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IbjtOtfNMorj.owbtiMcttnenr.ulit 246N. High Jt, Cot,a 43315 April 27, 1988 Ltgul Section Industrial Commission of Ohio Rft OD 28874-22 246 North High Street Clifford Henson Columbus, Ohio 43215 U.8. Steel Corp Corain, Ohio Attn. Judy Spencer Risk 81 0002 Dear Ms. Spencers No visit Mas mad* in the investigation of this claim, because conditions under Mhich the claimant worked literally no longer exist. The claimant alleges that his medically diagnosed condition of "chronic obstructive lung problem and interstitial flbrotic changes seen In both lungs..." is the result of workplace exposures to "coal dust, asbestos, steel dust, etc." and to "many kinds of gases, dust, etc.*. The claimant's work history was provided by the company and is Included with this report. The claimant appears to have spent most of his career working In the pipe mill warehouse and shipping departments. The coke plant was shut down in 1984. In addition the Division of Safety and Hygiene's records were reviewed for relative Information pertaining to occupational exposures in the pipe mill wharehouse. This review yielded no information. - Emphysema and chronic bronchitis make up the disease category called chronic obstructive pulmonary disease (COPD). At one time they were viewed as distinct clinical conditions, but it is now clear that in most patients these diseases coexist, although one or the other may predominate. These are chronic disorders and are characterized by progressive limitation of the flow of air into and out of the lungs. Emphysema is identified by its characteristic alteration of lung architecture. A person with emphysema has destruction of the walls of the smallest air passages called bronchioles, and the walls of the small air sacs, called alveoli, that function as the gas exchanging units of the lung. The alterations result in abnormally enlarged air spaces. Chronic bronchitis is characterized by excessive 00 # 28874-22 Clifford Henson, U.S. 8teel , Lorsin Page 2 mucus secretion in the bronchial tree which leads to a persistent, productive cough* An individual is considered to have chronic bronchitis if cough and sputum are present on most days for a minimum of three months for at least two successive years or for six months during one year. <1> In emphysema, the limitation of airflow is caused by abnormalities of lung elastin, a supporting tissue in the smallest air passages and the walls of the alveoli. This abnormality in elastin results in collapse or narrowing of the small airways which in turn limits airflow out of the lung. Once this damage occurs, it is irreversible. Emphysema can follow chronic bronchitis or any other lung condition in which the airways become seriously clogged or obstructed. (A few people have an inherited enzyme deficiency that predisposes them to emphysema, regardless of other lung diseases or exposure to hazards.) (1) In chronic bronchitis, airway obstruction is due to inflammatory changes in the walls of the bronchi which causes them to thicken. This thickening, together with excessive mucus production obliterates some of the saialler air passages and narrows larger ones. These changes are to some degree reversible. (1) From other information provided by the company (dispensary notes) it appears as though the claimant was, at one point in time was a cigarette smoker. "By far the most potent factor, though not the only one, causing this disease (bronchitis), is cigarette smoking." (2) "Ther<r is surprisingly modest support for the concept that industrial dust or irritating fumes play a role in the development or aggravation of chronic bronchitis or emphysema. It is difficult to accept the belief that no role is played by these agents, particularly with respect to place of residence, medical care, and general air pollution. These agents may overshadow any demonstrable influence of Industrial dust, fumes, or gases. In studies in which these other factors are corrected for, there is some suggestion that occupational dust per se may contribute to chronic bronchitis, even though it Is not the most potent factor." (2) "Every detailed investigation of the symptoms of chronic bronchitis and some on the emphysematous lung have brought to light the harmful effect of smoking cigarettes. A graded relationship between the intensity of smoking and the prevalence of disease has been observed." (3) "Although occupation stakes a contribution to the initiation, progression, and outcome vf chronic ^ OD 41 28874-22 Clifford Henson, U.S. Steel, Lorain Pag* 3 bronchitis, its contribution is very small compared to th* effects of smoking." <3) "Chronic bronchitis may occur after repeated exposure to chemical irritants. Usually, however, the underlying cause is cigarette smoking." (4) "Low-level exposure to all irritating gases, including those in cigarette smoke and urban air, probably produces a continuous minor irritation of the medium sized air tubes, causing overproduction of mucous by the bronchial lin'ng, resulting in increased susceptibility to infection of the air tubes, or acute bronchitis. After repeated infections, he or she may develop chronic bronchitis" <3) According to Occupational Diseases. A Guide tP_ Tiifir Racoonition. (pp. 112-121) agents capable of producing fibrosis (interstitial or nodular) include silica (both simple and complicated fibrosis), hematite, mixed dusts (iron silica), silicates (kaolin, bentonite, diatomite, tripoli, mica...), coal dust, aluminum, asbestos, beryllium, and tungsten carbide. According to th* company's industrial hygienist, the potential for exposure to any of these materials within th* pipe mill warehouse / shipping and "cold side" is zero. Because working conditions appear to have changed, this could not be easily verified. From the medical rerords supplied by the company the claimant appears to have had reduced pulmonary function results dating back to at least 1976 (enc.) and a chronic cough dating back to a 1974 physical examination questionnaire (enc.). Also from th* company supplied medical records is a notation dated "12-12-84 MEDICAL SURVEY... Pulmonary function Class II, restrictive & obstructive" (enc.). Finally, in a letter written by Dr. Sanford E. Rabushka dated Spt*mb*r 29, 1987 (enc.), chest x-rays appear to exist for t`` r". aidant for the year* 1967, 1972, 1978, and 1984. Thi*' letter go*'* on to state that "... There is no evidence of <ibrosl*. There is no evidence of pleural thickening...". Yet th* claimant's physician, Bashir AmeJi , M.D. states "X-Ray of th* chest revealed the patient had multiple small micronodular opacities in both lung*. Also, patient has interstitial flbrotic changes seen in both lung* which is consistent with chronic lung disease.' In closing, the claimant worked for U.S. Steel from July 1934 until January 1986 (work history enclosed). Th* claimant alleges that his medically diagnosed condition of chronic obstructive lung disease and interstitial flbrotic changes ire th* direct result of occupational exposures .o coal dust, asbestos, gases, and dust in general. According to a company industrial hygienist th* potential for exposure to coal dust, asbestos, and gases within th* pipe mill 00 N 28874-22 Clifford Henson, U.S. Steal, Lorain Pag* 4 Marabous* / shipping and "cold si da" is virtually non-axistant. A ravlaM of tha Division of Safaty and Hygiene's filas Mas appaars to b* void of raports Mhich Htantion axposuras in tha pip* skill Marabous*. Finally* bacausa thara Is a distinct diffaranc* in tha medical opinions (company physician vs. claimant physician) and tha claimant's history of tobacco usage, It is baliavad that tha claimant may naad to b* rafarrad to an indapandant spacialist for a dafinitiva diagnosis. WJB anc. Claimant's mot* history summary Job dascription Hookar <ERU finishing) Claimant's smoking history docusmntation Claimant's physical axamination questionnaire, 1974 Pulmonary function rasults 1976, 77, 78, 80, 84 Company physician x-ray Interpretation Madical racord indicating rastrlet!va/bbstrurtJv* problam Footnotasi <1> "Chronic Obstructiv* Pulmonary Disaasa", U.S. Dapartmant of Haalth and Human Sarvicas, Public Haalth Sarvica, National lnstitutas of Haalth, NIH Publication No. 83-2020, Kay 1983. <2> Voijmt I. Oanaral Principles, Patty's Induttrial -Hraitut and Toxicology. J. Wllay and Sons, 1978, p. 193. <3)Encrclooedia of Occupational Haalth and 8liix International Labour QffJ_CA McQraM--HI 11, 1974, pp. 331-334. <4)Chamical Hazards of thf-HocKailfit* N.H. Proctor, Ph.D., J.P. Hughes, M.D., J.P. Llpplncott Company, 1978, p. 74. <3>HorK is Danoarous to Your-Haalth. J.M.StalIman, Ph.O., Random House, Inc., 1973, pp. 138-139. 7-7.3-54 17-4-54 4-14-55 3-8-55 11-16-57 2-17-59 2-73-59 5-5-60 7-24-61 11-25-61 2-6-62 5-19-63 4-22-63 7-77-63 6-2-64 10-15-65 12-13-65 9-23-63 * 7 10-13-63 ( 10-23-63 11-10-68 12-16-53 R-2 - 82 9-13-32 9-20-32 5-20-33 6-7-83 1-31-86 WORK HISTORY CLIFFORD HF.MSOH Docks Layoff Maintenance Shipping Layoff Rolling Mill Conditioning Pipe Mill Whse & Shipping Layoff r Pipe Mill Whse 6c Shipping Layoff Pipe Mill T!hse & Shipping Layoff Pipe Mill Whse & Shipping Layoff Pipe Mill Whse 6c Shipping Layoff Pipe Mill Whse & Shipping Coke Plant 'k- Yard Department Pipe Mill TJhse & Shipping Yard Department Ripe Mill TThse & Shipping Layoff ERW Mill Pipe Mill Uhse & Shipping Layoff Pipe Mill Whse & Shipping Retired Loader Laborer Loader Loader Loader Loader Loader Loader Laborer Laborer Loader Laborer Loader Hooker Loader Loader JC.I Job Descrlptlon-Dnlted States' Stfeal Corporation rvi. * - Welded Pin# Mills E.B.W. finishing KdmmAM*A r*>4> 08-0620-FH-01B60 TWU Hooker (EJUV. finishing) Plui_________ Lorain Works JOiguat 9j 196$ Primry Fwctioa Signal cr&nflo&n and hook and unhook lifts* Pt..* Ttol. ..... pu> r<wu 9#9 Tools and Eqtdpgisgt Various hooking dertces, handing equipment* etc. Materials X.R.W. p3pe of rarlooa grades and sixes. $ Source of Staperrlalop Turn Forman. Directed by X^.V. finishing Craneman. Direction Beardsed Sane Working Procedure 1. Receives varic instruct!an* rt Turn fbreman. 2. craneman* perform hooking and unhooking functions In assigned area, changes crane lifting attachments* as required. i \ J > ii ij -' o Vrfw-'; Tbeabova .% -- . cAs-*? rSfacU tW fwi dct*a uwwiJywl 7 to rt--rffii (Jbt priadpaJ (uactfao. tan.# ri. amt rawinon--ti tint fW Title. Job Claasificaticm4Jnted States StoeTUarpcratica ____________________ TT.u Hooker (K*B*y* Pint idling) Factor (or CbaaiicaHoQ 1. rtEwploywt Traiabf. TMo )ob raqofaaa the natality to loam to; Carry ant simple verbal instructions* Hook and unhook erans lifts. X Eiployn Tnlwiac aad Ftpaiwn. TWa job raqaim 3*6 months continuous progress* oa tfcia and nUtad workal X MmuISUB BepatltlTa job of ordinary crass hocking 1stairing sen# variation in routine* Coda Uc Baj B B 1*0 Use banding equipment to band Hfte of pipe* X Fnirw~Unry far Material Ordinary care to srcld miring steel when changing grades, walls, etc* B Eatiaiatad Cnat Under f$0*C0 B X lUapoMibiBty lor Taala ul BqsipSMSt Probability of damage to equipment is remote* 7. Rtayoarfbiliry farOpaadoaa Hook and unhook crane lifts coordinating activities with Craneman* tw HiipoAMbfiity for Sitey of OcJnto Considerable care and attention required to make proper hooka, warn others of hazard* X Maatal Sint light mental application to hook and unhook crane lifts, observe and coordinate movements with those of crane* Base B .8 B IX Physical Effort Moderate physical exertion in handling chains and cables, walking, occasional climbing on pipe lifts* *8 !L Svyondiifi kvsrage factory conditions, dirty, noisy* IX Huaid Hazard moderate, injuries consist of bruises, and fractures encountered Base B | Job fl--. Total $2 Oanibod By! D*0*B* Cliaifad Bys 0.0*B* Data 1Approval By: / _________________________________ ____________ r-' * `A V * i ` ^x SANFORD E. RABUSHKA. M.D, S.C. TELEPHONE, B7 8 6700 EXT 2354 LOUtS A. WEISS MEMORIAL HOSPITAL 4646 NORTH MARINE DRIVE Chicago. Illinois 60640 September 29, 198? Robert Edmunds, H.O., FACS Medical Diurector United States Steel 180/ Fast 28th Street Lorain, OH 44055 CHEST: Clifford Hanson Films are available from 1967, 1972*' 1978 and 1984. These films demonstrate normal lung fields. There Is no evidence of fibrosis. There Is no evidence of pleural thickening. The hilar structures are normal. The trachea is mldline. The diaphragmatic leaves are normal. The heart Is of normal size. Conclusion: Normal chest Is demonstrated on all of the examinations dating through December 12, 1984, without evidence of fibrosis or pleural thickening. /) SER:mc RADIOLOGIST: Sanford E. Rabushka, M.D., S.C. i 9 uss Lorain Works 1607 East 28Ui St/eel Loram, OH 44055 September 23,1987 Sanford Rabushka, HD Weiss Memorial Hospital 4646 North Marine Drive Chicago, Illinois, 60640 * re: Clifford Hanson * #90684 Dear Dr Rabushka: The above named retired employee has filed an Occupational Health Claim with the Ohio Bureau of Workers' Compensation for pulmonary difficulty secondary to exposure to gases and dusts here at Lorain Works. Enclosed please find five chest x-rays from 1967 through 1984 for your ILO evaluation. Thank you. Sincerely, Rober)^drau^d^lMDV FACS Medical Director cc file A dmeon of USX Corporation foi>2Y CJmt X*Ray Findings ILO 19 8 0 1A. PATE OF X-RAY IB. FILM QUALITY C*h"e*im*a*ai /|ej * Mo Oav Vf. t 3r 'P 1C IS FILM COMPLETELY .NEGATIVE? vp[& *D mmmarmMmsMmmmmmmmmmmmmmmmmmma 2A. ANY PARENCHYMAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS? 2B. SMALL OPACITIES YES o 72C LARGE OPACITIES e. PROFUSION a i. SHAPE/SIZE PRIMARY SECONDARY b. ZONES % % /i p ps y0 /. 'A SIZE O Qi ru qt fu RL v, 7, % v, 7 3Ai ANY PLEURAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS? YES NO 3B. PLEURAL THICKENING* a. DIAPHRAGM (pUquc) SITE b. COSTOPHRENIC ANGLE SITE 3C PLEURAL THICKENING ... Chest Wall* a. CIRCUMSCRIBED (plaque) b. DIFFUSE SITE 0 R IN PROFILE L WIDTH 0 A 8 it. EXTENT 0 t 3 c 3 FACE ON lii. EXTENT 0 i 3 3 I3 23 SITE O R IN PROFILE o AB i. WIDTH H. EXTENT o 1 2 FACE ON o1 3 iii. EXTENT c 3 3 OL o A8 c o1 3 3 o1 3 3 3D. PLEURAL CALCIFICATION SITE 0 R EXTENT a. DIAPHRAGM_____ 0 1 3 3 b. WALL O1 3 3 c. OTHER SITES_____ 0 1 3 3 H! L EXTENT a. DIAPHRAGM_____ O 1 2 3 b. WALL................ O13 3 . OTHER SITES_____ o 1 3 3 4A. ANY OTHER ABNORMALITIES? YES 4B. 4C. OTHER SYMBOLS (OBUGATORY) o ax at jam bu ca cn CO cp Cv di as Ir hi ho id lUpOft jum 13 which may b of pmcM clinical tigtuAcaace in Ihta tccuoa. 11 14 IS la 17 (SPECIFY od.) OD * 30 II 32 31 13 34 OTHER COMMENTS i'h ki pi P* P 10 10 23 3'. UVcrIvIooa7j 9Pbytician notiftad? Mo. Oay Vf. RECORDS CERTIFICATION I, the undersigned, an employee of the Bureau of Workers' Compensation, do hereby certify that the microfilm images on this reel of microfilm or microfiche are complete and accurate reproductions of the original records of the _ $ + // __ as accumulated during the regular course of business, and that it is the established procedure of this department to microfilm its records for permanent file a^d to dispose of the original records after microfilm reproductions have been made. ___ %{s Date Oats