UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH

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SUMMARY MINUTES

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APRIL 22-23, 2021

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The Advisory Board met via teleconference, Steven 

Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN

KENNETH SILVER

MIKE VAN DYKE

MEDICAL COMMUNITY

GEORGE FRIEDMAN-JIMENEZ

ROSE GOLDMAN

STEVEN MARKOWITZ, Chair

MAREK MIKULSKI

CLAIMANT COMMUNITY

JIM KEY

DURONDA POPE

CALIN TEBAY

DIANE WHITTEN

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
THURSDAY, APRIL 22, 2021

Welcome and Introductions:

Mr. Chance called the meeting to order at 1:07 p.m. He began by 

announcing that Christopher Godfrey, the new Director of the

Office of Workers’ Compensation Programs (OWCP), will be

addressing the Board this morning to introduce himself. Mr. 

Chance noted that Board is continuing to convene its meetings

via teleconference as a result of the COVID-19 pandemic. He 

thanked Board members for making themselves available for this 

virtual format, and particularly thanked those members who have 

been working to fight the pandemic in their professional roles. 

Mr. Chance reviewed the logistics of the virtual meeting and

reminded Board members that some of the materials and 

information that they have received in their capacity as special 

government employees, including private contracts personally 

identifiable information, should not be shared or discussed 

publicly.

Chair Markowitz welcomed Board members, DOL staff, and the 

public to this meeting of the Advisory Board on Toxic Substances 

and Worker Health. He led the Board members in a round of brief 

introduction for those in attendance.

Re-Chartering and Response to the Advisory Board’s Request for 

Resources:

a. Re-Chartering

For the benefit of new Board members, Mr. Chance reviewed the 

Board charter renewal process, which is governed by the Federal 

Advisory Committee Act, also known as FACA. Under this Act, the 

Board charter must be approved every two years by the Secretary 

of Labor. The Board’s charter expires in June and staff is 

working with DOL leadership on the approval process. DOL staff 

does not anticipate any changes to the charter for this cycle. 

Chair Markowitz said he was happy with the current charter but 

asked that staff inform the Board of any proposed changes if 

they arise. 

b. Request for Resources

Noting that the Board and DOL staff have been discussing the 

Board’s desire for a Board work support and consulting contract, 

Mr. Chance was pleased to announce that will be releasing a 

Request for Information (RFI) in the coming weeks. The final RFI 
language will incorporate changes made in response to comments 

from the Board on the draft RFI. Once the RFI is released, DOL 

will review any responses from vendors in order to assess the 

technical expertise of the bidders and the level of resources 

needed to move forward. Chair Markowitz asked Mr. Chance to 

inform the Board of the date the RFI will be released and 

provide a link to the official announcement once those items are 

finalized. 

Chair Markowitz recalled that once aspect of the Board’s request 

was assistance in reviewing claims and the related need to 

establish a recordkeeping system or some other solution. He 

asked DOL staff for an update on that process. Staff said they 

would get back to the Board on that question after the meeting. 

Chair Markowitz said he was aware that creating a new database 

could be cost-prohibitive but recalled discussions about 

possibly modifying existing systems to fit the Board’s needs. 

Rachel Pond, Director of the Division of Energy Employees 

Occupational Illness Compensation (DEEOIC), confirmed Dr. 

Markowitz’s recollection, adding that the thought had been to 

develop spreadsheets based on extant data rather than creating a 

new database out of whole cloth. She added that this component 

may not be specified in the RFI but would be taken up by the 

parties post-facto in order to speed up the process. Dr. Rose 

Goldman asked whether the contractor will help assist review of 

claims where information has been scattered across disparate 

sources and has caused certain claims to be difficult to review 

in the past. Staff responded that the contractor’s activities 

will largely be governed by the final contract language that 

will be determined at a later date. Chair Markowitz said he 

anticipates the contractor being able to assist in the type of 

situation described by Dr. Goldman.

Message to the Board:

Christopher Godfrey, OWCP Director

Mr. Godfrey was hired on as Director of OWCP and he is working 

with staff to learn all the nuances of the programs under the 

office’s purview. Ms. Pond, Mr. Chance, and other staff members 

have been invaluable resources during this process. Prior to 

joining OWCP, Mr. Godfrey served as administrative law judge in 

DOL’s Federal Employees' Compensation Act (FECA) program where 

he reviewed final appeal decisions. Prior to joining DOL, he 

served as Iowa Workers’ Compensation Commissioner. In that role, 

he acquired experience working with an advisory board, which 

gave him insight into the important role such boards can play in 
assisting federal and state programs. Throughout his career he 

has been committed to supporting and protecting social insurance 

programs. The Advisory Board on Toxic Substances and Worker 

Health provides highly valuable technical assistance and Mr. 

Godfrey looks forward to working closely with the Board going 

forward. 

Review of Agenda:

Chair Markowitz briefly outlined the day’s agenda. Topics 

include DEEOIC’s response to Board action items, COVID-19 as a 

compensable illness, and the six-minute walking test to measure 

respiratory impairment, among others. 

DEEOIC Updates:

Ms. Pond provided a general update of recent activities in the 

program. First, she discussed DEEOIC’s operational plan goals, 

which include approximately 30 different timeliness goals that 

run the gamut of stages in the compensation process. Over the 

past fiscal year, the program has exceeded nearly all of those 

timeliness goals. The program is simultaneously working to 

upgrade its quality review process, which will be an ongoing 

activity throughout the year and will replace the annual 

accountability reviews. One aspect of the new quality process 

that Ms. Pond highlighted is that supervisors have increased the 

number of claims they are reviewing each month. Supervisors are 

now providing feedback every month on the quality of the work to 

every claims examiner and Final Adjudication Branch reviewer in 

the country.

Ms. Pond next updated the Board on the impact of the ongoing 

COVID-19 pandemic on the program’s work. As mentioned at 

previous Board meetings, the program issued a bulletin that 

allowed for the use of telemedicine for routine medical 

appointments. This allowance has been extended through September 

2021, and discussions are ongoing about potentially making 

telemedicine visits permanent for certain types of appointments. 

The program has also decided, given the heightened vulnerability 

of its population, to completely cover the cost of COVID-19 

vaccination for all previously compensated workers. As far as 

compensation for workers who contract COVID-19, the program 

currently compensates for conditions that result from previously 

accepted conditions. This is how the program will treat these 

cases until COVID-19 itself becomes a presumptive condition, 

which the Board will be discussing in greater detail later in 

this meeting. As far as administrative impacts of the pandemic, 
the program has seen delays in obtaining records from the 

Federal Records Center, the Social Security Administration, and 

the Department of Energy, as well as delays in medical 

appointments for impairment evaluation. This, unfortunately, has 

led to delays in claims processing, and some of the program’s 

timeliness goals have taken a hit as a result. Ms. Pond 

anticipates these setbacks to resolve themselves as more people 

get vaccinated and more employees return to their offices. On 

the DOL side, staff has been able to do nearly all its work 

successfully via telework thanks to previous digitization 

efforts. One challenge has been that DOL was forced to close its 

resource centers to the public and move all interactions to the 

phone. 

Ms. Pond next updated the Board on the program’s new case 

assignment process. Cases had previously assigned to regional 

offices based on the location of the employee’s employment. 

However, the program found that this policy led to disparities 

in workload across the regional office. Going forward, cases

will be assigned to the regional offices at random. The hope is 

this will afford the program more flexibility as far as 

oversight and hiring and will lead to more consistent claims 

process outcomes nationwide. To facilitate this transition, the 

program has been cross-training regional claims staff in order 

to bring them up to speed on sites that traditionally would have 

been outside of their purview. 

Ms. Pond announced the release of Version 5.0 of the Procedure 

Manual, which includes the Board-recommended presumptive 

language for asthma and Parkinsonism, as well as clarification 

regarding the SEC dates for Oak Ridge/K-25, among other updates. 

The program is also working to construct a means through which 

claimants, authorized representatives, and, eventually, 

survivors can access their case file digitally. Ms. Pond hopes 

to have this project completed by the close of the fiscal year.

Ms. Pond also updated the Board on recent outreach efforts 

conducted by the program. The program, in partnership with its

sister agencies, has been holding monthly virtual outreach 

meetings covering topics such as benefits and survivorship, the 

adjudication process, and policy updates. Despite the pandemic, 

these events have been very well attended. Other outreach 

mechanisms include email newsletters and legacy media 

advertising. Finally, Ms. Pond discussed the program’s training 

activities. DEEOIC hired a contractor to update the program’s 

claims examiner training and brought on a training specialist to 

oversee continuing education among staff.
Member Silver asked Ms. Pond if any of OWCP’s sister agencies 

with regional offices have used random case assignment. Ms. Pond 

said she believes FECA does something similar but she would have 

to confirm. Mr. Chance said the Black Lung Program switched to 

random assignment for similar reasons in 2017 and the transition 

went well after the cross-training Ms. Pond mentioned. Member 

Silver asked DEEOIC to keep a close eye on the claimant 

community during the transition. Many claimants and their 

families develop relationships with regional staff, and regional 

staff have become trusted experts on certain sites, and these 

individuals may find this transition disruptive. Ms. Pond said 

those staff members with subject matter expertise will be 

identified to serve as points of contact for when issues on 

certain sites arise or if other examiners need assistance on 

specific issues. Chair Markowitz discussed with Ms. Pond some 

other causes for delays in claims, such as claimants waiting to 

see a specific doctor of their choice and decrease in medical 

visits because of the pandemic, as well as the details of the 

quality review process.

John Vance, Policy Branch Chief, presented DEEOIC’s responses to 

the Board’s follow-up items from its last meeting. The first 

item asked for an update on the program’s quality assurance (QA)

effort. Ms. Pond discussed this previously at a broad level, and 

Mr. Vance added some additional details about the QA process. 

For FY 2020, staff reviewed we reviewed 1,248 cases and 416 

decisions. The goal is to assess both quality and accuracy. 

Ultimately, the idea is to improve the overall quality of 

decisional outcomes and to identify areas for improvement and 

training. 

In the second item the Board asked what proportion of new nonimpairment claims get referred to industrial hygienists (IH). 

DEEOIC said the program does not maintain data that breaks down 

claims as new versus old. Overall, for the period of October 1, 

2020 through March 31, 2021, there were 1,180 contractor IH 

reviews and 76 internal IH reviews.

The Board asked if DOL is considering standing up a research 

office of evaluate claims data. Mr. Vance said the program’s 

position is that its legislative mandate is case adjudication 

activities, and the program does not have the authority to 

conduct activities outside that specific purview. 

For the fourth item, the Board noted that EEOICP has started 

implementing the new Occupational History Questionnaire (OHQ)
and that the program would be asking the Resource Centers for

feedback on this process. The Board asked for an update on this 

feedback. DEEOIC conducted an informal canvassing of the 

Resource Centers and related staff and compiled the feedback in 

a table that Mr. Vance provided to the Board. The Resource 

Centers have conducted over 1,900 OHQ interviews. Overall, the 

reception has been positive. Respondents said the new OHQ 

captures more relevant information. One recurring criticism was 

about the text size and formatting, which will be corrected in a 

future version. 

The fifth question from the Board asked DEEOIC to discuss how 

the Medical Director is engaged in claims evaluation and their 

role in general. Mr. Vance referred the Board to the Procedure 

Manual for a detailed description of the Medical Director’s 

responsibilities. In general, their role is to provide expert 

analysis and consultation on various aspects of the adjudication 

process, such as diagnosis, credentialing, causation, and so on. 

The Medical Director also supports OCWP’s medical billing and 

coding activities.

The final question from the Board asked DEEOIC to comment on how 

it handles potential bystander exposures, which may not be 

included in the SEM. Mr. Vance said program examiners and 

physicians consider all information at their disposal, including 

the input of IH experts and the worker’s history and contact 

with particular toxins, and if there is indication that the 

worker was incidentally exposed then that can be included in the 

Part D compensability analysis. The OHQ plays crucial role in 

collecting all relevant information for the program to consider.

Chair Markowitz said it might be useful to get the input of 

contract and federal IHs on how helpful the new OHQ has been. 

Mr. Vance said the federal IHs he has spoken with are finding it 

useful, particularly the added detail and context that the new 

version allows for. Chair Markowitz suggested checking with the 

contract IHs, too. He also asked whether the OHQ includes 

questions about bystander exposure. Ms. Rhoads said she would 

send the OHQ to the Board members for them to review at their 

leisure. Chair Markowitz asked how the Medical Director becomes 

involved in individual claims. Mr. Vance said that is determined 

by the claims examiner working with their management on whether 

the Medical Director needs to be consulted on a particular 

issue. That process is conducted by the Policy Branch, who 

determines whether the issue is most appropriately referred to 

the Medical Director, a Contract Medical Consultant (CMC), or 

back to the treating physician. If the issue is referred to the 
Medical Director, the response is in writing and subsequently 

included in the case file.

Update on Prior Recommendations:

The first Board recommendation had to do with site-wide jobs. 

The Board recommended that “the Department develop and implement 

exposure presumptions indicating that job categories at DOE 

sites whose workers likely worked throughout their individual 

sites had potential exposure to all listed toxic substances at 

those facilities.” Chair Markowitz highlighted a key sentence of 

the Department’s response in which they indicate that “it is 

inappropriate to assign such a broad classification of exposure 

to specific labor categories in the absence of any underlying 

documentary support.” Chair Markowitz opened the discussion by 

noting that historically there has been varying degrees of 

documentation of hazards for specific job titles at DOE sites, 

both across points in time and from site to site. Chair 

Markowitz asserted that it is as problematic to tolerate 

variation in consideration of claims as it is to tolerate the 

lack of documentary support, reaffirming his support for the 

original Board recommendation. Member Key agreed and noted that 

the EEOICPA was created, in part, because of lack of 

documentation and monitoring at the sites. Member FriedmanJimenez said one option would be to create an exposure database 

that would gather exposure data from specific job titles and 

that would collectively provide the documentation needed to 

assess job-specific exposures. He noted that such a database 

would have more limited utility in comparing eras, however.

Board members discussed steps forward given the Department’s 

opposition to the recommendation. Member Goldman suggested the 

possibility of using the support contract to develop something 

like Dr. Friedman-Jimenez’s database idea to track job-specific 

OHQ data going forward. Chair Markowitz expressed the concern 

that would delay acting on bystander exposure. He also worried 

the OHQ would not capture the right information because the 

workers themselves would not know enough to report such 

exposures. Member Silver said he saw significant distinctions 

between certain bystander job titles, particularly firefighters, 

due to the nature of their work. He also suggested looking to 

the epidemiology literature for toxins that have documented 

associations with bystander exposure. Chair Markowitz suggested 

that this recommendation return to the Working Group for further 

consideration of next steps.

The next recommendation was that the Department develop an 

ongoing system to evaluate the objectivity, quality, and 
consistency of individual claim reports and IH and physician 

audits. The Department should also periodically audit the IH 

reports and IH review process. The results of these analyses 

should be reported to the Board on a regular basis. The 

Department agreed to implement changes to its quality control 

framework. The Department provided further response detailing 

the actions it proposes to take in this regard. Chair Markowitz 

asked program staff for an update on these activities. Mr. Vance 

said much of the actions were discussed earlier in the meeting. 

The work began last year and the program is looking at 

qualitative and policy application accuracy throughout its

entire decisional process. The program is also overhauling its 

CMC review process to include more objectivity. A lot of these 

efforts are still being developed, particularly on the IH side 

where it would be difficult to find third-party IHs to conduct 

audits given contractual and resource limitations. Chair 

Markowitz suggested that the Department consider whether the 

Board has a role to play in assisting in the development and 

redesign of the auditing process. Mr. Chance reminded the Board 

that any action it takes in these regard has to be valid under 

FACA.

IARC/NTP Carcinogens – Report and Recommendation:

Member Goldman presented the Working Group on Probable Human 

Carcinogens’ report and proposed recommendation. The other Board 

members on the Working Group were Aaron Bowman, Duronda Pope, 

and George Friedman-Jimenez. The task was to look at 

International Agency for Research on Cancer (IARC) Group 2A 

agents, which are those considered probably carcinogenic to 

humans, and to consider whether they should be added to the SEM 

and/or linked to specific cancers. The Working Group started by 

reviewing the 22 agents added to Group 2A since 2016, of which 

18 were toxic substances. In order to decide whether these 18 

should be added to the SEM, the Working Group looked at which 

substances have evidence of being linked to cancer in humans. 

The Working Group tried to avoid duplicating the substantial 

epidemiological and literature review that was already conducted 

by IARC. By being in Group 2A, these substances at most have 

limited evidence of human carcinogenicity but may have 

sufficient evidence in animal models or mechanistic relationship 

to other known human carcinogens. Based on the Working Group’s 

review, of the 18 toxic substances, 11 had limited evidence of 

carcinogenicity in humans. Of these 11, all were found in the 

SEM, but none are currently linked to cancers in specific 

organs.
The Working Group had three recommendations for the Department: 

1) Toxic substances that are found to be probable human 

carcinogens (IARC Group 2A) and that have limited human 

epidemiological evidence for specific human cancer sites, 

as identified in Table 1, should be linked to those cancer 

sites in SEM.

2) The SEM should specify that IARC and National Toxicology 

Program (NTP) evaluations have been used in addition to 

Haz-Map for the purpose of asserting linkages between toxic 

substances and human cancer sites.

3) Future IARC Group 2A substance-cancer linkages identified 

by IARC or NTP should be incorporated in the SEM. Data from 

IARC and NTP should be used in addition to Haz-Map for 

health effects and linkages of toxic substances to cancers. 

Chair Markowitz commended the Work Group for their excellent 

work and briefly discussing the history of this particular 

effort. Member Bowman moved that the Board accept the 

recommendations, which was seconded by Member Key. 

Member Silver asked whether DOL keeps an eye out for newly 

identified toxic substances, or known substances that have been 

newly found to have toxic properties. Ms. Pond says the SEM is 

constantly being updated based on the state of the literature. 

Member Friedman-Jimenez discussed with program staff the details 

of how the SEM is updated and what factors and inputs are 

considered, including Board advice, active surveillance of the 

literature, and public input, among others. Member Goldman said 

one way to simplify the process would be to merely follow IARC, 

and when they add substances, automatically add them to the SEM.

Following discussion on regular updates and ensuring that the 

SEM follows IARC in both adding and removing substances, the 

Board amended the third recommendation to read: “Data from IARC 

and NTP should be used in addition to Haz-Map for health effects 

and linkages of toxic substances to cancers. At least on a 

yearly basis going forward, future IARC Group 2A (as well as 

Group 1) substance-human cancer site linkages identified by IARC 

and NTP should be updated in the SEM.”

The Board voted unanimously to approve the recommendations.

DOL Query on COVID:

Chair Markowitz reviewed the Department’s query to the Board on 

COVID-19 disease. The Department asked where it is reasonable,
under certain circumstances, to presume that a certain type of 

accepted work-related illness will increase the severity of a 

positive COVID-19 diagnosis. Under such a scenario, the program 

would be able to accept COVID-19 as a compensable consequential 

illness without further action. Otherwise, DEEOIC would have to 

seek the opinion of a physician to establish such a relationship 

on a case by case basis. 

Chair Markowitz presented his draft recommendation for the 

Board’s consideration. It reads: “The Board recommends that any 

chronic health condition that is listed by the CDC as being 

associated with severe COVID-19 disease by meta-analysis, 

systematic reviews, cohort studies, case control studies, crosssectional studies, case cases/series or mixed evidence be 

considered to be presumed to lead to COVID-19 disease. That is, 

the diagnosis of COVID-19 disease is a consequence of those 

chronic health conditions.”

Member Goldman said she felt that the last sentence makes it 

sounds like chronic health conditions make people more 

susceptible to contracting the virus and she was not sure the 

evidence supports that. Members Bowman and Friedman-Jimenez said 

there is evidence that having those conditions leads to more 

severe COVID-19 disease. Ms. Pond said the severity was 

ultimately irrelevant as far as compensability. Chair Markowitz 

raised the issue of so-called long-haul COVID-19 disease, where 

symptoms may arise well after initial infection and may occur 

even in people who originally had a mild bout of the disease. In 

light of these concerns, Board members discussed whether to 

specify “symptomatic” or “severe” COVID-19 in the 

recommendation. Member Bowman said he preferred “severe” because 

it was consistent with the CDC language. 

The Board postponed further discussion on this topic until Day 2 

of the meeting in order to take public comment.

Public Comment Period:

Terrie Barrie, Alliance of Nuclear Worker Advocacy Groups

Ms. Barrie discussed how the Radiation Exposure Compensation Act

(RECA) provides for compensation of workers exposed to uranium 

radiation and listed the diseases covered under the Act. Uranium 

has both radiological and toxicological properties. SEC classes 

should be applied to workers who may have suffered toxic effects 

exposure to toxic radionuclides. The Board should consider 

whether a presumption should be recommended for non-cancerous 
diseases covered under RECA. 

Ms. Barrie also raised concerns about Final Adjudication Branch 

(FAB) claims examiners cherry-picking evidence. She pointed to a 

noteworthy case from South Carolina in which litigation 

ultimately led to DEEOIC overturning FAB’s final decision. Ms. 

Barrie stressed that all the evidence DEEOIC used to overturn 

this decision was previously extant in the case file. She asked 

the Board, perhaps via its new contractor, to audit FAB final 

decisions and reconsideration denials to determine if there are 

other cases where FAB ignored evidence in the case files.

D’Lanie Blaze, CORE Advocacy

Ms. Blaze focused her comments on her work on behalf of former 

workers at the Santa Susana, Canoga Avenue, and De Soto 

facilities. As a result of the program’s decision to remove 

claims from their region of origin, the claimants Ms. Blaze 

represents have repeatedly reported dealing with examiners and 

hearing representatives with shockingly little familiarity with 

their work sites. This results in important information being 

overlooked and inconsistent and contradictory decisions, which 

in turn has led to more requests for reconsideration and delays 

in decisions. These sites are highly complex and the related 

data demand a great deal of familiarity and expertise to be 

properly understood. Ms. Blaze also reported ongoing problems 

related to claims examiners proving unwilling to examine the 

entirety of the case file. There have also been incidents in 

which unfamiliar claims reviewers are not accepting previously 

established corporate successorship documents related to the 

Canoga Avenue facility. This could be resolved by the three 

sites being reclassified into a single site. In the meantime, 

BTComp should be updated to reflect the proper corporate data so 

that unfamiliar claims examiners do not inappropriately reject 

these claims. Ms. Blaze also asked the adjudicatory jurisdiction 

be returned to the originating regional office with the 

institutional knowledge and expertise to properly adjudicate 

claims at these complex sites.

Faye Vlieger

Ms. Vlieger applauded the Department for their efforts to stay 

in operation throughout the pandemic. However, she has 

experienced a number of problems with the claims adjudication 

process in the past year, including claims examiners not 

consulting the SEM for all possible exposures. In addition, the 

SEM is not properly linked to labor categories and labor 
categories consistently have no toxins associated with them. She 

also discussed cases in which she felt the Medical Director was 

improperly consulted and given erroneous statements of facts. 

This consultation is also being used as an end-run around the 

refereed CMC opinion. Despite these issues, the program has seen 

many improvements over the years, and Ms. Vlieger thanked staff 

for their ongoing efforts to continue this improvement effort.

Jean Cisco, Portsmouth Site

Ms. Cisco described ongoing issues with workers being improperly 

classified based on inadequate job descriptions. The Portsmouth 

collective bargaining agreement has more complete job 

descriptions but Ms. Cisco has been unable to get the program to 

accept these descriptions despite repeated attempts. She also 

expressed displeasure at removing claims from their regional 

office origin. She suggested rotating examiners through the 

different regions to gain expertise before rotating the claims. 

She was glad to hear the Board will be recommending a COVID-19 

presumption and she suggested using the “symptomatic” language 

rather than “severe” because a mild case of COVID-19 could 

significantly aggravate the preexisting condition.

Gary Vander Boegh, Paducah Gaseous Diffusion Plant

Mr. Vander Boegh described his difficulties getting workers’ 

plutonium and beryllium exposures at Paducah and elsewhere 

recognized by the Department. 

End of Day One: 

Chair Markowitz adjourned the meeting for the day at 4:57 p.m.

FRIDAY, APRIL 23, 2021

Call to Order:

Chair Markowitz called the meeting to order at 1:06 p.m.

Following Board member introductions, the Chair listed potential 

work group topic areas for the Board to consider during the 

day’s discussion. His proposal was to establish one work group 

focused on reviewing the Department’s efforts to improve claim 

quality, objectivity, and consistency, and another work group to 

explore and follow up on public comments. 
DOL Query on COVID (Continued):

The Board resumed the conversation on its draft COVID-19 

presumption recommendation that it had begun on the first day of 

the meeting. Board members continued to debate and fine-tune the 

language around symptomatic versus severe COVID-19 disease. 

Member Goldman it was important to be clear that the 

recommendation would cover individuals who develop a symptom of 

COVID-19 per the CDC definition. Member Bowman felt it was 

important for the Board to be evidence-based in its language, 

and the current literature connects chronic health conditions to 

increase risk of severe COVID-19 disease. Chair Markowitz agreed 

that the language should refer to CDC definitions, but noted 

that mild disease has not been a research priority. He agreed 

that the recommendation should be worded to cover the spectrum 

from mild to severe symptomatic cases. Dr. Friedman-Jimenez

pointed out that the literature on COVID-19 disease continues to 

evolve, particularly with the emergence of what has been dubbed 

long COVID. As time goes on, long COVID may become a more 

dominant concern. While he agreed that the current 

recommendation should remain more narrowly tailored to acute 

COVID-19 given the state of the literature, Dr. Friedman-Jimenez

suggested including a mechanism for updating the recommendation 

if the literature evolves. Chair Markowitz argued that the 

language “diagnosis of symptomatic COVID-19 disease” would cover 

long COVID,but agreed with Dr. Friedman-Jimenez’s suggestion.

Member Goldman concurred and suggested using similar language as 

the carcinogen recommendation from Day 1. The Board was in

consensus that the recommendation should be claimant-friendly in 

its construction; given the lack of hard data on certain aspects 

of the disease, the Department should err on the side of 

inclusivity.

After further discussion on precise language, the Board settled 

on the following recommendation: “The Board recommends that any 

chronic health condition that is listed by the CDC as being 

associated with severe COVID-19 disease by meta-analysis, 

systematic reviews, cohort studies, case control studies, crosssectional studies, cases series or mixed evidence be considered 

to be presumed to lead to COVID-19 disease. That is, the 

diagnosis of symptomatic COVID-19 disease is a consequence of 

those chronic health conditions when it follows or coincides 

with the onset of those conditions. The Board recognizes the 

need to periodically review (at a minimum, annually) and update 

this recommendation based on the evolving scientific and medical 

knowledge on this topic.”
Member Goldman moved to accept the proposed recommendation, with 

Member Pope seconding. The Board voted unanimously to approve 

the recommendation.

Asbestos – Report and Recommendation:

Chair Markowitz updated the Board on the Asbestos Work Group’s 

recent activity. Members Catlin, Van Dyke, and Whitten join 

Chair Markowitz in comprising the Work Group. In January, the 

Work Group presented three draft additional recommendations:

1) We recommend that Paragon Technical Services (PTS) 

reevaluate the job titles of chemical engineers, 

industrial, health, and safety engineers, mechanical 

engineers, and that these titles be added to the list of 

occupations presumptively exposed to asbestos under EEOICP.

2) We request access to the Generic Profiles, including the 

Asbestos Generic Profile, as cited in the PTS report.

 

3) We recommend that the DOL clarify how DOE jobs that 

correspond to the job title “maintenance and repair, 

general helper” are classified within the SEM and whether 

they are linked to asbestos exposure.

These recommendations built off previous Board discussions on 

whether the Department’s list of presumptively exposed job 

titles should be expanded. The Board reviewed data contained in 

the National Occupational Mortality Surveillance (NOMS), 

particularly data related to malignant mesothelioma, the most 

prominent asbestos-related cancer, and produced a table listing 

job titles with the highest proportionate mortality ratio (PMR).

This data was forwarded to the Department last year as part of 

the Board’s prior recommendation. PTS provided DOL’s response in 

which they accepted some of the job titles, including HVAC 

mechanics, firefighters, and stationary engineers, but not all 

the trades the Board had recommended. PTS offered several 

explanations for why certain titles were rejected: if the SEM

does not connect asbestos to the occupation, if the occupation 

has uncertain relevance to work performed DOE sites, or because 

the job title was rare at DOE sites, among other reasons. Chair 

Markowitz acknowledged that these arguments are compelling for a 

number of occupations listed in the NOMS data. However, the 

Asbestos Work Group believes these arguments are unpersuasive 

for occupations with high PMR in the NOMS data, with a 

significant number of related mesothelioma cases, and that exist 

with a reasonably high frequency within the DOE complex. The
Work Group identified three occupations that meet these 

criteria: chemical engineers, mechanical engineers, and 

industrial, health, and safety engineers. As such, the Work 

Group recommends that these three job titles be added to the 

Department’s presumptive exposure list.

The Work Group’s draft recommendation related to the Generic 

Profiles arose from a section in PTS’ report in which they list 

22 work processes associated with asbestos exposure in the 

Generic Profile. Chair Markowitz pointed out that several work 

processes in this list (janitorial activities, laundry, and 

power/communication line maintenance) are not included in the 

program’s asbestos presumption list.

Finally, the Work Group is asking for more information on the 

maintenance repair, general helper job classification as it 

shows increased mesothelioma risk in the NOMS data and it is now 

clear how that job title is treated within the DOE complex.

Member Goldman asked if the purpose of adding these titles to 

the presumptively exposed list was solely in relation to 

mesothelioma or whether it would have applicability to other 

asbestos-related illnesses. Chair Markowitz said it would apply 

to all asbestos-related diseases. 

Member Friedman-Jimenez moved to accept the recommendations, 

seconded by Member Catlin. During discussion, Member Silver said 

the Department and the Board should consider how sites may 

distinguish engineer versus technician titles by level of 

education in order to ensure the data is comprehensive and does 

not exclude certain workers because of semantical differences. 

The Board voted unanimously to approve the recommendations.

Six-Minute Walking Test – Report and Recommendation:

Chair Markowitz invited Member Friedman-Jimenez to deliver the 

report prepared in response to the Department’s query regarding 

impairment assessments for lung diseases that are attributable 

to occupational causes and compensated by the EEOICPA program. 

Member Friedman-Jimenez described how American Medical 

Association (AMA) Guides are used to assign levels of impairment 

based on each individual claimant. In this particular case, the 

Board was asked for its opinion on the permissible testing 

methodologies that can be used to assign VO2 max per the Guides. 

The Board believes that there are two permissible methodologies: 

1) direct measurement of VO2 max or VO2 peak in a pulmonary 
function laboratory that is experienced in performing 

Cardiopulmonary Exercise Tests (CPET) using a treadmill or cycle 

ergometer; and 2) the 6 Minute Walk Test (6MWT) along with a 

regression equation to estimate VO2 peak. Dr. Friedman-Jimenez 

discussed how the Work Group came to this conclusion based on an 

assessment of the AMA Guide impairment classifications and a 

review of the literature. The cardiopulmonary exercise test is

considered the gold standard for estimating the VO2 max by the 

American Thoracic Society and the European Respiratory Society.

One disadvantage is that exercise testing requires a qualified 

and experienced pulmonary function lab, which may not be easily 

accessible to all claimants around the U.S. The 6MWT been 

studied extensively for a variety of patients, primarily those

with cardiac disorders, but also on patients with lung 

disorders, COPD, and asbestos-related lung disease. In these 

studies, it has been shown to more repeatable than the CPET, and 

overall has been found to be a valid and reliable means of 

measuring functional exercise capacity in adults with chronic 

respiratory disease. A systematic review also concluded that the 

relationship between the six-minute walk distance and VO2 peak 

was moderate to strong and consistent across patient groups with 

COPD and interstitial lung disease. Additionally, the 6MWT is a 

widely available field test that does not require specialized 

equipment and can be safely performed in typical medical office 

settings. Because the 6MWT measures V02 peak, some mathematical 

conversion is needed for application in the AMA Impairment 

Guide. Member Friedman-Jimenez described the best available 

equation for this conversion, which was published by Ross et al. 

in 2020. 

Dr. Friedman-Jimenez presented the Working Group’s draft 

recommendation, which reads: “The Board advises that the 6MWT is 

entirely acceptable to measure VO2 max for the purposes of 

impairment assessment. The best valid and available method to 

estimate a value of VO2 max from the six-minute walk distance 

(6MWD) for application in Table 5-12 of the AMA Impairment Guide 

is to use the equation derived by Ross et al. (2010).”

During discussion of the recommendation, Dr. Friedman-Jimenez 

asked that the word “mean” be removed from the Ross et al. 

equation. Member Mikulski moved to accept the recommendation, 

seconded by Member Whitten. The Board voted unanimously to 

approve the recommendation.

Board Comments on DOL Impairment:

Chair Markowitz led the Board in an open discussion on topics 
related to impairment assessments under the EEOICP program. A 

Working Group was convened to discuss these matters, with 

Members Catlin, Tebay, Pope, and Markowitz as members. Chair 

Markowitz began by reviewing the Medical Director’s annual 

audits of CMC reviews. These audits look at causation 

determinations, impairment assessments, outside opinions, and 

other less common review types. These audits determined that 

impairment assessments had the most reviews classified as “needs 

improvement,” with 32% falling under this category across the 

two audit years of 2018 and 2019. Ms. Pond confirmed that the 

2020 audit has not been conducted yet because the Medical 

Director has been focused on COVID-19 matters; it has also been 

delayed because of the program’s internal efforts to improve 

quality assurance. Mr. Vance added that the 6MWT has been one 

source of confusion in the impairment assessment process, which 

he hopes the Board’s recommendation will help address. Member 

Friedman-Jimenez asked for clarification on what types of errors 

caused assessments to be classified as needs improvement. Mr. 

Vance said it was a wide range of issues, from inconsistent 

technical application of the AMA Guides to incorrect ratings and 

other methodological errors. 

The Work Group posed several questions about the Medical 

Director for Board discussion and for the Department to 

consider. How many impairment ratings were performed in the last 

two years? How many of those impairment ratings have been 

flagged for review by the Medical Director? How many of the 

impairment ratings that the Medical Director has flagged have 

been challenged in one way or the other? Are there specific 

impairment physicians with more challenged impairment ratings 

than others? What actions has the CMC contractor taken to 

improve impairment ratings?

Chair Markowitz said he reviewed the role of the Medical 

Director as defined in the Procedure Manual and did not find any 

language about Medical Director being responsible for providing 

input on individual claims when requested. He asked program 

staff for the statutory basis for that responsibility. Ms. Pond 

said that function is viewed as part of the Medical Director’s 

audit oversight of the CMCs. Mr. Vance added that the claims 

examiners primarily utilize the Medical Director as a subject 

matter expert to consult in questions of a medical nature. Chair 

Markowitz argued that the CMCs should be able to fulfill this 

role, but the results of the audit suggest that the CMCs may not 

be as reliable as one would hope. Ms. Pond said these are all 

factors that will be reviewed as part of the program’s quality 

assurance overhaul. Ms. Pope expressed the concern that 
examiners appear to be using the Medical Director in lieu of 

formal second opinion requests. Ms. Pond said while the Medical 

Director opinion may confirm the conclusion of treating 

physician, it frequently does lead to second opinions, as well.

Chair Markowitz again volunteered the Board to assist the 

program in its QA improvement efforts through its chartered task 

to evaluate the quality, consistency, and objectivity of the 

industrial hygiene and medical input into the claims evaluation 

process. Mr. Vance thanked the Board for their assistance on the 

Six Minute Walking Test matter and he anticipates the program 

will bring other issues of a similar nature to the Board as they 

arise going forward.

The Board discussed whether it should make a data request on 

this topic or formally submit its questions to the Department. 

Chair Markowitz recommended that the Working Group refine the 

questions based on the discussion today in anticipation of 

formally presenting them to the Department at a later date. 

New Business:

There was no new business. 

Board Process and Next Board Meeting:

Chair Markowitz indicated that the next Board meeting is likely 

to be at least partly virtual in nature, although he expressed 

the desire for an in-person meeting, if feasible. When full inperson meetings do return, the next DOE site in line to host the

Board would be the Nevada Test Site. 

As he mentioned at the beginning of the day, Chair Markowitz 

recommended the establishment of work groups focused on 

reviewing the Department’s efforts to improve quality, 

objectivity, and consistency of IH and medical evaluations, and 

for evaluating public comments for potential action items. The 

Board discussed whether subcommittees or work groups would be 

the preferred vehicle for these bodies under the FACA 

regulations. Work groups do not have to be publically noticed 

and can move more quickly, while subcommittees are more 

transparent and allow for public access. Member Silver asked 

whether Board members would be able to contact public commenters 

under the work group structure. Mr. Chance said that could be 

problematic but he would have to consult the regulations for 

confirmation on what is allowed in that regard. Member Goldman 

argued that work groups would be the better mechanism given the 

technical nature of the discussion and the need for the Board to 
fine-tune its conclusions before sharing them at-large. Chair 

Markowitz agreed. He reminded members of the public that the 

Board welcomes input at any time, not only during formal public 

comment periods at Board meetings. 

Chair Markowitz asked for volunteers to serve on the two work 

groups. Members Whitten, Pope, Key, Silver, and Mikulski 

volunteered for the public comment work group. Members Whitten, 

Pope, Van Dyke, Catlin, Silver, and Markowitz signed up for the 

IH quality work group. 

Chair Markowitz raised the topic of consulting other sources 

beyond IARC and NTP when it comes to assessing potential 

carcinogens for inclusion in the SEM. Ms. Pond said the program 

consults as many sources as it can, given time and resource 

limitations. Member Goldman said her group decided to start with 

IARC because of the depth of data and research it brings; she 

acknowledged that there are other sources, but the Board, too, 

has limited time and resources. One practical next step would be 

to look at IARC substances beyond the 22 the Work Group chose 

for its initial assessment. Member Friedman-Jimenez said it will 

be important to see how well the 11 new additions to the SEM are 

integrated, assuming they are accepted by the program. The 

Department should consider how an update to the SEM could help 

make it more user-friendly. The Board also discussed how to work 

with Haz-Map in integrating their findings into that database. 

Ms. Pond said she would look into how that process might take 

place. 

Close of Meeting:

Mr. Chance adjourned the meeting at 4:19 p.m.