MPH

JD,
Gregory A. Cade, Columbla
Vennont and thnDistrict of ral Clains
AISO c o n a e d
inUnitad Stalas Cour
LAw OFFICES OF Mark L. Rowe (1950-2017)

ENVIRONMENTAL Kevin B. MCKiee

Nso lcensod in the r Cam

LITIGATION GROUR, PC. United Slatoa Court of
ary A Anderson t
United Slatos Court ot Fecderal
Channika De Silva Gonzalez
Chandler Duncan, JD, MPH
Wondy Garman
Anelia Kelser De buys. CLP. FP

March 23., 2022

Robert Lewis Snyder

1645 W Palm Dr
Aransas Pass, TX 78336

URGENT: Medical Records Needed for 3M Hearing Loss Case

Please provide Medical Records diagnosing
your Hearing Loss and/or Tinnitus Injury

Requirements:
The records must come from a from a board certified physician, ENT, PCP or Audiologist and give:

"AClear&Specificdiagnosisof HEARINGLOSSandlor TINNITUS

Such records should include: comprehensive physical exams, physician notes any reports such as

Audiograms, Full hearing tests, Audiometry evaluation, Otoacoustic Emissions (OAE), Auditory Brainstem

Response (ABR), or Hearing conservation data reports.

**Appointment cards, VA disability paperwork or pictures are NOT acceptable**

DO NOT SEND REcORDS

STAPLED, CLIPPED or STICKY NOTES
*They will be returned* Sincerely,
Environmental Litigation Group. P.C.

tSNC()- Y SoBm TD AS PSR PEO

A s PAS
MY a r eIstLne
luelasI#TSS TBSSAoLd SMFT eR
H
BecA se 1 Birmingham A SIG S
Street Address: Phone: (205) 328-9200 Mailing Address:
Birmingham Fax: (205) 328-94566 Post Office Box 550219
2160Highland Avenue South Toll Free: 1-800-749-9200 Birmingham, AL 35255
Birmingham, AL 35205
www.ELGLAW.COM
 ZIP CODE/APO
NEARING CONSERVATION UATA
DOD COMPONENTT A-ARMY
N-NAVY
4-RMARINE CORPS SERVICE COMPONENT
-OTHER DOD ACTIVITY R-REGULAA G-NATIONAL GUARD

SSN
F-AIR FCRCE

AS NAAME-FIRST NAM-+AIDSLE TiAL

R V-RESEPVE 1-OTHEA

DATE OF y s e r , manin, Y

PAY G4ADE, JN!F SVCS FEMALE

GRADE, CIViLIAN sEFVICE DUTY MAILING :DDRESS OF ASSIGNMENT

LOCATION-PLACE OF wORK /233/i527 ANiH_EM iC1aE T MAJOR cOMMANDD OUTY PHONE

SiMA4 AUDIOMETRY
zz 13|
PURPOSE 1-90 DAY 2-ANNUAL 3-TERMINATION 4-OTHER

AUDIOMETRIC DATA LEFT AIGHT

RE: ANSI s3.6 S00 1000 2000 3000 4000 6000 500 1o00 2000 3000 4000 6000
CURRENT AUDIOGRAM
DATE

REFERENCE
GaO7L12S
AUDIOGRAM
S5|5030|15|
year
S 30|3|10
DATE

THRESHOLD SHIFT
0 2810 OS 25 OS|5S1S 20S|
Poorer Better itsl015*5
1-No Significant threshold shift Counsel vAidared byreviewer STS
Notify supervis
STS Followup No. ! after minimum
22-Yes t 2018 or greater NO
Return to duty OrgiAsalth record YES
Retest.in 12 mo. e Send copy to registry 15 hours noise free
NAME OF EXAMINER (Last, first, MI) TRAINING SSN
SERVICE OJTY
OCCUPATION CODE
OFC SYMBOL
cERT. NO.

1-Manual ODEL
27o06
MANUFACTURER SERIAL NO. | LAST ELECTROAcOUSTIC
O28S
TYPE CALIB DATE
2-Self-recording (auto)
3-Microprocessoor RALOO 7RALDR /I22
FOLLOWUPNO.1 Minimum 15 hours noise free

AUDIOAETRIC DATA LEFT BIGHT

RE: ANS! S3.6 500 1000 2000 3000 4000 6000 500 1000 2c00 3000 4000 000

CURRENT AUD!OGRAM O. yezr

DAT

REFERENCE AUD!OGRAM_year
DAT
3 lo O 55sOs5
THRESHOLD SHIFT
. = Poorer Better 0-5 toO s SO
1-No Sigrificant threshold shift STS
Counsei Validated by reviewer
TS Notity Supervis
Return to duty Orig ir health record YES Cleared by medical reviweT
2 2-Yes t 20dB or greater
NAMEQ, EXAMINER (Last, irst, MI)
NO
Retest
TRAINING
CERT. N0.
in 12 mo.
SSN
Send copy toregistry before Followup No. 2
SERVICEDUTV
OcCPATION CODE
OFC SY M8OL
A -
MANUFACTURER SERIAL NO. | LAST ELECTROACOUSTIC
TYPE 1-Manual MODEL CALIB DATE
2-Self-recording (auto)
3-Microprocessor ALOO ALOR o
FOLLOWUP NO. 2 Minimum 40 hours ioise iree since Foilowup No.1
LEFT RIGHT
AUDIOMETRIC DATA
RE: ANSI $3.6 500 1000 2000 3000 4000 6000 500 1000 2000 3000

CURREN7 AUDIOGRAM yeer month CEy

DATE
221SabLT O17015 O / 0 5 O53035
REFERENCE AUDIOGRAM year month day
DATE

THRESHOLD SHIFT

Better
Poorer
Significant threshold shift Counsel Validated by reviewer
Refer to approO Validatbe èy Teviower
STS STS airective Orig in heslth record
20dB or greater Return to duty Orng in health record
NO YES Requires medical Send copy 1oappr
Retest in 12 rno. Sene copy to registry
disposition registry
1-No es
:NING SERV!CE DUi_ OFC SYMBoL
NAME 5 EXAMINER (1 as s t . Mi) SSN OCCUPATION CODE
ET
OO00
KIHSER PATRICMAMODEL MANUFACTURER SERIAL NO LASTELECTROACOUSTIC
TYPE 1-Manoál CALIS DATE

3
2-Self-racording (auto)
3-Miçroprocessor
SERVICE DU
7RACO
SSN
0 OsC SYMEOL
REWEWED &ALIDATED BY: AUTOVON
OCCUFATON COD

S/N Ci02-LF-002-2161

DD Form 2216
SEP 79
 .DATE SYMETOMS, DIAGNOSIS, 1RIEAIMNT, IREATINCGLORGANIZATION (Sign
each entry)
26 MAY 19
Military Medicine, NAVHQSP. Corpus Christi, TX 78419
D aPZTne ln2Cut C u t S/CF/U.

-
R StatuS TerNo
Ceaint
TEAP PULSE&2 B/PË H WT
iavå5

SHil he sis Ths.ldh.F._ml/

PoAnJnn
57 S

DOCION*
EN
2nsTICVT CTAIC
4¥AYT H0DALYTCC

****

U.S. Governrnent Printing Oftice: 1991- 281-782/40140 STANDARD FORM 600 BACK (REV. 5-84)

(a)
 HEARING CONSERVATION DATA ZIP CODE/APO
DODCOMPONENT A-ARMY M-MARINE CORPS SERVICE COMPONENT
7 18 I719S1
WSSN
N-NAVY
F-AIR FORCE
1-OTHER DOD ACTIVITY
R-REGULAR
V-RESERVE
G-NATIONAL GUARD
1-0THER
LAST NAME-FIRST NAME-MIDDLE INITIAL
SEX DATE OF
BIRTH year montn
PAY GRADE, UNIFSVCS GRADE, CIVILIAN SERVICE DUTY
FFEMALE
MAILING ADDRESS OF ASSIGNMENT
E-
LOCATION-PLACE OF WORK
OCCUPATION CODE

SmA LviE srDE, LD 237

MAJOR COMMAND
DUTY PHONE
SMA ZnaLESIAE,TA SmA 77 32,
PURPOSE 1-90 DAY
AUDIOMETRY
2-ANNUAL 3-TERMINATION 4-OTHER
AUDIOMETRIC DATA LEFT RIGHT
RE: ANSi $3.6
500 1000 2000 3000 4000 b000 500 1000 2000 3000
GURRENT
DATE
AUDIOGRAM month day
4000

REFERENCE AUDIoGRAM
OATE /2 |1Sda 25 |35
THRESHOLDSHIFT L1510I4 121R |0 J00505200 6S05S|s|/o
+ Poorer = Better

1-No Significant threshold shift

51O10
Counsel Validated by reviewer
0O//|CCSe
STS Notity supervisor
2Yes i 20dB or greater NO
Return to duty
RetestIn 12 mo.
Orig In health record
Send copy to reglstry
STS
YES
Followup No. 1 after minimum
15 hours
NAME OF EXAMINER (Last, first, noise free
MI) TRAINING SSN
SEFVICEDUTY OFC SYMBOL
TYPE
PResTon
1-Manual
JupYA
MODEL
23 o OCUPTION CODE
6028
2-Self-recording (auto) MANUFACTURER SERIAL N0. LAST ELECTROACOUSTIC
3-Microprocessor
ILALCO FOLLOWUPNO.
TRMA 1 Minimum 15 hours noise free
CALIB DATE

AUDIOMETRIC DATA LEFT RIGHT

RE: ANSI $3.6 500 1000 2000 3000 4000 6000 500 1000 2000 3000 4000
CURRENT AUDIOGRAM
DATE

REFERENCE
DATE
AUDIOGRAM
al7 month day
3 oolS|000 20 2 oS os 0o5 25
THRESHOLDSHIFT
SIs| |lo 0o-sS 25 00 |05 |05-s OS|1oC
+= Poorer - = Better

1-No Significant threshold shift STS Counsel

Return to duty
+st51s|- Validated by reviewer
Orig in health record STS
o-so 5
Notify Supervisor
2-Yes t 20dB or greater NO Cleared by medical reviewer
Retest in 12 mo. Send copy to registry YES
NAME OF EXAMINER (Last, first, MI) before Followup No. 2
TRAININGG SSN
CERT. NO. VICE DUTY
OCCUPATION CODE
OFC SYMBOL

TYPE imen eq
1-Manual
JCsUS
MODEL
940706 |65 o 3 6
MANUFACTURER SERIAL NO. 7432
2-Self-recording (auto) LAST ELECTROACOUSTIC
CALIB DATE
3-Microprócessor
TKA4OO|reme tsics|$zso FOLLOWUP NO. 2 Minimum 40 hours noise free since Followup No.1
3
year month

Aolo
AUDIOMETRIC DATA LEFT RIGHT
RE: ANSI S3.6
500 1000 2000 3000 4000 6000 500 1000 2000 3000 4000 6OC
CURRENT AUDIOGRAM year month
DATE day

REFERENCE AUDIOGRAM
DATE month

THRESHOLD SHIFT &Isl ol2ix looo |20oro lolLelos

+ = Poorer

Significant threshold shift

+ 20dB or greater
- = Better

fos|tes 1o|03 /o0 tosto (t2l

STS Counsel Validated by reviewer o
Refer to appro Validated by reviewer
Return to duty Orig in health record STS
NO airective Orig in health record
Retest in 12 mo. Send copy to registry YES Requires medical Send copy to appro
1-No 2-Yes
disposition registry
NAME OF EXAMINER (Last, first, MI)
TRAININGG SSN SERVIE Du ons
CERT. NO.
OFC SYM8OL
CoRNISH_LLViN
TYPE 1-Manual MODEL 13500y3s|A2lz sasT
UPATION CODE

47432
2-Self-recording (auto) MANUFACTURERR SERIAL NO.
LAST ELECTROACOuSTIC
3-MicreprÖcessor
REVIEWED& VALDATED BY:
RA 40 SERVICEDUTY
TAGETRCS
OCCUPATION CODE
AUTOVONN
SO3f
SSN
CALIB OATE
13
year month

OFC SYMBOL
lo
da

776 s71 E743

DD Form 2216 S/N 0102-LF-o05-8900
1 JAN 89
 REFERENCE AUDIOGRAM 2IP CODE/APO,
DOD COMPONENT
SERVICE cOMPONENT
1813 l2 s1ol2ls
A-ARMY M-MARINES
N-NAVYY
F-AIR FORCE
-OTHER DOD ACTIVITY A-REGULAR G-NATIONAL GUARD
V-RESERVE -OTHER

SSN PERSONAL DATA

|LAST NAME-FIRST NAME-MIDDLE INITIAL
SEX
DATE OF BIRTH
SN YDG
PAY GRADE, UNIFOAMED
ROBEL7
GRADE, CiVILIAN
M--MALE SERVICE OUTY
year month day EHVICES OCCUPATION CODE
M F-FEMALE
MAILING ADDRESS OF ASSIGNMENT Llslol72 EN 4329
SimA BC0 G. 237
AUA StATi oA
LOCATION-PLACE OF WORK LH6LES1OE IX MAJOR COMMAND DUTY PHONE

SimA_ SimA 12) 77e4323

AUDIOMETRY
1. REFERENCE ESTABLISHED PRIOR TO INITIAL DUTY IN HAZARDOUS NOISE AREAs
2. REFERENCE ESTABLISHED FOLLOWING EXPoSURE IN NOISE DUTIES
3. REFERENCE RE-ESTABLISHED AFTER FOLLOWUP
PROGRAM
HEARING THRESHOLD LEVELS OF TEST FREQUENCIES RE: ANSI s3.6
LEFT EAR RIGHT EAR
500 1000 2000 3000 4000 6000 500 1000 2000 3000 4000 60C0

OS|oS
DATE OF AUDIOGRAM
oo S|25 30 o
DAY OF WEEK MIL-TIME-DAY HOURS SINCE ENT PROBLEM AT TIME OF TESST
1-SUN 4-WED 7-SAT LAST NOiSE
year month day EXPOSURE

13lilzl 3
2-MON 5-THURSS -NO 2-YES
3-TUES 6-FRI O2olo 3-UNKNOWN
LAST NAME-FIRST NAME-MIDDLE INITIAL
EXAMINER
TRAINING SSN SERVICE DUTY OFFICE SYMBOL
CERT. NO.
OcCUPATION CODE

CoRwIA LEVIN S_ 13fooy 3lslnl2

AUDIOMETER
sz Hm EL32 47432
TYPE MODEL
1-MANUAL. MANUFACTURER SERIAL NUMBER LAST ELECTROACOuSTIC CALIB
2-SELF-RECORDING DATE

31 year month day

automatic)
3-MICROPROCESSOR RA YoO TREME1 S 92 SO38 213 lo ol
PERSONAL HEARING PROTECTION
TYPE USED EARPLUGS ISSUEDSIZE EARPLUGS
1-SINGLE FLANGE (V51R) 5-NOISE MUFFS DOUBLE PRO- GLASSES WORN
FREQUENCY
1-XS TECTIONN including goggies) GLASSES WORN
2-TRIPLE FLANGE 6-OTHER 1-NO 2-YES
AL 2-S USED 1-ALWAYS
3-HAND FORMED EARPLUGS
4-EAR CANAL CAPS
3-PREVIOUSLY
ISSUED
3-M
4-L
5-XL
2 1-NO
2-YES
1-NO
2-YES
2-SELDOM
J-N/A
REMARKS

RE FGRCGre
AFTE o ta, F/
PeAE o DETLED SURUCELACE ProCAA

CONTENTS REVIEWED AND VALIDATED BY

NAME OF REHEWER (Signature) SERVICE DUTY AUTOVON SSN
OCCUPATION OFFICE SYMBOL

DD ORM
1 Sep 79 2215
T1g/1 1776 yS2s kkliok/lZ 47432
)
S/N 0102-LF-002-2151