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' �'f . �. r;'�''" �.1'�..p- .��':.. ,I rl rs�s1.' °��`• c_...r °`rir"' .': . . , .. . . . . . , •i' � . �'a'� y�'� . . , , , � fy . , . ' �. , , . . . , . . , � � . , ' ' r� ' . . ' �, . . � . � ' ' , . • , ' , ' � , ' , ,' � . '+ . • . � ' } , , � . rt� � . . ' . , , , ' , ' ' .. , ' � ' , y . ' . � ' � � , , '3 . . • . � . , . . � . . � � . . . ' � ACTION AGENDA� . 1 . , ,.. .. - .. . . . ` . . . ., Baard of 7r�stees oi the �mp�oyees' Pertsian Fund � � . � • • , . ' . ., , � ' , � . Navemt�er 13, 1995 • . , : � . ' � . . � � � �. . . ° , . , . . , . _y.�, ..�:. . , '/' � � , ` . , , �� . ' ' ' � ' �. ; � . � 1. � Call to order ' � ; �. . '. : � . 1:20 p m. ' . � � . �: .. . , ; . . . . .. .' ' . . , ' , 2. Approval af�Minutes �' � 2. Approved as.submftted.� . � .� � � of ��I2I96 �� � . � � � � . � . � ?z , . , ' , � . , �. . � ' . t ' , •, , , � 3.� ,,. Req�est far accep#anca , . , . 3. Approvec�.' � . . . � . . � . ; � , intQ ,memaers�{p; � ' , . " , . . � , � � � . , . . , .. , � . , � . � , . . �1 Richard Hicks � � . . � . : � . , � ' : , . �b? Anne Greon : . . � . , � . , .. � . � . . . , . ' � 4. � . Jr�t�-Gonr�ected Disa6ility Pension � 4: Grant�d. ' . � ' . , � . . to #�e granted: , � �, � , . , ` � . � . �, . � . � � Timathy DeBvrd ' , � . ' , z ' � ' ' ,.. . . ; . . . . . , 5. Job-Connected Disabiiity Pension 5. Granted. ', :• ' .. . � . ta iae granted• . . • , , � � � � , . . :. Gary I.utman . � � ' � . . '. fi. Extar�d agreement' with Coapers &.' � 6. A�proved: , �, � �ybrar�cf to per#orm actuarial . ' . , ' , valuatior�s fvr the General " � � . � � Employees f'ension Plan as of ' . � � ..� .' 111196 and 1/1 !97 for a fee not to � , � exceec! $ i 3,000 per year . • , • 7. � Other Busin�ss: 7. Analysis of how new r�les will affect : � � di�-abi�ity pensians �to be rovided at ., , $.. Ad�aurfiment: . �, �r �...:.,.... . ° �, W p next meeting. 8. 1:23 p.m. • , ' , � . � ' � - , • . � � , , . , � '��� zs.,f�i � ,�.i.'...`. . , � ;r�', � ' � . . • , , .i�. • � . .� ; . .. � ..� . . �. i'41: r. . �� . . . . . . . ' 1 ",�. . . . . � . . � ' . . , � . ' .. � ' . `(���i; � '...`� ' � , t . . ' `if'_ ' . . . � , ' ' , , . � i � ' , � ` , f' �, � � , , �� . . , � ' .. . . . � . . E . . � � . .. � � . .. e . � 5 �, � . . S• . ' , . � . ' , f i ' � . ' ' . 1 ' . .. �, f�. i j `` . . . . ' . � . � � , ' � . . ' `� • � . , � � ' . . . • , . . .. .,� . ..'�, . �... .. .� " . . . . . � � • r � , ' ; 1 . . . , . � .. • / ' , r• • f . , . . . .. .. . ; . . � . . . , . il .,1 . . ��'.� " . ..1.' : . . "l � ' . . ' } . . ' � , ?, . .. ', ' • .� . ' ' ' . . '' f� E> �1 sf � . � .� .1,� " � ' . � '. " 1 •!� ' � , ' , �` ' � " � 1� , , ,�. .� '! Y'i,l .'; :',. ,• .�<'.. . `�I . ' � . .. . ; . � 3' , . , .., . , . . .. ' ' , � ,E. : , ti . � . I . . . . li , �'!. �� :"j �ij� �7�•+ � , . ' , ' , � . ` . ' , �• . � � , �l'd"`, `� �'� �54 lJ.. .�.. , . , .� e . , . . ' . � .. . i " .., ' . � 4 ' ' . . . • z �' . ( : r'.. .. ; i, �� . '�rr . �r , f , t . �.' ` : • ' :' , ' ' � � . � . . . . . , � ' . .. �.��:p,�9 1�f>;�,�•i,��t':k'''��t`{ff��:'i,�'ir^ ��'E,�y�,.' `' ��• , ' ' r . ,i' ' „ . . . ' . . �. F . . ' . . 7 �fi,v� ��'I�!{¢S�.a:f. °�`� i;y'�•?.�:�4i;�..9i} fsii����'r � :,.` - :r.� . .. . � . , 'y���,�,��:��r ESt;,•''��7�p�.i:;:��j14�'�°.,'�X"r"�r' rx:''.;;�.:•' . ,' . . � , ' ' , , � . , , � !�j(`^/. ;:�s�,,� � {i i}•' y�,b4,lkl�{�,4•,j�,ataF.:J:z �.i� t"�i' `�� �•�::f`.. ':���`�..�4 }'.ij�; .E�, ..«��� a=. yi:t r�'d;' i, gh.-..��i. �iy.�,�, . ' °4� � • ;�' rl�� ::'i.,� " q ,�;:'}���1 ' 4��� , ��-�Y :7: �P. , a:f.' :r.��;i.��� S� °y.yr:: � . ..} . c: .: c . :�:l�r�; F•.,, . � .51':' �f . tl` �'tl' ^ �t� °s , h . 1 l •. � � ' . �rr ' I''.� . 'c r�..A'!.!:., rj,` 'x�lT�; a: �'It] ,i,.>�.;`i?i✓����I,,.�n.r��.r?4'���.�:L��'i.'J�'!�� ,�'a r !�'t...... ..= i, , .. � ... . . i:'/� . �.,��i� ��:'�' , w . � , �' . • ' . .. . . . ' Y . . � , � 'E , , • . . ' . . " " . . . � . � � � , . . �• �. . ; .o . . . .l , . ' , ,' . � `, . . � . . . ' ' . ' ' ' ' • ' . . . , : ' � .' ,. . �, � � •CITY Q�' CL�AR6VATER � ' ' ' � ' , '' ' . � EMPLOY�ES' PENSI�N PLAN . � • '� • :: �=°'' � � , . . , . '� - � '� . PEN5j(}N ADVISORY COMMITTEC. � � �. .�. , � � , � . . . � , , �;:;,.., . , . . , .. , . . � . 'i'O: � F'ension � Trustees . � � . ' , � - ��. � � • �FROM: . P�nsion Advisory Cnmmince � 1 � � . . � . ' ' ' ' ' . � � � . . • � .` . . �`�� �= - . 5UB3ECT: Recommrndatton for Acceptancc into Pension P�ua , ' � � � ..' . � � , , , • . ,, . . . , � . . . �. . ' , DAT�: . Octaber 1 �, l 995 . ' . � � ' ' � As Trustcs:s of tl�e City ef Clcurwater.Empiny�es', Pensian Fund, you ure hereby notified that the •' � �'' � employee(s) listeci helow � have becn duly cxnmincd by a Incn! nhysiciun und cttch hAS bcen � � design�atcd' as �a "�rst c�nss 'risk". � , , � ' � , , � .These em�loyces � are eligible fat pensian memb�rship us nnted in the f�et�sian Elibibility Datc ' , . cnlutt�n ' helow, and it is the recnmmendation of � the Pension Advisory Cummittee thnt tliey be ,�ii:e�ptcd � �into membcrshi�. . . , ' � ,:��4�_ � . . ;�.� . t �' � � , ;;. ` . , , . . , , Pensian P.li�: . � �� Nnme. 1ob: Clnss,,,,,& Dent.IDsv, � Hire �nte p� ' � Richard Hicics, � � l 0/1 G195 1 Q/ 1 G195 , Eguipment Operutar I ` . � � , � � � � � Ar�nc Grcet�, ' . � - ' , . Staff Assistani II � � • � � . . .` � 10/16/95 I 0/16l95 � � � `. . . ' . . . . . r, • . . � • , � ' � , ' F I . . � . . , . ,` . . ' 3 . . . . . I ' . � . , ' ' . . . . ' . . . . � � . . • . . . . � � . , � . . • ' , � � . . ' � " ' ' . � , r � . : , ' � . i ' TRUSTEES OF 7HE EMPLCIYEES' PE�lSION FUND � � = ' A�enda Co�er Memorar�dum Item �► h�teeting Date: 1 1/13/95 � � r�� u��u��uui i i r��n�������r��nrn���nnm�nnir�iiq�rWrr�rWr - � ���r subJect: Pension to be Granted RecommendationlMotian: Timothy. llcBord, Fircfiglttcr, Firc Dcpartmcnt, bc grantcd a job-connccted disability pensian und�r Scctian 2.397 of th� Emp�ayees' Pensian P�an as recommended 6y thc Pcnsion Acivisary Committee. ❑ and that ihe appro rfate officia�s be authorized to �xecufe sam�. BACKCROUND: Tir�rothy DcBord, Firefi�ittcr� was employcd by the City on Octobcr 1�, L980, and be�an p�riicipatin�; in the Aens�on Plan an khat clate. On OCiAbCF 18, 19y5, the Pension Advisory Committec (P�►Cj determined that Mr. DeBord was el�gi�l� far a�ob-connectec! disabitity pensian b�s�:d on ltis disubility resu�ting from an on-t}�e-,�ob injary. His injuries �re descrihcd as d��enerative disc. dise��se com�licated by a slip und f�!! injury which c�used permanent damabc to his lower bt�ck, specifically LS-Sl, m�king him �erm�nently unable to do his j�b. The inj�arics ��re c�acumented by medicul st3tements from Francisco Gomes, M.D.; Clinton D�vis, M.D.; P.obert Grubcr, D.O., s�nd Josepl� Papia, D.C. ' The injury of Mr. DeHard is initially documcnted by �i Notice oC Injury datcd S/I1/�2 indirating he pulled muscles in his iowcr back on Agri! 29, 19$2, wttilc �xercising on duty, A sccond Notice of Inj�ry, datcd March l3, 1995, reflects that an injury occurred aiti March 11, l9y5, wlicn I1�Sr. J.1cBord s(ipped off' a rnotor cover, canting down fram fil�ing a tank. Dr. Gon�cs relut�s by letter of' July 2f}, 1945, that, "I believe this patie�t has h7d lan�-tcrm deger�erative dl5C dise�se problcros aggravated by the in,juries of Marcn Il, 1995. This �atient is �oin� to be left �vith ��ermanent im�airment due to the injnrics...I t�a�e determined ttzis paticnt c�n no lor�ger #�e a fire fighter. By follow-up lette;r dated Je�iy 2?, i945, I�r. Gantcs rciates tfi�it Mr. DeHord will reach MMI (maxiinum medical im�rovcmcnt) by Octobcr 1, 1995, with n PPI (perman�nt physical itnpairmer�t) of �}�'o to the body as .i whale..." Dr. Clinton Davis states an August 7, I995, that he t�a� rcviewed patient's MRi scan and, "...It sliows de�cneratian uf thc LS-S 1 disc with central disc bulging and degeneration of the L4••S disc with central disc bulgin�, bt�t n o evidence for disc herniation or signif'icant s�ina� stenosis, nor is tiiere any tn�3latign�ient of t h e Reviewod by: Lec�al _.__ NA 8udget . NA Purchasing NA Risk Mgmi. NA CIS NA ACM Other NA %�1) SubmittQd by: City Mar�ager Originating Dept: Human Resources User Dep4.: AdvQrtlsed: Date; Papor: �] Not required Afiectod partles ❑ Notitled ❑ Not required Casts: $ Total Current FY Fu�ding Source: ❑ Capt.lmp. ❑ Operating ❑ Olher pnnsian Apprapriatfon Code: f�4�-o��tn-�i� o, -Q s�s- r,�4,� Commisslnn Actian: ❑ Appraved ❑ ApProved w/c4ndit�ans ❑ Donfed ❑ C�ntinued to: AttaCh ments: Latter(s) ❑ No�e °r � .. � . ' . , , ' �. , . ' � � , . ' . , � . � � • 4 � ' ' , s • . . , . , ' �' . ' ' • � • '. . , � • - � ' . • - ' . . . • . r. �� , ' . . , � .. , � . . ' e, . • ' • [ . . , ., � . . . � - . ' � . . , ' ' ' � � li .,. ' ' ' ' ' , l„ ' . �. ' • , ' . . � . . , '�. �' ` . � ' �}'. , r � ' ' � , I � . • r ` , . . ; � � ,� �' � • 1 . r ' .. . ' e ' � . . � ' . . _ , ' � e ' ' . � . . , � , II .5 . . ` . , � ' .. 'i . ' � . ; E .! . � . . ; , _ ` �. i �� . � r • . r ..� . . . � , . . • . . ' �, ' ' . � � ' �'i .1 ` . � ' � ., , . �'';t,' ,r�\.!'•�F�Ls, .rF.}�'i:f��l��:.�IY'Fi��li�.'':S• f4�: �.i[1,�1. , , 1 .. ' � � .i , r -.! ;1' ' 1. r .' :�! , � . , .�{ '���. ''. ' � •. ' � . .. • . .le. :� � .i`�'� . ' � . i � ..� . �� �. � . . � �j�:, . . . . . . �•, v . � . . ' • .I �.. � . 1 . . • . � I Agendn it�rrr—Timntf�y .DcAora., . • . � � . Pt�ge 2 . . , Navemb�r 13� ; 1995 �� , , � � s�ine,..I do belseve he hus rcuci�ed, maxitnum medical improvement t�s of this date and the •, limstutians hc has as a�result of t�is injury...�re likely, to be � perm�nent..." Dr.� Gruber. rel;�tcs on . OCtober 10, �995, "With, respect� ta whet�ier or naf his current symptoms are related to a joU- connected in,�ury, it is ths opinion of t�is� ex��miner that they indr;ed nre causally reluted, to the slip • and f�ll of 3111/9S. Th� patient did • have preexisting degenerative disc disease bUt extremely mild. TypicAl� symptoms to ba cxpecced with such inild' degenerative disc disease arould be �:arly moroing b�ck stiffness relieved with gentic flexibility exercises nnd nat the severity of symptoms which lte f #�as dcmar�strated aver the past 7 morrt�s." Dr, Papia, by �etter dated June 28, 1995, stutes th1t, "In my opir�ion tl�is patient has �reAChcd muximum �nedical imprvvcment...sti�i rnanifests subjective complaints as well as objcctive fsndiiy�s - which �►�e Cf1U511Iy related to th� slsp anci fall accident of March i 1, I995, And arc permanent ir� , nuturc...I have given Mr. DeBord a 10 per�ent impairment of whole person...He can expect furth�r spin�l joint a�d nerve ropi complic�tians in the future..." Based an �n avcrnge salury of ap�roximately $3�,989.92 aver the last five years and the scventy- - five percent {75°lnj niinimum disability benefit, Mr. DeF3ord's pcnsion wili approximate $27,242.44 . annunlly. Churts from Fi;�nncc - whie;h take into conside:ration mortality r�tes nricl age r�ilect th�t "present val�c cost nf f�nancing" tl�is pension will be appraxim��ely $38�1,I5y.63, The tot�l � actual payout will approximaie $950,155. , . . �.�'. ' . ., .. , � � ' . . s �.� �5 . � r .' ' ' ' .' � • . . . . , ' . , . . . �3, E ��. � . , .. 1 • ,. ., : � j ' . �' �� . . ' � . � � ' ' . . . 'i . �� .S . . . � � ' , � .i ' ' ' . . . . . . .� .1 .. • 1 � ' . � ' . � , • , , , ' , � �f � � , . . ' . � , . � . ' � � ' � � . . ! ' ' .. . . . . S f � , � . � ' ' i � 5 � . i�� . .. , • � . ' . , ' , � . • ' , � . I ' <I . . � � . �� � _ ' ` I ' ' ' ' � I' . . �S' ' � i . ��. � ' ' t .. � , .I• , ' ' " , ' .. • � . ' , , ' ' . � fi �. '. . .. . ' u�. , � ' ' I s .!. ' / '� I� ' � � ' , . : � . , � ' � , , . � � , . � �. -. ,' . � . ��.���..i�rklf'.4;: �.F�: ,i �, 't�ria '•p. .y. . . . �.��u' �s'7 �:t�: "3i" �:n�:'7 _t•'ti° � .�� t�r�i i'• � ,�r. � . . ' ' ' . . • � , . . �. . . . e' � , � . . z;:<' . , .. _., , , .. . :�,> <. .: � . , �.:�, ;��;.' , . . . _.,�. , ':, - , . . . .. � • • , . � ���, . , . . . f,,,,,.,,..,. +'�II�t���5.��1s'fwY � � �1T`- ' ��.,'� �y�:: ; �;• , , i . �, �t � ��.,� , „�. w� _.. . C�► -� ti ;;-��.� ���itt� �^��� 1 �Y��f�141 . . ''�rq��lrl Humrn Fiesourcat Department � 813f482�i874 �,,,. . . w . �} FROM: COP�S: su��c�: DAT�: C, T� T�'Y - C� F. � C L E A R�'�±1r A T E R ' PQST OFFICE 80X arae Cl.�ARWAT�R, FLORIDA 34R18•4748 •Honorable Mayor and Members of tne City �Commission 1y Trustees of the Employecs' Pension P��n . . � . Pension Advis�ry Cnmmittee � � ' � Deb�ic Bailey, Payroil 8ervices Managcr; Risk Man�tgeFnent Pension for Timathy DeSord--Joka-CanneCted Disa�iiity Pcnsion ' Octot�er 1 �, 1995 The Pension Advisory Committee {�AC) received an �pplication for disability pensian fram Timothy DeBord an AU�ust l4, 1�95. Mr. . DeBord hus been c�etcrmincd by the Pensian Advisory Committee to mc�;t �]� c reyuir�ntents aC the Pension Plan f'or a job-conr�ected disabiiity �ensian. He was cmpInyed b� the City an '�ctober l3, 198Q, and begnn partici�ating in thc Pension Plun on that datc. Furtljer, he �ias submitteci medical f�OCUlT1C�llation, c�pies of which arc attached, rclativc to E�is disabiiity which has #�een rc:viewed �nd approvect by the PAC. By mntian made and duly carried at its mecting of �ctober 1$, 1995, the �'cnsion Advisory Cornmittee ap�roved/recommended the grailting ai �i j4b-connected ditiability pcnsinn to Mr. DeBard in accordance with provisions o�' Section 2,397 af thc City Code. Tl�is peRSinn i ti to be effcctive on a•date to be determitied. The un�aunc oT Mr, DcBord's �cnsion wil) be calculated by thc Finar�ce Department ticeordi�g to thc: formulu in thc �ension Plan f'ar ,job-cannected disability pcnsion ut suc}i tim�: as h i s lust five years of service and sal.iry can bc computcd. I hcs•eby certit'y that thc Pensinn Aclvisary Committee has up�roved ihc granting of a joh- connected disribility �ension for Tiinothy DeBord and ttie above dutes are corrcct, �' � , �� . . � C�i711CIli�ti, �Pcnsian Adv sory, ii�iticc: ��� "�qual Employmenl nr�d Affirmative A�tiun �mpiayor" .. ` , . .�. ' ' ' .,. ' • , I • , . � . � - � . . ' � . ' , , � ,I' � , • , � ' • � . . . . . . ,. ' ! . � r . , . . , ' , . I �` � :J'• . ' ,��' � .. ' t:� k..F.r:r Y�a'Y-iv .�`.1 , ; ' . , . , • . rrY�4rYr rwwr . . � .. � � � . . i ' ' -.... ' ' ' . . ' . � � , . .. � . . f . � � ' 1 ' . . '^ . . , . , � � , � � , � �'ENSZON REQU�ST rORIYi . , �, I. Tf����y �� �e,84rd do hercby apoEy �or retircment from chc City aE Clcarwater � G��eral Employces' Pension Plaa. , . My benefiks date is actflber ].3,I.980 (Entry dats .�nto pensian• plan} ., � y, date a£ h�ire is p�tob�r 13, �98p , , ' � . Viy birti�day i5 J�:ne 27, 1954 � • ., 4fy �job classificat�on is F�r���g�ter .�_ _-r..,.,._,..,,_---..., �r�d I, work in' the ' 1 � Fire • . _ „_ ,_ „_,_ _ _ _ _ Degartmenc, _._„__,,. Divisinn. yt y resigaatiart da[e is �d' be determined . Tne typa o� pension ror wnic:� I am anpi�in; is {chcck anly one): �� Regular Pension based. on yaars vr service . . x . . �,Toi�-coa�ected D�sa�biizty Pensivn � `lon-,�ol�-connected Disability Pension � � ��iy spous�`s name is: . � Dependent children �nder the �;e oi 1S and •residin� in mv househoid are: Ki.m�erly D�nie�.I.e peBozd � October 27,�, �.�,�i _._ Kl��St.Q�QI.� ���C�'�1_��a'r��� vamej {Chiid's Dace or �inh) Sep�ember 24. ��80 F�erei�v �s:tir,� ail at �he above ta �e crue and cor;��c: , � , .r • • ; . � . 1 , • , • , _ . w.�� � i).yf �'1 ���. � r ' August 1.t� ,p 1g9S � ' � �D�te) �T.�,T� OF FLORID:s,, ihe �are;ain� inscr�men� ��vas �ctinowiec#;ed ber'ore rn� ch'-s COC7NTY . OF PINEX�L�.S� ' � by.--„ = wRO is ?�rson�li/.. , . :cnown to me or �,v�ta nas �rod�c�� ���- �� , ,: � + � �:' ` �.; = �• - - � '� � as identizir�cion �nd wao didldid zot t�it� xn �ath. , • ' -�S���z-� - - . ` • �� � ; ' �iocar� ��lolic � ' ��Y n � C,���'�C�pRlfi7K � . , r �� Lr�' C EXP��ES F.IAY 22.Ifl 9 t� CalT�miSS10�! �O. , . � `� � aar+q�o tH�ari p . _ ' �_,,. ���,��d ATU►NTlC80kpINC3C0..��+�. --',��,mc ai �ocax�� _nnced} �' ' _ ` • , � . . • , , . � i • , . • ' , ' ' � . � ' . ' i . � . . . ' ' ' ' ' . � . V . . ' , . , � ' ' , . . . . '' .. • , .. .�. . ' � . � ' � � ' , , . , , . . ' ' t� � � • � � . � � , . ' � . ' ' , .. . . . . � ' � • . . . , " . . , ' ' t , � . , ' ' � ' ' , ' . • • ^ . . ' i ' . . . ' ' • � � , " . , � . , . � ' , 1 . � '" � � .. . . . i. ' . . . • t�, � � • ' . . . - i .1 ' r . . . . .! � ' . ' . . . . . , . . , ' ' • 1 . ' i ' . . • r' n1ez • . ....., rn��.�.ir�w AJ. .4 . �S��fr' � �.�� .•,. .li: . i. •... . , � ' . �.. � " ' .11 ..Il ' ° . ° . . , 1 • . � . • i • .. i E ' � , CITY OF CLEARWATER � . GENERAL EMPLOY�ES' PENS�ON PLAN OPTIONS - FIREFiGHTERS • OPTI4N #Z: � � � Employces cun receive � lUmp sum payment for � vacation and , � � � holiday pay and 112 af accrued sick Ieavc at the timc of : separation from the City. There wil! be no 5�% . c�ednstion for , � pensian frorri this lump sum paymec�t nor will this amount covnt � ' � as ea,rnittgs in ttte c�ictzl�tiaa of tt�e pensxon. Tha 2a5t day Qf , , work wil� be the terminatian date and pensian benefics will begin ' , • � . thc follawing day. - OPTiC1N �?: � Empioyee ca�n extend termiaation date 6y the time due for � �� . vacation, haliday pay, ' and 1/2 of accrued sick leave. Tecmi�nation date will be� �the final .day of extended time. Pensian beneFits will � � �� . begin the foltowing day. �� �� (4nly avai�zble ta� ernployees hired prior t� IO11/88.) �E *+N*�k�M�k�k�k*�M�MN�M+M+k�#*�Ne�k�N**�k�*,k**�}�k,k***,�yr*�N�k**�k+�*�k+R�k�k#*�k# *:k�k^k•��k�k**+M*** I —. � i� . Y� �� Ti,mothy E. 'DeBord , an employee of the City of Clearwater, heref�y appiy for _ Qensiott benefits ur�det the City's Emplaytes'� Pensian Plan. I her�by �certify that I fully �vnderst�nd the two options afiered to m�. i chaase to r�tire usin; � . C?ption m � and wish my benetits t� be calcuiated under this fl�tion, I undcrstand that once chis form is signeci, my decisic�n is irrevacable, r� .�i%+,� i r " %� /� i EMPLOYEE'S SIGiVATURE:- � ' _,�� r � t�. ` � S�CIAL SECUR.iTY #: 3ai-54—a�e4 WIT�IESSES: r�DDRESS: 315d t�sildxed Orive �r ��� �_�.'r� ,�-..� � � � _, , r Palm i�iarbor, FL 3�G84 ' w� � � �„ :.' .' � �f,��.•.� . .lLrE-- / v DA'iE: Auqust 14 , 3.995 i.k�. � . . � . . ,, . . . .� . • . . . , t`et - , ! ' r+� . . _ . . . .. . .. . . , . . . .. . . � . . . . � . . . �i�' 'Y ; , . . , . . . ... . . ' ' ' t . r 1 ' .✓ ./ , `/ �4r V+ �r �. rw . vr 4 � �.. . v ✓ � � . . • �... �,{� ���*. � ] � •' •:• ' . ' �STATEOF FLOFiIDA � . `��.+� Q� 1����� ' �EPAR'TME�VT OF l.AgOa A11t� EMPLOYMENT S�CURI' , •. � . Division ot Warkers' Cnmpensatian � � ' . � : '� � ' � Z3ZZ �xecutive Cen�er i]rivE, East ' , Tallahas:ea, FloricEa 323p1 ' ' Ai"iE�1Tf[)N: W.C. CE.AlMS DFFICE �epoK aii daaths'by telepho�e or telegram within 2Q hnurs. PF10R11: 1•800•3Q2•1741 EMPLOYER INF�iiMAi'IQN ENfPLOYE� iIV�aRMATiqN FlR�N"5 TIA0.1E liAtiiE fFir{t. M�dGie, La7T1 50C1AL SFCLJRl7Y NUMBFA ' �• •- City of C�earwater . iimothy E�ward DeBord �Oi-54-8684 AAA11.iNG AC�i;E55 lfnciuo� Zlp Goer1 HbME AOD.tE55 Ilncwde Yiu Cnarl dCCUPATION Aqr�t Fire�i h�er ��.0. a0X Y�4H r4U� ��Ri��� S�. 5LpEAV1SOA�NAly1E . : C1 earwater, F� 335Z 7 C� earwa�.e'r, FL 335i 5. Lt. Nii chae� Ara�a , ' flEPqp7M@NT NAME � � Clearwater Fire iELEPH�NS TEI.FFI-IaNE AA7E dF BlFt7►f SE:( ,,�,. c�.: 813 �,,,m�.. �t62-65QU �,... co�.. 813 Numo�r• `t[]� -1773 6/27/5� � M C� F LQI:ATIpN v 5�m� r� M��I�n,� ►fow lonq Numper pf hour� �p�r W�ak Numd�r o� aaV� AqTE OF PAY � � �mplqVlC7 work�C work� p11f wR�K � 7e �� r 56 � p.� o.� 5558. 7$� �., ►+o� ' i�2 J. Osceoia ��1�. II p�ece work or commnuon, enter !f baar6, tpaq,ng o+ otrtcr p pe� �a, Gi eanvater, �� J3:J f 9 Wfr'Qf wevqlV imCU11t amaun�� lurmsneti. �ft�e+ WMkIY U'� ..week�yA.• Wc _ � SYpRKER'S GOMPENSATION CUVERAGE BY r����uranr� �pm9��ti' X S�lt•Inyurrtl � GI VE NAME, AQCRE55 AYd F'OLIGY NUh48E R OF INSURAfvCE CDMPqNY vATURE OF 6tf51NF55 OR SHl.f•I�,,�Rpp SFRVICE GOMPANY, �iunz ci pal ity R. P. H�WlT7 ANC3 ASSOCIAT�S OF FL�RIDA INC, ' 'El)ERAL ES�SPLQV�Fi I.b. rvuhi8�fl P. 0. BOX i9126 • r��–���Da2�� OFiE.ANDO, �LOF�I�A 3Z8i4 PHdNc {305! 89d-4011 ACClOENT INFf)RMA'TION ]:.:� aNp r�ti+E qF aGC�GENS DATE ANp Tit.1k FiRST REPORTEU NAl.1E, A17DPG55 AN4 �MQIJE !,lUht$ER dF pM�51C�. 4/29/82 Zfl3D hrs 4 29 82 203� hrs. Fr�d Tucker plACE OF ACC1��fKT 1$l�r�t. GtY, GUUntY.51�t�1 1.ASi OATE EMPLdYEE WpAKEI� 534 htandaZay Mortan P3ant Haspital Clearwater, �L �E*URTlE� TO WORK Y*i �`10 pHYSIClAN AUTHOAI,',ED F!Y �MPtOYEFI LJY�s 4J� � �Pineilas} IFY�S,DpTE NAME.AbDRE55MNl7i'HONEOFrl65�{TAL mpwr+.•a�d+or �Yn ❑Na .4.'. °„" "„ Morton P1 ant Hospi ta� �l��pLOYEE MISS�D ONE Sli1FT, OrvE OnY_OH MARE? n y.+ pNo � 323 Jeffords 5t. , C1 earwater .YA5 INdUHY FATAL7 CYet +�,'-]�o II Yet, b�te p} p�ath sLAPL4YEE'S DfSCRIPTION QF ACCiL]cNT IG��e avtailF tuch si, f*11, w�� �nuck, rtc.! "Exercisir�g" doing s�uats using barbel7 weight. , I comp�eted two sets of squats, on tt�e third set of squa�s the last repetition when i stood up to � replac� the bar on �f�e racic, I felt a pa�in in my lower hack. ;MPl,QYER: t ap�e wi[� th�� ddcrionani Q Yn � Na If no.•��pl�in In eomm�nt�. QMMENTT: {Include narr�es o# 4�tnesses to ihc aC�idenL.a DESCFIIl3E INJVRY OR pISEASE ANO �NOICAi" PART O� B017Y AFFECTED I�.q. Ampuutinn ol n�� indu ��nqcr •t aecqntl �oint, F�actur�q r�ps, Lei panoninp, src.J Pui i ed me�scl es of the 1 awer hac} Any person who, lsnowingly and with intent to injure, defraud ar d�ive any emoloyer or empinyee, insurance tompany, ar self•insured pmcpam, files a statement oi claitn containing any false or misle�ding infprmetidn is guilty of a felony ot the thlyd degree, .. , . . �, � EMPLOY�R {Read and Sig�1 `�—�—� NATURE . DATS q� .�. ��- EMPLOYE� {Read and Sion1 ' ` ' ' . –• �,��1� � src�aruNE � Aa,r� '�t. . _ . _ .., . .. . . .. . t.. .. . ..., . . � ,� ..... . . , .,. ... . , , .. . , . � _�._........._._....__.------_.._____..�,....��_._.__._..,.._..,�_..._ .. ..__._.p.._.:____.._..._ .....-----�-..-....._... .._..._�_.._�..�._�.: omsiorr ��ca�c� r ' ' . FOR CAWAIER'S fJA'�� $TAMP � FLORiDA DEPARTMENT O� LA84R AND EMPLOYMENT SECURiTY R6c'D BY CARFiIER S�NT To DlvfslON � DIVlSION O� WORK�RS' COMPENSATION � ' 1-80�Q-3d2•�7a� {or) contaci y+aur loctt! emca tor asslstanc� . �OT�C� OF iNJURY , , • , Aepnrt aif deattts wikhin 24 hours (904) 486•3444. - 1 - ' ' ` f%�-,,,, •' V ;, � �MPL4Y � INFORMATION NAINE {Firat, Mbdlo, last) Sa�al SeCUr�Sy Numbor Oate and lime at Accidant T��athy :. ���or� ��I-��-'���� �'?-_1-'�� �na0 hrs. � M%AAORE 5(Indutie ZIp} � EMFLQY�E'S 0£SCRIPTfQlV OF ACCfDEi�ti io rra[tk.l..#x� SC. �1.earwatc:r r; 340�.& S� i o��r� off motor cav�r, coni nc� down �rom '�a� k ' , • t L,�PkiON 0�5CR18E tN.11JRY QR DlSEASE ANb tNbICATE PART O� 60DY AFFECT�D 1 Nea Ln4� t t'I MrnEw :.: '1 _.: '! rTlS c � r�. �3 I �? ! `,r� (e,g. Ampulatian a(ri4h1 Index fmyer at,sacon �oinl. lrpUyrod nbs, �oad polsaning, elc.f �acx, �ert ar�n� r��n� �en, rz�t�t �n�e , 01Q YOl7 RE(}UE9T M�DICAI. CARE7 .�YES p NO IF Y�S, pl0 EMPLOYER PROVIRE MEpiCA1.7_ � YE$ n AIO . �M��.OYER fN�ORMAY'tOM - -- F1itM'S NAh1E ANp A�DRESS FE��RA�. 1.D. NUMBER DATC AND 71ME F3Fi57 AEP4RTEti C��y ot �laa.:aazzr, �Jept. 12?J ": _r;, r •1 0 �};,11,.�� ''}�:�� },r . 1� .Q. BQX 4%4d • W.C. COVERAC3E BY POLICI7MEMB�R Nlfkl6�R l+�E.'�rWa�zx �� :i4b i �i � iNSUreAr�c� c0 � SELF-IN5UR�b � � � � NAM�, Al7i7R�5S, TE�EPHON� OF EpHON� INSURANCE C4. OR SEFiVIG� GOMPANY W11.1. YQU CONiINUE TO PAY � �A'� � � �`"' � Jah�s Eastero Company, ��C. SAWRY� :� YE5 ❑ NO PNG� pFl�C.CCIBE�I'T (5treet, Clty, Counry, Stata) post Office [3ox 3318 LAST DAY PnID THROUGW 1�� ��1 �Ra�C�Vi el�! �Od� Snrasate, FL 3423Q r � �Z�ai'��Iu�21'� �iii���cT$� r�Qt'T�id i-$00-749-3044 ApTEflFP1,Y �HH �lWK NAM�, Al7DRE55 ATJb 7�LEANpNE S L. 33� pE� � pAY G� Mf0 qF PNYSIGtA13 OR H05PI7AL Num �! t�aurs , �IO 7HE �MPi.OYEE KNOWiNGLY R�FUSE TO U$� A SAF'ETY ' y . Week • A,PPLIANCE PHOVIb@D BY YiOU. THE �MP�OYER7 C YE5 � N� �Q �:���" t� ;°f�� �'" IY1 y� i n 7 C �! mper Of hquts �(: L1ATE EMPLOYED LAST OATE EMPEAYE£ WORKEp �r ��k '„ �'j �� j �' , i ! . � . 1 '� Numtrer ot days ;,'� I 1 � /'�� rj� t ? i � r� ;;_ ,?�;^�.J•� �?1" �'� �'��'� 1 PRrID FflR t7AT� O� IIYJURY 7r1r+ .��r7-- • fiETU�3NED Tp Wt}�K Q Y�S Ea NO RiJi}iQRiZ���Y �MPWY�H � YE5 � N� YES ["..p NO � EF YE9, GIVE t7AF� ! � LQCATIQN ADDRESS WAS INJUqY FAFAL7 �j Y�S � NQ IF YES, GIVE dAT� pF DEAiN! � {tOCA710N +� , IF APP�.ICABL� A�GH�E V'11TH pFSCRIPTION O� ACCl�ENT7 NAT(!flE O� BU6iNESS � YES Q hfq fF NO ATTACH EXPLQNRitC3N Ariy porsan who, knowingfy and w�tfi Intenl ta Iniure, dalraud or decelve eroy umplW er or emalayea, �n,urarlce comparty or se�l•insur8d pragram, files arty statament n} ela�rri cantaininq arry falsu ov misieading inlormatian is guilry a! � telany �i 1hs thiref degree. I havQ qrovid� Ihn emp[ayee their copyr ot ctr's notrce: � � In Perscn � By, Ma�l ..±�: �'.I,,ri �i:� ',�L� .���:�j����^_ ^,�' ��� � � ^T ,. ...��+' . J �• � '� , . 1 EMPL0IIE£ 51GNATURc pl evnskabk W sy�n) pATE EA+tPLQYER S�CyNAT�RE GATE GAflRIE{i IiVFQRfiRATION Carrier Rudii � Lacation # Sef�rrCa Co. � Cani�r Fila � L� �. Go�ttrararling Caso—DWC-12, NOTECE OF DENIAL ATTACFiE� p 2. Lost'�'Ime Case—Rats of First Paymar�t � ! AVYW ._ Camp f�ato — -- First day of dlsability � � —Dale of First Contact with CiaEmant...�> > �!n Person r'' 7elephone ^ Ma�i --�tolico Filed pue lo Multlplu Periods of []i5ability. Oates Cwered by �ivst Paym�nt ,._— .. „_., ❑ 7TD. t] T.P.D. Oate �orm Rec'd. i � ❑ Cat�strophic �� P.T.�. �� Death C� 3. Madlcnl �nly whlch t�ecame a Lost T1me Case. {Complete all intormat�on in itam 2 a�avoj REMAflKS: A[7JU5i�Fi NRM�: CARRIEf� NAME, ADpFiE$5 $ 1'�I.EPHONE; ��� �ES Fwm flwc�t t�r�il � _ . :`.��]I f`�I �� ^!`R�.I - ; � ` . � `. , . �i5. , . . ' ' 1 . , , 'r . . . . . ' . ' . . .'� I ' ' .. ' • . . � . � 3 . , � . , 3 . ' � ' ' ' i I ' . � . = . ' . . � . . t ' � . . � • ' � i � � i . 1 " .� � , ' • � , ` ' � . .. , 1 . I� � , ' •, , ' • . ' �� i . • ��.»�'. i < . ... ... ., + f � . � ')�' � tt•A•f• t�•�� nf..: •l:' .. . ' . . .. . . . . . .... � � ' 1 � � �'. . � � � w■�� �� ' � • �'R.�,NCI5C0 B . GOMES , M . D . , F . A . ' ' . � SPZNE SPECrALTY � � � HQARD CEftTiFZED. N£UiZOLOGICAL Si1RGE�N 52PJ6. N. ARMEisIA AVE. � � . 7A9�. ULMERTON RD. #2—B TAMPR, FL 336�i3 � ' LARGO, �'L 3A64�., (8�,3? 875-2225 � . (813} 539-0554� . '. FAX (813} 87�-56�.3 • , . . �i�JL'i :.C►, ia�� " ,' . T�: �:�?�IS�Ojd �►�JVISU�?Y� CC�i�t:zTTE� .'.E . `s�TrnC��1':: I' D$B��:J i•lP.. TII•lUT'.-:�' �eBaR'�J ?:�i.S $�;�t;► i�r.Ta.EyT CJ�' I9�I�?�. ST_I�C= AP ;�i� 12, i9a5. P�TT�.�'�'T' S�YCri I'': �'UR?ES G� BAGK TO K��:iL .s0, ? 982. Ti�iS Wna r� I�I�'TI?'1G Yi`l3U�:Y e�T WG?.�C. PATTEI3T� OV�R ' THr, Yr,n:,S :iAa" T1�,VELOt��D PROGRESSs.VE �LGEPJ�P,RTTVE DISC DIS�AS� n'?' 30Tu L�,Vc,LS, L4--5 �.VA �w5� . Pr,?'IEid?' :�ti -IPIJi3F.�D 'r'.IS BACu :.GnTN �T WORK rN E�1r,icCr: ��� , 19�a. ::. 4i;,,S RF-WOP.K�1] lI� W�T�i ;1�.� ng�r r,� Tu� LUI•IBQSAC:[AL SPII'��. �:•? nPR.rL i�, :.995. `ii:a.S �3rOW5 n�V?-i:ti�-=-� s��G�,?�1��:.TI'VE �ISC JTSE:,SE �;T B�TI�: LEVELS, L4-5 Ad�:� r-3 � ZdSi:i BL1LC•,z?�cT 3liSCS nT �DTti? ?��V�LS� t�lUR� MnF.i:�:1 nT L�-5i. .i 3^LX:.V�, TH�4 ?.;'I��'I'da' Hn5 ^ni� LDI�G�i'�,n9d D�G�N�dnT�V;: �?',:C i�=$��.5� ?ODi�u�!•15 rGi:r.KV:."E'�.U,3Y '?''::. _:iui�R1:aS 'JF �9ARC:� :��, �9�+�. ;::-r5 an�_:i:': i� GrJ�I�i� Tta ;�� LErT ��=T:! i, ��itll:,�`.'�rlT ?'I•i�'r".IKI•3�'i.T :l:I� '..� `I'i-._ _:•!.Jva��.•a n::�. ?oQGF.��S_`l� T��•G�1'1Ey.�TTr,s1 UF :'ii� '_,��.�iB;-:�? �J?'Sr5 :,'�' �.�-> >i��J 3�-51. nFi'.��.'.. �EVI.r�iiI';G TIti�, CTTY OF CL��,RW„x£�. : ru�` �.�G'r.'Z'�It(= Ji?� n�'a�v�P^:�C�i, _ HriV�� p�m��r,iT:d�D T�?rT T?i�.,S :�_rz�,f.;m rnl: "�C� �.�C^-�:'�:'. ��' � r?'R� FI�H��.R B�Ci�US� OF Tn� P!�iYSICn�, DE�;r,NDS '?'!:r.'� VU titlTu '.'h� JOB �" SCK� �TT_QI� r II?C?yUDS2�G `I'Hr. 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OF FORCE i,11: T�i� C�:�:�5'i';' US� �U`f'U �'.'.T�ACT?at: �Q�T?r�E�JT �l�=G;;�P:G 6�J L�iS. �'Y:.T ::hS ?O'� �.i1Ti�L TWIS i II;G I•IUTiOI': T::AT CnP1 C.:fC.=..= J��0 L3S . Or : OP.C�.. ;�LI� ' 'i`ii�S� PHxS�Ci,1� RE2Ll�.R�I�i�..lT� W+�`JLD T$P2L� TQ nGGxAVA"' : HIS C.�:��I'I'i�".�t.; �,S D.�nGi;OS :'� C.�US�:iG FvPTh'�:? p��4Gi;�SS�V : �.7'�?WR��P.:;T=�i:. ' �riPROVEI�:E::T I':'. EMPLOY�,�.' S �OI�7iTZdi'; xS :�UT �::?�CT�'a TC QC�.Ui: 1:�� �'??�' c�1.'TLrR� DUE Ta T?i� ?E�M�1�iE�`1T r1l,TLSR� U'r' '�'!?E �1��Ji1F:� :5 �,'•�J ?:;pGR�',^,SIV� �ETEt�..�CiRA'rI0:3 QF T�� St'Iivn�'� ?nTHC}s.r3GY. ' �: ?:?Uf:;:::r`.'1 : �'S�'1_�. tl�ini.=ll�if'� �'..�.1�_Cn� ?:i�:��V:�'�Fi��iT� �J C'i�_ _J��.� _, 1 G4� . a�S�.nSL f:.:•� . �!+I° tLrrtjri IF 'iGU �.I1=�� APlY sURTs-;�f: ?'::!"qRIiY.�TG": C'"�i '�'H=S r�e:Tr�'"''r. � � Ja 1 � W.�• . .`' � � ,� U rL�=r n � . . I , . � . � ��:nrac: sca :�. cei�r�s, r�.n. , �.�. = �c=i i���� � . ����:Tn�' ;D �sl� i :�:0 i ��(]OFREAT] � ' . 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' �p�,;�� ' . . `'� . :� - � .�.� ...� .:... . . . . ::..,, :.�..,4K. �Y�:<<��,�,•. . ;,��°.r:;, _.,r•P.r.��: 6�°�';° . „ � ,•.�:� � r ,,. .. ._ . . • , , � ��. . .. _� •, . � , . . . . . . . , �, , 1 . ' I , ' • ' . . " - . , , ' • , . � � ' . � , • i , . i j_ � ' . . . � . . ' . . i'� � .� , . , . . , ' � " � �� FRANC�SCO �. G�34ES, M.D., P.A. . ! �.�. � � � � SP�NE SPECIALTY . . � m . .. , � �, , � ,� � " � BOAR� CERTIF��,D NEUROL4GTCA� SURGEON �� � ,•5206 N. ARMWN�A AVE. 749�. ULMERT�N RD. �2—B, ' TAMPA', FL ' 33fq3 � ,� ' L�RGO� �'L 3�6�1 (8��3) 8"T5-2225 ' • . . (8�.3} 539-0554 . .. ` � FAX (.813j 875-56}.3.� . � ' ' �71�i� ��, Z�+G7 JG�i! � i�IAP.C�+J " ' • ��.Si: i'YhA�iJ'Al+�t:�1�T SP�C.Ie�LTST �' . ' ' Cw7`'t •C��' �LLr,ntZ,SJit'."Ett � ' . P.O. ���X.�7d_$� ' , . . � . �. CLEAFW;,TEF., FL ."s4ti? �5-47�� � ` � , . ?E: 'I'�rdOTHY �eSORD ° WE HAVE R�V:.�WED T�:E ��IEDICAL P.ECORDS OFti T�MOTk:Y LIeBORA. �Fd. i•.Y OP.�i�FID�� THiS PATx�ivT CA�,'r;OT R�mURId TO HIS ?�RLV�OU� E:lPLQ'�I�3Et�T - � izc :� :=::� F_TG�T�.R Wi'i'ii T'�E C.iTY OF Ci�E:,RWATER F?�F'k' ��J�.PA�:'1•1=;1T. I FiEL,�VF TH:.S ?ATIE.�1T WILL P.EACH t•1M? (AIA:�II�fUf�i E•.���C�,L TMPn4V�t.��•7T} �':' OCT4Hr.:: 1, ? 995 � W�T'r: F� PPI {��f;I•3A:v.�".:`}T Y'H ; S�;C�L ?MPTi�P.t•?£P;T )�� �`+� TU T:i�' BUD�' , i�S r► WHdI�r, . PL=.IiS:. L�T Ei : l?VC�t�T IF' '�t�i� ?��^,�D l�f,t•.• 'r'U::'I'�:.=� j�:`:: ��Ct•3;�TIOII OIv a[ii S r�ATZE�iT . � ..r��'' •.• � . /*r , � � F . , , ` � ���L '�-2� - , t.� . � . . ti �Pnra���.�c� �. �-�i•iES; t�i.D. , �.�►. , � w��;.i,;� , . , , D? CT,�T:.?i 3UT i:r'T � r�POOFREAD . � r �u � � .�.�.�. � ., . � . , ,� � ' ' . . , • , ' , • . ; � � � ' . .� �.� �� . , . ��i , .. , . � � . . .� i1 , � � ' . .. . . • . i � .� . �1 1 1 . � � . � . . . � � . � '�. i � I . ' .. , � �!, � . , ; . , ' ' .r ., .. ... ..� . � .—. .. i. �. r . '��:� ..e i. . ��ts .�. . . . . .., � . , ., , i �t . . . E R � . � ti.I. F�.��RID:1 ���TfI�P.I��[C. ;1SSnCI1T�5 ;�Ot} �'r7GR'Cf3 STREET `'OI?.TH � :�'. �CTE:?S�t;P.G. CE. �.","0� � Sl]iJ� �a�.���a�.l� . , PROGRI'Sy `;�TF ' � r'•1���Ei 'L/F'L+41l�L+, i 1�.�{�Tf��[ , ' � . � � � . PTn: � a:i7 s 1 ' � • .�G C: �t 1 . . . RF.T': k��? .�'��DE¢ �[�`' , ' L3/�: C?`:r��ItiG . . D;1TL: ��,��}^_ 1�� . � 11r. DeF�a: rl is ��1 �ear c�Ic� firefi�;ttter °ar the t�itc of CZe��r�v;�t�r. ���e's rsferred . to me hc� Pam Laucleri,�.ch. `.1r. Def3orrl is sz���' for eval�aation of, la:r i��;�c:k :�iicl ri_hl 1�� �ain. Ff� iriiti�ll�• �uffered an an--tt-�e-lrsb inj+.�r,v in� 1'�32 wi�iii� tiftin�. He s�lfferec.l aPV�r� lo:{:er baciC ,�+ain as a r�sult, af this liFtin� injalry and :+�as off ::•ar�; f�;r �t,r�e :�r:�k�.. �lis :t-rati•s :serw• ne��.�tive fnr :in.y Fra,:G+i��PS, iin:ti��ver. he �.la�s r�r�t fP�l l�e'.: �v�r ra�ll,�•.been the �ttni� as f':�r �:, lzis lc,t�� h.�c:k is cnnc�rn�ci �inr:e that kini�, �fe h�s ljac! rec+�r•rert� r�pi::r,clrs rtf �na�� .t�;�r:1: �,�in an�1 sr�,�,e r�i�,•}yt ��.�ktock �n��l «osterior thi��h p�ii�. irlcr�ati�cl :cit€� siktin�, Then, on �.^,/tI/'?�. he slipp��i an�l �f�ll nff tl�e uic�kc��� �nv�r nP th� fire en�ine. , lan�line on a r.'onci•et� floor, svtiicli i��ark�alj�• :��;��ravateci f��is Eok�Pr I,;,c� an�i ri�;itt . le� ��ir�. H� �.�•as s�en zt �:4al1;--i� r,Iinic: �ihere h� ws�s nol.��l tn t��ave � l�t oP � nti�asc:iQ :,�asm in his lotver }7ac}c. �i� �,►�as r,1t11htF: ta ��•�rk for a cr�ek .;nrt tftien ::�tr Dr. I'a�ia: Ke a1�U t�.�cl sc�uic i�ft-si�l�ci iiec.k ��ir� as a res�.ilt ol' t.h� f:ill f'rc�n� thN fira �����ine. i�i� 1«:r l��acl: �.zin is a�'�•rav�tL�.l t•�,�� cu�.i«�l�in�. ;»r�::r.ii�_ afl�.tinir��. �rt►]�r���c! siitln_ 1����slir,:;� f�r:rari3 c,r Iiftili�;. ' � fl.� :��5�: ::�:� Dr. Ft•�r��i::;:o Go��rE�s. ,�•l��� s�s�t hi��� Co�• .�f; tiIF.I :�c.�;, �.+•1�i�.:f�R :t,ti� abt��iiied 7t `��rthsi�le Hospilai. T i,,�ve rc�vie�reci 6��t1� l}» rt�U�sr�. .�ntl t1�e !,iTt! sca;�. It si•�ac�s �.t��;eneratior� c�f lt�e La-SI cti�c ;a•it}� �:entr:�! cllsr, �,Ul;ir�:; an�l cla3�neratiun af the L-�-:S clisc �vitl� c�ntr�zj disc f�UlE�riri�'. hux nc� �videncs {'ur r�i::c: herr�iation or �i�nificant spir�al stenosis. nnr is ti�erf� art,�• u�.�luli=n�ri�nt of t!�e spine. ' T��e p�tierit :�:ys :;�nt Cnr :� FuncEion:i� C;i�a.�r,ii�� �valu��tion :�;,icli he ��,tiri. tchich i�l�iicat�rl that h� iia�i ��Q 11�. llftisi; :•estr'tction. TI��� p�7lienl r.,���� ttsat. �.tr�ft,rt��nal�l�'. ;ti•itl� his i�:jcn anci its �:urrir�l c�n�ii�ion. �;c' ; r�alI�• +.�r��ti�lc� tu �.l�, hia nor�i�:�l �curi; c,��ahilitie� as a fir�fi�lztar. �ie i� r�quic•er� to clo �� l4t o;' :ti•nrk with � 3� lh. ��ir-�acic nn his bacl�. The patis�tt has t�ken I���tprofen ancl C�rc�o��nzoprir��. !{� harl ph.rsic=31 tl�er.tip�• , f�r a cn�l�le �{' iiionths :vhich dicl help hi�n. but l�.�s «at :allasc��ci I�im to �et h:i�:lc tn th� point :� here iie �oulci' do hi� previa�s �ioh. N�'s alss� t�.3c� sur:�e +:lzir•+�E�rrac�tic , .��1 ju�t�ii�:r�t� :4�1-�i�:h I-�e fr�ls 1���-1�e�! hini :,niii�:. C[;RRE`:T 1�tED[C.�1TI0`�S: I�7E1�31�u£�r� an�i Cti'clape�lz,�prinE�, nRi;G :11,I.�RGIES: tifln� knuwn. S1�C7KI.`�G 1�[5'r�R�': ��N�r;Stivt�. `°..' � � � . . .. . � , . , , . , r• . '. � �, . ' ` ' ' ' ' � . . , , . . � , . . i '� I, • , t � , � � . � . . � . . , � . . � . , .. . . F� . . , ' . ' . � ] � � c. . t . . ' . � . � . . � . . . . • � � � 1 . . � . . . �.�[ ' i ; : t. .; . . ° . ' " ' ' � . ' � � � , i. . � . . .' ' ' ' �. . , , ' � �S ,' ' 1 . � ' . . !. . '' � . . ' . � , . ! � . ' • � � . � � � ' . � , 1 `. . . � � � . �i ' , ' � � . � � f.1t.r . ..v . ... ... ... .. . . .... ..�.. ,.f . 't:t'i� „ .i,. � :t. . � � . . . . , r � 7•• t . � :p� 1 i�. . . ' ' f � • • �� ' ' ��' • • . :�r.�. �co�:r�:t ��TFi��,iEDrc .�ssocr,.�Trs : ��an r�c��'RTiI STP.�i T �aRTx � � ST. PET�FtSL3CR�. FL a�7Q ; • , ' , " i $t.�i� J��i "'J��« . � PR�GRESS �ioTr �P.1GE .�'S1'(? `�:�1[�: . �'TK: �:iTE:. at��f3RD. rI11�Tl�(Y ���'T 1 08,'Q"_; n� � 3 • . . � ' . . ., . 1 • . . ' i I P�1�'SIt',��. Ev�1�1:. �h�uws �3 ���altfi�•-aP���rin�, a0 �•e:ar o1�3 «hite ma�� ir� n� ar.��te ciistress. K�: t�as niild t�;rtc�ern�:;s in the �o::'�r Lumhar ar�a. Strai�hl l�� raisina nn thp left cloe� ai�ravate E�is la,�er l�r�ck p�in. F,ul dnesr�'t c�a�is� lr+ie raciicular 1�� pain. He i•�aa a no�mal neuroln�ic exam throu�izout th� lower extr�uiities. Ther�'� �ZO lrurik :,liiFt. �caliosis or spinai 'rleFarmit�•. �e r.an F�r�,►���rd f]e:t a5�u# 6�' corol�ijtet.i lurn�ic�sacral nioti�a�z �n�� r.;�i} e::ten�i ;0'. . . I.'.iPR�SSiO��: D��sr�2rativF luiiiblr L-�-S �tic� L:i-Si cle,�ti�rative ciisr, r3,is�mse �cit�-� �r•au:�zatic a�T�rr,3watic�ri. � ��pQ�rentiv. the �:�ntrat questian that tt-,e patieni neeci� ar�s�verin� is his +ti•oi•!c ciis�psition. He doe5 not i'eel that hc� can retiirn to his prQvi�ils jUl� clesc:ri�tion :�nci ��e i� �iver� the cap1• o£ that nffzcial jnb �iesr_ription and it is q�sit� t•i�c�rous an�i i cio�l��. ��lv{�i2 t�i� condition. �ze irnulci 1,� a1�1� �a nQrforn� L�lf?SP. rl:�ties in the f;jt:.�re. :'v� t��le' hini t��at most of t�i:; co��s�sj:�ir��� ,1re�, nf �:u���•s�. �cilfi�c:liv� in ncit�.ir� an�.� tl►at ik is u,ft�n'c�i�'fir,ttlt 1.r� r.ni•relat.e tlzQ .;��l�j��tiv� r.nm�}:�ints xill� tltie ua�izctive finctin�•s nt� �tiz p11�•si�:ai �:c���tiin�tiu�i �r«i ti•�e `.1R1 l�st�. t�;�r. tI�i� is nt�t �.�n�.�stial, C�rtai�;t�•. F�is cnn��laints a!•� cansiste��t �.��ith lhe inj:��ies tl-�.it h�'s ha�t 7r►ci tt�� tiRI s�:3n Cinc�in�s that t�e has had. F3aseci on th� hiwt��}• :i��t h�� h�is �riv�rti me. �t ;vo�1ld seeni f�irl.�• cle�r tt���t his lo:c h��c:k pr•ohlen�s anE] lir��itations ar� clii•�r,ti�• rel��ket1 tn the t�.�o si�nificant in3uries th��t Y�e', ha�.l ,4 hile �+•or�:in�. F�in r,eliev� lt� 1»s r�acit��i ma:ciiii�sn� meciic�l improvemer�t �} � ctif thi� aata anci t�i�f �F�� �iniit.atinns h� fias as ci resu)f �sf ti�is in i,ir}- anci ,�s ,�ccit'iccil��• riotc�<I itt h�is T'unctiqn:a! Cap�,cit�- �val�iatinn �r� likel�• to l,e oe�•m:�i�er�t. Rf.tlEl�n f�R`:. CIir�l�n F. Davis. J1.D. CBD/nrr E"D OF R���3RT � , T: c}Si07/`?5 � . r;c:: . Timc�tl���• Det3ord � . ' ��nsion .-tdvisor.� Committee Insurance Carrier �'..•l " +—r �. �; ' f . � •' . ' ' . . T� �, : �' "�-�' r' ' � . ; !�� ;�;�e r'' ., . �•'".[;w= ��, � .:`�.�/ �� � ++ �.i .,r.r'' , ��� r � , : . � . � � .' ' , � . ' . ' r . � . + . , i ,;: . , � . . . . � ' , � . ' '�. . . � � ,. , ' � � ' � . . . . . . ' , . . � ' ' � .. . • , , . . � . ' ' • . ' � , ' ' - ' . • , , • , � 1. I � . ' . F . , • � ' • .• . ' � • • , . ' . `' .. . . . �. . . . ' „ 1 � � � . . . .. i . . i ' ' � , , . ' . . ' . . . . . , . ii . ' , ' , ' . . . . � . , . ''Sfz ';•e..:�:'.'r ti. �' '� . , f . . .� -t . ' . � • ' . ' . ; f. . � , . . . S' ' ' . . �; ,:; i � ' . �'i i 'c a , ` . . ' ' .. . • . . � :' � ' . �::'�e ..:`,i� .' f. o.. .''?'3 ...���`,' � .'lv-�'?... . . �r' ` , .: �:, . , „ � .. .,. . . , . . . . . i . , � � � ` ' � � � r � . � . `�� T�'.� l � ' � . �M�if M �� . . �. � �i� A.LL FL.a�ii)A� O�THOPAEDiC� .A�SSO�CIA'�ES • . Robert G. Hamiltan. M.D. . � � , � : ,. Lawrence M. Gnage, M,D. � � � Brctt R. Hol�ofner, M.D. � Dule G. Bramlct, M.D. � ° � ' ' ; � Clintoa �. Davis, �,I.D. _ � � � . � lorgc A. Rodriguez.lr., M.D. � . ' � , . • , ' . Scott E. Raub. D.�. '. . ` � ., September 25, 1995 Txmothy Desord — ' � 3154 Mildred Drive, � ' . � Palm Harbor,,FL 34684 � ' RB: DBBORD, Timothy ' �' ', , . PT#: 55771 ' • � 1]ear Mr . DeBord :� � This letter is written in response �o your request of.09/14/95 �or a Permanent �rrmairment Rat�.ng. ' I have consulted the Florida I�aizmu�nt Guide, Page 13, N�iaer q, which would be in ef�ect �or the dates o� yaur injuries, and it indicates that you wvul.d be entitled ta a Permanent Irapairmen� of 7�C �o= one �.evel and l�C �or a second l�ve� and thus your combined Perm�.nent impaix�nen� with respect �o the whole body would b� 8�r. � agzee with a Maximum Medical improvemen� date of 4ctober �., �.995. 5houid you have an}� other ques�a.ons or concerns regasding this matter please conCact me. Sincerely,� �, ;�?i�"� �•.•:—''�r'•,1•r, Jri • -: ,,,,,w�;,,;,..,� ,�t � •'�r ;;,�.�,�,,��: r.-,� r . � ';.. � , C?in�on B, Davis, M.D. C9n;cmc ?': .09/28/g5 � P,O. Box 7b33Q � 5t. Petersburd, Flnrida 3373Y • � .�60� »th 5�re�t North • St. P�ter�bu���, Florida 33703 •(313) 5?7•5272. •�aY (8 i�) S�'_-7� i 3 S .� ., . . . . . . . .. . .. . , >, . � .. ' � i - :;�'t;,��r;r<<��;�r��� �:<<,��r . : �'��o�1d�. ��ine ��s����#� i)nl�upar�lic Spi�tc tiiirgcry � Cllcy Lclr�c�st JI�t��t�• s�r,r�� r.'u,�� c��,►r��r �,r rc��� i•�rrr�•�� .tir�rr��s � n��,i���, r �t�i�lan��, ��.lf„ i�.1, i � • . � �lit.�lxti► c;. �irns, �! U.. i'..1 � . I'.itii 1. '/..�E�. !I.U. ' �. - . • �n�cr�«•�,: »,�,�r.u.�f. octaber 10, 1995 ,�., . , . ! C):ni�t.�. `tc�,.it.sr. �I,l). � , . ; - �crtR�•, ;li:�m.Il,li. i. � llnho���rdi� 5tiir�cr} . , . � �`"` `� '�"'�"'�'��°3� • Deborah L. Ford, Staff Assis�ant II� �ht•��C:�l �t�ai�:�t� City oF C3.earwater, Human R�sourc:es Dept. , . � uc ttchah{��is�ian • p, 0. BOX �748 ' ��,h�n�,��n�hc;.!)tf � C�earwater �'L. 347618�4748 � �:�„►�t:lrltinc G. ]iuucl:l:iti. 11.I) � . � I !'r.��ic:�:+� �1. I'f�rn>•iL��nn,. .Il.q. I i�rn�ictl� i�. EDutti�•ii�. .�1.U. , Re : T a�mothy Dehard � 2��. Z� � � � []c:ti:�n�in f(. .lucrh.�ch. n.l). ' ��ur,lt,�. � Dear Ms . Ford : - . i �.�in� l). t,i'�rrm�-(:u��ulu. �1.0 i � Lt�������r�«���.!����� , The �o].low�.ng Tndependent Medica�. Ev�luation is per�ormed ��un,n�i����,y ! on patient, Ti.mothy Debord, for EvaYuat�.on of injuries {:. E�, a�»i,. u.L�. ; received status past accupational injury. zt is' bas�d Psychuln�,ry I upon reva.ew o� medical records, exam�nation o� the �tl�h;�rd �',1'r.rrtl,. Nft. p. p8t1�'iit� r@V1EW � Of current X��'8]i� aS We�.�. a5 my train�.ng and exper�.ence as a� Board Certif a.ed Specia3.zst in Chrnnic :':eEn , c:�,.�ri�, �:. n��i����:. n.c�. � Phys�.cal Medicine and Rehabilitation. I.ti nur t', i:ulu�36tu. n,U. . � CHIEF COMPLAZNT: . Low back and 'r.ight ].eg pai.n. �(�ifrc� �:�r��c�.5c�i•ric•c�s. t r�u:��;in� ; H=STORY: 41 yeaz o1d white mai� presents for evaluation ���z: � of iow back and right �.ower extremity �ain report�dly an '•r'��1° = onset 3/11/95, �ft�r sZipping from a�ir� truc3c. He ��`•`�"''`'"�, ' states that whi1� employed as a fi.re fighter h� wa5 ;�}it1� ����;�n� ` coming back �rom the scene of an acci.dent when he was '�;,'.`irt�t"".�n:�•"",'' ' cla.mbing down the �ide of the fixe �ngine. His faot �"`"`n"�""""`� slipped of� the engine compartment, he fell backward f'rr�i:t:mruii> i'u•i+m> � ,<<,i,,,,,, approximatPly 5' l.anding on ha.s right buttock and right ��r��,:�t:•�_����.�- : shou�der reg�.on impacting onto the concrete Floor. He �!���,,;:,«•�t r1;-�, : denzed any ].oss of consciousn�ss but d.id have onset of t:tresrudl:eyci��,tic �lcilicf��c � low back pain which was ini.tiaZly evaivated at a I.acal. t:�ir waZk-in �la�.� c. The p.�+_in;�± �.:�s 3_�.Sr.o�Y� :�•it:: a 1:::��ar ��•��1:"�,u�„�,���,'�_,�:. strain but due to persistent symptoms, was eventually '"�'�' referred ta Dr, Gomes who in turn referrec� th� patient �curui«�;irsl.������rn�t�t for a lumbar MR�. That study was compieted in Apri.1 1995 ';"����� i3����r���'r and demvnstrated no evidence of di.sc herniata.on, mai;�l,y '�`�:"�."!„�' `�`�"'."`` disc dessication at L�--S and 5-�. with mild bu3.�i.r�g. :s��t�:�+„i;��t����t���r�•����, Ther� was no canvincing nerve root az thecal impingement. ,��:�•���.:; �t,_���:E,� •�.•+� �I �:rt��n�Iiii�����n� � Til� pati.ent �'laS Z1c1C1 d �Ll].]. COIlY'Se O� conservata.ve �,. ,.,,,, i����•.�:,, ��.,..,:,„„ man�gement since including phys�.ca1 therapy, anti- ,� �:��r. �;,,�.•� .�n��ammatory agents, muscle relaxants and narcotic :,.,.���t���,�«::� ti�•�•«t+ anal.gesa.cs and chiropractic manipu�.ations . overa�.�. he I:� .h�.u�us� ,� I'r�•�,iu:+4tEt i' �u ��.Ui.;,Cinr�it ;{��>i�r:�h.��:; , •���t t'i.++uc iiHur�� `• �.u^. i ��s ij.,t i� „� :��•� .it:il �f ttcr.:4n • ' •x�tl..t:.`tt.•,,.�! ��t�CCii�:�t� . ' Irr_�crf'r:�u�;sn�t�,���+�• ,:��f1 i)E'�l1' SLl4l:[� (,IC:11`1t;ltCt. f'iUl'1Ci.1 j�(1?ti � I,�`3� j) ���'"•"�Ibi ' i':I\ 1y17} .=43•I��i11 �« � ' � � ,, � • � ' �. • f . � ..Y♦ . .' � ', • � iY . � 4 � S . "If � � . •. . � 1 . � #� � � � ,. , ` � , , ' � ' ,� i City of.C�ear*aater, Human Resources ❑epartmenfi Octob�r �.D, �.995 . Page 2 • ' . Re: Timothy Debvrd . � . , Y1 . . 1 � . � , � � � � ' � � > stat�s he i.s samewhat better but stil�. plagued with chronic low back� and right lowEr� extremi.ty pai.n w�.�h h�.s back 3nd leg pain essential.�.y aggravated with sitting and bending activa.ties, re�.�.eved on].y by rest and ly�ng down. He admits to standing and wa�.king intvlerance, 30 minut�s and �.000' respectively. Denzas any bowe]. or bladder inconti.nence. He has had no ].ower extrem�.ty electradiagnostic studies; he ha� had no epid�zral stero�d injecta.ons. � PA�T MED�CAL HI9TORY: Noncontra.butory. PABT SIIRGiCAL HIBT�RX: Notab�.e for tonsi].].ectomy in �.966 and right hand ].acerat�.vn 1.993. � � CIIRR�NT I�iEDZCATxONB: Aspirin, Relafen. � � ALL�RG3E8: penied. soezAL HISTORY: He i� currently of� duty per his current Worker's Comp physician, Dr. Franci.sco Ho].mes and has, in fact, �een o�f duty since 3/�0/95. He dena.es tobacco use, admits to occasional ethanal use. No history of adcii.ctive t�ndencies. REV�EW OF 6YSTEMB: Notable for di�ficul.ty with sleep, generaliz�d fata.gue, irregul.ar bowel mavements, �norning stiffness, }aladd�r urgency. No history of prostatS.c da.sease. FAMILY HISTC3�tY: Noncontributary. PHYSICAL �X1�,MIN�TI�N: Reveals a well developed, weZl nouz�shed 4�. year old white male crho is a3.ert and oriented, friendly and cooperat.�ve to�examinatinn. H� stands 5'll" tal1, wezghs a stated wea.ght vf � 84 lbs. Ambu�.ation reveals a smooth reci.pzoca�. gaa.t pattern, no evid�nce o� �oot s�.a�, to� drag or Trendelenburg sign. He �.s able to heel and toe walk. He complaxns c�f increased i�ack pain with heel. wa].ka.ng however. �nspect�.on o� the spine rev�als narmal rerva.cal., tharac�.c and lumbar curves . Na ev�.denc� af sco�.iosis o� deformity. Palpation of th� ].umbar spine revea�.s increased muscle tone in the bilateral ].ow �.umbar paraspinal.s; � no £ocaZ trigger poinis appreciat�d. He admits to tenderness in the r�ght sciatic notch region. RoM is limited in the flexion and extens�on plan�s wzth complaints o�' i.ncr�ased back and right �.eg pain. Standing Trendelenburg is negative bilaterally. rn the sitting position SLR is notah�.e for right proxima�. leg pain; na �� . �� . . � � . , . , � .' . C�.ty of C].earwater, Human Resources Department October � Q �' 1,995 . � . � ' Page 3 � . . Re: Timothy Debord '� . �ull sciatic: expr�ssion however. Le�t SLR is negata.ve. Ther� �.s no ank3.e c�.anus . Tone is norma 1. Lower extrem�.ty ref 7.exes are Z+ at the Achil.].es and pa�ell.�r sites. Sensation is intact i.n �th� L4, L5 and S1, dermatomcs. EHL strength is intact bi].ateraliy. There �.s no �vi,dence oi atxaphy or fascicu3.ation. . X-RAYS: None repeated. Out�ide p].ain �i1ms r�viewed. Those were ta}cen on 3/20/95 and demonstrat� mild disc space narrowing at L5- S1, c�therwise unremarkabl.e. Lumbar NIl�� reviewed as we].1. PJ.ease see .that report for details. The only notable Finda.n� on my r�view is .the axia� v�.�ws at L5-S1 d�monstrating slight centra]. d�.sc bulga but na �l.ear nerve root cut--o�f and certain].y no significant stenos�.s . ' ' � IMPRESSIpN: 1. St�tus post s].ip and fra].�., 3/T.1/95, with secondary ].umbar myofasria�. pain syndrome. � 2. Status post s�.ip and �all wi,th right i.eg pa�.n, �uspicious 'of �, radicul.capathy, but without objective neuro].agic def�.cit or evidence of nerve root a.mp5.ng�ment of imaginq studzes. Transient compressive radicular in�ury a� the �a.me o� slip and fal�. is a pos�ibilit�. � 3.� Preexista.ng lu�ba� degenerativE disc disea�e. FL�1,i�i: 1. At tha.s poa.nt the pert�nQnt question related to ha.s exam tc�day a.s one o� occupat�ona7. disability re].ated ta his injuries. The patien� has undergone a�uncti�na]. capacity eva3�.ia�ivn at Hea3.thsouth, p].acing him a.n a med�.um job demand category and review Q� his suppla.ed job demand as defined in the dictionary of occupataonal titles �or a fire f ight�r describe this to be , a v�ry heavy work categ�ry occupata.c�;� wit:� the occas�onal. nead ' to exert in excess o:� 100 �.bs of forc�, the irequent need ta � ex�rt a.n excess o� 50 lbs. o� �orce and constantly in excess o� 2 D� 3bs . of �orce . �n adda.t,ian, the patient has described the �requent need to lift an air pack of 35 l,bs. , boots and pants weigha.ng 15 1bs ., a coat ot 6 lbs ., helmet o� 2 lbs. , mask of 2 l.bs. with a total protective gear �on the jab �er job task of 6� 1bs. Given a�.� of �he above in.�ozmation as well. as ta7czng inta account thc functianal capacity evaluation � competed, it ��ould be the impression o� tr.is examiner that Mr. Debord is job speci�ic, totally disab�ed �rom returning to work as a fir� fighter wi,th the C�.ty of C].earwater. If � l.im�.ted duty accammodat�.ons wer� ava�.lable, then med�.um duty job tasks would be acceptable with 1.i.��ing, bending and sittinc� limitations. . ' • �1 Y 5 • . � '' , . , �` , � ' ' . ' � . . . � . � .. . . . . ' �� . � i , � ` • . . r , . � , . .� . , 1 . ' � ' � . • � t , � ' , , �y ' , . . ' ' , . . , . � . � .i , . , . , . � �„ ,�,�. , ...,� �..�.3� . . ;.; . . ' , •'�', . - � . , . .. . . . . . . . . • � f ' . . , City of C�.earwater, ., Huinan RESOUrces D�partm�nt , � October 10, 1995 . � Page 4 � , . Re: Timothy Debord � ' � „ � 2. With respect ta whether or not his c:urrent symptoms are � rel.ated to a job conn�cted injury, it is �he opa.na.on o� this examiner that they indeed are casual].y related to the slip and fa�.�. of 3/11./55. The patient did have preex�.st�.ng , degenerat�,ve disc dis�ase but extremely � ma.�.d. Typical .' .sym�toms ta be 'expected �aith such mild degenerative disc ' di.sease wauld be early morning back stifxness rel.�.eved wa.th � gentle ��exibil.ity �xercises and not the severa.ty vf symptoms which he has demonstrated over the pa�t 7' months. 3. � Medically speaki.ng, future management will be d�ferred to his ., Warker's Comp physicians. our recommendations would include ra.ght ].ower extremity EMG/NCV, th�n �if pasitive, CT mye�ography. I� the CT mye].ography a.s suggestive oF nerve root �.mp�nqement, a course o� FS�s ar�d if unresponsive; consid�rata.on for decompres�ive surgery. The patient�s � predominant bac}c pain does make h.�m ].ess of an ideal candidate for back surgery. The pata.ent does understand this and � ha.mself would �refer to avaid operat.�ve intervention if � possible. D�cisa.ans whether or not �o proceed wa.th any � further meda.caJ, management or d3agnostic testing remain' � between him and his Worker�s Camp physicians. � , Rob rt D. Gr er, D.O. • Dipla�nate, American Soard of Physical Medica.ne and Rehabilitation � . Medical Direeto�, Fiorzda Spi�e �nstitute RDG/]r . D: 10/1.0/95 � T: �.0/1.0/95 ' � , , ., �. . . . ' , ,. . � ; � , � � ' • � . .� . , . � . . ti . � , .. . , . . .' . . � . . . . ' . . . . . . . , . , ' . . � � � � • � . � •I' . � . . . ' . . . � � � 9 � ' . . . � ! . � . � .� � . , , � � � � ■ 1.� . ' ' ' • � ' ' . . � , , r , . � r . . . . ' '' . . . . . �r,F.,,.�„ .,, . ��. . ... .... .ir,., s, f r:'� '��. � .. -'r' �i , • . . .. . . . , � . t � � � � . . � .. ' ' ' � � . :1�'w ��� . ' . � �' . + . �"ap�a Chirapraetic C�xnie � - � �,� `i, � � � Fam.tty segl tk ca.re � � �} idO4 Norih Finridr� Ave. • Tam ti�. :�;;, � pa, Ftorfdu 33sn2� . E .,ti , . {si�} z��-a2o� ' �i: � ,�. �ti:•�•rY " , � . mr`r. , ��-'�'�' Joseph A. Pt�piu, D.f;.,.Cliatc niractar , �",�y� ' June 28; ].995 . � ,� � l . . . , 1 Jon Marca.n � ' Risk Mana�ement Spec�.aZist . � . � City o� Cl.earwa�er � , P.a. Box�4748 � � . Clear�ra�er, FL 346�8=4748 ' RE: Tim Debord � ' , � ,� DA: 3/11/95 Dear Mr.. Marcin: ' On March 20. 1995, this 43, year o1.d maJ.e came �o this o�fice f�or evaluaGion and trea�ment vf.�.njuries sus�ained in a work related acci.dent on March �.x, � ,1995 . , � , Pa�ienC descr�,bed �i-4e accid�n� as fo�.lows: On March 3.�., 1995, a� approximately 9:Q0 a.m., whi.l.e comz.ng dowis �rom the top o� a�ire engine, he s].zppe�3 a�L of the mo�or cover and �el� �a a concr�te �I.00r. The pa�ie�nt reported �he acciden� to his supervisn�. He went to a walk-in cl.inic where , he 'was �xam�.ned and given prescriptions for pain medication and musc].e relaxants. ENTRANCE CUMPLATNT •. Tre patien�. complained that he suffer� from daily, constant, mid lav�er back pain. �t is a dull, aching �ype o� pairi most of the t�.me wi�h sharp "kn�.�e like" stabb�.ng pain into his mid thoraco- �.umi�ar reg�on. His srif�ness is wars� upon get�i.ng up. nis pain goes into both Iegs d�wn the back side. it is worse zn�o his righ� Zeg'to the caZf. His 3egs f�eZ weak. H� has �zng�.zng sensa�ions down bo�h legs to l�is ca�ves, cnore on righ�. This is wo�se when sirting or dri�crzng. When hava.ng a boweZ mo�er��nt he has pain into th� �ower back, marz on the right s�.d�. His boweis are }.00se and come on righ� away, He has dai�.y, constant neck pain on boCh sa.des, more on the ].eft. He has a du�.l ache which g��s intense and becomes a'headach� at �he base a� �he sku1.�. This is a�hrobbing t�rpe heada�he wi�h nausea. . ' 1 �� . �..�..�. �': �� . ' '. . � � . • 5• • • , � '. � , � .. . i � • . ' r. 11. e ,. .� .. . , , . �. � . .< . . . . . . ,+., , . , , j�� . . .. i . . , _. .. Re: Timakhy Debord June 28,.1995 �age 2 � . . . . .. F .. .. . , � 1� . He has difEicul�y �hinking. He ��cperiences confusi.on. He has pain � - in#:o hz.s ieE� �ar. His; neck gers s�iff . He has numbness into both hands � which comes and goes . .When sitta.ng, his chest ��e1s very tigYs�. � His �eet �ee]. very col.d. He also sta�ed he experiences a . pappi.ng sound in�o his mi.d back wi�h rnovement ., The pa�ient stated,al? the above symptoms star��d right af�er �he � accident of March. 7.1, 1995,� a.n his . low back. He �urther sCated o�her symptoms have develaped since the March 1.�., 1.995, accid�nt,• and are gAtt�.ng wors�. He�s�aGed h� has never had all �h�s� symptoms be�ore. His condition is aggrava�ed by s�.tting, standing, drava.ng, �.ifting, and znove�nent. His pain is only relieved by laya�ng down . � . � • � PA�T HISTORY � The pa�i.ent stated that he had pu�.�.ed a muscle in his back in 1982-- 83, He had not rPCe�.ved treatment for that injary. He also s�at�d tha� he has Experienced right ].eg and`knee pain. � The patient s�a�es that h� has no� consu],�ed a chiropractor �.n the past. The pat ient is currently ��aking m�d�.cata.on for pain . PF?YSICAI� EXAMINATZON , Physical examination revea.�s a whi�e, we1�. nourished, ma�.e w�.th a Io�.00d pressur� of 1�0/84; PuJ.se o�' 64; Ausculra�ion oE the heart and lungs rev�aled no significan� a�.�erations; Height is 5' l.p �� ; weigh� is 180 paunds. �. . . ORTHQPE�TC AND NEUROL�GICAL EXAMINATION pATIENT STANDING Postural aval.uation demonstrates a head tiZ� to .the �.A�t, a n�.gh 1.e�t shou�.der, a high i.e�t hi.p, an appearazice of a decrease . in �he ce�ri.ca�. ].orCOtic curve, and an appearance of a decrease izi the �horacic curve; Finger to nos� coordina�ion ��s�ing was no�al; Rhomb�rg's coordination C.esting was norzna3.; Gai� revea3.ed no si.gni�icant ai��rations. Thoraco-lumbar range of motion d�monstra�ed t�.exion 70 degrees with pa�.n at the L1.�L5 levels, extension 20 d�grees w�.th nain at th� LS : , . . � , , ' . ' . . ' i . . � ' , ' , ' � . . ' �. . ' . , ' . . ' , . , ' . I . . ' � I' � . . , ' } � . ' I.„�, ...1 . -. .�. . � r ��: ... . .... {. .. . � � . . �.,�(:3 . . . . ! . � � . . � . . . . ' �� Re�: Timo�hy Debord � June 28, � 1995 . � . ''� �Page 3 : �� . � �� j . � ].eve1,' 1�EG �a�era]. �1.exion 35 degrees, =ight �.at�ral �lexion 38 degrees. Measurements taken with a Cybex �,nclinometer.. ICemp's Gest was pos,i�ive bi�.atera�.ly wi�h pain at.the L5 level; Kick �esti'� was nega�ive; Heel and roe walking was'norma�.. FATTENT SITTING ' . Cerva.cal range a� motion demonstra�es �lexa.on 45' degrees, extens�.on 45 degrees,.left iat��a1 f�exion 28 degrees, right lateral flexion 33 degr��s, �e�t r�tation 64 d�g�ees, right ro�ation 74 degrees. Measurements taken wi.th a Cybex �nclino:ne�er. Cervical Orthopedi.c Compressian.tests d�mons�rated Maximum Ro�ary Compress,ion was posi�ive bilatera�.�.y with pain a� the C7-T1 ].ev�ls; Rotat�.on Compression . was nega�i.ve �or pa�.n, La�era� Flex�.on Compression was oositiv� bilar_eraiiy wi�h pain at Ghe C7-T1 levels, Hyperextension Camprsssion tES� was positive bi.].a�erally wi�h pain at �he C7-TZ ZeveZs; �is�racCian� test was posi.�izr� bi3a�era3�.y �or reli.e� of pain; Shoulder Depression test was posi�ive b�.laCerally. wz�h a dzcr�ase in radial pu�se; Adson's Tes� was positive bilaterally w�,th a decrease in radial,pulse. � Cervica� Muscle �esting �eveal�cl a�.l were Grade �V normal; Musc�.e test�.ng of �h� unper and lower extremity �es�ed Grade V normal.; R���.exes of �he upper and lower extremi.ties reveal.ed Patellar was +3 ba.l.a�e�ally, al}. others were �2 normal.; Peripheral sensi�ivity of �he uppe� extrem�.ties ��s�ed noxmal.; Bech�erew`s TesC was negat? Ve; Va].salva Tes� was posi.t� v� �or pai.n at the L5 I.eve1.. PATIENT SUPINP� Soto-Ha1,J. �est was posita.ve Lor pain a� �h� T4 3.evel; Lindner's test was posit�.ve tor pain a� che :�5 ievel; Double Zeg raisir�g ��as posi�i.ve at 70 degrees wi�h pain at the LS 1eve1; Straight l�c� raising aas posi.tive at �80 degre�s on the right wa.th pain at the L5 1ev��.; Braggard's was riegative; Gaens�.en's Test was nega�ive; Fabere's Test was negativ�; Peziphera�. sensitiv�.��r of che lower extremiCies tested normal and z.n�act. PATIEN'I' ARQNE � Yeoman's T�st was negat�.ve; E1y's Test was n�gative; Scia�ic nerve palparx�n was nega�ive to any pain or tendern�s's; Para so�nal. musc�e pa].patwcn demonstza�ed musc�� spasm and ter�dern�ss from th�C�-C7 levels bilaterally, mor� on �he r�.ght, and the LI-L5 l�vels bi].at�erally; Vertebral spinous palpa�i.on demonstrated pa3n and tenderness �rQm the C�.-C7, T�, and �3-L5 �evel.s. 1 ' , � , . = f t .. ' � . ' � F � •; . � � , .. , , ' ' ' . . ' '' , � � � . i . ' . , , • i: . � .. . .. . .. .. �� ..,,� ., . �• , , , � , , , i � ,. ' . Re;� Timothy Debord Jun� 28, ��.995 Page 4 � , . � , , t ' 'i ' X- Y EVAL A ON ' �• '� Taken or� �March 2 0, 19 9 5 , At our of�i.ce . A-?�, LATERAL LUMBOSAC2AL PELVIC �VIEWS: Demonstrate rotational sublulcarions throughout the lumbars o� �he le�t being most proma.nent in the � mid and upper �.umbars . A 3 6 degree ].umbosacral angl'e. Early degenera�iv� discapathy is noted between L4-L5 and rnoderate bet•ae�n L5-S1 •�it�h a d�crease i.n the zVF be�ween i�4-L5 and L5-5�.. . , A,P. LA.TERAI�_ THORAC�C i7�EWS_:_ Demonstrate rota�ional sub�uxa�ions �hroughout �he �horacics on �he le��. A.�P. _ LATEF..AL��_TRANSORAL� AND STRESS _FLEXIONIEXTENS_IQN , CERVZCAL VxEW�, � Demons�rate a mild righ� cervical cu�-�re . Ro�a�iona�. sub].u�cations in the upper and ].ower cervicals on Che right . There is a�.a�eral `lex�.an subZuxa��.on of C5 on C6 �o �h� �.e�t with disc w�dging: A loss nf the normal cerv�.ca1. lordotic curve and a reversa�. o� tk:e same and a-145 degree P�.erce ang�.e. Hypermobi.lity is nored in the stress exten�ion v�.ew between C4-05 and C5-C6 wi�h intQrruption in Gporge's iine. Hypermobz3.ity is noted in Che s�ress, flexion view betwe�n C3-C4, C4-05, and C5�C6 with interrupti.on a.n George's Zine an increase in the �acet spacings. ADD�TYONAL FXAMINATIONS MRI was performed to �his patient's lumbar spine on Apri.z 17, �.995, at Di�gnos�ic imaging aG Nor�hside HQSpita�. The renort by Dr. S�ephen C. Anderson, M.D. is as �o�.lows. �mpressi�n: . i. , �egeneratio� o� the disc with diffuse cer��ra]. disc bu�.ga.ng at LS-Sl. � 2. Degenera�i.on of the disc with di��use central dzsc bulging �.s also present ar L4-5. 3. Na other �i.ndings ar� nated. There is no ev�.denc� for ciisc hern�a�.ian on �his s�udy. [7pon Dr. Franc�.sco S, Gom�s, M.D.'s reva.ew of the above-re�erenced MR�, he had on May 2, �.995, the following recommendations. H� is not a candidaCe for surg�ca�. intervention. Patien� may ben��i.t �rom epidural. s�erozd injec�zons if 'no� signi�icantly improved w�.th a couxse of nnnstzroidal anti-in�lammatory agents. Cont�.nue presen� �h�rapy ��i�h �r. Papia. Second opi.ni.on regarding �ur�her care was requ�sted by Dr . Gomes o� Dr . Fred McClinans, Orthopedis� . ir�`. ' ' . 1, ,- � �. , ----- , �'. � , � •, � . . � . �,�„ . . .. . :��.. ,. ,.� �.. � �. . � �:,� - � .� . . � ; '. . . � � , . ;�,, �. Re: .Timo�hy Debard June 28, 1995, page 5 � „ . . . -• � ,� Dr, Gomes sta�ed �hat.after discus�ing with Mr. Debord the duta.es , o�'�his job he �elt he would be be��er ofi to geG into a di�;Eerent l�ne o:E work. . . � . On May 9,.1995, Dr: Gomes sta�ed �ha� he beli.ev�d Mr. Debord had a long term degeneraGx�re disc disc�ase whi.ch was ag�ravated by �he ��in�u�f o£ March 11, 1995. H� furt�her stat�d he detennined thaC Mr. Debord could no Ionger be a tire f�.gh�er because v� �he physs.ca�. demands that go w�.th the j ob descript�.on . An �ME was per�ormed by Dr. Gary Moskovi�z, M.D, on May i5, 1995. His opinion was concurrent with Dr. Games' that becausc� o� rhe pre- � existen� degenerata.ve d�sc pathol�ogy, Mr. D�bord may have suf�ered injux-y �.�o� these areas �rom the �a�.1 of March 11, �995. He also comm�nt�d in his report �hat if sym�toms persa.sted for longer �han szx months withou� significant improvement, �ha� Mz. Debord may be a candzda�e for opera�ive �.nteruentzon. � Dr. MeC].inans subr�i�ted a work capaeity assessmen� an May 23, �1995. "Recommendations; �G is the opi.nion oE the evalua�ion team, based on the objec�ive tast data �ha� Mr. De3�ard is currentZy ar the med=u�n physica7. demand capacity. He is inappropri.ate Co return to hzs pr�vious job wi�h Ci�y of- C.Learwater as a£ire �igh�er which was descri.bed to be heavy �o very heavy i.n the physical d�mands requ�.ring a max ].iEG o� 140 lbs , when dragg�.ng and carryir�g va,c�ims �r.om entrapmen�s accorda.ng to the job descr�,p�a,on supplied by the emp�oyer. . It is recomm�nded that �h� pa�ient participa�e in the �o].].owinS: Singl.e servi.ce physa.ca]. th�rapy ini�ia�.ly to pr�pare for entry a.nGo a comprehens�.ve spine program �o incr�ase srr�ng�h, �3exzbi�.�.ty, and �ndurance �o� upgrad_ng �o ze�uzr. �o work." IMPRESSION Mr. Debord suffered. a s�a.p and faz1. injury wh�.ch resu�.�ed .i.n a. cervical./lumbar spra�.n, sca.atiCa associa��d w�.�h a �iisc �.n�vol.v�ment, superi.mpo�ed upon a degeneration of ,�.umbar I.V.D. , a hypoxordotic cervi�al spine w�r,h reversa�. of �he curvature, cerv��a�/cran� al�-brachial syndr4me, as well as c�rvica3., thoracic, and �.u�nbar sublu�cat�.on syndrome . � He has recei.ved -Zow val.tage e�.ec�r�.ca1 �herapy wa.th hor fomenta�ion to �he cervic�l-lumbar spine in conjuncCion �rii�h lumbar intexmitGent trac�ian �al�,owed by specific spina3 manzgu�.a��on. A l.umbar support was prescra.bed. , t' ,. . . , . , , � f�iloryf> -'3. �.r . .e:... ,r� ..,,1, '1;�y',:�•4'�• . . . ^i'� . i ,'". Re: Timothy Debard � June 28�, �.995 � Page G �., . _ ,. , . , . , .� . ,, . _ � . ,. . � . 1 1 �� , �n my opin�,on �his pa�ient has reach�d maximum medica�. a.mpzovemen� : Re-exarnination was performed on June 20, 1995� �ahich revealed �hat thi� patzent s�ill �t�ani`ests subjective compl.aints as w�1�. as objecta.ve �indings which aze causal�.y reZated �o the slip an.d �'ai�. accident oF March 11, 1995, and are pErmanent in nature. These are as �ollows : �� , � 1. � Continues to. experience 1.ow back pain especa.ally when siG��ng or driving a car. 2. He has nain daily �hat i� cons��nt in�o his r�.ghC buttock � � ana �high.when sitC�.ng. � � 3., Lumbar range a� motion reveal.ed Flexion was posirive �or , gain at �he L5 1eve� and Extension was positive �or pai.n at the L5 level.. . � 4. Kemp'. s tes� was positive biiaterally w�.t�Z pai.n ar the L.� � level. � ' 5.� Cervical Range of Motion reveal�d Fie�ion restric�ed tc+ . • . 48 degrees . � 6. Cervzcal Orthop�dic Compres�a.on t�s�s demons�rared La�eral Flexion Compression was positive bi,lateral.ly wirh , pain a� �he C��T1. 3.evels, Da.straction test was posi.rive b��.ateral3y for relief af pain, and Adson�s Tes� was positiv� ba,latera�ly for decrea�e in radial pu�.se. 7. ��a�.sal.va' s Test was posi�ive for pai.n a� the L5 Zeve�. . 8. Lindner' s�est was po�i.tive for pai.n at �he L5 �eve1 , 9. Doub�.e ].eg raa.s�ng was pvsitive at 80 degrees wi�h pain a� the L5 leYrel. �.0. S�raight �.eg raiszng was posi.�i.ve a� 80 degrees on the right wi�h pain at the L5 l�ve�.. 1]..� Para spinal muscle pa�.pati.on demonstra�ed musci� spasm and tenderness �rom �h� levels of C1-C7 on �he, right. 12. Vertebral. spinvus palpati.on �demons�rated pain and � t�ndernES� z:rcm ChE levels o� C��C7 and L•4-L�. Tt is my opi.nion with th�.s �ype o� trauma to th� spine whereas ].igamenrous connecta,ve tissu� and int�rvertebra� di�c are invo�.ved, �hat ,chronic ins�ab�.lity of spirl�3 jo�.n� �.ntegri�y along T�ri�h nerve roaC compl.ications results. The injur�.es that Mr, Debord has sus�ained �rom �he acciden� of March 11, Z995, have result�3 in this type o� � a.njury to �he c�rvica�. and iumbar spi.ne and are pennanent in nature. I have ga.v�n Mr .❑ebord a].0 percent impairmen� o€ *Nho�.e person as i� re].a�es �o the permanent injury o� the cervicai sp�.ne (3 percent, so�t tissue lesion -��.gamen�ou�} and 7.umbar spine t7 percpn�, in�ervertebral disc) . Based on thz F3.orida �mpa�.rment R�:�ing Gu�de �.992. '+ ;'t',5L r�'t:'z • . ' t.e . ' t . . . • . - , 1 . . ,r . , .. . - . . . . ,•r. • . ,� " �!. ''s4, S'- F� . . . . . . :�:'.'t . `���1ij� �;�� . ' . ,P.� , . . , . . . , � . . , , .. . , �� ' , . • ' .� . �. � . . . . ��J�','.: :., "j�r, .. � .. �._ •�.. 1.�. " 4 .� . .. , ' k ` ,' . 5 . 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"i ,.r , S�'�� . . . . . �3(. � . .. . 'i�.f � ����.��. ,. ... .��?'��� i; : .! 't j ' � . � .. � ,. , ' .. ' !. +' � ' , � � , k � i .•� ', ' . � . . , , I1 ' 1. ' ' . .. 4� � � . .' , . ' t � . }. . , ' � ' . . � ' I . ' r 'F . � ` ' . + �r � �. , ' � . ' ' r . � , '.. .. . • . . • ' ' , ' . 1 ' , , .' .. � . !�; ' � � , Fte: Timothy �eb�ord .. �,�.� � � `' �, .. ' .. ` , , - � � , , : : : � ; , . ` , �June .28, �,995�. . , o , . . � , . �`� . . . . .. Page 7' - .. , , , . . , � � . � ' � ' . .. . ' . ; �„ , . ,,: � ; I' . ' � .. � � . ' . ' . . ` . ' , . f � . � , li , ' t I . e �'• ' � 1 • • • � � . . . .. ' '. � ' • ' ' • , .. I � .��` He �an �expect �,furCher spinal j oint � and n��ve roo� . compZieations . in ' !��:°„ -; � � �he . fu�ure : � He., wi�.I have' need of �uture,. su�portive �reatment and � ' . that it be based on, a� PRN type schedule ., . . �. �' �''� . . . , . .�� � . ._ ,. z� �� may Ioe of .,any �furthex assistan�� p�.eas� con�act � my of�ic� . ,' incerely, � � .. , � ; , ' i � � .. � �� . '.� ' � � � � �� ' , �. � � . ; ' . : �� , ` r . ,' . , , . .� � • 4� �t�C• �. � . ' ; . . � , � ',�,. � l� . . � � � � � . , , J seph �A. Papia, D. C. f. � ' �. ' � ,. • . . - , . �J /cdh . ,. . �; � , . � .. , . , , , . . . ,� � - . . , � . . . , . , . . . . . . . �"� � : :. , . � ; - . _ � . . . , . ' . . . . , . . . , . � � � � � � . :� , . . .. . . °' � �.�� � � . .. � . , "' . �� . � , . � . � .. . . � ' � . � � . F � . � , . , . � � ' , ' i .� � ,� ' � , � ' ' .. . , . .. , . , ' + , ' . • , � . . , � • � � ' � . ' • . l , � . , . . . � � , s � i� . . � � . ' . . � . .� ' � � '. . . . . • . . 1 , . . <� . . . � �> . . . , . , . ' ' 7 • . . � ' ' � � � . � ' , ' �� ' � .. , . � . ` . . , �' ' . .. . � ' i � . , i ; ,t � ��/HI� ' •..,... . ' , , ` v�r� . � . ,.. . ; . � . . : ' 's ' . ' • . ' ' � • � , I • , • . . � ' . ,'v'r 'r1. ,It „'1, . , .r � , . ; . .. • i .. ' . , .. . . . ', , ' ' 1 ' . , � � . . .' � . ' � , � . ' . � . . . . , � • , ' I, , . ' ' . � � � . ' . �i . � , � . , � ' � , , ' , . �. . ' . . . ' ' � . � . . . . . � . .. . .; r � ' , i . 1 , r ' , ' , ; . ' , . . . . . ' ' . ) i , ' � .�r . ' ' . i . .. .� j� �1 � . �. . . � ' . ' ' ' . I . � ' . ( . ' . . ' � t 1 ' . . � � " . � � ' " ; ' . r ' . � . . .. . . , ' ' ! , . a •,t . ; � . .ti "i: � •� . • � I � ' " . , � � 1 . 1. . . . ' _ � ' r . � , , � � • lj i � ( • 1 • � . ., r 3 . � � 1 . . � ' i .. 1 �. ,kj: 1' '. �.. ; � .r ii• I `. • . . . ' ,. 1 • . ' ` . . , . . , . .� . . . , �r� � � , , � ' ' � � .�� ', ' � � . � i � ....rr+r'M.,.. .-n.-. :i�•..fvc.�,y�. ,:fl..�•.4,i11e���.::?�l.t . ... .. � ' ., . � � � ,.. .. � , ` � . �`� i ... � . ' . � � ,' � . . , . ��� ` t . � �rl � ,. . � . . . .. , � ` . . , .',.. I � . . ( ' , ' � � . � . , . � � , • ' ' � ' . ' ,' � � ' . . . . , . , � ' � � . . � i' . . E � � � ' � � ., . ;.' FRANCZSCO 8. GOMES, M.D., P.A. '; � . � ' , SPZNE SFECZALTY . � BOARA CER�xFZED N�UROLOG�CAL 5[TRGEON 5206 N. ARMENZA AVE. � � .. 7g91 ULMERT�N RD. #2-S TAMPA; FL 33603' � � � � LARGO, Fli� 34647. �$�.3) �375-2225 , ' .f 8�.3) 539-055� , � �A}�C (SZ3) 875-5613 � � � NEUROI,OGxCAL CONSi]LTATrON � ` � , PATIENT: TTM DeBOR� DATE: �q-�2-95 CFIIEF COMPLAINT: . . . 1 . NECK PAIPt : , � , � , � Z. L�W SAC� PAIN � • ., 3. RIGc1T LEG PAIN hND NUMBN�SS � �� H�STOk�Y OF PP.ESENT ZLI,NESS : � ' � 4p YEAR OL1] PAT�ENT, FIF�� F�GHTER, WHO SUFFERED WDF�KERS' , . > �COPSP R�LATED IPlJL7RY MARCH 11, 1995. PATIENT WAS WORKTi�1G ON TOP OF THE FIRE ENG�N�, WHEN H�S r�OT SLIPP�D a�"�' ANA �iE �'EVL T� T'�:� GROUND APP�OXZMAT�LY 5IX FE�T ON CONCRETE PLOOR. PATiENT LA4dDE!] ON THE RIGHT SH4UL�7ER AND ON tilS BACK. HE Tri�S DAZE� BUT []r17 PIOT I,DSE CQNSC�QUSNr.55. HE LATWR ON WA$ SEEN AT r�. WALK—SN CF�II�i7C, WAS THErd REP�RRE1? TO DR. PAk'�A. i'ATiEP�T HAS HAD SIGNT�'ICANT . I�iPP.OVEMENT AS EaR A5 H�S N�C� PAZN AND S�VEP,E STIFFNESS �tin HEeiDACHES. THE•CHIEF CQMPLA�NT �5 LOW BACK PAIN DESCRYBED�nS�A �ULL C�TiSTnNT PATN WTTH INTERM�TTENT SHnF.�' PA�PiS �NTO TH� RTGHT � � � , , ' I,EG W�TH NL1tS�Pi�SS . . • � � , • � REC�IVED � ��1AY 2 4 1q�� '�'`:�us • z:.�� r� � , �,1�. _ ...�.. . , , . , . ... . . , � . �� � . � � }�1� ' � . ° . ` £5 . � .. .• • • � � ' • � . . ' ' . ' . ' . ' ' . . , , . ' . `' . ..} � i '' f, . . . i • .. . ' l; • . . . 1 . . � . ' .. • . , �',i ' , ' .. . • ' � � . - . ' . , � � " � .' :�.f ' '. � � � .i . . � t • ' ' ' � . .t . , ' . . . . I, ' ' ' r '. , " , + . � . • �. . , . , . . � , � . . � ' , ' . , , I , , .' . ', .��It , i , . . ` . � ' i . . .. � . ' 1� . � . , � . . • , � ' �. . , , ' , " .i.' '� � � �:. , ' ' . '' . �'� .,. � ' . '' . ' � . � s � ; , ', ' , ` ' r . . � • ' � ' ��. i .� : . , ' ' ' , . . , .. � t• � . . , ' , � . e . , . . , s> i . , . .. . . .., � . 'Y � '. ' . . ' . , . ' . . ' !„ � . . . � � r , • � . ,1 � . � . ' ' • � ' � � . .� ' ' • ' , . . . � . ' � ' ' ' . . . . � . �, . . . , . . . i . ; . . ' ; " , . '. . ` ' . ' � ' ' '. . . .. ' � , Y"�t�Y w .iry'� .lF1�.i./�3tiFiiY+"rtY' r •l6�.yk`a� •W' .1'}.Jr ,',d... �'3� 1 � :S� f . � :I . , .. �1/7' e . . � f�' ..... . . . 1. . � � � ' . . ' � . . . . .. . . , a . . i . J . . t , . , . . . . . ! t � , . � � . 1 . , . � , • . I , � . � . � , � � ' , � TSt40THY DeBORD - PAGE 2 0� 3-- �/12/9S . � ' • PAST MEDICAL Ai'iD StiRG�C�L HISTDRY: � � � ' PREVYOU5 IN3URIES :].� 8 G^.-� 3 LOW BT,CEti STt�niN r ROI1 A LT_FT'si]G .� � i.NvURY�, EVENT[3Ai,F�Y �ECOVEREI],: P�.fiI�P1T SUFFEf�,Ep e� KNEE Ii�JUr�Y ' I1V ' �992 WI��LE. PiILLl�'JG �s �'�RE HOSE r�,T W�P.I�. PREV�OUa �SURG�R�ES: ' NONE.. PRESENT ME��CATIDNS: OVER-THE-�COUNTWR. ALLERGIES: NOE�E, � • W'ORR STATUS : PAT:C�,NT IS � FIR� r�GHTER �TiTH THE CTTY OF , ' � � CLE�.R�I�TER r YR� DEPARTME�T . � � �NEUROLOGYCAL EXAM�NATTON: 4@ YEAR OI.�D rRTTENT, 5'i0", 179 I,�$S., r1LERT aND ORTEPJTED TO . . PLACE, T�ME �rr�� ?EpsoN. P45TU�� �S ERECT, GA�T �S NOP.Mni,. � ° � MUSCI�E BULK SiIOWS ,IO �TROPFiY �V TI-!� MUSCL� Gi?OiiPS �F THE JPa:.R ' �� , ' '�►ND LOW£R .�XTR�MxT�.:.S. MOTOR FUNCTZON 5/5' UPk�ER AMD LOWEP.. DEEP � TENDON REFLEXES 2Y- ntdD SY'MMETR�Cr�.i.�. 5ENSpRY MODAL�TTES: UPPER :;XTREMIT�ES NO4t�iAL,; L�WER E:{TREt�1ITIE5 SHOWS S�NSORY LOSS TO �iIVPR?'CK LS-S1 ON TH� R�GH�. . S P �NAL E�CAM • RANGE C7�' MOTTON ��' THE CERVICAL SPINE: � FLz::I�[V 9 q/9 5 W?TH MSLD �J� SGQ34F�RT ' E�T�N520N 4a/45 WZT�i M�LD DiSCOM�'OP,T � R_TG^T LATERAL FL�,:{�OI3 �0/45 .WTTH t���,D D�SCOid�OP.T � � �,,�FT L�TEc�AL FLEXION 40I4S WITH MTLD DISCOt�SF�RT � � R�Gi?T .c2aTATIQN 7�1I80 WITH M�LD DZSCOMF'�RT � � L,=..� T RQTnT?"ON 70/80 '�T3TH MIF�D DI5CDI�7E'Or7.T � � THE�� ?'S I�fILD ::Y°ERT�rIICiTY aN PAi�PAT70ri �F TiiE PA�ASP_NK�, . � CERV�CAL Musci,�s . . . . aE�'..�1V�D � � MA Y ? � �Q9=, ; � • . , . ' . `%�f�tNS: �'„S TERN Ca,. �'�tC. '. 'ei . � , ' •. ' � " . ' � � �. . ; ♦ � ' . .!' . ,' . . . ' . : F � ; . . . � �' � ' , , il. ' . , . � ' ' ' ' ' � �, . " . � , , . � , . - . . ' , ' ' " ' . 1 ' • ' . ' , .. ' . ' . . ' ' .. � , ' . . ' - . . . `_ ' , `; I , .' ' f � i� ' o . .. ' . • . . . - � i . . t . . . � . . .. .i 'i . . . . . . ' • . .. . • . ' . , � . • . • .. ' � ' � ., i , � J � � . ' ' .. ' . . � . . . ' ' , ' , , .. .`�1�� � ' ' r ' i `I' . , ' ( . � i ' . � • ' � ' �rl�, ' f' . .. . ; �` . � . � , . 1 ` , . . '' � . 1 .. . � � . ' !� � ' . ` . � . . , � , � ' . ' ?`k''rf'.,.e..:�41.a r � .��IS.i .1••.51•}.i�. :1;'.. � ,��"4�y�.�'!.� .a , ' . . � ) . . + ) ' • ' • 1 • � `r'• ,-�� � � , t � ' . , { 1 . � ' 'l� .. � I`. . . . . ' .�� ._ .1� . � , 1 ' I . . . � �, , . .'. • � i , ' , � ,' , . . .. , � , I . � TxM[?THY aeBCJRD --.�PAGE 3 OF 3 - 4/12/95 • . � ,' . , . . . , • - , � R1�NGE 4F MOTION OF THE LEIMBOSACRAL SP�NE: �� ' � " -� � 'FLE:{ION . 94?/9@ WSTH PA�N , � � , . � :EXT�NS�OPi , • �.�/30 WITH PATN ' . R�GHT L�iERnL FLE:{�ON 10/3� WTTS� PAIN � . L�FT� L�►x��AL' FLc��iON 20 / 3Q WITEi . PATN ' , , � � RiGHT ROTATION , � �.0/30 WZTii PAZN , ' .' �. •� L�EFT r�OTATZON 1.4}/30 WITH PAxN ' • THE?tE i5 Sc,V�R�.. HYPSRTONTC�,TY Oh� PALPATrDN OF TI?E PARASPTNAL ' F�UMBAR MUSCLES. $z�,.�TER�L, F,�CET JO.iNT TEtSDERrt�SS. MODERA�E SCIr1TIC I�lQTCH T�ND�'RNESS HTLAT�RALLY. STRAIGHT LEG RAISZNG TEST, � POSIT�VE BxLAT�R:�LLY AT SQ DEGREES. WYTH LS AND RADICULAR PAIN. �PREVIOUS X-RAYS: ' � �• C-SPTN� X-RAYS, STRr1T_GF:TEN�NG pF THE Cr,RVZC?�L LOR�OSiS. � • L�lM805r�CR?.i, SPI?�IE :��-R�.Y� ,. �ISC 5�ACE NA�tROW�NG L5-'S1 . ` ASSESSMENT: � 1: R�50L�JY*iG C��VZCAL STRAIN • 2. SEVERE' P�ST 'iRAUMAT�C LUMBOS�CftAL SPR�T�V/STP��P� 3. RU�E OUT I,IlMDAR HERNTATED yUCLEUS" PULPOSUS � 9. RU�.,E OUT Li3M�AR R�DrCULOPATHY , � RECOt�iENtiA�`�ONS : , MR� LUFS�AR, �ULE OUT LU�i��R H�RN�ATEA TIUCL�US PULP05iJS . � : A�2�PJ� orr TEriPaR�RY ToT�U DTs�B�LZTY. T�KE oV�R-�HE-co�NTE� •� r�NTI-ZNF�,ArIb1AT��Y AGENTS. COflTTNUE PRESEDiT TH�RAPY W�TH, DR. Pt1!�I�. r • f� �..' r � � . � �% �`1 r � .. . • v V � ��'•-L 'Ci l�C��U�D �. ..� , �:� , ',.�,,,,� _. . . . ��iAY 2 4 i9�5 ..a. ��;iC_TSCC S. GO"!�S, M.D. , P.r�. t sc - r� s � ,;or�rvs ��:,��, � co.; wr:: DICT�.TE� �SUT ItOT ?'.?OC3F�?�'�D " � • . • � a �` .. - .� ..� ,.. . ', � . . ., . ,�� � . . -; . , , ..� . " . , � .. ; ' . . . . . � ,. , � , • ,�•' . � . � , . � � . . ' ; . . . . " • , . I. ' ' . , � . , ' ' � ' ', ' , , . ' • . • ' ', . . � . , . + ; , ` s . , . , .< �. ,, • ' . ' . � •. . ' . � ' 7l . � • ' . � , ; ' , .. .' 1, , i ". �. � • � � . � � ' . ' '' , . ' .+, �r . . . .. ' . , . . , . ' � � ' . .. . . . E♦ . , ,4 � r�/ , . ' .1, � ' � � ' � . �. . � .i, ' • .� ,� ' � 1 � � � ' 3.'� 1 � • . . � ' '� , , �. • � . . , ' . . . 4� • . . ' .. . '. , ' , � � , . . ' • ' . , , 1 . � ' � • � ' . . . . . . . . , ' � . . . � � ' . r � ' ' ' . . . � • • � . ' ' °� '.�: . ' ' .� r. �.. sl �I.•�k ..wfwa •.�(�� � _..}1_�°l.:S�i.':'�' i a.... -'�F'.. r . -E' - ' .... .i .... . , ol �; :.. , . .'F. . • � . . .� . �. . . 'N ;� . � � . . . . ' . 4. . . � . � . � �. . � � . � .. G�.C.O�.C. INST�TUTE FvR SPECYAL S��G��Y� ' � �� . � � � � OF JO�NT UISEAS�S . �� � ,�. . � � . . , ;�� ��� ,� �� - � . . , .� ;� . � ;� . � v „ ,� . . .. . • Date: C�� �� r� � ' � ' ' � � � ' . . , . . r�" ' ° a - Patieni Name: � lrn��it� ���.��' Chart Numbcr: ��'���� � , ,�� . Pleas�. �be advised that the abov� referericed patient F�as �een recomme�ded ta� 1"�m��-�y� �'�'� '� R�TURN TQ WORK.on � ❑. R�TURN FOR RE•EVALUATION . , 1 �nr� .r . , , ,�e! O R�HASILITi�TiONlTRAINING FOR A NEW YI�CATION . .. � with the fallnwing restrietionS: ' ' . . , . ❑ CERVICA� S�fN� . l.Uhtf3AR SPlN� , . No 1iFtir�g over � po�i�ds . No lifting vver '�t� ' Pounds ' � No heavy pulling o� �ushing No prolonged periads oF standirig'ar sittir,g; No cantinuo�s Flexian or extension oF tF�e neck � must be a��e to changp position5 frequently - � ; No cor�tir�uous nNisting, squatting or bendi�g �� � No prolonged periods v� driving (more than 30 m�ntites) . . C SHOIlLOER Na iif�ino ov�r pounds N� co�itin!�ous i��avy �rushing or pullin� ho continuQUS re���in� ov�; head , � KN�� - � No cvntin�aous squatting or bendin� ' No twisting movemEntS af �h� knee No continuaus c�imbing, {i.p., �tairs, ladc�ers, etc.) 1'� ithin tE�pse r�strictians, t�e patient will be ab�e to work �n a J FULL-rl�tE ❑ ,PAR�'-TIh1E basis. � . I{ you have an� questions �on�ernir�g �his malter, p�ea5e do not hesitare to con�act our priice. „ : . �,����� � �;��,��,� - - �-.. , 73 I: H �dson .avcn�: • Nudson, Flori�a� �,66 �• i:lepnor►c iS i 31 af�8•95f�3 • � Ficirida �'o!l�Frc: I•SO4•.30-�s2o? r , �. , �, • . . , . ■ . . �. ,,,. _ . ' • � . , • .. .. , , .. .. , ., �' . ', ' r�` . �� .. � ;r .. . , , ? s��,�. � . . . - . � � . , I� �J. � • ' ' � , , , . r . , G.C.O.C. ��1ST�TUTE �OR SPEC�A� SUR��RY � . � OF. JazNT DzSEASES 0 ❑ • y�[ M ` �\ Z � •r �. . ^ ; rt� �?•,��'t�oW.¢ti.n�``°�~ =� .. r�'N • .r,P�'G�� c�T No: sasi9 DATE: 09/19/95 N�ME : DEBORD, TZMO'�-�Y �+,GE : 41 5EX : NiALE HISTORY: The par�.ent �s a 41 ye.ar o13 whi�e ma1� who presents with a cnief complaint of back pain. The pa�ient s�ates that he was in his usual state o� heal.th un�il 1962 when the patien��was lifting a� work and noted a papp�,�g sound in his back with 3.ow�r back pain. The natient states chat he wenc hom� and rh� �v�lowing morning he �iad di.z�icu].�y geGting ou� or Ded. He was �aken tQ Morton P�.ant Hospital, X-rays were taken and he was discharg�d w��h m�dications. The patient stat�s rha� ne took two to three cveeks o�f . He did to�low up witn �r. Tucker zor a�o11ow-up visit, but no fur�her treatmen� was rendered. The pa�ient s�a�es �hat s�,nce tha� tzme h� has had'�ntermittent gains perta�,ning to his� lumbar spine, some�ines severe, resolving on ��s own wa.th�ut �reat�ent. The pat�ent sta�es �hat on March �:?, 1995�the �a�i.ent was a� work once again. He w�s coming down ofL of tne tn� aL a iire engine wh�n his �oot sliop�d. Tne pati�nC fEll down some s�ens, �and�ng on a cancrete f?oor an hi� rzght bu�tock and�nip rea�on. The parien� states tha� he nored discomtort nertainin� to his neck, tharacic spin�, �.ower back and 3.eg �ain. Tt:e na�.��n� s�ates tnat he .wer�C to a walk-�n cl.inic ;.wa 'hours a�ter �he injur��, T:�� pataen� was �o�.d that h� nad an acuee back s�ra:.n . He was giv�ri a�usc� e �eZa::er and aair: m�dications, includ�:ng :�u�ro�en. The pa�went s�a�es �.hat he retur��d rwo to �hree ciays ? ater, agazn ��i� ? havi.zlg som� d�.scamfarts and cor.�inued to h�ve i.ncrea5ed �awn �or wh_ch he aid spPk �.rea�.m�r.c with a ch? �onrac�or by Lhe name aw t7r. Papia, who ?�as �een �r�a�� ::g tre pat:.Pnt si::ce w? Lt1 mani�u� a�wans and �- st�r�. . The DaCS�:!l. di� unde_Qo K-rays a� �naG �imp as we?? . ?'he �a�ient �vas toid thac he had some aegena_ativ� disc di�ease and disc s�ace na���w:.ng be�wzen �he L4/�5 ar.d L�/S1 �evei . '?'he na:.�ent s�aces �.:►a� he con�.inued �o nav� �a�.n per�aiaing �a hi5 ? umbar sp�.n� al�nougn he � dic? have semR =�provement �ri�n hws thoracic and cervica? a�eas ,- re w�nt o:z nis ow°;� to see �► �eurosurgeon b�i the nam� o= D�. Gom�s i.n Aoril of �9°5. The �a�_�r.� was _o?c Lha� n� nad a�p�aw�;. :ie subssrue^t1y underwent an ti9?�ii SGdI7 dS'..'�. WG,S wp�a L.'ld� t3� had deaer.��3C3V�? �pi:1C Q1.5@&a�'@ a:":Ci �isc d_sease ar ;.ze �4/L5 ar.d L5/S1 l�v �? .� T::e �aLie.^.t scat?s ti:ac he was to3.d to con�_nue �'r.ysica? ;.:�ara�y. ::e ?:as a? so bLe�r. �e�r. �V �w . i`ICC� :. :'` : :''. O� t.^.C��^? C SL"" , . ma ., . _�e�n cr. •,:a:.. 7 �, ? �9� ro� ?�_am. r• 73I� Hucison A��cnue • Hudson, Flo�ida 3�s667 • Te�ephor�e (813) $6$•�463 , rlorid� Toll Frec 1-8Q0-330-»25:, � � . �,. . . � � � � ' � ' . i' . , � . � . , I,- � . , , ., . `_ . .. , , .<<, . ... . , . . � . , � , . ` . . ' ' � .. , ,. CfiP�RT NO .: 5 0 919 . • NAME : DEBQRD, TIMOTIfY � . DATE: �Q9/�.9/�95 IN�TIAL L•"V'ALUAT��N (CONT. 2} c?e was ;.o�d not ro li�� more Lhan SO ].}as,. at a tim�. The patien�. .' � has.a�so been se�n by two YME doc�ors, one by Che name o� Dr. � Moskovitz, who rold the�pa�ient• thac� h� may subsequen�ly need sur«ery someta.me down the road if.it continu�,, as we?1 as Dr. . � Dava.s on OS/2/9� �or a secand I�E exam. The patienr states Cha� � he �.00ked us up in rhe phone book and presents ta G. C. 0. C.' f or further e�a�uata.on. The pari.ent dpnies any oth�r injuries, �rauma '�� or surgeries relating �o ha.s lumbar spine. The patient is taka.ng � A�pir�n a� tha.s �a.me. He has been on F�er.�ril, Soma, Darvocet and . zbuprafen.� Th� pa�ient denies any history oi canGez or pPp�ic ulcer d�sease . He i.s not al�.ergic to any medicat�.ons . , The pati�nt descr�.bes his back paa.n as be:.ng a pretty mvch constant aciiing sensa�ion iri the �.umbar. spine, =igh� and �.e�t SiC��S and ,� central�.y, radi.at�ng up in�o tightness and muscle spasms in �he , .tharacic spxn�. The na�ient doe� admxc to r�ain �in the right but�ocks trave�.ling down the oosterior asp�c� and �atzra3 aspect. o,� ha.s r�gh� thigh and ca1� ro the ba11. of the x�.ghr foot . He does admi� to an occasional numbing sensa�ion o� his �egs upon lyi.ng. down straight. The patient denies any real. pain travelling down the �.ef� 1ow�r Axtremity. The pa�i�nt scaces that rhe pain does ' �requently, awakpn nim at night. I� is aggravated by bending, . twis�.=ng, ��voting, s�tting �or �ong perzods o: �ime, standing a.ld wa�.ka.ng on a tr�admi�l. The patwen� deni�s any weakn�ss af his� � }.ower extremities. He.does state �hat b�th Iegs feeJ. heavy zL h� stands �or any Zonger than �evera� nours. The patien� deni�s �walking wi.th a 3.imp .and does not use arty ambu].a�ory aid�s. � BACK• PHYSICAL EXAMINATION: ��ysica? examination o� the �umbar �pine �shows that sensozy to 3.ight touch is no�ed to be �+�zthwn normal ?zmits. The S�raight Leg Raxsing Test is narma�.. Crossaver pain i.s :�orma�. and th� �owsc:.•ing Sign is no�mal , De�p tendon re�lexes - . :;.nee jerks are ?� bi��tera? �,r. :�zkle j�Yks are 0 on the l�ft ar.d 1-2+ on the ric�ht. Dorsi:le�ion �.s �vrma�. Motor is naCed �o b� � out o� 5:r, `:ze �l.pxc�s bilaGerall.v, S out of 5 in rhe ex�Ansors �a.�.ateraiiv and � aut oz 5 in zhe quads bilatera�.?y. Flzxion o= �.he lumbar spine is not p�wnfu� at 20 aegr��s. La�era?wza�ion ow � Lhe ?umbar $p�Ze �o �he right is pawnzul 3t �5 de5r�e�. � Latera�a,zation az �he lumbax- st�zne �a the �e�t is �ain�u� at � ; ' �?egrees . - - , IMPRESS�ON: I. Lo�Ner back �ain ��ri,tn symntor,tis of 'Yadiculopa:.hy. � ? . Previ�usiv abn�_ma? i�fR= scan. �� . ' � ' ' . � �A'1 . . , . . . ' � . � . . . • ' . ' ' . . � � ' � . . . . I .r . ' ' . . , C . . r . .. . . . ' • ' . ' , � } ` � �.. 1 . . . � . . . � . , . . . • . . , � . � ' 'r � r ' . . ' . � . . � . � i � � � � � • �r 4'�'r�.3i�j�,-. . �� '��5 ..i 4 . � y'i';4�' :a'.. ' 1 S . . il.� . . . .. ,. . . . . . �.( r .. . . � 0 1 �� � _ ... . � ' � .. , ' . ' . , � . � ,� � � .� . . �' CHART N�. : ' � 5Q87.9 � . � I�AM.+ : DEBORD, TiM�THY - � D,�1TE: 09/19f 95 iNrTI�T, EVALiJATION (C�NT. 3) PLAN: I have suggested tha� the nati�nt undergo re-�eval.uaCion of L•he �.umbar �pine ��rith X-rays, an ;�iR� scan, ui.trasound �or �a�e� . evaluation anci CPT, PAT, and PT �va�,uation. Upon comoletion of �hese'tesCs �he �atient will be seen �or consu�,:.ation with Dr. � Honat�. regarding any �ur�her treatment pertaining �o his �umbar � spine and possib�.� surgical intervention re].aeing to the pa��.�n�' s chronic pain despite the use of anta.-i.nt�ammatory medications, :muscle r�laxers and si:t manths of physicai �herapy. I t�el, tha� �he, natient c�aes hav� �.imited abili�y for lifting at this time and � I have sugges�ed that the pa4zent use �he �unctiona? capaci�y exam as a means by which to measure hzs�abilaty for lifring and heavy � work. I�ee3. tna� �.he patiEn�� may be a candi�ate for 1.umiaar laser � disc , surgezy pe»tasning to h�.s radicular pains re�.ating to h�.s r�.ght lower extremity bu� fuxthzr eva�.uation g�ndi.ng �he re�u�.ts � o� the above mentioned test and surgical discuss�.on. .� The natient was informed�and advis�d of.the above. MWP/�b . . � CHART 1s14 .= 5�3 8 l 9 . N�ME: . DEBORD, TxMOTHY ' � � � DATE: 09/19/95 MRI DZSCUSSTQN , The pat�.en4 was se�n today by Dr. Perry ror his :.ni�ia3. eva3.uation. He rares�nts now for discussion o� comp�et�a MRr, which was periormed on 04/i7/95 aC anoCher facility. . BACx: 'I'he pat�ent i.s compla�.ning or pain •.yhich � raciiates irom the back Ca the right hip latexa?iy on �he rzght th�.gh �owards the antero�a�er��. aspec� or ;n� caz� towards �h� top of the foo�, a�r�c�ing �he L5 ne�ve root on che ra.ghr.� The patient also comra3.�xns oz �awn wha.ch �adiaces rxom the �ack pos��riarly on �he ri.ght �h�gn r.n th� �osterolatzral asaec� o: the cal� �owa_cs the sma?� coe, ai�ecting �ne 51 ne�ve �oot on �t�.� rigi�.4. PHY5ICAL �XAMINATION: �hysica�. e:amwnation ��; tr� Zumbar spine snows De�n tendon �e�lexes -kne6 j�'�ks arA 2� �i].a�e,all:r. Ank? � jerks a_e 0 on :.he ��rt and �-?� on �hc righc . Dorsi€��xion is normal. Moror :.s :ioted �o be 5 ouG of 5_n G:ze ��exors .bi? ��erali�r; � out oz S�:� the �xtensors b� i at�rail;r �:�d 5 aut o� 5� n the cuacs ai? ateza].�.y. F1.exaon o� �:�� ? umbaY s��.r_� i� not nainyul a� ?0 ci�gx��s . Lat�rai:.za��.on o� ;.;�e � umbar spxr�e �o �he ri5'.:r is �n�n`u� a� �S degrees . La��ra�Z�za�_or. o` �i:e ? umbar spine to tae ?�z� � s^a:.nzul a� 5 ciegrees. Thew� is �:t�nsoY di�itorum � on�us muscle r�eakn�ss and �i:erp =s cicc=easec sz:�sa :ion on th� ? ateraz aspect ot �!:e rig!�C leg to ch� ��_ sum o� �:�e r� ghC �oo� . Th�re.�s peraneus longus muscl.e weakness and ;.h�re is decr�ase� 5f':25c�i].0I1 �17 Cjl� la�eral. aspec� O� tRe ?"� C�.:7L =QQL : � , �.. - � ' ' ` ; . � ` �. - , � : ..' � .� . , ,. ; . . . � . , , � � , ' ' , '.. .. , ' , , ' � . , ' , . , , ,. . . . , ', ,'• , � ...'. , , ' ,. ' . , , .. , . , . .. . • •; . . r� � , ., , '. ' . , , . . . . ; . I I[ . . . . I.' . ' : ,I . � ; : j, f � . , ' ' . . , . � . . .' � � . I � , � . � , � i' , .. . . . • � x , '.5 ' . . . . . . . . • � ' . �' . . � . . , r � ' � ' ' ' . � , e ' ; � , . � ' , . . . , j � � . . � r + 4 ; � . ' . � � , . . ; , . : . . . � , � � � I . � ` i ' � . � . ' . • 't ` � f . � • � . . , � ' , ' � . � . � . �� . ,i � . � � .. ' r'i'a.6y 4.� �` 1 . � � . � . :�, � 1. , ' l�... t ' � . , � � . . .x•.!Mi.�tsE4.a., .s'i' . ,.... � . 'd! r s � . � a . `2`.j'.�.4} .,�ii yti'jH, ,tr s. . . . . . , . .. . . .. . ' ' � . . � . . � . � ' ... . . � ° . , ' . I� .. ` ' `. ' , , � � ' , � � ' ' ' . i . . . � . ' � . � . . , ' . . . , , . , � , . ,,• �. - � CHART 'ND.�: ` soe�� � .. � � , NAME :� ' DEBORD, TZM�Ti3Y ' � � � DATE: �� 09/19/95 . MRs DISCUSSZON�(C�NTZNUED 2) t�Ic ' The patienr had a magnetic resonanc�. study o� t�he .'� lumbar spine,per�ormed on ��/17%95 �which was ordered by Dx: Gomes. � ,� My review of Lhe. zz�ms , revea�s a bu�ging disc .a� L4/L5 and L5/S1. � and degeneraGive disc disease.. � � . X-RAXS: X-rays show the. hips ,and p�1v,�s appea, Ga be wi,tha.n normal limi�s. The sacroil.iac,3oa.nt areas appea� to �e within � normal J.imi�s. The sacrum appears normal, The disc spaces appear .: to be within nozmal limits except at L5/S1 where the disc space � appears Co.be decreased. The �oramen sp�ces appear to be within norma�." �.a.mits except; at' L4/L5 and L5/Sx where the forami.na space� � appear to.,be narrowEd. Examinati.on o� thE verteDrae°revEal.s 5 iumbar vertebrae, which are wi.thin nvrmal �i.mi�s. Tre facets ,� appear �o be' within na'rmal lir�its. �, xMPRESSiON: �.. Back pain �with L5 radicu�opa�hy. on �he , . ra.�ht . . � � 2. Sack pain with S1 radicu�.onathy on �he � � � ri.ght : . PLAN: The x�.ndings.were� diacussed with the Datient and the . ,�� pa�hology was exp�.azned. The plan o� �rearmer.�. was discussed and � agreed to.� we will o��ain an ultrasound� of the Iumba� sp�.ne, racer X-rays and an upda�ed MRI of �he lumbar spin�. Upon �omDlEta.on of trxese tests th� pat�ent wi,l�. r�turn to cliai.c � zor a consul�a�ion '_egarding �urthe: �rea�ment., � , The natient was :.nzorm�d and advised o� `h� above. � AaB/cb . t� � . , . , 9 • s � • �. ' � . ...� , . , . , . , � . ,�: r . � � � . • 613a�6d336 � � 09�29�93 T��3� � 813 ��6 •336 , i �..„ � � . l�f�HAEL J. /�NDRfC]LA, M.D, ; � . .....� .�'". NEUROLt3GY . .....,._ .. _...�.�..�.. . t.:...---- . .. .. ,. •-•-- • . _ . .._ , llndrlol� Cha��ered li]ll Jcrtards 51,, 614R A, Cle�rwittr, Finrfd� 3461G k13•��[;•3295 f AX ��fr•i33G � Sep�amber' 2�, ���95 ' OFF�'�CE CDNSUL7'A7'� ON i'Sc��oL•hy �i�bvrd . . kEUROLf1GV P,B1 111FI�n���1 Ar�r�il�n Ma+d �kn�ri�i���� I NIAr 4R��r�e�t w�aR�ny �+f Ns��nln�� The pstien� is a 41 yoar old n�a�a referrad �nr �nd���c�d�nt medical Evaauatipn f�r sym��tor«s ccrntir�uiiig foi�owinc� �� work acc�dent t.l�at occurrud on 3/�. ]/95 , The nati.ei�t s�.i ppeci o�f thc� ntio�oz covdr wl�i.l e comi.ng dowz� f r•om the tvp o� � t i re �+ngi ne anc3 �n) 1 to a conc�ote floo� . He had pa�n �ir� his neck and back, trtia �aLtAr radi�ti�ig to isi.� r. ight. but�ock and l eg. Ho was seeit ii.rs� at. a Wa� k�n CJ # nic, g2 va�t sou�� ni�d� �atin,��; arid thar� uc�cl�rweni a ��eriad o�� chi ropr�cti c tr. eatr�tiunts wi, t,t� somc i.mproveni�t,t . He wafi oval.ua�ad neurosurg i�:a l 7 y anci o:'tttoPedi cu11 y ori �evera � � occa�ions. An MRx scf+r� a�t Nortlzsi.de Si�spiL�� showed �t�mr� de�ene�at f.ve d i.sc ch�nges �a w� i 1 as a disc bul,ge at �,-4 , S and �,- a, S-� • Nc�ui•�surgica] d�inioj� wa� Lha� ttse��e wa� r�o indication tor sur.�er.y but epidtii•�k steLC�id injecti.��n mig}�L• be hE�)�£ul. 7'he patiec�t has Ue�n roluctant to receiv� L•t�is type vf trcatmant. Onc� oF �he� orthopedisEs, Ur. Mvskovit� h�d ir�dica�od tt�at tt�e patient may bcs a surgica� ca��didat� ii' lsis symptoms did s�ot, r�so�ve nv�r �=i � dppro�ri.ate �ari.od, somawherc� i ri Che �•ange of' 6 rnont:t�s . Oth�r orthoped�st� h�ve be�►n } vs� ��eci f ic �s t.o whe�hcsr tt�Ere was any S.ndication for starger'y. The ��ti e:�t was tri ed on somo anti - in£iammaiorx m�t3i.calions bu� currently i� taking a��sirin 7 to 3 Limes a r3ay. H� i�as ��arrici.pateci in a£unclianal rehabi� i�aLi�n ' �aragran► �ut appaars t.o h�v� react3ed a pZate+au in territis a� any i tn�rovemant . At ttie ��r.esent t�ime t?�e pat i�i�f: GontiEiue� l.o hav� p�i i� di f�us� ly in f�ts ]ow�r back extending into ttiis right butto�k ��nci �i� �osteriar ieg, Ocily �cca�iona] ly i t gcses bc��aw t��e knee and h� ttias no aasoci.a�ed nun►Unfl�s. �'}��c� p�.in seo�►6 aggrava�ed by azty �ignzfic2�nC ac�.ivity �i�d alea t�y �rolonged sittilig or �tandzng, 1�rfving zs quit.e U��CUn�fU:•table iai� hiiii. H� doos ,y�t �o�r►� re} ir�t )�y IY1 i1t� dowii . PI�ST �i I �'1'URY st2Dws that 1.hp' pat i e�'�L• h�d a 1��3ck straS.n i»j��ry in 1�$7 �hax occurred whx l e Z�a was per��rnisng �quats wi�.11 ��ee w, ig•h�s, 'i�his �•�solved �v�r a sl�vrt p�rioci ancl t,e w�s t'ra� af pain i�z hi� back and ur�der no tred�meni. iar maciy yea�•s ��r•iox• to tt�e csr���l �f tt�� cuz rer�t : 1) ��vss. Th� ����L i enr_ uttn�ii�tRd to con�.�itlue woi•kir�g and fe) 1 on th� 3/:f 1/�`� e�ir,od�?, Lru� wit2i istc�•Qasirti<� �ymutio��s, ht.o����ed w;�rr ai�ounci 3/�(�,'9� ��nd }ti��s �lo� wor•ked ai.nca. �ZEVI�W OF aYS7'F.M�: �'atic���t dc�nie� 1�aa�idcnE�E, �.�iz�•inasb, dy��n��, COUgh� cha�t pain, nou�ea, vonfiting, diarrh�a, dysuria, anl:ae BWp�.��11g� ��3vL�i� 6ICiE�E� Cii6i:ut'bc���C:� o�' �1gl���iC.�nl WGiG1�L C1iai�qR. tr��ll�Oi�flG3C �XAPS: ,. , � . , � ,. r � , r , ,`.�,� °, .�.:.•„ .�`' '�+i�`: ' . . . .. . . . _ , i� . . . ... . . . , . ,. � . �. , . �. � , : � , ,:, , , ��.,.. , � '., .. . . , , . I , , ' . Q9�29r9� `i2rjS , � 8l3.a�6 ♦1Sd � ' Y ' � � :, . ' i N�upotoo� r.ax i , ' , ,'�`i��ot}�y �lehord --7,-- 9/25/95 MENTAi. 5m}1'1�tSS ; Pa�i �r� � wa� ori �nLed t o t i u��, p� t�c� and p�,rso�z , His�oriCaS ev�ni,s wt�r•c� rela�ed in a C�tiezerit or•g��ni�ed mat�r�er. ']'her�e was a»or•�tal tu��d ��' gor�era} inrorroai i.an. CRANIAI, NERVFS: Cr�nial ridrv� exam showeci nar�ta3.ky rea�ctiv�, ��u�i ls, c] oaz' iundi ar�d ��ul t range o� �xt rtsocu� a1- mot.i nr�, � �'hero was . no vi 6ud1 ! i�l.d d�r'ert. TlS��•e w�as �v � acial w�aaknes� vr asymmA{,1•y . Tnngue , j aw a��c� Z�ya 1 ats movcments . we r'ca �s�srma �. t���CK; shows s�iyttit re�t')'icti��r� of l.�tt �a#era] i'o�:�tinri iii the �ieck wi i.h tandnrness �t�d som� i r�crease�d tane i� t?�c puhLeri oX �►ardverteb�•aZ mu6c]P� c�uinc,� irrtc� the tr.ap�►s.ius rE�gi�n, No z�adic�Zar sympto�ti�s w�r� el i ci tod by nc�clr ntoti.on. .'�'�s�s af � ��eutovasculai• c:ompre��ion ware npg�ti.v�, RAC�{ �:XAA�: ShowR�i dif{u�e tPnci�r��e5� in tho )owc�r h�r:+c with I i�ni t�ci Qx Lens i Qn i.c� 0�leyreeE , 1 i mi tpd f?�ex i arz t � "!� riegl�c�es wi th r�o 1 i ini l.at i a� ut � dtera l t����� ing . St ra i giit � eg ra i s i nc� i�; Uordarline p0�3i:IV0 ar� tha right a� 9� degrees, rragativa on the iof� to well past 9fl c3�gr•eE�s. 'I'her� i� some Lei�dc�rri�+�s ove�• tt�e righi: seiaLxc nntr.h e�•c��. Ther� is no t�nderre,�s ovar ehe �i�s �ursa. H�1� r��a�ion doo�. noi: iricrease }�i� pax�, MOTpR �;}{AM i NA7�3 O.� ; Sl�t�wed we l l de��e Zu�)�d a�1d �yn,�+ti�L r i c�� 3 mu�cul�ture. 'I°iier� was ric� evid�nc� oi any week�3f��r; in any tittuscle group. , No ai.i•u��1iy �r i asci ct►] a�ion� ws��•t� ��csteci. '�'h�:y��• waE nd tane �l�angc� . R�FL�XES: HCi1Vi3 an� symmatrical. 'I'herQ werc� n� pa�hnlogical i•ef iexes . fik.NSATION: Sensot'y testiny r� moda].itsas o! 4��ic�, gas�+Lion and vi}}rd�ar�n showc�d no evid��7r:� of ),oss. Therr� w�rf: rio a�'n�� t�� � }�yperpathi � ot' iocal i�ed tH�c3��'r�ess; H�mUex'g te�t was negativt�. C:�qFt!}INAT�ON: Norit��l bLnt�ot� nnci c��i i. Na� i►-►a�t w�� �f,l� In ��e� for��ti ��i�id altercia�zng ��av��ti��i�1t bi 3 a�,ar�l ly wi C��t3t' diti`iculty. Einger t� z�oss{ testir�g st�Uw��i ri� �bnhr�m�l �tie�. ' Zi•!�'RF5S10N: l. Cttia'o��Sc. ��ost-t.r�unxatic l�ack E�ai�� wit�� � Ec:iati� coR�pone�zL.. ) tt�irik the pa�ic�T�t ha�; el�m<<r��� csF �.umb�SaCrn1 �uyofasci�i� ��r�d sac:r�f Z�ar f;yc�c�vi�is. 7'}tia r;uttution i� whetito=' in additi��r� to t.h� soft t i�suo c.onti��onc�n t& t�hoz•Et i� i rticieed a�•ad ti c�u 3 opa�,l�y � 1. c3. BC:3 c��i C tl@1'V9 LC1Qi CCztl1�)t'tib�,;i.Ltiii f YU1�� Ci� 8c; . herni,��io«. 'Pl1� S�{�I sct�s►�; 3 rauiew�d ��icy i1�ey s�a•� •t• i. ��' �. k,: '�...� :r.�,� � . . � . . � .. .. . �. �. , ,., , . . , , ,. , . _ � .!.. . . � ,. , .��..�.� . . , t � ., , , , . ' , �., .. , ', � .. . , . �� ' � � �, � ' � ��.'��f�. '�S.l.� �f:' .sR t.t '�- �iF'.���i.' , '.d�• . .. , . . . . .. ;%.,.. ' . .. ' . � � . ' • . �4/�9i7S t?�13 .r�t' .E . . r , . � ' � i , t � . . , . ' S 9!3 �46 4336• NfiURQL06V . , . . , P.03. '!'ir�othy Uobord -3� ��/��►/9� �� ' aq�iivc,r•�l �zh�+w�ng ni�ly �iie ciis� I�Srlc�iny as . ntieri� i t�t�c�ci . - � . � � �. CerviC�) niyol�t-�Fciti�. • Iti:CQMMi�:NdATiON: S).Zl(:E� tt�� �a�ir�nt has rdac:rz�a �, �►taLe��� wit�ti ronservat3�� lre��m�nt , lhe deci si�n th�t rroods �t o hc� �itiade' i s ..wi�ettier or not to pvi sue i:}�e pa�si ba.li �y �! surg� c�) t r•eatr�r+�it - i'urther, as roco:�unc�rsded by Dr . Mo�kov i. t�z .] t. wou ) d bc� my ro�ommendal.i oci tt�rat i hc� ��a� ient underyc� a l unlbar myel ar�zar�r to cS �xify Liio 3 il(�1C8�� D11 ay' 1�ck of Sdm� f ot' sut•c�a��y. 1!. f tirther ,. dvidence oT norve i•oc�t. c;c.��t���ressi an is ic3e��t i f iod on my�logr�m� �t�on thCt n�tLient. wi J}, wi th rt�� surgenz�, l�e�d t�o m�ko :s, deai sian t�s to the i•i sks drid �a�ne�i'i ts tt�ereoi'. T�mphas� x�d• to tha I�a�ieizL ti�at evc�t� i.f ho dzd i�av� a.�it�t rii �►��d iumbax �ii �r- wi t}ti � adiculo�aLhy that tl�ezd was � ikely a�igni fi.cant porti�on of ttiis F��in t��at was duR to sai t tiss,t�� i.t�jury �i�at wou7 ci not i�r� al t�rc�d !�y �ucli s+�Lgery, LiSOUgt� such sui��er•y woul.d be l i kc�) y Lr7 i�e lielpfu� wi L'h the scs at i c� c�m�on�rit ot hi s pra1�) ei��. I C l.he iuyeloyram fai � S to ident.i fy any su�-giGal ly remerliabl� ]�sioi�, i.hr�n ir i� niy feeling tl�rt the pati�nt i�: at m:;ximum ' n�pdiCdJ. ,icn�r'OVpm9�1ti ���d has a �}erm��n�i�t iiijury i�� tat'm�� �f tt�� di�gr�o�os abovR. � nI:GATI0hS�31P TO i�JUkY; ?t ib u�y onicziori tt��t t•h� ��atic�nt'� c��ronic back pain prol?] aius a�•e a di rert �•PSU� t oi the t/a 3/9� work accicienl. WORK S'I'A'I'US: At thc� p�•e�.e:�t t i r��e, �.he E�a�i er�t i s ir1Ca�.�t�le of [serforming his dv�ies a� � fir'� fight�i•, 7t i� ntiy n�ii���n tn�t even i.f tl�fl patient h�5 d�ux�gical tesion and �uccassf��lly undorgoes suresery tha� 1�� wi 1] remain unahJ.�► �o work a�� a f i r� f i g}sl:ex�, i. ra . meot th� a�p��o��si i ate 1 i 1 1, i �tig aitd b�nd i ng ��equi.i'ORtiOi1tB and i.hoiei"o�•�: wF�at�vr��� tt�� vu*con�e, �+e wi � 1 rzeea to b� medical iy rotix�ed fr�n� t,he t ixs departmonl., Ir� the � uture, hA w� 11 �i•obauly ��eed to work fn. �� 1 ic�ht du�y ar� �Qtieititdry ro]�. � � ��t''�f r��'�' M1C EL .7. �HaKIOLA, t�.U. /j�t . �.�.�■ • � , . .. :r . � ,�,, � ;� �.. '... . ', , . , . ,'�� . ' . Exp�cted Pe�sion Cost f���sh Pavout Over Life af Pension�r and_Spause� . �� Preseni Value of Exaected Pension Cost � Annual Interest Rate 7A°/a ' . Ann��l Pension'Amount �34 115.1 G�ftect�ve 11/14/95 � � Pensianer Sex , Male '. Pensloner Age 41 � Pensioner ufe Ex}��ctancy � � ' 76 . � Years Remair�ing . . 36 � Child #i: DOB 9/24/SO Gk�ild #2; DUB �U/27183 # Pensio�er Spouse Present � Annuat Amount Years A�c _e_ Ag� Value Interest � Paid � 41 r�/a 384�159.63 25,�97.� 4 34,i 15.16 2 �2 �� , i.`�b'" 25,1(37.88 34, � 15. � 6 � 3� 43 � -. 366,734.34 24,477.37 ' 3a 115.1 fi 4 44 357,Q96.55 23,�4�.�0 3a � 78.80 5 45 350,858.25 23,503.82 30178.80 6 45 3�t4,183.27 23,036.�7 30 �78.80 7 � 47 337,04� .04 22,67�4.39 26 242.�44 8 48 333,472.99 - 22,424.62 26 242.44 � 8 49 � 329,655.17 22,� 57.38 26 242.�4 10 50 325,�7Q.T 1 2t,87i.42 28 2�42.�4� 1� a1 321 ,� 99.09 21,565.45 26 242.�4 12 52 � 316,522.10 21,238.06 26 2�2.4� 13 S3 311,517,�3 20,887.76 26 242.a4 14 54 � 3Qfi, t 63,04 2Q,� 12.93 26 242.44 15 55 � 3�0,433.53 20,111.88 26 242.�4 16 56 � 294,3q2.95 � 9,682.72 26 242.�4 i 7 57 287,7�i3.23 � 9,�23.54 26 2a2.�44 � 8 58 280,7'2�#.33 18,7�2.22 26 242.44 19 59 � 273,2� 4.11 i 2,2p6.50 26 2�42.44 20 6Q 265,178.17 �7,643,99 26 242.�}4 21 61 256,579.72 17,042.09 26 24�.44 22 62 247,379.37 � 6,398,07 26 242.44 23 63 237,535.04 1�a,'T08,9fi 26 2�2.44 24 64 227,�01.53 14,97� ,62 2G 242.�4 25 65 215,73�.7� �4,182.66 � 26 242.44 2s 66 2Q3,670.93 13,338.48 " 26 242.44 27 67 190,786.97 � 2,435.20 2� ��2.44 28 B$ 176,8�9.74 1 1,46$.70 2fi 242.44 29 B9 � 162,� 85.99 i O,�13�,53 26,242.44 30 70 148,378.09 9,327,98 26 242.44 31 71 129,463.63 8,�43.97 2fi 242.44 32 72 . , 11 1,365.16 fi,877.Q$ 26 242.44 33 73 91,999.79 5,5�1.5� 26 242.4� 3� i4 71,278.$5 4,Q71.�a 26 242.44 35 75 �9, i 07.45 2,5 � 9.04 26 242.44 36 75 25,384A4 858.40 26 242.44 y980�155, lc�ranr.tiubr�svw+vua�r•xsromrar�w.vn.►��u �;.� Balance ' 375,741,62 �66,,734•.34 357,�96.55 350,858.25 34�4,183.27 337,04� .04 333,472.99 3�9,655.17 325,570.11 32�,f 99.OS 316,522.10 3� � ,517.73 305,163.Oa 3Q0,433.53 . 294,302.95 287',743.23 2$0,724.33 273,2�4.i i 265,178.17 256,579.72 247,379.37 237,53�.04 227,Q01.53 215,730.71 203,67a.93 i 90,766,97 17�,959.74 162,185.g9 i 46,378.09 129,4fi3,63 111,355.1 fi 91 ,999.79 7� ,27s.s� as,�o�.a� 25,384.p4 fl.�� r�.,suT �• �� �` TRUS7EES OF THE EMpL.0YEE5' pENSION �UND = ��,� Agend� �over Nfemorandum su�ject: .. Pension io be Grnntcd ttem N Moeting [7ate; � 0 RecommendationlMotio�: G3ry T�utman, Mechanic I[, Fleet Mainter�ance Division, � Generaj Services Department, be granted �� job-connccter� c#isabiIity pcnsian ur�der 5ection 2.397 of thc �mployees' Pension P1�►n as recommendcd by the Pension Advisory Committee, ❑ and that the ap ropriate officlals be autharized to execufe same. BACKGROUND: ,G�ry Lutman, Niechanic II, w�s ernployed by the City nn June 4, 198�4, and began participating in the Pension Plan on t�ai datc. Mr. Lutman submittcd letters to t��e Pe�sion Advisory Commiuce (PAC) frotn Gordan Zucrnr�orfer, M.D.; Gury Muscovitz, M.D.; Mich�ei Evnns, M.D,; anci Mark Manical, M.D. establishing the existence of multiple impairinents resuiting from on-the-job circumstances. Those impairments involve the left hip, upper extremitics and back 7nd knee and mttke �im l�ermancntly unable t� perform his job functior�s. On October Z S, 1995, the PAC determin�d that Mr. �utman is entitled to a jab-canr�ected dis�bility per�sion. The letter from Dr. Z.uerndorfer relates that, "Regardin� Ii15 left knec, he l�as reached what I 6elicve is n maximum medical imprnvenzent,..he wi11 have ongoing proUlems with intermittcnt pain, sw�lling, anc! limited motio� in the knee, a�d I would rate Him a 5� total boc�y disab�lity based on his Ieft knee,.." Hc further relates with res�ect to Mr. �.utman's right hip ti�at, "...options arc mainly surgical ones, including �ossible fusion versus hip rep�acemcnt, and I am in favor a f hip r�piacement..." Dr. Muscovitz in his lett�r n#' 1►iiy i 0, i 995, relates that, "...Hc only h�s o n e useful extremity �vhicH is his (L) upper extremity. He has carpul tunnci synciramc in his (L) npper cxtremity t�at precludcs �iin from doing a job �s a mechanic..." In a lettcr datcd 3uly 2S, t995, Dr. Mu►cavitz aives Mr. Lutman a G°lu impairment rating. Dr. Monical's Icttcr relatcs th�t, ".,.Mr. Lutmar� is r�ot �ble to perCarm the duiics af t�is pnsitian on a rcbular and cantim�ous basis. The follawing �nd determining factors limit Mr, Lutrnan fr�m his job: pasitive pain and I-iNP 1umbAr sPinc, positiv� pain down lcft lowcr extremicy, �trophy of the righE up�er cxtramity, ald brachinl �al�xus injury, carpal tunnei syndrame Icft hand, degencrative joint discase of both knecs and rig[�c ankje, arthorUSCOpy of tf�e ieft knce, pain down IeFt leg, status/post ri�nt h i p rc�lacement..." Revie►r�ed by: Lega! Budget P�rchaslr�g �„ NA Risk Mgmt. �,[�_ C1S T, NA, ,4CM _ Other � NP.___,,,_,, Submltted by: City Manager Originating Dept: Human Rosources User Dept.: �tctv�rtised: Date: Paper: ❑ Nol required Afiocted partles ❑ NauFied ❑ Not required Costs: $T$9.7_9Z.i2 Tatal Curreni FY Funding Source; ❑ Capt.lmp, ❑ Operaiing ❑ Otl�er pr�nsj,g�._.,, ApproprlalEan Cade: �{�-47�i I U-51�,00-585- ��S! Commission Action: ❑ Approved ❑ Appravad w/conditions ❑ Donled ❑ Continued to: Attach ments: E.etter(sj ❑ NonQ , ,k r •.t'. . . . . . ' ' ' . ' � . . � ,� � ; ' � . . ' . . i. . ',ji� .a°� � � ' ..., i. ` � , � '1 '. i. . � � � , . ' ` ' . . ; ' . ', . . ' . . � i. , .. ; ' ., � ' - , . . � . � .. ' ' . i ' I . ' ' 3 . � . . , ' , . . 1 � ' . r.. . . , ' ' � . . . � � ' ' . . . � � � . ' , ..� � � . . , � . � - . ' . . , ' � ' , , ' • , ' � . , ' . . . � � . ' � . ' � � . � ' . . . � ' ' . . � � ' , '•�� :� ♦ ( �� ' �. 5 ',t , � . � , � . �� . �, ' . . , ' i` ,.. . � � . . . ' • ' ' • . e ' . . ; ° . �. � i . . � ' � . .. . � . ,/i11 ' , .. • ' . , . t t .' �. . . �'. '.. . � � ' . . ' . :i ' • . , , , i. . . ° ' . �°i ' �.. . • . .4 , � ! }� � ' ' . .� . . , . . ' ' .' { ' ' ' ., � .. , ' ' . . . i. . • , � t . • r .. i , . �. � ' ' ' ' � . . � ' .�, , . . . � ' . � , , 1�;•:. •:f- �a. ;.� ;�. �,. � ' ,:,c,�., .r ' ' �, . �. , t. , :�.. .�,., .. . , ` . . ;. . • : � . �. • , � . . ' �� ±��� 1,'. :� ° .'r, :;� � ff�, ��;`(a'. .z . '.{;��, ) ,,� ,:j�' `�'ti..,if.;Yf�', `S 515�"rn•:iL . � .. �i=•.•f"t' „ :�� , . - ... , . . . � � � . � � ' � ' � ' ' ' � ' .. � . ' ' . , . . • , � ' �� � �' . • . ' . . , � � � � � , � � 1� . . . � . � � . i. .. . , � . � , ,' , .' ' ' . '' � Agc�dA Yterr�—Gary Lntman '. . � � ' . . . . ' � . . . . Page 2 . � � . . . ' , � ' . � . . , � . � �, November 13, t 995 � ' �. , • . � . ,� Mr. Lutmnn doc�mented four different �o�-thc-job accidents. ' On Ju�y�2l, ig92, he sliQped� on �� ' r �� some oil and fell as� his left knee. A Notice of Injury was comglet�d on Octaiier 1, 1993, � relative to continu�l wear ' und teur on' thc hand. On November 11 � 1994, ha develoged � p�t i n � � in his . back fram puil starting 5aW5. - On March 22, 1995, while p�1i startin� ar� angine� • i�e , experienced� a pap in his left I�ip, with warsening pain through the day. The City's Risk ��� Ma�iager, Leo Schrnder, in a memo dated July 31, 1995, stated, "When Mr. Lutman's re y U e s t of 6l20/9S for nn extension of' light, duty was approved, �iE had not yet been detcrmined ' '. whet�er or ntit his baek ancl hip � prob�ems wera work rel�tec3. It has now been so � determined that s�ch.' p�ysiGa� � problems are work reluted and ihe City will be responsible ' � for Mr..Lntm�n's buck and.��ip proble�ns. Mr. Lutman continues to be perm:�nently disabled . and unable to return � to his nvrmal empioym�nt duties becuuse of his campensable ' w ri s t � injury...,� . . . , Based an un uvernge salary of approximately �29,Q43.S3 over, the last fivc y�AlS �nd the ' •.sev,enty-five perc��nt (75�0) minimum disabi[ity bcnefit, Mr. I.utman's pension will ap�roxim�te $21,782.87 annualjy. Charts � from Finance which take ir�to cansideration � mart�3ity r�tes �nd �ge reflect� t��t "present value eost of financing" this pensian will be • appraxim�ttely. $289,797.12. The total uetn:�1 payout will a�proximate $74U,618. � �. v� . ' _ , �;� ' ,. '.`, .: .. � , ' ' , �, . . , , �,I T�: � Y �.' 1 � . � � ' ' � , .� . . . ' - ., l . , � � . � i . . . ' . i, ; r � � .. ' . . , , ` ' , ' � : . .1'. � ' ' ' , � , � - . • - � . �• . ' , , t. . ' . j � , ' ' . , . � � ' . � . . r� . ' ., s . ' , ' , ; • , .� , s � ' � ' ,• , , '. '.' ' • ' ' i;iz'�:r,��r ' , ' . . ' ,i ix iq�{:.•. ,tk� } I, � �;''t�iri ; i •4';;' : �' , i. ,� ' ' � �.11, , ., ... ... .. ., _ �.i't��; , .,, ., ... .. ; , . . '�i.:�iirt+f�. Numan Rraoures� Depa,Sment 813/d6Z�8870 ' . ' �. , � rt , - ..� � . 'it � ��'.. , . .. '. . ,,. . . C I T Y O F C L E A R iN' A T E I�. . • � Pos'r OFFICE eox �r�a CL�ARWA7�R, FLp�i1�A 346'!8•4748 �° iU Honorable Mayor and Membcrs of the City Commissi�n 15 Trusiees of thc Employees'. PenSion. Ylan � FRQM: , P�nsion Advisory Committce • , COI'IFS: Debbie Bailey, Payroll Services Man3ger; Risk Mana�ement � SUBI�GT: � Pension for Gary '' LUimnn—Jnb-Cannected Disability Pension DA'I'E: October 1 S, 1995 . ., Thc Pension AS�VI50C}' Cornmittee (PAC) received an application far disaUility pension f r4 m Gary Lutman on October 2, 1g95. . . Mr, Lutman h�tis ��en cicterminecl by the Pe�sian AdviSOry Commiuec to meet � the reqt�irements oF the Pensini� Pihn ft�r a job-connected disabiiity �Ser�sion. Hc was em�i4ycd by the City an Jur�e �, 198�1, and be�an particip;�ti�g in the .Pcn�ion P�an an that date. Further� he has submittecl medical dQCUmentation, capies af whicti arc attachcd, rel.�tivc lo his� disability �vhich ht�s been reviewzd and a�proveci by the PAC. � By mation �nade and duiy �arried at its meeting of October 18, 1995, ti�e Fension Advisory Committee approvedlrecommended thc granting nf a job-cannecte:d dis�bility pension to Mr. I.utman in accordance with provisions of Section 2.397 of thc City Codc. 'I'his pensian i5 ro be effective nn u date �to be detcrmined. Th� aniount of Mr. Lutman's pension will be caicul�ted hy the Finl�ce Ucpartment according to the formula in thc Pension PIan for job-cnnnected disability �ension at such time as i�is last five yc;ars af service and salary cun be computed. I hereby certify tlzat the Pension Advisory� Committee has approv�:d thc granting of �� ,jab- corinccted dis�6ility pensinn ior G�►ry Lutman and the ahove d�tcs are corrcct. . � � ` � Chairman, en ' n dvis ry Committcc ��� "Equal Emplqymenl and Alllrma�tive Actlon Em��ayer" , . . . . . ... . . . . . . � � �. . . ... . � . . , � . . . i � . . . ' . ,. . . . . . { . . . , , � ' � . ' � . ` � ' � � . � � � , <� _ .. . . . , . . . ' � i� ' , , , : . , , , ,. ° , . . . . . . . . , � � , ,. ,' ' ' ' ;; , , � . ' . ' ' , . • . .= a �:.d, , �. . . ..w ' .. . . " , . . . . . . . . - . . . . ' .. ' . , . . . ."t" . �,_ . .. . . .. n.r... . ' . . ��• .!, � , .. , . • �.�' � . , , . . - . , . . ..... —.�.�. .....�—,. �r�.+-�-..� ...,, ; , , , ' . . . , ' � � . i � ' . . � �- ' PEi'�SiOY REQ�EST FOR.'�L ' ' � , . �� , � :�Iy • 'Gar A. Lc�tinan dn nerc�iy agpCy Ear retirement fram ti�c City oE Clearwatcr Gc�era[ Emptaycss' Pansioa Pl�a, . � � y1y benefits date is �'�� 4, 1.9g4 � (Entry date inta pe�sion� pian) • M y da�te of hire, is �7un� 4, �98� � . � ' �, �iy bzrtt�d�y �s May ].2, i?52 � . ' . . il�y jats classification is � r����anic �?' and i, work in th� � Gener�z Serv3.ces . D e p� r t m� n t, = Z�� �•'�aintenance D i v i s i a n. �. �M y resi�nation date is _tO..be aeterrtin�d., . � � , Th� type ot pensian for which I am aoplying is (check onfy ori�): �Re�ular Pet�sion bas�d on years ot servica � x �ob-connecte� Disa�bility gension ��ion-job-connected . Disability Pension ' � Wiy spouse's name i5: � , �]ependent children under the 'a;e of 1S and -resiciin ; ir� mv . hotis�ho�d are; fprin� C:zild's w�.�il vame) -.. . � (C�.iid's Jace o; 3i:.t3) � :�erebvi ce�ify all ai the a�ave c� be tr�M an� co ct: '� , � ` ... _ , �Y � t i �,.an:: e'� � �%,ga5 • - (D�[�`} ST�,'TE OF �'S�ORI�� ne tort�vir�� .-��scr�nentr �•v�s �cL^awl�c?td ��;or=�.,��`��'-5 CUUi�[TY OF PIN�LL�,.S ' ���� �v� �,"'•� ' •1''-:�'^ %�f '�na :s��ersor�al� ' �ow� ;i o,•in� or ��+ho ''rraS ?raducea �~Y � '�•�s iaea it Ficacion anci �uno eic/�ic nc: tai�� sn oz � � � �... � . . � 11�`� �1 \ � �'• ,��� ` � �� � �1 ' .�� :Votarv ?L�fic ' � �' " : : ` (5i;narure) � . . ' .. Ca�missio� Na. 1 I �i� �` ��� tr , I �y I . � t� �_�� ; �-�^,,�•\ �� \' � , �� �N�me ac Noc, ry ?rin�ed) I `� . ' ' ��� �,. - - , ' .'. , ' , ' .. . .. ' , � . �, . , , ; , � � : . �- .;., . . � , � . . , � � . � , . � � ' � . i � . � r , '. ' : � : . . � . � , � . .. . ' . ' ,� ` �.. .' , �,, • . „ , ` . �, �, • . , ', . , � �.: � , . ' �. `, . ' , , - ; , , �, � ' , , .- , . ; , � • . . . . • , . ._ . , . ,_ . . .; , `, , . : �j . � � � . . „ , � =� ' , � � . � , , • � ' � � , . , � . , . � '' � ,, •'�I ' ' . .'� 1. . , . i , ..• . . '. � . . , ' . � ' S , •� ' '..� . . • •! . • .l , ' • . . � . . . ' � ' • y . .. � .. . � . �}./— e . Il.l:.. tr'1� . =1. ...Y�, h. ..� ...•..�... •...... . . ,..yiL • � . e.. '. . • 1 . . . .. � , , � . • � . � ' ' ' Ir � . . ' t � ' � CITY DF� CLEAR�V aTER � .. , . , GENER�ii, E1�IPLDYEES' PEVS�ON PLA� � � OPTIONS - GEVER�#L El�IPLOYEES � • • f � � OPT�OI�I nl: . ' �mpioye�s can receive � lumo sum gayment.• for vacaci�� and � � � haliday� pay and 1!? oF acc,ued sicfc leave a� the time� of � senaration, from the City. Ther� will be na 5�'c deduction for � . � ,�cnsiar� ,fr�r� this lurr�p ,,s�m paymenc nor wi�i this amount c o u n t � . � ' ' �'�s earnin;s in the calculatior� or che pension. The last day of �. �.vor1: will be �he terminacian dace and pensio�► benciits witt he�in � .tae' iolIowina cEav. ' , . ; . , OpTIQN n3: � �rriaioye� can axsend te:mination dace b;� the time due for � , � � , v�ca�ion, holiday �ay, and !i2 oi ' accrued , sic'� leave. e erminacion ' �. d�re will be �t�e ;i�al ciay ot extended timc. peRSifln beaefits � will . cesin cne foElowi�g aay. • ' (Ottly available ta ,empioyees t�ir�d prior to �01119�.) • • ' . �F :M �M IN re r ye at a� M +M n Y�c +� r r a r� f� a� ie r� r �[ �r x +c x tie � u ■ rc ir +t x r� a� r� n Y� ri a ae a� �r *e ae ir yr w Yc x u M � �r �c �e ir r�s �a n w x 1► , t� , ���-y' �A. Lutman , an emalove� oi tl�,e Ci�y oi Clearwacer, hereby ��piy. �or . �en5ion �enriits under cne City'= cmployess' �'ension �lan. , ,. . I ne:ebv c�rtiivi �hac F.;ui�y unders.and ;ne ,wo aocions oti�red to m�. I c�oase �o -etire usina Dazion = ��nd wisi;� mv �eneiits �o be c�Ece�laced �n�er :his oo�ion. I unaerstanci tnaz once cnis [ar;�. :5 SiCned, mv decisinn is :rrevocaoie. � � =:viP! OY��'S 5IG`1�TUR�:� �--- SOCI�L SECL"F?TY �: 4? �°��-3774 . �'` WTi�1ESSES: � � ,�DpRESS; '-590 St:nset Loint Road , \` `�-, .~� ;�,, �`L1�;'�'��-'-��,a.V.Z , Clear-wazeY, =� 346I5 , , ,s � �G 7 %~r-� � I995 ��i.��-1;-C.cuL ��Y Z-c��� Dr�Tr: � �••� � � � ,.�.�.� I' ,y •, ., , , . f ! 3 e.: .. , �, . . , ,. Si . I. . . . . . . . � f � . � 1 I .:t� � ....._.. — ���:�•�" '.1: .:..:^... ^�_.._...r+„� �- :�"' =�::.- � �...�..r..� :'�� ««.:..:9�.:�- _.J � ` _'�i.'::rG ,...;.-: �'..�.",i !� :. _� 7��y: 'i�"'� -..� ..��"�a'.:i.`�'.,�►-'r�.si' r •s.':� � 's: .ci�r�:.7s: 'i��:,�:�-s;j�"' .� �� �i• j-Va�',,` i«_.=i�.�•��L.�Y��.:�^-�:..i:.......r�...�.� : f *. . . � ^ ^r: '-sr.r-�.�r.,...., ~ „-r.�:rr'�»5:�.;.. ' v , .,.�. �J%:;�`is3:•,'�.;.-+r��...u:.�",�,n�:. � ";i.-� t}. �C': " . ,7^,_^.'.'��"'�l_: �... .��... �•�:•�.�.-�:'f»w-5..":Yr q�.:� �;L. a-�-« �:'.� ^w,: : ,� _ . . . � , »�. �.�'+'. . ti...�.. : !. 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'� y87. . _'�:::r- �:�i....�:�t ...r. ��:_.`.. :.`�'� . . - .... , •7.-' _ :,,.'. _ -� 1 1�{ . .�,���:�.�:::i �n. , � . �.r.d .L. ,.�r�+1 .�tr.� �+...'w"pw��w ....l�� •„�•4'L... -. �...+�r�.�+~�i'.•. •. w:l:�.1•./. �' 1 � 1 �•►/ :t , ! '� I .f'�.�.,r.al��"'�!4twa±F+ah:r�ajc5a+�..rc+MC.-aY�.4.wre-.wt.;.+.;s' ...a. �+.r+.rw'� •..f�tr•+�T .::.,r..,~ 1 ..,f . . �;�*.� � ���t:. � � -.» .-,s� .-�: _ '. �a.. �f r�Y� �«-...w.• .�•crf.+��l�4��'.�S!^ ��e�r.�.+ru.��;: r, K•' «.rry . '�r•. ` �(3;�� �+�1(�AA1 ^•-� �rr� r..•y •T:, »,r. ��, .�.... 1,:�.�� .:.,-t.�.l.., _�:.. ..,.-�. t� •..!'+ua.Y..��. � ,"�I�.�$��I�Q..' �7�GL[�/iiY�lJ 1.C':C� ��.f'.�a.'.rw���'� M:�i.s�..� �- _ ."^'"-.�...:r - ; ' �. :�.c.�. _Y�V..�.i-,' :w.:•�':•:. �le...�.-�J :.�,. ' ' •��: =�'+J�' �,sj.. � ,. ..:.._. <<:a_°° �'"': ``+�.�.�'...�"`.�~:..a+-.�.�.r.:'1."����� s-;',�''.{...'; 'j�"' � .• '' r• {.l.11�' ' I � �. =�7.=..�+��T�. .y, �1�:�� �..... `�%;. _�s�." _= :s:_s - -- .�=�''�" - - .t �_. � _.�Jx�:zt-..�,.s.�' .: __. �'':.. '»T :,i�tt� �5.:] ��'i?4;'•' :.aai7-.�,�.'-`�;r•'....r �^..: y���.rr„l.�=,�, :n.ra�:w=-^--:i.:r �:z_'! •• ..u...: .-.l:'�'�.:� �..�:._•�.. .n'��C:'}FJ.�^.'.'L��; T.*T�:����s� « . � ..a.�:n�:.r�:-+►�1T''.f:.�s.�tr.;.;� �f:�•��a�. ��i:':.r .�rr'-� • - ��r� ii:: iia.:1... ' - ^I{.1i.3.: tf4J�.�:1„'t• y:. �+� .��-.,+.:,,,-r..,.� . _ ~; .- 'w._:" :.�.:.: � _ .... �.::.... :CIAS:i`DEFIN�TION;=INTERMS��F:�`:;;�;'=�' :s.'- =� -- ': ._ , .-.e,t~ �`"�- � � .;r� z � � .. �. - - _�:':::..,..,.'�• '-i�. :� e'v*„r,r ` � .1..... . -� � ��' ' _ R;'�;.. : �-s'� ' . �. i. �;1� rw- �.-ri•%;r� _ .��. - ... �.�� .�:�R..� � � _5�: �..'1.... .� �..�ryr �r�Y� ti.��,�.^S� ^J:T��'A• ,�'• +�C: .�.:�-:":y,:� ^:},.i� :i.i�.;e::�, ��'. � _""'1s�.' s�+�' ::w:. ::::�::.:.":..."�.�.� ---+.•t,.�v � r� ' � w�. ::«.-:':.:'1?:..�';� .« :� .:i.�....�.......�-....,.�.�::� __ �,.' . �� :��._`_�� ��� � .w1�vJV�.�..� ���-N�r��H+ YL.�. -._._ _�!.�. ..�� M1r�.f.-+•�v�r� �. .z.. _...: - - - �': t. r : � .. � .'--i�i,.:�� r. i........:. •�? �... ; :-.;.-• ._N,. .. . . �. � ..... __ .... .,. . , _ ..i.:,..,-:,'.;.:,..... • . ,.., �..-.. , ...c: ....... ..a.;.s....- � , .�c.r'.... . 'C:'c:�.: s'?;r�• r+af'�.'+i�tic rt-,;,,.r�.�� u. r.r •• • .r-.c�ti ...� _ �;..._.'..L�.�.u=:.:.1'r�:r.hr�': . . . ,�•, . .�.�..� _ •..... . w .i,.�� ��a� "s�?r. :r' %i+,�f,-,��r'.�.-_r:.�...�w:. %.w,.�n -��^ri�' ' '.-tr:.�`rwrY�y�.r.xa�..�n-,�e.-�.�..t:: i..J_r' :a�`.. ��;.�:,,^;���. � .`: .�.s�rwG N' ...'1'! I'.__-_•'—:'•i.:.wt�!�Yw-.'�r.r`��e.=ss+�iY�.'^`•�^'�!-^ �..~�.� �...'.� .-�r.�n��ti+�. .tirr.rti.�r.wi'..F� K � -•..t.....,;:.:,��W:..��.�s...•�,r±y•. I Skilleci`mechani i�,iiv . _. ._. _.-.. ..�•.— - .�__.,......_.._.. . � _�: '-�:���. , ca ork�,�at 'thesloumeymar�s�l�vel��in'the �r Ir., nd 'r = " �-' �'''��=:�`� ; y epa ,=a acor�ditioning .of�.a�ttamotiva and-�-=: :. ' ,� �athe�ti power=drivei�"eqvi merit"";� _ =_:�.� .::. -- -- - - ��- - _ ��: :_:,_,. _ _ _ _....� 3.,,_� �;�' _ _ ,P • _ - �; _; �'._ ,. =;' .. . . ; =,.:....:. ..; ....� . . ...� � ... .. ,_ ..�.. . . . . . .. .._ . . . � . _ , . , , -_ _;, � �� ...Assignments�:are::generalEy,made.oraliy ar�d work..is �erformerl:semi-indepenclently�•with �assfslance�For��. ' . advice given by a'Supervisor or.higher Eevei Meci�anic as needed.� � . . � .� , - - �' - �� 2. 3. � �� � � � + - . � � �iu-� Maintains, repairs, 'and recar�ditions var�ed eqUipment incEuding autamabiEes, trc�c�cs� gar�age pacicers, p�smps. tractors, motarcycles. grad�rs, mowers, and sirriilar apparatus. �verr�auls ' transm'issio�s, �ngines, cfulches, ur�iversals, alternators, generaiors, and stariers. Repairs a�d nverhau�s axle assemblEes. Acijusts and reiines brak�s. l.ocates and repairs defects in hydra�lic sysiems; tur�es engines antf perfQrms c�eneraE s�rvicing. Makes service ca!!s and fi�id repairs; tows braken-dowr� equipm�ni to shop far repairs. May do necessary �velding anci �ainting. Cperates s�ar�darc� a�tomotive test and shop eq�ai¢ment. Performs retated tasks as assigr�ed. Minimum Quali,F,i.�,3,t�n RQ�ruirements; � � As ta knowledg�, skilis, abilities, and otE��r attributes: Considera�le knawledge of the methocs, practices, materiaEs, tools, and eq�ipment of a�iomotive anrf power-driven eq�ipment repair, adjustment. overhaul, and maintenanc�. Considerable knowiedge af the operating principles and mechanics �# i�ternal combustior� engines. Skill in the use and care �f standard iools and eguipment oi t�e trad�. Ability to iocate, d�fine, anrt repair d�fects in automoiive ancf mur�icipal equipment. Ganc� physicai conditioR, manual dexteriry, na serious defects af eyesight or hearing, and normal color visian. Possessior� af a va[ict State ot Florida Chauffeur's IiCense. A5 ZC 5C�1001lT7J, training, and experience: Compl�tion of tenth {y Oj grade. �aur (4y years of experience in the ser�iGing, maintenance, and repa€r ot vacied a�tar�otive eguipm�r�i. Any equi��alent cambinatian of edt�cation, traini�g, and ex�erience. - 3 � � . 3 •• M.,�� ���� � . • , � . �I.ORIDA OEpqqTlVl�rj'T' qF t.qB4R ANO �MPLOYMENTSECURiTY � DIV1S10N �� WOF�K�RS' COMFENSAT{ON 1•800-342-t7�3 (orj c�ontect yrnir Gocal alnca �Or asslslance• �,. . . . . . .. `.:> NoTtCE 4F iNJURY •- • � �s: . • � Aepart alt dealhs wlthl� 24 hours {9Q4) 488-3D4•l.� �� � ' . . • • /l . li . .•7. . . •. . . . :� :! .. . . � � . ' . � ,. . ' ' �. . ' . i. � . � ' ' " ' " . • � ' �MPZOY�� INFORJ4lATIQN 0 ; ��1,. Gar'1 e�. Tutman i��(} Si�nse� PQ�n� r�d, , C1w. 34G23 EL HON� �� �� PSaX I.2 � ],�52 ..► ....., . . i �`b M • n � ' �� R�G'D 8Y CARRI�A . ��NT �fip diVl&IqN '. . , •�. ••,�, , � , � . � • . . � ;•� . . , . �..� .. . .:, . f . �' 1 • 1 S r 'J' . . . � � � :. � � •� . .�. .l� r . . ���.. �y ..u���w� , vwv wwa ��q�e w n�.a.timn :.1 �1�–��-37'7�t • .... • 7/21/92 A.P-1,:. ,":��'" Slipved��on o'i1 and �ell an ].��t � � . ii1E! U Fl 1 /lf�! {N /1 p7�A Y A � � (a.p. M,r�ratlan cf riqrn �r,dex Hrper.r seoon4 �a�nt. hncn,ree nbs. �aaa pasanlriQ, et�.j � � . , , wv .� C310 YqV R�OU�Si TAEQlCAL. CAR�7 ❑ YE5 � NQ '� . • ; :� •' r' ": `::[+i' . !F YE3, OtQ EMF�QYER PtiOV�DE l4iEQICAL7 Ci Y$S ••❑ NO . NPLDY�A IN�D�MA710N . . • ,� - - ., :,�� _ � � FIHA1'S NAM� AND ADOAE55 • FEOEFIAL 1.0� NUMflER DA7E AND 71ME FIH5� AEFOR�"EO : � � . 65L1. , • ,.. :;•, '� 59--5Dt?02$9 .;. ° • .. _ � . 7/?Z�9� "� ' '�A..i�L' '•'� - - . City ..of Clearwater F1�� Maintenanc� rv,c. CO�I�fils{�E BY � • . P4ttC1?IltE�1ld�R NU1l�8ER .. ._ •.'• • �9U0 GYand A�. . . . . . . G.�arrrat�, EZ 3•�625 0�+�s�wtr,cc co. ❑ s�ir-•arasu�FO �. - . . . . NMA�, AqDH�SS, TE�EPHON�, OF . "INSURANCE CO.OFi SEf�VtCE Cpf�ipAF/Y YV�I.L �'O!) G�r+ U� Tp PAY �� �H � """ �" "^'a" � Johns �a:tarn Compeny� Inc. �uRY7 �'�v�s p � PV.C�, �F ACCIOENT (Straet, C+ry. C.oUnty. 5tate} .r: . . .. ., . Post O{#�ce �ox 3318 , �nsr o�v �io tr�HOUC3� .l:�: � ' . ;.. . ..• � . . . . . .. ,. •, .,... . ._.a�� a►s a1�C7Ve S�rasoft�� F� 3�Z30 ,� .•c .. . ,�,.�:. . :� ..... .. ..� . ,�.�, . : .. . . . I -B0�-749-30�l3� . . . ,. S. , . ..�. �':� .. •: .. +. . �. . .. MAM�./1D�F��SB AND TEI.�PF1dc�E . , � qF PHYSICUW Oq HO6PlTilL DiR iiiE �MPLOYEE KNOW7IY{3LY FfFUSE T� 11SE A SJ�FETY �?�'. � G. + 7,L1P.�Zid��� .�? -' AFPl.IMiCE PFi�111DED BY Y'W. 'FHE EIsAPI.DYER7 ❑ YE5 }r'� NC) . � . .• ., :�: aAT� �MPWY@D LAST DATE ElySFt�YEE WQRK�O 3`��� ��t Ec�i DXa'V� 6 r 4 i 8�4 �l��� Y��� 'i� 'z9 ''� 93 ?.�3ai �FL;�3�64Q..,�? ,__...� — � `� �� �a c�rE oF �y .• 1�� o wx � �� �: r���g •�.��� o n+ar a Mo � t Numbe�ry houn $ .. �, �',, Nur�i�r bt Fxwn �' { a• r .' �' �f YMek i T "�-' r� N � p�d wookd� � �, :. : a,,io �oR w+r� oF iwumr AETUFiNED'fD WOAK .� YES. p N� . , , . , „ . �f; BY �MPLOYEF3 � ❑ YES �NO 'f�$ C�. HO ❑ : - • • . � 1FY�S.ONE RATE U 11 '(Ll ,Q'� . .• . j. . • . .. -.. iOCATION AOOFiE55 , �;ti : . , .. , , �'s:E� �� ��� �,,I,riljll'i 9`1S. WAS Irllll�iY i',4TJU.? C] Y�5 � NQ "+' iF Y�S. (3iV� i]�T� OF iJEATH r � r � • '� ., • . :°'': [LOCATION � ' � • �� • �•s • • , iF RPPl.tC.�BL.� •r�;t� ; �C:^'3Q �rit ��.t • AOR�EWlT}i(}ES�AIi'TIONDFJIGCIDENi7 . ,•_ ., .• . . NATUREQF9U51NE55 • �s,�•:: . „ . : ,.. ..: •c. ..;,,.�'}It.:.� �L°::�•�. � LYYES ❑ NO IF NO A7TACH EXPLANATiON TL�1I't� �ClI1. •. , !, r:��:;�'1k`.!: cl! :9'f�.��^� MY pvrEOn �Nt�a. xno+�u+py end w,m inaantto in�ur., Celreud o� decelve My em�oyo r a emqoree. �ruurana� com a saii•►�uuraa �rgn,.t�es eny s�amorr.a�, cfevm contalninq erty fe�sa or mt�JeadlrrQ fnfarm� is �uilry ol a felany ot Ihe thtrd depree. �, I mre �the emplayp� Meir capy d tf�r r�otice: ��a. .��104 �, , . � I Per�orl1 jn MaA � 1l i rJ�13{i �UO� i;.9 �,�3 '�'Si'i . if�l1!1' . ':qf�iht�ns� i'{�� zl+���r�,,.! 1'2�1T9.?���= �'ii��l���� � ���j: � � ,���;:i i:yi�'.,1i..�.'4:1"ii•�r'1���3i!i�� •.. � ; . 1Q (!l�v�MabMnalqnj. . �• +�• :� :}• 6ATEr� .,�> ;�;• . EIAPLL7'lE.fiS1ONATUR�� ... �: ,�... .y`:�::.tir.���41SIEG%�l '� . � �. �• ! • -:��.,.' 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Lost T3mo Case--��te o1 Flrst Paymont � � AWW, �j` Comp Rate Flrst day o( disabl�ffy , . . . . .•` � . .': _,.,'D�ta of Frsi Caritc�ct witt� C�aEmant .; �"" •� • � Q in Persan Q 'iaivphana ❑ Mail ' . . . ..' �" . �•- . , . . . ` �� —plotka Fiod Uue to �tultlpta Pvriods a! �IsabiliPy. Dplo� CovBrad by F?rst �rmant .. ., ' " . ' ' . 'ri: .�ry� `� ' '.• '• :;�� _: C7 T.T.� ❑ 'T.P.D. . Dote Form Fec'd.'.. � . �. . ... � Catastnoph�c p P.T.�. � �eat� - .... _ . . . . - _ p 3. Mad'�cal Only whlch bucamv a Last 1'tme Case.�{Cam�plalo aft�in�Ortr�atian in item 2 aba+o}f ."., ,� ;:� ;," ;. �i';':':,'� :� :t�"�N��"' :��`1 �' • . F�EMARKS: -�--•—�-- _ . . . , , ii _ •��,. ...,�; , , '� ... ': AWUSTER SIGNATUH�: I 1.E5 Pomr RWG1 �1(91) . � .— _ ! f CApRIEii i�AME, ��UQR�SS S �, J�i,� �;} EMPLDYEE COPY ' . .� . . . .. . .. .. .... ..._1...._..___ --- ... _. _ .. _.. .. �, � • , , 'f , � , 81V151C`I M�CiipFltlA � � ��a�iiDA D��AATMENT OF I�ABOR �1ND �Mpl.OYMEN�' SECURI7Y a�VISlON d� WQAK�RS' COMPENSATl4N � �"''' '" "': �'""" �' ;T �p0-aa2•17s1 (arj canla�t ynur local ohico 1ar ass�saanco I�i�i.1 . rr.r.��IJ;��.� •�• nt�., ..t ,��..�,.;,..S.,r Nt7T10E OF iN,SURY J i ! � i . � V .. � . � 1 . r � n �, -- .� Rapart all d�alhs within 2a houcs (9Q4f .t8� •30ad. , . ... .. _:< � { •r., . ..• .__ ., s�... :.:,;:,:,..., . _ ,,_. . � ���io�r�� �r��o�MaTror� I � . FQR CAF�FIIEA'S pAT� �7Ah1P �i�C'� @'(•C�A�F�IEFi SEt�T 70 QIVISICN � �....,1 �: . r� �. � acT �� �� J �ns ��8i�frr Co,, frtG. NAItiAF, {Ffrit, yflCCfe, t,ast� soc�ai 5ecunty ��umoer Qe[n ana � ime qf .�tc:aant Ga�� �►. :.ut-�tzan � ��.7-7�-3774. - ��rox. 3.8 �non s a 1's ME �OD�EaS {IncluGe Zip} � " � ; =,41PLQYEt'S QE CAIPTIpN OF �GC;O�NT . ? a90 Sun�t Point �d. , C?*�r. 34623 j Cantin�a�, w�r ancl ���r on hand 7�l�PHONE �h. cw. i31� vw+a+'`��i��� ��2 1 ti7E5CR1B� lNJUFiY CR ElS�.�LSE .11Vd 71`iU1CA7E P.1FiT QF �COY .�FFtC7ED '�� q„amqwatia ai ngri incea 5nqet 3t seccn� jCint. !rac�urta ros. !ead po�saning, e�c.) cccua,ar� N��c:�ans,c 839�. *�F� nan�, coes �v s.�ee CA CF 31iiTti � 5EX � 010 YQU RECtUE5i'+lE{��C�L C�RE7 �YES �`+O ] ! � 2 � �2 '+ :� M � F 'F YES, 410 �F�IPLqY�R pl�CYIpE !tiEC,iC�L? v `rES �i NO cM�LQYEA 11V�O�iMA710N ' r'!qM'S NAME AN� �D4FiES5 p��,�, i i�tiERA� i.D, NUMB�R � OaTE A�p TiME FrRST �iEPQR'r�� � � ' � a9-6Q04289 - - -- - ' ?.��r_�x. __� Z :nont�s �go_ C1.u! Cfi C� �v�Id�P.� - 1 E'°t �Sc13.I1r�Ylr3.L1C° h •rJ.C. COVEFIAGE BY � PCL�CYIM£ti18cR YIfMSEr� �9 o a Cranci ave , 1 ��_ C1�x*hatpar :L 3�625 , � �NSUr,a�ce co. �'s���•�NSUaEO _ _ _ _ .�_ / � VAMF, .10DfaE5S, i c�EP*lQtJE OF '��'�Fh��� 4.. c,,�. 813 �� �,--5a33 I��UAANC �. QR S iC� CQMPA�iY �'NILL YCU CdA1TiNUS TO�PAY '"'""" ' .loitns st rri �a�}�anY, �nc. � '�'t'�'AY? '�'h{YES !�4 �t.,tC£ OF aCCiQE�VF {Street, C:tY. Caunty, State) � i,rtST �:,� F,�SD THFiCU H � Post Of 8ax 33 ! & '� — �- 5arasat , Z30 1 5�:+_ ,.�e3s:� ��.d Same as a.bave f- 80 - 7�4-3044 � aATE CF PAY :: R �r'NK 1,'!'1hl�. dOAA�65 .1ND i EL�PHONE � ��i .:1�. PEA � t7AY r' tv1� OF P1iYSICIAN QR !iOSPITAL ,� I�Iumper c! haurs � � ��d ; H� EMP1.Ow�� x�OWfNGLY REFU58 TO U5� a SaF�TY , 5�1 "�� .r- �er aay I O r I Numcer c+ hours � Q .�PFl.1ANCE r'�10V10Ep $Y YCU. iNQ �tAP�OY�e±? �� Y@S :{NO i �Z. �%iLiS I aer •�veex . uumour.zi rs�ya OAl'� :1dPLflYED j y.;sr oArt �UPLOYEE'NOf7KQ� � �j�,�,���4�� �T n i C � .er ��e� ..?-- --- o' ! =� 1 3�i 1 $'t1.1.� .��i:C:,':C! � ?�a! '�TESt �3V �iisj�r� rar�p ' r�AIDi�":aCAiE�FIt�Jl1RY I �FTUfiN�O �O WGF�K � YL�S = NO I�U=NdRtZEO BY C4lPtOvEr� = Y�5 �u0 f ��S�� rr0 �___ _ +F YES. GfV'c �?A'�E ! � • IOCAT�pN AOOF;�55 WA$ lNJUAY FAiAL? ❑ YES �',,.�`tZQ +� YES, GIVE aR7� QF OiA7H � � I �IOCaTION # . ;F :�PP�SG�BL�y AGFIE:',YiTH p�SGRIpT1QN OF ,�CC10ENi7 t.LATURE OF flU51NE5S iYES � NQ �F �O AT'�':�CN EXAL.�NA7�4N 1 y�iinici�a}. Garaae ,: .ry carsan wrro, knav�nr�sy ano w�tll infant 10 inlura, defr�uC o[ uecaive arry !mplcyar ar @mqiayne, �nsuran�e Camparsy cr sed•�nsure4 crrgiam, `,ias any s�steman� ot claim canta�n�nc� nr�y taisa cr rn�s�eaa+ng �n�crma�icn �s gudty a! a tabny ct tne tn�rq aegree. ;� ave arw�caa the emo�evee tnan ��y o! �t��s nauca: •.3.n � 9v ' 'l�--�^.-�-�� �• �.ol�l�� �al�l�3 eu pYE°_�IG[�[,1iUP� Gst ,s+ra.isd� 00 Lyn� ;�r� - . � °�'r� C�RFil�fi !A!�'ORMA77QN � `~ ' '� �^i n � �c�Rit3C �illdtt .� �.00311qf1 # SAN�CB C,D, � � � � Cancer Fi1e * ��, C.znrrrnrarnng Case—DWC•s2, �y�T1C� Q� D�MIAL �i�.�CME{3 �, c � b� r ! � � �. �_ost Time Case—�ata al.F'trst Payment! � ��N�N �Camp Race Fsrsi cay of ct�ao�Gty --Oate o! Firsc Contac: with Cta�mant ` ' = In Rerson � ieleGhone _��afl —NOUCe Filed Que to l�tuttrpre Perraus ol0isaaility. 9ares Cavered by ��rsa P�yment � T.T,p. � T.Fp. Oni@ rQflTi F3EC'd. ' � � Ca�astrocn�c =�.T.�. � s:eain �. �1Btli��l fln ' h�8 R1B :S=051 rlftl��4�.�.7 ^g:9 3fl ;nfcrmatiC�f� i_n��lgllf 2�DOVB} � f % r q�MAFiiCS: � 1 f) . CJ ! F�� i � 1� �lr . _ �, kC��� ap.,u5;ca SIGuaTUafl. � � �n� � ��� �_ _:5 :mm _:tiC•t �i 'Itl �,.�,r► ,d.�.n. � (I VAME. .�dDF�55 '� ; �! =r�yC.•tE, ,�,.,. ,�. _ � �:.... ..........._.:...... . ; tiw. ,-' � • . ,.... .. . . ' .� . . ' : • . • . . ... .....�., ,�; � . �����w� :.���/l�ION C��v � - . . ,, � � . arv�s�ar+ �a�cr+oa�u.� r � . � . � �I.ORID� DE�AA7M�NT �F LA84A AMD �Mi�L�YMENT SECURIT'Y . DIV1510N O� W�RK�RS' CQMAENSATiON 1-9G0•342•17d1 {or) cantact your Iqcal oHiGq �o� assf5tanco . NOT�C� OF �NJl1PY , Report a1i dnaths withfn 24 hours (9Q4j �#88-3044. C,�x'� r�,I1eri Lut�i'an ���0 �.zn�t Fai.�t �.d., C1;a. ?4G1S �PtiONE �.C�w w�•�e« � "•t��•s � i � Y � a2 � �M � � �� � • FC7R CARflIER'9 i7AT� 5'�AMF� AEC'D BY CARRI��? S��i r0 D!Yl51DN 4�.7-74�377� � 11-4-9� 2:D0 P..�. 4Pl.OYEE'S DEBGRIPTION Q ACCIDENT '� evelc�;i n,,�in � �a,c.� fr�n �.tall �ir� satas. ;5 R�BE rM�UFiY OR OIS�PS� AND aNDSC�TE PAAi QF �ODY AFFEGTED �AT�uta�°��,�riy�it Ind�x finger at sucand �oint. lractured tabs. tead paisaning, etC.F nio Yoc� R�au�sr f�eorca� caRe7 � r�s � r�o IF Y�S, DIO EMPLOY�Fi Pf�OV14E M�C3�CAL? '�Y�S r�� iN�oRMartorr C:itv of Cl�a..**.aa�..�r G''� �� ��ntcsaa..rt.� � �9�000�8� ��� '� �9Q0 Grartd �t��c, w.c, cav��ac� aY PULICYl��i�h18Efl NUl41B�Fi � ��a.s.�,at�s, FL ajlb?5 � W«�s�KAr�cE �o. �s��.F•aKSUaEO ,. ' `. +�� NAMC. Ao�A�ss. �tEpr+or�E oF �ELEPHQN� . IiYSIiFiANCE CQ. �f� S�RVIC� COlNF�ANY WII,L YOU CO�INUE TQ PAY •`•• c°°• ""••"°" 6 rtr '' Jol�ns Ees�errr Campaay, Inc. SALARY? vES 0 No �l.4CE DF r1CCf0ET1T (Stre9f, C�ty, County, 5fa1e►1 � �ps} QfijCp So�t 3� 18 . � L+15T OAY PAID THROUGH Sd� a5 �t7� '; ti '', Sarasota, ��. 3�F230 r � � , �� 8�0 - 749�30� RA7E OF PAY =� HR ,r'.� WK ✓� ' NAME, AObR�55 ANp 1'ELEPH�N� S�r�PER � 4AY � MO 1 CF pliYSICIAN dR NOSPIi'A!. N�mnHl ol lwurs OID 7?i� EMPtOYEE KptOWiNCsLY REFU5�T�7 tlSE A S�tFE7Y C.YS. �'Tc.1L1C�x11 �.Z'11C ! Q�"Z! �� Num��an� haurs �� APPl.tANCE PROVII]Ea 0Y YQU,TNE EMFLQ1dER� ; YES ;ratQ ., Par week � DA7E �?APLQYED L1ST �ArE EMPLOYE� wOAKE� "6�� i�. �. c:S�lt%. �`3 ��. N�m�9r n� Cays r, i �, Cl�?aa�kC�r, c�� 3357� _ _��rweux_ � � _ 3 � �3a .:1r , r 9� �A�� raR a�re eF ��ru�v RET'URNEO T4 WORK � YES �NO i AUTKORi2E0 9Y �iv[PLOY�R e� Y�5 = HO � Y£S � NO � IF `l�$, GIVE OATE -- t___ t__ LOCATIQN RqQRESS WA5 IN,fURY FATAL7 �,.., YES ik0 1F YES, GIV� �A7E QF OEATH � ' ZL4CA71�N d , IF aPRLICABtE) A,GFiEE Wl7H OESCfiIP'F1pN �F �CCt0ENT7 ,� CT! f.� Nr/ATURE QF 9U51P2�55 '� YES =.'' NO iF NO A77�H EXPL4�tATIOH ., �} •�/47 I% c.1 •',%!', . Any person wltio, knav/mgly and wnh inlent to in�uru:" ehadd or ��;eprv_�j emplayer or err+q , insurs�nc� ar se1!•Insuted �roqram, fifps arry SfFitprrEqnt 4f claim contasniru� arry fulsu or mis�eaainp �nlorrnatron is gudty oTa fe�6r+y ni.ttsn tnud negree,� ;••, �� � f��vapWG:C tha emdtyee 1f�eir rapy a� inis nauca: S t , �rj',Person � ,,,; 8y !Ae�l t.'I1�.vc3] t y`r51r� �Qi SZC�TZ3�L�E �%l�r' � Z/I��l�_ t.�,`� � ✓ � � . ����t. '^' 11--8^94 EMPLOYEE S,GNAiUR� Id c,w�Wl� tp s+qn� 4' � 'JATE � �.. _1dP�0Y�R SIG?�ATUAE QAiE � � CARRt�R !l�FQAMAiIQN � . . Carr�er Audit � - -- - �acation � Servica Co. � Carrier Fife +� � i. C�r�travert3ng Case-D1NC-�2, NCTIG� OF DENIAI.�ATiACl�ED � 2. l.cst iime Case-�ace of First Aayment! !-- �WW � Comp �a1� First dey af disability ,.. f -�- — �---�are c[ �irsi Cantact wFrh Cl�imanr ' ! � tn Person � Teleqnone � Ma�! -I�atica Fited Q�e to lvlultiple Per�4Us ol Dlsability. �atos Covered Gy First Paymont �" �%D. ;� '(P,�. Date �orrn Aecr7. - -{ - � � Catastra�nic = rPi.�. � qea�h � 3. 41Q�icat Only wnich �ecame a Lost itrne Case. {�orrrpfe�e at3,in�arma�rafi'frrll�r�..',`aboveM, .• !!� • ' / � / 4�1 � n "� r�Eh1ARi(S: , � ._ � ti% � :i 4.tii :? � t i • • � .a ' .�a�uSr�R rsa���, �OJU ..�%f� � qAT�: 1 r i .. -- � i 3 LES Form OwC•t I��OtiI �a�r.��nrs.�i���.... — – — �� . �-_ VOV 09 1994 0 � � � �\ 1 �R V �,� E�API.QYEA COPY �' � . ' . • ( ' . . . . � f D1V19lON M1Cf1pFlLAA / •, , � / . �' • FLORIDA.D�PARTM�N7 OF 1.A80R AND EMPLOYMENT S�CURITY . DIVISION OF W�RKEHS' COMPENSATION i t•B00•3a2•t741 (nrj ca�lact your tacat offEca far assfstanco � NO'i�CE QF iNJURY �� � � ' Report all deaths wilhin 24 ho�rs (9U4) 46B•30Aa. � - � EM�LOYEE INFORMA�ION �I �UFI CARRIER'S QATE �TAMP ' REC'D 8Y CAFiRI�fi SEiVT 70 �IVISION , � NAht • 1Ffr31, Middio, ke�l) 5oclql 5acuiuy Plumber , Dnte end Tima a! Aecldont E ; i �, i � GAitY AI,i.E2� LvTriAH �11-74-177k 3/22/95 7:�0 a.m. HahAE A�Ofi S(intluda Zip) —� �T. ��i r} EMPI,qY�E'S OESCRIPTIOP� �F ACCIOEh7 y e pu 6CL1tC�.fls 1`r9U Sunuet Pa�.�it..Etd. �{:lerir�,r,ht+�r, esi��r�e� kelt� pnp ln �e�t i�ip. �'ain- Waxoe�ie�i ur� el� w�: TEL�EPH0IVE �„����Z3 ���, r,��?_45�z L7�5 RIDE P1.fURYORfl16�ASEANOINI31CA7EPARi� g00YAFFE TEn ' OI1 QCC{1PA 1 t� Mechanic $;j� � la'4' Amput Er}nC ( nq'1t i{+�Casory�n4� is�acand joinl, lractured ribs, IoatS possqninp, e1c i t, z s t s� r i s, pATE IH H �x p�D ypV A��UEST MEf}ICAL CARE? � YES O NO S / i 2 / S? }�j M Q F I� Y�$. 010 EMPLOY�R PROVEp� ME�ICAL7 :�.7 YES 0 N(� Carrier Audit H Lacntion # 5erv+ca Co. A� Carriar Fila �.�_____..�_._.. p I. Conlravertln� Casd�—OWC•12, NOTtCE pF O�NIAt'A71'ACH�D ' �] 2. LaS! Tlmo Casa—palo al First Paymani _.... � � AV'JW Comp Ratc3 Firsl day o{ drsauility :! � ._.. —pa1� a! �irst Conlact with CtaimanE � � ❑ tn Persqn � 7ol�phonQ p M��I —Matica Filad Due ta trtultipla E�eriocfs o! Disabilily. Dutos Govered �y Fiisl Payment _... �._. p T.T.D. ❑ T,P.�, Da�a Forrrt Rec'd. � ! ❑ Ca�ustropldc L� P.T.D. p De�lh p 3. T�lodicut Oiily whictti becnmo a Lost 71me G�so. (Co+npla�a aEl Inbnn�tlon in itom 2 above� ��r.�ar�r�s: �. _. _ _ - - — ��• ADJUS7ER NA1.1�: CARRI�R P7Afd�, AODRESS d T�IEPHOf1E: �^} OATE: �..,�, r � RaJUST�R SIGNATURE: 1 ES fu�,� pWC t I�+�q � CARRiER CUPY �, � i ' . . • i . ' ,� , , '4 �. , . . i � +., i •1' r , :. . � � ' ' ' . . ' I . ..' ' ' . . . ' . . I ' � . . . . ' . � � • � ! 1 � . , � . I . • I � ' • ` � . .� �x 1: ��l...f�`. �'�'. ..1.+: '3'v •.fz.�.. » i 1 . , , �� . . ' � . . ' . . . . . . � � . . , _ .. . . ... . .. � �� .. . � • . ' . . . 1 . � • � , ,,; , , � � r � • � � � � . - D��N��T��C CI��N�C � � � � � � Mgin Off�te: i551 West 8a•� DrEve �� I.�rgo, �lorlda 3d540 •'(E3131 581-8767 . � 3131 McMulten 8oath Rogd.:'�Ife tQU, Cleerwater. F�arfda 3d621 �(8�3j 726-6871 . • � 1485 S. �!. �iarrison, 5ultr 204; Clearwater, �larida 346�6 • �873) d43•�i542 , ,` LUTMAN, ' GA.RY A. •, OFF�CE CALL � January 2 4,.199 4� �� az �o ls � - . , jj• , � , � . . j... This 41-yeaz ❑�.d, obese man pr�� ant� �or �o�.�ow--up o� h�s �eft knee witk� connpla�nts of some ongoing �ain and swelling in. the l�ft knee, but mvst signi�icantl� i5 very sever� pa.�n in the right hip. H� is now cl:ose to six manths a�ter ; ha.s arthroscopy i.n th� left knee Wh�re arthrit.is was �noted, but; he has now returned to work full duty with the knee caus�ng a�n•nst a dai�.y swel�.ing and some paa.n, but �he is able tcs function q�•i.�e weJ.� wi�Y� th�s. On the r�':her hand, his rxght hip has remain� 3 a pro3a7 em. The hip paa.n had cnme on a�ter h�s injury at wark wnich mai.nl.y affected h.�s I.ef� knse and, as I stated be�ose, he has been di.agnosed to have adv�nced 'asteoarthritis a.n the,right"�hip which may be.fiared by a.ncreased stresses on the right side due �:o the knee prob].em, but is actual.Zy an unre�.ated condition. '� He has recsuired Darv�cet� a�ew an a daily basis ta control the pain. Re�.a�'en d�es not s�em �a be he].ping much. Exam�nat=an �oday shows h.m wa�.kin� with a very severe anta�.g�.c 3.imp an the right. His ri �ht h� p�aday has no a_eas; of �.aca�.ized � tenderness to�palpatzon, but �h� motzon is very Zimi4ad. F3,ex�on maximum is 75', extension -5, a�duction about �D, adductian -�0, int�rnal rotatian �.�, externaZ rotatior� 30. a�.�. �hese mota.Qns cause pain. '�he le�t knae has a mild synovitzs�, �ange c�E mot�on �.s fa�.r at � to 11.0' . This flexion causes some� pazn �oste4i.or?y. Again we ��.scussed treatment opta.ons mainl.y for th•r� kne� sugges�i.ng now h� use heat on it as he has been s�art�.ng tv�ldo. �lsa, wi].l discont�nu� Rela�en a5 �his do� ; not se�n wo be hav��.ng much e�fect. R�ga�din� h�.s hip, we had '" di.�cussed treatm�nt o�t9.ons and now continue to do so. Today he wi].i on? y be iawl�.ed under war.kezs' Comp for the knee prab�em, but � in di.scuss�.on •�rith him about his hzp, my options ar� ntazn�.y surg�cal ones, �.ncl.uding possibie �us�on versus hip replacement an� i am in�favor of the hip re��acemen� as a choice o� the t•,�o dti� �.:o hi.s disafl�.�.�twes r�garding his righ� ar:�t, and al.so hi.s Ieft �eg no��. I fee� he has �he best chanca of a very �unctianai c,utcame witi a h=_p rep�.acemen� and this is an3y ment�.oned �rith the appreciati.c 1 ot the €act that it may not last a �l�wa t�.me �n, a m�n ar his age . nd �.is s;.ature. .�7e �a dwscuss so�ne a� zi�is 4aday and he wil.]. cons: ier a hip �epiacemen�. he may go on r�om th�s oo�.nt �o cantac� ou. azL�.ce, discuss i.t and �zan i.t in ' some detai.l. • �� . . ' . ' � � � ..,_, .,, . . ,, �,. K_ . �,s„�., :�.� ;,s . �•�:i:;ty�sr: ,� f r` :�11':.�;�1�'�� r',;r � ', !} : ;�. . . � .. . s`[ .. i. � • . . , . . j � s �t•�. 'i:: �:k �;�, r �.; i. �', :s' .�t . . . ,. , , � . i-, . ' . F:l. , . , � •i� . i .. [•�� .. :. . ' - .� ' , . ' ' �- .. . , . , , .' . c . 'i.~ . . . . , ' . . �� - f � � r(: : t� �.e::t, ;'�' , ' .�.� '. .'� ' P . ' . ! . .. " ; . . , e ' ' . ,� , , , . r , '!� {. t . . ' f�.,...� 1f' . " .� .4. '" � . '' .. .. , ' , .' . . • . . . ' . �1:, �f:� .. �. � . �. .'� • / ' . •• . � . .. . . ' . . � ' .. � ' . . ' f !'�. 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' .�� ,. '. � . � ,� ' . ,. . j • ' ' . , , ��� • . � . � . r� � � • . •f . • , � . . . .� , ; � . ' i .�� , ' ` ' . � . ; , . � ' , . , , j` . : , . . � . � . � . � . � ' � 1 � . ' . ' . ,. ' . . , • � ' . ��'�' ' . . � . . ' . ' . ,� ' . . . , E. .. , . , . � � � i1 , ' .. ' r',' . � . ' , .' . ' . ' ' , . " ', , ' , , . `1,�, , . . � ' . � . . ,i � �� , . � r . `. , . . . � � . . ty�r . ' �.. � , J. . '. � , � . . . ' .� � `. ` , . . . ', I' � . , � . .� , ' ,• ' • , � .. , �,� ' �, , ' , , . �. .� LUTMAN,' ��GARY A.. � �. � OFFICE CALL : � �'aeu�ry 24', 19�4 , � � ���' ��'� 02� 9� �1& . . ' . . _ . . ' � . , ' . �� , . � . -' . - , • -.� . � , , ���'` ' �R�garda.ng �his �.eft .•kn�e, he h�s reached, , what .x be1.$�ve, �.�.s ' a '. '���, � ' � �maximum medica3. �impsavement .by.'now. I �ee�. he wi1J. hava ongr��.ng . � �' prablems wltix .� intexmifitent p� in; .' swel�.ing, ' and limited mo�3.nn � in � ��,, �` �' � the 'knea'; and T' woif��d rat� h�.a� a�5 � t4ta� body df sabil ity based � vn • � ��� ��. his �left Y�nee 'and ze�ated t❑ the �ecent WDZ'k in� ury. For this z ' � , � ,,;. � , , wi1.1 �see , him Qn a prn ba� �.s in �he fczture . , � . � ; ,, - . , . . .;; • rc . . , , . . , .. , . � � ;" � . � 'DxAGNOS�S : ost�oarthritis; Ieft� knee. . � � ' , . ' � �� „ , � , , � ,�steoarthritis, right hip. ' � . - ' � � , . . � . . . , , , . . • .. � . � �, � • � � � � . . ' � � � ' . , , � GoRDON H . ZUERNDORF�R � MD : pmt� . . . .� . • , . `Y � . . S� . . 1 ' ' . . . ' � ' � . . � ` � . - . , � I � � , . .. � • ' ` � . , . . . � . � . � . . � i I • • ., . . . ' . � , . . ' '' , t . , • . ' . ' ' . . ' ' . , I , ' 1 . � ' . � ' � . , • . . . � � . ' ' . . . • . ' � '' �' � .. � � r i � • , . � . . . � ' 1 , . � ' . . . 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'�Fy�s �v�{,►� . , , ' CL�ARWAT�R, FI,ORiOR 34618•a7�9 � '�y"�TE�t;���=`` . � , �:I�IC IlariBj�df+Gflt O�V�L�OR � � ���•,.»rr� . . . Tal�cn�: (8�3) 4b2-57S4 .July iI, �,495 � � � Farsimile: i8i3) �62-b757 � . . Employer: City o� Clearwater� . � �mpiayae: Gaxy T,utman . U/A: 4/5/92 . ' � � SS,�: 417-74--3774 .D�a�r t�Sr. Lts�tnan, � , . ' ' � Your treating phya}.aian haa r�partec3 that you have �eached maxi.mum m�dica3, impravemarit and yau snay xe��rn ta work but tisat you have a permanent 4.mpairment which hae reeul�ed in a work--related , physical res�rictian which may affect yau�r ��bilS,ty ta perfqrm tihe d�ti3.ee pf yau� usual occtspatioct , o� o�her approp�ia�e empl�yment. I� thi� physS.cal re�txi.ctian cauees you ta lo�e wagea, you may be entitled ta additional benefit p�yments under th� Floricia Workere' Cottsgene�tion La:w. , I f you ].qse wagea, yau mu's� camplete and eend a RLQUL'sT FOR �1AGE LDSS f TEMIsGRAItY YARTIAL BEN�P'ITS form (DWC-3) to u� within.i4 days after �he end of any �wo week period £ox which a�.o�s of wageg is clai.med. If yv� �a�l ta eend the campleted form w�thin that 14 day period; yc�u may be � inel.igi.ble fo� wag� lces t�enefi�a during �haC peri.oci. �n additi.on, �o be el,i.giial.e for wag� lase faene�i.t�� you mu�t c�emonstrate that you hava made a valid effort �.a abtain suitab].e gai,nful �mp�oymen� and Chac your loee of wages i� due to your .work--rc�Lated phyr�ical reatriction and tdqT due �Q ecanomi.c canditiotts, the unavai.labi.ii.�x af jwbs, your unempI.oyment du� �o miacq�td�sct or yc��r Eail.u�e �o accept empl.4yment wf.thin your capabill.tiee, To show �hat you have made a genuine et`fort ta.abtain empleymer�t, �.ist tise dates, na�nea, addre�eec3, '�ype of.work, persan cr�ntacti�d and �he �eZephatte nuniber a�' rhe placea of employmenC tha� yau havs :conCacted on tho r+�ver�e aide af the REQUE3T FOR WA�E LOSS/TEMPOF�RY PARTIAL BENEFITS �orm. Yau � �i�ouLd ai�o Zi�t the. datea you cnade con�act with ttse F�orida Jola 5erv�ce office and any other ' pub2ic cr p�ivate emplayment agency> Pl�aa� r�oic� �hat �he �lorida workere � ComQenaatian Law allows us to ev�luate your e�forts to obtain gainful employment bc�gini:}.ng wiCh �h� 3.3th we�k aft�r ynu have �eached maximu�t �edical fmgrovemer�t. If it can be shnwn *hat there are ac�ual job openir�gs wi.�hirt yrsur geog�api�i.ca]. area and which ar� within yaur physical and vacational Gapabilities, �he a�naunt aE �arning yav cou].d have earned a� thase jaba can be deducted from your bsneff.t p3yr�ent. � Enclo�ed are REQUES� FOR WA[�E 7.05Sf�EMFORARY PARTIAI, HEt3��'ZTS form� for yaur ti�ee. iteep �hem with yonr otk�er valuabZe docamen�a until yau either use them ar you enti�lement to these beriefits , axgireH. �74 are alna reparting your perm�nsnt i�npr�irment to thc� oivigion of worlteze � Compen�ariert i.n Ta13.ahaseee. � If you degirc� furtiher informa�ian regarding wage loas benefi.tis� plea�e do na� heBitate �o contiac� . me ar yau m�y caZl tha Employee Aeaietance anci ombudsman aEfice of tha i�ivision v£ Wnrkers' , compeneatian a�t any o� �hvf.r lacal afficea, ar at 3.-Sa0-342-1'741. Ve� tre�Zy youxe, � , • . � Jo . Marcin � Ri Managemen� Specialist � Ericlo�u�e .� JCM/vbd , . . � � . , , , . . _ . . ... . .. . .. ...����...rr��.�. • . ± 'f yt.. _-- . . � r{ . �j' , t . / . • . . .� .J `�S� t�,�t��' �.1,; .�(,i ' .. . � ' 7. ., . . . . .� ' . � , ' ' . , ' ' . . . ' . .1 � , . ' ' � , . , '3 1. •' .. .'t ` f � " ; � .'. . • . , • .. � . � . . . ' . . ' - ' . 1 ' . ' � . � ,, '•s ' ;.� .. ... . :'r„ ` � , . ' ' , ' ' . . ... ' ' � . � . � , „ ' ' , ' ' r . � ?r' � .� � � � x: ' . ' • . • f ' . ' ' . . � � ' .. � . e , , .e � ' „ ' � � � .. . � . .. , ,, � . . .. , . . • .i . . ,. . � � - . � . , . . ' � . - � . - . . . i F!� ::� ,,(�; ' ;vi� . r.r`�',�.' f r'i° , � , . . ��' � � � I ' . i . � • . �'' . � . . , ', ` . . . ' , • . ' ..,, � � , r;,�'i.f, �f4 ' ;, , 'f.' .' ' ' , , .,' . . . , . � . ' . ' . , . , ; . . 'S� � ' ' .. . I1;`,, , ! ili ' j� � ,,'; � . ' I ',t : � . �' ' . � , , . t- . :_' �� , ' � ' . ' ' ' . . � . . :t ' ' � � . ; : . ' , , � . . , ' . . )� r • ' 1 ��� , r •�+' .. , , F, ,I . ' ' . � ' . . , . 1 .. '. � f� , �.1: ' :I 1� ' . � � . � .. ' , . , ' ' ' . � . ( ' '• ` ' i'3'.iC7�5!��i'.�.t`f�J:N{'". . �, r .��. � . �� ", , ' . . , ' ' ' '.i ' . . , y � . , . . . . i�Y4:1��'1�I h r. �,. e ,� �, i , . � , � ...4. . . . ... ....� b�ku...,- . ' . .` f N. � J . r� ''� E, . l. :��' i �7 i.l ...b'�-' 6. . ' . . � . ,. �•1.':S'��f'•. .`r�'. .. .il:, � .d . ' : l' J . . .f :�ft ' � ��...���� � . . , . :'�, ��cv�____ � . � :� 0 � � � -� ., Q.�g��-�urg�enter of C#ea�w�ier P,�.A: . � oRr�roP�nlc s��c��r. , ' � � � . Oip(orna�ex Oj1Yie :trnerican 8aurrf OJ' . .. , , arrhopxrdre 5argery . ' . . ' - � .. )ahn,St.,ttcClurel1t,13.A. , . ' Ju1y 25r I995 ; � 'Cltama.s 0. Scilwa6, �It.D. • • ' . ' Ilarry 5tainmxtt.11.Q. � � ' . . �i:h�rles �..�brrlf;u��sen.1l.A. . . . '.' � ' ' tfich:�tL.ltochberg,�lt.a. Jon Marczn � . �s�y�. �tost�avicz,,ti.D. �. �'�s�r Management Specia�ist PHYSI��L.4[�DlC1�Y� . City o� Clear*Na�er . ., � '' c R�FIriBILlT17fON � PO BOx 4 r 8 ' , ' Crzi�,�.Seit►��rtt,ti,Q. ��-zarwater, FL 34&18-a748 � ' . .. , � - Re: Gary Lutman �. . � DOA: 4/5/92 ' � � ' ' Dear Kr . Marci.r� : �, � , �---.. . � ' i� � . �' �n ;.. 's � -., � � .�s � �L �::�. u �� 0 �JUL S � i�'l� �� � ���-t�'� � �'?,� ;��` f �.3 �i �'L�l��� r � 9""+`�s�:��ws . M��. Lutman has a(L) carpal�tunnel syndrome and his � impairmer,t � a�ing �a Minnesa�a Guide��.nes .is three percent ( 3,� ).� � This ��.s assuming naxma�. zunc�ion af the o�tier ttand �ince his cather hand and {R} ���er ex�remity i.s mark�dly imnaired. , E�is vnZy practic�l use�ui extr�mi.:y is his (L) si.de.� The actua]. rat9,ng, in � my opinican� uould be �szx pezcent ( 6� ). TE�is is accordinq to �Ii.nnesota G�a.de?ines, musculoskeleta� schedul.e, wri.st, 5�23.0�.30 {3)(=)• . . ' : {.' � . , � . . . ,� . s . � �� , r Sincereiy, ��� � � � .,, - Gary G. Moskovitz, M.�. . Baard. 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'�" :{.:�i'';��'_'}-'� ' - � . 't::�' �:�t w:' �•L.`:�.'.':.."r_�, ' . . ' . , "�' ;•:• •:! ,.�CV-.�.,.... . •' ' ''�� . '• . . , ... . �i' ., . � L�.�,r,iF •�., . �' . =i r, �� Dear�� Mr:' :Marcin ::,. � • •�. . . . '�� :,:; • -:... - .. .. . , 'r�� .. . , . • . � . . • . . • :,*:-., ���.• . , , � ' _ , ' � ' . �4': ..,.: : : , , . . .• ;'; '.'� � . , . ' . ' . ,: �• ' . � � '• • !�..�•: �, .•f : � �• ' � ' . . • ' � ., ,_�s .�� ����had �an-�oppor�unit"f �i.Q etTa�.u�ate=.Mr. Lutman�'��S?,�C35�� 1it , � ' ' ,_ ,1 cieta�.:�:�on••�fay. �:9, .J.�9S �. ��He�'�on�y h�s.'ane .use�.u1� �e:�tremit'y";-:;wYii'ch �is . ' ,i • ; • _: tii�s� �,(.L�j;�_iipner;� ext;. pi�i�y .' iie has � carpa�.' tunne� synci=ome � in�.:his { L ) •� . , , . - ;upp�r;x'.extremity'�iiat�.,�p�ecludes 'hi.m� :roin•'do��ng:�'a•.�.�abzr:as'•�;a'='•inechar.ic ..� " . ' � , '.t�%DB'�FZ;Z' � . . � : � ;' ' . .' ' , ' '.. ' � : . ' . I . . . ' . . � •� • -� • ��a� � I_�do not �hi,nk �hat he -i5 able� to work �as� a �echanic �vpe • , �. :� �_�.�.,: •'vsirig •on��• hand arily�. � `�hus, i recomr�ena him �or 'a. job� cor.nectec3 . � . .��disabi�iLx��pens�.on. His caLpal �unnel � synd�:ome,. 'in my .npinion, .is ' . _ • -�di�� = directl� as a� resu.l �. a� his j ob . - ' ' . � _ �. � . - . .. .,, , . , . . . .. .. ' . . : �. • . �. . �.. • 1.. • �, � . � , • Sincere� y, � � , � • ,. �.' •. • . . .. .. f : . . • . � � . • � . . • . .. , � • . , . � �� - . . . � � •� �.• . G�ry G. Moskovw�.z, M.D � � ' � - � - "�". � ' � , � ' ` . � � . � Baard Certiy�ed �r�ho�aed_c '�Surgeon . .- � � � � � ' ,� �� . , . � .� = e�.7 awship mrained Spine � Su=geon � . � .c•hni�_. . -.•., �; „ • . ..,. .�.:.-•.i . � � . :xc�: • _�Ga�y•.�Lutman , � .� . �-� . � . . � - �. , � • �: . � : . . ' . . . . . ' . ' � ', .. > . . �;- . � ., � ` ; , � � • ' ,' ' . � • • � . ' �. ? � ' . "' . . . ' . - . . , , . , � ' . r � . ' .. . � � � � � � ' . . li2$ I.���u� �taad ` ' C4��c�, �lur►da : �bto (S!3? y6�-Ga?G F�.� S8l3} �bi•i49� � ' �,,� ;,�:��.�-. ;.� ,- ' :� , . , , , . � • ,. . , • , , . .. , . . � . ��j.'�.fi: :r`�r'.; . '.r : t • . . , • � . . • A:,1 �tiis � ' . , � .�. `.i . , • � ' ' ' • . . . ' . ' ' . • � . . . ' , � � � I � ` � ' , '' . � . • `�' � r � . . . . .. �^I. . .' . i � . ' . . . . . . ' ' . , � � � ' i, ` � ' , � 4. .. r ��'. � ��:Z• � . � � ., . � � � � • , � . . � � . � . . ' � . . �� , � � � •_� • ' ' �� � , � , ' � � � . . . ' . , � ii . . .!�' � r. .. . . ' � . , . , .�� � . ' . ' � • � � , � � ' •k�. . , ;� 1 ' � � r '.I . . ' . . �� � , , ' , i ' ; , � y . F' , I ;; .. .. .S'1 . . ' • . ' . , � • , ' . . , , . . � � ' I . . .1 . h' ; , . ;s f'4';.. �:,_iS., '� �.�5 �e r-�1r '� ' �i ° , �v ' . � . , , . � .. e . ' •' , • :'''�,j4; ,'r�'. , , . s'• .s, �.,; i', `i. ; " ' .. < , , � .. ; ; , . • ! ,. s + ' � f �'< '.1; ' � . , , , , • , , ,� ' ' , • • . � 1 , , 1 i�. ���� �•� {' •F .. . � . ' . ' . , .1'��� ��., �7 'r I: �f � ` ,, , e' . . . '.FJ..�.r ' . � .� ' � � � i . :t'.'1• :'1' .. ' . � . � .S ' . , ��}i €�,n�,yt� .s,�y�:- �;,� , i • ' . ' , •� < < . . " . . ;�,. . . , ' z'. �'�'. .�.. . , . .a N.a:_.. . . : , �..�� ,... .... , ... .. .. . . .� E ' � . • z , ' � � � • . � .i. , � .���il���ii ��� � � � � , . � ' � . . . �.. .� �� , � , ; �`='�•�'�`-� �� � , , �, n `'•� ; �? . � ::�Z',�` J�� � �� � `�. , —� � � ; i � . � M+� �r�� �%....iiiii June � 16�, . �,995 ,; . -. , ���� � C I'T ~Y O.�' C�� 4. R W�. 'T E�t • ' POST pF�ICE 90X ♦7aa ' CLEAAWATEA, F�ORIDA 3a618•a7aB , � Risk Mnru�perxnt divisioeti ialephor�e: (8�31 46z-675G Facsimilc: c8i31 462-6757• 'Gary Moskovi�z, M.D., �, ' �Ia28 Lakeview Road � . .� • C�earwater, F1. ��616 �, , � � '' F.e : Emn�.oyee : Gary Lutnan � � � � � ; . D/A:�, 4/5/32 , , ��ear Dr. Moskov�.:z, ' , � ' � . Thank� you � or �vaur repart a; 5 / 19 / 9 � : . . � : , •A�� you know, t�:r. Lu��an has� a carpa�. tunn�7. syndrome ir.volving . his.le�� hand, which has 5een.accepted as work welated. As Mr. Lu�man's �ob r3u�:�s as a M�chanic �i requ�re. the . • rep�ti�ive L1SE Ci his ?��t handr �ir Lu��an does not _ee� he �s � ab�.e ta ps�_ar:n h�s job dutias wi�haut re5t�icLion. . � Mr. Lutman is R? i5�b1� �o� a job connec�.eci disab�.l�.ty ne:�s:,on :.L h� is unable �o Qe� �a�^� a? 1 0� h�.s �}an du�i�s as � Mecn�r�ic TT � as •a resul� of � �job connec�ed � njury. � . � To auaJ.i:y �c�r a nension, :�lr �u�m�n ne�d� �-ao neciicaw opin�ans ,stating that he can nct ��r�ar� a11 a= �.h� jan du�ies o: a Mechanic T_?' as a_�su_� o� a job connec`ed �.nju�y, an� :.ha� the inju�y is �er�anEn�. � � As Mw. L�tman's.c�rpal tunne? syndrome is work ��la4ed, he wil? crtz��.i�y �or a pens_or =� his vermanent _es�rict_ons ��on 4he c�r�a? tunne� preven:. hzn �rom performi.ng a'1 oL his �o� cuties as a Mechana:c �.�.. � M� Lu�;�an need no;. pe :.o�.a? ly disab3.�d `wom a1i gain�u? emp�oy;;�en�, or.? ��a an em�loynler�� as a Mechanac T_� . Mr Lutman wii� be contacting ��o� �or a pension iette:. � �� you be? weve ��a L��!� . T�u�man �zs di�abl�d �= wou�d a�p� �c � at� y,ou arov�.ding :�:.m w� �;� 4he .annra�riat� � et�er, so �:�a �:�� �: �? l �e a�,�e �a get a job c�nnec�ed c.isab�lity pension. . Mr. Lu:.�ar. is res�onsiwle �or �ny c!�arqes connec;.�d ��ri�h h�.s „ �pque;w ��r a d�sGb=:.�ty �et��r. , . � �e � _�ua� � . .. �. r "'' ���,, ».r .�,:+ �� ,. .�,.,.., _... , �. ....., , , ' _. — �.�.r..,.,� . f � ,'� , r ., � i�'d.yJ`��r'��3J;ik�aa�,e.l'� �'^=��5�� � ..'R�"P�x'Z�(" :.f� 4r�iY".� ''I''F �' ' • �'E. 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Yurr) I ln I Mn, t i p. � � - l�nnAr� ,1 1 n+d, !A q ��� � ���`����°�� s��E� I� T�[� L�N� nMr..� r���.. Mo. � 1 �� Jq+Mhan `7, Fi�dn.l.l(S. � pE►1�N CLOOY���,iMMD. . j F��d ."+ �3�rtmin, M D. . �. Mr.6w. � Nayne�. Mg. � L�da 1 Ldry�.?.1 p. � , ' W�nmO Wrd.IAD. , �r�noc►�:,�aconr June 15 Z 9 95 ' w�►+�n r. r.��,,, M ct � r � � rn�a�v rr�nr�cE . Jan v! CM+��cy. 6t U. � Jam!y E. Lrn, II, hi p. JnndM.�n P flpqy, AAp. . Ed+rar! � O►�vn. bl p ' � E, pao'hy i'l�n4a, M D. � Clrr, trph�!r J. PurcMl, t.l p. P�tAiS Sc�Ahaid bSl) • I .� � • , � �� i • ' . ,. ' ' OEtICMG�tiSCL't�R8UF40EFiY The Pensi,on Advi.sor Ca�ittee �a�, �. r,n�,,.►ao Y • Mkha+�E.1l+�ney,►�0. �,'a,t o� CXearwater �►rr�n��n� �e�o�c�r�� Y � JnrrKS A hvry. M Q. . ' ' f? Cira*`a!YE'�nx�n.ldp. �°�''' �"".s.1° . At�n: Ms. �e�biaie Ford . � � . ,us+1n Fi ti�iieon, M�. . Hn�in��,;;�tGk,R1D Staf� Assistant III � Pabr,k F. f.�+44Y. M �. Dairyiy r Pnce, M4. � CM�r�iL. ruq'�Y.1.1D ' . s�:� s r�Mn�a. M o. ' RE : GARY A LUTMAN n M, ti show�. M b. M�etv»�J.Ihnrn�r,M.O. CL�NxC rro. floz�aa.� flkhnrttF Tinrnrx�s.INp, Alpu�sf �. Tn.nno, M p. • � lofn S �c�euA�e�. M Q. � . ir�rERru�. M�n�ci�a�cnR�u�adY De�,7C Ms . Fo�d : ai.� s, n��a,rm�, r�o. wrMCrU Johnson,l.1D. � FT1l�i'4 F. �,N1Z. !�t U. � . °n��s r'°','M�'nM�'� � T hav� been fo3.lowing Mz�. Lu�man fzom 1.989 �o presen�. �rm►�.�, o, r,,,4�, ►�n ,►n£n►�►aEO��:N� � � initial.l.l saw him in 1989 wz�h regard �o his °"d�'�;"s �,« °,°a, Iongs�andi.ng right brach�a�, plexus in�ury . I saw him J�'K" �';,�,�,b. in I992 and diagnased carpa�. tunnel syndrame �n the �r,reRr u'��nAR1�ML-D�CIltE basa.s of a n�rve conductian study, which demonstrated �Y��",;; P,.°;;;�;°ao, modera�e sl.owi.ng vf the median nerve across rhe carpa�. Janry 1: r}ti�ntlmk. III, 6tQ. IMTEiitt�L�6�Gi71C�F;� tunnel.. �lt �ha� pai.n�, he had had symptoms tor ►t��rnT❑�oa,r�or,��o�,r ap�aroxi.mately }.8 mon�hs . That inita,ai tes� was done in �1fTEA{A�,l+EF?7CItEF�Pt-lRd.QOY June and I saw him again in Qctob�r and repea�ed �he �r�T�"�H�'�.t o�cix�o��co�cx�Y nerve conduc�xon study wt�ich si:i�l show�d mod�rate INTFRfLtLf�aClt{E��p� s�.�W1.i1CJ vf �he median nerve across the carpal tunnel, �FanciaJ/Av�� io syndrome. I again saw him in January nf 1995. A iianabE Brnwn,�,o. r� ��� nerve conduction deman��rated unchan ed al.owin YlJl:ivn J. R�ch,rdf. Ji.. l.i p, p g g 1t1T�HhtALId�QS.ICEF1FiHEL'FRA70L0C3Y p� th� m�dian n�rv� c'iG=OSS ttl-G' Car c'��. tunne�+ �� Wc'iS N,�i�in �.i. Nln�nn, ld D p ,�r"F'°L°`3" fitted wi�h a custom wrzst s�.�.nt for canservativ� F�Kh.•el El. Ev+u�s. M.p � sr,�i� { ynN t o°' treatment af his condi.�ion. 2 sa�a h�.m in �oll.ow up on . oB�ti- n�"^ YttEjL�liY 6/z6/95. �ie con�inu�d �o ttave episodi.a pares�hesias, ;;x ;;;;w�'„`h epi.soda.c s�nsv�y symptoms of� the �ir�t �hre� digits a� Jasnli�J.FLuehi.Iq,R14 ' �, �; ri �� h�nd a� w�l� as deereased ri 5�r�n �h. IvM�vn Ilu�r,. M U. '� 9 r. � � g OpNl4intl.t(71.q�iYrSUTk3EfiY,t Th�i� seem�d �O �e lIt1 rvvemen� a.n h.is C3r d�. �unn�l oisaflo�ns c�r• ri� �r� P P Edw�rd ra. (7eus�cher, � a. s ndrom� . ��,�, a R„�,t,. ►.i o, Y o�rE+oreore sur►���Y aun 1 q�;,vrs. ►a o. . W�iamF�r�i,Mp, ��g cur�ent dza nosis is l.e�t car al tunnel s ndrame, +som«� ���-,�wa,��, r., n. 9 P Y aro��nr��ro�nnr ��d �� h� bsachi,a�. 1,exu� in ur , zn add�.tion he has � �Ft, r�O5E y sf�r;oRT 5 P 7 Y � YnricnS C3.l�tic�n,°+o. a numb�r of �ther conditions inc�.ud�.ng back �roubl.e, a P�ilarrc�lPM:I.,.,o h.ip re�lacemen�, and a damaged knee. ' P�pA1RIC3 A Fran1 (iGnes. Id p. . A r"�oLn1 l.for�Y, ti4p. . . (►r,L.y V�aiai, A1 D. ,�„i�a vNM�o.r.�o. CQPaTYNiJED: PCqtAff�l'S 1'F,bIA7Filf� f1HEL'MATO�O�Y Firpm� LM. F7�kcwn, Ji, ).! (} , , ' P�/ISTIC i1}faC'iEi1Y n�a�s r ���c�o. �t o. . . Rnoint.ac;Yr�vn�r�osnc �rMC3�rx� , n r.rarvm Finarv. �ro. a,1 L�rrr� I Inbn1.1.S 1). A hla�tn lvidry, lu, h1 D. Yfn�T Lce,IS�. . Ho�titid U. flu'Jin, h!O VROLpGY�URCLC(i1:p� SUF�'JEiiY � noCn� �►1xwe�, ra D. ISS l Wusl6ay OriYQ, l.m$o, Hloifdn 3�t6i0 Pheno; (E17} Sat-676T pruce.� sen�r,1.e0 3f71 N. f.leMullrtn 800th Fioud, Ctea�wa[or, FToiida 34521 Pttionu: (6fy� 7I�dd71 �1pr.uM 57 M 1 Q!l.CCq �rt•�,� n rr��rn� 1163 S. Fk. Nneiisan hVonuo, Sui10 20a, Claarwaloi, Florida }1616 Phoreu: (tll� 413�501 �q5ti Tempn Flond, Su�fo d, Qfdsmar, Florlda 31k77 Ptiona� RSI7) �54-230s CENTER f4R Cl1ChA71�NT SURiiE1iY f401 YluslBny pirya, Lurgo, IlorW� 3.1bt0 Ahonv: 1613� 3E3-�SOQ :���r,, , . , . - sa. :�1'�� : � c. 'y', . . � , . , . . . . . . „ �� .'. . f� , . .r� �>' � ' .��� :. , . . , i. , ' � ' r � - . � . ' E � . �' . . . . . . , ., ' ,`: . . ; t . ..` , ,. , , , . . : �. . • ' ,., . . � ; � ' r ., :.f ,,a.i t! ` .S', .,• . i.. , ', . .. ��' � � � . . , . I ' . .r � � ' ' , ,� �. : � �:Y.1. - �� �, r�.j1 ' � .` ' , �.. ' 1 .f � . ' l i .. . . . • ' , . • ' ' ' � � 1,'' .. i� !' ',( ;1 ,,'1Y . ' -t �' `• ' ( i . 1'�r . ; ' . � ` . . . '' . . . , , � i�-1..l. ��i,=t' t ''�S•v•ri. . � �j.�'` . ,�. �r � ' , .. . . .[..' .' , � ! � ,• � � ° . . i �.�'! ����`.' .5 ,1. ' . . ' . • � ' . . . ' , .. .� � ' � , . ,1�, • �r � _k.. ,. . .. . 'i! . :1, � .. • . . � . . .. � . �i•r' r� � �' �t�.� 'Y` ' , '� � � ' - ' • . , � � ' . ' , . ' . ' ' `��, . .? '.' � • ��'�" .�e , . �. , , ' , • , , . r, : , ' . , . . , . . `_; F i: . �� � �-:.'' . �., � - ' , ' ' � r �. .� � ' . • ° s. � .. , � ' � �*�I�:'4�':�"�:��r%�iS^:.�:'[i�,Wfr.t{fP.�i� �k; �� , � .,�. . � I..'� ' ' . , � � . � . ' . r . � .g . 5.,, ` .. � � � ' ' � ' . ' , . � �.7 '� ��� �' �i�' 'I�'1;i..F_ � f . h �TY� . rt<. .. , ..,�1..Fe..Fi .... . , ��.. . �+i. ;��' � � ,.. . . . .� .. .'�:... � .i. .7�r;ti,'� '';�� � � :��'•� ' . . � . . . . . . . . , . �� ��; � � . , � � . . - . , . . � . . � � � . . ��''� . .' � � ' , ' ' , ' . . �. , .. ; � ; ' ; . � i ; ., . � . � • . � � ' � � � . � r . ' , � � '� ' � � ' , �•i; , � , � �' � � ,. . ' . • ,, ' ' . . r ,. �.'1r- � ' • . � �; .� ., . " -. . . • . ' ' , . ' . .. ' � � .. : �. �': � . , • , ' ' ' . . , 1 . ` ' , ' ` " . . ' . • ' � � 1 , ' ' � ' ' ' �' j• . ' � , , • , • ' ' � , . ' . . } , � ' . � � . . � • � . ,. . , � . . . , . � � r . , . . � . . � . r , �. � i � , , . . . . . . . � . . r �.. ,.� �' ' , � � , . , . . . ,,. CONTYNUATxON e � . � ' ' .' , , . . . � . • • : RE : � , GAAY , A LUTMAN • . . , � . . ',. •_ . , , . .'. ; . � CLIN�C NO. �oaz�ois ' . , , , . ,. .. '' � � �. ...�.PAGL� �' . . . • . . . � , . . . . . . . , ' ' . , . . ' ' � � , � , . � o �' . . • . , .l, . , . ' , . , . ' ' . . . �'. _ .•' ` ' Th'e pa�ient appsars to have not' responded ta an � , '. � � , , � ex�ensive .periad o� sp].in�ing of h.is �.�ft hand � and � � � , � , ` ' . , �. treatment �f' his .carpal, tunael �i►ndrome. �t se�►m� . ' �'°: .� � ' � . � • 'unZik��.y �ha� h�� will a.mprove fur�her us�.ng th.i.s . . , , : ' .� . . . . °mod�.�.ity. The next step �,n �rea�ment , would b� to do � ,. . " �'. s�rgery of the carpa�� tunne3 syndrome. � would ' , � I• , , ' . . : ' ��.r�commend that this be done�by a plastic surgeon. This could 3.eaui to comPlete reso3,ution of his symp�orRS . � �. x zead �h��descript�.on of the,patien�'s"�jab as a ,,� mechanic I� �or the Ci.ty r�� Clearwater�. Clearly, this : job invalv�� �xtensive taol use wi.th hi.s l�ft hand. I�. 'think it unlikely that� he w�,l.�. be ah7.e to continue � •� doi,ng that jvb in ha.s present state . I cannot commErit '. on whether he wi7.l be ab.�e �o.per�arm that job af�er � carpal tu�nel surgery. . ' ' r am sending this �ep4�t �o yo�u in care�of the pa�i�nt, Mr. Gary LutrRan: ' � � � , Yours SinGerely, -, . c: , t . � , � � �-�-,c��....._.....��..�i�.., . Mzchael B. Evans, M.D,. � � MBE/LZS .' � � , . . , • 153I Wesl Bey Orroo, Ldpo, F7aicla 3dbi4 ' ' Phone: �813) 3b1-6767 ' 3131 McF.lultan 9oolh Aoad, qonrw�unr, Flar�tla 7sb21 Phonn: (a�]1 71b-�e71 � ti ' 14616. FL Na�iison AvenuQ, 5u�ls YW, Claerwoiur. Fk�rids 34516 . Phonn: (817) �u3--ISal , . � CENi�fi WA OUTPATIEAlT SURp�RY ,' iaa�,woc� a,y a��vo, w�qo, Flaiaa 3a�su Phano: cb�a1 sas-�soa �. , . , � , � „ . � • ' ' . . , • , �. � � . � t. � . � , .� , , �,. . 5�� _ : �, • � ,, �', ,'s�� ' �. ••��' . . ., . . . . . . , .. , : .:. • , , .. `'. ' , . � ., , r , ' � , � + � , � � ' � . � .��.. , ' ►�ES�O�OOY � � ' q lio F�1.n� l�10. rr� J lyd.Mp. • '+1 A L�wnamc, J�A f3. Y 1 ; .�++ Prlir�. I�IQ. � , .trsn g. Arsn. F4O .1 �a1t F. WO�+�� 4�x�6 MMi[1fif1Y i � / � � . �1D10�3Y ' ' . ��� ! 8. 4�wnry FID. � ' ; , . a1. � AM �� "�°�� . ' . . artl]. W�id.l�l0. + . . , . 'Iill�'O104Y - 1k . E � � �en P. CroorR AEC. M$�r � 3 j J. 7� rJ .�' I-'. � r e , ` PiiAC17CE . x. n...�y µ o. , , •: ' . ' N E. lrtL �, MD. � � � t ' •�ti�P.N.�c,,.ua. � - ' • TO wHOM �T MAY CONCFR� � .�a �. cr�w,. ►� a . 9d �� i Mn. ' � � ; , ��� s`�� R� : MR . GARY A LUTM.� , ' �,.7. fro«n. ►�ta . ��+ E����p� I.5�0 S[TNSET F�T RD � ' � �:"'."��:«�.�n. CLEAR�+IATERr FL: 3�5�5 . Y��'`��' CLINrC N0, g029015 tin H. �Awoe� !d R ' • ' . ' �.� x�r�o. . . , . . ' ck F. AMw cy, M b. �In� �. PAO�. Irt�. . � � ��•4iw»r.�*o� f�4i�. Lutman �aa- baen under m c$ze sinca Au uet of �985. .�,... r,.y„d.. �,cn. Y � �H•s�w•��� ' 'F�d ��centl ht�d be�t� }iavi� rob].eme .with hia �.att hi «� ,. �+enw.o� r� a -y , Y g� P ''^0F•t�p"+�p• ��'ICl waa dia nosed b Dr.��asan a� we1Z as �h� r�v�oua .� �. r�.�. Mb. 9 � � � � p �e�V•�wµa o=thoped.�st, as hav�.nc� �ame �eg�ner�t�.ve aoint digease. -�L MEflICINFiCAfipOLOVY � . . g��O�h�'��• OVBi the past. �ne tnont� h� in�ured hi� ].e�� h�.pr ;,���;M cauaing h.zm to lose a�u��tan�ial amount �� �una�ion. kv E. Lsn� IA O. -� •y�''�p�'�� ' �ie has, notic�d an ina=eaging pn�p�.nc� and grinding as a a, n T,.ti.r Ma. � � �'��'�� resiil�. This in u� occu`r=ed a aren�l , on 3I22/95 •ENIERO�GpY � 5xnce �ha� time tPie has noticed a r ►�s�•►"D• w��I.e a� wark. �,p�'�, prng=essive decl.'a.ne �ri iti� ability t� ainbula�e �,ri�h�ut ,n x w+� ►�o. .���►'���o�,�E' pain and certainZy' �a per�orm h�.� currerit dutie� on �he ,�M.o6.�.Ma . job. Whi�.e �he underl.y�ng ar�hri�is was mas� ' � ti. r+a.anl r.�.o. � F. FLwnu�tt Yl. �IIU. � � � . +µ.�•o.uo. c�rtainly present, �}�e mo'st zecent in�ury c�.early � ���� :�ooY�oa,r exacerbated �he problem. � = FNn�ntl.4 MG_ �t MEdC�t�ElNEP1i:�O�00Y � ' , _' ��ac�ti«�,ca.onv F,� this pain�, he �as �ad an �pinion fram a � .�►.+ ���N�'�D� rh�umatalogiet, ae w�11 as an. o.rthapedist tha�: hi.p � �°r«+ �.� replacernen� wili be n��dec� �a z�medy the problem. d F. $orhn, M.4. ml. A�rd�,Ji..1AD, ;T� �.u�F AEU�ATC%.O�Y Foil.o�ing hip r�piacejiten�, it i.a ditfi,cul� ta know �e ��M,.�,❑ . whe�her the patient wi11 be ab�e �n perf�rr� h3.� curren� ��"�s� Ma � duties . Certainly, vacat�.onal �enabi�.i,tation might be , 11. s1.ru+.on ►A D. i =�cs.arr,,er,�ooY in orc#er ta a,�low hi.m �v �ror�t a� a job which �e �.e�� � E.Oasn.4A.D. � � •. 1J.H�r,AtO. �3 �IS1Cc'3�.��I dBlTlciC1�I.11C�. �O.KwMt,Ip,Mn. .� Rul� i�l D. ' tiIUIOUI'�SUW3ERY 3 , � :�o�x��rE tf I can be o� ahy �ur�hez 'service, pl�ase do n�t r�l.e O+ulrarr, Re a. . . ..�.aoo.�ti.�►a. �iesi�.ate to cal�. • � 'cp�C 5LFY3ERY O�r.r�, AID. ' n rir��, M.O. J n Zurn[�afu, I�f.D rr`J.�.Xi ��L ��l 1 rNpOL4(3Y ' s� a rkAO,�x • ,. 6. �.r.. M.o. n S. c3der.,� un. � Y*'7+4 7OY ,�� � J . ar,d PFd, AID, �a�....µn. t��.�h�el J.� Tho�tpson, �t.�. . o�e� Mo��, MO. ` y Vu�wr� A1 R. . . 'i �CS�?EDIAiFilO RHEl11.lATOL�4Y ♦ +`7 r� / � X l� , , � w. ta�� �r., uo. _ • � . SUAQEAY • • . .. , 7 ?. /.IoCu»� J�AO. 4Yr0�aNO8nC i>.uQINC! , . � . nm F�rWy. F�iO � • tm H.+o.r� AI 0, � . . ' rLn l.+�nqry I�I. i.10. • Lrs. AID. , � • . . . � d 0. Avon, M 0. YNROl.00iCAL SUFi05AY t E. H W�nl� !.1 {7. ,� 5.�. Mp, ' J331 riasl Bay Dirva. Ld�po. F�aW+ 31W0 • Phanu: iri3) 5s1-1?67 rriAif,��C�� )131 McMulwn gov�h Roe�d, Cbelw�lw, FlaWn 31611 Phona; �II]1 725•7�1T1 , � R DwDQW l�G� 9. Ft. Heimon l+vorwr. 6uNU 74/. Ct�awn�a, Flalda 3/Gi0 Pnono: f1171 a�1• �3v2 •. . CENTER F�H Ol[TpAT{�N� SL1RG�i�Y 'y-r���' ' . . 1141 Wosl {iny O�nQ. 1,1�+00. �Iplda }1619 � P�o' �a131 SA}.y}IHl . � �f?"�;�i�f,� r.';'�'tir: �r s.. � ...�. � � �� :.>r,::f''� ( '.,, �'. � � . • .. . � . .... . . ' /.. . . . ,. y' . ' , ' '� . � � • ' � . . ' .. " , . • , . , '. • . . � : • ,,': , ` � , ' , ' ' i, � � � : , ,I • 3' j ' .. � e ' . � ' , . ' . . . . . , ' , ' . . . . . . . ' F . . ' , ` � � � I� I � . . • � ' � . . . .. � ' . . . ',:� � .� : , �I r �. -, ..�..; . , ' . ,� . . � � ' i , � . �; " ., ,� 1 ,," ' , '• � .. � ., . ' �=!' ' . • � ' . ' '. ' , , ' '. ' ' , ` ,' � ' , ..,, :� ' .� !� .. . � ' S'� .i5':��1f .,' ' .11 ' , . . ,t � . . . ° ' _ . ,. .. . ', i 1 ,'. . . '1. ,. , . ' : ' , . .. , � � � . .. , j i , 1 . �c�r:� '{�I�`.�"it�af`•:a?4�,"^".',:. �,��;..;�. ` ' ' ' ` , ' ' , :>, - - ' . � � E,y,..� • , . ' � � �.1 , o ,,.M ., ; . �.., ..,,, •.. ._ . .. s..:, . . . . . , .. � . . � . „ , „ ... „ . . . � , . �, , ', � j' � ' . ' ' ,� • ' � ' � ' ' . . ' . , i� . . . � . . , � , ' � - . • ! � , .• � ' ' ' � ' � � ' . � � '. � _' • �,, i>. ' , it`� s:. � ; _ � ' ". . �: � . . , . � ; � � �� DrACNOSTac eLZ�rxc � � , � � . -. ' LARGO OFFICE - ' ' . � �.55]. Wes� .Say Drive � , � ' , � Largo, ,Florida 3�6�0 * (813) 58�-8757 . �ATiE�iT ID...: 00290I5 � GARY,A LUTMA�'�I . __.._.. �---_...,__ . nQ8/SEX.:.�.:.:, Q5/22/52 { �2,) � NWLE ' � :D�.CTATED AY. . : W�LL��1M. WASI�N � � , : SpECIALTY....: RHEUMATOLOGY � , , � • SFRViCE. .,. . ..�: �,03/27/�95 CDNSULTATIOI�i � . S�' CHZEF COMPLAi�1T,: Patien� z.s a 42 year old 3entleman seen in �: �� � consul�ation �or Dr. Thompson �nd �r. z�uerndarter �or � evalua�ion oi. aithri��s. � � • � � • �. � HrSTORY' �F PRESE�TT ILL�`1E�S : . � � � , � .'�. 1.. Pal-.i.ent had. a motorcycle accident �.n 19;9, w�.th , ', •. , signi�ica:�t brachi.al. p�.exus . inj ury and resi.dua�. ' � �.. � para�.ysis o£, rignt arm. � � . � In �.991.�, ��tient slipped, at work, in�ured hz.s �.efu ' � knee . H� had progressive probl.ems wi.th �he knee, . �' resul,ted in surg�ry�in 1993, by Dr: Zue�ndorfer, with a '�� men�.scecromy and c�.�anout o£ the cax�ilac�e. �Patient had ongoing prob�.pms ��ua7.ka.ng. � , , ' 3: Patient und�rw�n� rxgtat, �o�a1. hip arthrop�asty. ' , P�Cient cantinued �'o work. � � � 4. Patient has deve3.op�d rapidly progress�.ve ar�hriCxs �.n , the �.eft hip. � � 5. Pari.ent injur�d �hi.s back ar :,�ork on 1.1/'7/94 and � � � 3/23/?5; ca�.tsing.,signi�ican� exac�rbation o� 5�,�n+�l'.oms � � with sca.ati�a radia�ing down hi.s l��t 1.?g- . ., � 5. Pati.�n� h�s carpa7.' tunnel s��ndrome ot l��r w?�ist but hQ . �cannot have surgery a� this t�.me because o� his � �� overTah��.ming o�her medical. prob].ems and �aaral.ysa.s o� the right nr�. Pa�i�n� has been Cri�d on a varisGy of nons�eroa.cal • mc3i�a�a.ana includiizg reZd�ne, ,Vol�aa-ei�, an� Qruvaa.J., none o� wh�.ch have h�? pPd c��matica3.l.y, A3.1 he�.x�ed a� i.�t�e bit . ' S(7CItiL SiTUATIof�i: �atien� is dPspsraCe at �his ��int in ,� tim�. He do�s no� �eel he can work but dpspFra�e7y wants ta work. There are several. �.egaZ implicata.ons and prob�.��s � wrapped . u� wa.�h his ovEraii medica]. situara:or., � R�V7EW OF SYSTEMS: Pa�ienC denies significan� mc_ning � sti�fness, jaw claudicatian. He has paralysis oi �he r�.ght` �� arm. The lefr a�ni h�s same mild numbness and r_i.r:gling i.n � � L-he. wri�r . HE Ii�s aain ar:d di.scom�ort in his I'oc•r bac€s , •, • 'COPITI I�IUED t.: , ! . ., , . . � , ' � � . � . � ' � • . . � . , .. , , , .� • , ' - ; , � .. ' . - : , . ° . , r . ;+ . . , : � � ' , ' � , , • , , , ' ' , _ r ` ,, . '.' ,. , , . - . � .� �� � . ' .. . .. . � ' . �. . � , . , . . � � , . ' s ' � ..� �. " , . ' . � . � . � . . . ' ' . . ' . ' 'I . • � � .. ' i � . .. ' . ' . . . , 5 , i1 . � .. � . , � . �. � .. '"r , . . . . ! ' .� � ' , .. ° : �. � . , , „ . .r . ' .. , , . . . . .� ' . . , � ' , .,. . , : ' , { ' 1 `�, . ,r' �'' . •i . � . ' . .. �. , . + . .i. _ . ' ' . , , . ', , ' ' , r' ' ' `' ' r : ' ' ' . � r' ' ( . ' _ . . .. , . ' � ' ' � . , , ' ' � , .� ,i� . ; . , � + . � � , ' ` , . . � � • �� � , , ' ' ' � ' � ' .. . .. ' . , i � , � , ' ' . , • ' . . , , . �r,7f.41�„�.�.�y., Y. .4 .�... .� e� .,' :.�1 .. . . ' , , , . s i . . �,• ' . . , • �. . � .,t F . . . . , . ., ... ,. .. . i � . . � � . , • � . . . . 's t .. . . . ' . . ' ,� ^ � ' ' ' • , ' � . . . . , . ' � ,� . ' � ` ' � . � � .. , � � . , Y t, . � , . . � ' � , . � PATIENT ID.�..: 0029�J.6 - GARY A LUTMAAI � � . . . . � � ' . DQB/SEX. . . :�. . : � OS/12/52 { 42) i4ALE � � ' . ' ' . � � DrCTAT�D BY. . : � W�LL�AFd 4dASC3N " ` � � � � SPECXALTY. : . . c RHEG"�,TOL�GY . • � ��. SER�IICE......: ..C)3/27%95 COI�ISULTATxON �. ' . .. � , ' . � CONTIDNED PADE 2: . . . ' � radi.ating� do*�rn tri� 1.eft leg with popping and snapping around , � � the ha.p . ' , `. � . . , O ..ilITAL SIGrTS : �P ? Sd/F10 . Pulse, 68 . Weigh�' �325 . . ' ' �Riit�.i�i'�Y'�r�.:�"�a OC . 6 . , : � NECK: Supple. ,• � � � ,. I . . LLNGS : Ciea� . , � . � ' . ' CARDSAC i ReguJ.ar rhythm. • � � . ' " � AHDOMEN: Obes�, wi.thauC detectab�.e h�patflsplenomega�.y. � '� � ��UPPER.EXTP.EM�TIES: Revea�. para�ysi� a� Che right arm wirh , onZ�� some pr�:c:.ma1 mator func�ion in the arm and shoulder .�. ��'. area. Lef� hand is unr�markable as �ar as arthri�is goes.' � � � He has a weaki y posiGa.v� Tinel' s si.gn . � ,� • FtIGHT E�iP : i?as gQad motivn with mi.nimum pain at extr�mes :� , Minimum'cr�pi�u� in.th� knAe:' . � • LEFT,HIP: Has s�gnx€ican� limitpd mobiliCy wi.th pa�.n and� � disGOm�or�. � � BAC�{: 5hows a short 7.e�'� leg by one-half to rhree-quarters . inch compar�d to the. r�.gh� . Leg raa.se is posi�i.ve on �he � ' �.��t . � � � � �' a 1. 8rachial p�.e:cus injury, 1.9'79. 2. Le�C knQ� injury wa,th subsequent men�.sc�c�orny in 199� .�' � ' 3. DeSene= ��i�re arthritis of r�,gfit hi.p �Ni�h �ata1. hip � � , . .�ep�,ac�rrtent. • � 4. Progressive degeneraCz.ve arChri.tis o� left hi.p whic� ' wi�3 re�ui.zQ surge�y �.n the �oreseeable future. � �'. Si.cni�ic��n� decrenerative disease o� back with sci.atic sy�nptoms acid 3.eg. �e'ng�h discrepancy . 6. Carpal �unn��. syrs�t�ome, 3.��t wris� . � ' DTSCUSS�OA1: � , ,. 1.. .az�h tiie s.cc�pC.zon a� �he right �rm, canditions f�rere ' . ; ��' not pr�-e:ci.sr ing �priox- to ha.s employ�nent tNith the City ; . � of C3.earwater in z984. . �. . , � 2. His injury on 11,/7/9� and 3/23%95 s�.gna.fican�l.y � � , ', ' � ' aggravated i�;s back si,�uation. � � , � 3. � H� � s�not li�:ely to b� £�.xabJ.e under his curr�n� . , . ' � �si�uation a�td I woul.d consider him Cora�Iy disab3.ed as a 2�t�ch�tnic I�, bas�ed on his job d�scra.prion thaC he . , � giv��s me ��cay . � ' � C�JDIT�NU�D • . � . ' . � - � �:,., .� �� ,'�.',!,�,'.�r,� •�'� 3;' ' , . ., � _'`. `'c� , � ' 'i� .. .. , . . . - , . . , �� 1` . '. . . .. .. . . . �� � . . . k �f". . , , . ' . ' . � • :�7l•��•{, � � • 4 , ,+, . , ' '� " , ��i � , ' . .� ' . , ' � ' �� �4 • 3' ,• � �•i• . • � � . •�1�',z�1' � �, j 'S � `'3' • � . , ` . 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Fi - G�1RY -11 LUTMAN � . • � , ,, . • � ` ndF3/SrX.�. . . ._ , Q5/1?./52� ( ���} � M7�,LE '. � ' . � , ' . ' ' � . � . i�,fi: �'1'J1'�ED � BY . . : : �r1I TJS.,T,1f�t wnsoar . � � . � • � � � . � � �, t=�'E�ZnGmY.. : : FtfFrtN�tr1'E�+�ir�nry . � � . . � _:°. ' � ���;iz��.t{_r, : ... . o:�/a•�/.�Y . e�r�sur�TnT�or� � , . � . . , , . . . � .. r r M r � � .. � � � � » � . � . .. .� .. � � � � .. � � � � � w .. .. � � � � r � w � � � � � � .. � ' � � � �. � r � w ' � � : ' , � :!�ri�r � rrr�co `. P11GE � . � . ` � � . � � � �. , . � � � . , �� . �Pat'zent: ��i�. 3 1 :�.l.r�r�:�t cer,tainly need a �o�a]. hip ' � , r;, . • , r�p7.acerti�yri�' . • , . . ' , � � _ ' � : � 5 �. ' . I_; W�JIl�.��� :'Oilrjr�n:'i� a �ha7.�F-i.nci� li f� tr�� 1¢L�. s11ae '�o � , � . '. � , ,� miclim�.ze i�.i.^ h�tr_k di.scomf�z't . 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LARGO' �FF�CE I551 Wes� F3ay �Drive �, rt � , Largo, . Flo�i.da 34640 * {81.3} 561-8767 � �i, . � PA�'IEN�'~-�D. . . ~�Q29016��-YGAHY A LUTM�T~-- --�-�_"-__--__..-- ------ ��,: .. DOB/SEX. . . . . . : 05/12/52 , �( '42) MALE � � . . ; ' ' D�CTAZ'ED BY..: MZCHAEL EVANS� � I SPECZALTY....: NEUROLOGY � _� , ; . . : SERV�CE. �. . . . . : Ol/OS/95 NERVE CDtdDUCTiQN STUD'�' � � r1 M w � � r �w r .r r r « • .r w w w .� r � � � � � � .. � � � � � � � � � � r � � � � � � � � . 4� � ' PATIENT HISTORY: The paL:i�nt i.s a'�2-year-old whir� male wi.�h ��. �� documented carpa}. tunnel syndrome in rhe past. � `, �� NERVE CONDUCTxON STUDIES: � � � •�• DISTAL CONDUCTION NERVE L�ITENCY AMPL�TUDE VELOCrTY �' L. Median, (s) index � 5. 0 msec* 7 uv • � ' • midd�.e 5.5 msec* 5 uv pa�lmar 3.7 msec* 10 uv . � L. U�nar . ( s j V fz.nger 2.. 7 msec � 1,6 uv L. Radial (s) ' 2.4 msec 1.5 u�v �' L. Median (m} wr�st APB 5,7 ms�c* 7.5 mv � 52 M/sec L. U�.nar (m? wrist ADM �� 2.5 ms�c 1.0 mv 57 M/sec * abnorma�. values � � � � ** borderline values , - RESULTS : i'he ��di�n nerve showed s.Iow�.ng across the carpa]. tunnel. bQth in the sensory and mator wav�forms. The slowing was • essent�.al�.y �.dentica�. ro that o� hi.s last EMG and n�rve conduct.zon study dated 11/23/93. � , i . I . . MYCHAEL B �VANS, MD : L25 ' <FILED�........09:16:30 47 JAN 1995 : LZS.: ' , f �, �.. ;� � . �. . . . . ' . . , • ,� , . ,.. , � . ., . . - �. � • ' � . . ; � _ . : . , , ' . , t.. �� . , . ., , , ° . . '. ,. ' ' �- . , . ' � ' - -� ._ • ' ''�,� � . � � dI�AGNOS�TIC C�,INIC , . ' �551 West Hay Dri�e • Larga, F1�or�da �464fl e(8I3j 5B1-B767 � . . � .,, . 'M � NEURODIAQN�5TIC REPORT P�ITTENT'S N�#ME: LUTMAN, GARX A. . RE�UEST�Nt� PHYSICIAH: M. Tfi0MP50N,, M.D. � CLIN�C N�. 0� 9� ].5 DATE: 1I-23--93 , PR�C�DURE: NER�iE C(?NDtiCTTON VELOCITIES AND EMG • pATI£NT H�S'rUR'at: The patien� is a 41-year--old white maXe. Thi� i� a ia�low�up evaluat�.vn'��= aarpal tunne], myndrame. He ig about the �ame. NERVE � L. Median {sj index midd�.e palmar L, U1.nar ( s} v finger L. Radia�. ( s ) ,. D�STAL I�R.TENCY 4.7 msec* 4 , B nys�c* 3.7 ms�c* 2.6 mg�c 2.4 msea AMPL�TUDE 7 uv 5 uv 18 uv 13 uv 1 g � uv CONDUCT��H ' VEL(}CZTY L. Med�.an (m) wras� APH 5.0 msec* 6.5 mv 5�4 M/s�c L. UJ.nar (m� wzist ADM 2.3 msea 10 mv 59 M/�ec � *,Abnarmal va�.ue� RE�iJLTB: The median nerv� shawed s�lowinc� of bo�h matar and sensory :��ber� across the caxpa�. �unnel. The c�mpa�iaon radi.ai. and ulnar nervQa were tiaithin narmal limi�s. EMC: Electromyagraphy w.itih monopolar d�,:�posable need�.e� wae done in �he foJ,l.owing musc�es o� th� 3.e�G hand: APB, FDr and ADQ. RES[TLT3: A11 muscles were narmal in inserti.on and re�ting activitx, mfltar unit potent�iala and recrua.tment. ANALY3I3: �he r�erve acsnduc�i.an studies ehr�w�d a carpal tunnel syndrome, s3ight].y �.anprnved from the iast s�udy dorie on f/30/93. The muscl.es in the hand wexe wi.�ha.n normal l.�.mit� wi.th no �uggestion of denerva�ian. This is a s�.ight a.mpravement �rom the previous study. NiICHAEL' B. EVANS, M.D./JS cc: Ar. Thampson � � _ 0 ;`�•!'� � I'•! ?:;'. . ,'�� *, r. . . . � �ik �� � " DxAGN�STIC CI.INIG . I 155�. Wes� Bay !Drive • Largo, Fl,ari,da 34640 •(813j �8�.�8'167 I NEUROOIAGPIUSTrC IiEPORT � � � PATZENT'S NAMEs LUTMP.N, GARY A. ' CLIHZC N�. 02 90 1fi REQUE3TxN(3 PIiYSxCIRti: � DATE: 06-30-93 , PFtQCEOUREt NERVE CONDUCT�ON VELOC�TYES AND EMG PAT�ENT 13ZSTDAY: TH� PATZ�NT �IS � 4�-YEAR-OLA W�ITE MALE WITH SUSPECTED LEFT CARPA� TUNNEL SYNDROME. NERVE L. Median �sj index � middle � palntar L. Ulnar ( s ) v �ing�:r L. Radia� (aj DISTAL LATENCY 5.2 msec* S.4 m�ec* 3.8 m�ec� 2.5 m�ec 2.4 meec AMPL�TUD� 4 uv 5 uv . 19 uv 14 uv 11 uv CONDUCT7DN 'iT�ELQCI�Y L. Me�ian (m} wri�t APB 5.8 msec* 7.25 mv S3 M/eea L, U�nar (mj wris� ADi� 2.4 �naec 10.5 mu 59 M/€�ec . � *Abnc�xmal values R.ESULTS: In the Ief�� arm, the m�dian n�rve sensory and mQtor waveform was slowed across the carpal tunnel. A11 other parametera wer� normal. The compari�on nerves wex� normal, No right comparison nerves were dflne �or comparison purpos�s becaus� o� his pre-existing righ� brachial piexu� abnormality. EMC�: Electromyography with manogolar di.spasatale needle� was done on the �ollowing musc�.es oi the �eft arm: biCeps� brachioradialis, extenaor carpi radialis, �1.exor ca.rpi radialis, �lexor carpi ulnari.e, and th� i,ntrinsic h�r�d musclss, AP�, ADQ and FDI. RESULTS: The FDZ muscle showed fibra.Z�.ati.ons and �asc,iculation� in multi�le loaations. A11 nther muscles we=e norma�. in. in�e�tion and resting activity, mo�or unit patentiaZa ar�ct recruitm�nt. ANA,LYS�S:� Nerve conducti4n� were compatible wiLh cazpa�. tunnel on the �.e�t sa.d�. EMG study di.d no� can�irm �hie �nd ahowed aau�e denerva�i.on changes in �he FDI muscle. MICHAEL �. EVANS, M.D./JS �� � f�! �f ! ,� ' ,� {. ..� . . ' i ' , ' . " ' ' . , � ' ' i . , . , ; .� ' . . . . . ( t ! . . � ' r � � � � . � � � . . . '. � � � , , � • i ��� . � ,' , a, , ' � . , ' � .. ,i : t .. .� . , � < " � . . ' ' ' � . . � ' , . , .. •i� • . . �. . . - .� � . , ' .� ' . ' � , . � . "„ ' ,' . •� '� . ' � ' . . � ' . . . r� „' . . ' . � , . . ' � ' . � � �•1{ • 'r , � r;' . ; ' , �,,5,.', . .. . . ' i � ' . . � . 14� . . 1 iil f � ..� .. � , �, . . . . , . . . � . ' . . . . , i , . ' . �' �`�E� . . . . . . �� . . ..' � . �, �.:� ; ��. , :�7 �� . . �, . ' : � '' .., ' ' ' , ' ; .. � � ' . � � I � �,ti� '-`;. ',.�i�r � ' ��,: k+. ' 4' ,'!. �. ' . .' � 3:. . '� . ,� � : ' , `. � - . . �. j� • . . �'�4'.�. t.=^�.�' '�' '•'F'' ' �. " . `1 ... ' ... ' � . . ' , . •, ' , ' ,". • r. ..��KI^l7r.'k9c�>t'1}'��Yl�;'.`.i.la�`F"Rdk�M>�.r.� . rr • � .k.f j'� 1.' ... � li � i' ���' ' � S . .. . _ .f.. .. . �.. � , .. -1" . .a. 11. . � . . � . - � � � ' � . �. '�z W� . . . . . � . . ! � . �I. . :Y � � �. oc���7-9a, ruE v� : i.� pr�� . . . . � : � . � �. 02 , . � . ' � � � . '. . � • � � . , , ; , , . � . . �L�rgo; Qrthoped��s , � � . .� ' ` ��lof�n Fras�r,�.o. , � ���, �� . . . � � � � . �� ' � � � , � ' � C� t b t 1' �IJ95 ' . . , � , . �, '� . . ca er � , , � . . ',. � , � . ,, �. � � . . � � Jori Mar�r� � � . . ' . . � � � � ' � � City af �le�xwater - �. , � � lZisk Ma,na�ement Division , . � � . PO Box 4748 ' ° � � : Ciea�wat.�r, FL 34�I.8-�7�$ � . . � RE ; ' . LITi:I�'V, G�R�' . � � � ' , . . D/b/I . {?3-22-95 ' , � � � � SSN . �4 � 7-7�-377� ' ' . , T�e�.: Jan, ' . � ' , . ' Gary suffers from severe end stage degenerative joint disease af his Iumb�.r spine, which � cst�ses him se��ere inCracta��e 2a�t sci�tic�. I�e also has a cQr�comitas�t 1�t� hip �rthri�ic cnnciitinn •�vith c�ilapse �nd �eterioration of the femoral head, causing him severe pain. Ha has previousty hnd a right total F�ip repl�c�ment which remains somewhat painfu�. Ac this time, I am recommending thaE h� be su�ported €� his medical carc by �� � intermiktent bac.k in3ections and �ossi�lc hip injec�ons. He is not a cartdidate far surgery at this time due to t�u ov�r,veight condition, which may welI �et better wit� cime. He rec:tains rt�edical�y. disapted. . , . � Since �y yotirs, . . Jahn Fraser, 1�i.D. � . ,�F/tr;j f�v ' , , . , . � '1 � 2�0 S�minale Hlvd. • S�ite � 03 � Largo. �lorida 34G�0 •(8'13j 39H-D600 , �_: , o s o � . . . . . , � . _ :ti'` . � ; , ... , .. ,. . ' ' . � . ' , . � ... '. . . .. . .. . . , . ... . , i , , , . , ' µ = . . . ' . : ' ' . . I . ' � , . 1 , � . .� . . . . , ' ' . ' . . � , .i�''4rr ' t''i . '. .} ' � ' ..�r�, ..�r.. , •t 1f • ., ,t� .. ,. �. ' � . . . " � � ' . ' ,. ' , , I. ' � .E ' .. �. � .. . , . , . . . ' � r ' . • . , . . � , t. � ;' . . � 1 ' �'i ' � , . -.r . ' ' .' . , , . ' ' , . . ' . . ' . ' , , , . 1'� ie•. .... � . . .. �. . �: � �.`!l' ,,r. . .. ' � � ' 1' ' , �. . , 1 ' ' • ' ' ' . � � .s ' . . �.�� • � ' . . . '.' . , .3'� ' , . . . . � . . ' . • . . . � � ' , . ''v�;i'"r3�f•� •',�rbw'�,�f�.:, �i,'�r-zy..:. ' , '` �.�. ' , , " 1 V . ..5 • R'�,i � ' ' . ' .f., .� , ' � . . ..� �. ... . .. . . ... ., .. . . .. . . . . , , . � . . � . . . � � ' �, pCT-fd3-1995 � .17� 17 F�tOh! ' � TO � � 6d90 P.01 ' .'. - � , , . . • ' , � , �. ' � , � . . � , � �. . , .: , � � C�I'TY O�. CL's�A�WATER ' ` . .,. � ,, �. . � ; . InterofCce Correspondence S�ieet � . , � .� � , �. ' . � . � . :. � , '. �, � , � . �, � , � � TO; . Debdzc Ford, S�ff AssistanVHurrian Resouro�s . .� � �� � `. � . � �ROM: - W�lUarri 0, ���ird� General Senrices �Director � � ; , . , , . , . . ., � � COPIFS: � � � � � , SU$�ECT: . Gury Lutmari-�Appl�c.�tion f�r Di�ab�lity � � , . ' � � � � , , ' � •,: , . •• � � ' ' • � , � � DA,�: .� , � October 3, Z995 ' '. ' � . �' Based upon my conversations wlth Mr. Lutman, it is apparent to me that he wvu3d not bc able � � i� perfbrm the job tasYs associated with arty positions available in the Gcneral Service,s Departm�nt. , � . ;'� � Mr. Lutman has tried for sevesal ycars� alorig witi� F�eet Ma�ntenance staff, to accan�modate his � medical problems {e,g., �hearing disozrier, carpa� tunnel, hip replacem�ni, �nd �oth irnee and , ' bac�c problems): ' . � Ii' furthex i,nformation is clesired�. p�easa feel fre� to cal� me. . WU�:pat , . . ��._ . �o�n. ��t,.�.�(�� oa�:i� /3/9S • � .'�7: � • � � � �° - � �a[�5 rNa.�o+rvG � 7H13 Plsf,� i � 1 � M {p ��.� �..._ FAX 1: � � 6� i�IOfVE �: %'i 7 % � . , � ,`� FAX �-.—.. .. .., —_. .. _ . .... . � I =' � - � � � � � � � . ', l� iOTAL P.Q1 �:-� ., � , � ,- . , ' ;: � � , � . - . , . . . : . �, � � �. � f . ; � � � • � ' . : .�. ' . - . . , 1 . � .� . � � . , � . . , ,� . � , • . � .. , , : . . . , ' ." ° �� . ' ' . � , � > ' � :� , . , .�r.i�.� Y�: . .. .��, :�lr•�(• .. .. , , . .,. , . _ .. . . . � -� ,, . . . . . , . , ' . � , � . ' . +° . ' ' � , ' �` � � � � �� , � � � � G�TY C3F CL�E��WATER � � � . � � ;W � . , � � � , �s� �" INTERO�fiICE COR.RHSPONDENCE SHEET � • � � � � �r ;,-. ��� � � . �� wJ .� S.. �:::.� TO:� .Mike Laursen, Human,Resaurces Directpr • . Via: Leo �Schrader, Ri.sk Manager � � FROM: . Jon Marcin, R�sk Mai�agement � �' , CDPIES: Kathy Rice, Deputy C�.ty Manager; Margaret Simmons, F�.nance oirector . SUSJECT; Gary Lutman � . � . � DATE: July 3�., ],995 G� Mr Lutman' a.s currerit�y work�.ng �i.ght duty a.n Central Permi�ting. When Mr. Lutman's r�quest o� 6/20/95 for an extensi.on o� lzght duty was appxoved, i.t had not yet be�n determa.ned wh��:her or not his back and ha.p probiems were t�aa�rk re].ated. It has naw been so det�rmined that such physi.cal prablems are'work re�.ated and the Ca.ty wi].1. be responsibl.e �or Mr, Lutman's back and hip prob�.ems . � Mr Lutman continues to be permanentl.y disabled and unable to return �o his normal emplaymen� duta.es because of h�.s compensable wr�.st inaury, however Mr. Liitman's back and h�.p are currentl.y being treated as Worker's Compensation. .It is unknown wha� p�zman�nt restri,ctions will resu�.t �rom the back and hip,� howevez it i.s a sa�e bet that he wi�.I be Ie£t with restric�inns regarding bending, stoopi.ng, wa],king, and li�ting, Under the current 1. ight duty po �. ,icy i.n e�' f ect�, Mr . Lutman . i.s nat eligible for any �urther extension o� ].ight duty after 9/20/95 because he wi3.1 not lae ab].e to return ta his ��ob in the General Services Department. � xt is my und��s�anding that Mr. Lutman is now warking with the Human Resources Depaz�ment in an.ef�'ort to pursue a disabzlity , pension or alterna�ive suitab].e �mployment with the City. �� �n� FRIN'i'�I3 ON RECYCl.�D PMER . n ,. , , , � . , - ... , , , � . , <. � � ' ,. . , ' � �� .. �e. ."...! �.. t' "r . •. „ •' ' . ' .- . . ., � .. , . , .r . , , „ . � 2.�` �� �[ � � � , � � � 'r M� ' : {' , . � � � a u � , � � ���� � � . . , � ���� ��.���.���i���:t'�'� �� ' � . u �. �� � . ��� � � - �� �.�� c��-a� c�.r�.wA�R IE�ITEFt��'FiCE CQR.RESP�ND�NCE SHEE'[' ��-�a �—;� KEC�fvE� � � �o : ;�a.r"�r� A = � �- Y � .� �J N � � �995 riT�: L�a ;�i. schradpr, Rwsk :4anager C(i'( �y1RP�AG�,� f FZt4M; � • J�n ��tazcin �,�` , SUBJc.CT; �e�uest cor c.�CQnsion a= �D Work �sszgnm�nt - Gary Lut;nan D�.T�: Jun� ?0, ' 99�5 • � Submi���d :lerew:.�h is a�equ�s� =ar Light Duty :xtens?Qn w�rsuant ta the City' � Li.Sht Duty �01 icv� 5tat�ment . t•ir .�.u�:nan a*_'_? comp�.ete 9n days or �.ight du�y in CentraI. �Gr:,ti�tinq, an J�ne �4,1995, anci has nvt ye� �een �eleaspd to =�turn ta �uil duty. �Fr Lut;nan has numer�us work _elat�d an non woxk �elatVd nhysical, imgai�en�ts, as per th� a�ta�h�d letue�r ta �z :�asko•Ji�z oz May a, ?9�5. �r, ►foskovi.tz" encZosed ��tE report of :�ay ? 9, 1995, SEQTRS �o indicate th�� �;r Lut�nan zs ver:�anen�Zy un�b�.� �o pe�,or~� nzs nar�al job duties as a mechanic, b�cause of his 1�.:� nand and wrist restr�ct�.ons �rom hzs �,prz3, 5, �.992 •rrc injury. �s suc;z : have reconunended ta ,ir. Lut�nan that he contact Human Resaurces and �ursue a work ��lated dis�Di.Iwty reti.rement. :�r Lut:;�an is howev�: s�i? ? actwv�? y 4rezt� ng Far hw� ar�d back nrr�b].ems � �ahich �ay o� :nay no� �e :�ork �el.ated. �7r. �ioskav� �z ? nd�.cated �hat he believed �hat Mz . Luz:nan recoverAci r=am his �+IC aack ;.njury, and Lhat h?s curr�nc back dif�:.cult;es ae�e rel.ated �o �� his are�x�s�znq non wark relatsd iaack prob].ems, and t:za� h�,s hip arob�.�:ns are si:�:.].arl.v n�t ��ork �elated. 0 `'.;ii`.': ;i{�,.i�'.��`.. � � , � �. . .' ` ' ..' .. , � . . ' . , . . ., . . , . . . r, .. = . ; ' . ,. . .. ' , , t � � .�� ' � . . . ' . �, ' ' � , , ' ' � � '' " � , ' � � ,, , ' ' . . . ' ' . . ` , . . , . ,' , . . � . ' � �. . � : F ' �� ; ' � � � • , � .. � . ' � � , � , � ' 1� ' ' i (, , 1 . , .. 1' . .. I � ,' . �. ' � ' � . � . . . . ' , j� � � . � . ' ' . . � . . . . . ,. . � . • . . • . ' < .. . . ' . ���.f ` , ' i' ,� '� 1+,� ' ,r . .�i!}.. •i� � ` ' / � .. , '' . ' .. ' ' . , � , . .. , , �� .. � r. , ' ' , . . . � . . � � � . .' • . f . . . � � . ' . . • � ' } t . ', .if � . , • 1 � � . , .'�1. i� . � . ' � ' . ' ' ' . ' . . , � ' ' ' . � ' � . , 1;j ' � � . �` 4� - .l . ' .. , !� . . ` . I " . � ' ' , ", � , , , . ; � . .. ' , ' ' � . , �• ''F `, .� .frl• �, [ .' .' ' • ... „ . 1, . ' ' � .. . ,' ' . ' • , � `r . • ' . ' . ri".u�cr•�n.R.y}i�i�z.s.,r.)�. �-r�r.'w � � . , . ', � �, ' � , ' . . . ' ' , ": . . , .0..�5',i'�.?�j,tti�{lirr..���-,. . ..,.e �v r � " . . , . � , I , . . ... . . .. . . ..� �� , ."" . � ' . t �. '� ' , �' f ' � ' , ' . �i > � � � ' � . s• , ' . , ' . � . � � have wri.tten ;�Ir. Lut�an's �r�a�ing physician, t7r, Fraser, ,�or ha.s . ;.". • �opi.nion regazding ths rela�ionship og. Mr..� Lutman,�s� ongoxng back � '- .prob�.ems t� h�s wc i,ri�ury oE 13./4/94, but have y�ti �a recaive a ,. ' reply. 'pz. F=�ser�appears �a agree w�.�h Dr. �Ioskovitz that.Mr. � ('"''- �. Lu�man'.s ha.p nroblems are not WC rel.ated. �' � . .. , , �� . " As such t4r.� �,ut:�an has � be�n assignEd to �].ight � duty primari.l.y . becauae of � his h�p and 'saack �r�blems *�+h�ch are .probably nat WC � re�lated;�,bc�t he a�.s4 has pe�manent �estri.ctions �rom h�.s p�i,or hand � injury of. �pr�iZ �, x992,� �ha� azabab�.y r�nd�r ha.m unable to ::pturn � ,: to' ful�. dc:ty, empzoy�ent as a mechan�.c. � . � � •. ��t �ha.s stage I,t�ro�t?d ,�ecom�erid �hat sal�ly zrom the� standpoint o� . . hi.� ' current back 'r�str�c�.�ans,' tha� he be gx�anted a�,i.gh� duty `�� ' , �ex�ensi�n until. Dr. ,�, rr�ser� ciari�ies =.rnether or. no� his back , � � �aroblems ar� *�rork' re].a�ed: . . � � � � � � t � � . ��! .� �. ,� � :, , . . , ' F �' . t . � Ciai �ft!?�rt"'rD ON FiECfC..: � P�FeR � . m , . ' � • • , . ..� .,. . . . . ..' , . . ,. . . . , . . . . Expected__Pension Cast (Cash PaYout Qver Life of Pensior�er and Spoe�se] Present Value,a# Expected Per�sian Cost � � A�nu�l Interest Rate • 7.o% � .� Annual Per�sian Amount �21,782.$7 Effectiva 111��lg5 Pensioner Sex Ma�e � , . � Pensioner Age , 43 Pensioner Life Ex}�ectancy � 76 '. � ' . Ysars Remaining � 34 IEk"i #' ' , Pensioner Spause Years . � Ac�e Ac�e 1. 43 �la 2 , 44 � 3 �35 4 4fi , . 5 � 47 6 ` 4� 7 49 ' 6 �0 9 51 10 � 52 11 53 i 2 � 5A� . 13 55 � 14 56 15 57 1fi S$ 17 59 . 18 GO �9 � 61 20 62 21 63 2� fi4 23 BS 24 66 25 67 2f 88 27 65 26 70 29 71 30 72 .. 3� 73 � 32 74 33 75 , 34 76 !L�lL1iT�11l�FIIL•31JNrtt�IVSV�F�'SlD.rltllf�trl,Y, WJ�1 Present Annual Vaitte Interest 289,797.12 19,523.40 8 � ;`� ��';`5 19,365.23 285,12Q.01 19,196.04 282, 533, � 4 19, Q� 4.92 279,765.� 9 1 a,821.16 27fi,803.48 18,513,&4 273,634.46 18,392.01 27'�,2�33.�D 18, � �4.65 2�8,615.38 17,900.68 262,733.18 17,G28,92 258,579.24 17,338.i 5 254, � 3�.5 � � 7,027.02 249,378.66 16,694.1 1 244,�89,89 � 6,337.89 238,$44.92 15,956.74 233,41 �.T9 # 5,54$.91 228,784.83 � 5,112.54 224,114.50 � 1�,645,61 212,977.25 i 4,14BA1 205,3�0.38 13,611,43 197,1 fi8,94 13,Q39.�3 � 88,42�.50 i 2,427.38 ' � 79,070.�1 1 � ,772.50 1 fi9,059,64 � 1,07� .77 158,3�48,55 10,322,OQ 148,887.67 3,519.T4 134,624.54 8,661.32 121,502.99 7,742.8� 107,462.93 6,760,0� 92,4�4D.06 5,708.40 7fi,365.59 4,583,19 59,�fi5,9i 3,379.�� 4Q,762.26 2,p90.96 2� ,o7a.�s 712.5� Amount paid 21,782.87' 2� ,782.87 2� 21,782.87 21 r782.87 2i ,782.67 21,782.87 2 i .782.87 78 Balance 287,637.55 285,120.0� 282,533.� 4 279,765.� 9 276,8fl3.48 273,634.�F� 27q,243.6(} �66, 6� 5.38 �62,733.18 258,579.24 25 �4,134.5 � 2�F9,378.6& 244,289.89 238,844.92 233,018.7'9 226,784.83 220,114.�0 212,977.25 205,�44.36 i 97, � 68.9� 18$,�25.50 179,Q7Q.01 169,059.64 158,348.�5 146,$87.87 134,624.54 � 2Z ,502,99 10i,462.93 92,440,Q6 76,365.59 59,165.91 4a,762.26 21,070.35 o.00 !6.'',S7S � i' ' . Y 1 � I. •. ' . . . - � , 1., .. � r • . . . ' ' r ; ,� 1" ' M ' � t P.�i 1f , , „ � MaotinD Date: , _111�3/95 � TFlUSTE�S OF TH� �MPl.OY�ES: P�NSIOM �IIND =' � A�enda Co�er Memorandum � BQB�ECTt APPO�NTMENT OF ACTUARY FOR 1995 AND 1997 VALUAT�ONS RECaMMENDATION/MOTZDAi: Extend the agreement with Coopers & Lybrand ta p�r�orm actuarial val.uations for trie General Employees Pens�.on �].an as af January 1, is�6 and January 1, 1.997 for � fee not ta exce�d $13, 00o per yeaar I� nnd that the eppropriete afficiela be nuthorizcd to executa samr. �r,cxaROVNn: The at�ached praposal �etter �rom Coopers & Lybrand relat�s to actu�ria� services for the next two fiscal years. Coopers & Lybrand was tirst hired in 1988 in respans� to a r�qu�st for pronosal far actuarial services. They have successfu�ly performed the last eight actuarial stc�dies. They have also ass�.sted the City in several speci�l pro�ects, including th� recent chang�s to the General. E7np�.oyees Pension P1an. Staff has always been p�.eased with the quality and timeliness ot their work. Di.�cussions he�d with the Trustee�s in November, �.993 r�sulted a.n the City Man�ger requesting that actuarial serv�ces be rebid at �ea�t every ter� (�.0) years. Therefore, th$s w�.1�. be the fa.na3 agreement extension and actuari.ai servi.ces wi.11 be rebid in �997. The $7,3,000 annual fee represents no i.ncrease in the pra.or two year agreement� and staff recommends ya�r approvaZ of the p�oposed extensa,on agreemen�. Funding was anticipated and will be provid�d �ram the assets of the pension plan. Ravie+rod tiy_ priqCnntins� Dept: Costs: S_ZG,000 Cammissian Action: L�al � Finance iotoi Li ,�pprovcd Budpet �� ❑ Approvad u/corxiitiens Purchasinp X S 1�,,,OOQ p penird Risk Mflrnt. NM �� p�p�; Current Fiscul Tr. C1S � H/JI � Continued to: ACM F�sdir�G Sourcc: Other � Cepital Irip. Advcrtisod; ❑ opereting Attochscnts: Q�t�' � Other Emn. Pnnsion P1an Propasal LetCCr �(�,`q� Faper: 0 Hot Required 5�taittad by; Affccted Parttes Approprietion Cocle: � ND^� C] Natified . 646•Q7�S0•5301Q0-5$5-OOn Cit Monagar � kat Requircr! ��'. ��. � � :S� , � . ` L ' ' � , , . ' . , , . ' . . . ' . . ' . . . . . r ' . • . . �l, ' ; ' . . � ' . ' . . ' . " • ' ' • . . , , � � ' • � ' ,. � � .�� ! . , ' . 1 ' 1 ' � i . � ` . 1 - , , i�i�'', j• � . ` � . � � � � � , � � . . . ' ' . � . ' r! . ' . , . ; . " , ' ' . . • , . . , , � ' r . . . , � „ ' E , . , . . .� ` . r . . , ' . . ' ' . . , ; . . � � " . . ^ . i , • . ;�A: . , , `f ' :'., � , j ; ; �,i . �t4 ` . , .• . . l " . .. ' ' .��' . `. , ' � . ,� � '` .. ' . . , � , � . . e` � .• . ' ' , . � � ' ,.i ' � � � +� . � � . ' .. . . . � � � ' � .� � ' , ' , ' . � , � ' � , �� ;z. . , ' ' '�:l� . .. . . , � . ' .. ,r' ..,' ' ' ' ' , ' € i.'_�.' , � ` '`'. ' ; '` '. .' • . . , :'�. � •� ' '1� .� . ; ' ' ' . ' , ' • . • . ' . � • ���r i. �st�Hi���itli�r ��'�75���cf: .i . ' � •.. �� � . . . , . . .. . , . . f !YiFClf.4'��i� ��..( . .i�t�, , o .�. ���;�cf'� i�i��sjaF.>iF���G!'r!�, � . � � . . �. � �. �, , �.si''ft � . � E: �::: �'•' � . �� t,I • ' . ' .. • . . � � � � ,��.. . . . . 4"' �';°' , . •' � ., ,� . • Coap�rs 8 Lybrand �.L,P. 104 Enat Kennedy Bbulevard � felephano (8i3� 229•022i � Coo ers a p�o�ees+or.i1 ierv,ces ium , Suite 1540 � ' ' ' � • iAmpd, F�or�da 33602•a�9A , , �acsimile. �(A13j 228�pfi39 1 ' . � ��y 1 [.41 IL.t � lfam�n Aisourc� Advlsa►y 1 ` , . . . . � , , , , . , .�� , ' � � , � � . ' i`. . ' . . . . , . . . � � ., • �Ci{)�iCr ��, i �iS, , ' � '. . . . . ' . � . . Ms. Marbaret L. Simmnns, CPA ' : . : „ ' � ' , � � .. • � � . Finance Director � � . � . ' ' � . . .'. �. �. � �City of Clearwater � , ; . ' � � , ' . . • . , ' , � , , � I2 South dsceola Avenue . � � . �, � � . � . � � , -. Clcarwater, FL ��15 i 8-47�8 ' _ ' . ' � Dear Margie: ' , ' . . . � : . . . As you requested; this letter.�vi1�� serve as our proposai to contin�e to serve tl�e City of Clea���►�ater� - ' as actuaries and consultants. ' � ' � V+re wiil gerform the January �, 1996 anci January 2, 1997 actuarial valuatians of t��e City's � pension p3an for f�es not to exceed �i3,OOO�per year. This fee quote includes preparing a drah � �� valuation report for your �re<<iew ar�d attendance at a meeting to pr�seni the �repori, at your �� request: As always, we �uara�tee a State-accepted va�uation report. � ' � ` � The City of Cleanvater is a valued client of our Finn and the Human Resource Advisory practice � and wc feel v��e ha�e pro�ided hi�l� quality and timel�� professianal servi�es. �'�re have enjayed � our'rejatianship �vith the City the past ei�ht }�ears anc� would, of co�trse, like to cantinue ta servc� as }rour actuazies and consultarits. , � . V�ry tt•�lp yours. � . . L.� ��i �1 �� � � Stephen M. Metz � � � Principal � . � .. SMNlllmb � . {, . ', . . � , � . . Coppqro d 4Yb�8nd L L P., s�ep�6lered hm�tec! hab�hty pehnersnip, �s e member i�rr*i at CppperG 1s Lybtan� 1nlerr,a��oral � � . � .. . , . ,