Advisory Board on Toxic Substances and Worker Health, Department of Labor

Recommendation on Presumptions for Job Categories with Site-Wide Exposures to all 

Toxic Substances

Adopted November 5, 2020

Recommendation

The Board recommends that the Department develop and implement exposure presumptions 

indicating that job categories at DOE sites whose workers likely worked throughout their 

individual sites had potential exposure to all listed toxic substances at those facilities.

Rationale

There are a limited number of job categories at many, if not most, Department of Energy 

sites whose job duties routinely involve work for variable periods of time at many buildings and 

locations within the site where people with these job categories work. Examples of such job 

categories include, but are not limited to, firefighters, security guards, health physics technicians, 

and safety personnel. Examination of the potential exposures for some of these categories in the 

Site Exposures Matrices (SEM) of the Department of Labor demonstrates substantial variation in 

the number and type of potential exposures associated with these job titles. An easily understand 

example is that of security guards at the three gaseous diffusion plants in Paducah, Portsmouth 

and Oak Ridge. These plants were very similar, performing a singular operation (gaseous 

diffusion) from the 1950’s to the 1980’s and beyond. Yet the number and type of potential 

exposures for security guards at these plants vary greatly in the SEM: 10 at Oak Ridge, 29 at 

Paducah, and 61 at Portsmouth. Exposures of health physics technicians show similar variation.

A highly plausible explanation for this occurrence, for the particular example cited above 

as well as for another few job titles, is a significant level of variation in the amount and detail of 

documentation of exposure that has been gathered across the DOE sites over the past 75 years. 

This is no surprise, as the DOE sites were operated by different contractors over the decades, 

who frequently changed, and who were likely not provided with uniform and specific 

instructions on documenting exposures at the plants. The SEM is based on such documentation, 

which represents a principal strength. But the utility of the SEM is vulnerable to known gaps in 

exposure documentation, which, by virtue of the absence of information, is not obvious to users 

of the SEM, such as claims examiners. 
Compounding this limitation, it is just plain difficult to identify a specific list of potential 

exposures of highly mobile workers who roam throughout the site’s facilities, as needed, to do 

their jobs. Security guards would not have kept exposure diaries, worn air monitoring pumps, or 

even tracked which buildings they visited over time, much less described what occurred in those 

buildings or which chemicals were present. The same can be said for fire fighters, health physics 

or industrial hygiene technicians (and their aliases), and others. 

An appropriate solution to this deficiency in information is to implement an exposure 

presumption for these job categories that indicates that they very likely had exposure to a very 

broad set of chemical agents that were used at the sites where they worked. The SEM could then 

be used, if at all, to identify the universe of toxic agents and diseases that are applicable to the 

relevant site to determine a first order applicability to the health condition that forms the basis of 

the claim. Alternatively, the SEM could be bypassed in favor of an industrial hygiene evaluation 

of the exposure information provided by the claimant and knowledge of the job category and the 

DOE site in question. The exact procedure would be determined by the Department, though the 

Board would appreciate the opportunity to provide additional input. The desired end result will 

reflect the recognition that, for a limited set of job categories and their aliases, there was 

potential for exposure to a great number of toxic substances used at the relevant site with their 

attendant risks of disease. 
Advisory Board on Toxic Substances and Worker Health, Department of Labor

Recommendation on Evaluation of Industrial Hygiene and Medical Reports in Energy 

Employees Occupational Illness and Compensation Claims Evaluations

Adopted November 6, 2020

Recommendation

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.

Rationale

Medical reports

The EEOICP currently assesses aspects of the quality and objectivity of the contractor medical 

reports through a quarterly review of approximately 50 claims by the Medical Director of the 

Energy Employees Occupational Illness and Compensation Program (EEOICP). This is a 

praiseworthy effort. The findings of the Medical Director’s Audits, 2018-2019 are summarized

in the table below.

 Results of EEOICP Medical Director Audits of Contract Medical Consultant Reports, 2018-2019

Type of 

Review

2018 2019 Combined 2018-2019

Total No.

No. that "need 

improvement" 

(%)

Total No.

No. that "need 

improvement" 

(%)

Grand Total

No. that "need 

improvement" 

(%)

Causation 67 1 (1%) 79 0 (0%) 146 1 (0.68%)

Impairment 67 25 (37%) 71 19 (27%) 138 44 (32%)

Other* 63 12 (19%) 47 3 (6%) 110 15 (14%)

Total 197 38 (19%) 197 22 (11%) 394 60 (15%)

*Supplemental, clarification, second opinion and others
There are two notable findings in this summary of the Medical Director’s Audits: 1) the near 

absence of errors in causation reviews, and 2) the high frequency of errors in other types of 

claims reviewed. Less than 1% of causation reviews but one-third of impairment reviews were 

found to need improvement. Based on the ABTSWH’s review of a substantial number of 

different types of claims over the past 3 years, the paucity of errors discovered in the Medical 

Director’s review of causation evaluations is implausible. While the Board reviewed many 

excellent causation analyses by contract medical consultants, it also found that more than 1% of 

the claims review had significant errors in the causation evaluation and decision-making. The 

second finding, that 32% of impairment evaluations and 14% of other claims reviews contained 

errors is also concerning, since the medical contractor has been performing such evaluations for 

numerous years and should be expected to produce reports with less than a 5% to 10% error rate. 

The results of claims reviews also suggest, assuming the claims audited by the Medical Director 

are reasonably representative, that there are likely to be a large number of claims that contain 

errors that go undetected. Both findings raise important questions about the validity of aspects of 

the claims evaluation process and support the implementation of an augmented evaluation 

process to ensure the quality and consistency of claims evaluations.

Industrial Hygiene Reports and Review

At present, the contractor industrial hygiene reports are reviewed on an individual basis by 

Federal industrial hygienists at the time that reports are submitted during the claims evaluation 

process. There is no periodic audit or analysis of a sample of industrial hygiene reports, such as 

the EEOICP Medical Director completes for contractor medical reports in his audits, to evaluate 

the consistency of findings or to detect any patterns of errors across industrial hygiene reports. 

Hence, the EEOICP has no aggregate view of the quality, consistency and objectivity of the 

reports provided by the industrial contractor. In addition, there does not appear to be a broad and 

substantive review of the decision-making entailed in the individual industrial hygiene 

evaluations or of industrial hygiene review process. The latter would include the following: the 

quality and completeness of the overall exposure information reviewed and used by the contract

industrial hygienist; the quality of the exposure information in the Statements of Accepted Facts;

the appropriateness of the questions directed to the industrial hygienist; and the usefulness of the 

industrial hygiene report in the case review by the contract medical consultant and the claims 

examiner. Addressing these two components of the industrial hygiene input into claims 

evaluation – a periodic audit and a process review – would improve confidence that this critical 

function in claims review reflects an appropriate level of quality, consistency, and objectivity.