Attachment to CA-2 Form 

 

Robert F. Farmer

March 21, 1993

 

Evidence Required to Support a claim for occupational disease:

 

1. Employee's Statement:

 

a) History:

 

After a physical examination by Dr. Walcott on February 9, and follow up examinations by Dr. Dabe (February 22 through March 17, 1993), I was diagnosed to have Chronic Myelocytic Leukemia (CML). My spleen is enlarged, my white cell count was 150,000, and I have the Philadelphia Chromosome (parts chromosome 9 and 22 are interchanged) which confirmed the diagnoses of CML.

 

Dr. Dabe informed me I probably had the disease for several months to a year.

 

I am currently in treatment under Dr. Dabe of Group Health. Preparations are being made for a bone marrow transplant at the Fred Hutchinson Cancer Research Center. A search is being made for a donor.

 

b) Factors responsible for condition:

 

During my employment at Puget Sound Naval Shipyard I have been exposed to many agents that may have caused or contributed to my cancer (leukemia). They are listed on the attached Cancer Causing Exposure Data Record.

 

Because of several cases of cancer to workers in my office, at least two of them are leukemia, I believe there is significant reason to believe the conditions of my work may have caused or contributed to my condition.

 

2. Medical report:

 

The medical report will be requested from my treating physicians at Group Health Cooperative of Puget Sound and the Fred Hutchinson Cancer Research Center of Seattle, WA.

 

I am submitting this claim before getting a medical report to meet the reporting time limits of my claim.