good morning ladies and gentlemen our first case for this morning is in penrod against  this case is about a climate with a heart condition that can take kidney condition a back condition among other problems including parents diagnosed psychological problems  that appeared to be going downhill and he was not able to get treatment for it and i'm going to be showing as i go through my points today first that the administrative law judge decision shows are suggest that the his his impairments went up hill or at the very least stayed the same but in fact they went down the second that  his impairments in combination were not considered in the r f c the residual functional capacity the minimum amount that he's able to do and finally that the administrative law judge decision erin's credibility  just ask you as you do this it's going to be helpful for me at least if you focus on what the record shows as of his date last insured because because if he's i mean obviously he passed away which shows something  but but if he had not reached the point that he couldn't have a job by the date last i'm sure the law says that you have to deny benefits that's correct and so the date last insured here is  june thirtieth two thousand and thirteen and there was an initial hearing that was on i believe april eleventh two thousand well for some reason be administrative law as far as the what what happened between those two dates and leading up to those two dates in january two thousand and twelve you had something going on apparently with this heart that led to hospitalization or at least an emergency room visit in april two thousand and twelve that seemed to happen twice in november two thousand and twelve again and there were citations or there were place in the record indicating that the symptoms occurred frequently more frequently than that it's not just just the times he went the emergency room this is a gentleman who wanted to avoid costs at all you know he went to extreme measures to avoid costs due to his financial situation and presumably that this situation with his family he for example had a stress test recommended multiple times he went to the e r and he didn't have insurance so he wasn't able to afford it i think the cost for him regards the cost of what it would be to do it with something like seven thousand dollars and that was a spur of a stress test which which is it is an important term that's going to come up in a subsequent argument  but the administrative law judge decision if you compare that april two thousand and twelve one to the subsequent one actually increases the time that supposedly he can stand by about two hours that's perhaps the most notable thing and yet based on his testimony under oath and his impairments in combination he had quite a bit of fatigue and chest pain so it doesn't really stand at will doesn't that seem to negate the point you just made about the increase rather than the decrease or holding it the same the the point i think you're making is that it might be debatable in terms of the reservations in the prior opinion for the additional three to five minute breaks that that that they rate that included but in terms of the total time standing over the course of the day  t in the in the final analysis it comes down to the specific jobs he's able to do and the mystery of what that decision says that he could stand six of eight sandor walk six of eight hours in the subsequent administrative law judge decision where as it was maximum half the day in the first so that's showing it and it is if things improved and things did not  d in terms of the kidney stones for example there was a stone removed and then he had a heart thing and so it didn't get removed and so he seemed to live with it and that pain in the kidneys is i think somewhere connect next the back in so in terms of the pain i think that adds to the credibility and i mean i think the point you're trying to make me and of course an administrative law judge does need to provide a window into the reasoning to see why the judge may have thought that the r f c was actually a little better than it had been recorded to be last time doesn't necessarily mean that he was wedded to the earlier one he just has to have a reason and he's looking at these various medical assessments right i think you're right that there needs to be a logic to it and and other than that i don't disagree with the way you said he had significant mood and behavioral instability now granted this was july two thousand and thirteen the month after that date less insured which which which you pointed out at your lease is an important legal matter  hope no evidence of severe mental limitations before however that approach is no worse the entire line of contrary evidence connected to the heart conditions and the lack of a all these different you know doctors and things but you look at this guy's history he clearly has very significant heart problems people who are having to pop nitroglycerin all the time are not people with a healthy heart stress is particularly troublesome and the acting commissioner is in the awkward position of saying this man who dropped dead two months after the hearing was just fine and could work as of a up and you know to june let's say as of june twenty nine two thousand and thirteen and it seems to require quite an exercise in mental gymnastics to get there your honor i would like to clarify mr penrod died almost two years after the expiration of his state last ensure it was only two months after the hearing at which point the judge was assessing all of this stuff and even before the date last insured he has quite a few cardiac incidents in which the the administrative law judge rather casually is saying oh well but he was fine he took a second nitroglycerin pill most people don't go around needing to take nitroglycerin just to make it through the day well as pointed out in my brief the mayo clinic has said that nitroglycerin pills are frequently used to treat and giantess symptoms and then an individual doesn't need to go to the emergency room unless they've taken three nitroglycerin pills and if i'm not sure that that would be universally accepted health advice i have seen other health advice that suggests a future if you're experiencing the kind of symptoms of a time from april two thousand and two through june of two john hundred thirteen when we really find the onset within but by june thirtieth right that's the date last insured by the date that penrod actually only went to the emergency room for those symptoms one time he did go one time earlier but it was only because he did not have nitroglycerin pills and i dribble certain pills that he had were all so yes he did have to go to the emergency room once because he took two nitroglycerin pills if you look at them and so yes hard symptoms twice so he doesn't have three pills he did of heart sometimes twice but he didn't have the medication the first time really and that's one by people who doesn't seem to have enough money to take care of themselves health wise so  he i would say at a minimum the lowrance that you can draw an adverse inference against somebody for that no i don't believe they are jaded in this case the l j looked at the evidence in the record and acknowledge that there were certain treatment that mr pen afford yet determined that based on the medical evidence that was in the record which included a very lengthy treatment note from his cardiologist there was enough evidence to prove that he only suffered from intermittent chest pain which was what the medical records what mr king penrod's cardiologist mentioned multiple times in the treatment notes and mr penrod himself reported that his symptoms were typically relieved either with one nitroglycerin pill or went away on their own so i don't discern any other just in the record about the correlation between people who have the initial symptoms and the people and those who like mr penrod then have the big one the big heart attack let me show you said higher risk than the general population for a heart attack sure and the elegy acknowledged that his coronary artery disease was severe and that he did have a heart attack more than a year and a half after the expiration of his stateliest ensured the hearing which was at the end of two thousand and fourteen was also after the expiration of his date last insured and while there is sympathy for that this individual the l j is bound by this snapshot in time you know if mr pen was not disabled by june thirtieth two thousand and thirteen the elegy can't grant him disability regardless of what happened to the and it was your thousands fourteen that's the law but the question is sometimes you get medical evidence and it's not the type of condition that just wasn't there one day and springs into being the next day you can extrapolate backwards you can say this has been building the coronary artery disease obviously had been triple bypass surgery in two thousand and fourteen yes which was again well after the expiration of his date last insured which is unfortunate but the but built dish and that leads to the need for a triple bypass surgery i'm saying it's not like one day you're healthy and the next to go in and see your cardiologist who says oh it's true triple bypass surgery sure there's a period of time in which the need for it builds up right and i think that what you are saying is that the l she says at the bottom of page ten of fourteen consistent complaints of intermittent chest pain no question the heart disease progressed over time eventually became very serious in september twenty four team yeah evidence the evidence on him before june thirty so that makes me wonder is she looking at the evidence after june thirty and asking the question that we're discussing just that relate back well the evidence as of june thirty two one of mr penrod's appointments with his cardiologist his cardiologist said he's doing well from a cardiovascular standpoint and this is not to say that he doesn't have symptoms they are knowledge that he did have symptoms and the record shows that building up to june thirtieth this is you know it's not like we were wondering whether he has you know a neurological disorder we see that he has a cardiac problem and he's taking nitroglycerin from time to time and again all of this discussion about age ten so i'm just wondering to the gail take the post june thirty evidence and arabs does this shed light on what was happening before way i'm sorry if i and if you look further the l j considers mr penrod's activities at the hearing and said while his activities at the hearing seem to relate to two thousand and fourteen when his condition got worst but i just don't see anything in the record showing that this relates back to two thousand and thirteen and she articulate that in her decision and you know it's a it's a very significant period of time and b it's a very short period of time it's covered in the ala jay's decision and one more thing that i just quickly wanted to add i know i'm getting close to being out of time you had mentioned that the l a a j would need to explain the basis for her residual functional capacity assessment which is the most a claimant can do despite his limitations and in this case the ael j s residual functional capacity assessment are as we typically call it tracks the state agency doctors opinions to doctors who reviewed and summarized the medical evidence in the record that during that time period and found that mr penrod had the ability to perform light work with the restrictions set forth in the our our apps and to the extent that the l j added additional limitations she explained the basis for those so if the court does not have any further questions i request that they that the court affirm the elegies decision all right thank you very much anything further mr rodman briefly your honor i guess i would would answer first it seems like he mr parent is doing well person one who cannot afford the recommended stress test and some and sometimes not even blood thinners think that and i think that's right i i will note that in terms of the hit the appointments and the times he he he had things that triggered the emergency room those things would be referenced in the in the opening  brief and did seem to be simplified condensed a bit by the administrative law judge decision at the various condensed if not leaving things out explicitly and it also strikes me as listening to the argument today that the sit sta deaths it is important in terms that the last insured which comes back to the importance of those psychological symptoms for the for the sake of penrod's argument today and i guess i would reference the arnett case and the castro case bring extra least suggests that full of explanation and exploration has not been made and thus we ask to remain all right thank you very much thanks to both counsel will take