but i don't know what the heck the this is this case involves two different arbitration hearings the first one went up to the circuit court and stop in that case the arbitrator found then the case went up on appeal and sort of stopped dead dr ritter who was the treating physician in two thousand and seven did not find arthritis to be a big factor and that's part of what what the second he had maybe a preexisting condition but the conclusion was that there should be nice or three and then the two are going to go together then there was a guy to get from the arbitration to the circuit court went from july of two thousand and seven to i think may of two thousand and ten during that period of time the petitioner left the respondent and began working for another when he left the respondent he lost group had no health coverage whatsoever well they're still appealing the case on the issue of accident and causation no medical was furnished to it as he went through his new job actually second job after he left th he drove what was called of the long haul what he did is drive a semi or i think it was two hundred fifty miles put some distance drop the trailer turned around and came back he did not do anything physical in the way of loading or unloading good one to get in and out of the truck maybe three to five times a day or a ship i should say it's not anything more unusual than a person walking down the street or up up and down a set of stairs when it came time to finally get to be seen by dr ritter in december of two thousand and ten the man was at the stage that he needed a total knee replacement with the longer i'm in a sec to me the original medico from two thousand and seven did not show any real problem with the arthritis the petitioner said he never had any complaints with his knee prior to the two thousand and seven accident he did back injury between two thousand and seven and the trial from there to the visit to dr ritter in two thousand  it is our position and the reason why i am here is i believe that dr gahl ski's evidence of reliance upon doctors in those fields report is contrary to the evidence in the case the commission had already found in two thousand and seven that is the condition of those related and he was entitled to a surgery there was some arthritis there subsequent to the visit with dr ritter in two thousand and ten dr ritter gave us a deposition in that deposition dr indicated that first of all the loss of them in this case is like that are without a higher that his suspension system goes more quickly because of that fact the same thing with them i quickly which accelerates the development of arthritis at the c four to seven four to eight the miscues tear plus the lack of treatment for three years because the condition that he has now is the need for a total knee replacement doctor in the gulf city examining the old records and in my reading of his report he tends to pick at what the commission decided in the first opposite way so you're telling us that there are some bond ational problems with the gulf news opinion that would totally undermine his opinion i think that that there is yes that he he said that there not further so not true which so they would be just if you could not be revisited by the commission i understand but i think it doesn't necessarily what they did though is it i mean they said is need for total knee replacement but if you look at the records from two thousand and seven both dr levin and the doctor ritter did not think arthritis was a problem with his the he had some yes it's not denial that there but it progressed and it's going to progress when the  case wears out and therefore that's why i don't i don't think that the doctor both of these opinions are really sound in the commission when they when they found when they made their finding indicated that because he continued significant labor while he was working as a truck driver but he wasn't doing anything radically physical with his knee other than getting in and out of the truck a couple time while not a couple of spirit five three to five times and he was in loading or unloading and there's no description of the demands of the over the road driver and then they argue about him not getting medical care will he be had no backup with the payment of medical care that responded was appealing the case so they were not agreeing that there was any type of calls or relationship and secondly he didn't have group insurance to pay for it he needed to work so it is my belief that they relied ritter significant tributed doctor in the gulf is saying that it isn't there and it isn't a factor and i know from the two thousand and seven dishes and finding them in its history i don't know how you can argue that it isn't from the doctor's opinion anyway i believe that and i know i've been here enough times and long enough you don't like to change factually sure i understand it but i think this this one needs to change the factual result of the commission i think is just totally wrong i don't understand why they did it sense in some other senses which i won't mention i understand why they did but i would ask this court to to really take a look at least the evidence take a look at the reports to look at the decisions and i think you'll agree with me that the commission's decision is erroneous on a factual status questions that i don't believe there are thank you so that nature but then as you noted looking point because if there isn't and if there is something blatant i'm not describing this case but if there was a case where there was something like the flaw in the foundational basis and there was no objection i basically comes to the score or consideration of that opinion without taking into consideration the foundational paul said well perhaps if it was an extreme situation such as a doctor reviewing the wrong records for a physician to treat the individual using something like that perhaps you could make that statement but in this case this is a matter of weighing the opinion we've got we've got opposing opinions in this case and i would i would encourage you to take a close look at the  we were not related getting whether or not the surgery that was originally ordered by the commission was reasonable whether he should have to have it based on its current condition that fact his own doctor dr british is that you don't need that surgery more he says you need so i i think what dr new gosbee did is he took a look at the condition that was being presented think this is a degenerative condition related to osteoarthritis this is not a natural progression of what had happened before the prior injury and he said it's not causing related their doctor looked at it and said i think it is a natural progression so that's the classic doctor's opinion versus doctor's opinion and that's really good your doctor doesn't have to identify because here he can to simply refute topic to twenty nine the deterioration a significant loss of articular cartridge and changes around the need it was suggested significant preexisting problems he continues to talk about how the continue the symptoms continue to develop so yeah i think he does i mean i would agree that certainly you can see as an employer the physician can say that's not related in and stop but here i do i do think he tried to offer an alternative explanation is that if you enter the condition that preexisted that continue to deteriorate  and lead to the total knee replacement which a different question than whether or not you original miscues terror was related and that's not before the court at all and again the question is which of the two positions interpretation of the need for the total knee replacement and its relationship to the original accident was a commission to accept i mean if the commission would have went the other way and found it compensable then a lot of very well i could be standing up here making the exact same argument i would say if i were reviewing it is the same it's the same result you don't like the result the commission evaluated the medical opinions one doctor might be criticised for the sas pick another doctor might be criticized for different aspects but in the end somebody got away that and come up with a conclusion commission did that and they just don't like the fact that  related i think the one thing that is missing from this discussion that we've had so far is that there were there were two real findings by the commission here i think are important that we talk about the medical opinion evidence but the commission found it significant that both doctors that there was a divide in the commission found the the late significant delay in seeking additional treatment keep returning to work full time working as a five hundred mile round trip drive or five days a week climbing in and out of a truck twenty times a day performing your job  years where he was he was able to return to work after he was told he needed a miniscule repair he returns to work without restrictions performs a job they've they've concluded it was a strenuous job and that's a fact question they concluded it was for us john they found that to be significant as to whether or not there was a break in in the original condition and where he appeared more he presented in twenty ten i think that's exactly what the commission did they said someone who who has is this medical request to have the surgery performed ministers repair and then goes on and does this work for three and half years without any any attempt to see a doctor without any restrictions exciter of that there's enough of a break now that it said the word right but i think that's a clear implication of what the commission's decision said and i think it's it more consistent with common sense isn't what i'm looking for but this doctor to go off his opinions concerning the need for totally replacement to the issues other than the word makes more sense from a medical and a common sense perspective and i think that's exactly what the commission is talking about is at that period of time and i think that's very important now councilman is dr levin and i want to touch upon him for just a second or two before before i close dr levin did offer some medical opinions relating to the first accident well first arbitration two thousand and seven and even if looking at dinner at that point in time in offering his opinions at that point in time his opinions do not relate to two thousand and ten or any time afterwards so we had a very limited snapshot in essentially how i interpret dr levin's question opinions are he says that a person with a preexisting condition would be more likely to develop a tear but he doesn't talk about at all in his  whether or not a tear would progress to a need for tone replacement so i think for the purposes of why we're here today that i would in the second commission decision dr love his opinions really are if they don't mean anything and they was all true or false that's correct those are the two that were actually off this part of this i understand you can look back for a comparison basis certainly but the opinions that were given by dr levin or in two thousand and seven six years prior five years prior to the arbitration in which case and i don't think they hold any weight condition developed in the caressing time i think that's how we read his opinion and i think that's how the commission took that opinion in conjunction with this other evidence of his talk was repeated again but but i think that's where you get to the point when the commission makes the comment that they find that the cause being unrelated to the employment makes more sense from a medical commonsense perspective the commonsense perspective is if you're order to have a procedure you're allowed to have a procedure you don't have  procedure and you go back to work have no restrictions exciter and then you have a need for another procedure the you can say that they're not related i think that's what the commission did here is just articulate opinion in a one hundred percent articulate opinion probably not but but the gist of what the it will wear away faster and arthritis ultimately it will be replacement which is where i'm standing at this point is very likely i don't condone that he didn't get medical care for three years but he didn't have a