it contains a lot of interior that could be considered missing from the record and specifically if you look at the order of the commission in the factual findings the factual findings  specifically from the commission found that the petitioner in her condition was related to her work activities what they did is they rejected the only opinion evidence in this case in doing so that being of dr horn blat in reviewing the record there really is no opinion after opinion evidence offered by eat fish and or the injured employee in this case the goes from the they talk about a strain to ridicule or component to an m r i that shows a bulging disk i mean it all makes sense in terms of the sequence of events that is not correct but if you look at it tre celebrated a preexisting condition is a compensable well it could be but i think that you need evidence to prove that and i think that there is no evidence in the record on the part of the injured employee in this case stating that her condition was aggravated by an underlying the genera that was because what you introduced was her primary care physicians records correct including your time she had a cold or whatever correct going back to when she was about eighteen in and pointed out that she had asked several times about breast reduction surgery because of back problems and that her mother and her grandmother had the same problems but there's nothing in those records about where the back problem was what it was like couldn't it true i think that's w the i have large breasts my mom and my grandma had the same problem and ultimately that's what she had surgery for were some hold back so i mean i don't think the records even say low back when she talked to her memory care physician do th i think that whenever you reference the back i would presume that you would presume it's a little bit correct that i think that there were maybe specific references also in those family records to neck pain as well i think he said neck and back i think he said both but i think that that's sort of the point also piers you didn't introduce any evidence to specify at all what would those records refer to you didn't have the doctor come in testify about it you know you're i mean didn't say that there was any pre on to say she needs surgery to correct i don't i mean he doesn't say the magic words i have an opinion within a reasonable degree of medical certainty that this discreation was caused by the need to work with heat to save it but he never in this case you're looking at a whole bunch of pretty musicians who diagnose that because you know with the lumbar strain and interestingly the decision of the commission is variances sings and does not really provide any large factual support to back up the opinion other than to say that there is a rejection of the respondents expert witness in this case and then the reason that they use is contradicted by the very evidence that's put into the record i don't think that the commission can just arbitrarily reject the only opinion evidence is offered in a case i think that there has to be some reason given as to reject that will be evidence to show does it not the sequence of events in that she was working poorly the timing of it is she was working doing fine for the sap and then she ends up with surgery recommended over and assisted she made use of medical treatment she undoubtedly has surgery eventually form but i think the gist of what the point is is that whenever you're looking at the commissions findings you see that you have got rizzoli and dr better who quite frankly is for doctor her own orthopedic surgeon who looks at her lumbar studies and says this is a pretty big leap to offer a surgical of or to award a surgical to surgery should i say by that commission an over three hundred thousand dollars in medical bills without somehow tying those  think that there has to be some sort of bevan and shown in the record by the petitioner saying this surgeries causally related to the back in dition problem or i mean i specifically am not able to go in and look at these imaging studies has no basis for opinions essentially his opinions because they contradict the treating surgeons that's not correct and i think that when the commission puts that in a decision that's pretty indicative that it's not a proper one wing on the part of the this case by the petitioner other than to put in some medical record and by and large if you look at the bashful findings by the commissioner so sure there are absences same to ration that the listing of medical bills are in the same decision commission are very sane and don't really offer any guidance with regards to the opinions that were placed in front of them at the time of the hearing i think that the family doctor preexisting problems with low back pain that cannot be ignored by the commission and specifically if you look at pointed out in the theory that there was a family doctor records shortly after the work gets to them and we think she mentions that work and so she goes back in there and says the same thing that she's been saying all along i have low back problems and i think that i need to have some sort of surgery to correct that that's has nothing to do with the work and i think what you do that the case law been entered the next point i want to bring up is that medical bills were introduced and they were never really laid a foundation or i think under the these good old you object to the introduction of the medical bills yes they were of the bills is that right that's correct and i'm not stating that the bills are not actually i think under the the schedule probably the reasonable aspect prong of medical bills may be out the window now i think the question is are they medically necessary and so really  mean can you throw over three hundred thousand dollars of medical bills and record and expect them to be paid without any evidence to support that i don't think you can i mean there's nothing in the record to support those medical bills are necessary secondary to w all we have are some complaints dating back to the one nine hundred ninety nine well before this injure that you had some back pain well i could've had back pain two months ago doesn't mean i have a preexisting condition so i think for him to stand before your honor's and say that i think is a little bit disingenuous and again nothing in those records to say it was a little back there's no evidence of any treatment heather was asked about any prior treatment other than and she did she was asked excuse me whether  fireback conditions and she said no and the reason she said no is because there was no prior treatment no prior injections no prior therapy no prior surgery no prior diagnosis of any preexisting back dish and i think counsel makes his in the patient that she was a thirty two year old c n a injured at work on march sixth two thousand and seven her therapist after a koli at north suburban medical notes from march to august when she was in therapy stated that she suffered an occupational injury dr polly at the condo medical center a pint and a note from two thousand and nine that she suffered from chronic back pain since her injury at work in two thousand and seven and even after cora black can say that she wasn't injured at work or that's not even an issue here he says that she had a work related injury on march sixth two thousand and seven so that we go now to what was the diagnosis ok and their lab is being made with regards to those lumbar strain that she was diagnosed with now come insulin his brief cites dr strong indicating a diagnosis of a low back strain but doesn't tell you that that diagnosis was made prior to the because i think it's a very important i think when counsel makes an argument that he provided the only cause ation opinion with regards to whether the surgery was necessary you know what causation opinion do we have here so why had he had this virus at concern and incomplete record to review and making his decision i november first two thousand and seven he had records to review again and began admitted he did not have the there is nothing in that finding that said she had a preexisting anything that those are words coming out of the actor compliments now but again i didn't have the films to review on that second report now his third report may twenty second two thousand and eight you barely get the i'm r i of april two thousand and seven showing exactly what i just stated remember this is may twenty second two thousand and eight doesn't review another and that one that occurred in april of two thousand and third report incomplete information he commented on the need for surgery and says no she doesn't need surgery but again doesn't have the report indicating the broad base this is turning ations and then in his final report from july third two thousand and eight again a record of your report and says oh now i finally have both and i don't see a difference between the two well obviously there's a difference between the two dr sits how found the need to write a report himself indicating that he strongly disagree greed with dr combat and then he had seen dr corm glad to the same surgery with same presentations on other patients and question his motives and i think that's what this court should do and that's what the court did is question dr corn plants motives we have for reports all incomplete all incomplete information and i think it makes all of his opinions suspect so what do we have again we're left with a chain of events here we have a pain medications are given to her she has physical therapy she has at the general steroids injections and then finally a recommendation for surgery once her condition has worsened as evidenced by to our eyes to one year apart and i think again that chant of a bad day that your honour's alluded to is it's clear from the record that there is a causal connection here between her date of accident and her subsequent surgery in light of all that you know i i don't believe that council has met its burden i think the commission's decision should stand and should not be reversed because it is in the purview of the commission to decide conflicting monocle evidence you are just briefly counsel mentioned that there are these two m r i showing a rush of the disease and that's the need for surgery and i think that's the gist of what i'm getting at how can we reconcile that whenever evidence how did the commission come to its conclusion without having those opinions in evidence i think the commission made a big leap here i think they made a huge that they've reviewed the medical records and made their own medical opinions i don't think the commission can necessarily do that i think if you go on a chain of events that you can't have such complicated medical finding such as this with multiple m r i studies and everything else and in essence counsels asking that the commission can make these determinations without opinions and then in the record and frankly pinions that are in the of injury and look at the film and say this lady had it from our screening that's x absolutely in harmony with dr horn flat and contrary to a surgery that was performed by that over a year after the injury thank you