surgery on the second theory issue is whether or not the employer is liable for shoulder surgery the standard of review for this appeal is the manifest weight of the evidence the employer asserts that commission the chain of events but based on the facts of this case i don't believe the chain of events argument applies here and specifically the employee underwent lap elbow surgery on october second two thousand and thirteen at hearing the employee testified that he started having stiffness in the shoulder three to four weeks after the surgery while those arm was in a sling the shoulder complaint was first testified that he did not think the shoulder complaints were due to over use because the employee was not using the arm when it was in the slaying but he said that quote things get a little bit of flare up and quote due to the immobility dr garst and according to dr garst february tenth twenty fourteen office note the employee said that he was he was not sure if he had symptoms in the shoulder before yellow surgery but the symptoms got worse weeks of physical therapy that's the only cause of connection opinion and and there is no opinion of the findings in the m r i are costly connected to the elbow surgery or the a i think dr levy talked to the employee at the during the on the i m e n and got the specifics as to what was wrong with the shoulder and i guess what doctor we base this opinion on well i mean the only thing we know from the medical records dictate that if your arm is immobilized you're not going to be it's certainly not going to causing tears in your shoulder and it's not going to aggravate any of your shoulder any and tears in the shoulder because your arm is immobilized it's in the spine it's just like if you break into the oval surgery is an aggravation you know medical opinion that if you're just looking at it from a layperson standpoint how can how can you aggravate a tear piers on the shoulder if your arms mobilized and that's why that's why i don't think a chain of events applies to this an m r e with you with you that you know this testimony at least give some color to the argument that there's an aggravation wally's in there if you look at what's actually going on the shoulder based on the m recognized as some expertise and medical matter we have to defer to their expertise in resolving better well then it would have been nice to see that in the commission's decision that that's what they came to but i as i pointed out documented in the commission cision and i would also like to point out that he did say initially to dr garst that he wasn't sure if he had shoulder symptoms prior to the to the elbow surgery so there there is some evidence and i would assert that there that statement should be given more weight because it was made closer to the time that these events were current and was the testimony hearing so i think that statement should be given given more more weight so in conclusion i believe that based on the evidence it's clearly apparent that the employee yes phaedo in his burden of proof shoulder condition requiring surgery is c family i represent the employee in this case i agree with mr classic that the standard overview in this case is manifest weight the in my opinion the appellate is asking the court three way facts in this case and the doesn't actually state that it was an over use and rome issue and his testimony about five or six pages later the next three pages we discussed the shoulder injury itself and he explains it like this why wasn't the classical over you syndrome what he explained was once your arm is mobilized in a sling the for the elbow surgery there is movement for the shoulder and what he explained was if he's protecting the elbow and he's moving the shoulder and what he says in those was able to use the shoulder and to protect the elbow is how he explained it in his deposition so it's a little bit different than what the hell it is arguing that you take one line out of like five pages of testimony to say he didn't say it was over and then he recommended conservative care which is physical therapy so the back to really did oh trying some reasoning why the show back there right oh absolutely and i have to ask him specifically was the elbow and the left shoulder treatment up to that point which was his right before the m r i i think a few weeks for the m r i and he stated that yes that was a reasonable and necessary medical treatment and that's what i'm saying if you take the totality of his testimony not just one line which is what the appellate is using in his argument i think it creates a clearer picture and that part of my argument secondly of another line that the appellant is stating is this one line in a medical record that states he was unsure about a shoulder treatment while this was clarified in direct examination and cross and redirect specifically did you have any shoulder complaints prior to the surgery dr mosel felt states in his medical records at his deposition he did not have shoulder problems or complaints prior saline coming off and so i think that saying unsure to a doctor is not a mission but is not saying it wasn't a problem so i say at the time i was unsure of man it really hurt after came out of the sling that's not a definitive statement saying i had shoulder problems prior to but it got worse and so if you use i think the commission focused in on the testimony of dr mitchell folks records and dr garth records or guards of the fire problems my client two thousand and eight did have prior elbow problems but he testified at trial it was consistent with any medical treatment of you as asymptomatic prior to taking this job he worked his job for a couple years maybe eighteen months it started to develop elbow problems he went for treatment from february two thousand and thirteen until he had a surgery october two thousand and thirteen never making any statements or had any complaints of shoulder problems the first time in the medical records that he has shoulder problems is after comes out of surgery about a month or two later when they pick the sling off the shoulder that has problems and if you read like i say before the medical records and the testimony that he has range of motion issues he has implementation and he has pain in that shoulder which is consistent with the findings in m r i that was found later in this case i think and what i stated is that we have a chain of events of going through this is you have an individual that was doing a highly repetitive job of problems his doctor while not knowing the extent of the injury at least politic next the symptoms and the pain complaints and then he goes on have an m r i then has shoulder surgery and i believe and then also  so you just kind of using the shoulder so you get some tenderness and inflammation there the waiter on he testifies that but i don't think bat it's over years because you can use this and and so these get a little cleared up but it shouldn't be anything that doesn't go away therapy there's nothing on the on the m r i and this is back in may six of twenty thirteen that  that's going to to support of a finding of aggravation so i think in this case there should have been some medical testimony after that the m r i the shoulder was done to tie up the findings in the