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 UNITED STATES DEPARTMENT OF LABOR

 + + + + +

 ADVISORY BOARD ON TOXIC SUBSTANCES

 AND WORKER HEALTH

 + + + + +

 SUBCOMMITTEE ON EVIDENTIARY REQUIREMENTS FOR

 PART B LUNG CONDITIONS (AREA #3)

 + + + + +

 MEETING

 + + + + +

 WEDNESDAY,

 SEPTEMBER 21, 2016

 + + + + +

 The Subcommittee met telephonically at

1:00 p.m. Eastern Time, Carrie Redlich, Chair,

presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MEDICAL COMMUNITY:

STEVEN MARKOWITZ

CARRIE A. REDLICH, Chair

LAURA S. WELCH
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CLAIMANT COMMUNITY:

KIRK D. DOMINA

JAMES H. TURNER

OTHER ADVISORY BOARD MEMBERS PRESENT

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
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 C-O-N-T-E-N-T-S

Introductions. . . . . . . . . . . . . . . . . . . 4

Update on other subcommittees. . . . . . . . . . .11

Review of Task/Scope of Assignment

 Part B lung disease claims - diagnostic

 criteria for CBD, BS, CS . . . . . . .11

 Part E lung conditions (COPD, ILD) . . . . .12

 Complications Part B lung diseases,

 treatment. . . . . . . . . . . . . . .12

Review questions to DOL and responses. . . . . . .13

Review of data requested and data received . . . .13

Review of initial data analysis

 by Dr. Dement. . . . . . . . . . . . . . . .18

Discussion next steps, timeline

 Review/evaluate cases. . . . . . . . . . . .45

 Review other materials . . . . . . . . . . .73

 Additional data analysis . . . . . . . . . .74

 Other information. . . . . . . . . . . . . .74

Goals before October 18-19 meeting . . . . . . . .80

Other items. . . . . . . . . . . . . . . . . . . .81

Adjourn. . . . . . . . . . . . . . . . . . . . . .91
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1 P-R-O-C-E-E-D-I-N-G-S

2 1:05 p.m.

3 MS. RHOADS: Hi. Good morning or

4 afternoon, everyone.

5 My name is Carrie Rhoads, and I'd like

6 to welcome you to today's teleconference meeting

7 of the Department of Labor's Advisory Board on

8 Toxic Substances and Worker Health, the

9 Subcommittee on Part B Lung Conditions.

10 I'm the Board's Designated Federal

11 Officer, or DFO, for today's meeting.

12 First, we appreciate the time and the

13 work of our Board members in preparing for this

14 meeting, and for their forthcoming work as well.

15 I'll introduce the Board members and

16 do a quick roll call for the committee members.

17 Dr. Carrie Redlich is the Chair of the

18 Subcommittee. Are you on the line?

19 CHAIR REDLICH: Yes, I am.

20 MS. RHOADS: Okay. And the members

21 are Dr. John Dement.

22 MEMBER DEMENT: Here.
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1 MS. RHOADS: Mr. Kirk Domina.

2 MEMBER DOMINA: I'm here.

3 MS. RHOADS: Dr. Laura Welch.

4 MEMBER WELCH: I'm here.

5 MS. RHOADS: Mr. James Turner.

6 MEMBER TURNER: Here.

7 MS. RHOADS: And Dr. Steven Markowitz.

8 MEMBER MARKOWITZ: I'm here.

9 MS. RHOADS: And he is also the Chair

10 of the Board. And Ms. Faye Vlieger, another

11 member of the Board who is also on the line. We

12 are scheduled --

13 MEMBER VLIEGER: I'm here.

14 MS. RHOADS: Hi. We are scheduled to

15 meet from 1:00 to 4:00 Eastern Time today. In

16 the room with me is Melissa Schroeder from SIDEM,

17 our contractor.

18 Regarding meeting operations today,

19 the timing. We'll take a ten-minute break around

20 2:30, if that works, unless we think we don't

21 need one. We'll check in about that time.

22 Copies of all meeting materials and
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1 any written public comments are or will be

2 available on the Board's website under the

3 heading "Meetings" and the listing there for this

4 Subcommittee meeting.

5 The documents will also be up on the

6 WebEx screen, so everyone can follow along with

7 the discussion. 

8 The Board's website can be found at

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

10 d.htm.

11 If you haven't already visited the

12 Board's website, I encourage you to do so. After

13 clicking on today's meeting date, you'll see a

14 page dedicated entirely to today's meeting. The

15 web page contains the publicly-available

16 materials submitted to us in advance. We'll

17 publish any materials that are provided to the

18 Subcommittee. And there, you should also find

19 today's agenda as well as instructions for

20 participating remotely.

21 If you are participating remotely and

22 you're having a problem, please email us at
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1 EnergyAdvisoryBoard@dol.gov.

2 If you're joining by WebEx, please

3 note that the session is for viewing only and

4 will not be interactive. The phones will also be

5 muted for non-Advisory-Board members.

6 Please note that we do not have a

7 scheduled public comment session today. The

8 call-in information has been posted on the

9 Advisory Board website, so the public may listen

10 in but not participate in the Subcommittee's

11 discussion.

12 The Advisory Board voted at its April

13 meeting that Subcommittee meetings should be open

14 to the public, so a transcript and minutes will

15 be prepared from today's meeting.

16 During Board discussions today, as

17 we're on a teleconference line, please speak

18 clearly enough for the transcriber to understand. 

19 When you begin speaking, especially at the start

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

21 get an accurate record of the discussion. Also,

22 we've had some problems, so speaking into a phone
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1 is generally better than using a speaker phone

2 for the transcriber.

3 Also, I'd like to let our transcriber

4 please let us know if you're having an issue with

5 hearing or anyone or with the recording.

6 As DFO, I see that the minutes are

7 prepared and ensure they're certified by the

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

9 available on the Board's website no later than 90

10 calendar days from today, per FACA regulations. 

11 If they're available earlier, they will be

12 published before the 90th day.

13 Also, although formal minutes will be

14 prepared, we'll also be publishing verbatim

15 transcripts which are, obviously, more detailed

16 in nature. Those transcripts should be available

17 on the Board's website within 30 days.

18 I would like to remind the Advisory

19 Board members there are some materials that have

20 been provided to you in your capacity as special

21 government employees and members of the Board,

22 which are not for public disclosure and cannot be
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1 shared or discussed publicly, including in this

2 meeting. Please be aware of this as we continue

3 with the meeting today.

4 These materials can be discussed in a

5 general way which does not include using any

6 personally identifiable information, such as

7 names, addresses, specific facilities, if a case

8 is being discussed, or doctors' names.

9 And with that, I convene this meeting

10 of the Advisory Board on Toxic Substances and

11 Worker Health, Subcommittee on Part B Lung

12 Conditions. I'll now turn it over Dr. Redlich,

13 who is the Chair of the Subcommittee.

14 CHAIR REDLICH: Hello. Welcome,

15 everybody. Can everyone hear me?

16 MEMBER WELCH: Yes.

17 MEMBER VLIEGER: Yes.

18 CHAIR REDLICH: Okay.

19 MEMBER TURNER: Yes.

20 CHAIR REDLICH: I think I am now on

21 the WebEx, but I had thought it was disconnected.

22 So does everyone have the agenda?
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1 MEMBER WELCH: Yes.

2 CHAIR REDLICH: And before we start,

3 does anyone have anything they'd like to add to

4 the agenda?

5 MEMBER MARKOWITZ: Carrie, this is

6 Steve Markowitz. So just if, in the discussion,

7 we could begin to identify some things that you

8 think ought to be raised at the October full

9 Board meeting, that'd be good. It doesn't have

10 to be a separate agenda item. Just as we

11 otherwise discuss the issues.

12 CHAIR REDLICH: Okay. Very good. I

13 don't know whether it would be helpful for us if

14 we update on the other working groups or leave

15 that for now. We obviously have an upcoming

16 meeting, so --

17 MEMBER MARKOWITZ: Well, yes. This is

18 Steven. I and Laurie, John, Kirk, others who

19 participate in these other committees can weigh

20 in here.

21 I don't really think an update is so

22 necessary. If it touches on the issues that we
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1 discuss today, then we can just chime in as to

2 what the other committees are doing about this.

3 But they kind of recognize that Part

4 B lung diseases are the province of this

5 Subcommittee. And, I guess, one of the

6 committees is, at least, eavesdropping on some of

7 the claims that have been prepared for this

8 Subcommittee, just to begin to get an

9 understanding of the claims process. But that's

10 not really relevant to what this Subcommittee

11 does, so --

12 CHAIR REDLICH: Okay. Very good. So

13 I think it took me a couple days of reviewing

14 everything to come back up to speed. But I

15 thought it would probably just be helpful for us

16 to review what our past and the scope our

17 assignment, specifically with Subcommittee.

18 So I think there's definitely some

19 overlap between the different subcommittees. And

20 so it's just a refresher. They're really

21 specific questions related to Part B lung disease

22 claims in terms of really the diagnostic criteria
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1 used.

2 And then I actually wanted

3 clarification because it seems that, once you

4 start talking about Part B lung conditions and

5 claims, it's since many people will also file a

6 Part E, I was actually a little unclear. And,

7 obviously, the data that we were given included

8 Part E lung conditions, too. So it might be

9 helpful to get a little bit of clarification on

10 that.

11 My sense was that we were focusing on

12 Part B. But to address some of those questions,

13 we are interested in information about some of

14 the E conditions, such as how many sarcoidosis

15 cases there are. Is that everyone's

16 understanding?

17 MEMBER VLIEGER: Yes. This is Faye.

18 MEMBER DEMENT: Yes, and this is John. 

19 I think, you know, we received data that were

20 Part B and Part E. And, clearly, there are lots

21 of people who file under those parts. And so it

22 becomes a little fuzzy for some of the
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1 conditions, you know, how they're accounting, I

2 think, in the data. But I think the intent of

3 what we're doing is on par.

4 CHAIR REDLICH: Okay. Okay. Good,

5 very good. And I just wanted to make sure that

6 we were all on the same page as far as that goes.

7 So I thought we had asked the DOL for

8 some questions and got their responses. This is

9 item number three and four on our agenda. And I

10 felt we got pretty reasonable responses. But I

11 wanted to check if other people felt if there was

12 an area they really wanted more information or

13 weren't happy with the response.

14 I think, by some of the back and forth

15 I got a little better appreciation for what was

16 available and how easily it could be accessed or

17 not. But did anyone have any specific either

18 concerns or questions about the responses we got?

19 MEMBER VLIEGER: This is Faye and I

20 have a question on Item 4 where you had asked

21 about QTC and the CMC's vetting process. And

22 they said that they provided a Statement of Work. 
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1 I'm sorry. I don't know that I ever saw that.

2 MEMBER WELCH: Yes. Faye, this is

3 Laurie. I looked in on that. I thought maybe it

4 would be attached to that document. And I think

5 we've asked that and the SEM Committee also

6 wanted to see it. 

7 CHAIR REDLICH: Okay. So --

8 MEMBER MARKOWITZ: This is Steven. 

9 So, Carrie Rhoads, do you recall offhand whether

10 we've gotten the Statement of Work from QTC or

11 the contract under the QTC?

12 MS. RHOADS: Yes. I think we did

13 provide it. I think it's on the website under

14 the April meeting. I'll see and --

15 MEMBER MARKOWITZ: Okay.

16 MS. RHOADS: -- go check.

17 MEMBER MARKOWITZ: Yes. I'll check it

18 as we are on the phone. That's fine.

19 MS. RHOADS: Thank you.

20 MEMBER WELCH: One thing I can add to

21 that about the Statement of Work was in our other

22 call about the SEM. I learned that we had asked
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1 her what kind of training is given to the CMCs

2 and the industrial hygienists and that is

3 proprietary. So we can't see the training

4 materials, the language for it.

5 MEMBER MARKOWITZ: Yes. This is

6 Steven. I think this needs to be discussed

7 further. I guess I'm not used to government

8 contracting. I can't understand why training

9 materials used by the contractor couldn't be seen

10 by the contracting entity. It's not really, on

11 the surface, an answer that we can accept at face

12 value.

13 CHAIR REDLICH: Okay. Yes, and I

14 agree. You know, some of the responses that we

15 got, I wouldn't say that they were the most

16 enlightening in terms of they actually have

17 qualified physicians. I just sort of felt like

18 asking the question then was probably not going

19 to be that -- I mean, maybe --

20 MEMBER WELCH: Carrie, this is Laurie. 

21 I'm thinking what they do is they have a contract

22 where they specify certain things, and then
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1 they're leaving it up to their contractor to meet

2 the specification. So they probably can't really

3 -- I mean, so when we see the Statement of Work

4 and we can see what appropriate credentials are,

5 that might be helpful.

6 CHAIR REDLICH: Yes.

7 MEMBER MARKOWITZ: So this is Steven. 

8 The Statement of Work, as Carrie said, it is on

9 the list of materials provided for the April

10 meeting, so --

11 CHAIR REDLICH: Oh, okay.

12 MEMBER MARKOWITZ: -- it's a 29-page

13 document. So it is there.

14 CHAIR REDLICH: Okay. You know, also,

15 I felt, in terms of the overlap potentially for

16 the weighing the medical evidence component. And

17 talking to, also, Tori Cassano, it seems that I

18 thought it might help if we sort of focused on

19 more of what the medical criteria -- because it's

20 very easy to switch over to the process, just

21 sort of wondering how the outcome was decided.

22 So I think it is a little unavoidable
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1 to ask some process questions, even though it

2 seems like that the other subcommittee is

3 addressing those issues.

4 MEMBER WELCH: But I think that

5 they're -- I mean, they are addressing it. With

6 the part of this committee, when it's just Part E

7 that probably nobody else has addressed.

8 CHAIR REDLICH: Okay.

9 MEMBER WELCH: Okay. I think that,

10 you know, kind of the definition of some of the

11 statutory language, that I think, you know, it's

12 the way they did that. And actually, you know,

13 I'd say they're asking DEEOIC -- and I don't know

14 how you say that. So, you know, the questions

15 they ask us about.

16 CHAIR REDLICH: That's right, but I

17 agree, I agree. Okay. And then we did get quite

18 a bit of data that we requested. And John has

19 started to sort of understand it, and, John, I

20 appreciate your efforts here. Do you want to

21 maybe just give us a run through of what you did

22 and your summary?
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1 MEMBER DEMENT: Yes. The summary is

2 shown here. Let's go back to the end page of

3 this. So what we had added to the one we had

4 before were several new fields. One had to do

5 with the reason for denial and then some others

6 with regard to when it was referred out to --

7 CHAIR REDLICH: You know, John. I'm

8 having a little trouble hearing you. Is anybody

9 else?

10 MEMBER VLIEGER: Yes. There's a buzz

11 on his phone.

12 MEMBER DEMENT: Is this better?

13 MEMBER MARKOWITZ: Oh, much.

14 CHAIR REDLICH: Yes. Thank you.

15 MEMBER DEMENT: Okay. So we had some

16 additional fields that were added to the

17 information we received and the prior data. We

18 did get the latest CMC referral date, right, it's

19 referral date. We got an additional field that

20 referred to the reason for first denial. 

21 So one caveat with regard to this

22 data. There's a line for each individual that
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1 lists the conditions under Part E and Part B that

2 were filed and it gives various fields with

3 regard to whether or not it was accepted or

4 denied.

5 This one field that says "denial

6 reasons" relates to not every condition in the

7 file. So what I'm saying is the reason for

8 denial may or may not specifically relate to one

9 of those conditions. And I don't know that this

10 is an issue that can be resolved in the future

11 whereby each individual has a line item for every

12 condition that they have filed and we have the

13 information on acceptance or denial.

14 Anyway, that, be it as it may, what I

15 tried to do, sort of this initial path was to

16 look at the other role rates of filing and

17 approval. I did it for both Part B and Part E so

18 we could at least contrast where they are and

19 also summarized the reasons for denial.

20 So if you look at the first table at

21 Part B and look at CBD, looks like a little over

22 about 41 percent of the CBD cases are approved,
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1 sensitivity about 55 percent, and silicosis about

2 67 percent.

3 Sort of contrasting down in looking at

4 Part E, it's really not that much different with

5 regard to those three conditions. It's about the

6 same. And if we look at some of the other

7 conditions, asthma doesn't get approved but about

8 a little over a third of the time, about the same

9 as COPD. The interstitial lung diseases are not

10 getting approved about 75 percent of the time. 

11 And so, you know, we can get at least sort of an

12 overall picture of approval.

13 MEMBER WELCH: John, could I ask you

14 a question?

15 MEMBER DEMENT: Yes, of course.

16 MEMBER WELCH: So that the cases in

17 here that are asthma, COPD, interstitial lung

18 disease and sarcoidosis, are those cases there

19 because they have one of the Part B conditions

20 and those are not --

21 MEMBER DEMENT: Well, yes. The table,

22 if you look at the data file, there are flags in
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1 the data file that says approved under Part B. 

2 And it will have some of these asthma, COPD,

3 interstitial lung diseases. But I think those

4 are pulled in sort of as part of the other

5 diagnosis. I think those are actually, in and of

6 themselves, taken care of under Part E.

7 CHAIR REDLICH: This is Carrie. I

8 have a basic question. Each case ID, there are

9 people, their numbers will have shown twice. So,

10 like, for than a given number, there may be, you

11 know, two entries for that. So my assumption was

12 that the case number was a person, and I just

13 wanted to be sure about that. You know, the

14 multiple claims per person issue.

15 COURT REPORTER: This is the

16 transcriber. Could folks try to use their

17 handsets when they talk? Things get garbled over

18 the speaker phones and just hard to follow.

19 MEMBER DEMENT: Yes. I couldn't hear

20 that either, Carrie. Could you repeat that

21 question?

22 CHAIR REDLICH: So my question was
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1 just in terms of what the person versus a claim. 

2 So there was an ID number for -- and my

3 assumption was, because there were sometimes

4 entries with two for the same number, that that

5 was the ID was a person. But I wanted to just

6 make sure I was correct about that.

7 MEMBER DEMENT: Well, you know, I

8 think the case ID, it could be the employee could

9 file or the survivor could file as well. So that

10 may be part of that. How that case ID number was

11 assigned to this data, I do not know.

12 CHAIR REDLICH: But there are two

13 entries to the same -- because let's say a given

14 case ID can have multiple entries --

15 MEMBER DEMENT: Yes.

16 CHAIR REDLICH: -- that number. And

17 so, in your summary, I was wondering how you

18 handled that. 

19 MEMBER DEMENT: I use the case ID as

20 the unit of measure. So these are cases. You

21 know, I assume that a case in their data system

22 was, in fact, a filed case. So, you know, these
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1 are cases as opposed to, perhaps, individuals. 

2 And that's probably a good point, but there's not

3 many in there that are duplicates.

4 CHAIR REDLICH: Okay. Okay. I wanted

5 to be clear. So each case number was a --

6 MEMBER DEMENT: Right. Each case ID

7 is counted as a unit. And the other thing in

8 this data file, we have cases that are presented

9 to us that don't have one of these conditions.

10 So this data file, it includes more

11 than just the conditions that we specifically ask

12 for, the lung conditions. But the medical

13 conditions for those are left blank. Those are

14 not counted. We're only counting the ones with

15 conditions that we specifically have asked for.

16 So we ask for reasons -- and let's

17 move onto reasons for denial. And what I found

18 in that was the categories are listed in this

19 table. They range from an employee not covered

20 down to survivor not eligible.

21 And so, I tried to just get an overall

22 look at Part B and Part E in terms of the
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1 percentage that were -- I mean, the distribution

2 list of the reasons for denial.

3 So you look under Part B and under

4 Part E. And the Part B, the medical information

5 being insufficient is about half the reasons for

6 denial. Negative causation, about 11 percent

7 under B, but it's much higher under Part E. It's

8 up to about half, negative causation result. 

9 Otherwise, the other distributions are reasonably

10 consistent. The medical condition not covered is

11 a much higher portion under Part E where you

12 could file for lots of different things.

13 But that is about as far as I can go. 

14 And I just want to make sure everybody

15 understands that, on each data line that's filed,

16 there could be multiple conditions. And the

17 employee can file for CBD, COPD, lots of

18 different things.

19 What this data file did not provide

20 was a specific reason for each of those

21 conditions separately. They simply provided, you

22 know, one, for the first reason for denial. So
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1 there may be some other types of data that we

2 could get. I'm not sure. I'm not clear, you

3 know, how these were pulled from their main data

4 file.

5 CHAIR REDLICH: Okay. And, you know,

6 just one question that I have is, you know, the

7 cost-benefit ratio of sort of requesting

8 additional data. Or sort of then they'll say,

9 you know, what we have, that --

10 MEMBER DEMENT: Yes. I --

11 CHAIR REDLICH: -- to use that, just

12 to --

13 MEMBER DEMENT: Yes. I don't know if

14 it's worthwhile, going much further. One thing

15 that we discussed in our meeting on the SEM is

16 the category specifically of the negative

17 causation result.

18 You know, some of the other issues are

19 more fundamental to the program, but we're not

20 going to have any impact on that. They're built

21 into the implementing regulations.

22 For example, the employee not covered,
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1 the maximum benefit and that, those things we

2 cannot deal with. So I think, you know, I would

3 like to review a lot of -- I don't want to spend

4 a lot of time reviewing case files where the

5 reason for denial is the employee is not covered

6 or the maximum benefits are met. If I'm going to

7 spend time reviewing it, I'd rather review a

8 large number that have the negative causation

9 result.

10 MEMBER WELCH: Or the medical

11 condition not covered because, you know, it's

12 interesting if that actually is a condition. I

13 guess there weren't that many of those. Medical

14 information insufficient is also a really good --

15 MEMBER DEMENT: Yes, it is.

16 MEMBER WELCH: -- one. I'd like to

17 understand that one. But, John, let me ask you

18 one question. So if somebody had four diagnoses. 

19 So the first reason for denial could have been

20 they denied one of the diseases. But then, later

21 on, accepted -- you know, they denied the person

22 for silicosis but accepted CBD, for example.
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1 MEMBER DEMENT: Yes. And I --

2 MEMBER WELCH: And the data didn't

3 reflect that level of complexity.

4 MEMBER DEMENT: No. Because the data

5 files are listed on the case ID, which can have

6 multiple conditions on the same line.

7 MEMBER WELCH: Right.

8 MEMBER DEMENT: What will be better if

9 we added -- I didn't know -- and yes, these may

10 not be worth the time. But if we had, for each

11 individual, multiple line listings for each

12 condition. You know, if they had a line listing

13 for the CBD and the COPD, and have specific

14 information for the reason for denial for that

15 condition, which I don't think this file gives

16 us.

17 And, for that reason, I didn't feel

18 like it was worth a lot more time looking at it

19 in lots of different ways because it would be

20 misleading. For example, I could, you know, look

21 at these reasons and stratify, you know, by the

22 conditions that were in the file. But I don't
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1 think it's meaningful because it's not

2 specifically tied to those conditions.

3 MEMBER WELCH: Right. Right. And is

4 this the whole program from the beginning? I'll

5 pull out the data file again. So this is all

6 cases for all years?

7 MEMBER DEMENT: Well, I can't answer

8 that. The data file contains over 22,000 cases.

9 MEMBER WELCH: Yes. So that's

10 probably the complete data file?

11 MEMBER DEMENT: That's my

12 understanding that it's likely that, but --

13 CHAIR REDLICH: It seems that one

14 thing that I tried putting together all of the

15 years. It does seem that there has been some

16 changes in terms of trends as far as, you know,

17 which claims are more common and also some

18 changes in the acceptance or denial rates.

19 MEMBER DEMENT: Right.

20 CHAIR REDLICH: So one thing that I

21 had started to do that I was getting too many

22 numbers and I didn't get it all organized. But
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1 it does seem that the last couple of years are

2 most relevant in terms of just, in a sense,

3 moving forward.

4 MEMBER DEMENT: Right.

5 CHAIR REDLICH: Well, and some of

6 those years are different from the prior years. 

7 To me, it seems right that there's an increasing

8 number of parts in claims as a general trend,

9 which probably makes sense in terms of COPD.

10 But there was still a reasonable

11 number of beryllium sensitization. But it seems

12 that the new CBD claims have gone down, just in

13 terms of -- and that was another piece, I guess. 

14 The timing of the whole process, I wasn't totally

15 clear on. Because we have a date, I think -- I

16 didn't know what was the case create date was, so

17 I --

18 MEMBER DEMENT: Well --

19 CHAIR REDLICH: You know, because

20 that's getting probably confusing because, two

21 years later, a given person could have another

22 claim.
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1 MEMBER DEMENT: Right.

2 CHAIR REDLICH: And then would

3 honestly be a different date.

4 MEMBER DEMENT: Right.

5 CHAIR REDLICH: And that's why I got

6 hung up on the date. But I was thinking that it

7 might be good for us to let's say compare the

8 last two years to prior in terms of --

9 MEMBER DEMENT: Yes.

10 CHAIR REDLICH: -- if they say it's

11 acceptance or denial of claims.

12 MEMBER DEMENT: Yes. Well, there is

13 a field for the day of diagnosis for these

14 conditions. There's a lot of missing data in

15 those fields. And so, it's possible to perhaps

16 look at some of that.

17 There's another field, the first

18 calendar year of approval and the first calendar

19 year of denial. And you could stratify this

20 information by, you know, some date ranges to

21 see, you know, sort of the trends. That might be

22 possible to repeat, if you will, the first table
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1 and stratify it by the most current two or three

2 years versus prior. I can do that.

3 MEMBER MARKOWITZ: The other thing,

4 John, this is Steven, is if there are large

5 numbers of cases for which there's only a single

6 condition --

7 MEMBER DEMENT: Right.

8 MEMBER MARKOWITZ: -- in claims, then

9 if you just looked at those. For instance, I'm

10 thinking that could even be the majority, looked

11 at the reasons for denial of those, then we get

12 more clarity as to the reasons. And it's not

13 muddied by multiple conditions.

14 MEMBER DEMENT: Well, unfortunately,

15 I have to take a look at it in more detail, look

16 at that. I think a single line item may be the

17 majority, but there's a substantial number that

18 aren't. But it could be looked at it that way. 

19 For example, only beryllium sensitivity.

20 MEMBER WELCH: But I think Steven is

21 saying beryllium sensitivity with no other

22 diagnosis.
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1 MEMBER DEMENT: Yes. That's what I

2 mean, yes.

3 MEMBER WELCH: Yes.

4 MEMBER DEMENT: Yes. You know, there

5 are multiple line items on the file.

6 MEMBER WELCH: Yes.

7 MEMBER DEMENT: We could restrict this

8 analysis to those who have single medical

9 conditions filed. I can do that.

10 MEMBER MARKOWITZ: Right. And if that

11 turns out to be the majority of claims, then we

12 can compare that with the table we're looking at

13 right now and eyeball the differences.

14 MEMBER DEMENT: Yes. Yes. I can do

15 that and I can look at it by year. So those are

16 two updates that I can do for it.

17 CHAIR REDLICH: Yes. And, also, you

18 obviously sort of lumped diagnoses together which

19 seems make to sense, too, for the Part B

20 conditions.

21 Do you have other thoughts in terms of

22 what else would make the most sense to do with
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1 this data, John, just since you've played with it

2 the most?

3 MEMBER DEMENT: Well, you know, the

4 objective was to maybe direct how we look at

5 specific claims in great detail. And also to

6 give some idea, sort of more globally, what

7 things look like as opposed to looking at, you

8 know, a smaller sample of claims. And I guess

9 that objective, you know, in my mind, will be

10 somewhat accomplished if we can do some of these

11 additional analyses that we've discussed so far.

12 CHAIR REDLICH: Yes. See, I agree. 

13 I think it is helpful. I thought also the yearly

14 breakdown was also helpful that you had done.

15 MEMBER DEMENT: Right.

16 CHAIR REDLICH: It's a little harder

17 to summarize that data. And we could, by looking

18 at it, maybe for this, lump the last couple of

19 years and then compare that to the earlier or

20 whatever. I think it'd probably be -- you had

21 some natural breaks would be in terms of

22 grouping.
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1 MEMBER DEMENT: Yes. I'll take a look

2 at that and see where we get sufficient numbers

3 in the tail end. It makes sense to do it that

4 way.

5 CHAIR REDLICH: Yes. And, see, I know

6 that we, obviously, can't depend on the data from

7 the -- I can't pronounce it properly, but the

8 EEOICPA claimants, their website. They've, I

9 think, taken the data that was available from the

10 DOL and I don't know if you've all looked at it.

11 But they actually have -- because the

12 DOL data, each year, they gave the number of

13 additional claims gathered, so you have to do

14 some arithmetic to see how many new ones. I was

15 just sort of curious whether these numbers seem

16 generally aligned with the numbers that they had

17 and I feel that just a quick eyeball needs to be

18 in the right realm.

19 MEMBER DEMENT: Yes. I looked at it.

20 CHAIR REDLICH: It's just a little bit

21 reassuring in terms of that it's not total -- if

22 we're all starting with similar data.
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1 MEMBER DEMENT: Yes. Yes, I looked at

2 it, too, just in the same way, just as a rough

3 eyeball.

4 CHAIR REDLICH: Yes. And so, I was

5 sort of happy to see that it was exactly similar.

6 MEMBER DEMENT: Yes. We don't have

7 any other way of sort of comparing apples to

8 apples. But it does look similar to the numbers.

9 CHAIR REDLICH: Okay. Okay. So then

10 you had also done that? Okay.

11 MEMBER MARKOWITZ: Carrie, it's

12 Steven. I just want to comment on this table.

13 Now, looking at Part B, one of the

14 other committees here, SEM spent a lot of time

15 talking about exposure and the problems of

16 identifying exposures.

17 And under the Part B reasons for

18 denial, it would appear for silica and beryllium

19 that the issue is predominantly medical and not

20 exposure. It's predominately that the claimant

21 can't prove the diagnosis to the claims

22 examiner's satisfaction.
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1 Whereas there are -- to give you a

2 number of negative causation cases, they're

3 proportionally much fewer. And so, the issue

4 really isn't exposure, or much less so exposure

5 than disease. And that's kind of the opposite

6 with the Part E, actually, which makes a lot of

7 sense. I mean, it conforms with sort of how we

8 look at this thing. And it also is why, I guess,

9 this Subcommittee was really directed towards the

10 medical evidence around the Part B claims.

11 MEMBER DEMENT: And that's --

12 CHAIR REDLICH: Because I --

13 MEMBER DEMENT: -- consistent with the

14 handful of claims that I've reviewed. This is

15 John Dement as well.

16 MEMBER WELCH: So can you hear me

17 there? John's essentially has two things. It

18 has the overall approval or denial and diagnosis,

19 and then it has the reasons for the whole

20 population, B and E. So we can't really see the

21 silicosis except in comparing the B and the E

22 cases. Is that what you were talking about?
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1 MEMBER DEMENT: Right. Yes, that's

2 exactly right. But, you know, if we have enough

3 single diagnosis silicosis cases, then we can

4 look at these reasons in more detail by those

5 sort of breakouts and hopefully we get a little

6 more clarity.

7 MEMBER WELCH: And necessary. And

8 that would help benefit, the idea is to

9 eventually find cases that will illustrate

10 whatever the problems may be. Then we're

11 getting, you know, if you can find, you know, you

12 will know the denial is for that specific

13 diagnosis. And then we can find the ones that

14 are in more recent years. Those could be the

15 first places to start, even though they're not

16 random. You know, they're not a random sample. 

17 Because that person only --

18 MEMBER DEMENT: We don't have enough

19 person power to do a random --

20 MEMBER WELCH: Right, exactly. And it

21 doesn't really matter because actually --

22 MEMBER DEMENT: So --
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1 MEMBER WELCH: -- what we really want

2 to do is find the group that -- we want to

3 understand, I'd like to understand, you know, how

4 they get a negative causation result.

5 MEMBER DEMENT: Right.

6 MEMBER WELCH: Particularly, you know,

7 if they have a diagnosis of chronic silicosis. 

8 And so, under Part B, you know, it shouldn't be a

9 causation issue if the diagnosis is correct.

10 Anyways, so looking at some of these

11 files would be very helpful. But, I mean, I

12 know, John, you went through some. It's, at this

13 point, I mean, they're interesting. But they're

14 not necessarily relevant to what's kind of

15 happening now, unless we can get cases that were

16 the most recent to be adjudicated, so --

17 CHAIR REDLICH: Okay. So the

18 silicosis, chronic silicosis, the last couple of

19 years based on -- John, you had broken up the

20 tools by year.

21 MEMBER DEMENT: Well, I did in the

22 other data file that we --
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1 CHAIR REDLICH: The initial one?

2 MEMBER DEMENT: Yes.

3 CHAIR REDLICH: But I'm not sure --

4 and you can figure it out by the -- that the

5 conditions filed by year, I don't think you had

6 sorted that out by year?

7 MEMBER DEMENT: No. I think, at the

8 time that I did that one, the conditions, well, I

9 have to go back. I have to do a process in this

10 long text of things to pull those specifically

11 out, which I've done for the new data set.

12 CHAIR REDLICH: Yes. Okay. Because

13 the total number of -- you know, sort of a more

14 manageable number in terms of the CBD, silicosis,

15 in terms of yearly cases, it's not happening. I

16 guess it's the approved, the silicosis is

17 actually more than I had thought. But I think

18 where you should be able to get a pretty good

19 feel for, like, the beryllium disease. Because

20 it's just not that -- the numbers aren't that

21 huge for the past couple of years. If you just

22 break down by the yearly breakdown.
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1 MEMBER DEMENT: Well, what I'll do is

2 I'll take the new data and break it down by the

3 more recent, say, two-year period and look back. 

4 Is that going to be acceptable?

5 CHAIR REDLICH: That's sounds good,

6 yes. And I appreciate all you have done with it.

7 MEMBER DEMENT: Okay. Just --

8 CHAIR REDLICH: Okay. Because part of

9 the decision --

10 MEMBER DEMENT: -- I'll proceed --

11 CHAIR REDLICH: -- making, moving

12 forward, to me, seems to relate to sort of the

13 magnitude of cases that you have. I mean, you

14 know, the total number of sarcoid is pretty

15 small.

16 MEMBER DEMENT: Oh, yes.

17 CHAIR REDLICH: To me, it's the

18 sarcoid and person worked in the place of any

19 beryllium, you could decide that that was

20 sufficient. You know, you may put based on also

21 I think any decision making about possibly

22 simplifying some of the decision making by using
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1 some presumptions. Then having the total number

2 of cases is helpful in terms of thinking about

3 how long we deal with any presumptions.

4 MEMBER VLIEGER: Dr. Redlich, this is

5 Faye. If I could interject just a moment here.

6 I think the reason for the high denial

7 numbers is that when the CMC receives the

8 referral about whether or not a claim is CBD or

9 sarcoidosis or any of the conditions that could

10 result from the Part B lung conditions we're

11 looking at. They are not given the instructions

12 per the procedure manual. And then they base

13 their decision on their experience, which this

14 goes back to the vetting of the CMCs.

15 And when I have asked this question or

16 when I've had a CBD claim, the person has a

17 positive blood test. They have a restrictive and

18 an obstructive lung disease. When the CMC looked

19 at it, he said, well, no, this isn't beryllium

20 disease because nobody told me it was beryllium

21 disease and the claim was denied.

22 So this goes back to weighing the
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1 medical evidence and the vetting of the QTC

2 physicians. Even just to the procedure manual

3 standard for what the department accepts as a CBD

4 diagnosis.

5 CHAIR REDLICH: Yes. So thank you. 

6 And then, probably, I think it goes back to the

7 point that, I think, Laura had in terms of in the

8 prior request of seeing what, you know, sort of

9 educational or guidance documents the physicians

10 are being provided, to help them in the decision

11 making, correct? Because we don't know if it's

12 actually the same thing that's in, you know, the

13 act or in the information that we have.

14 MEMBER WELCH: And so Part B, you

15 know, it's really Part E that would allow any

16 kind of flexibility because Part B is pretty

17 specific, you know.

18 CHAIR REDLICH: I know Part B is very

19 specific. But do we know, for sure, that

20 contract providers are being, what wording they

21 are actually given to follow?

22 MEMBER WELCH: We don't know anything
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1 about them, but my sense is that, because they're

2 very specific. I don't know how many of the Part

3 B claims got a medical review and, you know,

4 medical review for causation.

5 Then the notes back from the DOL folks

6 is they can't tell us that. They can tell us

7 there's CMC information done but not specifically

8 why. So, you know, if you look at files, we'll

9 get an idea. I think looking at denied files

10 will give us an idea.

11 CHAIR REDLICH: Okay. And so, in the

12 example that we just heard was then where it's

13 CBD was the specificity that is in the -- you

14 know, as criteria for diagnosis. But we still

15 don't know what educational pieces are being --

16 you know, what framing is really being done of

17 the contract providers, correct?

18 MEMBER WELCH: Right. And I'm sort of

19 slowly looking through the training on each scope

20 of work to see if there's anything useful in

21 there. I have been looking at the same time, so

22 I'm not really reading it. I'm just still
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1 looking there.

2 CHAIR REDLICH: And I also agree that

3 reviewing some of the cases will help clarify, I

4 think some of these. Because the few that I

5 looked at, it appeared to me that the kind of

6 stated criteria weren't necessarily the ones that

7 were being consistently used.

8 MEMBER VLIEGER: That's my experience,

9 and this is Faye.

10 CHAIR REDLICH: And that could be good

11 and bad in terms of -- I mean, I've reviewed one

12 where there was a diagnosis of sarcoid. There

13 was a BeLPT that was negative. And, basically,

14 the presence of this was presumed for the

15 purposes of the computation to be CBD. So that's

16 actually not following the written rules. So I

17 think we'll try and look at these.

18 Okay. So before we move on from --

19 any other thoughts, comments, suggestions as far

20 as the data component? And John, we most

21 appreciate your willingness to do this.

22 MEMBER DEMENT: You're welcome.
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1 CHAIR REDLICH: Okay. So our next

2 item, let me just get our agenda up and let's see

3 with it. And we've been over this. I think that

4 a key piece that we obviously want to discuss is

5 how we review these cases and sort of extract

6 these for information from them and how we divvy

7 up the work. So to probably --

8 COURT REPORTER: This is the

9 transcriber. I missed that. 

10 CHAIR REDLICH: -- jumpstart the

11 process --

12 COURT REPORTER: It's just difficult

13 to understand.

14 CHAIR REDLICH: Oh, I'm sorry. Well,

15 I think the next item in terms is, really and a

16 big piece we need to discuss, is reviewing the

17 cases that we have received. And I think we've

18 all sort of reviewed a few of them to get a feel

19 for what material we've been given.

20 So I had thought -- and I'd like

21 everybody's input. I had developed some initial

22 template forum that we could, you know, divvy up
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1 dates. And, you know, for everybody reviewing

2 some, we didn't -- you know, so if people wanted

3 to review more, they could. But at least so that

4 we review all that we'd been given. And I

5 thought it would helpful if we sort of had

6 similar criteria or new information that we were

7 addressing on these cases.

8 So I had drafted an initial sort of

9 form to use. And my guess is, with any sort of

10 form, like, if that's being used on a couple

11 cases, you realize you have, you know, lines that

12 you don't need or lines that you need to add. 

13 But let me see what other people's thoughts are. 

14 Anyone?

15 MEMBER WELCH: I'm just getting back

16 to looking at it.

17 CHAIR REDLICH: And I think there's a

18 tradeoff between trying to extract too much

19 information versus, you know, how user-friendly

20 the form is. 

21 MEMBER WELCH: You know, I think going

22 in, we'll probably know the answers for some of
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1 these questions. You know, if we're choosing out

2 of the data that John has, really we know that it

3 was this criteria of having it to be, and so the

4 reason it was denied.

5 And then we have the patient doesn't

6 have the disease, couldn't reach the diagnosis. 

7 We do know sort of it was either medical, the

8 diagnosis, or a medical negative causation. They

9 don't have a separate category for inadequate

10 exposure. I think that's probably the negative

11 causation, and so in the --

12 MEMBER DEMENT: We have cases that

13 have been given to us to review.

14 MEMBER WELCH: Well, it shows based on

15 the criteria that we asked them for.

16 MEMBER DEMENT: Right.

17 MEMBER WELCH: Yes. So it's going

18 back to that document.

19 MEMBER DEMENT: Those cases are quite

20 voluminous.

21 CHAIR REDLICH: Yes. And the couple

22 that I looked at, there, you know, could be more
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1 than one diagnosis and, you know, one or more of

2 those diagnosis could be addressed. But I think

3 it was also, to me, at least, seeing what the

4 sort of number one diagnosis was, and this is

5 just a handful that I had looked at. 

6 MEMBER MARKOWITZ: This is Steven. 

7 One issue is pre and post-'93 for the CBD cases. 

8 We need to add that.

9 But, you know, we know, from John's

10 work, that the most common reason for denial, the

11 Part B cases, medical information insufficient. 

12 So we, you know, really need to drill down on

13 exactly what is missing or what the claimants

14 lack for cases that are denied. And I'm not sure

15 that the detail under two fully gets at that.

16 CHAIR REDLICH: Okay. Yes, I think it

17 is, too.

18 MEMBER MARKOWITZ: And that one, it

19 would require, you know, looking at the pre and

20 post-criteria specifically. And then maybe

21 looking at each case, which criteria are met and

22 which aren't and we can --
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1 CHAIR REDLICH: Yes.

2 MEMBER MARKOWITZ: --the hold up.

3 CHAIR REDLICH: That's a good

4 suggestion. I think I should because I think

5 part of the reason of that form is just to go off

6 the first in reviewing the cases. So I should

7 probably have a little checkmark for, you know,

8 is it clear which criteria were used?

9 And I will say the couple beryllium

10 cases I looked at, you know, in the more recent,

11 current tense. And I wasn't -- so some of the

12 criteria depends on when the initial diagnosis

13 was made, the year, but it's in the report. 

14 And so, I should probably make a note

15 for us to try and figure out which criterial were

16 used, and is that appropriate? So at least to

17 address that question.

18 I also wanted to somehow have cause of

19 the person, too. Because there can be the

20 scenario where there's incomplete information

21 that you could get, and then there's just

22 incomplete information that you're not able to
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1 get.

2 So let's say someone never had a BeLPT

3 or didn't have a biopsy, so you're lacking that

4 information. You're lacking information. It

5 could either be it was done but you don't have

6 the information, or it wasn't done at all. But

7 in reviewing the cases, it would be helpful to

8 differentiate those.

9 MEMBER WELCH: If you can.

10 CHAIR REDLICH: If we can. Exactly. 

11 But because I think there's always the necessity

12 for clinical decision making within incomplete

13 information. So just trying to get information

14 that you're probably never going to get, so --

15 MEMBER WELCH: I'm looking at one of

16 the final decisions, a sarcoidosis case. And it

17 lists, under Part B of the act, it establishes

18 the services. And then says since the medical

19 records submitted indicated that I missed the

20 sarcoidosis in 2010. Your case was evaluated

21 under the post-'93 CBD criteria. So maybe we'll

22 find that in the final decisions.
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1 CHAIR REDLICH: Okay. I did see --

2 one of the cases did review, you know, this issue

3 about the reason for denial was a sarcoid where

4 CBD was denied because there was no documented

5 exposure, and that the --

6 MEMBER WELCH: That's a weird one. 

7 Because I think when you look at the Part B law,

8 exposure is presumed.

9 CHAIR REDLICH: That's right. That's

10 right. I need to --

11 MEMBER WELCH: Maybe it was a Part E

12 and then Part E can be handled in a lot of

13 different ways.

14 CHAIR REDLICH: Okay.

15 MEMBER WELCH: So do you have a

16 thought about do we review the cases that we were

17 sent, or in some systematic way? Or we going to

18 try to take a subset of those where the final

19 decision was the most recent?

20 In terms of one way to do it is to

21 look at the -- I mean, even the -- since all the

22 cases have an ID number on them, we could
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1 potentially, ourselves, pick out the ones that

2 are, you know, in the last five years as opposed

3 to previous years. 

4 CHAIR REDLICH: Yes. So the total

5 number that we were sent, I averaged this off,

6 how many was the total number? I think it was

7 probably, like, 50? But what I was thinking is

8 that maybe it would be nice before our October

9 meeting to at least have a quick look at as many

10 of these as we could.

11 And that maybe I could update the form

12 with some of the suggestions here. We put aside,

13 you know, everybody divvy out, like, 50 cases

14 making sure everybody is reviewing some. And

15 then maybe after one or two cases, people just

16 give me some feedback in terms of, do we want to

17 modify the form to make it more user-friendly or

18 to get the information we want, and then

19 continue.

20 I don't have a total, because I must

21 say that frankly I didn't open every little

22 document on them. So what I did, I'm hoping that
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1 my preference would be to try and look at a

2 larger number. If not, it seemed that some of

3 the documents just weren't that relevant for what

4 we need to do. So it wasn't quite as onerous as

5 it seems.

6 MEMBER WELCH: I mean, I think, you

7 know, looking at the --

8 CHAIR REDLICH: Maybe that's an

9 optimistic view of that.

10 MEMBER WELCH: I mean, the final

11 decision letter does really -- if it's done well,

12 it lays out all the facts in the case. And then

13 if you want to find some of the supporting

14 documentation, that's a little bit harder to

15 find. Because there's all these different PDFs

16 and they're not labeled. 

17 CHAIR REDLICH: That's right. But at

18 least with some of the cases, that letter, to me,

19 was, like, okay, this makes sense. You know,

20 this was done appropriately and I agree with it. 

21 So I think some of them would be rather quick

22 because it seems reasonable.
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1 And just reading those letters, it

2 leads to some idea, or at least me. And I know

3 you're more familiar with the process, Laura, and

4 a feel for, you know, how it's actually worked. 

5 But then some of them will be -- and particularly

6 those with the denials, understanding, you know,

7 then looking further. 

8 And I think even the ones that were

9 accepted, if they're accepted but we think, yes,

10 it's accepted, but did they use the criteria that

11 we are understanding of what criteria should be

12 used? I think it's important for us to note

13 because my sense is one of the issues is

14 consistency.

15 So if there are cases that are

16 approved but we're sort of thinking, wait, I'm

17 not quite sure why--it might be meaningful-- but

18 so this issue of consistency. Because talking to

19 some of the pulmonary clinicians involved, that

20 was one of their concerns.

21 MEMBER WELCH: Yes. No, I think

22 that's right.
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1 CHAIR REDLICH: Okay.

2 MEMBER WELCH: So how many total files

3 did you get? Wait a second.

4 CHAIR REDLICH: I didn't either and I

5 don't have the disc with me. But that's on

6 another computer to see it on there. Does anyone

7 know the total number?

8 MEMBER MARKOWITZ: This is Steven. I

9 can figure it out and toward the end the

10 conversation, I'll let you know.

11 CHAIR REDLICH: Okay. Yes, I think

12 it's just that --

13 COURT REPORTER: There's a lot

14 background noise. It's getting difficult for me

15 to focus.

16 MEMBER WELCH: He's talking over you.

17 CHAIR REDLICH: I have the number that

18 we requested, but in terms of what we actually

19 received is what I'm not clear.

20 MEMBER MARKOWITZ: While we figure

21 that out, I just want to remind you, in terms of,

22 Carrie, what you're talking about, reviewing
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1 cases and changing the template, et cetera, is

2 that we have three and a half weeks until the

3 full meeting. So just if --

4 CHAIR REDLICH: Yes.

5 MEMBER MARKOWITZ: -- you think that

6 we should just lay out a time table over the next

7 three weeks.

8 CHAIR REDLICH: Okay. Okay. So

9 you're going to find that, figure out the total

10 number of cases?

11 MEMBER MARKOWITZ: Right. All right.

12 CHAIR REDLICH: So, okay. Ideally, if

13 we could round to the number, if two people

14 review each one, there would be -- but while

15 Steven is figuring that out, I would propose,

16 seeing we're on such a short time frame, is that,

17 you know, I could modify this form and send it

18 out tomorrow, you know, with suggestions from

19 today. If, in the next day or two, people had a

20 chance to just look at one or two cases or have,

21 you know, other suggestions to how to fix up the

22 form to make some edits and get it back to me.
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1 MS. RHOADS: Okay.

2 CHAIR REDLICH: Because I think if the

3 form sort of has what we want, it will, like,

4 just in terms of us being consistent of what

5 information we pull out. And then I don't know

6 what people's -- their time is like for the next

7 few weeks. The more of these cases that we could

8 look at.

9 MEMBER WELCH: Really, when we get to

10 the meeting, we're not really going to have -- we

11 won't have done any summary across the group

12 unless you're planning to have us send these

13 forms in. 

14 CHAIR REDLICH: I've been thinking if

15 you sent the form back, I could at least attempt

16 to summarize, you know, what we've got. If

17 people thought, you know, that it would be

18 worthwhile for us to just have a call among

19 ourselves in between or we could also, in terms

20 of if we come up with something for obstacles.

21 MEMBER WELCH: And given the fact that

22 if we had a call on each, several of us, then we
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1 could split up the time, but --

2 (Simultaneous speaking.)

3 MEMBER WELCH: And then part of it is

4 what you want to do. I mean, I think we need to

5 have a call to discuss the reviews before we make

6 any conclusions in front of a big group. That

7 would be my request. Because I think they're

8 going to be -- I don't think there's probably an

9 easy way to capture all this information on the

10 form that gets the nuances of what we want to

11 know. I think it would be --

12 CHAIR REDLICH: Well, my guess is also

13 that, just from similar, other types of cases,

14 that some of them will be clear cut. But then

15 there will be some that, you know, what I'd like

16 to see what everyone else thought about it, or

17 exactly.

18 So my understanding of the need for --

19 it sounded like we had requested that the

20 Subcommittee, these calls be public, but that we

21 could have a -- we're not prohibited from having

22 a nonpublic call.
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1 MEMBER MARKOWITZ: No, no. This is

2 Steven. And Carrie Rhoads, you can correct me. 

3 But if the entire Subcommittee meets, then our

4 promise is that there would be public access to

5 that meeting.

6 CHAIR REDLICH: Yes. Is that correct,

7 Carrie?

8 MS. RHOADS: That's right.

9 MEMBER WELCH: I think that is what we

10 -- at the meeting, everybody was pretty emphatic

11 that they wanted to do that. You know, we could

12 talk one-on-one with each other but not really

13 all together without other people listening in.

14 MEMBER MARKOWITZ: I have a number of

15 cases, if you want. The beryllium sensitivity

16 20, CBD 20, silicosis 10. And if you're

17 interested in pneumoconiosis and sarcoidosis,

18 it's about 20 pneumoconiosis and the same

19 sarcoid. So 20 of each for each of the four

20 categories and 10 of the chronic silicosis.

21 MEMBER WELCH: That's 90, yes.

22 CHAIR REDLICH: Yes. 
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1 (Laughter.)

2 MEMBER WELCH: And so, I also know the

3 sarcoidosis cases are interesting in that, if

4 somebody had a diagnosis of sarcoid. Like, one

5 of the cases just randomly I looked at was one

6 that I submitted a letter explaining why the

7 worker would have a negative BeLPT.

8 So if you didn't get accepted at a CBD

9 case, it gets accepted as a sarcoidosis case. So

10 those would be worth looking at. The other

11 pneumoconiosis, maybe we could strip them out. 

12 That would be my thought. But the beryllium

13 sensitivity CBD, the sarcoidosis, and the

14 silicosis are all very relevant to the questions

15 they asked us.

16 CHAIR REDLICH: Yes. And so, I

17 believe of the 20, it's been some that there's --

18 originally, the request was sort of half accepted

19 and half denied. But I don't know if we -- and

20 altogether.

21 MEMBER WELCH: You have to open the

22 file to know. I mean, they're not written that
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1 way.

2 CHAIR REDLICH: You just don't know

3 right now.

4 MEMBER WELCH: I mean, they may be. 

5 But you couldn't say, all right, let's just look

6 at their denied claims without another some kind

7 of data sort to identify those IDs.

8 CHAIR REDLICH: Okay.

9 MEMBER WELCH: The ones I looked at,

10 it's the case number, and then you open it and

11 see the way it is. Assuming they are in that

12 vein, because the document we got back from Doug

13 that, you know, in response to the request. All

14 right, good to know. 

15 CHAIR REDLICH: So Steve, I know that

16 the other subcommittee had the time to sort of

17 review some of the cases. How many was there to

18 look at?

19 MEMBER WELCH: The SEM committee kind

20 of had to review these because they couldn't give

21 us cases that had data to see. So people looked

22 at them just to understand what a final
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1 determination looked like, but not as anything

2 more systematic. No comment about the other

3 committees.

4 CHAIR REDLICH: Yes. About the claims

5 process, that committee has sort of divvied out

6 reviewing the cases. But I didn't know if they

7 were attempting -- you know, if they had selected

8 a certain member to review. Do you know, Steve?

9 MEMBER MARKOWITZ: Yes, yes. No, but

10 I don't think the other committees review these

11 cases, if going to be helpful to the questions of

12 this Subcommittee.

13 CHAIR REDLICH: Okay. So --

14 MEMBER WELCH: There are four -- how

15 many people on the committee, five, four

16 officially? And if you wanted to overlap some

17 files, that means everybody would be reviewing,

18 you know, 25 or 30 cases. If you wanted every

19 file reviewed by two people, it's a lot more than

20 that.

21 CHAIR REDLICH: Yes. So I think we

22 should, for now, forget about everyone reviewing
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1 these, you know, twice. But, I mean, I think

2 reviewing 20 cases would be feasible. From the

3 three or four that I looked at, some of them were

4 pretty quick, I think.

5 MEMBER WELCH: But somebody needs to

6 make an assignment of somebody needing to -- 

7 CHAIR REDLICH: Yes, definitely.

8 MEMBER WELCH: -- figure out which

9 cases you want us all to review.

10 CHAIR REDLICH: Okay. So what if we

11 planned this, that we assigned everybody 20 cases

12 but maybe a mixture. You know, like, five of

13 this and five of that rather than all of one

14 group.

15 MEMBER WELCH: That makes sense.

16 CHAIR REDLICH: And then people could

17 review those. Anybody who wanted or was curious

18 to review some additional, you're welcome to. 

19 And I agree with your prioritizing in terms of

20 beryllium, the silica and the sarcoid as the top

21 priority.

22 And I think we could also just have a
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1 -- and my preference would be for all of us not

2 to get too bogged down on one if it's very

3 complicated and we can't -- you know what I mean? 

4 We could prioritize this one set, you know, just

5 for everyone. The first one we can start with is

6 the very complicated one so we can get a feel for

7 the cases.

8 And then we would at least have -- you

9 know, we could, just by email, just let people

10 know if they, you know, about when we're through,

11 I think we'll have an idea about the feasibility. 

12 You know, if we were all just taking much longer

13 than we anticipated. Does that seem like a plan?

14 MEMBER WELCH: Sure.

15 CHAIR REDLICH: Okay. So I think just

16 to review the plan would be to, initially, I

17 would send out a revised template form to use. 

18 And we would then assign people cases. And if

19 people have suggestions on the form or

20 suggestions after they use it once or twice, then

21 I could quickly revise it so that it's most user22 friendly and have the information we wanted. And
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1 then, ideally -- then if, hopefully, you know,

2 people, that the ones that they do, I agree, we

3 don't want to present this to everybody without

4 us reviewing. 

5 In terms of sharing the forms between

6 each other, we could have a system to do that. 

7 Ideally, I agree, I would be nice to have a call

8 where we could then review what we come up with. 

9 But in terms of between now and the meeting,

10 that's not really feasible, correct, in terms of

11 the timing?

12 MEMBER WELCH: Yes. I don't think it

13 is.

14 CHAIR REDLICH: I mean, do we have the

15 time to set up a -- in terms of being a -- so

16 that's just not an option?

17 MEMBER MARKOWITZ: This is Steven. I

18 think you could report on impressions from the

19 review. You know, or provisional observations,

20 something like that, without pretending it's more

21 systematic.

22 CHAIR REDLICH: Okay. I mean, I would
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1 be happy to compile what -- just to sort of move

2 things along and to make the best use of our time

3 in October. You know, I think we could compile

4 the forms that I had gotten into some summary

5 that attempted at a preliminary summary, to use

6 these as a template or a starting point.

7 MEMBER DOMINA: Hey, this is Kirk.

8 CHAIR REDLICH: Yes, and no summary at

9 all.

10 MEMBER DOMINA: Hey, this is Kirk. I

11 was thinking of one thing you need to add to this

12 form would be your years that they were working

13 at a DOE site.

14 Because the reason is I want to see if

15 those bulletins come in to play if they're saying

16 after 1996 that you weren't exposed to anything. 

17 Which I know is not true for out here. 

18 Especially when you get into beryllium, our

19 people weren't supposed to be exposed ever. So

20 how did that come to pass when a lot of these

21 people have hired in at the year 2000?

22 So I think we need to put, you know,
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1 when they started at the DOE site. And if it's

2 one or more, which some people have.

3 MEMBER WELCH: That's a good point.

4 CHAIR REDLICH: Okay. So we need

5 their years of employment along with this

6 criteria that we'll use.

7 MEMBER DOMINA: Right. Because when

8 they're talking about inadequate exposure, you

9 have somebody that's doing it from 3,000 miles

10 away that has no idea if there was monitoring or

11 not. Which most of the time, there wasn't.

12 And, you know, I want to see if

13 they're using the lack of exposure data against

14 the individual. And then also comes into play, I

15 don't know if we need to add this, that, you

16 know, we've had people from over five

17 uninterpretables in a row, some of them over ten.

18 (Telephonic interference.)

19 MEMBER DOMINA: I know, but it's what

20 happens, you know.

21 MEMBER WELCH: Yes.

22 MEMBER DOMINA: But anyway, it's just
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1 my --

2 CHAIR REDLICH: Actually, one of the

3 cases I reviewed was in that scenario.

4 MEMBER DOMINA: Yes.

5 CHAIR REDLICH: Okay. Those are good

6 suggestions.

7 I also feel like for a reason to deny,

8 there's the reason given and then whether we can

9 put that as a reasonable conclusion. We may not

10 have the answer to that. So I don't know if

11 there's a way to kind of incorporate this on the

12 form. And the conclusion was there was no

13 exposure and then I, personally, it would be

14 helpful to know whether we think that is a

15 reasonable conclusion.

16 MEMBER WELCH: Yes. And I think --

17 CHAIR REDLICH: So I will, again --

18 MEMBER WELCH: It's just really one

19 other thing I think would be useful is for us to

20 decide ones we think everyone should look at and

21 discuss. And maybe you can figure that out from

22 the form itself. But, you know, we'll probably
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1 find ones that are --

2 CHAIR REDLICH: Sure, yes.

3 MEMBER WELCH: -- really interesting

4 and useful.

5 CHAIR REDLICH: That's right. Or,

6 potentially, an example could be, so let's say,

7 from the point that was made earlier, it does

8 seem that we're going to have more issues with

9 where there's a question about the medical piece. 

10 Where it may well be -- and maybe that doesn't. 

11 But I think that's a good suggestion on all

12 accounts.

13 And, obviously, those who are more

14 familiar with the exposure side will be able -- I

15 will get a feel for that on the medical side. 

16 But I guess the other thing is we may -- well,

17 yes, I guess by Friday which ones because I can

18 easily imagine a scenario where, Kirk, I would

19 like your opinion on -- well, somebody else on

20 the exposure side, their case. But I think if

21 we'd flag, maybe we all put in a place also for

22 just these are the reasons to flag it. Those are
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1 the suggestions. Okay.

2 MEMBER VLIEGER: Dr. Redlich, this is

3 Faye. I have a request when you're reviewing the

4 files. The information that's often sent to the

5 CMCs is not what would be medically relevant to

6 making a decision. So I would just ask that you

7 look at what's actually sent to the CMC, that it

8 was actually the correct information to make an

9 informed opinion. What I see when I request the

10 records for a file is that the referral to the

11 CMC has incomplete information to make an

12 informed opinion.

13 CHAIR REDLICH: Okay. I submit there

14 could be two possibilities. One is that the

15 information exists but it won't be sent. And the

16 other is that the testing or whatever wasn't done

17 or it could be either of those possibilities.

18 MEMBER VLIEGER: There's a third

19 issue. The CMC referral couches questions to

20 their doctor to answer. And many times, those

21 questions are inappropriate or inadequate. So

22 that's part of the CMC referral.
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1 And so, they don't send all the

2 records that could be pertinent. And the

3 questions they ask of the CMC physician, and

4 that's what they're supposed to answer, they're

5 not supposed to go outside of what's requested of

6 them, is they're not the appropriate questions

7 for what's going on.

8 CHAIR REDLICH: Got it.

9 MEMBER VLIEGER: When you look at

10 that, it's the same idea as what we saw with the

11 IH referrals is they narrow it down to only these

12 possible answers and all of those answers are

13 going to be no.

14 CHAIR REDLICH: Okay. I guess --

15 MEMBER VLIEGER: Just look for that

16 when you look at the file.

17 CHAIR REDLICH: You know, that's a

18 good one and I'm just thinking if we're editing

19 the template that I had. Because I think the

20 referral, it's going to need to include the

21 reason or question for the referral and

22 everything. Okay. Do we know how many, what
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1 percentage of these are referred?

2 MEMBER WELCH: We don't know that.

3 CHAIR REDLICH: Okay. 

4 MEMBER WELCH: I mean, in Part B, it

5 might be a little bit easier. Because when I've

6 done these things, under Part E, people can be

7 referred to a medical consult for an impairment

8 rating. And so, you don't know if it's a

9 causation opinion or an impairment rating. We

10 could probably see how many don't get any

11 referral at all.

12 CHAIR REDLICH: Okay. That's why I

13 thought percentage. Then for that, that doesn't

14 -- you know the overall percentage of referrals

15 doesn't reflect that, you know, just what we have

16 or to physically do those. Okay. That's a good

17 suggestion. I will add that for the form.

18 My guess is after we use it on a case

19 or two, we'll realize that there are some other

20 pieces of information, the same reason. And so,

21 those who are more familiar with the process,

22 don't hesitate to let me know. 
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1 Okay. We were supposed to take a

2 break. Carrie, what time are we supposed to take

3 a break?

4 MS. RHOADS: Anytime. It's 2:30. If

5 you want to take a break, you can take one now,

6 if it's a good time.

7 CHAIR REDLICH: What do people think?

8 MEMBER WELCH: Well, I'm going to take

9 off at 3:00, so --

10 CHAIR REDLICH: Oh, okay. So if

11 you're taking off at 3:00, then maybe we should

12 just forge ahead. We've actually, I think,

13 covered quite a bit on our agenda. Let me just

14 get it out again.

15 So we've actually discussed reviewing

16 the cases. I had asked were there any review of

17 all the other materials that were on the CD. I

18 don't know how much people looked at to date.

19 Is there any other -- essentially, to

20 me, that these cases are the priority, but other

21 materials we should be reviewing that we do not

22 have? Does anyone have any thoughts on that? I
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1 think these cases will keep us busy, but I just

2 wanted to raise that. 

3 Okay. But I think we discussed the

4 additional data analysis that, John, you --

5 MEMBER DEMENT: Yes. This is John. 

6 I'll try to get those out in the next few days.

7 CHAIR REDLICH: I appreciate it. You

8 know what always happens the day that you look at

9 it, when we see and whatever analysis, then

10 there's more questions you can have. So I will

11 try and refrain myself. If I ask any others,

12 it's usually more curiosity, but that would be

13 great.

14 Okay. And I just had any other

15 information that we would like to have before our

16 next meeting? 

17 MEMBER MARKOWITZ: This is Steven. 

18 So, you know, you may recall at the April

19 meeting, I can't remember who presented from the

20 DOL in this Part B, one of B's issues. But there

21 were a number of issues they identified that they

22 wanted our help with. And some of these, we're
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1 going to get some insight into by reviewing the

2 claims, but others are separate issues.

3 So, we've got to keep those on our

4 radar. And, you know, I don't think there's the

5 time or clarity to deal with those issues on this

6 call. But we just need to keep them in our

7 minds.

8 CHAIR REDLICH: Thank you. I didn't

9 resend -- we had sort of summarized those issues. 

10 And I agree, because some of them had to do with,

11 like, sensitivity and specificity of the test. 

12 You know, Laura, you know very well out of

13 anybody.

14 MEMBER WELCH: You know what? As a

15 reminder, I think it might be helpful if we have

16 a summary of those issues and questions that was

17 in that information. And if we send it to

18 everyone again. Because I think, also, just

19 reviewing them, while going through cases, I

20 think will be helpful.

21 CHAIR REDLICH: I had actually done

22 that myself to refresh my memory, so thank you. 
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1 Because we do want to keep our eye on the task.

2 And hopefully, so -- and I think the

3 main piece of information that we've identified

4 that we haven't necessarily gotten our hands on

5 to. I'm not sure we will which is the exact, you

6 know, sort of the more specific training for the

7 contract physicians or providers. I think we

8 made the request, so I'm not sure there's

9 anything else to do on that.

10 MEMBER WELCH: Except that we've been

11 told that DOL can't give us that information. So

12 I don't know when we're going to visit it. 

13 Steven will provide us and then so that we'll

14 visit it at the meeting or some way or another.

15 I looked through the Statement of

16 Work. And in terms of, you know, knowledge or

17 qualifications, it just says that the doctor has

18 to be in the right specialty field. And then

19 they put a note in the letter that they're

20 qualified to review the case and that's pretty

21 much it.

22 I mean, there's no -- so it's up to
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1 the claims examiners to decide what qualification

2 that's necessary. You know, whether they're

3 talking about if this is a pulmonary for these

4 cases, for example, and so --

5 MEMBER VLIEGER: This is Faye. And I

6 just want to interject that I find their vetting

7 process to be inadequate.

8 And at a recent hearing in the spring,

9 I vetted the doctor myself for a final

10 adjudication branch hearing for a claimant and

11 found that the doctor had no less than 15

12 malpractice citations. And so, I was very

13 disappointed. And when I contacted the

14 Department of Labor, they had no idea that they

15 were using a neurologist that had been cited. He

16 lost a court case and he'd been cited in 15 other

17 states.

18 So I find their vetting process

19 entirely inadequate. And the QTC contractor

20 doesn't seem to be required to vet them properly.

21 CHAIR REDLICH: Thank you. Okay. And

22 then, I guess, I had looked at that document. I
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1 didn't find a lot of specificity, if it was the

2 right document, in terms of, you know, whether

3 how you would actually interpret the guidelines

4 for this would be an accepted case or not.

5 MEMBER VLIEGER: So just so you know,

6 the doctor has to qualify. The claims examiner

7 presents the questions and the doctor has to

8 answer the questions for the claims examiner in a

9 way that a non-medical person could understand. 

10 That's pretty much what I got out of it.

11 CHAIR REDLICH: For the World Trade

12 Center, there was actually, okay, if you're going

13 to diagnose asthma, this is sort of what you

14 need, if you're going to -- I mean, it was laid

15 out for each condition that was a potential

16 condition. And it doesn't seem like there's that

17 same degree of detail for, you know, specific

18 conditions.

19 MEMBER WELCH: Well, yes. It's true. 

20 But, you know, I think just having looked at

21 files there, it depends on what you're talking

22 about. And as we do this, there is very specific
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1 criteria that this Statement of Work is for the

2 overall program altogether.

3 And then I think there's probably less

4 focus on the specific diagnosis, if the person's

5 medical records show that the individual has that

6 diagnosis. But you have to learn that by looking

7 at the files. The DOL does not say a diagnosis

8 of asthma must have this, this, this, and this,

9 and this.

10 CHAIR REDLICH: But we look at the

11 training manual for the World Trade Center was

12 sort of, more or less, you know, generically laid

13 out. Not like the specific questions for this

14 person, but, in general, this is what you need

15 for this diagnosis.

16 MEMBER WELCH: Yes. We don't know if

17 the contractor gives that to their doctors, too. 

18 The DOL doesn't seem to specify them or they

19 would've told us that.

20 CHAIR REDLICH: Okay. Very good. All

21 right. So I think we have what we are going to

22 get, at least for now as far as that question.
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1 Okay. So I think the next item we

2 have on our list were goals before our October

3 meeting. So I think we sort of got a plan in

4 terms of the additional data now and review of

5 we'll find cases.

6 As far as the number of cases that

7 people feel that they can review, I think,

8 obviously, it'll become more apparent after doing

9 some. So we can assign everybody 20 and see what

10 people get to. Is everyone okay with that?

11 MEMBER WELCH: Yes.

12 MEMBER MARKOWITZ: Yes. I'm good.

13 MEMBER DEMENT: Okay.

14 CHAIR REDLICH: Okay. And then we'll

15 make a note of -- and that'll also include the

16 ones we got from our discussion. And I will also

17 on the ones that we get through, the people from

18 the, you know, one page or so. Then I could try

19 and summarize what we have. And in addition into

20 something while we review, you know, the CBD

21 claims and try to then summarize, you know, if

22 they were accepted, denied, the reasons and the
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1 like.

2 Okay? Any other thoughts of what we

3 should be accomplishing before our next meeting?

4 MEMBER MARKOWITZ: So yes, this is

5 Steven. So I'm looking at the issues that DOL

6 brought us in April around these, around Part B

7 lung diseases.

8 Most of them actually are really to

9 the scientific medical questions that don't

10 depend upon review of claims. They really need

11 expert medical consultant advice.

12 So maybe, by the meeting, we can

13 develop a plan for the future of how to construct

14 these here, get some answers. Whether, for

15 instance, forming a subgroup of the Board that's

16 going to take on these issues. Whether one or

17 two people from the Board could work with some

18 outside experts to develop answers to these

19 questions.

20 Whatever the approach is, I just think

21 we should float some ideas before and at the

22 October meeting. And if you really look at the
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1 issues that they raise, you'll see what I'm

2 talking about.

3 CHAIR REDLICH: Yes. No, I do. I had

4 actually -- and this was after the last meeting. 

5 I could send around what I had done.

6 I had gone through these questions and

7 some of them it was I felt like, well, there's an

8 accepted medical answer for this that really want

9 to explain but doesn't need much more work. And

10 then some of them were more involved.

11 Because you're right, a lot of them

12 were. And some of them, I would say, let's say

13 the ATF has a recent document on CBD. Where one

14 could actually just cite that as, well, this is

15 what is sort of the answer. And then, as you

16 said, I think some then were more involved. But,

17 like, as a starter we could start with that, and

18 in terms of which ones would then be more

19 involved.

20 MEMBER MARKOWITZ: Right. Right. 

21 Yes.

22 CHAIR REDLICH: I mean, could I send
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1 -- I don't want to -- just in terms of

2 communication, I could send that to Carrie and

3 she could send that to everybody to just take an

4 initial look at to think about.

5 MEMBER MARKOWITZ: Yes. This is

6 Steven. I think that would be a good idea just

7 to, you know, take off the discussion. Again, I

8 don't know that there'll be time or we'll be at

9 the point of, you know, we'll be discussing

10 specific answers to the questions in October. 

11 But at least if a plan for addressing the issues

12 is presented, that would be good.

13 CHAIR REDLICH: Exactly. And then a

14 sense of how much more work would be involved in

15 coming up with the answer.

16 MEMBER MARKOWITZ: Right.

17 CHAIR REDLICH: Okay. I think that's

18 a good suggestion. Okay. I'm just making a note

19 here, original questions. Any other items,

20 questions, suggestions? Laurie, do you have

21 anything?

22 MEMBER WELCH: No. I don't have
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1 anything else.

2 CHAIR REDLICH: Okay. I think we've

3 accomplished quite a bit. We don't have to use

4 our full time, do we?

5 MEMBER WELCH: Great question.

6 CHAIR REDLICH: I don't want to --

7 MEMBER MARKOWITZ: I know that --

8 CHAIR REDLICH: No, if there's people

9 -- do we know who's listening in? And I guess

10 the people who are listening in who have

11 comments, suggestions, if we can get those; is

12 that correct?

13 MS. RHOADS: Anybody is free to send

14 in written comments. Yes, that's fine.

15 CHAIR REDLICH: Yes. I mean, I guess

16 assuming someone took the time to listen to our

17 conversation and has lots of opinions, then it

18 would be good to get them. So anybody who is on

19 the line, we would appreciate your input and

20 suggestions.

21 MS. RHOADS: And in the Federal

22 Register notice about this, there is an email
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1 address to send comments to or, you know, you can

2 also use regular mail. There's an address for

3 that as well.

4 MEMBER MARKOWITZ: Yes. This is

5 Steven. Let me just make a comment.

6 You know, we have had in the past from

7 Department of Labor on this which is, you know,

8 specific. We have the issues presented by DOL

9 which are mostly scientific and medical. We've

10 heard some concerns through the public commenters

11 and through Board members about the issues in the

12 past here.

13 And the only way we can know whether

14 we're addressing kind of the full spectrum of

15 concerns is if we get feedback from the public

16 and also eventually from DOL about their issues. 

17 So I would encourage some feedback as to whether

18 we're pursuing the issues that people are

19 concerned about.

20 MEMBER DOMINA: Hey, this is Kirk. 

21 I've got a question for Dr. Markowitz.

22 In our April meeting, you had
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1 mentioned something about, if I remember

2 correctly, about a couple pulmonologists behind

3 Oak Ridge about trying to see if you could get

4 them to the meeting to see what the issues are

5 that they have. Because there was only, like, a

6 couple in the area that were doing this.

7 MEMBER MARKOWITZ: Right. Right. 

8 Yes, I do remember that.

9 MEMBER DOMINA: Because I would like

10 to see -- you know, because some of these doctors

11 send in well-rationalized opinions and then

12 they're getting pushback.

13 MEMBER MARKOWITZ: Right.

14 MEMBER DOMINA: I guess, to me, you

15 know, you're hearing it from the horse's mouth. 

16 You know, because then if they're sending it to

17 the CMC or what are they sending to the CMC?

18 MEMBER MARKOWITZ: Right. So yes. So

19 Kirk, this is Steven. Yes. Through the public

20 comment mechanism, they can participate. So try

21 to get the word out.

22 CHAIR REDLICH: Well, I mean, I agree
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1 with the concern just sort of generally raised

2 that we have the perceived different person,

3 different people. But I still feel like, you

4 know, are there other groups involved where it

5 would be useful to get their input? And, you

6 know, is there anything more active we should be

7 doing to do that?

8 MEMBER WELCH: Well, I think, you

9 know, this is really -- I think there are many

10 people who have been pushing for a long time to

11 get this advisory committee established and

12 people who represent the claimant community. So

13 I think we've cast a pretty broad net or the

14 Department of Labor did, in, you know, announcing

15 to the community and setting it up and talking

16 about it at public hearings. So, you know, it's

17 more just making sure people feel it's worth

18 their while to send in a comment and that we

19 actually read them and things like that.

20 CHAIR REDLICH: I asked informally. 

21 The sort of community of occupational and

22 environmental lung medical specialists is not
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1 huge. That, you know, with the National Jewish

2 or some of the others and Laurie, obviously, has

3 a lot of expertise.

4 I sort of, over the last several

5 months, when I've been at any meetings and have

6 just asked for their input in terms of, you know,

7 from their perspective, what some of the problems

8 are. And I think I emailed one summary and, you

9 know, any suggestions they had. But that's

10 obviously an informal, you know, not very

11 scientific approach.

12 And it's also I do feel like that the

13 contract physicians play a very important role,

14 and that does seem to be a group that we're not

15 hearing from. So I don't know they're just new

16 to accept it, if there's any input that would be

17 useful.

18 MEMBER TURNER: And this is James.

19 MEMBER MARKOWITZ: And we are meeting

20 at the DOE community which are the largest number

21 of claimants, Oak Ridge. So that was my last

22 meeting. So we're certainly making ourselves
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1 available for anybody which is good.

2 MEMBER TURNER: This is James. Yes,

3 I'd like to say that on May the 26th of this

4 year, I attended Sarcoidosis Research as a case

5 program and that has to do with health with Dr.

6 Lisa Maier, Dr. Nabeel H-A-M-Z-E-H. Are you all

7 familiar with those doctors?

8 MEMBER WELCH: With Dr. Maier,

9 definitely.

10 MEMBER TURNER: Okay. Well, they have

11 the results of those meetings or programs, it's

12 on YouTube. So if you can look that up, would

13 you all interested?

14 CHAIR REDLICH: Where was it from? 

15 Where was it held?

16 MEMBER TURNER: At National Jewish

17 Health Center.

18 CHAIR REDLICH: Okay. And the topic

19 was?

20 MEMBER TURNER: Sarcoidosis research

21 educational program.

22 CHAIR REDLICH: Okay. If I can't find
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1 it, I will call you. Thanks.

2 MEMBER TURNER: Okay.

3 CHAIR REDLICH: Okay. Do we have an

4 agenda yet for the October meeting?

5 MEMBER MARKOWITZ: No. No, I was

6 waiting for all these second round of calls to be

7 done. So within the next week after that, I'll

8 draft something.

9 CHAIR REDLICH: Okay. Then from your

10 perspective, Steve, is there anything else that

11 you would like us to be prepared for by that

12 meeting?

13 MEMBER MARKOWITZ: I don't know. I

14 have to give it some thought. If the

15 Subcommittee had come up with any

16 recommendations, they would be good to present. 

17 If there are any particular plans or request,

18 plans to move forward or requests for more data,

19 that's appropriate. But how we're going to

20 structure, you know, work to date, I just have to

21 figure out.

22 CHAIR REDLICH: Okay. Very good. 
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1 Okay. Anybody else? Anything that you want to

2 go over any stuff? And I was just going to say

3 if anybody listening who has information they

4 would like to share with us, to please submit it.

5 Okay. I think we are ready to

6 adjourn. All right. Okay. Thank you all. I

7 appreciate everybody's efforts. And I think

8 we'll all have a sense of these cases after the

9 review. Okay.

10 MEMBER MARKOWITZ: Thank you.

11 CHAIR REDLICH: So I will communicate

12 through Carrie, the other Carrie, in terms of

13 I'll send it to her and she'll send it to

14 everybody. I think it's a good form of

15 communication. Okay. Thank you.

16 (Whereupon, the above-entitled matter

17 went off the record at 2:50 p.m.)

18

19

20

21

22
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A

able 39:18 49:22 69:14

above-entitled 91:16

accept 15:11 88:16

acceptable 40:4

acceptance 19:13

28:18 30:11

accepted 19:3 26:21,22

54:9,9,10 60:8,9,18

78:4 80:22 82:8

accepts 42:3

access 59:4

accessed 13:16

accomplished 33:10

84:3

accomplishing 81:3

accounting 13:1

accounts 69:12

accurate 7:21

act 42:13 50:17

active 87:6

add 10:3 14:20 46:12

48:8 66:11 67:15

72:17

added 18:3,16 27:9

addition 80:19

additional 3:12 18:16

18:19 25:8 33:11

34:13 63:18 74:4 80:4

address 12:12 49:17

85:1,2

addressed 17:7 48:2

addresses 9:7

addressing 17:3,5 46:7

83:11 85:14

adjourn 3:19 91:6

adjudicated 38:16

adjudication 77:10

advance 6:16

advice 81:11

advisory 1:3 2:14 4:7

7:9,12 8:18 9:10

87:11

afternoon 4:4

agenda 6:19 9:22 10:4

10:10 13:9 45:2 73:13

90:4

agree 15:14 17:17,17

33:12 44:2 53:20

63:19 65:2,7 75:10

86:22

ahead 73:12

aligned 34:16

allow 42:15

altogether 60:20 79:2

analyses 33:11

analysis 3:9,12 32:8

74:4,9

announcing 87:14

answer 15:11 28:7

68:10 70:20 71:4 78:8

82:8,15 83:15

answers 46:22 71:12

71:12 81:14,18 83:10

anticipated 64:13

anybody 18:8 63:17

75:13 84:13,18 89:1

91:1,3

Anytime 73:4

anyway 19:14 67:22

Anyways 38:10

apparent 80:8

appear 35:18

appeared 44:5

apples 35:7,8

appreciate 4:12 17:20

40:6 44:21 74:7 84:19

91:7

appreciation 13:15

approach 81:20 88:11

appropriate 16:4 49:16

71:6 90:19

appropriately 53:20

approval 19:17 20:12

30:18 36:18

approved 19:22 20:7,10

21:1 39:16 54:16

April 7:12 14:14 16:9

74:18 81:6 85:22

area 1:6 13:12 86:6

arithmetic 34:14

aside 52:12

asked 13:7,20 14:5,22

23:15 41:15 47:15

60:15 73:16 87:20

88:6

asking 15:18 17:13

assign 64:18 80:9

assigned 22:11 63:11

assignment 3:4 11:17

63:6

assume 22:21

assuming 61:11 84:16

assumption 21:11 22:3

asthma 20:7,17 21:2

78:13 79:8

ATF 82:13

attached 14:4

attempt 57:15

attempted 66:5

attempting 62:7

attended 89:4

available 6:2 8:9,11,16

13:16 34:9 89:1

averaged 52:5

aware 9:2

B

B 1:6 3:4,6 4:9 9:11

11:4,21 12:4,12,20

19:1,17,21 20:19 21:1

23:22 24:3,4,7 32:19

35:13,17 36:10,20,21

38:8 41:10 42:14,16

42:18 43:3 48:11

50:17 51:7 72:4 74:20

81:6

B's 74:20

back 11:14 13:14 18:2

39:9 40:3 41:14,22

42:6 43:5 46:15 47:18

56:22 57:15 61:12

background 55:14

bad 44:11

base 41:12

based 38:19 40:20

47:14

basic 21:8

basically 44:13

beginning 28:4

believe 60:17

BeLPT 44:13 50:2 60:7

benefit 26:1 37:8

benefits 26:6

beryllium 29:11 31:19

31:21 35:18 39:19

40:19 41:19,20 49:9

59:15 60:12 63:20

66:18

best 66:2

better 8:1 13:15 18:12

27:8

big 45:16 58:6

biopsy 50:3

bit 12:9 17:18 34:20

53:14 72:5 73:13 84:3

blank 23:13

blood 41:17

Board 1:3 2:14 4:7,13

4:15 5:10,11 7:9,12

7:16 8:19,21 9:10

10:9 81:15,17 85:11

Board's 4:10 6:2,8,12

8:9,17

bogged 64:2

branch 77:10

break 5:19 39:22 40:2

73:2,3,5

breakdown 33:14 39:22

breakouts 37:5

breaks 33:21

broad 87:13

broken 38:19

brought 81:6

BS 3:5

built 25:20

bulletins 66:15

busy 74:1

buzz 18:10

C

C-O-N-T-E-N-T-S 3:1

calendar 8:10 30:18,18

call 4:16 14:22 57:18,22

58:5,22 65:7 75:6

90:1

call-in 7:8

calls 58:20 90:6

capacity 8:20

capture 58:9

care 21:6

Carrie 1:14,21 2:20 4:5

4:17 10:5 14:9 15:20

16:8 21:7,20 35:11

55:22 59:2,7 73:2

83:2 91:12,12

case 9:7 21:8,12 22:8

22:10,14,19,21,22

23:5,6 26:4 27:5

29:16 48:21 50:16,20

53:12 60:9,9 61:10

69:20 72:18 76:20

77:16 78:4 89:4

cases 3:11 12:15 19:22

20:16,18 22:20 23:1,8

28:6,8 31:5 36:2,22

37:3,9 38:15 39:15

40:13 41:2 44:3 45:5

45:17 46:7,11 47:12

47:19 48:7,11,14 49:6

49:10 50:7 51:2,16,22

52:13,15 53:18 54:15

56:1,10,20 57:7 58:13

59:15 60:3,5 61:17,21

62:6,11,18 63:2,9,11

64:7,18 68:3 73:16,20

74:1 75:19 77:4 80:5

80:6 91:8

Cassano 16:17

cast 87:13

categories 23:18 59:20

category 25:16 47:9

causation 24:6,8 25:17

26:8 36:2 38:4,9 43:4

47:8,11 72:9

cause 49:18

caveat 18:21

CBD 3:5 19:21,22 24:17

26:22 27:13 29:12

39:14 41:8,16 42:3

43:13 44:15 48:7

50:21 51:4 59:16 60:8

60:13 80:20 82:13
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CD 73:17

Center 78:12 79:11

89:17

certain 15:22 62:8

certainly 88:22

certified 8:7

cetera 56:1

chance 56:20

changes 28:16,18

changing 56:1

check 5:21 13:11 14:16

14:17

checkmark 49:7

chime 11:1

choosing 47:1

chronic 38:7,18 59:20

citations 77:12

cite 82:14

cited 77:15,16

claim 22:1 29:22 41:8

41:16,21

claimant 2:9 35:20

77:10 87:12

claimants 34:8 48:13

88:21

claims 3:4 11:7,9,22

12:5 21:14 28:17 29:8

29:12 30:11 31:8

32:11 33:5,8 34:13

35:21 36:10,14 43:3

61:6 62:4 75:2 77:1

78:6,8 80:21 81:10

clarification 12:3,9

clarify 44:3

clarity 31:12 37:6 75:5

clear 23:5 25:2 29:15

49:8 55:19 58:14

clearly 7:18 12:20

clicking 6:13

clinical 50:12

clinicians 54:19

CMC 18:18 41:7,18 43:7

70:7,11,19,22 71:3

86:17,17

CMC's 13:21

CMCs 15:1 41:14 70:5

come 11:14 57:20 65:8

66:15,20 90:15

comes 67:14

coming 83:15

comment 7:7 35:12

62:2 85:5 86:20 87:18

commenters 85:10

comments 6:1 44:19

84:11,14 85:1

committee 4:16 14:5

17:6 61:19 62:5,15

87:11

committees 10:19 11:2

11:6 35:14 62:3,10

common 28:17 48:10

communicate 91:11

communication 83:2

91:15

community 1:17,19 2:9

87:12,15,21 88:20

compare 30:7 32:12

33:19

comparing 35:7 36:21

compile 66:1,3

complete 28:10

complexity 27:3

complicated 64:3,6

Complications 3:6

component 16:16

44:20

computation 44:15

computer 55:6

concern 87:1

concerned 85:19

concerns 13:18 54:20

85:10,15

conclusion 68:9,12,15

conclusions 58:6

condition 19:6,12 24:10

26:11,12 27:12,15

31:6 78:15,16

conditions 1:6 3:5 4:9

9:12 12:4,8,14 13:1

19:1,9 20:5,7,19 23:9

23:11,12,13,15 24:16

24:21 27:6,22 28:2

30:14 31:13 32:9,20

39:5,8 41:9,10 78:18

conforms 36:7

confusing 29:20

consistency 54:14,18

consistent 24:10 36:13

57:4

consistently 44:7

construct 81:13

consult 72:7

consultant 81:11

contacted 77:13

contains 6:15 28:8

continue 9:2 52:19

contract 14:11 15:21

42:20 43:17 76:7

88:13

contracting 15:8,10

contractor 5:17 15:9

16:1 77:19 79:17

contrast 19:18

contrasting 20:3

convene 9:9

conversation 55:10

84:17

COPD 3:5 20:9,17 21:2

24:17 27:13 29:9

Copies 5:22

correct 22:6 38:9 42:11

43:17 59:2,6 65:10

70:8 84:12

correctly 86:2

cost-benefit 25:7

couches 70:19

counted 23:7,14

counting 23:14

couple 11:13 29:1

33:18 38:18 39:21

46:10 47:21 49:9 86:2

86:6

course 20:15

court 21:15 45:8,12

55:13 77:16

covered 23:19 24:10

25:22 26:5,11 73:13

create 29:16

credentials 16:4

criteria 3:5 11:22 16:19

43:14 44:6 46:6 47:3

47:15 48:21 49:8,12

50:21 54:10,11 67:6

79:1

criterial 49:15

CS 3:5

curiosity 74:12

curious 34:15 63:17

current 31:1 49:11

cut 58:14

D

D 2:11

d.htm 6:10

data 3:8,8,9,12 12:7,19

13:2 17:18 18:17,22

20:22 21:1 22:11,21

23:8,10 24:15,19 25:1

25:3,8 27:2,4 28:5,8

28:10 30:14 33:1,17

34:6,9,12,22 38:22

39:11 40:2 44:20 47:2

61:7,21 67:13 74:4

80:4 90:18

date 6:13 18:18,19

29:15,16 30:3,6,20

73:18 90:20

dates 46:1

day 8:12 30:13 56:19

74:8

days 8:10,17 11:13 74:6

deal 26:2 41:3 75:5

decide 40:19 68:20

77:1

decided 16:21

decision 40:9,21,22

41:13 42:10 50:12

51:19 53:11 70:6

decisions 50:16,22

dedicated 6:14

DEEOIC 17:13

definitely 11:18 63:7

89:9

definition 17:10

degree 78:17

Dement 1:18 3:10 4:21

4:22 12:18 18:1,12,15

20:15,21 21:19 22:7

22:15,19 23:6 25:10

25:13 26:15 27:1,4,8

28:7,11,19 29:4,18

30:1,4,9,12 31:7,14

32:1,4,7,14 33:3,15

34:1,19 35:1,6 36:11

36:13,15 37:1,18,22

38:5,21 39:2,7 40:1,7

40:10,16 44:22 47:12

47:16,19 74:5 80:13

denial 18:5,20 19:5,8

19:13,19 23:17 24:2,6

24:22 26:5,19 27:14

28:18 30:11,19 31:11

35:18 36:18 37:12

41:6 48:10 51:3

denials 54:6

denied 19:4 26:20,21

41:21 43:9 47:4 48:14

51:4 60:19 61:6 80:22

deny 68:7

department 1:1 4:7

42:3 77:14 85:7 87:14

depend 34:6 81:10

depends 49:12 78:21

Designated 2:18 4:10

detail 31:15 33:5 37:4

48:15 78:17

detailed 8:15

determination 62:1

develop 81:13,18

developed 45:21

DFO 4:11 8:6

diagnose 78:13

diagnoses 26:18 32:18

diagnosis 21:5 30:13

31:22 35:21 36:18

37:3,13 38:7,9 42:4

43:14 44:12 47:6,8

48:1,2,4 49:12 60:4

79:4,6,7,15

diagnostic 3:4 11:22

differences 32:13

different 11:19 20:4
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24:12,18 27:19 29:6

30:3 51:13 53:15 87:2

87:3

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frame 56:16

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provided 6:17 8:20

13:22 16:9 24:21

42:10

providers 42:20 43:17

76:7

province 11:4

provisional 65:19

public 6:1 7:7,9,14 8:22

58:20 59:4 85:10,15

86:19 87:16

publicly 9:1

publicly-available 6:15

publish 6:17

published 8:12

publishing 8:14

pull 28:5 39:10 57:5

pulled 21:4 25:3

pulmonary 54:19 77:3

pulmonologists 86:2

purposes 44:15

pursuing 85:18

pushback 86:12

pushing 87:10

put 40:20 52:12 66:22

68:9 69:21 76:19

putting 28:14

Q

QTC 13:21 14:10,11

42:1 77:19

qualification 77:1

qualifications 76:17

qualified 15:17 76:20

qualify 78:6

question 13:20 15:18

20:14 21:8,21,22 25:6

26:18 41:15 49:17

69:9 71:21 79:22 84:5

85:21

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12:12 13:8,18 17:1,14

47:1 60:14 62:11

70:19,21 71:3,6 74:10

75:16 78:7,8 79:13

81:9,19 82:6 83:10,19

83:20

quick 4:16 34:17 52:9

53:21 63:4

quickly 64:21

quite 17:17 47:19 53:4

54:17 73:13 84:3

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radar 75:4

raise 74:2 82:1

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Neal R. Gross and Co., Inc.

98

random 37:16,16,19

randomly 60:5

range 23:19

ranges 30:20

rates 19:16 28:18

rating 72:8,9

ratio 25:7

reach 47:6

read 87:19

reading 43:22 54:1

ready 91:5

realize 46:11 72:19

realm 34:18

reason 18:5,20 19:7

24:20,22 26:5,19

27:14,17 41:6 47:4

48:10 49:5 51:3 66:14

68:7,8 71:21 72:20

reasonable 13:10 29:10

53:22 68:9,15

reasonably 24:9

reasons 19:6,19 23:16

23:17 24:2,5 27:21

31:11,12 35:17 36:19

37:4 69:22 80:22

reassuring 34:21

recall 14:9 74:18

received 3:8 12:19

18:17 45:17 55:19

receives 41:7

recognize 11:3

recommendations

90:16

record 7:21 91:17

recording 8:5

records 50:19 70:10

71:2 79:5

referral 18:18,19 41:8

70:10,19,22 71:20,21

72:11

referrals 71:11 72:14

referred 18:6,20 72:1,7

reflect 27:3 72:15

refrain 74:11

refresh 75:22

refresher 11:20

regard 18:6,21 19:3

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Regarding 5:18

Register 84:22

regular 85:2

regulations 8:10 25:21

relate 19:8 40:12

related 11:21

relates 19:6

relevant 11:10 29:2

38:14 53:3 60:14 70:5

remember 74:19 86:1,8

remind 8:18 55:21

reminder 75:15

remotely 6:20,21

repeat 21:20 30:22

report 49:13 65:18

REPORTER 21:15 45:8

45:12 55:13

represent 87:12

request 42:8 58:7 60:18

61:13 70:3,9 76:8

90:17

requested 3:8 17:18

55:18 58:19 71:5

requesting 25:7

requests 90:18

require 48:19

required 77:20

REQUIREMENTS 1:5

research 89:4,20

resend 75:9

resolved 19:10

response 13:13 61:13

responses 3:7 13:8,10

13:18 15:14

restrict 32:7

restrictive 41:17

result 24:8 25:17 26:9

38:4 41:10

results 89:11

review 3:4,7,8,9,12

11:16 26:3,7 43:3,4

45:5 46:3,4 47:13

51:2,16 56:14 61:17

61:20 62:8,10 63:9,17

63:18 64:16 65:8,19

73:16 76:20 80:4,7,20

81:10 91:9

Review/evaluate 3:11

reviewed 36:14 44:11

45:18 62:19 68:3

reviewing 11:13 26:4,7

44:3 45:16 46:1 49:6

50:7 52:14 55:22 62:6

62:17,22 63:2 65:4

70:3 73:15,21 75:1,19

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revise 64:21

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5:1,3,5,7,9,14 14:9,12

14:16,19 57:1 59:2,8

73:4 84:13,21

Ridge 86:3 88:21

role 19:16 88:13

roll 4:16

room 5:16

rough 35:2

round 56:13 90:6

row 67:17

rules 44:16

run 17:21

S

S 1:22

sample 33:8 37:16

sarcoid 40:14,18 44:12

51:3 59:19 60:4 63:20

sarcoidosis 12:14

20:18 41:9 50:16,20

59:17 60:3,9,13 89:4

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saying 19:7 31:21

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scenario 49:20 68:3

69:18

scheduled 5:12,14 7:7

Schroeder 5:16

scientific 1:17 81:9

85:9 88:11

scope 11:16 43:19

screen 6:6

second 55:3 90:6

seeing 42:8 48:3 56:16

seen 15:9

selected 62:7

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35:14 61:19

send 56:17 57:12 64:17

71:1 75:17 82:5,22

83:2,3 84:13 85:1

86:11 87:18 91:13,13

sending 86:16,17

sense 12:11 29:2,9

32:19,22 34:3 36:7

43:1 53:19 54:13

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sensitivity 20:1 31:19

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sent 51:17 52:5 57:15

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separate 10:10 47:9

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services 50:18

session 7:3,7

set 39:11 64:4 65:15

setting 87:15

share 91:4

shared 9:1

sharing 65:5

she'll 91:13

short 56:16

show 79:5

shown 18:2 21:9

shows 47:14

side 69:14,15,20

SIDEM 5:16

silica 35:18 63:20

silicosis 20:1 26:22

36:21 37:3 38:7,18,18

39:14,16 59:16,20

60:14

similar 34:22 35:5,8

46:6 58:13

simplifying 40:22

simply 24:21

Simultaneous 58:2

single 31:5,16 32:8

37:3

site 66:13 67:1

slowly 43:19

small 40:15

smaller 33:8

somebody 26:18 60:4

63:5,6 67:9 69:19

somewhat 33:10

sorry 14:1 45:14

sort 15:17 16:18,21

17:19 19:15 20:3,11

21:4 25:7,8 30:21

32:18 33:6 34:15 35:5

35:7 36:7 37:5 39:13

40:12 42:8 43:18 45:5

45:18 46:5,8,9 47:7

48:4 54:16 57:3 60:18

61:7,16 62:5 66:1

75:9 76:6 78:13 79:12

80:3 82:15 87:1,21

88:4

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sounds 40:5

speak 7:17

speaker 8:1 21:18

speaking 7:19,22 58:2

special 8:20

specialists 87:22

specialty 76:18

specific 9:7 11:21

13:17 24:20 27:13

33:5 37:12 42:17,19

43:2 76:6 78:17,22

79:4,13 83:10 85:8

specifically 11:17 19:8

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specification 16:2
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Neal R. Gross and Co., Inc.

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specificity 43:13 75:11

78:1

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spectrum 85:14

speed 11:14

spend 26:3,7

spent 35:14

split 58:1

spring 77:8

standard 42:3

start 7:19 10:2 12:4

37:15 64:5 82:17

started 17:19 28:21

67:1

starter 82:17

starting 34:22 66:6

state 7:20

stated 44:6

Statement 13:22 14:10

14:21 16:3,8 76:15

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states 1:1 77:17

statutory 17:11

steps 3:11

Steve 10:6 61:15 62:8

90:10

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14:8 15:6 16:7 31:4

31:20 35:12 48:6 55:8

56:15 59:2 65:17

74:17 76:13 81:5 83:6

85:5 86:19

stratify 27:21 30:19

31:1

strip 60:11

structure 90:20

stuff 91:2

subcommittee 1:5,13

4:9,18 6:4,18 7:13

9:11,13 11:5,8,10,17

17:2 36:9 58:20 59:3

61:16 62:12 90:15

Subcommittee's 7:10

subcommittees 3:3

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subgroup 81:15

submit 70:13 91:4

submitted 6:16 50:19

60:6

subset 51:18

Substances 1:3 4:8

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substantial 31:17

sufficient 34:2 40:20

suggestion 49:4 69:11

72:17 83:18

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52:12 56:18,21 64:19

64:20 68:6 70:1 83:20

84:11,20 88:9

summarize 33:17 57:16

80:19,21

summarized 19:19 75:9

summary 17:22 18:1

22:17 57:11 66:4,5,8

75:16 88:8

supporting 53:13

supposed 66:19 71:4,5

73:1,2

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survivor 22:9 23:20

switch 16:20

system 22:21 65:6

systematic 51:17 62:2

65:21

T

table 19:20 20:21 23:19

30:22 32:12 35:12

56:6

tail 34:3

taken 21:6 34:9

talk 21:17 59:12

talking 12:4 16:17

35:15 36:22 54:18

55:16,22 67:8 77:3

78:21 82:2 87:15

task 76:1

Task/Scope 3:4

teleconference 4:6

7:17

Telephonic 67:18

telephonically 1:13

tell 43:6,6

template 45:22 56:1

64:17 66:6 71:19

ten 67:17

ten-minute 5:19

tense 49:11

terms 11:22 15:16

16:15 22:1 23:22

28:16 29:2,9,13 30:8

32:21 33:21 34:21

39:14,15 41:2 42:7

44:11 45:15 51:20

52:16 55:18,21 57:4

57:19 63:19 65:5,9,10

65:15 76:16 78:2 80:4

82:18 83:1 88:6 91:12

test 41:17 75:11

testing 70:16

text 39:10

thank 14:19 18:14 42:5

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Thanks 90:1

that'd 10:9

they'd 10:3

things 10:7 15:22 21:17

24:12,18 26:1 33:7

36:17 39:10 66:2 72:6

87:19

third 20:8 70:18

thought 9:21 11:15

13:7 14:3 16:18 33:13

39:17 45:20 46:5

51:16 57:17 58:16

60:12 72:13 90:14

thoughts 32:21 44:19

46:13 73:22 81:2

three 13:9 20:5 31:1

56:2,7 63:3

tied 28:2

timeline 3:11

times 70:20

timing 5:19 29:14 65:11

today 5:15,18 7:7,16

8:10 9:3 11:1 56:19

today's 4:6,11 6:13,14

6:19 7:15 8:8

told 41:20 76:11 79:19

tomorrow 56:18

tools 38:20

top 63:20

topic 89:18

Tori 16:17

total 34:21 39:13 40:14

41:1 52:4,6,20 55:2,7

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totally 29:14

touches 10:22

Toxic 1:3 4:8 9:10

Trade 78:11 79:11

tradeoff 46:18

training 15:1,3,8 43:19

76:6 79:11

transcriber 7:18 8:2,3

21:16 45:9

transcript 7:14

transcripts 8:15,16

treatment 3:6

trend 29:8

trends 28:16 30:21

tried 19:15 23:21 28:14

trouble 18:8

true 66:17 78:19

try 21:16 44:17 49:15

51:18 53:1 74:6,11

80:18,21 86:20

trying 46:18 50:13 86:3

turn 9:12

Turner 2:12 5:5,6 9:19

88:18 89:2,10,16,20

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twice 21:9 63:1 64:20

two 21:11 22:4,12 29:20

30:8 31:1 32:16 36:17

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56:20 62:19 70:14

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two-year 40:3

types 25:1 58:13

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unavoidable 16:22

unclear 12:6

understand 7:18 15:8

17:19 26:17 38:3,3

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understanding 11:9

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understands 24:15

unfortunately 31:14

uninterpretables 67:17

unit 22:20 23:7

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upcoming 10:15

update 3:3 10:14,21

52:11

updates 32:16

use 21:16 22:19 25:11

46:9 54:10 64:17,20

66:2,5 67:6 72:18

84:3 85:2

useful 43:20 68:19 69:4

87:5 88:17

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verbatim 8:14

versus 22:1 31:2 46:19

vet 77:20

vetted 77:9

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viewing 7:3

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visited 6:11

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9:17 12:17 13:19

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70:18 71:9,15 77:5

78:5
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Neal R. Gross and Co., Inc.

100

voluminous 47:20

voted 7:12

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wait 54:16 55:3

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wanted 12:2 13:5,11,12

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way 9:5 17:12 31:18

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website 6:2,8,12 7:9 8:9

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WEDNESDAY 1:10

week 90:7

weeks 56:2,7 57:7

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42:22 43:18 46:15,21

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54:21 55:2,16 57:9,21

58:3 59:9,21 60:2,21

61:4,9,19 62:14 63:5

63:8,15 64:14 65:12

67:3,21 68:16,18 69:3

72:2,4 73:8 75:14

76:10 78:19 79:16

80:11 83:22 84:5 87:8

89:8

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well-rationalized 86:11

went 38:12 91:17

weren't 13:13 26:13

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why--it 54:17

willingness 44:21

wondering 16:21 22:17

word 86:21

wording 42:20

work 4:13,14 13:22

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45:7 48:10 76:16 79:1

81:17 82:9 83:14

90:20

worked 40:18 54:4

worker 1:3 4:8 9:11

60:7

working 10:14 66:12

works 5:20

World 78:11 79:11

worth 27:10,18 60:10

87:17

worthwhile 25:14 57:18

would've 79:19

wouldn't 15:15

written 6:1 44:16 60:22

84:14

X

Y

year 30:18,19 32:15

34:12 38:20 39:5,6

49:13 66:21 89:4

yearly 33:13 39:15,22

years 28:6,15 29:1,6,6

29:21 30:8 31:2 33:19

37:14 38:19 39:21

52:2,3 66:12 67:5

YouTube 89:12

Z

0

1

1:00 1:14 5:15

1:05 4:2

10 59:16,20

11 3:3,5 24:6

12 3:5,6

13 3:7,8

15 77:11,16

18 3:10

18-19 3:15

1996 66:16

2

2:30 5:20 73:4

2:50 91:17

20 59:16,16,18,19 60:17

63:2,11 80:9

2000 66:21

2010 50:20

2016 1:10

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22,000 28:8

25 62:18

26th 89:3

29-page 16:12

3

3 1:6

3,000 67:9

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NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE., N.W. 

(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com 

C E R T I F I C A T E

This is to certify that the foregoing transcript 

In the matter of: 

Before: 

Date: 

Place: 

was duly recorded and accurately transcribed under 

my direction; further, that said transcript is a 

true and accurate record of the proceedings. 

 

 ----------------------- Court Reporter 

101

Evidentiary Requirements for

Part B Lung Conditions (Area 3)

Toxic Substances and Worker Health Adv. Bd.

09-21-16

teleconference