a medical exam in this case the word in a prior room and were ordered the v a to either obtain a medical opinion or conduct a medical exam and left to the discretion of the medical professional whether he would actually conduct an exam were diagnostic tests were are simply do a file  test is necessary can substitute for the medical professionals conclusion what a parent is or are doing is whether the brewer still has a responsibility to review the medical exams and address certain basic fact there's such as if the were the event says that this review or exam should be conducted scenario you are describing the veteran has only repealed as to i believe you said normal ok if a claim is denied and the veteran does not appeal that denial it's not before the board so in that one in a similar function as cross examination in an adversarial proceeding would be said that in jennings now in this case the court of appeals for veterans claims never a diagnostic test when it comes back to the b v a that that determination by the medical professional shouldn't be review admits there's fifty years where he didn't have any troubles with his knees it's just age related osteoarthritis should she and it go through would we do this at all second time well if it's  look and they come back and say on this record it's not necessary now how do we given the context that you discussed with clevenger how do we possibly call ok you've got exam inquiries that there are from either regional office or the appeals management center kind of a super regional office within the v a then they took the board decision and they translate it into an examining work that exam or inquiry goes to a b a so hospital which is here what you're suggesting is that in this sort of a situation the board should have sent a runner should do is look at what the the documents before what did the exam incurs say what is there in the medical opinion that indicates that the doctor knew that this was something he should doctors here's the doctor's response i looked at those six or seven pages now is it clear from those six pages that this physician really knew that he should make that call at the say they sent to a second doctor who misunderstood that the first doctor had not conducted an exam which the board carried on so these are the things that i and both examiners offered well supported conclusions and indicated specific consideration of the veterans contentions concerning his condition the board then went on to say the v a medical opinions appear to be can ruin with the medical evidence of record which although indicating an in service injury show no identifiable residuals there other so it's clear from this record that the board didn't abdicate its responsibility but in fact did exactly what mr stickler suggesting and the board looked at all of the record and determined any any of it various battery of tests that could be conducted what the doctors did was review the record and said in their opinion it was less likely than not that there was a nexus here that the arthritis is need based on the file and or for an examination or for both and there to this is simply to clarify it to the to the individual they're sending it to whether an exam is specifically being required or whether exam is at the discretion of the physician and so record the b v a had an obligation to recognize that and to be here had an obligation to ascertain whether this particular examiner did or did not have on the better discretion and then they would have to write that up on a piece of paper seven want or we're going to the ball be in caps i understood your argument in the break based on the result of this set and that's not true your position seems to be that that issue has to be raised by the better or doesn't have any independent scouring do our position your honor is that if the veteran independently raises it then the board has a duty to address it if he worries if you raise that that not to say that the board doesn't have some duty to look to the record the board does have a duty to review the record for sufficiency and if the record barely raises an issue then the board should address it here there's no evidence there's nothing to indicate that it fairly raised these issues and that's a factual finding by the board of the better sport that this court can't review the better they're going to make a factual finding with regard to question  babies in green the board said there wasn't an issue there of whether additional diagnostic testing was necessary but the veterans court looked to the record and said in fact there there was an autopsy needed in davis sending green more information about whether polio was was related to the leg injury and so the veterans court remanded to the board to more fully evaluate whether additional diagnoses not diagnostic tools were necessary in those cases it's  in each individual case whether the word whether there's sufficient information in the record to raise the issues such the board has to address and it's every one of four and here ok what he wants is an m r i to have been conducted in there was no m r i conducted here and he says the board should have said why not the problem with that is there's not enough here to raise the issue to the board's consciousness where the and if the physician believed that exam was necessary to make a diagnosis that the position would have a duty to say in his opinion i can't make this assessment with that it's further diagnosis as the physicians did in davies and bringing in both those cases  determination here in this case where the doctors didn't do that they didn't say we need an m r i otherwise we can't tell if the positions here that said we need an m r i otherwise we can't tell then the board would have a duty it would be fairly raised in the and that's often the case that a position will say on this record i can't tell i need more testing i need to do an exam here the position is typically told if you need to do exam do an exam but even if it if there were a letter or an autopsy don't do an exam any circumstances still the physicians opinion if it be believed that in exam was necessary but it said i can't give an opinion without that exam and that's what the physician did said in davies and greene and in both cases the veterans court remanded saying the record fairly presents that question of whether additional diagnostic testing is necessary here there is there's nothing like that there's no indication that it in an m r i would even help to establish whether there's a nexus and we're qualifications which it appeared from his brief that's what he was challenging then yes that rizzo treats an absolute bargain he didn't raise it below that's it if he's saying that the but the doctors there was great and there's no problem and so we get away from this issue of the no exam no exam we accepted the doctors did a good job but independently the board had some duty to order another exam because there's some reason to believe there's an m r i then the government's answer to that is that there's nothing in this record to raise that issue before the board that it can be the case that something is fairly raised in the or in the record and the board has a duty to address it even if it wasn't specifically raised by the veterans but if he's challenging the better it's qualifications which it appears in his bloomberg if they were the serena if if someone's qualifications if someone gives you an exam psychiatric exam and there are what doctor then the exam of necessity is no good if the qualifications are totally missing the exam so i don't understand why you're not arguing that you want to basically try to argue that they gave you no wrong exam it's the same question you are at this if this quote thinks that is the same question and that under any circumstance the veteran needs to raise it the government certainly doesn't it doesn't not oppose that determination presented but not actually we're not suggesting that that's what and that's your position is it not i hope that i didn't get that impression why didn't you write the the border has a duty to address certain things those things that are presented in the statement the case as your honor suggests and by the better and the same of the case of course part of the record we're not trying to suggest that the board has this duty to independently scour the entire record of course it just doesn't but the board  record so that two thousand and seven was after the two thousand cried the record wasn't complete when the two thousand and five medical opinion was written so the board asked for another one and said review all these records see if this changes anything if the records don't if the employer's two conflicting instructions the remain and was to decide whether there's a nexus between the knee injury and the arthritis today it wasn't to determine whether an exam was necessary to determ there's a nexus and both doctors said we don't see any evidence of a nexus here and they didn't indicate that m r i would help them make that determination so they said that was big didn't explicitly say but they didn't indicate that an exam was necessary to reach believe additional testing were necessary then it's their duty to say that in their opinion and that's the issue that reserve squarely addresses and if the better doesn't bring that issue of the better of the doctor's competence to the board's attention only address whether the veteran has to challenge the qualifications of the doctor it's not a broad pronouncement that the veteran has to raise a point at the b the ed it seems to me that the rule please extrapolate this to any other situation in this case we have a better his initial in service injury was diagnosed in the military as lesions medial he comes forward after many years he says to the v a look i worked as a draftsman all my life i didn't have that many instances where my need gave what i'm seventy years old it's getting worse they give