all right our second case for this morning is another social security case that nap against barry hill and we'll hear again from mr rodman with it being step five the s s a and i'm and i'm quoting here from the clifford case cited in the briefing by the s s a has the burden of a stablished chain that now has the capability of performing other work in the national economy and so on through my points today am i'm going to show how that person was not met first off with the chemotherapy residuals  she would have trouble concentrating staying on task and remembering what i asked to do i will be showing that that should have been credited in terms of the neuropathy  and other limitations that really this gets to dr kidders opinion he didn't just say she couldn't work he started in the lead statement was that the breast cancer and then other things such as that are opti or going to be in a difficult state and i'm paraphrasing here a little bit so so how does the neuropathy relate for example i'm looking at page sixteen of seventeen of the male j's decision where the vocational expert testified that there are these jobs such as a dresser surveillance system monitor document prepare and final assembly or how does the neuropathy relate to those well i would think it and i would think that that relates to the ability to use the that the hands the extent to which the neuropathy is is is on the extremities peripheral neuropathy right and and so it comes into that the hands but and this kind of sneaks into might second arguments all the talk about it now since you've asked the question well which is that there is a there's chemo bra connected to chemo brain chemo brain it isn't the sort of thing that one goes back to work with without some kind of accommodations and with her she did go back to work and so presumably you know was was managing you know had some strategies that really worked until her impairments in combination i think probably most notably the depression specifically diagnosed major depression depressive disorder sort of ganged up on and knocked off that whatever delicate balance she was able to do  kept her from continuing to work which is to say connected to dr kidders observations it seems to be implicitly again the residuals breast cancer then these other things it and also the specific you know approximate two year period it mirrored an earlier opinion that it really was before the formal time period but what was before she started the cancer or the cancer therapy that specific the chemotherapy she the doctor guys the cancer doctor of mine that you know would be at least a solid year in and all these different things were going to go downhill significantly and i think if you look at the record the extent of time that she was under chemotherapy it's more than most folks under chemotherapy go through so i mean if i could just s first but in terms of and i will point to the beardsley case here they talked about how you know these not examine consultants just because you've got that where and where that combines with conservative treatment and it's not consist in the ones in the consultant is not consistent with the description of the activities that that she's dealing with then that is not good enough to as i read them require that the r f c be based on all relevant medical evidence and here you have dr kidder who treated miss now if i read the record right going all the way back to two thousand and six but all understanding of the condition and circumstances that the claimant is going through and and so i don't disagree that that argument has salience it but the favorable to a finding of ability to work and she looks at him when it is favorable to the finding that she wants to make so i see a real inconsistency in her approach objective on findings of dr carey and dr cutter's treatment notes and i'm talking about when you when you refer to the doctor killers to opinions you're you're referring to the very brief april of thirteen in october of thirteen the one paragraph c that medical authorities provide and in that exact letter he only indicated that support for his opinion that she could not work was the combined impact of her medical conditions he did not actually reference any earlier treatment records or any medical findings or any functional limitations but it was in the record that's the problem and he's who snapped through her lawyer is certainly arguing that there is a lengthy and deep treatment relationship and the able j doesn't mind looking if those clinical notes for other purposes it's not as though the l j says i'm just putting blinders on i'm not going to look at dr kidders notes at all while the notes are mentioned repeatedly through the opinions so if the notes are pertinent then these two rather summary things should be read against the backdrop of the notes he's just given the bottom line but i'm looking at the are of c and this is a woman who's got serious psychological problems she's on coke a set which is not a minor drug she's got pain after useful beast she can only clean part of the house each day because she's got to rest and we frequently have mentioned that you know the cleaning up the bathroom in the kitchen and then taking a nap isn't the same as having a job well your honor they all dated consider her report that she cooked and cleaned and did laundry or help from her children but she also reported on more vigorous activities that ship camping every other weekend and despite her mental limitations while he was camping vigorous i mean i could imagine somebody who camps who get someone to drive them out to a camping site then they sit down in one of those folding chairs you know and enjoy the forest and then they lie down why is camping vigorous we don't know the extent of the camping very good point you don't know me and certainly you're one of those people who scaling mountains that's a different thing but we don't know correct but that was relevant evidence for the l j to consider and weighing her allegation only if it shed some light on how active she was and you've just admitted that it didn't well with respect to h mental limitations and see alleged difficulty concentrating and yet she did admit that she was able to continue working well after she stopped undergoing chemotherapy treatment in two thousand and eight but that but but mr rodman says you know she didn't work for a while to her credit but when the depression kicked in she just couldn't you know that's one of the classic signs of depression you just can't manage to get yourself out of bed with her name the depression she testified at that hearing that her to question in anxiety were both well controlled by medication and she did believe not eve that those impairments would actually limit her ability to work and she's the expert i mean you wouldn't accept that from from a doctor you'd say oh you brings me back to the point the judge would make you to buy a concern about cherry picking because i think you're right that that is the way she testified but she also testified that she has serious problems concentrating you know and with with her memory ditch so i don't we can't we can't focus you know on the one hand and her saying you know my moods are ok but i can't concentrate i can't remember anything which is probably what letter to you know stop working in what was a taco bell might write well they're grabbing the concentration and they also reasonably found that the longitudinal record did not support her allegation that she was i'm able to concentrate and she had adequate adequate concentration on during with the bow and center i'm dr karen noted that adderall helped improve her concentration but improve is different from cure i suppose you know where we're looking for is something that grapples with the evidence that she really can't concentrate sufficiently to manage a full time job and i realize the limits her friends say aspace work such as assembly line limits hurt is superficial interaction with other objects immediately one out of three after five minutes check is pretty pathetic one out of three options after five minutes well the examiner to be working the examiner found that those test results revealed that her concentration was only moderately below normal she was awful able to count backwards from twenty to wine and complete other math calculations so this these test results in combination with the treatment record notes revealing that adderall did help she reported that to her treating physician that it help june twenty ninth two thousand and twelve i believe that's actually when she had a after she had a panic attack at pizza hut i think so in other words it was a time when the psychological disability was starting tried to go back and work at it at pizza hut for a little bit and then it you know that was only a couple weeks right because this is something that something like that yes yes your honor and just to elaborate on that a little bit some principles that overlap and so for example it talks about you know some p t tests that that came you know you know we're sort of i mean i don't when he's are coming back normal at some points appear sorry prepon or function test it's a whole different type of animal but the principle applies in that when just because there are there are spare moments or just because there  are spare citations and to record doesn't mean that the broader effect doesn't need to be considered in this context the the history of the chemotherapy and the depression and the fact that major depression depressive disorder was diagnosed i would also like to underscore the step five burden that i began with today that naps began with today which is that the jobs that the administrative law judge seems to have selected seem to be ones like a dresser involving quite a bit of concentration in detail orientation and that's one reason in the opening brief nap goes into detail about