i msuezt 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 1 of 55 PageID: 925
V1 rW*qruup 

2 floor, Suite 3 

Eet Oreethuslt New York 12031 

January 28, 2009 

Dr, Kenneth Kutner 

339 Princeton Hightstown Road 

Cranbury, NJ 08512 

RE: Ralob Van Deventer 

DOB: 

Dear Dr. Kutner: 

Thank you for agreeing to perform an Independent Medical Examination on the above employee of Johnson 

& Johnson on Thursday, February 12, 2009 at 10:00am. The purpose of the [ME is to provide an 

independent, impartial and objective evaluation of the individual. 

Mr. Van Deventer has been losing time from work primarily due - to a diagnosis of 300.4 Dysthymio Disorder; 

Anxiety Depression, Depression with Anxiety, Depressive Reaction, Neurotic Depressive State, Reactive 

Depression since 9/1712008. Mr. Van Deventer continues to apply for disability benefits for issues related to 

the aforementioned diagnosis. The employee alleges continued symptomatology that prevents him from 

performing the essential functions of his job. Based on plan provisions, Mr. Van Deventer needs to 

demonstrate disability from his position as a Senior Compliance Analyst In order to evaluate the employee’s 

eligibility for continued disability benefits the following issues need to be clarified. - My specific questions are: 

- - --What is-the-current condition?_ -Please address,- 

2. Did the claim. an demonstrate emotional decontrol? Please base your response on objective clinical 

observations. Reference the emotional presentation ybu directly observed. Specify the claimant’s 

ability to demonstrate appropriate affect to content discussed and whether the claimant was able to 

compose himself within a reasonable time-frame. If the patient exhibited emotional decontrol, did 

validity testing suggest symptom magnification and/or malingering? Please explain. 

3, Did the claimant demonstrate cognitive impairment in attention, concentration and/or memory 

functions as compared to standardized norms? Please base your response on objective testing to 

support your answer with the scale, index and/or subsoale scores from performance based testing, 

e.g. WAIS-Ill, Folstein Mini Mental Status Exam. If the claimant displayed cognitive impairment, did 

the validity testing suggest less than optimal effort that suppressed performance? Please explain. 

4: Did the claimant demonstrate any reality testing impairments? Please base your response on the 

clinical interview and behavioral observations, Describe any aspects of a formal thought disorder, 

(i.e. presence of delusions and/or hallucinations), and if these symptoms affected your ability to 

interact with and test this claimant If the claimant displayed reality testing impairments, did the 

validity testing (test results and behavioral observations as compared to self report), suggest 

symptom magnification and/or malingering? Please explain. 

S. Did the claimant demonstrate any clinically significant behavioral impairment? Please address social 

behavior (i.e. eye contact, hygiene, communication skills), psychomotor activity, and impulse control 

you observed during your clinical interview and psychological testing. If the claimant displayed 

behavioral impairments, did the validity testing (test results and behavioral observations as compared 

to self-report) suggest symptom magnification and/or malingering? Please explain. 

6. Is the claimant able to perform an 8-hour-per-day job? 

7. Are there sufficient abnormal findings that would support a functional impairment which would prevent 

this individual from working in his own occupation? Please comment on current treatment 

regime and recommendations for optimal treatment. 

Confidential 

Admin Rec. 00483 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 2 of 55 PageID: 926
B. If this individual could return to work, what would their limitations or restrictions be? For how long 

would these restrictions be in place? 

9. Participants in Johnson & Johnson’s Disability Plans are required to cooperate fully and provide 

factual information for all aspects of claims processing. Failure to do so will result in the forfeitue of 

benefits and/or loss of coverage. Therefore, based on the findings of your evaluation, please 

document the specific cause of any findings of poor performance, suboptimal effort and/or symptom 

magnification. Define the association of these findings to the participant’s disabling condition, or, if 

you are unable to do so, document why an association cannot be made. 

Thank you again for your assistance in this matter. Please send your report to my attention at Reed Group, 

15 TecftValleC 2M. Floor, Suite 3 East Greeuibush, New York 12061 and/or fax the same to me at 

(518) 880-6610. 

Thank you, 

Reed Group 

Confidential 

Admin Rec. 00484 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 3 of 55 PageID: 927
IA’ i ReedBrnup 15Th’IIey OM 

2-Floor, &ilte a 

stGreethut New York IM 

January 28, 2009 

jw";;nter 

Jr. 

Dear Mr. Van Deventer: 

Your case was referred to case management on 919/2008. 

An Independent Medical Examination (IME) has been scheduled for you on: 

Thursday, February 12, 2009 at 10:00am with Dr. Kenneth Kutner. Dr. Kutner’s office is 

located at: 

339 Princeton Hightstown Road 

Cranbury, NJ 08512 

For directions to his office you may call (201) 498-1166. 

Please bring a snack or lunch with you as this examination will last approximately 

6z8 hOuis. 

Please be aware your failure to attend, put forth reasonable effort or otherwise fully 

cooperate in this evaluation will result in the termination of your disability benefits as 

well as any other benefit programs you may be eligible for through Johnson & Johnson. 

Please contact me at (866) 829-8861 (Toll Free) with any questions or comments. 

Thank you, 

Reed Group 

Confidential 

Admin Rec. 00485 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 4 of 55 PageID: 928
CjRnedGruup FM 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

January 28, 2009 

Rall phR. Van DeyarnerJr. III,, 

Case #:74518 

WvVID#: 10900 

Dear Ralph Van Deventer Jr.: 

Johnson & Johnson has contracted with the Reed Group to review and monitor requests for Short Term 

Disability (STD) benefits. 

Your request for STD benefits was received on 09/09/2008 for your absence beginning 09/08/2008. 

Rase–ac_yonz.diagnosi&andnaedcl nfnrrntinn srEbmifiedJnL4LoJdr He!th (re Prnvirlerjhe ctatus_oL_ 

your STD benefits are as follows: 

09-08-2008 03-02-2009 Approved ---- Disability Duration 

Reed Group will continue to review your claim on an ongoing basis to determine the potential for an 

earlier release to return to work, with or without temporary restrictions. Therefore, if is determined by 

Reed Group that you can return to work, in any capacity, prior to the last authorized date of our 

disability as indicated in this letter, you are expected to comply in order to continue receiving STD 

benefits. In the event that you and your health care provider determine that you can return to work prior 

to 03-03-2009, please contact us immediately to facilitate your return to work. 

Fitness for Duty Requirements to return to work: You are required to provide a release to return to work 

from your provider. Failure in providing this notice may delay restoration to your job. 

It is important to note that should you require an extension or will not return to work on or before the 

authorization end date, it is your responsibility to ensure that you and/or your health care provider 

submits additional objective medical documentation to Reed Group five (5) days prior to the last 

authorized date for review to extend STD benefits. Examples of this objective medical documentation 

are: 

Physician office/progress notes 

Diagnostic test results (X-rays, MRI, etc.) 

Laboratory results 

Physical Therapy notes 

Medical clearance from disability 

confidential 

Reed Group 115 Tech vefley Drive 1 2

n0Floor, Suite 3j East Greenbush, NY 120611866-829-8861 ASHn EA 

JJ207 - STO Only Extension Approval Ltr.doc Page 1 of 2 7455 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 5 of 55 PageID: 929
- -7C ----- - - 

- - 

M M fir 

Per the Company policy, if an employee does not return to work within three (3) business days of the 

end of the approved time off, the Company may determine that the employee has voluntarily resigned 

and consider the employees employment to be terminated. 

Please call 866-8298861 if you have any questions or concerns. 

Thank you, 

Cristina Teta 

Reed Group 

Reed Group 115 Tech Valley Drive I 2 Floor, Suite 3 t East Greenbush, NY 120611 866-829-86616& 80-6e 10 

JJ207 - STD Only Extension Approval Ltr.doc Page 2 of 2 Adrnn RdÆ568487 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 6 of 55 PageID: 930
FROM A-Z VIDEO FAX NO. 7322724267 Jan. 27 2229 23: 31PM RI. 

]Q 

t v 

-- 

Fc 

I 

............ 

S(C 

received on 1127/2009 1:47:56 PM [Eastern Standard Time] 

Confidential 

Admin Rec. 00488 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 7 of 55 PageID: 931
FROM A-Z YIDEO FAX NO. 7322704297 Jan. 27 2009 23:31FM F2 

EMPLOYEE REQUEST FOR MEDICAL INFORMATION 

AUTHORIZATION FOR USE OF INFORMATION 

To Red Group] 15 Tech Valley Drive, 2 FIoor,Suitt 3; East Greenbush, NY 12061: You are 

authorized to royide to me or to my authorized representative information concerning my medical 

disability case and/or any employment-related inlormation regarding my primary and for secondary 

diagnoses as they relate to any futuro claim for disahWty benefits as maintained in my file at Reed Group, 

I understand that this authorlzahon isand untll’t subrfit wrien revocation to Reed Group. I hereby 

release any person or entity providing Information from any and all liability for furnishing such 

hIormaben. I agree that a photographic copy ot this authizatlon Is as valid as the original, I understand 

that Reed Group has fifteen days to respond to my request. 

Empo pe" ignature: Data; 

Please Fax Comoleted Form to 516-650-661 o 

RsGroup 116 Thc?Va4evDflyei2’Fcr, Suta 3, EostGreepaua4 NewYcrk 1O6i 1 seS.929.686 Fax: 518.s80-S$10 

rec&ved on 11271200 91:47:56 PM F-astem Standard Talej Confidential 

Admin Rec. 00489 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 8 of 55 PageID: 932
Access. Medical Evaluations, Inc. 

P.O. BOX 510837 

LIVONIA, MICH. 48151 

Mail Records to: 31153 Plymouth Rd., Ste. 107 

Livonia, Michigan 48150 

TELEPHONE: 800-375-0270 

FAX: 734-425-1042 

EMAIL: Accessevaluation(iDaoL corn 

tlDI3mltflflaMUI 

Date of Referral: 1/27/2009 

Claimant Information 

Case/Claim #; 10900 

"me: Ralph R Van Deventer jr 

Address: 

City/ST/Zip: 

Date of Birth: 

Telephone #: W" 

Please Check: 5Th: XX LTD: 

Is this account: Union represented 

(Access use only) Received by:_________ 

Adjuster/Client Information 

Company Name: Reed Group 

Adjuster Name:. Megan McRae 

I CIICAL. 0’6u’-0’27’--0’861 X 

FAX: 518-880-6610 

Email: mmcrae(ärg1.net 

Account; J&J 

WC: Pension: 

Non Union represented 

DISABILITY 

DIAGNOSIS: 

Physician/specialist 

300.4 Dysthymic Disorder; Anxiety 

Depression, Depression with Anxiety, 

Depressive Reaction, Neurotic 

Depressive State, Reactive Depression 

1" choice: NPSY 2nd choice: 

Pension Disability:_____ FCE:_______ 

Disability Status ’A-RR: Other:________________________ 

Exam; 

Approx amount of 

medical records: 1/2 (Fax if 30 pages or less) 

in. 1 in. 

SPECIAL INSTRUCTIONS: Please notify if unable to schedule for within 10-15 business da: 

Thank you. Please schedule with Dr. Kutner. 

** FOR OFFICE USE ONLY** 

Appointment Date: 

Specialty: 

Physician: 

Date of last Credential: 

Office Contact:_______________________ 

City/state/Zip: Charge:________________ 

Addn’l chrgs; nay other 

FAX Invoice: Admin Rec. 00490 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 9 of 55 PageID: 933
Date EE contacted: showed: show Canceled:______ 

Confidential 

Admin Rec. 00491 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 10 of 55 PageID: 934
FROM A-Z LIDEO FPX NO. 73227e4297 Jan. 21 229 1:39FM Fl 

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received on 11211200 11:56:26 AM [Eastern Standard Time] 

Confidential 

Admin Rec, 00492 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 11 of 55 PageID: 935
FROM AZ UIDEO FR< NO. 7322734287 Jan. 21 2239 01:43FM P2 

J JLt . fl 

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Cl srt *No tpervo pate n 

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received on 112112009 11:56:26 AM (Eastern Standard lime! confidential 

Arimin Rec. 00493 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 12 of 55 PageID: 936
FROM A-Z L)IDEO FAX NO. 732274287 Jan. 21 25 4FM P3 - 

BRICK FSYCEJAnIC ERV1CZ5 U4C. 

ZVLFTQAR £ RASP UT, MD 

BOARD CERTIflEJ) PSYCRL&1’BJST 

1541 Route 88 West. Suite! 

Bricktown, NJ 0fl4 

732202-0622 

(Fax) i322fl2.O52O 

Thru2y 13, 2009 

I; aph Yen Deventer 

To WI orn It May Concern: 

Ralph. has been apaticut in this oce since 9/17/200S He is su–Thtig with deprn ion 

andt Kiety, He is currently under my care and is taking mcdicatktz. If there are any 

ftxrth- questions please do not hesitate to contact this office. 

Sincecrtly. 

Zu r A- RsJpui, M.D. 

received an 112112009 11 :56:25 PTII [Eastern Stidard Timel Confidential 

Arlmhi Rec. 00494 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 13 of 55 PageID: 937
NORMAN M. REYMAN, M.D., P.A5 

ORTHOPAEDIC SURGERY 

245 UNION AVENUE 

BBIDGEWATER, NEW JERSEY 08801-3092 

TELEPHONE (908) 526-2589 

FAX (908) 526-6753 

PtLWW OF ThE AMBKCAN ACAV.4Y patcw OF ThE AMERICAN ACADITh4Y 

OF ORTHOVAEDTC SURGEQ4S or SURGEONS 

Exam Coordinators Network 

123 Northwest 13 Street, 0207 

Boca Raton, PL 33432 

January 14, 2009 

RE: It&LPM VAR Df’ER 

DOD: 

Fmut 21"B 

CLAIM: 

EXAMINATION: 

DIE: 01/13112009 - 

EXAMINING 

ORTHOPAEDTC SURGEON: NORMAN M. HEYMAN M.D. 

To Whom It May Concern: 

Mr. Ralph Van Deventer was seen In orthopaedic consultation for an independent medical examination on 01/13/09 

in the Hopela-wn office with complaints of back pain and left foot and ankle pain 

msTeRi-onntsL’r-----ras&me-paticnftndyeara-genthmarrwho-intiicerthatbethar-------------------

soreness and distress and discomfort In his back all of the time. He lakes Motrin all the time on a daily basis 

bemuse his back is -always sore. Jo June 200& his back seemed to get and .heiiad. pain jnot only in his .low . 

back, but in his middle and in his upper back. He tried to wait It out in that he has had pain in his back over the 

years subsequent to a back injury in 1979 when he worked in the ski patrol with the United States Army. In the 

past, he has always been able to work out his back difficulties, but in this case, it did not seem to get better and he 

Went to 5CC Or, Strouse in September and Dr. Strouso started him on physical therapy at the end of September. 

Around the seine time in September, he began to have pain in his left ankle and he noted a bump in his ankle . and 

Dr. Strouse Immobilized him in a walking boot, and -because he did not improve, in the beginning of December he 

was started on physical therapy where he had heat and electric stimulation. He indicates that his back is starting 

to improve, but it is not to the point where he believes he can go to work and his back hurts If he sits for too long 

and he cannot stand for too long, and he is unable to sleep on each sides but has to sleep on his back because his 

sleep apnea is affected when sleeping on his side. He is unable to shift from side to side and he tried to do some 

home work with some tools at home above his head with a screw driver and screws. He worked for a few minutes 

and had to stop in that he could not move and had a great deal of difficulty for several days. 

He, however, indicates that he is somewhat better. 

Rec. 00495 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 14 of 55 PageID: 938
RE: Ralph Van Deventer 

Page 2 of S 

PAST MEDICAL HISTORY: Pie past medical history reveals that he has no other serious medical problems 

with no hypertension, no cardiovascular disease, no diabetes, and no asthma or pulmonary problems. There is no 

history of genitourinary problems, gastrointestinal problems, dennatologic, h ematologic, neurologic, or 

orthopedic problems. Tip until four days ago, be was using Soma as a muscle relaxant, hydrocodone for pain, and 

meloxicam as an antiflammatory for pain. 

He had his right bee operated on artbroscopically some four years ago and has had no trouble subsequently and 

as noted above. He injured his back in 1979.and his right bee when he worked with ski patrol for the army and 

had a motor vehicle accident two years ago for which he had no treatment. 

EMPLOYMENT HISTORY He is a senior compliance analyst for Ortho Diagnostics and Indicates that he sits 

most of the time, but sometimes is required to lift between 10 and 50 pounds from the floor to the waist and 

oveiliesd. He has been out of work since September 08, 2008. 

MEDICAL RECORDS REVIEW: Medical records includes 

1. Authorization to disclose and use medical information for disability related determination signed by Mr. Van 

Deventer, 

2. Ajob analysis worksheet indicating sitting most of the time, lifting, and carrying I - lU pounds with the 

necessity to lift from waist to shoulder and the use of simple grasp. 

3. An attending physician’s statement, which is dated 09/2.5/08 indicating a lumbar sprain and tenosynovitis of 

the left ankle. Prescription for physical therapy three times a week for three weeks without any specific 

directions on 09/29108 and note from Dr. Strouse of 10/17/08, continue physical therapy, continue out of 

work. 

4. A note to continue physical therapy from Dr. Strouse dated 10/24/08. 

5, Anote from Dr. Strouse dated 11/10/08 indicating MU of the lumbar spine to further delineate pathology and 

to continue physical therapy because he is complaining of increased left sciatica. 

7. NMI of the lumbar spine indicating transitional-type vertebral body referred to 23 L5 for this report, disc 

bulge at L4-L5 and L2-L4 with & superimposed disc herniation in the right neural foramen at L4-L5, and 

8. Fxcusc slip from Dr. Strauss, no work until 12/29/08. 

9. Note from Dr. Strouse dated 11/24/08 to continue physical therapy and remain out of work. 

10. Excuse slip from Dr. Strouse, no return to work until 01/20/09. 

Ii. Prescription from Dr. Strouse to continue physical therapy three times a week for four weeks dated 12122/09. 

12, Note from Dr. Strouse dated 11124/08 to continue physical therapy. 

13. Note from Dr. Strouse dated] 2/22/08 to continue physical therapy and referring him to pain management 

specialist to see if epidural blocks are indicated. 

’llYSICAL EX4.M2qA11ON: Physical examination reveals a 50-year-old gentleman who stands 6 feet and 

weighs 215 pounds, He is orientod, cooperative, responsive, and in no acute distress. He is wearing an Aircast 

Caxn boot on the left side and having been driven to the appointment by a Mend. 

OflSERVATJoN On observation, he walks with a mild antalgic gait on the left side putting most of his weight 

on the right with no aid for ambulation, no crutch or cane. He stands erect with head In the midline, shoulders and 

pelvis level. Normal curves of the cervical, thoraaic, and lumber spine with mild flatness of the lumbosacral 

iordosis. He is unable to walk on his heels and toes, particularly on the left foot. Trendelcnburg’s test and gait 

are negative. Facial features are symmetrical. Pupils are equal, round, and reactive to light and accommodation, 

Confidential 

Admin Rec. 00496 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 15 of 55 PageID: 939
RE. Ralph Vain Deventer 

Page 3 of 5 

RANGt OF MOTION: Range of motion of the cervical spine is fall-and free In all pianos with 20 degrees of 

extension, 20 degrees of right and left lateral ilexion, 90 degrees of right and left lateral rotation, and 45 degrees 

of forward flexion. There is a negative Spur[ing’s test, negative axial head compression test, and a negative 

extension test indicating no signs of nerve root irritation. 

With respect to the lumbar spine, there is mild paravertebral muscle holding on the left. Thereis limited 

extensionperliaps 5-7 degrees and about 30 degrees of forward flexion without reversal of the lumbosacral spine. 

There is no lateral flexion and no lateral rotation. 

NEflOLOGJCAL EXAMINATION: The neurological examination is physiological and reveals no deficit or 

deficiency in the dermatonies, inyotomes, or scierotomes innervated by brachial or lumbosacral plexus from 

cervical 3-4 through and including thoracic I and lurnbosacral 3-4 through and including sacral I 

There are no long tract signs or pathological reflexes in the upper and lower extremities. All deep tendon reflexes 

are 2+ in the upper and Sower extremity. Motor and sensory functions are satisfactory in the upper and lower 

extremity. There are no signs of peripheral nerve compression or entrapment in the upper and lower extremity. 

RANGE OF MOTION.- The range of motion of the shoulders, elbows, wrists, and fingers show 180 degrees of 

motion in flexion and in abduction bilaterally, which are symmetrical + equal 90 degrees of Internal and external 

rotation of the shoulders with the shoulder abducted 90 degrees bilaterally. There is 70 degrees of internal 

rotation and 30 degrees of external rotation with the shoulder unloaded and the elbow at the side 

Range of motion of the elbows is arid of the wrist is to 130 and of the wrist is 90 dares of extension and 90 

degrees of flexion. Range of motion of the fingers is normal, 

ere1sfulrznge-ef-motiaofmehips,4cneesranklesr andfeetwhLohJs equal .au4symmetrLLbUa–eraJly2?iPL 

110 degrees of hip flexion, 45 degrees of abduction, 30 degrees of external rotation, and 20 degrees of Internal 

rotation without pain on flexion contraction. In the knee, theta is 0-130 degrees with no medial and lateral laxity 

rawcrwithrnegative posterolateral drop back. 

There is negative MoMurray’s test and negative MeMurray’s sign with negative Apley grind test, negative 

Steinmarm ’s test, and negative pivot shift with no sign of pateilofemoral syndrome with negative patellofemoral 

compression and suppression. 

Range of motion of the ankle is satisfactory on the right side as is the range of motion of the foot, but the range of 

motion of the ankle is reduced minimally on the left with S degrees of dorsifiexion on the left and 15 degrees of 

dorsiflexion on the right There is 25 degrees of plantarflexlon on the left and 35 degrees plantarflexion on the 

right Eversion on the left is about 3-5 degrees and on the right 5-7 degrees. Inversion on the left is 7-10 degrees 

and on the right it is 12-15 degrees. 

There is significant thickening of the Achilles tendon from the muscular ligamentous junction all the way down to 

the attachment at the bone. At the base of the Achilles tendon distally, there is a small lump about the size of a 

peach pit This area is not tender and is not soft, but appears to be firm. 

SPECIAL TESTS IN THE LOWER EXTREItUTY: Special tests in the lower extremity reveal positive 

hamstring muscle holding with negative straight leg raising. No sign of sciatic nerve root irritation with negative 

sciatic stretch and negative sciatic attention test. Fabere and Oaenslen tests are negative, but tight. 

CIRCULATION Circulation in the upper and lower extremities is satisfactory 

Confidential 

Admiri Rec. 00497 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 16 of 55 PageID: 940
DTAGNOSS; 

I, Lumbosacral sprain and strain. - 

2. Lumber syndrome, mechanical in nature. 

3. Degenerative Achilles tendinitis on the left side. 

Mr. VS Deventer brought some x-rays with him. nz x-rays of his lumbar spine were incomplete, but there was 

bulging of the L3-L4 disd and herMation to the right of the L4-L5 disc. There wasmitd thickening-of the left 

Achilles tendon with some degenerative changes in the tendon sheath. Attachment was noted to be firm at the 

bony junction. - 

Questions to be answered: 

Question * I: What Is the current condition, please address. 

Answer Mr. Van Deventer’s current condition is a chronic lumbosa.cral syndrome mechanical in nature with 

weak trunk muscles and weak muscles in the lower extremity. This is evidenced by his inability to sit for long 

periods of time, stand for long periods of time, and inability to shift his weight from side to side getting in and out 

of a car, which he states he is unable to do. He also has a degenerative Achilles tendon on the left side. 

Question *2; Is the patient’s condition preventing him from ftinctioningin his current job position? 

Answer I think that the patient’s condition is partially preventing him from functioning because he is unable 

really to bend and to lift, and though I think he can sit, If he sits comfortably and properly in a chair, he indicates 

that he Is unable to sit for longer than half hour, but with the proper coaching and proper teaching and sitting with 

a lumbar roll, I believe he could sit for a longer. 

For him to be able to stand longer, Mr. Van Deventer has to be able to exercise and strengthen his trmntk muscles 

and his lower extremity muscles along with the muscles of his back, and based up on the exercises that he has 

him. 

Question Question #3: If he is capable of performing his cur entjob, what specific functions of the job is he capable ot, 

and specific functions of the job he is not capable off? 

Answer. I believe that he is capable of performing his current job in the sedentary position and in walking around 

and standing fur short periods of time, I do not believe that at this point in time he requires the air walking cam 

boot. He can be treated with either a lift inside the shoe or a lift outside the shoe to protect the Achilles tendon. 

Therefo% I think he can perform his sitting and walking around minimally, but I do not believe that he can lift 

and put something up on a top shelf at the shoulder level. So that the functions that he is not capable of doing is 

ling heavy objects and bring them to shoulder level, standing for long periods of time, and sitting for long 

periods of time. As noted, he is capable of sifting for short periods of time with occasional standing and walking 

around and standing for short periods of time. 

Question 44: Is the patient capable of working for S hours per day? 

Answer; I think the patient is capable of working for S hours a day, but he will have to take frequent breaks, be 

able to stand, and be able to walk around with certain frequency and he must be sitting with a lumbar roll in the 

lumbar lordosis to put the least amount of load and the least amount of strain on his back. 

Question 45: Do you agree with the treatment to date? If further treatment is recommended, what further 

treatment would you recommend, and how long do you feel treatment should be provided? 

Answer. I do not agree with the treatment to date and my recommendation would be to get him out of the boot 

and put him in a shoe with a heel pad to elevate his heel or build up the outside of the shoe. 1 think that exercises 

for his Achilles tendon and for his That are not indicated and he should be on a particular program to stretch 

hamstrings and stretch the piriformis on a daily basis and twice daily basis and he should be on strengthening 

exercises for his trunk, for his low back muscles, for his quadriceps hip flexor, and for his knee extensor. 

Confidential 

Admin Rec, 00498 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 17 of 55 PageID: 941
Btt Ralph Van Deventer 

Page S of S 

The use of the heel lift and heel pads should be until the swelling is down and he is com fortable, which may be 6 

months to B months, and his exercises need to be started immediately and they should be monitored for a short 

period of time at most 3-4 weeks, but they need to continue for the rest of his life to maintain long thin muscles 

and gradually strengthen trunk muscles, back muscles, and lower extremity muscles. He also must have a lumbar 

roll or a lumbar pillow to put in the lumbar lordosis when he is sitting and he should have this at home, in all of 

his chairs at work, and all of his chairs in his automobile. 

oujyou ret uire any additional information, please do not hesitate to call on me. 

I state that Tarn a physician, authorized bylaw to practice in the state of New York and the state of New Jersey: 

am not party to this proceeding; sin the physician who subscribed the above (or attached) report; have read and 

personally, by my hand, signed the same and know the contents thereof; that the seine is true to my knowledge, 

except in the matters stated to be on information and beIkf, and sa te the matters, I believe it to be true. 

The undersigned hereby affirms that the foregoing statements are true under the penalties of perjury. 

I am available, for testimony via telephone on Tuesday afternoons at 2p.m. and Wednesday afternoons at 4 p.m. 

weekly. 

Thank you very kindly, I remain, 

Very truly yours, 

Norman M. Heyman, M.D. 

4 t~ 

F-X.XO-.K 

Tax LD.22-2093588 

NMHJad 

Confidential 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 18 of 55 PageID: 942
N: 

la 334Q 

92 

Bill To 

Maria Wallace 

Reed Group, Ltd. 

15 Tech Valley Drive 

E. Greenbush, NY 12061 

Claim Nbn 

Date of Loss: 91812008 

E1L 

-1/1312009 -1,00,1 -- lndependentivledical[-Evaluation~-- 

BR - Provider: Norman Heyman, 

-$1,1-95.00 -$1 ’195.0a: 

Examinee: Ralph Van Deventer, 

Jr. 

Sub Total $1,195.00 

Total $1,195.00 

Thank you for your businesslllt 

Tax I.D. Number-02-06219a6 

Confidential 

Admin Rec. 00500 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 19 of 55 PageID: 943
Initial Notification Email 

Template’ 

Initial Notification 

Name: RALPH R VAN DEVENTER JR 

WWID#: 10900 

Case Number: 74518 

First Day Absent: 09/08/200 8 

Primary Diagnosis: Degeneration of Thoracic or Lumbar 

Intervertebral Disc 

ICD-9 Code: 722.5 

Seco..dryD nosis-- .44--Sgcainan4-Stca4neo-Othec-eRdUnspecified Parts of Back, Lumbar Spine 

ICD-9 Code: 847.2 

’eçirpvide any pertinent information regarding this claimant 

’tEfsel might impact the disability management process. 

&in

ith a benefit determination. Please email me at 

ssreedqroup.com if you have any questions 

laim. Please include either the employee’s name 

 your e-mail. 

Confidential 

Admin Rec. 00501 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 20 of 55 PageID: 944
30900 03 UIWPV 

equapuOQ 

[IPU1C tkUlflThTJffOiflQ,?JUI 1 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 21 of 55 PageID: 945
ReedGruup FM 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

January 12, 2009 

a

R. Van Denter Jr. 

Case #: 74518 

VANID#: 10900 

Dear Ralph Van Deventer: 

Johnson & Johnson has contracted with Reed Group as the Service Administrator of the Johnson & 

Johnson Long Term Disability (LTD) Plan. Reed Group’s Short Term Disability (STD) Care 

Management Team has advised us that you have been on STD leave since 9/8/2008. Assuming 

your disability will continue, your last day of STD will be 3/8/2009 

-We recommend- that -you.bLegin-the process-for fling_a claim for Long-Te.rm.Disab[lity-(LTD.)-b.e.n. efits_ 

You must complete and return your LTD forms even if you believe you may return to work before 

your STDperiqd is exhausted. Should you return to work before your STD period is exhausted, 

your LTD application will be cancelled. 

LTD BENEFIT AMOUNTS 

If approved, your LTD benefit will equal 60% of your monthly base salary in effect when your Short 

Term Disability leave began. 

To file a claim for LTD benefits, the enclosed forms must be completed and returned to Reed 

Group within three weeks of the date of this letter. A reply envelope is enclosed for your 

convenience. 

1. Application for Long Term Disability and Attending Physician Statement - 

Both of these forms must be completed and returned to Reed Group to process 

your application for LTD. 

Electronic Funds Transfer - You may elect to have your LTD benefit check 

electronically transferred into your bank account each month. In order to receive 

this service, please complete the enclosed form entitled Authorization for Direct 

Deposit. Please also enclose a voided check with this form. If depositing to a 

savings account, please provide the Routing/Transit Number for your account. 

Please be aware that there may be a delay before the direct deposit takes effect. If 

this occurs we will mail your LTD payment directly to your home address. 

Reimbursement Agreement - You must sign this agreement. In doing so, you agree to 

repay the Johnson & Johnson Long Term Disability (LTD) Plan any amounteri!e in 

excess of the amount you would have been entitled to under the Plan. Admin Rec. 00503 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 22 of 55 PageID: 946
Reedjrç,p ri 

The Long Term Disability Plan benefit will be "offset,’ or reduced, by any other disability benefits 

you may receive, such as Primary Social Security or any Workers’ Compensation payments and 

settlements. The LTD Plan requires that you apply for Social Security Disability benefits. 

Additionally, you are required to immediately appeal a denial of your claim for Social Security 

Disability benefits. If awarded, the amount of your Social Security Disability benefit will reduce your 

monthly LTD benefit. If Family Social Security benefits are payable, the amount of the monthly 

benefit shall be the lesser of your regular Monthly earnings reduced by your Primary Social 

Security Benefit or 70% of your regular monthly earnings reduced by your Primary and Family 

Social Security Disability Benefit. 

Social Security Claimant Assistance Program 

The Johnson & Johnson Long Term Disability (LTD) Plan enlists the expertise of Reed Group’s 

preferred SSCAP partner to assist you in the Social Security application process. The Johnson & 

Johnson LTD Plan Document requires all disabled claimants to promptly file for Social Security 

Disability Income (SSDI) benefits under one of two methods. 

1. You may seek the assistance of Reed Group’s preferred SSCAP partner to represent you in 

making this filing. Reed Group’s preferred SSCAP partner is a recognized leader in this field 

and your decision to use them offers two additional advantages besides having their expertise 

working on your behalf: 

benefit-s----

are awarded or denied, the Johnson & Johnson LTD Plan will pay your full monthly 

P___ flflfl I i- . ,,.,,,..;!, 4....J+.’..A,Ih, .-,..r,,w+ke.. 

for all monies "advanced" to you during the filing period. 

b) Johnson & Johnson will pay 100% of the SSCAP partner’s fees to provide these 

services on your behalf, thereby saving you hundreds of dollars of what would 

otherwise be a personal expense. 

2. Alternatively, you may choose your own representative to handle your filing for SSDI benefits. 

If you elect to do that, please recognize that: 

a) Your monthly LTD benefit from the Plan will be immediately reduced by the estimated 

amount of your monthly SSDI benefit. 

b) You will be fully responsible for paying your representative for the services provided. 

You will be obligated to keep us informed about the status of your SSDI filing, exhaust all appeals if 

your filing should be denied and to advise us when you have been awarded or denied SSDI 

benefits. 

Your monthly LTD benefit from the Plan will be adjusted, if necessary, once SSDI benefits are 

actually awarded and a copy of Social Security’s written decision is sent to our attention by you or 

Reed Group’s preferred SSCAP partner, as applicable. 

Your Current Benefits 

If your claim for Long Term Disability benefits is approved, Health Care, Vision Care, Dental, Term 

Life, and Voluntary Group Accident coverage that you currently have for yourself and your covered 

dependents will continue at no cost to you except for any required Medicare Part CcØ2iitiats (if 

applicable). If enrolled, contributions to the HealthAccount and/or CareAccount v#klsdoI 0B504 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 23 of 55 PageID: 947
44tIflif4 

any Company paid Business Travel Accident insurance to which you may be eligible. If enrolled, 

you may choose to continue your Group Universal Life Insurance coverage by participating in the 

carrier’s (MetLife) voluntary direct lump sum deposit program. Alternatively, you may elect not to 

make any future contributions to your Universal Life Insurance and your cash value account will be 

subject to future interest earnings only. If enrolled, you may also maintain your Long Term Care 

coverage. The carrier (CNA) will bill you directly for this coverage. If participating, contributions to 

the Savings Plan will also stop. If eligible, you will continue to accrue Retirement Plan credited and 

vesting service while you remain on an authorized LTD status. 

If you have questions regarding the benefits available to you while on an authorized LTD status, 

please call the Johnson & Johnson Benefit Service Center at (800) 565-0122 and speak with a 

Benefit Service Representative. 

Next Steps 

All completed forms must be returned to Reed Group within three weeks of the date of this 

letter. Once received, your claim will be processed. 

If your claim for LTD benefits is not submitted to us in the time frame stated above or is not 

approved by us, you may be without income for a period of time or will not receive income from the 

Johnson & Johnson Long Term Disability (LTD) Plan. However, if your claim is approved, benefits 

will be paid retroactively to the date you commenced an authorized Long Term Disability status. 

Once -you have-exhsusted-youF-2E- weeks -of-Shert-T-er-m-DisabiIifyand-you have--been -notified-that-----

your Long Term Disability (LTD) claim has been approved, you will be placed on LTD status. At 

thattimerxaurempi.entsta–..icJr.cncirierer 1 sfr.r.ive nrl there icnn.gurnt.ee ..nfyniir 

reinstatement to your job unless otherwise required by any workers’ compensation laws in effect in 

the State in which you reside. In the event that your medical condition improves and you are able 

to return to active employment, you are welcome to contact your Human Resource representative 

to obtain information regarding any available employment opportunities. Any return to active 

employment requires a statement of medical clearance, which should include any suggested 

restrictions or request for accommodation. In addition, you may be required to attend a fitness for 

duty evaluation at no expense to you. Any questions you may have concerning your company’s reemployment procedures should be directed to your local Human Resources representative. 

If at the end of your 26 weeks of Short Term Disability you are still unable to return to the workplace 

and have not submitted the enclosed LTD forms, you will be considered to be on an 

unauthorized leave and must contact your local Human Resources representative to discuss your 

employment status. Therefore, it is imperative that you complete and return the enclosed forms as 

soon as possible to avoid any potential interruption of your benefits. 

Please call (866) 829-8861 if you have any questions or concerns. 

Thank You, 

Reed Group 

cc: Occupational Health Nurse 

Confidential 

Admin Rec. 00505 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 24 of 55 PageID: 948
RedGroup 

nw.rgLet 

APPLICATION FOR DISABILITY BENEFITS 

r.TOE COMPLETED By EMPLOYEE PLEASE TYPE OR PRINT CLEARLY ANSWER ALL QUESTIONS 

1. EMPLOYEE FULL NAME (Last, First, Middle Initial) 2. Social Security Number 

3. Address (City, State, Zip Code) 4. Phone Number (Area Code) 

S. Date of Birth 

Mo Day Yr 

IS. Height 17. Weight 8. Gender 

U M 

U F 

’9TMadthl Status 

U single U married 

0 widowed U divorced 

10. Spouses Date of Birth 

Mo Day - Yr 

First Name 

11 Es Spouse Employed? 

n Yes 

 0 No 

12. Number of 

Children 

13, List names with dates of birth for unmarried children who have not finished high school: 

PART I - INFORMATION ABOUT YOUR CONDITION 

14. What is your disabling condition? (Briefly describe the injury or illness that prevents, or has prevented, you from working.) 

15. Is your injury or illness related to or caused by your work in any way? U Yes U No 

I. On what date did your condition first bother you: Month Day Year 

30) 0 Yes ONe26. If you did work since the date in item 1, did your condition cause you to change: 

Your job or job duties? U Yes 0 No 

Your hours of work? 0 Yes 0 No 

Your attendance? U Yes U No 

Anything else about your work? 0 Yes U No 

(If you answered ’No’ to all items under 28, go to items 3A and 36.) 

20. If you an swered ’Yes’ to any item in 28, explain below what the changes in your work circumstances were, the dates they occurred, and hov 

your condition made these changes necessary. 

3A. On what date did your condition finally make you stop working? Month Day Year 

36. Explain how your condition now keeps you from working. 

Confidential 

Admin Rec. 00506 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 25 of 55 PageID: 949
IA"ReedGroup 

www.rql.net 

Describe the kind and amount of physical activity this job involved during a typical day in term of 

 Walking (circle the number of hours a day spent walking) 0 1 2 3 4 5 6 7 8 

 Standing (circle the number of hours a day spent standing) 0 1 2 3 4 5 6 7 8 

 Sitting (circle the number of hours a day spent sitting) 0 1 2 3 4 5 6 7 8 

 Bending (circle how often a day you had to bend) Never’ occasionally’ Frequently’ Constantly 

 Reaching (circle how often a day you had to reach) Never Occasionally * Frequently Constantly 

 Lifting and Carrying (describe below what was lifted, and far it was carried; check heaviest weight lifted, and weight frequently lifted 

and/or carried): 

- ..-- .. - - 

HEAVIEST WEIGHT LIFTED WEIGHT FREQUENTLY LIFTED/CARRIED 

0 10 lbs. 0 10 lbs. 

0 20 lbs. 0 20 tbs. 

0 50 lbs. 0 50 lbs. 

Cl 100 tbs. .0 icc tbs. 

0 Over loolbs. 0 Over lOOlbs. 

Have you been hospitalized or treated at a clinic for your disabling condition? 0 Yes 0 No 

If Yes,’ show the following and give dates of confinement: 

Name of Hospital or Clinic: Address: Dates of Confinement: 

Names and addresses of any physicians consulted: Dates Consulted: 

PART 11 INFORMATION ABOUT OTHER INCOME 

Are you receiving any income benefits? 0 Yes 0 No 

11 "Yes," check applicable box or boxes below and provide detail. 

0 Disability Benefit 0 Federal Social Security, Railroad Retirement Act, Veterans Administration, any Federal, 

0 Pension Plan State, or other Government Agency Benefits or Employers Liability Law Benefits 

0 Workers Compensation 0 Other - 

0 Sick Leave 

Source of Benefits Monthly Amount Commencement Date of Payments Termination of Payments 

PART Ill - INFORMATION ABOUT YOUR EDUCATION 

1. What is the highest grade of school that you completed and when? 

2. Have you gone to trade or vocational school or had any type of special training? 0 Yes 0 No 

If *Yes, show: 

 The type of trade or vocational school or training: 

 Approximate dates you attended: 

 How this schooling or training was used in any work you did: 

Employee Full Name WNID # Confidential 

- Admin Rec. 000507 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 26 of 55 PageID: 950
RccdGroup rT , wwwxL net 

F PART IV - INFORMATION ABOUT THE WORK YOU DID 

1. List all jobs you have had in the last 15 years before you stopped working, beginning with your current job. Normally, this will be the kind of work ye 

did the longest (If you have a 6th grade education or less, AND did only heavy unskilled labor for 35 years or more, list all of the jobs you have had 

since you began to work. Use a separate sheet as necessary and attach it to this form.) 

Job Title 

(Be sure to begin with your ’current" 

job) 

Type of 

Business 

Date Worked 

(MonthandYear) 

Days per Week Rate of Pay 

(Per hour, 

day, week, 

month or 

year) 

From To 

a. Provide the following information for your usual job shown in item I line 1: 

In your job, did you: 

 use machines, toots, or equipment of any kind? U Yes U No 

 use technical knowledge or skills? U Yes U No 

 do any writing, complete reports, or perform similar duties? U Yes U No 

 have supervisory responsibilities? U Yes U No 

Describe yc ~r daily- activit[es-iR thefol[owtng afeESI and state what and hcvLmuch- you -do-afeach-and- how often-you-d- it’ -- ........ ,.. ........ . . . - 

0 Household maintenance (including cooking, cleaning, shopping, and odd jobs around the house, 2S well as any other similar activiijes): 

’b Recreational activities and hobbies (hunting, fishing, bowling, hiking, musical instruments, etc.): 

 Social contacts (visits with friends, relatives, neighbors): 

 Other (drive car, motorcycle, ride bus, etc.): 

I hereby authorize all physicians and health care professionals, hospitals and other healthcare institutions, insurers, employers, and group policy 

holders: You are authorized to provide Reed Group, 15 Tech Valley Drive East Greenbush, NY 12061, acting on my employer’s behalf, with informath 

concerning my health care, history, examination, treatment (including but not limited to copies of my medical record), advice, and supplies provided tc 

me, and any employment-related information regarding my primary and/or secondary diagnoses as they relate to my disability benefits. This 

information will be used to evaluate and administer my application for disability benefits and may be reviewed by authorized medical and/or human 

resources professionals affiliated with my employer. I understand that this authorization is valid until I submit written revocation to my employer or Re 

Group. thereby release any person or entity providing information from any and all liability for furnishing such information. I agree that a photograph 

or facsimile copy of this authorization is as valid as the original. 

Employees Signature Date 

Employee Full Name WWID # 

-orm Fr4ttJ 

Confidental 

Admin Rec. 00508 

nfld ol,,,,. c,,;L ’ nf flrnh,,eh My ,nar RRp_Oo,R1 nv c1qn.fig1n 

vrn Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 27 of 55 PageID: 951
ReedGruup . 

ATTENDING PHYSICIAN STATEMENT 

Please Fax to 518-880-6610 or Mail to the Address Listed Below 

NOTE TO PHYSICIAN OR OTHER WEALTH CARE PROVIDER: Your full completion of this form is necessary so that 

the employees application for benefit maybe received end processed. Space is available on the reverse side if you wis) 

to amplify your answers. 

PLEASE ANSWER ALL QUESTIONS, RETURN FORM TO REED GROUP PROMPTLY. 

Name of patient Date of birth 

Mc. Day Year 

Employer name 

1. HISTORY 

(a) When did symptoms first appear or accident happen? Mo.__________________ Day__________________ Year___________________ 

(b) Date patient ceased work because of disability Mo.__________________ Day__________________ Year___________________ 

(c) Has patient ever had same or similar condition? U Yes []No If Yes’ state when and describe: 

(d) Is condition due to injury or sickness arising out of patient’s employment? U Yes U No U Unknown 

(e) Names and addresses of other treating physicians: 

2. DIAGNOSIS (including primary and secondary diagnoses or complications) 

(a) Diagnosis: 

(b) Date of last examination Mo.__________________ Day 

(c) Subjective symptoms: 

Re 

Group in making this difficult determination, we request your cooperation in forwarding: the yield of objective tests already taken (for example, 

electrocardiograms, angiograms, etc. for a heart condition; vital capacity readings for emphysema; x-rays for muscular skeletal disorders) and the 

results found thrngll did uder oute(cunicdi Zeonniques. - 

Do you wish this information returned? U Yes U No 

3. DATES OF TREATMENT 

(a) Date of first visit Mo. Day ___ 19_ 

(b) Date of last visit Mo. Day 19 

(c) Frequency U Weekly U Monthly U Other (Specify) 

4. NATURE OF TREATMENT (including surgery and medications prescribed, if any) 

5. PROGRESS 

(a) Has patient U Recovered? U Improved? [I Unchanged? U Retrogressed? 

(b) Is patient U Ambulatory? U House confined? U Bed confined? U Hospital confined? 

(o) Has patient been hospital confined? U Yes 11 No 

If "Yes,’ give Name and Address of Hospital 

Continued from through 

6. CARDIAC Of applicable) 

(a) Functional capacity U Class 1 (No limitation) U Class 2 (Slight limitation) 

(American Heart Ass’n.) U Class 3 (Marked limitation) U Class 4 (Complete limitation) 

(b) Blood Pressure (last visit) / 

SYSTOLIC DIASTOLIC -- 

- Confidential 

Admin Rec. 00509 

- Reed Group 115Teoh Valley Drive 1 2t Floor, Suite S) East Greenbush, NY 12061) 566-829-8661 1 Fax: 516-860-6610 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 28 of 55 PageID: 952
ATTENDING PHYSICIAN STATEMENT 

7. PHYSICAL IMPAIRMENT 

U Class 1  No limitation of functional capacity; capable of heavy physical activity. No restrictions. (0-10%) 

U Class 2 Slight limitation of functional capacity’,capable of light manual activity. (15-30%) 

U Class 3 Mod-erata limitation of functional capacity; capable-cf clerical administrative (sedentary) activity. (35-55 9/.) 

o Class 4Marked limitation. (60-70%) 

0 Class 5 Severe limitation of functional capacity; incapable of minimal (sedentary) activity. (75-100%) 

O Remarks: 

6. MENTALJNERVOUS IMPAIRMENT (if applicable) 

0 Class 1  Patient is able to function under stress and engage in interpersonal relations (no limitations). 

U Class 2 Patient is able to function in most stress situations and engage in most interpersonal relations (slight limitations). 

U Class 3Patient is able to engage in only limited stress situations and engage in only limited interpersonal relations (moderate limitations). 

U Class 4Patient is unable to engage in stress situations or engage in interpersonal relations (marked limitations). 

U Class 5Patient has significant loss of psychological, physiological, personal and social adjustment (severe limitations). 

U Remarks: - - 

Do you believe patient is competent to endorse checks and direct the use of the proceeds thereof? U Yes U No 

6. PROGNOSIS - 

- -PATtENT’SJOB ANY ---- -O-THERWORK 

(a Is patient now totally disabled?. U Yes U No . U Yes U No 

(b) Dc you expect a fundamental - 

or marked change in the future? U Yes U No 0 Yes U No 

(1) If "Yes," when will patient recover//.... U I Mo. U 3-6 Mos. /I- _ U 1 Mo. U 3-6 Mos. 

sufficiently to perform duties Mo. Day Yr. U i-a Mos. U Never Mc. Day Yr. U i-a Mos, U Never 

(2) If "No,’ please explain: 

10. REHABILITATION - 

PATIENT’S JOB ANY OTHER WORK 

(a) Is patient a suitable candidate 

for trial employment? U Yes U No U Yes U No 

(1) If "Yes," when could trial / / U 1 Mo. U -ô Mos. - / /,.._.......,,,, U 1 Mo. U 3-6 Mcs, 

employment commence? - Mo. Day Yr. U 1-3 Mos, U Never Mo. Day Yr. U 1-3 Mos. U Never 

(2) If "Yes," what training will patent require? 

(3) If "Yes," what type of employment would you suggest? 

(4) If "No," please explain: 

11.REMARKS 

Physicians Signature Date 

Name (Attending Physician) Print Degree Telephone 

- Street Address City or Town State of Province Zip Code 

Employee Full Name "WilD # 

.,Confir1ontil 

Admfri RSC, 00510 

Reed Grcuc 1 15 Tech Valley Drivel 2nd Floor. Suite 3I East Greenbush. NY 120611 866-829-8861 1 Fax: 518-880-6510 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 29 of 55 PageID: 953
IRecdGrq9p ri 

Direct Deposit Enrollment Form 

To enroll or stop in Full Service Direct Deposit, simply fill out this form and mail or fax it to Reed Group at 518-880-

6610. Also, when enrolling, please also attach a voided check - not a deposit slip. If depositing to a savings 

account, ask your bank to give you the Routing/Transit Number for your account, It Isn’t always the same as the 

number- on a savings deposit -slip, This will help ensuFe that you are paid correct1y. 

Below is a sample check MICR line, detailing where the information necessary to complete this form can be found. 

!’OkE3 

PGu1ngffranütt 

IA 9-digit number thways 

between these two marks) 

9114 01 Q-1 

check 4 

Checking AccountP Ithis number matches The number in 

the upper right comer of the abetS-- 

not needed for sign-up) 

Important! Please read and sign before completing and submitting. 

I hereby authorize RGL to deposit any amounts owed me, by initiating credit entries to my account at the financial 

ristituticrr on this-formi-, -Furtherj-authorize-Bank- to-accept-and toi cTad it 2nd-crecit 

entries indicated by RGL to my account In the event that RGL deposits funds erroneously into my account, I 

.aUhc4ze RGLtc debit my acccunt for aa-amout-nct-t -exceed the cci-inaI-amcunof4he&rcnao.us-credit 

This authorization is to remain in full force and effect until RGL and Bank have received written notice from me 

of its termination in such time and such manner as to afford RGL and Bank reasonable opportunity to act on it 

Name Social Security #: 

Signature: 

1. Election (Must Select One): 

2. Account Information 

1, Bank Name/City/State: - 

2. Account#: 

Date: 

o Start Direct Deposit o Stop Direct Deposit o Change Account 

3. Type of Account: o Checking c Savings o Other 

4. Routing! Transit #: 

Please Mail to the Address Listed Below or Fax to 518-880-6610 

Confidential 

Admin Rec. 00511 

Reed Group 115 Tech Valley Drive} 2d Floor, Suite 3[ East Greenbush, NY 120611866-829-8861 1 Fax: 516-880-6610 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 30 of 55 PageID: 954
REIMBURSEMENT AGREEMENT 

Johnson & Johnson Long Term Disability Plan 

aEMPLOYEESTATEMENT 

Name: Social Security Number: Date of Birth: 

Address - Street: City: State: Zip Code: 

Home Telephone Number: Employee’s Rome E-mail Address (if available): 

am familiar with and understand the provisions of the Long Term Disability Income Plan for Choices 

Eligible Employees of Johnson & Johnson and Affiliated Companies (the Plan") that require that monthly 

payments to me will be reduced by certain amounts, such as Social Security and Workers Compensation 

benefits. I understand that these reductions may sometimes be based on a reasonable estimate of the 

amount of other benefits that will be paid to me, I agree to these reductions. 

I further understand and agree that I am required to repay the Plan for any overpayments that have been 

rna6tcrmw7’includingywftftout hmitatEonTpayments thath-avn-otbeerruffset noffaetfullyy far - retractk’c’ 

awards of Social Security, Workers’ Compensation or other relevant benefits under the terms of the Plan 

an4-thet-4-ai--req44wed4op.aay_a:mounth that 4-ce6ever 1rom a third party in conneetienwfth-my--- 

disability to the extent provided under the terms of the Plan, I agree to make these payments promptly, in 

accordance with the terms of the Plan. I understand and agree to the terms of the Plan regarding other 

rights of the Plan to recover amounts through subrogation and third party reimbursement. 

I further agree to notify the Reed Group immediately upon my receiving notice that I have or will receive any 

amounts that offset my benefits under the Plan or any amounts that oblige me to pay or repay any amount 

to the Plan. 

Employees Signature: Date: 

Witness Signature: Date: 

Please Fax to 518-880-6610 or Mail to the Address Listed Below 

Confidential 

Admin Rec. 00512 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 31 of 55 PageID: 955
V ReedGroup 

www.rLngt 0

Social Security Administration 

Consent for Release of Information OMB No 0960-0566 

TO: Social Security Administration 

Name (Please Print) 

Data of Birth: Social Security Number: 

I authorize the Social Security Administration to release information or records about me to: 

NAME ADDRESS 

AlIsup, Inc. (AlIsup) 300 AlIsup 

P1., Belleville, IL 62223 

I want this information released because: 

..-1.pIease.release4hefeflewing-inf&rrnatiorU -------------------------------------------------- -- - 

ucityNwnber- .. . . 

NA Identifying information (includes date and place of birth, parents’ names) 

X Monthly Social Security benefit amount and date of entitlement or NIP 

NA Monthly Supplemental Security Income payment amount 

NA Information about benefit/payments I received from - to 

NA Information about my Medicare claim/coverage from - to

(specify) 

NA Medical records 

NA Record(s) from my file (specify) 

X Other (specify): FACT Query for Primary and/or dependent(s 

I am the individual to whom the information/record applies or that person’s parent (if a minor) or legal 

guardian. I know that if I make any representation which I know is false to obtain information from Social 

Security records, I could be punished by fine or imprisonment or both. 

Signature 

Date: Relations 

Please Fax to 518-880-6610 or Mail to the Address Listed Below 

SSA-3288 Internet (12/99) 

Confidential 

Admin Rec. 00513 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 32 of 55 PageID: 956
P. ’ 

the’ 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

January 2, 2009 

Dr. Norman Heyman 

Office Of Dr. Amato 

75 New Brunswick Avenue 

Hop&awn, NJ 08861 

RE: Ralph Van Deventer 

DOS_ 

Dear Dr. Heyman: 

Thank you for agreeing to perform an Independent Medical Examination on the above employee of 

Johnson & Johnson on Tuesday, January 13, 2009 at 5:00pm. The purpose of the IME is to provide an 

independent, impartial and objective evaluation of the individual. Please note that no tests or 

diagnostic studies are to be performed without prior authorization from Reed Group or Exam 

Coordinators Network, 

- . Mr. Van Deventer has been losing time from work primarily due to diagnoses of 721.3 Lumbosacral 

Spondylosis without Myelopathy; Arthritis; Osteoarthritis; Spondylarthritis, 847.2 Sprains and Strains of 

Other and Unspecified Parts of Back, Lumbar Spine, and 727.06 Tenosynovitis of Foot and Ankle since 

918/2008, -arid 7 -2-2-. &-Deg eneration- of-Throracic -or-Lum bar intervertebral--Disc since -1-tPF3f2008.- Mr:-Varr 

H Deventer continues to apply for disability benefits for issues related to the aforementioned diagnoses. 

functions 6f his job: Based on plan provisions, Mr. Van Deventer needs to demonstrate disability from 

his position as a Senior Compliance Analyst. In order to evaluate the employee’s eligibility for continued 

disability benefits the following issues need to be clarified. My specific questions are: 

1. What is the current condition? Please address. 

2. Is the patient’s condition preventing him from functioning in his current job position? 

3. If he is capable of performing his current job 1what specific functions of the job is he capable of, 

and what specific functions of the job is he not capable of? 

4. Is the patient capable of working for 8 hours per day? 

5. Do you agree with the treatment to date? If further treatment is recommended, what further 

treatment would you recommend and how long do you feel treatment should be provided? 

Thank you again for your assistance in this matter. Please send your report to my attention at Reed 

Group, 15 Tech Valley, 2 nd Floor, Suite 3, East Greenbush, New York 12061 and/or fax the same to me 

at(518)880-6610. . 

Thank you, 

Reed Group 

Confidential 

Admin Rec. 00514 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 33 of 55 PageID: 957
RecdGruup 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

January 2, 2009 

Mr. Ralph R. Van Deventer Jr. 

Dear Mr. Van Deventer: 

Your case was referred to case management on 9/912008. 

An Independent Medical Examination ([ME) has been scheduled for you on: 

Tuesday, January 13, 2009 at 5:00pm with Dr. Norman Heyman. Dr. Heyman’s office is 

located at: 

Office Of Dr. Amato 

75 New Brunswick Avenue 

Hopelawn, NJ 08861 

YouWill h Øod1Thflh1Wflff%ran.rMRtThmSo isevamalibiirtdfl’Will need 

to request these from your physician. This is necessary for the physician to properly 

evaluate you. 

Please be aware your failure to attend, put forth reasonable effort or otherwise fully 

cooperate in this evaluation will result in the termination of your disability benefits as 

well as any other benefit programs you may be eligible for through Johnson & Johnson. 

Please contact me at (866) 829-8861 (Toll Free) with any questions or comments, 

Thank you, 

Reed Group 

Confidential 

Admin Rec. 00515 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 34 of 55 PageID: 958
9ReedGroup 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

December 30, 2008 

Ralph Van Deventer Jr. 

Case #:74518 

WWID#: 10900 

Dear Ralph Van Deventer Jr.: 

Johnson & Johnson has contracted with the Reed Group to review and monitor requests for Short Term 

Disability (STD) benefits. 

Your request for STD benefits was received on 9/9/2008 for your absence beginning 918/2008. Based 

on your diaposis a nd medical information submitted by your Heath Care Prov i der, your SD benefits 

have been approved and extended through 1/28/2009. Reed Group will continue to review your claim 

on an ongoing basis to determine the potential for an earlier release to return to work, with or without 

capacity, prior to the last authorized date of our disability as indicated in this letter, you are expected to 

comply in order to continue receiving STD benefits. In the event that you and your health care provider 

determine that you can return to work prior to 1/29/2009, please contact us immediately to facilitate 

your return to work. 

It is important to note that should you require an extension or will not return to work on or before the 

authorization end date, it is your responsibility to ensure that you and/or your health care provider 

submits additional objective medical documentation to Reed Group five (5) days prior to the last 

authorized date for review to extend STD benefits, Examples of this objective medical documentation 

are: 

 Physician office/progress notes 

Diagnostic test results (X-rays, MR[, etc.) 

Laboratory results 

Physical Therapy notes 

Medical clearance from disability 

 Per the Company policy, if an employee does not return to work within three (3) business days of the 

end of the approved time off, the Company may determine that the employee has voluntarily resigned 

and consider the employee’s employment to be terminated. 

Please call 866829-8851 if you have any questions or concerns. 

Thank you, 

Cristina Teta 

Confidential Reed Group Admin Rec. 00516 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 35 of 55 PageID: 959
12/29/289 12:32 7325711937 

-m.low, 

The Information contained hi, lb s facsimile mssege is privileged en! contidentiak lrtfbrniatbr Intonded ci ly for 

the use of the Individual or entity 

named shove, If the reader 4 f this 

message Is not the Intended eoipIant, you are hereby notified th2 t any 

dissemination, distribution or cc pyftig 

of this corru44nicatjon Is. sMot1 prohibited if you have received this 

communication In error, plpase notify 

us immediately. 

PIeasradcaens -oflnrdifflaufflww 

receiving this fransmisIon by a JIing 

the numbers rstŁd above, 

STROUSE/LOPANO PAGE 31 

IRVING D. SThOUSE, M.D., P.A. 

279 Third Avenue, Suits $04 4655 Pouts S N 

Long aranch, NJ 07740 Howell, NJ 07 

Telephone: (752) 2294333 Telephone: (752) 3704 

Fax- M2) 571-1937 Far, (732) $70-1 

TO 

NameL 4e(s/i It 

Company _– - 

FAX Nui 2L 

FROM; 

Name 

Date 

TRANSMISSION 

This cover letter plus pages attSied. 

i- Il 

I.. 

-ç 

 

. I REPLY REQUIRED?_L..LJRGENT?______ 

I An 

received on T2900810:30:42 AM astern Standard Iifflej ConE entlaY 

Admin Rec. 00517 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 36 of 55 PageID: 960
12/29/2338 13:32 7325711337 STROUSE/LOPC PAGE 82 

RALPH VANDE (ENTER 

D00 

U24-O 

HISTORY: Path at did have an MRI perfonted of his lumbar spine, which I reviewed. 

There is transitiorn I type vertebra. There is disc bulge at L4-L5 and L3-.4 with 

superimposed disc herniation along the right neural foramina at L4-L5. There was diffuse 

degenerative chan e. Neurologic exam remains unchanged. He is still significantly tender 

over the Achilles, 

PLAN: For now, we will continue his physical therapy and keep him out of work. 

RETURN; 4 wei los 

ms:pb 

received on 12129/2008 10:30:42 AM [Eastern Standard Time] Confidential 

Admin Rec. 00518 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 37 of 55 PageID: 961
12/29/2E08 1@:32 732711937 SThOUEE/LOFO PAGE es 

RALPH VAN])E TENTER 

DOB 

11-24-08 

HISTORY: Path at did have an MRI performed of his lumbar spine, which I reviewed. 

There is transition 1 type vertebra. There is disc bulge at L4-L5 and 1.3-4 with 

superimposed disc herniation along the right neural foramina at L4-L5. There was diffuse 

degenerative than1 .e. Neurologic exam remains unchanged. He is still. significantly tender 

over the Achilles. 

PLAN: For now, we will continue his physical therapy and keep him out of work. 

RETURN: 4 we iks 

ms :pb 

Confidential 

Admin Rec. 00519 received on 1212912008 10:30:42 AM [Eastern Standard Timel 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 38 of 55 PageID: 962
12/29/2eee 13:20 7325711937 STROUSE/LOPANG PAGE @1 

IRVI io a ST-ROUSE, M.D., P.A. 

279 Third Avenue, Suite 504 4E95 Route S N 

Long flrnch, NJ 07740 NeweL NJ 07 

Telephone; (722) 22S-4333 Telephone: (732) 2704 

Fsx (732) 571-1937 Fac (732) 370-1 

The Infonflaflon contained In 0113 

sFt1)He message Is privileged an confIdentIa1 Information Intended or Iy for 

the ue of the Indtvfdual dr entity 

runad above. If the reader o this 

message Is not the intended I soipiem, you are hereby notified the any 

dhsemInafior1, distribution or cc ylng 

of this comnjdoallon Is stiotty prohbita& Af you have received this 

communication In error, pipese iotify 

us immedetØ&, 

Plimm

- 

- 

rseeMng this transmls&orr by c illing 

the numbers itsthd above. 

TO; 

Mn ( ’As1 

FAXNbL 

FROM: 

Name 

Date iime_ 

TRANSMISSION 

This cover letter plus pages attached. 

4 

 . REPLY REQUIRED? - URGENT?________ 

received on 121291200S i:8:26 PM [Eastern Standard iiniej Confidential 

Admin Rec. 00520 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 39 of 55 PageID: 963
12129/2008 13:20 732711927 ETROUSE/LOPANO PAGE 02 

tal $:SE1O3Skl uMtI 

JLIL1 

12-22-08 

HISTORY: Patie at is basically unchanged. His back is a chronic problem. He still has 

tenderness and sw fling. 

PHYSICAL Efl %IINATION: Exathination reveals spasm and limited motion. There 

is no change in his neurologic status. He is still tender with swelling ever the Achilles. 

PLAN: For now, RC will continue with his physical therapy. I am also referring him to a 

pain management pecialistta see if epidural blocks are indicated. 

RETURN: I moth 

TDS:pb 

Confidential received on 12129(2008 1:18:26 PM (Eastern Standard Time] Adrnin Rec. 00521 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 40 of 55 PageID: 964
FROM A-Z t)IDED FAX NO. 7322724267 Dec. 23 2228 12:42FM Ft 

/0 Ta /Lthf 

F. 

ofpy s: 71 

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TtcA/ Ckr s4tr j 

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recevd au i2!22OOS 10:57:58 AM tEastern Standard flue] 

Confidentia l 

Admin Rec. 00522 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 41 of 55 PageID: 965
FROM : AZ VIDEO FAX NO. 7322704287 Dec. 23 2208 12:40PM P2 

EXCUSE. SUP 

IRVING t. STROUSE, M.D., P.L 

Dolvvaf6 Amattn ScaRf of Drthop< Surgery 

mmlrd AvonUØ, Sue 504 

Lon-Erozzh NOW Jetoy 07740 

(712l2294333 

T* 

 Whom 

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 conce rn: 

b 

I~ under my care, 

He/She: . 

’4 Wa seen In my office today for a necessary appointment 

0 Pease Gxcttae ftr to: school work 

ttosisou M4RKgD saze77cNs saov: . 

. 

Pieasnxt,zntforbe bSnttromsthłoftwcor . t ________________ 

 0 seIesad;torłturn.to school ’ 

o isp tó return ta<on 

Fall Duty Light Duty 

o Is/Is nut able to participate in the physical eduon program at school. 

Is nbt ablejq prtIoipate In . .__ ___.. 

0 Siiris sohedued for ___________________ arid.patlent may return to school) work after . w$aks. 

1ó dfsurgety to be performed: 

Or 

Lj 

received on 1V2312008 10:57:58 AM jEastem Standard Time) 

Admin Rec. 00523 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 42 of 55 PageID: 966
FROM A-Z JIDEO 

9W 

4 0 

, 

& bu’ - 

._. 

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received on 12(23/2888 185758 AN jEastern Standard Thie ct7322704297  Dec. 23 2 

: 

s 

12:41FM P3 

Confidential 

Admin Rec. 00524 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 43 of 55 PageID: 967
FROM S-Z L)IDEO FAX NO. 7322724287 Dec. 23 2228 12:4IFM F4 

N 

.tIISt1: 1 

’UN Ot 

received on 1V23302 10:57:58 M 

Confidential 

Admin Rec. 00525 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 44 of 55 PageID: 968
]:1 ;1*IihitI1Sfl 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

December 9, 2008 

A

h Van Deventer Jr. 

Case #:74518 

VNID#: 10900 

Dear Ralph Van Deventer Jr.: 

Johnson & Johnson has contracted with the Reed Group to review and monitor requests for Short Term 

Disability (STD) benefits. 

Your request for STD benefits was received on 9/9/2008 for your absence beginning 9/812008. Based 

on your diagnosis and medical information submitted by your Health Care Provider, your STD benefits 

and extended through1212M Reed Group will continue to review your claim 

on an ongoing basis to determine the potential for an earlier release to return to work, with or without 

temporary’ restrictions. Therefore, if is determined by Reed Group that you can return to work, in any 

.CZJC.flLy , LLJUI Cl’? OLLLI I IlL1 Al.I II Ill ’.IIl, I’-’IL’-1 , 7 

comply in order to continue receiving STD benefits. In the event that you and your health care provider 

determine that you can return to work prior to 12/29/2008, please contact us immediately to facilitate 

your return to work. 

It is important to note that should you require an extension or will not return to work on or before the 

authorization end date, it is your responsibility to ensure that you and/or your health care provider 

submits additional objective medical documentation to Reed Group five (5) days prior to the last 

authorized date for review to extend STD benefits. Examples of this objective medical documentation 

are: 

Physician office/progress notes 

 Diagnostic test results (X-rays, MR[, etc.) 

Laboratory results 

Physical Therapy notes 

Medical clearance from disability 

Per the Company policy, If an employee does not return to work within three (3) business days of the 

end of the approved time off, the Company may determine that the employee has voluntarily resigned 

and consider the employee’s employment to be terminated. 

Please call 866-829-8861 if you have any questions or concerns. 

Thank you, 

Cristina Teta 

Reed Group Confidential 

Reed Group 115 Tech Valley Drivel 2nd Floor, Suite 3 1 East Greenbush, NY 120611866-829-8861 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 45 of 55 PageID: 969
11/26/299 9:40 7325711937 

WAR N IN S 

The Information contained in !hh facsimile message is prMleged and conficenflah Information intended on V for 

the use of the individual dr arstity 

nnied above. if the render ci this 

message is not the intended r ctpiera., you are hereby notified the any 

dissemination, disfitulion or co ,ytng 

of this conwunicatIcn is, strictly prohibfted if you have received this 

ommunication in error, pipese i ictily 

us immedlat&y. 

Pinaseadvse-.us.cf... any .diffiou1i.s-tn.-. 

reocivirig this transrnlssiort by c4 illing 

the numbers listed above. 

STROUSE/LOFANO PAGE 01 

IRVING CY. STROlJS, 1A. 

279 Third Avenue, Suite 504 4695 Route S Nor 

Long Branch NJ 07740 Hcwe, NJ 07724 

Thiephona: (722) 229-4333 Telephone: (732) 370.4$C 

Far (722) $71-1937 Fax: (722) 370-1 2$ 

TO: 

Nate _ . esIk) ,7t. 

Company 

FAXNfl 2o: £c’iD 

FROM: 

Dais . Time 

TRANSMISSION 

flfF[ff-_fl 

pages attached. 

REPLY REQUIRED? URGENT? 

bMS&4 M, 

received on 11126/2008 9:38:32 AM [Eastern Standard Time] Confidential 

Admin Rec. 00527 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 46 of 55 PageID: 970
11/26/2008 09:40 732711537 STtEE/LC PAGE 02 

RALPH VANDE% ENTER 

not 

11-24-08 

HISTORY: Path it did have an MR] performed of his lumbar spine, which I reviewed. 

There is transltionn. type vflbra. There is disc bulge at L4-L5 and L:3-4 with 

superimposed disc ieruiatlon along the right neural foramina at L4-L5. There was diffuse 

degenerative chang . Neurologic exam remains unchanged. He is still sitificantly lender 

over the Achilles. 

PLAN: For now, we will continue his physical therapy and keep him out of work. 

ccTum’q: 4 wei Ics 

receivedU° n:3t32 AN CEastern Mr flmAl VII I IILVIL VO Ut SaUl U I lIS,J Confidential 

Admin Rec, 00528 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 47 of 55 PageID: 971
FROM A-Z VIDEO FAX NO. 7322704207 Nov. 25 2028 34:1OFM Pt 

\J Z3)O 

3 

Eo.- 5iS’a -at (t2(air’ 

: 

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vDe 4 

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received on 11I25O08 2:29:4 PM jEastern Standard Time] - Confidential 

Admin Rec. 00529 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 48 of 55 PageID: 972
FROM AZ VIDEO FAX NO, 7322704287 Nov. 25 2028 04:iOFM P2 

EXCUSE SLIP 

IRVING D. STROUSE, M.D., P.A. 

DIaInato American ?caM of Onflopedic Swwy 

27a Third Avenuł, Suite 504 

Long 8rch, New Jersey 07740 - 

(732)2e.4339 

Dater . - 

16 Whom It May 

I 

1W Was seen in my office todayfor a necessary appointment. 

0 P(ease excuse for being -taidy to: school work 

- DiAGNOSiS (FO44 MARKE9 SELECTIONS BELOt4’: 

Is under my care. 

Iii i’- I C" 

0 Is released to return to school on 

0 ls released ro return to work on 

Full Duty Light Duty 

o Is / Is not able to participate in the physical education program at school. 

o Is not able to participate in 

0. sthrgsryls sthedulsd for ____________________ and patient may return to school / workAtSr . WSICS. 

Type o- surgery to be performed: 

xassmos: 

t. 

IRVING D. STROUSE, M.1, PA. 

n 

 4 

’""’ received on 1112512002 2:29:14 PM [Eastern otafluw d Admin Rec. 00530 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 49 of 55 PageID: 973
FROM A-Z VIDEO FAX NO. 7322704287 Nov. 25 2208 04:IIFM P3 

IRvING 0. SIRCUOR M0., PA 

ORTOPE0i0uRCgPV 

1’ 

SUITE Z& 

:7, 1H1W AVENUE 

LOI10 6IWIC. NJ 07740 

(flZZZ-403 1- 

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CONTINUE 

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FOCI (1 ELECW )WF7SI MkW-C (]RIMS 

II 0HOILOER OTHER 

R\’I 4GiE. StEOUSE. M.D. 

received on 1112512008 2:29:14 PM [Eastern Standard Tie1 

Confidential 

Admin Rec. 00531 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 50 of 55 PageID: 974
ReedGroup M 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

December 2, 2008 

i"A;r Jr. 

Case #:74518 

WWID#: 10900 

Dear Ralph Van Deventer: 

This letter is to inform you that as of 11/30/2008, you will have exhausted the 12 weeks of Family 

Medical Leave (FMLA) entitled to you under the Family and Medical Leave Act (FMLA). Therefore, 

Reed Group will close your FMLA case effective 11/30/2008. 

Please call 866-829-8861 if you have other questions or concerns. 

If you had previously been approved for short-term disability (STD) benefits for this absence and you 

still have remaining approved STD days available, your eligibility for this benefit will remain in effect. 

It is important to note that should you require an extension or will not return to work on or before the 

STD authorization end date, it is your responsibility to ensure that you and/or your health care 

provider submits additional objective medical documentation to Reed Group five (5) days prior to the 

last authorized date for review to extend STD benefits, Examples of this objective medical 

documentation are: 

Physician office/progress notes 

Diagnostic test results (X-rays, MR[, etc.) 

Laboratory results 

Physical Therapy notes 

Medical clearance from disability 

Per the Company policy, if an employee does not return to work within three (3) business days of the 

end of the approved time off, the Company may determine that the employee has voluntarily resigned 

and consider the employee’s employment to be terminated. 

If you have any questions about your employment status or benefits, please contact your employer. 

Sincerely, 

Reed Group 

cc: J&J Supervisor Confidential 

Admin Rec. 00532 

4fl k,k IV4n IOCOnnOOI lrC4O OOflCClfl 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 51 of 55 PageID: 975
ReedGroup ;1 

15 Tech Valley Drive 

Suite 3, Second Floor 

East Greenbush, NY 12061 

November 19, 2008 

Rail phR. Van Deventer Jr. 

Case #:74518 

WWID#: 10900 

Dear Ralph Van Deventer Jr.: 

Johnson & Johnson has contracted with the Reed Group to review and monitor requests for Short Term 

Disability (STD) benefits. 

Your request for STD benefits was received on 9/9/2008 for your absence beginning 9/8/2008. Based 

have been approved and extended through 11/30/2008. Reed Group will continue to review your claim 

on 

temporary restrictions. Therefore, if is determined by Reed Group that you can return to work, in any 

capacity, prior to the last authorized date of your disability as indicated in this letter, you are expected to 

comply in order to continue receiving STO benefits, In the event that you and your health care provider 

determine that you can return to work prior to 12/0112008, please contact us immediately to facilitate 

your return to work. 

If you had previously been approved under the Family and Medical Leave Act (FMLA) and/or State 

Family Medical Leave (SFML) for this disability and you still have enough remaining days available, 

your FMLA and/or SFML approval will be extended, If you have exhausted your FMLA and/or SFML 

days, you will receive notification in a separate letter. 

It is important to note that should you require an extension or will not return to work on or before the 

authorization end date, it is your responsibility to ensure that you and/or your health care provider 

submits additional objective medical documentation to Reed Group five (5) days prior to the last 

authorized date for review to extend STD benefits. Examples of this objective medical documentation 

are: 

 Physician office/progress notes 

 Diagnostic test results (X-rays, MRI, etc.) 

Laboratory results 

 Physical Therapy notes 

 Medical clearance from disability 

Per the Company policy, if an employee does not return to work within three (3) business days of the 

end of the approved time off, the Company may determine that the employee has voluntarily resigned 

and consider the employee’s employment to be terminated. 

Confidential 

Admin Rec. 00533 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 52 of 55 PageID: 976
Please call 866-829-8861 if you have any questions or concerns. 

Thank you, 

Cristina Teta 

Reed Group 

Confidential 

Admn Rec. 00534 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 53 of 55 PageID: 977
FROM A-Z LJIDEO FAX ’C. 7322704287 Nov. 16 208 12:35PM Pt 

r 

oY 

)i 

Fyu,

: 

fl_: 7*stS 

CDar Ck ;r , 

/..Y*Jr– 

Co1 7 ( t- - 

received on 1111812008 10:54:48 AM FEastem Standard Time] Confidential 

Admin Rec. 00535 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 54 of 55 PageID: 978
MRN: 237273 ETh E-00456507 

FROM AZ LJIDEO FAX NO. : 732272237 Nov. iS 2056 12:36FM F2 

Advanced 

Medical Imaging 

of Toms River 

1433 Hooper Ave 

Torts River, NJ 09753 

(732) 349-2557 

IRVING STROUSE M.D. 

270 3rd Ave 

Ste 504 

Long Branch, NJ 07740 

Patient Name: RALPH VANDEVENTER 

Exam(s): 

LUMBAR $F BCH I5 MRI 

HISTORY: CHRONIC SACK PAIN 

PRIOR EXAM: NONE 

TECHNIQUE: Sagittal FS E, TI FLAIR; axial FS L3_tbcoigh.S1 with additinnl sl iCA through the 

disc spaces from TI I through L3. 

FINDINGS: The conus is intrinsically normal and located at the LI level. No cord compression is 

seen. 

Ti 1-12 - L2-3: There is no disc bulge or herniation. There is mild facet degenerative changes without 

central canal, lateral recess or neural foraminal stenosis. 

L3-4: There is disc desiccation and degenerative changes of the apposing endplates. There is a slight 

disc bulge. There is facet degenerative changes. There is no central canal, lateral recess or neural 

foraminal sterlosis. 

t4-5 Thäre is disc desiccation. There is a disc bulge more prominent postarolaterally in-the interiorneural foramen with a superimposed disc herniation in the far right lateral neural foramen. There is facet 

degenerative changes. There is mild lateral recess and neural foraminal encroachment. There is mild 

central canal stenosis. 

L5-SI; There is sacralizaticn of L5 with a disc remnant at this level. There is no disc bulge or hemiation. 

No central canal, lateral recess or neural foraminal stenosis is seen. 

IMPRESSION: TRANSITIONAL TYPE VERTEBRAL BODY REFERRED TO AS L5 FOR THIS REPORT. 

DISC BULGE L4-5 AND L3-4 WITH A SUPERIMPOSED DISC HERNIATION IN THE RIGHT NEURAL 

FORAMEN AT L4-5. DIFFUSE FACET DEGENERATIVE CHANGES. 

THANK YOU FOR THE COURTESY OF THIS REFERRAL 

received on 11h8/200 10:54:8 AM [Eastern Standard time] Confidential 

Admin Rec. 00536 

Case 3:10-cv-06344-PGS-DEA Document 14-15 Filed 05/13/11 Page 55 of 55 PageID: 979