behalf of ms gates this time it please the court my name is greg wallace and i represent tammy gates in the social security disability appeal this case a fifty year old woman who has only been work due to severe and persistent pain in her neck and back the issue before the court today is whether the hale j properly discredited the opinion of the scates treating primary care physician dr davidson  davidson after treating gate since two thousand and twelve gave an opinion that she cannot do any work requiring sustained sitting or standing that she requires frequent changing of positions and frequent assessment ordinarily under the rules of this circuit treating doctor opinions are entitle to great deference the ael j in this case rejected dr david opinion and he gave two reasons he said first it's inconsistent with his treatment notes and second it's inconsistent with her daily activities now with respect to the treatment notes there were several inconsistency as are supposed that like to use that make it sound like that all you're doing is taking a few aspirin over the counter for your pain missed gates actually had undergone surgery for her me to desk and dr davidson was treating her for persistent neck and back pain with steroids injections he was also pushed driving strong narcotic medications all within the purview of his of the treaty mohd allergies that a primary care her in her cervical spine now apparently we don't know whether that surgery was was unsuccessful dr campbell thought that her continued pain was muscular so there was no real reason  dr davidson to refer her back to a neurosurgeon for simply muscular type pain but nevertheless she continued the fact of the matter is is that she continued having pain even after her surgery which was treated by dr davidson that the l g a then third said that you know there is no significant neurological or muscle abnormalities indicated in dr davidson's treatment notes distress but i may be maybe wrong about that but but typically those kinds of of things are those kinds of descriptions are reserved to people for example who may be on on the floor in pain from a heart attack or sweating profusely or something as we explain or even this court has recognized in the in the combs case that such such descriptions really are not relevant when you're dealing with chronic pain type type situation  the problem is acute distress you're right would be you know writing on the floor in agony or you know experiencing stress distress that varied and no apparent distress would indicate maybe i'm wrong about this would indicate that up she seems fine today i mean there's not a problem here which would be maybe again what he thought it meant was no acute distress because he said look she's she's been she's consistently complained of pain and we have consistently observed things that are consistent with out throughout her course of treatment here  over the several years that we've we've treated her so so one of the points that dr davidson made in his letter was that her complaint and what he seen in the clinic have been consistent a overstated those activities as oftentimes they'll chase do if you look at her testimony and specifically the testimony after the first hearing she describes a very limited pattern of daily activities  she she only can can stand to cook for a little bit and then she has very little housecleaning she has to lay down and rest most of the days now you know we can we can say well ok of course that's what people who are going to be claiming disabled one to say but at the same time you know you've got a you've got a fifty year old woman here with a good work history and claim it with a good work history isn't titled under the law of the circuit to to a considerable credibility she's paid into the system all these years and and i think at least dr davidson with respect to his interaction with her found her to be credible in that regard we have to defer though in a different way to those particular findings i mean those are things we can't get off of bear record when we look at the treatment notes versus the versus the latter we can we can evaluate that you know based on the documentary evidence but you know that the rest of it came in through testimony what she could do how she could do it things like that and that would seem to be a factual finding and that might be subject to more deferential standard of review at least for by is there any anything to that well i think the response i would have to that is that if you look at how the describes those activities and then you look at how she describes those activities  both her testimony and in the forms that she said minutes and those forms sometimes are you know they contain questions like have you stopped beating your wife kind of thing but but as in if you look at the two descriptions of her daily activities the o j case description does not really match her own description now now i mean we can we can say well maybe she's not telling the truth about that but the l j can't just you know in accurately describe what she's testifying in this say well that's her daily activities so so i think that's the starting point for that you've got to take you know what she says you know at face value and then determine whether you know there's substantial evidence to support the case determination that apparently was not credible and then compare that with dr davidson's notes why didn't dr davidson ever say earlier that she had these restrictions is there any reason for well there was no wrote these letters and but my point is is that there was no occasion for him to because she wasn't working so why would he put meaningless restrictions on her in terms of his treatment of those you know don't when you're working don't go in and saying he never said that she had the kind of disability that she's now that he's now saying in the letter and what what is that worth well i think that's i think if if if treating doctors if family doctors typically put those things in their notes which as i've reviewed hundreds of medical thousands of medical records of the i do see that typically unless they're about work related sickness if you've never asked for it so i think that's that that would be the response that i have thank you make a valid reasons for discounting dr davis is opinion the a l j properly considered dr dave's own treatment records the other medical evidence of record playing of daily activities and play notes report of h injection for back pain he then referred her to a neurosurgeon who perform a cervical who performed cervical fusion all that happened within three months of her wish one that day and that's also three months within three months of her initial complaint to our position that she was experiencing neck and back pain now post surgery dr dave says records reveal that plane nose condition improved the civically d prescribe any steroid injections post surgery norty he will for her back to a specialist in fact plain of reported to dr davis and her pain symptoms improve with medication and she described her pain stand when he has not noticed any corresponding abnormalities in his clinical findings so your point is that even if even if the condition was pretty pretty bad pre surgery pre cortisone shot side cetera that after the surgery and after those cortisone shots or or steroid shots begin dition proved it is inconsistent with the later letter indicating that there there would be significant limitations that would constitute a disability impose restrictions on her but that only restriction is to avoid heavy lifting which is not in conflict with the a l j found in this case next to the l j properly consider the other medical evidence in the record so we also have dr campbell the neurosurgeon who abnormalities so two months post surgery we have dr campbell's treatment record stating that plaintiff was reporting that her pain symptoms had improved and moving forward dr campbell recommended that plane of undergo conservative treatment which only consisted of over the counter medication massage and heat so that's a part of the other medical evidence that the a l j consider when discounting dr davis is opinion he also consider  excuse my ignorance of this i've been dealing with workers compensation cases which is a little different but my question for you is what's the significance of the consulting physician the non treating physician are you relying on that for evidence to you know pos conclusion that the treating physicians opinion is invalid because it's inconsistent or can you rely on the consulting physicians opinion to show that the treating physicians opinion isn't valid which which of the two are you relying on it for or can't stand alone it has to be supported by clinical findings to l j looks to what are those what that treating physician report his treatment records he also looks to what other medical evidence examiner he finds that she has overdue some range of motion in her neck and lumbar spine that's similar to what dr jamison found however they have different conclusions at the end of their examinations we that her medication was enormously effective and she had no side effects so in conclusion it's not the role of this court to reweigh the evidence but to determine whether substantial evidence supports