good morning everyone morning before we actually begin our all arguments judge ban i would just like to thank again ology judge janice jackie's visiting with us from the so their district of texas and we're very pleased to have her with this best for a few day today is a young woman with an extensive mental health history of depression anxiety childhood trauma panic attacks and social phobia who was treated for about two years by psychiatrist dr mansoor today adjusted her medications and works in a clinic that specializes in care for young adults and whose opinion is supported by the record the nd is that the ale j erred in formulating a residual functional capacity that is not supported by the record well but the nd issue was at the a l j or in formulating the residual functional capacity that's not supported by the record in this decision the ail j rejects treating source dr months or so opinion by providing the reason that she had a good response to medications and that they remained unchanged but that reason is not specific and legitimate nor supported by the record misandrous medication types or dosage was changed nine times between june rd teen and july tw fifteen notations of a good response to medication read her short lived coincided with medication adjustment or case management so her medications were increased is that correct both for prozac correct they were increased and they were changed there are times where they added traffic down to deal with them for sleep issues which also deals with some of the symptoms related to flashbacks really to a p t s d and then also her types was changed pa prozac and they also added search for a lean in addition they changed the dosage multiple times of nine times over the course of treatment is it correct that she was a non compliant patient that's i guess what the judge found well finances exactly not having insurance not understanding the nature of her condition so really she is compliance most of just about all the time in the record with her medications and her noncompliance is really only related to insurance finances or inability to access care and going back to the residual functional capacity that the a l j provided in this decision it's not supported by the record because it doesn't include all of her limits and this is sanchez's limitations in the residual functional capacity formulation the only mental health restriction provided is that she has to have no public interaction and only occasional coworker interaction however multiple medical sources agree that she has at least some limitation in her abilities for concentration persistence and pace in fact multiple doctors on the record agree that the sanchez has at least some limitation in eight additional functional domains none of which are provided for in the residual functional capacity if your argument is at least with respect to the r f c is that to get there don't you have to  weighed the decisions in his the opinion of man sore and priest there still remains the step to issue new where this even non severe symptoms should need to be included in the residual functional capacity formulation and those symptoms related to post traumatic stress disorder migraines a d h d are not mentioned at all and not even touched upon in the residual functional capacity also but i think your pr priest simply was not supported by substantial evidence that's that's correct your honor and i and we do believe that it was not supported by substantial evidence but even other medical consultants and the record doctors lizer and weiss who the judge purported to give considerable weight to and dr carey who reviewed the record but not exit was a non examining doctor still found at least moderate limitations in her functioning which is not accounting for the residual functional capacity so even if in the absence of that which i believe the court should find that there is no specific and legitimate reason or support by substantial evidence for the findings of dr preset dr months or the residual functional certain conditions that are reflected throughout the record the matter what that sounds like it's just a street renia which is possible in acceptable as well however according to the vocational expert testimony the vocational expert j would have found her to be disabled because of that the case will experts testimony who found that any one of those symptoms singularly or combined would cause her to have no jobs i'd like to reserve the rest of my time for a bottle notion that non severe impairments need to be included in the r f c is incorrect they need to be considered in the r f c analysis and the a l j did consider them all of the impairment or the restrictions or limitations that would have arisen from those impairments in the analysis of the r f c therefore there if there was any error at step two and i don't think there was st some of them in particular migraines which was specifically addressed but if there was any error at step two at all it would be harmless error because it was the limitations from the mental health conditions let me say let me start let me back up when you have a severe impairment that means an impairment that more than minimally or significantly affects a person's ability to perform work so there have to be talking  is a severe impairment and i have no knowledge that it's not discussed in the step to area which is on page fifteen or twenty eight dollars of the of the excerpts of record page three of the the decision but it is discussed later in the opinion and our position is that that satisfies that sufficient to address what counsel read the records from mansoor and levy i did not see the picture that the claimant is painting of those particular records and i think the a l j did not either so when i read that i saw and i have i can go through for you many many notations of pretty normal except maybe for depressed mood in some cases mental status examinations i saw the or didn't find her to be as ill and the problem claims i'm saying let me be that's a good clarification let me be clear so they all jury has to reject the opinion based on have the l j saying i decided to climb to assign controlling weight the medical sources from mansur and levy and the most important part of that paragraph is when they say their own clinical records conflicts significantly with their opinions that's very important that's in line with thomas said he and that is why i think this decision is defensible because when you read their notes who's  meaning at eight of ten it was very high at three of ten and quite low depression improved from seven out of ten to one without side effects they did modify the paxil medication later but then you see that when they changed it to prozac she continued to report that she was feeling better and i think what the ale j was saying was we have these opinions saying that she's very limited but we don't have the medical records it doesn't look that well the records show know that they had to adjust her medication repeatedly over a long period of time both in the in the quantity and the type and i think that's true they were just saying it was a they were medical management appointments so she continued to complains about her not taking it at various times that's also a complicating factor i think when these doctors you can see they're prescribing medicine and they're listening to you know i think on the paxil she said i'm feeling good i'm sorry go ahead she said i'm feeling good my mood is good but then later on she had a good response to paxil this is on page five hundred significantly improved mood she'd been pretty active she's she's going to help her sister out in parks with photography her and her montel status was normal and then later she says she thinks she's having increased irritability and anger with the paxil so then they go back to prozac this is now months later after they're no complaints in here that she's deteriorating she's having suicidal thoughts that doesn't happen in between she's feeling good she's saying she's feeling good but i married a boy i mean she's ok let's try prozac then she reported that when you're there pretty common drugs for yes i mean i don't think that the decision turns on you know the characterization of the care is conservative or not i think it turns on the fact that they l j is seeing improvement and that she is saying in these records i'm better i've gotten better i've gotten better now i do want to point out that this and i believe this is what were the fact that the doctors records their own clinical records conflict significantly with their opinions so she's real that's eleven reason right and i think that's the controlling that's and that's  reason i think that is the reason that's supported by substantial evidence the most substantial evidence and i think that carries the day ok would you understand the relief to be here that there's you can i think that we should that you your honors for the firm but in if you don't this is not a case where you you're able to remain for payment this as if you read the decision there are so many conflicts in the evidence and you see that going back and getting more evidence getting more evidence precisely because it just doesn't line up on the papers it just doesn't make sense to the l g on the papers that's why there was the medical expert at the hearing then they even beyond any of man sores opinions and there were lots of findings in presupposes opinion there they did a lot of testing and a lot of the testing was normal so the l g then got another expert so in a case like this where you're seeing you know continual conflicts it's just it's not a case where payment would make sense immediate payment ok nothing to tell us what conflicts significantly with the opinion the only insight we have is what we've mentioned earlier is that her medications remained unchanged which we see is not sure who and that she had a good response to medication and if we look at the good response to medication over time every time she is there is some notation of good response or more improvement there's also multiple notations of ongoing symptoms indeed her mental statics exam shows that she sat or has some sort of and is not explained there's really no it's not a legitimate reason or supported by the record next commissioner also mentions that than there were normal tests dr preece but every single test notation has a line after noting that in situations of high emotion ality that her cognitive ability would decrease and did indeed this is not a case about her cognitive ability but about her mental health symptoms and limitations and we