# Joint Appendix — Metropolitan Life Ins. Co. v. Glenn > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385016_0513%3A06 ## Record - **Collection:** Supreme Court brief - **Document type:** Joint Appendix - **Published:** January 1, 2008 - **Citation:** 554 U.S. 105 ## Text 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, v. 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 li 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)................. iv | 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 la 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 12/20/2005 04/28/2006 3a * * * 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 09/01/2006 10/26/2007 02/05/2007 4a 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] 5a 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. * * * 6a 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) —— * = 4 08/10/2004 7 Stipulated ADMINISTRATIVE RECORD manually filed w/Clerk of Court. (jk) (Entered: 08/11/2004) 7a * *~ 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 10 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 11 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 12 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 8a 11/30/2004 14 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 15 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 16 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 17 ORDER denying Defendants’ 16 Motion to Strike, granting alternative motion for leave to file a sur-response brief. Signed 9a by Judge Mark R. Abel on 12/15/04. (dms) (Entered: 12/15/2004) 12/15/2004 18 REPLY filed by Defendants to Plaintiffs Memo Contra to Defendants’ MSJ. (dms) (Entered: 12/16/2004) 12/16/2004 19 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 20 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 21 REPLY filed by Defendants to Plaintiffs Memo Contra Defendants’ Motion for Judgment. (dms) (Entered: 12/20/2004) * * 06/08/2005 23 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 24 CLERK’S JUDGMENT in favor of defendants against plaintiff. Signed on 6/8/05. (lvw) (Entered: 06/08/2005) 07/07/2005 25 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 42 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 VM (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 contact us at the number listed below. This matter is 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 contact us. 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 t a * { BS ] oa ‘ ‘ 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, aS 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 a 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 4 4 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_) oe ( 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, ed 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_) ( ( ( ( ( ed 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 Vv y 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 ed III. Claimant can Never Occasionally Frequently Continuously carry A.) Up to 10 lbs. ( ) B.) 11-20 lbs. ( ) Es ( C.)21-50lbs. Cy_) ¢ ( ( y 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 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 nt 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: No 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 mA 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: No Limitation 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- 50 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 a verbal written communication ’ , 7 2 , if . : 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, [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385016_0513%3A06. Public record. Not legal advice.