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The above-captioned patient was examined by me on this date for the purpose of making and impartial determination regarding his ability to work and regarding the possible industrial origin of his disability. I have reviewed some, but not all, of his medical records from the factory and have also examined documents shown to me by him.

He states that in 1979 he began to notice gradual onset of chronic tiredness and lack of normal pep and energy. He states that his wife was aware of the before he was. He took frequent naps and lacked sufficient pep for normal activities. Later he began to experience episodes of pressure or pain in the midchest, particularly at night, lasting minutes to hours. These were not triggered by exertion or eating, nor were they associated with dyspnea or diaphoresis. The pain did not radiate. He had very little cough but did occasionally note wheezing in his chest.

His private physician evaluated him thoroughly but was unable to document any abnormality except mild hypertension for which Inderal was prescribed. He was evaluated at an environmental health clinic, and according to their report, a copy of which the subject showed me, he demonstrated bronchial hyperreactivity to toluene di-isocyanate (TDI) as manifested by reduction in forced vital capacity (FVC) and one-second forced expiratory volume (FEV)1. He also demonstrated bronchospasm in response to a methacholine challenge. Radioallergosorbent test (RAST) was negative for IgE antibody to TDI.

A diagnosis of bronchial asthma with TDI sensitivity was made, and Theo-Dur and Alupent were started with some relief of symptoms. He returned to work at the factory with the approval of his physician and with restrictions on exposure to TDI, asbestos, carbon black, and other noxious inhalants. Although he experienced no symptoms while at work, he had chest paint and dyspnea that night severe enough to require medical consultation. He is presently taking Theo-Dur, Alupent, Bronkometer, Vanceril, and Aldoril. He denies any history of asthma or wheezing before 1979. He smoked one package of cigarettes daily from 1967 to 1980.

On physical exam, A 2 is equal to P2 in intensity. The thorax is symmetrical without increase in anteroposterior diameter, and respiratory excursions are full and symmetrical without accessory respiratory muscle activity. Bronchovesicular breath sounds are heard over both upper lung lobes on auscultation, and there are a few coarse, sibilant expiratory rhonchi over the right middle lobe, not clearing with coughing. The percussion note is normal throughout the chest.

Posteroanterior and left lateral chest radiographs taken today are not in full inspiration but show no abnormalities. There is no cardiomegaly, and the lungs are free of infiltrates, fibrosis, calcifications, or space-occupying lesions. The pleural margins are clear. Pulmonary function studies done on the date show an FVC of 2.4 L (48% of predicted), FEV1 of 1.8 L (48% of predicted), and FEV1/FVC of 0.78 (101% of predicted). Assuming maximal effort by the examinee, these studies show significant restrictive and obstructive abnormalities.

A clearer picture of his condition might be obtained by doing FEF 2575 blood gases, and ventilatory and perfusion lung scans. Scans have apparently been done in the past but with equivocal results. On the basis of information available to me, I cannot say that this man's present symptoms definitely are or definitely are not due to TDI exposure. I would not consider the subject disabled for gainful employment.