UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES

AND WORKER HEALTH

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SUBCOMMITTEE ON SITE EXPOSURE MATRICES (AREA #1)

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MEETING

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SUMMARY MINUTES

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TUESDAY,

SEPTEMBER 20, 2016

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 The Subcommittee met telephonically at 1:00 p.m. Eastern Time, Laura Welch, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MEDICAL COMMUNITY:

STEVEN MARKOWITZ

LAURA S. WELCH, Chair

CLAIMANT COMMUNITY:

KIRK D. DOMINA

GARRY M. WHITLEY
OTHER ADVISORY BOARD MEMBERS PRESENT

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
Introductions

Ms. Rhoads opened the meeting at 1:01 p.m. Chair Welch said that she had asked the subcommittee

members to review some of the beryllium case files to ensure everyone had a good understanding of

the case review process.

Request for data on claims by specific ICD codes

Chair Welch asked if the department could make the cases available in a more easily searchable

fashion. Having everything (e.g., all of the medical records) in one PDF would be very helpful. The

subcommittee needs more information on claims by specific ICD code so that they can get an idea of

what people are filing for and what is happening to those cases. Dr. Welch informed the committee that

DEEOIC staff reported that the department does not code the incoming claims in a specific or routine

way. Based on that, although with the current compilation of data that the subcommittee has, it may not

be able to identify the total universe of cases, the data can be used to identify cases that the

subcommittee wants to learn from. The department is trying to find all of the claims by using text

descriptors and the ICD codes. That seems like the best that the department can do.

Request for case examples with presumptions

The subcommittee can learn a lot by looking at individual cases. But the department is not collecting

information such as if a case is denied because employment wasn't verified or because a medical

opinion was turned down. The subcommittee could at least get a description of the number of cases that

are accepted and denied by broad categories. It looks like 30% of the denials are lung disease. Chair

Welch reiterated that the subcommittee wants to get claims data by ICD code in order to get a sense of

the big categories of medical conditions in the claims process. Member Vlieger said that she could

provide, via Deb Jerison, a copy of the data dictionary for the codes that the department uses. The

subcommittee needs to look at how to dive into what information is available to determine if the SEM

is entering into negative claims decisions that might be contrary to a known exposure association for a

particular job category. Along the spectrum of reasons for denial, a crucial area to take a look at is to

see if the SEM/occupational history could play a role in the negative causation results. The

subcommittee needs to look at a subset of claims where there was a negative causation result for some

of the conditions.

The category “employee not covered” usually means that DOL has not found adequate site presence for

employment. There are also claims that get sent to contract medical consultants after review by the

industrial hygienists and toxicologists that are denied.

At some point, DOL started applying presumptions to COPD. The subcommittee needs to understand

the timing of when DOL started applying those presumptions. The bulletin on the presumption of

COPD was issued on December 28th of 2015 and expires in December this year. Member Markowitz

said that even if the subcommittee looks at claims from January 2016 and the few months after that,

they may be able to gauge how well the presumption is working. Chair Welch said that the

subcommittee will request a couple of different reports that reflect a wide range of data. 

DOL's response to IOM report on SEM
The recommendations from the IOM report are quite extensive and too big of a task for the

subcommittee to take on alone. Chair Welch suggested that instead of having some process to peer

review literature, OWCP should use its reliable sources like IARC, EPA, and the National Toxicology

Program. Member Vlieger said this approach would be good and that it takes away the issues with the

Haz-Map and the lack of peer review in the previous reports. Member Domina said he is for anything

that will help the claimant. He reminded the subcommittee that 34 sites have no SEMs. Member

Markowitz suggested looking at claims from a place that has no SEMs and see how DOL makes

decisions in those cases.

Member Vlieger said that in the past when there was no exposure data from either an incident or an

accident where there would have been air sampling, a number of chemists and metallurgists were

turned down because their diseases weren’t in the SEM and there was no monitoring data. Also, a lot of

the occupational history that’s in the files are variable in terms of quality and completeness.

The subcommittee agreed that board needs to form a plan for looking at how DOL can use other expert

data effectively. 

The IOM report said that the SEM does not adequately address mixtures or synergistic processes. The

subcommittee agreed to brainstorm on this issue.

Review of OHQ completed at resource centers

The OHQ is a beginning but it’s not enough. Chair Welch suggested that the industrial hygienists call

the claimants during their review of cases. Turning claims down because the claimant didn't collect the

information that would support the claim does not seem right. Some of the questionnaires do talk a

little bit about the claimants’ work activity, but very little. The industrial hygienists have been relying

on their general knowledge of industrial hygiene and what can be expected to happen in an industrial

facility, construction site, etc. Member Dement cited the example of a laundry worker that claimed

CBD and was denied based on the lack of specific exposure information. The industrial hygienist

probably should have gone back and spoken to this individual. Member Whitley added that many

workers have no clue as to what they were exposed to. Member Markowitz said that the interview

should not be used against a claimant. Any recommendation from the subcommittee on this point needs

to express some limitation of the interview approach. Whether or not the claimant should be open to or

allowed to have a second party with them during the interview is a question that deserves

consideration.

Member Vlieger said that it would be great if there was someone actually looking at the work processes

that the claimant might have been affiliated with. The exclusions that DOL assigns to things needs to be

broadened. The completeness of occupational histories needs to be enhanced. Perhaps the

subcommittee could recommend that the resource centers hire former workers to be trained up and to

administer the OHQ. In addition to having former workers, there needs to be some continuous

improvement to better understand the data collection. Improving the OHQ is now on the board’s

agenda.