and the award perspective medical treatment grows out of in the course of his employment built from ariel e and it's our position that his current condition arose out of him in the course of his employment with his current employer p t i trucking and not with bill we have a repetitive trauma believes to recovery followed by the exact same employment repetitive trauma that leads to a new issue of of whether that was the injury so of course was previously addressed which is where he knows the truck driving caused the problem with this elbows he received treatment for those problems his doctor treats some over the course of several months often only release restrictions whatsoever related to his arms he starts trouble driving for a different company and he starts going downhill he's doing the exact same thing the exact same headed on doubt that repetitive with a new employer is neck and back in those are accidents and the employer argued this should be an independent intervening math and the court held that it wasn't because he was in a weakened condition so i said you know it's the natural flow  the conduct that arises out of him in the course of his employment and there are other things that make it worse that is still on the employer but that's different than what we have with mr peterman mr peterman wasn't in a weakened state now one point was we can but  inclusion i think is really the strongest language is says when circumstances in cases where the claimant returned to work after receiving treatment for the work entries had been working for several months at the time of the continued to drive that tingling in progress to pull a long futile tunnel syndrome all while he was working for p t i trucking it cannot have been in the horse and in the scope of his employment bills for mary lee because all of this developed the second injury medical records and doctor coffees medical record shows returned to work with no restrictions and each of the documents on the months or that you have slowly decreased the restrictions to the point that it was returned to work with no restrictions so to now also after he two months later and drives for another company for eighteen weeks doing the exact same repetitive conduct that is the repetitive trauma should be completely factual argument that they are making this is within the province of the commission you heard it counsel say the words weakened state i don't even know how many times that we need to look to the medical records to determine how  seems to think that because he was released to return to work with no restrictions that this man doesn't have any symptoms and that's just not true if you look at the record and the evidence mr peterman testified at trial and equivocally which was on her about it that he still has symptoms they never went away following the first search if you also look at dr healthy these records before he started work with this new employer you can see that that's also in fact the case so i think what they're doing here is exactly what you said they're trying to get you to ignore certain facts that are in the two of my briefing so let's take a look at the medical records first and see exactly what they do say and how i think that that supports the commission's decision in this case mr peterman underwent cubital tunnel releases in tennis elbow surgeries explains to him because of procedure that he had he had an owner nerve decompression and because he did not perform a transposition on the on their nerves that he may still have symptoms when you presses elbow on specific surfaces he even talks about activities that he do at home that aggravates this as well as activities that you performs maybe even when driving a truck so he's talking about in july of two thousand and eleven trying not to rest your past your ear medial elbow and the edge of the the chair or truck door and then in october of two thousand and eleven again this is still before he obtains the second employment with this other employer in december of two thousand and eleven he reports a king in the left elbow on the lateral aspect with calms down he doesn't have any pain when he's at rest and his pain is overall less than before surgery but still gets pain with lifting pains down palms down excuse me he says for now i would not recommend doing anything more  so your honour's this is not a man who has a typical recovery from cubicle tunnel surgery in which he reports that his symptoms have completely resolved it's documented in the records he's still going to the doctor complaining of these problems even before he takes this other job and i think it's also noteworthy to point out in dr count these records every time he characterized these characterizes the symptoms that mr peterman's having he calls them persistent recurrence he doesn't use the word new ones with regard to the le tunnel which is what's being recommended for the for the the revision surgery on that side the perspective medical care and treatment that we're asking the court to award today i think he does say he's having newer symptoms on the right side but at this point the there's nothing being recommended for him on the right side all of his problems are on the left side he gave him some home exercises and stretching to do for the right side which took care of this problem so all of the complaints with regard to the lack of these type this recurrent and persistent cowpies records it's not characterized as new at all which is how counsel is painting this picture for you and how they make numerous references to the word new symptoms and it's great that's just simply not supported by the medical records case the case law tells us an intervening accident has to completely break the causal chain and we can state i think that that's important this man clearly wasn't and we as the courts is found in those numerous other cases he still had symptoms he wasn't cured from it's the same treatment that's being recommended it's not like as the cases the council pointed out where completely different treatment is being recommended national rate case this is the same essential treatment it's just a revision it's not anything new being recommended this point so i think the vocal case is on point was clearly in a weakened state before he even took this job and also from a practical standpoint what would my manifestation date have been if if you would have filed a claim with this new employer his first day to work for the new employer the that the new employer is an argument of course it would have been well you did all this work before that was clearly causing the contributing to your problem you can't say that this was caused from one day on the job working for us so i think that the commission's decision also makes sense from that practical standpoint this  another important thing to note is that the courts have often said in repetitive trauma case specifically that recovery is granted against the employer on which the claimants injury manifests itself that's to a cns case the manifestation date is not in dispute it's may tenth two thousand and ten in this case that's not disputed by respond in this case so according to those case file in that case when it comes to repetitive trauma injuries liability is fixed against the employer who he was working for when his injuries manifested which in this case was clearly goes to mary i think it's clear from the records that this man symptoms never went  away they did become worse when he worked for the souther job i thought i don't think i can dispute that it's clear that when somebody goes back to work doing the same thing that injured them in the first place their symptoms are going to be aggravated but that doesn't break the causal chain in this case and it does not these medical notes on october nineteenth two thousand and eleven he indicated that mr peterman had totally recovered from the people tunnel on november twenty first dr kalki wrote may return to work without restrictions