FILED: QUEENS COUNTY CLERK 12/15/ :11 PM INDEX NO /2015 NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 12/15/2017

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2 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS X MOHAMMED H. ULLAH Index No.: /15 Plaintiff -against- AFFIDAVIT of MOHAMMED QASIM SALEEM and CAPITAL CAR & LIMOUSINE SERVICE, INC. TREATING CHIROPRACTOR X Defendants. STATE OF NEW YORK ) COUNTY OF QUEENS ) ) ss. I, Dr. Ted Rusek, D.C., being duly sworn, hereby depose and attest to the truth of the following, under penalty of perjury: THAT 1. I am a chiropractor duly licensed to practice chiropractic medicine in the State of New York. 2. I have personally provided chiropractic care and treatment to the plaintiff herein, MOHAMMED H. ULLAH, with regard to injuries he sustained in a motor vehicle accident on August 7, I have personally prepared, reviewed and signed two narrative reports, dated March 28, 2016 and December 12, 2017 which contain my findings, conclusions and opinions regarding the history, care and treatment, and prognosis provided to the plaintiff herein, MOHAMMED H. ULLAH. 3. I hereby certify that my aforesaid narrative reports, dated March 28, 2016 and December 12, 2017 which are annexed hereto and incorporated by reference herein, along with the findings, conclusions and opinions rendered therein, are true and accurate within a reasonable degree of professional chiropractic ceitainty.

3 4. I also certify that the annexed Billing records, which are incorporated by reference herein, are true and accurate copies of my business billing records, as kept in the normal course of my professional practice, regarding this patient. 5. I further certify that the annexed treatment records, which are incorporated by reference herein, are true and accurate copies of my business treatment, as kept in the normal course of my professional practice, concerning this patient. Dated: Queens, New York December 14, 2017 DR. TED RUSEK, D.C. ~~, c., Sworn t before me on this I > day of December, 2017 NOT (RY)UBLIC JENNY G. LOBO NOTARY PUBLIC, STATE OF NEW YORK NO. 01L QUALIFIED IN Q UEENS COUNTY

4 DR. RUSEK CHIROPRACTOR Woodside Avenue Woodside. NY I 1377 Telephone: (718) /28/16 I CERTIFY THAT THE FOLLOWING NARRATIVE ON PATIENT MOHAMMAD ULLAN RUSES,' WAS DICTATED BY MYSELF, DR. TED RUSEK, AND I ALSO CERTIFY TNAT I AM THE ORIGINAL AND SOLE AUTHOR OF THIS MEDICAL LEGAL REPORT. I ALSO CERTIFY THAT I ATTENDED AND PERSONALLY APPLIED THERAPY TO THE ABOVE NAMED PATIENT DURING THE ENTlRE COURSE OF TREATMENT WHILE UNDER MY CARE PATIENT: Ullah, Mohammad ACCIDENT DATE: August 7, 2014 Dear Attorney; Mr. Mohammad Ullah presented himself for examination and treatment at this office on 8/14/14 following an automobile accident in which he was the driver of a car that was struck by another vehicle on the above mentioned date. He suffered injuries to his neck and back, and he has upper and lower extremity radiation of pain and paresthesias as a result of his injuries. The patient also stated that he had pain in the left and right shoulders and left knee, left ankle/foot and he also stated that he suffers from dizziness and headaches. complaints: This patient came under my care on 8/14/14 for injuries sustained in this accident which occurred on 8/7/14. He was complaining of neck pain with stiffness that was sharp and aching in nature. The patient also had lower back pain which was sharp and aching in nature that was increased by bending or sitting for long periods of time. It was also increased with changing positions that radiated the pain Into the left and right leg,but mainly to the left. Patient also has left and right shoulder pain. Mr. Ullah stated that he had left and right arm numbness and left leg pain and numbness. Past Medical History: The past medical history was not a contributing factor.

5 Physical Examination: Physicai examination of the neck on 8/14/14 revealed that it was in spasm with pain and tenderness over the cervical spine paraspinal muscles on levels C4 through T1. Also noted was limitation of range of motion. Range of motion in the cervical spine showed a decrease in flexion to 30 degrees with pain /50 normal. Also seen was a decrease in extension to 30 degrees with pain /60 normal. There was also a decrease in left rotation to 50 degrees with pain /80 normal. Right rotation was decreased to 40 degrees with pain /80 degrees normal, and left lateral flexion was decreased to 30 degrees with pain /45 degrees normal. Right lateral flexion was decreased to 20 degrees with pain /45 degrees normal, upon range of motion. The patient had a positive Shoulder Depressor test right and left indicating cervical nerve root involvement. The patient also had a positive Foraminal Compression test indicating the possibility of disc injury on both the right and left side. The patient also had a positive cervical Kemp's test on both the right and left indicating the probability of cervical disc involvernent,mainly on the right. The patient had a decrease in the deep tendon reflex which was noted at +1 on the right biceps. All other reflexes were sluggish but normal. Inspection of the lumbar spine revealed pain and tenderness of the lumbosacral spinal and paraspinal muscles at the levels of L5-S1, more pronounced on the right. Lumbar range of motion testing on 8/14/14 indicated a decrease in flexion to 50 degrees with pain /90 degrees normal, upon range of motion. There was a decrease of extension to 10 degrees with pain /30 degrees normal, upon range of motion and a decrease of right lateral flexion to 15 degrees /30 degrees normal, upon range of motion with pain. Right and left rotation were decreased 20 degrees each /30 degrees normal The patient also had diffuse tenderness in the lumbar regions. There was a positive straight leg raising test on the right. There was a positive Kemp's test indicating disc pathology with nerve root involvement, mainly to the right. The patient also had a decreased deep tendon reflex on the right patella to +1. The other reflexes were sluggish but within normal range. Further Evaluations: Based on the history of trauma and physical examination findings, the possibility of cervical, thoracic and lumbosacral intervertebral disc bulging and herniation was suspected. The patient had severe injuries as a result of this accident. He was referred to Astoria lvledical Imaging for a MRIs of the cervical, thoracic and lumbar spine. The MRI of the

6 cervical spine revealed broad based central posterior disc herniations at C4-CS and C5-C6 C6-C7' Indenting the ventral thecal sac and a disc bulge at C6-C7 indenting the ventral sac as read by Dr. Prakash reading the MRI on 9/10/14. MRI of the thoracic spine was Unremarkable. MRI of the lumbar spine showed right foraminal disc herniation at L2-L3, narrowing the right foramina and abutting the right L2 nerve root, and the lumbar lordosis as read by Dr. Prakash on 9/10/14. straightening of Due to the fact that the patient had persistent neck and back pain and in view of the positive MRI results, I referred him to Dr. Deepika Balaj, neurologist, for neurological evaluation and consultation. Dr. Bajaj concluded in her report dated 8/27/14 with her diagnoses as cervical radiculopathy, thoracic spine derangement and lumbosacral radiculopathy, left knee derangement. Dr. Bajaj performed needle EMG testing of the upper extremities on 1/21/15 and concluded with denervation on the muscles and paracervicals at C6-G7 more on the right indicating cervical radiculopathy more on the right. She again performed needle EMG testing of the lower extremities on 2/11/15 and concluded with delayed left post tibial F-waves normal amp, denervation noted on the right. Due to the left and right shoulder pain and neck and back pains, Mr. Ullah was referred to Dr. Reddy for evaluation, Dr.Reddy concluded with his diagnosis as traumatic paracervical myofascitis with left radiculitis, postconcussion syndrome,traumatic paralumbar myofascitis with radiculopathy, internal derangement left knee, left shoulder, sprain right and left hip, contusion right leg,ieft leg and foot in his report dated 8/26/14. Mr. Ullah was also referred to Dr. Liu, a pain management specialist. Dr. Liu, in his report dated 11/06/14, gave his impression as cervical disc herniation, lumbar disc cervical and lumbar strains. cervical and lumbar radiculopathies, thoracic strain. Mr Ullah followed up with Dr. Liu in reference to the severe pains he was suffering as a result of this accident. Mr. Ullah stated that as a result of this accident he was suffering right shoulder pain which became more prominant and needed evaluation too. Mr. Ullah had an MRF of the right shoulder done on 4/20/15 on the referral of his own physician, Dr.Baynes. The MRI revealed tendinosis of the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus and a tear of the anterior labrum at the equater as read by Dr. Payne at All County Diagnostic Radiology. Due to persistent pains in the cervical and lumbar regions, along with the shoulder pains and MRI findings I referred Mr. Ullah to Dr. Sotelo, an orthopedic surgeon. Dr. Sotelo, in his report dated 6/3/15, recommended right shoulder operative arthroscopy and was to follow up with him. ~QI Dia_qnoses After consideration of the history, the symptomatology, orthopedic and neurological testing, along with MRI testing, the following diagnoses were made.

7 1. Post-traumatic diminished range of motion cervical and lumbar spine 2. Cervical radiculopathy, post-traurnatic mainly to the right, left and right shoulder pain 3. Lumbosacral radiculopathy, posttraumatic, mainly to the right. 4. Severe muscle spasm along with trigger points in areas of the paralumbar spinal musculature noted at L5 to S1. 5. Objective confirmation of positive MRI and EMG findings as described above in the previous section of this report indicating disc damage and nerve root impingement in the upper and lower extremities. 6. Postconcussion syndrome 7. Internal derangement of the left knee 8. Right shoulder damage on MRI as mentioned above and subsequent arthroscopic surgery 8/20/ Left ankle, left foot pain The above accident is the competent producing cause of the patient's current symptoms and diagnoses. Conclusion: Under treatment at this office for an extensive period time, Mr. Ullah has shown slight limited improvement. On re-examination which was done on 1//6/16 the patient had a fair range of motion in the cervical spine with constant restriction on right rotation in the cervical spine. All reflexes returned to normal. Shoulder Depressor and Foraminal Compression tests were still positive on final re-evaluation of the patient's case. in the cervical spine, re-examination of the range of motion done on 1/6/16 to determine the restrictions caused by this accident was performed and indicated the following decreases in range of motion. Range of motion in the cervical spine continued to show a decrease in flexion to 40 degrees with pain (50 degrees normal). There was also a decrease in extension to 50 degrees with pain (60 degrees normal). There was also a decrease in the left rotation to 60 degrees with pain (80 degrees normal), right rotation was decreased to 50 degrees with pain (80 degrees normal) and left lateral flexion was decreased to 40 degrees with pain (45 degrees normal), upon range of motion. Right lateral flexion was decreased to 30 degrees with pain (45 degrees normat), upon range of motion. The patient still has restriction in range of motion in the cervical spine that indicated a persistent muscle spasm and chronic irritation due to the acute accident and the affected disc involvement as result of this accident that occurred on 8/7/14. In the lumber spine, ranges of motion were examined again on re-exarnination that was done on 1/6/16. This testing indicated a decrease in flexion to 60 degrees with pain (90 degrees normal), and there was a decrease in extension to 20 degrees with pain (30 degrees normal. There was a decrease in right lateral flexion to 20 degrees with pain

8 (30 degrees normal) There was a decrease in left lateral flexion to 20 degrees with pain (30 degrees normal). There was a decrease in right rotation to 20 degrees with pain (30 degrees normal) and left rotation to 20 degrees with pain (30 degrees normal). All of these ranges of motion were decreased significantly from normal ranges of motion. It is obvious that the patient has severely limited ranges of motion in the cervical and lumbar areas of the spine, which indicated the severe restriction caused by damage to the spinal discs,surrounding musculature and ligarnentous attachments in the cervical and lumbar spine due to this accident. Periodic re-evaluations of his case also exhibited positive orthopedic and neurological findings. This indicated that his condition was quite severe as a result of the injuries he suffered due to this accident, especially the right shoulder. At this point the patient is not being treated at my office for symptoms with ongoing therapy.. The patient only felt temporary relief for a short period of time after receiving therapy at our office. This only alleviates the symptomatology, but does not cure or resolve the permanent loss of function in the cervical spine and lumbar spine leading to disability in the upper and lower extremities as a result of this accident. As of this date the patient remains with loss of function in the cervical spinal area and the upper extremities as a direct result of the accident not limited to any type of mild physical labor. The patient also developed cervical spinal impairment subject to flare up with any type of physical activity or physical labor. The patient has a partial permanent disability and loss of function of 30% of his pre-injury capacity in using the cervical spine or upper extremities in any type of physical activity. This includes lifting or weight bearing of his body on the cervical spine and using the cervical spine to carry any light objects weighing more than 10 Ibs. This is obviously due to the persistence of decreased range of motion in the cervical spine. The patient remains with 30% disability as determined by the New York State Worker's Compensation Board (WCB) Medical Guidelines booklet dated November 1994 reference page 28. This is for determining moderate disability in the cervical spine. This includes a history of pain with positive physical findings and lack of improvement over an extended period of time with conservative treatment. The patient also developed lumber spinal impairment subject to flare up with any type of physical activity or physical labor. The patient has a partial permanent disability and loss of function of 30% of his pre-injury capacity in using the lumbar spine or tower extremities in any type of physical activity. This includes lifting or weight bearing of his body on the lumbar spine and using the lumbar spine to carry any light objects weighing more than 10 lbs. This is obviously due to the persistence of decreased range of motion in the lumbar spine. The patient remains with 30% disability as determined by the New York State Worker's Compensation Board (WCB) Medical Guidelines booklet dated November 1994

9 reference page 28. This is for determining moderate disability in the lumbar spine. This includes a history of pain with positive physical findings and lack of improvement over an extended period of time with conservative treatment. I have informed Mr.Uttah to stay in contact with me regarding his cervical and lumber pain and to stay in contact with his orthopedist in reference to his right shoulder pain and post surgical options, if necessary. It is obvious that the right shoulder also has a partial permanent injury due to this accident. I believe all signs and symptoms mentioned in this report are causally related to the accident and injury on the above-mentioned date. Very truly yours, Dr. Ted Rusek Doctor of Chiropractic C. /, Dr. Ted Rusek. licensed to practice in the state of New York, do hereby effirm the contents of the foregoing report under penalties of perjury.

10 DR. RUSEK CHIROPRACTOR roadside Avenue Woodside, NY Telephone: (718) /12/17 RE-EXAMINATION REPORT RE: PATIENT: ULLAH, MOHAMMAD ACCIDENT DATE: August 7, 2014 Dear Attomey, Mr. Mohammad Ullah was re-evaluated today in reference to multiple injuries which he sustained as a result of a motor vehicle accident on 08/07/2014 in which he was the driver of a car that was struck by another vehicle. His re-evaluation today revealed that Mr. Ullah still has mild muscle spasms noted in the cervical and thoracic spine. Spasms were noted in the right and left trapezius muscles and right and left rhomboid muscles. The lumbar spine revealed bilateral paraspinal musculature in spasm. ORTHOPEDIC EXAMINATION Orthopedic examination revealed: A. Foraminal Compression test positive on the right. B. Shoulder Depressor test positive right and left, more on the right. C. Cervical Kemp's test was positive on the leftt, more on the right D. Lumbar Kemp's test was positive on the left and right. E Lumber Lasseque's test was positive on the right. NEUROLOGICAL EVALUATION Neurological evaluation revealed: A. Diminished reflex on right biceps to +1. All other reflexes were sluggish, but normal.

11 RANGE OF MOTION FINDINGS: Cervical S pine: A. Flexion was restricted to 40 degrees with pain, normal is at 50 degrees. B. Extension was 50 degrees with normal at 60 degrees. C. Left rotation was 50 degrees with normal at 80 degrees. D. Right rotation was 60 degrees with normal at 80 degrees. E. Left lateral flexion was 35 degrees with normal at 45 degrees. F. Right lateral flexion was 40 degrees with normal at 45 degrees. Lumbar Spine: A. True flexion was decreased to 40 degrees with normal at 60 degrees. B. Extension was decreased to 20 degrees with normal at 25 degrees. C. Left lateral flexion was decreased to 20 degrees with normal at 25 degrees. D. Right lateral flexion was decreased to 15 degrees with normal at 25 degrees. E. Right rotation was 20 degrees with normal at 30 degrees. F. Left rotation was 20 degrees with normal at 30 degrees. It is obvious from the re-examination today that the positive orthopedic results and decreased and restricted ranges of motion indicate that his body is still guarding the affected cervical and lumber spine even after several years since the accident indicating the bulging and multiple herniated disc involvement in both the cervical and lumbar areas are causing nerve root impingement as confirmed on EMG studies done on 1/21/15 and 2/11/15 by Dr. Bajaj. Mr. Ullah stated today that he still suffers from persistent low back and neck pains. He also stated that he is not sleeping well because of the pain. Mr. Ullah stated that he occasionally has right leg pain and right hand numbness/tingling since the accident. Mr. Ullah stated that he still has persistent pains in his right shoulder even though he underwent surgical correction for it. He also complains of left shoulder pain and some left knee pain. Due to the persistent symptomatology, positive MRIs, positive EMGs, positive orthopedic, neurological and range of motion deficits present in the re-examination today, Mr. Ullah suffered partial permanent injuries in his cervical and lumber spine as a result of the accident on 08/07/2014 and my disability findings as to the significant injuries he sustained as a result of this accident as previously stated in my report dated 03/28/16 are confirmed. He also suffered a partial permanent injury to his right shoulder as a result of this accident. I advised him to stay in contact with his orthopedist in reference to any future treatment necessary in regard to the right shoulder and the other extremity injuries suffered due to this accident.

12 Sincerely, e<~ I,P. Dr. Ted Rusek Doctor of Chiropractic Chimpractic