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' t :f'.; ' '" ' ,�, 5,' '' • , . , . , ' , , . ; .l; . '3'' ,�. •i'. . . .i:; . ' ,; . . , . . . . . . r . � , . � . . , , , . . i��� ''1.�.1'. .�`r' ''Y•f' t . .5 + �1� . . , e � i', � ' .' . ., , i . � 'j , ' . � ' . .� .t , � �•, . �1 r' S� . � .��� . . 'r !I ��. . , ' , v r' ' , � � , . . . . , , � t ' � . ' . .� . ,ty '_ , �� ` . i .• � , 1• � F' ' •1^ i, . . � . • . � :.i,. �L �L S I}i.',..,�;�� ' � }�,.' '� i�, . � ;.��x,�if'�jf��}i��.a`t`..'-:�3i.'1.:�'t���,M' �.i.i'i' •��_ .. . . � .. .�f:,'p'.�' .j ./io,l.'.f , `l: �� , �:, } �. '.I �1}• . � ' � ;T •s� " p � :�. ,�i:,,�,; �,�t '.j . . , . , . , , • , . .. � ; , �,�i��ri_: y , ':YI! . .'i.,. .. P�t:*i• .SSI��,.C'EJ..w .. .4�.. . i'�� . t' � .� ' . . . .. . , . . . . , . ��, . r.���,.,.,.... , . . . . � � . . . , ` • ' ' 1 ' • r , . ' . i. ' ' ' . ; � , . . • ' . • � ;' ' . . ' ' ,' . ,' ' , ' . . i.:', , ,,; ' . . ' . . ACTION AGENDA � - . � . � . ' � ' � ,. ,. . . � ` � , ' 8oard of Trustees of the.�mployees' Per�sio� Fund � � ' � , . {. � . ' � , . � , � � � . ❑ecember 4, � 995 .. . . ' � , . . • , • ' . ,' ' , � � � � , 1. Caii to order � �1. 9;53 a.m. � . ' ,. ' . � . � . . , . e �. ., 2.' Approua) of Mirsutes ', 2. Approved as submitted. ' • � . '. of, 'S 1113/95 - . , . . . . � '-' �� , 3. Request far aCCeptance � � - � 3. Appraved. , . , .. � � �. � .. � , . inta membarship: , , � . . . , . . . . . . . . ' � . � aj Judy Martin . . , . . ` . , � . b} Lnis N�rman � � � � ' , ' � ; � � . I �. � � � 4. � Job-Cannected Disability Pension ' 4. . Granted. � ' � . ' . , . ta �e granted: .Gary �. Milarck . . . ' ' ' , �.�' . � � ' v. Job-Connected Disability Pension � 5. Granted. .� � � '� ta be granted: David D. Bossard ' . . � � � � , . � fi. Job-Connected Disability Pensifln fi. Granted. � � , � . , to #ae granted: Rabert Batten � � 7. Job-C�nnected Disabiiity Pension 7, Granted. � , � . ta �ae granted: Linda Tr�ub . � � � � � • � � , 8. Non-Job-Connectet! Di�ability S. Granted. Pension to be grantad: Willie A. . . F�azier ' . � • 9. Surv9var's Pensia� to he granted: 9. Granted. � ' '� . . Cora M. Bennett, wife of Ernest � � Bennett {deceasedj �� . � , 10. Other Business: � i 0. PAC meeting set for 9:00 a;m,, ' . 12�12195, 11, Act�aurnment: - 11. � 0;01 a.m. � � , . ,. � . F '._ ai� � ��` � ' , . , . ., � , . . , i . ! , . . . � • ' . r. . . ' �., . ' ' . , � } � ' . .1 . ' ' � � .. . . .� . ... , � • , i' , , � . � e . . . , ' , � , . • ' ' ' . ' ' �rs�y..���`-,��'> .r, ' . . , ' . .� . " ' , , � ,� � ° � �:f�• ° ,�f� J,f1 ,.. .s� .�:i �fr t' . .e :l....+.-'lx- �.� , . .. . . . . . > �, � . �� ' . . , , � . � Ta: ' � � FRC)M: � � SUBJECT: ' 1 CITY �F CLEARWATER � � 1n#erdep�rtmehtal Correspondence She�t 1 ' I.. . . ��� . � �Itzabeth Deptufa, City Manager � • - , H. Michael �aursen, Human Resaurces Dlr�ctor � r���''� Pens9on Plan Comparison DATE: � November 21, 1995 . Tho December 4, 199�, Per�sion Trustee�' Agenda cantains a number of recommer�datfons ior disability panslon. At the last meeting af ihe Tr�astees a re�uest was made for ir�farmak�an as tn a comparlson of the exisling pensEan plan and the revised plan that wiil becomo effective January 1, 1996. • In response to that request the foilowing is submitted: (iigures are approximate) l(.��da Traub. Container Maintena�, _W„4rker, $oltd, W�.ste ,!� �Qnn�,cted ��a�#IEty Pansion � � Ms. Traub Y�ad approximately 18 years pension service credit g�d , Pfan . B� Y�.� -_%-- Avc�SaIJS__Y�s P_ension � 2.a X 1 B � �5.00 X $22,825.1 S= $10.271 .33 Min. Disabllity ot . 75.00 X 22,825.18 = 1 7', y�i t3 . 8 9 � New Plan , � 2.75 X 1 S — 49.5 X .$22,825.18 = $11,298.46 Min. Dtsability of G6.667 X 22,825.18 - � 5, 2 9 6, 8 6 . ., �Ms, Traub wauld havo received $�,9�2,03 Iess on an gnnual basis in pension under kho new Plan due to the reduced rr�ir�imum dfsatriHEy gcrarantee, Addi#ional�y, she would havQ baert � sui�ject to reassignment in anather job area in lieu of receiving p$nsion benetits and subject to reca�l In khe future. Ms. Traub's disability would preclude r�assEgnment to a pos9tion invoiving repetfifve bending, squ�tting, stair climbing, or fifting wofght in �xcess oi 15 pounds, hut would allow reassignment to a passive type jo�. 6�'. �. �,' � �, . .. , , v j. _ ` ' . ,' , . i'r : � • . ' . � . . ' . . . ; '• . . , ' � , , ... . ' . . � . . � � . . . . ' ' � s . . + ' . i� . . . � . . , ' . . . , . . ' , ' . . � ' ' . :F!a,J'�1,�!'ir ?�` �,fi.. � � •'��Y. •;', , , e, .. .. , .... . , 1 �, . . � • � ' • . � � .�.. . . � i` , �t ; , � � � � . � . � , � ' . � ' . I . ' • . i , . I, ' , • , ' , � � � ' , , . . . • . , I s' � Wlll� C�zle ' Eauip�eni__Q��, ta or_�I, Parks & Recreation � A.�..,,� Z��_ � I�1� .lob C�2[]..r�s�#..B��.i.lty � � i. � � . � . ;'�� � Mr. Frazior had 20.3 years of pensfon service credEt. �� �� � � - . . I. � ' • ' • ,, � � • �� . ' �' . � fl�tQ . , • � ._°L� �vg �al/5 Yr� pension � . �.5 X 20.3 = ,50.7'5 X � . $27,$D5.48 = $'13,702.7�4 i . � � . ' , , � ' .N��t__.P.I�D , � . � 2.75 X. �20.3 � 55.�25 X $27,405.48 T $15,299.11 � Mr. Frazfer wauld have recei�ed $1�a96.37 more in �nnua� �ension under t�te now Plan. , � He would, however, have been s�bject io reass�grament ta an alt�rnate Job tn Ifeu af recQiving � the pension. His �imltatfor�s would preclude nis assignment to a Cabor job invof�ing heavy . � exertion but wauld allow his poteniial reassignmeni to a clerical or oiher �non-�abor �ob. , ��. ' Robert B�tt$.p_��.�]�4RQL�1]��ap�ra#or �IL..,��b�i� Works .l� C��aecie�._[,�ig�jJitk Penston � ' Mr. Batten had approximately i 1.5 ysars of pensior� service cred€t � Qld Plan .H�L� Yr� __.°/s_.._ P�n�n 2.5 , X 1 1.5 = 28,75 X $24,1 t 1.39 � .$ 6,932.Q2 M1n. Dlsabillty of 75.00 X 24,i 11.39 = 7 8, 0 B 3. 5 g �] ►[�P1.� 2.75 X 1 1.5 = 31 .625 X $2�4,1 � i.39 = $ 7,625.23 M�n. Disability of 6fi.&fi7 X 24,111.39 = 16,074.3a Mr. Baiten wauld have receivec! $2,005.20 Eess an �n annual basis in pension unt�er iho new Plan d�e to 1he reduced mfnlm�m dEsability guarantee. AddEtional�y, he wouid have been suk�ject to reassignment in another job area in lieu af receiving disability beneilts and subjeot to recalE in k�e f�ture. Mr. Batten's dlsabflfiy would precl�de reassignment tv pl�ysical demanding labor work invaiv�ng lifting, 5endir�g,eic. . . . � . i: , . ,�, , • � ' t' � `.. ' ' , t .. • . � � � � ' . �' . ' , ti � • , � �� ' . ' , . ' • . ' � , ' ' I . r . . �5 � . . . J�I' ' l - ' 1 .. ' . . ' ,�'r' i� . .�, a .r . . . � . 1 � f.• , } , �. t� . :. i i ' , � . n� .. � ,,, � ,� . .. . � �. � , � � ' . • . . �f ' �. . • . , � 1 � � ` �: i • . � � `' ' . . � . . � � �D. Boss�rd� �Ir,�jiahtor�,,,,.F�,fe,.,,,.1'�E�R€�It�nt � � - ,19E�cvnnec��d �isabiltt�, Pe�sfon . Mr. Bossard had approxfmateEy 24.25 years at pension servfca credit ,' � � �Idw Plan . H�t� Yt�. '—ls_._ . P.��.SaI.IS Yrs. P�l.� 2.5 X �4.25 = � B0.625 � X $40,413.16 = $24,500.48 Mir1. Disablllty ot �75.00 ,. X 4Q,413.16 = 30,309.87 Plus 15% addt. tor each depandont chiid (Pensian of $3�,3q9.87 X 15% _$�4,546.48} 2 Chitdren X $4,546.48 = $9,092.98 ' • Tata4 Pension, with dependent chil�ren iaeneiits = $ 3 9�, 4 0 2, 8 3 ' L�ew Rlan � �.75 X 24.25 = 6fi.fi875 X $40,4� 3.16 = $2S,95a.53 Min. �isabflity of 6B.S67 X -$�O,�i 3. i 6 = 26,942'.24 Mr. 8oss�rd would ha�e received $3t359.34 (ess �n an �nnual basfs i� b�se pension �ncler iho new Plan dus io the reduced minimum disability guarantee. He aiso wou[d nat r�cei�e the � additional amount ior dependent children. In lie�a af receiving disabifiiy benefits Mr. Bossard would have been 5ubf act to reassignment within a class within the IAFF bargaining (flrst tier option) in that five pasltians are ta be ailocated far such assignment. Such assignr�tent would be acceptable if limit�d duty accommodations were made with respect to lifting, bending and siiting (per Luis �igueroa, M,D, (etter}, �c�ra Bc�r��et�„ Widow ,of Ern�st B��n�tt._-SQt�s!_Vlt�s��___W__ork�r._ Sol{d--Waste �urvl�or's P�.sion Mr. gennett had approxfmately 19.�4 years of pension service credit �, P�an . g� y�,, °� Avg.Sal./5 y�, P�sion 2.5• X 1 9.3� = �48.35 X $35,233.74 '_ $1 7, 0 3 5. 51 �.�.11 �2.75 'X 19.34 = 53.185 X $35,2�3.7�4 � $18,739.Q6 Ms. Bennett would #�ave recefved $1,603,55 mare in pensfon benefits under ihe new F'lan. �J' ' Fe :i � � . ' . . t � ' . , i . . , !S �L' Jf.. '� �.. � ' � • �( . � . . ' � ' • . . . + . � . . ' � ' . . . . . � ' • jj; ' t . . ..1 � � : . � • ' ' 1 • � . . � . . • ' ' . . . � . . . � y,�,R . .+1`�� ; . . , � . 1 �' , ' . . . ' ' . . . .. ' ' . ' .i . � . � ' .. � • � . , • , + .. �� . ' � , . `•� . t ( . , ' • . f 1i ' . � • . . . . " ` , `! . . .1 ' . � ' ,�.e �• � '.., + . � . .� . 1'' , r. �i . . . � � " .'. � .... . ` , � . . . .4' ' •1' le ' . . . � . , . � ' < . ' ' . � . . , . i � ` l.. . � . � ' r�l � . . � . ' . . . . . ' � . ' � ' � t . .• , . • � � � • � � ' � rt ' . � . . � � .. t ... . 'le . . .'' . . ��,' :;_ , , , ' ,:. , ,. , • . . . . . . , , ' � ' , , '_. � �, . � . .i'� . , ' � �F f , ' ' . . . � • � Iq� ° . �. • ` ,' , r �i�`.�' ' ,`,. . � � . ' ' t I�. . �• ' . ' � . ' . . , 1 , r � 4, �+.�. Ir� .�.. .•�`4. � ,3 ,,•i,� ' ' r.ei . �' , � � . . 1 . . � ., i1,� , '� � , ' � .. , . ' ' ' � ' ' 'I�. .�t��.�� ,���j ' f ' . . � , i . � Y�l•�. , 1 , � , s . . .� • , "Si . .1.. '1y` �{� ....��.�'•.l '�i' ' . , ��� •(-'�!� �� Y� �j )rA'�' 1iP• ^�.7 . � '. . ) . . . .1:.�.� i. . ' � �� ;���t��. � , ;.. !' �n^5..:'.Tt. ,:iY'�S'l�i� F . .�S � . ' : , . � 1. 1 . ��i. �1 j •y :1 � .y�{.'r.� ., t' Y , � .. f .. o!n: . �r �,)�:'i�':a�1Sat'f�_ ..�... ....,:a:,.. ' ... . , �r- . ��.�. 'sf �E:.` ' �� . . , . .,. .. � � � .. • . . . . . . ' . . . , .�. � . . s. . . . . . ' � ' , . . . � ' . , ' • ' . ' .• � . . . ., � , � .3 , 1 ' . 1 � ' ` , ��� � i , � ` ��. CennaCted o1�,hl.![�Y�n�,on � ' � . , i' . . ' � � � - .� � , `' � :. � , Mr. Mil�rck has approximately 16,3. yer�rs of pension servlc� cradit - �. � - , �� : �. Old Plan � � � ,' . , � � ., H�t� YC�► � °ls— � , F_ivg.SaIJS Yrs. Fe�nsfon� . � ' ,, � � � . „ ' 2.5 X � '16.3 _�� 40.75 X $25,662.10 = $ifl,�57.31 � � . ,, , - ':.:, ' ` � . ,N��n. Disability of 7.5.00 ' .X � 25,682.10 � 19,2�46.58, � ,. . . .. , , , � � ' ,.. , . . , . : : : . ,,, . �v�_ P_I�n . ' ' , . ' , � � I,- - • � . � .� . � � , ' 2.75 X •. i 8.3 � ��:825 X ' $25,662.10 = $� 1 ,5Q3.04 � � � . �. Min. �Disability of, �� 66.667 X 25,fi52.i0 = � 7,1 iIB:1 5 , ;�` , .. ;� � Mr, Milarck��woutd have received $2,138.a3 less on an annvat �asis ir� p�nsian under the Naw ,; �, �. Plan due to the redu�ed� minimum �isabllity c�uarantee. Mr. M�larck wou�d ha�e been su��ect ��` . .�, to reassignment in anoiher �ob in tF�e �ity in Ifeu of receiving pensian ber�efits a�d subject to � �' ' �ecall in the future. Mr. Milarck's disabilEty wouid preclude reassignment to a�ositfon �'' • involviRg twlsting, bending or !i�#irrg beyond 30 �o+�nds, but would altaw for reassignment to a, �' ��; ` . � passive typq jah. . . �, i . ., , . , . �� . . ° . �,......�..., ,.... �.. . � . . . � . . ' ' . . . . i ... ' � • � ' • • � • ' . . � � �� I� � ' � '� � 1 � ' � r . � t ' , ' ' 1 � ' ' r! 1 ' � ' 1 , ' 1 � � 1 � ' . � . . . � � � . ' 1� . . , • ' � . ' . . , . . , � ,' , � ' 1 . . . ' ' , , S . . . 1 � .. :=olj�. .}r ,i� _ .� . .. I � ' }.'� . , ' .. • t � . . . ' . ,'['. . . � . . , . .� .. . .. � � . . . . � . . . . . . . . � . . , � � �` � TRUSTEES AF THE EMPLOYEES' PENSION FUND. Item # � . �� MaeSing Date: 1?�1 � 19 5 Agenda Cover Memorandum . � suk�ject: . , Membcrship in Employces' � Pcnsion F'lan . Reccamm�ndation/Matian: � . Emplayee(s) 3isted bclow be accepted inta the Emplayees' Pension Plun ns recornmend�d by the ' Pensinn Advisory Committee. � �❑ and ihat the appropriate officials be autharized to execute same. . . 11����1� I w�l��� I . _ _ __ . _ . __ _ . __.._ ._ _.__ ---���I��I�P�q1��P�II��������I�����IPI�^I�PIr 6ACKGROUND: . . Ldumc a Jab Clas� . J�dy Martin, Libr�ry Assistant Lois Norm�n, Staff Ass'sstar�t I Revlewed by: Origineting Dept: H�man Resa�rce: Laga! � NA _____ Bttdget _. NA _ - _ _ Purchasing _ NA _ ____ ,User Dept.: Aisk Mgmt. _, NA , . Ct5 NA ACM Advertised: Oihor _..,.,,.. NA. , Date: Paper: ❑ Not requirod Submitt�fd �bv.: Aftected partEes ❑ Notitfed ' ❑ Not required CiIV' M�tt�per ��� .. . Ser�iarity Pe.nsion Dept./Div. Date �yg� ate Library Department 10/30/95 1 q130/9S Palice Department ] 0/30195 1 �/3�f9S �sts; Camm€ssion Actiar�: To1al ❑ Appro�ed ❑ Approved wlcancfitions Current FY ❑ Denled ❑ Continued tn: �unding Source: ❑ Capt.lmp. ❑ �pQraiing ❑ Other Attachments: Appropriation Code; Letter(s) ❑ Nane . . � i:iu l �, . • . " ., i -� , � ; •r . . . '' � . -;' � ' . . ' ' . . ' ' ' . . ' .. .. . v'. ' ,��.t� . ' , , ' , ,1 ., . � . . . ' y ; . ' .. •� ,. E , , .f�.l ,� .'' " L � � � �. ��• . . ' � , � �, � • � . . � ' ' . . . • ' � °, i I, �y� ., . , , ' ' . . .- ' �. r ' `,. ' • : ,. , ' . ' < , .1 1 . r , . , ' � ' � � . I' . , . ' , S ' ° " i . . ' ' . . , ' ' ' . ,1 . ' . ' •j,..{ � .• . . . .. I''!1'•S '1''I. �. ',�� `• •� , . . , 1 ' , iI. � : �' : ; . ,,r . ' . ' ' . . . . S , ' ''' 1. .1. . � . 1 . . � . . i . . . � ' • 7 �- � . . " �. � � . ' t , ,! . r . { � ' . , - . e � ' , r , ` . � � . 4 ;{ 'f ;+; �'..'s E'• . , .. , , . . ' , , � , . , ` ' . . ' . • . , � . . . , . .. . . • . . �'l ' , �. • ' ' . ��'• , � ,- . . . ; . , � , : . ` � . . � � . .. , ; . ,' .. ; , . , � �' , , ,, , , , • � � , . � �;: . . , ., II �t� . � . ' ! � �,; . . � . . , ' ' ., ' , i'S- 'F• . . � � < i�•. � � ' � ' � • t � ' .i . � . .. . �.: t,,'' . f� . 'F t ' r S � � � s`'�� � ' �_ �, ��. > > '� .: . .i' ' •�.,5. . �Gih,:i'�'• .. C;�'jii.��, �-"rs,�nt,-;=:y:-�e'°}'i5!�j';i�'°:�w;:, ��a..�:.. ....,eM� ...� .. - . ' , � , • . . � ' ... Jl. � ` � . ' . ' . � . � � � . . � ' � i � • 1 I • • . . . . 1 . . . ' . . , . . t ' , • . ��i � �, • " � . � . C1TY OF� CLEARWATCR. � � • ' . ' " � � EMPLOYE�S' FENSION PLAN � • : ' �'�� � � � � - ' PENSION ADVISO�iY COMMITTEC � � - � ' � . •,�; . . , , . . . TO: Pcnsion . Trustecs �. . . , , , , � . r. . , � FROM: Pcnsion Advisory Cammittee ��t-...�. . � ' � �4� : , � � SLB��CT: Rccommendation far Acceptunce inta Pension Plun � � � � , � ' ' , DAT�: �� , Navember 1, 1995 . � ' ' � � ' •As Trustees of thc City af Clettrwater �mpioyees' Pensian Fund, you urc hercby nvtified that the �� employee(s) listed • belaw huve becn duly examincd by a local physicinn and cach t�ns hacn �� �designnted tts � "�rst �CIA55 risk". , - �,;; Th�se employces �are eligible for pension membcrshi�. us nated in thc Pension Eli�;ibil'sty D�tc : , column belnw, und it is the recnmmendAtion of the Pension A,�visory Committcc , th�t thcy be ' , nccepted ' into membership. � . � � � , � � � ' ' Pension Elig. � .Nnme._Joh. Class._.Rc De�t.IDiv. Hire Dzte . Unte ' ,� - - --- -- , � Judy MArtin � ' 1 U/30/95 10/3p/95 � _ . � ' � L�t�rary Assistnnt, Librury Dept. , � � � Lais Norman � '. 1 d130195 1 Q/30195 Staif Assistant 3� Policc Dept: � , , . � , � , - � • . � � . . � . . , ,. �,,� � . .� � � . � � '',� � TRlJSTEES OF THE EMPLOYEES' P�NSIQN FUND --- ` Agenda Co�or Memorandum 5ub�ect; Pcnsian to bc Granted Item # Meoling Dale; i2I4 L 9 5 R�commenciatianlMation: G�ry E. Milarck, Marine Department, be grAnced � jab-connecteci disability pension under Section(s) 2.397 and/or 2.399 of the Cmpioyees' Pensinn Plan �s rccommendec� �y tttc Pensian Advisary Commsttee:, ' ❑ and that the appra riate afiicEals be auihorized to execute same. �ACKGROUND: � Gury E, MilarcK, Murinc Cncility Operatnr, Marinc DepArEment, wus emplayed by City on AUgvst 5, t978, and began participating in the Pension Plan an July 27, 1979. Mr. Milarck's em�layment date and �ensinn service diifer bec�use he w�s initially emplayed as tt�rermanent part-time emplayee. On November 1. i99S, the Pension Advisory Committce (PAC) dctcriniiied that Mr. Milarck was eligi�le for a job-cnnnected disa�bility pensian baseci on l�is disabijity resulting from an on-ti�e joi� injury. His injury i5 described ns Chronic Lumbos:�cral Sprain and Bulging Disc L4-5 and LS-S1. The injuries are doc�ment�d by statements from Robert D.� Gru�cr, D.Q.; R. W. Springstead, M.D., P.A.; Richard Lyster, M,D, and others. Mr. Milurck's injury is b�sed on a job injury reported in 1989 when he strained i�is aack w��ilc moving a� chair in the Toll Plaza Of�c�. As a result of that acc;ident he was off work for �evcrt�l mot�ths. He suhsequ�ntly returned to work but wit� certain work restrictions :�5 to lifting. Accamr��odntions wer� sable to be made in that type of worf: to enablc iiim to cuntinue to work as u IVlarine Facility O�crator. The reccnt c�osura n�' th� Tal! Facility at thc Sand Key Brid�;e has e4iminated thc positian duties in tl�e Tall Plaza and rec�uires reassi�enment to othcr t�skti wit�in the Marine Facility Operutor job C�:155 th�t are outside Ihc scope of his �hysi�al ca�abilities. Remaining positinns within the job ciass, �rimariiy at the Marine Fuel Dnck, rc;yuirc u�re�t c3cal af [iftiR�;, b�nding and stretching. (Prior to the cl�s�rc of the To�l Plaz.i Mr. Milurck did attempi to perform duties at t�re Marine Fuel Docic but was unablc ta contir�ue p�rformin� ti�ose cfutic;s,) Re�[ewed by: Legal __ _ _ NA_ �,^ Budget __,_„ NA_ F'urchasing �yg Risk Mgmt. , N� CIS _ _— N� ACM � �thsr NA Su6mitted by: City Managor Otiginating Dept: Human Resa�rcos User Qept.: Ad�ertisQd: Date: Paper: ❑ Not requlred AFiected perties ❑ Nollfied d l�ot raqufred osts: $2_,59.66_4 Total Current FY Fund[ng Source: ❑ Capl.lmp. ❑ Jporating ❑ Olher �?ension Appropriation Code: 64fi-n7�i0-� �,240-585- � Cammission Action: ❑ Approvsd ❑ Approvod wlcondilic�ns ❑ Denled ❑ Continued to: Attach ments: Lettor(s) ❑ Mone °'�� ,�.., ';. � .,, , '.� ' ; , . , � , , .. ' ... , .. � ;. , ' .. , ,::. . . .� .� _� , . , , �. " . ' .� � , ., . ' . ; � I, � � . ' ' . . ' • . ' . . ' �.I 4 - � � , . 1 � ' � � � . . ' . .,.- ,. �. . ; . � � � . � . . . ' .. , , . . , , ., r , ; , , , � ,' � ' ,'{. . . ' ' , , . , . , � , :�: . , + . r . , . .f;! . ,f • ,, . • , , i . , , ,. l . • . . . ' . .. '.t. ' .r ' � f� � i . � ... • � • . ' � . .. . . . , ' .� . 5 � � 11j' • . . ,I � . ' ' , y , � , ' , - ' �. ' ' � ' . . � " ' . � i . . � � • • t • il f f ' 'r ' r i ' . , . �` ' ' � . i . . . . � . � . ``" ' ° . i•. f� . .• :�� . . . ' ' : ' . �. . � � i� • , , �. .11" - . I[Y�i:'��I�.fif %'�4!" � � 'i' i.� •l . _ . . F . ' :S� . . S' £ ` t r ..�.. .f � �; � ,���i �,; ��� r.� � . ,F, � '`1.. I;a.. �i...0 � . .. 'i.'. �rs+l�i. ...�ri'$�'�:trrwwJ.., � - . . ..... - , � .i .. � ' � . . . ` . � . . . � . • ' . ,. . C ', . , � . ` ` � ' . . . ' ' . . .. ' ' f • . . ' � � ' �� t . , ,r ' � r - ' , . , , . � , ' " I . . ' . . ;�E' . � . ; ' .. � � , . • ' . , . ' . . . . � ' , •' . . . ' , . , � .. . . . , ' �}. � . . . . � . . , ' � ' . .. . ' 1 , . ' ' . . ,, "Agen�a ltem—=Gnry E. Millarck , � � � � , ' ' . � • , : , ` . , Pugc ' Z . • . � ; . , , . . Dccem6cr 4, 1995 �. • � . � � � � � . . . . . _ . „ . , ,, � . i , . , . . . , . , , ' : � . . � , ' ' . . . . � � . ' ,�' , . ' ' , , ' ' . ' ' � . ' . . �. Gri�ber h�s indicateci tht�t "...the fuel dack aperation � gasition ' has �lready demat�strated to he i n. �� excess 'af his physicul cupahilities,,." {8/25195), that "...�e .hus been pl�ced iandcr a.�perma��ent lift '. restriction� of 50 pounds...", and'that 'tlie incre�sed �evei of activities at the fucl dacic ":..may p�ace `. ' him ut ttisk for rccurreni bnck und leg p�in �nd possiblc ��pra�ressiot� of ciisc bulge to� full � � ' . � herniation.�.:" � {7/181�5). , � . , ��. . Dr. Spxin�stead relutes {817195) that "I do nat feel that he can return. to...employment as a marine � fuel dock op�rator. It wili put too� mucH dem�nd nn �is lawer back and could CAUS� him contini�ed . problems:.," He f�rthcr �upines tht�t Mr. Milnrck. "h�s reAChed MMI from his hnck injury" and ".:.hres sust�ined some permar�ency �s � xest�it of it�c injury ,to his lawer back." ' , '� Ricitard F. Lyster, M,D., reports tht�t Mr. Milurck "is at MMT witt� �n Imp;�ir�ent. Guidc r�iting af 6 :. percent." He recommends "...no twisting ar bending nnd would ��lso recornmend a 30 Ib, weight � iimit restriction.. T[sis � pntient wot�Id be ar�af�le�. to perform th� job description Of 3 Marine. F�cility .� � Oper�tor...�� � . . B�sed on un uverAge salary of Appraxitnatciy $25,662.10 aver the last five yeurs nnc3 t�c sc�enty- five perceni {7S�'io} minimum disability benefit, Mr. Milarck's pension will ap�roxima�le $19,246.58 �tnnually. ' ChArts from Finance witiieh tayke into consideratinn mdrtality rates and age rafl�ct that "present vnlue cnsi of financing" chis �pcnsion will be approxi�n�tely $259,6b4.p8. The totA: actua3 g�yout will � approximate $692,877.i}0. , � � . , . , . . , . , . . . , �r�.�.., -• , . , . . � , � e }i,��'. j' ', v� , � ,� . .. : . . . � . . ; : � , ; ' � ' ., . � ` • ; . ; ' . . , � . , � `*1 , t. } . . ' . . . . . . , . . � , . . . � • . : ' , , . . , � • .� .� . ' ' • . . � ' . � . , ' , . ' ' • . , , , , ' , - . . � ' i,. , , ' � . , . , ' ' � , , � , . . . . .z .� • , � � � . � . . � � . .� . . � .� ' . .i ' . . . ' ' � r . , . � . � . . 1 e . � . �. ' ' � ' ,j " , i • , . . . ,' • , � ' .. . 'e . ' e' . 1 , . . . . ` . a • • • 1 .' ' 1 ' . � . t '1 ' I , ' � . ' • . . .• ' ' 1 ' • , , . � : . . . . . . ' . , � . . ( . . ' ' . '.; . �,' • .; . �r..� • , r,,'. : , , ' ' " . . . ! . , • . . . � , ' . ' ' � . . . 1 �' r. ' ' ' .i• . � i ` � � � ' i , . � . � � . ��-�°�,i'���'+�iiil��.I,`�. `F�,'s �'rt'� . ',de��°�i':f•;t r . .. . � . : . :� .. . [ , , .. . ` e: . . . . . � . � . �F .. ' '>,. . . 1!'.� .04. � .. .. . ... . .. . . . � . .. . . . . . . . • ' , Fluman Rawurts: �gpnrimant {813) 462�dB70 � - .. � FR4M; COPTES; SU$,iCCT: DATE: � � �. C I a' Y C� 1� C L E A► �. �V � T E�. � • PD5T OF�=1C� 60X 47nA • , � CL.EA}aWAT�FI, FLQRIDA 34618-4748 6 Hor�or��Ie Mayar �nd Mcrnbers nf the City Commissian us • Trustees c�f thc Emp�oyees' P�nsian Plan Pcnsion Advist�ry Commiltce Dc6bie Bailcy, Payrol� �Servic�s Mana�er; Rislc Mana�emc:nt � Pension for Gary MilArck-3ob-Connccted Disability Pe;nsion Navember S, 1995 � The Pension Advisory CommiEtee (PAC) receivec! an applicatic�i� I�or disability pcnsion from Gary Milurck on August 3U, 1995. Mr, iVfilarcl:.l�as beet� dctcrmined by t��c Pcnsio� Advisory Caciir�ifttec ib ITICCI ilic requirenients ai the Pension Plan far a job-connectcd ditiahility �ension. He w;is employcd by the Cicy an Augvsi S, I978, and be�an participating in thc 4'ension Pl�n on 7uly 28, t979. �urther, ,�ie has submitted medicul document�tion, copies nf w i� i c h are attached, retative to his disat�itity �vhsch has t�ecn revic�vcd and �pprovec! by thc PAC. - By motion m�de And du�y carried at its meeting nf Novemb�r S, I9�S, the; Pension Advisory� Committee ap�rnved/recommenc3ed the gr�intir�g of A,�p�}-CO(il'iCCICC� disubilicy pension tu Mr. A�ilarck in accordance witt� provisions of Scctian 2.397 o f ' the City Cade. This pensio�� is to be effective an t� date tn be determineci. � The amaunt of Mr. MiIurck's []L'fi51b11 will bc calcutatad by the Finance Department according to the formulu in thc Pension Plan for job-c�nnectcd dis:tbility pcnsion ;st s�rh tim� as his lust fivc years af service and sal:�ry can be computed, [ hereby certify that ti�e Pe;nsion Advisory Committee has a�provcd the granting of a ,jnh-can�ected dis�biiity pcnsion tor Gary Milarck �nd thc ahnve dates arc correct, Ch�irrnun, c, i n Advi •ory � ummittcc � "Equnl mploymont nnd AffirRiativQ Aatlon,Etnplayer' .% �' . � ' l � . . . � , . � . . . � , � . 'i . ' � . . . . .• s . . . , ' , . , . , • , � ' . , , � . . { • • • • � � � ' � . ' . . � . I � ' . ' 1 . . ' • , � , � , � .. • 1 f'• ' , � , ! ' . • � ' ' ' • . ' ��, . . � . .f ' . � � /, ,1 ' '. t . . . � ' � ' 1 . 1 ` . , � t . . � 1 f . . , . ' ' ' � ` ' 1 � r .� , � . . I � . t1:' S� � � ' . � � ' ' . ' . . y.+' a, `t, 3'. .��.�,;�; � s � . .� � . � . . . � . . : , . . � .''i:'� ._. . ,. 'C�+�.a�r,,.... � � . s .i •� �. ' �, ' � � ' ' ' . ' ,,. . . . , 1. � .. ' . - ! . � , . , . � � � , � rEr�sz�rr ��uEST �o�i . � � X� G3ry Mi.�arcic do hcrcby app�y for rctiremertt from tt�c City af Clcacwatcr � Gencral Employeas' Pcnsion Ptan. � . M benefits datc is '���'Y ��' �9�9 . y (Eatry date into pension� glan) . M y date oC hize is �ug��� �, ��7� ' • ' � My birt�da.y is APxiI 15,].95q - . � . lrfy job classificatioa is ' Mari.ne Facility Opera�or �• �nd I, work in tne . ' Mr�rine I? e a r t rzt e tt t � . F ]Jivisloa. �� �i y resigaat{on date is �° �Q d�ti��'�nec�. � . , � � � fi�c typ� of pensioa foc which 1 arn app�ying is (chcck oniy Qnc}: , � . � �Regular Penston based on yaars of servicc �,�ob-connected Disability Pension `' �to�•joh-ca�nected Disabillty Pensian y1y S�ouse's narne is: - , ,- ..-.,, ,__�_..._-_..__ . � Dependent chisdrer� under the age of i3 and •residittg in my�.-hor�sehold are: (°:int C�tiid's Full Vame) (Child's �atc af Birth) I hercby certify ai� oi t#�e abave to �e true and carrec • , � ' r � (S i�naNrc) ' , Augttst 30, 1995 . (Dace) ST��'E QF �LORIB� The fareg 'v i scrumeat was acl��awiedged bcfor� '' � COZINTY O�' PZNELL,�S ` 30�`�' C'�a� 1u�(o�-fi�- wha i person�lly I; • . knawn to mc ar wha has pra uced . � �s ide�tification and who id/d' not ca,lce an oath. , . ' i ' o'r�t ary Public . (Signature) �GTARY SLiC,s'I'A'i'� OF �A�tDR . � CO�f�i�J@.lt MY C�MMISSZON £X�'. MAY Z2.1997 . ' • . �-c �o fc.� � ��. �. +� - - {Name �i' Nat�.ry Printed) . _ ��„ sr•�� � � —,.�....�...�.�s......r._.�. ---- — - ��.,.�------ --- -- � 'i . ,° , ' '. . �. � ° , . _ ' ' • : " . , , : _:' , , ° , . - „ . . . . , '� . . �� . • . . � , . ', � , � . , , f :. . i: . , . ' . , . , . f . , . �� . . , ' ' . . , . . , ' . . , i ' , ' �` . '. . . .. , , � � ' . ' . ' ' . . . .. : '' .. . . � . . . � . , . , � . � �'r" � ' , - " � ' ° ' � •f. . , � , � . . ' • .. ' . ' � , ,� E , . .� , , � . : . . . ' . • '- . . i� . � . . 1 . '. . � . • ' i • ' . . F ' 1 � • . r.�, t , : '• ° : � • � � . . � . " , ;2ri.r;{.r,t�,.,1. r �. :�o;i.',.. ,,,_..=s ...� .' ... , ,. .�.. , �. , - , � . ' � �.. ' � ., ' ' . , ' ' � . � . � . . r r . , � .' . � � . ., ..yi . , �. : , . . ' . • r . - � CITY OF r�.EARWr�TER � . , �; GENERAL. E�iPLQYEE5' PENSION PLAV � � � � , , � . OPTION5 - GEyER�,.L E1�SpLQYEE5 , . � � , . .. "' . CiPTION- rt1: ' EmQ�oyees can reeaivc a 1�mp surr� payment Far V�C�{!OR �lif� I. . . . , holiday pay and 112. of sccrutci sick Ienve at th� time +ai saparatian from the City. i'herc w111 be no 59a deduction Foc � � •, pensian Eracn this lump sum paymant cior will this nmoant count � , , as zarnin;s ia che calculatian ot tHe pettsian. i'he t�st day ot �Hark wiil be tt�c terminatian �ate '3nt# pet�siort ben�fits wi2! begin � • . thc follawin; day. . � QPTION n�: , . Empl�y�e caa extCr�d terminativn ciate by the time du� for . vacation, �oliday pay, and I/? of accrued sic4c leave, i�rminacion ., date will be t�e �r�ai day at �x�endecf time. Pe�siast ben�fits wili � begitt Eh�. foll�wing r�a�. � � (Only avaiiable ta empioyees hired �rior to 10/1l9�.1 �� '1� M i1� � II 4 7� �l �i K i� f R a N yt eK 1R Y Y 1Y �t iM ul �II 11 �I Ml �F N Y IY �l �l i 91 �! �t M W R M YI fl 'M rt Y VI 1k re �N �Y �* A M](1 ��R i[ M IY .fl M+It +t tt . �+ � Gary Milarck . ', 3n emp�oyee or' �he C:tv oi Cfe�rwatcr, hercby �pply tor ��nsidn benefits urider ttie � City's EmPioyees' pensioc� �fan. I;�zrebvi certiry ahat I tully unders�and the two opcions �7i►��ed tn �ne. T choose �o re:ire �lsin� O�tio� Y � snd :visn my ben�fi[s to �ae c�iculated under chi5 ootia�. i��ndecst�nd chat �nc� ti�i� iorm is si;n�d, mv �ecision is ir;evocabiz. . . � ..--. i E�IPLOYEE'S SIGV�TLf � . SOCG�L �ECURITY = _`_, �� —a��osas _ – — �VIT�'ESS�5: :�D�RESS: ].�.195 BSth Terrace Hortih ' Semino].e, FL 34642 x,l�R✓�h0..� DA'TE: _ ' Aug'ust 30, ].�95 � ' l if . 'I '.t.. ,4 : ,. . '. I ' ' � '' ; . • ; ' ' .I . � " . . � • ' • � . `I" ° ' . 1 . f• . ` . ; ' � • . ' r " . . . � . � � , . , . , ', • , _ ' � . � ' • • ' ' • . ' • . . i . ' . . ! � . • +, � .. , ' ' . 1.• . � .. �' � ' � � , • ' ` . ' ' ' 1• ' , . .1 . ' � . . � " . . ' ' ' . . .. . . ' '1 . ' , ' , 1 . . . • • . ,. . .� ' .•' • .. ' ' . � . . .. � " . �! � ' . . S ' � . . •• . , ' . � !< �, . • � ' ' . , ' •. . . S. ' . . . �Ii, ''' [ �� . ' . . . 1 . � . � . � . . . `� ,,l.', .� , 'i >•' � , • '��� 1 .i • '{,1 ... . ' . •'' ' , � e r .. ' ' �. , ' ,'1 � ' . . ��' 't*.'.E.l � ' . . 'I,'. . . . , . . �r�€,:i�iaF'�t:,��s�.fit,,;� � ,. i ��. ,i . . . . , . , �_ ,.fen,.. �;ia4`.°" 1:�i, s ..4.i.. .. , � . .. .. ., � a ,.y .i . . . , , , � f . . • ' . . . � , � .. . . . : i � .. �' � I� � % � ,:t• . . � . . . � ' .. . • � � . ' • . 7 . , , . . ' . . . ' ' � ' i . . � ' ' , . � � � � � � . - � � ,�vTxoRiza�rxoN �o RELEas� � . . � ,�� �� �.. . , . ; �� 1�IEDICr�►L AND REL' ATED RECORDS ` : ' �r� . � . ' ' - ��� � Gary Miiarck an agplicant for disability pensi�n , under pravisions of � . the Employacs' ' Pe�tsior Pl�n.�of the City af Clearw�ter, hereby aut�orize � any physician ar "�, ochcr mediGal carc pravidcr wha cxamines or treats • me or who has ex�min�d. or created m z , � or whv ir� the future examines or treats me to rele�se any and aEl medical and ralated records � � percainin; to me co the City of Clta�water's Pensian rldvi�ory Commicce�, Pension Trus�ees, .. ' Personnel Direct�r, . ar acsthariz�d ernployces or ' a��rtts of thc City of Clearwat�r, F�or:da. . �� . � . ,. ' � , � � . � � � � -- � � , . ' . . � Si;t�a�turs ' � . . ' , � � August 34, I995 �I . . •. ' � � � , . Date , 1 , ' ST;�TE OF FL4RZDA The fa e;ain; insuuinet�t was �c�Cnawledg�d 3eture :ne chis C � V�i "� Y � F P IyE L L?. S �'' �-LC�-a't�C. � , , . � who is ar�ona y known me or who 5as �ro3uced � � as ideritificatior� •. � . � and who did/did not �ake an �ach, urrl�.u+4 r+�t �__r•++� u�T i i L77T (S i�nature} Npr��Y PtJBWC 51'AT6 OF FIARiDA � � ' om�faNd�o. �c�3� � r(r, u� MYCAMM1gStOM RX � MA 2� 1497 � � � �-t �aoro`�'• �L � (�1ame �o[ �locary Printed). ;, , �. . , � , • ' " . . , . . ,, ,. . � i f : , t � ! � Q ��tE�� � �f �� j�ury � �, � INO. �nn++n�►w, ���� a�r wt r�rarfoor RL•HAB. ��a �xa. ��n.. ��nv I �� r .cc.souncr {, S7A7� QF FLURII)A ' Q�PARYM�f� p LABOR AIVD EMPLAYMENT SECURITY G�vis}on ai Warkers' Compensatfotr � 1321 Executlre Cerstcr Qrire, E�st '' �"�`"`� . � Talbhatsee, �lorid� 32301 AiiENTiON: W.C. CtA1MS 4FFICE Flep�xt st1 desths by tetephone or teieyr�sn withfn 2� heurc. Pi,�AS� TYPE Phone: �•800•34Z•1741 €fV�PLOYER tNF�RMATIQN FIRM� N�1M���Y �f Cxsan�a�er IrlAILING �►ppRE5S Il��u�� TirlR;pda3 r u iiv q�grs ca.E��,ac�r, � �as� r 1L'r � �Y •I+•4�� ��`( ���� L, f�'•'� 1•.A i tY•1 � .l,i L' � - � "�� rE��PHOwE 813 462--�54* :�.,.. , Arw �oda: fVumbN' � � • - � I.QCAiION "gam� �f TulaUinq •... .r. �G� #. � :� NA7UFifc OF BU51NE55 ��e�,�a1 G�vaxrx�en� F�gEAAI. E J�`�� �ZtiyR�iBER EMP�QYEE 1NFORMA�'I�N � ��dl� ��S�:i�G�C�a'� 1 fifiM�aQOA��S (�ncEu�e �tg Codel ltil s ln�e 1�.� ���. � saa�� � � NUMS�A QM�� Aiaar Pac. 4pr. 1373 SUPEHVISORS IYAME � �O�rC �'a�11f t DEPARTM f�tT h1AME � � M,arl.ne Sridge TELEPliDN DATE dF 81flT1-1 SEX 13 S31-0S87 � �115/54 A��a Cnd�: IJumb�►• � M ❑ F Hnwionq ii umher o} h40t p�� yyf�k Number of d�ys pATE QF PAY fmploy�dT worktd workrFj p�r w�ik ]���s� ❑ Psr 4�Y Bi��� ❑ PK Naur if pi�c* work or [ommitffan, rnter tf �arrd, �od�nq ar ath+r ❑ pK p+y artr�9a wel4ly imounl �tiv�nSOp�s lurnishrd, ent�r wrfkly atnaunr ❑ �ar 1M��k WqHKER'S CdMPENSATION GOVERAG@ BY �Insursnc� Cnmpany 5�1l�Insured GIVE NAME, A170RES5 ANp pOL1CY NUfNflER QF INSUHAFlC£ COMPRtYY pR S�LF•lNtSURED 5�NVICE COMPANY. GALL.AGH�R �3ASSETT SEI�VlCES, INC. 2953 U.S. �5 Nar1h, Sulla 341 Ctaarwater, F�arlcla ��1521 wnn�r�rai^r �w�rr�n��w'*'�raw� OAT� ANO T F �ID f�tT D TE �+lD TIAAf FIRST REPqRTEO �"�i81�� �:o� a.�. s7iais� �:ao �.m. PIAG� QF RCCIOENT fStrHC, CitY. CauntY. Stut�) LAST DATE EMPLOYEE WORICEO $/].0/89 5aind 9Ctp� To].1 P],.uza R�TURNfi� 70 WORK r., g�� Qll� �G{31fl�'srd 1F YES. OAT� 4�e�i.,K�I.�r. � � ��{T�Y nhfloYN •�tl lar 6 � �n uer Yf'1 ❑NO �MPLOYF� MISSEQ GNE SFi1FT, OIV� qAY DR lNOHE7 YH �No WAS 1NJLlAY FATAL7 QYpy f�ta 41 Yrf, DMtM a� Cae�lh EA+IPLOYEE' aESC !PT O OF AC ID NT (CI�� d�tails cucn as, f�11, wa� struck, �tt.) sStYa�e� �ir�ck w�2.�� �aniu� a c�a�r in tlics TO].1 Plaaa O�fice. I EMpLOYER; f iprr� with tf�is d��cripUasi COMM�fVTS: Yn r] Mo f) na, i=p�+in !n cCmm�nn. �1E, A�ORE$$ ANp RFSONE'YVMB£ii OF Ph1Y nQZror� e Kelkin c�inf.0 PHY5ICIAN AU7i-IqRIZEO BY EMPLOYER UYp C�No NAME, AOORESS ANO PF10fVE OF MQSPfTAI. DESCRlBH tNJURY pp L)ISEASE AND INpICATE PAf1T OF 90DY AFfECTED i�,y. Amputatinn ol Aqht ind�x }inq�r at ti�cond �oinl, Fnttur�d ribs, L�aq Paisnnlnq, �te.} Lwab+�►r S tra in Any persan v�rho, knqwingly and with intent tn injure, cietraud or tleceive any emptayer or emp�oyee, inwrance company� or seir•rnsureo program. files a staten'ient oi claim containing any talse qr misleading informatiun is guilty oi a tefony of the third degree. P��ASE ��LL IN AZI. S�ACES A90VE �'' �y 'f f r�'-�S :ii-� .' ' �i :/,�•� i' r ..y -'��.•.�"" � EMPLaY�R {Read and Sign} SIGNATURE pR'�� �MPLOYEE iRead and S�gn! ����ilab�.e fo7r signatura 8115/89 S1GNqTUR[ DAiE LES �O1m U+G1, 1 lR�v. B�i41 P." • -� :':1��..0Y �9 aOQY ' - . M ' �. + , , ' jr.,' •� . . � � ' ' • � � ,• .. + ^ •r � � • ' . ��. ,. . . .... , . . . cr�r o� eL��wAZ�R, �.,o�n�, ., STAT�'YiENT O�' RESIC�IA'I'ZON 0 Gary Milarck Marin� Fac�lity �perator• I. . em�lvyed �.�t i�l t�� 1?ivisinn oF Mari�e Dcpurtntcr.: cic� h�rcby rcxi�n t'rum t�c u:rvice ut thc Ciry ut Ciwrwutcr. I rcyuc�t tfi:ac.this �ai�:nucie�n bc �tuiy u�r�{�tcd by my Dcp�a�- n�rnt He:�cl �n�! the App�ainiinL Auc�tarity' Rc� tx�:c�mc et'te�tivc am upoa appsaval of a di.sab�.l.i�y �eas�au . by the R.� Pensien Advisory Co�tittee aud Pansion Tx�s�tees. .. T'h� rr:�un ti�r thi� r�.r•i�*a�tican iti u.�t ti�l�t�wx; R�tirement on disa�i3.iCy pension. � , � , Rqgust 3Q, 1�395 Etnp�avice's si�n3c�tr ''' D�ce si�net� DE�?�RTti�E�!'I' �►CTION: . A�grc�vcd bv Divisiun H�sci n;�t� DIV15iUR f-Ic:�d Cc�mm�r+�4 {Qptit�nu!? ' �pprc�veci by ❑cp�rtmcat H��d - - �utc Depurtrnent H�:�d CUmments (Option:;l) . �.c�zatv oF a�eomrr�rrc Ac�r��ofu•r�r . i uccepc chis «signa�ian ta bccnme et'tieccive un thc date und uc the tis�ic ,h«wn abt�ve. D�tc A�poincinu Auths�riry r���c�in�ir�� Auchnrity Ccrmmcnc.� {Qptiur�u!) IMPORi�tVT NO'�'E: The rc�.���n fix ihi4 re:�ignutiun must bc tihown irt thc tipuc� pn�vicic�. Thc uri�:inat fi�rni. whcri tii�;neci by th� �mplcryec :�r�c# thc c�i�itiic�r� und de�urtmcnt heael. iti lt� b� utcachcc� �a it�4 pe:rs��nnci uctiun shcLt ur��l t'urwartJec� tu th� Ferticmnci C�t'tir�. PenuRnel ;�ctie7n shcct mr�tit rcticcs thc scatuti t�t nny Cir}� �uc�ni4a cluc to ur hy this ctnpis�yz�: in u�c:t�cclanrc wsth the CivRl Serviec R�les ;u�tf cc��lcctive b�r�*uinin�: ��:r���m�r�tx rurrcnily in �i't�:�c. x�.��,� :�K7 ' �,•: ,,. ,. . �{ �.. � , ,.�' ... :? P.',�. ,.i�,,;r, � ,. . ,.... ,.� �.,�, . ,. ,. _. ,> .�.�.; .,�. , . �., , . . . . 3 ii � , N ,P: . ' , . ' . • � . � . .. ����• ' .. . . . . .. . . ... . . . . -. ' , ' 1 �v�: CITY �F CLEARVVAT�R �r�terclepartment Correspondence Sheet � , T�: , �'Gary Mifarck, Marine Facility Operatar FFiOM: H. Michael Laursen, H�aman Aesources Dir COPiES: Kathy Rice, De��ty City Manager �.eo Schradef, Risk M�nager , 8i11 Held, Har�ormaster SUBJECT: Your Request fnr bisabllity Pensfa�--C�ty's Requesi ior Information Relatir�g To ReasonabEe Accommodation � �DATE: AuguSt 31, 1995 � � , Yo� have appiied for a disability pension �ander provEsions ot the C�earwater Emplayees' Pension Plan. By this action, you have indicaied t�at you believe you have a disability whicit limits yo�rr abifity to periorm your job. � � T�e Americans wit[� Disabiltties Act (ADAj pro�ides that an amployer has an oblic�atipn to make reasonable accommodatidr�s for a disa�i�ct employee to allo�v !he emp�oyes to contir�u� to wark, u�less it � can be �emonstrat�d that iha r�quested accommodations wau�d impose an undue �ardship on the employer. Reasor��ble accommodations may include such actions as ma�Cing existfng facilities readily accessible to and usa�le by the employee, restruct�ring the job to eliminate marglnal job functio�s, moditying tf�e wark schedule iiself, modifying equipmenl useci by the emplayea In hislher job, etc. I t also may iriclude reasslgnmer�t to a vacant position. The A�A reguiations provi�e that a q�alified individua� wEth a d'+sabiHty is n r i,,� to request or to accept an accommodation that he vr she chaoses not to acce�t. The City seeks tn engage i� an interaciive process with you to dciermir�e if reasona�le accommodations are souc�ht so you may continue as a� act+ve emplayee, Therefore, we ask that you adv�se i�ie Cily oi what reasanable accommod2tio�►, if any, yau request that would make it possibie far you to rema#�r an em�loyee of tha Cify in your currenl job or ir� an altematfve job while perforrrting lhe, essenliai job functions vf such jab(sj. Two cnples af this memo are bei�g provide� to you. Please reiurn one of the capfes oi ihis memo to H. P�iichael La�rsen, Human ResoUrces Direclor, with one vf tE�s aptions Initialed as to whether yo�a seek reasonable accammodations which woctld al�ow you to continue ta work. HML/dlf aption t:�� dcznQL,�� and wi�f nat accept any reasonable accammodaffons fram 3ha Ciry of Clearwater Ihat would aiiow mo tn continue in my current job class ar in some othsr avallable vacant posilian. I chaase to seek approval for disability per�sion pursuant to the larms oi Ihe Emplayees' Pension P1an. Qpkion 2: i�o r��5t that the City conslder reasonable accornmodatians for my disabil�iy whlch wou�d allow me to corltinue work�ng, whether ln my c�rrent job class or in same alternale availabfe vacant pasitfon. E will submfi to the Human Ftesburces Director of iha City of Clearwater a listing af accommodatians which I believe a�e reasonable anr! necessary (ar me to continue worKing. Designatfon of ihis option does ttat in any way precluda me (rom continui�g with my request ior disability pension. . � � � . � , .., '� � , , � ' �� 'f , . ,, , , .. , . , • , . , • . . , � . . ' �` � ' . � . ' � ' � � . .., . . , . , ' , � � � � � . � � � . { ,� ; , , � '��,'., . ��.... . , . , , , . . .��'���.�i1.�1J . 1 . � • . . ..<< . .... , . '� . "� tMAOiNO CL�N'i'!'slt� 1NC.', � � � i� " . ,. PATiENT: � . MILAEtCK, GARY DATE dF BIRTH: � 04/15/5q �ATE OF �XAM: 05/].9/91 CLIHICIAiVt � . DR. JOS�PH SENA ' blRI OF TH� LUM$AR SFINE . � ` ' ; HISTORY: Evaluate �ox disc hsrniation., • � MR skudy a� the lumbaz spir�e was performed u�i.lizing the tollawing puis� sequences: sag3ttal 15fl0/34, sagi�tal Z50Q/80, sagi�tal 68/24 (���.p angle �45 degrees}, axial 68/24 (f�ip �ngle �45 dec��ees). MR study o� the lumbar� �pine was performed in saga,tta� and axial project�,ons. x see no evidenae o� ver�ebral bgdy p�tholQgy oz eli.�nment abno�mal�tx. Th�re 3.s no e�,idence o� c�n�l compromise, Mild desiccation o� t�e L4�5 and L5�8�, disas are id�nti��ed with disc bulge� se�n centrally a� both levels. I 9ee no evidNnce of disc•herniation. The study i:� atherwise unremarl�abl�. • IMPRESSiON: ' � . � Mf�ld .cte8i�ccatian a� �he L�-5 and L5�SI discs with c�ntral disc }�ulges at bofi�h level�. fiy�ank you far this cansulta�ion. � . � . � REVlEYY�Q AfYD APPRQVED BY.• � OR. L4WAENCF MiiROFF M D, � � LAWRENC� �. t4UROF�', M.D� LRM/law D: OSf20/9� ,T: U5/24/9�. �1 � �� .,,, . . ~\ . �, � � a�� • � � o. ❑ I810if 11.5. 19 lV., 5uiie S09 � Clcarwaicr, flnrida 14b21 • 1'linuc tR�.��K� rhx �d131799•1963 �. ' . ., � � � , � ,- . , r �1rk-' '.'•i , i.• j' '�. , - , ,. . . � . . � . � � �� fi�1�� r .��'i 1 � . c►a�nrRncr ic w � PTny 9 � 1994 � U � . ' � ' . RL: Gary �•lilarcic . � , . , . 'I'o Whom �t �lay Car�cern: . . � . � I�fr. .ttilarc�s rras re--cval.ciated on 2/IG/94. Ile compla�ns o� t1s� s�m� ;�ymptoms. ilis sci�tita lFas returne�l. Cl��'ropra�tic.hmd liandleci tl�is. Since his last V�.S�t in 1/93 hc states he hns.h�d a gr�dual del•erior�tion ;�nd returtiti o� aame symptams ovcr' time: , fle now lt�s rigltt le�� cal�' a�ftl � hee.I p�in. The lo��ger Itc s�ancis tlie Ez�ore pronoun�eci �ttie �,atn is. � �XAT1I?��►ti':'3Lr1: � •• -Weight 218 15s. with 9 16�. weight im6alnnce to l.eft si.d� o:� ��.I.A�Ci'�1 � scale. � -Pa�tur�! �v.�luation slinus (�igh le£t l�ip a��a p�lvic rotation coui�tecclockuise. -�4otion P�ipntion shous 6iiateral soct'c�ilf�� hyromobt�ity 1[ypamo4f•tity is also noted at L5� L4� L3 on Riglit an�i � Bi�nt�r'�1 c�p�er cerv3cals. � -Cosit.ive I.asegue�s is :�oted Bilateraliy at 45 degrces ��evaLian . -R 8 L laCerai �Z�x�on oecurs �rom thor�cic area anste�d of �um�ars � -I'iuscle we�knesses are noted in low ��ck, buktocks�& �egs -D![� fl�xion l5 degreea� eztension i5 dcgrecs � T?2is patient re�ched rir�� samc time .ago. i�e lyas permr�nent impairment. Chiropr�ctic is the ther�py tli�e helped tl�e most. Ilc shouid be p�lowed c�,re ot� en us needed basis at a freque��cy oF 1 ta 2 visits/per montls. Er�clos�d find � ca y of �ar,�y tests and re#�orts. • Siricerel /- f�.i�w 'n' r , � �� � � Iti.Clc 1lrg.�ilr . . RA:m++k . ' �Keeping CC : ['t E i i e you hcellhy � G!'1 ��. t1 r c k xnd para•rref • ior llfc. " 813 •�47-4Ga7 • Fax 913 • an3-� 195 • 131 G7rdan Avenue P�orth • Ctearwaler •�lorida 34615 �' � . . . . • � . 'I � . . . ' � ' • + � . ' ' .� . . � , . � ' Ii� . i. ' , . . . . � . • ' . . . � . � . ` . , ' , ' F. ' ' . . � .� . '. ' ' . . ' � � ' „ ' r. ' � ° � . . � � . , . ''� , . � ' , ' . . � , j, . . . . . • ' . . . ' . . ' '.�'i'��'�i="r��''';A� �1<<.F, � �. � � .,-�P ,�. .. . ' � . .. , . ,. ' ' � ' ' , ' ' • ' � . ., . , . , ...,.s�. . . . , . ,. , . , . . � � _ _ _ � : N.'�3•�chrr Rd. 37'00 Eae1 B�y pr. �, ,�• ''' /-�,�, C aarw�t�r. l�i. 3�iBx 1,grqa, �L.34641 , �[���1� �+ti� , ��Q•22x� 630-��444 , � . � ' f ����� ' . � t�i�81 W�1.1nyh�m Rd.. �it3Gq Saminol� Otvd. WALK-tN CUM�CS �.��o. � aae�u s4ms�,otg, �t. 3���a � �� 593•zzaa asz•zz2a . � � ' AUDIOMETRIC SCR��N�NG it�;PORTS - �� � � • � ' PATIBNT NAME: � r , � . . . SOCIAL S�CUIiITY NUMIi�R: 1�� �7'�� O� � . -'.� 1 DATE : �Q �'L. Cfs � . . � � Ai]DIOGRAM IiLSULTS: Dase].ine _k'd11ow up• _ � -.- - .` . � .� , , Other Auiliometri� CalibraCed ��� , � ....._ _... _ .......__ .Y.�,��� - .` ' . . ' ' . j =� �-��= .,_.��=�.�� � , ' . �' � � � . . � � . � ' .' / F1��i1I0� ;r;M ' , � ::» ±t•:;�ordai�ca w:Lti QttiS;. �^.6-1G89} � + � � � i�� :1:� ��'1�� �� 6,: ti�: ��, b;; Rr: . �� . — ' C-" ..~.1.�1 �:J 1 J :� J I J C C� r', i.� �� � � ' ' _ :�' �5 : 5 �r� 'a� 1 �� : � �5 �i I? ' . � . , � ���:: ��s�3 ��,L: .v! :� u?.: . Si2rs�l+:���: _. • �,��,s��..�� : . . Dv you �ee�. thi� te�[ w�s satfsfact�zy7 Yes/No . I.E �o, wou].d you like this Cest r�p�ated?. Yes/No .;dition�l, commer�ts; • •�134-9A Satcllite ciinics of ��� Mociical C�nter u�an, , �r,or��oA , < .a,. � � r .c,' .. .. ... .. .. . i� . l. r��... . . � ..e:.. . ..'�., � � ... . .r �� ,. - �1,!�i ..i � . .. . . � ' . � . . .. . , I � ,. .�� ,` . . . , , • . �. . .. . , . , , � � �. N ' � Ad. 3700 �aa! �Ay Dr. �. r r---- Cbaervw�a` 94825 .. i.�r0o� F�. 34841 , � . . � ����13% �r��� � � 419-�?Z�t 530-3�M1 : � � t ��nters � . � � . , . , �y}�( �M ��,;NSC$ i4581 iNafain�ham Rd. 19240 SumtnolQ Blvd. , , Lar�o. F� 3484d Sominofe, FL 34848 � � ' bS3-222�4 3Q2•2�24 i , ' � � . � PHYStC�IL EXAtVttNATil7�f RE�4RQ �„. 7�v � �v�� a r+a�++��t �enotv�ut !Oa�netal Nppcaran�o � '�iaad and Hotk � �Sc�Ip end F�oo •Eyaa (DeaaJba Fims�ascopla 1f.A�t�Qrrr,at} . �Pttpli�. �t�r MaMty ✓ �Noa. ar,a srnu�o� ./ 'Mou1h arx! Thraat �� rfvofi fEara. TympanlcMembrans � ✓ ���� ,� «Thanx {Includo Btos�ls 1� donn} �� �tl� ..� '�Kaari � "�edphere�! Ya.cuiar Syslem ,/ "At�domon "Mu� (D�aplbo Roclal tl dona) 'r(3oaiWle ./ "SpEtw Ih1obEUly. Abnarmal Curva�, Palnj ��Uppor Ext�omflfe� '"Lawor Extrem!lfoa _,/ "Fnal (Pa� planu� in�tp�s� oic.) tr ps� ✓ n���� .� ../ �'Erxioalna � r�'I�louranusa�lar � "Paychla�rlc (Mo�laf AlUluda) �'Scars� i'aitoo�, Mar1c� � A- �•Pnlv{a (a� donoj NO YE5 „Ncrnla ll1-8-9Z � /df�, � 4 nESCrap� �cH �a�roru,�uTr �n ast�n. � .,� i � � .l�ccuc�.� � � �- v�d �.�f `, — �rl%�' . � �� . , �,�, ,� `.'� � `,�' `�, C� °� � > ��' . � � , r � € �. , 3 � � � r � .� 1 � t � l.an , � r.+_.�.,._ . , , : . � � __+.--�— — �ATIENT WEAi�3: � � ' QISTANT VIStON �J( �� � �""j" i�12Q1 Cal. b �CV � 4j7�i., �--� S�n 30l Cort. b�o�l • CAL�R•Vl51QN � DEP"rH i'�RC�i'TION . � �! V � AUptOM�TRY ��UO'" �FA 600 iC00 2t)OO �OOQ �too0 6f,�0o ao00 Totarxr� o� �ary) -_ - o�or isa«�ryl ' . �?H]l�IAI.' fi�� �� �u�ar/�1uca�o ,� Dtl�ar (�oalNj ' Fiaport RII�c3�ed �/� i3ADIC?LOaY � Cfio�t Lumbar 2 ��lewa (li nacoszrvsry� �thor (Spvdfy) SECTI�t�t x4x{s��t►sta�[."'r�u1►Qd' . SLOOp CH�M�STRY Nd Glucaso • 14tbumin x u� � G�ot� d Crva�r�s SGOT Ca ' itlgfyco+ide SQP� i' C�olcs�xci l.DN BLJN H�l. Ctwt. (Op�asa� • 7. 8�irubin � i: Prottdn Atk. Pho�. •' N�i YjSION l�qht�4l . • • anri.l0 20/ VM Zp/ � C�ot�. b ?�1 P�RIPHE�AI. Yt510l� F€ll� x�r Frodic.U�d � da�. d�la 5 � PxoIoENA�xrrnin Npaoacopb `�`�` Fiepa[ Rllachat! Reporl Atl�chnd•• F'i1lMONfWY t!!`�t�'i�:.'� 'il r" " F�V� FVC Fiepari A«ached . 3��.MATOLO(3Y iiOB RBC ` YygG HCi' Mi.`V MCN MCiiC pU�dranllal Piate�ata �ea��a?. (�t��v) ._,—._pepo�� nc�a�nea s�x�;e��(�? is�h►i �aport ni�,cr�Qd �fst s�y phystcal ar p*ycholagtcat condltlans whtah muy prahtblt Iha �rs,� ol r� tea�lrnfar #nd nola on Phyotcal proAle SUMMJWY i]F �EFECTS M!D JIBNqRM�4I. ��SUL'�S- �C� ��1Ss�'� � , . � GYr/ ��/ �u r y Ll�r`'�rt( `)�dr*.l -��CCCUtt�..l t� d�d '�/V/4 �' � i� i��u�"��''�"" s.•-+�i G.ti�.✓ ��'� ��j �0�°7� O�.d ��j �danURod � v�p�ictutVarnployoe vl abnormattlaa � � 6 21 � 6�arriirirq Pny.+ee�n s�QnaH,r� p.�• F�ECOMMENpA7lONS•FUfit19E 0$8A1�ffbR� �1(S/OP �0$i.! isvt't�h' 1nlr r+d r�sW[s �nd rwt� vn Pt�sul Prar�+1 f �,Q1[tG� � �?t e..Q �� �-- • �� '�-�n`�`�+`'q� /'Q� r a�, C r�, i� � Reparl Aitachod 711-8-�97 :' i ��� ' T rllt' �1'�1.�175 /!! 1�e��c•,t• rr,rrl 13i�ck r�r�� nnh��Met[ic ti�►Inr Sur�cry Ih�t�y;i.�•,1.11'�,�IIruJ..�1.U., i!A. l:lir.�hrth i'. �ims, �I.U..1!�1. 1':tut 1 %ak. 11.U, Uti{In��• �:, �Is.l•r. D.U. �i.11lt:.� EItfSli:tf� ����#. . Icllrct �. llurp. l).i S. or�hurardk stir�,+rr�• , lc�,•� 1�'. �I�►�n. 11.I). i'Eii3ia�1 1te+tich�r . tt Achzhilltaliart x���xrt �). l�ndx�r, u.c?. t:un�l.mUnr1�, If��;wGl:». �f,l'l. I`r,nuiK�+ �I I'urt��R,nn�h. �i.l). KC�ute�lil�. iks��� tn. �l.U. fk•nr.sutut 11..t�krtrs�b. i).c�. � � uraky}t}• lai�� I). llhr��nnl:tipidu. �f.U. •I.11iw{i ('i},111'Rx1. 11.I). �rumrrdiol��,�• �:. i'. �hah. �1.1). t��•rhUl„�,�• itith.�ru � :'ra�tif,, t'1i. U. c:hn,nic rain i.11.lflty �i. i�iiilK'i:. til?. Lrnnr �:. Iad�uttikeu,. l).U. S�J111 E' Ct!)tP ,SN�'i'1CNS tm�Rfrtg .iHi �:7 Kan ►1� cl� �ur.�m Spinr �urRcn- ��iinri N�c�m,inntums I�..�•r Di•l,r���u�rE}. i'rrcutanc�iu, i'��,lu�n �ct �1 i � �•i. ��,�n.�� •�.�„�r�. tl��nn.ei�d i)iti� £S�Y�sr�Miaun�f+�ir �tedleine !�ui \i n•r t'��ndiwliun �lu�!} �•i.t� \c�sn�lir�ical �r,��,wmcnt •f�in�l I)ir�nlcn IlcaJ,��h��. x k�iiun:s R��li:�hfli��tlur� tier-r�tc� 1'h�•l..�i Iltirrapt i'Itt•i�.�l K�zuu�lillunin}; 1yu.���� Il►cr.�p} !l,�� I� >�, h� M+i .1nit�ti. H�Ik�t l�.}ehi�lu�i��l kr'►•Ec�� i,�alu,�u,�n.'C fn�aim►•nt 1',�m �I.ia1,�.t•mcnl ����,��•.,�i�.�. �. . ��i� rt,.��.:��i���• 51.uu��iil.�u���► I'iit•i�.11 1i:4r.qu � �,.':.-.a •'�nwl i�ui� : �.i. ... �, ...�� i���t�.�„ . F'l�r�d� Sp�+� IY1��1td1$e Tlir Lclryes� SFngle S'phre Ccrr� :. il�r I� 1be U1ilred Strtl�s July lB � 1.995 Mr. John Marcin Ra.ek Management Speciali.st City af Clearwater P.O. HoX �7�48 C��axwa�er, FL 34618-47A8 Re : f3ary M�.larck ( 712 7} Dear Mr. Marcin: � , I am in receipt o� your �eG�er o� June �, �.995 authvrizing me.to con�inue �o �rea� Mr. Gary Milarck. Y am alao in rec�ipt of your independen� medical �va1��aCioz� by �r. Moskowicz on'�Apri1 2A, �995 releaeing h�m to �u�.l duty work. � did see Mr. Milarck in the o£fice �oday �ar a�x u�nexpected foZlow-up vi�it at which poa.n� he was complaining o% increased back paa.n and radi.�.t�.ng pain inta �hs right l.eg. Therae ar� the same complain�s tha� he had wkten he initially pr�sent�d to our o�fice back in January of 1993. i]rader rrfy care, h� had iaeen placed under a permanent 3.�.ft restrictior� of 5� pounds and had been do�.ng we�.l un�i1 recenC�.y when h3.a �ob nositian wae changed £rom a toil plaza ope�ator i:o a mara.ne fue�. dock operator. From th� descr�.p�ion of the �ob d��nanda from Mr. M�.Zarck� i� aounds at� �hough moat o� the activities required in thi� new pos��ion exceed his 5o pound. �xft limit . I would adviee yau that his 5A pound �ift �imi� ia long-term and g3ven th� presence of ha.s bulging disc L�4-5, I believe thia incrEased le�cre�. o� activx�iee may piace h�m at rxsk for rec�arren� back and �eg pain and posaibly progress�,on o� d�,�c bulge to �ull herniation. I certaa.n�y �ake o�tenee in the progre�asa.on o� my patient� e jab demazzds wi�hout discus�ing them wi�h me as his �reating phy��.cian �ixs� and �hen e�ec�ing me �o continue to manage his progregsive pa�.n re].ated �o Chos� on-the�job change�. Perhaps the phyaician who felt he could �olera�e euch �x�rtion should be �he one to addrese h�.s pain comp�,ainta that they have produced, _"7i� 1)n�r �crrrt. c:lr;m�•.itrr. fluricl.� a�G?S � cNl �)'�)"'-�hi • F•ix {�il i) "�{ri�tt�� . � r' A`' I, ',' YF, rf, ' 1 .. ___.', . ' ��� , � � � , } ��'�`; �� . .� � . ' � . , ' � . � ' ' , . _ ' `' • .. . , , ' ' ' . ' ' ; . ' j '�{�t• 1 . .i , 1, .` , . � . '. . � •� , j','� � ' i '' ' �' • � ' � 1 '• ' � ^'S( •''� { ��'� . . � S 4' +�1 : ' • • �' e . ' � � � ' . , r ' ' . ' . ' . . . . j�F� '� � ����j� � ' , , ;' ." ,�� �..� i•�� '� � '�1'• 1 ' ' � ' ' . . � , " • • , , ' ' • ' . , � • � ' , i iL' .I �'. - ... �t; `7 . I ' '� , . . . . . , • ' , . . � • .. ' ��� . r' '$ . �f.�.���1.'f. � ''1�. 3�. , 'Ji . . . - � • � .e . . ' ' ' , ' ' � . � ' . . � ,�.1 ;,. .• �.��: �` ' . / F . . . � . . � ' � � � i� . . . f' ' Ii' Y'�,S � . �:1.J� ��°i'.� � : . . .. . 1��, � ` ' . � ; ' � - . ' ' � f.� 3 , 1 , '!' , ., i � fti;r, '€•.`t � `` . .'s� ,•FI`.1�.. ,S. S . , � �� ', � • ° ' � ' , •, ` � 'i ' '' `I�. . _ ' , . .. . �''`+{i�fP�`2?l[!{���1�1y}'j�' � ,�,' . i`� e , , . . �f� ', . �' � . . �`• ' . . ` • • � . . • r • �'". .� ' ', .'SY�.l�Jet 7!1 .,� .� � �:{�� � o . . .' :i :� . ' . . . , � � . , . . .�Vr^ �i•if �l .i��iFSf'1:''i:r�bv�..�i „ ,. . ,, .. ... ,-s . .-,J S .C�..I'Ei� ����'!��',.C';tr1" 'E':; . . ' . . ' ' ' � . ' , . . . , � . , . . . , 't7.''� (t... 't,. � ��'! . _ . ..� �'�e . . i.tr +i#.�V,.a.74 A •t . . . . > . . . .. . . 1! � '� r �� ..i ' � . , . .. . . - , . . . � ' 1 �- . � ' ' '. � , . , ' I 1 .� ; . � Mr John Marcin . � , � . ' . ` , . f � , . . ,, ' Ju1y ��8 � 1955 . . . ' � . . . ;- . ' . `. , . Page � � , � , � . . . � << ' . : Re : Gary Milarck {7 t27 � , . . . + , . ' � . , � , . , �. : Pleaee � axrange �or a foll.ow-up visit with`. Dr . Moskawatex �o addre�e ,� � �� , , hie new and progreesive , eymp�om�'. . � • , : ' . , . � , ,. • � . . � , . - ' � , Sincerely, . � � � � " � � .: � . , , , • � ' � .' ,. . . , . � , ' Robert D. Grub�r, D. 0. � � � . � . . ' Dip�.omate � Amer3can Bdard of � . , � . - _ � ' Phyeical Medicine and Rehabi�.i�a�ivn � , . � Medica�. D�.rector, F3.ari.da 3pine Institute . � , . ' ` � . . x�cJdd , ' , : . � . . . , , , .. , . cc : Mr . Gary Milarck � , , ' . . , . , � . • ' � ,D: �07/18/9S , . . . . . . ' • . . . � • � - , • . , . . . '�: fl7/18/95 . , ' , � , .' ' , . _ . . .. . , , , , ' . ' ' ' . I ' � . ' . � . � . . . . . ' � . 1 . . ` ' ' . ' ' ' . • r i i . . . . . � . . • • . � . � . � ' . . . � � , • ' , : . , ; . 1 , i � . , , , ' ' ` � ' .. . : , • , . , � , :� , , • , ' . . . i 9R������ j ' . . i , � , • -� '��.� � � . , - • . �_.__._ � . , . •. � i . , , � " , I �} , � , , z " , , � . � � . � . � �� � � , . , ':� . � � , 3�. , '4 .. �° �f� . ;t.i , �. � , . , , ,, � �� s �r .�'� . .. . . . . � , . � . . . . , i . ' . . , �� . . ' .. .� ... . ..... .... .,- . .... . �. .�... -.- � _. � .. ..��.. .�... ........� .. �... �.- • .' '.. �.. ... ....��-...«.. � »'""... ... . �_..... �. .. i .. . : , .,� .. .:r.�,;� : '. =r� . � . .. ...� . t• . i' ..� ' ... . . • • �..�- :, .. , '��•.::;.'. u�. July .28; ].995 CZ 'I` � Y O� C L E.:a► R W A� '� E R ' Posr �Ft+�� eox 4r.n ' CI.EARWATER. FtORIDA 3481B.;7a� Ri*k Manrp�nt b4vlsion T�l�pho�rs (at3) ;62-675� ' fiCrI111ILR: �613) �.�Z•G737 Robert,D. Gr�bPr, D.O. � Florids Spine Institute � � �. 2250 Drew St. � Cleaxwater, F1. 34625 � Re : �npl.oyee : Gary Mi.larck � . D%A: a/�.o/s9 � . , � Dear Dr. Gruber, I received your letter of July 1s, 1995, indicating that Mr. Ma.l.ar�k's job demands were increased beyond the restrictian you� had previous�y p�,aced upan ha.s physicaJ, act�viti.es(50,� permanent ].i�ting zestrictzon) . As you are aware, an April 24, i995, Mr Milarck saw Di. Moskovitz, who d�.d not p�.ace any restrictions on Mr. Milarck's activities. Mx�, Milarck subsequentl}� requested au�horization to return to you for angoing car�, and of course, as you pai.nt out, my �etter ta�you of 6/1/95 authorized you to continue to treat hxYn. . At no time-prior to your evaluation of fi/14/95 wer� Mr. Mi�arck'� job duties changed or mod�,fied. , Aftez you evaluated Mr. Milarck cn 6/14J95, you indicated that. Mr. Mi].arck's restr�.ction had not changed �ince�yaur prior• � evaluation, and that he still had a permanent 50# �i�ting restrictian. ' . Subsequently, on 5/22/95, Mr. Ma.J.arck was sent to Dr. Monichal for a fitness tor duty evaluation. Dr. Monichal. also felt• that Mr. Mil.arck should have a 50,� li.fti,ng restrict�on. On,6/30/95, based �pon your apinion, and that af Dr. Monichal, Mr. Mi.�arck was trans��rred �rom the tal.�. plaza to the marina fuel doc}cs . Enclosed is a capy o� the Marine Facility Op�rator(mar�na fue�. docksj jvb description, and physical requirements. As you wixl note, none af the activa.t�.es exceed Mr. Milarck's 50� liiting restric�ion. . ��� _..,.� �"+� _�'r��! ]'�, at'�"net ld aC��Dn ����Oyet ,� ' • ` � � . � . ' • � � � . . 'r. ' � , . � ' ' � . . , � . ' . ' ' . � , . .' ' . • ' � ' � ' � • ' : ' ' . ' • , �� • ' . ' , . � . , ' �''° � " ,. ' ,` ;'.,.. •. , . � ' ' � � , � � . � • � , ' , , . '�,� • ' ', , ' ' . ,. ,� . , , � � • . I �` � , � '. ` � , ; � ' � ' ' „ : � � : . ' - .' , . ' , t3r �:s�r,:,: =i:. � ' . . :.;: ° . . . • . s.��, .. . - . .�C1�iE..�..{i�._ .-. , , u, a . .• J`�. es; �,�.n. . . ��� � ,. �n . . ' . . �. , . . . � . � � . , �. � . ' . . . . • I� . . . .. .. .. . . . . ..... ._._ .._.._. . � _ .... . .... ... . �. _.. . _....... _ ... ....... ... ... .,, ».. _._ ,.... .y_,. _ ........_.... . .,- ,._....._. ._. _ . ... ..... ��.. , • � . . . , �r . . .. . � 1 � � Mr Mi3.arck's assignment at the toll plaxa was undoubted�y less � '. physically demandinq thari his assiqnment at tha marina fuel • dock�, however neither a�ssi,gnm�nt required 1�.ttf.ng in excess o� ' SDf, and appeared ta be wi�h3.n Mr; Milarck�s physical � �restri.ction. I . . ' .. E: . . .. , As Mr. Milarck was unabl.e to pertorm the �ob duti�s at the � marina,'he was transierred back to his former assignment at the t�o11. plaza, The reason �or tha transfer to �he marina was that Mr. M�.larck's , position at the to1.I. plaza wf lI be elimi,nated as soon as the new Sand Key Bridge i.s completed. As such all of Mr. M�.larck's.recent medicai evaluations were utilized in an effort t4, insure that Mr. Milarck cou�.ri safely perform the job duti,es at , the marina, and enable Mr. M�larck ta remain �mployed as a Marine Facility Operato�r once his assi.gnment at the ta].�. plaza was el.iminated. .+ Ceztainly it was not intended to require Mr. Mil.arck to perform any , 3�ob activ�.ties in exc�ss oi the restri,ction you placed on h�,s � a�tivi,ties, and as the activities d3.d in Eact nat exceed his restricti4ns, there did r�at appear �o be any need �o discuss�the chang� i.n his job duties witih you. � I trust this cZeazs up any misunderstanding you may have had regarding Mr. Mi�arck's emp�vyment status. . � O� cour5� should you have any ques��,ons or concerns, pleas� do not hes�tate to contact me. .. very truly, . E �� � � Jon Mazcin � � Risk Management Specialist . � c�: Bill Held, Harbormaster , Gary Milarck = I . „ i .. ' � ' � • . . ' . . �. . ' � 1 ... .. ...� ... '�....��.... _"' ,. . . . .F ... . .-�.. - .-.. ... �...�.....�.� � .. �. �.�.. _..� . �� ..... _. . ...� _ ..�..� . .. �.�w...w.......�.....�. .� ....�... ...... . .�. , .� . .� , ' Marine Facility Op�rator a� C�earwa�er Marina� i. Must b� physically able to assist boa��rs at the Marina �uel dack by tieing up their vesae�.s, which sometimes requires tha pulling oE the vc�,sel into the dock, est�mated to be lifting/pux�,inq approxima�te�,y 30-5� lbs. . 2. Must b� physical3.y able to pass �uel hose lines to the boater wh31e observi�,g all safety precautions. This requizes pulling out approximately 84' of fue�. hose from the hose reel containers�and rewinding as ne;.essary, estimated to be lifting/pu�,].�.ng approximately 95 ].bs. 4. Must be physica3.].y able ta operate the ADA handicap �.i.ft at the Marina fue� dock and Commercial. fuel slip. This requfres th� placement o�-the davit, seat and other equipm�nt and a�s�.st�.ng handicap boaters/guests into the lift and operat3.ng the winch both in lowEring and ra�sing the pers�n, � estimated to iae li�ting/pu1.li.ng approximately 40 lbs. 3. Mu'st maintain alZ fuel dack equipment and cl�an th� a.nt�rior of the fuel dack building. 4. Must b� able to change� bath gascla.ne and diese� �uel dxspensers filters, fue�. nazz�.es and clean fuel screens. 5. Must be physically ab1� ta operate �he sewage vessel pump out s�ata.an, whicr requ�res suppl,ying the boat�,er with the pump out hose oE approximately 5� to fiA feet fram the hvse ree� conta�.ner and flu,hi.ng out and r�winding the hose aft�r use, estimated to be liftinq/pulli.ng apprcximate �y 2 � lias , 6. .Must monitor the security of entire marina and a11 vesse],s, wh�.ch requi�res the walking o� the entire ma=ina comp3.�x at �.east ance dur5.ng each shift, checking fvr safety related items. 7. Must be physical�y able to adjust maoring �ines on vessels if necessary to protect bath the vessel� and city docks, estimatEd to be lifta.ng/pulling approxS.mately 30-50 �kas. 8. Must be physically able to remove the dewatering pump �rom the storage area and place on any 'V@55�1 at the Marina takinq on water. This is considered emergency wark and estimated to be l�.fting/pul�,a.ng appr�ximately 47 l,bs. 9. Must be physically ab�e to b� First responder to oi.7. and iuel � spil.ls at the Mara.na. This requires the placement of oi1 soak pads and booms in the water. This is consid�red emergency work and estimated ta be liftingJ�ulling approximate�y 45 �.bs. 1�. Must take fue�. tank stick and fue� da.spenser readings for each shift assign�d. Must prepare reports, cZoses out shi�Et, take cash regis�er readi:�g, account far shift sa�.es and close out credi.t card machine. 11. Must assa,gn transient slips to boater� and d�.rect them to proper sla.ps and sometimes assist them in getting the vessel into the slip. 12. Must ��ve informatian to boaters and the genera], puhlic. r � , �� � • � �i./ ... , . � i� , n� DI�SIaT+ate Amerkan Ikwrd Of Orthop�nedk Surgery August 7, 1995 Gary � Mtiarck ]1964 85th Terrace Sernlnoie, �L 3u5�i� w.��+ . 1 � R.W. Springstead, M.D., P.A. E ORTH�PAED�C SURGEON �� PC�NGE DE LEO�! O�IJLENARD pi�00iCSVILI.E. FZ.U1t�DA �460t. 1 phone, (904) 746•Oa24 fox� (904) Sdd•08Q1 To Whom lt May Concern: �� Mr.Gary Milarck was �een in my� offlce on August 7, 'I995 for orthopedic � evaluatlon. HlST4RY OF PRESEMT iLLNE55: This 'is a�1 year ald male who says he � � was injured warking on his �ob in �989. He lifted a 45# chair and injured his back. He says when he fei! hEs back gave out. He was out of work for abaut fi�e months. He was under th� care of the Flarida Spine Institute. He also had chiropractic #reatments. H� was refea5�d basically ta light wark, which he has been doing, r but apparentEy thts job w�i1 saon Qxp�re and he will have to return tn his pr�vinus job working at a fue! dock which requlres a lot af heavy puifing and str-aining to the back. � He has continu�d to have chronic pain in his back and takes medicatlon. He can't llft anything very h�avy. He can on�y stand for about an hnur at a time. He develops low hack pain and ir�creased law back pain and radicular pain down his right �eg. PAST MEDICAL HISTi}RY: Allergies: None. Medication: Soma, . Mo#rin. 11lnesses: None. Operations: None, QRTHOPEDtC EXAMINATION: This is a we[I devetoped, we[� r�ourished, � male who is 6'�" and 215�s. Back � iawer ex#remitles: He has some tenderness in the �ower tumbar � Spi�e. He bend5 aver only about 60°. He has t0° ex#ension. He �s able ta walk an � his toes ancl heels. Reflexes active, na � weakness or sensory Ioss. Straight leg raising t�st is p�infu! at about 6�° in both Eegs, par- � � ' ticularly the right. Good ra�g�e of motion of � his htps and knee�. a ',5� , .. . . �° F;'� . . . . . . , ; . - , . . . : . � . ' ' . 1. ' i ' �M . � 1' f� ' . � . • ] ' � ' � � . . , . . . '� . � . , . i � � . . . . ' . . � . . . ' . . � , . . ' . � . ' t . ' . . I . . ' � 1 ' � . . � ' � . �1 . � • , � , , � • ' .!. . . , ' � ' I . , , • ' , 1 . � . , . . � ' . , � , . ' ' . 1 � � . ' . ^ , '' � " � � • ' , . � . . � ' � ' ` 'ef',' . . ' . ,I' ; ��� . . . �.� . ,` � ' , .i' .4 . . , �'� . . . ` ' ' • . . . `^ . , � . A'. . . . "5�. . .: , . . � ' r � .; . , ''' .!' � � ' . � .. .� • � ' . � .. . ' � . ;. , i ' �'a, J i •' . ,"if ' ' . . ' '1 , , ' ' . ' l� ` • �� ' , r ,(1 I�i�' , �• I. ,� � . , .. . ' , ' ' . . ! � ` ' ' , . . ' ' 1 � � ' . '.S!i:'F,S,>�'�S' ,Y , �Ois,tt'�k.'+� �.Ie ' ` ' r t ' • r � '• ' , �' . , ! • � , � . . . . • � . . � , ' . 1 °.p� .. . �S�?t':�.x ..� a � ..- �i: . j �t , r • . . � �5, 1 J .� � 1 � , • . � . . . . . . . . . ., . � ' . . . � ` � t ' . J r • , , . . • • • Z August 7, .1995 . � , � � � � ev�tu�stfon contfnued , , ' ` � � . , . � . � � . � - � � . . . . _ . ' MILARCK, �ary . � . � • . � , . . . �: i... �� : �� .. . �, � 0 REYlEW OF. MRi :. � .,. Previous MRL shnwed some buldging discs � . , at L�-�5 'and L5 51. � � �. � Recent xra�ys dated D3-15-95 appear ta be , � narmal. � � '� ' IMPRESSlON: � CHRONIC LUMgOSACRAL STRAIN: � � � �. . BULDGI NG D1SC L�-5 E L5 Si . DISCUSSION:'� � ' . � 1 da nQt f�e! h� Gan return to his previous � employmer�t as a marine iuel dock aperator. �t will-.put too much demar�d' on his lower back and could cause him cantinued pro�lems and .fncreased, probfems wlth his back in the fuiure. I wauld recommend that he continue on some lightc�r type of work, such as he had previnus�y warked at a toll piaza, but certalnEy if not that a job in simiFar restrictions. .� !n my opinEon he has reached MMI. fror� his back injury. I feel he has sustainr�d some permanency as a result of the injury ta his �awew back.� 1 feel he can on�y return to some EEmited duty with' restricilans that have previously been specified. , ' Sincerely, , , . � � ,. �R.W. SPRI G57EAa� M.D, , , RWS : jjf �c: chart � � .. � , . . .. . . ; . ., � ,s ' • ' . � r . �`t•• ji, , 1' � . ( • ,. , .. . . . . . . ..... . . . � , •' . � � � ' . . , � � � � . . , � . . . � � orvrs�o�r t�Eao�o�a�ar��r viR��r�R� w�vlEw� , , � . . � �, � ,. ,r •� . . ! � � • - . . - ! ,j�� �''r r�,��� . r ,.. . . • . . • • � • � � �r , �i.:.. Y.. ' � ,w.,� Annu$i Perinvmar�ce �d Dsvebpmsnt Review� , , �, � .� . ; : `; :"�. : . . .. ~ ' . � . . �. .. , , ,, . . �. _,...�,�, Interim porfarmarx;e and bevebprrien# pevlew . , . � . , , � �_.�_..._. Three-Month Rev�ew • �. .� ' . . ,""" . . . . . , .�� S!x-Month Revlew • . � � = � ,. .' .. . _ .. , . • I agzee wf�h th� ��alua�ion ot Su�ceesful £o�r Mr. Milarck."� No�e Mr. ��M�.Larck has had three supervisors durtng �his xa��ng pe�riod. �Lee Achterhog {acting supervisor:�xvm:9/i7/94 �0•�!/2,�9Sj, Lelarid E�tes (�c�ing supervi�or �rom 4/3/95 to 8/20/95), Michael Willis (supervisor �rom 7/IO/95 �o �/23/95) and � Lee Acttterhnf (acti.ng supervisor fxom 8/21/95 �;o mic3-Sep�ember 1995. The ', C1�arWater Pass Hridge i,s �cheduZe to'clo�e �n,mid -September I995, �� ' ' �_.� � , , � � , . ... - $ � 4_S,�'� �,. . � - � Signaturn • � .. . . _ _ . . .. . q� . . J�� , . ' • . . ... � � " ' I � i `f ' . "�� � . � � ',/�� Jf . � W f� V \ . /�f /�//"' � � r . � "` / • � � � � ' ��� 1 ~ • 1� / �7 � . ' � /� � ` . . O�� v . - / - _ C' /' D l �� —7/ �%�I�� �%�� / L1Y� 1/�/CIC � ✓�- —1 � � / . + � �? - � • _ � � �.. � �� . . • � . . . .�. .�. �. ��� � :- ... . _. �_ � . . ' si�nature . .... _.. __. ,. � _ .,. � .. _ .� _. __ ., � . � � -.._�._: ..'::. . .�.. ..;;�..:��-'.. � � .,. ' • , .,.. ; . ,r . , rsv. 12/07/92 7 � ' . ... t�� — --' "- — -^^�---�ti�����_�.:..��.� �r � �. ' "'� «w�;, �� � . �.......-���:a,,,��t�� F . �....`..... _ .�..._ . _ . � . _� - . ° • • . � . . .. . �di • � , . , � � � , . . i a ;'°, . ..�.� . . ,..,. , ' � .. �ev. t�a7 � cmr a� c�.EnRwar�A ����ss Titte; MAAlNE FAC�E.tTY �PERRT� - CI.ASS DEFlNITION� 1N TERMS OF: . 1. ' �uties that �re Char�ctarfstic as ta � 3010 0 Serviae, sates, �nd maintenance w�rk ot ordinary ditficulty in connectior� with trie operetlon of mur�icipal marina dacking lacilitfes or oper�ttor� of � fnll cailectior� iaciiity, An empicyee in this classi�r.Ation is respansib3� far the gafe and efflctent operatbn of a marine tuelfng tacil�ty �t�d pubiic docks ov far the operatlon at a toil baath at a City taU �acility. Par�ocmed under . . ggn�rat sup�rvision. Q. Ty�jcal Tasks or Assi�m@�: " - �ispens�s marine �uels and lu��icarits ta a v�riaty of watercraft. iriSUras that all a�propriate saiery preoautla�s ar�a absarved. Receives and accaunts for rash. Processes ci�ecks and cre�it card sates. Preparas daily report> and recc�rds. Rec�ives, accowlt� for, arid inventaries fuel stock. Asstgns �lips to transiertt vessefs and assists sam� in moaring. Monitors �o�bcs and moarad wa#ar�rah tf�rnugh Aoria�ic inspections. Ad�usts mnd re-positions mooring ii�es as requirad. Answers telephnn� calls and pravides ma�ine infarmati�n. Callects s�ip rentals and issu�s parking perm�ts. Reads and records ele�tric m�ters. Perfonns minor maintenance and marine-rnlaiErd ta��cs. Makas change far motorists and sells tok�n�. (ns�res ihat �raper falls are pa�d by tatf facitity c�se�s. Provides gQn�ral info; matlon to m�tarists. R�ceives �nd accaunts 1or cash on hand in tt�e tolf chsnge iund. F"r�pares simpie r��arts �n trafrc. Oper�tes drawbridgo when requirvd. Peri�mns light hauseiceeping and mainter�anco ta,sics at tf�s ' toll facility. PeKorms retated tasks as assigned. ti � �� u � •� ;:. _u=� ' a� As to knowledqe� ►k�ils, abfltties, and other attrib�tes: � t Knowiedge oi gerieral marir�e praciices related to fueiing and dacking. Knowledge af local and surrnunding beac� and geographic areas. A�ility to i�and{e targe sums of rnoney. . Abilify to make c�ange quickly and accUrately, to prepare simple reports and ta maintain recards. � � Abiliry ta work rotating shi�ts. � Ability to provi�e general intormatifln to both bvaters and motnrists in a co�rteaus and iacttul manrter. Good physical car�ditton with no serious dafects ot vision, hearing, ar lirnbs. Possass#on oi a va!!�f State of Florida drive�s license. b. /� to schooling, Uaining, ana experience: High Sc�oai graduatinr�, Hfg#� Sctzo�� Equivale�rcy Dipfoma, or G.E.D. Certtficate. ar�e {1) yaar. af exp�rience in service statlon operatfons or in work f�elated to boating or dor�cir�g aperations. Six months a! ex�erier�ce i� h�ndiing mor�ey and making change.. n s� , .�'���-1955 1 �� 2a FRda u.�w��a rua� � rw ' � � � Ti? . � '+ � � , te�rin• Faa�li�y o�a�ri�ru� et Cl�nrr►�t�r Harina� •�� ��r�/ a.I�rr/ •►Ii yV1 f'� 1 wr�� G�90 P�Bx . M�ta� be phyeioall abl• �v aaai�� bon��ara at tha Nc+r�.na tuax " loak by t�ainy up thf�r v�ti�e�,s. whiah aomo�fmna roquira� �he iul].it�q o� �ho v�a�re1 i��a �hn dook. . . Ku�t b� physi�t��.�y t��le �v paaea tuBl hoao �,�nos �o' �hn boakar. �hi�o oh�axviriq a�,� a�at�ty proanu�iona. �h,�a raquirass pul3.i�q ti� a�pproxl.sar��oly �0+ o� tuel hos�o xrot� �h� hasa rbo�. cont�i�prr hd rarrind9,nq n� naaa�r�ary. ' . Hup� �o physioally abZa to operaCe �htr ADA h��dloa� 1i�� at ho Mdrin4 �ue]l dnok 'and ConmerofaZ tu�1. �Y.ip. '�h.�a raqt�iro� �hd 3,�camnnt ot �h� davit, eflc�t ar,d othor �quipmon� and ��raitrtirig bandia�p baa�ar��gu�ata in�o the� ���t �snd operat�.hq �hQ wi.noh bn�h �� 1.r�wars�q nnd �rai,sing �t�a parr+nri. s. Mue� ma�ri��in �1� �ua1 Clac�k nqu�pMant and a�c,an tiha in�c�rinr o�C �1�0 lua�, daak butid�t�g. 4. Munt ba a�hie �o a��anr�m�c ba�h g�mollri� a�d diaAa� �uA�. dispan�a�t� P�,i�ar�, lUmi noa�cl�a nnd o�laah tubl �tarQen�. S, Hua� be phy�3.atill.y e►b�i �a ape►reta �ha o�wag� vaQOn1. pnmp ou1: .�taC�on, vhi�h.requiree��nupplyi�p �h� bon�ar with �ho� pum� aut baoo a� �pproxima���y �0 �c� GO �a�� troz� �he ha�� raa� aon�ainar and. ��us�hinV awt et�d r�windin� th� ho,xe �t#:er ��e. 6, Mud� monitor rh+a �ooUrity e� anl�ire mnxin� and ��], ve�aola�� �hinh ra q�lrep tha wnik�nq nt the ���ira ro�x�.t�a aomplax e�t Zoa�� onca •dc�rinq aaah a�hi�t� cheakir�q tor uata�y r�ln�s�d i�emt�. 7. Mu�� ba phyn�.aQl].y ebla ta bc3 jvs� moarinq lin�a on v�suo�� .it c►aaesstuary �,o pro�oat both �hn va��e}.� anc� afty dock�. . •• 8. Mu�t bs phyeianily �b�e to rotaova th�a do�a���r�,rt pump tram tlim nta�r�qn a�co�a and plaa� on any vss��l a� tiha M�x��n ��k�ny v� HA��r. Th�a �� �ar���dnrr+d em�+rydt�ay work. 0 0 y .• A. Nu�� bo p�yaioax��. abla �o ba tixp�: rn�pondar tio aii a�nd fua�, apilla e►t �he Marin�•,;. Thia roquixs� tho pleoem�n�. �9� �i� �az�k _ psdo and bn����n in th� �A��r� �Th�n i� oartaidor�d i�u�ar���ncy xvrk. '` . Ys � - , ..., ;.,., . . . Y•r �•; '� So. H�at take �usl �nnk �tiok �nd luok �i.npv��er re�din�r� �ar eaoh �hitt c��e�gne+d. �v�k prc�pnro r�pa��b, a].oa�n aut ehl.�t� �nka aadh rogi��or roadin�, �ocroun� �o� �hitt oa�a� and alo�� ou� aroclit o��rd mavhinw. 1�.. Mu�r� �sita�qn trane�iar�� aYip+ ta bnatarw e�nd diravr tham �o prapn�x r�l�.prt and �+amQ�imep a�aia� thon it� Q��tinq �he vorraol l����� ' � tha �].ip. , � • . ��. Hua� give .�ni4�fid�t�0� �o bon�arr �nd th�� qan��aJ, pub],ia, � . , . '""` a- . �rara. p. e2 � . � ,. . . . . . . .� ,. . , � . a •. . . .. .,w+.. .' f,. .. '' . � ..r . �,i . . , 1:� . . ' � ' � 'y . ' � ' � � . � . . , , , , � , . � , � ' ' . � .. . . � . ' �� , . . . . ' � : , ' � � � � , � . , . � .. , ' ' . ' . , , i . � ' . r�'� , � i . '11 ' , . . .' '.. . . � 1 ' � . ' ' , . . . 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O p. ,{� . 1 l��l /�4,��L �D.� � �_� �. GU �h ]� �� e�,+� �� � n 7` ��� 7` f, . � /� � / / ' , . � /�` S -� !y �c s !/ � � r5 .c . 7G �o i � ' ' � V ! �{ / /il .�S '?i��� h%p/ �• �GJ ! � . � , ����� ��.� �� �o ����,--�� `��� � � r,v �-� �. �t c� c v�-.- .�... v� a'�� o K s. . , ` 1 �, , , � � . �/ S[� �Q. 1 7`(� �G Lr CX � h t� UI C Gti t' . , � C� r r/ v�S i n C% T� �cJ .' "t' L[ b-t v�. G. e SS • c 0 � �' � . . . . ' ' ' � ' ' . � i_',,1�,�,• � . , . ' � � •. '.. . . , ' �� , '� ; 'i�' ' . � . ' � • � � .. . •� � . � . , . . e � � , , . . , . . . ' ' f. , ' . . , , . r , . ' ' ' ' o ' . � � . ' ` . ' , ' , r � i . , . � �. � . ,.' f. . � . � ' ' • .. ` ' ' . , ' . . I ' . , •'s . ' ' . � ' � . , �. � ; : . ' , . , , � :�' . . , ' 'i; ' , � . , ,}, �, �,,: r�-,r,, �,t . � , . , , . , , t .1 � ..-f�. .-... . ,« e`SS r,F.h.�..k�..i... .. . . .. � . .... � . � .i. . � ` 1 1 � ' • • � ' � ' ;i z���� r�n��r•rs r,� � ��:���[� � �n�' ���tl�u$� ' �e�c'k ,rr1r! Nuc'k (.'rrrt� � �� onhap�e�c Spme sw�rry Tbe l.argext Sjngle Sp1ne Ccire G'��jTtNr ln r1�e L7![ted 5tudes Ui�u�s j. Wdtand. !►�.t3., P.A. � L1�rabeth C. 5ims. H.D., PA. � I�.�ul J, iak. H,D. � Andrerv C ►4asrr, i7.0. I,� lY�vic! A. Benaiir. M.D. ;� .Irlin,�• 5. 'llurp. Q,U. �; - clttltop�edk Surgcry• ;� Jc��� ��. �tar�n� 1t.n. � , � ' Yhysk�l Mc�llttne � 1� Rthabilltatlon R��hrn [}. Gnihcr. I},Q. ' ' �:euu�ntknc G. Wat►chlu, �I.D. . Fr�ncisco 4i. "t'urre�R�mns. N.i3. Krnncth P. Batwin, 4l.D. qrn�amb� ti. Aucrbarh. D,O. �tcur�r{o�y , Jains U. Lih�rrosCuplda. hLD. I,UI. G. �igutm�. 14.D. . �euroradtok�gy . c.: n. rt,�n. ��.d � �yci►at��y � , Ki:^��xr�,�'. Fr�nk. #�i�. D. ('1►rttttic Patt� I �:Irari,y K P+�fuci�, b.U. i.� anc c:. Lt�Euml�us, U.C?. til�irtc� Grr1�.� 5c�rr�i�'��� . � �mzRtn� »itt . . �: i' arsn a1►�clo�:un 5plrie Sur�y �pir�t Rc�unstn�ctions l •r+rr Rislc��tam}� Pcr�tiwlcnus Fusi�lns , ku�iuols ° ��lr►xl5crnosis • }fe•rni��cd n�sCS . �l��csroatagaosste �edlcfae 1:.111i tirn't CnncfuCtfun Sn�dy �,ti� f�curologlcai tisessment ti�+ina! pi�arcict� . Hcaclychca � xixurts ' 1tcl�sbWtation Services ; 1'i�ysic.�l Thcr.�PY ! Pha�sica) Rrcondlt3oning Aq�r�tic'ihmPY � fi�ck 5ch�at �rthtitis Rciicf nsychulo�kal Scrvlrts Errluatinn S i'n:llmtnt . f•afn KanaKrmrnt iliaft�c�l6ack 5aR TLksuc Inj ur'y �1�nipul�tinn F'hyticyl Thcr�pY . f�idur�l Strn►id 1njKCtions 'I'ri�ri PaGti� Znjcctinns . �,' Augugt 25, 1995 , , TO WH�M �T Ml�►Y CONCERN RE: GARY MILARCK (7127) � , . .Ilr . •. . � Mr. Mi.iarck has advised me that��n the near �uture, his posi�ion ag a tol� operatur wi11 be �1.iminated and that his on�.y remain�ng �ob°option w�11 be as a marine fuel dock operator. The ��ue�. dack operator p�sition has already demons�rated to be in Excess of his physicaZ capabi}.ities and atf a similar position to the toll operator, or at Ze�st one wfthin his phys�.cal. limitat3.ons cannot be accammodated, th�r� T do bel�.evo that he is occupationally d'is�bled from warking as a marine faca.r�ity� operatar. � ' If there are any further questions, p�.ease don't hesitate to contact �his ofPice. Sincerc�Iy, ' r Robert D. Grubex, D.O. Dip3amate, Am�rican Board of ; Phyaical Medicirie and Rehabi�.itation �Medi.cal Directoz, Flarida Spine Inst�.tute ' RDG/jr . D&T: 08/25/95 . ?250 Drcw Streec, Clearwatrr, Finricl;i 3�G25 '� (fi I 3) 797•7�G3 � E�ax (8l3) 72Cr138U � ■ . ` � �...�� i � � �F � .' . , ' : , . , � , . ' � , � � � � • �.1r...:l��' t' ', . , ' ' ... .� ..' . .. 3 i . • � . . l• E � Y�vc���t c� YAZVC��� AITOR N �Y5 S E P 2'� i995 WILUAM Fi. YANG�R JR. . . • OFF10ES - WILLIAM L YAfVG�R pLE'AS� R�PI.Y TO; 7AMPA AaDRESS � 324 S. HSrp� P�tHK AVENU� cwRrsroP►�Ea.�, sM�rr� �5eptember 25, I995 � su� z�o 7AMF'/� F1AItI0A 336QE Ma. Debbie. Ford • T��.��►+or�e ta�3i �zg•oeaa FIICSIMILfi (813) 22D-e�oa Human Rasources City of Cl.Ber'w$te�C' x�a s�. N��ew�v �a Poat p�fice Box 4748 � � 5u"� a GRY5TA1. RIVER FTAi7�DA 34420 Cilea�i�$t8i� Flarida 34b�.���74� TELEpHONE (pW) 363•8466 ' � FAC5IMILE {DOA) 383-6A89 � Re: Employee: Gary Milarck � , , ss#: . �.a�-a�-oesa . Dear Ma. Ford: � . Thie is to confirm my telephone� discusaion with you on �� Monday, September �5, 199w wherein we diecussed the following: x advised you thst � represent Gary Milarck, � Ci�y of Clearw��er em�loyee, that has applied for an in line o� duty . .� d�sabil�.ty pension. ' � Mr. .Mi�arck, as you are aware, was scl�eduled to appear before the Pension Advisory Comm�.ttee of the City af Clearwater ,on Wednesdny, September 27, x995. � Mr, Milarck had echeduled an �appoin•l:ment with Steven Bifulco, M.D..for Friday, September 22, 1995 for an examination regarding his medical conditivn, hawaver, Dr. Hifulco's offfce called Mr. Milarck on Friday, September 22, .1995 ond told Mr. M�,l.arck that the appnintment �or the ext�mination� wou3.d have to be rese� for 5eptemb�r 29, �.995. The reas�on for reset�3nr� the appointment was that Dr. B�.fu�co was called out of town and would not be avai�able �'or the exam�.nation. � Mr. M�.larck plans to have the examinatian on Fi•iday, �ept�mber 29, 1995. . You advised me �hat you wou�d give notice to the Pensivn Advisory Commi�tee that Mr. Milarck would r�at appear on September 27, 1995, but would be appearing eithar on Octobar 4, 1995 or October 18, �.995. Thank you in advance �or your cont�nued coopesation. � Youre truly, . ��� �� . � s�� � � W#.11iam H. Yanger, Jr. WHYJr/san � cc: Gary Milarck �' , , � ,. , . . . � . I i � . '' . . . � ' ' ' ' . ' . ' ' . . . ' � ' �t� ' � . .'A. � . . .. s. . .� � . . -� . � ` . . . . . . � , � ' . , � , � �'_: ., i 3 . � � � , • ., • ' . . , ' , ., , ' , ' . . ' ' . [ , r � . � . . . . � • i � . • . . � . ' . . . . . ' . . t ` � ' . . � r � ' ' � . t. �1'' ai . : � : ' , � ,' � ' ' ' . ' . �•ti ! , ' , , , ' ' ' , ' ' � . � i . . . . . . [ . . . . . , r . ' .. . • ' ' _ . . �' � . . . ' � . . , . . 1 .. . . . . � . 1 ' . . � . . " . , ',, . . � , � ' � ' � � - ' .� ' ' : � ' . • . ! . , � e . . • . . ' . ' . . � . 1 .. ' " , ' ' . . 1' � E ' •. ' . ' . —I . . . . I . t` . .! ' 1 ' , ` i� . . > > . .. i ' � . � . i ' • . . •ii. •5 1 ' . � . �I � . �.1:. � �'��'�i �l:ea�F�ia �. .. �i •� z•'.��'. �.�ia� .. .. . . . . . ... ...4. .. . ,.i , � . . . . . - � . . � . r ' . '' ` f �' �.1 ` „ � . .. � . . . ��• r � . R . ' . ' . . � � � � �, RI'CNARD F. LYSTER, M:C�, P'.A. � � � � . , ' • OIt�.QNATO Qf TH� AAIf.fUGIN MWRD dF OR7'HOMSDIC SUfiOERY , �, , I"iL1,0�M AAIEJlfG1N AG►AF�+tY OF ORTHOMF.DIC Su11dERY . ' ' '• 12Q�1 FlF�'H AYFNLIE NO�iITH. Siil7'� 100 ' ' . TECEPHCtN� � '�! , ST: PEi'ERS�i1�, �LDRIDA 317a3 ' . {�1]? Q22•]IlU � � Oct.c�ber 27, 1995 ' � � . � ' Debbi� �ord . � � � • ' � Gitti of Clearwater , ' � ' . . :,�., ' ; P. 0. Hox 47�#8 . . . � . • Cl�earwater, FL 3�61$--4748 . . � . �� . • • • RE: Gary � Mi.larck � . � � ' � . . . 'i `'. DO�: 8/l0/g9 . � � � .� .• , .Em��loyer: Ci�y of Cle�rwater ��, .i, . ' De�r Ais. . �'ord, . ' � . ''� ;:. Y. e�t�rmined Mr. Gary Milarclz in my of.fice on �ctober 27 t 1995 � He � . �cas not accompanied by t�nyone. My o£fice manager was presertt � � ,� r�titrin� �he eYamination. �s . . . � � PRESENT HISTORY ,� ' � � # The patient was injured August 10, �989 wtien he ,k,ifted a h�avy a � ch�ir anu ,tvrned, gi.ving him a sharp pain in the middle oi' r��e ���� luwer �.i�m�ar area. He was seen.at m wAZk-in-cli.nic and was given � F��xe,ri3. �nd at�ather medication and x--rAys ���ere ta)ten. He was � theu referred to Dr. Gogue and was sent to rl�r�on Pl.ant. for,. pt��sic�Z therapy of ultrASaund and �x�rcises. Aiaout two ta tirree � monttis l.�ter he re,�urned ta work at Clearwat�r P�ss I3ri.dge as � , � L413. ta�:er and bridge operator. He staved under t}ie eare �i' Dr. Lo�3ie far �bo�tt a yeai• �nd was �. ther� transferred to Dr. SenH. He j � start,ed with Florida Spine Ins�itute from roughly 1991 to i.t;e . i.� pi•FSeiit" time and t�AS beei� changpd ta Ur. Goober, D.O. for continuing treatment. The patient harl a riRi orc�ered kry Dr. Sen� in 1953. " , �i.s current job status is light duty bec�us� standing for lang ' periods of tim� caUSes pain to radiate down ihc� right leg ta the �eeZ� li� has been in th�rapy consisting of an exercise program and �s talcin� Matrin and Soma� The patient w�s tz�ansferred to Clearwater Mari.na when the Clearwster Bridge tiaas clos�d in July af 1995. He s�ates th�t th� . wark is too strer�uous for his back and his leg pai.ns bec�me more severe. -� � �. PRESENT CD�PLA�NT � � , � , The pa�ient has lower back pein with modez�a�e leg pai.ns in the , � right leg wlth occasiot�al left ].eg pains. �� , , , , , ' � . ,� �. , . � � � . - -- ' �.,..s�..�.��.�.....� ..., . , .f� r ' , . � " 'e- . j. . . . . � . ' ' .. . f , . . . . . � , F 1 , ' . ' ( ' � ' ' .�', . ' �� . . . ' ... . , . � . � 11. ,' �' � .�' � 'r , ' ' • . . . I ' , � ' , � � . � .� f . . i , � � 1 • I.i �. . . . � ' . . . 1 . � . . , i . � � : . . . ' 1}�f�p'ij, � ' ' . I ' . ?i. � � . . . . • . ��r . � . . � r . .. . . �. . �. . . � . , �. � , ��ARY MILA�CK , , j I , :, , , . . . � . ���� � ��ST HiSTORY ' ` .' The pAti�nt has no hfstory af. gou�, rheuma�oic3 �rthritis, , diabek,es, or al.lergies. He was an Airforce v�tex�an for three mQnt}is� and was releaseci because af ulnspecified allergies while in service� in Tex�.s. fie dfles not know of any allergies tt1At I7� naw has. 'I'he patiien� has worked for'18 years for tne City o� CJ,earw�ter. He is �I'years of sge and single. There is no fAmiZv'history oi back trouble and ihe pa�i.et�t has not been in any auta accidet�xs ar�had any sports i.njuries t� his knowledge� PHYSICAL EXAM�NAT�QN � The patient s�ands 6'�4�" and his present weight is 2�fi 1/2 �bs. On phpsical� examinati.on � the patier►t wa].ks wi rh � normal walkin� gait, he cAn heel and i;oe w�ll�, but conipl�ins of pain in the right Ieg with hee]. wa�kxng. He gaes �o a f�ll squat anc� stands witlio�t� difficul�ty. � On lumbar' examinatian the pati.ent has no k�dney �.enderness to p�rcus�ian and has no �raehanterzc tenderness ta p�lpation, He farward f�eYes �a 70 degrees brin�zng his hands to a�ot�t 1-� � �inches.o,f touching the floor. He exten�s �6 degrees, he side . bends ta .the ri�ht 20 degrees and 15 degrees ta the Zeft. He rotates to the rigiit 6Q degrees, and to the left 6Q degrees� Hi.s reflexes are �sll +2 in both the Achilles �nd k.he patellar te�ndvr�s.. �n the sitting position �he patient leans back slightl�- and has straigHt leg raising at 9Q degrees at that point. He � daes not have �ny cdmpl.ain�.s of dascomfort,. He has gaod ehtens�r tendon stren�th both great taes. �n the sitting position the pRtient has diminished sensation over �.he erttire right lo�e.r is� k.l��t stops at the Itnee and does no�r �o be�on� that �e�•el.. Ttie ieft leg appeKrs to hav� normal s�nsation throughout. In the s+ip i ne gos i t zon the p�t i�nt can 1 i f t both l.e�s appro� i.ma�� 1 y � 5 degrees from'the t�ble And then complains of low back pain. H� h€zs straight le� raising ��i�t�r�ilv at 7D degrees in the supine pasition wi'th back discomfort. Both ltnees flex to th� c�est and at �.ha� pai.nt he complains of bacic pai.n. Patri.ck's tes� on the 1eft.with wi.de abduction causes low back pain, on the i�ig�i� ne has some restriction and abducts about 70 degrees in the PAtrick's test and then resists further externaI. rotatian. The pt�fiiet�t has no abdominr�l pAin to palpat�on and bimat�tia.l. p�l�atioii of tHe kidneys. Un cerv.i.cA� examination, the F�atient has a f.ull r�nge of moti'an in the cervi,c�]. spine And �here is r�o evidence oi ].in�itation. He has f'u11. rarige ai motion a.n bath upper extr�mities, intern�l �external rotation are a21 withiii normal limits. 'Fhe pnti�n� has ch�est e�par�sion nf 1/2 inch. , � � .. ' �, ''�,i .. ' (' . . .' e� • • , , ' " i . i ' ' ` ' � ' , � ' . . ' • ' ' t - , ' � • , s, .. • . , _ , . . . � . • ". ' ' � ' � � ' . . . ; I� . ' �f � .� . . , ' � .5 . • ' ' .. . . ' ' ' ' ' . 1 . , •t' ' 1 � '' ' ° 'r, � , , . ' . • • ' ! t . . ' , ' , .' . ,• ' ,. ' 1' /� . . t , ' . . . , . . . � . , ' � ' . � , i � � . . � . . . � � . ' ' . . . �� , . � ° ' .. . . , ' , ' ' ' ,. ' ' .1,s;t ��5� , ''f �1�.'? , ... `', � . .. ' . .�. •i�'��"7'r �• .... ,. .. � ., , .., .. . . .. . . � . . . � . . 'f .. , '�• �� . .. ,'� < , . , t . • . • '� . j' � � i. ♦ . � � , � . � . � GARY MILARGK . � ' . . � pa8�' � , ' �{�►,Y FIND� INQS . ' � � . ; . � X-rays accompanying the patient in the AP and lat�ral views do ' nat shok� any spondylolvsi�s or spandvlolisi�esis. He daes ha�'e a .. spir�a bifida occulta nt �the L�-S1 Ze��el. No ob�.iques .or.spvt �� fil.ms wer�'presented'and there is na, wav of teZling whether he has a pars defect in the�e areas. The MRI accompanying the ' ,.� �, ps�ti�nt was done in 1993 �and to my i.nterpretation, he appears to ' have A� disc hernia�ior� a� L5-S�. � , � . . � .. X-rays.of the iumbosacral spine were taken at St, rinthon�• �� � Hospztal. ,Copies are er�clased with thi.s repori. The impression , ,• is dege�erativ� chan�es.invalving the facets at L4-5 and L5--S1 on the ieft.- There is na evid�nce af frac�ures, spondy�.ol.ysis or � spondylv�isth�sis. , � � . , � � aJ.so oraer�d a CT scaiz done at St � Anthany H4spi.ta�. and � capy will. be �arwarded with this repart'. The impressian is no � defi.ni.�e evidence of a hernia�ed nuc�.eus pul.posus oi the ].umbar � �spine. There is mild central spinal canal stenosis at L4-5 and , �� L5-S1 leveJ. secondary to mild diffuse disc bulging �.nd bila4eral � facet jaint hyper�rophy. There is nc� evidence af a pars interarticularis defect of the lower iumbar spine. Spina bifida �, occulta at S1 is noted,on the right. Minimal f$cet joint � , , hypertrophy at,L3-4 1ev�i. �MPRESSION � • � Using the 1993 F�orida Impai.rment Guide, Pnge 14 for spinal. s�tenosis and segment�� insiabiLi�y unaperated wit�e a6jec�.ive signs of injury �.umbnr would be 5 percen�. Since �he spinal canal sienosis covers L4-5 and i5-S1, I would have �o add 1 percer�t iar a total of 6 percent Tmpairm�nt Gui�e Rating. I be�.ieve the pA�i.ent is at MMi with an �mpairment Gt�id� rating o� 6 p�rcent. I would recommend no twisting ar bending �nc3 wo�].d a].so recamm�nd a 34 lb. weight ],imiL• restriction. This patient would �e �nable to perform the job descriptian of a MArine Cacili�y Op�rator �s forwarded to my office in th� area of � adjusting and re-posi.tionin� mooring 1in�s �nd fuEling ' wat�rcraft� I would �recommend that he be reassigned to �,ol}. booth work. If there are further questions, please feel Pree �a contact my affice. � � • � 5incerely� , � , , Richard F. Lyster, M.D. � � RFL : j g , . , � enc , � � � � � . . . ._, . , . . �, . . , �. � . ,� . . • ` � . . , , . . t� , . � , , , . ., � . � , . 5 � . • . 1 . . . • , . . . • �. . R€:{f },y' � , ��� � • . • . ' � . � � I • � ' ' . . • �� �' . . . . . 3 � . � � . . , . . . . .. .. x r . , i . . . . , . ' ` . . � ' ' . . ' � � . �•.. .. .- �.. �. . • �.. ; . _ ..» .. . . ' ' ' . 87'. AN�'NaNY. R Hp�PITAT� . � , 17.8p � 7TH AV1� N, • � . � ' . � p. 0. AOX 1 ?. � F�8 � � fiT. P�TkRSArlAr,, F�� .�.3 � 33 � pt . N�ma, �I�f,A�7CK, GAt�Y � � l.JqB 'r 641,t 5/5� Age �1x Y , Mf�R A�00�57.1 a6S � Roam/Saurce 1�IS . .4rct. Dt. ' l�xem lJAter ,I6/�7/95 IR43 � Account � 95.��0�0�57 Chk-Jn� 94569 . Relecaeed, 10/T&19.5 J�J a �1rd�. Pl�ys�C.t�nr t.YS7'�N, �i�'F1AHl� � . Arim� I,YST&N, RtCNARD F i� . � ....�w �.. - � � - � � - . .....�._ C a n � � �rd l,oct �pT . '� Ar . A.�r, NR RD F' t, I�,S7'�4R, � M13 � . ! J7.01 5ti� Avenue N., ;�3�0 � ' . �,,�t.� ,Peier�b��rg.,... . ; Ft.. 33T65 . . . .. , � , , , . . �. � C017 C f'AGi: lJHl�TF. r r,hk- in � �Jrder �x�m . � ` '�45�p � fl007. 3, 7.�iA4 CT 1�t1MRAR ,SP71dl� Wfr.� r_nNTRh,sT . �?r�i 1?���, R��l P�J,S,S. AARS DRFh'f,'7' bulge h�F � sJr�ilAr- cnnfigilr��icrrr �� �n �1�e previt7t,s JN�.T' �car�. � . There �s aver�� 2 mi 2��i cerrtr�.1":�?�trr�.I c�r��! ,�teno�t.g �C tltiq leveI secartdAr�y Gn tJ�e diRC ��l)CjP in CAli��?f1iA�:�On witlt fAC:Pr ��}nt nYp�rtrophy. � . ,..,,�...,.,� T[�ere �a no evtdsnce a;� a p�re .trtteret.Clcularia defect ai �he L�i Qt- •.;�;,�;��,�.��.b3. �verr�brp. ,:.agit��� b,if,ida acsculta o� S2 .1��r..rrot.�� on �h� , r1ghC . , . 1"MF�R��S�SIpN r . � NC? nRFTNTTR RVTIJRNC.R DF A{��f7NTAr�n N(ICf�RIl,S A(JI,F��,SU,S OF' THR l,i1M8AR ,fiP.rN�. ' �fTLA C�SNTRAJ� ,SPTNAJ, CANA1� �S7'RNC1�5F�S AT THFs 1,4-5 ANf� 1�5-,SJ . L�i/�t,�S �S�CON�pARY Tc1 ��'t�A �iFFU,SR �isr, �11LGiNr RNi) �3I't,ATRNAII �AC�ST ��OJ'NT NYP�sRTROPHY. � . ,,.. • . ,, .... , . . . . . . . . . . ' , , N4 �'�IFp�Nr,� DF A FAfi, �NTf�RAR?'ICfILARIS DI�F'h'CT 4F TNl� )�r�W�R 1,tlMAA14 �pTH�. �SP7NA Ar�TI�A o�CUT,TA oF ,sl T� NnTRl7 �JN TH�' FtIGNT. � MJNJl�fA1� F'ACftT J�TN7' FfYF�ATRpPHY RT �'ff� f,3,l,4 !��'V1�L. , THANK YOU Ff7R THIS RP�!?�RHA1,. NJ�S Int'prpre#:ed byr Ch�J�tirrP l,�r�en N,n, Rp1�a�ed by, Chr.t�tlr�P l,flr�ert M.[3. . , t • ' 7 4. . tr p ��T. �q;�u.Cpy Ce v,. ` a�,a►��'���I���/1 �P� � r3. .•:���1j�i�Y' '�' �)'Y�' Rfl? _ ���:��;�t/� ��+�....`+.���il; •'': .�V�:'y, ri F �" }�/�i=i1l►� i ''4' •i'F {. �l�.�',rj� y +5 :4 .i. . S \ � it � �i�. � 1. t•' ti'i'• � •!. . - � � tr�[ fiY'��•','Ih �� 'Yi• ���• '4 . � �� � r�� - - � � � �.,} . , , '. . � ' ' , �. . � i�, � . ' . , � . . ' � . . . . . . . � ' . � . � . r � '� ' • , . . .,. , . � , � , • ��' i ' � � ' ' . ' �. , ' , , � ' ' ' ` � . , ' . . , . .. . . ' , . . , � ' � � . . , . . , �. , ,• , . . _ . , . '. 1 � � • ,, � . ' " • � '€ „���; � �u.w;,. ,SF, ..., . . � ' �,i:rl;�; ......:. .. ,. .:� 4 ' .' . . ,. . .. , , � � , � . ' . „ i � . �3 �' � � � .S7'. AN7'N�NY' �S fla,SPl TR 1► � . 11'" �, � � , ', � � , 120� 7�'N AV�s N. � . ' , , , � .F�p. HOX 17.SAF� � . . : ��, �. . . ' � ' F?'� ABT$RSSfIRG, FL .33733 . , ; . .. . . � , . , � � ,�'� , � � ,' � . . -� Pt. Ntlme� NI1.Ai�C1C,GARY B�� . D4I� i64/15/5�f A9e 4.jY • NR� ' A6000521 �F5 Rontnl�S'o�rce i?J�fi . Urd. nt. , � . l�x�m Uate� .ts127/95..�8�3 . . Accaunt �� 9.5.�6D@PJ057 Cttk-?n/ �4569 R�1 e��p.d: J�/?.8/45 162,9 , tlyd. PhyBic.lr�n� LYSTSR, RICXARD F hd�s �GYST�R, RrCNARD F • ,,," • � . ' C b n � . nr. "�xc���n �''L'�'s�a1�, Hn• � � � � ' � , . . �rd �vcr 4AT - � Y ' . + . . � , ,, ,,_ . .�,. ,, ,. � � i'2@1 Sth Avenue N., �30A � � �' . ,� .St. • Peier�b��rg Ff, 3.?7B5 � . , � �CanCrACt NAme� . ' � � Chk,1n ;� �Jrrier � Bxem � . � � ��4569 006?. .7.75B4 GT f,I1HRAR aSPINR W/0 r:01JTR��ST , � Or�i DtAg: A/� PC�S,S. PAR�S A,�FKC7' T�CNN�?br7GI.ST, Rartaln Wt.i.I�amB, _ C7' SCAlJ 0�' TH�S I,UNBAR �tiPTN� WI7'NOUi' CONTRA�ST� . �T�CNNiQr1�4, 3 mm sxi�I ��.ice th��knegR 1m�ges c�ere performed of the d�gr. :�par.�;► oc �11e L7-.� �r�c! 1�3-9 vpr�e6rr�P.� 3 mm ex��l sl ic� Ghlckrrese fma}�� wpra p'er�Eormed through most of the f,� v�riebra �daNn to �hP mfd �S1 v�rtabr�ee. � � F�TNr�zNr,S� fihz C.'T 4r.Ar1 �F tlre lumh�r �p.tn� �� cead ir� car��ur�ction wit1� the patlent'e pr•eviavs NRT scAn f.rom CIe�arNatPr Cc�mmurlity ImAg.trr� Cer�Cer dated 3-1.5-43. ' •f�t t'he J.?.-3 errd �t tfle 1,7-4 JevelF tl�ere is no evic�Fnce o� �n obviatls herrriated r�r�c�l�us pulpoRUS. Tllere i9 n� �vld�nce of centrel 8pinal cpr�al .st�nogJs And rra P.V,�fJPnCP. af,� ne�raa faremin�l ',�tenr��L�. ,wltrimer f�cet joiRt hypQrtrr�phy !s identifled �t the L3- 9 1ev�J. 7'1�erp is r�o abv�ous Qv�dence af. � pprs interarrlc�rler.is cfeiect HC th� L7 vr t, � teve.� . � � At' tf�e !�a-5 tli�re� is a mild diffuse di�r. hu1g�. Ther�P js aver-e�JJ mi td cerrtral sp�n� 1 CRnAi stenas�s aC this level Recortd�sry �to �he ; ..,:,�..�,.df,a,�,;by����;:t�n�{�o�b.ln�tJon:.w.ith m1�.Id.,b��a,��era1.L,,f,ace,tr��a�;intr.,..,:,���c.--,�,�;:,:,.��..��s ,� . . + ' e,,. h'yp�rt�roF�ry, T�ie�re 1a` tio ob�i�acrs evidence 'of �e lterrrf�ti�rr o� the . n�cle�s psalpos�ls and r�a evlder�ce of neural for�min�J �rPn�sis pt rri ts i�ve1 . At �.1t� L5-.51 JPVe1 there, i:a � milci diff.use disc bulge, Tlrp disc FI'NA1, R�PART Acrp�lc�te �' . . � , �r,ontlncleci on next P�9�1 1 --- _._ _ .._..._.._._ . .. _ _��._. - - :� l• ' i. ' . . . _ •�'til7: . ... � . . � � ... ' . ' f . .. .. . J • ' ' i � . . . . ' . ` 'F, • . , •i� ' . � . 1�. . ' . � � ' . ' ' • , , �' , 1 ' , � .. . . � j� ', , ' . '. . .� , ' ' � ,' 1 ' . ' . �, � . . . � ' � . . , . . � . • � . . . . � , . .i . . . . ` � '� ' � .. . . '.� ' , � , r� . . ` . � ' ' � . . ,`,' ,t, , .'t . e , . . . .. • , � � : , . , .. , , ' , . . , . • , , . .. . 1 ,� , � . �. . , , ' ' . • • ' <� . . ' � r . . , � , .. ' 1 _, . , . , , 1 , ' ,�1�'��� 'L� t �,•' ' ' � �,' . ... - .. i '' .' ; ; : ' ' ' ,. , �' ,� � �' ' . ' , ' � , ' ' , j �. ' ' . i . � , ' ' ' ' . • , . � . ,- � t r.<;:a�. � � ' � ' .i', , ' . �.� , ' ', � • I ,:r. �;;`.°=:f,�,:�.• ��. .�•�v..��;.n _.. . _ : �ST. �AN7'NON�Y'��S �N�p,SN1 J'+41,� . . ,,� . ; , . , . .,; . � :l . , . � . � �, 17�8 y?'N �AV� N. � , � . . . . , � . � '� P.O. A�X J rSBB . . . -..N „ . . , . ' � . . '. , . . ,5T'. PJ�TRRSB!lNG, F1. 3.� 7 3 � . , , �. , . . _ . . .' Pt . NRma, �lII,RRCI�, rRRY K � �. DOB' , 8�f/1 5l59 Rge �� Y ; . NR�i '' A�00057.1 �65 � Ftoo�lfiaurce nrs � f�rd: �,At. .. . � . . ', • ° � �xsm A�te, .IA/2?/95 1114 � � � Account � 95��@0s�57 C1�k-Tn�i, •9�97@ ' ' R�l�ae�d, )s/,?7l,95.?.@�Y� ' : Drd. Phy�lcten, .l,YS7'�R, �%CHAAD F• � �dm� 4Y,5TI�f7, H7'CFIAAp F' ,� _ .� ...,, .. ,. ,.- ---..�, -- � .. ^ ' • C o n � � � ' , ' � , , � � rJrd Loc, QAT '. - Dr. 'Rrr,H,4R� F I,YSTRF7, N[3 � , . . � 120? 5t11 AvPnue N�., #�3@0 � � , � � S�. P���rshurg ' FL ,33�65 , .. � Contr�ct Nam�� . ' ' • � �,. � . , . . . � � . . . , , r,hk-�n �v �orcier•� �xam � . � Qga'7p �001 ' ?�577 �� RD l',IIMAAR .SACRAIa ,SP7N�S � QAL ' , � fJrd D1��,�: R/CJ FAR�S C1�SF'�CT fIR DI�SC L�-L5 , � . � . • TRr,F{Nqr,Dr,.iS�r ��rlSAN. r CR�1NP7'�N, . . �� . ' LUN9USA4^AAL�.SAI1J�� , , . � - . . . . . . , . ., � . . ...�:�; . , . Therr� �rrP five �1um#�ar typ� vertebrt�e. The verLelar�J badi�s. eppeA�r - ' intac� w�thoi�t comprassfon deformtty. � Ther� �rP riegpnpretJve ct�eng�� invn�ving tt�c: f�cets At l�4-1,5 �nd � . ` L5-,St nn.trt� left. Nv fr�cttrre, sp��nc�ylolystr� ot .� �pandyloi�sthes3s. . . rr�e �NCrum �rtd ���zro1Ilac .?��n�s �pp�ar 1r�r.��t. � , . , . � 1'MPR��S,SiQld r ' - !]�C,R1d�,RA7'lV� GNANGf��S T1JVCi1,U7NG TNR FAC�TS AT J,9-1�,� �rrn t,5-.St �N 7'H� I.��.T. N� �RACTrlRR, 5Fr1NnYLC]LYSi,S �R �5P01JnY1�0I,7�STH�i�STaS. THANIti Y(JU FAl� 1'H.TS R�iF�RRAl,. TntPrprerc�d by, TN4MA+S �T ,�.C,ArJ M,n, � R�t��sett .byo ChrlsCine l,�rsen N.D. NJS ' • , ' ?�I NA1, �Rl�PQRT �up1 i cR t e , ��"t _ ��.�` '� � r�'� ,>.I. , � t, i� . . . , � � , i ' ' . � .' � ' �' �. �. . � , � ''' e ... � � 1 ' � , .�. ' ' .. , . . . ' ' , ' � . ' . . � ' � . . . �i . ' ` . . . . . � . . , ' ' . ' 1 ' ' ' . ' � ��, � • . . ' , . , . � , i. . � � � , � � . . ' ,��.•a � ' , . . , �f,' . ' � � . ' . ' , . . , ' � I.�, i.,• . ,1 ../ � ' ' . . ' . ; 1 ' . . �, t : .. . • ` . . • ' � . , . • ' .y � I. ' � , . � . . . . ' ' . . . . '. ' . . • , , . ' � . . � . � � ' . I. 3t 1 , 1 . � � �; � .. : . •.'`# �� 1, • ! � � ' r ' ' . . . , � � � ... • � ' ` A . . ' . ` 5' � . � � . ' ' ' . 3 . � .' . . } . . , : • �+ � !. . ...' . , . � � `. . . ' . � . � , � . , � � , ��I��i�Gt" �. '.e.. �,� , " ' � � . . ' . . .. , ' ' � ' • ' • � . ' , ��.,'4�41����.�`Al•.i . �h'til.ti:'f�e � � .....:q.��rvV'_i.r.w..—a � • . • ' i .. •,.. ' ` . ' • � ' . . � . ! i�� , � . ��' • . I . . .... . . . t , . . . . ; ' � ' �� . . � " . . . � � . � � . . . , . . , . . . � . 's , • , � . ST. " ANTHDNY'. S HQSP i TAL � �. ! ' • A200 7TH AVE N. � '' ' � - ' � � P. �. aDX 12588 � , - ' `� . ' � ' � 5'1'. PETERSBURD, . FL 337�3 ' � � ' F't. N�me: MILARCK,GqRY,E � ;. . DOB ;04Jl5/54 Age 41Y • .Ma# , A0000�22065 � ,, � Raom/Source DIS C}r�d. Dt. - � � . Eic�m Dat Q; 10/27/95 i l f 4� ,� Accoun�, # 9530000�57 Chk--in# 944?0 . ReleaSed: 10/27/95'2017 { O�rd. Fhys�ei�n: .LYS7ER� RICHARD F ,' � ' Adm: LYSTER� RICHARD F, I . .__._ C o n : . . � � . . ,. Qrd � Lae : DF''i - � . Dr; �IC{-IARD F LYSTER, MD � � � Y203, �th Avertue N. � #30@ ' � � 5t. �eter5b�r� FL 337�5 Contrac� Nam�: � ' rhk—in # �rder Exam � 944'70 .� 00@1 2h577 RD LUMHAR SACRAL 5G'INE -� DPL ' �, . � � Ctr^d L�iag: Ft/0 F�AR� nEFECT DR D,i5C L4—L5 TECHNaL�GIST: SUSAN C CROMRTDN, LUMAOSACRAL S�INE:� � , � � 7here are five lumi��r� type verte�:,�e. 7he v�rtebr�l f3df�1�5 a�ppear, int�ct wi�hou� compression defor�mi±y. , � . . Ther�e ar� de�enerativp chan�es invnlvin� the f�ce�5 at L4—LS �nd ' �.5--51 on tMe 3ef�. I�c� frac�ur�e, �porrdylolysxs or � 5pondyinii��hesis. ' � The s�cr�tm and s�cr4iliac jc�ints a�rpear i,ntact. F M�' RESS T ON : C3EGENEF�Ai I VE CHAN�ES I NVOLV i NG THE FACET5 AT L�+—L5 AND L5—S1. DN 7HE �EFT. NO FRACTURE, S��ONI]YLOLY5IS OR 5F►ONDYLDLISTHL�SIS. THANEi YOU FdR THIS REFE�tRAL. Interpreteci ty: Rele�aed by: NJS � FIIVAL RE�"ORT D��pi i cat e �. . . , 1 ,. � . ;f .�� � TH�MAS J EGAN M. D. Chris�ine Larsen M.D. � � .,. , ', ' , , �� . , . . . � . � � , , �,:' ,�' ' � • . .' . . . ' ' . ,. . , . . . , ' . . i � 1 �, � • � . . . .� . , , ' .i', , . �. ' ' ., � , ' � ,., �1 . ' . � � ' ' , . l,e .i II il. + r ' , ' ` Y. .. ' � • �' . ' � ' �� -`. . � . . � � . ' . � . � � .I . . I,� • t ' � . . . • . � ' � ' • � , • • .. . . . . I ' . . . 1`• °f ..., ., . , ••.st:o ._. � . . �. .'t:'� . ., i e. . ... e... .. , � � . . i�", ... . � � , . 'i ` , . � . ., .r � . . ' , . . . , ' �, � , �; ' . � � � � ST. ANTHDNY�S HdSRITAL � � 1 � ' � ,1200 7TH AVE N. � � � � � � � P.O. HDX 125�8 , � � 5Tr F+ETERSBU€iG, F'L 33733 �, � , �.�. � F't, N�me. MILARCKi GAFtY E D0� :4��+/15/S4 Age %+lY � t: MR#� A0�0@S�i0b5 floom/Source DIS Ord. Dt. . Exam Dat�: 1�/27/95 1843 ,, Accnunti # 953�Q�Q�Q10�? ' Chk—In# 945b9 ' Re1�7sed: 10/�B/95 1619 ' Qr�d. Physician: LYSTER, RI�HARD F Adm; LYSTER, RICHARD .F � Co�t: . � �r�rl Lnc: OF'T Dr. RICHAR� F LYSTER, MD ' � . 1:'Q�1 5th A�en�e N. ! #300 S�: �et�rs�urr� FL 337�� ' .Con�r�ct N�me: ' . ' , Chk--i� #� Order^ Exam . • 94569 �0�c�� 275B4 Ci LUMBAR 5F'INE W/0 CONTRAST .. � Ord Di�g: ft/O �DSS. FA�tS D�FECT ?�CHNC3LQGIST: Ranald Willi�ms, , , C7 SCAIV ❑F THE LUMPAR SF�INE WITHOUT CONTRAST: TECH4V�QUE: 3 mm ��ial �lice �r11C�lTip55 imaq�s wet,e performed of the disc spaces af �h� 1.�--� and L��4 ver,tebrae, �, m� �xi.a1 slie� thickness images were per�armed thrnugh most o�F the L�r vertQbra dnwn �o the mi.d S� veti���brae. FIhIAINGS: The CT sc�n nf the lumbar spi.ne i� read in con,junctian with the pa�ier��'s pr•evioz�s MRI scan from Cle�rw��et^ Cnmm��ni.ty Im��ing Cen�Qi� datec�.�-15-9�. . . A� the Lc-3 ancf at the L3-4 lev�i5 thpre is no evidence of an obvia�s herni�ted nucleus pulpos�as. �'her� zs no evidence af centt�al 5pi.nal �anal s�enosis and na evidence of ne�sr,al fnra�ninal stena�is. Minimal �ace� joir�t hypertrophy i� iden�ified at �he L3� 4 l�ve1. There i5 n�a obvious �vidence of � pars in�erar^�ic�alaris d�f�c� �� the L� or L3 level. At the L4-5 ther�e i5 a mild di.ff�.�s� cfi�c bulge. '��ere is uver^all r�ild centr^�1 spinal c�nal Stenosis �� this level secondary to �he di�c bulge in �ambinatian wi�h mild b,ilateral f��et join� � hypertr�phy. There.ia na dbviou5"eviden�e of a hernia�ion of �he nucl���s p��lposi�s �nd na eviden�e nf net�ra3. 1`or�minal stenosia at . this Ievel. � • 'Ax �he LS--Sf leve� �h�re is a r�ild c�iffu�e disc �aulge. The disc FiNAL f�E��OR7 D�tpl icate (Continued c�n next page) .} � '.s . - . . � . • . . . 4 . ' �S: , } ' . ' ' ' . , i � . � R � � . . , � ' . ' . . • ' . . ..f ' -- ' ' . ' ' ' ' ' . ' . �i . , . � � , " , , . � • . . , ' � i .` . ' • ' . - ', . ,. � , : . , + . . , . .. . , , . ,. . , � t y' , ' ' . , ' • . r , . . . � . : . ; . , ' ; • . ' " , . ' ' � � '. .. ' ' , . , . e '. ; .. , , . , ; ' i , . � .. , ' ' � , iU=�°.�:- :�''+...�"a:; , . .... , . —, '''� : ..., :.... . , , . ,. . . , , ' , , • , . . . . - , ... . � ! .� . '., . . ' 1 � ., k . ` � � ' � 8T. AN7HONY' S HOSR I TAL • ' , � ' � 1c00 7TH AVE h!. � ' � � , � p. �. PDX 1?588 • � � . ST. � G'ETER5HURG� �L 337�3 . ' Pt. N�mp: MILARCK, GAFtY E D0� :Q�4/1�l5# Ag� 41Y .' � '. MR� ` . A@0@0��l�E�S ' � , ' Rnana/Saurc� DIS �Clyd. Dt. - Ex�m A�te: �Q�/��/9� 18�+3 Accaun� # 9�3�004�057 Chk-In# 94��+9 � ReZeased: 10/�$/9� 1�19 � Qrd. ,Pl�ysician: LYSTER, ftICHARD F Adm: �LY5TE,R� RICHARD F. � � ._... , _,., - _. -- - .... " Cr� ri : . ' ' Drd Loc: 0�'7 Dr. RICHARD F LYSTER� Mi� � � � , �"��� 5th Aven�e N, , #a1�0 � � � � S�. � Re�terst�ur� FL 3,?,705 Gcrn�r�et N�me : . � : � � Chk�-in # Order Exam , � 94569 �i00�' �7584 CT LUM�AR SP�NE W/O CONTRpS'C ' Or�d Ai��: R/0 ��05S. ��ARS DEFECT btiilge ha5 � siu�il�r canfigur,�tion a5 on the previ,a�is MRi scan. There is over�ll r�i�d c�ntral spinal �an�l S�EiZP515 at ti�xs Ievel 5�cond�r•y �o th� dise b�tilge in combin�'�ion with facet jaint� � hyper�raphy. Th�t�e is r�o evi,dence o� � par�s i.nt�t�articulari� defec� of th� L4 nr � L5 vertebra. S�in� b'ifid� occ�.�lta, fl� S1 is noted on �he r,igh�. � IM�RESSIDN: ' ND AEF z N I T'E EV I DEiVCE OF A HERN i ATEb NUCLEIJS '�+ULF'OSUS 0�' , YHE LUM�AR S� F I��. M I LD CEN�' RAL �'aP � NA!_. CANAI... 5TEi�i�Sl S AT THE L�-� AiVD La-S 1 LEV�LS SECOiVAARY TD MILD DIFFIJSE DISC gULGING AND � B3LATERAL FA�E7 .70INT HYF�ERTRO��HY. NO EVIlJENCE CIF A�'ARS I�`!1'ERARTICLJLAR�S i7EFECT OF THE L�W�R LUMRAR 5PTIVE. SF'INA PIFIDA OC�ULTA 0� 51 IS Nl7TE� ON �'k-�E RIGHT. , MINIMAL FACET JQINT HY�ERTR�F'HY AT TH� L�-L4 L�VEL. THANIS YOU FpR 7HIS ftEFEf�F2AL. Interpt�e�ed tay: Cht�i5l;ine Larsen M.D. F3ei �as�d by : Chri 5t ine LarSen' M. D. NJS FINAL REC�ORT Dupl icat e � , . • . � . ,� , • � � � � . . . . . , . . `� [ � � �. ��� ' TRUS7�E5 O� THE ENipI.OYEES' PEN510N FUND � � � Agenda Ca�er Memorandum � � Item # Meeting Datd: 12141�5 ��rri��n�u �ni iq i��r���r�r�w iww�w�wnn iw�ww��i����nm�in�rm�n�u� �i SUE}�6C4: � . Pcnsic�n ta 6e Granicd . � ���I�I��q��I1qPl�l �MIIIIP���IIA�Ir��Al�l � I �I��I�iIPPI����r RecammendatianlMvtion: D�vid D. Bossard, �irefightcr, bc grantcd a job-eunnected ciisability pensian � Under Section(s) 2.397 of tt�c Empiayees' Persinn Plaa as recomm�nd�d by the Pensior� Acivisary Commiuee. ❑ and ihat the a pro riate afficials be authorized ta execufe same. BACKGROUND: , + Dt���jd D. Bassarti, rireff �hter, Fire D c p a r t m e n t, was employed by the City on Se�temi�er 1, 1971, and bcg�n participacing in the Pension Pl�n on thst date. On Novetnber !, 1945, the Pension Ad�isory Committes (PAC) determitied that Mr. Bnssard was efigible f'or a�ob-conncctcd disnhi2ity pensior� b�sed an t�is disubifity resultin� from nn injury, His injurics �are described' as a herr�iated disc ak CS-6 with impingement on thc spinal cord, 'I'he injuries are documented, by iettcrs . fram Rosariu A. Musella, M.D.; H. �3ushne3l Clarke, M.D.; G.�ry G. iVloskovitz, bt.D.; Michaej J. Andrioka, M.D. and Luis �igueron, M.D. The injury is repvrted to have accurred on July. 2l, 1995, when Mr. Bossard wris restraining a patient who �iad a seixure. Dr. Musella reports that a review �f an MRI of the ccrvical spine of Mr. Bt�sss�rd reveals "...s �arge herniatcd disc at t��e CS-G level eecentric to thc leit resultinb in � mild com�ramise of the spinal cunal,.." He notcs the �atierst }��s nat responc�ec� io conscrv<�tivc measure:s unci is a candid�te for op�ration and thnt "�leanwhilc, the paticnt is totally disabled a n d �naUle to resume �iis occupation as a paramedic and firei'ighter.,." Dr. Cl��rkc rciates hi5 itnpression th�t Mr. Bossard has a left C-G radiculoputhy and "Tliis is m�nifcsted by ruciicular pain in the arm, bicep weakness and }�ar�sthesias. In �fc�dition, he may Iisive u ceritra! card syndrorric; campaner�t �vith some gur�sthcsias in all five �ingcrs...there is a possihility...hc would not be ablc to return �to this lhis, norma! �osit'son) regardless of operative intervention..." Dr. Figueroa opin�� that Mr. Bossard "...is job specific tat�lly disablcti fronn returning to work as a iirefightcr and paramedic...Mr. Bassarci's currerit symptoms and problems :�re relatcd to � jab cans�ected injury..." and th�t Mr. Bossard "...is kccnly aware of his diagnoses and hc knows th�t �ic hus to seek medicul �tker2iion ir} case he clevelops warsening �veakness, loss of scnsation, Ur�steadiness of gait, bladder ar scxual dysfunction or if the pain becomes niore disabling,.." R��ie�y�d �y: Logal . NA Budget ._. N� Purch�sfng �� Risk Mgmt. .�A _—_ CIS � NA ACM Other NA _ Suhmltted by: Clty Manager Origlnating pept: Fluman R�source; User Dept.; Advertised: Date: Paper: Q Not required Aiiected partles � Notified ❑ Not rec�uired sts: S a Q 8, 6�4 0 Commissian Act�on: i'atal ❑ Approved ❑ Approvod w/condltlons Current FY [� Denled ❑ Continued to: __.. Funding Snurce; ❑ Capt.lmp. ❑ �perating ❑ Other P�nsion Approprlalfan Code {�,4(i-{174 I 0-5 ! 420D-SR5- � Attachment�: l.etler(s) ❑ Nane 0 f.. �` �� ' ', . . � � ' , ' . , ' . � . �. .. .. � '. . . � . • ' � � � .. .'� . , �1 ;Yi 4., _' ;''. . ,� . • . ' . ' . . • � • �, ' ',.�, �`' ' • .' ' . . • ' , ; .�� 1, . ' , • , . . . . ' , .. ,' • � ' • '' �" ..`. ,'}• �' '1,.'� ' � . 'i4 � r � .. � . ' , '; � � � .. • ' � � . • � ; �ti. ' ,Frsi,r,• ��`�1.+.' .'fit �1'`• .. ' ,' . ' , . .. � , ..� � � ,.� � � . �. . . . . . ' ' , s : . . i'' �� . . i ' . .. }S' ' . . . I � � � � . ' r . , ' . . , • , . . . � � � . . ` ' , � � . ' � . � . . ',. E: ,(�. ''y s . ,/. °�,_, `1' . ; , , . � , .� , . ' � � . . . . J, � � . . �i�:i � ' . . , : i: �,l . ''i..r : , . f �. ' , � . ' � . ' � . , . � . � , � " , . , . .' : , , . '�'f'" "7: , ' , r l�' y :�t' (iy'V� ;i,. • � . �F ' � �. . . . . o ' „ . � � .� i :f . . . , � •I�� ..�. ,ri� 'd'` '-4t�'F���:y! .i�`�` F'•`� .., , , }t , . , ,. '�. . . � , o , . , � . . , . , . ;E� . . �.l' , i= . � ' ,'f' � i. . , , . . �' � . . , ' , . . ' . . � t ' � � � ' w . ' �, � �, ., � . , , ' . � �r , � . . , � . ' . ..•, J "ei , 'i' �•i�. , �1� . f: , • . . , .I , , . ' �. . . , ' f. • . � � , ;�(i.'�` ,,.�`. '.E i)r'�: .'r i i . . , . . . �: � , . , , . ��f � :oi. +'�i�N n5�'�. " _ 3:r'. . � f 6 - . ' .. . . ' � . � ' ,��� '.'�� ..� c t ., ii F.'3� 7.,.o;c`'�5,:—'�%;f't': „e� • :r.•,,.�t.�: .s� .t."., ,.,a'y,'r t''',�� , .. . , ... ... r.*0.t.e.� .Fi .�.5 ". • f, ' r� :�av � - f a :rt!rst.4, , , , , , , .. � , . �. . . . . . . . . . . . ��.: ��iCYfn.:,. ., :prr4u ��t �".�a»vr°n��s�. v..4 i�P'. .ty.�.iir•.4r.r: � . . ' ,� . � . ' . � e � ' , ' . � ` . �. • ' � ; ' � ' . . . � , . � ' . � , , , "• ' • , ' ' , . . .. . � ' , ' � ' , ' ' ` � : ' li ''6`j4` , ' . , � . ;. , t . , ` 1 , , , . , . , '' ... � • . � , ,. ''-.. , • .. ' . I ,fr � � . Agend� �item--DAVid- D. BQSSard . �' , . , - , � . . � , , . .' f� •. .. . �Dece ber ' : •. ,. . , . . . . � , . , � ' . . � , : • '! `�.',;, 4 � � 1395 . , . . . . ,° . � , � � , , , :,; , : � , � ,. . � . . ". ,:� `S t . , . � � : ' . , • . ,. , ' • � . '} > ' , � : � , � ., , . � � .: � � �Dr. AIIiS�IOIA � �1R{�5 �tE1At "The p�ti�nt's , response ta conser�ative� cttre...has � been , � � 1 �� '•subopti�in�l,,.it is un�ikely that conservative care wi�l resulve the problem entirely und � in -. �:.� ,.� fact .the guticrtt .will ncea s�rgery." H� �ndditionu3ly states ih�t ".,.it is.my npii�i�r� thut ths '.. ', ' �'•� pstient• is not�uble.�:to meet thesc (�ob1 requir�rnents at the present time, nar wi�l hs be atile ' ' ., to meet them in :the future, wHethes he, i�as� 'surgery or not." � ,� � � ;'r . • , ' . , • , � ' . :• � Bused � att� s�n avcra�e sA[ary of approxim�ttely �4U,413. l6 over ihe l�st , Five � years and ' the ' se�enty=five � percent {75%) minimum disability b�nefit,' Mr. Bossard.'s bas� pension wiSl " �. �'; .� appraximate $30,309.87 , annually. With two` . dependerit ct�ildren,° he wilt receive �t n � .' �dditional• $4�S4G:48 for' each 'child durin� , their �eiigibility {until age 18}. The�reforc:, . his � initittl pe�sion �wi1l approximaie $39,442.83 annu�lly. Charts fram Finance, whicli t�ke into � ��� s` consit3cration mortality , rutes And a�e, �efi�ct that "present vAlue cost oC financing'' � this ,. . � pension �will 6e, approximute�y $A08,639 97. ' The toial actuul psiyout w'sll ap�roximatc ' � �,247,630.U0. � .. - . . . � � ., � • � . . � , , ,. , • t , ,. , . ' . ' ' . ' . � , ' . 1 . 4 � . . ,' ' . . . . . � . � , . � . ' . . ' . . . F . � ' I ' , ' . . � , . , � . � � , ' . . , ' � �t� . � . 1 . ' , 7 . y.' ' . � ' • . . . . I., ' ' " � � . . . ' ' . . � . . . . ' � " . 3 . ' ' . � � � �. . . . I� • . • ' ' •. ' • ' . . � � ' . . I1 . . • ' , . . . ' . .. . . ' . . , , r . . ' . . , . . � ' . � , .� � • ' . ` , i � I ' . , i . _ ' f . � . . . � � � � . I. . ' , . ' . . i � . , , . . ' i ' . �. ,. � . ; , ' .' . ,� � . l� � '� , , ' � ';1 . . � . , . � ' . , . � ' � t . , ' . .', � . . •� � � �. , , , . ' 1 ' ' �`. ' . � .r .� , . . . ' , . . . � . . . . � t . . � , . � •• � . . ' , . , � � . ' + . ' . . .. . ' ' .� . . ! . . . . . . . . � . � . �'i` !' I ' � . . i I ' � . ' , • ` • i , . ' �i � � i. �• . ' .' . . 1 � . ' ' , ' . ' ' , . . i . ' . ' ' . �� .� . .. . . r .. ' . . , . , ' . ,� • � ' • ' ' ' , ' . � . � , '' . [ . . , . .�< ' . ; .�� • ' . ' . � . � . . � ' � . �:{y��•, ;.��..:R. ;� . , . � ' • . . � ��� i - �. .��r `�" .S�n. � . , . i. v . � �� .��....... � . , . . •I: ' . �, n. .. . � . �. ' . ` � ' ' .. � . 1 � f. .i tii , . . }� . Muman Resourco� aopartment i819) A1�2-G87D , ' , � . FROM: � ' COPIES: SUBJECT: DATE: . � C.� T Y U F C� E A�. W A'x` �� � • F'OST OFFiC� dOX 4748 � , CL�,��RWA7ER, �LARIDA3461e-a7ae Honorable Muyor and Members of tfi�: City Commission as Trustees of the Employecs' Pension Plan . Pe�sion Advisory Commitiee � Debbie B�iiley, P:►�rolt Services Manager; Risk Managem�;r�t Pension ior D�vid Bosssrd—]ob-Conn�cted Dis�bility. P�nsion November 8, 1995 . T�e pensinn Advisary Cammittce (PAC) receiv�d an a�plication for disahiiity ,�ension from David Bossarc3 on October 17, 1995. Mr. 8ossard hus been detcrmined by thc Pcnsion Advisory Cominittee to mcet th4 requirements of the Pe�sian Plan for a job-coztinected �isability pensian. HG was employed by the City on Sepiember I, 1971, anci begaR. particip�ting in thc Pens'san Plan on Septembcr 1, �971. Furthcr, he h�s sut�ir�3tied �r�edic�l documcl�tatiAn, copies of ►vhic� ure n�tached, relativ� to l�is disubility which ha;; been re;vie�ved and ap}�raved by tlxc PAC. By matian m:�de and ciuly carried at its mcctinb of N�vember �, �995, ti�c Pcnsian Advisory Committee �pproved/recort;mended tlie granting of a jo�-connecced clisabi�ity pension to Mr. Bassard in accorda�ice �vith .�rnvisians of Sectian 2.397 of the City Code. This �ension is to bc effective on � datc; tn be d�termined. The �►mount of Mr. Boss�rd's }�ension will be calculated by t�e Cinancc: �epartmc:nt according to the formulA in the P�;nsion Flan Tor job-connecteci disability pension at 5ucf� time as his lnst #'ive years of service anc� salary can h� co�nputed. � n�r�:by cej�tify that .th� .Pensinn Advisory Committee has upproveci the grantin� of a joU- co�inectcc! disubi�ity pensian ior David Boss.tird and the al�ove ciatc:s arc cai•rect. � � � . . � ` �� � '� . Chairman, Pens'on Adviso � �jnmittee , � •"�qu�ak Ernplayrnent �and Afflrmntivs Act[on [mployar' u5si� � , , a �i; �, e �r ' i. ' ' ��' r.�r... � E,'• . . , ' .. • ...-. .. i. ... �. ..,.:f . . 1 3 . � • � . . •• � , �w ,�. • ♦ r• , • • ••,♦ a. � , � � .r . , - � . �'ENSX�N REQLF�ST FORNI � ' i� Aavid p. Bossazd. � • do hercby app�y for rc�ixcrnent from the City of Gicarwater GCnCi`�1 �mployces' P�nsioa P�aa. M beneiits date is �$p��er �' �g�� Entr date �r�to Y . t Y , pe�siort� �p�an) . M y date o[ k�ire i5 ��p����r l, 1971 , . - My birthday is ��cember 27, x952 � .�h1y job classi�'icatian is �'ire�ighter �.._�._�,"_. aad I, work ., in thc ' �ire Degartment{ ., _. Divtsiaa. M y resignation date is to be c�etiermined � � The type af pensian fnr w�ich I am app�yiug is (chack vaIy oac): �Regular . Per�sion �ascd on years af service . � X 3ab�cannected D[sability Peasio� , �� Noa-job-cannectec� Disabtlity Pension ' . � Sandi � 6/�4/�4 ' . yIy spouse's nar�t� is: ,, �—-- bependent chiidren under the age af 13 and •residing in my ho�rs�hald are: ' �renhiter 9/�2,L79 � . � (Print Child's �ull Narrie) tChiI�'s Date o� Birtlz) � Melissa 7/Z7J8_2__ I hcrchy cercify ail of the above ta be crt�e and corr�ct: � � �.J v� lSignature) ' 4ctobex 1'7, 1995 {Dgr�) STATE OF FLd�tiBA , T a e iag ' 5LCUm n[ waS �cKapwled;cd bcforc r�c {tt�s CL7UNTY �F PYNELL�S ' J�� �by �ro'i wha� is personaliy knnwn ta me or wha has prad�ced � �✓��s� � • idcncificatian and who di did noc ta.ite an oach. � � / ►' �c.� ✓' Notary Public . �" � IrtRflFiA E. MR�turc} , ;.; �'! A�IY��QC+�tB�rFklRES Commission Nn.,,.,,��. ��� Ocir�,yr �,19� . . • . �,�"°�', �o"����''"�'�' (Namc of Notary Pnatad} �_ . ���..m.r..r.�e. ... ---- �� ,., . . . � .. � . . � ; � - . .F . , . , . . , . ` . . , ' • � . . ' , . , . . t , . ., , ' � , ' - . . � ° . , . � ' ' , � . , ��.. i;' . , , ' . �,� . . . � �� , � � . , ' . .'i ' . . . , . , ' . ' . . � , , ! �e�4� ��1'� f" :'f� � ' � . . �. .. . _ . .. . .. r. .�. , ..s. � ,. . , :�. . :r�, . . , �r, . i , , � � ` � . „ ' t � �� � � r �. �.. , . � � . . ; � . . � ., f ' . : v . . .' ' ' ... � i , ` :i ' � . CITY OF CLEAR'VVATER � GENERAL EMPL4YEES' PENSION P�,AN OPT�ONS - TIR�FiGHTERS � 4PTION #1: � � � Empioyees can rcceive a iumg sU�i payment far vncatian and � itoliday � pay and 1/2 of accrued sick lcuve at the timc af , so�aration from t�c City. Therc wil[ �c na 69b deductiaa for per�sion frotn this �ump sum payment nor �vill this amount �coUnt tts earniags in the calculation, of th� pension. The last� dtty of � � work will �c thc termiaation date ar�d �ension benefits will begin . � ' the fo[iawing day. C�PTION #2: . Employee can extend terminatian date by tht time due for , . ' vacatian, holiday pay, �nd 112 of accrved sic�; leave. Terminatina ' datG will bc thc �na� day of exte�ded time. 1'snsion boncfits wii! begin the fo�lowir�g aay. (4nly . s�vailab�e to emQioyees hired prior to IOl1/88.) *���**�***s*•��*o�s�w***w#�s**s*****•�r***�*+�*�****��***a�*�*����*•�*a Y� David D. sossard , an emplayec .of ��te City of Clearwater, hereby apply for pension bene�ts under the City's Emplayecs'' Pcr�sion Plan. I hereby ca=tify t�at � fu[[y understand the cwo aptions offered to me. I cho�se ta retire assng Q�tidn # � and wssh my ber�efiis to bc ca�c�l�ted �nder this aptipn. I uaderstand that. once this form is signed, my decision is irrevacable. , ` �-✓ 4�c!'�'j� EMPI.O'k'EE'S SIGNA'�'URE: S�CIAL 5ECiJRI'TY #: 2G3-D8-2199 SES: � ADDRESS: 901. Nolan Drive Fast � � � �,.� Largo, FL 3464Q ��'-c�t.a-�C� - DATE: October 17, I995 - �il�~ ' . . . . . .. . � � ,.'S i'.. '. . . ,i ' . ' ' ' ; � . . . � , � [ , �. . � ., . .( ° � ., a . ' •' .,yJ � � /' , . � . � ' , � , .. ' ' ' , . ' ,• ' . , . ' . � ' � " . , � , ' ' . .y' ' . . � . , .. , " , .' , ' ' . • ' . ' .' • , . ' . , � � ' . � � , � � ' ' � , � . , ' ' . . � .. .. : ' '` � ' � �� ' , � . I .� .. . . r . � . � , ' . ' ' . • . ' ' ' . . . , •. , i . . .. . . , , ' ' ' � . j, � .i''`f�.�� ,�(�' � ' ' „ . . . . " < ' ' ' ' � ' , ' . . , � , , , . . �, s . . . . .. � �, � . '��. , • � . ,. . . ,�`....r , .. ' �, . . : . . ; �, � ' .' � ! ' . , . . .j�. , . . , , . • � , ' , . . � i . ' . .. . � . . � „ . , , � . � • . ,. . } ' . ' � . . ' . i . 1 , a ' , . v �ii'�f';t�';,rf+v.yt ' y, .. . ,. ' '. .';..� . . . i; ' . ' . . . ' , ' • .. . � ' ' _ � . . . . �r. . . :rt,4.�a...... .. . .. •r-'tr+e�e::F......�.. ..... � , .. s.��`-t . . , . � . ' r. . ' - �, �� ' � ' . '�.i .. , , .. ,�' • i ' ' . . ' , ; , �, . , AuTxo��zaTtoN To ���,�a�sE � � . . �� .� � � ' � � � �1+IEDXCAL AND RE�ri►,TEU RECQ�tDS . � � ;. ; , , . , . . , . ; . � �, ,_,: �avii3 t�, _ s�r$ _ �n� app�icar�t for �isubtlity g�r�sJon ur�der provisions of � ', tha � Employecs'. Pension . Plan oE tt�c .C�cy of Cieacwa�er, hcrcby auchocize any �p�lySician �OC . acher medica[ care providcr wh�a axami�es or treats • me or who has cxamincd or treated . m e . or, who ir� the futufa exarnittes or treats me . to release any and �lI medical and ralated record5 ' pertaining to rne to the City of C�earwatcr's Fension �ldvisory Commit�t�, ?ension Truste�s, �� Persannel I7irector, or authorizzd emplayer,s or a;ents of che City ' oF C�carwater, �tvrida. � . � f . , VV � . � • � � � . . ' Si�nact�re . � � � � � • , � actober 17�, 1995 . Date , °. ST:�.T� OF FLORIDr�, � T� fareaaine instr� nt w s acknowiedped bafore rne this . . �C�liNTY . OF PFyELL:�S ��I �fi{,.,�r��b y� c� rrl , � w�t cs aer r�ally known ro me or �Nho has �raduced • � ' � 1�r.d� e/ .s �e 3.( �s � idcntificatior� . an �.vho did/did not c k� �n o�t�. � P�.� ✓ Vota�y Pubiic . �''i'�' ��''� l�UlDF�11E1�AliFiEl�VStail3CltCC) ' ' � � �.t� 1 �:i RfYEX��M3.S�OfitCC�1i896F�Pfi�S �0, ' ' COfI1Ii3�55iOi3 --_ . • ' � . � y� y'��}� �Qc��Mv E`.�1�9��� _'.' �•IIN�� W�Y �/1iY 11�M� IM�wq�u�� ' . • � � (�1ame ot �iotary Fri�tedj , , ' �` , � ' ' � . �„ � ,' � r � 0 v �, l. � . r . . . '' . ' � i . . . o� . ' ' . . . � � . . , tii'�' `����i� ..i , . .. . ' � � ' � �:, . , . . .. .. ..� i �.. .. .,� . . .. . . . ' 0 1� � , , . . ' ! � C��`Y QF CL�r�R�VATER, FL(�RIDA 5T�TEI�IEN'Z' QF RESIGVATZQN �. David [�. Bassarc� , t�jp��sY�� �y F'irefighter •. in tf�� Dtvi�iun n!' F�'ze � De�srs���c�t �c� h�rcbv sr�i,�rr t'rc�ni thc: ,�rvizc ul'thc City 1�f' Clesrxstcr. �l rcyucsi th�t thi� rc.tii�;natis�n h� �luly arccp��s� hv sfiy D�g;�rc- �tr�nt He�ct �n�4 ihc P►p��intin� �lutharity t�� bcc:umc ci'I'cctivc ,auc ��n �pproval aE a disa.bil.ity pension }ay the �c�, Pension Advisoxy Commi.�tee and Pensiart Trustees. :ss y �.Yl. Thz r�y,c�n ti�r �i�i1 rc.�i�*nsticjs� is ax ti�i�awy: . . . . . Reti�rem�nt on da.�abil.ity per�si.on. r . Oc�.c�ber 17, I995 E:nptuve4', si��nscure Ds�c �i�n�e# DEPaRTtitE�iT �CI'IO:^�: ,a�pru�cti b� ai�i,ic�rt Hcac! d:tte Divitii��r� He::d C��rrtmsr�ts i0ptiunaia ApQmvecl by De�srtmc�t H�•��1 Dat�; t7easrtmenc H�•�c# Cvr�ments IC?ptii�n:�l) �LTION �F �P�[`iT:NG :�UTHORlTY � � i;�icc�t ti�is rcyivna�iun �n becc:me �t�tcc:tiv� on.the �fute sr.c� st the tiezi� ,nc�wr� :��ctvr. � ❑at� ,�pguintiri�'Authurity t ♦ �ppcyincin� �uthurity Cc�mmcnta (Optiunal! i;�iPORT?►�+T tiOT�: Tii� rca.ti�in tiir thia rr�it;nstic�n me�yt he: ,h�swr� in th� �parc pnovicf�cl, Th� nri_�insi �ifrriti, ��fic;� �i�_Rc:e! bv t�G L���gi��v��: antl lh+: �ivitiiun arici ��¢nrtmtnt hwei. i� e�i bc: :�tts�h��c! tc� thc: �r���nn�! a�ti��n ,ii�:,:t sn� I'nrw�;se�lta cc� ��t� P�r.+;mr.�t (3t�tit�:. Pcr:�crnt+c! actiun shccs muat rctl�ct th� ,tutu, ul''anr• Ci�v is�unic� �tu�'t�� �ir hy c�ti.� L'n��l��z•�� in :�cLUrcl:�n4� wi�h thL Ci�'ii S4�•i�L Ru��s artc! �cafls:ciivi �?3Tl:;)iRlfil: �,�ri�r���r�����urrcntiy in �II'4c:t. �e:,�...i � �r . " . � � `. � �• • - 0 .�� . � . � . � FIAS7 FiE�ORT OF INJURY QR I�.[.N�SS fi0A1IlA D�AT. QP iA90R i LMPLdYMSNT SEGLiAITY UIViSIQN dF WOfiKENS• cor���M��r�aN For ■ssissrne. eatl t•aOOSaZ-t74t or eoht�tt your IocFl �AO pflic• �.�o�e.�� a�r�r+. w;t�,;n 2� r�ovr� E40�j �II6�p4t PLEAS�Pp1N7QRTYPEDSHA� Zfl� r � R�CEIVp{1 [3Y CAR►i�ER S�NT 70 b11�fStOM ' DlY1310N IR6C't? DJ►7E �v� �o Dzv�s�� � . . AUG � 0 1995 £MPLOYE� tfdFORMATfflPi �MP�OY�R JNFOAHIAT��t+1 CZTY OF CLEAF'ZWATER ° �� on r ey ��r� COU�MIY N�►+E• ..,��__.�._._��_�......�__.._.._._. 5 9& 0 0 0 2 8 9 0 7/ 21. /�. 9 9 5 D6 �.: �...._..,,._,__._..��_.���.�_.."_'._��._.... . , . � Srn e rF+..�P vI4-- �Y+.Q-�-,r ��� _.»_. �."..." u.,CLEARWATE$,� s�.�.FL __ z,Q: .345].S „_� MUNICIPALITY 1iLEvNO�+f ►�s. Grm. Nu�n.. . r YES ❑ NO ' E�►lCr£R'S lpCafiiCH� , R e+n...�rt LAS7 DA ElAALO E OR� EO • W1L� YOU CON7INU� TO PAY WAGES 1t�l57E� CxTY OF CLEARWATER � ._ oF woaK��s' Ct]hAP� }(p� ve: y�„t p0 H�X 4 7 4 3 '""_�__._.._...�.__.._... a8 rz 4�� � Jr U5T f3AY WAGES YJILL 9E PAR3 IN5iER0 OF �„�CLEARWA�'ER s„�.FL�'re �`� 6��...,^F nEi'LJRN�O TO WORK Q Y�S �3 NQ woRSC��s ea��� � , tOGAiION � i<�aW�c�h��1 4� �~ � IF Y�S. GIVE DATE X HAT� D� PAY � H�. WK -^ (1..�CE Of ACGJFHT IS4r�+t C;�. s�r�.. no� O C�TY OF CLEA.T�tWATER' --'----�- � s PEa ��AY �❑ Mo �_,�_ pAT@ OF DEAili ji1 Rpplicabfe� u eF 1 oura par day sr..e p� BOX 4i �$ f r i Numbar ol hourx prr weaN �r GMCLEFLRWATEk� �� .�y��FZ �o. .3 ���-� r ��pE y�lM C�SLa�piFOri OF �GCIOEN�T Nurt�ber of deys per week �Y cou�n oF �cuofxr; __ _ Y�S [] ;VO NAtdE, ADDAE55 AND 7�L�AHONE nr p�non wno, naw�ng y�n w� �n �n o �n�wr, a r�u , or a +r� �ny �mp oror or smp oyoa, qF PHY5ICIAN pR HQSPI7AI. inaur�nar comp��y, pt �ofl•In�urod p►ogram, fl1�r a s[il�mont at ef��m conf�tning any fi1�a or m�r���dlnq G�Y MOSKOVITZ MD inforrnsllon i� gullty o! a f�l ny i o ihird d�gr��. I hav� i�vi�w�d, und�ralsnd �nd ■ekhawi�dq� th• �bnw rt�� «...,� EA�P Y�E SIG4AfUliE Pf F•��_�..W,�tl �hI ,_--_.._ _...�� �,•.».._ �A� �.-��_.._ � � � �% E�pLOrEA StGU�rUaE �Aai� � Ailfi![Y1i1FD DY �1AP�0'�iA YEE C� NO CARHiER INFOFiMAT10N ❑ �. Case Oenied•-OWG-12. Notic� oi DoniR1 ,lqaehed �] 2, Mcdkce[ Only which bec�me Lost Timn Cesa {Camplete Ril inlo in I�} � �. �ost Time Cesr —!st day ot dfsab�llty � 1 rZ� r� Selary contlnund �rs lleu cl oompX� Y�5 , Se1ury End pele /___� U�ela Fi�t1 Anym�ni M�rilad � ! ! -�-�� ��,_ Comp�Rie �L 0 T.T. � T.T,•8076 ❑ 7.P. [�] 1.8. ❑ P.T. ❑ Denlh` ' j{ � AE�IARKS: L,�„sT nnv�z� nrr rr erm m� vrT+GT a l d/ p�� l�t1AT'P7Nf77TJC T{7 PAY Fi1L�T. GWE' SEFwCE GDRP+� COUE • 917 3'--0 Q �uv1,OrEE's mSK CLASS COOE 209 CAREiIER h1AM£s ADDRESS 5 TELEPNONE C7TY OF CLEARWATER PD Box a�aa CLEARWATER F; 3�i fi 18 (813j ��2�-6754 Is am�lqyer scl!•�nsurrd? �L.] YES Q NO �_ .-� -- - -- . .i, �� �i . . . � . . . . ' , ' ,F ' . . ' ' � . ' � , � . . � .� . .i .. . . . ' ' . ti' . •� � ' ' • • � . . • ' � . ; � . .. , ' � • . ' ' �. ' . �. . . I ' ` • � • . • � • . 1 . .y ,� . I . � . ' 1 � . ' � ' ,. • ' . • � ' • • ' , I • .` ' ' ' . ' ' .. . . . . ,, . . .. . � �;'[ L I ' � '' . � . � � . � ' ' ' ' . . ' , � , � . . ' .. 'l,ij' %r.� . . , . _. . .e d�.. . � � , i �.'�;, , , �. � � . .... . . . .. ' . . � �.' , . . ' ! � ► , � ; pRTHaP�'' `iC SURGERY CENT�R OF CLEr[RW� �'sR, P.A. �•,. . .T5Z8 Lakrvtew Ror�d � . � ,. • . . Cleanvater, Florlda 3��1b � ��, ' r L$1�.L4�I��� ,.,__�� �, ., ... � i�l.�] ��1-14�2 . r�� � � � � . �� , B�SSA�p� Q�v[d D. .� Accoun� #: 29�60 $�'i4%95 `� -;;�..�.i�5c�.z.•�d'�'fiad a'��Ij�S'caii of the aervical spine. �This � showe a� large �entral to ( L) e�.ded diec hernietion �t C5-C6. �.have reviewed the MRI Scan mysel£ �nd coacur. He cont�nu�s to ba pere�.etently �ymptom+�t�.c regarding the (L} trapezial aren ar�d the (L) upper extremity. I recommend that we.�treat him coneervativeiX. A prescriptidn was given for physiotherapy thr+ee timPe weekly wi.th home tract�,an and oti�er local mod�'litie�. z have also recommended that we keep him o�� h�.s re_r,u1$r duty se a paramedic fire�ighter. Appropriete reetrictions ��r�x ;,::3 �:�:-^ '� "�"�^QP� ^r.d m�,rk9c�. :�e ie r.�t �1lowed to lift g�'eater than 1S pounde, avoid �::cE�ea.� � �:urn�.ng ru�ic:�r,t�� i,i . ��a neckl and neurovascular precauta.or.s �pp?y. He will be seen again in throe to �our weeks time or eaorter if he becomes worse. I am also �cheduling him ta have EMG nerve Conduction studie� performed in abou� one �o two weeks time. D,�ctated bv: Gar,y G. Mo�kovi,�z, ��Ftichm. ,� � xc; iohn Marcin Ci�y oi �l�a�-water, PO Box �4748, Clearwater 34618-4748 C , . . , . �� •. . . �� . r'�- . ' , • .a�,. � � . - �-... . :•�� � e �r�OM 7�-E� r�=��� : oF �L.VT'NRNOi1T'�G►:; ���i �ti�QFn�:,D T� AVOIC� �j��,qY '' f. ', � ` . .. .:'�. 3 .. 1• � � � r � � . . �� � {� '1���o� D Vr i�/ : S�P 0 6 1995 � :.;��� �A��4G�����' � % ��f'. : ': r , .� .r .. � . � ' , �, . j.' . , . � � . � .7' ' 1 . . . . ' 1 • ' c ''� , ' t .. � � . :� . . . , . . . . . . . ` � ( , , , . � . . � . • . � , , . ,1', � . � �. . . � ' . . I , , . . � E . t � �. . ' � .• � j '' , . ' � , � , � . .' . : ' . ' ' . ' 1 � , .� . .. ' � . ' .. . . . . � . . . i � � . � � � . . . i ° , � ' . . �` , ',. '�'s.• ' ; . ' , , ` , . � '�; � . . '' ' � .. `. ` , t.� � �, i , ..'r. . . � � _ . � . . . . � . ' , . ' • , ` •• , • � . � � � . 1 � � . e ' �11 9� . . ,4 . .I' ' �e iI' . ���� � . , . .. . . ' . � , . , � ° • . � �,'� . � � 1�} ' ' ' f. 1,, . i 51 (� . . k• � . � . � E • • . ,' � . . 1 � ,. � . ' . . � f� y:��,rl� . . .!. ' ' • � . . . • . ' '! ' . . i � . ,f' t�. , .. .j. �'i`•. .1.. . ./r " �•! . � � .. ' i� .a � ' ' � ,�� � . " , � .. , � � .� .. , .� �1 � � �.f.. . 'I,� . j . . . ,. . ' . . ; ' . . • ; , . ' ' Y . ,,`i"„�i�.°F`n�.i.�t�y il�°l4�.0 [� ' si , ' � , 1 ' ` . � S .4 �4 , ` � � , .. . .. . ' ; r � 5 3� ir... . ., .-f•.*a;,.,h.,.. Y. w.4�.�,.. � � � •r.«.. .. �. �i' •i'. . <.. .�- `�,. ,.f. �� . r;'� r. =;4,-..;.. � � : ORTNUPA�, , 'C SURGERY CENTER OF Cl.�#1tW.�� ,1�, 1'.rl. � ; � . , , , `• �538 L�'s�v .Road � , , °.� �'�'� ; �� " ' � � ' ' , Clearwatar, .Florfda 3f61b � � ' ' , ' . `` ` . . , . . ' ' : l� � . , . ' , ` . ' . . . • ,j :.. t$�� �46r-6�z_� �. � ,. � - � _ _ , _ t�r3� �a6r-r�a�z . 4Y�'; � � � ---- - � r�r , 1.�'� ' � ' , � , � � ' » . . . .`��;� ,: B�1�S�i�i]i , C,�aV�C� � � � AcCaU�� �#: ,29� 6Q" , � � ' � ' ' ', , .. . � , � �1�5195 David was � e�al.u�ated �oday. . � � � ' � � ' � �� ,� � • �. � . He has had EMG nerve cor�duction atudies and tite�e - � `are congistent with' a C� lesion on �he .(Ly sa.de which, �o� course, '� ,� correlates with ha.s cervical disc herni�tion at C5-C6. � He has f��.t � �� batter with therapy. . He feels he is regaa.ning strength in the (L} ;�, upp�r �xtremity. � ` � . , ,; �� EX,AI�INAT�ON: � On exaynination taday he has weakness ot thumb � .. �. : . extenaor and a].so sflme weakness af elbow f�.exo�� . , , , • �.. �: � � . � .� � � PL�iN: Conti�us to ob$erve, , � . . � . . � �� Continue with therapy . Ac�ivS.�y restxictiong sti.13. . , ' app3.y: '�, am giving him the nex� week o�f �work� Fie is� �o return to ; ��� work 9/3/95.�with previous light duty as described. Dictated bv:_ - �� Gary�G._ Moskova.tz,�,_M�,D. �„chm._ � � ' � � , . . , , . • , � . � � � • .., . i'. � , ; . i • i. , , , . ' , . . . � � � . ,. . ' • . ' � . � • � + . , . • � . , . , , .. . 10/IZ/9� O8:Y9 'd'81� ax2 01�� N�URQSURCICAL � � � � .,-�, . , . � . H. �U�HNELL �LA,�{.�, M. D., P.A. �', � ____ —_ "'__ _' _"-- � .j � . : .� .� ,. :. Q .� . �2�3 FiFTH AVE3VlllE NQRTfi. SUITE 408 S''C. �E�'ERSSURG. FIARiI�A �37U� QC�ob�t �14r �995 �'ef �rey sourb�ex, M. D. 2715 W. eay Dr�ve Largo, FL 34b�4� a � �oi��di�� .. � .... .. _. �.....,._ _,.._„�...__..,. r �� � PH�?NE: �$13? 894-551 t {s��� sz�-esaa Fa�t: tai3i a2�.o2�s Rmr Davxd Bossard � Dear D�r. So�arbeer: Th�e p�ti.ent 3.s a�2 yea� oLd right-handed white male ��en ivr ev;�.u�►tion of c�rv�,c�l s�pir�e pro6Zem�, The �ati�n� sta� �►s that appraxima���y thrpc� months aga, whi�.e a� work, hs wns halding dvwn a patient who was apparently seixing and he h�gan tc� deve�op acut� n��k pair�. E�e '�hen beqan to deve�op a lef� upper �xtremit� Xad�CU�.ar pain. The pati.en� �x�ended down �he �houZdez, down th� ante��.rar aspect ot the �e�t uppe� a��a ir�to �.he �orsax-m. I�e also noted numbn�ss� in the �humb and par��thesias inta �h� finc�er�. He deni�d any sima.Zar problems in th� past. He had underqone a course of physica�. th�r$py and has noCed �ome �mprovement hut is �til� h�ving s�gnitic�n� di��Om�prtr par�icularly wi�h movem�nt of any ob�ecta. �ie a�so haa noted we�kn�:ss �.n the I�it bi.c�p �xnd some atraphy in the shvuldc� g�.rd].e bu� the t�houlder girr�le atar�a�hy hae improved. ALLERGTES ; Nane kn�wt� . MEDICATTON'S: RelaEen. P�►S'X' ME1��CAL HIS'�4RY: Unremaxkabl�. PAST SUR�ICA,L Hx�TORY: Unremar)cable. FAM��Y AND -S��AY, HxSTnRY: �e �.a married wa.t� twp chi�.dren. I3e do��r�'t amoke. PH7�SICAL EXAM; H� �£s a very pleasant stocky maz� �n no d�u�e distre�s. NEURaLdGiC EXAM: He �.s awakef a1er�, �anvexsant. C�an�a3, nerves �I-XYI intact. Motar exam S15 ��rength throuqhout wi.th the axc�ption a� }.�ft bic�p oi 4f�S. Ae did have di�ticul.ty in compl.ete sup�nation o� hi�e arm� b��a�eraZly', whzch he �ta�ed is pre$ent 9�.�1C8 bzrth. . 4• . ' , i ' . ' ,i ' � ' � 1 f. , , . , , , - , ' . ' , ' , , ' , , � .+ . � , .� �. ' . . . � , � i � � � , i.. . , ' . ��ti ,j ,�,Ls.— ,. . ,., ' ... �.-,r<<. .. . . .., . .., �+" . , . 'IO11a19n Ob:2d 'QF;�� 8ZZ 01�6 . . � � � BQSSARD, DAV�D � �,` Paqe 2 . . �, r� ' . , ' � ' , „ ' . � ;" ' � � �00�/00� � � NE[lRUSElRGICAL ., � _ � � ,. ,.� � . _ �.�� �. ' ,_, , � � S�NSoRY �XAM: i3ima:nution of pinprick �.n. the le�t thumb. DR�p tc�ndon r�rf iexes we�e 2+ in thQ � right bicep, 1+ 3,h the �.eft � 2* at the xight� brachial radi�l�.a and .�+ at the l,eft, 1+� �et �he t�ricep and 1+ at the kneQS and ankles.. Ha had bila���a� down qoing taas. Revi,�w vf th� MR� scan show� �vidence for a disc hernia�ian at C5,fi ' w$th spin�c� co�d�camprea�ion �nd dei`armation of �he cord. it has exter��ian �,aterr�lly w�,th aampre�eion o� the �et� C6' nsrve �ao�. �t �.s �ny impreasion that Mr. Hoedard has � Lef� C6 rada.cu}.vpa�hy. Thi� is m�►n���st�ed by rada.cu3.as pain in �he azm, bi��p weakness and pr�r�s�hesias..� ��n �ddition, he may have a cent=al cord sync�rom� cvmpanets� with sv�e pare�t#�esias in a�}. �ive ��.ngezs. � �� x fee� that if�his symptom� do nvt resolve, that he would b� a candidate for a cerv#,c�� microdi�hectomy qiv�.rt his de�gree a� spint,I�. � cord compress3,on and r�exve rov� campres�ion. He apparen�Zy Gannot retuzn to hier norma�, pv�sition �� thi� point and th�re i� a possibility that with n cerv���l radiculopathy and hi�s vary . �r�,gorous position at wark, whez� he rt�eda to move 1�0 pound weight� and has has �igni.�i.can� bendinq, twisting ar�d lifting, that h� wa��d not be abZ� �n r��urn to thi� r�gardl.ess v� op�r�tS.ve i.nterv�ntion. How�ver. with persi�tent symptoms, I iee� tha+�, hi.a ci�ance to � raturn to a po��ttion would be improved as his cervica�. rad�.culopathy wvu3.d be more adequateZy tzeated. Sinoere�y, H. Hu�hne3.� Clarke, M.D. I3BG : sw � ,, ., , ,r , .� • �, . �,.. ... . , � ,�.;:'.. . .•.,: ... � ti � !� , .`. . �`� ... "s'n � • .. ��t`. [r't.'\e ..... I' . . �_ . V :f , '�' ,d! �j ' � � ' . ��� ' • • � • ' . ,.r �� .. � � i.. �°r:.' � , ' , , �. ., , ' a � z r • _ � c�asu�clo a� �ua.���a, �t �►, ��e�, �?�f , NEUROL�GICAL. SURGEF�Y . D�PLOAIAT� AA�tERICJIN 24'7 C(�iEY AVENUE ��� � ST, PEiE BEACH, Fi�iIDA33?'06-1Bi0 ' • F1�Llf�OtCGlCAL SURGERY � 7ELEPHON� (819} 367-4593 Octob�r� 12, 1995 H. Bushnell C�arke, M.D. ' Su�te 408 ' , , 1 �0'I Fif�th Avenue North � - St. Petessburg, FL 33705 RE:� Dav�d D. Bossard ' Da�e o� injury: 7/21/95 Dear Dr. Clarke: I have examined your patien�, Dav�d Bossard, �or the purpose �� a second opinian. ' The patfen� stat�s tha� he developed �h� curz-ent camp�.aints whil� he was on duL-y as a paramedic and f�.re�ighter the 2�st of Ju1y, '1995. Mr. Bossard was a�tend�.ng a patient who had experienced a seizure. He was ��a�ting an IV when he experienced neck pain w�.th radia�ion down the left upper extremity. Since tha� time, �he patien� has develop�d pexs�.sting neck and lef� arm pain wh�.ch �.s exacerbated by exe=�ion as w�ll as by neck motion. Pain is associated with numbness �.nvolving the 1e�t hand and decrease af str�ngth for flexion of the 1�€t forearm. He is curren�l.y working �n ligh� duties and has taken a course a£ physica� thezapy. He �.s a�.so on Re].afen. Despi,te these measure�, his symp�oms have not im�rov�d. MRx of th� cerva.cal spine, which I ha�� reviewed, rev�als a large hernia�ed disc at �he -05-6 Zevel eccentric to the left resulting in mild campromise of �h� spinal canal. The patient's past meaical. histoxy 3.s unremarkable, and his family h�.s�ory �.s noncontributory. Examina�ian rev�als a pleasant, conversant, and cooperati,ve individu�l who is well oriented in all spheres, The patient has a medium�build�and is nu� overwe�.gh�. Cranial nerves are intac�, and the optic fuhdi are clear. Gait is norma�. Muscle stsength is probab�.y �ntact except �or i, . • � .� .. .r � � . . . , . �. . , . . ; . ,. ,. ..,, , ., . ; .. , . { .. . ' Tt �'E'. . �� � � ......t-E .. c. �.� . � .� , , � ' i,� . • 1 . ., , I ' � • H. Hu�hnell Clar.ke� M.D. � Oetob�aC 12 � 7 995 � '� � � Page 2 � RE: David D. Bossard� � i ,, ., ,� � �� . �. , �, ,,f , .. .�,... ,# , , ... �., . . give away weakness of the left bicep ana wris� flexion and extension. Strei.ch r�flex�s are symmetrically sluggish, and there are no pdtholagical reilexes. Coard�na�ion is in�act. .Sensat�on to pin prick is decreased over �he l.e�t C6�derma�.ome. � � Th�re i3 moderat� impairment of cerv�,ca�. sp�ne mot�,on range and. a positive left Spurli.ng sign. There i�s no impairm�nt o� thoracolumbar� spine motion range- and no i�npairment of straight 1eg rais�.ng. , , The aiagnosis is a herniated C5-f disc with �.e�t C6 radicu�.opathy . SinGe the patient has not responded. to conservative m�asures� he is a candida�e for operation which appears �o be i.nd�.cated in his case �in view of the clinical and MRI �fcindings. The pa�ient has�been advised rhat operation is recommended and wi�.]. cans�.dEr this recommEnda�ion. M�anwhile, the patien� is to�ally di.sab�.ed and unable to resume his occupa�ion as a paramedic and f�.z�ef�.gh��e�. The patient's inavili�y to resume the duties of his occupation is p�rmanent un3ess h� �lec�s to undergo operation, fo1.].nw�.ng which reassPSSmen� may b� required to determine hi.s ab�.l.a�ty to retuz�n to work as a paramedic and �irefighte=. Please let me know i� � can be of furth�r ass�stance with this case. , S�ncerely, ' . ��i�dr�G.o ���� i�osario A, Musel�.a, Ma, FACS, PA .Clinical Associate Professor Department of Surgery � Universi.ty af South F�orida (Signed in abs�nce �o avoi.d delay.) ' � RAM/ac � ' �Mr. David Bossard . i]: � 0/12/95 � . M: 'EO/13/95 . . . ��W , 10�3�i95 10:48 R�BE�i G WA�KER PA Mi�HAE�. �. ANE7R���.A, 1!�1,C�, N�URO�OOY ._ ,. ..�.,.....,... . _._. . ... ., , , ...�.._... � _ . ,. .. . �.... . . , � w •• ..ww� . .. Andrial� Ch�r�er�d 1011 )cf�ords 5i,, gldx A, Cls�tw�attr, Florid� 1�616 dll��l43•a29S i�nx aafr4��r OFk') C�, �'ONS�L`t'AfiIU� oatobor a 6, � �y!� n�vx» �vssAao .� ....+.. .. . .�.... . . . .._..... _ . ,... nN��s�e�► AT1/fNyIR�M(IAIA�IYil�lr�i filfn, AinNhfhAHRr�q r�n'n,,,•!>f, Pa�ient. is � 4Z y��;� vld s���ld i:etorr�d ��x i:�d�pend�nt mQdical avaluat�an �aocau�q ot' �ymp#,am� con�inuin� fol�owiri9 A wark injur.y wh�ah accurr�d an 71�;}I55, Ti�� nn��anr �tat;��; �{ �hrr� iimQ i:i h�� wo��k �s � param��ic he wa� attomptinq to �ta►rt �ri 1� t�� �r r��s��� who w�s h�viz�g r� � se��ur. e. zn tho ��r��ggl� tihat �ri�u�d hv oxparf�ncod the on�o�: c�t' pa��� ir� h�[� r�eck ar�d �t���� g���eduaily i o�ta:� �h�t day i� n�en��d to exk.end down h i.� l�af � arm w� th a��maf ��ad p�r�gtihasf �s . H� was saen f� i r��; r�t a wal k� t r� ol fn# � +�nd �hen r�fer:•c+d �a �r� o,•LhoE��dist. x-ray� wore s�o���.i.v� Uu� �ubrdqu�n�ly a�n M�2 eCc�n Rhowed a 1.ar�a ��arni at,Pd dxpfi �r G5-b A��uwi ng L►c�t�i cord e��id nc�rvs �•�c�t �ncrnachment . He w�� t ra�te�d i n phy0icaa th�rapy us���g int,o3•mittenx high weight t1-ac�ivn ��d ��ven Re�afer� �s a m�dic:�tia� aaor�g wf th a�ri axorc:f se �>�rogram �nd do�s ��ot f�el ho ht�n m�d� �oo ,��uch in i:ho way o� imp�-ovem�nt �nd # n�'act. at Li ���tis wi L1� 1.t�� �r�-�ct i or3 he fe l t wvr�e f n terms o� atore� rain �fterwArd�, Ni� �ympt�,omai:ology hue con��inued tv b� p�ir� in t�� nec�#c and ]e+�'t arm ��r�icui�rly iri �tho r$�iun af' t,h� de�tc�ict wi�:h nun�bn�es �nd t�nq�ing �[n Zha ont�E�'e �.�g� ar�► dc�wn io l3ic; f inqars. App�ront�y� �t�ma a'��'ophy in i:h9 ctextvfd a�' �u�,r�a�pi�l�tus wa� not,ed +��ra i�r in l7�� aoursa Alt,4�au9h thl� �oems to l�a�d �osherrad �omewn{�t� w��iz ex�raia�. He has no ��r�w3ous hisl:nry uf neck or t�mck probleme e�nd Zsa� be�n in �xcel ��nl hemltt3 n� iar �o t�hi.s 3 nCid�nL , Hv hos bven on 3 i qh�. duty s i nce+. . M�N'PAL BTATU9: Peti��r�t w�s or•�ehtad to �.�me� pl��c� �r�d perb�n. i��.stpr�oa] •vArite� wei•� ro2�ted in a c�h�rH�tit o�cl�ni7�� t�i�nner�. rhAre w�� � noi•n�e�2 �und of gen�ra? irtfvru�a! ion, GRANYAi� N�RV�6: Crani�i ne:�vH �xR�n �livwec:t s�orm�k �,y r�activp �up�.l.�� clea� fundi �nd a Y;ull f�angs a� eKLr�ar.«?a�r m�t�,fon. l��rQ w�� no vieua3 i ield defQtst �'the�e w�s no ��sGiai weakness nr. asy���et.r� .'�'anyu�, j aw and �sa18�o ���ov��z�nts werd norma� , Ni�CK: Showa 1;endar�bea azortq t��� left sidF� af l�i� n�+ck a��d sig»��zCan� lim�i;a�SOii oi ���otion fox t.�u�h le�t )�tex•al y�c�t.ati.pn �anQ eKten�io�. P�r�athesia� arc e]i�citad by �t.Ce�ip�6 t�u rota�e or k�ettd hi e neck �o the ] c�!`f.. S�ICK BXAM: Sh�we4 t.�u] i:•ar,qa ai mo�iu�. t�d ���aE;m at• i a�i��rne�s was noted. Strai.ght ) oq r,� f�ing we� n�qat �ve bi 1�te+ral ly, �;, „ ' , , . , ' � i � � ' � � . � • ! • • I ' � � � . Z1 � ' , • � � 19r31i95 i0:46 o�r� 3 cG �pt�sU t,r��� i GN i�AVIn �d&8�lRD RUB�Rr G wr�LKE� pA - 2� (ICtobA�' 1 G, 1 �$:� / � � M�TQk �xAMxNATxON� Show� bnrde���in�� w�akna�Q �n ��,� d4��oi,d a�id � n3i�d ta mo4erate w��kn�sH in Y.h� 18� � bi �Qp�;, t ri ��p�� ei�� � � bre�chior.�c�ialia musc)��. ,� A��t,EXRB � 9how e�b��r1t bi t,tsE��: �rid bracttl ur �d a� i��► 1�e ��c�K4t� Q�t tlie 1�fG and r��igbtl d�►�i•n��ad i�raiCe�a �n tt�a lexl �omN���c�d f:n t�he r, igh� � 4tT�ex ref���x�R a�•e i.nt�G� , mhc�rd �r�, �to hy�a�raafi i v� � rqtlex�� �1� �he loWar �xt riQmi ky. l�EldHATICIN: BAri�Grry testir�g L� ��ud��iLias �� p�t�ir pnsit�tvn r�rtd vibr�tiG►n ehowed nv gvi.denG4 of' lo��. 'i'?ierc� we��� nd �rea� Ai' hy��r�athfiQ or fo�al #.�ed tan�e�ne�s. �tornbAZ�g �;a�t� w�s �oq�l:�v�, C�itDINAi'�GN� No�mr►� �ta�tia�; And q�it. 1'AfifQt11; w�g a?a�e to ' �riertoz�m raj�id a3 �er.���t,i n� muvom�n� bil�dt�roi �y w! #,hrn�t difftcu�l;y. Fin�er t� nn�c; t,e�ti.nq �1�aw��3 r,o e�J�nc,�•m���i.Se�, TMi'R�;F3�xnN: H�tn�aLuC! cerv�.cc�l dieG, C��E�. 7�h� ��ation�:'s M�ti �can wae aua� l ab14 fo�• r��v i�w ���d r aqreo wi. t:�� th� ���terprnt f on . nC�MM�NqA`TxON�; Tha na��ont.'� r�a�p4n�N t.o cd��ge?�vati.va.a�►ro t,o thi� �o�n� 11e� been �ut�optinti�+3 a�yd whf�� St ig �a�asik�l� th�� �urthe�r. ctsnsvrvo►ti�vu t,�t•o t�iiq��t >>r�o�uca r+ f.ur�:��r,r, int>>r•uvdma»t, I t,hink S� ia unl ike��� ih�t r:onE��r•v�tfve cfi:•d w� �? x��osvo thd prtobl om �r�1: ire).y �r�tT i n � Hc� the► pati er�t wi l] nc�oA au�•q�ry. 7'he patioy�t f��omewh�t relur,t�ni �bC�ut. ciearg�,ry �nd f��e�king t,u �got �ome �Qditional bu�•�i.ca� opinlon� �s #,o wt�ach uur�i�cc�l prooedurc� m�qht b� mc�st 1 i ko]X to ho2� ?y�,m a�nd 1 et��aUUrc�gc�d ��im �.o q�t b� m�ny api.nian� �g 1i� nvod�d tu �ae ��f:•iy c�t+nfidet�� it� t�hib r�QppCt, . WdkK �TA��S ; x r�►v i ewad �.he p�t i.ent `�: � ob desC� � pt �.onF 1 � t�t;ed urider Clae� U�finit�t�or� c��` F'Sxot'f��tt�er� oaaef�l.lu1 iun��.ior�� tho��o�', a»� i!, is roy a��nf�un thBL• ti,a nati�r�t !� n��. eb)� L� m�e� Lts��a roau� xem�nt�a �t �hA pre��e�r�t. �� mc,, r�ar• wi X 1 ho b� t�bD c� ta m��E th�m in �h� iuturA, whather. t�� l��s �urignry hr nnt, ` r� ' � • M�'cH L�. ANGRIbLA, r! , v. /�.N ac; At.lorn�ay Waxk4� , _� � ' � 1 . . ' . � ' 1 1 t �:1 t � 1 .. � .. . . . e. . ....•i � 1 ! � � f .4 . . s �, w:� � fi �„ ��: ,- i'• =.� �, .. . i ' . � ��t � i 1� ' • C{TY OF GLE,i4R�IlATER lrtterdepartmenR Correspanden�e Sheet Tt} Dar►td Bo�sard, F�reiigt�tor , � . FR�M: H. Michael taurser�, Human Resources Direc,or � COPIES: K�tt�y Rice, Deputy City Manager ' I.eo 5chrader, REsk Manager � Bob Da�idsan, F�re Chis# . SUBJECT: Yaur Request ior Disabifity Penston--City's Request tor Intarmation Rela#ing To Reasona�le Ac�amm��atian DATE: �ctober 18, � 995 �You ha�a appl��d tor a disabi�ity �ension under pravisions of tY�a Cle�rwater �mployees' Pension Plan. � By t�is actian, yau have indfcated that you �elfeve you have a disability which Iimits your ability to perform your jcb. The AmerEcar�s with Disabliities Act (ADA) provEdes that an employer has ar� obligation to make reasona�le accommodatEons iar a disabfed �mployee t4 allow the empfoy�e to cantinue to worfc, unless ii . � can be demonstrated that the requested accommedatfor�s wau{d �mpose an ur�due hardsf�ip on the empfoyer. Reasonable accommodations may fnclude such actions as making exfsting tacilities rea�lily accassible to and �sable by the employee, restructurEng t�e )ob to eliminate marginaf job f�nctians, moditying the wcrk schedule itself, modifying e�uipment used by, ihe employee in hlslhar job, etc, 1 t alsa may lnclude reassignment to a vacant positlon. TheAL?A regulatEons provide that a q�3lifiecf indlvidual witt� a disabiiity is r 'r to request or to acce�t an ac�ommodafion that he or sE�e choases not to accept. The CEry seeks to engage in an interactive process with you ta determine if reason�ble accammodatinns are sought so yo� may caniinue as an activQ employee. 7herefore, we asic that you advise the City of what reasonable accommodafion, if any, you request that would make it �ossibie #or yau to remain an errsp}oyee at tf�a Clty in your current job or in an aiternative job while perfarming t�+e essential jab f�r�ciions af such job(s}, • Twv capies c�f this mo are being provided to you. Ploase retum one of the capies of ihls memo ta H. Michael Laurs , H�rran ResourcQS Director, witt� one ofi the opkians initiaied as ia w�ether you seek , rea nable acc mmo tions w' Ed-att�you to continue to work. HMi./ciif . Option 7: I��t recl,uest and will not acoept any reasona�le accommodations irom ihe Ciry ot Clearwater that wouid aliow me to contfnue in my current jab class or in some other available vacant position. f choose to ses�c appraval for dlsability pension p�rsuant to the terms of the Employees' Pension F'lan. � Option 2: I do r�quest that 1F�e Clty cnnsider reasanabl� accammodatians tor my disahiEily which would aliow me to continue working, wheiher In my c�rrent �ab class or in sor�e alternate available var.ant pasitfon. I will submit to the Humar� Resources Director af the City of Clearwater a Iisting af accommada#lor�s which f believe are reasona�le and nec�ssary for me to corttinue working. Desigr�ation of ihis npilon daes not in any way preclude me trom continuing wEtt� my roquest tar disabiiity pension. � ��: i ' .. 77�e SplRC �'vrr Erperla � i��rid� Sp��e Instit�te (ltthcr�cdlr tipinc Surgrry l3nU�las� J.11'riland.11.[Y.. P,1 F.Iltat�rlh C, Slrna. li.i)., ('�1 }'ai�! 1. T.��k. 'It.l�. ,�u4rrw C, �Il��srr. U.11. D�}vld A. BenctiWr,'�I.U, Jcfhe4 S. T�tar��. p,tf. - Qrtho�uscdfr 5urgrry Jessr.11', \�nr�;a��, �S.U. Phyalcul Mrd�clne & Rth�rbililatlan Huhe�rl fi. Grutarr. �.i3, Curtistantii�c G. Fiourhlas. I11.d. � Franrisrn ht. Turres.Ramas, �I.I7. t;enneli� P, Boiwi». A1,D. I;EnJamin H.,�S1CfL:iC�1. U.u. ,'Veurulaqy J��Eru U. Lihrcr�s�Cupido. !►S.d. � Luis G. Figucraa,ll.U. \eurnradioloqy C. P. Shah.li.D. PaychoZoK}• klcitiarcl N. �r:ink. l�ii. 0. Chrnnlc Yain Charles R. Pltlu�l�. Q.Q. . (.yrme l'. Ca[u�»bus, D.O. Spfne Carr 5rrrlcc� Imaging RSRI Ci'Sian ,�1}•c lagra m Spine �urgsry . Spknal Reratis�rucllnus �..�ser Uisl�ectotny F'ercuWn��rws F'usions s�:oliosis tipinal �lcnusts Hernlatcd Discs f.lrcirodiugnastlr, Aiedicinc Ef11G Ncrvc Cunclurltc�ri SU�dv S�EY ,Scurolo�irnl �latcssment $��tna1 pisnrders H4�adaclics & �rizurrs RehaUllltaliun 5en•Icea F'h}'sEcal Thrra�i}� f'I�ysical Rec�rndilturtitng ,lquatic T4���rqr�. fiack 5rt�cxr! Ar�hrlUs f�rticf Psychulogicul Scevires F.v�tua�lcm & Tr��atrnent f'�Ir� 11},�nny�rnu�nt lllufreclb.7ck SuR Ti�ur lujury Ilaitl��ufalloio i'Eiysica! 'CNcrapy EpYdurak 5;rra�id laijc�'lions i'rk�;�;rr Poi�il ltt�tctic�ns ; Fl�rida's lar�;est Cenier f)ev�ted �ntlrely to Medicai and Sur�ical C7re o{ the Nerlc and Back � PATIENT: BOSSARD, DAVID ; CH�iRT #: 22374 # AC3�: 42 DOEi: 12/27/52 ; REFERRED BY: IME/CITY OF CLEARWATER � DATE: 10/30/9� Ta Whom s� May Concern: The following independen� medica].evalua�xon i� performed on �atien�, Dav�.d Sossard, �or evalua�ion o� injuries received statue pos� �ccupat�.ona1 injury. I� i� baeed upon review of inedica�. recorda, examxnation a� the pati�nt, review of current x�-raya and a recenr MRI �f the cervical spine as we11 as my train�.ng and experi�nce as a Board Cer�i�i.ed speci.a3.i.st in Neurology . CH=EF COMPLA�NT: Neck and letti arm pain wi�h w�aknees. I��S�QRY OF PRESENT ILi,NE55 : Mr . B�ssaxd i� a 4 2 year old, rig�it-handed gentleman wi�h no particu�.ar m�dical. problems who waa absolutely well un�i�. appraximat�ly 3- 7./2 months ago. He was holding down a pa�isn� that waB sei.zing. He waB �ryir�g �o pu� an IV line in. The pa�ient works as a fire figh�er and pazamedic for th� Ca.Cy o� C�earwater. He s�arted deve].oping pazn in the neck at th� scene. Two hour� la�.er he ��arted experienc�ng �evexe sharp pain in the �.eft upp�r extremi�y. The pain radi��ed down �he anterior aspect of the ai-m and forear�n . It reached �he hand dif �ueely . �n additiori to tha.e, he was exp�ri.encing a burn�ng senea�ion and tingZing paresthesiaB in th� above mentioned terr�tory. Th� pain was ao int�nse �hat he had to li.terally leave his arm "hanging". He waa initial.l.y sEen by a doc�or who diagnosed a cerrica� spra�.n. ACte� Beveral weeka, he was re�erred for an evalua�ion by an orthopaedic surgeon who ordered an MR� o� the c�rvical apine which diecZosec! the presence af a large herniat�d diBC at the C5-6 iev�i. During that time, because oE the gevere pain, he deveZoped atrophy o� the Ahouider girdZe Y�e repazts. Thanke to the physi.cal �herapy he had, thi� ha�, in his own words, returned almoa� completely. F� few houra a�tez �he ifzi�ial injux-y, he notiiced that he was dropping �hings trom hi� left hand. O�her examiners ha��e reported �he prEaence of weakneas of the let� biceps, 2?S{1 Drew Street, Clearwater, �lor[da 34fi25 •(8!3) 79-5PINE •($13) 797-74Ei3 • Fax (Sl3) 72fr1580 + ., i � ' . . �! .. , �: ., � . E..,. . .....,, �, � �;' . S y , , ,...t_ . ,,� PATI�NT: B03SP►RD, DAVID . " ,. . CiiFiRT: 22374 � � DATBs�, ' 10/30/95 � PAC3E: 2 � . . The patient ha� had eigh� or nine weeke of physical therapy which � have helped h�.m. He deacribeB �he pai.n in the neck aa modera�e in intensity and d�ll �n nature. r� ia virtually con��an� bu� it �e aggravated by �1ex�on or extenaion oE the neck ae , wi�th �.atera�. . ro�ation o� the neck. . He now experiences intermittent pain over the posteri.or aepec� of �he �houlder, bu� the main �Xmp�oma in �he le�t upper extremi�y are t�.ngling parea�hesia� as well as numbneBS.� A�ew daya a�ter.t�he onset o� �he symp�o��e, he atarted exper3encing , numbnesa of �he'whole hand aB well as 3oes af Ben�ati.on ot the �ingerti.pe. He ie empha�ic in asaerting that the weakne�s and th� sensory changes have not changed over the paat severa7. weeke. He has �be�n oftered �urgery bu�, for the tim� beingr he hae dec�.ined. Na changee hav� been observed in �he character or the intensiL-y o£ the pain with Val�al.va maneuvere. The pati�n� den�.es nausea, vomiting, ver�igo�. dysarthria, , dysphagia, dxplop�.a, unst��dincs� o� gai�, recurrent fa�.ls, ].ose of consciousness, hoareeneBS, tinnitug, �ing].ing or burn�.ng paresCheeias a.n eithe� ex�remities, focal. weakne�s or numbness in the right upper or in the lower �xtremities, urinary �requency, ' uzgency or incontinence, f�ca]. incflntinence, tremors or other abnorma�. movernen�s, or sexual dyaFunc�ion. He also state� that hi� l�f� thurnb hag been weak �ince h� atarted cleveloping these probl�ms bu� �hi� haa a].so no� changed Qigni��.cantly for several weeke. The pati�nt has a�so be�n tr�at�d with anti-inf�.ammatory medicatione aa we11 as muscle rel.axanta. Ac�i.va.ties euch as t�itting, bending and standing fc�r a lang pera.od o� t�.me make the pain worse. S�anding for short period� o� time as well as ly�.ng down on the floor ��eme to make th� paa.n better. He has a standing �a�erance of abou� 30 �� 45 mi�tlutC�Br and h.e can only � walk �or about 150 tee� with no ar miraimal pain. P�AST MEDICAL HISTORY: Aa above. PAST �URGiCAL HzSTORY: Negative. CLJRR�N"Y' MEDIGATION3: He i.e prer�ently taking Relafen 500 mg PO BID. AS�LERGYES: H� haa known drug allergiea. . 1 ' . . . . � �- 1 , � LKl ( PAT�BNTa BOSSARD, DAVxD CHAitT s •� 2 3 7�4 DATEi . �,U/30/9� PA{3S : 3 � 30CiAL H�STORY: H� wae born �.n New Yor}c and reared in Florida. He ip, a fire fighter and � paramedic. He currently ie off duty per doctar. He has been off work �ince Jul.�r 21, 1995, He doeg not amoke or drink. He deni�s drug addi.ction. �� F1�.MYLY HIST�RX; Remarkable for hear� disea�e.. R�VYhW OF SY3TEMS: Pleaee ee� que�tiQnnaire. PH3t'3�CAL EXAMINATiON: Rev�a�.s a w��� developed, we7.2 nouriehed young gen�leman wha ie in no appar�nt di.etrees and �s very p3.�asan� and coopera�ive wi�h the �xamination. He �tands 5'7" �all and weighs 173 poundB. S�INE: Examination o� the spi.ne revea�s no obviouB sca].iasie, lordoQis or kyphosia. There i� �endern�s� on percuasion of the lower cervica�, apine . There i� �endernesr� on pa�pation o� the �.eft low�r �ervical. parasp�.nal muacles and �he 3.e�t trapez�.u�. Spurling's and Lhermit�e'a are negative. Cervxcal, range of motion is Freeerv'ed. Exten�ion� f3,exion and �.e�� �.ateral, rota�ion elici� mi3.d �u moderate di�comfor�. No viaxble muacle �pasm is n���d. NEIIROL4GrCAL ExAMINAT�ON:. No meningeal sign� are preaent. No cranial or ca�otid brua�ta are apparen�. CaroG�.d pu�aes are 2+. MENTAL STATUS : The pa�.ient is a�.er� and ori.entied x3 . Speech ie non--dysarthric. Language ie tlu�nt. Comprehension and repeta.tion are narmal. There �,� no dyspraxia and no �e£� to right con�ua�an. Attention apan aa wexl, as shor� term and remate memary are �.ntact. Af�ect, intel�ect and judgement appear normal.� CR.ANIAL NERV�S : EOMI . PERRI�. Visual fiel.dg a�� fuZl �o confrvntiat�.on. Op�oki.netic reeponae� ar� normal. There i� no nye�agmus. Funduscopic examina�ion ie norma]„ Sac�adee and emaoth visua�. pursu�.� movementa are preaerved. Corneal. reflexes presen� bi�.a�eral].y, Jaw mov�mEn�e and tacial eeneation are normal. There is no �ac�.a1 asymmetry or w�akneas. Weber i� in the n�idline. Gag is symmetrically preeen�. Uvula i8 not devxated. Trap�zius and SCM muscle power io n�armal. 'The tongue protrudee �n the mid�.ine. No a�rophy or �aeci.c���.atiQns are observed in thie or.gan. TONE: Norma�. a.n �h� lower extremities as weJ.� ar� in the ax,ial muscl�a. �t was �impoae�.ble �o a��eae adequately in the upper �xtremitiee, due to a cnngeni�a3. I�mi�a�ion of pronation and supina�ion: MOTOR: Ther� i� no pronator dri.�t. �,ine mo�or movements a�e normal. Mild atrophy of tihe 1.eft bicep� and the muec].�s of the shoulder gird�.e ia obeexved. No fascicula�ions are obviouB. l. ' 1 �I. S � . 1 ' f . ii . . , '�. • . ,' . ' . � . � � ' � � ' . � ' .' . . . , . i II�. , . � � ' � + V'.. ° . � rx . . . . �r ... .. . ....... " . "�' . ` .� .. . .�.�- ' [� � PATI�iTa BOS3ARD, DAV�v CHART: 22374 ' � � . , ' ' DATi�:� , 1Q/30/95 , . PAaS: � 4. . Muscle power , teeting is � ae fol�.ows : R�.ght upper and bo�h lower extremf�i�g are 5/5 for all. musC].e groupe �eeted. Le��C upper ex�:remity deltoid ie 5-/5, biceps ie �+/5, tric�pe 5/5, wrist � extension 5/5, wriet flexi.on 5/5, izitrLnaic hand mueclee 5-/5, �pen�or function 4+/S. • � SENSORY; There is an ar�a of hypve��heaia and hypoalgeeia which �oiioW� a C6-C7 derma�:oma]. dietribution in the le�� upp�r ex�rem�.�y. Joint poeit3on sense ia normal throughout. � S�ereognosis and graph�s�h�exa are norma7.. Vi�bra�ory and proprioceptiive �ensory modalitieB are intact. COORDINATION: R�pid alterna�3ng movements are normal. 7'here ie no dysmetria, dyasynergia or �ction tremor. � RE�'LEXES: Deep tendon retlexes are abs�nt to trac� in both th� t�pper and lower extre�i�ies . There iB nv �nk1e or patell.ar cl.onus . Plantar responaes ax� mu�e to Babinski., Bing and Chaddock. GAZT:� There i.r� no re��o, �n�ero or latero pulsi.on, Arm swing and s�ride are norma�. Pos�ure and stance are norma].. Tand�m gait as we�l as ti,p tae and heel walking is within normal. limita, ASSE58MENT: Mr. Boseard �.� a 42 �rear old, right-handed gentleman with iio particul.ar medxca�. probiema who preaente �ar an independen� medical evaluat�on regard�.ng cex-vical pain radia�ing down th� let� upp�r extremity. He xs ba��.cally here for an evaluation o� injuries received atatue poe� occupat�ona�. a.njury. Physzcal examina�ion diBClos�s the presence of paxn on percussion o� �h� l.ower cervical spine, �enderness on pa].pa�ion of the 1.e�t l�w�r cervical paraspina]. muec].eB and the �e�t trapezius, mild to moderate di�comfort el.ici�.ed by flexian and �x�en��on ae wel]. ds le�t 1.atera�. ro�a�ion of the neck. Neurolog,�cal exam�.nation d.iac�.osea �he pres�nce a� mild weakne8s of the lef� upp�r extremiGy (del�.oid, bicepe, i.ntrinsica and inter- function are mil.dly weak). There is also an area of hypoeath�sxa and hypoal.g�s�.a which �ollawg a C6-C7 d�rmatoma7. dietribut�.on. IMPRESSION: 1. Subacute Z�ft C6 rad�.culapa�hy. 2. CS-6 herniate�l.nuc:�eus pul.po�i�. 3, Non-progr�eBive, compress�.ve c�rvieal myel.opathy. • � � .; � . , , ._ . . ��' ■ ,r �w . . • � , PAT�ENTz BOSSARD, DAVID CHART :� 2 2 3 7�4 ' DAT$: 10/30f95 PA4S : 5 . � PLAN: �� 1. The �.mporGant question reZated to h�.s exa�� �oday 3s ane of 2. 3. � occupational and da.saloilit� related �o hie injuries.. Hig - eupplied job demand a� de�ined in the Dictionary ' ot 4ccupa�ional Titles for a F�.re Fight�r describeB thie to be a very heavy work category occupation with the occasivna�. need to exer� an exc�s� of 1.D0 pounds of forc�, the frequent need tv exer� an exce�� o� 5� pounds of �orce and cons�antly an exceeB of 20 pound� o� �force. The patient, due to hia occupation, eees Che frequent n��d tv lift an air pack o� 35 pounde, boots and pante weighing 15 pounde, a coat o� 6 pounc3e � helmc�� o� 2 pound� ��ask o� 2 pounde wi.�h a totai pro�ective g�ar on tYte job per job ta�k a�E a�aproxxmately 61. pounds. Giv�n a13. o£ the abov� in£oi-mation, it ze the a.mpreesa.on , of thia examiner that M�. David Hosaard is �ob specifi� �o�a3.ly di�abled from returning �o work as a fire fight�r and paxamedi,c wi.th the City of Clearwater. �Tf 1imi�ed duty accommoda�iona are ava��.ab1e, these would b� acceptable a� long ae they entai� li.E�ing, bending and sitting 1i.�nitatian� , I� ie tny imp�'EBSion� as an a.ndep�ndent medical examin�r, that Mr, Bose'ard's curren.� symptoms and probl.ems ar� relat�d to a jvb connected injury. I� i.s my opiniaii that they ar� ind�ed casually related to Ghe i.njury h� suBtain�d while ar�8isting a pa�i.ent on 07/21/95. i have diacua�ed the sx�uatian a� 1eng�h with �he pata.enG. At this point, basing myself on the �ac� that hie �ocal neurological findznge and Bymptiame laave rem�ined virtua�.�y stationary �or severa�. w�eks � it ie n�� unreasanab].e to fo��.ow this pa�i�nt very closely. He is keenly aware of �i�s diagnoai� and he knowa that he har� to seek m�dica2 atten�ion in case he� dev�elope worBening wealtness, 1.oas of �enBa�ion, unoteadineae o� gait, bladder or eexual dysfunction ar it the pain becomes more disabl�ng. In terms of. £ur�her med�.cal management, hi� radicular pain couZd reapond to a trial af cerv�ical epidura�. steroid injectiona. The pata.ent ver3oaliz�d unders�anding of tha ai�ua�i.on, aiid he hae 8ta�ed tha� hs would pre�er to avoid operative in��rvention i� ati a11 poss�.b].� . , �'�''I?�.f�{i? ."s'� . .'`r:._� (� .i. .. - � . . ,. . '..� . ' �' . . , . .. ' .... .'f: ''�.:,' � ;=i', ' '��'t `���'w � •�� r�" � �� . , , �.� �'i�! � i°�' :l:g . ' ' . ' ' ' ' ' . . � r ,' ' , t' . . . ' . . � . . .� , � , :7.�. � ;`,y�. . �r � , . . . • . . . . , . ' . ^ , ..} o".r,f;` �r ;�''',. ' �`�• .. 'r., e. , � ... . ' . . .. . � . .� '.� ` , . �.. • : • ' ..r ' `,� �� ;�i�l _�t• . � , � . 't.r .� .. 'e,. 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W.-r.-"�.,.v . . . °k� � o . ir-��� .,.� r�r+�:xe�.�. ._l:�+a��_ . .... _. �t''�'-;Pc'{-�y.,� .st�, "�`•r� 1a�'.n• - t'i ' ! ' , ' � . " ' . ' . . . ' . . . . � • .... .. ' , � .. . . , , ' . ,' .. ,r � , • : ' � .� � . � ' : . . . , , , ' , : , ,. :, ' . ' � • ' , . , � ' . " ��. � ' ' , ,� ' . , . , .. � ' . ` ' , , , . . � ' ' . . . . ., � • . , � ' ' '� . . , i , � . J � � .. � � . � > � ��t•` f��. ;: .�� � : : PATIgN"P s ,; BOSSARD � . DAViD .� � . • , � . . • . . .. � ' , � . � � . CF�ARTi�� 2237�1 . , ' , � . . , �s:� � � � ' . �DAT$s, ,; ',� 10/30%9,5 ". , � . : • '.' � . , : . . � `.. � • . ; . � . � �r' , PAQR s • � 6 ; � � , : . ` ' � . � " ' ... . , , �.. . . , . . . � , . . , . . , � � � ! ; � Decisione whether � or � not 'to' ,pxoceed � with ,any furkher � mediaal. ' � ° ; , �• � .�management remain be�ween him and . hi� • workers' comp phye3.cian� : r.. . ��., :�.. . .. . . . . , . , , ; . .• , ' : ' . . ..� . ' , . ?r,. .'. . '. ' , . �. . 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'. ,'�. ., , ..' . , • .� , . , - .' .� � . . ., . � . � . . , . . � , . .. . � , . � - , . , - ..- . - • . � . , • � , . .. . . . ; ; . , , �, . , . , � ' .., : ,. � . , �. e � . , . . - • � : � .. . , . � ,, . . , , � .; . .. � '. . ` � . , . , , � , . � , , . � � � . � • .,,. :, ' • : � . . � ,'' . � , ' ; , • , . � , . , � . . . . : � � � . . ' , - , , . , . . , . . . . : . � f . , , . . � . . � , � ' ' . � '.' �. .� . , � , � � .. " � • � � � , ` .. , � I'..., ' ' `' � , , • , . �. i : . , ��, � ' • ' � � � , � � �.� , i�'.. .e.,. , .'• •� .,' _' . , . . .. -. . , �• :- . . ,< . �.'', - . . ��. � ,� �Y ;•r 4 "A'"'—w�7,� ���� _ �v . 7RCIST�ES UF TH� EMPLOYEES' PENSION FUND Agend� Correr Memarartdum subject: . Pcnsian to bc Gruntec! �t�l71 # MeQtfng Date: i21�� ReccmmendationlMotion: � Ro6ert Batten, Pu�lic Works De�artmcnt, be granted a job-connecteci disability pension under Section(s) 2.397 nf the Employees' Pension Plan as recommended by the Fcnsion Advisory Committc�. ❑ and that tha ap rapriate officials he authorized ko execute same. 8/�C�iGROUND: Robert B�tten, �qujpmenk O�er:�to� . II�, Pubiic Wor�cs Departmcnt, 1V�5 empinyed by the C'sty on 3uly 30, 1984, und begar� participueing in the Pension P�an an that date. 4rt Novcmhcr 8, I995, the Pet�sion r�dvisory Committee (PAC) dctermined thut� Mr. Batten ,was cli�ible for tt job- conr�ected disubility pensior� based on his disuhility resulting from an on-tHe-j�b injury. Thtit injury was described as a CG-7 Uisc hernia�tian which resulted in u CG-? antcrior ccrvical disCCCtamy and fusion. His dis�biFity is dacumented by lctters from Mich:�el B. Cvans, M.I7,; Dcnrtis M. I,ox, M.D.; J. S�dler Hoad, M.11.; and Richard �. Lyster, M.�. Dr. Evans reports {Ietter o#' 9118/95) that "The p:�tient's diagnnsis is n�echanical back pfiin secondary io dcgenerative joint diseasc...[�ie} has iindergone extensive �hysicul tl�erapy without improvemenc. Improveme�t in his c4ndition seems unlikely to occur." A subsec�uent Zeiter (1013/y5) frorr� Ur. Evans relates cliat "...he has �;onc tkzrough thc �nost intcnsc tre.�tmcnt for mechanic.�l back puin th�tt I am awure of..." nr. Lox (letter of 11101/9S) npines thut "...the �alicnt has reached a Qoint af m�ximum medical improvcment. Hc: lias sustained a 9'lo impairment, based on the Fiarida Guidclines for his cervica! ciiscectomy and t'usion and •a 5%n, im�airment b:yscd on his lumbar strain with dc�enerutive changcs...In referencc ta r�view of equiprnei�t operatar III job descriptinn, I feel that the paticnt is permancntly disabled with regai•ds to that typc o f emglaymer�k." Dr. Hood states (l�tter of 1�/12195) "...the patient's diagi�oses are perinancnt and I do not b�lievc there wii! be imprnvcment in the em�iaycc's conditian and/or ability to work..." und "I believe ttie �atient's ciia�nases fuily disablc him from the job perforn�ance af an EquiP�ient Oper�tor III." Dr. Lyster (lctier of 1112195} concurs that the �aatient has a 14°Io impairment ( a cervica� spir�c raiinb of ���a anr� spinul sten�sis in thc �l1�bAF spine of 5�'0) nnci has rcaclied MhiI. ❑r. Lyster st:�tes "the paticnt wauld be �iyable to perform his dutics of Equi�rncnt O�crator II1 uncier �is �resent Qhysica! conciitian..." Revieweci by: Legal _ N�{. Budget Purchasing {�q._ Risk Mgmt. N�__ C�S � N�j, ACM Olhor [Vg Submltted t�y: Ci1y Mnn�ger Originating Dept: Human Resource; llser De�t.: Ad�ertlsed: DaRe; Paper: ❑ Not rec�uired Affected partles ❑ Notiiied ❑ Not requireci osts: $23�,476 7olal Currant �Y Funding Source: ❑ Capt.lmp. ❑ Operating ❑ Other !'ensfon A�proprlation Code: (�}�Z-(?74 ��i j �2{ifl-SRS- � Commisslon Aatfo�: ❑ Approved ❑ Ap�roved wlcondltions ❑ Oonfed ❑ Continued io: Attt�chmentS: Letter(s) ❑ None ;:�i�Crt��`a.- , L: y�., , . . . ' r'� . . � ' , � , � � ' ' �. �, .. . . . . , . .. , .t . , ' �, r' ' ,�` � „ � ; ' � � . , ' . . ; � I , . .. � ' , � � ' . 1 , � � � - • ' , . . 1��., . ' ' ' � ' ' ` ' , '. . . . , . . ' , . ' ' . , ' ' . ,' ' �•.1 . ' , . . . , .s . . . , � ' i ' . . . , . , . . . , ' , . . i;.S�. ! .. .� � [ . . ,� �..i � ' , i . ' ' � � . � i', i , • .. . _ . i,.1`: A�1 1' i . , � . .�. ' . ' . , � ' , ' ., ' .t . . . ' ' �t�I. . It� � . .�1. .. , i .! . . . � � � ' . ' � , � ' . , . � � . •. . .'ir . .'}j� ' �j . f '.i � y� ';', , . , ' , ', .�{ � ' ' � .• . ' 1 ., � . � � . • � . {,,'J fi. ,s�. � ''. , ' {'. � � fS.. . . , � . . � • � � � , ,. ' , . �. ° � . " , . ' , . E,` • ,. . 1�� i' , . . ; . � � .,t . . r. . � ` , � , ' - . .!. .. �y� ° � ' � ,.'i' . ' ' . ' .. � . E ' ° _ . . . . � . , , - , , ' �,' . ' ' .'�, � � � `�.�1� � ' ' . :�..t, '�' , r' ' ' . . ' . . . . . . . . . , � . . . . '� , ' . , , t �l r , . •�. >� , i - ' . . . � . �,z.��� . . .. . . ;F', t "� . f• � � � ' � ' ' . � � . . _ .., , v . . . , ' . , . ' *i . . i ' , . � r . � , • , , ' 'r • , "?, '�` �,1 . ' ' ' ," ';' . ' � � ' ' �h. , ' • „ 1 'ty` i4� ' .i�• .a' . .,re:w.tr9.�':-I i..i�.�f��.�.�,� 3 ' ' •i'n� '?`" 'T.:�':.• ' " ' . '}� 'x.'` .i' , ���.1 . . ,n1�""''+i"'1°7��':;�'7!:"`�y'�e<4K-�.Vt,t:dhi�s...., !f,.4.`kr,%e.:i�,.����A��c.�.�,:., 4.� ,,��°� :{.v�..Y..'F.3° }.;� , . ;e ° . .< • � . , . . . � i . � . � . , �. . . I � ' ' , , � , . . . '. . . , . . r. � . . ' .. . . � _ [ . ; - �� ; �, ' . ` _ ' , � ' ,' . .'l. . � " � � . ' ' ! � , ' 4 ' ' . '' . . � � . � . . r . • + � ' ' • Agenda' Item—Robcrt Bput;n � : � ' � • � . ' : .f • . • . . � � . � P�gc� 2 � : • ' • ' ' � ' � � i � December �{, 2 995 � . . . . ' , . , � . . ; � � . . t`;. '� . , , . . ���'� . � . . . � . . � . � , . � . j. . . . , x . . . • - , l . ' , . . ' ' � . . ' ' � . . �,. Based an an: uvert�ge s�lary of _ upQroxin�ntely �$24,111.39 over the' last fivc yeurs �nd tt�c sevenXy- �' '• five; psrcent (759''4) minimt�m •dis�bility" l�enefit, Mr. Batten's pensian wil! Zpproxintute 9+18,083.5� , ,, anr�ua��y. . Cht�rks frnm Finance, whict�. t�ke intn consideration ritorti�iity C�[C5 - Ail[� �tge, reFleet th�tt� , "present . v�lt�e cast of - fin:�ncing" � this pensinri will be ap�roxim�ately $23�t,�76.08. .The tot�l � �ctunl payc�ut wall �pproximace $56U,S9D.. � , , . . . � ' .� ' , � . . . � . . . � ',: . � , ' � � . . � ; . , , ' , . . .. , ' . . . , , � , . , , , . � . . . . l ' 1 � ' ' ' r , � • . . . . . � � ' F • , � . . , I � , � ' . ; ; , ' ' , ' , � � , . ' .• � • � � . I ! ' • i . . r ` . , ' ' . I' � . . . . � . . � . . � � � _' � , . . . . . , . l. ' � ' ' ' � " . E• ' � . • ' , ' . . �� . . . . . . ' , I. � . . ' . . ' . . � � y ' ' � . • � . 3 . . . � , - . si ' . . � ' ' ` " o � .. . � . ' • . . F�',.,, f ' � . . . . ' , ' ' + . � � �. . ! . ... ' ' . . . ' . . � . ` . � , . . , fi . .'�. ' ' '!I ' ' � , � ' . . . ' . , _ . � � . • ` . 1 ' . � � � , , . ' , . " �' . ' � . ,� . . .� ' . , . . � . i i ' 's , . . . , . . . . . r , . . 1 � .' , � � ; . . i� ' . . . ' � ' i . ' � . . . . ' �' . . i. � .+ ' . . � ' ' • . ,. . . . ' � . . ' . . ' ' � , � . . . _ . .s. , . . .� . .. . � � . ..� � � • , ' � � �f 1 �I i : i �i i: �• . . , ' ' . � • � � � . . .. . . . 15 ;'' ' �' .i E� .' . . ' , � . .. ' , . ? . �, • � . . � �� � j}� �_ e�+.onEswy.,s,,...�,�yc..ti...•—�.—..�r . . `:1'"''S.s.i.e ..,}l. . ' . . .. . 'a, ... .... . .., . . � .rsk. � �. , . , ! . , Nurnan R�sources pepartment • (813) 4G2.6870 � 7� FItOM: COi'IES: , SUBrECT: DATE: C I T Y 4 F .. ' � ' . , ;. " . � i .. ' . . � . � � . . ' . �I i . . C L'E A R W�A T E R, AOST OFFlG� �pX 4748 C�EARWATER, �LOFiIDA 3481e-47'48 Honorablc IV��yor and Members of the City Commission as Trustees of ttie Emplayecs' Pension Flan . , Pension Advisary Comrnittee , Dcbbie S�ilcy, f'ayr�ll Services Man�ger; Ris1; Mnna�ement � Per�sion for Robert Batten—Job-Cannecteci Disability� Aension� November $, 1995 ' , The P�nsion Advisory Committee (PAC) received an application �for disaUility �ension fro�n Rabert Batten or� SepEcmber 27, 19J5. Mr.� Batten �tas been detcrmined by thc Per�sion Advisory Contmittee to mect t h c reyuiremer�ts of the Per�sion Flari for � jo6-con�ecied c�isaGi�ity pcnsiorr, He wus em�lvyecf by th� City on Ju1y 3�, Z984, and begnn partici�ating in the Nension P1an on JuIy 30, 1�84. Furth�r, he has submitted mediraI documcntation, capies of' which are attach�d, rclative to his disabiiity whic�� h�s b�cn reviewcd and np�rc�ved by t��a PAC. By motion m�de and duiy carried at its mceting of Navember 8, 1995, thc Pension Advisary Comcnittee ap�roved/recomrnended tli� granting oi a�ob-canncrted disubility �ension to Mr. B�tten in accardance witt� pravisions of Section 2.;i97 of thc City Code, "I'Itis pcnsion is ta be effective on a datc tu b� determined. Tiie :���c�unt of M:•. Batten's �ension will bc calculated by tlie fiinance Dc�artment accarding to tt�s: Formufa in the Pcnsion Plan for job-conne�ted dis��iility pension at such time as h i s last five yeurs oF servicc �ind salary cun bc CDIT1�l1L(:CI. [ hereby cc:rtify thut the Pension Advisory Committee has �pproved thc granting of � jni�- connected [I15�1�1i[iY pension for Robert Batten a�d the ��ove d��tes �re cvrrect. �� , , � ' _.��.....�: ---- -- Cliairm�n, Pension Aciv so � ommittee . � "Equai �mpfoymont and Aifirmofive �4ction Empfoyer` .. .. � , ,.,, , , � 4 I� - � ' r . . Ey �Y rY�w��a i i r. . .�s .. . 1 � � � • . . � � r s � . ' ! c � 1 . . � • • r. � � ' • , � ' ' E " ' . . � - PENSION R.EQUEST FORiy� • � , �r � Robert Ba�ten do S�creby app[y fot' retiremcnt From tha City of Clearwater Gencr� Emplayces' Pension Plan. , My benefits date is Ju�y 3Q, 1984 (Entxy date Into pension� plan) Ju.ly 30, I984' M y date o� hiz�e is . . My 6irti�day is Augus� 23, 194�. . � M ob classi�ication is E�xP�ent eratflr r�a • y 3 and I. wark in thc PubYic Woxks pepartment putsii,c Div�siou. M y zesign�t3on date is tO b� determa.n�d , ,, The � ty�c vf pettsion for which I am applying is (check only onc): ._�„�___�Rebutar P�nsion basccf on yrars of SCFYIC� ' x �J�b-�onnected Disability Peasion �,�ion-,�ob-connected� Disability �'ension � �ily spot�se's name is: ���'a ����n 6/27/�3 ' Aepend��t ch3ldren �nder ihe age of 1� a�nd •residin� in my . hausQhofd are: (Psint Child's Full �Tarrtc} (Child's Date af Birch) T her�by �crtify a!1 af the ak�a�c ta be true and correct: � � � r , c� .� � �� (Signature} ` September 25, 1�g5 � (Dace} � STAT� OF FLORi��i Ttse forcgcsjag ir�trument was ackno lcdQed bcfote me th�s C4UNTY O�' PINELLAS ' ����T by_i.�[�h�-#'�Qf'}"� � who- is personally 4cnown co mc or wi�n 'has produced ' ��� as identification and wha didldid not take an oath. �p �ja3� nx}�c�n�. noTnRY s�n�. Yacary P�blic t�A;�CY ANN DF.LEON {$igtlaNre) ; ;t`;;.�'! PLfIiLiC Sl'A'T£ OF FiAR[DA Ci►4t�liSSiON .ti0, CC42G678 CO[ri,IIll5S10a Na. C� � �'4 CCJM�Il�.�iU11 E�in. D�C. b.7998 �j - , .. . . ! V �n�r1�1-L L�1 (Name of Noia.ry Printcd) • � ` � _ �— - - - _ . . , � _ — ��� -- --- P lt, : ` � � . • . . ,. , ' i. ' 1 . � ' , ' . . . . . ''' . , . . ; 1 ` � ; � � • . ' ' � I � �. ` ' . ' . . . � . . I . ' ' /. ' ' I , 1 ' ' 1 . ' ' ' . . ' � . , � 1 � � � , l . ' � . . ; . • ' . � . � ' ' ' � � �' 1 . . . ir '� � � . . .' � � ' , � � i . . I • . 1 • . " � ' ' . I f . s , . . .. . . . . . , , . . . ' , � ' 1 ' t . • t' .' ` • ' � � , ' . , ' , ' ' . . . �1: .. . i � % �; � � . ., 'j . � `.r .' ' . � . , ' � . . � . . ' . . � . . . / '' ' . ' . � . ' ' , . , . ' � . , ' t . . . ' . i'` � .r�� ' .. , , , . � , . • . . . ' f • v � . , ' , . . , , • � • , � � , �.._ .. �..�s . .'F'•`. �: . . r ,�.•. , . , , , : �n.v•l' •,-t . . . ., .,. �.l��� . i .. .. . � . � . . . , . 'f • ; , ' .� � I ' : , � t , . 1f , . �+. . � � � . ' , ' . � � • � � ! -. � � � ' � � � . - CITY OF CLEARWATER� . • �,� ' '. - �, � . ��� ' , �� � .GENER�L E1�IPi.OYEES' PENSiQN PL�.V � . � i � � � � � ' , . OPTXONS - G�vER�L E1�IPLOYE�S ' ' OPT�ON �T:, � • Employees can iCCCjVC a lump �$um payrrrent for vacailor� and ' � ' �oliday pay �nd 1!? at accrued, sicic� Ee�ve �t the timc ai �. , � ; scparation Ecom the City. Thtre will be ao 6% deduccion for ' . , pension Erom this Iump sum payment r�or will this amaunt count , . . as e�rnings . in the calcuiation of tt�e �oensian. T'he �ust �day ar ., . .� work will be the termination �ace �and pen�ion benefits will be;in ' � -, . tE�e foliowin, day. � �� �. OPT�ON '�2: •' Employee can extend terminatio� date 5y ch� time due ior ' . , vacaciori, hatiday pay, and 1!? of accrued sick {�ave. T'erminaciart � .' � ' c#ate will be the final d�w of exzcndeci � time. �ension benetits � w F� I - be,in • th� tollowin; dav. � �� (C�nly avail:�ble to etnployees hired prior to 1Q/I/90,} '+N ♦ M+k ii *#* At �k {�t ��!� f �N {1 rp �M ��k �R fr y i� ye � a It 1� r�r +[ !� 1� K�r re ��t eK Ie k ar ut +r K M M�Ir k� dr +!e 1r ♦t +k �e ,K dr ar x it �r � M H . �, . �Robert Ba�ten A Y . Y P Y .ior ' � �� _.._..__� __. ,_„�_,_ _;__ , an �m lo ee of the City oi Clearwa.ter, hereb aa i per�sio� ben�fzts . c�nder che Cicy's Empla�ees'� Pe�sion Plaa. � . C hereby :,erti�y � t�i�r I tuliy underscand tE�e two opc'tons atfzred to me. I choase to retir� usin? Oo�ivn Y�_and wj;i� ;riy benetiitS ro be 4�lculated und�r ��his aotion. � . I understand that arte� chis torm ts signLd, mv deesion is irrevde3ofz. � ' '� El�IPE DYEE'S SIGy.�TURE•�� � - � SOC�L SECL�tITY =: �65-62-8996 � SSES' :IDDRESS, �001 North Greenwopd Ave. , B�dq 6,�_ A�. 2 � CZe�rwater, FT. �34b�.5 � � t- � DA"IE: S�p�em�b�:r 25, �955 r, I . 9�_.—._ --- —. _.. • , '1 .. . : �f ' .� '. . , ' � .' • . ' . . . ' . ' ' ' � , ' ' ' F . � � . . � .i. , , . . . , ' � - ' .. ' . � . � ' � � � . � ' � . ' . . . � �' . • '. . , , ,7, . , ' ' ., . ' ' � ' ` s • ' � , . . ' ' ' . ,[1'. � :'°�.5' , ' ,� . . ' . ' ' ; ' • , " • , �.� �� , . , '. , . . , ' . . , ' . . " .��t a �. " ' . r�.' , ' .. • � , � ` .i . . . . ' . ' , ; ' � . ; . . . . .� � . � ' !'1 . '. ' �, � .. ,i. � r . � . : . . „ ' ' . .. ' ' ' r ' � . ' . . . t .,r �, ' ';�..�`.1',i1 5 . , �. ��'. � . . ., ,. . . '. , . , -� � . ' , , � ' �. �F - ' .. fi � ' � . ' . � . � � . � . , r ' . . � i. ' . ' tr ' l . . . �. , . , � � . • . �.. §i�, r . �'i ` '::�� ' , . �{� ' �:', , . , ... - ' � . . .. . � . , , - ' . . , . ' . . � . ,ic �r,� �. � .Ee. ,'• .. ; , � , ' . . , ', •q � ' ' , . ; ' . , . ' i � . . , . ' • .3s�1.w�^. w�:,y.. „��v .,r� ,_.�..�. �t.q,i;.. � -�r. .''�:.` . ... '�� .. . , i � . . . , i. . � .i .. � , •, . - . , � . r , � � ' • , • . ' ' � ' � . � '��.. . ' ' ' I• � . ' . i � F� . � � , � . . � ' 1 , � . . .ii � •� . � . . � ' . . . ' ' � !� � .. ' � . ; AU'�'HQR�Z,�i,T��N TG �tELEASE � � ' . � � �. , . F . . ��: �, � ' � � . , il�.(�DZC�i� AND REL�TED RECORI}S �. . � �* � Robert �3atten , �n apglicant foc disability pensioa under pravisions af �. ttrG Emgloyecs' Pcr�sior� Plan o� .thc City of Clearwater, h�rcby autha�ize any physician or �.. �ather n�dical care provider who �xaritinas . or tceats • rrie or wha has �:ami��rl. or � treaud m a or wh,o in the futura examinGS or trcacs me to refeasc any and alI medical and . related records pertainia� ta me. ca the City af Claarwaccr�s Pcnsion Advisary Committce, �cn'sion Trustees, Pcrsoanel Directnr, or authorix_d empiayees or a,ents of the .City flf Cle�rwater, Florida. � , . 1� ,, . .. : . r� s { � . . Signatt�ce ' � � . . . September 25. 39R5 • , � • ' ' �,ace ' � � ,' ST�TE OF .FLORIDA ` Tht forcRoi�; instru ent was �ac nowted;ed 'aefore mt this • COG'YTY OF PINELLa5 4 �' � y 1� �� f'�- �-�-�-��,�. , . w o �s pecsonaily '�nown �o me or who has �roduced , ' T-� ti z �4- - i- as idencific�cion • • and who didldid not cake an oac�t. Q g'��� f e„� r�ttt�c�. �aRYS�a[, votary Public: � , IAi�CY A.VN D�f.�O� , • (Signature} � :+� :i�F1' i'lJBLIC STATF. OF Fi,ORIUA CO[[1Ri155i011 V0. � C:+;yiLtiSrslE7li �:q. �GLf�b7$ . � - '�•1' �O�i\1l5�1Cl�I �?(r. D�C. b.199B ' �f7C�e..� ��wn� _���,.Q�_,{�iame oi Nacary Printed) ,� ��• � .. . . . . 1 ' . � a r F . • , . I. . . . .� , f • � , . � , 1 ' . ' . ' . , ^ ._ '/:� . , ' . � . i�.. •'"' , . . . . . .�. ..p. .. �. � ' � . e '. � .. r . . . , . . ' . � 1 ' r ' ' ' i . , � CITY �F CLE�R�N�,'���t, �LO�t�D� ST�T�y1E`,!T ,QF R.ESIG�fATXON � • Rober� BaCten � (. — - - ,. .. ., _ _,_.. ' . tritofuyc�I 3w �_ _ ��fPment otsera�ar �Ix ' � P�lic Sezvice P�zbZic Works is� thC pivisiun �l' Dcp�rtiisc;�c �i�� hc;:�ny rCSi,_� t"rc�m tht,�:vi�� t�l':tte Cir� ��t'Cjc•.:r,�sccr. E rcq�e,c that thi4 rcvi:_n:�tii�n h� c!�!y :�it;r�lLti �v ��t� Di`part• +t:c::�t H�::�! :���! thc rlo�s�intin__ �+uth��ritv ;t� bczc�mc �i'E'cLcivc u�c upc�n agprovaz oE a c�fsability pensiar� �Y ��►� �S?t,�� Pensioct Advi.sory�Ca�us�it�ee and Pens,ion Tr�s�ees. ::t .�„�.�,:�.1+1. Ti�t� �c:cscTn ti�r chi, r�.�i�naciun i� :ns �'uilcswa: Retirement vn disab�l�ty gens�.an. . , � � � , . - c:i::l�yr=', si�,ri•.:t�sr� �' � D�lc >>Lnc�l s�'P�em3�er :?5, 1495 D��.�RTtiiE`�T :�CT:Q`�: - - --- — S�erttvz-! �'� i7ivi�iv� :?�•�+i D:.��� �7iviyiun H�::� C��rrzr.�cr.�s {Oo�i��n;�i� r�: �Cnv�!� �3 f uC�1Pt��C�lt :1�::L� �Si� � �t::.�s;,;.�^t ;-f�:;c! Cumm�^:s t0�tiunsEl .�.LTi4Y pF �PPfldtii:�G .�U"i'HORiT'� � ::�cc�t !�i, rcai _na:ic�R 3n �C:ctm� .:'tc�:ivr :�n the J:�te ir.ci ::t :::c :i��:� ,na,wn �nuvc. Ontc .�occaintine �.auth��riiv � . � ,rta�v�incin�; ,:uti�urity Ct���m�nc, t4otiun:c�1 . . � ___ ._ _ _._ .. - - - ._— -- _ - - i>IPORT.=�`�T ti07E: T;.t rG•.:aun ti�r chiti r4•ai`nscic�n ziu,t i��• ,�nwn in ch� ,�sr:: �rK�vi�tr:i. Th� ti,rr:�:n::i t;►rf:�. �.�•: �;: .i:�r.c:i �v tr�� �:11C�tiY4_ ::rrsi thc �,livi,ii�n �nJ c�c�anm�:�t :�c•�ci. iti tc� a� �u::�:,�� c« tts� ;:c:rs�rnnci ::c;c��n ,i,���; �ns t�,r�.v,::::;:� ��ti t�t ?�:�e�nr:c:3 011it�;. PL:st�nr��l ��tiisn ,nc::; niu�t rct3���t the ,t:.�cu, �»�-::n}� C:tv ����sni�, �uc tu ��r ;�� tni•'�::��n�sr�:;:� ir� ::er:�r�l::ne�s ��i�n tnc Ci►•ii S�rvi��� �c�it, :�n�! cc��l�:L:�vc ;�:�r.�:zinim_ �:�reL:ticnt•��urrc;�tir i� L:t�t:. . . �:�«u.*� � .• - . . . a 0 _ + ., OMl���I ti. '• . �.QqIpA D�PARTMENi OF U►�OE� AND EMF'l.OYM�NT 5ECUH�TY p�V1S{ON QF WOfiKERS' COMP�NBAi'�ON 1•�04•3�2•t�41 {Ol� tO�tlAQ Y4ue bC�101fcEy l0� 0.ttds{1tn0� NUTICE OF IN.fURY Repost alti doadhs vrlthin 24 hours (4W} 4�-3044. .� �.+ 1 I324 Jad�WOO�d Ave. c����,,.��.r �rr, �a� '. FlRb13 11r41�3C AI+Ip ADOHESS ct�y of Ci�rvater P. o. Box 47� C�AaL'�+BCe�. PL �4�'i �� �+. o+w �er Pu�C.F DF I�GGDfH'i i5bsn4 C.�tY. C4�� �sla,zd W�y Clearv�te� pine�],aa ;.. .1 S �EC'D,By� RIER 9�NT T�0 plVl$IQN :' - .=J ;�,� .. - '�d �,�i ` ;��►,. : �,;, . �: ;;, �::::. .r: �. � os��k/sa ���o �.� Whil� rc].ling tnrp on ;OL� ;&ir�•k"1p`n"'°n c�+,Qh� rxf�+� ��:.conc joint. k.cr�u.c �+a+. Mse c,r�.or+np. tne.1 p!O 1rOU HEpUEST M�OICAI. Clll�i �] Y�S ❑ NO F 1F YE8. O�D EFAALOY�Fi PRCNlOE MEd1CAd,7 }(iYL-S i1 NO ].343 �--�----�_—� i�.1 E'I, pI01Tf� EMFIOYEE KNO'�I�Nt3i.Y #�ftlSE 70 U5E A S,4F�71' 47 r 30 r 8�4 .� 03 i�-rv�FO To woA►c Q r�s �tr+o if Y�9. 4NE DAiE _--! 1 WAS 7tl!l1ftY �•ATALT p YES }[XNO iF YES. 0� DrtTE 0� I3E#TH %.� J N6UftANCE GQ. OR SEFiViCE CCt+�f3WY .fO�IM Etlif01'R Cotll�lt�f� j11C. Pcst Office Sox �318 Sua�ot�, R 3�2�D I - B00 • 749•30�N �1AFdE, AI7�FtESS A11D iEI.SPNON� JF PNYSICI�IV OR h103PRAl. Dr.�� Wr�lk--xn C].�.n#c �sa� v.s. i� rr clea�atex � 3�4sz� . tiU7'H�R�� BY �f�tPt.o'YER Q4 tr�S G M� �LOCATk4N f , !F t�1ATl1F� Q� k3U5�NE.riS JWD T� Fti3: .4/94 - 7 wn..1. YCw carrnau� s4 �r 9ALAFiY7 Q� YE.9 ❑ h10 LA9T pAY RAtO THFiCJUG�i ; OF PJSY �s H� a w�c Kr�f�ouE� f] GAYa t31+�10 �'+kr�o �p NO f�i �s iZrto ix rio �,rt� �t►,x+��►+ � I ._-- Mr De��on,+rtw� kr+a+lrpN �+E whh Irdsrrt b k+lui, dakwa a wair� any em �oy + a a�vbYe�. �xx,+or mnpary a�11•tnwr�d propr#m. �i e� eny etueme►� o+ wM, aor�axwq .n,r r,ts. a m�sse�d4+� hb�s�a+s �C wnr d. r.,orycr th. C�°rd °Iep+s�. Q�w+ �+a`�dsd O py°�►� q,�r oop�r a n�l. n000.: PMora rt�t �va�i�Y� �� tx�ig �i� o��.a�s�_ �.� .�e�.� � _ tA1'8E 6�f'.NA11Xifa �R M�16h 4 I�ON t?�YY � [A1rL01�118 itilf'�i �NT� C�trsor At�t E .., "l [ / .J�,—, t.oeatian � _ -- 5eivloe Co. � ' �..,rL_._� Garrier File i - � 1�.. onit�averik►p Ces4—dVYC•lZ. MOTICE �� HEO �� ��7 � tosi �ttma Caan—De�o d Fra �xymarn � Comp A l. i �!_�ust da ol d�sa Raato ot F1rst Costtoct with CI8lmoftt � !n Persvn ❑%io'pt�one �iq�� � l�� —NOt, llod 1)1J010 Mv1Up[u Pet3ods ol �tsabill�r, Dat Covor�d hy F1rGS Paynwnt . ,..., -. .,_ .— /� 0. O 7P.D. Da1e Fom� Rac'd.� � Cateslrqph3c Q RT,D. ❑ Daath �'3, Modicat O�ty x k bo e a Lo;t Ti o� .� ar ra ' 1 i�m 2 e REM�RKS'�Ti� � n_ `1 i � � i ►�-�, �. �. .. .. .� �� ~ ua Fw� orrc�� nnsi ZD'd � t .i0h119 �8�1ari1 CiO,, ii1Q. P.O HOX i348 5�,.....•, ��.3�i230 LS�9 "�.'9b $iE 1W9W'�ISI23'2llT'i'Y�'�O'd.lY� n��nn�r�#�nnnu r� e 4,�? ti ��` •' , ' •, � : •rl � � �� � �i � �'. !1 �'1� �� •�' t ? � 1'.y�i�ti '1 '� �` ��r . + , , r� . � .Ci Id A Cfurlrrwl �LO. �nir R. Flryrr� I�tO. d� J. IA#3. IIw��Y IA.D. : �w►cn� � n n W. FMr�1ry 1�I D. rrw �. I.�L r. W11�. S. YWca�lti M D. 1L IlEDICR�FJC�Ft�IOI � f}o��rr+l� �ln. � Q. Jofsroe� fYtD. rSm E. Lr►; MD. � w. ��.�ern �a n� a. � Qr �N�ID. MEMkliOLOOY � x �a�...�.n. w ab.m.t un. fi K Wloae�t IAO. MI P. X�elb. l+l.b u�a�w,►Y�c �c� ��oa.�ua iis A. PrQ�ein� 11.D. r F. ww�r1� sl All�. ■ ti+. s+.a µo. �u�ar�Y o��s ���. r. �� �a �,.►� E. a�� �+n. Vl�iem J. Rialrrd� Jr.. AlS ltlftRfiAL 1.�OIC�1El114 rE11F101OCiY��►. �ID. ldirtuel B. Eriw. MlQ �ti�flrtrL LI�. SiusA E. 5inoA. Llp. ,�.,rn. A. a7w+rn«� 4ca CASTEiii1CSK�YrECOLO4Y Jart� E. Oonn, lul Q acders .f. Hdw. A�to. � F 1( �D IM, MJ). QYHTt41UJ'JLOdY�ER UiSOi�fcRS �]F 71�E EYE Estv�ed IJL Oautsd»r 6l.fJ a«m.s r� Ron.r+.. Mb, o+���c sur��r N�n J. C'uau++� MD. w,�w.�, r�. ��, awdan 7NemdoMr. F�t.p A c�awr.+� u�o. Pial, �,lD. �«�.. un. AIorK I�ID. �eptember I8, 1995 T�.WH�M �T MAY CONCERN: RE: ROBERT BATTEN c��r�zc No. 09895�40 The patient is a 54-year-ald b3ack ma�e with 1ow back pain. The patient consulted me on 7/9/95 with ].ow k�ack pain of �ive months' duration, His neurological ex�.nata�on was norma]. except �o= eviden�e of a polyneuropathy. LS spine x--rays were remar.kable for degenerative joint da.seaae, retroiisthesis o� L4 vve� Z5, disc degen�ration at L4-5 and L5--S1, partial sacralizatian at L�, and facet arthropatY�y at L4-5 and L5�S3.. 8is EMG and t�erve canduc�ion study were nox�nal. �� uuderwent physical therapy, and tl�en a iollow-up pf�;�sical therapy cour�e in �he work-hardeaing program at Healthsouth. These therapies hav� not improved h.�s back pain. The patient's diagnosi� is mechanical back pain secondary to degenerative 3oint disease affecting both discs and bony structures in the lumhosacra�, spine. There is no evadence for damaqe ta th� spinal cord or tn the nerve roote. The pat�.en� has undergone extensi,ve physical th�rapy without impravement. Improvement in his candition � se��� :::.�ike »� 4o accur. � The pata.ent' e job a.g with the City af C�.�arwater as an equipment operatvr I�I, which inva3.ves operating hea�y equipment, and also �ertormi.ng "incidental semiski�.�.ed and unski�.led labor." This phrase the patient i.nforms me refer� to digging ho�.es, ],a.�t�ng bags of cement, laying forms �or concrete, and shoveling concrete, as wel�. as other acta.vities, �a�ii�i�o�r�ic w�u�u�r CQI�TII�TUED : }iabwt W. Ni�a�a1, Jr., MilO. PL.AS71G 511R0EFiY F1ob�1 P. A7c+Cuw. IAO. FtAplplflCCiY101/ANC1671C IA4tGI1Jf'! Fi 1.lrvirt Fie�d�r. 41 D. wl. UMCn h�rWr1. AlD , l� A+Js+fin(r�y 11l, A10. Ye+p T. Is�, i�lQ Ha�rsid B. R�in, A�10. llfiOLbOYAJFiDlO(31GN. SURi3ERY L►ru�• A S+µ� Da iS51 Ww! Bay OaNR 1arQo, F1or�da 3Jbt0 Fharw: Inl]� 51!-wlb7 A41��N9TAATOH,C�4 3131 �C6Au11on 8aolh Road, C1o�uw�l�r, Flpldn 3161! Phorw: (yl)1716-ai71 Rp�wt R. O�ps�a�p 1�6.� S. Ft. kafnton AVenuq. SuAa I04. C4perwlu�t, Fbnda 31616 Phorw: {tIJ) <d}.4gp2 CEN7F.R FOH OUTPATIfNT SURGERY � 1s01 Wosl Bay D+rvo. l�po. FIaWn 3r6rR Rtwrw: 1�111 Sl3•v�cx�� �cv a+ ',�r�h' .'rp'a> :�� . . . , . , ; . .. . . , � , _ . I' « •' ' ' ' 1•' . � . . . ' . ,, . . . � , . • • ' ' . 1 �5 , . , ' .� ' , , �' � . . �.. �.. i ; �'. . � , ' ' -' ,� . ' t � .. . , . ; , � , . ' ; , . -, �' . . ,t. i .� • . ' ' ' , ' .. ' t , . . . -. . 1 ' .1 ' ' ' � ' ; '' I . . .� , . . • . . � '. ' � • l:��� '� ��' � � ' . ' .� a.4.' . il . � �. .. . • � . � . 1 ' � . . . . .. .' � .. . ', ,i. ' � � , . �� . " ' .. ' , " . � � . . ' � . . . " . � . , � .1 � 5 , i ' •'€ v � , 3'S�� .. . . ' . � . . i ' ' � . � � . � . � . . . � . . � � � . t . .. ' . e . . . . � '1'• ' . ;�.� ' i.�� �,i,'r �S " I,�.. ',... , " . � ,q�.i � , �. . � � t` .. .i ; . ' •' .' ' . � I 5;. . . `� r�. �.� � ' � }' �!+ .� s: ' • . 1w . + . � ., ' � �. � , 1 .�.}t � � .`' , , .. '� ' :i'. �� � . � � � ' . " , � � . .�; , , . .1 ' � , ' ,. . • . � '��'r, �, . :,} °.t , ., /. . .• �1tsi' �. . .�;`�� , . ' P , o ' , , , �r . , ��. •1 `, ' y . ' •°• . � � ' ' . AY� �'�.'". `�f'.C..4iY:��€r . ,�,. , :'r'� i . . J�; "�fl- . ' •r . � . , " ' . ' .f. ' ' . ' . . . ' , r . . . . '1?t�'necn ei4hr. •«......'in�. �.�3•.',rs+��.yn ; .'�.. .� �Y�I:'.-: ..1� ��.f'�.r�t•i . .. . 'F' , � r. , ..��� . .r�� :✓"� '.�'r".i.° , . • �i' . . . . . ' �. f' � . , � . , � � � . . , F � , , � ' . �. ' . � . � . . � � , . . ,f 1 ' ' ' ' . . . � � . . . � . . • ' '` . � • i � . .• ' ' ' . . ' . . � i �' . . � . . , . , ' , � . � . i . [ . , . ' � ' . • ' , � ' •. • " II , � . ' . . . ' . . � � � . ' � � . . � . � � COIIT�NUAT�ON; . � , ' , � ' . RE: ROBERT BATT�N � . � � � . � . . "CLZ13�C �]0. 0989540 � � � ' � . � � . � PAGE 2 . . , . , ,,.. The patient's back pain i� r,er�sinly da.�ab�.ing in . regard to nll of these activities, � :- It �should be nated that Y havs nat tested �he patient . . with regard to vocationa�, ac�ivit�.es. � Th�.s, however, , � should have been done as part o� th� work--harden�iig •� , program at,Sealthsouth, and reparts from there shou3.d , be more exact as to the patient'� abilita.e� and � , . . probl.ems . � � . �� � MICHAEL B EVANS, MD ` � MBE/L2S , � �� �::..,..,.,. . . . , . . N ' 3ss� Wasl6ey orhr0. terpo; Fiortde }e610 ' Fr,arn: (ll9? sa��d'ra7 3i3i �,lcMull�n 0oalh Rosd. Ctoarw�r, Fbrido 3�621 Phorw: (tf3)'r2�tt7i i165 8. Fi. Hlufta�l AYa�w, BuMa �61. 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J•' � . ,� •� � . �: .� • `!�': `�, '�I. �.y.. e "�. `irr. ',..., �.`.'.�. ,�,Y r � 4• 1 { !f.'�,f'�� . '� .\� � .� ..f,' ,' ,,.•1'. '� , :n � �f! �� �1'•'!.-:`.` `..; i�f. ,f,, -''�... ,1^. :" ,i4.i•�.•_: ',f 'l�:.,/-��;�5�'�. � �' ' �I '�'� .1�� � �, '.,•�. i� �' , '' ��, ,` ,� +.�'; � •. �i ;�;• ' ,,`, � 1/' _�; : , . . . �, '.Y.�� .. .. . . i., , .. �:. . . � . ` I .�. . � . � . . � i . . . . . . . . . . . : f,t,, . . . _ •S 1 . ` r� .. re r � �'. .� . . .. . . . . . , . �� . . � , ,. '. , ., s : � F.:1�. .�. .! . . . _ 1 �— .. . , ♦ � � . �, 1. , � ..i.'.'.i , . i... ' 0 1� �i .. .7 , � � .r , . � J: , , . . , G I T Y d? F C L E A►. R.'�+V' A x' E R POST O�FIC� aox �,��n CL�ARWA3EH, FI.OFiIDA. 3�8�19•�746 ' � S t b Z5 995 ' --,;; ��,�;,,�• , ep em cr , 1 . Hur�an Rosouren Oe�rtm�nt . � e��r��a�a . � � � Jeffrey S, W�iker, M.D., P.A. � . 120i Fifth Avenue North, Sui�e 511 St. Petcrsbur�, FL 33705 �� � ' D�ar llr, Walker: ' � Robcrt $utten, an employe� af the City of Clearwater, hns applied to the Peasion AdYisory Co�z�mitt�e {PACj for a �Il5��i�ity pens�o� under [3�OV151Qt15 of the Cily EmpSoyees' � PensinR Plan. YaU ha�re been trcating Mr. Batten for �is jab-co�nected injury. Key considera4ions for the PAC in i#s review �re t) is tfte emp�oyee dis�bled frorn performing t�is/her work; 2} did the disability occur o� the job or. aff the job; and 3) is the disability ' perm�nent. . . � It wnuld be appreciated if you cou[d �rovide to the PAC clarification as co t h e ��� following: ' � ,��- ,�u� i , 1. Your mediCal opinion as to whether the employcc is p�,rmanentiv d�s�bted �.1-.�� • c.' with regard to his employment . as an Equipmcni �perator TII with Ehe City , I� of Clea�rw�ter. A capy . of the employce's jnb descriptian i5 attachec� for your refsrence. � • �"�'��,�u , �. - � 2. YoUr medical apinis�n as co � the extent of any impairment und th� perc�nta�e of any such intipairment and whether the patzent �as reache . maximum r�edical isr�provement. ��) � � . ��.�^ ,. .-r,,... �' `'�t �'� � .. t .ti4,�r�. � � • , , --_.,... � `� � � 1 �1 �+ L � :�, While we are aw:�rc that this request may be samewhat af An incanvenic;nce t ou, please be Assured thAt this review is extremely im�ortant ta ihe �mployca and to t h e En�ployee'a �'e�isiu�i I'l:�u. Tlf;. 1'�`►C Stri�;;s t� re�ie�v in a�horougli und imp�rtial mann�r alI requests #'or disa�ility pensson to ensure that thc �mpioyse re�eives A fair r��iew and_ tt�e integrity of the Pension Plan and Fund are protected. - To preclvde any cor�cerns as to the relcasc of this medica� iriformation to an outside garty, you may send the ne;w ieitcr directly to Mr. Batten. . Your coaperation and attention to i�i5 request is appreciated. � Sinc r�ly, �� H. Mic�a�t Lacsrsen � . Humurt Resources Director � � � i-�1ViL/dlf . " S 1 � ��� "Equel EmpCoymenl and Atfirmat{ve Aation Emplpyar" . • � .'4.1. . � � � � ` " . " . . � ' �' ' �, ' ; . . � . ' .'� '� . . . . .. � .1 � '�t . . . . . . . ., . ' �� . � .� � ' • . . � , ' ' . , ` � . . . . � ' . . , 7� . ' ' ' , � � . ' � . � . ,. . . T� . ^ t.. . . . .. . • ° .. , , . :.... ...Z.f.�'i,. . . ,,.._. .. '. • .,.,,.f . �>r�� ..'r• . .'. , . � . . } w �, • . � I , . . � . . o: � . i . , � • ' � I ' " . . ' ° � � G I T.Y O F C L E A�'. W A T E R P�$T 4FFICE BOX 47A0 • � . CLEARWAi�R, FtQRIpA 3�818•4T48 � � Septcrr�ber 27, 1995 . Human p��ourt� DeqarSm�nt ' BI;V48��8BT0 . . Michaei B,' Ev�ns, M.D. ' , - Dia�nt�stic Clini� � � . . . � . � 551 Wcst Hay Dtive . . L�rgo, FL 3464Q , Dear I�r. �var�s: - ' � �` Robert S�ttcn, an employe� of the 'City of Clearwater, has applied to the I'ensioa Acivisory Gommittee (PAC) far � disability p�nsion under � provisions vf the City Employess' P�nsinn Plan. Mr. HaEten w�s seen by yo� for a second o{�inior�. Key co�tsideraiions for tk�e PAC i n its review are. 1) is the employee disa�led from performir�a hi5lher work; 2} c�id the disabiiity occur or� the �ob or of�' ttte jab; ana 3) is t�e dis�bility permanent. , P�eass prnvide the folio�ving infarmation: l. Current dia� o5is of the patient, ?. Yout meciical ppinion :is tp ti�e axter�t of any temporary and/dr p�,m a_n e n�t impnir,ment. , 3. The prognosis far the pa�tient. , � . �3. Naturc and exter►t af 3ny continuing treatment reguired. . S. Yot�r rttedica! op:t�ion �s to �whether the em�layee is permanrntly disabl�d with FCaACCj tv i�is/her employment as an Equipment Oper�tor TII with t h e City of C1e�rwater. A copy oF tlte es�ip�oyee's job description is attnche� €o r your refercnce. With respec.t to disability as an Equi�ment Qperacor I�, please enumeratc ti�e type of duties that are contain�d within the jab description tf�at tl�e emplayee cannat perform or w�at limitations may be imgoseci on tlte individual (e.�;. limitations a n lifting, �tc.}. W�i�� we are nware that this request m�y be somewhat ot' an incanvenienc� to you, � plense be assvr�d that this review is extremeZy imp4rta�nt to the �mplayce and to the Employee's Pensian Plan. The PAC strives to review in a thorough and im�urtia�l m�nner a�� r�q��ests far disability per}sior� to enSU�s thAt thc employee receive5 � fs�ir ret�iew �nd the integrity of th� Pension Plan and �und ar� protected. ��� "EQ�aI EmpEayment �nd Alfirmaliv8 Action Emplpyer" i .. �� , i.�u "!�'e� if: �� � , . . .. �' .. . * {.; � . " , . . , ,i . ' . ' , .. � , . ' , , � . . .., . . , � . �. . . . f� . �,,!,•l?^� 1`'�S,,S}f� ,• + '3e F . , • ' ` ;' •. ', ' • 'S'�' „ . . ' � � � ' ' ' • I ' ' � . , ' , �.),�. tij. . t . • • ' . . t ' , . . . . , 1 � I � .. � • . . . , . . ' . •• , . ' . ��" '^!r . :Si : ..1�. . ' ' ' ¢ . : . . . . ' . , . ' . , t . ' � . . � ".5� i� . ! ' � e . . j , . . . .. . . . . , . . A�'��i''f`";�'' ��g.`i •` , n . • �� . . . ` , • , ' . . � _ , � � . . • r' . .i ' . . •'�� .Si�,�F� ` ; r` � 1�;i .. . �i'i• .. �' - ; � . . I . . � ' . .i . . �� � . �. v � �. � . , � .�S.�.f. . �� ' ,. ' ' . ..` . . � . . � , � � ' . . . � . � . � , {', .�l�, . . Yv�'�..'k1:,s ��1 (•3.� . ' .� . '�! , .� ,�'4. � . . . , .. . . .. , � . � ' I , . . ' . .,I . , .. �r . .. � I � • ."1 .!` 3. � . ' . � �i� � y � . � ' . . . " ' ' ' � . ' , � ' `.ir f••iYl'. .`�i `l" ' . il .� . • . . . ' � . . ' , •" 7� I� ' ' S e ' ' � . ' ' .. . ' ' ' . . . . ' . . � . �� .�� ��).. ?�� `- ' . � . I, �' , � ' . ' � ' .� � ., ' . . . . . � . � . , , .. �`: a ?4t.���E� . ..,�'s � � . � ' . ' .. .. ' , . ' � � ; ' �. • ,�i�• '; E t', � �' J'�r,'•�' � `�. . ,�. � i .. . �. , `� +1' • �:f , . . . .�.•Si':7.,.�i,�.l� , ,e','����,i .. . , , . . . '. . . , , � , . , '� jL���:� �.���' 'i�• ' j , ' �'. � ' ., , � . ' ' � ., � ' , ' : , ,. � ,J • , , ' . . �' • i! .f. q . , , � . � �• , Ef r` . . ' ' , .i . . , , ' . � `3:• �'j• • �i j�• , .:ii/• ;j1;, � -j� ' 1 . .. ��j e � j�� ' . . ' " . ., '. � ' , ' � �.�^�e.,� ;r'. � `i.; r ; ,... . � . . . . . , ,� ' . � . , ,.ialit•.�14ilt114dX,c•??%S'"+,Wi�.fti.y.r:u...�:.4�.�.. ,�.... .-.{ �ry+,"i�'inSr�'. .. �,t-.'.q•.i�:f!!ii%4'S'•'i:;�'�� ,,�. 's,°4�. �i- � , � 1 ,�1. � � 1; � �> .�:.. ��.e �%. �l t .� . �{� . r+„� . . . . � . e f:�, 4rr , � ,�s �..':r.i� .�1.4�,r,.t,.y�,,, . } `Y� 't. r. �. 'y, r�: iy� . . _ . ., '.t;'•,' ,.� � .. ;;} �. j; � •.Y . t��. 4. � e;��� .� �.t�� "' .' , � . . " . . �. ' . . .� ' , . ' . . . . • � , . , � ' . . � . s , . , , � . . . .� / , , , . . - ' . . . ;i: . , � �, . : : ,,� .,. . .I '� . ,. • ; .. :� . . . . .. , " f - , .. � F:�f• , . M1C�It�C� . B. 'Evans, M.D. ; . . , � � ;t.:�� ' � . . ' P�gc.:2 .` . . , . . , , . . , . . . . �. Scptemticr 27, 1995 � . � � , � � ' . ' r. � � � � , � "'' ` ' ' � ' � . . I , ' � � 4:: � . . � ' ` . . . . ' - ' . � , . , , . , � . , `°� '� �. � To prectude any cancerns as to the 're�cas� of this. medica! , inform�ttion .��to an �outside -' party,, ynu may send the ncw Ictter directiy tg ' Robert Batt�n: -� .'. .�, . . Your conQeration and �ttention to this req�est t5' S1p�CCCIfltCa. ,� '� � :.i. �. . ', . � � . . . ' , ' , � . . . , . , . < . � . , :f�, • � . ' Sincerely, � '� , . ', � . , ' � � �!�.�---�—. , ,. � - ,! , . ` � � H. : Michuel L�t�rsen � � • . � . . , � ., � . Huin�n Resources Dircccor �nd , ' ' . � � � ' � � ��� : '�: Secretary, Pension Advssory Corr�rnittae . � , � � � . . � ' : � � ` � . HML/dsf � , . . ,.. , I , . � . . � . , � ., � � : , c c ' Pension Advisory Committee • . � �� '.� � � � � , � • . � Robert ,Batta�n ' ' ' • , � ,. , . .. �, ; , , ' .' � ; , � � ; � ' � • ° � t ' - �. , . , . 4 � � ' . . ' . � ' 1 ` . • �i . . ' . , . . ' r . ' F . [ , ' ' . � . , •f , • ' ' . � ' - ' ' ' r. . ' . . i. 1 . . . v . ' . • ' • . ' - ' ' � . � ' � . ' , � . . , � ' t ' . . , . , , . t. ' • ' ' � ' . , ' i ' � " ' ' � . , i• . . .4.. � . . .. , . . . . . .. , , . , '��' ��:r;�,, . . � � , ' - � � , . , . . � . ' ' . � � . .1 ' . � . • , ' ' . . , � , � ' ' . ' . . .�. . . o c T � 1 �ss� �a � OIiAdC bVF10�F�Y r�Q i40. � IiID. u��. . . �n. M� w� 1�1A �i.1�L0. OctobEr 3, 3.995 H. M. LaurBen,.Duman R�saurce� Director City of Clearwate=, Human Reeources Department P.o. Box �4748 ' Clearwater, FL 346�8�4748 � R�: ROBERT HATTEN CL�N�C NO. oga�5ao Aear 5irs: I am rep3.ying to yaur lett�r da�ed September 27, 1995. �lr. Batten has previou�].y reque�ted letterB to me to be sent �o hun for transmiesion to you. In yaur �.etter, you znentianed that you a�s includi.ng � �he job descrip�a.on of an equipment operator �II. However, there was na such enclosure. I, how�ver, have pzevicssl.y reviewed such a job description supplied by Ms. Hatten. � In answex� to your specific questians: � I. His d�.agnos�a is mecnana.cal back pain. $e doe$ m not havz a neuro].ogica�. diagnoa:is . I found na '„��i�Y eva.dence �or apinal. cord, nerve root, nerve, or '�"D- muscle injury. .Iseroo E. oa.r41�ln Rtbrrl,l. FiNr.1,tD. � �t, �'c,'�t°- ��r�� s e�►.�a �c o.�r,�,.. �a. .w,.�. �. �..�.. �b. T1i0pEL�IC SlJfK3�RY IUr► J. O►++�+. AR�. '�n w.r. u�j. Dordan �rndari�r, lAp. OIJ1FiY? �Y T Ft N0.4� [�ar'D� B. 84�.1�D. TiiOl[l[sY �� Il�t�. ��ka ���r�a. 1l Frank CiartrR I.lb. �l iiohai FLayll, M O. 2. The extent o� hi� impairment. I am not sure what you are a�ter with this question. He states that his impair�nent :�n iaac:k pain is sev�re enough to make wori��.�g impossib3e. 3. His prognasis. x do not know if thi� i�s a temporary or a permanen� impairment. He has gone through the most intense treatment far mechanicai hack pain �ht�t x am aware o�, th� work-ha�rdening program at IIealthsouth. PossibZy, further phy�i�aZ therapy could help his condition. I found notning th�t wou�d suggest surgical k.' µn raD°'' CONT�NUEn: �a ,nc «.tuu►A FradY. GID. Fk�b�r� LRD. �rnary, r4 i�tD. H, wt4 , fic� Aifl. iI�RDC�IC L SUF�CiERY S.n` �ss� w�a� BaY Drhn� t+roo. Roriea 3154a Pnon.: catsl s��-s�a� 9111 N. Lfcl,kilan BoaU� Flot�d. parvnda, Ralda 14621 Plr�w: (il3) T16�-;tT1 l46S g Fl Hxrirrn Awnu�. 6uk� 201. Cloorw�for, Florlda 3�616 Ahprie: (�131413-4lD2 �U30 Tumpa iioed. SuG� 9. OIC�me1� Horide 31G77 Ahorw: (�17) W-230t CENT�R FOR OliTPA71ENT Sl1ROEAY I�oi wost Bay or�ra. �►oo, taaiaa �a�n anaw: ��isM �ts�soo ' . . e . � ' . , . . ' • . � . . . � .. ' ' . ' . . ' ' � ' . , �I . ,. ' , . . ' ' ' , . � ' � ' . � . „ . I , , , � � �. .\' • � I , . . '' .. . . � , . . ' 1 ' . L. � . � � � . � � . • . ' � , , � � • , • li . � � � , ' ' . , e ' . . . . ' , 1 � , � . , , � , ' � � � ' . � , , . ' � ' , ! .� . I� , ' .� . . ' ' . � 1 . ' . 1 . . ' . .. , 1, ' i, , .1 � , ''� � ' � � . �. ; r , ' ' ' ' ,....f...... ' . •F:�S': "'.k. � ,.....e . , � . . ..�. �° , '1.,....... � .. , . ' � .: . . ,a . . . � , - . J. . . ' .. . .. ' �` f � ' . .. 't. . . . '` . • . 1 i CONTINUAT�ONt . RE:� R�BERT BATTEN � �.. � ' CLYN�C N�. 0989540 PAGE 2 � � . �' treatment wou�.d be of use, but an opin�.on from�a �,' ' t�ack sur�geon might be useful in this�regard. � � �� ,4. As'to queation �our, as answered abov�.� � 5. As to whether he is permanently disabl�d with regard to his equipment opergtor TI� j'ob. In my ' �,� � review ot the �ob der�crip�ion supp].ied by , Mr. Batten,�it was listed in addition to driving � heavy equipment that h� was expected to help with � � some unskilled manual l.abor,.which he deecribed to . �. me as c�r=y�.ng bago af concrete, ehovel.ing, and digging. His back pain wo�ld certainly prevent � hiun from doa.ng thes� thinge. � You aaked if his condition is perr�anent. Once again, I ' find it di�ficult to an�wer this question. Ti�e moat useful information in thiB =egard would he s�nplied by I3ealthsouth who evaluated him extensively with regard to his back pain and what he was capahle of doing. In�th� paragraph preceding the specific guestions, you , � note some key �onsiderations, one of which is "Did the disability occur on the job or o�f.the jab?" �There waa no acut� ev�nt* making thi� soz�ewhat di,fficuit to . , answer. Certaa.nly, the �ob desc�ciption provided t4 me , and �he detaa.�.s supplied by Mr. Ba;tten are o� work.that could cause or aggravate a back condi.tion. CONTiNUED: , �ss� w� eay o�►�o. �oo, � Ka�a �: nur s,�-rrez ' 3113 iwlCti+lullo� BodA Rod4. �atwdor, �or�da 3+ait �: t�i�) na-�m 1465 8. FL Harrieon Avonw, SuAa 204, C1�erwatK. florida 31b1b phono:. (i13) s13-�307 ' CENTEA FOR qIIfAATI�IYT BliqQ�RY f�oi wat aay an�a � r�or� }ib10 Pt'�: Ri3} 315-9500 ��I�, �3. � , �SS��,1�' .. . . � � " . . . . � . , ���:t': .�.,Z.z. ,. . ' . •. , .. ,' � _ , ' i� ; , , � .� . . . ' � ' '`� .i ',�� ,`i`F. JrFf� •� . � � �� , , . , . `� . , , r ' .� .., .' - . ' �i� . , ,' . . . r� �. I. .. . . .. ��,��1�� . , ' ' ' . . ,. . � . � � . . � . •. . . � . ' . ' � • , ' _ i ��,' �'�'.4�• •�' a. II • `.. .. . • . �, � � f� � , � . ' .� , � . . , � ' ' � • t� ..f' �t. 1 . .. .i . .i •�� .. ' ,ii �. ' • ° �� ; ' , .. , , � . . ' .. � . . �7�` S � . . ' � ' . ' . . . , , . . .f �'� r ' . .'`, �_ �a `.� r � � �r' , , � ' . ' . , ' r I';P,ry � ' �'' '' .. �'f: .'i. ' �� ' '`'.'` . ' ' �' , i . . ' � ' ' � ' , . . � F ' i' , . ;�, . ti � , •�1.' •�.' ; ;�'. . r ' . .. }. , . , . . � , ' � - ' , + , , . , � #. �: . ., . ' .i .�, fl`•` �� ' `� �r t'� � ' , . ' „ � . :} , i: � � . � � , `�,: .., . ' ,' �. �!•, <<.�;� . �,. , . , .. �� . , , ... . � .51�. • ` ' '; . '� . S .. ' . t' ' � ' 4 , i . . � . �' . � .i'i 1 .i� . � e . ' . � . . .r�+f�M.({t�yV'�i�lki.tT'l3+. '�� ��I,�IL�.^.� .v ' . '1' .F ,� ;,�., .� . i. : . . ' . . � , , ' I . ' ` .. . . ' . � . • . � `'+r•�` .��r ,4»...,itia�^.,.e1n,r.,.��.f1,'�xv;...f�;��.��,`"J E,. '� 'r � F. , ,., t . _ , . P,� s . .�.., .. _. , .. 'v', i , .3.... �y.�. . ' . . . .:YP ,'�..',� -7' ,..��.. hi 4r:. . j • ' � ' � ' • . • ' I . . • � . ., � . , . `': , ' � j' . I � . . ' . ' ' , ., ' . r . t ' . : . 1 , . 1` . . � • r ' . ' I ' . � . � . i.r. . . • ' . � . .1 � � ' . . � , ' � . ' . . . • . . ' • . � . � t . � � I . ' , ' ' � � ' , � � . .. ' I � ' . , ,. , . . . ' I . . { . � . 1 . ' ' � � � ; . . ' . � , � ' . � • , . � ' , ; � , . ; . ' ' ' .. , . f ' . , ' � � . � . , . , � � ' . ' CONTxNUATIaN,: , � . , ° , � , . ' .,� .: ,`, .. ,� . �, • � RE; � ROBERT HATTEN � � • ' . ' . ; . . . .. . . CLINIC. NO,. 0�8354a � ' � . , . ': � : � • , PAGS 3 � , � �`. . ' , � • . , . • . , . ,. � . � , � ' , � hope this i9 asefu� . . ' " � . . � ' . . , . . �3 . , .. . .. , . i � . . � � . . . . . � . . . . , . '.1' , . ' � � ' . . � . . ' . '. � . .. . yourH aincerel.y; . � � _ ;� . . . ,. , � , � , � � �. - , . , . '. , �; , . , . . . ��. .� ; ` Michael.�B. Evane, M.D. � � � . � ' . 1 � . .. �, - ' ' �. MB�ILZS ' � � . : . , � •, ; � ,` , �. .�� �. , cc:.. 2�ir. Rob�rt Hatten : • ' . , . , < . . . , , , . �� ls3f wK� aay or1w. LarOo, Florlaa 31640 ' Phoaw: t�t3? sti-rra7 ' llit �Ac1rM�qr1 F�odti Aord Claatwalor, Fioridl� 31G2! � phona: {ti3) 7t6-�t71 1�67 8. PL l�atthon Avar�. 8uAe 2Dt, CMerwetw, Worilda 3�616. Phorsr. ;tt3) 413�01 ' ' CENr�A F�R �U'TPAT�FM Bl1RflEAY . 1401 Wa�t &ry DiNa Laipo, Rorlda 31N0 ' Phono: �1i3j SlS-9300 ;, .,� � ,. . ,+,., '� . ,. , '`, , t , , '� � , • �..���__ -- — --- — - - ' o � � � �� .♦ . . ' r . . . . . . . ,. � � . ' �. ' � . ` . . .. , . . . . , � ! 1 P�iTT�N, Rn6erL• L. Fag� 1 Uc�aber 12� i'i95 PEMS�UN ADVISfIRY CDttMITTE� EVALIJA�'i{]� . I have b�nn nrnvi�l���l wi �!•� r i::h��n ��age� �f no�p� irom I�r, Wallc�r� ��re ne�trosurgean, guing frdm Ac�gcfs� 1�'�4 +,u Atlyr.��� r�f �t�ris yPar. i 3]�n t�tave ::�-r�y repwr� and M��I 5ran repur� nf � F�35 l�imtr3r *�{�in� fr•�.�m m�d-�±��q���h �af F1�;� ,,;•n,�r. Iln l�a�lP ;� job r�PSCrip�ion fnr �q�Eipmen�: Upr.r��nr t.i [,znrt ��+• F���.,r� �����4+ fr rain rr.�nif� t�if;:r fr+rm E�-��-�� f-i�s t!'�r�� 5P�C.it1C qttestinris �t�.�t tf�ey w�i�L ��n,ws±r'���1, ihe p��ien�L• dat�s (�ii5 i.njury 4,�� i1�r�:I� 11, 1`?9�{. � Fle ��aa pu�-�inq �tp �k��e tarp an a dump Eri�ck., wf,Pn h,�r+? rpV4'�' i72r��t1p �7L�i�_t� ���I ti-�e In�Jr�Y j�rk.�cf I•,im. We s�_�s�ain�+S � 7 uranci�ing inJUry t;�� I-�is r�w�l�.. kl� iit�.l:i�.��J ��re�,t; Fe> >�-�,3tl�--in clinic antl �F�en u�s trea�:ed by I�r. [+c+dsen. f�n 19F1I �r-:,n �;a� �al�h,;�i�}n�l_ 4�I����:f-� �I�,�w�,� � ls��i��iti :�� �-7 �nd t•�e waa rnf�rred to I�r. blalker, t�hn ir►iti.+lly ���� h�im ��� �1���f��•_� :�, 17'?�i. C�iiri�J..ly, cansert�a�i��e n►nda7,i�ie� were �r Ir���, �it� I, l��n r.�,h t i.�ti�.����f L•u I��a�: r._ �_j L� �].rl.il E�;� ;tii�! i r� in�� hnrnl�er u f li'��. I'�� un�terwen � Cb-t an��rinr �prt�zcal niir_Y�rl.i��;e�tr�m� �r�� Ft�sir��f u�.:i.ny iliac be�ne cresF �ane yr�F�. Fo.11c�winq ��R _�dT'�or-v� il��� [!:l�:t�?11k. +:UIlE:.111�.!!'ri �:Q [ICI�;�' ��1i�la �lx=�_amfort 1[1 �'i15 Il►3CI?� WlEii '��JRIC' raslzation .r►�rl: irrl:,, �.1r� .�;r:���►�zziar 7YFar;� }�i.la�:�r�F+l i�. H� waG able �o ��t b7ck �n l.iyhN dut�y, b!��. nr�,,��r- .��,�.•� ►,�� ���t I���.l� �;�� I•�is F,.cl� d���;�. �'F�e pati,eni:'= ,jnb r�qa�irement� had b�en r�+vi,Awed an�! +t�ey r-prf:rii.ri:l� f,n�rr,l+le ,� �a� „� r,t,kr��.n�� rno�ir�ns of CF�p ieruical spin�. 1fi��p pa�i.�nt: n�t�� ����.�I; 1•�*� I,��r �I��Yr�.�3?�i I'iQ�l ��f tt���� necl:. and wh��n �•�e does mave tr�e neck. 1��e r��� �3in in i;f��� �,"�L•e��ir�r r����N`t; r,f i:t�f+ r.��r�1i,r�1 Cpine �f�a� radia�:e� dnwn ir��o tr�e �r��.�e:.4�t� :��•ry7��. r, i lal��.�r;, ily. 11� �1ns�= f�nt; �p�y�ar Eu hav� anw �r�.te �.ipp�r• p:,rremity raUic��lar �,YP� i.���i�l;�i��ii. ilu.�lr,�� rz��L�.s r:r��i.t��� t��:it1�, ma+leinent of F�is r:erv�xcal spine. N� na�a� cr�me di�cr�mr�.��°� �.�{� in I:I-�� �r�pr�~i�.�s arpa w1•oen t�� i117`1L�5 F�is st�ot�lders. Ti-,e p�tipnt alsca F�as G�►r��� l���F b�r.k. sli�_cvrnfr�ri, . aiirl �c�mp i.i.�na�:�tiar� uf matinn wi�k�� discominr•t ta mov�men L- �af i;F�� ia.��.l:. F'NYSICA� �',"�Af�IbIATIt)hl: Tr�e �ai:z�nt'� G�Y'JiCd� ��sine sh�nws no swQ}.1ing, fl�tt�uance� ma��es or ��Y'LIC�Ltral �leformity. i`}-�ere are nd areas of mark�d lural �rig�er pazr�� �er�t�err�r���. �UM is m�rk.e�Jly limi �ed wi�t� resp�ct to s.ide�-bending and ro�ator� mov�menk,� bcing anly abou� �Q'!. af p;;�ected. Fle:;ion is f�tll ar�d e;;�ensian i� a#ao�it ��:: nf e::�ect:ed. il'��re i�- �lisr.u�nft�rt at t'��r� e:�;�rsmes. There, is 'som� mi�d crepitc�5 palpablN wi,th �n�vwmpnN. �:,amin��:i�n oi I-Fis 5i'�o�.11der5 �h�ow iull, Qai�-fYee Rf3�1 of �t�e glenflf�um�ral ,juint�. blz�F� F�ctl averl���ad flp.;ian • af �a�r� �hou�der�, he r��� some r�ild discamivr� up ii� th�e mi,d�-�rap��ius area. YF�ere i� nn crepi�us or impingement sysnp�nma�nlnyy wi t;F� shaulder �:fJi� ��s�ing. Upper e;,�remi�y nectroldgic e:;am is in tar�. E::amin��ion nf I•,i•a law � bar_i�. �i•�qws n� swelliny� fl�tctu�nce, masses, or str�,ictiural. defarmi ty. �:0�1 i� abo��L• 5� L•n �4;: nf e:suec tPrJ in a11 directians, ui�F� some mild discamfort •�t �i�r�? ��ctreme�. Tl��er� is no SW?J.I'111f�� ilatctuance, m855�5t or s�ruc�ural deformi�y, no ar�i�.-�� af lr�cal f:riyypr painE ti�ndnrn�s�. rr��,-� is no spasm, yuarding� or asyr�me�ry witF�r mov��m�n�. X-RAY EXAf7i�•iF1ilfl�l; ir�� pat�en� hrinq5 in rwr� jack.�ts of ;c-r�ys, �F,r:�e were bn�f, � Ye������►ed. TI��? cAr��ic31 rpiitia filr�s gn fram Aur�u�t 1'�'3�4 r4 August of �f��ss yea��, t.ctuEi��r spin� film� �r�c1 MF2I are frnm F1+.�g��st of tY,is year. �lo5t recen� eervical antl lt�ml�:�ti f.ilm� _f��oti� L•}��3�h, 1;1-�� yrafi; ai: C6-7 appharh to be well i.ncarporated. 1'h�re is rtiu ma�inii +�n EF�N fTr::inn e;:�;eri�inn vie��r��. Some �legenerativ� Gr�anges are no�ed zn t�o�f� rhe c�+rvic3l ::r��l lurni�,�r arnaa. IMPRE55IQhi: �. �(357-TftAUMATiC ARTHRITIS GERVYCA� SPYHE FOLl.OWIHG C6-7 f�ICf20G�SC�CTD�1Y ANI1 FU5IOF#. 2, S3EG�NERA'�iVE AR��IRT'fIB, �.11MBAR 5NINE. � , ��. �.y�Y,�; . t, � , •.� .r, j. . �� .. .. °! t,'f ,76 � , . , , , , . . _ ( .e. .t� � ��' . ��fe i.F . , i. . ,f .. . . . . � . . �. ' ' ' • . �1 �i..� . . �� , " i � ..f� . ! , r ' 1 ' • . . , .,' .. ,�`• � ,. • • . � . � � ��. . � ` 1. . r ( , � .. � . � ' , ' � Y • � . �. ' � 1 � . . •.1 ,t� " , . . . . .`'�1 �il' ' . . I 1 ' . _' . 1 . .,.. .. . � � �.� , . .�.. . °,i � . . . , ' . , • ' ' ' .. . . . - � � . . �.�t. � i! e • ii��; ' ' 't ' � . . . , . I t ..5. , � , � . . ' , . � ` j�- . � , �' 3, . , , , . , ; , , , . , 5; , • � � � ' , , t � . � 3' . . ' . I � i . • r . . � I . � . . . . . � . ' . �i,ti' ��; '' ��5��;�• , ,S� . `� F �i f ,� .�ty � � . � ' . . � . _ . , . . . .. . . . . . .�. � �E ' .i��•�,i � .�� ;�'� .i.,' ' .' ��! ' � ' � ' . ' � . . . � � . ' . � ' ' � ' . , �•�• ' ,r :g.;4.°f: . ,�' ' .1 . ... , . � +, � .. ' • � . ,���7�?:.ti, ' . �' j�y,� �f� 't:t',..; . . . J� i' :I:�,` ' � � , . � ,. ..+ . , . ' . . � ' , ,:i •!�0"1� j�� J' . .�,t . °/�'� .I' � °� ��.`I� i .i� i: . . , . . i� . , . . , ' F. ' . . ,.;k. . ..}.1: I;' e . . , , . � . �E, � ',1� >f. :�s . `.�.'' �'1-` .f` ;�' , , . } ... I�� . .,. .�t ` . . r . '�' . ' j y (.1 . i1 S r. f . ' t ' • f ', � • ' 1 , � � . �• . . . . � � , , ' ' . � ' . ' , • . . , . . . ;�}. � :. ..i'•��, . . � � . , . . .e. . I ,�t •r.. ' �',�,Y''.' ��' ' . t. � �. . . ' es��' � ''� .. ' , . _ . .` i [ .� . . ' ' . r:i,irnsfi±h.""i.`9'YJ'Y-tic�ai��-i�. ...r,... » .. , '� ' � i: � � 1 � �,�+;tier�r�i�'f;,�, � . . ' ' . S. � . . ... ,. —;+�nq0!^4�"i r�aw.r mr.-. 5�:��.7.. � r � .. ' • t �t.t.;...: �e,�r. � �:•. • . . . . . ri . wA��F. . ., t:°:`b..,r';• . �41Y , .;f e' .� � =f'i `.t,:''t`':��.Y!ef ''71'� 7�r:� . e, i , . � , . , . . . . � . . � . . . � i . . � ' . . � . , ' � . . . ' . ' ' f , �1 r o' E t, '� , i � t . . � � ; � ; .. . ' � � ' ' , ' .. � . . , � � . t , � .. . • � ' ' ,il . � . , ' . ' ' � . � � , ' .f�A�YEH, �E�aber� .' ..�. � ' , ,� �, `. , �':►ye � � ,' , . �� �';'". - YFt�F�Tf�EMY F'l.AH: TF'r�s '�fISLJ�YS' �u �:t�e qU4�5tf o�15 �re a� follow�: � . . . � ' � � ' A'.. ' � 3e� impra�s5icm abnv�: ' ' �. � ' � . . � , .. . , , . , ,. , , . , , , , . '; g. :, I belipv� E��r� �atiien�!5.dt�e.�nr��e!► xl'p �Fy�rm�ne�i� and I do na�-b�li�ve.�her��.w�l� . .. � be im�� 'ruvn�n�n � tn tr�p, emp t_nynh � 5 r.�nri z�; �un ar��llr�r �b i l i, ty ta wnrk .• ..,� � . ' S . -� . . ' ' , , ,. ' .. �. . . . , . . , . . C.� � �� �. b�i���l� �r�� .E���i�nt�a �liacanci�e�. Full;� �l k�atil�� him frnm �F�e ,it�b p�r.formance c�f ' � . .. Equipm�n� Qp�x':�tor �{Ii: , , - / , , ' . . � . , � � . . � � , - , J �er �laad. � �1: �: ' � � . � � � . JSH/dmw �, � � �� . � , . '� � ' , . � ' , ,. ,�� : Ci�y n f' C3e��rwa t�r . , . . . �, , , ' � . -, . .. . • ,. � , . , . ` ` , . � ..,. � , i ,; � � �. ,. " _ . , . � . . _ , a , . , . . - .. , � ' • , • ., . ��. � . . . . , , , . � � , . . � , , . . . . �. .. . .. . , . . . . . ; . . , , , , ' . ' ' , � ,� � � • . . ,` � • e . '. , I� . . . � } , . ,' ; s. .� ' � • ' . . . , .. � . ' � , ' , , . � - . •' . � , , , . ,. - , , • � . . . .. , � • � - . ` � . .� ' � . �� ' ; � . � , . �. . .. .. , . . .. `. �. , . � • � • . ' , . , � . , i ., � . . _ , � � . '• , ., , . , P, . � ' . . . 1 , e . � . • � . 1 . • . . ' . . 1 . , .. . . ' ' ' ' . . i, , .. . , , , � • i . . , , � , , , I. < .. . , . , ,.._ , '.. . '�., ' ' ' • ,.: ,;' '' � ' . ..' .. � . . , YL�.� � � ' • , . , , � '.� A'. , '-.l�• i � � .... .. . .,. , t. � . r.F. . ' ... � � � � .. ' . ' � CITY OIF CLEARWATER interdepartment Carrespondence Sheet �: Robert Batten, Equiprr�ent Operator I11 FROM: H. M�chael l.aursen, Human Resources Directo� COPIES: Kathy Rlco, Dep�ty C�ty Manager Leo Schrad�r, Risk Manager Ga�dner Smfth, Public �Narks Qlrec#cr SUBJECT: Yaur Request iar Disability Pension--Cfty's R�auest tor fRformatfon Relatfr�g To Reasona�fe Acx,ammodatfan� DATE: October 18, 1995 You have appped for a dlsability pensEon Under provisions of ihe Ciearv�ater Emplayees' Pensiar� E'lan. By this action, yau have indicated t�at you be�isve ya� ha�e a disabqity whfch Ilm�ts youc abilEty to perform y�ur jab. , The Amer�cans wfth C3tsat�ili#ies Act (ADA) provides that an smployer has an obligatiar� to m�ke reasonable accommadatio�s for a disabled emp�oyee to aliow the employee ta contfnue to wark, unless ft can b� rtemanstrateci that ths requssted accommad�tions would impQSa an �tr�dtre hardship ort tne �mployer. Reasnr�able accommodations may incfude s�ch actions as maEc�ng �xisting facilitles readily �ccessible to and usable by f#�Q empfoyeeT restructuring the job to eliminate margi�al job functio�s, madifying the wark schedule itse�f, modifyir�g equipment used hy the employQe in hislt�er job, etc. I t alsa may incl�de reassignment to a vacant positian. 'Che ADA regulations provid� that a qualified individual wifh a disabiiity is n�t reauired to req�+est or to acce�t an accornmodaticn iha,t re or she chaoses not ta accept. 7he Clty saeks to engage in an lnteractive process with you to determine €f reasonaale �ccommodatlons are sought so you may co�tinue as an activ� empioyee, Thorefore, we ask that yau advise tF�e City of what reasor►able accommodation, if any, yo� request th�t w�uid mak� tt possible tor you to remain an employee of t�e City in your current �ob or in an alternative job whEle perfarming t�e �ssent�al job functions of suci� Jflb{s). Two capies of this memo are betng provided ta you. Piease r�t�m one ot the copies ai t�is memo #o H. Michael E.aursen, an Resaurces Dirsctar, wltt� or�e of the options lnitialer! as tt� whethar yau seek reasa hie acaom tfons whlc� wou�d allow you to continua ta work. 7� . HML/dlf C}�tivn 1: I do not r c�� and will not accept any reasonable accommodations from the City of Clearwater that would aiiow me to caniinue in �ny cur�ent jab class ar in same other available vacant posEtion. I choo�e to se�k ap�rova! for disabillty pensEon pursuant tp the terms cf the �m�loyoes' Pension Plan. Optiun 2; . I do rea�est that the Ciry cansider re�sonable accommadakions for my disabiliry which wou{d allow rr�e to cantlnue workfng, w�ett�er In rny currerrt job class or Pn svme altemate a�ailable vacant posltion. I wf�l su�mit ta the Human Resaurces Director af the City of Ciearwatar a fisting of accammodatlons wF�ich t befieve are reason�ble and necassary far ms to cantinue working. Designatlon of t�ls optlon daes not I� any way preclude me from continuing wEth my request for disability pensian. � . , , ; . . ; �� � „ ,�i �5 . �� . . � , , 1 ' , I . . ' . ' � � . . , . .=:1/. . e _ .i. � 1 .. . . e . � � .. . .. . '\ s � . ' �.. ' � r � ir , r_ . r . � . �Iaridn �p � Sp�nc & i�� � �Spor�s Medicine �Cx1tG�' , .,r. . j' - ' Ah�rlcal Mcd1�lrr� a�id RrltablJllr�rlon , . � INiTxAL EVALt1ATZQN �l�'�rrar�ra�vgraphy � T+al�r Ma1;a�r.�rr�irr - � . . Sr�TT��, �c��1�kFf� ! ��t / Q� j� r GLw7.'R � � i�r . l�c�x . � . , i . pftfiS�NT rLLNgSS: Mr., l�at�en �s s�c�n �;od�y tar c:��l�t�i;,�,on a� �.��uriH� su��r�ined � �n� 3/11 r�4. Wr�.��.e 1.n �tic c�vr�c o!,' hi�; '�:mpl,oymc�nL, he was load ng a�arp on�c� a �ruck and �n�iar.•ec3 �,3.s n�ck anc3 �ow�r back , Hi.s oxkuR -ha�s ��.ncZud�d an M�tY o� thc� cex�vi.aal � spin�, wh�.cli 'r.�vaa�l.ed a C5-7 d3.so hHrn�aL�.on. Un �/7j�4, k:ca ui�doxw�n� � C6-7 �►n��r, or � cer.vi.c�.�, di. sCe�Fomy anci S'us�.o� by �. Dr.. ,7e£fr.ey wa].ker. � e wa:� qiven therapy and pl.acac� al� mta:c�mum moa�.cal. imprc�vement, �.th a 9� im�a�.rment. }�e wrss re�c���od Zo . � x�l:urn �,o wox�k� i n t� li, ri�•-c�uty cap�r.i,1:y, �i.th • Fi �h�zi.y--��unti �.i tL• 'and a x�aoommendai��.on o� nc� c3ig�3.r�g, He has also h�ci ar� M1�� cai' the �lumbaX �spir�e ni:. Sun�oa t�Haspi�al on .8/18/�5, whic.h r�ver�lca�i some netirofar.am�.na�. �;�;anasi . , PAST MrOxC1tL� H�STOitY; Pa�� medi.c:a.� h�.si:�ry ,i,� nonaon�r.j.4�►�Lor.y i'a�. . prior s�.mi � ar � campZ��.n 's. SoC�A�, HI5'i'oRY: �ne on�h aga, he sf:o�pPd wor.kinc� j n h�:� � 3�hi:-- duty pc��if�i.an, be�au� o� comp'�airtts o� p2��.1)� W�.th the Gi�.y o� Ci�arwatsr. ���is �ab descript�.on is avai].ab1e, �� a� eqiiipm�n� op�raLax� ���' r whiah 1.1 �ec� typi c�1. t�zsk�s car assi qnmc�ni:s vneraL:�.ng r� pa�r.a1. gradPr �'ar �haping and md:Entain�.n� xoad servi.cs�s �nd l.evc�lany and grr�ding o he� �reas, Qpc�ral:�.ng hc�av.y Rc;t��pinent, 1ay3.nc� sswer. anc3 w�te�c p�pe� �ar�d �.i£i::tng an�� movir�g, heavy �:qutpm�n�. M�nrCATxON5: Pri]�oseq dnd Px:opulci,d . . � ' PHYSICRL EXAMYNATSQNr 1 Phys�.ca]. �xam reve�lec� resi.ra.c:i:ed cc:r.�vicml rang� f�t� �he end ,�ar��e� �.n a��. plr�ne5. Lumbar r�ngc: was diminish�d �.n fuZ1 fl�xi.an. ' Lxf; nsion and si.de� b�nding were �u]] , � �tauxo3.c�gicaa �.y, manu� mt�scl.e L'esti.ng was 5/5 7rr i:hc� u�}�er �ia�c� lc�wor exi.remiti�s. S nsor.y was �.nt�c:�. Re�lc�xes wer�e 7+ a� �?ar knao �nd tr.abA a� �.h� anitl�s. St'rajc�h� 1eg r.��a4e was r��c���:IVe. I}�nr�1b��. �ox� M.l�. CelUfli� ►X 1ki A�erlern 3�rxrd ul Mbf�lo�l �iraYNn� �wA p�h�liltt.tluu �1'�Jn] �j@���f ��U. � Crflfii�d kX Il�t ArrN�ltln #trard al � r1,��k.1 l�U�Erl�w �n1 keh�til�lutfan � A r�ct n9. �3���on� M.U, t►N�rd ra�tihtr, ��+erir�n n���A ��r � Yhytlal �trdltlnr �ad pr5��f�lkltMllnn 0 � CZ�fiCN'�I�CC tR�! N. Dr�rh�t lid. 5ullc L'-f � 346�5 �4�•r,j9� rnx: �9�•4aos 'I Ncw Part R�chey S.i19 Mnilne i'arkway Suitc 7 � 34t�s� 641�KU7U �AXt �S►•S6t�7 � nw�,.rr��� — .�--- - St� Pelcl'Fb1fr� a�9y Niulh A��c� I�� suttc �n , :�;�7 i � 121�i0f�G C�A�i:;121�2I�q� ' � 1 . "' ' . . � ' ` ' , .. " " ' 1 ' • •• . . . � � , , � ' , � ' 1 � 1 � . ' � . ' � , i � � ' �1 . . • � i. , . .' . � �. ` r . ' . � . . ' . • � i i � 'S � ' . ' ' ' . , , i , � • � } . � ' - , ' . . , . . . ' � .. . , .1 I .. . . . , . 1 , • � . . . � i ' ' . � ! ' . ' ` . . • � . , ' , , . • . � . , , � ' ? . ' �i . . • ' ! ' . ` . �. � ' . •• �i . ' . ' ' . . � � I . � .' � 1 • , I • � . ' I ' . � 4 �� �' • ' r� `• • � . � i � ' ' • � � , � t � ;,q�k^.�•,s�• • . � t� m ,. . �... . . . . .'. .. ;aE�'A'r„ �t•. �! . � ' .. ' a . . � , �7 . � ' ��' ' i� , , ' , � , ' .. � ,' , . � . . . . � . . s�' � , � ' i .. . � . . . . , y . � � PACE TWD . . � ., � . , . � RF: He��ten, Robsrt � , � . � 1/0.1 /95 Dr. Lox � . . . . �n�pecti.dn n� hi.s u�p� and 7.c�wHr pxtr�mit�es r.HVeAl�d no 4wc�1.'l�.r�g, � �� � mal.tl �.nc� or. ��mper�tu e� �hanges ., 3na}?eaL�on o� hi � r1C�C:k , r�c�vH�lea '� r� �wal1.-•txedlQd� lo�i:-s�.�ed ani:Qri.or surgica]. 3nr:isi.nn �13.r�� �nd � . w�ll-hcsn].c�d, r�.ght�-s�Ec�cd ili.ac cra$t i.ncision �.inc�, .� . ,° '. . DxAGN�STxC TMAGxNG STU T�S : Rev�. ew of � x-rays ��zd Mti�. r�n �3 % B/ 9� of '� , �h4 ].umha�.• s�� n� �e ez►l.ed neuro�oram�.na], nt�rr. ow�.n� al.. L�'i--:31 . � � Cc�rvi.c�]. sp�.ne ser�e� da��d, Jun� 23, i995 r,�:v��],ed pasl. i'us�lon � change�� ak G6-7. MRx f the cervic:aJ. sp�ne is .no� ava�lab�.a. � ` ' IMPR�SSxQN: � . � . ., . �� „ 1. . S�a�us p�s� C6�7.anterxc�r c:c�rv�.c;n]. discaa�am� and r{�sa.on. , � 2 . �,umb�r. degenex-�t ' v� joint d��e�t�� . � , , �': P�AN: l�t i:h�.s �o�.n�, T�ee�. that� the pati.en� h�s x��act�ec� �� po�ni: � . o:� max9.mum medical imp .ovemen�:. He has sustair�ed a 9� 1mpa�.rmenL•, ; h��Ad �inon tho Florid Guidel.ines �or his ocxvica.l di.scQat:omy and " ��. �usion and a� 5�b impa r.ment, based upon his �.umbar sLy�A�.n w��h � . deg�ner.ati.ve ehanges. Th�s rel�tes �a a'1��, i.mna�.rmenl. �of' tF�o � w�o3,� � p�r, son, based u on i:he Plor�.r3a Guidc�].ines . � � He h�ts .xe�c:hed a po�.n of max�.mum mod�.�a�. �.m�z�ovc�mc�,ri�, t�ry� �i�, thir� paint, � wou�.d r.�comm nd on1.y �.nterm�.t�en� �a] i.a.�t� ve t:��°c: ha�ed tz�an his sympi:oms. � � ' Yn rc�£�r�nce Lo rev�.e a� equipment ap�ra�or ] T7 jc�b de�scr.�.pi:ion, . ' T fo��. t;htt� �he pa��. nt �.s p�r.mt�raentZy da.b�blec� .wi�h r�_y+�rc�H to �haL• i:y}�� o� emp�.oymer�t . , � I Dcann�.� M. Lox, M.t7. DML: opi: ' (d�c��tiors trt�nscr�b� � l bu4: nol: �coad ) � , y , � . e; . . � . s ,' .� . , , ' � ' . ..., � � •! . '1.. ,.. ,, t. .. . . <. . .. . 'k ; . � � � , ' . , � . � RlCHAaD f.' LYSTER, M.Q, P.14. D�FI.OMAl'� OF THE AIMP�IGN AMRD DF ORrF10MED1C SUROEAY lrELE.�OUY AMF�IlCAN AG1pFalY OP ORTlIdP41EpIC SUItGE1lY N�W �"� � �99� 12fl1 F1Fii! AV�NU� PiOtCT'Fi. StJRE � . . 7'�LEPHCINE S'r. PE�'i'L�RSBUyt(3, FIlJR![)l► 337M . t81]1822•31l0 . �io�-�mbe r 2 , 1995 > Jackie iiline . Httma�n Resr�urces ' � C�tv of Clearw�ter P,. O. Ba� �74$ .. G�earwater� Fl� 396F8 R�: Rabert L. �ai:t�n , Emp�oyer: Ci.ty of Clearwater � DOB: $/23/4� , , � DOI: 3/11/9a Aear �is. Klin�, I ex€�mined rir. Robert Batten i,n my af£ice on IVavember 2, 1995 for an' Independent Medicu2 Evalua�ion after having • read thc it� Farmz�t ion thnt was forwarded to mv o f f ice . Mr . Ar�tten, c,�c�s Accampanied bv his wife. hiy x-ray technica.an was present f'oL i:he �xamin�tion. PRESE� HISTORY Th� pa�lent s�ates that h� was working as an Equipment Operator Grade III on March 11, I99•�, He was winding a�arpaulin an a dump.truck wh�en th� crank apparen�ly stapped and the pat'ient was halding on ta th� tarp mnd had a pul.ling sensation in his neck. H� had a sting �.n the neck and reportEd it. H.is neck hur� more �he fo�.lowing c3ay. He was sent to a walk-in-cl.inir_ at US 19 and Cnun�ryside in C],earwater where h� was x--rayed and given m�dications. He wa� then sent to another dac�or, Dr. �odson in St. Petersburg. He was giv�n m�dicAtions, x-rays were to;ken r�nd he was sent #,a All. Florida Orthogedics for therapy. He had massage, uitrasound, and exercis�s. The pain w,�s locat�d in his neck and in his �.umbar �rea� He denied any his�ory of arm ar leg pains throughout any of the perioci of �i�e. 1{e stmtes �hat he was in therapy far sever�l months artd was then transferred to Dr. J�ffrey Wallter. At tha� paint he was sent �o Nax�hsi.de Kospita.l And had a MR�. The pA�ien� also had a MRT done at Suncoast Hospi�ai. In S�p�.ember of 199� �he pa�ient was operated by Dr. Jeffrey Wa.Zker and hr�d s f�sion p�rformed u� �he C6-7 �.evel. He �as placed on restrict�d activity for six mont}is �.nd was ihen sent to �herapy at, All Sports Therapy again. He again had ultt�asound �a the neck, arr�� and shaulder. Exercises were also perfarmed. The pata.ent then went back to iight duty at Code Eniarcement. He cantinved to see Ilr. Walker and was finally released to light duty. The patien� stated that his neck continues to "grind". The patient, has cantinued ta �ave pain i.n the neck and across bo�h shoulders. Coughing and sneezi.ng are positive. Bendin�� tUrnin�� and twisti.ng the neck is painful. He al.so hms acute �ow back psin when trying to bend. . ;. . .. . , . . . .. , : , .' ,� � �, ' , .. , . ,�,; � �:� ;..:�. . . , ..:,.. ; � '. � . , i , . s r ,., , ,. . .. , . . - , , . . , ROBCf1T BATTEN � page Z �'AST IiISTC?RY . . Tt�e patienti denies any pr�ior history of back in�juri�s. He is �urrently 54 years of a�� and states �hat he is � border line �iabetic, but not ort meciicati4ns. He -denies ariy history of gaut or rheumak.aid ar.thriiis. �He'has not had a prostAte�examinatian f�r m�ny �-eai�s.� • PR�SENT C�MPLAIHTS , �1t' the pt•esent tim� the pa�ient complains of pr�in in the bac�, of the neck. He has ncr arr� or ].eg pains. TH� pati.ent states thaC h� h�zs been advis�d �o pu� ir� for his pension because he has a 9� disability. PHXS�CAL EXAM�NATION � On physical �xamination of the lumb�r ar�a� the patient walked with approaimately a five degree Porward ti.l�. of the body. Walking was slow, bUt he appeared �a hav� a normal gai�. Toe waYking snd heel wa].king were �done showing that h� did h�:ve adPqua.te strength in the lower e�tremities. He could ga Lv a f�Zl sq�iat with some assistance �rom a nearby tab�e and could came back to the erec� pasition. In the standing posi.tion he had ��.umbar .�ordosis oi' 34 c3sgr�es and was tender over the right and leiti kidney areas ta �ild percussion. When asked ta farw�rr� fXex ,he put his° hanc3 across his low back, bent £orward 30 degrees and stat�e� th�t he could na� �enc� any further. in the ex�ension the pa�i�nt�maved from 34 degxees to -�1 degrees comp�aihing of severe psa.n in the back. Side bending �o the,right was 14 d�grees and to ti�e ].ef� was ? c3egrees with a pull.ing sensAtian �nc3 again, mu�.tiple complaints of bac�: pain. When asked �o ratate to the ri.ght and l.eft, he rota�ed 30 c3egrees i.n both directions, In the sitting positian he had equnl and active �2 patellar and Achilles refl.exes, straight ��� rais�ng was 11�$A�11�@ at 90 degrees i.n the sitting positian. He had moderate strength in �oth great toe extensors. He appeared to h�ve some diminished sensation in the ieft foot to light touch, but the remminder of the iegs were wi�h.in normal Ximits. On cervic.al Pxamination the pa�ient was asked fio bring his chin to his chest; he lscked two in�hes of bri.nging his chin to his chest. When asked tu extend, he exienc�ea 45 degre�s r�n� stopped b�cause oi pain. He rotated to the z��.ght to �5 degrees and 5 degrees ta the lef�. wit�h complain�s o£ Pain in both directions. Ne later�►lly Ylexed ta th� right 2 degrees and �o �he left 10 ciegrees, bu� complained nf pu.�la.ng sensata.on in the neck. The patient had a well healed sc�tr in the anteri�r cervical area af the neck. His ref�ex�s in the upper extr�mi.ty w�re �+2 .thraughout, ihe biceps, triceps, nnd radial. Muscle strength was good throughout the upper extremities, a�though the patient did camplain af pain with muscle testing. The pAtient had tenderness � , . . , , � . . • , t ' ' �' � ' . . . • � , , �;. � �' , ' �} � � : .' . . , , ' :, . . , - , , . , � � � 3 � � ' , . . � � ' . . . � � . . ' . � , t . .. . � . � . . • ' . , l. . ' ' ' � . ' � t r .,. � . . .. , . ' ' ' ' . ' ., , ,I . . , , � • y • . , �..,.iv. . . •Yi,,,� � ..v .... . ........�—.....,...6.,�,•t, .-�=:�,.i•. i . . . ' -. , '. . ' '�' ' s � FtOHERT HATTEN � 1 5'' �� , .. .�� �, ' , , , � , .�..,... . ,..� . .. ... � . ".. . ' , � � . . paga 3 Qver a�.l. spinaus process�s of the c.erv�cal spine nn paipation. Ke also had complsints�o£ pain starting aUou� L1 and extendin��to � the s�cral t�rea oveir the spinous processes of the l�xmbar s�it7e, In the � supine position the patient �,��s unabl� La eZev�te k,oLti legs more thar� � degr�es. Sir�i�ht teg raising w�s positi,`�•e bilaterally at abotit 30 degrees and kh�n Flexinq th� 1cn�es to 9U de�rees, t�e p�tieriti stil.l compl�ined of sever�± low baclt p�in. rn t,he ttpper extrer�ities k.he patient w�s t:nable to elevate bath rirms beiond ,135 c�egrees, he was able ta have e�terna� ratation af 90 degrees bila�.eral.ly at the shoulders. He had interna], raiata.ort o€ 70 degr�es at the shoulders� k�i�h passive mavements anci comp3ained of pain• in a:11 the mavements. Abductian was ta 90 de�rees. z cauld elici.t ,.na crepitu� in �he shoulc�ers w�ith internal/er.te�nal. ratati.on. ' x-�RAY FIND�NGS - , X-ray� accompanyxng the patient showed tha� the patient had mu3tiple x-r�ys ai �he. cervical spin� dane at Edward White Hospita,l in.199� and 1995. The 1994 fUSi.o�n appeared �o'be solid. � was not convinced thai the Z93� f.iims showed�that he had a snlid.fusion. ' TMPRESSX4N � ' � Usi�ng the F'�,orida Impairment Rating Guiae of 199�, the p�tient, '' has unoperated, but diagnased�spinai stenasis i.n the �umbar spi.ne �f 5X. Tha patient has had a cervical fusion at C6-7. He has pa�n in �he c�rvical spine. The cervical. spine rating is 99G. I would p.�ace the combir�ed Impairment Ra�ing at 3.�9G and � believe the, pati�r�t is �t MMI. The patien� wns advised that I felt tiyat i� wou].d be helpful to have a CT of the cervical. spine ta �nak� sure that ihe fusion was intact mnd sorne af �.he grinding that he was heari.ng was not caming from �hat area. IVa return visit was me�d�. I believe the �ati�nt wauld 6e un$ble ta perform his duties o£ Eq,ui.pmen� Op�rator III under his present physicml candition and wou�d be eligib�e for disabz3.ity, If ther� are further questions concerning this repart, please fee� free to contact my office. Sinqere�.y, c � � . rt Richard F. Lyster, M.D. � RFL:jg � i � � � �� I.,: , � ., , . .,. ".. .�� .°� , � �. : . : - �, . , � � A ' , �'� ' TRUSTEES OF THE EMPLQYEES' pENSION FUND . == �, - Agenda �Co�er Memorandum Item # MeQtfng Date: 12/4l95 suhject: . � . Pcnsiart to bc Granted Recommendatfon/Mokian: Lind� 'I'r�uh, So1id Waste Deparirrier�t, be granied a�jQb-canncctcd disF�bility pension undcr Sectian(5) 2.397 of ihe Emplayces' Pension Plan as r�;commendec� by the �'ensior� Advisory Cammittee. � and that 1he appro riate officials be authorized ta execute same. BAq�GROUN!]: Lindu T�aub, Contui�er MAintenance Warltcr, Sa1id WUSte Depurtmet�t, wus empl�yerl by the City or: 3anuary 9, 1978, and beg�n participating in the Pensinn �'lun on thnt date. On i+lovem�er �, 1995, ti�e Pension Advisory Corr�mittee {PAC) determincd that Ms. Traub w��s eligibic for a job-connected disability pen�ion b�se�l on her disabiFiiy resuiting from an on-the-job injary. Hcr injuries are described �s knee anci lower extremity traum�n and reconstruction. The injuric�s are documentecl tiy ictters i'rom d. Sudt�:r Hoad, M,17.; Elizabeth C. Sirr�a, M,D.; anc� Luwrencc M. Gnage, M.D. A Notice oi InjUry report renect5 that Ms. Traub was injured on 3/6/92. While painting thc lids on �n eight-yard container, she stepped aff �f � lacider, misscd a step and jammed her knec. Dr. Hood relates ��is impression to be that: "1. Ti�e 5�t'.ClflC nawrr of the injury is post-traumatic �irtt�ritis uf the ri�ht knec. 2. I think the patient's conditinn is permanent. 3. I thin�: this is causaliy relatecl ta her injury of 3/6/92. �. Wit}� tt�e ciegr�c oF �rthritis tliat s�sc h�is, 1 da not think she u+�uld �c ublc to perform her jah as d�scri�ed in her job as described in her job descriptiorr, which requires climbing o�er and around farge metal dumpst�rs, repairing them, using �owcr toois to do so , f�r part af thc job." Re�iewed by: Legal Sudget Purchasing ��_. Risk MgmL �Q�l.. CIS _,,, NA _ _,_ ACM Other NA _� Submlt#ad by: City Manager Originating Dept: Humat� Resourco; llser Dept.: Ad�ertls�d: Date: Papar: ❑ Not �equlred Aliected partles ❑ NoUiied ❑ Not requlred osts: S24Q,220 T�fal Current FY Fvnding Source: ❑ Capt.lmp. ❑ Operating ❑ �ther Pensfon _ Approprlat�on Code: 64h-07al0-SId2(]0-iR5- � Commission Action: ❑ Approveci ❑ Approv�d w/conditlons ❑ qenEed ❑ Contin�ed to: At#�chments: l.ettor(s) ❑ None �+� . . � , . ' , . . . . , ', . � ' . . . ' ' , � ' . ! . . . , � , " . ' , , . . . . . .'. � : , .r . ' ' � . . , • • . . � , ' .. ' � S 1�. � . . . , i . . , ' � ' ' . � . 1 ' ' � � ' i . . � ' . � � • . r . � . ' . . • ' 1' ' . E,! . � ,. . ' ' �. , 1 . I `� , � ', , 1 ' I I ,f . 1' ' � . . . ' . .. � ' .. � . ' � � . ' .. . ' . .i 1 ' ! .1 • .. • ' . ' .. ' ' . . � I� .�. � � , Y . . • . . .'! . . .� �. " ' ' • , ' • . � � � i � � ' I. t .f . , . . , ' ' . . . .. . � .�, .' j ; .'1� , i .. . ' ' ..i '.. . ' , . , , . . . i. ( { ' _ , . ,I . � . 1, ,. � ' . � .. ' � .1 .. . , . . • �. � . , � ' . . . . . ' , � � ' � , ' : ' t . ! . ' � . 1 , ' ' � . ''I ' ' ' ' . . , , , � [: . . ..:If a.ir"4c, �.j } v:{�.�..x;n.-.g k:.'t"''�t. ' .. , � ! . . . , , � •� .�. . � ' .� . � :i.,:: i . • : � .'�i �i; IY(i� 'C�`p,e',4�:��f . `�I.Si�: � r�iF . �;4'�t, 1 :�. < �� z:.�f i s,- r . . .3i' . � . . , ` . ' " 3 ° . ` . . , . , . . , , . . . . , .. ' ' , , . ' ' . . . W.Y'1� �l«f` ,% t'? ^.� . . :i� • . . . .. . . , ' ' ` � , � i , , � ' ' ' . , , ' ' . . � . � ' . . ' ' . � . ,in . ' . • ' � ' . . . . . . � . ' . ` Agenda .item�Linda TrauS . .� ' ` . , ' ' � � � � . .,,- � - , P�gc 2 � � � � � ' ' � . � ; ' . . December 4, 1995• : � � , , ; , � ' � � . � � � . ' , � . . -, , . � . . � ...Dr. , GnAge reports th�tt she �has reached MMI with an imp�irmer�t rating of, 8°Io to the wt�ole , person ' ° aqd, inciicatcs ":..She should be on permar�cnt r�strictians of t�o cxccssive 'standiag ar walking, no . , • climbing." �. , . � • � '` �f � �Dr. SirnA condvcted ��n jndependent Medica) Exam on Ms. Traub and reports a�3 impression as - . follows: � ' . �, � ' . . � . �"l.. - Status pvst work rclaicd injvey, complicated with menisceclomy,, milc� dcgcnerAtive . ,• �rthritis of the medis�i compartment und tYbial psteatomy wit�t removal of t�ardw�re. . . . 2. P�te�lafemorAl p�iri syndrome." , By su�plemental report Dr. Sirna �indicates Ms, Tr�ub has reached MIV�I acyci' designute5 h c r � cnqdi[ion us permancnt witf� "no repetitive bcr�ding, squatting, fiFting, st�ir� climbit�� c�nc� �,.•.jumping. No, re�etitive liftinglc�rrying greuter than iS .lbs,',' Based. on �lorida Im�airment �. G�ideiines (1993) An impuirment rating of 89'o is assi�ned. Within reasonaUle medical probability . Dr. ' Ssrna indicates Ms T�aub will � requirc future surgery for a total kr�ce rePlacement. . . Based on an uverage salary ,of agproximately $22,825.18. over ihe pnst fivc years 7nd tt�c scventy- � fiv� percent (75°.'0) mini�tium disa�iility benefit, Ms. Traub's pensian wil� approxims�te $17, I i 8.89 ��nnually. Charts from Finnnce, which , take inta consideratian �nortality rate and ��c, refiect th�t the "present vaiue � cost of financing" this �ensian wi�l bc appraximately $Z�0,219.71. The tatnl actiial payout will approximate $753,2� 1.Oq. , . ' • , �r� .. . � , . � . � ;'�;t'�.��� . �r:� .. . . , ; . . . .. � ' • . , 1 . . �.' � 1 . , '' . ' � . " . . . � , . . ' , ' . , I ' . . . ' I . • f � , . . ' . , , ' ' ' • • , �' ` . � � � ' � � � . ' � . f• , i , , '. � . . . ,' � . � 1 . ' � . �. : ' ' ; , . , _! 1 � � . . . ' 1 . . . ' . 1 , . .. ..�' , I �} �•,� .. .. �' ' r ' .I , t • , , ' , • � . . . . � • . ' � J , , ! �.. �.IS II� , - ��, 1 . , ; , ' '' , .' . � .� . � ' '' 1 I . ' • � f: ' ' , • i " ' • � 't i . [ � � ' , , � ' . , ° ' � ` .��i�./; r�G}�••�t..il.kxr. � , �i�� ..,.•,��.�,,r�i'�i,-M11o.e.�. 't�� . ' . ..� .'..3�,.'�;. , . . � 1 .�'..�' " .. � ' ���s''. °' ' . ' . .� , ( . . . . . . . . . t � , . . . . . � . . � � f . i ,. Nurnan Rciowcas Depar}ment ' ' (B!3)AS?-G87b : l�fii FROh4: �, COPIFS: 5UBlECT': DATG: .. C�I '1' Y O� F C� E A It. W�A T.-E �. ' ' . . Pt3S'i' O��IC� BOX A74E3 ' f , - . CL�A(�WA7ER, F�ORiDA346'is-4748 Honnrahle . MAyor and Members of tiic City Commissian Us TrUStees of the Empioyecs' Pension F[an � Pensian �Ac�visory Cornmittee � Debbic Bailey, I'ayroll 5crviccs Mana�cr; Risk Managemcnt Pcnsion for Linda Traub---Jab-Cannccted Disability I'cnsion � � November g, i 99S . � The Pension °Advisory Committee (PAC} received an application ior 'disability pension from Linda. Truub on August 31, _1995. � , Ms. Trn�b h�s beezr detsrmincci by the Pens�ion Advisory Committee to mcet the requirements ot' the Pensian Pl�n 1'or � 1ob-cannected disability pcnsian. She was employed by ihe City nn January 9, l978, und bc�;an �:�rticipating in tlie F�ension Plan on lanuary 9, 1978. Further, sl�e has submitted medic�il docamentatian, COp1C5 of which :trc attached, relative t� her dxsttbility which has he�n re�iewcd and a�prc�veci by the PAC. I3y motion tnade and duly carried at its mceting o( Navem�er 1, 149�, the �ension Ad��isory Conlrnittee approvedlrecommcnded the grantin�; of � job-cannectcd disabiiity pcnsion eo Ms. Tr�ub in �ccordance with provisions of Section 2.397 of the City Code. This F�cnsion is to bc eFfective on �� daie ta E�e determined. Thc �imount of Ms. Traub's �en5ion wil) be culculated 6y the Finance Departme�t accordi ng to the formula in the Pension Plan for job-connected disahility pension at such timc as her lnst five years of servic� und sal.�ry can be com�utcd. I hereby certify that the Pension Advisory Cammittee has approvecl the grantitzg of ;i jnb- connecied cfishbility ��nsion for Linda Traub anci the abavc dutes are c�rrect. �_ .� _ �._� �_.._ � _�_ � Chairm�n, Pcnsior� Adv�sor� y �ommittcc ' � 'Equal �mploym�nt �nci AlJl�m�tivo Aciion Err�ployer" �� ' , ' ..+ , . 1 � ' � . . � . - ' . , ' ' , , ' , ' . . . � • . i� � � . . . , . , . . } . � . . ' - , " . r�.�.' ' ' . . .j. � f , (,!� I � , � i . . . . , � . .�.. !" � i ` - .f. ♦ . ' . . . .� � ' '� ' .' „ ' , ' rr� wrr���r�� �+r�� w�. ' � . . ' ' , � , , ' . , , r � � I � • • � ' � � • �1 � � ,, � PENSXpN REQUL.ST F4RM I..` ���h �,�, ,..!,! �+v �] du hareby agply for rctircment from th� City of Cic�rwatcr ' General Employees' Pcnsian Ptar�. . � My benefits data is �Qh•� �,��q,7� {Entry date inta pensian• planj �vi y date ot iaire is �C? rl • _ 9� /,� %�' _ " _ . - �riy birthday is � �1s� ►�rty job � ciassificatton is �d/�T"Q-!'rJ'�f' �%Li.l;/17�. _, Wd��r arid I work in� thc „r...�,,._,��d��,�- �f1S�C� . . _ _ Dep�rtment. . ". , . , ..,. ,....__ „Divlsion. 1+1 y resignativn date is _ � _ �? � �e��rm� ��° � . + . Thc type of p�r�sion for which I am app�yiag is (c}�cck only ont): R�gular Pension based an years af servicc , _�,,,,Iob-connecterl Disability �`ensi�n �fart-,�ob-connected Disa�bility Pension � � � Vfy 5j701l5�'S aa�ie is: De�endent �hildren under the age of 13 �z�d �resicling in my �sa�s�hold are: (�C'�f:t CilI���S �l��l ��If1C� {e}�lICf�S d�EC (7[ �ICChj I heceby �ertify a!1 oc the �bove to be true and corrcct; �,� r � ' {�] � Y��� y � � . (Dace) STa.TE OF �FLORiBri � T fare oiug i s�rur��nt was acknawledaed bet"orc rrie th�s C0�]NTY OF PXi�ELL�S ` 'by,��-vu� ��� __1 tivho is pC[SQri�II known to mc ar w}�o has praduced . as� id �ca�ia� aad who didldid t�at cake an aach. � . . �� - - - —Notary Public �,.,.,, . i�; t� ry�� µADFi� E.��� _.. :,z �Jf�f OaMMt551oH � t�ittSSS6 fxPiR�B Corr�mission Na.._____,_,_,�..... , � :t� Qcm4�ar 6� 5998 • . �:�.,R..��' �n�rAar�++aauuv,a.+�s. (Name of Noiary Princcd) n .. ' r. � 3, . - 1 � • . � ' . i . ' � . , ' , '! � �. . � r 1 . • • � • , , . , ' � t ' . � . • 1 . 1 � , . � � � . . � .. ' . ' � � . . � , ii� , . . .' ' T , , �.Pa `. . `1�`• o � �: i�.., � ,:. �4+r . 3�tY � t'rF- :i'r:`. .ff",4 ��h' ' ., , . , l� �� 4. zf . � . ,•` , . . , . � a . , �f. . � . • . . . 1.'. �� �..' � CITY OF CI.E�,R�Y�,T�R � G�N�R�,L� �MIPLOYEES' PENSION i'LAN � OPTYON5 - GEy�R�L E1�I�'L4YEES • . �1 ,� aPTIQN ,�Y: � Employens can rcccive s lump sum �aymcttt for var.�tion . and � ,�, , holic�ay pa•r and I!2 aE �acc;ued sick ieave , at che time of � � �• scparation fram the City. There wili bc r�o 6�'o deduccio� fpr ' � gensior� fram this fump sum payment �or wijt tf�is amourit c o u�Z t �, ' , . as "�arni�;s in ��c calculation af thc pensidn. The lass ciay of ' � . warlc will be che termination date and �gensian bencFits will be�ia � . , . ihc �Fallowing day. � � OPTZO,N 7?: � Employee can extend cerminatiQn date '�y the time du;; � tor � vacacivn, holidav pay, ar�d L/Z oi acerued sic�c leave, Termination �� � ` da,te wil! be tht tinal d�y of exte�deri time. � P�nsi'on benefits wil� � � " be;in �he fallowin; day. � ` � (Qnly avai�ab�e to emplayees hired prior to 1011/90.? N� �le * ik �M * �ie # fe M� * +r a �% ,e M t w *� s ■ ye x ■ �t ,{� rf �r • w w * r �r r � x � � ie w ir .M r +[ �r .e +� � V� * Mr M � �e h+ �e K +r �e re ye �!r M .k M � . � • � ��+ , • . I, � ��"/ , an cmp�oyee of the �ity of Cle�rwater, her�by appiy ior � pension benatics e�nc�er� rhe City'� Ecno�oyees'� Pensian PIaR. � I h�reby .c�rtit� :h�t I[ulky understand :he �wo optlons acfzred tc mz. I choose to re:ire usi�; O{�Eion � l �na ':v{,� tny ben�tits. ta �e _alculated under this �ptian. [�.�nderscand �E��t .snce z�is forrn is SZn��ri, mv decisian is irrevoe�o�c. �/ � r ` � '��� ../ � `' � � ��� � � � ��Ep�.QY��"S SFG�i�TU � SC1CL-�L ScC�,12ITY T:_ �?6 �- � 9 - ,7 7 ��" _ .�DktESS: yS/ .,5� �I'�d re �r: �/ �le� �wa�e�' �L ,3f�d � o�.r�: _ � �� I- 9� � _ ..ar , , . . . . �.�.• ' 1 ' '� . .. . , . ' . ' • ' ' . � .. , � ' ' ' ' • � � , �� � F . r , r� , . � , � . ' ' � � � ' ' � � . � . . . � ` ' • , , , . . , , � ' / . . ' , . ' :.�. . . . � ' . . , . . ' . ' � ' ' ' . " � , i ' ' r , ' t' . . . I . + . . ( ., ; ' . . . . � . � , . � . s � . . . � � f e' , ; • � . ' .f' ` � ' ' ' r 1 , , i . .. , , ' . :; .` � , , . . . . , ' � , ' •' • . . . , . . • ..p't ' , ' . . . � . , > ' . ' . . . ' ., - s , 'I' . . '1},' 4 � ' � 1 ' :' � � l.I . � I , .. . 1 � � ' � S . • ' . . . . 7 ' � 1 ' . . . .� . . . � � t. . f , . ' � ' � . . �. ,, � �. . . , ' , � ' � � . � • ' . ' . ' . • ' . L '' . . ' ' ' ' , � . ' • .wui;it:'.�ife�iR�j i''Ff �?{'�F.�ii.f}e. .S.l.6i.i'+�:<�;r�.t:.�f;' ' � � . . x � r � . � � � - � � ' , � ' , . . � . ' . . . . ..�j. .. 2..... : . ��� . '�� � �� �I� . . . . � � . . . . : .. .. . .. .. . , . . " . . , , � . " � . � , � � ' � • . , . � � , . � A,UTHQRiLr1.TZ4N TO RELE�SE . � . ' . � �� � � �. �EDICr�,L ANDJ RELATED R�CQR,llS , � ��,� - � � , ;; , " . r . � �-�,� � . � � � ,�.La � ,��� . an apgl:canc far. d�sab�l�ty pens�on �nder provisior�s of s.�: '- r#�e Employee's' Fension Plari of the Cicy of Cleacwaeer, hereby authociae �.ny physician or 4•,'o[t�er mcdical care provider w�o �xamints oc treacs • rrie ar wi�n has exa,mincd or tre�tcd rt� c oc who ia t�e F�ture examines ar trea[s me ro releas� any and �Il medical an� relatcd re�ords , , �. pertaining to, me '� to : the City of Cle�rw�tcr's Pcnsion rldvisary Cammittce, Perisinn Trustees, ' �� Personna( Director, or authvrized em�loyees or agettt� oF the Cicy at' Clearwacer, �lorzda. ' . , � . . ' . . . � � � r� . ' ,'. � �, , • . , , � ' , � . , Si;natvre . . � . : , , � � � . � -.3I-9S � . •� • ' ' Date � , �� ST.3TE ��F �'L�RID�� CC}GYTY, OF .PrvELL:aS �T�. vre;o n� instru ent v�ias acL�owl�d;ed bztore me this -�.�b v .���:�� .. ._. _. _.� . , , w�o xs QEf ,' �o .me or wha has produced . as identificacion a d who di�/did noc take an aacn. '��^++-- � ���' Votarv Public �Si��acure) ' F�`�'r`y� t,.t'``�: `. ..";i I��:��� " CO�Ilff1l55lQii `�a. ': �• � ��i � 1x�1 f D9Q �JS���$ _� �r+�i�; �.,�c_ {Nam� of ►�ocary Frinc�d) .. . , � � , , I�i_.' ... , . . • . , -- - .�..�.�,`.. — ----- � ,� � , . �� � , � . . . � . • . . , . � . .. , i� , �, � .. + . • a ��TY OF GLEAR'i�ATER, FL4RLDA � . . � . . srA�rrr a� �.�s�G�r�►�o�r , � � . �• '� � . cmplc�yed �.ti r � ��t thc Divitiiun c�t , Dcpuccmcnt c�a ��rcby rcsi�n tram �l�c �:rv�ce ut thc City ul' C1e�rwater. ! rc�uc:�t that. thi5 resi�:n�tiun bc tluly ur4�pt��} hj± n�y Dcpcirt- iziCnc Heu�i uncS thC Appointin� ,=►uchuritv tu bc�:umc et'f�s.'isv� � uP°� �'�g�°��1 °� ���sai�3.1.�.ty pens�oa by th� R.�d1dx PeASian Adviso�cy� Co�,i.��ee and Fensiaa Trustess. , . The re:zacm tur this r�i�n:�cian is as ti�l�nws: ` Retire�erat on diSabiZity pensivn. ' Ent�luyc�'ti tii�= � -.� r� J � "� 0 Duse .i�: DEP.�RT:�[E�T ACTIQN: .a�pravec! by Di�isiun' He;�ti Dute Divi�it�n He�ad Ctammencs iOptiunuU ' . �pprc�vcci by Depurcment �fes�1 _ _ _ _ . . . . _ . ----- - Date Degurtmcn� Head C�mmcnc� fQptEOn;�!) . � .. _,.,._ ,_._,_,.�._..—� r#C'I'Ib�+f QF r1�POINT],I�G AUTHORiTY i ac;cCpc chis rr:�ign�cia� ta �ecome et'�cetivc on thc cir�tc und �t t#�� timc sh��wn :�bc�v�_ Darc . Appoin[i�� Autnc�ri�y Appc�inting Authc�riry Cummen�� lOptic�nal) IMFORTr+,a`�T HUTE: T�c rci4c�r� ti�r thiti re�ibnutic�n mccst �e shciwR ir� thc: sRue� provicfcc#. Th� uri��ina� li�nn. tivhcn tii�neci by the cmpl«yce unci thc clivisic�n unc# depunment i�euci. iti tn be ;�ct�cfttcl ta the pe:r5c�nncl stii�rrt sttc�t sncl ti�rw:�rrlcc! ' tt� tlte Pcnc�nnc! Ot'ti�:c. Penunncl ac:ricro shcet mu5t �filcct thc sc�tuti c�t' any City i3u�ni`s ttt�c tc� cfr by t�tis cnip�ctycc: in �ccc�ni�ncc wich thc Civil Scrvice RuiGS unt3 cc�ilcc:tivc bur�uinzne ;�Lr��:mrntti rurr�:Rtfy in ci'tcc;t. � u�.�..�r :��r ' � , . . .. • � ,.i. .. . . .., . '�:.. �'. .. .. , . . ....� , .. , „ , . ,. , _ . , 1.., . � � � m . � . .. . . , .�, , � . ` • , , � � . � CITY Q� CL�ARWA7E�t ir�t�rdepartment Correspondence Sheei 'i� Llr�da Traub, Ccsntainer M�i��enance 1rVorker � / / r--- _ . _ . FRpA►!: H. Mlchael �.aurser�, Human Resaurces Dire f C�PlES: Kathy Rlcs, Deputy C1ty Manager Leo Schrader, Risk M�nager . 8ab 8rumback SoNd Wasts Direcior SUBJECT: Your Request for Dfsab�fity Pens�or�--Gity's Requ�st ior Informat[on Aelating 7o Reasonable Accommodatian - DATE: August 31, 1995 You have apptieti tot a disabfEity pension ur�der �rovisions of the Clearvv�ter �mpjoyees' Penslon Plan. By this action, you have indi�ated fh�t you beiieve you have a ciisability wh�cf� limfts your abflity io perform yaur job. The Americans wit� Disat�iiliies Act (ADA) provldes. thai an emplayer has an o�ligation to make roasonable aocommodations (vr a disabled empldyee io allow 1he empbyee to continua ia w�rk� unless it can be demonstrated ihat the requesled ac.�ommodations wauld impose ar� und�e hardship on the employer. Reasonable �ccommadaiinns m�y inctude suct� actlor�s as malcing existfing facilities readily access�t��e ta anc! usabts by the emplayes, reslr�ciuring the Job to eliminat� margir�al job iunctinns, modiiying the work schedufe itselt, modifying equipment used by the emplayee in hislher Jab, etc. I i also may tnctude reassignmer�t to a vaaar�t pos�tton. TneADA reguiatiar�s provide that a qtraiffiect ir�divid�aa! with a d�sablttiy is not rs �rired to rer�uest or ta acr.ept an aocommodation ihat he a� she chooses not to �.cc�pt. The Ciry seeks ta engags !� an interactive process wiih yau to dstermine if reasonable accammodal�ons are soug�t so yoU may conifnue as an active employee. Therefare, we ask tt�at you advise the City of what reasonabte a�commodatlon, if any, you requsst that would make it }�ossibfo for you ta remai� an employee of ihe Clty in your current job or �n an a�ternative job while pertormfng the esser�tiai Jab fur�ctions of such job�s). � Two cop�es af ihls memo are being provided to you. Please return ane oi the copies ot Shis m�mv to H. Mlc�ael Laursen� Huma� Aesources Dir�ctar, wilh one af ths aptio�� initialed as to whelher yu� seek reasonable �ccflmmadatlar�s which would a11ow you #o canifnua to work. HMUdif Optlon 1: I do not re�ue�t and wtl� r�at accept any reasonabie accommadatlons from ihe Clty of C�earwa er t�at woc�ld a�low me to c�rttFt��Q �n my currer�t job class or in some other ava�lable vacant position, i choase to seek approval fnr disablifty pension pursuant to the ierms ai the Empfoyees' Pens��n Plan. p�t{an 2: i� that the Clty consider reasonable accammodatffl�s tor my disabili�y whEch wo�id allow me to continue working, whelher �n my curreni job class ar �n some alternata availabEe vacant posHion. I wiil submit to the Ftuman Resources �frectar of the Ctiy af C�earwater a tisting of accommodations wi�ich I beAe�e are reasonable and necessary tar me ta continue woricing. Des�gnation of Shis oQiion does not in ar�y way preclude mo from r;ontinuin� with my request fov dlsabiiity per�sEon. ..,,.., 0 � i w � ` ' , • � . . • ' � , �. , . . �.F f'. , ' ' . . .+- 1�'. .�. .• .'�. . . . �J� ' . .� � � . . . ' . ' ` . . 1 � , �� � . • . � � ' ��� • � � � ♦ •� ���. r •• �r • ������w�.�r �• � ♦ � � , � � , • 1 . . . . . • . • � �� SUPERVISOR•5 �NVESTIGAT�ON REPORT. � � � : + , ^--` . . r . , , 011 . , ,. w . ' � , � . PERSpNA1. INJ�Ui�Yr ACC i D�NTS � � , . . �. � . ,. } � ' . . . " �� " . EmployeB's N�me: � !!�?.Dii- �r �1� � ' . � ' s , ' y ° occupat ion: ..���� . 0'�.1, � Q[ ��f' � ; — � Dare S Time o� Acciden�: _-��,��Z ' /4= �o �%yy� . ' : , . ... ..; 1]ate & Tzme �'�rs� RPport�c3: -..3 L Z I► ' 4� ; , -Tr- - . .. , ''i � I.oca�ion on sody of xnjury: � � , _..._...�, .., ...._ .. � ;; , • ,� �. LocaGion oE Acciden�c� � C c-� ,,," � .� . . , . �� .� , � , .S , , . �� 'Wha� was employee doing at time o� �ccidant? !� G� � 4 � , ' � 8�� G3� x : . .,., .� . . .�., . �e s a r i p t i o n o� Ac c i c3 a n t:� c..C/�-�- ��2 ..._.. �.��, �_.� s'�`? /� � � .�1�_,. � [ _ ' _ � ._ _� � � ,L� � _ ` � . _ _ 1 / .� Has Employee been to see the�City Nurse7 . No �✓ Yes Employe� going �o/been to City Doctar7 '� :No , ✓ Yes Is Employ�e h�ck . �o .work7 - ' � , ' No r� Yes Has Employae lost any work hau�s? " �,No � Yes . . I� so� wh�n'did Empl.oyee 3asC work? .. Superviso�;s S£gnature � � Da�e � �f .. �� ' . � . � . r �. � . � , � . �!, • � ;' ' � � ... �• .. . • . .. � ♦ . ... ..�.� .u........ �.... ... .. r���r� � .�� . . �. .. . . . .',,, •. •� �..�. ���� �,a. � �rr � � .. • ,• � • • • � ,� ' � D�Nl�7p! �I�IZOFM.l�1 / : """'1 :«J { ..,+! f jy, , � � � '1 , ,; . �, .,: - - � . � ` ,, , , , � . � ,. FOR CAFiRlER'S dAT� STAMP •�,;''x��� �FL�RiDA bEPA TMENT�OF LABQR AND EMPL.�YM�NT SECURITY�' ReC'p BYCARRIER SENT7Dp�VIS10N �t � . �, � , ., ol��EO�,oF�wqpKE�s� coMP�,N�P?��� y��l i��1�1�; ��'�"�� �' k ;t;� . � � . . . .;: ^ I� } „;-, 1•B00•3��-1741 jor) contact jrour 1ac.el o�'ice ior asslstance . � , r� . .. .�� .,'' . ,,�.• :4�•,�:;: c���'�NOTICE•�O�j INJURY �(���;�;F��itiFU4 ���;1L,���� �: :�:��,-,.:�• ,. . , . .. �� , , �,r s:r , .. , ; . �� Report �II deaths wfEhfrt 24 haurs (Sp4j.488•3Q44�H,�:��;� t :? s�: t�ittri �.��• �r� . , � , . . ,� .�I1;,�.• • � ;�) �[,i �l , . ...� i!i� jl : .�+..�:� ,:o f• i�ti ,�;�lai ��JV.�l;.�il tl3i�i •.; •e�:t ,'�' � „ . ��' ' .. ' . � .:►.i 1`7 .. .1, � � '�� �T�•'�:.lr �{ ;; L+;! �•:�:�tl tl:�i'.;��i'�i elh i3Hi1f'•!0 � 6�i#��rfEliri��i� fEf���, �+'t!�' �,� , . ��'.t,. : .. ` �• .i .,, � . t'` �llA1µ�E, f�irst� �ddGS. iuq � . . . � . �. f . .. • u r � ' fl�te �nd Tl�ne of Aa I �� l.�•l'. ' �. !•''ii ..'. :��'. ���tiJ l'11'.1.;:1'�•f;•..:1.:��'.,i t�� �1i +fClV�« �{� ����l.�C.�1L'.•�s• 1 � ' � � I Lind� Traub ` . . . �: �26�-29—�7.65._.._...... ..� 3%6/92 at. .. / r .j �+ � � � T1��7GL'l7R'.Il�l���:ii OF AG[:IUENT ��a�� W�S , �,;,,�l:��i�;. .. '� , :�:! i1 '. . �. 1 'si£�.,�;E',.'J'r �:: �-; � •. r. �'. � n s.,, '"•• "+'• ""'°" "r " [n,q. r4i�pt1tillon o1'� hi [r�mi fk+p r N aaconG jotnl, hacturod dbs� iead. pdwnir+�. etc.j .C1:�171 N Ii i . .'�.. . � ..>C � �� S�Eil� � : Ta;O ` �i I. � � . S:• .. � '� . _�:�rej : v,� ��� rx . .�;�,ii t. . ..� �• �x��� � :s .. . �1c..� ,�o�DY�U,�a�,Ql��5T.1�ED1C�L,Cf�#L•7; LXY�S oNO ,' � , , :;�Z ;� , • o I � I,l �� 9 M O F iF YES, blp �MPl.OYER PFiOYtpE M�pICAL? fSYES .. 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'� • �'��t •• +' � • •, '� +: • . , ' `�'' � • � �' C3 T.T.Q+ � O�T.P.ain Dsto Form Rac'd: � t'''+�� .y;�'�;.(�� p Calaslroph��� p�PT.D. ❑ �eath': � . . �'. .+ . .. . p 3. �4tad�cal Only whrch �became a l..ost Time Casa, (Camplata a�l lndoimaffon�n i��fri�2 abqvey �� � �� .! i;.i 1 � , • � ; .�'. � , , � ; . ,. . .: � ::. F�Eh1ARK5: ' �:•� .�' •�:� I� i.���.iE�:� � 7� i�i•1?i�l •'ii t' =iV�1;?til �f ��:��! il:� � {:'il:�:.i ;r.�• 1 �:; ' :� ' � � ' � �'t' i i " .t'•��.yfl, �,.�q ;�,.� �; ,... t - j. .�-'! '` , � �c � - ' � . ADJl1STER NAME: � � ' : . • + ' : :�- •CAAAlE 1kA�l�� UpRE �.j�1.EAHON�: . . � DATE. ! • 1 �r� .� , `... . . .�,� ' :)',f.�. �i'; `7' ;d' � l.. , t , .. ' . . .�Art,' ' , . ' � , e . . � • . . . . . . ,��.� , � . ' , .. .. ' . '`J� . , . . , .1' . . . � - , �. ��.t 1t '�Y. '4 i .�7' . . �e S . . . ` ? .• , .�� '} .� ' . ' , ' • . ' . . . . . L . , � ;: ��.. l.� . . . �' . 3 ' , f. . � . . ! . � �. � � . . � , � .. . . ' .. .. . J . . : .• . . . 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' �; , . � , Gcan't . � � �' . .. � � ;• . 3?'r ��f V,� ., , ` .. ].adder �the enp�. ee mf ssed a s�ep � and j anmeci her kn�e. � �. 1 '�� . , ' '.' . . . � . . ` .. � ' �. � . � .. ° • ' . ' �. � � , � ; ,. ���,, � , . : , *Ln�ASE tx7l'E: On 3/6/9� the employee was'�t ask to gv , , , . ' '. ta. �i1e docbar, hvwevex�; on� 3/].0/9� the pa.in becam�e wor��. � '� � ' :i; , • � > , � • . t .�.: ` :: � At that time Ms, . Traub requ�st�d that she gd �o the � -�, .� � � � Doc�ar's Wa�c In Clinic. A.�ter' her visit the C].xnic �, . . , €, suggested_tha��she ]oe put on ��ght du�y., , � � . , . ; . � � . :. . . � .. � ` , � �.� � , . . . , . . . . . � e� , , . , � , ,. � � ',� . � . . � '� • � �� , � ' ' ' �� . . . ., . � . ' . . ';' ", � . , . .` -. , ", . ` ' . ." ' , - . ,. . . . , _ , . ., � . � . . . , , , „ . . ` ,,. . ,.` ,. ` , ' , . . -. . � . , � . . ,� , r, , . � , � �.. .. 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' 1� , . , , � . _ � ; . . .• . , � k ' � , t , , , . . �'. , t . . . . �� . . � • , . • . ' � , . .`, ' t.�r'v� ',f. ' � ,' i, � ��1i1��, . - � � ' . , � . � � . . � ' '�� ' ^el ! . . + , , . '[ �, .. Y. . � . • � " • ' � � . • • ,t ', ! i � � � ' � � � � 4 � � � • . . . i� � �r.r.. �.� . ,`1 ' " . . . . • ` � , � . .• •. < .� . ' . ' . ,.. , - I ° . i � '` � . . � . ;�. �'� . . . � .. ' .. ' ' �.f :. ' ' ' ' , � . .. ., , . . ' ' . . . � � ' .. , • .� 1 �•f'.. �. �_ � . :�� ' . ' , •. .� . ' , fy . �, ' � .1,�' . ' �i , . - . � .. ' r;ry9t�r �.li...`:`�!���';',+.n, �a4r, ���. s�4!i. I.fr.eit :�i'�zd'� �;: - ,� . . • � T�,. �.. . .� . ' ' ° ' . � � .� =i itf. ���f!:- :S a ..s':" ".�'=.�ii�, :�t-a _.�r.es, .i,� .r•�i�{. .t . , ,:'ir..' . �". �a..i � � �>.. s� :i , . . , . . . . .' . . . - n; �I. >>�r � , �• � . , .. , si. . I '.���' . ' , . ' ` ' ' , . ` • ' . < , ' . '' ',. . . . . ' , . ' • ` . �:i. ' . . , � ;vt{ � ' � � . :� r . , ' ; , ` � ' . ' .� � ' • ' • �. . , / . . , . . ' . i, ' � : . . 1 :z � . � ' ' . � ��+ , � , . ' ALL� FLORIDA ORTHOPAEDIC AS50CIATES �'� � � � � � . ' ' � ' 46UQ FOURTH STREET �IORTH � � � � • . . . .. , � ; . : 5T, P�TER5BURG. �L • 33703 , . � . ° .� ,. ., ' ' . ' . ' ,. . . ' . . . i 813) 527-5272 . ' , � ' ; ' . ;; . , � , . PROGRESS ;1pTE ; � ��, . .. , , � ° , � � � NAM�: �TRAUB. LINDA � � . , . � � . �; � � � . � ' � . PT�: � 3$509WG , . • , , . . • , , ° aGE; 3s , , • , � . . . . ' RE�':, w�r_ � . � , . � • . . � . , . � . DrA: 03/�6/92 . � , , , � , � �. . .' . DATE: 06/21 /95 � � . . � � • • �':�� . - S�en for rec�eck of her ,kne�. .She's doing �wel� with it, She still has same ! �. � � � c�m�lair�ts; has evicte�c� of stili some atrophy. These aie mainly mr�sc��ar--type � ''� � camplair�ts. Her jaint looks fine with na effusian.� T.here's no crepitation an ra�ge ',�i ��� ,. ' � ' of motion. At this poini. i dv t�ink she's MMI and I won�d feei �ter smpairmeri� �, � � �' ' rating is S� to Lhe wha�e person. accordicig ta the Guides. Shs shauld be on . :� � permanent restrictions of na excessive staniiin� or walking, no climbing. � , L�wrence M. Gnage, kl.D. � � � � . �. . . ' LMG/nrr � . , , ' . . � �. , �� ' , END hF R�PORT � . . � '. � T: 06/23/95 ' . ` . , ' � cc: Ta��s Eastern Co. . , � � � � � P.�� Q. Hox a7�8 ' � �. ° � . ' � Clearwrster� FL 34618 . � � : � , � At�n: �. Srend�, Ad,�uster . . . ' �'ity of Clenrwater � � .,. . , 1605 Harbor Drive . , , � Clearwater. FL 34615 � ' � � � Attn: Workers' Comt�. ` � . . � � . � , . ;� � � � . � � � - . , ,. , . � r;, ������ � . � , �JUf� 2 3 1995 . ����� ������������� f �. . , _.e . , . . .. � � , . , � .r ■� _ , .. . � ��a��, �.s�aa d. , • P�g�.x � , Aa�ugt�x7� 1995 Trre patferr� ra�es fn fa�^ eval«��iart fur a p�nsia� f�qm �he ci�y of Cl�arwater. Th�i� is in re�pec� ta h�r rfgh� �Cnee. I have baen prnyicieci �ii�F� mecfitat r�cord� 1ra�n i�r. Gna�e �tar��ir�g nn S�pt�mber Z�� i��� and proceedfr�g �hraugt� 5121 of� tF,is year. I al�a have been pravfded ui�t�� nperatfve repnr�a canterning fier surgir:al �rocedures. i t��ve been prnvided ui�h a jab descrip�inn. I have a]5v been prnvided �rith� a 5t���� nf paper specifying ui-�ati 1:he P��ien� i�dvisary Commit�ee need� Nit;h respec� tu m�dic�l npinion� frar� m�. ThPae h��e �11 b�en r�viewed in detail, I am not gvfng �n r�peat �very warcl.��t thts I;i.m�. ih�p p�1:ieJ�►�'s dii�ii�ul�i,ps nri4inally started nn Mar�li 6, 19'��. 51�,e w�� c��mirtg duwn same ��.airs after having b��n wnr�ing r�furbi5hing a dumps�er. Sl�e m:i�and �I•�e sl:ep wi�h her lef� faoi: and wen� all th� way daw� �d the battqm. As a r�sitlt tf�e ric�h�t 5h�oe kind of hung tip an. th�e step and aF�e �ust�ined a ��tis�ing �orqti�ng sort �f an inJUry tn t�re rigYrt kne�. She was initia]],y sent '�o ane tii, the u�Ik- in �linic� and �F�en Wound �ip uitt'� Dr. 5ena. H� artnra5cnp�d f�er (cr��e, i� �oun�s lik� rre dfrl a meniscaZ debridement. it�is uas about sfx �o eigl-�t mon�trs follawing her ini�ial, , inj�iry. 5t�� ar;d C+r. �ena eviden�ly did no� see �ye �o �ye, tf��re wa� som� p�rsonali,�y conflit�, and in Sep�emb�r 1�9� t+er care wa� �ransferred to Irr. Gr�ag� w1�ro ha5 can��ne�ed ,'. to folinw h�er �intil �Y�is pc�int in Cime. 5f�e r�as undergone thrre� sur�ical� pracedures fram #�in�, �h�e first being arth�rosrapy and debridemen�, �i'�e second bpzr�g a r�igh i:i�ia3 valgcts n�t�atamy, and ���e �t�,ird t�eing remova3, af �F+e t��ar�iwar�. rr�Q p��i�nt� hau�ver, t�a� continitied �o r��ve discnmfc�rt. Sr�e �a�^s crepitus and grin�ing in t�re k,nee, �5pecia�ly wi�#-� ueigh� bearing ac.�ivi�ies. 5h�e 5����5 t��r ma:;imum 5�anding tnler�n�� is abau� �0 • mitttt��s. S��e is unatale tti rlimb �tp st�ps ur a 1�dder unl�,s sF�� go�5 one 5�ep a� a time, l�a�iin� wi�h tl-,� gon� ley. �1�,e nntp5 di5rnmfor� is �resen� ar�o��nd tr,e m�dial� j�int li.ne, witr, s�m� radiat�on down �t��e s�lbcuEanea��s bbrder af ���e pro:;i.mal tibia. 5r,e na�es accasiar�a� �wellint� in �hre kn�e. PFiYSICAL �XAMIt�r17If1l�c Ti�� p�tier�tts rigrr� kne� �I��a�r� a maturing hic�h �ibia� val��tis o�t;e�tomy �y�e scar. 7ri�re �s modpra�e tn perr�ap5 evert mark.ed atropfry af rfie r{gf��E qt�acErir_ep�. �{t��er� i� miZd at�raph,y of �rre rigt-ri: C�I�. E��en�ian of the knee a.s mint�� �ba��i: twa degrees wl-�en campared ra th�e c�n�ralal:eral sid�. Fler.ion is ab�u� 10 d�grees lea� �li�n ��e con�i��iateral sici�. ii��er� is no iris�abi3ity �En a�ress t;es�ing nf �r�� rigr�t k.n�e, uut crepitus no1;�d wi�r� varus and �»xg�« s�resa. ihere i� some crepitus uith� ac�ive and passive �ibia�iemnral artid pa�ellnfemoral mo�ion. �h�re i� no synovi�is nr ef fusit�n. INPitEaSIUH: PQST�TRAI!(1ATIC AR7WRITiS RrGH7 KN�E. iREAi'M�MT �Lt�N: iJith respect '�a the medical infarma�ion req�aired t�y th� Patien� Advisory Cnmmit��e: 1. 1'h� 5p�cific nature of �h� in,�ctr'ie5 is post-�t•auma�ic art�-rri�ia �f �he rig#�t knee. �. Z �hink �he patien��a �andi�inn is permanent. 3. I�f�ink ti-�is ia c�su5ally reJ,ated �o her in,itrry of 3t6/9�. q. Wi�� �he ��gree af arthri�is �h�t 5t�e F�as, I do �ot �hink she wau�d be abl� �� perform t�nr job as described in �'��r ,iub descriptidn, Wr���r� req«ires cli,mbing ov�r �nd arnund large metal dump��ers� repairing �hem, uaing pouer �n�rls �o da sa �or pa t af tP,� ,jnb. 3. � pr }iaad, M. D� . JSH/dmw . cr: DebSie Ford City af CI@8!'W��pY� Patiesti� Advisary Commi.ttee 7'!rr Spinr G'arr Er�rf�rf:r Qrshnp�cdlr 5pinr 5urgery �rntgl��,s J� N'e�2�inrl. 11.7)., F!A. Eliral�r.tl� C.51rn�.11,p., P,1. Yaul J. Zak.11.f1. ' rini�i4�14 C. �iai!'r, I%.i) �)a��id A. lienalar.11.0 1c�![rev S. iti�rp. U.fl. Onhnpacdk� Surgcry• Jrsac 11', ;IScxKa�i, h1.U. Phpairai :1lydlcln� & i�chub11i1ntlan fic��ert U. Cruber. U.{l. Cnnsl,�nlliic G. Bouchlas, I�I.D. Fra��rJsrn 11, Tur►rs•Ramus, ll.U. Kenncltt E'. k3o1N•in.11 I}. {�Cp�11I1j11 ��. r�Ul!f�)BC}l. d.�). �iruralagy Jatrp p. ZIf3�crosd: �tE3�dc�.11.�f. Luls G. Flgucroa.11.U. �curoradlulo�y C. P. Sliali.11.U. rati c��n�o�• Rlrttiard N. Frauk. Ph. D Chronir i'afn Ch:�rles [�, f'itliir.k, D,U. I.��nne C. Cokurnbus. [].{). Splr�e Cure Serr�cer f oie.g�ag ��w r'f scan �i}'C�U��3ti1 Spine Surgery 5pin�l Recunstrucuuns 1.35Pr disl;eclncnf� f etcutaneous Fusluns 5cntlasls Spinal Slenusks Firrnlated Rlscs F'�ectrmliagnoatfc liecticlne F1SC � 1e�t�'n Candurllun Sipcl}• ���F \euroluglral Axsc�mrut �x�ir��d Uiior�lrrs Hcacinclies.l' S��izurc•s Rehahiiit�tlao �n�ices i�r��•5ic,�l Thrrapy 1'tr}'sf��ai urru��clrli���tlr►�� Aqua�ir 7'iie�rapy Back 5rhoul Arihrltls RrIIcI P�schnlu{�leuf Srn�lrrs E,�•aluylicm k �'r4°a�rnrut Pairi tiian��;rmcnl s�����t �t�:«�k s�>r� r�u� i��Ju�►� 1lanlpulallun f'I�}�sicaE 7tirr7py F:piclural 5tc�ul�l InJt��•i i�ms 7'ri$4i�r 1'r>b�l 1��)i�c•fi��n+ Fl�rid� Spi�� �nstitut� �CT 16 ��95 Florida's Largest Center Devoted Entirely ta PAedfcal ,7ild Surgf�ai Care of ttie Neck and 13ack PI►TZSNT 3 ��tT � s ]�C8 s 3 9 • REgffi�tR�D Bx s DAT$: TRALIB, LINDA zl8s.o noHs Q9/22/95 The following zndependent Med�cal Evaluation is performed on pa�i.ent, Linda Traub �ar eva3uat�.vn �g �.njuries recexved atatus post occupational injury on September 24, ].993. It is based upon rev�ew of inedical records, examatnation ot the patient, review of current x-rays as wel�. as mx traini.ng and experience as a Soard Certif�.ecI orthopeda.c spine surgaon. H3BxnRY: The pat�.ent �.s a 39 year o1d �emale wha pre�ents for an IME. The patient i.s 39, �ooking much older than her stated ag�. I had the notes fram Dr. Hood dated Aus�ust 22, 1995. From the.notes, I deemed the followi.ng history. Thi.s patiQnt was working �or th� City of Clearwater until September 24, �993 when she had an inJury to her knee. She was seen by Dr. Sena who d�.d an arthro�copy. The patient states she did not get any better. 5he pre�wnably had a meniscal debridement at that time. She states that she personal.ly did not Zike Dr. Sena and she thez� was transferred to Dr. Gnage�s care. Since that time, she has had a high tibia�. osteotomy for a diagnosis of inedial compartm�nt dege�nerative arthritis that was done w�.th hardware and then �emoval of the hardware. �n addition, she has an elbow work compensation c�.aim which I did not see tk�e pati.ent far. H�r chief complaint taday is right knee pain araund the knee cap and pa�,n with clicking. She says she cannot bend, she cann�t squat, she cannot cl,imb or �ump down. she says tha� her kne� swells. She says that the muscles around the right kne� hurt. Most o� her pa�.n, she attributes to the ra�ght knee cap. She is kind.ly referred by IME. PHYB�CAL ERAMYNAT�ON: The patient has a valgus deEaria�i.ty of the right knee, more so than the ieft, obvi.ous�y from her ��.bial osteotomy. Sha a�.sv appears to have r�ome z�ild rotation of the distal. femur, more so than on the opposite side, Again, that may have been secondary to h�r surgery. Her ga�.t 3.s not antalgic. She can walk on �2S(} Drew Street, ClearH�ater, Fkoricla 3��G'15 •(K13) 7��-SPi�i�: •(R!3) 7Ji-T�Iti3 • Fa.�c (813) 72fi-15R{} � . f ' ' y � � � � �, � � � ' . I ' . . � . ' ' ' .• ' . .� � . . . . ' � . . ' ' . • � . . :1 ' , i'rE . . 1iF; ' �r.:�4 r.�r>E'.•l•...' . 4'� 1 i' . . . � . . ��1� r � •'t�b: , . ' , . .. .. .. ..., � :.f.:i: , � � ' . . �ri� � . l � , ' � 1 � � � PATiENT: TRAUH, LxNDA ,. , ' CHAFtT : 218 7� 0 . ' , � . . • . DATE: 09/22J95 ' . Pa1GE : 2 . . her toes artd her hee�.s witY�aut diffir.ulty. Examination of h�r right knee reveals no heat, no �lui.d �(e�fu�ion3, no synovial h�rpertraphy. She says she ,can fee]. hex knee cap cl�.cking. x felt a very min3.mal, mi.nimal amoun� o� crep.�.tus and thig wa� only �after the third or fourth time that I flexed and extendec3 her knee. She does have peripateliar tendernesg, as weil as to uisual 3.n�peot�.Qns and mi].d quad atrophy �specially of the VMO.� iiar �eflexes are intact. �.have reviewed her films. She has evidence of hardware being pl.aced in�o.the tibia. She.ha� some ostearienia vx� x-�rays. �therwise, h�r �o�.nt sp�ces are fair�.y well preserved. I also waa able to review akyline'pictures of her knee which do not show any subiuxa��on, and �.n fact on physica]. examination she has negative rotatinn test, negative anterior drawer and her knee cap �s stab].e ta lateraJ. thrust. , ZiKPRE88Y�Nt . � . 1. Status post work related in�ury, complfcated with meriisoeatomyi miid degenexative arthzitis of the media�. compartment and t�bial a�ateo�amy w�.th remova��. of hardware. 2. � Patallofemoral pain.gyndrome. A8BS88MSNT= I fe�], that �he patel�ofemoza3 pain syndr4me is causing mo�t of her complaints. The pat�.ant states she has been unable to strengihen her quads because of pain durinq exercise� The,only other resort to 3.ncreasing quad which r pers4nally have had good results with pat3ents is ueing a musc�,e st3.mulator on an outpatient basis. Thi� patient is certainly able to work in a job which �.a.m�.ts bend:�ng, squatt�.ng, �umping and lifting. I wou�d recommend a tunctional capacity evaluation. D; 9/22/95' �: 9/26/95 cc: City of Clearwater , 0 -.�.�,� k� , �, . ' ' � , t ' � ' f ' . � . . � � i: . ' . . . . � . ' . . I � � i I I ' � I. • ' � , ' ' . � ' I'.�d��ul'1' ' . �1_ � . ' �l� ..f �!�.��4��4'_�, il� �`� � . �.. i � 1 � , . .. � . . � � �QNALD . C . RN�?�R50N 1'El. � S I �-32�-3252 � �� , , �, ' ' ' ' , ri .. , � � . . . ... . , �ct 31 9S� 15:49 No.00b P.02 � I�O: Lif1(�D �fAUU City a1'Gfcarwalcr - Dlsnbilit�r Puigion . ' 13ns�d tipa=� yos�r examination end flndings, ha� Linda Trae�b reacl�ed me�cimum medica� iEiiprovcmc�it (MMI} 'tIt rcgard �o th� di�gnosts ct�ted �n your 9f22/9S rcpott7 � ' . Ye�, ,_ ,. Na (ciiock onc) 1!'no, pleasc stnte wh� you expcct htir to rtach MMI: � Aru �ltL cor�ctitians whi�h you diagnoscd in your repan dnted 9122/95 perma��cstt �n naturo? � Ye� � No (ohcck one} iCy�s, �lcn�a xtntc w1��t, iCany, �}cnnnnent t'ur�ction�ni limitations Untl� Tr��b wi3l hnvc na a res�il� of tl�ese dia�nascs (ploesa ndc�ross whcil�cr tlss lim�tatior�s stnted in yaur 91221�3 report, i.�. bcnd;ng� �c�uatt�ng, j;impli�g,liiliri�, sre incla��ler!), �n� � dascribo thc de�rcc orsuch limitatians (i.o, nvoid complctcly, no cxcessive, etc.): �Wl�nt p{ � W'sll Lii � i'�e�,sc sign 3�ora: � C �a�..� ..�-�-�--� a o'� ,S ! `� � ' .D. Ur�te � r� �� �� �� /�-!' rQ--l��� � C�'`rd-R'�`�''.� P • . . ,�. ., ti....��.�Jr..�►.�s,rlwwaC•+u:.�wl.ra.A1S4..+.NrM..,�l i�'�l/�ii4� � , �� � . . ' . . � . . � i. +! � '.� . , a, :� . . .. . . . . . . . . . �;, �_� t!i'b�a.ifr , s'• . ' . '.i �f' , ... . . � ' . ' . . . . ` . , � . . .. ` , .+ • ' . . . .. • ` . ,`l��. y. � ..� �If ' � .� • ,'� � . ! F. ' � ' • , , ' , ' � � ', ' � � , r , , ' .. ` �' �. . 1 f . . .1 . . . ' . r . . � 1 . '. � .. . . ' • . �I � ,� 1•�� �'• •• ,. � .� . . 1 �. i tI �. �i . . ' . ' . . , . 1 ' � . . . . .. . .j • . . . , � • . . . . 1 . � . � . ' � .. � . ' . . �°.t`�e i .'.. i�: . �:`I.f : , � '., � : , . , ; , � . ; : ; . � ' . " ' ' � t ' . . . .. ' . . � ,�� �1,� . , , , i. . . . . . .. .. . . .. • . . , . . . . . !,. .1-• :1 ' �it.1� . . . , ��• � . . . . i .� ' �'t �I�, •1�. � �]i"' ';F� . 1 ,tl: 1„ . . � � .. , . . . . ; ' ,' � � ' , ' . ; . .. � . 'f;i' ._�: ,1r;='''��� �� i . �`f1'. �i, t . .... � ., � , , '7' '.. � . � �. .. ' ��i e� , ' ' , ' � .. ' � � ' �:r�. ' ' � �,!'�`, E :i•' � E��• , 'f.�.. .. �.1�• .` . . ; . . .. . ' , . : , . , ' , • . � . . ' � ' � , i( . F. � .� � , � ' , � �i j� . . . ' � - . � . . � � , . , . . - . . i�,� �'�P-. .. ... . . . . . • , .. � . . . , . , n .. � . �ri7' Et°+ ' . � �, - { �. `..�l.�J 'f" .' . , ' e t � � ' �:x, �� .�,; � , .�I...�., �.��. � ' � � . c.u.?�t.,�[f��F''`{`�,�}�.�£;+" ,..�`"":S'?'';t'�;IJ+'fs'%�s",.�'�"� n�.;;:ic.«4:t;,,�a.��. ... • : � � '�� .:rb�• • , , . . : � .�i: ,.r . . . �i:' t.�. r•,. , , . , 'r'; . ;.. � � � ! . �ONALD C .� R�DERS�IN • . T�L : 82 3-323�3252 � � � �c t 3i � 95 . 15 � Q8 No � 00S' P .O1 ; . . ' . . i) o ,. . . . . ' . . ' ' , . ' . ' . � ' . . '1 ' � . , . ' . . - . � . , 1 . ' I ' ' . � . . . � � . . ' . . �,�a. � . ', . I .�. � f. ' ��� � �� , . ' 1 � � � . N��Ii�SI�l� , . � . . . . .li`, . . " , .,., , , . , , r ' , ��nw U�lc�s aF A�vn�kso� &'�'uc.�c�:R . : . � � . t`,;�.. ' , _ , ' • , � , � Y G 1 FSrTN AveNU6 h[ArsTr� , • • , � �' , • � � . . �3r. PcrrraruRO. F'I�. 337 I 3 , . , , �:� ' • . . ' , . , ' {Q l �}�2�•808tl • . ' . , � � . � ' � �• . . , 1�'Ax: ID t �}3Pa•3852 . ' , , } . ' � ' , ' � ' , . � ' . � ' ' � i � � . . • ' ' �� . � : � To: . .iackie �fC�ine Datc: Octaber 31, Z 9v5 , ' �' � .' ' � � . . �. FaY �; . .. 462-G490 . � � � � - �� . , . . , : • .. - , , . , P,�ge�: , 2, includi��a �his cov�r sheCt. � � , �. ., , , �.�rnm: .. Joht� V. 'f'�ickcr, Esq. � � . , ' � � ;,� ., . . • � � � , ����',� Siibjects Lindq Tr�u� - Psnsion Advisnry Coii�mitte Hrs. On 1111/95 . . : � COMEv�NTS: � . . �� ' � �' . ' 'E'�e su�pplcmental rcpnrt froin llr. Sirna t'aliaws. l j�tst i•e�civec� Ihiti in my mail ye:�tcrday��Artid '� � , will �rin� the arigin�l to thc Pension Advisory CorTUnittce Hc�ring tnitiorraw morning. �'i'lus ' .,; report addresse� each of t��e area�; of cc,ae�rrt voiced by t#ie ccunmittee ut the Fast tneeting. Thank �' ' �. . ' � ° . you for your ttsssstan�c. � � ' � . � � i • ' . ' . , � , , � • , ,. , . , . . . ' � i , . � , , � , . . , . .: , , � • ' ., ' � _., ,. , . ., ; � . �:J ' � F��1 lr •��t.���' 1 i i� . ��1•f .� 1 . . , . � � � �� '� +'�. . ' [� � � - TRUSTEES OF THE CMPLOYEES' P�NS10N FUND Agenda Cover Memorandum Subject: , � Pcnsion(s) To Bc vrantcd Recammendation/Motion: Ilem # Moetiny Date: i21�.(�.4 Wiliie A. Frs�zier, Fnrks 8i Recreatian De�rartment, be granted a nan-jot�-cottn�Ctcd dis�bi�ity pen�'son �nder Sectiorr(s) 2,396 of the Employces' Pcnsion Plar� as recammended by thc Pensian Advisary Comnn'sttce. ar�d that the appro�riate afticials be authar�xed to exec�ate sam�. Wi�lle A. Fxazler, Fc�uipment Ogermtor III, Parks & Recrc�tfon Department, w a s �mployed by the City on lanuary l3, 1975, and be�an partici�ating in the Fmployees' Pension P1An on Jt�ly 13, 1975. At the time Mr. Frazier was hired, employees �ciid nat �arcicipate in the nension for the first six months of employmeni and such time was not counted as �ension service crcdit. Subsequently, when ernplayees ware given the aption Eo buy tliat service tirne, Mr. Frazier opted not io do so, Qn Navember i, 1995, tt�e Pensian Advisory Camntittec (I'AC) detcrmined th�t A�r. Frazier was eligible for a non-job-cannected c�isability pension basec! on tiis disability which i s described as lz�ng cuncer and the remaval of a lun�. His disabiiity is �ocumcntcd by medical st�tements of Qwen Linc3�r, M.D. and Rcss� M. McDonald, M.D. Dr Linder rclatcs tt�at "Incurring adenocRrcinom� of the lung is � permanent candition. 95�'o af victims die oE adenocarcinoma' within Eive ye�rs.,.Th� dimin"rshed �ulmonary capacity resu�tin$ fro�n 1 liing being resected is a perm:�nent impnirment. i�ie wiIi be unable to do tiie `labor' aspect of the job d�scribec� under equipmertt operator III," Dr, McDonald reportcci th:�t Mr, Frazier ".,.underwent a ieft pneumor�ectorny in May of chis year for moderately cliffcrcntiated ader�ocurcinoma, Prior to his surgery his FEV1 was 2.5 liters, i.e„ it was �vithin norm�l limits, After his surgery he is now 1.5 liters...1.5 litcrs is a moderate puImon�ry defect and wotild make him una�le to c�a any �eavy exertion. Ro�lewec! hy: Legal IVA Budgel NA Purchasing NA Rislc Mgtnt. NA CIS NA ACM Othor �q SubmittecE by: City fvlanager Originating Dept: Human f�esources User popt.: Aclvartiseci: Da1e; PapQr. ❑ Nat requlred Affected parties ❑ Natif[ed ❑ Not reRulred osts: s� �� .ao� 7'ota� Currer�t FY Fundiny Sourca: ❑ Capt.lmp. ❑ Operating ❑ Other �.�.sian Apprapriatlon Code: 646•07a10-51A30D-585• 000 Commisslan Aciian: � Approved ❑ Approved w/co�dilfans ❑ Denied ❑ Contl�ued to: Attachments: Letter(s) ❑ Nane •;�t;;l��... •,��d.4�. ti;�.l. ., .'tl.�ti'.i..if� t;�•.1,: .C.�_ t ,. �'��. . , ,. .. �t ,,Ht� 'd:� i�El�' i�",�.t4�•� �n•i', 'i'rt' • .�^il�rv ' �! =i.,' . 'ti:�' '��'�''� wir\.��. .. !_�� t; . r �. . . . , ' f � . . . ..7' ' ,! � .:� � . . . � 1 . �.I° . ' !'�i5.`. .ir: {.. s'�, �t�V � � ' {lv ' . '�.' (�� '. ..,�. � 5�` ' ;. . i1 . , . , ` .< 5'' . ' j� . � ' r{�r � .1� 5.< .r+Pl• ' ' '• • .. 5 . . � .. . . 1. e .r , . , �� 1`t, � ��* ' ' S , '%` . . . . .. . . . 1 1 . � , � � � �� , � t}�f . " . . 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'if. � '�' , . . 5 Y. �7f. •_�: .:f �'(�; �i Z 1,'!i "S.• ' .t .'f. .t 'rl� •,1 ��.. �r'.(]' �i.: .�i Y l.'.�i� :'1�'�':i�l'. ltx iMF�. .� . �.'e.'� ` ,. • .i .`tr:.°; .1,�' r! ,1;•ti.�,';�� +n` �:a• a)• . :!� ��! '� et> '�Sf,)i�a�l�r.i:6.: �l:t.1•: �7s.. :3 '.s n��. i•�'C:.�ti�1��F'• r.���° `x; '.i�. ,F• .i• ` .,i .�'a.:.... ti+ � l.'f�: % �'?:",4��� , f.f, �.�. s : ��, ' ��4 #.`x.t.'��..t ,� rt,i.. .�£ , t ':r.� �r �'>>� :l+ �Y {� f<:'{�:�. ti.�:t'�:�,�..G :t: r7�:'.,�., �i�( rt, l�s j !'• "f•,Y!t4i;'�.. �t •'.t1;�ii:.3 �=" ��u. ���,� `�,. ;�ar.�K�J� �i�..+l:ptf.N`J:��.atlnl:,-....t,^;'.�:.:itr:�,4�:`h' ;.:i�.i.4�„ �.':� �� .r..,�. -'r,,,s -�„ •sr .1 ��"�. , �y� '.d.�t� `� °� r�'�;';9;��s:`'�w ` .t�`afv: .,,�. � `�l�'.., i ' .h'{;� ,'c:,. iF,lS.'iAS.:�Yr�h •�i�s�S��{.J � . .�...�� �:�Z,,�l,�l�61W'll:�ie�."•'t7r.r�,n ,1�.� . +�y'".f... .: :i`�' f�'.,f�..�,,. ". . � ., . •, � . . , =•tr �.ri�` ..�. , :'I'.6:'. :�' wr,-�I�• +'�'�'�.�i..��...,{),�•`.�j��r.4. ;t�+ j .�, 'y. l� `.� ! ' , . F .� , I !, ' .. ; e} . , . . �,i. . �; . � . . , ' • . . .. . . . . i.��_ ' . . , � .. . i , •. , . ' ' � .. . f ` � � .. .� , . .' .t. . ,'i. . ; . �. .��. . '. . ' . , ..� . ... " � � . . . , , . � . . , . . ." . , +'q ' � . ' � , • . . . , � . • . � . � . , � � � , �aff`' -3= '' .�, i ��� ,��'. . . • "' � � ! ' . .. . , . � • � ' �� ., ,'' � ' , . .�, , , ' .• . ` .'!.: . � � t ' r ' ' . . • . . � . � ' ' . ' ! . � ' • . " ' ` . , . . . . � k " �i�' . , . . •f� . . i li � � ' , � . , . . , ,�•� �+ � F. A�enda ,1tem=W illie A. Frazier . � . � . � ; ' , . . .b . ,k . , . ' , ' . ' - ' . - � �,. . � . f� �' �,'} Fuge 2 � . , ', ', . � . . . . . . ; , , ; , , �:� Deccmbe� �4� .1995. � ; � � . � � 9 . � ' ` � .' � , � . � �; , �,� i , . ' . , �r . . . .. . ' . . ' . . . , � .' . � ,." ' , . . • ' � .' . ' : �•. . ;s; . , , ,- . . ��. . � .. , . � �� . , t . �. . „ . . � . , , . , , . . 'p; � „ � , , , . : � , � ., � . �� ,. . .. �� ��, �. �.�13ased, an an uver�ge snlary �of �pproximately ,�$27,405.48 over the � past .five ,years And with twenty � °;: �...� . ye�rs , af � p�nsion � service, .Mr. Frazier's pension: ,will ��proximAce $13�9U8.28 annuuliy. .' C�Arts . ';';,:�.:�. ..from Financc which' tuke into ` consideratiori mort�lity rates . and age reflect the "�resent value cost . ' _ , : of ' finanaing, this .. pension . will bc �pproximatcly' $�91,40�.88. � .Thc totnl : �ctuAl payout will �� , �PProximatc� � �55b,33I.t7A. '' . .- . , � � ' . � , �� � ' � : ; ; , • � ' F, .. .�. .. . . . . � ' . . ' � ,. . � . . � � . ' � ' � . ' 1 . . . ' , i , ` � � j 1 ' . . . . . , ' . � . , - ` - � i ' . � ; ' , . � . ' , � � � e . . . . . � � . , . � . .. . . ' . ' . , ' � . , , . � . . � . . • . . ' . � . . . .. . . � ' � ' . . ' . . . � �i �• � ' . ' � ' • • ' � '. ' . . f'':. • ' . � r . ' . . ' ' ; ' . r . ' ' . . , . ! . r. < ' I' ' . . ... . .,i ' ' � ' � . . � ' ' ' ' , � ' ' , � • I I. ' � ' ! ' ' �� ' ,. . •' • • � � � • J , � • � 1 ' ' . . . I . . � . � ' � . , ' . . , . . ' ' ; ` � .r . . . ' • I ' . . . . . . � ` . � . . • � '' ' ' ' . . . ' ' . . . . • . � • 11 , ' • • . I , t .. � ' � � .1 . . .. ; ' ` ' ' ' , ° i. . 1 � . . •• ' . : � ' . � . . " ' ' . . � . , i' � , . ' . , . ' . . . � � � � � ' • � , . I � i r � I'. . ' . , • . . • I.j' 1S i� • . 9+' � � �. . r�_. � . � � � I . . Fi ' • I � � �'lJw.......i Y.:.. . . . ;, . � ' r . " r .. .I. ., { . � • . ' I � . ] • . .� ���'; .�. �;` , .r`°. . , s� ;F.,; , � . ,� ,�.. ,,; , , , , , � . ;,, g, �, ;:t 1i . . ' . , . . , • . � . , , . , . . . . • • . ' ;, . . ; ' ' `` , . l ' y � � • . , � � . . ' . . ' S , • , . � . . ' 1 1 , , i � . ' . .�' .,.(f.i .' .•• , I ' . , , ' ' . • ; � - � ° , ' . , '�, � , � . � �. ... �.]r ;1. , �' f ' ' . 1'� ' . . ' `, � ' � .� ,F � � , • . . , , , ; . . '' ' : • . , e ' ,.. .. .'1F . -'� . /� .,ri1 5 3 . `. ; , ... , .. � , , . .r . " . . � '. ' � ' . ' . . ' . ''1 .. ' , , � • - •. ' �' r ., .� '!:. . � I, .. . .' ' . ' .. ',� r .s# � . ' '�i' :l . ' ' � �.� ,' � . ' . ,' j , ' 1 . � ., ., i ' , � ' ; ' , �S :'!e i.' ; . , ' , • S i � ; 1 ' _ , � . , ' ' ' ' � � ` , ' . : ; ' � . � � : � . ` � ' . � . � n, FrFjf...�f., �� �', t,�.,� w,.�.,��^ y, ., . �'� .i� �r.;.�; %i. ,� „F..� � .�2 ,�.,��,��. o�tc r .. � � . t:`1"�`.�.'°ii�•� °.il:it".✓ . :zr,�.�.t�.r.,:e°��. . . , . . . . . , � ,. . . . . • . . � . „ }'. ° , . � . . i i . � . 4 . n , , ! . I� �. Fiumdn Resaurcos Daparlmanl (Bl3) 467.�6b70 �: � FRDM: CQPIFS: SUB.}'ECT: DATE: V T r� Y O F� C L E A R, yV A T E R . posT oF�ic� pvx a�na , ' CLEARWA7�,R, FL��IIDA 34818-47�8 ' Hanorabte. M3yor und Membcrs ot the City Commission as Trustces of the ' Emp�oyees' P�nsian Flan , � � Pension Advisory Committae ,. , . Debbie B�iley, F'ayrall 5ervices M�n�ger ,• Employce's File � � Pension for WilIic .A. Frazier—Non-jab-connected Dis�bility Pensfon November $, 1995 Thc Pcnsion Advisory Cocnmittee (PAC) received �n :��plic;atic�n far di�ability pentiion fro rn Wsllie t'�. Frazier on October 1 S, 1995. , Mr. Frazier has 6een determir�ed by tne Pens�a� Advisary Cornmittec to me�t tlrc requir�ments af tl�e Yension Plan for a rion-job-connectcci disability �cnsion. He was emplc�yed by the City on January 13, 1975, nnd be�an participating in the pension �lan o n July 13, 1975. Further, he has sut�miEted medical documentation, copies of which are uttnched, rel�ti�e to his disabilit,y wl�icti hns bcen reviewed ancl approveci by the PAC. By niotion madc and d«!y c:�rricd at its meetin� of Navember ?8, 1995, ttie Pension Ac)visory Coinmittee uppravedlrecommended tl�e, �;r�tnting of u non-jab-coiYnectcd disahility pension to Mr. �ruzier in uccurdance witt� pravisions nf Scctian Z.39G �f thc City Cada This pensi��n wilZ b� �ffeetivc an n date to be c�etcr��inec�. The amount of Mr, Fr�zier's �cnsion �vii� be c�lc«lated by she Fin�ncc Deparimcrit accordi�tg to the formul� in the Pc�isinn Piun for non-jab-cnnnecteci disability �ensiun at such time as his last iivc years of scrvice and salnry cun be cnmputed. I(�ereby certiFy that the Pensior� Advisory Cornmittee �t�y a��raved tt�c: �ranting of a ri o n- jub-connected disUbility pension ior �Villie A. Frazier und tt�at thc aho�c d�tcs are carrect. � �r ' . , . � ���_ � _� _� Cliairrns�n, Pens�� Ad 'sory Committr.c . � '�q�a� Emplaymant r�nd l�lffirmntiva Aatian Err�ployar" .� . . . ..., ,.,,, , . �'i,-. ... � . , � ' ' ' r � , , , , , . , • • . s '� , � ` . ' , � , . �•, ' ,,s • r '. . , . . , , ; . .� . , . , . ' � "' �� .. � � „ . : . �,Jr .�, . � � ', . � ' . t.: � ., - .:.3.� � . . . -�.. .,.� . :4:',?E`. . , •� .. . ..�, .. . � • _...,. ..._._ ._..........� __�.. ._. . .. ..+ � . � � , . , � , � • �� • . � ,F . . • , PENSTOi�� REQUE5T FORiY� ' �� , . Wi��ie A. Frazier � d� ���.G�y ����y for retiramcnt frartt the Ciry of Clearwatcr '. � Gencr3l Emptoyacs' �'cnsion Plan. � � . My beneflts date is �u1y I3' 19�5 (EnEry date Inta pensian� pZan) , IVi y date o� h9re is '7`�riu`��y �3� �J?� , � � : � My btrchc�ar is ��v�mber a, �9as ' . � . Yty ja� class�flcation is �ipmenr Operatar 2iz • and I, work in thc Pazks & Aec�reatian D e p a r t m e t� t, parks ^ � D i v i s i o n, , ,. M y . resig��tfon d�:te is �o be de�erma.n�d '. . The type of pcnsion for wt�ich i am applying is (check ondy onc3: Re�ular Pensiaa bascd on years of SCCVICC . �Job-cannecied Disabilx�y pension , '' x . zlon-job•co�nected Disability Pension � . yiy spouse's n�me is: �7uanxta 3I16/56 . Dependent children under the �.�c af 13 and •residing in my . ho�sehQ�d are: �r (Princ Chiid's Full �iame) (CE�iId'S D�KC 0[ BICT�i� I hercby certify aIl of thc above ta be trt�e and cocrcct: ' � � � (Si, rc3 � � �tobar 4, 1995 (Da�c) STA'rE OF FLORI�A � T o going ins �ument w� �cicnowledged bciore mG chcs COUMTY OF, PINELL�S ` �a byi�l�l/FA haa�' f'�Z� . wha is pecsonafiy � known to me or v�ho has produccd - 1.�'� e.r5 � � as sdc�tificacion and who did/di not raice an oach. �, l lc.'.1A1. U1'A t S'AL �,�fti�.:'f Ay"1 (zkLF.at� Nocary Public � .:�',�,�i:r t�U►�f.EC: �C�TF O� Ni.rJR[p�+. (Signatur�) 7��� i:tl�:�t�tli �IO[d PlO. CC4:55i� ! i'� :'�?111�!'.�; :O�V �XP D�C. 6.19'18 ' Co�m►issioa No ��-f %� �, �l,��ame af Natary �'rinted) � . ���1�lldlyY��r�srn�.—� - — _—_ .l � I.. . ; . ' . . . . . . , ' ; , • " ' ' � ' ' „ � ' : I ' �, . �' , . . . ' . . . . . . ' • 1� ' . . . � . . . � ' ' i � . . . , . � i ' . . . � , ' . '�i . �..¢ � � ' �' . . .. . : � ' � • . . . ' � � . . � - . . . � . ' , s � . ' . , � � i • � . ' • . . ' ' } ' ' . • � . . . � ' ' . ' � , � ' , ' ' , • . .r . ' , . , ' , ' � � , . . ' , � f I• � . . . � ' � , ' ' . . " ' . .� ' . ` . . ,� . . . . � • . � ' ' � . � , ' , ' ' � • 1 ' f. . ' . .;• ' ' . � . . ' ' .. , � . . .aru;,.t41l�Y'.. '.!''. !�� iir•r,t�.�.5..v�•5..t�,� .�s,: „e.Ci•: d.��`�' '.?.r. , '' . . . � '.� . , ' - .. ' .. , . ' , . . . '��'� . , .e,.i :�' � . , . , ° . . . . ' ' ' " ' . � � .t. . . , , . ,. �� t� � . ' . . � � . � . . , • J 1 .; ' . . . ' , . . , ,. , , , , i� • � ' ' , � , . , , f I , "�CIT'Y,`; i�F CLE�RWrLTER � GENER,�iL EwIPLOYEES' P�NSION PL�N 4PTIQNS - GENERaL E1+IPLOYEES OPTI4N ,�T: � � � • Emgloyces can receive a lumg sum payment far vacation �rtci �. '� � . �: .� , holi�ay pay and 1!? of arcrued �icic leav� at r�e � tim� of �� �, , � ', separation frarri the City. Th�re wi(I be � no 5�o deducti�n for . �. , • . .pensiart frarrs rhis lt�mp st�m paymer�t nor �.vi!! this arnoe�nt c o u n t �� � as earnin�s in the �alculation of th� pension. , The iast day of . �. work wiil bc tha termination ,date �nd pension benefits will 6egin ' � � � , thc � follawing day. ,' . , C3PTIOY 7Z:' ��. Emp�oyee c�n extectcf cerrrilnatio�� . d�ta by che time clue tor , � �, , ��acatian, holirla�y pay, an� 1J2 of accrued sick leave. T�rmination , '�. . � date wil! be ti�c f'tnal day af ex�znded timc. Pension beneii�s �wil1 . : • � . � • � begir� the toilowin� dav. . � , (Only ava�ilable to e�npiqyees hired - prior to i�li/4�J.) *+k+l�t•**.KM*x:�ir�r�k,*s���ww�r. wk**rs*+� r�+�w�#�e*rr *r�r�w���i�*�r r N+�.��.w rw*r� Wi],lie A. i'razi.�r I,�;__.__., _ __,M,-�.. an �mgloyee of the Cicy flr Clearwac�r, hereby apQly toc perision �e�zfits under 'ths (:isy's . Emqloye�s'� Pension Plar�. . r a�reby 4artifv tha� i R�sll�, �cnderstar�d thz two options offereri to cna. i chaose to r�_cire �csirtg Q�rian ;? �nd �wt�h my bcn�tic� to be ;.alculated under this ootioR. I undersc�rtd tn�r �7r�ce t�is rorrn is xisr��•d, rny cfecision is irr�voc�bie. � � � ' . Ey[�'L4YEE'S SIGy�►TUR�: • ' SOCI�L S�CURITY ;: 25�-5 -- 685 13.th Avenue North � • 5 E5: � :�DURE55: _ � Safety Harbor, FI, 3Ab95 p��: Octob�r 9, I995 � �.. � , ;'i'r . "i � S�'t .�,.. . , , � , . , E - • . . . , . , . . , . .� . .. . � ' • '4=' . � ,. , . � . � � ' ' , ' . . . ` , . .. , . .. . � �e . - ' . . . ., � � , . . . . . . � ' . ,. � . . . . . . . � , . . . • . , . . � . . . � � , . . } 1 , j. . 1 . ' . . ' ` . . . . ' ' . _ ' : ' , .i� . , .. , • � . . . �, ' , . ! . � . . . ' ` ' : t . ; � ' .. � . , � ' . .. . . ' r , . .I' � ' . ' e ., r . , • . ` .. ' � ° . I � , i '�;� ' , .. � • .. . F . . , , i , . 1 . . e � ; . � � � ' ' , .' ,. 1 . . ' . � ! � ' I. � . e � . ;� ' ' : . . . L .. I�' a.,}'�i•` , ` 1 . . a 1 •. �. . � . . . � 1 .' . � . � { � , � i r • , .y...�.,af'.•3 ��a.�:`�;�;lr'�'i. �ff°• '�.h1,�`. ,, ..:{"�'!�`.rt`"f�':',�' � ;r— T.. i .e.,Ei_ , :u � • , ,�,� , ' � ' � � � ' � . ' . • . . . ' , ' � ; � r. . � , . . . . . � . � � , � ` � C • , . � ' , ' . � . . .... � . . . . ' • ' , . ' ' ; � . , , n . � . ��� . ,. , ' ' ' . , . . - � � . . � � ' - . ' . . � . � , � . � AU'�'H�R�Zr�,TIO►� TO RELEAS� � ' ` � � � � '. � - . � 1��EUIC�� AND R�L,�TED R��4RD5 � � . . , ' . � � , � � . , `�' � Wi].l�e A. Fraz.��e� ;, �. � i, '� ar� applicanc for disabiiity pe�sion u�der �roviSions af ��� "�� the �rnpioyces' ' Pcnsidn Plan of the City oF Clearwater, hereby authorize any physiciarr or •�. . �. other . medic�t care provider wno exarr�in�s or trcats • me � ar who hns .examined or treutcd � m c � ar who in ` c�te fucuce ex�mines or creass me to. release �ny ar�a alI �rncdi��l ��c! rciatCd reeords , . Qerc�ir�in� ta me. to ihe City af Clea�n��ter's F�nsion Advisory Commictee� Pension Trustecs, � Pcrsonn�l DireGtor, ar authorized. employees or agcnts af the City of Clea.rwater, Florida. ', . � ��������_„�. _,� , � , � � � ' SiSr�i�tur� . , �� • � , � ' , � � Octobex 9, 1��95 � � • . • � ' Date. . � ' � ST.�iTE 4F F�ORIDA The f regoir�; ictst�ument was acknaw�ed�ed �efore _�r►e 1this • COlii�TY UF: P��fELLaS !� b v /.7r��rCl�Jl���' ���lE�J_, ' • � who i' pecsanally !cnown to me ur who has roduced � � . � � + �' �� s identifica[ior� � �nct who did/ d noc ake an oath. ��-~�i:��! iL� '� J.�•� � L, U: a�Y .. i��iL , � : �:tie•r �,:�;J t����i�,v �+o�arv Public �, . ..�_ �l':'�:i:�.',C_i:.'lc�� ��L.CF.fl�A �SiaT1SiUCC] . , � CL�I�i'�T:;;'.�i.}�lr;ii.CCvlOGia � �^, �: i � � :i,`,�1S:::17�f FS(P. l�FC. 5.�998 CAtzititlS5i0ii \`o. � �CJ . • �am� ot �lotary Printed) �� • , �� , ' 1; ' � . . . . . . :' . _�������� . •.'�� , , , ' ' , ' ' � .. � . . i 1 � .. � � � � ' . � ' ' � I , ' � . � � . � } � . . . . . 1 . •! , r .i, i. . ' ' I ' ' r {' ` ' � . ' . � . 3 . , � � ' ' . ' ..�..I� Y. lit . '��. ..5 . .. w � t '�� �e r�...,�. � � '.{ .., t .. ,� . � SS � . � ` ' . ' � , � � � . . � , r � � ' . . . . � • � . �ITY,�4�' CLE,�R�ir�TER, .�LOR�D� ST�TEI�IEyT QF RESICy�TIO� � r' ' .� . f. Wiilie A. �rax�.er � .��to{uyc� y, � Equipment Opera�ar ��][ �'�xk$ � Parks & Recrea�ian � In li�C - --- -- - — - - - Divi�icln n�� Oc;r:�rt�llc�t , cit� ii�:: ay. rr,i_�n t'rilm sh�: ��rvi�c tit';hc Cicy crt'CZ�c:rx;��cr. �! rc�uc�t•th:�� Ihi� rc�i��l1:11l1)Fl hL` L,j13IY :,tl:�;L•�Slt;�,j ;3Y 1)14 DL'�art- � eitc::tt i�.,�I :tR�l ih� �g��i�tin� �,uti�i�rity tc� bcct�n�c ei��ccci•rc cmc ��'an apprava�. a� a d.a.�abi�..ity gensinn by the sgc�, �ertsiart Rdva.sory Comrr�i�tes and Pension Trus�ees. • , st �.�.,Lt. i hc; rc:t�c�r� ti�r :hi�: t��i�natic�� is ::� ti�ltt�wx: � . Retir.em�n� an disabi.Zi.�y pension. � � ��, �.:t1DkUV�r'a ai;�:ta('_ Oci:ober 9, 1995 ��tc ,itn�tf. . ----�-- ---- . DE?.�RT`tE�T :�CTiO'�: — . � :? acrc�vLL ��. Di�'i�iurt ::��ci d::tc • . L7ivi�ici� ���d C��mr.r,^.t4 rC?�tissn::iJ .�:.�mve:i �v ���src��e:►t ��•.:� _ ��c� a��;:r;r;te::i y�•�:i C°�mr:�c^;� �Oo�i«n�{l a�T�4�y �� :�P�OItiT:tiG .��THORiTY ! ::�=��t :�,i� ;c,iunutiur� cn br::�rrte �:'t'c��:ive aan �re ;i:�tc �r.:i :;t :r.c :i�r,� ,����wn ;sa�►vc. ' � o�tL �1 onc�inunu ',a uthi�r�cv � r,cF�rintin;,_ ,�.u�Risri�v C�smcstc;tca iQ�tit:n:�E? i.ZiP�RT.�tiT tiOTE: � c��: rc•�.,�rn ti�r tni� r�,�ai�n�ti+�n ��u,t n�: ancswn i� tn� .�ac� �n�vi�L:3. i n� trri..:�n�i t��►r��i. �.�•��;i ,i�,rc:i �y :���: ..=i�Eciv�t ;:.nct �hL �livi,iun �nci sl4purcm�at :tc_c�. is us c� ;:tt::��,�c� tc� �hc �xr�l�nn�! :��:�un ,n4:: ��� fiir�.�;.r�s�:� ;�� t�� ?•_���nr,L! Oltiu4. °�;;,��nn�{ uc:iten ,�cs:i �iu1i �rtl�:t t�re: ,t�tu, �,i •am• C;tv �i���ni�a �iu�: tu t�r �v tn�� L:�tni��: r:; in set�tirci;:nc�: •.�«n th� CiviE Sc:r�•ic:w� ;ie�l�, 1nc! �:�lI,:L:�NC aar_�:1tf1iflL' ::.�r��;ii�nt� �urr�n�lv in c,C�t;. t:��..v _ .t � , � . , , . � , .' .` �, . � . . .s. , , , ., . . � �, . � � , . �, ., '.� " . .. , , � ' . ' . � ,� , �. . , ' . , ' .' . , � � ' , � , � . ' ' , ' . , . ' `, , � ' �� , ., - . • �. , . ' , , � • . i{ � . . . , � � • , . � • .. . . '�-, i , ei�:�['�.1, il.'-.`.� t e ��f�� . r. . . . i. . �i� . .. . . . . - . � : S' . � � � � ' .. . ' . . . � • p. . . ,. , . •' �J.VY�I 1 Lli IUG�� IYI. V. � ' , , � .� . - , . � DiptamasM d the Arr�ican Bau� d Intqrna! Medicln� '' � .� � , 9fi� Main S#reat� �atety Herb', �FL 3d695 � � , � , � T6i���i�6 (813) �'26-4721 . f` � , � � � Re��rdt�Q Wite Fraz�er . . � � . ;, . . , • . . �718/�5 • ,-, � 5lt/g5 the k[t Wn� was r�em4�rad fn order !a traat � i��l mode�a#ely diftereMlatecf �denocarctnoma. � � ,, The bronchi�t m�rgi�s vr�re ckar. Two mediastinal Tymph nodes wera �egativ�. He Is 5' 8' taA Wter bsanchodit��or his bes� FEV1 is 1.5 L. !n my aiiice he was tesled iltir�g a twrnty �ound '�. �� wa)�hi ind a!en po�nd w���M. AAer TiAing ien pounds severnl Ilmes in 2p seconds he was shart �. .. . of bre�th. His steady �taie exertional c�pachy was exaeede�. Ha can 11� ��nty pounds , � . . � . � occ�sioRaMy. � . , ._..__ . � � . � 7her� ere twa �spects ta his possibk �otrtg on aocfa� sec�r�ly disabl�ty. Or�a la t�a! ailar a majar ., � car�c�r oper�tion he ahouid be cnnsldered disabkd fram the standpolnt that his tinal puMonary l�neflon and th� g�eatest i�nood ot cancar recurrence wiq bath be muc� more certal�y known � .. aft�r.a year haa pass�d, in Ihls tesRect a ane year er�ro�ent oi disabi6iy roGs is justi�iabk. . ' � , Secoadty even immedtately poSS op his remaining pulmonay filnctton �xc�eds d�sa�iGty crli�rlu. .' , , 'f�Is means h� v�iq nat br given dlsability on fhe 1h� pu�nor�ary f�nclio� criieria abne �i �he lirst � kvel of ad�udicailon, �� � Ha�xwer th� eambinatios� oi �rEng imm�diate post cancer resection and hauing bordtrfne , ' , , pu9monary function may enil#k h!m to �isabi�ity. Thls decistor� Is one for ihe �tate 10 make. . . �r� thc m�ar��1k iiMr. Frazier is wi�n� to p�rform ighi (or stdemaryy wark v,fi►ich teq�ires ilting , ' 10 pounds as'oRen as necessary or 20 pounds occasionaRy than idea�y his emplay�r wiN . i , � � resta�ian or ntrain him f�r this kvef of v�ark iRStead ot t�e heavy exertion he had been ' , � pertorm�ng. , . � I[ the empioyer has sny iuriher quesiions pltase siate them expTicft�y #n wr�t�ng �ar I�e sake of , . . aactiracy. . �� • . � � � Raspect�uy, ', ;. , �. . � I I r r � � • I / ��� C�w A ti... �k t... Pr � n.y .[L, d o...e C eu-ti ►•� o.-.,. . o. �-i�. t,�.., I S 4 Qt.s..c �/� Ctf •. d! r�°^ • I p �` I' d.e.�-e t avLG. w�»-.< <.,. �/'^� L• 't� � t �° 2,Y'J'' ! .S � a4 � tJ r GJZ �....5 4 ��. � O !. `�' I � S Ur � �':....� r s ►..o �' �e.�c�G.y--� • /I ` % • i I ' . 1 ha. � i ��w f � � 4t. l+u�..t a� C cr-p a-ar, �r r t' ! ••-� �+ �",� %` o �. � ! �-4,� �t1 � / � l � l`f' s��l'�d r S 4 /a ��'``�-�-�' I ��M�` �`O� "� L �i /� rC 1d �+� u� i 1! t� �. � ix � O. o JLa L�.tti : Lr Qf.�/J eu G_- / J , ,� � �� ��,���. . dcsuY�sF,i «-.d�r � � . ��;� 11u���� � r . � 0 �: .....�; ,,...�� . 264 �� ar r:+ �s►� ir ti��:� � • .00�-Q�S340 , �� , CD•2B r� �/' jJ'� V' '� - 7 , r�'�`�►� r i � TO BE CQMPLCT��? BY �Ti�NialfV� PHYSICIAN OR HE�LTH CAi�� PROViDEl� AL.��RED ANSWERS MAY NOi SE ACC�RTEp UNl.�SS CONFIRMED BY PWYSICIAN {t� PATIEN7'5 NA�tE {2� PA'�iENT'S k�R3HDATE Month ! Day ! Yaar ��RAZI�R,WILLIE A ( 1 1 C� s � ��) PpIM�3iY pISRBLING CONaIT14N�Sj AHaIOR OIAGNOSiIC CQDES �3A) DO YOU D�P�CT A fl1HDAME31iA1. Ci�AHOE IH COHDI710�17 d /�,.,G-c Y7 � � f�r^7 ' Q lmproVOment terloraEldrf p No ChaRQe [4j IF PREGNANT • INDICAT� THE TYP� OF DELIV�RY ❑ Vaglnal Casar+sun SCCtlon Edlmded ps1lv+ry Dst• Actuai Dr11wry Dat� � ' � � z j5j liST C0�1?I.ICATIQNS Tf�al Prw�ttid pntE�nt �rcm Worldttg Prlor To Uellvory Dale D�t� Campliptlon� BKian []at� Compllcallan: Endid � I l I I �{B� i.t5i �OMP�IGRifONS i��! PrwlrM�d PatlMii �rorR WDrirJlq Altq� t7e!lvery uca»on e�gan Dat� Complluuons Ena�e! � � � � � �(7� OATE FIRSi TRFJ�IT�� P�tlant For Thl� Condlttan w InCluning PrnCrip[lon Mvdic.a;lort � � . �� Qt1�57tQ�1 111�i� WCR EXPLAtiA71GN IF YE5 - Pinase Llst Most Recent Date t]f Medlcal �'�eatment � (8j HA5 PATIENT Q�EN REC�NTLY �5 � �p � T3iEA'FEE] FOR Ti�lS COM�I �O�17 �I I y�,�, C p fF MOT TRFAT�(} !N 7H� PR5i 8 JNONF�S - Aleaso Ex�la�n YVhy Mot � � x � Sfl� IS PA7IENT 5iIL� ifi ND • indlcatc �ala Released Fram Your Care t UNpER YOUR CARF� �ES ❑ NO j � U �.,, (10j WA8 PATIENT REFER�tED 7D IF YES • Provitla Name, NA E- REFERRED TO PHON� W ANOTH�ft PHYSICIAt��R f0 A Aclaress d� Phone, /�� L ( � �Y�S ❑ NQ Oi Physiclan (�r '� y 1 fh.�" �� s.c*- N � ���( �J f iC �(11} pU YOU SUPAOFtT Rahabl!ltaUon ADDRE5S - REFERR�D T I V DISASI�lTY UNTIL REFERRAL7 ❑YE5 O f�0 �ntnr � j 1�� j �J��'li` C��, 3�� f� f % TO�WORK �U�E �] PRII A��Y UNABLE ,� �isaa�.iH� coN��r�oN �l I f a IF YE5 -� Oate Capable Dt Working C] Rcr,�ukar Dury }iours Par Day �(13J HAVE Y011 REL�A5E4 PATIENT 0�.�� ��� f � ��ht Duty rSaur� Per Week. TO RE7URN Td WORK? � IF Y - Ust Work Reslrlctlons Antl Len¢th Of T�me Restrlctlnns Apply i�- r`�- � � + � ��5� � ,,,, � f � ��^ � I� tta • otv EstEmated Ron,rr: Tn work nai� � �i� r 16ApaR'iAHT -(7h1s Alay Ellmrn�ta the NaeC For Yau 70 � t F'rec�uentty Comptate C1��m Farmsl 1 d � PROGNC515/ FiEMARKS � ' tY �,..,�A.. .� In � h-. r � a �� < � Q s `� � Ci� l �.1.�+ � w �C ��' V Hq1�A Q� PFfYStCIAN , t�JVIUER TN( I�f# F � r.� � ��� � � � �G 3 3 � �' �apDR�55 OF P Y5VCIAN pFiONE NUMBER OF PFiYSiCiAN � � IvG /�.�i�a�" ��a� �2 � �7 z � CI , 5iA�' �1P FAC511�IL� NUMBER OF PHYSICIAN � . � � � � � y�-' c��3) z 2s� � � t �. �C IF Ap , 710NA OR 1,+1lSSING tNFORA,t IQN IS NEEDED - WhiO Cl1N VYE CONiACT7 PHq�1E NIfAAB�R OF CC3N7AC7 PER50N �' h'�-�^ ' � � � � AWYSIClAN SEGhtATUR� �EGREE /� iODAY'S DAiE � I � r �a . ! J iS. �� 1.�,y�� i24S-CD-38 (3/95) J� ? � ' , . E � � ' . ' • . � ' . . ,� . i• � .. . � ' , ' , . . • � , ` , , � � � ! 1 `' , � � 1! . � 1 .. � . . . ; � 1 , ' � . 4 '= i r �, r � . . . � . . f ` i • , . '' , , . L. ' � . , ' F ' . . . ' � • , , � � � � � . . 1 . . ' . r . �. . ' ' . , i.Yl ' � . . . ' . ; i • f" ' 1 . ' . . .. . . .. ` . . i ' , �Wr.Tl.�:'S':r,��i4ri .�. .. � . .. . ✓.i�'.:«. �1�..'��x.J., . . .>r,g• �. . < ., , l ' ; • . , ' ' . 1 . . . . . . 1 . . . I ' � . 1 .r . . � . � • k ., ' � . • � • , l� , f ' � � . • . ' . . �1j' �.•1.t•�'4�r�w��G.yi„� t '�.�F=r'.'� ;i+�r; � ` � I . i. , � � � � � . � � � „ �i'�� l��� CH�C PI�1�'S��Il�lriS� P.�. . � .. . :. . �. �� r�j`�..� � � „ . �,; �, ' . I�v't�o�rAAY ��s�►sxa � C�ric� C� � � � - , . � . �� � Su H. �. M.b,� F C.C.P.. � � � ` zoia torur r�� � : � Rmau► M. !1+lfcDerrntb, M.II.� P.�.G�. � . � ' � c�w�rs�. t�wa�nr► iaat� � I�tt»u N. A,�ari� M.D., F.C,C.P. � i��oo �ocs �+.r►a., surr� aa� C. Z'HOM� M�sttt+t�Lt.s, M.D., F.C.C.F. � � . 1�00, �.au�na s�stt ' �oe��ts �U�a�c�rr �o� . . . . � � �l�� 4i.1-06l1 , os Jttss�es�u. M�fcxx� , ' � �AX (�t�� 46t-li/93 *��7p AKalttcut Bn,uttf dP Ptli�IqMArI� DrtiAJ�E ' ' 1 � , , B�Qt�1�0= ��� 1�9� poi� wf1Zi� rra=i�r , - � � To Wi�sm� It Hay Con�soYni � Mr. . Wi�.iio Fxeezi�� und�aewpnt a 1,oft pr�eumanec�omy in May o� this year �ar modera�oZy dflf�rdntin�ed adanaaarc�nama. Priox �o �i� �u� �ry hie P'�'�2 wa� 2�� lit�r�, i. e., it r+�s �ithin normn�]. �im�ts. Altoz �ia �urqa=� he ia now l�a �.it�x�. Thg pati��t hr�� not bsrn t��rt�d in� my otgiao in tio�nm af his wask capdb.iZ.�ty, howovoz� 1. ��.�.to�rn ie A a�od�rA�a puLaor�ary ciotec�� and wculd mn.k� him uadbl� �a do any, hoavy ozertion. I►].so o! r�ots �.� th�e faot tha� �� haa au apprax�mat�ly Z0� tive y�eer ouinf,v�e►1 ret� with hi� diagna��e . � Kou�d thi.nk that both oP thoea� �4at�, when eQnsl.dored t�agsthez, uould mak� Hr. Fr�►xi�r , �1�.q�bxs �az� soaial seourity di�ab3.�ity, It you hnva any �uzthqr que�ti4nr, pise.a• �eel �r$s to cal�.. � ��n �.y� Ros�a N. Ha�an�xd, K�D.� F.C.C.P. � ' AHHf pmtk � � 0 9 Iz �.I �� � . ' oci Owea Linder, M,D. � � d � . � -- 0 n � .. , ., , , . ; �,. , L .� T�} Willie Fraxier; Equipment Ope CITY QF CLEARWATER lnterdepartment Corrnspondence S�te�t rator I�l FRDM:� H. Michael Laursen} Human Resources Direc �. . . � I � COPI�S: Kathy Aice, Oeputy City Manager L�n Schrade�, Risk Manager Ream Wilson, Parks & Recreation Directar SUB.lECT; Your Fiequest far Disability Pensian�-Cfty's Reguest for Information Relating Ta Reasanabfe . . Accommadation DATE Octflber 9, � 995 Ycxr have applfed ior a disability pension under provisions of the Clearwater �Emplayees' Pension P1an. By this action, yo� have indEcated that you bel�eve you have a dfsabflity whict� limit� your ability to periorm your jab. . , The Americans ,w�th Disa�ilities Act (AQAj prauides it�at �n emp�oyer has an obl�gat�on to make reasonable accommodations for a disabled employee ta al�ow khe employee to contfnue to work, urrless it can be demanstrated that the request�d accammodations would impose an c�ndue hardship arti the emplayer. Reasonable accommo�at�ons may incl�de such actions as making existEr�g facilities readEly accessibie to and usabl� by the employee, restr'ucturing the job to �liminate marginal job functians, modifyir;g the worEc schedule itselt, modifying equipment used by the employee in hislher jab, etc. k t also may include reass�gnment ta a vacant positian. The ADA regulations provlde that a qualified individuai with a disabiifty is not reau�red to request or to accePt an accommodation that he ar she chaoses nat to accept. Ti�e City seeks to engage in an interactive process with you to cfetQrrnine if reasonable accommodations are sought so you may continue as an active employee. Therefore, we ask tha# you advise tf�e City of wh�t reasonable accammodation, it any, you request that wauld make it poss�bla far ynu to remain an emplayee of lhn City In yaur current job or in an alternative job while pertorming the essentlal joh tunctions of suc1� joh(s). Two copies oi this memo are being prav9ded to you. Please return ane of the copies af this m�mo to H. Michaef �a�rsen, Human Rasaurces Director, with ane of the options lniiialed as to whether you seek reasonable accammodations whic� would allaw yota to contin�e to worEc. HNIL/d1i flptlor� 1; I da r�ot request and w[II not accept any reasonabla accommadations (rom lhe City ot C�earwater that wa�ld al�ow me ta continue ir� my current �ob class or in some other available vacant pasiiian. I chaose to seek appraval for disability per�sfon pursuant to the terms of ihe Employees' Pensian Plan. O�tion 2: 1 do reauest that the City consider reasonable accommodations tor my disability which would allow me to contfnue warking, whether in my current job class ot in sorr�e alternate availabfe vac�nt posit�on. I wilE submlt to the hiuman Resources Director of the City of Ciearwater � listing oi accommodations which ! believe are reasonahle and n�cessary ior me fo contlnuE working. Designation of this optjon does nnt in any way preclude me (rom cantin�ing with my request for disabi�ity pensEon. . ; Q � ,�� . . �, �,,:�. , �, , ,� , , . 51J' , '� ` TRUST�ES OF TME EMPLOYEES' PEN510N FUND �tem # �.-` �' Mesiing ❑ate: �.,�� ` A�enda Cover Memorandum 5ubject: �cnsion ta be Grantcd. Recommendatior�IMntfon: Corn M. Bennett, wife of Ernest Bennett, Salid Wnste Department (deceased), �e gr�nted m survivor's pensivn t�nder Section(s} 2.398 vnd/or <2.349 af ti�c Employees' Fension Pian As recomrnended by th� Pension Advisnry Committee. � ❑ and that the apprapriate officials be auihorized to execute same. 9ACKGROl1ND: Ernc�si Bennett; Solid Waste Workcr; Solid W�steDepnrtmcr�t, was em�Ioycd by thc City on A}�ril 2G, 19'7G, and hcgnn participating in ihe Pe�sion Plan on thai date. He passed away on August 3, i995. . Cpra �4. Bennett, wife of Ernest Bennett, has ap�lied for survivor's benefits under Provisions �f the Pcnsio� Pl�n. . Upon presentation of tl�e uppro}�ritt�e c�ocumentation, the Pensinn Ad�isory Comsniltce appravcd Cora Bennett's request at its �n�eting nf Novcmber 8, 1995, This pension �viil be cft'cctive on August 4, 1495, at the beginni�g of the day. Based on �n avcrage s�lary of approximalely $35,233.74 aver the past five years and thc Formulu for computir�g survivor's bc�nefits, Mrs. Benr�ett's �ensian will approximate $l7,035.51 nnnuaily far firre yemrs; thereafter, it wili ap�roximate �8,517.7b annually. Charts from Finance, wf�ich takc into consideration mortality r�ates and �gc, reflect thttt the "�resent value cost oC financing" tt�is pensian will be approximatef}� �151,OG3.61. The estimated pen5ian cost (rash payout ovcr thc �iic of the gensior�er} is $349,228.D0. Reviewed by: Legal � NA _ Budget P�rchasing ...�8, Rfsk Mgmt. .�4�_ CIS ACi�! , Olher , , NA _ ,��, Submitted �y: City Manager , �:� �riginating Dept: Costs: �'J 5�i . 064 Commission Action: Human �esaurces.. i Toia1 �f � ❑ Approved '� ❑ /�pproved wlcondiiions EJs�r Dept.: Current FY ❑ Denied ❑ ContinuQd to: Advertised: qate: �aper: ❑ IVot requirad Rffactad partfes ❑ N�iified ❑ Not raquired �unding Source: Q Capt. imp. ❑ Operating ❑ Othor L'ension Appropriatfon Code: f ��-07d 9 0-51 �„40b-585- � Attachments: l.etter(s) ❑ Nane '��`i�v;r' ;.R'�i . Sr�.. �. �1� � . • 6,- ' ' i€ � . . � �F . � i. i . � . . . f< a � r •,�4 . �Y. � l.'.i : . 1 . . . . . , i . i . . � . ' ' ` . ' ' i • •�'•� •F ' � '. .�'� � 1,' .` .` , ... , ,, . , ' ' � � ' � � , ,' ' ' , . • ` I . . . . . • . � 1 1 , . , • . i�'S , • ' '.ti' I. � � . � ' ' .. � • . . � . •�, • . � � ` . . � . . . � , ' �� ' I ' � . . . . � � , , �•�l t � . � �1., • .. •. � . � - . � . ' . • ' � � ' . . ' . . �i. . . r ' 'r. ,. S. ` .. . , . . . rt � ' . ' ' . i' � � `` . . � ' • , � , � . ' `/ r� � � , 1 . .. I. � . � . '!` ,'.�Jr ' . .. . � . . .. . � . , .� ' . . . ' . � . .. . ' . '`r.�, ,`,, :.f, � �''�1 � .. � : .f• . ' �I� °�' , .. ' ' , ' . . ' , ' . ' � ' F ' . � r ' � . . , . . . . t ' . . . . . . � , i � , . . � ' � , , , ' � �li{sl�i.i4s/�3! �•1 .i"��fl�. .'', ' .. �� '� . i ��. . � .' ! ,tf'�'. �. 'L�'I� .r'... . . �}'.�. .�it . � �, , . . .�. '1 r.i',""',E . ;.. . . o .:�F'ftCr.��. %.7f-0`7',•ts+i<�--or..�......Y:�t:��i.'.')t\'f �� 'rk��s• pC..`!"�',. .. � � , � . .. i . . • , '- , , . . • si .. . . . I� e ' .� . . � . . . . ' . C I. T Y � F C J�r � � � � t'1► r�y �L Jl L I�o��t' or•r�c�:.��x a�at� CL�ARWAT�R, F�.(�F�I�A 3�lQie-�7'�� Hw»an Resources Dspa�[Tment . (81S} 4G2�7D ' ' � . 'iU � HanorAble Mayor and Mcmbers of tk�e City CommiSSian c�s Trustces of the � � Employces' Pcnsion P�an . b FROM: Pension Advisory Committee C�PIES: Debbie B�iley, Payrol� Ser�ices � Manager �. � ' Err�p�oyEe's Pile SUB7EC�': Pension for Cora M. Bennett, Wif� of Ernest Benr�ett = DATE: Navember 8, � 995 r Cora M. DenRett, wife af Ernest Bennett, has bcen determiaed by ihe Pension Advisory Committee ' to meet thc requirements af ihe Pension Plan for � a survivor's pension bascd o n the fo�Sowing: E'rnest Sennett, (lj was' employed by the City on April 26, i976; {2} beg�tn partic�pat�ng i�n the Pens�oa P�an on October 26. 197b; and (3) pass�d away on August 3, 1995. By mation made and duly carried at its meeiing of No�ember 8, 1995, the Ycnsian Advisory Committee approved the survivar's �ension for Cora M. Bennett 'sn accordance with provisio�s of 5ection 2.�4�7 of thc City Cade: This gensic�t� is to be effective August 4, 1995, At the beginning n� i�ie day. The amaunt of the pension will be casculated by the Finance Departmerit uccording tu the farmula in the Pension Plun. I her�by s�rvivor's correct. � certiiy � thut the Pension Advisnry Comrnitt�e �as appraved the �ranting of a pension to Cora M. Bennett, wife of Ernest Bennett, mnd the above c3�tes nre � Chairman, Pen 'o Advi ry ommittce � � "Equn{ EmplQyment cxnd Aifirmativo Action Employer" :;i.�`;}�� , ��o`�`` . , - . '�i.l,. ' ' . . , . ' 'i, ,. ' 3 ' ' .' .. � � .� �. , . . � ir' . . .. , , • .�, . „i'e° ,.,, 's •?' �� � � ' i �� .. ' . .. ' �.�.1 , t . . . � � ' . .�. . . . ' � . ' , � . . „ : '�.I.�' � , . , . � � ' .. . • '. . �' � ' ' ' . . 1 . • . . . . , . � , .'_ ' � r . . �' , � . . � , � ,i . � . . . � � . � • , � . . � � ' . . . ' . 7 � ` • r � � : � . � . . ' , , , , . , . , t ' � ' , ' ' , � , • ' • ' . � . � .�' , '.4:'- , , •.�1 , * . , ' ' ,:� ' : � ; ' , � ' r � . . � . . , ' ' � ' . . . , , . . . , . � . 1' . . . � �:' ; t � � . . . , ' ' , . , ' . . , , ; �� . , '', f i . i� , .,}�.- ..1,� � . � ` . . .' . . ' , ' ` . . , '. . � . . � - . . . , • r , � .�f' .`4.'`, !.. . '. ��` :'yr1' '•�i. : ' , '.'r. , ' ' ' '. . • ;' ' ' .. , , i � .. .. . ` 1 . ., ' '.. . �;i .�� " "! 3�: , ,� ' � . ..5 �P'� . ' , ' . ' � ' , ' � ' ' • .. , . � , . . . , . ' , , .�.i. ,. , ' �� � .. ' . ..�'• ' 1 . -+= f� � � .. ,. .. � . ' , „' . " it ' •:3" � '�• � � ' � . �, � . . - ' , .c , . !,."' �,��E :••�7',' . .`S' ` . . � ' � t ' �t � ,f � • . . � � , � ' ,� < <. . . .i,, , _ - . . . . • Cr:21�: -'�riLs`:L'th.�.�� r .^.r�.. �it....,wo..., r�i:.�,r!.r•�,,.j:� �. T�F''� _ `.,•p� , ':r � �i, • " ' ' � � • ' , h�aao- r'��.r.t�; . . � ,. �'�•�• •'' 'ti`. . �c �•,, ,'',- � .. . ' ;tr`• . ' . , �f ' . � . � 1` . . . . . , . . . ';.. . ' =. . . . ; ., c . .. � , . ". � . . . .�� . � . . ' . . , ' , , ' �' , i:1 ' ' 1 ; • , , , f , �. • • .�l . � , ' , . . • r{ � ' ' • . . , r1• , , .. • ' . � , • , � . � r , . � . , . • ; . • . . . � .I . ' •. , . . . , , � , . . . ' . , ' , . . . . , � . � .. � � . ;.. . � , . . , . . . ; ��, I, Cora Bennett, :�vidow of Emest ' Bennett, f�ereby muke ap�licutinn . for peneia�i bcncfits under the .. :;�City. of. Cle�rwater's �Ecnployecs' Pensiori Plan. Pravidcd herewith i� a copy of uur marriage • certificate and his dcath ��erti��ate. � ' . � c, , . � . , . . � � ' ' , , � . D�i�� �u �la��' .�..7, ,14 9 � . � � , . � Cora Bennett � . � � � � `"STATE .OF FLORIDA �. COUNTY OF 1PINELLAS , � , � •ti � h� for�egoin� ' stru�nen was r� c owlcdgcd before me this �. y " � , who 's ersonally � � nowt► to � me ar who . has � praduced �- � _ � ide ifc�ation. .wh �d/did 'not take �n oAth. . . ', , � � _,,,,,, otary Public � � . � {Signature} � Commiss�on No, (Namc of Notnry Printed) .. . 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NJV+i� {�►a o Ibl � i ��� Aug 3. 1995 :00 YM M i+10 Stabbcd by �nothcr �erion ]t� RaCE Or MaJUl1i � M Mnw. 4nR ]T IC�CAf �ON FAn+f wi N...Or � Msll4Mr I+M�M Gry r�+5 tirl Homlcide """•'""'��""�°'�'� retidence 803 NartL Qirdca Avc„ Crcar�rtttu, FL . i IS IS A CEATIFIFp T $ O GORi1ECT pF, TFti OfFICIAL HEWfiG ON FRE IH TH13 OFFIGE '. ' �{. (`l � F `!/� i J f �1��: �U�. I1, �7��' � � r . � V •"� i�4.�1 d �i .r.� �.�' j'� �i �� �Qtiof ky..Reyfstrar,5 `P#�3Xius -C6ijnl�,�'' `�� •� �;;; ; Statti Repbtr�r � c� � :.:� . . �4..��� ''� .,:!' '�` 'r .^. : '. , �; '! ' i �'Iv:,� t.����. �i �I+' .[ ° v ! s.•- . - � •, ,':.�3i`a.,- ;. .r: Ty,•:.•.; •. �. ,� . ,! � � i : � � l, t +. :: j �- �'��a���} �f ��'r�L' �����:ik� �:� �' � � ' � `:` t 't,�t'r��'F;!�.t%�'•�t+�' : i i ��W�#R�ING, � �'�"`��T,'�`'��'���6�a„�"w E � ��r �� I ' ; � � . . , . '. ' . � � . , , . . • . � ► ������� � �P��t��C��'E LICENSE NO. , � 1-2.4 5 .................... � ST�T� OF SOUT� C�R��.�NA, pROBATE COURT. � WiLLIAMSBURG CUUNTY � � '� . 4 4 T'o �hom dt ll�ay Corrcern: � � � THIS I5 TO CE�iTIFY. That on the..-- � 2 th .,.. .. ..d�y of........FebruarY ....... ... ......19...� 6 ¢ : � Kingsi:ree ,., South Caxofina, � Ak..-• .............••-............_. . . ...-°.�..._........._........... ,................_.._..........�_._.... ..._.... . 4 Ernest Jas er Benn�tt C�.earwater FL 20 �' ' .... at�d � ....._........_......._.......---._...._..... ...................... r.._........ .._.._................ ..... __.......__. . ......................... . . . _.... �1A�i5 hAlli: ADpAESS ACE � Cora Ma� Snowden Salters, SC �8 ,a, ., ......_ ................._..---•--..._............---......_.�............_..�......._.................... ........�-----......_...,----...._................... � WQMAH'S NA6fE ADpAESS ACE . M werc uniied in the Bands of Matriman b C�� G.� ' ¢ Y Y•---......_ y._... _...�.�m.�.r�S�.s�X _......._..--� ....... ... ........... ¢ Proba�e Judge �` ... ................._ ........,.---..- ...................�...........�..�......._.._...in aorordance with the la�v oE Sout4i CarolinA {� QFFiCiAL T[Ti.B � in sucli cases made and p,rovided, and as shown by ttie recorcis oE this Court in Boak... �.4 6 �* and Ptt�e....�s..... nnd Certified; tlink the [nEormatian �;iven is that their race is.._....Bxack....._...... �'� r¢ :�nd thesr N�tianaiitv is American. i¢ ' ;� r,� �'Vitness my Ha.ad and Seal of said Court, this ��• r�, � the. .1�4th ...day of . ... ...`�ugust .. l.9 �� r} .... .. ... ., ......w... } . fi A TRUE COPY •� � .� ... .�.1. ��� � Attest: ,� �Vp .E OF PROtiA'I'E �'OIi �;iILLxAAtSB[JEiG CO[1N"lY� � Sp['7Ji {:AAOLItiA. �_ AY(lliC/�fi StSTEYS. C4tUL1l�A, SC ��