February 16, 2004

Group Health Medical Center-Tacoma 
209 Martin Luther King Jr. Way 
Tacoma, WA 98405
(253) 596-3300

RE: Rationalized Medical Opinion for Robert F. Farmer's workers' compensation claim for chronic myelogenous leukemia (chronic myelocytic leukemia) and chromosomal injury File Numbers: A14-282174, A14-320904

Dear Sir:

In my medical opinion Mr. Farmer's chronic myelocytic leukemia was aggravated or precipitated by his work history of exposures to the listed agents in the attached record provided to me by Mr. Farmer.

These agents are recognized by many governmental and private scientific studies to cause cancer including the chronic myelocytic leukemia.

In my medical opinion these exposures of many years make a reasonable medical certainty of the causal relationship to his illness.

I have been Mr. Farmer's primary oncologist since he was diagnosed in February 1993 for PCR positive chronic myelocytic leukemia. He underwent hydroxyurea therapy initially at diagnosis in February through September 1993. In September 1993, at the Fred Hutchinson Cancer Research Center, he underwent a bone marrow transplant from his HLA related sibling. This was complicated by vaso-occlusive disease of the liver during the transplant and other associated problems such as Graft Verses Host Disease (GVHD). This was ultimately controlled with cyclosporine and prednisone until April 1996. His has tested positive by BCR-ABL RT-PCR in routine tests since September 1998. The BCR-ABL RT-PCR tests are accomplished by the Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance Long Term Follow (LTFU). His minimal residual disease (MRD) is monitored by routine blood tests (BCR-ABL RT-PCR and CBC). The most recent test was on February 2, 2004.

Sincerely

Irwin Dabe, MD 
Hematology/Oncology Clinic
Group Health Cooperative of Puget Sound
209 Martin Luther King Jr. Way,  Tacoma WA 98405

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