[00:00:00] Speaker 04:
Thank you both for your excellent arguments.

[00:00:10] Speaker 04:
The next case on the argument calendar is Collins.

[00:00:21] Speaker 04:
versus the Commissioner of Social Security.

[00:00:25] Speaker 04:
And this case is set also for 10 minutes per side.

[00:00:31] Speaker 04:
So we'll hear first from a appellant.

[00:00:39] Speaker 04:
Mr. Goddard, you've got 10 minutes scheduled.

[00:00:48] Speaker 04:
If you'd like to make a rebuttal argument, please try to save some time for that.

[00:00:57] Speaker 03:
Thank you, Your Honor.

[00:00:58] Speaker 03:
May it please the Court, Jordan Goddard appearing on behalf of appellant Adrian Collins.

[00:01:04] Speaker 03:
I will do my best to reserve two minutes for my rebuttal.

[00:01:09] Speaker 03:
Ms.

[00:01:09] Speaker 03:
Collins has never been able to sustain full-time work due to her long-standing mental health issues.

[00:01:16] Speaker 03:
As a result, she is disabled from PTSD, depression, and anxiety.

[00:01:22] Speaker 03:
Unfortunately, however, the administrative law judge who heard her case made multiple errors of both law and fact in denying her application.

[00:01:33] Speaker 03:
Specifically, with respect to the credibility finding, the ALJ's

[00:01:38] Speaker 03:
Discussion is facially inadequate as it does not provide sufficient clear and convincing reasons articulated in the decision.

[00:01:48] Speaker 03:
Additionally, when it comes to the opinion of Dr. Yoon, who examined Collins, the ALJ made multiple errors.

[00:01:56] Speaker 03:
First and foremost, when it comes to the supportability factor, which the Commissioner's own regulations require the ALJ to discuss in the decision, there is no such discussion.

[00:02:09] Speaker 03:
Under the supportability factor, the ALJ is required to discuss how she considered the objective evidence cited by the medical source and any supporting explanation provided.

[00:02:22] Speaker 03:
As this court has recognized, in the context of mental health evaluations, mental status examination results are considered objective medical evidence.

[00:02:32] Speaker 03:
And Dr. Yoon noted a number of objective abnormalities during the mental status examination, such as with respect to concentration and memory, as well as effect.

[00:02:43] Speaker 03:
Yet none of these are acknowledged anywhere in the decision in any way, shape, or form, which is a blatant violation of the controlling regulations.

[00:02:54] Speaker 03:
Additionally, there is the Personality Assessment Inventory, the PAI, which is an important test that has internal validity indicators.

[00:03:04] Speaker 03:
Dr. Yoon cited the PAI results repeatedly in her discussion of Collins symptoms to corroborate them.

[00:03:13] Speaker 03:
Notably, the validity indicators did not detect any overstatement of symptoms.

[00:03:21] Speaker 03:
In other words, her testing came back as valid.

[00:03:25] Speaker 03:
Under these circumstances, the ALJ was required under the regulations to explain how she considered this evidence in addition to the mental status examination results.

[00:03:36] Speaker 03:
But like those mental status examination results, you would not know from the ALJ's decision that this evidence was ever reduced.

[00:03:42] Speaker 03:
It's not mentioned anywhere in the decision.

[00:03:45] Speaker 03:
When it comes to one of the two most important factors for evaluating a medical opinion, that of supportability, the ALJ's decision just doesn't do it.

[00:03:54] Speaker 03:
Additionally, to the degree the A.L.J.

[00:03:57] Speaker 03:
said anything that could conceivably fall under the supportability factor category, the A.L.J.

[00:04:03] Speaker 03:
tried to link the provisional diagnoses that Dr. Yoon made and say that this somehow shows that she relied more on Colin's self-reports rather than the objective evidence.

[00:04:17] Speaker 03:
I have no idea how that makes any sense, and at no point has the commissioner even attempted to defend that finding.

[00:04:26] Speaker 03:
What the regulations envision is a discussion of the objective evidence that Dr. Yoon cited in support of her opinion, and that just doesn't appear in the decision.

[00:04:37] Speaker 03:
That alone is enough to require remand.

[00:04:40] Speaker 02:
ALJ provided some response to that, right?

[00:04:45] Speaker 02:
I mean, the ALJ said things like the medical records shows that Ms.

[00:04:49] Speaker 02:
Collins has linear and concrete thought process.

[00:04:53] Speaker 02:
She's alert and has normal insights.

[00:04:56] Speaker 02:
At least it appears to somewhat address some of the concerns you raise.

[00:05:01] Speaker 03:
There are some mental status examinations that are noted, but none of Dr. Yoon's mental status examination results are noted.

[00:05:09] Speaker 03:
And the regulations specify that those are the mental status examinations that need to be discussed.

[00:05:18] Speaker 03:
Whether or not any random mental status examination, any observation

[00:05:23] Speaker 03:
Uh, in the record needs to be discussed, um, is, is not specified except for those that are induced by the, uh, the medical source whose opinion is being evaluated.

[00:05:35] Speaker 02:
So that gets to probably with Dr. Lewis's assessment, I guess the LJ found that Dr. Lewis's assessment, uh, that Dr. Youn's assessment conflicted with Dr. Lewis's assessment.

[00:05:46] Speaker 02:
Yes, you can address that.

[00:05:47] Speaker 03:
Absolutely.

[00:05:47] Speaker 03:
So, I've raised a couple of problems with that.

[00:05:49] Speaker 03:
First of all, simply saying that one opinion was inconsistent with another is logically problematic, because if you're discounting Dr. Yun's opinion as being inconsistent with Dr. Lewis, why aren't you also discounting Dr. Lewis's opinion as being inconsistent with Dr. Yun's?

[00:06:10] Speaker 03:
You've got to go to the underlying evidence.

[00:06:13] Speaker 03:
Just the fact that there's one doctor who said a different thing isn't really a reason to resolve... The ALJ said that Dr. Lewis's opinion was supported by the objective treatment records and mental status examination.

[00:06:26] Speaker 00:
So it wasn't just saying, you know, I'm just picking one, I'm flipping a coin.

[00:06:30] Speaker 00:
There was a reason, wasn't there?

[00:06:32] Speaker 03:
I think we have to look to that, yes.

[00:06:34] Speaker 03:
I agree, and maybe I'm splitting hairs here, but I guess I wanted to point out the fact that the opinions are different in and of itself isn't really a reason.

[00:06:45] Speaker 03:
To the degree the AOJ gives a reason, it has to be grounded in those mental status exams.

[00:06:50] Speaker 03:
However, we do discuss those mental status exam results, and this now is, I guess, moving past the legal errors and more into the factual errors, the substantial evidence issue.

[00:07:01] Speaker 03:
As discussed in our briefing, there are quite a few mental status examination results that are just not acknowledged anywhere in the decision.

[00:07:10] Speaker 03:
I think it's fair to describe this as a cherry picking of positive results.

[00:07:15] Speaker 03:
Whenever there is, for example, say, a brief mental status examination when Collins went in for a smoking cessation appointment, as I point out, that gets cited.

[00:07:27] Speaker 03:
However, when she goes to see her mental health therapist on the exact same day and the mental health therapist notes multiple abnormalities during the mental status exam, that's not noted in the LGA's decision.

[00:07:39] Speaker 03:
And that's an unreasonable way to lay out the evidence, to only cite the high points, particularly when a lot of those high points are from people who aren't even mental health professionals and completely disregard the regular abnormalities that are cited, particularly by the mental health professionals who see her regularly, is not a reasonable way to evaluate the evidence.

[00:08:03] Speaker 03:
So, while yes, the ALJ did address one of the two factors that she was required to address, unfortunately, substantial evidence does not support her decision when it comes to those mental status examination results.

[00:08:20] Speaker 03:
They're simply too cherry-picked.

[00:08:23] Speaker 03:
They don't reflect the record as a whole.

[00:08:27] Speaker 03:
Additionally, I think it's important to note the argument that we raised with respect to the medication adjustment.

[00:08:36] Speaker 03:
While, yes, the AOJ does say that she's preferring Dr. Lewis's opinion because

[00:08:42] Speaker 03:
because of mental status examination results, the regulations do not limit this analysis to only mental status examination results.

[00:08:50] Speaker 03:
In fact, the relevant regulation on consistency specifies that the ALJ has to consider also things like consistency with non-medical sources, which tells you right there, this can't be all about the objective evidence.

[00:09:03] Speaker 03:
So while it's not error to consider the objective evidence,

[00:09:06] Speaker 03:
Here, where we have someone who is maxed out on her medications and getting regular adjustments to those medications, there's more here than the ALJ recognized.

[00:09:18] Speaker 03:
And the consistency factor requires the ALJ to consider some of those things and not be myopic and focus solely on mental status examinations, as was done here.

[00:09:29] Speaker 03:
I would like to reserve the rest of my time for rebuttal.

[00:09:33] Speaker 04:
Thank you, counsel.

[00:09:37] Speaker 01:
So we're from the appellate First time I met this podium good morning your honors Elizabeth fair on behalf of Martin O'Malley the Commissioner of Social Security this ALJ's decision is Accurately reflect reflects the record here.

[00:10:01] Speaker 01:
This is a claimant who has

[00:10:02] Speaker 01:
had lifelong anxiety symptoms, but her condition has been responsive to treatment.

[00:10:09] Speaker 01:
The ALJ cited every record in the medical record history, as well as the claim it's subjective accounts and the subjective accounts from her mother,

[00:10:20] Speaker 01:
And accurately came to the conclusion that this record shows that this claimant's condition is amenable to treatment.

[00:10:27] Speaker 01:
That doesn't mean she's not limited at all.

[00:10:29] Speaker 01:
And if you look at the RFC finding, it is particularly limiting for someone who is young, someone who is

[00:10:37] Speaker 01:
has these mental conditions.

[00:10:39] Speaker 01:
The ALJ limited her to simple work, simple unskilled work with reasoning levels one or two, limited her to work that only had occasional changes in the surroundings, the tasks, limited her to work that didn't require her to engage in independent

[00:10:56] Speaker 01:
tasks independently coming to Setting up things put it that way and also that she Should work mostly independently, but was able to work with up to three co-workers that RFC accurately reflects this record here and

[00:11:18] Speaker 01:
My opponent takes issue with, I'll start with Dr. Yoon's opinion.

[00:11:23] Speaker 01:
Dr. Yoon examined her wants and didn't review any other evidence in the record.

[00:11:31] Speaker 01:
That's at 1F in the record.

[00:11:34] Speaker 01:
If you look at it, the ALJ said Dr. Yoon didn't, she was unable to review other evidence.

[00:11:41] Speaker 01:
She didn't support, she had these provisional diagnoses.

[00:11:46] Speaker 01:
She didn't support her findings.

[00:11:47] Speaker 01:
The ALJ maybe didn't use the word support on page 23 in the record, but you can tell that she's talking about how this doctor's extreme limitations weren't supported by her findings.

[00:11:58] Speaker 01:
And my opponent says that Dr. Yoon

[00:12:01] Speaker 01:
correctly that she did examine the claimant, but if you look at that examination, there's really nothing in that that would support these extreme marked limitations that Dr. Yun checked on the box.

[00:12:13] Speaker 02:
Just one thing, in the ALJ's opinion, the ALJ seems to suggest that Dr. Yun only relied on subjective symptoms.

[00:12:21] Speaker 02:
It's a little bit unclear what the ALJ was saying, but wouldn't personality assessments and mental status health assessments, aren't they objective evidence?

[00:12:30] Speaker 01:
They can be, but if you look at, especially on pages 359 and 360 in that exhibit, Dr. Yun is talking about all kinds of things, chronic conditions, things that she would have absolutely no way of being able to have objectively documented during that one examination that she conducted.

[00:12:49] Speaker 01:
And I would also, she does cite that PAI Personality Assessment Inventory, I think it stands for.

[00:12:57] Speaker 01:
But on page 367 in that same exhibit, you'll see that Dr., I think her last name is Mosey, she specifically says nothing in this report should be, no conclusion should be based on this report alone.

[00:13:12] Speaker 01:
So to the extent Dr. Yun is relying on that personnel, that PAI,

[00:13:17] Speaker 01:
That document within itself is only a minuscule part of this record.

[00:13:22] Speaker 01:
It's not meant to be a be-all, end-all, and that is really the only thing that Dr. Yoon cites in support of her findings.

[00:13:28] Speaker 01:
And then, again, the ALJ found that Dr. Yoon's conclusions were inconsistent with not only Dr. Lewis, which she specifically cites in that paragraph, but also Dr. Covel, and that's two paragraphs above where the ALJ discusses Dr. Lewis.

[00:13:44] Speaker 00:
I have a question about a different subject, which is the ALJ's treatment here of Collins' subjective symptoms testimony.

[00:13:54] Speaker 00:
So we require that ALJs provide specific, clear, convincing reasons for rejecting such testimony, and we also require that the ALJ link

[00:14:05] Speaker 00:
the testimony to the particular parts of the record that support the ALJ's determination.

[00:14:11] Speaker 00:
I have to say that I don't see that in this opinion on page 21 of the record.

[00:14:18] Speaker 00:
makes a statement that Colin's statements about his symptoms are inconsistent with the objective medical evidence, and then just goes on to recite the evidence, but without, I think, linking it back to the testimony.

[00:14:32] Speaker 00:
I'm assuming you see it differently, but I'm hoping you can tell me why.

[00:14:35] Speaker 01:
A couple of things.

[00:14:37] Speaker 01:
There's two places in the record where the ALJ acknowledges the claimant's subjective allegations on page 19 and then again on page 21.

[00:14:44] Speaker 01:
And her subjective allegations include things like she cannot organize her thoughts, she's unable to follow directions, she can't finish what she starts, she shuts down under pressure, she can't deal with people in a work setting.

[00:15:01] Speaker 01:
And then the ALJ's discussion, and it's true the ALJ does say it's not her, her subjective allegations aren't supported by the objective medical evidence.

[00:15:10] Speaker 01:
And I would just direct your attention to this court's case, Carmichael, where the court does say contradiction with the medical evidence is a sufficient basis for rejecting subjective allegations.

[00:15:20] Speaker 00:
But then... Well, that's right, but there still has to be a linking between the record and the parts of the claimant's testimony that, you know,

[00:15:29] Speaker 00:
undermined by the record.

[00:15:31] Speaker 01:
Yes.

[00:15:31] Speaker 01:
And I understand that.

[00:15:34] Speaker 01:
And what follows the ALJ's summary of the claimant's subjective allegations is a very accurate summary of the objective evidence, the treatment history, that discounts many of those things that the ALJ had already summarized.

[00:15:50] Speaker 01:
For instance, claimant

[00:15:51] Speaker 01:
Clement's memory is fair to good in several reports, which is inconsistent with her claim that she can't follow instructions, that she can't complete tasks.

[00:16:01] Speaker 01:
She talks about the claimant being able to get along with people.

[00:16:06] Speaker 01:
She has a decent presentation during these treatment visits, which is inconsistent with her assertions about not being able to get along with people.

[00:16:16] Speaker 01:
And again, the ALJ acknowledges that this claimant does have some limitations.

[00:16:22] Speaker 01:
And I would also direct your attention to language in Lambert, and I know in Lambert this court found the ALJ's analysis of the subjective allegations.

[00:16:32] Speaker 01:
was insufficient.

[00:16:34] Speaker 01:
But that case also says that if there is enough reasoning in the ALJ's analysis for the court to meaningfully determine that substantial evidence supports the ALJ's conclusions.

[00:16:47] Speaker 01:
And here, even though there might be some missing connecting words between here's what she says

[00:16:53] Speaker 01:
Here's what's in the record.

[00:16:54] Speaker 01:
These contradict each other.

[00:16:56] Speaker 01:
It's still there.

[00:16:56] Speaker 01:
There's still the juxtaposition of what her subjective allegations are with what the record actually shows.

[00:17:03] Speaker 01:
And also, I would like to point, Your Honor, to the fact that the ALG's analysis goes through all of the records.

[00:17:10] Speaker 01:
It starts in 2019, which is right after the claimant filed her application, and it goes through 2021.

[00:17:16] Speaker 01:
And the last two exhibits in the record, B7F and B8F,

[00:17:21] Speaker 01:
show that this claimant is very capable of managing difficult situations.

[00:17:26] Speaker 01:
The last one in particular deals with how she's dealing with COVID and schooling her children during that time.

[00:17:33] Speaker 01:
It shows that she was able to secure housing.

[00:17:38] Speaker 01:
through difficult circumstances.

[00:17:40] Speaker 01:
She's accumulating things for her children in the house.

[00:17:44] Speaker 01:
She's getting new beds for them.

[00:17:46] Speaker 01:
She gets a freezer at one point.

[00:17:47] Speaker 01:
There's all these things that support the ALJ's assertion that she was progressing.

[00:17:54] Speaker 01:
This record shows that she is progressing.

[00:17:58] Speaker 01:
that is an accurate account of the record, even if the court might want a little bit more detail in that discussion.

[00:18:05] Speaker 01:
It's accurate.

[00:18:06] Speaker 01:
And what might or might not be missing from the ALJ's discussion is evidence that actually fails to support the disability claim.

[00:18:14] Speaker 01:
Again, there is a lot of evidence in that last exhibit, B8F, that shows how functional this claimant is.

[00:18:23] Speaker 01:
There's multiple places where the treaters say,

[00:18:26] Speaker 01:
her coping skills, she's progressing with her coping skills, and that her scores on the depression and anxiety inventories are improving.

[00:18:34] Speaker 01:
So overall, yes, there could have been more articulation in this ALJ's decision, but that doesn't mean it's inaccurate.

[00:18:42] Speaker 01:
That doesn't mean that this court can't meaningfully connect her reasoning with what the claimant's subjective allegations are and how they're not consistent.

[00:18:52] Speaker 01:
The record simply doesn't support

[00:18:54] Speaker 01:
that this claimant is unable to work, given her treatment history and the medical evidence in question.

[00:19:02] Speaker 01:
I'm happy to answer any further questions.

[00:19:06] Speaker 01:
But we ask that you affirm.

[00:19:08] Speaker 01:
Thank you.

[00:19:10] Speaker 04:
Thank you, counsel.

[00:19:11] Speaker ?:
My pleasure.

[00:19:18] Speaker 04:
Then we'll clear the roadblocks.

[00:19:23] Speaker 03:
Well, with all due respect to opposing counsel, I feel like we're looking at different decisions here.

[00:19:29] Speaker 03:
I am unable to find any of this analysis that she's discussing.

[00:19:32] Speaker 03:
She references page 19 for credibility analysis, however, is pointed out in the reply brief.

[00:19:40] Speaker 03:
page 19 has no credibility analysis whatsoever.

[00:19:43] Speaker 03:
In fact, the ALJ goes on to specifically disavow this analysis as credibility analysis, which is pointed out in the reply brief.

[00:19:52] Speaker 03:
This is a very blatant post-talk rationalization.

[00:19:55] Speaker 03:
Additionally, I have to point out that

[00:19:58] Speaker 03:
The opposing council spent a significant amount of time talking about Exhibit 7-F and 8-F and how they demonstrate through Collins schooling her children through the pandemic, which she was required by law to do, that it shows abilities that

[00:20:18] Speaker 03:
that support the A.L.J.'

[00:20:20] Speaker 03:
's decision.

[00:20:21] Speaker 03:
Unfortunately, none of this is in the A.L.J.'

[00:20:23] Speaker 03:
's decision.

[00:20:24] Speaker 03:
There is no finding whatsoever with respect to Collins' daily activities, her schooling of her children, any reference to that as a reason

[00:20:35] Speaker 03:
to either discount Dr. Yun's opinion or to reject Collins' subjective statements.

[00:20:40] Speaker 03:
These are just very blatantly post-hoc rationalizations.

[00:20:43] Speaker 03:
And as far as the accuracy of the ALJ's decision, I would like to point out that the ALJ inaccurately said that Dr. Lewis had reviewed a majority of the objective evidence, and that's why she was review was deferring to Dr. Lewis.

[00:20:59] Speaker 03:
Opposing counsel has never challenged the fact that that is just blatantly not true.

[00:21:04] Speaker 03:
Dr. Lewis only reviewed a small portion of the record, nowhere close to a majority.

[00:21:11] Speaker 03:
And so if you look at the ALJ's actual reasoning, it's not accurate at all.

[00:21:16] Speaker 03:
It's this reimagined decision that counsel puts forward that she is in fact is defending as accurate.

[00:21:23] Speaker 03:
The ALJ's decision as written is legally deficient and inaccurate.

[00:21:30] Speaker 04:
Thank you, counsel.

[00:21:34] Speaker 04:
I want to congratulate both counsel on both sides of the case for their excellent arguments when we receive such strong and persuasive arguments.

[00:21:49] Speaker 04:
It helps us to decide the case, but it can make it very difficult for us to decide.

[00:21:57] Speaker 04:
So I thank you both, and the social security case shall be submitted on the briefs.