UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH

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MEETING MINUTES

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OCTOBER 17-19, 2016

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The Advisory Board met at the Comfort Inn Oak Ridge-Knoxville, 433 S. Rutgers Avenue, 

Oak Ridge, Tennessee, Steven Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MARK GRIFFON*

KENNETH Z. SILVER

GEORGE FRIEDMAN-JIMENEZ

LESLIE I. BODEN

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

LAURA S. WELCH

ROSEMARY K SOKAS

CARRIE A. REDLICH

VICTORIA A. CASSANO

CLAIMANT COMMUNITY:

DURONDA M. POPE
KIRK D. DOMINA

GARRY M. WHITLEY

JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

ANTONIO RIOS

*Participating by telephone
Monday, October 17, 2016

Welcome and Introductions

Mr. Antonio Rios, the Designated Federal Official (DFO), opened the meeting at 3:12 p.m. and the 

Board Members introduced themselves. 

Review of Agenda

Chair Steven Markowitz reviewed the agenda for the meeting and described the tasks of the Advisory 

Board on Toxic Substances and Worker Health (the Advisory Board or Board), which are (1) to find 

ways to improve the Site Exposure Matrices (SEM) used in the claims process, (2) to look at medical 

issues, in particular around Part B lung disease issues, (3) to look at the consistency and quality of the 

industrial hygienist (IH) and physician input in the claims process, and (4) to look at how claims 

examiners (CEs) use medical information/medical evidence to make the decisions and how that might 

be improved.

Advisory Board Issues

Since the full Board meeting in April, the Board has learned much about the complicated Part E 

compensation program for Department of Energy (DOE) employees. Gaps in the members’ knowledge 

still remain, and they look for feedback on factual matters from Department of Labor (DOL) staff. Four 

subcommittees were created to address each of the four tasks and seven subcommittee meetings have 

been held telephonically. The meeting transcripts and the minutes from the meetings are all publicly 

accessible. Chair Markowitz briefly met with Secretary Perez, who expressed deep support for the 

Board. The Board submitted its comments on proposed Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA) rule changes, which are being considered as part of the 

rulemaking process. This process is governed by the Administrative Procedures Act, which dictates that 

DOL not to provide feedback on the recommendations they received. The Advisory Board has made 

several requests for information to DOL (such as copies of reports, manuals, procedures, data, etc.). 

The Board’s Associate Designated Federal Official, Carrie Rhoads, prepared a 24-page list of requests 

with DOL’s responses and statuses. The majority of the requests were granted, and the information was 

provided. 

The Advisory Board has been asked to make recommendations to the Secretary of Labor on ways to 

enhance EEOICP. The Board can either make recommendations at each Board meeting as they are 

developed, or wait until several recommendations are prepared and present them as a group. DOL has 

requested a succinct written rationale for each recommendation. The Board needs to deliberate and vote 

on each recommendation in a publicly accessible forum. Publicly accessible and advertised 

teleconferences of the full Board might be used to carry out a vote in the interval between in-person 

meetings. Written rationales can be provided to DOL after a recommendation has been voted on by the 

Board, though some elements of the rationale should be agreed to at the Board meeting. 

Dr. Boden asked about electronic voting. Mr. Rios said that electronic voting may stifle conversation 

between Board members but he would get back to the Board on the issue. Member Sokas asked if it 

would be useful for the subcommittees’ draft recommendations to be available to display during their 

presentations to the full Board. Chair Markowitz endorsed this idea. 
The Board requested that DOL alert them to any changes to the Procedures Manual, circulars, memos, 

or bulletins. John Vance, Branch Chief, DEEOIC Policy, Regulations and Procedures, discussed other 

DOL transmittals, including several circulars involving newly established Special Exposure Cohort 

(SEC) Classes and multiple updates to the Procedure Manual. When changes are made to the Procedure 

Manual, a transmittal is issued that identifies the subject matter being updated. All of the Procedure 

Manual changes, circulars, and bulletins are listed on the DOL website.

SEM Subcommittee

Laura Welch, Subcommittee Chair, discussed the subcommittee’s ideas about helping DOL to improve 

the Site Exposure Matrix. The Institute of Medicine (IOM) had previously reviewed the SEM and 

published a report with specific recommendations. The SEM subcommittee requested and reviewed 

DOL’s response to that report. 

The subcommittee has held two public meetings via conference calls with the first focused on 

establishing its mission. The SEM has two primary roles: establishing exposures and establishing 

exposure-disease relationships. OWCP has used a database called Haz-Map that is maintained on the 

National Library of Medicine’s website as the basis for the exposure-disease relationships. The 

subcommittee discussed whether to expand their discussion to cover exposure assessment broadly. The 

group agreed that they need to look at all potential inputs into the determination of disease 

causation/contribution/aggravation, including an expanded view of exposure assessment. In order to 

ensure that the OWCP has the best information on worker exposure, the subcommittee agreed to 

address the Occupational History Questionnaire (OHQ) and how, generally, to improve other exposure 

assessments. The other main focus of the conversation was in relation to OWCP’s response to the IOM 

report and how the Board could assist with implementation. The subcommittee discussed its data needs 

and requested information from DOL. Other items identified to be addressed by the subcommittee 

include the presumptions used for adjudicating claims and learning more about the 1995 memo. The 

subcommittee learned about the complexities of getting reports on claims from the EEOICPA database

and has not been able to review reports or specific cases to date (other than those requested by the Part 

B subcommittee). The subcommittee agreed on the Chair’s recommendations for a way forward with 

the IOM recommendations, a process for enhancing the OHQ, and a process for expanding exposure 

assessment for individual claimants.

Member Vlieger said that the subcommittee should look into whether DOL has added information on 

tasks to the OHQ as their response had indicated. Member Boden asked if there is a process in place 

for the Board to work together with DOL and not in parallel. Chair Markowitz said that when they have 

asked to speak with DOL personnel their requests have always been complied with, though there is no

established process. Member Vlieger also noted that, in their response, DOL stated that they have 

discontinued their relationship with Haz-Map since the MOU has expired. Mr. Vance clarified that 

DOL still utilizes Haz-Map as the basis for health effect data in the SEM. Rachel Leiton, Director, 

DEEOIC, said the MOU has expired and DOL does not have a formal relationship with them anymore, 

though Haz-Map is still used. Member Silver suggested taking a close look at how claimant responses 

to questions regarding personal protective equipment (PPE) are used in the claims process. People may 

feel that it is necessary to say that they utilized PPE in order to have their claim approved. Member 

Domina said that the interviewer needs to have knowledge of what is being discussed because a lot is 

being lost in the details. Member Sokas said that these questions are typically used as a marker that the 

place or task was bad enough that PPE was provided, but it is not reasonable to expect that peopleused 

PPE adequately. She also stated that in most occupational medicine practices family history is no 

longer obtained, and that it should probably be deleted from the beginning of the form. Member 
Cassano agreed with Member Sokas and suggested stating that PPE use is irrelevant in determining 

whether an exposure occurred. Member Welch said that the subcommittee is going to request cases that 

were denied because the exposure was inadequate and find out if all of the information was recorded 

properly. They will focus on a few specific diseases and look at the ones that were denied due to 

causation. Member Domina noted that sites with SECs that do not have a SEM will also need to be 

addressed. The Board discussed whether the question regarding use of PPE should be deleted and noted 

some of the complexities of answering it. Member Welch said that the Board will not instruct DOL on 

what information it collects or how it is used, but should recommend phrasing the question in a way 

that makes it clear the interviewee is being asked as part of an assessment of the hazards. Chair

Markowitz added that he believes there is a lot of room for misinterpretation by the interviewers, and 

he is not convinced that misinterpretation can be completely prevented.

IOM recommended that OWCP use other data sources, beyond Haz-Map, to include exposure-disease 

relationships not currently in SEM, and to assure those links are current, comprehensive, and 

transparent. They also recommended adding nature and extent of exposure to the SEM and improving 

its functionality. The subcommittee agrees and proposed recommending that DOL create a committee 

to develop a list of other sources that could be incorporated into Haz-Map, including databases from 

the Environmental Protection Agency (EPA), the International Agency for Research on Cancer (IARC), 

and the National Toxicology Program (NTP). Member Sokas proposed recommending the use of a 

contractor to assemble the data sources. Chair Markowitz said that his interpretation of the IOM report 

was that they were deeply critical of Haz-Map’s database and procedures. The IOM recommendations 

present a very large task for DOL. He felt that, at a minimum, authoritative reports on causality should 

be incorporated into Haz-Map and the SEM. Member Welch said the subcommittee agreed that if the 

relied upon sources have not determined a causal link, then it is not necessary for OWCP to do a 

detailed review of those chemicals independently, as other agencies at some point will convene 

committees on suspected causal links and produce a decision. The way IOM wrote their 

recommendation, it could imply that DOL should do detailed reviews themselves, but given the nature 

of the program and its resources it makes more sense to rely on other high-quality federal and 

international agencies to do those reviews. 

Member Cassano suggested the Board whittle the list authoritative sources down to the most valuable 

sources and provide DOL with information on monographs written for specific agents, such as National 

Research Council’s monograph on trichloroethylene (TCE). Chair Markowitz disagreed with narrowing 

the list, because only two or three chemicals are evaluated each year at most by each source, so that 

using all of the sources is not an overwhelming task. He asked how DOL might monitor the literature 

for other consensus statements beyond the primary agencies. Member Vlieger said that, in her 

experience, anytime you stray from anything specifically referenced in Haz-Map, CEs won’t accept it 

without an outside toxicologist’s approval. Member Silver said being able to cite reputable sources 

gives advocates and representatives some traction with CEs. Chair Markowitz said if DOL embarked 

on an expeditious process to take expert consensus statements and fold them into the SEM, CEs could 

reliably find it there and not rely on looking at additional authoritative sources. Member Cassano said 

that if a CE cannot parse a document it should immediately go to an IH and/or the Contract Medical 

Consultant (CMC) to evaluate. Member Welch said there isn’t much new information coming out so it 

wouldn’t be that difficult to annually implement what is being suggested. Chair Markowitz said that the 

IOM report specified that criteria for causation should be described in the program. Dr. Welch said that 

causation is currently determined by Haz-Map. Member Friedman-Jimenez said that determining 

between IARC’s probable versus possible human carcinogens is outside of the realm of a CE; it 

requires having a broad skill set and no conflicts of interest. There needs to be a mechanism by which 

difficult cases are evaluated at an appropriate level by disinterested experts. 
Member Sokas posed a question to DOL concerning an issue with the Solicitor of Labor refusing to 

allow National Cancer Institute (NCI) information to be considered. DOL will provide a written 

response to the question. 

The meeting was adjourned at 5:01 p.m.

Tuesday, October 18, 2016 

SEM Subcommittee (continued)

The meeting came to order at 8:40 a.m.

Member Welch presented the subcommittee’s other issues and recommendations. The IOM

recommended adding nature and extent of exposure to the SEM. The subcommittee agreed with 

DEEOIC staff that that would be very difficult. The subcommittee proposed recommending that DOL 

establish a process whereby the IH interviews the claimant directly when necessary for adjudicating the 

claim. 

Member Boden said that the Former Worker Program (FWP) did a lot of work getting information 

about exposures and other matters. He asked if that information is used, and if so, how. Member 

Dement said that getting nature and extent of information through worker interviews would be pretty 

difficult, so they focused instead on location and task, at least for construction trades. For example,

they ask about frequency of doing the task. Through this analysis they were able to develop an 

algorithm to separate individuals into high, medium, and low types of exposures, which has proven to 

work reasonably well. Member Welch added that FWP site assessments are based on existing records 

that were available to the contractor that created the SEM, but she did not know if those exist in the 

SEM. Member Dement said that the OHQ in conjunction with the SEM would be advantageous to the 

program in trying to get the nature and extent of exposure. Member Boden said this should be kept in 

mind when the Board is making recommendations for updating the OHQ to make it as relevant as it can 

be to nature and extent of exposure. Member Dement said he would like to know from DOL when they 

would plan to have an updated OHQ because the Board needs that in order to make intelligent 

decisions about the exposure assessment process. Chair Markowitz noted that DOL has invited the 

Advisory Board to provide input on the OHQ. He also said that OHQs do not go into the depth that is 

needed for decision making around claims. Member Sokas said the IH & CMC subcommittee found 

that the CE often determines what information goes to the IH. Member Boden said input on the role of 

the CE and guidance to the CE in the decision making process will be essential to the Board in

fulfilling its mission. Member Redlich said that, in some cases they reviewed, such as those related to 

COPD, including the SEM complicated the process and would have been better had it been left out. 

Member Welch said that the SEM, OHQ, and IH interview will overlap but each approaches the

information in a different way; each are useful tools but none should be considered the ultimate answer. 

The subcommittee has decided that it is more important to put an effort into broadening the range of 

assessments rather than trying to make SEM do things that it may not be able to do. Member Vlieger 

said that the EE3 form could be improved and additional context from it added to a claimant’s 

documents. Also, by contract, the unions change their jobs at the sites and that information should be 

captured. 

The subcommittee’s final proposed recommendation was to have former workers be trained to 

administer the OHQ rather than staff with limited experience at the site or specific training on 
administering the OHQ. The Building Trades Medical Screening Program would be willing to work 

with DOL to implement the development and quality assurance process they’ve been using to ensure 

the questionnaire captures as much as it can. The Board was in general agreement about the 

recommendation, and Chair Markowitz said it has been a very valuable approach in the FWP.

Part B Lung Disease Subcommittee

Carrie Redlich, Subcommittee Chair, reported. The subcommittee held two teleconference meetings 

since the previous Board meeting. The first focused on clarifying the subcommittee’s charge and 

defining their data and information needs. During the second teleconference meeting, they reviewed 

initial data analysis and planned to review cases they had requested. DOL sent several questions 

concerning Part B conditions under five general areas: (1) beryllium sensitization, beryllium 

lymphocyte proliferation test (BeLPT), and medical monitoring; (2) diagnostic criteria for chronic 

beryllium disease (CBD); (3) overlap of sarcoidosis and CBD; (4) silicosis; and (5) complications of 

disease and treatment. The subcommittee felt they needed more information on the Part B claims 

process and cases they could review. They requested any other relevant surveillance or data from the 

sites that might be useful as well as input from patients or providers. DOL was very responsive to the 

requests. Member Dement reviewed the data the subcommittee received. For many individuals with 

multiple conditions filed, the way the data is structured can be misleading. There are several issues with 

displaying the information in a graph. There has been a downward trend in approval rates for CBD but 

the reasons for that can’t be determined from the data received. Member Domina commented that, 

based on the claimant’s demographics, this may not be the best program for them. Member Dement 

said that 60% of Part B denials for CBD were attributed to insufficient medical information, which is a 

primary driver for most conditions under Part B. Under Part E, the primary reason for denial was a 

negative causation result; the Board needs more information on why the negative causation results were 

decided. Member Dement said that, in his review of the cases so far, he thinks the information 

represents a good ballpark look at the major reasons for acceptance or denial. Board members 

discussed the differences between claimants with multiple claims versus a single claim and how 

representative the data is. Member Pope wondered if not having an advocate was a contributing factor 

to the insufficient medical information denials. An area for further inquiry may be what the likelihood 

is for some of these cases being approved if additional information was provided. Member Vlieger said 

it may lead to a recommendation on CE guidance for weighing medical evidence because an unassisted 

claimant would have no recourse to their denial. Chair Markowitz pointed out that the extent to which 

these claims stop at the CE is not known. Also, DOL has requested assistance in interpreting 

“consistent with” from the EEOICPA and the extent to which medical evidence is insufficient is really 

about that interpretation. 

The cases selected for review include 20 beryllium sensitivity, 19 CBD, 10 chronic silicosis,15 

sarcoidosis, and 20 pneumoconiosis, with about half accepted and half denied. On the issue of 

sarcoidosis and CBD overlap, at least from the cases reviewed, there has been some confusion about 

how to interpret and implement the presumption related in part to whether it is pre- or post-1993. The 

subcommittee recommended presuming CBD in any worker with sarcoidosis and beryllium exposure. 

BeLPT should not be an absolute requirement for diagnosis whether pre- or post-1993 due to the 

limitations of the test. The subcommittee feels it has answers to a majority of the other specific DOL 

questions they were asked. From the subcommittee’s initial review of cases, which is still in progress, 

they frequently agree with the conclusions. The issues so far involve non-CBD cases, such as 

interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). Other concerns 

include disparate readings and the limitations of the Radiation Exposure Compensation Act eligibility.

Chair Markowitz asked how this differs policy-wise from the way DOL currently addresses sarcoidosis.
Member Redlich said that her understanding is that it is a fairly confusing one-page presumption 

document. Member Dement said it might be helpful to establish the pulmonary component of a 

primarily non-pulmonary sarcoid. Members discussed the sensitivity and specificity for the BeLPT and 

other limitations of the test. Member Vlieger requested that the Board consider drafting recommended 

clarifications for the pre- and post-1993 criteria in the Procedure Manual, as well as instructions for 

CMCs regarding acceptance of CBD claims. Member Cassano said that the easiest way to resolve the 

confusion is probably to take away the pre- and post-1993 differentiation by not requiring a BeLPT if 

there is a diagnosis of sarcoidosis. Members discussed the difference in medical benefit coverage 

between Parts B and E. Member Redlich added the issue of complications of treatment of disease, 

which does not currently have a presumption. Member Vlieger complimented DOL on their recent 

work in this area, but believes the Board’s input could provide additional value. 

Pre- and Post-1995 Exposures – Steven Markowitz

Chair Markowitz read the DOL circular from December 2014 concerning post-1995 occupational toxic 

exposure guidance and a memo clarifying the Department’s rationale. Member Vlieger said that a 

number of advocacy groups questioned DOE’s lack of input into the circulars when they were drafted. 

Union members protested the circulars and pointed to several inspections and oversight documents that 

proved the toxic exposure regulations were not being followed. She also noted that the regulations were 

not issued until September of 1995 but are being applied to the full year. Member Cassano said that,

from a medical position, she felt the presupposition to be wrongheaded for two reasons: (1) simply

because regulations are in place does not mean that everybody is following them; and (2) regulations 

are not necessarily protective of a particular medical outcome. Other members agreed and discussed 

some possible consequences of the current guidance. Member Welch said the rule is misleading in 

many ways to medical providers who may not have much exposure to the nuances of exposure-disease 

relationships. This is why the SEM subcommittee wanted to allow individual assessment of individual 

cases. Member Friedman-Jimenez said that the inspections being done are not representative of the 

levels seen every day in the work process. This is a non-evidence-based ruling and the Board should 

make a strong statement that it does not match the level of science available. Member Dement said that, 

from the exposure perspective, many exposures occur during non-routine operations. He also argued

that a presumption of exposure within the guidelines based on use of PPE would not be appropriate. 

Member Vlieger said that DOE has stated that they do not have individual exposure records for 

workers. Member Redlich said that, in addition to the Board’s recommendation on the statement, the 

review process it went through should be examined. Chair Markowitz will formulate a recommendation 

for the Board’s review. 

EEOICP Memo/Policy re: solvents and hearing loss – Laura Welch

This memo discusses one of a limited number of presumptions that have been developed to help CEs 

adjudicate cases and determine in which cases organic solvent exposure can be a contributory cause to 

hearing loss. Member Welch walked the Board through the steps of developing a presumption. DOL’s 

criteria for solvent-related hearing loss states that an employee must have a diagnosis of sensorineural 

hearing loss in both ears, must have been exposed to one of the listed chemical solvents before the year 

1990, and must have worked in one of the listed labor categories for the required concurrent and 

unbroken 10-year period. She presented the list of accepted solvents and job categories that qualify for 

compensation. An item should be added to the disease causation list if it is in Haz-Map as well as EPA, 

NTP, and other sources listed in the IOM report. The relationship between organic solvents and hearing 

loss has been accepted by several of those agencies, and therefore meets the criteria for adding the 

exposure-disease relationship. She reviewed the findings of the Rabinowitz, et al., human 
epidemiological study, which is useful when considering the presumptions set by OWCP. Systematic 

reviews concluded that both animal and human studies clearly establish the effect of solvents on 

hearing. A review of compound-specific data has clear limitations since most workers are exposed to 

multiple solvents. Reviews of mixed exposure data are more limited. Consensus statements are 

available from NIOSH and EPA. The presumption as set by OWCP is unnecessarily stringent.

The SEM subcommittee may be able to help DOL establish additional presumptions, particularly for 

diseases that are being reviewed. There needs to be a transparent process for establishing presumptions 

with clearly stated assumptions about the factors, particularly the required dose. Member Sokas said 

that there are some chemical-disease associations that have been established but it is not clear whether 

or not these types of exposures could or have occurred in DOE sites and at what doses. Member Boden 

said that a threshold that might apply appropriately to a presumption for a solvent alone might be 

higher than a threshold for a solvent in combination with noise-induced hearing loss. Member Whitley 

said that CEs are holding strictly to the list despite its well-known holes and denying claims to workers

that fall just outside of one aspect of the criteria. Member Cassano responded that, in the VA, if a 

claimant doesn’t meet the presumption, everyone has the right to present additional evidence for 

consideration by a Medical Examiner. At DOL, it should go to the IH first then the CMC. She also said 

that she feels these presumptions need to be subjected to the entire rulemaking process so that they are 

set in statute. Member Vlieger asked that language about the synergistic effect of a product’s 

components or mixtures be added to the guidance. Chair Markowitz commented that it would be very 

problematic for a CE to not have a list of presumptions. An additional list would be helpful to facilitate 

the process. He asked if there is enough scientific knowledge available to enable the Board to provide a 

rationale for an alternative formulation of presumptions. Member Sokas said yes, but in order to 

provide the OWCP with something rigorous that they can point to and use there needs to be some 

further subcontracted work done. She thought the Board could propose which issues could benefit from 

more thorough analysis and offer to review the results. Member Vlieger asked DOL for a briefing on 

how these recommendations will be maintained in the Department. Mr. Rios said the process is that the 

Board submits its recommendations, DOL determines where the Board’s recommendations fall in terms 

of their existing priorities, and generally after about four or five months a report can be requested on 

how they are being processed. 

IH & CMC Subcommittee

Rosemary Sokas, Subcommittee Chair, reported on the subcommittee’s work to-date, which included 

one teleconference meeting, and shared some of the information and clarifications they requested from 

DOL. OWCP is looking for assistance from the Board on a number of issues relating to toxic 

substances. The subcommittee chose six to focus on and is preparing reports on each.

Member Vlieger discussed her review of cases and information provided by DEEOIC. The reviewers 

found that the information sent to the subcommittee was incomplete for following the logic pattern of 

what was going on in the claim. One claim started and repeated through no less than four recommended 

decisions because of inadequate instructions to the claimant. The claim went through multiple reviews 

by CMCs, multiple decisions, and multiple remand orders because the evidence was not properly 

considered. Member Sokas said her review made it clear that there are enormous communication issues 

occurring routinely. DEEOIC policy teleconference information was extremely useful and may be a 

very valuable source of information especially around interpretation and understanding how things are 

being done. Reviewers discussed specifics of issues related to their cases. Member Boden asked if it 

seems that one would need to request all the information with respect to a person rather than with 

respect to a claim. Member Vlieger said in her experience you have to request the entire claim file to 
see what was taken from where and whether the assumptions were correct.

Member Friedman-Jimenez walked through the process by which he does literature searches. It 

typically takes him between one and six hours to do a thorough review. He reviewed searches on the 

relationships between cadmium and arsenic and prostate cancer as well as occupational exposures and 

Parkinson’s disease. Doing these reviews can be very tricky; a CE doing a similar level of evaluation 

and critical reading of the literature is not going to happen in most cases. There needs to be a system to 

have difficult questions triaged to a group of reviewers with the necessary skill set. Member Sokas said 

that TCE and prostate cancer are probably not high on the list, but the other relationships might move 

forward, based on preliminary Board member evaluation, to go on to a subcontractor whose results 

would be reviewed by the Board. She briefly touched on the issue of diabetes related to occupational 

toxic exposure, which involves an enormous epidemiologic challenge. Member Redlich said that the 

questions DOL raised may not be the most important questions to answer. Member Sokas agreed and 

said that the claims for the conditions are what the Board should be paying attention to. Chair

Markowitz said the Board is responding to specific requests from DOL for assistance on selected 

issues. To broaden that would become an enormous task that would involve perfecting the Haz-Map 

system, which the Board does not have the resources or the charge to do. Member Redlich suggested 

recommending implementing a structure to deal with these issues on an ongoing basis. Member 

Cassano said that when something is patently obvious, or when there is an exposure of concern at DOE 

facilities and a presumption has been established by another agency, the Board should at least list that 

as a possible presumption to be evaluated further.

Given the number of questions about terminology and language, Member Sokas said there is an 

enormous need for personnel in the program to have a translator-physician within the program. There 

has been someone hired in this capacity and hopefully the Board will have an opportunity to interact 

with him. It would be very helpful if all of these issues had engaged medical expertise, in particular if 

the memos had some level of input and oversight at the program level.

Member Vlieger briefly discussed additional items, including the vetting of CMCs for actual 

experience in the field they are opining on, such as clinical hours required; consistent queries to CMCs 

for claimed medical conditions by CEs; use of current standardized library of medical references by 

CEs and CMCs for occupational illness causation; and the review of any cases already completed by 

the new IH contractor. Member Sokas presented the subcommittee’s proposed recommendations to be 

refined and voted on the following day.

Providing DOE Records for EEOICP – Gregory Lewis, DOE

Mr. Lewis discussed the process DOE conducts to provide DOL with records and presented some 

related statistics. His office at DOE exclusively works with FWPs working on behalf of program 

claimants to ensure that all available worker and facility records and data are provided to DOL, 

NIOSH, and the NIOSH Advisory Board on Radiation and Worker Health. They use the Secure 

Electronic Records Transfer (SERT) system to ease the transition of records to DOL and NIOSH, as 

well as to protect the records. His office provides support to large-scale records projects, such as the 

SEM and NIOSH’s Special Exposure Cohort research projects. They also conduct research into facility 

coverage, primarily for smaller Atomic Weapons Employers. For individual claims, they respond to 

three types of record requests: employment verification, dose records, and the document acquisition 

request (DAR), which includes everything else on file for an individual. DOE has EEOICPA site POCs

who are extremely important for helping coordinate activities and research at the sites for DOL and 

NIOSH, as well as providing onsite EEOICPA information to workers. He walked the Board through 
the steps of the records search process for individual claims. Employment verifications typically 

average about 14 pages, NIOSH dose record requests are about 50 pages, and the average length of a

DAR is about 150 pages, though there is wide variation for each of these. Member Vlieger asked where 

IH records are kept and why they aren’t appearing. Mr. Lewis said in many cases there are no IH 

records but they can’t tell if the record is incomplete. All they can do is go to the source and conduct as 

exhaustive a search as possible. In FY 2016, DOE responded to 18,621 records requests to DOL and 

NIOSH from over 25 different DOE locations, many with sub-sites. Their responses were under the 60 

day goal for 95% of the requests, with many sites having near perfect timeliness. DOE also supports

work on the SEM, the FWP, and participates in all Joint Outreach Task Group meetings.

Chair Markowitz asked about the amount of resources required to retrieve records. Mr. Lewis said that 

it is site and claim-specific. The Office of Legacy Management has developed a search tool for all of 

the closure sites, which expedites the process. For recent records, many exist in electronic format which 

can easily be uploaded to SERT. A lot of records from the ‘90s and earlier have not been scanned in and 

it will take five or six people using 15 to 20 search tools on the front end effort which leads to physical 

searches at Local or Federal Records Centers, followed by a labor-intensive scanning process. Member 

Cassano asked in what format the claims file is sent to DOL. Mr. Lewis said the only thing that gets 

synthesized is the employment verification, everything is else is sent as is for DOL to do the 

interpretation. Member Vlieger asked if DOE has a database with names associated to incident/accident

reports. Mr. Lewis said some sites have search tools that include that information, but in many cases if 

there is no mention in an employee’s file about a specific incident/accident there may be no way to 

search the records. Member Vlieger also asked if the Computerized Accident/Incident Reporting

System (CAIRS) is used in these searches. Mr. Lewis said he didn’t think CAIRS is checked because 

the sites submit the information to CAIRS and so it should be in the sites’ own database. If there are 

omission issues, DOE will certainly look into it and adjust their process as needed. Member Silver 

asked if DOE and DOL have a mechanism for exchanging feedback on the value of the information 

provided. Mr. Lewis said there is not a formal feedback mechanism; they simply send in what is found.

He discussed the case of the Los Alamos County Warehouse.

Weighing Medical Evidence Subcommittee

Victoria Cassano, Subcommittee Chair, discussed the subcommittee’s work looking at how CEs 

develop claims, determine what medical evidence is relevant, and decide a claim based on the medical 

evidence they receive. The subcommittee reviews and evaluates issues pertaining to training materials 

available on specific toxicants outside of the SEM and makes recommendations. The subcommittee has 

reviewed the CE Procedure Manual and found that, in general, the manual does not provide guidance 

on how to perform duties. In cases going to the CMC, all submitted medical evidence should go to the 

CMC, not just that which the CE determines to be valid. CEs need some type of document that parses 

publications and consensus documents with better information on causation and outcome. A CE may 

not be aware of the medical information needed to adequately adjudicate a claim, and thus require 

affirmative assistance. The subcommittee also found issues with restrictive reasons in the Procedure 

Manual for sending a case to an IH or CMC. 

The subcommittee sent questions and a request for information to DOL and reviewed their responses at 

its second meeting. DOL stated that only medical evidence that the CE determines to be relevant goes 

to the CMC, but the subcommittee did not feel that the CE had the expertise to determine what was 

relevant. The subcommittee also felt that the treating physician cannot determine deficient evidence 

regarding wage loss. They found that most of a CE’s training is on-the-job, usually by a more senior 

CE, with no evident standardization. The subcommittee requested forming a focus group of CEs they 
could meet with to discuss the development of a claim. The subcommittee requested CE training 

materials besides the Procedure Manual and some Part E claims to review specifically from the 14 

priority areas. The claims folders received were incomplete for evaluation but many times they felt that 

the denials were not necessarily appropriate.

In the near future, the subcommittee wants to conduct a more complete review of Part E claims and 

draft recommendations for improving CE training materials. The subcommittee will also be 

investigating how to operationalize causation/contribution/aggravation. Member Cassano presented a 

draft version of the subcommittee’s proposed recommendations to be refined and voted on the final day 

of the meeting. Chair Markowitz said they are going to formulate a new request and discuss it with 

DOL to be sure the Board is communicating what it is they want so it can understand what DOL is able 

to deliver.

Member Cassano presented a VA guidance document on asbestos exposure that is disseminated to CEs. 

It isn’t perfect, she argued, but it is better than what DOL uses now. Similar documents that are 

developed by good medical personnel are necessary. The training documents include references that the 

CE is free to use, making it a more inclusive process rather than a restrictive one. Chair Markowitz 

asked what the role of the physician reviewing the information is if the person meets the exposure 

criteria and has the linked disease. Member Cassano said that the VA does not rely on CE’s expertise to 

parse the claim. If a CE cannot rule on a claim based on a presumption it is supposed to go to a Medical 

Examiner to get a decision. Member Boden asked if the Board should start assigning members the task 

of beginning to draft presumptions that could be further developed outside of the Board. Member 

Welch said the SEM committee felt a better understanding of the major diseases being claimed would 

be a good start; some presumptions may be easier to write but there may not be that many claims 

available. Some kind of combination of Board oversight and subcontractor work would be needed to 

develop presumptions. Member Redlich said that before they decide who does what, they should 

develop a better system for addressing the issues and figure out what kind of resources would be 

needed. Chair Markowitz said it would be useful to look at how DOL uses presumptions.

Member Cassano presented the disabilities benefits questionnaire for multiple sclerosis that discusses

required criteria for meeting service connection for certain disabilities. This also is not perfect in its 

specifics, but the concept could be utilized to tease out appropriate information. Member Boden said 

that specific presumptions could be useful in ensuring that physicians conduct the tests that are called 

for. Member Silver asked about the potential flaws in VA’s use of flexible presumptions. Member 

Cassano said that the VA has in the past dragged its feet until they are forced to do something, then 

deliver overly-generous presumptions because they didn’t do all of the appropriate scientific analysis 

early enough to incorporate good epidemiology or toxicology. Much of the data is instead extrapolated 

from sources that may not align well. Member Silver asked about the program administration costs if

MDs were more involved in each claim. 

Discussion of Causation/Contribution/Aggravation

Chair Markowitz led a discussion around the issue of causation. He read the EEOICPA causal standard 

language that is used to link exposures with illnesses: “At least as likely as not that exposure to a toxic 

substance (at a DOE facility) was a significant factor in aggravating, contributing to or causing an 

illness.” Numbers aren’t used in the Act, only qualitative language: “at least as likely as not” is a very 

generous standard; “significant factor” is subjective but is generally understood to be a nontrivial 

factor; it includes not only causing, but contributing or aggravating, which are usually less rigorous 

than causation alone. Chair Markowitz discussed the timeline of disease development for a worker and 
how toxins affect the course of illness. Many contributing causes probably contribute less than 50% of 

the causation. He drew a distinction between the level of certainty that a toxin is a cause of a disease 

and the degree to which a toxin contributes to an illness. He discussed the example of second-hand 

smoke and lung cancer to better understand causation/contribution/aggravation and rejected the twofold increased risk threshold. EEOICPA does not specify a level of contribution and for most 

multifactorial diseases it is not even possible to quantify the contribution of each risk factor.

Member Welch said determining whether exposure was a “significant factor” is a different process than 

determining causation. Member Redlich commented on the difficulty in parsing many potential causes

and the importance of considering synergy between two causes. Member Boden said that the most 

difficult thing to communicate to CEs is going to be significance and it would be worth the Board’s 

time to provide assistance in determining whether or not something is significant. Chair Markowitz 

said questions of significance should not be determined by CEs, but should go to the IH. Member 

Boden said that should be clearly stated in the Procedures Manual. Member Friedman-Jimenez said the 

terminology of “at least as likely as not” is problematic mathematically and asked if there is a 

possibility of changing the causal standard to give physicians more leeway. Chair Markowitz said the 

wording of the Act is unlikely to change; the legislators were not concerned with mathematics, they

were trying to be as claimant-favorable as possible in the decisionmaking process. Member Vlieger 

said that removing this decisionmaking piece from the CE will streamline the process enormously. CEs

want numbers and definitions that they can write into a decision. Member Boden said it may be an 

education issue that the Board could help the DOL with. 

Public Comment Session

Deb Jerison – Ms. Jerison is the director of the Energy Employees Claim Assistance Project (EECAP). 

Ms. Jerison said that DEEOIC reversed 14 years of approving claims under Special Exposure Cohorts 

(SEC) for people with uterine cancer, fallopian tube cancer, and chondrosarcoma of the cricoid 

cartilage of the larynx by rescinding final bulletins and circulars from 2002 to 2012. It is inequitable 

and unfair that people with these cancers in the SEC before last week will be paid while those from 

now on will not. Changes like this need to go through the rulemaking process. She also discussed 

medical reimbursement issues. EECAP has developed a survey on medical benefits and has gotten 

1,700 respondents in just a month; the survey will be open until the end of October. She presented the 

report of the survey’s findings to the Board.

Terrie Barrie – Ms. Barrie is a founding member of the Alliance of Nuclear Worker Advocacy Groups 

(ANWAG). Ms. Barrie submitted written comments and spoke to the statutory requirement for 

causation under Part E. DOL does have a definition of the legal standard for causation under Part E: 

“more than reasonably suspicious but less than the preponderance of the evidence.” OWCP’s 

regulations from 2006 defines “significant factor” as any factor.

Paige Gibson – Ms. Gibson is a Former Worker Protection Employee that worked at the Mound Plant 

in Ohio. Transmittal 1609 hits the FWP very deeply, as its founder, Sam Ray, would not be 

compensated for his illness under the current guidelines. Former workers should be administering 

OHQs. She commented that claimants have been denied on the basis of not being in the same job for at 

least ten years consecutively, even though their job did not change, only the job titles. She discussed

post-1995 SEM Incident Reports and the fact that none include a job title or the names of individuals

involved.

Glenn Bridges – Mr. Bridges is an employee at Y-12 National Security Complex. He commented on the 
tasks in the SEM. People do a lot of different tasks under the same job classification and that’s not 

being taken into account. He agreed that current and former workers should be working with the 

Resource Centers to determine what these tasks were for workers in different areas. Employee 

Advocates and CEs need more training and should not be responsible for decision making. He said 

disability and impairment go hand-in-hand in a nuclear weapons plant, which needs to be taken into 

consideration. The concepts around causation presented earlier need to be considered in the context of 

prostate cancer, hearing loss, and other issues where a disease-exposure link cannot be directly 

determined.

Tim Lerew – Mr. Lerew is the chair of Cold War Patriots. On behalf of the Cold War Patriots, he 

thanked the Board for their work since the last meeting and for holding this meeting in Oak Ridge. He 

encouraged the Board to hold future meetings near nuclear weapons facilities in order to hear directly 

from the worker community. He pointed the Board to the U.S. Federal District Court’s decision 

findings in the Lucero v. DOL case that DOL’s interpretation of “compensation” in EEOICPA was 

arbitrary and capricious. This is just one instance of a DOL rule or policy potentially changing the 

intent of EEOICPA in practice. It was not intended to impose unnecessary legal and administrative 

burdens on those already struggling with sickness. Most claimants or their survivors lack the resources 

or the time to appeal to the courts to clarify DOL’s rules, procedures, and administrative practices that 

adversely affect their claims, and, by precedent, the claims of many others. The Board has the charter to 

respond to DOL’s own requests to provide clarity and appropriate processes for when CEs are 

challenged to fairly decide and administer a claim. He asked the Board to support Cold War Patriots’

request that the Department formally withdraw its 50-plus rule changes proposed in the fall of 2015 and 

instead engage in a negotiated rulemaking process with stakeholders consistent with prior Executive 

Orders. 

Tee Lea Ong – Mr. Ong, from Professional Case Management, commented on the issue of medical 

second opinions (MSOs). These are often required of claimants on short notice. The Procedure Manual 

calls for a travel distance of 25 miles or less in order to get an MSO from a DOL-appointed CMC. 

Recently, there has been an increase in the distances sick workers are being asked to travel, and the 

contract solicitation DOL issued had CMCs bidding on a 200-mile radius service area. This creates 

serious difficulties for sick workers. He asked the Board to consider whether it is necessary to require a 

sick person to travel that far in order to get an MSO in comparison to what’s in the Procedure Manual. 

He also asked DOL to communicate these kinds of changes to the former worker community. 

Walt Schuman – Mr. Schuman worked at Y-12 for over 42 years. He commented on behalf of assembly

persons (machinists and chemical operators) that were left off of the Worker’s Compensation category 

for hearing loss. He described some of the tasks associated with this group. It is critical to include in 

the SEM what was done in the facilities and not just which chemicals were present

Claude Martin – Mr. Martin worked at K-25 and Y-12 after his military service. He described some of 

his symptoms, including multiple tumors. His claims have been denied and he would like to know why.

Louise Presley – Ms. Presley worked in administrative capacities at Y-12 for over 36 years. Her late 

husband, Robert W. Presley, worked at Y-12 for over 44 years and served on NIOSH’s Advisory Board 

on Radiation and Worker Health until his death in 2011. She read into the record a letter from one of his 

coworkers describing aspects of his employment history working in contaminated areas without PPE

and described their experiences with the claim process. She has also been diagnosed with breast cancer 

and has had multiple skin cancer lesions, but her own claim was denied despite working with key 

punch cards that circulated through contaminated areas and using carcinogenic solvents to clean her 
typewriter. These claims are not handouts; they are medical insurance payouts for those who survive 

after treatment or life insurance payouts to the families of those employees who did not survive.

Jan Lovelace – Ms. Lovelace is a widow of a fireman that worked at ORNL for 26 years. The SEM did 

not include firemen for ORNL, but it did for Y-12 and K-25. She was able to get in some classifications 

that were given by the current Commander. The job titles of truck driver and dispatcher do not tell you 

that a fireman went into nuclear waste burial grounds on an hourly basis every day he worked. 

Radioactive material has been found above ground where her husband worked, but his claims have 

been repeatedly denied. The SEM needs to be updated to include more detailed information. 

Leisha Tremmel – Ms. Tremmel’s father worked at Y-12 as a construction laborer in 1953. His claims 

were denied despite the IH report finding several exposures. Her uncle also worked for Union Carbide 

and was exposed, but his claims were also denied. 

Hershell Moore – Mr. Moore described his duties as a roofer in a radiological area and his experiences 

as a carcinoma survivor. 

Larry Lane – Mr. Lane worked as an instrument technician for 39 years at X-10 and he filed a claim for 

hearing loss based on chemical exposure. The CE reviewing his case recommended acceptance but it 

was ultimately denied because his work classification was not in the SEM. The SEM has since been 

modified but it is still incomplete because it does not list him as having been exposed to any solvents. 

Y-12 and K-25’s SEMs are complete and include the link. Affidavits have been submitted to the CE but 

Mr. Lane was concerned that someone in Washington would not be able to accurately determine his 

exposure.

Tim Badie – Mr. Badie was a production machinist at Y-12 for over nine years. He said some of the 

chemicals he was working with did not have names, or even code names, that he can tell his doctor. 

The chemicals he was exposed to have caused his chronic encephalopathy and hearing loss. His claim 

was denied because he was only employed at Y-12 for nine years. 

The meeting was adjourned at 6:03 p.m.

Wednesday, October 19, 2016 

Defining EEOICPA’s Standard for Work-Relatedness

The meeting came to order at 8:39 a.m. Chair Markowitz thanked members of the public for 

participating by phone or in person. The Board will discuss what the appropriate length of the public 

comment session should be as well as where on the agenda it would be most appropriate for future 

meetings.

Discussion of Causation/Contribution/Aggravation (continued)

Chair Markowitz asked Member Vlieger for details on the OWCP definitions she cited the previous 

day. Member Vlieger said that a training document needs to discuss in statistical language what “as 

likely as not” and “significant” convey, rather than the common definition, which is additive. Chair

Markowitz said that, when both occupational and non-occupational risk factors are relevant, there are 

very few non-occupational risk factors that are so overwhelmingly important to causation as to dwarf 

occupational risk factors from toxins. Member Sokas said that may not be true when it comes to 

common illnesses with many contributing factors, such as diabetes. Ms. Leiton said that CEs are 
instructed not to consider smoking as a factor when evaluating asbestos. Member Vlieger said that it 

may not be a factor, but, because smoking does appear on the OHQ, the referrals to CMCs often cite 

that. This portion of the training has not been explained to everyone and the Board should consider it 

when formulating OHQ recommendations. Ms. Leiton said they are very close to sharing a new draft 

version of the OHQ with the Board. Member Friedman-Jimenez discussed the difference between 

multiplicative interaction and additive interaction. He concluded that the Board is at a loss to work this 

out in a rigorous way and will likely never be able to have a calculable Probability of Causation.

Instead, it comes down to who the doctors are that are making the determinations and how were they 

trained. Ms. Leiton said DOL lawyers do take “at least as likely as not” to be 50% or more for 

causation, but there is aggravation and contribution to be considered. She thought Chair Markowitz’ 

explanation of causation/contribution could be a great help to the Department in interpreting the Act. 

Member Boden said there is clearly an ambiguity in the language and the Board might consider 

conveying its thoughts to the lawyers. If the “at least as likely as not” refers to the word “significant,”

then the Board should recommend instructions or examples for the CMCs in order to ensure 

standardization of interpretation. Member Cassano said they do not want to do a statistical evaluation 

of this issue and that the “contributed/aggravated” drops the contribution of the occupational exposure 

below the 50% threshold of causation.

Chair Markowitz said that, by way of example, he felt IARC’s “possible” level of certainty rating 

(IARC 2B) does not meet the standard under the Act. Member Friedman-Jimenez said one difficulty is 

that neither IARC nor NTP typically rate carcinogens for specific cancers. Member Cassano agreed, in 

terms of determining a presumption, but some IARC monographs are pretty old – it might be listed in a 

training document that the CMC has to conduct some research to see if there is no new research that 

would bring a possible to the level of probable. Also, IARC just looks at cancer and there is no 

equivalent stratification for agents that are not carcinogenic. Chair Markowitz said that if you want 

consistent decisions, you need information that’s used consistently throughout the program. Member 

Boden said it is important to remember that a presumption is a floor, not a ceiling. Member FriedmanJimenez suggested looking at asthma because there is a more clear distinction between aggravation and 

causation. 

Subcommittee Recommendations

Weighing Medical Evidence Subcommittee

• Recommendation: The entire case file should be made available to both the IH and CMC when 

a referral is made to either, and not just that information that the CE believes to be relevant. The 

CE should map the file to indicate where relevant information is believed to be. 

Rationale: Limiting the information that the IH or CMC have access to based on the

determination of someone with limited expertise in either field denies the claimant a

comprehensive evaluation of their claim. The professionals asked to provide an opinion on 

these cases may therefore be drawn into a faulty conclusion because pertinent information was 

not made available to them.

The Board voted unanimously to approve the recommendation and rationale. The Subcommittee’s 

second recommendation was withdrawn to be reworked and presented at a later time.

SEM Subcommittee
• Recommendation 1: We recommend that DEEOIC ensure that the disease-exposure links 

identified by the sources listed in Table 3.1 of the IOM Report are included in the SEM.

The Board voted unanimously to approve the recommendation.

• Recommendation 2: We recommend that DEEOIC establish a process whereby the IH may 

interview the claimant directly.

The Board voted unanimously to approve the recommendation.

• Recommendation 3: We recommend that former workers from DOE facilities be hired to 

administer the OHQ. 

The Board voted unanimously to approve the recommendation. The subcommittee will draft and 

endorse a rationale for each of the three recommendations through a publicly accessible teleconference. 

IH & CMC Subcommittee

• Recommendation 1: We recommend DOL review the policy teleconference notes, redact

confidential information, and enter the information into a publicly available database searchable 

by topic area.

Rationale: The notes contain extremely useful information about case determination and 

available guidance that would be of use to claimants. While it is important to maintain the free 

exchange of information, this internal mechanism allows thoughtful redaction to exclude 

claimants’ personally identifiable information as well as material not broadly applicable and 

will allow the program to post useful guidance and improve transparency.

The Board voted unanimously to approve the recommendation and rationale.

• Recommendation 2: We recommend DOL explore the feasibility of having new case files be 

made accessible to the claimant in read-only format through a password-protected electronic 

portal.

Rationale: Claimants already have the right to access their records, although the current system 

only allows this after the fact. Access in real-time would promote transparency, help decrease 

misunderstandings, and allow claimants to offer additional information at an earlier stage where 

needed.

The Board voted unanimously to approve the recommendation and rationale.

• Recommendation 3: We recommend DOL reorganize its occupational positions into an office 

comparable to the organizational structure of the Office of the Solicitor of Labor, with positions 

organized in groups to support OSHA, MSHA, OWCP, and other units, as well as to provide 

overarching support to DOL.

Rationale: The gap between the current program and the medical community reflects serious 

communication issues that require in-house expertise. However, physicians and other healthcare 
professionals, as well as attorneys, face challenges when working in isolation. The Office of 

Occupational Medicine in OSHA is an example of how professionalism and quality can be 

maintained, but it would be more efficient for DOL to develop an office directly reporting to the 

Secretary which can offer the same quality service across the Department, including for smaller 

units. Such an arrangement would allow cross-coverage and avoid the gaps that have been 

problematic with this program.

The Board voted unanimously to approve the recommendation and rationale.

Part B Lung Disease Subcommittee

• Recommendation: We recommend a presumption of CBD in situations with a diagnosis of 

sarcoidosis in an individual who meets the definition of a “covered beryllium employee” under 

Part E or Part B. A positive BeLPT is not required to make a diagnosis of CBD in this situation 

whether pre-1993 or post-1993 CBD criteria are used.

Rationale: The blood BeLPT can be falsely negative, especially in a patient with CBD on 

immunosuppressive treatment. A lung lavage lymphocyte proliferation test is an invasive 

procedure that can be too risky to perform in a patient with chronic lung disease. The blood 

BeLPT test is not a routine blood test. It is difficult to obtain on a patient who is not currently in 

a beryllium surveillance program. The prevalence of CBD in beryllium exposed workers is 

higher than the prevalence of sarcoidosis in the general population. 

The Board voted unanimously to approve the recommendation and rationale.

Circular 1506: Post-1995 Exposures

• Recommendation: We recommend that Circular 1506: Post-1995 Exposures be rescinded.

Rationale: The issuance of plans and guidelines does not constitute evidence that exposures 

were kept below those guidelines. Exposures below standards may still lead to health effects. 

The Board voted unanimously to approve the recommendation and rationale.

Letters to the Board from ANWAG

The June 3, 2016 letter addresses the issue of certain facilities not being considered DOE facilities

because they don’t meet the DOL standard of DOE having a proprietary interest in the facility. 

ANWAG has requested from DOL a definition for what “proprietary interest” is. Member Boden felt 

this is a question of legal interpretation which would be outside the bound of the Board’s charge. 

Member Domina said that DOE needs to take responsibility for protecting its employees. Member 

Vlieger said that is this is an area of deficiency, similar to gaps in the SEM, and thus it would be part of 

the Board’s charter. Member Cassano felt the question was outside the Board’s scope, but suggested 

sending the letter along to DOL and asking that the appropriate parties address the issue. Member 

Boden made a motion to table the question until the board has more background information. The 

motion was seconded and approved unanimously.

The September 9, 2016 letter raised issues relating to inaccuracies within the SEM. The letter stresses 

that people who have not had traditionally recognized hazardous occupations may also have had the 
opportunity for toxic exposures within the complex, and asked how the SEM addresses this issue.

Member Welch will take this into her subcommittee to figure out an approach. 

Current and Future Use of Presumptions

Chair Markowitz had prepared a number of circulars that use presumptions on asbestos, asthma, TCE 

and kidney cancer, and others, but could not go through them due to time constraints. The Board needs 

to identify a process going forward where it can deliberate on them. Member Sokas suggested listing 

the Board’s requests to DOL in writing and ask them for a response to the presentation on their hearing 

loss presumptions (specifically on the ten years of continuous service) and the public comments 

received on the issue. Member Cassano said that, the simpler presumptions are, the less confusing they 

are to people. Member Boden proposed forming a working group that could bring to the Board 

suggestions on how to proceed. It was agreed to form a working group that cuts across the 

subcommittees to review current presumptions, tease out DOL’s reasoning, and also to look for issues 

within those presumptions. The work group will develop advice on future presumptions as well as a 

broader discussion of use and limitations of presumptions. 

Advisory Board Process: Discussion

Next Meetings: Chair Markowitz said that holding a meeting in the field was extremely useful for 

hearing directly from the people affected and also allows for the opportunity of touring the facilities. 

There may be some advantage to having a meeting in Washington, D.C., in order to meet with members 

of the new administration. Member Domina said the Board should hold the April meeting near a 

facility west of the Mississippi. Member Boden noted that holding the meeting out west wouldn’t 

preclude anyone on the Board from meeting with new administration staff. Denver and Las Vegas were 

proposed as possible locations. 

Board administrative issues: Chair Markowitz asked for suggestions on how to improve the advisory 

board process. Member Sokas said that the Board should be informed of changes to the Procedure 

Manual, circulars, bulletins, etc. Member Vlieger suggested setting a regular schedule for 

subcommittee meetings. Member Cassano said it would be helpful to have a teleconference of 

subcommittee chairs to coordinate efforts. Chair Markowitz suggested some committees have a nonphysician co-chair in order to enhance their input.

Comments from DOL

Ms. Leiton apologized for not being present at the meeting due to an illness and thanked Mr. Vance for 

filling in. She takes the work of the Board very seriously and believes the Board can help with some of 

the most difficult challenges the program faces. She assured the Board that their recommendations are 

given great attention, that DOL is very happy to have the Board’s input, and will do their best to be 

responsive to the Board’s requests despite not having dedicated resources for handling it. Dr. 

Armstrong is the new Medical Director and will attend meetings once he has a better understanding of 

the program. The Department will make itself available to the Board wherever they hold their meetings 

regardless of a change in administration. 

Public Comment Session

Paige Gibson – Ms. Gibson spoke on behalf of Jeannie Cisco, who worked at Portsmouth Gaseous 

Diffusion Plant for 30 years. A group at her work turned in over 200 chemicals with MSDS sheets and 
letters from the company explaining which buildings these chemicals were in. They were added to the 

SEM and then removed without explanation. She would like to know why. She also asked the Board to 

evaluate DOL’s statement regarding people with beryllium sensitivity flying all over the country to 

receive treatment. Ms. Gibson stressed that job classifications and tasks are different for each site and

the SEM does not address this. She noted that OHQs are being done telephonically so it shouldn’t

matter where the former worker lives.

Terrie Barrie – Ms. Barrie suggested the Board look to the Radiation Exposure Compensation Act for 

presumptions rather than the VA benefits. She reminded Board Members that workers worked daily in 

an environment with multiple toxic exposures.

Vina Colley – Ms. Colley is a former worker from the Portsmouth Plant and co-chair of the National 

Nuclear Workers for Justice. She encouraged the Board to hold a meeting in Portsmouth, Ohio. DOE 

failed to protect workers there with adequate monitoring and protection and never told workers that 

they were working with plutonium. There has been plutonium at the plant since 1953. DOL is 

withholding sick workers’ benefits because failed to recognize the relevant causation which has been 

affirmed by the claim’s experts and the treating physician. She objected to the demands that sick 

workers are being forced to go through and the conflicts of interest concerning EEOICPA. She 

discussed her experiences as a claimant. 

Tim Lerew – Mr. Lerew acknowledged the work of Janine Anderson in getting the National Day of 

Remembrance started. He invited everyone to attend this year’s National Day of Remembrance at ten 

sites around the country. One of Cold War Patriots’ missions is to keep alive the memory of the 700,000 

people that worked in the nuclear weapons complex. He expressed their appreciation for the work of 

the Board on behalf of the worker community. 

Tee Lea Ong – Mr. Ong urged the Board and Subcommittees to clarify the scope and medical practices 

of Nurse Consultants, especially as it relates to the MSO. Any changes to this position should be 

communicated in a timely fashion to the Board and stakeholders. 

Janet Mitchell – Ms. Mitchell worked at K-25 and has been working on these issues since 1995, as her 

health has allowed. In 1996, she worked at the barrier plant where nickel was processed. After having 

her claim denied twice, she requested her complete file. She felt SEM that was used to evaluate her 

claim was pathetic. She discussed other exposures at K-25. She said she sees two choke points in the 

EEOICPA process: one is unhelpful CEs and the other is whether DOL will accept and implement the 

recommendations of the Board. 

Donna Hand – Ms. Hand is a worker advocate, authorized representative, and member of the Beryllium 

Health and Safety Committee, and a member of DIAB (DEEOIC Interim Advisory Board), and has 

been involved with the EEOICPA program since 2001. She discussed OWCP’s mandate and the fact 

that the CE’s Procedure Manual only requires plausible or potential exposure. She discussed various 

interpretations of causation and said that it does not require a high standard, medical certainty, or 

statistics. She asked that the committee on CBD define chronic respiratory disorder and also address 

the characteristics of X-ray abnormalities.

Etter Pegues – Ms. Pegues is the widow of Eldred Pegues who worked at Y-12 for 32 years. She 

described his struggles with cancer and some of his occupational exposures. She is glad the Board is 

looking at workers’ exposures now rather than just the diseases.
Dorothy Colquitt – Ms. Colquitt worked in packing at Y-12 for over 19 years. She has had nine 

borderline and abnormal BeLPT results from beryllium exposure. Her physician told her the person at 

Oak Ridge handling her case had the wrong information about her, which led to DOL denying her 

claim multiple times.

Susan Adkisson – Ms. Adkisson shared a case she worked on for a fireman that worked at K-25 and Y12 and developed mantle cell lymphoma. No IH or CMC reviewed the case. During his claims process, 

the SEM was updated to remove gasoline and diesel exhaust fumes. As a result, his claim was denied 

and remains so.

Sherry Oren – Ms. Oren worked at K-25 and ORNL for ten years. She believes her issues were caused 

by inhalation from the TSCA incinerator and is glad to hear the Board discussing respiratory illnesses. 

Her claims have been denied, as have her requests for reconsideration. She read the responses into the 

record and contradicted several of the statements therein. EEOICPA was meant to help workers, but

claimants have seen the administrative costs increase, the number of approvals decrease, and people in 

the former worker community are dying before they get approved.

Shirley Watkins – Ms. Watkins worked at Y-12 from 1969 until 1973 and was diagnosed with 

Parkinson’s disease in 2012. She was found to have elevated levels of mercury, which was common in

the Beta building she worked in. She described her struggles with Parkinson’s and said she would like 

to see secretarial positions added to the SEM.

J.B. Hill – Mr. Hill was a beryllium worker at the Y-12 plant since 1970. He said he was glad the Board 

was there because the doctors in Oak Ridge are not in the favor of workers. He was diagnosed as 

borderline and wanted clarification on what that means and what can be done about it. His claim has 

been denied and he intends to apply again and asked what his next steps should be. 

Carl Richardson – Mr. Richardson worked at multiple Oak Ridge facilities over the past 50 years. 

Initially he was acknowledged to have received significant radiation exposure but then his dose 

reconstruction was lowered and he was denied. One of the questions asked of applicants is what 

chemicals they have been exposed to, but back in the ‘60s and ‘70s no one told workers what chemicals 

they were being exposed to. That information is now available and claimants should be told what 

chemicals were present in the areas in which they worked. 

Hugh Newsom – Mr. Newsom has precancerous skin growths that could turn into melanoma. His file 

contains multiple inaccuracies including when and where he worked. He has noted these discrepancies 

and had his former employers write letters concerning his time of employment. He has not received any 

acknowledgment of the corrections and wondered how much of his denial was based upon faulty 

information.

Dan and Nona Morgan – Mr. Morgan worked at Y-12 for 31 years and has had numerous cancers. His 

records are missing and they believe others’ are as well.