The James L. Zadroga Compensation Act Passes
$8.1 Billion Measure to Reauthorize The James L. Zadroga 9/11 Health and Compensation Act Passes, Other Legislation and Coverage Follows; Related Injuries Continue Mounting
Zadroga Act Reauthorized Year-End 2015
Following approval of the $8.1 billion measure to renew the Zadroga 9/11 Health and Compensation Act, President Obama signed the bill into law on December 18, 2015, reauthorizing the Act.
The reauthorized James L. Zadroga 9/11 Health and Compensation Act passed in December 2015 will provide adequate funding and benefits to sufficiently care for the first responders and survivors of the 9/11 terrorist attacks throughout their lifetimes. Congressional representatives included an $8.1 billion measure to renew the Zadroga Act in the $1.1 trillion omnibus spending package that was finalized and released in mid-December 2015. The measure extends the Zadroga Act's programs.
The expired World Trade Center (WTC) Health Program will continue to provide medical treatment and monitoring and has been extended for another 75 years to 2090 with $3.5 billion in funding to monitor and care for 73,000 responders and survivors. The Victims Compensation Fund (VCF) is no longer set to expire on October 1, 2016 and has been extended for another five years to 2021 with $4.6 billion in funding.
New York Governor Cuomo Signs Legislation Concerning Benefits for 9/11 Workers, Volunteers
On September 11, 2016, the 15th anniversary of the 9/11 terrorist attacks, Governor Andrew M. Cuomo signed legislation to extend the length of time workers and volunteers seeking lost wage and medical benefits may make claims due to their rescue, recovery, and clean-up work at the terrorist site.
The bill, known as S5745-C/A7958-C, extends the deadline for individuals to register under the World Trade Center (WTC) Disability Law until September 11, 2018, enabling individuals to receive workers' compensation, disability, and accidental death benefits due to their work during the as a result of their participation in the WTC rescue, recovery, and clean-up operations.
"Though September 11th may feel like an eternity ago, we still feel the pain and the loss like it was yesterday, and the thousands of brave men and women who stepped up in our darkest hour are still grappling with the after-effects," Governor Cuomo said. "We vow to do whatever we have to do to provide these brave men and women and their families the benefits they deserve. As New Yorkers, when we are knocked down, we get up twice as strong because we have our fellow New Yorkers to raise us up. The volunteers and workers raised us up in our time of need, and we will ensure they get the resources and the support they need."
Governor Cuomo also strongly urged all 9/11 responders to consider using the WTC Health Program, which is administered by the National Institute for Occupational Safety and Health (NIOSH) for health treatment and monitoring. Responders are seen and treated by experts at specific clinics, at no charge; the clinics also monitor responder health. As of September 2016, services were available at many Clinical Centers of Excellence in New York City, Long Island, and New Jersey, as well as through a nationwide network of providers. The list is maintained by the U.S. Centers for Disease Control and Prevention (CDC) at: www.cdc.gov/wtc.
Many lawmakers and advocates praised the move. For example, Assembly Speaker Carl Heastie said in part, "After the horrific events of 9/11 so many brave citizens stepped up and showed the world what we are made of by helping in the rescue and recovery operation. Many of those who were involved in the days and weeks after this senseless tragedy continue to develop illnesses, and we must do all we can to ensure that they are compensated for their sacrifices. The healing process continues 15 years after 9/11..." New York State AFL-CIO President Mario Cilento said, "None of us understood the extent of the dangerous conditions working men and women were exposed to during the aftermath of 9/11. Many symptoms of those illnesses are only now starting to manifest themselves. We are pleased the governor has signed this legislation so critical to the needs of the heroes who served during the rescue, recovery and cleanup operations. Now those brave New Yorkers will continue to have access to the benefits they deserve while also knowing that their government supports them."
Benefits in 2010 Zadroga Act Passed with Half Planned Benefits
At year-end 2010, Congress passed the original James L. Zadroga 9/11 Health and Compensation Act. The vote was described by some as a "Christmas miracle.'' While the 2010 Act was not everything that Ground Zero responders, survivors, and advocates had hoped for, it was seen as a victory and was believed to be the start of more measures to permanently extend benefits.
Following the September 11th terrorist attacks at Manhattan's World Trade Center, researchers determined that the thick plume of dust and debris that followed the collapse of the World Trade Center Twin Towers and hovered over lower Manhattan contained a toxic mix of compounds, including asbestos, lead, pulverized cement, jet fuel, and other chemicals. Many rescue and recovery workers and survivors exposed to the toxins have since been diagnosed with various illnesses, including asthma, obstructive pulmonary disease, gastroesophageal reflux disease, and over 50 types of cancer. Tragically, many have succumbed to their illnesses in the years since the attacks. And, as of year-end 2015, at least 4,166 cancer diagnoses have been linked to exposure to the toxic cloud that hovered over Manhattan; the number of cases is expected to increase.
The Act, named after a deceased New York Police Department (NYPD) detective who worked at Ground Zero, was approved after years of intense negotiations. Finally, concerns over the Act's cost led to a final version that was significantly smaller in scope than what was first conceived: A 10-year, $7.4 billion treatment and compensation package. To get the measure past Senate Republicans, the Act was reduced by about half: Five years at $4.3 billion. The final version provided $1.8 billion over the next five years to monitor and treat injuries and also set aside $2.5 billion to reopen the September 11th VCF for five years to provide payment for job and economic losses. Attorney's fees would be capped at 10 percent and responders who accepted the World Trade Center Toxic Dust Settlement were prohibited from "double-dipping."
Parker Waichman actively worked toward the 2010 passage of the Zadroga Act, including taking part in lobbying efforts and trips to the nation's capital, often along with the firm's clients-other responders and survivors.
In 2015, Congress Allowed One of the Zadroga Act's Programs to Expire
Sadly, Congress allowed one of the two programs that make up the Zadroga Act, to expire in October 2015; specifically, the program that provides medical treatment to survivors. The Act is comprised of the World Trade Center (WTC) Health Program and the September 11th Victim Compensation Fund (VCF). The WTC Health Program was running on cash reserves after it was allowed to expire and was expected to run until benefits ended entirely. The VCF was scheduled to expire in October 2016 if Congress did not take action.
With more than 33,000 sick responders dependent on the program for medical treatment, another 70,000 being monitored, and sick responders and survivors living in every state and in 433 of the 435 Congressional districts, immediate action was needed.
Parker Waichman Part of Powerful Lobbying Group
The firm's support and commitment for permanent extension of the Zadroga Act never stopped. For instance, Matthew McCauley, Senior Litigation Counsel at Parker Waichman and a former New York Police Department (NYPD) first responder attended nearly weekly lobbying events, delegations, and rallies-many in the nation's capital and some at the site of the Twin Tower attacks-to ensure the Act was extended and "that every hero, resident, volunteer, worker, and survivor receives the benefits and compensation they deserve, today and in the future."
Mr. McCauley was part of a powerful group of advocates, including many lawmakers; surviving responders; survivors; John Feal of the FealGood Foundation, a 9/11 advocacy group; Ray Pfeifer, former Fire Department of New York (FDNY) firefighter; Benjamin Chevat, Executive Director of Citizens for the Extension of the James Zadroga Act, Inc.; Richard Alles of the Uniformed Fire Officers Association, Deputy Chief of the FDNY and Board Member of Citizens for the Extension of the James Zadroga Act; and Jon Stewart, Zadroga Act advocate and former host of "The Daily Show."
"These individuals selflessly answered the call for help during and following the attacks and their heroism cost them their health," noted Mr. McCauley. "They should never have been forced to beg for benefits, and permanent extension of the Zadroga Act should never have been an issue that was up for debate." Permanent extension was especially important given that some 9/11-related conditions, such as cancer, may take years to manifest. "Some responders and survivors may not know they have a developed a serious, life-altering condition as a result of the attacks," said Mr. McCauley. "These individuals now know that these benefits will remain open for them and their families."
Research Reveals Correlation Between the 9-11 Terrorist Attacks and Extensive Medical Conditions and Injuries
Significant injury research related to the 9/11 attacks reveals how extensive medical conditions and injuries have impacted New York Police Department (NYPD), Fire Department of New York (FDNY), emergency medical services (EMS) responders, and other rescue and recovery workers and volunteers. Information was released December 2016.
FDNY and EMS Workers
Short-term Impacts: 1-4 Years after 9/11
FDNY first responders began experiencing adverse health effects soon after the attacks, some within the first week. In fact, 99 percent of exposed firefighters reported no less than one new respiratory symptom while working at the WTC that they had not experienced before, according to NYC 911 Health. Within the first six month following the attacks, “World Trade Center cough” was diagnosed in three percent of firefighters who performed WTC rescue and recovery work and were enrolled in FDNY's WTC monitoring program, as well as in eight percent of those present during the Twin Towers’ collapse. In the year following, firefighter pulmonary function dropped at a rate 12 times greater that the average decline seen with aging, according to NYC 9/11 Health. Of 10,378 firefighters enrolled in the FDNY WTC Medical Monitoring and Treatment Program after 9/11 and who were evaluated yearly in the first four years, cough and sore throat declined from 54 to 16 percent and 62 to 36 percent, respectively. Other respiratory symptoms-dyspnea, wheeze, nasal congestion, or Gastroesophageal Reflux Disease (GERD)-was stable at 45 - 35 during this time. Initial arrival time at the site was associated with increased risk of respiratory symptoms at each exam. Individuals evaluated at year one and year four experienced symptoms tied to earlier arrival time and longer work duration at the site with every additional month increasing the likelihood of symptoms by eight to 11 percent.
NYC 9/11 Health noted that, of 8,487 firefighters enrolled in the FDNY Program, 12 percent tested positive for probable post-traumatic stress disorder (PTSD) symptoms in the first six months following 9/11. Some 28 percent who screened positive for PTSD received counseling in the first 2.5 years following the attack; a five-fold increase over those prior to 9/11. Elevated PTSD risk was significantly associated with counseling use, functional job impairment, and mental health-related medical leave during this period, NYC 9/11 Health wrote.
Prior to 9/11, one study revealed a less than expected number of sarcoid cases among FDNY firefighters, suggesting that firefighting presented a potential increased risk for the disease; however, after 9/11, another study revealed 13 cases of new-onset sarcoidosis or sarcoid-like diseases among FDNY firefighters, representing an increase some six times greater than pre-9/11 levels. Thirteen additional cases were identified over the next four years, according to NYC 9/11 Health.
Mid-term Impacts: 4-9 Years after 9/11
Eight years after the attacks, the number of several physician-diagnosed respiratory conditions among 10,999 WTC-exposed male firefighters increased when compared to men in the general population. NYC 9/11 Health noted that firefighters 44 years of age or younger were likelier to report sinusitis/rhinitis, bronchitis, and COPD/emphysema. Firefighters 45-65 years of age were much more likelier to be diagnosed with sinusitis/rhinitis, current asthma, bronchitis, and COPD/emphysema. Sharp, often disabling, declines in pulmonary function were first seen among firefighters and EMS workers within one year of the attacks and persisted among never smokers. Chronic airways disease was the main lung injury seen in firefighters with respiratory symptoms referred for evaluation within seven years after the attacks. Some were diagnosed with interstitial fibrosis.
The prevalence of probable PTSD among over 11,000 firefighters in the FDNY Program nine years after the attacks was four times greater that what was seen in the general population. Early arrival at the site and exercising less and drinking more alcohol were tied to the continuance or onset of PTSD symptoms. The same was seen with co-occurring respiratory or GERD symptoms.
Surveys of 12,000 firefighters and EMS workers between 2005-2008, revealed that more than 36 percent were at high risk for obstructive sleep apnea (OSA). The earlier they arrived at the WTC site and suffering from acid reflux, upper respiratory, and PTSD symptoms were associated with increased risk for new-onset OSA.
Substantial co-morbidity of physical and mental health conditions was seen among firefighters. A study of 11,000 firefighters seven to nine years after the attacks revealed that nearly half reported probable PTSD and also self-reported a physician diagnosis of obstructive airways disease (OAD)- asthma, bronchitis, or COPD/emphysema-with probable PTSD or depression and a self-reported physician diagnosis of OAD, according to FDNY researchers. FDNY researchers also found that, among those with depression alone, nearly one-third self-reported OAD. Similar results were found when medical records were used.
FDNY researchers confirmed 263 new cases of cancer from September 11, 2001 through 2008 among 8,927 male firefighters responders, which is 25 greater than should have been seen in men of similar age, race, and ethnicity in the general population, the National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population indicated. When researchers compared WTC-exposed firefighters to unexposed firefighters, they discovered a 19 percent increase in cancer overall. NYC 9/11 Health notes that it is unlikely that any cancer would develop within two years of the attacks.
A review of FDNY retirement pensions discovered that, in the seven years before the attacks, nearly half of the pensions were for accidental disability; however, in the seven years after the attacks, accidental disability pensions made up 66 percent of the total with 47 percent (1,402 pensions), associated with the attacks and typically due to respiratory illness. The FDNY study estimated that WTC-related FDNY pensions added $826 million in increased costs to the system, according to NYC 9/11 Health.
According to NYC 9/11 Health, a longitudinal study of some 3,000 police responders enrolled in the WTC Health Registry revealed the prevalence of probable PTSD doubled from 2003/2004 to 2006/2007, with female officers significantly likelier to report PTSD symptoms in the first survey. The gender difference disappeared by the second survey. PTSD risk factors included post-9/11 unemployment and disability.
The New York/New Jersey WTC Consortium assessed some 8,500 police responders who pursued services from 2002 through 2008. The Consortium discovered PTSD prevalence during the prior 30 days was similar to that found in other studies of police responders and a significantly increased rate of what is known as “subsyndromal” PTSD-a condition involving similar, but not sufficient symptoms to fulfill PTSD criteria. This was tied to a five times increased need for mental health services, including one-on-one counseling, stress management, or psychotropic medication, when compared to those who did not meet criteria for either full or subsyndromal PTSD. Also, a longitudinal study of some 11,000 responders enrolled in the WTC Health Program (formerly known as the New York/New Jersey WTC Clinical Consortium) reviewed responder mental health at three, six, and eight years after the attacks, NYC 9/11 Health reported.
Other Rescue and Recovery Workers
Short-term Impacts: 1-4 Years after 9/11
Research involving over 1,400 New York State employees-including staff from the State Police, National Guard, and Department of Transportation (DOT)-discovered that, while these workers arrived later and experienced less intense exposure at the WTC site, state employees report increased mental and physical health effects, NYC 9/11 Health pointed out. Mental health symptoms included excessive fatigue, sleep disturbance, and irritability; physical ailments included respiratory symptoms such as dry cough. State employees trapped in the toxic dust cloud were likelier to report mental and physical health issues. Construction workers involved in the cleanup effort-truck drivers, heavy equipment operators, laborers, and sanitation workers-experienced a three-fold greater likelihood of respiratory illness when compared to individuals who did not work at one of the WTC sites. Cleanup start date, worksite location, and participation duration may be tied with increased respiratory symptom risks. Other research of rescue and recovery workers in the Consortium revealed a significant tie between worsened respiratory symptoms and early WTC arrival.
An review of blood samples from about 500 New York State employees and members of the National Guard who worked at the WTC site on 9/11 and December 2001 revealed concentrations of perfluorochemicals-manufactured chemicals used to make heat-, oil-, stain-, grease-, and water-resistant products-that were two-fold the amount found in the general population. Chemical blood levels were similar between those who did and did not report symptoms; however, levels were higher in those reporting increased levels of exposure to dust or smoke. The blood samples were taken May 2002-November 2003; the potential health effects of these chemicals are unknown.
Another study, involving 136 rescue and recovery workers diagnosed with WTC-related atopy (allergies) between 2003 and 2005 revealed that these individuals may be at increased upper airway disease risk, including sinus or nasal congestion, when compared to individuals not diagnosed with atopy. Workers diagnosed with atopy were diagnosed with more serious airway disease symptoms.
Studies of the mental health impacts on police officers and firefighters involved in the WTC response revealed that over two-thirds reported experiencing at least one disaster-related stress symptom 15 to 27 months after the attacks, according to NYC 9/11 Health. Meanwhile, two studies of over 3,000 mostly male utility workers screened for mental health conditions at their place of work revealed key information concerning early traumatic stress among WTC recovery workers. Ten to 22 months after 9/11, a number of 2,960 workers suffered PTSD symptoms, depression symptoms, anxiety, and panic disorder. The significant PTSD predictor was a belief that their life was in danger. Workers with trauma symptoms who did not meet criteria for full- or sub-threshold PTSD within the first two years of 9/11 were screened at one and two years after the attacks and nearly 30 percent met the criteria for sub-threshold or full PTSD at “Time 2”; almost one-quarter met the criteria at “Time 3.” Workers diagnosed with sub-threshold PTSD reported impairment levels some four-fold greater than workers with no PTSD symptoms.
Probable PTSD among rescue and recovery workers enrolled in the Health Registry increased from just two-three years following the attacks at the five-six year mark. Probable PTSD was late onset for a number of workers, meaning symptoms increased between the two time frames. Among the risk factors for developing probable PTSD involved arrival at the site on 9/11 or working there for longer than 90 days, according to the research, wrote NYC 9/11 Health.
Mid-term Impacts: 4-9 Years after 9/11
Injuries-broken bones or burns-were related to increased risks for chronic disease five-six years later, according to a study involving over 14,000 enrollees. Participants reported no previous diagnosis of heart disease, respiratory disease, diabetes, or cancer and enrollees who reported more than one injury-some 2,000 people-were two times as likely to report respiratory illness when compared to the uninjured. Those with multiple injuries and probable PTSD experienced a three-fold likelihood of reporting heart disease when compared to those with no injuries and no PTSD diagnosis, according to NYC 9/11 Health.
A review of verified cancer diagnoses among 21,850 rescue and recovery workers enrolled in the Health Registry revealed small increases in the rates of three types of cancer in 2007-2008-prostate, thyroid, and multiple myeloma-when compared to non-exposed New York State residents during the same time. A review of confirmed cancer cases since the attacks among 20,984 rescue and recovery workers enrolled in the Health Program revealed an increase of cancer cases greater than the expected. overall. When restricted to cancer cases diagnosed after six months of enrollment in the program, additional cancer was discovered. Both analyses revealed more thyroid and prostate cancer cases than expected.
Another clinical study involving more than 3,000 workers who were reviewed twice at least 18 months apart between 2002 and 2007 at the Consortium revealed that weight gain between exams-not the degree of WTC exposure-was tied with the ongoing loss of pulmonary function. Another risk factor seen on the first exam for continued pulmonary function loss included abnormal bronchodilator response, a potential asthma indicator. Most experienced pulmonary function within the normal range; however, the incidence of reduced pulmonary function at the second exam continued to be higher than the general population. Also, over 12 percent of 25,000 workers enrolled in the Registry reported developing new-onset asthma in the five-six years since working at the site, a rate higher than was is expected in the adult population during that time. New rates of new asthma were highest in workers who arrived at the toxic site on the day of the attack or who worked more than 90 days at any WTC site, NYC 9/11 Health wrote.
A prospective study of some 21,000 rescue and recovery workers who sought care at the Consortium reviewed asthma self-reports. The prevalence of ever having asthma remained consistent from 2000 to 2007 in the general population. Responders were twice as likely to report asthma during the past year when compared to the general population. Meanwhile, clinical studies of WTC rescue, recovery, and cleanup workers who voluntarily enrolled in a monitoring program at the Consortium revealed that respiratory problems remained for some and often co-occured with other diagnoses. A study of 42 sequentially selected patients diagnosed with GERD suggests the disease may be related to abnormal lung function and, of 172 randomly selected workers, 10 were diagnosed with vocal cord dysfunction (VCD), which may cause hoarseness or pain when breathing. Workers all had GERD and chronic rhinitis. Early findings suggest VCD may be part of the growing WTC-related respiratory disorders spectrum.
The New York State Department of Health discovered that responders with moderate exposure were likelier to report persistent lower respiratory symptoms-cough, wheeze, shortness of breath, chest tightness-not asthma, in the five years after the attacks when compared to a control group. Those with prior asthma and who were most exposed to the toxic cloud were likelier to report more significant asthma symptoms.
Consortium researchers found an increased incidence of sarcoidosis among nearly 20,000 rescue and recovery workers who received care for 9/11-related health problems when compared to other published background rates. The highest incidence occurred two-three years after the attacks. Using biopsy results, WTC Health Registry researchers confirmed 43 sarcoidosis cases among adults in its cohort of rescue and recovery workers, Lower Manhattan residents, area workers, and passersby, according to NYC 9/11 Health. A so-called “nested case control study” revealed that working on WTC debris significantly increased the sarcoidosis risk for rescue and recovery workers.
Research involving rescue and recovery workers who snored and received diagnoses for respiratory disease, acid reflux symptoms, or a mental health condition during 2003-2006 revealed that 62 percent suffered from obstructive sleep apnea. Researchers investigating obstructive sleep apnea (OSA) at the Consortium compared a group of 50 workers with aerodigestive symptoms who also reported habitual snoring 6-7 years following the attacks to a similar group of men without WTC exposure, but who snored habitually. Two small studies of rescue and recovery workers who received care at the Consortium revealed that the workers, specifically those exposed to the toxic cloud on 9/11, were less likely to detect nasal irritation or odors more than two years later and were also less likely to detect odors seven years later.
A NYS Department of Health study of 43 WTC responders discovered that their blood contained increased rates of chemicals typically released when solid municipal waste is burned when compared to the general population.
A longitudinal study of more than 27,000 rescue and recovery workers who sought treatment at the Consortium conducted detailed physical examinations on each worker and assessed workers’ self-reports of physician diagnoses from 2002 to 2010. Nine years after the attacks, among those in treatment, 1,893 still had active asthma; 2,042 had sinusitis, and 3,195 had GERD, which were all tied to increased levels of WTC exposure among workers, according to NYC 9/11 Health.
Spirometry, which measures functioning of the lungs’ large airways, validated respiratory symptoms in nearly 19,000 rescue and recovery workers monitored at the Consortium. Workers reported persistent cough, wheezing, or difficulty breathing upon exertion and were likelier than workers with no symptoms to experience lower lung function and increased rates of bronchodilator responsiveness during initial clinical visits between 2002 and 2008. The nine-year cumulative incidence for spirometric abnormalities seen in 5,769 responders at risk in the Consortium was about 42 percent with most abnormalities involving low forced vital capacity. This is a measurement taken when the responders exhale the air in their lungs as forcefully as possible. NYPD researchers found, in a longitudinal study of 139 NYPD emergency service workers who responded to the disaster, evidence of mild lung function declines six years later. Abnormal spirometry was tied to earlier arrival and longer duration at the site. The greatest declines were seen in smokers and workers without respiratory protection, noted NYC 9/11 Health.
A study of over 10,000 workers monitored at the Consortium from 2002 to 2007 indicated that some may have alcohol problems, met the criteria for probable PTSD, had probable depression, and had probable panic disorder. PTSD was significantly tied with loss of family members and friends, disruption of family, work and social life, and higher rates of behavioral symptoms in their families. Studies of WTC rescue and recovery workers revealed trauma either before or after the attacks increased vulnerability to PTSD or led to greater symptom severity:
Another study of more than 1,000 WTC rescue and recovery workers suggests that disaster workers with increased anger levels may benefit from early intervention to prevent chronic PTSD. Individuals with low anger levels experienced fewer PTSD symptoms over a one-year period compared to those with high levels. Workers with higher anger levels had increased symptoms of depression and other psychiatric problems. Nine years after 9/11, rescue and recovery workers reviewed in the Consortium-excluding police responders-continued to screen positive for high PTSD rates, depression, and panic disorder. Police responders tested with lower rates, according to NYC 9/11 Health.
Rescue and recovery workers who sought treatment at the Consortium from 2002-2010 reported significant co-morbidity. For example, in a clinical population of over 27,000 workers, about half diagnosed with asthma reported at least one mental health condition, as did over one-third of workers with either sinusitis or GERD. Also, most workers who reported PTSD, depression, or panic disorder reported a physician diagnosis of at least one physical disorder. A study based on the initial screening data of nearly 21,000 rescue and recovery workers in the Consortium from 2002 to 2008 suggests PTSD may contribute to the continuation of respiratory symptoms.
A longitudinal study of nearly 5,000 adult volunteers enrolled in the WTC Health Registry revealed differences between affiliated and lay volunteers. Compared to affiliated volunteers, lay volunteers were likelier to have been present in lower Manhattan, experienced the toxic cloud, witnessed dreadful events, experienced an injury on 9/11, and reported unmet health care needs. The group was also twice as likely to have reported an early post-9/11 mental health or asthma diagnosis or reactive airways dysfunction syndrome and were more that twice as likely to be diagnosed with chronic or late-onset PTSD, or new or worsening lower respiratory symptoms, according to NYC 9/11 Health.
A longitudinal study of 9,296 rescue and recovery workers enrolled in the WTC Health Registry who worked no less than one shift at the debris pile provides new insights concerning use of respiratory protective equipment (RPE), including that less than 20 percent of workers reported use of standard respirator models on 9/11; half wore no facial covering of any kind on 9/11. Also, the greatest predictors of adequate RPE use were affiliated with construction, utilities, or environmental remediation organizations, as well as previous RPE training. Workers who reported not using respiratory protection were likelier to report recurrent respiratory symptoms and some respiratory disease, noted NYC 9/11 Health.
Study: Increased Prostate Cancer among WTC Responders
In 2016, an increased incidence of prostate cancer was reported in three cohorts of WTC respondents. It remains unknown if the increase is due to WTC-related exposures or heightened observation. Prostate cancer cases 2002-2013 were received from the WTC Health Program. Age, race, and so-called “Gleason” score distribution were compared with New York State Cancer Registry cases during the same time frame, according to the National Center for Biotechnology Information (NCBI)
Models involving two or more variable quantities were adjusted to accommodate for age and race. Review of the clinical characteristics of prostate cancer cases in the cohort were conducted and were adjusted for age, race, and WTC exposure categories, NCBI noted. Significant WTC exposure was tied to advanced clinical stage and respondents continue to experience increased prostate cancer rates when compared with New York State populations. The study found that respondents with increased WTC exposure level may have had a more advanced clinical stage of prostate cancer.
Study Ties PTSD and Cognitive Issues and Dementia with WTC Attack Exposure Trauma
Research of the first responders to the 9/11 terror attacks on the WTC in New York City have confirmed a link between PTSD and cognitive impairment, according to a late August 2016 UPI report. Researchers say this impacts how first responders, military veterans, and others diagnosed with PTSD may be treated.
For example, researchers at Stony Brook University of Long Island, New York, say that patients diagnosed with PTSD should be monitored for signs of cognitive impairment, based on research that constantly revealed that the one condition could be predictive of the other, especially following deeply traumatic experiences, according to the UPI. Prior research linked PTSD, major depressive disorder (MDD), and cognitive impairment; however, the new study, published in the journal Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring, is the first that found an increased incidence of impairments in civilians who responded to the terror attacks and had not sustained head injuries.
The U.S. Centers for Disease Control and Prevention (CDC) began the program in 2002 to monitor the health of police, firefighters, and other officials involved in search, rescue, and cleanup efforts following the 9/11 attacks, according to UPI. Of the over 33,000 responders enrolled in the WTC Health Program, about one-fifth developed PTSD, which, according to UPI, makes the research results “significant and far-reaching.”
"This is a problem we must solve," Dr. Maria Carrillo, chief science officer at the Alzheimer's Association, indicated in a press release. "The silver lining in these troubling new findings is that they will help us better understand the relationship between PTSD, cognition, and dementia. More research is needed in this area. This is crucial so that we can provide better care for all individuals who experience PTSD."
Researchers screened 818 responders at Stony Brook University who reported for annual monitoring visits for cognitive impairment and dementia, UPI noted. About 12.8 percent of the study responders revealed signs of cognitive impairment and 1.2 percent revealed signs of potential dementia. The researchers deduced these figures estimate that, overall, between 3,740 to 5,300 responders may suffer from cognitive impairment and another 240 to 810 may suffer from dementia. "These numbers are staggering, considering that the average age of responders was 53 during this study," said Dr. Sean Clouston, an assistant professor of public health at Stony Brook University. "If our results are replicable, doctors need to be aware of the impact of cognitive impairment among individuals who have experienced traumatic events leading to PTSD. For example, cognitive impairment can compound the course of PTSD and depression, impairing the person beyond the impact of PTSD itself,” he noted, according to UPI.
COPD Covered As An Independent Injury Under the Zadroga Act
In September 2016, chronic obstructive pulmonary disease (COPD) became an independent injury under the Zadroga Act. This means that COPD is covered independently and without a prior diagnosis or tie with any other respiratory illness, such as asthma, when making a claim under the Zadroga Act.
In July 2016, the September 11th Families Association explained that, when new-onset COPD became a covered injury under the Zadroga Act, only pre-September 11th COPD cases worsened by the attacks were covered. Meanwhile mounting recovery workers and survivors of the September 11th terrorist attacks have struggled with new-onset COPD for years.
Now, COPD is covered under the Zadroga Act without prior diagnosis or association with another respiratory illness.
According to the U.S. Department of Health and Human Services (HHS)/National Institutes of Health (NIH)/National Heart, Lung, and Blood Activity, COPD is a progressive lung disease that makes breathing difficult and worsens over time. COPD may lead to coughing with large amounts of mucus, shortness of breath, tightness in the chest, and wheezing, among other symptoms. In the United States, the term "COPD" includes both emphysema and chronic bronchitis and is known by names such as chronic bronchitis, chronic obstructive airway disease, chronic obstructive lung disease, and emphysema.
In patients diagnosed with COPD, less oxygen flows in and out of the lungs' airways because the airways and sacs lose their elasticity (emphysema), the walls between air sacs are destroyed (emphysema), the airway walls thicken or become inflamed (chronic bronchitis), and/or, the airways make more mucus than normal, potentially causing clogs (chronic bronchitis), which adversely impacts breathing.
COPD is a major cause of disability, the third leading cause of death in the U.S., and has no cure. Millions of people are diagnosed with COPD and many more may be unaware that they have COPD because of how slowly it develops.
WTC Health Program Adds New-Onset Chronic Obstructive Pulmonary Disease and WTC-Related Acute Traumatic Injury to the List of WTC-Related Health Conditions
On July 5, 2016, the Health and Human Services Department (HHS) issued a final rule that followed a WTC Health Program review of published, peer-reviewed epidemiologic research concerning potential evidence of chronic obstructive pulmonary disease (COPD) and acute traumatic injury among those individuals who were responders to, or survivors of, the terrorist attacks, according to The Federal Register.
The WTC Health Program Administrator found that these studies offer extensive evidence to support a causal association between these health conditions and exposure to the WTC site, The Federal Register indicated. Because of this, the Administrator is publishing a final rule to add both new-onset COPD and WTC-related acute traumatic injury to the List of WTC-Related Health Conditions eligible for treatment coverage in the WTC Health Program.
Concerning new onset COPD, in the past the patient required either a worsening of existing COPD or other certified respiratory injury tied to the COPD for eligibility. Under the new rule, new onset COPD will also be considered a covered injury, in addition to the existing, related injuries.
Acute traumatic trauma will include eye and head injuries, burns, fracture, tendon tears, etc. and the patient must have received treatment by September 11, 2003. A diagnosis, however, is not required as of the September 11, 2003 date. In addition, the injury must be tied to a so-called "energy source," such as a fall, an object hitting an individual, and/or heat and/or chemical exposure and does not include repetitive motion injuries, such as back pain tied to lifting as these fall under musculoskeletal injuries that are already covered.
Parker Waichman Fights for Zadroga Clients Nationwide
"Similar to the national response by rescue and recovery workers on 9/11, the firm has long provided national representation to those injured during their service," said Jerrold S. Parker, Parker Waichman founding partner. "Passage of the Zadroga Reauthorization Act provides us with a unique opportunity to bring our clients permanent healthcare, which was a driving force for the firm remaining so solidly involved with the project. Getting this done during the 2015-2016 holiday season is a gift to everyone, regardless of what holidays we are celebrating, Mr. Parker noted.
The Zadroga Act is vital for first responders and survivors in all parts of the country, including Florida and New York; Mr. Parker's insight into representation of those injured originated in New York, but expanded greatly with offices in several states, including Florida. With friends, family, and former law enforcement colleagues in New York and Florida it was a "natural expansion to assist those who had a similar background and geographical migration after their law enforcement retirement," noted Mr. Parker, who spent many years as an investigative agent with the United States Government.
"The reauthorization should put to rest any fears that responders and survivors have that they would be left with no benefits and compensation," said Mathew McCauley, Senior Litigation counsel at Parker Waichman. As of year-end 2015, the firm represented more than 600 clients with claims involving the 9/11 terrorist attacks.
"Just like they never quit, Parker Waichman never quit or gave up," added Mr. Parker. The fact that there are nearly 2,000 Zadroga claimants residing in Florida showed the need for a national response to assist these responders by those in Washington, DC, as well as those representing them, and "Parker Waichman assisted them, and all of our clients, in various states, every step along the way."
9/11 Health and Compensation Reauthorization Act Includes Residents, Workers
Parker Waichman notes that, in addition to responders and volunteers, residents and workers who were at the September 11th terrorist attack sites in Manhattan, specifically those who spent significant time south of Canal Street in the months following the terrorist attacks and through July 2002, may have legal rights for related illnesses. The firm is very concerned about those workers and residents who have been diagnosed with certain cancers in the past two years, including breast, prostate, thyroid, and blood (leukemia and lymphoma) cancers.
Study: 9/11 Attack Workers Suffer from Weight Gain, Obesity
In June 2016, researchers discovered an elevated prevalence of obesity and weight gain in former WTC workers and volunteers, according to an online report on the National Center of Biotechnology Information website, which appears in advance of publication in the Archives of Environmental Occupational Health.
The researchers surveyed 220 participants at the WTC Clinical Center to assess obesity, current employment and disability status, WTC occupational exposure level, medical comorbidities, and dietary and exercise habits. Bivariate (two variables) and logistic regression multivariate (multiple variables) analyses were conducted to review associated risk factors. Researchers discovered that obesity was associated with active employment status. The study also revealed that other significant covariates included non-Latino African American race, a high number of comorbid chronic diseases, low frequency exercise level, and not drinking any juice on a daily basis, according to NCBI.
Study: Lung Function Decline Persists 13 Years After 9/11 Attacks
As of June 2016, researchers reveal lung function decline among firefighters who responded to the 9/11 terrorist attacks 13 years after the attacks took place. Responders continue to suffer health problems due to the toxic dust exposure to which they were subject during and following the attacks.
A study published in CHEST found that WTC-exposed firefighters suffer from reduced lung function, with the greatest decline found among smokers and those who had the greatest exposure to the toxic dust cloud. "We showed in this latest follow-up that smoking worsened lung function in this group of World Trade Center responders, which is not really a surprise," said study author Thomas Aldrich, MD, of Montefiore Medical Center and Albert Einstein College of Medicine in New York City, according to MedScape. "But we also showed that stopping smoking makes a major difference, and the earlier the better in terms of lung function."
MedScape noted that this study is the longest of pulmonary function in rescue workers involved in a major environmental disaster and included 10,641 New York City firefighters who underwent a baseline measure for forced expiratory volume in one second (FEV1). This is a test of lung function and was conducted before 9/11. After 9/11, additional FEV1 measurements were taken. During previous follow-ups of one and seven years following exposure, FEV1 decreased an average of 10 percent among those who were WTC-exposed. Over 10 percent of the cohort developed new obstructive airway diseases.
"There was little recovery over the first six years," the authors stated, according to MedScape. "Follow-up into the next decade allowed us to determine the longer-term exposure effects and the roles of cigarette-smoking and cessation on lung function trajectories."
Some 15 percent of the cohort responded to 9/11, and 65 percent were never smokers. The findings revealed that lung function continues to be worse among firefighters who arrived the morning of the attacks when compared to those who responded a few days later.
VCF Reauthorization Act Interim Final Rules Released
As of May 24, 2016, the VCF paid over $1 billion to claimants since the VCF reopened in 2011, according to the Fund's Special Master. This includes all payments made as of May 2016, partial or full, on Group A claims. According to the Special Master, by end-of-day May 22, 2016, the VCF team authorized the final payment on 8,717 Group A claims. This means the team authorized full payment on all Group A claims except for those payments on which issues were encountered that might have prevented payments.
Group A payments must be made before funds will be made available to pay Group B claims. According to the VCF, if claims with unresolved issues prevent the Fund from making payments, it will authorize the claim payment and the DOJ accounting office will place those funds into an account for future payments and will enable the Fund to authorize all Group A funding, while confirming Group B fund availability.
To allow potential claimants to meet Zadroga Act deadlines-regardless of if they may ultimately file a claim-the VCF continues to enable individuals to "register" with the Fund, preserving the right to file a claim any time before the VCF closes submissions on December 18, 2020. The Special Master noted that the VCF has allowed individuals to file an "Interim Registration." Updated VCF program statistics through end-of-day March 31, 2016 were published and indicate that, as of that date, 67,295 registrations have been filed with the VCF On June 15, 2016, the DOJ released the interim final regulations for the James Zadroga 9/11 Victim Compensation Reauthorization Act (28 CFR Part 104; Docket Number COV151; RIN 1105-AB49) according to the Federal Register. The VCF is now expected to begin the next round of payments.
The new law directs the VCF to issue full compensation to claimants with Group A Claims, which are those nearly 10,000 claims for which a loss determination was made on or prior to December 17, 2015. These payments are to be followed by payment of Group B claims.
The Reauthorized Zadroga Act makes a number of changes. According to the DOJ, if approved, the statute specifically states that it:
- Extends the deadline for filing a claim from the original October 3, 2016 deadline to December 18, 2020.
- Establishes new claim categories that are based on the timing of a letter to be issued that sets forth the total compensation to which a claimant is entitled for both groups A and B, and which are based on the date the Special Master "postmarks and transmits" its final award determination to a claimant.
- Executes limits on the total non-economic loss that may be computed for various conditions-categorized as cancer and non-cancer-and imposes a $200,000 cap on the annual gross income (defined in Section 61 of the Internal Revenue Service [IRS] Code) that is used to determine economic loss.
- Directs the VCF to prioritize claim compensation for the most incapacitating physical conditions.
- Makes the original $2,775,000,000 appropriation immediately available to pay claims. Previously, $875,000,000 of this amount was available through October 3, 2016; an additional $4,600,000,000 in funding is provided and becomes available in October 2016.
- Directs the VCF Special Master to conduct yearly reassessment of policies and procedures.
Senate Unanimously Passes Bill To Allow Families of 9/11 Victims Sue Saudi Arabia
In May 2016, the United States Senate unanimously passed a bill citing Saudi Arabia's alleged role in the September 11th terrorist attacks. The move went against White House efforts to quash the legislation, according to Reuters.
Under the bill, neither Saudi Arabia, nor any other country that has alleged associations with terrorist groups would be allowed to invoke legal immunity in U.S. courts, noted The Huffington Post. As of May 2016, the 1976 Foreign Sovereign Immunities Act does grant such immunity to countries not designated state sponsors of terrorism.
The bill followed the ongoing dismissal of claims in New York courts filed by the families of 9/11 victims and brought against Saudi Arabia. Allegations include that Saudi Arabia assisted in financing the 2001 terrorist attacks. Senators John Cornyn (Republican-Texas) and Chuck Schumer (Democrat-New York) brought their "Justice Against Sponsors of Terrorism Act," seeking a quick vote that stalled for months. Neither Senate Majority Leader Mitch McConnell (Republican-Kentucky) nor House Speaker Paul Ryan (Republican-Wisconsin) expressed interest; however, the Act made it through the Senate chamber on a voice vote. "The bill is very near and dear to my heart as a New Yorker, because it would allow the victims of 9/11 to pursue some small measure of justice by giving them a legal avenue to hold foreign sponsors of terrorism accountable," Schumer told the HuffPost. "These courts are following what we believe is a nonsensical reading of the Foreign Sovereign Immunities Act."
The White House hopes to stop the bill as administration officials warn the bill would put Americans overseas at legal risk; leave the U.S. susceptible in global court systems; and, perhaps, place Americans in peril over threats made by Saudi Arabia. Meanwhile, Saudi Arabia denies any role in the 9/11 attacks and has threatened retaliation by selling hundreds of billions of dollars in American assets should Congress pass the bill, HuffPost reported.
VCF Pays $1.52 Billion to Ailing 9/11 Area Survivors and Responders, Residents, and Workers
In June 2016, the VCF issued $1.52 billion in compensation to area workers and residents, responders, and other survivors who suffered illness or injury due to the terrorist attacks. The VCF and WTC Health Program are funded through the 2015 Reauthorized Zadroga Act. According to a June 15, 2016 report issued by the DOJ, the VCF posted updated regulations for the program. These are available for public comment. The Fund has indicated that it is now ready to enter its next phase.
The $1.52 billion involves payments for which a compensation determination was made on or prior to December 17, 2015, so-called "Group A" claims. Final payment on 8,930 Group A claims has been authorized since the VCF was reauthorized on December 18, 2015; less than 200 claims remain that require authorization for full payments. The VCF indicated that it is working to resolve payment issues for remaining claims.
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Parker Waichman vows to continue its efforts to safeguard these heroes and ensure that they receive their deserved Zadroga Act compensation. Please fill out the form at the right for a free case evaluation or call 1-800-YOURLAWYER (1-800-968-7529) today for a free case review by one of our qualified Zadroga attorneys.