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Resolution No. 82441 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RESOLUTION NO. 8244 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF VERNON GRANTING THE DISABILITY RETIREMENT OF DAVID RUMLEY, A LOCAL SAFETY MEMBER EMPLOYED BY THE CITY OF VERNON (Government Code Sections 21154 and 21156) WHEREAS, the City of. Vernon (hereinafter referred to as "Agency") is a contracting agency of the Public Employees' Retirement System; and WHEREAS, the Public Employees' Retirement Law requires that a' contracting.agency determine whether an employee of such agency in employment in which he/she is classified as a local safety member is physically or mentally incapacitated to perform his/her duties for purposes of the Public Employees' Retirement Law; and WHEREAS, the Agency, pursuant to Government Code Section 21152(c), applied to the Public Employees' Retirement System ("PERS") on behalf of Mr. Rumley for disability retirement on or about May 1, 2003; and WHEREAS, on or about May 28, 2003, PERS requested the Agency make a determination regarding whether David Rumley was incapacitated for the performance of his duties and therefore eligible to retire for disability; and WHEREAS, by letter dated June 18, 2003, Bruce V. Malkenhorst, City Administrator/City Clerk, notified Mr. Rumley that the matter o his industrial disability retirement would be considered by the City Council on July 2, 2003; and WHEREAS, by Minute Order on July 2, 2003, the Agency approved advanced disability pension payments to David Rumley employed by the 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 9XI! 25 26 27 28 Agency in the position of Police Sergeant in the Vernon Police Department; and WHEREAS, the City Council of the City of Vernon has reviewed medical evidence and other evidence relevant to whether Mr. Rumley was incapacitated. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF VERNON AS FOLLOWS: SECTION 1: The City Council of the City of Vernon hereby finds and determines that David Rumley is disabled within the meaning of the Public Employees' Retirement Law from the performance of his duties in the position of Police Sergeant in the Vernon Police (Department. SECTION 2: The City Council of the City of Vernon hereby finds and determines that such disabilities are industrial, in that they are the result of injury or disease arising out of and in the course of employment, that neither the City Council of the City of Vernon nor Mr. Rumley has applied to the Workers' Compensation Appeals Board for a determination pursuant to Government Code Section 21166 to determine whether such alleged disability is industrial, and that there is no possibility of third -party liability in this case. SECTION 3: The City Council of the City of Vernon hereby determines that, based upon the report of Dr. F. Daniel Kharrazi, a Qualified Medical Examiner, dated May 20, 2003, Mr. Rumley is unable to perform the essential job function of his position as a Police Sergeant in the Vernon Police Department, that no appropriate reasonable accommodation can be made to do so and that the permanent and stationary date for retirement purposes is May 20, 2003. The City Council therefore determines that Mr. Rumley should be retired. The last day - 2 - David Rumley was on the City's payroll was January 5, 2003, and Mr. Rumley retired effective January 6, 2003. SECTION 4: The City Clerk shall notify Mr. Rumley of the City Council's determination granting his application for industrial disability retirement. SECTION 5: The City Clerk of the City of Vernon shall certify to the passage of this resolution, and thereupon and thereafter the same shall be in full force and effect. APPROVED AND ADOPTED this 2nd day of July, 2003. ATTEST: Gam' BRUCE V. MALKENHORST, City Clerk LEONIS C. MALBtT.RG, Ma or - 3 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 STATE OF CALIFORNIA ) ss COUNTY OF LOS ANGELES ) I, BRUCE V. MALKENHORST, City Clerk of the City of Vernon, do hereby certify that the foregoing Resolution, being Resolution No. 8244, was duly adopted by the City Council of the City of Vernon at a regular meeting of the City Council duly held on Wednesday, July 2, 2003, and thereafter was duly signed by the Mayor of the City of Vernon. I (SEAL) BRUCE V. MALKENHORST, City Clerk - 4 - SUPPORTING DOCUMENTS CITY COUNCIL LEONIS C. MALBURG Mayor THOMAS A. YBARRA Mayor Pro-Tem WM. "BILL" DAVIS Councilman H. "LARRY" GONZALES Councilman W. MICHAEL MCCORMICK Councilman BRUCE V. MALKENHORST City Administrator/City Clerk FAX (323) 826-1438 Mr. David Rumley 3475 E. Elm Street Brea, CA 92823 CITY HALL 4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058 TELEPHONE (323) 583-8811 July 14, 2003 ' RE: Disability Determination by the City Council Dear Mr. Rumley: EDUARDO OLIVO City Attorney FAX: (562) 869-1883 KEVIN WILSON Director of Community Services & Water FAX: (323) 826-1435 KENNETH J. DeDARIO Director of Utilities FAX: (323) 826-1425 STEVEN E. PARKER Fire Chief FAX: (323) 826-14o7 BRUCE W. OLSON Police Chief FAX: (323) 826-1481 After conclusion of the hearing to determine your disability retirement request on July 2, 2003, the City Council approved your request for disability retirement. The City Council made this determination through the adoption of Resolution No. 8244, a copy of which is enclosed herewith for your records. If you have any further questions regarding this matter please contact Ms. Joan Francone, Risk Manager. Very truly yours, CITY OF VERNON V1k' /nhorst� B ceV.Mae City Administrator/City Clerk cc: City Attorney f `Manager BVM/gjo CITY COUNCIL LEONIS C. MALBURG Mayor THOMAS A. YBARRA Mayor Pro-Tem WM. 'BILL" DAVIS Councilman H. "LARRY" GONZALES Councilman W. MICHAEL MCCORMICK Councilman BRUCE V. MALKENHORST City Administrator/City Clerk FAX (323) 826-1438 City Council City of Vernon Honorable Members: CITY HALL 4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058 TELEPHONE (323) 583-8811 June 11, 2003 EDUARDO OLIVO City Attorney FAX: (562) 869-1883 KEVIN WILSON Director of Community Services & Water FAX: (323) 826-1435 KENNETH J. DeDARIO Director of Utilities FAX: (323) 826-1425 STEVEN E. PARKER Fire Chief FAX: (323) 826-1407 BRUCE W. OLSON Police Chief FAX: (323) 826-14811 David Rumley was hired as a Police Officer on July 8, 1991; and he incurred several work related injuries. In accordance with GC 211.52(c) the City filed an Industrial Disability Retirement application, which was received by Public Employees Retirement System (PERS) on May 1, 2003. Mr. Rumley has exhausted his Labor Code 4850 benefits as of January 5, 2003. The report of Dr. F. Daniel Kharrazi M.D., dated May 20, 2003, supports Mr. Rumley's inability to return to his job as a Police Officer. Based on the information provided Mr. Rumley would qualify for an industrial disability. This has been reviewed by our Risk Manager and it is hereby recommended that the City Council approve Police Sergeant David Rumley's Industrial Disability Retirement and issuance of advanced disability pension payments in the amount of $1,505.32 until PERS begins payments. Very truly yours, Bruce V. Malkenhorst City Administrator/City Clerk BVM/ gm CITY COUNCIL LEONIS C. MALBURG Mayor THOMAS A. YBARRA Mayor Pro -Tern WM. 'BILL" DAVIS Councilman H. "LARRY" GONZALES Councilman W. MICHAEL MCCORMICK Councilman BRUCE V. MALKENHORST City Administrator/City Clerk FAX (323) 826-1438 Mr. David Rumley 3475 E. Elm Street Brea, CA 92823 CITY HALL 4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058 TELEPHONE (323) 583-8811 June 18, 2003 Re: Request for Disability Retirement Dear Sgt. Rumley: EDUARDO OLIVO City Attorney FAX: (562) 869-1883 KEVIN WILSON Director of Community Sen ices & Water FAX: (323) 826-1435 KENNETH J. DeDARIO Director of Utilities FAX: (323) 826-1425 STEVEN E. PARKER Fire Chief FAX: (323) 826-1407 BRUCE W. OLSON Police Chief FAX: (323) 826-1481 The City has reviewed your personnel file and any available workers' compensation proceedings involving you. This review appears to justify a determination by the City Council that you qualify for disability retirement in accordance with Government Code Sections 21154 and 21156. At this time, based upon information we have in our files, I will be recommending to the City Council that they grant your request. The hearing before the City Council with respect to this request for disability retirement has been scheduled on July 2, 2003. If you desire to submit any additional evidence regarding medical examinations or records, such information must be received by my office no later than five days prior to the hearing date. Within thirty (30) days after conclusion of the hearing, the City Council will make written findings of fact and conclusions of law and render its determinations. If you have any further questions concerning this matter, please do not hesitate to contact the Risk Manager. Very truly yours, Bruce V. Malkenhorst City Administrator/City Clerk cc: City Attorney Risk Manager ® USA Airbill —Mr— Trackg 8337 5923 3892 Express Nambar Sender's FedEx . Senders Name (9 /D /� //7 /�� �Cl� Phone (323) 583-861 1 Nam Comoanv CITY OF VERNON Address 4305 S SANTA FE AVE DeptrHoor/Sure/Room cfi, VERNON state CA zip 94058 2 Your Internal Billing Reference / ©/ J "�" too ® NO MA-- Fiound 24 cllnternalaBillppear ongv e. 3 TO RecName + �(' I ni le , / Phone Name _J�r) 1 l K lF Address) � / To "HOLD" aFed& location, prim Fed&address. Address Dept/nour/Sube/aaom City ne—A State Ch ZIP C9 3 By using this Airbill you agree to the service conditions on the back of this Airbill and in our current Service Guide, including terms that limit our liability. Questions? Visit our Web site at fedexcom sae 4a Express Package Service Peske9eseprotSD/bs FodE Delivery commihneM may he Inter In same areas. ❑ Overnight ❑ "ads Fi�;t eemgp ilaw slePriorrityOas gvernight NFeddEx_Standard aftemoorn dariness vwymeakctmaadons ❑ FedEx 2Day ❑ FedEx Express Saver Second huncess day Third business day Fed& Envelope rare nor available. 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Malkenhorst, City Administrator FROM: Joan Francone, Risk Manager/Personnel Assistant DATE: June 10, 2003 'oA SUBJECT: Industrial DisabilityRetirement - Police Sergeant David Rumley g C\�,� PpN�\N\S The City applied for an Industrial Disability Retirement on Rumley's behalf under Government Code 21152 (c), which states that an application to the board for retirement of a member for disability may be made by the governing body, or an official designated by the governing body, of the contracting agency. The application was received by the Public Employees Retirement System (PERS) on May 1, 2003. In a letter dated May 28, 2003, PERS acknowledges receipt and advises that, in accordance with Section 21157, Government Code the City is required to make a determination within six months relative to Rumley's disability status David Rumley was hired by the City of Vernon as a Police Officer on July 8, 1991. He has had several work related injuries since date of hire and was off duty on a shoulder injury and subsequent surgery on December 9, 2002. He continues to be off duty. Rumley exhausted his Labor Code 4850 benefits on January 5, 2003. Labor Code 4850 provides that a safety member while on leave of absence due to an injury or illness arising out of or in the course of his or her duties is entitled to receive no loss of salary for the duration of the disability but not exceeding one year. This benefit is in lieu of temporary disability or maintenance allowance payment. In a medical report dated May 20, 2003, F. Daniel Kharrazi M.D. notes that Mr. Rumley is likely a qualified injured worker for vocational rehabilitation. This supports Mr. Rumley's inability to return to his regular job as a Police Officer for the City of Vernon. Based on the above it is recommended that Mr. Rumley receive an Industrial Disability Retirement as a result of his orthopedic condition. The effective date of retirement should be January 6, 2003. There is no possibility of third party liability in this matter. Until Sergeant Rumley begins receiving his retirement benefits directly from PERS, the City is required to make advanced disability pension payments to him under Labor Code Section 4850.4. When PERS begins paying the disability retirement allowance, the amount advanced Industrial Disability Retirement Police Sergeant David Rumley Page 2 will be deducted from the retroactive portion of Rumley's retirement allowance and reimbursed to the City. Advanced disability pension payments may not exceed 50% of the average monthly pay rate for the last three years prior to retirement. According to Sergeant Rumley's payroll records this amounts to $1505.32 per month. JF/cc cc: City Attorney Benefit Services Division P.O.'Box 2796 Sacramento, CA 95812-2796 (916) 326-3232; (800) 352-2238 Ca1PERS TDD - (916) 326-3240; FAX (916) 658-1280 May 28, 2003 City of Vernon 4305 Santa Fe Avenue Vernon, CA 90058 Dear Personnel Officer: RK4 69?1316 '03 JJN —3 P 154 CIT Y 017 RISK This letter acknowledges receipt of the industrial disability application you filed on behalf of David Rumley, in accordance with Section 21154 and 21156, Government Code. It is required that you make this determination within six months of this request unless the local safety member waives the requirements of this provision (Government Code Section 21157). Under the California Public Employees' Retirement Law, disability means the incapacity of a member for the performance of duty in public services for permanent or extended and uncertain duration, as determined on the basis of competent medical opinion. Disability is not necessarily an inability to perform every function of a given position. Rather, the courts have concluded that the test in any case is whether the employee can substantially perform the duties of the position he occupies. These criteria apply whether the member is being retired or is being reinstated from disability retirement. Disputed questions regarding the industrial relationship of the disabling injury to the member's work will be resolved by the Workers' Compensation Appeals Board. In the event there is no dispute, such a finding can be made by the employer. A Workers' Compensation Award is not sufficient evidence that a local safety member is disabled for retirement purposes. There must be a specific finding under Government Code Section 21166, by the employer, with respect to the disability for which the member will be retired. If it is determined that the member is not disabled for the performance of his or her duties, a Resolution to that effect must be filed with the System. Please refer to Sample resolution No. 1, Benefits Procedures, Procedures Manual for Public Agency reporting to the Public Employees' Retirement System. If the member is found to be disabled, the following will apply: The Retirement System will require at least the following documentation: 1. A finding that disability exists. PERS-BAS-175-W (3/96) California Public Employees' Retirement System Lincoln Plaza - 400 P Street - Sacramento, CA 95814 -2- 2a. A finding by your agency as to whether or not the disability is industrial. 2b. In case of a dispute, a Findings and Award by the WCAB, resolving the industrial relationship. 3. A certified statement (Resolution) by the local agency, last day member is on payroll. In case of a dispute regarding the member's effective date of retirement, a request must be filed with the WCAB for Finding of Fact to determine on what date the member's condition became permanent and stationary. That date then becomes the effective date of retirement (Government Code Section 21164). 4. A statement identifying the type of disability retirement determined, i.e., non- industrial disability retirement or industrial disability retirement. A member must have minimum of five years of credited service to qualify for non -industrial disability retirement. If a member does not meet the minimum service requirements for disability retirement, he may still qualify by re -depositing previously withdrawn contributions, or contributing an amount for service rendered prior to membership with the System. Time during which the member is absent from State service by reason of injury or illness, which is determined within one year after the end of such absence to be job -related, shall be considered as time spent in State service for the purpose of qualification for retirement and death benefits. 5. A statement by the agency to the effect that there is, or is not, a possibility of third -party liability present, if member's disability was caused by negligence or an intentional act of a party other than employer. 6. A statement identifying the reason for the disability, i.e. orthopedic, psychological, cardio-vascular, internal, neurological or other. 7. If advance disability pension payments will be paid to the member, include the monthly amount. Also include where the reimbursement check should be mailed. 8. If the employee was hired after 1/1/80, include the following in accordance with Government Code Section 21417: a. Was the disability the result of an injury which was a direct consequence of a violent act perpetrated upon his or her person? b. Did the disability occur during the performance of those portions of his or her duties which are particularly hazardous and dangerous? (For the particularly hazardous and dangerous exception to apply the disability must have occurred during the performance of job duties which had an especially high risk of danger when compared to other duties which were performed. It is not sufficient that the -3- overall job duties were hazardous or dangerous to some degree; the exception pertains to hazards or dangers which stand above or apart from the expected hazards of the job. This exception does not apply simply because a member has an inherently hazardous and dangerous job.) All such documentation submitted by your agency must be signed by the governing body or its lawful delegate (City Manager, Chief Administrative Officer, County Executive, or other comparable individual). If the governing body chooses to delegate the responsibility of making a determination, a certified copy of the delegation order of this authority must accompany the finding by such delegate in each instance. Under the law, if a person (other than the employer) caused an injury that results in certain CalPERS benefits being paid, then CalPERS has the right to recover from the responsible person up to one-half of the total retirement benefit costs payable due to this injury. This right is known as a "right of subrogation". (Government Code section 20250 et seq.) Accordingly, the Retirement System request that you, as the local agency, send us copies of all injury reports sent to the State Compensation Insurance fund (or your Workers' Compensation carrier) concerning any and all injuries sustained by this employee. Please advise us if you are aware our member is pursuing a claim (other than a Workers' Compensation claim) against any person or entity for the same injuries that also entitle the member to a disability retirement from CalPERS. We hope the above information is helpful to you. If you have any questions, please call. Sincerely, Marylin Keller Disability Determination Section Enclosure: Copy of BAS-369D & BAS-183B cc: David Rumley A,. Benefit Services Division, P.O. Box 942711, Sacramento, CA 94229-2711 BR f e CalPERS Telecommunications Device for the Deaf - (916) 326-3240 - (800) 352-2238 ' Disability Retirement Election Application ?03 MAY - i PM ip 43 ❑ Disability Retirement W Industrial Disability Retirement ❑ Service Pending Disability Retirement ❑ Service Pending Industrial Disability Retirement Important: Local Safety Members Should Not Complete Sections C and D. use" only RS A P" pplication Section A - Member Information Initial 3475 E. ELM STREET Ct Male ❑ Female 05 106 / 1967 Mailing Address Date of Birth BREA City Home 577-0238 Home Phone CA -92873 USA State ZIP Country ork V.3.7 Section B - Retirement Information rement Date (Required Only P[1T_T! F cinrrrrer Position Title (Do Not Abbreviate) Final Compensation Period: / (If any period is higher than last 12 or 36 months.) From CITY OF VERNON To Other California Public Retirement Systems: ❑ Yes Jl No If yes, complete the section below. Name of System From To Date of Retirement Dates of Service Credited Section C - Workers' Compensation Information If you filed a Workers' Compensation claim, please provide the following information. Workers' Compensation Carrier Name of Adjuster Telephone Number Mailing Address City State ZIP Claim Number(s) Relating to Alleged Disability Date of Injury(ies) For Ca(PERS Use Only Reviewed by: Date-s—&O 3 PERS-BSD-369-D (6/02) Keyed by: Dates Disability Retirement Election Application page 1 of 6 Benefit Services Division P.O: Box 2796 hozz-,-, Sacramento, CA 95812-2796 (916) 326-3232; (800) 352-2238 Reply To: Unit 432 CaIPERS TDD - (916) 326-3240; FAX (916) 658-1280 Refer To: 554-69-1316 May 28, 2003 David Rumley 3475 E Elm St. Brea, CA 92621 Dear Mr. Rumley: This letter acknowledges receipt of your employer's application for your disability retirement. Your employer is required to make a determination within six months of this notice unless you waive the requirements of this provision (Government Code Section 21156). Enclosed is our disability application booklet (PERS-PUB-35). Please read PERS- PUB-35 in its entirety to familiarize yourself with important information regarding disability retirement. It is important that the Disability Retirement Application form BAS-369D and Survivor Questionnaire form BAS-54 be completed and returned to CalPERS as soon as possible. If you do not agree with the filing of the application, you are not required to sign the BAS-369D. However, the information contained in the BAS-369D will be helpful in the calculation process should you be approved for disability retirement. Following your employer's finding of substantial incapacity, your retirement cannot be canceled. However, if you are eligible, and wish to change to a service retirement in lieu of disability retirement, you must apply for the change prior to the effective date of your disability retirement or within 30 days after notification of approval (Government Code Section 21156). Under the law, if a person (other than your employer) caused an injury that results in certain CaIPERS benefits being paid, then CaIPERS has the right to recover from the responsible person up to one-half of the total retirement benefit costs payable due to this injury. This right is known as a "right of subrogation" (Government Code section 21450 et seq.). If you pursue a claim against any person for the same injuries that also entitle you to a disability retirement from CaIPERS (other than a Workers' Compensation claim or an uninsured motorist claim) YOU MUST INFORM CALPERS OF THE EXISTENCE OF THIS CLAIM. This is true even if the claim has not yet resulted in a court action. CaIPERS has the right to participate in any such claim either through filing its own action against the responsible party, intervening in your claim, or filing a lien against any PERS-BAS-700-W (3/96) California Public Employees' Retirement System Lincoln Plaza - 400 P Street - Sacramento, CA 95814 -2- judgment which you may recover. IF YOU SETTLE SUCH A CLAIM WITHOUT NOTIFYING CALIPERS, CALIPERS MAY ALSO BE ENTITLED TO FILE A LAWSUIT AGAINST YOU FOR RECOVERY OF CALPERS' SUBROGATION RIGHTS. If you entered the membership category (for which your disability occurred) after January 1, 1980, your industrial disability allowance may be less than 50% of your final compensation. The allowance cannot exceed the amount that would be payable for a service retirement had you continued in employment and reached the age of 55. This limit does not apply to a member whose disability resulted from an injury which was a direct consequence of a violent act perpetrated upon his or her person or occurred during the performance of those portions of his or her duties which are particularly hazardous and dangerous (Government Code Section 21417). For the particularly hazardous and dangerous exception to apply you must show that your disability occurred during the performance of job duties which had an especial high risk of danger when compared to other duties which you performed. It is not sufficient that the overall job duties were hazardous or dangerous to some degree; the exception pertains to hazards or dangers which stand above or apart from the expected hazards of the job. This exception does not apply simply because a member has an inherently hazardous and dangerous job. If you are notified by CaIPERS that your disability application has been approved, and upon receipt of a separation document from your employer reflecting your last day on the payroll, we will send you additional information under separate cover. If at any time prior to the mailing of your first warrant you wish to receive a refund of your accumulated contributions in a lump sum in lieu of a retirement allowance, you may do so by sending written notification to the return address shown above. You should be advised that membership in the Retirement System terminates upon mailing of a warrant refunding contributions, making you ineligible for future benefits unless you return to employment covered by CalPERS (Government Code Section 20390). Sincerely, Marylin Keller Disability Determination Section cc: City of Vernon 06/1,0/2003 09:15 9098603995 COLENANDLEE PAGE 02 s oKER�AN-JoOBE «'here the s acncc of medicine enbaaco the an of Iife. Robert IC Kedon, MD 1922-1996 sports Medicine Surgery Frank W. Jobe, MD Clarence L Shields, Jr., Mo Stephen J. Lombardo, MD Lewis A, Yocum, MD May 20, 2003 James E. Tibone, MD Ralph A. Gambardeila, MD Ronald E.Glousman,MD Colen & Lee W/c Ronald 5, Kvitne, MD NealS.ElAtttache,MD 14 7 0 S Valley e y Vista Dr Suite 230 Daniel Kharrazi, MD Diamond Bar, CA 91765 Spine surgery William H. Min, MD RE • RUMLEY, DAVID Jae H. Chop, MD EMP : CITY OF VERNON P.D. Trauma Surgery D / I : 2 / 15 / 9 9 Robert W. chandler, MD CL# : 013 - 9 8 - 0 0 0 2 0 Armruw Joint S S#: 554 69 1316 Replacement Andrew I, Spitzer, MD AGE: .36 Peter J. Thadanl, MD Fost/Atrkts surgery PROGRESS REPORT Phillip K. Kwong, MD Jiun-Rung Peng, MD HISTORY- - Hand Surgery Norman A. Macerl, MD George A,MD David Rumle g y is seen for a re-evaluation of his right shoulder and right elbow. -The patient has had a previous right shoulder Craigilhousne Craig J. Mlhouse, MD and elbow revision surgery and at this time he reports that he g y Carol L. Ohs, MO continues to have discomfort and pain both in his right shoulder Neurolegy/PailManagement and right elbow. At this time, he reports that with swimming, Vernon 13. WillWns, MD he has had discomfort in his right shoulder. He is also PhysicalASportaMedicins complaining of significant pain. Luna Podesta, MD UscutiveDiluter PHYSICAL EXAMINATION: Posie Garpa *r, RN,MSH,M,PR Physical examination of his right shoulder shows that he has a well -healed incision about his right shoulder. Forward Main Office elevation is 140, abduction is 150. Neer and Hawkins are 6801 Park Termce positive. Stability examination reveals negative apprehension Los Angeles, CA90045 Tel: (310) 665-7Y00 but positive Neer and Hawkins testing.AC joint i � s slightly tender. Elbow examination reveals that he has a well -healed medial incision. Range of motion is from 0 to 135. His 2400East KaMllaAve, Soft 4W varus-valgug stability is intact. Anaheim, CA 92806 Tel: (714) 237-1338 ASSESSMENT • Far. (714)937-181a Continued right shoulder and right elbow pain. 2080 Century Park East Suite 208 Right shoulder and right elbow industrial injury. Los Arwies, CA 90067 Status post revision LI%Tlar w%1 e„1•ye trail ,%position, right elbow by Tel: (310) 203.0710 Dr. ElAttrache . ', : ; a •„ ; ; aa: ; i Fax:(310)208-0751 . Status post rev�isi&" faghtrahhao-&ld*e A2 throscopy, superior labral repair with anterior labral repair and arthroscopic 301 North Lake Ave. decompression on 12/09./.2002, Suite 201 �aa Pasadena, CA 91101 Tel: (626) 598-9030 Phyr ianf ro the Dodgerm, An c1 r, Lahsrs, .ki-rs, _h d ts. ive--wort, 3,par-, GA4ax), PGA Tour, Senior PGA Toter, Zzrswr, Loyola and USC Spo7-v Fax: (626) 569-9507 World renowm care a:n a Joss . 6onaut:a3ca ' cu.gdry • Room on • Dtapnostics wanckerian)obe-com 06f10f2003 09:15 9098603995 COLENANDLEE PAGE 03 RUMLEY, DAVID May 20, 2003 Page 2 RECOMMENDATIONS: Unfortunately, David's symptoms have not improved significantly. He continues to have significant discomfort and pain. He will likely be considered a qualified injured worker and will require vocational rehab. I do believe that an addition six weeks to three months of therapy would be indicated to maximize his benefits and at that point he should be considered to have reached maximal medical improvement and should be considered permanent and stationary. He certainly has not reached that point yet as he is only approximately 5 months postop. I have recommended continuation of his exercises. Follow up in about six weeks. WORK STATUS: 'His work status is TTD ,six weeks. DISCLOSURE: I declare under penalty of perjury that I have not violated Labor Code Section 139.3 and that the contents of this report and bill are tr and correct to the best of my knowledge. Sincerely, f / /21 /1 A /7 A F. Daniel Kharrazi, M.D. Qualified Medical Examiner (Q ) Diplomate, American Soar of rthopaedic Surgeons FDK:wmx • . . . . .. . .. ... . . . ... ... ... . .. . .. .