Rosana Sta. Ana vs. Prudential Insurance Company of America, et al. Case No: EDCV15-02520 SVW
For 22 years prior to the onset of her disability, Rosana had been continuously employed by Rite Aid as a Store Manager. Her job was demanding, as evidenced by her Job Description, which set forth the “Physical Demands” of her position that “must be met to successfully perform the essential functions of this job”. Those included to ability to: 1. Stand dynamically for long periods without a break; 2. Frequently twist upper torso; 3. Frequently stoop, kneel, crouch or crawl; 4. Frequently reach up and out with hands and arms; 5. Frequently lift up to 10 lbs. and carry it a distance of 200 feet; 6. Frequently push or pull up to 50 lbs. a distance of 100 feet; 7. Occasionally stand statically for long periods without a break; 8. Occasionally climb stairs and / or ladders; 9.Occasionally lift up to 25 lbs. and carry it a distance of 100 feet; 10. Occasionally pushor pull up to 10 lbs. a distance of 100 feet; 11. Rarely remain seated in a normal position for long periods; 12. Rarely push or pull up to 100 lbs. a distance of 10 feet.”
Rosana had to leave work, when she suffered a work-related injury to her right foot, but her real problems began a long time before that accident. But after the foot injury, everything seemed to cascade and she was never able to return to work again. She had long suffered from multiple medical problems, relating to her neck and back, which far pre-dated and were completely independent of her foot injury. She had been diagnosed with chronic pain syndrome of neck and back, cervical radiculopathy, Klippel-Feil deformity of the cervical spine, cervical spinal cord compression, osteopenia, torn meniscus right knee, knee pain, pelvic pain, carpal tunnel syndrome, muscle tension headaches, migraines, insomnia and fibromyalgia. In addition to all these problems, she had just been diagnosed with early stage smoldering plasma cell myeloma. All of Rosana’s medical problems taken together have rendered her unable to perform the duties of not only her occupation, but any “gainful occupation”, as defined by the plan.
Rosana sought treatment for her pain in hopes of eventually returning to work. But her complaints of severe, debilitating pain were prolonged and unrelenting. She saw a number of doctors and underwent diagnostic tests, including an MRI of the cervical and lumbar spine, EMG, and x-rays. The first EMG noted an abnormal study of the bilateral upper extremities. A second EMG showed, “Impression: Impaired conduction” “Left T1, first Thoracic nerve plus 5 very severe.”
Rosana had surgery (C4-5 and C6-7 anterior cervical discectomy and fusion), physical therapy, chiropractic treatment and trigger point injections without success. She took medications, but these did not control her pain. Her orthopedic surgeon diagnosed multiple cervical, lumbar and knee problems. In his report he opined that she “should not stand or walk for a prolonged period of time.” He stated, “No lifting greater than 10 pounds, no prolonged standing or walking; and no repetitive bending, stooping, kneeling or squatting.” An MRI showed degenerative dehiscence, as well as Klippel—Feil deformity of the cervical vertebrae.
Rosana’s primary care physician was an internist, who had treated her for more than 8 years. He fully documented her longstanding complaints of chronic pain and “Klippel-feil deformity cervical spine”, as well as right knee pain. He noted that her chronic pain had become continually worse to a point where her pain was “virtually intolerable and debilitating”. He stated the following restrictions: “no prolonged standing and walking, no lifting greater than 10 pounds and carrying more than 200 feet, no pushing or pulling greater than 50 pounds past a distance of 100 feet, no repetitive bending, stooping, kneeling or squatting, no reaching up and out with hands and arms.”
An orthopedic surgeon diagnosed: “1. Thoracic strain; 2. Lumbar strain; 3. Torn meniscus, right knee; 4. Crush injury, right foot.” He cited the EMG and MRI results and stated: “Objective Factors of Disability” were as follows: “The patient has weakness about the knee and foot regions. She has limitation of motion of the thoracic spine and lumbar spine with mild guarding.” Work Restrictions were No “very heavy work.” No “repetitive kneeling or squatting.”
Because she could not return to work, Rosana’s employment was terminated. She submitted an LTD claim, which was denied. The denial was based on a classification of Rosana’s occupation (as “light duty”) and upon a report by a (then) unidentified paper-review physician.
I submitted an administrative appeal of the denial, accompanied by additional medical reports from Rosana’s doctors.
The appeal was denied.
Result: A lawsuit was filed. The case was resolved satisfactorily.