what frequency plaintiff appellant could engage in handling an fingering over the course of an eight hour workday the ael j in the decision acknowledged that no state agency reviewing physician was even aware of appellant subjective complaints of of hand related limitations and were likewise not privy to a substantial portion of complex medical in addition to that what having a medical expert look at this case could do is they could speak to whether this degenerative issue which as the court knows is something that gets worse over time and doesn't happen overnight they can also speak to whether such limitations would relate back even further than that that two thousand and seventeen era  innocence handling the case as claimant and her attorney request well because yale j should note that this court has continually held that when complex imaging like an i like an x ray of the elbow or the or that the bilateral hands it's shown a fracture in answering a question as to whether how often that's that that claim it can use their hands that that consistently has been found to require that a medical expert scrutinize that imaging or the internet and that evidence that while we know that line of cases but we also i and yet the court still found that because of the significance of that imaging that the judge should have on his own accord subjected it to a medical expert especially here where what you have is you have the outcome determine if question she had a sudden residual functional capacity she was an individual under the age of fifty at that time and really one of the only ways for for such an individual to be approved for benefits on a physical basis is to have significant hand limitations when confined to a sedentary residual functional capacity and so i had had a doctor look at the m r i at the doctor looked at the the hand x ray that showed a fracture in her left hand or significant question or it's a significant finding when you're talking about the ability to consistently handle things over the course of an eight hour workday what's more significant certainly is the cervical spine m r i that indicates and could be could be what was causing her her hand limitations  other concern would you along these lines is there any obligation in seeking reversal on this kind of ground to come forward with some indication of the significance of  what this actually shows as opposed to just say i'm i'm i'm worried about your genius to adopt a rule that in essence leaves the record open indefinitely  it's not a it's not a question of keeping the record open it's a question of when the when the judge sees that there's significant objective medical imaging that's complex and that that that that where there is a now come to terms of question that the answer lies within the medical imaging that we need a doctor to make to come to that conclusion rather than a layperson ale jay and what you have here to support the significance of this imaging is is the national institute of health characterization it demonstrated and and what that can cause there is no there has been no that i'm aware of any any decision by this court that requires a rd party medical opinion from a treating physician or examining physician in order for an l j to need to subject it to a social security contracted reviewing expert thank you was an m r i that came in after the state agency doctor reviewed the record and it showed only mild changes to the individual's condition here similarly we have a cervical spi one of the record exhibit seven f corresponds on page i believe seventy two the set of evidence submitted from in med diagnostic services which corresponds to  appropriate both of those cases moderate this line of cases by saying by standing for the proposition that st may reasonably look at later evidence and if they can reasonably infer that that evidence shows only mild changes don't need to go and secure the advice of an additional medical expert but also for the proposition that the court should hold the claimant seeking relief from an agency decision to their burden to show harm by identifying both non presidential correct they're both unpublished that's correct your honor but nevertheless i would urge the court that they are worthy sort of in terms of their to me if we're talking about asking about evidence that exists at the time of  think i mean it still it still places the burden entirely on the ale jay because as your honor said two opposing counsel there is an entirely separate line of cases that says if if you are represented by counsel you have contemporaneous medical care you're expected to present your best case for for benefits so in a case like this wouldn't we at least expect that appellant would go to her doctor and say can you give me a medical enough that's gone on here as a result of the birds who visit physical therapy the x rays themselves that everyone would benefit from a nd state agency consultation or some other review is there a certain line that you're saying we should draw well the problem of course is that the specific facts of this case are going to set forth the rules that apply to cases going forward so you wan forth a rule that applies reasonably across the board and one thing that i would say is contrary to appellants arguments appellants allegations of and hand problems were in front of dr keno so if you look at age seventy seven of the record dr king a specifically notes d opponents allegation of trouble raising her arms that she could not use one hand to do cooking because it caused pain that she without even sort of acknowledging her own burden to provide evidence in favor of her claim on this issue and without acknowledging that to your i'm sorry because they did part of the problem here is the the evidence was in the record these scans the two thousand and seventeen scans were were part of the record the question who understood it was not about supplementing the record in terms of the scans but in terms of indication that dr mohamed thought any additional limitation flowed from those that those findings are dr dr did who examined her that that same month who found her elbows to be quote unquote fine  and there's no indication that she asked those doctors for an opinion or heard that her attorney did and then as your honor said at the hearing didn't just ask for time to submit that evidence that those doctors  notes but didn't ask for an opinion or the ability to submit an opinion and certainly could have for it you have the last best opportunity to do so and to find in her favor would up and her burden to prove her limitation if but if the court members have no additional questions we we for the reasons i guess and if i could just add one additional question  the with the the a l j concluded that quite specifically ms kemp one could engage in frequent handling but not constant correct that's correct so what was the what was the basis the medical basis in the record for the frequent but not constant limitation m v l j doesn't specify such a reason but what the court should should note in the circumstances that the ale jay was giving partial credit partially crediting her allocation of manipulative limitations to things that i would i would note in response to that one is one of the jobs that the vocational expert identified call out operator of which there were sixty seven thousand dollars nationally would still have been available had the even limited her to only occasional rasping and each so handling figuring in which  that is she looked at a cervical spine x ray from april of that year she went into detail with regard to the lumbar m r i and there's just no mention of any cervical m r i imaging it would it would seem that she would not have just ignored ignored that had she been aware of it and in addition with regard to dr mohammad this the signal into intensification of the cervical spine that was observed there that that is indicative of cervical spinal cord compression not per me but per the national institute of he