The Independent File Review

Abstract

An independent file review is an independent medical evaluation that does not involve an interaction with the examinee or claimant. It consists of a review of the presented medical and sometimes nonmedical records that surround a claim only. File reviews are usually narrower in scope that independent medical examinations where only one or two questions are in dispute.

Specific impairment rating values cannot be assigned by a file reviewer because the standards of practice dictate that for a physician to calculate an impairment rating number, an independent history and physical examination must take place.

Peer reviews and pre-certifications are considered special types of independent file reviews and may also include the independent review discussing the case with the treating physician.

Appendices

Appendix 1: Independent File Review Report Examples

January 22, 2014

NANCY WILLIAMS

CLAIMS EXAMINER

RISK ADMINISTRATION SERVICES, INC.

P.O. BOX 89310

SIOUX FALLS, SD 57109-9310

RE: Elissa Battin

YOUR CLAIM#: 235287

DOI: 10/31/13

SS#: XXX-XX-5862

DOB: 6/11/1985

Dear Ms. Williams:

I am in receipt of your request, per your letter dated January 13, 2014 to conduct an Independent File Review, concerning the above named individual’s claim of injury.

Thank you for your introductory letter that includes the questions that you need to have addressed.

You have enclosed the lady’s South Dakota Employer’s First Report of Injury, as well as relevant treatment records, which include those from the office of Wallace Fritz, M.D., as well as diagnostic test results.

Claim Summary

Ms. Elissa Battin is a 28-year-old female who works for Sanford Medical Center as a Registered Nurse in the Cath Lab.

This lady received an influenza vaccination that was administered to her left upper arm on October 31, 2013.

The day after this, she went to a massage therapist who noted a nodule in her left collar bone area.

She followed up with her primary care physician on November 5, 2013, and it was identified that this was a left supraclavicular lymph node. She subsequently underwent both ultrasound and CT scan imaging which noted 3 separate areas of lymphadenopathy. A fine needle biopsy was then performed on November 27, 2013 that returned lymphoproliferation compatible with a reactive lymph node change.

From a treatment standpoint, the lady has been advised simply to do conservative based cares.

Discussion

You have asked, in your letter, whether or not influenza vaccines can cause a reactive lymphadenopathy. The answer to this is that they can. While I appreciate your informal conversation with an Infectious Disease Specialist, I, frankly, do not understand the reasoning behind what he told you. All vaccinations work on the concept of creating an antigenic stimulus to the lymphatic system which, then, in turn, produces antibodies to said antigen. Obviously, the lymph structures must be involved in this process.

I conducted a literature search regarding this and would point to 2 articles that I identified.

The first one is entitled, “Lymphadenitis Caused by H1N1 Vaccination: Case Report,” from Vaccine 2010 MAR 2; 28 (10): 2158–60. This is an article written by Toy, the primary author, that discussed an ultrasonography identified solitary lymph node that occurred in the supraclavicular area approximately 1 week after H1N1 vaccination. It discussed that there was a pathologic examination of this lymph node that did show evidence consistent with proliferative immunoblasts. The conclusion of the author was that lymphadenitis can be a side effect of H1N1 vaccination.

The second article entitled, “Axillary Lymph Node Accumulation on FDG-PET/CT After Influenza Vaccination,” from Ann Nucl Med 2012 APR;26(3):248–52 is an article with Shirone as the primary author that talks about the accumulation of certain inflammatory markers in lymph nodes after any vaccination. This particular article does specify influenza vaccination and makes the point that ipsilateral axillary lymph node accumulations of this have been well documented.

It is, therefore, established in the medical literature that ipsilateral lymphadenopathy can develop after vaccination with influenza.

Specific Questions

In regard to the 3 questions that you pose in your letter, I respond as follows:

• 1. “Diagnosis and prognosis.”

Answer: This lady has a left supraclavicular lymphadenitis. Her prognosis is good.

• 2. “Causation of the diagnosed condition to the influenza vaccine on October 31, 2013.”

Answer: The left supraclavicular lymphadenitis was caused by the sequela of the influenza vaccine administered to the ipsilateral extremity on October 31, 2013.

• 3. “Can it be stated with a reasonable degree of medical certainty that Ms. Battin sustained an injury or trauma at Sanford that caused the diagnosed condition?”

Answer: I am not sure about the terms “injury” or “trauma.” What this lady suffered was a left supraclavicular lymphadenitis/lymphadenopathy secondary to an unusual sequela from an influenza vaccination that was given in the ipsilateral extremity.

Conclusion

The above statements have been made with a reasonable degree of medical certainty/probability.

The opinions rendered in this case are the opinion of this reviewer. The review has been conducted without a medical examination of the individual reviewed. The review is based upon documents provided with the assumption that the material is true and correct. If more information becomes available at a later date, an additional service/report/reconsideration may be requested. Such information may or may not change the opinions rendered in this report. This report is a clinical assessment of documentation and the opinions are based on the information available. This opinion does not constitute, per se, recommendations for specific claims or administrative functions to be made or enforced.

If you have any questions with respect to this report, please contact me personally through the office.

Sincerely,

Douglas W. Martin, MD, FACOEM, FAADEP, FAAFP, CIME, CEDIR

Fellow, American College of Occupational & Environmental Medicine

Fellow, American Academy of Disability Evaluating Physicians

Fellow, American Academy of Family Physicians

Certified Independent Medical Examiner (ABIME)

Certified Evaluator of Disability & Impairment Rating (AADEP)

DWM/lap

Smith vs. Torch

RE: Smith v. Torch

Dear Ms. Defence:

Per your request, I have had an opportunity to review your submitted information regarding the above named action.

Thank you for supplying the voluminous amount of records and ancillary documents for my review electronically.

For a listing of the records reviewed in this case, I refer you to Appendix A attached to this report.

Case Summary

Amy Smith is a 53-year-old white female who has previously worked as a Certified Public Accountant. Ms. Smith began to develop symptomatology in 2006 consistent with a diagnosis of small fiber peripheral neuropathy. She filed a claim for long term disability with the Torch Insurance Company, which was initially denied and then subsequently, upon multiple appeals, was approved from a timeframe through and including 2013. After that point in time, a review of the medical and psychological data led Torch Insurance Company to terminate their long term disability coverage.

I have been asked to provide a comprehensive review of not only the medical information, but the other ancillary support information in this claim regarding the verifiability of the long term disability condition.

A review of the medical documentation indicates that this lady has previously dealt with morbid obesity, having undergone a gastric bypass procedure where she has lost a considerable amount of weight. The medical record would go on to indicate that, more recently, she has been diagnosed and treated for a fibromyalgia condition, as well as having been identified with Ehlers-Danlos Syndrome.

Based upon the current Occupational Medicine Specialty designation’s determination of fitness for duty, which is based upon the risk/capacity/tolerance paradigm, this lady should have the capability to continue to work as a Certified Public Accountant on a full time basis without risk of harm to herself or others.

Discussion of Case

The medical record would document that Ms. Smith started to develop symptoms of dizziness with numbness and tingling in the extremities in 2006.

After presenting to her primary care physician with these symptoms, she was subsequently referred to physicians within the Medical College of Wisconsin. She was living in the Wisconsin area at the time. She had a variety of specialty evaluations and baseline diagnostic evaluations or tests conducted.

A Neurologist at that facility gave her the diagnosis of autonomic dysfunction, as well as autonomic neuropathy and postural orthostatic tachycardia syndrome.

A review of the medical records would suggest that there correctly has been some degree of concern about the specificity and validity of that diagnosis, from the standpoint of the various different tests and clinical presentations.

Indeed, autonomic neuropathies are typically either categorized as either inherited or acquired. The Medical College of Wisconsin physicians and, for that matter, a number of physicians, for a number of years after that time, assumed that this was an inherited or a genetic type of autonomic neuropathy. However, as one physician in the medical record has astutely indicated, there have been no genetic tests done that have confirmed this. Thus, my view is that it is more likely an autonomic problem that has no familial linkage.

Acquired autonomic neuropathies also are very difficult to delineate and to diagnosis; however, there are some characteristic features of the disease process. I would respectfully point out that, in this particular case, the objective basis for the issue is primarily due to a skin biopsy that identified a small fiber neuropathic problem. Indeed, if one looks at the medical texts and references regarding acquired autonomic neuropathies, one finds that there is a condition known as idiopathic distal small fiber neuropathy which has characteristic clinical features that are very similar to this lady’s. It is more than likely that is the appropriate diagnosis to give this individual.

I can not necessarily assign, based upon the information that I have in the medical record, that a postural orthostatic tachycardia syndrome is a better diagnosis; or, for that matter, any other type of primary or secondary acquired autonomic neuropathy.

The most common acquired autonomic neuropathy is that from diabetes mellitus. One would naturally consider that as part of the differential diagnosis in this individual, given her significant problems with obesity. However, the medical record also does not seem to verify that is a concern.

As she has undergone a gastric bypass operation, it appears as though appropriate attention has been paid to folic acid and Vitamin B replacements, which also, often times, need to be considered within this differential.

The lady continued to report symptomatology secondary to these issues thereafter. She subsequently moved to Cedar Rapids, Iowa and established physician relationships in this area. She has had some other evaluations performed specific to her neurological issues. One of which was by a Dr. Talman, who is affiliated with the University of Iowa, who actually, in review of the entire medical situation regarding her neurological problems, questioned the validity of an autonomic abnormality.

A variety of physicians have been involved in review of this long term disability case and claim over time. There has been some variableness with regards to opinions concerning physical activity level.

There seems to be a preponderance of individuals who believe that this lady’s physical activity is somewhat limited, but there have been differences of opinion as to whether or not it is sedentary, light or something different. There, obviously, are differences of opinion regarding her primary treating physician, Dr. Karen Harmon, who, no doubt, takes the position of a patient advocate, which would not necessarily be unexpected.

Regarding any issues with respect to mental health or psychological issues regarding this claim, the plaintiff and her representatives have indicated that it is their belief that her medical condition has led to some sort of deficiency, with respect to cognitive capabilities and performance. However, a careful review of the various psychiatric and neuropsychological batteries that have been administered to this lady over time, show that there are no deficiencies in those areas. Thus, the overwhelming thought processes by these evaluators has indicated that, at least from a performance standpoint, this lady does not have a psychological or cognitive barrier to functioning as a Certified Public Accountant.

With regards to the diagnosis of Ehlers-Danlos Syndrome, I would indicate that it appears that the medical documentation suggests that this was identified mainly as a result of genetic investigation. There does not appear to be a preponderance of symptomatology reflected in the medical record that is consistent with typical presentations of that disorder.

Regarding the more recent diagnosis of fibromyalgia, this has been subjected to evaluation both by local physicians, as well as a specialty physician and tender point injections have been done by Dr. Kim. Fibromyalgia is a common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive distribution, psychiatric symptoms, and multiple somatic symptoms. The etiology of the syndrome is unknown, and the pathophysiology is uncertain. Despite symptoms of soft tissue pain affecting the muscles, ligaments, and tendons, there is no evidence of tissue inflammation. Like other functional somatic syndromes, fibromyalgia has been a controversial condition. Patients look well, there are no obvious abnormalities on physical examination other than tenderness, and laboratory and radiological studies are normal. Thus, the role of organic illness had been questioned, and fibromyalgia was often considered to be psychogenic or psychosomatic.

Even more recently, there has been an issue with trigeminal neuralgia, which has been treated with injection therapy. Trigeminal neuralgia is characterized by recurrent brief episodes of unilateral electric shock-like pains, abrupt in onset and termination, in the distribution of one or more divisions of the fifth cranial (trigeminal) nerve that typically are triggered by innocuous stimuli. It is a rare condition that affects women more than men. Despite its low incidence, it is one of the more frequently seen neuralgias in the older adult population. The incidence increases gradually with age; most idiopathic cases been after age 50, although onset may occur in the second and third decades, or rarely, in children.

As one looks through the holistic perspectives of this claim and its implications, one is directed mainly to the issues of endurance, with respect to job tasks and job capabilities. The plaintiff states that she does not feel that she has the endurance or capabilities of doing the job as a Certified Public Accountant.

A CPA/CPA Consultant typically is identified as a position that is primarily of desk orientation. This does not require heavy lifting, which can accommodate either a sitting or a standing type of an environment, which requires a reasonable amount of writing capability, computer skills and communication skills.

The ancillary information that has been presented for my review includes not only video surveillance, but also a record of this lady’s activities for volunteer organizations. It would appear that her involvement in these types of activities and what is included within the video surveillance does not show any degree of physical or mental limitations or barriers.

In applying the principles of analysis, from an occupational fitness for duty perspective, the general medical and scientific perspective that has been now formalized in multiple references indicates that it is, indeed, the case that physicians rarely, in the past, have concentrated upon the importance of the fitness for duty or return to work decision making process. It is important to understand that there has more recently been a focus on illnesses and injuries in situations that are non severe and for which there are many patients with similar problems who work, and yet, other patients who consult with physicians seeking medical information to support a disability application. As is the case here, and in those other cases that are similar, the disability phenomenon or construct is not obvious and both patients, employers and disability insurers request information from treating physicians and also from second opinion or independent medical physicians regarding their implications. In these cases where there is neither obvious severe disability, or obvious major pathology, similar to what we have here, there can be quite a difference of opinion. The question remains as to what weight should be given to the benefit of the patient regarding the return to work situation.

As a result of this, a more focused attention has been paid to what is commonly now known as the risk/capacity/tolerance paradigm. This paradigm is based upon the foundational principles that physicians can assess certain items of the equation, but not all. As a rule, physicians are very good at identifying risk. They are reasonably good at identifying capacity. However, tolerance is not something that can be measured scientifically and it has been stated that tolerance is really not a concept or a subject that physicians can provide any type of opinion at all upon, given the fact that it is individualistic and is driven primarily by motivational issues of the individual patient.

More recently, this concept has been published by the American Medical Association in a textbook known as The AMA Guides to the Evaluation of Work Ability and Return to Work, Second Edition.

Applying this paradigm to this particular case, when one analyzes the medical record, it appears that there is insignificant risk for Ms. Smith to work as a full-time CPA/CPA Consultant (and certainly not in an intermittent part-time capacity). There does not appear to be any evidence of the medical documentation or ancillary documentation that would support a risk of harm to herself or others in that capacity. Thus, it does not appear that risk is an issue here.

It may be more appropriate to consider capacity, in that this is an area which takes into consideration the degree of strength, flexibility and endurance necessary in order to perform a particular job task. Although there appears to be some differences of opinion, with respect to this lady’s capacity, most physicians have indicated, within their actual personal examination or review of the records, that this lady has some degree of capacity. Most physicians that have talked about this in the medical records that have been presented have used the dictionary of occupational titles terminology such as “sedentary” or “light.” Although those titles often times are still utilized by practitioners, the current Occupational Medicine viewpoint is that labeling or categorization often times fails to yield the degree of specificity necessary to answer a particular question about a particular job. It is important to understand what the necessary physical demands are with respect to a Certified Public Accountant. As I have indicated previously, it is primarily a job that is frequently known as “sedentary,” but rarely requires any type of strength, flexibility or maneuverability tasks. As it is a job that primarily is involved in mental task functions, the focus with regards to this particular disability claim should rightly be placed in those crosshairs. And, as such, given the objective information that has been communicated within the psychiatric, psychological and neuropsychological tests, there does not appear to be any limitation in that regard.

Therefore, the issue here primarily has to do with respect to tolerance. Tolerance is what is frequently known as a psychophysiological concept. It addresses the ability to tolerate sustained work or activity at a given level, and pays particular attention to reported symptomatology in that regard. Tolerance is, often times, stated to be dependent upon the rewards available for doing an activity that is in question. Frequently, when a patient describes his or her activity tolerances, a physician may feel that this should be the basis for physician imposed activity restrictions. However, on a medical certification form, the term, ‘work restrictions’ means what the patient should not do on the basis of risk or harm to themselves or others. Symptoms alone do not harm. So, ‘work restrictions’ are not appropriate, if based only on symptoms.

This has led experts in the field to describe tolerance as not being a scientifically verifiable concept. This also explains why 2 physicians can have very different explanations and viewpoints with regards to concepts of work ability. When objective pathology is dramatic, physicians can generally agree upon what an individual should or should not be doing for work activity. But, it is less clear in situations for which there are not great degrees of objective pathology involved. This case is a classic example of that, in that we have objective information that is based primarily on a dermal biopsy that has shown an abnormality of a small fiber neuropathy. There does not appear to be any other objective basis that I can find within the medical documentation of verifying or validating other types of autonomic or other neurological concepts, save for an electrodiagnostic test that has shown a degree of carpal tunnel syndrome.

Therefore, the argument here is that physicians should not be involved in concepts or issues of tolerance, as that is an individual decision. The point of all of this description discussion is that tolerance has a lot to do with regards to motivational factors and the desire to perform and to also need work. It appears as though tolerance is the issue for the claimant, in this situation. Thus, from a scientific standpoint, it would certainly appear that this lady has little risk of returning to her full time job as a CPA/CPA Consultant, and has the capacity to do so. Therefore, from a medical and scientific standpoint, it is my opinion that this lady would have no limitations on her specific job tasks as a CPA/CPA Consultant.

She may have some job task limitations if she was doing some type of a job that required heavier physical exertion. I think that some of the physicians that have reviewed this lady’s situation in the past have probably correctly identified some of those things. Although the identification of capacity, in this situation, is not well grounded because of lack of tests, such as a Functional Capacity Examination or other ability determinant analyses, it is probably more true than not that this lady could at least operate in what individuals have described as a “light” physical demand level. My general viewpoint on this is that this lady should, in general, be able to manipulate, from a material handling standpoint, 20 pounds. She should be able to sit, stand and walk with reasonable breaks. She may have issues with respect to balance, and I would caution her with regards to work at unprotected heights or situations where balance is important in an upright position, such as walking on uneven surfaces, standing on platforms, ladders and so forth.

Specific Question

I have been asked 2 questions in this case, which I respond to as follows:

• 1. “Does Ms. Smith have functional impairments from August 1, 2013 forward as a result of any 1 condition or combination of conditions? If so, please list the functional impairments and the evidence supporting your opinion.”

Answer: I have taken into consideration Ms. Smith’s situation with regards to the previously identified small fiber neuropathic abnormality identified on her dermal biopsy, as well as the previous labeling of an autonomic dysfunction or postural orthostatic issue. Also taking into consideration the fact of her previous morbid obesity, the fact that she has undergone a gastric bypass operation and has lost a considerable amount of weight, and the more recent implication of her Ehlers-Danlos Syndrome, her fibromyalgia, and other more chronic long-term medical issues.

It is my opinion that Ms. Smith probably does have some degree of functional impairment from August 1, 2013 forward, when one takes into consideration the combination or collaboration of all of these diseases and how they interplay into her activities of daily living. However, I think it is important to understand that these functional impairments, in my opinion, would not preclude her activity as a full time worker as a Certified Public Accountant.

In general, I believe that this lady would have the capability of material handling 20 pounds. I do believe that this lady would have some difficulty with respect to balance issues and I would preclude her from uneven surfaces, unprotected heights, ladders, platforms, etc. I think that she should be able to walk, sit and stand with reasonable breaks. I do not have any other rationale or basis to limit her in any other way, going forward.

In analyzing this issue, I did take into consideration the more recent diagnosis of fibromyalgia. One point about that medical condition is that all medical guidance documents and evidence based perspectives, including that of the American College of Rheumatology and the American Academy of Family Physicians indicate that, within that diagnosis, individuals should and must be encouraged and counseled to be “normal” with regards to both work and activities outside of work. People with this diagnosis typically are able to work full-time.

As I have indicated above, I do not feel that the Ehlers-Danlos Syndrome that has been more recently identified necessarily has manifested itself in the medical record with any degree of significant limitation.

As I have discussed, I think the small fiber neuropathic problem is likely idiopathic and I think that is the true diagnosis that exists.

As to how much it is implied with respect to any type of autonomic issue or hypotensive issue, there probably is some degree of that. However, I think to label this lady with a diagnosis of something other than that is not correct.

When we look at those issues primarily, and in combination with each other, there probably is some degree of functional impairment limitation which is based upon the small fiber neuropathic process. In this analysis, I have used my experience as a Disability Evaluator, as well as an Occupational Medicine Physician, but also, and even more importantly, in my experience as a Board Certified Family Medicine Physician. The reason that I say this is that, as I have indicated before, a small fiber neuropathic presentation often times is most common in individuals with diabetic neuropathy. As diabetic neuropathy is quite common, I think that one can use reasoned comparisons of other patients with diabetic neuropathic problems, as they often times will manifest themselves in the very symptoms to which Ms. Smith has. Utilizing that extensive degree of experience, I think bolsters my perspective that, while there is some limitation that likely exists in this situation, it should not be a limitation that rises to the level of being unable to be employed or completely disabled, from the standpoint of performing CPA/CPA Consultant functions.

• 2. “Please identify appropriate restrictions and/or limitations, i.e., sit, stand, walk, reach, carry, push pull, perform repetitive and fine motor hand activities, perform upper extremity activities on a full time basis, etc. based upon functional impairments you have noted above. Please, specifically identify specific documentation in support of your opinion that the restrictions are/are not medically necessary?”

Answer: Largely, I have addressed those issues in Question #1’s answer above.

To reiterate, I think that this lady should be able to material handle 20 pounds. She should be able to walk and sit with reasonable breaks. She should be able to have unrestricted capabilities with respect to upper extremity use otherwise. I do not think that there should necessarily be any concern here about any other issues, vis-à-vis her occupational demands as a Certified Public Accountant.

The documentation that I have used in support of this analysis is the entire medical record, as well as the ancillary information that has been given to me. I think that, from an objective standpoint, what we have here is a verification of a small fiber neuropathy on a dermal biopsy. I think we have very little else in the medical record that can be specifically identified as an “objective” true record of any other issues. Largely, the reports in the medical records are of symptomatology. One also needs to look at the trend analysis, with respect to the number of years that this lady has been dealing with this condition. For example, I do not see in the physical therapy records that there is identified any huge or tremendous issue with regards to any postural orthostasis abnormality.

The other information that has been given to me does not seem to support any type of cognitive or psychological dysfunction with respect to her job tasks.

This would also seem to be borne out, based upon the ancillary information that has been given to me, regarding her involvement in her volunteer activities, travel activities, as well as what is seen on the video surveillance.

I have noted that there seems to be some disagreement, in this case, regarding what the plaintiff’s actual work as a CPA/CPA Consultant entailed. When you look at the financial records, it does not appear that her financial income was consistent with what an expected full-time CPA/CPA Consultant would necessarily make in a calendar year. Without knowledge as to why that might be, I do not think that necessarily has any implication here, with respect to my perspectives on this. I think that, because of the information related above, this lady should be able to work full-time in her occupation of a CPA/CPA Consultant. I think it is irrelevant whether the individual might work, for example, 50 to 60 hours in 1 week, and then perhaps have no hours for the next week. Since there does not appear to be any type of job task or requirement that requires a significant physical component to her issue, any type of claims of endurance or stamina would seem to be more oriented toward any claims of cognitive impairment. But, as I have indicated above, there does not seem to be any of that that has been documented in the information that I have been given.

I would conclude my answer to Question #2 by referencing the fact that there are consensus statements of many different physician organizations that talk about the importance of maintenance of employment or work as a part of an individual’s better long-term outcome, from a health perspective. The consensus statements of the Canadian Medical Association, the American College of Occupational & Environmental Medicine, and the American Academy of Orthopedic Surgeons all recommend that physicians return patients to their usual work goals as soon as possible. They note that prolonged absence from one’s normal roles, including absence from the work place, is detrimental to a person’s medical, physical and social well-being. They go on to identify that withdrawal from normal social roles can occur when individuals are not in their work role, and can be destabilizing to the patient’s mental, physical and social well-being.

More pointed studies, such as those that have been conducted by Waddell and Burton, indicate that individuals who are not working actually may have significant harm being done to them, such as a higher mortality rate, poor physical and mental health conditions, increased health care utilization, and other social negative determinants.

Conclusion

The above statements have been made with a reasonable degree of medical certainty/probability.

The opinions rendered in this case are the opinion of this reviewer. The review has been conducted without a medical examination of the individual reviewed. The review is based upon documents provided with the assumption that the material is true and correct. If more information becomes available at a later date, an additional service/report/reconsideration may be requested. Such information may or may not change the opinions rendered in this report. This report is a clinical assessment of documentation and the opinions are based on the information available. This opinion does not constitute, per se, recommendations for specific claims or administrative functions to be made or enforced.

Sincerely,

Douglas W. Martin, MD, FACOEM, FAADEP, FAAFP, CIME, CEDIR

Fellow, American College of Occupational & Environmental Medicine

Fellow, American Academy of Disability Evaluating Physicians

Fellow, American Academy of Family Physicians

Certified Independent Medical Examiner (ABIME)

Certified Evaluator of Disability & Impairment Rating (AADEP)

DWM/lap

References

• AMA Guides to the Evaluation of Work Ability and Return to Work, Second Edition; copyright 2011, American Medical Association, Editors Talmage Melhorn and Hyman; published by the AMA Press; Chicago, Illinois

• The Personal Physician’s Role in Helping Patients with Medical Conditions Stay at Work or Return to Work; American College of Occupational and Environmental Medicine Position Statement; December 11, 2008

• Preventing Needless Work Disability by Helping People Stay Employed; American College of Occupational and Environmental Medicine guidance document; June 27, 2006

• The Physician’s Role in Helping Patients Return to Work After an Injury/Illness; Canadian Medical Association; May 21, 2004

• AAOS Position Statement on Early Return to Work Programs; American Academy of Orthopedic Surgeons; May 21, 2004

• Barth, R.J., Roth, V.S., Health Benefits of Returning to Work: Review of the Literature; Occupational and Environmental Medicine Reports; 2003; 17:13–17

Appendix A

Records Reviewed

Amy Smith

• 1. Consultation and letters from consultation sources:

  • Alex Barboi, M.D.

  • Mark Burns, M.D.

  • Paul Darby, M.D.

  • Denise Davis, M.D.

  • Nick DeFilippis, PhD

  • Donald Feinsilver, M.D.

  • Karen Harmon, M.D.

  • Sunny Kim, M.D.

  • Donwook Lee, M.D.

  • Steven McIntire, M.D.

  • Sudhakar Misra, M.D.

  • Lucien Parrillo, M.D

  • Joseph Rea, M.D.

  • Kathleen Sawasky, M.D.

  • William Talman, M.D.

  • Randal Wojciehoski, D.P.M., D.O.

  • Mary Yellick, APNP

• 2. Listing of Prudential Insurance Company contracts relevant to this case

• 3. Expert reports:

  • Karen Harmon, M.D.

  • David F. Peterson, M.D.

  • Randal Wojciehoski, D.P.M., D.O.

• 4. Treating Provider records:

  • Laura Ledger, D.C.

  • Dr. Sedlacek of Anesthesiology

  • Dental records from Dr. Tyler Link & Barnes

  • Personal training records for Fitness Together

  • Dermatology records from Forefront Dermatology

  • Records from Gastroenterologists, P.C.

  • Records from Mercy Hospital and Clinics

  • Records from Neurology at the Physicians Clinic of Iowa

  • Physical therapy notes from the Rec Center

  • Notes from Steve Washler, LISW

  • University of Iowa reports, Dr. Genadry

  • Dr. Pryba

  • Dr. Kori-Graf

  • Froedtert Clinic and Hospital

  • Matthew Goldblatt, M.D.

  • Joe Barrash

• 5. E-Mail correspondence documents and communications with the following health care providers:

  • Mary Yellick, APNP

  • Miscellaneous other notes regarding her treating physicians

• 6. Pharmaceutical records from OptumRX

• 7. Copies of a variety of health related text messages

• 8. E-mail correspondence regarding health issues

• 9. Records regarding Milwaukee County Contract Invoice and Support

• 10. Exercise tracking information

• 11. Additional listing of prescription medication correspondence

• 12. Correspondence regarding health club, fitness center and gym memberships and activities

• 13. Copies of photos of the plaintiff

• 14. Information regarding volunteer activities of the plaintiff

• 15. Correspondence regarding previous job activities of the plaintiff, including accounting manager, a position regarding duties and qualifications

• 16. Copies of requests and answers from both defense and plaintiff regarding interrogatory questions

• 17. Surveillance videos and surveillance reports from September 28, September 29 of 2010, as well as October 23 and October 26 of 2014

• 18. Copies of correspondence between Torch Insurance Company and either Ms. Smith or her attorney representatives

• 19. Deposition transcripts of the following:

  • Karen Harmon, M.D.

  • Randal Wojciehoski, D.P.M., D.O.

  • Said deposition of Amy Smith

  • Deposition of plaintiff’s husband

• 20. Social Disability Case Analysis