All available documentation submitted for this claim has been reviewed from the perspective of Internal Medicine. The claimant is a male (DOB 11/23/1953) who was diagnosed with frequent dizziness, leg weakness, frequent falls, severe alcohol use disorder, liver disease, tobacco abuse, and possible ongoing depression.
A recommendation for short-term disability benefits from 01/02/2018 - 02/11/2018 is being evaluated based on documentation submitted by the treating physician.
The claimant’s occupation is listed as Seed Technician and his essential job functions including specific tasks were included with the documentation submitted.
An occupational Health note from Dale Zaruba, MD, dated 12/04/2017, indicated that the claimant presented for a fitness for duty evaluation. The claimant was noted to have a history of tobacco and alcohol use. He …show more content…
He had an intentional tremor of his hands and a slight resting tremor of the head. He was unable to walk heel to toe without having to hang on the wall. He appeared very unsteady on his feet. He also had multiple bruises up and down the forearms. He was diagnosed with dizziness, tachycardia, hypertension, and tremors. On 12/15/2017, a chest x-ray showed chronic changes from his tobacco use. An ultrasound of the upper abdomen showed an enlarged, fatty liver, consistent with alcohol use. It was noted that his alcohol abuse was impacting his physical capabilities and physical health to a significant degree. On 01/11/2018, he stated that he does not feel well and had decreased energy. He had dizziness and was unsteady on his feet. He reported lightheadedness and his legs were very weak. He had fallen 3-4 times daily. His bilateral arms were discolored with bruising. He stated that he can feel his heart rate increases when his blood pressure increases. Laboratory results showed elevated levels of ethanol at 0.093%, total bilirubin at 1.53, ALT at 218, and AST at 391 with low levels of
A recommendation for short-term disability benefits from 01/02/2018 - 02/11/2018 is being evaluated based on documentation submitted by the treating physician.
The claimant’s occupation is listed as Seed Technician and his essential job functions including specific tasks were included with the documentation submitted.
An occupational Health note from Dale Zaruba, MD, dated 12/04/2017, indicated that the claimant presented for a fitness for duty evaluation. The claimant was noted to have a history of tobacco and alcohol use. He …show more content…
He had an intentional tremor of his hands and a slight resting tremor of the head. He was unable to walk heel to toe without having to hang on the wall. He appeared very unsteady on his feet. He also had multiple bruises up and down the forearms. He was diagnosed with dizziness, tachycardia, hypertension, and tremors. On 12/15/2017, a chest x-ray showed chronic changes from his tobacco use. An ultrasound of the upper abdomen showed an enlarged, fatty liver, consistent with alcohol use. It was noted that his alcohol abuse was impacting his physical capabilities and physical health to a significant degree. On 01/11/2018, he stated that he does not feel well and had decreased energy. He had dizziness and was unsteady on his feet. He reported lightheadedness and his legs were very weak. He had fallen 3-4 times daily. His bilateral arms were discolored with bruising. He stated that he can feel his heart rate increases when his blood pressure increases. Laboratory results showed elevated levels of ethanol at 0.093%, total bilirubin at 1.53, ALT at 218, and AST at 391 with low levels of