Opinion ID: 855794
Heading Depth: 2
Heading Rank: 3

Heading: Continued Review of Neaton’s Claim

Text: In March 2008, Navy Federal informed Hartford it was willing to consider whether Neaton could return to work with appropriate accommodations. To “update” its assessment of Neaton’s ability to work, Hartford contacted both Neaton and Dr. Schuldenfrei for more information. Neaton reported he was still “tender” from his January surgery and that he was scheduled for another surgery on both ears and his scalp. Neaton stated he needed three to four months to recover from a Moh’s surgery, but only one month to recover from a “regular” surgery. Dr. Schuldenfrei reported that he was treating Neaton “frequently” and that on a typical visit, he discovered between five and fifty new skin cancers. Dr. Schuldenfrei opined that Neaton “could work in his home environment,” provided, of course, that he was protected from ultraviolet light. He also reported that Neaton’s recovery time “varie[d] greatly,” from several days for “superficial” surgeries and “a week or more” for Moh’s surgeries. Dr. Schuldenfrei noted that, during the previous two years, Neaton’s cancers had become more aggressive, necessitating more Moh’s surgeries. Dr. Schuldenfrei anticipated that monthly surgeries would be required “for the foreseeable future.” On May 1, 2008, Hartford began an employability analysis review in an attempt to “match” Neaton to other positions he could perform with his restrictions. At first, Hartford found positions available in which Neaton could earn a comparable salary. Later that same day, however, Navy Federal agreed to accommodate Neaton’s condition by allowing him to perform his former job at home. Hartford also forwarded Neaton’s file to Rehabilitation and Re-Employment, Inc., for an occupational-research survey. According to the results, which were received on May 22, 2008, the duties of Neaton’s former job could be performed from home. The report identified five suitable -6- full-time positions: Loan Counselor, Collections/Sales Representative, Collections Account Representative, Customer Service Agent, and Telemarketer. On May 2, 2008, a note appeared in Neaton’s file stating that Hartford intended to conduct a “peer review” of Dr. Schuldenfrei’s restrictions in order to “clarify” the impact of fluorescent lighting on Neaton’s condition. During the peer-review process, on May 14th, Neaton underwent another Moh’s surgery. On May 29th, the peer review was completed by Seth Kates, M.D., a boardcertified dermatologist. Dr. Kates attempted to contact Dr. Schuldenfrei without success, so he completed the review without the benefit of Dr. Schuldenfrei’s input. Dr. Kates opined that “the effect of fluorescent light [wa]s minimal” and that Neaton could work indoors with protective clothing and sunscreen. Hartford decided not to change Neaton’s status without allowing Dr. Schuldenfrei to comment on Dr. Kates’s report, so Hartford forwarded that report to him. In June, before Hartford received Dr. Schuldenfrei’s comments, Neaton underwent yet another Moh’s surgery. Dr. Schuldenfrei disagreed with Dr. Kates’s assessment. Specifically, he noted that Dr. Kates’s assumptions seemed to be based on research of “common” basal cell carcinomas, not Gorlin’s syndrome. Dr. Schuldenfrei continued, “[i]t is my strong opinion that unless your consultant can cite specific references on patients with this specific syndrome to the contrary, it must be assumed that patients with Nevoid Basal Cell Carcinoma Syndrome require life long limitation of exposure to ultraviolet light from sun and from other sources, including fluorescent lighting.” Dr. Schuldenfrei based his recommendation on a consultation with “a leading Dermatologist at the National Institutes of Health who has treated many patients with [Gorlin’s] syndrome.” Dr. Kates was given the opportunity to respond, and he opined that while Dr. Schuldenfrei’s statement was -7- “factually correct,” it was “practically incorrect” because ultraviolet radiation from fluorescent bulbs “is, although real, extremely limited and probably not clinically significant compared to other sources of ultraviolet light.” According to Dr. Kates, Neaton would continue to develop skin cancers “regardless” of his exposure to fluorescent lighting. Dr. Kates stated his opinion was based on his three patients with the same condition and on the “current literature.” Neaton also weighed in on the debate, stating that his cancers, which were on his ears and head, were located “exactly” where he was exposed to fluorescent lighting at work. Neaton also informed Hartford that he had undergone another curettage and cautery procedure on July 10, 2008.