6/5/2020 E-Library - Information At Your Fingertips: Printer Friendly examination reads as follows: Physical Examination: There is no tenderness elicited when pressing on the left buttock. Slight tenderness and radiating pain was noted when the L5-S1 facet joints were pressed. Assessment; Sacro-iliitis, left and Bilateral facet joint arthropathy, L5-S1 Plan: Local anesthesia injection into the left sacro-iliac joint to determine significance of the sacro-ilitis. If there is a slight improvement or complete improvement, then the sacro-iliac joint will be injected with steroids and long-acting local anesthesia. Then bilateral facet joint injections at L4-5 and L5-S1 will be performed on the same day.[32] On April 28, 2008, respondent consulted another independent physician, Dr. Alan Leonardo R. Raymundo (Dr. Raymundo) - an orthopedic surgeon of the Philippine Orthopedic Institute - who issued a Medical Report[33] which states: This 37-year-old seaman was repatriated here last May 2007, because of low back pain after carrying a heavy load while on board a ship. He was first seen at St. Luke's Medical Center when he was repatriated x x x and has undergone an epidural shot for his low back pain. His MRI plates show no significant disc protrusion that might be impinging on the nerve and his EMG NCV results were also normal. However he continuous [sic] to have low back pain whenever he would walk for long distances and whenever he would sit for long periods. He claims that his pain is actually in the area of the sacroiliac joint radiating down the buttock area and posterior to the thigh when this would occur. He was referred to Dr. Ramon Santos Ocampo to look for the pain generator and injection of the Facet Joint and the Sacroiliac Joint of the Lumbar Spine were done. After the procedure the pain was relieved, however after three weeks the pain recurred. Because of the recurrence of the pain and considering the nature of his job as a seaman, I told him that it would be impossible for him to return to his previous work duties. I would therefore declare him not fit for duty.[34] On October 8, 2009, respondent underwent a second MRI of the lumbar spine at the elibrary.judiciary.gov.ph/thebookshelf/showdocsfriendly/1/61305 5/25