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NAILAH K. BYRD
CUYAHOGA COUNTY CLERK OF COURTS
1200 Ontario Street
Cleveland, Ohio 44113
Court of Common Pleas
NOTICE OF
October 27,2022 16:10
By: THOMAS M. SAXER 0055962
Confirmation Nbr. 2688453
JAMES TRUETT CV 22 970426
vs.
Judge: HOLLIE L. GALLAGHER
WARRENSVILLE DEVELOPMENTAL CENTER ET AL
Pages Filed: 7
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IN THE COURT OF COMMON PLEAS
CUYAHOGA COUNTY, OHIO
JAMES TRUETT ) CASE NO: CV 22-970426
)
Plaintiff-Appellant ) JUDGE HOLLIE L. GALLAGHER
)
vs. )
)
WARRENSVILLE DEVELOPMENTAL ) NOTICE OF EXPERT DISCLOSURE
CENTER, et al. )
)
Defendants-Appellees )
***
Comes now Defendant, Warrensville Developmental Center and gives notice to
this Court and all counsel of record that it shall call Aivars Vitols, D.O. as its expert in
this matter. A copy of Dr. Vitols August 25,2018 report is attached hereto as Exhibit A.
Respectfully submitted,
DAVID YOST, ATTORNEY GENERAL OF OHIO
By /s/ Thomas M. Saxer
Thomas M. Saxer #0055962
AMER CUNNINGHAM CO. L.P.A.
Special Counsel for Defendant,
Warrensville Developmental Center
One Cascade Plaza, Suite 1510
Akron, Ohio 44308-1322
(330) 762-2411
tsaxer@amer-law.com
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CERTIFICATE OF SERVICE
I hereby certify that a copy of the foregoing will be served via the Court's electronic
filing system upon David Steiger, Attorney for Plaintiff, SHELDON KARP CO., LPA,
1835 Midland Building, 101 Prospect Avenue, W., Cleveland, Ohio 44115 and via e-mail
to Daniel Kirschner, Attorney for Administrator, Bureau of Workers' Compensation, 615
W. Superior Avenue, 11th Floor, Cleveland, Ohio 44113 on this 27th day of October, 2022.
/s/ Thomas M. Saxer_______________
Attorney for Defendant,
Warrensville Developmental Center
13292-037 notice of
expert.docx
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INDEPENDENT MEDICAL EVALUATIONS
Aivars Vitols, D.O. LLC
4160 Little York Road
Suite 10
Dayton, OH 45414
Vitolsinc10@aol.com
937-545-8398 / 937-776-9627
Fax: 828-338-5004
August 25, 2018
MedQuest Evaluators
P.O. Box 234
Lewis Center, Ohio 43035
RE: James Truett
Claim; 13-304853
Employer: Warrensville Developmental Center
Occupation: TPW
DOI: 02/01/2013
ALLOWED CONDITION: Sprain of right shoulder
Contusion of right shoulder
Right shoulder supraspinatus tear
ALLEGED CONDITION: Partial tear of long head of right biceps
FILE REVIEW ISSUES: Opine as to request for additional allowance of partial tear of
long head of right biceps
INDEPENDENT MEDICAL REVIEW
Iam in receipt of medical records, which have been reviewed. I accept the allowed conditions. I
accept the findings of the POR, though not necessarily their conclusions. No previous
physician/patient relationship has existed and none has been established. All opinions will be
rendered within the realm of reasonable medical probability.
HISTORY AND MEDICAL RECORDS REVIEW:
The ciaimant has sustained a work-related injury on 02/01/2013, reporting, "I was assisting with
a hold during a physical behavior on house 2, kicking, twisting, turning of the individual who was
in behavior." X-rays of the right shoulder of 02/06/2013 are negative for fracture and
unremarkable.
The claimant has been evaluated at Concentre on 02/20/2013 with complaints of right shoulder
pain, He was attending physical therapy and noted some improvement. The claimant continued
with physical therapy.
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August 25, 2018
RE: James Truett
Claim: 13-304853
03/23/2013 MRI of the right shoulder reveals moderate supraspinatus tendinosis, articular side
fraying, and low-grade partial tear. There is low-grade partialintrasubstance tear
posterior supraspinatus. There is mild glenohumeral joint arthrosis. Moderate long
head biceps tendinosis, no partial tear.
The claimant is reassessed at Concentre on 03/29/2013, 04/09/2013, and
04/26/2013. He continues with significant pain. He undergoes a cortisone injection
and it is noted that he had significant improvement on 04/26/2013 following the
cortisone injection. He stiff has some decreased motion and some mild weakness.
Continue off work.
The claimant was re-examined at Concentra on 06/13/2013, 07/15/2013, continued therapy with
work modification and no significant new findings.
08/27/2013 The claimant undergoes right shoulder arthroscopic surgery by Dr. Parsons. The
claimant is diagnosed with a right shoulder cuff syndrome. He undergoes extensive
debridement and a subacromial decompression with acromioplasty. Operative
report documents that there was extensive synovial injection throughout the intra
articular space. The report notes that the long head of the biceps tendon and
subscapularis tendons were intact and normal. The posterior superior cuff
demonstrated mild undersurface sprain, but no full thickness tearing.
The claimant is reassessed by Dr. Parsons postoperatively 11/21/2013, progressing well. The
claimant receives a cortisone injection on 09/11/2014 with some improvement noted.
11/24/2014 Repeat MRI right shoulder reveals miid supraspinatus subscapularis tendinosis.
There is subtle low-grade partial intrasubstance tear of the supraspinatus with mild
glenohumeral joint arthrosis. The long head of the biceps tendon is unremarkable
with in the bicipital groove.
12/11/2014 Dr. Parsons reassess claimant. Diagnosed the claimant with partial tear of the
rotator cuff. Recommends continued physical therapy and requests cortisone
injection.
03/05/2015 Reassessment by Dr. Parsons finds that the claimant is "doing well." He declares
the claimant MMI and returns the claimant to full duty work.
IMPAIRMENT EVALUATIONS:
05/20/2015 Dr. Pellegrino, 2% WPI.
06/23/2016 Dr. Moghal 15% WPI.
08/11/2016 Dr. Pellegrino 2% WPI.
08/04/2017 Rebuttal correspondence, Dr. Riffle, in regards to denial of request of further
treatment. He opines that the process of deconditioning and weakening of the
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Page 3
August 25, 2018
RE: James Truett
Claim: 13-304853
claimant's right shoulder is occurring. He opines that any surgery, especially rotator
cuff region, will have a secondary side effect that the patient can experience
ongoing problems for years, He opines that this is a chronic condition that will
require occasional care to re-stabilize the injured area.
05/01/2018 MRI right shoulder. Mild AC joint arthrosis. Rotator cuff tendinosis of supraspinatus
and infraspinatus with bursal-sided fraying without full thickness or substantial
partial thickness tear. Minimal fraying of posterior glenoid labrum and mild to
moderate biceps long head tendinosis with fraying and possible partial tearing of
the Intrascapular component.
05/21/2018 C9 requesting additional allowance partial tear long head of biceps via flow-through
- has been forwarded to assigned BWC to render decision.
05/30/2018 C9 request for PT and PT re-evaluation by Dr. Riffle denied.
05/31/2018 C84 motion requests additional condition of partial tear of long head of the biceps,
right by the way of flow-through. Supporting evidence office note Dr. Riffle
05/21/2018 and MRI 05/01/2018.
06/05/2018 MCO denies C9 request 05/30/2018 citing ODG parameters and not meeting Miller
Criteria.
06/20/2018 Physician review by Dr. Yosowitz opines that ihere is insufficient medical evidence
to indicate that the alleged partial tear long head right biceps tendon is a direct or
proximal result of the claimant's 02/01/2013 injury, a substantial aggravation of that
injury, or a flow-through injury from 02/01/2013 industrial injury.
06/26/2018 BWC; recommends to deny request for partial tear of long head biceps, right, citing
report of Dr. Yosowitz of 06/20/2018.
07/26/2018 Ohio Industrial Commission, record of proceeding; hearing officer additionally
allows claim for partial tear of long head of biceps, right based on report of Dr.
Riffle 05/21/2018, 07/02/2018, and injured workers testimony.
SUMMARY/DISCUSSION:
The claimant sustained a work-related injury of 02/01/2013, as has been documented. The
claimant has been
initially treated conservatively with physical therapy. He has undergone an
MRI of 03/23/2013, which documents a supraspinatus tendinopathy with partial tear, mild
tendinopathy of long head biceps with no tear. He has undergone arthroscopic surgery of
08/27/2013 that consisted of extensive debridement, decompression, and acromioplasty. At the
time of surgical intervention, documentation reveals that the long head of the biceps tendon was
intact.
Repeat MRI of 11/24/2014 documents that the biceps tendon is normal. The claimant is
evaluated by Dr. Parsons on 03/05/2018 found to be "doing well", declared MMI, and returned
to full work. -The claimant continues with physical therapy and chiropractic care.
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August 25, 2018
RE: James Truett
Claim: 13-304853
Repeat MRI of 05/01/2018 reveals AC joint degenerative changes, rotator cuff tendinopathy,
minimal fraying of posterior glenoid labrum, and mild to moderate biceps long head tendinosis
with fraying and possible partial tear of the intrascapular component,
INTERROGATORIES:
The following interrogatories will be addressed based on review of available medical records:
1. Do you believe the claimant has/had the alleged condition? Please explain.
It is my professional medical opinion that the medical records have not substantiated positively
that the claimant has the alleged requested condition. MRI report of 03/23/2013, 11/24/2014,
documented a normal biceps tendon. Arthroscopic report of 08/27/2013 likewise documents that
the long head of the biceps is normal without tear and this is under direct visualization.
The MRI of 05/01/2018 documents degenerative changes and cuff tendinopathy. There is
tendinopathy of the biceps tendon with only question of a possible partial longitudinal tear that
has not definitivelybeen confirmed. In the event the MRI is true and accurate for a partial
longitudinal tear of the biceps tendon, this is a new pathology that has been identified5 years
post original work-related injury.
2. If you believe the claimant has the requested condition, please state within the realm
of reasonable medical probability whether the claimant's alleged condition is caused
primarily by the natural deterioration of tissue, an organ, or other part of the body.
Please explain the basis of your opinion.
It is my professional medical opinion within the realm of reasonable medical probability that the
requested additional alleged condition iscaused primarily by natural deterioration of tissue, an
organ, or other part of the body. Previous MRI reports of 03/23/2013, 11/24/2014 document a
normal biceps tendon. Arthroscopic report of 11/24/2014, under direct visualization, documents
a normal biceps tendon with no evidence of tear. It isnot untilthe MRI of 05/01/2018 that a
possible partial longitudinal tear is suggested of the biceps tendon with tendinopathy. This isa
new finding that is5 years removed from original work-related injury. It isa new finding. Itis
consistent with degenerative processes. MRI isindicative of arthritic changes of the AC joint,
cuff tendinopathy, as well as long head biceps tendinopathy. These findings all are
degenerative. They are the result of the aging process.
3. Please state within the realm of reasonable medical probability: if you believe the
requested condition is related to this industrial injury by direct causation, by way of
substantial aggravation, flow-through, or do you believe there is insufficient objective
evidence on file to relate the conditions to this industrial injury? Please explain.
It is my professional medical opinion within the realm of reasonable medical probability that the
alleged requested condition is not related to industrial injury by direct causation, by way of
substantial aggravation, or flow-through.
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August 25, 2018
RE: James Truett
Claim: 13-304853
The MRI report of 03/23/2013, obtained 3 weeks post DOI, reveals no evidence of a long head
biceps tear. The arthroscopic report of 08/27/2013 likewise reveals no evidence of biceps tear
or pathology under direct visualization. The first evidence of a possible partial longitudinal tear
of the long head of the biceps isreported on the MRI of 05/01/2018. This is5 years from the
date of injury and no causality exists to date of injury.
The medical failsto establish that any substantial aggravation exists. Previous diagnostics (
MRIs) do not reveal any progressive physiological changes. The firstevidence of a possible
partial longitudinal tear is identified on the MRI of 05/01/2018, 5 years removed from the dale of
injury. Medical records do not establish any mechanism of flow-through pattern. There is
insufficient objective evidence to relate the alleged requested condition to the industrial injury by
any means.
The foregoing opinions have been expressed in terms of reasonable medical probability. If more
information becomes available at a later date, such information may or may not change the
opinions rendered in this report. This report is a clinical assessment of documentation and the
opinions are based on the information available. This opinion does not constitute per se
recommendations for specific claims or administrative function to be made or enforced,
Yours truly,
Aivars Vitols, D.O., C.I.M.E.
Board Certified, American Soard of Independent Medical Evaluators
AV/cs
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NAILAH K. BYRD CUYAHOGA COUNTY CLERK OF COURTS 1200 Ontario Street Cleveland, Ohio 44113 Court of Common Pleas NOTICE OF October 27,2022 16:10 By: THOMAS M. SAXER 0055962 Confirmation Nbr. 2688453 JAMES TRUETT CV 22 970426 vs. Judge: HOLLIE L. GALLAGHER WARRENSVILLE DEVELOPMENTAL CENTER ET AL Pages Filed: 7 Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH IN THE COURT OF COMMON PLEAS CUYAHOGA COUNTY, OHIO JAMES TRUETT ) CASE NO: CV 22-970426 ) Plaintiff-Appellant ) JUDGE HOLLIE L. GALLAGHER ) vs. ) ) WARRENSVILLE DEVELOPMENTAL ) NOTICE OF EXPERT DISCLOSURE CENTER, et al. ) ) Defendants-Appellees ) *** Comes now Defendant, Warrensville Developmental Center and gives notice to this Court and all counsel of record that it shall call Aivars Vitols, D.O. as its expert in this matter. A copy of Dr. Vitols August 25,2018 report is attached hereto as Exhibit A. Respectfully submitted, DAVID YOST, ATTORNEY GENERAL OF OHIO By /s/ Thomas M. Saxer Thomas M. Saxer #0055962 AMER CUNNINGHAM CO. L.P.A. Special Counsel for Defendant, Warrensville Developmental Center One Cascade Plaza, Suite 1510 Akron, Ohio 44308-1322 (330) 762-2411 tsaxer@amer-law.com Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing will be served via the Court's electronic filing system upon David Steiger, Attorney for Plaintiff, SHELDON KARP CO., LPA, 1835 Midland Building, 101 Prospect Avenue, W., Cleveland, Ohio 44115 and via e-mail to Daniel Kirschner, Attorney for Administrator, Bureau of Workers' Compensation, 615 W. Superior Avenue, 11th Floor, Cleveland, Ohio 44113 on this 27th day of October, 2022. /s/ Thomas M. Saxer_______________ Attorney for Defendant, Warrensville Developmental Center 13292-037 notice of expert.docx Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH 44 From;15012216500 To:2167573483 Speed:1440Q TimeiAugust29t2018 at9:13:41 AMEDT IQIC I Pg. 2 of 6 08/29/2018 8:09:52 aM -0500 SEDGWICK-------------- ■"PZiOE 2-- OF-^ Aug 28 2018 09:21AM HP Fax page 1 INDEPENDENT MEDICAL EVALUATIONS Aivars Vitols, D.O. LLC 4160 Little York Road Suite 10 Dayton, OH 45414 Vitolsinc10@aol.com 937-545-8398 / 937-776-9627 Fax: 828-338-5004 August 25, 2018 MedQuest Evaluators P.O. Box 234 Lewis Center, Ohio 43035 RE: James Truett Claim; 13-304853 Employer: Warrensville Developmental Center Occupation: TPW DOI: 02/01/2013 ALLOWED CONDITION: Sprain of right shoulder Contusion of right shoulder Right shoulder supraspinatus tear ALLEGED CONDITION: Partial tear of long head of right biceps FILE REVIEW ISSUES: Opine as to request for additional allowance of partial tear of long head of right biceps INDEPENDENT MEDICAL REVIEW Iam in receipt of medical records, which have been reviewed. I accept the allowed conditions. I accept the findings of the POR, though not necessarily their conclusions. No previous physician/patient relationship has existed and none has been established. All opinions will be rendered within the realm of reasonable medical probability. HISTORY AND MEDICAL RECORDS REVIEW: The ciaimant has sustained a work-related injury on 02/01/2013, reporting, "I was assisting with a hold during a physical behavior on house 2, kicking, twisting, turning of the individual who was in behavior." X-rays of the right shoulder of 02/06/2013 are negative for fracture and unremarkable. The claimant has been evaluated at Concentre on 02/20/2013 with complaints of right shoulder pain, He was attending physical therapy and noted some improvement. The claimant continued with physical therapy. Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH From:15012216500 To: 2167873483" Speed:i4400 2018 at 9:13:41 AM f'-fmezAugust 29, EOT !OIC | Fg. 3 o'-f 6 “ 08/29/2018 8:09:52 aM -0500 SEDGWICK “ ' ’ .. "PA'G'E.~S'~. OF' 6 Aug 28 2018 09:21 AM HP Fax page 2 Page 2 August 25, 2018 RE: James Truett Claim: 13-304853 03/23/2013 MRI of the right shoulder reveals moderate supraspinatus tendinosis, articular side fraying, and low-grade partial tear. There is low-grade partialintrasubstance tear posterior supraspinatus. There is mild glenohumeral joint arthrosis. Moderate long head biceps tendinosis, no partial tear. The claimant is reassessed at Concentre on 03/29/2013, 04/09/2013, and 04/26/2013. He continues with significant pain. He undergoes a cortisone injection and it is noted that he had significant improvement on 04/26/2013 following the cortisone injection. He stiff has some decreased motion and some mild weakness. Continue off work. The claimant was re-examined at Concentra on 06/13/2013, 07/15/2013, continued therapy with work modification and no significant new findings. 08/27/2013 The claimant undergoes right shoulder arthroscopic surgery by Dr. Parsons. The claimant is diagnosed with a right shoulder cuff syndrome. He undergoes extensive debridement and a subacromial decompression with acromioplasty. Operative report documents that there was extensive synovial injection throughout the intra articular space. The report notes that the long head of the biceps tendon and subscapularis tendons were intact and normal. The posterior superior cuff demonstrated mild undersurface sprain, but no full thickness tearing. The claimant is reassessed by Dr. Parsons postoperatively 11/21/2013, progressing well. The claimant receives a cortisone injection on 09/11/2014 with some improvement noted. 11/24/2014 Repeat MRI right shoulder reveals miid supraspinatus subscapularis tendinosis. There is subtle low-grade partial intrasubstance tear of the supraspinatus with mild glenohumeral joint arthrosis. The long head of the biceps tendon is unremarkable with in the bicipital groove. 12/11/2014 Dr. Parsons reassess claimant. Diagnosed the claimant with partial tear of the rotator cuff. Recommends continued physical therapy and requests cortisone injection. 03/05/2015 Reassessment by Dr. Parsons finds that the claimant is "doing well." He declares the claimant MMI and returns the claimant to full duty work. IMPAIRMENT EVALUATIONS: 05/20/2015 Dr. Pellegrino, 2% WPI. 06/23/2016 Dr. Moghal 15% WPI. 08/11/2016 Dr. Pellegrino 2% WPI. 08/04/2017 Rebuttal correspondence, Dr. Riffle, in regards to denial of request of further treatment. He opines that the process of deconditioning and weakening of the Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH jrw ** F,^'/J\012^1650<1 T°-ai6?S73‘183 Speed: 14400 TimerAugust29,2018 at 9:13:41'ah' EDT 08/29/2018 8:09:52 aM -0500 SEDGWICK---- '----- Aug 28 2018 09:21AM HP Fax page 3 Page 3 August 25, 2018 RE: James Truett Claim: 13-304853 claimant's right shoulder is occurring. He opines that any surgery, especially rotator cuff region, will have a secondary side effect that the patient can experience ongoing problems for years, He opines that this is a chronic condition that will require occasional care to re-stabilize the injured area. 05/01/2018 MRI right shoulder. Mild AC joint arthrosis. Rotator cuff tendinosis of supraspinatus and infraspinatus with bursal-sided fraying without full thickness or substantial partial thickness tear. Minimal fraying of posterior glenoid labrum and mild to moderate biceps long head tendinosis with fraying and possible partial tearing of the Intrascapular component. 05/21/2018 C9 requesting additional allowance partial tear long head of biceps via flow-through - has been forwarded to assigned BWC to render decision. 05/30/2018 C9 request for PT and PT re-evaluation by Dr. Riffle denied. 05/31/2018 C84 motion requests additional condition of partial tear of long head of the biceps, right by the way of flow-through. Supporting evidence office note Dr. Riffle 05/21/2018 and MRI 05/01/2018. 06/05/2018 MCO denies C9 request 05/30/2018 citing ODG parameters and not meeting Miller Criteria. 06/20/2018 Physician review by Dr. Yosowitz opines that ihere is insufficient medical evidence to indicate that the alleged partial tear long head right biceps tendon is a direct or proximal result of the claimant's 02/01/2013 injury, a substantial aggravation of that injury, or a flow-through injury from 02/01/2013 industrial injury. 06/26/2018 BWC; recommends to deny request for partial tear of long head biceps, right, citing report of Dr. Yosowitz of 06/20/2018. 07/26/2018 Ohio Industrial Commission, record of proceeding; hearing officer additionally allows claim for partial tear of long head of biceps, right based on report of Dr. Riffle 05/21/2018, 07/02/2018, and injured workers testimony. SUMMARY/DISCUSSION: The claimant sustained a work-related injury of 02/01/2013, as has been documented. The claimant has been initially treated conservatively with physical therapy. He has undergone an MRI of 03/23/2013, which documents a supraspinatus tendinopathy with partial tear, mild tendinopathy of long head biceps with no tear. He has undergone arthroscopic surgery of 08/27/2013 that consisted of extensive debridement, decompression, and acromioplasty. At the time of surgical intervention, documentation reveals that the long head of the biceps tendon was intact. Repeat MRI of 11/24/2014 documents that the biceps tendon is normal. The claimant is evaluated by Dr. Parsons on 03/05/2018 found to be "doing well", declared MMI, and returned to full work. -The claimant continues with physical therapy and chiropractic care. Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH ** From: 150122165OtJ To:21678734B3 Speed:14400 TimeiAugust29,2018"at 9:13:41.fflEDT |"bic j Fg. 5 08/29/2018 8:09:52 aM -0500 SEDGWICK------------------- PAGE.5 Aug 28 2018 09:21AM HP Fax page 4 Page 4 August 25, 2018 RE: James Truett Claim: 13-304853 Repeat MRI of 05/01/2018 reveals AC joint degenerative changes, rotator cuff tendinopathy, minimal fraying of posterior glenoid labrum, and mild to moderate biceps long head tendinosis with fraying and possible partial tear of the intrascapular component, INTERROGATORIES: The following interrogatories will be addressed based on review of available medical records: 1. Do you believe the claimant has/had the alleged condition? Please explain. It is my professional medical opinion that the medical records have not substantiated positively that the claimant has the alleged requested condition. MRI report of 03/23/2013, 11/24/2014, documented a normal biceps tendon. Arthroscopic report of 08/27/2013 likewise documents that the long head of the biceps is normal without tear and this is under direct visualization. The MRI of 05/01/2018 documents degenerative changes and cuff tendinopathy. There is tendinopathy of the biceps tendon with only question of a possible partial longitudinal tear that has not definitivelybeen confirmed. In the event the MRI is true and accurate for a partial longitudinal tear of the biceps tendon, this is a new pathology that has been identified5 years post original work-related injury. 2. If you believe the claimant has the requested condition, please state within the realm of reasonable medical probability whether the claimant's alleged condition is caused primarily by the natural deterioration of tissue, an organ, or other part of the body. Please explain the basis of your opinion. It is my professional medical opinion within the realm of reasonable medical probability that the requested additional alleged condition iscaused primarily by natural deterioration of tissue, an organ, or other part of the body. Previous MRI reports of 03/23/2013, 11/24/2014 document a normal biceps tendon. Arthroscopic report of 11/24/2014, under direct visualization, documents a normal biceps tendon with no evidence of tear. It isnot untilthe MRI of 05/01/2018 that a possible partial longitudinal tear is suggested of the biceps tendon with tendinopathy. This isa new finding that is5 years removed from original work-related injury. It isa new finding. Itis consistent with degenerative processes. MRI isindicative of arthritic changes of the AC joint, cuff tendinopathy, as well as long head biceps tendinopathy. These findings all are degenerative. They are the result of the aging process. 3. Please state within the realm of reasonable medical probability: if you believe the requested condition is related to this industrial injury by direct causation, by way of substantial aggravation, flow-through, or do you believe there is insufficient objective evidence on file to relate the conditions to this industrial injury? Please explain. It is my professional medical opinion within the realm of reasonable medical probability that the alleged requested condition is not related to industrial injury by direct causation, by way of substantial aggravation, or flow-through. Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH ” From:15012216500 To:2167873483 Speed:14400 ~ Tirteiwwust29.2018 at 9:13:41 AM fdt 08Z2U7ZDTS"8:09:l>2 AM -0500 SEDGWICK----------- Aug 28 2018 09:22AM HP Fax page 5 Page 5 August 25, 2018 RE: James Truett Claim: 13-304853 The MRI report of 03/23/2013, obtained 3 weeks post DOI, reveals no evidence of a long head biceps tear. The arthroscopic report of 08/27/2013 likewise reveals no evidence of biceps tear or pathology under direct visualization. The first evidence of a possible partial longitudinal tear of the long head of the biceps isreported on the MRI of 05/01/2018. This is5 years from the date of injury and no causality exists to date of injury. The medical failsto establish that any substantial aggravation exists. Previous diagnostics ( MRIs) do not reveal any progressive physiological changes. The firstevidence of a possible partial longitudinal tear is identified on the MRI of 05/01/2018, 5 years removed from the dale of injury. Medical records do not establish any mechanism of flow-through pattern. There is insufficient objective evidence to relate the alleged requested condition to the industrial injury by any means. The foregoing opinions have been expressed in terms of reasonable medical probability. If more information becomes available at a later date, such information may or may not change the opinions rendered in this report. This report is a clinical assessment of documentation and the opinions are based on the information available. This opinion does not constitute per se recommendations for specific claims or administrative function to be made or enforced, Yours truly, Aivars Vitols, D.O., C.I.M.E. Board Certified, American Soard of Independent Medical Evaluators AV/cs Electronically Filed 10/27/2022 16:10 / NOTICE / CV 22 970426 / Confirmation Nbr. 2688453 / BATCH