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NPI or UPIN-1225123318- lic #--D43471
4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com
His case has lingered until now. It important to note that his smoking history was minimal compared to
his TB (restrictive type) loss of lung function in the early and late 1950s. His spouse had known him
since 1957 and she stated that he could not even walk a short distance without being short of breath (1
MET) and could not dance or do anything physical even when they first met in 1957- again due to his
shortness of breath.
METs are defined as follows:
1. 1 MET = Eat-dress use toilet- standing at rest or oxygen uptake at 3.5 mls per kg of body wt per
minute
2. MET = walk around
3. MET = walk 2 blocks on level 2-3 miles/hr
4. MET = wash dishes, dust
5. MET = climb a flight of stairs
6. MET = run a short distance walk briskly >4 mph
7. MET = scrub floors, lift heavy furniture
8. MET = dance, play golf or tennis
9. >10 MET = swimming, basketball, skiing
His daughters stated that their Dad never played sports with him due to his poor pulmonary function. He
had been smoking for about 15 years at this point as a casual smoker and the time lag for significant
pulmonary damage from smoking is my experience longer than 15 years. METS are normally used for
cardiac dysfunction in the rate schedule but his dysfunction over the years is best described using the
MET system, which encompasses both cardiac and pulmonary dysfunctions.
Recommendations:
1. All patients with lung diffusion that is not solely due to one pulmonary disease should get a DLCO test
along with PFTs.
2. All patients should get good lay statements to support their cases as the above statements clearly show
that this patient had severe lung disease early in his claims process.
3. All patients should consider the METs system to help establish disability if they are not able to do
cardiovascular demanding type work or recreation.
Craig Bash M.D. Associate Professor