U.S. Department of Labor Office of Workers’ Compensation Programs

Washington, DC 20210

January 13, 2021

Dr. Steven Markowitz, Chair

Advisory Board on Toxic Substances and

Worker Health

Queens College, Remsen Hall

65-30 Kissena Boulevard

Flushing, NY 11367

Dear Dr. Markowitz:

I am writing this letter in response to the recommendations that the Advisory Board on Toxic 

Substances and Worker Health (Advisory Board or Board) adopted from its public meetings on 

November 5-6, 2020. You attached both recommendations to your letter to Secretary Scalia, and 

the Department of Labor’s (Department) responses to each recommendation are addressed 

below. 

The Board adopted the following recommendation on November 5, 2020.

The Board recommends that the Department [of Labor] develop and implement exposure 

presumptions indicating that job categories at [Department of Energy] sites whose workers 

likely worked throughout their individual sites had potential exposure to all listed toxic 

substances at those facilities.

As the Department communicated to the Board by letter dated June 2, 2020, the assignment of 

toxic substance exposures to positions, such as firefighters, security guards, health physics 

technicians, and safety personnel, is dependent on site-specific data. The Department has 

provided to the Board the site profile information it requested to further assess this topic. It is 

the Department’s position that it is inappropriate to assign such a broad classification of exposure 

to specific labor categories in the absence of any underlying documentary support. Accordingly, 

the Department does not agree with the Board’s recommendation. The Department remains 

willing to dialog further with the Board about specific toxic substance exposures that the 

Department could assign to highly mobile workers at particular facilities. 

The Board adopted the following recommendation on November 6, 2020.

The Board recommends that the Department develop an ongoing independent third party-based 

system of reasonably frequent periodic evaluation of the objectivity, quality, and consistency of 

both the individual claim reports and the aggregate audits of program industrial hygienists and 

physicians. The Board also recommends that the Department implement a periodic audit of the 

industrial hygiene reports and the industrial hygiene review process. The results of these 

evaluations and analyses should be reported to the Board in a timely and systematic fashion.
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The Department agrees to implement changes to its quality control methodologies to enhance 

independent evaluation of the objectivity, quality, and consistency of industrial hygienist and 

physician reporting. Currently, the Department conducts annual accountability reviews and 

ongoing quality control auditing of our claim adjudication process. Moreover, the Department 

designed its case adjudication process around the allowance of a claimant to object to a 

recommended decision before the Final Adjudication Branch independently assesses the claim to 

finalize the recommendation. However, the Department will design additional methods of 

objective audit review that focus on the outputs of the industrial hygienists and contract medical 

consultants. For the industrial hygiene evaluations, the Department will develop an audit 

process, separate from the entities engaged in case adjudication, to ensure the outcomes conform 

to procedural, qualitative, and consistency standards. Additionally, the Department will redesign 

the Contract Medical Consultant review process to supplement the current reviews conducted 

quarterly by the Office of Workers’ Compensation Program’s Medical Director, once an 

additional Medical position is filled within that Office. This change will allow for an additional 

review of these reports from another medical physician and provide a higher degree of 

objectivity in the application of qualitative measures. The Department plans to implement these 

changes within the next few months, or as soon as possible after the additional physician is hired. 

On behalf of the Department, the Office of Workers’ Compensation Programs, Division of

Energy Employees Occupational Illness Compensation, and the communities we serve, I look 

forward to the continued efforts of the Advisory Board.

Sincerely,

Julia K. Hearthway

Director, Office of Workers’ Compensation Programs