Marchese v. Commissioner of Social Security

Filing 21

MEMORANDUM OPINION. Signed by Senior Judge Glen E. Conrad on 09/27/2019. (aab)

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ANGEL LUI M ARCHESE,
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M EM ORANDUM OPI ON
NI

ANDREW SAUL,
Comm isone ofSoc a Se trt A
si r
i l c liyy

By: on. l n E.Co a
H
Ge
nr d
Se o U nie St t s D it i tJ
ni r t d a e s r c udge

D e e nt
f nda .

Pl ntf ha fl d t s a ton c le ng c ran pori ns o t fnal de ii n of t
ai if s ie hi c i ha lngi e ti
to f he i
c so
he
Comm isone of Socil Se trt e t bls ng pli tf e ilm e t a c os pei of
si r
a cliy pa ihi
a n ifs ntte nt o
l ed zod
.

dia lt f r pur es of pl i i s cli s f r di a lt i tr nce be is a s eme a
s biiy o
pos
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am o s biiy nsla
neft nd uppl nt l

s c t ic meb ne st e t eSo il c rt Ac, sn n e , 2 U.. j 41 ()a 4 3
e miy n o e Gt md r h ca Se u iy ta me d d 4 SC. j 6 i nd 2 ,
a 42 U. C.j 1 1e s q.r peci l Jliditon oftlsc ti ptruan t 42 U. C.
nd
S.
38 t e , es tvey. trs ci
li our s ts t o
S.

j4 ( )a d4 U. C.j1 8 ()3 .
05g n 2 S.
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s ur ' eviw s i t o t r nai n o
t he ç s ubsa il vi nce
t s
o uppor t Com misone ' c l i n t tpli ifwa t radi a lt fom M a c 1 201
the
s i rs oncuso ha a ntf s mde
s biiy r
rh , 2

t rug S p e e 25 2 4 b tn tt ra tr I s c s b ikta e ie e e ss t fn l
h o h e tmb r , 01 , u o hee fe . f u h u sa il vd nc xit, he ia
decsonoft Commisone mus beafr d. Ha #. lva 907F. 1 1 ( hCi.
ii
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si r t fime
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2d 453, 456 4t r
t i
1 9 ) La v.Cee rz e 3 8 F.d 6 0 6 (t Ci. 1 6 ) Stt d brefy,subsantal
9 0 ; ws
lb e z , 6 2 4 , 42 4h r 9 6 . ae i l

e de hmsbe de i d ass h r lva te de e co i rng t r or asa whol a m i ht
vi nce
en fne
uc ee n vi nc , nsde i he ec d
e, s g
bef md a quat t s ppo taconcuson by ar as bl mi
ot de e o u r
l i
e ona e nd. Ri r on v. r e , U.
cha ds
Pe als 402 S.

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9 01 1 71 . ç o it f r h n
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ry

p ru n t Fe ea Rueo Cii Prc d r 2 () seas 4 U. C.j4 5g (cin slvv srg r ls o a y
u sa t o d rl l f vl o e ue 5d ; e lo 2 S.
0 () ato t ie e ades f n
r
c n ei tep ro o c p igteo c o Co sin ro S ca Set i )
ha g n h esn c u yn h x e f mmiso e f o il clt .
ry

prp n e a c . Ha c c v Asnz, 6 F.d47 , 7 ( t Ci. 1 )(n en l u tto maks
e o d r n e' n o k . t e 6 7 3 0 4 2 4h r 20 2 itr a q oain r
'
a ciai o te . Thus Ghet ehol f s he de ir s ce yi nothi ' Bi tk
nd tton mitd)
,t hr s d or uc vi ntay uY inc s
t
gh. ese
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v. r li ,1 9S. .1 4 ,1 5 ( 01 )
Benr l 3 Ct 1 8 1 4 2 9 .
al
The pl ntf,M ge Lui M a c e,wasbo on Augus 22,1 . He di notgr dua e
ai if
l s r hes
m
t
971
d
a t

fo h g sh o b t ve t l e r e aGED ( . 7 ) M r Ma c e eh sb e e ly da a
r m ih c o l u e nual n n d
y
Tr 2 0 . . r h s a e n mpo e s
lb rra f r lf o eao . ( . 7 . Hels woke o ar g a a ds sane ba i i 2 1
a o e nd o k it p rt r Tr25 )
a t r d n e ulr n u ti d ss n 01 .

( . 8 . OnDe e e 5 2 3 Mr M ac s flda piain f rd s blt i l a c b n f
Tr 4 )
c mb r , 01 , . rhe e ie p lc to s o ia iiy nsz n e e ehs
r
a s pplm e als curt i om e be ft. l flng hi c r ntc am s M r M ar he e ale d
nd u e nt e iy nc
ne is n ii
s ure l i , . c s l ge
t thebe nme dia edf ra1f m sofs t nta ganf le oym e on M a c 1 2011 d t
ha
c
s bl o l or
ubsa i l i u mpl
nt
rh ,
, ue o

lwe b c p i a d a trtsi b t h nd . ( .2 6 2 9 . Att etmeo a a miitaie
o r a k an n rh i n oh a s Tr 1 , 6 )
i
h i f n d n srtv
he rng on M a c 8, 7, a n ifa nde hi a i to s ast r fe ta al ge di a lt
ai
r h 201 pli tf me d s pplcai ns o o e l c n le d s biiy

o e d t o M ac 1 2 1 ( . 8 . M r M ac e eman an t a heha r man dd sb e t
nst ae f rh , 0 2. Tr 5 )
. r h s itis h t
s e ie ia ld o
t pr e tm e. W ih r s c t hi a ia i f dia lt i tr nce be ks t r c d
he es nt i
t e pe t o s pplc ton or s biiy nsla
nef , he e or
r veas t t M r M ar hes m e t i tr d s a u r quie nt oft Ac a a lr e nttm e
e l ha
. c e t he nsle tt s e r me s he t t l elva i s

c v r db tefn l e iino t eCo sine. S ec n r l 4 U. C. j41 ()a 4 3 a .
o e e y h a d cso f h mmiso r e e e al 2 S. j 6 i nd 2 ()
v
M r M a c s s a i a i we e de ed upo i ta co i r ton a r onsde aton.
. r he e' pplc tons r ni
n nii l nsde a i nd ec i r i

Het nr se a r ei da#qnovohe rngandrvi beor a Admi srtveLa J
he equetd nd ec ve ai
e ew f e n
nitai w udge.
l a o ni da e M a 3,201 , t La J
n n pi on t d y ' 7 he w udge r l d t tM r M a c s wasdia e f al
u e ha
. r he e
s bld or 1
f ms ofs t nta ganf le o e fom M a c 1 201 tloug Se e r25,201 due
or
ubsa il i u mpl ym nt r
r h , 2 lr h pt mbe
4,
prm a iy t rghtuppe exte iy i ime st tpr l
i rl o i
r r m t mpa r nt ha ecuded pl ntf fom ha ng e f tveus
ai if r
vi fec i
e
ofli r g ,dom i ntha f ha i f nge i o f elng. H o e r bas on t tea m e
's i ht
l
na
nd or ndlng, i rng, r e i
w ve , ed
he r t nt

pl ntf r c ve d i t tpe i i l ng rghtt b a wrs szge i s t La J
ai if e ei d urng ha rod, ncudi i hum nd it lr re , he w udge
de e mi dt tpl i ife de edm e ca i pr m e ta ofSe e r26,201 r uli i
t r ne ha antf xpe nc
di l m ove n s
pt mbe
4, es tng n
a i r a e i li r s dual fm c i l ca ciy. The s l c e da e of m e c l i pr m e
n nc e s n ls e i
l tona pa t
ee td t
di a m ove nt

c ncdedwih apos- pe a i e l ton, twhi hM r M a c s r po td t bei ng wel' nd
oi i
t
to r tve va uai a
c
. r he e e re o s
doi
l'a

wa f u dt h v ç o dmoino t edgt'wi o l T n ma d so ot' ( . , 45 .
s o n o a e ç o to f h iis' t ny i i l ic mf l ' Tr 26 6 )
g
h
mi
I hi opi on,t La J e f md t tM r M a c s c i
n s ni he w udg ot ha . r he e ontnuest s f rfom t s me
o ufe r he n
s ve e i i nt t twe e pr s ntfom M a c 1 201 tzough Se e r25,201 nnme y,
e r mpanne s ha r e e r
r h , 2 lr
pt mbe
4,
l

rg th n a dm i to to rl tswi c re tv s eis o st , n lmba o ( .1 , 4)
ih a d n
s se a t i t o rcie mg re , be iy a d u g . Tr 8 2 .
ui
h
TheLa J
w udgea s f undt tpl n ifls e nty de l pe t f l ngaddii lGe r
lo o
ha aitf iubs que l ve o d he olowi
tona s ve e'
i i nt : i htti rGnge wih c r c i slge y,biatr e c
mpanne s rg rgge
r t ore tve tr r l e al pi ondylts a hit r oflf
ii , nd so y e t

s o le i i e n . ( .2 ) Ho v r t e La J d e d tr n d t t d s ie s h
h ud r mpng me t' Tr 4 . we e , h w u g ee mi e ha, e pt uc
'
i i nt,M r M a che er t ne t c pact t pe f r abr de r ngeoflghtwor a tviy
mpa nne s . r s eai d he a iy o ro m
oa r a
i
k ci t
asofSe e r26,201 The La J
pt mbe
4.
w udge as e s d pli ifs r sdua ca ciy f rt pe i
s s e antf e i l pa t o he rod
beg nni on t tda easf l :
i ng
ha t
olows
Afe c r f co i r ton of t e tr r c d,t t r i
tr a e ul nsde ai
he n ie e or he mde sgned
fndst t be nni on Se e be 26,201 t cli a ha had
i ha , gi ng
pt m r
4, he am nt s
t r i ua f to lc pact t pe f r lghtwor a de i d i
he esd l hnci na a iy o r o m i
k s fne n

20C. R.( j 40 1 6 09 a d41 9 7 1 e c p hec nn ve be
F. j ) 4.5 7 n 6.6 49 x e t a e r

e g sd t h z rs l h z ro s mahney a d u poetd
x o e o a ad i a ad u c i r n n rtce
ke

heght ;oc sona l pe f r ha i fngei a f e i wih
l s ca i ly r o m ndlng, i zng, nd e lng t
t rgh ha
he i t nd; a ha oc sona e
nd ve ca i l xposze t t mpe a ur
lr o e r t e
e r m es wenes ,hlmi t a vi a i .
xte , t s l diy, nd br tons

( .2 ) Gi n s c a r sd a f n to a c pa iy a d a tr c n ie ig tsi n fo a
Tr 6 . ve u h e iu l u cin l a ct , n fe o sd rn e t y r m
mo
voc tona e r, heLa J
a i l xpe tt
w udgede em i t tM r M a c er m ansunabl t pe f m a of
t r ned ha . r hes e i
e o ror ny

h sp s r lva t r . ( . 3 . Ho ve,h La J d efu dt a sn eSe tmb r2 , 01 ,
i a t ee n wo k Tr 3 )
we r te w u g o n h t ic p e e 6 2 4
M r M a c eha pos e s dt c pa iyt pe f m o he lg wo k r e t te s i sg f
. r hes s s s e he a ct o ror t r iht r ols ha xit n i nikant

n l es i te naina e o o ,s c a tej b o us e a d c u trcek ( .3 - 4 .
l r n h to l c n my u h s h o s f h r n o n e lr . Tr 3 3 )
mb
Acc r ngl t La J
o di y, he w udge co l d t tpli i sdia lt e
ncude ha a ntY
s biiy nded o Se e br 26,201
n pt m r
4,
a t t he has not bec
nd ha
ome dia e a i snc t t dae. Se c ne a l 20 C. R.
s bl d ga n i e ha
t
e e r lv
F.

j 4 4.5 4 9( )a d 41 .9 ( )5 ( i. Th s t e La J d er ld t tMT M ac e ewa
j 0 1 9 ( 8 n 69 4 b ( )vi
) u , h w u g ue ha . rh s s
3

e t ldt aco e p ro o ds b l yfo M ac 1 2 2t rug Se tmb r2 , 4. ( . 4 .
ni e o ls d e id f ia ii rm rh , 01 h o h p e e 5 201 Tr 3 )
t
t
The La J
w udge' opi on was a pt d ast fna de son oft Comm isone by t Soc a
s ni
do e
he i l cii
he
s i r he i l
Se urt Adm ilsr to s Appe l Col cl Ha ng e use al a ia e a rita i
c iy
zitai n'
a s m i.
vi xha t d 1 va lbl dmilsr tve
r me e ,M r M a c s hasnow a ald t t sco t
e di s . r he e
ppe e o hi ur.
W hie pl i if m a be dia e f c ran f r of e o e ,t c u alf tl
l antf
y
s bl d or e ti o ms
mpl ym nt he r ci ac t
al
de e mi ton i whe he pl n if i dia e f r a 1f ms of s t nta ga nf e oyme .
t r na i s
t r aitf s s bl d o 1 or
ubsa il i ul mpl
nt

S e 4 U. C.j 4 3 d ()a 1 8 () Thee a e f t ee n s o p o fwhih mus b
e 2 S. j 2 ()2 nd 3 2ca . r r ol lme t f r o
r
c
te
c n iee i ma i s c a a ayss Th s ee nsaesl rz da f lo : 1 o j ci
o sd r d n kng u h n n l i. e e lme t r l
mmaie s ol ws ( ) be t
ve
me ia f csa ciia fndn s ( )te o i n a c n l i n o te t p y iin ;( )
d c l a t nd lnc l i g ; 2 h pio s nd o cuso s f r ai h sca s 3
ng

s b e tv e ie eo ph sc lma ietto so i ar n s a d s rb dtr ug acama ts
u j cie vd nc f y ia n fsain f mp ime t, s e cie h o h li n '
tsi n ; nd()t ecama tse u ain v c to a lit r , e iu l kil, n a e Vie v.
e tmo y a 4 h li n ' d c to , o ain l l o y r sd a s ls a d g . tk
s
Fi h 43 F. 1 5 1 5 - 0 (t Ci.1 7 ) Un e woo v. b c f,2 8F.d 8 0 8 1( t
nc , 8 2d 1 7, 1 9 6 4 h r 9 1 ; d r d Riio f 9 2 5 , 5 4h
Ci.1 .
r 962)
Afe a r vi w of t r or i t s c e,t co ti c taned t c ude t tt
tr e e
he ec d n hi as he ur s onsr i
o oncl
ha he

Comm iso rsfna decson i s
s i ne ' i l ii s uppore by s t n i le de e. Alho h M r M a c eha
td
ubsa ta vi nc
t ug
. z hes s
a hit y of mus ul kee a dys u ton, s t nta e de e s
sor
c os lt l f nci
ubsa il vi nc uppors t La J
t he w udge s
'

de e mi to t ts t nta me c li o m e toc u r d a ofSe e r26,201 a t t
t r nai n ha ubsa il di a mpr ve n c r e s
pt mbe
4, nd ha
M 1 M a che ehasbe a et pe f m c ran lghtwor x essnc t tda e.
. r s
.
en bl o ror e ti i
k ol i e ha t
The r c d r ve l t t be wee M a c 1 201 a Oc obe 31 201 M r M a c e
e or e a s ha t n r h , 2 nd t r , 3, . r hes
t r ntf z s gialpr e eson hi dom i ntrg hand a wrs. On M a c 22,201
mde we olr m c
oc dm
s
na i ht
nd it
rh
2,

plitf t ewe ta rg tt u c po t c pa ( C) on a tr d ssa Caiin Cln cs
an if md r n ih h mb a mea a l CM j it rh o e i t rl
o ii'
n ao y szgey ce e . ( .33 ) Plitf so t edi s ge Dr Ca M idsh,
mbultr tr r ntr Tr 4-36 . anif rhopa c ur on, . y e c

ce r d hi t rtr t wok i Au us o 2 2 ( .5 9 . Al o g p an if iiil
lae m o eu n o r n g t f 01 . Tr 1 ) t u h litf ztal
h
l y
pr e s we l he r m r d t Dr M irs h i Aprl a M ay of 201 wih co ait of
ogr s ed l,
e ne o . e ic n
i nd
3 t mpl n s
4

p ritn p i t a p e n e Mm fo wo kngwihhi rg t a d. ( . 6 , 29 . OnMa 9
e sse t an h t rve td
r m r i t s ih h n Tr 3 5 5 )
y,
201 Dr M ids h r m oved s gi a ha dwa e a pe f med tndon t nol i on t of
3, . e c e
ur c l r r nd ror
e
e yss
wo

p an i sdg tt l tn o s ( . 68 3 0 4 2 5 3 1 0 ) Folwi gt ep o e t e Mr
litc
h hl e d n . Tr 3 , 7 , 0 , 3 , 0 4 . lo n h r c dt , .
mb
r
M a c e c tnue t c
r hes on i d o ompli ofpe sse pan t twa pr ve i li 9om wo ki wihhi
an
r itnt i ha s e ntng lm
r ng t s

rg t ha . ( .4 - ) On Oco e 28 2 3 Dr ids h p ro me a rg t wrs
ih nd Tr 43 44 .
t b r , 01 , .M e c ef r d ih it
a t os o wih de i m e of lgn nt t ar a s vii, i l ng t r di a al a
rhr c py t brde nt
i me e s nd yno ts nc udi he a oc p
nd

mic r l on s ( .4 4 . Ove te n x s v rlmo t ,p an ifc ni u d t c mp an o
d apa j it. Tr 0 )
r h e t e ea nhs litf o tn e o o li f
t l a d m i tp i ( .45 -5 46 .6 ,471. Co e ue ty,o M a 1 ,2 4 Dr
hl
mb n
s an. Tr 8 9. 2- 5
)
ns q nl n y 5 01 , .
M irs hpef r darg ttu CM C s s n ina t o lsy. ( . 5 )
eic ro me ih h mb
u pe so rk p a t Tr 5 6 .
Tr t e no esr fec se dy i ove e i pli i srg ha s
eam nt t e l t t a mpr m nt n antY i ht nd ympt f l ng
oms olowi
t M ay 1 201 pr dur I Jmeo 201 M r M a c er po td t thewasdoi we la
he
5, 4 oce e. n t f 4, . r hes e re ha
ng l nd

t t i panwa c nr le wi me iains ( . 7 ) Onp sc le a n to p an ifh d
ha hs i s o to ld t dc to . Tr 5 8 .
h
hy ia x miain, litf a
E
t
good r nge ofm o i n oft di t' a çs edic or ...s c
a
to
he gis' nd dom
s omf t
e onda y t pa n a s lngy
r o i nd weli '
'

wlc wa noe t b S p rpraef rt sitr a o he ln . ( . 78 9 . Hewa rf re
l h s td o e t p o it o hi n ev l f aig' Tr 5 -7 )
i
a
'
s ee rd
t oc upa i
o c tonalt r py f f t r te t e . I J y of 201 pli if r po td c i d
he a or urhe r am nt n ul
4, antf e re ontnue

i r v me t nhswrs p i al wa f u dt b G o n wel s o rtv l . ( . 81 2 .
mp o e n i i it an, r s o n o e t i g lpo t peaiey' Tr 5 -8 )
d
d
'
On Se e r26, 4, r M a c ewasoncea i f t t beQdoi welpos ope a i y.
pt mbe
201 M . r hes
gan o md o ç ng l t r tvel '
'

( .6 5 . Thee n nng ciiin n td t tpanifsp i wa c n r le wi me iains
Tr 4 )
x mii l ca o e ha litf an s o told t dc to ,
n
h
a t theha çg motonoft di t wihmi maldic or'a S
nd ha
d Good i
he gis t ni
s omf t nd ç opposton.' ( .
' good
ii ' Tr

6 ) Th e mi ai nrpo t loi iae t a M rM ac s S ttl ) h t eh sb e wo ln
45 . e xn n to e r as ndc ts h t . rhe e t ae d t a h a e n rc g
s
i
a ap itr'b t anifd ze d ig s a t ea mi srtv he rng ( . 4 ) Uli tl ,
s ane , u plitf el d on o t h d nitaie ai . Tr 6 5 . tmaey
'
i
pl i ifwas a s d t co i t ki M o c a nonse oi la ii l mm a o y dnz a t
antf
dvi e o ntnue n ng bi,
t r da nt-nfn
tr
g, nd o

c n iu wihrn eo moin a dsrn hel ge ecs s ( . 45 .
o tn e t a g f to n te gt rn x rie . Tr 6 )
i

5

0n No mbe 1 201 M r M a c s pr e e t Dr Aye ha Nazia Ne Ho ions
ve r 8, 4, . r he e es nt d o . s
l t w rz
H e t a e w ih c pl i t of pa n i li l f u r n m . Pli if r pore t the ha be n
alhc r t om a n s
i n ls e t ppe r
antf e td ha
d e

t li giqu l ...mo e'a d h d t o by .. s ri e hi n m. ( .6 5 . An
i png h s nce
he
v ' n a ç ba l
pr
p an d s r ' Tr 7 )
'
.

e m i ton ofpl i ifsl f a m a s de r ve e nos li orr dne s a hewasf md
xn na i
antf e t r nd houl r e ald
welng e s , nd
ot

t ha ef 1 rn eo moinwih u p i ( . 7 ) Dr Na l da n s dplitf wi as r i
o v u1 a g f to t o t an. Tr 6 5 . . zi ig o e an if t p an
h
a c i d hi e si m e cai ns
nd ontnue s xitng di to .
On Nove be 25 201 M r M a c s r t ne t Dr M irs f a f l up
m r ,
4, . r he e e ur d o . e ich or
olow-

a nt e . Pli ifr pored t tt the c i d t e re pai i li rghtt
ppoi m nt a ntf e t ha ha
ontnue o xpe ince n n as i humb,a
nd

t a hec ud n td a y t e v g ipn ' o S e u i swo k a ad moii ns ' ( .8 )
h t o l o o n i a y rp ig' r s s me l r s e lto it' Tr 78 .
h
r
i
On physca e m i ton,M r M ar he e was f
i l xn na i
.
c s
ound t ha ç
o ve t
good m o i n of t di t wih
to
he gis t

mii lds o o t'S o d o po iin, a d G p r p itl ' c ni u d we k e s ( .8 8 .
rma ic mf ry l o p sto ' n i p o raey' o tn e n n s . Tr 7 )
l
' g
'
a
An x-a ofpl i ifsrghtt lmb s wedt tt a t o asy wa i a ta r vea e onl mid
ry
antf i h l ho
ha he rhr pl t s nt c nd e l d y l

atr p t y (on d s a e. ( .8 ,9 4 . Dr M irs h n td ta a y pesse tp i a d
rh o ah it ie s ) Tr 78 5 ) . eic o e h t n ritn an n
we k e sma b t er s l o a t ii. Hea miitr da ij cino t rd o a lo n a
n n s y e h e ut f rl ts
u
d nse e n n e to f he a i c pa j it nd
pr vd datu s iab a e ( . 7 )
o ie h mb p c r c . Tr 8 8 .
Ata f l w- a nt e o J nua y 6,201 pl i if a s d Dr M irs h t thi
olo up ppoi m nt n a r
5, antf dvie
. e i c ha s
wrs wa f lng be tr butt the c i d t e re e tnde e sa t ba e ofhi t l
it s eei
te ,
ha
ontnue o xpe i nc e m s t he s
s hlmb.

( . 8 ) On p y ia e n n to , anife iie rd c d g i sr n t,b tc niue t
Tr 8 7 .
h sc l x miain plitf xhbt' e u e rp te gh u o tn d o
d
(

h v ç o d rng o moi n o t d gt wih mi ma d so o t' ( .8 7 . Dr Mirsh
a e < o a e f to f he i is t ni l ic mf r. Tr 8 ) . eic
g
'
o d rd aCT s a t a s s t eSTT j it Th rs lso t eCT sa we eS o a e c p f r
r ee
cn o ses h
on . e e ut f h
c n r i nn l x e t o
n
veymidrdi a a t ii. ( .893)
r l a oc pal rhrts' Tr
'
.
On J nua y 22,201 Dr M i ds h wr ea(ro W hom l M a Conce n'l te c i mi
a r
5, . e c ot ç
'
t y
r ' e tr ontr ng

t a plitf a b e ap te ti h sp a tc sn e2 0. ( . 5 ) Hen tdt a plitf h d
h t anifh d e n ain n i rcie i c 01 Tr 9 2 .
oe h t an if a
t r
mde gone s ve a non- r tve a s gialte mentm odaii t a e s li rg t
e rl
ope ai nd ur c r at
ltes o ddr s ls i ht humb
6

i ime ,a t tpli tf c i st e re epan i hi t l a m i tt ta f c shi
mpa r nt nd ha a n if ontnue o xpe i nc i n s hlmb nd s ha fe t s

a lt t gi a dl t ( . 2 . Dr Mirshs e i l o n dta plitf h sat n n n
bii o rp n i . Tr 95 ) . eic p ct l pie h t anif a i na e t
y
f
ka y
pe

i ar n o h srg tu pe e te t' ta û r v n gqhi fo rt r i t j b rq iig
mp ime t f i ih p r x rmiy' h t G e e ts m rm eu nng o o s e urn
p
mmma lb r' ( . 5 )
l a o . Tr 9 2 .
'
On Fe a y 24,201 M r M a c s pr s nt dt Dr Na iwih c
bnz r
5, . r he e e e e o . zl t ompl i sofpa n i hi
ant
i n s
lf el
e t bow and s de . On physc lexa i ton,pli tf was f md t ha f l r nge of
houl r
ia
m na i
a n if
ot o ve ul a
m oto i hi lf ebow wihoutpai Howe r hee bie pa nfl r
i n n s et l
t
n.
ve , xhi t d i il angeofmoton i hi l t
i n s ef

s o le . ( . 7 )
h ud r Tr 6 1 .
OnAprl2, 5, antf e l n d t Dr M irs h f af low- p a nt nt Physc
i 201 pli ifr tl e o . e ic or o l u ppoi me .
r
ial

e mi to fndng we e u ha g d e c p f r I an wi g i png . ( .8 3 . Dr
xn nain
i s r nc n e , x e t o f i t rpgi q' Tr 9 )
p
h
'
.
M i rs h a s s dpli tf t c oni m i tt
e ic s es e a n ifwih hr c s/humbpan, no e t tnoa to ls g r was
i but t d ha
ddii na ur e y

i dc td a t a p it Heas noe t tp anifiwll n tb a l t u eE i)rg th ndf r
n iae t h t on .
lo td ha litf i il o e b e o s hs ih a o
l
a y h a y ma u llbo i t f tr 'a Smjy r q r ln tr p i ma a e n . ( .
n e v n a a r n he ' ue' nd s a e uie o g e m an n g me t' Tr
u
l
'
8 4)
9 .
On Aprl6,
i 2015, r M a c s pr e t d t Ca ii Clni Orho edi f a e l ton
M . r he e es n e o rlon i c t pa c or n vauai

o h slf eb w p i,whc h d rpo td y b e p e e tf rsx mo t . ( .9 0 . Hewa
f i et lo an ih a e re l e n r sn o i nhs Tr 0 )
s

da no e wi lf ltr l pc nd l i f rwlihh r c i e ac rio ij cin Plitf s
ig s d t etaea e io yi s o zc e e ev d o t ne n e to . an ifwa
h
t
s
as p o ie wihawrs b a ea ah mee ecs p o rm. ( . 0 )
lo r vd d t
it r c nd o x r ie r g n Tr 9 3 .
On M a 1 201 pl i ifr t ne t Dr Na l f af l w- a nt e t Alhough
y 4, 5, antf e ur d o . z i or olo up ppoi m n . t
M r M a c s co i
. r he e ntnued t c pli oflf s de pan,physca e m i ton fndi we e
o om a n e t houl r i
i l xa na i i ngs r

u r mak be ( . 6 )
n e r a l. Tr 6 9 .
Dr Nazir f re pli ift Ca ii Clni Orhopae c whe e hewase mi d a n
. l e e r d antf o rlon i c t
di, r
xn ne gai
o M a 1 201 M r M a c er pore t thi el pa n ha i oved sncehi l s vi i,
n y 9, 5. . r hes e td ha s bow i d mpr
i
s a t st

b tt a h h d b e e p re cng s ud rp i fra fw mo t . ( .9 2 . Ba e o t e
u h t e a e n x ein i ho le an o e
nhs Tr 1 ) s d n h

e mi to fndi ,J i Cr ke ,a physcan' as itnt dignos d pl i ifwih l f r a or
xn nai n i ngs ule oc r
i i s ssa , a
e antf t e t ott

c f s n r me S a miitr d a c rio e ijcin a p o i e panif wih h me
uf y d o . he d nse e
o ts n ne to nd r v d d li tf t o
e ries ( . 4)
xecs . Tr 91 .
Ove t ne f w mont ,M r M a c s c tnue t c
r he xt e
hs . r he e on i d o ompli of s de pa n. An
an
houl r i

M R. su y s we G u stsa d tn io i,b tno fn k ta s' ( .9 ) Li e s ,x ry
I td ho d l rii n e dn ss u
b
rn e r . Tr 31. k wie -a s
'

r v ae n sg so a ueose u ijlyo a trts OnAu u t , 01 , . irs hd a n s d
e e ld o in f c t s o s nt r rh ii.
r
g s 6 2 5 Dr M eic ig o e
pl i ifwih l f s de s c om ili pi e e . Bas on t ci ca fndi a t l k
antf t e t houl r uba r a m ng m nt
ed he lni l i ngs nd he ac
o s ce s wih nonope a i te t e , Dr M i ls h r omm e d t t pl i if t r
f uc s
t
r tve r am nt . ei c ec
nde ha antf mde go

a tr s o i slg r . ( . 3 ) Th s r ia p o e t ewa p ro do Se tmb r1 , 01
rh o c pc t e y Tr 9 3 . e u g c l r c dl s ef nne n p e e 6 2 5.
r
r
( .4)
Tr 9 2 .
Tr a me r co ds r fe tt tpli ifs s
e t nt e r e l c ha antf ympt
oms i o d f l ng t pr dlr
mpr ve olowi he oce ze.

On Se e be 22,201 M r M a c e r po t t the wa çdoi wel'a t thi pan was
ptm r
5, . r hes e red ha
s s ng l' nd ha s i

c nr le Wi me iains ( . 4 ) Th s mewa tu i Oco ro 2 5 Plitf wa
o told t dc to . Tr 9 2 . e a
h
s r e n tbe f 01 . an if s
o e ve t be ç ng we lpos opertvey,'and r po td tsow a se pr e swih bot
bs r d o t
doi
l t
ai l '
e re tl nd t ady ogr s t
h

pan a Ea g o moinl' ( . 4 )
i nd rn e f to . Tr 9 9 .
'
Fi m o hs lt r i M a c of 201 M r M a c e pr s nt t Cmi i Clni
ve nt a e , n
rh
7, . r hes e e ed o
lon i c
Orho ed cwihanew c
t pa i t
ompl i ofG i rng fnge c c ng'f rwhih hehadnotye r ceved
ant l ght i i r athi ' o
r
c
te i

a yte t n . ( . 6 ) Plitf as c mp an d o dg t lo p i a ice s dp i wi
n r ame t Tr 9 2 . an if lo o lie f h eb w an nd n r a e an t
h
gi pn a l t g Dr M ids hda n s dplitf wiht g rsn e a de c n y i s ( .
rp ig nd i i . . e c ig o e anif t dg e g r n pio d lt . Tr
fn
i

9 5 . Hea miitrdatig rfng rij ci n a drc mme d dho e rie a Votrn
6)
d z see rg e i e ne to , n e o n e me xecs s nd lae
l
c e m f pl i if sel
r n or a nt f
bow s pt s.
ym om
Ata f l w - a
olo up ppoi t e on Apr l28 201 M r M a che e r po t d s e i pr m e
n m nt
i , 6, . r s e r e om m ove nt

wihli rg rngfnge,bu worelngpai i hi rg ebow. ( .973) X-a oft ebow
t ls iht i i r t s ri
n n s iht l
Tr
. rys he l

8

rv ae n a ueo s o sc n e . ( . 76 . DrM irs ha mi itr da eb w ijcina d
e e ld o c t se u ha g s Tr 9 ) . e ic d nsee n lo ne to n
a v sdp an ift c niu wihhsh mee e cs r gme ( . 76 .
d ie litf o o tn e t i o x r ie e i n. Tr 9 )
M r M a c er tz edt Dr M i ds h on Se t m be 1 201 . Her poredt tt rght
. r hes e t
m
o . e c
p e r 3, 6.
e t ha he i

rn fn e p i h drt r e f lo ngt ij ci n a de p e s ditr s i s r ey ( . 9 )
i g i g r an a eu n d o lwi he n e to , n x rse nee t n u g r . Tr 9 3 .
OnOco r3 2 6 Dr M irshp ro datig r ee s pr c d e ( . 0 4 .
tbe , 01 , . eic e fnne rg e r la e o e ur. Tr 1 0 )
Fotrm o hs lt r on J nua y 31 201 M r M a c s pr e e t Dr M ids h f a
z nt a e ,
a r , 7, . r he e es nt d o . e c or n

e l tonofli rghtebow. Pli ifde c i hi pa nasG ode a e'a i c t d t ti wa
va uai
ls i l
antf s rbed s i
ç
m r t ,' nd ndia e ha t s

G o fne t Eh l me il a d
ç ni d o te
c
da n

. . a s cae wih no ohe s mptms' ( . 1 0 )
so itd t
t r y o . Tr 0 3 .
'

El todi gnosi sudi ,whih wer obt l e t as e s pl i iff c t ltl ls nd o e
ecr a tc t es
c
e a d o s s antf or ubia lnne y r m ,

wee ç r l' ( .1 0 ) On p y ia e n n to plitf e h btd s me rg tebo
r l ma. Tr 0 3 .
no
'
h sc l x miain, an if x i i o ih l w
e
tn r s a d afw p stv srs ts sg . ( .1 0 ) Ho v r plitf h df l fe in,
e dene s n e o iie te s et ins Tr 0 7 . we e, anif a ul lx o
e e i n,a pr nai n r ngeofm o i a hi e bow s
xt nso nd o to a
ton, nd s l
howe no sg ofa obvi usde or iy
d
i ns n
o
f m t

or e m a.
de

Dr M irs h r omme d t t pli tf t r a rg el
. e ic ec
nde ha a n if mde go
i ht bow medil
a

e c
pi ondyl t
ecomy a c ure ul c lt r llgn e tr o tuci
nd onc r nt na ola e a i m n ec nsr ton. A s e ntM RIof
ubs que
pl ntf s rg ebow r veaed t nd noss of t c
ai if iht l
e l e i i
he omm o e e r o i n,bu no fndi t
n xt do rgi
t
i ngs o

e ant rpo tdul rsde pan. ( .1 4)
xpli he e re na-i d i Tr 01 .
Att tmeoft a nita i he dng o M a c 8 201 pl i ifha notye unde g
he i
he dmi sr tve a
n z h , 7, antf d
t
r one
s ge y on hi rg ebow . M r M a c s t sii dt tt s gi lpr e lewa s he edf
ur r
s i ht l
. r he e e tte ha he m ca oc dtr s c dul or
t f l ng da Howe r he r c d doe not c an a e de e c im i t t t
he olowi
y.
ve ,t e or
s
ont i ny vi nc onfr ng ha he
pr ed ewa a t lype f m e
oc ur s c ual ror d.
D l i t a i s r tve he r ng, M r M a c et si dt thea tm pt t l k f ls
z ng he dm ni ta i ' a i
r
. r hes e tle ha
te ed o oo or e s

srn o swo ki 2 2, u hsç at us wa n t o da a1' ( . 9 . W h na k dt a d e s
te u u r n 01 b t i G lhj t s ' g o t l. Tr 4 )
he
'
e se o d rs
t physc a tviy de c i d i hi me c lr or , antf denid doi wo k asapantr As
he
ial c i t s rbe n s di a ec ds pl i if e
ng r
i e.
f rt e de i i a i t theha pr vi l hel d hi t l m ove M r M a c et tte
o he vi nce nd c tng ha
d e ousy pe s mc e
, . r hes esii d

t a he tid t h l h st l mo a lr ebo b twa u be t d i. ( .5 - 5 . M.
h t re o ep i mce ve a g x u s na l o o t Tr 4 5 ) r
.
M a c e ed ne b iga l t efci l u eh srg t r t p ro m a ytpeo wo k ( . 9 .
r h s e id en be o fe t y s i ih a m o ef r n y f r . Tr 5 )
ve
M. M ac e eas tsiidta h h st 1 d wnç lt etme' e a s o p i. ( . )
1 rh s lo etfe h t e a o i o t l h i 'b c u e f an Tr 61.
.
.
e
a
Afe c i rng a 1oft e de e ofr or t La J
tr onsde i l
he vi nc
ec d, he w udge f md t tM r M a c e
ot ha . r hes

wasdia e f alf ' ofs tntalganfl a tviy fom Ma c 1 201 t salege o e
sbld or l ol
ms ubsa i i l ci t r
l
r h , 2 hi l d nst

d t)tr ug S p e e 25 2 4 The La J g ' sn i i ti r g r r s le fo h s
ae h o h e tmb r , 01 .
w ud e s dng n h s e ad e utd r m i
de e na i t tt pli ifha ç e f tveus ofhi rghtha f rha i fnge i or
t nni ton ha he antf d t feci
no
e
si
nd o ndlng,
rng,

feig'd rng ta pei d b tc u d oh m ie p ro m lg two k ( .1 ) Ba e o t e
e ln ' u i h t ro , u o l t e s e fr ih r . Tr 9 . s d n h
t tmony of a vocai le t t La J
esi
tona xper, he w udge f md t ts r titonsr r d pli if
ot ha uch esrc i
ende e antf
t bl t pe f m li pa tr l va wo k 9om M a c 1 201 t oug Se e r25,201 a
ma e o r or zs s e e nt r
r h , 2 hr h pt mbe
4, nd

t a t r we en ohe j bsi te n to le o o ta panifwa c p b eo pef nnng
h t hee r o t r o n h aina c n my h t litf s a a l f ro i
wi o th vig efci u eo h srg tha d ( .2 -2 ) Ho v r a i dc t da ve t e
t u a n fe tve s f i ih n . Tr 3 4 . we e , s n iaç bo , h
h
La J
w udgede e mi d t tM . M a c e e re ed me c li ove e asofSe e r26,
t r ne ha r r hes xpe inc
.
di a mpr m nt
pt mbe
201 whi h ga rs t a l s r src i r i ua f tona c pa iy. Spe i aly,t La
4, c ve ie o es e titve esd l unci l a ct
c fc l he w

J
udge de e mi d t t M r M a c s r i d t c pa iy t pe f r lght wor wih t
t r ne hé
. r he e egane he a ct o r o m i
k t he

f lo n rsdcins dlj c n ne e be e p s d t h z r s lk h z r usma hiey a
o lwig e t to : ç- e a v r x o e o a ad i e a ado
gl
c n r nd
unpr e t he ght;oc aso lype f r ha lng,f rng, ndf e i wih t rg hand;a
ot ced i s c i nal r o m nd i mge i a e lng t he i ht
nd

h v oc a ina e p szet tmpeauee te s wene s h mi i ,a d vb ains ( . 6 .
a e c so l x o l o e rtr xrme , t s , u dt n ir to . Tr 2 )
r
y
Afe c i rngt pli ifsc r trsi sa t t tmony oft voc tonale r, heLa
tr onsde i he a ntf ha ac e itc nd he esi
he a i
xpe tt
w
J
udgeco l
ncudedt tpli ifc d notpe f m any ofli pa tr e ntwor butco d pe f nn
ha a ntf oul
ror
ls s elva
k,
ul r o

ot wo k r es e si i sgni a numbe i t naina e nomy. ( . 33 .
her r ol xitng n i fc nt
r n he to l co
Tr -34)
The e or t La J
r f e, he w udge f
ound t tpl i ifs di a lt e d on Se e be 26,201 a t t
ha a ntf
s biiy nde
pt m r
4, nd ha

pli ifha no be meds bld a i snc t tdae. ( .34)
antf s t co ia e gan i e ha t Tr .

Ona lt t scou pli it t o h c ms l make s veala pl nt i s
ppea o hi tt antfl hr ug ot e,
s e r r me s n uppor of
t

h smoin f r s mmay j g n . F rt Mr M ac e e ag e t tt La J g erd i
i to o u r ud me t is, . rh s r u s ha he w ud e re n
fnd ng m e ca i o me a of Se e r26,201 l de i ng whehe a i vi '
i
di l mpr ve nt s
pt mbe
4. n c di
t r n ndi duals
dia lt co hmest ough t dae ofhi de ii n,t La J
s biiy nt
hr
he t
s c so he w udge S us de e ne i t r ha
t t t nni f he e s
m

b e a yme ia i r ve n i ( cama ts i ar n t)a ,fs , eh rt sme ia
e n n dc l mp o me t n t li n 'q mp ime ts nd i o wh t e hi dc l
he
i r v me t i r ltd t Eh cama ts a l y t wo k' 2 C. R. j 4 4 1 9 (
mp o e n s eae o t e li n ') bit o r . 0 F. j 0 .5 4 $,
i
'
41 99 *. Me ia i r v me ti d fn d a ç n d ce s i t e me ia s v rt o (
6. 4(
dc l mp o e n s e e s ç y e r a e n h
a
dc l e eiy f a
cama ts i ar nts whih wa p e e ta t etme o t emo tr c n fv r beme ia
li n ') mp ime t) c s rs n t h i f h s e e t a o a l d c l
d cso t a gh camml wa l ia ld. 2 C. R. j1 9 ( )41 .9 1 1 d tr n to
e iin h t t e li t s d sb e ' 0 F. j 5 4 b , 69 4( ç ee mi ain
'
9. A
t tt r hasbe n ade r a ei m ed c ls ve iy mus beba e o i pr m e i t s
ha he e
e
ces n
i a e rt
t
s d n m ove nt n he ympt m s
o ,

sg s a d o lb rt r fn i sa s cae wih ( ecama ts i ar n s' l .
in , n /r a o ao y idng so itd t t li n ') mp ime t. d
h
'
Upon r viw oft r c d,t co tc l s t tt La J
e e
he e or he ur oncude ha he w udge' fndi ofm ed c
s
ng
i al
i pr m e i s
m ove nt s uppore by s t nta e de e. Asi cae a
td
ubsa i l vi nc
ndi t d bove, heLa J
t
w udgef undM r
o
.
M a c s dia e fom t pe i ofM a c 1 201 t o h Se e r25,201 be us hi
r he e s bl d r he rod
r h , 2 hr ug pt mbe
4, ca e s

rghtha a wrs i r nt we e o s h s ve iy t tpl i ifha ç e f tveus ofhi
i
nd nd it mpaime s r f uc e rt ha antf d t feci
no
e
s

rg t n f rh n ln ,i g rng o fei . ( . 9 . Th La J g d tr n dta p an if
ih ha d o a di g fn ei , r e l ' Tr 1 ) e w ud e eemie h t litf
ng '
c ud n tpefr a yj b i t e o my wih s c lmiain . I fn i Mr M a c e e
o l o ro m n o s n he c no
t u h i tto s n dng . r h s
di a e f t tpe i t Law J
s bld or ha rod, he
udger le on ci c sndi a t pl i ipsalegai ns
ei d
lnial
ngs nd he antf
l to
wih r s c t hi rg ha a wrs pr e ,whih t La J
t e pe t o s i ht nd nd it obl ms
c he w udge f md t be ge r ly
ot o
ne a l

c nsse t t t eo j cieme ia e i e c t r u hSe tmb r25 20 4. ( .1 ) TheLa
o itn wih h b e tv dc l v d n e h o g pe e , 1 Tr 9 .
w
J
udge a s c i r t pr e esM r M a c e t r ntt te thi rghtuppe e r m iy
lo onsde ed he oc dm
. r hes mde we o r a s i
r xte t

i nne sdurng t tpei whih i l d f szgeison hi rghtha a m i t ( .
mpai nt i ha rod, c ncude our tr re
si
nd nd s. Tr
19 .
-22)

The r c d s
e or upporst La J
t he w udge' fndi t t f l ng t pl ntf rghtt
s
ng ha , olowi he ai ips i humb

slge y i M ay of201 hi co ton gr dualy i o d t t poi t t by Se e be 26,
tr r n
4, s ndii
a l mpr ve o he nt ha ,
ptm r
201 t pl n ifcoul oc asonal pe f m ha i Enge i a f lng wih hi rghtha
4, he aitf
d c i ly r or ndlng,
rng, nd ee i
t si
nd.
On t tdae,M r M a c s r pored t the wasç ng we1' t thi pai wa c r l wih
ha t
. r he e e t ha
ç
doi
1,' ha s n s ontoled t

me iains a t th srng o mo inha i r v d ( . 45 . On p y ia e mi to
dc to , nd ha i a e f to d mp o e . Tr 6 )
h sc l xn nain,
t e panifwa f l d t b t on welp s o rtv l ' ( .6 ) He e hbi d l go d
h litf s ol o e t ig l o t peaiey. Tr 45 .
n
d
'
x i t ç jo
e l
o po iin' a d R o d mo in o te d gt, wi o y H nma ds o o t' ( .6 5 .
p sto ' n g o
to f h iis' t nl mii l ic mfr. Tr 4 )
' h
'
Addii nal t La J er as bl obs r dt tt f c t tpl ntf he pe hi t l m ove
to ly,he w udg e ona y e ve ha he a t ha ai if l d s mce

f s t n t m on hs l t f rhe s ppo t t c l i t the l d r gane s ofhi
es ha wo
t aer u t r u red he oncuson ha
ç e i d ome
ha
s

a iiyt u ehi rg tha db ta tme d s ieo g i dfkute . ( . 6 . Alh u h Dr
b l o s s ih n y h t i , e pt n ong it lis' Tr 2 ) t o g .
t
'
M irsh s e ntynoedi Aprlof201 t tpli ifwoul t tbea et us E s rg
eic ubs que l t n i
5 ha antf
dt
no
bl o e hij iht
ha f ra he vv mmm a lbo i t f tle' Dr M irs h a no poi s
nd o ny a
l a r n he ' tr ,' . e ic t
u
nt ugge t t tpli tf
sed ha a n if

wo dno bea l t ef cieyu eisrg th n a al ( . 9 )(mp a i a d d . M o e v r
ul t be o fe tv l s l i h a d t l. Tr 8 4 e h ss d e )
i
ro e ,
s ve almont pas e wiho sgnii n m e ca te t e f pl i i srghtha
e r
hs s d t ut i fca t di l r am nt or antY i
nd. I wasnot
t
t i M a c of201 t tpl i ifs w Dr M irs h f rrg rng fnge ca c ng,whih wa a
mtl r h
6 ha antf a
. e ic o i ht i i r t hi
c
s n

e trl n w i ar nt ( .9 2 CTr ame tt d t h s b e n n .) Ev n te M r
n iey e mp ime . Tr 6 ) e t n o ae a e n o e'. e h n, .
'
M a c e co i
r hes ntnued t e bi nor sr ngt a r ngeofmoton i hi wrs a fnge s a
o xhi t mal te h nd a
i n s it nd
r , nd
t r a e no docl e co plc tonsorc
he e r
lmentd m i ai
ompl i soffnge pa n f l ng t t
ant
i r i olowi he dgge fnge
ri r

rla ep o e u epel me i Oco e o 2 6. ( . 6 ,9 6 9 7 9 6 . Fo te er a o ,
ee s r c d r rbr d n tb r f 01 Tr 9 4 7 , 8 , 9 ) r h s e s ns
t co tco l
he ur ncudes t ts bsa i l e de e s
ha u t nta vi nc uppors t La J
t he w udge' fndi t t pl i if
s i ng ha antf
e r e d m edi ali pr ve e i hi a lt t us hi dg ha
xpe i nce
c m o m nt n s biiy o e s ht nd.

M r M a che ene a gue t tt La J
. r s xt r s ha he w udgef iedt pr l c i rte t e r or
a l o opery onsde r am nt ec ds
r l t t li lf s de a lf el
e aed o ls e t houl r nd e t bow. Upon r vi w oft r or howe r t c ti
e e
he ec d,
ve , he our s
t bl t ag ee. The La J
ma e o r
w udge r ogni d t tM r M a c ew a te t d f l tebo pan
ec ze ha
. r hes
s r a e or ef l w i
12

(p c n y i s a dlf s o le i i e n i 2 5 b t ee i dt a s c i ime t we e
e io d l i) n e t h ud rmpng me tn 01 , u d tnnne h t u h mpar ns r
t
nots s ve east pr ve pe l m a eofar duc r ngeoflghtwor Ast La J
oe r
o e nt rbr nc
e ed a
i
k.
he w udgenot
ed
i hi decson, pl ntT s Glf- i
n s
ii
ai i
te tsded c
ompl i s a
ant ppea t ha r s
r o ve e ponde f il wel t
d a ry l o

te t n . ( . ) M r M ac s E t l)i r ve n i t eb w pan' fe ac rio e
r ame t' Tr 31 . . rhe e ç ed mp o me t n he lo i'a tr o t n
'
no
s

ij cin i Aprlo 2 5 ( . 2 9 2 . Alh u hplitf utmaey r q r da tr s o i
n e to n i f 01 . Tr 91 , 2 ) t o g anif li tl e uie rh o c pc
slge y on hi lf s ul r i Se e be of 201 he was f md t be Gdoi wel pos
tr r
s e t ho de n ptm r
5,
ot
o
ç ng l
t

o e ai l' a rpo td ta hs pan wa t o to ld wi me iains' ( .9 2,9 9 .
p r t y' nd e re h t i i s t nr le t dc to . Tr 4 4 )
ve
c
h
'
Pl n ifa s r pored e re i sow butse pr e swih hi s de pa n a r nge of
aitf lo e t xpe inc ng l
t ady ogr s t s houl r i nd a

moin, n h wa f t t ha eç o deb w (a eo moin . ( . 4 9 9 . Ac o dn l ,
to a d e s omd o v s o l o rng f to q' Tr9 2, 4 ) c r ig y
g
'
t co ti s tsi d t ts t nta e de e s
he ur s aife ha ubsa i l vi nc upporst La J e' a s s m e ofpli ifs
t he w udg s s e s nt
antf
l f- i i ime s
e tsded mpa r nt .

Th c u t s as rj c M r M rc e e sa gl n t tt La J g fie t p o e l
e o r mu t lo ee t . h s ' r t tha he w ud e ald o r p ry
me
co i rli rghte bow i im e t The La J e r cog z t tpl ntf wa di gnos d
nsde ls i
l
mpar n .
w udg e ni ed ha ai if s a
e
wih rghtlt r le condylts i 2016,and t the wa s he e t unde go s ge y a trt
t i a e a pi
ii n
ha
s c dul d o
r ur r fe he

a mi srtv he rng ( .
d nitaie ai . Tr

Howe , t La J
ver he w udge dee mi d t t çi wo d be
t r ne ha Gt ul

t e ona y s ultvet ma a sl i nsa
mr as bl pec a i o ke s tmpto bouthi poso r tvec s a t ssa ' snc
s t pe a i our e t hi t ge, i e
'

t eewa n e ie c r g r igt eslg r o plitf c n iin f lo ngi. ( . ) Th
h r s o vd n e e adn h t e y r an ifs o dto olwi t Tr 31. e
r
La J
w udge alo a cm a ey not d t t a pr ope a i e mi i n of t rg e bow s
s c tl
e ha
e r tve xn nato
he i ht l
howe
d
ç s a e t nde e s a s
t olt d e m s nd ome l s of fe on,butno m a r nge ofm oton o he wie,nonna
i
os
l xi
r la
i t r s
l

crulto a d s n ain a d n o v o s d f nni ' ( .31 1 0 ) Up n r ve o te
ic ain n e s to , n o b i u eo t ' Tr , 0 7 . o e iw f h
y.
r c d, t c ' fnds no e r i t La J
e or he ouz i
t
ror n he w udge s as e s e of pli tf rght ebo
' s s m nt
a n ifs i
l w
i pai
m rment
.

Fi ly,M r M a c s ar st tt La J
nal
. r he e gue ha he w udge' f ngs a t hi r i
s mdi
s o s esdualf to l
nnci na

c pact snc Se e be 26,201 a e no s
a iy i e pl m r
4 r t uppore by s t nta e de e. I pa tc a ,
td
ubsa i l vi nc n riulr

pl i ifa guest tt La J
antf r
ha he w udgee r i f ii t i ude a l tuppe e r miy lmia i
red n alng o ncl
ny ef
r xte t i t tons
ora lm ia i on pli ifs a lt t r ac To s
ny i t ton
antf biiy o e h.
uppor t s a g e ,pl ntf onc a i
t hi r um nt ai if e gan
cie t t f tt tM r M a c s unde we tslge y o hi lf s de a wa s hed e t
t s o he ac ha . r he e
r n tr r n s e t houl r nd s c uld o
t r s ge y on M srg el
mde go ur r
i ht bow. Howe r t m e e f c t tszge y wasr c me
ve , he r a t ha tr r
e om nded o
r
pe f me doe no co
r or d s t ndusvey esa ih t tpli ifha a tonalf nc i na lm ia i ori
i l t bls ha antf d ddii
u to l i ttons s
o he ie dia e f a1f msofs t ta ga nfl e oymen . Se Ra ph v.Be hil
t m s s bl d or 1 or
ubsmlil i l mpl
l
t
ç ndol
n l,

No. 1 - v 1 71 2 9U. DitLEXI 31 2 a * 2( D. a Fe . 7 2 9 C<Tje t n
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r c ds r ve t tc am a s f r d fom ll ra c r i lpai t tr quie t e s pra e
e or e al ha l i nt ufe e r lmba nd e vca n ha e r d hr e e t
szge i ,butt m e e f c t t c am a
lr res
he r a t ha l i nt...t r nt s ge' .. .doe notesa ih M s
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S 5 5 ,t
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7 M D. l. r , 01 ) çul d r ong wo u g re , n nd f he ev s o s o
g
etb iht a E cama t wa d sb e o h d a yfmci n l i tto . Asi dc tda o e
sa ls h t a li n) s ia ld r a n t to a lmiains'
).
n iae b v ,
M r M a c s wasf
. r he e
ound t ha lgoodel r ngeofmoton'a s e diy pr e sng r nge of
o ve ç
bow a
i ' nd t a l ogr s i a
m oton i hi l ts de f l w i t a t os pi pr d e pe f m e i Se e be of201
i n s ef houl r olo ng he rhr co c oce ur r or d n pt m r
5,

a he e bie f 1r nge ofm oto i hi rg ebow on J nua' 31 201 e e f sihty
nd
xhi t d ' a
u1
i n n s iht l
a t , 7, xc pt or lg l
y
.

l td fe in. ( .9 9 1 0 ) I d tr n n p an ipsrsd lf n to a c p ct a o
i e lx o Tr 4 , 0 7 . n ee mii g litf e iua ' cin l a a i s f
mi
u
y
Se tmb r2 ,2 4 t La J d e c r f l c n i ee t o j ci e me ia e d n e te
pe e 6 01 , he w u g a eul o sd rd he b e tv dc l vie c , h
y
pl i ifste t e lit r a Dr M irs h' opilont tpli ifc nnotus hi dg ha f r
antf r am nt lso y, nd . e i c s zi ha antf n
e s ht nd o

a yç a yma u llbo . ( . 9 ) Th c u t sstsidt a t eLa J d esa s sme to
n ç v n a a r' Tr 8 4 . e o r i aife h t h w u g ' s e s n f
he
'
pl ntf r i ua f tonalc pa iy i s
ai ifs esd l unc i
a ct s uppo td by s t nta evi nc
re
ubsa il de e.
I a fnni t Com m i s one ' Enal de i i n, t c t doe not s
n fi ng he
s i rs
c s o he our
s
ugge t t t M r
s ha
.
M ar he e i f ee of a1 pai a di c f t I e t m edi alr cor c i m s t tpl i i f
c s sr
l n nd s om or . nde d, he
c e d onf r ha a ntf

s fe sfo mu c l s eea i ar n st a c nbee pe tdt r s t ns be tv l tto .
u fr r m s u o k ltl mp ime t h t a
x ce o e uli u j ci e i ains
mi
H o ver s t nta evi nce s
we , ubsa i l de
uppors t La J
t he w udge' sndi t tpl i if srg wrs a
s
ng ha antf i ht it nd

hand s
ympt
oms ha de r as d i s ve iy a no l r ca e t dia i lm iai t t
ve c e e n e rt nd
onge us he s blng i t tons ha
e se pror t Se e
xitd i o pt mber 26,201 Alhough M r M a c e has bee di gnos d wih a
4. t
. r hes
n a
e
t nd
te t d f a to li ime t snc t tda e,t s e ntmedi lr c dssmpl do no
r a e or ddii na mpar n s i e ha t he ubs que
ca e or i y
t

i cu e ciia f ig o o j ci ts rs ls ta ae c n itn wih ttl d sb ig
n ld l c l mdn s r be tve et e ut h t r o sse t t oal ia ln
n
y
s mp o tl g . l mu tbe rc g z d t a t ia iiy t wo k wih u a y s b e tve
y tmaoo y t s
e o nie h t he n b l o r t o t n u j ci
t
co pl nt doe notofis l r nde acli a dia e Se Cr i v.Cha e ,76 F. 585,592
m ai s s
te f e r am nt s bld. e a g
tr
3d

(t Ci. 9 6 . l a pe r t t ec u tha t eLa J d ec n iee a1 ft me ia e d n e
4 h r 1 9 ) t p as o h o r t t h w u g o sd r d 1o he d c l vie c ,

a wela alo t s j ci fco sra o a l s p re b t er c r ,i a j d c tn 11.
s l s 1 f he ube tve a t r e s n by u po td y h e o d n du iaig .
1
M a c s ' c am sf be f . Thus t c tc l st tal f cesoft Co misone '
r he e s l i or neks
, he our oncude ha l a t
he m s i rs
fna dec son a es
i l ii r upporedby s t nta e denc
t
ubsa il vi e.
Asa g ne a r e,her s uto ofc lc si t e denc i am a trwihi t pr nce
e r l ul t e ol i n onfit n he vi e s
te t n he ovi
of t Com misone ,e n i t c tmi htr s l t c lc s dif r nty. Riha ds v.
he
s i r ve f he our g e o ve he onfit f e e l
c r on

Peal ,402 U. a 400 Cr z,76F. a 58 Oppe i v.Fi h,495F. 396,397( h
r es
S. t -01; ai
3d t 9;
nhem
nc
2d
4t
Ci.1 . Fort ras sae t cotr fndst Commiso rsr s utonoft petne
r 974)
he e ons ttd,he lt i he
sine ' e ol i
he ri nt
c lcsi t r cor i t sc et be s
onfi t n he e d n hi as o uppore by s t nta e de
td
ubsa i l vi nce. Ac or ngl t fna
c di y, he i l
de ii n oft Com misone m us bea fr
c so
he
s i r t fimed.
The Clr i die t d t s nd co e oft sm e a um o ni t a1 couns lofr co d.
ek s r ce o e
pis hi mor nd
pi on o 1
e
e r

DATED :Thi ksA da o Se e r
s
y f pt mbe , 2019.
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r

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ni
t d a e src udge