is it appropriate for the commission to then a word benefits to that claimant based soley on the contention that job activities can produce symptoms it is our contention that in setting forth the standard that causation is proved by a production of symptoms the commission straightforward the claimant is a forty nine year old custodian as in october october thirtieth two thousand and six you've been working with the district for five and a half months by her own testimony she has a variety of different job tasks including cleaning classrooms wiping blackboard vacuuming emptying wastebaskets cleaning dust and tables and mopping floors her testimony is that she had noticed numbness in her hands predominately in her right hand and that she sought medical treatment with dr konar on october thirtieth two thousand six he testified that she stopped working for the district in november the rocketry thought that her initial medical treatment was a couple of medical visits and six sessions of physical therapy she then has no treatment for six months during the six months she's not working for the district she tells her doctor when she goes back to her condition is much worse and there's evidence that she's been working for someone else doing activities in the meantime she's referring to dr welch dr welch doesn't jackson's in november two thousand and seven so at this point we're twelve months beyond what us work for the district ultimately is you know she and she has a carpal tunnel release now she's seen for section twelve exam with dr venter dr venter opined specifically better job activities are variable and not sufficiently forceful to have a causal link to development of carpal tunnel syndrome claimants council then solicits a narrative opinion from the treating physician dr welch and this is where the plot thickens because dr welch in his written opinion essentially agrees with dr venter in that he also says did not have sufficient force to have a causal relationship with carpal tunnel syndrome goes on to say that it can't beat not that it is but it can be that her symptoms could be aggravated by the activities but that the condition itself in that circumstance is not that a preexisting condition can be excel or it can be shown by acceleration aggravation or the production of symptoms there is no case law that is far as i know there is no standard under the actor has never been a standard the production of symptoms without a material worsening of the condition itself represents one of us has grown since from one tower on one of our our separate indistinguishable from this reason first of all insist probe you're dealing with a situation where you don't just pay out the production of symptoms which you haven't sent cicero is an underlying condition which was aggravated to the point where the doctor actually opined that you condition was because the main issue  not whether or not is a production of symptoms enough the main issue insists fro was whether it was the standard of whether or not it's the straw that broke the camel's back or they're in such a destabilized condition that anything would have causes condition there's a specific opinion from the treating physician insists that the is expressing has nothing to do with an aggravation of an injury i'm not saying it has nothing to do what would be the distinction and that is i believe that the production of symptoms can be instances eight factor that can be wa part she's got an underlying condition or can her her condition she suffers from now is cost at least in part by work activities you can say that he says she's got some symptoms that are produced while she's working but that the condition itself is not materially worse  right but i still would say that decision is counter to manifest weight that's how we set what the arbitrator in this case said he set forth the legal conclusion that aggravation acceleration or the production of symptoms constitutes compliance ability that's wrong that's not standard with out and finding that there's been an actual material causation of the condition of material worsening of the condition the production of symptoms in and of itself is not in the narrow line you saying that is a matter of law that's the case are you out his findings was but in any event even if he had made that determination and you want to put into a box richman it must wait to the extent that there's no opinion supporting man then you've got it a clear violation of the standard you ultimately because of the symptoms has triggered what he says is she has symptoms she's not internally worsened by the condition and then twelve months later after not working for the reason for twelve months after working other jobs in the interim she then has surgery that he would have said and the commission would adopt it and only consider it but from symptoms as a factor i think what i'm saying is have your arbitrator set in looking at aggravation will consider some of these things and or any of that this case is about one thing it's about manifest weight simply and i think we should initially start with the arbitrator's decision in this case we've heard of you heard a lot from council about production reduce it's about man's applied here the arbitrator's decision while it mentions the production of symptoms early on says towards the end this is true vito's carpal tunnel syndrome was not caused but aggravated by her work activities where the respondent it's very clear we start moving around words about production and what is the manifestation of symptoms and what's this the work aggravated her carpal tunnel syndrome is it's my opinion that the symptoms can be aggravated by her activities however the cause of the tunnel itself is not materially worsened merely made more symptomatic during such does activities as described above talking about the  he says the carpal tunnel self was merely made more symptomatic during such activities and described above when the arbitrator we have dr welch nobody's offering a new legal theory of production of symptoms we have dr vendor who in his evidence deposition suggests why didn't know she cleaned a chalkboards or whiteboards eighteen times a day i didn't know she wiped desks all throughout the classroom with her dominant hand the affected very little dispute here again when the word renders a preexisting asymptomatic condition symptomatic compensable injury has proven that's been proven here and proven in multiple levels we have a right hand dominic custodian asymptomatic there's talk about claim thirteen years prior she wasn't seeing a doctor for that in fact i want to talk about the reporting of the history too warning of the injuries she talked to her primary care physician on the first visit  i believe that's that's the the art i believe it is and that's something one of the arbitrator's decision but we get to the end words even more clear her carpal tunnel syndrome was not caused but aggravated by her work activities for the response so  a production out of that sentence it was aggravated production simply an opportunity for the respondent to bring this matter before this court to make arguments that there's a new standard that there is an expansion of the worker compensation act that this will open the floodgates of litigation all types of claims that haven't occurred before and it's simply not the case again welch supports the theory dr venter once he has more facts that he didn't have a doesn't agree but the commission made certain decisions regarding credibility at that point they believe dr wel believed the report provided to dr cohen or they believe the petitioner in this case in order for the decision to overturn it needs to be against the manifest weight there is substantial evidence in support of the commission's decision it is not against the manifest w spine when i get up here make this argument i'm standing before you for fifteen minutes it may very well cause a production of symptoms it may cause my back to her and maybe even be annoying enough that i finally decide i'm going to go seek medical treatment has this really started to drive me