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FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020
NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022
EXHIBIT G
FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020
NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022
Richard P. DeBenedetto, Ph.D. 100 South Bedford Road
Clinical & Neuropsychology Suite 340
NYS Lic. #: 008548-0 Mt. Kisco, NY 10549
Email: drdebenedetto@gmail.com
(914) 954-8064
Law Office of Kevin J. Philbin
One Whitehall Street, 13th Floor
New York, NY 10004
ATTN: Danielle Figaro
To Whom It May Concern:
At your request and with Ms. Lanza‘s consent an Independent Neuropsychological Examination was performed on
the date below. Ms. Lanza stated that she understood the purpose of the examination and that the normal
doctor-patient relationship did not exist for the purposes of our interaction.She provided identification and
agreed to take part in the examination.
Identifying Information
Re: Independent Neuropsychological Examination
Name: Sarah Lanza
Claim #: 01947306 / 20-018329
EW Case #: 21504868
DOL: 03/11/20
DOE: 10/12/21
Procedures and Tests Administered
Procedures:
• Mental Status Examination
• Neurobehavioral Status Examination
• Review of Records
Tests Administered:
• Reynolds Intelligence Assessment Scales-2 – RIAS2
Verbal Intelligence Scales
Nonverbal Intelligence Scales
Verbal Speeded Information Processing Scale
Nonverbal Speeded Information Processing Scale
• Neuropsychological Assessment Battery-NAB:
Attention Module (Digit Span, Spatial Location)
Language Module (Conf. Nmg., Comprehension)
Memory Module
Spatial Module (Org. /Pln’g.)
• Repeatable Battery for the Assessment of Neuropsychological Status-RBANS:
Spatial Module
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• Wisconsin Card Sorting Test-WCST
• Test of Verbal Conceptualization and Fluency-TVCF
• Stroop Color Word Test-SCWT
• Color Trails Test-CTT
• Hooper Visual Organization Test-HVOT
• Line Orientation Test (RBANS)-LOT
• Figure Copy (RBANS)
• Medical Symptom Validity Test-MVST
• Test of Memory and Malingering-TOMM
Records Reviewed:
• Verified Bill of Particulars: 2/18/21.
15-29.
• Physician Evaluation: 5/6/20 – 9/22/20; Be Evergreen Medical, P.C.
• Orthopedic Evaluation: 6/9/20, 10/30/20; Luke Carey, P.A., Anjani Sinha, M.D.
• Neurology Evaluation: 5/5/20 – 5/11/20; Mehrdad Golzad, M.D.
• MRI of Brain: 11/20/17 – 12/3/18; Karl Hussman, M.D.
• Operative Note: 7/18/20, 11/12/20; Joseph Jimenez, M.D.
• Electrodiagnostic Evaluation: 5/27/20; Sherrie Rawlins, M.D.
• MRI of Spine, Knee: 5/22/20; New Age Medical, P.C.
• MRI of Knee: 8/3/20; Siddharth Prakash, M.D.
• Physical Therapy: 5/17/20 – 11/6/20; Be Evergreen Medical, P.C.
• Chiropractic Evaluation: 5/5/20 - 10/28/20; Sean Diamond, D.C.
History
History of Injury and Treatment as Record Review and Ms. Lanza‘s Self-Report :
Ms. Lanza was involved in a motor-vehicle accident as the restrained driver of a car when it was struck from the
rear by another vehicle. She states that her vehicle did not strike any other objects or vehicles after being hit.
She
reports that during the collision she struck her head on the steering wheel. There was no loss of consciousness,
though she reports feeling dazed for a few minutes after the collision. There is no reported anterograde or
retrograde amnesia.
She did not require medical attention at the scene and did not go directly to a hospital.She states that she had a
friend drive her to her local ER sometime later that day because of a headache. At the ER she was examined, given
a CT scan of her head and x-rays of the affected parts of her body, and was discharged later the same day. *
*Note: There were records regarding her ER evaluation in the materials sent for review.
Her injuries involved her head in the form of a headache, her left shoulder, left knee, and left hip.
She has
consulted and/or treated for these injuries with an orthopedist, neurologist, physical therapist, chiropractor,
acupuncturist, and pain management physician. Treatment for her bodily injuries has included physical therapy,
chiropractic therapy, acupuncture, pain management (medication, epidural injections), and surgery on her left
knee and shoulder.
She has had an MRI, MRI/DTI, Neuroquant and metabolite study of her brain.*
*Note: See discussion in Clinical Summary section.
On in-office neurological consultation* she reported complaints or deficits in the following areas of cognition:
memory, attention/concentration, slowed mentation, organizing and planning. Psychological symptoms included:
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depression, anxiety, negative change in mood and personality. Physiological symptoms included: persistent pain,
dizziness, headache, fatigue, and disturbed sleep pattern.
*Note: Her score on the MoCA exam of 26/30 was within normal limits for her level of education.
Personal History:
Ms. Lanza is a 50-year-old, woman. She is divorced and has three daughters, ages 23, 28, and 33. She lives with
her youngest daughter. She has 12 years of education, earning a high school diploma, and was employed in
housekeeping at the time of the accident. She has not returned to work since the accident reportedly due to her
injuries related to pain and physical limitations.
Her medical history is significant for a hysterectomy (2010), carpal tunnel surgery (2010), removal of a breast
tumor (2010), and shoulder surgery (2017). She has been diagnosed with hypercholestemia. Medications taken
on a regular basis include Lipitor, Hydrazidine, and Montelukast.
There is no other reported significant medical, psychological, or neurocognitive history prior to the accident.There
is no reported history of learning problems or attentional disorder. There is no history of problems with drugs or
alcohol. There is no history of physical or sexual abuse.Developmental history as reported is within normal limits.
Family and social histories as reported are unremarkable and noncontributory. There is no reported history of
mental illness, alcohol or substance abuse, or dementia in any first-ranked relative.
Examination Findings-Behavioral/Psychological
Behavioral Observations:
Ms. Lanza is a right-handed, woman. She is 5’2” tall, weighs 170 lbs. and is of average body-build.
She has black
hair, black eyes and appears to be her stated age. She was casually dressed and well-groomed, appearing to be
well-nourished and otherwise healthy. Her gait and posture were normal. Gross motor-functioning and general
activity level was normal. Her conversational speech was normal for volume, productivity, and tempo.
She related in a cooperative manner, establishing, and maintaining an appropriate level of social rapport. No
overt signs of cognitive dysfunction, emotional distress, or pain behaviors were observed.
She was alert and attuned to task and situational demands. She understood instructions and task demands
without difficulty.No unusual test taking behaviors were observed. Her profile on tests and empirical markers of
response-bias and effort fell outside of acceptable limits for a valid neuropsychological test profile (see section:
Clinical Impression).
Note: She was accompanied to the evaluation by Daniel Belenjacob, who served as a representative of the law firm representing Ms. Lanza. Mr.
Belenjacob remained present throughout the examination.
Neurobehavioral Status:
On examination:
Thinking:
• Logical: Yes
• Coherent: Yes
• Appropriately goal directed: Yes
Ideational productivity and tempo: Within normal limits.
Intelligence on gross examination: Within average limits.
Reasoning and judgment: Sound on gross examination.
Speed of mental processing: Within expected ability limits on gross examination.
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Orientation:
• Day: Yes
• Date: Yes
• Time: Yes
• Person: Yes
Place: Yes
Count from 1-20: Yes (slowly)
Count from 20-1: Yes (slowly)
Spell the word WORLD forward: Yes
Spell the word World backwards: Yes
Able to comprehend and follow simple commands: Yes
Correctly answer questions involving simple reasoning and concentration: Yes
Correctly answered 2 of 5 general information questions
Correctly answered 1 of 3 questions dependent on intact, remote, incidental memory.
Understood the purpose of the examination: Yes
On self-report cognitive symptoms questionnaire, she endorsed the following symptoms or complaints currently:
Poor Immediate Memory
Poor Concentration
Poor Attention
Thinking feels slower
Psychological Status:
On examination:
Mood-Euthymic: Yes
Affect-Expressed a full range: Yes
Evidence of Thought Disturbance: No
Thought content unremarkable and appropriate to task/situational demands and expressed mood: Yes
Mood and affect responsive to task and situational demands: Yes
Obsessions present or described on self-report: No
Compulsions present or described on self-report: No
Phobias present or described on self-report: Yes No
Psychosocial functioning reported as within usual or normal limits: Yes
On a self-report symptom questionnaire, she endorsed the following symptoms currently:
Depression
Anxiety
Fear of something (e.g., riding in a car)
Hear voices in your head
Irritable Often
Become angry easily
Somatic Complaints:
On self-report somatic symptoms questionnaire, she endorsed the following symptoms or complaints currently:
Headaches
Vertigo
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Always Tired
Trouble falling asleep
Waking Up Frequently
• Pain on a daily a constant basis
• Pain interferes with or prevents you from doing any of the following:
bath/dress yourself
do routine household chores
be at home alone for 24 hours
socialize with family and friends
work at your old or a different job
Examination Findings-Neurocognitive
Note: All test findings are reported either in relation to the individual's expected or estimated premorbid level of intelligence ability and
cognitive functioning or in relation to the general population. Where the statement reads "within", "above" or "below" expected ability limits,
the reference is to the individual's expected or premorbid level of ability or performance on a given task. Where the statement reads "average",
"below average", "above average", the reference is to expectations in relation to the individual's peer group drawn from the general population.
Note: Tests were administered by Nick Diamandis, B.S. under my direct supervision. All tests administered were selected by this examiner. All
records and test findings were reviewed and interpreted by this examiner.
Note: The Intake portions of this examination (interview, mental and neurobehavioral status, concluding interview) were conducted by this
examiner via a secure, encrypted telehealth conference link (DOXCY). The psychometrician was present throughout to ensure the integrity of the
process. All tests were administered in person by the psychometrician. The entire testing process was monitored and supervised via the
telehealth link by this examiner.
Interpretive Guide
Percentile Rank Descriptive Interpretation Normal Curve
98 to >99.9 Very Superior 2.2
92 to 97 Superior 6.7
75 to 91 Above Average 16.1
25 to 74 Average 50.0
9 to 24 Below Average 16.1
4 to 8 Borderline 6.7
2 to 3 Mildly Impaired 2.2
1 Moderately Impaired -
<1 Severely Impaired -
Validity Measures: This battery employs a combination of stand-alone and embedded test measures as well as empirical markers to assess
response-bias and effort. Failure on one or more of these measures may indicate a lack of effort, symptom magnification, malingering or other
factors which could invalidate some or all test findings.
Findings:* Questionable
*Note: See Addendum for a list of test scores. See Clinical Impression for a discussion of validity test findings.
Intelligence:
Premorbid level of intelligence functioning based on a consideration of level of academic and vocational
attainment falls within the Below Average-Average range.*
Performance on an abbreviated measure of intelligence places h with the range of intelligence.
*Note: Findings and test interpretations will be referenced to the Below Average-Average range.
Composite Intelligence Index: Provides a summary estimate of global intelligence.
Overall performance on the RIAS2resulted in a CIX score within the Extremely Low range of ability.
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Verbal Intelligence Index: Provides a summary estimate of verbal intelligence as assessed by verbal reasoning and reflecting primarily
crystallized intellectual functions.
Overall performance on the RIAS2 yielded a VIX within the Extremely Low range of ability.
Non-Verbal Intelligence Index: Provides a summary estimate of nonverbal intelligence as assessed by nonverbal reasoning and
reflecting primarily fluid intellectual functions.
Overall performance on the RIAS2 yielded a NIX within the Extremely Low range of ability.
There was no difference in level of ability between crystallized and fluid intelligence abilities.
Memory:
Verbal Memory Discrete: Process: How well subject can recognize, remember, and retrieve words immediately following
exposure and after a 15–20-minute delay. Relevance: Remembering a scheduled test, recalling an appointment, taking medications,
and attending class.
• Immediate: Borderline
• Delayed: Borderline
• Recognition (cued recall): Borderline
• Retention (rate forgetting): Borderline
• Learning Curve (the ability to benefit from repetition [rehearsal] of the information to be
learned: Positive trend
Verbal Memory Semantic: Process: How well subject can recognize, remember, and retrieve words following immediate
exposure and after a 20–30-minute delay. Relevance: Remembering a scheduled test, recalling an appointment, taking medications,
and attending class.
• Immediate semantic auditory memory (specific facts-details): Mildly Impaired
• Immediate semantic auditory memory (thematic content-gist): Below Average
• Delayed semantic auditory memory for (specific facts-details): Mildly Impaired
• Delayed semantic auditory memory for (thematic content-gist): Borderline
• Retention (rate of forgetting):Below Average
• Learning Curve(the ability to benefit from repetition [rehearsal] of the information to be
learned): Positive Trend
Visual Memory: Process: How well subject can recognize, remember, and retrieve geometric figures immediately following
exposure and after a 10-minute delay. Relevance: Remembering graphic instructions, navigating, operating machines, recalling
images, and/or remember a calendar of events.
• Immediate: Below Average
• Delayed: Borderline
• Recognition (cued recall): Mildly Impaired
• Retention (rate of forgetting):Average
• Learning Curve (the ability to benefit from repetition [rehearsal] of the information to be
learned: Negative trend
Working Memory: How well a person can store, focus attention on and manipulate information for a brief period of time.
Performance on measures of working memory falls with the range of ability.
• Auditory-Simple (rote): Severely Impaired
• Auditory-Complex (sequencing): Mildly Impaired
• Visual: Below Average
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Attentional Processing/Executive Functions Domains:
Sustained Attention: Process: Sustaining and directing attention and focus on specific stimuli or activity over time without
becoming distracted or losing focus or intent. Relevance: Self-regulation and behavioral control: Borderline to Below Average
Complex Attention: Process: Ability to track and respond to a variety of stimuli over time and/or perform complex mental tasks
requiring vigilance quickly and accurately. Relevance: Self-regulation and behavioral control:
Borderline to Below Average
Verbal Reasoning: Process: How well is subject able to recognize, reason and respond to verbal abstract stimuli. Relevance:
Critical thinking skills, ability to forge insights, discern meaning, and ability to perceive relationships:
Severely Impaired
Non-Verbal Reasoning: Process: How well is subject able to recognize, reason and respond to non-verbal visual-abstract
Severely
stimuli. Relevance: Critical thinking skills, ability to forge insights, discern meaning, and ability to perceive relationships:
Impaired
Planning/Organization: Process: The ability to analyze information and formulate an effect plan of action directed at a specific
goal or task outcome. Relevance: Carry out a task, intention, solve a problem, effect a desired outcome:
Variable, ranging
from Borderline to Average with performance falling off with increasing task complexity.
Cognitive Flexibility:
Process: How well subject can adapt to rapidly respond to changing task demands [set-shifting] and
increasingly complex set of directions and/or to manipulate the information. Relevance: Reasoning, switching tasks, decision-
making, impulse control, strategy formation, attending to conversation:
Mildly Impaired
Response-Inhibition: Process: The ability to suppress an overlearned response in favor of a new response in the context of task
or situational feedback. Relevance: The ability to discontinue a response-set [plan or action] in order to respond to new information,
changing situational dynamics:
Borderline
Processing Speed: Process: How well a subject recognizes and processes information i.e., perceiving, attending/responding to
incoming information, motor speed, fine motor coordination, and visual-perceptual ability. Relevance: Ability to recognize and
respond/react i.e., fitness-to-drive, occupation issues, possible danger/risk signs or issues with accuracy and detail:
Severely
Impaired to Borderline
Expressive-Receptive Language Functions: Expressive language involves the ability to communicate verbally and in writing
incorporating correct semantics, syntax, grammatical constructs, and emotional tone. Receptive language involves the ability to perceive and
understand spoken and written language, to comprehend semantic constructs, syntax, grammar, and emotional tone.
Expressive language ability: No dysarthria, dysprosia, paraphasias, anomia or aphasias were evidenced.
Verbal fluidity:Within expected ability limits.
Oral productivity: Within expected ability limits.
Receptive language ability: Within expected ability limits
Fund of vocabulary and word knowledge: Within expected ability limits
Grammatical and syntactical knowledge: Within expected ability limits.
Visuospatial Functioning: Process: The ability to perceive and organize information about the visual environment. This encompasses the
ability to recognize objects and spatial relationships and the ability to organize and integrate visual information.
Relevance: The ability to
negotiate and manipulate aspects of the visual environment in the service of purposeful action.
Visuoconstruction-organizational ability (absent motor component): Impaired
Visuoconstruction-organizational ability (including motor component): Borderline
Ability to recognize spatial relationships:Borderline
Topographical orientation: Sound
Motor Functioning: Process: The ability to perform simple and complex movements. Relevance: Produce and satisfy an intention towards
a manual action and goal.
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Gross-motor functioning: Within expected ability limits.
General activity level:Within expected ability limits.
Fine-motor functioning:
• Coordination- Within expected ability limits
• Speed- Below Average to Average, within expected ability limits
Clinical Impression
Ms. Lanza‘s presentation on mental status examination was within normal or non-clinical limits. Her psychological
profile based on self-report suggested the presence of the following symptoms or syndromes: anxious-depressive
disorder, negative change in mood and personality.
Her performance on neurobehavioral status examination was within normal or non-clinical limits with the
exception of a deficit for comprehension of tasks requiring simple reasoning. Her cognitive profile on self-report
suggested the following cognitive deficits or syndromes: immediate recall, attention-concentration, and speed of
information processing.
Performance on intelligence measures was inconsistent with expectations based on below average to average
premorbid intelligence abilities, and fell within the extremely low range, below the 1st percentile.
Her overall neurocognitive test performance was inconsistent with expectations based on estimated premorbid
intelligence and fell within borderline to impaired ability limits within and across most cognitive domains and
processes.
These findings are interpreted within the context of Ms. Lanza‘s performance on empirical markers, stand-alone
and embedded measures of response-bias and effort which fell outside of acceptable limits for a valid
neuropsychological profile. In addition, interpretation references a comparison of test performance to accepted
empirical markers head injury severity, and expected associated cognitive deficits fell outside of acceptable limits
for a valid neuropsychological profile (see discussion below).
For example, her performance on the MSVT falls below that of healthy children-grade 5, patients with moderate
TBI and positive findings on neuroimaging, and patients with advanced dementia, on which this test was normed.
His performance on the TOMM also falls below that of normal controls, healthy children aged 5, and brain injured
patients on which this test was normed.
Ms. Lanza also fails 2 of 4 embedded measures of response-bias and effort: RDS, FR < Rcg., Inconsistent
performance within a test (i.e., failing easier trials while passing more difficulty trials of the same test).
With respect to empirical markers of TBI severity, the degree of cognitive deficit reflected in her test performance
is inconsistent with her normal or non-clinical performance on mental status and neurobehavioral status
examination as well as with reasonable clinical expectations based on the amount of time since the injury, the
empirically determined degree of severity of head injury (mild), as well as her reported level of daily functioning.
A decline in intelligence abilities, especially of the degree reflected in her performance on the RIA 2 is markedly
atypical and not found in the population of genuinely mildly or moderately brain injured individuals.
Her MRI was within nonclinical limits. Her repeat MRI/DTI (11/17, 12/18, 5/20) were within nonclinical limits.
There is an interpretation of lowered FA for two brain areas, but review of the report reveals that while lowered,
these scores fell within 1 standard deviation of the control mean, or within normal limits. Neuroquant studies over
this same period of time reflect variability, with a decline, then increase, followed by decline in some brain areas
(see reports). There can be several reasons for this finding of variability including methodological error.
The
Neuroquant reports should be reviewed by a neuroradiologist.
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Consequently, the observed atypical or clinically inconsistent performance on almost all neurocognitive tests
within this test battery cannot be accepted as a reflection of her true level of ability or functioning in the areas of
cognition assessed by these tests.
Factors contributing to failure on measures of effort and response-bias in the present case may include:
• Symptom Magnification (e.g., a preoccupation either conscious or unconscious with perceived cognitive
difficulties and/or emotional distress and to over report or exaggerate these symptoms)
• Other motivational factors (e.g., compensation)
In summary, based on the issues and factors discussed above, there is no objective evidence in these findings to
support a claim of neurocognitive disability or neurocognitive deficits secondary to TBI of the degree represented
in some of her test performance. There is no objective evidence in these findings to support a claim of
psychological disability or psychological symptomatology secondary to physical injuries and/or TBI of the degree
represented in her performance on some psychometric tests or self-report.
From a neuropsychological perspective, and in the absence of valid contrary findings, it must be expected that Ms.
Lanza can meet usual demands and activities of daily living as well as those of her employment.
If there are any questions about this report, contact my office.
ATTESTATION
Pursuant to CPLR 2106, I, Richard P. DeBenedetto, Ph.D. hereby affirm under the penalties of perjury, that I am duly licensed to practice
psychology in the State of New York. I also affirm under the penalties of perjury, that my assertions and conclusions contained in the above
report are true.
__________________________
Richard P. DeBenedetto, Ph.D.
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ADDENDUM
Test Scores
Validity Indices
MSVT:
TOMM:
Trial RS Cut-Off Score
Trial 1 32 20%
CIX < SPI 15 yes (.01) >20%
SNT < SPS 8 yes (.01) >20%
VIX is the Verbal Intelligence Index, NIX is the Nonverbal Intelligence Index, CIX is the Composite Intelligence Index, SPI is the Speeded
Processing Index, SNT is the Speeded Naming Task, and SPS is the Speeded Picture Search Subtest.
Attention-NAB:
Attention Module Score Table
Form 1
Raw
Score Score %ile
Digits Forward
3 <1
(DGF)
Digits Forward Longest Span
4 <1
(DGF-spn)
Digits Backward
1 3
(DGB)
Digits Backward Longest Span
3 2
(DGB-spn)
Dots
3 16
(DOT)
Memory-NAB:
Memory Module Score Table
Form 1
List Learning Score Table
Raw
Cum.
Score Score %ile
%age
List Learning List A Trial 1
2 <1
Immediate Recall (LLA1-irc)
List Learning List A Trial 2
6 6
Immediate Recall (LLA2-irc)
List Learning List A Trial 3
8 15
Immediate Recall (LLA3-irc)
List Learning List A
16 5
Immediate Recall (LLA-irc)
List Learning List B
4 38
Immediate Recall (LLB-irc)
List Learning List A
--- ---
Short Delayed Recall (LLA-sd:drc)
List Learning List A
4 7
Long Delayed Recall (LLA-ld:drc)
List Learning List A
--- ---
Percent Retention (LLA-%rt)
List Learning List A Long Delayed
9 4
Forced-Choice Recognition (LLA-dfc)
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List Learning List A Long Delayed
Forced-Choice Recognition 3 11
False Alarms (LLA-fa)
List Learning List A
6 19
Discriminability Index (LLA-dis)
List Learning List A Recall vs.
44 11
Recognition Index (LLA-rvr)
List Learning Semantic Clusters
8 28
(LL-sem)
List Learning Perseverations
3 85
(LL-psv) a
List Learning Intrusions
3 86
(LL-int) a
aHigher cumulative percentages indicate poorer performance.
Note. “---“ indicates a score that could not be calculated due to missing data.
Shape Learning Score Table
Raw
Score Score %ile
Shape Learning Trial 1
4 50
Immediate Recognition (SHL1-irg)
Shape Learning Trial 2
5 25
Immediate Recognition (SHL2-irg)
Shape Learning Trial 3
3 3
Immediate Recognition (SHL3-irg)
Shape Learning
12 14
Immediate Recognition (SHL-irg)
Shape Learning
3 4
Delayed Recognition (SHL-drg)
Shape Learning
100 50
Percent Retention (SHL-%rt)
Shape Learning Delayed
4 2
Forced-Choice Recognition (SHL-dfc)
Shape Learning Delayed
Forced-Choice Recognition 1 11
False Alarms (SHL-fa)
Shape Learning
3 2
Discriminability Index (SHL-dis)
Story Learning Score Table
Raw
Score Score %ile
Story Learning Trial 1 Phrase Unit
17 10
(STL1-irc:phu)
Story Learning Trial 2 Phrase Unit
19 3
(STL2-irc:phu)
Story Learning Phrase Unit
36 2
Immediate Recall (STL-irc:phu)
Story Learning Thematic Unit
13 14
Immediate Recall (STL-irc:thu)
Story Learning Trial 1 Thematic Unit
6 25
(STL1-irc:thu)
Story Learning Trial 2 Thematic Unit
7 10
(STL2-irc:thu)
Story Learning Phrase Unit
16 2
Delayed Recall (STL-drc:phu)
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Story Learning Thematic Unit
6 8
Delayed Recall (STL-drc:thu)
Story Learning Phrase Unit
84 13
Percent Retention (STL-%rt)
WSCT:
Age & Education
Demographically
Corrected
Raw Standar T
WCST scores scor d scor %iles
es scores es
Total Correct 22
Total Errors 42 66 27 1%
Perseverative Responses 33 71 31 3%
Perseverative Errors 24 73 32 4%
Preview
FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 EXHIBIT G FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 Richard P. DeBenedetto, Ph.D. 100 South Bedford Road Clinical & Neuropsychology Suite 340 NYS Lic. #: 008548-0 Mt. Kisco, NY 10549 Email: drdebenedetto@gmail.com (914) 954-8064 Law Office of Kevin J. Philbin One Whitehall Street, 13th Floor New York, NY 10004 ATTN: Danielle Figaro To Whom It May Concern: At your request and with Ms. Lanza‘s consent an Independent Neuropsychological Examination was performed on the date below. Ms. Lanza stated that she understood the purpose of the examination and that the normal doctor-patient relationship did not exist for the purposes of our interaction.She provided identification and agreed to take part in the examination. Identifying Information Re: Independent Neuropsychological Examination Name: Sarah Lanza Claim #: 01947306 / 20-018329 EW Case #: 21504868 DOL: 03/11/20 DOE: 10/12/21 Procedures and Tests Administered Procedures: • Mental Status Examination • Neurobehavioral Status Examination • Review of Records Tests Administered: • Reynolds Intelligence Assessment Scales-2 – RIAS2 Verbal Intelligence Scales Nonverbal Intelligence Scales Verbal Speeded Information Processing Scale Nonverbal Speeded Information Processing Scale • Neuropsychological Assessment Battery-NAB: Attention Module (Digit Span, Spatial Location) Language Module (Conf. Nmg., Comprehension) Memory Module Spatial Module (Org. /Pln’g.) • Repeatable Battery for the Assessment of Neuropsychological Status-RBANS: Spatial Module FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 2 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 • Wisconsin Card Sorting Test-WCST • Test of Verbal Conceptualization and Fluency-TVCF • Stroop Color Word Test-SCWT • Color Trails Test-CTT • Hooper Visual Organization Test-HVOT • Line Orientation Test (RBANS)-LOT • Figure Copy (RBANS) • Medical Symptom Validity Test-MVST • Test of Memory and Malingering-TOMM Records Reviewed: • Verified Bill of Particulars: 2/18/21. 15-29. • Physician Evaluation: 5/6/20 – 9/22/20; Be Evergreen Medical, P.C. • Orthopedic Evaluation: 6/9/20, 10/30/20; Luke Carey, P.A., Anjani Sinha, M.D. • Neurology Evaluation: 5/5/20 – 5/11/20; Mehrdad Golzad, M.D. • MRI of Brain: 11/20/17 – 12/3/18; Karl Hussman, M.D. • Operative Note: 7/18/20, 11/12/20; Joseph Jimenez, M.D. • Electrodiagnostic Evaluation: 5/27/20; Sherrie Rawlins, M.D. • MRI of Spine, Knee: 5/22/20; New Age Medical, P.C. • MRI of Knee: 8/3/20; Siddharth Prakash, M.D. • Physical Therapy: 5/17/20 – 11/6/20; Be Evergreen Medical, P.C. • Chiropractic Evaluation: 5/5/20 - 10/28/20; Sean Diamond, D.C. History History of Injury and Treatment as Record Review and Ms. Lanza‘s Self-Report : Ms. Lanza was involved in a motor-vehicle accident as the restrained driver of a car when it was struck from the rear by another vehicle. She states that her vehicle did not strike any other objects or vehicles after being hit. She reports that during the collision she struck her head on the steering wheel. There was no loss of consciousness, though she reports feeling dazed for a few minutes after the collision. There is no reported anterograde or retrograde amnesia. She did not require medical attention at the scene and did not go directly to a hospital.She states that she had a friend drive her to her local ER sometime later that day because of a headache. At the ER she was examined, given a CT scan of her head and x-rays of the affected parts of her body, and was discharged later the same day. * *Note: There were records regarding her ER evaluation in the materials sent for review. Her injuries involved her head in the form of a headache, her left shoulder, left knee, and left hip. She has consulted and/or treated for these injuries with an orthopedist, neurologist, physical therapist, chiropractor, acupuncturist, and pain management physician. Treatment for her bodily injuries has included physical therapy, chiropractic therapy, acupuncture, pain management (medication, epidural injections), and surgery on her left knee and shoulder. She has had an MRI, MRI/DTI, Neuroquant and metabolite study of her brain.* *Note: See discussion in Clinical Summary section. On in-office neurological consultation* she reported complaints or deficits in the following areas of cognition: memory, attention/concentration, slowed mentation, organizing and planning. Psychological symptoms included: FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 3 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 depression, anxiety, negative change in mood and personality. Physiological symptoms included: persistent pain, dizziness, headache, fatigue, and disturbed sleep pattern. *Note: Her score on the MoCA exam of 26/30 was within normal limits for her level of education. Personal History: Ms. Lanza is a 50-year-old, woman. She is divorced and has three daughters, ages 23, 28, and 33. She lives with her youngest daughter. She has 12 years of education, earning a high school diploma, and was employed in housekeeping at the time of the accident. She has not returned to work since the accident reportedly due to her injuries related to pain and physical limitations. Her medical history is significant for a hysterectomy (2010), carpal tunnel surgery (2010), removal of a breast tumor (2010), and shoulder surgery (2017). She has been diagnosed with hypercholestemia. Medications taken on a regular basis include Lipitor, Hydrazidine, and Montelukast. There is no other reported significant medical, psychological, or neurocognitive history prior to the accident.There is no reported history of learning problems or attentional disorder. There is no history of problems with drugs or alcohol. There is no history of physical or sexual abuse.Developmental history as reported is within normal limits. Family and social histories as reported are unremarkable and noncontributory. There is no reported history of mental illness, alcohol or substance abuse, or dementia in any first-ranked relative. Examination Findings-Behavioral/Psychological Behavioral Observations: Ms. Lanza is a right-handed, woman. She is 5’2” tall, weighs 170 lbs. and is of average body-build. She has black hair, black eyes and appears to be her stated age. She was casually dressed and well-groomed, appearing to be well-nourished and otherwise healthy. Her gait and posture were normal. Gross motor-functioning and general activity level was normal. Her conversational speech was normal for volume, productivity, and tempo. She related in a cooperative manner, establishing, and maintaining an appropriate level of social rapport. No overt signs of cognitive dysfunction, emotional distress, or pain behaviors were observed. She was alert and attuned to task and situational demands. She understood instructions and task demands without difficulty.No unusual test taking behaviors were observed. Her profile on tests and empirical markers of response-bias and effort fell outside of acceptable limits for a valid neuropsychological test profile (see section: Clinical Impression). Note: She was accompanied to the evaluation by Daniel Belenjacob, who served as a representative of the law firm representing Ms. Lanza. Mr. Belenjacob remained present throughout the examination. Neurobehavioral Status: On examination: Thinking: • Logical: Yes • Coherent: Yes • Appropriately goal directed: Yes Ideational productivity and tempo: Within normal limits. Intelligence on gross examination: Within average limits. Reasoning and judgment: Sound on gross examination. Speed of mental processing: Within expected ability limits on gross examination. FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 4 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Orientation: • Day: Yes • Date: Yes • Time: Yes • Person: Yes Place: Yes Count from 1-20: Yes (slowly) Count from 20-1: Yes (slowly) Spell the word WORLD forward: Yes Spell the word World backwards: Yes Able to comprehend and follow simple commands: Yes Correctly answer questions involving simple reasoning and concentration: Yes Correctly answered 2 of 5 general information questions Correctly answered 1 of 3 questions dependent on intact, remote, incidental memory. Understood the purpose of the examination: Yes On self-report cognitive symptoms questionnaire, she endorsed the following symptoms or complaints currently: Poor Immediate Memory Poor Concentration Poor Attention Thinking feels slower Psychological Status: On examination: Mood-Euthymic: Yes Affect-Expressed a full range: Yes Evidence of Thought Disturbance: No Thought content unremarkable and appropriate to task/situational demands and expressed mood: Yes Mood and affect responsive to task and situational demands: Yes Obsessions present or described on self-report: No Compulsions present or described on self-report: No Phobias present or described on self-report: Yes No Psychosocial functioning reported as within usual or normal limits: Yes On a self-report symptom questionnaire, she endorsed the following symptoms currently: Depression Anxiety Fear of something (e.g., riding in a car) Hear voices in your head Irritable Often Become angry easily Somatic Complaints: On self-report somatic symptoms questionnaire, she endorsed the following symptoms or complaints currently: Headaches Vertigo FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 5 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Always Tired Trouble falling asleep Waking Up Frequently • Pain on a daily a constant basis • Pain interferes with or prevents you from doing any of the following: bath/dress yourself do routine household chores be at home alone for 24 hours socialize with family and friends work at your old or a different job Examination Findings-Neurocognitive Note: All test findings are reported either in relation to the individual's expected or estimated premorbid level of intelligence ability and cognitive functioning or in relation to the general population. Where the statement reads "within", "above" or "below" expected ability limits, the reference is to the individual's expected or premorbid level of ability or performance on a given task. Where the statement reads "average", "below average", "above average", the reference is to expectations in relation to the individual's peer group drawn from the general population. Note: Tests were administered by Nick Diamandis, B.S. under my direct supervision. All tests administered were selected by this examiner. All records and test findings were reviewed and interpreted by this examiner. Note: The Intake portions of this examination (interview, mental and neurobehavioral status, concluding interview) were conducted by this examiner via a secure, encrypted telehealth conference link (DOXCY). The psychometrician was present throughout to ensure the integrity of the process. All tests were administered in person by the psychometrician. The entire testing process was monitored and supervised via the telehealth link by this examiner. Interpretive Guide Percentile Rank Descriptive Interpretation Normal Curve 98 to >99.9 Very Superior 2.2 92 to 97 Superior 6.7 75 to 91 Above Average 16.1 25 to 74 Average 50.0 9 to 24 Below Average 16.1 4 to 8 Borderline 6.7 2 to 3 Mildly Impaired 2.2 1 Moderately Impaired - <1 Severely Impaired - Validity Measures: This battery employs a combination of stand-alone and embedded test measures as well as empirical markers to assess response-bias and effort. Failure on one or more of these measures may indicate a lack of effort, symptom magnification, malingering or other factors which could invalidate some or all test findings. Findings:* Questionable *Note: See Addendum for a list of test scores. See Clinical Impression for a discussion of validity test findings. Intelligence: Premorbid level of intelligence functioning based on a consideration of level of academic and vocational attainment falls within the Below Average-Average range.* Performance on an abbreviated measure of intelligence places h with the range of intelligence. *Note: Findings and test interpretations will be referenced to the Below Average-Average range. Composite Intelligence Index: Provides a summary estimate of global intelligence. Overall performance on the RIAS2resulted in a CIX score within the Extremely Low range of ability. FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 6 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Verbal Intelligence Index: Provides a summary estimate of verbal intelligence as assessed by verbal reasoning and reflecting primarily crystallized intellectual functions. Overall performance on the RIAS2 yielded a VIX within the Extremely Low range of ability. Non-Verbal Intelligence Index: Provides a summary estimate of nonverbal intelligence as assessed by nonverbal reasoning and reflecting primarily fluid intellectual functions. Overall performance on the RIAS2 yielded a NIX within the Extremely Low range of ability. There was no difference in level of ability between crystallized and fluid intelligence abilities. Memory: Verbal Memory Discrete: Process: How well subject can recognize, remember, and retrieve words immediately following exposure and after a 15–20-minute delay. Relevance: Remembering a scheduled test, recalling an appointment, taking medications, and attending class. • Immediate: Borderline • Delayed: Borderline • Recognition (cued recall): Borderline • Retention (rate forgetting): Borderline • Learning Curve (the ability to benefit from repetition [rehearsal] of the information to be learned: Positive trend Verbal Memory Semantic: Process: How well subject can recognize, remember, and retrieve words following immediate exposure and after a 20–30-minute delay. Relevance: Remembering a scheduled test, recalling an appointment, taking medications, and attending class. • Immediate semantic auditory memory (specific facts-details): Mildly Impaired • Immediate semantic auditory memory (thematic content-gist): Below Average • Delayed semantic auditory memory for (specific facts-details): Mildly Impaired • Delayed semantic auditory memory for (thematic content-gist): Borderline • Retention (rate of forgetting):Below Average • Learning Curve(the ability to benefit from repetition [rehearsal] of the information to be learned): Positive Trend Visual Memory: Process: How well subject can recognize, remember, and retrieve geometric figures immediately following exposure and after a 10-minute delay. Relevance: Remembering graphic instructions, navigating, operating machines, recalling images, and/or remember a calendar of events. • Immediate: Below Average • Delayed: Borderline • Recognition (cued recall): Mildly Impaired • Retention (rate of forgetting):Average • Learning Curve (the ability to benefit from repetition [rehearsal] of the information to be learned: Negative trend Working Memory: How well a person can store, focus attention on and manipulate information for a brief period of time. Performance on measures of working memory falls with the range of ability. • Auditory-Simple (rote): Severely Impaired • Auditory-Complex (sequencing): Mildly Impaired • Visual: Below Average FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 7 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Attentional Processing/Executive Functions Domains: Sustained Attention: Process: Sustaining and directing attention and focus on specific stimuli or activity over time without becoming distracted or losing focus or intent. Relevance: Self-regulation and behavioral control: Borderline to Below Average Complex Attention: Process: Ability to track and respond to a variety of stimuli over time and/or perform complex mental tasks requiring vigilance quickly and accurately. Relevance: Self-regulation and behavioral control: Borderline to Below Average Verbal Reasoning: Process: How well is subject able to recognize, reason and respond to verbal abstract stimuli. Relevance: Critical thinking skills, ability to forge insights, discern meaning, and ability to perceive relationships: Severely Impaired Non-Verbal Reasoning: Process: How well is subject able to recognize, reason and respond to non-verbal visual-abstract Severely stimuli. Relevance: Critical thinking skills, ability to forge insights, discern meaning, and ability to perceive relationships: Impaired Planning/Organization: Process: The ability to analyze information and formulate an effect plan of action directed at a specific goal or task outcome. Relevance: Carry out a task, intention, solve a problem, effect a desired outcome: Variable, ranging from Borderline to Average with performance falling off with increasing task complexity. Cognitive Flexibility: Process: How well subject can adapt to rapidly respond to changing task demands [set-shifting] and increasingly complex set of directions and/or to manipulate the information. Relevance: Reasoning, switching tasks, decision- making, impulse control, strategy formation, attending to conversation: Mildly Impaired Response-Inhibition: Process: The ability to suppress an overlearned response in favor of a new response in the context of task or situational feedback. Relevance: The ability to discontinue a response-set [plan or action] in order to respond to new information, changing situational dynamics: Borderline Processing Speed: Process: How well a subject recognizes and processes information i.e., perceiving, attending/responding to incoming information, motor speed, fine motor coordination, and visual-perceptual ability. Relevance: Ability to recognize and respond/react i.e., fitness-to-drive, occupation issues, possible danger/risk signs or issues with accuracy and detail: Severely Impaired to Borderline Expressive-Receptive Language Functions: Expressive language involves the ability to communicate verbally and in writing incorporating correct semantics, syntax, grammatical constructs, and emotional tone. Receptive language involves the ability to perceive and understand spoken and written language, to comprehend semantic constructs, syntax, grammar, and emotional tone. Expressive language ability: No dysarthria, dysprosia, paraphasias, anomia or aphasias were evidenced. Verbal fluidity:Within expected ability limits. Oral productivity: Within expected ability limits. Receptive language ability: Within expected ability limits Fund of vocabulary and word knowledge: Within expected ability limits Grammatical and syntactical knowledge: Within expected ability limits. Visuospatial Functioning: Process: The ability to perceive and organize information about the visual environment. This encompasses the ability to recognize objects and spatial relationships and the ability to organize and integrate visual information. Relevance: The ability to negotiate and manipulate aspects of the visual environment in the service of purposeful action. Visuoconstruction-organizational ability (absent motor component): Impaired Visuoconstruction-organizational ability (including motor component): Borderline Ability to recognize spatial relationships:Borderline Topographical orientation: Sound Motor Functioning: Process: The ability to perform simple and complex movements. Relevance: Produce and satisfy an intention towards a manual action and goal. FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 8 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Gross-motor functioning: Within expected ability limits. General activity level:Within expected ability limits. Fine-motor functioning: • Coordination- Within expected ability limits • Speed- Below Average to Average, within expected ability limits Clinical Impression Ms. Lanza‘s presentation on mental status examination was within normal or non-clinical limits. Her psychological profile based on self-report suggested the presence of the following symptoms or syndromes: anxious-depressive disorder, negative change in mood and personality. Her performance on neurobehavioral status examination was within normal or non-clinical limits with the exception of a deficit for comprehension of tasks requiring simple reasoning. Her cognitive profile on self-report suggested the following cognitive deficits or syndromes: immediate recall, attention-concentration, and speed of information processing. Performance on intelligence measures was inconsistent with expectations based on below average to average premorbid intelligence abilities, and fell within the extremely low range, below the 1st percentile. Her overall neurocognitive test performance was inconsistent with expectations based on estimated premorbid intelligence and fell within borderline to impaired ability limits within and across most cognitive domains and processes. These findings are interpreted within the context of Ms. Lanza‘s performance on empirical markers, stand-alone and embedded measures of response-bias and effort which fell outside of acceptable limits for a valid neuropsychological profile. In addition, interpretation references a comparison of test performance to accepted empirical markers head injury severity, and expected associated cognitive deficits fell outside of acceptable limits for a valid neuropsychological profile (see discussion below). For example, her performance on the MSVT falls below that of healthy children-grade 5, patients with moderate TBI and positive findings on neuroimaging, and patients with advanced dementia, on which this test was normed. His performance on the TOMM also falls below that of normal controls, healthy children aged 5, and brain injured patients on which this test was normed. Ms. Lanza also fails 2 of 4 embedded measures of response-bias and effort: RDS, FR < Rcg., Inconsistent performance within a test (i.e., failing easier trials while passing more difficulty trials of the same test). With respect to empirical markers of TBI severity, the degree of cognitive deficit reflected in her test performance is inconsistent with her normal or non-clinical performance on mental status and neurobehavioral status examination as well as with reasonable clinical expectations based on the amount of time since the injury, the empirically determined degree of severity of head injury (mild), as well as her reported level of daily functioning. A decline in intelligence abilities, especially of the degree reflected in her performance on the RIA 2 is markedly atypical and not found in the population of genuinely mildly or moderately brain injured individuals. Her MRI was within nonclinical limits. Her repeat MRI/DTI (11/17, 12/18, 5/20) were within nonclinical limits. There is an interpretation of lowered FA for two brain areas, but review of the report reveals that while lowered, these scores fell within 1 standard deviation of the control mean, or within normal limits. Neuroquant studies over this same period of time reflect variability, with a decline, then increase, followed by decline in some brain areas (see reports). There can be several reasons for this finding of variability including methodological error. The Neuroquant reports should be reviewed by a neuroradiologist. FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 9 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Consequently, the observed atypical or clinically inconsistent performance on almost all neurocognitive tests within this test battery cannot be accepted as a reflection of her true level of ability or functioning in the areas of cognition assessed by these tests. Factors contributing to failure on measures of effort and response-bias in the present case may include: • Symptom Magnification (e.g., a preoccupation either conscious or unconscious with perceived cognitive difficulties and/or emotional distress and to over report or exaggerate these symptoms) • Other motivational factors (e.g., compensation) In summary, based on the issues and factors discussed above, there is no objective evidence in these findings to support a claim of neurocognitive disability or neurocognitive deficits secondary to TBI of the degree represented in some of her test performance. There is no objective evidence in these findings to support a claim of psychological disability or psychological symptomatology secondary to physical injuries and/or TBI of the degree represented in her performance on some psychometric tests or self-report. From a neuropsychological perspective, and in the absence of valid contrary findings, it must be expected that Ms. Lanza can meet usual demands and activities of daily living as well as those of her employment. If there are any questions about this report, contact my office. ATTESTATION Pursuant to CPLR 2106, I, Richard P. DeBenedetto, Ph.D. hereby affirm under the penalties of perjury, that I am duly licensed to practice psychology in the State of New York. I also affirm under the penalties of perjury, that my assertions and conclusions contained in the above report are true. __________________________ Richard P. DeBenedetto, Ph.D. FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 10 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 ADDENDUM Test Scores Validity Indices MSVT: TOMM: Trial RS Cut-Off Score Trial 1 32 20% CIX < SPI 15 yes (.01) >20% SNT < SPS 8 yes (.01) >20% VIX is the Verbal Intelligence Index, NIX is the Nonverbal Intelligence Index, CIX is the Composite Intelligence Index, SPI is the Speeded Processing Index, SNT is the Speeded Naming Task, and SPS is the Speeded Picture Search Subtest. Attention-NAB: Attention Module Score Table Form 1 Raw Score Score %ile Digits Forward 3 <1 (DGF) Digits Forward Longest Span 4 <1 (DGF-spn) Digits Backward 1 3 (DGB) Digits Backward Longest Span 3 2 (DGB-spn) Dots 3 16 (DOT) Memory-NAB: Memory Module Score Table Form 1 List Learning Score Table Raw Cum. Score Score %ile %age List Learning List A Trial 1 2 <1 Immediate Recall (LLA1-irc) List Learning List A Trial 2 6 6 Immediate Recall (LLA2-irc) List Learning List A Trial 3 8 15 Immediate Recall (LLA3-irc) List Learning List A 16 5 Immediate Recall (LLA-irc) List Learning List B 4 38 Immediate Recall (LLB-irc) List Learning List A --- --- Short Delayed Recall (LLA-sd:drc) List Learning List A 4 7 Long Delayed Recall (LLA-ld:drc) List Learning List A --- --- Percent Retention (LLA-%rt) List Learning List A Long Delayed 9 4 Forced-Choice Recognition (LLA-dfc) FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 12 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 List Learning List A Long Delayed Forced-Choice Recognition 3 11 False Alarms (LLA-fa) List Learning List A 6 19 Discriminability Index (LLA-dis) List Learning List A Recall vs. 44 11 Recognition Index (LLA-rvr) List Learning Semantic Clusters 8 28 (LL-sem) List Learning Perseverations 3 85 (LL-psv) a List Learning Intrusions 3 86 (LL-int) a aHigher cumulative percentages indicate poorer performance. Note. “---“ indicates a score that could not be calculated due to missing data. Shape Learning Score Table Raw Score Score %ile Shape Learning Trial 1 4 50 Immediate Recognition (SHL1-irg) Shape Learning Trial 2 5 25 Immediate Recognition (SHL2-irg) Shape Learning Trial 3 3 3 Immediate Recognition (SHL3-irg) Shape Learning 12 14 Immediate Recognition (SHL-irg) Shape Learning 3 4 Delayed Recognition (SHL-drg) Shape Learning 100 50 Percent Retention (SHL-%rt) Shape Learning Delayed 4 2 Forced-Choice Recognition (SHL-dfc) Shape Learning Delayed Forced-Choice Recognition 1 11 False Alarms (SHL-fa) Shape Learning 3 2 Discriminability Index (SHL-dis) Story Learning Score Table Raw Score Score %ile Story Learning Trial 1 Phrase Unit 17 10 (STL1-irc:phu) Story Learning Trial 2 Phrase Unit 19 3 (STL2-irc:phu) Story Learning Phrase Unit 36 2 Immediate Recall (STL-irc:phu) Story Learning Thematic Unit 13 14 Immediate Recall (STL-irc:thu) Story Learning Trial 1 Thematic Unit 6 25 (STL1-irc:thu) Story Learning Trial 2 Thematic Unit 7 10 (STL2-irc:thu) Story Learning Phrase Unit 16 2 Delayed Recall (STL-drc:phu) FILED: KINGS COUNTY CLERK 08/20/2022 02:54 AM INDEX NO. 523020/2020 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/20/2022 13 Lanza, Sarah Independent Neuropsychological Evaluation 10/21/21 Story Learning Thematic Unit 6 8 Delayed Recall (STL-drc:thu) Story Learning Phrase Unit 84 13 Percent Retention (STL-%rt) WSCT: Age & Education Demographically Corrected Raw Standar T WCST scores scor d scor %iles es scores es Total Correct 22 Total Errors 42 66 27 1% Perseverative Responses 33 71 31 3% Perseverative Errors 24 73 32 4%