Miller v. Colvin (114 F. Supp. 3d 741, 2015)

ORDER

LAWRENCE L. PIERSOL, District Judge.

This Court referred the case to United States Magistrate for the purpose of issuing a Report and Recommendation. The Magistrate Judge has recommended that the Commissioner’s denial -of benefits be reversed and remanded for reconsideration pursuant to 42 U.S.C. § 405(g), sentence four.

A sentence four remand is proper when the district court 'makes a substantive ruling regarding the correctness of the Commissioner’s decision and remands the case in accordance with such ruling. Buckner v. Apfel, 213 F.3d 1006, 1010 (8th Cir.2000). Remand with instructions to award benefits is appropriate “only if the record overwhelmingly supports such a finding.” Buckner at 1011.

Even though no objections have been filed, the Court has carefully conducted a de novo review of the Magistrate Judge’s Report and Recommendation and the record of the administrative proceedings. After having reviewed the-record, the Court agrees with the Magistrate Judge’s Report and Recommendation. Accordingly,

IT IS ORDERED:

1. That the Magistrate Judge’s Report and Recommendation, Doc. 17, is ADOPTED by the Court.

2. That Plaintiffs Motion to Reverse Decision of the Commissioner, Doc. 11, is GRANTED.

3. That the Commissioner’s decision is REVERSED .under sentence four of 42 U.S.C. § 405(g) and the case is REMANDED to the Commissioner for reconsideration pursuant to 42 U.S.C. § 405(g), sentence four.

REPORT AND RECOMMENDATION

VERONICA L. DUFFY, United States Magistrate Judge.

INTRODUCTION

Plaintiff, Cosette L. Miller seeks judicial review of the Commissioner’s final decision denying her. payment of benefits under Title II and Title XVI of the Social Security Act. Ms. Miller has filed a Complaint and has requested the Court to reverse the Commissioner’s final decision denying her disability benefits and to enter an Order awarding benefits. Alternatively, Ms. Miller requests the Court remand the matter to the Social Security Administration for further development with' instructions to (1) properly evaluate the opinions of her medical providers; (2) reassess her residual functional capacity; (3) reassess her testimony and credibility; (4) further develop the record with additional consultative exams, testing and expert vocational evidence as necessary; and (5) issue a new decision based on substantial evidence of the record as a whole and proper legal standards. The matter is fully briefed and has been referred to this Magistrate Judge for a Report and Recommendation. ■ For the reasons more fully explained below, it is respectfully recommended to the District Court that the Commissioner’s Decision be REVERSED and REMANDED.

JURISDICTION

This appeal of the Commissioner’s final decision denying benefits is properly before the District Court pursuant to 42 U.S.C. § 405(g). Judge Piersol referred this matter to the Magistrate Judge for a Report and Recommendation pursuant to 28 U.S.C. § 636(b)(1)(B) and Judge Schreier’s Standing Order, dated October 16, 2014.

STIPULATED FACTS

A. Administrative Proceedings.

This action arises from Ms. Miller’s applications for SSD and SSI benefits protectively filed , on September 6, 2011, alleging disability since September 7, 2011, due to auto immune disorder, fibromyalgia, migraines, depression, and obesity. AR 26, 75, 82, 85, 92, 173, 175, 182, and 226 (citations to the appeal record will be cited by “AR” followed by the page or pages).

Ms. Miller’s claims were denied initially and upon reconsideration. AR 112, 118, 121.’ Ms. Miller then requested an administrative hearing. AR 124.

Ms. Miller’s , administrative law judge hearing was held on September 24, 2012 by the Honorable Robert Maxwell, (“ALJ”). AR 41. Ms. Miller was represented by different counsel during the hearing. AR 41. An unfavorable decision was issued on October 12, 2012. AR 21.

The ALJ found that Ms. Miller met the insured status for benefits through December 31, 2015, and she had not engaged in substantial gainful activity, (“SGA”), since the alleged onset date of' September 7, 2011. AR 26. The ALJ found that Ms. Miller had multiple severe impairments including fibromyalgia, obesity, and migraines, but that none of her impairments met or medically equaled a Listing. AR 26-29.

The ALJ also found that Ms. Miller had additional medically determinable impairments including ’ diabetes type 2, obstructive sleep apnea, arthritis syndrome, thyroid disorder, affective disorder, and personality disorder, but determined that all of ‘these impairments were nonsevere. AR 26-27.

The ALJ determined that Ms. Miller’s mental impairments caused her mild limitations in activities of daily living, social functioning, ■ and in concentration, persistence ór pace. AR 27-28.

The ALJ determined that Ms. Miller had the residual functional capacity (“RFC”) to perform less than a full range of light work: she was limited to lifting and carrying 20 pounds occasionally and 10 pounds frequently, sitting with normal breaks for about 6 hours out of an 8-hour workday, standing or walking with normal breaks about 4 hours out of an 8-hour workday, limited to frequent stooping, crouching, kneeling, crawling, and climbing of ladders, ropes, scaffolds, stairs and ramps. AR 26-29.

The ALJ found that Ms. Miller’s medically determinable impairments could reasonably be- expected to cause the symptoms alleged by her, but her statements concerning the intensity, persistence -and limiting effects of those symptoms were not fully credible to the extent they were inconsistent with the RFC determined by the ALJ. AR 29-30.

Based on the RFC determined by the ALJ, the ALJ found with the assistance of a vocational expert that Ms. Miller was able to perform her past relevant work as a credit card analyst, a customer service clerk, and a technical support person. AR 32. The ALJ stopped the sequential evaluation at this 4th step and concluded Ms. Miller was not disabled. AR 32-33.

Ms. 'Miller timely requested review by the Appeals Council. AR 19. The Appeals Council considered the additional evidence that Ms. Miller submitted, but denied her request for review, making the ALJ’s decision the final decision of the Commissioner. AR 1-7. Ms. Miller then timely filed this action.

B. Plaintiffs ■ Age, Education and Work Experience.

Ms. Miller was born in 1970, making her 42 years old at the time of the decision. AR 182. She completed college in 2008. AR 227.

The vocational expert, (“VE”), found Ms. Miller had past work as a credit card analyst, customer service clerk, and technical support person. AR 266. The ALJ noted the VE’s findings, and stated in the decision that Ms. Miller reported she worked as a software technician, a credit card analyst and a customer service clerk, citing exhibits 10E and 13E. AR 32. Ms. Miller reported in exhibit 10E that she worked for Cigna Home Delivery Pharmacy between June 2006 and September 2011, and her duties were to process medication changes for cost savings as a pharmacy technician at a mail order pharmacy. AR 227, 263. Her duties at Citibank between May 2002 and June 2006 involved credit analysis. Id. Her duties at Software Unlimited between March 2000 and January 2002, and at Sweet Computer Services between March 1998 and March 2000 involved software support technician. Id.

C. Relevant Medical Evidence.

1. Sanford Clinic — Family Medicine: Douglas R. DeHaan, MD:

Ms. Miller was seen-by Dr. DeHaan on 9/23/10 for a headache, 3 days after being treated in the emergency room for a migraine headache. AR 290. At the time her headache occurred, Ms. Miller was taking hydrocodone and the antidepressant Nortriptyline as a prophylactic medication. Id. Her depression was described as stable, but she had recently stopped Wellbutrin and started Zoloft. AR 291. The objective examination revealed a normal neurological examination, intact sensation and cranial nerves, a normal gait, a normal range of neck motion, and no tenderness. 'AR 291. Ms.. Miller’s other ongoing diagnoses inéluded hypertension, diabetes, fibromyalgia, dysthymia, iron deficiency, hypothyroidism, and Gastroe-sophageal reflux disease (“GERD”). AR 293.

Ms. Miller was seen for other minor matters by other doctors at the clinic, but next saw Dr. DeHaan for her fibromyalgia on 1/14/11. AR 310. Ms. Miller reported soft-tissue pain in her chest, trunk, arms, back, buttocks, and legs, and noted that the pain was fairly severe and gradually worsening lately, . AR 310. She also reported moderate fatigue which was also gradually worsening. Id. Her medications included Neurontin, Vicodin, . Zoloft, Amerge for headaches, Prilosec,, and Pamelor. AR 310-311. Ms. Miller was considering applying for short-term disability and requested that an FMLA form be completed. AR 311. Dr. DeHaan’s exam documented tenderpoints including Ms. Miller’s chest, trunk, arms, buttocks, and legs, and his impression was moderately severe fibromyalgia which was gradually worsening. Id. Neurontin was started and Dr. DeHaan completed the FMLA form. Id.

Ms. Miller saw Dr. DeHaan again on 1/28/11 to complete short term disability paper work. AR 320. She had been off work since 1/13/11 due to fibromyalgia pain which was aggravated by her job which required sitting at a computer all day and caused more pain in her. arms, back, chest, neck and legs. Id. Ms. Miller reported being extremely tired and sleeping most of the time she was off work. Id. She reported that the gabapentin (a/k/a Neurontin) started on 1/14/11 was starting to help the pain, and that the day of her appointment was her first pain free day. Id. Dr. DeHaan increased the gabapentin dosage, completed the disability forms, and recommended more aerobic exercise. Id.

. Dr. DeHaan saw Ms. Miller next on 6/29/11 to follow up on treatment Ms. Miller received in the emergency room for chest pain. AR 325; - The pain was not like'any Ms. Miller had experienced before, but Dr. DeHaan noted bilateral chest wall tenderness' along either side of her sternum without crépitance, but Dr. De-Haan doubted it was cardiovascular disease. Id. Dr. DeHaan noted that the emergency room evaluations were negative including CXR, ECG, labs and stress ECHO. Id. The emergency room examination revealed Ms. Miller was alert, oriented x3, pleasant, cooperative, and had a depressed demeanor. . AR 345, 548, 555-56, 564, 581. She had a normal mood, affect, and behavior; her neck, chest, cardiac and abdomen examinations were unremarkable; she had normal heart and breath sounds; her neck was supple with a normal range of motion; she denied headaches, exercise intolerance, neck pain, swelling or redness of her joints, syncope and light-headedness; she was independent in activities of daily living; her extremities had no edema or tenderness; and she had normal muscle strength and sensory examination. Id. The Review of Systems was positive for cardiovascular chest pain, and positive for musculoskele-tal back pain. AR 548, 564. Ms. Miller’s EKG included abnormalities with, severity borderline, and her lab finding for CK, WBC, and .Seg Neut Absolute were not in the normal range. AR 548, 549, 565-67. On the stress ECHO, Ms. Miller completed 6 minutes or the end of Bruce Protocol Stage II, and it was negative for ischemia. AR 348. Ms. Miller was following up with Dr. Solberg, a cardiologist. AR 342-345; AR 325-326. .

■ Ms. Miller next saw Dr. DeHaan for her annual checkup on 8/3/11. Ms. Miller reported chronic fatigue, diffuse pain consistent with fibromyalgia, and more headaches recently. AR 329. Dr. DeHaan performed a gynecological exam which was normal. Id. His assessment included fi-bromyalgia (AR 330), and he increased the Nortriptyline for improved chronic pain control and insomnia, counseled Ms. Miller on exercise and weight loss, and told her to return annually or as needed. AR 330. The comment by the medical assistant stated, “Concerns that she would like to go on disability.” Id.

Ms. Miller saw Dr. DeHaan again on 8/2/12 for her annual checkup. AR 395. Ms. Miller again reported chronic fatigue and diffuse trigger point tenderness consistent with fibromyalgia. AR 396. She said that her pain was a 3 on a scale of 0-10. AR 414. She continued to have migraines, worse lately, and depression which was stable and without suicidal thoughts. Id, A breast exam and pelvic exam were normal. AR 396. Ms. Miller’s pelvic exam indicated her extremities were normal with no deformities or edema. Id. The Review of Systems showed Ms. Miller’s extremities were positive for diffuse trigger point tenderness consistent with fibromyalgia,- neurologic review of systems (ROS) was positive for migraine headaches, which were worse lately, and psychiatric ROS was positive for depression: stable, denied suicidal thoughts, had chronic fatigue. AR 395-396. Dr. DeHaan’s assessments continued to include migraine, depression, and fibromyalgia, and he counseled Ms. Miller on exercise, diet, and weight loss. Id. As of 8/2/12 Ms. Miller was noted under Social ADL as not exercising, and her exercise goal was noted as two times per week for 15 minutes. AR 401. Ms. Miller was also scheduled for a routine colonoscopy on August 8, 2012, where the pre-procedure examination revealed normal- mental status, lung and heart functions. AR 456.

The appeal record contains two Fibro-myalgia Questionnaire ■ and Physician’s Statements (“Physician’s Statement”), from Dr. DeHaan. The first is dated 8/24/12. AR 364-367. The second is an updated version of the Statement, dated three weeks later on 9/14/12 with minor changes, and an added sheet documenting specific tender points for Ms. Miller. AR 417-421. Both Physician’s Statements document that Dr. DeHaan has treated Ms. Miller for two and one-half years and that she is diagnosed with fibromyalgia as well as depression, sleep apnea, ADD, hypertension, diabetes, hypothyroidism, anemia, and migraines. AR 364,417.

On both Physician’s Statements Dr. De-Haan noted symptoms of multiple tender-points, nonrestorative sleep, chronic fatigue, irritable bowel syndrome, frequent ■severe headaches, depression, hypothyroidism and’ chronic fatigue syndrome. AR 364, 417. On the updated Physician’s Statement he added morning stiffness as an additional symptom. AR 417.

On both Physician’s Statements Dr. De-Haan indicated that Ms. Miller was not a malingerer and that emotional ^factors do contribute to her symptoms and functional limitations. AR 364, 417.

On the 8/24/12 Physician’s Statement Dr. DeHaan indicated Ms. Miller had pain bilaterally in her lumbosacral spine, chest, shoulders, arms, and legs. AR 365. In the updated Physician’s Statement he added pain bilaterally in the cervical and thoracic ' spine, hands/fingers, hips, and knees/ankles/feet.' AR 418. The pain is described as constant and moderately severe. AR 365, 418.

On both Physician’s Statements Dr. De-Haan indicated that Ms. Miller’s attention and concentration necessary to perform even simple work tasks would-typically be interfered with on an occasional basis. AR 365, 418. He stated she could only tolerate work stress in a low stress job. Id.

On the 8/24/12 Physician’s Statement Dr. DeHaan indicated Ms. Miller was limited to sitting two hours at one time in a competitive work setting, but later changed it to one hour on the 9/24/12 Physician’s Statement. AR 365, 418. He indicated she could sit a total of six hours of an eight-hour work day, but would need 10 minutes of walking around every three hours, and would require 10-15 minute unscheduled breaks every three to four hours where she could sit quietly, and with prolonged sitting she would need to elevate her legs one foot about 20 percent of the workday. Id.

On the 8/24/12 Physician’s Statement Dr. DeHaan indicated Ms. Miller could stand/walk about two hours of an eight-, hour workday, but he later reduced that to less than two hours on the 9/24/12 Physician’s Statement. AR 365, 418. He stated she could stand about 30 minutes at one time. AR 366, 419.

On both Physician’s Statements Dr. De-Haan indicated that Ms. Miller could lift and carry 10 pounds occasionally and never lift and carry 20 pounds or more. AR 366, 419. He also indicated she should rarely twist or climb stairs, and never stoop, crouch or climb ladders, and could rarely look down or up and sustain flexion of .her neck, and only occasionally look left or right or hold her head static. AR 367, 420.

On both Physician’s Statements Dr. De-Haan stated that Ms. Miller’s impairments would likely cause “good days” and “bad days” and he estimated that she would miss about three to four days per month from work. AR 367, 42Ó. On the 9/24/12 Physician’s Statement Dr. DeHaan added a tenderpoint chart indicating Ms. Miller had pain in 18 of the standard 18 tender-point locations, as well as pain on each shoulder and her forehead. AR 421.

The ALJ noted that both Physician’s Statements provided by Dr. DeHaan would limit Ms. Miller to less than sedentary work activity. AR 32,67-69.

In a medical treatment note sent to the Appeals Council, Dr. DeHaan reported that he saw Ms. Miller again for her fibro-myalgia on 9/16/12. AR 643. She reported stable moderate soft tissue pain in her forehead, neck, chest, bilateral torso, both shoulders, upper arms, forearms, lower back, buttocks, and upper legs. Id. She also reported moderate fatigue and moderate depression, the latter of which was controlled with medicine. Id. Dr. DeHaan also noted moderate IBS symptoms. Id. Dr. DeHaan noted that Ms. Miller is applying for disability, and his exam confirmed tender points at the same locations Ms. Miller had soft tissue pain, and his assessment was moderately severe fibro-myalgia overall course unchanged. AR 644. Ms. Miller requested a form for her disability case documenting the specific number of tenderpoints because some of her records just indicated “multiple.” Id. Dr. DeHaan completed the form, left her medications unchanged and recommended she follow up in six months or as needed. Id.

In a letter submitted to the Appeals Council dated Augu'st 19, 2013, Dr. DeHaan stated Ms. Miller has been diagnosed with fibromyalgia, migraine headaches, and depression with her fi-bromyalgiá diagnosis confirmed by Ms. Miller’s Rheumatologist and himself. AR 646. He stated this condition is characterized by pain and fatigue and made it very difficult to maintain a regular job düé to the degree of pain and fatigue. Id. He stated Ms. Miller is on medication for pain, but noted that nothing will eliminate the pain, and her condition is long term and probably lifelong. Id. Dr. DeHaan then invited contact if there- were further questions regarding her medical care. Id.

2. Avera Rheumatology and Orthopedic Institute: Joseph J. Fanciullo, MD:

Thé earliest rheumatology exam in the appeal record is an 8/18/05 exam with Dr. Fanciullo when Ms. Miller’s care was transferred for a five-year history of bilateral uveitis that was controlled with-corticosteroid drops. AR 391. - The examination notes that she had also been previously diagnosed by another rheuma-tologist with fibromyalgia, and she had a positive rheumatoid factor. Id. Ms. Miller related a two year history, of myalgia and fatigue with the fatigue slowly in-, creasing recently. Id. Ms. Miller also had been experiencing ocular migraines and other migraines. Id. She was taking Zyrtec, Wellbutrin, Strattera, Prozac, Atenol, Amerge and Excedrin for migraines, and Trazodone. Id. The examination revealed that Ms. Miller was 5'4" tall, weighed 222 pounds, had multiple tenderpoints suggestive of fibromyalgia, and exhibited no detectable synovitis. AR 391, 393. Dr. Fanciullo’s impression was that Ms. Miller probably did have fibromyalgia, but it was unrelated to her uveitis. AR 393. He suspected an underlying systemic process leading to the uveitis. Id.

At a follow up exam on 11/10/05, Dr. Fanciullo confirmed the fibromyalgia diagnosis, but had been unable to identify the suspected underlying systenjic process related to. the uveitis. AR 387.

Ms. Miller was seen next on 12/27/06, and continued to ache all over, but had also had another bout of uveitis. AR 383. She reported pain in her hips, knees, elbows and shoulders, morning stiffness, and occasional GERD. Id. Dr. Fanciullo again confirmed multiple fibromyalgia tender-points. Id. She was started on ’ Imuran therapy for the uveitis.- Id.

The Imuran was stopped due to side effects and changed to methotrexate. AR 380-381. Dr. Fanciullo’s impression included a history of possible inflammatory arthritis. AR 379. By a 6/13/07 examination, his impression was inflammatory arthritis and uveitis. ‘ AR 378. Ms. Miller reported that her eye problem seems to be stabilized and,she had not had to use the steroid eye drops in “quite some time.” Id. Ms. Miller reported that her joint pain is a little better as well, she had no major flares, and the physical examination revealed no evidence of any inflammation of the wrists, hands, knees, or elbows. Id. On 7/3/07 Ms. Miller was 'given prednisone burst for flares of pain in her shoulder, hands and wrists. Id. Ms. Miller’s pain continued and following a 7/12/07 examination she was given hydrocodone. At that examination there was no tenderness in the muscles and no fibromyalgia tender-points. AR 374.

Ms. Miller was seen on 10/1/07 and was on a low dose of methotrexate, which was helpful with her joints and she had no uveitis reoccurrence. Dr. Fanciullo’s assessment was arthritis uveitis syndrome. AR 373. However, due to complications with other medical conditions the metho-trexate was stopped by 3/31/08. AR 370.

Ms. Miller next saw Dr. Fanciullo at the Avera Rheumatology clinic on 1/8/10. AR 368. Ms. Miller was seen for her fibro-myalgia and was hurting “all over.” Id. She was on Provigil and Savella prescribed. by her family physician. Id. Dr. Fanciul-lo’s examination reyealed multiple fibro-myalgia tenderpoints including trapezius, anterior neck, anterior chest, brachiora-dialis, lateral aspects of the hips, and medical aspect of the knees, and brachioradialis muscles with no synovitis of the wrists or hands. Id. Dr. Fanciullo noted that Ms. Miller had not had uveitis in quite some time. AR 368. His impression was chronic- uveitis, arthritis syndrome in prolonged remission, and fibromyalgia. Id. Dr. Fan-ciullo stated he had nothing else to offer for medications since she had already tried pretty much everything including Lyrica, Cymbalta, and now Savella, and had also been on hydrocodone and Releían. Id. He noted she had been riding a stationary bike one to two times per week, and he advised Ms. Miller to get more consistent with the bike. Id. He noted that she would be getting her medications from her primary care physician, and advised her to begin a very low level aerobic conditioning program such as the stationary bike three to five times per week. AR 369. He told her to follow up with him if she developed problems with the uveitis or inflammatory arthritis., Id.

3. Sanford Behavioral Health:

Records from Sanford Behavioral Health which are included in the appeal record begin with a 9/7/10 call from Ms. Miller complaining that her Wellbutrin was causing nausea and vomiting. AR 363. She was told to stop talking the medication and scheduled to see Linda Kauker, PA-C. Id.

Ms. Miller was seen on 9/17/10 by Linda Kauker, PA-C. AR 361. Ms. Miller was talking Savella and Provigil for her fibro-myalgia, but it was not helping and she had been missing quite a bit of work that year due to her fibromyalgia. Id. Ms'. Miller indicated that she is tired when she gets home from work every day so she has not been exercising or engaging in weight loss. Id. She reported that her depression and anxiety are about equal and needed to be addressed. Id. Ms. Miller reported she was sleeping fairly well, was not having racing thoughts or hallucinations, but had low energy, and was still able to concentrate enough to maintain accuracy in her work. Id. The objective exam was normal, she was spontaneous and friendly, she had an appropriate affect and speech, her thoughts' were concrete and linear, and there were no psychotic or psychomotor abnormalities. Id. The impression was depressive disorder NOS, generalized anxiety disorder, AD/HD per history, borderline traits per history, and her GAF was assessed at 55-60. AR 361. She was started on Sertraline and her Savella was decreased. AR 362.

' Ms. Miller was seen again on 1/14/11 and reported that her fibromyalgia had “really been beating her up the past few weeks.” AR 360. She said she had been missing work about two days per week and was considering short-term disability because of her pain and discomfort.' Id. She also reported her depression had gotten worse. Id. Linda Kauker again assessed Ms. Miller as alert, oriented, in no acute distress, with a euthymic mood, a full and appropriate affect, normal speech, concrete and linear thoughts, and no psychotic or psy-chomotor disturbances, her impressions remained unchanged, and she increased Ms. Miller’s Zoloft dosage, and individual therapy was recommended. Id.

Ms. Miller was seen again on 3/11/11 and she reported that due to her fibromyalgia she had reduced her work hours to 24-32 hours per week. AR 359. She was taking Gabapentin which helped with her pain, but she was having fatigue issues: Id. She reported the prior increase in the Zoloft dosage was helpful and she was having less low moods. Id. The objective findings were again unchanged and normal. Id.

Ms. Miller saw Linda Kauker again on 8/4/11 and when asked how things were she said, “Terrible, my 'health has been bad. I’ve missed a lot of work due to my fibromyalgia.” AR 357. She reported she felt she may be fired from her job due to absences and was considering filing for disability. Id. She reported feeling down and anxious fairly often,, her energy level was down, and her focus and concentration at work were ,not as. good as they used to be. Id. She reported she was making mistakes or forgetting some things she is supposed to say in her job. Id. Ms. Kauker’s objective findings show Ms. Miller’s mood as having kind of a serious tone with a congruent affect, which was unusual for Ms. Miller, and show Ms. Miller as alert, pleasant and calm, her speech was normal in rate and tone, her thoughts were concrete and linear without psychotic indices, and she had no evidence of psychomotor agitation or retardation. ' Id. Her Zoloft dosage was increased and she was started on Intuniv. AR 358.

A medical treatment note submitted to the Appeals Council shows that Ms. Miller next saw Linda Kauker on 9/19/12. AR 647. Ms. Miller reported that she had been terminated from her job in September 2011, and was off her psychiatric medications from November 2011 to February 2012 because she could not afford them. Id. She reported sleeping well, increased anxiety lately, but no depression currently. Id. She said her Zoloft wás working well. Id. Ms. Kauker’s impressions were anxiety disorder NOS and depression by history. AR 648. Ms. Kauker noted that Ms. Miller wanted to follow up in four months, but she is financially strapped without working and agrees to call if she has problems in the meantime. Id. The mental status examination revealed that Ms. Miller was alert and oriented, she was spontaneous and friendly, her mood was-primarily eu-, thymic, her speech was normal,, her thoughts were coherent, and there was no psychosis or psychomotor disturbance. AR 647.

4. Healthwise Chiropractic: Chad Neki, DC:

The appeal record contains treatment records for chiropractic treatment from Dr. Neki for 3/4/11 to 9/5/12. AR 623-35.

In March of 2011 Ms. Miller was seen for a series of treatments. AR 624-628. Ms. Miller received treatment for her neck, upper back, and lower back. AR 624. Ms. Miller reported that her daily activities were seriously affected and she had to take time off work during February because of her fibromyalgia symptoms. Id. Dr. Neki’s exam revealed hypertonic musculature, subluxations and tenderness in her cervical and thoracic spinal regions. Id.

Ms. Miller continued treatment through 3/22/11. AR 625-628. On 3/11/11 Ms. Miller reported she worked less that week and was having moderate headaches and bilateral upper back and shoulder pain. AR 625. The exam revealed similar findings as before, and moderate pain, significant edema, and active trigger points overlying the thoracic range bilaterally. Id. On 3/15/11 Ms. Miller reported that the pain still seriously affected her daily activities with the afternoon usually worse. AR 626. She reported she had to leave work early that day due to lower back pain and mid back pain the prior day. Id. Dr. Neki’s exam continued to reveal similar findings as prior exams. Id. On 3/18/11 Ms. Miller reported she had been unable to work for two days due to lower back pain. AR 627. On 3/22/11 Ms. Miller reported her neck pain was a 2, her upper back pain was a 3, and her lower back pain was a 5 on a scale of 1-10. AR 628.

Ms. Miller, received additional treatments from Dr. Neki on 2/10/12, 2/14/12, and 3/23/12 for pain in her neck, upper back, and lower back, where her pain had worsened to a marked degree. AR 629-631. Ms. Miller reported her pain was seriously affecting her daily activities. AR 629. She reported that her pain was usually worse in the afternoon. Id. She had to quit her job in September the prior year due to more severe fibromyalgia pain and muscle spasms, so she'was not working. Id. She reported moderate headaches, and neck and lower back pain which radiates into both legs. Id. Dr. Neki’s exam generally revealed moderate pain, muscle spasms and tender trigger point in the cervical, thoracic, and lumbar spinal regions. Id. Dr. Neki’s notes indicate slower than expected progress, noting no real improvement since her last visit. Id. Ms. Miller was in a supportive phase of care and would see Dr. Neki on an as needed basis. Id. On 2/14/12 Ms. Miller reported more pain with prolonged sitting or standing. AR 630. Her diagnoses at that time were thoracic subluxation, muscle spasms, lumbar sacrum and cervical subluxation, and headaches. Id.

Ms.. Miller was seen again on 8/3/12 on .a referral from Dr. DeHaan for a flare-up in headaches, and neck and back pain. AR 632. Ms. Miller reported that chiropractic treatment improved her headaches and pain symptoms in her lower back an,d neck, but reported that nothing works to make her symptoms better in her upper back. Id. When she returned on 8/24/12, she noted she had a new bed and her pain had improved, reporting mild symptoms in her neck, upper back, and lower back, and improved symptoms for her headaches. AR 634.

5. State Agency Assessments:

The state agency experts reviewed Ms. Miller’s records at the initial level and provided physical and mental assessments on 10/18/11. The agency expert found severe impairments of fibromyalgia, migraines, and obesity, and nonsevere medically determinable impairments of diffuse diseases of the connective tissue; diabetes, other’disorders of gastrointestinal system, affective disorder, anxiety disorder^ organic- mental disorder, and personality disorder. AR 76,86: •

The mental health expert at the initial levél concluded that the nonsevere mental impairments caused mild difficulties in maintaining concentration, persistence or pace, and no difficulties in maintaining social functioning and activities of daily living. AR 76, 86.

The physical expert at the initial level concluded Ms. Miller could lift 20 pounds occasionally and 10 pounds frequently, stand/walk four hours of an eight-hour workday, and sit walk six hours of an eight-hour workday.. AR 78, 88*. Ms. Miller was also limited to frequently climbing ramps/stairs, ladders/ropes/seaffolds, stooping, kneeling, crouching, and crawling, she was unlimited pushing and pulling, (except as noted in the lift and carry limitations), and unlimited balancing, and had no manipulative, communicative or environmental limitations. AR 78-79, 88-89.

At the reconsideration level state, agency record reviews identified the same impairments as found at the initial level: severe impairments of fibromyalgia, migraines, and obesity, and nonsevere medically determinable impairments of diffuse diseases of the connective tissue, diabetes, other disorders of gastrointestinal system, affective disorder, anxiety disorder, organic mental disorder, and personality disorder. AR96,106.

The findings of the mental and physical state agency experts at the reconsideration level were -virtually identical to the findings at the initial level. AR 97-100, 107-110.

D. Testimony at the ALJ Hearing.

1. Ms. Miller’s Testimony:

Ms. Miller testified, that she completed high school, and received a degree in accounting from Colorado Tech, but had never utilized that training. AR 47, 61.

Ms. Miller testified she lived with her boyfriend who helps her financially. AR 58. Ms.:Miller said she did file for unemployment, but was told she could not have it because she filed for disability. Id.

Ms. Miller testified she is 5'4" tall and weighed 243 pounds. AR 61. Ms. Miller testified she has pain trying to accomplish daily activities, like folding a basket of clothes where she takes a break and rests due to pain after folding only three or four items. AR 57. When cooking she gets distracted and frequently burns things, and she is only able to clean if she takes frequent breaks, and usually the breaks last longer than the time spent doing the activity. Id. She explained doing dishes she needed a break after 15 to 30 minutes, and would then rest for at least 30 minutes. Id. Ms. Miller said she does still drive, but, not if she took a hydrocodone because she doesn’t feel safe, they “make me out of it”, and the furthest she had driven in the last six months was five to six miles to her attorney’s office. AR 58.

Ms. Miller testified she worked as a computer technical person at Software Unlimited and Sweet Computer Services, assisting customers with computer issues and accounting software. AR 48. She left those jobs for other better jobs or due to relocation. AR 48-49.

Ms. Miller testified that she had lost her job at Cigna in September of the previous year because she was not performing up to standards. AR 47. She explained that at Cigna she would talk with customers on the phone, enter notes in the computer processing, or transcribing prescriptions and enter them on the computer. AR 48. Ms. Miller said that her pain got worse during the time she worked at Cigna, and as time went on she was able to concentrate less due to issues with pain from “having to do continual motions.” Id. She said she was not able to meet Cigna’s standards for accuracy and was let go following prior verbal and written warnings. Id. Ms. Miller explained that she would make mistakes with doctor’s names, quantities, and dates when transcribing prescriptions. AR 49, 55.

Ms. Miller testified that she had FMLA leave at Cigna and had used all of her available FMLA leave and her sick leave, which then led to the disciplinary process with a notice of correction in August 2011, and termination in September 2011. AR 55-56.

Ms. Miller testified that she was diagnosed with fibromyalgia years ago by Dr. Eckhoff, and more recently by Dr. Fanci-ullo, but she was obtaining most of her current treatment from Dr. DeHaan. AR 47. Ms. Miller testified that she had positive fibromyalgia tenderpoints at all 18 locations on her body now, and years ago when first diagnosed with fibromyalgia she had 14 tenderpoints. AR 51-52. She testified that she saw Dr. DeHaan about every three to ■ six- months, and recently about once a year because she was at a point where there is not much else they can do for her, and there was a point when she did not have insurance for three months, and when she did have insurance early in the year they had a very high deductible to pay, so she tried to limit her visits to when she absolutely had to go. AR 59.

Ms. Miller testified that she takes Nor-co, which is hydrocodone and acetaminophen, when the pain gets too bad, the generic form of Synthroid for her thyroid problem, Amerge for her migraines, ome-prazole, gabapentin, and the generic form of Zoloft for her depression. AR 49, 56.

Ms. Miller said that doctors had told her that exercise or weight management might be beneficial to her, but that was difficult for her due to pain, and she was not on any sort of regular exercise program, but does some weight management by watching her diet. AR 60. She said her rheu-matologist had said to avoid things which cause pain and light aerobic exercise would assist on those days when she wasn’t feeling a lot of pain, but she feels pain most days. AR 62-63.

Ms. Miller testified that she also had problems sleeping including sleep apnea and insomnia with trouble getting to sleep and staying asleep, so she frequently naps through the day. AR 52. Ms. Miller said even with her napping she has fatigue problems and is still very tired, and her muscles are sore and achy. Id.

Ms. Miller testified she had also had problems with irritable bowel syndrome about four to five times per month. AR 52-53.

Ms. Miller testified-she had headaches about once or twice a week and she gets migraines. AR 53. She said she takes a combination of Excedrin and Amerge for her headaches, which helped to some degree, but does not: always stop the. pain right away. Id.

Ms. Miller testified she also -receives chiropractic treatment for pain in her lower, center, and upper spine. AR 53-54. She said- she also has pain, fatigue and soreness in her chest, arms, shoulders, hands, and hips that increases with.use. AR 54. When asked why some of these areas were not noted on Dr. DeHaan’s form Ms. Miller explained that she has had fibromyalgia for.a while and “some things have become normal for me.” AR 54-55.

Ms. Miller testified she had been treated for depression and recently resumed treatment with Linda Kauker, after a period last year -when she did not have insurance. AR 53. She said she had seen Ms. Kauker about four or five times over the last three years, and her depression was fairly maintained by medications.- AR 62.

Ms. Miller testified during the best part of her day she was limited to sitting 30 to 45 minutes at one time, before she needed to get up and walk around, and then she could sit another 30 to 45 minutes, and as the day progressed she would need to walk around more frequently and for a. longer time. AR 50-51. She said in addition to the quality issues she had taking that many breaks impacted her ability to get the expected quantity of work done also. AR 51.

2. Vocational Expert Testimony:

The VE was present by telephone during Ms. Miller’s testimony. AR 42. The VE testified that prior to the hearing he had prepared a summary of Ms. Miller’s work history, which was received as exhibit 13E, (AR 266), and in it he described her work as sedentary and either semi-skilled or skilled in nature. AR 64.

The first hypothetical question the ALJ asked the VE was to assume a person under 50, educated through the bachelor’s level degree, a work history as the VE described, with limitations as noted and described in Ms. Miller’s testimony, and the VE testified that the individual would not be able to do any of Ms. Miller’s past work or any other full-time work due to the issues with chronic pain. AR 65.

The second hypothetical asked by the ALJ, which he stated was “intended to ask you about the state agency’s assessment” in exhibit 6A, (AR 93-101),- assume someone the same age, education, and work experience as before and were limited to ■lifting or carrying up to 20 -pounds occasionally and 10 pounds frequently, sitting with normal breaks about 6 hours out of an 8-hour workday, standing or walking with normal breaks about 4 hours out of an 8-hour workday, frequent climbing, stooping, crouching, kneeling, and crawling, unlimited balance and pushing/pulling within the lifting and carrying weight limits, and, no manipulative, visual, communicative, or environmental limitations. The VE testified this would allow all past work. . AR 66. The VE also testified that Ms. Miller can also perform all the sedentary occupations and a partial range of-the light occupational base. AR 67.

The ALJ then asked the VE about the limitations described in Dr. DeHaan’s medical source statement received as exhibit 7F, (AR 417-421), except the ALJ omitted the limitations related to mental impairments such as the person attention and concentration necessary to perform even simple work tasks would typically be interfered with on an occasional basis, (AR 418), and the person could only tolerate work stress in a low stress job, (AR 419), and the VE testified the limitations described by the ALJ would preclude all past work and all other work, based on the three to four day per month absenteeism alone. AR 69.

Thé only hypothetical question to' the VE which incorporated any limitations associated with concentration, persistence or pace due to either mental impairments or chronic pain was the hypothetical based on Ms. Miller’s testimony, since she testified to difficulties with both concentration and with pace.

. The VE. testified that there was no conflict .between his descriptions of the cited jobs and how the. Dictionary of Occupational Titles (DOT) describes them. AR 69. Ms. Miller’s counsel did not question the VE. AR 69. •

E. Other Evidence.

Ms. Miller’s earnings reports document consistent SGA earnings for the 15 years prior to her termination at Cigna. AR 202-203.

In a work activity report dated 9/12/11, Ms. Miller stated she was allowed easier duties at Cigna due to her inability to concentrate. AR 215.

Ms. Miller completed a Function Report, dated 9/30/11', as part of her disability application in which’ slie stated, some days she was unable to raise her arms to dress herself, she had too much pain or tiredness to shower, she was unable to curl her hair or use a hairdryer, raising her arms to shave caused problems, she was unable to cook most days, and she needed help sitting to use the toilet. AR 234. Ms. Miller said she needed a strict routine to help her remember things, and used a pill minder. AR 235. She stated when making meals she was unable to stand and cook complete meals. AR 235. Ms. Miller stated she could unload the dishwasher for five to ten minutes, that it took her one hour or more to clean the bathroom every one to two weeks with, frequent breaks, and her boyfriend prompts her and encourages her to complete these tasks. AR 235. Ms. Miller stated she has help shopping for groceries, and it takes one to two hours once a week, and it leaves her tired for a couple of days. AR 236; She stated it was difficult to concentrate when reading or watching TV, and she has difficulty lifting over 5 pounds, sitting, standing more than a few minutes, reaching, walking more than a block, kneeling, completing tasks, concentrating more than 5-10 minutes, understanding, and following instructions. AR 236-238. - Her social activities include spending time with others eating out at restaurants or their homes every few weeks. AR237.

In a Disability Report dated 11/1/11, Ms. Miller reported she had not been able to meet her needs as well, with, difficulty dressing, bathing and fixing meals. AR 245.

In a Third Party Function Report, dated 12/18/11, Ms. Miller’s boyfriend stated Ms. Miller usually gets up between 10:00 a.m. and 1:00 p.m. usually naps again about two hours after getting up. AR 248. He stated he needed to remind Ms. Miller to take care of her cat, that Ms. Miller often cannot sleep due to pain and takes baths in the middle of the night, that she often times does not get dressed, seldom brushes her hair unless she 'is going out, has problems cooking on the stove, and she gets distracted. AR 249. He stated Ms. Miller may cook only once or twice per week, and she cannot cook without getting distracted. AR 250. He stated Ms. Miller does clean the bathrooms once or twice a month and it takes her 30 to 40 minutes each. AR 250. He noted that Ms. Miller goes outside 3-4 times a week, drives and rides in a car to travel, she can go out alone, and goes shopping 40-60 minutes 2-3 times a week. AR 251. He said Ms. Miller reads 2-3 hours a day and watches television 2-3 hours a day. AR 252. He noted that Ms. Miller gets tired quickly kneeling or stair climbing, and she has problems concentrating because she gets distracted and makes mistakes. AR 253. He stated she can walk about 50-100 feet before needing to rest for two to five minutes, and can only pay attention for five to ten minutes. AR 253. He also noted that whenever the weather changes Ms. Miller has a lot of pain and she gets migraines two to four times per week. AR 255.

F. Other Evidence Submitted To Appeals Council.

Ms. Miller submitted multiple documents describing the FMLA protection she received while working at Cigna. AR 273-288. Ms. Miller described the essential functions of her job as entering prescriptions into the computer, analyzing costs, sending facsimiles, and talking to customers on the telephone. AR 281. First is Dr. DeHaan’s physician’s statement given to support the FMLA leave dated 1/8/10, in which Dr. DeHaan stated Ms.- Miller had fibromyalgia causing diffuse pain and fatigue, and her medication caused sedation. AR 282. Dr. DeHaan stated Ms. Miller’s condition will cause periodic flare-ups making it medically necessary for her to be absent from work due ■ to pain and fatigue approximately two times per month for three days per episode. AR 283.

A 2/21/11 letter from Cigna to Ms. Miller acknowledged Ms. Miller’s request for intermittent leave beginning 2/11/11 through 8/11/11 and showed that 12 weeks of leave had already been used as of 2/21/11. AR 273.

An 8/11/11 interoffice memo from Cigna, DLE Supervisor to Ms, Miller gave her an attendance probation warning, after her seventh unscheduled event occurred on 8/3/11 and shows she was being, placed on probation having failed to successfully complete her attendance written warning period.- AR 276. The attached attendance record showed 511:20 FMLA hours used from 8/10/10 TO 8/9/11. AR 277-280.

A 9/7/11 interoffice memo from Debbie' Hoffman, Cigna, DLE Supervisor to Ms. Miller regarding Ms. Miller’s failure to meet the standards in the 8/11/11. attendance probation memorandum terminated her employment as of 9/7/11 due to unsatisfactory performance. AR 275.

DISCUSSION

A. Standard of Review.

When reviewing a denial of benefits, the court will uphold the Commissioner’s final decision if it is supported by substantial evidence on the record as a whole. 42 U.S.C. § 405(g); Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir.1993). Substantial evidence is defined as more than a mere scintilla, less than a preponderance, and that which a reasonable mind might accept as adequate to support the Commissioner’s-conclusion. Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971); King v. Weinberger, 514 F.2d 423, 425 (8th Cir.1975). “This review is more than a rubber stamp for the [Commissioner’s] decision, and is more than a search for the existence of substantial evidence supporting his decision.” Thomas v. Sullivan, 876 F.2d 666, 669 (8th Cir.1989) (citations omitted).

In assessing the substantiality of the. evidence, the evidence that detracts from the Commissioner’s decision must be considered, along with the evidence, supporting it. Woolf, 3 F.3d at 1213. The Commissioner’s decision may not be reversed merely because substantial evidence would have supported an opposite decision. Id. If it is possible to draw two inconsistent positions from the evidence and one of those positions represents the Commissioner’s findings, the Commissioner must be affirmed. Oberst v. Shalala, 2 F.3d 249, 250 (8th Cir.1993). “In short, a reviewing court should neither consider a claim de novo, nor abdicate its function to carefully analyze the entire record.” Mittlestedt v. Apfel, 204 F.3d 847, 851 (8th Cir.2000) (citations omitted).

The court must also review the-decision by the ALJ to determine if an error of law has been committed. Smith v. Sullivan, 982 F.2d 308, 311 (8th Cir.1992); 42 U.S.C. § 405(g). Specifically, a court must evaluate whether the ALJ applied an erroneous legal standard in the disability analysis.' Erroneous interpretations of law will be reversed. Walker v. Apfel, 141 F.3d 852, 853 (8th Cir.1998) (citations omitted). The Commissioner’s conclusions of law are only persuasive, not binding, on the reviewing court. Smith, 982 F.2d at 311.

B. The Disability Determination and the Five Step Procedure.

Social Security law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected rto last for a continuous period of not less than, twelve months. 42 U.S.C. §§ 416(I), 423(d)(1); 20 C.F.R. § 404.1505. The impairment must be severe, making the, claimant unable to do his previous work, or any other substantial gainful activity which exists in the national economy. 42 U.S.C. § 423(d)(2); 20 C.F.R. §§ 404.1505-404.1511. The ALJ applies a five-step procedure to decide whether an applicant is disabled. This sequential analysis is mandatory for all SSI and SSD/ DIB applications. Smith v. Shalala, 987 F.2d 1371, 1373 (8th Cir.1993); 20 C.F.R. § 404.1520. When a determination that an applicant is or is not disabled can be inade at any step, evaluation under a subsequent step is unnecessary. Bartlett v. Heckler, 777 F.2d 1318, 1319 (8th Cir.1985). The five steps are as follows:

Step One: Determine whether the applicant is presently engaged in substantial gainful activity. 20 C.F.R. § 404.1520(b). If the applicant is engaged in substantial gainful activity, she is ,not disabled and the inquiry ends at this step.

Step Two: Determine whether the applicant has an impairment or combination of impairments that are severe, i.e. whether any oí the applicant’s impairments or combination of impairments significantly limit his physical or mental ability to dd basic work activities. 20 C.F.R. § 404.1520(c). If there is no such impairment or combination of impairments the applicant is not ¡disabled and the inquiry ends at this- step. NOTE: the regulations prescribe a special procedure for analyzing mental impairments to determine whether they are severe. Browning v. Sullivan, 958 F.2d 817, 821 (8th Cir.1992); 20 C.F.R. § 404.1520a. This special procedure includes completion of a Psychiatric Review Technique Form (PRTF).

Step Three: Determine whether any of the severe impairments identified in Step Two meets or equals a “Listing” in Appendix 1, Subpart P, Part 404. 20 C.F.R. § 404.1520(d). If an impairment meets or equals a Listing, the applicant will be considered disabled without further inquiry. Bartlett, 777 F.2d at 1320, n. 2.' This is because the regulations recognize the “Listed” impairments are so severe that they prevent a person from pursuing any gainful work. Heckler v. Campbell, 461 U.S. 458, 460, 103 S.Ct. 1952, 76 L.Ed.2d 66 (1983). If the applicant’s impairment(s) are severe but do not meet or equal a Listed impairment the ALJ must proceed to step four. NOTE: The “special procedure” for mental impairments also applies to determine whether a severe mental impairment meets or equals a Listing. 20 C.F.R. § 404.1520a(c)(2).

Step Four: Determine whether the applicant is capable of performing past relevant work (PRW). To make this determination, the ALJ considers the limiting effects of all the applicant’s impairments, (even those that are not severe) to determine the applicant’s residual functional capa'city (RFC). If the applicant’s RFC allows her to meet the physical and mental demands of her past work, she is not disabled. 20 C.F.R. §§ 404.1520(e); 404.1545(e).' If the applicant’s RFC does not allow her to meet the physical and mental demands of her past work,- the ALJ - must proceed to Step Five.

Step Five: Determine whether any substantial gainful activity exists in the national economy which the applicant can perform. To make this determination, the ALJ considers the applicant’s RFC, along with her age, education, and past work experience. 20 C.F.R. § 404.1520(f). ,

Ci Burden of Proof.

The- Plaintiff bears the burden of proof at Steps One through Four of the Five-Step Inquiry. Barrett v. Shalala, 38 F.3d 1019, 1024 (8th Cir.1994); Mittlestedt, 204 F.3d at 852; 20 C.F.R. § 404.15Í2(a). The burden of proof shifts to the Commissioner at Step Five. “This shifting of the burden of proof to the Commissioner is neither statutory nor regulatory, but instead, originates from judicial practices.” Brown v. Apfel, 192 F.3d 492, 498 (5th Cir.1999). The burden shifting at Step Five has also been referred to as “not statutory, but ... a long standing judicial gloss on the Social Security Act.” Walker v. Bowen, 834 F.2d 635, 640 (7th Cir.1987).

D, Thie Parties’ Positions.

Ms. Miller asserts the Commissioner erred -by finding her not disabled within the -meaning of the Social Security Act. She asserts the Commissioner erred in four ways: ,(1) The Commissioner erred in evaluating the expert physicians’ opinions; (2) The Commissioner erred in evaluating Ms. Miller’s credibility; (3) The Commissioner failed to properly evaluate whether Ms. Miller’s fibromyalgia medically equaled a listed impairment; and (4) The Commissioner’s determination of Ms. Miller’s RFC is not supported, by substantial evidence.

The Commissioner asserts substantial evidence supports the AL J’s determination that Ms. .Miller was not disabled during the relevant time frame, and the decision should be affirmed.

E. Analysis. .

Ms. Miller assigns four .points of error to the Commissioner’s denial of benefits. They are discussed in turn below.

1. The Commissioner’s Evaluation of the Expert Medical Evidence.

The ALJ’s discussion of the medical evidence begins on page seven of his written decision (AR 30). The ALJ reviewed medical records received from Ms. Miller’s rheumatologist (Dr. Fanciullo); her behavioral health records from Sanford (Linda Kauker-PA-C); records from her primary care physician (Dr. DeHaan); and her chiropractic records (Chad Neki, D.C.). He also considered' the assessments of the non-treating, non-examining state agency medical consultants (Dr. Frederick Entwistle and Dr. Kevin Whittle).

Out of all the medical providers whose records were considered by the ALJ, only Ms. Miller’s primary care physician (Dr. DeHaan) and the state agency consultants were asked to offer opinions regarding Ms. Miller’s ability to function in the work-placé. Ultimately, the ALJ assigned declined to give controlling weight to the treating physician. AR 32. The ALJ instead assigned “little weight” to the opinion of Ms. Miller’s primary care physician, but assigned “great weight” to the opinion of the non-treating, non-examining state agency consultants. Ms.’ Miller asserts the ALJ -erred in evaluating the expert medical evidence. The court agrees.

The ALJ’s discussion of the weight he assigned to the medical opinions appears on page nine of his written decision (AR 32). It is reproduced below:

Turning to the opinion evidence, the undersigned has considered the opinion's of the claimant’s primary care physician, Douglas DeHaan, M.D____; Dr. DeHaan opined that the claimant was essentially capable of less than a full range of sedentary work' activity and would likely miss 3-4 days of work a month due to her impairments. In accordance with Social Security Ruling 96-2p, the opinions of treating physicians are to be analyzed with a deference towards giving controlling weight, provided they are well-supported by medically acceptable clinical and laboratory diagnostic techniques and are not inconsistent with the other substantial evidence in the record. Dr. DeHaan’s opinions are not assigned such weight because he is not a specialist and because the large treatment gaps do not support these extreme limitations. The claimant admitted she went over a year without seeing Dr. DeHaan. (Hearing testimony). In the interim, the claimant sought out chiropraetic care and reported improved results with mild pain symptoms.... Due to these inconsistencies in the record, the undersigned affords Dr. DeHaaris assessments little weight.

Conversely, the undersigned has considered the State- agency medical ■ consultants’ assessments____.The medical consultants’ (sic) opined the claimant was capable of less than a full range of light work activity____ The undersigned adopts the medical consultants’ assessments as consistent with medical evidence of record taken as a whole and affords them great weight.

AR 32.

, [16 — 18] “Generally, a treating physician’s opinion is given more weight than other sources in a disability proceeding.” Anderson v. Astrue, 696 F.3d 790, 793 (8th Cir.2012) (citing 20 C.F.R. § 404.1527(c)). “Indeed,, when the treating physician’s opinion is supported by proper medical testing and is not inconsistent with other substantial evidence in the record, the ALJ must give the opinion controlling weight ... However, an ALJ may discount or even disregard, the opinion of a treating physician where other medical assessments are supported by better or more thorough medical evidence, or where a treating physician renders inconsistent opinions that undermine the credibility of such opinions.” Id. (citations omitted, punctuation altered, emphasis added). “Ultimately, the ALJ must ‘give good reason’ to explain the weight given the treating physician’s opinion.” Id. (citing 20 C.F.R. § 404.1527(c)(2)).

Additionally, SSR 96-2p instructs that, Adjudicators must remember that a finding that a treating source medical opinion is not well-supported by medically accepted clinical and diagnostic techniques or is inconsistent with the other substantial evidence in the case record means only that the opinion is not entitled to. ‘controlling weight,’ not that the opinion should be rejected.' Treating source medical opinions are still entitled to deference and must be weighed using all of the factors provided in 20 C.F.R. §§ 404.1527 and 416.927. In many cases, a treating source’s medical opinion will be entitled to the greatest weight and should.be adopted, even if it does not meet the test for controlling weight.

See SSR 96-2p, Policy Interpretation, at p. 6.

Conversely, the opinion of a consulting physician who examines a claimant once or not at all does not generally constitute substantial evidence. “We have stated many times that the results of a one-time medical evaluation do not constitute substantial evidence on which the ALJ can permissibly base his decision.” Cox v. Barnhart, 345 F.3d 606, 610 (8th Cir.2003) ’(citations omitted). “This is especially true when the consultative physician is the only examining doctor to contradict the treating physician.” Id. Likewise, the testimony of a vocational expert who responds to a hypothetical based on such evidence is not substantial evidence upon which to base a denial of benefits. Singh v. Apfel, 222 F.3d 448, 452 (8th Cir.2000) (internal citations omitted).

The factors to consider for assigning weight to medical opinions are set forth by regulation:

(c) How we weigh medical opinions. Regardless of its source, we will evaluate every medical opinion we receive. Unless we give a treating source’s opinion controlling weight under paragraph (c)(2) of this section, we consider all of the following factors in deciding the weight we give to any . medical opinion.

(1) Examining relationship. Generally, we give more weight to the opinion of a source who has examined you than to the opinion of' a source who has not examined you.

(2) Treatment relationship. Generally, we give more weight to opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, long