TITLE TO BE ADDED

, 2010

RE: MALDONADO, Alejandro

Reviewer: PitaDoctor: Dr. Braiker

“A two-inch stack of medical records was reviewed page-by-page. Among the documents reviewed, there was multiple itemized statements, review for determinations between carrier and providers, CMS-1500 forms with professional charges details, super bills, proof of services, and Workers’ Compensation Appeals Board notifications and application for adjudication of claim. I have reviewed the documents page-by-page. The rest of the documents were reviewed and summarized as follows.”

12/02/08, Doctor’s First Report of Occupational Injury or Illness, Satish Patel, M.D.

In addition to including the insurer’s, employer’s, and the patient’s information, Dr. Patel provided a date of injury that occurred on 12/01/08. His first examination took place on 12/02/08. The history stated that this claimant was cleaning a dumpster and when he moved it “he felt severe pain to his lower back. The patient took over-the-counter Motrin last night.” The claimant’s subjective complaints included low back pain with radiation to both thighs with increased pain in bending or seating. Objective complaints revealed tenderness to palpitation over the bilateral paralumbar L3-L5 area, mild midline tenderness over L4-L5. No CVA tenderness bilaterally. The ranges of motion indicated that flexion to shins with pain, side bending, and rotation 30 degrees bilaterally, extension 20-30 degrees. Dr. Patel provided a diagnosis of:1. Lumbar strain.2. Treatment rendered consisted on comprehensive exam, revealed past medical and social history, provision of a polar pack, back brace, and Motrin 800 mg. Mr. Maldonado was placed on modified work on 12/02/09 with restrictions of no pushing or pulling over 5 pounds. No repetitive bending. No lifting.

12/09/08, Physical Therapy Treatment Order, Dr. Patel.

Multiple prescriptions for physical therapy with request of three times per week frequency were found and reviewed. This treatment

orders indicated a diagnosis of lumbar strain, however on 12/09/08, a diagnosis of right elbow lateral epicondylitis was added. It was also indicated that this claimant remained with modified duty to also include no pushing or pulling and involving activities with the right arm. There is an indication that on 12/16/08 tennis elbow brace was dispensed in addition to Robaxin and Motrin 800 mg.

01/12/09, Progress Report (PR-2), Paz Eilat, M.D.

This progress report by Dr. Eilat described the claimant’s subjective complaints of pain persisting pain to the right elbow and back. On a pain scale (6-7/10) not improved significantly. During the examination there was tenderness to palpitation over the lateral epicondyle on the right. Diagnosis:1. Lumbar strain.2. Elbow epicondylitis lateral right.3. Thoracic strain.

Treatment and plan included a request for an orthopedic referral, the continued use of ice pack at home, medications, with request for more treatment. This claimant remained on modified duties with no pushing or pulling, no repetitive bending, no lifting over 10 pounds, and to wear the back brace. On an attachment to this progress report it was described that the objective findings for the examination also revealed tenderness to palpitation with pain involved during bending at the ranges of motion for the back. Orthopedic testing demonstrated on straight leg raising at 80 degrees “bilaterally with back/pain.”

01/16/09, Doctor’s First Report of Occupational Injury, Farshid Hekmat, M.D.

In this report, Dr. Hekmat indicated a history of the “the patient stated that on 12/01/08 at approximately 09:45 p.m. while working as a sidewalk maintenance worker for Kleen-Sweep Inc. he was pulling on a large garbage dumpster filled with waste in order to clean the way, to clean the sidewalk when he felt a sharp pulling pain on his neck and back.” The subjective complaints involved the neck, low back, legs, right elbow, right arm, and shoulder pain, further more there is subjective complaints of psyche and sexual dysfunction. This examination included objective findings mentioning only a painful restricted range of motion for the cervical spine, shoulder, and elbow. The diagnosis presented was:1. Cervical spine.2. Lumbar spine.

3. Right shoulder.4. Right elbow.

The treatment rendered included “chiropractic”, hot/cold packs, “mass”, ___16:12____, and “EMS.” Further treatment involved an MRI of the cervical spine, lumbar spine, right shoulder, and right elbow.

01/16/09, Med-Legal Initial Orthopedic Examination, Farshid Hekmat, M.D.

A job description for this claimant as a maintenance worker since April 2008 and working eight hours per day, five days a week and earning to $12 an hour was provided. There is also detailed description of the activities required for his regular job duties. The history of injury as related by the claimant indicated that he sustained an injury on 12/01/08 as he was pulling on a large garbage dumpster filled with waste in order to clear the way to clean the sidewalk. He felt a sharp pulling pain on his neck and back.

This claimant also stated that he continued performing his customary duties and reported the injury before going home. That night “he was unable to sleep properly due to the intense pain he was feeling on his head, neck, back, testicles, right elbow, and right arm.” The following day, he was sent to the company doctor who took x-rays, provided pain medications, and sent him back to work with restrictions. Because there was no light work available for him, he was provided with documents “to get Workers’ Compensation Benefits.” This claimant continued to receive physical therapy from the company doctor. He was feeling very depressed, anxious, tense, stress, frustrated, and worried about his condition. “He also was having trouble sleeping due to pain and mental anguish and was often awakening with flashback of his work.” He also felt dryness of his throat from the exposure of chemicals he used to clean the sidewalks with without being provided with proper protection. He was also suffering pain in his testicles and a loss of sexual interest. Therefore, he sought a legal council and referred to Dr. Hekmat for further evaluation. The chief complaints included “headaches, numbness, stiffness, blurred vision, and memory loss in his head/neck area, movements of the head and loud noises aggravate the pain. He also complained of back constant aching, throbbing, and pressure-like pain with numbness and soreness. The pain radiates to the legs. Tingling sensation and pain on the right elbow and arm, aching, cramping, pressure-like pain, and soreness in his groin and psychological complaints that included sleep deprivation,

loss of sexual interest, and sexual dysfunction. The past medical history was uneventful. A physical examination took place with objective findings at the cervical spine, right shoulder, right elbow, and lumbar spine. All these areas revealed tenderness and painful ranges of motion. Orthopedic testing for the right shoulder was positive Neer’s sign, Andrew’s sign, Hawkins sign. Straight leg raising and Fabere/Patrick Test was positive bilaterally. Diagnosis:1. Cervical sprain and strain with musculoligamentous stretch injury.2. Lumbar sprain and strain with musculoligamentous stretch injury with radiculopathy.3. Right shoulder impingement.4. Right elbow lateral epicondylitis.

A request for ACOEM compliant treatment request was made that included chiropractic, physical modalities, low stress conditioning, aerobic exercises, MRI scan, scans of the cervical spine, lumbar spine, right shoulder, and right elbow. Furthermore EMG/NCV studies of the lower extremities were requested, psychological consultation and a return for followup in four to six weeks. Mr. Maldonado was considered temporarily totally disabled until 02/16/09. Dr. Hekmat felt and believed that this claimant’s symptoms were “causally” related to the injury on 12/01/08.

01/16/09, Initial Report, Kohanim Chiropractic Inc., Renee Kohanim, DC.

This report indicated that the claimant Maldonado had sustained multiple injuries as he was injured on an industrial basis. “Despite conservative treatment measurements”, this claimant has continued pain. Diagnosis:1. Cervical spine sprain/strain.2. Lumbar spine sprain/strain.3. Left shoulder sprain/strain.4. Left elbow sprain/strain.

Dr. Kohanim conducted a computerized muscle testing and range of motion testing. This doctor stated that findings from this exam would determine the extent of function loss and assist in the development on modifications of the treatment and plan. The testing was conducted using J-Tech, T-Tracker, and ROM-a computerized range of motion measurement system utilizing dual inclinometers. The ratings indicated loss of range of motion for the cervical, lumbar, and upper extremity areas. Several tables and graphs were provided in these reports. There is an

indication that when compared to the opposite side on muscle testing there was a 15% strength difference generally recognized as an indication of a motor deficit for the neck/trunk and the extremity.

02/13/09, Progress Report, Farshid Hekmat, M.D.

Several progress reports (PR-2) were included in this medical records review, documenting subjective complaints for this claimant to his lower back and right elbow. The diagnosis remained unchanged as a lateral epicondylitis of the right elbow and rule out lumbar spine disc protrusion. The reports are handwritten, indicating treatment and recommendations in the form of shockwave for the right elbow. Additionally, chiropractic treatment, acupuncture, work conditioning/work hardening, and a referral to Dr. Bashamber Chabra was made. Dr. Hekmat recommended on lumbar spine MRI. On 03/20/09, the diagnosis was again updated to a lumbar spine strain and on 04/24/09 only all the subjective complaints are maintained for the lumbar spine and no diagnosis or objective findings are provided in the specific progress report. As for the work status the claimant remained off work until 05/24/09.

05/05/09, Treatment Notes, Boniface Onubah, M.D.

Treatment notes for ESWT low energy, shockwave, treatment with for the right elbow was provided. Three sessions were documented.

06/10/09, Progress Report, Marina Kuznetsova, L.A.C.

An improvement was noted for the subjective complaints of low back and right elbow pain. Recommendations to continue under acupuncture treatment were made. Two more progress reports were provided from Dr. Kuznetsova for acupuncture care, another one dated on 07/15/09 and a 08/19/09. No noticeable improvement was documented. The treatment regimen included electro-acupuncture infrared heat, and soft tissue manipulation.

08/25/09, Doctor’s First Report of Occupational Injury, Mark H. Michaels, Ph.D.

This report by Dr. Michaels indicates that the patient while working he was pulling on a large garbage dumpster filled with waste in order to clear the way to clean the sidewalk when he felt a sharp pulling pain on his neck and back. He went to the office to file a complaint and was sent to a doctor to next day.

The subjective complaints included that “the patient complained of depressed mood, anxiety, decreased sleep, tension, irritability, social detachment, decreased libido, worries, decreased concentration, and decreased (illegible). A diagnosis of MDD mild, anxiety, and insomnia with secondary depression and pain was provided. Recommendations included medical consultation/stress treatment for eight weeks and biofeedback for six weeks.

09/15/09, Initial Psychiatric Report, Metropolitan Health Medical Group, Barry Alan Smolev, M.D.

This report presented a chief complaint of referral for possible treatment with psychotropic medications. Diagnosis:1. Major depressive disorder, single episode, moderate, nonpsychotic. Problems with occupation, economics, and legal issues moderate, GAF of 65. Mr. Maldonado was provided with a prescription for Prozac for depression and trazodone for sleep.

09/22/09, Progress Reports, Mark Michaels, Ph.D.

Two progress reports were provided for review dated 09/22/09 and 10/20/09 where it is shown that his condition worsened after he run out of medications. After provided with medication he felt some improvement and advised to continue with his psychological and psychiatric treatment.

08/25/09, Initial Psychological Comprehensive Report, Metropolitan Health Medical Group, Mark H. Michaels, Ph.D.

A clinical history with interviewing data, job description, and responsibilities, history of injury and past medical history was provided in this report. Mr. Maldonado complained of pain in his back, elbow, and groin. He also reported emotional and psychological symptoms as the result of his work-related injury. He underwent psychological testing and given a diagnostic impression of:Axis I: Major depressive disorder, anxiety disorder, insomnia due to depression and pain.Axis II: Diagnosis deferred.Axis III: Physical disorders and conditions referred to the appropriate specialists.Axis IV: Severity of his psychosocial stressors included pain and physical limitations, financial problems, legal system involvement.Axis V: GAF 50.

Recommendations were provided to continue with a psychological treatment to include biofeedback as well as use of psychotropic medication.

09/21/09, Progress Reports, Metropolitan Health Medical Group, Kimberly Westfield:

Several progress reports documenting Psycho-Educational Group meetings were provided with review. These reports also included and intake a questionnaire sheet filled out by the patient. The last report provided for review is dated 11/16/09 where it is reported that some improvement have been reached.

10/02/09, Progress Reports, File Sheet, Hekmat, M.D.

A reevaluation with a surgical authorization request was conducted on the patient Alejandro Maldonado. Dr. Hekmat felt based on the physical examination conducted of the right elbow that this patient would benefit from right elbow surgery. In regards to the lumbar spine condition, Dr. Hekmat did not provide any further recommendations. Disability status remained as temporarily totally disabled until 11/02/09.

10/02/09, Progress Report, Renee Kohanim, DC.

This report indicated that there is medical necessity to obtain an additional computerized muscle testing and range of motion for the cervical spine, lumbar spine, and upper extremity. It was noted that with comparison with the previous testing that some improvement had been established. Slight improvement had been reached with comparison as well 13% of the whole person improvement for the period between 01/16/09 through 10/02/09.

11/02/09, Initial Urologic Consultation, Comprehensive Urology, Robert S. Sanford, M.D.

Mr. Maldonado complained about scrotal/testicular pain, erectile dysfunction, and low libido. A medical record review is noted. A physical examination was conducted. Initial diagnosis included an epididymo-orchitis bilateral, erectile dysfunction/low libido, and low back pain. Dr. Sanford felt that this diagnosis is directly related to his injury of 12/01/08. He provided this claimant with a trial of Levitra, instructed to intake NSAIDs for scrotal support and nightly warm baths for his testicular pain, as well as continued treatment until reaching a permanent and stationary status from a urological perspective.

12/01/09, Final Psychological Evaluation Report, Metropolitan Health Medical Group, Mark H. Michaels, Ph.D.

Recompilation of information obtained in the initial evaluation for this claimant done under the office’s of Dr. Michaels. Psychological testing results were provided and a diagnostic impression of:Axis I: Major depressive disorder, anxiety disorder, insomnia due to depression and pain.Axis II: Diagnosis deferred.Axis III: Psychological physical disorders and conditions diagnosed by the appropriate examining specialist.Axis IV: Severity of psychosocial stressors with pain and physical limitation, financial problems, legal system involvement.Axis V: With a global assessment of functioning (GAF) currently of 50.

The prognosis was considered as fair with an anticipated of recovery that will continue for another twelve months. He was considered to have reached a permanent and stationary status. A whole person impairment rating deemed to be WPI of 30, recommendations to continue with psychologist and/or psychiatrist evaluations for the following twelve months.

02/25/10, Followup Urological Report, Dr. Sanford.

Recommendations on this claimant for his erectile dysfunction and testicular pain including local measures to reduce his testicular discomfort by taking Levitra as needed for sexual activity. He was considered temporarily partially disabled and restricted to lifting no more than 10 pounds from a urological point of view. He was advised to return for a followup in three months.

02/23/10, Pain Management Report, Downtown, Los Angeles, Ambulatory Surgical Center Inc., Sanjiv Kumar Jain, M.D.

Preoperative diagnosis:1. Herniated lumbar disc.2. Lumbar radiculitis.3. Lumbar facet joint syndrome.

Postoperative diagnosis:1. Herniated lumbar disc.2. Lumbar radiculitis.3. Lumbar facet syndrome.

A percutaneous epidural decompression neuroplasty of the lumbosacral nerve roots with lumbar facet blocks was performed on Mr. Alejandro Maldonado. No complications were encountered.

03/02/10, Pain Management Procedure, Dr. Jain.

A second percutaneous epidural decompression, neuroplasty of the lumbosacral nerve roots with lumbar facet blocks was performed on this claimant. The preoperative and postoperative diagnosis remained the same as the initial one. No complications were encountered. The levels involved were the levels of decompression included the left L3 and L4 levels.

05/25/10, Progress Report, Dr. Jain, M.D.

This followup indicated that this claimant was status post epidural intervention with inadequate relief from the procedure performed. He was referred for an orthopedic consultation.

05/28/10, Progress Report, Dr. Hekmat, M.D.

The subjective complaints included a right elbow pain and lumbar spine pain. Objective findings revealed tenderness over the right elbow, lateral epicondyle, and lumbar spine tenderness over the facets (illegible). Diagnosis:1. Facet pain lumbar spine rule out disc involvement.2. Lateral epicondylitis, elbow.

Recommendations for an MRI of the lumbar spine and surgery to the right elbow were requested.

06/15/10, MRI of the Lumbar Spine.

Impression:1. Multilevel disc changes as described which involved a 2-3 mm annular tear/fissure of 2-3 mm at L4-L5 levels and a 3 mm at L5-S1. Additionally, it was found a compromise on traversing nerve roots on the bilaterally at levels L4-L5 and L5-S1.

End of medical record review for Alejandro Maldonado for the Dr. Braiker. Instructions for transcriber please after typing this medical record review have it forwarded to Pita for review and editing.

TITLE TO BE ADDED

, 2010

RE: RAMIREZ, Raquel

Reviewer: PitaDoctor: Dr. Braiker

A four and a half inch stack of medical records including a deposition were reviewed page-by-page and summarized as follows:

02/02/10, DWC 1 form.

The claimant Raquel Ramirez provided a date of injury of continuous trauma for the period of 06/04/08-06/09 with injuries described as a continuous and repeated physical trauma caused disabilities. Bilateral lower extremities another parts of her body. In these medical record reviews an additional claim form was provided dated 05/14/09 with the date of injury of 05/05/09 and injury described as “the applicant slipped and fell sustaining injuries.” The body parts affected including the left upper extremity, cervical spine, thoracic spine, sleeping difficulties, headaches, internal, psyche, and other parts of her body. In addition to the other claim forms a claim form written in Spanish was provided dated 05/05/09.

12/21/09, Deposition of Raquel Ramirez vs. Baxstra Inc.

Deposition Admonitions.

Pages 1 through pages 15, information pertaining to this claimant is provided. This claimant has been married twice. Her first marriage which ended in 1987 from Rumaldo Valenzuela had “a lot of problems.” She had domestic violence problems. Ms. Cruz provided additional information regarding her driver’s license, her children, and current address. She arrived in 1981 to the United States. Her last day of work was 06/06/09. She is currently receiving State Disability payment as given by her Dr. Capen. This claimant began working for Baxstra Inc. in 02/02. Prior to working for Baxstra, she worked for Patricia Edward as a seamstress for this furniture company. While working for Baxstra she had a period of a three months second job were she worked for Lilly Jack where she “quit in May 2003” doing woodcraft activities and sewing. She was only worked at this company for three months and she left because of the environment. Then she returned to work for Baxstra. She stated that she stopped working at Patricia Edward because there was no work and she was laid off. She denied sustaining any injuries for the other

employers. She also stated that in 2002 she worked sewing furniture for Jim’s Peter and prior were she work for around a year and prior to Jim’s Peter, she worked for Design by Image in 1995. She worked there for five years as a seamstress. She stated that she had been hospitalized twice in 2000 and 2006 at St. Mary in Long Beach for a female condition. She was also hospitalized at another hospital in Downey due to the same condition. She stated that she consulted with her primary doctor, Dr. Tahani Soliman through her private insurance Aetna after she fell on 05/05/09. She also sought the care that she received some pills for her left arm pain, but she did not buy them because the insurance told her not to go back to her doctor. This claimant clarified that she saw Dr. Soliman a month after her injury.

On pages 35 through pages 50, this claimant stated that currently she was treating with Dr. Capen, Dr. Curtis, and Dr. Concepcion Aguirre. Last time she saw Dr. Capen was a month prior to the deposition. She is taken pain pills and a rubbing creams for the pain. She stated she is taking codeine. Ms. Ramirez stated that previous to seeing Dr. Curtis she has sought psychological care through Dr. Eduardo Lopez-Navarro once. She found the doctor on the radio and wanted to get some help because she was feeling “kind of bad and I wanted counseling.” She paid for the consultation as she was having problems with her husband. This claimant stated that she currently was seeing Dr. Curtis because of depression, anxiety, fear, and fear of what her future maybe and sleeping difficulties. This claimant stated that the last time she was at her employer’s location her manager Javier Arce was not very cordial to her. She also stated that she has heard that anyone who gets hurt does not get their job back and this causes depression and anxiety on her. She also stated that things that caused her depression and anxiety or her pains in her neck, her upper back, and her left arm and elbow. This claimant started noticing a pain in her right arm and elbow on 01/05/09 as she has to pull materials and remove wrinkles. She is constantly pulling and pushing. First she felt pain and then her skin started burning over the right elbow area. She did not report the injury that day, but until the third months when she mentioned it to her manager because she could not take the pain anymore. She reported the injury on 03/09 to Javier Arce. Ms. Ramirez did not seek medical treatment immediately, but she would put over-the-counter pain creams on. After she reported the injury, she was sent to a clinic, given treatment and then went home. She returned to work the following day. On 05/05/09, she was entering quickly and “some papers flew from Javier’s work

station. I stepped on them and slipped.” After that she fell backwards.

On pages 51 through pages 66, right before the fall she continued experiencing symptoms in her right elbow with burning sensation. She was also having pain in her right foot at the heel area. Then she corrected herself and states that she had “a little bit of pain in her neck.” This was before the fall of 05/05/09. Previous to this accident she also had low back pain which it had being hurting for sometime. However, she did not report it because she thought it would, because the pain come and go for the past two years. She stated that the pain she had in her right heel in approximately in 2007 would increase after walking for more than 15 minutes. As a result she would have a limp and could not sleep correctly. She sought medical care from Dr. Soliman. Ms. Ramirez stated that she reported the neck pains to Javier a week before she fell, however, he told her that she was exaggerating that it was nothing. Ms. Ramirez noticed she had been experiencing low back pain for a little bit more than two years. At the same time she was having pains in her right heel. She did not report those pains to anybody except her regular doctor. Ms. Ramirez stated that no treatment was provided by Dr. Soliman as she was awaiting to be referred to a specialist, but she was never referred to anyone. The only treatment she received was creams and taking pain pills as prescribed by Dr. Soliman. She was taken Advil, but she did not receive any treatment from Dr. Soliman. Ms. Ramirez describes pain on her right arm and elbow. She stated her skin burns. Within the last 60 days she has been experiencing the same pain as well as in her right arm as well as her neck and her upper back. Her pains interfere with her activities of daily living. She described her pain in her lower back as sharp. She denied having any pain on her right arm prior 2009. She had some light pain before 2009 because she spent “so much time working with her head bent down.” She denied having these neck pains before March 2009. She stated that before 2007 she started hurting in her lower back. Prior to that period 2007 she did not experience lower back pains. Ms. Ramirez stated that she has some physical limitations with household chores due to her pains and that she gets help from her husband doing some of them. She denied ever being convicted of a crime, arrested, or being victimized. She stated she has eight children, however, she denied taking care of them. She would like to return to work for Baxstra. End of deposition.

Tahani Soliman, M.D.

This set of medical records provided information for a period between 05/01/97 through 07/15/09. Among the records included in this set it was noted progress notes, laboratory reports, referral request notes, cytopathology reports, certificates for return to work, authorization request, and radiology reports. This physician consulted with this complaint for multiple conditions that included gynecological conditions, urinary conditions, and gastrointestinal conditions, and respiratory conditions. Among the diagnosis given: Hypercholesterolemia, urinary tract infections, hypertriglyceridemia, depression, upper back-musculoskeletal (05/07/09); abdominal pains, rule out diabetes mellitus, gastritis, tonsillitis, left shoulder pain (07/12/08), left breast cyst, backaches (07/12/08), muscle spasms (01/20/08), postmenopausal syndrome, insomnia, anxiety reaction, bronchitis, foot pain (03/02/08), backaches (03/12/07), arthritis (11/13/07), muscle spasm (11/13/07), menometrorrhagia, tonsillitis, hypermenorrhea, headaches, dysmenorrhea, flatulence, sprain right foot (09/03/05), asthma, bronchitis, rule out fibroid, rule out ovary cyst, backache (06/27/08-07/03/02), nipple discharge, backache (01/05/01), muscle spasms (01/05/01-02/13/01), and hemorrhoids, backache (09/14/98, 01/25/99, 03/25/99)(06/15/98, 08/31/98), anxiety, backache, and muscle spasm (09/23/97 and 10/25/97). This claimant was provided with medication to stabilize or improve her conditions and included multiple types of antibiotics, medications such as Motrin, Tylenol, BuSpar, Pyridium, Keflex, nitrofurantoin, Pyridium, bacitracin, Triphasil, Prevacid, nitro therm, MetroGel, Phenergan, Voltaren, Tagamet, Ativan, naproxen, Zantac, Anaprox, Lopid, Zoloft, Macrobid, and Robaxin. Multiple studies, work performed on this claimant, however, were not orthopedically related as they were focused on gynecological conditions. Among those records also were found physical examinations, evaluation reports, and chemistry profiles.

03/02/09, Doctor’s First Report of Occupational Injury, Richard Oswald, DO.

History of injury was described as “dolor en el brazo poco aporo cada dia mas dolor.” These objective complaints indicated that this claimant was experiencing burning, moderate, intermittent pain on the right elbow. “I have pain in my arm. It started in January, I use a tool to push the leather for sewing and I have to use a lot of force with it. I worked for five years.” She had been working for this company (Baxstra Inc.) for seven years. Objective finding was positive for tenderness over the lateral epicondyle. Diagnosis:1. Lateral epicondylitis on the right.

Treatment was rendered in the form of examination, x-rays, prescribed with tramadol, diclofenac, omeprazole, Banalg. She was also provided with a Band-it Elbow Brace, thermophore, with the Banalg cream, and returned to work on modified duties with limited use of the right hand. No lifting, pushing, pulling with the right arm. She must wear the elbow support. Physical therapy was recommended three times a week for two weeks.

US HealthWorks Medical Group.

This set of medical records between the dates of 03/02/09 through 05/22/09 included progress reports, nurse notes, physical therapy chart notes, rehabilitation evaluations, daily therapy treatment notes, work status reports, and health history information regarding the claimant Raquel Ramirez who sustained an initial injury to her right elbow on 01/05/09. The diagnosis provided was:

1. Lateral epicondylitis on the right.

The claimant received treatment for her right upper extremity in the form of physical therapy, Lidoderm patches, and placed on modified duties by Dr. Richard Oswald, M.D. The progress reports noted that the patient recovered slower than anticipated and continued experiencing the symptoms for the right upper extremity. On 05/05/09, she was seen for a new condition that included the left lower extremity. There was tenderness on over the ankles, there was tenderness over the left thoracolumbar musculature down to the buttocks and left shoulder tenderness at the trapezius and deltoid areas. The patient reported to US HealthWorks stating that she had pain over her back, her left ankle and right shoulder due to a fall sustained on that same day. There is patient information filled up in Spanish and signed by the patient. The patient was advised to continue treating at this facility. The diagnosis provided was that of:1. Left shoulder.2. Left ankle.3. Lumbar spine.

No specified diagnosis was provided on the initial date of examination. She continued experiencing left elbow symptomatology. A diagnosis noted on a coverage report dated 05/05/09 was as follow:1. Contusion.2. Left shoulder.3. Lumbar spine strain.4. Left ankle.

05/05/09, Doctor’s First Report of Occupational Injury, Richard Oswald, DO.

Subjective complaints were expressed in Spanish “me cai de espalda al resbalarme con unos papeles.” The claimant complained of dull moderate intermittent pain.

12/07/05, Doctor’s First Report, Richard Oswald, DO.

The patient gave a history of some material flying on her right eye and on her cloths. She complains of right eye pain. There was a diagnosis of corneal abrasion.

06/25/09, Psychological Report, Thomas Curtis, M.D.

The claimant was evaluated by this psychiatrist who conducted an initial evaluation and requested authorization for psychiatric treatment for the injuries sustained on 05/05/09. Dr. Curtis stated that as the result of the persistent pain and disability, the claimant developed symptoms including depression, anxiety, irritability, and insomnia. He recommended that she undergo psychiatric care.

03/08/10, Progress Reports, Dr. Curtis.

Reference to the comprehensive report dated 02/16/10 was advised the diagnosis was that of a depressive disorder not otherwise specified with anxiety, psychological factors affecting medical condition.

02/16/10, Permanent and Stationary Psychiatric Report, Thomas Curtis, M.D.

A recapitulation of the initial comprehensive evaluation was provided in this report, an interim history providing treatment and condition up to date by this claimant. Psychological testing was performed and results were recorded in this report. The diagnosis provided was: Depressive disorder, not otherwise specified with anxiety, psychological factors affecting medical condition, and a global assessment of functioning (GAF) of 52 as the symptoms caused moderate difficulty in social and occupational functioning. Dr. Curtis provided that whole person impairment of 27. The mental and behavioral disorders impairment charts classified this patient on a class III moderate impairment on her activities of daily living, social functioning, concentration persistence and pace, and the adaptation. A 15% of

apportionment due to combinational factors was documented and future psychiatric treatments were recommended as they would benefit the claimant.

02/05/10, MRI of the Ankle, Pacific Hospital of Long Beach.

Impression:1. Negative MRI of the left ankle.

05/27/09, Doctor’s First Report, Daniel A. Capen, M.D.

The date of injury of 05/05/09 was indicated. The history of injury was illegible. Subjective complaints indicated cervical spine pain, including the neck, head, and the bilateral shoulder area described as sharp. Left shoulder pain with a throbbing sensation and always present to some degree. Mid-back pain. Left ankle pain being moderate, aching and throbbing with a burning sensation. Kidney problems. Feelings of anxiety and depression and sleep complaints. Objective findings were illegible. Diagnosis:1. Cervical spine sprain/strain.2. Left shoulder contusion and strain.3. Left ankle ligament strain.4. Depression, anxiety, and possible internal medicine stress disorder. Treatment rendered was described as MRI of the cervical spine, left shoulder, and left ankle. EMG/NCV of the upper extremity. Physical therapy and a referral with Dr. Curtis for psyche consultation. Dr. Leoni for internal medicine consultation. Stimulator and medications. This claimant was placed on light duty, sitting down, and no use of the left leg.

06/04/09, Progress Reports (PR-2), Andrew R. Jarminski, M.D.

This claimant presented herself to this physician’s office on schedule complaining of flare-up of the cervical spine and left scapula symptomatology “requesting help.” This physician performed two trigger point injections to the left cervical spine and levator scapulae muscle. She was placed on temporary total disability until 07/09/09.

06/22/09, Progress Reports (PR-2), Dr. Curtis.

The subjective complaints it is mentioned that found to be set by pain and disability, and “too withdrawn and insecure.” Diagnosis remained the same and the treatment plan continued as recommendations for psychotherapy, biofeedback, and psychotropic medications on an as needed basis.

07/17/09, Progress Report, Daniel Capen, M.D.

This progress report indicates that the patient had advised the physician that the claim’s examiner Dr. Nicky Rountree planned on removing her from his care. The patient disagrees with the decision and asked that Dr. Capen respond accordingly. Dr. Capen explained that the patient suffers from a chronic condition of the left ankle ligament, left shoulder contusion, and strain and cervical sprain/strain syndrome and depression and anxiety with possible internal medicine stress disorder requiring continuity of care by himself. He mentioned the treatment plan which included MRI scan of the cervical spine, left shoulder, left ankle; physical therapy; and referral to Dr. Thomas Curtis for psyche complaints and Dr. Sean Leoni for her internal medicine complaints.

07/09/09, Progress Report, Dr. Capen.

The subjective complaints remained the same with neck pain with radiation to the left arm, left shoulder pain, thoracic spine pain, low back pain, and left ankle pain.

The patient is being treated for with her family doctor for a kidney condition. Recommendations continued to obtain diagnostics and consultations.

08/12/09, Initial Report, Daniel A. Capen, M.D.

This is a comprehensive report for the claimant Rachel Ramirez which included the chief complaint of cervical spine pain to include the bilateral shoulder area, left upper extremity to include the left elbow, hand, thoracic spine, and left ankle, internal, psyche, and sleep. The history of injury, work history, past medical history, and social history was provided. The physical examination is noted with positive tenderness noted on the cervical spine left greater than right to the bilateral levator scapulae, left greater than right and on the midline of the lumbar spine. Orthopedic testing was positive under left for Spurling’s maneuver. Additionally, tenderness over the bilateral malleolus and anterior joint was noted. Diagnostic impression:1. Left ankle ligament strain.2. Left shoulder contusion and strain.3. Cervical sprain/strain syndrome.4. Depression and anxiety.5. Possible internal medicine stress disorder.

In his discussion, Dr. Capen stated that he was unable to comment on this claimant’s permanent disability and that he would do so on his permanent and stationary report. He provided recommendations for treatment.

10/01/09, Progress Report (PR-2).

Progress report on a PR-2 format were provided every or so 45 days recording continues symptomatology to the left shoulder, left ankle, low back, and neck. Treatment authorizations were requested. Medication was prescribed and it was noted that no improvement is recorded, but on the other hand there is increase of symptomatology developing radiation to the right leg after 12/29/09. On 01/21/10, it is stated that she was off work and that she does exercises. She developed headaches. She continued taking her medications without any changes in her status. She was scheduled to return to remain off work until 03/18/10 at her following appointment.

04/08/10, Orthopedic Reexamination, Allied Medical Group, Inc. Dr. Daniel Capen, M.D.

This reevaluation report mentions that the patient was last seen on 03/18/10 and that her condition was in need of her to remain temporarily totally disabled as well as her being provided with authorization to obtain further medical care in the form of consultations and continued treatment including physical therapy program. The diagnosis was updated to:1. Cervical disc herniation.2. Lumbar sprain/strain syndrome with minimal L4-L5 disc protrusion.3. Mild left shoulder tendinosis.4. Ankle pain, etiology uncertain.5. Anxiety and depression.

It was noted that a diagnostic scan result was reviewed with an impression of 1-mm L4-L5 disc protrusion. “She has minimal left shoulder tendinosis. She has abnormal abdominal ultrasound. She has a significant C5-C6 protrusion and to a larger extent C6-C7 protrusion. This is rather permanent and probably represents the source of most of the problems.” The MRI of the ankle was “totally normal.”

04/19/10, Allied Medical Group, Inc., Daniel A. Capen, M.D.

Supplemental reports dated 04/19/10, 04/20/10, 06/01/10, 06/29/10, and 07/12/10 were included in this medical record

review for Rachel Ramirez and content of this supplemental reports indicted the status of this claimant while under the care of Dr. Capen as well as providing review of medical records from the secondary treating physician’s Dr. Curtis. After assessment of this claimant’s subjective complaint, continued care was requested. Review of medical records is noted. Under supplemental report dated 06/29/10, Dr. Capen indicated that the claimant had informed him that she was suffering from gastrointestinal disturbance and upset stomach due to medications. Dr. Capen felt that she should have been referred to an internist for evaluation and referred her to Dr. Mashour to evaluate this condition.

04/29/09, Atlantic Chiropractic Center, Dr. Ramon Mendoza.

This claimant sought care from Dr. Ramon Mendoza for the period that included 04/29/09 through 05/11/09. On four occasions this claimant received chiropractic care and physiotherapy treatment for a cervical and lumbar sprain/strain condition in addition to cephalgia. Dr. Mendoza indicates as well complications of kidney inflammations. End of medical record review of Rachel Ramirez.

10/29/09, Computerized Spinal Range Of Motion Exam, Paul Daily, DC.

This dual inclinometer examination indicated a 6% right deficit deposition II when compared with the opposite hand, with less than 15% considered within normal limits.

12/14/09, Computerized ROM and Muscle Testing Analysis, Essential Diagnostics, Paul Daily, DC.

The result of this computerized evaluation of the right upper extremity indicated a 24% left deficit deposition II when compared with opposite hand with less than 15% considered within normal limits. On pinch test the deficit was a decreased 22% for the right.

03/18/10, Analysis of Computerized ROM and Muscle Testing Data.

On grip test there was a 46% left deficit deposition II when compared with the positive hand, with less than 15% considered within normal limits.

End of medical record review for Rachel Ramirez.

TITLE TO BE ADDED

, 2010

RE: ZAMBRANO, Aura

Reviewer: PitaDoctor: Dr. Braiker

“A four and a half inch stack of medical records was reviewed page-by-page. Two depositions were included with these records and the summary is as follows:”

US HealthWorks.

The records provided from this facility dated 01/31/05-09/01/05 provided a diagnosis:1. Strain of elbow.2. Right lateral epicondylitis.

As part of the treatment provided for this injury, the claimant received an elbow sleeve, a prescription for Motrin and a kalpak. Further down the treatment protocol, the claimant was provided with an elastic brace, an elbow support, and a wrist brace. He was advised to take Aleve for his pain. The claimant received physical therapy at the same facility. There is a period of temporary total disability between 01/31/05 to 09/01/05. Referrals were made for this claimant to have an orthopedic evaluation by Dr. Zoppi. He was returned to work without restrictions as of a report dated 09/01/05.

Progress Report (PR-2), Anthony Zoppi, M.D.

Several progress reports between the periods of 06/07/05 to 10/04/05 were reviewed in which this claimant was seen for a right lateral epicondylitis condition. It was noted that there was some improvement reached by 10/04/05. Dr. Zoppi made recommendations for this patient to continue taking Naprosyn and advised to return to work with no limitations. The claimant’s condition improved but it was slower than anticipated and a report dated 03/07/06 is included when this claimant’s condition is improved as expected and declared permanent and stationary with future medical care. There is no indication in this report about the details about the future medical care.

06/07/05, Initial Orthopedic Consultation, Anthony Zoppi, M.D.

The claimant Aura Zambrano was evaluated due to a complaint of right elbow pain. History of the medical treatment provided reports contained that she had been treating as US HealthWorks by Dr. Batch for an elbow strain and epicondylitis condition. She was treated with an elbow brace and ibuprofen. On her return to work, she had increase pain at the elbow, being referred for that status for an orthopedic evaluation. A physical examination is noted where there was tenderness at the lateral aspect and at the epicondyle areas with increased persisted wrist extension. The ranges of motion were within normal limits. Diagnosis:1. Right lateral epicondylitis.

Dr. Zoppi made recommendations for this patient to have an elbow injection with Kenalog and Marcaine. She was also advised to continue to use the counter brace support, ice, and stretching. She was given ibuprofen for pain from the injection. She continued working at her usual and customary work activities with the elbow counter brace support.

07/19/05, Discharge Note, Dr. Zoppi.

Ms. Zambrano was discharged on an improved condition and declared permanent and stationary. She was released with no work restrictions and future medical care; however, this was not provided in detail.

01/29/05, Progress Report, Dr. Zoppi .

The claimant returned to see Dr. Zoppi due to an exacerbation of pain in her right elbow. The examination revealed within normal ranges of motion, no swelling or deformity, but tenderness at the lateral elbow, lateral epicondyle that was increased which resisted wrist extension. The assessment was that of exacerbation of the right lateral epicondylitis. Recommendations for reopening the case were provided as well as being treated with her Naprosyn and a brace. She was returned to work with no restrictions.

03/07/06, Permanent and Stationary Evaluation, Anthony Zoppi, M.D.

Ms. Zambrano was declared permanent and stationary as of 03/07/06. A physical examination stated that minimal tenderness was found on the lateral elbow and epicondyle. Dr. Zoppi’s opinion was that this claimant had 0% improvement rating. He also felt that she could return to work at her usual and

customary capacity and as part of her future medical care. He stated that the patient might be in need of an orthopedic reevaluation, oral anti-inflammatory medication, brace, and a need of injection should she have a recurrent pain.

10/20/08, Operative Report, Beach District Surgery Center, Julian E. Girod, M.D.

Preoperative diagnosis:1. Right shoulder impingement syndrome with biceps tendonitis.

Postoperative diagnosis:1. Right shoulder fraying of the supraspinatus leading edge intra-articular, not full-thickness tear with impingement, bursitis.

Procedures performed:

Diagnostic arthroscopy, debridement of partial rotator cuff tear, intra-articular, bursectomy, subacromial decompression, and resection of the coracoacromial ligament.

A description of the procedure is noted. No complications are recorded.

Progress Report Coping (PR-2), Alexander T. Latteri, M.D.

Five progress reports were provided for review between the period of 04/17/09 and 10/07/09 for the claimant Aura Zambrano. The treatment provided under Dr. Latteri’s direction was as part of this claimant’s future medical care. The claimant continued complaining of right shoulder pain with a status post surgery. She also complained of neck symptomatology dermatology, sleeping disturbances, hypertension, and depression. Dr. Latteri requested that this patient be provided with continued physical therapy, psychological consultations, internal medicine care, which apparently had been denied. On 11/18/09, Dr. Latteri felt that this patient had a need of a new MRI of the right shoulder. The diagnosis provided and without change since his first examination included the following:1. Chronic bilateral shoulder sprain/bursitis/tendinitis.2. Chronic cervical sprain/strain.3. Radiculopathy, upper extremity.4. Anxiety; depression with sleep disturbance.

It is noted in this progress report as well that Dr. Latteri provided medication to this claimant. He also recommended that

she be provided with Thera-Band; although no specific description of the thoracic medical equipment is provided. Apparently, this claimant was demonstrated home exercises and on 11/18/09 Dr. Latteri felt that she would benefit from manipulation under anesthesia in addition to the other recommendations. He also found that she would benefit from an internal medicine consultation. On the report dated 04/07/10 apparently she had already been going under psychological care as it had been very helpful. There it was an authorization request for right shoulder surgery and is noted that this claimant was encouraged to “see weight at home.” She remained temporarily totally disabled; and a note for a last day of work of 10/10/08 is provided.

Doctor’s First Report Of Occupational Injury or Illness, Alexander T. Latteri, M.D.

This is an undated report of Ms. Zambrano when examined by this physician. No date is provided on the first examination or treatment. However, information regarding how the accident happened is provided indicating that she had worked for Servicon Systems since 2002 and due to repetitive work activities she gradually noted pain to her right elbow. On 01/23/08, she injured her right shoulder while cleaning an elevator. A subjective complaint included marked pain in the shoulder, “weakness, numbness, limited motion of the right upper extremity, pain on the left shoulder, depression, bursitis, and difficulty sleeping due to shoulder symptoms.” No objective findings are provided for diagnoses except for a note “report to follow.” Her work status is not clear probably indicating a 09/18/09 is provided in this report.

03/31/08, Initial Orthopedic Consultation, US HealthWorks Medical Group, Julian E. Girod, M.D.

A history of present injury indicated that this female injured her right shoulder while she was cleaning an elevator at work. The physical examination revealed that she had limited forward elevation to 150 degrees actively, A causative impingement sign with a positive Hawkins and a negative Neer. She had apprehension to Jove’s Testing, but strength was noted. She had full range of motion for the elbow, wrist, and hand. O’Brien’s Test was negative. No bicep tendons of tenderness. X-rays were obtained with an impression of “failed to reveal evidence of fracture. There is no certification.” A diagnosis was provided:1. Right shoulder impingement.

Recommendations were made for her to have a cortisone injection. This claimant received a mixture of 4 cc of lidocaine and 1 cc of DepoMedrol to the subacromial space. She was also given naproxen. Recommendations for an MRI of left shoulder to rule out other symptomology were mentioned. She was recommended to stay off work for three days due to first injection pain. A review of medical records is noted.

05/15/08, MRI of the Right Shoulder.

Impression:1. MRI findings are consistently biceps tenosinovitis.

06/09/08, Progress Report, Dr. Girod.

The patient was reevaluated and complaining of right shoulder pain. The assessment remained unchanged. Dr. Girod recommended physical therapy as well as to be evaluated by an endocrinologist. Subjective complaints are blood pressure and low sugar.

06/30/08, Permanent and Stationary Consultation, Julian Girod, M.D.

A history of injury indicated that she had been diagnosed with impingement syndrome. She received an injection with benefit; however, she has side effects from the medication including weight gain. Overall, improvements were noticed and she was released to regular activities. The examination revealed that she had full range of motion. She had preserved the strength to Jove’s Testing. Diagnosis:1. Right shoulder impingement syndrome, improved.2. Biceps tenosinovitis.

Future medical care was advised in the form of axis II orthopedic consultation, medications, injections, and subacromial decompression. She was found to be able to resume her usual and customary activities.

08/25/08, Progress Report, Dr. Girod.

A reevaluation was conducted for this claimant. She noticed in accordance of her symptoms and therefore she was referred for an orthopedic evaluation. The physical examination revealed Neer and Hawkins test positive. Tenderness was found over the bicep tendon below. Speed’s test was positive. The assessment was that of:

1. Right shoulder, biceps tendinitis with impingement syndrome, recurrent.

The patient was orienting on surgical versus continuation of a physical therapy program. She was advised to continuing to home exercise program prior to recommending surgery. She was providing with Banalg cream. Her work status remained without restrictions and a followup was advised in four weeks.

09/22/08, Progress Report, Dr. Girod.

The results of the MRI are reviewed, which “failed to review evidence of rotator cuff tear, but revealed evidence of biceps tenosinovitis.” The examination had the same results as of previous one with the exception that she had crepitance to circumduction of the one. Tenderness is around over the biceps. The assessment was obtained:1. Right shoulder chronic, impingement with biceps tenosynovitis.

Dr. Girod’s plan included a more aggressive treatment which included a recommendation of arthroscopic exploration of the cuff, a subacromial decompression and/or ___36:37____. She was allowed to return to her regular activities with ___37:04____.

10/29/08, Progress Report, Dr. Girod.

Ms. Zambrano was reevaluated for status post right shoulder subacromial decompression. She was given a prescription for physical therapy and ____37:35___. The assessment was that of a status post subacromial decompression. She was considered to temporarily totally disabled until next appointment in two weeks.

11/12/08, Progress Report, Dr. Girod, M.D.

A reevaluation revealed that even though she was status post surgery with recommendation of physical therapy. A physical therapy was not authorized. Dr. Girod expressed his concern about the post surgical status on this patient requiring therapy in order to avoid stiffness in her shoulder. The patient remained off work until her next appointment.

12/03/08, Progress Report, Dr. Girod.

Physical therapy was then confirmed. The claimant stated that she had ongoing pain. A physical examination review if there was no infection, she had full range of motion of the elbow, wrist,

and hand. There was no distal neurovascular deficit. The assessment was that of:1. Status post right shoulder rotator cuff debridement, with subacromial decompression.

The patient was oriented on a physical examination finding and advised to continue physical therapy twice a week for four weeks. She was provided with a prescription of Ativan, and advised to remain off work until her next appointment.

02/11/09, Progress Report, Dr. Girod.

No changes from the previous report. She was advised to return in four weeks.

03/11/09, Progress Report, Dr. Girod.

The claimant noted the significant improvement with physical therapy. The diagnosis was:1. Status post right shoulder subacromial decompression with debridement of partial tear with adhesive capsulitis, post surgical.

Recommendations remained unchanged with exception of her being progress to home exercise program. She was allowed to return to work with restrictions of no lifting greater than 10 pounds, and limited overhead work no more than six times per hour. A review of medical records is noted.

05/23/09, Permanent and Stationary Consultation, Dr. Girod.

Dr. Girod stated that this claimant returned to him for an orthopedic evaluation on this claimant’s right shoulder condition. He provided a history of treatment and also stated that the claimant described residual pain with overhead motion and stiffness. A physical examination revealed a well-healed surgical portal with no evidence of infection. Dr. Girod noted that the patient was apprehensive to forward elevation and resisted abduction. A diagnosis was:1. Status post right shoulder rotator cuff debridement with subacromial decompression and residual adhesive capsulitis pain.2. Right shoulder AOE/COE, stiffness of the shoulder.

Dr. Girod’s opinion was that this claimant had 3% whole person impairment with an additional 2% added due to significant pain and totally 5% whole person impairment. The future medical treatment included access for orthopedic consultation, physical

therapy, diagnostic studies, and injections. She was limited to overhead lifting, lifting above the shoulder, and no more than two hours of weight lifting no more 20 pounds.

01/31/05, Doctor’s First Report OF Occupational Injury or Illness, Louis Batch, M.D.

This claimant sustained an injury on 01/29/05 when she was lifting a bag of linen and hurt her right arm. The objective findings indicated that she had tenderness to palpation to the antecubital fossa, pain in her right forearm. A diagnosis was:1. Right elbow strain.

She had an x-ray of the right shoulder with no abnormalities found. The treatment included a tennis elbow support, Motrin, a tennis elbow support, and use of cold pack. Her work status included limitations for lifting up to 10 pounds maximum.

12/03/09, Doctor’s First Report, David R. KAUSS, Ph.D.

This is doctor’s first report indicated that this claimant has a physical injury with development of psychiatric symptoms. These objective complaints included anxiety, depression, sleep disorder, nightmares, irritability, anger, social withdrawal, tearfulness, low self-esteem, decrease libido, poor concentration, and forgetfulness. The diagnosis provided by Dr. Kauss included an adjustment disorder with mixed anxiety and depression, insomnia type sleep disorder due to pain, female hypoactive sexual desire disorder due to pain, and psychological factors affecting a medical condition. Recommendations included biofeedback and medication.

12/03/09, Extended Report of Consulting Physician in Psychology, David R. KAUSS, PH.D.

This report indicated that the exam was completed on 12/03/09. He provided a history of the present illness as described by the patient, and this claimant’s psychological status with psychological testing results. The diagnosis provided was that as stated in his doctor’s first report. A medical record review is noted.

12/10/09, Deposition of Aura Zambrano vs. Servicon System Inc, Gab Robins North America, Inc, Volume I.

This deposition containing 64 pages provided initially the usual deposition admonitions. On pages 8 to 17, the claimant stated

that she had not taken any medication prior the deposition. She provided her personal information regarding her current address, who she lives with, her husband’s name, and the ages of her children. She stated that she also provided information regarding her city of birth and about her moving to the United States in 1984. She confirmed having possession of a California drivers license. She denied ever being arrested, filing for bankruptcy, serve the military, or smoking cigarettes. She confirmed that she is taking a medication for pain, medication for sleep and medication for inflammation; although, she did not remember that names. The medication for pain was prescribed by Dr. Latteri. She stated she continued having inflammation in her right shoulder and therefore she had to take some medication and rubbing on some ointment. She stated that she had been involved in a previous automobile accident as a passenger many years ago and that she could not remember anything. The claimant stated that she did not recall many of the details about her motor vehicular accident with the exception that she got $300 for the vehicle damage. She confirmed having a Workers’ Compensation Claim filed 20 years prior the deposition while working for Evis Hotel in Carson around 1989 or 1990. She stated that she sustained injuries to her lower back. The claimant described that she slipped washing a bathroom. She received pills and therapy, and received a settlement for her case. She did not recall any further details in regards to that. On pages 18 through 30, Ms. Zambrano stated that she did not have surgery for her work-related injury occurred in around 1989 or 1990. She stated that she sustained an injury to her right elbow in 2005. At that time she was working in the operation room with the linen bag. When she was going to get it out, “get it out of the cane, something stretched or pulled, I felt.” She indicated she felt pain in her right elbow. She received treatment with the company doctors, in the form of medication, pills, and two cortisone injections. She returned to regular work duties and continued having “problems” with her right elbow. She continued experiencing pain and weakness. Ms. Zambrano stated that that the pain or weakening her elbow affected her with her work, but she tried to do it. She was “afraid to get more cortisone.” She was initially hired by the company Pedus in around 2003 and 2004 as a housekeeper. She was in charge of all the floors at the hospital. At that time she began working at Harbor Hospital. While performing her days as a housekeeper at Harbor Hospital, she had to clean the bathrooms, sweep, mop, clean the walls, clean the high areas, and making the bed. In average, she would work for example when she was in the ER she would do about 20 to 25 beds. If she had to work on another floor with bed she would do about 5 or 6. She had to sweep and mob on a daily basis. She

also stated as she used different type of products to clean the floors and use the bucket. The claimant stated that on a daily basis she will have to lift up to 25 pounds. She will have to also lift about 15 bags of linen on a daily basis. Ms. Zambrano clarify that she did not perform those duties for a long period contrary to working longer at the elevators and the public areas. When cleaning the elevators she had to do the walls, vacuuming, and cleaning the doors as well as mopping the floors. While cleaning the elevator, she had to clean up higher spaces and; although, not at first, she used a ladder or a stool. She performed these duties for three years. She clarify that she had to use a stick to clean the high walls in the elevators. Everyday she had to clean nine elevators and she had to perform all these duties by herself. On pages 30 to 50, the claimant stated that prior working for Pedus as a housekeeper, she worked at Younger Optics as a checking lenses. She left that job because she did not like working sitting down and before working for Younger Optics she worked for a company called DMS for almost 10 years as a housekeeper. While working for DMS, she used to work in different areas in different buildings in the Santa Ana and Torrance areas. She stopped working for DMS because she got tired of working and driving too much from place to place. She stated that she worked for Evis for five years. While working at Servicon, she sustained an injury to her right shoulder on 01/23/08. At that time, she was cleaning an elevator, her supervisor “told me to clean it all the way up and I am short. So he gave me a ladder and he told me to go all the way up. And I could not reach, even with the ladder. So I stretched out my arm as far as I could, and that is where I felt a pull somewhat.” At that time she was standing on the ladder and her supervisor’s name was Albino N. Gregorio. She stated that she did not report the injury right away because she thought she was tired and she continued taking ibuprofen. She stated that her gynecologist gave her the medication because she had terrible cramps. The first time that she reported the injury was on 02/07, but she was not sent to the doctor. Ms. Zambrano stated that even though she reported the injury and she was not sent to the doctor she continued working her regular job duties during those two weeks. Finally, she reported the injury to Martha, who told her that she would buy another ladder so she could reach. So until 02/20/08, she continued working her regular duties. On that same day, she told her supervisor that she was too sick that she could not take it and she was sent to US HealthWorks. The first time that she went to US HealthWorks was on 02/21/08. The doctors there examined her right shoulder. And then until she was released by Dr. Girod on 05/09. The claimant confirmed that she had undergone surgery on her right shoulder. However, she stated

that after the surgery she could not move her arm very well. She also stated that her neck hurts and her right arm has been limited in movement. She described having difficulty with for example putting on her bra, or getting dressed. She also stated that she had difficulty cleaning her house, she had to cook slowly, and she had to spend more time sitting or laying down. The activity that she is absolutely incapable of doing with her right shoulder is cleaning the walls, washing the walls in her bathroom, mopping, sweeping, vacuuming, or laundry. If the bags of grocery are too heavy she is unable to carry them. She also stated that she is unable to rise up her arm over her head. This claimant stated that she developed the neck pain mostly in her right side after her surgery. Ms. Zambrano stated that she was referred by her attorney to Dr. Latteri. Between the time that she was released by Dr. Girod and by the time that she saw Dr. Latteri, she did not seek any treatment. She stated that she told Dr. Girod that she was also having neck pain while receiving treatment for her right shoulder. She also told Dr. Girod that she was having pain in her left arm. She was compensating for her being unable to use her right arm. This claimant also indicated that she was having difficulty sleeping and began experiencing nervousness with the pain. She described her sleeping patterns and the difficulties that she is having to fall asleep. She also explained the difficulties that she was having with the medications to relieve her sleeping difficulties. She also stated that she had been diagnosed with hypertension. On pages 51 through 64, Ms. Zambrano stated that even though US HealthWorks took her blood pressure that she was not told “anything.” She stated that no doctor has told her that her high blood pressure or hypertensions were caused by her employment for Servicon Systems. She confirmed that the back in October 2007 she was also having issues with her high blood pressure, her neck hurting, and feeling very nervous. Ms. Zambrano stated that her gynecologist told her around 2009 or 2008 that she had high blood pressure. Ms. Zambrano also confirmed that as part of her cumulative trauma and her specific injury of 01/23/08 she filed a psychological claim. She stated that she was having some crying, nervous, and family/relationship problems. She stated that she is having problems with her husband. Her father had already passed away, and her mother lives a few minutes away from her home which whom she has a very good relationship. She stated that the last time that she saw Dr. Latteri was the day before the deposition. And Dr. Latteri had reviewed the results of her MRI suggesting that she should do another operation.

04/29/10, Volume II of Aura Zambrano vs Servicon Systems.

Pages 69 through 90, depositions admonitions, Ms. Zambrano confirmed that she was taking medications as prescribed by Dr. Latteri and Dr. Levy. She stated that her condition was “a little less.” She stated she has been attending to a woman’s clinic called Clinica La Mujer.

She sought medical care at Long Beach Memorial Hospital for some condition as she was unable to having symptoms “because she could not go to the bathroom often.” She also sought care at the Santa Maria Hospital in Long Beach, many years ago. She also sought care at Harbor Memorial in Torrance around 2006 or 2007 because she was having breathing problems. Pages 82 to 119, Ms. Zambrano stated that she went around 2009 to Long Beach Hospital because she was having gain weight problems and she thought she has had problems with her thyroid or diabetes. The claimant denied ever being diagnosed with a chronic condition. She also denied having a family history of diabetes, thyroid, cancer, and high blood pressure. She stated her father died of cirrhosis and that she has always had a good relationship with her father and mother. She denied being emotionally, sexually, or physically abused by her parents. She described the relationship that her parents had and the recurrent relationship of her mother. The applicant stated that even though she lives with her husband she has an extramarital affair with a man by the name of Cosmo Moreno. Her husband is suffering of an illness; although, she is unsure of what. She stated that she told about her extramarital relationship to Dr. Lopez, but she did not recall telling anybody else about that. This claimant stated that she has an arrangement with her husband as to she can have a relationship with someone else. She confirmed that her husband had extramarital relationships in several occasions. However, she continued living with him because of her children. Mr. Moreno is an alcoholic and he has been arrested. This claimant stated that she is helped financially at times by her siblings and she is also financially so poor and some issues by Mr. Moreno. She continues experiencing her loss which whom she told Dr. Kauss and Jenny, the psychologist at Dr. Kauss’ office. Ms. Zambrano stated that in two occasions while she was driving she had a nervous breakdown, started having panic attacks, and felt like she was going to suffocate when she would driving. Ms. Zambrano stated that she continues to see Jenny Castro, the Psychologist because of her sleeping problems and her crying back and her being so nervous. Ms. Zambrano also mentioned that she continued losing her hair and that she did not have those issues before her employment at Pedus.

02/20/08-05/27/09, US HealthWorks.

This set of document included the patient intake information, progress reports, daily therapy treatment notes, nurse notes, and in house PT/OT/chiropractic treatment notes. Furthermore, there were several work status reports notes, request for authorization for surgery, physical therapy daily notes, rotator cuff exercise charts, and work status reports. The diagnosis provided was that of:1. Right shoulder strain.2. Right shoulder biceps tenosinovitis.3. Right shoulder impingement syndrome.

On 05/27/09, it was recorded an improvement as expected and she was returned to work with limited over her work for two hours a day and limited lifting, pulling, and pushing up to 20 pounds. She was discharged at that time.

TITLE TO BE ADDED

_______, 2010

RE: LEXION, Jerry

Reviewer: PitaDoctor: Dr. Braiker

“A four and a half inch stack of medical records was reviewed page-by-page. A deposition was provided as well, which was reviewed in its entirety. The documents are summarized as follows:”

04/13/10, Deposition of Jerry Raynard Lexion VS City of Santa Monica.

This deposition was contained in 55 pages.

Pages 1 to 25: the deposition admonitions, Mr. Jerry Lexion confirmed that he had a deposition taken in the past. He had not been taking any medication prior the deposition with the exception of herbal compound cat’s claw. He explained that it is for immune system and arthritis. When asked who prescribed it to him, he stated that Dr. Oz on TV. He also stated that he was prescribed Naprosyn and ibuprofen; however, he did not take it on a regular basis, but more on an as needed. Dr. Sobol prescribed him Naprosyn, and Kaiser prescribed him ibuprofen. Mr. Lexion

provided his personal information that included his complete name, his date of birth, current address, and marital status. He has no children, he has no siblings, and he has no parents. He continued that he was currently employed by Santa Monica working on modified duties. He was hired by the City of Santa Monica on 07/25/01. Prior to working for the City of Santa Monica, he worked for Jackson Limousine and prior to that he worked for Entertainment Coaches of America. While working for Jackson Limousine as a driver, he worked on a full-time basis for a period of five years. He left because there was no insurance benefit and he got married. At that same time while working for Jackson Limousine, he was working for Entertainment Coaches of America, a tour company. Mr. Lexion clarified that both companies were merged together. One was a Limousine Service and the other one was a celebrity tour bus; however, he received two separate checks. Prior working for Jackson Limousine and Coaches of America, he worked for Hertz as a driver. His duties were to drive cars back and forth from the airport in Los Angeles to Hertz terminal. He worked 40 hours a week and at some point he has worked with Hertz overlapped Jackson Limousine. He left Hertz employment because he needed a more relaxed type of job. He denied sustaining any injuries while working for Hertz. Prior working for Hertz, he worked for Coach USA as a bus driver. This company was City Charters, group site seeing to Long Beach, driving people back and forth from their hotel to sites. He worked for the Coach USA for about a year; however, it was in that consistent year. He may had worked six months, then stopped, and then went back for another three months. The period he worked for Coach USA was in the 1990s, but he did not remember the exact date. He denied having any industrial injuries or health problems while working for Coach USA. His previous employment before Coach USA was when he first got his commercial license when he worked for Ryder Ate, subcontractor for MTA. He worked full-time there for may be a year or a year and a half on assigned routes and schedules. He sustained an injury while working for Ryder Ate to his shoulder and back when the brakes went out on his bus. “The brakes failed on a bus.” He filed a Workers’ Compensation Case and settle; although, he did not remember any details about such injury. Prior working for Ryder Ate, he worked for American Building Maintenance and prior to, he worked for Bradford Building Maintenance. While working for American Building Maintenance, he had a back injury; however, he did not remember anything in regards to that injury. Mr. Lexion was hired for the City of Santa Monica as a motor coach operator on 07/23/01 on a full-time basis. At the time of the deposition, Mr. Lexion stated that he was working on a salary basis and that he was receiving the same salary; although, he was working less

hours. He was making $24.73 “or above that.” Prior he used to work 40 hours plus any available overtime. Mr. Lexion explained that as a motor coach operator, he drives a bus known as the Big Blue Bus “generally from approximately 6 in the morning to 4 or 5 in the evening.” He is sent doing modified duties. He stated that “usually he would sign in at 06:00 a.m. and by 10:00 a.m. he would have a break and that split is usually one or two hours, which involves a rest period, either rest or lunch or whatever you chose to do.” Then he goes back to finish the balance of his day. The claimant stated that that there are four different types of bus, the MCI, NABI, and a new flyer, so “three different style of buses. The sitting is different in each one. There are some that are favorites and some that are least favorites.” Then there also are smaller buses depending on the route, but everything is according to what you bid. Mr. Lexion explained the type of operator’s seat that these buses have. Some of them are LNG, CNG, and some are diesel. This claimant concurred that the steering wheel could be adjusted by height and angle, they could be power steered, and the seat could either be raised or lowered. They also have power breaks. “They are basically in the same location, but the usability is different. Some will be a little easier to operate than others based on the actual position of the pedal. They are in the general area.” The claimant has to take notes at the end of the day and needs to examine the vehicle before taking it out of the lot. He is not required to do any maintenance work on them. He denied having any materials printed out in the bus. Mr. Lexion was placed on modified duties on October 2009. He denied having any breaking employment due to termination and around April 2002 he had an extensive medical leave due to an industrial injury. He denied having any other employment difficulties. He confirmed having some forms of self-employment as a freelance photographer. Periodically, he stated he do some “head shots.” However, he considered that probably a hobby more than anything else. He denied having any disciplinary problems with his employer, any motor vehicles, any other accidents, grievances, or any other situation with his union. He stated that he was off from work for around nine months in 2002 because he had any industrial injury involving his knees. Mr. Lexion stated that he had surgery performed by Dr. Sobol, and a Workers’ Compensation Claim was filed. He remembered going to stipulated award with a negotiation and agreement about his level of disability, paid out overtime, and future medical treatment to his knees. The award was issued in 02/04. Between the time that he got the award in 02/04 to date, Mr. Lexion had the opportunity of using part of his future medical treatment and went to see doctors regarding those injuries. The first doctor that he went to was in October

2009. Mr. Lexion stated that he may have going to Kaiser in Marina Del Rey. Mr. Lexion stated that if he had any treatment done to his knees, he probably would have gone through these facilities. He did not seek for any medical treatment until about October 2009. Mr. Lexion stated that in order to deal with his pain, he had to use ice treatment and elevation. _____21:54__ daily on a daily basis and not until recently he lost time from work because of his knee pain. When he went to see the city doctor, he took him off from work. “The original--the original place I went to was Kaiser for my knees when they swell up, and then when Kaiser finished doing their evaluation, they came to the conclusion that this is an old injury, and then I went to the city and said this is a report from Kaiser, that this is the old injury to the knee, and that was when I went to see the city doctor.” So his condition just got unmanageable around September 2009. His modified duties include “I actually work in the stockroom for the parts department, and I enter information, basically logging in fuel, intake of the vehicles. I distribute parts to the mechanics when they need the parts. So basically I am sitting at a part window at counter.” The claimant is off his feet and at moments “they have their moments, there are times that I do get up, I just do not sit. There are times I get up and go retrieve parts.” When he went to Kaiser, the knees were swollen, the right worse than the left as well as the left ankle becoming a problem. The city doctor drained the fluid from the knee and gave him an ace bandage and referred him back to Dr. Sobol. As far as therapy, they have drained the knee a few times, and he was provided with braces for both knees, the right knee, primarily the braces on everyday, but there are occasions where he has to wear both of them. Exercises have been also been provided to Mr. Lexion for his knees and ankles. Besides getting his knee braces, he also got heel cups. The claimant stated that he has adopted his behavior, “so I do not knew things that are going to cause him to be more unconformable”, for example he has to adapt himself to move to avoid the pain as it effects his activities of daily living for example intercourse, carrying capacity, grocery shopping, washing clothes, or weight bearing. By weight bearing, he meant in the way that he stands as it becomes uncomfortable. He may start leaning against something. Walking on the level ground these are not too bad; however, climbing stairs is different, going downstairs is a whole different adventure. Sitting and then raising up give him a problem depending on how low the seat is. The ankle is “if I am walking more one day than the other or I may be up and down, the ankle will give me a lot of more problems that they, or pop, like to date is popping and cracking. That is one of biggest problems with the ankles.” The claimant stated

that at work he has cards for parts. The cards are to lower place for pulling parts that are too heavy and then an elevator. If they are too heavy they come down the elevator. In regards to driving, his difficulties are that as long as the driving short and he tries not to do anything extensively over 30 minutes. Kaiser gave him restrictions, which were no extensive stooping, bending, or heavy lifting, no driving heavy equipment. The claimant stated that he did have a calf of his right leg “called the separation, but that happened at work, where I got out of the seat and the muscle popped. It felt like a marble, somebody hitting you with a back of a marble, but they treated that. I was off work for may be a month and went right back. They treated it with therapy and healed up fine.” This injury occurred on “probably 2008.” The claimant confirmed that he had been a member of Kaiser since 2001 when he started working for Santa Monica. He did not having any other conditions related to his blood pressure, cardiovascular disease, heart problems, arthritis, or any other illness. He states he used to play football and he denied having any problems with his knees or ankles. He denied having or sustaining any other sports injuries. End of deposition for this claimant.

ADDITIONAL DICTATION: ___29:46____

“A five-inch stack of medical records was reviewed page-by-page. As part of these records a deposition was included and the summary for the review is as follows:”

07/27/88, SCPMG-West Los Angeles, Kaiser Permanente.

The 309 pages for these locations were reviewed page-by-page, among the documents provided. It was found physical examinations, evaluation reports, progress notes, radiology reports, chemistry profiles, medication and summary chart, work status reports, authorization status, emergency information, and immediate care for this claimant. Additionally, it was found optometry records, food allergen panels, and testing her laboratory results for this claimant. The period involved in these records is for 07/27/88 through 10/06/09. The diagnosis percentage included rule out hyperprolactinemia, rule out diabetes, folliculitis, laceration of the left upper extremity, lacerated left wrist, cholesterol, hypogonadism, dextrocardia, history of arthroscopy for the knee with meniscus repair, and testicular failure with hypogonadism. Complete situs inversus with dextrocardia, thalassemia, anemia-microcytic, asthma-controlled, obesity, and osteoarthritis of the knee. On 09/29/09, there is an initial contact from this claimant with

registered nurse, Serena Gonzalez stating that he had called regarding a sooner appointment than 10/06/09 as he stated that he had an injury at work in 2002, and that he required to see a doctor prior to work, for a diagnosis to work light duty. This claimant presented himself to Kaiser on 10/01/09 complaining of a right knee pain for six weeks and prior week was worse. He was seen at the Urgent Care Clinic on 09/23. His condition did not respond to ice, bracing, or NSAIDS. The knee was worse with certain movements with the feeling of “giving out.” There is a history of 2003 torn meniscus surgery. The orthopedic evaluation revealed right positive for moderate crepitation, some mild tenderness, and pain on range of motion, small effusion present, no pseudolaxity noted. X-rays were obtained with an impression of decreased medial joint space with medial tibial and femoral condyle spurs. Some fluid in the suprapatellar bursa may be “an osteochondroma is seen on the lateral view projecting from the proximal posterior tibia. This area is not fully imaged on the frontal view.” Therefore, an MRI was requested on 10/08/09. The impression for the 10/08/09 MRI of the right knee was: minimal osteoarthritic changes seen involving the knee joint. Marginal osteophytes noted. Calcification of interosseous ligament noted in the proximal portion of tibia and fibula. Moderate amount of joint effusion, posterior cruciate ligament intact with diffused edema throughout the anterior cruciate ligament, suggestive of conclusion of partial or partial anterior cruciate ligament tear, degenerative changes seen involving the medial meniscus. Narrowing of the medial compartment of right knee joint is noted. On 10/12/09, this claimant was diagnosed with degenerative meniscus tear, medial. He was prescribed ibuprofen 800 mg. A note is placed to followup with his Workers’ Compensation case.

The Hertz Corporation, City Corporation.

Employment records were reviewed from this employer. The records seen above are date of hire of 02/01/00. The documents included policies and requirements for employment, time payroll records, incident reports, and DMV, driver record reports. No further incident or accident reported.

Workers’ Compensation Appeals Board.

Documents included for review in this set dated between 1991 and 1993 involved the claim between Mr. Jerry Lexion and the Pep Boys. The compromising release was signed on 01/19/93. Documents included compromising release, substitution of attorneys, issues of rehabilitation, or the approving compromise and release, agreement statements, and lien settlements for

Dr. Stanley L. Goodman, M.D. for psychotherapy treatment, alien for Dr. Daniel Dorman, M.D., and Dr. Mark Greenspan. A claim form 1 dated 05/30/91 by Mr. Jerry Lexion indicated a date of injury of 02/28/91-05/17/91 on a continuous trauma injury to his back, neck, and psyche.

07/01/91, Orthopedic Report, Mark Greenspan, M.D.

This report included a job description, work status, and history as presented by this claimant to Dr. Greenspan. As part of his past medical history, Mr. Lexion stated that he had a previous injury to his back for which he received treatment and made a full recovery as of work-related injury, which occurred in 1989. During this examination, the claimant’s objective complaints included the neck with a moderate-to-severe pain without radiation. He also noted associated headaches and a “popping sound” with any movement. A physical examination is noted. X-rays were obtained with no abnormal osseous roentgenological evidence. Diagnosis:1. Myoligamentous strain of the cervical spine.2. Stress-related headaches secondary to myoligamentous strain of the cervical spine.

Dr. Greenspan felt that this patient’s diagnosis was related to his industrial injury. He felt this patient would benefit from a combination of medications such as Fioricet and Tylenol. He also felt that he could have physiotherapy and counseling.

08/08/91, Psychological Report, Stanley L. Goodman, M.D.

Dr. Goodman evaluated this patient for injury sustained while working for Pep Boys on 06/17/91. Dr. Goodman provided an impression of axis I: major depressive disorder-moderate with no personality disorder.

07/03/92, Psychiatric Evaluation, Daniel Dorman, M.D.

It is mentioned in this report that the last date that Mr. Jerry Lexion worked was in 05/17/91. Psychiatric evaluation was conducted. Testing was performed. Medical records were reviewed. A diagnosis was provided of personality disorder, not otherwise specified, and malingering. It is opinion of Dr. Dorman that Mr. Lexion did not sustain an industrial injury to his psyche while working for Pep Boys. He felt that this claimant was malingering and he had a long history of cocaine use for his drug addiction.

St. John’s Health Center.

This claimant presented himself to St. John’s Health Center on 07/13/01. There is evidence that he had a chest x-ray with no active disease, with the exception of dextrocardia. On 04/08/02, there is evidence of an industrial injury. There is a doctor’s first report of occupational injuries dated 04/08/02 with injury to his right knee. The history indicated “had been driving from 11:15-04:50 at the layover, I got - up and my knees locked up, and there was pain in my top left knee and my right back of knee. An evaluation was performed. Diagnosis provided was that of acute right knee injury. An acute right Baker’s cyst ruptured. Treatment rendered was an exam and evaluation, ACE grab, crutches, and medications. On 02/24/05, this claimant presented himself again to this facility and examined by Dr. Joseph. At that time another doctor’s first report of occupational injury was filed, where the claimant stated that on 02/24/05 he sustained an injury while working as a bus operator for the City of Santa Monica. The history was described as “getting out of a seat for new driver, stepped down, and pain began in my right lower leg.” He complained of right calf pain; an examination was performed and a diagnosis of acute strain of the right calf was given. The treatment rendered besides on exam and a Doppler included a splint, crutches, pain medications, pulse oximetry, and recommendations to followup at Kaiser were given.

05/14/02, MRI Scan of the Right Knee, St. John’s Health Center.

Conclusion:1. Horizontal tear, posterior horn of the medial meniscus, extending to the inferior articular surface. There appears to be a small intrasubstance tear of the anterior horn.2. No evidence of an articular surface involving the lateral meniscus.3. Cruciate ligament appear intact.

08/05/02, Progress Report (PR-2), Philip A. Sobol, M.D.

Bilateral knee surgery remained unchanged. The claimant was awaiting for right knee scope on 08/12/02. A change of physical therapy facility was made. Objective findings included of positive McMurray for the right knee, tenderness of the MGL, medial ROM, condyle, popliteal cyst with tenderness. For the right knee there was a TTP peripatellar, popliteal cyst with tenderness. Diagnosis:1. Right knee medial meniscus tear/pop cyst.2. Left knee PFA and pop cyst.

The treatment and plan included continue physical therapy, awaiting right knee scope, continue bracing, refill medications, followup. He remained temporarily totally disabled for another 10 to 12 days.

08/12/02, Operative Report, Philip Sobol, M.D.

Preoperative diagnosis: Right knee internal derangement and chondromalacia.

Postoperative diagnosis: Complex tearing, posterior horn, mid zone, medial meniscus inner rim, and posterior horn small tearing, lateral meniscus, sinovitis, plica, and chondromalacia grade II, medial femoral condyle, and medial distal patella. Procedure performed: intra-articular arthroscopy, partial medial lateral meniscectomy, synovectomy, plica excision, and chondroplasties.

08/12/02, Preoperative Report, Pain Net Medical Group.

These records indicated an examination, laboratory work, and anesthesia, recovery room records regarding this claimant. The assessment was right knee injury, dextrocardia, and situs inversus. Additionally, there were laboratory results.

05/28/02, Progress Reports, Dr. Sobol.

Mr. Lexion stated that he had involved in a work-related motor vehicle accident in 1998. He sustained injuries to his neck, back, and right shoulder. He obtained a full recovery. In the 80s, he was involved in a work-related injury to his back with a full recovery. A physical examination was performed with objective findings revealing mild swelling anteriorly for the right knee, tenderness over the medial joint line and medial femoral condyle, as well as tenderness over the suprapatellar area, popliteal cyst, retropatellar crepitus, and positive McMurray’s for pain and click at the medical joint line. For the left knee, tenderness was located over the peripatellar region, with popliteal cyst. Diagnosis:1. Right knee medial meniscus tear and popliteal cyst.2. Left knee patellofemoral arthralgia and popliteal cyst.

05/28/02, Doctor’s First Report of Occupational Injury or Illness, Philip A. Sobol, M.D.

Jerry Lexion presented himself to Dr. Sobol stating that while working as a bus operator for the City of Santa Monica sustained an industrial injury on 04/08/02. He stated that he was standing off from the driver’s seat to change overhead destination sign when he noted locking of both knees followed by pain. An addendum was attached to this doctor’s first report which indicated that diagnosis of:1. Right knee medial meniscus tear, pop cyst.2. Left knee patellofemoral arthralgia, pop cyst.

Dr. Sobol recommended braces for the knee and surgery of the right knee; scope. He determined that the claimant was unable to return to work.

08/26/02, (Unknown).

A physical therapy log.

This document indicated that the claimant, Jerry Lexion received physical therapy to his knees in the form of treadmill, bike, and multimodality physical therapy for the period that involved 08/26/02 through 12/05/02.

01/17/03, Progress Report, Dr. Sobol.

This claimant has a postoperative status with improvement recorded. He continued receiving physical therapy and exercises with a home program. Recommendations were made by Dr. Sobol to continue physical rehabilitation, heel cups, medications, and stationary bike for homecare. He remained him on a temporary total disability for another four to six weeks.

03/18/03, Permanent and Stationary Report, Philip A. Sobol, M.D.

After providing a summary of care provided to this claimant, Dr. Sobol conducted a final physical examination with objective findings documented for residual tenderness to the knees especially the right knee, crepitus was noted and pain with active and passive ranging. Furthermore, there is finding to the left ankle with tenderness over the Achilles tendon and peroneal tendon. The diagnosis provided:1. Status post right knee arthroscopy involving partial medial and lateral meniscectomy, synovectomy, chondroplasty, and plica excision, 08/12/02.2. Left knee patellofemoral arthralgia.3. Left ankle tendonitis-secondary to altered gait/favoring the right lower extremity.

As part of his recommendations after being considered permanent and stationary from an orthopedic standpoint, Dr. Sobol provided a loss of pre-injury capacity of 35%-40% for lifting, running, jumping, squatting, kneeling, climbing, walking over uneven surfaces, pivoting, crouching, and similar activities of comparable physical effort as well as 25% of his pre-injury capacity for weight bearing. With regards to the left knee, he provided 20%-25% loss of pre-injury capacity and for the left ankle he gave a 20% loss for the pre-injury capacity for running, jumping, squatting, crouching, or climbing. He stated there was no history of prior disability for the knees or the left ankle therefore there was no apportionment given. Future medical care was awarded in the form of orthopedic reevaluations and refills of his prescription medications. Brief courses of therapy up to six-week period as well as replacement of supported of orthopedic devices such as knee and ankle braces/support. Should he fail to improve, MRI/radiograph/other imaging should be obtained. Local injections of cortisone and Synvisc may be considered and lastly, consideration for additional arthroscopy for both knees and/or left ankle. Vocational rehabilitation was not indicated.

01/08/04, Review of Medical Records, Dr. Sobol.

Review of medical records is noted and the medical records were reviewed and Dr. Sobol felt in his opinion that after reviewing the provided information that he would not alter his previously stated opinions as expressed in his permanent and stationary report of 03/18/03.

02/01/10, Doctor’s First Report of Occupational Injury, Dr.   Philip Sobol.

This claimant provided a history of repetitive strain operating bus, applying brakes/pushing pedals, continuously throughout eight-hour work a day. This objective complaint indicated an increase bilateral knee pain/onset of the left ankle pain. A physical examination was performed, which revealed portal scars over the right knee, mild swelling of the right knee, tender medial joint line and peripatellar, the right greater than the left, medial pain with McMurray, the right greater than the left, PF crepitus bilaterally, tender left ankle gait (illegible)of the right lower extremity. This claimant was placed on modified duties of no bus driving and assigned to a desk work since (illegible).

02/24/10, Prescription for Therapy, Sobol Orthopedic Medical Group.

This prescription for Mr. Lexion with a diagnosis of post right knee scope, (illegible), indicated treatment for both knees with physical therapy twice a week for four weeks including modalities and therapeutic activity.

04/16/10, Review of Medical Records, Dr. Sobol.

Medical record review noted.

07/02/10, Progress Report, Dr. Sobol.

No show, missed appointment.

07/02/10, Progress Report, Dr. Sobol.

The claimant remained symptomatic, an evaluation was performed. Diagnosis:1. Status post right knee plica excision, 08/02, with effusion (OA possible partial crepitus ACL tear).2. Crepitus MRI 10/08/09; slight-to-moderate medial compartment, mild P-F comp (illegible).3. Left knee status post/crepitus PFA/severe medial comp, mild P-? compartment OA (x-rays).4. Left ankle SP secondary altered gait.

He was advised to continue with his home exercises to continue the medications and to return for a followup in four to six weeks.

08/27/03, Orthopedic Evaluation, S. Sanford Kornblum, M.D.

History of injury that included treatment of to date for this evaluation, the past medical history indicated no previous injuries to the knees. The subjective complaints included the knees, left heel, and left ankle. The physical examination revealed the right knee scars well-healed, just a minimal tenderness of the plantar fascia insertion into the left heel, some tenderness over the left Achilles tendon, but no thickening. X-rays were obtained of the ankles and the knees with normal limits with the exception of minimal heel spur of the ankle, and minimal sharpening of the femoral and tibial condyle bilaterally laterally with minimal sharpening of the superior pole of the patella for the knees. A review of records is noted. Dr.

Kornblum provided his opinion along the medical record review. Diagnosis:1. Postoperative right knee surgery with mild patellofemoral chondromalacia.2. Left knee strain.3. Pain in the left ankle.

Dr. Sanford did not agree with the opinion provided by Dr. Sobol in his permanent and stationary report. Rather, Dr. Sanford provided his own opinion regarding the work restrictions. Dr. Sanford indicated that “apportionment is indicated in that that very heavy work restriction was imposed previously in the year 2000 for his spine and shoulder and this disability has still remained at the time of the accident of 04/08/02. Since the WCAB includes these in a very heavy restriction regarding the back and lower extremities as well as the cervical region, there was previous disability with respect to the back and lower extremities and these are applicable with respect to the disability that he presently has regarding the knees.” He was not considered a qualified injured worker.

10/21/09, Orthopedic Evaluation, Frederic G. Nicola, M.D.

As part of the history of injury obtained it is stated that on September 2009 while driving the bus, his knees started to become sore and then he have an “overt swelling of the right knee on 09/23/09.” He was seen at Kaiser and he was given ibuprofen and ice. He had x-rays and told that he had a tumor. He returned for crepitus MRI of the right knee. The claimant complained of right knee pain and swelling and difficulty ambulating. He is allergic to shellfish. A physical examination noted that there was effusion in the right knee with difficulty ambulating heel/toe gait, unable to squat, significant joint effusion with one to two low sign medial joint tenderness and mildly anterior drawer on the right medial patella, tracking normally. For the left knee, there was no tenderness or effusion. X-ray examination revealed the slight vitals malalignment of both knees and some chondral changes in the tri-compartmental regions bilaterally. A medical record review is noted. Diagnosis:1. Right knee effusion, slight ACL laxity, underlying varus degenerative joint disease. Dr. Nicola gave this applicant an injection of lidocaine, Marcaine, and Celestone to his right knee. He felt that the claimant would benefit from a course of anti-inflammatory medication, six weeks of physiotherapy for strengthening of the right knee, a hinge knee brace, and a reevaluation in two weeks.

06/15/10, Review of Medical Records, Dr. Sobol.

After reviewing the medical records provided for multiple facilities, he commented that the records were consistent with the history provided by the patient upon his initial evaluation on 02/01/10.

THE DICTATION ENDS ABRUPTLY: