as well as some teach honor to this disease that appeared on the x rays and on the arm rise at that time he recommended that to smoking undergo physical therapy for spikes of medications as well as the m r i as stated just a couple  browne for their own evaluation and dr brown is it time recommended all conservative measures before even considering surgery specifically dr brown stated that an e m t should be considered prior to surgery because if the petitioners lanes were coming from this couple tunnel then the cervical surgery would not help at all dr brown diagnosed mechanical neck pain and again maybe carpal the shoulders light duty about shoulder respect the commission decision is clearly against the manifest with evidence they disregarded the evidence as a fault it were case of counts versus i need after neither decision quite frankly i don't think i would be here today however neurosurgeon he made it very clear that she needs to undergo all conserved measures before even considering surgery dr brown did not state in his report that fisher is a candidate for surgery he insisted on conservative measure he was making progress his diagnostic tests his m r i his x rays showed some degeneration but no spinal cord i wasn't there evidence so the testimony of the claimant their view was that with these conservative methods he was not feeling better because sort of minutes were minimal they were short lived his overall condition continued to deteriorate and he underwent an extensive progression his objective progression in his therapy then i think it's clear that the manifest weight of the evidence shows that surgery in fact was not warranted and in the progression you're saying is showing he was getting better the progression in the physical therapy once he starts up with sedentary and ends up with light to medium that is some sort of progress in addition his subject to complaints of pain in his therapy represent we've started it may have time to end up with a four out of five  to be i believe medium to heavy when he was returned to work in the light duty they were going to accommodate those restrictions fisher testified and its in the physical therapy notes that he felt he could not turn his neck and he did not feel safe driving and that react he drove himself to all the physical therapy i believe in excess of twenty physical therapy visits and would because in the physical therapy nothing in his he would keep his kids up from school look to all of the other evidence in the record but i think finding specifically that surgery was warranted and running toward first surgery is agree just in terms of the record as a whole testify that he feels that his condition is not improving yet the medical evidence shows otherwise not cause according to your doctor you're not the claims doctor according to county who pushed for surgery from visit three on correct but according talk light medium i believe the evidence is in the injections after the second injection he testified that he had said that these are really found at second injection i believe that he again let's review feels that he's subject to complaints of pain maybe getting better he went from an aids to a four out of five i believe that the conservative may have worked like again i think the commissioner reacted and followed along the same lines of saying injury pain pain pain surgery we evidence of his treating surgeon the substitute surgery problem with his neck that still leaves him with limited motion of his neck back amended not only by the petitioner's testimony but also the medical records and the physical therapy of a very simple causal connection situation we have absolutely no evidence that this individual had any prior problem with his neck no evidence of any prior treatment to his neck no intervening accident for the responded to hang your head on that this somehow disrupted because of connection situation we have a clear aggravation of a preexisting cervical neck condition that manifested itself right after this accident and to condition specifically in the last paragraph of dr brown's report he indicates and i quote today i recommend he pursue all reasonable conservative treatment before considering an interior decompression infusion at  six if it comes to surgery perhaps we should have him undergoing e m t of his neck and upper extremities to rule out carpal tunnel syndrome since it he has they have problem surgery will not affect it again it's respondent injections and so is that relevant that is relevant and he needs progress after that second one which is extremely relevant to this case to show that he was improving seven days work i believe this is testimony of improvement following a second epidural injection