unskilled work history she would have been disabled under the medical vocational god lines instead found that she was limited to light work with a sit stand option you know this t as the record shows cannot perform the prolonging standing and walking requirements for light work and the issue on appeal is whether the ale j's finding that she can perform white work is supported by substantial evidence on the record as a whole of course we contend that it's not mr spain suffers from chronic pain in her back in her knees in her feet that is well documented in the record based on both medical imaging and clinical examinations she has a favorable treating doctor opinion doctor crawly who her treating doctor limited her t standing and walking only three hours in the day for counsel i thought that that was sort of the primary issue was the deference given to the treating physician the treating physician should be given more weight by the l j but my problem with that is the check the box form that some of the things that you're citing right now you check the box and then we don't know really what medical evidence supports that because there really isn't a narrative to tells us why she can't do these things certainly  this court in the cox for says barnhart case was presented with a similar argument by the government in the court said that if all we had was the at that cool and it was a letter from a treating doctor if all we had that then yes that would be a problem because the letter is conclusory without more explanation but the court went on to say that that letter is simply one part of the larger medical record that was supplied by both the treating doctors and other doctors who had treated the the the claimant in the record and that is consistent i think with something that i want to underscore in this case that the standard of review is  l evidence on the record as a whole not just substantial have substantial evidence on the record as a whole that what those court said in cox versus barnhart is consistent with that type of review so it's not that we just take the t supports some of the that the check the boxes because my understanding of the record is that it's just it's just not much there and you make you have to kind of resort to looking at everything to figure out whether or not she was just you know when the dissident disability yes which is precisely the point under substantial evidence on the record as a whole and under this court's decision and cox but you don't think that undermines the deference of the treating physician in other words the requirement if you defer to the treating physician would seem to be at the treating physician has has that opinion that support it right and it doesn't really matter what anyone else may be a look at it as a whole when you get substantial evidence but maybe you don't defer to the treating physician because the treating physicians evidence or support is not really that dr brandt and she was also treated by dr roll at the post i interest dr brandt treated her for problems with her knees dr rowlett were problems with her feet and he no doubt had access to those records now we agree that his his office notes are are rather sparse and and it but but if you look at that in light of the record as a whole and the fact that he must have had he must review because he talks imaging performed and and the clinical evaluations performed by these other doctors so i think it at that point you know other than than us going in and saying you've got to be more specific  all of your records and changing his entire way that he practices i think for these purposes especially when there is no conflicting evidence in the record that there should be some deference given to d drugged her let's suppose we disagree with you let's suppose we say look at the training for this and we're going to treat his records look just like everybody else because he did provide enough support that it just becomes balancing the two sides of the equation you've got the treating physician who actually has a long term problems with ail jase relying on the these are these agency doctors first of all they're employed by the agency and who is making the decision and they examine the medical  provided to them at the initial and reconsideration stages of the claim now the claim continues on sometimes for a couple of years after that and and those those doctors don't have all of the medical evidence they didn't have in this case dr earlies opinion about how you know what her limitations work so it's it's it's hard to say that that constitutes substantial evidence on the record as a whole for to support the  decision when these agency doctors who never examined mrs despain but only reviewed some of her records are are sufficient to overcome in this case the medical imaging  the clinical evaluations and the opinion of her treating doctor plus you add to that a thirty year work history with no evidence of bowling green and and this is a very strong case for disability on her part and it's very difficult to see in some of the exams there were full range of motion but in others in fact if you look at the doctor croly found tenderness and abnormal reflexes on his own same thing about his but but but of the others there was decreased range of motion there was an abnormal gait dr roll at her her wrist noted repeatedly noted swayed by pain and swelling and an aggravation of her tendons  even the doctors at the at the jones for health clinic where she went after she lost her insurance noted positif straight leg racing so there is is plenty of of clinical evidence although at times and and the question i think is is again the the medical evidence on the record as a whole rather than just you know cherry picking one or two instances here where  was a normal range of motion in in those doctors reports there were other several other instances where there was not normal range of motion this is what i'm trying to say in that regard  occasions so given a given the evidence here that substantiates the medical evidence that substantiates her or her conditions for x rays that showed bone on bone arthritis in her right knee disc in her back in two thousand and fifteen that was possibly contracting the nerve root along with moderate narrowing of the opening where the nerve exits the spinal cord so you have all of this medical evans plus the treating d plus a thirty year work history and it and our contention is that before you're done there's an aspect of this case which struck me as unique that i want to yes your ask you about and that's where you started the th essential nature of the light work finding and the jays and it's referred to as an accommodation that not seen that that's that's an a da word it's not a social security word but the a using it the a b a accommodated by saying the requisite six hours of sit stand is is met if the job gives basically gives her unlimited discretion and so to speak to sit or stand in the ve opined that with the with the limitation worded that way and there was like work available and you argue in your brief that that's an improper accommodation it is i think clearly a get around the sedentary like work issue you have any authority there in s s a rulings or in the case law that that it's not out there but i can't find it no authority doesn't mean it's not that's right alicia but if she has to say most of the day to due to her lower extremity problems then the l j should have found that she is limited to sudden terry work which would make her disabled under the grips in other words as i think you picked up on this stand option can't be a proxy for sedentary work for and allow the l j to get around the the like work required to do this in my job and the more the older i get the more i do it i have various places in my in my chambers where i can work and if i'm mentally or physically tired of where i am i go somewhere else i don't think i understand the reality or the significance in terms of physical limitations of an employee having that freedom so what the a l j did is to me not not counter  but i given its significance here was just wondered if in other cases medication or if the s s a is had occasion to consider i think in this in this case of the if if he finds that she can do like work with the sit stand option i think the understanding or the at least the implicit aspect of that finding is that she can stand for most of the day but occasionally needs to s i can respond to your comment as well i just wanted to follow up on what professor wallace was saying with respect to all the there's enough record evidence to support her claim and in this case not only was dr medical source date when a checkbox form there's a separate reason they gave little weight to his opinion because dr crowley's treatment notes do not include any of the limitations he included in this checkbox form which is a separate reason for giving it less weight which this court has noted on many occasions and it's interesting to note that on the very day that dr crowley completed his checkbox form he examined mrs dismaying on that day and he did not find any of the limitations he included in this checkbox form he in fact noted on that day a musculoskeletal examination showed she had a normal range of motion he prescribed some pain medication for her and invited her to use them sparingly he did not include any gait abnormalities in his clinical findings and he did not include any any reference to the limitations what about the they also make the also makes a point that these reviewing physicians don't have all the records so therefore they're entitled to even less weight than the ordinarily would be what's what's your response that yes your honor the at the time the reviewing agencies completed their assessment they didn't have all the record have and however the l j considered all of that evidence and i worth noting that there's not a lot of medical evidence in this record the state agency reviewing physicians did consider the physical treatment notes they considered dr crowley's part of his for his records up until i believe it was maybe early twenty fifteen or mid twenty fifteen when they completed their assessment but the l j discussed all the record evidence after that and in fact gave plaintiff the benefit of the doubt by finding her to be more limited the state agenc disabled as of may six june third two thousand and fifteen that's contrary to ninety five percent of search thirty cases we get your honor and in other words all of us sure that you can say the medical records were slight but they were and are or spare source slim or short duration they persuaded the a l j that she was disabled talking about is the date your honor i don't believe the o j found plaintiff was disabled in this case they i thought i thought isn't the case where the benefits were granted that might have been and that might have in the bag your honor the where there was a previous period two benefits only she wasn't eligible for title sixteen benefits it looks like her application was only for title two benefits based on her earnings and i think i think i of those occurred prior to the relevant period in this case at a time when she was working for freedom lay as a as a packing machine operator and so those records including the orthopedist that he's referring to was prior to the relevant period so that doesn't help her in this in this instance and also for the same reason the the larger medical evidence he's trying to get around that the flaws in dr crowley's reports by saying well let's look at the larger medical record well when we look at the larger medical record in this case there's not enough evidence to support mistrust means claim we have an m r i which showed mild degenerative changes in a small  neurosurgeon however she did not pursue it according to her own testimony is there precedent on the treating physician board so my view as i was articulating to opposing counsel is when you have the treating physician the treating physician needs to support his or her own opinion there needs to be some notes that supported his argument is that no you can take into account other physicians who may or may not have the treating physician may have looked at their notes and that forms the basis for deferring to the treating physician what's the rule what's the precedent on that does the treating physician after after support their own notes yes yes your honor your the treatment that the weight that you give to treating physicians opinion depends on how well supported it is and in making that determination you look at to what extent it's supported by the record to what extent he lost a record or just well yes in both his own clinical treatment notes and the record at large so for example you would look to dr crowley's treatment notes where he recounted the physical findings and clinical findings and in this case those don't support his conclusions so that's a basis for discounting it and then beyond his own treatment notes you look at the treatment notes of other physicians and in this case that was what i wanted to one of the things i want to address is that the larger medical record consists of two visits to a podiatrist who did not include any limitation on plaintiff's ability to walk and physical therapy treatment notes which showed varying degrees of improvement so those are two reasons your honor for giving less weight you can't you can't look to the other record to shore up the treating physicians opinion you you can discount it based on his failure to support his own medical findings which is what he did in this case you can't that she has a checkbox or however that she has severe limitations and i believe this i would characterize her residual functional capacity using the s cases don't have a can do any work because usually the opinion being sought is can't do any work so if their fifth dr crawley says says she's fit to do  think the folk the focus really is on what they found and he found light work with a certain stand option it doesn't have anything to do with the fact that that would somehow kick back to sedentary work because they're particularly the ve did include the sit and stand option and the ve based on her testimony testified that she missed us fine could perform those jobs so i think that was included in much detail as to what job well that was what kind of option the jobs that she identified and why isn't it well because the ve the l j posed the hypothetical to ve containing the sit and stand option the ve testified yes these jobs would allow that and you have to look at the record as a whole we've already established that dr crowley's check u check box form standing alone isn't entitled to weight the rest of his clinical records did not include any limitations on her ability to sit and stand in fact he found normal range of motion you look at the larger medical record it doesn't include any limitations from  knees she did have prior treatment for news before the relevant period and she went back to work after treatment with the orthopedist so when you look at the time period there the read of the the medical period is really about a fourteen month period we're talking about she did not have treatment for any pain during that she complained about joint pain but she she did not get the treatment from the orthopedist was prior to to the relevant period in this case so the record just doesn't support she has a good work this is so this an employee with an excellent work record yes worked with with significant joy issues for many years i have to quit i day and she can't perform that work and she told the physical therapist i have no other experience i have no clerical or office experience my only places and manufacture so no she may not have been able to do the twelve hour a day standing job but they recognize that and found she could do like work which was at a less exertional level than she had performed and if there are no further questions i'd like to thank you for your time