I I and XVI : E valuation of Sy mptoms in Disability Claims: Assessing the Credibility

of an Individual’s Statements). The AL J , of course, and not the r eviewingcourt, is tasked w ith evaluating the cr edibility of witnesses, including that of the c laimant. W alters v. Comm’r of Soc. Se c. , 1 27 F .3 d 5 25 , 5 31 (6 th Cir . 1 99 7) ; Crum v. Sullivan , 9 21 F .2 d 6 42 , 64 4 (6t h Cir .1 99 0) . H ow e ve r, the AL J is no t f re e to make c redibil ity

deter minations based solely

upon an “intang ible or intuitive notion about an individual’s cre dibilit y .” Soc. Sec. Rul. 96-7p, 1996 WL 374186, at *4. Rather, suc h deter minations
mus t f ind su pp or t in the reco rd. W he ne ve r a

c la ima nt’ s c omp la int s r e g ard ingsy mpt oms , o r t

he ir intensity and per sistence, a

re not supporte d by

objective medic al evide n ce , the AL J must make a deter mination of the credi b i l ity of the c laimant in connec tion with her complaints based on a consideration of the entire c ase r ecor d. The e ntire ca se re cord inc l u d es any medical sig ns and laboratory

finding s, the claimant’s ow n complaints of sy mptoms, any

information provided by

the treating phy sicians and other s, as well as a ny other re levant evi d en ce contained in the r ecor d. Consist ency

of t he var ious pieces of information containe d in the rec ord should be scr utiniz ed. Consist ency

betwee n a claimant’s sy

mptom complaints and the other evide nce in the r ecor d tends t o support the cr edibility

of the c laimant, while inconsistency , althoug h not nece ssarily defe ati n g, sh ou ld h a ve the op po sit e e ff e c t.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-22- Social Security

Ruling 96-7p a lso require s that the AL J e xp la in th e cr edibility

deter minations in his decision with suf

ficient specific ity as “to make c lear to the individual and to any subsequent
re v ie w e r s th e w e ig h t th e a d ju d ic a to r g a v e to th e in d iv id u a l’ s s tate me n ts an d th e r e a s o ns for that weig ht.” I n other words, blanket assertions that the claimant is not believa ble will not pass muster, nor will expl anations as to cre dibilit y which are not c onsistent with the entire rec ord and the weig ht of t he relevant evidence
. And, as the c ourt noted in Ro ge rs, “g iven the natur e of f ibromy alg ia, wher e subjective pa in complaints pl ay an important role in the diag nosis and treatment of the condition, providing justification for discounting a claimant’s statements is pa rticularly important.” 486 F.3d at 2 4 8 (c i t i n g Hu rst

v . S e c ’y of H e alt h &Hu ma n S

e rv s. , 753 F.2d 517, 519 ( 6th Cir. 1985)). I n the pre sent ca se, the AL J ’s consider ation of Ka lmbach’s subjective pain complaints and assessment of he r cr edibi l i ty do not comport with the Administration’s require ments. The AL J ’s discounting of

Kalmbac h’s cre dibilit y was based on (1) the absenc e of obje ctive medica l evidence ; (2) the a bsence of more ag g ressive treatment; a nd (3) the AL J ’s conc lusion that Kalmbach e ng ag ed in “essentially

normal daily

and socia l activities.” (AR 21.) A s discussed above , howeve r, the
a bs e nc e of ob

je c tiv e me dic a l e vid e nc e to su bs tanti a te the dia g no sis of fi br omya lg ia

or its se ve ri ty is b a sic a lly

ir re le va nt, and mor e “ a g g re ssi ve” tr e a tme nt i s n ot r e c omm e nd e d f or fi br omya lg ia patients. I n other wor ds, the first two base s for the A L J ’s discounting Kalmbach ’s cr ed i b i lity are irrele vant. Fur

ther, his conc lusion that Kalmbach e ng ag ed in “e ssentially normal daily

and socia l activities” g rossly

mischara cter izes the available e vidence
.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-23- Kalmbac h indeed testified that she went to the groc ery store, the pharma cy , and chur ch, and that she wa s able to prepa

re her own meals most of the time, and usually able to dre ss herself

without
a ssi sta nc e . Sh e wa s a

ble to d ri ve , b ut h a d to li mi t it to less tha n th ir ty min ute s p e r d ay . T he se minimal activities are ha rdly consistent with eig ht hours’ worth of ty pical wor k activities. Cf. Ro ge rs , 486 F.3d at 248–49 (finding that the plaintiff’s da ily functions, including her a bility to drive,
c le an he r a

pa rtme nt, c are fo r t

wo do g s, do la

un dr y , r e a d, do str e tc hin g e xer c ise s, and watc h th e ne ws , wer e not “c ompara

ble to ty pical wo rk activities” a

nd did not just ify

the AL J ’s discre diting her te sti mony ). Ka lmb a c h a lso te sti fi e d that she su ff e re d fatigue and

pa in b a sic a lly

a ll the tim e , th a t it took very littl e activity to “we ar [ her] out” t o the poi nt wher e she could not function or c oncentr ate,
an d t h a ts h e d i d n o t a t t e mp t t o u n d e rt a k e m o r e t h an o n e a c t i v i t y o u t s i d e t h e h o m e o nan y g i v e nd ay, beca use doing so would cause a fla re- up in her sy

mptoms. (AR 443, 452.) She t est ified that she spent most of her tim e si tting with her leg s propped up, e ither re ading or watching television. The AL J ’s deter

mination that s h e engag ed in essentially normal daily

and socia l activities is not supported by

substantial evidence in the rec ord. Moreove r, Ka lmbach’s testimony was c onsistent with the available medical evidenc e. As
ear ly as Oc tober 2001, Dr . Og nenovski discuss ed wi t h Kalmbach the possibilit y of her working f e w e r h o u r s “ a s a

w ay o f c o p i n g w i t h h e r [ f

i b r o m y a l g i a ] s y

mp t o m s an d

f a t i g u e . ” ( A R

3 0 9
. ) In Fe b ru ar y 2002, he obser

ved that she w as fe eling much better and wa s less fatig ued, in larg e par t beca use she wa s working reduc ed hours, thoug h she “of course ” continued to t ak e analge sics and muscle re laxants. (AR 310.) Over the next seve ral y ear s, her c ondition remained ba sically stable,No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-24- but Dr. Og nenovski noted that she pe riodically experience d flare -u

ps in her pain sy

mptoms requiring her to incr ease her me dications and rest for periods of three to f ive day s befor e she w as stable a g ain. (AR 314.) The se notations substantiate Kalmbac h’s and both he r phy sicians’ a ssessment that she would be re quired to be a bsent from a

ny work she attempted a minimum of three day s in any g iven
mon th. Al tho ug h D r. Og ne no vs ki n ote d in 20 03 tha t it wo uld be be tte r “ ov e ra ll” fo r K a lmb a c h to “re main[] functional,” i.e. , to wo rk if sh e c ou ld, the c on te xt o f his state me nts make s it c le ar h e did
no t me an s he sh ou ld wo rk fu ll tim e . (A R 32 0. ) An d, a lth ou g h Ka lmb a c h c on tin ue d to w or

k unti l Ap ri l 20 05 , h e r t e sti mon ia l e vid e nc e , th e fi na nc ia l e vid e nc e in t

he re c or d, and he r p hy sic ians ’ treatment notes indicate fa irly conclusively that she was not workingfull time for the last fe w y ear s she worked. ( See, e .g. , AR 388 (Dr. Og nenovski’s treatment note for Septembe r 30, 2004, indicating Kalmbac h’s fibromy alg ia was at “base line,” that she “re main[ed] fairly functional” and “c ontinued to work par

t-time”).) No r c an th e fa c t th a t D r. Ka lmb a c h r e c omm e nd ed wei ght loss and e xer c ise be de e me d to detra ct from Ka lm b ac h ’s cr ed i b ility
. Cf. Ro ge rs , 4 86 F .3 d at 24 9 ( “ [T]he fa c t th a t a patie nt i s
encour ag ed to re main active doe s not refle ct t he manner i n which such activities may ag g ravate the patie nt’ s sy

mpt oms . Not a

bly , Rog e rs ’ ow n tre a tin g ph y sic ians a lso re c omm e nd e d th a t sh e re ma in
as ac tive as poss i b l e, y et this did not alter their opinions as to her f unctional limitations and wor k restric tions.”). I ns u m , w h i l e c r e d i b i l i t y d e t e r m i n a t i o n s r e g a

r d i n g s u b j e c t i v e c o mp l a i n t s r e s tw i t h t h e A L J, tho se de te rm inatio ns mus t be re a so na ble and su pp or te d by su bs tanti a l e vid e nc e . Th e de c isi on in t hisNo. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-25- case does not contain spec ific re asons for disc ounting Ka lmbach’s c redibility ; those rea sons that are g iven are not supported by the evidence in the case record. The AL J ’s dec ision to reject Ka lmbach’s subjective complaints and their eff ect on her ability to w ork is not supported by substantial evidence in the rec ord and c onstitut es re versible e rror . V. CO NC LU SION Th e Com mis sio ne r’ s f

a ilure to g ive g oo d re a so ns fo r his re je c tio n of the tr e a tin g ph y sic ians ’ op ini on s c on sti tut e s le g a l e rr or , a nd his ult imate de c isi on

to d e ny Ka lmb a c h’ s c la im f

or be ne fi ts i s not supported by

substantial evidence in the rec ord. When, a s here , the nondisability deter mination is not supported by substantial evidence , we must de cide whether to reve rse a nd rema nd the matter f

or fur ther proc eeding s or to reve rse a nd order benef its gra nted. The c ourt has author ity to a ffirm, modify or re verse the Commiss ioner’s de cision

“ wi th o r wi tho ut re mand ing the c a us e fo r re he a

ri ng .” 42 U. S.C. § 4 05 (g ); Melk onyan v. Sullivan , 501 U.S. 89, 100 (1991). Gene rally , b enef

its may be aw arde d immediately “only if all essential fa ctual issues have been r esolved a

nd the re cord adequately establishes a plaintiff’s entitlement to bene fits.” Fauche r
v . S e c ’y of H e alt h &Hu ma n S

e rv s. , 1 7 F .3 d 1 71 , 1 76 (6 th C ir . 1 99 4) ; see also Abbott v. Sullivan , 90 5 F . 2d 91 8, 92 7 ( 6th

Cir . 1 99 0) ; Va rle

y v . Se c ’y of He alt

h & Hu ma n S

e rv s. , 820 F.2d 777, 782 (6th Cir. 1987). Be nefits m ay be awarde d only wher e the proof of disability is strong, a nd opposing evidenc e is lackingin substance, s o that rema nd would mere ly

involve the pre sentation of
cu mulative evidenc e, or w here the proof of disability is overwhe lming. Fauche r , 1 7 F
. 3 d at 176;No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-26- see also Felisky v. Bowen , 3 5 F .3 d 1 02 7, 10 41 (6 th C ir . 1 99 4) ; Mowery v . Hec kler , 771 F.2d 966, 973 (6th Cir. 1985). Such is the case here. I n view of the plaintiff’s tre ating phy sicians’ opinions and the plaintiff’s own a ssertions of dis ab ling pa in, stiffness, fatig ue, and ina bility to conce ntrate, the re exis ts strong evidenc e that the plaintiff’s c ombined impairments meet or e x cee d a listed impairment under the Social Security regulations. More cr itically , t h er e ef fe ct ively is no opposing evide nce, such that re mand would mere ly involve the pre sentation of cumula t i v e evidenc e, and a denial of benef its on remand would nece ssarily be deemed unsupported by substantial evidence in the rec ord. Cf. Harris v. Heck

ler , 756 F.2d 431, 435 (6th Cir. 1985) (“The medical opinions a nd diag noses of treating phy sicians ar e g ener ally acc orded subs t an tial defe renc e, and if the opinions are uncontra dicted, complete defe renc e.”)
. We the ref ore REVERSE the judgme nt of the district court a nd REMAND with instructions to t he dis tr ic t c ourt

to r e mand

the c a se fo r a

n a wa rd of be ne fi ts.No. 09-2076

Kal mb ac h v . Co mm iss ion e r o f So c ial Se c ur ity

-27- BOGG S, Circuit Judge, concurri n g in p art and diss enting in part . Iag ree with the majority opinion that the Administ rative L aw Judge err ed in rejecting the opi nions of Ka lmbach’s treating phy sicians without adequate re ason, as that opinion explains
. Howeve r, I believe that an
awa rd of be nefits at this time is not warrante d, and thus I dissent from the portion of the opinion that
rema nds for a n awa rd of be nefits, rather than f or re consideration under the prope r standar d. Ibelieve that the evi d en ce is sufficiently mix ed that it would be within the compete nce of the Commiss ioner to dec ide this case e ither wa y under the proper

standard.