DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR MEDICARE & MEDICAID SERVICES

MEDICARE REDETERMINATION REQUEST FORM — 1ST LEVEL OF APPEAL

1. Beneficiary’s name:______________________________________________________________________

2. Medicare number: _______________________________________________________________________

and
suspension of medicare A&B entitlement
3. Item or service you wish to appeal: _________________________________________________________

4. Date the service or item was received: _______________________________________________________

5. Date of the initial determination notice (please include a copy of the notice with this request):
(If you received your initial determination notice more than 120 days ago, include your reason for the late filing.)

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
5a. Name of the Medicare contractor that made the determination (not required):
______________________________________________________________________________________
5b. Does this appeal involve an overpayment? Yes No
(for providers and suppliers only)

6. I do not agree with the determination decision on my claim because:

______________________________________________________________________________________
______________________________________________________________________________________
________________________________________________________________________
7. Additional information Medicare should consider:

_____________________________________________________________________________________
_
______________________________________________________________________________________
______________________________________________________________________________________
8. I have evidence to submit. Please attach the evidence to this form or attach a statement explaining what
you intend to submit and when you intend to submit it. You may also submit additional evidence at a
later time, but all evidence must be received prior to the issuance of the redetermination.
I do not have evidence to submit.

9. Person appealing: Beneficiary Provider/Supplier Representative

10. Name, address, and telephone number of person appealing: ______________________________________

x 78266 210-294-4533
______________________________________________________________________________________

11. Signature of person appealing: _____________________________________________________________

March 1,
12. Date signed:____________________________________________________________________________
PRIVACY ACT STATEMENT: The legal authority for the collection of information on this form is authorized by section 1869 (a)(3) of the Social Security Act. The
information provided will be used to further document your appeal. Submission of the information requested on this form is voluntary, but failure to provide all or
any part of the requested information may affect the determination of your appeal. Information you furnish on this form may be disclosed by the Centers for Medicare
and Medicaid Services to another person or government agency only with respect to the Medicare Program and to comply with Federal laws requiring or permitting
the disclosure of information or the exchange of information between the Department of Health and Human Services and other agencies. Additional information about
these disclosures can be found in the system of records notice for system no. 09-70-0566, as amended, available at 71 Fed. Reg. 54489 (2006) or at
http://www.cms.gov/PrivacyActSystemofRecords/downloads/0566.pdf
Form CMS-20027 (12/10)
 DISABILITY REPORT - APPEAL
SSA-3441-BK

PLEASE READ THIS INFORMATION BEFORE COMPLETING THIS REPORT

This report is used to update your information for your disability appeal. Completing this report accurately
helps us process your claim. Please complete as much of this report as you can.

IF YOU NEED HELP

Please do not ask your health care provider to complete this report. You can get help from other people,
such as a friend or family member. If you cannot complete this report, a Social Security representative
can assist you. If you make an appointment with us, please complete as much of this report as you can
and have it with you for your appointment.

HOW TO COMPLETE THIS REPORT

If you have Internet access, you may be able to complete this report online at
www. ssa.gov/disability/appeal

If you complete this report on paper:

•
Print or write clearly.

•
Include a Z I P or postal code with each address.

• Provide complete phone numbers, including area code. If a phone number is outside the
United States, also provide International Direct Dialing ( I D D) code and country code.

•
If you cannot remember the names and addresses of your health care providers, you may be
able to get that information from the telephone book, Internet, medical bills, prescriptions, or
prescription medicine containers.

• ANSWER EVERY QUESTION, unless this report indicates otherwise. You can write "don't
know," or "none," or "does not apply" if you need to.

• If you need more space to answer any question, please use the R E MA RKS section on the last
page, SECT ION 10. Include the number of the question you are answering.

YOUR MEDICAL RECORDS

If you have any medical records that you have not given to us, send or bring them to our office with this
completed report. Please tell us if you want us to return them to you. If you are having an interview in our
office, bring your medical records, your prescription medicine containers (if available), and this completed
report with you.

YOU DO NOT NEED TO ASK DOCTORS OR HOSPITALS FOR ANY MEDICAL RECORDS THAT YOU
DO NOT ALREADY HAVE. With your permission, we will request your records. The information that you
give us on this report tells us where to request your medical and other records.

HOW TO SUBMIT THIS REPORT

Send or bring this completed report to your local Social Security office. If you have Internet access, you
can locate your nearest Social Security office by zip code at www.socialsecurity.gov/locator. Our offices
are also listed under U.S. Government agencies in your telephone directory or you may call Social
Security at 1-800-772-1213 (TTY 1-800-325-0778).
 Privacy Act Statement
Disability Report - Appeal
Collection and Use of Personal Information

Sections 205 (42 U.S.C. 405 (a) and (b)), 223 (42 U.S.C. 423 (d)), and 1631 (42 U.S.C. 1383 (e)(1)) of
the Social Security Act, as amended, authorize us to collect this information. We will use the information
you provide to update your disability report information.

Furnishing us this information is voluntary. However, failing to provide us with all or part of the information
may prevent an accurate and timely decision on your appeal for your claim.

We rarely use the information you provide on this form for any purpose other than to update your disability
information. However, we may use it for the administration and integrity of Social Security programs. We
may also disclose information to another person or to another agency in accordance with approved
routine uses, which include but are not limited to the following:

1. To enable a third party or an agency to assist Social Security in establishing rights to Social
Security benefits and/or coverage;

2. To comply with Federal laws requiring the release of information from Social Security records
(e.g., to the Government Accountability Office and Department of Veterans Affairs);

3. To make determinations for eligibility in similar health and income maintenance programs at the
Federal, State, and local level; and

4. To facilitate statistical research, audit, or investigative activities necessary to ensure the

integrity of Social Security programs (e.g., to the U.S. Census Bureau and to private entities
under contract with us).

A complete list of when we may share your information with others, called routine uses, is available in our
Privacy Act Systems of Records Notices entitled, Claims Folder System (60-0089) and Electronic
Disability (60-0320). Additional information about these and other system of records notices and our
programs are available online at www.socialsecurity.gov or at your local Social Security office.

We may also use the information you provide in computer matching programs. Matching programs
compare our records with records kept by other Federal, State, or local government agencies. Information
from these matching programs can be used to establish or verify a person's eligibility for Federally funded
or administered benefit programs and for repayment of payments or delinquent debts under these
programs.

Paperwork Reduction Act

This information collection meets the requirements of 44 U.S.C. § 3507, as amended by Section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid
Office of Management and Budget control number. We estimate that it will take about 45 minutes to read
the instructions, gather the facts, and answer the questions.

You may send comments on our time estimate above to:

SSA, 6401 Security Boulevard, Baltimore, MD 21235-6401.
Send ONLY comments relating to our time estimate to this address, not the completed form.

AFTER COMPLETING THIS REPORT, REMOVE THIS SHEET AND KEEP IT

FOR YOUR RECORDS.
 Form Approved
SOCIAL SECURITY ADMINISTRATION OMB No. 0960-0144
DISABILITY REPORT - APPEAL
For SSA use only. Please do not write in this box.
Related SSN ___ ___ _ _ __
_
Number Holder ____________

If you are filling out this report for someone else, please provide information about him or her. When a question
refers to "you" or "your,'' it refers to the person who is applying for disability benefits.
SECTION 1 - INFORMATION ABOUT THE DISABLED PERSON

1. A. Name (First, Middle, Last, Suffix) 1. B. Social Security Number

Michael Thomas Paul 465-59-7389

1. C. Daytime Phone Number, including area code (include IDD and country codes if outside the U.S. or Canada)
2102944533

D Check this box if you do not have a phone number where we can leave a message.

1. D. Alternate Phone Number - another number where we may reach you, if any

none
1. E. Email Address (Optional)
mtp7389@HOTMAIL.COM

SECTION 2 - CONTACTS
Give the name of someone (other than your doctors) we can contact who knows about your medical conditions,
and can help you with your claim. (e.g., friend or relative)
2. A. Name (First, Middle, Last) 2. B. Relationship to Disabled Person

none n/a
2. C. Mailing Address (Street or PO Box), include apartment number or unit if applicable.
n/a
City State/Province ZIP/Postal Code Country (if not U.S.)

n/a n/a n/a n/a

2. D. Daytime Phone Number, including area code (include IDD and country codes if outside the U.S. or Canada)

n/a
2. E. Can this person speak and understand English?
D Yes D No
If no, what language does the contact person prefer?
n/a
2. F. Who is completing this form?
0 The person who is applying for disability (Go to SECTION 3 MEDICAL CONDITIONS).
-

D The person listed in 2.A. (Go to SECTION 3 - MEDICAL CONDITIONS).

D Someone else (Please complete the information below).
2. G. Name (First, Middle, Last) 2. H. Relationship to Disabled Person

n/a n/a
2. I. Mailing Address (Street or PO Box) Include apartment number or unit if applicable.

n/a
City State/Province ZIP/Postal Code Country (if not U.S.)
n/a n/a n/a n/a
2. J. Daytime Phone Number, including area code (include IDD and country codes if outside the U.S. or Canada)

Form SSA-3441-BK (03-2015) ef (03-2015)

Page 1
Destroy Prior Editions
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 SECTION 3 - MEDICAL CONDITIONS

3. A. Since you last told us about your medical conditions, has there been any CHANGE (for better or worse)
in your physical or mental conditions?
OCTOBER 2 1 2o14
[8] Yes, approximate date change occurred: D No

If yes, please describe in detail: HOSPITALIZED FROM ELECTROMAGNETIC FLUX AND PULSED

MICROWAVE RADIO FREQUENCY FROM ELECTRIC UTILITY.

3. B. Since you last told us about your medical conditions, do you have any NEW physical or mental
conditions?

[8] Yes, approximate date of new conditions: OCTOBER 2, 2014

D No

If yes, please describe in detail: Additional Physical impairment caused from Thermal Absorption of
Impairment

microwave radiation from Titanium Plate Implants causing nosebleeds, blurred vision,

s e vere knee pain and s t iffness , heart arithmia,memory loss,uncontrolled spasams

If you need more space, use SECTION 10 - REMARKS on the last page.

SECTION 4 - MEDICAL TREATMENT

4. A. Have you used any other names on your medical or educational records? Examples are maiden name,
other married name, or nickname.
D Yes [8] No

If yes, please list the other names used: ������

4. B. Since you last told us about your medical treatment, have you seen a doctor or other health care
provider, received treatment at a hospital or clinic, or do you have a future appointment scheduled?

[8] Yes 0 No (Go to SECTION 6 - MEDICINES)

4. C. What type(s) of condition(s) were you treated for, or will you be seen for?

[8] Physical D Mental (including emotional or learning problems)

If you answered "Yes" to 4.B., please tell us who may have NEW medical records about any of your physical or
mental conditions (including emotional or learning problems).

Use the following pages to provide information for up to three (3) providers. Complete one page for each
provider. If you have more than three providers, list them in SECTION 10 - REMARKS on the last page.

Please include:
doctors' offices
hospitals (including emergency room visits)
clinics
mental health center
other health care facilities.

Only list the providers you have seen since you last told us about your medical treatment.

Form SSA-3441-BK (03-2015) ef (03-2015) Page 2

 SECTION 4 - MEDICAL TREATMENT (continued)
Provider 1
4. D . Name of facility or office Name of health care provider who treated you
METHODIST HOSPITAL STONE OAK
EMERGENCY STAFF

ALL OF THE QUESTIONS ON THIS PAGE REFER TO THE HEALTH CARE PROVIDER ABOVE.
Phone Number Patient ID# (if known)
(210) 638-2000
465-59-7389

Address
1139 E Sonterra Blvd

City State/Province ZIP/Postal Code Country (if not U.S.)

San Antonio TX 78258

Dates of Treatment (approximate date, if exact date is unknown)

Office, Clinic or Outpatient visits at Emergency Room visits at Overnight hospital stays at
this facility this facility this facility
First Visit __ _ _ _ __ Date 1oI02/2014 Date in 10/2/14 Date out10 /3/14
Last Visit _______ Date 10/??/2016 Date in ___ Date out ___

Next scheduled appointment Date 11/2015

__ _ _ _ _ __ Date in _ __ Date out _ __

(if any) ________ D None D None

What medical conditions were treated or evaluated?

EMF/RF SICKNESS 10/02/2014; ABCESS 10/16

What treatment did you receive for the above conditions? (Do not list medicines or tests in this box.)

REFERALS AND MEDICATION

Has this provider performed or sent you to any tests? Please include tests you are scheduled to have in the
future. � Yes (Please complete the information below.) D No (Go to the next page.)

KIND OF TEST DATES OF KIND OF TEST DATES OF

TESTS TESTS
D Biopsy (list body part) x MRI/CT Scan (list body part)
D 10/02/2014

HEAD/CHEST

� Blood Test (not HIV) 10/02/2014 D Speech/Language Test

D Breathing Test D Treadmill (exercise test)

D Cardiac Catheterization D Vision Test

D EEG (brain wave test) D X-ray (list body part)

� EKG (heart test) 10/02/2014

D Hearing Test � Other (please describe) 10/03/2014

CHEMICAL INDUCED
D HIV Test STRESS TEST

D IQ Testing

If you need to list more tests, use S ECTION 10 - R E MA RKS on the last page.

If you do not have any more providers to describe,

go to SECTION 5 - 0THER MEDICAL INFORMATION on page 6.
Form SSA-3441-BK (03-2015) ef (03-2015) Page 3
 SECTION 4 - MEDICAL TREATMENT (continued)
Provider 2
4. D . Name of facility or office Name of health care provider who treated you
METHODIST HOSPITAL
Live OAK Emergency room staff
ALL OF THE QUESTIONS ON THIS PAGE REFER TO THE HEAL TH CARE PROVIDER ABOVE.
Phone Number Patient ID# (if known)
465597389
(210) 757-7000
Address

12412 Judson Rd, Live Oak, TX 78233

City State/Province ZIP/Postal Code Country (if not U.S.)
Live Oak Texas 78233

Dates of Treatment (approximate date, if exact date is unknown)

Office, Clinic or Outpatient visits at Emergency Room visits at Overnight hospital stays at
this facility this facility this facility

First Visit Date 10/2015

------
Date in ���
Date out ---

LastVisit Date ________ Date in Date out ___

Next scheduled appointment ------

Date in Date out ---

(if any) __ _ _ _ _ __ 0 None D None

What medical conditions were treated or evaluated?

absess treatment
What treatment did you receive for the above conditions? (Do not list medicines or tests in this box.)

emergency room care

Has this provider performed or sent you to any tests? Please include tests you are scheduled to have in the
future. D Yes (Please complete the information below.) [8] No (Go to the next page.)

KIND OF TEST DATES OF KIND OF TEST DATES OF

TESTS TESTS
D Biopsy (list body part) D MRI/CT Scan (list body part)

D Blood Test (not HIV) D Speech/Language Test

D Breathing Test D Treadmill (exercise test)

D Cardiac Catheterization D Vision Test

D EEG (brain wave test) D X-ray (list body part)

D EKG (heart test)

D Hearing Test D Other (please describe)

D HIV Test

D IQ Testing

If you need to list more tests, use S ECTION 10 - REMARKS on the last page.

If you do not have any more providers to describe,

go to SECTION 5 - 0THER MEDICAL INFORMATION on page 6.
Form SSA-3441-BK (03-2015) ef (03-2015) Page 4
 SECTION 4- 4
SECTION MEDICAL TREATMENT
- MEDICAL TREATMENT (continued)
(continued)
3 3
Provider
Provider
4. D.4.Name of facility
D. Name or office
of facility or office Name of health
Name care care
of health provider who who
provider treated you you
treated
SAN ANTONIO PAIN CLINIC Kanishka Manis

ALL ALL
OF THE QUESTIONS
OF THE ON THIS
QUESTIONS PAGE
ON THIS REFER
PAGE TO THE
REFER HEAL
TO THE TH CARE
HEALTH PROVIDER
CARE ABOVE.
PROVIDER ABOVE.

I
Phone Number
Phone Number Patient ID# (if
Patient ID#known)
(if known)
1-844-789-2746 465597389

Address
Address
110 Stone oak Loop

City City State/ProvinceZIP/Postal

State/Province Country
CodeCode
ZIP/Postal (if not(ifU.S.)
Country not U.S.)
San Antonio Texas 78258

Dates of Treatment
Dates (approximate
of Treatment date, date,
(approximate if exact date date
if exact is unknown)
is unknown)
Office, Clinic
Office, or Outpatient
Clinic visits
or Outpatient at at Emergency
visits EmergencyRoom visits
Room at at
visits Overnight hospital
Overnight stays
hospital at at
stays
this facility
this facility this this
facility
facility this this
facility
facility

First First Visit

VisitJul 9, 2o14 Date Date DateDate
in in DateDate
out out
14, 2015
Last Last Visit
Visit Jan Date DateDate
in in DateDate
out out
Next Next scheduled
scheduled appointment
appointment Date Date DateDate
in in DateDate
out out
(if any)
(if any) 0 D None
None D D None
None
WhatWhat medical
medical conditions
conditions werewere treated
treated or evaluated?
or evaluated?

chronic pain syndrome, knee pain both l egs

What
What treatment
treatment did you
did you receive
receive forabove
for the the above conditions?
conditions? (Dolist
(Do not notmedicines
list medicines or tests
or tests in box.)
in this this box.)
injections for pain, nerve obl ations, prescription durabl e medical devices for legs

Has Has
this this
provider performed
provider or sent
performed you you
or sent to any
to tests? Please
any tests? include
Please teststests
include you are
youscheduled to have
are scheduled in thein the
to have
future. D Yes (Please complete the information below.)
future.D Yes (Please complete the information below.) [8] D No (Go to the next page.)
No (Go to the next page.)

KINDKIND
OF TEST DATES OF OF
DATES KIND OF TEST DATES OF OF
DATES
OF TEST KIND OF TEST
TESTS
TESTS TESTS
TESTS
D Biopsy
D Biopsy
(list body part)part)
(list body D D MRI/CT
MRI/CT ScanScan
(list body part)part)
(list body

D Blood
D Blood
Test Test
(not HIV)
(not HIV) D Speech/Language
D Speech/Language Test Test

D Breathing
D Breathing
Test Test D Treadmill
D Treadmill
(exercise test) test)
(exercise

D Cardiac
D Cardiac
Catheterization
Catheterization D Vision
D Vision Test Test

D EEG
D EEG
(brain wavewave
(brain test) test) D X-ray
D X-ray
(list body part)part)
(list body

D EKG
D EKG
(heart test) test)
(heart

D Hearing
D Hearing Test Test D Other
D Other (please describe)
(please describe)

D HIV
D Test
HIV Test

D IQ
D Testing
IQ Testing

If you need to list more tests, use S ECTION 10 - REMARKS on the last page.
If you need to list more tests, use SECTION 10 - REMARKS on the last page.
If you do not have any more providers to describe,
If you have
go tobeen treated5by
SECTION more providers,
- 0THER MEDICAL use section 10 REMARKS
INFORMATION on page on
6. the last page.
-

FormForm
SSA-3441-BK (03-2015)
SSA-3441-BK ef (03-2015)
(03-2015) ef (03-2015) PagePage
4 5
 SECTION 5 - OTHER MEDICAL INFORMATION
5. Since you last told us about your other medical information, does anyone else have medical information
about any of your physical or mental conditions (including emotional and learning problems) or are you
scheduled to see anyone else?
This may include:
workers' compensation
vocational rehabilitation services
insurance companies who have paid you disability benefits
prisons and correctional facilities
attorneys
social service agencies
welfare agencies
school/education records
D Yes (Please complete the information below.)
D
X No (Go to SECTION 6 MEDICINES)
-

Name of Organization Claim or ID Number (if any)

State Medicaid 609981702
Address
110 Windy Meadows Dr
City State/Province ZIP/Postal Code Country (if not U.S.)

Schertz Texas 78154

Name of Contact Person Phone Number
Jerri
Date of First Contact Date of Last Contact Date of Next Contact (if any)
2011 2017
Reasons for Contacts
QMB

If you need to list more people or organizations, use SECTION 10 - REMARKS on the last page.

SECTION 6 - MEDICINES
6. Are you currently taking any medicines (prescription or non-prescription)?
D Yes (Please complete the information below. You may need to look at your medicine containers.)
X No (Go to SECTION 7
D - ACTIVITIES)

IF PRESCRIBED, REASON FOR MEDICINE SIDE EFFECTS

NAME OF MEDICINE
NAME OF DOCTOR YOU HAVE

If you need to list more medicines, use SECTION 10 - REMARKS on the last page.
Form SSA-3441-BK (03-2015) ef (03-2015) Page 6
 SECTION 7 - ACTIVITIES
7. Since you last told us about your activities, has there been any change (for better or worse) in your daily
activities due to your physical or mental conditions? (Examples of daily activities are household tasks,
personal care, getting around, hobbies and interests, social activities, etc.)
XD Yes D No
de
________________________
_

If you need more space, use SECTION 10 - REMARKS on the last page.

SECTION 8 - WORK AND EDUCATION

8. A. Since you last told us about your work, have you worked or has your work changed?

D Yes D
X No
If yes, you will be asked to provide additional information.

8. B. Since you last told us about your education, have you completed or are you enrolled in any type of
specialized job training, trade school, or vocational school?

D Yes D
X No

lf yes,what type? ______________________________

attended: ------ Date(s)

If you need more space, use SECTION 10 - REMARKS on the last page.

SECTION 9 - VOCATIONAL REHABILITATION, EMPLOYMENT, OR OTHER SUPPORT SERVICES

9. Since you last told us about your vocational rehabilitation, have you participated, or are you participating in:
an individual work plan with an employment network under the Ticket to Work Program?
an individualized plan for employment with a vocational rehabilitation agency or any other organization?
a Plan to Achieve Self-Support (PASS)?
an individualized education program (IEP) through an educational institution (if a student age 18-21 )?
any program providing vocational rehabilitation, employment services, or other support services to help
you go to work?
D Yes (Please complete the information below.)
D
X No (Go to SECTION 10 - REMARKS)
Name of Organization or School
n/a
Name of Counselor, Instructor, or Job Coach Phone Number

n/a n/a
Address
n/a
City State/Province ZIP/Postal Code Country (if not U.S.)

n/a n/a n/a n/a

Date when you started participating in the plan or program:

If you need more space, use SECTION 10 - REMARKS on the last page.
Form SSA-3441-BK (03-2015) ef (03-2015) Page 7

If yes, please describe in detail:

 SECTION 10 - REMARKS
Use this space to provide any information you could not show in earlier sections of this form or any additional
information you feel we should know about. Please be sure to include the number of the question you are answering
(For example, 3A, 40, etc.).
This information is being supplied for a redetermination hearing before a DHO for
appeal of denial of continued benefits which have been ongoing since award in 1999.
I have been scheduled for reviews every 7 years because my condition is that of no
improvment expected and I am unable to engage in substantial gainful activity.
I am requesting my checks to continue during this process which is within the 10
days of first being notified by U.S. mail on Saturday February 18, 2017, SSA Pub No.
L8052 which stated a SSA PUB. No. 05-10090 Explination of Determination was included
as an Enclosure document but there was no document included in the envelope so I am
uninformed of the reason for determination stopping my disability retirement payments.

Date Report Completed MM/DD/YYYY: 02/22/2017

�������

Form SSA-3441-BK (03-2015) ef (03-2015) Page 8

Senator Cornyn,

The Administration has alleged I did not comply with the following Federal Regulation

Code Of Federal Regulations

§ 404.705. Failure to give requested evidence.

Generally, you will be asked to give us by a certain date specific kinds of evidence or
information to prove you are eligible for benefits. If we do not receive the evidence or
information by that date, we may decide you are not eligible for benefits. If you are already
receiving benefits, you may be asked to give us by a certain date information needed to decide
whether you continue to be entitled to benefits or whether your benefits should be stopped or
reduced. If you do not give us the requested information by the date given, we may decide that
you are no longer entitled to benefits or that your benefits should be stopped or reduced. You
should let us know if you are unable to give us the requested evidence within the specified time
and explain why there will be a delay. If this delay is due to illness, failure to receive timely
evidence you have asked for from another source, or a similar circumstance, you will be given
additional time to give us the evidence.

Which is the basis for the termination of my Continuing disability payments.

1. This is a false accusation and reason being used to cease paying my qualified entitlement
because I was never requested to provide any further information after the last letter received
stating my application was incomplete missing the last 2 pages.
I had realized I didn’t supply the last two pages and sent the entire application through the
US mail which I sent from a USPS bluebox outside the City of Selma municipal offices. So I
again drove to Social Security’s office and provided another copy of the originals.

2. The Administration states my disability certification was for a cervical injury which could
have healed along with problems of my left arm. This too is a false statement. The cervical
injury refereed too was a secondary debilitating factor as too was the left arm.
When I was originally certified as 100% totally and permanently disabled it was based on
medical documentation provided from my attending Orthopedic Surgeon Dr. Frank Kuwamura.
Lieutenant Commander Dr. Frank Kuwamura was the Chief Orthopedic Surgeon stationed
at the Bethesda Naval Hospital in Maryland and was one of only two hospitals that are tasked
with providing medical treatment for the President of the United States.
As I am ex navy having enlisted in 1985 I sought out the best military doctor to attend to my
medical needs.
 Dr. Kuwamura being retired from the Navy and having a private practice in San Antonio,
accepted me as his patient after reviewing my medical records In 1998.
After exhausting all non-invasive treatments determined I was going to have to undergo
Spinal surgery due to multiple bulging disks that were pressing into the spinal cord that was
causing me to have respiratory and neurological problems.
Dr Kuwamura operated and performed a multi level lamanectomy (a surgical procedure
developed and utilized by the US military during the Korean and Vietnam wars ) Becuase the
surgery does not fuse the bone with plates and pins I will always have severe instability in my
thoracic spine.
Dr. Kuwamura explicitly stated that my condition was as good as it will ever be in 2001 and
that it will progressively get worse the older I get.

3. New disability factor caused from being assaulted where My femur was broke while in
custody of the Bexar County Sheriff on a misdemeanor charge requiring surgical implant of a
titanium plate and pins in 2007.
This was addressed to the Administration on my last review in 2009 when I was sent to a
physician who performed my review.

4. Additional disabilities caused by the placement of two smart meters on my home that due to
my implanted plate caused permanent damage to me physically. I am currently suing the City
of San Antonio in Federal District Court for injury, product liability, failure to provide warning,
fraud, and conspiracy with General Electric Power, Itron, and Outback Power corporations.
Cause 5:16-CV-0119-OLG western district of Texas. The medical information was provided on
my review application listing the date of hospitalization and tests performed.

Sir, as you can see from the document provided by the Administration to you in response to your
inquiry, there are no dates anywhere showing when the documents were created. This being the case
Social Security can not position me as having not responded within the proper time to appeal any
action they have taken nor can they require me to make a statement for untimely requesting an appeal.
I sent the reconsideration request by fax last weekend and also request my checks to continue
through this process. I also asked for an in person hearing before a hearings officer so I can verbally
present my position and question witnesses.
 I’m beginning to feel as though I am being subjected to the exact same treatment that I endured last
year concerning my QMB medicare medicaid for which my monthly checks were stopped then also
and only after getting in contact with your office was I able to resolve that improper action and recover
my entitlement.

Dated : FEBRUARY 28, 2017 /s Thomas Paul

Michael Thomas Paul
9123 Easy St, San Antonio Tx 78266
mtp7389@hotmail.com

“I state under penalty of perjury that the foregoing is true and

correct. Executed on February, 28, 2017.
”.

28 U.S. Code § 1746