i turned around and saw an empty microphone and i think this case can be simplified a little bit by focusing on two issues the first sorts of things and found that the mental impairments were not severe what strikes me as odd about this is that the physical symptoms upon which the a l j focused the credibility of mr napes so he could he could stop the jerky movements the disk and he says by stopping the medicine and then he would be back in his bipolar suicidal situation that we are well actually i'm not a doctor so forgive me forgive me for saying this but i just happen to know what these symptoms don't necessarily go away if you have basically sticking out your tongue every thirty seconds you stop the medication that doesn't go away and there's nothing to be done to cure you have that for the rest of your life and again forgive me i'm just i know what i can't pretend i don't know well even assuming he could stop it by stopping the medication he'd still be back with it's if you stop the medication he'd still be back with his bipolar suicidal correct situation correct and mr neighbor was not ignorant of these twitter or both side effects record shows that he was advised about them and yet knowing of these symptoms some of which he actually suffered from the torticollis those sorts of things he nonetheless subjected himself to that drastic treatment doesn't that say everything about mr mapes credibility that a person would subject themselves to that traffic treatment and actually suffer from some of those horrible side effects from his neck was twisted to the it was the left all the time the so if he was willing to subject himself to those side effects and the doctors were willing to prescribe those medications knowing that they could cause those side effects that says everything about mr naves credibility and not wanting to end up in the hospital like he did twice during the period of time we're talking about and how he wanted to improve his condition would you explain this l j relied on dr these problems at the time that he saw dr mclean so what do we do out how do you how do you explain that again forgive me i'm playing doctor a little bit here those side effects can coming up so the fact that during that is that in the in this record no it is not but it is in the record that the side effects waxed and waned went up and down in terms of severity so the fact that they were lesser at any one particular time in this is in the record they were lesser at and he one particular time doesn't mean that they weren't observable at other times and you know i could take the thrust of my oral argument going through page by page by page by page by page by page where the treating physicians counselor psychologists whomever observe these symptoms i mean  symptom testimony to be a person who would be off task ten percent of the time nancy you know juries characterization and vocational expert testified without contest station that a person had that limitation would be unable to perform sustained work i suggest that that's should be the end of this case under the lincoln filter precedent this court has said a clinton claimant symptom testimony alone with i pronounce you dr hecker testimony basically basically just decided that the findings were outside of his area of expertise however completely ignoring that dr akhter was a primary care physician is that correct it's correct and it's wrong and their primary care physicians in fact treat their patients i want to wake make one more point doctor mclean made her assessment while the claimant was in a assisted living situation that's very important thank you stated that mr nape reacted well to medication and she assigned no specific work related limitations based on mr napes mental impairments and under this court's precedent in town a pet in mclean's examination rested on her own independent clinical findings that constitutes substantial evidence in addition and i say the second point is that the medical evidence in this case demonstrates that over time mr nate did in fact improve with medication and we have multiple instances of this for example in february tw thirteen in the year leading up to the ail g s hearing in this case february twenty third team mr nate states i'm doing well his doctor noted that he was quote unquote much improved no psych no psychotic symptoms his concentration was good his memory was intact going forward a few months in may of two thousand and thirteen mr began says i'm happy with the program that i'm in his dr notes that he continues to do fairly well on his current treatments there's a lot of credit for that it seems to me but in december two thousand and twelve as i understand it he tried to commit suicide by hanging himself and cutting his wrists and taking in taking an overdose of medication and then after that he was living with a supervised living situation so the fact that he looked good and said he was feeling better in light of that  contrary the no did it step two that mr nate had a medically determinable mental impairments but the question at step two is whether or not those mental impairment significantly limit mr napes ability to do basic work activities now as your honor points out he did go to the hospital in late two thousand and twelve but when we look at the treatment notes there we see the united commit suicide correct yes and we see but what we see is under treatment and with the adjustments in his medication he improved and over the course of two thousand and twelve and over the course of two thousand and thirteen there are numerous instances not just of mr nape reporting that he felt better but of doctors observations that mr  quote unquote much improved for example in july two thousand and thirteen kind of going for with more treatment notes this was just a few months before the hearing his doctor examined him and found that his concentration was good his memory was intact he continues to do fairly well on his current treatment regimen so yes there's no there's no question that he had there were i think two instances where he went to the hospital which is which obviously indicates serious symptoms at that point and issue that that's looking more now to what are mr napes physical impairments and yes the physical impairments that we're seeing at the person correct correct but the physical impairments that come from this case are from the side effects of his medication which is for the mental impairment correct but when we look at but when we look at what the physical impairments are the a l j accounted for those physical limitations on this is on page twenty seven of the record gave him a quote unquote quantifiable sixty to seventy percent benefit for stiffness tightness in pain if we move on there were times when his neurologist observed no tremors at all he had a normal range of motion in his neck on several occasions and in fact he underwent testing for a normal involuntary movements and scored a zero that's on page six eighty nine so yes there were side effects as mike as my colleague pointed out this morning but but the l g considered those accounted for the credible limitations stemming from those but explain why they were not disabling and why mr knight could still perform work in accordance with the residual functional capacity hacking is was a treating physician yes that is that is a relevant consideration l j recognized that dr hack in use was mr napes primary care physician but provided specific and legitimate reasons for  assigning for discounting dr hack and yes his opinion so the treatment relationship is just one factor to look at special specialization is another factor to look at here and we have a psychologist who however one  made that made that as one point correct in primary care physicians see the entire person in the gamut of people from babies to geriatric patients in the primary care physician is actually the first point of contact for most people who suffer from mental illness and they are eminently qualified to treat people suffering from mental illness they prescribe medications they prescribe psychotropic medications they make recommendations for other outside resources and they make referrals so to say that this is outside of his area of expertise is patently false well you're right i think what i what i would what i would stress is that what the ale j's point was recognizing that dr hack in us was a primary care physician was that unlike dr mclean who specialized in psychology dr hack in us was a primary care physician and didn't didn't necessarily have the specialization th a medical doctor this specialist i believe was a psychologist right that's not a that that is not a medical doctor but does but but the psychologist does constitute a sceptical medical source that the o to deal with certain side effects or change medication to deal with certain side effects and dr mclean if she had a patient couldn't do any of those things and would have to actually rely o tourist and and your honor i mean that is that is a point well taken i do think that it's important though to also keep in mind that that that was just one reason the ale jay provided for discounting dr hacking  a mental condition if it is not severe at that time the hospital will not take you unless you are threat yourself or others and as as i pointed out earlier to judge to judge s question on this issue what we what we do see in the record is improve relatively quick improvement and then a long period of time where when he is on the treatment regimen that he was on over the course and thirteen improvement much improvement in his symptoms to the point where he could live independently he was correct he was living i believe he was in a program where he where it was i think he had to check anything else he says about what he experienced well we we do i mean we do see statements in the treatment records from mr nate himself saying that he's doing well and that he and that he feels as if medication is improving his i want to talk about two cases that counsel referred to turn a pet him that was a case of an examining doctor up against a treating doctor and the treating doctor provided no evidence of the underlying impairments little known the symptoms to quote this court not even a clinical observation improvement throughout this case yes i don't disagree with that is it sustained improvement in garrison cases specifically say the periods of improvement do not gainsay the overall finding of disability mr nabors discharged from the hospital because he was improved that's why you discharge people from the hospital is because they've been improved that doesn't mean they can function on a sustained basis dr mclean did some tests and if you're a careful reading of her report is important in addition to what i've already said about the administration of the psychotropic medications why mr heaps testimony and the vocational experts conclusion based on that should be the basis for this court