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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THURSDAY

FEBRUARY 28, 2019

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The Advisory Board met telephonically at 2:00 p.m. 

Eastern Time, Steven Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

JOHN DEMENT

GEORGE FRIEDMAN-JIMENEZ 

MAREK MIKULSKI

KENNETH SILVER

MEDICAL COMMUNITY

MANIJEH BERENJI

STEVEN MARKOWITZ, Chair

CARRIE A. REDLICH

CLAIMANT COMMUNITY

KIRK DOMINA

RON MAHS

DURONDA POPE

CALIN TEBAY

DESIGNATED FEDERAL OFFICIAL

DOUGLAS FITZGERALD
Call to order

Mr. Fitzgerald called the meeting to order at 2:07 p.m. Eastern 

Time. All members of the Board were present with the exception 

of Member Cassano. 

Chairperson Markowitz comments:

EEOICP Bulletin 19-03

The bulletin was updated to include the following: 

· Reduced the days of aggregate exposure to asbestos from 250 

days to 30 days and the latency period from 30 years to 15 years 

for mesothelioma.

· Reduced the latency period for exposure to asbestos from 20 

years to 15 years for ovarian cancer. 

· Reduced the latency period for exposure to asbestos from 20 

years to 10 years for pleural plaques.

· Added benzidine as an agent related to bladder cancer.

· Added carbon disulfide and n-Hexane as agents related to 

hearing loss.

· Added a presumption about lung cancer related to asbestos 

exposure.

The bulletin also provides insight on how DOL goes back to look 

at prior claims when the criteria for compensation changes and 

evolves over time. 

Chairperson Markowitz comments:

Proposed revised asbestos presumption recommendation

DOL has accepted much of the Board's advice on asbestos. 

In the current asbestos presumption causation, the Procedure 

Manual only refers to the fact that a claimant needs to have a 

significant level of exposure. Whether that exposure is high, 

medium, or low doesn't enter into consideration in the causation 

presumption. Thus, there is no need for potentially confusing 

language about high, medium, and low levels of exposure as 

currently exists in the Procedure Manual. 
For labor categories other than those on list 3a(1)of the 

Procedure Manual, it is reasonable to retain a presumption that 

they have some level of exposure to asbestos. Currently, the 

Procedure Manual has a negative presumption about asbestos 

exposure after 1995 for jobs other than those on the list. The 

Board's recommendation is that the Procedure Manual have more 

neutral language about exposure and, when there is uncertainty, 

leave the question of causation to an industrial hygienist to 

resolve. 

The asbestos diseases causation presumption adds a requirement 

of “day by day” exposure for all but two asbestos disease 

categories. This measure of exposure frequency should be 

presumed for claimants who meet the asbestos exposure 

presumption of significant exposure noted in list 3a(1). The 

Board recommends that “day by day” be retained only for 

evaluating the claims that are undergoing review by an 

industrial hygienist. 

The most important part of the Board's revised recommendations 

on asbestos is that the list of job titles that can be presumed 

to have asbestos exposure prior to 1997 is incomplete. The Board 

recommends that a Board committee work with the EEOICP and their 

industrial hygiene contractor to examine all SEM job titles and 

aliases and identify job titles that should be added to list 

3a(1) for the purposes of a presumption of asbestos exposure. 

Board vote on the revised asbestos presumption recommendation

(note: See final revised recommendation document for exact 

language)

1) To recommend the deletion of the rubric for high, medium, and 

low significance. 

2) To recommend for the current language on labor categories

other than those on list 3a(1) that it is reasonable to retain 

the presumption that workers in those labor categories had “some 

level of exposure to asbestos” prior to 1987, and that the 

industrial hygienist should determine the significance of that 

exposure in decision-making on claims.

3) To recommend that the language regarding the presumption that 

the labor categories "do not have significant exposure prior to 

1996" be deleted.

4) To recommend that the issue of day by day exposure not be 
applied to any labor categories that are presumed to have 

significant asbestos exposures. 

5) To recommend that the Board work with DOL to identify 

relevant job titles that should be added to list 3a(1) for the 

purpose of asbestos exposure. 

The above recommendations were adopted unanimously by the Board

members present.

Member Dement comments:

Proposed revised Occupational Health Questionnaire (OHQ) 

recommendation

(note: See final revised recommendation document for exact 

language)

DOL did not consider the Board's prior recommendations on the 

revised OHQ to be useful. The Board has made recommendations 

specific to DOL's new questionnaire. Member Dement described the 

history of the Board's recommendations regarding the OHQ. The 

Board recommended that an expedited review of the Board's 

revised recommendations occur so that timely progress can be 

made on the creation of a revised OHQ and its pilot testing and 

implementation. The Board voted unanimously to accept the 

recommendations. 

Member Redlich comments:

Proposed revised occupational asthma recommendation

(note: See final revised recommendation document for exact 

language)

A considerable part of the recommendation has been accepted by 

DOL and they have revised the language of the Procedure Manual 

with regard to the criteria for medical diagnosis of asthma. The 

issue of exposure is still outstanding, as well as the issue of 

what type of exposure can be presumed to be related to workrelated asthma. The Board noted that most cases of work-related 

asthma are not preceded by a specific exposure incident or by 

identification of one specific inciting toxic substance. Rather, 

most cases of work-related asthma work in environments with 

multiple toxic substances, often precluding the ability to 

narrow the cause to a single toxic substance.

The Board recommended the following revised wording for the 

Procedure Manual:
"ii. After a period of covered employment, a qualified physician 

conducts an examination of either the patient or available 

medical records and he or she concludes that the evidence 

supports that the employee had asthma and that an occupational 

exposure to a toxic substance was at least as likely as not a 

significant factor in causing, contributing to, or aggravating 

the condition. The qualified physician must provide a wellrationalized explanation with specific supporting information, 

including the basis for diagnosing asthma or worsening asthma at 

the time of covered employment and the basis for the 

relationship between asthma and the covered workplace (examples 

of supporting information could be provided here or in training 

materials). If the CE is unable to obtain the necessary medical 

evidence from the treating physician to substantiate the claim 

for work-related asthma, the CE will need to seek an opinion 

from a CMC. If a CMC referral is required, the CE will need to

provide the CMC with the relevant medical evidence from the 

claim file and provide a detailed description of the employee’s 

covered employment which should include each covered worksite, 

dates of covered employment, labor categories, and details about 

the jobs performed." 

The Board voted unanimously to accept the revised 

recommendations on asthma, including the revised language for 

the Procedure Manual. 

Chairperson Markowitz notes that the Board requested 20 asthma 

cases from DOL to review on December 10, 2018. 

Parkinson-related diseases (report from working group and review 

of data)

Member Mikulski summarized the work group's efforts at looking 

into the relationship between Parkinson-related diseases and 

occupational exposures. Parkinson-related diseases affect the 

dopamine system. There has been epidemiological research on the 

possible causes of Parkinson's disease and occupational factors. 

The work group looked at the correlation between work processes 

and Parkinson's disease using the SEM. The two biggest work 

processes/job categories related to Parkinson's were machinists 

and welding/welders. 

An action item for DOL is to provide the Board with a list of 

all of the toxic substances in the SEM that relate to the 

Parkinson's codes that DOL uses with regard to health effects. 

The work group should have more information for the full Board 
meeting in Augusta, Georgia.

Chairperson Markowitz notes that the Board requested 10 denied 

and 10 accepted Parkinson's claims from DOL for review on 

December 10,2018. 

Public comment tracking

Chair Markowitz presented the extensive public comment Excel 

spreadsheet to the Board. The intent of the comment spreadsheet 

is to keep some of the concerns that the public has in mind on 

the Board's agenda. 

Review of final DOL EEOICP rule regarding Board recommendations

Chair Markowitz noted that most of the Board's 

comments/recommendations on the proposed regulations were not 

accepted in the final regulation. The details are in the 

extensive rule that was published in the Federal Register. The 

rule cites the Board's comments and responds to them. 

Board Action list, November 2018 Board meeting

Chair Markowitz summarized the progress of the Board's action 

list:

How many cases have been reopened as a result of Board 

recommendations?

DEEOIC has published Bulletin 19-03, which provides guidance to 

staff for the implementation of a review of 2,010 potentially 

affected cases due to the changes to causation standards updated 

as part of Version 2.3 of the Federal (EEOICPA) Procedure 

Manual. The Board would like information on the reasons why the 

cases were reopened. 

The Board requests to meet the DEEOIC Medical Director and 

Toxicologist in person

DEEOIC does not consider it appropriate to permit staff 

employees, including the Medical Director or Toxicologist, to 

interact with the Board in a public forum. DEEOIC requests that 

the Board submit any questions relating to medical health 

science topics to the program in writing. DOL did provide CVs 

for Dr. Armstrong (Medical Director) and Dr. Stokes 

(Toxicologist). The Board notes that the CVs should be posted to 

the website for the public to access.
The Board would like to see annual statistics on cases and 

claims (Annual Report numbers for Part B versus Part E), 

especially by year for the most recent four years.

DOL sent the Board web statistics for 2015 to 2018. The 

statistics provided by DOL represented cumulative numbers. The 

Board wanted a more detailed breakdown of the data so they could 

get a better sense of the volume of claims flowing through the 

program by year and rates of approval/denial for both Parts B 

and E.

What percentage of cases now go to an IH? Are there categories 

of reasons for why cases are sent to an IH?

DOL response:

Generally, an IH referral will occur when certain criteria 

are satisfied, as described in the Federal (EEOICPA) 

Procedure Manual (PM) Chapter 15 (Version 2.3):

1. Given the claim filed, DEEOIC obtains evidence to 

establish that an employee has a diagnosed medical illness 

and that the employee has verified covered Part E 

employment.

2. DEEOIC then seeks to establish that the diagnosed 

illness has a medical health science link (health effect) 

to a particular toxic substance. To do this, DEEOIC applies 

health effect data maintained in SEM or the opinion of a 

claimant’s physician to determine such linkages. See PM 

15.3 for more information.

3. Employment evidence from different sources can establish 

a potential exposure by the employee to one (or more) toxic 

substances that have a health effect link to the diagnosed 

condition. See PM 15.9 for more information.

Once these conditions are satisfied, DEEOIC will usually 

submit the claim, including relevant exposure data from the 

claim or developed by a CE, to the IH for a more detailed 

characterization of the employee’s likely exposure (See PM 

15.11). Depending on the unique features of a claim, 

validation of potential exposure by SEM or other records 

sources may not require an IH referral.
DEEOIC is developing a report that will identify the total 

number of Part E claims filed with a final decision to 

accept or deny that also have an IH referral. DEEOIC will 

share the report with the Board once it becomes available.

DOL sent the Board a table of claims that had been reviewed by 

an IH.

Accountability review findings – see link below

https://www.dol.gov/owcp/energy/regs/compliance/accountability_r

eviews.htm

DOL conducts accountability reviews of the district offices. The 

Board wants clarification on what metrics DOL uses in its 

accountability reviews. 

The Board requests to see the drafts of documents that will 

address auditing of industrial hygiene work and reports.

DOL response:

All IH referral reports undergo individual screening and/or 

certification by the Lead Industrial Hygienist for 

consistency and quality. Moreover, DEEOIC also evaluates 

the quality of IH development during the annual 

Accountability Review conducted for each district office. 

There are no further audits outside of these processes.

The Board will be requesting additional details beyond 

DOL's response.

When will the medical audits conducted after the 4th 

quarter of 2017 and for 2018 be posted online?

DEEOIC has posted the quarterly audits through the 1st 

quarter of 2018. DEEOIC uploads all audit reports as they 

become available at the following online link: 

https://www.dol.gov/owcp/energy/regs/compliance/cmc_audits.

htm

Most of the weaknesses of the contract medical physician reports 

centered on impairment analysis; almost nothing in the audits 

addresses causation. 

The Board requests, if they exist, the listing(s) of scientific 
articles or sources in support of Exhibits 15-4 and 18-1.

DOL response:

The causation and exposure standards listed in Exhibit 15-4 

have developed over time, with some having been influenced 

by input from the Board. It would be helpful if the Board 

could identify particular standards that are the focus of 

interest so DEEOIC can provide background information.

DOL provided a contractor analysis by Econometrica, Inc., 

conducted in 2005, which is the source for Exhibit 18-1.

The Board thought that the "Matrix for confirming sufficient 

evidence for non-cancerous covered illness" needs to be 

reexamined because much of it is in conflict with what the 

Procedure Manual now says for asbestos, COPD, etc. 

How many claims are there for Parkinson’s/Parkinsonism/related 

conditions?

DOL reported that there were 1,154 claims for Parkinson's 

related conditions since 2006. DOL also provided ICD codes for 

Parkinson's-related diseases.

Is it possible to see recent data on claim filings from 

different specific DOE sites? Number of claims filed and 

accepted or denied by DOE site for recent 3 years (by year and 

by B versus E) would be a useful starting point.

DOL response:

DEEOIC does not keep data on the number of claims by DOE 

site. A given claim can include employment from multiple 

sites. DEEOIC does not understand the nature of this 

request and it asks the Board to provide clarification and 

specifically link the request to one of its assigned 

responsibilities.

Claims paid by DOE site can be viewed on the DOL website.

Information/data on the volume of public submissions to SEM, and 

the turnaround time; that is, are they verified or not and how 

long does it take to make a decision on them?

DOL response:

For CY2016, CY2017, and CY2018 there were 62, 62, and 57 
submissions to the SEM website, respectively, and the 

average response time was 6.0 days, 6.6 days, and 4.5 days, 

respectively. The actual response time is extended when DOE 

verification of submitted information is necessary.

The average response time to the submitter includes: 

receipt, verification, research, and submittal of a draft 

reply to DOL; editing (if needed) and approval of the draft 

reply by DOL; and transmission of the approved reply to the

submitter by the SEM Site Administrator.

Public submittals to the SEM website or by mail can be 

generally classified as seeking information, suggesting 

changes in SEM, or being inappropriate for further 

evaluation.

 

Submissions are considered valid except in those rare cases 

when they are obviously submitted in error; e.g., inputs 

for work in non-DOE facilities.

If a document authored by DOE is submitted, it is used 

without further verification unless there is a reason to 

question its authenticity. In such cases, the SEM 

contractor contacts DOE for verification. Sometimes 

documents are submitted that the submitter says were 

authored by DOE but have no identifying markings. In these 

situations, the SEM contractor contacts DOE to verify the 

document prior to use in SEM. The public often submits 

suggestions with no or inadequate supporting documentation. 

In such cases, the submitter is requested to provide 

documentation that supports their submittal. Any 

documentation submitted with requests to make changes in 

health effects are provided to Dr. Jay Brown (Haz-Map) for 

evaluation.

The Board wants to find out whether DOL keeps track of all of 

the changes made to the SEM and whether the Board can see all of 

the revisions to the SEM.

Once aware of a new record/record source for the SEM, how does 

DOL (or the contractor) analyze the information for particular 

locations to make decisions about whether or how to add the new 

record(s) to the SEM? How and which Paragon staff evaluate the 

information?

DOL response:
A record used to make changes in SEM is one that provides 

valid information (1) specific to a DOE or RECA site, (2) 

applicable to many/all DOE or RECA sites, or (3) not 

applicable to a DOE site but applicable to SEM health 

effects and chemicals. Information specific to a DOE or 

RECA site is applied only to the SEM profile for that site. 

Information applicable to multiple sites is applied to the 

SEM profiles of all those sites. General information is 

applied to the SEM profile of the involved chemical or

health effects.

How to add information to SEM is defined in SEM procedures. 

SEM team members involved with the review of source 

documents are engineers, chemists, technical managers, or 

similar with education and experience in the review of 

technical information. All have work experience in nuclear 

facilities and most have experience in DOE facilities where 

they authored and/or used such documents in the past.

SEM team members and Dr. Jay Brown review and evaluate the 

usefulness of resource materials. Chemical information is 

reviewed almost exclusively by the project chemist. Disease 

information is reviewed by Dr. Jay Brown. Site-specific 

information about labor categories, work processes, 

incidents and toxic material usage is evaluated by SEM 

researchers and the project manager. In all cases, staff 

with the National Office reviews and approves new 

information included in SEM.

Could the Solicitor’s Office and the EEOICP explain how they 

interpret the statute regarding the definition of “toxic 

substance”?

DOL response:

The regulatory definition of “toxic substance” used by the 

Department of Labor originates from the definition of that 

term that the Department of Energy (DOE) used to administer 

former Part D of the Act. With the repeal of Part D in 

2004, and the transference of all of the requests for 

assistance that had been filed with DOE to DOL for 

processing as claims under the newly enacted Part E, DOL 

adopted DOE’s definition of “toxic substance” when it 

promulgated its regulations for administering those claims, 

since it would have been unfair to change the meaning of 

the term from what had been used by DOE.
Is there a process for the IH to ask questions or ask for 

additional information without interviewing the claimant?

DOL response:

Yes, the IH can contact a CE directly (or vice versa) to 

ask questions or seek clarification on any referral.

Is there information in SEM or otherwise on bystander exposures 

across the sites? 

No.

How many conditions are in SEM? How many aliases are there in 

the SEM? Are aliases used elsewhere besides the SEM?

DOL response:

There are 124 active occupational diseases currently in 

SEM. There are 237 occupational disease aliases currently 

in SEM. The aliases in SEM come primarily from Haz-Map. 

There are a few based on DOL-National Office policy 

decisions.

Board Data and Claims request, December 2018

The request for data was submitted in December and the Board has 

yet to receive any information. Mr. Fitzgerald has made 

inquiries into when the information would be available and also 

suggested that the Board narrow the scope of the request given 

the resources involved in gathering the data. The Board 

suggested that DOL begin fulfilling the data request by 

providing the Board with data on lung diseases and 20 claims for

occupational asthma and 20 claims for Parkinson’s-related 

conditions, as previously requested on December 10, 2018. 

The Board previously asked (December 10, 2018) to review 20 

claims for each of five pulmonary conditions and 20 additional 

claims for Parkinson's disease. As part of the closing out of 

the previous Board, all of the claims previously reviewed by the 

Board needed to be returned to the DOL. The Board asked for DOL 

to produce a timetable for getting the requested information. 

Non-cancerous Outcomes of radiogenic substances

Member Silver provided a roadmap for a potential working group 

to follow in examining the topic of non-cancerous outcomes.