Robert F. Farmer
411 Pinewood Dr. NE
Bremerton, WA 98310
(360) 373-5136
Email address: ocitgo@yahoo.com
Consumer Number: 020685
October 19, 2001
Irwin Dabe, M.D.
Group Health Cooperative
209 Martin Luther King, Jr. Way
Tacoma, WA 98405-4267
Subject: Worker's compensation claim for chromosomal injury and or chronic myelogenous leukemia
Claim File Number: A14282174 and A14320904
Attending Physicians Report - Rationalized medical opinion
Dear Dr. Dabe
I have decided to go ahead with the following and request reconsideration of the original claim.
In the decision dated January 17, 2001, James M. Bankert, Hearing Representative for the Director of Office of Worker's Compensation Programs combined my claims into one claim per the following statement:
ADDENDUM: It is noted that in filing the present claim, the claimant indicated that he had "new information" since the original claim. However, "new information" does not constitute a basis for filing a new compensation claim, and the present claim is in fact a duplicate of the original March 21, 1993 claim. Based on either the "new evidence" or his belief that he was mentally or physically incapable of filing a timely appeal of the January 10, 1994 decision, the claimant may file a request for reconsideration of the original claim with the District Office.
I need two statements in letterform.
First, I need to present evidence that I was mentally or physically incapable of filing a timely appeal of the January 10, 1994 decision. I believe your report from my medical files dated1/24/1994 titled To Whom It May Concern shows I was incapable of filing a timely appeal. I have enclosed a copy. In reference to that report, please provide a statement that I was incapable of filing a timely appeal.
Second, I request a well-reasoned medical opinion with specific exposure to employment hazards. These exposures were to sources of benzene in exhaust, welding, paint, and cleaning fluid fumes. I was exposed to heavy levels of hot tar and the dust from the roofing project of my office building (public works). In addition, I was exposed to nuclear radiation (ionizing radiation) as a nuclear worker. I believe that there is medical evidence that exposures to benzene and nuclear radiation are risk factors and have a casual relationship to CML. Even though you said the same in your Attending Physician's Report (Form CA-20) dated 2/28/1997, it was not adequate because it was not explained in detail. Per a letter from OWCP dated 1/20/2000, which I paraphrase as follows: the attached letter needs to provide results of tests, a firm diagnosis, and a medical discussion of the etiology of my disease with specific discussion of whether/which/how one or more of the employment exposures caused or worsened the conditions of my illness.
Attached is a list (page 3) of the carcinogens that apply to my claim. The times and places of exposures were part of my claims that I previously submitted to OWCP. In the 1/10/1994 decision, they were accepted as true as quoted below:
"The evidence of file supports the fact that the claimed events, incidents or exposures occurred at the times, places and in the manners alleged. However, a medical condition resulting from the accepted trauma or exposure is not supported by the medical evidence of file. Therefore, an injury within the meaning of the FECA is not demonstrated"
To help you make your statement standup to the workers' compensation law, I am presenting the following authoritative information that you may use in your narrative report.
The Report on Carcinogens is mandated by Section 301 (b) (4) of the Public Health Services Act, as amended, which stipulates that the Secretary of the Department of Health and Human Services shall publish an annual report.
The most recent report is the 9th Report on Carcinogens Revised January 2001
http://ehis.niehs.nih.gov/roc
The 9th Report on Carcinogens lists all known Carcinogens by name as of the published date.
Several new studies support my claim that exposures to benzene are causal to my leukemia.
This is a link to a web page about one of the studies:
http://ehpnet1.niehs.nih.gov/docs/1996/Suppl-6/linet.html#results
It is a Chinese study of 74,828 workers exposed to benzene verses 35,850 workers not exposed to benzene.
This is a link to legal report about benzene.
http://www.law.duke.edu/pac/cranor.pdf
I have enclosed the paragraphs about benzene.
CML is listed as one of the many covered cancers in the Energy Employees Occupational Illness Compensation Act of 2000. As a Department of Energy employee, I would be receiving compensation under this law. Because I was a nuclear employee of the Department of Defense, this law does not apply. Never the less, I believe it does provide strong causal support for my claim.
I believe it would be better to put the content of your Attending Physicians report dated 2/28/1997 in a narrative format that includes the a well-reasoned medical opinion with specific exposure to employment hazards. I am enclosing a copy of the original form. OWCP complained to me that it is difficult to read your handwriting.
I will send your letters to OWCP as soon you provide me with them. I appreciate your support.
Sincerely,
Robert F. Farmer
This is a list and summary of carcinogen exposures that apply to my claim
Employment at Puget Sound Naval Shipyard from April 1964 - April 1994
1. Benzene - in paint, cleaning solvents, printed circuit card manufacturing and repair
2. Toluene - used as clearer to aid soldering process.
3. Soldering fumes - contains several carcinogens
4. Exhaust fumes - while working in Building 431, 850 and 855 from April 1964 - April 1994 (benzene is a component of exhaust fumes)
5. Tars - roofing project while working in building 855 (Crane Engineering)
6. Paint fumes - while working shipboard and in shops (benzene is a component of many paint fumes)
7. Trichloroethelyene (TCE) - while working in cleaning booths
8. Welding fumes - shipboard and shop
9. Metal cutting and burning fumes - shipboard and shop
10. Electromagnetic force/electromagnetic pulse (EMF/EMP) - in the workplace from ship radars, electronic counter measures systems, and communications systems. Some of the radars and electronic counter measures systems produce energy levels over one megawatt in very narrow beams.
11. Ionizing radiation - from ships nuclear reactor and x-rays of hull and components such as piping.
Scientific Ignorance and Reliable Patterns of Evidence in Toxic Tort Causation:
Is There a Need for Liability Reform?
Carl F. Cranor and David A. Eastmond
http://www.law.duke.edu/pac/cranor.pdf
<snip>
D. Injuries Long Precede the Scientific Understanding of the Causes of Injury
Injury from a substance might easily precede scientific understanding and documentation of that fact. And, it might precede it by years, if not decades. The point is not merely that tort law compensation is retrospective, but a deeper one that in many cases it can take years to have clues that substances cause harm, even longer to document the cause of damage, and longer yet to develop a consensus on the issue. Whether scientists will ever have a full understanding of the toxicity of a substance is an even more open issue (if they ever do).
Consider benzene, an important industrial product and by now a well-known human carcinogen. Benzene was implicated in the 1890s of causing various blood diseases. In the 1920s, it was reported to cause leukemia. However, scientific documentation of and substantial agreement on benzene's leukemogenic properties did not come for another sixty years. In 1974 the World Health organization's International Agency for Research on Cancer, shortly after it was established in 1970, noted that it could only indicate that a relationship between benzene exposure and the development of leukemia was "suggested" by case reports and one case-control study. By 1982 the same organization judged that there was sufficient evidence that benzene was carcinogenic to man, and by 1987 it found that benzene "is carcinogenic to man." Surely people were contracting leukemia long before 1982 or 1987, and probably at higher rates than were seen in the 1970s and 1980s. However, until the last two decades there would have been little scientific consensus on it. Thus, there would have been no compensation for anyone who contracted leukemia from benzene exposure until there was "appropriate" documentation of the injuries in question.
Benzene is not an isolated case; similar problems have attended the scientific discovery of the adverse health effects of arsenic, dioxin, asbestos, and other substances. Although there is little systematic evidence on this point, benzene may be more representative than a substance such as Bendectin, for which there was a relatively quick scientific evaluation. Thus, slow knowledge accumulation poses serious problems. The more stringent courts are in screening scientific testimony, the more this will exacerbate it. Statutes of limitation only add to the problem.
Sample letter content
To present evidence that I was mentally or physically incapable of filing a timely appeal:
Robert F. Farmer was mentally and physically incapable of filing worker's compensation appeals for during his bone marrow transplant in September 1993 and much of the first year afterwards. He was a patient of Fred Hutchinson Cancer Research Center in Seattle, WA from 8/25/1993 through 11/4/1993. He was hospitalized from 9/1/1993 though 10/1/1993. My report dated 1/24/94 is evidence of his medical condition. He was again hospitalized for 1 week in February 1994 with Graft Verses Host Disease. He was treated for the next 2 years with drugs to control Graft Verses Host Disease. They affected his general well being and ability to be functional. During this time, he had several hospitalizations and required very frequent visits to my office and other medical clinics examinations, lab work, bone marrow biopsies, IV's, and blood infusions.
Narrative report from Attending Physician
a. Date of examinations and treatment
b. History given by you
c. Detailed description of findings
d. Results of all diagnostics tests
e. Diagnosis
f. The clinical cause of treatment followed.
g. Doctor's opinion, with reasons for such opinions, as to the relationship between any you may now have and the factors of employment. (A well-reasoned medical opinion with specific exposure to employment hazards.)
Attachment to CA-2 Form
Claim # A14-273881
Robert F. Farmer
SSN: xxx-xx-xxxx
May 18, 1992
Evidence Required to Support a claim for occupational disease:
1. Factors responsible for condition:
During my work in Crane Engineering, C/471.2, I was exposed to fumes, dust and dirt (that fell from large cracks in the ceiling/roof) caused by the roofing project of Building 455, from approximately 9/16/91 to 9/24/91. The dirt and dust was 1/4" to 1/2" deep. It caused significant lung, nose, and eye irritation.
From the start of my employment in Crane Engineering, C/471.2, on approximately 7/9/91 until the present time, I was exposed to high levels of vehicle exhaust fumes coming in off the floor of the Public Works shop work areas and the south side of building 455. Also during this same period I was exposed to high levels of welding and burning fumes from the Public Works shop work areas that penetrated my work areas.
The office and work areas for Crane Engineering are located over the Public Works Shops, in Building 455, that repair automobiles, trucks, heavy equipment, fork lifts, and cranes.
The windows of my office open to the south side of the building directly over the tire changing area. Truck and vehicle exhaust enter directly into my office windows. The exhaust pipes of many of these vehicles are directly at window level. They are often left running for the duration of the tire change (20-40 minutes).
2. History of condition:
During the time of this exposure, I had a sinus infection that lasted approximately 6 weeks. I was treated with 3 different levels of antibiotics before the infection was controlled. I was treated on 2/20/92, 2/26/92 and 3/11/92 at the Group Health Clinic in Silverdale for this condition. At the present time, I still feel some irritation in my sinus.
During the time of the exposure(s) I had headaches, nausea, and diarrhea. I also became very stressed out emotionally by the situation and my activism through the union to eliminate the health hazards.
Note: The levels of exposures vary with the work and the weather. During the winter months, the exposure was very high. When the main doors to the vehicle areas can be left open during good weather, the levels of exposure seem to be lower.
Attachment to CA-2 Form
Robert F. Farmer
SSN: xxx-xx-xxxx
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.
Group Health Cooperative of Puget Sound
209 South K Street
Tacoma, WA 98405
Transcription
January 24, 1994
To Whom It May Concern:
RE: ROBERT FARMER
MEDICAL HISTORY NUMBER 020685
Mr. Farmer is a 53-year-old male who was diagnosed as having chronic myelocytic leukemia in February 1993. He was treated initially with Hydroxyurea to control his white count and ultimately underwent a bone marrow transplant from his HLA related sibling on September 9, 1993. The transplant was complicated by vasoocclusive disease of the liver during the transplant, hypertension, hypomagnesemia, hyponatremia, nutritional deficiency and severe nausea and vomiting that was proven to be due to graft-versus-host disease involving the GI tract. The patient was placed on Cyclosporine and prednisone and maintained on a number of other medications as well and had resolution of his nausea and vomiting on treatment, however when he tapered his prednisone off on December 23 on Day 127 post-transplant, he had fairly rapid recurrence of his extreme nausea and some vomiting as well. He restarted himself on steroids at that time and rapidly improved that symptomatology, however endoscopy showed some evidence of Candidal esophagitis and also biopsies of his proximal small bowel were consistent with graft-versus-host disease. In addition, a skin biopsy on Day 80 had shown evidence of graft-versus-host disease although he had not had clinical rash. The patient currently is on high dose prednisone, Cyclosporine, Procardia, magnesium oxide, Septra, omeprazole and fluconazole. He currently is feeling fairly weak and up until recently had required red cell transfusions because of anemia, however in January his platelet count, white count and red count began to improve and he is now significantly better as of January 18. He will require a tapering schedule of high dose steroids and Cyclosporine through at least October of 1994. This makes him susceptible to infection, it may also cause glucose intolerance and require insulin therapy and might increase his risk of peptic ulcer disease. He also has the potential for mood swings and depression and also the Cyclosporine can cause renal failure and tremors and even occasionally seizures and coma, although these are rarely seen if the levels are monitored adequately. I think the patient at least in the near future would be best advised not work, however he is interested in trying to work part time for a period of time and I think it is reasonable to allow him that opportunity, hoping not to expose him to people with known infections because of his increased risk due to his immunosuppression.
Sincerely
Irwin Dabe, M.D.
Oncology Clinic
(this is an OCR'ed copy of the original)