she was knocked off a therapy ball and hit her back commission determined that it was a temporary aggravation of a big speech up above but i'm sorry the commission determined that that was a temporary aggravation of a back condition january thirty first of two thousand  tripped over a bag striking her knee on the floor and that is the subject of the current appeal of the employee suffered a injury to her left knee it was complex regional pain syndrome is a diagnosis from both treating physicians dr karim and dr glacier the petitioner treated for several years eventually there were depositions found was a quick and dirty estimate of what they could do per his deposition testimony the commission determined that the employee met her burden of proof in establishing that she did not work based upon the medical opinions of dr glacier and her current who both rely primarily on dysfunctional baseline of a million assessment the functional baseline assessment indicated the petitioner could work ten pounds lifting two hours working walking or standing two hours sitting with ability to stand every two hours that same assessment indicated there was some moderate bending lifting the squatting limitations commission determined that the opinions of the doctors as to the ability to work along with the testimony of the petitioner worth of bases were her determination that she was permanently and do based on the testimony of dr glaser and secondly that even with that baseline assessment it indicates she could do certain activities and it looks as if she could work a sedentary job and neither of the doctors  testified to any extent as to why these limitations would prevent her from working a job in the commission in turn merely relied upon the evidence the positions of these two doctors to determine  she can't work at all those two opinions rely on the f b a and the f d a merely says that she has limitations there's no question she should have some limitations the question really is in determining whether she can work at all how do they make the determination other than to rely on those medical opinions and then you go round and round those medical opinion for a lie and you have to be able the f b a says you could work don't say she can't work it says she could work with restrictions the doctors then turn around and say well i don't think she years earlier or two years earlier so she was relying primarily on what she wrecked no recall from her of the evaluations and from the medical records there's no question there is pain petitioner testified that she has pain and that it's reduced with the use of the elements of her claim and the commission itself when you look at the opinion it's more like just giving us one line that says i'm relying on the medical opinions the commission itself makes some but both medical doctors indicated they're all related back to the one nine hundred ninety nine incident so there's some errors there and just some very unclear determinations from the commission and i don't think the commission itself has indicated that the claimant has met her burden of proof other than to just say that there were medical opinion saying that she could work it's the province of the commission to determine whether the claimant can work with the province of the doctors to determine what those restrictions are and it's our assertion that when the doctors determine their underlying opinions nothing more then a quick and dirty estimate of what the petitioner could do if that's not reasonable well ok so if there was another if there was a full of c would that it might have been more probative does it mean that the one that was actually done was valid i don't believe well look the what was done i'm not saying it's not valid what i'm saying is that the commission has to determine based on the medical evidence it has whether the this claimant can can work and versus giving her other benefits that she might get and instead of the permanence of all disability they may look at whatever the m b a one of the have see and determine that she can work there's nothing in the record in my opinion that determines that she can current testified incapable of employment but again that's for a vocational expert we're looking at man malevolence when it comes to doctors and that's a promise of the commission to determine that based on that medical evidence whether that person could commission's decision that indicates why based on these restrictions even if we accept them is true why you can't work a sedentary job i mean it says you can work ten pounds lifting two hours walking or standing two hours sitting with ability to stand every two hours that's a sedentary position the question is why can't you work a job with those restrictions and the only answer we have is big well the doctor said you can't work but it's not the promise of the doctors to determine whether she can work it's a promise of the commission all the commission has is that one single indication that he was unable to work so what you're seeing responses are give us very simply and right to the heart of the matter the commission relied on dr mary jo  qur'an and its findings dr conrad is a pain management specialist she deals with the issue of our eyes the more complex regional pain syndrome on a regular basis baseline evaluation of f c and she looked at that report prior to testifying at her evidence deposition and she said the testify there based on her hand the diagnostic treatment the blocks in everything that were administered were not only for treatment purposes they were for diagnostic purposes and a record clearly shows i had a temporary improvement which confer you diagnosis not only from those two doctors but the record all also contains a third pain management doctor dr kim who she initially started treating with referred to him by her orthopedic surgeon no i guess what i'm saying is that the pain management specialist based on the treatment the pain that she was having her subjective who finds the change in the collar of her  they had this employee is permanently and totally disabled from any and all i can patients and she was going to be on opiate management indefinitely which she still is and she'll has been throughout the entire case and opiate medications are quite couldn't even home or own hair without assistance or get dressed without assistance with those types of things that she was battling i think it was eminently reasonable for both pain management because the the opinion wasn't stricken doesn't mean that it carries credibility with the commission certainly the commission can look at this man determine the credibility of the of the doctor to opine in this area and afford it the weight that it deserves which in this case is saying well they're going to the commission to get it anyway and yet it's in the record it is in the record and there's no indication that the commission gave any specific area of the testimony more weight than any other it just said based on the medical opinions didn't say that it was relying on their opinion that she couldn't work it could be that the commission was relying on the opinion that she had certain restrictions and then the commission itself made a determination that the risk of the petitioner could not work remember in this case it's not the the doctors who generally on a medical on a total disability versus an ocelot which you would have vocational testimony is purely medical the commission that will make that determination is to based on the medical but just the fact that it is in the record doesn't necessarily mean that the commission was correct in making that and it's not against the manifest weight of the evidence because the only thing we have we don't have the underlying opinions all we have is the testimony i see from dr karim the primary problem is severe pain which causes heart to be unable to emulate with ease well that's taken care of under the f b a so we keep going back to that it isn't there it's taken care of is too she has limitations we know she has limitations on her ability t so it's our position that we were looking at weight of evidence and we're looking at the commission's decision again to go and say this is a permanent told his ability versus this is something that requires permanency we're looking at someone who has restrictions we admit that the question is can she work in a reasonably stable a market or  industrial commission and the arbitrator treated this almost as a repetitive type of exposure unlike the have been very similar to the case and heard earlier in the us can this is a one time industrial accident mercury and dr hunter but all of the doctors identified the one chemical that mr hodges was exposed to in the difference with this case and amongst many others is that all of the doctors it's undisputed who apparently takes on the role of examining physician for argonne in these types of situations i am arguing to this court that an instant replay is required that do novo that this court is clearly gives this court jurisdiction to review the issue of causation it is very rare however to say to this gives this court the ability to review subsequently relied upon dr kahn to bear ignored a significant fact in this case which was what existing condition history morbid state your honor castings case which we cited to is the case that allows us to look at that and overturn a ton of peers decision look at her opinion and say that it was incorrect but what's the linkage awakened some sort of alcoholism because there was a condition here the condition was the phenol exposure and immediately there after there was symptoms it really did it did it it defies logic to look at this case and not find a causality between the exposure and the immediate onset of symptoms and the subsequent is the evidence that's presented by all of the other physicians namely we can we can look at like it was the toxicologist and mike and i know there was a suggestion in the respondents brief and also in the arbitrator's decision  like and did not rely on facts and science but that is absolutely incorrect like and and i have a list like and base this opinions on science and fact number one he testified portion of it so that you can review this the noble there was a calico which was identified nobody disputes the chemical become a coal was identified through the amas the ice sheets there was the immediate onset of symptoms which more all of the people who were exposed to it that location on that same date at that one time exposure complained of they off as the five and they all complained of the same type of smell and they complain of the same types of symptoms clearly we have a page for twenty seven of his record i believe also cited to the level of pheno in your honor may it may i point to you that you're in count was taken on january five this exposure occurred  january two so even if we want to look at that you're an phenol count in a narrow window it's you have normal twelve is abnormal no matter how you want to characterize it it is of no normal count and that was taken three days after the exposure and that was by dr stalker at argonne lab who requested that mr hodges come into his office and undergo examination so three for exposure and causalities it defies logic that his symptoms following this occurrence which were never complained of if you look at the old the old adage of the one tech of the clock at the one tick of the clock before this occurrence where were these symptoms where was mr hodges is this ability according to industrial commission definition as far as his ability to work all of that sorry i didn't listen i think the argument is that he had no symptoms prior to exposure even if he was guilty but that is correct that that is the argument here i mean the symptoms of white headedness nausea vomiting wooziness none of them were present so he would have to better understand the argument you don't need the medical you could rely on the good health and then after the incident or exposure you could become have symptoms but i was swearing in addition to making what dr like in the reports to the u s deal well in terms of the basis for their findings you don't have to rely on u s department of labor if you feel that their argument is it is is either stale or  it raises some other point but just look at what he roll lies upon in terms of his basis for his opinion and he's in he explains exactly what it is and then that's why i say it defies logic and if we go to it is suggested in the introductory letter to dr khan appear in terms of what she should find dr stocker clearly suggested the opinion that she should render in the introductory we reverse and if we go under man of the most weight of the evidence you know if you look at the standard of manifest weight if your honour's choose to look at manifest weight you know i don't know where that falls i guess it falls somewhere beyond between beyond a goes to justice hoffman when he said about there's no symptomatology before this if there were no symptoms i can't even say that this was an aggravation and i'm not going to because there's no indication that it was an aggravation this is these are new symptoms new findings and i think the who counsel for responding to find anywhere in the record were these exact symptoms so the issue is very narrow here we have we have exposure it's simply the causation of those symptoms to the disability and under this court may review and if your honour's choose not to review this the no manifest weight is clearly a standard which you may review this on her because an opposite conclusion may be reached based upon kind of bears dr believe it was dr mercury who is the internist who had some indication in there but it was never a diagnosis of alcoholism made or even a recommendation for treatment and most  disagree with that analysis that he made because somebody can say yes i consume ten of something and then you're going to multiply that ten times every day of the of the of the of the month and times of the year so i don't agree with that i don't agree with that interpretation of that they come from a medical but but but again your honor i just want to emphasize that the disability occurred during a one time dramatic event typically we exposure cases should say typically but first and foremost i want to point out this is and always has been a question of fact whether or not the pheno exposure was sufficient to cause these it's a question of fact and therefore this is the manifest weight of the evidence review the examination she did review all of the material data safety sheets the industrial hygiene tests all of the medical reports from the days following this event none of the other doctors conclusion i'm not pointing to just the urine samples in the blood samples which arguably were taken a few days later where some of the substances were found in nobody's body petitioners or any of the other workers ok for the sake of argument let's say well another exact replica of that the mama and tested its contents to make sure that the levels could be enough to garner an exposure to harm anybody no levels were ever found sufficient so they commented on why reading on at least one or two individuals was elevated to twenty and that was found to be because they usually at the beginning of the beer that you're saying yeah i'm sorry i think i introduce quickly that doesn't affect feel his muscles it affects the underlying of the evidence demonstrates why is that because the gentleman drink before and after in his symptoms can be more readily explained by him to continue consumption of alcohol which is toxic leading to the dark no diagnosis of  this was a phone call the petitioner in the accepted one letter from dr lekan to base their decision there was no opportunity for contrary evidence to be presented will stop it without a boy and i don't believe so judge i just i want to make sure i address that and again u at less weight because he did not have all this information was not privy to it when he offered his opinion on cause of connection that is why dr converse opinion was considered more valuable it is within the discretion commission and therefore indicates that to establish proximate cause ation the plane didn't much show that an event in the natural or problems sequence produced the injury complaint and that's exactly what we have we have natural probable sequence of events we have exposure and start we have an event exposure complaints and subsequent complaints  disability and before the event there is a powerful ross it's a blank slate of anything with respect to complaints or even disability related to carmex when nobody ruled out these other issues at the time of the urine count or even a year afterwards that was given in an evidence that position is is other substances that contain phenol and don't forget there was a demolition project in room two twelve in argonne national laboratory there was a demolition project of walt's whose this is a that the come from the walls and not only the thermometer because many people were exposed during the event and subsequent to it one of the things that lichen relies upon here is that other people were also exposed and also had the same complaints that counts that amounts to your decisions and looking at this case in determining arbitrator and the commission made a rony is findings they relied on flawed testimony and evidence here the evidence came uni clear and i know it's hard to sit in the back of this room and listen