the facts of much him only to the extent that i need to elaborate of an argument with respect to the first accident a specific trauma accepting fifty pound bags of salt i would like the court to t mcelhaney treated the condition with an epidural steroid injection and suggested that surgery was a surgical option in two thousand and six january two thousand and six and also that the other option was returned to work for the same responded that destruction his work activities were so modified and he continued to perform his work activities in the same manner in about the five the summer of two thousand there were a few treatments of future office visits with dr levy throughout the summer treatments were started putting medication some injections he was referred to a dr henry who was also a bit confused as to whether continuing contributing factor to his current condition and i believe dr moment testified to is such and i believe the petitioner's testimony supports this but there is no evidence of an intervening x and that's a ffirmative defense of the responsibility for years there isn't the concept of maximum medical proven stability is not synonymous with an intervening effect it is there is no legal precedent for the finding that a condition stabilizes through choice of patient care or trying to get treatment that ends the inquiry or as the condition for all future problems as you know the case law states that every condition that naturally restrictions or not and even if you say there were no work restrictions that is not what the fed the fact that this case turns up if he goes back to work in the course of daily activities or work activities the condition destabilizes or becomes commissioner specifically for me there are two issues i believe that but as i was saying originally that they found a manifestation date which i believe was inappropriate and i believe it was inappropriate because there was no evidence that you testified that there was no discussion between he and the doctor that these work activities were in fact destabilizing or contributing to the civilization of his lower back condition and has further corroborated by the fact that because that was always in his mind in the medical records he says the bible writers state as much that he attributes it back to that time when he went in and spoke with his doctor here the primary care she told you that the work activities could be aggravating since that's what the treatment notes say that is but you have to look at it in the context of the situation of the circumstances just i don't think if you have a person who's had specific accident knows that they were believed that they have a lumbar spine condition already it is necessarily has that be the we're wired legal knowledge to know that he's experiencing a repetitive trauma accident which must be reported he is still operating under the assumption that he had the previous work incident but he has the restrictions and that these were victims are merely causing sentence much as he testified he had symptoms thro course of his life that wax and wane so that doesn't end up in my opinion i don't think it should cause the commission to say ok here's your trap door now manifestation has occurred merely because dr lee said that after suddenly i go in the spring in april of two thousand and nine was referring back to the two thousand and five accident and clearly at that time the history was the petitioner was giving dr savio this is from  testimony demonstrates that it's not in the in the normal understanding of laypeople that repetitive work activities are necessarily causing a new accident in this context if perhaps there was no history of a lower back and that perhaps in those circumstances you can use that first treatment date that date when it appears as if the medical the victims are being discussed and the doctor is mentioning that these are aggravating symptoms that can be perhaps perhaps a date of manifestation date in the absence of any history but when you have in this situation in this context of an injured worker who has a known or at least his might be known lower back  using the date where the the testimony and the evidence is clear that the concept of a repetitive trauma accident the work activities and condition became apparent to him and it's not  is a strain doesn't cut off prosecution as well he testified that he would go to work at his work would be always at a single level during the first begin of the day that it would go up towards the end of the day so he always had symptoms he just chose not to treat them breast we would ask that the court reverse the commission remand the case for findings on additional temporary disability medical expenses and permanency find that the proper manifestation date anyway and i believe it's pretty clear that it worked as regular job duties for at least two and a half a year for you said he started having some problems in the summer of two thousand and eight was there any evidence of it in reporting to any doctors mother the medical facilities that you work two days might be causing this problem i don't think it's unreasonable for three tries the fact really to this point to reach the same conclusion that if you're having pride if you if you start having two thousand and eight when the gentlemen started treating the i believe it's clear that in there in case law that if you've reached a point where the it's no even when he saw dr mann in the spring of two thousand and nine in his intake form in his own head writing he says his symptoms started in in two thousand artist two thousand and eight and he was lifting doing having what heavy lifting so he knew what the problem was he always knew of the problems if this was an extension of the two thousand and five claim there would have been a day we would have been arguing about this from the from day one instead it was done