thank you judge even though this is going on for a year never strikes me the oddness of doing these sort of arguments over a video made it please the court my name is brian alex and representing lorraine been near palance in this social security disability case capacity two of those three offered specific opinions as to her functional limitations the judge gave little weight of varying degrees of weight but all little weight to all three opinions and in doing so often some rationales but not rationales that would be specific met and based on substantial evidence and i've forgotten to mention that i would like to reserve one minute for rebuttal if i may thank you judge the treating primary care doctor doctor offered two opinions as bonaire specific functional limitations the judge offered five rationales for discounting that they are not specifically judgement based on substantial evidence the st was a blanket assertion that it was somehow inconsistent with the medical evidence no citation was given at that point of the decision if the court were inclined to look to other parts of the decision for a more thorough explanation what the court would see is that the recitation of the medical evidence is somewhat selective in nature the extensive list but not listed by the administrative law judge are severe pain on cervical spine flexion severe pain on adduction of the right and left upper extremities severe pain on flexion and extension of the through assoc spine severe bilateral s i join tenderness severe lumbar tender points severe paris spine is tenderness at two levels of the lumbar spine severe pain with flexion and extension of the lumbar spine that's an example but it's a representative one of the  decision which tends to be somewhat selective in nature and does not give an overall picture of the medical evidence of course we asked the administrative law judge to identify and resolve conflicts in the medical record that is what the task is to do  what is it that's the word well the core of the physicians judge is actually the physical complaints the three physicians have that have a pint to treat three treating physicians that upon the limitations of a pi  to physical limitations in a very specific functional way they have limited her in terms of her sitting and standing and walking the less than an eight hour day judge and that is treating physician and treating discuss momentarily there certainly are mental health issues here but there is not a treating physician who has endorsed those limitations and but on the physical side there are multiple that have a  sort of an extension of or discussion of the medical evidence says that dr high as she appears or may have based his opinion on mis subjective complaints now there's no say tape and to evidence for n the conditional way by saying may have a bit have adopted subjective complaints certainly doesn't rise to a specific reason as the standard requires let me ask you this very minute she testified that she doesn't drive time certainly and offered a glimpse into increasingly significant limitations and so the judge perhaps inadvertently grabbed a piece of evidence from a period of time that a miss knowledged to the agency that she was not in fact disabled and that contradiction may have been a contradiction had the onset of disability stayed the same but mr near acknowledged to the agency that the evidence did not support disability at just able to give me i'm not sure that the a o l j is talking about evidence during which she conceded she could drive that right ma'am and i'm so i'm still working on this question yes judge  partly for flipping through pages but you know it at the time of the hearing certainly missed and here was not driving i think that's it that's testim that's testimony that is truthful certainly at the time of the hearing i don't recall hearing trance or be indicating that the l g asness been here about the length of time that shit on without driving and my recollection is that the function report that was cited as evidence of driving predated the onset date here and evidence as to which is not claiming disability that she can drive and now she says she can't and we don't get in and risk credibility finding are some sort of an exaggeration of symptoms finding directly from the l g i guess i've got a problem with what the did help me a the terms of the detail given to her physicians it's pretty sparse we do know that the judge found contradiction between the physician opinions and those cruises that seem somewhat curious given the nature of cruises where one can sit and stand and lie down in a recliner at one's leisure seem to find that a limitation to sitting standing and walking up to four hours out of eight as it is inconsistent with the cruise wear and a vigil could presumably lay down the entire day if they so chose or or needed to and so that inconsistency struck me as not based on any evidence certainly not any cited evidence but certainly no logic as well i see that i'm down to about a minute much the panel has any questions i would asked reserve the balance of my inconsistency in her testimony she initially said she could drive in a function before but then later said no she can't drop it but there is evidence that she did drive in the record during the ju there was normally e g and there were no objections to dr and that's what e r six except now wait a minute no objection driving is different from saying that she can drive i heard physical their best that he noted that she drove to the session she told him she didn't believe should be able to the that that is just one example i was able to find quickly where she was dr physicians three constitutive examiners and three state agency reeling physicians they l j also considered among other things that except for two brief periods when claimants abruptly stopped their medication clinical finding they did not have specific legitimate reasons to reject d both of those opinions were allowed to check the box forms they didn't provide references to objective evidence they didn't provide any explanation for the extreme limitations they  i don't believe it was four hours of sitting and standing i believe both doctors so that she couldn't sit stand or walk for more than twenty minutes at a time she would miss more than sixty days a month of work and notably with respect to the travel doctor opinion is dated right after he's sorry and she said that she was doing great and that she was about to go on a cruise or about to go travel though that reasonably undermines the suggestion that she would be so limited as to be unable to stand or walk for even twenty minutes ye the travel and in the of itself it is more than just sitting and she lives in arizona she needs to get to a port which means she needs to get in a vehicle be driven or drive to the airport jessa go through security lines through the airport board on onto the airplane and then sit for a few hours on the airplane and then get to the cruise ship where she then boards the cruise ship and then her activities there also undermine some of the mental limitations jiggle edged physically just the idea to do that to do all of that when she claimed she was then surely bedridden spending most of the  the majority of the day in bed and being able to drive to the airport go through the airport get on a plane get on a cruise and then do all that on the return back it may not be the only interpretation of the seven but was it rational and that's enough but in the absence of any we don't have any evidence about what you know sort of accommodations she did or didn't have on the airplane but i guess i am just having trouble seeing how you get from y i suppose that's one supposition you could have about what it would be like to travel that given that we don't really know in the whole day really to know how you can infer from the fact that a person was able to find a way to do that that they would therefore be able to work at a it just seems like it doesn't quite match up well there's he did ask her or her attorney elicited this information at the hearing what accommodations she needed and traveling and the only thing that she described were a but the only accommodation she described her were mobility from getting from point a to point b so they only asked about that she didn't describe you know that was a moment if she had genuine difficulty you know with a two week travel like that as multiple times you know when she's alleging intractable pain and fatigue that would be a moment for her to write that information and she did it and so that i think it was reasonable they said maybe not the only interpretation but but a reasonable format it's not just that it was on a check box one because if if the ale jay had i'm sorry if the doctor had explained the reasons fruit limitations that would be a different story this this case is more like for y salt where there's a checkbox form that the doctor checks what the limitations are there by extreme and then doesn't provide any basis for that here there's an there's nothing to explain the  thousand and fourteen of the october two thousand and eight pm form where the question is is a medically necessary for the patient to alternate between sitting standing or walking yes every one to twenty minutes  mean you can't just keep the person sitting for a long time she's going to move around a little bit now doesn't i'm not sure whether to say that if she's going to go on a cruise she can't be in a car for an hour or an airplane for two hours or whatever it is that's a one time event or maybe once every two weeks of one going on one coming back is not every day so considered and it was a rational interpretation of the only one you know that the fact that she's going to her doctor saying i need this form filled out for my disability claim can you please say that i'm it it's kind of the whole record that the i think makes the l g s conclusion reasonable here ok you know any further questions from the bench that somehow medical judgment is left at the door without affirmative evidence to indicate that that is exactly what this court criticized in leicester that we may not assume or the l j made out a sound that physicians are regularly untruthful simply in order to help their patients that they don't check medical judgment at the door that the physician i've got a question though is about these forms i'm looking at all three of them that the doctor how she filled out in those october fourteen in the march th form when we get to question five about limitations less than occasionally the doctor checks the zero to twenty percent for everything then in the october eighteen the more recent worm he does not check zero to twenty percent for everything he differentiates as i well understood he should between use of the right hand and left him she's got a prior stroke which apparently does limit the motion so all of a sudden he's actually being differentiating saying that use the right hand continuous it's ok use of the left hand zero to twenty percent and then he says that she can use the right in the left foot twenty one to thirty three the fact that he's differentiating in the most recent report suggests and this is now a point in favor of the government suggest that really filled out the other two he was just kind of blowing through it and not paying much attention i'm not necessarily sure that's the case judge  n the need for rest he said on this occasion i don't think that applies so individuals condition may wax and wane over time but it does not necessarily indicate that they're somehow breezing through the former not giving it their attention to try c m m well over time and i