at the age of fifty seven years of age she suffers from bipolar disorder in the past she has worked as a lawyer and in the pharmaceutical industry becoming was making as much as eighty seven thousand dollars a year in her past work on social security should be eligible for approximately twenty seven thousand dollars a year the claimant treated since i think it was two thousand  hospitalization in two thousand and twelve as a result of her bipolar disorder of the doctors that provided an opinion in this case were of the opinion that the claimant was only able to sustain any work in a national economy but by reason of the doctors particularly the treating doctor is entitle to controlling weight where their opinions are supported by their treatment records unless good cause is shown as to why those opinions would be ignored as it is that the doctor's opinion about about her medical status or about what job she's capable of doing i think that the doctor makes  determination the doctor makes a determination as to what the claims condition is and how that condition affects a residual functional capacity the a would take that evidence because that's substantial evidence as to the claimants ability to do work functions and then incorporates that assessment into a finding that she suffers from bipolar disorder would provide an r f c that would be inconsistent with work if that hypothetical were proffered to the vocational expert it's clear that it's step four dollars and five dollars this process the vocational prior work as an attorney well i think he provided two opinions one in the art of form and one in response to question then when he responded in narrative form he indicated that the claim suffers from bipolar disorder these are all the issues that she have and she certainly couldn't work as an attorney any more that it doesn't necessarily follow that just because she can work she can't work as an attorney any more that she can do other jobs that's a fallacy to follow a question has to be well can she do other jobs and in this instance ducked if i'm about provided a a car for cation into in the terms of the the questionnaire and the responses that he provided in the questionnaire as to the ability to do any work in a national economy five days a week eight hours a day those responses are inconsistent with full time competitive work he appointed she would be absent more than three times per month the vocational expert said that under those circumstances such a person would be unable to perform any jobs he indicated that she had  moderate impairments and concentration persistence and pace which as to find would prevent the claim from doing any job in a national economy the vocational expert testified that even fifteen percent off task would her past work as a lawyer that's sheer speculation st off because even if you if the just the narrative was presented in the record the narrative does not say that she's able to do work it just it says that she's unable to work perhaps the did consider all this evidence and simply came to a different conclusion about it but the l j is making a they assessment of this record that lay assessment cannot serve as substantial evidence he doesn't have medical evidence that supports his conclusion that she's able to work he is reviewing doc to record the record of the other  psychiatrist in the record saying based on my lay opinion this claimant can do work the l g in this particular case which happens every day in these cases could have had the final record reviewed by a doctor he could have had a doctor in the hearing testify as to what he believes this record shows he didn't do that it is it appropriate for if the treating aren't treating physicians supposed to be given more weight the medical that's correct and even social security's doctor in this case was of the opinion that the claimants residual functional capacity was inconsistent with full time competitive work in fact  granted the claim of benefits in this case and isn't the issue with the particular disability that your client has bipolar disorder is that you can you have highs and lows and you can be doing well at one moment in time and then not that's that's exactly the issue in this case the records demonstrate that she cycles that she has periods or or days where she's doing pretty well she reports doing well but then if you look at the record the treating psychiatry's actually increases her medications because i think that psychiatry is an art and the person is doing more than just accepting responses they're also reading the patient's body language talking to family members you can see consistently throughout this record this claimant is on at least four different significant psychiatric records throughout and these medications keep being increased and decreased because she has different problems adjusting she's having problems with sleep she says she's starting to feel a little bit different she is depressed she  minute she thinks her husband is a wonderful man in the record the next minute the police are being called to the home these are all this is all evidence of the bipolar disorder that she suffers from and it is not for the la person to dismiss the opinion of the longtime treating doctor almost ten or eleven years this doctor treated with the claimant it's clear that bipolar by its nature has ups and downs right so what in your view what at the tensional claimant need to show if anything beyond a diagnosis of bipolar disorder and order to qualify for benefits i think if in other words is that if you have bipolar disorder is that automatic or is there something what do you mean by support what would that medical expert need to show other than just that you had a diagnosis of bipolar disorder i think that the medical expert would have to provide an opinion as to the person's ability to maintain concentration persistence and pace the person's ability to appropriately socially interact with others the person's ability to show up for work in a timely manner five days a week eight hours a day that psychiatry has to or a psychologist is in the best position to make those type of assessments the nd part of it is you can go back to the record and see what's going on in the record in this case we have to psych hospitalizations the judge minimizes it but their site cost but it was ations in one dollar case because she was found in a fetal position and throughout the record the doctor continues to maintain these for medications he doesn't ever take her off the medications completely if we saw that in the record and we saw a no psychotic who is ations and we saw that she was doing things that were consistent with work we may be able to say that the record doesn't support the doctor's opinion but it certainly supports the doctor's opinion here we're continues to note that she's irritated hostile depressed not sleeping and there are other moments where she's doing better so this is not the case though where on every visit we see the claim it's doing fine i'm lowering her her medications she's doing better i don't need to see her again for another three months that's not what happened here  more question because i see your time is up it do we have evidence that at times when your client was taking her medication she had these same symptoms or are all of her declines at times when she was not taking her medication you know i think that the record shows st of all she's manic depressive so a person is manic becomes elated feel better the medications are very sedating she says in the record that she has bad side effects from these medications it's not unusual for somebody that suffers from this condition to continually attempt to remove themselves from the medications but even on the medications directed does demonstrate that the notes say that she's irritated angry she's depressed and that all the time she's doing better but it's a back of what it's the cyclical nature of the condition and just to identify those indications in a record which state that she's doing well does not support the finding that the ale j came to in this case thank you thank you you have saved your time for a battle so thank hear from you again court developed and shing i would think not your honor for the reasons this court and ross which was a post change case and unpublished and unpublished right and p t s d not bipolar severely disabled due to the mental impairment numerous hospitalizations and was rarely stable other words it's the opposite of this case there were times in this case where the claimant experienced exasperate of her symptoms but most of the time if you look at the launch of two in a record she was stable when on medications but the issue is synching were obviously a panel of three to the opinion of the treating physician and in shank it it the court said that there has to be something in the record the l j must give a treating physicians opinion substantial or considerable weight unless good cause is shown to the contrary and so to go to judge martin's question why should this not be remanded to further evaluate the case based on the now controlling authority of the circuit  dition claim it consistently reported that she was doing well or great with primarily normal findings and mental examinations over and over and over again she had only and change as i said the claimant had only brief periods of stability in contrast to claimant who had brief periods of significant symptom exacerbation i think i think you know ross in terms of the law is is not different than the shrink it's the application of the law to the particular facts of the case else the bothers me about this case i mean i may be wrong about this and that's why i bring it up so it looks like to me you know it step to the a l j made an affirmative finding that the claimant had the severe impairment of bipolar disorder yet when the a l j pose the hypothetical to the vocational expert didn't didn't include that if there isn't in that what happened here that's what happened but   hypothetical didn't include the all the symptoms of the impairment and so you know that's that's a problem i mean right well symptoms are not limitations and symptoms all have specialises in area i'm not i mean i mean as you say you know the facts of bipolar disorder i mean their argument is didn't include in the hypothetical the effects of that were not completely consider vocational expert in iraq being at the the you know that she could work l j accounted for her bipolar disorder by limiting true simple work instructions and to only occasional interaction with the general public and that's what they all just charged to do to take into account the entire record what limitations flow from the impairments that are severe or and also  in this case the a j accounted for the bipolar disorder by the mayor to basically unskilled work you know that i mean what about the inability to get to the office during an episode is that something that was considered well speaking to the record was there an incident of that and i'm saying i think i've heard i've heard suggestions that this this individual would be unable to it consistently consistently be at work was that was that considered because even unskilled labor you have to actually show up yeah that was a doc dr fleming bombs opinion in the questionnaire but they all j rejected it because look at the longitudinal evidence evaluation well under twenty c f r for four point one five two seven c l j considers the factors listed there in weighing a doctor's opinion and those factors include things like the special of the doctor whether the doctor gave supporting objective evidence to support the opinion which dr from involved in not do in this case and then also did the objective is the objective evidence medical evidence and other evidence or record  port the doctor's opinion and if it doesn't and the ala j may discount the doctor's opinion i'm still worried about this hypothetical you know i'm just not quite satisfied that the so i think in the hypothetical the a l j told of occasional expert that miss a mule's could interact with the public  you know on a on a routine basis or something like that and that that doesn't fully consider the effects of bipolar disorder does it well it depends on the person  because people with bipolar disorder are different levels of functioning there are many people who back to sink some days are good some days are bad i mean there might be days where she couldn't interact with the public and the occasional expert destructed to assume that she could but some people with bipolar disorder function very well and are able to hold down jobs for many many years because they're taking the medication as as prescribed in this case it's countless there's countless examples of time time again claim it stopped taking her medications and this is what precipitated her two hospitalizations over the six year period and the exasperated over systems symptoms most of the time when she i've got that right i mean the hypothetical that the vocational expert was instructed to decide from included the fact that the missing e mails could interact with the public own occasionally yes  as opposed to frequently well or constantly ok this case your honour's definitely does present conflicts within the evidence there's no doubt about that in our brief we cite wheeler which held that in so surely case that does present conflicts within the earlier under the highly deferential standard review and so scary disability cases which is substantial evidence if more than a scintilla of evidence exists to support the algaes findings in reviewing court must affirm and more over as this court reiterated in philip's reviewing court may not decide facts a new or reviewing court may not really weigh evidence a review in court may not substitute its own judgment for that of the commissioner and our position is that the this court can affirm the decision in this case because the a l j took her duty to resolve the conflicts of the evidence very seriously she discussed the evidence at length the overall record and her factual findings  by the record now this court may conclude that the evidence preponderance against a particular finding of hers for example the r c the hypothetical but as long as substantial evidence which is a severe impairment and then in assessing her mental r c she considered the record as a whole and she gave good reasons supported by substantial evidence for the weight she gave to the various medical opinions  point out in our brief and i note that claimant did not dispute in reply at a majority of the appointments she had with treating psychiatrists claim it reported that she was doing well or great she was stable  medications and she demonstrated an remarkable findings on mental status examinations moreover no treatment records indicate claim to have any specific mental limitations on her ability to function now they  discounted planets subjective allegations of disabling symptoms for similar reasons that is the credibility determination treatment providers repeatedly noted in the progress notes they claim it was doing well in stable when taking medications and although claim it complain at times of situational environmentalists stressors in particular related to her relationship with her husband my daughter attempted suicide the treatment records never described her as complete being disabled or unable to function particularly for any twelve month and nd of period which is the duration requirement that the so security act imposes or over at times are court requires the you know the it doesn't have to be continuous if there's an episodic nature to the disability the that has to be considered definitely your right your honor but i would say that the she was not severely episodic unlike the claimant and shrink she was mostly stable with occasional episodes that were usually associated that didn't i mean the the i didn't consider that well they didn't didn't consider the episodic nature that there would be bad days as well as good days where they all j noted the act as a patients in are symptoms maybe did not use the word good days bad days but did talk about episodes of his aspiration being symptom increases due she had stopped working as a composite entirely after two thousand and nine but the record indicates that several times she told medical providers that she was working as a lawyer and least a part time basis after two thousand and nine and she also in treatment notes described that she had good relationships with others she was able to care for grandchildren she was doing some sort of a church charity work during this time and these activities undermined her allegations of disabling limitations  your honors the hypothetical the post of the vocational expert as i said earlier fully accounted for her mental impairment including her moderate difficulties in the broad functional areas of social functioning and sconce a trace of persistence or pace because the a l j limited her to short simple work instructions and to occasional interaction with the public and this resulted in in the ultimately finding that you can only do unskilled work and the vocational expert identified three jobs that said that did not require more than simple instructions and did not involve more than occasional interaction with the public and of course under the social security act the question is not does the person's impairments limit them to a point where they can perform their the work that they're accustomed to in this case a lawyer she also worked the pharmaceutical industry now the question is is there no work whatsoever that the person can do given their limitations that's they are see given their vocational background and here they found that she could do some other work thank you i would just like to note that there is no medical evidence in the record to suggest that the claimant can work there's no dispute that the ale jay has to reconcile we don't have a training dr from so security that indicates that i believe that the plaintiff can sustain simple routine repetitive work over the course of a work day the training doctor says that you cannot do that and the social security doctor at ten dollars to a record specifically states due to severe bouts of depression the claimant would be would not likely perform activities within a schedule or maintain regular attendance she's quite withdrawn and isolative and would have difficulty interacting with others in a competitive setting that is completely consistent with treating doctor does nothing for the a l j to reconcile in this particular case the hypothetical to the vocational expert does not take into consideration the claimants ability to persist and maintain pace let's assume for the sake of argument that she can understand simple tasks and complete a simple test that does not mean that she's is taking into consideration her ability to show up for work on time to perform those simple tasks throughout a work day and to show up five days a week and complete those simple tasks so this hypothetical is not supported by the record to rip the record the opinion of the training doctor the opinion of social security doctor is that the claimant would be unable to do those things that is the medical evidence in the record that is the substantial evidence in this record law expert said that more than one or two unscheduled unexcused absences you know would not be tolerated are would become a problem i think is the language and he also says that if she was off task fifteen percent of the work day or more she would not be able to maintain employment ok so the vocational experts testimony would have precluded classes for several hours per day three hours at a time there's no psych hospital is ations in ross rush is a completely different case than this case this case is more in line with shank and it's more aligned with  all right thank you very much we appreciate the argument we are going to take a five minute break before