FROM: Barbara Hannah, Chief Counsel
SUBJECT: Disability Retirement Application of Tina S. Rosales
RECOMMENDATION:
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Review and determine the disability retirement application of Tina S. Rosales.
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Requested Benefit:
1. Non-Service Connected Disability Retirement with Supplemental Retirement Allowance
Staff Recommendation:
1. Tina S. Rosales is permanently incapacitated for the performance of duties and a disability retirement be granted.
2. Tina S. Rosales’ disability is non-service connected based on the claimed injury(ies)/disease as listed in Exhibit A; therefore, grant a non-service connected disability benefit.
3. Tina S. Rosales is not capable of gainful employment; therefore, grant the supplemental disability retirement allowance.
4. Staff shall initiate disability benefit payments with an effective date of April 16, 2018 date of application provided the benefit is requested in writing.
BACKGROUND:
Medical Advisor - Joseph Dotan, M.D.
Attorney - None
STAFF CONTACT:
Barbara Hannah
Dave Lantzer
ATTACHMENTS:
Exhibit A: Claimed Injury or Disease
Exhibit B: Demographic Information
Exhibit C: Medical Advisor’s Report
Exhibit D: Independent Medical Examiner’s Report
Exhibit E: Applicant’s Statement of Facts and Physician’s Report
Exhibit F: Department Statement of Facts
Exhibit G: Job Description, Physical Requirements