it's our contention that the l g a failed to properly consider two key medical opinions in assessing mr bradshaw's mental residual functional capacity the pain of dr thomas the consulting psychologist and the routine tasks with minimal contact with the public and coworkers and rejected dr thomas's opinion and claim to give great way to dr lance burke opinion but did not include significant limitations also found by dr lance for it's important to know that the social security rulings provide that there are some rican ponens to being able to perform the mental demands of unskilled work the first component is to understand carry out and remember simple instructions in this undisputed that mr bradshaw can do this he can follow simple instructions both his both these doctors said he could but the second is to respond appropriately to supervision coworkers and usual work situations two thirty eight of the record there he had a medical store statement and the very different definitions in the in this statement and one of them one of the definitions is fair and that is the is that the evidence supports the conclusion the individual's capacity to perform the activity is impaired and dr lance burke said it was impaired ability to perform activities within a schedule and maintain regular attendance to complete a normal work day and work week without interruptions from psychologically based symptom and to respond appropriate changes in a work setting the third one is very important because slow screw really eighty five fifteen which i was referring to the three parts of the mental demands of unskilled work the third component is you have to be or is it that there was more development of what fair constituted that was required could you help me understand which one both because the definition says that it is impaired but the degree extent of the impairment needs to be further described this is in the form you have to look at fair has a different definition according to be have to look at what the form says the definition is because that's what the doctor is answering the questions on the f know that the government argues we know it wasn't poor because poor would have been the other option so it's somewhere between good and poor is that not sufficient and then it's between good and poor that's correct it's but it's impaired and is impaired to say to the degree we do not know because he never answered the question but certainly it has some limitation and that is an important limitation to the ability to perform unskilled work as set forth and ruling eighty five dash fifteen as i just mentioned now the a i would say the other thing it's very important to point out is that dr thomas's opinion that mr bracha had difficulties dealing with others is also supported by very important lay evidence from his from two  masters of counseling individuals who somebody reports in the rectory of pages one sixty two and one sixty three we have a letter from stephan gonzales who's has a dual diagnosis drug and alcohol counselor and then on page one sixty three a letter from she who has an m s in counseling at the time both of these individuals wrote these letters they had been working with mr bradshaw for eighteen months and both of them found significant problems getting along with other individuals for example and this supports dr thomas's opinion for example to explain to me after thomas opinion because she seems she says it's mildly impaired it's moderately impaired or it's unlikely that he would be able to interact at all anxious it's unlikely that he will be able to interact with coworkers and the public the different components of work so the doctors describing different aspects of the functions of work so he says he'll be unlikely that he would be able to interact with coworkers on that she says that  he has the ability to say except instructions and interact with coworkers in the public it appeared moderately impaired and he couldn't do it at all so it was just it was difficult for me to understand what her or her conclusion actually was and then she says a half of forty five which is the l j indicated is inconsistent with her other findings as i mentioned earlier there he can do simple work but that's not the only and now says you have to look at you have to also remember that the three components i mentioned at the outset and clearly according to dr thomas he has a significant limitation ability to respond to supervision coworkers and useful work settings and that's a significant limitation and would be consistent with a gaffe of forty five because the commission's regulations say a substantial loss to meet any of the basic work activities would severely limit that the tensional occupational base and this can so of just one any of these work related activities so it is e l j s c say that mr bradshaw was limited to minimal contact with the public and coworkers why doesn't that take into account the  two doctors view that he was impaired or moderately impaired or had their ability to interact with the public so minimal contact that as he is limited to simple routine tasks and all contact with the public so why doesn't that take it into account will minimal contact is not nil contact it's quite a different thing when the other doctor said no contact i think was on my only harry gable to interact but that's only one of the three things she said the other places she said it was moderately impaired that's correct and but also overall when you read the report i think it does show significant limitations and as i was mentioning those other evidence that shows the degree of limitations and while not acceptable sources cannot make a finding of a diagnosis a condition their opinions are entitled to weight under rulings zero six three p i thought the ale case and there were reasons for rejecting them but they were inconsistent with l that know that and i had indicated the l j rejected them because he said they said he had concentration limitations and mr bradshaw stated on activity living form that he could cove and it was referenced in our supplemental it wasn't and they have medical evidence in that case that there was progress there was evidence of progressive deterioration was there medical evidence of progressive deterioration my base case well i think in general he should be the  evidence is showing that that clearly his his late the late people i was explaining they've they found he's quite significantly limited they worked with him for these eighteen months and they both find that he has difficulty relating to people in appropriate manner he can be quick to anger he has difficulty relating to authority figures in response inappropriate requests for direction from people with authority over his actions he isolates you voice contact with others they live with him they work with him on a daily the ale cas inconsistent with the a d l zz and his testimony and so then the question would be well was there and you know the argument that was made in the brief for him that you made was that well that those eighty l's were couple of years earlier and so the question as well was there evidence in the record that he had progressed a disease that was progressively deteriorating like in this evidence or case the what he said in the form was that he wasn't there though was there evidence of progressive deterioration in his condition medical i suppose and i think the evidence of the his treating doctor shows he was he actually got a prescribed additional medication it's in the record that a year after doctor a year after dr thomas evaluated the gentleman he was he was told he was there was evidence that he on page two sixty nine of the records they they prescribe risk for all which is a medication because he was having disturbing dreams  depression with insomnia associated with disturbing dreams to a year after dr thomas evaluated him and he's not he this is a regular general practice clinic they prescribe additional medications which show he's gotten worse because they psychologist but he only saw the mr bradshaw twice according to my record and it was early in the application process i having being seen by the quote treater that's what you're calling landsberg right to where you talk about acceptable medical sources and to me the three reports detailed the observations that are made of mr bradshaw for eighteen months by mr costin he's described in the record and i'm now at page i think one thirty four of volume two cost is described as the manager i assume that means the manager of the residential with this says that mr bradshaw is coming to realize he might not be able to work at one thirty nine he says he's disappointed that he's not able to work mr gonzalez who is the dual diagnosis drug and alcohol treatment riviere it's an a barbara describes her background she says i've been working with as a health care provider for over thirty years i've had significant contact in the unique opportunity to observe and the premise for my question is this i went to the practice of so security law here it says the reality of medical care in the era of h m o's and other managed care situation is that many people are prevented from actually seeing a physician until an insurance carrier allows them to hence an increasingly large population may be seen an issue and perhaps on a regular or prolonged basis by a nurse practitioner of physicians assistant or in mental health cases a therapist who both treat and screen who ultimately get to see quote the doctor this is a real change from traditional medical practice and while s s a definitions of acceptable medical sources has not appreciably change the reality of  listed both would require contact with the public a cafeteria attendant job and an office worker and we look at ten and that's a violation of zero zero for you but i do want to reserve a few minutes for rebuttal and also we did point out the credibility finding had some mistakes and at the lower court initially found that the finding on the credibility regarding his for example he didn't have a tens unit and he wasn't taking a potent medications that that was incorrect because the man is an addict he can't take medications and there is evidence that he was on a tens unit physicians what do we do about the thomases statements which include the statement that as opposing counsel points out it is unlikely that he would be able to interact with coworkers in the minimal public contact well she said as one of the three or four things she says is it is unlikely that he would be able to interact with coworkers in the public and then she goes on to say moderately impaired moderately impaired  but there is that one statement regarding his inability and clearly the r f c doesn't say no contact with the public as minimal contact with the public restrictions you minimal public contact minimal contact with her i have a question for you after hearing from mr bradshaw's counsel about the meaning of this word fair which we see  evaluation dr landsberg would you comment on it he you argue i think that the affair doesn't equate with inability to work but she suggests that the meaning of fair and how it's used in the different documents needs to be figured in what is your response to  look into the form itself it is evident that the word fair does not mean inability to sustain there were other options on the form at the top doctor could have chosen including por which would indicate that the individual cannot usefully perform sustain activity dr lanza or didn't select that option rather he chose fair and in light of the contemporaneous and remarkable mental status of the m that dr landsberg performed on that public workers so so posing counsel suggests that this has to be sent back to expand on what fair and that was one of the arguments are you so why why wouldn't we do that given that the form itself says the degree extent of the imperative impairment needs to be further described and he didn't choose to describe it there's no duty to further develop the record because there is enough information in the record for the l j certain directions and changes in your workplace or you know can he actually completed a normal work day in light of some of the psychological impairments that's kind of what's missing from the so called treating doctor on the l j puts significant reliance at least in the mental field they also relied on the state agencies like heart to specifically intensity persistence and limit limiting effects of these symptoms are not creditable to the extent they are inconsistent with the above residual functional capacity assessment by the way this appears in almost every decision am i correct want to know there's no evidence in the record of a lingering what is the specific reason that's clear and convincing evidence that he should not be believed alternate on on page fifteen isn't the only isn't the end of the analysis of his adverse credibility determination and he continues on page eighteen and nineteen to provide additional analysis after having pain but but what's the reason he's not believed that he's reciting the medical i agree with you there was such the medical what is the reason that they have to take gives that he's not believed because he did not so if somebody doesn't participate in treatment that's consistent with their pain they're therefore not credible it is one of the factors that an l j can consider in determining whether the allegations are are credible well the first opinion of the magistrate judge said about that and i'm at volume one page ninety seven quote some of the reasons the l j gave for rejecting plaintive subjective pain testimony were based on misstatements of the record and are therefore not clear in convincing the alleged areas with respect to the ted's unit the tens unit that claim it used was from approximately two thousand and four five years before the period as you claim it testified that the ten you know was at least somewhat effective in controlling his pain so despite that he didn't ask or ok to get back to judge my feelings question for a moment at page ninety nine that judge says failure to do more than see conservative medical care is an erroneous reason to disbelieve what would you say about that it wasn't the only reason that the  discredited claimants allegations there were several other reasons and if this is the conservative but but could you answer the more specific question about the link between the nature of treatment and the credibility finding that i know there are other credibility  gs but before you get to those i'm not sure exactly what well it's really what judge pratt's question was you were going on said yes but then there's all these other credibility findings so the question is we have from the magistrate judge this question about how the nature of the treatment sought really undermines his credibility and yours and you haven't really responded to that more specific point conservatives is a basis for disbelieving to ask you because i don't get the context of this the vocational expert testimony i'm at page sixty nine the ale j without any prompting he has the v page sixty nine of volume two examination of vocational expert by administrative law judge he gives his past work says he can't do it he was an experienced carpenter and he can't do it then out of the blue no question pending that hail j i guess announces because it's not a question now i will not put together counsel based on testimony because it's supported by the medical evidence and obviously no judge such a functionally restricted no job such a functionally restricted could not know i understand that and that shifts the burden to the commissioner doesn't it ok obviously no job such a functionally restricted person could perform j makes his comment which seems to say carpentry is not a job that someone who is functionally restricted as mr bradshaw is could perform and then they go on i believe to determine what occasional expert with twenty years of experience testified that such an individual would be able to do these jobs after you were an office worker i thought my challenges was that the a l j didn't include representation that he could do those functions yes they will be specifically asked if there were any conflicts between the bookies answers testimony in the dictionary of occupation titles and the testified that there was no conflict i mean  mr kenny yes how is it substantial evidence to leave out of the hypothetical question the three people that had observed the plaintiff day in and day out for eighteen months one of the three people to whom i believe you're referring is ronald casa he wrote the overseer at right at the the living facility and he supported the eld the claimant statement that he didn't have concentration  the residual functional capacity finding of the l j and not be included in the hypothetical because they were not the l j properly rejected in the words of those limitations were not supported by the record in the l j only has to include those restrictions that are supported by the record where they seem to be lay witnesses if they weren't so he had to give germany reasons is that right that is correct and and in your view he gave germane reason for that your main reasons i weight than just of a parent or a family member giving a statement under zero six three p they are providers of health care and they should carry more weight as long as they are they can give diagnosis but their opinions are functional limitations should should have been properly credited with there the evidence has other shows that he had serious problems with his knees he has an m r i of the lumber spine which was ignored by the hail j as an x ray of the right knee which was not referenced by the l j abnormal findings he has decreased sensation problems with reflux as well add a really significant weakness reduce range of motion positive straight leg raising test these are all significant findings the support his subjective complaints regarding his physical impairments and as mentioned earlier the tens unit reference was incorrect as well as in the issue of the pain control was difficult for him because of his history of addiction i'd also want to quickly mention that even the hypothetical question the l j did not include the limitations that he did credit from dr lansbury he credited the limitations he said he give great weight to the this doctor's opinion but didn't include any limitations in dealing with the work without changes in a work setting completing a normal work w some statements fail jay said right up before they've even testified which was mentioned by judge press that i will our counsel based on the testimony because it's supported by the medical level it's obviously no job such a person could perform i'll just give you one here we get the new evidence so i think it was assumed that was going to be a favorable decision to be honest based on the judge's own statements i think thank you and i think both counsel for their arguments this morning the case of great job versus coleman is submitted