To whom it may concern,

I had the opportunity to perform an orthopedic evaluation on the claimant in my office today, 8/27/25. The claimant is a 62-year-old female, who is 5’2” in height. She related the following history to me.

The claimant tells me that on 6/8/21, she was involved in a motor vehicle accident. The claimant reports that on that date, she was the restrained driver of a sport utility vehicle that was struck from the rear by a car. The claimant states that on that date she suffered an injury to her low back, and she also had some bruising on her chest area from the seatbelt restraint. The claimant reports that she had no longstanding complaints in reference to the seatbelt issue.

The claimant states that the day after the motor vehicle accident in question, she was seen by her primary care physician, who gave her a muscle relaxant. The claimant did not seek any medical care for several months, and then subsequently came under the care of Patrick Fall, D.O., a pain management physician. She was treated with some physical therapy for about six weeks, and she also underwent multiple injections performed by Dr. Fall, including medial branch blocks and rhizotomies. The claimant tells me that her most recent lumbar injection performed by Dr. Fall was in May of 2025, but she is uncertain exactly what type of injection she received at that time.

In terms of her past history, the claimant tells me that she had a prior history of lower back pain secondary to the diagnosis of osteoporosis, for which she has been seeing rheumatologists over the years.

As far as her employment at the time of the 6/8/21 motor vehicle accident, the claimant tells me that she worked as a registered dietitian and counselor. The claimant states that she has retired from this job.

At this time, the claimant’s chief complaints are those of some persistent low back pain and spasms. She denies any bowel or bladder symptomatology, and she denies any numbness or tingling in her legs as well as any other radicular component of pain in reference to her low back.

Other than the most recent injection given by Dr. Fall in May of 2025 into her lower back, she states that she is not receiving any active medical treatment at the current time. The claimant presents today for my evaluation.

Physical Examination:

Physical examination today was conducted in the presence of a member of my staff, Brittany Beck.

Examination of the claimant’s lumbar spine today shows that, when I asked the claimant to bend forward and touch her toes from the standing position without bending her knees, she is able to touch her toes. The claimant does not have any complaints of pain with this maneuver. She does have full reversal of the normal lumbar lordosis, but she does have a complaint of “tightness” in her low back with this maneuver. She is able to stand on her heels and toes. There is no palpable paralumbar muscle spasm present today. From a supine position, the claimant is able to perform a sit-up with minimal assistance from her arms with good reversal of the normal lumbar lordosis and no complaints of pain. There is a negative sitting root test and a negative straight-leg raising test. Her knee jerk and ankle jerk reflexes are +2 bilaterally, and there is good great toe extensor strength bilaterally. There is no sciatic notch tenderness on either side, and there is a negative Patrick’s test bilaterally. There are no motor or sensory deficits in the lower extremities. She has a negative sciatic stretch test bilaterally. There are also no upper motor neuron signs in the lower extremities.

Review of Records:

Available for my review today is the Commonwealth of Pennsylvania Police Crash Report, which was written in reference to the 6/8/21 motor vehicle accident in question.

I have also reviewed several black and white photographs which showed a Ford Explorer with minimal rear-end damage.

There is a report of x-rays of the lumbar spine, dated 7/8/21, which was read as showing a mild levoconvex curvature. Moderate degenerative changes were seen at L5-S1 with disc space narrowing and productive changes, and facet hypertrophy was seen as well at L3-4 and L5-S1.

There is a report of an MRI of the lumbar spine, dated 3/16/22, which was read as showing mild multiple-level degenerative changes in the lumbar spine without significant spinal canal or neuroforaminal stenosis.

I have also reviewed some records regarding physical therapy, which the claimant underwent at Abington Physical Therapy in November and December of 2021.

I have for my review multiple reports from SEPA Pain and Spine, the office of Patrick Fall, D.O., including his initial note, dated 3/30/22, in which he discussed the 6/8/21 motor vehicle accident in question. Dr. Fall stated that the claimant’s prior low back complaints were severely exacerbated after the 6/8/21 incident. He rendered the diagnoses of lumbar spondylosis, low back pain, other intervertebral disc displacement, and spinal stenosis. There is a note from Dr. Fall, dated 11/8/22, indicating that on that date he performed a lumbar medial branch block procedure. There is another report from Dr. Fall, dated 1/26/23, indicating that on that date, the claimant underwent bilateral L4 and L5 dorsal rami medial branch rhizotomies. In a report from Dr. Fall, dated 6/30/23, he indicated that on that date the claimant underwent lumbar facet joint injections at several levels. There is a report for my review from Dr. Fall, dated 2/8/24, indicating that at that time, the claimant underwent bilateral L4 and L5 dorsal ramus medial branch blocks. In a report from Dr. Fall, dated 10/31/24, it was noted that on that date the claimant underwent bilateral L4, L5, and S1 facet joint injections and medial branch blocks. I have a note from Dr. Fall, dated 5/12/25, indicating that on that date he performed a lumbar medial branch block procedure as well. I also have a report from Dr. Fall, dated 5/23/25, indicating that on that date the claimant underwent bilateral L4 and L5 dorsal rami medial branch rhizotomies. The most recent office note that I have from Dr. Fall is dated 5/12/25, at which time he rendered the diagnoses of lumbar spondylosis without myelopathy or radiculopathy, low back pain, spinal stenosis, lumbar region, without neurogenic claudication, and other intervertebral disc displacement in the lumbar region.

There is a report for my review authored by Lauren Vernese, D.O., dated 10/17/24, when the claimant was evaluated for complaints of bilateral lower back pain.

I have a report for my review authored by Virginia Pileggi, MSPT, a physical therapist, dated 12/10/24, when she saw the claimant for complaints of bilateral hip pain. There are also some additional physical therapy notes for my review from Ms. Pileggi regarding physical therapy rendered for the claimant’s bilateral hip complaints.

There are also multiple rheumatology records for my review from the Rheumatology Speciality Center from back in 2017 and 2018, which indicated that they were evaluating the claimant for the diagnosis of osteoporosis. The most recent note that I have from this provider was authored by Dana Jacobs-Kosmin, M.D., dated 6/5/24, indicating that on that date she saw the claimant for the diagnosis of osteoporosis.

I have also reviewed the Transcript of Deposition Testimony given by the claimant dated 1/14/25.

Impression:

Normal examination of the lumbar spine with no evidence of lumbar radiculopathy.

Discussion:

I would note that in Patrick Fall, D.O.’s initial report available for my review after the 6/8/21 motor vehicle accident of 3/30/22, he noted that the claimant had prior low back complaints that were exacerbated after the 6/8/21 incident in question. The fact that x-rays of the lumbar spine, dated 7/8/21, only one month after the incident in question, showed significant degenerative changes at L5-S1 with disc space narrowing and productive changes, indicates that these degenerative changes obviously predated the 6/8/21 motor vehicle accident. Similarly, the fact that an MRI of the lumbar spine, dated 3/16/22, was read as showing significant degenerative discogenic and arthritic changes at L4-5 and L5-S1, would also indicate that these changes predated the 6/8/21 incident in question.

It is certainly possible that the claimant may have suffered some soft tissue sprain and strain-type injuries after the 6/8/21 motor vehicle accident that were superimposed on her pre-existing degenerative changes. Soft tissue injuries such as these typically resolve in a period of 4-6-8 weeks after such an incident, and I see no reason why this would not have been the situation in this case.

Examination of the claimant’s lumbar spine today showed that she exhibited full range of motion of her lumbar spine, no neurologic findings in the lower extremities, no muscle spasms in reference to the lumbar spine, and no clinical evidence of lumbar radiculopathy.

Based on my examination today, it is my impression that the claimant has completely recovered from any soft tissue injuries that she may have suffered at the time of the 6/8/21 motor vehicle accident in question.

I see no reason why the claimant would benefit from any ongoing active medical treatment in reference to the 6/8/21 incident in question, and that would include her ongoing injection therapy.

In summary, I find no evidence of any orthopedic residuals in reference to the 6/8/21 motor vehicle accident. It is my opinion that this claimant did not suffer a serious or permanent impairment of bodily function or permanent disfigurement in reference to the motor vehicle accident in question.

All of the above opinions were rendered within a reasonable degree of medical certainty.

If I can be of any further help to you in this matter, please do not hesitate to contact me.

Sincerely,
Leonard A. Brody, M.D.