Joint Appendix — Metropolitan Life Ins. Co. v. Glenn

Supreme Court brief2008

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FEB 25 2008

| pe + Dr OFFICE OF THE CLERK.

IN THE

Supreme Court of the United States

METROPOLITAN LIFE INSURANCE COMPANY AND

LONG TERM DISABILITY PLAN FOR

ASSOCIATES OF SEARS, ROEBUCK AND COMPANY,

Petitioners,

WANDA GLENN,

Respondent.

On Writ Of Certiorari

To The United States Court Of Appeals

For The Sixth Circuit

JOINT APPENDIX

MIGUEL A. ESTRADA E. JOSHUA ROSENKRANZ

Counsel of Record Counsel of Record

AMIR C. TAYRANI HELLER EHRMAN LLP

MINODORA D. VANCEA 7 Times Square

GIBSON, DUNN & CRUTCHER LLP New York, NY 10036

1050 Connecticut Avenue, N.W. (212) 832-8300

Washington, D.C. 20036

(202) 955-8500 Counsel for Respondent

Counsel for Petitioners

PETITION FOR WRIT OF CERTIORARI FILED JANUARY 3, 2007

CERTIORARI GRANTED JANUARY 18, 2008

TABLE OF CONTENTS

Page

Relevant Docket Entries from the United

States Court of Appeals for the Sixth

I a scocnocnension la

Relevant Docket Entries from the United

States District Court for the Southern

District of Ohio, No. 2:03-CV-00572.................... 6a

Excerpts of Stipulated Administrative

Record:

Excerpts of Long Term Disability Benefits

LE lla

Excerpts of Diary Notes (A.R. 25).................0...eeeee 13a

MetLife Decision Letter (May 20, 2003)

I a cee 23a

Letter from Nancy Perry to Wanda Glenn

Ee 27a

MetLife Decision Letter (Aug. 28, 2002)

BERETS AE SEE MOR Pa Ake ae 29a

Letter from Nancy Perry to Wanda Glenn

SS EES Se 34a

Letter from Wanda Gienn to Earl Chesler

Ae 35a

Letter from Dr. Pujara to UNIVAL

EEE 37a

Letter from Dr. Patel to Stanley Myers

ES Eee 4la

Letter from Dr. Patel (July 22, 2002)

EEE SS SE 44a

Letter from Dr. Patel to Dr. Rhee

ne I Oo cen cesctpemsatinngienel 46a

Letter from Dr. Patel to Dr. Rhee

as crnrsnessccssssccosssees 48a

Letter from Dr. Patel to Dr. Rhee

| ST TET IEEE 50a

Letter from Earl Chesler to Dr. Patel

i I... cccosnccccosconesenensss 52a

Physical Capacities Evaluation

GD Fag Se Gs EP cscccccccccccccccccscccccsvcserese 54a

Physical Capacities Evaluation

fe aaa 57a

Letter from Dr. Patel to Dr. Rhee

Is tee I ID oie cv cccccccccccccccccesecseess 62a

Letter from Dr. Patel to Dr. Rhee

| | ee 64a

Attending Physician’s Statement of

Functional Capacity (Dec. 19, 2001)

8 EE 66a

Letter from Dr. Patel to Dr. Rhee

ON SS) ES ee ..Tla

Echocardiographic Report (Mar. 28, 2001)

ESL ae 73a

Letter from Dr. Patel to Dr. Rhee

SE | 75a

Attending Physician’s Statement of

Functional Capacity (Nov. 20, 2000)

EGER ES 77a

Letter from Dr. Patel to Dr. Rhee

(Apr. 7, 2000) CAR. 125) .........0:.ccccccccrsrroveedscees 82a

Letter from Dr. Patel to Dr. Rhee

I I I BI on cccascccsccoscssonsedoes 84a

Letter from Dr. Patel to Dr. Rhee

CE, Bi I Re BID ectcccnsecesccccccccssccscenensgi 86a

ili

Letter from Dr. Patel (Apr. 19, 2000)

GN SE tetiidebihinaniontnienseniconsctincrevenccecceevccensenees

Letter from Dr. Patel to Dr. Rhee

(Mar. 13, 2000) (A.R. 129) ......................eeceeeee

Letter from Dr. Patel to Dr. Rhee

(Mar. 15, 2000) (A.R. 130) ...........................6..

Letter from Dr. Patel to Dr. Rhee ,

(Mar. 3, 2000) (A.R. 131) .............:.cscccceseereeeees

Attending Physician’s Statement of

Functional Capacity (June 27, 2001)

EASES ETT EOE

Transferable Skills Assessment

(July 10, 2002) (A.R. 151) ...............ccccccccessseees

Attending Physician’s Statement of

Functional Capacity (Aug. 2, 2000)

EEE EOS LG

Employer’s Statement of LTD Claim

(July 2, 2000) (A.R. 169) ..........0.......cccccccccessoes

Letter from Maria Flores to Paul DePree,

(July 8, 2002) (A.R. 177) ......cceccccceecceeeeeeeeeee ee

SSA Notice of Award (June 15, 2002)

EES ESET SE AE SA

List of Exhibits to the SSA Determination

(Apr. 22, 20GB) (A.B. BOB) ...0.cccccceseccccscssesscceess

Letter from Valerie Barich to the Honorable

Thomas P. Piliero (Mar. 12, 2002)

ESE RS CSAS

Letter from Ed Peters to Wanda Glenn

(Oct. 10, 2000) (A.R. 217) [second page of

letter reproduced from App. 1 to

Plaintiffs Motion for Judgment on the

Administrative Record (Sept. 4, 2004)}......... ?

Summary Plan Description (A.R. 231).................

| The following opinions and orders have been

omitted in printing this joint appendix because they

appear on the following pages in the appendix to the

petition for a writ of certiorari:

Opinion of the United States Court of

Appeals for the Sixth Circuit

EE Sc la

Order of the United States District Court for

the Southern District of Ohio

ESSE SEI SS ER ar 27a

Social Security Administration Decision

sal inasinhcncnenndsined 4la

General Docket

United States Court of Appeals for the

Sixth Circuit

Court of Appeals Docket

#: 05-3918

Nsuit: 1890 Other Statutory

Actions

Glenn v. MetLife, et al.

Appeal From: Southern

District of Ohio at Columbus

Case Type Information:

1) Civil

2) Private

3) Federal Question

Originating Court

Information:

District: 0648-2 : 03-

00572

Trial Judge: George C.

Smith, U.S. District Judge

Date Filed: 06/23/2003

Date Order/Judgment:

06/08/2005

Filed: 07/20/2005

Termed: 09/01/2006

Date NOA Filed:

07/07/2005

WANDA GLENN

Plaintiff — Appellant

Vv.

METROPOLITAN LIFE INSURANCE COMPANY,

et al.

Defendants — Appellees.

07/20/2005

08/17/2005

09/27/2005

11/02/2005

Civil Case Docketed. Notice filed by

Appellant Wanda Glenn. Transcript

needed: n.

* * *

TRANSCRIPT ORDER FORM filed by

Stanley L. Myers for Appellant Wanda

Glenn: No hearings held in District

Court. [05-3918] [3218029-1]

* * *

PROOF BRIEF filed by Stanley L.

Myers for Appellant Wanda Glenn.

Certificate of service date 9/26/05

Number of Pages: 45. [05-3918]

* * *~

PROOF BRIEF filed by Charles S.

Lanz for Appellee MetLife. Certificate

of service date 10/31/05. Number of

Pages: 46. (05-3918)

11/18/2005

12/16/2005

12/20/2005

04/28/2006

* * *

PROOF REPLY BRIEF filed by

Stanley L. Myers for Appellant Wanda

Glenn Certificate of service date

11/17/05 [05-3918]

* * *

FINAL BRIEF filed by Charles S. Lanz

for Appellee MetLife. Copies: 7.

Certificate of service date 10/31/05, not

updated for final brief. Number of

Pages: 46. [05-3918]

* * *

FINAL BRIEF filed by Stanley L.

Myers for Appellant Wanda Glenn.

Copies: 7. Certificate of service date

12/19/05. Number of Pages: 51. [05-

3918]

FINAL REPLY BRIEF filed by Stanley

L. Myers for Appellant Wanda Glenn.

Copies: 7 Certificate of service date

12/17/05. Number of Pages: 33. [05-

3918]

* * *

CAUSE ARGUED on 4/28/06 by

Stanley L. Myers for Appellant Wanda

Glenn, Charles S. Lanz for Appellee

MetLife before Judges Keith, Merritt,

09/01/2006

10/26/2007

02/05/2007

Daughtrey. [05-3918]

OPINION filed: REVERSED the

judgment of the district court and this

case is remanded ffor further

proceedings consistent with the opinion

of this court [05-3918], decision for

publication pursuant to local rule 206

[05-3918]. Damon J. Keith, Circuit

Judge, Separate concurrence by Gilbert

S. Merritt, Circuit Judge, Martha C.

Daughtrey, Authoring Judge.

JUDGMENT: REVERSED and

remanded.

* * *

MANDATE ISSUED with no cost

taxed. |05-3918]

*« * *

Appellees’ MOTION to recall mandate

and stay mandate filed by Charles S.

Lanz for Appellees MetLife, et al.

Certificate of service date 2/2/07. [05-

3918]

ORDER GRANTING appellees’ motion

Ca/aa007 to recall and stay the mandate filed by

Charles S. Lanz. [05-3918] Damon J.

Keith, Circuit Judge, Gilbert S.

Merritt, Circuit Judge, Martha C.

Daughtrey, Circuit Judge.

* * *

U.S. District Court

Southern District of Ohio (Columbus)

CIVIL DOCKET FOR CASE #:

2:03-CV-00572

Glenn v. Metlife, et al. Date Filed: 06/23/2003

Assigned to: George C. Jury Demand: None

Smith Nature cf Suit: 890

Referred to: Mag. Judge Other Statutory Actions

Mark R. Abel Jurisdiction: Federal

Demand: $0 Question

Member case: (View

Member Case)

Case in other court: Sixth

Circuit, 05-3918

Cause: 29:1001 E.R.LS.A.:

Employee Retirement

Date Filed # Docket Text

06/23/2003 1

COMPLAINT (referred to Mag.

Judge Mark R. Abel) (no. pgs: 3)

(lvw) (Entered: 06/23/2003)

08/25/2003 2

ANSWER by defendant MetLife

(no pgs: 5) (Gh) (Entered:

08/26/2003)

——

* =

08/10/2004 7

Stipulated ADMINISTRATIVE

RECORD manually filed

w/Clerk of Court. (jk) (Entered:

08/11/2004)

* *~

09/24/2004

— |

MOTION for Judgment as a

Matter of Law by Plaintiff

Wanda Glenn. Responses due by

10/18/2004 (Myers, Stanley)

(Entered: 09/24/2004)

11/08/2004

RESPONSE in Opposition re 9

MOTION for Judgment as a

Matter of Law Memorandum in

Opposition to Plaintiffs Motion

and Cross-Motion for Judgment

on the Administrative Record

with Memorandum in Support

filed by Defendant MetLife.

(Attachments: # 1 Appendix 1#

2 Appendix 2# 3 Appendix 3)

(Lanz, Charles) (Entered:

11/08/2004)

11/09/2004

MOTION for Judgment on the

Pleadings by Plaintiff Wanda

Glenn. Responses due . by

12/3/2004 (Myers, Stanley)

(Entered: 11/09/2004)

11/12/2004

MOTION for Judgment as a

Matter of Law by Plaintiff

Wanda Glenn. Responses due by

12/6/2004 (Myers, Stanley)

(Entered: 11/12/2004)

* «x

11/30/2004

REPLY to Response to Motion

re 12 MOTION for Judgment as

a Matter of Law filed by

Defendants Long Term

Disability Plan for Salaried

Associates of Sears, Roebuck

and Company, MetLife. (Lanz,

Charles) (Entered: 11/30/2004)

12/02/2004

MOTION for Judgment as a

Matter of Law by Plaintiff

Wanda Glenn. Responses due by

12/27/2004 (Myers, Stanley)

(Entered: 12/02/2004)

12/13/2004

MOTION to Strike 15 MOTION

for Judgment as a Matter of

Law or, in the Alternative, For

Leave to File Sur-Response Brief

by Defendants MetLife, Long

Term Disability Plan for

Salaried Associates of Sears,

Roebuck and Company.

(Attachments: # 1 Proposed

Journal Entry #1 # 2 Proposed

Journal Entry #2 # 3 Appendix

1 (Defendants’ Reply’ to

Plaintiffs Memorandum Contra

Defendants’ Motion (for]

Judgment) Lanz, Charles)

(Entered: 12/13/2004)

12/15/2004

ORDER denying Defendants’ 16

Motion to Strike, granting

alternative motion for leave to

file a sur-response brief. Signed

by Judge Mark R. Abel on

12/15/04. (dms) (Entered:

12/15/2004)

12/15/2004

REPLY filed by Defendants to

Plaintiffs Memo Contra to

Defendants’ MSJ. (dms)

(Entered: 12/16/2004)

12/16/2004

MOTION Leave to file sur-

response brief re 15 MOTION

for Judgment as a Matter of

Law by Plaintiff Wanda Glenn.

(Myers, Stanley) (Entered:

12/16/2004)

12/20/2004

ORDER DENYING Plaintiff's

12/2/04 motion for judgment as

a matter of law. Order

GRANTING motion for leave to

file sur-response brief. Clerk of

Court is DIRECTED to file the

sur-response brief. Signed by

Judge Mark R. Abel on 12/20/04.

(dms) (Entered: 12/20/2004)

12/20/2004

REPLY filed by Defendants to

Plaintiffs Memo Contra

Defendants’ Motion for

Judgment. (dms) (Entered:

12/20/2004)

* *

06/08/2005

ORDER denying 9 Motion for

Judgment as a Matter of Law

10a

and granting defendants’ cross-

motion for entry of judgment.

Signed by Judge George C.

Smith on 6-7-05. (ga) (Entered:

06/08/2005)

06/08/2005

CLERK’S JUDGMENT in favor

of defendants against plaintiff.

Signed on 6/8/05. (lvw) (Entered:

06/08/2005)

07/07/2005

NOTICE OF APPEAL as to 23

Order on Motion for Judgment

as a Matter of Law & 24 Clerk’s

Judgment by Plaintiff Wanda

Glenn. Filing fee $ 255.00,

receipt number 247319. (jk)

(Entered: 07/08/2005)

* *

02/27/2007

ORDER of USCA as to 25 Notice

of Appeal filed by Wanda Glenn:

It is ORDERED that the

mandate be RECALLED AND

STAYED until the Supreme

Court disposes of the case. (kch)

(Entered: 02/28/2007)

04/03/2007

ORDER STAYING’- CASE.

Signed by Judge George C

Smith on 4-3-07. (ga) (Entered:

04/03/2007)

* *

lla

YOUR EMPLOYEE

BENEFIT PLAN

SEARS ROEBUCK & CO.

* * *

TABLE OF CONTENTS

Section Page

SCHEDULE OF BENEFITS

(Also see SCHEDULE SUPPLEMENT) .................... 1

SCHEDULE SUPPLEMENT .................:000 ceseseseeseeees 3

DEFINITIONS OF CERTAIN TERMS USED

idviiniiiinienaibendiilianiiadionienerisnsunceccenesesvecescosecees 5

ELIGIBILITY FOR BENEFITS...............:cccccssseeeeesees 6

EFFECTIVE DATES OF PERSONAL BENEFITS .. 6

LONG TERM DISABILITY BENEFITS ................... 8

CLAIM PROCEDURE FOR

LONG TERM DISABILITY BENEFITS ................. 15

WHEN BENEFITS END.................ccsessssssssssssssssecsees 16

CONDITIONS UNDER WHICH YOUR ACTIVE

WORK IS DEEMED TO CONTINUE ...................... 17

CLABES ENP ORBEATIONN .......cccccccessorscsssosssseseseesaces 18

* * *

LONG TERM DISABILITY BENEFITS

12a

Section B.4.d

d. In any case, when you do receive approval or

final denial of your claim from the Social

Security Administration:

i. your Monthly Benefit will be adjusted;

and

ii. you must promptly refund to us an

amount equal to all overpayments. If you

do not promptly make such refund to us,

we may, at our option, reduce or offset

against any future benefits payable to

you or through other legal actions deemed

appropriate by us.

* * *

CLAIM PROCEDURE FOR

LONG TERM DISABILITY BENEFITS

* * *

F. Medical Examinations

While a claim is pending, we, at our expense,

have the right to have you examined by Doctors

of our choice when and as often as we reasonably

choose.

“

Pere ae eT Ow

13a

Excerpts of Diary Notes

* * *

(X096) — On 10/11/2000 12:48 — For 690008108949

Social Security Attorney is:

Kennedy & Associates

6732 W. 173rd Street, Tinley Park, Ill. 60477

Phone 1-800-637-0593 Fax #708-832-7847

Letters of introduction were sent to the claimant and

CC went to Kennedy. This claim was reviewed and

chosen in a social security audit of active claims for

potential SSDIB candidates by Dave Kennedy of

Kennedy & Associates.

Ed Peters

* * *

(U015) — On 12/14/2000 08:37 — For 690008108949

All medical, vocational, & social security info from

file copied & sent to Kennedy agency

* * *

(N192) — On 07/12/2002 08:36 — For 690008108949

Call-Up For: (N145) - On 07/15/2000 Call-Up

Complete: (N145) — On 07/13/2002

SS award information

Date of Notice: 6/15/2002.

Retro DOE: 10/2000.

DOE Benefit Amount: $825.00.

Fully favorable ALJ award level.

COLAS: 12/00; 12/01.

Earnings Adjustment: 1/01.

***SSDI Benefit Offset***

10/00 through 12/00 SSDI benefit offset amount:

$825.00.

l4a

1/01 through current SSDI benefit offset amount:

$859.00.

(Minus 12/00 COLA/plus 1/01 earnings adjustment)

Dependent information: per Atty Ltr dependent

benefits not involved.

None indicated on DP screen.

Att Fee: $4434.50 approved by SSA. EE has been

paid the Atty fee-see

DCN: 020710000436.

Atty Fee Code: SS award.

SS Status Code: ALJ approved.

SS Reason Code: Att handling SSDIB dev.

Date of Disability Onset: 4/30/00.

DCN: 020701009560.

* * *

(N145) — On 07/13/2002 12:20 — For 690008108949

Transition Decision Summary

Transition Date is 9/17/02

EE disabled from her OCC. OF Manager since

4/30/00, due to Idiopathic Cardiomyopathy, SOB,

Fatigue.

Per EE’s Cardiologist, in an 8 hour work day, EE can

sit 8 hrs., stand for 4 hrs, walk for 2-4 hrs, lift/carry

up to 10 lbs. Occasionally, use hands/feet for

repetitive actions, frequently bend & squat,

occasionally reach above shoulder level. No

emotional stress or heavy exertion.

TSA identified alternate employment as account info

clerk, attendance clerk, classified ad clerk.

Therefore, final benefits approved through 9/16/02.

(N145) — On 07/13/2002 12:21 — For 690008108949

Outgoing correspondence to EE

15a

(X059) — On 7/16/2002 08:15 — For 690008108949

Call-Up For: (X059) — On 08/13/200: Call-Up

Complete: (X059) — On 07/30/2002

New overpayment details: Rec SS award for $825.00

per month effective 100100 through 123100 and

$859.00 per month effective 010101 causing an

overpayment of $17,937.00 less approved fee credit of

$4434.50 for a new Op Bal of $13,502.50; wrote EE

ltr explaining and requesting reimbursement; also

advised EE we will begin withholding the new

monthly benefit of $991.00 starting Aug 2002

NPerry

(UZ13) — On 07/17/2002 16:42 — For 690008108949

Call-Up For: (N145) -— On 07/17/200 Call-Up

Complete: (N145) — On 07/18/2002

CRC: Trans EE CM N145 @ 4:40PM. Wants to

discuss her claim ending on 9/16/02. She states she

doesn’t understand why if SSDIS states she is

disabled then why doesn’t MetLife agree. ADV EE of

(U839) — On 07/18/2002 11:24 — For 690008108949

Call-Up For: (MRCQ) -— On 07/18/20 Call-Up

Complete: (N145) — On 07/18/2002

CRC: Call back request call transferred to N145 VM

(N 145) — On 07/18/2002 12:03 — For 690008108949

Outgoing Call to EE

She asked me to explain decision, I went over info. in

file. I also advised her to review letter explaining

16a

how to appeal. She feels that Dr. Patel told her very

different info. re. what she can & can’t do. She also

asked why SS reached a different decision. I told her

that we base our decision on all info. we received. If

she feels that any info used by SS to reach a decision

should be part of her appeal, she should include it

with her written appeal.

* * *

(N145) — On 08/09/2002 14:39 — For 690008108949

Call-Up For: (N131) - On 08/12/200 Call-Up

Complete: (N131) — On 08/20/2002

Referral to nurse consultant/please review new

information/appeal does the new information

submitted by the insured provide support of her

inability to work at any occupation?

* * *

(N140) — On 08/26/2002 10:52 — For 690008108949

NC call/EE interview

8/15 — States she is capable of walking around mall,

unsure of distance approx 1-2 miles QAM, 20

minutes after which she showers and occasionally

naps. Is capable of light housework I.E. dusting,

dishes, and OCC. cooking. No vacuuming. Children

are grown. Socially she gets together with family on

weekends, OCC movies. Dr. Choo placed her on

dietary restrictions, current WT 183 (was 200s) Does

not follow BP regularly, last 130/80. Current

medications per PT include: Plavix, Normodyne,

Norvasc, K-Dur, Lanoxin, Diovan, Labetolol, ASA,

MVI and Calcium. States she is unable to work due

to inability to withstand psychological stressors.

States she has good and bad days. States ICD has

17a

‘shocked’ her one time in the past, unsure of date. No

SOB during telephone conversation noted.

* * *

(N131) — On 08/27/2002 13:04 — For 690008108949

Call-Up For: (N145) -—- On 08/27/200 Call-Up

Complete: (N 145) — On 08/28/2002

NC Appeal Review / Recommendation

50 Y/O sales manager. Employed 3/20/90. SSD

approved. The claimant has HX of sudden cardiac

death syndrom. Her current DX is dilated

cardiomylopathy. She has an ICD with insync

pacing. The most most recent echocardiogram

findings reported for LV function was April 6, 2001

where her ejection fraction was reported as anywhere

from 40-50%. Dr. Patel has documented concerns

regarding c/o general fatigue and SOB assoc with c/o

psychosocial problems. Medical documentation

submitted for appeal review includes:

-- Claimant letter dated 7/26/02

-- Letter by Dr. Rajendra C. Patel, cardiologist, dated

7/22/02.

-- Letter by Sandy Roads, RN, dated 3/4/02,

describing what happened in heart failure that might

necessitate an ICD. Described how the claimant’s

ICD device works.

-- Copies of ICD interrogations from pacemaker

implant of 1989, one rept from current device of

10/10/00, and pocket revision rept of 2/28/01.

Claimant’s letter states ‘I do not dispute the fact that

since receiving the new N-Sync

pacemaker/defibrillator, my condition has slightly

improved. With the new device, I still experience bad

days when it is impossible for me to perform even the

simplest task of getting out of bed.’ She speaks of her

18a

dependability as an employee, that her condition is

permanent, and that it is stressful enough to have to

accept this and that it will probably never change.

But, she states, if forced to go back to work, have to

call off 3-4 time/mo, leave early, or get ill at work, it

is hard to imagine the stress that she would be

under. Dr. Patel indicates she has dilated

cardiomyopathy and HX of ventricular tachycardia

requiring implantable defib device. States she has

been on multiple medications for her condition,

continues to have significant difficulty in returning to

even any kind of sedentary job because any kind of

psychologic stress at work causes. significant

problems w/her cardiovascular condition and she

decompensates fast. States this has happened on

multiple occasions in the past. States tried to RTW

in the past w/exacerbation of symptoms and her

condition. States he does not believe she should be

forced to return to any kind of even sedentary work

particularly because it is psychologic stress of work

that really exacerbates her cardiovascular

condition/symptomology. States she basically should

be considered completely disabled from her condition

and history of ventricular tachycardia. The

pacemaker reports were reviewed. The 2/28/01

operative rept describes revision of device pocket due

to painful insertion site. The device was removed

from the left abdominal area and implanted to the

pectoral area. She had developed a painful mass in

the previous site. Excisional debridement of necrotic

tissue and removal of extensive scar tissue was

performed. The 10/10/00 rept is actually the bottom

portion of the operative rept indicated above, w/hand

written date 10/10/00 inserted. The reports of

4/24/02, and 7/10/02, indicate each defibrillator eval

was normal. The capture and sensing thresholds

19a

were appropriate. There were no detections or

therapies delivered by the ICD. Each rept indicated

the ICD battery is now showing significant wear and

is likely in the last year of service before replacement

will be needed. The 7/10/02 rept indicates the ICD

was reprogrammed to final settings reflective of

appropriate safety margins and optimized to battery

efficiency.

-- NC Recommendation:

1. The records submitted support stable cardiac

status with no recent detections or therapies

delivered by ICD. If ICD battery change necessitated

within near future, an uncomplicated recovery is of a

few wks duration.

2. The records submitted for review do not support

cardiovascular impairment from performing at least

F.T. sedentary level work of some type. There is no

supportive medical documentation evidencing

exacerbation of cardiovascular condition/

symptomology due to subjective c/o work stress.

NC/CMS reviewed file for supportive information

regarding claim previous RTW attemps. None

appeared to be in the file. Per CMS ER interview

8/9/02 there was no prior RTW since disability

absence started. There is no_ supportive

documentation submitted for psychiatric impairment

from working. The medications listed in the file

include lasix, potassium, lanoxin, norvasc, aspirin,

calcium, normodyne, and diovan. There does not

appear to be any psychotropic medications

prescribed. Per the TSA performed by the VRC, the

claimant would have numerous and varied jobs from

which to choose, within her TE&E for full time

sedentary level work. Incidental absences for what is

described as ‘bad days.” Could be covered by other

benefits and or possibly FMLA.

20a

3. NC recommends that the information submitted

on appeal does not change the previous finding for

denial. Recommend apeal committee referral for any

further consideration.

* * *

(N145) — On 08/28/2002 10:03 — For 690008108949

Denial rationale

EE submitted written appeal, indicating that she is

still umable to RTW. File reviewed by NC who

discussed file with EE, and also obtained additional

medical records. NC concluded that EE’s cardiac

condition is stable, and does not preclude her from

working at full time sedentary employment. VRC

previously verified existing employment within

sedentary level of activity. Therefore, we are

upholding any OCC denial.

* * *

(N169) — On 02/21/2003 08:16 — For 699008108949

Call-Up for: (N145) - On _ 02/21/200 Call-Up

Complete: (N145) — On 02/21/2003

NC walk-up done with N145

-- NC recommendation/see previous diary.

-- MD states in APS that EE was fit for sedentary

work, in March of 02 In letter dated 2/03 MD states

that based on her clinical condition and

symptomology there is not time where I feel EE can

return to F/T employment. However no additional

medical has been received to review for change in EE

status.

2la

(N145) — On 03/18/2003 13:13 — For 690008108949

Incoming call from Cathy Stein @ Kennedy &

Associates. They have requested the file from

storage. They will fax to us ASAP. I asked for rush

handling, as we are reviewing an appeal by EE.

* * *

(U184) — On 05/20/2003 12:40 — For 690008108949

Appeal determination by appeal unit: termination

upheld.

Letter mailed to Atty.

DLW: 4/29/00 as a sales department manager. TSA

based on 6/12/02 AP restriction identified sedentary

jobs. CLM terminated at trans (9/16/02).

February 12, 2003, letter from Dr. Patel. Dr. Patel

noted that his previous reports indicated that Ms.

Glenn was fit for sedentary work, however based on

her clinical condition and symptomatology, Dr. Patel

never felt that Ms. Glenn could return to full-time

employment. Dr. Patel’s position was that Ms. Glenn

should be considered completely disabled from her

cardiomyopathy and associated symptoms from her

LV dysfunction.

IPC: Ms. Glenn’s ejection fraction had improved with

medical therapy and probably with biventricular

pacing. The consultant indicated that clinicaliy Ms.

Glenn had improved and has been relatively free of

any significant cardiac decompensation as

documented by Dr. Patel’s follow-up notes. The

adenosine cardiolite stress study and 2-D

echocardiogram, failed to reveal any evidence of

reversible ischemia and the left ventricular ejection

fraction went up to 40-45%. The consultant noted

that based on the medical information Ms. Glenn has

23a

MetLife

May 20, 2003 PO Box 14592

Lexington, KY 40511

Stanley Myers

Attorneys at Law

221 S. High Street

Columbus, OH 43215

RE: Long Term Disability

Claim No: 690008108949

Group No: 31003

SS#: [OMITTED]

Claimant: Wanda Glenn

Dear Mr. Myers

We have completed our review of the termination of

Ms. Glenn’s claim for disability benefits. For the

following reasons, the original determination is

upheld upon appeal review.

The employer’s plan states the following:

As used in the Plan, the term “Total Disability” has

two definitions:

1. During the Waiting Period and for the next 24

consecutive months, “Total Disability” means that

because of Illness or Injury, you cannot perform the

material duties of your own job.

2. After that time period, you will no longer be

considered Totally Disabled unless you are totally

incapable of performing the material duties of any

gainful occupation for which you are reasonably

qualified based on your training, education, and

experience.

24a

We have reviewed Ms. Glenn’s entire claim.

Our records indicate that Ms. Glenn’s last worked on

April 29, 2000 as a Sales Department Manager. Ms.

Glenn received Long Term Disability benefits

through September 16, 2002. In order to receive

benefits beyond September 16, 2002, Ms. Glenn must

be incapable of performing the material duties of any

gainful occupation as defined in the plan.

Current Medical information is required at various

points during a disability to substantiate the

continued existence of a disabling condition as

defined in the Group Plan.

We review an individual’s vocational information,

medical information and an individual’s specific

restrictions and limitations that are supported by

objective medical evidence in making a claim

determination.

On June 12, 2002, Dr. Rajendra Patel, Cardiologist

completed a Physical Capacities Evaluation form.

The form indicated that Ms. Glenn could sit for 8

hours, stand for 4 hours, and walk from 2-4 hours in

an 8-hour workday. Dr. Patel noted she could

occasionally lift and carry up to 10lbs. It was noted

she could use her hands for repetitive action and her

right foot in operating foot controls. Ms. Glenn could

not crawl or climb. She could occasionally reach

above shoulder level and frequently bend and squat.

The form indicated she should avoid unprotected

heights and being around moving machinery. Ms.

Glenn had moderate restrictions for exposure to

temperature changes, driving automotive equipment,

and exposure to dust, fumes, and gases. Dr. Patel

indicated additional restrictions of no emotional

stress or heavy exertion.

25a

On July 10, 2002 a Certified Rehabilitation

Counselor performed a Transferable Skills Analysis

(TSA). The TSA was based on Dr. Patel’s June 12,

2002 restrictions. The TSA identified alternative

sedentary occupations that Ms. Glenn demonstrated

the transferable skills to perform within her residual

physical capacities, which were found in her

geographical area.

We received a February 12, 2003, letter from Dr.

Patel. Dr. Patel noted that his previous reports

indicated that Ms. Glenn was fit for sedentary work,

however based on her clinical condition and

symptomatology, Dr. Patel never felt that Ms. Glenn

could return to full-time employment. Dr. Patel’s

position was that Ms. Glenn should be considered

completely disabled from her cardiomyopathy and

associated symptoms from her LV dysfunction.

On May 2, 2003 an Independent Physician

Consultant Board certified in Cardiology reviewed

Ms. Glenn’s claim. The consultant noted that Ms.

Glenn had a biventricular pacemaker implanted. Ms.

Glenn’s ejection fraction had improved with medical

therapy and probably with biventricular pacing. The

consultant indicated that clinically Ms. Glenn had

improved and has been relatively free of any

significant cardiac decompensation as documented by

Dr. Patel’s follow-up notes. The adenosine Cardiolite

stress study and 2-D echocardiogram, failed to reveal

any evidence of reversible ischemia and the left

ventricular ejection fraction went up to 40-45%. The

consultant noted that based on the medical

information Ms. Glenn has achieved a relatively

stable cardiac status.

We have determined that the documentation

currently in the file does not support a disability that

26a

would prevent Ms. Glenn from performing any

occupation, as defined in the plan. Therefore, the

original claim determination was appropriate.

Upon request, MetLife will provide you with a copy of

the documents, records, or other information we have

that are relevant to your claim and identify any

medical or vocational expert(s) whose advice was

obtained in connection with your claim. You also

have the right to bring civil action under Section

502(a) of the Employee Retirement Income Security

Act of 1974.

You have exhausted the administrative remedies

under the plan, no further appeals will be considered.

Yours truly

/s/

Sal Marchese

Procedure Analyst

MetLife Disability

1 800 300-4296

27a

Metropolitan Life Insurance Company

MetLife

MetLife Disability

PO Box 14590

Lexington, KY 40511-4590

November 22, 2002

Wanda Glenn

2566 Sonata Drive

Columbus, OH 43209

Re: Long Term Disability

Claim No: 690008108949

Group No: 31003

Dear Ms. Glenn:

We are contacting you in regard to the outstanding

overpayment balance of $210.47 due and owing to

MetLife and the Sears Roebuck & Company Group

Disability Plan. As explained to you in previous

correspondence, the amount due is the result of the

reduction of your Long Term Disability benefits by

the amount you received from your Social Security

Award. This reduction is mandated by the terms of

the Group Long Term Disability Plan. The above

amount remains due and owing and must be repaid

immediately to MetLife as Claims Administrator of

the Sears Roebuck & Company Group Disability

Plan.

This letter is final demand for either lump sum

reimbursement or a monthly installment agreement.

Please keep in mind that we are not computing

interest due at this time. If a lump sum repayment

is not possible at this time, we are willing to consider

an installment arrangement.

28a

You should understand that you have been overpaid

employee welfare plan benefits, monies to which you

are not legally entitled. These overpaid benefits

necessarily reduce the assets of the plan and the cost

of such is passed on to all plan participants. If

Metlife were to allow you to retain the overpaid plan

benefits, we would not be treating all plan

beneficiaries fairly. It is necessary that you contact

the undersigned immediately to arrange to repay the

monies.

Should you fail to reply to this letter by December 26,

2002, we will be referring this overpayment to a

collection agency to commence collection efforts

against you for the recovery of the adjusted plan

benefits due the Plan and MetLife. We urge you to

on an urgent status and requires your prompt

attention.

Sincerely,

Nancy Perry

Offset Recovery Unit

Met Disability

800-300-4296 ext. 1761

29a

Metropolitan Life Insurance Company

PO Box 14590, Lexington, KY 40511-4590

Met Disability MetLife

August 28, 2002

Wanda Glenn

2566 Sonata Drive,

Columbus, OH 43209

RE: Long Term Disability

Group #: 31003

Claim #: 690008108949

Dear Ms. Glenn:

We have reviewed your July 26, 2002 request to

reopen your Long-Term Disability claim. We have

completed our evaluation of your claim, which was

conducted to determine your eligibility for continued

Long-Term Disability benefits. Your claim has

already been approved for Long-Term Disability

benefits through September 16, 2002.

As part of the review process, we obtained additional

information from you, and from the Ohio State

University Medical Center.

Your plan states:

To receive benefits from the Plan, you must be

Totally Disabled. As used in the Plan, the term

“Total Disability” has two definitions:

1. During the Waiting Period and for the next 24

consecutive months, “Total Disability” means that

because of Illness or Injury, you cannot perform the

material duties of your own job.

a a?

;

}

. 30a

2. After that time period, you will no longer be

considered Totally Disabled unless you are totally

incapable of performing the material duties of any

gainful occupation for which you are reasonably

qualified based on your training, education, and

experience.

All of the medical documentation that we have

received from your cardiologist, Dr. Rajendra Patel,

was extensively reviewed.

The Attending Physician’s Statements and office

notes from Dr. Patel indicated that you were disabled

beginning April 30, 2000, due to idiopathic

cardiomyopathy, shortness of breath, and fatigue.

As of November 2, 2001, you had an ICD device in

place. You had better exercise tolerance than before.

From overall evaluation, you seemed to be clinically

stable.

On January 9, 2002, Dr. Patel stated that you could

do the following activities: occasionally lift and carry

up to twenty pounds, perform bilateral! repetitive foot

and hand movements, and occasionally bend, squat,

and reach above shoulder level.

As of February 5, 2002, you showed an ejection

fraction of 35 to 40%.

On March 13, 2002, Dr. Patel stated that in an eight-

hour work day, you were capable of sitting eight

hours, standing four hours, and walking two hours.

There were no current physical-barriers preventing

you from returning to fulltime work.

Dr. Patel advised us on June 12, 2002, that in an

eight-hour work day, you could sit for eight hours,

stand for four hours, and walk for 2 to 4 hours. You

could occasionally lift/carry up to ten pounds, and use

3la

your hands and feet for repetitive actions. You could

frequently bend and squat, and occasionally reach

above shoulder level. Your functional limits included

no emotional stress and heavy exertion.

Your June 18, 2002 examination showed an ejection

fraction of 35 to 40%.

We have also reviewed medical reports from April 24,

2002 and July 10, 2002, which indicated that each

defibrillator evaluation was normal. The capture and

sensing thresholds were appropriate. There were no

detections or therapies delivered by the ICD. Each

report stated that the ICD battery is now showing

significant wear and is likely in the last year of

service before replacement will be needed. The July

10, 2002 report indicated that the ICD was

reprogrammed to final settings reflective of

appropriate safety margins, and optimized to battery

efficiency.

The records submitted support stable cardiac status

with no recent detections or therapies delivered by

the ICD. If the ICD battery change becomes

necessary within the near future, there should be an

uncomplicated recovery of a few weeks duration.

There is no supportive medical documentation of the

exacerbation of your cardiac condition and

symptomology, due to subjective complaints of work

related stress. The records submitted for review do

not support cardiovascular impairment that would

prevent you from performing full time sedentary

level work.

Therefore, the information submitted on appeal does

not change the previous finding that you are capable

of performing full time sedentary work.

32a

We previously advised you that on July 10, 2002,

your file was referred to our Vocational

Rehabilitation Coordinator, who performed a

Transferable Skills Analysis that identified positions

in your geographic area, which we felt you would be

capable of performing. A Transferable Skills

Analysis is a system that determiies a persons

potential for alternative work given their physical

abilities, education, and work history. A

Transferable Skills Analysis was conducted on your

behalf and based on your Training, Education and

Experience and your Restrictions and Limitations,

you are qualified to perform the following occupations

at a sedentary exertion level:

e Account Information Clerk DOT# 210.367-010

e Attendance Clerk DOT# 219.362-014

e Classified Ad Clerk DOT# 247.367-010

The full description of these positions can be found in

the Dictionary of Occupational Titles, in any public

library.

Based on the above information, we are unable to

grant further Long-Term Disability benefits based

upon medical evidence that does not support your

inability to return to any occupation, as defined in

the Sears Long-Term Disability plan.

MetLife reserves all of its rights or defenses either

expressly stated or implied.

You may appeal this decision by sending a written

request for appeal to MetLife Disability, PO Box

14592, Lexington KY, 40511-4592 within 180 days

after you receive this denial letter. Please include in

your appeal letter the reason(s) you believe the claim

was improperly denied, and submit any additional

33a

comments, documents, records or other information

relating to your claim that you deem appropriate for

us to give your appeal proper consideration. Upon

request, MetLife will provide you with a copy of the

documents, records, or other information we have that

are relevant to your claim and identify any medical or

vocational expert(s) whose advice was obtained in

connection with your claim.

MetLife will evaluate all the information and advise

you of our determination of your appeal within 45

days after we receive your written request for appeal.

If there are _ special circumstances requiring

additional time to complete our review, we may take

up to an additional 45 days, but only after notifying

you of the special circumstances in writing. In the

event your appeal is denied in whole or in part, you

will have the right to bring a civil action under

Section 502(a) of the Employee Retirement Income

Security Act of 1974.

Should you have any questions or concerns, please

Sincerely,

Earl Chesler

Case Management Specialist

MetLife Disability

(888) 868-3997

Fax: (866) 690-1264

34a

Metropolitan Life Insurance Company

PO Box 14590, Lexington, KY 40511-

4590

Met Pisability

August 8, 2002

Wanda Glenn

2566 Sonata Drive,

Columbus, OH 43209

RE: Long Term Disability

Claim No: 690008108949

Group No: 31003

S.S. No: (OMITTED)

Dear Ms. Glenn:

MetLife

Thank you for your reimbursement check dated

July 20, 2002 in the amount of $12,600.50. It has

been applied toward your overpayment, leaving a

current balance of $902.00.

Per our telephone conversation today, we will

withhold $451.00 from your August and September

2002 benefits to satisfy the overpayment balance.

Sincerely,

Nancy Perry

Overpayment Unit

Met Disability

800-300-4296 ext. 1761

35a

July 26, 2002

Mr. Earl Chesler

Case manager specialist

Med life Disability

P.O Box 14592

Lexington, KY

40511-4592

RE: Appeal

Dear Mr. Earl Chesler,

I have just received your letter dated 7-15-02 denying

me further long-term disability.

Disappointment is not a strong enough word to

describe what I feel. I do not dispute the fact that

since receiving the new N-Sync

Pacemaker/Defibrillator, my condition has slightly

improved. With the new device, I still experience bad

days when it is impossible for me to perform even the

simplest task of getting out of bed.

I was a manager at Sears therefore I know that an

employee must be dependable in order to maintain

employment. I know I cannot be a dependable

employee when I continue to have these bad days. If

you look into my work history any supervisor will

confirm without a doubt I was very dependable,

dedicated employee and gave 100% of myself to any

job.

The damage to my heart, I am told is permanent. It

is stressful to have to accept this as a part of my life

that will probably never change. However, if I am

forced to go back to work and have to call off 3 to 4

36a

times a month, go to work and leave early or become

ill on the job. It is hard to imagine the stress that I

would be under.

I am not a lazy person and I am not asking for a hand

out. I ask that you review what I have written along

with the letter from Dr. Patel. This state I should

not be forced to return to any type of employment.

Overturn your denial and grant me further long-term

disability.

Enclosed you will find documents from Dr. Patel,

Kennedy and Associate, Social security and OSU

pace maker clinic for proper consideration.

Sincerely,

_/s/

Wanda Glenn

37a

CARDIOVASCULAR ASSOCIATES, P.C.

Berton L. London, M.D., F.A.C.P., 27177 Lahser Road, Suite 103

FA.C.C. Southfield, Michigan 48034

Oswald Bostic, M.D., F.R.C.P. (C) Telephone: (248) 357-1380

Juan C. Rojas, M.D. Fax: (248) 357-1745

Luis Osterberger, M.D.

Vijay Kudesia, M.D., F.A.C.C. 27472 Schoenherr, Suite 140

Antonio P. Carrillo, M.D., F.A.C.C. Warren, Michigan 48088

Chandrakant Pujara, M.D., Telephone: (586) 778-2950

FA.C.C. Fax: (586) 778-3240

Samer Salka, M.D., F.A.C.C.

Eduardo Garcia, M.D., F.A.C.C., 4020 Venoy Road, Suite 200

FA.C.F. Wayne, Michigan 48184

Syed A. Mahmood, M.D., F.A.C.C. Telephone: (734) 729-6710

Fax: (784) 729-6715

May 2, 2003

UNIVAL Center

2890 Corpenter Road, Suite 1400

P.O. Bex 130770

Ann Arbor, Michigan 48113-0770

Re: Glen, Wanda

CLAIM #: 690008108949

SSN: [OMITTED]

EMPLOYER: Sears Roebuck & Co.

MY LICENSE #: 036190

To UNIVAL administration:

I had the opportunity to review the medical records of

Ms. Wanda Glen at your request. Ms. Glen is a 50-

year-old African-American female who is from

Columbus, Ohio, and was employed at Sears Roebuck

Corporation since March 1990. The patient has been

on medical disability as recommended by her

attending Cardiologist, Dr. Raj Patel since April 30,

2000. She was originally seen by Dr. Patel in 1989

when she presented with ventricular fibrillation. She

was seen in the emergency room. At that time she

38a

had extensive cardiac workup and she was diagnosed

to have idiopathy dilated cardiomyopathy. She had

left ventricular ejection fraction in the range of 25-

30%. Her coronary arteries were normal. Automatic

intracardiac defibrillator was _ prophylactically

implanted subsequently. The patient is being

followed regularly by Dr. Patel and her primary care

physician, Dr. Chin, in Ohio. The patient has been

having easy fatigue and occasional palpitations along

with exertional dyspnea. The patient had has

electrophysiological evaluation and original AICD

was replaced. The patient had biventricular

pacemaker implanted at that time. The patient has

been on medical regimen, which includes Zestril,

Lasix, potassium supplement, Normodyne, Lanoxin,

as well as calcium supplement. The patient’s ejection

fraction indeed has improved with medical therapy

and probably with biventricular pacing as well.

Clinically, the patient has improved and has been

relatively free of any _ significant cardiac

decompensation as documented by Dr. Patel’s follow-

up notes. The patient had also undergone adenosine

Cardiolite stress study and 2-D echocardiogram,

which failed to reveal any evidence of reversible

ischemia and the left ventricular ejection fraction has

come up to 40-45%. The patient claims that she is

unable to bear any kind of psychological or physical

stress. The patient’s vocational training and work

experience has been, according to the dictionary of

occupational titles, to be described as manager of the

department store and she has also functioned as a

safe manager, sales representative and audit clerk.

The patient’s physical restrictions and limitations as

described by Dr. Patel on June 12, 2002, indicated

that she was capable of sitting for eight hours,

standing for four hours, walking for two to four

39a

hours, ability to lift and carry up to ten pounds

occasionally, inability to perform bilateral upper

extremity movements, ability to bend and squat

frequently, inability to crawl, climb, being

unprotected heights and moving machinery. Dr.

Patel had also noted additional restrictions and

limitations as no emotional stress or heavy exertion.

In view of the patient's diagnosis of dilated.

cardiomyopathy with complex ventricular

arrhythmias requiring medical management, which

includes diuretics, beta-blockler, AC6 inhibitor, and

potassium supplement long with device

management including AICD and biventricular

pacing, the patient certainly is not able to do any

exertional physical activity. However, based on the

information provided, Ms. Glen was deemed capable

of sedentary activity as per the U.S. Department of

Labor guidelines. I understand that alternative

occupational classes were offered, which included

account information clerk, attendance clerk, or

classified ad clerk. The actual impact of any form of

real or perceived emotional stress on cardiac

arrhythmias, or cardiomyopathy is difficult to gauge

in an individual patient. However, based on Dr.

Patel’s own physical capacity evaluation on June 12,

2002, the patient seems to be a reasonable candidate

to try one of the sedentary job classes at least on a

trial basis. If the job environment entails significant

degree of emotional stress, and the patient is not able

to cope with that, then certainly permanent disability

can be considered. Based on the information, which

is available in the medical records provided to me, it

appears to me that with the appropriate medical

management and biventricular pacing, the patient

has achieved a relatively stable cardiac status. Her

left ventricular ejection fraction has also significantly

40a

improved and in spite of the history of ventricular

arrhythmias in the past, the patient’s defibrillator

had fired only once and that too probably wrongfully

on the basis of sinus tachycardia. In any event, the

patient’s work capacity should improve with the

biventricular pacing as well as evidenced by the

recent clinical trials using the cardiac recent

conization therapy in her type of patients.

If any further information is desired, please do not

hesitate to contact me.

With best regards,

_ts/

Chandrakant Pujara, M.D., F.A.C.C.

CP:EMT:21

{

]

‘

4la

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Pickerington Office * 641 Hill Road North * Pickerington, Oho 43147 * Phone

614/920-3410 * Fax 614/920-3413

Lancaster Office * 2405 North Columbus Street * Lancaster, Ohio 43130 *

Phone 740/653-7511 * Fax 740/655-7512

Richard M. Bardales, MD Charles W. Noble, Il, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Sandeep Chopra, MD Reuben A. Sheares, MD

Michael J. Meleca, MD Shantanu Sinha, MD

February 12, 2003

Mr. Stanley Myers, Attorney at Law

221 S. High Street

Columbus, OH 48215-4503

RE: Wanda Glenn (DOB: 12/11/52)

Dear Mr. Meyers

Thank you for your correspondence dated

January 29, 2003, regarding Wanda Glenn’s

disability issue. In summary, Wanda is a known

patient to me. Initially she was seen by me in 1989

when she presented to the hospital with cardiac

arrest and ventricular fibrillation. At that time she

was worked up extensively and was diagnosed as

having idiopathic dilated cardiomyopathy. She

underwent prophylactic implantation of a

defibrillator. Since then she has been followed up by

me with symptoms related to left ventricular

diastolic dysfunction and cardiomyopathy. Her

ejection fraction has varied from 30% to as high as

40-45%. The patient had recurrent episodes of chest

pains, and in March 2000, she underwent another

coronary angiography at Grant Medical Center. At

42a

that time she did not have any coronary obstructive

disease, however her left ventricular systolic function

was severely impaired. At that time the ejection

fraction came out as low as 20-25%. The patient also

has been in the emergency room at University

Hospitals on one occasion because of firing of her

defibrillator device from sinus tachycardia.

The patient has been on multiple medications for her

dilated cardiomyopathy. The patient has continued

to have difficulty in terms of her exercise intolerance,

general fatigue and tiredness. Apparently, after the

initial event the patient was on temporary disability,

and at that time was advised to seek social security.

She was given social security benefits at that time

and has not worked since then.

Previous reports filled out by me state that the

patient was fit for sedentary work, however based on

her clinical condition and her symptomatology, there

was never a time where I felt that this patient would

be able to return to full-time employment. I strongly

believe that employment would put significant stress

on her overall system, and she may decompensate.

Ms. Glenn does not have any emotional condition

that causes her cardiac problems. She has a cardiac

problem that is exacerbated by any kind of stress.

My position is that she should be considered

completely disabled, mainly from her

cardiomyopathy and associated symptoms from her

LV dysfunction. It is to be noted that the ICD device

that she has is meant *o rrevide defibrillation in case

of veniricular fibm © ©™ »« sudden cardiac death.

This device has net ivii ut terms of improving her

cardiac function.

43a

Please do not hesitate to call me if I can provide any

further information or discussion to clarify the issues

raised by her insurance carrier.

Sincerely,

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCP/sat

a Seles thes 6 eh a ee x

44a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Pickerington Office * 641 Hill Road North * Pickerington, Oho 43147 * Phone

614/920-3410 * Fax 614/920-3413

Lancaster Office * 2405 North Columbus Street * Lancaster, Ohio 43130 *

Phone 740/653-7511 * Fax 740/655-7512

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Sandeep Chopra, MD Reuben A. Sheares, MD

Michael J. Meleca, MD

July 22, 2002

RE: Wanda Glenn (DOB: 12-11-52)

To Whom It May Concern:

Ms. Wanda Glenn has been a patient known to me.

This is a patient that has dilated cardiomyopathy as

well as history of ventricular tachycardia requiring

an implantable defibrillator device. The patient has

been on multiple medications for her dilated

cardiomyopathy. The patient continues to have

significant difficulty with exertional shortness of

breath on any kind of moderate exertion. She also

continues to have significant difficulty in returning

to even any kind of sedentary job because any kind of

psychologic stress at work causes. significant

problems with her cardiovascular condition and she

decompensates fast. This has happened on multiple

occasions in the past. The patient has tried to return

to work in the past with exacerbation of her

symptoms as well as exacerbation of her condition.

At the present time, I do not believe Wanda should

be forced to return to any kind of even sedentary

work particularly because it is the psychologic stress

45a

of work that really exacerbates her cardiovascular

condition and symptomatology. The patient basically

should be considered completely disabled from her

dilated cardiomyopathy as well as history of

ventricular tachycardia.

Please do not hesitate to call me if I could provide

any further details or further discussion in this

matter. With best regards.

Sincerely,

/s/

Rajendra C. Patel, MD, FACC

Dictated, but not reviewed.

RCP/clo

46a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Pickerington Office * 641 Hill Road North * Pickerington, Oho 43147 * Phone

614/920-3410 * Fax 614/920-3413

Lancaster Office * 2405 North Columbus Street * Lancaster, Ohio 43130 *

Phone 740/653-7511 * Fax 740/655-7512

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Sandeep Chopra, MD Reuben A. Sheares, MD

Michael J. Meleca, MD

June 18, 2002

RE: Wanda Glenn (DOB: 12-11-52)

Choo Y Rhee, MD

1492 E Broad St #1604

Columbus OH 43205

Dear Choo:

Ms. Glenn was back in our office earlier than

expected. The patient complains of general tiredness

and she says she has gained weight. She describes

exercise intolerance and shortness of breath on

moderate exertion.

Physical examination today, however, revealed no

evidence of JVD or carotid bruits. Lungs are

bilaterally clear. Cardiac auscultation revealed a

regular rhythm with an S4 gallop. Abdomen was

benign. Extremities revealed no ankle edema and

good pedal pulses.

Electrocardiogram shows sinus rhythm with P

tracking pacemaker functioning normally. If you

recall, the 2D echocardiogram in December of this

year showed an ejection fraction of 35 to 40%.

47a

I believe most of her exercise intolerance is from

dilated cardiomyopathy.

At the present time, in the absence of any overt

congestive heart failure, I have decided to hold off on

any further imaging or another echocardiogram. I

have advised her to continue her current

medications. There is also significant anxiety on her

part regarding the disability and having to return to

work. From my standpoint, again, considering her

cardiomyopathy, I do not believe she will handle any

kind of stress well at her work and she would be

better off being on disability. I will keep you posted

regarding her progress.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCPY/bjj

48a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, II], MD

April 30, 2002

Choo Y Rhee, MD

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn (DOB: 12-11-52)

Dear Choo:

Ms. Glenn was back in our office today for cardiac

followup. Since her last visit she has had no further

ICD shocks. As you recall, she still gets extremely

short of breath, particularly under any kind of

emotional stress as well as any kind of significant or

heavy exertion. Fortunately she remains free of any

PND, orthopnea, or leg edema.

Current medications include: Lasix, KCI, Lanoxin,

Norvasc, aspirin, calcium, Normodyne, Diovan and

Plavix. She had an ICD interrogation and the ICD

battery is coming to it end of life. She has been

scheduled for ICD revision and at that time they are

also planning to move the power pack device away

from the breast tissue.

From a cardiac standpoint, her physical examination

revealed no evidence of JVD or carotid bruits. Lungs

49a

are bilaterally clear. Cardiac auscultation revealed

regular rhythm with an S4 gallop. Abdomen and

extremities were unremarkable. Blood pressure was

140/80.

At the present time I have advised Wanda to

continue current medications, continue her ICD

follow-up with Dr. Chuck Lowe at Ohio State and

from a cardiac standpoint I plan to see her back in

four months.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCP/bjj

50a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/645-0107

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, II], MD

February 5, 2002

Choo Y. Rhee, MD

1492 E Broad St #1604

Columbus, OH 43205

RE: Wanda Glenn (DOB: 12-11-52)

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow-up. In November or December, she was seen

at Mount Carmel East with symptoms of TIA and

was started on Plavix over and above her aspirin.

Also; last month she was seen at Ohio State

University Hospital main campus because of ICD

shock. At that time, the ICD interregation

apparently showed some form of sinus tachycardia.

She was seen by a cardiology fellow over there and

somehow the information was passed on to the

emergency room physician who was advised to start

the patient on beta blockers. Interestingly enough, I

am not sure whether anybody looked into the chart

in detail. Ms. Glenn is already on Normodyne 200

mg po BID. Fortunately, she has had no further

shocks. She continues to have exertional shortness

of breath on any kind of emotional excitement or any

5la

kind of significant physical exertion A 2-D

echocardiogram in December shows the LV

dysfunction being progressive. [Ejection fraction

again has gone back down to 35-40%. I have advised

Ms. Glenn at the present time to go to see Dr. Chuck

Love at Ohio State regarding her ICD adjustment.

Meanwhile, from a cardiac standpoint I have advised

her to continue her current medications, including

Lasix, potassium, Lanoxin, Norvasc, aspirin,

calcium, Normodyne, and Diovan, as well as Plavix.

She did have some questions about all her

-medications, particularly since she is going to face

the jury and the court regarding the long-term

disability, and I gave her an extensive idea about her

medications as well as her current heart condition.

From a cardiac standpoint, I plan to see her back in

three months.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/ _

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCP/sem

52a

Metropolitan Life Insurance Company MetLife

PO Box 14590, Lexington, KY 40511-

4590

MetLife Disability

June 5, 2002

Dr. Raj Patel

423 E. Town St.

Columbus, OH 43215

RE: Wanda Glenn

DOB: 12/11/52

Claim #: 690008108949

Dear Dr. Patel:

Thank you for the information you have provided for

your patient Wanda Glenn. At this time we are in

need of additional medical information so that we

may proceed with our evaluation of the claim. We

would appreciate your assistance in providing us

with the following:

Please complete and return the enclosed

Physical Capacities Evaluation. Also, please

send us photocopies of the medical records

from November 3, 2001 through current,

including test res ilts, medication flowcharts,

and physical therapy notes. This information

needs to be faxed to my attention, with the

claim number on the fax cover sheet.

Please fax above to my attention at: 866/690-1264.

53a

Enclosed you will find a signed authorization from

our claimant. We look forward to your prompt

response. If there will be a fee for your service,

please enclose with your tax ID#.

If you have any questions, please contact our

Customer Response Center at 888/868-3997.

Sincerely,

/s/

Earl Chesler

Case Management Specialist

54a

MetLife

Physical Capacities Evaluation

Name of Wanda Glenn Birth 12/11/52

Claimant Date:

Important: Please complete the following items based on your

clinical evaluation of the claimant and other testing results.

Any items that you do not believe you can answer should be

marked n/a (not answerable).

Note: In terms of an 8 hour workday “occasionally” equals 0%

to 33%; “frequently,” 34% to 66%; “continuously,” 67% to 100%

I. In au 8-hour workday, claimant, can: (Circle full capacity

for each activity)

A.) Sit ‘Hoo. £326 2 e's

B.) Stand- No- 1 2 3 4 5 6 7 8 (hrs.)

C.) Walk - No- 1 § 6 7

Il. Claimant can Never Occasionally Frequently Continuously

lift

A.) Up to 10 Ibs.(__)

B.) 11-20 Ibs. (y_)

(

C.) 21-50 lbs. Cv) (

(

D.) 51-100 Ibs. (_v_)

E.)100+lbs (Vv)

ee a ed

a a TE ce TE ce EE ec,

III. Claimant can Never Occasionally Frequently Continuously

carry

A.) Up to 10 lbs. )

B.) 11-20 lbs. (y_)

a aa

(

C.) 21-50 lbs. Cv) (

(

)

D.) 51-100 Ibs. (_v_)

E.)100+lIbs (y_)

(

Fe EE ee EE a,

eee ee”

)

55a

IV. Claimant can use hands for repetitive action such as:

Simple Grasping Pushing & Pulling Fine Manipulating

A.) Right (Vv) Yes ()No (v¥)Yes (.)No (y) Yes (.)No

B.) Left (Vv) Yes ()No (y¥)Yes ()No (y) Yes (.) No

. Claimant can use feet for repetitive movements as in

operating foot controls:

Right Left Both

(vV)Yes(_)No (_)Yes(_)No (_) Yes(_)No

. Claimant is able Not at Occasionally Frequently Continuously

to: all

A.) Bend -

B.) Squat Ric 5

C.) Crawl Cv)

Cy)

‘3

D.) Climb

E.) Reach

above

shoulder level

i i ed

Restriction of None Mild Moderate Total

activities involved

A.) Unprotected

heights oe Co oe eee

B.) Being around

moving

machinery Rie cad - a ae

C.) Exposure to

marked changes in

temperature or

humidity Rua Gad ed: Oo

D.) Driving

automative

equipment ( ) (

E.) Exposure to

dust, fumes &

gases aoe ee Oe ee ee ee

nail eM Good

és

: ss

56a

i 10

Remarks (on above, on other functional limitations):

No emotional stress / no heavy exertion

Date 6/12/02 Signature of /s/

5 Physician

Please mail directly to: Metropolitan Life Insurance Company

P.O. Box 14590

Lexington, KY 40511

57a

Metropolitan Life Insurance

Company

MetLife

MetLife Disability, PO Box

14590,

Lexington, KY 40511-4590

Phone: 1-888-888-3997

Fax: 1-647-391-1727

March 12, 2002

Dr. Rajendra .Patel Re: Wanda Glenn

Capitol City Claim # 69008910849

Cardiology SS# [OMITTED]

423 E. Town Street

Columbus, OH 43215

Dear Dr. Patel,

MetLife Disability Imsurance is_ currently

administering Long-Term Disabilit:y benefits for your

patient, Ms. Wanda Glenn. We are evaluating her

ability to resume a functional lifestyle and her ability

to return to fulltime work within her capabilities. To

complete our assessment we need your input and

kindly ask that you complete the following in

consideration of full-time work.

On the Physical Capacities Evaluation form dated

January 9, 2002, you have indicated Ms. Glenn’s

ability as the following:

> lift and carry up to twenty pounds occasionally

>» ability to perform bilateral repetitive foot and

hand movements

58a

7 > restriction from unprotected heights, being

around machinery, dust, fumes and .

: temperature changes.

| * Please indicate Ms. Glenn’s full capacity to

- perform sitting, standing or walking in an eight-

. hour day.

Sitting 8 # of hours

Standing _4 # of hours

i Walking _2 # of hours

* Do you believe Ms. Glenn is able to work in a

sedentary physical exertion level occupation?

>. a

* With or without accommodations? Please describe

* If No, please explain current physical barriers

preventing Ms. Glenn from returning to fulltime.

N/A

Ls/ 3/13/02 _

Physician Signature Date

If you have any questions call me at 1-888-868-3997,

extension 3337. My office hours are Monday through

Friday 8:00 A.M. to 4:30 P.M., CST.

Sincerely,

Lisa Hissem, MS, CRC

Vocational Rehabilitation Consultant

59a

MetLife

Physical Capacities Evaluation

Name of Wanda Glenn Birth 12/11/52

Claimant Date:

Important: Please complete the following items based on your

clinical evaluation of the claimant and other testing results.

Any items that you do not believe you can answer should be

marked n/a (not answerable).

Note: In terms of an 8 hour workday “occasionally” equals 0%

to 33%; “frequently,” 34% to 66%; “continuously,” 67% to 100%

I. In an 8-hour workday, claimant, can: (circle full capacity for

each activity)

aime = @- £88 & 8 SE

B.) Stand- No- 1 2 3 4 5 6 7 8 (hrs)

C.) Walk - No- 1 2 3 4 56 6 7

II. Clatmeatcan Never Occasionally Frequently Continuously

lift

A.) Up to 10 Ibs.(__) (__y__)

B.)11-20lbs. ( ‘=

C.) 21-50 lbs. (y_) ¢ )

D.) 51-100 Ibs. (y_) ¢ )

E.)100+lIbs (y_)¢ )

(

ee ee ee

Ce a, EE a, TE

III. Claimant can Never Occasionally Frequently Continuously

carry

A.) Up to 10 lbs. ( )

B.) 11-20 lbs. ( )

(

C.)21-50lbs. Cy_) ¢

(

Fe ee ee

ee eee

D.) 51-100 Ibs. (y_)

E.) 100 + lbs (vy)

ee ee a

Fe EE ee ee

a a

60a

IV. Claimant can use hands for repetitive action such as:

Simple Grasping Pushing & Pulling Fine Manipulating

A.) Right (v) Yes ()No (y)Yes()No (wy) Yes ()No

B:) Left (y¥) Yes ()No (v)Yes()No (vy) Yes ()No

. Claimant can use feet for repetitive movements as in

operating foot controls:

Right Left Both

(vy) Yes(_)No (v)Yes(_)No (Cy) Yes(_) No

. Claimant is able Not at Occasionally Frequently Continuously

to: all

A.) Bend es ae Fee = )

B.) Squat me Fs Ss See iz )

C.) Crawl (Cv) ¢( . ¥ 4 )

D.) Climb Cy) ( = .¢ )

E.) Reach SS ye tS ee > )

above

shoulder level

Restriction of None Mild Moderate Total

activities involved

A.) Unprotected

heights = a » ( ») CW)

B.) Being around

moving

machinery ( ) ( ) ( ) (Cv)

C.) Exposure to

marked changes in

temperature or

humidity ( ) ( » ( . eg

D.) Driving

automative

equipment Risskal ( = Gas

6la

E.) Exposure to

dust, fumes &

gases = ay Wee s

Remarks (on above, on other functional limitations):

More LF dysfunction noted on recent Echo.

Date 1/9/02 Signature of /s/

Physician

Please mail directly to: Metropolitan Life Insurance Company

P.O. Box 14590

Lexington, KY 40511

62a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

November 2, 2001

Choo Y Rhee, MD

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn (DOB: 12/11/52)

Dear Choo:

Ms. Glenn was back in our office today for cardiac

followup. As you know, she is a 48-year-old female

with severe dilated cardiomyopathy as well as a

previous histor,’ of cardiopulmonary arrest and

sudden cardia: death from which she was

successfully resuscitated. She now has an ICD in

place along with biventricular or InSync pacing.

If you recall, last Mach a 2D echocardiogram

showed some improvement in her LV function. She

continues to have better exercise tolerance than

before. She, however, still gets fatigued out and

short of breath, particularly if she is under any kind

of significant psychologic stress. She denied any

PND, orthopnea or leg edema.

Physical examination today revealed no evidence of

jugular venous distention or carotid bruits. “Lungs

63a

were bilaterally clear. Cardiac auscultation revealed

a regular rhythm with an S4 gallop. Abdomen was

benign. Extremities revealed no ankle edema and

good pedal pulses.

Electrocardiogram shows sinus rhythm with mild

resting sinus bradycardia at a rate of about 90 beats

per minute with InSync dual-chamber pacing.

From overall evaluation, Wanda seems to be

clinically stable and I have advised her to continue

her current regimen including Lasix, potassium,

Lanoxin, Norvasc, aspirin, calcium, Normodyne and

Diovan. If you recall, she could not take Zestril

because of a significant cough.

I plan to see her back in three months.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

Is/

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCPY/bijj

64a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove C#*-, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-C |

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel,

Reuben A. Sheares, ITI, MD

August 3, 2001

Choo Rhee MD

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn (DOB: 12/11/52)

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow-up. As you know, she is a 48-year-old female

with a history of dilated cardiomyopathy and now

has an ICD in place along with biventricular pacing.

Since her last visit she has had some social probiems

at home and is now going to divorce. Recently she

has noted increasing fatigue and tiredness as well as

exercise intolerance. Fortunately, however, she

denied any PND, orthopnea or leg edema.

Physical examination today in my office revealed no

evidence of jugular venous distention or carotid

bruits. Lungs were bilaterally clear. Cardiac

auscultation revealed a regular rhythm with an

impressive S4 gallop. Abdomen and extremities

were unremarkable. Blood pressure was 140/90.

65a

Apparently she could not tolerate Zestril because of

cough and she is. now on Diovan.

From my standpoint she looks clinically well

compensated. However, I am concerned about her

increasing general fatigue which could be from all

her psychosocial problems or there could be some

involvement of her cardiac status causing her

symptoms. At this stage, however, I have reassured

her that I do not see any overt congestive heart

failure. My inclination would be to see her back in

three months. Depending on her clinical status at

that time, we might consider another ultrasound to

make sure that the LV function is not getting worse.

I will keep you posted regarding her progress.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

Ls/_

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCP/bjj

MetLife MetDisAbility

Attending Physician’s P.O. Box 3043

Statement of Functional Utica, NY 13504-

Capacity 3043

The information provided is to be used for claims

evaluation and auditing purposes only.

The patient is responsible for having this form

completed without expense to Metropolitan or the

Employer.

Patient Name

First Middle Last

WANDA GLENN

Group Number

0031003

Social Security #

[OMITTED]

1. History and Diagnosis

A. Date symptoms first appeared/or accident

occurred: 02-1-00

Date patient ceased work: 04-30-00

Date of most recent examination: 11-2-01

Frequency of visits: 2-3 months -

Past history:

Subjective symptoms:

Objective findings (including test results):

TOs moO &

. Primary diagnosis affecting werk ability:

CMP - Idiopathic, SOB, fatigue, CHF,

67a

Hypertension

I. Secondary diagnosis affecting work ability:

J. Present and future course of treatment:

K. Other known injuries or presently active

diseases that may affect work abilities:

2. Does patient’s medical condition allow exposure

to the following; please check appropriate box and

explain any limitation below:

No Some Avoid Cannot

Limitation | Limitation | Completely | Determine

Dust/Gasses/Fumes

Chemicals/Solvents

Temperature See

Extremes Attached

Noise Levels

Allergenic Agents

Stairs/Ladders

Scaffolds/Heights

Enclosed Spaces

Drafts/Damp Areas

Explanation:

3. Because of the patient’s medical conditions, are

there any limitations on any of the following

activities; please check appropriate box and

explain any limitation below:

No Some Avoid Cannot

= , Limitation | Limitation | Completely | Determine

Transportation

Standing

Sitting —

Change of Position

(sitting/standing)

Limitation

Avoid

Completely

Cannot

Determine

Assuming

Cramped/Unusual

| Positions

Rea

ching

_(forward/overhead)

Attached

"Balancing

(exposure to

falling)

Bending/Stooping/

uatti

Operating

Truck/Dolly/Small

Vehicle

Operating Heavy

Equipment

Operating

Electrical

Equipment

Concentrated

Visual Attention

Other

Explanation:

4. Evaluation of carrying and lifting abilities

includes both the intensity and frequency of the

activity. For each weight class listed below,

please indicate the reasonable top limit of

frequency. Please provide an explanation below

69a

with any additional comments regarding

limitations on duration, handlability and distance

(in front of body and above floor).

Intensity Frequency: Percentage of Workday

. Less than Greater

in Pounds | Never 20% 20% - 60% | than 60%

0-15 v

16-30

31-45

Greater

than 45 L

Explanation:

5. Is there a past or present psychological problem

that might interfere with the patient’s ability to

work? If yes, please list your findings according

to the DMS-tti multiaodal classification.

‘Yes [J No [] Not Determined [_]

Explanation: See attached

6. If you have any additional information that is

relevant to patient’s work ability, please indicate

below.

See attached

7. Progress Evaluation

Recovered [_] Improved [_] Unimproved

Retrogressed

(Please check appropriate box and explain below:)

70a

Explanation:

8. Disability Evaluation

Is patient now totally disabled?

For Any O i For His/Her 0 r

Cannot Cannot

Yes ] No[_] Determine[] Yes[_] No [X Determine [_}

If No, when was patient able to resume work

activities?

For Any O ) For His/Her 0 i

Cannot Cannot

Determine [_] Determine [_]

If Yes, when do you think patient will be able

to resume work activities:

Occupation

Approximate

Date: Never

Indefinite:

Never: ‘

Cannot

Determine:

Raj Patel MD

Name of Physician Board Certified

Specialty

423 E. Town St Cols. OH 43215

Street Address City or Town State

(614) 464-0884 /s/ 12/19/01

Telephone Number Date Signature

T7la

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479 -6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

April 6, 2001

Choo Y. Rhee, M.D.

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn (DOB: 12/11/52)

Dear Choo:

Ms. Glenn was in our office today, earlier than

expected. As you know, she is a 48-year-old female

with dilated cardiomyopathy, complex ventricular

arrhythmias, and an ICD in place. The recent ICD

change was combined with biventricular pacing,

which is a new technique for patients with

cardiomyopathy to improve the synchronized left

ventricular wall motion. Ms. Glenn came in earlier

to see us because she has been experiencing some

general fatigue. Interestingly enough, she says that

she is doing more than before; however, after she has

done an activity, she feels tired for a day or so.

Apparently she used to only walk two laps at the

mall, and now she is walking four or more laps. She

is also walking four or five times a week, rather than

two to three times a week. She denies any exertional

72a

angina, excessive shortness of breath, paroxysmal

nocturnal! dyspnea or orthopnea.

Physical examination revealed no jugular venous

distention or carotid bruits. Lungs are bilaterally

clear. Cardiac auscultation reveals regular rhythm

with an S4 gallop. Abdomen and extremities are

unremarkable. Blood pressure was 148/98.

Ms. Glenn was extremely concerned about her LV

function and we did do a 2D echocardiogram on her,

and this showed an left ventricular ejection fraction

anywhere from 40% to 50%, which is much better

than 30% which was seen on previous studies.

I am not sure whether the biventricular pacing has

improved her ejection fraction, or whether she is

clinically improving spontaneously. At the present

time I have reassured her regarding the absence of

any deterioration, and I have explained that her

ejection fraction looks slightly better. I have advised

her to continue her activity at the current level,

trying to gradually increase it; however, she should

not push herself beyond her limit.

I plan to see her back now in four months, and I

deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCP/cjm

73a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

ECHOCARDIOGRAPHIC REPORT

Test Date: March 28, 2001

Patient Name: Wanda Glenn

Ref. Physician: Rajendra C. Patel, MD

Patient History: Idiopathic cardiomyopathy

with Implantable defibrillator

2D: X} M-Mode: X] Doppler:

Tape #: 10

Age: 48

PCP: Choo Rhee, MD

Wt:

Ht:

E ] li } . M t:

Aortic Root _ 3.5 (2.0-4.0)

AoV Opening - 2.0 (1.5-2.6)

Lt. Atrium - 3.2 (1.9-4.0)

Pl. Effusion -

Sm.{[] Mod.[] Lg.C}

74a

RVD - 19 (0.9-2.6)

IvS - 11 (.7-1.1)

LVD - 6.2 (<5.6)

LVS - $8.2 (<3.5)

LVPW - 11 (0.7-1.1)

RVSP - mm/Hg.

HR - 106 BPM

EF - #@ &

Interpretation:

The indication for this study is to evaluate a

cardiomyopathy.

Standard 2-D, pulse, continuous wave and color-flow

echocardiography were performed. The study is

technically good. There is no pericardial effusion.

Both atria are normal. The tricuspid, mitral and

aortic valves are structurally normal. There is a

catheter in the right ventricle which is probably a

pacemaker. There is an echogenic area running

across the tricuspid valve annulus which may be a

coronary sinus catheter. The left ventricle has a

normal diastolic dimension and normal wall

thickness. Systolic function is at the lower limits of

normal. I put it at 45-50%. In one view it appears

that the inferior base is akinetic. Doppler evaluation

reveals normal function in the mitral, tricuspid and

aortic valves. Mitral diastolic flow is consistent with

diastolic dysfunction.

CONCLUSION: This study demonstrates evidence

of mildly reduced ejection fraction.

Technician /s/ Cardiologist /s/

David Cowles, Bruce L.

BS, RDCS Auerbach, MD,

FACC

75a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Grove City Office * 2041 Strongtown Road * Grove City, Ohio 43123 * Phone

614/545-0101 * Fax 614/545-0107

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, ML Charles W. Noble, Il, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, LII, MD

December 15, 2000

Choo Y. Rhee, MD

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn (DOB: 12/11/52)

Dear Choo:

Ms. Glenn was back in cur office today for cardiac

follow-up. As you know, she is a 48-year-old female

with dilated cardiomyopathy as well as complex

ventricular arrhythmias and diabetes. She continues

to have good days and bad days; however, mostly she

is remaining out of any significant failure. Recently

her ICD was revised and now she has an ICD with

three leads and biventricutar pacing, which is a new

technique for patients with cardiomyopathy. She

does feel slightly different in terms of how her hearts

beats; however, she remains free of any excessive

shortness of breath, paroxysmal nocturnal dyspnea,

or orthopnea.

Physical examination in my office showed no jugular

venous distention or carotid bruits. Lungs were

bilaterally clear. Cardiac auscultation revealed

76a

regular rhythm with an S4 gallop. Abdomen and

extremities are unremarkable. Electrocardiogram

showed an interesting EKG of biventricutar pacing

with beat tracking.

From overall evaluation, it seems Ms. Glenn is doing

clinically well. In the absence of any new symptoms

I have advised her to return in six months for follow-

up. If you recall, she also follows up with Dr. Carl

Leier once a year for her dilated cardiomyopathy and

she sees Dr. Charles Love at Ohio State University

for her pacemaker follow-up.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/_

Rajendra C. Patel, MD, FACC

Dictated, but not read.

RCP/sem

77a

MetLife Met DisAbility

Attending Physician’s P.O. Box 3043

Statement of Functional Utica, NY 13504-

Capacity 3043

The information provided is to be used for claims

evaluation and auditing purposes only.

The patient is responsible for having this form

completed without expense to Metropolitan or the

Employer.

Patient Name

First Middle Last

WANDA GLENN

Group Number

0031003

Social Security #

(OMITTED)

1. History and Diagnosis

A. Date symptoms first appeared/or accident

occurred: 02-1-00

Date patient ceased work: 04-30-00

Date of most recent examination: 07-28-00

Frequency of visits: every 3 months

Past history:

Subjective symptoms:

Objective findings (including test results):

. Primary diagnosis affecting work ability:

CMP - Idiopathic, SOB, Fatigue

Secondary diagnosis affecting work ability:

ZO sO w

—

—-'78a

J. Present and future course of treatment:

K. Other known injuries or presently active

diseases that may affect work abilities:

2. Does patient’s medical condition allow exposure

to the following; please check appropriate box and

explain any limitation below:

No Some Avoid Cannot

Limitation | Limitation | Completely | Determine

Dust/Gasses/Fumes

Chemicals/Solvents

Temperature See

Extremes Attached

Noise Levels

_Allergenic Agents

Stairs/Ladders

Scaffolds/Heights rg

Enclosed Spaces [| | ~~

Drafts/Damp Areas

Explanation:

3. Because of the patient’s medical conditions, are

there any limitations on any of the following

activities; please check appropriate box and

explain any limitation below

—

No Some Avoid Cannot

Limitation | Limitation | Completely | Determine

Transportation

Standi

Sitti

Change of Position

(sitting/standing)

Assuming

Cramped/Unusual

Positions

No Some Avoid Cannot

Limitation | Limitation | Completely | Determine

Reaching

(forward/overhead)

sting (arm/leg See

controls) Attached

| Grasping/Handling

Finger Dexterity

Repetitive

Movement

(hands/feet)

Climbing

(stairs/ladders/scaffo

lds)

Balancing (exposure

to falling)

Bending/Stooping/S

_quatting

Operating

Truck/Dolly/Small

Vehicle

Operating Heavy

Operating Electrical

Equipment

Concentrated Visual

Attention

Other

Explanation:

4. Evaluation of carrying and lifting abilities

includes both the intensity and frequency of the

activity. For each weight class listed below,

please indicate the reasonable top limit of

frequency. Please provide an explanation below

with any additional comments regarding

limitations on duration, handlability and distance

(in front of body and above floor).

80a

; Frequency: Percentage of Workday

he ~ceam Less than Greater

Never 20% 20% - 60% | than 60%

0-15 v

16-30

31-45

Greater

than 45

Explanation:

5. Is there a past or present psychological problem

that might interfere with the patient’s ability to

work? If yes, please list your findings according

to the DMS-tti multiaodal classification.

Yes [_] No [] Not Determined [_]

Explanation: See attached

6. If you have any additional information that is

relevant to patient’s work ability, please indicate

below.

See attached

7. Progress Evaluation

["] Recovered [_] Improved [ ] Unimproved

[_] Retrogressed

(Please check appropriate box and explain below:)

Explanation:

8la

8. Disability Evaluation

Is patient now totally disabled?

For Any 0 r For His/Her O i

Cannot Cannot

Yes ] No[_] Determine[[} Yes[_] No XJ Determine [_]

If No, when was patient able to resume work

activities?

— i For His/Her O i

Cannot Cannot

Determine [_] Determine [_]

If Yes, when do you think patient will be able

to resume work activities:

For Any For His/Her Occupation

Occupation

Approximate

Date: Never

Indefinite:

Never:

Cannot

Determine:

Raj Patel MD

Name of Physician Board Certified

Specialty

423 E. Town St. Cols. OH 43215

Street Address City or Town State

(614) 464-0884 11/20/00 /s/

Telephone Number Date Signature

82a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43226 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

April 7, 2000

Choo Y. Rhee, M.D.

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow-up. As you know, she underwent coronary

angiography at Grant Medical Center which showed

evidence of primary dilated cardiomyopathy with an

LV ejection fraction now of about 20-25%. She was

started on Zestril 5mg. po qd which she is tolerating

well. She continues to be generally fatigued and has

some exertional shortness of breath. She denies any

paroxysmal nocturnal dyspnea, orthopnea or leg

edema. Her main problem now is the stress at work.

She works in a Sears eataleg store and does have

physical as well as psychologic stress. Considering

her low ejection fraction, I feel that she may not be

able to continue to work in any kind of environment

that would cause any significant physical or

psychologic stress and demands.

83a

At the present time I have advised her to try for

disability. I have also advised her to increase the

Zestril dose to 10mg. a day. I have advised her to get

a chem-7 study done in about a week to make sure

that she is tolerating the ACE inhibitor well without

any electrolyte disturbances. Down the road my

inclination would be to increase the Zestril dose to

about 20mg. a day as tolerated. She is already on a

beta blocker (Normodyne) and Lanoxin. She was

seen by Dr. Charles Love at Ohio State University

for her pacemaker follow-up, and he is planning to

refer her to the cardiomyopathy clinic at Ohio State

University Hospitals.

From a cardiac standpoint, I plan to see her back in a

couple of months; however, depending on where she

goes for her cardiac follow-up, I will decide whether I

will be continuing to see her on a regular basis.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/

Raj. C. Patel, MD, FACC

Dictated, but not read.

RCP/cjm

84a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, Il, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

July 28, 2000

Choo Y. Rhee, M.D.

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow up. As you know, she is a 47-year-old female

with a history of idiopathic dilated cardiomyopathy

as well as complex ventricular arrhythmias requiring

a defibrillator. She has been evaluated by Dr. Carl

Leier because of progressive LV dysfunction

regarding the possibility of a cardiac transplant if

needed. Fortunately, she showed good functional

capacity and tolerance at the non-invasive workup at

Ohio State University Hospital and at the present

time has been under surveillance by Dr. Carl Leier.

He is planning to see her once a year. Ms. Glenn still

wants me to be her primary cardiologist. She

basically has felt much better since last visit. I feel

some of her improvement is from the reduction of

stress and strain of work. She still has good and bad

days and in fact there are periods where she feels

85a

extremely tired and fatigued and runs out of steam.

She fortunately, denies any paroxysmal nocturnal

dyspnea, orthopnea or leg edema. Recently, she was

seen in your office because of significant non-

productive cough which possibly was related to

Zestril and since then has been switched to Diovan.

Other medications include Lasix, potassium,

Lanoxin, Norvasc, aspirin and calcium as well as

Normodyne.

Her physical examination today in my office reveled

no evidence of jugular venous distention or carotid

bruits. Lungs are bilaterally clear. Cardiac

auscultation revealed regular rhythm with an S4

gallop. Abdomen was benign. Extremities reveal no

ankle edema no acute distress good pedal pulses.

From overall evaluation it seems Wanda is doing

clinically well. I have advised her now to return in

four months for re-evaluation. Meanwhile, I have

advised her to look for a permanent defibrillator

considering her significant LV dysfunction. She will

also be seeing Dr. Carl Leier once a year for her

progressive myocardial disease.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/_

Raj. C. Patel, MD, FACC

Dictated, but not read.

RCP/cb

86a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, Il, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

April 28, 2000

Choo Y. Rhee, M.D.

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow up. She has been tolerating her Zestril well.

Her chem 7 looked okay. I have now decided to

increase her Zestril to 20 mg a day since her blood

pressure today was 150/100. As you know, the other

medications include Lasix, potassium supplement,

Lanoxin and Norvasc as well as Normodyne. Ms.

Glenn had multiple questions about her activity level

and role of exercise program. i explained to her that

aerobic type of exercises will definitely help her

cardiovascular condition and in fact if her insurance

company would approve it would be best for her to

join a cardiac rehabilitation program for her dilated

cardiomyopathy. I also answered some of her

questions regarding her prognosis. I explained to

her that prognosis in this condition is quite variable

and it depends on the progression of her disease.

87a

Periodic 2D echocardiographic studies as well as

clinical evaluation will help to evaluate her progress.

Ms. Glenn is planning to go to Ohio State for further

evaluation of her cardiomyopathy and I agree with

the plan.

From cardiac standpoint, I have advised her to see

me back in three months, however, if she decides to

have all her care taken at Ohio State University

Cardiology Group, I would have no problems with

this. I have advised her to have them contact me if I

could provide any further details regarding her

previous history.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

/s/

Raj. C. Patel, MD, FACC

Dictated, but not read.

RCP/cb

88a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, Il, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

April 19, 2000

RE: Wanda Glenn

TO WHOM IT MAY CONCERN:

Ms. Wanda Glenn is a patient of mine who suffers

from severe dilated cardiomyopathy. This patient

has significant difficulty with general fatigue and

exertional shortness of breath because of her cardiac

condition.

From my standpoint, this patient cannot return to

any kind of job that would require any significant

physical or psychologic demands on her.

Please do not hesitate to call me if I can provide any

further information in this matter. With best

regards.

Sincerely,

_Its/

Raj. C. Patel, MD, FACC

Dictated, but not read.

RCP/bjj

89a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Reuben A. Sheares, III, MD

March 13, 2000

Choo Rhee, MD

1492 E Broad St

Columbus OH 43205

RE: Wanda Glenn

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow-up. Her adenosine cardiolite study did not

show any inducible ischemia, however, it did show a

fixed anterior defect which could be from breast

attenuation, or it could represent an area of severe

ischemia or infarction. Also, her ejection fraction

was as low as about 22%, which is markedly reduced

compared to her ejection fraction in the past which

has been as high as 40-45%. Wanda had another

episode of chest tightness while coming to our office.

She describes continued difficulty with exertional

chest tightness.

I advised her to undergo coronary angiography,

particularly because of the progression of her LV

dysfunction as well as continued symptoms. She has

agreed with this. I had a lengthy discussion with her

and her husband regarding the pros and cons of such

90a

a procedure along with the risks and possible

complications.

I will keep you posted regarding the cardiac

catheterization findings, and then make additional

recommendations as needed. I deeply appreciate the

opportunity to participate in her care.

Sincerely,

SLs/_

Raj. C. Patel, MD, FACC

Dictated, but not read.

RCP/cjm

9la

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43130 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, II, MD

Barney B. Beaver, DO Rajendra C. Patel, MD

Rajesh D. Gagiani, MD Reuben A. Sheares, III, MD

March 15, 2000

Choo Y. Rhee, MD

1492 E Broad St #1604

Columbus OH 43205

RE: Wanda Glenn

Dear Choo:

Ms. Glenn underwent coronary angiography which

basically showed normal coronary angiography with

no evidence of coronary obstructive disease. Left

ventricular cineangiography showed severe dilated

cardiomyopathy with an ejection fraction of about 20-

25%. She was started on Zestril (5 mg) po qd as an

ACE inhibitor along with her other medications, and

I will titrate this ACE inhibitor dose as tolerated.

I deeply appreciate the opportunity to participate in

her care.

Sincerely,

_ls/_

Raj. C. Patel, MD, FACC

Dictated, but not read.

RCPY/tjs

92a

CAPITOL CITY CARDIOLOGY

Main Office * 423 East Town Street * Columbus, Ohio 43225 * Phone 814/444-

0884 800/479-6802* Fax 614/464-3440

River View Medical Office * 2405 North Columbus Street, Suite 130 *

Lancaster, Ohio 43.30 * 740-653-7511 * Fax 740/653-7512

Bruce L. Auerbach, MD Michael J. Meleca, MD

Richard M. Bardales, MD Charles W. Noble, Il, MD

Barney B. Beaver, DO Rajandra C. Patel, MD

Rajesh D. Gaglani, MD Reuben A. Sheares, III, MD

March 3, 2000

Choo Y. Rhee, M.D.

1492 E Broad St #1604

Columbus, OH 43205

RE: Wanda Glenn

Dear Choo:

Ms. Glenn was back in our office today for cardiac

follow-up. As you know, she is a 47-year-old female

with history of sudden cardiac death syndrome,

chronic left bundle branch block, and primary

myocardial disease, moderate LV _ systolic

dysfunction and normal coronary angiography. She

had a cardiac catheterization in 1993. She has an

ICD device which is being followed up by Dr. Love at

Ohio State University Hospital. Ms. Glenn has been

clinically stable on medical regimen and has not seen

me for awhile. She now returns to see me because of

concerns about substernal chest tightness. The chest

tightness is in the form of vague heavy pressure

which lasts several hours at a time, not always

related to exertion or emotional excitement.

Episodes come and go however they have become a

little more frequent and concerning to her. She

93a

denies any exertional shortness of breath,

paroxysmal nocturnal dyspnea or orthopnea. She

denies any dizziness or syncope.

Current medications include Lasix, potassium

supplement, Lanoxin, Norvasc, aspirin, Normodyne,

as well as calcium supplement. She does not smoke

and denies any alcohol overuse.

Physical examination revealed a 47-year-old fe~ale

with normal physical build. She is warm and dry.

There is no jugular venous distention or carotid

bruits. Lungs were bilaterally clear. Cardiac

auscultation revealed regular rhythm with an S4

gallop. Abdomen was benign. Extremities revealed

no ankle edema and _ good pedal pulses.

Electrocardiogram shows chronic left bundle branch

block with secondary ST changes. The EKC is

unchanged from previous tracings.

From overall evaluation it seems Ms. Glenn is

having difficulty with recurrent chest pains, chest

tightness and pressure. I am not sure whether we

are dealing with ischemic heart disease or whether

this is non-cardiac chest discomfort. Considering her

dilated cardiomyopathy and chronic left bundle

branch block, I have decided to do a 2D

echocardiogram and Adenosine Cardiolite study to

evaluate this situation further, and depending on the

findings, I will make additional recommendations

regarding coronary angiography or medical

management.

I deeply appreciate the opportunity to participate in

her care.

95a

MetLife Met Disability

Attending Physician’s P.O. Box 3043

Statement of Functional Utica, NY 13504-

Capacity 3043

The information provided is to be used for claims

evaluation and auditing purposes only.

The patient is responsible for having this form

completed without expense to Metropolitan or the

Employer.

Patient Name

First Middle Last

WANDA GLENN

Group Number

0031003

Social Security #

[OMITTED]

1. History and Diagnosis

A. Date symptoms first appeared/or accident

occurred: 02-01-00

Date patient ceased work: 04-30-00

Date of most recent examination: 04-06-01

Frequency of visits: Q 3 months

Past history:

Subjective symptoms:

Objective findings (including test results):

. Primary diagnosis affecting work ability:

CMP - Idiopathic, SOB, Fatigue

ras noo

96a

I. Secondary diagnosis affecting work ability:

J. Present and future course of treatment:

K. Other known injuries or presently active

diseases that may affect work abilities:

2. Does patient’s medical condition allow exposure

to the following; please check appropriate box and

explain any limitation below:

Limitation

Some

Limitation

Avoid

Completely

Cannot

Determine

Explanation:

3. Because of the patient’s medical conditions, are

there any limitations on any of the following

activities; please check appropriate box and

explain any limitation below.

No Some Avoid | Cannot

Dar ee Limitation | Limitation | Completely {Determine

Transportation

Standing

Sitting

Change of Position

(sitting/ standing)

No Some Avoid Cannot

Limitation | Limitation | Completely | Determine

Assuming

Cramped/Unusual

Positions

i ,

| Finger Dexterity

Reaching

_(forward/overhead)

Pushing/Pulling/

Twisting (arm/leg See

controls

) Attached

_Grasping/Handling

Repetitive

Movement

(hands/feet )

Climbing

(stairs/ladders/scaffo

Ids)

Balancing (exposure

to falling)

Bending/Stooping/S

Operate

ting

Truck/Dolly/Small

Vehicle

Operating Heavy

Equipment

Operating Electrical

ipment

Concentrated Visual

Attention

Other

Explanation:

4. Evaluation of carrying and lifting abilities

includes both the intensity and frequency of the

activity. For each weight class listed below,

please indicate the reasonable top limit of

frequency. Please provide an explanation below

with any additional comments regarding

98a

limitations on duration, handlability and distance

(in front of body and above floor).

Frequency: Percentage of Workday

Intensity

bn Semehe Less than Greater

Never 20% 20% - 60% | than 60%

0-15 v

16-30

31-45

Greater

than 45

Explanation:

5. Is there a past or present psychological problem

that might interfere with the patient’s ability to

work? If yes, please list your findings according

to the DMS-tti multiaodal classification.

Yes [_] No [] Not Determined [_]

Explanation: See attached

6. If you have any additional information that is

relevant to patient’s work ability, please indicate

below.

See attached

7. Progress Evaluation

[] Recovered [_] Improved [_] Unimproved

[_] Retrogressed

(Please check appropriate box and explain below:)

99a

Explanation:

8. Disability Evaluati

Is patient now totally disabled?

nr r For His/Her 0 i

Cannot Cannot

Yes [KX] No[_] Determine] Yes[_] No [XJ Determine (]

If No, when was patient able to resume work

activities?

For Any Occupation For His/Her Occupation

Cannot Cannot

Determine [_] Determine [_]

If Yes, when do you think patient will be able

to resume work activities?

For Any For His/Her Occupation

O .

Approximate

Date: Never

Indefinite:

Never:

Cannot

Determine:

Raj Patel MD

Name of Physician Board Certified

Specialty

423 E. Town St. Cols. OH 43215

Street Address City or Town State

(614) 464-0884 /s/ 6/27/01

Telephone Number Date Signature

100a

TRANSFERABLE SKILLS ANALYSIS

CLAIMANT: Wanda Glenn

CLAIM #: 690008 108949

SOCIAL SECURITY #: [OMITTED]

DOB: 12/11/52

GROUP #: 31003

D.O.D: 4/30/2000

EMPLOYER: Sears

REFERRED BY: Earl Chesler

DATE: July 10, 2002

CONSULTANT: Lisa Hissem, MS, CRC

INTRODUCTION

Ms. Glenn is a fifty year old Sales Department

Manager for Sears, Roebuck & Co. who has been out

of work since April 30, 2000. She is diagnosed with

Cardiomyopathy. Ms. Glenn’s current Monthly

Long-Term Disability benefit is $1,850.00. Ms.

Glenn has been employed by Sears Roebuck & Co

since March of 1990 and annual salary is $36,999.96.

A Transferable Skills Analysis and Labor Market

Analysis was requested and completed using the

Dictionary of Occupational Titles (DOT), the

Occupational Access System (OASYS) and the

America’s Job Bank for the state of Ohio.

VOCATIONAL/EDUCATIONAL HISTORY

According to the Training, Education and Experience

for Long Term Disability claim form, Ms. Glenn

reported completing twelve years of education. Ms.

Glenn worked at Sears, Roebuck & Co. as a Sales

Department Manager, from 1994 to 2000, which

involved maximizing store revenue and profit;

identify and solve business problems; develop and

maintain quality customer service; and hire, train

and supervise staff. Additional responsibilities

10la

include coordinate daily activities of sales

department; monitor merchandise replenishment;

and establish and communicate performance goals

and standards. Ms. Glenn also worked as a Sales

Associate from 1986 to 1994 and an Auditing Clerk

from 1988 to 1989.

Ms. Glenn’s vocational training and work experience

can best described by the following descriptions from

the Dictionary of Occupational Titles:

Title DOT#

Manager, Department Store 185.117-010

Manager, Sales 163.167-018

Sales Representative, General 279.357-014

Merchandise

Audit Clerk 210.382-010

The physical demand categories for these

occupations are sedentary to light according to the

Department of Labor (DOL). A Department Store

Manager is considered to be a skilled occupation

requiring over four years and up to ten years of

training to acquire the skills and knowledge

necessary to perform the job at an average level of

competence.

MEDICAL HISTORY-RESTRICTIONS AND

LIMITATIONS

Physical restrictions and limitations were obtained

from the Attending Physician Statement, dated

June 12, 2002, by Dr. Rajendra Patel. Dr. Patel

indicates that Ms. Glenn is capable of a sitting for

eight hours, standing for four hours, walking for two

to four hours; ability to lift and carry up to ten

pounds occasionally; ability to perform bilateral

upper extremity movements; ability to bend and

squat frequently; inability to crawl, climb, being

102a

around unprotected heights and moving machinery.

Dr. Patel also notes additional restrictions and

limitations as ‘no emotional stress and heavy

exertion’.

An Independent Physician Consultation indicates

the above restrictions and _ limitations § are

appropriate given the diagnosis and level of

functioning.

Based on this information it is determined that Ms.

Glenn capable of Sedentary Exertion Level activity

defined by the U.S. Department of Labor. Sedentary

Level is defined as “Exerting up to ten pounds of

force occasionally and /or a negligible amount of force

frequently to lift, carry push, pull or otherwise move

objects, including the human body. Sedentary work

involves sitting most of the time but may involve

walking or standing for brief periods of time. Jobs

are sedentary if walking and standing are required

only occasionally and all other sedentary criteria are

met.”

TRANSFERABLE SKILLS ANALYSIS

Alternative occupations were identified using the

OASYS software program (Version 1.30, 2000). This

search identifies occupations that are consistent with

Ms. Glenn’s Specific Vocational Preparation, General

Education Development, physical capabilities and

required skills she has demonstrated the ability to

perform in her past work experience. Occupations

listed in the DOT are based on the DOL’s standard

criteria, as performed in the general labor market.

The following jobs were among those identified:

103a

Estimated

Exertion Monthly

Title DOT# Level Wages

1. Account 210.367-010 | Sedentary $ 2,116.66

Information

Clerk

2. Attendance | 219.362-014 | Sedendary $ 1,768.33

Clerk

3. Classified 247.367-010 | Sedentary $ 1,960.00

Ad Clerk

LABOR MARKET ANAYSIS

The estimated wages given are based on OASYS

wage information obtained from the Bureau of Labor

Statistics utilizing Occupational Employment

Statistics (OES) as its basis. Utilizing Americas Job

Bank to match industry codes with those most likely

to hire for these occupations identified, employers

were noted to exist with Ms. Glenn’s geographical

area of Columbus, Ohio.

CONCLUSION

Ms. Glenn is a fifty year old Sales Department

Manager for Sears, Roebuck & Co. who has been out

of work since April 30, 2000. She is diagnosed with

Cardiomyopathy. The Attending Physician

statement has noted restrictions and limitations that

match the Sedentary Physical Exertion Level as

defined by the U.S. Department of Labor.

Alternative occupations that she has demonstrated

the transferable skills to perform within her residual

physical capacities were identified. Employers from

the industries most likely to hire for these

occupations were noted to exist in Ms. Glenn’s

geographical area of Columbus, Ohio.

105a

Attending Physician’s Mail this form to

Statement of Functional Sears in the self

Capacity addressed

envelope.

It is a crime to fill out this form with facts you know

are false or to leave out facts you know are

important.

The information provided is to be used for claims

evaluation and auditing purposes only.

The patient is responsible for having this form

completed without expense to Metropolitan or the

Employer.

1. History and Diagnosis

A. Date symptoms first appeared/or accident

occurred: 3-3-2000

Date patient ceased work: 4/30/2000

Date of first visit: |

Date of most recent examination: 7-28-2000

Frequency of visits: every 3 months

Past history:

Objective findings including test results:

. Subjective symptoms: see attached

State primary diagnosis affecting work ability:

State secondary diagnosis affecting work

ability: See attached

Present and future course of treatment:

=a =" FQ BOO D

Other known injuries or presently active

diseases that may affect work abilities:

106a

M. Surgery:

Performed — Date 3/14/00

Anticipated — Date

2. Does patient’s medical condition allow exposure

to the following; please check appropriate box and

explain any limitation below.

No Some Avoid Cannot

Limitation | Limitation | Completely | Determine

Dust/Gasses/Fumes

Chemicals/Solvents

Temperature See

Extremes Attached

Noise Levels

Allergenic Agents

Stairs/Ladders

Enclosed Spaces

Drafts/Damp Areas

Explanation:

3. Because of the patient’s medical conditions, are

there any limitations on any of the following

Please check appropriate box and

activities?

explain any limitation below:

Limitation

Avoid

Completely

Cannot

Commuting:

(a) Ability to drive

(b) Use of public

_ transportation

Walking

Sitting

Change of Position

(sitting/standing)

No Some Avoid Cannot

Twisting (arm/leg Attached

Visual Attention

Other

Explanation:

4. Evaluation of carrying and lifting abilities

includes both the intensity and frequency of the

activity. For each weight class listed below,

please indicate the reasonable top limit of

frequency. Please provide an explanation below

with any additional comments regarding

108a

limitations on duration, ability to handle and

distance (in front of body and above floor)

Intensity

in Pounds

Frec

uency: Percentage of Workday

Never

Less than

20%

20% - 60%

Greater

than 60%

0-15

16-30

31-45

Greater

than 45

Explanation:

See attached

. Is there a past or present psychological problem

that might interfere with the patient’s ability to

work? If yes, please list your findings according

to the DMS-tti multiaodal classification.

Yes [_] No XJ Not Determined [X]

6. Indicate below if you have any additional

information that is relevant to this patient’s work

ability. Please refer to the questions on the front

of this form regarding Job Description and, if

necessary, discuss them with the patient.

See attached

. Disability Evaluation —- We are seeking your

Medical opinion on this topic. It will be our

responsibility to assess it against vocational data,

such as level of earnings (and job availability.

109a

The following questions take into account

whether the patient can perform the important

duties of his/her job with reasonable continuity,

including commuting to work. They also take

into account whether the patient can perform the

important duties of any other job with reasonable

continuity including commuting to work. In

answering these questions please consider his/her

age, physical capacities, education, training, and

experience.

Is patient now totally disabled?

For His/Her 0 i For Any O i

Cannot Cannot

Yes ] No[] Determine[] Yes[_] No X Determine

If No, when was patient able to resume work

activities?

110a

If Yes, when do you think patient will be able to

resume work activities:

Occupation

Approximate

Date:

Indefinite:

Never: 0

Cannot

Determine:

If Yes, is patient a suitable candidate for:

(a) vocational rehabilitation Yes [_] No [_]

(b) therapeutic rehabilitationYes [_] No [_]

8. Progress Evaluation

Recovered a [] No[]

Improved Yes [] No H

Unimproved Yes [] No

Retrogressed Yes [] No []

llla

9. In your opinion is the

patient competent to

endorse checks and

direct the use of their

proceeds? Yes KX] No [] ;

10.Remarks: If you have additional information

relative to this disability claim, please use page

four.

Raj Patel MD Cardiology

Name of Physician Board Certified

Specialty

423 E. Town St. Columbus, OH 43215

Street Address City or Town State

(614) 464-0884 8/2/00 /s/

Telephone Number Date Signature

112a

SEARS MetLife

Met Disability

P.O. Box 3043

Utica, NY 13504

Fax # 315-792-2514

EMPLOYER’S STATEMENT OF LTD CLAIM

FRONT SIDE TO BE COMPLETED BY THE

ASC. REVERSE SIDE TO BE COMPLETED

AND SIGNED BY THE UNIT MANAGER

Claimant’s Full Name: Glenn, Wanda

Date of Birth: 12/11/52

Social Security No.: [OMITTED]

Service Date: 3-20-90

Employment Status:

Regular Hourly [J

Part-Time Regular Hourly [_]

Salaried

LTD Insurance Effective Date 4/1/91

Unit No 1370

Div/Dept 7003-A

ASC No 745166

Last Day Worked 4-29-00

[] Hourly Current Hourly Benefit Rate

] Salaried Current Monthly Rate

Status:

X] Active

[ | Terminated/Retired

Date

[] Date of Last Contribution

[_] Leave of Absence

[ |] Type of Leave

BEST AVAILABLE COPY

113a

[_] Date Leave Began

If currently a member, period of

time, if any, without insurance

coverage or with suspended

coverage From To

If not currently a member, date

of coverage termination

| Current LTD monthly covered earnings $3,083.33

Other Disability Benefits - Always Complete This Section

For Associates covered by the disability plans of Rhode

Island, New York, New Jersey, Puerto Rico, Hawaii and/or

California, give amounts and dates of disability benefits

under such plans received beyond 20 weeks.

Weekly Benefit $

Anticipated Expiration Date*

*If no expiration date show “continuing”

Did the disability result from a work-related

injury or illness? Yes No

Has a claim for workers compensation

been filed? Yes No

ll4a

If yes, provide address and telephone number of

workers compensation claim office in space below

If a claim has been filed

Legal Rate Per Week $

Date Statutory Benefits Started / / /

Date Statutory Benefits Terminated _/ / /

If no termination date, show “continuing”

Attach a copy of al! notices, agreements, awards

and/or compromise settlements

Worked in State

ASC Stamp

SEARS, ROEBUCK AND CoO.

Associate Service Center

4740 Hugh Howell Rd.

Tucker, GA 30084

115a

_ls/

Signature of ASC Manager

7/11/00

Date

(770) 496-7800 _

Telephone No.

It is a crime to fill out this form with facts you

know are false or to leave out facts you know

are important

19081 Rev. 3/95 Sears Forms Management

(See Reverse Side)

CLAIMANT’S JOB DESCRIPTION

Name Regular Hourly []

Glenn, Wanda = eau Regularly Hourly

Salaried J

Job Title Present Assignment Date

Manager 7003A 3-20-90

Part-Time Regular

Number of Hours Worked Per Week Prior to Disability _40-

CURRENT OCCUPATIONAL REQUIREMENTS

Please check appropriate box to indicate current occupation

requirements. When more than one exposure or activity is

listed per line, cross out that which does not apply.

1-19% 20%-60% | 61%-100%

Exposure Working | Working | Working

to: 0% Day Day Day __|

: Dust/gas/fumes Xx

Chemicals/solvents 4

116a

PS) PSPSPS] iPS / PS

a] Mal baited tale aa

truck/dolly/small

vehicle

Operate heavy

| equipment

Fine visual auditory

attention

verbal

written

communication

’

Explanation (if necessary):

Supervisory Functions (if applicable): Directly supervises 20-30

sales associates

Other Significant Factors or Comments:

Ss im Pat Butler (614) 868-7094 7-2-00

Signature of Print Name Telephone Date

Unit Manager

118a

KENNEDY & ASSOCIATES, INC.

P.O. Box 159

Tinley Park, Illinois 60477-0159

tel.: 800-637-0593 * fax: 708-532-

7847

email: SSAAid@aol.com

July 8, 2002

Mr. Paul DePree

Metropolitan Life Insurance Co

Disability Management Services

P.O. Box 14590

Lexington, KY 40511-4590

Financial Index for Claim No: 690008108949

Re: Glenn, Wanda

Claim #: 690008108949

SSN: [OMITTED]

Group #: 31003

Group: Sears

Dear Mr. DePree:

Social Security Award information for claimant was

previously submitted. We are writing to advise of

payment received from the claimant for our services.

Kennedy & Associates has received payment from

Ms. Wanda Glenn for our services in securing her

Social Security disability award.

The payment received was check number 3382 and

the amount was $4,434.50.

As always, we greatly appreciate the opportunity to

provide you insured with an effective means by

which to secure their Social Security benefits, and we

look forward to your future referrals.

120a

Social Security Administration

Retirement, Survivors and Disability

Insurance

Notice of Award

Office of Central Operations

1500 Woodlawn Drive

Baltimore, Maryland 21241-1500

Date: June 15, 2002

Claim Number: [OMITTED]HA

WANDA GLENN

2566 SONATA DR

COLUMBUS, OH 43209-3211

You are entitled to monthly disability benefits

beginning October 2000.

The Date You Became Disabled

We found that you became disabled under our rules

on April 30, 2000.

However, you have to be disabled for 5 full calendar

months in a row before you can be entitled to

benefits. For these reasons, your first month of

entitlement to benefits is October 2000.

What We Will Pay And When

e You will receive $17,738.00 around June 21,

2002.

e This is the money you are due for October

2000 through May 2002.

e Your next payment of $911.00, which is for

June 2002, will be received on or about the

third Wednesday of July 2002.

12la

e After that you will receive $911.00 on or about

the third Wednesday of each month.

e These and any future payments will go to the

financial institution you selected. Please let

us know if you change your mailing address,

so we can send you letters directly.

The day we make payments on this record is based

on your date of birth.

Enclosure(s):

Pub 05-10153

Pub 05-10058

Return Envelope

Form (HCFA-2690)

See Next Page

122a

Your Benefits

The following chart shows your benefit amount(s)

before any deductions or rour ding. The amount you

actually receive(s) may differ from you full benefit

amount. When we figure how much to pay you, we

must deduct certain amounts, such as Medicare

premiums. We must also round down to the nearest

dollar.

Beginning Benefit

Date Amount Reason

October 2000 $825.40 Entitlement began

December 2000 $854.20 Cost-of-Living

adjustment

January 2001 $888.70 Credit for additional

earnings

December 2001 $911.80 Cost-of-Living

adjustment

Information About Medicare

You are entitled to medicare hospital and medical

insurance beginning October 2002.

We will send you a Medicare card. You should take

this card with you when you need medical care. If

you need medical care before receiving the card and

your coverage has already begun, use this letter as

proof that you are covered by Medicare.

If you do not want medical insurance, please

complete the enclosed card and return it to us in the

envelope we have provided. You will need to do this

by the date shown on the card. If you decide you do

not want the insurance, we will return any

premiums that you have paid.

123a

Information About Representative’s Fees

We have approved the fee agreement between you

and your representative.

Your past-due benefits are $17,738.00 for October

2000 through May 2002. Under the fee agreement,

the representative cannot charge you more than

$4,434.50 for his or her work. The amount of the fee

does not include any out-of-pocket expenses (for

example, costs to get copies of doctors’ or hospitals’

reports). This is a matter between you and the

representative.

How To Ask Us To Review The Determination

On The Fee Amount

You, the representative or the person who decided

your case can ask us to review the amount of the fee

we say the representative can charge.

If you think the amount of the fee is too high, write

us within 15 days from the day you get this letter.

Tell us that you disagree with the amount of the fee

and give your reasons. Send your request to this

address:

Social Security Administration

Office of Hearings and Appeals

Attorney Fee Branch

5107 Leesburg Pike

Falls Church, Virginia 22041-3255

The representative also has 15 days to write us if he

or she thinks the amount of the fee is too low.

If we do not hear from you or the representative, we

will assume you both agree with the amount of the

fee shown.

124a

Other Social Security Benefits

The benefit described in this letter is the only one

you can receive from Social Security. If you think

that you might qualify for any other kind of Social

Security benefit in the future, you will have to file

another application.

Your Responsibilities

The decisions we made on your claim are based on

information you gave us. If this information

changes, it could affect your benefits. For this

reason, it is important that you report changes to us

right away.

We have enclosed a pamphlet, “When You Get Social

Security Disability Benefits..What You Need To

Know.” It will tell you what must be reported and

how to report. Please be sure to read the parts of the

pamphlet which explain what to do if you go work or

if your health improves.

A state or other public or private vocational

rehabilitation provider may contact you to talk about

their services. The rehabilitation provider may offer

you counseling, training, and other services that may

help you go to work. To keep getting disability

benefits, you have to accept the services offered

unless we decide you have a good reason for not

accepting.

You do not have to wait to be contacted about

vocational rehabilitation services. You can contact

the nearest state vocational rehabilitation office

directly and let them know that you are interested in

receiving services.

If you go to work, special rules can allow us to

continue your cash payments and health insurance

125a

coverage. For more information about how work and

earnings may affect disability benefits, you may call

or visit any Social Security office. You may wish to

ask for any of the following publications:

e Social Security — Working While

Disabled...How We Can Help (SSA Publication

No. 05-10095).

e Social Security — If You Are Blind—How We

Can Help (SSA. Publication No. 05-10050).

e How Social Security Can Help With

Vocational Rehabilitation (SSA Publication

No. 05-10052).

Other Information

We are sending a copy of this notice to THOMAS P

PILIERO and DAVID B KENNEDY.

Do You Disagree With The Decision?

This action supersedes our previous determination

and is in accordance with the decision on your

hearing request. You have already been notified of

your appeal rights regarding the decision made on

your hearing request and what you must do to have

that decision reexamined. If you want this

reconsideration, you may request it through any

Social Security office. If additional evidence is

available, you should submit it with your request.

We will review the case and consider any new facts

you have. A person who did not make the first

decision will decide your case. We will correct any

mistakes. We will review those parts of the decision

which you believe are wrong and will look at any new

facts you have. We may also review those parts

which you believe are correct and may make them

unfavorable or less favorable to you.

126a

e You have 60 days to ask for an appeal.

e The 60 days start the day after you get this

letter. We assume you got this letter 5 days

after the date on it unless you show us that

you did not get it within the 5-day period.

e You must have a good reason for waiting for

more than 60 days to ask for an appeal.

e You have to ask for an appeal in writing. We

will ask you to sign a Form SSA-561-U2,

called “Request for Reconsideration”. Contact

one of our offices if you want help.

Please read the enclosed pamphlet, “Your Right to

Question the Decision Made on Your Social Security

Claim”. It contains more information about the

appeal.

Things To Remember For The Future

Doctors and other trained staff decided that you are

disabled under our rules. But, this decision must be

reviewed at least once every 3 years. We will send

you a letter before we start the review. Based on

that review, your benefits will continue if you are

still disabled, but will end if you are no longer

disabled.

If You Have Any Questions

We invite you to visit our website at www.ssa.gov on

the Internet to find general information about Social

Security. If you have any specific questions, you may

call us toll-free at 1-800-772-1213, or call your local

Social Security office at 1-614-469-6850. We can

answer most questions over the phone. If you are

deaf or hard of hearing, you may call our TTY

number, 1-800-325-0778. You can also write or visit

127a

any Social Security office. The office that serves your

area is located at:

SOCIAL SECURITY

4177 EAST BROAD STREET

COLUMBUS, OH 43213

If you do call or visit an office, please have this letter

with you. It will help us answer your questions.

Also, if you plan to visit an office, you may call ahead

to make an appointment. This will help us serve you

more quickly when you arrive at the office.

Ss/

Jo Anne B. Barnhart

Commissioner

Of Social Security

128a

LIST OF EXHIBITS

Claimant: Wanda Glenn SSN: [OMITTED]

Exh. Part No. of

No No. Description Pages

;

| MEDICAL RECORDS

1 F Catherization Procedure 3

Records dated 3-02-03 from

OSU Hospital

| 2 F Myocardial Perfusion Report 1

dated 8-14-96 from OSU Heart

: Center

3 F Stress test Report date 09-01- 2

99 from OSU Heart Center

4 F Clinic Medical Records 8

covering the period from 6-2-

00 to 7-11-00 from OSU

Hospital

5 F Medical Records covering the 22

period from 3-03-00 to 8-04-00

from Raj C. Patel, M.D.

6 F Medical Report dated 8-31-00 5

from Choo Y. Rhee, M.D.

7 F Medical Report dated 9-14-00 6

: from Carl Leier, M.D., OSU

| Center for Wellness &

Prevention

129a

Description Pages

RFC — Residual Functional 6

Capacity Assessment —

Physical (completed by DDS

physician) dated 11-04-00,

Paul Dillahunt, M.D.

Medical Reords covering the 8

period 9-27-00 to 12-15-00

from Rajendra C. Patel, M.D.

Medical Report dated 01-04-01 3

from Choo Y. Rhee, M.D.

Medical Records covering the 8

period from 10/20/00 to

10/15/01 from Dr. Rajendra

Patel

Medical Report dated 6-20-00 3

from Carl V. Leier, M.D.

Medical Report of ECG dated 2

7-11-00

Medical Report dated 9-27-00 1

from Pacemaker and

Arrythjmia Services of The

OSU Medical Center

Medical Report dated 10-11-00 3

from the Pacemaker and

Arrythmia Services of the

OSU Medical Center

130a

No _ No. Description Pages

16 F Medical Report dated 11-15-00 1

from the Pacemaker and

Arrhythmia Services of the

OSU Medical Center

17 F Medical Report of Arrythmia 2

Device Operation dated 2-28-

01 from The Pacemaker

Implant Department of OSU

18 F Medical Report dated 4-11-01 3

from The Pacemaker and

Arrthmia Services of the OSU

Hospital

19 F Medical Report dated 10-23-01 1

from The Pacemaker and

Arrythmia Services of the

OSU Medical Center

20 F Medical Report dated 1-19-02 4

from The Pacemaker and

Arrythmia Services of the

OSU Medical Center

21 F Medical Report dated 1-19-02 1

from Robert Hoover, M.D.

22 F Medical Records dated 3

12/19/01 from Capitol City

Cardiology, Dr. David Cowles

23 F Medical Expert Analysis dated 1

3/13/02 from dr. Gordon

Snider

13la

KENNEDY & ASSOCIATES, INC.

P.O. Box 159

Tinley Park, Illinois 60477-0159

tel.: 800-637-0593 * fax: 708-532-

7847

e-mail: SSAAid@aol.com

The Honorable Thomas P. Piliero

Administrative Law Judge

Office of Hearings and Appeals

280 N High St Room 300

Columbus, OH 43215

March 12, 2002

RE: Wanda Glenn

SS: [OMITTED]

Dear Judge Piliero:

This letter addresses the issues to be decided

regarding the aforementioned individual’s claim for

Social Security Disability Insurance Benefits, and

sets forth her representative’s argument for a

favorable decision on this claim. Ms. Glenn presents

before Your Honor on Wednesday, March 13, 2002,

at 1:00 p.m. I, Valerie C. Barich, a staff attorney

with Kennedy and Associates, will be present to

represent Ms. Glenn. To the best of my knowledge,

and after due inquiry, all relevant medical

information has been identified and submitted.

PROCEDURAL HISTORY

The claimant filed her application for Disability

Insurance Benefits on August 11, 2000, alleging an

onset date of April 30, 2000, due to severe dilated

cardiomyopathy associated with extreme fatigue,

132a

shortness of breath and tightness in the chest [Ex

ID; 1 E/2]. She has no previous filings for disability

benefits [Ex 2E/1], and her date last insured is

December 31, 2004 [Ex 2E/1]. Her initial application

and request for reconsideration were denied [Ex

1B/1; 3B/1], and the claimant’s request for a hearing

was timely filed [Ex 8E/1]. The claimant is

scheduled for a hearing on March 13, 2002 at 1:00

p.m., and will be present with her representative.

_ VOCATIONAL HISTORY

Ms. Glenn is a forty-nine (49) year-old individual

with 12 years of formal education resulting in a high

school diploma [Ex 1E/8]; she was forty-seven (47)

years old at her alleged onset date. She last held

substantial gainful activity from September, 1994

through April 30, 2000, as a full-time sales manager

of the women’s clothing department within Sears,

Roebuck, & Company [Ex 4E/1-2]. Her duties

included overseeing daily operations of the

department, identifying and solving business

problems, and setting high merchandising and

customer service standards [Id]. In this job, she

frequently-to-constantly walked, occasionally-to-

frequently stood and handled merchandise, and

occasionally sat, climbed, stood, and wrote reports

[Ex 3E/1-8]. She estimated that she frequently

carried 10 pounds, but did carry and lift as much as

20 pounds. Prior to this, Ms. Glenn was employed

from September, 1993 through September 1994, as a

full time replenishment team leader with Sears.

From September 1986 through September 1993, Ms.

Green was employed with Sears as a part-time sales

associate. In this position, she stood for 5 hrs,

walked for one hour, frequently lifted 10 pounds, but

lifted as much as 20 pounds [Ex 3E/1-8).

1330

Simultaneous with this part-time position, Ms.

Glenn was employed full-time as an auditing clerk

from January, 1988 through September, 1989, and

part-time as an educational aid from September,

1985 through September 1987, and again in

September, 1989 [Id.]. Following exacerbation of her

cardiac status by increased stress on the job, Ms.

Glenn ceased working on April 30, 2000; This was

the date she and her treating cardiologist, Dr. Patel,

agreed she should discontinue working due to severe

dilated cardiomyopathy that was worsening and

interfering with her ability to perform her work

duties.

MEDICAL HISTORY

The claimant’s medical history is positive for

hypertension, sudden cardiac death syndrome,

chronic left bundle branch block, primary myocardial

disease, and moderate LV systolic dysfunction with

normal coronary angiography. Ms. Glenn has had

significant systemic hypertension since 1984-1985

with antihypertensive therapy since that time [Ex

1F/1]; 4F/2]. In October, 1989, she survived sudden

cardiac death [Ex 1F/1; 2F/1; 4F/2; 5F/2).

Catheterization at the time demonstrated normal

coronary arteries with an overall ejection fraction of

about 35 per cent [Ex 4F/2], and an AICD

defibrillator system (epicardial pads) was surgically

implanted. Its purpose was to prevent additional

sudden death/malignant ventricular arrhythmia

events, and maintenance of the device has been

followed by Dr. Love [Ex 4F/2; 5F/2]. In 1993, the

claimant began to experience chest pain and was

hospitalized; Repeat catheterization again revealed

normal coronary arteries, but also revealed global

systolic dysfunction with an overall ejection fraction

134a

of about 35 to 40 per cent [4F/2; 5F/2]. A left bundle

branch block was discovered [Ex 2F/1), and she was

hospitalized again in August 1996 for chest

discomfort; In 1996, she had two defibrillator shocks

that year, one while riding a bicycle and the other

while performing a treadmill exercise test [4F/2-3].

In March, 2000, she returned to Raj C. Patel, MD,

FACC, because of concerns about substernal chest

tightness. Ms. Glenn described it as vague, heavy

pressure lasting several hours at a time, and not

always related to exertion or emotional excitement

{Ex 5F/2]; While the episodes would come and go,

they were occurring more frequently [Id.]. An

electrocardiogram at that time showed chronic left

bundle branch block with secondary ST changes [Id].

An Adenosine Cardiolite study revealed a fixed

anterior defect and an ejection fraction as low as

about 22 percent, a rate markedly reduced compared

to past ejection fraction rates as high as 40-45 per

cent [Ex 5F/3-5). Repeat catheterization in March,

2000, revealed patent coronary arteries, but an

ejection fraction around 25 percent [Ex 4F/3].

Between March and June, 2000, Ms. Glenn reported

increasing dyspnea on exertion, easy fatigability

with increasing fatigue by the end of the day, and

pedal edema with prolonged standing at work [Id.].

She was experiencing dyspnea going up two flights of

stairs or walking about four blocks [Id.].

Because of the claimant's. progressive LV

dysfunction, Dr. Patel, the primary cardiologist,

referred Ms. Glenn to Dr. Carl Leier regarding the

possibility of a cardiac transplant [Ex 5F]. A June,

2000, examination revealed a weight of 189 pounds,

standing blood pressure of 126/90, | slightly

diminished carotid arteries, jugular venous

135a

distention above the clavicles with positive

hepatojugular reflux, right ventricular lift

moderately hypokinetic with palpable S4 gallop,

precordium that was hypokinetic and wide rather

than sustained in duration, a loud S4 gallop over the

precordium, an occasional ectopic beat, and slightly

diminished femoral pulses [Ex 4F/4]. An ECG study

revealed normal sinus rhythm, left bundle branch

block and an overall abnormal ECG [Ex 4F/6].

Overall, the June, 2000 examination revealed that

Ms. Glenn had developed dilated cardiomyopathy

with long-standing hypertension as her primary risk-

etiological factor. As a result of this condition, she

was then left with biventricular enlargement and

dysfunction deemed systolic, and likely diastolic as

well given her history of hypertension [Ex 4F/4]. Her

over: ll function class at that time was graded to be

“II-early III [Id].” At that time, she was taking

Zestril, Lanoxin, Norvasc, Normodyne, Lasix, K-Dur,

adult aspirin, calcium, and a multivitamin daily

[4F/3]. In response to the examination, the

Normodyne was converted to carvedilol, Aldactone

was added to the treatment regimen, an oxygen

consumption study was ordered in order to assess

Ms. Glenn’s candidacy for cardiac transplantation,

and initiation of a regular exercise schedule with

daily walking and weights was recommended [Id.].

Following work cessation and resultant stress

reduction, Ms. Glenn had made some improvements

by July, 2000 [Ex 5F]. However, she continued to

experience good days, bad days, and periods where

she felt extremely tired, fatigued, and easily run out

of steam [Ex 5F/19]. Based on his July 28, 2000,

examination of Ms. Glenn, Dr. Patel limited the

claimant to lifting no weight, and evaluated Ms.

Glenn to be totally disabled for her own occupation,

136a

but was unable to determine the claimant’s disability

status as to any occupation [Ex 5F/22]. In October,

2000, the claimant’s previous implanted ICD device

was explanted from her abdominal area due to the

battery at end of life and the patient’s need for a

change to a dual chamber system. The new “InSync”

device, a new technique for patients with

cardiomyopathy, was implanted by Dr. Charles Love

in the pectoral area and involved both biventricular

pacing and three leads [Ex 9F/2, 6; 10/10/00

Arrhythmia Device Operative Report, submitted to

OHA 02/05/02]. In December, 2000, Ms. Glenn

clinically appeared to be doing well, remaining out of

significant failure, but still having good days and bad

days. She was advised to return in 6 months. In

April, 2001, she returned to Dr. Patel earlier than

expected with concerns over her LV function. She

was experiencing general fatigue, but had been

slowly increasing her exercise regimen from walking

two to three times per week up to four or five times a

week for slightly longer distances [04/06/01

Treatment note, Raj C. Patel, Md, submitted to OHA

10/23/01]. Examination revealed an S4 gallop, and a

blood pressure of 148/98. In addition, a 2-D

echocardiogram at that time showed an left

ventricular ejection fraction of 40 per cent [03/28/01

ECG Report, Capitol City Cardiology, submitted to

01-TA 10/23/01).

In February, 2001, Ms. Glenn had developed a mass

in the area of the old pacemaker device. In response,

Dr. Love proceeded with debridement of the

pacemaker pocket which involved cutting and tying

the leads to reduce bulk, and debridement of

extensive, necrotic scar tissue [02/28/01 Arrhythmia

Device Operative Report, Charles Love, MD,

submitted to OHA 02/05/02). On April 8, 2001, the

137a

claimant presented to the emergency room with

complaints of five to ten minutes of heart fluttering

and shortness of breath [04/08/01 Emergency Report,

submitted to OHA 02/05/02]. The final impression

was palpitations, and the claimant was discharged

home with instructions to follow up with her regular

cardiologist in three days [Id.]}.

By August, 2001, her blood pressure was 140/90, and

cardiac ausculation revealed regular rhythm with an

impressive S4 gallop [08/03/01 Treatment note, Dr.

Patel, submitted to OHA 08/15/01]. The claimant

had reported recently increasing fatigue and exercise

intolerance, but denied PND, orthopenea or leg

edema [Id.]. In November, the claimant continued to

have better exercise tolerance, however she

remained fatigued out and short of breath,

particularly at times of significant psychological

stress [11/02/01 Treatment note, Dr. Patel,

submitted to OHA 02/27/02). However, this

treatment note included the following handwritten

comment: “Echo in Dec 2001, show moderate LV

dysfunction...EF 35 to 40%.” The interpretation of

the claimant’s performance on a December 19, 2001

ECG included the following: “(2) Left ventricular

chamber shows mild chamber enlargement with

moderate global LV systolic function with an

estimated ejection fraction of about 35-40%...; (5)

Color flow Doppler study shows mild tricuspid

regurgitation. Pulse wave Doppler study shows

mild-to-moderate reduction in LV _ compliance

(12/19/01 ECG, Capitol City Cardiology, submitted to

OHA 02/27/02].”

On January 18, 2002, the claimant presented to the

emergency room with complaints of left arm and left

chest pain, that her defibrillator fired, and some

138a

complaints of paresthesias with recent initial of

Plavix for questionable TIA [01/18/02 HRT Discharge

Summary, submitted to OHA 02/05/02]. The device

was the new defibrillator implanted by Dr. Love.

Upon examination, Ms. Glenn’s blood pressure was

143/98, her pulse was 106, and she appeared

uncomfortable secondary to left chest and arm pain

[01/18/02 Emergency Report, submitted to OHA

02/05/02]. Interrogation of the device revealed

recordings most consistent with sinus tachycardia,

and laboratory results revealed mildly low potassium

level [01/18/02 HRT Discharge Summary, and

Emergency Report, submitted to OHA 02/05/02].

The diagnosis was ‘arrhythmia, automatic

implantable cardiovascular defibrillator fired [Id.].”

Ms. Glenn was discharged home with no new

prescriptions save for a supplement for her

potassium [Id.], and a discussion with regard to her

beta blocker therapy occurred [Id].

Admittedly, the residual functional capacity

assessment provided for the Administration in

November, 2000, and February, 2001, indicated the

claimant is capable of light work [Ex 8F]. In part,

the reviewing source indicated that the restrictions

provided by Dr. Rhee and Dr. Leier are not

supported by the medical evidence, specifically that

there is no evidence that postural limitations apply.

However, both Dr. Rhee and Dr. Patel, who had a

longstanding treating relationship with the claimant

that the examiner did not have, indicated that such

postural activities precipitate symptomatology.

Overall, the claimant remained, at all times since

her alleged onset date of April 30, 2000, under

physical restrictions by Choo Y. Rhee, MD. As the

claimant’s treating internal medicine physician, he

stated in August, 2000, that Ms. Glenn suffered with

139a

chest discomfort characterized by tightness without

radiation, precipitated by walking or exertion,

relieved by rest, and worsened since January, 2000

[Ex 6F/5). He noted that the claimant’s symptoms of

recurrent or persistent fatigue, dyspnea, anginal

discomfort, and palpitations occurred upon ordinary

physical activity, and that her recovery may have

been or may be delayed as a result of idiopathic

dilated cardiomyopahty [Id.]. Finally, Dr. Rhee

indicated that sitting, standing, walking, bending,

lifting, carrying, handling objects, and traveling were

restricted; He did not restrict the claimant’s hearing,

speaking, or mental activities [Id]. In January, 2001,

Dr. Rhee assigned the same restrictions, indicated

there had been no changed in the claimant’s status

since November, 2000, but that the claimant’s ICD

defibrillator has been changed to an InSync ICD [Ex

10F/2-3]. Again, these restrictions were indicated by

the claimant’s longtime treating physician in

response to her delayed recovery, and lapse of

hypertension and sudden cardiac death into chronic,

severe dilated cardiomyopathy.

In addition, Dr. Patel has never released the

claimant back to work since he first recommended to

Ms. Glenn that she cease employment in April, 2000.

In September, 2000, Dr. Patel responded to a

disability inquiry on an Attending Physician

Statement of Functional Capacity form provided to

him. In it, he opined that Ms. Glenn was totally

disabled from her own occupation, but that he could

not determine her disability status as to any

occupation [Ex 5F/21-22]. On November 20, 2000,

Dr. Patel responded to another disability inquiry on

a similar Attending Physician Statement form;

However on this form, the two questions regarding

disability evaluation were flipped. Instead of the

140a

question in the first column relating to disability for

the claimant’s own occupation, as it had on the

September, 2000, Attending Physician form, it

referred to any occupation; in response, Dr. Patel

indicated total disability for any occupation. Then,

the question in the second column inquired about

disability status regarding the claimant's own

occupation, instead of inquiring into “any occupation”

as the September, 2000 form inquired; To this

question, Dr. Patel indicated “no.” Arguably, if he

had not examined the order of the questions, then his

response is consistent with his earlier indication that

he could not determine disability as to any

occupation, and that Ms. Glenn was disabled for her

own occupation. This November, 2000, evaluation

was conducted at the time when the claimant had

not developed any new symptoms and was remaining

out of significant failure, but had just submitted to

implantation of a new ICD device that not only

responded to arrhythmias, but also aided in pumping

blood to the heart.

In addition to the previously noted disability

evaluations, Dr. Patel indicated as recently as

October 15, 2001, the claimant’s functioning

remained restricted. In addition to findings of

impaired myocardial function, Dr. Patel indicated

that the severity of Ms. Glenn’s symptoms and

physical condition were aggravated by emotional

stress. While Dr. Patel opined that the claimant

would tolerate low stress jobs, he simultaneously

opined that Ms. Gleane symptoms were severe

enough to “freque»*’ ««rfere with attention and

concentration, a: ‘xe’ her impairments or

treatment would cause three absences from work per

month. Again, this opinion was rendered by a

longtime treating source who had referred the

l4la

claimant for implantation of a new cardiac device,

referred the claimant for transplantation

assessment, and provided consistent care while the

claimant’s left ventricular functioning deteriorated.

DISABILITY ARGUMENT

At this point, the claimant, through her

representative, asserts that she has not engaged in

substantial gainful activity since April 30, 2000. The

claimant further asserts that her severe dilated

cardiomyopathy treated both conservatively and

aggressively since April, 2000, persistent and easily

fatigability, and exacerbation of cardiac

symptomatology with stress and activities of daily

living evidence a severe medically-determined

cardiac impairment. As a result of her impairment,

the claimant has been unable to tolerate the stress of

employment, suffers with good and bad days, and

has been unable to predict her pace and persistence

at a task or household chore. She has had a period of

improvement wherein she was increasing her

physical activity; However, her reduced left

ventricular functioning persisted to the point of

necessitating explanting of 1989 defibrillator device,

and implanting a newer “InSync” combination

defibrillator/pacemaker device that not only

responded to fibrillation events, but also proactively

facilitated blood flow through the heart.

While she suffers with a medically-determined

severe impairment diagnosed as severe, dilated

cardiomyopathy via medically-accepted diagnostic

techniques, it is questionable whether her condition

meets or equals the severity requirements of any

cardiac section of the Appendix I Listings of the

Regulations. She did initially suffer with an ejection

fraction of less than 30 per cent in March, 2000. It

142a

was reported improved to at least 40 per cent by

March, 2001, and at least 35 per cent by December,

2001. Despite failure to meet listing-level

requirement of less than 30 per cent, the claimant

continues to experience arrhythmia and some left

arm and left chest pain. Left ventricular analysis in

1993 revealed left and right projection ventricular

wall motion abnormalities, and a New York Heart

Association functional class grading of I [Ex 1F/2].

And by June, 2000, she was reclassified as NYHA

functional class Il-early III [Ex 4F/4], and noted to

have right ventricular lift palpable and moderately

hypokinetic with palpable S4 gallop [Id].

In the alternative to meeting or equaling a listing,

the claimant’s severe impairment precludes her

successful performance of both her past relevant

work and all work at any exertional level. The

claimant’s past relevant work is light to medium in

exertional requirements [Ex 3E/1]. Based on the

residual functional capacity assessment completed

for the Administration in November, 2000, and

January, 2001, the claimant is limited to light work

activity; this limitation would not preclude the

performance of past relevant work. The claimant

maintains, through her representative, that her

impairment has_ resulted exertional and

nonexertional limitations that are reasonably related

to her diagnosed condition and clinical findings.

These limitations preclude her from performing her

past relevant work, and limit her residual functional

capacity to less then a full range of sedentary work.

Most significantly, the claimant’s’ cardiac

symptomatology is often precipitated by minimal

activity as indicated by her treating physicians.

While the claimant was able to increase her physical

143a

activity, medical testing subsequently revealed

diminished ejection fraction and increased fatigue,

left arm pain, and left chest pain with arrhythmia.

Non-exertionally, Ms. Glenn’s constant fatigue with

the need to lie down and nap during the day, coupled

with the unpredictable bad days renders her an

unreliable employee. As indicated by Dr. Patel, bad

days would cause this claimant to be absent from her

work duties three times per month as a result of

cardiac symptoms. Vocationally, this limitation on

work activity in even an _ unskilled work

environment, at any exertional range, precludes

reliably appearing for scheduled workdays.

Her pace and concentration are additionally

impacted by her fatigue. She has remained unable to

perform activities of daily living without an

unreasonable number and length of interruptions in

activity due to the need for rest periods. Overall,

this nonexertional limitation significantly prevents

the claimant from maintaining a consistent pace or

rate of production expected in an unskilled work

environment, and precludes her from returning to

the level of activity tolerance that would enable her

to work on a sustained, corsistent basis at any

exertional or skill level.

CONCLUSION

The claimant has a history of sudden cardiac death,

and has gone on to develop a dilated cardiomyopathy

with long-standing systemic hypertension as her

primary risk-etiological factor. She suffers with left

ventricular dysfunction with dyspnea and pain upon

exertion. She has been treated both conservatively

and aggressive, yet remains, as evidenced by notes

and reports of her treating cardiologists, with a

severe medically-determined impairment. Her

144a

impairment has resulted in documented limitations

of function including: restriction of postural activities

such as sitting, standing, walking, bending, lifting,

carrying and handling of objects; interruption of pace

and persistence at a task; and the need for frequent

rest periods during the day including daytime naps.

While her cardiomyopathy and reduced left ejection

fraction questionably meet or 2qual the level severity

required of the Appendix I Listings of the

Regulations, conservative and aggressive treatments

have failed to provide long-term, consistent relief or

improvement that would allow the claimant to

return to a sustained level of work activity, even at a

sedentary exertional level, without exacerbation of

her cardiac dysfunction. The claimant is a younger

individual with a _ semi-skilled work history;

However, with her severe, chronic cardiac condition

that has persisted and resulted in severe limitations,

she falls within the purview of Section 201.00(h) of

Appendix II of the Regulations. Pursuant to 20

C.F.R.§404.1520(), Ms. Wanda Glenn, the claimant,

is and has been disabled since April 30, 2000, and,

therefore, respectfully requested that a decision be

made in favor of the claimant’s application.

Respectfully submitted,

David B. Kennedy

Representative

By: /s/.

Valerie C. Barich

Staff Attorney

Kennedy & Associates

145a

Metropolitan Life Insurance Company

MetLife

MetLife DisAbility

PO Box 3017

Utica, NY 13504

10/10/2000

Wanda Glenn

2566 Sonata Drive

Columbus, OH 43209

RE: Long Term Disability

Claim No: 690008108949

Group No: 31003

SS#: [OMITTED]

Group: SEARS ROEBUCK &

COMPANY 7

Phone: 6142362588

Dear Wanda Glenn

Our records indicate that you are not receiving Social

Security Disability Insurance Benefits.

Since you have been out of work, you may be eligible

for such disability insurance benefits. You should be

aware that you have the right to be represented by a

qualified person in dealing with the Social Security

Administration at any stage of your claim.

If you are approved for Social Security Insurance

Benefits, you will realize several advantages:

Social Security Disability Insurance Benefits

increase automatically to reflect rises in the cost

of living.

146a

As soon as you have been entitled to Social

Security Disability Insurance Benefits for 24

consecutive months, you become eligible for

Medicare coverage, even though you are under

age 65.

Failure to establish a claim for Social Security

Disability Insurance Benefits may adversely

affect your Social Security Old-Age (Retirement)

Benefits.

Since it is to your advantage to receive Social

Security Disability Insurance Benefits, we have

given your name to Kennedy & Associates, a firm

that specializes in obtaining Social Security

Disability Insurance Benefits for claimants.

Please contact Kennedy & Associates at 1-800-

637-0593 in the near future to discuss the

feasibility of pursuing a claim for Social

Security Insurance Benefits.

MetLife will reduce any overpayment created by

your receiving retroactive Social Security Disability

Benefit payments by the fee charged by your

Representative up to $4,000.00. The Representatives

have agreed not to charge other expenses caused by

their development of your case. Statistics have

shown that people with representation have been

more successful in obtaining Social Security

Disability Insurance on appeal.

If you currently have an attorney, or other

qualified person representing you, simple

advise Kennedy & Associates or MetDisability.

You may qualify for this reduction also.

This is a voluntary program. Please extend your full

cooperation to the representative who helps you as

he/she will be doing everything possible to help you

147a

and your family in receiving Social Security

Disability Insurance Benefits.

Should Social Security Disability Benefits be

awarded while you are represented by Kennedy &

Associates and your application results in a

retroactive award, a recalculation of the benefits

properly payable during the retroactive period will

be performed. This adjustment may result in an

overpayment and you will be responsible for

reimbursing MetLife for monies advanced prior to

your Social Security award from the lump sum check

sent by Social Security.

Yours truly,

/s/

Ed Peters

Social Security Specialist

Met DisAbility

1-800-300-4296

Ce: Kennedy & Associates

SEARS ROEBUCK & COMPANY

148a

LONG-TERM DISABILITY INSURANCE

FOR SALARIED ASSOCIATES

..an extra measure of security

SEARS

SUMMARY PLAN DESCRIPTION

If you are unable to work for a long period of time

because of a serious illness or injury, your paychecks

would stop—but you'd still have regular living

expenses. Sears Group Long-Term Disability (LTD)

Insurance Plan makes sure that youli have a

continuing source of income to help meet those

expenses throughout a disability.

This booklet is a Summary Plan Description which

describes the provisions of the Plan that apply to

salaried associates. Should your employment status

change to that of hourly, contact your Human

Resources representative or unit manager to obtain a

copy of the booklet which describes the provisions that

apply to hourly associates.

The provisions outlined in this booklet apply to

participants who become Totally Disabled on or after

January 1, 1995.

149a

TABLE OF CONTENTS

A Summary of How LTD Works. .......................0ceeee0008 3

i 3

Eligibility and Enrollment.....................cccccccssssseeseeeees 4

io ersanneeneasndtdanenseaneesuininbents 4

TTT dictiicnidcccnnenneectinsnancnsicinnenasenndentboentiitl 4

, TT ETT EE 5

acerca ricenicailienianndiebeaieneibialii 5

NE RT 5

i laiesiiseeel 5

When Coverage Terminates...........................cccece0eeeees 6

Suspension of Coverage .....................s:cccseeecesseeceees 6

Payment of Contributions......................:cccesesssssseeeeeeees 7

TELL TPT T NTO TTD 7

LTD Contributions During Total Disability ......... 8

isc casctesessnstetonennensl 8

Meaning of Total Disability... ...........................00 8

LT Oe RE 9

inns cnncinnceecienniconensinnindnbiiianiel 9

EY )

When Benefits Are Not Payable.......................... 10

Pre-Existing Conditions..............................seseeeees 10

Mental/Nervous Disorders.............................00000+ 11

SE LE 11

PES I 12

I oo cc cerceneinntenasnintnananidesoninn 12

RE 12

Leave of Absence at Time of Recalculation......... 12

Monthly LTD Covered Earnings ......................... 12

150a

Amount of Monthly Benefit While

ns cetucnsenanen 13

CI I ccs scincccccescscccccccoccnesense 13

Social Security Benefits ......................ccccssessseesees 14

Workers’ Compensation, Benefits ....................... 15

Dinas sntenssinanenasactonsiannsanne 15

Rehabilitative Employment ........................ccseeeeeeees 16

Amount of Benefits—Examples...........................00008 16

i. scscnce

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