UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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SUMMARY MINUTES

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MONDAY,

JUNE 19, 2017

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The Advisory Board met telephonically at 1:00 p.m. Eastern 

Time, Steven Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MARK GRIFFON

KENNETH Z. SILVER

GEORGE FRIEDMAN-JIMENEZ

LESLIE I. BODEN

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

LAURA S. WELCH

CARRIE A. REDLICH

VICTORIA A. CASSANO

ROSEMARY K. SOKAS

CLAIMANT COMMUNITY:

DURONDA M. POPE

KIRK D. DOMINA

GARRY M. WHITLEY

JAMES H. TURNER

FAYE VLIEGER
DESIGNATED FEDERAL OFFICER (DFO):

DOUGLAS C. FITZGERALD
Call to order and roll call

Doug Fitzgerald, the designated federal officer (DFO) for the board, 

called the meeting to order at 1:08 p.m. and took the roll. The board 

members introduced themselves.

Opening remarks

Chair Markowitz urged the board members to read the public comments. 

The comments raised issues that the board has not yet addressed. The 

committee chairs should pay special attention to the public comments. 

Beryllium issues

Member Redlich said that her subcommittee has looked at data on the 

beryllium claims and has reviewed the recommended decisions on 80 

Part B cases. The subcommittee has also reviewed the DOL guidelines 

relevant to Part B cases. At the last subcommittee meeting, the 

subcommittee made a recommendation regarding borderline beryllium 

lymphocyte proliferation tests (BeLPTs). The subcommittee has come up 

with a few draft recommendations and a complete response to the 

questions that the Department of Labor (DOL) had put forward to the 

subcommittee. Member Redlich presented the subcommittee's 

recommendations to the board.

Draft Recommendation 2

The following criteria are proposed to define a clinical course 

consistent with a “chronic respiratory disorder” for use in 

evaluating pre-1993 chronic beryllium disease (CBD) claims:

 

i) Respiratory symptoms (e.g. shortness of breath, cough) that are 

chronic* 

ii) PLUS ONE of the following:

a) Abnormal pulmonary function tests (PFTs) OR

b) Abnormal chest imaging (chest x-ray or CT scan) OR

c) Hypoxemia, OR

d) Use of respiratory medications such as asthma or chronic 

obstructive pulmonary disease (COPD) inhalers

*“Chronic” indicates symptoms (or medication usage) that are present 

for more than three months, to differentiate from symptoms (or 
medication usage) related to an acute infection or other problem that 

resolves. If the claims examiner cannot determine, based on the 

record, whether the condition was present for more than three months, 

then the case should be referred to a contract medical consultant 

(CMC) to determine if the condition was a chronic respiratory 

disorder. 

Member Redlich's concern with greater specificity is that it may lead 

to arbitrary decision-making on the part of claims examiners (CEs). 

Member Boden crafted language as an addendum to Draft Recommendation 

2 that will give the CEs leeway in evaluating whether or not a 

claimant's condition fits the category of chronic respiratory 

disorder. That language is represented by the above sentence 

beginning with, “If the claims examiner cannot determine...” The 

board spent a significant amount of time wordsmithing this sentence. 

The board agreed that having a mention of specific months was a good 

idea. Three months was the consensus duration. With regard to 

medication, Member Vlieger said that during the course of her 

treatment, she was told to purchase over-the-counter medication. 

Member Cassano suggested that a supervisory claims examiner be 

standing by during board and committee meetings. 

Chair Markowitz noted that according to the pre-1993 criteria, the 

claimant has to have a history of beryllium exposure. The board

thought that the recommendation didn't need to say “prescribed”

medication because a successful claim would need to include three of 

the five chronic criteria spelled out in 13B(ii) of the EEOICPA, four 

of which would require that the claimant had received medical 

attention.

The board unanimously approved the updated Draft Recommendation 2 

after a roll call vote.

Draft Recommendation 3

The Advisory Board recommends a substantial revision of sections of 

the Procedure Manual and related materials relevant to Part B 

conditions, taking into consideration the comments in this document 

and other feedback from the Advisory Board.

Rationale: Sections of the current Procedure Manual and related 

materials are inconsistent, confusing, and at times medically 

inaccurate, which can hinder proper adjudication of Part B claims.

Responses to DOL's specific comments and questions
Member Redlich presented the responses to DOL's specific comments and 

questions. Member Redlich read the responses and asked for questions. 

All of the issues raised were addressed in detail. There did appear 

to be cases where some workers that were covered beryllium workers 

did not get compensated because the CMC did not recognize berylliumrelated disease or exposure. 

. 

The board unanimously approved Draft Recommendation 3 after a roll 

call vote. 

Endorsement

The Advisory Board endorses the presumption of CBD in situations 

with a diagnosis of sarcoidosis in an individual who meets the 

definition of a “covered beryllium employee” under Part E or Part B.

DOL Criteria on Solvent Related Hearing Loss

Member Welch gave the board an update on solvent-related hearing loss 

issues. Member Welch reminded the board what the current DOL 

presumptions are for solvent-related hearing loss and presented the 

list of solvents in the DOL criteria. She presented some literature 

on solvent-related hearing loss. Recent reviews conclude that both 

animal and human studies clearly establish effects of solvents on 

hearing. The review of compound-specific data has clear limitations 

since most workers are exposed to multiple solvents. Review of mixed 

exposure data is more limited.

Consensus statements are available from The National Institute for 

Occupational Safety and Health (NIOSH) (2003), the Environmental 

Protection Agency (EPA) (2003), Nordic Expert Group, and the European 

Agency for Safety and Health at Work (EU OSHA). There is no consensus 

on dose-response or existence of threshold in reviews, although a 

recent paper has addressed it (through European collaborative study).

Systematic review by NIOSH and the Nordic Expert Group for Criteria 

Documentation of Health Risks from Chemicals shows styrene, toluene, 

and xylene carbon disulfide cause hearing loss at or below current 

occupational exposure limits (OELs). Xylene, ethylbenzene have more 

limited occupational data. Animal data show effects at or below 

current (OELs). Trichloroethylene (TCE) and solvent mixtures show 
significant effect in human studies. Mixtures most often include

methyl ethyl ketone (MEK), methyl isobutyl ketone (MIBK), xylene and 

toluene.

There are good data that noise and solvent exposure are synergistic 

in causing hearing loss. However, site exposure matrices (SEM) do not 

include any information on noise exposure, because noise is not a 

hazard considered under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). 

The board considered the following proposed recommendation for 

solvent related hearing loss:

A claim would meet the presumption for solvent-related hearing loss 

if there is

A diagnosis of sensorineural hearing loss

AND

Significant solvent exposure defined as:

Work for at least a total of 7 years (or equivalent) in any of the 

job titles on the list in the current presumption, or in any 

construction or maintenance job.

OR

Reported exposure to one or more of the following: styrene toluene, 

MEK, MIBK, N-hexane, xylene, ethylbenzene TCE, or carbon disulfide on 

OHQ, or evidence for exposure to organic solvents in the SEM, for at 

least a total of 7 years (or equivalent)

OR

Reported exposures to organic solvent mixtures on the occupational 

history questionnaire (OHQ), or evidence for exposure to organic 

solvent mixtures in the SEM, for at least a total of 7 years (or 

equivalent)

OR

Solvent exposure for at least a total of 7 years (or equivalent) 

established through work history and DDWLP

Additionally, claims examiners should not routinely deny claims for 

solvent-induced hearing loss if the worker has had fewer than 7 years 

of exposure, does not have a DDWL for task, or is not in a labor 

category on the list. Claims that do not meet the requirements set