only has ten minutes i'm john philips representing rodney burkey i'll also try to keep track of my time and will attempt to reserve two minutes for rebuttal i thank you this is a case of confusing apples with oranges the crux of this matter is the ale jase rejection of dr parsons opinion the treating psychiatrist dr parsons opinion which appears at three twenty nine of the record consider the impact of berky's mental impairments in a work setting and according to the vocational expert at fifty five persons limitations per clude work well let me ask you tess ok so the alan i think basically discounted dr parsons testimony because they say they believe that parsons testimony was inconsistent with the overall record and with dr trump opinion and with the vocational experts evaluation with parsons oh no it's because parson had some notes and then had a report why isn't that enough for us to affirm because dr trump opinion is actually her opinion is actually consistent with the doctor person's opinions dr person's notes are just that they are notes taken in the doctor's office by a professional who is trained to put people at ease and as we're dr trumps findings before she got to the opinion obviously he testified correct yes and he testified about the things that he's capable of doing and that he cooks for complete meals a week which is more than some of  which isn't isn't wrong well it is all of that all of the testimony and the doctor's notes and doctor trumps findings they were all considering  work situation each medical professional felt that when mr burkey while he could survive living in a cocoon department where she is generally afraid to leave with his father keeping him coming every day feeding him clothing him actually than say clothing feeding him anything you mean gone out more than he dad except he didn't have a car he with the father was also transporting him that is the father was visiting every day and the father kept track of him that is that was a support system he had to stay in his house the judge also felt it was inconsistent that a person with agoraphobia could live alone for eight years but what the judge did not recognize was the impact of the father and also the office notes themselves consider mr burkey in a controlled environment but when the report that dr parsons wrote is entitled mental ability to do work related activities and she is charged on that report form to state your opinions of the individual's cognitive limitations and their impact on the person's ability to engage and work full time that's the or and let me ask you this dr parsons assessment that he had limited use of judgment and what's the use of the ability to function in a work environment assessment was based on the inside me that she observed the panic attacks the agoraphobia that you mentioned is there anything inductive prompts examination in notes that would contradict those findings in terms of his social similar diagnoses but when she should with switches over to the last page dr trops findings state first of all she stated that mr burkey is genuine incredible without exaggeration and then she burke will not may will have trouble with sustained concentration persistence ability to carry out simple instructions maintain attention and concentration to maintain a regular appearance attendance scuse me that is the same findings of dr parsons so actually not findings but opinions so those they're actually in agreement the judge felt they were vet that dr tromp was vague i suggested a reasonable person looking at this would not find dr tromp vague we also when i posed to the vocational expert dr parsons opinions dr trops opinions i posed five hypotheticals after each hypothetical the vocational expert stated no jobs and that those were individual on those individual factors the judge posed one hypothetical saying that there was a limitation in the ability to interact with people well that isn't that was one of the minor things and that was it no consideration of work environment and what the ail j what the stated was that he could do is past work on the other hand the nine examining doctors found that he couldn't do skilled work and his past work he limited they limited mr burkey to unskilled work and both of his past jobs one  was skilled and the other one was at least semi skilled so there is a sense that was not included in the jones judges one hypothetical there were testimony was he could do his pas t work but he couldn't because of the findings of everybody in the file other than apparently the judge and the judge did not inquire to alternative jobs if you have any other questions we don't parrot if you want to reserve the balance of your time yes please thank you thank you ey perhaps could have been a little clearer on certain points but the pressure points that i'm looking at is how in the record did they say explain far as that goes and i think it also had sort of thought that mr burkey was credible on certain things but not credible on others and how was that explained in the record in a satisfactory manner according to the law well it's not the best written decision it is a little strange for the first says well i think the activities of daily living don't help and i think the medical record doesn't help and then he went into an explanation of why it doesn't help his credibility doesn't help the give credence to what he claimed his continuing limitations are and part of what he he did talk a little bit about even though his father came over every day that nonetheless this claim it was able to do a number of things and survive by himself is pretty brief but  it does go into some explanation of what the elder was talking about then when you talk about medical improvement this is all in the r f c component of the decision and where some cases of said well you have to just say everything you want to say about the claimants credibility or now we're calling it in consistency with the record that the l j probably could not have gone on and you clued into the evidence about judge parsons decision as part of the assessment of plaintiff's consistency or inconsistency with his claims you know it's the district court judge tried to help and values basically said well i think the elders clearly judge trump and judge the doctor tromp and dr parsons were inconsistent with regard to cock into impairment but i think i think that's the problem with this case the district court did try to help deferential review but the one area that our case law has been very consistent in requiring a further explanation is when b l t fails to give the treating doctor's opinions controlling weight so  get into the pressure point that judge callahan explored with you the doctor treating doctors know dr parsons fairly consistent that he's able to function by himself on a certain level because he  lives in the apartment and takes care of his own food needs etc but he's always had pretty severe social anxiety he rarely leaves the house his panic attacks are really triggered when he's around other sex meant that he had severe anxiety panic attacks and gore phobia that would limit his ability to function in a work environment the a j rejected that ultimately conclusion but i don't know why is there an explanation in the record as to why i discounted dr parsons assessment that he is going to have limitations severe limitations in the work environment because his panic attacks are essentially triggered by being around people and in answering that question if you can focus on doctor because there are some inconsistency there that the district court observed but i'm not sure you understand that either because dr tom said that it's likely he would apparent improvement over time and this was evidenced in dr parsons treatment notes not in either of the two examining opinion our doctor tromp or dr parsons were to us basically early on in the treatment period right improvement in terms of golf course and his ability to function but not improvement as far as i can tell in terms of social functioning skills i mean is this a situation the bottom line in my mind is this is a situation where the explanation is adequate such that we have to remain until further factual findings well i you know i you know i recognize that our case law likes it to be more specific  likes the l j to be the one who gives the examples but the reliance on the gaffe score used to be relied on much more heavily by psychologists and psychiatrists it's gone out of her least as far as the associate american association says they don't longer recommend gaffe scores because they are too subjective and they're too much as well ok you're here defending the decision i am all right so how that can be best defended well i can be best offended by saying that what the l j is looking at the treatment notes and the improved gas cores over time did show medical improvement and that was the gist of his disagreement with dr parsons opinion not so much the disagreement with doctor trying to paint now there was dr parsons look did you know made this assessment in january twenty third teen after she had been treating the claimant for several months but over the next two years you know whether or not these are the lessons symptoms indicated probable lessened impairment in the workplace is a leap that the  doctor's make or the l g s make based on their assessment ok he's starting to be able to go out by his own more often he has friends he's walking in the public these would seem to be lessened symptoms and there is why do you know i guess are the assumption is if these are in the personal life why wouldn't they translate to the workforce it's kind of a that is what the l g is assuming that this is the kind of medical improved but the but the problem is that the  testimony that's not borne out by the record because i'm looking at the treatment notes that progressed from january thirty one twenty thirteen may may twenty thirty and she saw him he'd have to anxiety attacks since his last  appointment and august twenty third team his mood swings he's not so stable he's easily tearful he doesn't want to meet people november twenty third team his mind is still trump also didn't see the subsequent treatment and her assessment obviously was based on her meeting with the claimant the one time they didn't say that her assessment was and certainly when the gas score is favorable to the claimant they will point to it and the gas score is more favorable to the commissioner at the l j may point to it but there's just one piece of information the l j certainly could have and probably should have gone into more detail about each of these subsequent veges where the claimant himself says i'm doing ok i'm doing pretty much better and if in the same treatment now he's also talking about that he's had some more panic all right well right he did try to explain that eat well you have to look at whether or not he gave a fair assessment of this these treatment and he any did recognize that there were positive signs it meant went toward disability of panic attacks and crying or being irritable or stating he was depressed but by the same time it looked to the l j from those treatment notes that it was a kind of a steady if slow improvement over time and when there was an exacerbation or the gaffes were dipped a little bit the judge the treating doctor increased his medications and subsequently the gaff score went that or tried to that said look you recognize that it dipped here but then overall it was going said only in a positive direction the that is what he said that is what he did and that's where the r court may decide that wasn't it wasn't adequate but you know you come down to what substantial evidence and most of our decisions have said that substantial evidence is enough evidence to support say convince a reasonable person that this was right you have at least two people here who are reasonable people who believe that this was sufficient that's where we are all right i mean what's the panel has any additional questions i've taken a little bit over all right thank you thank you could you answer a question for me yes or no when i first looked at this case i was impressed with the work the district court judge have been i thought very careful about how the district court proceeded with the process and while there may be certain differences that there are it seemed to me that the district judge did a very good job in what way would you disagree with that where did the district judge go wrong in your view he did not thank you he did not consider the work environment factor i'm sorry he did not consider the work environment factor this is not a thomas said he case this where you had a spinal disorder that spinal disorder will appear one way in the notes and in the evaluation it'll actually appear the same way as far as workability here we have a mental condition that changes that transforms from in his prison of an apartment to the point that where he has to be in a competitive work environment that's what the that's what this driver in judgment was he was a painter which do have to work in tandem with coal employees and you also have to respond very quickly and very effectively with your supervisors you also have to go out and earn a living which is exactly what this guy's file he actually in the you know the alcohol issue is is a big thing and what i do for a living but he actually quit drinking and then he couldn't handle anything else i would like to point that out i'm sorry and which doctor pointed that out that that it's a it's also it's an tromp it's also one person's no no no that this became a game changer that he quit oh the work your work history i would suggest you search that both in trump and in the parsons opinion where they switch from documentation of like office notes or findings in trump's case and then they go over to answer questions about how he would perform in the work history that's where they're united i would also say with he was being honest searle and thorough and polite i guess is what he said in any event what the what we have here is a failure to understand that the work environment changes unlike a spinal case where your spine doesn't change when you go to work well said that they failed to understand it or that they saw it differently than you did because that that makes a difference i think the forms themselves call for a different thing and they're not recognizing it they fail to understand what those forms do they're not notes taken in an office cushy office that's a big difference you have somebody who's trained and paid to put you at ease so that you can so they can treat you that isn't what you have at the work site and i have been at work sites i can and i could i think we all know that those work sites particularly construction work sites which both of those work can be quite intimidating certainly to somebody with panic attack and so when you say we all know you mean it doesn't as the in the record that's why i backed away from that shut it's not in good idea t