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 UNITED STATES DEPARTMENT OF LABOR

 + + + + +

 ADVISORY BOARD ON TOXIC SUBSTANCES

 AND WORKER HEALTH

 + + + + +

 MEETING

 + + + + +

 THURSDAY

 APRIL 28, 2016

 + + + + +

 The Advisory Board met at the

Department of Labor, 200 Constitution Ave, N.W.,

Washington, D.C., at 8:30 a.m., Steven Markowitz,

Chair, presiding.
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MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MARK GRIFFON

KENNETH Z. SILVER

GEORGE FRIEDMAN-JIMENEZ

LESLIE I. BODEN 

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

LAURA S. WELCH

ROSEMARY K. SOKAS

CARRIE A. REDLICH

VICTORIA A. CASSANO

CLAIMANT COMMUNITY:

DURONDA M. POPE

KIRK D. DOMINA

GARRY M. WHITLEY

JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

ANTONIO RIOS

PRESENTERS

JEFF KOTSCH, Senior Health Physicist and Unit 

 Chief, Medical and Health Science

RACHEL LEITON, Director, DEEOIC
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 TABLE OF CONTENTS

ITEM PAGE

Welcome/Introductions. . . . . . . . . . . . . . . 4

Recommendations for Dept. of Labor . . . . . . . . 8

Proposed Rule Changes. . . . . . . . . . . . . . 103

Draft Recommendation . . . . . . . . . . . . . . 105

Item 11/Contractor Employee Definition . . . . . 150

Public Comment . . . . . . . . . . . . . . . . . 163

Proposed Rule Changes. . . . . . . . . . . . . . 196

Administrative Matters . . . . . . . . . . . . . 260
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1 P-R-O-C-E-E-D-I-N-G-S

2 8:44 a.m.

3 CHAIR MARKOWITZ: So, let's get

4 started. Ms. Gibson, in the back? Ms. Gibson,

5 can you hear me? Okay, thank you. I was just

6 checking the mic.

7 Welcome. This is the third day of the

8 Advisory Board on Toxic Substances and Worker

9 Health. Sorry for the delay. We had a little

10 problem with the WebEx.

11 For those of you who are participating

12 remotely, you can still reach us on -- through

13 the phone. If you want to see the PowerPoint

14 presentations, or otherwise participate, you will

15 need to send us an email, and then we will give

16 you instructions on how to connect with us. Is

17 that right, Tony?

18 MR. RIOS: Yes.

19 CHAIR MARKOWITZ: Thank you. Today is

20 Worker's Memorial Day. So, we recognize the many

21 thousands of workers who -- actually, each year

22 over 4,000 workers who die from traumatic
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1 fatalities, and some multiple of that who die

2 from chronic occupational illnesses.

3 We will do that by 10:30, between

4 10:30, which is our scheduled break, it will --

5 we'll prolong it until 11:00. There is a

6 ceremony and some speakers downstairs. Ms.

7 Duronda Pope is going to speak, our Board Member. 

8 So, we will break at 10:30, and those

9 of you who wish to attend that, where it -- do

10 you know where it is exactly?

11 MR. RIOS: The Great Hall.

12 CHAIR MARKOWITZ: The Great Hall,

13 wherever that is, okay, but we'll -- must --

14 we'll find it.

15 So, let's quickly do introductions,

16 and then we'll proceed from there. Dr. Laura

17 Welch.

18 MEMBER WELCH: Laurie Welch. I'm the

19 medical director of the Building Trades Medical

20 Screening Program, which is one of the DOE funded

21 former worker programs, and I'm an Occupational

22 Medicine Physician.
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1 MEMBER TURNER: James Turner from the

2 Rocky Flats Nuclear Weapons Plant, near Denver,

3 Colorado, diagnosed with chronic beryllium

4 disease in 1990.

5 MEMBER POPE: Duronda Pope, United

6 Steel Workers, also a former 25 years Rocky Flats

7 former worker.

8 MEMBER WHITLEY: Garry Whitley, a

9 former worker from Y-12 National Security

10 Complex.

11 MEMBER DOMINA: I'm Kirk Domina. I'm

12 the employee advocate for the Hanford Atomic

13 Metal Trades Council in Richland, Washington.

14 MEMBER VLIEGER: Faye Vlieger, former

15 Hanford worker, injured worker claimant.

16 MEMBER SOKAS: Rosemary Sokas. 

17 Occupational Physician, Professor and Chair of

18 Human Science at Georgetown University School of

19 Nursing and Health Studies.

20 CHAIR MARKOWITZ: Steven Markowitz,

21 Professor at City University of New York,

22 Occupational Medicine, Physician and
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1 Epidemiologist.

2 MEMBER SILVER: Ken Silver, Associate

3 Professor of Environmental Health in the College

4 of Public Health at East Tennessee State

5 University.

6 MEMBER CASSANO: Victoria Cassano,

7 Occupational Physician, former Naval Under Sea

8 Medical Officer, Radiation Health Officer and

9 former VA head of radiation physical exposures

10 and environmental health service.

11 MEMBER BODEN: Les Boden. I'm a

12 Professor in the Department of Environmental

13 Health at Boston University School of Public

14 Health.

15 MEMBER DEMENT: John Dement, Professor

16 at Division of Occupational and Environmental

17 Medicine, Duke University Medical Center.

18 MEMBER GRIFFON: Mark Griffon,

19 Occupational Safety and Health Consultant.

20 MEMBER REDLICH: Carrie Redlich. I'm

21 an Occupational Medicine and Pulmonary Physician

22 and Professor of Medicine and Director of the
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1 Yale Occupational Environmental Medicine Program.

2 MEMBER FRIEDMAN-JIMENEZ: George

3 Friedman-Jimenez. I'm an Occupational Medicine

4 Physician and an Epidemiologist at Bellevue/NYU

5 Occupational Environmental Medicine Clinic.

6 MR. RIOS: And I'm Tony Rios. I am the

7 Designated Federal Officer for the Advisory

8 Board.

9 Also for those folks that are on the

10 phone that did want to join us through WebEx, the

11 Chair asked that you email us. I just wanted to

12 give you our email address.

13 That's energyadvisoryboard@dol.gov.

14 That's located on our website, but I just wanted

15 to make sure everyone had it.

16 CHAIR MARKOWITZ: So, next we're going

17 to discuss the fourth area that Department of

18 Labor has asked us to provide recommendations on,

19 as a Board, and I'd just like to read from our

20 charter what the assignment is before we begin

21 the session.

22 "The Board shall advise the Secretary
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1 of Labor, with respect to the work of industrial

2 hygienists and staff physicians and consulting

3 physicians of the Department, and reports of such

4 hygienists and physicians to ensure quality,

5 objectivity and consistency."

6 So, with that, I'd like to invite Mr.

7 Jeff Kotsch, who is a Senior Health Physicist and

8 Unit Chief of the Medical and Health Science to

9 come and present. Welcome. 

10 I'd also like to welcome back Ms.

11 Leiton. 

12 MR. KOTSCH: Up front, I'll apologize. 

13 I'm suffering through allergy season. I don't

14 know if anybody else has that affliction, but

15 anyway. So, if you see me sniffling up here,

16 that's what it is.

17 I think we are -- is it audible now or

18 -- okay. 

19 I think they've all started, all our

20 previous presenters have started with an

21 introduction of their background. Unfortunately,

22 I haven't been with DOL as long as most of these
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1 people. I only started a little bit after the

2 program started. You know, I started in August

3 of 2001.

4 Out of graduate school, I went to work

5 with the Nuclear Regulatory Commission. That was

6 back in '78, and ended up in a group, a licensing

7 group that actually did uranium milling

8 licensing, which was interesting and actually,

9 has come back in the loop because one of the

10 things that we cover is uranium milling, milling,

11 mining and ore transporting, as part of Section 5

12 of the RECA.

13 When TMI came around, I got drafted

14 because there weren't that many -- interestingly

15 enough, there weren't that many health physicists

16 in the NRC as you would have expected.

17 So, I got drafted into the emergency

18 response center and then continued from there,

19 working on reactor related things, until '81,

20 when I left, and joined a commercial nuclear

21 power plant in Southern New Jersey and headed up

22 the Central Radiological Protection Support Group
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1 for that, through the 80's, essentially.

2 In the early 90's, I joined a small

3 consulting firm in the D.C. area. We did a lot

4 of DOL and some NRC work, I mean, sorry, DOE, and

5 I was fortunate to probably visit all of the --

6 major DOE facilities, as well as a number of the

7 minor ones, doing nuclear safety assessments for

8 what was then the defense programs and also

9 later, the environment safety and health group.

10 So, I got to go to Rocky -- one of the

11 first things I did was, I went to Rocky Flats and

12 participated in the review for the startup of the

13 707 Building where they did plutonium pit

14 production. 

15 Unfortunately, that facility was never

16 allowed to go into operation. It did similar

17 things for K reactor at Savannah River, the

18 replacement tritium facility done there, and a

19 bunch of other -- they call them vulnerability

20 assessments throughout the DOE complex for

21 uranium and plutonium, and that gets me to the

22 point of where I joined DOL in August of 2001.
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1 Since then, initially, obviously I

2 came in as a health physicist for the Part B

3 program, when they took over Part E, or when Part

4 E implemented, they added staff. We added --

5 well, the members of our staff include a

6 toxicologist, actually with a PhD, but she also

7 likes to say that she's an occupational

8 epidemiologist, because she has an MPH in that.

9 We had, sadly passed away, our medical

10 director last -- early last year, and so, we rely

11 now on a -- the OWCP medical director, as we hire

12 a new medical director, and I think the intention

13 is to have that core group sit in OWCP, but to be

14 available to us, and certainly the OWCP medical

15 director is, and has always been, very accessible

16 to us for, you know, questions that we have.

17 The latter half of the presentation

18 will get into, you know, the CMC contract, but

19 the first part will be the IH, and the industrial

20 hygiene portion, and we have -- and don't let me

21 -- let me just start with the presentation.

22 I think you have it -- or the talking
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1 points. Actually, I was tempted, since we've

2 actually discussed, I think, most of the things

3 I'm going to discuss through Rachel's and John's

4 and Rhonda's presentations. I was almost tempted

5 to just say let's go straight to questions, but

6 I'm sure I'm not going to get away with that.

7 So, anyway, we'll just step through

8 this. We can probably step through it a little

9 more quickly. I have a couple things that you may

10 not have seen, and go on from there.

11 But anyway, as it says in the

12 overview, basically, we're to establish -- the

13 overview provides the basis of what -- you know,

14 the activities for the industrial hygiene, and

15 actual -- actually, the medical reviews

16 encompasses.

17 To show evidence of potential or

18 plausible exposure of toxic substances, evidence

19 of covered DOE along with evidence of covered DOE

20 contractor, subcontractor or employment under the

21 RECA Act, which is what we've talked about

22 before.
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1 The regulatory requirements there, the

2 first one comes from 20 CFR Part 30.23 -- or

3 231(d), and it talks about establishing

4 employment-related exposure to a toxic substance.

5 So, proof of exposure to the toxic

6 substance, that -- that is present, and then it

7 talks about the site exposure matrix -- matrices

8 being used as a basis for determining the

9 presence of the toxins, and the second portion of

10 that is the same citation except that the -- the

11 second -- I'm sorry, 20 CFR 20.231(d)(2) and it

12 talks about essentially, what goes into a review

13 for toxic substance, the nature, frequency and

14 duration of the exposure, evidence of the

15 carcinogenic or pathogenic properties, the

16 opinion as a qualified physician, and other demo

17 -- other evidence that demonstrates the

18 relationship to a particular toxic substance and

19 the claimed illness.

20 The industrial hygiene process. 

21 Currently, we have three industrial -- a

22 certified industrial hygienist. Two are Feds --
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1 are Federal employees, one is a contractor

2 employee, and the CIH's review and evaluate the

3 historical occupational safety and health data,

4 which may or may not include, and often doesn't,

5 specific -- employee specific industrial hygiene

6 monitoring data, along with the application of

7 the specialized knowledge that they bring to --

8 to the review, relating to the field of

9 industrial hygiene.

10 The process, and I think we've done

11 this before, the process starts with the claims

12 examiner in the field, obviously, identifying

13 that an exposure issue is present.

14 The CE basically formulates the

15 question as far as the potential for the

16 exposure, using the site exposure -- exposure

17 matrix, or matrices, the SEM and the case file

18 that frames -- and the information in the case

19 file to frame the question, and there are sub20 bullets there including obviously, the things

21 that they -- they need to address, the facility

22 exposure records, the DAR request from DOE, which
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1 may or may not contain a number of things, which

2 we may get into later, and some of the things

3 that show up here.

4 Obviously, one of the things they're

5 looking for is employment information, but

6 sometimes they will find, not related to the E

7 side, but to the B side, obviously records for

8 dosimetry, which NIOSH also gets, because they do

9 similar requests on their side, for the B side.

10 Sometimes we're lucky and, especially

11 at Savannah River site and the Rocky Flats Plant,

12 where we get actual documents that reference the

13 employee by name and discuss their -- their --

14 yes, their employment activities as a maintenance

15 mechanic or a laborer, or whatever it is, or if

16 there are multiple positions, it discusses those,

17 their acts -- their work activities, the types of

18 things they're exposed to, heavy metals or

19 whatever solvents or whatever it is.

20 That is actually useful, especially

21 since it's specific to the individual. 

22 The occupational health questionnaire,
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1 which it comes from the resource center

2 interviews, again which are conducted either in3 person or via the phone.

4 Those are useful because if you're

5 talking obviously to the worker, because you --

6 because you're getting their input. Yes,

7 obviously if it's a survivor situation, whether

8 it's the spouse or the children, that information

9 is generally of less value, simply because they

10 were not aware of all the things that their

11 father or mother did at the facility and because

12 of the security restrictions, a lot of those

13 things, you know, they may never have talked

14 about those things at home anyway.

15 Obviously, the employee records, the

16 verified affidavits of coworkers and other

17 people, the former -- DOE former worker program

18 screening records, if they're available, the

19 NIOSH site profiles, which generally, they don't

20 get into, but do provide some information, since

21 they're created for the B side, occasionally has

22 some information.
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1 Any evidence that the employee

2 submits. Sometimes they do indeed submit

3 supplemental information, you know, to describe

4 their work, or they may submit it after they've

5 had the interview, if they've thought of

6 something else or if the CE perhaps asks for

7 additional information, to expand on something

8 they said in their OHQ, and any other information

9 that they might submit, as it -- concerning toxic

10 exposures at the site.

11 All this gets rolled into what they

12 call the Statement of Accepted Facts, so, which

13 we'll go through. I'll hand out one in a few

14 minutes and we can just run through that quick,

15 and you'll see what information that contains.

16 So, that comes in. It's reviewed by

17 -- and we -- we have quite a few of those. It's

18 reviewed by our lead industrial hygienist, to

19 make sure the quality of it is what we need to

20 perform the review that we -- we don't need the -

21 - that the question is properly posed and things

22 like that.
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1 Initially, when the review is

2 performed, the -- they'll -- whoever is doing --

3 whichever the industrial hygienist that's doing

4 the review, assuming that the question is --

5 appears to be appropriate for the medical

6 condition and things like that, they'll re-run

7 the SEM, check, you know, to make sure that

8 that's properly done. Often, that is done fairly

9 early, even before it's transmitted to the other

10 IH's to review, and to ensure that we've got the

11 proper toxins that are identified for the medical

12 condition.

13 MS. LEITON: The SOAF is an area that

14 we constantly are reviewing because that's -- as

15 we've talked about earlier in the week, that's an

16 -- that's something that is reviewed by the IH. 

17 It's reviewed by the CMC.

18 So, we've tailored it. In some ways,

19 we'll tailor it to a referral to an IH versus a

20 referral to a CMC, and it's something that we're

21 currently still looking at and working with our

22 district offices to see if there is like -- if
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1 there is maybe a formulaic process for referring

2 cases to our IH. That would -- because it's

3 still kind of a struggle I think for -- since we

4 have so many different claims examiners, to

5 ensure consistency with this.

6 So, we're trying more and more every

7 year to make it as consistent as possible, with

8 regard to what we include in the information that

9 goes to the IH, what information that the claims

10 examiners claim, but also, what is attached to

11 it. 

12 So, just wanted to let you know,

13 that's something that's ongoing. I mean, it's

14 been a constant and it's -- but it's -- we do

15 evaluate it regularly to make sure that it's

16 still consistent with what we need to be using it

17 for.

18 MR. KOTSCH: And even format-wise, I

19 mean you'll see, actually one format, but it's

20 not even the common format that we use when I

21 hand out the example, but we are, I think in a

22 current effort to actually overhaul the OHQ, so
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1 any input you could provide -- yes, would be

2 useful.

3 I'm sorry, that was the OHQ, but even

4 the SOAF's, you know, we're always looking at

5 those things too. 

6 The SOAF is used obviously, to

7 transmit information for -- it could be for a

8 medical review. Obviously, it's a different one

9 than you'll see today, which is an IH one,

10 they're also used to transmit requests for

11 toxicology reviews or even health physics reviews

12 on the B side.

13 So, that -- it's a common mechanism

14 that is used for basically all the inputs to the

15 specialists in our group.

16 So, anyway, basically now that they've

17 redone -- they've done a SEM run again, to check

18 that and talk with the CE if they need to. We

19 have no direct interaction with the claimants. 

20 If there were any, that would go through the CE. 

21 We tap in sometimes occasionally to the folks

22 that support the SEM contract, some of their
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1 health -- industrial hygienists, if we need some

2 specific information that might have been in SEM,

3 or we think that is in SEM, or should be in SEM.

4 Obviously, sometimes there are

5 deficiencies in SEM that we can find, that we'll

6 identify and transmit over to them, and sometimes

7 they'll see things that we've missed.

8 So, anyway, the IH renders an expert

9 opinion in the form of a memorandum, which we'll

10 see a copy of, that addresses the issues as

11 specifically as possible. It addresses the

12 specific question which is posed by the CE, just

13 as for a medical one, you address the specific

14 question -- the CMC addresses the specific

15 question, and employs their specialized training

16 to make findings, based on the evidence in the

17 file, and there you see the things.

18 You know, you address obviously, the

19 toxic substance -- I'm sorry, toxic substance,

20 employee history, the medical condition and then

21 apply that in a -- hopefully, and communicate --

22 or I'm sorry, communicate that in a clearly
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1 understandable, written narrative.

2 So, at this point, I want to do two

3 things. We can hand out the -- Carrie is not

4 here, okay.

5 We can hand out the copies of the --

6 it's in that brown folder, just for the examples,

7 and the other thing we can do is have -- do you

8 want to talk now? And to have Doug Pennington

9 talk about our new IH contract.

10 MR. PENNINGTON: Good morning,

11 everyone. Again, my name is Douglas Pennington.

12 I am the Deputy Director of the Energy Program. 

13 I've spoken to you briefly before, and I

14 appreciate the opportunity to do it again.

15 I am going to give you a very brief,

16 unlike everyone else, I've been with the Energy

17 Program and OWCP since July of 2015. So, I am

18 exceptionally new.

19 I came here though with 20 years of

20 experience in the insurance industry, as a state

21 insurance regulator, and working for CMS for the

22 last five years, and so, I bring a variety of
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1 experience.

2 I am here to basically tell you that

3 we're very excited to announce that effective

4 3:00 p.m. yesterday, we executed a contract with

5 Banda International Group to perform certified

6 industrial hygienist work on our behalf. They

7 will be supporting the three industrial

8 hygienists that Jeff was mentioning previously,

9 our two staff and one contractor.

10 Their primary role will be supporting

11 all of these referrals that our claims examiners

12 have been making, and so, as previously mentioned

13 in the week, we do currently have a back-log that

14 they will be working towards eliminating as

15 quickly as possible, while also taking on new

16 industrial hygiene referrals.

17 So, since this contract was literally

18 executed yesterday afternoon, we will be in the

19 process of implementing and training and getting

20 all of that up to date over the next couple of

21 weeks. But we wanted to let you know that this

22 was something we were very excited about.
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1 Banda, just so that you know, brings

2 years of experience in industrial hygiene

3 activities, working for the National Nuclear

4 Security Administration, the Department of

5 Energy, various subcontractors of the Department

6 of Energy, and various private nuclear

7 facilities.

8 So, these -- this organization is and

9 provides a great deal of industrial hygiene

10 expertise in the nuclear facility world, which is

11 obviously something that excites us greatly. So,

12 it should hopefully reduce the training curve

13 that they're going to have to suffer through.

14 So, thank you very much, and have a

15 good day.

16 MR. KOTSCH: Thank you.

17 MS. LEITON: So, I think the timing of

18 this is really good, in terms of, we're

19 establishing the board and the guidance that you

20 provide, we can also relay to them. I think it's

21 a good starting point. So, I'm going to turn it

22 back over to Jeff.
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1 MR. KOTSCH: Okay, so, what I've

2 handed out has three parts to it. The first two

3 parts are, in essence, I tried to hopefully

4 redact it completely, and maybe over-redacted in

5 some cases, but just to protect the innocent or

6 whatever.

7 The first two parts that are stapled

8 together are basically what we get -- or in this

9 example, what we received from the CE.

10 Now, this can -- this is a little bit

11 more than we normally receive, but sometimes a

12 little bit less.

13 Like I mentioned, when we have

14 Savannah River site cases or Rocky Flats cases,

15 we often get those additional documents about

16 employment -- you know, work activity

17 descriptions, employment descriptions for, you

18 know, if it's a maintenance mechanic or a welder

19 or laborer, or whatever it is, you know, which

20 again, we find useful.

21 Unfortunately, I was trying to look at

22 this particular file and see if I could find the
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1 medical -- the SOAF that went to the CMC, but I

2 couldn't find it. I don't think I actually --

3 because of the dates on this thing it was

4 developed yet, but I was trying to -- I was

5 hoping I could get, you know, the complete flow6 through, the question that they pose and the SOAF

7 to the CMC, but I failed on that one, but I think

8 ultimately, we can -- yes, we can get copies of

9 those kinds of things.

10 So, anyway, the first one, which is

11 the two pages is basically the -- it's called the

12 IH referral, but it really, in essence, is what

13 we also call the SOAF. This one has a little

14 different format than many of the other ones you

15 see, which are primarily in the more of a textual

16 format, but it gives you the essence of what --

17 you know, what's contained in what we call an IH

18 referral or a SOAF or an IH review.

19 It starts with the demographic

20 information on the employee, medical information,

21 employment information, including, you know,

22 obviously dates of employment, position, work
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1 position. 

2 The number four is the -- the list of

3 toxins, and you'll notice in this one, initially

4 they came up with a long list, a longer list than

5 the three questions -- or the three toxins that

6 they ultimately requested to be reviewed, and in

7 the next package, you'll see that -- but we'll

8 get to that in a second.

9 I just included the email that they

10 sent to one of our industrial hygienists, on how

11 they whittled that down.

12 So, they present the three toxins and

13 then basically present the question, and then on

14 the following pages is just the -- it's basically

15 a summary of the employment again, and the right16 most column, the potential toxic exposures comes

17 from their assessment in SEM. They put the --

18 the facility and the labor category and the

19 medical condition, and then they start coming up

20 with conditions.

21 So, anyway, in the second package, the

22 first thing is just what they submitted, was
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1 actually a couple of emails on how the -- how the

2 longer list of 13 was basically reduced down to,

3 I guess is it three or four? So, I think it's

4 three. So. Sure. 

5 MEMBER WELCH: So, you know, I was

6 saying, well, is this a claims examiner or is

7 this a supervisor or is this a --

8 MR. KOTSCH: No.

9 MEMBER WELCH: -- because it's sort of

10 like -- I'd recommend that your IH referral ask

11 for exposure evaluation.

12 So, just to -- it helps me understand

13 the process.

14 MR. KOTSCH: This email?

15 MEMBER WELCH: Yes.

16 MR. KOTSCH: I'm sorry, yes. This --

17 the top one is from our industrial hygienist. 

18 Actually, our contractor industrial hygienist,

19 back to the -- to the CE.

20 Yes, the -- well, it has CE -- well,

21 I'm sorry. You know how emails go? They go back

22 to front kind of thing.
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1 So, the --

2 MEMBER WELCH: Oh, okay.

3 MR. KOTSCH: -- I guess my redacting

4 --

5 MEMBER WELCH: Okay.

6 MR. KOTSCH: -- the top of the second

7 page was essentially the email from the CE to the

8 industrial hygienist, you know, the one with -- 

9 MEMBER WELCH: Asking him to narrow

10 down --

11 MR. KOTSCH: -- asking him to narrow

12 down the 13, the 13 toxins, and then the top one,

13 I guess by over-redacting it, it loses something,

14 and then top one is then the recommendation back

15 from the industrial hygienist, back to the claims

16 examiner.

17 MEMBER REDLICH: So, somebody is

18 asking -- so someone is -- thinks that it will be

19 helpful to know which of these is the major

20 exposure or what is the --

21 MR. KOTSCH: Yes.

22 MEMBER REDLICH: -- question?
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1 MR. KOTSCH: Yes, we have a -- one of

2 the -- just because we get so many of these in,

3 until we had the contractors yesterday, we get so

4 many referrals, we've kind of said, try to limit

5 it to no more than seven for each particular job

6 category.

7 So, when they come up with 10 or 15

8 toxins or something, it may be a result of the

9 fact that they didn't properly do the SEM surge,

10 or it may just be a fact that there is

11 potentially, you know, 10 or 15 toxins in there.

12 So, then we ask them to talk to our

13 industrial hygienists and see if they can whittle

14 it down to some lesser number.

15 Now, if that's not possible, we will

16 -- it -- we will, you know, run all of those

17 toxins. But if we can reasonably limit it down

18 to the more -- you know, essentially the more

19 important ones, that's the goal.

20 MEMBER REDLICH: So, as an

21 occupational pulmonary specialist who does mainly

22 diagnosing things, like work-related COPD, having
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1 five specific toxins versus more general

2 information, the type of work processes, we don't

3 diagnosis occupational COPD based on like

4 measurements of phosgene.

5 The literature is -- that supports the

6 association is for exposures to fumes, dust,

7 vapors, and it's not one specific substance.

8 So, I'm not sure what that effort

9 accomplishes by making it a shorter list.

10 MS. LEITON: So, when we refer the --

11 we used to have -- if you look in the SEM, you'll

12 see this broad list of possible things people

13 could be exposed to, and when we refer it to an

14 IH, what we do is, we explain to the IH, what we

15 believe that the person's potential exposure may

16 have been and ask them to tell us the root and

17 nature of exposure, so that we can then go to the

18 physician with that information in mind.

19 So, that's the way that when we refer

20 it to an IH, we're asking them to opine on that

21 particular -- this person was in this job. We

22 narrow it down because we're not going to give
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1 them 25 different toxic substances, especially if

2 they've talked to an IH, talked about the job

3 categories, talked about the length of

4 employment, the IH is really -- these other ones

5 are not going to be as relevant.

6 So, these are the four that you would

7 want to have us focus on. That's the way our

8 referral process works.

9 CHAIR MARKOWITZ: Dr. Dement? 

10 MEMBER DEMENT: I guess what's missing

11 for me on this process is what the worker

12 actually gave you on their occupational history.

13 MR. KOTSCH: I'm sorry, this is coming

14 up then.

15 MEMBER DEMENT: Okay. So, none of

16 these things are in what was said to the -- IH,

17 well, we'll come to that.

18 MR. KOTSCH: Yes, it's attached. It's

19 just coming up in the -- behind a document. I

20 just happen to put this -- this email in there

21 first.

22 So, anyway, so, after the email, which
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1 was the first three pages, comes the SEM run, and

2 this is for an electrician, which he -- and

3 that's just a printout of it. That's what the CE

4 submitted in support of the -- and then they

5 submitted another one for a welder. This

6 particular individual, I think welded for like

7 four months of the -- of his employment.

8 Then where it says -- where it says --

9 I'm sorry, and then there is one page where it

10 says EEOICPA party DAR requisition. That is -- a

11 lot of times, that -- the first page of the --

12 whatever the document dump that comes in, and

13 that basically is a report back from DOE as to

14 what they found or couldn't find, and not all

15 those records may be attached to what comes into

16 the IH.

17 MS. LEITON: If there is anything

18 substandard in the records, it would be included.

19 MR. KOTSCH: Yes, so, at this point,

20 if there were -- if it was a more recent

21 employment and there was -- and they were able to

22 find monitoring data, say in the 90's or 2000's,
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1 that would be submitted too.

2 That is a rare event that we don't

3 often see any kind of monitoring data. It comes

4 in with the SOAF.

5 So, then the page after that --

6 CHAIR MARKOWITZ: I'm sorry, which

7 page are we on?

8 MR. KOTSCH: Okay, now, we're at --

9 I'm sorry, I should have probably numbered these

10 guys. This page? I'm sorry, I should have

11 numbered these pages. 

12 So, we're probably about what? Eight

13 or nine pages in. It's titled 'Energy Employees

14 Occupational Illness Compensation Program,

15 Occupational History Interview', or often called

16 the Occupational Questionnaire.

17 So, anyway, this is the first page of

18 what's often called the OHQ or the OHI, the

19 occupational history interview, or the

20 questionnaire. 

21 This is -- I know there is an effort

22 in the policy branch, to review this -- to either
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1 review and revise this document too.

2 This is the information that's

3 basically taken in at the resource center, again,

4 either in person or over the phone.

5 So, it starts off with basically the

6 name of the employee and whoever the interviewee

7 was. It could be this -- it could be the actual

8 worker or it could be, you know, one of the

9 survivors.

10 It goes through Section 2, which is a

11 health history, tobacco and alcohol use, non-DOE

12 work history. This is the second page of that.

13 Section 5 is now the third page,

14 beginning to talk about DOE work employment, and

15 listing out the facility -- I mean, the

16 contractors or subcontractors and the years of

17 employment.

18 The B section of that, which starts at

19 the bottom is basically the -- if they

20 participated in a former worker screening

21 program. 

22 The next page is Section 5C, the labor
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1 category. There is an extensive list that runs

2 on for -- well, at least two pages, that talks

3 about, you know, the different categories and the

4 labor years of employment.

5 So, those, as appropriate, are

6 checked, if not, you know, something else is

7 added at the end, if the particular title doesn't

8 show up.

9 The next page is Section 5D, again,

10 just giving the union affiliation. Section 6,

11 which is the work areas, which is important for

12 us as -- or important for the industrial

13 hygienists.

14 You'll note at the top it talks about

15 the frequency box and assigns numbers from one to

16 five, five being the most -- basically, daily

17 employment, one being -- essentially doing an

18 activity or presence in that building for a month

19 or less.

20 Then the box in the lower -- you know,

21 basically lists the facilities, PUREX and PFP and

22 East and West K areas and things like that, the
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1 different buildings, and we'll go on tank farms

2 and can be amended if it's even longer than that. 

3 If there is any additional information

4 that the interviewee wants to add, they add that

5 at the bottom of that section. Section 7 is the

6 PPE, protection -- personal protective equipment. 

7 That's used or supplied and those things are

8 checked off accordingly, and then they can

9 describe other things there, or add additional

10 comments, if they want.

11 Section 8 is the exposure information,

12 and then now they start to get into possible

13 lists of toxins, and you see the ones that are

14 checked -- checked off there, at least as

15 suspected of being potentially exposed.

16 There is a section on high explosives,

17 which we usually don't see much of, unless we're

18 down at the Pantech or something. 

19 The next section is radiological. 

20 Now, we flip the page again, and this section

21 talks about any major accidents or incidents that

22 there might have been in -- and these things are
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1 actually more B related, Part B related, you

2 know, whether they were monitored for radiation

3 exposure or had to do bioassay or something like

4 that.

5 The middle section discusses plastics

6 and adhesive resins, dusts and fibers are at the

7 bottom, and in the last page of -- is the other

8 toxic substances.

9 MS. LEITON: So, this was developed,

10 I think I might have mentioned, back when we

11 first got Part D, and we based it off of some of

12 the questionnaires that were used by Department

13 of Energy at the time, when they were doing the

14 Part D assessments.

15 So, that's why currently, we're

16 looking at it, and you know, rather than asking

17 them, going through a list of toxins, which

18 usually is not a very productive exercise, we're

19 trying to look for ways to modify this form, so

20 that it will actually be more useful and solicit

21 -- elicit the information that we need the most

22 from the claimants, when we're obtaining this
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1 information.

2 So, again, any input from the Board on

3 that area would probably be helpful.

4 MR. KOTSCH: So, that -- well, again,

5 that second portion and the first portion, which

6 is the SOAF is, in this case, what was provided

7 by the CE to the industrial hygienist for review.

8 Then the last three pages, or this

9 last three page stapled document is the -- in

10 essence, the industrial hygiene review.

11 Again, it states the question, in the

12 middle of the first page, that the CE posed, as

13 far as the potential exposures, cites the -- just

14 summarizes the background, as far as -- I'm

15 sorry, we're on this one?

16 So, cites the background and

17 summarizes the employment, and then gets into the

18 discussion, essentially toxin by toxin. So,

19 there is three of them there, cement, diesel

20 engine exhaust and then welding fume.

21 It assigns -- this person was employed

22 primarily as an electrician from '77 through
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1 2015, but I think -- yes, they're intermittent.

2 So, anyway, the way they do their

3 assessments, obviously Part E side is much more

4 qualitative than the Part B side, where we have

5 at least dosimetry and monitoring data and things

6 like that. So, it's a little more quantitative

7 than the Part E side, where due to the lack of a

8 lot of environmental -- or not environmental,

9 industrial hygiene monitoring, either individual

10 or area, it has, by nature, had to be a little

11 more qualitative.

12 So, essentially, they assigned at

13 levels of either low, medium or high, very

14 qualitative or essentially, incidental exposure,

15 which I don't think we have on this one, and then

16 at some points and more frequent time, they might

17 say at levels not exceeding regulatory standards,

18 which doesn't mean that there wasn't some

19 exposure, but that that exposure was considered

20 to be controlled by whatever regulations were in

21 place below the PELs and things like that.

22 The other thing it provides for each
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1 toxin is some estimate or some of what -- what we

2 think the exposure is, or what the industrial

3 hygienist thinks the exposure frequency was,

4 whether it was daily or weekly or monthly, and

5 tries, usually to assign it to some -- some

6 activity that we can glean from the SOAF or the

7 SEM or some other provided information that the -

8 - you know, for work at that site, and then the -

9 - conclusion is just a summary of those things,

10 and then the references are there attached.

11 Are there any questions on -- this is

12 basically, like I said, the submittal of a - - of

13 a referral to the industrial -- hygienist, and

14 then the review.

15 CHAIR MARKOWITZ: Mr. Domina?

16 MEMBER DOMINA: I just got a couple of

17 questions, because I -- I know the guy marked

18 beryllium in the back, and he is an electrician,

19 and it doesn't list as beryllium being in the

20 SEM, because everybody knows that electricians

21 are exposed to beryllium because it's used for

22 non-sparking stuff.
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1 You probably have beryllium on that

2 elevator panel out there, where you push the

3 buttons. We found it all over the place like

4 that, and then the other part, this guy spent

5 time in 222S which all of our high level samples,

6 and there is nasty chemicals and everything in

7 there, and I think -- because I have a lot of

8 energy on this IH stuff, because unless you are

9 at the site or know stuff, what goes on there

10 individually, you have no idea what these people

11 are exposed to, and it's just an injustice, in my

12 opinion, that -- because I've spent 33 years at

13 Hanford, that when you have, it looks like that

14 this SEM was updated November 5th of 2015, and

15 you don't even have beryllium listed for an

16 electrician.

17 Then like I said, working at 222S,

18 there is a toxic soup of chemicals there each and

19 every day that the chem techs, to me, they should

20 have listed the chem tech category, because those

21 guys crawl all over that building, you know,

22 whether they're fixing hoods, re-running new
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1 equipment.

2 I mean, it's just -- to me, it's a

3 terrible injustice.

4 MS. LEITON: So, this is as -- as we

5 tried to talk about the SEM earlier this week,

6 it's not complete. We haven't been able to go to

7 every site and talk to people at all of the 300+

8 facilities that we have there.

9 But we're always looking to get ideas

10 for how we might be able to get more site

11 specific information that could be added to the

12 SEM.

13 CHAIR MARKOWITZ: Dr. Friedman14 Jimenez? 

15 MEMBER FRIEDMAN-JIMENEZ: To put it in

16 more scientific terminology, what Mr. Domina

17 said, my question is, have these questions in the

18 questionnaire ever been validated?

19 In other words, if someone says, "I

20 was exposed to plutonium," what's the probability

21 that they were exposed to plutonium, or more

22 importantly maybe, if they say they were not
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1 exposed to plutonium, what's the probability that

2 they were not exposed to plutonium?

3 Has that ever been measured in any

4 validation study? Do we know what the -- how

5 well these questions actually reflect the reality

6 of exposure?

7 MR. KOTSCH: Well, if it were

8 plutonium, it would be a little more

9 straightforward, because there would be bioassay

10 data cited, you know, in that particular example.

11 But or there would at least be a lot

12 more monitoring data, beyond -- obviously, you

13 would get the other kinds of chemical toxins.

14 MEMBER FRIEDMAN-JIMENEZ: So, it could

15 be validated against that as opposed to just --

16 MR. KOTSCH: Right, and you know,

17 again, we don't have a lot of IH sampling data,

18 so it's hard to validate some of those things. 

19 Obviously, these things are present. There have

20 been reviews at the sites and things like that,

21 as far as the -- we know the -- may not know --

22 we know what things are present at the sites, or
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1 least that's what SEM tells us, and it's

2 incorporated into that.

3 But I don't know, that's a --

4 MEMBER FRIEDMAN-JIMENEZ: That's not

5 really my question, it's has there ever been any

6 validation done? Do we know how well or how

7 poorly these questions perform, in terms of the

8 actual exposure, either using bioassay data or IH

9 data, or some other measurement as a gold

10 standard?

11 MR. KOTSCH: Yes, I think the answer

12 to that would be no. Yes, right.

13 CHAIR MARKOWITZ: Dr. Cassano? 

14 MEMBER CASSANO: I am still a little

15 bit confused on how things get whittled down from

16 the CE to what you see. 

17 I presume that you see all of this. 

18 So, let's take COPD off the table for a second,

19 because that's got its own little special

20 problems and I'm not a pulmonologist.

21 But let's go to something that may be

22 a little bit more straightforward, like lung
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1 cancer, okay.

2 So, you get this thing from the CE

3 that says asbestos and cement dust or whatever

4 the things are. 

5 Do you actually look through all of

6 this and go, "Gee, SEM has cadmium in here, and

7 the CE didn't ask me to evaluate cadmium."

8 Do you then -- do you look at that and

9 then say, "I really need to evaluate cadmium," or

10 not?

11 MR. KOTSCH: Yes, in that case, like

12 I said, we do do the SEM run again, and we will -

13 - if they've missed something that we think that

14 should or not be, but the industrial hygienists

15 look at something and say, "Gee, this is

16 missing," or they're -- like in your case,

17 cadmium or something else is missing, then they

18 usually talk back -- check back with the CE and

19 say, "You know, we think we ought to add this to

20 it," and we'll just either add it to it, or ask

21 them to just add it to the question and resubmit

22 it.
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1 MEMBER CASSANO: Okay.

2 MR. KOTSCH: But we will address it.

3 MEMBER CASSANO: So, you do look

4 through all of the evidence?

5 MR. KOTSCH: Yes.

6 MEMBER CASSANO: Okay. Thank you.

7 CHAIR MARKOWITZ: Dr. Dement?

8 MEMBER DEMENT: Well, I am an

9 industrial hygienist, and frankly, I think a lot

10 of this is pure fantasy. 

11 There are -- these workers faced a

12 very complex situation, and frankly, this

13 probably would be better off to have been triaged

14 to saying this was an electrician there 25 years,

15 has COPD, just don't bother going to the

16 industrial hygienist because this assessment, you

17 know, he's done the best he can, but he basically

18 has very little data to deal with.

19 So, this sensitivity specificity of

20 this process is just not there.

21 MS. LEITON: So, the reason we had the

22 industrial hygienists review them is because we
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1 have so very little specificity. We don't have

2 records that are submitted, that are monitoring

3 for these types of toxic substances.

4 So, our solution was well, since there

5 is -- rather than just say, "Claimant, please

6 provide us with whatever exposure you have and

7 we'll send it to a doctor," and they say, "I

8 don't know what I was exposed to."

9 We send it to a doctor where they're

10 treating and they don't know. Nobody knows.

11 So, you know, it would be -- there

12 would be a lot more denials if we didn't have

13 something. 

14 So, we developed this process so we

15 would have something to give to a doctor. Most

16 doctors, as we've talked about earlier this week,

17 aren't willing to just say, "Yes, I believe it's

18 related to their," well, they'll say, "I believe

19 it could be possibly related to their work," but

20 we have very little specificity, and the doctor

21 doesn't know where the rationale is coming from,

22 because there is nothing that we gave the doctor
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1 to actually evaluate with regard to that.

2 Now, you know, if what you're saying

3 is, if we just tell them that he worked as a

4 welder for, you know, during these periods of

5 times, and we've talked about doing that, and

6 saying, "We're just going to go to the doctor

7 without that," and we've actually consulted with

8 physicians and saying, "If we were to just go to

9 you and say this person worked at Hanford as a

10 welder during this period of time, can you tell

11 us if it was at least as likely as not he was

12 exposed to toxic substances," and related that

13 these exposures to toxic substances, whatever

14 they may be, is related to their job -- related

15 to their condition.

16 So, that's where the doctors are like,

17 "Well, if you tell me -- you asked me if his job

18 might have been related, sure, maybe," but then

19 we have -- you know, that's where the catch 22

20 comes in, because you're right, we don't have

21 specifics, and yes, the IH has to base it on what

22 the IH can discover without records, and if we do
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1 have specific records specific to Hanford or K-25

2 or any of the other facilities, that's great and

3 we can use that, we can send that to the doctor.

4 But if we don't, then the question is,

5 what do we do? Do we just send it to a doctor

6 without any assessment, and have the doctor

7 hopefully figure it out, especially since you're

8 saying at Hanford, there was specific, you know,

9 very detailed exposures they may have had. 

10 We don't have that information because

11 we don't have, you know, expertise in every

12 single facility, providing us this information.

13 So, in lieu of that, this is what

14 we've come up with. If we can get a better

15 process or we can get -- you know, we don't have

16 the resources to have experts in every facilities

17 providing us with the type of detail as Mr.

18 Domina talked about over here. 

19 So, that's where the struggle is, and

20 this has been the best -- as you said, the best

21 we can do without that level of specificity.

22 CHAIR MARKOWITZ: Ms. Vlieger?
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1 MEMBER VLIEGER: I think one of the

2 most telling things on this particular OHQ is

3 under the reported PPE, the worker said that he

4 did not wear respiratory protection. It's not

5 checked, not even any of the qualifiers are

6 checked.

7 Yet the reported exposures that he

8 gave during the OHQ were not included in the

9 referral to the IH, and that ends up being a

10 problem a number of ways.

11 So, the veracity of the employer is

12 questioned in their OHQ and it's not even

13 provided to the IH.

14 CHAIR MARKOWITZ: Dr. Welch?

15 MEMBER WELCH: I have a comment on

16 what you were asking, if you allow me to talk

17 about my experience.

18 I mean, one thing to remember is that

19 Mark, how many special exposure cohorts are there

20 now? Hundred and something?

21 CHAIR MARKOWITZ: Hundred.

22 MEMBER WELCH: One hundred fifteen,
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1 and those are circumstances where the Radiation

2 Advisory Board has decided that the radiation

3 data is insufficient to do dose reconstruction.

4 Radiation data is -- there is probably

5 much more radiation data than there is toxic

6 exposure data. So, I think that gets you like, a

7 real snapshot the kind of information these guys

8 are dealing with.

9 So, then my question -- I have a

10 question, which is that -- I may be the only one

11 who noticed, the statement of accepted facts has

12 an end date of 1995 in the IH, but you didn't put

13 in the -- what went from the claims examiner to

14 the IH.

15 I mean, I understand that memo, which

16 is in our book. Then the IH didn't actually use

17 that time frame because he talked about his whole

18 exposure, which is fine with me.

19 I understand that, but I was

20 interested in -- then that's what made me realize

21 that the actual like transmission memos we have

22 in here, from the claims examiner to the IH,
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1 don't mention that, but he puts it in the

2 statement of accepted facts.

3 So, there must be some -- one other

4 piece of paper he or she -- piece of paper that

5 we -- that we didn't see. 

6 MR. KOTSCH: Yes, there is a circular

7 that -- 

8 MEMBER WELCH: So, they -- so, he

9 knows it automatically?

10 MR. KOTSCH: Yes.

11 MEMBER WELCH: Without the --

12 MR. KOTSCH: Yes.

13 MEMBER WELCH: -- claims examiner

14 having to say --

15 MR. KOTSCH: Yes.

16 MEMBER WELCH: -- limit it to this

17 period of time, okay. Okay, that helps me.

18 Then my last question was, when you

19 were doing your intro, before you got into our

20 handout, it looked as if in every claim, you're

21 going to need a physician opinion, even if it's -

22 - you know, it could be the treating physician's
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1 opinion, it could be something that comes from

2 the claimant, and if not, does every claim go to

3 a CMC for a written opinion?

4 MS. LEITON: Not every claim will go

5 to a CMC. It depends on the information we have.

6 I mean, as I -- I believe -- you know,

7 some cases will be denied, based on what we have,

8 if we don't have enough information.

9 But if there is any indication, most

10 -- a lot of cases will go to a CMC, if we have an

11 opinion, but it's an opinion that's not very

12 strong or it's clear the doctor just didn't

13 really have the expertise, then we would refer it

14 to a CMC to get more of a clarification or a

15 better opinion or opinion, based on the

16 experience from that doctor.

17 MEMBER WELCH: And I guess the

18 question -- I had asked this before, but within

19 the system as it currently sits, a claims

20 examiner could make an award without having to

21 send it to the --

22 MS. LEITON: Yes, absolutely, and we
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1 encourage that when we can. The struggle is, as

2 we discussed earlier in the week, having the

3 appropriate -- you know, the doctor providing us

4 with a report that fits -- that actually is well

5 rationalized when we get them, and we use them

6 whenever we can.

7 Again, with the circulars that we're

8 trying to use presumptions which would avoid the

9 need to go back to a doctor, because we would be

10 able to say they were here, they have these

11 exposures, we're assuming that their COPD was

12 related, or whatever it may be.

13 MEMBER WELCH: Okay, thanks.

14 CHAIR MARKOWITZ: Dr. Silver?

15 MEMBER SILVER: I've been trying to a

16 draw a line through this that would make it well

17 rationalized, right to the bottom line, where it

18 concludes that his exposures for four months in

19 '77 would have been frequent and ranged from low

20 to moderate levels.

21 The occupational health questionnaire

22 says he had -- it was in the job classification
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1 of welder for -- from '77 to '79, so, I don't

2 know where the four months comes from.

3 Then low to moderate, I could make,

4 you know, a work sociology argument that a 19

5 year old right out of his apprentice program -- 

6 MR. KOTSCH: The SOAF -- in between

7 there, we have to assume that the CE

8 communicated, because we don't have that

9 information, you know, communicated with the

10 employer, to somehow refine that to provide the

11 information in the SOAF, which is basically their

12 summary of what -- 

13 MEMBER SILVER: But low to moderate,

14 where does that come from?

15 MR. KOTSCH: That's just based on the

16 judgment of the industrial hygienist.

17 MEMBER SILVER: Well, show us

18 something. I mean, you demand a whole lot more

19 detail when a physician is putting something in

20 writing, and here it falls far short of the

21 standard that others are held to when they're

22 outside the DOL.
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1 CHAIR MARKOWITZ: Doctor, is there a

2 particular follow up to this, and I would say, in

3 terms of discussing this individual case, to the

4 extent that it reflects larger issues, let's

5 discuss it, otherwise, let's not get it -- it's

6 not a criticism, Dr. Silver, but let's not get

7 into the particulars of this case, only to the

8 extent that it reflects more general issues.

9 I would note that we've got 50 minutes

10 left and you still have the medical section to go

11 through. 

12 So, I -- we will continue --

13 MR. KOTSCH: If you'd like, we can

14 take any more questions or I can move onto the

15 medical.

16 CHAIR MARKOWITZ: Well, how long --

17 roughly, how long will the medical presentation -

18 -

19 MR. KOTSCH: Shouldn't take very long.

20 CHAIR MARKOWITZ: Okay, so, let's -- 

21 MR. KOTSCH: We've gone through most

22 of this, and you know, it's really -- what I was
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1 going to present was just a summary of, I think

2 what you've already heard over the past two days.

3 CHAIR MARKOWITZ: Okay.

4 MR. KOTSCH: So, we could actually --

5 CHAIR MARKOWITZ: So, this back and

6 forth is extremely valuable to us, so, we'll

7 continue this, but we want to be cognizant of the

8 time.

9 So, I'm not sure --

10 MR. KOTSCH: I mean, what I provided

11 in this packet --

12 CHAIR MARKOWITZ: Okay.

13 MR. KOTSCH: -- I just provided it

14 more as an example.

15 Now, obviously, we know have issues

16 with, you know --

17 CHAIR MARKOWITZ: Okay, Dr. Sokas?

18 MEMBER SOKAS: So, I have two

19 questions. One is -- and this has to do with the

20 idea of synergy and different exposures.

21 This person -- well, so, this person

22 checked off that he had, in fact, had urine tests
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1 done for radiologic exposures, and I don't see

2 any -- I don't know whether or not that was

3 pursued and there was some actual data that was

4 collected. I don't know if it would be through

5 DAR or through some other mechanism.

6 Similarly, the fact that he worked in

7 certain areas where there were concerns about

8 large levels of exposures, were there any -- was

9 there monitoring done? Did DOE have any records

10 of exposures in those areas that would have

11 supported some of this other?

12 So, the one -- that's one question,

13 and then I have one quick one afterwards.

14 MR. KOTSCH: Well, as far as the

15 bioassay, we don't normally get those

16 measurements, especially if they're on the

17 radiological side, and they would have been --

18 they would have been through radionuclides

19 anyway, as far as that goes. Is that what your

20 question was?

21 MEMBER SOKAS: So, additional data,

22 both radio nuclides and --
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1 MR. KOTSCH: Yes, I'm sorry, yes.

2 MEMBER SOKAS: -- and so, there isn't

3 a look at whether any of his current exposures

4 could have interacted with potential radiation

5 exposures. So, that is not happening.

6 MR. KOTSCH: No, I mean, that's a

7 question we would pose to see if you --

8 MEMBER SOKAS: Okay.

9 MR. KOTSCH: -- guys could enlighten

10 us more. I know there's not a whole lot of

11 literature on that, other than --

12 MEMBER SOKAS: Okay.

13 MR. KOTSCH: -- the obvious one, which

14 is like the radon and smoke and things like that.

15 MEMBER SOKAS: And then the DAR did

16 not include actual exposure assessment for any of

17 the places that it was --

18 MR. KOTSCH: No, it was -- no, like I

19 said, we -- we normally do not receive much in

20 the way of industrial hygiene monitoring data.

21 MEMBER SOKAS: Okay.

22 MR. KOTSCH: And certainly not in this
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1 case.

2 MEMBER SOKAS: So, my final question

3 is that conclusion, who has to interpret that

4 conclusion and how would a claimant -- would it

5 be a claims examiner? Would it be a physician,

6 the treating physician gets that conclusion,

7 because it's kind of un-interpretable right now.

8 MR. KOTSCH: Well, the review goes

9 back to the CE, but then it goes on to the

10 physician.

11 MEMBER SOKAS: Okay, okay.

12 MR. KOTSCH: And we've found that the

13 physicians -- you know, sometimes when they don't

14 get an industrial hygiene review, someone will

15 ask, you know, and they'll send it back and say,

16 "Can we please get their input?"

17 Other people, even if they don't have

18 an industrial hygiene review, think they know

19 about a particular facility and exposure, that

20 they'll go ahead and make their decision based on

21 that.

22 But for the most part, you know, it's
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1 our policy to try to send them something, at

2 least some estimate of what we --

3 MEMBER SOKAS: So, can you tell us in

4 this case, how what was interpreted and what

5 happened?

6 MR. KOTSCH: The final outcome?

7 MEMBER SOKAS: Yes.

8 MR. KOTSCH: I don't know that.

9 MEMBER SOKAS: Okay.

10 MR. KOTSCH: Because this is fairly

11 recent. Actually, I grabbed a fairly recent one.

12 Like I said, I was looking for -- yes, I was

13 looking for the --

14 MEMBER SOKAS: Okay.

15 MR. KOTSCH: -- the SOAF that actually

16 referred it to the medical -- to the physician,

17 so I could show you, you know, that next step of

18 it too, but that hasn't, as far as I could tell,

19 at least from the system --

20 MS. LEITON: I don't mean to.

21 MR. KOTSCH: I wasn't done yet.

22 MS. LEITON: I was just thinking, I
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1 mean, you know, when you break into sub-groups,

2 there is probably more information we can give

3 you, like for examples, the whole package, and

4 then not only -- but just jumping over to the SEM

5 side, we could also give you a demonstration or a

6 -- have a conversation with the contractor who

7 puts together the SEM documents, who can tell you

8 what goes behind it. He can give you a lot more

9 detail than we can.

10 So, when you break into sub-groups,

11 please let us know if you want that sort of

12 information.

13 CHAIR MARKOWITZ: Mr. Whitley?

14 MEMBER WHITLEY: Garry Whitley. A

15 couple of things.

16 Whoever wrote this article, it says

17 that -- the circular, that says that after 1995,

18 it's not likely that they were -- would be

19 exposed to the chemicals, obviously has never

20 been to the sites, since 1995.

21 Second of all, what you really told me

22 in this case is that as good as the CM is, it's
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1 almost like the Bible that you all use. You do

2 use a little bit of other data, but it's -- I

3 know it's the best you've got, but it is very

4 incomplete, and obviously about five times in

5 here, you talked about the SEM and what you've

6 got off the SEM.

7 I mean, we know it's all you've got,

8 but it's not very good.

9 CHAIR MARKOWITZ: We appreciate going

10 over an average case, rather than a perfect or

11 ideal case. So, others? Dr. Redlich?

12 MEMBER REDLICH: If the claimant is

13 still alive, is there an opportunity to get on

14 the telephone and for the industrial hygienist to

15 interview and talk to the person?

16 MS. LEITON: The issue is that we have

17 a lot -- we've got thousands and thousands of

18 claimants.

19 So, we don't have a CATI like they do

20 at NIOSH, where they have individual interviews

21 with the -- even those aren't with the

22 scientists. 
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1 So, it would require a scientist, the

2 two and a half industrial hygienists we have,

3 calling all of these claimants. We just -- we

4 don't have the resources for that at this point.

5 MEMBER REDLICH: But how much time is

6 spent producing --

7 MS. LEITON: That's about two hours

8 for the occupational history questionnaire, for

9 the research. There's two to four hours,

10 depending on the complexity --

11 MEMBER REDLICH: The industrial

12 hygienist spends two to four hours --

13 MS. LEITON: Okay, so, when you're

14 talking about the questionnaire, when you're

15 talking to the claimant, that takes about two

16 hours for those people to do that.

17 So, the industrial hygienist doesn't

18 have the time to call every claimant and ask them

19 questions. At this point, our researchers don't

20 allow for it.

21 MEMBER REDLICH: No, no, but on the

22 ones that took time for the industrial hygienist
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1 to do this analysis and write this report.

2 MS. LEITON: It varies. I don't know

3 exactly how much time it takes him per case.

4 MR. KOTSCH: It obviously varies by

5 the -- you know, the number of -- well, if you

6 want to talk about the complexity of SEM run or

7 the facility or the number of toxins, but it

8 could range anywhere from two to four to six

9 hours.

10 It depends. You know, everything

11 total, you know, the review of the -- 

12 MEMBER REDLICH: Well, two to four to

13 six hours, you know, maybe 20 minutes on the

14 telephone might actually be more illuminating.

15 MR. KOTSCH: I agree. I think that

16 would be the ideal. 

17 MEMBER REDLICH: Yes, it would be.

18 CHAIR MARKOWITZ: Dr. Boden?

19 MEMBER REDLICH: And it might save

20 time on the four to six hours spent on the

21 report.

22 But and then the questionnaire, do
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1 they fill this out on their own or is there help

2 filling it out?

3 MR. KOTSCH: The resource centers fill

4 it out, and in fact, the --

5 MEMBER REDLICH: So, this is actually

6 filled out by -- 

7 MR. KOTSCH: Essentially there is

8 someone --

9 CHAIR MARKOWITZ: It's administered --

10 it's an administered questionnaire.

11 MEMBER REDLICH: It's administered?

12 MR. KOTSCH: That doesn't interview.

13 MEMBER REDLICH: Okay, because there

14 are lots of areas where there is either

15 inconsistency or things are checked like 'yes'

16 exposure to things, but then not filled in like

17 approximate number of years.

18 CHAIR MARKOWITZ: Sure, and I --

19 MEMBER REDLICH: So --

20 CHAIR MARKOWITZ: -- heard an

21 invitation for us to provide input to improve it.

22 MEMBER REDLICH: Okay, so, I didn't
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1 realize. So, this is a -- okay, so, there's

2 opportunity, since it's self -- not self3 administered, okay, thank you. That was -- you

4 answered --

5 CHAIR MARKOWITZ: Dr. Dement?

6 MEMBER DEMENT: My questions were

7 reflective of that and --

8 CHAIR MARKOWITZ: Okay, all right, Dr.

9 Boden?

10 MEMBER BODEN: So, first of all even

11 though I think we're generally concerned about

12 the quality of the data that you have to work

13 with, I think that we also appreciate that you

14 need to do something more, since the burden is on

15 the claimants to prove their cases, and I think -

16 - I hope that over the next period of time, we

17 can help you make that more effective.

18 I have a question, actually, either

19 for you or for other people who are still

20 currently on the former worker projects.

21 Back in 15 or 20 years ago, I was

22 involved in the Nevada Test Site former worker
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1 project, and we did make attempts to use the --

2 the collective intelligence of the people who we

3 interviewed to draw a picture of what exposures

4 looked like at the various sites that they

5 worked, and that seemed to me, to be a really

6 good idea and something that would be useful for

7 you, and I just don't know if there is a

8 connection there, whether other former worker

9 surveillance projects also did things that were

10 sort of like job exposure --

11 CHAIR MARKOWITZ: So, I can answer

12 that --

13 MEMBER BODEN: -- or matrices --

14 CHAIR MARKOWITZ: Steve Markowitz.

15 MEMBER BODEN: Yes.

16 CHAIR MARKOWITZ: All the programs,

17 all the former worker programs at each site did a

18 site profile, and those were published. I mean,

19 they're not published in the literature, but

20 available online, and I'm sure the Department of

21 Labor has been -- you can confirm this, but I

22 believe that you've integrated that into your
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1 work, those site profiles.

2 MR. KOTSCH: Yes, we'll need to

3 double-check.

4 CHAIR MARKOWITZ: Okay, okay. Well,

5 anyway, they are readily available from the

6 Department of Energy. Dr. Cassano?

7 MEMBER CASSANO: Well, I wanted to

8 first -- first of all, congratulations on your

9 new contract, but I was sort of interested in

10 learning what kind of training these contracted

11 industrial hygienists are going to get on the

12 various sites and the different exposures that

13 may have been there.

14 MR. PENNINGTON: This is Doug

15 Pennington again. 

16 So, most of the contractors actually

17 already have experience with the sites. It's one

18 of the things that was very exciting for us, is

19 that they have experience with virtually all --

20 according to the contractor, virtually all of the

21 DOE sites.

22 So, what we're going to predominantly
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1 be working on is our process and training them,

2 as to how -- what we're looking for, how we're

3 looking for it, the mode and modality by which

4 we're getting the information.

5 But as far as the actual information

6 about the site, obviously, they'll be using the

7 SEM like the rest of us, but we're also hoping

8 that they'll be providing their own information

9 and background and knowledge, to help augment our

10 existing database, as well.

11 So, does that answer your question?

12 MEMBER CASSANO: Yes. Thank you.

13 CHAIR MARKOWITZ: We have time to take

14 a couple last questions, and then we'll move on. 

15 Dr. Redlich?

16 MEMBER REDLICH: I appreciate how

17 challenging this is. Just to follow up on what

18 Leslie Boden said, as far as sort of the

19 collective knowledge.

20 We have an industrial hygienist who

21 sees patients, when we see them, and the

22 information she provides is qualitative in
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1 nature, but extremely helpful, because she has

2 the knowledge, you know, and if she doesn't,

3 she'll ask someone else with the types of

4 industries and processes, the workers.

5 So, frequently, her sort of succinct

6 qualitative assessment of the level of exposures

7 and the -- is extremely helpful, and it's based

8 on her -- when you mentioned, your sort of

9 collective knowledge of the industries in the

10 area over time, or what she's able to get.

11 It seems that that would be a very

12 helpful --

13 MS. LEITON: Is this -- so, the

14 physician is doing this?

15 MEMBER REDLICH: There is a --

16 MS. LEITON: You said an industrial

17 hygienist.

18 MEMBER REDLICH: -- trained industrial

19 hygienist who also, when we take a history, also

20 takes an occupational history, and you know, is

21 able to better interpret what five years of

22 welding at, you know, this particular site means,
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1 or under what -- or an electrician, you know, the

2 typical electrician at 'x' site did in that time

3 frame, that is extremely helpful.

4 MR. KOTSCH: I think all our

5 industrial hygienists would love to be able to

6 have the time and the opportunity to do that.

7 I didn't include an example in here,

8 but sometimes we do actually get, you know,

9 written pages from a particular worker, that will

10 say, in detail, you know, "This is what I did,"

11 nitty-gritty-wise, and they will be putting in

12 there, all kinds of toxins and chemicals and work

13 activities that they did, which gives the

14 industrial hygienist a really clear picture of

15 what -- you know, what that actual interview --

16 interviewee, or you know, the worker was doing,

17 which is unfortunately, a rarer event than the

18 norm, kind of thing.

19 But it would be akin to that, being

20 able to actually physically speak with them.

21 CHAIR MARKOWITZ: So, one last

22 question or comment from Dr. Dement, and then
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1 we'll move on, and Board Members, if you could

2 put your name card in a horizontal position, if

3 you don't have a question, that would help. 

4 MEMBER DEMENT: Just one comment --

5 CHAIR MARKOWITZ: There's just too

6 many questions.

7 MEMBER DEMENT: -- and it has to do

8 back to this, and I think it's an excellent

9 point.

10 From an industrial hygiene

11 perspective, the real driver of the exposure is

12 not the job title, it's not necessarily the

13 building that they're doing it in, or that some

14 complex chemicals can be there, or other

15 exposures for the workers.

16 It's the task that's being done, and

17 so, the more you can have this questionnaire

18 that's being developed, really get down to task

19 and the narrative part is useful, but you can --

20 you can drive that by having specific tasks that

21 we -- we already know are important for many

22 different trades, and have those as part of it.
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1 But the more you can get to tasks, we

2 found over and over again, that that's a driver

3 of exposure. We get often, based on frequency of

4 doing tasks, generate a qualitative assessment of

5 their -- of the magnitude of life time exposure,

6 that's useful for predicting health effects.

7 MR. KOTSCH: I think our folks would

8 agree. I mean, one of things with SEM is that it

9 will list the building, it may list the toxins,

10 but there could be a huge building, it could be

11 all kinds of toxins in there, whether the actual

12 worker, in his work activity, encountered those

13 things, you know, is a question and --

14 MS. LEITON: The revisions to OHQ

15 hopefully can capture that better, and more

16 succinctly and asking the right questions is a

17 huge piece of it, I'm sure. 

18 CHAIR MARKOWITZ: Dr. Friedman-Jimenez

19 has a very short question. Very quickly.

20 MEMBER FRIEDMAN-JIMENEZ: Just adding

21 onto what Dr. Redlich said.

22 We also have an industrial hygienist
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1 in our clinic, and I would say that maybe 10 or

2 20 percent of our patients, where there is a real

3 question about exposure, she will talk to the

4 patient and get more details. It saves a lot of

5 time for the physician, and it really improves

6 diagnosis.

7 I would say that you probably won't

8 need to do this in the great majority of people,

9 but those for which there is a question, I think

10 it's extremely helpful.

11 MS. LEITON: Yes, I think it would be

12 fantastic. Maybe we can just get all the

13 physicians to hire industrial hygienists, and we

14 can refer all our cases there. I think that

15 would really help our process.

16 CHAIR MARKOWITZ: Now, Mr. Kotsch, if

17 you could continue.

18 MS. LEITON: So, I'd just -- about the

19 CMC process and the medical referral.

20 Most, if I'm looking at the bullets

21 that we have, I think pretty much, we've covered

22 it, and I just don't want to -- in the interest
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1 of time, I thought I'd just let you know that we

2 talk about the CMC, what they look at. We've

3 talked about this before.

4 Diagnosis, causation, impairment,

5 sometimes the date of diagnosis, consequential

6 injuries, treatment and clarification.

7 Those are the main reasons we refer

8 cases, and I think we kind of covered that

9 earlier this week, and you know, sometimes

10 they're essential. We use them when we can't get

11 enough information from the treating. Again, I

12 think we've pretty much covered that.

13 So, rather than belabor this, I guess

14 we'd rather use the time to take questions about

15 anything regarding our medical reviews, unless

16 you'd rather -- if something particular you'd

17 like us to go over.

18 CHAIR MARKOWITZ: Well, if you could

19 go over where you -- where, on the screen there,

20 national office reviews and accountability

21 reviews, just describe a little bit of that, how

22 that works.
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1 MR. KOTSCH: Okay. So, then the page

2 after that, which talks about the national

3 office's reviews, there was a review in February

4 of 2015. The CMC and second opinion and medical

5 specialist audit, basically as indicated there,

6 reviewed the quality of the district office

7 inputs to the physicians, and then the quality of

8 the medical review and the opinion.

9 Again, this was performed by the --

10 couple of members of the policy -- the larger

11 policy group, and overall, they found that in the

12 essence of things, they found that the results

13 were satisfactory, as far as both the input and

14 the return from the physician.

15 I know one of the issues that they had

16 with the referrals essentially was, sometimes

17 they were not rigorous, always rigorously

18 approached, you know, where they could have maybe

19 resolved the issue, the CE could have resolved

20 that issue before they sent it to the physician.

21 So, maybe some of those were -- you

22 know, were sent without complete, but this often
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1 happened, you know, you completely work through

2 the system, and generally, the referrals that

3 come back from the -- not the referrals, the

4 reports that come back from the physicians are in

5 compliance, essentially, with the elements of the

6 contract, as well as when we had our physician

7 here, they were all usually well-written and not

8 a problem.

9 When they are identified as a problem,

10 they will recycle back through the contractor, to

11 correct the problem. 

12 But a lot of times, or not a lot of

13 times, but sometimes, if there was an issue, it

14 might have been -- maybe a reference wasn't cited

15 -- or references weren't cited, the physician

16 just made the opinion without citing anything,

17 you know, as far as a reference, which we prefer

18 and is required by the contract, at least they

19 try to provide some references, as to why -- you

20 know, why they made the particular decision.

21 The account -- the annual

22 accountability reviews do like as mentioned in
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1 there, do contain a component, but that just

2 touches on the CM report -- CMC reports and does

3 the case record demonstrate appropriate use of

4 the opinion of the treating physician, CMC or the

5 specialist, meaning the industrial hygienist or

6 the toxicologist.

7 Again, that was considered to be a

8 satisfactory finding, and I think that's it for

9 that section, right?

10 MS. LEITON: Questions?

11 MR. KOTSCH: I'm sorry, I meant, then

12 there is just the -- the performance,

13 essentially, contract performance types reviews

14 that are conducted.

15 CHAIR MARKOWITZ: So, can I request

16 that we receive a copy of the QTC contract? Not

17 -- again, not interested so much is the

18 administrative or financial aspects, but in the

19 scope of work and the requirements of the people

20 who work under that contract.

21 MS. LEITON: Yes, I've written that

22 down.
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1 CHAIR MARKOWITZ: And also a copy of

2 the 2015 audit?

3 MS. LEITON: Yes, I've got that --

4 CHAIR MARKOWITZ: And that process.

5 MS. LEITON: -- written down, as well.

6 CHAIR MARKOWITZ: Okay.

7 MS. LEITON: We'll get back to you.

8 PARTICIPANT: And the annual

9 accountability review.

10 CHAIR MARKOWITZ: And the annual

11 accountability reviews. In essence --

12 PARTICIPANT: Is that the same thing?

13 MS. LEITON: No.

14 CHAIR MARKOWITZ: And any other

15 relevant material that the Board might deem

16 necessary.

17 MS. LEITON: Sure. 

18 CHAIR MARKOWITZ: And I don't think

19 you can argue with that language. Comments or

20 questions? Dr. Friedman-Jimenez?

21 MEMBER FRIEDMAN-JIMENEZ: In your

22 audit, how often did you find that the CMC or the
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1 SECOP got a case established that would have

2 otherwise been denied, because the treating

3 physician wrote a weak letter or said that this

4 may be related, or the probability of causation

5 was judged low?

6 In what percent of the cases would

7 those denials be overturned and made into

8 established cases by the secondary -- second

9 opinion or CMC?

10 MS. LEITON: So, we don't have that

11 percentage. We would have -- I don't know if we

12 can even run a report on that. I can see if we

13 can run a report on it.

14 But I -- you know, we do review these

15 for that, to make sure they're not all denials or

16 all acceptances, you know, like one doctor does a

17 particular thing.

18 We do find that -- often, we find that

19 the CMC will find in the favor of the claimant,

20 and we'll be able to accept that case.

21 Again, in terms of percentage, I don't

22 have one, but I would say it's pretty balanced.
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1 In some of the analysis we've done, I don't think

2 it's really high, one way or the other.

3 CHAIR MARKOWITZ: Dr. Welch?

4 MEMBER WELCH: I actually -- I think

5 that audit is available on your website or

6 somehow I've -- the 2015 audit, because I think I

7 saw the -- I had a link to it from somewhere, no?

8 MS. LEITON: I don't know.

9 MEMBER WELCH: Maybe it's a prior one

10 then. There is -- I think --

11 MS. LEITON: There might be something

12 up there.

13 MEMBER WELCH: So, it's a prior --

14 MS. LEITON: I'll find out.

15 MEMBER WELCH: I think I read a prior

16 audit that looked at, you know, did the CMC's

17 form -- do they get the right questions and are

18 they actually answering the questions of the

19 claims examiner?

20 MS. LEITON: We'll look for it. Thank

21 you.

22 MEMBER WELCH: But we'll see them
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1 where we see one, and in terms of your question,

2 isn't it the case, Rachel, you're not -- the

3 claims examiners aren't saying, "Well, we're

4 going to deny this, but we'll send it to the

5 CMC." They're saying, "We don't have enough

6 information, so we're sending it to the CMC."

7 So, that -- so, you can't really

8 answer that question of how many would have been

9 a denial in the absence of the CMC, because they

10 don't complete the case, if they don't have that

11 information.

12 MS. LEITON: Right. The question we

13 could answer possibly would be after we go to the

14 CMC, how many are accepted. 

15 The problem with that is, it could be

16 other factors. The reason for acceptance could

17 have been, we got more information or something

18 else. 

19 So, it's really hard -- it would be

20 difficult to actually be able to pin it to the

21 actual report that came from a CMC. You know,

22 the other way would be to look at all the CMC
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1 reports and see how many times they said 'yes'. 

2 That would be a pretty daunting task. 

3 I'm not sure we could do it, but we'll look at

4 it.

5 CHAIR MARKOWITZ: So, can I suggest to

6 the Board Members that they look at page six and

7 seven of the handout --

8 MS. LEITON: Yes, I was just going to

9 --

10 CHAIR MARKOWITZ: -- because these are

11 --

12 MS. LEITON: -- go through those if

13 you want to.

14 CHAIR MARKOWITZ: These are on the --

15 beginning on the screen, there is a lengthy list

16 of areas in which the Department is requesting

17 our assistance or our input. 

18 I don't think we should necessarily go

19 through all of them. Some of them are quite

20 obvious or self-explaining. This is in the

21 handout.

22 PARTICIPANT: This is in Tab --
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1 CHAIR MARKOWITZ: I'm sorry.

2 MS. LEITON: Last two pages of the

3 handout. 

4 CHAIR MARKOWITZ: Section 9. 

5 MS. LEITON: It says advice and

6 assistance. 

7 PARTICIPANT: It should be the last

8 page in the briefing book.

9 MS. LEITON: Well, the last two pages. 

10 CHAIR MARKOWITZ: So, let me start

11 this off. The issue of presumptions, you have

12 come to agreement on some presumptions, and those

13 aren't right -- statutory -- I mean, those aren't

14 statutory or for that matter, regulatory. Those

15 are the level of policy, okay, and that is an

16 acceptable route in the future, as we think about

17 presumptions.

18 MS. LEITON: Correct.

19 CHAIR MARKOWITZ: Okay, the -- one of

20 the items you have here is the matrix of

21 consequential illnesses. That seems like a small

22 task, but it's probably quite large.
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1 Do you have any such matrix at present

2 that you use?

3 MS. LEITON: We have something in the

4 procedure manual that they refer to, when they're

5 looking at -- is this the -- this is for

6 consequentials?

7 CHAIR MARKOWITZ: Right, right. 

8 MS. LEITON: Oh, no. I'll show you

9 what we have. I'll point it out. 

10 We have some things, like related to

11 CBD and certain things you can assume if they

12 have CBD, that you would probably be paying for,

13 things like that.

14 So, I'll provide you with the link to

15 that, to those specific assumptions we've got in

16 there, or at least guidance that we have in

17 there.

18 CHAIR MARKOWITZ: And have you

19 encountered repeatedly with other common

20 diagnoses?

21 MS. LEITON: Yes. There are -- yes,

22 we've found that there are other -- the answer is
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1 yes.

2 CHAIR MARKOWITZ: Okay, thank you.

3 MS. LEITON: I would like to point out

4 on this advice and assistance, I forgot, we were

5 going to -- we should have -- we were going to

6 walk through it, but I know that we're running

7 short on time, and most of it is self8 explanatory.

9 I think the last one is the big one,

10 and we may have discussed this earlier in the

11 week.

12 But the circulars, they've been a

13 question or a source of consternation for a while

14 since we've published them, and so, I'd really

15 like the opinion of the Board on the relevance of

16 these circulars.

17 You know, we do have a program

18 memorandum that explains one of them, I believe

19 it explains the Circular 1506. So, we'll make

20 sure that's available. It's on our website, but

21 I think it's our only program memoranda that

22 talks about why we came up with this, how we came
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1 up with this.

2 It's my understanding from many

3 conversations we've had, that while it may be

4 true, what we're saying, that there may be

5 circumstances within the DOE complex, where it

6 shouldn't apply or wouldn't apply.

7 So, you know, we're open to

8 suggestions on both of these circulars, whether -

9 - you know, what we should do with them, whether

10 we should have them there at all, whether they

11 should be revised or whatever.

12 So, you know, I know it's a big issue

13 and it's something that's important to us, and

14 we're willing to take whatever comments and

15 thoughts you have on it. I know Mr. Whitley

16 mentioned them earlier.

17 MR. RIOS: Just FYI, I'd be -- the

18 Circular 1506 and program memoranda are in

19 Section 8 of your briefing book.

20 MS. LEITON: Thank you, and if you --

21 as you go through these and once you have your

22 committee, if you have questions about what we
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1 meant by this, or if you have follow up,

2 obviously let us know.

3 CHAIR MARKOWITZ: I'm not sure that

4 actually, the post 1995 circular issues belong,

5 necessarily in this committee, which is looking

6 at the IH medical expertise. It may belong

7 elsewhere, but we'll figure that out.

8 I have a question actually about the

9 item just above that.

10 The generalization of prior IH and CMC

11 findings, depending adjudication actions. Are

12 you talking about using your own data, your own

13 decisions, as you go along in the program, in

14 order to be able to feed back into your future

15 decision making? Is that what that refers to?

16 MR. KOTSCH: Yes, and in fact, that

17 one ties to the bulleted item that's two above

18 it. They're kind of linked, to try to come to

19 some, you know, presumptive type analyses in

20 these kinds of things, if there are cases where

21 we can better group these, you know, by

22 activities.
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1 MS. LEITON: So, we did start looking

2 at trying to look where we've had the most -- you

3 know, either acceptances or looking at -- can we

4 look at this particular type of welder or we can

5 look at this particular type of job category or

6 process or something, and where can we actually

7 make some leaps, and based on the experience in

8 the program, because we have been doing these for

9 10 years, I don't know -- you know, but

10 evaluating that sort of trend is what this is

11 about.

12 CHAIR MARKOWITZ: Dr. Welch? Okay.

13 MR. KOTSCH: Yes, I mean, the bulk of

14 our -- obviously, the bulk of our medical

15 conditions are -- the largest piece are lung16 related to COPD's and things like that. The next

17 big chuck are the skin cancers, things like that,

18 and then we get into some of the renal diseases

19 and then it starts to tail off there, as far as

20 which one would come next.

21 So, things that we can, you know,

22 presumptively associate with those things would
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1 be helpful.

2 MS. LEITON: This actually goes to one

3 of the questions that was raised earlier this

4 week, about finding the biggest -- the cases that

5 we have the most of, like you were indicating

6 lung diseases.

7 If we look at lung diseases, how many

8 -- you know, what processes and job categories

9 could go with that? That would be -- we could

10 maybe make assumptions on.

11 Taking the largest chuck and going

12 down, because that's where the biggest impact

13 would be.

14 CHAIR MARKOWITZ: Dr. Cassano?

15 MEMBER CASSANO: Just a comment on

16 presumption, since I have a little bit of

17 experience dealing with them.

18 Presumptions are always a two-step

19 process. There is a presumption of exposure,

20 based on whether you -- what you did and/or where

21 you worked, and then there is a presumption that

22 if you are exposed to something, it is presumed
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1 that your disease, if you have the proper

2 disease, was caused or aggravated or whatever, by

3 that exposure.

4 One -- failing one -- failing the

5 first part of that, i.e., there is no presumption

6 of exposure, if you can prove exposure, then the

7 second part of the presumption should still

8 stand, and what I see a lot of is that well, they

9 don't -- they fail the presumption of exposure,

10 so therefore, we cannot treat this as a

11 presumptive disease.

12 But you need to be able to accept

13 exposure evidence that proves exposure outside of

14 the presumption, to get to the second point. 

15 That's the only comment.

16 CHAIR MARKOWITZ: Dr. Welch? Dr.

17 Welch?

18 MEMBER WELCH: I'm thinking about the

19 four tasks that we have and in some ways it's --

20 this is a -- this decision about what's work21 related under the law is a process that's not

22 easily divided into this, this, this and this.
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1 So, we have one that's exposure

2 assessment, one that's claims process, one that

3 is the use of the consultants. 

4 I just want to make sure that maybe

5 every group is addressing the question of the

6 causal relationship, because it comes in, in some

7 ways it -- those are -- it's like the -- it's the

8 mission, the goals and the objectives, and we're

9 kind of at the -- the tasks are sort of designed

10 at the objectives level, but I think we have to

11 keep thinking that the goal is to help Department

12 of Labor determine work-relatedness, which

13 requires a diagnosis, exposure, exposure

14 relationship.

15 Because when I was looking at your --

16 at these -- some of these tasks that you have

17 here, they don't fall easily into any one

18 particular group.

19 So, I think rather than each group

20 think -- that's just my suggestion, each group

21 thinking somebody else is dealing with that, I

22 think if there is something that seems to
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1 overlap, everybody should be talking about it,

2 because in the end, we're going to come together

3 and talk about it as a Board, but that's

4 something -- you take that --

5 CHAIR MARKOWITZ: All right, I agree. 

6 I agree and let me just say that when people here

7 discuss causation, what they really mean is

8 aggravation, contribution and causation. That's

9 shorthand.

10 But the exposure disease connection is

11 -- actually, informs each of the tasks. So, yes,

12 each committee needs to keep that in mind, in

13 terms of addressing that. Dr. Dement?

14 MEMBER DEMENT: One quick question,

15 and it has to do with -- my question has to do

16 with the last case that we just reviewed. 

17 Just opining about exposure, refer to

18 some specific task that these individuals would

19 have done. For example, electrician, they drill

20 concrete and they test diesel engines.

21 But those are not on the history form. 

22 Did he just know that? Is there someplace -- is
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1 there someplace -- it is in the SEM? Where would

2 you find this?

3 MR. KOTSCH: Well, some of that I

4 think is just based on the fact that we've been

5 doing these things for 10 years and --

6 MEMBER DEMENT: Yes, his personal

7 experience.

8 MR. KOTSCH: Yes, experience as well

9 as, you know, maybe there was information from a

10 -- in the reference that are attached to the --

11 the review, but also, from -- maybe from some

12 other case, where you had an electrician doing

13 things and they figured it was probably -- you

14 know, they would be doing similar tasks, kind of

15 things.

16 MEMBER DEMENT: These are legitimate

17 tasks.

18 MR. KOTSCH: Yes.

19 MEMBER DEMENT: It's just that there

20 are many, many others.

21 MR. KOTSCH: Certainly, there is

22 always -- you know, you could -- you know, you
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1 can't always list 10 or 15. It's just a couple. 

2 I mean, it would be an attempt to just to try to

3 associate it with some kind of -- you know,

4 something within a -- with a task.

5 CHAIR MARKOWITZ: So, what -- my question to

6 the Board is, we do need to save a few minutes to

7 form a committee, and the question is, do we need

8 this further discussion or is it better to spend

9 the time asking questions? Do we need further

10 discussion before we form a committee? Just

11 think about it for the moment, while Mr. Turner

12 asks his question.

13 MEMBER TURNER: I'm an electrician

14 also. I was looking and I didn't see anything on

15 there about PCB's, that he would have come into

16 contact with PCB's quite frequently.

17 CHAIR MARKOWITZ: Okay. 

18 MS. LEITON: Yes, as I said, I mean,

19 we will look in the SEM for the exposures and any

20 other information we have a particular case file,

21 when we're adjudicating these.

22 CHAIR MARKOWITZ: So, Mr. Domina, yes.
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1 MEMBER DOMINA: I just have a couple

2 of comments for the Board and for them on that

3 Circular 1505 and 1506, because you look at the

4 time frame that this is -- this was done, and I

5 know money was short at that time, and so, we're

6 in the middle of a contract. The major

7 contractor was Westinghouse.

8 So, any time you're going to put in a

9 program and say arbitrarily, everything is going

10 to get safer, they're going to ask for a request

11 for equitable adjustment from the Department of

12 Energy, for more money.

13 So, there should be flow down for

14 that, because maybe they did it on some DOE

15 sites, but I'll guarantee you, they didn't do it

16 at Hanford, and that's just my comment.

17 CHAIR MARKOWITZ: Okay, okay. So, are

18 there further comments, actually about this

19 particular area, this task or about the committee

20 work here?

21 So, do we have any volunteers for the

22 committee? Is this -- yes, this is Committee 4D. 
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1 Okay, let me just get this down. Let's see. 

2 Kirk, Garry, I'm sorry, Mark, okay.

3 So, aside from here I have George and

4 Mark. Anybody else from this side of the table? 

5 Okay, and I've got -- and any volunteers to

6 chair? Okay, okay, great, okay, Rosemary.

7 Okay, so, we have Rosemary Sokas, Faye

8 Vlieger, Kirk Domina, Garry Whitley, Mark Griffon

9 and George Friedman-Jimenez. Okay, good.

10 So, we can -- were there any

11 additional points you wanted to make? We have a

12 few minutes, actually. Any additional points in

13 this request for assistance that you wanted to

14 emphasize?

15 MS. LEITON: No, just that we are --

16 you know, as you -- we do recognize that this is

17 complicated and there are holes. So, that's why

18 our list is so long, and I do also recognize that

19 this list can cross over your various sections.

20 But it -- this is the -- our biggest

21 struggle, and it always has been, in terms of how

22 best to make these determinations and so, the
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1 biggest thing I would say is just, I think that

2 the discussions we've had are on point and I

3 think that there are areas that we can really use

4 whatever guidance you can provide us, and we

5 would like to make sure that if you -- as you go

6 along, if you -- you know, we're going to look at

7 this big list of tasks already, but we are

8 willing to have like our SEM administrator, the

9 person who actually looks at the -- does the work

10 of inputting the SEM, come and do -- like a call

11 with you, or something like that, because I think

12 that might be really valuable.

13 So, if there are resources like that,

14 that we can provide or even maybe discussions

15 with our IH, those are things that we're willing

16 to offer. 

17 So, thank you all very much. I think

18 this week has been really valuable and I think

19 that you've got a long task ahead of you, but

20 we're here to help, and we appreciate again, any

21 guidance that you provide to us, will benefit the

22 program, will help everybody help the claimants
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1 and I think it would be a really good next few

2 years. Thank you.

3 CHAIR MARKOWITZ: Dr. Sokas?

4 MEMBER SOKAS: Thank you, and I just

5 wanted to kind of repeat what Dr. Markowitz said,

6 about anything we might possibly want, please

7 give it to us, but specifically, some redacted

8 evaluations by physicians from different areas,

9 in addition to the actual reviews that have been

10 done, would be very helpful, as well as, if

11 you're in the process of revising any of the

12 materials, like the health questionnaire, that

13 any thoughts you have or drafts or things that

14 you would like us to consider, the more explicit 

15 you can be with us, the better we can provide

16 thoughts and comments back.

17 CHAIR MARKOWITZ: So, thank you very

18 much, Mr. Kotsch and Ms. Leiton for this session.

19 So, we're going to -- we don't have a

20 break for another 12 minutes. So, we're going to

21 turn to the proposed rule changes, particularly

22 since we're going to take an extra long break and
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1 lose 15 minutes to that process.

2 So, yesterday, just to refresh your

3 memory, we were discussing a particular item

4 number six, we're going to come back to the --

5 we're going to go through the rest of the

6 proposed changes, discuss them and then we'll

7 come back to the ones that we did yesterday and

8 vote on them.

9 So, if we could look at number six and

10 this -- we were beginning to discuss this. This

11 is on page 55 of the proposed rule changes.

12 So, for anybody on the phone, I just

13 want to let you know that the proposed rule

14 changes are available on the website of the -- of

15 this Board, in case you're not able to connect

16 through WebEx. You could also -- you could find

17 it on our website.

18 So, we're at page 55 and we're looking

19 at Section 30.405, which deals with the issue of

20 the claimant's request to change physicians.

21 So, let me re-read the draft

22 recommendation, which is the Board notes that the
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1 added language does not clarify what the

2 claimants need to produce, and finds it

3 implausible that claimants can provide medical or

4 factual evidence in support of a request to

5 change physicians.

6 The Board recommends that claimants be

7 permitted to change physicians without requesting

8 permission from OWCP.

9 So, I would just -- I guess we're open

10 for comments about this. I have just a -- start

11 off by saying a couple of things.

12 First of all, we really didn't

13 understand what was behind this proposed change,

14 what problem is being addressed by it, by

15 changing the criteria or the -- or requiring

16 additional clarification for the request for

17 changing physicians.

18 There is probably a specific problem

19 that this is addressing, and we thought that this

20 was very broad language to solve a specific

21 problem, and that solving that problem, that

22 specific problem would probably be better done by
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1 addressing the specific issues of that problem,

2 rather than creating broad language that would

3 affect all claimants, really.

4 Secondly, there are many reasons

5 people change physicians and some of them may

6 seem not so important. They don't -- they're not

7 a question of medicine. They're not a question of

8 factual evidence. They're questions of

9 preference. They're questions of being unable to

10 communicate with the doctor or reach the doctor's

11 office or the like, or any number of issues that

12 probably arise fairly frequently in the

13 healthcare system.

14 So, then to go through a process where

15 you need to request a change of physician seems

16 quite burdensome actually.

17 So, the draft recommendation says that

18 basically that claimants should be permitted to

19 change without requesting change from OWCP. 

20 Other comments? Dr. Boden?

21 MEMBER BODEN: So, since the pre22 change rule actually required requests as well,
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1 and since our recommendation may not be fully

2 accepted, I think that we should also add

3 something to the effect that the change requires

4 evidence that is inappropriate or that's too

5 narrow for changes to be -- for claimants to be

6 required to provide. That's not the right

7 language, but I -- in other words, I think we

8 should add something that says not only that we

9 think that the old rule was not too good, but

10 that the change makes it worse.

11 CHAIR MARKOWITZ: So, you're

12 essentially saying that if the -- a program

13 retains, as it does, it going to enable --

14 retains the process of requesting permission to

15 change physicians, then that process should not

16 be made more burdensome?

17 MEMBER BODEN: Correct.

18 CHAIR MARKOWITZ: Okay.

19 MEMBER BODEN: Thank you. 

20 CHAIR MARKOWITZ: Dr. Friedman21 Jimenez?

22 MEMBER FRIEDMAN-JIMENEZ: I would be
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1 in favor of just keeping it simple and saying

2 personal preference is a legitimate reason for

3 changing physicians. The Board recommends that

4 the claimants be permitted to change without

5 requesting permission.

6 Just say that it's legitimate, right

7 out. 

8 MEMBER CASSANO: So, the language then

9 would be to keep sufficient and then to add a

10 statement that says that personal preference

11 should be considered a sufficient reason for

12 changing treatment physician?

13 CHAIR MARKOWITZ: So, here we need to

14 -- we need to see the -- 

15 MEMBER CASSANO: Yes.

16 CHAIR MARKOWITZ: -- go back to the

17 proposed rule, page 55.

18 MEMBER REDLICH: In the current era,

19 practices are -- physician's practices are being

20 brought up and moved around and they're group

21 practices and you know, the idea that you're

22 staying with one physician, even if you wanted
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1 to, and so, there is just so much changing of

2 doctors, and it's really hard from when you're

3 outside, to even know if it's a new doctor or a

4 different doctor or just that doctor's partner,

5 who is covering, and I just think you're -- and

6 even -- it isn't even clear.

7 Like as a referring doctor, I'm trying

8 to find out who referred me the patient, and I

9 can't even figure it out, and so, I mean, there's

10 just a lot more of switching doctors that is out

11 of people's control.

12 CHAIR MARKOWITZ: Yes, go ahead, Mr.

13 Whitley.

14 MEMBER WHITLEY: I think it's just

15 like she said about the CE's. They change CE's

16 all the time, not because DOL changes them. They

17 leave, they come, they go, they change. 

18 I think you should be able to change

19 doctors and you should have to notify them you

20 changed it, and that's the end of it.

21 PARTICIPANT: See, that's what I was

22 thinking.
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1 PARTICIPANT: Right.

2 CHAIR MARKOWITZ: Right, right, right. 

3 So, go ahead, Dr. Welch.

4 MEMBER WELCH: Well, we were kind of

5 sticking with the concept that we either had to

6 edit the changes or go back to the old language.

7 So, I think the suggestion, and I

8 can't remember if Tori made it or not, that we

9 eliminate all the changes and then under B, say

10 OWCP will approve the requests if it determines

11 the reasons submitted are sufficient, and

12 personal preference is a sufficient reason.

13 So, we're kind of editing that spot,

14 that had new language added, which seems like

15 something we can do.

16 PARTICIPANT: Yes, we're substituting

17 language for --

18 MEMBER WELCH: For our current

19 language, and then we just reject all the other

20 changes.

21 CHAIR MARKOWITZ: Can we move that?

22 MEMBER WELCH: Yes, that -- I think
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1 that may be the best we can do, given the

2 requirement and comment on the current proposed

3 changes.

4 CHAIR MARKOWITZ: Okay, go ahead, Dr.

5 Boden.

6 MEMBER BODEN: I think we should

7 probably go down.

8 I think it's worth our making the

9 statement of principle, that workers should be

10 allowed to change physicians without needing

11 approval, which can also be a long and daunting

12 process. 

13 But then we should say that our

14 recommendation is to reject the change.

15 CHAIR MARKOWITZ: Dr. Cassano?

16 MEMBER CASSANO: The only other

17 comment I have is, I'm still a little bit

18 concerned about the use of referrals to multiple

19 specialists or sub-specialists, because there is

20 nothing in here that seems to -- it sounds like

21 you can only have one treating physician, and I'm

22 trying to figure out if we need language that
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1 says, referrals are specifically exclude -- okay,

2 specifically -- or referrals from the treating

3 physician to other -- any other specialists are,

4 you know, allowed, ad libitum almost under the

5 statute. I don't know if we need that.

6 MEMBER FRIEDMAN-JIMENEZ: Are we

7 supposed to be there at 10:30? 

8 CHAIR MARKOWITZ: Yes, it's 10:27.

9 MEMBER CASSANO: Yes.

10 CHAIR MARKOWITZ: Yes, in one minute,

11 we'll close. Go ahead.

12 MEMBER VLIEGER: As a claimant, I can

13 tell you that I have my general practitioner,

14 kind of the umbrella doctor, and then I have the

15 specialists, and to date, I haven't had problems

16 changing when doctors have moved.

17 But they have required me to justify,

18 you know, that you're changing doctors and why. 

19 So, as a claimant, I can tell you that

20 I have more than one treating physician,

21 depending on the body part involved.

22 CHAIR MARKOWITZ: We're going to take
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1 a break now. We'll reconvene at 11:00. Thank

2 you.

3 (Whereupon, the above-entitled matter

4 went off the record at 10:30 a.m. and resumed at

5 11:00 a.m.)

6 CHAIR MARKOWITZ: We are going to

7 start again. Greg, can you hear me in the back? 

8 Good, thank you. I don't mean to interrupt,

9 much.

10 Okay, we're reconvening the Board

11 meeting. We're missing a couple of members, but

12 we need to proceed. So, let's continue.

13 The WebEx, Mr. Rios has an

14 announcement about the status of the WebEx.

15 MR. RIOS: So, this morning, we had --

16 we were notified that the link on our website was

17 broken for the WebEx. That has since been

18 repaired, and we also asked this morning that if

19 you're still having trouble, although several

20 people have logged on and confirmed that it's

21 working, but if you're still having trouble,

22 please send us an email to
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1 energyadvisorboard@dol.gov. Thank you.

2 CHAIR MARKOWITZ: So, if we could

3 bring up the draft recommendation, we were

4 discussing changing the physicians, and I changed

5 the language at the break, I think to reflect the

6 -- so, let's take a look at this. Let me read

7 it.

8 "Board notes that the added language

9 does not clarify what the claimants need to

10 produce and finds it implausible that claimants

11 can provide medical or factual evidence in

12 support of a request to change physicians."

13 "The Board recommends that the

14 proposed changes be eliminated and be replaced by

15 the following."

16 "The claimant may cite personal

17 preference as a valid reason to change

18 physicians."

19 "The language of 30.405(c) should be

20 changed in accordance with this recommendation."

21 So, if you look at the -- look at the

22 book on the proposed changes, you'll see that
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1 there's a B and there's a C, and they both have

2 parallel changes that are proposed.

3 So, additional comments, discussion

4 about this? 

5 Okay, is there -- let me ask -- let me

6 raise a question.

7 We say that the Board finds it

8 implausible that claimants can provide medical or

9 factual evidence. Sometimes they can, but can

10 routinely provide? Should we add some qualifier

11 like that? 

12 MEMBER CASSANO: We could say that it

13 places an undue burden.

14 CHAIR MARKOWITZ: No, well, that's

15 different -- that's different thought, actually. 

16 Dr. Friedman-Jimenez?

17 MEMBER FRIEDMAN-JIMENEZ: Maybe

18 someone with more diplomatic skills than I can

19 suggest alternative language, but I would say

20 it's inappropriate to ask for medical and factual

21 evidence to support a request to change

22 physicians, but that obviously, isn't polite to
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1 put in the document.

2 MEMBER FRIEDMAN-JIMENEZ: Well,

3 whether it's polite or not, there are instances

4 at which it's plausibly appropriate. So, I

5 wouldn't endorse that language. Yes, Dr. Boden?

6 MEMBER BODEN: So, this does not

7 include something that says that claimants --

8 that the Board believes that claimants should

9 generally be allowed to change physicians without

10 requesting permission from -- without requesting

11 permission.

12 CHAIR MARKOWITZ: So, the current

13 regulation requires --

14 MEMBER BODEN: Yes.

15 CHAIR MARKOWITZ: -- requesting

16 permission. All right, so that sentiment then is

17 -- doesn't address the change. It addresses the

18 current regulation --

19 MEMBER BODEN: Yes.

20 CHAIR MARKOWITZ: -- and I see your

21 point. So, at the end of the first sentence, we

22 could follow that with, this is our rationale
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1 part, so to speak. We could add another

2 sentence, which would say what?

3 MEMBER BODEN: The Board believes that

4 claimants should be able --

5 CHAIR MARKOWITZ: I'm sorry, I'm

6 sorry. Can we just go up to the previous

7 paragraph, and where it says -- you know, right

8 there, right, and --

9 MEMBER BODEN: The Board believes that

10 claimants should be able to change physicians

11 without approval or -- period? Without approval

12 of OWCP or whatever. Just --

13 CHAIR MARKOWITZ: Okay, so other

14 comments? So, we have a motion? 

15 MEMBER BODEN: Yes, could I suggest

16 that that be the first sentence because the

17 second sentence is the one that the recommended

18 change follows from.

19 CHAIR MARKOWITZ: Sure. Sure, if we

20 could move that up.

21 MEMBER FRIEDMAN-JIMENEZ: I move that

22 we accept this language.
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1 CHAIR MARKOWITZ: Second? Okay, so,

2 discussion. Dr. Silver?

3 MEMBER SILVER: We may not get exactly

4 what we want, and I remember in our conference

5 call, one of the doctors had an impassioned

6 argument about changing oncologists on a timely

7 basis. Was that Dr. Cassano or Dr. Sokas, and I

8 am just wondering if a sentence underlying the

9 urgency of that specific issue would satisfy that

10 participant's concern, but if she's not here --

11 CHAIR MARKOWITZ: Well, let me say

12 that if they really accepted our recommendation

13 that the personal preference was -- then it

14 should be a very expedited procedure.

15 MEMBER SILVER: Right.

16 CHAIR MARKOWITZ: And there shouldn't

17 be delays because there is very little to look,

18 once that request is recorded.

19 MEMBER SILVER: I agree, but like I

20 said, we may not get exactly what we want, and

21 then there is this exigent case that someone felt

22 impassioned about.
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1 CHAIR MARKOWITZ: Okay, so you want to

2 propose a friendly amendment, in terms of

3 particular language addressing this point?

4 MEMBER CASSANO: There was some

5 language that was in our group, about the fact

6 that if it were not approved within two weeks,

7 that it would be automatic -- that it's

8 automatically approved.

9 MEMBER SILVER: And that is -- I'll

10 drop it, if the person who was the motive force

11 isn't here. So. 

12 MEMBER BODEN: Yes, I think we should

13 keep it in.

14 CHAIR MARKOWITZ: Further discussion? 

15 Yes?

16 MEMBER VLIEGER: You all may not be

17 aware of the time limits that DOL allows

18 themselves to answer letters in. Thirty days is

19 considered a timely response. That's pretty much

20 a standard under the program, 30 days is

21 considered a timely response.

22 CHAIR MARKOWITZ: Other comments? So,
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1 we're going to take a vote. Do we need to read

2 this again for -- prior to taking a vote?

3 Okay, so, all those in favor of this

4 motion? Okay, all those opposed? Any

5 abstentions? 

6 Okay, so, all members present voted in

7 favor. There were 13 members present. Okay, we

8 could move to the next proposed change.

9 Okay, so, here we're referring to, I

10 think it's page 30. It's Section 30.206(a). 

11 It's page 31 at the top, and Dr. Cassano, if you

12 could just read.

13 MEMBER CASSANO: This is how a

14 claimant -- how a claimant proves that the

15 employee was a covered employee exposed to

16 beryllium dust particles or vapors in their

17 performance of duties?

18 Sub-paragraph A, proof of employment,

19 strike out 'at' or physical presence at a DOE

20 facility, or a -- and strike -- they struck out

21 'facility owned, operated or occupied by

22 beryllium vendor'.
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1 So, it now reads, "Proof of employment

2 or physical presence at a DOE facility or a

3 beryllium vendor facility, as defined in 30.5(j),

4 and we should probably go back to that.

5 CHAIR MARKOWITZ: So, the 30 -- I just

6 -- I have it in front of me.

7 So, on page 14, 30.5(j) recommends

8 that new language that says, "Beryllium vendor

9 facility means a facility owned and operated by a

10 beryllium vendor." 

11 Okay, so, let's turn to the

12 subcommittees for their committee comments on

13 this proposed change. Mark?

14 MEMBER GRIFFON: Yes, our subcommittee

15 basically said that we proposed the broader

16 definition of owned, operated or occupied by, as

17 the beryllium vendor.

18 CHAIR MARKOWITZ: Laurie?

19 MEMBER WELCH: We didn't really

20 understand the impact of the change, although I

21 think we did hear in the course of the meeting

22 today, that it would eliminate a lot of
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1 facilities. So, I would defer to Mark's group,

2 who had more information.

3 CHAIR MARKOWITZ: Dr. Silver?

4 MEMBER SILVER: Ditto what Dr. Welch

5 just said. That was our sentiment.

6 CHAIR MARKOWITZ: So, any comments

7 from the Board members? 

8 So, the draft recommendation reads,

9 "The Board is uncertain about the reason for the

10 apparent narrowing of beryllium-using sites and

11 is concerned that the change might unnecessarily

12 limit benefits to beryllium exposed workers who 

13 should be eligible for the program." Comments?

14 So, I would take no we're not --

15 unlike some of our other recommendations we're

16 talking about, we're not proposing language, and

17 we're not really -- we don't really make

18 regulations. 

19 But in this case, we're expressing

20 concern and pointing -- making a particular

21 point, rather than suggesting particular

22 language, but that seems appropriate to me.
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1 So, are there any other comments? So,

2 I need a motion. Dr. Boden? Okay, second? Dr.

3 Cassano.

4 So, any other discussion? Okay, so,

5 the motion I just read it, so I don't think I

6 need to re-read it, but all those in favor, if

7 you could raise your hand, and all those opposed? 

8 Any abstentions?

9 So, the 13 present members of the

10 Board vote in favor of this recommendation.

11 We're going to move to the next

12 proposed change, which is on page 64. I'm sorry,

13 65, and this is Section 30.509(c) and --

14 MEMBER CASSANO: Sorry. This is about

15 what addition of the AMA guidance was used.

16 OWCP only makes determinations based

17 on rationalized medical evidence in the case file

18 that is sufficiently detailed and meets the

19 various requirements for the many different types

20 of determinations possible under, strike out 'AMA

21 guides' and replace that with 'fifth edition of

22 the American Medical Association's guides to the
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1 evaluation of permanent impairment (AMA's

2 guides)'. 

3 Therefore, the -- well, I don't need

4 to read this. Therefore, the OWCP will only make

5 a determination for a deceased covered Part E

6 employee to the medical evidence or records, to

7 satisfy the pertinent requirements of the AMA

8 guides in Sub-Part J and its parts.

9 CHAIR MARKOWITZ: Excellent. Thank

10 you. So, essentially, it's specifying the fifth

11 edition of the guides, and the committee

12 comments, subcommittee comments? Dr. Silver?

13 MEMBER SILVER: Reflecting Les Boden's

14 amendment after the conference call, codifying

15 the fifth edition in the regulation may reflect -

16 - may reduce OWCP's flexibility in using future

17 editions of the AMA guides.

18 The citation to the specific edition

19 of the guides belongs in the procedures manual,

20 and that will obviate the need for future Federal

21 Register notices for updates.

22 CHAIR MARKOWITZ: Mr. Griffon?
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1 MEMBER GRIFFON: Yes, our group did not

2 comment on this section. We left it to others.

3 CHAIR MARKOWITZ: Okay, and Dr. Welch.

4 MEMBER WELCH: I think the sixth

5 edition is so detrimental to workers, that I'd

6 rather they be stuck with the fifth forever, than

7 have someone argue in court they should be using

8 the sixth. So, I like this language.

9 CHAIR MARKOWITZ: All right.

10 MEMBER WELCH: The fifth edition, as

11 you might know, Les, pretty much cuts impairment

12 in half for the same worker presenting evaluated

13 under the fifth and sixth.

14 So, maybe eventually there will be a

15 seventh but -- so, that was -- the comment from

16 our group was, we like this change.

17 CHAIR MARKOWITZ: Dr. Cassano?

18 MEMBER CASSANO: The only -- and I

19 recognize the whole issue with the sixth edition

20 and how draconian it sort of is.

21 The only reason I made that

22 recommendation was that if you really want to
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1 move to the seventh or the eighth or the ninth

2 edition, it's going to take you about four years

3 to get there because it requires the regulatory

4 change and all of that stuff.

5 So, if they can set some precedent in

6 procedure that says -- stipulates fifth edition,

7 but that the regulation says the -- the current

8 issued approved by DOL, the current edition of

9 AMA guides approved DOL, that will allow them to

10 move to a future edition without having to go

11 through the rigmarole of a Federal Register

12 regulatory change.

13 That was the only point that I was

14 making.

15 CHAIR MARKOWITZ: Dr. Redlich? No? 

16 Okay, any other comments? 

17 So, the draft recommendation is the

18 Board notes that codifying fifth edition in a

19 regulation may reduce OWCP's flexibility in using

20 future editions of AMA guides, citation to a

21 specific edition of the AMA guides in the DEEOIC

22 procedures manual will obviate the need for new
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1 regulations to adopt updated guides.

2 So, comments? Revisions? 

3 MEMBER BODEN: Just to clarify. I

4 think we have two different positions here,

5 right?

6 So, we -- one position says we

7 shouldn't change --

8 CHAIR MARKOWITZ: Right.

9 MEMBER BODEN: -- and the other

10 position says that we should.

11 So, we need to -- my comment is, I

12 think that we need to figure it out, and just

13 Laura, for you -- my comment that made a change,

14 the original one said something about -- that

15 sounded like we approved of the AMA guides, and

16 all of this. I don't --

17 CHAIR MARKOWITZ: All right.

18 MEMBER WELCH: Well, I mean, I think

19 it's not a medical question. It's a strategic

20 question, and I think this statement is fine, and

21 then the agency can decide whether they want it

22 in the regulation or the procedure.
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1 So, I mean, I'm fine with this, even

2 though it's not exactly what I would have said,

3 because I think it's a -- it's pointing out that

4 there is a decision to be made. It doesn't say

5 they shouldn't do it. It says may reduce their

6 flexibility. That's fine with me.

7 So, I'd move to accept this language.

8 CHAIR MARKOWITZ: By the way, this is

9 just draft language. This can be changed by --

10 very easily. Other comments? Ms. Vlieger?

11 MEMBER VLIEGER: My only concern would

12 be in a less favorable client, if we leave it

13 open to interpretation with the procedure, a

14 procedure is more easily changed than a

15 regulation.

16 So, I would rather have the stop-gap

17 of having an approval process, than allowing a

18 procedural change to readily change something

19 less favorable work environment.

20 MEMBER CASSANO: And I'm not married

21 to my position, so, I can -- I will not be hurt

22 if we just decide to trash it.
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1 CHAIR MARKOWITZ: Ms. Vlieger, are you

2 saying that you would prefer to see it fixed in

3 regulation, the use of the fifth guide?

4 MEMBER VLIEGER: That's correct. I

5 would prefer to see it fixed and then that --

6 that's a back-stop for the workers, I think.

7 CHAIR MARKOWITZ: So, what should we

8 do in terms of the language? Dr. Boden?

9 MEMBER BODEN: Fifth? So, I would

10 propose that we reject the -- the suggested

11 change. 

12 So, in other words, that we not offer

13 -- reject the one that's on the board, which says

14 that they shouldn't specify the fifth edition,

15 and let the -- and leave it as is, right.

16 CHAIR MARKOWITZ: So, just to clarify,

17 leave as is the proposed changes?

18 PARTICIPANT: Yes.

19 CHAIR MARKOWITZ: In other words to

20 essentially --

21 MEMBER BODEN: To not make --

22 CHAIR MARKOWITZ: To make the --
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1 MEMBER BODEN: The Board make --

2 CHAIR MARKOWITZ: Make no

3 recommendation about these --

4 MEMBER BODEN: Correct, yes.

5 CHAIR MARKOWITZ: -- changes. 

6 Comments? So, is there a -- so, we don't need to

7 -- I guess we would just strike this as a

8 recommendation. So, there is no new language for

9 us to look at.

10 So, if someone wants to make a motion

11 to that effect. Okay, Dr. Cassano makes the

12 motion and Dr. Boden seconds it.

13 So, discussion, and what's in play

14 here now is for us essentially, not to comment on

15 this proposed change. 

16 No discussion? Let's take a vote. 

17 All those in favor of -- 

18 PARTICIPANT: No comment.

19 CHAIR MARKOWITZ: Actually, there is

20 no -- there is no vote, because we're choosing

21 not to make a recommendation, not make a

22 statement, so there is no vote needed.
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1 But I would -- the sense of the group

2 seems to be in favor of this lack of

3 recommendation. 

4 Okay, let's move to the next one,

5 okay. This is regarding wage loss benefits, and

6 I neglected to have done what Mr. Rios asked me,

7 which is to cite where in the Board's charter,

8 our address of these proposed changes falls

9 within our scope, and the wage loss benefit

10 really -- we're going to address, has to do with

11 really -- for the most part, the Cartier around

12 causation, and assembling the evidence and making

13 the link between exposure and disease, which

14 falls within -- certainly, within A and B of our

15 scope.

16 So, let's move to -- it's 30.806. 

17 Okay, it's page 96.

18 The question is whether this is --

19 it's a lot of new language here, it's a whole --

20 it's a page really of new language, and the

21 question is whether we actually need to read this

22 out loud, in order to proceed. What's that, Mr.
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1 Griffon?

2 MEMBER GRIFFON: Aren't we just

3 talking about the 806 at the bottom of the page? 

4 CHAIR MARKOWITZ: Right here, right?

5 MEMBER GRIFFON: Eight-zero-five is

6 the one.

7 CHAIR MARKOWITZ: Okay, so, let's read

8 806, and we'll just confirm.

9 MEMBER CASSANO: Okay, 806. What kind

10 of medical evidence must the claimant submit to

11 prove that he or she lost wages due to covered

12 illness?

13 OWCP requires -- and this is all new

14 language, that is replacing it.

15 OWCP requires the submission of

16 rationalized medical evidence, of submission of

17 probative value -- of sufficient probative value

18 to convince the fact finder that the covered Part

19 E employee experienced a loss of -- in wages, in

20 his or her trigger month, due to a covered

21 illness. 

22 It asks medical evidence based on a
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1 physician's fully explained and reasoned

2 decision, see Section 30.805(a)(3).

3 A loss in wages in the trigger month

4 due solely to non-covered illness matters, such

5 as a reduction in force or voluntary retirement

6 is not proof of compensable wage loss under Part

7 E.

8 CHAIR MARKOWITZ: So, if you could

9 also read 30.805(a)(3).

10 MEMBER CASSANO: "What are the

11 criteria for eligibility for wage loss benefits

12 under Part E?"

13 A Sub-3 says, "The wage loss in the

14 trigger month was caused by the covered Part E

15 employee's covered -- was covered -- Part E

16 employee's covered illness, i.e., that he or she

17 would have continued to earn wages in the trigger

18 month from that employment but for the covered

19 illness."

20 CHAIR MARKOWITZ: Okay, thank you. 

21 So, comments from the committees? Mr. Griffon?

22 MEMBER GRIFFON: Yes, I said that our
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1 committee was okay with that language. But I

2 think it also -- I said that our committee was

3 okay with the changed language, but also, prior

4 to this, we had commented on these questions of

5 probative evidence, in our previous comments. 

6 So, I don't think we repeated those concerns.

7 CHAIR MARKOWITZ: Dr. Welch?

8 MEMBER WELCH: Our committee thought

9 it was important that the concept that the

10 covered illness could contribute to retirement,

11 as well as cause the retirement. There could be

12 multiple factors, and there needs to be some

13 assessment of the role of the covered illness,

14 and I actually think our comments are well

15 covered in what you've proposed there.

16 CHAIR MARKOWITZ: Dr. Silver?

17 MEMBER SILVER: We too ran out of

18 juice, but in written comments, subcommittee

19 members questioned what rationalized means,

20 suggested a simplification that OWCP require

21 submission of medical evidence based on a

22 physician's fully explained and reasoned
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1 decision, etcetera, etcetera, and also that the

2 work 'convince' is a bad word. It implies the

3 fact finder a priori does not believe that there

4 is a sufficient disability to incur wage loss.

5 CHAIR MARKOWITZ: So, comments from

6 Board members? Dr. Cassano?

7 MEMBER CASSANO: Yes, I think the idea

8 about convince was basically to say instead of

9 convince, but of sufficient probative value for

10 the fact finder to determine that, rather than

11 the term 'convince'.

12 CHAIR MARKOWITZ: Okay, other

13 comments? So, hold that language for the moment,

14 while we read the draft recommendation.

15 "The Board recommends that wage loss

16 should be compensated if the covered illness

17 contributed to retirement." 

18 For example, a worker was told work

19 was no longer available, due to his covered

20 illness and that the worker took early

21 retirement.

22 The Board recommends that the phrases,
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1 "Was caused," and "But for," in Sections

2 30.805(a)(3) be replaced by the spirit of the

3 standard of "aggravated, contributed to or

4 caused", that appears in the EEOIC Act.

5 That is, if the covered illness

6 aggravated, contributed to or caused the health

7 problems associated with wage loss in the trigger

8 month, then the wage loss should qualify for

9 benefits.

10 The Board recommends that the phrase

11 that contains the term "rationalized" in line

12 three of 30.806 be simplified to, "OWCP requires

13 submissions of medical evidence based on a

14 physician's fully explained and reasoned

15 decision."

16 I'm not sure that's simplification,

17 but it's a brief re-statement. So, are there

18 comments? Dr. Cassano?

19 MEMBER CASSANO: I would just add --

20 well, I don't know -- I'm okay with that, but I

21 would make an amendment to that, to actually

22 recommend changing the language of 'convince' to
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1 what I said before.

2 CHAIR MARKOWITZ: I'm sorry? So, can

3 you then provide us some language --

4 MEMBER CASSANO: Yes.

5 CHAIR MARKOWITZ: -- that we can use

6 and --

7 MEMBER CASSANO: So, the language

8 would be, OWCP requires the submission of

9 rationale or reasoned medical evidence, however

10 you want to say that, of sufficient probative for

11 the fact finder to determine that the covered

12 Part E employee's experience and loss in wages

13 with his or her true -- trigger month due to the

14 covered illness.

15 So, replace 'convince', 'to convince',

16 to 'convince the fact finder to probative value

17 for the fact finder to determine 'whether'. 

18 CHAIR MARKOWITZ: Okay, so, Kevin if

19 --

20 MEMBER CASSANO: No.

21 CHAIR MARKOWITZ: No, yes, you needed

22 to specify to Kevin, exactly what the language
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1 is.

2 MEMBER CASSANO: Okay.

3 CHAIR MARKOWITZ: So?

4 MEMBER CASSANO: Okay, so, OWCP

5 requires submission of reasonable and medical

6 evidence based -- no, it's above that. 

7 PARTICIPANT: Why don't you make it a

8 fourth paragraph?

9 MEMBER CASSANO: No, it's the first

10 part of that paragraph.

11 OWCP requires the submission of

12 reasoned medical evidence of sufficient probative

13 value --

14 PARTICIPANT: Direct him on the page,

15 where you want him to put the cursor.

16 MEMBER CASSANO: Okay, the cursor goes

17 under -- to be simplified -- see, it doesn't work

18 with this new simplified language.

19 CHAIR MARKOWITZ: So, do you want to

20 just replace the word 'convinced' with

21 'determined', essentially?

22 MEMBER CASSANO: Value to -- value for
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1 the fact finder to determine, is what I want, to

2 have -- in that first line.

3 But then it conflicts with what that

4 change is on the top.

5 CHAIR MARKOWITZ: Well, if the

6 significance of the proposed change is really

7 just to address the word 'convinced', convince --

8 MEMBER CASSANO: Right.

9 CHAIR MARKOWITZ: -- and change it to

10 determined -- soften it to 'determined' then --

11 MEMBER CASSANO: But then it's in the

12 wrong spot.

13 CHAIR MARKOWITZ: Well, then we don't

14 have to probably worry about it, if it -- if it

15 being in the wrong spot doesn't affect the

16 meaning, then we don't have to worry about that. 

17 We can just say -- because we're not rewriting

18 the regulation -- proposed changes, right? So,

19 we're just making proposals.

20 MEMBER CASSANO: Okay.

21 CHAIR MARKOWITZ: So, we can simply

22 say that the Board recommends that the word
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1 'convince' be --

2 MEMBER CASSANO: Changed.

3 CHAIR MARKOWITZ: -- replaced by the

4 word 'determine' or whatever word you're -- so,

5 if we could just add that right there, that the

6 Board recommends. Yes, that's correct.

7 So, the word 'convince'. The word

8 'determine'. 

9 PARTICIPANT: These are past tense.

10 CHAIR MARKOWITZ: Right, right. 

11 PARTICIPANT: Convinced and

12 determined.

13 MEMBER CASSANO: Or allow the fact

14 finder to determine. So, replace 'convince' with

15 'allow the fact finder to determine', that's

16 fine.

17 CHAIR MARKOWITZ: Yes. Okay, so,

18 before 'determine', just move it back -- just say

19 'allow' --

20 MEMBER CASSANO: Allow the fact finder

21 to determine.

22 CHAIR MARKOWITZ: Right. Right, in
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1 the quotes, right, allow.

2 MEMBER CASSANO: I'm getting lost. 

3 Allow the fact finder to determine.

4 MEMBER BODEN: So, you've got this --

5 so, once you're done with that, if you go back to

6 where it says 'convince'.

7 MEMBER CASSANO: It says 'convince the

8 fact finder'.

9 MEMBER BODEN: You want to say

10 'convince the fact finder'.

11 MEMBER CASSANO: Convince the fact

12 finder. Thank you.

13 MEMBER CASSANO: So, if we -- if we go

14 two paragraphs up to where the -- it says 'the

15 spirit of the standard', the spirit is not the

16 right word. Well, we could say intent. That's

17 better than spirit, but it's --

18 MEMBER CASSANO: The language --

19 CHAIR MARKOWITZ: -- the aggravated,

20 contributed cause is not the intent. That's the

21 --

22 MEMBER CASSANO: That's the language.
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1 CHAIR MARKOWITZ: That's the language. 

2 Right? Right. So, we could say by the language

3 of the --

4 PARTICIPANT: Yes.

5 CHAIR MARKOWITZ: Now --

6 PARTICIPANT: This one right here?

7 MEMBER CASSANO: Yes.

8 CHAIR MARKOWITZ: That's correct. 

9 Okay, then the one line up, if you can just go

10 one line up, go to the left and remove DOL. 

11 Comments? 

12 I think -- someone want to read this

13 one last time, as the proposal then on this? Is

14 there a motion?

15 MEMBER SILVER: I'll make it, but

16 after one minor editing change.

17 The very last line, replace with the

18 phrase.

19 CHAIR MARKOWITZ: Yes, yes, okay.

20 MEMBER SILVER: I make a motion that

21 we accept this -- okay. 

22 CHAIR MARKOWITZ: Okay.
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1 MEMBER SILVER: Ready? Make a motion

2 that we put forward this language in our

3 comments.

4 CHAIR MARKOWITZ: Second? So, can

5 someone read this, so that we hear it once again?

6 MEMBER CASSANO: Designated reader

7 here. "The Board recommends that wage loss

8 should be compensated if covered illness

9 contributed to the retirement, e.g., a worker was

10 told work was no longer available due to his

11 covered illness and that the worker took early

12 retirement."

13 "The Board recommends that the phrases

14 'was caused' and 'but for' in Section 3.805(a)(3)

15 be replaced by the language of the standard of

16 aggravated, contributed to or caused, that

17 appears in the EEOIC Act."

18 "That is if the covered illness

19 aggravated, contributed or caused the health

20 problems associated with wage loss in the trigger

21 month, then the wage loss should qualify for

22 benefits."
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1 "The Board recommends that the phrase

2 contains the term 'rationalized' in line three of

3 30.806, be simplified to OWCP requires submission

4 of medical evidence based on the physician's

5 fully explained and reasoned decision of

6 sufficient probative value, to convince the -- to

7 -- of sufficient probative value to allow the

8 fact finder to determine," and what that

9 eliminates in there is that parenthetical

10 statement that says, "Due to a covered illness,

11 i.e., medical," blah, blah, blah, blah.

12 MEMBER BODEN: So, the word

13 'simplified' should be just changed?

14 MEMBER CASSANO: Right.

15 MEMBER BODEN: It's not simplified?

16 MEMBER CASSANO: Well, yes, it is

17 simplified because you -- you're repeating it and

18 then you have a parenthetical phrase, which comes

19 out.

20 CHAIR MARKOWITZ: Okay, so, you read

21 --

22 MEMBER CASSANO: Yes.
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1 CHAIR MARKOWITZ: -- the proposal, the

2 motion, right? Okay, comments? Dr. Silver?

3 MEMBER SILVER: The second paragraph,

4 sorry to be the English teacher, aggravated,

5 contributed to or caused.

6 MEMBER CASSANO: Okay.

7 CHAIR MARKOWITZ: I'm sorry, it says

8 --

9 PARTICIPANT: It should say

10 'contributed to' because the act actually says

11 'contributed to'.

12 MEMBER CASSANO: It is -- says

13 'contributed to'.

14 CHAIR MARKOWITZ: I see, it's in the

15 second line.

16 PARTICIPANT: Below that, below it.

17 CHAIR MARKOWITZ: All right. 

18 MEMBER CASSANO: Okay, okay. I think

19 the read the 'to', which was the problem.

20 CHAIR MARKOWITZ: Okay, so, is there

21 a proposal to change the word, in the third

22 paragraph, change the word 'simplified' to
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1 'changed'?

2 PARTICIPANT: I think it's just

3 clearer that way.

4 CHAIR MARKOWITZ: I think it is an

5 improvement.

6 MEMBER CASSANO: To change it.

7 CHAIR MARKOWITZ: Yes, so, if you can

8 just change it. Okay, other comments or

9 discussion?

10 MEMBER BODEN: I move that we accept

11 this.

12 CHAIR MARKOWITZ: Okay, so, we're

13 going to vote now. All those in favor of this

14 recommendation, raise your hand. All those

15 opposed? 

16 Okay, the 14 -- there are 14 members

17 present and all voted in favor of the

18 recommendation.

19 Next we go to page 17. We are making

20 good progress, and this relates to Section

21 30.5(e)(e) under definitions, and the relevance

22 of our attention to this proposed change, in
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1 relation to our scope is that this defines --

2 this proposed change relates to who a physician

3 is, what physicians would be included in the Act,

4 and this -- in relation, that are providing

5 medical guidance, which is Task B, and Task D,

6 input into the use of medical experts, makes this

7 relevant to our discussion.

8 So, do you want to read, Dr. Cassano,

9 the proposed change?

10 MEMBER CASSANO: The proposed charge

11 basically says changes -- includes, "Physicians,"

12 'includes' was struck and 'means' was added. 

13 "Surgeons, podiatrists, dentists,

14 clinical psychologists, optometrists,

15 chiropractors and osteopathic practitioners

16 within the scope of their practices defined by

17 state law."

18 Then 'the' and then the term

19 'physician includes', and then it -- so, it says,

20 "The services of chiropractors, only to the

21 extent that their reimbursable services," that

22 was all struck, "May be reimbursed to limit --
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1 limited treatment consisting of manual

2 manipulation of the spine to correct the

3 subluxation as demonstrated by x-ray to exist."

4 Yes, I mean, it's hard to try to read

5 something --

6 CHAIR MARKOWITZ: That's very nice. 

7 Very nice.

8 MEMBER CASSANO: Thank you.

9 CHAIR MARKOWITZ: Reports from the

10 committees? Dr. Welch?

11 MEMBER WELCH: We thought this

12 definition of physician was way too narrow and

13 needs to be expanded. It excludes most of the

14 physicians that would be used as consulting

15 medical providers or treating physicians for

16 these patients.

17 CHAIR MARKOWITZ: Mr. Griffon?

18 MEMBER GRIFFON: We agree with exactly

19 with those comments. We said it's -- should be

20 more inclusive of the -- those that treat

21 patients.

22 CHAIR MARKOWITZ: Dr. Silver?
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1 MEMBER SILVER: We thought it should

2 be restored, so the definition reads, "Physician

3 includes surgeons." Medical doctors are

4 understood to be physicians. Later, someone else

5 raised the issue of psychiatrist, but that change

6 would satisfy the concern.

7 Then defining this non-MD provider

8 scope of practice under state law could mean that

9 each examiner will have to look of the scope of

10 practice in each state, in which the claimant is

11 being treated, said one of our doctors.

12 CHAIR MARKOWITZ: Comments from Board

13 members? Okay, so, let me read the draft

14 recommendation.

15 "The Board recommends that 'includes'

16 should be restored to the definition," and read,

17 "Physicians -- physician includes surgeons,

18 etcetera," in order to be more inclusive of

19 physicians who typically treat patients with work

20 related illnesses (for example family practice

21 physicians, internists, etcetera).

22 So, actually what this means is that
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1 we are proposing that they not use the new

2 language, and -- right, okay.

3 MEMBER CASSANO: In the first part.

4 CHAIR MARKOWITZ: In the first part,

5 yes. The second part wasn't address by the draft

6 recommendation. I don't know whether there is any

7 desire to address that, but any comments? Dr.

8 Welch?

9 MEMBER WELCH: You know, it's not

10 necessarily our call, but the English in that

11 sentence is -- it needs some editing.

12 I mean, I know what the intent is,

13 intent is to limit the payment to chiropractors

14 to a specific service, but I'm just sort of

15 pointing that out for the record, and I'm sure

16 DOL can fix that, when they do the final.

17 CHAIR MARKOWITZ: Thank you. Other

18 comments? Okay, so, let's take a vote on this. 

19 I don't think there's any need to re-read this.

20 All those in favor of this -- of our

21 recommendation, raise your hand. All those

22 opposed? Any abstentions? 
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1 So, there are 14 members of the Board

2 present, all of whom vote in favor of this

3 recommendation.

4 So, let's move to the next one, which

5 is Item Number 11, which is on page 16, and 16 is

6 part of -- of the definitions 30.5(x)(2)(3). 

7 This is the -- where a definition of who a DOE

8 contractor employee is.

9 MEMBER CASSANO: Read? "A civilian

10 employee of a state or federal government agency,

11 if the agency employing that individual is found

12 to have entered into a contract with DOE for the

13 provision of one or more services it was not

14 statutorily obligated to perform, and DOE

15 compensated the agency for those services."

16 "The delivery or removal of goods from

17 the premises of a DOE facility does not

18 constitute a service for the purpose of

19 determining a worker's coverage under this

20 paragraph."

21 CHAIR MARKOWITZ: Okay. So, comments

22 from the various subcommittees? Mr. Griffon?
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1 MEMBER GRIFFON: Yes, we basically

2 were concerned about this being too restrictive,

3 that some -- I think the intent was probably to

4 restrict vendors delivering Coke, I've heard that

5 used before. 

6 But this is overly restrictive of many

7 other delivery of goods or services -- you know,

8 goods to the sites, including construction and

9 maintenance type work, and the areas where they

10 might be delivering to.

11 We did say, in our subcommittee, we

12 said that the delivery or removal of goods from

13 the premises of the DOE facility does not

14 constitute a service, should be augmented with

15 the following phrase, "Unless a worker can

16 provide factual evidence of exposure to hazardous

17 substances while on the site." 

18 I'm not sure -- reflecting on that,

19 I'm not sure I agree with our subcommittee

20 language, but that's what we said in the

21 subcommittee. So.

22 CHAIR MARKOWITZ: All right, that's
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1 good.

2 MEMBER GRIFFON: I think that puts the

3 pressure on the worker to -- you know, to prove

4 that they were delivering to an area with

5 hazardous substances, and I think that wasn't

6 necessarily our intent.

7 CHAIR MARKOWITZ: Okay.

8 MEMBER GRIFFON: But that's what we

9 said.

10 CHAIR MARKOWITZ: Dr. Welch?

11 MEMBER WELCH: Yes, I think our

12 committee came up with something similar, which

13 was if the -- if delivery of services or removing

14 the service entails exposure to a hazardous

15 substance, then they should be covered.

16 MEMBER GRIFFON: Right.

17 MEMBER WELCH: But I don't --

18 MEMBER GRIFFON: But it shouldn't mean

19 the worker --

20 MEMBER WELCH: But and so, that could

21 be dealt with by eliminating that sentence

22 because everybody has to demonstrate that
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1 exposure to hazardous substance and this is a

2 presumption that delivery doesn't include that,

3 and we don't agree with that. 

4 So, I think the recommendation would

5 be -- well, we'll see what Steve had proposed,

6 but we might just recommend deleting that

7 sentence.

8 CHAIR MARKOWITZ: Okay, Dr. Fischer --

9 Silver?

10 MEMBER SILVER: We concur and

11 underline, as someone pointed out, removal tasks

12 are often among the most dangerous, removing

13 hazardous materials.

14 CHAIR MARKOWITZ: Okay, so, comments

15 from the Board members? Yes, Dr. Boden?

16 MEMBER BODEN: Does the Board want to

17 recommend that this change be struck or and so,

18 this is -- looks like a preamble to a suggested

19 change.

20 So, the Board believes that workers

21 who were exposed to hazardous materials, blah,

22 blah, blah, should be included and therefore, the
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1 sentence, "The delivery or removal of goods,"

2 blah, blah, blah should be struck from the

3 changes, right?

4 Therefore, the Board recommends that

5 that sentence be struck from the changes.

6 CHAIR MARKOWITZ: Comments? 

7 MEMBER CASSANO: Yes, I think we might

8 add to our justification then that those -- that

9 delivery and removal of goods should be

10 evaluated, to determine whether there was

11 hazardous materials involved or exposure to

12 hazardous materials, and that is why we don't

13 want them to regulate -- on a regulatory basis,

14 remove all delivery and removal of goods, if you

15 follow what I'm saying.

16 CHAIR MARKOWITZ: Sure. I mean, the

17 draft recommendation says, "The Board recommends

18 that workers who were exposed to hazardous

19 materials in the course of delivery or removal of

20 goods or materials from a DOE facility should be

21 included in coverage under EEOICP."

22 MEMBER CASSANO: Yes.
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1 CHAIR MARKOWITZ: So, it does try to

2 help define a class of workers, who deserve to be

3 included, but not all workers involved with

4 delivery or removal.

5 MEMBER CASSANO: But I think what --

6 they still need to evaluate anyone that delivers

7 and removes, to determine whether it is a --

8 hazardous materials were included, yes?

9 MEMBER DOMINA: My comment to that

10 would be no, for the simple reason is, if you're

11 inside like the fence at DOE, you're under one

12 standard, and then a lot of times, the standard

13 outside the fence is a lot different, which is a

14 lot less, and I don't believe it needs -- you

15 need to leave it alone.

16 I think the whole paragraph needs to

17 be stricken.

18 PARTICIPANT: The whole paragraph or

19 the whole sentence?

20 MEMBER REDLICH: I mean, I agree, I

21 don't think we need the second sentence, because

22 workers should be considered.
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1 I agree that we don't need the second

2 sentence, because we should not be excluding

3 those workers, but if someone could explain to

4 me, the first sentence, because I just don't

5 understand it, but I assume it's there for a

6 reason.

7 So, I don't want to approve something

8 that I don't understand. 

9 MEMBER CASSANO: I can take a stab at

10 it. I think what it's saying is, even if there

11 was -- if there was a contract, even if the

12 particular task was not included in that

13 statutory language, but the contract -- the

14 employee was paid to provide that service, then

15 they're going to compensate him, even if it

16 doesn't say, this is your particular -- this is

17 the job that this contract was meant to do. You

18 guys may have a better idea.

19 MEMBER VLIEGER: So, other

20 departmental employees are covered under this

21 program, if they are -- they were subcontracted

22 by DOE to perform a DOE function on the site. 
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1 An example would be if they belonged

2 to the Army Corp of Engineers, but they were

3 removing artillery sites from Hanford, for say,

4 they would not be covered because that's an Army

5 Corp of Engineer project, yet they were inside

6 the fence of Hanford and they were a federal

7 employee.

8 There are some strange lines here and

9 they have to look at contracts, to see if they're

10 actually covered as a Federal employee.

11 So, the first part of this covers

12 other departmental employees and whether or not

13 they would be considered DOE and covered under

14 the program.

15 So, some of that language is there for

16 that reason, to define how they would and would

17 not be covered.

18 MEMBER REDLICH: So, it's being more

19 inclusive of who is covered or is it being less

20 inclusive?

21 MEMBER VLIEGER: This changes

22 slightly, the previous language to be more
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1 inclusive, but it's very much the same as the old

2 language, than that first line, and the second

3 line I have to object to.

4 There are only so many IH's on a site. 

5 There are only so many HPT's on a site. None of

6 them follow truck drivers around. There is not

7 going to be any monitoring data for these people. 

8 We're going to be lucky if they have a dosimeter.

9 So, excluding them based on them

10 trying to provide evidence under the statute, or

11 saying, "Well, because you were just a delivery

12 driver," I think is unfair.

13 CHAIR MARKOWITZ: So, it seems to me

14 there are two sentences to this Item Number

15 three. The first sentence, actually stands on

16 its own, and doesn't relate -- doesn't relate to

17 our scope, in terms of what we've been asked to

18 look at, whereas, number two, second sentence is

19 within our scope.

20 So, let's just focus then on the

21 second sentence, which is the delivery and

22 removal of goods. Other comments? 
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1 So, one way we could address this is,

2 and what we're looking at on the board -- the

3 screen now, the Board recommends, replace

4 'recommends' with 'recognizes' or --

5 PARTICIPANT: Yes.

6 CHAIR MARKOWITZ: -- and then follow

7 that with a sentence, at the end, which says

8 that, "The Board recommends that the sentence

9 beginning with 'the delivery or removal of

10 goods'", right, be eliminated.

11 PARTICIPANT: Good.

12 CHAIR MARKOWITZ: And actually, our

13 real sentiment on this is that this should be --

14 that workers who deliver or remove goods, who

15 have hazard exposures should be included, and

16 those who don't, should not be included, all

17 right, okay.

18 Okay, welcome back, Ms. Pope. So,

19 just to orient you, we're on page 16. We're

20 discussing delivery and removal of goods from --

21 and we're about to take a vote. So. 

22 So, let me read this out -- the whole
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1 thing out loud, in part, to try to bring Ms. Pope

2 up to -- okay.

3 So, yes, on page -- are you on page

4 16? Okay, yes, so on page 16, you'll see it in

5 the blue paragraph, the last three lines. I'm

6 just waiting a moment until she -- that's okay.

7 Okay, so, we're looking at on page 16,

8 towards the top, Item Number 3, the last

9 sentence, which starts with 'the delivery or

10 removal of goods', and the motion is that -- is

11 the following.

12 The Board recognizes that workers who

13 were exposed to hazardous substances -- materials

14 in the course of delivery or removal of goods, or

15 materials from a DOE facility should be included

16 in coverage by EEOICP. 

17 The Board recommends that the sentence

18 beginning with the delivery or removal of goods

19 be eliminated.

20 So, I've lost track a little bit. Do

21 we have a motion to accept this?

22 PARTICIPANT: So moved.
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1 CHAIR MARKOWITZ: Okay, so, any

2 further comment on this issue?

3 So, all those in favor of this, raise

4 your hand please. Okay, and all those opposed? 

5 Any abstentions? 

6 So, there are 15 members present and

7 all voted in favor.

8 We're -- in a minute, we're going to

9 take a break for lunch. I would just say that the

10 Board recognizes that we are, in some instances,

11 recommending specific language for the proposed

12 changes, and that DOL needs to reconcile any

13 language that they might consider adopting from

14 what we've proposed, with language that they

15 already have in other parts of the regulations,

16 that some of which are pre-defined and so, we

17 recognize the need for some reconciliation of

18 that language.

19 We also recognize that there -- our

20 grammar may not be perfect in some of our

21 recommendations, so please forgive that.

22 Finally, that there are other parts of
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1 the regulations that may pertain or replicate or

2 mirror the sections that we're looking at, and

3 that we may not have caught every section of the

4 proposed regulations that replicate what we have

5 looked at, and we would hope that our

6 recommendations would also apply to those other

7 sections of the proposed regulations.

8 So, with this, we'll break for lunch

9 and we'll reconvene -- yes, Mark?

10 MEMBER GRIFFON: Just the process,

11 we're going to get back to those couple that we

12 left from last night, right?

13 CHAIR MARKOWITZ: That's right.

14 MEMBER GRIFFON: Okay.

15 CHAIR MARKOWITZ: So, this is -- this

16 is how the rest of the --

17 MEMBER GRIFFON: After lunch?

18 CHAIR MARKOWITZ: This is the rest of

19 -- how the rest of the day will look.

20 We'll take a break. We'll have lunch,

21 and let's return at -- let's return at 12:45

22 p.m., actually, and we'll begin the work on that. 
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1 At 1:00 p.m., we have a public comment

2 period for 45 minutes, and then we have some

3 additional time, we're going to work on the

4 proposed changes, and we are within our time. 

5 We're in good shape, I think. Thank you very

6 much.

7 (Whereupon, the above-entitled matter

8 went off the record at 12:00 p.m. and resumed at

9 12:50 p.m.)

10 CHAIR MARKOWITZ: So, the public

11 comment period will begin shortly, and I just

12 have a message for the people on the phone

13 online.

14 To access the public comment period,

15 you will need to hang up and dial the following

16 number, 1-800-369-3381.

17 That number is 1-800-369-3381, and

18 then you'll need to enter the code 2470553. 

19 Again, just to repeat that code,

20 2470553. Thank you.

21 Okay, apparently, we can't -- we're

22 not going to start for five more minutes, the
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1 public comment period, because it has to be at

2 1:00 p.m., but we're almost there.

3 So, we're not going to discuss

4 anything substantive at the moment, but I would

5 like to begin to raise an issue that we're going

6 to have to deal with later today.

7 After the public comment period for 45

8 minutes, we're going to return to our --

9 providing our recommendations of input into the

10 DOL proposed regulations. We've made excellent

11 progress, but we still have a little bit more to

12 go. So, we will do that immediate following the

13 public comment period.

14 Then we will begin to discuss

15 logistics around additional meetings in the

16 future.

17 The next meetings will be by the

18 subcommittee, and they will be in the next few

19 months. They will be scheduled by the chairs of

20 the subcommittees, and you need -- you should

21 then communicate with the members of the

22 subcommittee, and just make sure you copy those
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1 and myself, so we know what's going on.

2 But once you decide on a time and a

3 date for the subcommittee meeting, DOL needs

4 approximately seven weeks, in order to do what's 

5 needed to get it into the Federal Register,

6 etcetera.

7 So, tomorrow, when you go home and

8 begin to schedule these meetings, just think

9 about that seven week gap. The window begins

10 seven weeks from the dates that you're -- or the

11 window begins in relation to seven weeks from the

12 dates that you're looking at. So, just be aware

13 of that when you begin to schedule. 

14 You can't -- you couldn't for

15 instance, schedule a meeting right now for May

16 30th, because that is not enough time, right, but

17 you could for probably June 15th. 

18 MEMBER SOKAS: Just a question, and

19 we're talking about telephone meetings, right? I

20 mean, that's what we're talking about here.

21 CHAIR MARKOWITZ: That's correct.

22 MEMBER SOKAS: Okay.
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1 CHAIR MARKOWITZ: For the

2 subcommittees, yes. Yes, Dr. Welch?

3 MEMBER WELCH: Previously, I

4 understand the plan was the communications to

5 other members of the Board should be directed

6 through the advisory website.

7 Now, that we've decided -- our

8 decision, I think, was to make the subcommittees

9 public, so does that mean we need to do it that

10 way?

11 MR. RIOS: When you say make the

12 subcommittees public, we will post who is in

13 which subcommittee, but are you talking about

14 internal communications between the committee

15 members?

16 MEMBER WELCH: Well, I guess it would

17 help for me to understand how the Chair should

18 manage internal communications among the

19 subcommittee members and manage the meetings,

20 vis-a-vis public access.

21 MR. RIOS: The members of the

22 subcommittees, the chair of the subcommittee can
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1 communicate with the other members, with their

2 direct email address, as long as I'm copied on

3 every communication, as well as the Advisory

4 Board email.

5 MEMBER WELCH: Okay.

6 MR. RIOS: It just makes it easier,

7 especially if you're reaching out to your

8 subcommittee and trying to schedule the date.

9 MEMBER SOKAS: Do we have everybody's

10 email?

11 MEMBER WELCH: What's that?

12 CHAIR MARKOWITZ: I'm sorry, what's

13 the question?

14 MEMBER SOKAS: Do we have everybody's

15 email? Do we?

16 MR. RIOS: So, I'll provide the

17 subcommittee chairs with the email addresses for

18 the folks and their subcommittees.

19 MEMBER SOKAS: Okay, thank you.

20 CHAIR MARKOWITZ: But I would

21 encourage you to schedule those subcommittee

22 meetings as soon as possible, given the seven
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1 week gap in time and given the fact that after

2 seven-plus weeks, we start to head into summer

3 and people have different schedules during the

4 summer.

5 So, it would be best if you could

6 meet, say in the second half of June, or aim to

7 meet there. Explore those dates. Any other

8 questions about that?

9 Later, we'll discuss the -- our next

10 meeting in person. We won't pick a date here,

11 but we will circulate dates very soon. But I

12 would like to have a discussion a little bit

13 later about where we might like to meet, when we

14 meet in the Fall. 

15 The aim is to have another meeting in

16 the Fall, hopefully not too late into the Fall,

17 so we can do our work. Any comments or

18 questions?

19 So, now, I'd like to begin the public

20 comment period. We have four people who have

21 requested time. Three are in person and one is

22 on the phone. We'll have the people in person
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1 come first, and I would like to welcome

2 Congressman Ed Perlmutter, Seventh District in

3 Colorado. Thank you.

4 CONGRESSMAN PERLMUTTER: Good

5 afternoon, everybody. It's great to see this

6 Board convened.

7 My name is Ed Perlmutter. I'll be

8 brief in my remarks, because I know that you've

9 already had a long week, and you still have a lot

10 of business to conduct.

11 I'm here today because I wanted to

12 come and thank you personally for taking the time

13 to deal with some very serious matters, that over

14 time, have not been addressed in the way I would

15 like to see them addressed, and I want to thank

16 you all for bringing your experience, your

17 knowledge, your expertise to this Board. It's

18 pretty much an all-star Board, and we're very

19 fortunate to have you considering these matters.

20 As some of you know, I represent the

21 northern and western suburbs of Denver. So,

22 everything between Denver and Boulder, Colorado,
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1 which includes the Rocky Flats Plant, and now is

2 a wildlife refuge.

3 Beginning in 1952, the Rocky Flats

4 Plant built the plutonium triggers, or PITS, for

5 our nuclear arsenal. The plant used thousands of

6 chemicals and other materials, including uranium

7 and beryllium, and thousands of workers answered

8 the call from the United States of America, to

9 work at the plant in its decades of operation.

10 I don't need to tell any of you, the

11 wide range of illnesses these and other workers

12 across the country have faced as a result of

13 their service to the country. 

14 Congress passed the Energy Employees

15 Occupational Illness and Compensation Act as a

16 way to provide the healthcare and compensation

17 these workers earned and deserved. But it's an

18 understatement to say that the claims process has

19 not gone smoothly.

20 This Advisory Board was a result of

21 recommendations from the Government

22 Accountability Office and the Institutes of
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1 Medicine.

2 I worked with Senators Mark Udall and

3 Lamar Alexander, as well as representatives Ed

4 Whitfield and Jared Polis to authorize this

5 Advisory Board to improve transparency and

6 provide more certainty for claimants. 

7 This, I'm afraid to say, in this

8 Congress, is a very rare Bipartisan effort, but

9 it's because of the service that the men and

10 women at our nuclear plants provided, that both

11 parties came together on this particular Advisory

12 Board.

13 I can't tell you how proud I am that

14 this Board is meeting and considering these

15 difficult matters, and I'm looking forward to

16 your efforts to improve administration of this

17 very important program for our nuclear workers.

18 Last time I was in this building,

19 Hilda Solis was the Secretary of Labor, and now

20 it is Tom Perez, and I'm happy to see this

21 progress being made with this Advisory Committee. 

22 You have some difficult matters to consider. I
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1 thank you for taking the time and providing your

2 expertise and your experiences to make this

3 something that I think will be worthwhile for so

4 many people.

5 I want to introduce Jeff O'Neil from

6 my office, and I want to offer up our office as a

7 resource to you, if and when you feel that it's

8 necessary.

9 But thank you for participating in

10 this. Thank you for being here, and I'm glad to

11 see you're convened, and you said you're almost

12 done. So, I'm glad that this kind of talent has

13 been brought to bear on this subject, because it

14 needs it. 

15 So, unless you have any questions for

16 me, I just want to say thanks.

17 CHAIR MARKOWITZ: Thank you. 

18 MEMBER GRIFFON: Okay, good afternoon

19 and good luck.

20 CHAIR MARKOWITZ: Our next speaker is

21 Donna Hand, who has requested time to speak

22 today.
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1 MS. HAND: Long days. I would like to

2 briefly, you know, go through what we went

3 through today.

4 OWCP will consider, okay, this doesn't

5 mean it's mandated and everything, the nature,

6 frequency and duration, evidence of carcinogenic

7 or pathologic properties and an opinion of a

8 qualified physician with expertise and any other

9 evidence that demonstrates the relationship

10 between a particular disease and a toxic

11 substance.

12 You can consider it, but you don't

13 have to have all of it. If one, two or three of

14 it is enough to get that case through, then that

15 should be it.

16 In the original gears in 2005, 2006,

17 2007, 2008 and 2009, the SEM would list all the

18 toxic substance at the site, and then it also

19 lists, let's just say pulmonary disease. I lists

20 -- I think in the very beginning it had 32 toxic

21 substances that had a known causal relationship

22 to COPD.
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1 I called up Paragon, Mr. Stainaker,

2 and I said, "Okay, if it's in SEM and there is a

3 toxic substance and it's linked to a pulmonary

4 disease, does it need to go any further?" He

5 said, "No. We have found the causal link." 

6 That's it. 

7 We do not do aggravation. We do not

8 do contributing to. That's it, and in the

9 beginning, the only time it went to a DMC at that

10 time was if you did not have a diagnosis. You

11 know, you couldn't read the medical reports. 

12 That's the only time it went there. The case

13 examiners were making the decisions, and they --

14 you know, so they were able to do it.

15 Now, there seems to be a micro16 management type thing coming down, and the Site

17 Exposure Matrix now has gone into the advanced

18 Site Exposure Matrix, and you can go to a labor

19 category and it shows the toxic substance for

20 that and it shows also a building that that labor

21 category worked in.

22 You go to that building where that
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1 labor category worked in, there's more toxic

2 substances. You go to that process that that

3 labor category worked in, there's more toxic

4 substances, that wasn't exposed underneath the

5 labor category.

6 Remember, the statute said 'arose out

7 of and due to work-related'. It doesn't go to

8 just, you know, labor categories, and the labor

9 categories in this industries, which is the

10 nuclear weapons industry, is very, very unique.

11 They have expediters. What's an

12 expediter? He'll follow the product around,

13 making sure how much time do we have to do. They

14 had to write their own manuals, okay, how much

15 time can you spend a year? You know, now, can we

16 -- you know, quality assurance. Quality

17 assurance followed the whole product through the

18 whole thing, and even today, there's still

19 classified products and classified processes,

20 that cannot be told.

21 So, how can you have an IH say, "Okay,

22 yes, they were exposed to this," when you don't
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1 even know what it was? You know, and you can't -

2 - even if they say, "Okay, we can tell you that

3 uranium was involved in this classified process,

4 but we can't tell you the quantity."

5 We can tell you that plutonium is

6 involved in this process, but we can't tell you

7 the quantity. If you don't know the quantity,

8 how do you know how much exposure?

9 As far as claimants are not notified

10 when their file is sent to an IH or a CMC, so,

11 therefore, they're not notified to add in

12 additional information. The only thing they get

13 is the development saying, "This information is

14 not sufficient. We need more information."

15 I sent you my work records. I sent

16 you my medical. You know, so what more

17 information you need?

18 I had a case that was sent to an IH

19 that was from the Pinellas Plant, which closed in

20 1997. 

21 Okay, and so, this worker was there,

22 two years at an IH because of that 1995 memo. I
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1 had a fight to get it out of that IH. You don't

2 -- and you -- they admitted today, there is no IH

3 records. DOE admits, we don't have IH records,

4 and some of these facilities, similar to the

5 Kansas City Plant, they're tile floor wasn't tile

6 floor. It was wood. It was -- and they had to

7 creosote it every so often. It was all open.

8 Then now, you've got GSA workers,

9 specifically the maintenance workers, would come

10 in because the furnace was all on the DOE side

11 and they'd have to share fixing things.

12 So, you've got air filters,

13 conditioners, everything that's being crossed

14 over through, and plants, environmental plants,

15 especially close out tiger team report,

16 environmental reports, and then I would also go

17 to the Atomic Museum in Las Vegas look up records

18 there, at my own expense, and obtain employment

19 exposures, because this is what they had to do

20 for the neutron generator. This is what they had

21 to do for the neutron tube. 

22 They had to blow their own glass. 
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1 They had steel beds for the milli-tritides. They

2 metalized. You can look at pictures of a worker,

3 the soldering. They're the Kansas City Plant, in

4 a little cubicle. Everything else was open.

5 So, if this information is there, and

6 it's researched and an advocate usually has to

7 find it for the worker, and give it to Department

8 of -- we can't -- we can't establish exposure. 

9 We have to send it to an IH.

10 Then hypertension. I got one claimant

11 approved for hypertension. She has a picture of

12 her working there with lead, soldering lead. All

13 the rest of the ones that are also working with

14 lead, and in fact, after a chelation has even

15 lead in their bodies still, denied.

16 I had the same district office

17 consultant, or DMC, out of the Jacksonville

18 office state that a non-Hodgkin's lymphoma will

19 be caused by benzene for a male worker at the

20 Pinellas Plant and a male worker at the Savannah

21 River. 

22 But the two female workers who were
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1 also diagnosed with non-Hodgkin's, and also

2 exposed to benzene are denied, and it's the same

3 physician.

4 I have where, just because uranium

5 caused kidney disease at Savannah River, doesn't

6 mean it's going to cause kidney disease at Oak

7 Ridge. 

8 If you have trichloroethylene that

9 caused kidney cancer, doesn't mean it's going to

10 cause chronic kidney disease.

11 You know, you have Camp Lejeune people

12 just drinking the water for trichloroethylene,

13 where these workers bathed in it. You have, you

14 know, acute exposures from the World Trade

15 Centers, and you have presumptive diseases, and

16 that was acute exposures. We're talking about

17 chronic exposures.

18 I want to speak about the wage loss

19 for medical evidence you needed to establish it. 

20 It doesn't make sense, if you're already accepted

21 a covered illness, then you've accepted that he

22 was exposed to a toxic substance that caused that
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1 illness.

2 So, if you accepted that he caused

3 that illness, that person could no longer do that

4 same job and continue being exposed to that same

5 toxin. He would have to change jobs or he would

6 have had to quit, early retirement, because you

7 should not keep on exposing him to that same

8 toxic substance. 

9 But yet, you want to have a trigger

10 month and you want to have medical evidence. I

11 even sat down with a physician. We did exactly

12 what Department of Labor wanted, and did the

13 medical evidence for wage loss. Still denied.

14 Spent $3,000 of our own money to a

15 physician in Chicago. This doctor was a lawyer,

16 industrial hygienist, and also wrote four books

17 on heavy metal toxicity, so he was an OCC doctor.

18 Is there a link? Is there a substance

19 -- toxic substance that will aggravate,

20 contribute to or cause ulcerative colitis and

21 colon polyps? 

22 He looked, researched. Inorganic
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1 solvents will, and there are several studies. He

2 included the studies. Ms. Leiton wrote back. 

3 Even though his credentials are great, he wasn't

4 specific. So, we can't grant it.

5 I called up the doctor and I said --

6 he said, "As a lawyer, no doctor is going to say

7 that." No doctor is going to tell you what

8 specific chemical will do it.

9 But as the medical doctor, I need more

10 money, because I'm going to do more research.

11 These claimants don't have it. You

12 know, so, we do need a -- as one suggested, a

13 triage. Okay, if it's this, this and this, go

14 ahead and give it to them. If it's more

15 difficult, then yes, give your complex cases to

16 the IH, to the CMC's. But if it's a very simple

17 -- and that's what Congress' intent was, timely,

18 uniform, Administrative Procedure Act, timely,

19 consistent, and that's not what we're having.

20 Here, what, ten years after the last

21 amendment. Two-thousand-six was our final

22 regulations for Part E, and 10 years, and we're
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1 still having problems with it. It really doesn't

2 make sense, and it's not fair to these workers,

3 nor their families now, because we're running

4 now, for Pinellas, we've got 600 workers passed

5 away, and out of that 600, 350 of them filed

6 claims and were denied. That's just one

7 facility.

8 I have represented claimants all the

9 way across all the facilities, and we just -- you

10 know, thank you, thank you, thank you for being

11 here, but again, simplified, uniform and I think

12 even during the Congressional Committee reports

13 at the very beginning of this program, there was

14 a -- either a representative or a Senator. He

15 said -- he's an Administrative Law Judge, he

16 said, "Working comp cases are very difficult."

17 Do not make that hurdle difficult for

18 these workers, and everyone agreed. A bipartisan

19 said, "We will not make this hurdle difficult."

20 So, if you're making the medical

21 evidence to be specific, you're making toxic

22 exposure specific, that's ridiculous, and the
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1 Paper Reduction Act needs to come in there,

2 because you're making a lot of paperwork.

3 The Federal Employee's Compensation

4 Act was just amended, the regulations were, and

5 they have a new form now too. There is CE -- CA6 35, and it says, "Occupational disease or

7 illness," and they have a set check-off plant.

8 The very first step is for the worker,

9 the claimant, to do a little history and it's

10 very -- and the very end of it, then after the

11 history, it goes to the doctor later on, and then

12 at the end it says, "The nature of exposure, was

13 it primary, secondary, intermittent or

14 environmental?" 

15 Then the degree. Was it heavy,

16 medium, light or ambient, and the frequency,

17 hours per day. But you just check it off. Very

18 simple.

19 You know, so, why can't it be tweaked

20 to meet this program? You know, the occupational

21 history interview, I don't know. I don't know. 

22 I tell all my claimants, "If you don't know, say
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1 'unknown'," because believe it or not, those

2 chemicals were there.

3 The two chemicals in Agent Orange, one

4 of them -- one of them though -- one tri5 something or other, was in every single facility,

6 and you got cadmium and cadmium compounds. You've

7 got cadmium-109, which is a radioactive compound.

8 So, radiation needs to be addressed

9 under Part E, as well, because the site exposure

10 matrix lists radiation as a toxic substance. The

11 12th Federal report of carcinogens lists

12 radiation, ionizing radiation as a carcinogen, as

13 a toxic substance.

14 Underneath the definition of this Act,

15 it's a toxic substance. So, if it's a toxic

16 substance, at least as likely as not, less than

17 50 percent, more than suspicion, because we know

18 that it will aggravate, contribute or cause cell

19 damage. We know that there is cancer at Stage 0,

20 which is what? At the very, very beginning. It

21 doesn't have to be evasive cancer before they

22 should be underneath this program, and even the
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1 BEIR VII and V report even, has stated it will

2 cause benign non-cancer diseases and illnesses.

3 So, you already have all these other

4 Advisory Boards, listing all these illnesses,

5 known to these toxic substances, known to these

6 other work industries. Why are we -- you know,

7 start again at the wheel. Thank you.

8 CHAIR MARKOWITZ: Thank you very much. 

9 Next, I should say for people on the phone, if

10 you want to participate in the public comment or

11 make a comment, please let the moderator know. 

12 Our next speaker will be -- the last

13 one present will be Stephanie Carroll. 

14 MS. CARROLL: Thank you. Okay, well,

15 as you know, I know all about beryllium disease,

16 so I have a lot to say about it.

17 One thing that was under your purview

18 to review was page 32 of the new regulation on

19 chronic beryllium disease, and I just want to go

20 over it, in hopes that someone -- you know, I

21 truly do object to the fact that you don't have

22 more time to comment on these rules, because I
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1 think this is very important, and it is changing

2 the intent of Congress and the Act.

3 So, the intent of these changes seem

4 to make it next to impossible for BE workers that

5 meet the previous criteria, previous to these

6 changes, in line with the Act, to be approved.

7 Already, it is very difficult to be

8 approved for an established beryllium illness in

9 this program.

10 I started at page 28, because there

11 was an issue there, but and it's the basis for

12 this statement. Let's see, page 2830.114(c).

13 OWCP will evaluate evidence in

14 accordance with recognized and accepted

15 diagnostic criteria used by physicians, I agree,

16 to determine whether the claimant has established

17 the medical condition in accordance with the Act.

18 You do not have to be diagnosed with

19 chronic beryllium disease or diagnosed with

20 beryllium sensitization, to meet the criteria

21 that's been established by the Act. That is so

22 important, and I think it's very difficult for
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1 claims examiners even, to understand what that

2 means.

3 So, when a doctor says, "This person

4 does not have chronic beryllium disease," that in

5 no way should affect a claim examiner's review of

6 the case and understanding that the person has

7 met the diagnostic criteria, set out by Congress,

8 and the whole reason for the EEOICPA in the first

9 place.

10 So, but they just -- they can't put

11 those two things together. A doctor says, "You

12 don't have the disease, but I'm supposed to

13 approve you for beryllium disease." So, it just

14 doesn't happen.

15 Let's see. On page 28, 30.114(b)(3). 

16 Okay, this is a change not intended by the Act. 

17 It was the only -- it was only consequential

18 injuries that ever required a fully rationalized

19 report to approve the condition.

20 The addition of this requirement for

21 all covered illnesses is not in line with the

22 Act, and allows for CE's to judge the validity of
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1 a physician's opinions. 

2 Example, I had somebody with chronic

3 beryllium disease for many years. He had signs

4 of pulmonary hypertension. They wouldn't accept

5 that the pulmonary hypertension was secondary to

6 chronic beryllium disease.

7 I had to get a UCLA professor of

8 medicine, he was a cardiologist, write a two page

9 report, describing how chronic beryllium disease

10 could possibly lead to pulmonary hypertension. 

11 This refusal to accept pulmonary

12 hypertension related to chronic beryllium

13 disease, pneumoconiosis or any other lung

14 diseases at this point is a cost saving measure. 

15 They're trying to reduce the cost of treating

16 pulmonary hypertension, and we all know where

17 pulmonary hypertension leads.

18 So, right about now, it's been about

19 the last year or so, they've done everything they

20 can to refuse pulmonary hypertension.

21 In the procedure manual, there used to

22 be a list of pretty much, accepted conditions
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1 related to chronic beryllium disease. They

2 definitely didn't require a well-rationalized

3 medical report from a UCLA professor of medicine

4 and cardiologist to describe how pulmonary

5 hypertension and cor pulmonale, let's see, what

6 else is -- well, see, those, I think that's a

7 pretty good point right there. I think you can

8 all agree that it's not much of a leap to go into

9 those two conditions from chronic beryllium

10 disease.

11 But it's this well-rationalized letter

12 that's going to really get the workers. It's

13 scary, what's happening.

14 So, for covered beryllium illnesses

15 under Part B, medical evidence is set forth in

16 30.207 page 31, and that is also under the

17 purview of the Board.

18 Okay, so, written medical

19 documentation is required in all cases to prove

20 that the employee developed a covered beryllium

21 illness. I just wanted to point that out, and

22 the 30.207 that they -- it looks like they added,
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1 "How does a claimant prove a diagnosis of a

2 beryllium disease covered under Part B?" Seems

3 like an innocuous question.

4 What it should read is, "How does a

5 claimant prove that the employee developed a

6 covered beryllium illness?"

7 When they changed the language to,

8 "How does a claimant prove a diagnosis of a

9 beryllium disease covered under Part B," they are

10 now leading us into believe that it is a disease

11 that has to be diagnosed by a physician and now,

12 it doesn't have to just meet the Act's

13 requirements.

14 So, now, there are -- they're

15 massaging us into page 32. 

16 Okay, so, okay, did that. Got it. 

17 Okay, so, now, I'm on page 32, one, two, two --

18 it looks like D, where they added some language.

19 OWCP will use certain -- or will use

20 criteria in either of these paragraphs of this

21 section to establish the employee developed

22 chronic beryllium disease as follows.
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1 It's not developed chronic beryllium

2 disease. It's established a beryllium illness. 

3 That's from the Act, but when they describe it

4 this way, it becomes an illness that has to be

5 diagnosed by a doctor.

6 Okay, so now, if you just go down to

7 number two, this is referring to Part B, or not

8 Part B. This is referring to post '93 CBD. The

9 Act has laid out exactly what is needed for that.

10 Now, they've added something else to

11 the Act, another requirement. I don't know how

12 they were able to do this, but number two says,

13 "If the earliest dated medical evidence shows

14 that the employee was either treated for or

15 diagnosed with a chronic respiratory disorder, on

16 or after '93, the criteria set forth in paragraph

17 C1 of this section must be used."

18 Oh, that's interesting. Now, you have

19 to have -- have been treated or diagnosed with a

20 chronic respiratory disorder, before you can even

21 get close to meeting the Act's requirements to

22 establish a beryllium illness, which is establish
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1 chronic beryllium disease.

2 They have added to the Act, that you 

3 must have been treated or diagnosed with a

4 chronic respiratory disorder.

5 Now, you know most of my clients have

6 been, but to change the requirements of the Act

7 and actually add another requirement, that should

8 be listed in the Act, that is scary. I cannot

9 believe they're doing that.

10 So, if you go back -- just to the top

11 of the page, diagnosis after '93, you have to be

12 beryllium sensitized, and you have to have a lung

13 biopsy, showing granulomas. This is very

14 important, or a lymphocytic process consistent

15 with CBD.

16 Dr. Lee Newman was contracted to help

17 claims examiners determine when they look at a

18 biopsy report, if the lymphocytic process

19 consists of a CBD and the Act, actually exist.

20 So, when they see specific things on

21 the pathology, like a positive BAL,

22 lymphocytosis, which the numbers of lymphocytosis
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1 just willy-nilly go up and down in the procedure

2 manual.

3 It used to be for 14 or 15 years, 10

4 percent lymphocytes on lavage was enough to

5 qualify for a lymphocytic process consistent

6 with. 

7 They just decided to change it because

8 a CMC said that he didn't agree with that number,

9 and so, Dr. McTier did her investigation, but in

10 her investigation of that requirement, of 10

11 percent, which hundreds of people hopefully were

12 approved based on, now this one claimant is not

13 going to be approved. She said there was nothing

14 in the procedure manual talking about the

15 lymphocytosis numbers.

16 Well, that's funny. Dr. Lee Newman

17 actually describes it. It's peer reviewed. It's

18 got the footnotes and all references, and he

19 determined 10 percent lymphocytes was enough to

20 express a lymphocytic process consistent with

21 CBD, and I have one claim based on that.

22 Now, if somebody doesn't have me as
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1 their authorized rep, there is no way at 14

2 percent lymphocytes positive BAL, CT, PFT's,

3 everything else, they'd be able to get approved. 

4 They just won't.

5 CHAIR MARKOWITZ: One more minute.

6 MS. CARROLL: Okay, and then a CT scan

7 showing changes, that's fine. Pulmonary function

8 test and exercise test showing pulmonary deficits

9 consistent with chronic beryllium disease.

10 Right now, they do want a doctor to

11 say it's consistent with CBD. I don't believe

12 that the Act required that. It's if you have

13 obstruction, restriction and mixed process or

14 other issues that are showing that you have --

15 that you have pulmonary deficits. That should be

16 enough, and I think that's what Congress meant.

17 So, I would just please, for all of my

18 workers and so many beryllium workers out there,

19 and people that are suffering through all the

20 monitoring and never being diagnosed with CBD, if

21 someone on this Board could make comments on this

22 section, it would really help.
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1 I know that my comments are not going

2 to be -- I don't think as respected as comments

3 coming not from the Board, but from people on the

4 Board, it would make a big difference.

5 So, thank you, and if anybody ever has

6 any questions or wants any data on chronic

7 beryllium disease and beryllium workers, I've got

8 150 cases full of treating and site records and

9 exposure records, and I'd be happy to share it

10 with researchers. Thank you very much.

11 CHAIR MARKOWITZ: Thank you. So, our

12 next speaker is by phone. If the moderator could

13 make contact with Madeline Caudill, who has

14 requested five minutes. 

15 OPERATOR: She has dialed in at this

16 time.

17 CHAIR MARKOWITZ: Okay, so, moderator,

18 is anyone else by phone requested time?

19 OPERATOR: I don't have anyone cued

20 up. But again, if you have a comment, you may

21 press Star-One, and that will bring you into the

22 queue for your comment, and we'll stand by.
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1 CHAIR MARKOWITZ: And I should tell

2 you, if there is anybody else who is actually

3 present in the room and would like to make a

4 comment, you're welcome at this time.

5 So, speaking to the moderator, if you

6 could let us know in the next minute or so,

7 whether anybody else has requested time, I'd

8 appreciate it.

9 OPERATOR: Will do, and again, we're

10 standing by. If you have a comment from the

11 phone, it is Star-One. 

12 CHAIR MARKOWITZ: Okay, so, it seems

13 that no one else has additional comments. So,

14 this will be the end of the public comment

15 period. Thank you very much.

16 So, we will now return to our

17 discussion of the proposed rule changes, and

18 which means that we need to bring up on the

19 screen, if you can go back -- we're going back

20 actually, to the three issues that we already

21 discussed yesterday, and we actually have drawn

22 up some proposed language.
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1 So, we've had time to think about

2 those, and we're going to review them again and

3 vote on them. So, going back to number one.

4 This is on page -- it's 232(a), page

5 40. I'm sorry, 231(a). It relates to proof of

6 employment.

7 So, let me just say to satisfy the

8 request of my specifying the connection between

9 these proposed rule changes for the next three,

10 and the scope of the Board, that proof of

11 employment, proof of toxic exposure and proof of

12 diagnosis that's relevant to the exposure are all

13 covered within certainly, our Tasks A, B, C and

14 D, I think. So, just to specify that.

15 Does someone want to read this? This

16 is the language we drew up yesterday. I'm sorry,

17 read this out loud.

18 MEMBER CASSANO: Your designated

19 reader will comply here.

20 Thirty-point-two-three-one (a) proof

21 of employment, it's on page 3940 for anyone that

22 can't read the board.
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1 "The Board finds that the proposed new

2 language is vague and contradictory. The Board

3 notes that the proposed new language contradicts

4 Section 30.111(c) in a manner that limits the

5 value of affidavits."

6 "If the goal is to increase the

7 likelihood that affidavits are valid, then

8 guidelines on what elements need to be included

9 in an affidavit should be issued to clarify the

10 claimant's task of proving an employment history

11 in the absence of other evidence."

12 "The Board recommends that the

13 proposed rule changes not be made."

14 CHAIR MARKOWITZ: Okay, so, we're open

15 to comments now, discussion. Dr. Boden?

16 MEMBER BODEN: I move that the Board

17 accept the comment as written.

18 MEMBER CASSANO: Second.

19 CHAIR MARKOWITZ: Okay, so it's open

20 to discussion. Dr. Welch?

21 MEMBER WELCH: One of the things I had

22 wanted to do was -- this same language appears in
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1 other places.

2 So, it appears in -- and I guess we're

3 going to discuss it in the next section.

4 CHAIR MARKOWITZ: Right.

5 MEMBER WELCH: So, we want to make

6 sure that those two are consistent with each

7 other. 

8 CHAIR MARKOWITZ: Right, okay, good

9 point.

10 MEMBER WELCH: And maybe we should --

11 can we look at the 12(b) before we -- 

12 CHAIR MARKOWITZ: That's a good point.

13 MEMBER WELCH: And now, it's up on the

14 screen. I think so. I mean, I think we can -- we

15 can't really see them together, unless you make

16 the text smaller, but -- good, I think we can,

17 actually.

18 CHAIR MARKOWITZ: Okay. So, Dr.

19 Cassano, could you just read out loud --

20 MEMBER CASSANO: The second one?

21 CHAIR MARKOWITZ: Yes, it's

22 30.11(2)(b), right.
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1 MEMBER CASSANO: Right, 30.11(2)(b)

2 evidence of covered employment, it's on page 27.

3 "The Board proposes the following

4 language for this section."

5 "If the only evidence of covered

6 employment is a written affidavit and declaration

7 subject to penalty of perjury by the employee,

8 survivor or any other person, and DOE or another

9 entity either disagrees -- either disagrees with

10 the assertion of covered employment or cannot

11 concur or disagrees with the assertion of covered

12 employment, then OWCP will evaluate probative

13 value of the affidavit under Section 30.111."

14 PARTICIPANT: I don't think the

15 microphone was on.

16 MEMBER CASSANO: I guess I have to re17 read it? Sorry. Section 30.11(2)(b) evidence of

18 covered employment on page 27. 

19 "The Board proposes the following

20 language for this section." Sub-Item 3. 

21 "If the only evidence of covered

22 employment is a written affidavit or declaration
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1 subject to penalty of perjury by the employee,

2 survivor or any other person, and DOE or another

3 entity either disagrees with the assertion of

4 covered employment or cannot concur or disagree

5 with the assertion of covered employment, then

6 OWCP will evaluate the probative value of the

7 affidavit under Section 30.111."

8 CHAIR MARKOWITZ: Okay, so, you can

9 see, we tried to conform this second issue, or

10 second item, to the first item, limited by the

11 current language that exists in the second

12 current -- second item, meaning the specific

13 language disagrees or cannot concur or disagree,

14 which is in the current regulation, and not

15 subject to change.

16 So, comments? We should consider these

17 together, I think, because they really are close

18 cousins. Comments? Dr. Welch?

19 MEMBER WELCH: So, the -- what we are

20 in the prior -- in the comment further up, what

21 we're recommending deleting is pretty much, the

22 language that we are proposing for the second
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1 part.

2 Now, that's fine, because there is no

3 need to repeat it on subsequent pages, and we can

4 just refer back to that -- that other section.

5 But because we were -- where it says

6 -- if I'm following my -- if my brain is working

7 right. 

8 But I -- I still think that the

9 statement -- the discussion we have under the

10 first point that the -- you know, if the goal is

11 to increase the likelihood of affidavits are

12 valued, then guidelines would be helpful. 

13 CHAIR MARKOWITZ: Right.

14 MEMBER WELCH: I mean, it's -- it is

15 -- the two are consistent with each other. 

16 CHAIR MARKOWITZ: That's right. 

17 That's right. I mean, probative -- the probative

18 value term in the second part should refer back

19 to the guidelines that we're recommending in the

20 first part.

21 PARTICIPANT: Okay.

22 CHAIR MARKOWITZ: It should increase
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1 the probative value, if the claimant meets the

2 guidelines.

3 Other comments or -- okay, so, we

4 should consider these -- this set -- this really

5 -- of a couple of recommend -- well, really, a

6 single recommendation together.

7 Is there any need to read this out

8 loud? 

9 Okay, so, all those in favor, raise

10 your hand. Okay, all those opposed, and any

11 abstentions?

12 So, 15 members of the Board are

13 present all vote in favor of this recommendation.

14 So, next we move to -- it's 30.231(b)

15 which is -- hold on, I'm sorry, 30.231(b) which

16 is proof of exposure to a toxic substance. This

17 is on page 40 of the written version of the

18 proposed rule changes.

19 Does anybody need to see on the

20 screen? Maybe we should just place for a moment

21 -- if you could place for a moment, 231(b) on the

22 screen, mostly for the attendees who don't have
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1 the book in front of them.

2 So, to summarize, we don't really need

3 to read this. To summarize, these -- this

4 regulation addresses the sources that OWCP will

5 use to develop a probative thing or obtain

6 probative factual evidence for the purpose of

7 establishing exposure to a toxic substance, and

8 it lists three sources.

9 The first is DOE. DOE former worker

10 program or DOE contractor, essentially. The

11 second is the site exposure matrices and the

12 third is any other entity deemed by OWCP to be

13 reliable.

14 So, if we could now move to our draft

15 recommendation. 

16 MEMBER CASSANO: The draft regulation

17 states proof of -- Board recommends that DOL

18 issue guidelines on how OWCP determines

19 reliability of information under this section.

20 The Board recommends that the

21 following language be added to this section in

22 the -- by manner of adding a new number three,
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1 number four -- number three and number four.

2 That number three now read,

3 "Occupational history or affidavit obtained from

4 the claimant and/or coworkers," or number four,

5 "Occupational history obtained by a healthcare

6 provider, other than those who are part of the

7 DOE former worker program, or any other entity or

8 source that is deemed by OWCP to provide reliable

9 information to establish that the employee was

10 exposed to a toxic substance at a DOE facility or

11 RECA Section 5 facility."

12 CHAIR MARKOWITZ: Okay, discussion? 

13 So, if there is no discussion, can we have a

14 motion?

15 MEMBER CASSANO: Motion to accept.

16 CHAIR MARKOWITZ: And second? So, the

17 motion is to accept this recommendation, and all

18 those in favor? All those opposed? Any

19 abstentions?

20 So, it's 15 members present and 15

21 voting in favor. Very homogenous-minded group.

22 Okay, so, let's move onto the next
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1 one, which is establishing diagnosis of covered

2 illness. This is 30.232(a)(1) and (2).

3 MEMBER CASSANO: You have the new --

4 does he have the new language?

5 Okay, just to reiterate what the old

6 -- the proposed language from OWCP was, and this

7 is what the employee must provide to have a claim

8 processed.

9 The language was written medical

10 evidence containing a physician's diagnosis of

11 the employee's covered illness, as that term is

12 defined in Section 30.5(s) and the physician's

13 reasoning for his or her opinion regarding

14 causation, and to any other evidence OWCP may

15 deem necessary to show that the employee has or

16 had an illness that resulted from an exposure to

17 a toxic substance while working at either a DOE

18 facility, etcetera, etcetera.

19 That's not -- okay.

20 CHAIR MARKOWITZ: Okay. 

21 MEMBER CASSANO: Yes, there it is. 

22 So, new proposed language states -- where did it
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1 go?

2 CHAIR MARKOWITZ: It's coming back.

3 MEMBER CASSANO: Okay, sorry. That

4 number one, written medical evidence containing a

5 physician's diagnosis of the employee's illness

6 as that term is defined in Section 30.5, and then

7 Sub-A is if possible, that evidence should

8 contain a statement indicating how/why, let's

9 keep it simple, the physician believes that the

10 employee's illness was caused, contributed or

11 aggravated by the exposure.

12 Sub-Part B says, "If the claimant

13 submits an opinion of a qualified physician, as

14 defined in Section 30.230(d)(3), which provides a

15 rationale for determining that the employees

16 illness was caused, contributed or aggravated by

17 the exposure, then the opinion should be

18 considered probative by OWCP."

19 CHAIR MARKOWITZ: So this -- so, this

20 has some compliment to what we were looking at

21 yesterday, and I'm wondering whether Kevin, you

22 could take the one from yesterday and put it
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1 right above this, and see if we need to blend it

2 at all.

3 For instance, right, yes. Yes, that

4 paragraph and -- yes, right up to there, yes. I

5 guess so, yes.

6 I think that we could -- can we remove

7 that --

8 MEMBER CASSANO: Yes, we can remove

9 all that.

10 CHAIR MARKOWITZ: No, no, the first

11 paragraph, right? The question, right, we can

12 get rid of that.

13 MEMBER CASSANO: Yes.

14 CHAIR MARKOWITZ: So, let's now --

15 that's fine there, but let's look at the new

16 language that we've just seen. No, no, scroll

17 down, so we can take a look at the new language

18 first.

19 Well, okay, let me read -- if you

20 could go back up. Let me read the old -- the

21 language we were looking at yesterday, just so --

22 and if you can make it a little bit larger. 
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1 "The Board recommends that DOL remove

2 the requirement the claimant must produce written

3 medical evidence wherein, the physician describes

4 the 'reasoning' for his or her opinion regarding

5 causation."

6 Now, I'm going to skip over the next

7 paragraph, the italics, that's new. We hadn't

8 seen that yesterday. That was a draft I made to

9 try to address some of the issues, so, I'm just

10 going to stick with what we were doing yesterday.

11 "The Board believes that sufficient

12 expertise and causation of occupational illness

13 is unlikely to be available in DOE communities,

14 and that the time and commitment of physicians to

15 produce such documented report makes this

16 requirement unrealistic and places too great a

17 burden on claimants."

18 Right, so this is -- that's the

19 rationale, right, okay, and then, "In addition,

20 the Board is concerned that any other evidence,"

21 the phrase, "Any other evidence OWCP may deem

22 necessary," is overly broad, unnecessary and may
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1 form the basis for adversarial interactions

2 between OWCP and claimants.

3 Okay, so, now, if you can bring up --

4 scroll up, so we can look at the new language. 

5 Right. 

6 So, I have a question about the (b)

7 where it says, "If a claimant submits an opinion

8 from a qualified physician, which provides a

9 rationale that addresses the core issue of cause,

10 contributed or aggravated, then the opinion

11 should be considered probative."

12 I could imagine instances in which a

13 qualified physician provides a lousy rationale --

14 MEMBER CASSANO: Yes.

15 CHAIR MARKOWITZ: -- and it shouldn't

16 be considered probative.

17 MEMBER CASSANO: But I think the idea

18 of considered probative means that they look at

19 it for probative value, and then they can either

20 accept or reject it.

21 CHAIR MARKOWITZ: So, you mean should

22 be evaluated for probative value?
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1 MEMBER CASSANO: Yes. But I think

2 what we were hearing yesterday was that they

3 basically disregarded out of hand, and they're

4 not even looked at for their probative value.

5 So, evaluated for probative value may

6 be better.

7 MEMBER CASSANO: Okay, so, yes, you

8 can take out, Kevin -- if you take out 'should be

9 considered', and or take out 'considered' and

10 just put 'evaluated'.

11 MEMBER WELCH: You could just say 'may

12 be' instead of 'should be'.

13 MEMBER CASSANO: No, then they can

14 turn it -- should be evaluated, may be evaluated

15 --

16 CHAIR MARKOWITZ: Right, it's for

17 probative value, and then take out the -- no --

18 yes, right.

19 MEMBER WELCH: And just the --

20 MEMBER CASSANO: Yes, evaluated for

21 value is just --

22 MEMBER WELCH: Assessed?
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1 MEMBER CASSANO: That's why sometimes

2 words end up when you got --

3 CHAIR MARKOWITZ: Another -- this new

4 language omits something that the new proposed

5 regulation addresses, which is on page 41, the

6 new language one, it -- that the claimant must

7 provide "written medical evidence containing a

8 physician's diagnosis of employee's covered

9 illness". 

10 So, there, DOE -- I mean, DOL is

11 appropriately requiring medical evidence of the

12 diagnosis, right? Your new language doesn't

13 address that.

14 MEMBER CASSANO: Yes, it does, because

15 it says, "As defined in Section 30.5," and we had

16 a big discussion yesterday about covered illness

17 and the fact that it's a defined term, and that

18 they would have to then -- by saying it's a

19 covered illness, the physician would have to

20 prove that it was a covered illness, and I think

21 the idea was that you wanted any illness under

22 Part E submitted to be at least considered for
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1 coverage, correct.

2 CHAIR MARKOWITZ: Okay. So, I would

3 suggest adding after the 30.5(s), an 'and', so

4 it's clear that there are two different pieces --

5 MEMBER CASSANO: Okay.

6 CHAIR MARKOWITZ: -- that are being

7 required, or not required, but the first piece is

8 required and the second piece is if possible. 

9 Right there. Yes, right there. 

10 MEMBER CASSANO: And?

11 CHAIR MARKOWITZ: Yes, and. Dr.

12 Welch?

13 PARTICIPANT: Should there be a colon?

14 CHAIR MARKOWITZ: No, just adding it.

15 MEMBER CASSANO: Yes.

16 CHAIR MARKOWITZ: Okay. Yes, Dr.

17 Welch?

18 MEMBER WELCH: So, two things, sort of

19 as a friendly amendment.

20 We might want to make (b)(2) instead

21 of (b), because the (a) really relates to the

22 same letter that has the physician's diagnosis,
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1 and that refers to a second one.

2 CHAIR MARKOWITZ: Right.

3 MEMBER WELCH: The other thing, and I

4 don't know the answer to this is, the employee's

5 illness as defined in Section 30.5(s), 30.5(s)

6 defines covered illness. So, it has the toxic

7 effect in it.

8 CHAIR MARKOWITZ: Right.

9 MEMBER WELCH: So, you know, it's kind

10 of like I think what we're trying to say is

11 there's both a diagnosis, a medical diagnosis,

12 and then there is the work-relatedness decision.

13 This written medical evidence focuses

14 on the diagnosis --

15 CHAIR MARKOWITZ: Right.

16 MEMBER WELCH: -- of the employees'

17 illness --

18 CHAIR MARKOWITZ: So, would that --

19 MEMBER CASSANO: So, 30 --

20 MEMBER WELCH: -- and necessary --

21 maybe I don't think we should keep in that 'as

22 defined', because then that seems to imply it's
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1 the entire covered illness.

2 CHAIR MARKOWITZ: Right. I mean, the

3 -- we could solve that by, in that second line

4 after the one, which says as that term is

5 defined, simply saying the employee's illness

6 that is the subject of the claim, right? That's

7 -- I think that --

8 MEMBER CASSANO: Okay.

9 CHAIR MARKOWITZ: Dr. Friedman10 Jimenez?

11 MEMBER FRIEDMAN-JIMENEZ: As I read

12 it, 30.5(s) says that the illness or death

13 resulted from exposure to a toxic substance and

14 doesn't seem to include aggravation or

15 contributing cause.

16 MEMBER CASSANO: Yes.

17 CHAIR MARKOWITZ: Right, right. Yes,

18 maybe -- 

19 MEMBER CASSANO: That's what we said

20 every time it's mentioned that we --

21 CHAIR MARKOWITZ: Yes.

22 MEMBER CASSANO: It needs to be clear
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1 that the -- that they meet the statutory

2 language.

3 CHAIR MARKOWITZ: Right. 

4 PARTICIPANT: Because it's mentioned

5 -- that wording --

6 MEMBER FRIEDMAN-JIMENEZ: Are they

7 going to change that? Since it's not part of the

8 changes that are proposed.

9 CHAIR MARKOWITZ: Right, right.

10 MEMBER FRIEDMAN-JIMENEZ: I'm thinking

11 we should just state it outright, rather than

12 referring.

13 CHAIR MARKOWITZ: Right, okay, well

14 that would be a new recommendation, which we can

15 consider after we resolve this.

16 We've gotten rid of the problem here,

17 because we got rid of the reference to 30.5(s)

18 but we can take that up next, actually.

19 So, let's -- the suggestion pending

20 was that we form an Item Number 2, right?

21 MEMBER CASSANO: Instead of (b).

22 CHAIR MARKOWITZ: Right, okay, so, can
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1 we do that?

2 MEMBER CASSANO: I'll accept that as

3 a friendly amendment, yes.

4 CHAIR MARKOWITZ: Okay, can you not

5 only accept it, can you create it?

6 MEMBER CASSANO: We can create it.

7 CHAIR MARKOWITZ: Okay, so -- 

8 MEMBER BODEN: Then there's an (a)

9 without a (b).

10 MEMBER CASSANO: Then there's an (a)

11 without a (b), which is why I did that.

12 MEMBER BODEN: Why not just then, if

13 we're going to make a (2), just have the (a) --

14 PARTICIPANT: Be part of one.

15 MEMBER BODEN: -- be part of one.

16 MEMBER CASSANO: Part of the sentence.

17 MEMBER BODEN: And just not --

18 MEMBER CASSANO: yes.

19 MEMBER BODEN: -- strike the 'and'

20 then and just have the 'if possible', follow the

21 --

22 MEMBER CASSANO: So, claim and if
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1 possible, and if possible, if you want to use an

2 Oxford 'and'.

3 CHAIR MARKOWITZ: Okay, okay, okay. 

4 So, yes, if -- okay, so, the idea is you take out

5 the "a", right?

6 MEMBER CASSANO: You take out the "a".

7 CHAIR MARKOWITZ: And after the 'and',

8 and comma if possible --

9 MEMBER CASSANO: Yes.

10 CHAIR MARKOWITZ: -- comma, right,

11 okay. Okay, then Kevin, after the 'possible', if

12 you could put a comma, right?

13 MEMBER CASSANO: So, I guess it's not

14 technically an Oxford comma.

15 MEMBER GRIFFON: I hesitate to even

16 raise this question, because I'm worn out.

17 But I mean, this section that we're

18 commenting on, if you look at the header, could

19 be simply reference to covered illnesses.

20 So, even though we're deleting the

21 reference part from that paragraph, that defines

22 covered illness, the whole second phrase is
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1 addressing covered illness.

2 MEMBER CASSANO: Well --

3 MEMBER GRIFFON: I don't even think

4 that --

5 MEMBER CASSANO: But I think what

6 they're saying is, eventually it's going to be

7 determined, whether it's covered. So, if you

8 want to establish it as covered illness, you at

9 least have to give them a diagnosis of some

10 illness to be evaluated for covered illness, not

11 that you have to give them a definitively covered

12 illness first, because a lot of people wouldn't

13 know that.

14 CHAIR MARKOWITZ: Right, it's okay,

15 because the proposed change under this 'establish

16 the employee has been diagnosed with a covered

17 illness' is setting out the requirement that you

18 have to prove diagnosis and you've got to prove

19 the causation, essentially, right, or

20 contribution, aggravation, etcetera.

21 That is what the proposed language is. 

22 Our proposal is that we agree, you have to prove
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1 the diagnosis and that you should consider the --

2 if the physician produces a rationalized report

3 regarding causation, but you don't require it, in

4 order to establish a covered illness.

5 Then obviously there are other -- the

6 CE is including, you know, considering a whole

7 other set of things, the CMC report, the SEM,

8 etcetera, to come to that conclusion. Dr. Welch?

9 MEMBER WELCH: So, as far I could

10 tell, this is the only place in the regulation

11 that talks about making the link to toxic

12 exposure, and Tori and I sort of disagreed about

13 whether to delete the number two, in the proposed

14 language, where it says, "Any other evidence OWCP

15 may deem necessary to show that employee has had

16 an illness resulting from exposure to toxic

17 substance."

18 Because by doing what we did, we're

19 saying that the claimant does not have to provide

20 a rationalized medical opinion on the link with

21 toxic exposure, and then it's implied that that

22 happens in some other way, and maybe that's fine,
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1 or maybe we should put in here that then OWCP has

2 to find information to shed light on that

3 question. Do you understand what I'm saying?

4 MEMBER CASSANO: But I think if we put

5 it here, it means that the claimant has to

6 provide whatever other information OWCP may

7 continually ask for, you know, "I want the CT

8 scan. I want the chest x-ray. I want the lab

9 report. I want all of this," to establish this

10 is a covered illness.

11 So, that's why I think it -- it

12 becomes a way to constantly ask for information

13 that the CE may want, not for any real probative

14 reason.

15 You might say that if the above is not

16 available, then OWCP may ask for any other useful

17 information.

18 CHAIR MARKOWITZ: Dr. Friedman19 Jimenez, you have something on this particular

20 point or something else? I just want to pursue

21 this discussion -- this -- okay, I'm sorry.

22 MEMBER BODEN: Actually, I have first,
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1 something that I can't control myself about, that

2 is incredibly minor, which is that the 'which' in

3 number two should be a 'that'.

4 But aside from that, I do actually

5 have a comment on this.

6 If you look back at the four that was

7 crossed out right above this section, I notice

8 something very interesting. That four -- so,

9 this is directly above the section we're talking

10 about. It's 30.232(a)(4).

11 In that sentence, it talks about --

12 and so, this is what's being replaced by the

13 thing we're talking about.

14 It talks about that the employee has

15 or had an illness, that may have arisen from

16 exposure to a toxic substance, which is really

17 different from that resulted from an exposure to

18 a toxic substance.

19 So, the first one says, "We want

20 evidence to show you that this is kind of in the

21 ballpark of something that we may want to

22 compensate," and the second says that before we
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1 proceed, we want something that shows us that

2 this is, and I think those are actually two

3 really different things, and that if we accept

4 something onto that we say deemed necessary to

5 show that the employee may have -- has or had an

6 illness that may have arisen from exposure to a

7 toxic substance.

8 CHAIR MARKOWITZ: So, just to

9 summarize, what he's -- I think you're suggesting

10 is that you actually change the word 'resulted'

11 in item number two, to 'may have arisen'.

12 MEMBER BODEN: Right.

13 CHAIR MARKOWITZ: Yes.

14 MEMBER SOKAS: So, I agree about

15 deleting sub-paragraph two because I think the

16 point of this piece right here is really to show

17 that there is an illness, right?

18 It's not necessarily at this point, to

19 show that there is an illness that's related. 

20 You show there is a toxic exposure, then you show

21 there's an illness, and then if -- if you can,

22 under one or two -- you know, (a)(1) or (a)(2)
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1 there, link the two, that's great, and it would

2 be helpful if the treating physician can do that

3 or somebody else can do that, but that the burden

4 of doing that does not necessarily fall on the

5 claimant, that the burden for the claimant is to

6 show there is some illness there.

7 Then there are later procedures that

8 can talk about linking the two.

9 CHAIR MARKOWITZ: I'm sorry, Dr.

10 Redlich? Okay, is there a response to Dr. Sokas? 

11 Dr. Welch?

12 MEMBER WELCH: Well, I think that in

13 the regulation, I imagine, and I didn't read it

14 thoroughly, so someone should correct me, but I

15 think this is where that relationship is talked

16 about, and it's -- it's not -- and so, it doesn't

17 then say, and the agency has a responsibility to

18 make the determination of causation or work -- by

19 trying to say work-relatedness, because we know

20 what that means.

21 But you know, again, I think I'd have

22 to maybe go through it in more detail, to
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1 understand -- even understand how the regulation

2 relates to the processes that are -- I don't know

3 how much has to be specified here or not.

4 So, but it's -- but this section does

5 -- had always -- has always said covered illness,

6 because that was not changed. So, this section

7 was covered illness.

8 But it used to say, if you read the

9 strike through stuff, provide the diagnosis, and

10 then as Les pointed out, provide some information

11 that would suggest that it may have arisen out of

12 employment.

13 CHAIR MARKOWITZ: Well, let me just

14 say that covered illness is two words. One is

15 proving the illness and the other is proving the

16 coverage. So, I think that's what's encompassed

17 by this section. That's the only way it can

18 really be interpreted. Dr. Redlich?

19 MEMBER REDLICH: As just a general

20 statement -- as just a general statement about

21 this whole process.

22 I would like it somewhere -- I feel
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1 that it's just inappropriate. This has been in

2 place for years. To suddenly have a rush to edit

3 it, where we don't really understand, it's

4 complicated wording, with all these tracked

5 changes, of who it's actually changing the intent

6 of things, and since a lot of this actually

7 relates to the questions we were asked to

8 address, why you would want to finalize something

9 before we've had a chance to do our homework, and

10 more intelligently address these issues, this

11 just seems out of order and unproductive, because

12 it's going to make something more final, where we

13 haven't even become educated or addressed the

14 questions that we've been asked to address.

15 I don't see what the urgency -- it

16 doesn't sound like claims have been being

17 processed with such great speed, that you know,

18 whether this gets changed now or several months

19 from now.

20 But I'm just confused about this whole

21 process.

22 CHAIR MARKOWITZ: Well, let me just
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1 begin to respond just --

2 MEMBER REDLICH: I mean, personally,

3 I would prefer to not comment on this until I was

4 more --

5 CHAIR MARKOWITZ: Right.

6 MEMBER REDLICH: -- up to speed and

7 understood all the issues.

8 CHAIR MARKOWITZ: So, I understand the

9 frustration, and I actually mentioned at the

10 beginning that this was a challenge. The notice

11 of proposed rulemaking has -- is going forward

12 regardless of us.

13 We've been invited to provide some

14 input, some recommendations about the proposed

15 rule changes, which is what we're doing.

16 That train is likely going to move

17 regardless of what we do. So, this is our

18 opportunity.

19 MEMBER REDLICH: So, there isn't an

20 opportunity to delay that rulemaking, that's not

21 possible? I don't know what the rules are. So.

22 CHAIR MARKOWITZ: Yes.
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1 MEMBER REDLICH: If it isn't, then you

2 want to make the best of a situation.

3 CHAIR MARKOWITZ: That's what we're

4 doing, I think.

5 MEMBER REDLICH: Okay. 

6 CHAIR MARKOWITZ: And I also think

7 that some of these issues, we're going to be

8 visiting, right? As we've been asked to do, over

9 the next period of time, and we'll have more to

10 say, but you know, the proposed rule changes has

11 its own time table. Dr. Welch?

12 MEMBER WELCH: But maybe to make you

13 feel better, there are how many public comments

14 about the website about these rules, 300,

15 something like that?

16 MEMBER REDLICH: Yes.

17 MEMBER WELCH: So, there are people

18 who know more than us, who have commented on this

19 same language.

20 So, in a way, if we're coming out with

21 something similar to 280 of those 300 comments,

22 then we know more than we think we do. You know
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1 what I mean?

2 MEMBER REDLICH: I haven't read those

3 comments.

4 MEMBER WELCH: Exactly.

5 MEMBER REDLICH: I haven't done that.

6 MEMBER WELCH: I've only read some of

7 them. So, but --

8 MEMBER REDLICH: But that would be

9 relevant, because I think that there are people

10 who know way more about this than I do, and I

11 would appreciate their input.

12 MEMBER WELCH: Right, and I think --

13 I mean, I think the problem -- what Steve said

14 is, you know, there is a -- there's deadlines for

15 changing -- for regulation --

16 MEMBER REDLICH: That's why I said --

17 MEMBER WELCH: -- and we're stuck with

18 it.

19 CHAIR MARKOWITZ: Having said that, if

20 we feel truly uninformed about a given proposed

21 change, then frankly, we should not provide input

22 because that's not going to be valuable to the
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1 process.

2 So, the -- while we might not have all

3 the knowledge and experience we want, we have to

4 have a certain level of comfort with this

5 material in order to be able to provide changes

6 and feel confident that we're being productive. 

7 Dr. Dement?

8 MEMBER DEMENT: I guess when our group

9 discussed this, my concern with the changes,

10 there are a lot of changes here.

11 This striking out language has been

12 there for a long time. So, the scenario that I

13 see, that they are shifting from is where I go to

14 a doctor, I have a diagnosis and he says, it may

15 be or could be or it likely is related to work at

16 one of the sites, but it's not at this level of

17 medical written reason report.

18 But the -- the worker still needs the

19 opportunity to file that, to have that case

20 developed through the process over time. 

21 I just saw this as completely short22 circuiting that and throwing the onus right back
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1 on the worker, to have this reasoned report

2 before they get a chance to even develop the

3 case.

4 CHAIR MARKOWITZ: Right.

5 MEMBER CASSANO: And then the language

6 takes that out. The new language --

7 MEMBER DEMENT: It takes it out.

8 CHAIR MARKOWITZ: Right.

9 MEMBER DEMENT: So, my recommendations

10 would be -- why do we need to change language

11 that's already there?

12 CHAIR MARKOWITZ: Yes.

13 MEMBER DEMENT: Just my comment.

14 MEMBER WELCH: I remember yesterday,

15 Faye, didn't you say or someone -- someone on

16 this side of the table was saying you didn't like

17 the old language. 

18 So, that would be helpful, because I

19 thought the easiest thing was to go back to the

20 old language, but the -- if there is something

21 wrong with it, we should do that.

22 CHAIR MARKOWITZ: But one solution
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1 might be to -- instead of us recommending

2 specific language, which is to express our

3 concern and strong feeling about the problems

4 presented by the new language without necessarily

5 proposing specific language that would replace

6 the proposed --

7 MEMBER REDLICH: I think that's a good

8 approach because there is so many changes in so

9 many places, that we're actually going to find

10 them all and fix them all, so that they're all

11 consistent.

12 I think if we state what our concerns

13 are, that sounds like a good idea.

14 CHAIR MARKOWITZ: So, you want to

15 scroll back up? Sure, I'm sorry. 

16 MEMBER VLIEGER: It's taken 10 years

17 to get this bite at the apple. I am really

18 concerned that we're not going to take advantage

19 of it, at least to fix the problems with the

20 employee being required to produce evidence that

21 does not exist in order to establish a claim.

22 CHAIR MARKOWITZ: Thank you. Can you
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1 scroll up?

2 MEMBER SOKAS: Can I have a question?

3 CHAIR MARKOWITZ: Sure. Dr. Sokas.

4 MEMBER SOKAS: So, just also a

5 procedural question.

6 I think the other thing that happens

7 when all of the comments are in and it's closed,

8 that in any preamble to any new publication of

9 rules, they have to address the comments that

10 were received and what the determination was made

11 and why, right? 

12 So, that all gets done at some point. 

13 I just don't know when exactly that gets done.

14 MEMBER CASSANO: I think when they

15 publish the final rule. You don't have a second

16 bite at the apple.

17 MEMBER SOKAS: Okay. What is that

18 time line? 

19 CHAIR MARKOWITZ: The time line for

20 the proposed rulemaking? 

21 MEMBER SOKAS: Yes.

22 CHAIR MARKOWITZ: I don't -- the
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1 comments are closed as of May 9th, I believe, but

2 what happens after -- how long it appears -- the

3 period is after that, I don't know.

4 I don't -- it's not set, I don't

5 think, unless, is there -- 

6 MR. RIOS: It under-goes a series of

7 reviews.

8 CHAIR MARKOWITZ: Right.

9 MR. RIOS: That are within the

10 department and then over to OMB.

11 MEMBER SOKAS: That's where we get the

12 second bite. We go see OMB.

13 MEMBER WELCH: If you listened to Dr.

14 Michael's this morning, OSHA started the silica

15 rule 18 years ago. So, I mean, there is no --

16 there is no legal requirement to finish it in a -

17 - well, the definition of a timely manner Depends

18 on the eyes of the beholder.

19 So, I mean, this version of the silica

20 rule took -- all the time lines were missed,

21 particularly the OMB part.

22 MEMBER REDLICH: But that's -- there
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1 was a lot of industry wanting to delay.

2 CHAIR MARKOWITZ: Okay, so, let's

3 continue here. If you could move the third

4 paragraph to the front -- to the top, and so, it

5 -- no, the one above it, that one, right, just

6 above the -- right. No, no, right below 30.232.

7 So, we start off with our beliefs. 

8 The Board believes that sufficient expertise and

9 causation of our case is unlikely to be available

10 in DOE communities, time commitment with

11 physicians to produce such document report makes

12 the requirement unrealistic and places too great

13 a burden on claimants.

14 The Board recommends that DOL remove

15 the requirement that the claimant must produce

16 written medical evidence, wherein the physician

17 describes the reasoning for his or her opinion

18 regarding causation.

19 So, that's -- we're not saying what

20 the language ought to be. We're expressing our

21 clear view on the issue.

22 I think that it -- what's italicized
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1 can be removed. Oh, so, yes, it can be removed

2 there.

3 MEMBER BODEN: So, do we also --

4 CHAIR MARKOWITZ: And then we have

5 this additional -- yes, if you could just get rid

6 of that. Thanks, and then additional issue and

7 it -- the Board is concerned that "any other

8 evidence OWCP may deem necessary is overly broad

9 and unnecessary and may form the basis for

10 adversarial interactions between OWCP and

11 claimant".

12 MEMBER BODEN: So, there is where I

13 think my concern about the changing the 'may' to

14 the 'must' or changing the wording 'resulting

15 from' to 'may' to resulting from -- from may have

16 -- arisen from --

17 CHAIR MARKOWITZ: Right.

18 MEMBER BODEN: -- needs to be pointed

19 out.

20 CHAIR MARKOWITZ: Right. Okay. Okay,

21 so, after it says -- after 'claimants', Kevin,

22 keep going down. Right? Next paragraph.
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1 The -- the Board recommends that in

2 Section --

3 MEMBER BODEN: I think we should say

4 something that the Board is concerned that the

5 change of language from the -- from the employee

6 has or -- where is it? That may have -- an

7 illness that may have arisen from exposure to a

8 toxic substance, to no --

9 CHAIR MARKOWITZ: Illness that

10 resulted from?

11 MEMBER BODEN: To resulting --

12 CHAIR MARKOWITZ: Right, right.

13 MEMBER BODEN: I'm just looking for

14 the --

15 CHAIR MARKOWITZ: It's number two,

16 line two. Got it?

17 MEMBER BODEN: To show that the

18 employee has or had an illness that resulted from

19 --

20 CHAIR MARKOWITZ: Right.

21 MEMBER BODEN: -- places an extra

22 burden -- an extra, unnecessary burden on
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1 claimants.

2 CHAIR MARKOWITZ: To -- an illness

3 that resulted from an exposure to a toxic

4 substance. End of quote.

5 MEMBER BODEN: Right.

6 CHAIR MARKOWITZ: And now, you need to

7 finish the sentence.

8 MEMBER BODEN: Places an unnecessary

9 burden on claimant.

10 CHAIR MARKOWITZ: It's the same

11 sentence, but yes.

12 MEMBER BODEN: Yes.

13 MEMBER WELCH: And maybe it's

14 redundant, but the information about toxic

15 exposure and toxic substances in the current

16 process usually doesn't come from the claimant. 

17 They're relying on the site exposure matrix.

18 So, that it's -- this -- maybe we

19 don't have to say anything more than an

20 unspecified -- but the -- a lot -- a lot of the

21 information comes from other sources, the

22 document acquisition request, the SEM and things
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1 like that.

2 CHAIR MARKOWITZ: I don't -- that's

3 part of the system. It's handled elsewhere. I

4 don't think we need to address that. 

5 I mean, in the previous section, for

6 instance, D, with a list of sources -- so, can we

7 strike the language below that?

8 MEMBER CASSANO: Have we determined --

9 MEMBER BODEN: Let's not strike it

10 yet.

11 MEMBER CASSANO: Yes.

12 CHAIR MARKOWITZ: Yes, yes, no, well,

13 I understand. That's the --

14 MEMBER BODEN: Yes.

15 CHAIR MARKOWITZ: I'm raising the

16 question. I'm not --

17 MEMBER WELCH: The item that's point

18 two, the number two, is not addressed in our

19 comments yet. If we want to add something

20 specific to say that -- or we'll be quiet about

21 that. I think that's worth discussing. 

22 I think number one, we've covered,
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1 that -- the (a)(1), I think we've covered -- what

2 Kevin just highlighted, I think we've covered

3 that. We've discussed that in our general

4 comments.

5 MEMBER CASSANO: I think --

6 CHAIR MARKOWITZ: Yes, hang on.

7 MEMBER CASSANO: -- the question right

8 now, as I understand it, is whether to just put

9 the concerns in without moving language versus

10 moving language, as well.

11 So, is that a vote at this point or

12 what?

13 MEMBER BODEN: I'd like to hear from

14 the folks who have experience in this, and have

15 concerns about the original language about

16 whether you think it would be better for us to

17 suggest language or to state our concerns.

18 MEMBER WHITLEY: In my opinion, if we

19 don't have time to write the language that we

20 know takes the loop-holes out and makes the

21 claimant have to do a bunch of things to jump

22 through, we'd better be -- be better off to just
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1 say what we started to say, that this language

2 needs to be looked at, and we disagree with what

3 they're doing.

4 I don't think that we -- unless we

5 think we can word-smith it to take care of it, I

6 think we'd better off just to show that we're

7 unhappy with it. 

8 MEMBER CASSANO: So, you don't think

9 this solves the problem? This language solves

10 the problem.

11 CHAIR MARKOWITZ: You know, I think --

12 MS. POPE: I have a comment.

13 CHAIR MARKOWITZ: I'm sorry, Ms. Pope. 

14 

15 MEMBER POPE: I am somewhat in

16 agreement with Garry, but I think that if we

17 don't do something, in terms of the language, I

18 don't think it carries as much weight if we just

19 go with putting our recommendations. It just

20 seems like it's a softer approach, opposed to

21 saying that this is what we'd like to see in the

22 language.
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1 CHAIR MARKOWITZ: But I -- I don't see

2 where -- the language we're looking at, having

3 this language helps above and beyond, what we

4 have above this, wherein, which we clearly

5 express what we regard as the major problem here,

6 which is requiring, you know, the claimant to do

7 this. 

8 MS. POPE: Are you saying in this

9 particular section?

10 CHAIR MARKOWITZ: Right, right, right. 

11 You know, can I just ask for some clarification

12 on what number two means, exactly?

13 We're saying what, that OWCP should

14 evaluate the probative value of the physician's

15 rationale? Is that essentially what we're

16 saying?

17 MEMBER CASSANO: Well, if -- what the

18 thinking was, was that you know, if they go

19 through the effort of producing a good -- a

20 medical opinion, with -- from a person with the

21 qualifications that they stipulate in the

22 definitions, that they should at least look at
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1 that as potentially probative, rather than just

2 dismissing it out of hand, which is what happens

3 now, because nowhere else in this whole

4 regulation does it state anything about the -- we

5 talked a lot about the fact that the treating

6 physician can't come up with decent -- but if

7 somebody does come up with a decent one, there is

8 nothing that tells the claims examiner, yes,

9 you've got to look at this at least and make a

10 decision as to whether it's probative or not.

11 That's, I guess -- I'm just looking at

12 it from the system. 

13 MEMBER VLIEGER: Can we scroll back up

14 to -- can we scroll back up to the previous

15 section and look at the definition of the section

16 and then maybe that will clarify what we're

17 trying to do and not do here?

18 CHAIR MARKOWITZ: So, you want to go

19 back to the proposed rules?

20 MEMBER VLIEGER: No, I just -- the --

21 CHAIR MARKOWITZ: Okay, okay.

22 MEMBER VLIEGER: What we're proposing
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1 above.

2 CHAIR MARKOWITZ: Okay. 

3 MEMBER VLIEGER: So, 232, the section

4 itself. How does a claimant establish that the

5 employee has been diagnosed with a covered

6 illness?

7 So, there we're establishing the

8 criteria of how to make the diagnosis.

9 MEMBER CASSANO: No, we're

10 establishing what you have -- what a claimant has

11 to provide, and right now, it says they've got to

12 provide all this other stuff, including the

13 rationale, that there is a change in there, and

14 we're changing it back to no, all they need to

15 provide is the physician's diagnosis, and oh, by

16 the way, if there is reasoning or if there is a

17 medical opinion, then you have to provide that. 

18 MEMBER VLIEGER: Okay, and then the

19 second section changes this requirement how,

20 where it's saying we're going to consider what

21 the physician statement is that's provided by the

22 employee?
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1 MEMBER CASSANO: If it's -- you know,

2 I think let's -- I don't know.

3 What we're saying is that if -- on

4 their definition of a qualified physician, there

5 is a rational opinion that they -- you told us

6 yesterday that it was -- they just -- they don't

7 even look at it but --

8 MEMBER VLIEGER: But with the

9 qualifier at the bottom that says this will be

10 considered -- let's go back down, where you're

11 saying let's look at it as whether it's probative

12 or not, still has the option of being thrown out

13 in its entirety.

14 MEMBER CASSANO: Well, it could be a

15 lousy rationale.

16 MEMBER VLIEGER: Right. But assessed

17 for probative value, I think should be considered

18 probative, unless it doesn't meet the

19 requirement.

20 MEMBER CASSANO: Well, that is what

21 the original language was, considered probative.

22 CHAIR MARKOWITZ: Yes, no, I don't
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1 think --

2 MEMBER VLIEGER: I don't think we're

3 going to be able to fix this in one paragraph.

4 CHAIR MARKOWITZ: Yes, I don't think

5 you could say it's by default, the default is

6 that it's -- it's probably a tremendous variation

7 of these physician reports, but we could -- if

8 you go back up, we could address this by saying,

9 at the end of the second paragraph, where -- the

10 second sentence where it says, "The Board

11 recommends that DOL remove the requirements," you

12 could add a sentence -- you don't have to write

13 this yet.

14 But that the Board recommends that if

15 the claimant produces a report that addresses

16 causation, aggravation, contribution, that the

17 Board assess this report for its probative value.

18 In other words, put in something to

19 address the same point, but not give the

20 particular language. 

21 MEMBER CASSANO: Yes, so, take number

22 two from the language and put it up there to
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1 recommend, that would do it.

2 CHAIR MARKOWITZ: Okay, so, if we

3 could just scroll down, yes. No, not -- number

4 two, and then bring it up and then we're going to

5 --

6 MEMBER CASSANO: You could say the

7 Board recommends that.

8 CHAIR MARKOWITZ: Where? So, right

9 there, right there, yes. 

10 MEMBER CASSANO: And then put the

11 Board will also recommend.

12 CHAIR MARKOWITZ: So, the Board --

13 that's actually just dropped in there. Before

14 the 'if', you could say, "The Board recommends." 

15 Right. 

16 MEMBER CASSANO: I changed that back.

17 CHAIR MARKOWITZ: Okay, we're not

18 there yet. We're not there yet. We'll save

19 that. We'll save that for last, yes. Dr.

20 Silver?

21 MEMBER SILVER: When we were word22 smithing too, a little while ago, 'may' was
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1 changed because people thought it was too wimpy,

2 to 'should'.

3 In fact, the opposite of 'may' in

4 regulation and legislation is 'shall'. So, let's

5 go all the way. We're just recommending that it

6 'shall'.

7 MEMBER CASSANO: Yes, I'd like to use

8 'shall' a lot.

9 MEMBER SILVER: Yes.

10 MEMBER CASSANO: Yes.

11 MEMBER SILVER: Throw it in there.

12 CHAIR MARKOWITZ: I'm sorry, what is

13 the specific suggestion?

14 MEMBER SILVER: At the very end --

15 where did it go? 

16 MEMBER CASSANO: Shall be assessed.

17 MEMBER SILVER: Shall be assessed,

18 rather than should.

19 CHAIR MARKOWITZ: Okay.

20 MEMBER CASSANO: But 'shall' is more

21 --

22 CHAIR MARKOWITZ: Okay, no, hold on.
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1 MEMBER SILVER: Aim higher, like our

2 union friends.

3 CHAIR MARKOWITZ: Yes, but just to be

4 clear, we're not -- we're not writing the -- the

5 proposed changes. We're expressing our point of

6 view. So, 'shall' or 'should be' is fine.

7 Can we now get rid of -- if we go --

8 scroll down, Kevin. 

9 MEMBER CASSANO: Get rid of that line.

10 CHAIR MARKOWITZ: Yes, (a)(2) and (3),

11 right, those go? Okay, yes. 

12 MEMBER CASSANO: And (a) as well, yes.

13 CHAIR MARKOWITZ: Yes. Okay, and you

14 can get rid of -- delete that paragraph too,

15 whatever that was.

16 (Simultaneous speaking.)

17 MEMBER WELCH: So, the sub-paragraph

18 two was the one that said OWCP can ask for

19 anything that has an illness resulting from

20 exposure. So, we addressed that.

21 CHAIR MARKOWITZ: We already addressed

22 that.
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1 MEMBER WELCH: The illness resulting

2 from exposure, did we? Did we?

3 MEMBER CASSANO: It's down below. The

4 very last sentence. It might be gone already.

5 MEMBER WELCH: Yes, there it is.

6 MEMBER CASSANO: Is it completely

7 gone? There was a little tag sentence at the

8 end. Yes, it's gone.

9 CHAIR MARKOWITZ: Okay, so, now you

10 can -- yes, you can get rid of the one. If you

11 scroll up, we might be able to see the whole

12 thing now. Okay, okay.

13 Okay, okay, so, yes, that's fine. So,

14 there's a motion to approve this. Any second? 

15 Yes. Comments? Dr. Redlich?

16 MEMBER REDLICH: When we're done with

17 this one.

18 CHAIR MARKOWITZ: Okay.

19 MEMBER REDLICH: I just needed

20 clarification.

21 CHAIR MARKOWITZ: Okay.

22 MEMBER REDLICH: On something.
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1 CHAIR MARKOWITZ: Okay, sure. So, any

2 further comments about this?

3 Okay, so --

4 PARTICIPANT: Can we take one minute

5 for just background on this?

6 CHAIR MARKOWITZ: No, I'm sorry, no.

7 No, that's not allowed. Public comment period is

8 over. Okay, so, any other -- okay, so, we're

9 going to take a vote.

10 All those in favor of this

11 recommendation? Raise your hand. All those

12 opposed? All those abstaining?

13 So, it's there are 15 members present

14 and all vote in favor of this recommendation. 

15 Dr. Redlich?

16 MEMBER REDLICH: So, I just need some

17 -- okay, I just need some clarification of our

18 task.

19 In particular, since the committee

20 addressing the issues related to beryllium and

21 lung disease, so --

22 CHAIR MARKOWITZ: I'm sorry, can I
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1 just interrupt for one moment?

2 MEMBER REDLICH: Yes.

3 CHAIR MARKOWITZ: There was a -- a

4 request, I think either you or George, to one

5 final issue on the proposed changes, that we

6 wanted to address, which was where -- we're

7 making consistent, in where possible in the

8 regulation, that causation actually refers to

9 aggravation, contribution and causation, that we

10 -- that's the way that we understood.

11 Is this something that we want to --

12 to --

13 MEMBER REDLICH: Yes.

14 CHAIR MARKOWITZ: Okay.

15 MEMBER REDLICH: Yes.

16 CHAIR MARKOWITZ: Okay, so, if we

17 could just handle that, and then get back to this

18 issue.

19 This is a brand new recommendation. 

20 There is no language yet for this.

21 MEMBER REDLICH: Not for this

22 specific.
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1 CHAIR MARKOWITZ: Right. Yes, this is

2 -- yes, if you could put this into the other

3 draft recommendations. 

4 Okay, so, yes, you can take that out. 

5 You can take that out. Right. Yes, yes, right

6 there. Okay, okay.

7 So, can someone propose some language

8 here? Okay, okay, yes. 

9 MEMBER WELCH: Well, it's right in the

10 middle of the screen. It's close to what we are

11 talking about, right?

12 CHAIR MARKOWITZ: Right.

13 MEMBER REDLICH: Is this the statutory

14 language?

15 CHAIR MARKOWITZ: That's being quoted

16 here? No, this is from the regulations. 

17 MEMBER BODEN: So, I'm thinking the

18 first sentence, the Board notes the frequent

19 references in the regulations to "diseases caused

20 by toxic substances".

21 The Board also notes that -- the Board

22 notes the frequent references in the proposed
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1 regulations to "diseases caused by toxic

2 substances".

3 The Board also notes that the statute

4 refers to --

5 CHAIR MARKOWITZ: Aggravation,

6 contribution.

7 MEMBER BODEN: -- aggravation,

8 contribution and --

9 CHAIR MARKOWITZ: Causation.

10 MEMBER BODEN: -- causation. We

11 recommend that the -- that the agency examine all

12 references to causation and ensure that they are

13 consistent with the statute.

14 MR. RIOS: Yes.

15 CHAIR MARKOWITZ: Yes, yes, yes. 

16 Okay, so, I'm sorry, Les, can you just repeat

17 that?

18 MEMBER BODEN: No. Repeat which part?

19 CHAIR MARKOWITZ: Well, the Board

20 notes that the regulations make frequent

21 references to causation, right?

22 MEMBER BODEN: To causation.
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1 CHAIR MARKOWITZ: Right.

2 MEMBER BODEN: The Board also notes

3 that the Act refers to -- here --

4 CHAIR MARKOWITZ: Aggravation,

5 contribution and causation.

6 MEMBER BODEN: The Board, therefore,

7 recommends that the proposed changes in the

8 regulations make changes -- I said it better

9 before.

10 MEMBER WELCH: You did.

11 MEMBER BODEN: I know. 

12 MEMBER WELCH: Reflects what?

13 MEMBER BODEN: Right, reflect the

14 language of the Act. Thank you.

15 MEMBER WELCH: Editorial note,

16 aggravation, contribution, causation.

17 MEMBER BODEN: Okay.

18 CHAIR MARKOWITZ: Okay, so, comments? 

19 Discussion? Okay.

20 MEMBER WELCH: Move to approve.

21 CHAIR MARKOWITZ: Okay, second? Okay,

22 we don't need to read this because you read this.
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1 All those in favor? All those

2 opposed? Any abstentions? 

3 Fifteen members present. All vote in

4 favor of the recommendation.

5 So, that concludes our input,

6 comments, recommendations regarding proposed

7 regulations. 

8 MEMBER REDLICH: So, I -- 

9 CHAIR MARKOWITZ: I'm going to double10 check, to make sure that we have in fact, voted

11 on all of them, while we move onto other matters.

12 MEMBER REDLICH: Well, I was a little

13 unclear. Certain ones were selected for us to

14 comment and look at, and others were not.

15 So, I'm a little unclear. Were the

16 ones related to Part E the ones that we were

17 commenting on, but not the ones on B or --

18 CHAIR MARKOWITZ: No, the way that --

19 MEMBER REDLICH: How was it sort of

20 picked which --

21 CHAIR MARKOWITZ: Sure, sure.

22 MEMBER REDLICH: -- ones you were
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1 focusing on?

2 CHAIR MARKOWITZ: The process was that

3 we're invited to provide input into the proposed

4 changes.

5 We were briefed by DOL about the

6 proposed changes. DOL provided us with guidance

7 as to what they considered to be within the scope

8 and not in the scope of the Board's charter.

9 We were free at any moment to look at

10 any proposed change that we thought was addressed

11 within our scope -- our scope, our charter, and

12 take up that proposed change and examine it and

13 discuss it.

14 So, that was not a -- the -- DOL's

15 input and guidance about what was in or not in

16 our scope was not a requirement. We were, at all

17 times, free to select on our own, what changes

18 and in fact, we discussed that at the briefing. 

19 We discussed that on our subcommittee calls, and

20 since that time.

21 So, now, I was the one who came up

22 with the list, the initial list of the things
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1 that we've discussed on the subcommittee calls,

2 but again, called for members to add additional

3 proposed changes that they thought we should

4 address.

5 So, that's -- that's where we are

6 today.

7 MEMBER REDLICH: Okay, my brain may

8 have been a little slow in terms of the

9 processing all of this.

10 The reason I'm questioning it is

11 because our task -- one of the major

12 subcommittees is addressing a number of issues

13 around chronic beryllium disease and the benefits

14 under Part B.

15 CHAIR MARKOWITZ: Right.

16 MEMBER REDLICH: And yet, there are

17 sections in this document relating to that, that

18 we haven't really --

19 CHAIR MARKOWITZ: Sure.

20 MEMBER REDLICH: -- or I haven't gone

21 over that carefully, and so, that is a little bit

22 of what my concern is, because that does appear
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1 to be under what we have been asked to look at,

2 not just the Part E.

3 CHAIR MARKOWITZ: Right.

4 MEMBER REDLICH: And so, you know,

5 this whole added paragraph, I assume it has

6 impact because that's why it was added, but I'm

7 not really clear fully on it.

8 CHAIR MARKOWITZ: Right.

9 MEMBER REDLICH: And I guess it's a

10 little bit late now to address that, and I

11 suspect public comments have probably addressed

12 it.

13 CHAIR MARKOWITZ: I agree with you,

14 that it could be regarded as within our scope,

15 and we have not discussed it, and I agree with

16 you, it's probably too late to provide input into

17 that.

18 But yes, we are -- as I said before,

19 individual Board members are certainly welcome to

20 look at proposed changes, provide input into the

21 record, DOL's record on comments.

22 So, let's -- we have about 20 minutes
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1 before we need to close, and I want to just now

2 move to purely administrative matters, such as

3 the subsequent meetings. Couple of issues.

4 I want to talk about scheduling the

5 subcommittee meetings. If we -- let's say the

6 subcommittees were to circulate dates and agree

7 on a date by, say next Wednesday, come to

8 agreement on a date that they're going to meet by

9 next Wednesday, the earliest that you could meet

10 would be June 22nd, given the seven week delay.

11 So, June 22nd is approaching the end

12 of June. So, my question to the subcommittees

13 is, can we attempt and strive to by next

14 Wednesday, May 4th, come to, within each

15 subcommittee, a mutually agreed upon date for

16 each subcommittee telephone meeting that would

17 occur, essentially, the last week in June? Give

18 or take, I mean, just the -- the approximate time

19 frame.

20 MEMBER SOKAS: So, I mean, it's kind

21 of related, but we're talking -- I mean, I hate

22 to be this picky about it, but if we're talking a
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1 two hour phone call as opposed to a two day phone

2 call, that's easier to -- do you see what I'm

3 saying? 

4 CHAIR MARKOWITZ: Yes, yes, sure.

5 MEMBER SOKAS: So, what do we think is

6 going to be necessary, because that will help

7 with the scheduling.

8 CHAIR MARKOWITZ: Yes, right. So,

9 that's open for discussion. 

10 Mark, you've got some experience here,

11 but different Boards.

12 MEMBER GRIFFON: I was just going to

13 ask, just so we can all get our heads around this

14 a little bit.

15 Can you run through who the committee

16 members -- like the four committees and who is on

17 them? I know I volunteered for two. You know, I

18 know mine. I know mine, but I don't know who

19 else is on it.

20 Then I mean, I would advise that we

21 just caucus on our way out. You know, we have

22 calendars in our hands. It might --
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1 Maybe not. Maybe not. Right, right,

2 right.

3 (Simultaneous speaking.)

4 MEMBER CASSANO: Then I presume that

5 the four subcommittees can't meet on the same

6 day, because they're public. So, we have to

7 deconflict --

8 MEMBER GRIFFON: That's right.

9 MEMBER CASSANO: -- those as well.

10 CHAIR MARKOWITZ: So, let me ask, is

11 it -- does a four hour time slot seem reasonable?

12 MEMBER GRIFFON: Yes.

13 CHAIR MARKOWITZ: No, no.

14 MEMBER GRIFFON: Not to exceed, right.

15 CHAIR MARKOWITZ: For the subcommittee

16 to meet.

17 MEMBER GRIFFON: Right.

18 CHAIR MARKOWITZ: No, but that's a --

19 Dr. Welch?

20 MEMBER WELCH: Well, what I was

21 thinking of doing too was, you know, creating a

22 discussion agenda in advance of the subcommittee
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1 meeting, and one thing -- one consideration for

2 the group is, I think we all would like some

3 reports from the -- the database, some general

4 information on claims.

5 I mean, some of it is in the annual

6 reports. So, one question is whether we can get

7 anything else before the first subcommittee

8 meeting, if we were doing some records requests,

9 because if it turns out that we could get

10 something in two months, we might have the

11 subcommittee wait a little bit longer. 

12 So, you know, I think that it's --

13 four hours is reasonable if we don't have a whole

14 lot to work on. If it turns out we're going to

15 have a lot to work on -- I can't be on a phone

16 call more than four hours. So, you know, I mean,

17 usually by two and a half, I'm ready to go.

18 So, we might want to schedule multiple

19 ones, if we're going to have more to work on.

20 CHAIR MARKOWITZ: Sure, I'm sorry, Mr.

21 Rios has an answer to that question.

22 MR. RIOS: So, from the Agency's
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1 perspective, we can try to make anything

2 available to you that you request in advance of

3 your subcommittee meetings.

4 But I don't -- but I don't know if

5 your initial subcommittee meeting was to identify

6 the data that you're going to need. So.

7 MEMBER WELCH: I think we'd be able to

8 identify some of it -- some of it at -- during

9 the course of this meeting. I think we've

10 identified some things that we would like to see,

11 and having it in advance of the subcommittee,

12 might make things move faster.

13 MEMBER REDLICH: The stuff we've

14 already asked for.

15 CHAIR MARKOWITZ: Okay, but the

16 material we've already asked for are already --

17 are reports that -- and audit performances and

18 things --

19 MEMBER WELCH: And percentages of the

20 -- you know, what are the -- yes.

21 CHAIR MARKOWITZ: Okay, yes? 

22 MEMBER BODEN: Just a question about
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1 that. I know we asked for a whole bunch of

2 things. I didn't write all of them down. I know

3 they'll be in the minutes. Is there a way of

4 somebody's combing the minutes and providing that

5 to us?

6 CHAIR MARKOWITZ: Yes.

7 MEMBER VLIEGER: Didn't the department

8 keep a list as we were going? Yes?

9 MEMBER BODEN: Or either way.

10 MR. RIOS: There is three lists that

11 are going. So, we need to reconcile them, but at

12 the same time, we will look at the recordings.

13 Depending on how quickly you want the

14 list back and how accurate, meaning accuracy is

15 only -- you're only going to achieve that if we

16 listen to the recording.

17 So, do you want to -- do you want us

18 the list of the last two days, and then give you

19 the list, because we can do that. 

20 CHAIR MARKOWITZ: No. I would like the

21 -- send me the initial lists, and I will refine

22 them with assistance from Board members, and turn
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1 them back to you, and then we can supplement them

2 with any additions from the review of the

3 recording. Yes, Dr. Redlich?

4 MEMBER REDLICH: Could you just

5 clarify, because I'm not that familiar with

6 public meetings, and what communication is okay,

7 between the members or not, as far as -- so,

8 let's say there was a -- for an example, a list

9 of data that I thought would be useful to

10 request, and if I wanted input from the other

11 subcommittee members, is there anything else

12 you'd like to request?

13 Could I send an email to everyone --

14 CHAIR MARKOWITZ: Right.

15 MEMBER REDLICH: -- requesting that or

16 -- I just need some guidance --

17 CHAIR MARKOWITZ: Sure, sure, sure.

18 MEMBER REDLICH: -- on what is

19 considered appropriate.

20 CHAIR MARKOWITZ: Yes. I'm turning

21 that to Mr. Rios.

22 MR. RIOS: So, the rule book said that
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1 even for your subcommittee meetings, you don't

2 need to be this transparent. 

3 But since you all selected to be as

4 transparent, to have the public participate in

5 everything you deliberate, then you've changed

6 the rule book for yourselves.

7 So, if -- so, the requirements are not

8 that you have to have even the subcommittee

9 meetings in public.

10 With respect to the -- can you send me

11 an email asking for information and can I send it

12 to your subcommittee? Absolutely. But does that

13 conflict with your desire to be transparent? I

14 don't know.

15 But per the regulations, the

16 subcommittee can send me emails. I can send

17 emails to the subcommittee. The subcommittee

18 can have telephone calls without the public

19 notice, but the only thing that I would warn you

20 against is that if you're going to publicly state

21 that the public was -- was capable of witnessing

22 your deliberations, then you want to be
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1 consistent in your approach.

2 CHAIR MARKOWITZ: Sure, and let me

3 just say that, yes, we'll have to define some

4 boundaries, because we want an open process and

5 the meetings will be open. That's what we voted

6 on. 

7 On the other hand, there is a certain

8 amount of interaction that needs to occur for us

9 to make progress in what we're asked to do,

10 without a two month delay in that.

11 So, what we'll -- we'll have to

12 determine what those boundaries are.

13 So, did we -- did we settle on what

14 time -- how long these subcommittee meetings

15 might be?

16 MEMBER WELCH: Three hours.

17 CHAIR MARKOWITZ: Three to four hours,

18 okay, okay, and it is realistic that by sometime

19 mid next week or sometime next week, the

20 subcommittees might be able to decide on some

21 dates, and so, we can get the process along?

22 Okay, Dr. Friedman-Jimenez?
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1 MEMBER FRIEDMAN-JIMENEZ: Would it be

2 possible to do two two-hour meetings instead of a

3 four-hour meeting, because four hours is -- I am

4 suggesting that we have shorter meetings and more

5 frequent, because four hours is a big chunk of

6 the day and really affects the rest of your

7 schedule more.

8 CHAIR MARKOWITZ: Well, I am going to

9 leave that up to the subcommittee chairs to

10 float. Yes, Dr. Silver?

11 MEMBER SILVER: Dr. Markowitz, I don't

12 know if this is helpful, but yesterday, I jotted

13 down three things you wanted the subcommittees to

14 do, define initial issues and scope, define data

15 and information needs, and review and draft

16 initial work plan with time table.

17 So, maybe the chair of each

18 subcommittee could figure out how many hours we

19 need to do those three things. Is there more to

20 it?

21 CHAIR MARKOWITZ: All right, not that

22 I have.
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1 MEMBER FRIEDMAN-JIMENEZ: I think

2 there was a report from the data and the data

3 request.

4 CHAIR MARKOWITZ: Right. 

5 MEMBER SILVER: The second was -- yes,

6 the second was define data and information needs

7 and review.

8 CHAIR MARKOWITZ: Yes, okay. Okay.

9 MEMBER SILVER: So, rather than pick

10 the time and fill it up, those are the three

11 things we should do and figure out how much time

12 we need.

13 CHAIR MARKOWITZ: Okay, so, let's

14 discuss the Fall meeting. I think that Mr. Rios

15 can float some dates soon, because I know

16 people's calendars begin to schedule up with --

17 some with teaching and other activities. 

18 So, that we need considerable notice

19 on the Fall meeting, and we'll just circulate

20 some times. 

21 But I -- I favored late September,

22 towards the first half of October, so that we
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1 don't get too deep into the Fall, so we can

2 continue some momentum, but we're going to float

3 some dates and it will -- I would recommend a

4 two-day meeting. Not a three-day meeting,

5 because it will be more effective over two days,

6 and we can do as much in two days, except this

7 time, as we could do in three days. Dr. Welch?

8 MEMBER WELCH: I don't know if this

9 would be helpful in terms of the notification

10 issues for the subcommittees, but we might --

11 CHAIR MARKOWITZ: I need to hear this.

12 MEMBER WELCH: We might consider

13 having a regular time for a subcommittee meeting,

14 so that instead of -- you know, for each one,

15 having to go through the notification process,

16 would it be possible to say this subcommittee is

17 going to meet -- is going to call -- have a call

18 on a certain day, and then if we don't have it,

19 we don't have it. 

20 We could discuss that in our schedule

21 -- whether that fits people's schedules. But

22 would that help with the Federal Register Notice
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1 or would we still have to do a Federal Register

2 Notice for each committee meeting?

3 MR. RIOS: So, let me read you a

4 section in the regulations, okay?

5 It's Section 102-3.160, and it states,

6 "What activities of an Advisory Board are not

7 subject to the notice in open meeting

8 requirements of the Act?"

9 The following activities of an

10 Advisory Committee are excluded from the

11 procedural requirements contained in this sub12 part. 

13 The first is defined as preparatory

14 work, and it's meetings of two or more advisory

15 committee or subcommittee members convened solely

16 to gather information, conduct research or

17 analyze relevant issues and facts in preparation

18 for a meeting of the Advisory Committee or to

19 draft position papers for deliberation by the

20 Advisory Committee, and so, that was the first,

21 preparatory work.

22 The second is administrative work. 
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1 Meetings of two or more advisory committee or

2 subcommittee members, convened solely to discuss

3 administrative matters of the Advisory Committee

4 or to receive administrative information from the

5 Federal Officer or agency.

6 So, this -- the administrative work

7 piece, that sub-section says that you can convene

8 two or more advisory committee members to receive

9 information from the agency.

10 MEMBER BODEN: So, I understand that

11 we may not be subject to those rules, but the

12 question of wanting to be open and we need to

13 somehow let people know that they can hear what

14 we're saying --

15 MR. RIOS: Well, the reason I read you

16 that section in the regulation is because that

17 section does not cover subcommittees, and in

18 fact, that regulation covered other activities

19 that two or more members of the parent committee

20 can engage in, and if you -- and I will read you

21 the administrative work section again, because

22 that specifically addresses subcommittee members.
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1 So, again, Sub-Section B states

2 administrative work. Meetings of two or more

3 advisory committee or subcommittee members

4 convened slowly -- solely and slowly, to discuss

5 administrative matters of the advisory committee

6 or to receive administrative information from a

7 Federal Officer or Agency.

8 So, your stated desire yesterday or

9 two days ago was to have the subcommittee

10 meetings open to the public. This section that I

11 just read you does not pertain solely to

12 subcommittee meetings, but to administrative work

13 or preparatory work that the committee may engage

14 in.

15 So, it doesn't conflict with your

16 stated purpose, but I just want you to be clear.

17 MEMBER VLIEGER: So, prep work and

18 administrative work is excluded from the public?

19 MR. RIOS: Subcommittee meetings can

20 also be excluded from the public. But your

21 stated desire was to have the public participate

22 in your subcommittee meetings.
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1 Right now, you're talking about

2 administrative work and receiving and requesting

3 information from the agency. Can you do that

4 over email? Yes, because the regs allow you to

5 do all of that outside of the public view.

6 MEMBER VLIEGER: All right.

7 MR. RIOS: So, the reason I read you

8 that is because I want you to know that it

9 doesn't conflict with your desire.

10 MEMBER REDLICH: So, my --

11 MEMBER WELCH: And the information

12 between ourselves?

13 MEMBER CASSANO: So, I have a follow

14 up question then. 

15 The three things that Ken wrote down,

16 as you know, determining an agenda, requesting

17 information and I forget what the third one is,

18 could that be considered preparatory, because I

19 don't know if I want to wait until the middle of

20 June to figure out what my agenda is going to be

21 or to determine what information I'm going to

22 want my subcommittee members to look at, before
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1 we deliberate in the middle of June.

2 So, if we can consider that prep work,

3 then we can move on with that, and actually have

4 some deliberation occurring in June, otherwise

5 we've already put ourselves seven weeks behind,

6 to be able to do anything.

7 CHAIR MARKOWITZ: Dr. Welch? 

8 MEMBER WELCH: Well, I mean, I think

9 what Tony said is we can -- we, you know, under

10 the Act, these subcommittee actions don't have to

11 meet all the specific requirements of the public

12 notification, but we did decide we want to notify

13 the public.

14 MR. RIOS: Except in this --

15 MEMBER WELCH: And if we want to

16 notify the public by putting it in the Federal

17 Register, then that's the amount of time frame we

18 need.

19 We could do emails and stuff before

20 the meeting, that would get us better prepared

21 for the meeting, but I think we still want to

22 have it published in the Federal Register, so
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1 that the public would know the subcommittee

2 meetings are happening. That would be my

3 recommendation, but we could do some additional

4 prep work in advance, if we want to, by email.

5 MR. RIOS: Just to be clear, whenever

6 you communicate with each other, as members of

7 the committee or subcommittee, you have to copy

8 me, yes.

9 CHAIR MARKOWITZ: Okay, anything else

10 on the -- Dr. Redlich?

11 MEMBER REDLICH: An email with the

12 rules would be helpful.

13 MR. RIOS: I can send you all, all the

14 relevant regulations.

15 MEMBER REDLICH: Thank you.

16 CHAIR MARKOWITZ: Okay, so, that

17 covers subcommittee and the advanced notice, and

18 our meeting in the Fall. Let's discuss very

19 briefly, well, I just want to talk about where --

20 not decide on where we're going to meet, but just

21 open the -- the floor to the fact that we may not

22 meet here next time. We may meet in a different
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1 location.

2 But is there anything? We have five

3 minutes until we adjourn. Is there anything else

4 that -- on the administrative front that we need

5 to address?

6 If you have any questions about travel

7 or things like that, credit card reimbursement,

8 Mr. Kevin Bird is over here and he can answer

9 your questions. Yes, Mr. Griffon?

10 MEMBER GRIFFON: Just one question. 

11 You mentioned the September meeting. Did you

12 want to discuss location? You mentioned that

13 before.

14 CHAIR MARKOWITZ: Yes, yes. But is

15 there anything beyond that?

16 MEMBER GRIFFON: I'm sorry, okay.

17 CHAIR MARKOWITZ: Okay, so, the idea

18 is we could meet here in Washington, or we could

19 meet at a different location. Different location

20 could be presumably -- well, I don't think they

21 put Department of Energy sites in Hawaii much.

22 But there's a lot of logic to being in
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1 proximity to -- 

2 MEMBER TURNER: Denver or Kansas City.

3 CHAIR MARKOWITZ: What's that?

4 MEMBER TURNER: I said Denver or

5 Kansas City.

6 CHAIR MARKOWITZ: Okay, so, to be in

7 proximity to DOE workers, right, so that people

8 can attend and listen and provide public comment.

9 MEMBER SILVER: Could we do a site

10 visit at the same time?

11 CHAIR MARKOWITZ: Okay, so, yes. So,

12 we could -- let's -- if we just start -- I just

13 need your attention, I just need your attention

14 for five more minutes.

15 We could consider a site visit, but in

16 principle, does anyone have any strong feelings

17 about whether we meet in proximity to a DOE

18 community or where the DOE workers are, as

19 opposed to meeting here? Okay, Dr. Welch?

20 MEMBER WELCH: I think we should meet

21 near the sites, if we can arrange that, where the

22 DOE communities, but the communities are
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1 primarily, at least the ones we know are located

2 around the specific sites, the big sites, like

3 Oak Ridge and Hanford and Savannah River, and I

4 think we'd get a lot of interest from the public

5 if we met in those areas.

6 CHAIR MARKOWITZ: Okay.

7 MEMBER GRIFFON: Steven?

8 CHAIR MARKOWITZ: Yes, Mark?

9 MEMBER GRIFFON: One other thing that

10 we may consider is where the Radiation Board met

11 for their meeting, because it might be beneficial

12 --

13 MR. RIOS: Your microphone is off.

14 MEMBER GRIFFON: Oh. You know, it may

15 be beneficial to have the meeting in the same

16 location as the Radiation Board, you know, a few

17 days before or a few days after, whatever.

18 Just a thought, or you may want to --

19 not want to conflict with that --

20 CHAIR MARKOWITZ: Right, right.

21 MEMBER GRIFFON: -- because a lot of

22 the same claimants are going to be involved in
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1 those meetings.

2 CHAIR MARKOWITZ: Right, right.

3 MEMBER GRIFFON: So, just to check

4 those schedules, yes, and I think we have -- they

5 are meeting, I think in September.

6 CHAIR MARKOWITZ: Right.

7 MEMBER GRIFFON: So, just to -- yes.

8 CHAIR MARKOWITZ: I have a question,

9 actually for Ms. Leiton.

10 If we meet not in Washington, will

11 there be some attendance from people, DOL, your

12 unit, so that we can continue interaction?

13 MS. LEITON: We absolutely plan on

14 attending.

15 CHAIR MARKOWITZ: Okay, great. Okay,

16 great, thank you.

17 MS. LEITON: One other thing, if you

18 don't mind, just we do have to do outreach task

19 groups, and sometimes, you know, we'll go to

20 these locations. 

21 So, I don't know if you want to either

22 consider going to where we're going, or again,
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1 not going where we're going, to either be -- have

2 that done -- let them be part of this or avoid --

3 CHAIR MARKOWITZ: Right.

4 MS. LEITON: -- you know, whichever

5 conflicts, so we've got to schedule that as well.

6 CHAIR MARKOWITZ: Okay, great. Thank

7 you. We'll look at that schedule. 

8 Okay, so, I understand. That settles

9 that. Any other questions before we close? Yes? 

10 MS. POPE: Can we have Kevin give a

11 overview of the credit card information?

12 CHAIR MARKOWITZ: Okay, Kevin, you

13 have the floor, to explain the credit card to us. 

14 MR. BIRD: So, basically you all have

15 travel reimbursement forms in your packet. Fill

16 those out, or I -- after the conference, we can

17 also email them to you.

18 Just include all your expenses, not

19 including food and meals already reimbursed per

20 diem basis, so that's a flat fee. Provide

21 receipts for anything over $75, and then you --

22 we will process that, reimburse you and then you
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1 will pay that credit card bill. Five days. 

2 MR. RIOS: It's five days.

3 MR. BIRD: Just give me your travel

4 reimbursement form within five days from now.

5 MEMBER REDLICH: That's in our packet?

6 MR. BIRD: It is, and I'll email it to

7 everyone, so you have an electronic copy.

8 MEMBER WELCH: Kevin, what about cash

9 receipts?

10 MR. BIRD: Over $75.

11 MEMBER WELCH: Okay, thank you.

12 CHAIR MARKOWITZ: Okay, so, one last

13 -- if I could have your attention. I would just

14 like to thank numerous people here. Mr. Rios,

15 Ms. Rhodes, Mr. Salandro, who has been back

16 there.

17 Mr. Bird, who is key to many things

18 for us. Also, thank Ms. Leiton and the DOL for

19 not only being extremely informative, but also

20 being very clear about your desire for our input

21 into these various issues. So, we appreciate

22 that.
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1 Also, thank the Ombudsman and

2 Ombudsman's office for participating, and thank

3 the hard working members of the Board. The

4 meeting is adjourned.

5 (Whereupon, the above-entitled matter

6 went off the record at 3:00 p.m.)

7

8

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A

a.m 1:20 4:2 112:4,5

able 34:21 44:6,10

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above-entitled 112:3

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absence 85:9 198:11

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activity 26:16 37:18

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adding 76:20 204:22

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addition 102:9 122:15

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additional 18:7 26:15

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address 8:12 15:21

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68:11 69:3

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171:16

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187:5

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Agent 184:3

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and/or 93:20 205:4

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anybody 9:14 100:4

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anyway 9:15 13:7,11

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268:1

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118:8

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209:13 221:16 235:9

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Ave 1:19

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165:12

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b 12:2 16:7,9 17:21

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beryllium 6:3 42:18,19

42:21 43:1,15 119:16

119:22 120:3,8,10,17

121:12 170:7 185:15

185:19 186:8,19,20
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

287

187:4,13 188:3,6,9,12

189:1,9,14,20 190:2,6

190:9,22 191:1,2,22

192:1,12 194:9,18

195:7,7 251:20

258:13

beryllium-using 121:10

best 48:17 51:20,20

65:3 100:22 110:1

168:5 228:2

better 48:13 51:14

55:15 73:21 76:15

91:21 98:8 102:15

104:22 140:17 156:18

211:6 228:13 240:16

240:22,22 241:6

255:8 276:20

beyond 45:12 242:3

278:15

Bible 65:1

big 89:9 90:12 92:17

101:7 195:4 212:16

269:5 280:2

biggest 93:4,12 100:20

101:1

bill 283:1

bioassay 39:3 45:9

46:8 60:15

biopsy 192:13,18

bipartisan 171:8 182:18

Bird 278:8 282:14 283:3

283:6,10,17

bit 10:1 26:10,12 46:15

46:22 65:2 78:21

93:16 110:17 160:20

164:11 168:12 208:22

258:21 259:10 261:14

263:11

bite 232:17 233:16

234:12

blah 143:11,11,11,11

153:21,22,22 154:2,2

154:2

blend 208:1

blow 177:22

blue 160:5

board 1:4,18 4:8 5:7 8:8

8:19,22 25:19 40:2

53:2 75:1 82:15 86:6

89:15 96:3 98:6 99:2

103:15,22 104:6

107:3 112:10 113:8

113:13 114:7 115:8

116:3,9 121:7,9

122:10 125:18 128:13

129:1 134:6,15,22

135:10 138:22 139:6

142:7,13 143:1

148:12,15 150:1

153:15,16,20 154:4

154:17 159:2,3,8

160:12,17 161:10

166:5 167:4 169:6,17

169:18 170:20 171:5

171:12,14 189:17

194:21 195:3,4

197:10,22 198:1,2,12

198:16 200:3,19

203:12 204:17,20

209:1,11,20 235:8,14

236:7 237:1,4 246:10

246:14,17 247:7,11

247:12,14 253:18,21

253:21 254:3,19

255:2,6 259:19

265:22 272:6 280:10

280:16 284:3

Board's 130:7 257:8

Boards 185:4 261:11

Boden 2:5 7:11,11

67:18 69:9,10 70:13

70:15 72:18 105:20

105:21 106:17,19

110:5,6 115:5,6,14,19

116:3,9,15 118:12

122:2 126:3,9 128:8,9

128:21 129:1,4,12

140:4,9 143:12,15

145:10 153:15,16

198:15,16 217:8,12

217:15,17,19 221:22

223:12 236:3,12,18

237:3,11,13,17,21

238:5,8,12 239:9,14

240:13 253:17 254:7

254:10,18,22 255:2,6

255:11,13,17 264:22

265:9 273:10

Boden's 123:13

bodies 178:15

body 111:21

book 53:16 87:8 90:19

113:22 204:1 266:22

267:6

books 180:16

Boston 7:13

bother 48:15

bottom 36:19 38:5 39:7

56:17 131:3 245:9

Boulder 169:22

boundaries 268:4,12

box 37:15,20

brain 202:6 258:7

branch 35:22

brand 252:19

break 5:4,8 64:1,10

102:20,22 112:1

113:5 161:9 162:8,20

brief 23:15 135:17

169:8

briefed 257:5

briefing 87:8 90:19

257:18

briefly 23:13 173:2

277:19

bring 15:7 23:22 113:3

160:1 195:21 196:18

210:3 247:4

bringing 169:16

brings 25:1

broad 32:12 104:20

105:2 209:22 236:8

broader 120:15

broken 112:17

brought 107:20 172:13

brown 23:6

building 5:19 11:13

37:18 43:21 75:13

76:9,10 171:18

174:20,22

buildings 38:1

built 170:4

bulk 92:13,14

bulleted 91:17

bullets 15:20 77:20

bunch 11:19 240:21

265:1

burden 69:14 114:13

209:17 224:3,5

235:13 237:22,22

238:9

burdensome 105:16

106:16

business 169:10

buttons 43:3

C

C 114:1 197:13

C1 191:17

CA- 183:5

cadmium 47:6,7,9,17

184:6,6

cadmium-109 184:7

calendars 261:22

270:16

call 11:19 18:12 27:13

27:17 66:18 101:10

117:5 123:14 149:10

170:8 261:1,2 263:16

271:17,17

called 27:11 35:15,18

174:1 181:5 258:2

calling 66:3

calls 257:19 258:1

267:18

Camp 179:11

cancer 47:1 179:9

184:19,21

cancers 92:17

capable 267:21

capture 76:15

carcinogen 184:12

carcinogenic 14:15

173:6

carcinogens 184:11

card 75:2 278:7 282:11

282:13 283:1

cardiologist 188:8

189:4

care 241:5

carefully 258:21

Carrie 2:8 7:20 23:3

carries 241:18

Carroll 185:13,14 194:6

Cartier 130:11

case 15:17,18 40:6

47:11,16 58:3,7 62:1

63:4 64:22 65:10,11

67:3 81:3 83:1,20

85:2,10 96:16 97:12

98:20 103:15 117:21

121:19 122:17 173:14

174:12 176:18 187:6

230:19 231:3 235:9

cases 20:2 26:5,14,14

55:7,10 69:15 77:14

78:8 83:6,8 91:20

93:4 181:15 182:16

189:19 195:8

cash 283:8

Cassano 2:9 7:6,6

46:13,14 48:1,3,6

71:6,7 72:12 93:14,15

107:8,15 110:15,16

111:9 114:12 117:7

118:4 119:11,13

122:3,14 124:17,18

127:20 129:11 131:9

132:10 134:6,7

135:18,19 136:4,7,20

137:2,4,9,16,22 138:8

138:11,20 139:2,13

139:20 140:2,7,11,13

140:18,22 141:7

142:6 143:14,16,22

144:6,12,18 145:6

146:8,10 147:8 149:3

150:9 154:7,22 155:5

156:9 197:18 198:18

199:19,20 200:1,16

204:16 205:15 206:3

206:21 207:3 208:8
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

288

208:13 210:14,17

211:1,7,13,20 212:1

212:14 213:5,10,15

214:19 215:8,16,19

215:22 216:21 217:2

217:6,10,16,18,22

218:6,9,13 219:2,5

221:4 231:5 233:14

239:8,11 240:5,7

241:8 242:17 244:9

245:1,14,20 246:21

247:6,10,16 248:7,10

248:16,20 249:9,12

250:3,6 262:4,9

275:13

catch 50:19

categories 33:3 37:3

93:8 175:8,9

category 28:18 31:6

37:1 43:20 92:5

174:19,21 175:1,3,5

CATI 65:19

caucus 261:21

Caudill 195:13

caught 162:3

causal 95:6 173:21

174:5

causation 78:4 83:4

96:7,8 130:12 206:14

209:5,12 219:19

220:3 224:18 235:9

235:18 246:16 252:8

252:9 254:9,10,12,21

254:22 255:5,16

cause 133:11 140:20

179:6,10 180:20

184:18 185:2 210:9

215:15

caused 94:2 132:14

135:1,4,6 142:16,19

144:5 178:19 179:5,9

179:22 180:2 207:10

207:16 253:19 254:1

caused' 142:14

CBD 88:11,12 191:8

192:15,19 193:21

194:11,20

CE 15:14 18:6 21:18,20

22:12 26:9 29:19,20

30:7 34:3 40:7,12

46:16 47:2,7,18 57:7

62:9 79:19 183:5

220:6 221:13

CE's 108:15,15 187:22

cell 184:18

cement 40:19 47:3

center 7:17 10:18 17:1

36:3

centers 68:3 179:15

Central 10:22

ceremony 5:6

certain 60:7 88:11

190:19 230:4 256:13

268:7 271:18

certainly 12:14 61:22

97:21 130:14 197:13

259:19

certainty 171:6

certified 14:22 24:5

CFR 14:2,11

chair 1:21 2:7 4:3,19

5:12 6:17,20 8:11,16

33:9 35:6 42:15 44:13

46:13 48:7 51:22

52:14,21 56:14 58:1

58:16,20 59:3,5,12,17

64:13 65:9 67:18 68:9

68:18,20 69:5,8 70:11

70:14,16 71:4 72:13

74:21 75:5 76:18

77:16 78:18 81:15

82:1,4,6,10,14,18

84:3 86:5,10,14 87:1

87:4,10,19 88:7,18

89:2 91:3 92:12 93:14

94:16 96:5 98:5,17,22

99:17 100:6 102:3,17

106:11,18,20 107:13

107:16 108:12 109:2

109:21 110:4,15

111:8,10,22 112:6

113:2 114:14 115:12

115:15,20 116:5,13

116:19 117:1,11,16

118:1,14,22 120:5,18

121:3,6 123:9,22

124:3,9,17 125:15

126:8,17 127:8 128:1

128:7,16,19,22 129:2

129:5,19 131:4,7

132:8,20 133:7,16

134:5,12 136:2,5,18

136:21 137:3,19

138:5,9,13,21 139:3

139:10,17,22 140:19

141:1,5,8,19,22 142:4

143:20 144:1,7,14,17

144:20 145:4,7,12

147:6,9,17,22 148:12

149:4,17 150:21

151:22 152:7,10

153:8,14 154:6,16

155:1 158:13 159:6

159:12 161:1 162:13

162:15,18 163:10

165:21 166:1,17,22

167:12,20 172:17,20

185:8 194:5 195:11

195:17 196:1,12

198:14,19 199:4,8,12

199:18,21 201:8

202:13,16,22 205:12

205:16 206:20 207:2

207:19 208:10,14

210:15,21 211:16

212:3 213:2,6,11,14

213:16 214:2,8,15,18

215:2,9,17,21 216:3,9

216:13,22 217:4,7

218:3,7,10 219:14

221:18 223:8,13

224:9 225:13 226:22

227:5,8,22 228:3,6

229:19 231:4,8,12,22

232:14,22 233:3,19

233:22 234:8 235:2

236:4,17,20 237:9,12

237:15,20 238:2,6,10

239:2,12,15 240:6

241:11,13 242:1,10

243:18,21 244:2

245:22 246:4 247:2,8

247:12,17 248:12,19

248:22 249:3,10,13

249:21 250:9,18,21

251:1,6,22 252:3,14

252:16 253:1,12,15

254:5,9,15,19 255:1,4

255:18,21 256:9,18

256:21 257:2 258:15

258:19 259:3,8,13

261:4,8 262:10,13,15

262:18 263:20 264:15

264:21 265:6,20

266:14,17,20 268:2

268:17 269:8,17,21

270:4,8,13 271:11

276:7 277:9,16

278:14,17 279:3,6,11

280:6,8,20 281:2,6,8

281:15 282:3,6,12

283:12

chairs 164:19 167:17

269:9

challenge 227:10

challenging 72:17

chance 226:9 231:2

change 103:20 104:5,7

104:13 105:5,15,19

105:19,22 106:3,10

106:15 107:4 108:15

108:17,18 110:10,14

113:12,17 114:21

115:9,17 116:10,18

119:8 120:13,20

121:11 122:12 124:16

125:4,12 126:7,13

127:18,18 128:11

129:15 138:4,6,9

141:16 144:21,22

145:6,8,22 146:2,9

148:5 153:17,19

180:5 187:16 192:6

193:7 201:15 216:7

219:15 223:10 229:21

231:10 237:5 244:13

257:10,12

changed 108:20 113:4

113:20 127:9,14

133:3 139:2 143:13

190:7 225:6 226:18

247:16 248:1 267:5

changed' 145:1

changes 3:5,10 102:21

103:6,11,14 106:5

108:16 109:6,9,20

110:3 113:14,22

114:2 128:17 129:5

130:8 138:18 146:11

154:3,5 157:21

161:12 163:4 186:3,6

194:7 196:17 197:9

198:13 203:18 216:8

226:5 227:15 228:10

230:5,9,10 232:8

244:19 249:5 252:5

255:7,8 257:4,6,17

258:3 259:20

changing 104:15,17

107:3,12 108:1

111:16,18 113:4

117:6 135:22 186:1

226:5 229:15 236:13

236:14 244:14

charge 146:10

charter 8:20 130:7

257:8,11

check 19:7 21:17 47:18

183:17 256:10 281:3

check-off 183:7

checked 37:6 38:8,14

38:14 52:5,6 59:22

68:15

checking 4:6

chelation 178:14

chem 43:19,20

chemical 45:13 181:8

chemicals 43:6,18

64:19 74:12 75:14

170:6 184:2,3

chest 221:8

Chicago 180:15
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

289

Chief 2:20 9:8

children 17:8

chiropractors 146:15

146:20 149:13

choosing 129:20

chronic 5:2 6:3 179:10

179:17 185:19 186:19

187:4 188:2,6,9,12

189:1,9 190:22 191:1

191:15,20 192:1,4

194:9 195:6 258:13

chuck 92:17 93:11

chunk 269:5

CIH's 15:2

circuiting 230:22

circular 54:6 64:17

89:19 90:18 91:4 99:3

circulars 56:7 89:12,16

90:8

circulate 168:11 260:6

270:19

circumstances 53:1

90:5

citation 14:10 123:18

125:20

cite 113:16 130:7

cited 45:10 80:14,15

cites 40:13,16

citing 80:16

City 6:21 177:5 178:3

279:2,5

civilian 150:9

claim 20:10 54:20 55:2

55:4 187:5 193:21

206:7 215:6 217:22

232:21

claimant 2:10 6:15 49:5

55:2 62:4 65:12 66:15

66:18 83:19 111:12

111:19 113:16 119:14

119:14 131:10 148:10

178:10 183:9 186:16

190:1,5,8 193:12

203:1 205:4 207:12

209:2 210:7 212:6

220:19 221:5 224:5,5

235:15 236:11 238:9

238:16 240:21 242:6

244:4,10 246:15

claimant's 103:20

198:10

claimants 21:19 39:22

65:18 66:3 69:15

101:22 104:2,3,6

105:3,18 106:5 107:4

113:9,10 114:8 115:7

115:8 116:4,10 171:6

176:9 181:11 182:8

183:22 209:17 210:2

235:13 238:1 280:22

claimants' 236:21

claimed 14:19

claims 15:11 20:4,9

24:11 29:6 30:15

53:13,22 54:13 55:19

62:5 84:19 85:3 95:2

170:18 182:6 187:1

192:17 226:16 243:8

263:4

clarification 55:14 78:6

104:16 242:11 250:20

251:17

clarify 104:1 113:9

126:3 128:16 198:9

243:16 266:5

class 155:2

classification 56:22

classified 175:19,19

176:3

clear 55:12 74:14 108:6

213:4 215:22 235:21

249:4 259:7 274:16

277:5 283:20

clearer 145:3

clearly 22:22 242:4

client 127:12

clients 192:5

clinic 8:5 77:1

clinical 146:14

close 111:11 177:15

191:21 201:17 253:10

260:1 282:9

closed 176:19 233:7

234:1

CM 64:22 81:2

CMC 12:18 19:17,20

22:14 27:1,7 55:3,5

55:10,14 77:19 78:2

79:4 81:2,4 82:22

83:9,19 85:5,6,9,14

85:21,22 91:10

176:10 193:8 220:7

CMC's 84:16 181:16

CMS 23:21

code 163:18,19

codifying 123:14

125:18

cognizant 59:7

cohorts 52:19

Coke 151:4

colitis 180:20

collected 60:4

collective 70:2 72:19

73:9

College 7:3

colon 180:21 213:13

Colorado 6:3 169:3,22

column 28:16

combing 265:4

come 9:9 10:9 31:7

33:17 51:14 57:14

80:3,4 87:12 91:18

92:20 96:2 98:15

101:10 103:4,7

108:17 169:1,12

177:9 183:1 220:8

238:16 243:6,7 260:7

260:14

comes 14:2 17:1 18:16

28:16 34:1,12,15 35:3

50:20 55:1 57:2 95:6

143:18 238:21

comfort 230:4

coming 28:19 33:13,19

49:21 174:16 195:3

207:2 228:20

comma 218:8,10,12,14

comment 3:8 52:15

74:22 75:4 93:15

94:15 99:16 110:2,17

124:2,15 126:11,13

129:14,18 155:9

161:2 163:1,11,14

164:1,7,13 168:20

185:10,11,22 195:20

195:22 196:4,10,14

198:17 201:20 222:5

227:3 231:13 241:12

251:7 256:14 279:8

commented 133:4

228:18

commenting 218:18

256:17

comments 38:10 82:19

90:14 99:2,18 102:16

104:10 105:20 114:3

116:14 118:22 120:12

121:6,13 122:1

123:12,12 125:16

126:2 127:10 129:6

132:21 133:5,14,18

134:5,13 135:18

141:11 142:3 144:2

145:8 147:19 148:12

149:7,18 150:21

153:14 154:6 158:22

168:17 194:21 195:1

195:2 196:13 198:15

201:16,18 203:3

228:13,21 229:3

233:7,9 234:1 239:19

240:4 250:15 251:2

255:18 256:6 259:11

259:21

commercial 10:20

Commission 10:5

commitment 209:14

235:10

committee 90:22 91:5

96:12 98:7,10 99:19

99:22,22 120:12

123:11 133:1,2,8

152:12 166:14 171:21

182:12 251:19 261:15

272:2,10,15,18,20

273:1,3,8,19 274:3,5

274:13 277:7

committees 132:21

147:10 261:16

common 20:20 21:13

88:19

communicate 22:21,22

105:10 164:21 167:1

277:6

communicated 57:8,9

communication 167:3

266:6

communications 166:4

166:14,18

communities 209:13

235:10 279:22,22

community 2:2,6,10

279:18

comp 182:16

compensable 132:6

compensate 156:15

222:22

compensated 134:16

142:8 150:15

compensation 35:14

170:15,16 183:3

complete 27:5 44:6

79:22 85:10

completely 26:4 80:1

230:21 250:6

complex 6:10 11:20

48:12 75:14 90:5

181:15

complexity 66:10 67:6

compliance 80:5

complicated 100:17

226:4

compliment 207:20

comply 197:19

component 81:1

compound 184:7

compounds 184:6

concept 109:5 133:9

concern 117:10 121:20

127:11 148:6 230:9

232:3 236:13 258:22

concerned 69:11
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

290

110:18 121:11 151:2

209:20 232:18 236:7

237:4

concerning 18:9

concerns 60:7 133:6

232:12 240:9,15,17

concludes 56:18 256:5

conclusion 42:9 62:3,4

62:6 220:8

concrete 96:20

concur 153:10 200:11

201:4,13

condition 19:6,12 22:20

28:19 50:15 186:17

187:19

conditioners 177:13

conditions 28:20 92:15

188:22 189:9

conduct 169:10 272:16

conducted 17:2 81:14

conference 117:4

123:14 282:16

confident 230:6

confirm 70:21 131:8

confirmed 112:20

conflict 267:13 274:15

275:9 280:19

conflicts 138:3 282:5

conform 201:9

confused 46:15 226:20

congratulations 71:8

Congress 170:14 171:8

186:2 187:7 194:16

Congress' 181:17

Congressional 182:12

Congressman 169:2,4

connect 4:16 103:15

connection 70:8 96:10

197:8

consequential 78:5

87:21 187:17

consequentials 88:6

consider 102:14 161:13

171:22 173:4,12

201:16 203:4 216:15

220:1 244:20 271:12

276:2 279:15 280:10

281:22

considerable 270:18

consideration 263:1

considered 41:19 81:7

107:11 118:19,21

155:22 157:13 207:18

210:11,16,18 212:22

245:10,17,21 257:7

266:19 275:18

considered' 211:9,9

considering 169:19

171:14 220:6

consistency 9:5 20:5

consistent 20:7,16

181:19 192:14 193:5

193:20 194:9,11

199:6 202:15 232:11

252:7 254:13 268:1

consisting 147:1

consists 192:19

constant 20:14

constantly 19:14

221:12

consternation 89:13

constitute 150:18

151:14

Constitution 1:19

construction 151:8

consultant 7:19 178:17

consultants 95:3

consulted 50:7

consulting 9:2 11:3

147:14

contact 98:16 195:13

contain 16:1 81:1 207:8

contained 27:17 272:11

containing 206:10

207:4 212:7

contains 18:15 135:11

143:2

CONTENTS 3:1

continually 221:7

continue 58:12 59:7

77:17 112:12 180:4

235:3 271:2 281:12

continued 10:18 132:17

contract 12:18 21:22

23:9 24:4,17 71:9

80:6,18 81:13,16,20

99:6 150:12 156:11

156:13,17

contracted 71:10

192:16

contractor 13:20 15:1

24:9 29:18 64:6 71:20

80:10 99:7 150:8

204:10

contractors 31:3 36:16

71:16

contracts 157:9

contradictory 198:2

contradicts 198:3

contribute 133:10

180:20 184:18

contributed 134:17

135:3,6 140:20 142:9

142:16,19 144:5,10

144:11,13 207:10,16

210:10

contributing 174:8

215:15

contribution 96:8

219:20 246:16 252:9

254:6,8 255:5,16

control 108:11 222:1

controlled 41:20

convene 273:7

convened 169:6 172:11

272:15 273:2 274:4

conversation 64:6

conversations 90:3

convince 131:18 134:8

134:9 136:16 138:7

140:7,10,11 143:6

convince' 134:2,11

135:22 136:15,15

139:1,7,14 140:6

Convinced 139:11

convinced' 137:20

138:7

COPD 31:22 32:3 46:18

48:15 56:11 173:22

COPD's 92:16

copied 167:2

copies 23:5 27:8

copy 22:10 81:16 82:1

164:22 277:7 283:7

cor 189:5

core 12:13 210:9

Corp 157:2,5

correct 80:11 87:18

106:17 128:4 129:4

139:6 141:8 147:2

165:21 213:1 224:14

cost 188:14,15

Council 6:13

country 170:12,13

couple 13:9 24:20 29:1

42:16 64:15 72:14

79:10 98:1 99:1

104:11 112:11 162:11

203:5 260:3

course 120:21 154:19

160:14 264:9

court 124:7

cousins 201:18

cover 10:10 273:17

coverage 150:19

154:21 160:16 213:1

225:16

covered 13:19,19 77:21

78:8,12 119:15 123:5

131:11,18,20 132:14

132:15,15,16,18

133:10,13,15 134:16

134:19 135:5 136:11

136:14 142:8,11,18

143:10 152:15 156:20

157:4,10,13,17,19

179:21 187:21 189:14

189:20 190:2,6,9

197:13 200:2,5,10,11

200:18,21 201:4,5

206:1,11 212:8,16,19

212:20 214:6 215:1

218:19,22 219:1,7,8

219:10,11,16 220:4

221:10 225:5,7,14

239:22 240:1,2 244:5

273:18

covering 108:5

covers 157:11 277:17

coworkers 17:16 205:4

crawl 43:21

create 217:5,6

created 17:21

creating 105:2 262:21

credentials 181:3

credit 278:7 282:11,13

283:1

creosote 177:7

criteria 104:15 132:11

186:5,15,20 187:7

190:20 191:16 244:8

criticism 58:6

cross 100:19

crossed 177:13 222:7

CT 194:2,6 221:7

cubicle 178:4

cued 195:19

current 20:22 61:3

107:18 109:18 110:2

115:12,18 125:7,8

201:11,12,14 238:15

currently 14:21 19:21

24:13 39:15 55:19

69:20

cursor 137:15,16

curve 25:12

cuts 124:11

D

D 2:11 39:11,14 146:5

190:18 197:14 239:6

D.C 1:20 11:3

daily 37:16 42:4

damage 184:19

dangerous 153:12

DAR 15:22 34:10 60:5

61:15

data 15:3,6 34:22 35:3

41:5 45:10,12,17 46:8

46:9 48:18 53:3,4,5,6

60:3,21 61:20 65:2

69:12 91:12 158:7
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

291

195:6 264:6 266:9

269:14 270:2,2,6

database 72:10 263:3

date 24:20 53:12 78:5

111:15 165:3 167:8

168:10 260:7,8,15

dated 191:13

dates 27:3,22 165:10

165:12 168:7,11

260:6 268:21 270:15

271:3

daunting 86:2 110:11

day 4:7,20 25:15 43:19

162:19 183:17 261:1

262:6 269:6 271:18

days 59:2 118:18,20

173:1 265:18 271:5,6

271:7 274:9 280:17

280:17 283:1,2,4

deadlines 229:14

deal 25:9 48:18 164:6

169:13

dealing 53:8 93:17

95:21

deals 103:19

dealt 152:21

death 215:12

decades 170:9

deceased 123:5

decent 243:6,7

decide 126:21 127:22

165:2 268:20 276:12

277:20

decided 53:2 166:7

193:7

decision 62:20 80:20

91:15 94:20 127:4

132:2 134:1 135:15

143:5 166:8 214:12

243:10

decisions 91:13 174:13

declaration 200:6,22

deconflict 262:7

deem 82:15 206:15

209:21 220:15 236:8

deemed 204:12 205:8

223:4

DEEOIC 2:21 125:21

deep 271:1

default 246:5,5

defense 11:8

defer 121:1

deficiencies 22:5

deficits 194:8,15

define 155:2 157:16

268:3 269:14,14

270:6

defined 120:3 146:16

206:12 207:6,14

212:15,17 214:5

215:5 272:13

defined' 214:22

defines 146:1 214:6

218:21

defining 148:7

definitely 189:2

definition 3:7 120:16

147:12 148:2,16

150:7 184:14 234:17

243:15 245:4

definitions 145:21

150:6 242:22

definitively 219:11

degree 183:15

delay 4:9 227:20 235:1

260:10 268:10

delays 117:17

delete 220:13 249:14

deleting 153:6 201:21

218:20 223:15

deliberate 267:5 276:1

deliberation 272:19

276:4

deliberations 267:22

deliver 159:14

delivering 151:4,10

152:4

delivers 155:6

delivery 150:16 151:7

151:12 152:13 153:2

154:1,9,14,19 155:4

158:11,21 159:9,20

160:9,14,18

demand 57:18

Dement 2:3 7:15,15

33:9,10,15 48:7,8

69:5,6 74:22 75:4,7

96:13,14 97:6,16,19

230:7,8 231:7,9,13

demo 14:16

demographic 27:19

demonstrate 81:3

152:22

demonstrated 147:3

demonstrates 14:17

173:9

demonstration 64:5

denial 85:9

denials 49:12 83:7,15

denied 55:7 83:2

178:15 179:2 180:13

182:6

dentists 146:13

Denver 6:2 169:21,22

279:2,4

deny 85:4

department 1:1,19 7:12

8:17 9:3 25:4,5 39:12

70:20 71:6 86:16

95:11 99:11 178:7

180:12 234:10 265:7

278:21

departmental 156:20

157:12

depending 66:10 91:11

111:21 265:13

depends 55:5 67:10

234:17

Dept 3:4

Deputy 23:12

describe 18:3 38:9

78:21 189:4 191:3

describes 193:17 209:3

235:17

describing 188:9

descriptions 26:17,17

deserve 155:2

deserved 170:17

designated 2:14 8:7

142:6 197:18

designed 95:9

desire 149:7 267:13

274:8,21 275:9

283:20

detail 51:17 57:19 64:9

74:10 224:22

detailed 51:9 122:18

details 77:4

determination 123:5

224:18 233:10

determinations 100:22

122:16,20

determine 95:12 134:10

136:11,17 138:1

139:14,21 140:3

143:8 154:10 155:7

186:16 192:17 268:12

275:21

determine' 139:4,8,15

139:18

determined 138:10

139:12 193:19 219:7

239:8

determined' 137:21

138:10

determines 109:10

204:18

determining 14:8

150:19 207:15 275:16

detrimental 124:5

develop 204:5 231:2

developed 27:4 39:9

49:14 75:18 189:20

190:5,21 191:1

230:20

development 176:13

diagnosed 6:3 179:1

186:18,19 190:11

191:5,15,19 192:3

194:20 219:16 244:5

diagnoses 88:20

diagnosing 31:22

diagnosis 32:3 77:6

78:4,5 95:13 174:10

190:1,8 192:11

197:12 206:1,10

207:5 212:8,12

213:22 214:11,11,14

219:9,18 220:1 225:9

230:14 244:8,15

diagnostic 186:15

187:7

dial 163:15

dialed 195:15

die 4:22 5:1

diem 282:20

diesel 40:19 96:20

difference 195:4

different 20:4 21:8

27:14 33:1 37:3 38:1

59:20 71:12 75:22

102:8 108:4 114:15

114:15 122:19 126:4

155:13 168:3 213:4

222:17 223:3 261:11

277:22 278:19,19

difficult 85:20 171:15

171:22 181:15 182:16

182:17,19 186:7,22

diplomatic 114:18

direct 21:19 137:14

167:2

directed 166:5

directly 222:9

director 2:21 5:19 7:22

12:10,11,12,15 23:12

disability 134:4

disagree 201:4,13

241:2

disagreed 220:12

disagrees 200:9,9,11

201:3,13

discover 50:22

discuss 8:17 13:3

16:13 58:5 96:7 103:6

103:10 164:3,14

168:9 199:3 257:13

270:14 271:20 273:2

274:4 277:18 278:12

discussed 13:2 56:2

89:10 196:21 230:9

240:3 257:18,19
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

292

258:1 259:15

discusses 16:16 39:5

discussing 58:3 103:3

113:4 159:20 239:21

discussion 40:18 98:8

98:10 114:3 117:2

118:14 122:4 129:13

129:16 145:9 146:7

168:12 196:17 198:15

198:20 202:9 205:12

205:13 212:16 221:21

255:19 261:9 262:22

discussions 101:2,14

disease 6:4 94:1,2,11

96:10 130:13 173:10

173:19 174:4 179:5,6

179:10 183:6 185:15

185:19 186:19 187:4

187:12,13 188:3,6,9

188:13 189:1,10

190:2,9,10,22 191:2

192:1 194:9 195:7

251:21 258:13

diseases 92:18 93:6,7

179:15 185:2 188:14

253:19 254:1

dismissing 243:2

disorder 191:15,20

192:4

disregarded 211:3

district 19:22 79:6

169:2 178:16

Ditto 121:4

divided 94:22

Division 7:16

DMC 174:9 178:17

doctor 49:7,9,15,20,22

50:6 51:3,5,6 55:12

55:16 56:3,9 58:1

83:16 105:10 108:3,4

108:7 111:14 180:15

180:17 181:5,6,7,9

183:11 187:3,11

191:5 194:10 230:14

doctor's 105:10 108:4

doctors 49:16 50:16

108:2,10,19 111:16

111:18 117:5 148:3

148:11

document 33:19 34:12

36:1 40:9 115:1

235:11 238:22 258:17

documentation 189:19

documented 209:15

documents 16:12 26:15

64:7

DOE 5:20 11:4,6,20

13:19,19 15:22 17:17

34:13 36:14 60:9

71:21 90:5 99:14

119:19 120:2 150:7

150:12,14,17 151:13

154:20 155:11 156:22

156:22 157:13 160:15

177:3,10 200:8 201:2

204:9,9,10 205:7,10

206:17 209:13 212:10

235:10 279:7,17,18

279:22

doing 11:7 19:2,3 37:17

39:13 50:5 54:19

73:14 74:16 75:13

76:4 92:8 97:5,12,14

192:9 209:10 220:18

224:4 227:15 228:4

241:3 262:21 263:8

DOL 9:22 11:4,22 57:22

108:16 118:17 125:8

125:9 141:10 149:16

161:12 164:10 165:3

204:17 209:1 212:10

235:14 246:11 257:5

257:6 281:11 283:18

DOL's 257:14 259:21

Domina 2:11 6:11,11

42:15,16 44:16 51:18

98:22 99:1 100:8

155:9

Donna 172:21

dose 53:3

dosimeter 158:8

dosimetry 16:8 41:5

double- 256:9

double-check 71:3

Doug 23:8 71:14

Douglas 23:11

downstairs 5:6

Dr 5:16 33:9 44:13

46:13 48:7 52:14

56:14 58:6 59:17

65:11 67:18 69:5,8

71:6 72:15 74:22

76:18,21 82:20 84:3

92:12 93:14 94:16,16

96:13 102:3,5 105:20

106:20 109:3 110:4

110:15 114:16 115:5

117:2,7,7 119:11

121:3,4 122:2,2

123:12 124:3,17

125:15 128:8 129:11

129:12 133:7,16

134:6 135:18 144:2

146:8 147:10,22

149:7 152:10 153:8

153:15 166:2 192:16

193:9,16 198:15,20

199:18 201:18 213:11

213:16 215:9 220:8

221:18 224:9,10,11

225:18 228:11 230:7

233:3 234:13 247:19

250:15 251:15 262:19

266:3 268:22 269:10

269:11 271:7 276:7

277:10 279:19

draconian 124:20

draft 3:6 103:21 105:17

113:3 121:8 125:17

127:9 134:14 148:13

149:5 154:17 204:14

204:16 209:8 253:3

269:15 272:19

drafted 10:13,17

drafts 102:13

draw 56:16 70:3

drawn 196:21

drew 197:16

drill 96:19

drinking 179:12

drive 75:20

driver 75:11 76:2

158:12

drivers 158:6

drop 118:10

dropped 247:13

due 41:7 131:11,20

132:4 134:19 136:13

142:10 143:10 175:7

Duke 7:17

dump 34:12

duration 14:14 173:6

Duronda 2:11 5:7 6:5

dust 32:6 47:3 119:16

dusts 39:6

duties 119:17

E

E 12:3,4 16:6 41:3,7

123:5 131:19 132:7

132:12,14,15 136:12

181:22 184:9 212:22

256:16 259:2

e.g 142:9

earlier 19:15 44:5 49:16

56:2 78:9 89:10 90:16

93:3

earliest 191:13 260:9

early 11:2 12:10 19:9

134:20 142:11 180:6

earn 132:17

earned 170:17

easier 167:6 261:2

easiest 231:19

easily 94:22 95:17

127:10,14

East 7:4 37:22

Ed 169:2,7 171:3

edit 109:6 226:2

editing 109:13 141:16

149:11

edition 122:21 123:11

123:15,18 124:5,10

124:19 125:2,6,8,10

125:18,21 128:14

editions 123:17 125:20

Editorial 255:15

educated 226:13

EEOIC 135:4 142:17

EEOICP 154:21 160:16

EEOICPA 34:10 187:8

effect 106:3 129:11

214:7

effective 24:3 69:17

271:5

effects 76:6

effort 20:22 32:8 35:21

171:8 242:19

efforts 171:16

Eight 35:12

Eight-zero-five 131:5

eighth 125:1

either 17:2 35:22 36:4

41:9,13 46:8 47:20

68:14 69:18 92:3

109:5 182:14 190:20

191:14 200:9,9 201:3

206:17 210:19 252:4

265:9 281:21 282:1

electrician 34:2 40:22

42:18 43:16 48:14

74:1,2 96:19 97:12

98:13

electricians 42:20

electronic 283:7

elements 80:5 198:8

elevator 43:2

elicit 39:21

eligibility 132:11

eligible 121:13

eliminate 109:9 120:22

eliminated 113:14

159:10 160:19

eliminates 143:9

eliminating 24:14

152:21

email 4:15 8:11,12 28:9

29:14 30:7 33:20,22

112:22 167:2,4,10,15

167:17 266:13 267:11

275:4 277:4,11

282:17 283:6
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

293

emails 29:1,21 267:16

267:17 276:19

emergency 10:17

emphasize 100:14

employed 40:21

employee 3:7 6:12 15:2

15:5 16:13 17:15 18:1

22:20 27:20 36:6

119:15,15 123:6

131:19 150:8,10

156:14 157:7,10

189:20 190:5,21

191:14 200:7 201:1

205:9 206:7,15

219:16 220:15 222:14

223:5 232:20 237:5

237:18 244:5,22

employee's 132:15,16

136:12 183:3 206:11

207:5,10 212:8 214:4

215:5

employees 15:1 35:13

156:20 157:12 170:14

207:15

employees' 214:16

employer 52:11 57:10

employing 150:11

employment 13:20 16:5

16:14 26:16,17 27:21

27:22 28:15 33:4 34:7

34:21 36:14,17 37:4

37:17 40:17 119:18

120:1 132:18 177:18

197:6,11,21 198:10

200:2,6,10,12,18,22

201:4,5 225:12

employment-related

14:4

employs 22:15

enable 106:13

encompassed 225:16

encompasses 13:16

encountered 76:12

88:19

encourage 56:1 167:21

ended 10:6

endorse 115:5

ends 52:9

energy 23:12,16 25:5,6

35:13 39:13 43:8 71:6

99:12 170:14 278:21

energyadvisorboard...

113:1

energyadvisoryboar...

8:13

engage 273:20 274:13

engine 40:20

Engineer 157:5

Engineers 157:2

engines 96:20

English 144:4 149:10

enlighten 61:9

ensure 9:4 19:10 20:5

254:12

entails 152:14

enter 163:18

entered 150:12

entire 215:1

entirety 245:13

entity 200:9 201:3

204:12 205:7

environment 11:9

127:19

environmental 7:3,10

7:12,16 8:1,5 41:8,8

177:14,16 183:14

epidemiologist 7:1 8:4

12:8

equipment 38:6 44:1

equitable 99:11

era 107:18

especially 16:10,20

33:1 51:7 60:16 167:7

177:15

essence 26:3 27:12,16

40:10 79:12 82:11

essential 78:10

essentially 11:1 14:12

30:7 31:18 37:17

40:18 41:12,14 68:7

79:16 80:5 81:13

106:12 123:10 128:20

129:14 137:21 204:10

219:19 242:15 260:17

establish 13:12 178:8

179:19 190:21 191:22

191:22 205:9 219:8

219:15 220:4 221:9

232:21 244:4

established 83:1,8

186:8,16,21 191:2

establishing 14:3 25:19

204:7 206:1 244:7,10

estimate 42:1 63:2

etcetera 134:1,1 148:18

148:21 165:6 206:18

206:18 219:20 220:8

evaluate 15:2 20:15

47:7,9 50:1 155:6

186:13 200:12 201:6

242:14

evaluated 124:12

154:10 210:22 211:5

211:14,14,20 219:10

evaluated' 211:10

evaluating 92:10

evaluation 29:11 123:1

evaluations 102:8

evasive 184:21

event 35:2 74:17

eventually 124:14

219:6

everybody 42:20 96:1

101:22 152:22 169:5

everybody's 167:9,14

evidence 13:17,18,19

14:14,17 18:1 22:16

48:4 94:13 104:4

105:8 106:4 113:11

114:9,21 122:17

123:6 130:12 131:10

131:16,22 133:5,21

135:13 136:9 137:6

137:12 143:4 151:16

158:10 173:6,9

179:19 180:10,13

182:21 186:13 189:15

191:13 198:11 200:2

200:5,17,21 204:6

206:10,14 207:4,7

209:3,20,21 212:7,11

214:13 220:14 222:20

232:20 235:16 236:8

exactly 5:10 67:3 117:3

117:20 127:2 136:22

147:18 180:11 191:9

229:4 233:13 242:12

examine 254:11 257:12

examiner 15:12 29:6

30:16 53:13,22 54:13

55:20 62:5 84:19

148:9 243:8

examiner's 187:5

examiners 20:4,10

24:11 85:3 174:13

187:1 192:17

example 20:21 26:9

45:10 59:14 74:7

96:19 134:18 148:20

157:1 188:2 266:8

examples 23:6 64:3

exceed 262:14

exceeding 41:17

excellent 75:8 123:9

164:10

exceptionally 23:18

excited 24:3,22

excites 25:11

exciting 71:18

exclude 111:1

excluded 272:10

274:18,20

excludes 147:13

excluding 156:2 158:9

executed 24:4,18

exercise 39:18 194:8

exhaust 40:20

exigent 117:21

exist 147:3 192:19

232:21

existing 72:10

exists 201:11

expand 18:7

expanded 147:13

expected 10:16

expedited 117:14

expediter 175:12

expediters 175:11

expense 177:18

expenses 282:18

experience 23:20 24:1

25:2 52:17 55:16

71:17,19 92:7 93:17

97:7,8 136:12 169:16

230:3 240:14 261:10

experienced 131:19

experiences 172:2

expert 22:8

expertise 25:10 51:11

55:13 91:6 169:17

172:2 173:8 209:12

235:8

experts 51:16 146:6

explain 32:14 156:3

282:13

explained 132:1 133:22

135:14 143:5

explains 89:18,19

explanatory 89:8

explicit 102:14

Explore 168:7

explosives 38:16

exposed 16:18 32:13

38:15 42:21 43:11

44:20,21 45:1,2 49:8

50:12 64:19 93:22

119:15 121:12 153:21

154:18 160:13 175:4

175:22 179:2,22

180:4 205:10

exposing 180:7

exposure 13:18 14:4,5

14:7,14 15:13,16,16

15:16,22 29:11 30:20

32:15,17 38:11 39:3

41:14,19,19 42:2,3

45:6 46:8 49:6 52:19

53:6,18 61:16 62:19

68:16 70:10 75:11

76:3,5 77:3 93:19

94:3,6,6,9,13,13 95:1

95:13,13 96:10,17
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130:13 151:16 152:14

153:1 154:11 174:17

174:18 176:8 178:8

182:22 183:12 184:9

195:9 197:11,12

203:16 204:7,11

206:16 207:11,17

215:13 220:12,16,21

222:16,17 223:6,20

237:7 238:3,15,17

249:20 250:2

exposures 7:9 18:10

28:16 32:6 40:13

50:13 51:9 52:7 56:11

56:18 59:20 60:1,8,10

61:3,5 70:3 71:12

73:6 75:15 98:19

159:15 177:19 179:14

179:16,17

express 193:20 232:2

242:5

expressing 121:19

235:20 249:5

extensive 37:1

extent 58:4,8 146:21

extra 102:22 237:21,22

extremely 59:6 73:1,7

74:3 77:10 283:19

eyes 234:18

F

faced 48:11 170:12

facilities 11:6 25:7

37:21 44:8 51:2,16

121:1 177:4 182:9

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124:6,10,13 125:6,18

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(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

295

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(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

296

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154:11,12,18 155:8

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221:10 222:15 223:6

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implausible 104:3

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(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

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indicating 93:5 207:8

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18:15 20:8,9 21:7

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intelligence 70:2

intelligently 226:10

intended 187:16

intent 140:16,20 149:12

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interpretation 127:13

interpreted 63:4 225:18

interrupt 112:8 252:1

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interviewed 70:3

interviewee 36:6 38:4

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intro 54:19

introduce 172:5

introduction 9:21

introductions 5:15

investigation 193:9,10

invitation 68:21

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involved 69:22 111:21

154:11 155:3 176:3,6

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79:20 80:13 87:11

90:12 103:19 117:9

124:19 148:5 161:2

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59:15 79:15 91:4

105:1,11 194:14

196:20 209:9 226:10

227:7 228:7 251:20

258:12 260:3 269:14

271:10 272:17 283:21

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103:3 150:5 158:14

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Kevin 136:18,22 207:21

211:8 218:11 236:21

240:2 249:8 278:8

282:10,12 283:8

key 283:17

kidney 179:5,6,9,10

kind 20:3 29:22 31:4

35:3 53:7 62:7 71:10

74:18 78:8 91:18 95:9

97:14 98:3 102:5

109:4,13 111:14

131:9 172:12 214:9

222:20 260:20

kinds 27:9 45:13 74:12

76:11 91:20

Kirk 2:11 6:11 100:2,8

know 5:10 9:14 10:2

12:16,18 13:13 17:13

18:3 19:7 20:12 21:4

22:18 24:21 25:1

26:16,18,19 27:5,17

27:21 29:5,21 30:8,19

31:11,16,18 35:21

36:8 37:3,6,20 39:2

39:16 42:8,17 43:9,21

45:4,10,16,21,21,22

46:3,6 47:19 48:17

49:8,10,11,21 50:2,4

50:19 51:8,11,15

54:22 55:6 56:3 57:2

57:4,9 58:22 59:15,16

60:2,4 61:10 62:13,15

62:18,22 63:8,17 64:1

64:11 65:3,7 67:2,5

67:10,11,13 70:7 73:2

73:20,22 74:1,8,10,15

74:16 75:21 76:13

78:1,9 79:15,18,22

80:1,17,20 83:11,14

83:16 84:8,16 85:21

89:6,17 90:7,9,12,12

90:15 91:2,19,21 92:3

92:9,9,21 93:8 96:22

97:9,14,22,22 98:3

99:5 100:16 101:6

103:13 107:21 108:3

111:4,5,18 116:7
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

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149:9,12 151:7 152:3

165:1 169:8,20 173:2

174:11,14 175:8,15

175:16 176:1,1,7,8,16

179:11,14 181:12

182:10 183:19,20,21

183:21,22 184:17,19

185:6,11,15,15,20

188:16 191:11 192:5

195:1 196:6 202:10

214:4,9 219:13 220:6

221:7 223:22 224:19

224:21 225:2 226:17

227:21 228:10,18,22

228:22 229:10,14

233:13 234:3 240:20

241:11 242:6,11,18

245:1,2 255:11 259:4

261:17,17,18,18,18

261:21 262:21 263:12

263:16 264:4,20

265:1,2 267:14

269:12 270:15 271:8

271:14 273:13 275:8

275:16,19 276:9

277:1 280:1,14,16

281:19,21 282:4

knowledge 15:7 72:9

72:19 73:2,9 169:17

230:3

known 173:21 185:5,5

knows 42:20 49:10 54:9

Kotsch 2:19 9:7,12

20:18 25:16 26:1 29:8

29:14,16 30:3,6,11,21

31:1 33:13,18 34:19

35:8 40:4 45:7,16

46:11 47:11 48:2,5

54:6,10,12,15 57:6,15

58:13,19,21 59:4,10

59:13 60:14 61:1,6,9

61:13,18,22 62:8,12

63:6,8,10,15,21 67:4

67:15 68:3,7,12 71:2

74:4 76:7 77:16 79:1

81:11 91:16 92:13

97:3,8,18,21 102:18

L

lab 221:8

labor 1:1,19 3:4 8:18

9:1 28:18 36:22 37:4

70:21 95:12 171:19

174:18,20 175:1,3,5,8

175:8 180:12

laborer 16:15 26:19

lack 41:7 130:2

laid 191:9

Lamar 171:3

language 82:19 104:1

104:20 105:2 106:7

107:8 109:6,14,17,19

110:22 113:5,8,19

114:19 115:5 116:22

118:3,5 120:8 121:16

121:22 124:8 127:7,9

128:8 129:8 130:19

130:20 131:14 133:1

133:3 134:13 135:22

136:3,7,22 137:18

140:18,22 141:1,2

142:2,15 149:2

151:20 156:13 157:15

157:22 158:2 161:11

161:13,14,18 190:7

190:18 196:22 197:16

198:2,3,22 200:4,20

201:11,13,22 204:21

206:4,6,9,22 208:16

208:17,21 210:4

212:4,6,12 216:2

219:21 220:14 228:19

230:11 231:5,6,10,17

231:20 232:2,4,5

235:20 237:5 239:7

240:9,10,15,17,19

241:1,9,17,22 242:2,3

245:21 246:20,22

252:20 253:7,14

255:14

large 60:8 87:22

larger 58:4 79:10

208:22

largest 92:15 93:11

Las 177:17

late 168:16 259:10,16

270:21

Laura 2:7 5:16 126:13

Laurie 5:18 120:18

lavage 193:4

law 94:21 146:17 148:8

182:15

lawyer 180:15 181:6

lead 18:18 178:12,12,14

178:15 188:10

leading 190:10

leads 188:17

leap 189:8

leaps 92:7

learning 71:10

leave 108:17 127:12

128:15,17 155:15

269:9

Lee 192:16 193:16

left 10:20 58:10 124:2

141:10 162:12

legal 234:16

legislation 248:4

legitimate 97:16 107:2

107:6

Leiton 2:21 9:11 19:13

25:17 32:10 34:17

39:9 44:4 48:21 55:4

55:22 63:20,22 65:16

66:7,13 67:2 73:13,16

76:14 77:11,18 81:10

81:21 82:3,5,7,13,17

83:10 84:8,11,14,20

85:12 86:8,12 87:2,5

87:9,18 88:3,8,21

89:3 90:20 92:1 93:2

98:18 100:15 102:18

181:2 281:9,13,17

282:4 283:18

Lejeune 179:11

length 33:3

lengthy 86:15

Les 7:11 123:13 124:11

225:10 254:16

Leslie 2:5 72:18

lesser 31:14

let's 4:3 5:15 13:5 46:18

46:21 58:4,5,6,20

100:1 112:12 113:6

120:11 129:16 130:4

130:16 131:7 149:18

150:4 158:20 162:21

162:21 173:19 186:12

187:15 189:5 205:22

207:8 208:14,15

216:19 235:2 239:9

245:2,10,11 248:4

259:22 260:5 266:8

270:13 277:18 279:12

letter 83:3 189:11

213:22

letters 118:18

level 43:5 51:21 73:6

87:15 95:10 230:4,16

levels 41:13,17 56:20

60:8

libitum 111:4

licensing 10:6,8

lieu 51:13

life 76:5

light 183:16 221:2

likelihood 198:7 202:11

likes 12:7

limit 31:4,17 54:16

121:12 146:22 149:13

limited 147:1 201:10

limits 118:17 198:4

line 56:16,17 135:11

138:2 141:9,10,17

143:2 144:15 158:2,3

186:6 187:21 215:3

233:18,19 237:16

249:9

lines 157:8 160:5

234:20

link 84:7 88:14 112:16

130:13 174:5 180:18

220:11,20 224:1

linked 91:18 174:3

linking 224:8

list 28:2,4,4 29:2 32:9

32:12 37:1 39:17

42:19 76:9,9 86:15

98:1 100:18,19 101:7

173:17 188:22 239:6

257:22,22 265:8,14

265:18,19 266:8

listed 43:15,20 192:8

listen 265:16 279:8

listened 234:13

listing 36:15 185:4

lists 37:21 38:13 173:19

173:19 184:10,11

204:8 265:10,21

literally 24:17

literature 32:5 61:11

70:19

little 4:9 10:1 13:8

26:10,12 27:13 41:6

41:10 45:8 46:14,19

46:22 48:18 49:1,20

65:2 78:21 93:16

110:17 117:17 160:20

164:11 168:12 178:4

183:9 208:22 247:22

250:7 256:12,15

258:8,21 259:10

261:14 263:11

located 8:14 280:1

location 278:1,12,19,19

280:16

locations 281:20

logged 112:20

logic 278:22

logistics 164:15

long 9:22 28:4 58:16,17

58:19 100:18 101:19

102:22 110:11 167:2

169:9 173:1 230:12

234:2 268:14

longer 28:4 29:2 38:2

134:19 142:10 180:3

263:11

look 26:21 32:11 39:19

47:5,8,15 48:3 61:3

78:2 84:20 85:22 86:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

299

86:6 92:2,4,5 93:7

98:19 99:3 101:6

103:9 113:6,21,21

117:17 129:9 148:9

157:9 158:18 162:19

177:17 178:2 192:17

199:11 208:15,17

210:4,18 218:18

222:6 242:22 243:9

243:15 245:7,11

256:14 257:9 259:1

259:20 265:12 275:22

282:7

looked 54:20 70:4

84:16 162:5 180:22

211:4 241:2

looking 16:5 19:21 21:4

39:16 44:9 63:12,13

72:2,3 77:20 88:5

91:5 92:1,3 95:15

98:14 103:18 159:2

160:7 162:2 165:12

171:15 207:20 208:21

237:13 242:2 243:11

looks 43:13 101:9

153:18 189:22 190:18

loop 10:9

loop-holes 240:20

lose 103:1

loses 30:13

loss 130:5,9 131:19

132:3,6,11,13 134:4

134:15 135:7,8

136:12 142:7,20,21

179:18 180:13

lost 131:11 140:2

160:20

lot 11:3 17:12 34:11

41:8 43:7 45:11,17

48:9 49:12 55:10

57:18 61:10 64:8

65:17 77:4 80:12,12

94:8 108:10 120:22

130:19 155:12,13,14

169:9 183:2 185:16

219:12 226:6 230:10

235:1 238:20,20

243:5 248:8 263:14

263:15 278:22 280:4

280:21

lots 68:14

loud 130:22 160:1

197:17 199:19 203:8

lousy 210:13 245:15

love 74:5

low 41:13 56:19 57:3,13

83:5

lower 37:20

luck 172:19

lucky 16:10 158:8

lunch 161:9 162:8,17

162:20

lung 46:22 93:6,7

188:13 192:12 251:21

lung- 92:15

lymphocytes 193:4,19

194:2

lymphocytic 192:14,18

193:5,20

lymphocytosis 192:22

192:22 193:15

lymphoma 178:18

M

M 2:3,11,12

Madeline 195:13

magnitude 76:5

main 78:7

maintenance 16:14

26:18 151:9 177:9

major 11:6 30:19 38:21

99:6 242:5 258:11

majority 77:8

making 24:12 32:9

91:15 110:8 121:20

125:14 130:12 138:19

145:19 174:13 175:13

182:20,21 183:2

220:11 252:7

male 178:19,20

manage 166:18,19

management 174:16

mandated 173:5

manipulation 147:2

manner 198:4 204:22

234:17

manual 88:4 123:19

125:22 147:1 188:21

193:2,14

manuals 175:14

Mark 2:3 7:18 52:19

100:2,4,8 120:13

162:9 171:2 261:10

280:8

Mark's 121:1

marked 42:17

Markowitz 1:20 2:7 4:3

4:19 5:12 6:20,20

8:16 33:9 35:6 42:15

44:13 46:13 48:7

51:22 52:14,21 56:14

58:1,16,20 59:3,5,12

59:17 64:13 65:9

67:18 68:9,18,20 69:5

69:8 70:11,14,14,16

71:4 72:13 74:21 75:5

76:18 77:16 78:18

81:15 82:1,4,6,10,14

82:18 84:3 86:5,10,14

87:1,4,10,19 88:7,18

89:2 91:3 92:12 93:14

94:16 96:5 98:5,17,22

99:17 102:3,5,17

106:11,18,20 107:13

107:16 108:12 109:2

109:21 110:4,15

111:8,10,22 112:6

113:2 114:14 115:12

115:15,20 116:5,13

116:19 117:1,11,16

118:1,14,22 120:5,18

121:3,6 123:9,22

124:3,9,17 125:15

126:8,17 127:8 128:1

128:7,16,19,22 129:2

129:5,19 131:4,7

132:8,20 133:7,16

134:5,12 136:2,5,18

136:21 137:3,19

138:5,9,13,21 139:3

139:10,17,22 140:19

141:1,5,8,19,22 142:4

143:20 144:1,7,14,17

144:20 145:4,7,12

147:6,9,17,22 148:12

149:4,17 150:21

151:22 152:7,10

153:8,14 154:6,16

155:1 158:13 159:6

159:12 161:1 162:13

162:15,18 163:10

165:21 166:1 167:12

167:20 172:17,20

185:8 194:5 195:11

195:17 196:1,12

198:14,19 199:4,8,12

199:18,21 201:8

202:13,16,22 205:12

205:16 206:20 207:2

207:19 208:10,14

210:15,21 211:16

212:3 213:2,6,11,14

213:16 214:2,8,15,18

215:2,9,17,21 216:3,9

216:13,22 217:4,7

218:3,7,10 219:14

221:18 223:8,13

224:9 225:13 226:22

227:5,8,22 228:3,6

229:19 231:4,8,12,22

232:14,22 233:3,19

233:22 234:8 235:2

236:4,17,20 237:9,12

237:15,20 238:2,6,10

239:2,12,15 240:6

241:11,13 242:1,10

243:18,21 244:2

245:22 246:4 247:2,8

247:12,17 248:12,19

248:22 249:3,10,13

249:21 250:9,18,21

251:1,6,22 252:3,14

252:16 253:1,12,15

254:5,9,15,19 255:1,4

255:18,21 256:9,18

256:21 257:2 258:15

258:19 259:3,8,13

261:4,8 262:10,13,15

262:18 263:20 264:15

264:21 265:6,20

266:14,17,20 268:2

268:17 269:8,11,21

270:4,8,13 271:11

276:7 277:9,16

278:14,17 279:3,6,11

280:6,8,20 281:2,6,8

281:15 282:3,6,12

283:12

married 127:20

massaging 190:15

material 82:15 230:5

264:16

materials 102:12

153:13,21 154:11,12

154:19,20 155:8

160:13,15 170:6

matrices 14:7 15:17

70:13 204:11

matrix 14:7 15:17 87:20

88:1 174:17,18

184:10 238:17

matter 87:14 112:3

163:7 284:5

matters 3:12 132:4

169:13,19 171:15,22

256:11 260:2 273:3

274:5

may' 236:13,15 247:22

248:3

McTier 193:9

meals 282:19

mean 11:4 20:13,19

36:15 41:18 44:2

52:18 53:15 55:6

57:18 59:10 61:6

63:20 64:1 65:7 70:18

76:8 87:13 92:13 96:7

98:2,18 108:9 112:8

126:18 127:1 147:4

148:8 149:12 152:18

154:16 155:20 165:20

166:9 173:5 179:6,9
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

300

199:14 202:14,17

210:21 212:10 215:2

218:17 227:2 229:1

229:13 234:15,19

239:5 260:18,20,21

261:20 263:5,16

276:8

meaning 81:5 138:16

201:12 265:14

means 73:22 120:9

133:19 148:22 187:2

196:18 210:18 221:5

224:20 242:12

means' 146:12

meant 81:11 91:1

156:17 194:16

measure 188:14

measured 45:3

measurement 46:9

measurements 32:4

60:16

mechanic 16:15 26:18

mechanism 21:13 60:5

medical 2:6,20 5:19,19

7:8,17 9:8 12:9,11,12

12:14 13:15 19:5,11

21:8 22:13,20 27:1,20

28:19 58:10,15,17

63:16 77:19 78:15

79:4,8 91:6 92:14

104:3 113:11 114:8

114:20 122:17,22

123:6 126:19 131:10

131:16,22 133:21

135:13 136:9 137:5

137:12 143:4,11

146:5,6 147:15 148:3

174:11 176:16 179:19

180:10,13 181:9

182:20 186:17 189:3

189:15,18 191:13

206:9 207:4 209:3

212:7,11 214:11,13

220:20 230:17 235:16

242:20 244:17

medicine 5:22 6:22

7:17,21,22 8:1,3,5

105:7 171:1 188:8

189:3

medium 41:13 183:16

meet 168:6,7,13,14

183:20 186:5,20

190:12 216:1 245:18

260:8,9 262:5,16

271:17 276:11 277:20

277:22,22 278:18,19

279:17,20 281:10

meeting 1:9 112:11

120:21 165:3,15

168:10,15 171:14

191:21 260:16 263:1

263:8 264:5,9 269:3

270:14,19 271:4,4,13

272:2,7,18 276:20,21

277:18 278:11 279:19

280:11,15 281:5

284:4

meetings 164:15,17

165:8,19 166:19

167:22 260:3,5 264:3

266:6 267:1,9 268:5

268:14 269:2,4

272:14 273:1 274:2

274:10,12,19,22

277:2 281:1

meets 122:18 203:1

Member 5:7,18 6:1,5,8

6:11,14,16 7:2,6,11

7:15,18,20 8:2 29:5,9

29:15 30:2,5,9,17,22

31:20 33:10,15 42:16

44:15 45:14 46:4,14

48:1,3,6,8 52:1,15,22

54:8,11,13,16 55:17

56:13,15 57:13,17

59:18 60:21 61:2,8,12

61:15,21 62:2,11 63:3

63:7,9,14 64:14 65:12

66:5,11,21 67:12,17

67:19 68:5,11,13,19

68:22 69:6,10 70:13

70:15 71:7 72:12,16

73:15,18 75:4,7 76:20

82:21 84:4,9,13,15,22

93:15 94:18 96:14

97:6,16,19 98:13 99:1

102:4 105:21 106:17

106:19,22 107:8,15

107:18 108:14 109:4

109:18,22 110:6,16

111:6,9,12 114:12,17

115:2,6,14,19 116:3,9

116:15,21 117:3,15

117:19 118:4,9,12,16

119:13 120:14,19

121:4 122:14 123:13

124:1,4,10,18 126:3,9

126:18 127:11,20

128:4,9,21 129:1,4

131:2,5,9 132:10,22

133:8,17 134:7

135:19 136:4,7,20

137:2,4,9,16,22 138:8

138:11,20 139:2,13

139:20 140:2,4,7,9,11

140:13,18,22 141:7

141:15,20 142:1,6

143:12,14,15,16,22

144:3,6,12,18 145:6

145:10 146:10 147:8

147:11,18 148:1

149:3,9 150:9 151:1

152:2,8,11,16,17,18

152:20 153:10,16

154:7,22 155:5,9,20

156:9,19 157:18,21

162:10,14,17 165:18

165:22 166:3,16

167:5,9,11,14,19

172:18 197:18 198:16

198:18,21 199:5,10

199:13,20 200:1,16

201:19 202:14 204:16

205:15 206:3,21

207:3 208:8,13

210:14,17 211:1,7,11

211:13,19,20,22

212:1,14 213:5,10,15

213:18 214:3,9,16,19

214:20 215:8,11,16

215:19,22 216:6,10

216:21 217:2,6,8,10

217:12,15,16,17,18

217:19,22 218:6,9,13

218:15 219:2,3,5

220:9 221:4,22

223:12,14 224:12

225:19 227:2,6,19

228:1,5,12,16,17

229:2,4,5,6,8,12,16

229:17 230:8 231:5,7

231:9,13,14 232:7,16

233:2,4,14,17,21

234:11,13,22 236:3

236:12,18 237:3,11

237:13,17,21 238:5,8

238:12,13 239:8,9,11

239:14,17 240:5,7,13

240:18 241:8,15

242:17 243:13,20,22

244:3,9,18 245:1,8,14

245:16,20 246:2,21

247:6,10,16,21 248:7

248:9,10,11,14,16,17

248:20 249:1,9,12,17

250:1,3,5,6,16,19,22

251:16 252:2,13,15

252:21 253:9,13,17

254:7,10,18,22 255:2

255:6,10,11,12,13,15

255:17,20 256:8,12

256:19,22 258:7,16

258:20 259:4,9

260:20 261:5,12

262:4,8,9,12,14,17,20

264:7,13,19,22 265:7

265:9 266:4,15,18

268:16 269:1,11

270:1,5,9 271:8,12

273:10 274:17 275:6

275:10,11,13 276:8

276:15 277:11,15

278:10,16 279:2,4,9

279:20 280:7,9,14,21

281:3,7 283:5,8,11

members 2:1 12:5 75:1

79:10 86:6 112:11

119:6,7 121:7 122:9

133:19 134:6 145:16

148:13 150:1 153:15

161:6 164:21 166:5

166:15,19,21 167:1

203:12 205:20 251:13

256:3 258:2 259:19

261:16 265:22 266:7

266:11 272:15 273:2

273:8,19,22 274:3

275:22 277:6 284:3

memo 53:15 176:22

memoranda 89:21

90:18

memorandum 22:9

89:18

Memorial 4:20

memory 103:3

memos 53:21

men 171:9

mention 54:1

mentioned 24:12 26:13

39:10 73:8 80:22

90:16 215:20 216:4

227:9 278:11,12

mentioning 24:8

message 163:12

met 1:18 187:7 280:5

280:10

metal 6:13 180:17

metalized 178:2

metals 16:18

mic 4:6

Michael's 234:14

micro- 174:15

microphone 200:15

280:13

mid 268:19

middle 39:5 40:12 99:6

253:10 275:19 276:1

milli-tritides 178:1

milling 10:7,10,10

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281:18

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222:2

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194:5 196:6 251:4

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67:13 98:6 100:12

102:20 103:1 163:2

163:22 164:8 195:14

259:22 265:3,4 278:3

279:14

mirror 162:2

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112:11

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mixed 194:13

modality 72:3

mode 72:3

moderate 56:20 57:3,13

moderator 185:11

195:12,17 196:5

modify 39:19

moment 98:11 134:13

160:6 164:4 203:20

203:21 252:1 257:9

momentum 271:2

money 99:5,12 180:14

181:10

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monitoring 15:6 34:22

35:3 41:5,9 45:12

49:2 60:9 61:20 158:7

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132:3,14,18 135:8

136:13 142:21 180:10

268:10

monthly 42:4

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164:19 226:18 263:10

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122:2,5 129:10,12

141:14,20 142:1

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motive 118:10

move 58:14 72:14 75:1

109:21 116:20,21

119:8 122:11 125:1

125:10 127:7 130:4

130:16 139:18 145:10

150:4 198:16 203:14

204:14 205:22 227:16

235:3 255:20 256:11

260:2 264:12 276:3

moved 107:20 111:16

160:22

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110:18 133:12 263:18

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must' 236:14

mutually 260:15

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N.W 1:19

name 16:13 23:11 36:6

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narrative 23:1 75:19

narrow 30:9,11 32:22

106:5 147:12

narrowing 121:10

nasty 43:6

national 6:9 25:3 78:20

79:2

nature 14:13 32:17

41:10 73:1 173:5

183:12

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near 6:2 279:21

necessarily 75:12

86:18 91:5 149:10

152:6 223:18 224:4

232:4

necessary 82:16 172:8

206:15 209:22 214:20

220:15 223:4 236:8

261:6

need 4:15 15:21 18:19

18:20 20:16 21:18

22:1 39:21 47:9 54:21

56:9 69:14 71:2 77:8

94:12 98:6,7,9 104:2

105:15 107:13,14

110:22 111:5 112:12

113:9 119:1 122:2,6

123:3,20 125:22

126:11,12 129:6

130:21 149:19 155:6

155:15,21 156:1

161:17 163:15,18

164:20 166:9 170:10

174:4 176:14,17

181:9,12 196:18

198:8 202:3 203:7,19

204:2 208:1 231:10

238:6 239:4 244:14

251:16,17 255:22

260:1 264:6 265:11

266:16 267:2 269:19

270:12,18 271:11

273:12 276:18 278:4

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needed 129:22 136:21

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147:13 149:11 155:14

155:16 161:12 165:3

172:14 183:1 184:8

215:22 230:18 236:18

241:2 268:8 269:15

270:6

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neutron 177:20,21

Nevada 69:22

never 11:15 17:13

64:19 194:20

new 6:21 10:21 12:12

23:9,18 24:15 43:22

71:9 108:3 109:14

120:8 125:22 129:8

130:19,20 131:13

137:18 149:1 183:5

185:18 198:1,3

204:22 206:3,4,22

208:15,17 209:7

210:4 212:3,4,6,12

216:14 231:6 232:4

233:8 252:19

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nice 147:6,7

night 162:12

nine 35:13

ninth 125:1

NIOSH 16:8 17:19

65:20

nitty-gritty-wise 74:11

non-cancer 185:2

non-covered 132:4

non-DOE 36:11

non-Hodgkin's 178:18

179:1

non-MD 148:7

non-sparking 42:22

norm 74:18

normally 26:11 60:15

61:19

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note 37:14 58:9 255:15

notes 103:22 113:8

125:18 198:3 253:18

253:21,22 254:3,20

255:2

notice 28:3 222:7

227:10 267:19 270:18

271:22 272:2,7

277:17

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notices 123:21

notification 271:9,15

276:12

notified 112:16 176:9

176:11

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November 43:14

NRC 10:16 11:4

nuclear 6:2 10:5,20

11:7 25:3,6,10 170:5

171:10,17 175:10

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number 11:6 16:1 28:2

31:14 52:10 67:5,7

68:17 103:4,9 105:11

150:5 158:14,18

160:8 163:16,17

191:7,12 193:8 197:3

204:22 205:1,1,1,2,4

207:4 216:20 220:13

222:3 223:11 237:15

239:18,22 242:12

246:21 247:3 258:12

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193:15

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object 158:3 185:21

objectives 95:8,10

objectivity 9:5

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obstruction 194:13

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obtained 205:3,5

obtaining 39:22

obviate 123:20 125:22

obvious 61:13 86:20

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15:20 16:4,7 17:5,7

17:15 21:6,8 22:4,18

25:11 27:22 41:3

45:12,19 59:15 64:19

65:4 67:4 72:6 91:2

92:14 114:22 220:5

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6:17,22 7:7,16,19,21

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120:16

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occurring 276:4

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offer 101:16 128:12

172:6

office 78:20 79:6

105:11 170:22 172:6

172:6 178:16,18

284:2

office's 79:3

Officer 7:8,8 8:7 273:5

274:7

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OFFICIAL 2:14

oh 30:2 88:8 191:18

236:1 244:15 280:14

OHI 35:18

OHQ 18:8 20:22 21:3

35:18 52:2,8,12 76:14

okay 4:5 5:13 9:18 23:4

26:1 30:2,5 33:15

35:8 47:1 48:1,6

54:17,17 56:13 58:20

59:3,12,17 61:8,12,21

62:11,11 63:9,14

66:13 68:13,22 69:1,3

69:8 71:4,4 79:1 82:6

87:15,19 89:2 92:12

98:17 99:17,17 100:1

100:2,5,6,6,6,7,9

106:18 110:4 111:1

112:10 114:5 116:13

117:1 118:1 119:3,4,6

119:7,9 120:11 122:2

122:4 124:3 125:16

129:11 130:4,5,17

131:7,9 132:20 133:1

133:3 134:12 135:20

136:18 137:2,4,16

138:20 139:17 141:9

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145:8,12,16 148:13

149:2,18 150:21

152:7 153:8,14

159:17,18 160:2,4,6,7

161:1,4 162:14

163:21 165:22 167:5

167:19 172:18 173:4

174:2 175:14,21

176:2,21 181:13

185:14 187:16 189:18

190:16,16,17 191:6

194:6 195:17 196:12

198:14,19 199:8,18

201:8 202:21 203:3,9

203:10 205:12,22

206:5,19,20 207:3

208:19 209:19 210:3

211:7 213:2,5,16

215:8 216:13,22

217:4,7 218:3,3,3,4

218:11,11 219:14

221:21 224:10 228:5

233:17 235:2 236:20

236:20 243:21,21

244:2,18 247:2,17

248:19,22 249:11,13

250:9,12,12,13,13,18

250:21 251:1,3,8,8,17

252:14,16 253:4,6,6,8

253:8 254:16 255:17

255:18,19,21,21

258:7 264:15,21

266:6 268:18,18,22

270:8,8,13 272:4

277:9,16 278:16,17

279:6,11,19 280:6

281:15,15 282:6,8,12

283:11,12

old 57:5 106:9 109:6

158:1 206:5 208:20

231:17,20

OMB 234:10,12,21

Ombudsman 284:1

Ombudsman's 284:2

omits 212:4

once 90:21 117:18

140:5 142:5 165:2

oncologists 117:6

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33:4 38:13 66:22

103:7 178:13 256:13

256:16,16,17,22

263:19 280:1

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onus 230:22

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177:7 178:4 198:14

198:19 261:9 268:4,5

272:7 273:12 274:10

277:21

operated 119:21 120:9

120:16

operation 11:16 170:9

OPERATOR 195:15,19

196:9

opine 32:20

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opinion 14:16 22:9

43:12 54:21 55:1,3,11

55:11,15,15 79:4,8

80:16 81:4 83:9 89:15

173:7 206:13 207:13

207:17 209:4 210:7

210:10 220:20 235:17

240:18 242:20 244:17

245:5

opinions 188:1

opportunity 23:14

65:13 69:2 74:6

227:18,20 230:19

opposed 45:15 119:4

122:7 145:15 149:22

161:4 203:10 205:18

241:20 251:12 256:2

261:1 279:19

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Orange 184:3

order 91:14 130:22

148:18 165:4 220:4

226:11 230:5 232:21

ore 10:11

organization 25:8

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original 126:14 173:16

240:15 245:21

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osteopathic 146:15

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outcome 63:6

outreach 281:18

outright 216:11

outside 57:22 94:13

108:3 155:13 275:5

over-redacted 26:4

over-redacting 30:13

overall 79:11

overhaul 20:22

overlap 96:1

overly 151:6 209:22

236:8

overturned 83:7

overview 13:12,13

282:11

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23:17 104:8 105:19

109:10 116:12 122:16

123:4 131:13,15

133:20 135:12 136:8

137:4,11 143:3 173:4

186:13 190:19 200:12

201:6 204:4,12,18

205:8 206:6,14

207:18 209:21 210:2

220:14 221:1,6,16

236:8,10 242:13

249:18

OWCP's 123:16 125:19

owned 119:21 120:9,16

Oxford 218:2,14

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P-R-O-C-E-E-D-I-N-G-S

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p.m 24:4 162:22 163:1

163:8,9 164:2 284:6

package 28:7,21 64:3

packet 59:11 282:15

283:5

page 3:2 30:7 34:9,11

35:5,7,10,17 36:12,13

36:22 37:9 38:20 39:7

40:9,12 79:1 86:6

87:8 103:11,18

107:17 119:10,11

120:7 122:12 130:17

130:20 131:3 137:14

145:19 150:5 159:19

160:3,3,4,7 185:18

186:10,12 187:15

188:8 189:16 190:15

190:17 192:11 197:4

197:4,21 200:2,18

203:17 212:5

pages 27:11 28:14 34:1

35:11,13 37:2 40:8

74:9 87:2,9 202:3

paid 156:14

panel 43:2

Pantech 38:18

paper 54:4,4 183:1

papers 272:19

paperwork 183:2

Paragon 174:1

paragraph 116:7 137:8

137:10 144:3,22

150:20 155:16,18

160:5 191:16 208:4

208:11 209:7 218:21

235:4 236:22 246:3,9

249:14 259:5

paragraphs 140:14

190:20

parallel 114:2

parent 273:19

parenthetical 143:9,18

part 10:11 12:2,3,3,19

14:2 39:1,11,14 41:3

41:4,7 43:4 62:22

75:19,22 94:5,7

111:21 116:1 123:5

130:11 131:18 132:6
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137:10 149:3,4,5

150:6 157:11 160:1

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190:2,9 191:7,8 202:1

202:18,20 205:6

212:22 216:7 217:14

217:15,16 218:21

234:21 239:3 254:18

256:16 258:14 259:2

272:12 282:2

PARTICIPANT 82:8,12

86:22 87:7 108:21

109:1,16 128:18

129:18 137:7,14

139:9,11 141:4,6

144:9,16 145:2

155:18 159:5,11

160:22 200:14 202:21

213:13 216:4 217:14

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participate 4:14 185:10

267:4 274:21

participated 11:12

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31:5 32:21 34:6 37:7

45:10 52:2 58:2 62:19

73:22 74:9 78:16

80:20 83:17 92:4,5

95:18 98:20 99:19

103:3 118:3 121:20

121:21 156:12,16

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particularly 102:21

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passed 12:9 170:14

182:4

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pathologic 173:7

pathology 192:21

patient 77:4 108:8

patients 72:21 77:2

147:16,21 148:19

pay 283:1

paying 88:12

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peer 193:17

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penalty 200:7 201:1

pending 216:19

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71:14,15

people 10:1 17:17

32:12 43:10 44:7

62:17 66:16 69:19

70:2 77:8 81:19 96:6

105:5 112:20 158:7

163:12 168:3,20,22

172:4 179:11 185:9

193:11 194:19 195:3

219:12 228:17 229:9

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percent 77:2 83:6

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perform 18:20 24:5

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performance 81:12,13

119:17

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performed 19:2 79:9

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69:16 116:11 163:2

163:11,14 164:1,7,13

168:20 196:15 228:9

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periods 50:4

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permanent 123:1

permission 104:8

106:14 107:5 115:10

115:11,16

permitted 104:7 105:18

107:4

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40:21 50:9 59:21,21

65:15 101:9 118:10

168:10,21,22 180:3

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personal 38:6 97:6

107:2,10 109:12

113:16 117:13

personally 169:12

227:2

perspective 75:11

264:1

pertain 162:1 274:11

pertinent 123:7

PFP 37:21

PFT's 194:2

PhD 12:6

phone 4:13 8:10 17:3

36:4 103:12 163:12

168:22 185:9 195:12

195:18 196:11 261:1

261:1 263:15

phosgene 32:4

phrase 135:10 141:18

143:1,18 151:15

209:21 218:22

phrases 134:22 142:13

physical 7:9 119:19

120:2

physically 74:20

physician 5:22 6:17,22

7:7,21 8:4 14:16

32:18 54:21 57:19

62:5,6,10 63:16 73:14

77:5 79:14,20 80:6,15

81:4 83:3 105:15

107:12,22 110:21

111:3,20 146:2,19

147:12 148:2,17

173:8 179:3 180:11

180:15 190:11 207:9

207:13 209:3 210:8

210:13 212:19 220:2

224:2 235:16 243:6

244:21 245:4 246:7

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62:13 77:13 79:7 80:4

102:8 103:20 104:5,7

104:17 105:5 106:15

107:3 110:10 113:4

113:12,18 114:22

115:9 116:10 146:3

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picture 70:3 74:14

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piece 54:4,4 76:17

92:15 213:7,8 223:16

273:7

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pin 85:20

Pinellas 176:19 178:20

182:4

pit 11:13

PITS 170:4

place 41:21 43:3 187:9

203:20,21 220:10

226:2

places 61:17 114:13

199:1 209:16 232:9

235:12 237:21 238:8

plan 166:4 269:16

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plant 6:2 10:21 16:11

170:1,4,5,9 176:19

177:5 178:3,20 183:7

plants 171:10 177:14

177:14

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plausible 13:18

plausibly 115:4

play 129:13

please 49:5 62:16 64:11

102:6 112:22 161:4

161:21 185:11 194:17

plutonium 11:13,21

44:20,21 45:1,2,8

170:4 176:5

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188:13

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34:19 66:4,19 75:9

88:9 89:3 94:14 101:2

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poorly 46:7

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241:13,15 242:8

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portion 12:20 14:9 40:5

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24:15 31:15 32:12

38:12 122:20 167:22

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practice 148:8,10,20

practices 107:19,19,21

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practitioner 111:13

practitioners 146:15

pre- 105:21

pre-defined 161:16

preamble 153:18 233:8

precedent 125:5

predicting 76:6

predominantly 71:22

prefer 80:17 128:2,5

227:3

preference 105:9 107:2

107:10 109:12 113:17

117:13

premises 150:17

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161:6 185:13 196:3

203:13 205:20 251:13

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presentations 4:14

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presented 232:4

presenters 2:17 9:20

presenting 124:12

presiding 1:21

press 195:21

pressure 152:3

presumably 278:20

presume 46:17 262:4

presumed 93:22

presumption 93:16,19

93:21 94:5,7,9,14

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presumptive 91:19

94:11 179:15

presumptively 92:22

pretty 77:21 78:12

83:22 86:2 118:19

124:11 169:18 188:22

189:7 201:21

previous 9:20 116:6

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239:5 243:14

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probably 11:5 13:8 35:9

35:12 40:3 43:1 48:13

53:4 64:2 77:7 87:22

88:12 97:13 104:18

104:22 105:12 110:7

120:4 138:14 151:3

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probative 131:17,17

133:5 134:9 136:10

136:16 137:12 143:6

143:7 200:12 201:6

202:17,17 203:1

204:5,6 207:18

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211:4,5,17 221:13

242:14 243:1,10

245:11,17,18,21

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80:8,9,11 85:15

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105:1 144:19 216:16

229:13 241:9,10

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125:6 126:22 127:13

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193:1,14

procedures 123:19

125:22 224:7

proceed 5:16 112:12

130:22 223:1

process 14:20 15:10,11

20:1 24:19 29:13 33:8

33:11 48:20 49:14

51:15 72:1 77:15,19

82:4 92:6 93:19 94:21

95:2 102:11 103:1

105:14 106:14,15

110:12 127:17 162:10

170:18 175:2 176:3,6

192:14,18 193:5,20

194:13 225:21 226:21

230:1,20 238:16

257:2 268:4,21

271:15 282:22

processed 206:8

226:17

processes 32:2 73:4

93:8 175:19 225:2

processing 258:9

produce 104:2 113:10

209:2,15 232:20

235:11,15

produces 220:2 246:15

producing 66:6 242:19

product 175:12,17

production 11:14

productive 39:18 230:6

products 175:19

professor 6:17,21 7:3

7:12,15,22 188:7

189:3

profile 70:18

profiles 17:19 71:1

program 5:20 8:1 10:2

12:3 17:17 23:12,17

35:14 36:21 57:5

89:17,21 90:18 91:13

92:8 99:9 101:22

106:12 118:20 121:13

156:21 157:14 171:17

182:13 183:20 184:22

186:9 204:10 205:7

programs 5:21 11:8

70:16,17

progress 145:20

164:11 171:21 268:9

project 70:1 157:5

projects 69:20 70:9

prolong 5:5

proof 14:5 119:18 120:1

132:6 197:5,10,11,11

197:20 203:16 204:17

proper 19:11 94:1

properly 18:21 19:8

31:9

properties 14:15 173:7

proposal 141:13 144:1

144:21 219:22

proposals 138:19

propose 118:2 128:10

253:7

proposed 3:5,10

102:21 103:6,11,13

104:13 107:17 110:2

113:14,22 114:2

119:8 120:13,15

122:12 128:17 129:15

130:8 133:15 138:6

138:18 145:22 146:2

146:9,10 153:5

161:11,14 162:4,7

163:4 164:10 196:17

196:22 197:9 198:1,3

198:13 203:18 206:6

206:22 212:4 216:8

219:15,21 220:13

227:11,14 228:10

229:20 232:6 233:20

243:19 249:5 252:5

253:22 255:7 256:6

257:3,6,10,12 258:3

259:20

proposes 200:3,19

proposing 121:16

149:1 201:22 232:5

243:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

305

protect 26:5

protection 10:22 38:6

52:4

protective 38:6

proud 171:13

prove 69:15 94:6

131:11 152:3 189:19

190:1,5,8 212:20

219:18,18,22

proves 94:13 119:14

provide 8:18 17:20 21:1

25:20 49:6 57:10

68:21 80:19 88:14

101:4,14,21 102:15

104:3 106:6 113:11

114:8,10 136:3

151:16 156:14 158:10

167:16 170:16 171:6

205:8 206:7 212:7

220:19 221:6 225:9

225:10 227:13 229:21

230:5 244:11,12,15

244:17 257:3 259:16

259:20 279:8 282:20

provided 40:6 42:7

52:13 59:10,13

171:10 244:21 257:6

provider 148:7 205:6

providers 147:15

provides 13:13 25:9

41:22 72:22 207:14

210:8,13

providing 51:12,17

56:3 72:8 146:4 164:9

172:1 265:4

proving 198:10 225:15

225:15

provision 150:13

proximity 279:1,7,17

psychiatrist 148:5

psychologists 146:14

public 3:8 7:4,13 163:1

163:10,14 164:1,7,13

166:9,12,20 168:19

185:10 196:14 228:13

251:7 259:11 262:6

266:6 267:4,9,18,21

274:10,18,20,21

275:5 276:11,13,16

277:1 279:8 280:4

publication 233:8

publicly 267:20

publish 233:15

published 70:18,19

89:14 276:22

pulmonale 189:5

pulmonary 7:21 31:21

173:19 174:3 188:4,5

188:10,11,16,17,20

189:4 194:7,8,15

pulmonologist 46:20

pure 48:10

purely 260:2

PUREX 37:21

purpose 150:18 204:6

274:16

pursue 221:20

pursued 60:3

purview 185:17 189:17

push 43:2

put 28:17 33:20 44:15

53:12 75:2 99:8 115:1

137:15 142:2 187:10

207:22 211:10 218:12

221:1,4 240:8 246:18

246:22 247:10 253:2

276:5 278:21

puts 54:1 64:7 152:2

putting 57:19 74:11

241:19 276:16

Q

QTC 81:16

qualifications 242:21

qualified 14:16 173:8

207:13 210:8,13

245:4

qualifier 114:10 245:9

qualifiers 52:5

qualify 135:8 142:21

193:5

qualitative 41:4,11,14

72:22 73:6 76:4

quality 9:4 18:19 69:12

79:6,7 175:16,16

quantitative 41:6

quantity 176:4,7,7

question 15:15,19

18:21 19:4 22:12,14

22:15 27:6 28:13

30:22 40:11 44:17

46:5 47:21 51:4 53:9

53:10 54:18 55:18

60:12,20 61:7 62:2

69:18 72:11 74:22

75:3 76:13,19 77:3,9

85:1,8,12 89:13 91:8

95:5 96:14,15 98:5,7

98:12 105:7,7 114:6

126:19,20 130:18,21

165:18 167:13 190:3

208:11 210:6 218:16

221:3 233:2,5 239:16

240:7 260:12 263:6

263:21 264:22 273:12

275:14 278:10 281:8

questioned 52:12

133:19

questioning 258:10

questionnaire 16:22

35:16,20 44:18 56:21

66:8,14 67:22 68:10

75:17 102:12

questionnaires 39:12

questions 12:16 13:5

28:5 42:11,17 44:17

45:5 46:7 58:14 59:19

66:19 69:6 72:14 75:6

76:16 78:14 81:10

82:20 84:17,18 90:22

93:3 98:9 105:8,9

133:4 168:8,18

172:15 195:6 226:7

226:14 278:6,9 282:9

queue 195:22

quick 18:14 60:13

96:14

quickly 5:15 13:9 24:15

76:19 265:13

quiet 239:20

quit 180:6

quite 18:17 86:19 87:22

98:16 105:16

quote 238:4

quoted 253:15

quotes 140:1

R

Rachel 2:21 85:2

Rachel's 13:3

radiation 7:8,9 39:2

53:1,2,4,5 61:4 184:8

184:10,12,12 280:10

280:16

radio 60:22

radioactive 184:7

radiologic 60:1

radiological 10:22

38:19 60:17

radionuclides 60:18

radon 61:14

raise 114:6 122:7

145:14 149:21 161:3

164:5 203:9 218:16

251:11

raised 93:3 148:5

raising 239:15

ran 133:17

range 67:8 170:11

ranged 56:19

rare 35:2 171:8

rarer 74:17

rational 245:5

rationale 49:21 115:22

136:9 207:15 209:19

210:9,13 242:15

244:13 245:15

rationalized 56:5,17

122:17 131:16 133:19

135:11 187:18 220:2

220:20

rationalized' 143:2

re- 200:16

re-read 103:21 122:6

149:19

re-run 19:6

re-running 43:22

re-statement 135:17

reach 4:12 105:10

reaching 167:7

reactor 10:19 11:17

read 8:19 84:15 113:6

119:1,12 122:5 123:4

130:21 131:7 132:9

134:14 141:12 142:5

143:20 144:19 146:8

147:4 148:13,16

150:9 159:22 174:11

190:4 197:15,17,22

199:19 200:17 203:7

204:3 205:2 208:19

208:20 215:11 224:13

225:8 229:2,6 255:22

255:22 272:3 273:15

273:20 274:11 275:7

reader 142:6 197:19

readily 71:5 127:18

reads 120:1 121:8

148:2

ready 142:1 263:17

real 53:7 75:11 77:2

159:13 221:13

realistic 268:18

reality 45:5

realize 53:20 69:1

really 25:18 27:12 33:4

46:5 47:9 55:13 58:22

64:21 70:5 74:14

75:18 77:5,15 84:2

85:7,19 89:14 96:7

101:3,12,18 102:1

104:12 105:3 108:2

117:12 120:19 121:17

121:17 124:22 130:10

130:11,20 138:6

182:1 189:12 194:22

199:15 201:17 203:4

203:5 204:2 213:21

222:16 223:3,16

225:18 226:3 232:17

258:18 259:7 269:6

reason 48:21 85:16
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

306

107:2,11 109:12

113:17 121:9 124:21

155:10 156:6 157:16

187:8 221:14 230:17

258:10 273:15 275:7

reasonable 137:5

262:11 263:13

reasonably 31:17

reasoned 132:1 133:22

135:14 136:9 137:12

143:5 231:1

reasoning 206:13

235:17 244:16

reasoning' 209:4

reasons 78:7 105:4

109:11

RECA 10:12 13:21

205:11

receipts 282:21 283:9

receive 26:11 61:19

81:16 273:4,8 274:6

received 26:9 233:10

receiving 275:2

recognize 4:20 100:16

100:18 124:19 161:17

161:19

recognized 186:14

recognizes 160:12

161:10

recognizes' 159:4

recommend 29:10

135:22 153:6,17

203:5 247:1,11

254:11 271:3

recommendation 3:6

30:14 103:22 105:17

106:1 110:14 113:3

113:20 117:12 121:8

122:10 124:22 125:17

129:3,8,21 130:3

134:14 145:14,18

148:14 149:6,21

150:3 153:4 154:17

203:6,13 204:15

205:17 216:14 251:11

251:14 252:19 256:4

277:3

recommendations 3:4

8:18 121:15 161:21

162:6 164:9 170:21

227:14 231:9 241:19

253:3 256:6

recommended 116:17

recommending 161:11

201:21 202:19 232:1

248:5

recommends 104:6

107:3 113:13 120:7

134:15,22 135:10

138:22 139:6 142:7

142:13 143:1 148:15

154:4,17 159:3,8

160:17 198:12 204:17

204:20 209:1 235:14

237:1 246:11,14

247:7,14 255:7

recommends' 159:4

reconcile 161:12

265:11

reconciliation 161:17

reconstruction 53:3

reconvene 112:1 162:9

reconvening 112:10

record 81:3 112:4

149:15 163:8 259:21

259:21 284:6

recorded 117:18

recording 265:16 266:3

recordings 265:12

records 15:22 16:7

17:15,18 34:15,18

49:2 50:22 51:1 60:9

123:6 176:15 177:3,3

177:17 195:8,9 263:8

recycle 80:10

redact 26:4

redacted 102:7

redacting 30:3

Redlich 2:8 7:20,20

30:17,22 31:20 65:11

65:12 66:5,11,21

67:12,17,19 68:5,11

68:13,19,22 72:15,16

73:15,18 76:21

107:18 125:15 155:20

157:18 224:10 225:18

225:19 227:2,6,19

228:1,5,16 229:2,5,8

229:16 232:7 234:22

250:15,16,19,22

251:15,16 252:2,13

252:15,21 253:13

256:8,12,19,22 258:7

258:16,20 259:4,9

264:13 266:3,4,15,18

275:10 277:10,11,15

283:5

redone 21:17

reduce 25:12 123:16

125:19 127:5 188:15

reduced 29:2

reduction 132:5 183:1

redundant 238:14

refer 32:10,13,19 55:13

77:14 78:7 88:4 96:17

202:4,18

reference 16:12 80:14

80:17 97:10 216:17

218:19,21

references 42:10 80:15

80:19 193:18 253:19

253:22 254:12,21

referral 19:19,20 27:12

27:18 29:10 33:8

42:13 52:9 77:19

referrals 24:11,16 31:4

79:16 80:2,3 110:18

111:1,2

referred 63:16 108:8

referring 20:1 108:7

119:9 191:7,8 216:12

refers 91:15 214:1

252:8 254:4 255:3

refine 57:10 265:21

reflect 45:5 113:5

123:15 255:13

reflecting 123:13

151:18

reflective 69:7

reflects 58:4,8 255:12

refresh 103:2

refuge 170:2

refusal 188:11

refuse 188:20

regard 20:8 50:1 242:5

regarded 259:14

regarding 78:15 130:5

206:13 209:4 220:3

235:18 256:6

regardless 227:12,17

Register 123:21 125:11

165:5 271:22 272:1

276:17,22

regs 275:4

regular 271:13

regularly 20:15

regulate 154:13

regulation 115:13,18

123:15 125:7,19

126:22 127:15 128:3

138:18 185:18 201:14

204:4,16 212:5

220:10 224:13 225:1

229:15 243:4 248:4

252:8 273:16,18

regulations 41:20

121:18 126:1 161:15

162:1,4,7 164:10

181:22 183:4 253:16

253:19 254:1,20

255:8 256:7 267:15

272:4 277:14

regulator 23:21

regulatory 10:5 14:1

41:17 87:14 125:3,12

154:13

reimbursable 146:21

reimburse 282:22

reimbursed 146:22

282:19

reimbursement 278:7

282:15 283:4

reiterate 206:5

reject 109:19 110:14

128:10,13 210:20

relate 158:16,16

related 10:19 16:6 39:1

39:1 49:18,19 50:12

50:14,14,18 56:12

83:4 88:10 92:16

94:21 148:20 188:12

189:1 223:19 230:15

251:20 256:16 260:21

relates 145:20 146:2

197:5 213:21 225:2

226:7

relating 15:8 258:17

relation 146:1,4 165:11

relationship 14:18 95:6

95:14 173:9,21

224:15

relay 25:20

relevance 89:15 145:21

relevant 33:5 82:15

146:7 197:12 229:9

272:17 277:14

reliability 204:19

reliable 204:13 205:8

rely 12:10

relying 238:17

remarks 169:8

remember 52:18 109:8

117:4 175:6 231:14

remotely 4:12

removal 150:16 151:12

153:11 154:1,9,14,19

155:4 158:22 159:9

159:20 160:10,14,18

remove 141:10 154:14

159:14 208:6,8 209:1

235:14 246:11

removed 236:1,1

removes 155:7

removing 152:13

153:12 157:3

renal 92:18

renders 22:8

rep 194:1

repaired 112:18

repeat 102:5 163:19

202:3 254:16,18

repeated 133:6
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

307

repeatedly 88:19

repeating 143:17

replace 122:21 136:15

137:20 139:14 141:17

159:3 232:5

replaced 113:14 135:2

139:3 142:15 222:12

replacement 11:18

replacing 131:14

replicate 162:1,4

report 34:13 56:4 67:1

67:21 81:2 83:12,13

85:21 177:15 184:11

185:1 187:19 188:9

189:3 192:18 209:15

220:2,7 221:9 230:17

231:1 235:11 246:15

246:17 270:2

reported 52:3,7

reports 9:3 80:4 81:2

86:1 147:9 174:11

177:16 182:12 246:7

263:3,6 264:17

represent 169:20

representative 182:14

representatives 171:3

represented 182:8

request 15:22 81:15

99:10 100:13 103:20

104:4,16 105:15

113:12 114:21 117:18

197:8 238:22 252:4

264:2 266:10,12

270:3

requested 28:6 168:21

172:21 195:14,18

196:7

requesting 86:16 104:7

105:19 106:14 107:5

115:10,10,15 266:15

275:2,16

requests 16:9 21:10

105:22 109:10 263:8

require 66:1 133:20

189:2 220:3

required 80:18 105:22

106:6 111:17 187:18

189:19 194:12 213:7

213:7,8 232:20

requirement 110:2

187:20 191:11 192:7

193:10 209:2,16

219:17 234:16 235:12

235:15 244:19 245:19

257:16

requirements 14:1

81:19 122:19 123:7

190:13 191:21 192:6

246:11 267:7 272:8

272:11 276:11

requires 95:13 106:3

115:13 125:3 131:13

131:15 135:12 136:8

137:5,11 143:3

requiring 104:15

212:11 242:6

requisition 34:10

research 66:9 181:10

272:16

researched 178:6

180:22

researchers 66:19

195:10

resins 39:6

resolve 216:15

resolved 79:19,19

resource 17:1 36:3 68:3

172:7

resources 51:16 66:4

101:13

respect 9:1 267:10

respected 195:2

respiratory 52:4 191:15

191:20 192:4

respond 227:1

response 10:18 118:19

118:21 224:10

responsibility 224:17

rest 72:7 103:5 162:16

162:18,19 178:13

269:6

restored 148:2,16

restrict 151:4

restriction 194:13

restrictions 17:12

restrictive 151:2,6

resubmit 47:21

result 31:8 170:12,20

resulted 206:16 215:13

222:17 237:10,18

238:3

resulted' 223:10

resulting 220:16 236:14

236:15 237:11 249:19

250:1

results 79:12

resumed 112:4 163:8

retains 106:13,14

retirement 132:5

133:10,11 134:17,21

142:9,12 180:6

return 79:14 162:21,21

164:8 196:16

review 11:12 14:12 15:2

15:8 18:20 19:1,4,10

21:8 27:18 35:22 36:1

40:7,10 42:14 48:22

62:8,14,18 67:11 79:3

79:8 82:9 83:14 97:11

185:18 187:5 197:2

266:2 269:15 270:7

reviewed 18:16,18

19:16,17 28:6 79:6

96:16 193:17

reviewing 19:14

reviews 13:15 21:11,11

45:20 78:15,20,21

79:3 80:22 81:13

82:11 102:9 234:7

revise 36:1

revised 90:11

revising 102:11

revisions 76:14 126:2

rewriting 138:17

Rhodes 283:15

Rhonda's 13:4

Richland 6:13

rid 208:12 216:16,17

236:5 249:7,9,14

250:10

Ridge 179:7 280:3

ridiculous 182:22

right 4:17 45:16 46:12

50:20 56:17 57:5 62:7

69:8 76:16 81:9 84:17

85:12 87:13 88:7,7

96:5 106:6 107:6

109:1,2,2,2 115:16

116:7,8 117:15 124:9

126:5,8,17 128:15

131:4,4 138:8,18

139:5,10,10,22,22

140:1,16 141:2,2,6

143:14 144:2,17

149:2 151:22 152:16

154:3 159:10,17

162:12,13 165:15,16

165:19 188:18 189:7

194:10 199:4,8,22

200:1 202:7,13,16,17

208:1,3,4,11,11

209:18,19 210:5

211:16,18 212:12

213:9,9 214:2,8,15

215:2,6,17,17 216:3,9

216:9,13,20,22 218:5

218:10,12 219:14,19

222:7 223:12,16,17

227:5 228:8 229:12

230:22 231:4,8

233:11 234:8 235:5,6

235:6 236:17,20,22

237:12,12,20 238:5

240:7 242:10,10,10

244:11 245:16 247:8

247:9,15 249:11

253:1,5,5,9,11,12

254:21 255:1,13

258:15 259:3,8 261:8

262:1,1,2,8,14,17

266:14 269:21 270:4

275:1,6 279:7 280:20

280:20 281:2,2,6

282:3

right- 28:15

rigmarole 125:11

rigorous 79:17

rigorously 79:17

Rios 2:15 4:18 5:11 8:6

8:6 90:17 112:13,15

130:6 166:11,21

167:6,16 234:6,9

254:14 263:21,22

265:10 266:21,22

270:14 272:3 273:15

274:19 275:7 276:14

277:5,13 280:13

283:2,14

River 11:17 16:11 26:14

178:21 179:5 280:3

Rocky 6:2,6 11:10,11

16:11 26:14 170:1,3

role 24:10 133:13

rolled 18:11

room 196:3

root 32:16

Rosemary 2:8 6:16

100:6,7

roughly 58:17

route 87:16

routinely 114:10

rule 3:5,10 102:21

103:11,13 105:22

106:9 107:17 196:17

197:9 198:13 203:18

227:15 228:10 233:15

234:15,20 266:22

267:6

rulemaking 227:11,20

233:20

rules 185:22 227:21

228:14 233:9 243:19

273:11 277:12

run 18:14 21:17 31:16

34:1 47:12 67:6 83:12

83:13 261:15

running 89:6 182:3

runs 37:1

rush 226:2

S

S 2:7
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

308

sadly 12:9

safer 99:10

safety 7:19 11:7,9 15:3

Salandro 283:15

samples 43:5

sampling 45:17

sat 180:11

satisfactory 79:13 81:8

satisfy 117:9 123:7

148:6 197:7

Savannah 11:17 16:11

26:14 178:20 179:5

280:3

save 67:19 98:6 247:18

247:19

saves 77:4

saving 188:14

saw 84:7 230:21

saying 29:6 48:14 50:2

50:6,8 51:8 85:3,5

90:4 104:11 106:12

107:1 128:2 154:15

156:10 158:11 176:13

212:18 215:5 219:6

220:19 221:3 231:16

235:19 241:21 242:8

242:13,16 244:20

245:3,11 246:8 261:3

273:14

says 13:11 34:8,8,10

44:19 47:3 56:22

64:16,17 87:5 105:17

106:8 107:10 111:1

115:7 116:7 120:8

125:6,7 126:6,10

127:5 128:13 132:13

140:6,7,14 143:10

144:7,10,12 146:11

146:19 154:17 159:7

183:6,12 187:3,11

191:12 202:5 207:12

210:7 212:15 215:4

215:12 220:14 222:19

222:22 230:14 236:21

244:11 245:9 246:10

273:7

scan 194:6 221:8

scary 189:13 192:8

scenario 230:12

schedule 165:8,13,15

167:8,21 263:18

269:7 270:16 271:20

282:5,7

scheduled 5:4 164:19

schedules 168:3

271:21 281:4

scheduling 260:4 261:7

school 6:18 7:13 10:4

Science 2:20 6:18 9:8

scientific 2:2 44:16

scientist 66:1

scientists 65:22

scope 81:19 130:9,15

146:1,16 148:8,9

158:17,19 197:10

257:7,8,11,11,16

259:14 269:14

screen 78:19 86:15

159:3 196:19 199:14

203:20,22 253:10

screening 5:20 17:18

36:20

scroll 208:16 210:4

232:15 233:1 243:13

243:14 247:3 249:8

250:11

Sea 7:7

season 9:13

second 14:9,11 28:8,21

30:6 36:12 40:5 46:18

64:21 79:4 83:8 94:7

94:14 116:17 117:1

122:2 142:4 144:3,15

149:5 155:21 156:1

158:2,18,21 168:6

198:18 199:20 201:9

201:10,11,12,22

202:18 204:11 205:16

213:8 214:1 215:3

218:22 222:22 233:15

234:12 244:19 246:9

246:10 250:14 255:21

270:5,6 272:22

secondary 83:8 183:13

188:5

Secondly 105:4

seconds 129:12

SECOP 83:1

Secretary 8:22 171:19

section 10:11 36:10,13

36:18,22 37:9,10 38:5

38:5,11,16,19,20 39:5

58:10 81:9 87:4 90:19

103:19 119:10 122:13

124:2 132:2 142:14

145:20 162:3 190:21

191:17 194:22 198:4

199:3 200:4,13,17,20

201:7 202:4 204:19

204:21 205:11 206:12

207:6,14 212:15

214:5 218:17 222:7,9

225:4,6,17 237:2

239:5 242:9 243:15

243:15 244:3,19

272:4,5 273:16,17,21

274:10

sections 100:19 135:1

162:2,7 258:17

security 6:9 17:12 25:4

see 4:13 9:15 18:15

19:22 20:19 21:9 22:7

22:10,17 26:22 27:15

28:7 31:13 32:12 35:3

38:13,17 46:16,17

54:5 60:1 61:7 72:21

83:12 84:22 85:1 86:1

94:8 98:14 100:1

107:14 108:21 113:22

115:20 128:2,5 132:2

137:17 144:14 153:5

157:9 160:4 169:5,15

171:20 172:11 186:12

187:15 189:5,6

192:20 199:15 201:9

203:19 208:1 226:15

230:13 234:12 241:21

242:1 250:11 261:2

264:10

seen 13:10 208:16

209:8

sees 72:21

select 257:17

selected 256:13 267:3

self 69:2

self- 69:2 89:7

self-explaining 86:20

SEM 15:17 19:7 21:17

21:22 22:2,3,3,5

28:17 31:9 32:11 34:1

42:7,20 43:14 44:5,12

46:1 47:6,12 64:4,7

65:5,6 67:6 72:7 76:8

97:1 98:19 101:8,10

173:17 174:2 220:7

238:22

Senator 182:14

Senators 171:2

send 4:15 49:7,9 51:3,5

55:21 62:15 63:1 85:4

112:22 178:9 265:21

266:13 267:10,11,16

267:16 277:13

sending 85:6

Senior 2:19 9:7

sense 130:1 179:20

182:2

sensitivity 48:19

sensitization 186:20

sensitized 192:12

sent 28:10 79:20,22

176:10,15,15,18

sentence 115:21 116:2

116:16,17 117:8

149:11 152:21 153:7

154:1,5 155:19,21

156:2,4 158:15,18,21

159:7,8 160:9,17

217:16 222:11 238:7

238:11 246:10,12

250:4,7 253:18

sentences 158:14

sentiment 115:16 121:5

159:13

September 270:21

278:11 281:5

series 234:6

serious 169:13

service 7:10 149:14

150:18 151:14 152:14

156:14 170:13 171:9

services 146:20,21

150:13,15 151:7

152:13

session 8:21 102:18

set 125:5 183:7 187:7

189:15 191:16 203:4

220:7 234:4

setting 219:17

settle 268:13

settles 282:8

seven 31:5 86:7 165:4,9

165:10,11 167:22

260:10 276:5

seven-plus 168:2

seventh 124:15 125:1

169:2

shall' 248:4,6,8,20

249:6

shape 163:5

share 177:11 195:9

she'll 73:3

shed 221:2

shifting 230:13

short 57:20 76:19 89:7

99:5

short- 230:21

shorter 32:9 269:4

shorthand 96:9

shortly 163:11

should' 248:2

show 13:17 16:3 37:8

57:17 63:17 88:8

206:15 220:15 222:20

223:5,16,19,20,20

224:6 237:17 241:6

showing 192:13 194:7

194:8,14

shows 174:19,20

191:13 223:1

side 16:7,7,9,9 17:21

21:12 41:3,4,7 60:17
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64:5 100:4 177:10

231:16

significance 138:6

signs 188:3

silica 234:14,19

Silver 2:4 7:2,2 56:14

56:15 57:13,17 58:6

117:2,3,15,19 118:9

121:3,4 123:12,13

133:16,17 141:15,20

142:1 144:2,3 147:22

148:1 153:9,10

247:20,21 248:9,11

248:14,17 249:1

269:10,11 270:5,9

279:9

similar 11:16 16:9

97:14 152:12 177:4

228:21

Similarly 60:6

simple 107:1 155:10

181:16 183:18 207:9

simplification 133:20

135:16

simplified 135:12

137:17,18 143:3,15

143:17 182:11

simplified' 143:13

144:22

simply 17:9 138:21

215:5 218:19

Simultaneous 249:16

262:3

single 51:12 184:5

203:6

sit 12:13

site 14:7 15:16 16:11

17:19 18:10 26:14

42:8 43:9 44:7,10

69:22 70:17,18 71:1

72:6 73:22 74:2

151:17 156:22 158:4

158:5 173:18 174:16

174:18 184:9 195:8

204:11 238:17 279:9

279:15

sites 45:20,22 64:20

70:4 71:12,17,21

99:15 121:10 151:8

157:3 230:16 278:21

279:21 280:2,2

sits 55:19

situation 17:7 48:12

228:2

six 67:8,13,20 86:6

103:4,9

sixth 124:4,8,13,19

skills 114:18

skin 92:17

skip 209:6

slightly 157:22

slot 262:11

slow 258:8

slowly 274:4,4

small 11:2 87:21

smaller 199:16

smithing 247:22

smoke 61:14

smoothly 170:19

snapshot 53:7

sniffling 9:15

SOAF 19:13 21:6 27:1,6

27:13,18 35:4 40:6

42:6 57:6,11 63:15

SOAF's 21:4

sociology 57:4

soften 138:10

softer 241:20

Sokas 2:8 6:16,16

59:17,18 60:21 61:2,8

61:12,15,21 62:2,11

63:3,7,9,14 100:7

102:3,4 117:7 165:18

165:22 167:9,14,19

223:14 224:10 233:2

233:3,4,17,21 234:11

260:20 261:5

soldering 178:3,12

solely 132:4 272:15

273:2 274:4,11

solicit 39:20

Solis 171:19

solution 49:4 231:22

solve 104:20 215:3

solvents 16:19 181:1

solves 241:9,9

solving 104:21

somebody 30:17 95:21

188:2 193:22 224:3

243:7

somebody's 265:4

someplace 96:22 97:1

somewhat 241:15

soon 167:22 168:11

270:15

sorry 4:9 11:4 14:11

21:3 22:19,22 29:16

29:21 33:13 34:9 35:6

35:9,10 40:15 61:1

81:11 87:1 100:2

116:5,6 122:12,14

136:2 144:4,7 167:12

197:5,16 200:17

203:15 207:3 221:21

224:9 232:15 241:13

248:12 251:6,22

254:16 263:20 278:16

sort 29:9 64:11 70:10

71:9 72:18 73:5,8

92:10 95:9 124:20

149:14 213:18 220:12

256:19

sound 226:16

sounded 126:15

sounds 110:20 232:13

soup 43:18

source 89:13 205:8

sources 204:4,8 238:21

239:6

Southern 10:21

speak 5:7 74:20 116:1

172:21 179:18

speaker 172:20 185:12

195:12

speakers 5:6

speaking 196:5 249:16

262:3

special 46:19 52:19

specialist 31:21 79:5

81:5

specialists 21:15

110:19 111:3,15

specialized 15:7 22:15

specific 15:5,5 16:21

22:2,12,13,14 32:1,7

44:11 51:1,1,8 75:20

88:15 96:18 104:18

104:20,22 105:1

117:9 123:18 125:21

149:14 161:11 181:4

181:8 182:21,22

192:20 201:12 232:2

232:5 239:20 248:13

252:22 276:11 280:2

specifically 22:11

102:7 111:1,2 177:9

273:22

specificity 48:19 49:1

49:20 51:21

specifics 50:21

specified 225:3

specify 128:14 136:22

197:14

specifying 123:10

197:8

speed 226:17 227:6

spend 98:8 175:15

spends 66:12

spent 43:4,12 66:6

67:20 180:14

spine 147:2

spirit 135:2 140:15,15

140:17

spoken 23:13

spot 109:13 138:12,15

spouse 17:8

stab 156:9

staff 9:2 12:4,5 24:9

Stage 184:19

Stainaker 174:1

stand 94:8 195:22

standard 46:10 57:21

118:20 135:3 142:15

155:12,12

standard' 140:15

standards 41:17

standing 196:10

stands 158:15

stapled 26:7 40:9

Star-One 195:21 196:11

start 12:21 28:19 38:12

87:10 92:1 104:10

112:7 163:22 168:2

185:7 235:7 279:12

started 4:4 9:19,20 10:1

10:2,2 186:10 234:14

241:1

starting 25:21

starts 15:11 27:19 36:5

36:18 92:19 160:9

startup 11:12

state 7:4 23:20 146:17

148:8,10 150:10

178:18 216:11 232:12

240:17 243:4 267:20

stated 185:1 274:8,16

274:21

statement 18:12 53:11

54:2 107:10 110:9

126:20 129:22 143:10

186:12 202:9 207:8

225:20,20 244:21

states 1:1 40:11 170:8

204:17 206:22 272:5

274:1

status 112:14

statute 111:5 158:10

175:6 254:3,13

statutorily 150:14

statutory 87:13,14

156:13 216:1 253:13

staying 107:22

steel 6:6 178:1

step 13:7,8 63:17 183:8

Stephanie 185:13

Steve 70:14 153:5

229:13

Steven 1:20 2:7 6:20

280:7

stick 209:10

sticking 109:5

stipulate 242:21
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stipulates 125:6

stop-gap 127:16

straight 13:5

straightforward 45:9

46:22

strange 157:8

strategic 126:19

stricken 155:17

strike 119:19,20 122:20

129:7 217:19 225:9

239:7,9

striking 230:11

strive 260:13

strong 55:12 232:3

279:16

struck 119:20 146:12

146:22 153:17 154:2

154:5

struggle 20:3 51:19

56:1 100:21

stuck 124:6 229:17

studies 6:19 181:1,2

study 45:4

stuff 42:22 43:8,9 125:4

225:9 244:12 264:13

276:19

sub- 15:19 272:11

Sub-3 132:13

Sub-A 207:7

sub-groups 64:1,10

Sub-Item 200:20

sub-paragraph 119:18

223:15 249:17

Sub-Part 123:8 207:12

sub-section 273:7

274:1

sub-specialists 110:19

subcommittee 120:14

123:12 133:18 151:11

151:19,21 164:18,22

165:3 166:13,19,22

167:8,17,21 257:19

258:1 260:5,15,16

262:15,22 263:7,11

264:3,5,11 266:11

267:1,8,12,16,17,17

268:14 269:9,18

271:13,16 272:15

273:2,22 274:3,9,12

274:19,22 275:22

276:10 277:1,7,17

subcommittees 120:12

150:22 164:20 166:2

166:8,12,22 167:18

258:12 260:6,12

262:5 268:20 269:13

271:10 273:17

subcontracted 156:21

subcontractor 13:20

subcontractors 25:5

36:16

subject 172:13 200:7

201:1,15 215:6 272:7

273:11

subluxation 147:3

submission 131:15,16

133:21 136:8 137:5

137:11 143:3

submissions 135:13

submit 18:2,4,9 131:10

submits 18:2 207:13

210:7

submittal 42:12

submitted 28:22 34:4,5

35:1 49:2 109:11

212:22

subsequent 202:3

260:3

substance 14:4,6,13,18

22:19,19 32:7 152:15

153:1 173:11,18

174:3,19 179:22

180:8,18,19 184:10

184:13,15,16 203:16

204:7 205:10 206:17

215:13 220:17 222:16

222:18 223:7 237:8

238:4

substances 1:4 4:8

13:18 33:1 39:8 49:3

50:12,13 151:17

152:5 160:13 173:21

175:2,4 185:5 238:15

253:20 254:2

substandard 34:18

substantive 164:4

substituting 109:16

suburbs 169:21

succinct 73:5

succinctly 76:16

suddenly 226:2

suffer 25:13

suffering 9:13 194:19

sufficient 107:9,11

109:11,12 131:17

134:4,9 136:10

137:12 143:6,7

176:14 209:11 235:8

sufficiently 122:18

suggest 86:5 114:19

116:15 213:3 225:11

240:17

suggested 128:10

133:20 153:18 181:12

suggesting 121:21

223:9 269:4

suggestion 95:20 109:7

216:19 248:13

suggestions 90:8

summarize 204:2,3

223:9

summarizes 40:14,17

summary 28:15 42:9

57:12 59:1

summer 168:2,4

supervisor 29:7

supplement 266:1

supplemental 18:3

supplied 38:7

support 10:22 21:22

34:4 104:4 113:12

114:21

supported 60:11

supporting 24:7,10

supports 32:5

supposed 111:7 187:12

sure 8:15 13:6 18:19

19:7 20:15 29:4 32:8

50:18 59:9 68:18

70:20 76:17 82:17

83:15 86:3 89:20 91:3

95:4 101:5 116:19,19

135:16 149:15 151:18

151:19 154:16 164:22

175:13 199:6 232:15

233:3 251:1 256:10

256:21,21 258:19

261:4 263:20 266:17

266:17,17 268:2

surge 31:9

surgeons 146:13 148:3

148:17

surveillance 70:9

survivor 17:7 200:8

201:2

survivors 36:9

suspect 259:11

suspected 38:15

suspicion 184:17

switching 108:10

synergy 59:20

system 55:19 63:19

80:2 105:13 239:3

243:12

T

Tab 86:22

table 3:1 46:18 100:4

228:11 231:16 269:16

tag 250:7

tail 92:19

tailor 19:19

tailored 19:18

take 46:18 58:14,19

72:13 73:19 78:14

90:14 96:4 102:22

111:22 113:6 119:1

121:14 125:2 129:16

149:18 156:9 159:21

161:9 162:20 207:22

208:17 211:8,8,9,17

216:18 218:4,6

232:18 241:5 246:21

251:4,9 253:4,5

257:12 260:18

taken 36:3 232:16

takes 66:15 67:3 73:20

231:6,7 240:20

talent 172:12

talk 21:18 23:8,9 31:12

36:14 44:5,7 47:18

52:16 65:15 67:6 77:3

78:2 96:3 224:8 260:4

277:19

talked 13:21 17:13

19:15 33:2,2,3 49:16

50:5 51:18 53:17 65:5

78:3 224:15 243:5

talking 12:22 17:5

66:14,15 91:12 96:1

121:16 131:3 165:19

165:20 166:13 179:16

193:14 222:9,13

253:11 260:21,22

275:1

talks 14:3,7,12 37:2,14

38:21 79:2 89:22

220:11 222:11,14

tank 38:1

tap 21:21

task 75:16,18 86:2

87:22 96:18 98:4

99:19 101:19 146:5,5

156:12 198:10 251:18

258:11 281:18

tasks 75:20 76:1,4

94:19 95:9,16 96:11

97:14,17 101:7

153:11 197:13

teacher 144:4

teaching 270:17

team 177:15

tech 43:20

technically 218:14

techs 43:19

telephone 65:14 67:14

165:19 260:16 267:18

tell 24:2 32:16 50:3,10

50:17 63:3,18 64:7

111:13,19 170:10

171:13 176:2,4,5,6

181:7 183:22 196:1
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220:10

telling 52:2

tells 46:1 243:8

tempted 13:1,4

ten 181:20

Tennessee 7:4

tense 139:9

term 134:11 135:11

143:2 146:18 202:18

206:11 207:6 212:17

215:4

terminology 44:16

terms 25:18 46:7 58:3

83:21 85:1 96:13

100:21 118:2 128:8

158:17 241:17 258:8

271:9

terrible 44:3

test 69:22 96:20 194:8

194:8

tests 59:22

text 199:16

textual 27:15

thank 4:5,19 25:14,16

48:6 69:3 72:12 84:20

89:2 90:20 101:17

102:2,4,17 106:19

112:1,8 113:1 123:9

132:20 140:12 147:8

149:17 163:5,20

167:19 169:3,12,15

172:1,9,10,17 182:10

182:10,10 185:7,8,14

195:5,10,11 196:15

232:22 255:14 277:15

281:16 282:6 283:11

283:14,18 284:1,2

thanks 56:13 172:16

236:6

that' 222:3

the' 146:18

they'd 177:11 194:3

thing 23:7 27:3 28:22

29:22 41:22 47:2

52:18 74:18 82:12

83:17 101:1 160:1

174:16 175:18 176:12

185:17 204:5 214:3

222:13 231:19 233:6

250:12 263:1 267:19

280:9 281:17

things 10:10,19 11:11

11:17 13:2,9 15:20

16:1,2,4,18 17:10,13

17:14 18:21 19:6 21:5

22:7,17 23:3 27:9

31:22 32:12 33:16

37:22 38:7,9,22 41:5

41:21 42:9 45:18,19

45:20,22 46:15 47:4

52:2 61:14 64:15

68:15,16 70:9 71:18

76:8,13 79:12 88:10

88:11,13 91:20 92:16

92:17,21,22 97:5,13

97:15 101:15 102:13

104:11 177:11 187:11

192:20 198:21 213:18

220:7 223:3 226:6

238:22 240:21 257:22

264:10,12,18 265:2

269:13,19 270:11

275:15 278:7 283:17

think 9:17,19 12:12,22

13:2 15:10 20:3,21

22:3 25:17,20 27:2,7

29:3 34:6 39:10 41:1

41:15 42:2 43:7 46:11

47:13,19 48:9 52:1

53:6 59:1 62:18 67:15

69:11,13,15 74:4 75:8

76:7 77:9,11,14,21

78:8,12 81:8 82:18

84:1,4,6,10,15 86:18

87:16 89:9,21 95:10

95:19,20,22 97:4

98:11 101:1,3,11,17

101:18 102:1 106:2,7

106:9 108:5,14,18

109:7,22 110:6,8

113:5 118:12 119:10

120:21 122:5 124:4

126:4,12,18,20 127:3

128:6 133:2,6,14

134:7 141:12 144:18

145:2,4 149:19 151:3

152:2,5,11 153:4

154:7 155:5,16,21

156:10 158:12 163:5

165:8 166:8 172:3

173:20 182:11 186:1

186:22 189:6,7

194:16 195:2 197:1

197:14 199:14,14,16

200:14 201:17 202:8

208:6 210:17 211:1

212:20 214:10,21

215:7 219:3,5 221:4

221:11 223:2,9,15

224:12,15,21 225:16

228:4,6,22 229:9,12

229:13 232:7,12

233:6,14 234:5

235:22 236:13 237:3

239:4,21,22 240:1,2,5

240:16 241:4,5,6,8,11

241:16,18 245:2,17

246:1,2,4 252:4 261:5

263:2,12 264:7,9

270:1,14 276:8,21

278:20 279:20 280:4

281:4,5

thinking 63:22 94:18

95:11,21 108:22

216:10 242:18 253:17

262:21

thinks 30:18 42:3

third 4:7 36:13 144:21

204:12 235:3 275:17

Thirty 118:18

Thirty-point-two-thre...

197:20

thoroughly 224:14

thought 18:5 78:1

104:19 114:15 133:8

147:11 148:1 231:19

248:1 257:10 258:3

266:9 280:18

thoughts 90:15 102:13

102:16

thousands 4:21 65:17

65:17 170:5,7

three 14:21 24:7 26:2

28:5,5,12 29:3,4 34:1

40:8,9,19 135:12

143:2 158:15 160:5

168:21 173:13 196:20

197:9 204:8,22 205:1

205:2 265:10 268:16

268:17 269:13,19

270:10 271:7 275:15

three-day 271:4

Throw 248:11

throwing 230:22

thrown 245:12

THURSDAY 1:13

ties 91:17

tiger 177:15

tile 177:5,5

time 39:13 41:16 43:5

50:10 53:17 54:17

59:8 66:5,18,22 67:3

67:20 69:16 72:13

73:10 74:2,6 76:5

77:5 78:1,14 89:7

98:9 99:4,5,8 108:16

118:17 141:13 163:3

163:4 165:2,16 168:1

168:21 169:12,14

171:18 172:1,21

174:9,10,12 175:13

175:15 185:22 195:16

195:18 196:4,7 197:1

209:14 215:20 228:9

228:11 230:12,20

233:18,19 234:20

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268:14 269:16 270:10

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80:12,13 86:1 155:12

257:17 270:20

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173:3 175:18 177:2

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tomorrow 165:7

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top 29:17 30:6,12,14

37:14 119:11 138:4

160:8 192:10 235:4

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14:5,13,18 18:9 22:19

22:19 28:16 33:1 39:8

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toxicity 180:17

toxicologist 12:6 81:6

toxicology 21:11

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180:5

toxins 14:9 19:11 28:3

28:5,12 30:12 31:8,11

31:17 32:1 38:13

39:17 45:13 67:7

74:12 76:9,11
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transmit 21:7,10 22:6

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transparency 171:5

transparent 267:2,4,13

transporting 10:11

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traumatic 4:22

travel 278:6 282:15

283:3

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148:19

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120:11 211:14 265:22

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types 16:17 49:3 73:3

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ultimately 27:8 28:6

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unrealistic 209:16

235:12

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updated 43:14 126:1

updates 123:21

uranium 10:7,10 11:21

170:6 176:3 179:4

urgency 117:9 226:15

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53:16 56:5,8 65:1,2

70:1 78:10,14 81:3

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110:18 128:3 136:5

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valuable 59:6 101:12

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value 17:9 131:17,17

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137:22,22 143:6,7

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202:18 203:1 210:19

210:22 211:4,5,17,21

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variation 246:6

varies 67:2,4

variety 23:22

various 25:5,6 70:4

71:12 100:19 122:19

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vendor 120:3,8,10,17

vendor' 119:22

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verified 17:16

version 203:17 234:19

versus 19:19 32:1

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51:22 52:1 100:8

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127:11 128:1,4

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243:13,20,22 244:3

244:18 245:8,16

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122:10 129:16,20,22

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vulnerability 11:19
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67:6 77:22 86:13 95:4

102:6 103:13 117:4

117:20 118:1 124:22

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221:12 225:17 228:20

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218:20 220:18 222:9

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11/Contractor 3:7

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12(b) 199:11

12:00 163:8

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14 120:7 145:16,16

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1505 99:3

1506 89:19 90:18 99:3

15th 165:17

16 150:5,5 159:19 160:4

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163 3:8

17 145:19

18 234:15

19 57:4

1952 170:3

196 3:10

1990 6:4

1995 53:12 64:17,20

91:4 176:22

1997 176:20

2

2 36:10 206:2 213:20

216:20 217:13 223:22

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69:21 77:2 259:22

20.231(d)(2) 14:11

200 1:19

2000's 34:22

2001 10:3 11:22

2005 173:16

2006 173:16

2007 173:17

2008 173:17

2009 173:17

2015 23:17 41:1 43:14

79:4 82:2 84:6

2016 1:14

22 50:19

222S 43:5,17

22nd 260:10,11

231(a) 197:5

231(b) 203:21

231(d) 14:3

232 244:3

232(a) 197:4

2470553 163:18,20

25 6:6 33:1 48:14

260 3:12

27 200:2,18

28 1:14 186:10 187:15

280 228:21

2830.114(c) 186:12

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3 160:8 200:20 249:10

3,000 180:14

3.805(a)(3) 142:14

3:00 24:4 284:6

30 118:20 119:10 120:5

214:19

30.11(2)(b) 199:22

200:1,17

30.111 200:13 201:7

30.111(c) 198:4

30.114(b)(3) 187:15

30.206(a) 119:10

30.207 189:16,22

30.23 14:2

30.230(d)(3) 207:14

30.231(b) 203:14,15

30.232 235:6

30.232(a)(1) 206:2

30.232(a)(4) 222:10

30.405 103:19

30.405(c) 113:19

30.5 207:6 212:15

30.5(e)(e) 145:21

30.5(j) 120:3,7

30.5(s) 206:12 213:3

214:5,5 215:12

216:17

30.5(x)(2)(3) 150:6

30.509(c) 122:13

30.805(a)(3) 132:2,9

135:2

30.806 130:16 135:12

143:3

300 44:7 228:14,21

30th 165:16

31 119:11 189:16

32 173:20 185:18

190:15,17

33 43:12

35 183:6

350 182:5

3940 197:21

4

4 3:3

4,000 4:22
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40 197:5 203:17

41 212:5

45 163:2 164:7

4D 99:22

4th 260:14

5

5 10:11 36:13 205:11

50 58:9 184:17

55 103:11,18 107:17

5C 36:22

5D 37:9

5th 43:14

6

6 37:10

600 182:4,5

64 122:12

65 122:13

7

7 38:5

707 11:13

75 282:21 283:10

77 40:22 56:19 57:1

78 10:6

79 57:1

8

8 3:4 38:11 90:19

8:30 1:20

8:44 4:2

80's 11:1

806 131:3,8,9

81 10:19

9

9 87:4

90's 11:2 34:22

93 191:8,16 192:11

96 130:17

9th 234:1
NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE., N.W. 

(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com 

C E R T I F I C A T E

This is to certify that the foregoing transcript 

In the matter of: 

Before: 

Date: 

Place: 

was duly recorded and accurately transcribed under 

my direction; further, that said transcript is a 

true and accurate record of the proceedings. 

 

 ----------------------- Court Reporter 

316

Advisory Board on Toxic

Substances and Worker Health

US DOL

04-28-16

Washington, DC