janice arnold this is an appeal of a social security disability title to some chapter to claim it's a step for case which means that the mystery of law judge has to this case is really about is side effects and there's two primary ways we can look at the side effects argument one is an inadequate discussion of side effects another is  a side effect finding that is not supported by substantial evidence on the so the st is that you know the plain language of the spot that discusses or arguably discusses side effects  is all about the medications and what exactly the effects of when you read the administrative law judge the decision it seems like a refrain you know this is true this is this is treated this is treated but you know how what the effect of those treatments is isn't always ok i think some of it has to do with specifically the and this is maybe the big elephant in the room that the are not likely to help and then this comes up and that is not a side effect of medication me argument is that she experienced side effects from her medication that impacted her ability to work not that the medication didn't treat the underlying issue it but this this feeds into my nd argument this morning or another way of capturing the you know the single argument that i presented in the briefing which is and this is somewhat response to the defendant's brief as well  report of lack of side effects to simply looking at twenty nine up it appears and it appears that that office has a routine so as to note that side effects are not causing problems if they're not causing problems but only two of the four times is that correct which which is is less than consistent report of no side effects and that's half the time  because she's already at six times per day and they said it can't do more than that because you know how is that a side effect mr rabbit as opposed to an effective treatment so they're going to try something  else it's a side effect side effect of medication how what's the evidence that there were side effects of the medication not the underlying condition so these side effects of you your honor my name's leo much negril appearing for the defendant happily the commissioner of social security as was stated the only issue in this case involves the side effects of medication now side effects of medication are a sub issue of the caused the alleged pain it's not a problem here it's undisputed the claimant the next question is whether the duration and intensity of the alleged symptoms or pain is consistent with the evidence that is how long and how much the pain was is that consistent with what the evidence actually says and this includes consideration of various factors including side effects of medication and in this case l j discussed several factors including the nature of the treatment which was conservative consisted mostly of medication and exercise he talked about that at ages two thousand and twenty three of the records another factor was the objective medical findings in support of did support the degree of pain alleged there was no nerve compression in the physical examination findings didn't change over time and the medical opinion evidence also supports the algiers analysis because the medical opinions generally supported the idea of the claimant to light work as to side effects in particular side effects limits argument appears to be based on dr cross other statements about the medication itself about how to use it which is to say not to take the medication at work while driving or while using opposite so between those two statements i think it's reasonable to conclude that dr karl was saying that claimant did not have any side effects because he said just that now to the extent that you want to look at those admonitions about the use of medication as some kind of limitation on claimants ability to work well i have to point out that dr karl did not prescribe these medications to be used at specific intervals or even that much instead they were prescribed on an as needed basis he didn't say you have to take this consistently to control your pain he said essentially take it when you need it but not more than every four to six hours so there were some limitations b there but my point is the claimant had some control over how she could take the medication on top of that the as needed basis i think is consistent with what the l g said elsewhere about the nature of the treatment if  it's is as needed basis speaks i think to the level of claimants alleged pain if the payment of pain pain medication is being prescribed when she needs it as opposed to more often than that now there's other evidence in the record as to side effects dr greer the consultative examiner didn't find any side effects but she did say that claim it might have some fatigue to do her beta blocker therapy a cardiac therapy but dr greer again did as with dr kroll dr greer didn't say that women had fatigue she was talking about the medication that this medication might cause some fatigue so i don't know that that helps claimants case they're on top of that the cardiologist himself dr four he didn't mention it again so presumably that side effect was resolved with treatment that's pretty much the medical opinion evident just a side effects dr carl dr greer dr harden i submit that there is no evidence supporting the existence of side effects claimant points out that the l j only talked about claimants the medication when talking about side effects in the record and that's true i think that's the only place in the l g s decision where he talks about side effects but i think that's understandable if the medical opinion evidence didn't support any any side effects or at least any significant ones plus the ail jane his decision oh and to the extent that claimant argues that dr carlos admonition about the use of the pain medication applies to all medication in the record well i just said the cardiologist dr harden and the consultant jammer dr greer didn't find any persistent significant side effects of medication there so i guess my points overall are that none of claimants doctors affirmatively said that she was experiencing significant side effects claim and hasn't established also the other aspects of the l g s credibility fighting the other factors that they'll get considered are an challenge and also as to claim a pointed out beginning of his argument this is a case about the use of medications doesn't really establish side effects or if they somehow do they don't establish any specific side effect how do these medications if claimant actually has to take them suring work hours and it's not allowed to do so because of dr carl howe to the side effects if any actually prevent her from performing or pass from work as i believe it was an assistant daycare director which is very different from the  about not doing commercial driving or working with the machinery think it was in the end i submit detailed g s findings were supported by substantial evidence the credibility finding was  ordered by the reasons that the l j gave in his decision and the claimant stated issue about side effects well again i submit there is no evidence to support any side effects that would undercut the l g s decision in any way thousand and twelve up until the end of s t a it was a subsidized so it was fifty percent less productive more rest periods slower can't complete all required work lower quality standards allowed  process no the algae the injured were judged primarily talks about this prior work in terms of the well she could clearly continue to do the next month exertion a level beyond what you know the