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UNITED STATES DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES

AND WORKER HEALTH

+ + + + +

MEETING

+ + + + +

THURSDAY

FEBRUARY 28, 2019

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The Advisory Board met telephonically, 

Steven Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

JOHN DEMENT

GEORGE FRIEDMAN-JIMENEZ 

MAREK MIKULSKI

KENNETH SILVER

MEDICAL COMMUNITY

MANIJEH BERENJI

STEVEN MARKOWITZ, Chair

CARRIE A. REDLICH

CLAIMANT COMMUNITY

KIRK DOMINA

RON MAHS

DURONDA POPE

CALIN TEBAY
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DESIGNATED FEDERAL OFFICIAL

DOUGLAS FITZGERALD
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CONTENTS

Welcome and Introduction ...................... 4

EEOICP Bulletin 19-03 ........................ 10

Proposed Revised Asbestos Presumption

Recommendation ............................... 15

Proposed Revised Occupational Health

Questionnaire Recommendation ................. 40

Proposed Revised Occupational Asthma

Recommendation ............................... 62

Parkinson's Related Diseases ................. 77

Break ........................................ 95

Public Comment Tracking ...................... 96

Review of Final DOL EEOICP Rule

Regarding Board Recommendations .............. 98

Board Action List, November 2018 

Board Meeting ............................... 104

Board Data and Claims Request, 

December 2018 ............................... 107

Additional Items ............................ 119

Adjourn ..................................... 133
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1 P-R-O-C-E-E-D-I-N-G-S

2 2:07 p.m.

3 MR. FITZGERALD: Good afternoon, 

4 everyone. My name is Douglas Fitzgerald and I'd 

5 like to welcome you to today's meeting of the 

6 Department of Labor's Advisory Board on Toxic 

7 Substances and Worker Health.

8 I'm the Board's Designated Federal 

9 Office, or DFO. 

10 On behalf of the Department of Labor, 

11 I'd like to express my appreciation for the 

12 diligent work of our Board members since our last 

13 meeting in November preparing for this public 

14 meeting.

15 As the DFO, I serve as the liaison 

16 between the Department and the Board. The DFO is 

17 responsible for approving meeting agendas and for 

18 opening and adjourning meetings while ensuring 

19 all provisions of the Federal Advisory Committee 

20 Act, or the FACA, are met regarding the 

21 operations of the Board.

22 I am also responsible for making sure 
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1 that the Board's deliberations fall within the 

2 parameters outlined in its enabling statute and 

3 charter.

4 Within that context, I work closely 

5 with the Board's Chair, Dr. Steven Markowitz, and 

6 the Office of Workers' Compensation Programs to 

7 ensure that the Board as an advisory body to the 

8 Secretary is fulfilling its mandate to advise and 

9 is addressing those issues of highest priority 

10 and of greatest interest and of benefit to the 

11 Secretary of Labor who is ultimately responsible 

12 for the administration of the Energy Employees 

13 Occupational Illness Compensation Program.

14 And, finally, I also work with the 

15 appropriate Agency officials to ensure that all 

16 relevant ethics regulations are satisfied.

17 We have a full agenda for the next 

18 three hours this afternoon. Copies of all 

19 meeting material are available at the Board's 

20 website under the heading meetings.

21 The Board's website can be found at 

22 dol.gov/owcp/energy/regs/compliance/advisory 
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1 board.htm. Or you can simply Google Advisory 

2 Board on Toxic Substances and Worker Health.

3 The Board's website has a page 

4 dedicated entirely to this meeting. That page 

5 contains all materials submitted to us in advance 

6 of the meeting, but I would also note that some 

7 of the academic materials the Board may reference 

8 in its deliberations today are copyright 

9 protected, so they are not posted for public use 

10 -- but they cannot be posted for public use, 

11 although they may be publically cited.

12 Those papers are noted on the website 

13 as well.

14 There, you will also find today's 

15 meeting agenda as well as instructions for 

16 participating remotely in the meeting.

17 If you are joining by WebEx, please 

18 note that this session is for viewing only and 

19 will not be interactive.

20 During Board deliberations, I would 

21 like to remind the members to mute their 

22 telephones when they're not engaged in the 
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1 discussion.

2 Also, please do not use the hold 

3 function as it could result in turning the rest 

4 of us to some unintended New Age musical 

5 interlude.

6 The FACA requires that the minutes of 

7 this meeting be prepared to include description 

8 of the matters discussed here today and 

9 conclusions reached by the Board.

10 As DFO, I prepare the minutes and make 

11 sure they are certified by the Board's Chair. 

12 The minutes of today's meeting will be available 

13 on the Board's website no later than 90 calendar 

14 days from today per FACA regulations.

15 And, if available sooner, they'd be 

16 published before the 90th day.

17 Also, although the informal minutes 

18 will be prepared as required by the FACA 

19 regulations, we'll also be publishing verbatim 

20 transcripts which are, obviously, more detailed 

21 in nature.

22 Those transcripts will be available on 
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1 the Board's website as soon as possible.

2 I'm looking forward to working with 

3 all of you and hearing your discussion this 

4 afternoon.

5 And, with that, Mr. Chairman, I 

6 convene this meeting of the Advisory Board on 

7 Toxic Substances and Worker Health.

8 CHAIR MARKOWITZ: Thank you.

9 This is Steven Markowitz. I want to 

10 welcome Board members back to another Board 

11 meeting. I also want to welcome any members of 

12 the public who are participating.

13 If you have a problem seeing the 

14 materials or finding our website, all you need to 

15 do is put in our initials, ABTSWH and you will 

16 find our website.

17 We are, as you'll see some tabs in the 

18 middle of the page, we are under the meetings, go 

19 to the most recent meeting and you'll see the 

20 materials listed for today.

21 I want to thank Doug Fitzgerald, 

22 Carrie Rhoads, Kevin Bird for all the 
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1 arrangements, all the work that's done in 

2 preparation for today and also for the work 

3 that's done, some of which is invisible to us in 

4 between meetings. So, thank you very much.

5 Dr. Cassano is not participating 

6 today. She emailed yesterday and had a personal 

7 emergency so she's not able to participate today 

8 and Dr. Berenji will be a few minutes late.

9 So, the Board has 12 members, and to 

10 the extent we vote today, we will -- we may 

11 affirmative vote represents a simple majority. 

12 So, if there are 12 members of the Board in any 

13 given vote to pass a recommendation or whatnot, 

14 we would need 7 votes.

15 Usually, we come to consensus and 

16 reach a higher threshold than that, but I'm just 

17 letting you know that we would require seven 

18 votes either way on any given recommendation.

19 So, the -- almost all the materials 

20 that we are going to discuss today are on the 

21 website. There were a couple that I sent to 

22 Carrie late. I notice that one of them which I 
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1 sent yesterday did arrive or Tuesday did make it 

2 on the website just recently.

3 We're going to show most of these 

4 things on the WebEx. And so, both the members 

5 and members of the public, we'll be looking at 

6 much of what we're able to access on the web.

7 There will be a few detailed documents 

8 that we're not going to put up because it would 

9 probably be more confusing than not. But they 

10 are certainly available.

11 Let me see, if there's anything -- any 

12 other comments on our web materials.

13 So, the agenda, I'm going to go 

14 briefly through the agenda. We will make it 

15 through the agenda today, I'm confident.

16 We're going to -- you see the agenda 

17 on the WebEx screen, we're going to discuss the 

18 revision asbestos presumption recommendation.

19 I think, actually, we should take 

20 number nine which is the EEOICP Bulletin 19-03, a 

21 recent bulletin which describes changes in the 

22 procedure manual. I think we'll review that 
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1 briefly first because it pertains to the items 

2 one through three, the proposed revisions and 

3 recommendations.

4 So, we will show, Kevin just by way of 

5 notice, you don't have to show it right at the 

6 moment, but the next thing we'll go to is the 

7 Bulletin 19-03.

8 So, we're going to go through 

9 revisions and the three prior recommendations of 

10 the Board. All those recommendations stem from 

11 the previous Board.

12 To orient you on the materials, what 

13 we've done is compiled the original 

14 recommendation on that given topic with the 

15 original Department of Labor response together 

16 with any revised recommendation we made.

17 And, if there was a further response 

18 from DOL in that.

19 So, on the links on our meeting 

20 website, we have -- you don't have to go between 

21 different dates if you look at these -- the 

22 asbestos recommendation, you will see in sequence 
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1 the interchange between the Board and the 

2 Department. And, that will serve as background 

3 for the new text we're going to look at which is 

4 considerably shorter on asbestos on the 

5 occupation health questionnaire and on asthma.

6 I remind you that there are a couple 

7 of other outstanding recommendations that still 

8 require some work, specifically, COPD and 

9 occupational hearing loss. And, those will be 

10 covered at the next meeting in late April.

11 We're going to discuss initial work on 

12 Parkinson's related issues, a brief report --

13 actually, Marek is going to lead that and Duronda 

14 and I are going to add some things as well as 

15 maybe some other people.

16 We'll refer to the public comments 

17 tracking system we had. 

18 We're going to review briefly the new 

19 issued rule from the Department on EEOICP, but 

20 stay focused really on the outcome of the 

21 recommendations that the previous Board made in 

22 April 2016.
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1 We're going to spend some time on our 

2 action list we developed in our November meeting, 

3 where we are in that action list. We also 

4 submitted a data request December 10, 2018, I 

5 want to go over that.

6 And, then, there's an additional item, 

7 actually Ken Silver has nicely drafted kind of a 

8 reformulation of -- or proposed reformulation of 

9 DOL's request to the Board to look at the non10 cancer outcomes of radioactive materials.

11 And so, that's something that we will 

12 add to the agenda.

13 Are there other items that people want 

14 to talk about?

15 (NO AUDIBLE RESPONSE)

16 CHAIR MARKOWITZ: Okay.

17 Kevin, can you bring up Bulletin 19-

18 03?

19 So, this bulletin refers to the 

20 Procedure Manual Version 2.3.

21 Actually, if there's anybody from the 

22 Department of Labor on the phone who can chime in 
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1 as to when the Version 2.3 was issued, I'd 

2 appreciate it.

3 (NO AUDIBLE RESPONSE)

4 CHAIR MARKOWITZ: And, actually, while 

5 that question is hanging out there, let me ask 

6 Doug or Carrie, if we, you know, in our in person 

7 meetings, usually there's a member of the 

8 leadership of the program present who can answer 

9 some factual questions or sort of brief kind of 

10 non-policy issues, clarification questions.

11 Rachel, John or the like. Are any of 

12 them available to answer such a question on this 

13 call?

14 MR. FITZGERALD: I think we'd always 

15 had somebody on request after a question the 

16 Board had someone on the call. It's not a 

17 standing request, I guess.

18 CHAIR MARKOWITZ: Okay, okay. So, I 

19 take that as --

20 MR. FITZGERALD: If we requested them, 

21 we could have arranged for that. But --

22 CHAIR MARKOWITZ: That's fine. But, 
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1 the point is, there's no one available, right? 

2 Okay. That's fine.

3 So, this is a recently effective job 

4 bulletin. And, you can see some of the lists of 

5 changes that were made in the Procedure Manual as 

6 a result of, in part, of input from the Advisory 

7 Board.

8 And, with regard to bladder cancer, 

9 hearing loss, lung cancer, mesothelioma, ovarian 

10 cancer, and pleural plaques.

11 And, you can see, for instance, that 

12 they changed the amount of exposure for asbestos 

13 exposure for mesothelioma, they changed the 

14 latency for ovarian cancer, and pleural plaques.

15 And, they added benzidine. Actually, 

16 that wasn't something the Board weighed in on, 

17 but they added two new solvents to the list of 

18 solvents that could be related to toxic substance 

19 induced hearing loss.

20 And then, they, importantly, added a 

21 presumption on lung cancer and asbestos.

22 So, if you scroll down a little bit 
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1 more, Kevin, the bulletin then talks about 

2 actions to be taken in the program to look back 

3 at cases that are relevant to these changes and 

4 that need re-examination in terms of 

5 compensability.

6 And so, attached to this bulletin is 

7 some screening worksheets. We don't need to 

8 actually look at them, but it shows how the 

9 program, national office, and then the district 

10 offices lay out or screen and then analyze prior 

11 claims given these new presumptions and new 

12 attributes of compensation.

13 So, I just wanted to point out that 

14 this is happening.

15 And, any comments or question on this?

16 (NO AUDIBLE RESPONSE)

17 CHAIR MARKOWITZ: Okay.

18 So, if you haven't seen this, it's 

19 case law and it's worth taking a look at so you 

20 can understand better how DOL undertakes to look 

21 back at prior claims that, it can't be easy, but 

22 it's necessary when the criteria for compensation 
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1 change and evolve over time.

2 Okay, let's -- if there are any other 

3 comments on this bulletin, now is the time, 

4 otherwise, we can move on.

5 (NO AUDIBLE RESPONSE)

6 CHAIR MARKOWITZ: So, let's move to 

7 the proposed asbestos presumption recommendation.

8 Just by way of background, there's 

9 been -- the Board and Department have had back 

10 and forth on asbestos issues for some time.

11 And, there are a couple of outstanding 

12 issues that aren't fully resolved. 

13 The Department has accepted much of 

14 the advice, I would say, on asbestos from the 

15 Board.

16 Okay, so this is -- what Kevin's 

17 showing now is not what we're going to go 

18 through, but just to point it out, don't move it 

19 yet, Kevin, but it's an 18-page back and forth 

20 from April '17 until late 2018 or early in 2018 

21 in terms of asbestos. So, we're not going to go 

22 through this, but there is background and we have 
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1 it on the website.

2 It's our original recommendation then 

3 their response, our revise, their response. And 

4 now, we're going to talk about our revised 

5 recommendation.

6 So, Kevin, if you can bring up 

7 something called proposed revised asbestos 

8 presumption?

9 So, just scroll down a little bit. 

10 Hold on, this is the Occupational Health 

11 Questionnaire. No, we want to go with the 

12 asbestos proposed revised.

13 MR. BIRD: Yes, pulling it up right 

14 now.

15 CHAIR MARKOWITZ: Yes, yes, fine.

16 Okay, great. And then, if you could 

17 just scroll down a little bit.

18 Okay, so, briefly, just scroll down a 

19 little bit more. Okay.

20 So, we picked the provisions directly 

21 from the Procedure Manual, but the latest version 

22 that the program lists 19 labor categories from 
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1 an exhibit, but we've seen these before. They're 

2 mostly the mainstream construction and 

3 maintenance trades that are presumed to have been 

4 exposed to asbestos before 1996.

5 Those are the only labor categories 

6 and for which there is a presumption of 

7 significant exposure.

8 They -- item number two -- and, by the 

9 way, chime in if you have any questions or 

10 comments -- item number two is that the program 

11 and the Procedure Manual then proceed to assign 

12 different levels of exposure within the 

13 significant rubric, low, medium, and high.

14 And so, the list is presumed to have 

15 high significant exposure through '86 and low 

16 significant exposure from '87 to 1995. So, both 

17 periods of time of significance, the presumption 

18 is that it's high earlier and lower later on.

19 Item number three is that the program 

20 presumes that any job categories that are not on 

21 the list had exposure prior to '95, but it 

22 doesn't remark on the significance of their 
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1 exposure.

2 And then, finally, it -- the program 

3 and the Procedure Manual presumes that all these 

4 job titles other than the list do not have 

5 significant exposure after 1986.

6 So, if you scroll down to Table 1 for 

7 a moment, I don't know if this will help people 

8 or not. But, there we go.

9 Different time periods on the left and 

10 then the job categories, either the list or other 

11 jobs, and then, the overall exposure in the case 

12 of the people -- the job titles on the list it's 

13 presumed to be significant prior to 1995, 

14 although, one period high, another period low.

15 And then, in -- if you look at the 

16 last row and the other jobs are presumed to be 

17 not significant from the later time period.

18 So, Kevin, if you'd go back up now.

19 So, there -- and, I'm sorry, scroll 

20 down so we can just look at Section B here. 

21 Okay, okay.

22 So, in the Procedure Manual, when you 
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1 actually look at the presumption causation 

2 language, it only refers to the fact that the 

3 claimant has to have a significant level of 

4 exposure.

5 It doesn't -- whether that significant 

6 exposure is high, medium, or low doesn't enter 

7 into consideration in the causation presumption.

8 So, I think that's captured in Table 2 

9 below. So, let's look -- if you could scroll 

10 down to 2?

11 Okay, so this now, this summarizes the 

12 causation presumption within the Procedure Manual 

13 for the seven different asbestos related 

14 conditions.

15 And so, on the left, you see the 

16 conditions and then, the level of exposure in the 

17 causation for a claimant to meet the presumption 

18 of causation, there has to be significant 

19 exposure.

20 And then, there's some language about 

21 day by day in some of those, but the focus, 

22 really, is that it has to be significant and 
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1 then, the duration of latency, basically, it's 

2 250 days except for COPD and mesothelioma and 

3 latency is somewhere between 10 and 20 years.

4 So, and we're in accordance pretty 

5 much with the time factor, the duration, and the 

6 latency, that's -- those aren't really live 

7 issues.

8 The issue with COPD, frankly, there's 

9 a larger issue relating to COPD presumption. So, 

10 we didn't -- we're not really focusing on that 

11 here in asbestos.

12 Okay, so, you can go back up now to 

13 where we were before, okay.

14 So, these are the residual concerns.

15 So, the first thing is that the 

16 causation presumption only designates that the 

17 level be significant and it doesn't specify 

18 whether it's low, medium, or high.

19 So, it would appear there's no need 

20 for the language and it's actually potentially 

21 confusing as a -- with reference to the causation 

22 presumption, there's no need for this designation 
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1 of low, medium, and high because the list, where 

2 it applies which is the list --- because, the 

3 list of job categories, that group is presumed to 

4 have significant exposure during the relevant 

5 time period.

6 So, our recommendation is that that 

7 designation of low, medium, and high for the 

8 purposes of a causation presumption be deleted 

9 because it's not used and at the minimum 

10 potentially confusing.

11 And, item number two is, this is not a 

12 change, this is just to recognize that for the 

13 labor category other than those on the list, it's 

14 reasonable to retain a presumption as the 

15 Procedure Manual does, that they had some level 

16 of exposure to asbestos prior to '87 because 

17 there was asbestos in many of the locations.

18 So, but item three, though, the 

19 Procedure Manual, as it stands now, has this 

20 negative presumption about asbestos exposure for 

21 jobs other than those on the list.

22 That is to say, it -- the existing 
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1 policy presumes that that -- the asbestos 

2 exposure in those jobs occurred, but that it 

3 wasn't significant and, therefore, cannot be used 

4 in the causation presumption.

5 So, they don't -- that group doesn't 

6 enter causation presumption because they are 

7 presumed not to have significant exposure.

8 And, the rationale for that is that it 

9 was -- and this is between '87 and '96 -- the 

10 rationale that the Department offers is that the 

11 exposures were unlikely to exceed established 

12 occupational health standards.

13 So, here, this proposed revision 

14 points out we believe that the negative 

15 presumption is not justified because it's based 

16 on the rationale that the occupational health 

17 standards were fully protective, which they 

18 weren't.

19 And then, secondly, that all the work 

20 sites were in compliance or full compliance, 

21 which it, frankly, just unknown. The hopes were, 

22 but unknown.
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1 And so, our recommendation is that the 

2 Procedure Manual have more neutral language about 

3 this exposure. And, leave it up to when there's 

4 uncertainly, leave it up to an industrial 

5 hygienist who is looking at the facts of the case 

6 but not with the guidance that, of a negative 

7 presumption that the exposure was not 

8 significant.

9 And, thereby, more likely to be an 

10 unbiased assessment of the significance of that 

11 exposure.

12 So, our recommendation is that that 

13 language presuming that the exposure was non14 significant be deleted which really leaves the 

15 field open that when the claims examiner requires 

16 it that the industrial hygienist make an open, 

17 unbiased assessment of the significance of 

18 exposure to asbestos.

19 Number four is, you note before, I 

20 mentioned that there is in the causation 

21 presumption this language of day by day. That is 

22 to say that, to me, a given -- on most of the 
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1 asbestos diseases, our worker had to have 250 

2 days of day by day exposure meeting certain 

3 latency period if they were in a certain job 

4 title.

5 The -- this day by day reference is 

6 unnecessary for the group of job titles on the 

7 list because that group is generally known to 

8 have reasonably frequent exposure to asbestos in 

9 that time period.

10 And so, there's no reason to apply 

11 that day by day standard to the list which is 

12 what it looks like the language does.

13 The day by day analysis is reasonable 

14 for the industrial hygiene assessment because it 

15 communicates frequent exposure in a 250 day 

16 period, totaling 250 days. That's fine.

17 But it -- the way it stands now, it 

18 also seems to apply to the people -- the job 

19 categories on the list and it's not really 

20 necessary.

21 The most important, I think, part of -

22 - if you could scroll down just a little bit 
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1 more, Kevin -- of the revised recommendation is 

2 that the list of job titles that can be presumed 

3 to have asbestos exposure prior to 1997 is 

4 incomplete.

5 It does have many of the important 

6 maintenance and construction jobs, electrician, 

7 carpenter, sheet metal worker, mason, pipe fitter 

8 and the like. But that there are other jobs 

9 which are missing.

10 Now, this has been a matter of 

11 discussion with the Board for some time. And so, 

12 what Kirk Domina and John Dement and I did is the 

13 DOL gave us the existing job categories from the 

14 SEM and at five different DOE sites. So, it 

15 included Hanford and Y-12 and one of the gaseous 

16 diffusion plants, Idaho and, again, what's called 

17 construction job titles.

18 And, what we looked at, we looked at 

19 the complete list of job categories in the SEM. 

20 So, for instance, in Paducah, there have been 85 

21 job categories in the SEM, not the aliases, but 

22 just the main job categories and then, at 
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1 Hanford, there were I think about 400.

2 And so, we looked at those and we 

3 said, okay, fine. Which of those do you believe 

4 mostly because of maintenance and job -- and 

5 construction job relationship, which of those 

6 should be added?

7 And so, we -- if you scroll down, 

8 Kevin, to actually Table 3 for a moment.

9 Just a reminder of what Table 3 is 

10 what the list looks like currently. These are 

11 the job titles presumed to be exposed to asbestos 

12 prior to '93.

13 Okay, now, let's go to Table 4. Table 

14 4 -- if you can scroll down further. Now that 

15 you've got it.

16 Okay, so, Table 4, what it does is on 

17 the left, you see that list, that same list and 

18 on the right are additional job categories that 

19 John, Kirk, and I found at one or more of those 

20 five old sites that we believe can reasonably be 

21 presumed to have significant asbestos exposure 

22 prior to 1997.
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1 And, you'll recognize, maybe some of 

2 them presume to have -- probably have a 

3 relationship to the list on the left. It's 

4 unclear and we've made a request to the 

5 Department to provide us with a map, how they get 

6 from list 3(a)(1) on the left to the SEM and the 

7 various job categories on the SEM.

8 And, beyond that, how do they match it 

9 to the job titles that claimants actually write 

10 on their, you know, on their forms when they 

11 submit their claims.

12 But, and there may be some 

13 disagreement on the list on the right. But, most 

14 of us familiar with asbestos related issues would 

15 probably come to agreement on most of the job 

16 titles on the right.

17 So, but that represents five DOE 

18 sites. DOL gave us 15 sites in terms of the 

19 lists of job categories from the SEM. But there 

20 are, in the SEM, there are probably 60 or more 

21 different DOE sites listed.

22 And so, the next task would be to take 
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1 all of the DOE sites, take all of the job titles, 

2 the job categories and probably the aliases, too, 

3 and do what we did, which is identify job titles 

4 that are -- have a high likelihood of meeting a 

5 presumption.

6 And so, that would facilitate the 

7 claims examiner. One of it was enlarge list 

8 3(a)(1) to make it sort of more on target with 

9 reality.

10 But, also, it would help the claims 

11 examiner in decision making which is they could 

12 move quite quickly from the claimant submitted 

13 job title to the SEM to the presumption.

14 So, if you could just scroll back up 

15 to the text, the end of the text? Okay, there we 

16 go.

17 So, our thinking was how to do this. 

18 And, if you look at the last paragraph, so the 

19 recommendation is that a Board Committee work 

20 with the program and their industrial hygiene 

21 contractor to examine all SEM job titles and 

22 aliases and identify job titles that should be 
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1 added to list 3(a)(1) for the purposes of the 

2 presumption of that exposure.

3 An alternative would be for the Board 

4 to do this independently from the program. But 

5 we would require resources to do that because 

6 going through those lists is going to take some 

7 time.

8 And, John and Kirk and I discussed it 

9 and we thought, well, the Department has a 

10 contractor and many of those industrial 

11 hygienists are familiar with DOE sites, probably 

12 familiar with asbestos and that we could work 

13 directly with them and likely come to an 

14 agreement on the expanded list 3(a)(1) that is 

15 more realistic.

16 So, let me -- I'm going to stop here. 

17 John, Kirk, do you have any additions or 

18 comments?

19 MEMBER DEMENT: This is John.

20 I think you summarized our discussion 

21 and deliberations very well, Steven.

22 I think it's fair to say that what 
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1 we're presenting is these additional ones are 

2 examples of jobs that we think are perfect to 

3 list and not all inclusive, and we recognize 

4 that.

5 The other thing is, there were a lot 

6 of jobs as we went through these categories which 

7 had high -- I would say had high suspicion of 

8 being capable of satisfying this presumption, but 

9 would require just a few questions with regard to 

10 the actual work that they did.

11 So, I think the process of going 

12 through and identifying a list of -- and I call 

13 it jobs that we can come to a consensus on that 

14 would expand this list would greatly simplify the 

15 process for the things the examiner, at least in 

16 terms of applying this presumption.

17 CHAIR MARKOWITZ: Kirk, you have 

18 anything you want to say?

19 MEMBER DOMINA: Well, yes, going 

20 through this, because of, you know, you've heard 

21 me many times talk about jurisdiction and stuff -

22 -- and, like we had it like I was a technician,
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1 the RCT radioactive or the radiation monitors 

2 because they were never included on anybody's 

3 list.

4 And, like I said, they're always the 

5 first one in on the job and the last one out 

6 because radiation was always the thing until you 

7 get into the 2000s where chemicals and toxic 

8 substances were never, ever considered.

9 And so, and like, my main thing is, 

10 too, that all these DOE sites all had steam heat, 

11 so there's asbestos everywhere.

12 And so, you know, and so, certain job 

13 titles, you have to know on that site what also 

14 is under their jurisdiction. And, it's really 

15 important on that because not all of them are the 

16 same.

17 You know, it's just like our painters 

18 out here tear up floor tile, that's under their 

19 jurisdiction and, in these old buildings, it's 

20 all asbestos tile.

21 And so, understanding and not trying 

22 to just say, well, this job title only does this, 
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1 that's not true. You know, they do a lot of 

2 things and different things.

3 And, then, too, when -- during the 

4 Cold War effort, when you have an event happen, 

5 you're on a back shift or whatever, it's all 

6 hands on deck on getting things straightened out 

7 --- and, what people could have been exposed to.

8 Not -- we were never monitored for any 

9 asbestos exposure because it would have shut 

10 everything down. You know, they were never --

11 and then, you know, if something got knocked 

12 loose, they just made somebody had -- sure had an 

13 asbestos call and they went and picked it up and 

14 you just carry on.

15 You didn't take samples or anything to 

16 verify that the area was clear. You just moved 

17 on.

18 And, I just -- I think it's important 

19 that we look at it and work with them so they 

20 have an understanding, you know, from a worker 

21 perspective on how that goes.

22 I mean, to me, it's just like when the 
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1 Part B Board comes out and there are people NIOSH 

2 that come and talk to us because we're the ones 

3 that are in the trenches and can explain it and 

4 not say, this is what's supposed to have 

5 happened, but that's not what really did happen.

6 CHAIR MARKOWITZ: And, you know, we 

7 need to -- we need that kind of information in a 

8 process going forward to look at job titles 

9 across the sites. So, we would recreate the list 

10 if the Department accepts our recommendation 

11 about working with the contractor to identify job 

12 titles, we would definitely make sure that that 

13 perspective is present.

14 Are there other comments? Questions?

15 (NO AUDIBLE RESPONSE)

16 CHAIR MARKOWITZ: So, I want to 

17 mention, if we can vote on this. And so, Kevin, 

18 if you could go up, I want to point out what 

19 we're voting on because I've blended -- if you go 

20 to -- up a little bit more up to Item 1. There 

21 it is, right there is good.

22 Because I did a blended comments with 
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1 the recommendations. So, let me just be clear 

2 and I guess this is a proposal to accept this 

3 recommendation.

4 But, let me describe what the 

5 recommendation is.

6 So, Item 1 would be -- it has to do 

7 with this low, medium, high significance, rubric 

8 for significance and the recommendation is that 

9 it be deleted with reference to list 3(a)(1) for 

10 the purposes of causation presumption.

11 Number two, it's not -- this is 

12 actually -- is not really part of the 

13 recommendation because it's not -- we're not 

14 recommending a change. Were just saying that 

15 it's reasonable, the current language is 

16 reasonable.

17 Number three is about the negative 

18 presumption on the non-list 3(a)(1) jobs. And, 

19 there the recommendation is not explicit, so let 

20 me make it explicit.

21 Which is that, the presumption that 

22 these jobs do not have significant exposure prior 
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1 to '96 should be deleted.

2 Number four is that the issue of day 

3 by day exposure not be applied to any of the job 

4 categories that are presumed to have significant 

5 asbestos exposure.

6 And then, number five is the last 

7 paragraph which is that the Board and Board 

8 Committee work with the program and their 

9 industrial hygiene contractor to examine and 

10 identify relevant SEM job titles and aliases that 

11 should be added to the list of 3(a)(1) for the 

12 purposes of asbestos exposure.

13 Is there a second?

14 MEMBER FRIEDMAN-JIMENEZ: This is 

15 George, I second.

16 CHAIR MARKOWITZ: Thank you, George.

17 So, it's open for discussion or 

18 clarification if anyone needs it.

19 (NO AUDIBLE RESPONSE)

20 CHAIR MARKOWITZ: So, we're going to 

21 take a vote then.

22 Doug, Carrie, how do we do -- do you 
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1 want to roll call?

2 MR. FITZGERALD: I could do that. 

3 I've got a tally sheet in front of me. I can 

4 call everyone's name and ask for their yea or nay 

5 or abstention.

6 CHAIR MARKOWITZ: Okay, you can go 

7 ahead.

8 MR. FITZGERALD: So, is the motion 

9 moved or --

10 CHAIR MARKOWITZ: Yes.

11 MR. FITZGERALD: Okay, if we're taking 

12 a vote then, Dr. Dement?

13 MEMBER DEMENT: Yea.

14 MR. FITZGERALD: Mr. Domina?

15 MEMBER DOMINA: Yes.

16 MR. FITZGERALD: Dr. Friedman-Jimenez?

17 MEMBER FRIEDMAN-JIMENEZ: Yes.

18 MR. FITZGERALD: Mr. Mahs?

19 MEMBER MAHS: Yes.

20 MR. FITZGERALD: Dr. Mikulski?

21 MEMBER MIKULSKI: Yes.

22 MR. FITZGERALD: Ms. Pope?
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1 MEMBER POPE: Yes.

2 MR. FITZGERALD: Dr. Redlich?

3 MEMBER REDLICH: Yes.

4 MR. FITZGERALD: Dr. Silver?

5 MEMBER SILVER: Yes.

6 MR. FITZGERALD: Mr. Tebay?

7 MEMBER TEBAY: Yes.

8 MR. FITZGERALD: And, Chairman 

9 Markowitz? I assume yes.

10 CHAIR MARKOWITZ: Yes.

11 MR. FITZGERALD: Okay.

12 CHAIR MARKOWITZ: Okay, thank you.

13 Let's move ahead with --

14 MR. FITZGERALD: Is Doctor -- has Dr. 

15 Berenji joined us, by the way?

16 MEMBER BERENJI: I am here, yes, sir.

17 MR. FITZGERALD: Oh, okay. I did not 

18 want to forget you, either. Are you voting?

19 MEMBER BERENJI: I was a little late 

20 with patients, but I am here and I did hear the 

21 tail end, and I do approve, so yea.

22 MR. FITZGERALD: Okay, thank you very 
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1 much.

2 CHAIR MARKOWITZ: Okay, next is the 

3 Occupational Health Questionnaire revised 

4 recommendation. John, do you want to take over 

5 here?

6 MEMBER DEMENT: Sure, Steven.

7 I -- first of all, we've gone several 

8 rounds, I guess, the prior Board did, on the 

9 occupational history questionnaire.

10 We made some recommendations 

11 originally with regard to, I guess we called it 

12 the current occupational history questionnaire, 

13 and I tried to summarize it, if you could bring 

14 that up on the screen. I guess it's the Word 

15 file. Yes, okay, that's it.

16 And, so I've tried to -- what we tried 

17 to do in this draft recommendation is to 

18 summarize where we've been and where we think we 

19 need to go.

20 We originally looked at the history 

21 and we've, you know, we wanted more information 

22 that would drive exposure levels. And so, we 
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1 asked for more tasks to be included in it.

2 We asked for a response to a question 

3 with regard to gases, dusts, and fumes for COPD.

4 We recommended pulling in some of the 

5 tasks that we found to be useful from that 

6 construction trade former worker program, BTMed.

7 And, the DOL has responded back and 

8 basically didn't consider our recommendations, I 

9 guess, appropriate or useful. They responded 

10 back that they have another proposed draft 

11 questionnaire. So, we looked at that 

12 questionnaire as well in this round specifically. 

13 We've looked at it before.

14 Sorry, guys, I've got some things 

15 going on.

16 The new questionnaire basically is a 

17 lot of area to write responses to questions on 

18 and it's larger free text. And, we thought that 

19 that still didn't give enough triggers, memory 

20 recall triggers for the claimants to recall 

21 specific exposures.

22 And, therefore, we've gone back and 
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1 we've looked at the proposed new questionnaire. 

2 We've made some recommendations specific to the 

3 new questionnaire.

4 And so, if we can sort of scroll down 

5 to -- and we've taken it by sections.

6 MR. BIRD: Are you looking for the 

7 bottom of page one or are you looking for --

8 MEMBER DEMENT: So, it's the Section 

9 4d, the labor category.

10 CHAIR MARKOWITZ: It's the middle of 

11 page two.

12 MEMBER DEMENT: Yes, thanks, Steven.

13 MR. BIRD: And, you should be able to 

14 scroll on your screen.

15 MEMBER DEMENT: Okay, I have control, 

16 all right. Thank you.

17 So, we basically, and this -- these 

18 labor categories, we thought that the labor 

19 categories were sort of appropriate for broad 

20 classification and we wanted specifically, if 

21 possible, that these tie-ins to the questionnaire 

22 tied back to the major categories on the DOE 
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1 side.

2 It looks like it does, but it's sort 

3 of hard for us not having that -- the broader 

4 number of labor categories to really determine 

5 that.

6 If we scroll down, wait a minute, I 

7 got it. There's new Section 4(e) that requires 

8 the claimant for each job to classify what areas 

9 and activities.

10 And, largely, it's -- the new 

11 questionnaire just gives you a statement of 

12 categories of information that you're looking 

13 for. And, it really requires the claimant to 

14 really almost write out a written summary without 

15 much of a trigger with regard to what should be 

16 included in the summary.

17 So, it requires basically sort of an 

18 essay.

19 The example they gave was a very good 

20 one, but it's pretty unrealistic with regard to 

21 what you might expect to get from a claimant.

22 So, we suggested more structure in 
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1 that section. And, basically, in that section, 

2 we would like to have a bit more structure that, 

3 I guess, similar to what might have been in the 

4 earlier questionnaire but with a little more 

5 detail, if you will.

6 So, in each area, we wanted to retain 

7 a structure that had some, basically, some column 

8 headings and we give them some examples with 

9 regard to what we think those column headings 

10 might be. And, this is on page two.

11 So, these are the types of categories 

12 that we'd like to see. And, we've suggested that 

13 the old occupation history has -- I'm having a 

14 hard time scrolling for some reason.

15 Kevin, can you scroll that down? 

16 Mine's not working.

17 MR. BIRD: Yes, you're looking for the 

18 bottom of page two still?

19 MEMBER DEMENT: Yes, I'm coming up to 

20 the next page three.

21 MR. BIRD: Okay.

22 MEMBER DEMENT: We found, in terms of 
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1 exposure, frequency -- the current questionnaire 

2 has a much, I think, seven categories and pretty 

3 hard for -- to operationalize.

4 And so, we -- for our case control 

5 study, we simplified that and we used some key 

6 trigger words that we think might be helpful.

7 This is our recommendation here and 

8 it's one that we found to be useful and study 

9 just has been published.

10 I think this will, you know, these 

11 trigger words are easy for individuals to really 

12 understand.

13 Okay, if we move down to Section 5. 

14 In Section 5, the proposed new questionnaire 

15 really has just some very broad categories of 

16 exposure. It didn't ask the claimant to describe 

17 their exposures in those categories.

18 Again, we just didn't -- and, I guess, 

19 based on my experience of working with these 

20 building trades, particularly for years, we 

21 didn't feel that that would really glean the 

22 information that we were interested in getting.
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1 So, in each one of these broad 

2 categories, we're asking, again, to list a --

3 some -- a list of specific toxic substances that 

4 are typically seen on the DOE side. A lot of 

5 them are construction and maintenance trades, but 

6 there are lots of production exposures as well.

7 Realizing that, the sites are somewhat 

8 different with regards to exposures, but there's 

9 a lot of commonality. And also, where there's 

10 not a specific list of exposures to allow space 

11 for the claimant to put that in.

12 So, don't put the burden on the 

13 claimant to write out every exposure in a 

14 paragraph.

15 And so, in that section, we're asking 

16 to list toxic substances that were really 

17 somewhat for the other questionnaire, 

18 specifically those that might have a direct 

19 disease link as we discussed at the Board before.

20 We've also recommended that this list, 

21 because COPD is such an important outcome for the 

22 program that the materials and substances that 
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1 are known and the literature to be linked to COPD 

2 specifically be put on that list.

3 Let's see what else was here.

4 We also noted some of the areas where 

5 it seems like a lot of details requested on the 

6 old questionnaire, specifically the high 

7 explosives, I mean, has a lot of information 

8 there, a lot of different materials listed.

9 We think that ought to be probably 

10 pared down and not so extensive on the new 

11 occupations questionnaire.

12 Again, for each one of the exposures, 

13 we're asking for some measure of frequency and 

14 duration. So, we feel like the combination of 

15 knowing what the material is, the frequency and 

16 duration and allowing the claimants to describe 

17 how they used the material in a short sentence or 

18 so would give information useful in doing the 

19 qualitative exposure assessment, see how long the 

20 basic variables.

21 We also -- okay, can you give me 

22 control again, Kevin?
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1 MR. BIRD: So, you should be able to 

2 scroll on your screen. Do you me want to try to 

3 give you like total control so you control what 

4 everyone else sees?

5 MEMBER DEMENT: I can't get past this 

6 page.

7 MR. BIRD: You're on page 4 now?

8 MEMBER DEMENT: Yes, I am now.

9 MR. BIRD: Okay.

10 MEMBER DEMENT: Okay, and remember, in 

11 our last recommendation, we specifically asked to 

12 include some questions about vapor, gas, dust, 

13 and fume exposures. Those we tied back into our 

14 recommended COPD presumption.

15 The DOL say that they can't use this 

16 vapor, gas, dust, and fumes because they have to 

17 have a specific toxic substance.

18 You know, scientifically, we disagree 

19 with that, that the VGDF paradigm really drives 

20 COPD.

21 However, given the circumstances we're 

22 operating in, we are asking specifically that, 
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1 for the listed toxic substances in the list, to 

2 be a checkbox added to ask the question, are they 

3 exposed to VGDF?

4 That should satisfy the issue of 

5 whether or not it's a toxic substance or not, at 

6 least in our opinion.

7 Section 6 is the personal protective 

8 equipment. The old questionnaire and somewhat in 

9 the proposed new questionnaire, there's an 

10 extensive discussion about PPE use. That may be 

11 somewhat helpful.

12 We really think that that should be 

13 reduced. PPE is a secondary line of defense so 

14 the industrial hygienist is normally not very 

15 effective. The fuel protection factors for most 

16 types of PPE, particularly respiratory 

17 protection, are quite variable and often quite 

18 poor.

19 So, our view is this should be reduced 

20 back because we don't need extensive questions on 

21 PPE use. It's useful as a hygienist to know if 

22 PPE was required maybe in a job, but we don't 
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1 need an extensive list of PPE.

2 And, we really believe that positive 

3 answers to having worn PPE really should not be a 

4 factor in accepting or denying claims.

5 We've added a couple of different 

6 additional references that we specifically 

7 reference that we have a list of references on 

8 our prior recommendation that are still 

9 applicable.

10 The sort of -- the approach to this 

11 new set of recommendations is quite similar to 

12 our approach in the other. We've tried to modify 

13 it to be responsive, I guess, to some of the DOL 

14 concerns about how to implement it.

15 I'm open for questions at this point, 

16 if there are any.

17 CHAIR MARKOWITZ: I'd just like to 

18 make a comment, this is Steven.

19 So, this is not, you know, the aim is 

20 not a research quality questionnaire, lest 

21 anybody misunderstand. This is about getting 

22 sufficient information to allow a claims examiner 
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1 and an industrial hygienist to make informed 

2 decisions.

3 So, and, secondly, we have not 

4 redesigned the questionnaire. This -- these 

5 recommendations are elements or consideration for 

6 suggestions about the structure of the 

7 questionnaire. But they actually work with 

8 redesigning the questionnaire, formatting, et 

9 cetera, we let the department.

10 In terms of the vapors, gas, dust, and 

11 fumes, that question would be asked about any 

12 toxic substance exposure that workers report. 

13 So, it wouldn't be limited to the relatively 

14 small number of agents that are -- have been 

15 specifically related to COPD in the manner that 

16 the Department of Labor recognizes now.

17 This is just to be clear about that.

18 MEMBER DEMENT: And, I think that's 

19 good point because in many of the published 

20 studies, specific agents are not identified. 

21 It's simply vapor, gas, dust, and fumes as a 

22 general category.
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1 Being workplace generated vapor, gas, 

2 dust, and fumes, not genuine environment.

3 CHAIR MARKOWITZ: Right, right. And, 

4 this is -- so, and, we're clearly recognizing 

5 that this extra requirement that exposure to a 

6 toxic substance must occur for a person to be 

7 eligible for compensation.

8 So, this is a mechanism to kind of 

9 link that extra requirement with, you know, 

10 appropriate medical science at this point.

11 MEMBER DEMENT: Yes, I think it's 

12 fairly -- we try and approach the COPD 

13 presumption by -- in two phases.

14 One, it's specifically those agents 

15 that are known based upon the literature to be 

16 individually related to COPD. And, by expanding 

17 the check marks to include other substances as 

18 well.

19 CHAIR MARKOWITZ: I would -- this is 

20 Steven -- I would just also add one last comment 

21 which is that we've been talking about revising 

22 the occupational health questionnaire for quite 
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1 some time now.

2 And, it's not the entire policy 

3 decision that most of our recommendations -- many 

4 of our recommendations, particularly those we 

5 have presumption involved, it doesn't -- it's not 

6 the question of look back at prior claims, it's a 

7 question of appropriate and useful tool.

8 And so, it would be nice to move -- to 

9 make progress on this and get to a version that 

10 can be piloted and then implemented.

11 MEMBER DEMENT: This is John, again.

12 I think one of the other issues that 

13 we addressed in the prior recommendation and 

14 probably ought to be considered here, and I guess 

15 it's considered anyway, that whatever 

16 questionnaire they develop as a draft, it really 

17 needs to go into the field and be pilot tested 

18 under some surface -- sort of real world 

19 circumstances and get some feedback on both the 

20 individuals trying to administer the 

21 questionnaires as well as the claimants and how 

22 it actually works.
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1 So, pilot testing I think is needed.

2 CHAIR MARKOWITZ: Other comments or 

3 concerns? We would like to vote on this 

4 recommendation. So, if -- the floor is --

5 there's no motion yet, but the floor is open.

6 MEMBER POPE: I just want to -- this 

7 is Duronda Pope -- I just wanted to agree with 

8 John about the pilot testing. Most times, in 

9 order to find out how a system is working or how 

10 things are working out in the field is to ask the 

11 people that are actually doing work and to better 

12 -- get a better understanding of how that is 

13 really working out, that pilot program or 

14 suggestions sounds great to me.

15 CHAIR MARKOWITZ: And, the Department 

16 has previously communicated that they, you know, 

17 they completely agree with the idea of pilot 

18 testing. So, that's -- that would happen.

19 Other comments?

20 MEMBER SILVER: This is Ken Silver, 

21 two points.

22 Can we assume that the Labor 
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1 Department management is familiar with the great 

2 work that BTMed has done with these 

3 questionnaires and we transmit this 

4 recommendation, I think, we should draw their 

5 attention to either published literature or great 

6 literature, your own progress report, internal 

7 documents.

8 Because your questionnaires are really 

9 the best that I've seen on DOE sites. And, we'll 

10 probably come around to really appreciating all 

11 this work that's been done by BTMed on the other 

12 formal worker program division.

13 And, my other is, John, you sort of 

14 hinted at this, but going back to our first 

15 discussion, I think as Dr. Mikulski has 

16 repeatedly made the point that the mere presence 

17 of PPE is an indicator of hazardous exposures and 

18 we should kind of leave it at that and not try to

19 parse whether it was worn.

20 The mere fact that it's there tells us 

21 a lot.

22 MEMBER DEMENT: I agree. And, that's 
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1 the reason I think it ought to be in the 

2 questionnaire but just scaled back. We don't 

3 need to come to define -- get down to the type of 

4 respirator they used.

5 We need to only know that respiratory 

6 protection was required, which, as a hygienist, 

7 it's just applied that there's potential for 

8 exposure recognized.

9 I guess the, you know, there's -- if 

10 you're going to, just from my perspective, if 

11 you're going to spend a lot of time trying to get 

12 information on an occupational history, spend 

13 more of it looking at the exposures and less of 

14 it on the PPE.

15 Because, as a hygienist, we know that 

16 PPE is really not the way to protect individuals.

17 CHAIR MARKOWITZ: And, not to mention, 

18 it's hard to get a handle on the actual use, 

19 actual protection, whether the full program was 

20 implemented.

21 So, just an interpretation of that 

22 whatever comes out in the questionnaire but is 
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1 just very difficult.

2 Other comments?

3 (NO AUDIBLE RESPONSE)

4 CHAIR MARKOWITZ: So, we need to vote. 

5 Do I hear a motion? I need a motion to accept 

6 the recommendation.

7 MEMBER DEMENT: This is John, I'll 

8 move that we accept the recommendations.

9 CHAIR MARKOWITZ: Okay, is there a 

10 second?

11 MEMBER DOMINA: This is Kirk, I 

12 second.

13 CHAIR MARKOWITZ: Okay.

14 So, just to be clear, we're talking 

15 about it starts on the middle of page two where 

16 it says Board recommendations and it goes through 

17 to page four.

18 And, it's not even the short, succinct 

19 language, it -- there's some discussion rationale 

20 built in to it, but it's very clear.

21 And, so, it's open -- the floor is 

22 open for comments, discussion, questions.
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1 MEMBER DEMENT: This is John, again.

2 Kevin mentioned the prior publication. 

3 I think in the original recommendation, we have 

4 a list of the publications. And, if needed, we 

5 can provide a list of additional ones as well.

6 CHAIR MARKOWITZ: So, this is Steven.

7 If I could offer an amendment to the 

8 recommendation that the Board recommends -- would 

9 recommend that expedited review of this revised 

10 recommendation occur so that timely progress can 

11 be made on creation of a revised occupational 

12 health questionnaire and its pilot testing and 

13 implementation.

14 Is that friendly amendment accepted by 

15 the motion proposer?

16 MEMBER DEMENT: Yes, and we've thought 

17 through this, we're dealing with this from day 

18 one, yes.

19 CHAIR MARKOWITZ: Okay. So, what's on 

20 the floor then is the slightly revised 

21 recommendation.

22 Any other discussion?
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1 (NO AUDIBLE RESPONSE)

2 CHAIR MARKOWITZ: If not, then we 

3 should take a vote.

4 MR. FITZGERALD: Okay.

5 Dr. Berenji?

6 MEMBER BERENJI: Yea, I approve.

7 MR. FITZGERALD: Okay, Dr. Dement?

8 MEMBER DEMENT: Yes.

9 MR. FITZGERALD: Mr. Domina?

10 MEMBER DOMINA: Yes.

11 MR. FITZGERALD: Dr. Friedman-Jimenez?

12 MEMBER FRIEDMAN-JIMENEZ: Yes.

13 MR. FITZGERALD: Mr. Mahs?

14 MEMBER MAHS: Yes.

15 MR. FITZGERALD: Dr. Mikulski?

16 MEMBER MIKULSKI: Yes.

17 MR. FITZGERALD: Ms. Pope?

18 MEMBER POPE: Yes.

19 MR. FITZGERALD: Dr. Redlich?

20 MEMBER REDLICH: Yes.

21 MR. FITZGERALD: Dr. Silver?

22 MEMBER SILVER: Yes.
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1 MR. FITZGERALD: Mr. Tebay?

2 MEMBER TEBAY: Yes.

3 MR. FITZGERALD: All right, and 

4 Chairman Markowitz?

5 CHAIR MARKOWITZ: Yes.

6 MR. FITZGERALD: Okay.

7 CHAIR MARKOWITZ: Thank you.

8 So, the next is work related asthma. 

9 Carrie, you want to lead this or --

10 MEMBER REDLICH: You know, I don't --

11 I'm just getting on the -- I've been --

12 CHAIR MARKOWITZ: No, I'm much more 

13 happy to -- I'm happy to start with it, if you'd 

14 like. It's up to you.

15 MEMBER REDLICH: Sure, do you want to 

16 start? That's fine.

17 CHAIR MARKOWITZ: Sure, sure.

18 Okay, so, okay, but if you could bring 

19 a proposed revised recommendation, let me give 

20 the background because Carrie really led this 

21 effort.

22 There was language in the Procedure 
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1 Manual regarding asthma that didn't really 

2 accurately reflect what we know about work 

3 related asthma.

4 And, I should add that George 

5 Friedman-Jimenez also played an important role in 

6 developing this over in the last year and a half 

7 or whatever.

8 And so, the back and forth on work 

9 related asthma, again, that's available in a 

10 compiled format on our meeting website, a 

11 considerable part of the recommendation has been 

12 accepted by the Department and they revised the 

13 language of the Procedure Manual.

14 In particular, with regard to the 

15 criteria for medical diagnosis of asthma. That 

16 was an important area to come to agreement on.

17 So, we've moved beyond, for the most 

18 part, the issue of how the diagnosis is made.

19 What's still active is the issue of 

20 exposure and what kind of exposure can be 

21 presumed to be related to work related asthma.

22 And, in particular -- and Carrie, any 
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1 time you want to -- Kevin, can you bring up the 

2 work related asthma proposed revised 

3 recommendation?

4 MR. BIRD: Do you see it? I think I'm 

5 on it. Is that the wrong recommendation?

6 CHAIR MARKOWITZ: Okay, so this was 

7 just added to the -- to our webpage in the 

8 meeting items in the last 24, 36 hours.

9 What I'm still looking at is personal 

10 protective equipment. 

11 Okay, so, Kevin, while you're doing 

12 that, so, there is language that is in the 

13 Procedure Manual that we want to look at on the 

14 screen because that's the focus of some of the 

15 recommendation.

16 MEMBER REDLICH: And, just for 

17 background, the original asthma recommendation 

18 had sort of four parts. And, three of the four 

19 parts are generally, you know, the Department of 

20 Labor incorporated.

21 But, there was one important one with 

22 the criteria for work related asthma and they 
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1 were related to that end result in the Procedure 

2 Manual. And, that's what we're trying to get to.

3 CHAIR MARKOWITZ: Right. So, 

4 actually, we'll read this language, okay, just 

5 while we're getting this together here.

6 This is from the Procedure Manual, the 

7 Section 5c(2) from Appendix 1.

8 And, it says that the qualified 

9 physician conducts an examination and has to, and 

10 let me quote here, quote, must provide a well11 rationalized explanation with specific 

12 information on the mechanism for causing, 

13 contributing to or aggravating the conditions.

14 The strongest justification for 

15 acceptance in this type of claim is when the 

16 physician can identify the asthmatic incident or 

17 incidents that occurred while the employee worked 

18 at the covered work site and the most likely 

19 toxic substance trigger, end of quote.

20 So, let me ask Kevin, have you 

21 identified the document we're interested in?

22 MR. BIRD: No, I'm sorry. Which 
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1 document exactly are you interested in? Sorry.

2 CHAIR MARKOWITZ: It's called proposed 

3 revised recommendation for work related asthma.

4 MR. BIRD: Okay, so, we should be 

5 pulling it up now. It will just take a quick 

6 second. Can you see that?

7 MEMBER REDLICH: That's it.

8 MR. BIRD: Okay, great.

9 CHAIR MARKOWITZ: I see, okay.

10 Yes, my WebEx isn't working, but if 

11 you guys are looking at it, that's fine.

12 Carrie, does it show the --

13 MEMBER REDLICH: Yes.

14 CHAIR MARKOWITZ: -- we're talking 

15 about? Okay.

16 MEMBER REDLICH: Yes, it's up.

17 CHAIR MARKOWITZ: Okay, so, Carrie, 

18 you want to continue or you want me to address 

19 it?

20 MEMBER REDLICH: So, this part, we 

21 addressed the four and the concern was about the 

22 wording of -- if you turn so the first part --
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1 it's the physician is asked to give a specific, 

2 well, information on a mechanism that starts out, 

3 diagnostic tests do not help define the 

4 mechanism.

5 And so, a physician really would not 

6 be able to respond to that and would be quite 

7 confused.

8 So, we suggested removing that 

9 wording. We give -- the second page of this 

10 gives some alternate wording because I -- and if 

11 none of the evidence states guidelines for 

12 diagnosing work related asthma in the suggested 

13 the physician should identify specific 

14 mechanisms.

15 And then, the other wording as far as 

16 the specific event, again, most cases of work 

17 related asthma are recurrent repeated events and 

18 not one single specific event.

19 So, again, that wording, I think, it 

20 really confused the physician who was trying to 

21 follow the manual and the instructions. And so, 

22 we suggested removing that.
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1 Part of it, I think, historically, 

2 with that, the active airway confused it years 

3 ago originally defined as a single exposure 

4 event. But, it's now well recognized that work 

5 related asthma, whether it's irritants or 

6 allergens, most typically occurs in settings of 

7 repeated exposures to either irritants or 

8 allergens.

9 So, we recommended removing these and 

10 then suggested that they needed to identify a 

11 specific event.

12 And then, similar to the -- the final 

13 point was similar to the COPD discussion about 

14 they have discussions. This is recognized that a 

15 toxic substance can cause work related asthma. 

16 The issue is whether the physician is -- if it's 

17 not realistic for that physician to be able to 

18 identify the single toxic substance when it's 

19 most typically, there's a mixture of substances.

20 So, we felt that that wording just 

21 wasn't really necessary and was really just too 

22 confusing to the physician.
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1 So, we have proposed alternate working 

2 to this paragraph and that's what's on the second 

3 page of the document and on to -- here's the 

4 alternate wording.

5 Is it -- should I go ahead and read it 

6 or --

7 CHAIR MARKOWITZ: Yes, I'm -- it's 

8 only the middle section, actually, which --

9 MEMBER REDLICH: That's right, it's 

10 just part of it.

11 CHAIR MARKOWITZ: Right.

12 MEMBER REDLICH: And, the relevant 

13 part was really just removing the part that we 

14 mentioned in terms of the mechanisms, so the 

15 revised wording looks at how the physician must 

16 provide a well rationalized explanation with 

17 specific supporting information, including the 

18 basis for diagnosing asthma or working asthma at 

19 the time of covered employment, and that the 

20 basis for the relationship between asthma and the 

21 covered work place.

22 And, we haven't asked for a specific 
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1 mechanism or supporting information for these 

2 five that's either in the manual or in printed 

3 materials.

4 And then, the other revised wording 

5 is, if the CE is unable able to obtain the 

6 necessary medical evidence from the treating 

7 physician to substantiate the claim for work 

8 related asthma, then the CE will need to seek an 

9 opinion from a CSC.

10 So, we felt that that really provided 

11 clear guidance to the physicians. So, I think at 

12 this point, we can open it if there are questions 

13 or comments.

14 MEMBER FRIEDMAN-JIMENEZ: This is 

15 George.

16 Carrie, I think this is really well 

17 put together. I agree with everything. My 

18 question is whether, in your view, something 

19 that's an allergen would be considered a toxic 

20 substance?

21 Latex, for example, is not generally 

22 considered toxic. There are many asthma causing 
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1 or aggravating agents that are allergens. Some 

2 of them are not widely considered to be toxicant.

3 So, what's your opinion on how this 

4 will be interpreted and are likely?

5 And, also, given the exposures, do you 

6 think we're likely to miss many cases if we do 

7 not explicitly include allergens as toxic 

8 substances?

9 MEMBER REDLICH: Well, I think what 

10 makes something toxic is the dose throughout the 

11 frequency. So, the thing, you know, substance 

12 can be either not toxic or toxic.

13 The act mentions a toxic substance, so 

14 that's the wording. I mean, we could mention 

15 that it also includes allergens.

16 MEMBER FRIEDMAN-JIMENEZ: That's 

17 really my question, if you think it's worth --

18 MEMBER REDLICH: Yes, I don't have --

19 MEMBER FRIEDMAN-JIMENEZ: --

20 mentioning that?

21 MEMBER REDLICH: I don't -- we could 

22 just mention that it could be either an irritant 
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1 or an allergen and I think that would be fine to 

2 include.

3 I have to check if that wording was in 

4 some of the locations in the Procedure Manual 

5 because there's also a description. Because 

6 there -- I believe that there were earlier 

7 description in the manual and I think it was in 

8 the prior recommendation that it stops --

9 So, there is other wording sort of 

10 describing what work related asthma is in other 

11 parts of the Procedure Manual. I'm looking to 

12 see if I had it here.

13 CHAIR MARKOWITZ: Yes, I mean, we 

14 could -- this is Steven -- the Department does 

15 seem to take a broad approach to what is a toxic 

16 substance, to pinpoint it includes chemical, 

17 biological, and some other category.

18 I can't remember whether that's from 

19 the -- one the rules or what exactly, but it does 

20 tend to take the broad approach.

21 One way for us to take a look at 

22 whether it -- whether some of the allergens of 
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1 concern are included and just look at the SEM and

2 see whether they're included here in the SEM.

3 The SEM doesn't include everything, we 

4 know that, but it's certainly a good starting 

5 point.

6 MEMBER FRIEDMAN-JIMENEZ: This is 

7 George, again.

8 Another approach would be to look at 

9 the denied claims and see if anyone is being 

10 denied because their exposure is considered not a 

11 toxic substance, but would fall in the category 

12 of known or accepted asthma causing agents.

13 CHAIR MARKOWITZ: Well, we, in fact, 

14 have requested some claims to review and 

15 including looking up a number of claims of -- on 

16 asthma. So, we would have, you know, 20, I think 

17 we've requested 20 asthma cases to review. So, 

18 we would have a chance to look at that.

19 MEMBER FRIEDMAN-JIMENEZ: I think that 

20 would be interesting, thanks.

21 MEMBER REDLICH: Yes, I agree.

22 CHAIR MARKOWITZ: So, this is Steven.
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1 So, you know, this recommendation, we 

2 have made a, I think, a softer recommendation on 

3 this specific point in the past mixed in with 

4 other elements on recommendations on asthma. 

5 This one has not necessarily received the 

6 attention that it needs.

7 And so, this is about drawing 

8 attention to, frankly, an issue in which the 

9 Department policy is really out of sync with 

10 prevailing medical opinion.

11 And, it's hard for us to accept the 

12 Department's changes so far or readily accept 

13 their changes, but there still is this extra

14 piece to address in order to make sure that, you 

15 know, that their -- the policies reflect, 

16 obviously, this extra requirement, but also what 

17 current medical science also shows.

18 So, that's why I think we've come back 

19 to this point in a more focused way.

20 MEMBER REDLICH: Right, I agree 

21 totally. And, also, just wording that would make 

22 sense to a practicing clinician.
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1 CHAIR MARKOWITZ: Right. I think in 

2 the instance of the word mechanism, I think 

3 that's right. I think it's just not understood 

4 what mechanism means to doctors who have to write 

5 well rationalized reports.

6 Other comments?

7 (NO AUDIBLE RESPONSE)

8 CHAIR MARKOWITZ: So, we need a 

9 motion, actually, on this.

10 MEMBER REDLICH: Well, I can move --

11 CHAIR MARKOWITZ: Or more --

12 MEMBER REDLICH: -- that we recommend 

13 the revised wording to the language.

14 CHAIR MARKOWITZ: All right, I'm 

15 sorry, the proposal is to adopt the 

16 recommendation as set out on --

17 MEMBER REDLICH: That's correct. And, I 

18 guess the specific recommendation is to review

19 the record -- the recommendation that used the 

20 revised wording for the Procedure Manual on page 

21 two.

22 CHAIR MARKOWITZ: Okay, but just for 
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1 the sake of clarity, we can set specific language 

2 even better than some broader comments and that 

3 also say recommendation, too.

4 Is the proposal to accept the overall 

5 recommendation, including the specific revised 

6 language?

7 MEMBER REDLICH: Yes.

8 CHAIR MARKOWITZ: Thank you.

9 Hear a second?

10 MEMBER DEMENT: I will second.

11 CHAIR MARKOWITZ: Okay. So, the floor 

12 is open for discussion.

13 (NO AUDIBLE RESPONSE)

14 CHAIR MARKOWITZ: Okay, so, if there's 

15 no further discussion, then we need to take a 

16 vote.

17 MEMBER FRIEDMAN-JIMENEZ: This is 

18 George.

19 Are we going to add any reference to 

20 an allergen in the language that we're 

21 recommending?

22 CHAIR MARKOWITZ: Well --
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1 MEMBER FRIEDMAN-JIMENEZ: Or should we 

2 wait on it?

3 CHAIR MARKOWITZ: My feeling is that 

4 we should take a look at how -- on that issue, 

5 how the SEM addresses some of the allergens of 

6 concern to see whether, you know, if they're 

7 already using it and accept it, then we don't 

8 need a recommendation.

9 Or, secondly, to look at, I mean, look 

10 at 20 claims to see how this issue is handled and 

11 then to make a specific recommendation at that 

12 time.

13 MEMBER REDLICH: Yes, and I think if 

14 you look at any surveillance data that's been 

15 collected, the majority of cases, the 

16 overwhelming majority of specific allergen has 

17 not been identified.

18 MEMBER FRIEDMAN-JIMENEZ: Yes, I think 

19 that's true.

20 MEMBER REDLICH: Yes, I think it's --

21 yes, we could see what the cases show, but I 

22 think it's the understanding of toxic substance 
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1 is quite a broad word.

2 MEMBER FRIEDMAN-JIMENEZ: Okay. So, 

3 then, we can table that concern, see if it's a 

4 problem, and if it is a problem, then we may be 

5 able to raise it in the future. But, for now, I 

6 would agree with going ahead with the current 

7 language.

8 CHAIR MARKOWITZ: Okay.

9 Other comments?

10 (NO AUDIBLE RESPONSE)

11 CHAIR MARKOWITZ: Okay, so let's take 

12 a vote.

13 MR. FITZGERALD: Okay.

14 Dr. Berenji?

15 MEMBER BERENJI: Yes.

16 MR. FITZGERALD: Dr. Dement?

17 MEMBER DEMENT: Yes.

18 MR. FITZGERALD: Mr. Domina?

19 MEMBER DOMINA: Yes.

20 MR. FITZGERALD: Dr. Friedman-Jimenez?

21 MEMBER FRIEDMAN-JIMENEZ: Yes.

22 MR. FITZGERALD: Mr. Mahs?
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1 MEMBER MAHS: Yes.

2 MR. FITZGERALD: Dr. Mikulski?

3 MEMBER MIKULSKI: Yes.

4 MR. FITZGERALD: Ms. Pope?

5 MEMBER POPE: Yes.

6 MR. FITZGERALD: Dr. Redlich?

7 MEMBER REDLICH: Yes.

8 MR. FITZGERALD: Dr. Silver?

9 MEMBER SILVER: Yes.

10 MR. FITZGERALD: Mr. Tebay?

11 MEMBER TEBAY: Yes.

12 MR. FITZGERALD: And, Chairman 

13 Markowitz?

14 CHAIR MARKOWITZ: Yes.

15 Okay, thanks.

16 So, let's do one more topic for ten 

17 minutes and then we'll take just a short break, 

18 if that's all right. Is that all right with 

19 people? Or does anybody want to take the break 

20 now, let me know.

21 (NO AUDIBLE RESPONSE)

22 CHAIR MARKOWITZ: Okay, so, let's deal 
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1 with Parkinson's disorders. Marek, you want to 

2 start this off?

3 MEMBER MIKULSKI: Sure, thank you, 

4 Steven.

5 So, our group has been tasked with 

6 looking at the most recent evidence of 

7 Parkinson's disease relatedness to occupational 

8 exposures as well as helping DOL with some issues 

9 regarding the naming of the general group of the 

10 Parkinsonism disorders.

11 Just a brief introduction, the 

12 Parkinson's disease belongs to a group of 

13 neurodegenerative disorders that affect the 

14 dopamine system.

15 The dopamine system, amongst other 

16 functions, is involved in the control of body 

17 movement.

18 It is believed, based on the autopsy 

19 studies that the main cause of the Parkinson's 

20 disease is the reduction in the production of 

21 dopamine in the part of the mid-brain called 

22 substantia nigra that is responsible for control 
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1 of emotions and movement.

2 Parkinson's belongs or rather is 

3 included in -- under a -- in a group of diseases 

4 known as Parkinsonism.

5 Now, interestingly, Parkinson's is one 

6 of the most common causes of Parkinsonism. 

7 However, only 10 to 15 percent of Parkinson's 

8 disease are believed to be caused hereditary. 

9 And, there is a lot of research work being 

10 concentrated on the research of the remaining 80 

11 to 85 percent of cases which are idiopathic 

12 otherwise with no known causing factors.

13 There has been some work done and 

14 published on differentiation between Parkinson's 

15 disease and the other diseases under the general 

16 umbrella of the Parkinsonism set of symptoms.

17 Clinically, it has been believed that 

18 Parkinson's or the main -- or differentiation 

19 between the Parkinson's and Parkinsonism is 

20 possible due to or based on the positive response 

21 to the dopamine substitutes such as Levodopa.

22 The American Medical Association 
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1 published a set of a criteria -- diagnostic 

2 criteria for Parkinson's disease.

3 However, these criteria are not 

4 uniformly applied across the epidemiological 

5 studies. There is epidemiological work, as I 

6 said, being done looking at the causes or 

7 possible causes of Parkinson's disease.

8 And, there has been several research 

9 studies looking at occupational factors. But 

10 this is still an issue being looked at.

11 We have not had really that much 

12 chance to give an in depth look into the 

13 literature on the subject. We are just starting 

14 right now. And, there is a -- and the research 

15 actually is going in varying directions.

16 There have been studies showing an 

17 increased risk of Parkinson's disease following 

18 exposures to solvents, triflora ethylene as well 

19 as polychlorinated biphenyls.

20 And, these would be of the major 

21 interest of our group as these exposures were 

22 fairly common in the nuclear weapons context.
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1 Now, I did not talk much about 

2 Parkinsonism and I'm sure that you may have heard 

3 about the all different diseases that are being 

4 associated -- not associated -- they are being 

5 included under the general umbrella of 

6 Parkinsonism.

7 Those, in general, are the diseases 

8 that are believed to have or are known to be --

9 not associated, I'm sorry -- with known causes.

10 We are not looking at those, our 

11 interest, our focus is Parkinson's disease at 

12 this point.

13 There has been some updates in the ICD 

14 coding, the new coding ICD-10 is much more 

15 specific in terms of the Parkinsonism diseases. 

16 However, Parkinson's disease is still grouped 

17 under the same code as in the ICD-9 codes.

18 Steve, if you want to take it from 

19 here?

20 CHAIR MARKOWITZ: Sure.

21 Duronda, do you want to talk about the 

22 looking at the SEM?
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1 MEMBER POPE: Sure.

2 So, when I took a look at the SEM, and 

3 I think we were tasked to see if there was a link 

4 to Parkinson's disease, we did see a direct link 

5 with Parkinson's disease in looking at the SEM.

6 So, and, the connection with the work 

7 processes. So, I actually clicked on the health 

8 effects and looked at Parkinson's and then we 

9 looked -- they gave us a list of all the health 

10 effects list and then, when you click on the work 

11 processes, it gave you another drop down list.

12 So, there is definitely a connection 

13 in correlation depending on which site you're 

14 looking at.

15 CHAIR MARKOWITZ: Right. And, so, and 

16 we looked at, I think, two different sites, 

17 right? And, we --

18 MEMBER POPE: Right.

19 CHAIR MARKOWITZ: And, there was about 

20 somewhere between on each of the two of those two 

21 DOE sites, somewhere between 10 and 15 toxic 

22 substances that were linked to Parkinson's, 
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1 although a lot of them are, if I'm recalling 

2 correctly, a lot of those 10 to 15 different 

3 agents were variations of -- well, they contained 

4 manganese or they related to carbon monoxide for 

5 the most part.

6 MEMBER POPE: Yes.

7 CHAIR MARKOWITZ: Yes.

8 MEMBER POPE: I think the two major 

9 work processes or work categories were machinists 

10 and welders.

11 CHAIR MARKOWITZ: Right, and in fact, 

12 they had in the list of toxic substances, their 

13 mixtures, they included welding there.

14 Okay, so, anything else, Duronda, on

15 that?

16 MEMBER POPE: I don't think so. I 

17 just looked up after we spoke, I just looked up 

18 another couple of sites and found the same 

19 things. So, there is definitely, you know, 

20 evidence of connection there.

21 CHAIR MARKOWITZ: Right, right.

22 We tried to look across the complex 
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1 actually by disease health effects. And, the SEM 

2 isn't organized that way.

3 Actually, so, this is -- I think would 

4 be useful, this would be an action item for 

5 Carrie if the DOL could provide a listing of all 

6 the agents, toxic substances in the SEM that they 

7 relate to one of the family of Parkinson's codes 

8 that they use in the health effects.

9 And, I can fill that out later, 

10 Carrie, if you want. But --

11 So, Kevin, there's a file called 

12 EEOICPV or Parkinson's disease claims data that I 

13 sent to Carrie earlier, if you could bring that 

14 up.

15 So, Duronda, I'm sorry, did I -- I 

16 didn't mean to cut you off. Was there anything 

17 else?

18 MEMBER POPE: No, no. I just wanted 

19 to also mention that Ron helped me out, too. He 

20 was also simultaneously looking at the same 

21 thing. So, I think we arrived at the same 

22 conclusion. Do you agree with that, Ron?
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1 MEMBER MAHS: And, actually, the same 

2 thing just about at each site, painters, welders, 

3 and the solvents the painters used, in general.

4 CHAIR MARKOWITZ: Yes.

5 Okay, so, what we're seeing on the 

6 screen here is -- so, the Department provided us 

7 with a spreadsheet with some Parkinson's data. 

8 And, I -- you can leave the screen where it is.

9 And, I organized some of it, this will 

10 only take a couple minutes to go through.

11 And, I didn't ask for a full 

12 explanation of some of the variables. So, I 

13 don't fully understand them, but I think it still 

14 gives us some information.

15 Table 1 is who submitted the claim. 

16 And, you can see the survivors were involved in a 

17 fair proportion.

18 Table 2 is half the claimants were 

19 alive and half not.

20 Table 3 is interesting, I -- most of 

21 the claims have come in in the past 20 years. 

22 Now, admittedly, Part B -- Part E, excuse me, 
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1 that covers Parkinson's disease was part of the 

2 amended EEOICPA Act in 2005. So, the door wasn't 

3 open for compensation until then for Parkinson's 

4 disease.

5 Or, it was, rather, the opening was 

6 very narrow between 2000 and 2005.

7 But, in any event, most of the cases 

8 are relatively recent.

9 Next, if you could scroll down, I 

10 can't seem to do that, Kevin, from my computer 

11 here.

12 And then, the first -- and this is 

13 approved versus denial. First approval, first 

14 denial, just the numbers by year.

15 I'm not sure exactly what first 

16 approval and first denial is, and I don't believe 

17 that they -- this means that the claim was 

18 initially filed in the same year. So, there may 

19 be a little bit of mismatch between the numbers 

20 in the approvals versus denial years.

21 Nonetheless, I think it's interesting, 

22 you can see that a certain point soon after Part 
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1 E was put into effect, 50 percent of the -- in 

2 any given year, 50 percent of the claims were 

3 approved.

4 And then, there was a period of time 

5 that relatively a few of the claims were 

6 approved, 2013, 2014, 2015. But, in the last 

7 couple of years, it's going back up.

8 Again, the columns representing 

9 approval, denial are not necessarily the same 

10 years, so I wouldn't look at the numbers too 

11 precisely. We're looking sort of broadly at a 

12 trend.

13 And, not sure, necessarily what it 

14 means, but it also gives us a sense of how many 

15 of -- of what the proportion that are approved 

16 are which is we think about 50 percent.

17 I think there's another table --

18 here's another -- so, this is -- I forgot to 

19 mention that 1,154 total Parkinson's claims since 

20 2006, so a lot of claims, that's a lot of claims, 

21 I think, for this illness or family of illnesses.

22 And, here's the site that's listed. 
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1 Now, about a third of all people listed worked at 

2 more than one site. So, all we did was kind of 

3 the simplest thing which is to take --

4 disaggregate them, take them apart and then 

5 assign them to multiple sites.

6 So, that means that the total number 

7 we're looking at here is going to be greater than

8 the 1, 150 claims. So, if you can go back up?

9 Okay, so, this is -- and this is just 

10 -- this is not percentage of claims or incidents, 

11 it's just counts, it's just numbers of claims at 

12 a given site.

13 And, again, I wouldn't read too much 

14 into this in the sense of thinking that there's 

15 necessarily anything going on at those particular 

16 sites.

17 There are some of the larger sites, Y18 12, Savannah River, Oak Ridge, X-10, Hanford, 

19 that appear there and they obviously have more 

20 employees than most of the other -- many of the 

21 other sites.

22 And then, the thing, the caveat at Oak 
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1 Ridge is that the workers at Y-12, K-25, and X-10 

2 often worked at each other's facilities over 

3 time. So, to assign them to a single site is, 

4 for many people, isn't going to be necessarily 

5 true.

6 But, I thought, nonetheless, it was 

7 worth doing this as an initial run and taking a 

8 look, Idaho, which is about number 10 is a very 

9 large site. And, but the number of cases is 

10 considerably less than Paducah, which is, I think 

11 historically a much smaller site than Idaho.

12 So, in any case, this is, for what 

13 it's worth, this is -- and, if you can scroll 

14 down, you can see that there are a lot of DOE 

15 sites and many of them have, you know, a handful 

16 of cases.

17 Okay, so that's all I have to say 

18 there on that -- on those data.

19 So, Marek, anything else or should we 

20 open it up for comments?

21 MEMBER MIKULSKI: I think opening it 

22 up for comments at this point.
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1 CHAIR MARKOWITZ: Marek, Dr. Cassano, 

2 yourself, Duronda, Ms. Pope, who else is on this 

3 working group?

4 MEMBER POPE: And Ron.

5 CHAIR MARKOWITZ: And, Mr. Mahs, okay, 

6 thanks.

7 Okay, okay, so, this is the sort of 

8 the initial look and we've got a considerable 

9 more work to do.

10 The next meeting, April 23rd or 24th, 

11 that's in seven weeks, how far do you think we 

12 might get beyond where we are now by the time we 

13 meet next? Marek, any just ballpark sense of 

14 that?

15 MEMBER MIKULSKI: I think we'll be 

16 able to look at the -- and review the literature 

17 -- I mean, we've been covering the dose studies 

18 over the last couple of weeks and hopefully are 

19 going to be able to look at least most of them 

20 and have some more insights into this.

21 CHAIR MARKOWITZ: Okay. And, just 

22 something that Mr. Fitzgerald mentioned at the 
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1 beginning, so the medical articles from the 

2 published literature, unless they're open access, 

3 we can't put them on our website.

4 So, we can circulate them among 

5 ourselves, which we will do. But, it's 

6 unfortunate, because it means we can't 

7 necessarily provide all the literature we're 

8 going to look at in an easily available way to 

9 the public.

10 But, we could provide it by request or 

11 whatever. 

12 So, we'll have it by April 24th, we'll 

13 have a reasonable look at the literature in terms 

14 of causatives or aggravational agents. And, 

15 we'll -- hopefully, DOL will give us some data on 

16 sort of what the SEM says about the various job 

17 titles, work sites, et cetera, toxic substances 

18 that relate to Parkinson's.

19 Any other comments on -- anybody else 

20 want to work on this working group, by the way?

21 (NO AUDIBLE RESPONSE)

22 CHAIR MARKOWITZ: If you change your 
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1 mind and you want to volunteer, it's great, just 

2 let us know.

3 Any other comments? And then, we're 

4 going to take just a break for a moment, but any 

5 other?

6 MEMBER SILVER: Yes, this is Ken 

7 Silver, if I could just plant the seed of a 

8 question about what might be a large category of 

9 people who might be seen as having a very low 

10 dose.

11 Let's say that someone who welded 

12 their career and they have material safety data 

13 sheets for a typical welding rod that contained 

14 manganese, but they don't know anything about the 

15 base metals that they welded on.

16 I wonder how the CMCs and IHs are 

17 handling those claims? Would manganese in 

18 welding rods be sufficient to clinch a claim for 

19 Parkinsonism?

20 I know you probably can't answer that 

21 right now, but as we get into these and look at 

22 the SEM, it seems that there might be 
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1 demographics and tests of a pretty large group of 

2 people in that category.

3 CHAIR MARKOWITZ: So, it's a question 

4 about extensive exposure?

5 MEMBER SILVER: Right. So, would 

6 documented exposure to welding rods containing 

7 manganese with the worker having no knowledge 

8 about the base metal manganese content be 

9 considered a sufficient exposure?

10 CHAIR MARKOWITZ: Well, we have 

11 requested 20 claims, 10 accepted and 10 denied on 

12 Parkinson's disease. So, we will be able to get 

13 a direct look at that, I think.

14 MEMBER SILVER: Great.

15 CHAIR MARKOWITZ: But if it -- maybe

16 we can also ask -- we don't have to arrive at a 

17 final formulation of the question, but if there's 

18 a question we want to direct to DOL, how do you 

19 handle, you know, the whatever?

20 We can also ask them and ask for a 

21 response. So, if you want to come up with a 

22 particular question, again, we don't have to do 
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1 it on the phone, the particular question, then we 

2 can add it to the action. How about that?

3 MEMBER SILVER: Or maybe after the 

4 next round of analysis of the claims, we question 

5 them.

6 CHAIR MARKOWITZ: Yes.

7 MEMBER SILVER: We might have a little 

8 more data.

9 CHAIR MARKOWITZ: Yes.

10 Any other comments? Questions on the 

11 Parkinson's issue?

12 (NO AUDIBLE RESPONSE)

13 CHAIR MARKOWITZ: Okay, so I have just 

14 short of 3:55, we're going to take a five minute 

15 break. We have a fair amount to do, but we will 

16 finish by 5:00. So, but I would like to start 

17 back up promptly in five minutes, if that's all 

18 right.

19 MR. BIRD: This is Kevin Bird.

20 And so, probably, on that note, it's 

21 best if you can to just stay on the line so you 

22 don't have to call back in just so we can begin 
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1 promptly in five minutes.

2 CHAIR MARKOWITZ: And, Kevin, if you 

3 can bring up the public comment tracking 

4 spreadsheet, we'll look at that next.

5 MR. BIRD: Sounds good.

6 CHAIR MARKOWITZ: Okay, thanks.

7 (Whereupon, the above-entitled matter 

8 went off the record at 3:53 p.m. and resumed at 

9 4:02 p.m.)

10 MR. FITZGERALD: All right. Let's do 

11 a quick roll call to see who's back with us.

12 MR. FITZGERALD: Is Dr. Berenji here?

13 MEMBER BERENJI: Yes, I'm here.

14 MR. FITZGERALD: Okay. And Dr. Dement?

15 MEMBER DEMENT: Yes.

16 MR. FITZGERALD: Mr. Domina?

17 MEMBER DOMINA: Here.

18 MR. FITZGERALD: All right. Dr. 

19 Friedman-Jimenez?

20 MEMBER FRIEDMAN-JIMENEZ: I'm here.

21 MR. FITZGERALD: Mr. Mahs?

22 MEMBER MAHS: I'm here.
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1 MR. FITZGERALD: I heard Chairman 

2 Markowitz.

3 CHAIR MARKOWITZ: Here.

4 MR. FITZGERALD: Dr. Mikulski?

5 MEMBER MIKULSKI: I'm here.

6 MR. FITZGERALD: All right. Ms. Pope?

7 MEMBER POPE: Here.

8 MR. FITZGERALD: All right. Dr. 

9 Redlich?

10 MEMBER REDLICH: I'm here.

11 MR. FITZGERALD: All right. Dr. 

12 Silver?

13 MEMBER SILVER: Here.

14 MR. FITZGERALD: And Mr. Tebay?

15 MEMBER TEBAY: Here.

16 MR. FITZGERALD: We are all here.

17 CHAIR MARKOWITZ: Okay. Good. So 

18 we're looking at the screen. We're discussing 

19 public comment tracking. So what Carrie Rhoads 

20 has very nicely done is come up with a 

21 spreadsheet that summarizes the public comments -

22 -- these are comments we hear at the meetings, 
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1 but also emails that come in, comments that are 

2 officially submitted.

3 And you can see the source, the 

4 transcript page, that's from our meetings, if you 

5 want to look at the detailed comments. Of course 

6 the transcripts are on our website. And then 

7 comments -- now under comments. The third, 

8 Column C, this is something that Carrie has done 

9 --- it is trying to summarize the main points of 

10 the comment or at least some of the main points.

11 And they're not represented to be 100 

12 percent accurate. They're certainly not 

13 complete. They're intended to just be able to 

14 trigger if a person's looking quickly at this 

15 spreadsheet, to trigger thoughts about, if you 

16 want to look at the commenter's ideas in more 

17 detail that you can go to the transcript of our 

18 meeting or go to the full comments which are 

19 posted on our website.

20 So you may see some, I don't know, 

21 errors or whatever in that column, but sure, you 

22 can send those corrections to Carrie. But she 
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1 made a very nice attempt to summarize what people 

2 have said, or the major key words. And then 

3 finally in the, in the Column E is some 

4 responses, some comments, some of the department 

5 in relation to some of these comments. So that, 

6 you may find that illuminating also.

7 The intent of all this is to try to 

8 keep some of the concerns that the public has in 

9 mind, on the Board's agenda in an easily 

10 accessible way so that we can in the items that 

11 we talk about, take into account some of the 

12 comments and also it affects some of the, some of 

13 our agenda as we move forward. Unless there's a 

14 comment or question about that, I think we can 

15 move on.

16 Okay. Let's move on. You can take 

17 this down. I'm not sure, Kevin, that we need to 

18 be looking at anything or if you want, you can 

19 bring up the final, the final rules published 

20 February 8th by the department. So I wanted to 

21 spend a couple minutes really just to complete 

22 the loop here. So the Department put out a new 
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1 rule on assets of the program, February 8th, 

2 earlier this month.

3 By way of history, this rule has been 

4 in formulation for several years when the Board, 

5 the previous Board first met, April 2016, the 

6 Department nicely reopened the comment period to 

7 allow us to look at the proposed rule changes and 

8 then to comment on them. And we did that. It 

9 was the first, I think it was the first thing the 

10 Board did actually, even before we knew a whole 

11 lot about the program.

12 We made some comments and added them -

13 -- now in this rule here, and I, for those of us, 

14 which is most of us, I think, I'm used to looking 

15 at rules and final rules and what they consist 

16 of. Much of it is about the comments that were 

17 made on the proposed rules by the public, by us, 

18 by others. And the DOL's response to those 

19 comments.

20 By then, towards the end, it's 

21 actually the changes in the rules. It's not 

22 necessarily the easiest readings for those of us 
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1 who don't do this in life. But I suppose some 

2 people would say that about anatomy and philology 

3 textbooks also. If you go to Page 3043, Kevin, 

4 there's a specific section in which the 

5 Department -- yeah, on the right there, just a 

6 little bit, yeah, on the right column.

7 There's a subheading, Comments from 

8 the Advisory Board on Toxic Substance and 

9 Worker's Health. They referred to the comments 

10 that we made. We made about 12 comments or so. 

11 Half of them were considered within our, the 

12 scope of what the Board is about. Half of them 

13 were considered outside of our scope.

14 They stated of those that were 

15 considered outside of our scope, they nonetheless 

16 addressed the issues that we rose, that we raised

17 because those issues were raised by other public 

18 commenters. So our comments were not ignored. 

19 They were -- we had a couple of comments and 

20 recommendations about the issues that -- they're 

21 not even the subject of the notice of proposed 

22 rulemaking. So that was interesting.
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1 I don't really want to go through --

2 most of our recommendations were not accepted, I 

3 should say. The details are in this rule and 

4 they cite our recommendation and then they 

5 respond to them. To go over a couple just to 

6 give you a flavor. On the section 303, 3049 

7 actually. If you go to Page 3049? This is where 

8 the proof of exposure to a toxic substance and 

9 this is section 30.231. Okay. And we see it on 

10 the right-hand column here. Okay. So the issue 

11 was what -- let me just look for the -- okay.

12 So if you look in the right-hand 

13 column under Section B, this is, this is the 

14 rule, the advised rule, that it says that, I'm 

15 quoting, quote, information from the following 

16 sources may be considered at probative factual 

17 evidence for purposes of establishing an 

18 employee's exposure to a toxic substance at a DOE 

19 facility or a leak out, a Section 5 facility. 

20 One, to the extent practical, our purpose in DOE 

21 sponsored formal worker program or an entity that 

22 acted as a contractor or a subcontractor of the 
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1 DOE. Two, OWCT site exposure matrices, or three, 

2 any other entity deemed by OWCT to be a reliable 

3 source of information.

4 So we had suggested in addition to 

5 that list that it add among those itemized issues 

6 the occupational history or affidavit obtained 

7 from the claimant or from coworkers or the 

8 occupational history obtained by a health care 

9 provider outside of the formal worker program and 

10 those suggestions really weren't accepted. I 

11 think they were seen to be covered in Item Number 

12 3, of any other entity. So, so be it.

13 We commented on -- this is Page 3035 

14 but I think I can just summarize this. We 

15 commented on the ability of a claimant who has an 

16 effective claim for change positions and the 

17 Department was altering its language on the 

18 grounds by which or through which a claimant 

19 could request a change in a treating physician.

20 So the claimant gets to pick whatever 

21 initial physician they want to choose. But once 

22 they're in the program and have a treating 
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1 physician, if they want to change treating 

2 physicians, they have to provide a rationale for 

3 that. And we thought that was pretty 

4 restrictive. And we suggested that the claimant 

5 not have to actually cite any particular reason 

6 if they wanted to switch because people want to 

7 change doctors for all kinds of reasons.

8 It turns out that, that really, what 

9 we proposed wasn't really in play, if I 

10 understand this, the comments on the, on the 

11 final rule. The Department was mostly just 

12 interested in knowing what language or revision 

13 in the language as to what kind of evidence the 

14 claimant had to provide to the Department in 

15 order to be able to change physicians.

16 So in any case, there are a few other 

17 suggestions we made that were not accepted and if 

18 you want to go further into this then it's all on 

19 our website. You can look at the final rule. 

20 You can look back at our April meeting of 2016. 

21 That's where we made our proposed 

22 recommendations. Also April 2016, is a redlined 
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1 version of the proposed rules, so you can see the 

2 changes that were recommended. And that's, 

3 that's pretty much all I have to say about that. 

4 Any questions or comments? Okay.

5 So we're going to move on to the Board 

6 action list. Kevin, if you could bring that up 

7 Kevin?

8 MR. BIRD: Yeah. I'm going, I'm 

9 pulling it up right now for that. Let me just 

10 confirm that for everyone one minute.

11 CHAIR MARKOWITZ: That's fine. When -

12 - I don't hear anything unless you're over there. 

13 My phone has stopped working.

14 MR. BIRD: No, I think, I think I had 

15 you on mute. Is this, is this the correct one?

16 CHAIR MARKOWITZ: Yeah. Yes, it is. 

17 Yeah. Okay. So we're, we're going to go through 

18 this. There's a second part to this, which is 

19 Item number 8 on the agenda, which is our data 

20 request. So first we'll just talk about the 

21 action list that we produced from December and 

22 what's happened so far or not happened. And then 
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1 we'll talk about our data request.

2 So the first issue, and the link here 

3 is going to pull up Bulletin 19-03 that we 

4 started off, with leading with, which were the 

5 changes in the procedure manual relating to 

6 certain disease exposures. And it says here that 

7 those changes outlined in bulletin 1903 are 

8 prompting a review of about 2,000 pension 

9 affected cases. They're around causation. And 

10 how those cases will be identified and screened 

11 is what's in 1903, the bulletin, if you want to 

12 look at that more closely.

13 But that's the answer to our question 

14 -- it's a lot, it's a lot of cases actually. And 

15 so this is, for Carrie Rhoads an action item from 

16 this meeting, which is that we, I think we've 

17 made this request before, but I just want to make 

18 sure it's out there. We would, understanding 

19 that it takes quite a while to re-review these 

20 cases, we would like some information when it's 

21 available about the outcome of these reopened 

22 cases.
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1 And it's possible by, I believe in why 

2 they were reopened. Meaning that there were a 

3 couple of solvents added to noise and for the 

4 hearing loss that would be separate from the 

5 asbestos lung cancer is separate from the benzene 

6 bladder cancer and the like. Okay. So someone 

7 had asked to look at the training page I think 

8 for the claim's examiners, but it may be broader 

9 than that. I haven't looked at it recently, but 

10 there it is.

11 We had requested meeting the Medical 

12 Director, Dr. Armstrong and Dr. Stokes, the 

13 toxicologist. This is considered inappropriate 

14 as line staff do not interact with the board in a 

15 public forum. So if we have any questions about 

16 various topics in their domain in relation to the 

17 program, we should submit those in writing.

18 The board -- the Department did 

19 provide us with the CDs. Dr. Armstrong has --

20 those are not available on our website yet. They 

21 are available to the Board through email, but I 

22 think we should post them on the website, too. 
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1 As we post this, any attachment in what we're 

2 reviewing now should also be on the website. Dr. 

3 Armstrong has many years of experience in the 

4 administration and military medicine. And Dr. 

5 Stokes has many years of experience in 

6 epidemiology, in addition to toxicology.

7 The annual statistics on claims and 

8 the cases for 2015 to the present, we were sent a 

9 series of tables with this. I don't know if 

10 anybody got a chance to take a look at them. 

11 What I saw was cumulative data for each of those 

12 years. So in 2015 it was cumulative cases and 

13 claims from the beginning of the program. And in 

14 2016, it was the same thing. So it wasn't each 

15 of those years from 2015 to 2018 captured. It 

16 was a cumulative data over many years.

17 I don't know if anybody took a look at 

18 this and saw -- maybe I just missed it -- saw 

19 anything else. But anybody ever recall or have a 

20 chance to look at this and see whether there 

21 actually were one year, a succession of one-year 

22 statistics?
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1 MEMBER REDLICH: No, I think -- this 

2 is Carrie. I think this is the way it's been 

3 done each year. You sort of have to subtract the 

4 prior if you actually want to see the most recent 

5 year.

6 CHAIR MARKOWITZ: Yeah. Well, yeah, 

7 so we can do that. Matter of fact let me do that 

8 then ask the Department whether it's, we can 

9 interpret it as one-year numbers or whether, you 

10 know, things get rearranged, re-categorized 

11 cumulatively so that it's, it's just to get a 

12 sense of the volume flowing through the system 

13 and the Part B, Part E and also the relative 

14 rates of approval of denial. So I will do that 

15 and circulate that.

16 Next is percentage of cases that go to 

17 an industrial hygienist and what are the category 

18 of reasons why cases are sent. And so nicely 

19 made out in their response is the procedure 

20 whereby a claim is evaluated and under what 

21 circumstances it's sent to an industrial 

22 hygienist. So if people read that and have any 
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1 additional questions about that then we can look 

2 at that further.

3 They did send a table of industrial 

4 hygiene and I'm not sure exactly where this table 

5 is, whether it's on our website or not. It's --

6 MS. RHOADS: It's not posted on the 

7 website yet. You just sent it to the Board in an 

8 email.

9 CHAIR MARKOWITZ: Okay. Okay. So if 

10 you could, you know, put a link to this question 

11 so people can, the public can see it and we can 

12 track it. And it's got some categories that I 

13 don't really fully understand but it looks like 

14 where 2018 -- well that, that'd, well -- I'm 

15 about to say about 15 percent or so of both 

16 accepted and denied claims had been through an 

17 industrial hygienist evaluation.

18 I'm not -- that number may be as high 

19 as say, 25 percent, 26 percent. I just have to 

20 get clarification about this, which I will do and 

21 write up some comments so we can understand it 

22 better. With that, on first blush it looks like 
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1 somewhere between 15 and 27 percent of claims

2 have an industrial hygiene evaluation as of 2018 

3 --- but I think we need to get a better 

4 understanding of that, unless somebody else took 

5 a look at this and has a better sense of this.

6 Okay. Let's continue. Let's go down. 

7 Accountability review findings, we, so the 

8 Department does accountability reviews on all the 

9 district offices on the claims. And if you 

10 haven't taken a look, you can look at a link. So

11 my web's actually isn't working so I'm not sure 

12 what people are looking at. So Kevin, are we 

13 down on the accountability review section?

14 MR. BIRD: Yes. So it's on the page -

15 - you should be able to scroll down on your own 

16 screen.

17 CHAIR MARKOWITZ: Yeah, yeah, well 

18 mine seems to be frozen. So but I'm looking at a 

19 paper copy so I'm fine as long we stay up with 

20 it.

21 So if you look at the accountability 

22 review findings, it refers to, there's metrics 
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1 and indices used that aren't really apparent. So 

2 I think we need to ask for some better 

3 understanding of what those metrics are. And 

4 ultimately, I think a lot of it is not 

5 necessarily relevant to the board, but when we 

6 look through, we will, when we look through 

7 claims we're going to have some questions. And I 

8 think this accountability review process will 

9 help answer some of those questions.

10 The next topic is, we requested drafts 

11 of documents that also has auditing of the 

12 industrial hygiene work and reports. And the 

13 Department's response is that, individualized

14 reports are evaluated by lead industrial 

15 hygienists and that as part of the accountability 

16 review process, they look at the quality of the 

17 IH report and that there's no further audits.

18 I think we need more detail about 

19 that. We want to look, we are charged to 

20 evaluate the objectivity, quality consistency of 

21 the industrial hygiene evaluation process and so 

22 we need to request, I think, additional details 
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1 beyond this response. And if there's any metrics 

2 that are used as part of the accountability 

3 review that are informative then we should 

4 receive them, so I'll follow up on that and ask 

5 formally some follow up questions.

6 The next issue is the medical audits -

7 - they provided online previous medical audits 

8 and the more recent ones are now available. 

9 These are performed by Dr. Armstrong, the medical 

10 director. I looked at them all, the recent ones, 

11 the end of 2017 and the first quarter of 2018, 

12 and they're similar to the ones previously --

13 most of the weaknesses of the contract medical 

14 physician reports center on impairment for most 

15 of the detected weaknesses, center on impairment, 

16 problems with their impairment analysis. Almost 

17 nothing addresses causation. So that'll be of 

18 interest, I think when we get to look at claims 

19 and see what we think.

20 Again, interrupt me if there's 

21 questions or comments. The next issue was that 

22 we requested the scientific articles or sources 
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1 of support for whatever medicine or science there 

2 is in Exhibit 154 and 181. And we were asked to 

3 provide specific requests. But they did provide 

4 this report by Econometrica, 2005, which was 

5 completed mostly by some physicians I think at 

6 National Jewish Medical Center and a related 

7 contractor.

8 And if you want to understand why the 

9 procedure manual looks the way it does, I think 

10 it's worth looking at that 2005 document since 

11 that was kind of the foundational framework that 

12 they used to get where they are today with some 

13 evolution.

14 Did anybody get a chance to take a 

15 look at that or remember what it looked like? Do 

16 you have some --

17 MEMBER DEMENT: Yeah, I went through 

18 it in reasonable detail. And my take on it is 

19 exactly yours. I think it is the foundational 

20 piece for a lot of the, at least the initial 

21 parts of the program as it was developed. Now 

22 you could argue with lots of pieces of it if you
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1 want just, so we go through it line by line but--

2 CHAIR MARKOWITZ: But we're, but 

3 we're, we're not going to do that.

4 MEMBER DEMENT: Oh.

5 CHAIR MARKOWITZ: There is however one 

6 very specific piece that is retained in the 

7 procedure manual in the, I think it's in the 

8 exhibits. And if I can, I think it's in Exhibit 

9 18. Yeah, it's 18-1, which is called, quote, 

10 measures for confirming sufficient evidence for 

11 non-cancerous covered illness, end of quote. And 

12 it needs to be reexamined because much of it is 

13 in conflict with what the procedure manual now 

14 says for asbestos, for COPD and a number of 

15 different entities. So that just deserves a look 

16 by the Department of Labor and some editing to 

17 make it more consistent.

18 Okay. Moving on to the action list. 

19 We asked how many claims there were for 

20 Parkinson's Disease and we just discussed. 

21 There're 1,154 claims submitted to 2006. And 

22 then DOL provided us with question and answers 
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1 the working group had, which was what got 

2 international classification of disease, ICD 

3 codes where, that they use in the claims 

4 administration system. So that's a good thing.

5 We asked about claims filings for 

6 individual DOE sites and just to the aggregate 

7 data, it's a Part of B versus E by year, and 

8 apparently the program doesn't keep data on 

9 claims by site. So I think if we wanted to 

10 pursue that we would have to cite some specifics 

11 --- in fact in their response they say that they 

12 don't understand the nature of our request and 

13 want to know how it relates to our, one of our 

14 assigned responsibilities. No comment. Any 

15 comment?

16 MEMBER SILVER: This is Ken Silver. 

17 You can certainly go to the DOL website and look 

18 at claims paid by site and I don't remember 

19 hearing if they found a double biller when they 

20 pay a claim and reported that all of the sites 

21 where the employee worked. I'm kind of confused 

22 by their response.
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1 CHAIR MARKOWITZ: Yeah, well I know we 

2 don't have really much time to spend on this, but 

3 I didn't even realize that you could, you could

4 look at what you're saying, claim paid by site. 

5 So I'm going to look further. If anybody wants 

6 to pursue this conflict, we can come back to it.

7 Then we raised the issue of the public 

8 submissions to the site exposure matrix. And 

9 they provide some -- and then how long it took. 

10 And they provide some data that the turnaround 

11 time was roughly two months from submission. I'm 

12 sorry. There were approximately 60 submissions 

13 in each of the most recent fiscal or program 

14 years and the average response time was about six 

15 days, six or seven days.

16 I interpret this to mean the six- or 

17 seven-day response time to mean that, that's the 

18 date in which they were verified or not, you made 

19 a decision or not. Unless someone reads that 

20 differently. That strikes me as pretty quick 

21 actually.

22 It does -- there is a related question 
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1 that I wondered about, which is whether, how the 

2 Department catalogs the changes it makes in the 

3 SEM. I know it changes the SEM and then 

4 announces that a revised SEM is available. But 

5 does it have an inventory of -- and this is an 

6 action item or question, sorry. Does the 

7 Department maintain an inventory on the changes, 

8 additions and deletions that it has for each 

9 version of the SEM as it revises it?

10 I think they probably do, and the 

11 question is, but the question is do they? And if 

12 they do, could we see a recent example of that 

13 from one revision to the next? And if that's not 

14 clear, Carrie, I can clarify it later.

15 MR. FITZGERALD: Okay. We've got, 

16 we've noted that.

17 CHAIR MARKOWITZ: Okay. So the next 

18 item is -- again I'm not, I'm not looking at the 

19 WebEx. I'm kind of assuming these are appearing 

20 --- and I'm cognizant that we have 25 more 

21 minutes so we will get through this.

22 The question is, how does a contractor 
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1 for DOL analyze information on the SEM changes or 

2 recommended changes to the SEM for particular 

3 locations. So if there are any -- and so they 

4 give an explanation. So anybody has any further 

5 questions from that, we can discuss it now or 

6 people can send in some additional questions if 

7 they want some further clarification.

8 The next item was, could the 

9 solicitor's office and the program explain how 

10 they interpret the statue regarding toxic 

11 substance. And so they do that. And they 

12 basically say they derived it from how the 

13 Department of Energy defined it when they 

14 administered Part D. Part D is an obsolete part 

15 of the original Act, that existed between 2000 -

16 2005, to deal with occupational diseases, other 

17 than those covered by Part B. So Part D was 

18 superseded by Part E. And probably don't need to 

19 know more about that then just that.

20 There's also the deal for Act itself, 

21 which mentions toxic substance and then they give 

22 a quote, they give an excerpt from that. 
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1 Although it doesn't, it doesn't define it. It 

2 just, it shows where it references toxic 

3 substance. And finally part of their response is 

4 that vapors, gas, dust, and fumes are not 

5 synonymous with toxic substances, but they 

6 represent, quote, states of matter, end of quote. 

7 So we learned that. Any comments or questions?

8 So this is useful. This is a useful 

9 summary in case we get back to any questions or 

10 wonderings about how they regard their issue of 

11 toxic substance.

12 Moving on, is there process for the 

13 industrial hygienist to ask questions or ask for 

14 additional information without interviewing a 

15 claimant? And the response to that is, yes, the 

16 IH can talk to the claim's examiner. And then 

17 there's a quoted section from the procedure 

18 manual about how the IH interacts with the 

19 claim's examiner.

20 It raises the, we had recommended that 

21 the IH be permitted to interview the claimant 

22 directly, and DOL accepted that. They wanted the 
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1 claims examiner involved, which seems right. And 

2 we need to hear back from the Department. What's 

3 pending is that the progress on that activity is 

4 what we're supposed to hear about.

5 Two last issues on the SEM, one, do 

6 they include bystander exposure and the answer 

7 is, no. And then, how many conditions are there 

8 in the SEM, how many aliases? So 124 diseases, 

9 around 37 diseases aliases. And I think this 

10 question related to DOL's request to us to help 

11 them with looking at the aliases. So we can use 

12 that information to consider that, consider 

13 whether we the resources to help them.

14 Okay. If there are no comments, we'll 

15 move on. Are there comments?

16 MEMBER SILVER: I've -- this is Ken 

17 Silver. When do you want to get that training 

18 page link to work? Would you send it to me? We 

19 don't need to glum on it now, but anyone gets 

20 there, think of me and send me the working link 

21 would you please?

22 CHAIR MARKOWITZ: Well I couldn't get 
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1 it to work either. So maybe Carrie Rhoads, if 

2 you could follow up on that.

3 The Board, some board members, a 

4 subset of the Board formulated a data request at 

5 the direction of the Board, which was submitted 

6 December 10, 2018. And Kevin, do you have this -

7 -- it's called -- or are you showing it? ABC --

8 MR. BIRD: I'm pulling up. Yeah, I'm 

9 pulling it up now. It should just be one second.

10 CHAIR MARKOWITZ: Okay. Okay, that's 

11 fine. So this is a two-part request. One, had 

12 to do with data and the other had to do with 

13 claims. We requested data organized in a way 

14 that had been done for the prior board. Only the 

15 prior board it was restricted to Part -- pretty 

16 much, Part B positions or respiratory conditions.

17 And so we've asked for updated 

18 information by year for selected conditions and 

19 you can just -- I'm not going to go through all 

20 of this. But they included some lung disorders. 

21 They included the most common Part E conditions 

22 --- they included neurologic outcomes, cancer and 
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1 kidney disease. A similar kind of data for each 

2 of these areas. And then we provided a table to 

3 describe what, kind of what the output could like 

4 that would be useful.

5 This hasn't been produced and I don't 

6 know, Secretary, whether there's any update on 

7 when we're going to see some of these data? It's 

8 been, we point out, we submitted this request 

9 December 10 so we're now two-and-a-half months 

10 past that.

11 MR. FITZGERALD: Yes, we've made 

12 inquiries about the data and the status of that, 

13 and I think it would be helpful because it is a 

14 big request and considering the workload

15 involved, if we try to work with the program to 

16 prioritize the request and maybe narrow the scope 

17 a little bit because I think they're dealing with 

18 some resource issues in terms of the staff time 

19 required to pull this together.

20 CHAIR MARKOWITZ: Well does it start 

21 with, they just go in order? We don't need the 

22 whole set at the same time. In fact it'd be more 
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1 useful to get parts of it. It's the same kind of 

2 analysis for each subset of conditions. So once 

3 it's done for one, you know, the challenges, 

4 obstacles, whatever for one, the rest should be, 

5 should flow pretty easily. But, yeah, let's 

6 start with lung diseases and go from there.

7 MEMBER REDLICH: I think -- this 

8 Carrie Redlich. So lung disease was part, just 

9 really just to update of what they have given us 

10 previously. So we didn't think that would be 

11 that much work.

12 CHAIR MARKOWITZ: Right. That's, yeah, 

13 that's the lung, for the lung conditions. Right 

14 --- the others we hadn't previously asked for it, 

15 but regardless. Anyway, so, yeah, we hear it. So 

16 other request was for claims, to look at claims. 

17 And we -- to the part, for the members of the 

18 board who weren't on the prior board, we did look 

19 at a sizeable number of claims. I can't really 

20 remember. Does anybody remember the number? It 

21 was I think several dozen, mostly in lung 

22 disease.
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1 And so the request here was for more 

2 claims and 20 claims for each of five pulmonary 

3 conditions. That's 100 claims and additional 20 

4 for Parkinson's disease. And again, we don't 

5 need all the claims at the same time. A subset 

6 because we can't handle all, you know, all the 

7 claims at the same time. A subset would be most 

8 helpful.

9 If there needs to be priorities, then, 

10 sure, Parkinson's disease, a field could be in 

11 asthma would probably be the most useful. Unless 

12 other people have other ideas about that. Sure 

13 we could start with those, but we would like to 

14 start. We need to understand the claims. 

15 Actually for all four assigned tasks to the 

16 Board, so that is, that request stands.

17 Any other comments on this?

18 MEMBER DEMENT: This is John. I think 

19 it's important for our upcoming in face meeting 

20 to have some of those and for us to get a start. 

21 Yeah, we don't need them all. We can't review 

22 them all probably in that timeframe. But I think 
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1 we'll be more productive in April if we've all 

2 had a chance to get into these and develop some 

3 comments and questions for discussion.

4 So yeah --

5 MEMBER REDLICH: Yeah, you know --

6 MEMBER DEMENT: -- so give us what you 

7 have and let us get started.

8 MEMBER REDLICH: We had gotten about -

9 - I don't have the number exactly in front of me, 

10 but it was around 70 or so of the Part B claims, 

11 the respiratory ones. That was very helpful, so 

12 for them --

13 CHAIR MARKOWITZ: I would echo what 

14 John says. We have about seven weeks until the 

15 next meeting and it would be extremely helpful to 

16 be able to look at some claims before then. And 

17 we need, we need a couple of weeks to look at 

18 them.

19 MEMBER DEMENT: And just for more 

20 clarification, we don't have those claims 

21 anymore. You know, we, as the Board closed out 

22 its last, this last proceedings, we were required 
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1 as part of closing out the other board, to submit 

2 all of those data back to the DOL. So we don't 

3 have those in our hands right now.

4 CHAIR MARKOWITZ: Okay. So any other 

5 comments on that? Otherwise we're going to move 

6 on to the issue of non-cancer outcomes. If you 

7 could bring up that piece, Kevin? And Ken, if 

8 you want to -- I'm not, my WebEx isn't working at 

9 the moment so I can't see whether it's up or not 

10 --- but Ken, if you, and it is, well, if you want 

11 to lead this discussion?

12 MEMBER REDLICH: Just before we go on 

13 -- it's Carrie Redlich. I'm just a little 

14 concerned because I think last time, we did get 

15 both the data and the claims in a relatively 

16 timely fashion. So I think it would be, but 

17 where we're leaving this issue is just with the 

18 Department of Labor like us to prioritize?

19 Because we don't need everything all 

20 at once. I just, it seems like we don't really 

21 know where things stand, whether part of the 

22 information is just collected but not all of it, 
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1 and that's why we haven't gotten it. Or whether 

2 none of it has. So maybe we could just ask for 

3 clarification of the status because I think it 

4 would be fine for us to get the information at 

5 least.

6 CHAIR MARKOWITZ: Yeah. And so if you 

7 could also get the Department to produce sort of 

8 a time table over the next few weeks for this 

9 information.

10 MR. BIRD: Yeah, noted.

11 CHAIR MARKOWITZ: Okay. Ken?

12 MEMBER SILVER: Sure. So you all 

13 remember on the second day of our November 

14 meeting in D.C., John Vance distributed a two15 page list of topics on which program leaders 

16 might want our help. And one of them has to do 

17 with the non-cancer effects of exposure to 

18 certain radioactive materials.

19 And my first thought was that the 

20 leaders of radiogenic substances are radioactive. 

21 And then another thought is that the long-term 

22 study of the atomic bomb survivors are finding 
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1 some interesting things about circulator 

2 diseases, a broad category that includes heart 

3 disease and stroke. So the Board agreed that a 

4 couple of us might rewrite John Vance's paragraph 

5 and layout a scope of work, and if it's agreeable 

6 to the program leaders, perhaps embark on it.

7 I had access to a radiation biologist, 

8 you may know, Dr. Isaf Al-Nabulsi at the 

9 Department of Energy and she very helpfully sent 

10 some links to the reports of the United Nation's 

11 scientific committee on the effects of atomic 

12 radiation, their reports as well as -- they're 

13 organized in a weird way, when you try to access, 

14 but she had everything I needed at her 

15 fingertips.

16 So the first part simply makes the 

17 point that all of the isotopes mentioned in Mr. 

18 Vance's paragraph are heavy metals, but three of 

19 them have no stable isotopes. So if they're 

20 having non-cancer effects, it maybe the high 

21 linear energy transfer, alpha radiation that's 

22 responsible. Maybe chemical process, maybe as 
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1 ATSDR states in their plutonium tox profile a 

2 combination thereof.

3 One of the most interesting papers in 

4 the literature about the non-cancer effects of 

5 plutonium was published by Lee Newman in 2005,

6 and that's among the references, finding 

7 interstitial lung disease even after controlling 

8 for asbestos exposure. And then when it comes to

9 the atomic bomb studies, one of the UNSCR reports 

10 that U.N. committee has a table that summarizes 

11 the evidence of increased incidents of 

12 circulatory disease or mortality in nuclear 

13 worker populations.

14 So this is perhaps a roadmap to what a 

15 working group could look at if in fact this is 

16 what John Vance and colleagues want from us.

17 CHAIR MARKOWITZ: Kevin, could you 

18 scroll down to show some of the references, 

19 please?

20 MEMBER SILVER: I guess we can scroll 

21 down. There we go.

22 MR. BIRD: Do you see it now? Is that 
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1 what you need?

2 MEMBER SILVER: Yeah. Thank you very 

3 much.

4 MR. BIRD: Okay.

5 MEMBER SILVER: So I guess it's open 

6 for discussion. If anyone sees any flaws or 

7 revisions before we ask for John Vance and his 

8 colleagues to have a look at it?

9 CHAIR MARKOWITZ: So while people are 

10 thinking -- this is Steven. So what the process 

11 would be that we would submit this version of 

12 basically -- you don't need to vote on it -- but 

13 and ask them whether this represents what, 

14 actually what there, is this a faithful 

15 representation of their request. And then we can 

16 figure out to the extent that which we can 

17 address it. Does that sound right, Ken?

18 MEMBER SILVER: Yes.

19 CHAIR MARKOWITZ: Any suggestions or 

20 amendments to this, what Ken's written up? Okay, 

21 so fine, we'll pass it along and I asked whether 

22 it's, this is what they have in mind. And then 
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1 at next, at the Board meeting, we can -- unless 

2 someone wants to take this on before then -- we 

3 can discuss what to do about the request.

4 If there is a subset of board members 

5 who want to, assuming that the Department, this 

6 is acceptable to them or they, or some version of 

7 it, if there's a subset of board members who want 

8 to take this on, begin to take this on between 

9 now and April 23rd, 24th, then that's fine. 

10 Speak up. Otherwise we can just discuss it at 

11 the meeting.

12 MEMBER SILVER: One word of caution is 

13 that once you get into this literature, there's a 

14 lot of health physics involved, internal dose 

15 versus whole body dose. And this dovetails with 

16 someone's day job, that's great. But it could be 

17 a heavy lift.

18 CHAIR MARKOWITZ: Well thank you for 

19 the warning. It's good to know. Okay. So we'll do 

20 that. We need to close. Any other -- I want to 

21 talk briefly about the next meeting, but are 

22 there any other comments or questions at the 
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1 moment?

2 Okay. So we are meeting in Augusta, 

3 Georgia at the end of April. We're going to take 

4 up, continue some of the topics we've already 

5 discussed. I suspect we'll get to lingering 

6 recommendations on, that'll still continue, and 

7 on more, such as hearing loss. And I don't 

8 recall offhand whether there's some other 

9 recommendations that require further revision or 

10 response, but I'll check on that.

11 We'll make progress on the Parkinson's 

12 disease. We will hopefully have some claims and 

13 some data that we will have had the opportunity 

14 to analyze and discuss, and we'll pick up on 

15 whatever action items we've developed from today 

16 or ones that need some continued attention from 

17 the previous meeting.

18 All right. Any other issues that the 

19 people have in mind at this point that they want 

20 to raise at the next meeting? Okay. Well, so 

21 think about it and, you know, you can send me 

22 your ideas and we can circulate them within the 
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1 Board. And we'll take it from there. Any 

2 closing comments, questions? Doug, anything you 

3 need to tell us about the close of the meeting?

4 MR. FITZGERALD: No. I think 

5 everything's on track for our next meeting and 

6 we've been taking diligent notes of the 

7 discussion. That's all we have. So unless there's 

8 anything else, I will adjourn the meeting.

9 CHAIR MARKOWITZ: No, I just want to 

10 thank people for their participation and getting 

11 some work done. Telephone meetings are not the 

12 easiest. It's much more fun in person. But it 

13 was important to keep up some momentum and also 

14 get some recommendations reviewed and approved. 

15 So that's a good thing. Thank you.

16 MR. FITZGERALD: Great. Thank you all 

17 for your time and energy with regards to this 

18 effort. Appreciate it. And with that, we adjourn 

19 the meeting. Thank you.

20 (Whereupon, the above-entitled matter 

21 went off the record at 4:56 p.m.)

22