[00:00:01] Speaker 00:
ready when you are, Mr. Haffeld.

[00:00:04] Speaker 01:
Thank you, Your Honors.

[00:00:05] Speaker 01:
May it please the court.

[00:00:05] Speaker 01:
I'm Chad Haffeld, representing Ms.

[00:00:07] Speaker 01:
Andrews in her appeal of the ALJ's, the Administrative Law Judge's denial of her disability insurance benefits and SSI claims.

[00:00:15] Speaker 01:
This is a deniable review of the ALJ decision.

[00:00:18] Speaker 01:
A myriad of errors flowed for the Administrative Law Judge treating Ms.

[00:00:25] Speaker 01:
Andrews' conditions and symptoms as static.

[00:00:29] Speaker 01:
And whereas she does have baseline anxiety,

[00:00:31] Speaker 01:
Her primary complaint allegation is that she has debilitating panic at times where she cannot leave the home or when she leaves the home, she'll have to return back because of the panic disorder.

[00:00:44] Speaker 01:
Same with the physical conditions.

[00:00:45] Speaker 01:
These are conditions that flare relatively rarely and are pretty good control, but that's the baseline of a condition.

[00:00:51] Speaker 01:
We see here the judge formulated an RFC based upon references to the record of how she was functioning in her home.

[00:01:01] Speaker 01:
doing activities, daily living, and some of the days where she was able to leave her home and go to appointments on her good days.

[00:01:08] Speaker 01:
The RFC ultimately ended up being a light RFC, unskilled, away from the public.

[00:01:14] Speaker 01:
Now, this is very interesting because during the relevant period, Ms.

[00:01:17] Speaker 01:
Andrews attempted a part-time job as a motel housekeeper.

[00:01:22] Speaker 01:
That job is light, unskilled, and away from the public.

[00:01:27] Speaker 01:
This is the rare opportunity in a social security case we get a step away from hypotheticals and what ifs and anything else.

[00:01:33] Speaker 01:
We have a real world example that the claimant could not perform a job consistent with the ALJ's RFC.

[00:01:44] Speaker 01:
She worked only five hours a day, three days a week.

[00:01:48] Speaker 01:
And yet she testified she had to miss at least about one day per week due to her panic anxiety and sometimes had to leave home early, couldn't even finish her five hour shift.

[00:01:58] Speaker 01:
due to the anxiety.

[00:02:00] Speaker 01:
This is consistent with her testimony and the testimony of her treating providers, who despite what the judge says, judge says that these disabling opinions, disabling testimony, it's not that they said she can't work or she alleges she can't function.

[00:02:17] Speaker 01:
It's just that at time she's not able to function.

[00:02:20] Speaker 01:
As a psychiatric nurse practitioner,

[00:02:23] Speaker 01:
Holmes noted Ms.

[00:02:24] Speaker 01:
Andrews doesn't have any cognitive deficits, but she's unable to keep a specific schedule as she cannot predict when the anxiety or panic would flare up.

[00:02:33] Speaker 01:
Now, the treatment of the treating source of opinions, whereas the runners have numerous bases.

[00:02:40] Speaker 01:
Nurse Seifkin first, the ALJ said, this particular examination in January 2019 is not consistent with her limitations.

[00:02:51] Speaker 01:
However, if we look at page 535, the top page of the report, records reviewed, Nurse Difkin lists her own treatment notes from 2012 to 2019.

[00:02:59] Speaker 01:
This wasn't a one-time examination.

[00:03:02] Speaker 01:
She was basing on her seven years of experience where she notes worsening anxiety from 2012.

[00:03:08] Speaker 01:
She also notes the primary impairment was difficulty engaging in activities outside of her home.

[00:03:16] Speaker 01:
Now, Nurse Difkin had a lot of mild and moderate limitations here

[00:03:20] Speaker 01:
A lot of these questions have things like, you know, understanding very short instructions, being aware of normal hazards, setting realistic goals.

[00:03:29] Speaker 01:
So, of course, these were mild limitations.

[00:03:31] Speaker 01:
What you did find was a market level limitation.

[00:03:34] Speaker 01:
in the ability to complete a normal workday and workweek without interruptions and psychologically-based symptoms.

[00:03:40] Speaker 03:
She also underlines- If I can interrupt, a problem, maybe the problem I have about this case, is the mistake of the ALJ in confusing, or maybe I should say combining, the Siefkin evaluation with the Combs evaluation.

[00:03:57] Speaker 03:
He thinks those are evaluations by the same person, and because one,

[00:04:02] Speaker 03:
is not very favorable to the claimant, and the other one's much more favorable to the claimant.

[00:04:06] Speaker 03:
He says, well, these are so inconsistent, I'm not going to pay any attention to them.

[00:04:10] Speaker 03:
So what happens once we correct that error and we look at the Siefkin evaluation, which by and large, I have to say, is not all that favorable to your client, but the Combs evaluation is very favorable to her.

[00:04:22] Speaker 03:
What do I do with the fact that the ALJ makes that mistake, entirely discounts the Combs evaluation because he thinks it's the same as Siefkin and they're so inconsistent?

[00:04:33] Speaker 01:
Well, two things.

[00:04:34] Speaker 01:
One, I don't know if I agree that it's inconsistent as much as the forms were completely inconsistent in what they asked.

[00:04:41] Speaker 01:
I mean, the mark level limitation, Nurse Seifkin, is missing days of work and having psychological interruptions during her work day.

[00:04:48] Speaker 01:
That's what Nurse Combs, she also put moderate limitations, but a mark limitation of persistence and saying she missed four more days of work per month and being off task 30%.

[00:04:58] Speaker 01:
So it is harmful error in the fact that

[00:05:02] Speaker 01:
You know, we have a nine year period where a psychiatric nurse practitioner treating her and there's two of them.

[00:05:08] Speaker 01:
And the judge doesn't even, you know, consider that the second one nurse Coombs also had this opinion during this relevant time period.

[00:05:16] Speaker 01:
And those that bolster that consists of each other that there was this

[00:05:20] Speaker 01:
The main difficulty was attendance, time off task.

[00:05:25] Speaker 03:
Now, whereas Nurse Siefkind didn't put it- Just to make sure I understand your answer, you're saying that the Siefkind evaluation and the Combs evaluation were essentially the same or similar?

[00:05:34] Speaker 01:
Not the same, because the forms are so different.

[00:05:37] Speaker 01:
I mean, the questions were so different, but Nurse Siefkind's form had a lot more questions about very basic work activities.

[00:05:42] Speaker 01:
They didn't ask what she meant by market level limitation and the interruptions from psychologically based symptoms, whereas we see from

[00:05:50] Speaker 01:
Nurse Coons, which I think is consistent, marked level limitation in that area, was asked, well, how many days are they going to miss?

[00:05:57] Speaker 01:
How much time off task?

[00:05:58] Speaker 01:
And she answered those.

[00:05:59] Speaker 01:
These were four times the amount of off task that the vocation expert testified would be allowed in competitive employment.

[00:06:06] Speaker 01:
Yet the ALJ never said that, hey, a marked level limitation in the interruptions from psychological-based symptoms,

[00:06:13] Speaker 01:
would result in less than 7% time off task, or it would only be this many absences, the judge has completely left it open.

[00:06:20] Speaker 01:
So I'd say that Nurse Coons actually fills in the blanks of what this means, a market level limitation.

[00:06:26] Speaker 01:
They both are consistent that this is the primary impairment.

[00:06:30] Speaker 01:
She has a cognitive ability.

[00:06:32] Speaker 00:
Can I interject here for a second?

[00:06:34] Speaker 00:
Because my understanding of our job as a reviewing court is not to go back and read all these things, but to actually assess whether the ALJ provided sufficient reasons for discounting those opinions.

[00:06:50] Speaker 00:
And we can't just substitute our own judgment.

[00:06:52] Speaker 00:
What we're really evaluating are the reasons that the ALJ provided for discounting those opinions.

[00:06:58] Speaker 00:
Now, one of those reasons I think is conceitedly error.

[00:07:03] Speaker 00:
He thought they were the same person, they weren't.

[00:07:08] Speaker 00:
It's error.

[00:07:10] Speaker 00:
Then the question is whether that was harmful error.

[00:07:14] Speaker 00:
My understanding is that the ALJ provided some additional reasons for discounting each of those opinions.

[00:07:23] Speaker 00:
And there's a question in my mind of whether those reasons stand independently from the error.

[00:07:29] Speaker 00:
And if they do, whether they are sufficient under our standard of review.

[00:07:36] Speaker 00:
Can you address that question?

[00:07:38] Speaker 01:
Yeah.

[00:07:38] Speaker 01:
As far as being consistent with the record, as I noted, the judge will point off activities of daily living and sometimes going to appointments with baseline anxiety as inconsistent.

[00:07:50] Speaker 01:
That's not inconsistent with her testimony whatsoever.

[00:07:52] Speaker 01:
The opinion is missing days of work.

[00:07:54] Speaker 01:
I think it's really telling that at the nurse's appointment, she had anxious mood and affect.

[00:08:00] Speaker 01:
This is her treating provider.

[00:08:01] Speaker 01:
She's known for seven years.

[00:08:03] Speaker 01:
She's in a one-in-one room with a mental health professional and still exhibiting anxiety.

[00:08:09] Speaker 01:
We see the more exacerbations later.

[00:08:11] Speaker 01:
So it's not inconsistent with the record once you look at what the actual allegations are.

[00:08:15] Speaker 01:
Two is conservative treatment was the other thing.

[00:08:18] Speaker 01:
Ms.

[00:08:18] Speaker 01:
Andrews is on the maximum dosage of Xanax.

[00:08:22] Speaker 01:
She says before she has to go to employment, she has to worry, she has a tub of sleeping, has tried to relax the day before, takes an extra dosage of medication to leave the home.

[00:08:31] Speaker 01:
If she has a panic attack, she has to come home, take more medication, lie down, so she's better.

[00:08:37] Speaker 01:
She's gone to the hospital with chest pain, had to have it checked out, lightheadedness, dizziness, nausea, it was anxiety.

[00:08:45] Speaker 01:
You know, she has to treat this with anxiety laying at home.

[00:08:48] Speaker 01:
This is not conservative care.

[00:08:50] Speaker 01:
It's nine years of psychiatric nurse practitioner routinely meeting and on the highest dosage of anxiety medications as possible.

[00:08:59] Speaker 01:
Psychiatric hospitalizations, if that's what the ALJ is trying to find is required to show that she has absences from work, is not really relevant in this period because Ms.

[00:09:08] Speaker 01:
Andrews can return to baseline.

[00:09:10] Speaker 01:
She needs to go home.

[00:09:11] Speaker 01:
The records where it says she's doing better.

[00:09:13] Speaker 01:
She reports in New York homes in 2020.

[00:09:15] Speaker 01:
She says, my anxiety is a little better under a little better control, but I also haven't been leaving the house much.

[00:09:21] Speaker 01:
This is during the COVID pandemic.

[00:09:23] Speaker 01:
So we see that she does do better inside her home.

[00:09:27] Speaker 01:
She doesn't do, she does, has a lot more panic anxiety outside the home.

[00:09:30] Speaker 01:
That's consistent with the opinions.

[00:09:32] Speaker 01:
And so the ALJ's reasons for being inconsistent with the records and also that is conservative care.

[00:09:39] Speaker 01:
are not founded.

[00:09:40] Speaker 01:
It's not a reasonable interpretation of the record.

[00:09:44] Speaker 01:
Exactly just the opposite.

[00:09:45] Speaker 01:
Miss Anders of anything, she's consistently inconsistent with her sentimentology.

[00:09:51] Speaker 01:
And there's no real control when she leaves the home of when she's going to have these panic attacks.

[00:09:56] Speaker 00:
And if, what about supported?

[00:09:59] Speaker 00:
I believe the ALJ also said that the opinions were not supported.

[00:10:06] Speaker 00:
I think mostly because they were forms, right?

[00:10:09] Speaker 00:
And they weren't necessarily reasons provided.

[00:10:12] Speaker 01:
Well, the reasons were provided.

[00:10:14] Speaker 01:
I mean, we see that they said that the trouble was the frequency of the panic attacks was the main thing.

[00:10:21] Speaker 01:
And we've seen the record panic attacks going to the ER for heart problems.

[00:10:26] Speaker 01:
testifying that it does better when she stays at home, having to leave work early, missing days of work.

[00:10:32] Speaker 01:
The judge never challenged that she had to miss days of work at that job that was away from the public.

[00:10:37] Speaker 01:
It was never challenged.

[00:10:38] Speaker 01:
It was not challenged that she'd have to leave early from that job when she was attempting it.

[00:10:44] Speaker 01:
And also, of course, the ALJ, as far as support, she didn't realize that the other treating provider also had a similar opinion to have to miss days, Nurse Coombs, because she attributed it back to Nurse Seifkind again.

[00:10:57] Speaker 00:
Thank you.

[00:10:58] Speaker 00:
I'll give you a minute on rebuttal.

[00:11:00] Speaker 01:
Thank you.

[00:11:13] Speaker 04:
Good morning.

[00:11:13] Speaker 04:
May it please the court, Jeff Staples here for the commissioner who asks that you affirm the district court's judgment because substantial evidence supports the LJ's findings of fact.

[00:11:26] Speaker 02:
I think it's conceded by both sides that the ALJ made a clear error in believing that the reports of two different experts were, one, the report of a single expert, and while

[00:11:47] Speaker 02:
there might still be independent reasons for discounting both reports, some of which the ALJ in effect alluded to, albeit under the guise of this being one report.

[00:12:05] Speaker 02:
Wasn't all that hugely colored

[00:12:10] Speaker 02:
by the ALJ's basic opinion, quote, her opinions, because he thinks it's one person, her opinions were drastically inconsistent with each other.

[00:12:27] Speaker 02:
Isn't it reasonable to assume that that very much affected how the ALJ looked at the other difficulties that you might otherwise rely on to say that it's harmless error?

[00:12:44] Speaker 02:
And why shouldn't we then just send it back and see what the ALJ does once that error is corrected?

[00:12:54] Speaker 04:
Well, first of all, I think Judge Sung pointed out that this court does a harmless error analysis by seeing what's left over.

[00:13:05] Speaker 02:
Oh, I agree.

[00:13:06] Speaker 02:
But what I'm saying is, does that mean we have to disregard the fact that the ALJ felt so strongly

[00:13:17] Speaker 02:
used the word drastically inconsistent about that inconsistency that was, in effect, based on the ALJ's misinterpretation, that it inevitably was likely to have affected all the other findings.

[00:13:36] Speaker 04:
I don't think that you can, I don't think you see that infection in the remaining findings.

[00:13:44] Speaker 04:
So the other things that the ALJ said, you know, yes, the ALJ said they're drastically inconsistent with each other.

[00:13:49] Speaker 04:
That's one sentence.

[00:13:52] Speaker 04:
The rest of that paragraph, though, the ALJ goes through and said that

[00:13:56] Speaker 04:
each of these opinions are unsupported.

[00:13:59] Speaker 04:
And you can see that by looking at the opinions, you know, as we've been talking about.

[00:14:04] Speaker 04:
The form doesn't really, you know, there's a section for comments or for explanation, and both Nurse Combs and Nurse Safkin

[00:14:16] Speaker 04:
Really refer primarily to Andrews his own statements about the frequency of her panic attacks and things like that rather than object of medical evidence as the regulations require Then the LJ.

[00:14:29] Speaker 03:
Can I ask a version of?

[00:14:31] Speaker 03:
Dracov's question.

[00:14:32] Speaker 03:
I'm looking at the combs evaluation and she's got a sort of a checklist and she has a choice up to five five being severely limited it's the most limited choice that she has and

[00:14:45] Speaker 03:
Combs checks as severely limited the following ability to work a normal work week ability to accept instructions and respond properly to criticism supervisors ability to get along with co-workers ability to travel in unfamiliar places use public transportation and then Markedly limited to four Perform activities within a schedule and work and coordination if those evaluations are credited

[00:15:15] Speaker 03:
Is she disabled?

[00:15:17] Speaker 04:
I think so.

[00:15:18] Speaker 03:
Yeah, I think so too.

[00:15:19] Speaker 03:
So how do we know that if the ALJ had understood that these were from Combs rather than Seifert and had therefore not discounted them because they were so internally inconsistent from the same person, how do we know that the ALJ would have discounted this?

[00:15:37] Speaker 04:
Well, I think one reason that it's a harmless error to conflate the author is that the inconsistency between the two opinions, while in this case made under the mistaken assumption that it was from the same person, why are they making such inconsistent opinions,

[00:15:58] Speaker 03:
Inconsistency between two different opinions is itself part of the consideration that that's not an answer to my question Sorry, you conceded and I think I agree with you that if miss combs evaluation were credited she's disabled.

[00:16:13] Speaker 03:
Yes How do we know that if the ALJ had understood that combs was a freestanding person?

[00:16:20] Speaker 03:
That he would have discounted combs

[00:16:24] Speaker 04:
Because I think you look at the balance of the analysis that the ALJ provided, and we ask ourselves, does this analysis apply equally well to both opinions that the ALJ is discussing?

[00:16:34] Speaker 03:
That's the question the ALJ would ask of himself, or herself, I can't remember the gender.

[00:16:40] Speaker 03:
But I'm not sure that's for me to answer, I think it's for the ALJ to answer.

[00:16:44] Speaker 04:
Well, I think that is for you to answer.

[00:16:47] Speaker 04:
I think that's for this court to answer.

[00:16:49] Speaker 04:
And that's the way we do harmless error analysis.

[00:16:52] Speaker 04:
We see what remains, as Judge Sung was pointing out.

[00:16:56] Speaker 03:
But you've just conceded that if Combs is credited, she wins.

[00:17:00] Speaker 03:
So the question is, would the ALJ have credited her?

[00:17:03] Speaker 04:
And I don't think you can say the ALJ would have credited either one because the remaining reasons for finding those opinions unpersuasive are themselves supported by substantial evidence.

[00:17:14] Speaker 03:
And what remaining reasons are you speaking of?

[00:17:16] Speaker 04:
the supportability of both opinions, which the ALJ discussed and explained that the opinions were not well supported by objective medical evidence, you know, then also the consistency between those opinions and the, you know, largely normal mental status examination findings throughout the record.

[00:17:34] Speaker 03:
If the ALJ had done that and said that, I would sustain.

[00:17:37] Speaker 03:
I agree with that.

[00:17:38] Speaker 03:
My question is whether the ALJ would have concluded that.

[00:17:41] Speaker 04:
So I think, I mean,

[00:17:45] Speaker 04:
Could we get a better ALJ decision by remanding?

[00:17:48] Speaker 04:
Of course.

[00:17:49] Speaker 04:
I mean, that's always the case.

[00:17:51] Speaker 04:
But if the ALJ had just broken that paragraph into two paragraphs, I think it could have been the same thing.

[00:17:59] Speaker 04:
What do you mean broken into two paragraphs?

[00:18:01] Speaker 04:
So if you had had one paragraph for Combs and one paragraph for Siefkin and understood that they were from different people.

[00:18:07] Speaker 04:
And credit in Combs.

[00:18:08] Speaker 04:
Well, I don't think the ALJ did.

[00:18:11] Speaker 04:
The ALJ looked at Combs' opinion.

[00:18:12] Speaker 03:
But discredited, but entirely discredited.

[00:18:15] Speaker 04:
Yes, but not only based on the fact that it was a mistake about who was the author.

[00:18:20] Speaker 02:
So if the mistake, if the whole... The question is, you're right that that wasn't the only reason, but it was so strongly asserted that it sort of strongly suggests that it colored

[00:18:36] Speaker 02:
the ALJ's interpretation of everything else that followed, because in effect the ALJ is saying, this opinion is worthless because it's got drastically inconsistent stuff, so why should I even, I'm going to go on anyway and point out some problems, but by gosh, this is real nonsense.

[00:18:56] Speaker 02:
And that was all wrong.

[00:18:59] Speaker 04:
So I think that the supportability and consistency stand alone.

[00:19:04] Speaker 04:
I don't really see how those are tainted by the confusion about the author.

[00:19:11] Speaker 04:
I mean, an opinion is supported or it's not.

[00:19:14] Speaker 04:
It doesn't really matter who the author of the opinion is.

[00:19:16] Speaker 00:
Well, I guess.

[00:19:18] Speaker 00:
One way to look at this would be there's levels of supportability, right, and something's just wholly unsupported that would in and of itself be an independent reason to discount an opinion.

[00:19:32] Speaker 00:
Here we have supportability, consistency with the medical record, and then erroneous reason, which would be inconsistency with another opinion.

[00:19:46] Speaker 00:
I think the question is how do we know that the level of

[00:19:50] Speaker 00:
insupportability that the ALJ found or the level of inconsistency, the record was high enough that even absent the error, they would have still discounted, right?

[00:20:03] Speaker 00:
Because there's a world in which the level of supportability inconsistency would not have been enough on its own.

[00:20:10] Speaker 00:
And there's a world in which it is enough on its own.

[00:20:14] Speaker 00:
And I think the question is, how do we know which world we're in?

[00:20:19] Speaker 04:
I think you can, I think by looking at the opinions themselves and taking the LJA's reasoning for finding both of them unpersuasive.

[00:20:28] Speaker 04:
So, you know, as you were saying, the level of supportability, what is the level of supportability of these opinions?

[00:20:33] Speaker 04:
I think it's pretty low.

[00:20:35] Speaker 04:
I think they're really, you know, they're not served by the forms that they filled out, right?

[00:20:40] Speaker 04:
The forms are not providing a good space to elaborate, delineate the object of medical evidence that's supporting.

[00:20:46] Speaker 03:
narrative at the end of there is a narrative and it combs combs writes and this is now narrative she writes although cognitively miss andrews has few limitations her anxiety and panic would make working very difficult if not impossible she is unable to keep a specific schedule as she cannot predict when the anxiety or panic would flare up so so we do have a little bit of a narrative

[00:21:07] Speaker 04:
Yes, Your Honor, and that is an explanation.

[00:21:10] Speaker 04:
But is that an explanation that's based in object of medical evidence, or is it an explanation that's based in Andrews' own statements about her inability to keep a schedule?

[00:21:22] Speaker 04:
And I think the ALJ fairly decided that it was the latter.

[00:21:24] Speaker 04:
I see I'm out of time.

[00:21:27] Speaker 04:
I'd be happy to keep answering questions if you have any further, but we'd ask that you affirm.

[00:21:32] Speaker 04:
Thank you very much.

[00:21:38] Speaker 01:
All right.

[00:21:45] Speaker 00:
You might want to wait because your video screen is still rising.

[00:21:48] Speaker 00:
You let me know.

[00:21:56] Speaker 00:
Okay.

[00:21:59] Speaker 00:
Go ahead.

[00:22:00] Speaker 01:
All right.

[00:22:00] Speaker 01:
Thank you.

[00:22:01] Speaker 01:
I'll just briefly respond here.

[00:22:03] Speaker 01:
As far as referring to client statements,

[00:22:06] Speaker 01:
and not objective evidence.

[00:22:07] Speaker 01:
That's a very different argument.

[00:22:08] Speaker 01:
We have a nine-year treating length of the two opinions.

[00:22:14] Speaker 01:
Now, as far as Nurse Combs on her own, if the judge felt that was Nurse Sifkin's opinion, the women have access to Nurse Combs' treatment notes.

[00:22:23] Speaker 01:
We see in Nurse Combs' treatment notes, she was 706.

[00:22:27] Speaker 01:
Same was noted to experience anxiety on a daily basis.

[00:22:31] Speaker 01:
March the 20th, she suffered a panic, high anxiety with prows and grocery shopping caused her to feel like she has to rush resulting in frequent leaving the store halfway through shopping, particularly when the store is busy.

[00:22:41] Speaker 01:
702, 773, she put into the emergency room with chest pain for three to four days.

[00:22:45] Speaker 01:
775, she assessed with chest pain and anxiety.

[00:22:50] Speaker 01:
June 30th, 2020, she was worsening chest pain, underlying anxiety and hypertension.

[00:22:55] Speaker 01:
October, her anxiety was under control, but she stayed at home a lot.

[00:22:59] Speaker 01:
October 22nd, 2020, high anxiety, recent panic attack on the store, feeling warm, heart racing and nausea, equilibrium is off like she might faint.

[00:23:09] Speaker 01:
It's car 885, 889, 892.

[00:23:12] Speaker 01:
These are all recent records by Nurse Combs showing that they're having ongoing anxiety from someone they know well.

[00:23:18] Speaker 01:
If the judge wasn't tying these notes to that opinion, that would definitely throw off her being able to reasonably assess the record and the opinion evidence

[00:23:28] Speaker 01:
I would also just the last thing I'd state is a lot of the notation stating or that she's functioning well, decided by the commissioners brief noting 668.

[00:23:38] Speaker 01:
She was improving and she's fine with her anxiety and identifying triggers.

[00:23:43] Speaker 01:
It noted that she was having a good summer until she left her home to go to a pool party.

[00:23:48] Speaker 01:
She was having heart racing, nausea, dizziness, had to get an EKG that showed it was normal.

[00:23:53] Speaker 01:
She's back to three Xanax per day.

[00:23:55] Speaker 01:
They noted CAR 539, no difficulty relaxing.

[00:23:59] Speaker 01:
Well, the full sentence is no difficulty relaxing when she is by herself.

[00:24:04] Speaker 01:
That's a very important piece of information to leave out in this particular case.

[00:24:08] Speaker 01:
CAR 704, she had generalized anxiety disorder.

[00:24:12] Speaker 01:
That's her baseline, but the very next sentence says, she has symptoms of accelerated heart rate, shortness of breath, chest pain, feeling depersonalization, and fear of loss of control.

[00:24:20] Speaker 01:
She meets the criteria for generalized anxiety disorder and panic disorder.

[00:24:24] Speaker 01:
So there's just a lot of bits and pieces of information.

[00:24:28] Speaker 01:
And when you look at it in the full context, you see someone who can function well at home, and those things are cited by the judge, but they'll leave out the most important parts about the anxiety and the panic attacks at times when she leaves her home.

[00:24:39] Speaker 01:
Having two nurse practitioners, so you have an uninterrupted nine-year... Counsel, I think we understand your point.

[00:24:46] Speaker 00:
Thank you.

[00:24:47] Speaker 01:
All right.

[00:24:47] Speaker 01:
Thank you.

[00:24:51] Speaker 00:
Thank you council for your arguments and this matter is submitted.