-- GroupHeaith emu min ammo. siiwrosi- Mcalul Cam: Aoministrauuri 1 sin-mi. Way NW Slum-ll WA yam :iiaawuso WW an: on} September 12. 2013 Claims Examiner Us Department or Labor Office DiWorkere Compensation Programs Po. Box 9300. District 14 Seattle London KY 40742-5300 Date oi birth Claim No: ending Date o1 injury: 05/21/2010 Dear Claims Examiner: i am writing a narrative report in support oi the above patient's claimtor an occupational disease, Mr, Albert ls presently employed as a supervisor at the Puget Sound Naval Shipyard wastewater treatment plant. Approximately 5 to 6 years ago he began experiencing recurrent episodes oi acute bronchitis and pneumonia. He has required repeated treatment and courses oi antibifitifi. He has noticed a gradually worsening sense oi sinivay irritation, choking, cough productive at whitish sputum. chest tightness. on exertion, general malaise. increased fatigability and night sweats. At work he is repeatedly exposed While monitoring and titrating the pH of wastewaters to chlorine gas. heavy metals. cyanide. carbon monoxide and sulfur dioxide. He has had recurrent exacerbations oi his with these acute exposures. He works in an environment with inadequate safety and monitoring controls and has documentation supporting exposure to levels above the permissible exposure level or these chemicals. The question of his complex correlates with his ongoing exposure to these respiratory irritants and toxins In performance at his work duties at the Puget Sound Naval Shipyard. I originally evaluated Mr. Albert 06/17/2013 and saw him in follow-up this date, 09/12/2013, He has previously been evaluated by pulmonary specialist Di, Bennett Wang 04/29/2013 and undergone complete pulmonary function studies. His pulmonary function studies are within the normal range. Dr, Wang has diagnosed reversible airway disease or occupational asthma due to his occupational exposures, He currently requires avoidance or removal from additional exposure and medications including QVAR 2 inhalations twice daily with an albuterui rescue inhaler tor acute He continues to experience His present diagnosis or occupational asthma is a direct result of these occupational exposures, He also has considerable anxiety at this time due to uncertainty regarding his health and work requiring ongoing exposure to these respiratory irritants and toxins Sincerely. Mar/P Mes/?ow Michael McManus MD OCCUPATIONAL MEDICINE cc: Cathy Dena Puget Sound Naval Shipyard