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Dr. H . Rawashdeh Sj^fjjJt <qjb> j>*SdJl Consultant Orthopaedic Surgeon **-l>?- u-*^-*^1- J3*^h f*UaaJt *»•*>?> L$.?t'-w
Arthroscopy of Knee And Shoulder ^u^kP 1 u * - * * ^ >a:&M3 AJ&J\ J^US Paediatric Orthopaedics U. K s ^ ^ i ^ 3 jiAk&t $»Ua* a^ i ^^ ^ u ^ i
A W * A WI.JJ-. .wv/rrtYoo - • YVovrA.w :<^ji». - i V * w w - n\»too JSJUAH U 3 U - o U * J ^ - ^oJisWi hAi i** c M * * - os*^»- c** tJ»* - M I ^ * J I £ * * • Al-Aqailah Complex - Ibn Khaidoon St - Front of Afkhaldt Hospital - Jabal Amman - Tei. Clinic: 06/4610255 - 4611151 - Mobile 078/5728066 - 0777/334255 P.O.Box: 831348
Medical report
Name: K&fid M.Kuliy Date: 6th January, 2007
This patient Rafid MKully was presented to our clinic complaining of a right foot paift and swelling of his right foot since 8 months. This patient has involved in a trauma to his right foot last March caused a mild pain for him and multiple contusion to his upper limb , and another parts of his body.
For that reason the patient has been seen by an Orthopaedic surgeon who did him an operation to fix his talus with the navicular bone " talo-navicular arthrodesis "by K-wires. Cast was applied for 7 weeks then the cast and the K-wires were removed.
The patient said that he started to have pain after surgery progressively increased until rjow.
In physical examination the patient has swelling in his right ankle and foot with painful Movement mainly at hind foot with local tenderness in the talonavicular joint, the x ray showed a non- union of the talonavicular arthrodesis with local osteopania,so I think the patient has developed pseudic atrophy.
By revising the medical history of the patient and studying his previous x rays we didtft find any recommendation for the surgery it has been done, and I don't krnow why such a surgery has been performed. I advice the patient the following:
- to have a local physical therapy including heat and hyperbaric oxygenation which can be done only in Jordan in the specialty hospital. - after that I suggest a revision surgery to transfuse again his non-union fusion and to do what is needed.
This report was given upon the patient request
Dr. H . Rawashdeh Sj^JjjJt (*JL> JJJSdJl Consultant Orthopaedic Surgeon 21*.!^ ^LOO*.* J^-OOJ pUauJi **-i>?- tSjUv-*
Arthroscopy of Knee And Shoulder a ^ o i i cibUajfij WA3£JIJ JuSjJi jjiaijj Paediatnc Orthopaedics U K * ***>*» eJ^j Jtak&i f a** 2L^I>» ^ L - ^ I
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Af Aqa/lah Comp/ex IbnKhaWoonSt -Front of AlWiafdr Hospital Jabal Amman Tel CBroc 06/4610255 4611151 Mobile 079/5728066-0777/334255 POBox 831348
The gloWal treatment course is about seven months. The total cost is about two thousands and five hundreds for the physical therapy and hyperbaric oxygenation. Pour thousands JD is the cost of the surgery including the hospital and the doctors fees.
This reptort was given upon the patient request
Dr. Hatem Al.rawashdeh Consultant Orthopaedic surgeon
KM/16/L/84 23/1/2007
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AL KHALIDI MEDICAL CENTER A Heart & Comprehensive Specialty Hospital
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Name: Rafccl Muno'thar Koli Profile no.:274359 Age: 30 years
Date of Injury: March, 3, 2006 Company: L3-titan
Narrative History: A previously healthy 30 year old male, v/orldng as a translator. On March, 3, 2006 Patient was involved in a Road traffic accident, resulted in multiple trauma to the head, left shoulder and right foot. He received his initial treatment in Iraq and referred to Jordan for further evaluation and management. He arrived in Jordan on April 5th, 2006.
Condition at Presentation: A 30 year-old male patient, conscious, oriented to time and place, stable vital signs. Chest & heart: within normal limits. Abdomen: within normal limits Upper extremities: weakness of the left upper limb Shoulder abduction: 30 Shoulder extension: 0 Shoulder flexion: Normal Elbow flexion: Normal Elbow extension: Normal Supination ',md pronation: Normal Hand Grip: 3/5 Right limb all movements are normal and within range. Sensation intact in both limbs. Lower extremities: weakness of the right foot Foot dorsiflexion: 3/5 Planter flexion: 0/5 Foot inversion: 4/5 Foot Eversion: 2/5 Left lower limb, all movements are normal and within range Sensation intact in both lower limbs.
V UKAS
P.0 Box 5355 Amman 11183 Jordan <WJ« »"*r «*-* .r.« VSHJ: Tel 4644281-9 Fax 962-6 4616801 „ , m u , , ^ n. i tAu
website: www.kmc.jo
E- mail: [email protected]
Investigation: - Nasal bone x-ray: fractured nasal bone - MRI of the Brain: T l , T2 images were performed in all views. Flair sequence were also performed. All were within normal limits. - MRI of the cervical spine:
• Markedly increased lordaosis in the cervical spine. • Multiple disc bulges seen at C3-C4, C4-C5 and C5-C6 causing narrowing of the
nerve roots canal, at C3-C4, and C4-C5 on the right side and narrowing of the left nerve roots canal at C5-C6.
- Left shoulder x-ray: within normal limits - Chest x-ray: within normal limits. - Nerve Conduction Study:
Left Brachial Plexus lesion at the level of the cords affecting mildly left Musculocutanous nerve and severely left Axillary nerve injury with no signs of continuity.
- Laboratory: CBC, kidney function test, liver function test were done and were within normal limits.
Procedures: • Osteotomy for correction of post traumatic flatining of the right foot. • Physio and Rehabilitation therapy (60 sessions)
Follow-up: Patient was 'seen regularly in the out patient clinic. He showed remarkable improvement. He was evaluated on Nov.22.2006, he was found to have the following impairments:
-Right lower limb: • Foot dorsiflexion 4/5 • Planter flexion 3/5 • Foot inversion 4/5 ® Fool Evcrsion 3/5
- Left shoulder: • Shoulder abduction: 80 • Shoulder flexion: normal range • Shoulder extension: 0 • Hand Grip: 5/5
- Post traumatic osteoperosis. - Normal level of consciousness and cognetive abilities.
PO.Box 5355 Amman 11183 Jordan *»/" «»** oi—* •»-.. ^.^ Tel 4644281-9 Fax 962-6 4616801 \ M - I mu. \ . ^ - 5 U J I M U M - * :>:—«
Final Diagnosis:-1. Partial left axillary nerve injury . 2. permanent right sciatic nerve injury. 3. Stable nasal bone fracture . 4. Post foot osteotomy sclerosis with localized osteoporosis.
His condition is stable, but he had the following permanent disabilities:-1. Limitation of shoulder movement, he lost 20% of the function of
left upper limb. 2« Severe right leg atrophy with moderate right thigh atrophy and
limitation of foot movement due to permanent sciatic nerve injury, he lost 26% of the function of the right lower limb.
3. He might need surgical arthrodesis for his foot in the future with an estimated cost of 10000 US$.
P O Box 5355 Amman 11183 Jordan o>A< '"** JUX «r«* w.^ Tel 4644281-9 Fax 962-6 4616801 w - i n iu- i ,^+si-i xuirAi-4 o*-*^
Dr. H. Rawashdeh SJL^ IJJ I ^3l> JJJ&JJI ConsultantiDrthopaedic Surgeon ***J*-^LoOi-ij j>«aij ptta*]i a*.ij* ^jtsaj
Arthroscopy of Knee And Shoulder ***W> ^M**$fij WLSJIJ aj^i ^ ^ i i j
Paediatric Orthopaedics U.K ***#&* jw&riik*****^***
Al Aqailah Comptex (34) • fttn Khaldoun St • Front of AlkhaWi Hospital • Jabal Amman • Tel. Clinic: 66/4610255 • 4611151 • Mobile: 079/5728086 P.O.Box 831348 Amman 11138 Jordan
Medical report
Name; K&fid JVLKulIy Date: 22/6/2009
Mr. Rafid M.Kully presented to our clinic complaining of
a right foot pain and swelling of his right foot.
This patient has involved in a trauma to his right foot last
March caused a mild pain for him also multiple contusion to his
upper limb , and other parts of his body.
The patient has been seen by other Orthopaedic surgeon
who did him an operation to fix his talus with the navicular bone
"talo-navicular arthrodesis "by K-wires.
Then the cast and the K-wires were removed after seven
months.
The patient started to have pain after surgery progressively
increased.
Dr. H. Rawashdeh DJL-«JIJJI ^JL> J>JSOJ( Consultant Orthopaedic Surgeon **'>»• w*\*<&>*3 J3^^3 j * * ** 5 1 **•'.>*• ^ J 1 ^
Arthroscopy of Knee And Shoulder »-**W •aM-to >^a'J * - M j ^ * i
Paediatric Orthopaedics U.K s-sv^^j j u i ^ u ^ a * ^ ^ ^ ! ( UiUaijj } »j_uji iunU-
Al Aqailah Complex (34) • !bn Khaldoun St. • Front of Alkhaldi Hospital - JabaJ Amman - Td, Clinic: 06/4610255 -4611151 -Moblte: 079/5728066 P.O.Box83134« Amman 11138 Jordan
In physical examination there is swelling in his right ankle
and foot with painful movement mainly at hind foot with local
tenderness in the talonavicular joint. The x ray showed a non
union of the talonavicular arthrodesis with local osteopania, so I
think the patient has developed pseudic atrophy.
After that the patient advised to do a local physical therapy
including heat and hyperbaric oxygenation in the specialty
hospital.
The case of patient in the period of treatment from Jan /
2007 until 6 months was unstable and he was unable to work .
This report was given upon the patient request
Consultant orthopaedic surgeon Dr. Hatem AVRawashdeh
i
Dr. W. A. Bakir, ER.CS.
Othopaedic Surgeon 20 Ibn Khaldoun Str. • Jabal Amman
3rd. Circle P.OJox 830636 Amman 11183 Jordan
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CNnic962-06- 4621723Telefax962-06- 4621723 Res962-06- 5512522
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Clinic : Near Safeway - Shmeisani - Telefax Clinic: 5696963 - Tel. Res: 5819826 P.O.Box 498 - Amman 11831 Jordan
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Dr. Ziad Al-Masoud Neurology Clinic & Neurophysiology
Patient Information ID
Name
Date of Birth
Age Sex
Height
Weight
61
RAFED MONATHAR KOL1
11/18/1976
30y7m
MALE
In/Out Patient
Refer. Dcpt.
Physician
Examination Date
Examination No
Examined bv
'.-*•.- • > -In*e~:
DR *.'•=- \ 3 ' . K H \ F
T - : -
Motor Nerve Conduction Studv
Site Latency
(ms) Amplitude Area Segment ! NCV
j i m ' M
\ (NCVXD
Peroneal, L Ankle
Head of fibula 1 5ms P 3.75m
7.I4mV
6.00mV
12.21 mVmi 13.24m Vm
Ankle
Ankle-Head of fibula 385mm
5.00ms 8.75ms 44.0m/s
Tibial, R Ankle
Popliteal 6.35ms 14.85m
2.59mV 3.09mV
3.75mVms
5.27mVms
Ankle
Ankle - Popliteal 380mm
6.35ms
8.50ms 44.7m/s
Peroneal, R
Ankle
Head of fibula 12.65m
Popliteal
4.4ms 250.00uV 51.50uVm.< Ankle 220.00uV !09.60uVm Ankle- Head of fibula
14.2ms 220.00uV >92.00uVm Head of fibula-Popliteal 63mm 155ms , 41.9ms
• 1 Omni
4.40ms
8 25ms I 3 \6ms
-r
F-wave Study Nerve
Tibial R Stim.Site
Ankle
F-Lat.
55.5ms
F-Lat. N.D. M Lat. F-M Lat. F-Occurr.
l-N.-*»
Dhtance ] n\cv
1 N.D.
Sensory Nerve Conduction Study
Site Latency
(ma) Amplitude Area Segment Distance
(mm)
Interval (ms)
NCV (m/s)
NCV N.D.
Sural, R |Sural | 3.4ms | 8.00uV |0.71uVms|Sural |l40mm| 3.40ms 41.2m/s | |
supper ficial (supper ficialperone|3.32ms| 7.70uV 10.67uVms|Sural |l20mm| 3.32ms | 36.1m/s | |
Impression
THE NERVE CONDUCTION STUDY OF RT LOWER LIMB SHOWED SLOW CNODUTION VELOSITYOF LT SUPPER FICIA1 (SENSORY ACTION POTENTIAL THE MOTOR CONDCTION STUDY OF BOTH RT TIBIAL AND PERONEAL SHOW ED MILD AXONAL AND DEMYEUNATI> G AFFECTION. I EMGNEEDLE EXAMINATION OF RT TIBIALIS ANTERIOR.RT GLUTEUS MAXIMt'S ARE
NEUROGIMCALLY INSULTED. p .
Date 7/7/2007 Signature ^>*^^v Yv) 3
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Dr. Med Mohamed Abu Hammad Senior Consultant Orthopaedic
Surgeon & Traumatolfgsf Former Director of City St Matin
Hospital Gengenbach, Germany Member of the Association of
Orthopaedic Surgons In Germany Member of tha Association AAOS - USA
Member of the EESKA
Date......J~I.../Cu.lk/; ^fctft Age, ±L : > 4 - j |
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Amman - Jabal Al-Hussein - Sear Al - Satfa Biaza Centre Tel. CMc : 5659056 Telefax CHnic: 5659066 Telefax Res. :5528111 Mobile : 079/6667006 •w/nMV'-Asuai—•» ft*TAni«jjiu«>su&
Final Condition: Post Road traffic accident status resulted in:
- Impairment of Rt. Ankle movements equal to 10% disability of the leg. - Impairment of left shoulder movements equal to 20% disability of the arm. - Patient will need another surgery for his shoulder problem after 2-3 years with
a cost of USD 5000. - Patient will need another surgery for his anlde with accost of USD 10.000 - Patient was provided with treatment for oesteoperosis.
Rafed's condition is stable and final as no further improvement is expected. He was discharged on Jan. 20th, 2007 and advised one month sick leave, then go back to indoor job.
P.O.Box 5355 Amman 11183 Jordan Tel. 4644281-9 Fax 962-6 4616801
OJ/M u u r oL_** *r»»
KM/16/AIG/1033 18/7/2007
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AL K H A U D I MEDICAL CENTER A Heart & Comprehensive Specialty Hospital
FinaCMedicaC Report
Pt's name: Rafed Muna'thar Koli Age: 30 Year
Profile: 274359
The above mentioned gentleman was involved in RTA, which occurred in Iraq on March. 3rd. 2006. resulted in multiple traumas involving the left shoulder, head, neck and right lower limb, he was treated initially in Iraq.
He was admitted to Al Khalidi medical Center on April. 4th 2006, complaining of
- Left shoulder pain and limitation of movement. - Neck pain. - Mild Right foot pain.
His general examination showed: - Stable V/S. - Alert and conscious patient. - Normal heart, chest and abdomen. - Left upper limb; severe weakness of left shoulder, loss of
shoulder extension, shoulder abduction to 30 degree only. - Normal shoulder flexion. Normal elbow movement. Weak left hand
grip( 3/5). No significant sensory loss. - Normal right upper limb. - Unremarkable examination of both lower limbs.
Investigations: . Normal CBC, KFT, LFT, PT and PTT - Negative HbsAg, HCV and HIV - Normal Left Shoulder X-Ray - Normal chest X- ray - Normal Brain MRI - Cervical Spine MRI
PO Box 5355 Amman 11183 Jordan ^ v >»IAT J—«. *t** *.,>» Tel 4644281-9 Fax 962-6 4616801 , „ . , |1I1A , ^ ^ n u m . , ^ .*
website: www.kmc.jo
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E-mail: [email protected]
Marked increased lordosis. Multiple disc bulge at C3-4, C4-5 and C5-6 causing narrowing of the
nerve root canal. - EMG with Nerve Conduction Study showed Left brachial plexus
lesion at the level of the cord affecting mildly the left musclocutaneous nerve and severely the left axillary nerve (without sings of continuity).
- Nasal bone X-ray showed stable nasal bone fracture.
1. Severe left axillary nerve injury. 2. Stable nasal bone fracture.
He was seen by Dr. Salah Salah(Neurosurgeon), and he advised to go for physiotherapy and rehabilitation only, and no need to do any surgical procedure. He was also seen by Dr. Haitham Abdelhadi (ENT Consultant), and advised not to do any surgical intervention for his stable nasal bone fracture.
He went through a long physiotherapy program and showed good clinical improvement regarding his shoulder problem. He was discharged on April. 29. 2007, and continued physiotherapy as outpatient.
He started to complain of right foot pain and limping. He was seen by Dr.Ismail Ghazal ( Orthopedic Surgeon). There was flattening of the right foot with valgus deformity of the right ankle joint. There was no musculat wasting. Sensation was intact. There was loss of planter flexion, weak dorsiflexion(3/5), weak foot inversion(4/5), weak foot eversion(2/5). His right foot and ankle X-Ray showed no bone fractures, deformity of the talonavicular joint. He was diagnosed to have Pesplanus of the right foot.
Rafed was admitted to Al Khalidi Medical center on Aug. 23. 2006, and underwent Durham bone osteotomy( Pyramidal wedge osteotomy of the talo-navicular cuniform bone) to correct his foot deformity. K-wires was fixed and BK cast was kept for 8 weeks. He was discharged on Aug. 31. 2006. Wires and cast was removed on Oct. 23. 2006, and physiotherapy started.
Rafed was evaluated on Nov. 26. 2006. he was having right foot pain during walking only, no swelling, mild calf muscle wasting. Range of movement increased in all directions except in inversion. Muscle power was as follow: 1. Right ankle dorsiflexion 5/5. 2. Planter flexion 3/5. 3. Foot inversion 4/5. 4. Foot eversion 3/5.
P.O.Box 5355 Amman 11183 Jordan Tel. 4644281-9 Fax 962-6 4616801
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Rafed was evaluated on Jan. 2007 and was diagnosed to reach maximum medical improvement, and a final medical report was given to him , showing permanent loss of 10% of the function of the right lower limb.
On July. 7. 2007, Rafed was seen again, complaining of right foot pain, limping, limitation of right foot movements and decreased muscular balk. He was seen by Dr.Ziad Al-Masoud (Neurologist).
His examination showed: 1. Slight laxity of the right knee joint. 2. Severe wasting of right leg ( 6 cm difference from left leg) with
moderate wasting of right thigh(2 cm difference from left thigh). 3. Swelling and limitation of right ankle joint movement. 4. The Manual Muscle Testing (MMT) of right lower limb was as
follows : - Hep Flexion 4+/5
Extension 4+/5 - Knee Flexion 4/5
Extension 4+/5 - Ankle Dorsiflexion 3/5
Planterflexion 3+/5 Inversion 3+/5 Eversion 3/5
- EMG and Nerve Conduction Study ( NCS) revealed partial injury of the right sciatic nerve involving the right peroneal branch.
- Lurpboscacral MRI: Minor central disc protrusion seen at L4-5 and L5-S1 causing indentation on thecal sac.
- Right foot X- Ray : Increased bone density on margions of the previous osteotomy with
dense debris in the region of the neck of the talus. Evidence of sclerosis, and collapse of the navicular bone . Marked narrowing of the naviculocuneiform joint space.
The rest of the foot bones have normal bone density and trabectular architecture.
In view of the above mentioned new changes, his weakness and muscle wasting are due to permanent sciatic nerve injury and it is not related to his surgery .
Final evaluation of his left shoulder was as follow: - Shoulder flexion to 90 degree. - Shoulder extension to zero degree. - Shoulder abduction to 80 degree. - Normal shoulder adduction. - Shoulder external rotation to 50 degree. - Shoulder internal rotation to 20 degree.
P.O.Box 5355 Amman 11183 Jordan Tel. 4644281-9 Fax 962-6 4616801
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An^pean International Underwriter 79 Vm Stmt, Wwr YprK NY 1CT Cable Address "AM1NTERSUR"
UNITED STATES DEPARTMENT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS
/ Claimant Name* Rafid M. Koli
OWCP No.: 02-147189 / / /
/ Emolover Name: L3-Titan Corporation
and /
Insurance Carrier Name: The Insurance Company of the State of Pennsylvania
. / ' STIPULATION OF SETTLEMENT
The parties hereto agree to settle this case
under Section 8(i) of the Longshore and Harbor
WorKers' Compensation Act (the THWCA" or
th? "Act") as follows.
FApTMAIrSMMWfARY
Procedural Backaround
This case involves a claim for compensation
benefits and medical benefits under the
exclusive jurisdiction of the Defense Base Act
extension of the LHWCA brought by Rafld M.
Koli (the "claimant") L3-Titan Corporation
(the •'employer").
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1
The carrier for the employer in this case is The
Insurance Company of the State of
Pennsylvania (the "carrier"), sjnd the claim is
being administered on behalf/of the insured by
the representative Underwriters Adjustment
Company.
The Claimant's March 03.2006 iniurv and its
Afftrrnath
The claimant worked/for the employer as a
Linguist in the country of Iraq. On March 03,
2006 Rafid was injured while performing his
duties as a linguist when the vehicle he was
in was involved in roll over accident He
soon afterwards received injury that resulted
in multiple traumas involving the left
shoulder, h^ad, neck and right lower limb.
The claimant was initially treated in Iraq then
he underwent a course of treatment and
rehabilitation in Jordan which started on April
4, 2006/
The claimant was complaining of left
shoulder pain and limitation of movement,
neck/pain and mild right foot pain.
He went through a long physiotherapy
program and rehabilitation regarding his
shoulder problem and was not advised for
any surgical procedures for i t
On Aug 23,2006 the claimant underwent
Durham bone osteotomy to correct his foot
deformity. Rafid started another course of
physiotherapy after removing the cast frprn
his foot
in January 2007, Rafid was diagnosed to
reach maximum medical improvement no
later than the examination date.
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Ultimately, on July 7,2007 the claimant was
examined by doctor in Jordan Dr. Zlad Al /
Masoud (Neurologist) who found that the /
claimant attained the maximum medical
improvement no later than the date of the
doctor's examination in January 2007 and that
he is fit to work from Jan 25*. 2007. It was
found that the claimant will have (imitation
of shoulder movement equal t<^20% loss of
function of his left upper limfc/and 26% loss
of function of his right lower*limb due to
limitation in his foot movement.
Compensation Status
The claimant's average^eekly wage at the
time of the injury Marcji 03,2006 that is the
subject of this claim Was ($239.42), which gave
rise to a compensation rate of ($159.61) per
week.
The insurance paid for Rafid M. Koli his
Temporary Total Disability from March 4th,
2006 till the dare he was found fit to work.
TERMS OF THE SETTLEMENT y
The parties propose to settle this case under
Section p(i) of the Act in order to fully and
finally dispose of any and all existing or
potential case issues relating to the claim
underlying the March 6,2006 injury. Under the
terms of this settlement, the carrier will pay the
claimant a lump-sum in the amount of Forty
Thousand US Dollars ($ 40,000.00) upon the
issuance of a compensation order approving
the parties' settlement. Of this amount,
Twenty One Thousand, Nine hundred and
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U* 4($239.42/ <SJ£® ** ty*s* 2006 j!i»
.£jf-V! J ($159.61) £» u**j*3 J * - J\ AA
J 2006 j&< 4 0* UIJSJ CJSIJJJI <>&! &j& £»*>
^>UiSlJbj^
•a* JUjji S^J^J .2006 J i 3 &J% &**$
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Twelve US Dollars ($21,912.00) will be
attributable to any and all future disability
compensation benefits and Eighteen j
Thousand and Eighty Eight US Dollar J
($18,088.00) will be attributable to any antJ ail
future medical benefits. /
In consideration of the payments that Will be
made to, for or on behalf of the claimant under
this settlement agreement, the employer and
the carrier shall be fully and unconditionally
discharged from any and all past/present and
future liability for disability compensation
benefits, medical benefits, any pother benefits
that might be available under me LHWCA,
vocational retraining, travel and other incidental
expenses and attorney fees and disbursements
relating to the underlying crtaim.
BACKGROUNDS THE CLAIMANT
The claimant was born in 1976 in the country
of Iraq
FUTljRE MEDICAL BENEFITS
The medical/expenses of the claimant for the
past years are set forth as follows:
/ 2006 -($32,242.32)
20Q7-($».g51»4?l
Total -($41,793.77)
The parties submit that the amount of
($18,088.00) that is allocated to medical
benefits under this settlement adequately
*l> AMJ J <> \u±ij* ($21,912.00) < ^ l
#\ J\ ($18,088.00) <&j*S Jijt o^-S J ciU
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j$jd\ ^ 1976 &J* *•*•» 4f
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il»ljiuJl (j& A^iiJl < ^ ^ vJtjJL«M j !
($32,24232)-2006
(S9.5S1.4S 1-2007
($41,793.77)e>-^»
($18,088.00) £*** cfc ^ > V l j *
5"
I covers the cost of any necessary future
medical treatment in that regard, the claimant
does not have a collateral source for future /
medical expenses. /
ADEQUACY OF SETTLEMENT /
The parties submit that the proposed /
settlement is adequate in light of the /
uncertainty that the claimant will prevail in this
case on a claim for pemianent totalyoisability
compensation benefits. /
The claimant acknowledges that Re has read
this stipulation of settlement (or mat he has
otherwise had it read to him) ar/d that he
understands it fully.
Furthermore, the claimant acknowledges that
he enters into this stipulation upon his own free
will and that he has not in any way been
coerced, pressured or plabed under duress to
enter into this stipulation/.
SUMMARY OF SETTLEMENT PAYMENT TERMS
($21,912.00) Claimant's future disability compensation benefits
($18,088.00) Claimant' future medical benefits
$40,000.00 , To be paid to the claimant in a lump-sum upon the issuance of a compensation order approving the parties' settlement.
CONCLUSION
! In view of the foregoing, the parties
respectfully request the issuance of a formal
compensation order approving this settlement.
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The claimant speciTtcally directs and authorizes
the carrier to send the total amount covering t,
the compensation that will become due to the j
claimant under such a compensation order to 1
his bank account ( /
/ / /
) 777© claimant acknowledges tha/the carrier will
be deemed to have satisfied hs payment
obligations under Section l/(f) of the LHWCA
by sending the claimant's/compensation to his
bank account j
Dated: . 200?'
Claimant Name: l
Address:
Telephone No.:
Signed:
Witness:
Dated:
AIG Claim Examiner:
Attorney:
/
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American International Underwriter 70 Pine Street. New York NY 10270 Cable Address "AMINTERSUR"
UNITED STATES DEPARTMENT OF LABOR / OFFICE OF WORKERS' COMPENSATION / PROGRAMS
Claimant Name Rafid M Koli
OWCPNo. 02-147189
V
Employer Name L3-Titan Corporation
and
Insurance Carrier Name The Insurance Company of the State of Pennsylvania
STIPULATION OF SETTLEMENT
The parties hereto agree to settle this case
under Section 8(1) of'the Longshore and Harbor
Workers' Compensation Act (the "LHWCA" or
the "Act") as follows
FACTUAL SUMMARY
Procedural Backaround
This case involves a claim for compensation
benefits and^medical benefits under the
exclusive ji/risdiction of the Defense Base Act
extensior/of the LHWCA brought by Rafid M.
Koli (tHe ,'clalmant',) L3«Titan Corporation
^JJS Jxi* Ji l j ; <J&±AI\ fi+A
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LuUljunj VjJ ^ h l l *£>i :C#A\J1\ !*>*£ ?+*\
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V 1
The carrier for the employer in this case/is The
Insurance Company of the State of /
Pennsylvania (the "carrier"), and the/Claim is
being administered on behalf of the insured by
the representative Underwriters Adjustment
Company
The Claimant's March 03. 2006 Iniurv and Its
Aftermath
The claimant worked for the employer as a
Linguist in the country of Iraq. On March 03,
2006 Rafid was injured while performing his
duties as a linguist when the vehicle he was
in was involved in roll over accident. He
soon afterwards received injury that resulted
\n multiple traumas involving the left
shoulder, head,, neck and right lower limb.
The claimant was initially treated in Iraq then
he underwent a course of treatment and
rehabilitation in Jordan which started on April
4, 2006.
The claimant was complaining of left
shoulder pain and limitation of movement,
neck pain and mild right foot pain.
He went through a long physiotherapy
program and rehabilitation regarding his
shoulder problem and was not advised for
any surgical procedures for it.
On Aug 23, 2006 the claimant underwent
Durham bone osteotomy to correct his foot
deformity. Rafid started another course of
physiotherapy after removing the cast from
hfe foot.
\k January 2007, Rafid was diagnosed to
reach maximum medical improvement no
later than the examination date.
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Ultimately, on July 7, 2007 the claimant was
examined by doctor in Jordan Dr. Ziap Al
Masoud (Neurologist) who found that the
claimant attained the maximum medical
improvement no later than the date of the
doctor's examination in January 2007 and that
he is fit to work from Jan 25th, 2007. It was
found that the claimant will have limitation
of shoulder movement equal to 20% loss of
function of his left upper limb and 26% loss
of function of his right lower limb due to
limitation in his foot movement.
Compensation Status
The claimant's average weekly wage at the
time of the injury March 03, 2006 that is the
subject of this claim was ($239.42), which gave
rise to a compensation rate of ($159.61) per
week.
The insurance paid for Rafid M. Koli his
Temporary Total Disability from March 4th,
2006 till the date he was found fit to work.
TERMS OF THE SETTLEMENT
The parties propose to settle this case under
Section 8(i) of the Act in order to fully and
finally dispose of any and all existing or
potential case issues relating to the claim
underlying the March 6, 2006 injury. Under the
terms of this settlement, the carrier will pay the
claimant a lump-sum in the amount of Thirty
One Thousand and Nine hundred and
Twelve US Dollars ($ 31,912.00) upon the
issuance of a compensation order approving
the parties' settlement. Of this amount,
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3 ^jUaVI vlfij ^ ^ jJUa»VI ^ ^ l l j ^ l d*** (J&
U. *($239.42) <s&ti ** t**** 2006 jl3l
,£j^Vl ^ ($159.61) £l* a^j*5 cU* Jl *jk
j 2006 j ^ 4 < > U b y UJJIJJII ^j-otill A£^i CI*AJ
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Twenty One Thousand, Nine hundred and
Twelve US Dollars ($21,912.00) will be
attributable to any and ail future disability
compensation benefits and Ten Thousand US
Dollar ($10,000.00) will be attributable to any
and all future medical benefits. ,
In consideration of the payments that will be
made to, for or on behalf of the claimant under
this settlement agreement, the employer and
the carrier shall be fully and unconditionally
discharged from any and ail past, present and
future liability for disability compensation
benefits, medical benefits, any other benefits
that might be available under the LHWCA,
vocational retraining, travel and other incidental
expenses and attorney fees and disbursements
relating to the underlying claim.
BACKGROUND OF THE CLAIMANT
The claimant was born in 1976 in the country
of Iraq
FUTURE MEDICAL BENEFITS
The medical expanses of the claimant for the
past years are set forth as follows:
2006 - ($ 32,242.23)
£007 - ($ 8.430.87)
total-($39,274.07)
The parties submit that the amount of
($10,000.00) that is allocated to medical
benefits under this settlement adequately
O* U^JAJ ($21,912.00) v%>il Sij* j** J*
c fejujt l& uJUa J*S <iILLa j l (jajju Julji 3iL£j ( 1
A#L aij i AJ&J tf | j i ($l0,00o/o0) <^t>*l jVjJ
AAJ AJ_jp AIJ ci j *a i Ajji*jl\ b'ltk <LiUul <—XXJ^J
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J J j iU l l t-*a>jAi *j*y* Oj& O' 0 ^ <J J * ' ^ J *
cij jL-a^ll £ 4 Ufcj^&j jiuJI j ^ \ | A\\ c-Ajj^ill fcl&l
.V-luVI
. JIJ^I ^ 1976 eutf* ^ J J I Jij
($32 ,242 .32 ) -2006
($8 .430 .87 ) -2007
( $ 3 9 , 2 7 4 . 0 7 ) £ j ^
($10,000.00) £lf ck <J>V» j %
<i>n\ oil
4
covers the cost of any necessary future
medical treatment. In that regard, the claimant
does not have a collateral source rbr future
medical expenses. !
ADEQUACY OF SETTLEMENT
The parties submit that the proposed
settlement is adequate in light of the
uncertainty that the claimant will prevail in this
case on a claim for permanent total disability
compensation benefits.
The claimant acknowledges that he has read
this stipulation of settlement (or that he has
otherwise had it read to'him) and that he
understands it fully. '
Furthermore, the claimant acknowledges that
he enters into this stipulation upon his own free
will and that he has not in any way been
coerced, pressured'or placed under duress to
enter into this stipulation.
SUMMARY OF SETTLEMENT PAYMENT . TERMS
($21,912.00) Claimant's future disability Compensation benefits
($10,000.00) * Claimant' future medical .benefits
$31,912.00 f o be paid to the claimant in a lump-sum upon the issuance of a compensation order approving the parties' settlement.
(CONCLUSION
In view of the foregoing, the parties
respectfully request the issuance of a formal
compensation order approving this settlement.
ULJJL-OA] <«iLjal j ^ i r t i ^ - X A I I (JJU) ((jojduA^Jl I A
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tA}ju2\\ £* (3»lJJJ ( j -^J L^J* 3 J^
Jjjjau j^lall 4£>£l Jfrj j Aj aoL , / ^ t J*L
J
The claimant specifically directs and authorizes i
the carrier to send the total amount covering
the compensation that will become due to the
claimant under such a compensation order to
his bank account (
)
77?e claimant acknowledges that the carrier will
be deemed to have satisfied its payment
obligations under Section 14(f) of the LHWCA
by sending the claimant's compensation to his
bank account.
Dated: . 2007
Claimant Name:
Address: ,
Telephone No.:
Signed:
Witness:
Dated:
AIG Claim Examine)*:
Attorney: i
i t -. - - -
) ^ - ~ * - * — * J* uyj^ J* ' M*>>*r
/
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6
U. S. Department of Labor
June 11, 2009
Attorney Jennifer J. Nobley 255 California Street, Suite 600 San Francisco, CA 94111-4912
RE: OWCP FILE NO. 2-147189 Rafid M. Kully DATE OF INJURY: March 3, 2006 L-3 Communications CARRIER'S FILE NO. UAE944
Dear Ms. Nobley:
Thank you for your letter of June 3,2009.
The claim for TTD covered the period July 1, 2006 through March 16, 2008. You indicate the carrier paid benefits through January 25, 2007, but there was no LS-206 or LS-207 filed showing payment through January 25, 2007. Please provide an interim LS-208 reporting the periods of all compensation benefits paid.
As for the claim for TTD period from Janaury 26, 2007 to March 16, 2008, the medical reports on record show Mr. Kully had disabilities to his left shoulder and right leg.
• Dr. Emad Hatabah's email of June 2, 2009 says Mr. Kully needed more treatment and was going to»seek treatment elsewhere. When Mr. Kully was reevaluated in June 2007 by Dr. Rawashdeh, he was not able to return to Iraq at that time for therapy.
• The January 23, 2007 report from Al Khalidi Medical Center provided a final assessment finding Mr. Kully sustained impairments to the right ankle and left shoulder, with further surgeries anticipated for both conditions, but no further improvement was expected. He was released to return to work at an in-door job.
• The July 18, 2007 report from AI Khalidi Medical Center repeats Mr. Kully reached MMI in January 2007 and was left with 10% permanent loss of function in the right limb including limitations with the shoulder and right lower extremity.
Did the employer offer or accommodate Mr. Kully with employment from January 26, 2007 through March 16,2008 with an indoor job within his limitations? Did the employer identify suitable alternative employment? If not, I suggest the carrier accept the claim for TTD for this period in lieu of the issue being referred for resolution at a formal hearing.
Employment Standards Administration Office of Workers* Compensation Claims Division of Longshore and Harbor Workers* Compensation 400 West Bay Street, Room 63A, Box 28 Jacksonville, FL 32202 Phone # 904-357-4788
It seems the carrier is working on resolving the outstanding medical expenses. By copy of this letter to Mr. Barnett. please advise your client to contact the providers and give the carrier's contact information. The providers should not be billing Mr. Kully, and they can communicate with WorldSource to resolve the outstanding charges.
Thank you all for your attention to the claim as well as your cooperation in resolvmg the issues.
cc:
Mr. Dennis Fichtel, CPCU Paralegal with David Barnett, Esquire 2860 Marina Mile Blvd., Suite 105 Ft. Lauderdale, FL 33312
WorldSource, a division of AIL) 600 N. Pearl Street, Suite 700 Dallas, TX 75201-2883
Mr. Rafid Kully 624 N. Hamilton Street, Apt 45C High Point, NC 27272
__ _ f3rtf?~"\k jzjL >S^
J\/W 7-52 - ^ ^
" aj^&EIlCtt CC L i C m C r Fighting for injured workers j B g T f ; . X Professional Association wwwiojuredoverseas.com
June 17, 2009 VIA E-MAIL
rafid kul [email protected]
Mr. Rafid M. Kully 624 North Hamilton Street, Apt. 450 High Point, NC 27272
Re: Rafid M. Kully v. L-3 Communications OWCPNo.: 02-147189 D/A: 3/3/2006 Our File: 1876-07
Dear Rafid:
Attached is a letter recently received from the attorney representing the insurance company. As you can see, he addresses all of the bills that you are receiving. I would suggest that you go back to every company that sends you a bill and give them a copy of this letter. If they wish to be paid, you should advise them to stop contacting you, but, instead, to contact either Jennifer Nobley at the attorney's office or Lorraine Deniz at AIG's offices in Dallas.
As you can also see, they have indicated that they issued a check to you in January in the amount of $334.34 for certain out of pocket expenses. Please confirm that you received this. They also indicate that they have authorized an ultrasound bone healing system ordered by Dr. Lee, who is authorized to treat you.
I trust this resolves all of your issues, but if not, please feel free to drop me an e-mail and let me know how else I can assist you.
Very truly yours,
DENNIS J. FICHTEL, CPCU Paralegal DJF/sf Enclosure
F:\DEFENSE BASE ACTvCLIENTSVKully, Rafid M\clt11.wpd
2860 Marina Mile Blvd., Suite 105, Ft. Lauderdale, FL 33312 Phone: 954-920-7400; Fax: 954-920-9492; US Toll Free: 888-732-7425; E-mail: [email protected]
r r\sr f ANAHEIM Law Offices Of TELEPHONE (714) 385-9400
LAUGHLIN FRESNO XT A T T> S-\ TELEPHONE (559) 431-4900 t<AU3CJ> OAKLAND L E V Y &C TELEPHONE (510) 628-0496
jMLC-)RT\rSI LLP TELEPHONE (626) 568-9700
A UmiUdUabiUty Partnership June 3, 2009 S H O N E <SM 22*0268 MICHAEL W. LAUGHLIN, OF COUNSEL TELEPHONE (530) 222.0268 GERALD A. FALBO, RETIRED c A rTi A XimxiTrt
SAN BERNARDINO 255CALIFORNIAS'niEET,SUI-m600 TELEPHONE (909) 890-2265 SAN FRANCISCO, CALIFORNIA 94111-4912 SAN DIEGO TELEPHONE (415) 781-6676 TELEPHONE (619) 233-9898 FACSIMILE (415) 781-6823
SAN JOSE TELEPHONE (408) 286-8801
SANTA MONICA TELEPHONE (310) 392-8101
Kristina K. Hall - Claims Examiner S N E m 235-0275 Office of Workers1 Compensation Programs U.S. Dept of Labor - Longshore Division 400 West Bay St., #63A, Box 28 Jacksonville, FL 32202
Re: Rafid M. Kully v. L-3 Communications - Titan Corporation and Insurance Company of the State of Pennsylvania/AIU Holdings, Inc. D/Injury: 3/3/06 OWCPNo: 02-147189 LFLMNo: 326-161199
Dear Ms. Hall:
We are in receipt of your letter dated April 27, 2009 wherein you recommend that Defendants resolve certain medical bills and out of pocket expenses, confirm authorization of Dr. Li as the claimant's treating physician, and pay Temporary Total Disability ("TTD") compensation for the period of 7/1/06 through 3/16/08. We are also in receipt of Mr. Barnett's letter dated May 7,2009 which was addressed to your attention.
First, in response to each of the bills referenced in yours and Mr. Barnett's letters, we offer the following:
• $2,065.00 bill from High Point. This bill regards aNovember 4,2007 date of service when claimant went to the emergency room complaining of vertigo. The carrier contacted High Point and spoke to a representative who stated that the $2,065.00 balance was paid by Medicaid.
• The carrier contacted the North Carolina Baptist Hospital and requested itemized bills and reports for dates of service 6/3/08 ($1,249.25), 7/11/08 ($349.00), 9/12/08 ($325.75), 3/12/09 ($255.75), 3/13/09 ($1,017.50) and 4/3/09 ($325.75). At this time, Defendants are not in possession of any corresponding medical reports or documentation regarding dates of service 7/11/08 ($349.00), 9/12/08 ($325.75), or
RECEIVED
«"W n>Ar»Mie-r%-JB L C & M C - Q
Office of Workers' Compensation Programs Re: Rafid M. Kully June 3,2009 Page 2
3/13/09 ($1,017.50). Upon receipt of medical reports which support reasonable and necessary medical treatment, Defendants will place these bills in line for payment.
• $84.00 bill from Cornerstone Health Care. This bill purportedly regards a 4/8/09 date of service. Defendants have not received this bill nor any corresponding medical report.
Second, the carrier issued claimant a check in the amount of $334.38 on 1/12/09 to cover claimant's out of pocket expenses from CVS and his orthotics. The carrier also authorized Dr. Li as the treating physician and Dr. Li's bills are being paid. On 5/13/09, the carrier authorized the Exogen 2000+ ultrasound bone healing system which was ordered by Dr. Li.
Finally, Defendants paid TTD benefits to claimant for the period of March 4,2006 through January 25,2007. Defendants contend that claimant was capable of working during the period of January 23, 2007 through March 16, 2008. Claimant was evaluated by Dr. Emad Hatabah, of the Al Khalidi Medical Center on January 23, 2007. Dr. Hatabah deemed claimant to have reached maximum medical improvement ("MMI") and released claimant to return to work at an indoor job. On July 18, 2007, claimant was re-evaluated at the Al Khalidi Medical Center, by Dr. Neal Abu Kaff. With the exception of issuing different disability ratings, Dr. Kaff stood by Dr. Hatabah's January 23,2007 report. In support of the contention that claimant is not entitled to past TTD benefits, please find enclosed the medical reports of Drs. Hatabah and Kaff, in addition to correspondence dated June 2, 2009 from Dr. Hatabah which confirms that claimant was capable of working from January 23,2007 through the date of surgery in the U.S.
Very truly yours,
LAUGHLIN, FALBO, LEVY & MORESI LLP
Bv: pmAlM &* TkAifr* * Roger A. Levy V toger A. Levy
Jennifer J. Nobley
RAL/jjn Enclosures cc: See page three
Office of Workers' Compensation Programs Re: Rafid M. Kully June 3,2009 Page 3
cc: Lorraine Deniz AIU Holdings, Inc. 600 N. Pearl Street, Suite 700 Dallas, TX 75201 (Claim No.: DBA/0944) Via e-mail only
/ David Barnett, Esq. (w/enc.) Barnett & Lerner, P. A.
/2860 Marina Mile, #105 r/ Ft. Lauderdale, FL 33312
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AL-KHALIDI MEDICAL CENTER A COMPREHENSIVE SPECIALITY HOSPITAL
DEPT. OF RADIOLOGY
NAME: MR. RAFED QALI
AGE : 30 Y SEX : MALE
REPORT DATE: 02/12/2006
EXAM DATE :02/l2/2006
EXAMINATION : RIGHT FOOT X- RAY
Decrease bone density .
Bone cyst is seen in the head of proximal phalanx of the big toe .
Decrease in height of navivular bone which appear sclerotic . To be evaluated by physician .
REPORT No. XF04546S
RADIOLOGIST DR-SA#A# AL SHAMMA'
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DAR ALHIKMA X-RAY CLINIC
/Wr.ez Mutaz 2007 January 03.
fit Foot APS Lat; O.A. changes affecting the first CMC St MCP joints fiemode/ing deformity of the fit. Tarsal Scaphoid
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Dr. H. Rawashdeh Consultant Orthopaedic Surgeon
Arthroscopy of Knee And Shoulder Paediatnc Orthopaedics U.K
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Al-Aqailah Complex • Ibn Khaidoon St. - Front of Alkhaldi Hospital - Jabal Amman • Tel. Clinic: 06/4610255 • 4611151 - Mobile 079/5728066 - 0777/334255 - P.O.Box: 831348
Medical report Cf<&~~ Name: Rafid M.Kully Date: 6th January, 2007
This patient Rafid M.Kully was presented to our clinic complaining of a right foot pain and swelling of his right foot since 8 months. This patient has involved in a trauma to his right foot last March caused a mild pain for him and multiple contusion to his upper limb , and another parts of his body.
For that reason the patient has been seen by an Orthopaedic surgeon who did him an operation to fix his talus with the navicular bone " talonavicular arthrodesis "by K-wires. Cast was applied for 7 weeks then the cast and the K-wires were removed.
The patient said that he started to have pain after surgery progressively increased until now.
In physical examination the patient has swelling in his right ankle and foot with painful movement mainly at hind foot with local tenderness in the talonavicular joint, the x ray showed a non- union of the talonavicular arthrodesis with local osteopania,so I think the patient has developed pseudic atrophy
f By revising the medical history of the patient and studying his previous x rays we didn't find any recommendation for the surgery it has been done, and I don't know why such a surgery has been performed. I advice the patient the following:
TTo^BavTa local physical therapy including heat and hyperbaric oxygenation which can be done only in Jordan in the specialty hospital. - after that I suggest a revision surgery to transfuse again his non-union fusion and to do what is needed.
This report was given upon the patient request
Dr. Hatem ALrawashdeh Consultant Orthopaedic surgeon
Dr. H. Rawashdeh Consultant Orthopaedic Surgeon
Arthroscopy of Knee And Shoulder Paediatnc Orthopaedics U K
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Al-Aqailah Complex Ibn Khafctoon St -Front of Alkhaldi Hospital * Jai^il Amman -Tel Cltate 06/4610255-4611151 * Habile 079/5728066 - 0777/334255 - P.O Box: 831341
Medical report
V o?\
Name: Rafid M.Kully
Mr. Rafid M.Kully presented to our clinic complaining of a right foot pain and swelling of his right foot since eleven months.
This parent has involved in a trauma to his right foot last March caused a mild pain fof him also multiple contusion to his upper limb , and other parts of his body.
The patfent has been seen by an Orthopaedic surgeon who did him an operation to fix his talus with the navicular bone <vtalo-navicular arthrodesis 4"by K-wires. Then thfe cast and the K-wires were removed after seven months.
The patient started to have pain after surgery progressively increased until now.
Ill phylical Examination there is swelling in his right ankle and foot with painful Aiovement mainly at hind foot with local tenderness in the talonavicular joint. Tfte x ray showed a non- union of the talonavicular arthrodesis with local osteopenias I think the patient has developed pseudic atrophy.
% revising the medical history of the patient and studying his previous x rays we didtf t find any recommendation for the surgery which has been done, and I (ten't kftbw why such a surgery has been performed, Now I gfttvice for this patient the following:
- A local physical therapy including heat and hyperbaric oxygenation which can be done only in Jordan in the specialty hospital about fifteen sessions before tie operation and ten after the operation.
- A revision surgery to arthrodise again his non-union fusion with bone graft and m fa! , and fixation. This kind of surgery can be done in the Specialty hospital in Jordan.
- Rehabilitation M about thirty physiotherapy sessions,
Dr. HL Rawashdeh Consultant Orthopaedic Surgeon
Arthroscopy of Knee And Shoulder Paediatnc Orthopaedics LLK
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The global treatment course is about seven months. The total cost is about two thousands and five hundreds for the physical therapy and hyperbaric oxygenation. Four thousands JD is the cost of the surgery including the hospital and the doctors fees.
This report was given upon the patient request
Dr. Hatem ALrawashdeh Consultant Orthopaedic surgeon
Wake Forest University Baptist
July 21, 2009
Re: Rafid M. Kully Date of Birth: November 18,1976
To Whom It May Concern,
Mr. Kully requested that a letter be written stating his condition during the period of time he was getting medical treatment in Jordan and his current condition.
Mr. Kully has been under my care since February 2008. Per his report, he was involved in a motor vehicle accident while working as an interpreter for the Marines in Iraq in March, 2006. He sustained injuries to his low back and right foot, and was sent to Jordan for medical treatment. He did not have his medical records from Jordan at that time. He recently brought some medical records and imaging studies from 2007, which I have reviewed. There are no medical records or imaging studies from the time of the accident. It appears that Mr. Kully had a nonunited talar head fracture and avascular necrosis of the navicular, for which he underwent talonavicular fusion. He later developed failure of his talonavicular fusion and was sent to physical therapy. Clinic notes from his orthopaedic surgeon in Jordan recommended revision surgery for his failed talonavicular fusion. A letter from his orthopaedic surgeon also stated that his condition from January to June 2007 was unstable and that he was unable to work.
My opinion after reviewing Mr. Kully's medical records and imaging studies from Jordan is that his foot symptoms and limited functional status prevented him from going back to work because he needed further medical treatment. It appears that his status was deteriorating, which is why his orthopaedic surgeon in Jordan planned to perform revision surgery. At this time, Mr. Kully is doing well after his midfoot fusion 14 months ago. He has experienced delayed consolidation of his midfoot fusion and is currently using a bone stimulator. X-rays from his most recent clinic visit on July 14th show increased fusion and he reports improvement in his pain. Despite this, he continues to have moderate disability that will prevent him from returning to active duty in the field as an interpreter, He will be limited to a desk job.
Please do not hesitate to contact me if you have any further questions.
Sincerely
YiLfe Li, M.D.
North Carolina Baptist Hospital
Medical Center Boulevard • Winston-Salem, North Carolina 27157