medical opinion of his treating psychiatrist was submitted to the social security administration however the administrative law judge rather than following the general rule that's well established the treating providers medical opinion is entitle to substantial weight decided instead to give her opinion no way and the reason he did that he said was relying on an exception to the general rule which says that if the treating providers opinion is inconsistent with her own examination notes then he does not have to give it substantial way the the administrative judge or  the problem with that and the issue in this appeal is that how do you treat a psychological disorder that is by its very nature episodic that you have good days and bad days and you may report to your doctor one day and be feeling great and then two weeks later you may have had a flashback or some kind of a breakdown and you hear the notes reflect that you're doing terrible so we filed this appeal relying on case law from other jurisdictions and on the unreported decision of this court in the mace case arguing that that where the disability is episodic the fact that  some days where there is no finding no her examination reports that there are no issues that day does not by itself establish that there's no disability we made that argument and then after the priest were filed the decision and chink the commissioner came down and we filed a notice of supplemental authority social security administration responded and what the shrink decision did essentially has adopted the reasoning of the cases we cited and if i can find my glasses were specific in the shrink case they had a claimants who had bipolar disorder and the could in the same argument was made by social security that the fact that her or his medical records did not show a consistent pattern of  problems all the time showed that the doctor's medical opinion should not be followed and the cordon shrinks said that the fact that shrink at times seemed to be doing better does not support rejection of evidence of bipolar disorder rather the court said these ups and downs reflect the episodic nature of bipolar disorder or size of the what we're arguing in this case except as to what what evidence do we have here about how about just how bad the downs are i think and sink the downs or are fairly characterizes pretty extreme what evidence do we have here pretty extreme here to your honor one of the  consults of examiner dr gluck found that mr ross had daily traumatic memories of events involving actual threatened or personal harm to which he responded with intense fear helplessness and horrors and he had nightmares and distressing dreams of distressing events every day that he had distressing recollections every day including those of friends shot in front of him and of a little girl who blew herself up in front of him during his wartime service that he found that he acts and feels as if you were back in that situation when these things occur that he's hyper vigilant with an exaggerated startle response is treating fuse treating psychologist he's easily irritated irritated has significant hyper vigilance as many triggers based on his combat experience and can have flashbacks at any time and the triggers can prompt him to act out that combat experience by putting himself back in that situation or to bunker down and just shut down and not deal with anyone she said that in her testimony yes going down and also he was so bad that i could have hospitalized him but i looked at all of those treatments and i with there just seven of them and i did not see any indication in the treatment notes and they are not just talking about how he is right then they are talking about she she reported you know how he went to these court proceedings and he had the  police in child custody people come late at night and and so full of i saw no indication in those treatment notes that he ever riposte it all she ever made any note of any bunkering down zero in a so bad that she might have to hospitalizing is there any place else other than the treatment notes where there might be some corroboration of that was your honor pointed out it's in her testimony also let me point out some elements of her treatment notes which do in fact indicate let me so we just talk about the bunkering down for a minute before you go into that certainly there was a group basically is withdrawing and not dealing with the outside world taking cover wasn't in her notes but it wasn't notes that were in the record yes other notes in the record the very st exam with dr saban she reports that he was depressed he was stressed he was in an anxious mood he reported increasing anxiety hyper vigilance disturbing dreams paranoia and sleep problems that was on june th and it's a pigeon i know five of the record  on one july of two thousand and eleven dr saban again reported he had an anxious mood a restricted aff act reported increasing nightmares vigilance anxiety depression and education education and that's a page six hundred and ninety six t ninety nine of the record on october th of two thousand and eleven she observed dr saving observes that he was angry and tearful and overwhelmed that he reported an increase in anger and an anxiety  nightmares and extend truce of thoughts that he had the image of the little girl blowing up in front of him he remembered in the relieved picking up the river a friend's remains after he had been killed by an i e d on that examination thousand and fourteen he was removed she was she observed him to be depressed and tearful he had a global assessment of functioning of fifty one which indicates right on the border between moderate and serious  three she's observed that his mood was anxious and he reported that the boston marathon bombing which had recently occurred had triggered memories of his wartime service with intrusive thoughts of combat loss of life and severe decisions of the th and d c circuits which basically says that mental disorders cannot be ascertained and verified as are most physical illnesses because they are generally not revealed by objective medical tests such as laboratory analysis therefore it is necessary to place reliance on self reports because it would be impossible for a doctor to observe the contents of plaintiff's dreams the intensity of his solution   ations or his flashbacks so the the medical opinion and the legal opinion from the cuban case in the cases cited there is that so if reports are very valid and sometimes the he had these dreams and whose nations and so on and so forth or that she disregarded the fact that those made him unable to work i think she thought found not credible were never specified can you identify specific statements or symptoms that the ale j found not credible c are for the commissioner this case is about a claimant who had an active robust lifestyle he worked as a skydiving instructor taught motorcycle endorsement classes and cared for his infant granddaughter all during the period of time when he claimed to be disabled this case also has a date last insured issue claimant retired from the army in september two thousand and seven and alleged his disability began that same month is earning record shows you acquired sufficient quarters of coverage to remain insured through june th two thousand and thirteen so he must prove that he became disabled prior to the state to be entitled to benefits here the court can affirm th complaints were not entirely consistent with the evidence of records like to turn to claimants st argument about the nature of episodic mental impairments there is no per se rule that says episodic mental impairments preclude work that's just not true a diagnosis is not a disability contrary to claimants argument evidence of intermittent periods of improvement and documented in a treating source notes can be a good cause to discredit a treating source opinion as this court found in the phillips case in the crawford case which we believe is controlling here in philips the court found that there was substantial evidence to support the a l j suspicion to give little weight to treating physician opinion when it conflicted with treatment notes and claimants testimony about activities similarly in crawford this court found th shrink case we said it's not enough merely to point to positive or neutral observations that create at most a trivial and indirect tension with the treating physicians opinion by proving no more than the claimants impairments are not all it seems to me that doctors say vince opinions included that he had severe sleep deprivation trouble recalling or learning when he's experiencing stress experience five backs intrusive thoughts and some of the things that your opponent outlined here today you argue that her treatment notes contradicted her opinions because they show that he was alert oriented good contact had good judgment etc but she didn't upon that he always experience the symptoms so much explain to me why there's an inconsistency between her notes and her opinion because her opinion said that he could not be around other people and he couldn't around big groups of people and other individuals and that's why he was he was considered to be disabled that's what she testified to at the l j hearing that how can say he couldn't ever bear out another people or he can usually beer on the other people or told imitations of the r f c limited the claimant to routine repetitive tasks only no public contact and occasional interaction with coworkers of the l g effectively accepted that he couldn't be around and other people at least not on a regular that case found that there were no severe mental limitations whatsoever at step two but here in this case the o j found the claimant had severe mental limitations and he continued to and i was those throughout the steps the sequential steps of the evaluation indicative of anything in particular well that's true but the l j relied on that evidence seems to me if it relies on it in any way then it has to look at the entire record as far as that evidence goes isn't that right yes and the a l j did a look at the entire record when making the determination to get limited weight to the opinions of the treating psychologist and took into account that opinion that she gave at the a l j hearing that he had problems being around other people but in failing to discuss the scores of fifty or lower than fifty five it appears that the l j may have cherry picked the evidence excepting that the evidence in favor of the opinion and disregarding the other evidence find that he assigned limited weight to the trading psychologist opinion st he looked to the activities that the claimant was it being able to do on a regular basis and he looked to the normal exam findings and he also looked to the conservative treatment according to the record the claimant was a skydiving instructor motorcycle class instructor cared for his granddaughter socialize with friends in person and over the phone attended church contact he was alert fully or in it and cooperative with intact recent remote memory concentration and dutchman no abnormal motor activity or perpetual disturbances and he actually had an improvement of his p t s d stems and when his daughter moved out of the house as far as the conservative treatment the j noted that he had by monthly therapy sessions and medication management with very few adjustments but that he had no were not entirely consistent with the evidence of record if there are no further questions i'll conclude that the threshold for evidence sherry sufficiency in social security cases is not high p t s d was severe or very severe severe do you agree that the l g found in fact that the p t s d was severe it's up to the analysis yes your honor the i did find that the p t s d was a severe impairment and that's on page twenty two dollars of the record ok so the issue of whether the p t s d was severe isn't at issue in this appeal is that that's true that's a distinction from shank found finding number three on page twenty two of the record that one of his severe impairments was post traumatic stress disorder and as far as the the conservative treatment it seems to me this case is very different from fernandez because he was treated both with medication which was changed some regularity he had the individual therapy sessions he also had the weekly group therapy sessions and further dr stuart saban testified that in their appointment she could only go so far with him on certain subjects because of the trauma that it induced that's true your honor but also when fernandez the core pointed out that the psychiatrist the treating psychiatrist in that case that had many positive findings  regarding the claimants a mental impairment that his mental state included being able to interact with others so fernando's is actually very similar to just to respond to the court's question earlier the judge of the administrative law judges blab reasoning for not believing mr ross in terms of his statements about the severity hail j found that he only tried limited treatment on also that he had he had an active lifestyle to sums to some extent in that he was meeting with veterans groups that he was teaching veterans in a motorcycle  the l j social security is required to look at whether his level of functioning in that protected setting is transferable to a normal competitive work situation forty hours a week if i recall correctly those were in there in the record indicated those were with veterans the teaching the motorcycle riding skills that's right i think the question still i think is i think the court given the fact that many of these things were in a protected setting and some were as your honor indicated maybe sort of in between like the church the l j had an obligation to go it was not protected at all no the the when the  child services people and the police came to his house late at night those were not protected and he worked with neighbors to deal with the flood situation i think those are classic d situations in the court situation he went berserk and then he calmed down later in the child protective service thing it made him extremely upset and angry and he freaked out but then he calmed down and behaved badly when that occurred sometimes a sky diving instructor at a seattle here i'm sorry is it is his time as a sky diving instructor at su i don't think so you know that was right after he returned the beginning of his he did it for a short time and then stopped and no i don't think there's anything in the record as to why he stopped but it wasn't something that was ongoing and it wasn't something that continued much you know into the period record indicates it was a few months i'm not sure if i can get my hands on a citation to it