1. Cumulative Trauma Claim Jon B. Tucker, M.D.
Case Presentation
Cumulative Trauma Claim
Jon B. Tucker, M.D.

2. Current complaint: Tingling in the hands and low back
Minimal bilateral knee discomfort

3. History
Male, age 61
Railroad worker from 1985 until 2016, retired in 2016 on “disability”
Various jobs; trackman, foreman, machine operator, truck driver
Back sprain in 2008; three weeks work missed. ? MRI done
Diagnosed with “carpal tunnel” in 2013, conservative treatment
Knee pain started 2013; xrays taken, no treatment
2015 emergency low back surgery for large disc and partial cauda equina syndrome

4. At time of IME Medical imaging left wrist advanced degenerative dz
Knees, minimal degenerative dz, age appropriate
Lumbar spine, diffuse mild degenerative dz, evidence of lami

5. Positive Exam Findings
Left wrist, limited crepitant range of motion
Positive Tine and Phalen’s tests ( consistent with carpal tunnel syndrome)
Slight painless crepitus with bilateral knee range of motion
All other musculoskeletal exam findings were normal on physical examination

6. Plaintiff’s allege
Cumulative work trauma caused or contributed to conditions/diseases including but not limited to
L1-L2 Disk herniation
Degenerative disease of the lumbar spine
Bilateral carpal tunnel syndrome
Bilateral knee arthritis

7. Plaintiff alleges Unsafe work environment Outdated tools and equipment
Hazardous and excessive pace of work
Hand-arm vibration syndrome
Forceful, repetitive work in awkward positions
Walking for long periods of time on uneven railroad ballast surfaces

8. Records provided to expert MD for review
Complaint
Safety History
Training Record/classes
Occupational medical record
Medical provider records from 1978-present
Medical imaging and reports
Defendant’ ergonomist’s report
Plaintiff expert reports
Plaintiff MD expert report
Plaintiff ergonomist report

9. Issues to consider Jurisdiction What is the threshold/bar?
Apply appropriate medical evidence based decision analysis to expert opinion ideation
Redacted opinion letter distributed