Malden Retirement System Town Hall 110 Main Street Malden, U.S.A. Gentlemen: I examined the above-named claimant at your request in my office on 3/11/96. A history was obtained that on September 4, 1995, while occupied as a parole officer in her office, she fell off a chair onto her back. She indicated she received treatment from Dr. Singh, her primary care provider, who referred her to Dr. Morrison, an orthopedic surgeon. She sees the orthopedist once monthly and also Dr. Singh once monthly. They are awaiting authorization from Workers' Compensation to have her acquire a TENS unit. She received physical therapy twice weekly for a four-month period and now receives it on a once a week basis. There were no medical reports available for review, other than what was offered to me by the claimant, which was a report of an MRI of the lumbar spine taken on September 4, 1995. The impression was multi-level disc dessication and annular bulging with superimposed anterior disc herniation L5-S1. A focally herniated disc fragment, or canal stenosis, was not seen. Complaints offered at the time of my examination were pain in her lower back with numbness in the left calf. She does have occasional good days, but depends on the position she sleeps in. She indicated a definite tightness on this day of examination. Past history indicates an arthrotomy of the right knee in 1984, a contusion during an assault to her left leg, resulting in pulmonary embolism in 1987. She was out of work for one year. She fractured her thumb in 1991. In November of 1994, she had similar complaints regarding a pulmonary embolism, but the tests were normal. She has not returned to work since the injury of September 4, 1995. Physical examination revealed a well-developed, well-nourished, 45-year-old female, who stands 5'5" tall and weighs 145 lbs. She was observed to have a normal gait and station. She appeared to move freely and continued to utter complaints of her low back pain. Examination of the spine revealed the shoulders and pelvis to be level and the spine straight. She pointed to her lower lumbar segments as to the area of discomfort. She indicated discomfort on extension, lateral tilt and rotation of the trunk on the pelvis and forward flexion. She flexed until her fingertips reached the floor level. There was no evidence of muscle guarding in the form of spasm during her range of motion. She has good gluteal tone. She could heel and toe raise. Both sitting and supine flexion, straight leg raising and Laseque tests were within normal limits. She had full range of hip, knee, ankle and foot motion. There was no atrophy of disuse of the lower extremities. There was noted a fullness of the right knee without heat.