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 UNITED STATES DEPARTMENT OF LABOR

 + + + + +

 ADVISORY BOARD ON TOXIC SUBSTANCES

 AND WORKER HEALTH

 + + + + +

 SUBCOMMITTEE ON EVIDENTIARY REQUIREMENTS

 FOR PART B LUNG CONDITIONS (AREA #3)

 + + + + +

 WEDNESDAY, JUNE 29, 2016

 + + + + +

 The Subcommittee met telephonically at

10:00 a.m. Eastern Time, Carrie Redlich, Chair,

presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT 

MEDICAL COMMUNITY:

CARRIE A. REDLICH, Chair

LAURA S. WELCH

CLAIMANT COMMUNITY:

KIRK D. DOMINA

JAMES H. TURNER

OTHER BOARD MEMBERS PRESENT

STEVEN MARKOWITZ, Board Chair

FAYE VLIEGER
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DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
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 TABLE OF CONTENTS

Introductions/Logistics

 By Carrie Rhoads . . . . . . . . . . . . . . 3

Simplified Statement of the Problem 

 By Carrie Redlich. . . . . . . . . . . . . . 7

Define the Issues and Scope of the 

 Subcommittee's Topic Areas . . . . . . . . .11

Define Data and Information Needs. . . . . . . . .21

Adjournment
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1 P-R-O-C-E-E-D-I-N-G-S

2 10:09 a.m.

3 MS. RHOADS: Good morning, everybody. 

4 My name is Carrie Rhoads. I'd like to welcome

5 you to today's teleconference meeting, the

6 Department of Labor's Advisory Board on Toxic

7 Substances and Worker Health. This is a

8 Subcommittee on Evidentiary Requirements for Part

9 B Lung Conditions. I'm the Board's Designated

10 Federal Officer, or DFO, for today's meeting.

11 First, we appreciate the time and work

12 of our Board members in preparing for this

13 meeting and for their forthcoming deliberations. 

14 Dr. Carrie Redlich is the Chair of the

15 Subcommittee, and the members are Dr. John

16 Dement, Mr. Kirk Domina, Dr. Laura Welch, and Mr.

17 James Turner. Dr. Markowitz, the Board's Chair,

18 is also on the line, as is Faye Vlieger, who is

19 another Board member. In the room with me are

20 Kevin Bird and Melissa Schroeder from SIDEM, and

21 we're scheduled to meet from 10 to 2 Eastern Time

22 today.
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1 For timing, we're going to plan to

2 take about a 10-minute break at 11:30, depending

3 on where the discussions are, and a 10 to 20

4 minute break at 1:00, again depending on where

5 the discussions are. Copies of meeting materials

6 and any written public comments are or will be

7 available on the Board's website under the

8 heading Meetings and the listing there for this

9 Subcommittee meeting. The documents will also be

10 up on the WebEx screen, so everyone can follow

11 along with the discussion. 

12 The Board's website is

13 dol.gov/owcp/energy/regs/compliance/advisoryboar

14 d.htm or you can just Google "Advisory Board on

15 Toxic Substances and Worker Health" and it will

16 probably be the first thing you see. If you

17 haven't already visited the website, I encourage

18 you to do so. And after clicking on today's

19 meeting date, you'll see a page that's entirely

20 dedicated to today's meeting. We'll publish all

21 the materials on that page. You can also find

22 instructions for participating remotely, and
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1 today's agenda will be posted under that. 

2 If you are participating remotely and

3 you're having a problem, please email us

4 energyadvisoryboard@dol.gov. 

5 If you're joining by WebEx, please

6 note that this session is for viewing only and

7 will not be interactive. The phones will also be

8 muted for non-Advisory Board members.

9 Please note that we do not have a

10 scheduled public comment session today. The

11 call-in information has been posted on the

12 website. You can listen in but not participate

13 in the Board's discussion.

14 The Advisory Board voted at its April

15 26th through 28th meeting that the Subcommittee

16 meeting should be open to the public, and so a

17 transcript and minutes will be prepared from

18 today's meeting. 

19 During the Board discussion today,

20 since we're on a teleconference line, please try

21 to speak clearly enough for the transcriber to

22 understand. The transcriber has also called in. 
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1 When you begin speaking especially at the start

2 of the meeting, please state your name so we can

3 get an accurate record of the discussion. 

4 Also, for the transcriber, please let

5 us know if you're having an issue hearing or

6 understanding anybody or with the recording.

7 The minutes are prepared and then

8 certified by the Chair. The minutes of today's

9 meeting will be available on the Board's website

10 no later than 90 days from today, per the FACA

11 regulations. But if they're available sooner,

12 we'll publish them sooner.

13 Also, even though formal minutes will

14 be prepared, we'll also publish a verbatim

15 transcript, which will be more detailed in

16 nature. We are going to try to have the

17 transcripts posted within 30 days on the Board's

18 website.

19 I'd also like to remind the Advisory

20 Board members that there are some materials that

21 have been provided to you already in your

22 capacity as special government employees and
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1 members of the Board which are not for public

2 disclosure and cannot be shared or discussed

3 publicly, including in this meeting. Please be

4 aware of this as we continue with the meeting

5 today.

6 And with that, I convene this meeting

7 of the Advisory Board of Toxic Substances and

8 Worker Health Subcommittee on Evidentiary

9 Requirements for Part B Lung Conditions, and I

10 turn it over to Dr. Redlich, who's the Chair. 

11 Thank you. 

12 CHAIR REDLICH: Welcome, everybody. 

13 Let me just ask, did anyone else have trouble

14 getting into the WebEx website, or is that just

15 my internet? 

16 MEMBER MARKOWITZ: Yes, I'm having

17 trouble, but I have all the attachments that were

18 sent.

19 CHAIR REDLICH: You have the

20 attachments.

21 MEMBER MARKOWITZ: Yes, I have the

22 attachments.
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1 CHAIR REDLICH: Okay. So we put

2 together an outline, and, first of all, as I

3 wanted to say, for anybody who is listening but

4 cannot talk on this conference call, we are

5 interested in your input, thoughts, concerns, so

6 please communicate them afterwards through

7 whichever means you can communicate, and we will

8 receive that input. 

9 We have, I think, a large agenda

10 today, and if anyone has anything to add to the

11 agenda, basically I wanted to give a simplified

12 overview since we've been away from this. I

13 think, Steve, the main thing we were trying to

14 understand was the issues and scope, number

15 three, and then what additional information we

16 needed to accomplish our task and some sort of

17 time line. I was thinking of a time line between

18 now and our next meeting, but there's also a

19 larger time frame, so we could discuss that. 

20 Then I just want to make sure everyone has the

21 other documents that were provided. 

22 Does anyone have any big-ticket items
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1 for the agenda that does not fall under one of

2 these categories? Okay.

3 So I spent the weekend getting back up

4 to speed reading all the various documents that

5 we had received, and I thought, just so we were

6 on the same page, my simplified understanding in

7 about two minutes, and to see if others think

8 that this is our sort of goal, was that we have

9 the EEOICPA Act created by Congress that defined

10 very specific criteria for diagnosing beryllium

11 sensitization, chronic beryllium disease, which

12 is a complex and confusing area even for

13 knowledgeable pulmonologists. And so it seems

14 that this has been a challenging area to review

15 and adjudicate claims.

16 And then it's sort of complicated by

17 a number of factors. One is that there is a

18 substantial financial implication between having

19 just sensitization versus chronic beryllium

20 disease that can also push agendas and decision21 making. And then there's obviously a need for

22 consistency and fairness.
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1 And also, having looked over some of

2 the data and the numbers, appreciation really of

3 the magnitude of the claims process. We're not

4 talking ten claims a year. And also thinking

5 about this, recognizing that there is overlap

6 between our task and that of some of the other

7 committees.

8 So I think we're going to -- that's

9 sort of the problem is how to make this claims

10 process specifically related to Part B lung

11 conditions, chronic beryllium disease, beryllium

12 sensitization. Silicosis, which is also in with

13 these diseases, seems to be less of an issue.

14 And so that is my overall sense, as a

15 very simplified view, of the sort of key

16 problems. If anyone has anything to add to that,

17 it would probably be good if anyone just gives

18 their name first before they talk. 

19 Okay. And I will say the other thing

20 that I have done since our last meeting, I went

21 to the American Thoracic Society meeting and

22 spoke at length with my various colleagues at
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1 National Jewish and other places that deal with

2 these claims and patients on a regular basis. I

3 realized over the weekend a lot of the feedback I

4 got from them related to issues about the actual

5 claims process. And so I think we sort of next

6 defined the issues and scope. I personally was

7 sort of feeling that we need to clarify what

8 we're covering to make sure we're not -- the

9 medical evidence group is also obviously dealing

10 with decision-making and processing of claims, I

11 think, overall.

12 Okay. So does anyone have any other

13 thoughts on the simplified statement of the

14 problem, number two? Okay. So number three,

15 defining the issues and scope of our agenda. And

16 I had thought maybe this will take an hour, maybe

17 it will take longer.

18 So we have, at the Department of

19 Labor, that is one of our handouts. We have this

20 in more than one form. So people aren't

21 confused, there is the actual document that we

22 received at the meeting, and then there is -- I
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1 had just sort of taken the questions and claims

2 and organized them just in terms of the

3 categories that they addressed, so it's really

4 the same questions. These aren't additional

5 questions. And they're really quite technical

6 questions in terms of what's the best way to

7 figure out sensitization, and so I think our hope

8 is not to get too bogged down right now in

9 answering any one of these questions but

10 deciding, first of all, if these are the only

11 questions that we need to address or other issues

12 but also then what approach we need to take and

13 what additional information would be useful.

14 And so we have, for starters, the

15 questions raised by DOL. I put together a couple

16 of things in thinking about this that I also felt

17 we should discuss, potentially areas we wanted to

18 address, and so I wanted everyone's input on

19 this. That's number three under B that we want

20 to, I think, clarify our charge versus the other

21 subcommittees. You know, are we sticking to Part

22 B and not dealing with any of the Part E, sort of
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1 COPD. I think the issue with sarcoid and

2 beryllium disease are closely linked. Add some

3 sarcoid questions. Sarcoid could also be under

4 E. And also if there's any overlap with the

5 other questions.

6 The other thing that had come up was

7 complications with Part B diseases and how to

8 address them, is that under our scope?

9 Why don't I stop here and get input

10 from others on the phone? 

11 MEMBER DEMENT: Hi. This is John

12 Dement. As I went through our charge versus the

13 group that's looking at the Site Exposure Matrix,

14 there's a requirement, at least for 1993, and I

15 think the terms are an occupational or

16 environmental history. That's pretty vague. I'm

17 not so sure whether or not that overlaps with the

18 other committee or not or if it's something that

19 we should address directly in this committee,

20 because it relates more to beryllium directly

21 than it does sort of the general Site Exposure

22 Matrix.
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1 CHAIR REDLICH: Okay. There was a

2 weird buzzing noise that seems to be gone. So

3 you're asking whether -- the issue of how we

4 assess exposure related to beryllium? 

5 MEMBER DEMENT: Especially under the

6 pre-1993 criteria. There's a terminology in

7 there that states that what constitutes an

8 occupational or environmental history. 

9 CHAIR REDLICH: Okay. And I think

10 that this whole issue of pre- and post-disease is

11 -- one thing that I also sort of, I think

12 everyone realizes, I just had to also be

13 reminded, is that we're dealing with the EEOICPA

14 is a statute from Congress, and that's actually

15 that one document that has a fancy number, 73841,

16 as far as definitions. So I think one can

17 clarify definitions, but we're probably going to

18 try and have to work within this framework.

19 And the other document that we had

20 sent out was, I think, a more detailed version of

21 the current way that these two paragraphs are

22 interpreted, so the people actually doing the
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1 claims, and that's something we may want to go

2 through with more of a fine-toothed comb because

3 -- okay. So I think let's add, you're right, the

4 issue of the history, the occupational history.

5 MEMBER WELCH: Carrie, this is Laurie. 

6 Yes, I agree with John, we should probably look

7 at -- well, John was raising the question, but my

8 thought is we should look at exposure assessment

9 for beryllium as it's defined in the statute

10 separately. This committee should look at that. 

11 But I think that the other lung disease, like you

12 put in your agenda, Part E, COPD, this committee

13 should not address that, and that will be

14 addressed by probably all the other committees in

15 terms of how COPD is handled from the exposure

16 assessment through the claims process through the

17 consulting, industrial hygiene thing. You know,

18 that's going to come up because it's a big case,

19 but I think this committee should not deal with

20 Part E, other lung disease claims. That would

21 just be way too big. 

22 CHAIR REDLICH: I agree, so I was
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1 hoping others would be as Laura said. Okay. So

2 we can get into the -- my understanding also was

3 that there was also if you basically spent one

4 day at a beryllium facility, you were considered

5 having had exposure. 

6 MEMBER VLIEGER: Dr. Redlich, this is

7 Faye Vlieger. That's correct. The exposure

8 basis for the beryllium is one day of presence.

9 CHAIR REDLICH: Okay. And that's in

10 the Act. 

11 MEMBER VLIEGER: That's part of the

12 Act. There's a criteria for 250 days that pops

13 up a few different places but not for beryllium

14 disease. 

15 MEMBER DOMINA: This is Kirk. That

16 one day falls under 10 CFR 850, is where you

17 apply the one day, which is a beryllium CFR.

18 MEMBER VLIEGER: That's a DOE CFR, by

19 the way. 

20 MEMBER WELCH: And does that apply to

21 both the pre '93 and the post '93 cases?

22 MEMBER VLIEGER: Yes. 
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1 MEMBER WELCH: So this idea of having

2 some kind of occupational history seems like it's

3 not really relevant in a way. 

4 MEMBER VLIEGER: True, but they apply

5 it nonetheless. 

6 MEMBER WELCH: Oh, so then we need to

7 understand that at some point. 

8 CHAIR REDLICH: Thank you. And

9 please, for those who are more familiar with the

10 details of all of this, don't hesitate to speak

11 up. 

12 Okay. And I guess other thoughts --

13 thinking through it, part of it, when I spoke to

14 my colleagues, I think how the claims are

15 processed and what things are covered, to me,

16 that belongs through the other subcommittee, and

17 it's not our jurisdiction. 

18 MEMBER WELCH: I would agree, too,

19 unless there's something specific, that's

20 beryllium-specific that doesn't apply to all the

21 other claims. 

22 MEMBER VLIEGER: There is the issue,
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1 I don't know that it's so much claims processing

2 as it's training, between the CMCs and the CEs,

3 the contract medical consultants and the claims

4 examiners, and the other people who adjudicate

5 the claims is that they're not trained to

6 standard definitions, and they are often -- this

7 comes under ruling medical evidence -- they often

8 discount something they don't understand for that

9 reason.

10 CHAIR REDLICH: Okay. So we

11 potentially have the situation where beryllium

12 disease is quite complicated in understanding,

13 sensitization disease, the pre, the post, that

14 what you're saying is that pretty much everyone

15 gets the standard training. There isn't sort of

16 a centralized core group that deals with only

17 beryllium or something or -- 

18 MEMBER VLIEGER: There may be some

19 sort of training, but it's certainly not

20 standardized.

21 CHAIR REDLICH: Okay.

22 MEMBER VLIEGER: And the claims
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1 examiners, there's no group that deals with

2 beryllium claims. And the medical evidence they

3 get when sent to the contract medical

4 consultants, they don't follow the statute

5 because the Department of Labor is not required

6 to remind them of the statute requirements. 

7 Therefore, the doctors use their judgment versus

8 the statute requirements, or they use the

9 beryllium case registry criteria, which is not

10 the statute.

11 CHAIR REDLICH: Okay.

12 MEMBER MARKOWITZ: Carrie, this is

13 Steve Markowitz. I just want to add to this. So

14 if the general is, should this committee look at

15 the application of the evidentiary requirements

16 in the claims process, I think what Faye is

17 raising is part of a more general issue. It's

18 not just the CMCs. What comes in from the

19 medical provider? How does the claims examiner

20 look at these issues? So I think we have to get,

21 to some extent, into the claims process to see

22 how the evidence is constructed, viewed, and
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1 applied.

2 CHAIR REDLICH: Exactly. I agree. 

3 Okay. 

4 MEMBER WELCH: This is Laurie. One

5 more comment. Your number C, which was

6 complication of Part B, diseases for treatment, I

7 think that DOL had asked for specific help with

8 that: generally, what diseases can be a

9 complication of steroid treatment, for example,

10 which could apply to other lung diseases as well? 

11 But I think if we can help define which diseases

12 should be accepted as complications of kind of

13 the central core -- it doesn't mean it would be

14 exclusive, but it would be presumptive -- I think

15 that would probably be helpful. 

16 CHAIR REDLICH: That's right. And I

17 agree. Either fortunately or unfortunately, we

18 treat most pulmonary diseases with only a few

19 drugs, so I think we could cover this. If put

20 under beryllium, it would probably be similar to

21 the COPD group, too, if not exactly the same. 

22 But I think it is something. Or interstitial
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1 lung diseases, which would be under E. So we

2 probably, I mean, we could both give input. I

3 think it would be similar. 

4 Are there any other just sort of

5 defining the issues and the scope of what we're

6 hoping to accomplish? Okay.

7 So in terms of what we need to

8 accomplish our jobs, I think, Steve, we had put

9 together -- I'll say first we put together a list

10 of data requests, which is one of the other

11 handouts -- I think everyone has seen the forms

12 before -- of the type of information just, I

13 think in part to understand the magnitude and the

14 process. And we got that. I don't think anyone

15 had a chance probably to look at it. There are

16 20,000, a large number of cases in the database. 

17 I think some summary statistics on some of that,

18 of just number of X and percent accepted and the

19 number in the past couple of years. 

20 I think I have played around a little

21 with this over the weekend and sorting by

22 different ways, and what I came back with was my
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1 hope that there was some simple, simple solution

2 that almost there were very few cases that were

3 sensitization only, versus beryllium disease and

4 sensitization, that there would be some very

5 simple fix. I think it's not that simple in

6 terms of just the magnitude. So that piece was

7 helpful to me.

8 And I think we could learn more from

9 a closer examination of this data. So my thought

10 was one of the key -- I think if one actually

11 looked at the initial request that we had, I

12 think that the Department of Labor was quite good

13 in providing what they had that was, I think,

14 acceptable in their system. Other people will

15 know this better. I think some of the job

16 titles, worker site, gets way more complicated,

17 and so we had a wish list of things, I think. 

18 But I think a lot of the basic just of us getting

19 a feel for the claims and what they are and what

20 percentage are accepted.

21 So what I was going to propose on the

22 data side is that if we all look around at that
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1 Excel spreadsheet sometime over the next couple

2 of weeks and come up with what information,

3 summary sort of information we would like to gain

4 from that, and I am hoping that someone in the

5 Department of Labor could help us. Excel

6 spreadsheets are not my personal forte.

7 So that piece. And then when we look

8 at it, then I think after looking at that that we

9 might realize, I suspect we will realize that

10 there's additional data, some of which might be

11 on this original list, that we think would be

12 helpful, and we could then come up with an

13 additional list of data pieces that we would find

14 helpful and see what is available. 

15 So that was a general frame of what I

16 was thinking in terms of the data related to

17 beryllium disease, beryllium sensitization, and

18 silicosis. Other thoughts on the data component?

19 MEMBER DEMENT: Hi, this is John

20 Dement. Spreadsheets don't lend themselves very

21 much to really doing much in terms of analyses. 

22 I was able to take that spreadsheet and pull it
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1 into SAS.

2 CHAIR REDLICH: Oh, you're ahead of --

3 oh, I'm impressed. Okay. 

4 MEMBER DEMENT: I could at least run

5 tabulations and summaries on the data.

6 CHAIR REDLICH: Okay.

7 MEMBER DEMENT: I have a question.

8 CHAIR REDLICH: No, that's great. I

9 had asked someone to see if they could help me

10 with that, and it was too short time. But that -

11 - yes, go ahead.

12 MEMBER DEMENT: What's sort of

13 missing, to me, in the data are, for the denials,

14 the reasons for denial. I mean, we know that

15 they're denied, and we can tabulate the frequency

16 of filing versus accepted versus denied, but is

17 there -- are there other data fields that provide

18 the rationale for denial based on the criteria in

19 the statute?

20 CHAIR REDLICH: Yes, I agree totally. 

21 And I think that was sort of, that's exactly one

22 of the questions I had. I also wasn't, there
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1 were some other more technical questions I had,

2 whether this was like a final denial or an

3 initial. Where in the claims process -- and I

4 also wasn't sure, because someone -- so I had a

5 bunch of questions about the data. 

6 Carrie, in terms of, I wanted to get

7 some clarification, Carrie Rhoads. In terms of -

8 - and, John, you're totally right, an Excel

9 spreadsheet, we need to do something with the

10 data. Are we at liberty to do that ourselves and

11 see what additional -- should we request

12 assistance as far as just the process of making

13 sense out of the data? 

14 MS. RHOADS: We can go back to the

15 program and ask them for more explanation of what

16 they already gave you, if you'd like, or

17 additional fields they might have, whatever, we

18 can ask them for some additional help. 

19 CHAIR REDLICH: Okay. John, my guess

20 is that, if we want to, as you said, sort of

21 analyze this, that you're probably as good as

22 anybody at doing this. And I agree. I think we
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1 should come up with a list of additional fields

2 that we would like to see if we can.

3 MEMBER DEMENT: I know there must be

4 other fields in there that are used for managing

5 claims that I think will be helpful. I think

6 Steve pointed out that if we could get into the

7 claims process, how the statute is actually being

8 applied and look through that, I think this might

9 give us a first glimpse. 

10 I guess, in my view, I think it's

11 going to be very difficult to really get down

12 into the meat of this without having some

13 specific case studies that we look at. 

14 CHAIR REDLICH: Yes, I totally agree,

15 and that's why I put -- and I talked to Carrie

16 Rhoads before this call saying that I sort of

17 feel like it's so presumptuous to think that we

18 either understand it or to make recommendations

19 without actually sitting down and going through

20 some claims, seeing what the obstacles are, what

21 final decisions, and how it works. 

22 So I guess my question is, what would
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1 be the process for us to do this and to get the

2 information in terms of, could we request the

3 paperwork for 30 claims or whatever and -- 

4 MEMBER VLIEGER: Dr. Redlich, if I

5 could interject, this is Faye Vlieger. Among the

6 advocates, for many years, we have been

7 collecting a repository of claims paperwork,

8 recommended decisions, final decisions,

9 reconsiderations, remand orders from the claims

10 process, and the repository of the redacted

11 claims has been the EECAP website. And I had

12 sent information out previously about the

13 availability of these redacted files on EECAP, so

14 for expediency, if you wanted to go look at the

15 beryllium sensitization and the beryllium disease

16 files there just for your own leisure while we

17 wait for the Department of Labor to respond, but

18 there is a repository that's available to the

19 public right now. 

20 CHAIR REDLICH: For a given claim --

21 I guess we all have our experience in other

22 systems, so I had reviewed quite a number of the
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1 World Trade Center claims, and there was the

2 questionnaires and the forms, and then there was,

3 you could have everything from ten pages to a

4 thousand pages of medical documents. If there

5 were a thousand pages, there were usually ten

6 pages within the thousand pages. So the typical

7 documents you would have on a given claim, what's

8 the magnitude of it? I'm sure it's very

9 variable, but -- 

10 MEMBER VLIEGER: The size of the

11 reply, is that what you're looking for? It can

12 range from two pages to ten pages, and many times

13 the denial lies in the Department of Labor's

14 statement of accepted facts. And those facts are

15 the problem, is what they accept, pursuant to the

16 statute, in this particular -- in beryllium

17 disease, what the statute allows and what the

18 doctor that they referred it to decides, and like

19 I said, the further disparity between what the

20 statute allows and what the doctors actually are

21 approving, particularly the contract medical

22 consultants.
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1 MEMBER WELCH: Carrie, this is Laurie. 

2 The medical records reside somewhere, and I'm not

3 exactly sure whether the advocacy website has

4 that. But usually what I end up seeing when I

5 ask for claims, they have a long narrative from

6 usually the adjudication branch that says -- and

7 this is the same kind of information that they

8 send out to the consulting physician if they need

9 a physician opinion on causation. So they'll

10 say, you know, you worked at the Oak Ridge plant

11 from 1952 to 1982, and the SEM says you had these

12 exposures, and we got these medical records, and

13 they'll basically say they've approved, like,

14 say, for a COPD claim, which -- I haven't

15 actually reviewed beryllium claims -- but COPD

16 claims, they'd say, your diagnosis is accepted. 

17 So then you don't necessarily, for that claim,

18 need to look at the medical records because

19 they've accepted the diagnosis, and usually the

20 discussion is about the years of employment for

21 construction workers that are accepted facts. It

22 may be a smaller subset of what they reported
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1 they worked there. But then there's always a

2 pretty long narrative about the causation issues,

3 and one can get the consulting medical report,

4 which then is what the claim examiners rely on to

5 accept or deny a claim usually. 

6 So do your files collect the actual

7 medical records, too, or is what you have is the

8 adjudication information? 

9 MEMBER VLIEGER: Are you talking about

10 the EECAP files? 

11 MEMBER WELCH: Yes. 

12 MEMBER VLIEGER: Okay. I'm on their

13 web page right now, and the decisions are listed

14 by year, and it is the document from the

15 Department of Labor. In order to get the medical

16 evidence, you're going to have to have the

17 claimant's permission, or Department of Labor is

18 going to have to do a lot of redacting. And I

19 know that if they do that, it's going to take a

20 lot of time to get your file.

21 MEMBER WELCH: I actually think, not

22 having looked at files, I think we can make a lot
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1 of progress without the actual medical records

2 because you can see the -- in the rationale,

3 they'll say, well, the pulmonary function test

4 showed obstructive lung disease, something like

5 that. 

6 MEMBER VLIEGER: If they wanted to and

7 it's amenable to the Department of Labor, EECAP

8 would be willing -- I'm speaking for Deb Jerison. 

9 She runs that non-profit. She would be willing

10 to compile her files and send it for CBD approval

11 and denial. I'm looking at the website right

12 now, and there are files through 2013 with CBD in

13 them, and she does these by year. She's also

14 done some spreadsheet analysis of CBD and other

15 lung diseases acceptance and denial for the

16 advocates. We've been at this for a number of

17 years, and she's provided the statistics and the

18 website for our data. 

19 So that is something we can reach out

20 to her to do. She did participate or come to the

21 D.C. meetings and publicly speak, so she's out

22 there. She's willing to help. 
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1 MEMBER MARKOWITZ: Steve Markowitz. 

2 I just want to say something. If we want to

3 understand the DOL process, we have to look at

4 data claims that are fully representative of the

5 DOL's process. Otherwise, we can be viewed as

6 looking at a selective population, which is not

7 representative and, therefore, doesn't speak to

8 the underlying issue. So I think we need to

9 define what we want to know, and if EECAP, in the

10 short term, is helpful in providing some

11 insights, but, ultimately, we want to get our

12 data from the DOL database so we have a

13 comprehensive understanding of how they do

14 things. 

15 MEMBER VLIEGER: I agree with Dr.

16 Markowitz. This is Faye again. It's just I

17 think there's going to be a sizable delay in

18 getting what we're requesting from DOL. Yes, I

19 agree we need a full spectrum of what's going on.

20 MEMBER MARKOWITZ: Well, the problem

21 is, if we look at our smaller population, we're

22 vulnerable to the criticism that we didn't look
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1 at a fuller population that would have given us a

2 more accurate picture, you know what I mean? In

3 which case, we haven't gotten off step one. 

4 CHAIR REDLICH: Yes. So what I would

5 propose, I think, since -- what is available

6 right now, I think we can look at I think, what

7 would inform potentially what we simply ask or

8 the DOL or at least hone in on, one of the things

9 about beryllium is that there's a lot of -- and

10 the questions that we were asked were very

11 technical questions. What pathology counts and

12 the sensitization. And I suspect that to fully

13 understand this, we are not going to need not

14 only the summary of the rationale for the

15 decision-making but understanding the data that

16 that came from.

17 Now, the good side about pulmonary

18 disease is that there's a limited number of

19 diagnostic tests. There's PSTs, there's a CT

20 scan, and there's pathology and the beryllium

21 test. So we don't have like 50 different tests.

22 But I think I'm probably, at some
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1 point, at least to understand this -- is going to

2 need to actually review some claims, what

3 happened, and what information the physician was

4 given and then what decision-making they made

5 based on what was in front of them. 

6 MEMBER WELCH: Yes, I think that makes

7 a lot of sense. 

8 CHAIR REDLICH: Because, I don't know,

9 I've just been doing IOB, for 25 years and 25

10 years of IOB conference, and two pathologists

11 look at a past biopsy, and one sees granulomas,

12 and the other doesn't. One sees a CT scan that

13 looks like classic this, and another one says,

14 no, it's that. Both highly qualified people. So

15 they're not sort of cut and dry.

16 I think a key -- I mean, I think we

17 would like -- and, for starters, reading some of

18 the summary reports, for those of us who haven't,

19 would probably be informative. My guess is that

20 the medical records -- I mean, I've never seen

21 anyone receive medical records with the

22 information exactly what we want and all the
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1 extraneous information gone, which becomes one of

2 the problems, let alone the whole redacting names

3 issue. But I also feel that anybody

4 knowledgeable can sort of go through that stack

5 and, for these purposes, select out the critical

6 information because, from experience, when you

7 start to ask for medical records, the person

8 who's putting them together is not the sort of --

9 the person is nervous about not including

10 everything, and then it becomes sort of

11 overbearing because you get 500 pages of

12 documents and findings of five pages. But I do

13 think that's a solvable problem if we sort of

14 clarified what pieces of information from the

15 medical record we were interested in. 

16 So even simple questions, like, okay, 

17 in the chronic beryllium disease claims, what

18 percentage of them actually had a biopsy done? 

19 What percentage of -- so I think, you know, some

20 of that -- and even a very basic question, which

21 I have asked a couple of people, and I suspect

22 some people have a better feel, which claims
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1 currently coming in are the pre and the post

2 criteria? 

3 MEMBER WELCH: You know, this is a

4 little bit getting into the weeds, but I was

5 looking at the spreadsheet that we got, and it

6 tells you the CBD diagnosis dates, but it doesn't

7 tell you the claim filing date or the application

8 date or anything like that. So it's hard to know

9 -- 

10 CHAIR REDLICH: That's right. But you

11 don't know which criteria were being used in

12 those cases, and that was actually one of the

13 questions we were asked is, the onset of disease

14 is important because the pre-1993 is a more

15 inclusive diagnosis. 

16 MEMBER WELCH: Right. In the

17 spreadsheet, you can sort of guess at at whether

18 they had sensitivity, as well as CBD.

19 CHAIR REDLICH: And some of them, I

20 think from 1950 we know which -- I also think the

21 more recent claims where -- 

22 MEMBER WELCH: Yes, but you don't even
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1 know it's a more recent claim. That's the

2 problem. We know when the diagnosis was. We

3 don't know when that claim was filed. So if a

4 diagnosis is 1980; in theory, the claim could

5 have been filed in 2015. We don't know. So it

6 would be -- 

7 CHAIR REDLICH: Yes. So that would be

8 actually one of the additional pieces of data

9 that we would like on the data that we have is -- 

10 MEMBER WELCH: Well, I was thinking

11 maybe one thing we could all do is whoever wants

12 to look at the spreadsheet and say, oh, I'd like

13 to know this about the claims, and then we can

14 accumulate a list of additional data fields we'd

15 like to see. Because I know, in the past, when

16 we've asked DOL to give us information, they

17 don't tend to have a data dictionary that will

18 give you all the fields that are available, and

19 we could pick and choose. We have to say, oh, do

20 you have this; do you have this? And for this,

21 maybe there aren't too many fields that we're

22 missing. So if we were all to put our heads
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1 together and say, you give us a date. We could

2 let you know what we see that we want. 

3 CHAIR REDLICH: Yes, I think that's

4 exactly a good suggestion. So we will sort of

5 look through the Excel spreadsheet, at least on

6 that one, come up with additional, in an ideal

7 world, columns that we would like and see what is

8 actually available. 

9 MEMBER WELCH: That would be good. 

10 MEMBER MARKOWITZ: This is Steven

11 Markowitz. Question on process. I'm thinking

12 about the next full meeting in October. So if in

13 the next whatever period of time, a few weeks,

14 whatever it is, we individually communicate with

15 Carrie Redlich about additional data needed, and

16 Carrie could assemble that and submit that to DOL

17 with the idea of getting some output when

18 available but preferably before the October

19 meeting, so that when we come into the October

20 meeting, we will have already understood what's

21 available and even, to some extent, looked at it,

22 with the idea that, in October, we might be able
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1 to discuss the next level of data we're

2 interested in, which is actually examining claims

3 and a scheme for examining claims. It would be

4 nice to get to that point by the October meeting.

5 And the question then is, in order to

6 submit the next data request for existing data

7 from DOL in relation to this, do we need a

8 subcommittee meeting in September -- in which

9 case we've got to ask for the Federal Register

10 notice and all that business -- or can we do it

11 through individually sending the ideas to Carrie

12 Redlich, who assembles them and submits them to

13 DOL? So if you could just, for a moment, just

14 focus on that. 

15 CHAIR REDLICH: Okay, yes. So what

16 about one possibility. John, since you've

17 already put this into SAS, would you be able to,

18 just for basic starters, generate some summary

19 numbers for us to look at? I personally would

20 like to put short time frames on things because I

21 feel like I get my head around everything, and

22 then, if we let it go for a couple of months, it
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1 takes more time total every time we resurrect

2 things. 

3 I would think that we could probably

4 come up with the additional sort of key things,

5 like the reason, if there is a reason, for

6 denial, or Laura's suggestion for clarification,

7 what dates. I mean, I would think in the next

8 week, we could come up with that list of things

9 and get that to the DOL sooner versus later. 

10 MEMBER DEMENT: This is John. The

11 data in the spreadsheet are a little hard to deal

12 with from a summary perspective. For example,

13 many individuals have multiple conditions filed,

14 so there's a lot of parsing out, depending on

15 what kind of summaries you want. But I can send

16 tabulations now. It's just that it will need a

17 little work to pull out each one of these

18 categories for each individual. 

19 CHAIR REDLICH: It's true. I was

20 trying to get the big picture first, because if

21 someone has beryllium, and then they have on the

22 E side additional claims. They could also have
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1 asthma and COPD. I think the various overlaps

2 are important because when someone has beryllium

3 sensitization and some other condition, like

4 asthma or COPD, is that chronic beryllium

5 disease, or is it sensitization plus that? But I

6 was really thinking for just a very initial look

7 to speak to the B side of the spreadsheet because

8 --

9 MEMBER DEMENT: Yes. I could send

10 some summaries. I need some guidance -- 

11 CHAIR REDLICH: I actually, a biostats

12 person who works for us, I had come up with a

13 little list that I had given them to do. But I

14 think it makes more sense for us to do it

15 internally, so I gave them a list, and then I

16 thought let me wait and not have them to do this

17 until we have our call, because I think, and you

18 know what? I could send it to you. Sort of

19 really just percentage of, these claims accepted

20 -- I also wanted to get a sense of, in the past,

21 let's say three years, the numbers of various

22 claims, in terms of the current magnitude of the
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1 volume because part of I feel like the decision2 making is the magnitude. I think -- yes. 

3 Just a possibility, John, if you're

4 willing, what if we gave you our little wish list

5 and the things that can be done easily, you do,

6 and things that are more complicated -- and then

7 I think, with that, if we came up with the other

8 variables that we were interested in. 

9 MEMBER DEMENT: Yes, that's fine. I

10 need some guidance. Administratively, what is

11 our requirement for sharing this, the summaries,

12 amongst ourselves versus putting it on the

13 website? What is our requirements, for

14 clarification?

15 MS. RHOADS: This is Carrie Rhoads. 

16 The data set that was sent that you're all

17 talking about, that can't be shared on the

18 website or anything. Discussing it sort of

19 generally like we are now and trends is okay, but

20 the data itself can't be put on the website. You

21 can talk about it and share -- 

22 MEMBER DEMENT: Yes, tabulations. 
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1 We're not going to put any data out there. It

2 would be simply tabulations. But how do we share

3 that among ourselves, Carrie? 

4 MS. RHOADS: I can coordinate sharing

5 among the group through the DOL email. 

6 CHAIR REDLICH: And the reason I

7 actually didn't -- because a person to just help

8 quickly summarize it, I wanted to clarify if it's

9 someone I work with regularly as a biostats

10 person, is that okay or not?

11 MS. RHOADS: I think if it's someone

12 that you work with regularly, it's okay. But let

13 me just, I'll check with our attorney. 

14 CHAIR REDLICH: John is way more

15 qualified. John, it would be great if you -- I

16 don't think we need more than one person. But

17 that would be helpful to know because I just

18 don't want to violate any rules. 

19 MS. RHOADS: Right. So the Energy

20 Advisory Board email is usually how we can

21 distribute things amongst the Board members. 

22 CHAIR REDLICH: So, John, if we gave
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1 you some ideas that we had on the simple side of

2 things, what timing do you think? 

3 MEMBER DEMENT: Well, it depends on

4 how complicated your questions are. It's fairly

5 easy to write simple code to do tabulations in

6 this data. A week or so. 

7 CHAIR REDLICH: Okay. So what if we

8 plan, and we'll come up with -- we'll give you

9 our suggestions in the next day or two, and then

10 in the next week or two, you would, with the

11 summary that you have -- 

12 MEMBER DEMENT: Yes.

13 CHAIR REDLICH: And I think if we

14 looked at that, while we're doing this, we would

15 come up with a list of the other variables that

16 we would be interested in. 

17 MEMBER DEMENT: I think we ought to do

18 it simultaneously actually. 

19 CHAIR REDLICH: Yes. Because when

20 you're looking, you realize you want more. 

21 MEMBER DEMENT: I think this may

22 stimulate some questions. Tabulations that are
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1 possible on this data are relatively simple. 

2 MEMBER WELCH: You can completely

3 ignore the columns of medical conditions filed

4 and medical conditions approved. The ones that

5 have alphabetical data, like BDDS and stuff like

6 that, because in the end the data is embedded in

7 CBD approved or denied. So I think using the,

8 whether it's a survivor claim, a work site, the

9 diagnosis date, CBD approved, it's probably all

10 we need. 

11 CHAIR REDLICH: Okay, okay. So I

12 think that is a general plan, and I would propose

13 we try and do it just so we can get to the DOL

14 the other variables we want sooner rather than

15 later because that will give them more time to

16 figure out what they can assemble for us. 

17 MEMBER WELCH: This is Laurie. I have

18 a question for Carrie Rhoads. So if we want to

19 send information to John about data runs, should

20 we send those to you or can we send them directly

21 to him? 

22 MS. RHOADS: I would say, for now,
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1 send them to the Energy Advisory Board email. If

2 that proves to be too much of a burden, then we

3 can think about doing something else. But if

4 everything goes through there, it's better. 

5 MEMBER WELCH: Okay, great. 

6 CHAIR REDLICH: Okay. And then you'll

7 pass that on. Okay. So does that seem like a

8 plan as far as the data piece? And I think also

9 -- okay. So I think a little more complicated

10 is, I think, the desire that we all have to

11 better understand the claims process. And I

12 guess the issue is, what's going to be the best

13 way to do this and also in a way that it might be

14 a more than one-stage process in terms of an

15 initial review of maybe just decision letters

16 that could be done very quickly versus getting

17 medical records that would take more time? 

18 So if anyone has thoughts on just the

19 process. 

20 MEMBER WELCH: Well, what I was

21 thinking -- this is Laurie -- what I was thinking

22 about the spreadsheet and additional information. 
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1 If there are things like the date of the initial

2 decision, the date of the file adjudication, you

3 can kind of get a sense which cases went through

4 multiple levels of appeal because there probably

5 are dates for each of those things. Every time

6 they mail a letter to the applicant, there's a

7 date. And so, hopefully, those are captured in

8 some way. And then we could potentially then be

9 able to see claims that were decided fairly

10 easily without an appeal or ones that went

11 through -- you can end up going back to the

12 adjudication branch many times, and that would

13 probably give us the ability to pick out claims

14 that represented a spectrum of complexity, if

15 they have those dates. We could ask them for

16 that, too. We could say why don't you give us

17 ten claims that were decided in the beginning on

18 these criteria and these criteria and then ten

19 claims that had multiple appeals. But we may be

20 able to figure out how many there if we can get

21 more dates in the spreadsheet. Does that make

22 sense to anybody but me? 
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1 CHAIR REDLICH: I'm wondering whether

2 we should, to get more just of Labor, we could

3 just say, okay, maybe to the past, the 20 claims

4 that were most recently decided, recognizing they

5 may not be representative, but at least rather

6 than them hand -- and then we could sort of ask

7 if we have the 20 most recent, and do they think

8 those were representative. So you may also I

9 think have an idea, and looking over just the

10 decisions in that website -- I don't have strong

11 feelings. I think the sooner, if we look over

12 exactly some of those, I think -- but we'll have

13 to find out then, I mean -- so what do people

14 think? Should we just -- 

15 MEMBER VLIEGER: As far as the

16 documents on the website, they are representative

17 of what was submitted voluntarily by workers. So

18 I agree with Dr. Markowitz that we need a full

19 spectrum because we don't want to look like we're

20 slanted. However, I think when we go to the

21 Department of Labor, instead of saying, we want

22 this, do you have it, why don't we have them tell
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1 us what they have, and then we can choose what

2 data we want to see? What are the columns? What

3 are they defined as, and what parameters do they

4 actually track.

5 What we've found when we've done FOIAs

6 of the system, a Freedom of Information Act

7 request, is many times they'll say, we don't

8 track that, or we don't track that in a way that

9 we can retrieve it. And so instead of a back10 and-forth, back-and-forth with DOL, why don't we

11 ask them what they do track, and then we can

12 decide what to get? 

13 MEMBER WELCH: Good idea. We can see

14 what we get in response to that. 

15 CHAIR REDLICH: Others may know

16 better. My sense is that a lot of the tracking

17 has to do more with things like the timeliness of

18 the claims process, rather than like some of the

19 questions we're asking in terms of the reasons

20 for denial or did the person have -- what

21 percentage of these cases that were denied had X

22 tissue diagnosis or something.
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1 MEMBER WELCH: Carrie, this is Laurie. 

2 I think that that stuff is not in the database. 

3 CHAIR REDLICH: I guess we would -- it

4 would appear that the paperwork, as far as the

5 summary decision-making and rationale, should be

6 something that we could get sooner rather than

7 later. 

8 MEMBER WELCH: Individual claims, you

9 mean.

10 CHAIR REDLICH: That's right.

11 MEMBER WELCH: Yes. 

12 CHAIR REDLICH: So we could just say,

13 look, we have, for the past 50 claims, the most

14 recent 50, and see what we get. And then we'll

15 take a look through those, and it would give us a

16 flavor, and then we could, I mean, we could even

17 divide it among ourselves. My guess is that it

18 wouldn't take that long to flip through a

19 reasonable number.

20 MEMBER WELCH: Yes. I mean, I just

21 counted on the spreadsheet and it's a diagnosis

22 date, well, if the diagnosis date was 2013, for
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1 example, then obviously the claim was after 2013. 

2 So there were 35 accepted claims with a diagnosis

3 date of 2013, and there were 20 in 2014 and there

4 were 16 in 2015 with a diagnosis date. Now, I

5 think those are -- 

6 CHAIR REDLICH: CBD, correct?

7 MEMBER WELCH: Well, probably some

8 that were diagnosed in 2015 aren't adjudicated

9 yet, so we might want to, you know, look at the

10 35 that were adjudicated, that were diagnosed in

11 2013 that were accepted and then could probably

12 get another set if you want to look at ones that

13 were denied, too. 

14 CHAIR REDLICH: And I think we want to

15 look both at CBD and beryllium sensitization. 

16 Some are both, some are, you know, only

17 sensitization. 

18 MEMBER MARKOWITZ: This is Steven. 

19 But the goal of looking at this limited number is

20 not to draw large conclusions but simply to get a

21 better understanding of the kind of specific

22 information that is compiled and is used by
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1 claims examiners to make decisions? 

2 CHAIR REDLICH: I think so. My

3 thought was that this initial look could be done

4 in a week or two to get a feel for what we really

5 want of the claims process, in terms of the

6 medical records and the like, rather than

7 requesting all at once everything and it might

8 take months to get. 

9 MEMBER WELCH: That makes sense. So

10 everybody gets an idea of what, as Steven just

11 said, what the -- 

12 CHAIR REDLICH: That's right. Because

13 I think, Lori, you have been reading these and

14 have an idea. But to me, we could just say,

15 look, could we have just the most recent 50

16 claims of CBD that have been processed and their

17 decisions, accepted or denied, and the last 50 of

18 sensitization and maybe a smaller number of

19 silicosis. You know, that piece of it -- and we

20 could take a look at that in a short period of

21 time, I think, and then say, okay -- and I

22 personally think it would be helpful to have a
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1 phone call between now and the October meeting

2 because I would rather not, you know, to try and

3 do this, I think it would just be more time

4 efficient that way.

5 MEMBER WELCH: Yes. 

6 MEMBER MARKOWITZ: So the goal would

7 be -- Steven. The goal would be to develop a

8 provisional understanding for recent claims the

9 claims process has operated to better understand,

10 secondly, to better understand the types of data

11 that enter the system and are used by the various

12 participants in the system, the claims examiner

13 and the like, to draw conclusions. 

14 CHAIR REDLICH: Yes. And I guess I'm

15 partly -- the World Trade Center, there was, you

16 know, a vision of it. And then when you actually

17 looked at, and after looking at about 10 to 15

18 actual claims, the issues and the problems became

19 much clearer. And some of them seemed to have

20 quite simple solutions and others less simple. 

21 And so -- exactly. I think this would, and I

22 think whatever number we got, if we got 50 of
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1 each category, I think it would give us, we

2 recognize it's not representative of the whole

3 but at least initially where some of the issues

4 lie. 

5 MEMBER MARKOWITZ: This is Steven

6 again. Just to --

7 CHAIR REDLICH: And I probably would

8 propose like almost a little cheat sheet of

9 accepted, you know, we could come up with a

10 little way to go over that and that we sort of

11 not graded it but had a sense of, you know, and

12 what was reason it was denied and does that seem,

13 you know, reasonable or not or what pieces were

14 missing and et cetera.

15 MEMBER MARKOWITZ: This is Steven. 

16 But we're not -- this is a question. We're not

17 going to draw conclusions about the quality or

18 the consistency of the decision-making --

19 CHAIR REDLICH: No, no, this is just

20 hypothesis, you know, generating, I think, to

21 better hone in on what we do want. 

22 MEMBER MARKOWITZ: Makes sense.
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1 CHAIR REDLICH: Does that -- I mean,

2 just as one example, with the World Trade Center,

3 cancer, you think cancer, the diagnosis, the

4 requirement was you need a path report, so that

5 seems pretty straightforward. You know, you get

6 the path report. So there were a bunch of claims

7 that were denied when you looked at it because,

8 you know, there's the fancy oncologist who has

9 all the tumor markers and everything in their

10 notes, but the actual pathology report from the

11 pathologist is not there. Now, the person

12 clearly has a cancer. Any physician looking at

13 that would understand that. So that was like a

14 simple one where -- and there are multiple

15 reasons why the poor patient is unable to get

16 that path report which was done at a different

17 hospital and that hospital has been taken over by

18 this hospital and the records whatever.

19 So all you needed to say was a path

20 report or an oncologist diagnosis or something,

21 which seems like common sense, but I think when

22 you put these decision-making in a sort of
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1 strict, you know, do this and then that, oh, you

2 don't have that so, you know -- so I think it was

3 at least on feel. I'm not saying that's what's

4 going on here, but I will say that the issues of

5 what was helpful from actually, the reason things

6 were denied. And it looks like, since that's not

7 going to be in the claim data -- and, Steve,

8 you're totally right, we don't want to make

9 preliminary conclusions based on this because we

10 recognize that this is not necessarily

11 representative. 

12 In terms of the initial request, I

13 just put the number 50, but asking the DOL if

14 there are any other suggestions. Let's say 50,

15 you know, decided claims for beryllium disease

16 and 50 for sensitization and, I don't know, 20

17 for silicosis or something? 

18 MEMBER WELCH: If you want to get a

19 sense of the claims process, I don't think you

20 need to look at a hundred claims. I would hate

21 to have to read a hundred of those. 

22 CHAIR REDLICH: I was thinking maybe
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1 we each did -- okay. We can go to a smaller

2 number. I was thinking why we're asking.

3 MEMBER VLIEGER: This is Faye Vlieger. 

4 I agree. Once you read ten -- after you read

5 five you'll have an idea. After you read ten,

6 you'll be pretty sure what's going on. 

7 CHAIR REDLICH: Okay. I say 20. I

8 would rather ask for more. 

9 MEMBER TURNER: I was wondering if it

10 was possible, too, get to my case? My claim? 

11 CHAIR REDLICH: Okay. Yes, from

12 talking to a number of people and physicians, I

13 do have some thoughts, but I don't have, but the

14 documentation to -- okay. So I would suggest

15 that we put a request in for, and recognizing

16 there's overlap, but I would like to see some

17 that are sensitization claim only and some that

18 the beryllium disease could be beryllium,

19 obviously, and sensitization. 

20 MEMBER VLIEGER: That's fine. 

21 CHAIR REDLICH: I think we should look

22 at some of the silicosis, too. So how about 10
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1 of the silicosis, 20 of the beryllium -- so I

2 think -- Faye and Carrie, you can help us in

3 terms of what we're actually asking the DOL for. 

4 We're asking for the summary as far as the, you

5 know, whether it was accepted or not and the

6 rationale and probably, if it's accepted, there's

7 less of a rationale. 

8 But a given claim, and then would that

9 come with the history of the claim or is that

10 something we should -- 

11 MEMBER VLIEGER: If you're going to be

12 asking for the patient records, that's a

13 different ball of wax then asking for the

14 recommended decision and final decision in the

15 claim. Two different people write those

16 documents, and the recommended decision may

17 differ significantly from the final decision. In

18 each of the final decision and recommended

19 decision, there's something called the statement

20 of accepted facts, and that's what can vary

21 greatly. So that's the procedural process on how

22 they deny the claim. 
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1 If you're wanting to see the medical

2 records for each one, that's what's going to take

3 longer. So the initial ask, I would think, would

4 be for a specific claim to see the recommended

5 decision and the final decision, and then you'll

6 see how the process worked. 

7 CHAIR REDLICH: And what about the

8 statement of accepted facts? Do we want to -- is

9 that -- 

10 MEMBER VLIEGER: Yes. If there's a

11 referral to a CMC, the statement of accepted

12 facts to the CMC may be significantly different

13 than what's actually memorialized in the

14 recommended decision or the final decision. 

15 Sometimes, they're identical. Sometimes, they're

16 not. And so I would say, if we're going to ask

17 for a medical record for the claim in addition to

18 these, I would think that you would ask for the

19 CMC referral statement and the CMC report, as

20 well. Most of these go to a CMC.

21 CHAIR REDLICH: So right now I don't

22 think we're asking for the medical records
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1 themselves because we want to get something

2 sooner rather than later. So just to be clear,

3 the specific request -- I'm just writing this

4 down -- would be the -- 

5 MEMBER VLIEGER: Recommended decision

6 to deny or accept.

7 CHAIR REDLICH: And then the final

8 decision.

9 MEMBER VLIEGER: Right. And that can

10 be to deny or accept or it can be a remand. 

11 Those are the three options. And then something

12 that would be, in addition to that later on, you

13 know, we can discuss the contract medical

14 consultant referral and report, but that's going

15 to take more redacting. 

16 CHAIR REDLICH: Okay. So the contract

17 -- okay, I understand. And then the statement of

18 accepted facts is what you're saying is really a

19 medical document? 

20 MEMBER VLIEGER: No, the statement of

21 accepted facts is recited. It's memorialized in

22 the recommended decision and the final decision,
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1 so it's in the record.

2 CHAIR REDLICH: Got it. It's

3 included. Okay. So it sounds like then that

4 would be the thing that we should be able to get

5 relatively quickly on each claim. And then when

6 we requested that, if five or ten years ago there

7 had been a previous decision, would that be

8 included? Would we get the history of the claim,

9 or would we only get that one decision-making? 

10 MEMBER VLIEGER: Each person that

11 writes these has a different style, even though

12 there's a formula that they're supposed to

13 follow. And they may just briefly recite that

14 you applied and you were turned down. That may

15 be all they recite. Other times they could

16 recite the entire statement of accepted facts

17 from the previous ones. So if you're looking for

18 the chain on a claim that was attempted multiple

19 times, that's going to be a much more difficult

20 request, rather than saying, you know, for the

21 last 20, you know, you can hand us, it's a

22 different process, and each writer, each claims
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1 examiner, each hearings representative has a

2 different style, even though they follow a

3 certain formula that's put to them in the

4 procedure manual. 

5 CHAIR REDLICH: Okay. So at the

6 least, it would be apparent if it was a totally

7 new claim or one that had a prior decision of

8 denial? 

9 MEMBER VLIEGER: Yes, they recite the

10 dates of claim in the statement of accepted

11 facts, so recite what evidence they received and

12 what evidence they accepted.

13 CHAIR REDLICH: Okay. Very good. So

14 I think I would propose, if everyone is in

15 agreement, that we put in a request for those

16 items for 20 cases of chronic beryllium disease. 

17 You know, we say the most recent finalized ones. 

18 Twenty of sensitization, or I think we probably

19 want more of the chronic beryllium disease than

20 the sensitization, and then also for ten of the

21 silicosis claims. 

22 MEMBER WELCH: And, Carrie, it might
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1 help to specify some proportion of accepted and

2 denied. You know, if we did the last 20 claims

3 and they were all accepted, then we wouldn't have

4 seen the -- I mean, it's probably unlikely. So

5 maybe you want to say the last -- 

6 CHAIR REDLICH: Why don't we say at

7 least ten that have been denied? 

8 MEMBER WELCH: Okay.

9 CHAIR REDLICH: Is everyone okay with

10 that? 

11 MEMBER MARKOWITZ: Yes, this is

12 Steven. I have a question, and maybe, Laura, you

13 can help here because you've looked at more of

14 these than many of the rest of us. If we're only

15 requesting either compilations or interpretations

16 of the underlying medical information and not at

17 this point requesting either the CMC report or

18 these medical records, how much are we going to

19 learn? In other words -- 

20 MEMBER WELCH: If a claim was denied,

21 you really don't understand it unless you have

22 the CMC report. So I think we should ask for the
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1 CMC report with everything. 

2 CHAIR REDLICH: To redact a CMC

3 report, that's maybe a several page report. We

4 just need to get rid of the name, you know,

5 right? Is that -- 

6 MEMBER WELCH: That's correct, yes. 

7 It would probably have the, you know, if they did

8 a report correctly, your name would appear on

9 every page. And then sometimes within the text

10 of it, it will say Mr. Smith did this and Mr.

11 Smith did that. So someone has to go through it

12 and -- 

13 CHAIR REDLICH: Okay. But that's not

14 that -- 

15 MEMBER WELCH: The number of times the

16 guy's name is going to be mentioned might be a

17 dozen. Sometimes the report would be long but

18 it's blobbity, blobbity, blah about causation,

19 not about this case.

20 CHAIR REDLICH: Okay. So I agree. So

21 it seems like the CMC report, assuming it went to

22 a CMC which it sounds like a large number of them
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1 do, would be a critical thing? So what if we add

2 that to our asks? 

3 MEMBER WELCH: I think that's a good

4 idea.

5 CHAIR REDLICH: Carrie, I guess we

6 probably don't know, but this turnaround time for

7 an ask like this? Because, ideally, what I would

8 like to do is to get these, have us a chance to

9 look at them, probably come up with a summary of

10 our thoughts in terms of, you know, reasons for

11 denial before this October meeting. 

12 MS. RHOADS: Okay. I will ask the

13 program about how long it would take them and

14 tell them, you know, why you need it and when you

15 need it by and see what -- 

16 CHAIR REDLICH: I mean, ideally,

17 because I think it would be very helpful. I

18 agree I do not think it would take any of us that

19 long to go through these, and it would, and I

20 would prefer, even ideally, to have a conference

21 call after we have done that because I think it

22 would help us to focus our decision-making, and I
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1 think the critical thing being then also our next

2 request because, having looked at that, how much

3 we felt, you know, we needed more than a CMC

4 report. So that's going to be, I think, in terms

5 of understanding the process -- 

6 MS. RHOADS: Right. I'll ask them how

7 quickly they can get this together. 

8 MEMBER WELCH: When I've asked, you

9 know, sometimes our workers ask me to look at

10 their case file, and then I always want to see

11 the CMC report, so the worker actually calls

12 their claims examiner and asks for it, and

13 usually I get it back in a couple of weeks. And

14 that's one individual person, but it's not that

15 long for someone -- so I think when we're keeping

16 our asks down to 50 files, I just don't think it

17 should, it's not that -- it's a copying thing,

18 you know. So I think we should be able to

19 schedule a conference call in September and

20 definitely have time to -- 

21 CHAIR REDLICH: Yes. And if there is

22 a piece of the ask that is problematic and the
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1 other pieces are not, that would be helpful to

2 know. Okay. So is that -- I think now we've

3 basically come up with a plan for data in the

4 next really week or two. We've come up with a

5 plan for initially reviewing this information

6 that I think we're talking about over the next,

7 you know, month or two, before September. I

8 would hope that in September we could talk again

9 for the piece in terms of understanding this

10 aspect of the claims.

11 You know, I think understanding our

12 mission would really be focusing on, you know,

13 the reasons that these are being denied related

14 to really use the criteria and the pre, you know,

15 or post 19 -- you know, versus the issues of

16 what's the, you know, who's the quality or the

17 person doing the review because my understanding

18 is that those aspects of the process would go to

19 the other subcommittees. Is that -- is everyone

20 in agreement? 

21 Okay. So what if we do this? What if

22 we take a ten-minute break and come back? And I
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1 think, looking at our initial agenda, we have

2 gotten up to four. We've addressed A, and we've

3 addressed B, in terms of at least the initial

4 information about that. And we've partially come

5 up with a time line. But I did also want to just

6 raise, you know, potentially other information

7 and also we haven't, information also, you know,

8 our approach to sarcoid question.

9 So what does everyone think about a

10 ten-minute break? It is, let's call it 11:30. 

11 Or 15 minutes? Any votes here? 

12 MEMBER WELCH: Should we all hang up

13 and call back in? Is that the plan? 

14 MS. RHOADS: We can just have the

15 moderator put the call on hold or mute for ten

16 minutes and then come back on. 

17 CHAIR REDLICH: Okay. So we will be

18 back on at 11:40. And please, everyone, in the

19 meantime, we are actually making very good time,

20 but if there are other items or thoughts, do not

21 be shy. Okay. 

22 (Whereupon, the above-entitled matter
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1 went off the record at 11:29 a.m. and resumed at

2 11:43 a.m.)

3 CHAIR REDLICH: I think we are making

4 a lot of progress. We are still in the define

5 other data and information needs. 

6 MS. RHOADS: Has the moderator added

7 back in the public line? 

8 OPERATOR: Yes. Everyone can hear you

9 at this point. 

10 MS. RHOADS: Okay, great. Thank you. 

11 CHAIR REDLICH: I think we have

12 everyone back on. So I had a couple of thoughts,

13 but I wanted other people's thoughts in terms of

14 -- and I think, at this point, we're thinking

15 about additional pieces of data information that

16 will help us. 

17 So I will repeat that whoever is

18 listening on the line to not speak. We welcome

19 your comments, suggestions, particularly focused

20 on pieces of information that would be useful in

21 terms of decision-making. 

22 Are there other sort of constituents,
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1 constituencies that we might want to hear from? 

2 And I'm thinking of something, let's say,

3 physicians who are involved in the decision4 making, some of the, you know, people who are

5 struggling with doing the CMC reports or the

6 group within the DOL that makes a final decision? 

7 And I was thinking more of really the specific

8 issues related to beryllium, not the process. So

9 I wanted other people's thoughts. 

10 MEMBER VLIEGER: The physicians that

11 I deal with on these claims struggle to write

12 documents that meet the criteria that the

13 Department of Labor will accept, and I think

14 you've already touched on that in the defining of

15 the criteria. There are physicians who, you

16 know, from this area, pulmonologists, well17 respected pulmonologists that are ignored because

18 they're not meeting some tick box that the

19 Department of Labor requires. And I think the

20 vagueness of those requirements, even though the

21 statute is quite clear, and then presenting it to

22 the physicians in a way that they understand what
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1 the requirements are is one of the hurdles for

2 the claimant. 

3 CHAIR REDLICH: Okay. And so I guess

4 do we think that there would be another group

5 that would be helpful, in a more formal way, you

6 know, either canvas which are sort of the

7 particular areas. You know, I assume that there

8 are probably certain pieces that are more

9 challenging than others. I have sort of done

10 this informally with colleagues of mine, and I

11 did find what they told me useful. Some of the

12 things they told me I think related to other

13 parts of the process, but they were also a sort

14 of narrow group of people who know a lot about

15 this and I don't think were representative of the

16 actual clinicians who were -- 

17 MEMBER MARKOWITZ: This is Steven. 

18 You know, an interesting idea, I think, Carrie

19 Rhoads, have we definitely decided to meet in Oak

20 Ridge next time in October? 

21 MS. RHOADS: Yes, we're looking for

22 places in Oak Ridge. 
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1 MEMBER MARKOWITZ: So, you know, Oak

2 Ridge has a limited pulmonary community, and we

3 could reach out to them, at least put them on

4 notice that we're meeting them, and they might

5 participate in a public comment process about

6 their experience. And that way, we could get

7 some feedback. The only other organized group

8 would be the CMCs, but we expect to get, you

9 know, some of their issues through looking at

10 claims. I don't really know how else one could

11 look at the practitioner's experience. 

12 CHAIR REDLICH: Just so I understand,

13 the total number of CMCs in the system is about

14 how many? 

15 MEMBER MARKOWITZ: I think the range

16 is -- this is Steven. I think the range is 50 to

17 100, but I'm not sure. 

18 CHAIR REDLICH: And these are

19 physically scattered in different parts of the

20 country? 

21 MEMBER WELCH: Yes. 

22 CHAIR REDLICH: Yes. 
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1 MEMBER VLIEGER: I mean, in theory,

2 the claims should go to a specialist who's in

3 that area, so you would have an oncologist and

4 you'd have, you know, for the whole range of

5 people, not just for beryllium disease. You'd be

6 sending it to, you know, there could be thousands

7 of consultants. 

8 CHAIR REDLICH: But would it be in

9 certain sort of hotter spots of the country that

10 there might be, I don't know, five to ten CMCs

11 that would be useful to -- 

12 MEMBER VLIEGER: The QTC contract

13 vetting process is not understood by anyone, and

14 QTC is the one that collect the doctors -- QTC is

15 the name of the contractor. So the list of

16 vetted doctors in pulmonary occupational medicine

17 specialties is something we probably could

18 request. But I see them from all over the

19 country. They aren't necessarily doctors in the

20 region where the claim is originating. 

21 CHAIR REDLICH: Okay. Because one

22 thought I have thought about, you know, just is
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1 would it make sense, since this is a very

2 complicated area and for consistency and the

3 like, once you have records, you don't have to be

4 geographically for these claims to be sent to a

5 smaller group of people, you know, concentrated

6 in a smaller number, rather than sort of one

7 person has two and another has three all over the

8 place. And I don't know if that's happening now

9 or not, how it's decided. Are there CMCs that

10 only do beryllium disease? Are there others that

11 only do cancer? Because I wasn't totally clear

12 when they say a specialist what they meant by a

13 specialist. 

14 MEMBER WELCH: We'd have to ask the

15 Department of Labor about that.

16 MEMBER VLIEGER: I was going to say

17 Laura could speak to that because she's seen more

18 of the reports probably than I have, but the

19 vetting process that QTC does, the doctors are

20 then supposedly reviewed by their application,

21 but I personally can attest to the fact that QTC

22 does not always vet the doctors appropriately for
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1 specialty. The doctor may say that they're

2 qualified, but in claims that we review their

3 qualifications at a hearing, we find that the

4 doctor is not qualified to be opining in that

5 specialty. 

6 CHAIR REDLICH: Okay. And I guess

7 some of these issues are ones that, Steve, I

8 assume the other subcommittee is addressing. 

9 Knowing, and I think Laura and I probably are two

10 people from the medical side that know as much

11 about beryllium, as there are really a very small

12 handful of doctors. So just off the bat, and I

13 don't mean to sort of say negative things about

14 my pulmonary colleagues or my occupational

15 medicine colleagues, but, you know, world16 renowned interstitial lung disease specialists

17 who deal with sarcoid and all these other

18 diseases are clueless about beryllium. 

19 MEMBER MARKOWITZ: And they're

20 probably not CMCs either. 

21 CHAIR REDLICH: That's true. And the

22 occupational medicine ones, but if someone was
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1 saying were they qualified to be a CMC, they

2 would look awesome qualifications on paper, board

3 certified and this and that and the like. So --

4 MEMBER MARKOWITZ: This is Steven. 

5 Isn't the underlying problem that, and this is

6 what DOL actually raised in their list of issues

7 and if you look at the statutes, the underlying

8 problem is there's some very vague phrases that

9 it's not clear how you apply them. And so

10 whatever group, whether expert or not, until you

11 get in the room to examine records and apply

12 these vague phrases is coming up with

13 inconsistent results. 

14 CHAIR REDLICH: For beryllium is

15 pretty specific. 

16 MEMBER WELCH: Well, not really. You

17 know, you need radiography consistent with the

18 disease. 

19 CHAIR REDLICH: But then there is the

20 other more extensive handbook that gives more

21 information. 

22 MEMBER MARKOWITZ: You're talking
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1 about the procedures manual? 

2 CHAIR REDLICH: Yes, it's pretty

3 detailed. I mean, my thought is that it sounds

4 like what's happening is you've got a list of

5 pretty specific things you need to meet and you

6 don't meet them, and that's why it gets denied,

7 not that it's vague and it would fit under it. 

8 MEMBER MARKOWITZ: Well, you know, but

9 I have to say, if you look at the issues that DOL

10 looks, as part of their PowerPoint, one of the

11 handouts that we received, they want help with

12 this issue of, you know, "characteristic of CBD." 

13 They want help with a consistent uniform standard

14 for what is a chronic respiratory disorder. So

15 whatever details they've elaborated in their

16 procedures manual, they appear to still be

17 struggling with this probably for the same

18 reasons why some claimants are unhappy with how

19 they apply it, which is that these are, they

20 haven't been specified enough or some variation

21 of that. 

22 MEMBER WELCH: Or if the procedural
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1 manual was developed by the claims examiners and

2 one internal physician that's changed or, you

3 know, they asked some external person many years

4 ago, they might want a broader input. You know,

5 maybe, you know, if we look at what they've been

6 using and say that's good, that would be helpful

7 to them because, otherwise, you get people

8 arguing about what the statute says. The

9 procedure manual -- 

10 CHAIR REDLICH: So I guess I sort of

11 feel that one of the problems is is that, as you

12 try and define that in more detail exactly what

13 is meant, it then becomes harder to ever accept a

14 claim. And when you go to ILD conference and,

15 literally, a biopsy is read three different ways

16 by three different pathologists, it's almost, and

17 I think it's why people get towards some

18 presumption things because -- so, honestly, if

19 you look at the ATS document on beryllium and the

20 like, yes, you could tweak the manual that they

21 have, but it's pretty detailed.

22 MEMBER WELCH: Yes, but I think the
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1 question is whether -- so when we look at the

2 denials, we'll get an idea.

3 CHAIR REDLICH: That's right.

4 MEMBER WELCH: Because you're coming

5 into it with the idea that there's probably

6 people that have CBD who are having their claims

7 denied because there's evidence required they

8 just can't get, even though they, you know, an

9 expert would say they have CBD, or more likely

10 than not anyway. And I think wait until we see

11 some, and then we'll get a better idea. 

12 CHAIR REDLICH: And I suspect and it

13 sounds like there are also cases, and I think

14 consistency is important, of whether the, you

15 know, person has a positive, you know,

16 sensitization and doesn't have COPD but has some

17 other pulmonary condition, like asthma or COPD

18 and someone sort of decides -- I actually don't

19 think the question is do they definitely have the

20 disease because this is a compensation system,

21 so, I mean, I think that is a question, but then

22 I think it's also what makes sense in the setting
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1 of the current compensation. Because, I mean,

2 with any of these, whether it's Agent Orange in

3 Vietnam or the World Trade Center, it's not, you

4 know, it's sort of defining parameters that you

5 hope in the end that you compensate people that

6 deserve it and the like, recognizing any of these

7 systems, even when we use more probable than not,

8 that means that we're 51-percent sure so half the

9 people maybe it wasn't related. 

10 MEMBER MARKOWITZ: Yes, but WTC and

11 Agent Orange don't give diagnostic criteria,

12 unlike this statute. They don't tell you what

13 criteria you need to meet in order to be

14 recognized as having this disease or that

15 disease. 

16 CHAIR REDLICH: WTC has its criteria,

17 you know, X amount of exposure, you need this to

18 document the diagnosis. 

19 MEMBER MARKOWITZ: But not the level

20 of detail that's in this statute.

21 CHAIR REDLICH: That's right, that's

22 right. So part of my feeling is the level of
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1 detail, partly the level of detail that we are --

2 because it all does go back to, we go back to the

3 statute, the statute is pretty specific for, you

4 know -- that's right. And then there is some

5 further discussion of what a CT consistent with

6 beryllium disease. 

7 I think the point is that, everyone is

8 right, that when we review some claims, we'll get

9 some idea of the areas that are being denied and

10 maybe the areas that are being approved, you

11 know. Both ways, we're sort of wondering why.

12 MEMBER VLIEGER: Well, one of the

13 problems with that adjudication of these claims

14 is the statute is written in a manner that is a

15 little bit of a loop. So pre-CBD claim process

16 is first in the statute, and then, when they

17 transported that with the post-CBD criteria into

18 the procedure manual, instead of saying for pre19 1993 diagnoses, this is what's required, under

20 the post-1993, instead of saying in addition to

21 this you need this, they looped it. And to read

22 the procedure manual, it's quite confusing, and
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1 that's why the doctors can't quite understand it. 

2 Many times, I will write a letter and

3 specifically state out the criteria. And even if

4 you compare the U.S. Department of Labor's

5 brochures and pamphlets on the disease, it does

6 not match the wording that the claims examiners

7 are held to in the procedure manual.

8 So I think one of the things that

9 needs to be addressed is the clarity in the

10 procedure manual, and the way it was written is

11 very convoluted. 

12 CHAIR REDLICH: Okay. And that is the

13 document, just so we're all talking about the

14 same thing, I believe that is the document that

15 Carrie sort of sent to everybody this morning in

16 one of the attachments. 

17 MEMBER WELCH: Yes, it is. 

18 CHAIR REDLICH: Okay. It's about a

19 20-page thing? 

20 MEMBER WELCH: Yes. What you're

21 really looking at is about three paragraphs under

22 CBD, and you'll see that it's very convoluted. 
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1 Sorry. The pre-1993 criteria is stated, and

2 then, when you go to the post-1993 criteria, you

3 have to infer from the previous criteria what's

4 in there. And I think that's part of the

5 problem. 

6 CHAIR REDLICH: Okay. And then I

7 think two things related to that, in terms of

8 pieces of data that I think would be helpful, is

9 what percentage of these beryllium claims are

10 under the pre- and post-1993 is one question

11 because, obviously, being pre-1993 gives more

12 wiggle room in terms of not needing to

13 demonstrate the sensitization. And then also how

14 that's being decided because my understanding it

15 seems that that's one of the questions would be

16 onset of disease and how that's being defined in

17 terms of onset of symptoms or documentation that

18 you saw, and I don't know if anyone on the call

19 knows the answer to that. But it sounds like

20 that's an area of confusion. 

21 MEMBER WELCH: Once the worker

22 receives one positive beryllium sensitivity test,
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1 that qualifies them for a medical benefits card,

2 and then they are eligible to use that card for

3 their ongoing monitoring. That leads into when

4 they would apply for a CBD claim if they meet the

5 criteria, so then we run into the criteria

6 confusion problem. 

7 CHAIR REDLICH: Okay. But does anyone

8 have any sense now of, let's say, claims filed,

9 or reviewed from those when they originally

10 filed, recently, how many of them would be using

11 the pre- or the post-1993 criteria? I mean, when

12 this CMC person, is that part of their decision13 making, which criteria am I going to use, or is

14 someone else saying we've determined that this

15 person was pre- or post-1993? 

16 MEMBER WELCH: This is Lori. I'd ask

17 John to answer about what I said to him in the

18 meeting. I said it seems like this should be

19 easier because all your claims should now be post

20 '93, and he said, no, a lot of claimants are

21 asking to have the pre '93 criteria applied

22 because they want to demonstrate that their
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1 symptoms, that their chronic lung condition began

2 before 1993. And so I don't know what proportion

3 it is, but it's something that apparently the DOL

4 is struggling with, whether, you know, what kind

5 of documentation to accept that the chronic lung

6 disease began before '93. 

7 CHAIR REDLICH: That's right. And

8 they asked us that question. Okay. And in the

9 CMC report and the rationale, I would assume that

10 when you read that over, it should be clear what

11 criteria are being used, or is that a potentially

12 wrong assumption?

13 MEMBER WELCH: No, it's clear.

14 CHAIR REDLICH: Okay. So that's also

15 something, when we look at the most recent 20

16 claims or so, we should have a sense of?

17 MEMBER WELCH: Yes.

18 CHAIR REDLICH: Okay. I just wanted

19 to make note because I think that is, this is

20 obviously an important area, and it is one of the

21 questions on the list of the specific questions,

22 the pre- and the post-1993, and one could --
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1 okay. And also if we could ask, it's probably

2 not in the database, but we could still ask

3 because then it keeps it as something to remember

4 as a variable that we would be interested in.

5 MEMBER WELCH: Right, yes. I mean, if

6 we get the --

7 CHAIR REDLICH: Someone could say,

8 yes, I saw the doctor now, but my disease started

9 ten years ago, you know.

10 MEMBER WELCH: But the date of

11 diagnosis should tell us that. So if there is a

12 case with a date of diagnosis of 1990 and then

13 the case is being adjudicated in 2012, we would

14 be able to see that that's a pattern. But since

15 all we have is a date of diagnosis and not the

16 adjudication date, we don't know if there are

17 many with a long gap, you know, many where

18 there's a 20-year delay between the diagnosis. 

19 Those would probably the accepted claims. 

20 Just for everybody's information, I

21 just kind of counted out of that spreadsheet, and

22 there are 24,000 applications for either CBD or
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1 BES, and there were around 2500 approved and 2500

2 denied for CBD. And I didn't count how many were

3 beryllium sensitization. There's some for which

4 there's no information at all on the claim,

5 whether it was approved or denied, and I don't

6 know what that means, but that was one of our

7 data requests. 

8 Just to give you an idea of what kind

9 of numbers we're talking about, there's been, you

10 know, 2500 accepted ever. In the last three

11 years, it's around 50.

12 CHAIR REDLICH: That's right. It

13 wasn't a huge number for those. Okay. So I

14 think -- 

15 MEMBER MARKOWITZ: Carrie, can I --

16 this is Steven. I'm reading the minutes from the

17 full Board meeting in April, and John Vance said

18 that DOL is currently seeing more pre '93 cases

19 than post '93 cases. So it's a --

20 CHAIR REDLICH: Okay. We're going to

21 have to deal with that issue. And, again, I

22 think we can clarify what, you know, the wording
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1 on this statute, but I think we're sort of stuck

2 with the statute. 

3 So I guess, potentially, I would be

4 interested, if we -- okay. Maybe this is

5 information we could get. For the past 100

6 beryllium claims, how many different CMCs were

7 adjudicating? You know, is there any

8 concentration, or it is just -- 

9 MEMBER WELCH: There's definitely not

10 concentration. There's no system to send it to a

11 smaller number of people.

12 CHAIR REDLICH: But at least it would

13 be going, I think what would be helpful would be

14 some idea of, I mean, what have they considered? 

15 Because they pick someone, quote, with the

16 relevant specialty, so are these cases -- I think

17 it would be helpful to know -- and the CMC report

18 is, correct me if I'm wrong, that's a critical

19 step in this stage, right? Where things could

20 either --

21 MEMBER WELCH: Yes, absolutely. I

22 mean, for all these claims.
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1 CHAIR REDLICH: Okay. So I just would

2 like to know for the claims for beryllium, who

3 they send them to. Are they pulmonologists, occ

4 med doctors? We said, okay, these hundred claims

5 were reviewed by these 30 physicians. Who are

6 those 30 people? That's something the DOL should

7 let us know, right?

8 MEMBER WELCH: Well, when you look at

9 the report, you know, for the claims that we look

10 at, we're going to get the CMC report and it has

11 their, you know, their qualifications, to some

12 degree. I mean, there was a case I looked at

13 recently where he was occupational medicine14 boarded, but his initial training was in

15 orthopedics. 

16 CHAIR REDLICH: So that's the case

17 with probably the great majority of occupational

18 medicine.

19 MEMBER WELCH: But that person was

20 considered qualified to opine on an occupational

21 lung disease case.

22 CHAIR REDLICH: So maybe the, I think
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1 the Department of Labor must have some little

2 guidance that they use, okay, we have this claim,

3 we need to decide who to give it to. So we could

4 ask them what they're using. 

5 MEMBER VLIEGER: They base their

6 choice of doctors off of who QTC vetted, and the

7 vetting process that QTC uses has not been

8 disclosed. 

9 CHAIR REDLICH: Let's see what we 

10 get, right? 

11 MEMBER VLIEGER: No, and we also can't

12 get the CMC training manual, so that might be

13 something you want to ask for, too. 

14 CHAIR REDLICH: We would get the sense

15 of these ten, but the question is -- exactly. I

16 think, frankly, most occupational medicine

17 physicians, you know, I think are people who do,

18 you know, injury management. 

19 MEMBER WELCH: I mean, I think there's

20 two things there. There's trying to find

21 consultant physicians who understand the disease,

22 or they're trying to help with the adjudication
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1 process so it's not so complicated that you need

2 to have everyone being reviewed by, you know, a

3 subset of three doctors in the country. 

4 CHAIR REDLICH: But you know what? 

5 The number of total beryllium, those were

6 accepted claims, and that's why I think that

7 recent numbers, but I don't know. Let's say you

8 had 300 claims a year or something will have that

9 information related to beryllium. When you do

10 something regularly and familiar with it and you

11 understand it, it potentially would make sense to

12 concentrate that in a smaller number of people. 

13 When we did the World Trade Center, we had, like,

14 five of us who all sort of reviewed them and

15 actually had some conference calls to discuss,

16 you know, so I do think -- why don't we just do

17 this? Say we'd like to know who they consider

18 qualified, you know, which types of physicians. 

19 I assume that they have, you know, board

20 certified in occ med or pulmonary, if that's what

21 they're using. But why don't we just find out? 

22 Okay. So you said the thing that you
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1 haven't been able to get is the training, the

2 criteria used? 

3 MEMBER VLIEGER: We don't know the

4 vetting criteria, and we also don't have the CMC

5 training manual. 

6 CHAIR REDLICH: Okay. So there's

7 probably a vetting criteria for just, in general,

8 being on their panel. And then once you're on

9 the panel, depending on what your disease is,

10 would you go to like a neurologist or a -- you

11 know what I mean? Do we know? 

12 MEMBER VLIEGER: Like Dr. Welch said,

13 it's they don't look any further than the

14 certifications. They also don't look if they

15 meet the criteria where they're supposed to be

16 actually practicing still, where they're supposed

17 to not get more than 25 percent of their income

18 from doing CMC work, you know. That's the type

19 of thing that nobody ever seems to want to answer

20 -- 

21 CHAIR REDLICH: But I'm just asking is

22 there a separate criteria depending on what the
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1 condition is? 

2 MEMBER VLIEGER: Well -- 

3 CHAIR REDLICH: Criteria for any case.

4 MEMBER VLIEGER: Well, criteria for

5 using a particular CMC, the claims examiners and

6 their supervisors are supposed to choose who is

7 well qualified. 

8 CHAIR REDLICH: Okay. So I think,

9 personally, it would be helpful to know, and I

10 don't want to overlap with the clinical

11 subcommittee, but just simply for cases that have

12 to do with Part B, are there specific criteria

13 that they use to decide which CMCs they use? And

14 could they let us know for the past, you know, I

15 don't know, 20 or 30 CMCs. Maybe it will become

16 apparent from the reports, but I think that this

17 is an issue it can't hurt to ask. We would like

18 to know for the last, I don't know, 30 cases

19 reviewed that were under Part B who the, you

20 know, what the credentials were: how many were

21 board certified in what -- or even it seems to me

22 there's a pool of people that then review any of
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1 them? I just don't understand quite the process,

2 unless someone else --

3 MEMBER MARKOWITZ: You know, who the

4 CMC is ought to be in the database. 

5 CHAIR REDLICH: That's what I'm

6 saying. They should have --

7 MEMBER MARKOWITZ: And we want a

8 larger, I don't know, number per year I can't

9 remember, but we want a larger representative

10 pool. So if we ask for the last couple years --

11 CHAIR REDLICH: And I think the other

12 committee may be looking at this across the whole

13 system, and maybe it is the same across the

14 system. But I think specifically related to

15 beryllium where they, you know, having different,

16 you know, who they're picking. So could we put

17 that in as a request? Carrie, do you understand

18 what we're asking? 

19 MS. RHOADS: Yes, I'll write it down

20 and send it to you after just to make sure. 

21 CHAIR REDLICH: So we're trying to

22 understand who is actually writing these reports,
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1 and we'll get some idea from the claims that

2 we're looking at. We would just like a little

3 bigger look at that question. And then we also

4 would like, if we can see the criteria that are

5 used to pick people, if they have criteria, in

6 addition to who actually got picked. And we also

7 are interested whatever information about the

8 training that these people get. Have we covered

9 those pieces?

10 And then just also related, you have

11 the CMC report, and then how critical is the next

12 stage in terms of the person in, like, the

13 Department of Labor, the person who makes the

14 final decision? 

15 MEMBER WELCH: Well, if the CMC report

16 come back and say it's not CBD and the claims

17 examiner recommends a denial and it goes to the

18 adjudication branch and they look through the

19 whole file and make sure it was handled properly

20 and then they send the letter denying the claim. 

21 CHAIR REDLICH: Okay. So the claims

22 person pretty much goes along with the CMC
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1 report; is that what you're telling me? 

2 MEMBER WELCH: Yes, they send it to

3 the CMC because they need a causation opinion to

4 adjudicate the claim.

5 CHAIR REDLICH: Okay. So that carries

6 a lot of weight.

7 MEMBER WELCH: There might be some

8 cases that where the claims examiner can award it

9 based totally on the evidence in the record. But

10 probably most are going to a consulting physician

11 to get a causation opinion, like this is CBD

12 opinion. 

13 CHAIR REDLICH: Okay. So I think, in

14 terms of that's something that we should be able

15 to get relatively quickly and have some idea of

16 who's reviewing the CMCs, what their

17 qualifications, at least on paper, are. We

18 recognize that that may not reflect reality, but

19 it's a start. And whatever information we can

20 get as far as their training specific to this,

21 and we'll also get a feel for some of this by the

22 claims that we review. Does that seem like --
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1 okay. And then I think, from there, we could

2 decide whether we thought that any more

3 physician-level input would be useful. 

4 So, now, Carrie, the list of questions

5 that the DOL came up with, you know, which are

6 all very specific, good questions about what to

7 do about -- they have felt that, after years of

8 looking over these claims -- so I'm just curious

9 who in the Department of Labor came up with those

10 questions. 

11 MS. RHOADS: I think it was probably

12 the policy branch, but I can ask who they had

13 working on it, if you want to know specifically. 

14 CHAIR REDLICH: I just think that

15 we're trying to sort of -- yes, I think that

16 would just be helpful. People directly involved

17 with the claims -- 

18 MS. RHOADS: Okay. I can ask them how

19 they put that list together. 

20 CHAIR REDLICH: And I don't know, in

21 terms of the claims person, again, that reviews

22 beryllium, is it decided on a geographic basis or
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1 the beryllium are funneled to their beryllium

2 specialist claim people? How does that work?

3 MS. RHOADS: Okay. 

4 CHAIR REDLICH: Because this is just

5 a small number of all the claims. So it seems to

6 me it might make sense to have your beryllium

7 specialist who are very familiar with those

8 issues, but I don't know. How many different

9 claims people are reviewing these CMC reports

10 just for beryllium? 

11 MS. RHOADS: Okay.

12 CHAIR REDLICH: If we're thinking

13 that, at some point, there needs to be further

14 education of people involved in the process, I'm

15 just trying to get a sense of the number of who

16 we're talking about. 

17 MS. RHOADS: You mean the number of

18 different claims examiners?

19 CHAIR REDLICH: Well, that are dealing

20 with beryllium. 

21 MS. RHOADS: Okay. 

22 CHAIR REDLICH: Because I think if
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1 we're trying to fix something then it sort of

2 figuring out just the stages that it might need

3 some fixing at. Okay. So are there data and

4 pieces of information that we would like? I also

5 felt what we needed to talk about was sarcoid. 

6 MEMBER WELCH: I was actually just

7 looking at how many beryllium sensitivity cases

8 there were, but I can tell you how many sarcoid

9 cases there are in the database. That might

10 help. Let me just do that.

11 CHAIR REDLICH: Yes, but I looked. 

12 There were not nearly, there weren't, they're

13 more on the east side. And I guess for anybody

14 who's not directly familiar, sarcoid looks like

15 beryllium disease, and so I do know from seeing

16 some of the data from Hanford and talking to some

17 of the physicians involved that the feeling is --

18 and, actually, I pulled off the internet some of

19 the data they had from Hanford, and the feeling

20 was there was an excess number of sarcoid cases. 

21 So rather than getting in the details of one side

22 of things, you know, there are, it can be
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1 confusing. If someone has sarcoid and worked

2 with beryllium and, for whatever reason, didn't

3 have a BeLPT done or it was done and was

4 negative, assuming that they had exposure and how

5 common would that be, you could argue for some

6 sort of presumptions in certain circumstances. 

7 So I do think that is something that we should

8 consider, and then, right now, the issue would be

9 what other data would be useful to help in that

10 decision-making? 

11 MEMBER WELCH: The other thing that

12 can also happen with those cases is that they

13 could go to, become a Part E.

14 CHAIR REDLICH: And the database, most

15 of them are on the E side.

16 MEMBER WELCH: Right. But there's a

17 lot of denials on the E side, too.

18 CHAIR REDLICH: Exactly. So I think

19 I was sort of thinking that -- okay. So to

20 address that --

21 MEMBER WELCH: I guess the question is

22 if there's some data you want at this point, when
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1 we go back to our data request, that would help

2 you. Do you want to look at some of those cases

3 specifically?

4 CHAIR REDLICH: Yes. So that's what

5 I was thinking, that the sarcoid cases would be

6 helpful to look at.

7 MEMBER WELCH: Why don't you ask for

8 ten that were approved and ten that were denied?

9 CHAIR REDLICH: Sounds good. So that

10 is going off into the E category, but that's the

11 one pulmonary disease in the E category, unless

12 other people objected, that I thought we should

13 take a look at.

14 MEMBER WELCH: Well, how about cases

15 that were denied -- I mean, there were some that

16 were approved under B, and it would be

17 interesting to know about those. But, I mean, we

18 could ask John to give us a list of, an idea,

19 like, of all the people who were approved for

20 sarcoid under B also were beryllium sensitive,

21 for example. That would make it like that's not

22 a question. But it might be interesting to look
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1 at ones that were specifically denied under B and

2 then approved under E to see what additional

3 information was, you know, because E allows a

4 much more open interpretation of the medical

5 results. 

6 MEMBER VLIEGER: The other disease

7 that they tend to get shunted to is

8 pneumoconiosis, and that's also an E disease. 

9 And just a point of clarification, beryllium

10 sensitivity is an E coverage, Part E like echo. 

11 MEMBER WELCH: Oh, because it's

12 medical card only.

13 MEMBER VLIEGER: Right. 

14 MEMBER WELCH: Okay. 

15 CHAIR REDLICH: I thought beryllium

16 sensitization was B and E. Am I wrong about

17 that? 

18 MEMBER VLIEGER: There are not Part B

19 benefits under beryllium sensitization. 

20 CHAIR REDLICH: So you don't get

21 benefits, but you file under both; is that it? 

22 MEMBER VLIEGER: Yes, that's right. 
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1 CHAIR REDLICH: Okay. So you could

2 be, in other words, what you're saying is -- is

3 it possible that, let's say, beryllium

4 sensitization, it could be denied, could it be

5 denied in B and accepted in E, or once it's

6 accepted it's accepted in both, but then the

7 benefits you get would potentially be in E and

8 not in B; is that it? 

9 MEMBER VLIEGER: Right. The E would

10 follow with one beryllium sensitization, and you

11 would not get Part B, like boy, unless you were

12 approved for CBD, sarcoidosis, or for silicosis.

13 CHAIR REDLICH: Okay. So if you are,

14 if you're approved for being sensitized, then it

15 should be in both B and E; is that correct? 

16 MEMBER VLIEGER: Right. Now, you

17 would only get the Part B if you were first

18 approved for beryllium sensitivity or pre-1993

19 CBD.

20 CHAIR REDLICH: Okay. I think I

21 understand. So you raise a good point, though. 

22 I think when we are looking at this -- it is true
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1 that you could have interstitial lung disease,

2 pneumoconiosis, one of those diagnoses, and --

3 yes, we're getting into the potential category. 

4 And that category with sensitization, a category

5 for even without it, but, basically, because a

6 lot of people with interstitial lung disease do

7 not end up getting a tissue diagnosis, but they

8 have a diagnosis of pneumoconiosis or ILD.

9 I eyeballed the data, and it didn't

10 look like there was huge, huge numbers, but I

11 think it would be helpful, John, in terms of

12 we'll add this to the list of the basic data

13 things, at least I think it would be helpful to

14 get a sense of just the numbers. So in addition

15 to sarcoid, at least to get some idea of what's

16 in the pneumoconiosis/ILD category? 

17 MEMBER DEMENT: Yes, a lot of the

18 workers list multiple conditions. And if you

19 look across the table, you can see the ones that

20 are approved and not approved. Most of the

21 sarcoid under B, and there are relatively few,

22 have other conditions, as well. Most of the
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1 sarcoid looks like it's under E.

2 CHAIR REDLICH: That's right. The

3 sarcoid -- that's exactly -- yes. Sarcoid is

4 under E, that's right, and they tend to be

5 multiple things. So I think it would, because

6 there is the potential that the diagnosis of CBD

7 was called something else, and the things that

8 would most likely be called, if that were the

9 case, would be sarcoid or this

10 pneumoconiosis/ILD. 

11 MEMBER MARKOWITZ: This is Steven. B

12 doesn't recognize sarcoidosis as compensable, so

13 sarcoidosis couldn't appear under B. 

14 CHAIR REDLICH: That's right, yes. 

15 All I'm saying is if we're addressing the problem

16 related to CBD, we're sort of not doing justice

17 if we -- the question is, are there some CBD

18 claims that are in the E category that really

19 belong in B because the person was -- I guess

20 they should be -- ideally, if someone thought

21 that that's what they had, they would file under

22 B, get denied, and maybe they would be accepted
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1 under E. I think, Laura, that's what you were

2 getting at. 

3 MEMBER WELCH: Yes, and you don't have

4 to worry about cases being under E that weren't

5 reviewed under B. B is worth more to everybody,

6 and the claims examiners look at that. And I

7 don't think that gets overlooked. 

8 CHAIR REDLICH: Okay. So I'll tell

9 you what. As a data point that I think would

10 just help to see how big this pool is, would be -

11 - I would propose, as far as the data side, that

12 we look at the overlap of people that have filed

13 a B -- I mean, my guess is if you file for

14 silicosis it's under E, but it's conceivable you

15 also filed under B. 

16 But I would simply say for how many

17 total silicosis claims and then how many of those

18 were, as Laura suggested, filed under both B and

19 E.

20 MEMBER WELCH: Well, do you remember

21 that under B you had to work at a lot of test

22 sites for silicosis? I thought you said another
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1 site.

2 CHAIR REDLICH: I'm sorry. Excuse me. 

3 I meant sarcoid. I apologize. 

4 MEMBER WELCH: Oh, okay. 

5 CHAIR REDLICH: I apologize. So, for

6 sarcoid. For sarcoid, just because that is so

7 sort of specific in the beryllium issues, let's

8 just look at sarcoid. It does look like -- my

9 look at this, it looks like a lot of the sarcoids

10 were an E. And to me, it seems like that same

11 person would have -- what we're talking about,

12 would have filed under B because there would be

13 more benefit there and might have been denied but

14 awarded under E. 

15 But whichever way it is, if we simply

16 got a sense of diagnosis sarcoid, how many are

17 filed under B, how many under E, how many under

18 both, how many are denied, we'll have a feel for

19 what this sarcoid tie is. 

20 MEMBER WELCH: Well, the thing is when

21 you look at the spreadsheet a little more, you'll

22 see that there are people who are just -- it
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1 seems that sarcoid is not compensable under D. 

2 They have to get CBD. But they could have a

3 sarcoid diagnosis and be accepted as CBD, and

4 you'd see that in the -- you'd see, for some

5 reason, they're listed denial for sarcoid under

6 B. And they should all be denied, and there's

7 some that for which there's a yes. 

8 CHAIR REDLICH: I know, I know. I

9 spent many hours looking and sorting this data

10 set over the weekend.

11 MEMBER WELCH: If you look at the CBD

12 column alongside, the ones that were accepted for

13 sarcoid were also accepted for CBD and some that

14 were turned down were accepted for CBD. 

15 So I think that the sarcoid column

16 under B is going to be extremely confusing

17 because, as Steve said, there's not supposed to

18 be any. They're all supposed to be nos. It's

19 really only there -- the way it would help us is

20 not the yes or no on those but the fact that they

21 came in with a diagnosis of sarcoid and were

22 applying for CBD under B, so --
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1 CHAIR REDLICH: Yes, and we may not --

2 from this initial look, because if we don't have

3 the chronology, in terms of just looking at what

4 the piles look like, we could just -- and then if

5 we see what the numbers look like, what if we

6 simply said what number of sarcoid cases are

7 there under, you know, E, and what percentage

8 have been accepted, and what number are under B,

9 and which are under both, something like that,

10 and just see what they, recognizing -- 

11 MEMBER WELCH: Yes, maybe. And I --

12 CHAIR REDLICH: And there should be --

13 if sarcoid has been accepted under B, there

14 should also be a diagnosis of beryllium disease.

15 MEMBER WELCH: Yes, that's right. 

16 I'll --

17 CHAIR REDLICH: So I think if we just

18 see what these piles look like, and I think then

19 we could, you know, we'll look at it and we'll

20 obviously have some additional questions because

21 clear potential cases that would seem not to make

22 sense to me would be if someone had sarcoid and
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1 then, you know -- the other one is if they have

2 sarcoid and they are sensitized to beryllium, to

3 me, that should be chronic beryllium disease. So

4 -- 

5 MEMBER DEMENT: There are no -- 135 is

6 sarcoid, right? 

7 CHAIR REDLICH: Yes. Or I'd have to

8 check. 

9 MEMBER DEMENT: There are no medical

10 conditions approved under B that have sarcoid in

11 any way. I mean, even in a multiple diagnosis.

12 MEMBER WELCH: Yes, so that makes

13 sense. 

14 CHAIR REDLICH: Okay so then they are

15 all under E, so that's -- okay. So that's where

16 I thought they were mostly. 

17 Okay. So let's just look at sarcoid. 

18 They could have been denied under B. Is that

19 right? But they shouldn't even -- 

20 MEMBER DEMENT: Yes, they could have

21 been denied under B. 

22 CHAIR REDLICH: Okay. So what if we
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1 propose this? Let's look at whatever sarcoid is

2 under B, and it appears whatever number that is

3 should have -- are all been denied. But let's

4 just see what number are in that B category. 

5 MEMBER DEMENT: In the B category,

6 there are four that are purely sarcoid, and there

7 are four that are sarcoid plus something else:

8 one beryllium disease, one sensitivity, and one

9 just a lung disease. 

10 CHAIR REDLICH: Okay. 

11 MEMBER WELCH: Yes. Can I just add

12 something? I think the data actually has the

13 date of approval and denial.

14 MEMBER DEMENT: In that calendar year.

15 MEMBER WELCH: Yes.

16 MEMBER DEMENT: We have your approval

17 or denial, so we can look at that. 

18 MEMBER WELCH: Right. I just don't

19 know what the initials underneath it stand -- you

20 know, ICY and CY. I couldn't figure that out. 

21 So you actually can see what a lot of

22 claims that have a diagnosis date in the '70s and
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1 '80s were adjudicated in the 2000s. How

2 interesting.

3 CHAIR REDLICH: Yes, I know. It's a

4 huge lag between the diagnosis on some of them. 

5 MEMBER WELCH: Well, that's because

6 people are trying to get before that '93 date, I

7 think. 

8 CHAIR REDLICH: So you don't know when

9 it was filed. Okay. So let's do this then. 

10 For under -- there's only a handful,

11 so you already could have answered that under the

12 B. So let's now just go to sarcoid under E, and

13 if we could just look at, from the data, the

14 total number of sarcoid cases, how many are

15 accepted, how many are denied, and I guess among

16 those, under E, I think it would be helpful to

17 know if there's sarcoid with beryllium

18 sensitization. If there's sarcoid with beryllium

19 disease, it should be over in B. 

20 MEMBER DEMENT: Well, possibly. It

21 could have been filed but denied in B. 

22 CHAIR REDLICH: Maybe -- yes. I think
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1 you're right. I think we know what we're talking

2 about. We just want to see what's in this

3 sarcoid category that is maybe, you know, been

4 accepted, denied, and what's going on there. And

5 I would propose also then, could we, in the

6 request, when we ask for some CMC reports, if we

7 could request the last ten sarcoid claims? Is

8 that okay with everybody? 

9 MEMBER MARKOWITZ: Do you want to

10 differentiate between approved and denied or --

11 CHAIR REDLICH: Why don't we say of

12 the last -- 

13 MEMBER DEMENT: Well, most of them are

14 denied. 

15 CHAIR REDLICH: A bunch of them are

16 denied. That's right. So we need -- why don't

17 we just take the last 15 sarcoid claims and at

18 least ten of them denied.

19 MEMBER DEMENT: Most of the claims are

20 denied, unless they also have beryllium disease. 

21 The rest of them are pretty much -- 

22 CHAIR REDLICH: Yes and what I didn't
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1 look is I think the issue is, to me, if they have

2 sarcoid and beryllium sensitization, that's sort

3 of the key thing that -- but also I think -- so

4 let's do the both from the data and requests from

5 review of claims with sarcoid. 

6 MEMBER WELCH: I don't think you need

7 to bother. I just looked at it, and under Part E

8 it says if they have a sarcoid approved, they

9 have a CBD approved. All of them, every single

10 one. 

11 MEMBER DEMENT: They do. They're --

12 pretty much.

13 MEMBER WELCH: There's a couple that

14 are blank. 

15 MEMBER DEMENT: Yes, there are a couple

16 blanks in there but most of the sarcoid have

17 something else. 

18 CHAIR REDLICH: So I still would like

19 to look at, I don't know, five or ten denied

20 sarcoid claims.

21 MEMBER DEMENT: Actually, Laura, there

22 are six approved that just are sarcoid. 
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1 MEMBER WELCH: They don't have

2 anything under CBD one way or another. 

3 MEMBER DEMENT: No, they have nothing. 

4 If you look at the medical conditions -- 

5 MEMBER WELCH: You look at the medical

6 conditions, too, over there. 

7 MEMBMER DEMENT: The medical conditions

8 that are approved over there --

9 MEMBER WELCH: Yes, you're right.

10 That's 135, you're right.

11 CHAIR REDLICH: I think, you know,

12 sarcoid is something that is pretty specific when

13 someone has sarcoid. 

14 MEMBER WELCH: Right. But if they're

15 denied -- yes, you can look at them, but it's

16 like -- 

17 CHAIR REDLICH: Because it's a whole

18 literature on machining and, you know, there are

19 all kinds of other exposures, but the type of

20 work, and there is an excess of sarcoid in

21 Hanford from this study. I had pulled one I

22 found on the internet including a PowerPoint of
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1 data presentation on Hanford.

2 MEMBER MARKOWITZ: This is Steven. So

3 the goal in looking at the denied sarcoid is to

4 look at the level of evidence, whether or not

5 they have any beryllium sensitivity or disease,

6 and then also to look at what affirmative

7 evidence exists that they actually had sarcoid. 

8 Is that right? 

9 CHAIR REDLICH: Yes, I think the

10 question is if it's true sarcoid and they worked

11 in a place with beryllium, because some people

12 would argue just in terms of probabilities that

13 on a more probable than not basis, that is more

14 likely beryllium disease than sarcoid. 

15 MEMBER MARKOWITZ: But the point of

16 looking at the claims is actually to examine what

17 the claim record shows in terms of beryllium

18 exposure and what it shows in terms of --

19 CHAIR REDLICH: Right, exactly. So

20 the question is, is it really truly sarcoid, and

21 if it is sarcoid, is it beryllium disease that's

22 being miscalled sarcoid? 
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1 And I think, by a look at -- we would

2 have a feel for that because I feel like, after

3 the end of the day, we don't want to then feel

4 like, gosh, we actually missed a group of people

5 that -- and concern has been raised. 

6 My understanding is that Hanford also,

7 if you have sarcoid, and I can check because I

8 was reading this last night, and in the Navy, I -

9 - we have the Groton Sub Base here, that they

10 consider sarcoid an occupational disease, in the

11 sub. So I just -- I think we should see what the

12 sarcoid is. They're not a huge number. And

13 then, is it truly sarcoid, and do they have

14 beryllium exposure, as you said. 

15 MEMBER WELCH: So there were -- so you

16 kind of figure -- well, there's two categories

17 with sarcoid. There's sarcoid that is beryllium

18 disease accept it as that under the Part E, for

19 whatever reason. And then there's sarcoid that

20 they decided wasn't CBD and of those, there were

21 130 cases in the database, people who applied

22 with a diagnosis of sarcoid primarily and were
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1 denied. 

2 CHAIR REDLICH: Okay. So what if we

3 took a look at -- requested 15 of those? 

4 MEMBER WELCH: That's fine. 

5 MEMBER MARKOWITZ: It's Steven. 

6 Again, the 15 is just going to get -- it's fine. 

7 It's going to give us some hints about what's

8 going on. Knowing that to actually get a more

9 thorough look at possible misdiagnosis or

10 misrepresentation of the validity of the claim

11 that we would need a considerably larger number,

12 right? 

13 CHAIR REDLICH: Yes. I was thinking

14 just in this very short run to even get a feel

15 for what other questions we might want about that

16 group and what's in it. 

17 MEMBER MARKOWITZ: Because if we look

18 at a limited number and don't find a problem,

19 we're not necessarily going to conclude that

20 there's not a problem, right? 

21 CHAIR REDLICH: That's true. But we

22 will also, by looking at the data, we'll at least
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1 have some idea of the total number of sarcoid

2 claims in there, which is not huge huge. But

3 that is correct. I guess I would call it

4 exploratory, and maybe we should look at a little

5 bit larger number. They wouldn't take very long

6 to look at, I don't think.

7 MEMBER MARKOWITZ: Well, I mean, for

8 exploratory purposes, you know, we only need a

9 limited number. To get a real handle on it,

10 we're going to need a significantly larger

11 number. So that's fine. I just wanted clarity

12 about -- 

13 CHAIR REDLICH: That's right, I would

14 consider this -- that's right. It's exploratory. 

15 MEMBER MARKOWITZ: Okay.

16 CHAIR REDLICH: That is correct. And

17 I was thinking also if then we do want more

18 information at least it would give us some idea

19 of what information to request.

20 MEMBER MARKOWITZ: Right, right.

21 CHAIR REDLICH: That's what I was

22 thinking. 
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1 And then, not to prolong this until

2 whenever, but I think once we are looking at

3 sarcoid and because of the point that was made, I

4 feel like we should do the same with the

5 ILD/pneumoconiosis. And you know what, I don't

6 have the data set open now because I didn't want

7 to start cooking on columns and sorting, but I

8 think it would be helpful to know the number of

9 ILD/pneumoconiosis claims, again, accepted and

10 denied, you know, similar questions to that that

11 we're asking about sarcoid. 

12 And if -- because if you had a

13 pneumoconiosis and you had a sensitization, a lot

14 of people would say that sounds like chronic

15 beryllium disease. Laura is probably looking at

16 that right now, but I am refraining myself and I

17 am not opening the data. So if we could just add

18 that to the data piece. 

19 MEMBER WELCH: I mean, the thing is if

20 you have -- you'll be looking at the interstitial

21 lung disease under Part E includes a lot

22 asbestosis but you don't -- I mean it's a very
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1 non-specific diagnosis. Maybe we should leave

2 that for later because there are -- well let's

3 see, there are --

4 CHAIR REDLICH: It didn't seem like

5 that large a number, but I --

6 MEMBER WELCH: Two hundred approved

7 under interstitial lung disease and a lot more

8 denied, like --

9 CHAIR REDLICH: Okay. Since I don't

10 have it open, the other aisle, is pneumoconiosis

11 separate from ILD or is it in the same --

12 MEMBER WELCH: In this spreadsheet,

13 all we got was ILD. So there's, you know, 900

14 altogether, 200 approved and 700 denied. 

15 CHAIR REDLICH: Okay. But that's over

16 all these years.

17 MEMBER WELCH: Yes.

18 CHAIR REDLICH: Out of 20,000 claims.

19 MEMBER WELCH: So asbestosis is

20 clearly a different category because there are

21 thousands and thousands of those. 

22 CHAIR REDLICH: Okay. So I would
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1 propose that we, in the same exploratory way, I

2 think we would want to first look if there are

3 any with pneumoconiosis, or ILD, excuse me, and

4 beryllium sensitization from the data piece. 

5 That's really the piece that could be a --

6 potentially an inappropriately denied claim. 

7 Does that make sense? 

8 MEMBER WELCH: Yes, there are some.

9 CHAIR REDLICH: So I would propose

10 that we also request -- I'll look at the overlap

11 with sensitization. I would think, you know, if

12 they have CBD also then they're in the B

13 category, so we're talking about the people that

14 don't have CBD but have pneumoconiosis,

15 sensitization, and are denied. 

16 MEMBER WELCH: There are, you know, a

17 very small handful. There's like six that are

18 sensitized and have a diagnosis date under ILD.

19 CHAIR REDLICH: Okay. So I think --

20 MEMBER WELCH: And they were all

21 adjudicated more than a decade ago.

22 CHAIR REDLICH: Okay. So --
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1 MEMBER WELCH: And I don't know that

2 that -- I'm not so sure we'll get much out of

3 that.

4 CHAIR REDLICH: Okay. So should we --

5 then the other pneumoconioses are -- do not have

6 sensitization? 

7 MEMBER WELCH: Right.

8 CHAIR REDLICH: Okay. So since that

9 is a grab bag, I would still personally just like

10 to -- because a lot of things get thrown into

11 that grab bag, as just an exploratory thing, I

12 don't -- if we could maybe look at ten of those

13 claims to see what's going into that category?

14 MEMBER WELCH: There's a handful that

15 have -- that were approved that had both

16 beryllium sensitization and ILD, and they're

17 under Part E, and there's a handful that have

18 beryllium sensitivity and were denied for ILD. 

19 So you could look at, you know, you could look at

20 five of each of those that are beryllium

21 sensitive and approved and beryllium sensitive

22 and denied.
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1 CHAIR REDLICH: Okay.

2 MEMBER WELCH: You won't get more than

3 that many for each one because there's only about

4 that many. There's a few more that were

5 beryllium sensitive approved and ILD, and John is

6 quicker than I to look at the diagnoses. They

7 had multiple lung disease diagnoses.

8 CHAIR REDLICH: Okay. 

9 MEMBER WELCH: Accepted as beryllium

10 disease and beryllium sensitivity, and then they

11 have this ILD diagnosis, too, so they may --

12 CHAIR REDLICH: So I guess -- you know

13 what? I think the issue that comes up is and

14 another way to look at it is -- and from talking

15 to some of the physicians involved, it seems like

16 there's many more people have beryllium

17 sensitization than have beryllium disease. When

18 you have beryllium sensitization with another

19 pulmonary condition, that starts to get confusing

20 in terms of, do you have two separate entities or

21 do those two combined and now you have chronic

22 beryllium disease?
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1 Since that seems to be an intersection

2 that generates a lot of issues, it might just be

3 good to have a sense of how big that tie is,

4 which really would say, if people have beryllium

5 sensitization, how many of them have some other

6 pulmonary diagnosis? 

7 MEMBER WELCH: So in some ways the

8 other thing that comes up with that is that

9 beryllium sensitization, and they have some

10 chronic lung disease that is an interstitial

11 disease, not just COPD, why wasn't their claim

12 already accepted as CBD?

13 CHAIR REDLICH: That's what I'm

14 saying.

15 MEMBER WELCH: Well you won't find --

16 well, you might find those by looking at these

17 ILD diagnosis dates. But I think the problem is

18 then piecing that out of the spreadsheets could

19 be hard.

20 CHAIR REDLICH: Yes. So I would just

21 say why don't we, at least to have an idea of the

22 numbers because basically, a lot of people, once
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1 they have a chronic pulmonary condition and they

2 ever smoked one cigarette in their life, that

3 condition is COPD. So I've had lots of patients

4 that are called COPD and they're not COPD. They

5 got ILD and, you know --

6 MEMBER WELCH: Right. Well take a

7 look at whatever number you want, and then we'll

8 go from there because otherwise we're kind of, I

9 think, spinning a little bit.

10 CHAIR REDLICH: Yes. So let's just

11 say why don't we just look at -- because this is

12 an initial look and we'll have some idea of

13 positive BeLPT with another diagnosis in the

14 pulmonary realm and what those are, and then

15 we'll have an idea. You know, because the main

16 pulmonary diagnoses are COPD, asthma, and then

17 this, you know, ILD thing.

18 MEMBER WELCH: Okay. 

19 CHAIR REDLICH: And the question is

20 was their diagnoses that they gave us, were those

21 all the pulmonary -- you know, we basically want

22 to see that overlap because that's just a
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1 potential pile of things that could be getting

2 denied, then re-evaluated, and -- so just to

3 summarize then, the other categories we wanted to

4 look at was the sarcoid, if we are -- people are

5 getting misdiagnosed as sarcoid, and also if they

6 are sensitized and have a pulmonary condition

7 that's getting not called CBD, what is that? 

8 MEMBER WELCH: Okay.

9 CHAIR REDLICH: And then we would have

10 some idea of at least as an exploratory --

11 MEMBER WELCH: Can you make a request

12 that DOL be able to understand, like, you know,

13 it's called this and that, you know, like ones

14 that have a positive, whether B has approved and

15 interstitial lung disease approved, those are the

16 ones you want to look at, that weren't accepted

17 for CBD, is that the group?

18 CHAIR REDLICH: Well, I mean I guess

19 to do this, the first thing we need to make sure

20 is that in the Excel spreadsheet we were given,

21 that that captures the pulmonary conditions. 

22 MEMBER WELCH: Well, I guess the ones
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1 we asked for. It captures COPD, asthma, and

2 interstitial lung disease.

3 CHAIR REDLICH: Okay.

4 MEMBER WELCH: But it's not everybody

5 with a COPD diagnosis. It's people that have

6 something related to beryllium in some way.

7 CHAIR REDLICH: Well, what we

8 requested was -- no because there are people

9 under there that are in Part E that are not in B. 

10 MEMBER WELCH: Right because we didn't

11 get every single COPD E case. We got ones where

12 they had filed for something related to

13 beryllium.

14 CHAIR REDLICH: I think we'll have to

15 clarify that.

16 MEMBER WELCH: You don't want all the

17 COPD cases. There are 10,000 of those.

18 CHAIR REDLICH: I know, but --

19 MEMBER WELCH: We definitely don't

20 want them. I mean we only want the ones where

21 people were asking to be adjudicated for

22 beryllium disease in some way or another, not a
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1 COPD case. 

2 CHAIR REDLICH: I'm just saying the

3 initial request didn't clarify that, so I think

4 we should check.

5 MEMBER WELCH: And I think what you

6 can see, and this is a visual thing, but you can

7 see what conditions people filed for.

8 CHAIR REDLICH: Yes and I don't have

9 it open now, but when I looked it looked like

10 there were people, you know, if you sorted under

11 COPD, that filed only under E.

12 MEMBER WELCH: I don't know.

13 CHAIR REDLICH: Okay. Well, we'll

14 have to check that in terms of what data we have.

15 MEMBER WELCH: Yes, because I think

16 these are all people who had a Part B claim to

17 start with. I mean, everybody's got something

18 over on the Part B side. So they originally had

19 applied in some way or another for a beryllium --

20 CHAIR REDLICH: Okay, so that's what

21 we want.

22 MEMBER WELCH: Yes, and then they end
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1 up on the E side with other diagnoses.

2 CHAIR REDLICH: Okay, that's right. 

3 And what we're trying to get a feel for is really

4 do we have people that are on the E side that may

5 be misdiagnosed or denied chronic beryllium

6 disease who have it? 

7 MEMBER WELCH: All right. So if you

8 look at people with an ILD diagnosis who are

9 beryllium sensitive and those who are not, just a

10 handful of those, to get some sense of what's

11 going on.

12 CHAIR REDLICH: Exactly. That's

13 right. 

14 Okay, and so we're going to look at

15 that on just the numbers data that are not a huge

16 number, and we're just going to do that to get a

17 feel for the overlap with other pulmonary

18 conditions, recognizing that things like COPD and

19 ILD can get misdiagnosed. 

20 MEMBER DEMENT: Yes, this is John. 

21 It's not clear to me what data we really have. 

22 There are people, and a lot of them in this
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1 database, in fact most of them, who have nothing

2 in terms of medical conditions filed under Part B

3 but under Part E. 

4 MEMBER WELCH: Oh, really? Okay. 

5 CHAIR REDLICH: And that's -- I didn't

6 want to open it now on the call, but when I

7 looked at it over the weekend that was my take. 

8 MEMBER DEMENT: Yes, and actually the

9 majority of them --

10 CHAIR REDLICH: And the request was,

11 not knowing what the numbers were like, the

12 request was COPD, too. But we can, it's clear,

13 if someone hasn't filed under B, then we would

14 just not look at those for the question we're

15 asking now, right? 

16 Because really the question we're

17 asking now is if someone got beryllium

18 sensitized, they think they have a beryllium

19 condition, and it's being called sensitized, but

20 there's possible CBD because those are also the

21 people, a number of the questions that we were

22 asked relate to that cohort, and then what is
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1 being done then to evaluate if they have CBD and

2 how frequently and all these other things. So I

3 think at least getting a sense of what that group

4 is.

5 Okay. So I think we at least have the

6 request in terms of the data piece, and then, in

7 terms of the CMC reports that we want to review

8 related to all of this, I think, basically, we're

9 interested in people that have, there aren't that

10 many, you know, with pneumoconiosis and a BeLPT

11 that have been accepted or denied. And I think

12 also, at this point, we're not interested in

13 ancient history. So another way to look at this,

14 since there's not a ton of those claims is, you

15 know, the last ten pneumoconiosis claims and

16 making sure that we include the few that have a

17 positive BeLPT. Is that -- in terms of the

18 actual claims that we're looking at. And I

19 think, in terms of looking at further, it would

20 just be helpful to see what the numbers are with

21 this overlap, you know, how many overlap with

22 COPD and things like that. Is that okay with
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1 everybody? 

2 MEMBER WELCH: Are you talking about

3 that latter part of the spreadsheet analysis

4 request or something from DOL? 

5 CHAIR REDLICH: I think the piece from

6 DOL, I would like to see the grab bag of the

7 pneumoconioses diagnoses. 

8 MEMBER WELCH: Okay.

9 CHAIR REDLICH: And I think the other

10 stuff, let's just wait and see how big this pie

11 is.

12 MEMBER WELCH: Okay.

13 CHAIR REDLICH: I think it is an

14 important pie, a piece of it, because those are

15 people that, you know, have a lung condition, are

16 sensitized, and then are being, you know, re17 evaluated and the like. 

18 MEMBER DEMENT: Are you talking about

19 the silicosis? 

20 CHAIR REDLICH: No, all I was simply

21 saying was the people that are sensitized that

22 have some other pulmonary condition. 
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1 MEMBER DEMENT: Okay.

2 CHAIR REDLICH: Okay. And then I

3 think we decided that -- so for silicosis, I

4 think we would just want the same number of

5 claims. I think silicosis is not as complicated,

6 the number of claims, the number denied and

7 number accepted, and I think we decided we wanted

8 to review, we picked a number of silicosis cases. 

9 MEMBER DEMENT: Just on a quick look

10 under Part B, it looks like about half the

11 silicosis cases or slightly less than half were

12 approved. 

13 CHAIR REDLICH: Yes, okay. I think,

14 in terms of other data, and we've expanded the

15 data section, we've expanded a little bit some

16 cases we want to review, and with that expansion

17 has included some sarcoid and some

18 pneumoconiosis. And we have talked about also

19 other information related to who is the people

20 reviewing the beryllium claims that we would

21 like. 

22 We can get input from whoever is on
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1 this call, but is there other pieces of data we

2 think or information that we, at this point --

3 obviously, I think, once we look at things, we

4 will decide we want more, but, at this point, do

5 we have any other asks? Going once, going twice. 

6 Any other people we want to talk to? Oh, and I

7 guess, Carrie, we also asked just who came up

8 with the list of questions for us. 

9 MS. RHOADS: Right.

10 CHAIR REDLICH: And where they got

11 their -- I mean, I think it's a good list of

12 questions, I just, in terms of their sources

13 because those are issues. Okay. So I think

14 that's a very pretty thorough and good list of

15 data information needs. 

16 So in terms of the timeline for this

17 data. So, John, you had volunteered the sort of

18 basic stuff in a week or two? 

19 MEMBER DEMENT: Yes, if you can get me

20 the questions, I can, first of all, evaluate the

21 data here to respond to it and get back, and I

22 should be able to turn it around in about a week.
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1 CHAIR REDLICH: Okay. And my guess

2 is, when we look at that, we will have other --

3 and I think also what we were going to do in that

4 time and while we're doing that is any other

5 variables that we are hoping we can get for the

6 data piece, correct? And then, in the meantime,

7 we are hoping in the next, like, month or so,

8 that the Department of Labor, just speaking in

9 terms of timeline, would come up with the

10 examples of the recommended, you know, the

11 decisions, the final decision, the statement of

12 facts, and the CMC reports. And, Carrie, you're

13 going to find out what's feasible there. 

14 MS. RHOADS: Yes, I'll ask the

15 program. 

16 CHAIR REDLICH: Okay. And, ideally,

17 we'd love to get those sooner, rather than later,

18 because we'd like to review them before our next

19 in-person meeting. And I would propose that we

20 pick a time for a call, you know, after we have

21 at least had a chance to look at the basic data,

22 and, hopefully, depending on how long it takes to
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1 get the reports -- 

2 MEMBER WELCH: Well, we have to do the

3 Federal Register notice, so I think we have to

4 pick, we have to give six weeks. So we don't

5 have to pick a date now and then see where we get

6 that in because we have what? Let's see. July,

7 August, September. We have three months, July,

8 August, and September, before we're getting close

9 to our meeting. 

10 MEMBER MARKOWITZ: If we pick a date,

11 you know, mid-September, that's probably the best

12 we can do. 

13 MEMBER WELCH: Yes, that's what I was

14 thinking, too. 

15 CHAIR REDLICH: Okay. So, and

16 actually, six weeks would be in the beginning of

17 August. 

18 MEMBER WELCH: Right. So we could

19 wait a little bit and then pick a date, or we

20 could just -- I mean, I suggest why don't we

21 start working on a date in September, and then

22 we'll deal with what we have by then. 
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1 CHAIR REDLICH: I agree. So Labor Day

2 this year is on September 5th. It's a little bit

3 late. How about if we pick the week after that?

4 MEMBER WELCH: Do you want to do it

5 over the phone or -- I guess we could. 

6 CHAIR REDLICH: Yes. So why don't we

7 do this? Carrie, can we have someone send out

8 like either a, you know, invites or, you know,

9 one of those calendar things, whatever, and we'll

10 find a time for a call the week of -- or do

11 people want to do it that week of Labor Day? 

12 Right now, does anyone have a strong preference?

13 MEMBER WELCH: I mean, doing it the

14 week of the 12th just gives us that much more

15 time to get --

16 CHAIR REDLICH: Yes, exactly. I think

17 that is better. And Labor Day week is always a

18 dangerous week. 

19 MEMBER MARKOWITZ: Why don't you poll

20 people for the week of the 12th and the week of

21 the 19th just to be safe? 

22 CHAIR REDLICH: Okay. That sounds
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1 good. So our goal is to set up our next call the

2 week of either the 12th or the 19th and, at that

3 point, we will hopefully have reviewed data, have

4 some idea. I mean, in the meantime, we can

5 request -- we don't need to wait until then. I

6 think very shortly we could request additional

7 variables that we would like and go ahead and

8 we'll, you know, however people want to do that,

9 either feed it to me and I feed it to Carrie or

10 if someone else wants to be the person. And then

11 we will, hopefully, by the October call, have

12 reviewed data, even if there's any additional

13 data, and, ideally, some of the reports. 

14 So my thought, if we get, in an ideal

15 world, if we get the reports in time to review, I

16 was thinking it would be helpful to make up a

17 little criteria for rejection or whatever thing

18 so that we could then come up with some summary

19 of the reports, and I think it would probably

20 become apparent, once we reviewed some of them,

21 what we would want. So, ideally, we'd be able to

22 sort of say we've reviewed the 50 reports and I
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1 think, at that point, have a better feel for some

2 of the issues. 

3 And then I guess also, Carrie, by that

4 call, whatever information the additional things

5 that we had requested, in terms of just

6 information about the physicians doing the CMC

7 reports because I think that's probably something

8 either -- they should be able to give that to us. 

9 And I think someone had also mentioned also

10 whatever that people that had trouble getting

11 before but at least what criteria there are from

12 the selection and training. 

13 MS. RHOADS: Okay. I will pass those

14 on to the program. 

15 CHAIR REDLICH: And I guess, you know,

16 if it's something that we can get and it will

17 take extra time or if, for some reason, we can't,

18 then that's probably, you'll probably get an

19 answer relatively quickly. 

20 MS. RHOADS: Probably.

21 CHAIR REDLICH: Okay. Are there any

22 other items? 
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1 MEMBER MARKOWITZ: This is Steven. 

2 There are a couple of issues. One is the

3 silicosis is within the domain of the committee. 

4 It's a lot more straightforward for a number of

5 reasons. 

6 And then, secondly, on the attachments

7 that Carrie sent around, which was from our April

8 meeting where the DOL lists issues that they want

9 help on, there are a number of scientific issues

10 related to CBD that we haven't discussed --and

11 sensitivity -- that we haven't discussed, and we

12 probably don't need to discuss them here now. 

13 But we should develop a plan for it.

14 For instance, they've asked for our

15 input into, quote, consistency of testing results

16 among different diagnostic facilities. We're

17 probably not going to get that from the claims. 

18 That's probably --

19 CHAIR REDLICH: You know what? Thank

20 you because that was another question I had. 

21 And, actually, Laura knows a lot about the

22 literature on consistency. But my understanding
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1 now is that there are two facilities doing the

2 testing. Is that correct, or it is more than two

3 currently? 

4 MEMBER WELCH: I don't know what

5 happens if you're, you know, if you call up Quest

6 and they tell you what that was. I don't know

7 where it goes. You know, then we send them out,

8 from our program, we send them out to National

9 Jewish or ORISE.

10 CHAIR REDLICH: Yes. So I guess the

11 first question I had related to, those are the

12 only two that I am familiar with. So an

13 important question is are there any other labs

14 that are doing the testing? And that's something

15 that whoever is getting these records would know

16 from reviewing them. 

17 MEMBER WELCH: For the Department of

18 Labor's question, are they questioning a

19 particular lab? 

20 MEMBER MARKOWITZ: My guess is -- it's

21 Steven. My guess is they see discrepant results

22 between the two labs. 
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1 CHAIR REDLICH: You know, the American

2 Thoracic Society came out about a year or two ago

3 with one of their official documents that sort of

4 reviewed this. My understanding is that I think

5 there is much more consistency, and you can

6 correct me, Laura, that I think this is more of a

7 history issue, but I think there is -- 

8 MEMBER WELCH: Yes. I mean, I think

9 that there's a -- DOL did a cross-comparison of

10 labs, but it was probably ten years ago, between

11 what was done in the three reference labs because

12 Specialty in California was doing it. I don't

13 think there's been so much cross-reference

14 between the two, but, you know, you can get, if

15 you take the same guy and test him every year for

16 ten years, you will not come up with the same

17 results. I mean, the data from Wellman or

18 whatever their new name, shows that in their

19 surveillance program. And sometimes it's people

20 who have a very low sensitivity index, and then

21 the next time it's negative, the next time it's

22 borderline, then it's positive. So they're not
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1 really, it's not a lab variation as much as it's

2 the biological variation of the test.

3 CHAIR REDLICH: That's right. And --

4 MEMBER WELCH: I'm happy to take a

5 look at what's new on that and just kind of put

6 together a summary. 

7 CHAIR REDLICH: I have recently done

8 this, and, honestly, there wasn't, as far as I

9 was aware, of anything really new on this since

10 the ATS document. And I sort of, you know, the

11 newer, more relevant science on diagnostic tools,

12 I just don't think there is a newer or better

13 tool out there now. But it is true that we need

14 to address, I guess, at this point, the question

15 is a plan for how to address this. 

16 MEMBER WELCH: You know, if what

17 they're getting, is they're getting reports from

18 physicians that are saying, well, we don't have

19 an LPT, but we've done this something or other

20 and it shows sensitivity. Then they may need

21 help knowing whether to accept that or not. So I

22 think maybe some more clarification, and then we
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1 can do that at the next meeting on what the --

2 you know, we don't see there's an issue on moot

3 or variability, but can they be more specific? 

4 CHAIR REDLICH: Okay. And maybe, in

5 terms of an approach, I don't really want to

6 propose a whole evidence-based review. I mean, I

7 think there's a recent official document that --

8 but, you know, there are, and I think it's beyond

9 our scope, there's issues of, you know, one test,

10 two tests, and the like, but that's sort of been

11 decided, and that one positive is positive. But

12 I do think there was one or two other questions

13 that I actually wasn't totally clear what the

14 question was, and I would propose, if anyone has

15 -- like, one of them I think I put a question

16 mark on it. I just have to find it. But I think

17 if we have questions that we're not quite sure

18 they're asking, we could go ahead before the

19 meeting and, since Carrie is going to get back to

20 who actually came up with these questions, we

21 could ask for clarification, as far as that goes. 

22 And then I think -- but, Steve, you do
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1 raise a question. I have an opinion on some of

2 these, and I think it's reasonable, but, like,

3 something like input of false negative and false

4 positive and contribute to that. What I would

5 not like to propose is that we do some evidence6 based review on the subject. That's over and

7 beyond. But I think that there are -- and I

8 think we could cite, you know, recent, like ATS

9 document, address a number of these questions. 

10 MEMBER MARKOWITZ: This is Steven. 

11 Look, I don't think we have the resources or

12 ability, nor are they asking for any sort of

13 systematic review. 

14 CHAIR REDLICH: Yes, but I think

15 guidance and I --

16 MEMBER MARKOWITZ: They're trying to

17 take advantage of the fact that, you know, their

18 expertise in the past has not been necessarily

19 all that great, so they're trying to take

20 advantage of the fact that they have some people

21 that will do some work. And I think if a subset

22 of people put together their own consensus
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1 opinions that are reference that that would

2 suffice. 

3 CHAIR REDLICH: I agree. And I think,

4 at this point, that many of us would be able to

5 do that. Now, I mean, don't you agree, Laura,

6 that I think -- and John -- you know, just in

7 terms of if you've been seeing these people that

8 -- okay. I guess, you know, I was feeling a

9 little bit -- but, like, looking at some of the

10 actual claims reports might add some

11 clarification to some of the questions, and so

12 that's why I didn't want to get too bogged down. 

13 And a couple of them are, like, you know, one was

14 on critically ill patients. Yes, you don't do

15 that. And that's one of the reasons why you

16 might not have a tissue diagnosis.

17 MEMBER MARKOWITZ: So maybe in the

18 September call, we can revisit these questions

19 when we know more and kind of identify what our

20 product is and also what our time table is. 

21 CHAIR REDLICH: That sounds good. And

22 I think what we could also do by then is, you
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1 know, sort of maybe identify those that require a

2 little more time than others. Okay. 

3 And then the other issue that you

4 mentioned was silicosis. So I think we had

5 included that in the data requests and also the

6 review of charts request. I occasionally mince

7 my words between silicosis and sarcoid, so we

8 were going to look at the number of cases in the

9 data accepted and then also look at, given a

10 number of silicosis cases and at least, you know,

11 the number that have been denied. 

12 Okay. So I think that is the

13 silicosis piece. Do we have other items or

14 issues? 

15 MEMBER VLIEGER: I'd like to point out

16 that, along with the review of records that we're

17 requesting, please review the procedure manual

18 for these conditions, particularly CBD and

19 sarcoidosis, as the procedure manual is very

20 convoluted for both the claims examiner and the

21 claimants. And if we could, you know, look at

22 that and maybe clean that up a bit with the way
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1 that we look at the wording of it. A lot of why

2 these claims go to a CMC with a really circuitous

3 list of evidence is based on the way the

4 procedure manual has the claims examiner do the

5 work. 

6 CHAIR REDLICH: Okay. So now just so

7 we're clear, are you talking about the document

8 that got emailed? 

9 MEMBER VLIEGER: No, there's

10 additional evidence. You only sent part of the

11 procedure manual. It's actually a few paragraphs

12 below CBD is where sarcoidosis is. So you need

13 to look at the procedure manual starting under --

14 MEMBER MARKOWITZ: 12C. 12 is

15 sarcoidosis. 

16 MEMBER VLIEGER: Yes, but there's more

17 to the procedure manual than what you were sent. 

18 It's actually quite lengthy. 

19 MEMBER WELCH: At one point, we got

20 sent, in response to a question, a link to the

21 procedure manual, and I can send that or Carrie

22 can. 
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1 CHAIR REDLICH: Yes. What I had done

2 is I thought I had taken the relevant chapter

3 from it, but what you are saying is that there

4 are other relevant chapters in there that I

5 missed. Is that -- 

6 MEMBER MARKOWITZ: Actually, it's in

7 the same chapter, but, regardless, you know, the

8 procedure manual is available on the EEOICP

9 website. It's available through the Advisory

10 Board, our first meeting with the references. 

11 CHAIR REDLICH: Okay. And I had just

12 resent it. So I agree. And that's something I

13 think -- you had mentioned that it conflicts with

14 some other either pamphlets or information. I

15 think if there is any other sort of documents

16 where there are some conflicts, that would be

17 really helpful to get them. 

18 MEMBER VLIEGER: Those are DOL

19 publications. 

20 CHAIR REDLICH: Okay. Was there a lot

21 of -- Carrie, is there someone who could take a

22 look and see what other relevant information
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1 there is? 

2 MS. RHOADS: Well, which ones are

3 people thinking conflict with each other? 

4 Because I can look up whichever ones you think

5 conflict. 

6 MEMBER VLIEGER: I think, Carrie, if

7 you provide the current pamphlets on CBD and Part

8 B lung conditions, they show a simplified method

9 for what's really required, but then, when you

10 provide that information, it doesn't meet the

11 criteria in the procedure manual. 

12 MS. RHOADS: Are you talking about,

13 like, brochures or something? 

14 MEMBER VLIEGER: Yes, the pamphlets

15 and the handouts, the one-pagers that are at the

16 resource center and then the handouts that DOL

17 gives out at town hall meetings. There's like

18 five pamphlets. 

19 MS. RHOADS: Those should be on the

20 website, as well. I'll take a look and see

21 what's on there. 

22 MEMBER VLIEGER: Yes. There's
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1 different versions of them, too, and I'm not sure

2 which versions are still active. So it will be

3 important to see if there's more than one version

4 of those.

5 MS. RHOADS: Okay. 

6 CHAIR REDLICH: So this is just a

7 general question, and I suspect it will come up

8 under the medical advice subcommittee, but, as

9 institutions have switched to electronic medical

10 records, any medical history has sort of

11 disappeared from some institutions and it's

12 become sometimes even more challenging to get

13 records, at least at our institution. And I

14 don't know if that is a more general problem or

15 not. In this case, I guess we will find when we

16 review some cases because there can be an issue

17 of lack of documentation and then there can be an

18 issue of lack of actually having the record that

19 would have the documentation. And the World

20 Trade Center, that was only, you know, 10 or 15

21 years old, that was a big issue where just not

22 really even being able to get the medical
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1 records. So I think we will get some insights

2 into that when we review things. I don't know if

3 anyone has a thought or opinion on that. Laura

4 or -- 

5 MEMBER WELCH: No. I mean, I think we

6 should, maybe partly because I'm running out of

7 steam a little bit, I feel like we have a lot of

8 stuff that's going to be coming in and we have

9 another call and I can process it all better the

10 next time around. 

11 CHAIR REDLICH: Maybe just because --

12 I think let's leave that for now. Okay. I think

13 we have gotten a ton done today. Any other

14 thoughts? Steve, anything else that you think we

15 should be covering? 

16 MEMBER MARKOWITZ: No, no, that's it. 

17 CHAIR REDLICH: You know what? I do

18 think the overlap between the others, you know,

19 maybe when we have our call in September, it

20 might be good to get a little feedback on the

21 other two. 

22 MEMBER MARKOWITZ: Right, yes. I
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1 wouldn't worry, you know, I wouldn't worry about

2 overlap at this point.

3 CHAIR REDLICH: Okay. Well, thank you

4 all very much. I appreciate everybody's time. 

5 Carrie, do you have anything else? 

6 MS. RHOADS: No, nothing else. Just

7 thanks, everybody, for your time. 

8 CHAIR REDLICH: Okay. And --

9 MS. RHOADS: And all the work that

10 you're going to do.

11 CHAIR REDLICH: I guess you'll

12 circulate maybe the current understanding of our

13 endless requests, and then we will review it and

14 see if we have it on paper correctly. 

15 MS. RHOADS: I can send you a list of

16 what we think the action items are, and also I'll

17 send something around about picking a date for

18 the next call.

19 CHAIR REDLICH: Right. And then we'll

20 also get with John in terms of the data requests. 

21 Very good. Okay. I think we are ready to

22 adjourn. 
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1 And then, in terms of getting feedback

2 from anybody who is on the phone, how does that

3 work? 

4 MS. RHOADS: Well, anybody who has a

5 comment, in the Federal Register the comments

6 were to be sent to the Energy Advisory Board

7 email. That can be used for anything, as well,

8 after the meeting.

9 CHAIR REDLICH: Okay. So someone

10 would submit comments or suggestions to that, and

11 then you would pass them on to us? 

12 MS. RHOADS: I would, yes.

13 CHAIR REDLICH: Okay, very good. 

14 Thank you all. Happy July 4th. 

15 (Whereupon, the above-referred to

16 matter went off the record at 1:24 p.m.)

17

18

19

20

21

22
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A

a.m 1:10 4:2 70:1,2

ability 48:13 147:12

able 24:22 39:22 40:17

48:9,20 62:4 67:18

87:14 93:1 97:14

128:12 136:22 140:21

141:8 148:4 153:22

above-entitled 69:22

above-referred 156:15

absolutely 89:21

accept 29:15 31:5 61:6

61:10 71:13 79:13

86:5 118:18 145:21

acceptable 23:14

acceptance 32:15

accepted 21:12 22:18

23:20 25:16 29:14

30:16,19,21 42:19

52:2,11 53:17 55:9

59:5,6,20 60:8,11

61:18,21 62:16 63:10

63:12 64:1,3 87:19

88:10 92:6 104:5,6,6

106:22 109:3,12,13

109:14 110:8,13

113:15 114:4 121:9

125:9 126:12 128:16

133:11 135:7 149:9

accomplish 9:16 22:6,8

accumulate 38:14

accurate 7:3 34:2

Act 10:9 17:10,12 50:6

action 155:16

active 153:2

actual 12:4,21 31:6

32:1 54:18 56:10

72:16 133:18 148:10

add 9:10 11:16 14:2

16:3 20:13 66:1

105:12 112:11 121:17

148:10

added 70:6

addition 60:17 61:12

82:20 96:6 105:14

additional 9:15 13:4,13

24:10,13 26:11,17,18

27:1 38:8,14 39:6,15

41:4,22 47:22 70:15

103:2 110:20 140:6

140:12 141:4 150:10

address 13:11,18 14:8

14:19 16:13 101:20

145:14,15 147:9

addressed 13:3 16:14

69:2,3 83:9

addressing 76:8 106:15

adjourn 155:22

Adjournment 3:21

adjudicate 10:15 19:4

97:4

adjudicated 52:8,10

87:13 113:1 123:21

129:21

adjudicating 89:7

adjudication 30:6 31:8

48:2,12 82:13 87:16

91:22 96:18

Administratively 43:10

advantage 147:17,20

advice 153:8

Advisory 1:3 4:6 5:14

6:14 7:19 8:7 44:20

47:1 151:9 156:6

advocacy 30:3

advocates 28:6 32:16

affirmative 117:6

agenda 6:1 9:9,11 10:1

12:15 16:12 69:1

agendas 10:20

Agent 81:2,11

ago 62:6 79:4 87:9

123:21 144:2,10

agree 16:6,22 18:18

21:2,17 25:20 26:22

27:14 33:15,19 49:18

58:4 65:20 66:18

139:1 148:3,5 151:12

agreement 63:15 68:20

ahead 25:2,11 140:7

146:18

aisle 122:10

allows 29:17,20 103:3

alongside 109:12

alphabetical 46:5

altogether 122:14

amenable 32:7

American 11:21 144:1

amount 81:17

analyses 24:21

analysis 32:14 134:3

analyze 26:21

ancient 133:13

and-forth 50:10

answer 84:19 85:17

93:19 141:19

answered 113:11

answering 13:9

anybody 7:6 9:3 26:22

36:3 48:22 100:13

156:2,4

anyway 80:10

apologize 108:3,5

apparent 63:6 94:16

140:20

apparently 86:3

appeal 48:4,10

appeals 48:19

appear 51:4 65:8 78:16

106:13

appears 112:2

applicant 48:6

application 20:15 37:7

75:20

applications 87:22

applied 21:1 27:8 62:14

85:21 118:21 130:19

apply 17:17,20 18:4,20

21:10 77:9,11 78:19

85:4

applying 109:22

appreciate 4:11 155:4

appreciation 11:2

approach 13:12 69:8

146:5

appropriately 75:22

approval 32:10 112:13

112:16

approved 30:13 46:4,7

46:9 82:10 88:1,5

102:8,16,19 103:2

104:12,14,18 105:20

105:20 111:10 114:10

115:8,9,22 116:8

122:6,14 124:15,21

125:5 128:14,15

135:12

approving 29:21

April 6:14 88:17 142:7

area 1:6 10:12,14 71:16

74:3 75:2 84:20 86:20

areas 3:17 13:17 72:7

82:9,10

argue 101:5 117:12

arguing 79:8

asbestosis 121:22

122:19

asked 21:7 25:9 34:10

36:21 37:13 38:16

67:8 79:3 86:8 129:1

132:22 136:7 142:14

asking 15:3 50:19

57:13 58:2 59:3,4,12

59:13 60:22 85:21

93:21 95:18 121:11

129:21 132:15,17

146:18 147:12

asks 66:2 67:12,16

136:5

aspect 68:10

aspects 68:18

assemble 39:16 46:16

assembles 40:12

assess 15:4

assessment 16:8,16

assistance 26:12

assume 72:7 76:8 86:9

92:19

assuming 65:21 101:4

assumption 86:12

asthma 42:1,4 80:17

127:16 129:1

ATS 79:19 145:10 147:8

attachments 8:17,20,22

83:16 142:6

attempted 62:18

attest 75:21

attorney 44:13

August 138:7,8,17

availability 28:13

available 5:7 7:9,11

24:14 28:18 34:5

38:18 39:8,18,21

151:8,9

award 97:8

awarded 108:14

aware 8:4 145:9

awesome 77:2

B

B 1:6 4:9 8:9 11:10

13:19,22 14:7 21:6

42:7 69:3 94:12,19

102:16,20 103:1,16

103:18 104:5,8,11,15

104:17 105:21 106:11

106:13,19,22 107:5,5

107:13,15,18,21

108:12,17 109:6,16

109:22 110:8,13

111:10,18,21 112:2,4

112:5 113:12,19,21

123:12 128:14 129:9

130:16,18 132:2,13

135:10 152:8

back 10:3 22:22 26:14

48:11 67:13 68:22

69:13,16,18 70:7,12

82:2,2 96:16 102:1

136:21 146:19

back- 50:9

back-and-forth 50:10

bag 124:9,11 134:6

ball 59:13

base 91:5 118:9

based 25:18 35:5 57:9

97:9 147:6 150:3

basic 23:18 36:20 40:18

105:12 136:18 137:21

basically 9:11 17:3

30:13 68:3 105:5

126:22 127:21 133:8
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

158

basis 12:2 17:8 98:22

117:13

bat 76:12

BDDS 46:5

began 86:1,6

beginning 48:17 138:16

believe 83:14

belong 106:19

belongs 18:16

BeLPT 101:3 127:13

133:10,17

benefit 108:13

benefits 85:1 103:19,21

104:7

beryllium 10:10,11,19

11:11,11 14:2,20 15:4

16:9 17:4,8,13,17

19:11,17 20:2,9 21:20

23:3 24:17,17 28:15

28:15 29:16 30:15

34:9,20 36:17 41:21

42:2,4 52:15 57:15

58:18,18 59:1 63:16

63:19 71:8 74:5 75:10

76:11,18 77:14 79:19

82:6 84:9,22 88:3

89:6 90:2 92:5,9

95:15 98:22 99:1,1,6

99:10,20 100:7,15

101:2 102:20 103:9

103:15,19 104:3,10

104:18 108:7 110:14

111:2,3 112:8 113:17

113:18 114:20 115:2

117:5,11,14,17,21

118:14,17 121:15

123:4 124:16,18,20

124:21 125:5,9,10,16

125:17,18,22 126:4,9

129:6,13,22 130:19

131:5,9 132:17,18

135:20

beryllium-specific

18:20

BES 88:1

best 13:6 47:12 138:11

better 23:15 36:22 47:4

47:11 50:16 52:21

54:9,10 55:21 80:11

139:17 141:1 145:12

154:9

beyond 146:8 147:7

big 16:18,21 41:20

107:10 126:3 134:10

153:21

big-ticket 9:22

bigger 96:3

biological 145:2

biopsy 35:11 36:18

79:15

biostats 42:11 44:9

Bird 4:20

bit 37:4 82:15 120:5

127:9 135:15 138:19

139:2 148:9 149:22

154:7

blah 65:18

blank 115:14

blanks 115:16

blobbity 65:18,18

board 1:3,20,21 4:6,12

4:19 5:14 6:8,14,19

7:20 8:1,7 44:20,21

47:1 77:2 88:17 92:19

94:21 151:10 156:6

Board's 4:9,17 5:7,12

6:13 7:9,17

boarded 90:14

bogged 13:8 148:12

borderline 144:22

bother 115:7

box 71:18

boy 104:11

branch 30:6 48:12

96:18 98:12

break 5:2,4 68:22 69:10

briefly 62:13

broader 79:4

brochures 83:5 152:13

bunch 26:5 56:6 114:15

burden 47:2

business 40:10

buzzing 15:2

C

C 21:5

calendar 112:14 139:9

California 144:12

call 9:4 27:16 42:17

54:1 66:21 67:19

69:10,13,15 84:18

120:3 132:6 136:1

137:20 139:10 140:1

140:11 141:4 143:5

148:18 154:9,19

155:18

call-in 6:11

called 6:22 59:19 106:7

106:8 127:4 128:7,13

132:19

calls 67:11 92:15

cancer 56:3,3,12 75:11

canvas 72:6

capacity 7:22

captured 48:7

captures 128:21 129:1

card 85:1,2 103:12

Carrie 1:10,16 2:11

3:11,14 4:4,14 16:5

20:12 26:6,7 27:15

30:1 39:15,16 40:11

43:15 44:3 46:18 51:1

59:2 63:22 66:5 72:18

83:15 88:15 95:17

98:4 136:7 137:12

139:7 140:9 141:3

142:7 146:19 150:21

151:21 152:6 155:5

carries 97:5

case 16:18 20:9 27:13

34:3 40:9 58:10 65:19

67:10 87:12,13 90:12

90:16,21 94:3 106:9

129:11 130:1 153:15

cases 17:21 22:16 23:2

37:12 48:3 50:21

63:16 80:13 88:18,19

89:16 94:11,18 97:8

100:7,9,20 101:12

102:2,5,14 107:4

110:6,21 113:14

118:21 129:17 135:8

135:11,16 149:8,10

153:16

categories 10:2 13:3

41:18 118:16 128:3

category 55:1 102:10

102:11 105:3,4,4,16

106:18 112:4,5 114:3

122:20 123:13 124:13

causation 30:9 31:2

65:18 97:3,11

CBD 32:10,12,14 37:6

37:18 46:7,9 52:6,15

53:16 78:12 80:6,9

83:22 85:4 87:22 88:2

96:16 97:11 104:12

104:19 106:6,16,17

109:2,3,11,13,14,22

115:9 116:2 118:20

123:12,14 126:12

128:7,17 132:20

133:1 142:10 149:18

150:12 152:7

center 29:1 54:15 56:2

81:3 92:13 152:16

153:20

central 21:13

centralized 19:16

certain 63:3 72:8 74:9

101:6

certainly 19:19

certifications 93:14

certified 7:8 77:3 92:20

94:21

CEs 19:2

cetera 55:14

CFR 17:16,17,18

chain 62:18

Chair 1:10,16,21 4:14

4:17 7:8 8:10,12,19

9:1 15:1,9 16:22 17:9

18:8 19:10,21 20:11

21:2,16 25:2,6,8,20

26:19 27:14 28:20

34:4 35:8 37:10,19

38:7 39:3 40:15 41:19

42:11 44:6,14,22 45:7

45:13,19 46:11 47:6

49:1 50:15 51:3,10,12

52:6,14 53:2,12 54:14

55:7,19 56:1 57:22

58:7,11,21 60:7,21

61:7,16 62:2 63:5,13

64:6,9 65:2,13,20

66:5,16 67:21 69:17

70:3,11 72:3 73:12,18

73:22 74:8,21 76:6,21

77:14,19 78:2 79:10

80:3,12 81:16,21

83:12,18 84:6 85:7

86:7,14,18 87:7 88:12

88:20 89:12 90:1,16

90:22 91:9,14 92:4

93:6,21 94:3,8 95:5

95:11,21 96:21 97:5

97:13 98:14,20 99:4

99:12,19,22 100:11

101:14,18 102:4,9

103:15,20 104:1,13

104:20 106:2,14

107:8 108:2,5 109:8

110:1,12,17 111:7,14

111:22 112:10 113:3

113:8,22 114:11,15

114:22 115:18 116:11

116:17 117:9,19

119:2,13,21 120:13

120:16,21 122:4,9,15

122:18,22 123:9,19

123:22 124:4,8 125:1

125:8,12 126:13,20

127:10,19 128:9,18

129:3,7,14,18 130:2,8

130:13,20 131:2,12

132:5,10 134:5,9,13

134:20 135:2,13

136:10 137:1,16

138:15 139:1,6,16,22

141:15,21 142:19

143:10 144:1 145:3,7

146:4 147:14 148:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

159

148:21 150:6 151:1

151:11,20 153:6

154:11,17 155:3,8,11

155:19 156:9,13

challenging 10:14 72:9

153:12

chance 22:15 66:8

137:21

changed 79:2

chapter 151:2,7

chapters 151:4

characteristic 78:12

charge 13:20 14:12

charts 149:6

cheat 55:8

check 44:13 111:8

118:7 130:4,14

choice 91:6

choose 38:19 50:1 94:6

chronic 10:11,19 11:11

36:17 42:4 63:16,19

78:14 86:1,5 111:3

121:14 125:21 126:10

127:1 131:5

chronology 110:3

cigarette 127:2

circuitous 150:2

circulate 155:12

circumstances 101:6

cite 147:8

claim 28:20 29:7 30:14

30:17 31:4,5 37:7

38:1,3,4 46:8 52:1

57:7 58:10,17 59:8,9

59:15,22 60:4,17 62:5

62:8,18 63:7,10 64:20

74:20 79:14 82:15

85:4 88:4 91:2 96:20

97:4 99:2 117:17

119:10 123:6 126:11

130:16

claimant 1:17 72:2

claimant's 31:17

claimants 78:18 85:20

149:21

claims 10:15 11:3,4,9

12:2,5,10 13:1 16:1

16:16,20 18:14,21

19:1,3,5,22 20:2,16

20:19,21 23:19 26:3

27:5,7,20 28:3,7,9,11

29:1 30:5,15,16 33:4

35:2 36:17,22 37:21

38:13 40:2,3 41:22

42:19,22 47:11 48:9

48:13,17,19 49:3

50:18 51:8,13 52:2

53:1,5,16 54:8,9,12

54:18 56:6 57:15,19

57:20 62:22 63:21

64:2 67:12 68:10

71:11 73:10 74:2 75:4

76:2 79:1 80:6 82:8

82:13 83:6 84:9 85:8

85:19 86:16 87:19

89:6,22 90:2,4,9 92:6

92:8 94:5 96:1,16,21

97:8,22 98:8,17,21

99:5,9,18 106:18

107:6,17 112:22

114:7,17,19 115:5,20

117:16 120:2 121:9

122:18 124:13 133:14

133:15,18 135:5,6,20

142:17 148:10 149:20

150:2,4

clarification 26:7 41:6

43:14 103:9 145:22

146:21 148:11

clarified 36:14

clarify 12:7 13:20 15:17

44:8 88:22 129:15

130:3

clarity 83:9 120:11

classic 35:13

clean 149:22

clear 61:2 71:21 75:11

77:9 86:10,13 110:21

131:21 132:12 146:13

150:7

clearer 54:19

clearly 6:21 56:12

122:20

clicking 5:18

clinical 94:10

clinicians 72:16

close 138:8

closely 14:2

closer 23:9

clueless 76:18

CMC 60:11,12,19,19,20

64:17,22 65:1,2,21,22

67:3,11 71:5 77:1

85:12 86:9 89:17

90:10 91:12 93:4,18

94:5 95:4 96:11,15,22

97:3 99:9 114:6 133:7

137:12 141:6 150:2

CMCs 19:2 20:18 73:8

73:13 74:10 75:9

76:20 89:6 94:13,15

97:16

code 45:5

cohort 132:22

colleagues 11:22 18:14

72:10 76:14,15

collect 31:6 74:14

collecting 28:7

column 109:12,15

columns 39:7 46:3 50:2

121:7

comb 16:2

combined 125:21

come 14:6 16:18 24:2

24:12 27:1 32:20 39:6

39:19 41:4,8 42:12

45:8,15 55:9 59:9

66:9 68:3,4,22 69:4

69:16 96:16 137:9

140:18 144:16 153:7

comes 19:7 20:18

125:13 126:8

coming 37:1 77:12 80:4

154:8

comment 6:10 21:5

73:5 156:5

comments 5:6 70:19

156:5,10

committee 14:18,19

16:10,12,19 20:14

95:12 142:3

committees 11:7 16:14

common 56:21 101:5

communicate 9:6,7

39:14

community 1:13,15,17

73:2

compare 83:4

compensable 106:12

109:1

compensate 81:5

compensation 80:20

81:1

compilations 64:15

compile 32:10

compiled 52:22

completely 46:2

complex 10:12

complexity 48:14

complicated 10:16

19:12 23:16 43:6 45:4

47:9 75:2 92:1 135:5

complication 21:6,9

complications 14:7

21:12

component 24:18

comprehensive 33:13

conceivable 107:14

concentrate 92:12

concentrated 75:5

concentration 89:8,10

concern 118:5

concerns 9:5

conclude 119:19

conclusions 52:20

54:13 55:17 57:9

condition 42:3 80:17

86:1 94:1 125:19

127:1,3 128:6 132:19

134:15,22

conditions 1:6 4:9 8:9

11:11 41:13 46:3,4

105:18,22 111:10

116:4,6,7 128:21

130:7 131:18 132:2

149:18 152:8

conference 9:4 35:10

66:20 67:19 79:14

92:15

conflict 152:3,5

conflicts 151:13,16

confused 12:21

confusing 10:12 82:22

101:1 109:16 125:19

confusion 84:20 85:6

Congress 10:9 15:14

consensus 147:22

consider 92:17 101:8

118:10 120:14

considerably 119:11

considered 17:4 89:14

90:20

consistency 10:22

55:18 75:2 80:14

142:15,22 144:5

consistent 77:17 78:13

82:5

constituencies 71:1

constituents 70:22

constitutes 15:7

constructed 20:22

construction 30:21

consultant 61:14 91:21

consultants 19:3 20:4

29:22 74:7

consulting 16:17 30:8

31:3 97:10

CONTENTS 3:8

continue 8:4

contract 19:3 20:3

29:21 61:13,16 74:12

contractor 74:15

contribute 147:4

convene 8:6

convoluted 83:11,22

149:20

cooking 121:7

coordinate 44:4

COPD 14:1 16:12,15

21:21 30:14,15 42:1,4

80:16,17 126:11

127:3,4,4,16 129:1,5
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Neal R. Gross and Co., Inc.

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129:11,17 130:1,11

131:18 132:12 133:22

Copies 5:5

copying 67:17

core 19:16 21:13

correct 17:7 52:6 65:6

89:18 104:15 120:3

120:16 137:6 143:2

144:6

correctly 65:8 155:14

count 88:2

counted 51:21 87:21

country 73:20 74:9,19

92:3

counts 34:11

couple 13:15 22:19

24:1 36:21 40:22

67:13 70:12 95:10

115:13,15 142:2

148:13

cover 21:19

coverage 103:10

covered 18:15 96:8

covering 12:8 154:15

created 10:9

credentials 94:20

criteria 10:10 15:6

17:12 20:9 25:18 37:2

37:11 48:18,18 68:14

71:12,15 81:11,13,16

82:17 83:3 84:1,2,3

85:5,5,11,13,21 86:11

93:2,4,7,15,22 94:3,4

94:12 96:4,5 140:17

141:11 152:11

critical 36:5 66:1 67:1

89:18 96:11

critically 148:14

criticism 33:22

cross-comparison

144:9

cross-reference 144:13

CT 34:19 35:12 82:5

curious 98:8

current 15:21 42:22

81:1 152:7 155:12

currently 37:1 88:18

143:3

cut 35:15

CY 112:20

D

D 1:18 109:1

D.C 32:21

d.htm 5:14

dangerous 139:18

data 3:19 11:2 22:10

23:9,22 24:10,13,16

24:18 25:5,13,17 26:5

26:10,13 32:18 33:4

33:12 34:15 38:8,9,14

38:17 39:15 40:1,6,6

41:11 43:16,20 44:1

45:6 46:1,5,6,19 47:8

50:2 54:10 57:7 68:3

70:5,15 84:8 88:7

100:3,16,19 101:9,22

102:1 105:9,12 107:9

107:11 109:9 112:12

113:13 115:4 117:1

119:22 121:6,17,18

123:4 130:14 131:15

131:21 133:6 135:14

135:15 136:1,15,17

136:21 137:6,21

140:3,12,13 144:17

149:5,9 155:20

database 22:16 33:12

51:2 87:2 95:4 100:9

101:14 118:21 132:1

date 5:19 37:7,8 39:1

46:9 48:1,2,7 51:22

51:22 52:3,4 87:10,12

87:15,16 112:13,22

113:6 123:18 138:5

138:10,19,21 155:17

dates 37:6 41:7 48:5,15

48:21 63:10 126:17

day 17:4,8,16,17 45:9

118:3 139:1,11,17

days 7:10,17 17:12

deal 12:1 16:19 41:11

71:11 76:17 88:21

138:22

dealing 12:9 13:22

15:13 99:19

deals 19:16 20:1

Deb 32:8

decade 123:21

decide 50:12 91:3

94:13 98:2 136:4

decided 48:9,17 49:4

57:15 72:19 75:9

84:14 98:22 118:20

135:3,7 146:11

decides 29:18 80:18

deciding 13:10

decision 47:15 48:2

59:14,14,16,17,18,19

60:5,5,14,14 61:5,8

61:22,22 62:7 63:7

71:6 96:14 137:11

decision- 10:20 43:1

71:3 85:12

decision-making 12:10

34:15 35:4 51:5 55:18

56:22 62:9 66:22

70:21 101:10

decisions 27:21 28:8,8

31:13 49:10 53:1,17

137:11

dedicated 5:20

define 3:16,19 21:11

33:9 70:4 79:12

defined 10:9 12:6 16:9

50:3 84:16

defining 12:15 22:5

71:14 81:4

definitely 67:20 72:19

80:19 89:9 129:19

definitions 15:16,17

19:6

degree 90:12

delay 33:17 87:18

deliberations 4:13

Dement 1:14 4:16 14:11

14:12 15:5 24:19,20

25:4,7,12 27:3 41:10

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64:15,17 72:6 76:20

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exclusive 21:14

excuse 108:2 123:3

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expanded 135:14,15

expansion 135:16

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length 11:22

lengthy 150:18

let's 16:3 42:21 57:14

69:10 71:2 85:8 91:9

92:7 104:3 108:7

111:17 112:1,3 113:9

113:12 115:4 122:2

127:10 134:10 138:6

154:12

letter 48:6 83:2 96:20

letters 47:15

level 40:1 81:19,22 82:1

117:4

levels 48:4

liberty 26:10

lie 55:4

lies 29:13

life 127:2

limited 34:18 52:19

73:2 119:18 120:9

line 4:18 6:20 9:17,17

69:5 70:7,18

link 150:20

linked 14:2

list 22:9 23:17 24:11,13

27:1 38:14 41:8 42:13

42:15 43:4 45:15

74:15 77:6 78:4 86:21

98:4,19 102:18

105:12,18 136:8,11

136:14 150:3 155:15

listed 31:13 109:5

listen 6:12

listening 9:3 70:18

listing 5:8

lists 142:8

literally 79:15

literature 116:18

142:22

little 22:20 37:4 41:11

41:17 42:13 43:4 47:9

55:8,10 82:15 91:1

96:2 108:21 120:4

127:9 135:15 138:19

139:2 140:17 148:9

149:2 154:7,20

long 30:5 31:2 51:18

65:17 66:13,19 67:15

87:17 120:5 137:22

longer 12:17 60:3

look 16:6,8,10 20:14,20

22:15 23:22 24:7 27:8

27:13 28:14 30:18

33:3,21,22 34:6 35:11

38:12 39:5 40:19 42:6

49:11,19 51:13,15

52:9,12,15 53:3,15,20

57:20 58:21 66:9 67:9

73:11 77:2,7 78:9

79:5,19 80:1 86:15

90:8,9 93:13,14 96:3

96:18 102:2,6,13,22

105:10,19 107:6,12

108:8,8,9,21 109:11

110:2,4,5,18,19

111:17 112:1,17

113:13 115:1,19

116:4,5,15 117:4,6

118:1 119:3,9,17

120:4,6 123:2,10

124:12,19,19 125:6

125:14 127:7,11,12

128:4,16 131:8,14

132:14 133:13 135:9

136:3 137:2,21 145:5

147:11 149:8,9,21

150:1,13 151:22

152:4,20

looked 11:1 23:11

31:22 39:21 45:14

54:17 56:7 64:13 67:2

90:12 100:11 115:7

130:9,9 132:7

looking 14:13 24:8

29:11 32:11 33:6 37:5

45:20 49:9 52:19

54:17 56:12 62:17

69:1 72:21 73:9 83:21

95:12 96:2 98:8 100:7

104:22 109:9 110:3

117:3,16 119:22

121:2,15,20 126:16

133:18,19 148:9

looks 35:13 57:6 78:10

100:14 106:1 108:9

135:10

loop 82:15

looped 82:21

Lori 53:13 85:16

lot 12:3 23:18 31:18,20

31:22 34:9 35:7 41:14

50:16 70:4 72:14

85:20 97:6 101:17

105:6,17 107:21

108:9 112:21 121:13

121:21 122:7 124:10

126:2,22 131:22

142:4,21 150:1

151:20 154:7

lots 127:3

love 137:17

low 144:20

LPT 145:19

lung 1:6 4:9 8:9 11:10

16:11,20 21:10 22:1

32:4,15 76:16 86:1,5

90:21 105:1,6 112:9

121:21 122:7 125:7

126:10 128:15 129:2

134:15 152:8

M

M 1:14

machining 116:18

magnitude 11:3 22:13

23:6 29:8 42:22 43:2

mail 48:6

main 9:13 127:15

majority 90:17 132:9

making 10:21 26:12

43:2 69:19 70:3 71:4

85:13 133:16

management 91:18

managing 27:4

manner 82:14

manual 63:4 78:1,16

79:1,9,20 82:18,22

83:7,10 91:12 93:5

149:17,19 150:4,11

150:13,17,21 151:8

152:11

mark 146:16

markers 56:9

Markowitz 1:21 4:17

8:16,21 20:12,13 33:1

33:1,16,20 39:10,11

49:18 52:18 54:6 55:5

55:15,22 64:11 72:17

73:1,15 76:19 77:4,22

78:8 81:10,19 88:15

95:3,7 106:11 114:9

117:2,15 119:5,17

120:7,15,20 138:10

139:19 142:1 143:20

147:10,16 148:17

150:14 151:6 154:16

154:22

match 83:6

materials 5:5,21 7:20

Matrix 14:13,22

matter 69:22 156:16

mean 21:13 22:2 25:14

34:2 35:16,20 41:7

49:13 51:9,16,20 56:1

64:4 66:16 74:1 76:13

78:3 80:21 81:1 85:11

87:5 89:14,22 90:12

91:19 93:11 99:17

102:15,17 107:13

111:11 120:7 121:19

121:22 128:18 129:20

130:17 136:11 138:20

139:13 140:4 144:8

144:17 146:6 148:5

154:5

means 9:7 81:8 88:6

meant 75:12 79:13

108:3

meat 27:12

med 90:4 92:20

medical 1:15 12:9 19:3

19:7 20:2,3,19 29:4

29:21 30:2,12,18 31:3

31:7,15 32:1 35:20,21

36:7,15 46:3,4 47:17

53:6 60:1,17,22 61:13

61:19 64:16,18 76:10

85:1 103:4,12 111:9

116:4,5,7 132:2 153:8

153:9,10,22

medicine 74:16 76:15

76:22 90:18 91:16

medicine- 90:13

meet 4:21 71:12 72:19

78:5,6 81:13 85:4
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Neal R. Gross and Co., Inc.

165

93:15 152:10

meeting 4:5,10,13 5:5,9

5:19,20 6:15,16,18

7:2,9 8:3,4,6 9:18

11:20,21 12:22 39:12

39:19,20 40:4,8 54:1

66:11 71:18 73:4

85:18 88:17 137:19

138:9 142:8 146:1,19

151:10 156:8

meetings 5:8 32:21

152:17

Melissa 4:20

member 4:19 8:16,21

14:11 15:5 16:5 17:6

17:11,15,18,20,22

18:1,4,6,18,22 19:18

19:22 20:12 21:4

24:19 25:4,7,12 27:3

28:4 29:10 30:1 31:9

31:11,12,21 32:6 33:1

33:15,20 35:6 37:3,16

37:22 38:10 39:9,10

41:10 42:9 43:9,22

45:3,12,17,21 46:2,17

47:5,20 49:15 50:13

51:1,8,11,20 52:7,18

53:9 54:5,6 55:5,15

55:22 57:18 58:3,9,20

59:11 60:10 61:5,9,20

62:10 63:9,22 64:8,11

64:20 65:6,15 66:3

67:8 69:12 71:10

72:17 73:1,15,21 74:1

74:12 75:14,16 76:19

77:4,16,22 78:8,22

79:22 80:4 81:10,19

82:12 83:17,20 84:21

85:16 86:13,17 87:5

87:10 88:15 89:9,21

90:8,19 91:5,11,19

93:3,12 94:2,4 95:3,7

96:15 97:2,7 100:6

101:11,16,21 102:7

102:14 103:6,11,13

103:14,18,22 104:9

104:16 105:17 106:11

107:3,20 108:4,20

109:11 110:11,15

111:5,9,12,20 112:5

112:11,14,15,16,18

113:5,20 114:9,13,19

115:6,11,13,15,21

116:1,3,5,9,14 117:2

117:15 118:15 119:4

119:5,17 120:7,15,20

121:19 122:6,12,17

122:19 123:8,16,20

124:1,7,14 125:2,9

126:7,15 127:6,18

128:8,11,22 129:4,10

129:16,19 130:5,12

130:15,22 131:7,20

132:4,8 134:2,8,12,18

135:1,9 136:19 138:2

138:10,13,18 139:4

139:13,19 142:1

143:4,17,20 144:8

145:4,16 147:10,16

148:17 149:15 150:9

150:14,16,19 151:6

151:18 152:6,14,22

154:5,16,22

members 1:12,20 4:12

4:15 6:8 7:20 8:1

44:21

MEMBMER 116:7

memorialized 60:13

61:21

mentioned 65:16 141:9

149:4 151:13

met 1:10

method 152:8

mid-September 138:11

mince 149:6

mine 72:10

minute 5:4

minutes 6:17 7:7,8,13

10:7 69:11,16 88:16

miscalled 117:22

misdiagnosed 128:5

131:5,19

misdiagnosis 119:9

misrepresentation

119:10

missed 118:4 151:5

missing 25:13 38:22

55:14

mission 68:12

moderator 69:15 70:6

moment 40:13

monitoring 85:3

month 68:7 137:7

months 40:22 53:8

138:7

moot 146:2

morning 4:3 83:15

multiple 41:13 48:4,19

56:14 62:18 105:18

106:5 111:11 125:7

mute 69:15

muted 6:8

N

name 4:4 7:2 11:18

65:4,8,16 74:15

144:18

names 36:2

narrative 30:5 31:2

narrow 72:14

National 12:1 143:8

nature 7:16

Navy 118:8

nearly 100:12

necessarily 30:17

57:10 74:19 119:19

147:18

need 10:21 12:7 13:11

13:12 18:6 22:7 26:9

30:8,18 33:8,19 34:13

35:2 40:7 41:16 42:10

43:10 44:16 46:10

49:18 56:4 57:20 65:4

66:14,15 77:17 78:5

81:13,17 82:21 91:3

92:1 97:3 100:2

114:16 115:6 119:11

120:8,10 128:19

140:5 142:12 145:13

145:20 150:12

needed 9:16 39:15

56:19 67:3 100:5

needing 84:12

needs 3:19 70:5 83:9

99:13 136:15

negative 76:13 101:4

144:21 147:3

nervous 36:9

neurologist 93:10

never 35:20

new 63:7 144:18 145:5

145:9

newer 145:11,12

nice 40:4

night 118:8

noise 15:2

non-Advisory 6:8

non-profit 32:9

non-specific 122:1

nos 109:18

note 6:6,9 86:19

notes 56:10

notice 40:10 73:4 138:3

number 9:14 10:17

12:14,14 13:19 15:15

21:5 22:16,18,19

28:22 32:16 34:18

51:19 52:19 53:18

54:22 57:13 58:2,12

65:15,22 73:13 75:6

88:13 89:11 92:5,12

95:8 99:5,15,17

100:20 110:6,8 112:2

112:4 113:14 118:12

119:11,18 120:1,5,9

120:11 121:8 122:5

127:7 131:16 132:21

135:4,6,6,7,8 142:4,9

147:9 149:8,10,11

numbers 11:2 40:19

42:21 88:9 92:7

105:10,14 110:5

126:22 131:15 132:11

133:20

O

Oak 30:10 72:19,22

73:1

objected 102:12

obstacles 27:20

obstructive 32:4

obviously 10:21 12:9

52:1 58:19 84:11

86:20 110:20 136:3

occ 90:3 92:20

occasionally 149:6

occupational 14:15

15:8 16:4 18:2 74:16

76:14,22 90:13,17,20

91:16 118:10

October 39:12,18,19,22

40:4 54:1 66:11 72:20

140:11

Officer 4:10

official 2:9 144:3 146:7

oh 18:6 25:2,3 38:12,19

57:1 103:11 108:4

132:4 136:6

okay 9:1 10:2 11:19

12:12,14 15:1,9 16:3

17:1,9 18:12 19:10,21

20:11 21:3 22:6 25:3

25:6 26:19 31:12

36:16 40:15 43:19

44:10,12 45:7 46:11

46:11 47:5,6,7,9 49:3

53:21 58:1,7,11,14

61:16,17 62:3 63:5,13

64:8,9 65:13,20 66:12

68:2,21 69:17,21

70:10 72:3 74:21 76:6

83:12,18 84:6 85:7

86:8,14,18 87:1 88:13

88:20 89:4 90:1,4

91:2 92:22 93:6 94:8

96:21 97:5,13 98:1,18

99:3,11,21 100:3

101:19 103:14 104:1

104:13,20 107:8

108:4 111:14,15,17

111:22 112:10 113:9

114:8 119:2 120:15
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Neal R. Gross and Co., Inc.

166

122:9,15,22 123:19

123:22 124:4,8 125:1

125:8 127:18 128:8

129:3 130:13,20

131:2,14 132:4 133:5

133:22 134:8,12

135:1,2,13 136:13

137:1,16 138:15

139:22 141:13,21

146:4 148:8 149:2,12

150:6 151:11,20

153:5 154:12 155:3,8

155:21 156:9,13

old 153:21

once 53:7 58:4 75:3

84:21 93:8 104:5

121:2 126:22 136:3,5

140:20

oncologist 56:8,20 74:3

one-pagers 152:15

one-stage 47:14

ones 46:4 48:10 52:12

62:17 63:17 76:7,22

103:1 105:19 109:12

128:13,16,22 129:11

129:20 152:2,4

ongoing 85:3

onset 37:13 84:16,17

open 6:16 103:4 121:6

122:10 130:9 132:6

opening 121:17

operated 54:9

OPERATOR 70:8

opine 90:20

opining 76:4

opinion 30:9 97:3,11,12

147:1 154:3

opinions 148:1

options 61:11

Orange 81:2,11

order 31:15 40:5 81:13

orders 28:9

organized 13:2 73:7

original 24:11

originally 85:9 130:18

originating 74:20

ORISE 143:9

orthopedics 90:15

ought 45:17 95:4

outline 9:2

output 39:17

overall 11:14 12:11

overbearing 36:11

overlap 11:5 14:4 58:16

94:10 107:12 123:10

127:22 131:17 133:21

133:21 154:18 155:2

overlaps 14:17 42:1

overlooked 107:7

overview 9:12

P

P-R-O-C-E-E-D-I-N-G-S

4:1

p.m 156:16

page 5:19,21 10:6

31:13 65:3,9

pages 29:3,4,5,6,6,12

29:12 36:11,12

pamphlets 83:5 151:14

152:7,14,18

panel 93:8,9

paper 77:2 97:17

155:14

paperwork 28:3,7 51:4

paragraphs 15:21

83:21 150:11

parameters 50:3 81:4

parsing 41:14

part 1:6 4:8 8:9 11:10

13:21,22 14:7 16:12

16:20 17:11 18:13

20:17 21:6 22:13 43:1

78:10 81:22 84:4

85:12 94:12,19

101:13 103:10,18

104:11,17 115:7

118:18 121:21 124:17

129:9 130:16,18

132:2,3 134:3 135:10

150:10 152:7

partially 69:4

participants 54:12

participate 6:12 32:20

73:5

participating 5:22 6:2

particular 29:16 72:7

94:5 143:19

particularly 29:21

70:19 149:18

partly 54:15 82:1 154:6

parts 72:13 73:19

pass 47:7 141:13

156:11

path 56:4,6,16,19

pathologist 56:11

pathologists 35:10

79:16

pathology 34:11,20

56:10

patient 56:15 59:12

patients 12:2 127:3

148:14

pattern 87:14

people 12:20 15:22

19:4 23:14 35:14

36:21,22 49:13 58:12

59:15 71:4 72:14 74:5

75:5 76:10 79:7,17

80:6 81:5,9 89:11

90:6 91:17 92:12

94:22 96:5,8 98:16

99:2,9,14 102:12,19

105:6 107:12 108:22

113:6 117:11 118:4

118:21 121:14 123:13

125:16 126:4,22

128:4 129:5,8,21

130:7,10,16 131:4,8

131:22 132:21 133:9

134:15,21 135:19

136:6 139:11,20

140:8 141:10 144:19

147:20,22 148:7

152:3

people's 70:13 71:9

percent 22:18 93:17

percentage 23:20 36:18

36:19 42:19 50:21

84:9 110:7

period 39:13 53:20

permission 31:17

person 36:7,9 42:12

44:7,10,16 50:20

56:11 62:10 67:14

68:17 75:7 79:3 80:15

85:12,15 90:19 96:12

96:13,22 98:21

106:19 108:11 140:10

personal 24:6

personally 12:6 40:19

53:22 75:21 94:9

124:9

perspective 41:12

phone 14:10 54:1 139:5

156:2

phones 6:7

phrases 77:8,12

physically 73:19

physician 30:8,9 35:3

56:12 79:2 97:10

physician-level 98:3

physicians 58:12 71:3

71:10,15,22 90:5

91:17,21 92:18

100:17 125:15 141:6

145:18

pick 38:19 48:13 89:15

96:5 137:20 138:4,5

138:10,19 139:3

picked 96:6 135:8

picking 95:16 155:17

picture 34:2 41:20

pie 134:10,14

piece 23:6 24:7 47:8

53:19 67:22 68:9

121:18 123:4,5 133:6

134:5,14 137:6

149:13

pieces 24:13 36:14 38:8

55:13 68:1 70:15,20

72:8 84:8 96:9 100:4

136:1

piecing 126:18

pile 128:1

piles 110:4,18

place 75:8 117:11

places 12:1 17:13 72:22

plan 5:1 45:8 46:12

47:8 68:3,5 69:13

142:13 145:15

plant 30:10

played 22:20

please 6:3,5,9,20 7:2,4

8:3 9:6 18:9 69:18

149:17

plus 42:5 112:7

pneumoconioses

124:5 134:7

pneumoconiosis 103:8

105:2,8 121:13

122:10 123:3,14

133:10,15 135:18

pneumoconiosis/ILD

105:16 106:10

point 18:7 35:1 40:4

64:17 70:9,14 82:7

99:13 101:22 103:9

104:21 107:9 117:15

121:3 133:12 136:2,4

140:3 141:1 145:14

148:4 149:15 150:19

155:2

pointed 27:6

policy 98:12

poll 139:19

pool 94:22 95:10

107:10

poor 56:15

pops 17:12

population 33:6,21

34:1

positive 80:15 84:22

127:13 128:14 133:17

144:22 146:11,11

147:4

possibility 40:16 43:3

possible 46:1 58:10

104:3 119:9 132:20

possibly 113:20

post 17:21 19:13 37:1

68:15 85:19 88:19
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

167

post-1993 82:20 84:2

84:10 85:11,15 86:22

post-CBD 82:17

post-disease 15:10

posted 6:1,11 7:17

potential 105:3 106:6

110:21 128:1

potentially 13:17 19:11

34:7 48:8 69:6 86:11

89:3 92:11 104:7

123:6

PowerPoint 78:10

116:22

practicing 93:16

practitioner's 73:11

pre 17:21 19:13 37:1

68:14 85:21 88:18

pre- 15:10 82:18 84:10

85:11,15 86:22

pre-1993 15:6 37:14

84:1,11 104:18

pre-CBD 82:15

prefer 66:20

preferably 39:18

preference 139:12

preliminary 57:9

prepared 6:17 7:7,14

preparing 4:12

presence 17:8

PRESENT 1:20

presentation 117:1

presenting 71:21

presiding 1:11

presumption 79:18

presumptions 101:6

presumptive 21:14

presumptuous 27:17

pretty 14:16 19:14 31:2

56:5 58:6 77:15 78:2

78:5 79:21 82:3 96:22

114:21 115:12 116:12

136:14

previous 62:7,17 84:3

previously 28:12

primarily 118:22

prior 63:7

probabilities 117:12

probable 81:7 117:13

probably 5:16 11:17

15:17 16:6,14 21:15

21:20 22:2,15 26:21

34:22 35:19 41:3 46:9

48:4,13 52:7,11 55:7

59:6 63:18 64:4 65:7

66:6,9 72:8 74:17

75:18 76:9,20 78:17

80:5 87:1,19 90:17

93:7 97:10 98:11

121:15 138:11 140:19

141:7,18,18,20

142:12,17,18 144:10

problem 3:13 6:3 11:9

12:14 29:15 33:20

36:13 38:2 77:5,8

84:5 85:6 106:15

119:18,20 126:17

153:14

problematic 67:22

problems 11:16 36:2

54:18 79:11 82:13

procedural 59:21 78:22

procedure 63:4 79:9

82:18,22 83:7,10

149:17,19 150:4,11

150:13,17,21 151:8

152:11

procedures 78:1,16

process 11:3,10 12:5

16:16 20:16,21 22:14

26:3,12 27:7 28:1,10

33:3,5 39:11 47:11,14

47:19 50:18 53:5 54:9

57:19 59:21 60:6

62:22 67:5 68:18 71:8

72:13 73:5 74:13

75:19 82:15 91:7 92:1

95:1 99:14 154:9

processed 18:15 53:16

processing 12:10 19:1

product 148:20

program 26:15 66:13

137:15 141:14 143:8

144:19

progress 32:1 70:4

prolong 121:1

properly 96:19

proportion 64:1 86:2

propose 23:21 34:5

46:12 55:8 63:14

107:11 112:1 114:5

123:1,9 137:19 146:6

146:14 147:5

proves 47:2

provide 25:17 152:7,10

provided 7:21 9:21

32:17

provider 20:19

providing 23:13 33:10

provisional 54:8

PSTs 34:19

public 5:6 6:10,16 8:1

28:19 70:7 73:5

publications 151:19

publicly 8:3 32:21

publish 5:20 7:12,14

pull 24:22 41:17

pulled 100:18 116:21

pulmonary 21:18 32:3

34:17 73:2 74:16

76:14 80:17 92:20

102:11 125:19 126:6

127:1,14,16,21 128:6

128:21 131:17 134:22

pulmonologists 10:13

71:16,17 90:3

purely 112:6

purposes 36:5 120:8

pursuant 29:15

push 10:20

put 9:1 13:15 16:12

21:19 22:8,9 27:15

38:22 40:17,20 43:20

44:1 56:22 57:13

58:15 63:3,15 69:15

73:3 95:16 98:19

145:5 146:15 147:22

putting 36:8 43:12

Q

QTC 74:12,14,14 75:19

75:21 91:6,7

qualifications 76:3 77:2

90:11 97:17

qualified 35:14 44:15

76:2,4 77:1 90:20

92:18 94:7

qualifies 85:1

quality 55:17 68:16

Quest 143:5

question 16:7 25:7

27:22 36:20 39:11

40:5 46:18 55:16

64:12 69:8 80:1,19,21

84:10 86:8 91:15 96:3

101:21 102:22 106:17

117:10,20 127:19

132:14,16 142:20

143:11,13,18 145:14

146:14,15 147:1

150:20 153:7

questioning 143:18

questionnaires 29:2

questions 13:1,4,5,6,9

13:11,15 14:3,5 25:22

26:1,5 34:10,11 36:16

37:13 45:4,22 50:19

84:15 86:21,21 98:4,6

98:10 110:20 119:15

121:10 132:21 136:8

136:12,20 146:12,17

146:20 147:9 148:11

148:18

quick 135:9

quicker 125:6

quickly 44:8 47:16 62:5

67:7 97:15 141:19

quite 13:5 19:12 23:12

28:22 54:20 71:21

82:22 83:1 95:1

146:17 150:18

quote 89:15 142:15

R

radiography 77:17

raise 69:6 104:21 147:1

raised 13:15 77:6 118:5

raising 16:7 20:17

range 29:12 73:15,16

74:4

rationale 25:18 32:2

34:14 51:5 59:6,7

86:9

re- 134:16

re-evaluated 128:2

reach 32:19 73:3

read 57:21 58:4,4,5

79:15 82:21 86:10

reading 10:4 35:17

53:13 88:16 118:8

ready 155:21

real 120:9

reality 97:18

realize 24:9,9 45:20

realized 12:3

realizes 15:12

really 11:2 13:3,5 18:3

24:21 27:11 42:6,19

53:4 61:18 64:21 68:4

68:12,14 71:7 73:10

76:11 77:16 83:21

106:18 109:19 117:20

123:5 126:4 131:3,21

132:4,16 145:1,9

146:5 150:2 151:17

152:9 153:22

realm 127:14

reason 19:9 41:5,5 44:6

55:12 57:5 101:2

109:5 118:19 141:17

reasonable 51:19 55:13

147:2

reasons 25:14 50:19

56:15 66:10 68:13

78:18 142:5 148:15

receive 9:8 35:21

received 10:5 12:22

63:11 78:11

receives 84:22

recite 62:13,15,16 63:9

63:11

recited 61:21

recognize 55:2 57:10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

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recognized 81:14

recognizing 11:5 49:4

58:15 81:6 110:10

131:18

recommendations

27:18

recommended 28:8

59:14,16,18 60:4,14

61:5,22 137:10

recommends 96:17

reconsiderations 28:9

record 7:3 36:15 60:17

62:1 70:1 97:9 117:17

153:18 156:16

recording 7:6

records 30:2,12,18 31:7

32:1 35:20,21 36:7

47:17 53:6 56:18

59:12 60:2,22 64:18

75:3 77:11 143:15

149:16 153:10,13

154:1

redact 65:2

redacted 28:10,13

redacting 31:18 36:2

61:15

Redlich 1:10,16 3:14

4:14 8:10,12,19 9:1

15:1,9 16:22 17:6,9

18:8 19:10,21 20:11

21:2,16 25:2,6,8,20

26:19 27:14 28:4,20

34:4 35:8 37:10,19

38:7 39:3,15 40:12,15

41:19 42:11 44:6,14

44:22 45:7,13,19

46:11 47:6 49:1 50:15

51:3,10,12 52:6,14

53:2,12 54:14 55:7,19

56:1 57:22 58:7,11,21

60:7,21 61:7,16 62:2

63:5,13 64:6,9 65:2

65:13,20 66:5,16

67:21 69:17 70:3,11

72:3 73:12,18,22 74:8

74:21 76:6,21 77:14

77:19 78:2 79:10 80:3

80:12 81:16,21 83:12

83:18 84:6 85:7 86:7

86:14,18 87:7 88:12

88:20 89:12 90:1,16

90:22 91:9,14 92:4

93:6,21 94:3,8 95:5

95:11,21 96:21 97:5

97:13 98:14,20 99:4

99:12,19,22 100:11

101:14,18 102:4,9

103:15,20 104:1,13

104:20 106:2,14

107:8 108:2,5 109:8

110:1,12,17 111:7,14

111:22 112:10 113:3

113:8,22 114:11,15

114:22 115:18 116:11

116:17 117:9,19

119:2,13,21 120:13

120:16,21 122:4,9,15

122:18,22 123:9,19

123:22 124:4,8 125:1

125:8,12 126:13,20

127:10,19 128:9,18

129:3,7,14,18 130:2,8

130:13,20 131:2,12

132:5,10 134:5,9,13

134:20 135:2,13

136:10 137:1,16

138:15 139:1,6,16,22

141:15,21 142:19

143:10 144:1 145:3,7

146:4 147:14 148:3

148:21 150:6 151:1

151:11,20 153:6

154:11,17 155:3,8,11

155:19 156:9,13

reference 144:11 148:1

references 151:10

referral 60:11,19 61:14

referred 29:18

reflect 97:18

refraining 121:16

regardless 151:7

region 74:20

Register 40:9 138:3

156:5

registry 20:9

regular 12:2

regularly 44:9,12 92:10

regulations 7:11

rejection 140:17

relate 132:22

related 11:10 12:4 15:4

24:16 68:13 71:8

72:12 81:9 84:7 92:9

95:14 96:10 106:16

129:6,12 133:8

135:19 142:10 143:11

relates 14:20

relation 40:7

relatively 46:1 62:5

97:15 105:21 141:19

relevant 18:3 89:16

145:11 151:2,4,22

rely 31:4

remand 28:9 61:10

remember 87:3 95:9

107:20

remind 7:19 20:6

reminded 15:13

remotely 5:22 6:2

renowned 76:16

repeat 70:17

reply 29:11

report 31:3 56:4,6,10

56:16,20 60:19 61:14

64:17,22 65:1,3,3,8

65:17,21 67:4,11 86:9

89:17 90:9,10 96:11

96:15 97:1

reported 30:22

reports 35:18 71:5

75:18 94:16 95:22

99:9 114:6 133:7

137:12 138:1 140:13

140:15,19,22 141:7

145:17 148:10

repository 28:7,10,18

representative 33:4,7

49:5,8,16 55:2 57:11

63:1 72:15 95:9

represented 48:14

request 23:11 26:11

28:2 40:6 50:7 57:12

58:15 61:3 62:20

63:15 67:2 74:18

95:17 102:1 114:6,7

120:19 123:10 128:11

130:3 132:10,12

133:6 134:4 140:5,6

149:6

requested 62:6 119:3

129:8 141:5

requesting 33:18 53:7

64:15,17 149:17

requests 22:10 88:7

115:4 149:5 155:13

155:20

require 149:1

required 20:5 80:7

82:19 152:9

requirement 14:14

43:11 56:4

requirements 1:5 4:8

8:9 20:6,8,15 43:13

71:20 72:1

requires 71:19

resent 151:12

reside 30:2

resource 152:16

resources 147:11

respected 71:17

respiratory 78:14

respond 28:17 136:21

response 50:14 150:20

rest 64:14 114:21

results 77:13 103:5

142:15 143:21 144:17

resumed 70:1

resurrect 41:1

retrieve 50:9

review 10:14 35:2 47:15

68:17 76:2 82:8 94:22

97:22 115:5 133:7

135:8,16 137:18

140:15 146:6 147:6

147:13 149:6,16,17

153:16 154:2 155:13

reviewed 28:22 30:15

75:20 85:9 90:5 92:2

92:14 94:19 107:5

140:3,12,20,22 144:4

reviewing 68:5 97:16

99:9 135:20 143:16

reviews 98:21

revisit 148:18

Rhoads 2:11 3:11 4:3,4

26:7,14 27:16 43:15

43:15 44:4,11,19

46:18,22 66:12 67:6

69:14 70:6,10 72:19

72:21 95:19 98:11,18

99:3,11,17,21 136:9

137:14 141:13,20

152:2,12,19 153:5

155:6,9,15 156:4,12

rid 65:4

Ridge 30:10 72:20,22

73:2

right 13:8 16:3 21:16

26:8 28:19 31:13

32:11 34:6 37:10,16

44:19 51:10 53:12

57:8 60:21 61:9 65:5

67:6 80:3 81:21,22

82:4,8 86:7 87:5

88:12 89:19 90:7

91:10 101:8,16

103:13,22 104:9,16

106:2,4,14 110:15

111:6,19 112:18

114:1,16 116:9,10,14

117:8,19 119:12,20

120:13,14,20,20

121:16 124:7 127:6

129:10 131:2,7,13

132:15 136:9 138:18

139:12 145:3 154:22

155:19

room 4:19 77:11 84:12

rules 44:18

ruling 19:7

run 25:4 85:5 119:14
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

169

running 154:6

runs 32:9 46:19

S

S 1:16

safe 139:21

sarcoid 14:1,3,3 69:8

76:17 100:5,8,14,20

101:1 102:5,20

105:15,21 106:1,3,3,9

108:3,6,6,8,16,19

109:1,3,5,13,15,21

110:6,13,22 111:2,6

111:10,17 112:1,6,7

113:12,14,17,18

114:3,7,17 115:2,5,8

115:16,20,22 116:12

116:13,20 117:3,7,10

117:14,20,21,22

118:7,10,12,13,17,17

118:19,22 120:1

121:3,11 128:4,5

135:17 149:7

sarcoidosis 104:12

106:12,13 149:19

150:12,15

sarcoids 108:9

SAS 25:1 40:17

saw 84:18 87:8

saying 19:14 27:16

49:21 57:3 61:18

62:20 77:1 82:18,20

85:14 95:6 104:2

106:15 126:14 130:2

134:21 145:18 151:3

says 30:6,11 35:13 79:8

115:8

scan 34:20 35:12

scattered 73:19

schedule 67:19

scheduled 4:21 6:10

scheme 40:3

Schroeder 4:20

science 145:11

scientific 1:13 142:9

scope 3:16 9:14 12:6

12:15 14:8 22:5 146:9

screen 5:10

secondly 54:10 142:6

section 135:15

see 5:16,19 10:7 20:21

24:14 25:9 26:11 27:2

32:2 38:15 39:2,7

48:9 50:2,13 51:14

58:16 60:1,4,6 66:15

67:10 74:18 80:10

83:22 87:14 91:9 96:4

103:2 105:19 107:10

108:22 109:4,4 110:5

110:10,18 112:4,21

114:2 118:11 122:3

124:13 127:22 130:6

130:7 133:20 134:6

134:10 138:5,6

143:21 146:2 151:22

152:20 153:3 155:14

seeing 27:20 30:4

88:18 100:15 148:7

seen 22:11 35:20 64:4

75:17

sees 35:11,12

select 36:5

selection 141:12

selective 33:6

SEM 30:11

send 30:8 32:10 41:15

42:9,18 46:19,20,20

47:1 89:10 90:3 95:20

96:20 97:2 139:7

143:7,8 150:21

155:15,17

sending 40:11 74:6

sense 11:14 26:13 35:7

42:14,20 48:3,22

50:16 53:9 55:11,22

56:21 57:19 75:1

80:22 85:8 86:16

91:14 92:11 99:6,15

105:14 108:16 110:22

111:13 123:7 126:3

131:10 133:3

sensitive 102:20

124:21,21 125:5

131:9

sensitivity 37:18 84:22

100:7 103:10 104:18

112:8 117:5 124:18

125:10 142:11 144:20

145:20

sensitization 10:11,19

11:12 13:7 19:13 23:3

23:4 24:17 28:15

34:12 42:3,5 52:15,17

53:18 57:16 58:17,19

63:18,20 80:16 84:13

88:3 103:16,19 104:4

104:10 105:4 113:18

115:2 121:13 123:4

123:11,15 124:6,16

125:17,18 126:5,9

sensitized 104:14

111:2 123:18 128:6

132:18,19 134:16,21

sent 8:18 15:20 20:3

28:12 43:16 75:4

83:15 142:7 150:10

150:17,20 156:6

separate 93:22 122:11

125:20

separately 16:10

September 40:8 67:19

68:7,8 138:7,8,21

139:2 148:18 154:19

session 6:6,10

set 43:16 52:12 109:10

121:6 140:1

setting 80:22

share 43:21 44:2

shared 8:2 43:17

sharing 43:11 44:4

sheet 55:8

short 25:10 33:10 40:20

53:20 119:14

shortly 140:6

show 152:8

showed 32:4

shows 117:17,18

144:18 145:20

shunted 103:7

shy 69:21

side 23:22 34:17 41:22

42:7 45:1 76:10

100:13,21 101:15,17

107:11 130:18 131:1

131:4

SIDEM 4:20

significantly 59:17

60:12 120:10

silicosis 11:12 24:18

53:19 57:17 58:22

59:1 63:21 104:12

107:14,17,22 134:19

135:3,5,8,11 142:3

149:4,7,10,13

similar 21:20 22:3

121:10

simple 23:1,1,5,5 36:16

45:1,5 46:1 54:20,20

56:14

simplified 3:13 9:11

10:6 11:15 12:13

152:8

simply 34:7 44:2 52:20

94:11 107:16 108:15

110:6 134:20

simultaneously 45:18

single 115:9 129:11

site 14:13,21 23:16 46:8

108:1

sites 107:22

sitting 27:19

situation 19:11

six 115:22 123:17 138:4

138:16

sizable 33:17

size 29:10

slanted 49:20

slightly 135:11

small 76:11 99:5 123:17

smaller 30:22 33:21

53:18 58:1 75:5,6

89:11 92:12

Smith 65:10,11

smoked 127:2

Society 11:21 144:2

solution 23:1

solutions 54:20

solvable 36:13

sooner 7:11,12 41:9

46:14 49:11 51:6 61:2

137:17

sorry 84:1 108:2

sort 9:16 10:8,16 11:9

11:15 12:5,7 13:1,22

14:21 15:11 19:15,19

22:4 24:3 25:12,21

26:20 27:16 35:15

36:4,8,10,13 37:17

39:4 41:4 42:18 43:18

49:6 55:10 56:22

70:22 72:6,9,13 74:9

75:6 76:13 79:10

80:18 81:4 82:11

83:15 89:1 92:14

98:15 100:1 101:6,19

106:16 108:7 115:2

136:17 140:22 144:3

145:10 146:10 147:12

149:1 151:15 153:10

sorted 130:10

sorting 22:21 109:9

121:7

sounds 62:3 65:22 78:3

80:13 84:19 102:9

121:14 139:22 148:21

sources 136:12

speak 6:21 18:10 32:21

33:7 42:7 70:18 75:17

speaking 7:1 32:8

137:8

special 7:22

specialist 74:2 75:12

75:13 99:2,7

specialists 76:16

specialties 74:17

specialty 76:1,5 89:16

144:12

specific 10:10 18:19

21:7 27:13 52:21 60:4

61:3 71:7 77:15 78:5

82:3 86:21 94:12

97:20 98:6 108:7
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specifically 11:10 83:3

95:14 98:13 102:3

103:1

specified 78:20

specify 64:1

spectrum 33:19 48:14

49:19

speed 10:4

spent 10:3 17:3 109:9

spinning 127:9

spoke 11:22 18:13

spots 74:9

spreadsheet 24:1,22

26:9 32:14 37:5,17

38:12 39:5 41:11 42:7

47:22 48:21 51:21

87:21 108:21 122:12

128:20 134:3

spreadsheets 24:6,20

126:18

stack 36:4

stage 89:19 96:12

stages 100:2

stand 112:19

standard 19:6,15 78:13

standardized 19:20

start 7:1 36:7 97:19

121:7 130:17 138:21

started 87:8

starters 13:14 35:17

40:18

starting 150:13

starts 125:19

state 7:2 83:3

stated 84:1

statement 3:13 12:13

29:14 59:19 60:8,11

60:19 61:17,20 62:16

63:10 137:11

states 1:1 15:7

statistics 22:17 32:17

statute 15:14 16:9 20:4

20:6,8,10 25:19 27:7

29:16,17,20 71:21

79:8 81:12,20 82:3,3

82:14,16 89:1,2

statutes 77:7

steam 154:7

step 34:3 89:19

steroid 21:9

Steve 9:13 20:13 22:8

27:6 33:1 57:7 76:7

109:17 146:22 154:14

Steven 1:21 39:10

52:18 53:10 54:7 55:5

55:15 64:12 72:17

73:16 77:4 88:16

106:11 117:2 119:5

142:1 143:21 147:10

sticking 13:21

stimulate 45:22

stop 14:9

straightforward 56:5

142:4

strict 57:1

strong 49:10 139:12

struggle 71:11

struggling 71:5 78:17

86:4

stuck 89:1

studies 27:13

study 116:21

stuff 46:5 51:2 134:10

136:18 154:8

style 62:11 63:2

sub 118:9,11

subcommittee 1:5,10

4:8,15 5:9 6:15 8:8

18:16 40:8 76:8 94:11

153:8

Subcommittee's 3:17

subcommittees 13:21

68:19

subject 147:6

submit 39:16 40:6

156:10

submits 40:12

submitted 49:17

subset 30:22 92:3

147:21

Substances 1:3 4:7

5:15 8:7

substantial 10:18

suffice 148:2

suggest 58:14 138:20

suggested 107:18

suggestion 39:4 41:6

suggestions 45:9 57:14

70:19 156:10

summaries 25:5 41:15

42:10 43:11

summarize 44:8 128:3

summary 22:17 24:3

34:14 35:18 40:18

41:12 45:11 51:5 59:4

66:9 140:18 145:6

supervisors 94:6

supposed 62:12 93:15

93:16 94:6 109:17,18

supposedly 75:20

sure 9:20 12:8 14:17

26:4 29:8 30:3 58:6

73:17 81:8 95:20

96:19 124:2 128:19

133:16 146:17 153:1

surveillance 144:19

survivor 46:8

suspect 24:9 34:12

36:21 80:12 153:7

switched 153:9

symptoms 84:17 86:1

system 23:14 50:6

54:11,12 73:13 80:20

89:10 95:13,14

systematic 147:13

systems 28:22 81:7

T

table 3:8 105:19 148:20

tabulate 25:15

tabulations 25:5 41:16

43:22 44:2 45:5,22

take 5:2 12:16,17 13:12

24:22 31:19 47:17

51:15,18 53:8,20 60:2

61:15 66:13,18 68:22

102:13 114:17 120:5

127:6 132:7 141:17

144:15 145:4 147:17

147:19 151:21 152:20

taken 13:1 56:17 151:2

takes 41:1 137:22

talk 9:4 11:18 43:21

68:8 100:5 136:6

talked 27:15 135:18

talking 11:4 31:9 43:17

58:12 68:6 77:22

83:13 88:9 99:16

100:16 108:11 114:1

123:13 125:14 134:2

134:18 150:7 152:12

task 9:16 11:6

technical 13:5 26:1

34:11

teleconference 4:5

6:20

telephonically 1:10

tell 37:7 49:22 66:14

81:12 87:11 100:8

107:8 143:6

telling 97:1

tells 37:6

ten 11:4 29:3,5,12

48:17,18 58:4,5 62:6

63:20 64:7 69:15

74:10 87:9 91:15

102:8,8 114:7,18

115:19 124:12 133:15

144:10,16

ten-minute 68:22 69:10

tend 38:17 103:7 106:4

term 33:10

terminology 15:6

terms 13:2,6 14:15

16:15 22:7 23:6 24:16

24:21 26:6,7 28:2

42:22 47:14 50:19

53:5 57:12 59:3 66:10

67:4 68:9 69:3 70:13

70:21 84:7,12,17

96:12 97:14 98:21

105:11 110:3 117:12

117:17,18 125:20

130:14 132:2 133:6,7

133:17,19 135:14

136:12,16 137:9

141:5 146:5 148:7

155:20 156:1

test 32:3 34:21 84:22

107:21 144:15 145:2

146:9

testing 142:15 143:2,14

tests 34:19,21 146:10

text 65:9

thank 8:11 18:8 70:10

142:19 155:3 156:14

thanks 155:7

theory 38:4 74:1

they'd 30:16

thing 5:16 9:13 11:19

14:6 15:11 16:17

38:11 62:4 66:1 67:1

67:17 83:14,19 92:22

93:19 101:11 108:20

115:3 121:19 124:11

126:8 127:17 128:19

130:6 140:17

things 13:16 18:15

23:17 33:14 34:8

40:20 41:2,4,8 43:5,6

44:21 45:2 48:1,5

50:17 57:5 72:12

76:13 78:5 79:18 83:8

84:7 89:19 91:20

100:22 105:13 106:5

106:7 124:10 128:1

131:18 133:2,22

136:3 139:9 141:4

154:2

think 9:9,13 10:7 11:8

12:5,11 13:7,20 14:1

14:15 15:9,11,16,20

16:3,11,19 18:14

20:16,20 21:7,11,14

21:19,22 22:3,8,11,13

22:14,17,20 23:5,8,10

23:12,13,15,17,18

24:8,11 25:21 26:22

27:5,5,8,10,17 31:21

31:22 33:8,17 34:5,6

34:6,22 35:6,16,16
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36:13,19 37:20,20

39:3 41:3,7 42:1,14

42:17 43:2,7 44:11,16

45:2,13,17,21 46:7,12

47:3,8,9,10 49:7,9,11

49:12,14,20 51:2 52:5

52:14 53:2,13,21,22

54:3,21,22 55:1,20

56:3,21 57:2,19 58:21

59:2 60:3,18,22 63:14

63:18 64:22 66:3,17

66:18,21 67:1,4,15,16

67:18 68:2,6,11 69:1

69:9 70:3,11,14 71:13

71:19 72:4,12,15,18

73:15,16 76:9 79:17

79:22 80:10,13,19,21

80:22 82:7 83:8 84:4

84:7,8 86:19 88:14,22

89:1,13,16 90:22

91:16,17,19 92:6,16

94:8,16 95:11,14

97:13 98:1,11,14,15

99:22 101:7,18

104:20,22 105:11,13

106:5 107:1,7,9

109:15 110:17,18

112:12 113:7,16,22

114:1 115:1,3,6

116:11 117:9 118:1

118:11 120:6 121:2,8

123:2,11,19 125:13

126:17 127:9 129:14

130:3,5,15 132:18

133:3,5,8,11,19 134:5

134:9,13 135:3,4,5,7

135:13 136:2,3,11,13

137:3 138:3 139:16

140:6,19 141:1,7,9

144:4,6,7,8,13 145:12

145:22 146:7,8,12,15

146:16,22 147:2,7,8

147:11,14,21 148:3,6

148:22 149:4,12

151:13,15 152:4,6

154:1,5,12,12,14,18

155:16,21

thinking 9:17 11:4

13:16 18:13 24:16

38:10 39:11 42:6

47:21,21 57:22 58:2

70:14 71:2,7 99:12

101:19 102:5 119:13

120:17,22 138:14

140:16 152:3

Thoracic 11:21 144:2

thorough 119:9 136:14

thought 10:5 12:16

16:8 23:9 42:16 53:3

74:22,22 78:3 98:2

102:12 103:15 106:20

107:22 111:16 140:14

151:2 154:3

thoughts 9:5 12:13

18:12 24:18 47:18

58:13 66:10 69:20

70:12,13 71:9 154:14

thousand 29:4,5,6

thousands 74:6 122:21

122:21

three 9:15 12:14 13:19

42:21 61:11 75:7

79:15,16 83:21 88:10

92:3 138:7 144:11

thrown 124:10

tick 71:18

tie 108:19 126:3

time 1:10 4:11,21 9:17

9:17,19 25:10 31:20

39:13 40:20 41:1,1

46:15 47:17 48:5

53:21 54:3 66:6 67:20

69:5,19 72:20 137:4

137:20 139:10,15

140:15 141:17 144:21

144:21 148:20 149:2

154:10 155:4,7

timeline 136:16 137:9

timeliness 50:17

times 29:12 48:12 50:7

62:15,19 65:15 83:2

timing 5:1 45:2

tissue 50:22 105:7

148:16

titles 23:16

today 4:22 6:10,19 7:10

8:5 9:10 154:13

today's 4:5,10 5:18,20

6:1,18 7:8

told 72:11,12

ton 133:14 154:13

tool 145:13

tools 145:11

Topic 3:17

total 41:1 73:13 92:5

107:17 113:14 120:1

totally 25:20 26:8 27:14

57:8 63:6 75:11 97:9

146:13

touched 71:14

town 152:17

Toxic 1:3 4:6 5:15 8:7

track 50:4,8,8,11

tracking 50:16

Trade 29:1 54:15 56:2

81:3 92:13 153:20

trained 19:5

training 19:2,15,19

90:14 91:12 93:1,5

96:8 97:20 141:12

transcriber 6:21,22 7:4

transcript 6:17 7:15

transcripts 7:17

transported 82:17

treat 21:18

treatment 21:6,9

trends 43:19

trouble 8:13,17 141:10

true 18:4 41:19 76:21

104:22 117:10 119:21

145:13

truly 117:20 118:13

try 6:20 7:16 15:18

46:13 54:2 79:12

trying 9:13 41:20 91:20

91:22 95:21 98:15

99:15 100:1 113:6

131:3 147:16,19

tumor 56:9

turn 8:10 136:22

turnaround 66:6

turned 62:14 109:14

Turner 1:19 4:17 58:9

tweak 79:20

Twenty 63:18

twice 136:5

two 10:7 12:14 15:21

29:12 35:10 45:9,10

53:4 59:15 68:4,7

75:7 76:9 84:7 91:20

118:16 122:6 125:20

125:21 136:18 143:1

143:2,12,22 144:2,14

146:10,12 154:21

type 22:12 93:18

116:19

types 54:10 92:18

typical 29:6

U

U.S 83:4

ultimately 33:11

unable 56:15

underlying 33:8 64:16

77:5,7

underneath 112:19

understand 6:22 9:14

18:7 19:8 22:13 27:18

33:3 34:13 35:1 47:11

54:9,10 56:13 61:17

64:21 71:22 73:12

83:1 91:21 92:11 95:1

95:17,22 104:21

128:12

understanding 7:6 10:6

17:2 19:12 33:13

34:15 52:21 54:8 67:5

68:9,11,17 84:14

118:6 142:22 144:4

155:12

understood 39:20

74:13

unfortunately 21:17

unhappy 78:18

uniform 78:13

UNITED 1:1

use 20:7,8 68:14 81:7

85:2,13 91:2 94:13,13

useful 13:13 70:20

72:11 74:11 98:3

101:9

uses 91:7

usually 29:5 30:4,6,19

31:5 44:20 67:13

V

vague 14:16 77:8,12

78:7

vagueness 71:20

validity 119:10

Vance 88:17

variability 146:3

variable 29:9 87:4

variables 43:8 45:15

46:14 137:5 140:7

variation 78:20 145:1,2

various 10:4 11:22 42:1

42:21 54:11

vary 59:20

verbatim 7:14

version 15:20 153:3

versions 153:1,2

versus 10:19 13:20

14:12 20:7 23:3 25:16

25:16 41:9 43:12

47:16 68:15

vet 75:22

vetted 74:16 91:6

vetting 74:13 75:19

91:7 93:4,7

Vietnam 81:3

view 11:15 27:10

viewed 20:22 33:5

viewing 6:6

violate 44:18

vision 54:16

visited 5:17

visual 130:6

Vlieger 1:22 4:18 17:6,7

17:11,18,22 18:4,22

19:18,22 28:4,5 29:10

31:9,12 32:6 33:15
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49:15 58:3,3,20 59:11

60:10 61:5,9,20 62:10

63:9 71:10 74:1,12

75:16 82:12 91:5,11

93:3,12 94:2,4 103:6

103:13,18,22 104:9

104:16 149:15 150:9

150:16 151:18 152:6

152:14,22

volume 43:1

voluntarily 49:17

volunteered 136:17

voted 6:14

votes 69:11

vulnerable 33:22

W

wait 28:17 42:16 80:10

134:10 138:19 140:5

want 9:20 13:19 16:1

20:13 26:20 33:2,2,9

33:11 35:22 39:2

41:15 44:18 45:20

46:14,18 49:19,21

50:2 52:9,12,14 53:5

55:21 57:8,18 60:8

61:1 63:19 64:5 67:10

69:5 71:1 78:11,13

79:4 85:22 91:13

93:19 94:10 95:7,9

98:13 101:22 102:2

114:2,9 118:3 119:15

120:17 121:6 123:2

127:7,21 128:16

129:16,20,20 130:21

132:6 133:7 135:4,16

136:4,6 139:4,11

140:8,21 142:8 146:5

148:12

wanted 9:3,11 13:17,18

26:6 28:14 32:6 42:20

44:8 70:13 71:9 86:18

120:11 128:3 135:7

wanting 60:1

wants 38:11 140:10

wasn't 25:22 26:4 75:11

81:9 88:13 118:20

126:11 145:8 146:13

wax 59:13

way 13:6 15:21 16:21

17:19 18:3 23:16

44:14 47:13,13 48:8

50:8 54:4 55:10 71:22

72:5 73:6 83:10

108:15 109:19 111:11

116:2 123:1 125:14

129:6,22 130:19

133:13 149:22 150:3

ways 22:22 79:15 82:11

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we'll 5:20 7:12,14 45:8

45:8 49:12 51:14 80:2

80:11 82:8 96:1 97:21

105:12 108:18 110:19

110:19 119:22 124:2

127:7,12,15 129:14

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140:8 155:19

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50:19 55:16,16 58:2

59:3,4 60:16,22 64:14

67:15 68:6 70:14

72:21 73:4 81:8 82:11

83:13 88:9,20 89:1

90:10 95:18,21 96:2

98:15 99:12,16 100:1

105:3 106:15,16

108:11 114:1 119:19

120:10 121:11 123:13

127:8 131:3,14,16

132:14,16 133:8,12

133:18 137:4 138:8

142:16 146:17 149:16

150:7

we've 9:12 32:16 38:16

40:9 50:5,5 68:2,4

69:2,2,4 85:14 135:14

135:15 140:22 145:19

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website 5:7,12,17 6:12

7:9,18 8:14 28:11

30:3 32:11,18 43:13

43:18,20 49:10,16

151:9 152:20

WEDNESDAY 1:8

weeds 37:4

week 41:8 45:6,10 53:4

68:4 136:18,22 139:3

139:10,11,14,17,18

139:20,20 140:2

weekend 10:3 12:3

22:21 109:10 132:7

weeks 24:2 39:13 67:13

138:4,16

weight 97:6

weird 15:2

Welch 1:16 4:16 16:5

17:20 18:1,6,18 21:4

30:1 31:11,21 35:6

37:3,16,22 38:10 39:9

46:2,17 47:5,20 50:13

51:1,8,11,20 52:7

53:9 54:5 57:18 63:22

64:8,20 65:6,15 66:3

67:8 69:12 73:21

75:14 77:16 78:22

79:22 80:4 83:17,20

84:21 85:16 86:13,17

87:5,10 89:9,21 90:8

90:19 91:19 93:12

96:15 97:2,7 100:6

101:11,16,21 102:7

102:14 103:11,14

107:3,20 108:4,20

109:11 110:11,15

111:12 112:11,15,18

113:5 115:6,13 116:1

116:5,9,14 118:15

119:4 121:19 122:6

122:12,17,19 123:8

123:16,20 124:1,7,14

125:2,9 126:7,15

127:6,18 128:8,11,22

129:4,10,16,19 130:5

130:12,15,22 131:7

132:4 134:2,8,12

138:2,13,18 139:4,13

143:4,17 144:8 145:4

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welcome 4:4 8:12 70:18

well- 71:16

Wellman 144:17

went 11:20 14:12 48:3

48:10 65:21 70:1

156:16

weren't 100:12 107:4

128:16

whichever 9:7 108:15

152:4

wiggle 84:12

willing 32:8,9,22 43:4

wish 23:17 43:4

wondering 49:1 58:9

82:11

wording 83:6 88:22

150:1

words 64:19 104:2

149:7

work 4:11 15:18 41:17

44:9,12 46:8 93:18

99:2 107:21 116:20

147:21 150:5 155:9

156:3

worked 30:10 31:1 60:6

101:1 117:10

worker 1:3 4:7 5:15 8:8

23:16 67:11 84:21

workers 30:21 49:17

67:9 105:18

working 98:13 138:21

works 27:21 42:12

world 29:1 39:7 54:15

56:2 81:3 92:13

140:15 153:19

world- 76:15

worry 107:4 155:1,1

worth 107:5

wouldn't 51:18 64:3

120:5 155:1,1

write 45:5 59:15 71:11

83:2 95:19

writer 62:22

writes 62:11

writing 61:3 95:22

written 5:6 82:14 83:10

wrong 86:12 89:18

103:16

WTC 81:10,16

X

X 22:18 50:21 81:17

Y

year 11:4 31:14 32:13

92:8 95:8 112:14

139:2 144:2,15

years 22:19 28:6 30:20

32:17 35:9,10 42:21

62:6 79:3 87:9 88:11

95:10 98:7 122:16

144:10,16 153:21

Z

0

1

1:00 5:4

1:24 156:16

10 4:21 5:3 17:16 54:17

58:22 153:20

10-minute 5:2

10,000 129:17

10:00 1:10

10:09 4:2

100 73:17 89:5

11 3:17

11:29 70:1

11:30 5:2 69:10

11:40 69:18

11:43 70:2

12 150:14

12C 150:14

12th 139:14,20 140:2

130 118:21

135 111:5 116:10

15 54:17 69:11 114:17

119:3,6 153:20
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16 52:4

19 68:15

1950 37:20

1952 30:11

1980 38:4

1982 30:11

1990 87:12

1993 14:14 82:19 86:2

19th 139:21 140:2

2

2 4:21

20 5:3 49:3,7 52:3 57:16

58:7 59:1 62:21 63:16

64:2 86:15 94:15

20-page 83:19

20-year 87:18

20,000 22:16 122:18

200 122:14

2000s 113:1

2012 87:13

2013 32:12 51:22 52:1,3

52:11

2014 52:3

2015 38:5 52:4,8

2016 1:8

21 3:19

24,000 87:22

25 35:9,9 93:17

250 17:12

2500 88:1,1,10

26th 6:15

28th 6:15

29 1:8

3

3 1:6 3:11

30 7:17 28:3 90:5,6

94:15,18

300 92:8

35 52:2,10

4

4th 156:14

5

50 34:21 51:13,14 53:15

53:17 54:22 57:13,14

57:16 67:16 73:16

88:11 140:22

500 36:11

51-percent 81:8

5th 139:2

6

7

7 3:14

700 122:14

70s 112:22

73841 15:15

8

80s 113:1

850 17:16

9

90 7:10

900 122:13

93 17:21,21 85:20,21

86:6 88:18,19 113:6
NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE., N.W. 

(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com 

C E R T I F I C A T E

This is to certify that the foregoing transcript 

In the matter of: 

Before: 

Date: 

Place: 

was duly recorded and accurately transcribed under 

my direction; further, that said transcript is a 

true and accurate record of the proceedings. 

 

 ----------------------- Court Reporter 

174

Subcommittee on Evidentiary Reqs.

for Part B Lung Conditions (Area 3)

Toxic Substances and Worker Health Adv. Bd.

06-29-16

teleconference