yet another instance where the commission refused to heed discourse warning this band decades and relied on and demanded that mr lewis produce objective evidence not just of the pain itself but of the intensity of it and although this work as found by the commissioners by dale jr twenty nine and finally parties agree that if mr lewis his complaints were to be believed she would be found disabled and there would be no jobs available for her it's just a fight by the occasional expert and they are sixty that pain preclude her from working but the why this works out is that he wants the parties agreed on those first four issues and the burden to show that there are in fact jobs and actually economy business was could perform is not no longer mr lewis is now on the government and the government simply failed to carry the burden the government must show that mr lose lose doesn't suffer from as much pain as she alleges the government relies on to government support of this position and they say that there's like objective medical findings that she's able to do household chores and that the type of medical treatments received as conservative as opposed to sufficiently intense to make her clinic believable and each of those organs is simply wrong either as a matter of science or as a matter substantial evidence and that's in two thousand and six and hyper solvent at nine hundred ninety and going past a number of decades in fact commission's own regulations prohibit rejection of substantive testimony simply because of absence of objective find and that's my perfect sense from a medical viewpoint because the very nature of chronic pain often precludes the presence of objective evidence use chronic pain and like peripheral pain is the pain where the locus is not actually in a distant joint or not entirely credible correct and then making the next statement he seems to make some statements that are not factually accurate the record reflects th too because ordinarily we get tremendous weight to that so do we is that undermined by the fact that he's reciting facts that are not supported by the record yes it is just c he's required by regulations on less inconsistent the rest of the testimony and so rather than just exactly but he's allowed to give him he's required to controlling weight unless it consistent with the rest of the medical evidence and there's again no one consistency case i'm not giving the treating physicians ok i'm only giving them partial weight it goes back to the same three items that show up longitudinal conservative treatment record whatever that is the clinical examination findings treating physicians did not receive the weight that would appear to be required by the regulations for those three items is that that is my position i and i suppose a question about a truck opposing counsel but i don't see anything else out there that would  says well it's not surgical well first of all there was surgery a boat with the actual scalpel and would radio ablation but of course not every ailment is amenable to surgical intervention the definition the medical explained by objective medical evidence i'm not quite sure what more what kind of additional treatment would be no longer be conservative and interfere in my last couple minutes i do want to store point out  good to this idea of i'm going abilities beyond the fact that miss miss lewis does household chores including you know driving her son for wasn't thirty miles a day cooks basic is no indication that she can do much and as this court has noted a number of times that ability to do household chores at your own time is your own leisure including taking time off when you don't feel particularly well and having household chores are just cook meals or you know perhaps because trash in a backyard or things like that is sufficient to show i'm going capability of actually maintain employment in a national economy so all of these considerations that are  either inappropriate or me or simply don't support don't provide sufficient weight to the elegies finding one last point that i would like to address is that in his brief the government argued that  everything is relative your honor the conservative treatment that b o j was referring to was the surgeries that had occurred had occurred early on in the claimants allegations of disability she had recovered shoulder which miss lois herself concedes as her main one hundred percent her main centering problem an m r i revealed no evidence of ongoing problems around the nerves and no abnormalities of the nerves  right i would like to address the allegation of reflex sympathetic dystrophy and the chronic pain if i may and actually your honor if i may i'd like to begin with with actually two points miss lewis goes to great lengths to criticize the l j for not addressing mr lewis is reflex sympathetic dystrophy however i would remind the court consistent with the agency policy l j clearly is not required to address an allegation that does not amount to a medically determinable impairment another point that i would that i would like to write raise step two of the sequential evaluation process your honour's is a threshold step it requires a showing that a claimant has at least one severe impairment or combination of impairments that severe but once that showing is made the evaluation proceeds to the next steps and wish to claim it must prove either that her impairments are medically so severe to be presumptively disabling or in the alternative that the impairments preclude her from performing prior work or other work if i may provide an example hypothetically so you have a claimant with a severe visual impairment and  g unfortunately misses this at step two if they enter proceeds to discuss the evidence and appropriately incorporates limitations pertaining to say visual acuity in the r f c the decision is but the resident term credibility yes but if you read the decision in its entirety dale j thoroughly discussed all of the evidence discussed all of the factors that are required under ninety six seven p and no one sole but after her december twentieth levon surgery after her diagnosis of lupus and twenty twell it just seemed like the a l j didn't incomplete job in addition to the mess you know where and why shouldn't we send this back i mean i understand the huge difference that goes to be able to properly so but it just seems to me where you got the mess you were when he didn't address the lupus where he's relying on these older doctors reports he calls conservative was considered by the l j a transcript twenty seven there's discussion of her treatment for lupus here knowledge didn't discuss it in terms of the exertional limitation city i would also point out that the test is no answer that question he didn't address the lupus diagnosis in terms of the research in the limitation he did address dr jacobs opinion and gave appropriate reasons for recording that partial weight but i would point out your honor if i may that the testimony at the hearing by m lewis was that that condition fortunately was in remission and had been for one year at the time of her hearing and that was the appropriate time for the regulations the jury is required to give controlling weight to the treating physicians so long first but simply citing that for a he never explains that i can see why that neg ates the treating physicians pain diagnosis discount the treating physicians pain evidence the longitudinal treatment record it's detailed following the the recitation of the r f c for three or four pages of detailed description of  the medical evidence in the case the medical evidence repeatedly shows and again this is just one factor that repeatedly shows as they say here's item one two and three and these are what caused me to not give way to the regulations require are to the evidence of treating physicians he doesn't he doesn't resign one two and three but if you look through the record you can see where he discusses the medical evidence the medications that  that if we assume that he didn't do this on the conservatory record it gives to other reasons one of which is her ongoing capabilities he recites they all go in capabilities to be watching television writing her own checks going to the grocery store with her mother i'm lost just to see how that relates to a diagnosis of pain i guess our position your honor   that mr lewis heavily relies on and both of her briefs i would point out your honors there are three page references in a nine hundred fifty some page record that even refer to aristide the at all and three pages are in mr lewis is own disability report at transfer of one eighty four and this is just miss lewis is completion of a report in which she says aristides one of her disabling impairments the other two are from one time examiners one of whom was a psychologist and just simply at access three of dr miller's report simply lists aristeas one of the as one of the diagnoses clearly dr miller did not diagnose ms lewis with aristide's a psychologist and he saw her on one occasion the final one is transcript page five sixty nine another consultative physician dr murshidabad at the end of his report lists of number of impairment under impression near the end of that list dr mashad mentions possible reflex sympathetic dystrophy more to the point the only other reference in the entire transcript of record to does not have any concrete sign of c r p us which is complex regional pain syndrome what does this tell us runners respectfully it tells us there clearly are concrete signs of this condition and miss lewis did not have them she cannot establish that she had this now chronic pain she testified to this she also testified to her anemia which was in remission fortunately at the time of the hearing  to her carpal tunnel syndrome diabetes or anemia she also mentioned her thrash outlet syndrome and in fact emphasized that this was her quote big problem continues to be the through racicot outlets and she testified concerning some issues with anxiety and depression she of course did testify about her pain and the o j of acknowledge this testimony but she did not interesting lee offer any mention whatsoever of reflex sympathetic dystrophy  now s s a has a ruling that's devoted to aristid zero three two p and in this ruling s s a explains that there are certain clinically documented signs in the affected region that can establish the presence of reflex sympathetic dystrophy these are swelling autonomic instability which is like gooseflesh abnormal hair or nail growth osteoporosis or involuntary movements of the affected region now her brief miss lewis attempts to match these guidelines to her case without the benefit of medical support by citing to the presence of a quote precipitating injury and to miss lewis is own complaints of stabbing burning throbbing with this miss lewis claims that her symptoms match the commissioner's own description of aristide quote almost verbatim but other than evidence of tremors mr lewis meets none of the criteria that's actually set forth  necessary zero three two p in fact the evidence overwhelmingly shows no evidence of swelling autonomic instability abnormal hair or nail growth or osteoporosis your honour's yes ju alleged disability and worthy in a situation such as this where the a o j it properly discounts her credibility based on her residual functional capacity normal muscle strength range of motion sensation reflexes how can we say this is harmless not was even if we grant you most of what you said why isn't this a problem when pain  is and he used the wrong measurement to evaluate her credibility and credibility is so central to whether you can make a case of pain or not it is and i would agree with that judge but i would point out that i would point to thomas first of celebrating which says that a review in courts duty is to scrutinize the record as a whole determine whether the conclusions reached a rational now if the  anything was left out of the r f c that should have been in there she's not arguing that there is they are c should have been more restrictive so how could that have been harmful if everything that's in that r f c is in there he accommodated her left her her pain is centered and this is in the reply brief it's centered in the left shoulder and the left arm this was accommodated in the r f c very thoroughly limited her ability to lift with that non dominant left upper extremity he limited her ability to push and poll he absolutely precluded her from overhead work with that left arm he limited her reaching ability with the left arm and finally limited her finding gross dexterity with the left up that you only need to be off task five percent of the time as opposed to ten percent where's the evidence on that i believe that her own i believe her own disability report dispel that notion he pointed still has to be evidence to support it i think it could have been zero i think the l j was giving her the benefit of the down there was evidence that she did not suffer from  concentration deficit as well so in conclusion your hono strategic position is that in this case it is it appears to us that mr lewis would have this court hold a dangerous precedent that it's sufficient for a claimant simply to allege chronic pain without the presence of any medically determinable impairment and the commissioner with that is simply compelled to accept that claim at face value and pay benefits again i would emphasize that would be a very dangerous precedent with wide ranging effect and we urge the court thank you very much trying to let me just address maybe two or three points and let me begin with with where opposing counsel left off first of all we are not arguing god mere allegation of pain means the commission had to throw up its hands and just start work so she has evidence and they have not they they did just make it up and then finally i would like to point out again so commissioners misunderstand government understand what it means both miss citing the record and what it means to have an event for recovery so first off the surgeries although certain surgery have occurred early on must lose did have nerve blocks after her surgery so even though her rep was resected even though dr care said this might provide you some relief she still had to go through two separate nerve blocks and finally the same idea that uneventful recovery means everything's just fine you can have a surgery recover normally from it doesn't mean the problem is solved those are two completely separate issues and ultimately the government simply