3Jlt the

6upteme Court of Obio

STATE OF OHIO, ex rel.,LLOYD OLIVER,

VS.

Appellant,

USA WASTE OF OHIO, INC. ANDINDUSTRIAL COMMISSION OF OHIO,et al.,

Appellees.

CASE NO. 06-1325

On Appeal from theFranklin County Court of Appeals,Tenth Appellate District

Court of AppealsCase No. 05AP-666

SECOND SUPPLEMENT OF APPELLEETHE INDUSTRIAL COMMISSION OF OHIO

MICHAEL J. MULDOON (0034007)STANLEY JURUS LAW OFFICE1375 Dublin RoadColumbus, Ohio 43215Tel: (614) 486-2814Facsimile: (614) 486-8580

Counsel for Relator,Lloyd Oliver

NUU

JIM PETROAttorney General of Ohio

DOUGLAS R. UNVER (0051624)Assistant Attorney General150 East Gay Street, 22nd FloorColumbus, Ohio 43215Tel: (614) 466-4856Facsimile: (614) 728-9535Email: dunver@ag.state.oh.us

Counsel for Respondent,Industrial Commission of Ohio

MICHAEL L. SQUILLACE (0016824)Dinsmore & Shohl, LLP175 S. Third Street, Suite 1000Columbus, Ohio 43215Tel: (614) 628-6990Fax: (614) 628-6890

Counsel for Appellee,USA Waste Management of Ohio, Inc.

TABLE OF CONTENTS

Report of John W. Cunningham, M.D., August 26, 2004 ...............................................................1

Physical Strength Rating Report of John W. Cunningham, M.D., August 26, 2004 ......................5

Industrial Commission Order, May 31, 2005 ..................................................................................6

Report of Dr. Greer, August 26, 2004 ...........................................................................................10

Occupational Activity Assessment of Dr. Greer, August 26, 2004 ............................................... 14

1

CERTIFICATE OF SERVICE

This is to certify that a copy of the foregoing Second Supplement was mailed, postage

prepaid, by regular U.S. mail, on this ki day of November, 2006, to:

MICHAEL J. MULDOONSTANLEY JURUS LAW OFFICE1375 Dublin RoadColumbus, Oliio 43215

Counsel for Relator,Lloyd Oliver

2

COPY TD,Ctaimant

STATE OF OHIO Clalmant Rep_ ... _ ,THE INDUSTRIAL COMMISSION OF OHIO EmplOycr

S P E C I A L I S T R E P 0 R T Enlplayer I(epDther^

,p^\WDICAL SECTIDN

CLAIM NUMBER: 98-317972 HW:00-820943

Lloyd C. Oliver1016 Bellows AveColumbus OH 43223-1518

Usa Waste Of Ohio, Inc

Waste Management Of Ohio1006 W Walnut

Canal Winchester OH 43110-9757

***Stanley Jurus***

1375 Dublin Rd Rt 33Columbus OH 43215

N E C S Inc7791 Capital Bldg Ste 4Macedonia OEi 44056-2131

Dinsmore & Shohl

175 S 3rd St Ste 1000Columbus OH 43215-5197

Gallagher Bassett Services Inc5450 Frantz Rd Ste 220

Dublin OB 43016-4135

EXAMINATION CONDUCTED BY: Jown W. Cunningham, M.D. (OCCMD)

PLACE OF EXAHINATION: 30 W Spring St, 1-West

Columbus, OH 43266-0589

DATE OF BIRTH: 10/20/1936

DATE OF INJURY: 02/04/1998

DATE OF REPORT: 08/30/2004

DATE OF EXAMINATION:

CLAIM ALLOWANCES:

08/26/2004

98-317972 02/04/1998 CONTUSION RIGHT SHOULDER; TEAR ROTATOR CUFF RIOH'1'SHOULDER, RIGHT SHOULDER IMPINGEMENT SYNDROME; ADJUSTMENT REACTION WITHMIXED EMOTIONAL FEATURES.00-820943 09/28/2000 RIGHT CARPAL TUNNEL SYNDROME.

This 67 year old individual was evaluated on 8/26/04 at your request. The

injured worker was informed by this physician at the beginning of the

evaluation of the independent medical examination nature of this evaluationand that a report would be submitted to you. The purpose of the examinationwas outlined to the injured worker as you described in your cover letter.Tlie injured worker was advised that this is a one time visit and treatment

is not to be provided by this physician. The history that follows below wasobtained from the injured worker on this date and is included in it'sentirety as described by the injured worker on this date.

PURPOSE OF EXAM: Permanent Total Disability

I

continued

Claim No.:98-317972 HW:00-820943

Injured Worker:Lloyd OliverPage 2

HISTORY:

This individual denies previous difficulties with his right upper extremity,

including the right shoulder and right carpal tunnel, prior to the onset of

these two claims. He denies subsequent injuries to these areas of the body

since the date of lnSury. He states that he is right handed. His paitmedical history is remarkable in that he has high blood pressure and

coronary artery disease, he states. He denies drug allergies. He statesthat he takes Celebrex, Darvocet, Tylenol with codeine and Dextra

medication. His surgeries in his lifetime include a right carpal tunnel

stirgical release, surgery on the right shoulder and a coronary bypasssurgery. His only other serious injury in his lifetime was partial

amputation of the left foot. Social history reveals that he is married witha grown son living at home. He drives a motor vehicle on occasion, hestates. He states he is able to perform his own activities of daily livingwithout assistance. He denies smoking or alcohol consumption.

On the first date of injury (2/4/98) while working as a boom truck driver

for the above employer, he was standing on the side of his truck removing a

strap and as he started to get off the truck he lost his footing because itwas slippery and he fell to the ground, a distance of approximately 10',

injuring his right shoulder andarm. He followed up in the emergency on thedate of injury where he was treated and released. He was then off work at

first, he then returned to the work place at restrictied duty until heunderwent surgery with along with removal of the distal clavicle on 6/8/98.He states that he has not worked since his surgery. He states that he had 2MRI's in regards to the right shoulder, and an EMC in regards to his right

upper extremity revealed a carpal tunnel syndrome which is the claimallowance for the 9/28/00 date of diagnosis under 00-820943. He states thatthe surgery that he underwent in regards the shoulder was not particularlyhelpful to his symptoms. He states that he has significant limitation in

motion and pain in the shoulder. He does not weer a brace, splint, sling oruse a TENS unit in regards to the right shoulder or wrist. He performsexercises daily, he states. He states his symptoms are worse in the last

year. In regards to the right shoulder at the present time he complains ofpain and tenderness in acromioclavicular region. He states he also

experiences pain down the right arm to the elbow. He states that weatherchange or time of day does not alter his shoulder and arm symptoms. He

states that performing exercises or movement of the arm increases his right

shoulder and arm symptoms. He states that he is unable to raise his rightarm overhead. He states that the carpal tunnel surgical release which he

underwent in regard to claim #00-820943 in May of 2003 initially helped hissymptoms. He states that he has also had a post-operative EMC which is notincluded in the Statement of Facts. He wears a wrist splint currently on anas needed basis. He states that he has pain in the flexor right wrist andcomplains of numbness of the middle ring and 5th fingers on the right, Hedenies any association of his carpal tunnel symptoms with weather change.

He states that he does have night symptoms and has difficulty sleeping attimes because of his right carpal tunnel. He complains of weakness of pinchand grip on the right. He also complains of 2 "TORN" muscles being presentin the flexor forearm.

Physical examination at this time reveals a 5'8" individual who weighs 211pounds. He has no evidence of atrophy or edema in the upper extremities.

Pulse at the wrist are 2+ and equal bilaterally. He has decreased-sensationSn the entire right arm upper extremity which is a non-diagnostic finding.

Deep tendon reflexes of the upper extremities 2+ and equal bilaterally. AllTinel's signs on the right, including over right median nerve, are negative.He complains of local pain in the flexor wrist with median Tinel'stesting

but his Tinel's sign on the right is negative. He has no thenar atrop}iy onthe right. His grip strength on the right is weak, however his ulnar:;;

median and radial motor nerve when tested individually are weak but st'ronger

than his grip strength. He is post open I

surgeryand arthroscopic surgery of the right shoulder, and he is pqst

continued

2

Claim No.:98-317972 HW:00.820943Injured Worker: Lloyd C. OlliverPage 3

carpal tunnel surgical release. He has mild crepitus of the right shoulder.He complains of exquisite tenderness to palpation at the tip of the clavicleat the level of his resection. He also has tenderness over the anteriorrotator cuff. He shows abduction of the right shoulder to 60 degrees,foreward elevation 80 degrees, adduction to neutral, internal rotation toneutral, external rotation to expected and backward elevation to 40 degrees.He complains of pain in all ranges of motion on the right shoulder.

MEDICAL RECORD REVIEW:

This individual had 2 MRI's of the right shoulder, I before and 1 aftersurgery, these are dated for 4/17/98 and 12/19/00. His right shouldersurgery was carried out on 6/8/99. He also had 2 EMG's in regards to the

right upper extremity, neither of which are mentioned on the Statement ofFacts. The 6/4/04 report of Dr. Drown is reviewed. The 9/4/03 report of

Dr. Steiman is reviewed, as is the 2/20/03 report of Dr. Kerr, as is the

2/5/02 of Dr. McCloud, as is the 10/16/02 report of Dr. Burdge, as is t}je2/20102 report of Dr. Altic. This individuals 4/28/00 EMG and nerve

conduction study does demonstrate a right carpal tunnel syndrome.

DISCUSSION:

In my medical opinion, on both an objective and subjective medical basis,

this individual indeed has attained a maximum medical improvement statuslevel of permanency in regards to this claim and he has reached a treatment

plateau that is static or well stabilized at which no fundamental,functional or physiological change can be expected despite continuing

medical rehabilitative procedures. In regards to his right shoulder in

claim #98-317972 this individual's impairment is calculated on the basis ofrange of motion from figure 38, page 43; figure 41, page 44; and figure 44

page 45 which provides him with a 21% impairment of the upper extremity.This is conibined with his resection of the distal clavicle from table 27,

page 61 to provide him.with a 10% right arm impairment. His right carpaltunnel syndromeimpairment is derived from table 16, page 57 which provideshim w,ith a 107 impairment of the upper extremity. All these values combineto 36X impairment of the arm which computes to a 22% impairment of theperson as a whole, 6% of this 22% is related to the carpal tunnel syndromedifficulties with remaining impairment related to the shoulder. This 22%whole person permanent partial impairment includes his subjective

complaints, his physical examination findings the AMA Guidelines, 4thEdition, the medical records available for review, his surgicel

interventions and the administrative claim allowances of contusion right

shoulder, tear rotator cuff right shoulder, right shoulder impingementsyndrome, right carpal tunnel syndrome.

OPINION:

In my medical opinion on both an objective and subjective medical basis in

regards to these 2 claims and/or in combination, this individual indeed hasattained maximum medical improvement status level of permanency and has

reached a treatment plateau that is static or well stabilized at which no

fundamental, function or physiological changes can be expected despitecontinuing medical and rehabilitative procedures on a non psychiatric/non

emotional basis. As discussed and calculated above, this individual has a22% whole person permanent partial impairment in regards to these 2 claimsin combination.

A Physical Strength Rating Form has been completed on this date and isattached to this report for your review. In my medical opinion, this

individual is capable of physical work activity in some medium work,

provided he is not asked to utilize his right arm at or above shoulder levelin the course of his employment. This individual is capable of lifting,

carrying, pushing, pulling and otherwise moving objects up to 30

continued

3

Claim No.:98-317972 HW:00-820943

Injured Worker: Lloyd OliverPage 4

ro

pounds in weight provided his right upper extremity is below the shoulder

level. The above expressed medical opinions are on the basis of medicalinformation currently available to this physician and based on medical

information which objectively supported. I am in hopes this answers anyquestions you have concerning this case. -

Respectfully bmitted,

yohn W. Cunningham, i.D.

JWC:hmr

4

PHYSICAL STRENGTH RATING

INJURED WORKER: Lloyd C. Oliver CLAIM NUMBER(S): 9 8-3 1797 200-820943 - HW

My opinion of this iryured warker's physical stregth is indicated below and is based.snlely on theallowe(i cordition(s)tharfalls within my specialty. The medical evidence supporring this opinion is presented in the narrative portionof my report. The injured worke 3,s age, education, and work history are not considered in this estimate.

This tnjnred wsnfcer is rApable d' phpsiral work activity as indicated below.

)"SEDENTARY WORK'

Sedentary work means exerting up to ten pounds of force occasionally (occasionally: activity or conditionexists up to one-third of the time) and/or a negligible amount of force fiequenqy (frequently: activity orcondition exisLC from one-third to two-thirds of the time) to lift, carry, pu.sh, pull orothenvise moveobjects. Sedentary work involves sitting most of the time, but may involve walking or standing for briefperiods of time. Jobs are sedentary if walking and standing are required only occasionally and aR othersedentary criteria ure met.

( ) "LIGHT WORK'

Light work means exerting up to twenty pounds of force occasionally, andPor up to ten pounds of forcefrequently, and/or a negligible amount of force conctantly (constantly: activity or condition exists two-thirdsmmore of the time) to move objects. Physical demand may be only a negligible amount, a job should berated light work: ( 1) when itrequires walking or standing m a significant degree; or (2) when it requin:ssitting most of the time but entails pushing and/or pulling or xrm or leg controls; and/or (3) when the jobrequires working at a production rate pace entailing the conttant pushing and/or pulling of materials eventhough the weight of those mnterials is negligible.

(̂M&DIUM WORK" ^-p ^.li.c- E/2r/4

Mediumwork means exening twenty to `y pounds of'fome occasionally, and/or ten to twenty-five poundsof force frequently, and/or greater than negligible up to ten pounds of force constantly to move obiects.Physical demand requirentents am in excess of those for light work.

) "HEAVY WORK"

Heavy wmk meanc exerting fifty to one hundred pound.c of force occasionally, sndPor twenty to fifty poundsof force frequently, and/or ten to twenty pounds of foree constantly to move objects. Physical demandrequirements ere in excess of those for medium work.

) 'VERY HEAVY WORK'

Very heavy work means exerting in excess of one hundred pounds of force occasionally, and/or in excess offifty pounds of fo®e frequently, and/or in excess of twenty pounds of force constantly to move objeers.Physicaldemandrequirementsereinexcessofthosefbrheavywork.

I

5

The Tndustrinl Commi.ssion of Ohio

RECORD OF PROCEEDINGS

Claim Number: 98-317972LT-ACC-OSIF-COV

PCN: 2041841 Lloyd C. Oliver

LLOYD C. OLIVER1016 BELLOWS AVECOLUMBUS OH 43223-1518

Claims Heard: 98-317972

00-820943

M

U Date of Injury: 2/04/1998 Risk Number: 1220525-0^

This matter was heard on 04/29/2005, before Staff Hearing Officer KarenSampson, pursuant to the provisions of Ohio Revised Code Section4121:35(B)(1) on:

IC-2 App For Compensation Of Permanent Total Disability filed by InjuredWorker on 07/01/2004.Issue: 1) Permanent Total Disability

Notices were mailed to the injured worker, the employer, their respectiverepresentatives and the Administrator of the Bureau of Workers'Compensation not less than 14 days prior to this date, and the followingwere present at the hearing:

APPEARANCE FOR THE INJURED WORKER: Mr. Muldoon/Injured Worker/CourtReporter

APPEARANCE FOR THE EMPLOYER USA WASTE: NAAPPEARANCE FOR THE EMPLOYER WASTE MANAGEMENT: Ms. VerchotAPPEARANCE FOR THE ADMINISTRATOR: Anderson

It is the finding of the Staff Hearing Officer that this claim has beenallowed for: CONTUSION RIGHT SHOULDER; TEAR ROTATOR CUFF RIGHT SHOULDER,RIGHT SHOULDER IMPINGEMENT SYNDROME; AOJUSTMENT REACTION WITH MIXEDEMOTIONAL FEATURES.

After full consideration of the issue it is the order of the Staff HearingOfficer that the Application filed 07/01/2004, for Permanent and TotalDisability Compensation, is denied.

This order is based on the reports of John W. Cunningham, M.D., fromexamination of the injured worker on 08/26/2004, the reports of Earl F.Greer, Jr. Ed. D., dated 08/26/2004, and the injured worker's non-medicaldisability factors.

Dr. Cunningham. who examined the injured worker for the recognized physicalconditions, which involve only the right upper extremity, opined that theinjured worker has reached maximum medical improvement and the injuredworker is capable of "medium work." Further, Dr. Cunningham indicated.theinjured worker "is capable of physical work activity in some medium work,provided he is not asked to utilize his right arm at or above shoulderlevel in the course of his employment. This individual is capable oflifting, carrying, pushing, pulling and otherwise moving objects up to 30pounds in weight provided his right upper extremity is below the shoulderlevel." "Medium work" for purposes of determining the injured worker'sphysical strength rating is defined as:

Medium work means exerting twenty to fifty pounds of force offorce occasionally, and/or ten to twenty-five pounds of forcefrequently, and/or greater than negligible up to ten pounds offorce constantly to move objects. Physical demand requirements Q31Idware in excess of those for light work.

l 1 -.a an 5- Nnr so

5niVtJPage 1 dyf/dyf 6

The Industrial Commision of Ohio

RECORD OF PROCEEDINGSClaim Number: 98-317972

"Medium work" would also include the ability to perform "light work"and "sedentary work." "Light work" for purposes of workers'compensationbenefits, is defined as:

"Light work" means exerting up to twenty pounds of forceoccasionally, and/or up to ten pounds of force frequently, and/ora negligible amount of force constantly (constantly: activity orcondition exists two-thirds or more of the time) to moveobjects. Physical demand may be only a negligible amount, ajob should be rated light work: (1) when it requires walking or standingto a significant degree; or (2) when it requires sitting most of thetime but entails pushing and/or pulling or arm or leg controls;and/or (3) when the job requires working at a production rate paceentailing the constant pushing and/or pulling of materials eventhough the weight of those materials is negligible.

"Sedentary work" forpurposes of determining the claimant's physicalstrength rating for workers' compensation purposes is defined as:

Sedentary work means exerting up to ten pounds of force occasionally(occasionally: activity or condition exists up to one-third of thetime) and/or a negligible amount of force frequently (frequently:activity or condition exists from one-third to two-thirds of thetime) to lift, carry, push, pull, or otherwise move objects.Sedentary work involves sitting most of the time, but may involvewalking or standing for brief periods of time. Jobs are sedentary ifwalking and standing are required only occasionally and all othersedentary criteria are met.

Noting that the allowed physical conditions are limited to the injuredworker's right upper extremity, this hearing officer specifically acceptsthe above opinions of Dr. Cunningham, to the extent the injured worker canperform sedentry and light work only.

Dr. Greer, who examined the injured worker for the allowed psychologicalcondition, opined that the injured worker has reached maximum medicalimprovement, is capable of returning to work at any former position ofemployment, and is capable of performing sustained remunerative employment.Further, Dr. Greer wrote, "Work would be expected to be therapeutic,enhancing his self worth and with concentration, persistence, and paceadequate. Any vocational readjustment is recommended to be coordinatedwith psychological intervention." This hearing officer specificallyaccepts these opinions of Dr. Greer.

Based on the opinions of Doctors Cunningham and Greer, as accepted above,this Staff Hearing Officer finds that the injured worker's medicalimpairment from the allowed conditions is not, by itself, dispositive ofthis permanent and total disability issue; therefore, it is necessary toconsider the injured worker's non-medical disability factors.

The injured worker is 68 years old. Such age is a vocationally neutralfactor. While some employers prefer younger employees with more work-liferemaining over the course of employment, other employers prefer more matureemployees with past work and life experience.

The injured worker completed the 5th grade. The injured worker testifiedthat he left school to go to work to help his family. Per the injuredworker's testimony at hearing, he can "sparingly" read, write and do basicmath. He further indicated that he did read the newspaper, but does not doso since he cannot afford to purchase it. He likes movies, watches TV,sings karaoke, and does a little gardening. He does some dishes, cooking,laundry, and helps his disabled wife. At first blush, this hearing officerfinds the injured worker's educational skills to be a negative voca^pg^1

^ wfactor; however, when reviewed in light of his work history and abi4^y"tblearn to perform his jobs over the years, this hearing officer flRt $e6- N11r s0

s9P.iGF1IJ7

Page 2 dyf/dyf

The Indns[rial Commicsion of Ohio

RECORD OF PROCEEDINGSClaim Number: 98-317972

overall educational factor to be neutral.

- 'a The injured worker stated that he does drive an automatic transmissionvehicle, and he does have a valid driver's license. He took both hisregular driver's license examination and his chauffeur's licenseexamination orally.

^The injured worker testified to the following employment experience: farmlaborer, furniture store delivery helper, dock worker, trash collector,truck driver, and boom truck driver. The injured worker was in a laborers'Union for a period of time. He stated he was never fired from any job, andfrom this, the hearing officer finds he was able to learn all the skills

N necessary to perform the required work,9

The claimant stated that he last worked on 02/04/1998, has not looked for^ any work since that date, and he has made no attempt to secure a GED.

Over the course of his employment history, the injured worker demonstratedthe ability to perform repetitive work, read maps, keep logs, follow timeschedules, make judgments, work with hand tools, drive a forklift, drive atruck, operate a boom/crane, operate machinery, meet attendancerequirements, and work independently of direct supervision while driving atruck on the road. The injured worker testified that he was able to learnthe above jobs and tasks through on-the-job training and throughself-teaching. He enjoyed fairly steady employment after leaving schoolaround 1950, until he exited the job market in 1998. These past positionsprovided the claimant with some general vocational abilities/skills whichwould transfer into a light or sedentary unskilled position within therestrictions listed by Dr. Cunningham. This staff hearing officer furtherspecifically finds, based on the physical restrictions, that the injuredworker could not return to work at his former position of employment, butcould return to work as a lighter-duty truck driver within Dr. Cunningham'srestrictions, or could be re-trained through short-term, on-the-jobtraining, as an escort driver, assembler, usher and lobby attendant, gateguard, sorter, or "greeter" at a retail store. The injured worker's workhistory is found to be a slightly positive re-employment factor.

Based on the above listed medical capacities/restrictions, and thenon-medical disability factors, this staff hearing officer finds that thisinjured worker's disability is not total, this injured worker is capable ofengaging in sustained remunerative employment, and this injured worker iscapable of being retrained to engage in other sustained remunerativeemployment. Therefore, the injured worker's request for an award ofpermanent total disability benefits is denied.

All relevant evidence, including the injured worker's testimony at hearing,has been reviewed, and considered, in rendering this decision.

Typed By: dyfDate Typed: 05/31/2005 Kare SampsonDate Received: 07/07/2004 Staff Hearing OfficerFindings Mailed:

The parties and representatives listed below have been sent this record ofproceedings. If you are not an authorized representative of either theinjured worker or employer, please notify the Industrial Commission.

U311db!I 1 :8 WV 6- Nnr so

Sa^lIOilljPage 3 dyf/dyf 1 8

'Ihe Indostrial Commission of Ohio

RECORD OF PROCEEDINGSClaim Number: 98-317972

98-317972Lloyd C. Oliver1016 Bellows AveColumbus OH 43223-1518

Risk No: 1220525-0Usa Waste Of Ohio, IncWaste Management Of Ohio1006 W WalnutCanal Winchester OH 43110-9757

ID No: 10017-90***Stanley Jurus***1375 Dublin Rd Rt 33Columbus OH 43215

ID No: 1392-80NECSInc7791 Capital Bldg Ste 6Macedonia OH 44056-2131

ID No: 21849-91,Dinsmore & Shohl175 S 3rd St Ste 1000Columbus OH 43215-5197

ID No: 4000-05***BWC - DWRF Section***30 West Spring StreetLevel 10Columbus OH 43266-0581

BWC, LAW DIRECTOR

O311dW^ ^:a HV 6- Nnr so

(PTDDENY - PTO Denied Rev.S"

Page

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eoa eevaca novfeov

'COVrraSTATE OF OHIO Claimant IZ

INDUSTRIAL COMMISSION OF OHIO Claimant RepEm p!ayer

SPECIALIST'S REPORT Emp.cyer Rep i,Z' ( h)

SACKGROUNDINFORMATION

CLAIMANT:

CLAIM NUMHER:

DATE OF BIRTH:

DATE OFINJURY:

CLAIM ALLOWANCM.

PLACE OF EXAMINATION:

Othei___^L WICAL SECTION

Dy.Lloyd Oliver

' IJJ.4-U

98-317972.(H W : 00-820943)ate

10-20-1936

02-04-1998 (HW: 9-28-00)

Contusion Right Shoulder; Tear Rotator CuffRight Shoulder, Right Shoulder ImpingementSyndrome: Adjustment Reaction with MixedEmotional Features. (9100 -Right CarpalTunnel Syndrvme).

30 W. Spring StreetColumbus, OH

DATE OF F.XAMINATION: 08-26-2004

EXAMINF.R: Dr. Earl F. Greer Jr., Ed.DPsychologiet # 1703

PURPOSE OF EXAMINATION Permanent and Total DisabiJity

OCCUPATION: Driver Boom Truck

CHIEF COMPLAINTS:

Since the injury the claimant reported being moody and more easily irritated and agitated,frequently feeling nervous and tense, crying more easily and frequently, while frequentlyfeeling sad or depressed. He reported difficulty staying asleep with occasional nightmares(frequently of him sliding on the truck), eating less and eating more unhealthy, decreasedsocialization with some withdrawal, decreased sexuality, decreased motivation and interest,and difficulty with both memory (short term) and concentration.

The claimant also reported experiencing a constant pain in his right shoulder, right upperarm, right elbow, right wrist, primarily with the same degree of intensity. He reports. -frequent pain in his forearm, and occasional numbness in the fingers on the right hand^

HISTORY OF PRESENT ILLNESS:

The claimant reported that while on the truck to throw straps, he slipped; falling off of thetruck, and briefly unconscious (30 seconds). He reported laying there for approximately 5minutes, getting up on his own; completing the task, and then calling the company. Hereported having one delivery left, 6nishing the delivery; then returning to the company.Next he reported driving to an urgent care facility, then going to his family physician thenext day. He reports being off work approximately a month, then returning to the samecompany and job; working for approximately 3 months. He reported having surgery, withhim stating he has not worked since June of 1998.

GENERAL JOB DUTIES I REOUIREMENTS

The claimant's general job duties and responsibilities were reported to be that of a .9oomTruckDriveri primarily reported to have included driving, delivering and removingcontainers/ trash dumpsters, putting lids on dumpsters, putting coasters on dumpsters, andoccasionally helping in the containers shop.

MENTAL HEALTH HISTORY & CURRENT TREATMENT:

The claimant reports being involved in psychological / psychiatric treatment, in treatmentfor approximately 2 F^ - 3 years; currently being seen monthly, and on psychotropicmedication. He reported no involvement in psychological / psychiatric treatment prior tohis industrial accident.

(1Gvn,LfoyACWhwNf&J!]91]

10

FAMILY & OCCUPATIONAL HISTORY:

The claimant reported being originally from Greenup, KY; the 7th of 15 children(7 sisters 17 brothers). Both parents were reported to have been in the home, both

deceased; with him reporting that his mother died approximately 5 or 6 yeare ago. Theatmosphere in the home was described aa religious, primarily work oriented, while notopenly affectionate. His mother was described as a great and wonderful person, a friend,quiet and reserved, outspoken, firm and strict, while not having a temper. Theirrelationship was reported to have been great and close. His father was described as hardworking, outgoing and social, very outspoken, firm and strict, and at times quick tempered.Their relationship was reported to have been good and close. His t'ather was reported tohave been the primary disciplinarian in the home. In the relationship with his siblings hereported that they got along fine and were close in growing up; sharing that he perceivedthat they never had any arguments. Presently, he reports that they are still close but inirregular contact; while sharing that 4 brothers and 4 sisters are deoeased. He reportedtalking with his mother while growing up and experiencing problems. He reported feelingclosest to an older brother (2 years) in growing up. That brother was also reported to bedeceased.

EDUCATION:

Educationally, he reported initially finding school tough but liking it; sharing that he was abelow average student academically. He then reported dropping out of school after the 6t^grade (14 years old); dropping out of school to help the family financially.

WORK HISTORY:

After dropping out of school, he reported doing farm work for approximately 2 years. Hethen reports working on a truck farm for approximately 6-8 years, then working with afreight company for approximately 3 years. He then reports working with a trash haulingcompany for apprvximately 5 years, cutting his foot and off work for approximately 6months. Next he reported working with an oil company for approximately 2 years, thenwith another refuseltrash company for approximately 18 years. lie reported that thatcompany was sold to another refuse company, working with them for approximately 12years. He reported that the company was eold to another refuae company, working withthem for approximately a year. He then reported accepting the job where his industrialaccident occurred, working with them from October 1997 until June 1998. As previouslyreported, he continued to work following his industrial accident.

PAST MEDICAL HISTORY:

The claimant reported having one industrial accident related surgery relating to his 2/4/98industrial accident. He reported having had a partial amputation on the left foot, openheart surgery in 1999, and a tonsillectomy. He reportshaving higit blood pressure.He reported perceiving that his general health, other than her industrial accident relatedsymptoms; was in general pretty good.

DRUGS & ALCOHOL:

The claimant reported no problems with either drugs or alcohol.

SOCIAL HISTORY:

Presently he is married, married for approximately 47 years; and with that relationshipproducing 5 chffdren, 1 currently still in the home (34 year old son). He reported that_presently his marital relationship was good; also sharing that his wife not working due.tohealth problems, and she had open heart surgery in 1998.

LEGAL:

The claimant roported no legal problems.

CURRENT DAILY ACTIVjTIj;S:

The claimant reports getting up at approximately 7:00 a.m., addressing his pereonalhygiene, rsading the paper, eating, getting his wife up at approximately 9:00 am, helpinghis wife with some housekeeping, sitting, walking in the back yard and checking on thegarden, sitting, sitting on the porch, watching the news, eating, helping his wife with thedishes, sitting and watching televiaion, and going to bed at approximately 11:30 p.m.

011w, tlaydCIuLnM98.317913

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MENTAL STATUS EXAM:

During the interview, the claimant's general appearance was oooperative and appropriate,friendly and pleasant; with mild indications of anxiety and tenaion. His mood and affectappeared mildly depressed: with indications of si¢nifcant self devaluation and unresolvedanger in the content of his thoughts. His stream of thought was sequential, with no presentindications of hallucinations or delusions; and he was oriented to time, place andcircumstances. His general intellectual of functioning presently appeared to be in the lowaverage range of functioning.

PSYCHOLOGICAL ASSESSMENT / TEST RESULTS:

The claimant's personality test (MMP12-72836104) indicated that the claimant wasexperiencing psychological symptoms; symptoms primarily characterized by selfdevaluation, somatic over concern, and depression with anxiety-tension. His depression isexpected to be of a rather apathetic nature. Hypochondriacal concerns such as headaches,chest pains, and nausea or vomiting are expected to be frequent complaints; along withcomplaints of fatigue, weakness, or exhaustion. Periodic thought disorganization orconfusion is also expected; along with a loss in work el6ciency, initiative, and selfconfidence. Sensitivity to the reactions of others is also indicated; along with a tendency toaggravate or focus on physical or somatic concerns, particularly when under perceiveddistress.

Dynamically, there are indications of a pattern of internalizing and maintaining angryfeelings; with indications of significant internalized and unresolved anger.

Behaviorally, the claimant's teat results indicated that the claimant would be expected toprimarily appear self devaluating, with somatic over concern. His somatic over concern isexpected to be vague and medically atypical; with him also expected to experiencedepreasion with anxiety-tension. His depression is expeded to be of a rather apatheticnature. Hypuchondriacal concerns such as headaches, chest pains, and nausea or vomitingare expected to be frequent complaints; along with complaints of fatigue, weakness, orexhaustion. Periodic thought disorganization or eonfusion is also indicated; along with aloes in work efficiency, initiative, and self confidenee. Insomnia with excessive and non-productive ruminations is also expected; along with a tendency to aggravate or focus onphysical or somatic concerna, particularly when under perceived distress.

REVIEW OF MEDICAL RECORDS:

Reports by Doctors Vetter, Randolph, and Chavez were helpful.Reports by Doctors Farrell, Querry, Murphy, Flexman, and Drown were very helpful.

DISCUSSION:

The claimant appears to be experiencing mild psychological symptoms with the currentcGnical picture best described as an Adjustment Disorder with Mixed Anxiety andDepressed Mood (including symptome of depression, anxietytension, and periodic thoughtdisorganization paychophysiological reactions). His industrial accident on 02-04-98 appearsto have aggravated his pre-exiating personality pattern and 1 or emotional state.

DIAGNOSIS:AXIS I: Adjustment Disorrter with Mixed.9nxiety and

Depteased Mood-ChannicAXIS II: DeferredAXIS III: Constant pain in the right shoulder, right upper arm,

right elbow, right wrist, right hand. F}equent pain inthe rightforearm, occasional numbness in the fingers onthe right hand. High blood presaure and coronary

• pmblems.AXIS IV: Developmental, Interpersonal, Health ofSignircant

Other, ChronicPainAXIS V: GAF= 70

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OPINION;

The claimant has rsached maximum medical improvement with him reporting having beeninvolved in psychological / psychiatric treatment for approximately 2%r - 3 years. Hisdegree of permanent emotionaI impairment due to the industrial accident on 2-4-98, andreferenced by the AMA Guide to Permanent Impairments (411, and 2^11 Editions); is presentlyestimated at Class H/20%. Psychological intervention is reeommended to continue, withany vocational readjustment recommended to be coordinated with psychologicalintervention.

ANSWFRS TO SPECIFIC 9UESTIONS:

1) The claimant has reached maximum medical improvement, with him reportinghaving been involved in psychological! psychiatric treatment for approximately 2 F-3 years.

2) His degree of permanent emotional impairment due to his industrial accident on2-4-98 and referenced by the AMA Guide to Permanent Impairments (4th and 2^dEditions); is presently estimated at Class II/20%

3) The degree of emotional impairment due to his industrial accident on 2-4-98 wouldcurrently not be expected to solely prevent him from returning to his former positionofemployment. Work would be expected to be therapeutic, enhancing his self worth;and with concentration, persistence, and pace adequate. Any vocationalreadjustment is recommended to be coordinated with psychological intervention.

Respectfully Submitted,

a '&- (^-4- - AUxx`

Dr. Earl F. Creerdt,, EdD.Psycbologist # 1703EFG/klm

arwr, ucya I00nN98-7I1913

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^NJLfRED WORKER: Lloyd C. Oliver , CLAIM NUMBER(S): 98-31797200-820943 - HW

Ijndicate the injured worker's capability in each of the following activities with a check mark.^nsistency between the injured worker's level of daily living activities and potentialicupational activities is exnected.

04ased on the impairment resulting from the allowed/alleged psychiatric/psychological4ondition(s) only, can this injured worker meet the basic mentai/behavioral demands required:

YES NO

return to any former position of employment? (X

Tb perform any sustained remunerative employment? X

n9TLease give the findings supporting this opinion below:

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^.^v^ -^- . • ^QA _Psychiatrist/Psychologist signature Date

Earl F Greer

Psychiatrist/Psychologist Name

OCCUPATIgkAL ACTIVITY VSESSMENT

wi+

16 ' Z6' oej

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