court my name is hurley mehan i am the attorney for appellant rodney gregory mr gregory applied for social security disability benefits he had i'm hearing that we're complaining about district court as well the first is that it is the duty of the social security administration under twenty c f r section four hundred four point one five to zero parents he and parent and for one six point  zero parents he and parent it's the duty of the administrative law judge at that hearing and then subsequently the social security administration to determine all of the impairments that the individual who is applying for disability and severe is particularly denoted as if it imposes significant were strict sins upon an individual's ability to perform basic work activities now what's missing in this case from the decision by the administrative law judge by the social security administration and then ultimately by the u s district court is that mr gregory has a number of things in finding number three by the hospitalized for a month as he went through procedures and ended up when he came out of that with a pacemaker and it had to be implanted but that was redo procedures is what's noted in finding a number three by the administrative impact on workability the impact in as opposed to the overall heart condition that would make this a separate impairment that has to be independently identified quantified insofar as it impacts work one particular place is it twenty six twenty seven that is a report july thirty first a fifteen minute signing appendix or the administrative record that we have you know ok any five hundred pages of medical room had to anything like what it what does that say this is from the cardiologist just treating cardiologists that says mr gregory should be completely limited in lifting due to and then it lists for items his prior sternotomy s he's had two of those rewired after you've had your ribs cracked open his aorta and mitral valve replacements the judge mentioned that of the heart to two different to the atrial and the ventricle on the left side west repaired as part of the procedure and yet the administrative law judge missed that possibly because of the great number of records but also misled not intentionally i am not sure it was missed i think it's you know it's you just said he did it's in the listing of of multiple facets of his heart condition report which i'm not sure that that either the doctor or the judge looked at but that operative report is that they administered record at eight fifty to start with that means it mentions that it's an operation of high complexity on page eight fifty four capacity to work i believe that that's what dr besser report and he says he did several reports i only mentioned one in there where he refers to those those are actually and i think and and the record would reflect those of the more severe impairments than the operative report they had to remove part of the tissue between the two chambers of the heart and they had to sew it up that creates a weakness i don't think that well i know but i'm if you can somewhere where the doctor based on the presence of the aneurism limited his work capacity i don't think that there's anything that identify six identify sets separately from the listing of them but when questioning was that there what was that was that was the surgery record sitting in front of the witness when he was being questioned pardon you know so that he could look i mean did he need did he  line and he says i don't remember that or whatever as well as he didn't know about the pony function study well typical cross exam you'd then get the record out and show it to him and say are does this affect your opinion but he's not president he's by phone i can't i ask and he does you know he read he reads the record and you don't have you don't have a basis for saying he didn't he didn't read the record no i don't have and you didn't and you didn't make a record for may please the court many michelle stuart i'm here on behalf of the social security administration as you discussed earlier the record in this case is quite extensive but i think if you go back the arc of the medical story of this case it's pretty clear back in two thousand and one the opponent had heart surgery had a heart valve replacement applied for disability and was denied and then returned to work and worked until two thousand  ten he stopped working in two thousand and ten not for any heart related problems but because his employer was going out of business when he left a job he soon thereafter again applied for disability benefits then in june two thousand and twelve there's no dispute between the parties that he experienced a severe cardiac problem well specifically endocarditis which in laypersons term is when an infection travels to the interior of the heart it damages the structures inside the heart primarily the heart valves because that infection and the damage that resulted he had to undergo surgery he did have to undergo to have replacements shortly thereafter while he was hospitalized he did have to undergo also a pacemaker implantation he was discharged in july of two thousand and twelve had regular follow ups of this cardiologist he was placed on a regimen of anti coagulation therapy into the within the context of the heart surgery including the valve replacement even referred specifically to the enters them in the decision when discussing the cardiac impairment so did the cardiologist was the cardiologist aware of the things that mr gregory said he was not or mr may on said job that's the same job the l g a relied on that stuff for so i think that is significant so just to wrap that up i think and finally these decisions you have to consider the audience these decisions are written for this is first of all the old days of a lay person not a physician for us love to point out when they think the l c s playing doctor over these decisions are written for a lay person the written for the person who's claimed as in the written for review in the normal pattern you would expect where he was seeing his cardiologist less and less frequently and there was no evidence that he had a recurrence of severe heart problems but frankly the majority of this treatment was for the blood monitoring and the fact that he stopped working for reasons that weren't related to his impairment he was also there's evidence in the record that when he stopped working he was acting as a caretaker for his father so there was a lot of evidence relating to the consistency of his testimony of on the one hand that he incapable of almost any activity even on the other hand there's a lot of evidence that conflicts with out trying specifically a doctor gave its opinion as i said direct in this case is two thousand pages a medical expert isn't called one of these hearings to memorize the medical record in the record is there for all the parties to look at what the medical expert has called the serious force to review the evidence and then offer a medical opinion about whether that evidence shows evidence of a long term functional impairment that's really what the elder is concerned about and making the stuff for fighting and admittedly dr dative could not memorize forward after surgery there really wasn't any evidence of disabling functional limitations the cardiovascular examinations were fairly normal and routine on a few occasions he had a mild heart murmur on other occasions not echocardiogram showed normal heart function so based on that and start to get a properly i think his opinion is well supported that there wasn't evidence of disabling limitations rather that he would be limited to a range of light work and that wasn't just d just to close to briefly address the last argument in advance brief and terms of the regular absences from the workplace if you look at those records they're almost all blood testing records as i mentioned at before or after work or so everyone shares there's no showing that those blood draws would result in the types of absences the degree of absenteeism maybe make it sound easier than it is in the real world so i have no way of knowing well medication depending on what the test showed and those were sometimes once a week then as time went on they were mostly once a month i believe just inclusion i think the other step to finding was clearly consistent with the record the elder doesn't have to go through and itemize every abnormal finding a surgical port except to based on the opinions of the two medical experts to review the transcript ninety six is the vocational expert testimony who talks about that you can only miss twenty four to thirty six times and still maintain employability if you miss if you miss more than that you're going to lose your ability to maintain employment and the record shows that for medical treatment there was thirty six times after hospitalization in two thousand and twelve thirty days in two thousand and thirteen forty four days two thousand and fourteen thank you counsel course thanks both of you for your presence in the arguments you