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FILE NAME Manville JMA DATE 1966-1981 DOC JMA327 DOCUMENT DESCRIPTION Contract Unit Claim File Henry Peutz : ( ANTIOCH COMMUNITY HOSPITAL Antioch Calif DEPARTMENT OF RADIOLOGY M.D. : MARSHALL Radiologis TUCKER RADIOGRAPHIC REPORT RECEIVED DEC 1968 FILED Division of Industrial Atoldants OAKLAND OFFICE EXAMINATION.GER.SPINE EXAMINATIOEXAMINATION.GER.SPINEN.GER.SPINEEXAMINATIOENXA.MGINEARTI.ONS.PGEIRN.SEPINE CCHHEESSTT DATE 2-27-54 INPATIENT OUTPATIENT INDUSTRIAL DOCTOR Dowell wk NO.:35465 NO.:35465 NAME PUTEZ Henry AGE 56 The and vertebral bodies of density and without the cervical spine aur normal in outling evidence of fracture bone destruction or paravertebral mass The alignment seems normal Some f interve etebral spacing seeds present throughout but napraving parti ularly at and There is one anterior and lateral osteophyte T ph re eze pnetdicolnesthesee lm eftnoa rtma5l and Som 6e anpdoso tnerior osteophyotseteophyte osteaot phyte formation osteophyte formatiofonrmatiofnormationformation the right the The relationship of C1 and 2 through the Bias The apophyseal joints are not remarkable are present about the covertebral joints n nial No cervical rib is present Sete ae tr yt 100 Degenerative dine thinning . osteoarthritic changes with intervertebral The chrot in symmetrical the diaphragm clear The heart and aorta the hilus , normal the angles are rodiastinum and the trachea are not remarkable Both lung fields show a fine diffuse the parkings particularly in the lower half with small ) n dular sities The bony structures are not remarkable increase in den- IMPIMPRASIRNION ASINION IMPRASINION Bilateral suppose suppose that this is disease the most most Since litely this patient diagnosis works with arbestos Respectfully Respectfully subaitted Marshall H.Tucker M.D. Raliologist Raliologist ( RECEIVED | DEC 1368 FILED Division of inuicat inuicaitnuicat inuicat OAKLAND OFFICE HISTORY February 27 1964 PATIENT HENRY PUETZ PHYSICIAN R. J. CHIEF COMPLAINT DOWELL M.D. Auto accident a PRESENT ILINESS Patient failed to make a curve in his automobile while driving and rolled his vehicle He was not wearing a seat belt was not thrown from the car but does not know exactly what or where he struck in the machine His chief complaints are s re- neas in the neck and difficulty breathing ; . He was examined in admission arranged unconscious the emergency room rays were following these procedures He ordered had not and been PAST HISTORY Patient has significant silicosis and emphysema and . is under treatment for these by a chest specialist in Oakland Ite has had hypertension and is under treatment He recently saw a physician in Coalinga for chest congestion for which he was on tri- sulfaminic PHYSICAL EXAM This is an alert well developed well nourished white male in moderate distress He holds his neck firmly to the guerney No smell of alcohol is detected He states his face in ruddy and red as ucual HEAD EYES CARS THROATE NECK : CHEST LUNGS HART ABDOMEN : GENITALIA RECIAL NEURO INPRESSION : No bony abnormalities Pupils are round regular small but react to light Canals and drums are negative ; This is injected diffusely There is no exudate c is edentulous Tongue is negative Motion in any direction induces pain and is not attempted beyond perhaps 5" No significant adenopathy Thyroid palpable is not ; bilaterally Equal but minimal Breath sounds are expansion bilaterally somewhat distant the bases bilaterally display occasional medium rales less resonant than usually found The percussion note is His AP diameter appears : be to slightly increased oo, \ Sounds are fair to good quality N murmur is heard No No enlargment is deteceted.inxthe deteceted.inxthe organs or masses palpable There is n localized tenderness Normal adult male : . Not DTR done present and equal He is able to move all four ex- tremities and reports no paresthesias of tremities No pathological reflexes are the upper elicited - ex- Babin- ski or Hoffman i ' Probable soft tissue injury to the neck not whiplash . type Will rule out fracture silicosis silicosis intercur- with intercur- Chronic bronchitis emphysema silicosis | rent infection 11-= = SAN FRANCISCO OFFICE 444 MARKET STREET SAN FRANCISCO 94111 OFFICE SAN JOSE OFFICE 1671 THE ALAMEDA SAN JOSE CALIF 95124 LAW OFFICES OF HANNA & BROPHY 1540 SAN PABLO AVENUR OAKLAND CALIFORNIA 94612 Phone 5569 November 29 1968 RECEIVED 085 21969 Dr. Joseph D. Coate 2976 Summit Street Oakland Ca. 94609 FILED FILED 4h FILED tke FRESNO Ornes 500 DEL WESS FRESNO CALIF CENTER 3721 SACRAMENTO OFFICE SACRAMENTO OFFICE 26 J STREET SACRAMENTO 95814 . vol *. Rot Henry C. Puetz vs. Philip Casey Mfg Co. et al Case No. 66 OAE 20668 subpoena duces herewith your records which were mailed Compensation Appeals Board in response to tecm served on you at our request our courtesy in this matter y truly yours 16.c. c.c. c.c. Parrish 1.0.A.7 . with copy Omith Parrish State Compensation Ins MCMILLAN MCMILLAN > ALEXANDER S. KEENAN ATTORNEY AT LAW SUITE 700 220 BUSH STREET SAN FRANCISCO CALIFORNIA YUKON 6-1589 94104 December 4 1968 RECEIVED RECEIVED RECEIVED RECEIVED RECIVED RECEIVED RECEIVED RECEIVED 5 1858 DEC 5 1858 FIL Roeesy ge all ont FIL ae vd oe eo tdagts A A N N YY GFFICE Workmen's Compensation 1111 Jackson Street Oakland California Appeals Board Attention Referee Hickman Re Henry C. Puetz vs. Philip Carey Mfg Co. et General Accident Fire and Assurance Corp. Ltd. WCAB No. 66 OAK 20668 et al Life al Dear Referee Hickman This you that letter is filed in letter form I wish admitted pursuant to those parts my of into evidence request to note to Dr. Crantz's records The purpose of this letter attention to those records is therefore to call which show that the your suffered from cervical and lumbar applicant account for part of his problems which may the early discovery of Mrd.isPaubeitlzi'tsy t luondgaycoa nnddittioonshow Therefore please find attached to this letter certain documents contained in Dr. Crantz's copies records of ASK bh Attachments Very truly yours Header Kin Alexander S. Keenan CC State Compensation Ins Fund Sedgwick Detert Moran & Arnold Brobeck Phleger & Harrison Norman Hays Hanna and Brophy John Wilkes Smith Parrish Paduck & Clancy Industrial Indemnity Company ( RECEIVED ry, Plooca Leva When INSURANCE CpoOcoMliPtaANY Insure tf, Dloraees:Sia ote forza cemiy ycli 228 G28 getece. seo turned turned o premantly Insure your cheche will Ma a CONT romura huos compimed INSURANCEINSURANCE , romura INSURANCE COMPANY to forma pocolita fivision tor ty 1368 13ag FILED Industrial Industrial Accidents Accidents Accidents OFFICE OAKLAND OFNCE tre, LE : C. 2 FUE felisring: Elzelind : sill please Elzelind the following following Cott aes ef actify thatwas to ( cinch one fellowringi (2) expect retum retum work> en enawee ths If to logger disabled disabled disabled please . . Paeea 4 Cath yang di Cong $ dinding dinding di 4 tater di : CULPRINDINW ie: ATTENDING PETYSICIANCULPSRINDINW CULPRINDINW ATTENDING Le Ra Ye HERE C. PUETZ PETYSICIANS Time Low Dub GTATIH yp production hoodpalo BR scz el Nature eters es] I ( es eeony of sputumsputum eeveta ae thes, y Corvical hoodpalo y stante areareersaeesasn eesscegesancenseg, Osa . limber strain . ee acter se cenes srg 5. Qs) Borel ofAitwstany 12-2-0712-2-1072-2-07 5-20-03 5. tolak Pressly SESS Set traptrment 5-20-03 7 ve. 0B, . and of te) Plenty Plenty oftreat 12/2 3 4 11-67 12-2-67 3/2 6 Boa Lasplatin Lasplatin 12-2-67 19 19 1/2 ID, 29 . and 20-1559 12-2-07.13.1-122-4-67 & silentcontinuously diuited unetto unettocat city t12o -2-07.13.1-2 126-2--072.1-3.10-20 when Bha dual fad utim spproximately all the patient towodts. 12-2-07.13.1-2 12-2-07.13.1-2 - 12-2-07.13.1-212-2-07.13.1-2 + ....... nee . ascent rseseecase ae | ae en way Rome ee PO . 127. B. CA.63503 At Antioch Antioch Antioc, h CA. Antioch CA. 63503 anes metegtsTOO Otte t0t 63503 ne reat oF attacnwwe semsaees me. rene rnes emet ereae mes Doo nig. Ae Eke ee ong ee Ee Cre LEON LEWIS M. D. SHELDON MARGEN M.D. 2435 WEBSTER STREET BERKELEY CALIFORNIA 94705 PHONE 548.2727 October 24 1968 INTERNAL MEDICINS Smith Parrish Paduck and Clancy 405 Fourteenth Street - Lt Oakland California 94612 cee Attention Mr. David R. Nelson Re PUETZ Mr. Employer Henry Western Building Materials Company Gentlemen Enclosed Puetz at find a copy of the the Cardiovascular September 24 1968 second set of pulmonary Research Institute San function studies done on Mr. Francisco Medical Center on The lung volume studies 1968 and somewhat more are at slight variance with with those reported on favorable since the ratio of residual volume lung capacity is only 45 rather than 56 as previously found August 9 to total The second set of studies was capacity and as noted there particularly concerned with pulmonary diffusing is moderate reduction of this function The findings are characteristic of asbestosis with moderate restrictive lung disease In general the laboratory data confirm the diagnosis submitted on Page 9 of our report of July 9 1968 Sincerely yours Leon Lewis M. ertere D. ik . . C UNIT OPD CARDIOVASCULAR RESEARCH INSTITUTE PHYSIOLOGICAL SERVICES LABORATORY UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER ROOM 1351 MOFFITT HOSPITAL PHONE 1707 PULMONARY FUNCTION REPORT 9/24/68 SERIAL 6192 ; PUETZ Henry STUDIED BY Dr. Read REFERRED LEWIS AGE 61 YR CODE # HT +75 CM REFERRAL DIAGNOSIS wr 73.9 S.A. KG m7? LC FLO -- O -- --R PULM FUNCT DIAGNOSIS y 1 LUNG VOLUMES i VITAL CAPACITY inspired 1 1 INSPIRATORY CAPACITY ) j EXPIRATORY RESERVE i VOLUME L f RESIDUAL VOLUME U 1. ( TOTAL LUNG CAP TLC L RESIDUAL VOLILC 3 FUNCT RESID CAP FRC i N WASHOUT L Predicted | 4.0 | | Observed % Predicted 2.5 62 24 | 2.1 87 64 4.6 71 33 45 2 THORACIC GAS VOL * L :i plethysmograph y MECHANICS OF : BREATHING | 7S FORCED EXPIR VOL Ne FEV t X EXPIR IN I SEC i MAX EXPIR FLOW RATE | : { * | > 79 min 400-500 ** i MAX IIN NSS PIP R IR FLOW RATE min ** ** 300-500 300-500 AIRWAY RESISTANCE | cm H Osec 4 i NUNG COMPLIANCE | ! Liem Hy Ol , COMPLIANCE FRO cm H2 0.04-0.07 | TRANSPULM PRESSURE ; AT FRC 4-7 4-7 = 1 Icm H2O1 AT ILC > 20 a sa WHEN THIS VALUES ARE VALUE IS REPORTED REPORTED IT IS USED TO CALCULATE LOWER IN CHILDREN AND THE ELDERLY TOTAL TOTAL LUNG ! ON BASIS OF ACTUAL LUNG VOLUME dicted isoproters Alter 0.5 | % Proisoproters DISTRIBUTION OF VENTILATION | Pre- dicted s ALV GAS UNIFORMITY 1% N 750-1250 ml MT 1.3 1.3 N ELIMINATION RATE N ofter 7 breathing . 1 DISTRIBUTION OF GAS TO BLOOD WASTED VENTILATION ) physiological dead space . WASTED VENT./TIDAL VENT./TIDAL VOL 3 2.5 Pro- || dicted 5 40 min EFFECTIVE MIN VENT alv vent cak from wasted vent ALV CO DIFF mmHg VENTILATION RESPIRATORY RATE breaths Before Test < Air TIDAL VOLUME MINUTE VOLUME EXPIRED PCO mmHg ALV PCO PCO mmrig ART PCO mmHg by gas rebreath L min | Predicted 38-42 DIFFUSION PULM DIFFUSING CAP D mmHg PUUA CAPILLARY BLOOD VOL tv dicted ( dicted + ---- 21.2 | 15 CAPACITY AND RESIDUAL MEMBRANE CAPACITY VOLUME DIFFUSING mmrig COMMENTS Oto uncorr- ted for lenoglobin Puli onery diffusing capacity was moderately reduced rosic although a more marked reduction commonly isorder * Dco 71 of predicted This finding is consistent with is seen in patient's with this PEV Fe ... | Road H.B. M.R.A.C.P. Guadel GuadelGuadel Jay A. Nadal M.D. Julius A. Comroe M.D pene ae. | LEON LEWIS M. SHELDON MARGEN M. 2435 WEBSTER STREET BERKELEY CALIFORNIA PHONE 548-2727 94705 RECEIVED JUL 12 1968 Fine TO Smith Parrish Paduck and Financial Center Clancy 405 Fourteenth StrBeueitlding Oakland CA 94612 Attention Mr. David R. Re : PUETZ Mr. Henry Nelson FOR PROFESSIONAL SERVICES June 21 1968 Diagnostic evaluation Vital capacity studies opinion and report 150.00 10.00 Review of outside radiographs of the chest Note Referred for radiographic other laboratory and studies see attached bill 160.00 30.00 190.00 2435 WEBSTER STREET LABORATORY SUITE -: BERKELEY CALIFORNIA 94703 : : . 845-1851 . . : : TO Smith Parrish Paduck 405 14th Street Oakland CA 94612 and Clancy Attention Mr. David R. Nelson Re PUETZ Mr. Henry For Professional Services June 21 1968 Balance 5 wg gs, $____ Complete blood . . , Complete urinalysis . 5. 0, Sedimentation rate ' . . | Hematocrit soe ee Serology =. xic chemistry group - extended 8628 . 8936 8718 ti 8581 8675 8555 2 Sugar Cholesterol Uric Acid Urea nitrogen and Transaminase + Protein lodine ys 10 other tests tests oe.) 8710 . wti; tsi, 6.00 3.50 3.50 2.50 2.50 |. 25.00 White count and differential . . 8624 26 Partial urinalysis ee 8956 Hemoglobin see ee 8622 Electrocardiogram sis 9101 . Master's Exercise Electrocardiogram Rays 9104 15.00 _ and Lateral Chest . 7101 . | , 15.00 Chest only 2, 7100 expiratory inspiratory inspiratory - Wiha. superimposed inspiratory inspiratory expiratory 10.00 Laboratory tests other RECEIVED JUL JUL te 1078 1078 1078 Total $ 80.50 PLEASE MAKE CHECKS PAYABLE TO 2435 WEBSTER STREET LABORATORY H. CORWIN CORWIN HINSHAW M. HORTON C. JR HINSHAW M. 450 SUTTER STREET SAN FRANCISCO CALIFORNIA 91408 YUKON 2-7166 October 8 1968 SCIF SCIFSCIF _ _ ~ From To Subject earn ra HinCs . Hhina shw aw Jr. M.D. State Compensation Insurance Fund 55 Santa Clara Oakland California A15450 Henry C. Puetz - ti . rar h Se REPORT OF MEDICAL EXAMINATION Present Illness Patient's principal complaint is shortness of breath He states he first shortness of breath in 1961 and has had noticed of breath gradually increasingly severe shortness on exertion since that time . The shortness of breath became enough so he was unable to perform his severe regular work in November of 1967. He was off work from that time until five weeks ago This last five been working off and on doing easy work He still weeks he has feels he is not able to do his regular work which requires climbing which he is not able to do because of shortness of breath The patient has also had a cough which began after the shortness of breath began but he does not recall exactly when the The cough has also gradually continued to cough began ized four or five times in the last get worse He states he was hospital- year because of his shortness of breath the present time he is short of breath on At climbing six steps of stairs He is able to walk 400 to 500 feet on level ground He is not able to run at all and if he has to climb a hill he becomes out of breath very promptly His cough now bothers him mostly at night At night he chokes up and produces considerable of thick white sputum Sometimes he has to sit for amounts order to clear out his up an hour or two at night in lungs before he can go back to sleep He has some cough during the day but it is not severe He normally has about two colds If he does get a cold his shortness of breath is per year worse He feels he may have devel- oped a respiratory infection during the last day or so he has had symptoms of in- creased cough sore throat and upset stomach He has had pain in his chest and in the past when he has had bad spells of shortness of breath requiring hospitaliza- tion otherwise he does not have chest pain Lately he has developed frequent headaches He states that he feels a little dizzy all the time Last week he evaluated at the University of California Hospital here in San Francisco with c wo am s- plete pulmonary function studies arranged by Dr. Leon Lewis RECEIVED OCT 23 1968 OAKLAND LEGAL Page 2 From To Subject October 8 1968 Horton C. Hinshaw Jr. M.D. State Compensation Insurance Fund Henry C. Puetz System Review of Present Symptoms General Complaints He has no chills or fever His muscular He has gained ten pounds in the last three strength is satisfactory years respiratory Symptoms - See present illness He has not coughed up any blood He notices wheezing especially at night sometimes this will wake him He has no anginal pains palpitations or edema up intestinal Symptoms - His appetite has diminished pain or indigestion Bowels are regular .He has no abdominal . urinary Symptoms - No urinary frequency or nocturia No pain or burning Eyes Ears Nose Throat - He wears glasses His hearing has been diminished for a long time Neuromuscular - No back pain arthritis or rheumatism Personal History married wife : The patient used to smoke several cigars a day and an occasional he quit entirely about 1961. He has never been a regular cigarette csigmaorkeettreaunndtihlas < never smoked heavily He uses alcohol only occasionally He has been for nineteen years to his second Family History His mother is age 86 living and well His father died has seven brothers and three sisters living and well in the family and no other significant familial disease at age 49 of pneumonia He He knows of no lung disease tendencies Past Medical History His general health has always been good He had goiter operation about 1932 and a hernia operation in 1957. He has never had pneumonia pleurisy jaundice liver disease rheumatic fever malaria known allergies hay fever asthma or known heart disease He states he has had high blood pressure for about six to seven years He has been told it is not severe He takes medication for this Medications He takes high blood pressure medicine one tablet a day regular medication Otherwise he takes no Occupational History The patient has worked as an asbestos worker for forty years beginning in 1928 During this time he worked steadily at this trade This involved types of insulating materials including asbestos working with all During the early years of his employment asbestos was used almost exclusively He states that mineral wool began being used in 1941 and has been used in increasifnigbearmgolu asnstsansdince that time but he has continued to use some asbestos all along He has done all of insulating work and used all types of materials during the time he has workedtypHees would usually be required to cut the material that he is using and at times would be Page 3 From To Subject October 8 1968 Horton C. Hinshaw State Compensation Henry C. Puetz Jr. M.D. Insurance Fund Occupational History con't exposed to quite dusty conditions The . involves applying styrofoam work he is doing at the present time insulation to pipes He is not his current employment using asbestos in - Physical Examination General Appearance - Well Blood Pressure - 160/95 developed well nourished white male in no acute distress Pulse - 80 and regular acute Height - 69 inches Weight - 162 pounds Eyes Ears Nose Throat - No Lymph Nodes - No enlarged significant lymph abnormalities found Neck - The neck nodes are felt veins are not distended The Chest - The shape of the chest is thyroid is not palpable percussion The breath sounds normal The lungs are clear to auscultation wheezes are heard are normal in intensity and quality to No rales or Heart - Not enlarged Rhythm is Abdomen - No abdominal regular No murmurs are heard Extremities masses - Peripheral organs or tenderness vessels are good There is no edema clubbing of the fingers There is moderate Electrocardiogram Auricular Rate T Waves normal R Interval 75 Ventricular Rate 75 Rhythm sinus Position semi vertical Electric0a.l1A5xiR s normIanlterrvealma0r.k0s7-T normSaelgment isoelectric record ray Examination of the Chest Stereoscopic were obtained There is generalized fine PA expiration PA and lateral views consistent with an interstitial fibrosis infiltrate throughout both lung fields the heart border is rather The diaphragms are sharply demarkated vague and fuzzy Expiration view shows but diaphragm motion Previous rays are also reviewed Film taken good beginnings of the present disease in 1957 shows evidence of process largely confined to the lower lobes time The film taken in 1961 shows some advance in the at this largely confined to the lower lobes The film interstitial fibrosis still and now there is some involvement taken in 1966 shows further advance pared with 1966 shows in the upper lobes The present films further increase in interstitial fibrosis when com- CONCLUSION the last Generalized interstitial fibrosis which has over ten years The appearance is gradually increased over consistent with asbestosis Page 4 From To Subject October 8 1968 Horton C. Hinshaw Jr. M.D. State Compensation Insurance Fund Henry C. Puetz Pulmonary Function Studies Maximal expiratory flow rate Vital capacity in one second Three seconds Total % Vital capacity in one second Predicted 300 ~ 2.95 _. 3.92 - 75 Observed ; .- 165 . 2.00 ' 2.57 : 2.80 71 INTERPRETATION This study shows evidence of moderate restrictive restrictive There is no significant degree of obstructive airway disease abnormality ; Discussion pulmonary This patient does have a generalized interstitial fibrosis His whole picture is entirely consistent with asbestosis and considering the patient's occupational exposure it is my opinion that this patient does have asbestosis and that this is the cause of his present symptoms of rather severe shortness of breath on exertion The function studies which I did here do not accurately measure the degree of functional abnormality in a disease process of this sort The patient has had done at the University of California and I would like complete studies to review their findings if copies of this study can be obtained From the patient's symptoms however his disease is severe and causes severe limitation of physical activity He is not able to do any work which would very much in the way of physical effort and could not do require climbing or sustained physical exertion any work which required future This patient's asbestosis was gradually acquired over the many years that he has been working with asbestos and exposed to asbestos dust Exposure to insulating materials not containing asbestos have not had any effect on his pulmonary problem There is no specific treatment for his condition although he may well require medical and treatment for some attention symptomatic relief of the associated cough and expectoration and would also probably require treatment of an intensive sort for infections respiratory tract He should avoid any further exposure to asbestos dust in the Very truly yours HCH bod, oe Pustan Pustan pril Horton C. Hinshaw Jr. , M.D. . LEON LEWIS M. SHELDON MARGEN M.D. 2435 WEBSTER STREET BERKELEY CALIFORNIA 94705 PHONE 548-2727 August 20 1968 . . - INTERNAL MEDICINE A RECEIVED AUG 21 1968 Smith Parrish Paduck and 405 Fourteenth Street Oakland California 94612 Clancy Attention Mr. David R. Nelson fe Re PUETZ Mr. Employer Henry Western Building Materials Company Gentlemen performed cn Enclosed please find copies of the pulmonary function of on Mr. Puetz on August 9 report studies 1968 at the Cardiovascular Research Institute Institute of University of California Medical Center San Francisco the , The comments on Continuation Sheet 3 serve adequately to complete the submitted by our office Even though the pulmonary diffusing report previously previously unsatisfactory and will probably be repeated by sufficient to confirm the existence of the capacity test was Institute findings reported are pulmonary asbestosis restrictive lung disease characteristic of Sincerely yours 1 Leon Lewis M. D. LL _ C UNIT = NAME AGE : MT 176 W175 S.A. 1.9 CARDIOVASCULAR RESEARCH INSTITUTE PHYSIOLOGICAL SERVICES LABORATORY UNIVERSITY OF CAUFORNIA SAN FRANCISCO MEDICAL CENTER ROOM 1351 MOFFITT HOSPITAL - PHONE 666-1707 PVT PVT PUETZ Henry YR CM | CODE # PULMONARY FUNCTION DATE 8/9/63 8/9/63 8/9/63 REPORT HAMILHTON AMILTON ***** HAMILHATMOINLTON LILKER HOLST REFERRAL DIAGNOSIS Asbestosis Asbestosis Asbestosis + SERIAL 6192 REFERRED BY Lewis KG M FLOO PD OR PULM FUNCT DIAgnosis Restrli ungcdit sei aseve asbeswt itho ass besi toss is LUNG VOLUMES VITAL CAPACITY INSPIRATORY CAPACITY Pre- dicted | | Observed % Predicted | AHer 0.5 | % Pre- isoproteronal dicted DISTRIBUTION OF VENTILATION L } 4.09 24 59 L 2.72 1.46 1.46 54 ALV GAS UNIFORMITY - ( N750-1250 ml Pro- | dicted Ser 1.5 1.5 1.1 EXPIRATORY RESERVE VOLUME RESIDUAL VOLUME ~~ 7 | TOTAL CAP TLC RESIDUAL VOL TUNCT RESID CAP FRC N. WASHOUT 2 THORACIC GAS VOL * .p atnysmograph MECHANICS OF BREATHING L 1.36 1.36 L 2.36 w 6.45 m | 33 4 | sos ALI R C OPIED EXPIR VOL \ C FEVI ~fl 1 EXPIR IN I SEC MA MAXX EXPIR FLOW RARTAETE L min | > 79 400-500 400-500 = MMAXAX INSPIR INSPIR INSPIR FLOW RARATETE AIRWAY AIRWAY RESISTANCE min ** 300-500 . "a Mee 92 3,0 54 56 3.9 1.77 1.77 an 136 136 120 120 67 127 84 i 101 N ELIMINATION RATE N after 7 breathing O s) 2.5 1.2 DISTRIBUTION OF GAS TO BLOOD WASTED VENTILATION L physiological dead spoce Pro- 0 dicted | ser " " WASTED VENT./TIDAL VOL 40 EFFECTIVE MIN VENT min falv vent cak from wasted vent ART.ALY ART.ALY CO DIFF immHg VENTILATION Before Test 4 Air + RESPIRATORY RATE | breaths TIDAL VOLUME MINUTE VOLUME EXPIRED PCO mmHg PCQ2 ALV PCO PCO mmHg mmHg by gas rebreath : 22 4 430 Umini | 9 Predicted | 38-42 45__ 5.2 5.2 2 [oe] 32m 32m 7. LUNG COMPLIANCE \_) cm H Osec | . cm H O | COMPLIANCE FRC cm H O 0.040 TRANSPULM TRANSPULM Icm H20 AT FRC TLC 47 > 20 1.2 s ae + WHEN THIS VALUE IS REPORTED IT IS USED TO CALCULATE CALCULATE VALLES ARE LOWER IN CHILDREN AND THE ELDERLY O. SASIS OF ACTUAL LUNG VOLUME TOTAL LUNG CAPACITY AND RESIDUAL DIFFUSION Pro dicted + PULM DIFFUSING Dcol * mmHg PULM CAPILLARY BLOOD VOL L MEMBRANE DIFFUSING CAPACITY mmHg VOLUME ro} 187 COMMENTS * Test f pulmonary diffusing capacity capacity unsatisfactory for tecnical reasons  Cy... CARDIOVASCULAR RESEARCH INSTITUTE - PHYSIOLOGICAL SERVICES LABORATORY UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER ROOM 1351 MOFFIT HOSPITAL - PHONE 666 - 1707 PULMONARY FUNCTION REPORT PVT DATE 8/9/68 SERIAL # .6192 NAME PUETZ Henry AGY Si Hi 176 176 75 A 1.P R. CM KG Mi CODE = FLOOR OPD STUDIED BY LILKER HOLST HAMILTON REFERRED Lewis Lewis REFERRAL DIAGNOSIS - Asbestosis- chronic . bronchi PULM FUNCT Restric Restrictt ive iRestv rictive e Restrictive pulmonary disease : ~___ BLOOD ARTERIAL T CONTENT vol . 11 PS WED OO. . a -ACIN -ACIN 2 NATURATION ~ . 2 . e TENSION veoh Bl volt he , ImmHg __ Air 7 AIR - 20 2-279 2-279 19.1 19.1 Aik m7 03 9 20 76 99 AP NO AP. > 550 .3 J . 19.6 19.6 | 72 01 a 5350 ARTERIAL BLOOD EMOGLOBIN MATOCRIT O CO A CO - CONTEBN LOT OD - CONTENT PLASMA TENSION measuredi | if ; gm X X MMA | MM mmHg a i I 150 45 20.5.23 20.5.23 28.5 38 42 Air 146 146 46 19.8 24.0 24.0 36 02 35 ee J et ab. tun sh - 7.38 7.42 7.44 7 if ) TREADMILL - BICYCLE ARTERIAL BLOOD ENGGAN TmHy EXERCISE AND RECOVERY SpeedSpeed Speed Inclina WD Load 150 J REST | a oe bee one : cies Speed Incline Incline oe mph Speed Incline Incline mph KgM Load 230 Load 25 KgM pe 2 : 6 4 6 2 . - |) ,, 110 Recovery 4 6 90 Stopped exercis due to ; fatigue of) 34 743 0.99 34 7.44 Ni beats ean treats minu J Asterisk -- Rood determination done with patient breathing through mouthpiece AMM^ NINAMM^ NIN 37.8 37 196 0.4 PULMONARY FUNCTION ; HISTORY CONTINUATION SHEET # 3 PUETZ Henry 1 anme caps . SERIAL 6192 Ti man who has been an insulation worker for 40 years was referred for assessment functional impairment due to pulmonary asbestosis He has noticed gradually in- ressing breathlessness during exertion for about 10 years For a similar period he a chronic cough productive of mucoid sputum At the present time he has dyspnea dyspnea when tying his shoes when walking quickly and on climbing 8 to 10 stairs findings On mysical examination the 2nu rine inspiratory crepitations in the respiratory system are mild in the lower parts of the lungs finger clubbing The chest rays since 1957 show an infiltrative or fibrotic process increasing on serial . films . PULMONARY FUNCTION RESULTS - . Today'Todsay's tests values This disease The show a significant reduction of the vital capacity from the predicted taken with the normal airways resistance indicates a restrictive lung high proportion of wasted ventilation is due to abnormalities of ventilation and perfusion relationships in the lungs and this by the finding of a widened alveolar oxygen gradient conclusion is supported and mild arterial hypoxemia at rest The latter is not caused by hypoventilation since the arterial Poa is lower than normal nor could shunting of blood be responsible since the : Py arterial Poz reather tre expected value curing oxygen breathing There is chronic hyperventilation st res rest t and this becomes more marked during exercise Although oxygen transfer alveolar oxygen is improved from the oifference incresses resting state at light with increasing work workloads the Measurement of diffusing capacity of the lungs was unsatisfactory for technical restons We shall appointment for repetition of this test impairment of pulectory fui diffusing Capacity Capacity Capacity could be . consistent refeated with pulmonary asbestosis The ED a oe Peo aL . 4 a, \ 1 { ~ + De i SIGNtaE s SR IG. NERA .A. .C.C P . SIGNERP .A.C.P > Alu M.D Julius R.Conroe M.D LEON LEWIS M. SHELDON MARGEN M.D. Re July Page PUETZ Henry 5 1968 5 Mr. Puetz is a well developed and healthy appearing is of mesomorphic build with excellent musculature male of late There is no middle age who| apparent de- . formity There is a faint thyroidectomy scar and a more distinct herniorrhaphy scar There are tattoos of both arms and forearms and central hair is thinned and nearly bald The hair is grey left inguinal The anterior The cranium is smooth There is no tenderness The eyes are clear There is some wax normally in both ear canals but the heard at a foot distance drums are fairly well seen A watch is audible only when in contact with tick the right ear and at half inch distance from the left ear The nasal mucosa is normal because septum is intact The paranasal sinuses transilluminate transilluminate poorly obviously of dense bony structure The mucous membrane of the mouth is normal The gums are clear The tongue is normally coated The tonsils are small and not inflamed The mouth is edentulous compensated by two dentures There is no tenderness in the neck The thyroid gland cannot be felt no palpable lymph nodes in the neck or elsewhere There ' are The thorax is well formed Breasts are negative of resonance throughout both lung fields Breath There sounds is generalized impairment are bronchovesicular There are scattered crepitant rales in many areas over Breathing is mostly diaphragmatic abdominal excursion is the posterior lung normal The heart fields size is difficult to determine Heart rate rhythm and sounds are normal There are no murmurs Femoral and foot arterial pulses are normal The abdomen is rounded There hernia repair is satisfactory are no palpable organs or masses The left inguinal however there is now a small right inguinal hernia The external genitalia are normal Rectal examination discloses no hemorrhoids Sphincter tone is good The prostate gland is not enlarged There is no palpable mass The extremities small joints of are the essentially normal aside from hypertrophic changes fingers Foot and upper extremity temperatures are at the normal Neurological Examination Personality appraisal is rendered somewhat difficult by Mr. Puetz obvious diffi- culty hearing However he seems to be an intelligent well oriented and very cooperative man who has no tendency whatsoever to exaggerate his clinical mani- : festations + Gait station nystagmus coordinatio annd equilibrium are normal There is no dysmetria or Cranial nerve examination discloses quite contracted light and accommodation through a small range Mr. round Puetz pupils states which react to that he uses LEON LEWIS M. SHELDON MARGEN M.D. Re July Page PUETZ Henry 5 1968 6 considerable poorly seen amounts of containing but seem to be clear Ocular cough medication motion is intact The fundi are and sensation are normal There is Facial motor power mastoid no impairment of bone conduction over the processes Air conduction is better than bone conduction despite the impairment of hearing The Weber sign lateralizes slightly to the left The tongue protrudes in the midline without tremor Palatal and tions are normal pharyngeal func- There is no disturbance of sensation for pain vibration or temperature The superficial and deep reflexes are normal Musculoskeletal Examination There are no pathologic reflexes Posture is good There is no localized atrophy are free and normal There is no impairment of or hypertrophy Joint neck or spinal motion motions LABORATORY DATA Complete Urinalysis Color Character Reaction Specific Gravity Albumin Sugar Complete Blood Count Yellow Clear pH 5.0 Q.N.S. 3+ Negative Microscopic White Blood Examination Cells Rare Red Blood Cells Rare Epithelial Cells } 2 Bacteria Rare squamous Hemoglobin Leucocytes Packed Cell MCHC Platelets Morphology Volume 17.2 grams 15,150 48 36 Adequate Normal 116 Differential Neutrophiles Neutrophiles Basophiles Basophiles Lymphocytes Monocytes Count 79 0 20 % Sedimentation Rate 24 mm./hr Westergren Serologic Test for Syphilis VDRL Slide J reactive Extended Blood Chemistry Group Glucose ( hr Urea Nitrogen Uric Acid pc 130 mg 15.Omg 15.Omg 7.1 mg Adult Normal Ranges 72 - 120 mg 6 - 22 mg 3 - 6 mg fasting on plasma LEON LEWIS M. SHELDON MARGEN M. Re PUETZ Henry Page 7 Extended Blood Chemistry Group continued Cholesterol Total Transaminase SGPT Calcium Bilirubin Total Potassium Sodium Alkaline Phosphatase Protein Total Albumin Globulin A Ratio Protein Bound lodine 166 mg 52 U. V. units 9.7 mg .6 mg 3.8 mEq./L 137 mEq./L mEq./L 36 Intl units 9.3 4.8 4.5 0.9 gm gm gm 3.8 mcg Vital Capacity Study FEVI 1 sec FEV2 2 sec FEV3 3 sec Vital Capacity Capacity 1.7 2.1 2.1 L. 2.2 2.15 L. 2.3 2.2 2.3 2.3 L. 2.3 Adult Normal Ranges 150 - 260 mg S U. V. units 9 0.4 3.5 11 mg - 1.1 mg - 5 mEq./L mEq./L 135 - 150 mEq./L 13 - 40 inti units 6.0 - 8.0 gm 4.0 - 5.5 gm 1.5 3.5 gm 3.5 - 8.0 mcg ; *. Predicted Vital Capacity for height and age = 3.6 Vital Capacity is 64 of predicted FSV = 75 FEV = 92 FEV3 = 96 Electrocardiogram Rate 90 per minute Sinus rhythm PR 0.15 in Leads V and AVL U wave present in V QRS 0.08 QT through 4 0.36 seconds Flat T waves Conclusion Scattered ventricular ectopic beats No evidence of right Rule out hypokalemia U waves specific T wave changes in AVL and heart - strain LABORATORY SUMMARY v There is unexplained proteinuria of fairly marked degree It is not associated with other urine or blood chemical abnormality It was not possible to determine urine specific gravity The red blood cell values packed cell volume and hemo- globin are high suggesting polycythemia secondary to lung disease leucocyte count is also high although differential count is normal However the Neither the leucocytosis nor albuminuria is easily explained by clinical findings ce te nr ee tT LEON LEWIS M.D. M.D. SHELDON MARGEN M.D. Re PUETZ Henry Page 8 Blood chemical survey is normal except for elevated serum uric acid The serologic test for syphilis is negative Electrocardiogram is essentially normal hypokalemia Radiographic findings are characteristic Blood chemistry studies did not ; . . of progressive asbestosis See reveal . . below REVIEW OF RADIOGRAPHS OF THE CHEST Outside Radiographs The first film dated December 7 1957 is identified as 759786 Kaiser Founda tion Hospital Oakland It showed a medium thorax which is asymmetrical with relatively greater expansion on the right than on the left Bone structur are of normal density The lung shadows show some prominence of central bronch because of vascular markings and except for haziness of the cardiac outline overlying somewhat greyish lung shadow the pulmonary findings are not remarka beyond the limits of normal Heart aortic and diaphragmatic of the left leaf of the contours are diaphragm norm although there is slight irregularity The second radiograph is dated April 15 1961 and is from the office of J. D. M. D. 2976 Summit Street Oakland By this time the pulmonary shadow is very normal There is accentuation of central markings and faint greyish mottling throughout The heart shadow is distinctly blurred as is the medial portion c the diaphragmatic shadow show The third film on February 17 1962 also from the office of Doctor Coate of the findings previously noted There is slight thickening of a progression middle and lower lobes This is fain the interlobar fissure between the right visible in the film of April 1961 but is now much more marked There is more diffuse greyness and mottling and the cardiac border is no longer distinct A fourth radiograph of March 16 1963 from Doctor Coate's office made penetration than the prior film shows relatively little progression of monary disorder with le the pul By February 2 1964 another film from Doctor Coate's There is office shows findings si additional progression b to those of 1962 but somewhat more diffuse made on March 5 1966 seems to sh February 13 1965. A very light radiograph less density than the prior films but the most recent radiograph of February 1957 also from Doctor Coate's office shows a very diffuse process involving is distinctly larger and i both lung fields By this time the cardiac shadow However the diaph outline is blurred The diaphragm is generally irregular matic curve is well preserved there is no flattening LEON LEWIS M. SHELDON MARGEN M.D. Re July Page PUETZ Henry 5 1968 9 Radiogr maa depJhus ne 21 1968 : - a ae . As in the previously reported films there is asymmetry the chest ~ Bone oaf structures are of normal density Both lung fields show diffuse greyness wi| th . reticulation and exaggeration of central pulmonary markings The heart and at aortic contours are not beyond the normal range of size however they are diaphragm distinctly blurred and a clearcut cardiac outline cannot be made out The diaphragm. is slightly hazy along its margin but the costophrenic sinuses are well preserved ~ A superimposed projection of inspiratory and expiratory views of the chest shows a diaphragmatic excursion of 32 ments are made at approximately mm the on the right and 36 mm on the mid portion of the diaphragms ) left Measure- . The lateral view lung fields with dorsal vertebrae shows a prominent hilar shadow and generalized greyness of exaggeration of markings The heart size appears normal are well formed and the interspaces are normal the The DISCUSSION Review of the previously made radiographs dating from 1957 interpreted in con- junction with the fibrotic process current in both film lungs discloses a gradually progressive which is evidently restrictive but presumably not associated with marked secondary Heart and aortic size emphysema Diaphragmatic appear normal at present excursion is quite well preserved The findings are consistent with occupational disease of the lungs due to asbestosis -- a diagnosis suggested by the employment history DIAGNOSES 1. Asbestosis with moderate restrictive pulmonary disease a Probable secondary polycythemia b Probable chronic bronchitis 2. Right inguinal hernia 3 Proteinuria --- cause ? 4. Leucocytosis -+ cause ? rs 5 Hearing loss -- fairly severe Sincerely yours 1 Leon Lewis M. D. LL LEON LEWIS M. SHELDON MARGEN M.D. 2435 WEBSTER STREET BERKELEY CALIFORNIA 94705 PHONE 548-2727 July 5 1968 : INTERNAL MEDICINE Smith Parrish Paduck and 405 Fourteenth Street Oakland California 94612 Clancy Attention Mr. David R. Nelson Re PUETZ Henry Employer Western Building Materials Social Security Number 532-112-4188 Company Gentlemen Mr. Henry Puetz a year in this office on June 21 old twice married Caucasian workman was examined 1968 by the undersigned Leon Lewis M. D. EMPLOYMENT HISTORY Western at the Building Materials Company June 18 University of the Pacific Stockton 1968 to present California asbestos worker Prior employment Western Building Materials Company Stockton asbestos insula- tion application two weeks November 15 - 29. 1967. San Francisco California October 1 to November 15 Western McArthur Company 1967. Western Asbestos Company Los Landing California April to October 1967. Mr. Puetz has been an asbestos worker since 1928 at first in Portland Oregon until 1945 and since Seattle Washington 1945 in California until 1941 then in DATE OF ONSET OF SYMPTOMS 1957 PERIOD OF DISABILITY November 29 1967 to June 1 1968 PHYSICIAN P. E. Crantz M. 0 HOSPITALIZATIONS See Chronological Medical History JON HISTORY 0.Punca was born in Seattic Washington on May Pegon a 1941 and to San Francisco California thin Philippine served in the United States Army from 1925 to Philippine Philippine Islands 25 1907 He in 1945. He 1928 mostly moved to Portland completed high school serving in the LEON LEWIS M. SHELDON MARGEN M.DM..D. Re July Page PUETZ Henry 5 1968 2 His first marriage in which he fathered has two living adult sons the third son accompanied to the office by his present excellent relationship three sons terminated in divorce He was killed in the Korean War He was wife with whom he seems to have an He discontinued smoking cigarettes in 1965. Prior about half package daily He drank alcohol in cently but now does not drink at all to that time he says he moderation until fairly we smoked re- FAMILY HISTORY His mother is living and in reasonably good health at age 82. His father died of some type of pulmonary disorder leading to pneumonia at age 49. Seven brothers and four sisters are living and well His two sons are well He knows of no tuberculosis cancer or diabetes in the family PAST MEDICAL HISTORY and In addition to the ordinary diseases of childhood he had diphtheria at age 12. In 1938 he developed hyperthyroidism thyroidectomy was performed at the Bremerton Naval Hospital A left herniorrhaphy was performed at Antioch Hospital by Doctor Crantz in 1957. He was hospitalized for pulmonary disorder at the same hospital in 1958 1959 1960 1962 1964 1965 1966 and 1968. His last chest radiograph was made in March 1968. A gastrointestinal radiographic series was made in De- cember 1967 SYSTEMIC REVIEW Mr. Puetz sleeps poorly and has difficulty falling asleep tives He has frequent headache and dizziness His memory He wears glasses but has not been examined by an eye doctor years He does not use seda- has begun to fail within the past two He is subject to frequent is moderately productive chest colds and he has a chronic annoying cough which He has been told that his blood pressure was elevated chest discomfort but no characteristic anginal pain on slight exertion in He the past He becomes short has some of breath All has of his teeth a new set of have been extracted dentures to which he is poor and his abdomen is distended that he had a stomach ulcer and he has worn dentures for some time He has not yet become accustomed His appetite after meals He has been told in the past LEON LEWIS M.D. SHELDON MARGEN M. Re July Page PUETZ Henry 5 1968 3 Nocturia occurs once There are no other genitourinary symptoms Other general complaints are fatigability nervousness and tension 1. Shortness of breath on slight exertion a Walking causes dyspnea b Even tying his shoes causes some breathing difficulty C. Climbing a flight of stairs he must stop at least once to rest 2 Productive cough especially at night a Expectorates about half cupful of greyish mucoid sputum b Has never expectorated blood 3. Frontal headache lasting several hours in attacks 4. Giddiness occurring when he bends over CHRONOLOGICAL MEDICAL HISTORY During his early Mr. Puetz was in years and extending good health While through on duty his military service until 1928 in the Philippine Islands he was well and was never other infections hospitalized He did not contract He had no venereal infection malaria dengue fever or After his return to the United States he first began to work in the asbestos trade His first employer was the United States Government at the Bremerton Navy Yard where he was discharged from military service and became an employee employee For 13 years he remained at the navy yard and most of his work consisted of the application of asbestos covering on pipes Most of this work was done and at times he had to work in relatively confined spaces During the on ships entire period of his employment by the naval shipyard he worked without any kind of respiratory protection No radiographs of the chest were made and no medical examinations were done during his years of work After leaving the shipyard he moved to Portland Oregon where he was employed by Plant Asbestos Company He again worked applying asbestos insulation to pipes on ships On this job he also worked without respiratory protective equipment He does not recall having any chest radiographs made at this time in 1945 he moved to the San Francisco Bay area where his first employer was Western Asbestos Company He worked in the plant and while his duty was still the application of asbestos coating to pipes he was also exposed to the fabri- cation process Ever since 1945 he has worked on and off for Western Asbestos Company or their successors He was also employed by the Fiberglas Company in LEON LEWIS M. SHELDON MARGEN M.D. Re PUETZ Henry Page 4 San and Francisco rock wool There all of he worked not only with asbestos these materials having been used but for also with Fiberglas insulation He also worked for Plant Asbestos Company in Emeryville having spent about four or five years in their employ . In short since has been almost 1928 except continuously for periods employed in of disability in recent the asbestos insulation months Mr. industry Puetz which In 1938 while working at Bremerton he developed hyperthyroidism for thyroidectomy was performed at the Bremerton Naval Hospital He has a had to take thyroid extract He was then quite well until 1957 when he developed a left Wee inguinal hernia At this time he was already somewhat short of breath and coughing He remained in Antioch Hospital eight days after repair of the hernia he was not hospitalized for pulmonary disorder at that time but was under treatment by Doctor Crantz Although Mr. Puetz does not recall the exact dates he believes that he has been hospitalized about 10 or 12 times always at Antioch Hospital and always under Doctor Crantz care About 1962 he was in an automobile accident which required hospitalization for a back sprain Later in 1966 he suffered a neck injury and was again hospitalized On each occasion whether specifically for respiratory difficulty or for other causes he was treated for his respiratory problem usually with intermittent positive pressure devices and various medications At present his medical regime consists of two medications but he does not know their identity He also uses a cough syrup He reports to Doctor Crantz about every home four weeks He has never used intermittent positive pressure therapy at Recently during each year his condition has fluctuated considerably He is especially short of breath during the winter and gression of disability over the course of years there has been gradual pro- Mr. Puetz left his work with Western Building Materials 1967 because of shortness of breath chest discomfort to work for the first time since then on June 18 1967 with some difficulty to the date of this examination work he rested most of the time He now finds that it Company on November 29 and cough He returned and has put in two days During the period off is difficult to work overhead and he is easily fatigued He finds that climbing and working levels are extremely difficult He has not had to work above the ground past two days of his resumed employment at high the e PHYSICAL EXAMINATION Height 63-3 Weight 161-1 pounds Maximum prior weight 168 pounds in 1966 Blood pressure initially 138/102 in the left arm sitting After approximately 15 minutes a second reading was 170/94 Pulse rate 88 per minute J. D. COATE M. D. RADIOLOGIST 2976 SUMMIT STREET DAKLAND 9. CALIFORN CALIFORN LLEPHONE Temp 'roar6 U57 February 13 1465 Patients Address Purtz Henry . 1531 Marshall treetAntioch Physician Mr. Holmes Act 5 7121 mt CHEST : ws PA film of the chest again shows the rather extensive bilateral fibrou. changes throughout both lower lobes which have been observed on previo , examinations at yearly intervals since 4-15-61 There has probably been no marked increase since the last examination on 2-8-64 but comparison involve- with previous films is necessary to determine the progress of this ment The cardiac shadow is normal and the hemidiaphragms are smooth and rounded CONCLUSIONS Bilateral chronic fibrotic changes in both lower lobes probably occupational Diane <n JDC J. D. Coate M. D. . J. D. COAT~ M. D. RADIOLOGIST 2976 SUMMIT STREET BAKLAND 9. CALIFORNIA TELEPHONE TEMPLEBAR 6-4057 February 17 1962 Patient Puetz Henry C. Address Rt 2 Box192Oakley ; Physician Asbestos Workers Survey Aet 54 Mo --- C, een ce St Both lung fields show considerable granular thickening of the root .- shadows in both perihilar areas along with discrete milliary densities These changes were noted on examination 4-15-61 A direct comparison with the previous films would be important to determine the progress of this disease CONCLUSIONS Pulmonary occupational disease probably asbestosis JDC a . t h h ra . ne ee wee Thanking scort nr ra. * Thanking Thanking scort . report a report ; Cc) =: WORKERSINDUSTRIAL COMPENSATION APPEALS BOARD - INDUSTRIAL ACCIDENT CALIFORNIA COMMISSION prior to 1966 APPLICANT HENRY PEUTZ Asbestos Worker CASE OAK 20668 DATE CLAIM FILED July 22 1966 Amended INJURY ALLEGED Injury to lungs due to ALLEGED DATE OF INJURY 1945-1967 Jan. 1968 inhalation of harmful material EMPLOYER C. F. Braun et al Many defendants see Findings including including J.m Sales No apparent Canadian carrier OTHER NOTES Defendants did not dispute asbestosis diagnosis Several petitioned for Reconsideration by reason Statute of Limitations -- denied of -DATE OF RESOLUTION " Sept. 8 1969 RESOLUTION Findings & Award Feb. 11 1970 Comp & Release 13,440 + costs 8.280 settle . + wk , DOCUMENTS COPIED Findings & Award Mar. 9 1970 Affirmed after Reconsideration # OF PAGE 2 Compromise & Release 3 Report of Referee denying Reconsideration 4 Petition for Reconsideration attach admitting asbestosis - employment harmful to health Con vers a - Crenty Crenty Atel & Crenty Conte eben ees 3 5 13 / CLAIMANT Henry Peutz California Workers CARRIERS INVOLVED Compensation Appeals Board The AETNA Casualty & Surety Co. oAmerican Automobile Ins Co. oAmerican Employers Ins Co. American Motorists Ins Co. Argonaut Ins Co. . oAssociated Indemnity Corp. oCalifornia Casualty Casualty Indemnity Exchange oCalifornia Compensation & Fire Co. oCasualty Ins Co. of Employers California oEmployers Liability Mutual Assurance Corp.Ltd | oFidelity & CasualtLyiaC boi.lio tyf N IenwsYo Cor.k of Wisconsin _ oFireman's Fund Ins Co. oGeneral Accident Fire & Life oGlobe Indemnity Co. Assurance Corp. Ltd. . oGuarantee Insurance Co. Great American Ins Co. oHardware Mutual Casualty Co. Sentry Industrial Indemnity Co. Industrial Exchange Indemnity Exchange oInsurance Co. of North America oLiberty Mutual Ins Co. Ins ; Co. oLumberman's Mutual Casualty Co. oMaryland Casualty Co. oMichigan Mutual Liability Co. oMission Insurance Co. oNational Automobile & ONew Amsterdam CasualtyCC aos.ualty Ins oOcean Accident & Guarantee Pacific Employers Ins Co. Corp.Ltd Corp.Ltd oPacific Indemnity Co. oReliance Ins Co. Standard Standard Accident oRoyal Indemnity Co. Ins Co. oSecurity Ins Co. of Hartford U.S. State Compensation Insurance Fund oTransport Indemnity Co. The Travelers Ins Co. Casualty Ins Co. oThe United Pacific Ins Co. oU.S. Fidelity & Guaranty Co. oZenith National Ins Co. oZurich Ins Co. Continental Casualty Co. Martford Accident Indem Co. 00 5/81 mmf PAUL E. CRANTZ M.D. 127 E. 16TH STREET ANTIOCH CALIFORNIA PLATEAU 7-8700 November 15 1962 Joseph E. Smith Smith Parrish Paduck & Company Financial Center Building 405-14th Street Oakland 12 California Dear Mr. Smith Smith Thank en Mr. Pustz ave resulted confinal sutum for has Dur been etter rt a atient had November in this asben 7d m8 Saul oo, a , OPE f T Grantz H.D. Re : Puetz Henry C. regarding Henry C. Puetz cember 3 1959 He many years duration which ray of the chest cough with production of ales present in the lungs is or whether or not RECEIVED Patient Address ; : Physician J. D. COATE M. D. RADIOLOGIST RADIOLOGIST 2976 SUMMIT STREET CARLANG 3. CALIFUMNIA TELEPHONE 6 TEMPLESAD 4839 - February 8 1964 Puetz Henry 1531 Marshall Street Mr. Holmes Antioch Act 56 - . e- DEC5 1968 FILED Division of Industrial Accidents OAKLAND OFFICE : . 3460 _, ne 1 a sont es : pee : . ; . Lad : . . CHIEST ee < A cingle PA film of the chest shows the chronic bilateral fibrotic changes more throughout the levier half of both lung flolds marked on the right . aa . . associated associated perfiles thickening . side moderate with moderate bilateral : perfiles perfiles thickening Thes fo. toy ' changeshave apparently apparently Een progressing over the py years since 1957 we. . - oct wy ' me '. A comparison with all of thece former films was mademade in this office office on therecomparisons our exaratationexaratation of3-27-62 3-27-62 From time to time buld be made a , . . ' i Coe : HOLIS.ONR C Sf , te woo ER, : . . s wv, . mar * 10 fibrotle changeschanges throughout throughoutthroughout both lower h ye 7 . 7 , siglt ride- apparentlyapparently due to occupational disc Tes a . . Hoy OM Fe, oo : we 7" oo J aot 4 2 . a : . ' Coatea BOE .oD. Coate Coate M. : , . . a . , , poe 4 : . . es oat .. Lot . wy : 4, . i g 2 oo. ty . JD COATE MD MD RADIOLOGIST RADIOLOGIST 2976 SUMMIT STREET OAKLAND OAKLAND CALIFORNIA 94607 Telephone 636-4057 a we oabwek: Puetz Henry Aet 59 Ado Rt # 2- Box 101 Oakley Physician Physician Asbestos Workers Survey # B- 5278 - February 21 1967 CHEST ow, A single PA film of the chest again shows the extensive bilateral interstitial fibrosis generalized throughout both lung fields The hilar shadows are also increased in density somewhat more marked on the right side No localized areas of parenchymal infiltration can be seen The cardiovascular shadow is still normal in outline and the diaphragms are smooth and rounded A comparison with previous films is necessary to determine the progress of the disease CONCLUSIONS Extensive bilateral interstitial fibrosis throughout both lung fields JDC mc ABDC oe J. fo? Y D. Coate M.D. DCOATE DCOATE D - ALE ALE gt CARE AND anwsPER PER CALIFORNIA 7:45 Telephone 16 4957 Puetz Henry Aet 58 # B- 1016 Rt # 2 - Fox 101- D Oakley California | Asbestos Workers Survey ' March 5 1966 CHEST . A single FA film of the chest shows extensive bilateral interstitial fibrotic changes throughout both lung fields as previously observed since examinations made annually from 4/15/61 The hilar shadows are also somewhat is normal CONCLUSIONS Extensive bilateral pulmonary fibrosis probably occupational . JDC ag fam F , et D. Conte M.D. COATE D COATE COATE MD MD Fo eeett ote ts AND ALEPH'A ALEPH'A ALEPH'A 917 e Telephone 53 4057 Puetz Henry Aet 57 1531 Marshall Street Antioch Asbestos Workers Survey # A - 7121 . February 13. 1905 . CHEST } PA film of the chest again shows the rather extensive bilateral bilateral fibrotic changes throughout both lower lobes which have been observed on previous examinations at yearly intervals since 4/15/61 There has probably been no marked increase since the last examination on 2/8/64 but comparison with previous films is necessary to deter- mine the progress of this involvement The cardiac shadow is . normal and the diaphragms are smooth and rounded CONCLUSIONS Bilateral chronic fibrotic changes in both lower lobes probably occupational JDC ag a7 w ALO fe Oe J. a. D. Coate M.D. 10 COATE MD DAKLAND DAKLAND aA TEL | CALIFORNIA 94605 Telestine 16 4057 tp iaees Puetz Henry Aet 56 1431 Marshall Street Antioch nes Asbestos Workers Survey # A- 3460 February 8 1964 PA CHEST . A single PA film of the chest shows the chronic bilateral fibrotic changes throughout the lower half of both lung fields more marked on the right side associated with moderate bilateral hilar thicken- ning These changes past years since 1957. have apparently A comparison been progressing over the with all of these former films was made in this office on our examination of 3/27/62 From time to time these comparisons should be made thicken- H * CONCLUSIONS Chronic fibrotic changes throughout both lower lobes more on the right side apparently due to occupational disease marked JDC a J. D. Coate M.D. ual: vd PADI oa? MM ote ba 1 SANLAND SANLAND TAUFORNIA TAUFORNIA 201 Telephine 53 8057 Puetz Mr Henry C 1531 Marshall St Antioch Age 55 Asbestos Workers Survey A - 404 March 16 1963 PA CHEST Single PA film of the chest again shows the generaliz ed fine fibrotic changes throughout the lower half of both lung fields There which have been reported on previous examinations has been no apparent increase since the examination made one year ago The only areas showing any degree of emphysema are in the dependent portions of both lower lobes The upper lobes of both lungs appear to be relatively normal in appearance The diaphragms are smooth and rounded showing no evidence of any pleural adhesions CONCLUSIONS Chronic bilateral fibrotic occupational disease changes apparently pulmonary JDC ag a oa D. 4. ie uw Coate M.D. L JD COATE M.D. ADIDA CUST et SUM IT SUMMIT BAKLAND BAKLAND CALL STREETSTREET OPNIA 93769 Telephone 836 4057 . Puetz Mr Henry C Age 54 Addressi Rt 2 - Box 192 Cakley Phyx.clas Asbestos Workers Survey # 22832 March 27 1967 es PA CHEST of A review the recent film made on 2/17/1962 and compared with previous films made elsewhere in 1957 show a gradual increase in the degree of fibrotic changes in the hilar areas and throughout the lower half of both lung fields The film made in 1957 shows only a very minimal however early changes There has been no great increase in the degree of fibrosis as compared with the film made on 6/10/1961 However I do feel that there is definitely a very gradual increase in the degree of interstitial fibrosis during the past five years The inferior portions of both lower lobes appear to be somewhat more emphysematous as compared with the film made in 1959 CONCLUSIONS The gradual increase in the bilateral fibrotic changes and the radiologic appearance of the process strongly suggests this is probably pulmonar y occupational disease that JDC ag a 3.0 COATE MO Say ay "6 OAKLAND OAKLAND MY ST PERT PERT CALIFORNIA CALIFORNIA O40, Telephine 16 4057 Puetz Henry C Aet 54 Rt 2 Box 192 Oakland Asbestos Workers Survey Survey # 22832 February 17 , . in PA CHEST *. Both lung fields show considerable shadows in both perihilar granular thickening of the root areas along with discrete milliary densities These changes were moted on parison with the previous films examination would be 4/15/61 . A direct cor.- progress of this disea se important to determine the . = CONCLUSIONS Pulmonary occupational disease probably asbestosis JDC ag a rs J. D. Coate M.D. 2G COATEM WALE 1ST ete 1.5348 1.5348 ... SIDEET SIDET DAKLAND DAKLAND CALIFORNIA CALIFORNIA tec. Telephone 536 1057 . fub Aggress Puetz Route Mr Henry Age 54 Box 192 Cakley Calif # 21148 Physician Mr Holmes ( Asbestos Workers Survey April 15 1961 PA CHEST wy PA film of the chest shows considerable bilateral increase in both hilar shadows with considerable generalized increase in the root shadows throughout both lower lobes In some areas small discrete parenchymal densities can be seen The heart shadow is within normal limits and the diaphragm are smooth and rounded CONCLUSIONS The findings are very suspicious for a possible early asbestosis JDC ag D. Pa Conte M.D. ee eect WORKERS COMPENSATION APPEALS BOARD 2 STATE OF CALIFORNIA 3 HENRY C. PUETZ fF | CASE NO 66 OAK 20668 to 7 8 9 10 Applicant VS. ) C.F. BRAUN et al and AMERICAN MOTORISTS INSURANCE COMPANY et al Defendant } CERTIFICATION . 11 I hereby certify that the attached documents are true 12 13 and correct copies of the original documents filed in the records of this office in the entitled matter 14 15 Appeals ATTEST Board of my hand and the Seal of the the State of California Workers Compensation 16 17 18 -- --"--, 19 C. WILLIAMS 20 Workers ' Compensation Judge Workers Compensation Appeals Board 21 222 23 24 25 26 27 Dated at San Francisco California this 6 day of April 1981 DIA WCAD FORM 15 NEW 1.78 COCON NT OT S DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS WORKMEN'S COMPENSATION APPEALS STATE OF CALIFORNIA BOARD . HENRY C. PUETZ I Applicant ) ) CLAIM NO 66 OAK 20568 VS. ) C. F. BRAUN et al and ) AMERICAN MOTORISTS INSURANCE COMPANY et al ) Defendants FINDINGS AND AWARD . FILED FILED | SEP8 1969 10 11 12 13 14 15 16 17 18 19 2 The above entitled matter having been regularly submitted submitted before Richard A. Hickman Referee said referee makes his decision as follows FINDINGS OF FACT 1. Henry C. PUETZ born April 25 1907 while employed as asbestos worker within the State of California during the period be ginning 1945 through November 29 1967 sustained injury arising ou of and occurring in the course of his employment consisting of asbestosis 2. Applicant was employed and injury was caused by exposur during periods of employment and insurance coverage as follows EMPLOYER YEAR INSURANCE CARRIER Cork Insulation Co. Western Asbestos Co. Inc. Marine Supply George Engineering & Co. Golling & E. Gunder 1945 1946 1947 1954-1958 1960-1962 1964-1966 State Compensation Ins.Fu 1947 1947 Fibreboard Corporation Plant Asbestos Co. 1947 1948 self - insured 1948-1950 Pacific Employers Ins Co 1953-1955 ) 1957 1958 1960 ) Industrial Indemnity Company 1963 1964 Employers Liability Assur : Corp. Ltd. 1 2 3 ... 5 6 7 8 9 10 11 12 Bay Cities Asbestos J. T. Thorpe & Son Ltd | Western Fibrous Products Co. : Glass The Industrial Insulators Johns Manville Sales Corp. Armstrong Cork Co. Mundet Cork Corp. Thorpe Insulation Co. Gay Engineering Corp. Owens Corning Fiberglass Corp. 1948 1949 1948-1950 1949 1949 19419957-1953 ) 1955 1962 1953 1955 11996545--11996662 y Industrial Indemnity Co. Pacific Employers Ins( Industrial Indemnity Exc Travelers Insurance Com ; Travelers Insurance Comp Aetna Casualty & Surety Aetna Casualty & Surety Co. 13 Fluor Maintenance Inc. 1955-1957 14 Coast Insulating Products 15 Harold G. Lorentzen ' 16 | Lorentzen Co. Owen E. Leinio 17 San Jose Asbestos Co. 1956 1957 1956 1957 18 C. F. Braun 1958 19 20 21 22 23 John Newkirk Universal Insulation Co. Armstrong Contracting & Supply Co. Muldoon Co. Inc. M. R. Carpenter 1960 1961 1963 1961 1962 1962 24 Accurate Insulation Inc. 1962 25 ||Hickman Bros. Inc. 26 Keller Insulation Corp. 1963 1963 27 Metal Clad Insulation Inc.1964 28 Insulation Services Inc. 1964 1965 29 Associated California Insulation of 20668 65 .30 Jak MacArthur Co. uetz | 1965 1966 1967 : : Continental Casualty Co. Argonaut Insurance Co. Pacific Employers Ins C Industrial Indemnity Co. American Motorists Ins.C Industrial Indemnity Co. State Compensation Ins.F State Compensation Ins.F Pac.Employers Ins Compa Industrial Indemnity Co. Hartford Accident & Ind Great American Insurance Employers Liability Assu Corp. Hartford co Accident & Inde -2- 10 11 12 13 14 15 16 17 18 19 20 21 22 3. Applicant's earnings were maximum for both temporar permanent disability indemnity 4. The injury resulted in temporary total disability fo , period November 30 1967 to and including May 31 1968 or 5 The injury resulted in permanent disability of 64 % 6 Applicant is in need of further medical treatment to relieve from the effects of the injury 7 Defendants failed to furnish medical treatment neces to cure or relieve from the effects of the injury subsequent to 26 1966 after notice of need and applicant incurred expenses therefor 8. 295.50 Applicant reasonably incurred medical costs of 9. The reasonable value of the services of applicant's attorneys is 1,500.00 10. The Department of Employment paid UCD benefits at 7 per week for the period December 2 1967 through May 24 1968 currently with temporary disability found herein regard 11. The claim is barred by the Statute of Limitations wi to temporary disability indemnity or medical expenses for period commencing prior to July 26 1965 12. Defendants have not been prejudiced by lack of notic the injury 13. misconduct The injury has not of the employee been caused | by the serious and wi 14. Defendant State Compensation Insurance Fund is pri responsible for the payment of compensation and the furnishing o medical treatment as awarded herein but said defendant will hav right to seek contribution from the other defendants in an amoun be adjusted by said defendants or to . be determined by the Appea 5 6 7 o 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Board upon filing of an appropriate request therefor such proceedings being hereby expressly reserved Jurisdic WARD AWARD IS MADE in favor of HENRY C. PUETZ against STATE SATION INSURANCE FUND PACIFIC EMPLOYERS INSURANCE INSURANCE COMPANY IN INDEMNITY COMPANY INDUSTRIAL INDEMNITY EXCHANGE EMPLOYERS LI ASSURANCE CORPORATION LTD TRAVELERS INSURANCE COMPANY , AET CASUALTY & SURETY COMPANY CONTINENTAL CASUALTY COMPANY ARGON INSURANCE COMPANY AMERICAN MOTORISTS INSURANCE COMPANY HARTFO ACCIDENT & INSULATION INDEMNITY COMPANY GREAT AMERICAN INSURANCE CO INC MARINE ENGINEERING & SUPPLY CO COMPANY GEORGE 1 AND E. GUNDER FIBREBOARD CORPORATION THE INDUSTRIAL INSULATO THORPE INSULATION CO GAY ENGINEERING CORPORATION OWEN E. LE SAN JOSE ASBESTOS CO JOHN NEWKIRK UNIVERSAL INSULATION CO ARMSTRONG CONTRACTING AND SUPPLY CO jointly and severally as follows . a Temporary disability indemnity at 70.00 per week the period November 30 1967 to and including May 31 1968 1 1,840.00 to the Department of Employment in satisfaction of it for UCD benefits b Permanent disability indemnity at 52.50 per week ginning June 8 1968 and continuing for 256 weeks until the to of 13,440.00 shall have been paid less 1,500.00 to Smith Pa Paduck & Clancy as attorneys fee c Further medical treatment to cure or relieve from effects of the injury herein July d Reimbursement of 26 1966 to be adjusted medical expenses incurred subsequ by the parties or to be determine in upon filing of a petition and supporting documents e Medical costs of 295.50 payable 215.00 t Dr. 2 3 Leon Lewis and 80.50 to 2435 Webster Street f Interest as provided by law ORDERS Laboratory 5 6 7 8 mo 10 11 IT IS ORDERED THAT State Compensation Insurance Fund be primarily responsible for the payment of compensation and costs ar for the furnishing of medical treatment as hereinabove awarded subject to said defendant's righotf contribution as provided in finding no 14 above IT IS FURTHER ORDERED THAT Van Arsdale Harris Co. and The Budlong Corp. be and they are hereby dismissed as parties de dant herein 12 13 15 16 17 18 19 20 22 hg PUETZ 66 OAK 20668 RICHARD A. HICKMAN Referee SERVICE BY MAIL ON ALL PARTIES LISTED ON OFFICIAL ADDRESS RECORD SEP 8 1969 ot INSTRUCTIONS Do not ase this form in death cases Use Form 16. Do not use in party cases Use 17 if the injured employee be under 21 years of age and a guardian ad litem has not been previously of guardian ad litem and trustee must accompany this agreement s The guardian must sign this agreement on behalf of an injured employee who is under 21 years of such minor should also sign this agreement oS appointed age If the a petition for appointment . minor is above the aga of 1 Attach all medical reports not heretofore submitted to the Workmen's Compensation Appeals Board and advise when other reports were file COMPROMISE AND RELEASE WORKMEN'S COMPENSATION APPEALS BOARD DIVISION OF INDUSTRIAL ACCIDENTS RELATIONS DEPARTMENT OF INDUSTRIAL STATE CALIFORNIA . en Te CASE NO OAK 2066 SOCIAL SECURITY 532-12-4188 Mr. XXXXX HENCY C. PUETZ ... APPLICANT C.F. BRAUN et al CORRECT NAME OF EMPLOYER Rt 2 Box 101 Oakley Californ ADDRESS ADDRESS AMERICAN MOTORISTS INSURANCE NAME OF CO etal ADDNESS The parties hereto for the purpose of compromise only hereby submit the following agreed statements of fact Henry C. Puetz 1967 employee employee herein born on 4/25/07 claims as that he was employed on 1945 _day of _19_ Various Places in Calif asbestos worker GGCUPATION _by_ MONTH YEAR Various Employers INAME OF EMPLOYER CITY CITY STATE then insured as t workmen's compensation liability by Various Insurance STATE NAME OF OR carriers OSLP and tha he sustained an injury arising out of and in the course of his employment as follows evidenced by the medical reports on file with the WCAB The actual weekly wages of the employee at the time of injury were $ Maximum Maximum while the average weekly wages wer 3. The employee's present disability is in and the employee returned to work dispute STATE PREBENT DISABILITY RESULTING FROM THE INJURY IF DO STATE WHEN 4. a Temporary disability indemnity has been paid to the employee in the sum of None at $ beginning ._.______. to and including The amount due and unpaid to the employee is $ -per week b Permanent disability indemnity has been paid to the employee in the sum of 1500.0 advanced Covering prod to 5. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of 8280.00 in addition to any sums heretofore paid by the employer or the insurer to the employee said sum to be payable as follows SEE ADDENDUM _ 6. Medical and hospital expenses have been paid ALL by the employee and None _by the employer or carrier None Unpaid bills amount to : __, Future medical and hospital expense is estimated at In dispute by future medical and hospital expense is to be assumed as appli by c appa lic n ant t _ Unpaid and DIA WCAB FORM 15 PAGE ) FORMERLY FORM 431 NEV 1.66 84319-872 12-25 M ' ' csv oS ; . . Smith Paduck Clancy & WRIGHT 7. Name and address of employee's attorney if any 405-14th 405-14th Street Oakland California California 1. Said attorney requests a fee of 750.00 Amount of attorney fee previously paid if None 9. 9. Reason for Compromise parties wish to compromise their dispute as to injur COE nature and extent of disability need for future medical and limit ofalt imi ito atn ios ns 10. The undersigned request that this Compromise Agreement and Release be approved 11. Upon approval of this Compromise Agreement by the Workmen's Compensation Appeals Board or Referee and paymer accordance with the provisions hereof said employee releases and forever discharges said employer and insurance carrier from claims and causes of action whether now known or ascertained or which may hereafter arise or develop as a result of said in including any and all liability of said employer and said insurance carrier and each of themthem to the dependents heirs execu representatives administrators or assigns of said employee ` It is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employee and the W.C.A.B. may in its discretion set the matter for hearing as a regular application reserving to the parties the right to issue any of the facts admitted herein and that if hearing is held with this document used pu have available to them all defenses that were available as of the date of filing of this docasumaenntappalnicdattihoant tthhee dWe.feCn.dAa.nBt.s . thereafter either approve said Compromise Agreement and Release or disapprove the same and issue Findings and Award : hearing has been held and the matter regularly submitted for decision 13. For the purpose of determining the lien claim filed herein for the unemployment compensation disability benefits which have i paid under or pursuant to the California Unemployment Insurance Code the parties propose the following division of the sum upon for settlement and release of this case ag SEE ADDENDUM $ _for temporary disability covering the period to $ for accrued medical expense paid or incurred by the employee _for future medical care $... for permanent disability The above segregation must be fair and reasonable and must be based on the real facts of the case There should be no atte made to deprive the lien claimant of a reasonable recovery consistent with all the amounts involved WITNESS the signature hereof this 21 day of of eb. 1969 Congo Congo Congo ---- -- Mary Do Kekan Kekan Kekan Kekan Sharene Sharene V. WITNESSES ; Poss Poss THE INJURED APPLICANT'S SIGNATURE MUST BE ATTESTED BY TWO DISINTERESTED PERSONS OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC STATE OF CALIFORNIA County County of of $$ Hessory Jf <= Hessory ~ , CLANCY SMITH TK, & WRIGHT BY : " |e sie Sins \ See attached for contributions by signatures and defendant s On this day of A.D 19 before me a a Notary Public in and for the said County and State residing therein duly commissioned and sworn personally appea known to me to be the person whose name subscribed to the within Instrument and acknowledged to me that be executed the same IN WITNESS WHEREOF I have hereunto set my hand and affixed my official seal the day and written year in this Certificate first abi 2) SIA WLAS Ponce Taek FORMERLY FORM 4311 Ther 1.09 Notary Public in and for said County and State of Californi 86215-803-92-44 86215-803-92-44 602m I 03+ - .Y ADDENDUM TO COMPROMISE & RELEASE AGREEMENT HENRY C. PUETZ v C. F. BRAUN et al 66 OAK 20668 Carrier Rated Amount Signature Employers Liability Assurance Corporation Ltd. cof $ ~ 546.48 KIERNAN & Py MISCIAGNA Industrial Indemnity Company state Compensation Insurance Fund acific Employers Group Fibreboard Corporation Travelers Insurance Co. Aetna Casualty & Surety Co. Continental Casualty Company Argonaut Insurance Co. American Motorists Insurance Co. 1,068.12 INDU~STRIAL INDUSTRIAL 2,045.167 STATE Le BR 571.32 ~~ JOHN By HERLIHY 107.64 R BROBECK & HARRISON Muthulle 2,541.96 " SEDGWICK DETERT ARNOL By R R 82.80 ~~CONTINENTAL CO JohnX Hartford Accident & Indemnity Co. Great American Insurance Co. ESS Credit in the sum of 1,500.00 264.96 vy 200.00 66.626.424 200.00 200.00 for advances Rideon Rideon R. SEDGWICK DETERT ARNOLD RideoRindeon B t y he less attorney's fees and Less 280.00 to Smith Paduck Clancy & Wright for litigation expenses ad- vanced all to be deducted from the amount set forth above as being payable by AETNA CASUALTY & SURETY CO Q 6 CLAIM NO 66 OAK 20668 HENRY C. PUETZ REFEREE Richard A. Hickman C. F. BRAUN et al and AMERIC MOTORISTS INSURANCE COMPANAYMERIC 1969 Dictated October 2 1969 INJURY from 1945 through November 29 1967 REPORT AND RECOMMENDATION OF REFEREE ON PETITIONS FOR RECONSIDERATION I INTRODUCTION Asbestos worker born April 25 1907 alleges injury to his lun consisting of asbestosis as the result of harmful exposure during various employments in California during the period 1945 through - 1967 oe In the Findings and Award issued on September 8 1969 it was found that applicant has sustained compensable injury consisting of asbestosis the period during various employments by various employers during 1945 to and including November 29 1967. Compensation wa awarded for temporary total disability beginning November 30 1967 through May 31 1968 and for permanent disability of 64 % It was also found that the claim was barred by the Statute of Limitations only with regard to temporary disability and medical treatment for any period of further found disability beginning prior to July 26 1965. that the injury was not caused by the serious It was and wilful misconduct of the employee Timely Petitions for Reconsideration have been filed on behalf of various defendants contending primarily that applicant is not entitled to an award for compensation benefits because the claim is barred by the Statute of Limitations and that the amount of any award for benefits should be reduced by 50 % because of the serious and wilful misconduct of the employee It is further contended on behalf of State Compensation Insurance Fund that it should not have been burdened with paying the entire award and that have been apportioned amoring the various defendants liability should It is further = contended on behalf of Aetna Casualty and Surety Company and Mundet Cork that Mundet Cork should have been dismissed because employment by said employer was outside of California applicant's II DISCUSSION Statute of Limitations Applicant testified that he first began to experience lung problems including shortness many times for this of breath in about problem thereafter 1961 that he was hospitalized that he was treated by Dr. Crantz and had periodic chest rays by Dr. Coate Applicant further testified that he first quit a job because he could not perform the climbing work involved because of shortness of breath in 1965 when he was working for Plant Asbestos The social security records how- ever indicate that applicant did not work for Plant Asbestos in 1965 and that he last worked for said employer in 1964. In his Deposition applicant testified page 9 that Dr. Crantz told him in about 1962 to get out of the business and that it was harmful to his health _ He further testified page 10 that he lost an average of two months of work per year and that Dr. Crantz told him four or five times that he should get out of that type of work Applicant further testi- fied pages 12 and 13 that he was examined at U.C. in 1964 that a report of the examination was sent to Dr. Crantz who told applicant it indicated what Dr. Crantz already knew that applicant had .emphysema or asbestosis of the lungs The application herein was filed on July 26 1966. It was concluded that applicant had suffered dis- ability as a result of asbestosis more than a year prior to July 26 1966 and that applicant either knew or in the exercise of reasonable diligence should have known that such disability wascaused by his employment Under the provisions of Labor Code Section 5412 it seemed apparent that a date of injury could be established as early as 1952 PUETZ 2 3 * 66 Oak 20658 and certainly by 1964. It should have an enforceable would cause seem clear however that applicant of action for an industrial injury occurring within one year of the date on which the application was filed There does not appear to be any reason why applicant's claim should be barred to the extent that it is based upon any period of exposure during employment subsequent to July 26 1965. Applicant's claim alleges an injury which is cumulative in nature The medical evidence including the report of Dr. October 8 1968 exhibit D filed Horton C. on behalf Hinshaw of State Jr. dated Compensation Insurance Fund indicates that applicant's asbestosis and - present disability is attributable to applicant's continuing harmful exposure subsequent to July 26 1965 as well as to exposure during various periods of employment prior to said date On the basis of the prin- ciples set forth in the decisions in Miller vs. WCAB 33 CCC 68 and Burris vs. Southern California Rapid Transit District et al 33 CCC 419 applicant's claim for permanent disability and for the temporary disability found herein should not be barred by the Statute of Limi- tations Although the cited cases did not involve an occupational disease the theories are equally applicable to an occupational dis- , ease case which by its nature is a cumulative injury Under the pro- | visions of Labor Code Section 5412 not one but numerous dates of injury might be found on the basis of the history of applicant's various employments and recurrent periods of disability The Statute of Limitations should not be a bar to applicant's recovery for dis- ability which has resulted from the cumulative effects of his various periods of exposure Serious and wilful misconduct of employee Defendants contend that any award of benefits should be reduced by 50 % because of applicant's serious and wilful misconduct consisting PUETZ 3 66 Oak 2066 of continuing to work as an asbestos employment physician that such would worker after being be harmful to him advised by h Applicant tes worn fied that he has a respirator whenever he worked with asbestos in California There is no indication that applicant performed his wo any different than any other by his various employers It employee or is apparent in a that manner not anticipated applicant knows no tra other than insulation work and that to face starvation or at best becoming a give up Welfare to his trade would be case Applicant's cor duct in this situation does not constitute serious and wilful mis - conduct Form of award State Compensation Insurance Fund protests the form of the award in that said defendant is required to pay the benefits awarded and to seek reimbursement in subsequent proceedings This is the proper pro cedure as set in cases forth in involving cumulative injury the decision in Burris vs. with multiple defendants Southern California Rapid Transit District et al 33 CCC 419 Dismissal of Mundet Cork Defendants Aetna Casualty & Surety Company and Mundet Cork conter that that since Mundet Cork should have been dismissed his work for Mundet Cork was back East and applicant testified that he was hired t East for that job Applicant's testimony indicates that he first came California in 1945 but went back East in 1948 for 2 years He returne to California in 1950 for 2 years and then went back East again until 1954 when he again returned to California The social security recor indicates that applicant of 1953 and also in the was employed by Mundet Cork in the fourth qua second quarter of 1962. The evidence indicat that applicant's other employments in 1962 were in California It was concluded that applicant Mundet Cork and that his had forgotten about the 1962 employment by testimony concerning employment back East employment referred to the in 1953. In the Findings and Award the PUETZ 4 66 Oak 20668 employment by Mundet Cork was found to be only in 1962 RECOMMENDATION Deny defendants Petitions for Reconsideration Richerla Richerla deman deman hg 66 Oak 20668 RICHARD HICKMAN Referee Splayer Splayer PUETZ H. 3 SERVICE BY MAIL ON COT COT # 1959 Smith Parrish Hanna & Brophy Paduck & Clancy 315 Financial Center 1540 San Pablo Ave. Oakland Calif Bldg 94612 Oakland for Argonaut Insurance Company Travelers Insurance Company American Motorists Insurance Company Kierman Great American Insurance Company ) Misciagna & Golman 142 Sansome St. San for Employers Liability Assurance Francisco 94104 Sedgwick Detert & Arnold for Hartford Accident & Corporation Ltd. 11l Pine St. San Francisco CA 94104 Aetna Indemnity Company ; Casualty & Surety Company ) John P. Herlihy 244 Pine St. for Pacific San Francisco Calif 94104 Fermin J. Ramos Employers Insurance Company 220 Bush St. Suite 700 San for Industrial Indemnity Company Francisco CA 94104 Industrial Indemnity Exchange Brobeck Phleger & Harrison 111 Sutter St. San for Fibreboard Corporation Francisco CA 94104 State Compensation Insurance Fund P. O. Box Department of Employment P. O. Soc.Sec No. 532 - 12 - 4188 Box 1857 1010 Oakland Oakland Calif CA 94604 re RECEIVED RECEIVED BEFORE . THE WORKMEN'S COMPENSATION . . APPEARS THE STATE OF CALIFORNIA SEO 17:33 LEa.D LED LED LED BOARD OF LED re LED LED LED LED hd HENRY C. PUETZ vs. Applicant C. F. BRAUN et al Defendants Claim No. 66 OAK 20668 PETITION FOR RECONSIDERATION Defendant Fibreboard Corporation herewith petitions for reconsideration with respect to the Findings and Award served September 8 1969 upon the following grounds 1. That the Board acted without or in excess of its powers 2. ings of fact That the evidence does not justify the find- 3. That the findings of fact do not support the order decision or award and 4. That the order decision and award are not supported record by substantial evidence . based upon the entire This is an asbestosis case in which the Referee found injury during a period from 1945 through November 29 1967 and defendant submits that the claim in its entirety is barred by the statute of limitations because applicant was not only well aware of his condition as * . early as 1962 lost time from work because of it claimed that it was apparently related to his work and consulted his present counsel in that year although an application for benefits was not filed until 1966 In support of defendant's position that the case is clearly barred by the statute of limitations defendant adopts and incorporates herein as Exhibit A the Memorandum of Points and Authorities submitted by Accident & Indemnity Company and Aetna Company dated December 9 1968 counsel for Hartford Casualty & Surety Defendant further submits that in any event any finding for 50 because the applicant should have of the employee's serious been decreasebdy and wilful misconduct in continuing in employment in conditions injurious to his respiratory system although advised by his physician that this type of of the case work was harmful With respect to defendant adopts and incorporates this facet herein as Exhibit B the Points and Authorities Regarding The Serious and Wilful Misconduct of the Employee submitted by counsel for State Compensation Insurance Fund 1968 dated December 6 Defendant submits that no defense of the statute of limitations could be more valid than this case where the applicant supplied of the application and his attorney after he had years before the filing lost time from work because of the injury with a medical report with his handwritten notations thereon Applicant's counsel delayed for over four years before filing an application for benefits ( and the therefore this stale complaint statute of limitations is clearly barred by WHEREFORE defendant prays that reconsideration be granted and without further proceedings an order issue directing that applicant take nothing Dated September 16 1969 Respectfully ..... Attorneys for Defendant ^' VERIFICATION named I am in the one of the attornefyosr the defendant foregoing Petition For Reconsideration ; and make this verification on behalf of the defendant for the reason that the facts stated therein are within my knowledge I have read the said Petition For Recon- sideration and know the contents thereof and the same is true of my own knowledge except as to the matters which are therein stated on information and belief and as to those matters I believe it to be true I certify under penalty of perjury that the foregoing is true and correct Executed at San Francisco California . this 16th day of September 1969 Rinaldo Sciaroni Are 1 Nn 3 & 10 SEDGWICK DETERT MORAN & Attorneys at Law 111 Pine Street Eleventh San Francisco California Telephone 982-0303 ARNOLD Floor 94111 . Attorneys for Defendants Oo BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD 7 OF THE STATE OF CALIFORNIA = 8 9 10 11 22 13 14 HENRY C. PUETZ Applicant -VS- PEILIP CAREY MFG et al Defendants ated ate WCAB Case No. 66 OAK 20568 athe Tathes MEMORANDUM OF POINTS AND atin AUTHORITIES eatin cathe agin 16 17 18 19 2 21 22 2 2 2 Applicant by his application filed herein on July 26 1966 alleges lung disability as a result of his emplo ment for the period 1945 through 1957 The evidence on file herein clearly shows that the applicant was disabled and had knowledge of the reason for his disability at least one year prior to the filing of his applica Therefore applicant's claim is clearly barred by the Statute a Limitations POINTS AND AUTHORITIES 26 27 28 29 30 LAW OFFICES SEDGWICK BITERT BITERT MURAH Z ARNOLD 111 PINK Sintet Sintet CLEVINEN PLESN PLESN SAN FRAN ee Labor Code 5405 The period within which may be commenced proceedings for the collection of the benefits pro- vided by Articles 2 or 3 ox both of Chapter 2 of part 2 of this Division is one year from 2 The date of injury -1- Exhibit Exhibit Exhibit Exhibit A A 2 3 5 6 7 9 10 11 12 13 1999 1999 1999 17 18 19 20 21 22 23 24 25 26 2 28 29 30 L. ANTES SLOGWICK EFTERT EFTERT KORAN & 114 PINE EXCEPT Labor Code 55412 The date of injury in cases of occupational disease is that date upon first suffered which the employee disability there- from and either knew or in the exercise of reasonable diligence should have known that said disability was caused by his present or prior employment It is a well settled princial that injury in occupational disease cases is when the accumulated effects of deleterious substance manifest themselves and this would be when the employee becomes disabled and entitled to compensatio that is when under the established meaning of the term disability as used in compensation law there is a combinati of partial or total physical incapacity and inability to work Associated Indemnity Corporation vs. Industrial Accident Comm 124 CA 378 The Statute of Limitations commences to run whe the employee suffers work disability and knowosr in the exercise of reasonable diligence should know that he is suffering from a disease or injury caused by the employment Argonaut Insurance Company vs. Industrial Accident Commission 28 CCC 175 ARGUMENT Dr. Crantz's records indicate that applicant fi consulted the doctor on December 9 1959 because of trouble with his lungs Dr. Crantz noted in his records Asbestos inhalation many years Entry by Dr. Dowell in these same records dated May 3 1962 states patient has been unable to work today began coughing increased * . amounts yesterday and th -2 1 3 4 5 6 7 9 10 723 723 13 15 16 17 18 19 2 2 2 23 24 25 26 27 28 29 30 LAY OFFICES OFFICES began six days ago and developed productive profuse cough with a whole cup of sputum this morning which he On May 14 1962 the doctor reports There describes are still as milkmy ilky rails in the base bilaterally and anerior chest wall due to coughing less . coughing some pain in the left On May 21 1962 the doctor notes much improv still rails in the right base keep will off work until June 4 The above entries clearly show that the applica was off work because of his lung disability as early as May of 1962. states On February 2 that he is to 1963 Dr. Dowell in these same records Oakland see the consultant in soon about his chest for his attorney I told him it would be a good idea to get his films and he could use our EKG if he desires Therefore by these records it is clear that in 1963 the cant had knowledge that his disability was related to his appl employment and he in fact was to see his attorney about his chest condition disability was The fact that applicant had knowledge that his related to his employment is further evidenced by Dr. Cote's report dated February 17 1952. Said report has been made a part of applicant's deposition which is on file wi the Commission and concludes Pulmonary occupational disease probably asbestosis Applicant explains the note on the bottom of this report on Page 19 as follows lines 19 through 26 of his deposition Q. pSmriotbhl'Aespmparently was in you went over to Joe 1962. A. I believe it Q. To talk to him about that A. Yes Q. This letter here at the bottom of Dr. Cote's report of February 17 1962 that was to your lawyer was it A. Yc3 -3- There is no question but that applicant had th v report in his possession and in fact wrote on the bottom of 3 that report a note to his attorney Joe Smith The report an Pr thereon indicates that applicant had knowled 5 that his disability was related to his employment back in 195 @ which was some four years prior to the filing of the applicat 7 herein . ; 8 Further evidence of applicant's knowledge of h 9 disability being related to his employment is on Page Six lines 1 through 15 of his deposition where he indicates has had knowledge of his condition being related to his that . employment for some period of time and furthermore he state that he has been hospitalized perhaps eight or nine times because of his lung condition On page 7 lines 5 through 18 the applicant again indicates that he has had rays for his lung condition since 1957 and in fact the rays were paid for through a union arrangement Applicant acknowledges receiving copies of these ray reports from Dr. Cote which on file with the commission On Page 9 lines 9 through 19 o his deposition applicant further discusses his knowledge of his lung condition being related to his employment and states that as early as 1952 Dr. Crantz told him to get out of the business . . On Page 9 lines 22 through page 10 line 4 applicant indicates that he has lost considerable time over t years as a result of his lung disability and he states on Pa 11 10. Outside of the periods of hospitalization each year would you miss additional days of work due to your lung condition A. Well not too much 0. You would miss some -- --  C "fi 02 3 . 4 5 6 7 8 9 20 11 ; 12 13 14 15 16 27 18 work A. Some I don't know how much Not too much 8. Was there some work you couldn't do because of shortness of breath A. Well I've got so I can't hardly work now They fire a job I can't me do every time anything I get Q. Have there been any jobs that you have actually had haven't been to quit able to because do it you A. going up in the air and that we Yes do a lot of work in the air I can't climb Q. When did you first have ..... to actually quit a job because you ..... felt you couldn't do it A. Way back in 1985. I'd say back in 1965 Q. Who were you working for then A. Western Asbestos Q. And what was the nature of couldn't do A. the work that It was on the you towers at Standard oil you do the job climb That was Q. And why couldn't A. Because I couldn'^ Plant Asbestos instead of Western The Social Security records on file herein indic that actually applicant was employed by Plant Asbestos during - the quarter ending December 3 1964 and as the application was filed July 26 : 1965 ; clearly this disability predated the filing of the application by more than one year ; 19 - 20 21 21 22 23 24 25 25 26 27 28 29 30 CONCLUSION It is submitted . that ; the medical records ; and applicant's deposition indicate that he has had periods of disability from time to time since 1962 which is approximately four years prior to the filing of his application The record is clear that applicant has been aware that his lung problems ware caused by his employment as an asbestos worker As applicant's deposition reflects he not only had personal knowledge of the cause of his disability but was actually told as carly as 1962 by a physician that his condition was related to his employment Therefore it seems clear that under the FINE 111 a | , FEARG - 997 : 1 || Labor Code sections cited above 22 i the Statute of Limitations applicant's claim is barred by 5 ; 6 7 8 DATED DATED DECEMBER 9 1968 g Respectfully submitted HARTFORD ACCIDENT & INDEMNITY COMPA AETNA CASUALTY & SURETY COMPANY By Their Attorneys SEDGWICK DETERT MORAN & ARNOLD BY SA SA SASA Thfohm,asThomas : 2 William R. Thomas . a 10 | 11 12 13 | 14 15 16 PARTIES SERVED HARTFORD ACCIDENT & INDEMNITY COMPANY Oakland AETNA CASUALTY & SURETY COMPANY Oakland SHITH PARRISH PADUCK & CLANCY Attorneys at Law Oakland PACIFIC EMPLOYERS ATTN NORMAN HAYS INSURANCE COMPANY San Francisco CONTINENTAL CASUALTY ATIN JOHN WILKES San Francisco 17 BROBECK PHLEGER & HARRISON Attorneys at Law San Francisco ATTN RINALDO SCIARCHI JR 18 19 STATE COMPENSATION INSURANCE FUND Oakland 20 21 21 | KIERNAN & MISCIAGNA Attorneys at Law San Francisco HANNA & BROPHY Attorneys at Law ATTN JAMES MCMILLAN Oakland 22 23 ALEXANDER KEEMAN Attorney at Law San Francisco 24 26 27 28 23 30 ' Gr BERGWGY DEBERT MSDAG Ror BONG FIND s a i Cubist coreg Ficgon : rr 2 HENRY C. BEFORE RECEIVED - THE WORKMEN'S COMPENSATION APPEALS RECEIVED RECEIVED RECEIVED OF THE STATE OF CALIFORNIA SEP 17 1969 PUETZ CLAIM 66 OAK 20668 FILED . Division af fodustrial Actident CAKLAND CHRICE CHRICE Applicant . VS. INSULATORS & ASBESTOS INDUSTRY CALIFORNIA LOCAL 16 and STATE COMPENSATION INSURANCE FUND OF Defendants , POINTS AND AUTHORITIES REGARDING THE SERIOUS AND WILFUL MISCONDUCT OF THE EMPLOYEE .- . : Section 4551 of the Labor Code of the State of California sets out as follows 14 When injury is caused by the serious and wilful of the injured employee the compensation other- wise recoverable therefore shall be reduced one half except none apply except of the exceptions here The evidence in this case shows the through depositio of the applicant C. Henry Puetz dated November 8 1968 the following eet , On Page 9 line 9 Q. When you were originally treated by Dr. Krantz di~ you ever have any discussion with him about your difficulty | A. You mean my lungs Q. Right : A. Yes he told me to get out of the business He said its | harmful to my health Q. business Did you make any attempt to try and get out of the , one | A. I just can't afford to Q. of work was When was the first time harmful to your health he told you that : this sort A referred to Well I don't know I'd say in * * 162 The busines is asbestos worker as shown in the deposition Page 1 Exhibit B misconduct misconduct misconduct of of an 1 Imowledge Imowledge Imowledge Imowledge serious serious serious danger and or danger danger and and 2 that that that that that end end wilful wilful wilful wilful misconduct misconduct misconduct mmisconiduct sconductmisconduct misconduct must be the 8 approximate approximaatpe proximate approximate approximate or condition of hic hic injury injiurynjury injury injury injury and and and and his his his condition condition conditioncondition . Frazier Frazier Frazier Co. vs. I.A.G. I.A.G. I.A.G. I.A.G. his his conditioconndition condition condition condition condition condition condition condition condition condition continued continued continued continued s ommcsure IInnttaannttee informed informed hit hit to getget get 13 14 15 to continue continue to to expose continuousand and and and deliberate deliberate deliberate deliberate deliberate exposure exposure to show show herein showshow that thatthat that that this this this this this the proximate proximate proximate proximate proximate proximate proximateproximate proximate proximate proximate proximate cause cause 21 23 24 consequences consequences consequences consequences consequences conscequencesonsequences of of being being being being being warned warned warned warned applicant's disregard for disregard disregard disregard disregard disregard disregard his ~ own Horst Horst Horst Company vs. Company Company Company Company Company vs. vs. Respectfully N N 30C 51 G Parish Parish Parish Parish Parish Puduelt Puduelt Puduelt Puduelt Puduelt Puduelt Puduelt & & Chancy Chancy of of of service service service continued continued continued 2 10 < 5 0 7 9 CHaelnirfy G. Sanford Esq 714 Hobart Bldg San Francisco c - S. Norman Hays Esq 244 Pine Street San Francisco Calif Sedgwick Detert Moran & Arnold Attorneys at Law ill Pine Street San Francisco California Kiernan & Misciagna Attorneys at Law San Francisco Calif 142 Sansome St. Hanna & Brophy Calif Attorneys at Law 1540 San Pablo Oakland Esq Robert Calif C. Taylor 233. Sansome Street San Francisco J. Patrick cWilliam cWilliam R. Calif Goodwin Esq 41 Thomas Esq 220 Sutter Street San Francisco Bush Street San Francisco ; Francisco Brobeck Phleger & Harrison Attorneys at Law 111 Sutter ; Street San California * ...' ... 15 16 7 A2 A2 HENRY ( ( DEPARTMENT OF INDUSTRIAL RELATIONS RECEIVED DIVISION OF INDUSTRIAL ACCIDENTS WORKMEN'S COMPENSATION APPEALS . STATE OF CALIFORNIA FEB 26 1958 BOARDFILED BOARDFILED Division of industrial Aceld nb OAKLAND OFFICE ANSWER of THE EMPLOYERS LIABILITY ASSURANCE CORP I C. PUETZ INJURED EMPLOYEE Case No. 66 OAK 20668 Route 2 Box 101 Oakley . Date of alleged injury 1945 through 19 CORRECT NAME OF EMPLOYER . CORP . LTDECT NAME OF INSURANCE CARRIER ; ASSURANCE 1300 235 64th St. Emeryville . EMPLOYER'S ADDRESS Calif : . INSURANCECARRIER'S ADDRESS California California . CERTIFICATE NUMBER IF INSURED : 2 ANSWERING DEFENDANTS deny the allegations of the Application as indicated below with such pressly set forth and admit all other material allegations explanations as ex- DENIALS MARK X IF ALLEGATION IS DENIZD EXPLAIN BELOW X____E_mployment ~~ Occupation x Occupation Occupation Injury IF DENTAL IS BASED ON DATE OR PART OF BOUY INJURED EXPLAIN FULLY X_ In. surance coverage Liability for self procured treatment X Liability for_future medical treatment _____M_edical costs Admitted for Plant Asbestos Co. during years CHECK IF EMPLOYER HAS BEEN NOTIFIED TO APPEAR AND DEFEND 1963 & 1964 Earnings Periods of disability X Permanent disability IT IS FURTHER ALLEGED GIVE LAST DAY WORKED AND CORRECT DATE OF RETURN TO WORK Apportionment IP APORTIONMENT APPORTIONMENT IS CLAIMED SO STATE 1. Defendants have paid disability indemnity in the total amount of None _ at the rate of $ beginning _through_ _plus 2. Affirmative defenses and other matters S1t . atute of Limitations 2 Lack of Notice a week C cc Smith Parrish Paduck & Clancy The Employers Liability Assurance Corp. Ltd. PDreafcetnidceanitf sotdhoerniostsuweasidveevtehleopright to raise additional issues in accordance with the provisions of law and the Rules of Estimated time for trial All defendants medical reports have been filed Additional reports will be filed before trial Dated San Francisco | California 2-23-682-23-68 CITY BATED INSURANCE aos trial wanted TEB NO DIA WCAB FORM 10 REV FORMERLY FORM 36 8.66