court this is a social security case or a vietnam veteran combat medic who has been suffering from p t s d and who is found to be one hundred percent disabled by the veterans administration the social security administration however denied his claim for benefits finding that he was only mildly impaired by his social by his p t s d and that he could perform work that didn't require strict production quotas criteria by failing to weigh the regular factors and giving weight to the reviewing opinion rather than the examining opinion of dr pappa degas the magistrate judge in this case  dr sanders and we would argue today primarily that the ale g failed in her duties by not even mentioning these two doctors we recognized that the doctors did not provide  statements of disability but they did provide statements in the record indicating that there were negative effects on the claimants work productivity domestic relations and quality of life and as the magistrate said we believe that those opinions supported the ultimate determination of dr pepper degas at the v a that this individual was entitled to benefits we also argue that the determination that was made by the v a although not binding on the social security administration should have been given greater weight and greater consideration although the circuit hasn't indicated which how much exact weight to give to a v determination it has indicated that determination by the v a should be considered and other circuits have said that substantial and great weight ought to be given to these v a determinations reviewed the record indicated that he reviewed the c file did a clinical interview and did and reviewed the psychiatric treatment notes from the to psychiatry ists and his opinion was that the claimant was entitled to benefits and have had a chance to examine the claimant and that's not the case here it's also important that the judge give good reasons for rejecting the opinion of a examining source and we argued today that she didn't do so she the regulatory factors require her to consider issues of frequency specialization familiarity with the evidence duration of treatment none of these things were mentioned in the algaes decision finally i also think it's important your honour's to consider the fact that the first time these doctors the treating psychiatry ists are even mentioned by the agency is in the commissioner's brief we would argue that it is a it is a post hoc rationalization which is impermissible to after the fact say that those doctors opinions are somehow inconsistent when that's not something that the a j determined would also argue that the opinions are not inconsistent and that they should have been weighed as supportive of the opinion of dr or would also argue that the commissioner in the brief argues that dr lewis's opinion this this reviewing source should be given great weight and that the it was cracked and giving the opinion great weight but i would point out today that page id sixty nine in page six of the l g s decision she doesn't really even give great weight to this opinion that dr louis pyne that the claimant was markedly impaired in his activities of daily living and the ale jay found him only to say that the judge accepted this opinion of dr lewis is to some extent incorrect we argue that she supplanted her own opinion and only found those areas of dr lewis his opinion that supported her denial to v a treating specialists don't often don't give opinions the way they generally do it at the v a is that they have what's called a c and p exam or an examining opinion like this of dr  and the judge in this case specific specific notice that no treating source has given an opinion as supportive of disability as if to say that no treating source's done that for because they don't believe the claim is disabled but we would argue that that isn't correct that is the way that the v a does things and to say that a treating source is required in a v a in a person's case who has treatment at the v a does those individuals a disservice because they will never have a treating source opinion the best they'll ever have are the c n p exams that are we argue very credible based upon an evaluation of the evidence based upon an examination again there were treating sources in this case who did give statements that the magistrate judge believed were supportive of dr patrick is so to some extent the judge's failure to even mention those doctor's names or consider their evidence is we believe a significant error the judge does mention the claimants therapist mr hugger but we argue that it's possible that the judge may not have even recognized that that the claimant saw psychiatry as its she says incorrectly in her decision that the claimant only had four appointments with the therapist and that's not enough frequency to show a severe impairment but the claimant argues that the claim that he had at least twelve appointments page eighty to ninety six to eighty six five fifty eight and two seventy four show these additional treatments by the psychiatry ists post traumatic stress disorder so the judge found him limited to medium work but also gave very few mental work related limitations finding him incapable of assembly line production work step five we argue that they should have taken much more than that into consideration because this is an individual who clearly has been shown to have audio visual hallucinations anger and flashbacks commissioner argued that social security administration is not bound by determinations by the v a and we agree with that certainly there are some v a decision v a consultation evaluations that may be that may have occurred twenty to thirty years ago but in this case the v a determination occurred right at the beginning of the relevant time period this is a unique case in that way and we would argue that that opinion is  by far and away the best opinion in this case and the l g s rejection of it is just not supported by substantial evidence thank you thank you your better side it's important to note the time period of those of those opinions dr papa degas of examined mr keaton in november of two thousand and six this was right on the cusp of the period of time where mr keaton stopped receiving regular mental health treatment in april two thousand and six which is right around the mr king's alleged onset date him and his therapist came to the conclusion that he was pretty stable that he while he was still having dreams they weren't overwhelmingly emotional but he had good anger control that he was having a minimum of depressive incidents and therefore instead of having regularly scheduled sessions him in his therapist decided that he would call if you need an appointment and after that point he only saw his therapist mr hodder maybe three times a year from two thousand and six to two thousand and nine and all of those visits were precipitated by some sort of stressful event in his life such as his father's declining health his older death his father's eventual death all those kinds of things and he saw him he did see his training psychiatry just during that time dr savvy but he only saw him approximately once a year three times between april two treatment notes indicate that everyone was happy with the treatment schedule it wasn't as if he was you know as therapist specifically said just call when you need to be seen he called and he was seen and his psychiatry if there's nothing in the treatment notes to indicate that he thought that he should there's no indication in this case that mr keene was not seen by these doctors and that they just you know created these opinions out of thin air there's no indication that any doctor thought he needed to be seen more often and that he wasn't able to be seen  let me ask you this the one thing the a l j were supposed to do in rendering his opinion is to take into account the records of the treating physicians and give those appropriate weight or existing explain why they weren't being given away even if that was the case and you're the a r j didn't think to do here i agree that dr sabby is certainly a treating source he saw him regularly and while the l j didn't mention dr c b by name she referenced his treatment notes about thirteen or fourteen times in her decision so she inadequate well doctors say he never issued a medical opinion that the algae could weigh per se like an actual opinion but the bulk of her review of his of mr keaton history has flashbacks his nightmares his you know his the medications he was taking all of that information came from dr say these notes so i mean she did fail to name him and she did fail to you know devote a paragraph explaining the weight she gave to his notes but when she weighed his treatment history and the severity of his symptoms all of that information essentially came from doctors that require under our case law to give an explanation as to why he would not afford  more white for example to the treating physician than to somebody who never saw him at all like i don't think there's i mean there's no official medical opinion from dr c b for her to wait but his treatment notes i mean there nothing in them to there's nothing in them saying that mr keating was unable to do x y or z or that he had limitations of concentration there's none of those sort of functional limitations and there's no sort of overall examination mr k abilities instead his notes you know talk about how he had linear thought process and how he his mood was better his africa was not a while things like that so and she considered all of those things but there was no opinion for her  way you know it it would seem in this case that the quite apart what's required and what isn't it would seem in this case i mean the evidence from the the is really quite consistent even though it may not result in you know an ultimate opinion about his ability to work it really strongly supports the examining failure to even recognise the trading physician and and the how i don't know the whole opinion seems to have a number of errors here and there are critical here the v a opinion that he was disabled and dr papa takes his opinion were from early on in this in the relevant time period there from two thousand and six and january of two thousand and seven and after that point in starting in april two thousand and six his condition by all accounts improved he really rarely received mental health treatment he seemed to be functioning at at a price ok level not great but her star if he is fairly restrictive dr lewis didn't examine the record until february two thousand and eight at that point he had a longitudinal view of the fact that mr keating had received only sporadic as needed mental health treatment since you know the time that dr his opinion was written so she really does did have a better launch neutral view of his condition day to day abilities during the relevant time period so i think i mean before it will two thousand six he was seeing his counsellor every two weeks he was seeing his eye just more often but after that point because of the improvement and on the advice of his therapist his mental health treatment really became extremely sporadic and only occurred when he's really been doing badly for months but he wasn't able to call i mean he did go three four times a year so he clearly when he needed treatment he could call and i mean the latest notes even say that he you know he's had he's been doing well he's had very mild you're in the way you did i mean that's part of her and i think she does by focusing on the fact that he had very sporadic health treatment and you know naming the few times that he saw as their past after you know after the alleged onset date and i mean heard her opinion it's not perfect but you know the record as a whole is supportive of her decision or her decision is supported by the record thank you just very briefly your honour's we would like to argue that there is actually the opposite indication in the record that his condition has improved he was given increased dosages of medication he reported increased symptoms particularly with the fact that his father was very very sick and it was reminding him of being a medic in vietnam taking care of people i would also point out that the judge opinion here is in many instances incomplete she says for example that he sees his friends one time a week and that's an indication that he's able to get out and about but she fails to note that these friends he sees are other vietnam veterans that he talks to about his condition almost as if it's like a counseling session and that these are things that help him cope she also brings up the fact that at the level but we would argue that that's also an error of fact indeed his blood pressure was high he explained that he was very stressed out having just come from a psychological evaluation so we just respectfully request that the court review