Affirmed in part, vacated in part, and remanded by published opinion. Judge LUTTIG wrote the opinion, in which Judge WILKINS and Judge WILLIAMS Joined.
OPINION
Ronda S. Craig appeals from a judgment of the district court upholding the determination of the Secretary of Health and Human Services that she was ineligible for disability insurance and Supplemental Security Income. For the reasons that follow, we remand the case to the ALJ for further consideration.
I.
Craig, currently 34, began seeing Dr. David Keller, a family practitioner, in 1986. She complained of headaches, back pain, leg pain, and hip pain. Between May 1986 and December 1992, Craig visited Dr. Keller some 31 times, comрlaining of similar pains, as well as cramping, dizziness, fatigue, and swelling of the face, feet, and legs. In that time, plaintiffs various diagnoses included chronic back pain, chronic tension headache, lumbrosaeral strain, possible carpal tunnel syndrome, probable myofacial pain syndrome, fibrocytis syndrome, epigastric pain, and possible depression. In January 1990, Craig underwent an x-ray of the cervical spine which revealed degenerative arthritic change anteriorly at C3-4, C4-5, and C5-6 and that there was very early disk space narrowing. J.A. at 118. At the same time, a CT brain scan showed “normal.” Id. In September of 1991, Dr. Keller performеd MRI scans of the cervical and lumbrosaeral spines, both of which were “normal.” J.A. at 191.
On June 18,1992, Dr. Keller wrote a letter stating that Craig was disabled as of June 1, 1992, and that she would be disabled “indefinitely” because of “aching all over.” J.A. at 136. On that same day, June 18, Dr. Keller wrote Dr. Doug Lemley, a rheumatologist, a letter of referral for Craig, in which he stated that she had “no objective evidence of any joint symptoms” and that her lab work was “normal” except for high cholesterol and triglyceride levels. J.A. at 132. He made no mention of any disability in this letter. Dr. Lemley examined Craig and concluded that there were “[n]o signs of active inflammation about any of the joints at this time” and “adequate range of motion at all sites.” J.A. at 129. He also noted that she had complained of “occasional” swelling of the hands, feet, and knees.
On September 23, 1992, Craig had a session with Robert Madtes, a physical therapist to whom she was referred by Dr. Keller. Madtes found that she had “multiple muscle involvement with pain and decreased flexibility,” but he did not declare her disabled or suggest that she be restricted in her activities. J.A. at 210.
Craig is still able to sweep occasionally, mop once a month, do some dusting, sometimes mend clothes, do laundry once a week, go grocery shopping once a month, сook twice a week, wash dishes once a week, attend church occasionally, sometimes teach Sunday School, and drive occasionally. J.A. at 4(M2. Nevertheless, Craig alleges that *589 she has cramps in her whole body, her joints hurt constantly (specifically her knees, legs, feet, and hands), and she experiences severe headaches. J.A. at 34. She also testified that she cannot sleep very much, that she has trouble lifting a plate with her right arm, that lifting a two-liter bottle with her left arm causes pain, and that she can only blow dry the front of her hair because she cannot hold the blow dryer long enough to do the back. J.A. at 44-15.
On Junе 23, 1992, Craig filed for Title II disability insurance benefits and for Title XVI Supplemental Security Income. 1 The applications were denied twice, and, on December 31, 1992, Administrative Law Judge Emanuel C. Edwards conducted a hearing and denied benefits. He found that, although Craig had “severe impairments of the musculoskeletal system,” her subjective allegations of pain were not credible, and she had the residual functional capacity to perform medium work, which included her past relevant work, as a seamstress. J.A. at 17. After the Appeals Council denied Craig’s request for review, the federal district court adopted the magistrate’s recommendаtions and granted the Secretary’s motion for summary judgment of Craig’s complaint for review. This appeal followed.
II.
Under the Social Security Act, we must uphold the factual findings of the Secretary if they are supported by substantial evidence and were reached through application of the correct legal standard. 42 U.S.C. §§ 405(g), 1383(c)(3);
Coffman v. Bowen,
A.
Craig’s first contention is that the ALJ failed to follow the mandate of
Coffman,
[i]t is obvious that [Dr. Keller’s] opinion [that Craig is “indefinitely” disabled] is based solely on claimant’s subjective symptoms of aching all over and not supported by clinical findings or laboratory test results. In fact, Dr. Keller’s own office notes do not even suggest that claimant would be precluded from performing sustained work activity. In the claimant’s progress notes, Dr. Keller repeatedly made the same remarks he made in his office notes of July 30, 1992, i.e., no cervical adenopathy; normal thyroid; lungs clear to auscultation; *590 cardiac rhythm regular with no gallops or murmurs; abdomen soft but diffusely tender; no hepatosplemegaly or mass; pаtient tender all over with pain to palpation in all muscle groups, but no joint swelling or limitation of range of motion; muscle strength normal in upper and lower extremities.
J.A. at 15 (emphases added).
Circuit precedent does not require that a treating physician’s testimony “be given controlling weight.”
Hunter v. Sullivan,
[i]f we find that a treating source’s opinion on the issue(s) of the nature and severity of [the] impairment(s) is well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record, we will give it controlling weight.
By negative implication, if a physician’s opinion is not supported by clinical evidence or if it is inconsistent with other substantial evidence, it should be accorded significantly less weight. All Keller gave here was a conclusory opinion based upon Craig’s subjective reports of pain. His own medical notes did not confirm his determination of “disability.” On the same day, he wrote Dr. Lemley and mentioned nothing about any disability; indeed, he noted that there was “no objective evidence of any joint swelling.” The MRI was “normal.” The only positive laboratory evidence, 2 the January 1990 x-ray, showed merely very early disc space narrowing, and, on another occasion, Dr. Keller noted merely that Craig’s “headaches may be due in part to arthritis and/or disc disease.” J.A. at 154 (emphasis added). Moreover, Dr. Lemley found “[n]o signs of active inflammation about any of the joints” and “adequate range of motion at all sites.” J.A. at 129. And, Craig remained able to perform significant housework and worked until June 1, 1992, as a seamstress. Thus, sufficient evidence justifies the ALJ’s rejection of Dr. Keller’s conclusory opinion and his finding that the record contains persuasive contradictory evidence (including Keller’s own notes).
B.
Craig next argues that the ALJ erred in not considering expressly her physical therapist’s report because, under
Gordon v. Schweiker,
In response, the Secretary notes that a physical therapist does not even qualify as an “acceptable medical source” under the regulations, but rather would qualify only as an “other source,” whose opinions are entitled to significantly less weight. 20 C.F.R. §§ 404.1513, 416.913. Moreover, Madtes’s findings are based on only one visit and are contradicted by the findings of a physician, Dr. Lemley, who examined Craig that same year and found an adequate range of motion at all sites. J.A. at 129. Regardless, Mad-tes’ report did not even find Craig “disabled,” nor did Madtes prescribe significant treatment. Altogether, therefore, the ALJ’s consideration of the medical evidence was more than adequate.
C.
Craig next contends, relying upon cases from the Second, Sixth, and Seventh
*591
Circuits,
Bluvband v. Heckler,
D.
Craig also challenges whether substantial evidence supports the ALJ’s conclusion that she could perform medium level work and that she could return to her prior relevant work as a seamstress. Craig claims that, in determining she could do medium work, the ALJ did not consider all relevant evidence, specifically, Madtes’s assessment of some limited mobility, a DSS interviewer’s one-time notation that Craig had a “swollen” hand, and Dr. Keller’s letter that she could not perform any physical activity. 4 All of these factors were before the ALJ, and, nonetheless, in light of the objective medical evidence and Craig’s own testimony, there was more than substantial evidence to support his conclusion that Craig could perform medium level work. Likewise, substantial evidence supported the ALJ’s conclusion that Craig’s prior relevant work as a seamstress qualified as medium level work. Medium level work requires “lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds.” 20 C.F.R. §§ 404.1567(e); 416.967(c). Craig testified that the heaviest weights that a seamstress was required to lift were between 35 and 50 pounds, that her job was primarily seated (with frequent standing), and that she had to bend and reach frequently (but not walk). J.A. at 37-39, 93. This work falls squarely within the parameters of medium work, as defined in the regulаtion.
E.
Finally, Craig contends that the ALJ applied the wrong standard in evaluating her subjective complaints of pain. Although Craig’s argument on this point is difficult to ' follow, it appears that she believes that the law forbids the ALJ finding her testimony not credible. Instead, presumably, the ALJ was obliged to accept, without more, her subjective assertions of disabling pain and her subjective assessment of the degree of that pain. Of course, that is not and has never been the law in this circuit. As was observed in
Mickles v. Shalala,
The reasoning for such a holding was explained in
Mickles,
essentially verbatim, as follows. A person is “disabled” under
*592
the Social Security Act, and therefore potentially eligible for SSI benefits, if he is unable “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which ... has lasted or can be expected to last for a continuous period of not less than twelve months.” 42 U.S.C. # 8E8E # 1382c(a)(3)(A) & 423(d)(1)(A). A “physical or mental impairment” is further defined as “an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically accepted clinical and laboratory diagnostic techniques.” 42 U.S.C. §§ 1382c(a)(3)(C) & 423(d)(3). Thus, for disability to be found, an underlying medically determinable impairment resulting from some demonstrable abnormality must be established. While the pain caused by an impairment, independent from any physical limitations imposed by that impairment, may of course render an individual incapable of working,
see Myers v. Califano,
In order to make this statutory requirement even more plain, Congress in 1984 amended Title II of the Social Security Act, purportedly to codify the regulatory standard for evaluating pain. See S.Rep. No. 466, 98th Cong., 2d. Sess. 23-24 (1984); H.R. Conf. Rep. No. 1039, 98th Cong., 2d Sess. 29 (1984), reprinted in 1984 U.S.C.C.A.N. 3080, 3087-88. The amendment, in language which closely paralleled the Secretary’s 1980 regulations, see 20 C.F.R. §§ 416.929 & 404.1529 (1983), provided that
[a]n individual’s statement as to pain or other symptoms shall not alone be conclusive evidence of disability as defined in this section; there must be medical signs and findings, established by medically acceptable clinical or laboratory diagnostic techniques, which show the existence of a medical impairment that results from anatomical, physiological, or psychological abnormalities which could reasonably be expected to produce the pain or other symptoms alleged and which, when considered with all the evidence required to be furnished under this paragraph (including statements of the individual or his physician as to the intensity and persistence of such pain or other symptoms which may reasonably be accepted as consistent with the medical signs and findings), would lead to a conclusion that the individual is under a disаbility. Objective medical evidence of pain or other symptoms established by medically acceptable clinical or laboratory diagnostic techniques (for example, deteriorating nerve or muscle tissue) must be considered in reaching a conclusion as to whether the individual is under a disability-
42 U.S.C. § 423(d)(5)(A) (emphasis added). This standard was made applicable to SSI determinations as well by an amendment to Title XVI incorporating section 423(d)(5) by reference. See 42 U.S.C. § 1382e(a)(3)(G).
Interpreting section 423(d)(5)(A), this court held that in order for pain to be found disabling, there must be objective medical evidence establishing some condition that could reasonably be expected to produce the pain alleged.
Foster v. Heckler,
Although it still appears in the statutory codification and decisions have continued to be rendered under it,
see, e.g., Jenkins,
On November 14, 1991, the Secretary, acting pursuant to the rulemaking authority delegated by Congress in 42 U.S.C. § 1302, substantially revised the regulations governing the evaluation of pain in SSDI and SSI disability determinations.
See
20 C.F.R. §§ 404.1529, 416.929. These regulations provide the authoritative standard for the evaluation of pain in disability determinations,
see Pope v. Shalala,
Sections 416.929 and 404.1529, governing disability determinations, incorporate the standard set forth in section 423(d)(5)(A) and explain that standard each with more than three and one half pages of small type. These lengthy regulations begin by emphasizing the importanсe of objective evidence in determining whether a claimant is disabled by pain:
In determining whether you are disabled, we consider all your symptoms, including pain, and the extent to which your symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence.... However, statements about your pain or other symptoms will not alone establish that you are disabled; there must be medical signs and laboratory findings which establish that you have a medical impairment(s) which could reasonably be expected to produce the pain or other symptoms alleged and which, when considered with all of the other evidence (including statements about the intensity and persistence of your pain or other symptoms which may reasonably be accepted as consistent with the medical signs and laboratory findings), would lead to a conclusion that you are disabled. In *594 evaluating the intensity and persistence of your symptoms, including pain, we will consider all of the available evidence, including your medical history, the medical signs and laboratory findings and statements about how your symptoms affect you.... We mil then determine the extent to which your alleged functional limitations and restrictions due to pain or other symрtoms can reasonably be accepted as consistent with the medical signs and laboratory findings and other evidence to decide how your symptoms affect your ability to work ....
20 C.F.R. §§ 416.929(a) & 404.1529(a) (emphasis added).
Under these regulations, the determination of whether a person is disabled by pain or other symptoms is a two-step process. First, there must be objective medical evidence showing
the existence of a medical impairment(s) which results from anatomical, physiological, or psychological abnormalities and which could reasonably be expected to produce the pain or other symptoms alleged.
20 C.F.R. §§ 416.929(b) & 404.1529(b) (emphasis added);
cf.
42 U.S.C. § 423(d)(5)(A) (“[T]here must be medical signs and findings ... which show the existence of a medical impairment ... which could reasonably be expected to produce the pain or other symptoms alleged.... ”)• It is significant that the current regulations, like the statute upon which they were based,
see
42 U.S.C. § 423(d)(5)(A), and paralleling the regulations which that statute purported to codify,
see
20 C.F.R. §§ 416.929, 404.1529 (1983), were drafted using the definite article “the” and the adjective “alleged.”
6
Therefore, for pain to be found to be disabling, there
must
be shown a medically determinable impairment which could reasonably be expected to cause not just pain, or some pain, or pain of some kind or severity, but
the pain the claimant alleges she suffers.
The regulation thus requires at the threshold a showing by objective evidence of the existence of a medical impairment “which could reasonably be expected to produce” the actual pain, in the amount and degree, alleged by the claimant.
Cf. Jenkins,
This threshold test does not, as the regulation is careful to emphasize, entail a determination of the “intensity, persistence, or functionally limiting effects” of the claimant’s asserted pain. See 20 C.F.R. §§ 416.929(b) & 404.1529(b). At this stage of the inquiry, the pain claimed is not directly at issue; the foсus is instead on establishing a determinable underlying impairment- — a statutory requirement for entitlement to benefits, see 42 U.S.C § 1382e(a)(3)(A) — which could reasonably be expected to be the cause of the disabling pain asserted by the claimant.
There is, of course, a fundamental difference between objective evidence of pain (which is not required) and objective evidence of a medical condition which could cause the pain alleged (which is). Requirement of the former is obviously not the law, for the simple reason that pain, a subjective phenomenon, although sometimes objectively verifiable, often will not be. Objeсtive evidence of the pain the claimant feels is thus, quite sensibly, not required for entitlement to benefits. 20 C.F.R. §§ 416.929(c) & 404.1529(c). However, the latter- — objective evidence of a condition “which could reason *595 ably be expected to produce the pain or other symptoms alleged” — equally sensibly, is required by the Secretary’s regulation. 20 C.F.R. §§ 416.929(b) & 404.1529(b).
Indeed, that such a requirement is part of the regulatory scheme is confirmed by the portions of the regulations providing that, in the disability hearing process, before the ALJ, and before Appeals Council, expert medical advice may be sought and considered in determining whether an “impairment ] cоuld reasonably be expected to produce [the claimant’s] alleged symptoms.” Id.
It is only after a claimant has met her threshold obligation of showing by objective medical evidence a medical impairment reasonably likely to cause the pain claimed, that the intensity and persistence of the claimant’s pain, and the extent to which it affects her ability to work, must be evaluated. See 20 C.F.R. §§ 416.929(c)(1) & 404.1529(c)(1). Under the regulations, this evaluation must take into account not only the claimant’s statements about her pain, but also “all the available evidence,” including the claimant’s medical history, medical signs, and laboratory findings, see id.-, any objective medical evidence of pain (such as evidence of reduced joint motion, muscle spasms, deteriorating tissues, redness, etc.), see 20 C.F.R. §§ 416.929(c)(2) & 404.1529(c)(2); and any other evidence relevant to the severity of the impairment, such as evidence of the claimant’s daily activities, specific descriptions of the pain, and any medical treatment taken to alleviate it, see 20 C.F.R. §§ 416.929(c)(3) & 404.1529(c)(3).
The regulations, as did the statute,
see
42 U.S.C. § 423(d)(5)(A) (“Objective medical evidence of pain or other symptoms ... must be considered.”), specifically provide for the consideration of objective medical evidence of the pain (if any such evidence exists) in the evaluation of its intensity and persistenсe. However, because pain is subjective and cannot always be confirmed by objective indicia, claims of disabling pain may not be rejected
“solely
because the available objective evidence does not substantiate [the claimant’s] statements” as to the severity and persistence of her pain. 20 C.F.R. §§ 416.929(c)(2) & 404.1529(c)(2) (emphasis added);
see also Walker,
This is not to say, however, that objective medical evidence and other objective evidence are not crucial to evaluating the intensity and persistence of a claimant’s pain and the extent to which it impairs her ability to work. They most certainly аre. Although a claimant’s allegations about her pain may not be discredited solely because they are not substantiated by objective evidence of the pain itself or its severity, they need not be accepted to the extent they are inconsistent with the available evidence, including objective evidence of the underlying impairment, and the extent to which that impairment can reasonably be expected to cause the pain the claimant alleges she suffers:
We will consider your statements about the intensity, persistence, and limiting effects of your symptoms, and we will evaluate your statements in relatiоn to the objective medical evidence and other evidence, in reaching a conclusion as to whether you are disabled. We will consider whether there are any inconsistencies in the evidence and the extent to which there are any conflicts between your statements and the rest of the evidence, including your medical history, the medical signs and laboratory findings, and statements by your treating or examining physician or psychologist or other persons about how your symptoms affect you. Your symptoms, including pain, will be determined to diminish your capacity for basic work activities ... to the extent that your alleged junсtional limitations and restrictions due to symptoms, such *596 as pain, can reasonably be accepted as consistent with the objective medical evidence and other evidence.
20 C.F.R. §§ 416.929(c)(4) & 404.1529(c)(4) (emphasis added);
cf.
42 U.S.C. § 423(d)(5)(A) (“[TJhere must be ... a medical impairment ... which, when considered with all the evidence ... (including statements of the individual or his physician as to the intensity and persistence of such pain or other symptoms which may reasonably be accepted as consistent with the medical signs and findings), would lead to a conclusion that the individual is under a disability.”);
Gross,
In the instant case, the ALJ did not expressly consider the threshold question of whether Craig had demonstrated by objective medical evidence an impairment capable of causing the degree and type of pain she alleges. Instead, the ALJ proceeded directly to considering the credibility of her subjective allegations of pain. J.A. at 16. Accordingly, we remand to the ALJ to determine whether Craig has an objectively identifiable medical impairment that could reasonably cause the pain of which she complains. 7 If the ALJ concludes that she does, then, and only then, should it undertake an assessment into the credibility of Craig’s subjective claims of pain.
AFFIRMED IN PART, VACATED IN PART, AND REMANDED.
Notes
. The Social Security Act comprises two disability benefits programs. The Social Security Disability Insurance Program (SSDI), established by Title II of the Act as amended, 42 U.S.C. § 401
et seq.,
provides benefits to disabled persons who have contributed to the program while employed. The Supplemental Security Income Program (SSI), established by Title XVI of the Act as amended, 42 U.S.C. § 1381
et seq.,
provides benefits to indigent disabled persons. The statutory definitions and the regulations promulgated by the Secretary for determining disability,
see
20 C.F.R. pt. 404 (SSDI); 20 C.F.R. pt. 416 (SSI), governing these two programs are, in all aspects relevant here, substantively identical.
See also Bowen v. City of New York,
. Craig argues that the fact that Keller observed Craig (when she complained about the pain) transforms his observations into "clinical evidence.” If this were true, it would completely vitiate any notion of objective clinical medical evidence. There is nothing objective about a doctor saying, without more, "I observed my patient telling me she was in pain.”
. Likewise, Craig’s contention that the hearing was too brief to he meaningful is meritless. Here, the ALJ adequately questioned Craig and her witnesses and considered the relevant evidence. We cannot conclude, therefore, that Craig's hearing was too brief to be meaningful.
See Kelley
v.
Heckler,
. Also, Craig argues that the wrist splints Dr. Kеller prescribed for her possible carpal tunnel syndrome make her unable to work, and that the ALJ neglected to consider this disability. The obvious failing in this argument, however, is that Keller prescribed the wrist splints in 1990, and Craig worked uninterrupted for two years thereafter.
. In
Foster,
we also found that § 423(d)(5)(A) was consistent with our prior precedents.
Id.
at 1129 n. 7;
see also Thompson v. Sullivan,
. 20 C.F.R. §§ 416.929(b) & 404.1529(b) (emphasis added) both provide that,
[y]our symptoms ... will not be found to affect your ability to do basic work activities unless medical signs or laboratory findings show that a medically determinable impairment(s) is present. Medical signs and laboratory findings ... must show the existence of a medical impairments) which results from anatomical, physiological, or psychological abnormalities and which could reasonably be expected to produce the pain or other symptoms alleged.
See also Jenkins,906 F.2d at 108 ("|T]his court has interpreted [42 U.S.C. § 423(d)(5)(A) ] as requiring a claimant to show objective medical evidence of some condition that could reasonably be expected to produce the pain alleged, not objective evidence of the pain itself.” (emphasis added)). Even if our precedents were contrary to this regulation, which they are not, these regulations would be controlling. See Pope,998 F.2d at 485-86 .
.
The Secretary also argues, correctly, that, based on
Cauthen v. Finch,