excuse me who experienced carpal tunnel syndrome beginning in april two thousand and four she started treating and losing time from work as a result of that about six months later she was fired for these reasons the treatment and losing time from work symptoms did not a base after her discharge the employer's doctor agreed that she needed surgery the employer paid for the related surgery to the hand and the resulting lost time post op if you will but the a complication from the surgery as the reason for her ongoing to supposedly and he ordered a surgical revision he also found physical restrictions that were permanent that she was on likely to be employed as a on a regular basis as a result of this condition at arbitration the arbitrator found no causal connection which must typo i don't know because he did a ward temporary told the civility benefits surrounding the surgery and the recovery there from and also seventeen and a half percent loss of use of the right hand but he denied the medical some of the medical bills which are no longer an issue and also denied her claim for prospective medical care the surgery the doctor mask had recommended he denied those things wrongly as the commission found they found causal connection and entitlement to that prospect of care of the surgical revision but they basically taking issue with the commission's permanency decision correct and their temporary surgery would provide her with claim with enough to leave to return to work and he said it had an eighty three percent success rate he said her condition would be required from a restriction is quote unquote if she did not receive further medical care of her condition so it wasn't his opinion condition down to further surgery i'm sorry wasn't his his his opinion that that she would cover her restrictions as qualified by the assumption that she received no further medical care including the surgery recommended he didn't say to permanently disable under all circumstances and he well that's what the commission focused on when they issued their decision  solely on his surgical recommendation ok well we we we fail to see the logic there and let me explain the surgical recommendation our medical care is based on thin need to cure or relieve the effects of an injury but could a condition does not exist only if it's operated on that's sort of where that logic takes you conditions require treatment and or lost time and competent disability benefits thereafter but it's to sort of isolate the significance of these restrictions to the apply those findings to the rest of the case doesn't stand to reason over all the other doctors he found that she had permanent and uses that work limited use of that hand she was only capable of one handed work and of course the only vocational rehab opinion  record found that this lady's going to wind up and have a permanent hole in the commission finds that she needs the surgery as well yeah he did but he also said that at that point in time her condition was permanent there was no more surgery then what happens then i guess this lady is permanent as of october two thousand and six and it is her prerogative whether or not to choose surgery after all having having already gone through one failed surgery is as should be you know be reasonable for her to choose not to have another one and there is no evidence of record that she has had another one her last treatment it was two years from the date of the accident and ok well what happens if she has the surgery and she gets better act provides for it once again as of october two thousand  dr mass finds these very significant restrictions and the ball rehab evidence comes in firming that she unfortunately is going to be an atlatl permanent toll if she goes ahead and have said has the surgery  and if you think about the consequences of the ad that would if that were the case that would only serve to force workers to choose between their medical care and their permanent disability  think that's what they act in te there's much discussion regarding the issue of temporary told disability interstate scaffolding and the cook county case that i cite make very clear that the law benefits she was not there and i believe it's the cook county case gets into this issue of choice there have to be a doctor's belt and the answer is not now if you if you look at the circumstances again of this case let's recall that she was fired and you can see where the layman is going to figure out ok i don't have a job i've been fired how am i going to get medical care i'm going to go to the emergency room it's not so easy to get medical care now that's where she was forced and i'd hate to see that this isn't like this stand where we would have these problems again where for years once an employee's fire finds that they're forced that test some other case for whatever they can get and not get the medical care that they need in the wind up on the dole i think that's why we have the act that we have to prevent that very thing the commission that use the term i believe those words at the arbitration hearing it was to make clear the air we trade or that the we we anticipated based on the evidence would either find that this woman was entitle to temporary disability benefits from throughout this this entire period there's nothing to indicate that she recovered from the effects of this injury  d also entitled to the prospect of medical care if she chose to have it and as you pointed out around her eighty five percent i believe what dr massey has said that those are pretty good  and here's the alternative or bind them and she's reached a permanent state which she would have if she ever had any more care after that initial surgery as well as the prospect of medical prospective mountable the surgery prescribed by their chosen doctor dr massey that surgery was awarded and while in the record today it does not reflect that she's had a surgery for counsel to imply that it has not taken place is not accurate and is not appropriate as far as i'm concerned she's not in my mind until she's recovered from this surgery we're premature to determine permanency at this point in time when the commission has awarded to the petitioner the future treatment that in all likelihood according to their own down it is going to make her better and this is going to get her to a point where she can return to regular work so so why determine permanency now the issue of maybe she's had the surgery or maybe she has or has not had it let's see when she's done with see what her result commission was not against the manifest which is the evidence the petition is a burden to show that she is on able to work in order to collect temporary total disbelief i'm feeling that burden has not been met and there was and certainly plenty of evidence to she started treating with the doctor in april two thousand and four for her carpal tunnel she does not see the perk of her doctor again until after she is terminated as far as carpal tunnel is concerned when she sees the doctor in april of zero four there is no prescription for physical therapy there is no work restrictions applied it off nothing for the petitioner to come in and say i was fired because i was missing appointments due to physical therapy i was missing work due to physical therapy that's totally not true if you look at the medical records there's no therapies prescribed there's no therapy attended until two weeks after she is no longer working for my client told within one thousandth of zero four and that's when she starts physically there so to say that she's unable to do her work and that's why she's terminated over she's missing time at work and that's why she's terminated because she's going to physical therapy that's not supporting the record at all those those medical records will show she didn't have any of that tree and that's just not she was terminated because she mapping equipment to a store for a job nobody in a coworker who step is issue was taken to school work or had a lawsuit pending against my client so i would suggest that there was some bias there so in terms of before the surgery it's not until february of zero five that the no restrictions nobody's put any restriction nobody said the skin is unable to work until she actually goes under the surgery by dr heller in june at which point he t d s paid t t s paid through august range of motion she has an excellent outcome according to dr heller discharge from care full duty ok we then go thirteen months before she sees a doctor for treatment for her carpal tunnel thirteen months and then that's about her mass that is the attorney chosen by if she really couldn't work during all that time the thirteen months after she's just charged with an actual result by dr howard where's the treatment where's the doctor saying that she can work there are no restrictions there's nothing saying that she can't work during that time and there's no there's certainly enough evidence for the commission to say you know what she's not entitle to t t t for this period either because medically look at that kind you look at the results she had in august of zero five commission had a good fictional basis to rule as they did and they certainly had a decision that was not against the manifest weight on these issues if you think you coun that this surgery needed revision that either it was an act fully performed or the adherents of the nerve preventing movement of her hand occurred after a while  i felt real good but then very shortly thereafter i didn't and it was similar the symptoms were similar but they were just they were still different that's perfectly what backor mass found and what the manifest itself immediately after the first surgery it wasn't explained until we paid for her to go to see dr massey the company was away for only and then bass we put it all together so hell you're referring to documented medical treatment and prescriptions absolutely correct but dr mass takes it all the way back and he finds the origin of the problem that he tag noses in two thousand and six requiring this new surgery ok to be with the failed surgery of june sixteenth two thousand and five so we would suggest that that's enough that that that connects it and there was some mention made of my suggesting that maybe she didn't have the surgery and maybe if i guess the theory would be there she did have the surgery then well maybe she's better now and now it's sad and and so the decision was premature is i think you provided provided for in the act not to be determinative convenience of employers this is the workers compensation so now an arm so the speculation about the surgery causal connection i think commission found that responded was not contesting it i think the brief leaves on page thirteen made that pretty clear also counsel argues that  it's totally not true that the tissue or lost time from work as a result of this injury not if you ask her supervisor mary miles to test this case testified how she got drummed