for an hour every afternoon and the merck manual says is a footnote number two which states that when it comes to reactive arthritis it includes the fatigue one of the one of the symptoms is chronic fatigue the court this court noted in th clear decision congress places a great premium of agency expertise and for the sake of unity the courts should give great deference to lower courts and not substitute their discretion for the agency and therefore reviewing cour new law the social security disability benefits reform act of nineteen eighty four which appears to require that each claim be looked at neutrally without regard to presumption of continuing disability and the difficulty with that  long but this panel has no authority to deal with it because we can't overall something that was wrong but not superseded so my question to you it and i guess my other question to you is whether it in your view the presumption could make a difference in this case factually yes your honor it would make a difference because looked up what that is and i in footnote number two i indicated the merck manual says when it comes to active rheumatoid arthritis on that one will sometimes it is chronic fatigue  ms bond good morning your honor and shame on the behalf of the commissioner of social security i think i would like to address the presumption of continuing disability issue st so as your honour's have pointed improvement potential medical improvement of a claim that has already been adjudicated disabled and i think your honour's are concerned about what what happens when you have a case that had that after that amendment and what i yes i will file that but that that could that could be the avenue that if this court is looking to for instruction that could be the avenue that explains how the court can proceed given the existing circuit precedent but  think the other question you can ask ounces does this really have any impact if there is a presumption in our position is that ultimately the l g s decision has to be supported by substantial evidence and the conclusions drawn about medical improvement have to be supported by substantial evidence so the court is still using the substantial evidence standard here and of course it's our position that it does the l g s conclusions are supported under that it really highlight well gee she can do a few things around the house and therefore she can work better if we're so gentle and so they i really have difficulty with a all jews decision and extent of pain testimony was also very generic here it's sort of why i looked at the medical evidence and i've heard the claim that it doesn't match up in my view and that's basically what we have here rather than saying you know she claimed she couldn't climb a ladder and yet that range of motion is x you know that's the sort of thing we're used to seeing in this context you just seem very cursory to me i would i claimants complaints were when she went into her treatment providers talking about the pain around feeling emotionally unstable and then outlined the relatively benign clinical findings whether it's a mental status finding or a physical examination finding talks about the treatment that she was being prescribed notices that the treating records show that she was experiencing improvement in her symptoms to the point where she went for the mental impairment she goes from a label aspect to normal aspect or in terms of the standing and walking which really was the i think determining factor here between why she was found if able previously and then is not disabled now is that she increased  prolonged periods of time and it's you know she was doing pretty good now we do have the achilles tendon condition which developed later on and even then when that st appeared g explains in the decision that you know this just happened late started in august of two thousand and sixteen but even then her stance and gait examinations were within normal limits you know she did have some pain and swelling here again i think we would say that this this decision the sale decision doesn't reach are doesn't have the problems that were say in the cases like brown hunter or brough where there really was just a conclus statement from the l j that i find the claimant statements not credible or i don't believe them which is the problems identified in those cases we do have more analysis on this a l j and it's it's grounded in the record and it's we would argue it's it's officially specific and clear the rationale and the reasons provided have support in the record  council new x ray results of her right here on the ten it looks like that there is still certainly some serious damage to it and there is a possibility that she may still suffer from a partial rupture of that tendon  limitations whether it be a pain in her hands he mentioned this she had difficulty making a fist here and the user can block her but she never asked her about the need to elevate her legs which attend and whether required more surgery and if possible could result in a change in the outcome of the case the person used to elevate their leverage leaving the daytime court cases basically this counsel you've been very helpful to us thank you