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Qualified Medical Evaluation

Medical-legal evaluation report

Records reviewed

Claim No.ADJ-4471882

Date of Exam2026-05-18

ExamineeJ. R.

EvaluatorA. Reyes, MD

01

History of Injury

02

The examinee is a 41-year-old warehouse associate who reports a

03

lifting injury to the lumbar spine while moving palletized stock.

04

Pain was immediate and has persisted since the claimed date.

05

Records Reviewed

06

Imaging, prior treatment notes, and the deposition transcript were

07

reviewed and indexed as received.

08

Physical Examination

09

Lumbar range of motion is reduced in flexion and extension. Straight

10

leg raise is positive on the right at 45 degrees. Motor strength is

11

5/5 in tested groups; sensation intact.

12

Causation

13

14

A. Reyes, MD · QME · signature