conditions under broader circumstances. OWCP agrees to changing current latency periods for
all of the conditions as recommended, and to changing the duration of mesothelioma to greater
than or equal to 30 days. However, with regard to the 2005 date, OWCP seeks additional clarity
as to the underlying research and the rationale supporting the selection of that date as a temporal
basis for application in the Board’s presumption. While OWCP agrees with the Board that it is
difficult to assign a temporal threshold for use in a presumption, more specific documented basis
supporting the date of 2005 is necessary to satisfy the legal requirement that all presumptions
must have sufficient scientific rationale to withstand judicial scrutiny. Our research indicates
that DOE’s predecessor, the Atomic Energy Commission, began developing health and safety
standards as early as 1973, after the Occupational Safety and Health Act of 1970 was passed.
Those standards became longer and more detailed as the dissemination and enforcement of
enhanced safety measures progressed over the next two decades. Those safety measures were
standardized in 1995 with the issuance by DOE of Order 440.1, and accordingly, we could agree
that 1995 creates a clear demarcation date for causation purposes with a solid supporting
rationale that would withstand judicial scrutiny. To move that date out to 2005, on the assertion
that it likely took another decade for exposure levels to be significantly lower, is much more
problematic. The 2005 date, without additional support, places OWCP in a position of being
unable to legally defend the presumption, should it be challenged by an employee who only
worked after 2005. Accordingly, OWCP requests that the Board provide more substantive
medical health science justification or specific DOE operational data that supports the scientific
basis for its selection of January 1, 2005 as the exposure demarcation date for use in the
recommended presumption.

In response to Recommendation #1-3, OWCP agrees that all claims for the six asbestos-
associated conditions named above, that do not meet the exposure criteria, should be referred to
an industrial hygienist and to a CMC, as appropriate. By way of further answer and clarification,
OWCP currently stipulates in program policy that any case assessed for causation under Part E
that does not satisfy an established presumptive standard must undergo a case-specific
assessment ‘including review by an industrial hygienist and a qualified physician (Reference
Guidance in the Procedure Manual, Exhibit 15-4).

The Program addresses Recommendation #1-4 in its answer to the Board’s Recommendation #3
regarding chronic obstructive pulmonary disease (COPD) below.

Recommendation #2
Presumptions for Work-Related Asthma

1. DOL should use the generally accepted unifying term, work-related asthma (WRA) for
claims evaluation and decision-making. Work-related asthma includes: a) occupational
asthma (OA), or new onset asthma that is initiated by an occupational agent, and b) work-
exacerbated asthma (WEA), which is established asthma that is worsened by workplace
exposures. The recognition of both forms of work-related asthma should be communicated
to claimants, their physicians and consulting IH’s [industrial hygienists] and CMC’s
{contract medical consultants].


particular union or was part of the Former Worker Program. In the draft, OWCPreduces the lists
of toxic substances and instead lists broad categories under which the claimant may provide
specific toxic substances (e.g. “high explosives,” or “metals.) Over the last 10 years of
conducting OHQ’s, OWCP has found that the ability of a claimant (particularly a survivor) to
affirmatively self-select toxic substance exposures from a list oftentimes does not produce
reliable or useful information. With regard to the list used by BTMed (Reference
https://www.btmed.org/pdf/WorkHistoryQuestionnaire.pdf), this list refers solely to construction
and trades positions, and therefore would not be applicable to a general OHQ that applies to
employees in all occupations.

With regard to the Board’s Recommendation in section B that proposes to add a section on
reported exposure to vapors, gases, dusts, and fumes, our concerns are contained in our response
to Recommendation #3 regarding the use of this language. If the Board develops a list of toxic
substances that represents vapors, gases, dusts, and fumes, OWCP will consider how that list
may be addressed in the OHQ.

OWCP agrees with the Board’s Recommendation in section C that the new version of the OHQ
be tested multiple times prior to becoming final, and will have the resource centers conduct these
tests.

Attached is a copy of the draft OHQ. OWCP welcomes specific recommendations concerning
modifications to the draft that the Board may have.

Recommendation #5
Science and Technical Capacity in EEOICP

The Board recommends that the DEEOICP enhance its scientific and technical capabilities
to support the development of program policies and procedures, to enhance decision-
making on individual claims, and to inform its assessment of the merit of the work of its
consulting physicians and industrial hygienists. In its rationale section, the Board further
references the National Institute of Medicine’s recommendation to improve the SEM by, in
part, forming an expert advisory panel of scientists. The Board further states that while
OWCP has asked them to provide input into numerous possible exposure-disease links,
they do not have the resources to address this request fully. Therefore, OWCP interprets
this recommendation to be to convene another expert panel consistent with IOM’s
recommendation.

Response:

OWCP agrees that it would be useful to have additional scientific and technical research
capabilities to support program policies and procedures. While the primary responsibility and
mandate of the program is to adjudicate individual claims, OWCP recognizes that with the
complexity of Part E exposure and causation issues, it is helpful to be able to generalize
whenever possible. To that end, the program contracted with a group of scientists (Paragon),
mostly former DOE workers, to create and update the SEM on a regular basis. In addition,


Recommendation #3
Presumptions for Chronic Obstructive Pulmonary Disease

The Advisory Board recommends that the Energy Employees Occupational Illness
Compensation Program (EEOICP) revise its exposure presumptions that are used to
adjudicate claims for chronic obstructive pulmonary disease (COPD). We recommend that
EEOICP replace the presumptions it has established in DEEOIC Bulletin 16-02 with the
following alternative presumptions:

1. Any claimant with a physician’s diagnosis of COPD who worked in any covered facility
either:

(a) In any of the labor categories in Attachment 1 (which should be expanded to
include all construction and maintenance job titles),

Or

(b) Who reported exposure to vapors, gases, dusts, and fumes (VGDF) with relevant
tasks on the Occupational History Questionnaire for a period, which, in aggregate,
totals at least five years,

is presumed to have experienced sufficient exposure to toxic agents to aggravate, contribute
to, or cause COPD.

2. In addition, claims examiners should not deny claims for COPD if the worker had fewer
than 5 years of exposure; for example, a claimant who has experienced high intensity
exposures to VGDFs for a period <5 years during work in a covered facility would have an
equivalent exposure. Claims that do not meet the requirements set forth here but do have
reported exposure to VGDF should be sent for industrial hygienist and/or CMC review
under the policy established in Bulletin 16-03.

Response:

OWCP will consider modifications of the current COPD presumptive standard; however, we
have a number of questions and concems with this recommendation as stated.

OWCP’s current procedures provide that a claims examiner can assume that exposure to asbestos
at a DOE facility meets the Part E definition of causation for COPD if the following criteria are

_ met: 1) the diagnosis of COPD has been established by the medical evidence; and 2) the
employee must have been employed for an aggregate of 20 years in a position that would have
had significant levels of asbestos exposure. In order to meet the criteria for exposure sufficient
to make the causation presumption, the claims examiner must determine that either the employee
was employed in any of the labor categories discussed above for an aggregate of 20 years prior
to 1986, or an IH has provided a well-rationalized discussion of case-specific exposure at high
levels during any time period.


2. Medical criteria for the diagnosis of asthma: The diagnosis of asthma by a treating or
evaluating physician should be sufficient for the recognition that the claimant has asthma.
Bronchodilator reversibility of FEV; and/or a positive methacholine challenge test may be
helpful but should not be required to accept the diagnosis of asthma, which is made by a
health care provider.

3. Work-related asthma, whether OA or WEA, is defined as the presence of medically-
diagnosed asthma that is associated with worsening of any one or more of the following in
relation to work: asthma-related symptoms, asthma medication usage or asthma-related
health care utilization temporally related to work, or change in peak expiratory flows
associated with work. Such a history should be documented by a treating or evaluating
health care provider, or addressed by a CMC if consulted in a claim evaluation.

4. The same criteria for WRA should be used in evaluating asthma claims whether the
claim is made contemporaneous with the period of DOE employment or after the end of
that period of employment. A specific triggering event causing onset of WRA may occur
but is not typical or necessary. Inciting exposures such as dusts, fumes, heat or cold or
others should be specifically identified when possible, but should not be required for the
diagnosis of WRA.

Response:

OWCP agrees with Recommendation #2-1, and it has already modified the Procedure Manual to
incorporate these into the September 2017 revision (Exhibit 15-4).

OWCP also agrees that a diagnosis of asthma by a treating physician should be sufficient,
without specific reference to the tests listed in Recommendation #2-2; however, the physician’s
opinion should include appropriate medical rationale, based on objective findings, to support the
diagnosis, as is required for any other diagnoses claimed under the program.

For Recommendations #2-3 & #2-4, in its most recent update to Chapter 15 of the Procedure
Manual, OWCP applies a policy regarding the assessment of work-related/occupational asthma
that comports in part with these recommendations. OWCP policy requires evidence of a
contemporaneous diagnosis of occupational asthma during covered Part E contractor
employment or the well-rationalized opinion of a physician after a period of covered
employment, as recommended in #2-3. The policy differs slightly from the recommendation in
Recommendation #2-4, by requiring a triggering mechanism that occurred to cause, contribute
to, or aggravate the condition. Legally, OWCP must require evidence that the toxic substance
was the likely trigger for the condition because a condition can only be accepted as a
compensable “covered illness” if “it is at least as likely as not that the exposure to such toxic
substance was related to employment at a Department of Energy facility.” 42 U.S.C. § 7385s-
4(c)(1)(B). A mere temporal association, without identification of a toxic substance, would not
satisfy the statutory requirement for eligibility. In addition, neither “heat” nor “cold” (as
referenced in the Board’s recommendation) can be defined as a “toxic substance” under this
definition.


1. For each exposure reported, the worker should be asked to describe how he/she was
exposed to each material with an emphasis on describing the tasks associated with the
exposure; this would be captured using free text. The worker would also be asked to rate
the frequency of exposure to each hazard, using the scale from BTMed. In addition, we
suggest adding a box next to each exposure on the list, asking if the worker used the
material directly or was exposed as a bystander.

The current version of the OHQ asks about specific exposures that could be expanded with
the text box and assessment of exposure frequency.

2. The list of hazards should include asbestos; silica; cement dust; engine exhausts; acids
and caustics; welding, thermal cutting, soldering, brazing; metal cutting and grinding;
machining aerosols; isocyanates, organic solvents, wood dust, molds and spores. Each of
these has been shown to cause chronic obstructive pulmonary disease (COPD) and other
health conditions.

The Advisory Board also recommends adding to the OHQ the list of tasks that is currently
used in the exposure assessment by BTMed.

B. The Advisory Board recommends adding a specific question to the OHQ regarding
vapors, gases, dusts and fumes (VGDF). We suggest adding:

1, The question: “Have you been exposed to vapors, gases, dusts and fumes in your
work at DOE?”

2. If the answer to (a) is “yes,” the worker should be asked about frequency of
exposure to VGDF overall using the scale above.

3. If the answer to (a) is “yes” the worker is then asked, “Have you already
reported all exposures to vapors, gases, dust and fumes in your answers above?”
If not, he/she should be asked to describe additional tasks and materials
associated with exposure to VGDF, the frequency using the scale above under
recommendation (1), the assessment whether the exposure was through direct
use or as a bystander, and an assessment of the number of years of exposure.

C. The Board recommends that the version of the OHQ developed in response to these
recommendations be tested multiple times to determine if it is user friendly and has face
validity.

Response:

Upon review of the Board’s Recommendations in section A, OWCP agrees that claimants who
provide detailed accounts of work processes, labor activities, and other operational descriptions
of an employee’s work activities are the most reliable and substantive mechanism for assessing
employee occupational exposure to toxic substances. In fact, OWCP has revised the OHQ, and
the Board’s recommendation that the worker be asked to describe how he/she was exposed to
each material using free text is included. The draft OHQ also provides more room for
description of job tasks, and requests that the claimant advise as to whether he/she was in a


U.S. Department of Labor Office of Workers’ Compensation Programs
Washington, DC 20210

File Number:

NOV 09 2017

Dr. Steven Markowitz

Chair

Advisory Board on Toxic Substances &
Worker Health

Queens College, Remsen Hall

65-30 Kissena Boulevard

Flushing, NY 11367

Dear Dr. Markowitz:

I am pleased to send you the Department of Labor’s response to the recommendations made by
the Advisory Board on Toxic Substances and Worker Health, at the Board’s April 2017 public
meeting. The Department appreciates the dedication and expertise that the Advisory Board
provides to the Energy Employees Occupational IlIness Compensation Program and its
stakeholders. Your important work is making a difference.

On behalf of the Department, the Office of Workers’ Compensation Programs, the Energy
program, and the communities we serve, I look forward to the continued efforts of the Advisory

Board.
Sincerely,

lia K. Hearthway
Director

Office of Workers’ ’ Compensation Programs

Enclosure


Response:

OWCP agrees with the Board that quality assessment of CMC evaluations is important. To this
end, the program currently conducts quarterly quality control assessments of 50 written Contract
Medical Consultant reports submitted for use in the claim adjudication process. The medical
director for DEEOIC conducts the audits. The redacted audit findings are available online to the
public. See _https://www.dol.gov/owcp/energy/regs/compliance/cmc_audits_qtr2016.htm.
OWCP met with some members of the Board in July 2017 and explained how this assessment is
conducted. OWCP believes that as a result of this briefing, the Board had a better understanding
of the current audit process, which should satisfy this last recommendation.



OWCP has a mediéal director for DEEOIC, as well as several nurses to assist with overall
concerns or issues. As mentioned above, the medical director conducts quarterly audits of the
reports of the contract medical consultants. The program also employs a toxicologist who
researches current studies to assist the program with causation presumptions. Beyond that,
OWC?P contracts out for medical consultants and industrial hygienists to provide opinions on
individual claims. OWCP looks forward to any additional assistance the Board is able to provide
in this regard.

Recommendation #6
Interpretation of the Beryllium Lymphocyte Proliferation Test (BeLPT)

The Advisory Board recommends that the finding of two borderline BeLPT tests shall be
considered the equivalent of one positive BeLPT for the purposes of claims adjudication
under subpart B and subpart of EEOICPA.

Response:

OWCP does not support this recommendation. The recommendation is inconsistent with the
explicit statutory requirement that beryllium sensitivity is “established by an abnormal [BeLPT]
performed on either blood or lung lavage cells” in 42 U.S.C. § 73841(8)(A). While the Board
may be of the opinion that the BeLPT is "not a perfect test" or that "false negative and positive
BeLPT results can occur," DEEOIC is bound by the specific, clear, and unambiguous language
of the governing statute.

In the program’s administration of Part B, OWCP has adopted a limited number of exceptions to
the statutory requirement for the submission of an abnormal BeLPT; however, all of those
limited exceptions are based on the presumed existence of an abnormal BeLPT that cannot, for a
scientifically accepted reason, be obtained. The Board’s recommended presumption seeks to
equate two borderline BeLPTs with an abnormal BeLPT, which cannot be done under the statute.

Recommendation #7
Quality Assessment of Contract Medical Consultants

We request that the DOL provide the Board with resources to conduct a quality assessment
of a sample of 50 contract medical consultant (CMC) evaluations that have been associated
with claim denials. The quality review will assess the nature of the medical information
reviewed by the CMC, the use of standards of causation, the reasoning of the CMC, the
scientific basis for the CMC conclusions, among other items. The assessment will likely
require contracted services of worker-centered occupational physicians who are not
associated with the current CMC contract. The review may lead to recommendations,
including the development of guidance materials.


The Board has recommended that the duration of exposure should be 5 years, and cites an article
from Dr. Dement that is based on a study of former DOE workers who self-reported both labor
categories and exposure. This exposure limit conflicts with the results of OWCP’s own search of
other medical and scientific information, using the literature as described above in response to
Recommendation #1. Accordingly, in order for OWCP to consider these two presumptions
further, OWCP requests that the Board provide additional medical or scientific studies that
specifically reference these issues.

With regard to the Board’s discussion of labor categories in Recommendation #3-la, OWCP
requests that the Board provide the information about labor categories as described in response to
Recommendation #1.

Concerning the Board’s reference to “vapors, gases, dusts, and fumes,” the EEOICPA
specifically states that a condition can only be accepted as a compensable covered illness if it is
at least as likely as not that exposure to a specific toxic substance was related to employment at a
Department of Energy facility. 42 U.S.C. § 7385s-4(c)(1)(B). The program has defined a “toxic
substance” for purposes of claim administration as, “any material that has the potential to cause
illness or death because of its radioactive, chemical, or biological nature.” 20 C.F.R. § 30.5(ii).
“Vapors, gases, dusts, and fumes” is a broad reference that encompasses many different specific
toxic substances. Exposures to vapors, gases, dusts, and fumes apply to virtually all
circumstances that exist in either occupational or non-occupational settings. _ OWCP has
evaluated the literature submitted by the Board, and while it appears that different groupings of
individual toxic substances can be characterized under the lexicon of vapors, gases, dusts, and
fumes in scientific studies, there is not one consistent list of toxic substances in the literature that
represents this grouping. In addition, the program is legally required to offset awards for any
condition, including COPD, to reflect tort recoveries tied to specific toxic substances (42 U.S.C.
§ 7385). Therefore, OWCP is unable to implement this recommendation. However, if the Board
develops a list of toxic substances that represents vapors, gases, dusts, and fumes, we may be in a
better position to consider the presumption.

For all of the above reasons, OWCP is not able to accept this recommendation related to COPD
as written. OWCP welcomerecommended revisions to these presumptions, after consideration of
these concerns.

Recommendation #4

Revisions of Occupational History Questionnaire

A. The Advisory Board recommends expanding the current list of hazards, exposures, and
materials on the current Occupational History Questionnaire (OHQ) to include the list of

hazards and/or materials used by the Building Trades National Medical Screening
Program (BTMed).


In developing the labor categories for use in the asbestos exposure presumption, the program
primarily relied on the scientific research conducted and compiled by the Agency for Toxic
Substances and Disease Registry (ATSDR) within the Department of Health and Human
Services (HHS). They published a booklet on January 29, 2014, entitled Case Studies in
Environmental Medicine, Asbestos Toxicity. Pages 31-32 include a list of occupations they
determined to entail significant asbestos exposures. OWCP worked with its contractor, Paragon
(who created the SEM) to review the list and tailor it to the labor categories relevant to the DOE
complex. The scientists at Paragon are former DOE nuclear workers and very familiar with
labor categories at the DOE facilities. OWCP included in its policy more specific definitions
where appropriate (like maintenance mechanic instead of maintenance worker), excluded some
on the ATSDR list that were clearly not DOE-related (like longshoremen), and further tailored
the list to DOE job descriptions.

In determining the causation standards, the program also relied on this publication, along with
updated information from the International Agency for Research on Cancer (IARC) and articles
and publications based on human studies, including the American Journal of Epidemiology, the
American Journal of Respiratory and Critical Care Medicine, the American Journal of
Industrial Medicine, and the Journal of Occupational Medicine and Toxicology.

In reference to the Board’s Recommendation #1-2, to apply an asbestos presumption to “all DOE
workers who worked as a maintenance or construction worker at a DOE site,” OWCP needs
additional information and clarification. Included in the Board’s reference materials was a
listing of 17 construction and trade worker labor categories related to asbestos exposure, 15 of
which are already included in DEEOIC’s presumptive labor category listing. The two remaining
categories include “Teamsters” and “Administrative/scientific/security” jobs. OWCP requests
that the Board clarify whether their recommendations are that OWCP should include these
remaining two labor categories and whether there are additional specific labor categories that the
Board believes should be included in the listing. OWCP also requests that the Board provide the
research relied upon that supports the inclusion of the proposed new labor categories.

In reference to the Board’s recommendation to apply an exposure presumption prior to January
1, 2005, as indicated above OWCP currently has guidance concerning presumptions to be made
regarding the level of exposure to asbestos. Our Procedure Manual states that the claims
examiner is to assume high or low levels of significant exposure to asbestos depending on the
years of exposure. Anything after 1995 is referred to an industrial hygienist for an individual
assessment and then a physician must conduct a medical assessment. Then the program reviews
the evidence for causation presumptions, depending on the latency periods. In the Board’s
presumptions, it is suggesting not only that a presumption be made that the claimant was
significantly exposed to asbestos before 2005, but also that the exposure was sufficient to
presume that the asbestos exposure was at least as likely as not a significant factor in
aggravating, contributing to, or causing the listed asbestos-associated conditions. While OWCP
rescinded EEOICPA Circular No. 15-06, that Circular simply stated that claims examiners
should presume that any exposure after 1995 was within safety regulatory limits and therefore
need not be reviewed by an industrial hygienist. That Circular did not address causation, and the
program has continued to refer cases for an exposure and causation assessment for the listed
conditions prior to accepting for causation, where the employee was employed after 1995. The
Board recommends changing current guidance to allow for acceptance of these medical


Response:

With regard to Recommendation #1-1, OWCP agrees that the 250-day aggregate duration of
exposure is a reasonable standard to apply when assessing presumptive standards for asbestos
related health effects pertaining to the following five asbestos-associated conditions: asbestosis,
asbestos-related pleural disease, lung cancer, and cancer of ovary and larynx.

OWCP currently makes a distinction between exposure presumptions and causation
presumptions. The Division of Energy Employees Occupational Illness Compensation
(DEEOIC or the program) has determined that certain presumptions may be made as to the
nature, frequency, and duration of a specific exposure. Presumptions are based on knowledge
and evidence OWCP has obtained through industrial hygiene, knowledge of labor categories and
work processes, and environmental health and safety practices in existence. Therefore, OWCP’s
exposure presumptions are specific to certain labor categories, work processes, and/or
timeframes. If an exposure presumption exists, the claims examiner will apply the criteria to the
specified toxic substance. As long as all criteria have been met, the case does not need to be
reviewed by an industrial hygienist. With regard to exposure to asbestos specifically, the
program recognizes that asbestos is a toxic material that was present in all DOE facility
locations; however, OWCP assumes different levels of exposure depending on the employee’s
labor categories and years of employment. The program has developed a list of labor categories
considered to have had significant exposure to asbestos at high or low levels (referred to by the
Board as “Attachment 1.”) If an employee worked in one of these labor categories before
December 31, 1986, the program considers that he or she had significant exposure at high levels.
If the employee worked in one of the labor categories between 1987 and 1995, in one of these
labor categories, the employee is presumed to have significant exposure to asbestos at low levels.
While employees in all other labor categories or during other years of employment are assumed
to have had some level of exposure to asbestos, the level of exposure is determined by guidance
from an industrial hygienist on a case-by-case basis. OWCP applies these exposure
presumptions before applying any causation presumptions.

OWC?P currently applies a causation standard to the conditions of asbestosis, laryngeal cancer,
ovarian cancer, and mesothelioma, using criteria specific to each of these conditions. For all four
conditions, in order to apply a presumption that the condition is related to exposure to asbestos
under Part E, there must be a medical diagnosis of the condition, and the employee must have
been employed in a job that would have brought him or her into contact with significant
exposure to asbestos on a day-by-day basis for at least 250 aggregate work days. The exposure
can be determined by existing asbestos exposure presumptions, as outlined above, or through an
industrial hygiene assessment. The program also applies varying latency periods to each of
these conditions: for asbestosis, latency is 10 years after initial exposure; for laryngeal cancer, it
is 15 years; for ovarian cancer, it is 20 years; and for mesothelioma, it is 30 years. The program
has not yet created a presumption for lung cancer as it relates to exposure to asbestos; however,
OWCP agrees that sufficient literature exists to develop one. OWCP reviewed the Board’s
recommendation that the latency period for all of the listed conditions be 15 years and agrees to
change existing latency standards for all conditions except asbestosis. Since the current latency
period of 10 years for asbestosis is more claimant friendly, and OWCP’s research confirms this
period is scientifically valid, OWCP will retain the existing 10-year latency period.


Department of Labor Responses to Recommendations from the April 2017 Public Meeting
of the Advisory Board on Toxic Substances and Worker Health

Recommendation #1
Presumptions for Asbestos-related Diseases

1. All DOE [Department of Energy] workers who worked as a maintenance or construction
worker at a DOE site for 250 days or more prior to January 1, 2005 and who are diagnosed
15 years or more after the initiation of such work with 1 of 5 asbestos-associated conditions
will be presumed to have had sufficient asbestos exposure that it was at least as likely as not
that asbestos exposure was a significant factor in aggravating, contributing to, or causing
such asbestos-associated conditions. The five asbestos-associated conditions are asbestosis,
asbestos-related pleural disease, lung cancer, and cancer of ovary and larynx.

2. All DOE workers who worked as a maintenance or construction worker at a DOE site
for 30 days or more and who are diagnosed 15 years or more after the onset of such work
with malignant mesothelioma of any bodily site will be presumed to have had sufficient
asbestos exposure that it was at least as likely as not that asbestos exposure was a
significant factor in aggravating, contributing to or causing the malignant mesothelioma.

3. All claims for one of the six asbestos-associated conditions named above that do not meet
the exposure criteria described in items #1 and #2 above will be referred to an industrial
hygienist for exposure assessment and to a CMC [contract medical consultant] for
evaluation of medical documentation and causation. These six conditions are asbestosis,
asbestos-related pleural disease, malignant mesothelioma, lung cancer, and cancer of ovary
and larynx.

4. Chronic obstructive pulmonary disease may have a contribution from asbestos exposure.
However, claims for this disease should be evaluated as part of a broader set of
presumptions for chronic obstructive pulmonary disease.

Asbestos- Asbestos- Other Asbestos-related
specific specific Cancers
Exposure _ Diseases diseases Lung cancer.
criteria Mesothelioma Asbestosis. Cancer of ovary
Asbestos- and larynx

Duration > 30 days > 250 days
Maintenance Maintenance Maintenance
Job titles Construction Construction Construction
Calendar Pre-2005 Pre-2005 Pre-2005
years
Latency 15 years 15 years 15 years

(minimum)