administration during his young life you'd already had fifteen hospitalizations for that if you notice most of those hospital is ations involved acidosis which is a very life threatening condition that comes along with severe treatment plan involving a sliding scale for his insulin and count that necessary to counsel gets i'll give you the problem that i'm having so it is clear that your client has a very serious medical condition there's no question about that the a jay concedes concedes that if i find that there's just there's just no dispute that it also appears to be relatively undisputed that your client is very very poor at taking care of his medical condition and that and that the  state of medical treatment is such that with ordinary care that his diabetes would be quite manageable and that he likely would be able to work so the only question that this sort of residual in my mind  whether he has any other condition other than diabete us that prevents him from undertaking his own care his own medical care and i would like you to address that question and tell me very specifically what doctors address that thank you i will do that your honor and i think that is the key issue in this case is because there is noncompliance with treatment but the key issue is whether there's good reasons for the noncompliance and the other key issue is whether or not the administrative law judge addressed the good reasons given by mr hartman in any type of meaningful way so that this court would have something meaningful to review so as to the other conditions the administrators law judge found that he had borderline intellectual functioning that was a severe impairment however the administrative law judge did not discuss whether or not that was a good reason for his failure to comply with treatment what the medical evidence shows regarding his borderline intellectual functioning was that of the medical doctors who repeatedly refer to his noncompliance suggest that because of his low functioning i q that what's reflected in the gas score  and the other the other testing that he would not be able to take care of himself they didn't appear to understand his cognitive deficits but if you've got doctors who art who are actually examining examining him and they can't tell that he's low functioning intellectual in talking with him about his medical regimen that then how is that the we're supposed to conclude that because he's got a low i q that he can't do this if none of the doctors who've examined him and he saw a lot of people the lot of people who had their hands on this including including some who are not qualified medical specialists who still has still you know offered offered opinions sort of layman's opinions on on on his ability to care for himself well the doctors did offer opinions but they were the mental health doctors that were trained in that dr cio who gave value added he was a clinical psychologist said that hit after eight years of being diagnosed with depression that he had a vague understanding of his medications of his diet and of his exercise and that he did not have the ability on his own doctor to specifically said that he would remain just a bald unless there was some sort of dramatic intervention done that concludes his diabetes is highly likely to remain out of control and makes sustainable employment unlikely without an effective medical and diabetes management intervention what does he mean by that he went on to explain that that he said that that they needed to have a team approach with his physical doctors his mental health doctors and his family he couldn't do it on his own but to that point the last thing he said he couldn't do it on his own i just want to circle back to judge by piece question  sorts of concrete data we have i q test scores we have a wide range of cheeseman test scores and we know that his reading and writing levels are at the first second and third grade levels you know as math levels as they are we know he can't add a plus five we have that d and he said yes and if you listen if you read the transcript and at the hearing that's that's his very nature i mean this is a kid it was a special education the records show he was teased when he was in special education for being a special education and because of his appearance and the doctor says he lived a very solitary life as a student so he he actually has used programmed do you understand yes but he doesn't and it's clear from the data he doesn't understand it sounds to me like what you're suggesting is that because what they advocated was this interdisciplinary nature this team approach that that that there's a sub rosa there that there's that there's that the implication is that that was that support was necessary because was intellectual functioning but i don't the first is i want to make sure that i'm right about that in the second is i'd like to know what is the strongest support for that interpretation of the record so i think that comes from mr wolf perch who was a treating  his treatment and one of the main reasons why the algae found it was noncompliant because he couldn't count kyra hydrate so he couldn't take his medical medication correctly and because he couldn't follow his diet correctly at the hearing was this issue raised with the jury the issue of the excuse for noncompliance mental impairment it was raised in the with the says that that that if there's good reasons for the noncompliance that makes the person that doesn't mean that they're not credible i mean they are credible so it's the same thing so what you're saying you're suggesting is  ability to comply with his diabetes regimen you know the real big rub that i have is that the judge found that he had borderline intellectual functioning and she had the evidence from dr teal and mr will part that he couldn't comprehend this and but she didn't was helping him the record shows that during that period of time that for example on at three forty seven and for ninety three of the record shows he's got a diabetic classes he's exercising more following a good diet but is a one c was fourteen that's a three month average that's dangerous that's off the scales that's terrible and at seven seventy three it says he's compliant with his medications his girlfriend's helping him but his blood sugars have been greater than six hundred three straight days what there is also evidence in the record that i figure which doctors this is i can't remember can ever get all the straight but that that really the problem inability no because the judge found that he had a severe mood disorder and the medical records show now dr gupta didn't know that dr gupta didn't have any of those records for a one time exam but the records clearly show that he had a major depressive disorder that he was raised in a family where there was mood and psychotic disorders that there was harmful behaviors going on as far as self harm behaviors that he was physically abused that he was teased for being in special education he developed major depressive disorder inconsistent with his abilities to take care of himself including his diabetes control so not only do we have the borderline and all choke functioning but we have another severe impairment a mood disorder that dale jr shelf down was severe but again she didn't seven ninety five in the transcript says he's unable to set realistic goals his judgment regarding healthy choices is poor or he only has a vague knowledge about nutrition medication exercise that's after it had diabetes for eight years and been hospitalized fifteen times and on a scale of nine miles moderate mark or severe doctor feels that he was at the severe level in his ability care for himself because of his mental health and parents a doctor who couldn't know that assuming the plaintiff's council is correct and that there was borderline intellectual functioning and a mood disorder that impacted treatment the treating doctors the doctors who were treating mr hartman's diabetes said that he should seek education they repeated it over and over again on october sixth yes but  any of them asked the question that we've been asking or any of them asked the question about whether or not he is borderline intellectual functioning was part of the problem no no none were asked whether his intellectual functioning precluded him from it but i think they were aware that there was a knowledge gap certainly between what he was doing and his care because they were looking at a young man who was at certain points in the record had severe symptoms and wasn't treating them and they've told him repeatedly to seek the counsel of a dietician and a diabetic educator and it wasn't until two months before the hearing that he finally did that with any earnest effort and he testifies at pages fifty and fifty one that those classes help him with the symptoms and his blood sugars are now down consistently to two hundred hz testimony at the hearing so even assuming that there was borderline intellectual functioning and diabetes that impacted his ability it was not the evidence shows that the treating doctors knew that repeated education challenged at age twenty three of the district court's decision even the district court acknowledges there's no challenge to dr teal's opinion in this record there was a raise that the district court so that effectively is off the table the  stark yes no question your honor all right so what about that why isn't there wired to figure out if that isn't part of the problem why isn't there a wire about isn't that why this interdisciplinary team approach is needed in this case because as you said he had really serious problems controlling his diabetes very protracted period of well yes and my answer to that is twofold first the l j did consider it because he considered the medical opinions in which those sorts of  in terms of i mean the grounds on which he rejects dr teal i have to say didn't move me very much well fortunately they don't have to your honor because they weren't challenge on appeal and they weren't challenge that history it's been it's been waived so we don't get to we don't get to read of a very high level of abstraction which creates a problem for me because he doesn't reject dr teal entirely he says they're only given limited weight so you know immediately i'm not sure how much weight limited weight is but it's obviously some white as opposed to no  weight and then he just says they're generally without substantial support from other evidence of the record which obviously renders them less persuasive that such a high level of generality i have no idea what the l t is referring to i believe your honor the l g also referred to  the reports of his daily activity and that's the big and that's the big thing that the l j comes back in the l j comes back to that again and again and again hartman is caring for his girlfriend's children he goes on a bicycle ride promises the kids he'll take them camping and that those activities are specially most long twice a month and so on but i don't see that any of those that those reports are inconsistent with other things in the record that document that he has these episodes you know once a week i mean you can be caring for young kids go on bicycle rides promise them that you'll take them fishing or whatever and still have a medical episode once a week that would render you incapable of working so i don't know but i don't know what to do with that because the l j hasn't parse at that as a part of that level is he is able to function based on further questioning normally and that was in spite of uncontrolled diabetes and dr gupta was a one time was a one time examination right ye that indicated your borderline intellectual functioning not to my knowledge no it's not your contention that he was able to function normally with a functional i q of verbal i q sixty nine that's not what you're arguing is it well functioning in accordance with the residual functional capacity assessment well functioning if dr gupta we don't know much about what got dr gupta meant either but to say function normally as in i can move around the house i can do the dishes i can mow the lawn twice a month and watch my girlfriend's kids that's one thing quite another to feed i think for me to read into that that this individual could understand and comply with the diabetes treatment regime certainly your honor and i would like to get to that that's the second point so there is the specter that perhaps borderline intellectual functioning and the mood disorder impacted his ability to care for him self right that's lurking out there him one time but some fruit with the purposes for treating him in contrast to dr teal instead of relying on this supposition that these mental impairments may have a d cause difficulty the l j relied on concrete evidence that it was not for these mental impairment that were causing his problems it was specifically that he lacked motivation then go to january two thousand and eight physicians assistant knows he is not compliant but he is nevertheless asking me to sign public assistance forms indicating compliance and the l j could reasonably look at these records and say that the compliance was motivated the lack of compliance was motivated by something other than a mental health impairment you know it seems like if you want iffy if the condition of staying on public assistance whatever it was general relief or whatever he was getting required him to comply you would think that he would  oldest phrase in the english language that is still used today and it's not because we ride horses to the courthouse it's because sometimes people do things that aren't in their best interest and i think that's why it's hard to understand it was the case here i'm not prevent him from watching the children from taking care of activities at home and the l j so this you know i mean that's true you're correct that there is that there was evidence of that but you know i absolutely have no idea what it's like to be on insulin treatment or diabetes treatment it's complicated but these and the chronologists and these treating doctors see people from all walks of life and they didn't say at any point that their concern with your was that he lacked the capacity to understand their instructions rather they said he should go seek the educational resources available and mr hartman testified that when he finally did after his doctors were harping on him again and again to do that that long hold it helped the symptoms and his blood sugars were down in the two hundred level which is still uncontrol d but as dr gupta said they still show that he can function and they're certainly far below the four hundred six hundreds and a thousand levels that they were when he was hospitalized in the last the corners any further questions few minutes for rebuttal thank you your honor i did want to point out that the credibility argument that the judge gave was three fold primarily that he that mr hartman was not following prescribed treatment second that his activities consistent with his claims of disability and third that he had a poor work history prior to his alleged onset regarding his poor work history he was nineteen at its ledge oncet is still in high school so he would've had if you count how many jobs tried how many different jobs he tried at least three jobs to of which he was fired from for missing work because of his debut to us the other one hit was aggravating as they beat us and it got became more out of control he had to quit because of the the fact that he keeps trying to get employed to me is consistent with  not a lack of motivation quite the contrary but what about the two other grounds that were cited for because you'll need a one sided to support for the adverse credibility determination so activities of daily living i think is is clearly doesn't show that he can work because his activities at home were allowed he was allowed to rest take breaks when he was having a high blood sugar or he often have low blood sugars where he had become very and his girlfriend who the l j said that she accepted the girlfriend's opinion the girlfriend said that when he had these episodes he would just be out of it for a whole day he would be let out that inconsistent though a his testimony that when he had these problems he would have he would be down for  he'd be nauseous and vomiting or what not to be and be out of action in bed is what he said for a whole day but he also testified that he in the summer months took care of his girlfriend's children except that's what we learn in the transcript is that his girlfriend work in the home taking care of her mother mr hartman his girlfriend the kids all lived with his girlfriend's mother her job was at the caregiver to her mother in the home with the kids with mr hartman and  the testimony of mr hartman at the hearing all right thank you yes and so that's pretty pretty significant event to me because she was there with the kids the whole time that mr hartman is there and and so he when he could he would he would help her out and there was one other one that the district court rejected the other ground where they were they rejected the grounds of his prior work history didn't make him not credible because he was in high school at that time and that's not a ground for finding not credible the other one was the third one was his compliance with treatment which we've discussed which we've talked a lot about i did want to point out to the to your hon because in my brief i had listed also there was three different i q tests that were given and in my oral argument i mentioned the one score of the verbal of sixty nine in the other two tests he was given his verbal i q q was seventy three and seventy six and that's why we didn't argue that he made a listing because it was sixty nine he would have met the listing but the other two were seventy three and seventy six very poor scores and low and and didn't change dr shields because dr teal had all of them all three of those scores when he gave his opinions