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UNITED STATES DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES

AND WORKER HEALTH

+ + + + +

SUBCOMMITTEE ON THE SITE EXPOSURE

MATRICES (AREA #1)

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MEETING

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TUESDAY,

MARCH 21, 2017

+ + + + +

The Subcommittee met telephonically 

at 1:00 p.m. Eastern Time, Laura S. Welch, 

Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MEDICAL COMMUNITY:

LAURA S. WELCH, Chair

STEVEN MARKOWITZ

CLAIMANT COMMUNITY:
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DURONDA M. POPE

OTHER ADVISORY BOARD MEMBERS PRESENT:

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
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A G E N D A

Discussion of draft recommendations for OHQ .. 10

Discussion of draft recommendations for a 

presumption on COPD .......................... 37

Approach to exposure assessment at sites 

without a SEM ................................ 58

Additional recommendations from IOM to again 

recommend to DOL ............................. 64

Adjourn ...................................... 78
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1 P-R-O-C-E-E-D-I-N-G-S

2 1:03 p.m.

3 MS. RHOADS: Hello, everybody. My 

4 name is Carrie Rhoads and I'd like to welcome 

5 you to today's teleconference meeting of the 

6 Department of Labor's Advisory Board on Toxic 

7 Substances and Worker Health, the Subcommittee 

8 on the Site Exposure Matrices, or SEM.

9 I'm the Board's Designated Federal 

10 Officer, or DFO, for today's meeting. We do 

11 appreciate the work of the Board Members in 

12 preparing for this meeting. I'll introduce the 

13 Board Members and take a quick roll call. Dr. 

14 Laura Welch is the Chair of this group.

15 CHAIR WELCH: And I'm here.

16 MS. RHOADS: Great. And the Members 

17 are: Dr. John Dement --

18 MEMBER DEMENT: I'm here.

19 MS. RHOADS: -- Mr. Garry Whitley, 

20 who is not able to attend today's call, Mr. 

21 Kirk Domina, who will be calling in a little 
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1 later, Mr. Mark Griffon, who will also be 

2 calling in, Ms. Duronda Pope --

3 MEMBER POPE: I'm here.

4 MS. RHOADS: -- and Dr. Steven 

5 Markowitz.

6 MEMBER MARKOWITZ: Yes, I'm here.

7 MS. RHOADS: And Dr. Markowitz is 

8 also the Chair of the Board. On the line as 

9 well is Ms. Faye Vlieger, who is also a member 

10 of the Board. We're --

11 MEMBER VLIEGER: I'm here.

12 MS. RHOADS: Great. We're scheduled 

13 to meet from 1:00 to 3:00 p.m. Eastern Time 

14 today. In the room with me is Melissa 

15 Schroeder from SIDEM, our contractor. As far 

16 as timing goes, I don't know if we'll need to 

17 take a break today, that can be up to Dr. 

18 Welch, depending on how the discussion is 

19 going.

20 Copies of all the meeting materials 

21 and any written public comments are or will be 
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1 available on the Board's website, under the 

2 heading meetings, and the listing there for 

3 this Subcommittee meeting. The documents will 

4 also be up on the WebEx screen so everyone can 

5 follow along with the discussion.

6 The Board's website can be found at 

7 dol.gov/owcp/energy/regs/compliance/advisoryboa

8 rd.htm. If you haven't already visited the 

9 Board's website, I encourage you to do so. If 

10 you click on today's meeting date, you'll see a 

11 page dedicated entirely to today's meeting.

12 The webpage contains publicly 

13 available materials submitted to us in advance 

14 and we'll publish any materials that are 

15 provided to the Subcommittee. There, you can 

16 also find today's agenda, as well as 

17 instructions for participating remotely.

18 If you are participating remotely 

19 and you're having a problem, please email us at 

20 energyadvisoryboard@dol.gov. If you're joining 

21 by WebEx, please note that this session is for 
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1 viewing only will not be interactive. The 

2 phones will also be muted for non-Advisory 

3 Board Members.

4 Please note that we do not have a 

5 scheduled public comment session today. The 

6 call-in information has been posted on the 

7 Advisory Board's website so the public may 

8 listen in, but not participate in the 

9 Subcommittee's discussion.

10 The Advisory Board voted at its 

11 April 2016 meeting that Subcommittee meetings 

12 should be open to the public, so we'll prepare 

13 transcripts and minutes from today's meeting. 

14 During the Board's discussions today, as we are 

15 on a teleconference line, please speak clearly 

16 enough for the transcriber to understand.

17 When you begin speaking, especially 

18 at the start of the meeting, please state your 

19 name so we can get an accurate record of the 

20 discussion. Also, I'd like to ask our 

21 transcriber to please let us know if you're 
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1 having an issue with hearing anyone or with the 

2 recording.

3 As DFO, I see that the minutes are 

4 prepared and ensure they're certified by the 

5 Chair. The minutes of today's meeting will be 

6 available on the Board's website no later than 

7 90 calendar days from today, but if they're 

8 available sooner, they'll be public before the 

9 90th day. Also, although formal minutes will 

10 be prepared, we'll also be publishing verbatim 

11 transcripts. Those transcripts should be 

12 available on the Board's website within 30 

13 days.

14 I'd like to remind the Advisory 

15 Board Members that there are some materials 

16 that have been provided to you in your capacity 

17 as Special Government Employees and Members of 

18 the Board which are not for public disclosure 

19 and cannot be shared or discussed publicly, 

20 including in this meeting. Please be aware of 

21 this as we continue with the meeting today.
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1 These materials can be discussed in 

2 a general way, which does not include using any 

3 personally identifiable information, such as 

4 names, addresses, specific facilities if a case 

5 is being discussed, or doctors' names.

6 And with that, I convene this 

7 meeting of the Advisory Board on Toxic 

8 Substances and Worker Health, the SEM 

9 Subcommittee, and I'm turning it over to Dr. 

10 Welch, who is the Chair.

11 CHAIR WELCH: Thank you, Carrie. I 

12 am talking on my phone on speaker. I just 

13 wanted to ask the transcriber if he or she can 

14 hear me.

15 COURT REPORTER: I can hear you.

16 CHAIR WELCH: Great, because a couple 

17 of times, we've had some trouble with that. 

18 Well, hello, everybody. Thanks for being on 

19 the call. I had suggested four items for our 

20 agenda today, which is continuing our work on 

21 the Occupational Health Questionnaire and also 
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1 on a presumption for COPD. And I think we'll 

2 probably spend most of our time on those.

3 But there's one more, we have talked 

4 in the past about an approach to exposure 

5 assessment at sites where there is not a SEM 

6 and I wanted to be sure that we have addressed 

7 that as best we can with our previous 

8 recommendations regarding exposure assessment 

9 and the new recommendations for the OHQ.

10 And then, the fourth item is, Dr. 

11 Markowitz had asked me and our Committee to 

12 circle back and see if there were additional 

13 recommendations in the Institute of Medicine 

14 report that we should put forward again to the 

15 Department of Labor.

16 We had focused initially on the 

17 addition of other sources for causation 

18 information beyond Haz-Map. And I did prepare 

19 a summary of some of the other recommendations, 

20 which I did not send to you, but I thought we 

21 would have a general discussion of that.
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1 I sent out a document for you all to 

2 review and that we'll go over now, so if for 

3 any reason anybody doesn't have the draft OHQ 

4 recommendations or the COPD, let me know and I 

5 can forward it again. But it looks like 

6 everyone who is on the call was on the email. 

7 Any questions about the agenda before we move 

8 on to the number one? Okay.

9 So, improving the OHQ. We had 

10 talked at our last conference call and came to 

11 the consensus that the revision, the draft 

12 revision we have seen from Paragon, which is 

13 the contractor for DOL, didn't seem to be an 

14 improvement and we liked many of the things 

15 that were -- many of the items that had been on 

16 the previous questionnaire.

17 We identified that one of the 

18 problems was that the building sites

19 questionnaire does have information about 

20 tasks, which is very helpful in assessing 

21 exposures, but that the -- it's been very hard 
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1 to develop a list of tasks for production 

2 workers.

3 So, one of the action items was, I 

4 was going to talk to Mark Griffon to see if he 

5 had any ideas about developing a list of tasks. 

6 And then, I developed this draft that we have 

7 to look at and I discussed it via email with 

8 John Dement, to basically make sure we were 

9 covering the parts of the OHQ that we had 

10 talked about before.

11 And he gave me a preliminary okay 

12 with the recommendations I've included here. 

13 So, I thought we would just walk through them. 

14 And then, if we agree on these, there are four 

15 recommendations and I put in a rationale for 

16 each one with the idea that this document could 

17 then go to the whole Board for discussion and 

18 approval.

19 So, the first one is the, as I just 

20 mentioned, the current version of the OHQ has a 

21 list of hazards, exposures, and materials. So, 
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1 we're recommending that that list be maintained 

2 on a future version of the OHQ and that it be 

3 expanded by adding the list of hazards and 

4 materials from BTMed.

5 The idea for that is that the more 

6 information there is on specific hazards and 

7 materials for the claims examiner, the IH, and 

8 the medical consultant, the more they'll be 

9 able to assess an individual's exposure, which 

10 is clearly important for making a determination 

11 about whether the disease was caused by those 

12 exposures.

13 Anybody have any thoughts or 

14 additions on this expansion of the current OHQ 

15 by adding the BTMed hazards, exposures, and 

16 materials? Okay. You're all so quiet, but 

17 that's good. I mean, we'll be moving quickly.

18 Then, the next one is adding the 

19 list of tasks. So, we're recommending adding 

20 the list of tasks we have in BTMed, which is 

21 clearly incomplete and really serves some of 
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1 the production workers, if they're doing 

2 similar tasks, but not all of them.

3 But after talking with Mark and 

4 thinking over our prior conversations, we 

5 really thought it was almost impossible to 

6 develop a list of tasks for everyone. And so, 

7 we are going to give a way for workers to 

8 describe what they did without having to have a 

9 list of tasks.

10 I think tasks are somewhat like job 

11 titles, there are many different ways that 

12 people describe the same bit of work, depending

13 on who is performing it, so that we didn't 

14 really think we could come up with a list of 

15 specific tasks. And then -- oh, yes. Under 

16 the first one, the idea was that the workers 

17 would describe the tasks associated with the 

18 exposure.

19 So, if they mentioned they were 

20 exposed to beryllium, then they would in free 

21 text describe how they were exposed to each 
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1 material, with an emphasis on describing the 

2 tasks and that that would be a free text, but 

3 readily available to anybody who reviewed the 

4 questionnaire, as well as giving some 

5 information on frequency of the exposure, so 

6 that, rather than asking about a long list of 

7 tasks, we're hoping that we will get the task 

8 information by asking workers about their 

9 exposures that they had and then, from that, 

10 the task that entailed that exposure.

11 I think this is an area where you 

12 all should really think about it and see if we 

13 can think of any other way. I mean, this is 

14 coming off of talking with Mark and talking 

15 with John about what one could do as hygienist, 

16 that there may be other things that people who 

17 are more familiar with the facilities might be 

18 able to come up with another way, an additional 

19 thing we could add that might capture tasks. 

20 So, I'm definitely looking for comments on 

21 that.
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1 MEMBER MARKOWITZ: Laura, this is 

2 Steven. So, the -- I see on the BTMed 

3 questionnaire, you have the tasks and you ask 

4 for each one the frequency. So, would the idea 

5 with the non-construction tasks, that when a 

6 person says, yes, I was exposed to methylene 

7 chloride, and the interviewer asks, what did 

8 you do with methylene chloride, and they write 

9 down one or more tasks, that the interviewer 

10 would also ask the frequency in the same way 

11 that you have it on the BTMed questionnaire?

12 CHAIR WELCH: That's a good idea. I 

13 was -- I had -- what I was thinking was they 

14 would talk about the frequency of the exposure, 

15 but I agree, it probably makes more sense to 

16 talk about the frequency of the task, because 

17 that is what we care about, is a task may have 

18 methylene chloride, it may have other solvents, 

19 and often, we're looking at the combined 

20 exposure of the solvents. I can't quite 

21 picture a flow for that, but --
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1 MEMBER MARKOWITZ: Right.

2 CHAIR WELCH: -- maybe there should 

3 be a little box to the side that after you 

4 identify exposure or identify a task, we ask --

5 the full text goes into the task and then we 

6 ask frequency of that.

7 MEMBER MARKOWITZ: Right. Or the 

8 frequency could describe that exposure, so that 

9 whoever is interpreting the information would 

10 have the frequency of exposure to that 

11 particular agent, as well as have the tasks.

12 That might be better, because what's 

13 going to happen is the same task -- with the 

14 same task, if there are multiple exposures, the 

15 person filling out the questionnaire is going 

16 to say, see the above response to methylene 

17 chloride, or whatever, and then we won't get 

18 the frequency. But if you attach the frequency 

19 to the exposure, then it ought to simplify it.

20 CHAIR WELCH: Well, that -- it's 

21 easier to figure out how to do that if you're 
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1 asking about exposure and then you attach 

2 frequency for each exposure.

3 MEMBER MARKOWITZ: Right.

4 CHAIR WELCH: But if you think that's 

5 sufficient, that's clearly -- the flow would be 

6 easier.

7 MEMBER MARKOWITZ: Right. No, I 

8 mean, still get the task, because you want some 

9 sense of the intensity, right?

10 CHAIR WELCH: Right.

11 MEMBER MARKOWITZ: But you don't 

12 sacrifice the frequency information for that.

13 CHAIR WELCH: Okay.

14 MEMBER DEMENT: Hi, this is John. I 

15 agree with Steven's recommendation. I would be 

16 more interested in how frequently they had that 

17 exposure than trying to tag it all into each 

18 task, which I think just adds a lot more 

19 probably unnecessary time and detail that they 

20 probably won't remember anyway.

21 CHAIR WELCH: Okay.
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1 MEMBER DEMENT: I think that's a 

2 simplification that's workable.

3 CHAIR WELCH: Okay. And one of the 

4 last recommendations is that this be tested and 

5 tested again. So, if there's some confusion in 

6 the flow of questions, we can fix that, someone 

7 can fix that.

8 And so, the way it's described in 

9 this document, under the first recommendation, 

10 is that the worker will be asked to describe 

11 how he or she was exposed to each material and 

12 describe the task associated with that exposure 

13 be captured within free text. The worker will 

14 be also asked to rate the frequency of exposure 

15 to each hazard. So, that, I think, is what you 

16 all are recommending. So, I think we're good.

17 MEMBER DEMENT: All right.

18 CHAIR WELCH: Okay, good. Then, 

19 number three is adding specific questions about 

20 vapors, gases, dusts, and fumes to be able to 

21 help with causation for COPD. And the study 
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1 that's been used in population-based studies is 

2 the question, it's simply, have you been 

3 exposed to vapors, gases, dusts, and fumes? 

4 And then it says, if the answer is yes, the 

5 worker is asked to describe the tasks and 

6 materials associated with exposure and add a 

7 frequency.

8 I guess, what we're going to do is 

9 the same thing as above, it would make sense to 

10 have them describe the materials and then the 

11 tasks and do a frequency of the materials. 

12 This is one, I think it's going to take some 

13 laying out to make it make sense, to get the 

14 flow correctly.

15 I guess, my thought, just thinking 

16 about it right now, would be, we could advance 

17 this recommendation as it's written and there's 

18 the next step of figuring out the question.

19 Do you think we need to specify 

20 under where it says, if the answer is yes, the 

21 worker is then asked to describe in detail the 
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1 tasks and materials associated with exposure, 

2 the frequency using the scale recommended? 

3 Should we say, frequency of materials or leave 

4 it as it is?

5 MEMBER MARKOWITZ: I'm sorry, this is 

6 Steven. What do you -- leave it as is, what is 

7 it now?

8 CHAIR WELCH: Well, in the -- when I 

9 put in that the worker should describe the 

10 frequency, it's not specified whether it's the 

11 frequency of the task or the frequency of the 

12 materials. Because we say, if they say yes to 

13 vapors, gases, dusts, and fumes, they should 

14 describe the tasks and materials and then the 

15 frequency.

16 MEMBER MARKOWITZ: So, this is 

17 Steven. So, if this question comes after the 

18 hazard-by-hazard description of tasks and 

19 frequency, then it might be unnecessary 

20 actually to ask about, to re-ask about tasks.

21 If you were to ask, if there's a yes 
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1 to the VGDF question and then a person is 

2 asked, okay, what were those gases or dusts, 

3 and they name the particular hazards, whoever 

4 is using the information, the IH or CE, could 

5 actually look back at the list of hazards, 

6 because that's where the tasks are already 

7 going to be, to get a sense of what was done 

8 with that material.

9 The other thing is, of course, is 

10 that -- it's interesting, in the literature, 

11 the VGDF literature, there wasn't a whole lot 

12 of detail, I don't think there was a whole lot 

13 of detail captured about what the nature of 

14 those vapors, gases, dusts, and fumes were, and 

15 yet, that single question was highly 

16 predictive.

17 So, I'm not sure we need a -- I 

18 think if we went with, what were those dusts, 

19 gases, vapors, or fumes, and what the frequency 

20 was and then get into duration, that would 

21 suffice.
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1 CHAIR WELCH: Okay.

2 MEMBER DEMENT: This is John. I 

3 agree. Just a simple question in the 

4 literature, without diving into detail, is very 

5 predictive. It's been validated in population6 based studies.

7 CHAIR WELCH: I think that one reason 

8 to get associated materials is that, then the 

9 materials can, some of those materials can be 

10 used to look into SEM.

11 So, if the worker's been exposed to 

12 a mixture of agents and identifies a lot of 

13 them, if the claims examiner feels they need to 

14 find, they need to validate some of these 

15 exposures, maybe even just a couple of the 

16 mixtures in the SEM, then having the materials 

17 will be helpful that way.

18 MEMBER DEMENT: No, I agree. I think 

19 we should ask the follow-up questions, it's 

20 just that, even on the frequency, we'd be sort 

21 of happy to ask the same as we did with the 
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1 materials and this is just a mixture, asking 

2 the frequency of the exposure to VGDF rather 

3 than looking at each component.

4 CHAIR WELCH: Okay.

5 MEMBER MARKOWITZ: This is Steven. 

6 So, I notice you want to ask about the number 

7 of years of exposure and I'm wondering whether 

8 we should also ask simply the year of first 

9 exposure. But just to -- we'll be talking, I 

10 know, about the COPD presumption in a bit, but 

11 I think that's part of the COPD presumption. 

12 And if so, then we need it here.

13 CHAIR WELCH: Good idea, yes. So, do 

14 you think we can ask, instead of asking about 

15 materials here, ask them the frequency of 

16 exposure? Or are we safer asking them to 

17 repeat it again? Because it's very possible 

18 that if you ask the worker what materials they 

19 worked with, they won't really have thought 

20 about a lot of materials.

21 MEMBER DEMENT: Yes, it would be my 
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1 assumption they would not have list a lot of --

2 perhaps even list everything. But I think it's 

3 okay to ask of you here. One of the things we 

4 should -- it was going to be sort of the last 

5 question in this whole series, are these 

6 vapors, gases, dusts, and fumes covered in the 

7 previous materials that you described or 

8 listed?

9 CHAIR WELCH: Okay.

10 MEMBER DEMENT: I mean, it's possible 

11 they may have already been covered, but it's 

12 possible that they weren't. And I guess I'd be 

13 interested more specifically in ones that 

14 weren't already covered.

15 CHAIR WELCH: Okay. So, I could edit 

16 this to say that, we could say, have you been 

17 exposed to vapors, gases, dusts, and fumes, and 

18 then, have you described all those exposures in 

19 your answers above? If not, then describe the 

20 tasks and materials that aren't already 

21 covered. Because we are asking the frequency 
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1 up above.

2 MEMBER DEMENT: Yes, that sounds 

3 reasonable to me.

4 CHAIR WELCH: Okay.

5 MEMBER MARKOWITZ: The -- this is 

6 Steven. I'm picturing this, anticipating what 

7 we're going to talk about maybe a little bit 

8 later with the COPD presumption, I mean, what 

9 would be nice, it would be if the claims 

10 examiner had a simple little algorithm based on 

11 this series of questions, whereby they could 

12 make a decision about COPD.

13 So, exposed to VGDF? Yes. How many 

14 years? Ten years, whatever the respondent 

15 says, but it's above the threshold. Frequency? 

16 At least once a week. Positive response --

17 began at least 15 years ago? Positive response 

18 to those four questions? Then the person gets 

19 compensated for COPD. And I'm afraid if we 

20 complicate it too much here, then we'll make 

21 the use for -- to serve a presumption to be 
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1 more challenging.

2 CHAIR WELCH: That's good. Yes. So, 

3 then the notes I already made were that, rather 

4 than asking about specific hazards, we ask 

5 about year of first exposure to VGDF and 

6 frequency.

7 And then, ask, in your answers 

8 above, have you described all the tasks and 

9 materials where you were exposed? And if not, 

10 they can expand it. But we would already have 

11 had, as the first two questions, the frequency 

12 of that umbrella exposure and the year of first 

13 exposure.

14 MEMBER MARKOWITZ: Right.

15 CHAIR WELCH: Okay. And I think 

16 you're right, these may be -- if we could build 

17 it into the computer system, it just says, yes, 

18 yes, yes, okay, accept claim, you don't have to 

19 think about it.

20 I don't know if we could get that, 

21 but it's possible to do that if the decision 
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1 tree is right and once the answers are put in, 

2 the decision tree makes a recommendation. More 

3 thoughts about this? I would --

4 MEMBER POPE: This is Duronda --

5 CHAIR WELCH: -- I will --

6 MEMBER POPE: Duronda Pope.

7 CHAIR WELCH: Yes?

8 MEMBER POPE: I'm just trying to 

9 clarify. So, if a claimant says that they've 

10 been exposed to gases, vapors, and dusts, and 

11 then -- it just seems like that's the -- you're 

12 being asked that question again, later on in 

13 the questionnaire. Is that not true?

14 CHAIR WELCH: Well, up above, I mean, 

15 we've got -- the way I was picturing it was 

16 they would say, you'd say, what materials did 

17 you work with in your job?

18 MEMBER POPE: Yes.

19 CHAIR WELCH: And then, for each one 

20 of those, you'd say, you'd describe a task and 

21 some information about the frequency of the 
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1 exposure. Then, they'd come down to this 

2 question, have you been exposed to vapors, 

3 gases, dusts, and fumes?

4 And has the worker -- it would be, 

5 it should be repeating information that the 

6 worker has already given, but it's one place 

7 where we get them to say, yes, I have been, so 

8 that's every day for all the years I've worked 

9 there. Because the claims examiner --

10 otherwise, we just tell the claims examiner, 

11 these particular materials represent a vapor, a 

12 gas, dust, and fumes.

13 MEMBER POPE: Okay. And then --

14 CHAIR WELCH: And then --

15 MEMBER POPE: And then, you're going 

16 to ask them what's the first time that they 

17 were exposed to it?

18 CHAIR WELCH: Yes. Because in the 

19 presumption about COPD, we're recommending that 

20 the worker should have been exposed at least 15 

21 years prior to their claim, since it seems to 
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1 take that long.

2 MEMBER POPE: Okay.

3 CHAIR WELCH: And then -- so, you'd 

4 want to capture that there. I think it will be 

5 redundant, which is a good reason not to make 

6 it take too long.

7 But it does mean, if we want to go 

8 back at some point and try to do some kind of 

9 assessment of how well DOL implemented these 

10 recommendations, well, we could look at that 

11 question rather than having to look at the 

12 whole work history and figure out what should 

13 have been considered as vapors, gases, dusts, 

14 and fumes.

15 MEMBER VLIEGER: This is Faye. I 

16 just have a question about, the Department of 

17 Labor has been assessing the intensity of the 

18 exposure as a quantity of exposure versus 

19 duration, is this going to lay that question to 

20 rest because of the presumption by labor 

21 category or task?
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1 CHAIR WELCH: Well, this is -- you 

2 can't really ask the worker the intensity of 

3 exposure, I don't think. I mean, DOL has made 

4 some assumptions about intensity of exposure in 

5 some of their post-95 memo and the effect of 

6 presumption, but the industrial hygienist 

7 should be able to understand intensity by 

8 looking at the tasks. If there's a case where 

9 an individual -- where knowing intensity is 

10 important, then tasks is the best information 

11 for that. Does that make sense?

12 MEMBER VLIEGER: Yes, it makes sense 

13 to me. I was just wondering if we were going 

14 to get away from them asking the intensity, 

15 even if it is a presumption because they are 

16 exposed by task or labor category. That was 

17 the only hurdle I saw to this type of 

18 questioning.

19 CHAIR WELCH: Well, so, what you do -

20 - so, if someone stepped in with the 

21 presumption, like you could certainly have a 
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1 presumption for job titles or a labor category 

2 that wouldn't even require all the detail 

3 you're going to get on the Occupational Health 

4 Questionnaire. But it would be nice to have it 

5 for the people for whom some exposure is not 

6 presumed based on their job title.

7 MEMBER VLIEGER: Okay. I understand, 

8 I just -- I was just being devil's advocate 

9 there for a second.

10 CHAIR WELCH: Yes. Do you think 

11 that's okay? I mean --

12 MEMBER VLIEGER: If the presumption 

13 is that this particular task or this particular 

14 labor category has -- meets the exposure level 

15 from the studies, then, yes, I think it would 

16 fly, as long as we're clear about that, that 

17 this does not mean that they get asked about 

18 intensity of exposure.

19 CHAIR WELCH: Yes. So, that wouldn't 

20 necessarily be -- the reason that you'd want to 

21 ask about intensity here would be if there was 
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1 a presumption that we're relying on and we want 

2 to make sure they collect any information we 

3 would need that is invoked in the future 

4 presumptions.

5 I wouldn't try to put in some kind 

6 of assessment of intensity in a presumption. 

7 But there is -- the idea of intensity is built 

8 into labor category or task.

9 MEMBER VLIEGER: Yes. The workers 

10 don't have the information anyway, so we have 

11 to do something to get around that.

12 CHAIR WELCH: Right. And intensity 

13 is a little bit like pain, one person's ten is 

14 somebody else's five.

15 MEMBER VLIEGER: Exactly.

16 MEMBER MARKOWITZ: This is Steven. 

17 Are those --

18 CHAIR WELCH: Okay.

19 MEMBER MARKOWITZ: -- for the person 

20 responding, yes, I was exposed to vapors, 

21 dusts, gases, and fumes, that means that it was 
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1 enough to smell or enough to see or whatever, 

2 which implies a certain intensity.

3 CHAIR WELCH: Okay. So, the fourth 

4 one is that we -- pointing out that any new 

5 questionnaire has to be tested. And I would --

6 I don't think, at the time of our last call, I 

7 had read this new -- what's it called --

8 Bulletin, this Bulletin 16-03, in which they 

9 covered the direct disease link work process, 

10 which links medical conditions to specific 

11 tasks.

12 And the question would be, as we're 

13 developing the questionnaire that collects 

14 information, more information on materials and 

15 tasks, we would then be petitioned to support 

16 the process that they've described.

17 That -- 16-03 sounds great, I have 

18 no idea how they're going to implement it. 

19 Because prior to our recommending it, they 

20 actually asked about tasks, there's no 

21 information on task in the SEM or in the 
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1 Occupational Health Questionnaire.

2 So, just a small point. But since 

3 that Bulletin is going to be a way for a lot of 

4 people to have their claims accepted, I think 

5 it's important that we make sure over time and 

6 bring it back to the Board an assessment of how 

7 well our revised OHQ is capturing the 

8 information needed for that direct disease link 

9 process to work.

10 MEMBER VLIEGER: This is Faye. I 

11 don't know if any of you have tooled around the 

12 SEM site or not, but the links to -- it's hard 

13 to find labor categories, particularly under 

14 construction. You have to burrow down quite 

15 deeply now to find them.

16 And they're not consistent. An 

17 asbestos worker is listed a bunch of different 

18 ways and each one has different exposures once 

19 you finally get through the construction worker 

20 layer.

21 And so, I'm not sure how this direct 
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1 disease link work process stuff is going to 

2 work when they have so many different answers 

3 for somebody depending on how they responded to 

4 the OHQ.

5 CHAIR WELCH: Now, that's bad.

6 MEMBER VLIEGER: Yes, it is. And did 

7 I hear that we have a contractor listening in 

8 on the call today? Is that the contractor for 

9 the SEM?

10 MS. RHOADS: No, no, it's the 

11 contractor for the Board for logistics.

12 MEMBER VLIEGER: I might ask Dr. 

13 Markowitz, because the SEM is kind of the basis 

14 for all of this discussion on exposures, could 

15 we have someone at the Board meeting give us a 

16 demonstration of the SEM and what's going on 

17 with it?

18 MEMBER MARKOWITZ: Sure. Carrie, if 

19 you could just make a note of that? I know DOL 

20 will be there, so we can certainly do -- do you 

21 also mean, Faye, to ask for how this new 
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1 Bulletin is applied given the SEM?

2 MEMBER VLIEGER: Yes, because I'm 

3 having a hard time finding these direct link 

4 processes that they have listed. Until we 

5 started reconstructing the SEM a while ago, it 

6 was relatively easy by sight to find a labor 

7 category, but then they took the link disease 

8 process links out. I don't know if that was 

9 because they quit using Haz-Map or because Haz10 Map was found to not be the most reliable place 

11 to have those links, I don't know.

12 But even on the site, it says they 

13 took these disease links out, so I don't know 

14 if they're talking in Bulletin 16-03 about the 

15 public SEM or the SEM that only the claims 

16 examiners and DOL people have access to, which 

17 we call the private SEM.

18 So, just, this is all kind of 

19 confusing to me when they're saying, these link 

20 processes are there, but you can't find them 

21 very easily, if at all, on the public SEM.
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1 MEMBER MARKOWITZ: So, Faye, if you 

2 could just write out your request to make sure 

3 we get it right.

4 MEMBER VLIEGER: No problem.

5 MEMBER MARKOWITZ: Okay, thanks.

6 MEMBER POPE: Well, this is Duronda -

7 -

8 MEMBER MARKOWITZ: And --

9 MEMBER POPE: Go ahead.

10 MEMBER MARKOWITZ: No, go ahead, 

11 please.

12 MEMBER POPE: I think I agree with 

13 Faye in the respect that, not only asbestos 

14 workers, but RCTs, radiological technicians, 

15 radiation monitors, they were in all areas and 

16 exposed to many, many, many things, and so, to 

17 try to connect them to say that their 

18 particular task is connected to some type of 

19 disease, I would think would be very difficult, 

20 being that they were exposed to many, many 

21 different things at the sites.
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1 MEMBER VLIEGER: I would agree. They 

2 didn't even monitor for many of the things. 

3 Even as IH and radiation techs, they didn't 

4 monitor for everything that was out there, so 

5 for them to know how to report it would be 

6 difficult.

7 But I think if we just say, these 

8 people are presumed to have been exposed to all 

9 of these things, then that's it. A certain 

10 amount of time, I guess, if we can find that in 

11 studies to prove the duration required. But 

12 the workers don't know how to answer those 

13 questions.

14 MEMBER POPE: I agree.

15 CHAIR WELCH: I didn't realize that 

16 the SEM had been changed in response to that 

17 new Bulletin, so it would be great to have an 

18 understanding of what they're doing with it. 

19 Okay.

20 Well, I need to rewrite some of the 

21 text under the VGDF, which I will distribute 
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1 around to everybody relatively soon. And then, 

2 either you can take a look and see if you think 

3 there's enough, this is enough to send to the 

4 overall Board, once I've done that. Is that 

5 okay?

6 MEMBER MARKOWITZ: Okay.

7 CHAIR WELCH: Okay. So, let's turn 

8 to the COPD. So, there already is a COPD 

9 presumption and it is -- I don't know how to 

10 describe it, but it's not up to the current 

11 evidence, let's put it that way. But I thought 

12 it might be helpful to frame this presumption 

13 as making revisions to the current presumption.

14 So, we are recommending or I'm 

15 recommending that a whole range of specific 

16 agents be considered presumed to cause COPD. 

17 And that's within the first paragraph, under A, 

18 Covered Exposures.

19 And then, number B is that the labor 

20 categories that they had listed in the 

21 attachment to the prior, to the current 
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1 presumption, that those are definitely exposed 

2 to VGDF, but it's not an inclusive, completely 

3 inclusive list.

4 And that, if the worker reports 

5 exposure to VGDF on their Occupational Health 

6 Questionnaire, he would be presumed to be 

7 exposed and it would also be presumed that 

8 exposure would aggregate and contribute to a 

9 cause. So, either your exposure is determined 

10 because you are in one of the labor categories 

11 or because you put the exposure on the OHQ. 

12 Any comments on those two?

13 MEMBER MARKOWITZ: Yes, this is 

14 Steven. So, in your presumption for COPD item 

15 A, so there the query is about specific 

16 exposures or some specific tasks, right?

17 And those specific items, it's 

18 envisioned that they would be asked on the OHQ. 

19 In other words, the CE can draw a response or 

20 look for the answers to whether the person had 

21 these specific exposures by going through the 
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1 OHQ and identifying them.

2 CHAIR WELCH: That is a very good 

3 point. We were going to have a list of 

4 materials, so we'll make sure that those are 

5 included.

6 MEMBER MARKOWITZ: So, just to follow 

7 that line of thinking, so there's going to be 

8 some redundancy, because this list in A is 

9 going to be covered in the OHQ in the section 

10 on hazards and associated tasks. So, it's 

11 going to require some finesse.

12 But it raises the question that, do 

13 we need item A? What is -- and this is a 

14 little bit of a devil's advocate question, do 

15 we need item A? Or if a person responds 

16 positive to VGDF and with all the time 

17 parameters, what's gained by also asking the CE 

18 to look at the specifics on item A?

19 CHAIR WELCH: Well, I would worry 

20 that a worker might know that they were exposed 

21 to welding, but they might not call that a 
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1 dust. They might not really know what vapors, 

2 gases, dusts, and fumes means and how broad it 

3 is.

4 MEMBER MARKOWITZ: Right.

5 CHAIR WELCH: That would be my 

6 concern.

7 MEMBER MARKOWITZ: I mean, I kind of 

8 agree with that, actually. It's a bit of a 

9 safety net, because --

10 CHAIR WELCH: Yes.

11 MEMBER MARKOWITZ: -- we don't know, 

12 in any studies of VGDF, we don't really know 

13 whether it's going to miss some people. But I 

14 thought I'd ask the question.

15 CHAIR WELCH: Okay. Well, I mean, I 

16 think that there's a potential downside to 

17 having a specific list in that the claims 

18 examiner may feel like, well, if they didn't 

19 answer something on that list, then they 

20 weren't really exposed. And if these agents 

21 are part of other agents that are in the OHQ 
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1 and not singled out as representing the 

2 spectrum of VGDF, I think we will avoid that to 

3 some degree.

4 A lot of the studies also -- we said 

5 that this question is predictive, which it is, 

6 but a lot of the studies that have looked at 

7 occupational exposures to VGDF have done it 

8 based on job title. So, they've looked at 

9 case-controlled studies with COPD and then 

10 assessing based on the worker's reports, 

11 primarily their tasks and materials, tasks and 

12 jobs.

13 MEMBER MARKOWITZ: Right. And --

14 this is Steven again. The other thing is that 

15 there may be some sceptics about the VGDF 

16 approach and, for instance, if claimants are 

17 prompted to answer yes to the VGDF question 

18 without providing any further detail, then the 

19 compensation process strikes me as a little bit 

20 vulnerable to unfriendly forces, so that having 

21 some greater evidence beyond VGDF of that 
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1 exposure listed in A would be very useful. It 

2 would give a lot more confidence.

3 CHAIR WELCH: Good, okay.

4 MEMBER DEMENT: This is John. Just a 

5 comment also on how some of these studies have 

6 been done, because I think you can go at it 

7 both ways. Lots of studies have simply asked 

8 about the general question of vapors, gases, 

9 dusts, and fumes and really haven't gone into a 

10 lot of detail, but even that question in itself 

11 has been supportive of a relationship with 

12 COPD.

13 Most of the studies that we've done 

14 with VGDF, we approach it from the other end. 

15 We ask specific questions about a whole list of 

16 materials and tasks and then generated our 

17 index to VGDF exposures based on those 

18 individuals summed together.

19 And that, in itself, is also 

20 predictive of exposure. So, I think we're good 

21 coming at it from both ends. It just, in my 
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1 view, provides greater support, as Steven has 

2 said, for what we're trying to do with COPD.

3 CHAIR WELCH: Good, okay. So, the 

4 next item is, it should be presumed that 

5 reported exposures to toxic substances -- and 

6 maybe it should say VGDF -- will cause or 

7 contribute to or aggravate COPD at any period 

8 of employment are contributory.

9 Just pointing out that there's no 

10 reason to assume that these exposures have been 

11 eliminated just because it's the year 2016. 

12 And I don't think we're going to have a problem 

13 with that.

14 Now, the next one is the five year 

15 requirement and the duration of employment in 

16 the covered DOE facility of at least five years 

17 with reported exposures to VGDF. I spent some 

18 time looking for exposure data that was --

19 looking at studies that would allow us to come 

20 up with this number, it was certainly in our 

21 study of BTMed workers.
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1 And looking at exposures in the 

2 groups, populations that were exposed to VGDF, 

3 not necessarily asbestos or silica, there was 

4 very little information on duration of 

5 employment, but a lot of the population had 

6 more than five years of exposure to be 

7 considered exposed.

8 And then, if we look at specific 

9 agents, like silica or coal dust, it also 

10 supports the idea that five years' exposure is 

11 a reasonable requirement for causation and 

12 presumption. So, floor is open to comment on 

13 the five years.

14 MEMBER MARKOWITZ: This is Steven 

15 again. So, what I -- where I get hung up is 

16 not on causation, but on aggregation of 

17 contribution. And just thinking about 

18 contribution, most blue collar workers stay 

19 blue collar throughout their careers. So, 

20 they're quite likely to have exposures at non21 DOE sites that would involve -- if they had it 
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1 at DOE, VGDF exposure, they're likely to have 

2 it outside.

3 And I realize either by policy or 

4 perhaps, I think it's probably a DOL policy 

5 that the claims examiner don't look, inquire 

6 about non-DOE jobs. And that, I think, 

7 probably works to the claimant's benefit much 

8 of the time.

9 But it's a little problematic here, 

10 because it's easy to imagine someone who was 

11 there at a DOE site for three years, more than 

12 three years, but then spent, before or after, 

13 spent 20 years exposed to VGDF and you might 

14 say, well, the DOE contribution was minor, but 

15 the standard is contribute.

16 So, you also have another situation 

17 where the person develops COPD and within short 

18 order, with or without DOE exposure, but within 

19 a relatively brief exposure, could easily have 

20 an exacerbation due to VGDF exposure at DOE. 

21 So, there are a -- those are a couple of 
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1 scenarios that this doesn't quite accommodate. 

2 Although I don't have any ready solutions, I 

3 thought I'd raise them.

4 MEMBER DEMENT: I agree with you on 

5 both accounts -- this is John -- on both 

6 accounts, Steven. I -- a lot of our 

7 construction workers are in and out of DOE 

8 sites, many of them come to DOE sites having 

9 been in construction for many years.

10 And it's impossible to separate off, 

11 if you're looking at the risk of COPD, it would 

12 be impossible to separate off those 

13 contributions in the studies that we've done. 

14 And all we can really say is that all of those 

15 exposures likely contributed to the risk of 

16 COPD.

17 But I don't know how to get around 

18 it, except to be very specific in our 

19 presumptive language that this is not one of 

20 exclusion of individuals who develop COPD or 

21 aggravated their current COPD by lesser 
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1 duration of exposure. I don't have a solution 

2 for it either, that's all I'm saying.

3 CHAIR WELCH: In the next paragraph, 

4 we do say, for the 15 years since first 

5 exposure, DOL should consider their earliest 

6 date of exposure, considering employment prior 

7 to work at DOE if necessary.

8 Can we recommend that DOL, for this 

9 particular condition, assess exposure outside 

10 of -- prior to DOE work? I mean, could we put 

11 that in here and then, see what comments we get 

12 back from the Department of Labor people?

13 MEMBER VLIEGER: This is Faye. On 

14 the current OHQ, they do ask about your other 

15 DOE employment. There's a section on the 

16 current OHQ for it. However, they don't do an 

17 in-depth questionnaire of exposures.

18 CHAIR WELCH: How about work outside 

19 of DOE, though? They don't ask about that at 

20 all, do they?

21 MEMBER VLIEGER: They ask about what 
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1 your employment was on the questionnaire and 

2 what those exposures were.

3 CHAIR WELCH: Okay.

4 MEMBER MARKOWITZ: Well, and we can -

5 - this is Steven. We can ask DOL how firm 

6 their policy is about not looking at non-DOE 

7 employment. I mean, I can imagine it would be 

8 problematic and work against claimants in many 

9 instances. But what if we could float your 

10 idea, Laura, what about just applied to this 

11 condition, since this condition is different 

12 from many?

13 So, we can ask about that and if we 

14 get a firm answer, we can try to devise or we 

15 could either disagree and recommend otherwise 

16 or we could try to devise something that might 

17 begin to address this. For instance, lowering 

18 the five years to two years or some shorter 

19 period, which -- it depends on what kind of 

20 error you want to make, basically.

21 CHAIR WELCH: If we knew that 90 
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1 percent of the people who work on the DOE 

2 facilities had done similar work before or 

3 after, then you could presume if they had two 

4 years at DOE, they had five years altogether. 

5 And we don't know the answer to that. I mean -

6 - but we don't know it for everybody else.

7 MEMBER MARKOWITZ: Right. Or maybe -

8 - this is Steven. It may be just that for 

9 people with shorter exposure, they won't meet 

10 the presumption, it goes to the industrial 

11 hygienist and at that point, they could then 

12 inquire about non-DOE exposures and decide 

13 about contributions.

14 CHAIR WELCH: But I think we do have 

15 to be sure that the OHQ is asking that.

16 MEMBER POPE: So, is that -- this is 

17 Duronda. Is that -- if that claim -- if the CE 

18 looks at that claimant's form and sees that it 

19 is under the five years, does it stop there, it 

20 does not go to the IH or the CMC?

21 CHAIR WELCH: No, it would go on. 
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1 And I think we, somewhere in here, yes, when we 

2 go to, closer to the bottom, on the bottom of 

3 Page 2, claims examiner should not deny claims 

4 for COPD if the worker has fewer than five 

5 years of exposure or if the period of two weeks 

6 -- or until diagnosis is less than 2 years. 

7 Claims that do not meet the requirements set 

8 forth here, but do have reported exposure to 

9 VGDF should be sent for IH or CMC review.

10 MEMBER POPE: Okay. I didn't read 

11 that far, thank you.

12 CHAIR WELCH: That's all right. A 

13 lot of words on there.

14 MEMBER DEMENT: I think it might be 

15 helpful as we draft this language to capture 

16 some of this discussion in our recommendation 

17 for presumption. That is, a worker could have 

18 exposure prior to DOE or after DOE, that we 

19 wouldn't preclude that the DOE exposure in and 

20 of itself would not contribute to, aggravate 

21 exposure -- COPD just in and of itself.
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1 I mean, what I'm saying is, just try 

2 to capture some of this discussion so that 

3 we're clear that it should be okay to consider 

4 other exposures outside of DOE in the full, 

5 final decision.

6 CHAIR WELCH: Okay.

7 MEMBER DEMENT: I don't know exactly 

8 how to capture that more clearly.

9 MEMBER VLIEGER: This is Faye. Part 

10 of the problem when we refer it out to a CMC, 

11 when DOL refers it out to a CMC, they lump the 

12 cause, contribute, and aggravate into one part 

13 of the -- and they don't say, please opine 

14 independently on contributory, aggravating, or 

15 causation.

16 So, the CMC just parrots back that 

17 statement and never talks about contributing or 

18 aggravating. And so, many times when they 

19 should have done that, we get a no answer from 

20 the CMC, because they really are only look at, 

21 did it cause?
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1 So, I think, and if we're going to 

2 look at other work outside DOE and considering 

3 the DOE exposure to be aggravating or 

4 contributory, then we need to ensure that 

5 that's how the question is asked of the CMC and 

6 not just give them the clause that -- even 

7 though they're answering it, they're not really 

8 answering it.

9 CHAIR WELCH: Yes, I agree with you 

10 on that. I would expand it a little bit in 

11 that, I think that the CMCs don't understand 

12 the framework of the compensation program, that 

13 in the rest of their life it's unlikely they've 

14 been presented with a compensation program that 

15 would accept a claim that it was aggravated by 

16 or contributed to, a worker who's had 20 years 

17 of exposure, of which one year is at DOE, the 

18 CMCs are probably used to saying that that 

19 wasn't contributory.

20 MEMBER VLIEGER: I would say that 

21 they're also not, the CEs are not required to 
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1 provide that education in their referrals, 

2 because it is presumed that the CMCs have read 

3 the documents in the program, which it's a lot 

4 to expect. And this is demonstrated many times 

5 when they're asked about beryllium disease 

6 according to this program.

7 So, it's not just one incident or 

8 one disease where this is happening, but it is 

9 that the CMCs aren't given that little primer 

10 in their referral that says, by the way, this 

11 is what the program standard is. And so, 

12 unless we're going to fix that, I don't know 

13 how we can add the contributory and aggravated 

14 part.

15 CHAIR WELCH: Actually, that's a 

16 really good idea for the Committee that's 

17 looking at the CMCs, is that there could be a 

18 primer, there could be a eight page brochure, 

19 nicely done, that goes with each claim that 

20 says -- and that we don't presume that this 

21 particular CMC has done a case before or 
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1 understands the law.

2 And it can't be looking at 100 

3 different bulletins and circulars and trying to 

4 -- you see how long we spent trying to 

5 understand some of the nuances. It might be a 

6 really good idea.

7 MEMBER VLIEGER: Dr. Markowitz, would 

8 you like an email?

9 MEMBER MARKOWITZ: Yes, I would like 

10 another email, Faye, yes.

11 MEMBER VLIEGER: Okay.

12 MEMBER MARKOWITZ: This is Steven. 

13 On time since first exposure, can I make a 

14 comment on that? Are we there yet or --

15 CHAIR WELCH: Yes, please.

16 MEMBER MARKOWITZ: So, here actually, 

17 we're really in the problem of causation versus 

18 aggravation, because COPD is, for the non19 medical people on the phone, usually causes 

20 most trouble when a person has an exacerbation 

21 of the COPD, which can be provoked by cold or 
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1 exposures at work.

2 And so, it's easy to envision 

3 someone who did not work at DOE in their 

4 earlier career, moved to DOE, developed COPD, 

5 doesn't have 15 years since first exposure, but 

6 is exposed to dust and has an exacerbation. 

7 Which apparently is what I'm having right now. 

8 But, anyway. And it would clearly meet the 

9 aggravation standard.

10 So, it may be that we need to modify 

11 this time since first exposure, just to 

12 acknowledge that there are certain instances in 

13 which COPD could be recognized as aggravated 

14 with shorter time periods from first exposure.

15 CHAIR WELCH: The other option is to 

16 take it out. I mean, if we're looking at a 

17 five year exposure requirement, maybe we could 

18 get away without having a time since first 

19 exposure.

20 MEMBER DEMENT: This is John. I 

21 think that's probably the least supported piece 
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1 of this right now, is this time since first 

2 exposure. Can't you imagine somebody who had 

3 an intense exposure to vapors, gases, dusts, 

4 and fumes and developed COPD much quicker than 

5 15 years?

6 MEMBER VLIEGER: Right, and also --

7 yes. I think it's too hard to explain and I 

8 agree, I think we should take it out.

9 MEMBER POPE: I agree.

10 CHAIR WELCH: Steven, what do you 

11 think?

12 MEMBER MARKOWITZ: Yes. I mean, 

13 simpler is better. Especially --

14 CHAIR WELCH: Okay.

15 MEMBER MARKOWITZ: -- in a CE-driven 

16 process.

17 CHAIR WELCH: Okay.

18 MEMBER MARKOWITZ: I'm just -- so, 

19 what we're left with is a VGDF or other 

20 exposures, with duration.

21 CHAIR WELCH: Right.
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1 MEMBER POPE: Yes. And so many 

2 individuals have had other work and to look at 

3 time since first exposure, you would definitely 

4 have to assess that in other work and that's 

5 making it too complicated.

6 CHAIR WELCH: Okay. So, then, the 

7 alternative presumption here is, I'm trying to 

8 be pretty straightforward, any claimant with a 

9 physician's diagnosis of COPD who worked in any 

10 covered facility either in the labor categories 

11 in Attachment A or who reported exposure to 

12 VGDF on the OHQ for a period in which the 

13 aggregate totals at least five years -- and 

14 then take out the 15 years of time since first 

15 exposure -- is presumed to have sufficient 

16 exposure to toxic agents to aggravate, 

17 contribute to, or cause COPD. And when we want 

18 to -- additionally, they shouldn't deny claims 

19 if they have fewer than five years, those 

20 should be sent for IH and CMC review.

21 I think that follows pretty well 
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1 from the points above. And I'm going to edit 

2 it to take out the time since first exposure 

3 from all of them. Okay. And you all will get 

4 to see this one more time before I present it 

5 at our April meeting.

6 MEMBER MARKOWITZ: This is Steven. I 

7 have a -- I think this write-up is wonderful 

8 and I thank you for all the work, actually. 

9 But I have one suggestion on the rationale, 

10 which is specifically for the non-medical 

11 audiences, to explain that COPD, we really are 

12 in the heart of this cause, contribute, or 

13 aggravate issue, and that this is kind of the 

14 poster child condition in which we need to, and 

15 the players in the claims process need to 

16 recognize that this is a condition that really 

17 can be aggravated or contributed, rather than 

18 thinking predominately about cause, which is 

19 what I think most people are doing when they 

20 hear cause, contribute, or aggravate.

21 CHAIR WELCH: Yes, you're totally 
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1 right. And it's one in a way where it's, well, 

2 at least for me, it's easier to understand, 

3 because you can see it as a chronic 

4 inflammatory condition and how other exposures 

5 add on and can be contributory.

6 I can add some of that. I actually 

7 have some of the sort of biology of it in 

8 another paper, in our Collegium Ramazzini 

9 statement. So, I'll try to come up with 

10 something. I think it's a good point, I really 

11 do. I know it's more work for me.

12 MEMBER MARKOWITZ: Not a whole lot.

13 CHAIR WELCH: No, yes, not a whole 

14 lot. Because the -- there's one statement in 

15 here that a dust-response relationship has been 

16 seen, which is showing that additional 

17 exposures contribute. Yes, I'll work on that. 

18 And then, Steven, I'll send it to you and you 

19 can -- so you can wordsmith it before we put it 

20 in the final document. Okay.

21 I think we can probably get through 
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1 the other two without taking a break and be 

2 done by 3:00. Is there anybody who wants to 

3 take a break now? Okay.

4 So, the next question was whether --

5 really what I really was asking was, if we have 

6 really improved the OHQ, is there anything else 

7 we can do about sites that don't have a SEM? 

8 And that's probably for Faye and Duronda.

9 Are there things that, on sites 

10 without a SEM -- it seems that we're relying on 

11 the worker's occupational history and we have 

12 to have the claims examiners and the industrial 

13 hygienist accept that as prohibitive, because 

14 there isn't anything else.

15 MEMBER VLIEGER: The only thing that 

16 they could do is, in some of the labor 

17 categories that are actually a crossover to 

18 other sites or that have a link to other sites, 

19 to use those sister sites for exposures, or at 

20 least to start looking at the sister sites that 

21 they list for them.
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1 I mean, it's kind of a fallacy to 

2 think that every site was doing things 100 

3 percent different than any other site. So, if 

4 you had a nuclear process operator or a 

5 chemical operator, any of the other sites that 

6 they could draw from for the base exposure 

7 information, I think that that should be used. 

8 I don't think they do that now, because they 

9 don't have any direction to do that.

10 MEMBER POPE: I agree with Faye. 

11 There's not a lot that we can do without the 

12 SEM, but having those things that she mentioned 

13 in place, I think will help the process a 

14 little bit further.

15 MEMBER VLIEGER: And I have to tell 

16 you, the sites that don't have a SEM, the 

17 reason they don't have a SEM is because no one 

18 has taken DOL to task on it. Pardon me, I'm 

19 having one of those exacerbation moments, hang 

20 on.

21 It takes about 40 hours of work to 
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1 go to the DOE site record depository and look 

2 at characterization documents for the site and 

3 they all have them, it's just a matter of 

4 finding them and then turning them over to the 

5 SEM contractor.

6 When I was prepping to collect some 

7 errors on the Hanford SEM, I also looked at 

8 papers that were published in regards to new 

9 ways on how to handle waste for Hanford and the 

10 waste that they list in those documents means 

11 they were on the site and, therefore, they 

12 should be on the SEM.

13 So, there's a lot of corollary work 

14 that's already been done, but it takes somebody 

15 to actually go to that library and start 

16 pulling things out. So, it's not that there 

17 weren't laboratory tests done, it's that 

18 nobody's taken them out of the context of the 

19 DOE library.

20 CHAIR WELCH: And you think that's 

21 because the SEM sites have fewer workers, so 
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1 they think it's not worth the trouble?

2 MEMBER VLIEGER: I believe that to be 

3 the case, yes.

4 CHAIR WELCH: I was wondering 

5 whether, if the claims examiner receives a 

6 claim from an individual who doesn't have -- is 

7 from a site without a SEM, if -- I'm trying to 

8 think where this can happen.

9 Like, someone within DOL identifies 

10 that they don't have a SEM for this individual 

11 and then expands the Occupational History 

12 Questionnaire by looking at what we know about 

13 the person's labor category at other sites and 

14 says, oh, well, if you had been working at 

15 Rocky Flats, you would have done this, this, 

16 and this, did you do that at this plant?

17 And maybe that's, the only person 

18 who would do that would be the industrial 

19 hygienist when the case ends up at the 

20 industrial hygienist. It would be nice to do

21 it before, but it may require -- it's probably 
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1 not something that the interviewer at the 

2 resource centers could do.

3 Can we recommend that the DOL sends 

4 the industrial hygienist information from other 

5 sites on the labor categories? If a worker is 

6 a -- has a labor category, but no SEM, that as 

7 part of their statement of accepted facts, they 

8 send to the hygienist information on that labor 

9 category from other sites?

10 MEMBER VLIEGER: I think it would be 

11 reasonable. They do it in radiation dose 

12 reconstruction. They look at the radiation 

13 dose from a co-worker or from comparable data, 

14 even if a worker doesn't have dose records 

15 themselves, then they pull it from comparable 

16 work or comparable data. So, I don't think 

17 it's a stretch to do it with chemicals.

18 CHAIR WELCH: Do we want to recommend 

19 that from our group? I don't think there's any 

20 way we can explore it further, I mean, we don't 

21 know the answers of how representative it is --
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1 MEMBER VLIEGER: I think it's a 

2 start, to do something other than what they're 

3 currently doing.

4 CHAIR WELCH: Okay. I'll write up 

5 the recommendation and we can -- you guys can 

6 see if it makes sense.

7 MEMBER MARKOWITZ: This is Steven. I 

8 guess, if we recommend that, we should also 

9 recommend kind of a pilot period during which 

10 the industrial hygienists review those cases, 

11 look at those cases as well and they can take a 

12 look at whether that is a useful exercise or 

13 not, going to the SEM.

14 I mean, the whole thrust of our 

15 activities is to move away from the SEM, either 

16 through a better OHQ, through direct worker 

17 interviews by workers, through presumptions and 

18 here we are saying, rely on a faulty SEM. But 

19 it is better than nothing, so, yes.

20 CHAIR WELCH: Okay. That's a good 

21 idea, though, to evaluate it. Okay. So, then 
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1 for people without a SEM, they'll have the OHQ 

2 and they'll have information from other sites 

3 on the same labor category. Great, okay.

4 I'll move on to the last point, 

5 unless anybody's got any other comments on 

6 sites without SEMs. Which was, are there 

7 additional recommendations from the IOM?

8 One reason I didn't send it to our 

9 Subcommittee was, when I went back through the 

10 executive summary of the IOM report and pulled 

11 out their recommendations, I thought that these 

12 are really -- they're not so much exposure 

13 assessment questions, as much as big Board 

14 questions, because it really -- the IOM report 

15 fell into three different big categories.

16 Supplemental information for the 

17 health effect information imported from the 

18 Haz-Map, and we've already made a 

19 recommendation about that, pulling in

20 information from the table that the IOM report 

21 had provided, ATSDR, EPA, IARC, other ones. 
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1 So, I think we have addressed that one 

2 recommendation.

3 The second one was to improve the 

4 structure and function of the SEM and doing a 

5 quality control review of the SEM. That's all 

6 internal to DOL and I didn't think we could add 

7 anything, because those people at DOL 

8 understand the structure and function of the 

9 SEM better than we do.

10 I think that they, in DOL's report 

11 to us about how they responded to the IOM 

12 report, they have taken action on some of these 

13 items. And I think, if we follow Faye's 

14 suggestion that we have them do a demonstration 

15 about how they adapted the SEM for this direct 

16 disease link process, we may be able to get an 

17 idea how they're doing on quality control 

18 review.

19 The third one, the third big 

20 recommendation was the use of an external 

21 advisory panel to review the health effect 
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1 information in SEM. And in the IOM report, 

2 they actually imply that our Advisory Board 

3 should be that.

4 I think at our first Board meeting, 

5 we decided it was a much bigger project than we 

6 could take on, which is why I kind of pondered 

7 this one with Steven to decide how we should 

8 approach it.

9 The IOM divided it into things that 

10 could be done right away and ongoing support to 

11 the DOL on putting in new links in SEMs and 

12 then assessing new occupations and ongoing 

13 support on exposure and causation.

14 So, I didn't think that we needed a 

15 discussion about the structure and function of 

16 the SEM or how to get them to do an external 

17 advisory panel within our Committee, I think 

18 that should be a big Committee discussion, but, 

19 Steven, if you think we need to talk about it, 

20 let me know.

21 MEMBER MARKOWITZ: Are you talking 
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1 about further discussion of IOM recommendation 

2 number 3?

3 CHAIR WELCH: Yes.

4 MEMBER MARKOWITZ: Yes. So, this 

5 recommendation really kind of gets at, I think, 

6 the capacity of DOL to exercise some science, 

7 some very informed kind of decision making 

8 about the SEM. And otherwise, because it also 

9 applies to their decision making outside of the 

10 SEM, when the issues go to the National Office 

11 for determination.

12 And so, the -- my own feeling so 

13 far, and we're still getting into this, that 

14 they need enhancement of their scientific 

15 capacity to deal with issues and 

16 multidisciplinary. And it's not a -- at a 

17 central level, not just at the IH and the CMC 

18 level.

19 And that could be kind of in-house, 

20 but it could also be contracted out. But if 

21 you could imagine a highly qualified unit or 
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1 effort, looking at some of these things with 

2 this IOM recommendation number three, the 

3 process would get a lot better.

4 CHAIR WELCH: Yes. Yes, I mean, they 

5 recommend -- they point out that there's really 

6 been no peer review of Haz-Map and the existing 

7 causal link system could be tweaked, that's 

8 currently based on Haz-Map, and that could be 

9 either explained or defined or evaluated.

10 I guess, the Board could recommend 

11 that this be addressed with addition of 

12 internal staff or an external advisory panel, 

13 but if there's an external panel, there would 

14 really need to be a contract for ongoing work.

15 I think that our Committee, is 

16 really structured -- well, the process isn't 

17 structured to do this kind of work and it also 

18 could be quite a bit of work and we would need 

19 staff support.

20 I thought it's probably better to 

21 have, if it were possible, to have an outside 
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1 committee that does the work, rather than 

2 internal, just because if it's internal, it can 

3 rely on one person's ideas or knowledge, not 

4 likely to have a big internal committee.

5 From outside, you could have a small 

6 amount of more people's time and who are more 

7 likely to have quality control within that 

8 committee. I also don't think that -- it's 

9 just my -- I accidentally printed --

10 But I don't really know, I don't 

11 really know how to -- maybe it is related to 

12 the SEM and maybe we should address it in our 

13 next conference call, about how we -- I mean, 

14 because it is -- but it's a big question, 

15 because an external advisory panel to review 

16 the health effects information in SEM, but it's 

17 really establishing the criteria for causation 

18 and making sure that the right information is 

19 available to the claims examiner on causation.

20 I don't think you can build it all 

21 into the SEM, because the SEM is too, it's not 
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1 even too complicated, but it's too awkward. I 

2 mean, every, it seems like every time people 

3 who are advocating for the workers go into the 

4 SEM, you find things that are missing or that 

5 say give you different tasks for the same job 

6 title, depending on how you approach it.

7 There's so much that needs fixing, 

8 it just doesn't seem like we should spend a lot 

9 of time loading more information into the SEM, 

10 but they do need more help on causation.

11 MEMBER MARKOWITZ: This is Steven. I 

12 just -- we can use the example COPD as sort of 

13 a little bit of a window into some of the 

14 issues. The bulletin addressing COPD is, I 

15 think was entirely restricted to asbestos.

16 CHAIR WELCH: Yes.

17 MEMBER MARKOWITZ: And then, there 

18 was some language early, I think developed 

19 early on that was pretty nonspecific, not all 

20 that -- not providing all that much guidance. 

21 And Laura and John spent some time, they had a 
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1 head start because they knew the issue, worked 

2 with the issue, but regardless, spent some time 

3 assembling the relevant science and summarizing 

4 it.

5 That needs to be done on a regular 

6 basis, not by special outside committee, but 

7 internalized into the DOL compensation program. 

8 It would make their lives enormously simpler 

9 and would be, we hope, fair to the claimants.

10 And it's not that, I don't know how 

11 complicated that particular task was, but it 

12 wasn't impossibly complicated. And we're going 

13 to do the same for asbestos and we'll do the 

14 same for hearing loss and solvents.

15 And so, they need the capacity to do 

16 that on an ongoing basis. I think, my concern 

17 is that, and it's not really a criticism, but 

18 that they've -- this has not been an emphasis 

19 in the past and I don't know how to change, 

20 what we can do to kind of change that. And so, 

21 that there may be -- the Radiation Advisory 
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1 Board has a contractor that they work with paid 

2 by DOL that does those, checks on those 

3 reconstructions.

4 And it may be that a parallel 

5 effort, where there is an outside contractor 

6 who is working up these issues, but that we 

7 place some role, at least for the whatever next 

8 period of time, in helping to guide that 

9 process, so that we don't -- we don't have the 

10 time or capacity to do that ourselves, but we 

11 can be helpful in steering it. So, that might 

12 be an idea.

13 CHAIR WELCH: Yes. There was a list 

14 of 17 items that DOL asked us about, a number 

15 of them related to causation, and those would 

16 be places to chart, then you could have a 

17 contractor develop the background materials.

18 MEMBER MARKOWITZ: And the National 

19 Toxicology Program, when they look at an agent, 

20 they spend a long time identifying what agent 

21 to look at and getting a lot of input from 
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1 various sources, but ultimately they use a 

2 contractor to kind of work up the issue, 

3 according to their recipe.

4 But -- and the contractor drafts the 

5 document and it goes back to NTP and they have 

6 scientists who modify it and then present it to 

7 external boards. But this is -- there's a 

8 precedent for this, in fact, for a very related 

9 issue.

10 CHAIR WELCH: I think when we 

11 discussed this recommendation before, we did, 

12 the Board, and I don't know, I don't think we 

13 made a specific recommendation about it, but 

14 when we discussed the IOM report, there was a 

15 sense that, that's what we would like is that 

16 the Board could be of assistance, but there 

17 would have to be contractor support.

18 And now we've given a good example, 

19 how NTP does it, and that's also how the 

20 Institute of Medicine does it for their 

21 committees, they provide the materials and they 
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1 don't have to -- well, they do write a report 

2 based on the meeting, but they do the 

3 background research and provide all the 

4 materials.

5 MEMBER MARKOWITZ: So, should we 

6 recommend this and also recommend that our 

7 Advisory Board play a role in helping to 

8 formulate and initiate and kick off this 

9 process?

10 MEMBER VLIEGER: This is Faye. I 

11 would like to see it happen.

12 MEMBER POPE: I agree.

13 CHAIR WELCH: I think it's 

14 reasonable. I think they need it. Steven, do 

15 you want me to write something or -- I think 

16 you have, I really do think you have a better 

17 grasp than I do, but I can write something and 

18 you can edit it or you could write it yourself.

19 MEMBER MARKOWITZ: I'll write it, I 

20 mean, it's not going to be a big rationale, but 

21 I will draft something and send it to you 
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1 initially and then, you can --

2 CHAIR WELCH: Okay.

3 MEMBER MARKOWITZ: -- modify it and 

4 circulate it.

5 CHAIR WELCH: Great. I feel like, 

6 I'm very happy with what our Committee has been 

7 doing, I feel like we're making a lot of 

8 progress. And if we can get our 

9 recommendations implemented, it's going to make 

10 a big difference. So, that's great. Any last 

11 thoughts on anything we've discussed before we 

12 end the call?

13 MEMBER VLIEGER: This is Faye. We 

14 made recommendations from the IOM report at the 

15 October meeting and I was just wondering, have 

16 we heard anything back from the Department of 

17 Labor on the implementation of those 

18 recommendations?

19 MEMBER MARKOWITZ: Well, the only --

20 this is Steven. The only action that's been 

21 taken, definitive action, was rescinding that 
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1 one bulletin or circular. The others, I'm 

2 told, I think some of them have made it to the 

3 Secretary's Office, but not much is moving 

4 there. They're at various stages.

5 There's nothing official. We will 

6 get, both Rachel and Gary Steinberg will be at 

7 the meeting in Washington, so we'll get a 

8 firsthand report then. And there may be 

9 additional progress between now and then, but 

10 that's all I know.

11 MEMBER VLIEGER: Okay, thank you.

12 MEMBER MARKOWITZ: This is Steven. 

13 So, I agree that this Committee has done 

14 fantastic work. So, this means we can't 

15 dissolve this Committee, just because it has 

16 taken on major issues successfully.

17 CHAIR WELCH: Now that we've finished 

18 everything that has to do with the SEM, you're 

19 going to give us other things to do?

20 MEMBER MARKOWITZ: Yes, sure. To be 

21 discussed.
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1 CHAIR WELCH: All right. Well, do 

2 you have anybody, not that I'm volunteering to 

3 do it now, but is there anybody writing a 

4 presumption on hearing loss? Is anybody fixing 

5 that presumption?

6 MEMBER MARKOWITZ: Yes, I don't have 

7 a volunteer yet and it would be extremely 

8 helpful to boil that down. We have the SOAFs 

9 memo, you presented your PowerPoint, Rosie has 

10 the work that she's done, although I haven't 

11 seen anything in writing, but that may not be 

12 remembering everything.

13 But, yes, and we discussed in the 

14 presumptions committee call last week, right, 

15 certain aspects of that, but it hasn't been 

16 formulated into a recommendation or a 

17 rationale. So, Laura, not to burden you, but 

18 if you had some time, that would be great. I'm 

19 going to be working on, first, the asbestos 

20 one. And if we had three to present, finished 

21 ones, that would be great.
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1 CHAIR WELCH: Well, I mean, if I 

2 write one up, it would be -- I don't think our 

3 Committee would have time to review it, but I 

4 think we've talked about it enough that maybe 

5 that would be okay. We could write one up and 

6 have the whole Board discuss it, because we 

7 don't have time for another call prior to the 

8 April meeting.

9 MEMBER MARKOWITZ: Right. Yes, I 

10 agree with that. But you can circulate it --

11 CHAIR WELCH: Yes.

12 MEMBER MARKOWITZ: -- and people can 

13 look at it.

14 CHAIR WELCH: Yes, okay.

15 MEMBER MARKOWITZ: But we've 

16 discussed it repeatedly and more than probably 

17 some other issues, people seem to be primed and 

18 involved with this issue.

19 CHAIR WELCH: Okay. I will do that. 

20 Or I'll try. I have a feeling that I've 

21 essentially written it before, I think there's 
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1 a couple of things, bit of information I'm 

2 missing, like not too much, but what's the 

3 right amount, that kind of question.

4 MEMBER MARKOWITZ: Well, if you need 

5 some help digging up articles or any support 

6 work, I'd be glad to supply it, so just let me 

7 know.

8 CHAIR WELCH: Okay, great. I'll work 

9 on that. Okay, guys, thank you very much.

10 MEMBER MARKOWITZ: Thank you.

11 CHAIR WELCH: And I'll see you all 

12 next month.

13 MEMBER VLIEGER: Okay, thanks. Bye, 

14 guys.

15 MEMBER POPE: Thank you.

16 MS. RHOADS: Thanks, everybody.

17 MEMBER POPE: Bye-bye.

18 MEMBER MARKOWITZ: Bye.

19 (Whereupon, the above-entitled 

20 matter went off the record at 2:36 p.m.)

21
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