Symptoms were documented shortly after the event with early objective functional loss.

No prior shoulder treatment was identified in the records provided. Obtain earlier records if available.

MRI documents substantial chronic tendon and AC-joint disease that creates an alternative explanation for part of the pathology.

Potential future procedure is discussed, but medical probability, timing, restrictions, and projected cost are not yet established.

Obtain targeted orthopedic clarification before demand.

Triggered: disputed causation + future-surgery probability.