Document 2jZ7zjnEGp8XjrwBpq3de0zk7

FILE NAME: Baldwin (BALD) DATE: 1985 DOC#: BALD066 DOCUMENT DESCRIPTION: Worker's Compensation Claim - Frazee, Leroy m E V V / A .v6 IP " Dlll>rtv4n , O hio B u e a u of W o rk e rs C om p en satio n OCCUPATIONAL D ISEASE fi c l a im a p p l ic a t io n a QD 307 7 This form is to be used for Occupational Disease Claims as enumerated in O.R.C. 4123.68 This form applies for both Lost Time Compensation and/or Medical Benefits The E M P L O Y E E must complete and sign Part 1 The E M P L O Y E R must complete and sign Part2 The completed form(s) should be sent to: Ohio Bureau of Workers' Compensation, Claims Section, Columbus, Ohio 43215 12879 a P A R T I (Items 1 through 17 are to be completed by the claimant) Please Print or Type Employee's Name Social Security Number DO NOT USE THIS COLUMN Name L f t p Y- f t / v f V Horqe Address (Street & Number) , City, State, Zip Code W & t' S T T /p e rr County t - Z M A . i/ g y e / Marital Status ^ Birth Date AAgge f, Employer's Name wwemenzsi ' "/ e> Telephone No. & Area Code Sex A I/ t L / S , Number of Dependents EmploySer'srTeelephone No. File Date Division Plant Department M A L o C e / y )n - r )Y/5 Employearr' s Address (Street & Number) S U -c fi /y //!/// City-State, Zip Code W q .$ ,/{ 6 1 ^ ^ S ^ / R e zr County Plant l/ iA j O A / o YoouurrOccccuuppattiion (Job & Title) f f > v h e & 'r r J O p - D s t / . Date Symptoms 1st Appeared Date Reported to Employer Leniggth of tlm jsppoorrTrJjob In wh lcfv diselaassee^ogptrfred. OP, Jst DateWorked apartment // late Returned to Work T z / Date Diagnosjs.was made Type of Work Returned to < r zw ? A //? 10 7 ~ / b - f c Attending Physician (Name & Address) A / D / \ / Jz . 11 P B A IT 'S P/V / 0 O % y V S ~ t- / P lA / < J= T S v' A e e z : Representative (if any) 12 Last Date Worked Return to Work SIC FWW AWW Coun/Acc. Loc./Sex M^St./Age/Dep. O -- Describe the substance and details as to how you were exposed to the substance and typ^of work you were doing when the disease began. rn o /Y f . / / SS VK Z J 2 .$ . e S c i / r tlL - r : s ? L 13 c CW0X 7 j e s j Tjirge on'lob en J Accident Time Rep./Nature Body Part Give the exact nature of the disease and the part(s) of body affected (I.e. dermatitis of right hand, conjunctivitis ,,left eye, etc.) Nature of Disease Part of Body 14 e>Ton i.<ri p.srP.f?, _____ Were you exposed to the substance, which in your opinion caused this disease, in previous employments? f P&> l? 0 -AF/7' YES j^ N O If yes give name(s) and address(es) of employer(s) and date(s^ employed (attach sheet if necessary) Name____________________________________________________ From_______________ To________ __ IS Name_____________________________________________________ From_______________ To_______ ' Name ____ From____ _______ To___________ A. Did you receive your wages during disability. . . . . . . . . . . . . j^ Y es B. Have you previously,suffered from;the disease for which this ap ade . . . . . Yes C. Have you ever filed a previous application with the Bureau or In Commission for this OR for other diseases. . . . . . . . . . . ........................ 10 ( If yes, give claim number(s)) . Yes D. Have you suffered from any other diseases................................................................................. O Y e s ( if yes, give details, dates of treatment, name and address of doctor) DNo J 0 No Jg jN o [DNo Source Exposure Haz. Condition Agency Agency Part ;"CP " Aots C W | . 20 r$pge/as|ick " O S. f- ^Vcliteljyd m s* prj rrjsc, 3C .<; co m* CD <jO 3C-- R E A D C A R E F U L L Y B E F O R E S IG N IN G --I hereby apply for recognition of my claim under the Ohio Workers' Compensation Act for this exposure and/or condtion which I did not purposely contract and request payment as provided under the A ct for compensation and/or expenses as allowable on this form. By signing this application I expressly waive all provisions of law which forbid any person or persons who heretofore did or who hereafter may medically attend, treat or examine me or who may have Information of any kind which may be used to render a decision in my claim from disclosing such knowledge or information to the Bureau of Workers' Compensation, Industrial Com mission, or the Employer. 17 videTroofexapneydmiteedtihcaisl scelarivmic,esifisitaiustahloloriwzeedd., I waive any notices to which I may be entitled for hearings. Direct payment to the pro 1_ (if Applicant signs by mark, two witnesses mutt sign here) 2. OD--1 (7-79) Replaces OD -4 & O D -3 Date mark) Payee Doctor Payee Hospital Payee Rep. RICHARD F CELESTE GOVERNOR (jL4\dlA REU . 0 F * K e 85. ^ J S p ENSATQN U, /<J<^ im S W s T . LUHBUS# OHIO 3266-0581 TELEPHONE 66-1000 \ =5 L MAYFIELD ADMINISTRATOR CLAIM NUMBER FRAZEE LEROY 942 NORTH LIMA 0D187714 F OH 45801 R ISK # EMPLOYER NAME LIMA LOCOMOTIVE SOCIAL SECURITY DATE OF IN JU R Y C MANUAL # 0000 WORKS NO 281-18-3583 0" 9-16-85 DEAR CLAIMANT* T H IS ACKNOWLEDGES R E C E IPT OF YOUR APPLICATION ALLEGING AN INJURY SUSTAINED IN THE COURSE OF EMPLOYMENT. THE ALLEGED I N J U R I E S ARENAS FOLLOWS * L U N G ^ / f A S B ^ S T O S l S ^ O D ^ / ^ & ^ ' '* V '> THE CLAIM NUMBER ASSIGNEbv TO'THE' APPLICATION INFORMATION XONCERNING i!.t OUR C L AIM SHOULD GlVi US G IV E YOU ;THE` MOST.rEFplCIENT S E R V IC E . MBR IN ORHe r TO HELP THE ABOVE NAMED EMPLOYER DID NOT HAVE INSURANCEfi-COVERAGE ON THE DATE OF I N JU R Y . I T MAY BE THAT THE EMPLOYER'S NAME* T H E ^ R IS K NUMBERi:0R MANUAL NUMBER AS SHOWN DOES NOT CORRESPOND WITH THE INFORMATION ON THE EM PLOYER'S C E R T IF IC A T E OF COVERAGE. I F T H IS IS THE CASE, PLEASE NOTIFY THIS O FFIC E IMMEDIATELY. WHERE AN EMPLOYER, EMPLOYING ONE OR MORE PERSONS, IS NOT COVERED, THE OHIO WORKERS' COMPENSATION LAW G IV ES THE IN JURED EMPLOYEE TWO REMEDIES. HE MAY BRING C I V I L ACTION AGAINST SUCH EMPLOYER, AND/OR HE MAY F I L E A CLAIM WITH TH IS BUREAU. I F YOU NEED INFORMATION IN CONNECTION WITH T H IS CLAIM, PLE A SE FEEL FREE TO CONTACT THE ABOVE OFF I C E . , , ' . YOU ARE HEREWITH ADVISED; THAT YOU HAVE THE" RIGHT TO REPRESENTATION-IN THE ^ PROCESSING OF YOUR CLALM'OR TO ELECT NO REPRESENTATION. / ' ; : 1 ' '.i h `- ' ' f lW S S * YOURS T R U L Y ,' ".-A . . ' * . . 5 ' i' - .-'** " *r . / CLAIMS^ D T R E C T O R " * * * * * PLEASE RETAIN I R J Wi./; ' v. & & .V" " ;1 - A . " : ' - vr*'' :. .v ._____________ r\ % NVII WwOhoirokeBrusr'eCaoumopfensation % 'Com plete in duplicate Risk or Claim No. /?77/c/ EXAMINER'S INVESTIGATION REPORT Billing Document No. Nmy ^ 7 P Doing Business As r\ l & '' 1 ` Street and Number / ^ t . City. S i t e , & Zip Cope ' \' " , , 7 f a ____(__________________L Is Company cu/rently ' in operation................. ^ Y e s 1-- 1 L j No if No I _____________ _ Phone Number / / 7 - jl ^ 7 - / / / / date discontinued date last had employees Person Contacted Address (L o ' X / w Title/ . < 2 > vir> 4 / Phone Number ....... Number of Employees Check if Applicable Unable to Locate Unable to Contact Collection Type Regular Amt. Due $ Amt. Collected $ Balance $ Total balance due of $ Non-Complying Collected by Prem. Sec. Deposit C Check # $ $ I- Ir.gsh receipt # Date Collected $ $ 19 Time Collected $ $ \ i iam r>M is to be as follows; p Check <y ) Entity 1 Partnership 2 Limited Partnership 3 Association 4 Corporation "S' Individual Check ( / ) . .. ----- Type of Assignment Non-Assigned work --- Collection Regular Payroll Lapse and Non-Complying Payroll Change in Address U-9 Transfer 1 Application - Compliance Rating Inspection ---- Claims Investigation Miscellaneous UA-52 referral for part pay plan A. o Entity Check Obtained Regular Payroll Repo rtfoi^perfbel^ ror^ft, > 19 19 Obtained Non-Coverage Payroll" Repqi^t/f?^r.^pee?rrriiioocidateli VJ ?? Obtained Affidavit No ~>\U;F V J-' Did Predecessor carry Workers' Com perr^ ~ me Pi~7 ~ Ya N o ........ If yes, was successor advised to transfer? 19. ___ Yes r e m a r k s dfl.PaxfeJ' .. -<w U -- -yr-d^tTi -- i__ _ No ^ /97J Zg /?77, P / i * /& A/cnAo / 9 / 7 2 o __ / f ^ A -- / Z < 7 $ /%/). /^/Inug^- /P?9 7 /fS/ M u I A J ifa* ,/5 i _ - f) 0 P /(m J? /9O. ______ /AT*. %^^aa ^ " W!f:^-S V .A \ it m M M Continue Rem arks on renine tide Inspect _ District /*nh Date //"J7 BWC7523 (Rev. 4/80) U-20  ry u rt^ A w y /f < k j U w ^ :H4^gn^^c ~ ''^ | - fA*^ j <' '- . '^ v - / a y f a j/ 7 % A f a Jd C J j& s - s K J ,,. J d L u , . * r \ f a a u , ^gg'-MC- o P j* . q J^ / T if f ' ir d d Z / (JA ^ / d J f / 7 i4 t*9 > ~ ^ Z u ~ ft,'0 J t / 2 *j - c d ^ 'C C p C ^ C c rfu ^ ^ 4 P^U > s fr c P < r ^ S f & : P ^ U y 4 c J id i Lip o M C / a * r W ^ J^ n y y p ^ * p 4 P b n u r^ & y ? . g U s r ^ (P g > s A / ^ p 4 > o d s t ii- y / & U . A j /ti/ *. / / A jS Ju d L j! ~ p y z c 4 ~ U M ^ t/ l .- . O ^ J ftJ jiA ) y p o P y ^ j J . Lo n P ^ d y .^ ^ yosr J9 / o h - / / A Y , ;>!: go - / ^ < X4m a j ^ iM y y 4> y ^ u /? 7^ ' &: Co 0^t3 u o^ | e S I . oTM pe n s a P \ " CLAIMS S & U P N 246 NORTH H T'H S T . _ COLUMBUS# OHIO 4l266-0581 TELEPHONE 466-1000 jam es l m ayfield adm inistrato r 4 58 04 RISK # 889041 MANUAL # 3606 CLAIM NUMBER OD307-27 CLAIMANT NAME FRAZEE LEROY F ,, SOCIAL SECURITY NO 281-18-3583 DATE OF IN JU R Y 09-16-85 DEAR EMPLOYER: BECAUSE OF R E C L A S S IF W ^ T IO N OF. THE CLAIM OF THE ABOVE CApTIONED EMPLOYEE# THE CLAIM NUMBER PREVIO USLY ASSIGNED HAS BEEN CHANGED FROM 42,879-27 TO / 0 0 3 0 7 ^ 2 7 'V , THE ALLEGED*; I N J U R I E S ` ARE AS FOLLOWS* LUNGr/- NOINATURE STAJD / A IL - . THE LAIM F I L E WILL BE FORWARDED TO THE FOLLOWING OFFICE FOR HOUSING. YOU MAY ONTACT THAT BUREAU O FFIC E FOR FURTHER INFORMATION. BUREAU OF WORKERS* COMPENSATION TELEPHONE 71 TOWN SQUARE P . O . BOX LIMA# OHIO 45302-0710 419-227-3127 IF YOU KNOW OF ANY IR R E G U L A R IT IE S IN THE ABOVE CC Ai , ,,SEw W___H__I_C__H_ _MAY AFF. E--CT THE RIGHT OF THE CLAIMANT TO RECEIVE AN AWARD# NOTITTT THIS BUREAU OFFICE IMMEDIATELY# GIVING DETAILS. YOU ARE HEREWITH ADVISED THAT YOU HAVE THE RIGHT TO REPRESENTATION OR TO ELECT NO REPRESENTATION. ' _ . . ' ' ` , 'i' "* ' 'I ' YOURS TRULY# CLAIMS DIRECTOR :- 0 c ''"'i*' -T-' . K.-: V>- ' .-V';V' . ' ' .V:, : ' ; p ' : - W cn CG OD GO p-W a*. -- CD -o X ^ -rt. ro CO :x j rn ja? 3C - < c ? CD rn C3 CO "C * * * * PLEASE RETAIN T H IS LETTER FOR YOUR RECORDS * * * * * 1DDB W EST M ARKET STREET L IM A , O H I O 4 5 B Q 5 TELEPHO NE 2 23-1961 May 27, 1986 Mr. Tim Wolff Bureau of Workers' Compensation P. 0. Box No. P Lima, Ohio 45802-0710 RE: Mr. Leroy F. Frazee OD .307-27 Dear Mr. W o lff: -- . " . .After.Chest Xray of Septembbeerr 1166,, 119985 for Chronic Obstructive Pulmonary Disease, tthhee rraaddiioollogist in his report indicated the problem of Asbestosis. During con versation with Mr. Frazee,he indicates a history of having worked at the Lima Locomotive Plant where he was involved with asbestos in the insulating of locomotives m 1^49. ^ Ttioro ic nn nrpui mis xravs that indicated any findings Vy be the basis for his developing cnronic It is felt that Mr. Frazee should be considered for o? permanent disability due to his Pulmonary status. Sincerely, ohn D. Albertson, M. D. JDA/bg Enclosures RADIOLOGY D E P A R T W W E Q U E S T a ;-: LIMA MEMORIAL HOSPITAL, LIMA, OHIO L PORTABLE DMT Of- fH-ON n>n rofu uk>m FRAZEEl, ler 942 Mi. ! WEST T LIMA/;, PH IQ DR. ALBERTSON 64 9673054 !.. SURGERY IN A.M. T PA ONLY 09-16-85 UPPEjR G.l. nqAY______;_I__6_7_-__1_1_-_1__6___ r- 1...i AUDOMEN K U B , , ] ABDOMINAL 1 .1 SERIES:-" ; ' Li GALL BLADDER ` 11 REPEAT G B T 'i i v . ' : 1.1 C l lOi.ANGIOiIMAM U I.V.P.-I.V. U R O G R A M 1 T v o id in g !. ! C V S 1'OGHAM LJ ESOlj'HOGRAM Q G 'SM A LL b o w f i n w -k . V..:: BA R I O M 'EN EM A L l - " L PELVIS, `I' '-'..If H IP L ' CERVICAL SPINE ' COMMENTS ` i -L . '.rL--! L v ; ' . ' ' * ' , / ' V ' '.* . ; 1 G S K U l-L G SIN USES G T CERVICAL W/BLIQU ES ' ! J THORACIC SPINE il . -y G M ASO ID S LUMBAR. SPINE 1. .! R IO S G LUMBAR i W/OEH.IQUFS - / |;. ` ' . . ' J . .. . - '*.(* . / L 'G * * rn ' I imcrit'HiriAiioN' PA AND LATERAL CHEST 9/16/85 The diaphragm 1s low lying and there lis an increase in the re t ro s t e rn a l a1r space. The lungs appear hyperinfl a t e d . r V: C a lc i f ie d pleurel p.lfiques are,,.^een, i,n' the diaphragm. .There may be a small amqunt of p e ric a r d ia l c a l c i f i c a t i o n near the cardiac apex. < The ly,ngs are" cle ar o f 11nfi 1t r a t i o n . Smal l c a l c i f i e d r i g h t ' j iila n 'nodess' dre p re s e n t. ! ThUe" hu-e a rt is o f nor- mal size and the aorjta 1s m ildly to rtu o u s . There has been no s i g n i f i c a n t change sjlnce 9 / 1 7 / 8 2 . ` IMPRESSION: PROBABLE COPD. THERE IS PLEURAL CALCIFICATION SO,METIMES SfEN IN ASBESTOSIS INSTRUCTIONS: This medical report should be completed by the attending physician immediately after first treatment for occupational disease. Mail same to xhe Bureau of Workers Compensation. Office addresses are listed on the reverse side. This report should be used where claimant loses than one week from work because of occupational disease. STATE O F O H IO B ureau of W o rk ers' Com pensation Claim No. -- ------- O.D. s o p - d - 7 Attending Physician's Report of Occupational Disease ' 1. Name of disabled person 2. Address 9. _ /' //AZ? SZa&T' ..... .... O c f e y ......._ 3. Date of first treatm ent by you ..................... ,,.,,,,Date of diagnosis ,,,,,,J 4. Give accurate description of nature and extent of disability............................ ........... ' y ___... See attached 5. Describe treatm ent 6. What is the diagnosis?___ __ _______ ___ _____ 7. What in your opinion is the cause of the disease? 8. Give your best opinion as to the date claimant will be able to return to w o r k ...................... 9. Has this occupational disease resulted in a perm anent disability? ............................................ If so, what? ................... ......... .............................................. ......... .......................................;............. 10. Mention any previous injury or condition contributing to the claimant's present disability 11. Give name and address of any other physician who acted as: (a) Assistant ------ -------------- ------------------- ------------- (b) Consultant <3 cao? Co CO ,,Co.. CD ><o 3 *^ '` O - S r.....f-TJ -........... -e <?p CO f\j> CD Ds -- ...... ........ -.......---........ - ........ -......... -..............................(c) Anaesthetist ................................................................... . 12. If services were rendered by hospital, special nurse, X-ray or ambulance, give name and address: Hospital ,, ,, D i m a .,, M e m o r i a L ,, H o s p i _ ta l ........... ...X-ray ,, ,, ,, .P A .,, a n .d ...X iS .te .r a l...C h e s t...9 /1 6 /8 5 1 0 0 1 B e l l e f o n t a i n e A v e . L i m a , O H io Special N u rs e ........................................................................... ...................... :....... Ambulance ............ .......... ................ .......................... 13. Name and address of employer: ____ ...____ t .....____ ....__ The Ohio State University Graduate of College o f Medicine ..... Year 1951 License No..... .1.7..4.5.4. 5/27/86 Street Address...1 0 0 8 W e s t M a r k e t S t r e e t City or T o w n ____ L i - _f._.O h i o 4 5 8 0 5 Phon(1 1 9 .).,,,,2 2 3 - l ? 6 1 . Fed. IO#....3.4.-.1 .!.2 / 3.31 0-D-4a TO: DISTRIQTsHEARING OFFICER FR0M:o Z SUBJp ^S ET CLAIM NUMBER<^/^ REQUEST FOR FORMAL HEARING DATE: ' f - n ~For ... _ Formal Hearing On the Following Question(s) ITowance of Claim Allowance of C-85-A Allowance of C-86 , ; Q Further Compensation T.T. n T.P. Administrator's Motion for the following reason(s) Filed Filed Filed Other Objection filed by employer. See reasons shown on 'Objection by Administrator for the following reason(s) BWC-1221 (Rev. 4/83) C-98 Claim No. 0D-307-27 Social Security No. 281-18-3583 Claimant's Name Leroy F. Frazee Address 942 N. West St. Lima, OH 45801 REPORT OF INVESTIGATION Employer's Name Lima Locomotive Works Address South Main St. Lima, OH 45804 *(see comments) Date of Injury (disability) (per original application) Date of Injury (disability) (per investigation) Date of Application Filed. symptoms appeared 9-16-85. 9-16-85 9-23-85 EMPLOYER'S POSITION: business for several Post Office. (per application) ; ; years. Correspondence : The employers portion of OD-1 form was not , completed since the employer has not been in sent to the emplpydrbjjas been:returned by the COMPLETE WORK HISTORY: C-202 from claimant indicates prior to 1941 claimant was in school. 1941 to 1942 he worked at Lima Electric as a spray .painter. 1943 to 1949 he worked at Lima Locomotive Works, insulating (Lagging) boilers on locomotives. 1950 to 1970 he worked at a Honey Factory (Sioux) on South Elizabeth St. which is no longer in business/doing work of unloading, setupp and canning honey. 1970 to 1975 claimant worked at Lawndale, Lima,Ohio which is a bath tub company in which he hung tubs and drove lift truck. 1975 to the present he is working for Seyfert Potato Chip Co., in Lima, Ohio as a warehouseman. - OCCUPATION: Sheetmetal worker for approximately 6 years, insulating boilers on locomotives. NATURE OF EXPOSURE: (per application) A s b e s t o s .lagging on locomotives, covering with sheet metal. " (per investigation) C-- 202 from claimant states while working at Lima Locomotive Works insulating boilers on locomotives with about 6 to 8 .inches thick of asbestos. Did not-wear any face mask at that time. They did not know much about asbestos. Claimant has been smoking cigaretts since t e age of 21 at approximately, one pack a d a y . In September of 1985 claimant went to Dr. Albertson for a checkup. He was hot having any particular problems at.that time but the Dr. found some problem with his lungs through. X-rays. Recently claimant had been losing weight, hard to get breath, when doing any:amount of work-carring groceries,etc.-difficult to do much lifting. No prior breathing problems<2?-while working at Lima Locomotive Works. No lost time from work, for breathing-problems. Only went to the Dr. Albertson and hospital or X-rays. WITNESSES: (per application & per investigation) None stated. MEDICAL DETAIL SUMMARY: X-ray interpretation taken at Lima Memorial Hospital on May 4, 1986 indicates abestosis evaluation and congestive failure. Shortness of breath. Letter supplied by Dr. Albertson along with chest X-ray interpretation taken on September 16, 1985 indicates Chronic Obstruc tive Pulmonary Disease per radiologist report after X-ray of September 16 19 5. No prev ous X-rays had indicated any findings of suggestive asbestosis. .Claimant had been treated and followed for chronicobstructive pulmonary disease by Dr. Albertson since November 19/o* Dr. Albertson's O p i n i o n is that his exposure''to asbestos in 1949 may be the basis for his developing chronic obstructive disease and also the congestive failure and the probability of the mesothelioma. Dr. Albertson's letter is dated May 27, 1986. . * ** BWC-1138 (10/80) .... i ... : > . C-28-A Page 2. OD-307-27 Leroy F. Frazee PRIOR MEDICAL HISTORY TO SAME PARTS OF BODY: Dr. Albertson stated that he has been treat ing the patient since November 1976 for Chronic Obstructive Pulmonary Disease. The claimant stated no prior breathing problems 'before his work at Lima Locomotive Works. PERIOD OF DISABILITY: . No lost time at this particular date. Claiman has been working and still employed at the present time. Dr. Albertson per his letter indicates that the claimant should be considered for permanent disability due to his pulmonary status. COMMENTS: The employer Lima Locomotive Works has been out of business for some time. A U-20 form has been completed by Jerry Mason;underwriting-auditing supervisor of the Lima District Office concerning information on the Lima Locomotive Works which can be read for review. ENCLOSURES: OD-1 form, C-202 from claimant, X-ray and bill from Lima Memorial Hospital for May A, 1986, C-202 form from Dr. Albertson's office, cover letter sent to Dr. Albertson with OD-Aa form, OD-Aa form with attached letter dated May 27 from Dr. Albertson. TW/ws 6-3-86 X X ,x Employer Street and No. J f '" ' & v v . - / f t " t * *J ' r` \,J/*1-*',,;/'*/;.'Ac '* * , ''"> ,'w.' " ' ' ` 'h. v- -' L - Lina loQOBetiTO Wbrks Out of business South Main St. This matter came on the . . . . .O P rl .................... . ,, , mailed to the claimant, the employer,, their respective^rej of Workers' Compensation not less than 14 days priorit For the Claimant: ty A . -._ . ** . . For the Employer: For the Administrator: T&h N/A . . TM, -*V-'-**.'-.'V#* . . . `-v&it.-1 ^ "" :S m Refer to LEGAL (attns Spencer) for a safety any exposure data to asbestos for Claimants^. m " Thereafter, refer to 1QLSP fqr a file review;, developed aabesfcoais and far <es qoinion ` condition or whether it is pnotofolT"" by Dr. Albertson. i 1 Reset When TQLSP report is on file. Based on reports of Dr. Albertson. &. w i i ..jsj i#*i ' >#* 'jvK''i,t*.*'.;' angjua^v> vg'-x*, x , / ''V"?'v 7: ^ p f .- <- QIC-1000 (Rev. 3/84) DHO-4 In view of his work at the Lima Locomotive Works, it is very likely that exposures occurred at high levels and for long periods of time sufficient to cause respiratory complications including asbestosis and related diseases. The smoking, of course, is a complicating factor. With the other findings in Mr. Frazee's medical exam, the ultimate outcome of his problems seems apparent. If I can be of further assistance in this claim, please let me know. J F :rf Industrial Hygienist Tosether, we can make ______OhioJobs safer.______ DIVISION O f SAFETY AND W G IEN E THE INDUSTRIAL COMMISSION Of OHIO Richard f Celeste,Governor O c t o b e r 21, 1 9 8 6 Ms. Judy Spencer Legal Section Industrial Commission of Ohio 246 North High Street Columbus, Ohio 43215 Re: OD 307-27 Employee - Leroy Frazee Employer - Lima Locomotive Works (Out of Business) Attn: Judy Spencer Dear Ms. Spencer: Mr. F r a z e e is a m e m b e r of a r e l a t i v e l y asbestos insu l a t i o n w orkers who are at very developing complications and/or diseases of due to exposures to asbestos. small group of former high risk of t the respir y I n s u l a t o r s in m o s t c a s e s w e r e e x p o s e d to vel:^ dust during application and removal of asbestos insulation the s t e a m l o c o m o t i v e era, it was o f t e n n e c e s s a r y to remove in or apply asbestos in bulk to the bo i l e r s of the operations were carried out in enclosed p r o t e c t i v e equipment. During the years prior to 197^ particularly during the late forties and fifties, the 0r and u s a g e ot asbestos rose to an all-time high. Mr Frazee has been diagnosed as probably haying asbestosis. T h e r e also are X -ray findings to indicate pos s i b l e p r o g r e s s i o n to Ihe most serious of asbest o s - r e l a t e d d f aasea ` " * 3 ^ it'has One p u z z l i n g factor is the l atency period. In this case, been thirty-seven years. Usually, ten to twen 7 ^ t i m e s expected before symptoms begin to appear. Longe unhe a i d of, though. This may be one of the exceptions. are not One c o m p l i c a t i o n and c o n t r i b u t o r y factor is present however, tha? of smoking Sr. F r a z e e is an a d m i t t e d one pack per day smoker for forty-three years. This ^ ^ ^ f ^ e r M for more chronic respiratory problems than a 11 th combined. When combined with asbestos exposures, increase; the likelihood of asbestosis, lung cancer us V^ and e s 1181 88 other complications many times over. 100 Techne Center Drive Suite 105 Milford, OH 45150-9990 (513) 248-1970 Cincinnati District Office The 50 Park Techne Center CLAIM EXAMINERS' WORK; ;t CLAIM NO f t - 3 0 7 - 7 CLAIMANT AGE ( S ' SEX Jk & jt u OCCUPATION S U e J - n u A J U \ u J ? j 'A . DATE OF INJURY OR DISEASE. ADDRESS3: Q % ft.U l i s t ^ ., f iiM a j,(U u j> 4 S% 0 / DATE OF DEATH. S ,s 4 a v f- fg - e s t RlSuf f g ^ O ^ / HAlflUAL 3 & 0 ( > - Q j EMPLOYERS NAME , 'Sm w iAsi&AJj ` U M l A s i DESCRIPTION OF INJURY (paraphrase). O u L f X t m , ' < y (j) DISABILITIES ALLOWED NAME o , / c L s o A j f 'o Q } TYPE /c/ ADDRESS S lO 0 f l/ , t e a h i ^ Y ^ Z / Z / O C ( 2 ^ L o S fY O phoneY / ^ ^ O NAME payee# y z c y f d a y / ^ ^ ' TYPE DATE /<? 'c^ T ^ T I M E - /'^ ADDRESS PHONE PAYEE# DAY DATE TIME NAME TYPE ADDRESS PHONE PAYEE# DAY DATE TIME TYPE OF EXAMINATION.! M U L I lP [ a m J , M a f j U J J i V J ) P ia I a v l a O -Kj O / u j - h L A S ) a o ^ c c A Jtr CLAIMANTS REP. ^ EMPLOYERS REP. c l a i m s Ex a m i n e r N M A ! _____ DATE / M _____________________ rev. 08/28/86 dea SPIROMETRIC 8i.,mc. ^ ?P O vT R m odel 2 4 0 0 PULMONARY FUNCTION TEST REPORT Nam e__ Address Date. Sex M F t ? . IT J jg^ j /jf jr m d d * - S(p FD Age ;__________________ Occupation C ity Height (inches) Stata t / 2 - ... Rane Z ip 1 Ever Smoked: YesjZN o / Smoking Now: Yes N o / / Stopped^ ^ Y m TM Aon Years S m o k e d ^ V V Cigarettes (pks/day) / / Ci gars (day) Pinp Dyspnea Couah Restina Productive Exercise Volume Wheeze - R e s tin g ----- ------ Exercise . How l ong? Ambient Test Conditions Room Temperature Barometric Pressure Enter results from Spirograph Charts here Value, BTPS FVC FEV i.o F E V 1-0/FV C % ... F E F 25-75% Best v3, S ? /. - 3 Q ^3 9 % Routine Screening Predicted 4. d _____ . 3 . / >75% ______ z . , 4 % of Predicted /q Post Bronchodilation Screening Best % of Predicted . ( s /. *= r^ * ^ <? --------^-- .r.____L l_ -------1/ Q( os/on 41 h ______ S ~ 3 ....... U n % Patient Cooperation Fair Poor Use reverse side for interpretation and comments. NAME: X-RAY NO % Frazee, Leroy F 86-2155 BLANCHARD VALLEY MEDICAL ASSOCIATES Findlay, Ohio W i . ,. / W ' 12/29/86 . ; . ' .'v. V-' ,"v-' .. V CHEST: PA and left lateral chest show no soft tissue abnormality. The bones of the thora cic spine show some degenerative change and minor scoliosis;'/.The diaphragms are somewhat flattened with an increase in AP diameter. There is some calcification in the dome of'the left hemi-diaphragm and a questionable area of calcification on the right. The cardiothor- acic ratio is unremarkable. The aorta is slightly tortuous in the descending portion. Hilar areas show a few calcifications, but are otherwise unremarkable. The parenchyma shows a few small calcifications. changes are also noted. There is some increase in interstitial markings. Emphysematous > Impression: . 1) Changes of chronic obstructive lung disease. \ 2) Linear calcification in the dome of the left hemi-diaphragm. 3) Some scattered calcification, apparently from a previous granulomatous - . ' ' v process. 1 \ / * State Of Ohio Industrial C om m ission COPY TO: ' Claimant, Claimant Rep__ Employer Bop__ Othorv_ UEDICAL iiCTXOH 1 Rati Claim No. _ OD 307-27 Claimant L e ro y F . P ra s e s Address 942 N. West St., Lima, OH 45801 Date of Examination December 29, 1986 SPECIALIST'S REPORT Employer - A g e . 65 Tf&: ..rsport. ander following headings: (1) History. (2)Complaints. (3) Examinations, including X-ray and ' -' flaboratory work. (4) Discussion. (5) Opinion. Sign and mail T H R E E copies to the MEDICALSEGpOMlil'* '' Retain one for your file j ; / .'S'v ' ; REPORT OF EXAMINATION TO BE RETURNED FOLLOWING REq Ue^ H ^ V 1 ^ ' ) A4 . ' 1. '. " : HISTORY Thl-sTbb-y&ar-old man retired in 1986, due. to s h o r t n e s ^ o f breath, /weakness/ and arthritis^ He gives) a work history ^compatible with a six year\exposur^to asbesp^, perhaps in'Ire^y concenj/rations, as he worked as a boiler insulator~frL L i m a l lPetrfiiotive from 1943 .toN^ft^ilJlr^m 1950, to .197p j .approximdtely,. he worked for the Sioux .Honey Factory doing all.': ph^seh^nf--chnning of honey.: Since that time he has worked in two o t h e r 'j o b s / . without significant'exposure, the most recent being a potato chip distributorship;where ' ie^WQ^ked as a ..K^ehouse~liiaii. He gives a history of having been a cigarette smoker of . z2 pa^ks.per d a ^ ^ gZA^-jpears, but stopped two years ago..-,'; He had pneumonia in l970. He'Tierrlies/a^'history of,'tuberculosis, asthma, allergies except to SULFA, ori;chest p a i n . ' He has a'chronic daily cough productive of whitish-brown sputum. He has dyspnea on"exer- tioni walking one flight of steps, and at times with some activities of daily/living.; ',/ His shortness of breath-has .teen worse in the past 2-3 years. He has had an episode of congestive heart failure in the past in May, 1986. His current/medications are.Theo-Dur^ Indpcin.'iFeldene, ,Librium, and Lasix. His family history is unremarkable e x c e p t 'for'a - history of asthma. .He has no alcohol intake history He has had; no: remarkable/ot/signifi- cant ''surgeries. , `' ' , Physical'examination, reveals a healthy appearing elderly male in no acute;'distress^^Pul^ey.. is 80, Ri 18-20, *T normal*',,BP, 160/90. Examination of the HEENT was negative.; Neck'.`exam`v < was supple without :.?aderiopathy j thyromegaly, mass or bruit /'/Chest exam reveals'a"'slight increase-fin AP diameter .'The'diaphragms were low in position, as found on percussion/*;^/ ' ' Breath sounds were generally decreased. - . ' -// ' .?-> Cardiac -exam - f t h e 'heart .-tones were best heard in the epigastric -a r e a . No significant/^..! murmur or .gallop was-noted., 'v . / .v . , Abdominal; exam revealedVnoipalpable.organ;enlargement or mass. xszm.'. Rectal^and genital exams were deferred.. ` . Extremities r .showed no significant edemas clubbing, or cyanosis. t- M V Neurologic/was-intact' ' > . , '' ` ' A chest x-ray was d o n e .in -our office/.a n d ,a copy-of this report yis e n c l o s e d ,for7yournrecords. There are changes of chronic obstructive lung disease. Also,; findings .of calcification/;/>/ in the dome of the.left hemi-diaphragm is noted '.along''with''scattered/calcifications,'*appar,- ently from a previous granulomatous process^ Spirometry was .also done, and copiesi a r e ^ also enclosed'for your records. , There is a moderately severe obstructive defect'.,//The,/'' vital capacity is at the lpwer-limit;of normal. ^ni-o r0cnnnoo'i^:nntori*.t/i, . after inhaled Metaproterenol.- f-;Discussion:. -It, would -seem that this patient had the potential ,for'-high rlevels of;,asbestos . exposure for six years, .back in the mid-1940's.? Since that'time 'h e 'hast had '-tio`|s|gnificant -M? occupational exposure/that I;.can.;determine. His -clinical and chest xrray; findings''are* predominantly.,those.of.; chronic obstructive/ lung disease, 'and'this would be duetto his<.long-,*` term heavy cigarette .smoking^history.v./The/calcification in the diaphragm.could~beidiie^XT^'ijP to asbestos exposure, however, the rest of the parenchyma does not have features which'i'J'l^/S^; would be called asbestosis on- chest x-ray; / /w / ' ' ,> . >" .. ,, (CONTINUE REPORT ON REVERSE OF SHEET OIC 2002 ( R e v / 9/83) ' , .- A lv V ' : STATE OF OHIO % v ; THE INDUSTRIAL COMMISSION OF OHIO NOTICE OF HEARING CLAIM NUMBERS .. OD J107-27 i v " , Leroy F . F,razee. / 4 9.42'N..`West ,St. O'.-., . Lima, OH 45801 . V ' " v 'v . ' ' -, -, .- V S % Lima Locomotive Works , (out of business) . ; . LAW DIRECTOR, BWC < ; ' You are hereby notified'that the above claim has been set for hearing at. the office of the INDUSTRIAL COMMISSION OF OHIO: ; ' -- (STREET)- X: ' . ,! ' (ROOM). ' 71 :Town Square (FLOOR).. (CITY)'/ Limar .OH 45802 'W on Thursday, March 12, 1987, 3:00 p.m. (1) " (We e k d a y ) , '; * ( d a t e & t i m e )': 1 This notice is sent to you for information. You are urged to be present'and to introduce .all -testimony ,and evidence pertinent to your application.,You will notibe reimbursed for expenses.incurred in'coming to this hearing 5 unless'a subpoena;:ha'been issued for your attendance. ? , '' U4>o. ATTENTION QDESTIOIi; T BE HEARD: ' fM :Filing':Date: (9-23-85 ` 'V ' Action By: ,DHO Date 'Mailed: O 2-23-87 'Typed By:,;, jin' ' ` . < NCRWP'(C115rNOTICE) Revised 5/86 S v 5 e : ' .*' Mi ' l < ' >.. is : RADIOLOGY D EPARTM ENT REQ UEST LIM J H O SP IT A L PORTABLE LIMA, OHIO f .' DATE O F REQN. D A T E T O B E T A K E N L ) S U R G E R Y IN AJW.' LJ i-- i P A -LAT i-- i P A i-- i ! , M CHEST . O N L Y ^ v U U P P E R G . I . -, : A BD O M EN - K.U.B. ESO PH O G RA M LJ i-- i ABDOMINAL . . i-- i, . , S E R I E S - B O W E L -V . .v<f':.V ' '\ FRA2EE t LEROY 6* * 9 8 6 8 3 6 - 9 9H2 WORTH VIEST ST LIMA, OHIO DR. ALBERTSON X-RAY NO. 67-11-16 PELVIS C O M M EN TS: i-- i . . LJ HI P i M ?*}<?' 1 1 GALL BLADDER BARIUM EN EM A SPINECAL ' ^ i > | 1 ^ B u S i S ; : 1 1G J c H O L ^ G I ^ R A iI I 1 *N s' .' i 1 r^ i LUMBAR - ^ ' 1 .;.!.'..\v:...yr.LH .s p i n e ' " '' . | I p H AVOIDING - W f e iM & i 1L J ' CYSTOGRa M W k ^ ?1P tJO S R lB S M w W - ^ i;.-:r^ X - .'..:L W/OBLIQUS ' SPEC IFY ALii UNLISTED / EXAMS IN T H IS S P A C E - .- ''v ` iVA/t'vir'i:'k. i--V' i .''SfiS^f/V-j '}i" "v ' ' ' ' ^1' ' ' ' " `.`'h ' ' .. ' , . ,:. .- :- :; -- ' ..':. " ''' :..' - ' ;' V . , , .- .; ... \:r.?:!::Srtr.--' !: , :': . . ; - : \ _ V ' ' ' ' ': . '. m- ' 'i M L RICHARD Si GORDON, M.D./dg 5/20 ..U** / B ureau of STATE O F OHIO': W o rk er s ;C ompensation Record of Proceedings Employee:- Leroy F. Frasee .S.tree,t and. NMo___9_4_2__N_.__W_e_s_t___S_t_._ Claim No.. OD 3 0 7 -2 7 9-16-85 Date of Injury-- City. , Lima, OH 45801 . (State) E_mp,loyer:______L-i__m_a__L_o_c__o_m_o_t_i__v_e__W_o__rk-2s1-- Street and No.,,{OUI--OF-DUSINESS).__ ?-- c ity -- :______ ___________ _______ ______ Date quit work. 3606 Manual No------889041 Risk No.--------2. T.T, frnm T.T. from T P frnm PP, from P T frnm Total Medical PREVIOUS AWARDS FOR 1 to to ........ to ^ to ` ' ' " Services to date. COMPENSATION AND MEDICAL SERVICES ` Amt. $ ...... . ... . .......Overpd. $ ' '' .' Amt $ . . Ovfirpd. $ :-?> . ...' ...... Amt. $ _ ............. Overpd. $ __ - : * . ... ......... A m t $ ' _ _ _ Overpd.?__ ' Amt $ . . . . . .. . . Overpd. $ Amt. $ , Amt $ ..... _ - Overpd. ? ..1 -Overpd. ? . .. . V FINDINGS OF FACTS AND MINUTES ' _ On this day this claim was before the Bureau. Findings and orders w ere m ade for the paym ent of the Items listed below. The Auditor was Instructed to Issue such w arrants as are necessary to pay such Items. `Note to A uditor -- In absence of another nam e Claimant Is Payee. ' . / " v . ; ' ' . V ii - ' " MEDICAL SERVICES - ite m . I ' ` ` N a m e * . ' '' " " A d d xo m ' " ' " ' . A m ount W arrant Ho. Vw" . . V .rirV V i ! i;v*r. \ ' '`.'vV*: e Balance of $ 2 6 8 . 0 0 to be canceled in claimant 86-33041 .. .. ' . . ' : ' ' . -' V: -i*'-'i' - " ' `, . w . , v> ,0 ,( ' ` ` . Fe7.:'-, *.. - *( . , : ; a. , ... 1. . , Vv: : :,i'" ' , i. i ' -, >:,j --, ' . v <i . .. ' . '.V, '$.'r ' r`-v ; , : : . \/i' . '. 'A:./,'/,,' . a.;,-.;-. vVS,.'-'. IMPAIRMENT IMPAIRMENT Type __ -- COMPENSATION-- ____ COMPENSATION-- Period -- Weeks at Rate of $L--Weeks at Rate of $_ Amount W arrant T" ! ;I ; FINDINGS MAY 2 8 1 9 8 7 MAILED L *1 I , `S\ ^ feLV'V r-i* : -- ' ' il i.v:5 On hearing of,,_J*r& 23L amount of.$__286.0Q _. Medical Service aiy ""&?ifn~' -the.... __an a w ard was madeBjflara.nchard Valley,Medical Associates rz --payable -- This was an error and said award should haye been for $. following reason: : _they__say._ov?PA3^fit:--.----- m It is therefore ordered th at the overpayment qf $_ Hone J otthe'*,.;;; -be deducted ;; The Auditing Blanchard Valley Medical Assoc. `A, rants and or._ issuedf to-- No. No--J L -p * Cdncel and or Hearing of_ showTni, to saida dated,a amount $------- ----------------r-.-- ' ^dated- . ? --2.0--86.. deposit same. Credit3BtX&X)KSurplus Fund f --1 2 8 6 . QQ-- - ,,found an overpayment of amount $.--5 5 4 . 0 0----l l -- , _______ __-.medical service. , aV : -, . - r~ . a. . -- a_in the amoimt of :; " ... < and ordered same collected. Please take the !proper/procedure to apply the 'above' as,. ' a- r-a.., , , a. /j; . \V PAy a s SHOWN a Va overpayyimiieeiniut"^ -v *:.-v . - -.. -i -.( - *. . # ' . . i That any special finding or order written hereon supersedes any printed njatter; in conflict therewith. -i ^ ' ' ' *** IW- 5/28/87 PB/th '"JY,a*--m.%eAvsM.yftYXL, .'/,,-tMlna'ty.ffi4i' ea:l1.d(4,. ; Adm lnlxlrator.. 1 t ^ v #1# BWC 1136 C-27 Adj. B '.li 1.. ii& IS '