(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

1

 UNITED STATES DEPARTMENT OF LABOR

 + + + + +

 ADVISORY BOARD ON TOXIC SUBSTANCES

 AND WORKER HEALTH

 + + + + +

 MEETING

 + + + + +

 WEDNESDAY,

 APRIL 19, 2017

 + + + + +

 The Advisory Board met at 8:30 a.m.

Pacific Time, at the Red Lion Hanford House, 802

George Washington Way, Richland, Washington, 

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
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

2

CLAIMANT COMMUNITY:

DURONDA M. POPE

KIRK D. DOMINA

GARRY M. WHITLEY

JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

DOUG FITZGERALD

*Participating via telephone
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

3

 T-A-B-L-E O-F C-O-N-T-E-N-T-S

Welcome/Introductions/Logistics

 Douglas Fitzgerald. . . . . . . . . . . . . . . . 4

 Steven Markowitz. . . . . . . . . . . . . . . . . 8

Review of Agenda

 Steven Markowitz. . . . . . . . . . . . . . . . .14

DOL Presentation to the Board

 Rachel Leiton . . . . . . . . . . . . . . . . . .18

SEM Subcommittee

 Laura Welch . . . . . . . . . . . . . . . . . . .33

Weighing Medical Evidence Subcommittee

 Victoria Cassano. . . . . . . . . . . . . . . . 141

IH & CMC Subcommittee

 Rosemary Sokas. . . . . . . . . . . . . . . . . 192

Presumptions Working Group

 Steven Markowitz. . . . . . . . . . . . . . . . 246

Public Comment Session . . . . . . . . . . . . . 329
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

4

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

2 8:36 a.m.

3 MR. FITZGERALD: Good morning,

4 everyone. My name is Doug Fitzgerald and I'm the

5 -- I'd like to welcome you first to this meeting

6 of the Department of Labor's Advisory Board on

7 Toxic Substances and Worker Health. I'm the

8 Board's designated federal officer, or DFO. 

9 A couple of quick housekeeping items. 

10 I'd be remiss if I didn't mention that if there's

11 an emergency, there are two exits at either side

12 of the room, and please exit through those exits. 

13 And there is a restroom to the right as you go

14 out. And those are kind of the environmental and

15 safety issues I have to inform you of, I guess.

16 But first, on behalf of the Department

17 I wanted to express our appreciation to the Board

18 for their work and diligent efforts preparing for

19 this meeting. And I also want to acknowledge a

20 couple of individuals who helped make this

21 meeting possible. That's Carrie Rhoads, who's

22 with the Board's staff in Washington, as well as
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

5

1 Kevin Bird and Melissa Schroeder, our contract

2 officers who were -- who did all of the travel

3 arrangements and the logistics for preparing for

4 this meeting as well.

5 As DFO I serve as the liaison between

6 the Board and the Department. I'm also

7 responsible for ensuring all provisions of the

8 Federal Advisory Committee Act, or the FACA, are

9 met regarding operations of the Board. I work

10 closely with the Board's chair, Dr. Markowitz,

11 and I'm responsible for approving the meeting

12 agenda and for opening and adjourning meetings. 

13 I also work with the appropriate agency officials

14 to ensure that all relevant ethics and

15 regulations are satisfied.

16 We have a full agenda for the next

17 day-and-a-half, and you should note that the

18 agenda times are approximate, so as hard as we

19 may try to stay with the agenda, we can't always

20 keep to the exact times. We will try to me

21 mindful of breaks, however.

22 Copies of all meeting materials and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

6

1 public comments are or will be available on the

2 Board's web site under the heading "Meetings." 

3 The Board's web site can be found at

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

5 d.htm, or you can just Google "Advisory Board on

6 Toxic Substances and Worker Health" and you'll

7 probably get right there. 

8 If you haven't already visited the

9 Board's web site, I strongly encourage you to do

10 so. After clicking on today's meeting date,

11 you'll see a page dedicated entirely for this

12 week's meeting. That page contains all materials

13 submitted to us in advance of the meeting, and we

14 will publish any materials that are provided by

15 our presenters throughout the next day-and-a16 half. There you can also find today's agenda as

17 well as instructions for participating remotely

18 in both the meeting and the public comment period

19 at the end of the day. 

20 If you are participating remotely, I

21 want to point out that the telephone numbers and

22 links for the WebEx sessions are different for
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

7

1 each day, so please be mindful of those

2 instructions. If you're joining by WebEx, please

3 note that the session is for viewing only and

4 will not be interactive. 

5 The phones will also be muted during

6 the public comment period from 4:30 to 6:00 p.m.

7 today.

8 During Board discussions and prior to

9 the public comment period I would request that

10 people in the room remain as quiet as possible

11 since we're recording the meeting to produce

12 transcripts. We do have a scheduled hour-and-a13 half for public comment at the end of the day. 

14 The Chair will note that this isn't a question

15 and answer session, but rather an opportunity for

16 the public to provide comments about the topics

17 being considered by the Board.

18 If for any reason the Board members

19 require clarification on an issue that requires

20 participation from the public, the Board may

21 request such information through the Chair or

22 myself.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

8

1 The FACA requires that minutes of this

2 meeting be prepared to include a description of

3 the matters discussed over the next day-and-a4 half and any conclusions reached by the Board. 

5 As DFO I prepare the minutes and ensure that

6 they're certified by the Board's Chair. The

7 minutes for today's meeting will be available on

8 the web site no later than 90 calendar days from

9 today per FACA regulations, but if they're

10 available sooner, we'll publish them before the

11 90th day.

12 Also, although formal minutes will be

13 prepared because they're required by the FACA,

14 we'll also be publishing verbatim transcripts,

15 which are obviously more detailed. These

16 transcripts will be available on the Board's web

17 site May 20th. 

18 And with that, Mr. Chairman, I convene

19 this meeting of the Advisory Board on Toxic

20 Substances and Worker Health. Welcome.

21 CHAIR MARKOWITZ: Thank you. Good

22 morning. Can you hear me in back? Okay. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

9

1 Thanks. So I would like to add a note of welcome

2 to everyone here, my sister and fellow Board

3 members, members of the public who are here, the

4 representatives from the Department of Labor, Dr.

5 Worthington, Dr. Al-Nabulsi from the Department

6 of Energy, Malcolm Nelson, and I think Steven

7 Levin from the Ombudsman Office within the

8 Department of Labor, and other as well, including

9 we have some staff members from Senator Cantwell

10 and Senator Murray's Office. 

11 So thank you very much for coming.

12 I want to thank Doug Fitzgerald and

13 Carrie Rhoads for the hard work they've performed

14 on our behalf in keeping the Board properly

15 communicated and logistically supported in order

16 to do our work. In particular Carrie Rhoads

17 works very hard to keep us in touch with each

18 other and to support these meetings. 

19 So thank you very much.

20 In previous two face-to-face meetings,

21 which were last April and in October, October in

22 Oak Ridge and last April in Washington, sometimes
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

10

1 during the public comment period there were

2 individual DOE workers, former workers who had

3 specific issues relating to their claims, and we

4 found it helpful that there would be members of

5 the Department of Labor here from the EEOICPA

6 Program. 

7 Also, I believe there will be someone

8 here from the Washington State Department of

9 Industry and Labor, or Labor and Industry to

10 address questions one-to-one if you -- if members

11 of the public wish on issues of workers'

12 compensation. And of course the Ombudsman Office

13 from DOL is here as well. So that would be an

14 opportunity later in the day, or throughout the

15 day for that matter, if people want to have

16 individual discussions about particular claims. 

17 We should go around all do -- the

18 Board will do introductions and then I'll review

19 the agenda briefly. 

20 So I'm Steven Markowitz. I'm an

21 occupational medicine physician and

22 epidemiologist from City University of New York.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

11

1 Les?

2 MEMBER BODEN: I'm Les Boden. I'm a

3 professor of public health at the Boston

4 University School of Public Health.

5 MEMBER TURNER: I'm James Turner. 

6 I've worked at Rocky Flats for the last 26 years. 

7 I was diagnosed in 1990 with chronic beryllium

8 disease.

9 MEMBER VLIEGER: Good morning. I'm

10 Faye Vlieger, a former worker from the Hanford

11 site. I was injured in a chemical exposure there

12 in 2002.

13 MEMBER REDLICH: I'm Carrie Redlich. 

14 I'm a professor of medicine at Yale. I'm also an

15 occupational and environmental medicine physician

16 and a pulmonologist and director of the Yale

17 Occupational Environmental Medicine Program.

18 MEMBER SILVER: Ken Silver, associate

19 professor of environmental health in the College

20 of Public Health at East Tennessee State

21 University. Before relocating to Tennessee I

22 worked very closely with Los Alamos workers and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

12

1 families that advocate for passage of this law

2 and following up on implementation.

3 MEMBER FRIEDMAN-JIMENEZ: I'm George

4 Friedman-Jimenez. I'm the director of the

5 Occupational Environmental Medicine Clinic at

6 Bellevue, New York University School of Medicine,

7 and I'm also an epidemiologist.

8 MEMBER DEMENT: I'm John Dement. I'm

9 faculty at Duke University, Industrial Hygiene

10 and Epidemiology.

11 MEMBER DOMINA: I'm Kirk Domina. I'm

12 the employee health advocate for the Hanford

13 Atomic Metal Trades Council here in Richland,

14 Washington. I'm a current worker. I've been on

15 site for 34 years.

16 MEMBER WHITLEY: I'm Garry Whitley. 

17 I'm a former worker at the Y-12 Master Security

18 Complex for 42 years.

19 MEMBER WELCH: I'm Laurie Welch. I'm

20 an occupational physician and I'm on the adjunct

21 faculty at George Washington University and work

22 for the Center to Protect Workers' Rights, the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

13

1 Center for Construction Research and Training.

2 MEMBER CASSANO: Victoria Cassano. 

3 I'm also an occupational medicine physician,

4 retired military, radiation health and safety

5 officer, and also worked with the VA on -- as the

6 head of the Environmental and Occupational

7 Exposure Service.

8 MEMBER POPE: I'm Duronda Pope. Work

9 with United Steel Workers Emergency Response

10 Team, but also a former worker of Rocky Flats, 25

11 years.

12 CHAIR MARKOWITZ: And we have two

13 Board members on the phone. Rosemary Sokas are

14 you there? Can you introduce yourself?

15 MEMBER SOKAS: Yes, hi. Rosemary

16 Sokas, faculty at Georgetown University and an

17 occupational medicine physician. 

18 CHAIR MARKOWITZ: And also Mark

19 Griffon?

20 MEMBER GRIFFON: Yes, hi. Mark

21 Griffon, health physics consultant.

22 CHAIR MARKOWITZ: Did anybody hear
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

14

1 that? Mark, could you do that -- say that again?

2 MEMBER GRIFFON: Mark Griffon. Can

3 you hear me? 

4 CHAIR MARKOWITZ: Yes.

5 MEMBER GRIFFON: Mark Griffon. I'm a

6 health physics consultant.

7 CHAIR MARKOWITZ: Okay. Thank you.

8 You should have -- members, you should

9 have copies of the agenda which were available at

10 the table outside. I just want to briefly go

11 over it. 

12 This meeting is a little bit shorter

13 compared to the meeting -- last two meetings

14 we've had. It's a bit of an experiment. If it

15 ends up we have two little time, then next

16 meeting we'll revert to a somewhat longer

17 meeting. But I believe we should be able to get

18 our work done today and tomorrow morning.

19 First we'll hear from Ms. Leiton,

20 director of the Energy Employees Occupational

21 Illness Program. And then we're going to get

22 throughout the day subcommittee reports. So the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

15

1 Board has four -- the charter gives us four tasks

2 really, and we have these four subcommittees that

3 address each of the tasks. That's the structure

4 of the subcommittees. And in addition, we have a

5 working group to deal on an issue to -- cuts

6 across committees dealing with the use of

7 presumptions in the program. So first we'll hear

8 from the Site Exposure Matrices Subcommittee and

9 then later in the morning from the Weighing

10 Medical Evidence Subcommittee. 

11 The times are approximate. I guess

12 how much time each subcommittee report would

13 take, interrupted by breaks and lunch. So we

14 will go beyond the assigned time period if we

15 need to.

16 We're going to hear from -- after

17 lunch from the Industrial Hygiene and CMC

18 Subcommittee. And then later in the afternoon

19 from the Presumptions Working Group.

20 Tomorrow morning we will hear from the

21 Committee on Part B Lung Conditions. And then we

22 have some time mid and later morning to deal with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

16

1 miscellaneous issues. In part that's issues that

2 arise today and early tomorrow morning. So if

3 there are issues that we need to table and deal

4 -- think about overnight and discuss tomorrow

5 morning, we will have time to do that. And then

6 there are some other miscellaneous issues we'll

7 deal with as well tomorrow. And then we close

8 the meeting tomorrow at 11:00 a.m.

9 Now the public comment period is

10 longer. I think it's longer than the previous

11 ones. Previously it was an hour, but we had one

12 on each day. This time because of the time frame

13 of the meeting, we had a longer one on just one

14 day, an hour-and-a-half. So we'll see how that

15 goes. 

16 There have been numerous requests to

17 speak at the public comment period. If anyone

18 here decides they want to speak, they should

19 discuss this with Carrie Rhoads so that we can

20 schedule people properly. And for that matter,

21 for people on the phone if you wish to make a

22 public comment -- first of all, you're all
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

17

1 welcome to submit written comments, but if you

2 want to make an oral comment today, for people on

3 the phone you should send an email to Carrie

4 through the web site of the Board, which is

5 energyadvisoryboard@dol.com, just to let us know

6 so we can plan out that public comment period. 

7 so that email address is

8 energyadvisoryboard@dol.com.

9 PARTICIPANT: Not dot gov?

10 CHAIR MARKOWITZ: Dot gov. Good. 

11 Good point. Okay. Thank you.

12 So any comments about the agenda from

13 the Board? Additions?

14 (No audible response.)

15 CHAIR MARKOWITZ: Okay. Good. So

16 let's move on. We'll hear from Laurie Welch, Dr.

17 Welch, for the Site Exposure -- oh, no. I'm

18 sorry. Rachel. 

19 MS. LEITON: Rachel.

20 (Laughter.)

21 CHAIR MARKOWITZ: Rachel Leiton is

22 invited to come to the table. And I should say,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

18

1 we have -- in previous meetings we had Department

2 of Energy on the schedule as well. There wasn't

3 -- we -- I discussed it with them. There wasn't

4 a need really for a set time period, but I would

5 invite comments from Dr. Worthington, Dr. Al6 Nabulsi during -- throughout today or tomorrow

7 morning if issues arise.

8 So, Ms. Leiton? Thank you.

9 MS. LEITON: Thank you. It's a

10 pleasure to be here. I appreciate the

11 opportunity to speak to the Board, and I also

12 appreciate all the efforts that you guys have

13 made in the past year on various subjects. Mr.

14 Gary Steinberg, who is the deputy director for

15 Office of Workers' Compensation Programs, wanted

16 to be here today. He wanted to attend the tour. 

17 I would have attended the tour, but I've been

18 before. I know it's very, very fascinating. I'm

19 glad that you all had the opportunity to do so. 

20 But he did want me to read a brief statement from

21 him into the record. And then I've got just a

22 few comments. I'll try to keep it short so that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

19

1 you can get on with your business.

2 First he wanted to convey his

3 appreciation for the hard work the Board has

4 engaged in since its inception. "We have seen a

5 great deal of enthusiasm and focus on the four

6 areas that fall under the Board's purview. While

7 the Department is expected to provide a formal

8 response to the Board's initial eight

9 recommendations after we have confirmed

10 secretary, "I did send an interim response to Dr.

11 Markowitz indicating our agreement with the

12 recommendations on the circular and the reference

13 material for the SEM. Other recommendations were

14 very thoughtful and will be seriously reviewed

15 for potential implementation. 

16 "We recognize that the Board meetings

17 serve as a forum for open communication with the

18 public regarding the program. While we did not

19 hold an annual meeting with the advocates in

20 Denver this year, we are working with the Joint

21 Outreach Task Group to consider other forms for

22 communications. We welcome any inputs from our
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

20

1 stakeholders moving forward.

2 "I am very pleased with the results of

3 the Board's endeavors over its first year of

4 activities. We look forward to the Board's

5 recommendations on ways to further enhance the

6 SEM, potential presumptions that the program can

7 use in its adjudication process and enhancements

8 to the medical inputs provided to program staff.

9 "I'm also very proud of the

10 improvements that the program team have made over

11 the past several years. We continue to improve

12 the quality and timeliness of our decisions while

13 also enhancing our communications with our

14 claimants, the advocate community and our other

15 stakeholders.

16 "I hope you have a very productive

17 meeting and look forward to hearing positive

18 feedback regarding the activities this week."

19 That's the end of the statement from

20 Mr. Steinberg. I just wanted to make sure I got

21 that into the record.

22 But just a couple of other things. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

21

1 Mr. Steinberg mentioned in his statement that we

2 have delayed our response to the recommendations

3 because we don't have a secretary. We did send

4 an interim response. And in that interim

5 response we mentioned a couple of things. One

6 was that we've already rescinded the one circular

7 along with the memorandum regarding the post-95

8 exposures. That was based on the recommendations

9 of the Board.

10 In addition, we have -- we asked --

11 one question was in regard to the recommendations

12 of the IOM, and that was basically -- that list

13 is very broad and in some ways it's a little bit

14 inherently incoherent -- inconsistent. And so we

15 thought if you can help us narrow that, that list

16 a little bit, I think it would be more helpful

17 for us to say, okay -- because some of them are

18 related to things that really are occupational in

19 nature. So if we can narrow that to things in

20 that list, sites in that list that can maybe

21 really deal with occupation and how we could use

22 that, that would be really helpful.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

22

1 Those were a couple of things I was

2 able to talk to the administration about doing

3 before we send out the formal recommendation --

4 response to the recommendations.

5 I also just wanted to mention that we

6 have -- I've listened to most of the transcripts

7 for the Subcommittee meetings and I'm very

8 excited actually to see what's going to come out

9 of the presumptions and the Occupational History

10 Questionnaire recommendations that you'll have

11 for us. 

12 One of the things that we did send

13 after your last meeting on presumptions was just

14 a -- kind of a -- went through all of our policy

15 guidance that's out there and provided a list of

16 our exposure -- lifting up an exposure and

17 causation presumptions with development guidance

18 for certain conditions. And this is something

19 that we pulled together from published -- things

20 we've already published, some things we've been

21 working on. So this hopefully will be something

22 you can take a look at. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

23

1 If you have questions about the

2 references and that sort of thing after you've

3 had a chance to look through this, we will

4 provide that to you. If you want to know where

5 we got these assumptions, we'll probably have to

6 gather that from our science team and medical

7 team to get that to you later, but we thought it

8 might be a good starting point at least just to

9 keep in mind what we've been looking at. But

10 those -- the recommendations that you guys can

11 provide to us will really -- I think will help us

12 in long term. 

13 And I listened in on some of the

14 conversations you had about trying to simplify

15 the process so we don't have to run to a doctor

16 every time or don't have to run to an industrial

17 hygienist. I think we want the input of

18 industrial hygienists whenever we can get them,

19 if they're critical, but when we can avoid it, it

20 does move the process along a little bit more

21 smoothly. 

22 The same thing with causation
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

24

1 presumptions. The big distinction being when you

2 look at the document we've submitted, there's --

3 we've made some exposure presumptions, which are

4 just what can we assume these people were exposed

5 to versus some causation presumptions. This is

6 what they're exposed to and this is a condition

7 that might be related to it. So those are some

8 big distinctions that we're trying to make and I

9 think that you guys are going to really be able

10 to help us with.

11 I just wanted to also say that I'm

12 looking forward to -- the Subcommittee for

13 Weighing Medical Evidence is going to go to the

14 Seattle District Office this Friday, at least

15 some members of it, to meet with our staff. 

16 We're going to have senior staff that have been

17 claims examiners before. I think that that

18 conversation, going over cases, will be very

19 helpful. Jolene Smith, who's the DD, the

20 district director for the Seattle office is here

21 today.

22 Just a few current statistics. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

25

1 Nationwide we've spent -- paid over $13.6 billion

2 in compensation benefits. In Hanford that's

3 about 1.36 billion and in Washington State, for

4 people living in Washington State that's about

5 $1.1 billion.

6 We have been active with our Joint

7 Outreach Task Force Group. We've had events last

8 quarter in San Bernardino and Simi Valley to just

9 -- again, the point of the Joint Outreach Task

10 Force Group is to get the word out, to make sure

11 we're intaking claims and taking questions as we

12 can. We're going to have another one of those

13 tomorrow here actually in Pasco at the Red Lion

14 there.

15 That one's going to be more of a round

16 table. A lot of times we'll do presentations for

17 the public. This is going to be -- we're going

18 to have tables set up so people can walk around

19 and ask questions, talk about their claims and

20 that sort of thing.

21 For the year we're looking towards

22 doing some mailings and we're still planning what
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

26

1 additional events we're going to do.

2 I did send a list of policy updates

3 that have occurred since the last meeting in

4 October. Hopefully you all have seen that, but

5 it's also on our web site, those updates for

6 policy. Basically, there were a couple of new

7 SEC classes, the Santa Susana and Pantex SEC

8 classes. So we created circulars for those. We

9 also had some Procedure Manual updates regarding

10 impairment, home health care, ancillary medical

11 services and the medical bill process.

12 One of the -- our projects that we're

13 currently working on and I expect to be published

14 very soon is a PDF or our Procedure Manual. And

15 it's going to be one Procedure Manual with all

16 the updates in a searchable format so that if you

17 want to search by word -- it's something that

18 we've been trying to do for a long time. But if

19 you want to search by word, if you want to search

20 by subject, it's going to make it a lot easier to

21 do that. 

22 It's also going to be republished
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

27

1 whenever we make the changes, substantial changes

2 to it so that you don't have to keep looking to

3 find the various versions. It'll all be in

4 there. So I think that's going to be a really

5 big help for our claims examiners, for the

6 public, and I'm looking forward to making that

7 happen.

8 There will be a mechanism also for

9 things that we need to get published really

10 quickly that will get incorporated into it later,

11 but it might be easier to even do that,

12 incorporate it in with this format faster than

13 we've been able to do that in the past.

14 I just also wanted to mention that we

15 have been doing -- we have a subscriber list for

16 email blasts for information about medical

17 benefits and changes that we may have. We've got

18 a lot of subscribers, I think over 400. We're

19 going to be doing something very similar soon for

20 policy, for any updates to policy, trying to make

21 sure that when we make changes to policy, it's

22 out there. It's in an email blast. People can
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

28

1 subscribe to it and get updates as that happens.

2 We also started doing quarterly

3 teleconference call with medical providers,

4 meaning not all doctors themselves can attend

5 these sorts of teleconferences about the program

6 just to ask questions, but sometimes they could

7 send their staff or they could come themselves. 

8 And what we do is we try to get questions that

9 we've heard from the medical community and

10 provide answers at these quarter -- quarterly

11 teleconference calls. So it's another thing

12 we've been trying to do to just make sure that we

13 are being as responsive as we can be.

14 So I really -- I think that covers

15 most of what I wanted to talk about, but I just

16 again do want to say thank you all for your hard

17 work. And I know it's a pretty time-consuming

18 board and there's a lot of very, very complicated

19 issues to talk about. And we have been -- we try

20 to be as responsive as we can to your data

21 requests and that sort of thing and will continue

22 to do so. And if you need anything additional,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

29

1 of course go through Carrie and we'll provide you

2 with whatever we can, whenever we can.

3 Also I'm here this -- today and

4 tomorrow. If you need to call on me, just please

5 feel free to do so. Do you have any questions

6 from me before I -- 

7 CHAIR MARKOWITZ: Questions?

8 MEMBER SOKAS: I have a question. 

9 This is Rosemary Sokas. 

10 MS. LEITON: Yes?

11 MEMBER SOKAS: I just wanted to know

12 whether -- the one recommendation from last time

13 that was having those periodic telephone calls

14 where people troubleshoot, if that might be

15 something that you can comment on whether that 

16 could be made searchable as well. 

17 MS. LEITON: I'm not sure what you're

18 referring to when you say "periodic

19 troubleshooting." Are you talking about policy

20 calls?

21 CHAIR MARKOWITZ: Yes, I think it's

22 the teleconference calls where cases and issues,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

30

1 generic issues are discussed.

2 MS. LEITON: Well, what we do with

3 those policy calls is we are -- we take them, if

4 they're relevant to the broad policy of what

5 we're doing rather than a specific, very specific

6 case, then we try to incorporate them into our

7 policy and Procedure Manual. That's what we're

8 doing with this new PDF coming up. We've

9 searched through everything that we've had

10 published and tried to make anything that is

11 relevant to moving forward in general policy

12 public.

13 With regard to making the specific

14 calls from the past open to the public, I'm going

15 to have to wait for the secretary on that because

16 it is a formal recommendation.

17 CHAIR MARKOWITZ: I have a question. 

18 You referred earlier in your remarks to a new

19 document on -- sort of summarizing or compiling

20 really presumptions that currently exist, and my

21 read of that document is that it keeps some of

22 the current policies. It seems to appear --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

31

1 appears to drop certain language from the current

2 policies and then it adds some new language. Is

3 that -- did I get that right in my read of the --

4 MS. LEITON: What we tried to capture

5 was already out there, but there have been as

6 we've moved forward with certain cases some

7 thought -- changes because of case-specific

8 information. It's something that we're -- we've

9 got a draft of our toxic substance -- or our

10 toxic exposure chapter that we were -- and

11 thinking of adding these things, too. Any input

12 you have on what we have here would be very

13 helpful to us, because some of it hasn't been

14 formally published yet, but it is, like you said,

15 a little bit of wording changes, a little bit of

16 drop this and add that. That's why it's not a

17 public document yet, because we are in draft

18 stages of it.

19 CHAIR MARKOWITZ: So it's possible

20 that some of the recommendations we would come up

21 with today and tomorrow could impact this

22 document?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

32

1 MS. LEITON: Absolutely.

2 CHAIR MARKOWITZ: Okay. My other

3 question is some of the recommendations that we

4 made in the fall I know have been moved forward

5 to the secretary's office. Let's say that

6 they're approved, there's go ahead on some of

7 them. What happens after that? What's the time

8 frame?

9 MS. LEITON: Well, once we get

10 clearance for a response to you on that document,

11 we'll take action as quickly as we can. Some of

12 them require resources that we're a little bit

13 short on right now, but it will be one of our

14 priorities to ensure that anything that we've

15 said that we will do in the -- based on your

16 recommendations we do as quickly as possible. So

17 I can't give you an exact time frame. 

18 CHAIR MARKOWITZ: Sure.

19 MS. LEITON: It really depends on the

20 question and which one you're referring to, but

21 we will --

22 CHAIR MARKOWITZ: Okay.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

33

1 MS. LEITON: -- be -- it will be one

2 of our priorities.

3 CHAIR MARKOWITZ: Okay. Thank you. 

4 Any other questions? Yes, Dr.

5 Redlich?

6 MEMBER REDLICH: But, Steve, your

7 question regarding the update, was that the

8 chapter 20700 exposure on causation presumptions?

9 CHAIR MARKOWITZ: Correct.

10 MEMBER REDLICH: That's what you were

11 referring to?

12 CHAIR MARKOWITZ: Correct.

13 MEMBER REDLICH: Okay. Thank you.

14 CHAIR MARKOWITZ: Which is a draft. 

15 It's a draft.

16 MEMBER REDLICH: Yes.

17 MS. LEITON: It's a draft.

18 CHAIR MARKOWITZ: Right.

19 MS. LEITON: It says draft.

20 CHAIR MARKOWITZ: Right.

21 MS. LEITON: Just keep that in mind.

22 MEMBER REDLICH: Okay. Thank you.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

34

1 CHAIR MARKOWITZ: Any other questions? 

2 Okay. Thank you very much, Ms. Leiton.

3 MS. LEITON: Thank you. Hopefully you

4 have a successful meeting.

5 CHAIR MARKOWITZ: We will.

6 (Laughter.)

7 CHAIR MARKOWITZ: Dr. Welch?

8 MEMBER WELCH: Okay. So I've got two

9 slide presentations. 

10 Kevin, can we start with the other

11 one, the occupational history one? 

12 So two slide presentations, but there

13 are really four areas that we're going to cover

14 in -- out of the SEM Subcommittee.

15 So the one I wanted to start with

16 first is recommendations for the Occupational

17 History Questionnaire. In your agenda book you

18 have my written recommendations and rationale,

19 and that was sent out beforehand. And I know

20 some of you had a chance to read it, but I'm

21 going to summarize the recommendations here, and

22 then if people have questions about the rationale
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

35

1 for any part of it, we can talk about that

2 afterwards, after I run through the

3 recommendations.

4 I would say that my committee, our

5 committee, we spent a good amount of time on this

6 going through all the details, and it was

7 extremely helpful to me to get input. I mean, we

8 have a committee that includes people -- every

9 representation of the kind of subgroups on the

10 Board, and I just want to thank everybody for

11 thoughtfulness and input. And so I think we've

12 got something that is -- we believe is doable for

13 the Department of Labor and as -- would also

14 really improve the process.

15 So the idea is that there's a current

16 Occupational History Questionnaire that DOL uses. 

17 There was a draft revised one that we looked at

18 in draft, but we're -- here I'm referring to the

19 one that's currently being used. And we're

20 recommending that these changes be made to the

21 current one, kind of jumping over the draft one

22 that Paragon put together. So I'm not really
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

36

1 going to talk about that draft one.

2 So what we want to do is retain the

3 list of hazardous exposures materials that are on

4 the current OHQ, but expand them by adding the

5 list from the BTMed Occupational History

6 Questionnaire, which was also sent out to you

7 guys. We do have it available to put up on the

8 screen, but it's an expanded list of tasks and

9 materials beyond what's on the current

10 Occupational History Questionnaire. It's not

11 every task and every material, but it's an

12 available list that we can use to expand what's

13 there. 

14 And our experience is that when you

15 have lists of things it helps people recall the

16 work. If you just sit down with somebody and say

17 what do you do, what did you do, and try to

18 capture it from the beginning, it's not as

19 helpful as things that prompt people's memory. 

20 And the building trades has a pretty extensive

21 process of doing that using maps and other ways

22 of helping people recall where they worked. But
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

37

1 we -- it's our experience that this list of tasks

2 is very helpful. It's not really sufficient. 

3 And so then what we say after people are -- have

4 identified the materials that they worked with

5 that then they would be asked to describe how

6 they were exposed to that in free text, which

7 would be captured on the OHQ. So rather than

8 just checking off I did welding as a task, or I

9 was exposed to solvents, it would capture how

10 that individual was exposed to solvents. 

11 And those of us who have done

12 occupational medicine over the years know

13 important it is to know what the task is, because

14 that helps people who know about the work

15 environment understand what kind of exposures

16 someone would have had without having to have

17 industrial hygiene monitoring.

18 Then we would ask the worker to rate

19 the frequency of exposure that he has using the

20 scale that we have on the BTMed questionnaire. 

21 It's a five-point scale. And then assess if the

22 worker used the material directly or exposed as a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

38

1 bystander, which also helps with some estimate --

2 quantitative -- qualitative estimate of intensity

3 of exposure.

4 There's a new bulletin that I

5 neglected to send out to everybody, but it's

6 called the "Direct Disease Work Link Process,"

7 which allows the claim examiner to -- if someone

8 has -- they've done a certain task, that task is

9 now associated with disease. Rather than the

10 task having be associated with an exposure that's

11 associated with a disease, there's a link in the

12 SEM that says if you did this task, it can be

13 linked to the disease, which is a really great

14 improvement because the SEM is based on

15 individual exposures, not complex mixtures, for

16 example. And tasks often give you exposures to

17 complex mixtures. 

18 So as this process gets developed --

19 right now there aren't a lot of these direct

20 disease link work processes, but as the -- if

21 there's an opportunity for DOL to continue to

22 expand those, it's a way to deal with the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

39

1 question of mixtures, which was presented to us

2 many times and we really haven't had a figure out

3 a way to do it. But I'd recommend that people

4 take a look at that bulletin and take a look at

5 the SEM, just sort of FYI. 

6 But the thing about it is I think it

7 really fits with this recommendation because if

8 the -- the current OHQ doesn't ask about task, so

9 there's really no way to use the direct link

10 disease work process, or -- I mean, all those

11 words are in there; I'm not sure I'm getting them

12 in the right order -- without information on

13 task, because that's based on task. 

14 So it's -- I think that in some ways

15 we're -- the thought process is coming together

16 both from the Board and the DOL about the

17 importance of task. So that's the first one. 

18 Retaining the hazard exposures information,

19 getting information on task and detail on

20 frequency and intensity through this process.

21 So here's what the -- this is part of

22 that directories link work process bulletin. So
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

40

1 the middle part that says, "Data supplied by an

2 employee or survivor in an occupational history

3 or other personal statements can be accepted as

4 reliable when sufficient detail or other

5 information is provided that documents the scope

6 and type of work performed," which to me I read

7 that by saying a good detailed occupational

8 history can be accepted as reliable because we're

9 going to have the detail about the task, that

10 people describe in detail what they did. 

11 And we all have experience that when

12 someone tells you all that information, it's not

13 something that -- it's not just, oh, I think I

14 was exposed. It's a lot of detail. So I was

15 very happy to see that this new bulletin would be

16 relying on the task information that's coming

17 through the occupational history.

18 So we talked about the idea of making

19 a longer task list which would make administering

20 the occupational history much easier. It's much

21 easier to have a list than to have to collect

22 free text, which we're recommending. But
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

41

1 everybody here has at some point in time

2 addressed the question or thought about the

3 question about tasks for production workers. 

4 I mean, I can't remember how many job

5 titles there are; 20,000, something like that. 

6 So a lot of job titles. And then the job title

7 doesn't very well predict the tasks people did

8 because the job titles for the same -- people

9 doing the same set of tasks have different job

10 titles in different sites. 

11 So we fairly quickly decided that it

12 really wasn't feasible to create a list of tasks,

13 which is why we came up with the idea that we

14 start with materials and hazards and then have

15 people describe their tasks rather than trying to

16 make a list. But we do have a list on BTMed that

17 includes the tasks that construction workers do;

18 and many of those tasks are performed by

19 production workers as well, so that if we add

20 that list of tasks -- it's not complete, but it's

21 available, it's been tested, we know how useful

22 it is and it will help with the process of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

42

1 collecting task information.

2 And the second one I'm going to

3 present to you is presumption for COPD. COPD is

4 caused by vapors, gas, dust and fumes. And to

5 have the presumption work and really be able to

6 adjudicate claims for COPD you have to be able to

7 assess this exposure. So we're recommending that

8 we have a question added to the OHQ that

9 specifically asks people have you been exposed to

10 vapors, gases, dust and fumes in your work at

11 DOE. 

12 Someone -- this would come after

13 they've done all their task and materials, and so

14 if the worker thinks -- they get asked have you

15 already reported all these exposures and the

16 answer's above, good. Fine. We've captured

17 that. But it's an opportunity to circle back and

18 make sure that the process that was used in the

19 list of the work history actually captures

20 exposures to these range of aerosol exposures and

21 also to be sure that the frequency of exposure is

22 there and wanted people -- wanted to specifically
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

43

1 ask about the worker's assessment of their

2 frequency of exposure to all of these categories. 

3 We've asked them above about their

4 frequency of exposure to welding, for example, or

5 to solvents or other things, but it would be nice

6 to have someone to say, well, when I think over

7 my career, yes, I had daily exposure to something

8 that falls into that category. And that will be

9 really useful when we look at the COPD

10 presumption.

11 The last bullet is something that

12 we're going to have to get DOL's input on as we

13 move on and figure out what to do with it, but

14 work before and after the DOE Complex is part of

15 the cumulative exposure to vapors, gas, dust and

16 fumes. So we would like to have the OHQ collect

17 information on exposures outside of DOE which

18 allows an assessment of the total exposure that

19 they had, because setting a presumption you

20 really want to know that someone had the amount

21 of exposure that we consider minimum and it

22 doesn't have to all be at the DOL complex. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

44

1 But we do understand that the current

2 policy which was set up to be claimant-friendly

3 was to not include exposures outside the DOE

4 Complex. In this case it makes it harder for the

5 claimant I think, but again I think we need to

6 understand better how collecting occupational

7 history or using that in the adjudication for

8 work outside the DOE Complex -- if that's

9 possible to do. And if not, we can readjust.

10 And then as with many things we would

11 love to have this implemented and tested many

12 times rather than just used, because we're

13 talking about something that's a big change,

14 relative big change, and we'd want to make sure,

15 for example, that the information collected on

16 the OHQ is useful to the industrial hygienist

17 when it gets there. And that feedback would be

18 necessary to test a draft, so -- in addition to

19 getting the task information that's in that

20 bulletin 16-03. We just want to state this

21 explicitly and we're -- the Board is happy to

22 help in refining the OHQ. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

45

1 And I don't know if John Dement wants

2 to address that, but he was in charge of doing

3 this for our BTMed questionnaire which we

4 developed in conjunction with workers, but it was

5 very helpful to have a few rounds in focus groups

6 with workers before we implemented it.

7 John, anything you add on that?

8 MEMBER DEMENT: No, I think you've

9 covered the issue quite well.

10 I think the point with regard to the

11 BTMed, we know that it's -- we try to capture

12 what we feel or have felt based on the workers'

13 input over many years. Are there major tasks

14 that they have done largely in the area of

15 construction and maintenance types of work, but

16 some of it does, as Laura said, spill over into

17 more the production side. But they're tasks that

18 people do.

19 And I guess to sort of defend the task

20 approaches, over many years -- we know it's

21 imperfect, but we do know based on working with

22 it and trying to develop some of these
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

46

1 qualitative estimates over exposure that it is

2 predictive of several outcomes that we've looked

3 at over the years, and especially respiratory

4 diseases and COPD. 

5 MEMBER WELCH: So that's my last slide

6 on the OHQ, so I'd -- questions from the Board?

7 CHAIR MARKOWITZ: Yes, I have -- by

8 the way, do we need -- when we speak, do you need

9 us to mention our name for recognition later? 

10 No? Okay. So a couple of comments and

11 questions. 

12 First of all, just to clarify -- so

13 you made a distinction between construction and

14 production, which is a distinction made in the

15 Former Worker Medical Screening Program between

16 construction workers and everybody else who

17 worked on site. So I think when you mention

18 production, actually what that means to some of

19 us is a broad range of workers at the site

20 including production, including service,

21 including administrative workers, engineers and

22 the like. So I think that's what you meant,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

47

1 right?

2 MEMBER WELCH: Absolutely.

3 CHAIR MARKOWITZ: Okay.

4 MEMBER WELCH: Thanks for that.

5 CHAIR MARKOWITZ: So the very simple

6 question about vapors, gas, dust and fumes, which

7 looks almost overly simple, right? It's a single

8 question, but that question has been validated in

9 studies. Is that right? Or can you just give a

10 history of that a little bit, because it seems so

11 easy. It's seems almost too good to be true,

12 that a question that simple could produce valid

13 data. So could you just give a little bit of

14 background on that?

15 MEMBER WELCH: Yes. So going back to

16 the idea that inhaled dust exposures or dust and

17 fume exposures can cause COPD goes back many

18 decades now, and the American Thoracic Society

19 first published something about that in 2003. 

20 And usually if you get to a professional society

21 creating a statement, there's plenty of data to

22 support it. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

48

1 At that point it was based on really

2 individual exposures, but there were lots of

3 them. And on the -- and the biology would

4 suggest that if you have particulate matter of --

5 generated say with diesel exhaust that causes

6 COPD, particulate matter generated with another

7 process that's creating residual soot is going to

8 cause COPD. So at that -- when those studies

9 came out, it looked it would be not a handful of

10 substances, but many substances.

11 But there have been, oh, I don't know,

12 maybe 15 community-based studies and

13 occupational-based studies, too, but community14 based studies where they've looked at people --

15 population-based studies looking at people across

16 not just one industry, but across like the 10,000

17 people in Denmark. Asked a questionnaire. And

18 the question is, were you exposed to vapors,

19 gases, dust and fumes? And that predicted COPD

20 in these big population studies. 

21 And there's not a lot of detail you

22 can get when you're doing that big a study,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

49

1 because it's not necessarily one -- but you can

2 see when you do a big population study across a

3 country that it's not one industry or one

4 exposure, because that -- not everyone would be

5 affected by that. You wouldn't find an effect if

6 it was just a small subgroup within that. So

7 it's -- and one after another after another study

8 has found that occupational exposure to VGDF

9 causes COPD.

10 We also know from much work done by a

11 group out of Harvard that air pollution causes

12 COPD, the particulate exposures in the air

13 pollution, which is most likely a lower exposure

14 than what occupational studies are. So that sort

15 of supports the biology as well. 

16 But your specific question -- maybe

17 I'm giving too much information, but your

18 specific question is that there are tons of

19 studies that support silica and welding and

20 diesel exhaust causing COPD. And then lots of

21 population-based studies where people -- at --

22 were you exposed at work to this large broad
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

50

1 category was statistically and consistently

2 predictive of COPD. 

3 CHAIR MARKOWITZ: Right. Dr. Dement?

4 MEMBER DEMENT: I think that's a great

5 explanation. And I think -- so to add to it,

6 there's a growing body of information scientific

7 studies that support the concept that some of

8 these particles, particulates that have been

9 considered relatively low toxicity with regard to

10 regulations are nonetheless contributory to COPD. 

11 Coal mine dust is a fairly good example of a

12 relatively low toxicity dust. It has some silica

13 in it, but many, many studies of coal mine dust

14 exposures have actually quantified the decrements

15 in lung function related to these relatively non16 toxic materials compared to silica and asbestos. 

17 So there's a growing body of data that

18 really supports the concept that these particles

19 that we've pretty much disregarded with regard to

20 occupational regulations in a major part are

21 contributory to these lung diseases.

22 CHAIR MARKOWITZ: So I have 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

51

1 another -- 

2 MEMBER WELCH: Let me make one other

3 point, too, because it -- that follows from what

4 John said. Many of the occupational agents that

5 go into the vapors, gas, dust and fumes have no

6 regulatory standard set for them in addition to

7 saying that the occupational standard for silica

8 was only just reduced to something that's

9 reasonable this year.

10 CHAIR MARKOWITZ: Right.

11 MEMBER WELCH: So it was -- and some

12 people say it's too high still. But, so, current

13 regulatory guidelines for some of the components

14 of VGDF are not protective against this

15 particular outcome even now, but a great number

16 of the agents that could be included in that

17 rubric have no standard, and they've been

18 considered particulates not otherwise regulated,

19 or even just nuisance dust. Well, sorry, there

20 is a standard, but it's so high that it was --

21 it's not at all protective and it's not ever

22 enforced as a standard. So although I didn't say
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

52

1 it in -- we're going to talk about it in the COPD

2 one, current exposures can continue to

3 contribute.

4 CHAIR MARKOWITZ: Yes, Ms. Vlieger?

5 MEMBER VLIEGER: I wanted to point out

6 that there are task information that can be

7 entered on the EE-3 when the claim is made,

8 however, what I see a majority of the time is

9 that's kind of considered self-serving if it's

10 not justified within the employment records that

11 are provided under the document acquisition

12 request. And I'd like to get away from that

13 because I don't know any worker that would comb

14 the web looking for some set of terms that would

15 get them benefits versus telling the truth on

16 their form. 

17 So on the Occupational History

18 Questionnaire what I'd like to ensure is that

19 when the claimants do those forms and they sign

20 them, they sign EE-3, the OHQ does not have a

21 signature on it, but the information provided is

22 not considered self-serving all the time and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

53

1 discounted when it's reviewed later on. 

2 MEMBER WELCH: So do you -- would you

3 suggest adding a signature to the OHQ?

4 MEMBER VLIEGER: I would add an

5 affidavit signature like on the other forms

6 because that way there is some mark to it that

7 they know what's on the form and they approved

8 it.

9 The EE-3 section where you can say

10 what your job tasks and category was in very

11 small. And so even when you fill it out in the

12 PDF form, it gets tiny, tiny print just to be

13 able to put enough information in there. So

14 maybe we need to look at the EE-3 where they're

15 reporting their work as well, because this may

16 change that. 

17 CHAIR MARKOWITZ: So if I can move

18 onto another topic, the -- you raise the issue of

19 considering outside of DOE exposures. So this is

20 a -- would be a significant change. And we

21 should discuss this, the rationale behind this a

22 little bit. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

54

1 The issue really is taking seriously

2 the statutory language about contributing and

3 aggravating, because if for instance you set a

4 presumption of a minimum of five years of work in

5 DOE say as a carpenter in order to be eligible

6 for compensation for some disease, and that

7 carpenter worked for three years at DOE and then

8 spent 20 years outside of DOE working as a

9 carpenter, clearly they have long-term exposures

10 as a carpenter. But some of the exposure

11 occurred within DOE, not enough to get to the --

12 to a -- if a presumption is established for five

13 years, not enough to cross that threshold to be

14 considered. 

15 And the reality is, is that many

16 workers in the complex worked outside as well,

17 particularly in construction and maintenance, but

18 in other jobs as well. And many of those jobs

19 were along the same line. They're blue collar

20 jobs that involved important exposures. 

21 So the challenge is to figure out how

22 to consider sort of the totality of exposure. If
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

55

1 -- even if part of it is suffered or experienced

2 at DOE and is below say any presumption

3 threshold. And it's not easy, because then you

4 have to obtain information about outside

5 exposures, outside employment. So that changes

6 the nature of the occupational history.

7 MEMBER BODEN: So this raises another

8 interesting question for me, which is actually we

9 do collect what the DOE -- DOE collects

10 information about people's smoking history, which

11 is also a factor that's contributory to COPD. 

12 And it seems to me that that history ought be

13 considered in the same way as other occupational

14 exposures; that is, if combined with the DOE

15 exposure there is a history of smoking exposure. 

16 But really it's my -- stating this as a

17 statement, but it's really a question. Do you

18 think that all three of those ought to be

19 considered when thinking about the requirement

20 for compensation for COPD?

21 MEMBER WELCH: You'd need to take

22 smoking into account as causing and contributing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

56

1 most importantly if it was more than additive

2 with the dust exposure, would be my opinion. So

3 if it's more than additive or even

4 multiplicative, then the -- you'd have a

5 different presumption of how much exposure you

6 need if someone was a smoker or not. And then --

7 but I think we should maybe talk about that when

8 we get to the COPD presumption.

9 MEMBER BODEN: Okay.

10 MEMBER WELCH: But you did raise the

11 question. I mean, I don't think a smoking

12 history belongs on an Occupational History

13 Questionnaire, personally, but I didn't really

14 think about that one way or another. I mean,

15 it's something that the -- a medical reviewer

16 would want to know down the road when they're

17 trying to assess COPD and probably wouldn't give

18 an opinion if they didn't have it, but for COPD

19 it's -- for work-related COPD it's pretty much

20 irrelevant whether someone was a smoker or not,

21 in my opinion.

22 MEMBER BODEN: So the reason I raise
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

57

1 this is I think generally when somebody's

2 reviewing somebody's history and thinking about

3 work-related COPD and they see smoking, they

4 think, aha, right, the smoking caused the COPD. 

5 But given the legal structure that we're talking

6 about with the contributing-aggravating-causing

7 criteria, then actually smoking might put

8 somebody -- smoking combined with the DOE

9 exposure might put somebody over a threshold in

10 the same way that another occupational exposure

11 would put them over the threshold and in that

12 case might actually be beneficial to somebody's

13 case, just logically.

14 MEMBER WELCH: Yes, so when we get to

15 the COPD, that would affect the number of years

16 that -- some number of years of exposure to meet

17 a presumption. I mean, I think we should talk

18 about it then because there are different ways to

19 approach that. 

20 Would you want to add?

21 MEMBER CASSANO: Yes, a couple of

22 things. I see this -- I mean, it's not just with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

58

1 outside employment, but in general when I've

2 looked -- when we've looked at all of these cases

3 that we looked at in Part E, synergistic effects

4 of multiple toxicants are never looked at. They

5 look at one and then they look at the other and

6 they say, well, this isn't enough to cause

7 disease and the second one isn't enough to cause

8 disease. No toxicant creates damage at whatever

9 level to the exclusion of any other toxicant. 

10 And so we have a choice here I think

11 of looking at it as a proportionality versus

12 saying that, well, this person smoked and

13 therefore they're going to get COPD earlier or

14 it's going to be more severe because they smoked

15 in addition to their occupational exposure. I'm

16 not sure that's quite fair to those who develop

17 occupational COPD without any personal exposure

18 for doing that.

19 But one way of looking at this; and I

20 sort of mostly agree with you and with a little

21 bit of hesitation, is that the wording that I've

22 used is no one can say that if Mr. So-And-So had
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

59

1 not smoked, they would not have developed COPD,

2 nor can they say that because Mr. Smith smoked he

3 would have developed COPD even if he was not

4 exposed at work. And when you look at that, it

5 becomes irrelevant in some way to -- as you said,

6 to use smoking history as a negative predictor of

7 occupational cause of any disease.

8 CHAIR MARKOWITZ: Ms. Vlieger?

9 MEMBER VLIEGER: Sorry, no.

10 CHAIR MARKOWITZ: Dr. Dement?

11 MEMBER DEMENT: In reviewing these

12 cases, let's say a worker started work outside of

13 DOE, did primarily the same types of work on the

14 DOE site for a number of years, and maybe worked

15 afterwards. In my view as long as the sort of

16 exposure latency pattern is satisfied, that

17 cumulative exposures -- let's say the person

18 developed asbestosis -- that worker's cumulative

19 lifetime exposure all contributed to the ultimate

20 development of his disease. So you can't exclude

21 the DOE work. You can't exclude the other work

22 either. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

60

1 So the best that we can say

2 scientifically is that cumulative exposure was

3 the cause of this person's disease. Therefore,

4 in my view it satisfies -- the DOE work satisfies

5 the issue of at least contributing to the

6 ultimate disease. So I think we have to consider

7 sort of the time sequence of the exposure. Is it

8 at -- as biological how we would have predicted

9 it to be. So DOE exposures that were in that

10 time envelope I think are -- would satisfy the

11 compensation requirement.

12 MEMBER VLIEGER: I just want to point

13 out that there are a number of bulletins with

14 smoking considered as part of causation, and

15 we're going to have a bit of a fur ball when we

16 get into that because I just did a search and

17 there's more than four.

18 Rachel, would you like to speak on

19 that, please?

20 MS. LEITON: Well one of the things

21 we've actually tried to do is not consider

22 smoking as part of causation because of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

61

1 aggravation and contribution. We've in fact

2 instructed doctors, when we refer this, to kind

3 of look at the exposure to work over the smoking. 

4 Now, there are certain requirements. Like when

5 we go to NIOSH, we have to provide them with the

6 smoking history. It's part of their analysis,

7 but in general that's something that we've

8 actually tried to avoid having doctors look at. 

9 We tell our CMCs.

10 Now, and I mean because of the

11 aggravation and the contribution factor it's

12 actually something that we've made a point of

13 over the years to try to say try to not -- we're

14 not really looking at smoking history. So it's a

15 complicated issue. If you want to go over

16 specific documents that you've looked at, after

17 this meeting we're happy to look at those and

18 provide specific examples or explanations for

19 that, but overall smoking has been not something

20 that we try to consider.

21 CHAIR MARKOWITZ: Ms. Vlieger?

22 MEMBER VLIEGER: Rachel, I did a quick
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

62

1 review of bulletins. I haven't gone all the way

2 through the Procedure Manual during the

3 discussion or in the -- I don't know anything

4 about policy calls because those aren't

5 published, and I haven't looked at circulars, but

6 I cannot find the exact guidance on the things

7 that we would have purview on, on toxic exposures

8 to talk about not including smoking as a

9 causation. Could you talk about that later?

10 MS. LEITON: A lot of it's been in

11 training. I don't think we specifically said in

12 a document do not look at smoking. I would have

13 to look, but I don't know that we've said it in a

14 procedural document. It's something we address

15 in training when we talk to our claims examiners. 

16 When we refer cases to CMCs, some of the

17 questions that we've asked, those -- that has

18 been included. 

19 MEMBER VLIEGER: All right. Thank

20 you.

21 CHAIR MARKOWITZ: Dr. Friedman22 Jimenez?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

63

1 MEMBER FRIEDMAN-JIMENEZ: I think that

2 in the training of physicians smoking history is

3 ingrained as a major thing that you always have

4 to look at. And this is part of the culture of

5 the way that doctors think about disease,

6 especially lung disease.

7 I think trying to change that culture

8 is harder than trying to change the culture in

9 occupational health that we only think about

10 causation and not contributions and aggravation. 

11 And I think our efforts would be better spent

12 trying to reeducate the CMCs and other physicians

13 involved and the claims examiners to rethink

14 their concept in terms of contributions to and

15 aggravation of the disease in addition to just

16 causation, rather than trying to get them to not

17 think about smoking.

18 I agree that smoking mathematically

19 comes out irrelevant even when you're talking

20 about causation for some diseases, but there's

21 really not enough science there when you're

22 talking about contribution and aggravation and we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

64

1 should de-emphasize it in a different way rather

2 than trying to say don't think about it. Rather,

3 let's say the standard here is did the exposure

4 aggravate, contribute to or cause the disease? 

5 And really hammer on that, getting them to change

6 that. Then automatically smoking will be much

7 less relevant or completely irrelevant.

8 CHAIR MARKOWITZ: I mean, I would just

9 follow up with this comment: I mean, I think on

10 balance ignoring smoking has been and is a good

11 thing because doctors very readily blame smoking

12 for many diseases, in some cases often true. So

13 to -- but it's done to the exclusion of

14 occupational diseases. So on balance ignoring

15 smoking has been I think a claimant-friendly

16 approach.

17 Dr. Welch?

18 MEMBER WELCH: I was also going to say

19 that if we could now focus the issue on the OHQ

20 we could finish this one and maybe vote on the

21 recommendations on it. We've really moved onto a

22 different topic in terms of -- 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

65

1 MEMBER SOKAS: So -- 

2 MEMBER WELCH: I heard Rosie?

3 MEMBER SOKAS: Right, it's Rosie. 

4 Yes, thank you. I just want -- two quick

5 comments. One is I think if you focus on the

6 OHQ, then removing smoking is an intriguing way

7 of implementing the kind of educational piece for

8 the physicians.

9 The -- I'm getting some feedback. I

10 don't know if you guys are. But the second

11 comment I just wanted to make; and it's been made

12 a million times in the past -- I just wanted to

13 be clear that the family history's coming out,

14 that has no business being in the OHQ.

15 MEMBER WELCH: Yes, okay. Actually I

16 hadn't looked at the things that should come off

17 the OHQ. So I think we'll consider that and make

18 -- we can make an addendum later today, because

19 we were just thinking of the things we needed to

20 add. 

21 You have a puzzled look on your face.

22 CHAIR MARKOWITZ: Well, so this --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

66

1 before we move onto the next recommendation, you

2 want to take a vote on this, or do you think

3 there's -- more time is needed and we vote on it

4 tomorrow morning? 

5 MEMBER WELCH: I'd say vote on it now

6 because --

7 CHAIR MARKOWITZ: Yes.

8 MEMBER WELCH: Unless anybody feels

9 they need more time, wants to read more

10 documents, wants to think about it more. 

11 Does anybody want to put it off until

12 tomorrow?

13 CHAIR MARKOWITZ: Dr. Dement?

14 MEMBER DEMENT: I just want a point of

15 clarification. One of the most important things,

16 or one of the important things I think that this

17 Committee, the SEM Committee considered was the

18 accessibility of the industrial hygienist to the

19 worker to have this OHQ to go back, and if there

20 are things that were fuzzy, get -- directly ask

21 questions of the worker. And I believe we made

22 this as one of our earlier recommendations, have
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

67

1 we not?

2 CHAIR MARKOWITZ: Yes.

3 MEMBER DEMENT: Okay.

4 CHAIR MARKOWITZ: So you want to --

5 Dr. Sokas, was that you?

6 MEMBER SOKAS: I just wanted to say

7 I'd like to vote if possible.

8 CHAIR MARKOWITZ: Okay. So, Dr.

9 Welch, you want to --

10 MEMBER WELCH: So I'd leave it up to

11 you. Shall we -- well, there are like four

12 points. Shall we just vote in each point

13 differently, separately?

14 CHAIR MARKOWITZ: Sure. 

15 MEMBER WELCH: Okay. So let me just

16 go back to the beginning. So the first point is

17 what we're talking about is adding free text

18 information on tasks. I think we can actually

19 include this one -- no, sorry. We'll just do

20 this. Collecting information on going from

21 exposure of materials with then collecting

22 information on task with details about the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

68

1 frequency and whether it was direct or bystander.

2 So should we do -- how do we vote,

3 Steven?

4 CHAIR MARKOWITZ: Just are there any

5 comments? Yes, Dr. Dement?

6 MEMBER DEMENT: Just a point of

7 clarification. We should probably have in our

8 recommendation number one being that we retain

9 those tasks and materials that are currently in

10 the OHQ, because we had this proposal that we

11 looked at last time, which I think we pretty much

12 rejected.

13 MEMBER WELCH: Yes, I think that's a

14 good point. So why don't we make that our first

15 point. So it should -- we want to retain the

16 hazards, exposures, materials on the current OHQ. 

17 Does everybody agree with that? 

18 CHAIR MARKOWITZ: Well, so -- hold on. 

19 We need to have discussion. But if you want to

20 change the recommendation, we should -- if we can

21 do this, we should see on the Board what the

22 recommendation is that we're voting on so that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

69

1 there's some -- 

2 MEMBER SOKAS: And the title for that

3 slide is really the recommendation, right? I

4 mean --

5 MEMBER WELCH: Yes, the idea was that

6 that title would be the recommendation. 

7 MEMBER SOKAS: Right.

8 MEMBER WELCH: The written document

9 has it -- it's bolded for each one with the

10 rationale. So we should keep -- well, we can

11 keep it this way.

12 CHAIR MARKOWITZ: Okay. So we need a

13 motion on this.

14 MEMBER BODEN: So moved.

15 CHAIR MARKOWITZ: And a second? Hold

16 on. Second? Okay. So it's open for discussion. 

17 Ms. Leiton, did you want to make a

18 comment?

19 MS. LEITON: Yes, I just want to make

20 it clear that we are talking about the draft we

21 sent or the one that's published when you're

22 making these recommendations, because I think
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

70

1 they're slightly different.

2 MEMBER WELCH: The one that's

3 published.

4 MS. LEITON: Okay. Thank you.

5 CHAIR MARKOWITZ: Okay. So we have

6 this recommendation. Any comments, discussion? 

7 Dr. Sokas?

8 MEMBER SOKAS: Nope. I like it.

9 CHAIR MARKOWITZ: Okay. No, that's

10 okay. 

11 (Laughter.)

12 CHAIR MARKOWITZ: Okay. So we can

13 call for a vote. All those in favor of this

14 recommendation we're looking at, raise your hand.

15 (Show of hands.)

16 CHAIR MARKOWITZ: We'll get the phone. 

17 Okay. And your votes, Dr. Sokas and Mr. Griffon?

18 MEMBER SOKAS: Yes.

19 MEMBER GRIFFON: Yes.

20 CHAIR MARKOWITZ: Okay. So that's

21 unanimous. Next?

22 MEMBER WELCH: So it's -- following on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

71

1 that we recommend adding the list of tasks that

2 we have in BTMed. On the previous one we added

3 the list of exposures. Here we're adding the

4 list of tasks.

5 CHAIR MARKOWITZ: Okay. Is there a

6 motion to accept this? 

7 PARTICIPANT: So moved. 

8 CHAIR MARKOWITZ: And a second?

9 PARTICIPANT: Second.

10 CHAIR MARKOWITZ: It's open for

11 discussion. 

12 (No response.)

13 CHAIR MARKOWITZ: Okay. No

14 discussion. All those in favor of this

15 recommendation, raise your hand.

16 (Show of hands.)

17 CHAIR MARKOWITZ: And Mr. Griffon?

18 MEMBER GRIFFON: Yes.

19 CHAIR MARKOWITZ: Dr. Sokas?

20 MEMBER SOKAS: Yes.

21 CHAIR MARKOWITZ: Okay. So it's

22 unanimous. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

72

1 Next?

2 MEMBER WELCH: So the Committee

3 recommends adding a specific question regarding

4 VGDF with explanations of how that question would

5 be worded here on the screen and in the

6 recommendations.

7 CHAIR MARKOWITZ: Okay. Motion to

8 approve?

9 PARTICIPANT: So moved.

10 CHAIR MARKOWITZ: And a second?

11 PARTICIPANT: Second.

12 CHAIR MARKOWITZ: Okay. It's open for

13 discussion. 

14 (Pause.)

15 CHAIR MARKOWITZ: All those in favor

16 of this recommendation, raise your hand.

17 (Show of hands.)

18 CHAIR MARKOWITZ: And Mr. Griffon?

19 MEMBER GRIFFON: Yes.

20 CHAIR MARKOWITZ: Dr. Sokas?

21 MEMBER SOKAS: Yes.

22 CHAIR MARKOWITZ: Okay. This is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

73

1 accepted.

2 Is there another part?

3 MEMBER WELCH: No, as long as

4 everybody's accepting the points that there's --

5 to implement that -- the validity of that

6 question and includes those four other points. 

7 But everybody understands that we voted in favor

8 of it. I guess what I might recommend, that that

9 last point, that I make it its own recommendation

10 about outside occupational history and that we

11 vote on that specifically, which we could do

12 tomorrow or after the break. I can just make a

13 new slide for it. Do people think that's a good

14 idea?

15 CHAIR MARKOWITZ: Okay. So, Dr.

16 Boden?

17 MEMBER BODEN: Just a question. We

18 have a fourth point on here that -- did I miss

19 our voting on that -- about testing it multiple

20 times?

21 CHAIR MARKOWITZ: Right, we'll move on

22 to that.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

74

1 MEMBER BODEN: Okay.

2 CHAIR MARKOWITZ: But the question

3 here is --

4 MEMBER WELCH: Yes, I was wondering

5 whether --

6 CHAIR MARKOWITZ: Okay.

7 MEMBER WELCH: It's really -- it's

8 sort of a emphasis question, the fourth bullet

9 point there about --

10 CHAIR MARKOWITZ: Right.

11 MEMBER WELCH: -- collecting

12 occupational history about VGDF outside of DOE

13 work is a big enough point --

14 CHAIR MARKOWITZ: Right.

15 MEMBER WELCH: -- that it's probably

16 worth voting on it as its own recommendation. 

17 And I can break out the document afterwards to

18 provide rationale for that.

19 CHAIR MARKOWITZ: Right. So, okay. 

20 So as a matter of procedure we're going to retake

21 this vote because there was not full clarity

22 about what we were voting on. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

75

1 So let's make it clear that we are

2 voiding the previous vote just now and we're

3 going to re-vote on this, and that the

4 recommendation is as it reads on the screen about

5 adding VGDF to the questionnaire with all of the

6 elements included on the questionnaire on --

7 excuse me, on the screen except the final

8 bulleted item which addresses including

9 consideration of outside or prior exposures

10 beyond DOE work. So we're going to exclude

11 bullet item No. 4, or the fourth bullet item, and

12 we're going to re-vote.

13 So is there a motion to approve this?

14 And a second? Okay. Any discussion?

15 (No response.)

16 CHAIR MARKOWITZ: Okay. So all those

17 in favor of this motion, raise your hand.

18 (Show of hands.)

19 CHAIR MARKOWITZ: Dr. Sokas?

20 MEMBER SOKAS: Yes.

21 CHAIR MARKOWITZ: Mr. Griffon?

22 MEMBER GRIFFON: Yes.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

76

1 CHAIR MARKOWITZ: Was there anyone --

2 of the members present was there anybody who

3 voted against or abstained? I didn't see

4 everybody's hand.

5 (Show of hands.)

6 CHAIR MARKOWITZ: Okay. Is that a

7 negative vote or -- 

8 MEMBER FRIEDMAN-JIMENEZ: It's a

9 negative vote.

10 CHAIR MARKOWITZ: Negative? Okay. So

11 all members of the Board voted in favor with --

12 except for one member who voted negatively.

13 So we will consider the issue of

14 outside exposures separately in a -- not right

15 this moment. So let's move on.

16 MEMBER WELCH: And then the last

17 recommendation is that we recommend that the

18 version of the OHQ developed in response to these

19 recommendations be tested multiple times to

20 determine if the information obtained is

21 sufficient to support the process described in

22 16-03, which is tasks, having information on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

77

1 tasks.

2 CHAIR MARKOWITZ: Is there a motion to

3 approve this recommendation?

4 PARTICIPANT: So moved.

5 CHAIR MARKOWITZ: Okay. And a second?

6 PARTICIPANT: Second.

7 CHAIR MARKOWITZ: So is there any

8 discussion about this recommendation? Dr.

9 Friedman-Jimenez?

10 MEMBER FRIEDMAN-JIMENEZ: Just a

11 question. What kind of validation testing did

12 you have in mind in terms of testing multiple

13 times? What did you have in mind with that? A

14 validation study or just pilot testing a

15 questionnaire?

16 MEMBER WELCH: Yes, pilot testing. So

17 for example, it can be done -- focus groups are

18 useful in the beginning. We didn't recommend

19 that in particular, but that the industrial

20 hygienist probably would be the best person to do

21 this, to take a work history, a narrative work

22 history from the worker and then have them
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

78

1 complete the form and see if there are things

2 that the worker mentions that aren't captured by

3 the process, particularly tasks. 

4 Also to get an understanding of

5 whether the questionnaire is -- it gets long, so

6 do you start losing information from the worker

7 because of the nature of asking about much more

8 detail than we had before. Those are two things

9 I was thinking about. You really have to have an

10 expert who knows what the answer should be from a

11 detailed history with the worker and then compare

12 that to the form. But there may --

13 MEMBER FRIEDMAN-JIMENEZ: Okay.

14 MEMBER WELCH: -- there are probably

15 many other ways to do it. That's what I had in

16 mind. I think if DOL wants to develop a

17 different way of doing it, that's fine.

18 CHAIR MARKOWITZ: Dr. Cassano?

19 MEMBER CASSANO: I just wanted to

20 raise an issue not directly related to this; and

21 maybe Rachel can answer this, but all of this

22 that we're doing to the OHQ may be rendered moot
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

79

1 in the claims process because all of the training

2 documents say that the -- everything in the OHQ

3 has to be corroborated through the DAR process or

4 some other internal documentation. 

5 And so most of the time all of the

6 information on the OHQ, or for that matter the

7 formal workers' program stuff that may make into

8 the claims folder, isn't even looked at as far as

9 I can see by the CMC or the industrial hygienist,

10 or even the claims examiner. 

11 So maybe what I'm seeing in the

12 training materials and what we've seen in cases

13 is different than what actually is happened,

14 Rachel.

15 MS. LEITON: Okay. The -- part -- one

16 of the reasons we want to modify the OHQ is so

17 that we can get to information that is more

18 specific. When we say "corroborate," we are

19 going to look at DAR records, we are -- or

20 document acquisition requests from Department of

21 Energy as well as employment verification

22 documents in terms of the -- is it plausible
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

80

1 because they were here or is there -- we're not

2 -- as you guys indicated earlier when you were

3 talking about this, you said, well, when they're

4 talking about work processes, it's really hard to

5 just come up with something that they're not

6 going to -- we're not trying to say that they're

7 going to make anything up. When we verify, we

8 verify the broader as much as we can. 

9 I think that going into more details

10 about work processes that we can then look at

11 with regard to this Bulletin 16-03 will be very

12 helpful and connecting the dots. We look at the

13 totality of the evidence. So -- and we're not

14 going to -- I mean I can't say that we're going

15 to go and say every single one of these we'd

16 better find some documentation at -- in the DOE

17 records to corroborate it. It's really going to

18 depend on what they're saying, how much detail

19 they're giving us. 

20 I think that testing the questions,

21 like you suggested, could be very helpful in that

22 process, but we do look at everything in the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

81

1 information that's provided to us. The DAR

2 records are very helpful in many occasions. 

3 And as I said, you're talking about a

4 work process that's very specific in carpentry or

5 it's very specific to some other occupation. We

6 have SEM that helps us with that and we do have

7 these work processes. I think that all those

8 things together can help, but we're definitely

9 not going to disregard the questions. That's why

10 I think our purpose is to make this a little bit

11 more helpful, make this something that we can use

12 in the adjudication process more efficiently.

13 CHAIR MARKOWITZ: So I have a question

14 about this, the working of this language. It

15 looks as if the new Occupational History

16 Questionnaire -- let me just say that members of

17 the public are not necessarily acquainted with

18 the abbreviations we use, so that when we refer

19 to things we should very briefly explain them so

20 everybody in the room has a chance of

21 understanding what we're discussing as a board.

22 But so the occupational -- let's say
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

82

1 the Occupational History Questionnaire changes

2 that we recommend are accepted but they are

3 tested and found not to be sufficient to support

4 the 16-03 process, which is the new policy,

5 newish policy linking diseases with work tasks,

6 but nonetheless having that additional

7 information on tasks is going to be useful, and

8 having the information on vapors, gas, dust and

9 fumes is going to be useful. 

10 So I'm wondering whether we should

11 recommend testing this but not link it to see

12 that it's sufficient to support a specific

13 policy, because I think it's going to be useful

14 above and beyond that policy. By the way, we

15 don't know where that policy's even heading.

16 MEMBER WELCH: Actually, I agree with

17 that. As I read it I thought, oh, this is too

18 specific. So how about since I'm taking another

19 recommendation back into --

20 CHAIR MARKOWITZ: Well, I think -- no,

21 we can amend this.

22 MEMBER WELCH: Okay.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

83

1 CHAIR MARKOWITZ: We can amend it. 

2 But while we're thinking about new language I

3 think Dr. Sokas wants to say something.

4 MEMBER SOKAS: Thank you. So I mean

5 the point of the questionnaire review is not so

6 much to validate the questionnaire. It's not to

7 sort of see how accurate it is. It's to make

8 sure that the questions make sense and that

9 they're user-friendly, I think. I mean I think

10 that's the initial interpretation I took away

11 from it. And I think you could still interpret

12 the language that way. So it's less a formal

13 validation and more kind of an iterative approach

14 to creating questions that people can actually

15 understand.

16 CHAIR MARKOWITZ: Dr. Dement?

17 MEMBER DEMENT: Yes, I agree with

18 Rosie. I think we're not looking for a

19 statistical validation of this questionnaire. 

20 We're primarily interested in a couple of

21 questions. 

22 First of all, the way we ask these
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

84

1 tasks is relatively important. Can the worker

2 actually identify with it? So it's sort of face

3 validity. And many times in developing these

4 questionnaires for the BTMed we've tested it by

5 sitting with workers in focus groups and asking

6 them about the task. Do they understand it? Is

7 it worded in a way that they can relate to it? 

8 And if not, they tell us why not. So I -- it's

9 sort of face validity of the wording of the

10 question and to collect information.

11 The second is of course respondent

12 burden. I mean, we find in the BTMed after we've

13 been with this individual for a half hour to 45

14 minutes we've pretty much exhausted their ability

15 to really participate in the process. So there's

16 -- we're looking at the ability to collect the

17 information in a way that they understand and we

18 can understand in trying to interpret it.

19 CHAIR MARKOWITZ: Dr. Cassano?

20 MEMBER CASSANO: Just a third point to

21 that though is that the claims examiners feel

22 comfortable with it I think is another testing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

85

1 point and that they feel confident that the

2 information is useful to them. Because again, if

3 the claims examiner discounts it, it really don't

4 matter how much good information is on there. So

5 we may want to modify it.

6 CHAIR MARKOWITZ: Dr. Boden?

7 MEMBER BODEN: Hopefully this is my

8 most trivial comment of the day, but I assume

9 that we're -- we'll have to see and wait, but

10 just a small wording correction on the written

11 version refers to "Bullet 16-03." I think we

12 meant "Bulletin."

13 CHAIR MARKOWITZ: So what we need is

14 some new proposed language. Dr. Welch?

15 And, Kevin, is it possible to change

16 this so we can see the language, so we know what

17 we're voting on? Thank you.

18 MEMBER WELCH: So I'd recommend that

19 we have it just end at the end of the sentence so

20 it says "recommended be tested multiple times." 

21 Well, wait. Let me just -- multiple times for --

22 CHAIR MARKOWITZ: You had it Kevin,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

86

1 but --

2 MEMBER WELCH: It's the very last one. 

3 It's the last one. Yes.

4 So we take out "to determine if the

5 information obtained is sufficient to support the

6 process."

7 CHAIR MARKOWITZ: Dr. --

8 MEMBER SOKAS: How about instead of

9 "tested multiple times," "to be pretested for

10 ease of use?"

11 MEMBER WELCH: Okay.

12 CHAIR MARKOWITZ: I'm sorry. Could

13 someone repeat --

14 MEMBER WELCH: "Pretested" -- "be" --

15 "We recommend that the version of the OHQ

16 developed in response to these recommendations be

17 pretested for ease of use." And we could say

18 "face validity." I'm not sure. Yes, okay. 

19 There seems to be some consensus. So "for ease

20 of use and face validity." And the delete the

21 rest of the sentence.

22 CHAIR MARKOWITZ: Dr. Silver?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

87

1 MEMBER SILVER: Are we at all

2 interested in whether these questions that were

3 developed for the construction trades are

4 transferrable to non-construction or production

5 broadly defined? Would we like DOL to report

6 back to us on that issue?

7 CHAIR MARKOWITZ: Yes, I don't think

8 -- I think we should keep this recommendation

9 broad. I don't think we should get into

10 particulars about what we might learn through the

11 pretesting process. I think we'd probably come

12 up with a number of individual items. But we can

13 -- we could add that for instance to the

14 rationale, but I don't see putting it in a

15 general recommendation.

16 So are there other comments on this? 

17 (No response.)

18 CHAIR MARKOWITZ: So this is a

19 friendly amendment. This is a revised

20 recommendation. We're going to -- I can't

21 remember. Have we -- is there a motion to accept

22 this recommendation?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

88

1 PARTICIPANT: So moved.

2 CHAIR MARKOWITZ: Is there a second?

3 PARTICIPANT: Second.

4 CHAIR MARKOWITZ: Okay. So are there

5 any comments, further comments on this?

6 (No response.)

7 CHAIR MARKOWITZ: Okay. So all those

8 in favor, please raise your hand.

9 (Show of hands.)

10 CHAIR MARKOWITZ: All those opposed? 

11 Any abstentions? And Dr. Sokas?

12 MEMBER SOKAS: Yes.

13 CHAIR MARKOWITZ: Mr. Griffon?

14 MEMBER GRIFFON: Yes.

15 CHAIR MARKOWITZ: Okay. Thank you. 

16 Are there -- Dr. Welch, are there any other

17 recommendations on the OHQ, or are we done?

18 MEMBER WELCH: We're going to make a

19 fifth one, which -- to break out the taking

20 occupational history outside of DOE.

21 CHAIR MARKOWITZ: Right. Okay. Okay. 

22 But we still need to formulate that?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

89

1 MEMBER WELCH: Yes, we need to

2 formulate that.

3 CHAIR MARKOWITZ: Okay. 

4 MEMBER WELCH: So for this -- for what

5 we have here we can't vote on, we've accepted --

6 CHAIR MARKOWITZ: Right. Okay.

7 MEMBER WELCH: -- what we can vote,

8 and I'll present one more.

9 CHAIR MARKOWITZ: It's 10:00. We're

10 going to take a 15-minute break. We'll be back

11 at 10:15 and resume. Thank you.

12 (Whereupon, the above-entitled matter

13 went off the record at 10:02 a.m. and resumed at

14 10:17 a.m.)

15 CHAIR MARKOWITZ: Okay. We're going

16 to get started. All the Board members are

17 physically here. We're going to move on with the

18 SEM report.

19 Dr. Welch?

20 MEMBER WELCH: Okay. So the next one

21 we're going to -- the next topic the Committee

22 worked on was a presumption for COPD, and it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

90

1 really grew out of working on the Occupational

2 History Questionnaire. So we took this one. 

3 It's related, very strongly related to exposure

4 assessment, so we took it on as part of the SEM

5 Subcommittee.

6 So there currently is a COPD

7 presumption which I've summarized here on the

8 slide. 

9 CHAIR MARKOWITZ: Sorry. Could you

10 explain what -- just what COPD is?

11 MEMBER WELCH: Oh, yes. Thank you. 

12 So COPD stands for chronic obstructive pulmonary

13 disease and it's an umbrella term for a

14 combination of people who might be told they have

15 chronic bronchitis or emphysema. Both of those

16 are part of COPD. And what it is it's the

17 development of disease of the airways, either

18 destruction of the airways or extra phlegm

19 production, both of which interfere with airflow

20 in and out of the lung. It's pretty common. 

21 And it used to be that smoking was the

22 major cause of COPD. Worldwide smoking is no
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

91

1 longer the major cause and the major cause is

2 this -- these vapors, gases, dust and fumes

3 around the world that we were talking about

4 earlier. And it's pretty common. COPD is pretty

5 common among the former workers that we've

6 examined in the building trades. And I think

7 that's probably true for the other program that I

8 was referring to as production workers. 

9 So the current bulletin requires 20

10 years of exposure prior to 1980 in a subset of

11 labor categories. And --

12 PARTICIPANT: Sorry. Before you do

13 that, can we wait a second until Dr. Sokas gets

14 back?

15 MEMBER WELCH: Oh, okay. Yes, yes. 

16 We'll wait.

17 CHAIR MARKOWITZ: No, we should just

18 continue.

19 MEMBER WELCH: Oh, okay.

20 CHAIR MARKOWITZ: Yes.

21 MEMBER WELCH: Okay. And if someone

22 doesn't meet the presumption for that 20 years of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

92

1 exposure prior to 1980, the bulletin allows an

2 industrial hygienist, which can be a referral

3 from the claims examiner, to provide a well4 rationalized discussion of case-specific evidence

5 that again gives them 20 years of asbestos

6 exposure. So if they're not in the labor

7 category, the industrial hygienist can say they

8 have the same kind of exposure those labor

9 categories would have had. 

10 And then they have to have medical

11 evidence from a qualified physician which

12 documents a diagnosis of COPD. The bulletin says

13 documented diagnosis of COPD after evidence of 20

14 years of significant asbestos exposure. It's not

15 clear to me in that -- in the way the bulletin

16 works whether that has to be in the medical

17 records, but since we're going to recommend

18 getting rid of this bulletin in any case, we

19 don't really have to understand that. So pretty

20 much it's saying 20 years of asbestos exposure

21 prior to 1980. 

22 Now that is -- doesn't include all the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

93

1 dusts that are included in the VGDF combined

2 matrix, and the cutoff of 1980 is -- might be

3 appropriate if all you want to assess is very --

4 high exposure to asbestos, but certainly

5 exposures to the other causes of COPD, the other

6 dusts, vapors, gases, fumes continued after 1980. 

7 So both the focus on asbestos and the 1980

8 criteria are way too narrow to encompass current

9 literature and medical evidence about causes of

10 COPD.

11 So we're recommending that it be

12 replaced with a presumption -- different

13 presumption, that it would be any claimant who

14 has a physician's diagnosis of COPD who worked in

15 a covered facility. So they have to have the

16 employment verification and the diagnosis, which

17 can be accepted the way DOL currently does that. 

18 They were either in any of the labor

19 categories in Attachment 1, and we would add to

20 Attachment 1 all construction and maintenance as

21 a general category. So in any of the labor

22 categories in Attachment 1 as amended for at
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

94

1 least five years cumulative including non-DOE

2 work, or who reported exposure to VGDF on an OHQ

3 for a period which an aggregate total is at least

4 five years cumulative, including non-DOE work, so

5 that the labor categories construction and

6 maintenance the exposure is presumed and that it

7 doesn't have to be necessarily collected on the

8 Occupational History Questionnaire, although it

9 -- we presume it would be. But if the person is

10 not in one of the labor categories on Attachment

11 1, they can still be accepted under this

12 presumption if they report exposure to VGDF on

13 the OHQ. And we discussed how that is going to

14 be reported when we -- and we voted on that as

15 part of the OHQ.

16 So then if they meet those two

17 essentially exposure assessment -- way of

18 assessing exposure to VGDF, they're presumed to

19 have sufficient exposure to toxic agents to

20 aggravate, contribute to or cause COPD. And then

21 we have a footnote that if they -- if a claimant

22 does not meet those requirements, particularly if
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

95

1 they've had fewer than five years of exposure,

2 those claims should be further evaluated on an

3 individual basis with an industrial hygiene

4 referral because five years is a -- it's a

5 reasonable standard for the presumption, but

6 there will certainly be many cases that could

7 develop with fewer than five years. And the

8 industrial hygienist and then a CMC could compare

9 that to the literature database and determine

10 whether they had sufficient exposure to

11 aggravate, contribute to or cause. 

12 So the document I gave you, the

13 presumptions, has a lot more detail supporting

14 the rationale for this, but -- and we did -- I

15 did talk a little bit when we were talking about

16 adding that question about VGDF to the

17 occupational history about the literature that

18 supports the fact that this large group of

19 aerosol exposures that include vapors, gas, dust

20 and fumes in an occupational setting cause COPD. 

21 So I don't think I have to go through that again.

22 The -- our Committee spent some time
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

96

1 discussing this five years cumulative, and I've

2 put some rationale in the document for that. 

3 It's based on the study that we did in BTMed

4 looking at COPD among construction workers and

5 looking to see at what level of exposures -- how

6 many years of exposure you start to see an impact

7 of the dust on COPD. And that was in that five8 year range.

9 And then looking at the other

10 literature, the population-based studies that I

11 mentioned, to see if those could help us with a

12 number of years of exposures used for a

13 presumption. And generally it seems to support

14 that. There are exposures within the VGDF

15 category that probably have a higher risk in

16 terms of a -- if you try to look at estimating

17 how -- what kind of exposures measured in

18 milligrams per cubic meter in the air, what kind

19 of exposures over a lifetime cause occupational

20 COPD, there's some agents that are -- you need --

21 probably need a smaller dose. Some agents you

22 probably need a larger dose, a cumulative dose. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

97

1 So it again looked like those five years is -- we

2 thought it was pretty reasonable for the

3 presumption. And then if people don't have five

4 years, they'd get an individual assessment.

5 So why don't we open it up for

6 discussion?

7 CHAIR MARKOWITZ: Oh, okay.

8 MEMBER WELCH: Well, let me make sure

9 I don't have another slide. 

10 (Pause.)

11 MEMBER WELCH: This is what we already

12 voted on that we're adding a specific question on

13 VGDF. 

14 Oh, yes, there was one other thing. 

15 So these agents are going to be on the --

16 specifically on the Occupational History

17 Questionnaire. So this is a way of being

18 redundant, but all those agents are known to

19 cause COPD individually as well as part of this

20 VGDF matrix. So we're recommending that these --

21 if these specific agents are reported on the OHQ

22 separately or in combination for a period of five
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

98

1 years, that would also be sufficient. 

2 And as I said, we think that these are

3 going to be much overlapping, but if people

4 report five years of exposure to cement dust,

5 they should also have reported five years of

6 exposure to VGDF. But we're recommending adding

7 these specific exposures because asking people

8 cumulative exposure to this big matrix may be

9 hard for people to understand. But they will

10 know that they did metal cutting and grinding or

11 exposure to diesel exhaust for those periods of

12 time. So it will -- it should manage to capture

13 by being redundant all the claimants who would

14 have had this -- enough exposure to make this

15 presumption. 

16 CHAIR MARKOWITZ: Do you have a slide

17 with Attachment 1 just so people can see what the

18 list of job titles --

19 MEMBER WELCH: No, I don't.

20 CHAIR MARKOWITZ: So, Kevin, I have it

21 on mine, if you would bring up my -- and while

22 he's finding that -- so I'm going to just explain
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

99

1 BTMed. 

2 Dr. Welch referred to BTMed. This is

3 the Former Worker Medical Screening Program

4 supported by the Department of Energy for the

5 last 20 years in which the CPWR has examined 25

6 or 30,000 construction workers, many of them

7 repeatedly over time, in which they've both

8 assisted individuals in understanding their

9 illnesses, but also published studies about their

10 experience regarding COPD and other diseases in

11 the population.

12 So if you just go down until you see

13 a slide that's impossible to read, it's

14 Attachment 1.

15 (Laughter.)

16 CHAIR MARKOWITZ: It may be possible

17 to read up there, but not on the screen that

18 we're looking at.

19 So while he does that, Dr. Cassano,

20 you --

21 MEMBER CASSANO: Yes, it's hard to do

22 this without seeing what her -- what the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

100

1 recommendation is, but --

2 (Simultaneous speaking.)

3 CHAIR MARKOWITZ: There you go. So

4 just -- 

5 MEMBER WELCH: And this was --

6 Attachment 1 I think appears in two different

7 places, because the Attachment 1 I was talking

8 about was for the COPD presumption.

9 CHAIR MARKOWITZ: Right.

10 MEMBER WELCH: But I think it's the

11 same. It's the same as the attachment for the

12 significant asbestos exposure, and that makes

13 sense. So then for the COPD presumption we would

14 add another bullet that says all construction and

15 maintenance. And some of those are obviously

16 construction and maintenance tasks. Not all of

17 them are. Thank you for putting that up there.

18 CHAIR MARKOWITZ: Okay. Dr. Cassano? 

19 So you can go back to her --

20 MEMBER CASSANO: Yes, I just want to

21 add -- ask if we can add something to the caveat

22 at the bottom. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

101

1 MEMBER WELCH: And I didn't talk about

2 this, but we'll -- can you go back up to the

3 first slide? Oh, no. I can. Oh, let's see if

4 I'm capable of doing this. There it is.

5 MEMBER CASSANO: Yes, so you talk the

6 five -- on the caveat on the bottom if somebody

7 doesn't meet the five-years of exposure, but

8 we're still talking only about construction and

9 maintenance workers. And there are people --

10 even the secretaries or the administrative

11 support, some -- most of the time in these

12 facilities they're sitting in a cage in the

13 middle of the production area or they're in an

14 office that isn't isolated. And so I think we

15 need to add whatever -- those persons that don't

16 fall into the occupational categories, or however

17 you want to word that to -- that says anybody.

18 MEMBER WELCH: I think that's there,

19 because it says -- so after the "or." So they're

20 in any of the labor categories in Attachment 1 or

21 with reported exposure to VGDF on the OHQ for a

22 period of five years. So they don't have to be
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

102

1 in one of those labor categories. They have to

2 answer the question positively. So that could be

3 anybody.

4 MEMBER CASSANO: Right. That's true

5 if the OHQ is going to be used as prima facie

6 evidence of exposure.

7 MEMBER WELCH: Yes, well, I mean,

8 these things all -- they relate to each other. I

9 mean, you can't have this presumption without

10 those changes on the OHQ because you wouldn't be

11 assessing the -- you need that question for VGDF. 

12 So we're -- I'm assuming that that's true. And

13 then --

14 MEMBER CASSANO: Okay.

15 MEMBER WELCH: -- I don't know, it

16 could be that -- I mean, we should probably

17 discuss whether we -- I don't think it makes

18 sense to make a recommendation that the OHQ

19 should be considered a valid piece of

20 information. And actually in the direct disease

21 work process I did put up that part of the text

22 that says it is. So I think now as part of a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

103

1 procedure the Occupational History Questionnaire

2 is considered a --

3 MEMBER CASSANO: Yes, I mean that may

4 be -- we're going to -- you're going to -- we're

5 going to get to my presentation in a little bit,

6 but I think once we do our meeting in -- with the

7 people out in Seattle and we have -- we've delved

8 down to as low a level as we can as far as

9 determining what really happens when -- where the

10 pedal meets the metal or the leather meets the

11 road or whatever you want to say -- that we will

12 then come up with some of those recommendations. 

13 And I think that might be with the changes that I

14 think Rachel wants to make regarding the OHQ,

15 that we may be able to make that recommendation. 

16 That is it is used. But I'm not ready to do that

17 yet.

18 CHAIR MARKOWITZ: So just to be clear,

19 this recommendation sets out two exposure routes

20 from the presumption linking it to COPD. One

21 exposure route is five years working at DOE in

22 any construction or maintenance job title. And
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

104

1 the other route -- and you can go either route. 

2 You don't need both. The other route is five

3 years of exposure to vapors, gas, dust and fumes. 

4 And in this formulation of the recommendation it

5 can include employment outside of the Department

6 of Energy. 

7 So, Dr. Friedman-Jimenez?

8 MEMBER WELCH: Let me just make one

9 correction. You had said the labor category was

10 at DOE, but it's -- it could be outside of DOE as

11 well.

12 CHAIR MARKOWITZ: Okay. I'm sorry. 

13 Yes, okay. Okay. 

14 Dr. Friedman-Jimenez?

15 MEMBER FRIEDMAN-JIMENEZ: Just a

16 question. Didn't we just vote to remove the

17 occupational history of jobs outside of the DOE

18 from the OHQ?

19 CHAIR MARKOWITZ: So to clarify, we

20 put off that issue for further discussion. So

21 right now we have no position on that issue.

22 MEMBER FRIEDMAN-JIMENEZ: Okay. I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

105

1 just wanted to point out that this will be hard

2 to do. I agree with including non-DOE work. I

3 think that that's contributing in the same way

4 that cigarette smoking is contributing, or

5 analogously. And it's important to know what

6 non-DOE work is being done that involves similar

7 exposures, but that would be hard to do if we

8 didn't have non-DOE work as part of the OHQ.

9 MEMBER WELCH: So my plan was to take

10 that point that we took off that one slide and

11 present it as a separate recommendation. So

12 we're going to recommend it. I just wanted to be

13 able to put it on a slide by itself so we know

14 it's a recommendation. So, but just -- I guess

15 we'll probably do that tomorrow or after lunch,

16 depending on timing. So before we leave here

17 today that we could vote on that.

18 CHAIR MARKOWITZ: Well, but for the

19 sake of clarity I wonder whether we really should

20 include reference to non-DOE work in this

21 presumption, whether we really want to open the

22 door here for this disease with the fact that we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

106

1 haven't made a recommendation or really discussed

2 the recommendation for -- which is something

3 which would apply to a lot of conditions, not

4 just COPD. Think trichloroethylene and kidney

5 cancer, right? So it would apply to a lot of

6 conditions. 

7 And so what I wonder is whether we

8 should consider removing that provision from this

9 recommendation and then revisiting the issue of

10 non-DOE work, because it applies to any number of

11 conditions, and then if need be amending this

12 later on to reflect our more considered thinking

13 about non-DOE work.

14 MEMBER WELCH: That's okay with me. 

15 Yes, I -- yes, we could do that. 

16 Does anybody object to that, to

17 amending it to at this point take off the

18 parenthetical?

19 CHAIR MARKOWITZ: Well, yes. So let's

20 see. Let's have further discussion about that

21 particular point, I think.

22 Dr. Boden?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

107

1 MEMBER BODEN: I think it would be a

2 little simpler to hold off on approving this

3 until after we discuss the other one and then

4 come back to this rather than amending this and

5 then amending it again. So that would be my

6 suggestion is to keep things simple. 

7 MEMBER WELCH: We could -- you know

8 what we could do is we could -- there's one more

9 slide too I have that I didn't show you. We

10 could discuss the -- this whole presentation and

11 kind of everybody's got their mind around it and

12 ask all the questions. And then we could vote on

13 it after vote on the adding non-DOE work.

14 CHAIR MARKOWITZ: Yes. Mr. Turner?

15 MEMBER TURNER: I would like to

16 consider all the workers because like at Rocky

17 Flats there was a couple of secretaries that came

18 down with beryllium disease. And I think that it

19 would be all workers. 

20 MEMBER WELCH: Yes, the plan is that

21 all workers could be included. If they weren't

22 in -- on the Attachment 1 list, they would need
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

108

1 to report that they had vapor, gas, dust and

2 fumes exposure, which the new Occupational

3 History Questionnaire is going to ask people were

4 you exposed to vapors, gas, dust and fumes and

5 for how long? And so they would hit that -- they

6 could get into this presumption without being in

7 one of those job titles. So the plan is

8 everybody is eligible. There's two different

9 ways you can get exposure documented.

10 CHAIR MARKOWITZ: Dr. Cassano?

11 MEMBER CASSANO: Yes, I think as -- in

12 response to the list, I think on that other

13 discussion of non-DOE work we could add -- we

14 could word that in such a way that it could apply

15 to all of these things, all of the considerations

16 and all of the different medical conditions and

17 exposures, that we write it in such a way that it

18 says that when discussing the relationship

19 between an exposure and an outcome that non-DOE

20 work that includes that exposure or synergistic

21 exposures are considered. And I think that would

22 cover it for everything rather than putting it in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

109

1 each individual presumption. Just my thoughts.

2 MEMBER WELCH: Yes, but I think that

3 what Les was saying I think is that if we're

4 going to vote on particularly the five years,

5 that we're all going to agree on the five years,

6 we need to have already agreed that we're

7 including non-DOE work as part of the assessment

8 of causation, contributing and aggravating before

9 -- because that's -- would -- we're assuming that

10 for this. If it was DOE only, you might do

11 something different with the five years. I'm not

12 sure. 

13 So let me go ahead and show you the

14 last slide, which --

15 (Simultaneous speaking.)

16 CHAIR MARKOWITZ: But, Dr. Friedman17 Jimenez, you have a point --

18 MEMBER WELCH: Oh, sorry.

19 CHAIR MARKOWITZ: -- a follow-up point

20 here.

21 MEMBER FRIEDMAN-JIMENEZ: A comment on

22 that. Similar to smoking I think we should
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

110

1 handle non-DOE work as an additional contributing

2 cause. And again, we should really emphasize the

3 concept of aggravation, contribution to and

4 cause, because that sidesteps all of these issues

5 and it's really the fundamental change in culture

6 that we're recommending.

7 CHAIR MARKOWITZ: Dr. Boden?

8 MEMBER BODEN: I have a question about

9 the list of occupations and tasks. I'm wondering

10 -- so the list looks like a good list. I

11 certainly didn't think of anything I would add to

12 it, but I'm wondering if the list should be

13 considered open-ended and whether for example all

14 the work that's been done by the former worker

15 projects might end up having things in it that

16 would add to this list and that we might even

17 think about a recommendation about using that

18 work. But I'm not really sure, so I'm looking to

19 people who really have been more engaged in that.

20 CHAIR MARKOWITZ: So just to clarify,

21 the recommendation is -- expands this Attachment

22 1, that specific list. It includes all
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

111

1 maintenance and construction job titles. Just to

2 be clear.

3 MEMBER BODEN: Yes, understood.

4 CHAIR MARKOWITZ: Okay.

5 MEMBER BODEN: But I was wondering --

6 it's always in a way easier to have something on

7 a list than it is to try to figure it out other

8 ways. And I'm wondering whether work that's

9 already been done in this area could actually

10 provide additional useful information about tasks

11 to be added. I'm really wondering. I don't

12 know. I have no set opinion about that. 

13 CHAIR MARKOWITZ: Yes, yes, yes. I --

14 yes, I don't think empirical studies are

15 available to really look at the full spectrum of

16 other workers in the DOE Complex to be able to

17 come to a presumption about that. It becomes

18 very complicated because there are a huge number

19 of job titles across the complex that change over

20 the decades and are changed from site to site. 

21 So I don't think we have empirical data that we

22 can rest on.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

112

1 MEMBER BODEN: But I was actually

2 thinking about tasks rather than job titles, but

3 maybe the same answer would apply.

4 CHAIR MARKOWITZ: Well, right. Yes,

5 multiply your job titles by X number of tasks per

6 job and you, get an even higher number, so --

7 MEMBER WELCH: The list is really

8 occupational categories.

9 CHAIR MARKOWITZ: Right.

10 MEMBER WELCH: So that -- and that in

11 a way is easier, although there may -- some of

12 the things on those occupational categories

13 probably don't exist at -- in the DOE Complex,

14 but it does cover a lot of people once we agree

15 that construction and maintenance -- that all

16 construction and maintenance are included, that I

17 think will really streamline it. 

18 And actually, I mean, one point I

19 should have made at the beginning, having

20 reviewed -- all of us have reviewed a bunch of

21 COPD cases and they -- the number of times that

22 the case goes back to the claims examiner and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

113

1 maybe goes to the final adjudication branch, and

2 then we've seen ones that are remanded and

3 overturned, it seems these cases take a lot of

4 time and a lot of work on the part of Department

5 of Labor staff to make a determination. 

6 So we picked this one to start a

7 presumption with to really make it more timely

8 and more -- I guess more fair in a way because it

9 becomes clear who meets the presumption. And

10 we've had cases of construction workers who work

11 at the same site, been there about the same

12 amount of years in similar tasks, and one has

13 their claim accepted and one doesn't. And they

14 know that. They're -- maybe they play poker

15 together. So it -- there's a lot of sense that

16 this particular disease, it's just people don't

17 really understand what they need to provide. 

18 So I think it would be better for the

19 workers, but I also -- in terms of timeliness and

20 efficiency we think it will be better for DOL as

21 well. So -- which is really what presumptions

22 do. They streamline the process. And the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

114

1 presumption is good, it's a fair application of

2 the information.

3 CHAIR MARKOWITZ: Dr. Friedman4 Jimenez?

5 (No response.)

6 CHAIR MARKOWITZ: Dr. Silver?

7 MEMBER SILVER: A concrete example of

8 Dr. Welch's point, our Presumption Subcommittee

9 recently looked at -- or Working Group looked at

10 a handful of cases, and one of them was a COPD

11 case. Towards the end of the process someone at

12 DOL compiled the list of the doctors, 24 doctors

13 and 1,700 pages.

14 CHAIR MARKOWITZ: So if you could put

15 your card down, Dr. Silver, that would be great.

16 Okay. So --

17 MEMBER WELCH: Okay. So --

18 CHAIR MARKOWITZ: -- you have more,

19 Dr. Welch?

20 MEMBER WELCH: I have a couple more

21 points. So in terms of -- we discussed the

22 issues about timing and duration, and timing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

115

1 since last exposure. And these exposures to

2 vapors, gases, dust and fumes continue to take

3 place on DOE sites. And as I mentioned earlier,

4 for many of the dusts included in the overall

5 category there's not an occupational standard. 

6 So that -- and that's why I said many of them are

7 unregulated. So we believe that it should be

8 presumed that relevant reported exposures at any

9 period of employment are contributory up to the

10 present time. So there's no date cutoff where we

11 assume exposure is changed in some way. 

12 And duration of exposure, I did talk

13 about that. We started -- I started thinking

14 about it in terms of this 2015 study that we

15 published looking among construction workers

16 about when we began to see a signal for COPD

17 related to dust exposures and then looked at the

18 other literature to see if there was anything

19 that could change that estimate of five years. 

20 And it seemed to be supportive. So that was the

21 duration of exposure.

22 And time since last exposure, one
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

116

1 might -- let's say somebody has been retired for

2 10 years and gets a diagnosis of COPD. Well,

3 could work have contributed to that if he's

4 already been away from exposure for a long time?

5 And we concluded definitely they can. And that's

6 the nature of that disease. It's slowly

7 progressive. 

8 People often, particularly if they're

9 getting COPD and it's getting worse and they're

10 in their 60s, they think, oh, I'm just getting

11 old, I'm slowing down, just can't walk up the

12 stairs fast enough, don't sleep as well, but

13 don't really think about going to the doctor. 

14 And people often get a diagnosis of COPD when

15 they get a flu or they get a bad cold and they

16 really feel bad and they go to their doctor. And

17 that was the precipitating event. It didn't --

18 that flu didn't cause their COPD, but it knocked

19 them over to the point where they felt bad enough

20 to go to the doctor. 

21 I think that Dr. Redlich can probably

22 substantiate this, but when I was working in the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

117

1 hospital often people would come in and say I'm

2 healthy and you look at their lung function and

3 they meet the criteria for Social Security

4 Disability and you practically have to put them

5 on a ventilator to get over their pneumonia, but

6 they didn't know they had COPD because it came on

7 so slowly and we mostly like to ignore things

8 that we can ignore instead of running to the

9 doctor.

10 So anyway, so that we said time since

11 last exposure shouldn't be considered in

12 determining whether VGDF exposure were

13 contributory to COPD. 

14 And then the last point is exposures

15 outside the complex have to be considered. And

16 we've talked about that and we're going to deal

17 with that by going back and voting on another

18 specific recommendation. I think that was my

19 last slide. Yes, I already talked about that.

20 So that the -- there's really one

21 recommendation here, which is the presumption. 

22 So as I said before, I think we decided we'll
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

118

1 vote on this after we vote on the -- including

2 outside -- work outside of DOE, and we'll have

3 some discussion about that once I can edit the

4 slide to give a -- have a specific

5 recommendation.

6 So, Mr. Chairman, how do you want to

7 proceed?

8 CHAIR MARKOWITZ: Yes, sure. So any

9 further discussion? 

10 (No response.)

11 CHAIR MARKOWITZ: So just to remind

12 the Board -- should have done this earlier -- we

13 vote on recommendations, the language, the

14 specific language of recommendations. We don't

15 vote on the rationale. The rationale is provided

16 later. If there are important elements that

17 should be included in the rationale the Board

18 members should raise that at the meeting because

19 the person who elaborated that recommendation

20 will write up the -- a brief but important

21 rationale in the days subsequent to the meeting

22 and it will accompany the submission of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

119

1 recommendation to the Department of Labor. So

2 just a reminder, we're not taking a vote right

3 now, but we will on other recommendations. We

4 vote on the language of the recommendation, not

5 on the rationale. 

6 So is that it, Dr. Welch? We -- okay. 

7 So there's one further recommendation that's come

8 out of your committee which I will review, but --

9 MEMBER WELCH: Yes, actually there's

10 also one that I didn't -- I meant to make a slide

11 on it. Let me explain it to people now and I'll

12 bring back a slide. 

13 We were -- a question was raised about

14 how to look at exposure assessment at sites

15 without a SEM. And our recommendation from our

16 committee was that when DOL sends a case where

17 there's no SEM to industrial hygienists or the

18 CMC, they include information on the same labor

19 category from other sites so that they -- it's

20 not related directly to that specific person, but

21 it is useful for anybody evaluating that job to

22 know what that job exposure entails at other
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

120

1 sites within the complex. 

2 And I'm going to write that up as a

3 recommendation we can vote on, but can we discuss

4 it now?

5 CHAIR MARKOWITZ: Well, why don't we

6 -- no, why don't we discuss it when we see the

7 language --

8 MEMBER WELCH: Okay.

9 CHAIR MARKOWITZ: -- and then --

10 MEMBER WELCH: That sound good.

11 CHAIR MARKOWITZ: Yes.

12 MEMBER WELCH: And then there's one

13 more that --

14 CHAIR MARKOWITZ: Right. Okay. 

15 So --

16 MEMBER WELCH: -- you volunteered to

17 write up a recommendation.

18 CHAIR MARKOWITZ: Right. 

19 So, Kevin, if you could bring up my --

20 and while Kevin's doing that, I just -- I've been

21 asked to point out or ask a couple of people to

22 -- in the audience to identify themselves in case
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

121

1 people want to talk to them. 

2 The representatives, the staff from

3 Senator Cantwell and Murray's office, if you

4 could just indicate raising your hand who you

5 are. 

6 And also Mr. Nelson and Mr. Levin from

7 the Ombudsman's Office. 

8 Is there anybody else I was supposed

9 to point out? Okay. Washington State

10 Department of Labor and Industry. There is a

11 person here from -- and she's -- thank you. 

12 So we're moving on to the final

13 recommendation from the SEM Committee for this

14 board meeting under discussion this morning. 

15 This is a different kind of recommendation; it's

16 not a presumption, but it relates to the SEM and

17 how the SEM is used and how -- frankly the SEM

18 was created and maintained really as the data

19 source for decision -- for a good part of the

20 decision-making that occurs in the claims

21 process.

22 I'll read the recommendation and I'll
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

122

1 work through the rationale. Then I can add some

2 background as we do this. 

3 So the Board recommends that the

4 Division of Energy Employees Occupational and

5 Illness Compensation Program enhance the

6 scientific and technical capabilities to support

7 the development of program policies and

8 procedures to enhance decision-making on

9 individual claims and to inform its assessment of

10 the merit of the work of its consulting

11 physicians and industrial hygienists. 

12 So the next slide. I don't -- Kevin,

13 I don't have control over this, so if you could

14 do it. Or, Laura, you -- no, you can do it if

15 you want. Whatever. Whatever. 

16 So you recall the Institute of

17 Medicine examined the Site Exposure Matrices and

18 wrote a hundred-page report in 2013, made a

19 series of recommendations which were challenging,

20 frankly, to implement. And the Department of

21 Labor implemented some and postponed others

22 pending further activities. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

123

1 Among the recommendations were

2 included: (1) making sure that the site exposure

3 matrices incorporate readily available

4 supplemental data sources into the SEM to provide

5 a more complete picture of known exposure disease

6 links and forming an expert advisory panel to

7 establish explicit causal criteria for use in the

8 program, design and implement a method for

9 reviewing possible exposure disease links, and to

10 identify and peer review any new exposure disease

11 links for use in the SEM.

12 The issue of the one which was --

13 we've -- a subject of a prior recommendation of

14 ours from the fall, which is that the DOL use

15 authoritative sources which are identified in

16 SEM, is something that DOL is implementing and

17 has asked actually further assistance in sorting

18 out those data sources, which we will do.

19 But the Institute of Medicine also set

20 out a whole range of tasks which they ascribe to

21 an advisory panel, but really were not for the

22 most part advisory panel functions. They were
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

124

1 really ongoing functions that scientific and

2 technical experts needed to weigh in on the

3 program on a regular ongoing basis over the long

4 term.

5 Next slide. We've also -- Laurie,

6 could you do the next slide or hand that to me? 

7 Okay.

8 So this is a -- I wrote this up, but,

9 Ms. Leiton, you have to correct me actually if I

10 don't quite have this language, which is that the

11 program has ended its contract with the National

12 Library of Medicine for continually updating the

13 Haz-Map database, which is -- forms part of the

14 core of the SEM. Is that correct language or do

15 I need to amend that.

16 MS. LEITON: We have ended our

17 contract with them, but we do rely on what --

18 they do continue to update it, so we will review

19 and rely on what they have come up with, with

20 regard to any causation or links between disease

21 and exposures. But, yes, our contract itself has

22 ended.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

125

1 CHAIR MARKOWITZ: Okay. Thank you. 

2 So the Board has been asked by the program to

3 provide input into numerous possible exposure

4 disease links, some relating to lymphoma, others

5 relating to prostate cancer, and their

6 relationship to toxins. We haven't done that --

7 gotten to that yet. But clearly it's an

8 important need and frankly it's an ongoing need.

9 While the Board will assist in this

10 request, it's noted that the Board members have

11 full-time positions in addition to serving on the

12 Board and really have no scientific staff support

13 to do those -- that kind of literature search and

14 consensus-type recommendations. And moreover,

15 it's really an ongoing thing. Today it's

16 prostate cancer and given toxin, or it's

17 lymphoma. But this -- these issues repeatedly

18 come up.

19 Next. Oh, it's me. And we've also

20 observed -- in working up the presumptions we've

21 had an opportunity to carefully look at the

22 current policies involving important conditions
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

126

1 and exposure disease links including chronic

2 obstructive pulmonary disease, COPD, asbestos3 related diseases, asthma, and that frankly the

4 current policies are -- do not really fully

5 reflect state-of-the-art scientific knowledge.

6 And so those are the elements of the

7 rationale. 

8 Go back to the recommendation. I

9 would say that the Board has -- I think I speak

10 for the Board that we're certainly willing to and

11 would like to assist the Department of Labor in

12 implementing this -- accepting and implementing

13 this recommendation.

14 So it's open for comments. Dr. Sokas?

15 (No audible response.)

16 CHAIR MARKOWITZ: Mr. Griffon?

17 (No audible response.)

18 CHAIR MARKOWITZ: Yes, Dr. Silver?

19 MEMBER SILVER: We also had a

20 recommendation at our meeting I think a year ago

21 to rearrange the organizational chart for the

22 occupational medicine person assigned to this
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

127

1 program to create more interaction between them

2 and their peers in other parts of the DOL. And I

3 believe we passed it. And I see this overlapping

4 with that reform in that somebody has to do the

5 internal assessment of scientific and technical

6 merit and perhaps that occupational physician and

7 their newfound peers in other parts of DOL could

8 be the key player in doing that internal

9 assessment.

10 CHAIR MARKOWITZ: So, Kevin, if you

11 could just bring up the recommendations. 

12 Let me just respond to that. There --

13 we did recommend in the fall a kind of

14 reorganization of occupational medicine resources

15 within not just OWCP, but actually Department of

16 Labor, I think it was. That was strictly about

17 occupational medicine. It wasn't about all of

18 the functions that we're laying out here. And

19 this would include industrial hygiene -- this

20 recommendation that we're looking at now includes

21 industrial hygiene and toxicology, so it's much

22 broader than that particular recommendation.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

128

1 I would also say that frankly

2 reorganizing occupational medicine within the

3 OWCP or the Department may be -- end up being a

4 little bit more challenging than this

5 recommendation, which is really centered on the

6 program, either internally developing this

7 expertise, enhanced expertise or contracting for

8 it. But it's within the control of the program

9 and subject to availability of resources.

10 You had a follow-up comment and 

11 then -- 

12 MEMBER SILVER: So who do we have in

13 mind to do this ongoing quality improvement? You

14 don't use that phrase, but it was clear to me a

15 moment ago when I knew there was an occupational

16 physician interacting with their peers in DOL to

17 oversee the work of the consulting physicians,

18 but who do we have in mind to improve the

19 analysis of the industrial hygiene work?

20 CHAIR MARKOWITZ: I don't have

21 anybody. You mean a particular entity?

22 MEMBER SILVER: Well, DOL's Energy
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

129

1 Employees Program hasn't done it up to now. I

2 think we need kind of a concrete idea of who's

3 going to be the motive force inside the program

4 to really do this. On the medicine I can see

5 someone, but like where is it going to come from?

6 CHAIR MARKOWITZ: Dr. Cassano?

7 MEMBER CASSANO: I sort of feel like

8 Ken does. This is extremely labor-intensive and

9 I'm not sure how many FTEs it would take to do

10 this. And I think you need a small -- maybe a

11 smaller group of people that can review studies

12 that have been done by things like the IOM or

13 things like the Committee on Toxicology at NRC

14 where DOD and others go to, and not always to do

15 a huge study, but just they bring an issue to the

16 Committee on Toxicology and they say, look, this

17 is what we're thinking of doing. Does this make

18 sense? Give us your recommendations. And so

19 it's not a million dollar project.

20 But I think having been inside

21 agencies, this would be so subject to the

22 vagaries of funding and FTE requirements,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

130

1 etcetera, that I don't think it's feasible to

2 have this internally. Just from my experience.

3 CHAIR MARKOWITZ: Just for

4 clarification, you're arguing for DOL to engage

5 in a contractor? Is that what you're saying?

6 MEMBER CASSANO: Well, not a

7 continuous -- well, yes, they -- there could be

8 like an every-two-year re-look at some specific

9 site or some specific exposure medical condition

10 relationship or a group of them similar to what I

11 -- I sent you that Federal Register. But rather

12 than trying to have people in the agency do that

13 -- because even if you brought a cadre of people

14 in there, some of them -- you're not going to

15 have the breadth of expertise you need to do that

16 internally, I don't think.

17 CHAIR MARKOWITZ: Dr. Dement?

18 MEMBER DEMENT: I think the

19 recommendation itself is rather broad. I don't

20 think we're actually telling the DOL how to

21 accomplish this task. 

22 CHAIR MARKOWITZ: Okay.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

131

1 MEMBER DEMENT: And I agree with you,

2 I think it needs a -- and depending on the issue,

3 of course, needs a wide range of expertise. And

4 it may be that it's partially inside or partially

5 contract. So I don't -- I think we're simply

6 making a recommendation that -- have it available

7 to them, this ongoing technical/scientific cadre

8 of individuals who can help them in this whole

9 process operationally as it goes forward. 

10 CHAIR MARKOWITZ: Dr. Sokas, are you

11 on the line? 

12 (No audible response.)

13 CHAIR MARKOWITZ: Okay. So she wanted

14 to make a comment? Is that -- we don't know. 

15 Okay.

16 Mr. Griffon, also, if you wanted to --

17 if you want to chime in, you're welcome to.

18 Oh, Dr. -- Ms. Vlieger, yes?

19 MEMBER VLIEGER: Sorry, not doctor. 

20 This would not be dissimilar to what the

21 Radiation Board does with the contractors they

22 hire to do the advice on special exposure cohorts
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

132

1 where they actually are assigned a task from the

2 board and then they report back. So I don't know

3 that it would have to be a permanent-type

4 contract or that it could be maybe task-specific,

5 but I think because of the limitations of our

6 meetings and such that it certainly would help

7 move forward some of the questions that come up. 

8 MEMBER SOKAS: This is Rosie. I'm off

9 mute now. 

10 CHAIR MARKOWITZ: Yes, go ahead, Dr.

11 Sokas.

12 MEMBER SOKAS: Thank you. So I mean,

13 I totally agree that a subcontract -- and in the

14 same way that there's a kind of a parent contract

15 for the CMC, there could be an ongoing contract

16 for -- and I would suggest a group that has an

17 explicit worker-centered approach like AOC, for

18 example, where you could have a toxicologist

19 brought in for a particular task,

20 epidemiologists, physicians, industrial

21 hygienists, but you would specify that -- so I

22 think I heard others say that it doesn't have to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

133

1 be laid out entirely in this recommendation, but

2 that it's generally easier for the agency to do

3 this kind of work. 

4 We're going to have the same

5 recommendation for our subcommittee because

6 there's just no way the members of the

7 subcommittee can perform the functions needed. 

8 And it's clear that current staffing isn't able

9 to do it. So your recommendation is absolutely

10 on point, but it could be approached through a

11 contract. 

12 CHAIR MARKOWITZ: Dr. Redlich?

13 MEMBER REDLICH: No, I was just going

14 to strongly agree with the recommendation and

15 exactly how it's carried out I think could be

16 worked out.

17 I think the other -- an additional

18 reason this is so important is that -- I mean, I

19 have spent 25 years trying to educate practicing

20 pulmonologists about occupational lung diseases,

21 and my clinical practice is almost entirely

22 patients referred by pulmonologists to assess if
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

134

1 there is possible work-related disease. And

2 unfortunately treating physicians throughout the

3 United States are really most of them quite

4 clueless about diagnosing work-related medical

5 conditions. My own experience is predominantly

6 with pulmonary COPD and asthma.

7 And so I think that this is just a

8 very important fact that people need to

9 understand so that -- which is why depending on

10 the documentation that a treating physician

11 provides -- why that documentation may not be

12 sufficient. And so that the need to make very

13 clear guidelines and review those and have them

14 based on the latest information -- the physicians

15 doing this out and all across the United States

16 aren't themselves going to be able to do it

17 correctly. 

18 CHAIR MARKOWITZ: So I have a question

19 actually about this, which is that this

20 recommendation lays out certain functions of this

21 enhanced capacity. And my question is whether we

22 should -- whether there are additional ones,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

135

1 whether we should limit it to these three,

2 whether we should have an additional clause that

3 says other functions may also be useful to the

4 program. Because I am concerned there may be

5 some other uses of this capacity and we don't

6 want to artificially limit our idea about this to

7 these particular functions.

8 Dr. Cassano?

9 MEMBER CASSANO: Maybe "enhance" isn't

10 the proper word. Maybe it's "broaden" its

11 scientific and technical capabilities. I know

12 this is some of semantic, but that -- "enhance"

13 sort of means you build up what you have rather

14 than broaden it to include outside groups. And

15 that would solve the problem for me. 

16 And as far as adding other functions

17 other than development of program policies and

18 procedures, I think it's fine the way it is,

19 because I think that encompasses including

20 information about exposure, information about

21 nexus relationships and stuff like that because

22 it talks about supporting the development of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

136

1 policies. So I think -- I don't think we need to

2 add everything possible that this scientific body

3 could do for them.

4 CHAIR MARKOWITZ: Ms. Vlieger?

5 MEMBER VLIEGER: In your comment about

6 limiting it, are you thinking that maybe we

7 should not limit it to consulting only on

8 physicians and industrial hygienists? I think I

9 would agree with that, that we don't want to only

10 look at that issue because that's not our sole

11 charge. If we're going to have outside -- if

12 we're going to task an outside contractor to help

13 us with something, I would not want to limit that

14 recommendation to only specific areas like

15 physicians and industrial hygienists.

16 CHAIR MARKOWITZ: Well, so I'm just

17 going to respond to Dr. Cassano. I think

18 "enhance" is the right word, not "broaden"

19 because right now the program does have access to

20 toxicology, industrial hygiene, occupational

21 medicine, and with perhaps some element of

22 epidemiology. I'm not sure about that. But
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

137

1 "enhance" means really a much deeper bench and

2 perhaps to enhance some of the elements of

3 quality as well. So I prefer the word -- the

4 verb "enhance" rather than simple -- simply

5 address the breadth.

6 So is there any suggested amendment to

7 this before we elaborate? Yes, Dr. Redlich?

8 MEMBER REDLICH: So I just have a

9 question. The final one, inform its assessment

10 of the merit of the work of consulting, because

11 that's one piece of the final decision-making. 

12 The other is the internal process. So are you

13 not including that?

14 CHAIR MARKOWITZ: No, this is the

15 question I'm raising --

16 MEMBER REDLICH: Yes.

17 CHAIR MARKOWITZ: -- because this is

18 not a complete listing of --

19 MEMBER REDLICH: Yes.

20 CHAIR MARKOWITZ: -- everything that

21 this enhanced capacity can do. So I didn't want

22 that the language of this be something that will
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

138

1 seem as limiting. So we could add "and other

2 functions as are deemed helpful to the program"

3 without providing a complete listing.

4 MEMBER REDLICH: Yes, I think it might

5 be good to add some broader statement, because

6 the bottom line is you want to know if the final

7 end product is medically appropriate. So this

8 piece I may be -- but -- and let's see. I guess

9 the enhanced decision-making on individual claims

10 is quite broad, and that probably encompasses all

11 options.

12 CHAIR MARKOWITZ: So should we leave

13 it as it is? Is that the sense? 

14 (Off-microphone comment.)

15 CHAIR MARKOWITZ: Okay. That's good

16 because the person who could actually rewrite

17 this apparently left the room. 

18 (Laughter.)

19 CHAIR MARKOWITZ: So, okay. So a

20 motion to -- let me read the recommendation. 

21 "The Board recommends that the DEEOICP enhance

22 its scientific and technical capabilities to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

139

1 support the development of program policies and

2 procedures to enhance decision-making on

3 individual claims and to inform its assessment of

4 the merit of the work of its consulting

5 physicians and industrial hygienists."

6 Motion to accept?

7 PARTICIPANT: So moved.

8 CHAIR MARKOWITZ: Second? Any further

9 discussion?

10 (No response.)

11 CHAIR MARKOWITZ: So all those Board

12 members who are present, all those in favor of

13 this recommendation, please raise your hand.

14 (Show of hands.)

15 CHAIR MARKOWITZ: All those opposed? 

16 And any abstentions?

17 One abstention. So -- 

18 PARTICIPANT: I agree with it. Just

19 the language is a problem here for some reason.

20 CHAIR MARKOWITZ: So there are 13

21 Board members present. There are 12 votes in

22 favor and 1 abstention.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

140

1 MEMBER SOKAS: And I want to vote yes,

2 please.

3 CHAIR MARKOWITZ: Dr. Sokas?

4 MEMBER SOKAS: Yes.

5 CHAIR MARKOWITZ: Yes. And, Mr.

6 Griffon? Mark?

7 (No response.)

8 CHAIR MARKOWITZ: Okay. So there are

9 14 Board members voting. Thirteen vote in favor

10 and there's one abstention.

11 MEMBER GRIFFON: Steve, did you hear

12 me? I voted yes.

13 CHAIR MARKOWITZ: Okay.

14 MEMBER GRIFFON: You didn't hear me.

15 CHAIR MARKOWITZ: There are -- thank

16 you, Mark. Fifteen Board members present. 

17 Fourteen voted in favor and there's on

18 abstention.

19 So I think that -- Dr. Welch, that

20 completes the Subcommittee report?

21 MEMBER WELCH: Yes.

22 CHAIR MARKOWITZ: Okay. We'll move on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

141

1 to -- thank you -- move onto the next

2 subcommittee, which is the Weighing Medical

3 Evidence Subcommittee. 

4 Dr. Cassano?

5 MEMBER CASSANO: Good morning,

6 everybody. Thank you for being here, and away we

7 go.

8 So just to reiterate a little bit, the

9 members of my subcommittee are myself, Dr. Boden;

10 Dr. Markowitz is a honorary member, Ms. Pope, Dr.

11 Silver and Ms. Vlieger.

12 I wanted to review what the task was

13 for our subcommittee. We were asked not to look

14 at specific scientific information or medical

15 information, but basically to make

16 recommendations pertaining to the materials

17 available to the CEs, the logic process used by

18 the CEs and the training materials available on

19 specific toxicants outside of the SEM and make

20 recommendations. That's what we were asked to do

21 of one of the four functions.

22 Wanted to reiterate a little bit about
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

142

1 our prior meetings. We had a meeting in July of

2 2016 and then a second meeting in September of

3 2016. And then in the Full Committee meeting

4 based on the review of the information we made a

5 recommendation to the Full Committee that the

6 entire case file should be sent to the entire --

7 to the IH and/or the CMC when a review was

8 requested. 

9 And the reason for this was that we

10 found that using only the SOAF, which was

11 basically all that went, that the IH and the CMC

12 had a certain amount of tunnel vision when

13 looking at the totality of the claim and that

14 information that they might have considered in

15 adjudicating the claim if they had seen it was

16 not available.

17 We also asked to review the Part E

18 claims and that we receive the entire case files

19 to review so that we knew what was missing and

20 what was not, because the first set of cases that

21 we reviewed only had the SOAF and a couple of

22 other things. It didn't have the Occupational
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

143

1 Health Questionnaire, it didn't have the EE-1. 

2 And so we requested that we looked at the entire

3 case file. And I guess my statement at this

4 point is sometimes you need to be careful what

5 you ask for.

6 (Laughter.)

7 MEMBER CASSANO: So, and we asked to

8 review the training materials provided to the CE. 

9 Interestingly enough, we were first told, oh,

10 there aren't any outside of the Procedure Manual. 

11 And then at some point in time a whole list of

12 online training documents showed up. And so we

13 looked at those I guess in our -- we looked at

14 those at the next meeting.

15 And finally, we believed at that point

16 it was necessary to speak with claims examiners

17 to understand how they used all of the

18 information they were given and the process -- I

19 don't know how that got turned, but the process

20 by which they made decisions.

21 So we had a third subcommittee meeting

22 in December of 2016 and we reviewed all of these
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

144

1 training materials. And I'm not going to go

2 through each and every individual one, but there

3 was a very good introduction to the claims

4 process session. There is a whole training

5 document on weighing the medical evidence. We

6 didn't spend much time on the beryllium disease

7 because there -- Carrie -- the whole Beryllium

8 Group was working on that separately. And the

9 development for causation and exposure and

10 development for exposure, both the Participant

11 Guide and for the CEs.

12 And then we reviewed 14 Part E cases

13 based upon the use of a template that I

14 developed; I think I showed it at the last

15 meeting, where we went through to see if the

16 proper information was actually available. I'm

17 not going to put that up on the screen. 

18 So this is the result of what we came

19 up with between the 12th of December and the

20 current state of affairs.

21 In general we believe that the

22 training documents were actually very good. They
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

145

1 were very detailed, they explained what needed to

2 be done based on the information that they --

3 that were -- that they were given, or if

4 information was not available. There are -- were

5 several problems.

6 We did note in reviewing the claims

7 folders versus the training documents that there

8 were some gaps between what the documents

9 required and what actually this -- the -- was

10 happening at the claims office didn't always

11 follow.

12 Training documents specifically state

13 to use the OHQ, the SEM, the CMC and the IH

14 toxicology review to determine exposure and

15 causation, and it explicitly stated that the SEM

16 is never to be used as a sole reason for denial. 

17 So, but that's not necessarily what we saw. And

18 it also says that the Oak Ridge Institute for

19 Science and Education, the OHQ, the Medical

20 Monitoring Program and the Former Worker Programs

21 are all considered acceptable sources of medical

22 evidence, but again didn't seem that that always
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

146

1 happened.

2 One thing that was problematic in the

3 development for causation was no CMC review is

4 necessary if no known exposure to a toxic

5 substance or no plausible scientific association

6 between a toxin and a disease. And we're not

7 quite sure how a CE can parse that. So that was

8 one -- that was another issue that we had with

9 the training documents.

10 It does state that you're supposed to

11 look at labor processes. Buildings and areas

12 should be used when a person's labor category is

13 not listed in the SEM. So some of the things

14 that we just heard about as far as lists and some

15 of the presumptions, they're actually supposed to

16 look at all of that. 

17 And an interesting comment about the

18 Former Worker Program was that before EEOICPA was

19 established you could use the Former Worker

20 Program documentation as prima facie evidence,

21 but after 2000 it had to be corroborated. And

22 again, I think when we talk about the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

147

1 Occupational History Questionnaire and the FWP

2 programs, I think that's going to get fixed. And

3 the OHQ evidence must also be corroborated by

4 other evidence.

5 And we noted that only the SOAF goes

6 to the IH and the CMC, and we had already

7 recommended that the entire case file go. I

8 think -- I don't think that recommendation is

9 going to be implemented because I think it's

10 considered too onerous and I -- and now that we

11 know -- I know a little bit and all of us know a

12 little bit more about the process, I think we can

13 more specifically recommend what should go both

14 to the IH and/or to the CMC. The industrial

15 hygienist really has no interest in 1,000 pages

16 of medical laboratory work and things like that. 

17 They -- that's not their purview and it's

18 confusing I think to send all that.

19 And as we said before, the SOAF

20 precludes the consultant from making their own

21 findings of fact, and technically according to

22 the law, the industrial -- or their regulations,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

148

1 the industrial hygienist and the CMC are not

2 supposed to do their own fact finding. And that

3 again is problematic because we -- again, if they

4 don't have all of the information from which to

5 render a reasonable opinion based on all of the

6 evidence, then they're doing a claimant, and the

7 Department, quite frankly, a disservice.

8 And I'm not putting all this out there

9 to be judgmental, but this is our committee

10 telling it as we see it.

11 Review of case files. This was

12 actually quite interesting. There -- not all of

13 the conditions are listed on the EE-1, and that

14 -- for those people who don't know what the EE-1

15 is, that's the actual claim, the initial claim

16 filing -- were adjudicated even though medical

17 evidence was provided verifying the diagnosis. I

18 mean, there were some that had three or four

19 diagnoses, but only one was developed. I mean,

20 it didn't even get to the point of looking at the

21 SEM. So that was an issue.

22 Not all exposures that could cause a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

149

1 particular medical condition were evaluated by

2 the CE. Again, information -- it doesn't seem

3 like anybody ever utilized -- from what we saw

4 anybody utilized information in the OHQ. They

5 would look at the OHQ. They would ask for the

6 DAR. If it wasn't in any of the documents that

7 they got, it was just sort of dropped. And then

8 there were several instances where the claim was

9 -- the claim was denied by the CE only using the

10 SEM without asking either the industrial

11 hygienist or the CMC for -- to render an opinion.

12 What we saw actually was quite the

13 opposite in that even if the SEM supported a

14 nexus between exposure and disease, they would

15 send it to the industrial hygienist for an

16 opinion when in our look at this they really

17 didn't need to because it was well established in

18 the SEM. 

19 And as I think Laura mentioned, this

20 becomes particularly troubling for work sites

21 without a SEM. If they don't find it in the SEM,

22 that's the end of it. And I'm not sure how that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

150

1 gets through the final adjudication board, but it

2 didn't in several instances.

3 And some conditions were either

4 accepted or denied despite whether or not a job

5 was listed in criteria for acceptance. And we

6 didn't quite know how that decision was made,

7 even if it didn't go to industrial hygienist. 

8 Again, we weren't -- sometimes they were accepted

9 and the person was not on a listed exposure

10 category and sometimes it was denied when people

11 were without additional expertise input.

12 And then again when things went to the

13 CMC, again this sort of tunneling of vision, they

14 were only asked to comment on one or two

15 conditions or answer one or two questions. For

16 instance, is this considered a cancer? And they

17 don't -- didn't ask, gee, even if this wasn't a

18 cancer, is there some relationship between what

19 these people were exposed to and what the medical

20 outcome was? 

21 And we already talked about No. 7. 

22 And then cases where the -- there was one case
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

151

1 where; this was a COPD, the district's office

2 commented on a known exposure outcome

3 relationship. And I think it was nitrogen

4 dioxide, not -- yes, and COPD, yet never asked

5 the CMC to review it and the claim was denied. 

6 So that -- and I think the presumptions would

7 have helped with that. 

8 A claim where an IH stated there was

9 no evidence for an association between TCE and

10 Parkinson's disease, which is not quite where the

11 literature is at this point. As a matter of

12 fact, another agency has just established a

13 presumption for TCE And Parkinson's disease. 

14 They do not consider other exposures

15 and in general do not look at the synergy between

16 exposures at all. And I'm talking about

17 synergistic exposures, multiple exposures in the

18 same workplace and the same person. We're not

19 talking about outside DOE or personal exposures.

20 And then some -- I didn't see this

21 often, but a couple of times we did see a

22 radiation case was not developed because the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

152

1 claimant -- that particular claimant was not part

2 of a Special Exposure Cohort, however, there were

3 other cases where under Part E they were

4 developed. 

5 And I think this leads us to a

6 question about consistency. We just looked at

7 two claims. Same exposures, same work

8 categories, two different district offices, two

9 different industrial hygienists, one the claim

10 was accepted, the other the claim was denied. 

11 And so, that leads us to some of the questions we

12 are going to ask on Friday.

13 And one of the reasons we don't have

14 any recommendation is because we still don't feel

15 comfortable enough understanding the process to

16 be able to make good recommendations on how to

17 improve it.

18 So there are four of us going to

19 Seattle on Friday. There are -- representatives

20 from the district office will be there. We

21 wanted to speak directly to claims examiners, but

22 there were questions about job security and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

153

1 multiple other non-exempt employee issues that

2 sort of precluded that -- our ability to do that. 

3 So we are speaking with multiple people, all of

4 whom I believe have been CEs. They are -- first

5 of all, Christy Lang, who is the regional

6 director will be there. Joleen Smith, who is the

7 director of the Seattle office; Charles Elsen,

8 who is an assistant director; and Sadie Fine, who

9 is a supervisor. And apparently -- at least some

10 of them have done actual claims adjudication. 

11 The next question was what kinds of

12 claims were we going to look at? And initially I

13 -- we had requested claims from the Seattle

14 office, and we would like to have seem claims

15 that were in the process of adjudication because

16 we wanted to be able to look at the logic process

17 as they were going through it. That was again

18 determined to be inappropriate because they

19 didn't want the CEs to have any outside influence

20 in making the claims decision, which I can

21 understand. If I'm sitting there as an occ-doc

22 asking questions about a claim that they're
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

154

1 adjudicating to go yes, ma'am, yes, ma'am, and --

2 it's not fair to the claims examiner to do that,

3 and we agreed.

4 So how we ended up is there were four

5 cases that were chosen by our subcommittee that

6 we had already reviewed in December that we had

7 questions about. And we are going to -- we have

8 already developed those questions to ask on those

9 that are specific to those cases. There's a

10 lymphoma case, there's a multiple autoimmunity

11 disease case, a meningioma I believe or a -- I

12 can't remember whether it's a meningioma or

13 glioblastoma, and a case of diabetes and another

14 -- couple of other contentions.

15 Then each district office picked two

16 cases that had already been adjudicated that they

17 chose and then sent to us, and we will be

18 discussing those as well. So we have a total of

19 12 cases to discuss on Friday, 8 of which the

20 district offices picked and 4 of which we picked.

21 And my feeling is that they have given

22 us -- we are -- have been told that we are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

155

1 running the meeting, that this is our meeting and

2 they will respond to our questions. 

3 But I also think two other things. I

4 think that if there are representatives there

5 that have questions about those cases, they

6 should certainly ask us as well.

7 So the content of the discussion will

8 be general questions about the process. We all

9 know what the training document says, but how are

10 you -- how do you actually use the OHQ? Do you

11 use it? 

12 And then again how is the SOAF

13 developed? What is their logic process regarding

14 what I think we should put into the statement of

15 accepted facts? And again, part of that, how

16 does the CE determine what questions to ask the

17 consultant and what they don't think is

18 important? And the whole purpose of getting at

19 this is to find out how we can make this whole

20 process more equitable based on what we've seen

21 on the case files.

22 How do they use the Former Worker
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

156

1 Program documents? I've never seen them in any

2 of the case files even when the -- on the OHQ the

3 person says we've been -- I was in the Former

4 Worker Program.

5 And then we saw a lot -- we didn't

6 really know, but when an outside opinion is

7 available but they still send it to the CMC, how

8 do you determine which is more probative and do

9 you even send it -- do you send the other --

10 which you should I think -- send the other

11 doctor's medical opinion to the CMC, because a

12 lot of times if it's a well-developed medical

13 opinion there will be references and there will

14 be a good rationale. 

15 And determining which is more

16 probative, I've seen situations where I thought

17 quite frankly the outside consultant's medical

18 opinion was much more probative than the one

19 developed by the CMC, yet it was disregarded

20 because that person was not the treating

21 physician. And I'm like, well, that sort of

22 rules out of having any occupational physician
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

157

1 write a -- having their medical opinion accepted

2 because most of the time we're not the treating

3 physician. We are the consultant that determines

4 the nexus. So there are all these sort of

5 inconsistencies that we see that we need to get

6 to the root cause for.

7 And again, this is not judgmental at

8 all. This is just -- this is a big program. 

9 There are lots of different people that are doing

10 these files, some with more experience than

11 others, some with more understanding of what the

12 situation is like in these various work sites and

13 how do we make it more equitable? 

14 So again, questions on the individual

15 -- those were the general questions. And then

16 after that we'll go into the individual cases. 

17 And people are still developing the questions

18 they want to ask because quite frankly we didn't

19 get these files until the early part of last week

20 and most of them are somewhere between -- there

21 was one that was 291 pages. 

22 Faye, you were lucky.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

158

1 And then there was one that was 2,700

2 pages. And most of them were somewhere between

3 1,000 and 2,500 pages. Most -- a lot of us

4 didn't actually get through all of them. So

5 we're still working on the questions. 

6 But several contentions were raised on

7 the EE-1. With medical evidence why were only

8 one or two developed? Where did you make that

9 decision? Why did you make that decision? And

10 what documentation did you use to do that? 

11 Again, we ask it as a general question, but then

12 when we get into the case file we want to ask

13 that question about the OHQ again because if we

14 don't see evidence that it was used, if we're

15 told that it was used, then again there's a

16 disconnect between the ideal and the actual. 

17 Again, how does the CE determine which

18 goes -- what goes into the SOAF because we see a

19 whole bunch of information that seems

20 appropriate, but it doesn't get into the SOAF. 

21 And why were cases denied only after SEM review? 

22 That should never happen according to training
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

159

1 documents. And why were only some questions

2 asked of the district medical consultant? Now

3 hopefully after we get through all of that there

4 will be a general discussion on how to make the

5 process better.

6 There were a couple of other

7 recommendations. And I think that's actually the

8 end of the slide presentation. There are a

9 couple of other things, and then I'm going to ask

10 members of my committee to add what they need to

11 add.

12 We think it would be a very good idea

13 to look at some of these cases retrospectively

14 and see how the presumptions would have assisted

15 in the development of this claim. We think that

16 might be a useful process. 

17 And then one of the things; I think it

18 was Dr. Silver that raised this, is when you look

19 at some of the IH and the CMC reports, there's

20 this sort of wanton abuse of the word

21 "significant." In one paragraph in a SOAF it

22 said, "The industrial hygienist determined that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

160

1 there was significant exposure to toxic in A, B

2 and C." And the next sentence said, "But the CMC

3 determined that that was not -- the exposure was

4 not significant enough to cause disease." No

5 rationale for either in either the industrial

6 hygienist's report or the CMC's report. And this

7 gets put into the final statement of the case. 

8 And significant to most

9 epidemiologists and most occ-docs has a meaning. 

10 It has a specific meaning, and it's not a

11 qualitative word. It's a quantitative word for

12 the most part. And so to use it in a

13 diametrically opposed way in the same paragraph

14 seems totally irrational to me. And we need to

15 get to how this gets developed in this way. And

16 that's what we're hoping to do on Friday. I

17 don't know if it will work. And after that we're

18 going to sit and put our heads together and come

19 up with real recommendations. We can't do that

20 we feel until we get to the end of the line here.

21 In some ways this committee is most

22 dependent on the information that we get from the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

161

1 agency and from the sites because without that we

2 cannot move forward. And so we're very grateful

3 quite frankly to the agency that they responded

4 to us in getting us the training materials and

5 getting us the additional cases so we can

6 actually work on this.

7 Finally, there was one issue that was

8 raised to Dr. Markowitz that he assigned to my

9 committee, and I think I -- at some point I can

10 present it. We haven't really discussed it, but

11 I think it's going to need some broader input

12 than my subcommittee, and that is a question

13 about -- people basically have symptoms, they

14 have medical problems for a long period of time,

15 just like you mentioned with COPD, and then they

16 finally get a diagnosis. 

17 But the wage loss for the disability

18 is only retroactive to the date of diagnosis. 

19 And the question then; I think this is what the

20 person was asking, is how do you compensate for

21 wage loss prior to a definitive diagnosis when

22 you've been having problems with this issue for 5
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

162

1 or 10 years? And I'm not sure if that's

2 something that our subcommittee in and of itself

3 can look at. I think there may be policy that we

4 have to look at, but I think there should be

5 input from other people on the whole committee in

6 order to do that. But I wanted to raise it here

7 as an issue that we are going to look at. 

8 So I'm finished with my formal report

9 and I -- anybody on the subcommittee want to add,

10 please go ahead. Faye?

11 MEMBER VLIEGER: In reviewing our

12 individual cases one of the ones that I was

13 assigned to review the DAR records came from SRS,

14 Savannah River Site. And it was disconcerting

15 that in the DAR records the IH portion of it made

16 a statement about the fact that because this was

17 a clerk they were not exposed to any toxic

18 substances. And I felt that sending that to the

19 Department of Labor that way without any context

20 really, because they just said the clerk labor

21 category was not exposed to toxic substances,

22 therefore there was nothing to report, was front
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

163

1 loading a decision that they had no business

2 making a statement on. And so I just wanted to

3 comment that.

4 Dr. Worthington, if you'd like to talk

5 about that one later on, because it would be PII

6 information.

7 But I felt that the SRS site had no

8 business making that kind of a statement when

9 there was only asked for provide us all pertinent

10 records.

11 MEMBER CASSANO: Les? Dr. Boden?

12 MEMBER BODEN: So one area that's a

13 little different from the things that you just

14 talked about but that is of concern to me; and I

15 haven't really thought about how to frame it for

16 DOL, is in looking over these cases there were a

17 number of them in which it was clear that the

18 person making the claim was not either medically

19 or legally sophisticated and that their claim

20 failed at least in part because they didn't

21 provide the records that were needed for the

22 claim to go forward. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

164

1 And one thing that I think our group

2 wants to -- or at least I want to think about is

3 ways that aside from having somebody who's in an

4 advisory capacity towards that individual person

5 that DOL might help clarify to people what they

6 need to do in order to provide the necessary

7 medical evidence to have their claim go forward. 

8 That is done to some extent, but it doesn't seem

9 to be effective in many cases.

10 MEMBER POPE: I also think that it

11 would have been great to have the actual CEs to

12 speak with, because being a bargaining unit

13 employee or worker myself, I know for a fact that

14 talking to the worker, the people that do the

15 work, you actually find out what's going on. 

16 Being that we're going to be talking to the

17 supervisors, that's fine, but I believe that the

18 reason why we're getting all these

19 inconsistencies is because the CEs are

20 formulating their own opinions about these cases

21 and in a position that they should not be, in my

22 personal opinion, and formulating their opinions
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

165

1 about whether this case should go to the IH or

2 the CMC. 

3 I also found that looking over the

4 cases that I was assigned to being that identical

5 -- not really identical, but similar conditions

6 were diagnosed and then one was approved and one

7 was not just leads you to a lot of questions as

8 to why not? It is seen like there was a lot of

9 supporting data that was in this file that should

10 have made that file being approved, but just try

11 to understand all that and not coming from a

12 judgmental place, but coming from a place of

13 trying to understand the reasoning behind that.

14 MEMBER CASSANO: Just let me respond. 

15 I think one of the things that we had talked

16 about earlier was a survey that could be sent

17 out. And I don't know if we would have the

18 resources to do this, but the only way we could

19 really do this was to -- would be to have a

20 really good validated survey that went out to

21 CEs, non-identifiable, etcetera, and returned in

22 some way that we would not -- that would not make
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

166

1 them feel compromised as far as their position. 

2 And I think that's part of the issue

3 that if they -- if somebody feels, well, if I

4 speak out and I say something, whether it's true

5 or not, but it is a perception that if my

6 supervisor doesn't like what I say, somehow I'm

7 going to get retaliated against. And again, that

8 is not to say that would happen, but people feel

9 that. I mean, anybody that's ever had a boss I

10 think feels that, whether you're a physician or

11 an industrial hygienist or a clerk or whatever. 

12 And I think the only way to be able to

13 really do that would be with a good validated

14 survey, and we would need somebody to help us

15 develop that. And I don't think we have the

16 resources to do it.

17 Dr. Markowitz?

18 CHAIR MARKOWITZ: Well, the issue of

19 -- just to speak to that point, the issue of

20 resources, first we need to decide whether we --

21 what role such a survey would play, whether we

22 would advocate for it. And then we can request
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

167

1 resources. So I don't think the lack of

2 resources should hinder us from moving forward

3 with a good idea.

4 MEMBER CASSANO: I think you had

5 another --

6 CHAIR MARKOWITZ: Yes, I had another

7 point. Actually, the questions in the interview

8 process for Friday, I didn't see the EE-3. Isn't

9 that the occupational history information that

10 the claimant provides as part of the initial

11 application claim?

12 MEMBER VLIEGER: This is Faye. EE-1

13 is the application form.

14 CHAIR MARKOWITZ: Right.

15 MEMBER VLIEGER: It doesn't list any

16 exposures or experience. The EE-3 would list the

17 sites they worked at, the buildings, their labor

18 categories and tasks.

19 CHAIR MARKOWITZ: Okay. So my

20 question was whether you could ask --

21 MEMBER VLIEGER: Yes.

22 CHAIR MARKOWITZ: -- for the level of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

168

1 that. And then secondly, I didn't see that you

2 asked directly about their own experience using

3 the site exposure matrices. So -- 

4 MEMBER CASSANO: We can add those.

5 CHAIR MARKOWITZ: Yes.

6 MEMBER CASSANO: Okay. I mean, as I

7 said, we have not -- we are still in the process

8 of developing questions.

9 CHAIR MARKOWITZ: Sure, sure. 

10 MEMBER CASSANO: We're going to meet

11 again. We met last night. We're going to meet

12 again Thursday night in order to actually get

13 more questions going. Because until you actually

14 look at the files, you don't know. And I guess I

15 wasn't -- when I say EE-1, I think I was

16 including EE-1 and EE-3 as one whole document. 

17 So that's just my ignorance in doing that. But

18 we can certainly add that.

19 Dr. Dement?

20 MEMBER DEMENT: I think it cuts across

21 several different aspects of medical evidence and

22 exposure evidence, but one of the issues that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

169

1 based on my review of many of the files is the

2 deceased workers. I mean, they can't speak for

3 themselves. The next of kin typically -- they

4 may know their job classification where they

5 worked, but know very little about actual

6 exposures in work. 

7 So a sort of broader context is how

8 can we supplement that information either with --

9 we've talked about sites that don't have an SEM

10 and looking at comparable workers. How can we

11 think about supplementing that with information

12 that we think is reasonably reliable? Even in a

13 lot of cases I reviewed, not here, but coworker

14 affidavits and statements about what they did and

15 what their fellow worker did are often quite

16 valuable.

17 MEMBER WELCH: I just wanted to make

18 a comment on what Les had said about helping the

19 workers get the correct information. And it's

20 something that I don't know whether it's -- your

21 subcommittee could look at it, but I've seen a

22 number of those requests that go out to the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

170

1 worker for more information, and the language

2 could be way simpler and more straightforward. 

3 And sometimes it's asking for

4 something that the worker thinks they've already

5 supplied. So the worker sent in all of their

6 exposure information and the letter is asking for

7 exposure information. So it's quite confusing. 

8 So it would help to say we've received this,

9 this, this and this, but it's not sufficient for

10 this reason and can you provide what's missing? 

11 It's not -- they're -- the claims examiner must

12 have thought through that to ask for more.

13 So if you could also add to your many

14 lists of tasks the language that's being used. 

15 Maybe it's standard language. Maybe it's always

16 the same. I don't know whether the claims

17 examiner is -- writes the letters or whether

18 they're using a standard language that's provided

19 by the Department and is there a way we could

20 provide examples? Because it's really -- there

21 are a few things a claims examiner goes back and

22 asks for to move the case forward. We could
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

171

1 provide examples of language for that. 

2 MEMBER BODEN: Yes, just to respond to

3 that, I think that's a good idea. Sometimes it

4 -- I think it looks to the claims examiner -- and

5 even to me as am I'm reading it like the claims

6 examiner is kind of saying what's missing but

7 there's still some link that's not -- there's

8 some connection that's not made and the person

9 doesn't go ahead and get something which might be

10 not that hard to get. And it would be useful to

11 find out how to make that link better. And I

12 don't -- I really don't know the answer to the

13 question, but it's an important question, I

14 think.

15 MEMBER CASSANO: I think some of the

16 improvements to the Occupational History

17 Questionnaire might help that greatly in

18 prompting them to get the correct information. 

19 And maybe that's something that might be an -- we

20 can think about this in the -- an addendum to the

21 Occupational History Questionnaire that says,

22 hey, if you are in this -- these job categories
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

172

1 or this is what your potential exposure is, you

2 will need to provide some -- the appropriate

3 documentation. And that may be the easiest way

4 to do it. But that's going to be something we

5 discuss after Friday, I think. 

6 MEMBER BODEN: I think it will be --

7 I think that's a -- going to be a process. We're

8 going to have to talk to people and try to figure

9 it out. I don't think we know in advance what a

10 good way of doing that is.

11 MEMBER SOKAS: And one of the

12 questions might be whether those requests for

13 additional information are all pre-populated, if

14 those are all like legally approved templates

15 that have to get used or whether there is an

16 opportunity to shape it a little bit more. 

17 PARTICIPANT: Actually, Rachel, you

18 might be able to answer that right now about the

19 request for information. 

20 MS. LEITON: Absolutely. One of the

21 things I've always actually stressed is that I

22 don't like templates because of that reason of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

173

1 using something that isn't relevant. We try to

2 train our people on -- look for what's already

3 there, ask for medical evidence, factual

4 evidence. Some of the offices divide it into

5 medical evidence that's need, factual evidence

6 that's needed, and other offices don't.

7 We do have what we're -- we do have a

8 correspondence library that we're kind of

9 building up, but that's really more like

10 acknowledgment letters, things like that. When

11 it comes to crafting a development letter after

12 we've received information, we do try to stress

13 that they be as specific as possible as to what

14 they're looking for, but if they don't get

15 anything that -- or if they don't get any

16 exposure information at all or they don't get any

17 medical, sometimes they will ask for everything

18 that they think that they can ask for. 

19 And I think tailoring those letters is

20 always a challenge for claims examiners to know,

21 okay, I don't want to leave out something. Some

22 offices specifically say this is what we've
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

174

1 received, this is what we need. Putting those in

2 layperson's terms is oftentimes a challenge as

3 well. But, yes, there is opportunity for making

4 changes to it because we don't have development

5 letter templates as a rule. We might have follow

6 this format, but we don't have here's what you

7 need to put in every letter.

8 MEMBER CASSANO: I'm wondering if

9 sometimes the reason the continued requests go

10 out isn't because the claimant isn't providing

11 the right information, but because the CE doesn't

12 realize they have the information or they don't

13 really have a good understanding of what they

14 need to ask. 

15 So I'm wondering if there's any

16 opportunity at that point for the CE to go to the

17 industrial hygienist for instance and say, look,

18 I've got this claim for -- don't even have to ask

19 names. Just a general question. I've got a

20 claim for such and such and -- for this medical

21 condition. I have -- the guy has worked here. 

22 The SEM isn't helping me very much. What can you
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

175

1 tell me I should ask this guy for in order to

2 help his claim move along?

3 MS. LEITON: There is actually an

4 opportunity for that. The claims examiners can

5 email our lead industrial hygienists or they can

6 talk to them on the phone. And in fact they do

7 ask them those questions. I'm not really clear

8 on this or I've got this evidence. What do you

9 think I can do more with it? We also have

10 medical physicians on staff, the medical

11 directors on the staff. Now we have nurses on

12 staff that we can go to and ask those questions

13 as well, if there are clarifications that are

14 required.

15 I think that the claims examiners in

16 general terms do -- I mean, they're going to

17 review what they've received, but can I say that

18 I've never seen them ask the question again even

19 though they might have something. I can't say

20 that because it happens. But in general they are

21 trained to look at what they already had, make

22 sure they understand as best as they can what
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

176

1 they need to ask for further.

2 MEMBER BODEN: Yes, actually the

3 things that I'm talking about are not things that

4 the claims examiners have missed. Let me tell

5 you a little sort of anecdote.

6 I had a friend who was one of the

7 leading workers' compensation claimant's

8 attorneys in Massachusetts and who prided himself

9 on how well he could explain the process and what

10 people needed to do and so on and so forth. And

11 after having done this for quite a few years a

12 graduate student asked him if she could interview

13 some of his claimants. And she reported back to

14 him that when she asked them how well they

15 understood his explanations, most of them said I

16 really didn't understand anything he was saying.

17 MS. LEITON: Right.

18 MEMBER BODEN: So I think the

19 intentions are there, and the letters seem

20 reasonable to me, but it really sometimes takes a

21 certain amount of figuring out to know what

22 actually works for people who aren't experts in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

177

1 the process.

2 MEMBER CASSANO: Thank you. Any other

3 questions or comments? 

4 MEMBER VLIEGER: This is Faye. First

5 of all, it's not often that I do this, so,

6 Rachel, pay attention. 

7 (Laughter.)

8 MEMBER VLIEGER: The letters have

9 improved significantly since the beginning of the

10 program. I mean, leaps and bounds. So -- did

11 you hear that?

12 (Laughter.)

13 MS. LEITON: I'm sorry. I was

14 actually -- 

15 (Laughter.)

16 (Simultaneous speaking.)

17 MS. LEITON: I'm sorry. 

18 MEMBER VLIEGER: The letters to the

19 claimants since the inception of the program have

20 improved leaps and bounds.

21 MS. LEITON: Thank you very much.

22 MEMBER VLIEGER: However --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

178

1 (Laughter.)

2 MEMBER VLIEGER: Yes, she would like

3 me to stop there, I'm sure. However, it does

4 seem to be a subjective area which is always hard

5 to get people to go along with a program if it's

6 kind of free form, all play. 

7 So there are those letters that I see

8 from certain district offices, certain areas of

9 district offices where it is obviously a

10 boilerplate. It is quite obviously boilerplate

11 and at times there have been cut and paste errors

12 from other claimants' information in the file.

13 So this is just a recurring training

14 problem. It's been that way in all government. 

15 And we do cut and paste errors all over the

16 place. But I do think that when we're dealing

17 with the workers that if we can be less technical

18 in what we're requesting, specifically saying --

19 if you just write PFT down, they're not going to

20 know. If you write pulmonary function test,

21 which means this, then -- particularly in the

22 lung cases when that's one of the major missing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

179

1 pieces of data, then I think it would help us

2 great.

3 MEMBER CASSANO: Dr. Silver?

4 MEMBER SILVER: I want to thank DOL

5 for providing these most recent claim files in a

6 much better organized fashion that earlier

7 batches. They were sequentially laid out over

8 time, which reminds me that we saw a news item

9 about a new contract between the Officer of

10 Workers' Compensation Programs and a private firm

11 to manage the records of this and other programs. 

12 And maybe before we leave tomorrow we could learn

13 a little bit more about that. It would be nice

14 if a table of contents feature was built into all

15 of these claims files, particularly if we're

16 going to recommend that the IHs and CMCs under

17 certain circumstances receive their full file.

18 After my rant about the word

19 "significant" yesterday I slept on it and

20 realized it should be used in the punch line,

21 because that's the statutory standard. And in

22 public health school one of my missions is to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

180

1 make sure our students don't use it wantonly. 

2 "Substantial" Is a decent substitute, and quite

3 conveniently within administrative law

4 "substantial" is something less than a

5 preponderance of evidence. So we could consider

6 that.

7 And in one of these claims I did see

8 an example of the answers given by a claimant on

9 the OHQ being used against him on the issue of

10 personal protective equipment. We had a little

11 colloquy at the beginning of our Oak Ridge

12 meeting. Dr. Sokas rightly pointed out that

13 wearing a PPE is a red flag for hazardous

14 exposures, and some of us were worried that it

15 might be used against claimants. A skin cancer

16 case had exactly that going on in these claims. 

17 And I'll save comments about training

18 versus education for another day.

19 MEMBER CASSANO: I was reminded by Dr.

20 Markowitz that it is lunch time. We need to take

21 a break. So once again, I want to thank the

22 members of my subcommittee. Yes?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

181

1 PARTICIPANT: You have a comment on

2 the phone. 

3 MEMBER CASSANO: Oh, somebody had --

4 Rosie?

5 MEMBER SOKAS: I want to comment, but

6 I'll save it for later. We kind of overlapped

7 quite a bit in some of the discussion areas, and

8 so we had a recommendation about organizing the

9 records and charts.

10 MEMBER CASSANO: Okay. Thanks. I

11 want to again thank the members of the

12 subcommittee. For those of us from the East

13 Coast, we were up until the wee hours of the

14 night out here trying to look through these

15 records, and everybody did a really land office

16 job here on looking at them. Thank you very

17 much.

18 CHAIR MARKOWITZ: So it's 12:00. We

19 can continue this committee discussion at 1:00

20 when we will reconvene. Thank you.

21 (Whereupon, the above-entitled matter

22 went off the record at 12:02 p.m. to resume at
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

182

1 1:00 p.m.)

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

183

1 A-F-T-E-R-N-O-O-N S-E-S-S-I-O-N

2 (1:06 p.m.)

3 CHAIR MARKOWITZ: Okay. Let's get

4 started now. 

5 So there are two members who are a

6 little late, but I know they are going to be a

7 couple minutes late, but they will be here

8 shortly: Dr. Friedman-Jimenez and Dr. Welch. 

9 So we are going to continue where we

10 left off this morning, with the Medical Evidence

11 Subcommittee. Dr. Cassano? 

12 MEMBER CASSANO: We wanted to continue

13 a little bit of this discussion about how -- and

14 I am totally -- not quite clueless, but totally

15 at a loss for how to approach this -- on how to

16 determine -- if there is a way to determine wage

17 loss over a period of time prior to definitive

18 diagnosis where the wage loss should be

19 considered in those conditions that are slowly

20 progressive or not diagnosed properly for a

21 period of time from when symptoms develop. And I

22 am not quite sure how to do that in any way that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

184

1 isn't totally subjective at some point. 

2 CHAIR MARKOWITZ: So yes, so I think

3 the issue, if I understand it, is identifying a

4 date, appropriate date for wage loss. 

5 MEMBER CASSANO: Yes.

6 CHAIR MARKOWITZ: Should it coincide

7 with the date of diagnosis for the accepted

8 claim, or should it -- could it be an earlier

9 diagnosis, for instance a diagnosis when --

10 excuse me, a date when the symptoms became

11 prominent or onset of symptoms, or, in the case

12 of wage loss, presumably symptoms that led to

13 loss of employment, right, stopping the work --

14 MEMBER CASSANO: Yes.

15 CHAIR MARKOWITZ: -- which are

16 significant symptoms. And it could well be that

17 significant symptoms leading to a work stoppage

18 could precede a date of diagnosis, and therefore

19 should the claim for wage loss derive --

20 originate in the date of symptoms leading to work

21 stoppage, or should it date from the date of

22 diagnosis? I think that is the question. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

185

1 MEMBER CASSANO: Yes. I mean, I

2 understand the question. I am just not sure if

3 there is a good way to approach it other -- now,

4 if somebody has gone to doctors with the same

5 complaint for six -- five or six or seven years

6 and finally gets diagnosed, but they weren't --

7 let's say it's a chronic condition and they were

8 being looked at as, you know, recurrent acute

9 exacerbations of something, and then finally

10 somebody says oh no, you've got COPD, you know,

11 you're not getting upper respiratory infections

12 and that is why you're disabled, so there may be

13 a way to look back to the time that the symptoms

14 became -- were first presented clinic -- to

15 someone clinically. 

16 Otherwise, you're left -- you know, if

17 you say symptoms were bad enough to lose

18 employment, I would presume that by that point,

19 they had gone to a doctor already. I don't know. 

20 CHAIR MARKOWITZ: Well, what are the

21 options? I mean, if the treating physician, the

22 evaluating physician states -- obviously there is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

186

1 a date of diagnosis in the record -- but states

2 or writes that in fact, this person was diagnosed

3 with this disease on such and such a date, but

4 his symptoms -- the onset of significant symptoms

5 was a different date, was an earlier date. It

6 was providing the date, and that these symptoms

7 at that point were sufficient to contribute to

8 his inability to work at that time, so that the

9 physician writes that. 

10 MEMBER CASSANO: Yes. 

11 CHAIR MARKOWITZ: Shouldn't that be

12 acceptable? 

13 MEMBER CASSANO: Well, that -- I think

14 that should be. I don't know what the rules are,

15 but that should be acceptable, but that is

16 incumbent upon the employee or the claimant

17 knowing to ask his --

18 CHAIR MARKOWITZ: Sure.

19 MEMBER CASSANO: -- physician to put

20 that in the record, and so -- and a lot of them

21 don't, so I don't think --

22 CHAIR MARKOWITZ: Right. Okay. Dr.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

187

1 Boden? 

2 MEMBER BODEN: So a couple of thoughts

3 about that. So the issue of the knowing to put

4 it in the record could be addressed by the claims

5 examiner in their contact with the claimant,

6 number one. And number two, probably the

7 examining physician would not only have to say

8 that they believe that the onset of symptoms was

9 not extant, but they would have to provide some

10 sort of evidence in the medical record that that

11 was the case, right, I assume, because otherwise,

12 it would be unsupported by -- you know, whatever

13 the wording is in usual -- you can't just make an

14 assertion as a physician. You have to have some

15 reason for the assertion, right? 

16 CHAIR MARKOWITZ: True, but we make

17 assertions all the time. 

18 MEMBER BODEN: Yes, I know you do. 

19 (Laughter.)

20 CHAIR MARKOWITZ: So many of them are

21 appropriate. 

22 MEMBER BODEN: Medical and other, yes.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

188

1 CHAIR MARKOWITZ: Many of them are

2 appropriate. 

3 MEMBER BODEN: Yes.

4 CHAIR MARKOWITZ: You know, it is

5 based on the medical history. This is what the

6 patient reports. Yes, if there were previous

7 visits in which the person had that symptom, and

8 it was in the medical record, that would add

9 another layer, but if the physician by way of

10 medical history identifies that in fact this

11 person had symptoms that date back 18 months ago,

12 that was when some -- and in fact, they no longer

13 worked at that point due to those symptoms,

14 writes it in the medical record, I don't see why

15 that would need to be corroborated by further

16 prior medical evidence.

17 Yes, Ms. Leiton? 

18 MS. LEITON: Just as a point of

19 clarification, what we look for is medical

20 evidence establishing that the individual lost

21 wages as a result of the condition that is

22 covered. It doesn't say it has to be diagnosed
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

189

1 at that time. The doctor has to say I believe

2 this person became -- was unable to earn wages or

3 unable to earn a certain amount of wages as a

4 result of their covered condition beginning on

5 this date. It is really -- that is what our

6 procedures say it's tied to, so I just want to

7 make sure that that is clear. 

8 CHAIR MARKOWITZ: Okay. Well, that

9 would seem to address the issue, I think. Yes,

10 okay. Okay. Well, that --

11 MS. LEITON: Problem solved. 

12 (Laughter.)

13 CHAIR MARKOWITZ: Non-problem solved. 

14 Okay, thank you, clarification. Dr. Silver? 

15 MEMBER SILVER: We probably shouldn't

16 discuss wage loss again until we review the

17 relevant part of the statute 7385s-2. I am not

18 going to do it here. 

19 One thing I have learned from

20 experience is that some DOE contractors had a

21 program they called early medical retirement, so

22 short of people's Social Security age, they left
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

190

1 the employment of a DOE contractor with medical

2 conditions that prevented them from continuing to

3 work. So a good write-up for a party claimant

4 would look back at the documentation of the

5 medical retirement and take that into

6 consideration when having diagnosed the

7 occupational illness many years later. 

8 CHAIR MARKOWITZ: Any further comments

9 before we move on to the next committee? Go

10 ahead. 

11 MEMBER CASSANO: The only other thing

12 I wanted to add was going back to the questions

13 for Friday, if any other members of the Board had

14 thought of questions that you want us to ask on

15 Friday to the -- to the supervisors at the

16 district office, if you can't think off of the

17 top of your head now, you can email them to me. 

18 If anybody has any comments now, I would

19 appreciate it. 

20 CHAIR MARKOWITZ: Okay. So we are

21 going to move on. Dr. Sokas? 

22 MEMBER SOKAS: Okay. In response to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

191

1 Dr. Cassano's question, though, I did want to

2 mention that -- I am getting feedback here. Are

3 you getting feedback when I speak, or no?

4 CHAIR MARKOWITZ: No.

5 MEMBER SOKAS: Okay. Then I am not

6 going to worry about it.

7 And I will -- and I forgot what I was

8 going to say about Dr. Cassano, so I will just

9 get started with us. And Tori, I will call you

10 later, okay? 

11 MEMBER CASSANO: Okay. 

12 MEMBER SOKAS: Oh, I know what it was.

13 I am sorry. We hadn't made these recommendations

14 that there be some facilitation of the

15 communication between the CEs and the physicians

16 involved, that there were some language problems

17 and challenges, so it might just be interesting

18 to kind of ask about that and to see what they

19 would like to see from the -- the physician who

20 is there who might be able to help, you know,

21 communicate maybe more effectively with some of

22 the either treating physicians or the CMCs. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

192

1 Okay.

2 CHAIR MARKOWITZ: So Dr. Sokas? 

3 MEMBER SOKAS: Yes, all set. 

4 CHAIR MARKOWITZ: Okay. Let me just,

5 I want to -- I need to make an announcement. I

6 just want to announce again I think to members of

7 the public who are either on the phone or present

8 here that we have a public comment session

9 beginning at 4:30, and that if you would like to

10 speak, you should simply give to on the side your

11 name if you haven't done so. And some people may

12 be unaware they are able to sign up and comment,

13 but you can up until the 4:30 time slot.

14 So okay, Dr. Sokas, you can go now.

15 MEMBER SOKAS: Okay. Great. And I am

16 going to ask someone to forward those slides if 

17 -- I don't know if that is Kevin or you or -- .

18 So this is the Subcommittee on

19 Industrial Hygiene and Consultative Medical

20 Reports, and I would like to move on to the

21 second slide, please.

22 And just to review, the -- the purpose
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

193

1 of the subcommittee is to really evaluate the

2 work itself of the hygienist and the physician to

3 ensure quality, objectivity, and consistency, and

4 we are mostly focused right now on the quality

5 piece of it, but they are all intertwined, as you

6 can imagine. And I just put up for your

7 appreciation the members of the subcommittee, so

8 you've got everybody there in front of you, and

9 Mr. Griffon on the phone. You can go to the next

10 one, please.

11 All right. And this again is a

12 reminder because many of these will directly

13 impact quality, objectivity, and consistency. So

14 we had previously recommended that a process be

15 established in which the industrial hygienist

16 would be able to directly interview the claimant,

17 so that remains something that we're very

18 interested in. We did -- and I appreciate Ms.

19 Leiton reporting that the -- the concepts that

20 rise to policy level are now being developed in a

21 way that is searchable by people outside DOL.

22 I did want to comment that the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

194

1 teleconference notes that we reviewed included

2 comments that might not necessarily rise to a

3 programmatic level. I mean, there was a

4 discussion back and forth about someone who

5 committed suicide and what that meant for the

6 different aspects of the program, and so there

7 may well be pieces of information within those

8 teleconferences that -- that are the real nuts

9 and bolts of how things are handled that might

10 nevertheless, you know, be useful for others to

11 see if there is a way to de-identify and scrub

12 them, you know, and so it -- it does remain a

13 request that we have had previously.

14 The one that -- that Dr. Cassano and

15 Dr. Silver and others commented on that -- that I

16 want to highlight because we're going to go into

17 it a little bit more is the request that the

18 entire claimant case file would be available to

19 the claimant online, and we were told that there

20 are approaches to having that happen, that that

21 is under development right now to make sure that

22 the -- the technology is functioning adequately,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

195

1 and this we think would also help moving forward

2 with the -- the physician and industrial

3 hygienist evaluations because they -- they

4 clearly need to be able to go through the entire

5 case file on occasion.

6 We -- we repeat the request that was

7 mentioned at the beginning about having an

8 occupational medicine resource at the Department

9 level that would allow for additional depth as

10 well as coverage when the physician hired by the

11 program is not available, and that the -- and

12 that the entire case file -- again, this has been

13 recommended in the past, but that the complete

14 case file be made available.

15 Now, if I could go on to the next one,

16 we can get into some more specifics. So the

17 subcommittee met in December, and one of the

18 things that we couldn't really not comment on

19 were the -- the depth and the -- the multitude of

20 comments that were made by the public during that

21 meeting, and so we did want to thank the

22 Department for having the ombudsman and other
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

196

1 personnel available, and we are very grateful

2 that that is happening again today.

3 There was, and I don't know if Mr.

4 Griffon is -- is on the -- I know he is on the

5 phone, but I wanted to turn this next bullet

6 point over to him, that we would like to see a

7 formal tracking and response to the comments that

8 are created or that are brought forward, and --

9 and I would like to ask Mr. Griffon to describe

10 how that -- no, I am sorry. If you could go back

11 one? We are not ready for the IH review. Right.

12 So -- whoops, sorry. Was there one in between?

13 All right. The -- the one that has

14 the date on the top of it, if we could get to

15 that slide? Next -- this one. Okay. So if we

16 could stay with this one for just a minute and

17 ask Mr. Griffon if he wouldn't mind describing a

18 little bit about the approach that the Radiation

19 Board takes? 

20 MEMBER GRIFFON: Yes, sure, Rosie. 

21 This is Mark Griffon.

22 Yes. I did follow up- on the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

197

1 Radiation Board side. I can't remember exactly

2 when we -- when I was on that board, when we

3 initiated this, but we had had an ongoing sort of

4 question of there were lots of public comments,

5 and it was unclear how -- what action NIOSH had

6 taken in response to those comments and sort of

7 tracking them as time went on, and so eventually

8 -- again, it wasn't right in the beginning, when

9 the Board first started, but eventually NIOSH set

10 up a system, a fairly simple Excel spreadsheet

11 type tracking system to track comments made and

12 what the sort of response, if necessary.

13 Sometimes, it was questions related to

14 individual claims, so then the response might

15 have been that the Agency contacted the

16 individual and discussed their claim, you know? 

17 Other times, when there were broader comments,

18 there were other ways that they, you know,

19 addressed the concern. But at least we had a

20 system that we could see what -- you know, what

21 items were sort of pending, what were closed out,

22 and what were individual issues.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

198

1 And I got the NIOSH people to forward

2 I think a couple of months of examples, or a

3 couple meetings of examples, of those

4 spreadsheets to the Department of Labor because I

5 think they did have some privacy issues in them. 

6 They were just emails, you know, internal

7 government email, and I don't think they can be

8 shared at this point, but the DOL is considering

9 that to adopt in similar situations. That is my

10 understanding, anyway, is that DOL is considering

11 a similar tracking approach. 

12 MEMBER SOKAS: The question for the

13 Board as a whole is whether this needs a formal

14 resolution, or whether we will just kind of

15 follow up in subcommittee to see if that is going

16 forward. 

17 MEMBER GRIFFON: Or Rosie, maybe we

18 can just ask Labor right now if they -- you know,

19 if they have gone any further with this, or where

20 they stand --

21 MEMBER SOKAS: Okay. 

22 MEMBER GRIFFON: -- on this. Yes. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

199

1 MEMBER SOKAS: So I don't know if Ms.

2 Leiton would want to comment on that now, or -- ?

3 CHAIR MARKOWITZ: The -- the hands or

4 the lack of hands, so let me run this for you. I

5 personally don't think we need a formal

6 recommendation on this issue. I think we would

7 make a request. We know that DOL is moving on

8 it, and we will follow up and make sure it

9 happens in a timely way. That is my own --

10 MEMBER SOKAS: Okay. 

11 CHAIR MARKOWITZ: -- opinion. 

12 MEMBER SOKAS: That sounds good. 

13 The next bullet point is similar, in

14 it was one of the issues that was raised --

15 (Simultaneous speaking.)

16 CHAIR MARKOWITZ: Dr. Sokas? Dr.

17 Sokas? I am sorry, I am sorry. 

18 MEMBER SOKAS: Pardon? 

19 CHAIR MARKOWITZ: Someone just raised

20 their hand here. Ms. Vlieger? 

21 MEMBER VLIEGER: Sorry, Dr. Sokas. I

22 was a little slow. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

200

1 Do we know that there is a process

2 going on for this, and what is the rollout date

3 for it? 

4 CHAIR MARKOWITZ: So I am informed

5 that the comments have been entered into a

6 spreadsheet, and I don't have a date, but I don't

7 know, maybe Carrie, do you have any sense of

8 movement on this? 

9 Okay. So within a week or so. 

10 MEMBER SOKAS: So Ms. Vlieger, I am

11 going to turn the final bullet on this slide over

12 to you. This was about a concern that was raised

13 at the meeting about the 200-mile distance for

14 DOL-directed medical evaluation. 

15 MEMBER VLIEGER: It is -- DOL from

16 time to time directs a claimant to go through an

17 evaluation by a doctor of their choosing for the

18 continuation or evaluation of home medical

19 services, and this stipulation of 200 miles,

20 particularly on the aged and ill, is -- I am

21 trying to find a nice word for saying "really not

22 nice." 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

201

1 CHAIR MARKOWITZ: Burdensome,

2 burdensome. 

3 MEMBER VLIEGER: More than burdensome. 

4 CHAIR MARKOWITZ: Very burdensome. 

5 MEMBER VLIEGER: Yes. 

6 (Laughter.)

7 MEMBER VLIEGER: And so if they can't

8 find a doctor locally to disagree with the doctor

9 that is prescribing the home health, I think that

10 this borders on doctor shopping, which -- which I

11 know you're going to have a comment, Rachel, but

12 I still find it -- I am going to use a word that

13 I like to use -- I find this repugnant. So

14 that's what I have to say on this. 

15 MEMBER SOKAS: So I think we did have

16 questions about how often it was put into use and

17 whether it is still necessary, so maybe we will

18 just phrase that as a question to the Department.

19 CHAIR MARKOWITZ: Oh yes, Ms. Leiton?

20 I am sorry.

21 MS. LEITON: Okay. The only reason

22 this provision -- well, the only place you will
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

202

1 find this provision about the 200 miles is in the

2 contract that we have with our -- our contract

3 medical consultants. We have had one second

4 opinion since October of 2016. I don't know if

5 that particular one was over 200 miles, but that

6 is the only in-person second opinion that we

7 actually have heard, according to my statistics.

8 You know, the only reason we would go

9 that far -- it is not general practice. We try

10 first to find people who are willing to undertake

11 these examinations through our contractor near

12 the person's home. It is our -- it is what we

13 have asked for first, and we have been working

14 with the contractor to try to get more physicians

15 because we frankly don't have enough physicians

16 to do this, that are willing to do the second

17 opinion evaluations in these particular

18 circumstances with regard to home healthcare.

19 But we are definitely not doctor

20 shopping to find somebody else that will say no. 

21 As I have mentioned many, many times, we are in

22 the business to approve claims. When we find it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

203

1 necessary to do an in-person second opinion, we

2 go through our contractor. We try to be as -- we

3 -- we have asked them to be random, but we have

4 asked them to be as close to the person's home as

5 possible. On occasion, it has been not possible,

6 and we haven't been able to find a doctor to do

7 that.

8 And, you know, we are working with the

9 contractor to try, as I said, to get more

10 physicians in more rural areas, but it is not

11 always possible. But again, it is very rare that

12 we -- that we do this. 

13 MEMBER SOKAS: So just to clarify for

14 -- for our purposes, it only happened once since

15 October. It is only for second opinions for

16 individuals who are requesting home healthcare. 

17 It is not part of the rest of the program. 

18 MS. LEITON: For the most part. I

19 mean, we don't -- we have the ability to use

20 second opinions for other issues if it -- if

21 necessary, but that is the majority of any second

22 opinions we'd had in person. We have CMC reviews
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

204

1 of case files, that sort of thing, but it is rare

2 that we have others that are -- that it is

3 applicable to other situations. 

4 MEMBER SOKAS: Thank you. So I would

5 like to go back to a useful exchange of

6 information. I would like to move on to Mr.

7 Griffon --

8 CHAIR MARKOWITZ: So, I am sorry, Dr.

9 Sokas? 

10 (Simultaneous speaking.)

11 CHAIR MARKOWITZ: Dr. Sokas, there is

12 still some discussion here. 

13 MEMBER SOKAS: Okay. 

14 CHAIR MARKOWITZ: So, okay, so Dr.

15 Cassano? 

16 MEMBER CASSANO: This would seem to

17 be, except for some of the most extraordinary

18 cases, a very good place where telemedicine might

19 be able to be utilized, and the local office,

20 local hospital can bring the -- the transmitting

21 equipment over, and then the interview can be

22 done, and, you know, if it's a range of motion
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

205

1 issue or if it's a -- whatever the function is

2 that you're looking at, there can be tasks that

3 are given to the person to -- to help evaluate

4 it, but I think that is something that should be

5 looked at in those situations. 

6 MS. LEITON: Yes. That will depend on

7 our contractor, probably, and whether they have

8 that, the doctors in there have the ability to do

9 that, but I absolutely agree it could be done

10 that way. 

11 CHAIR MARKOWITZ: The other resource,

12 the former worker medical screening programs all

13 use -- pretty much all use local physicians and

14 clinical facilities for the screening exams, and

15 these are clinics under contract to various

16 entities for the medical screening protocol, and

17 they may be receptive. So we could provide you

18 with those -- the names of those clinics.

19 I know the BTMed, which is the

20 construction worker project, uses how many

21 different clinics around the country? 100, and

22 the National Supplemental Program has more than
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

206

1 that, so if we could provide those names or those

2 --

3 PARTICIPANT: Sure. 

4 CHAIR MARKOWITZ: -- clinics to you,

5 then a contractor might be able to use them.

6 Mr. Vlieger, did you leave yours up or

7 down? I couldn't -- 

8 MEMBER VLIEGER: I just wanted to

9 comment that while your statistics for the last

10 six months or so may be accurate, I don't think

11 that that has been the application over the past

12 few years in its entirety, and when you're

13 dealing with aged and infirm claimants, any

14 attempt to -- to do it more locally would help

15 them, and I think it would benefit the Department

16 because the additional expense of the travel and

17 all of the other things that go on because they

18 are being sent on government orders basically to

19 go to this claimant would benefit the program

20 overall too.

21 You know, they don't -- the aged, the

22 employed claimants don't always have someone who
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

207

1 can take off work and drive them to the

2 designated date and time of the appointment, and

3 so I do. I find this really repugnant, and I

4 hope we don't have to continue it. 

5 MEMBER POPE: I had a question about

6 what are the options for that claimant currently?

7 MS. LEITON: Well, they -- they submit

8 any -- if they have to travel, we will pay for

9 it. We have -- in fact, we have paid for, you

10 know -- we have paid for any -- if it's a taxi,

11 if it's whatever they need to take them there, we

12 will pay for it. So that portion of it, since

13 we've asked them to go to this, we will pay for

14 it, if that's what you're asking me. 

15 But as I said, we try to avoid it. We

16 really try to avoid it, and I agree that we want

17 to be close to the individual's home if we have

18 to undergo these second opinion evaluations. 

19 There have been occasions that that hasn't been

20 possible, and we are trying to reduce that in our

21 contract. 

22 CHAIR MARKOWITZ: Other comments?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

208

1 (No audible response.)

2 CHAIR MARKOWITZ: Thank you, Ms.

3 Leiton. 

4 MEMBER SOKAS: So if we could go back

5 to the preceding PowerPoint, not this one, but

6 the IH review? And I asked Mr. Griffon if in

7 addition to reading through these -- the next

8 one, the one in between. So this is subcommittee

9 meeting, and then the next PowerPoint after that,

10 this one.

11 And Mark, if you would actually, when

12 you get to the point about the claimant records,

13 describe how it has been handled again at the

14 radiation end. 

15 MEMBER GRIFFON: Sure. Yes, this is

16 Mark Griffon again.

17 We -- the subcommittee here, the

18 review of sort of the role of the IH in this

19 process in our subcommittee, and I will go

20 through this sort of quickly because I think a

21 lot of the points the earlier subcommittee, the

22 Medical Evidence Subcommittee, raised a lot of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

209

1 similar points, so I think there is going to be a

2 little bit of overlap with what we found and what

3 that group found, and I am -- and I am really

4 interested in when they do their people probe by

5 visiting the Seattle office. That may be very

6 helpful as well.

7 But the first point is that -- and

8 this is based on a small sample of cases -- but

9 based on these, it seems a little unclear to us

10 what exactly triggered a review, and we -- we

11 didn't go as far as crosswalking the procedures

12 or the training manuals with -- with the cases,

13 but it seemed, again, just on this small sample,

14 that some things that I thought might be useful

15 for an IH review were not included in the IH

16 review, and therefore we sort of had a question

17 of what is the threshold when -- when it goes to

18 an IH review?

19 Also, understanding I think this --

20 this recently changed, I think you have now an IH

21 consulting contractor, but at the time, for a lot

22 of these cases, you had a fairly small number of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

210

1 industrial hygienists available, so there was a

2 resource question too to certainly consider

3 internally. 

4 And then when it did go to an IH

5 review, the other point was it -- it seemed as

6 though, again in the small sample, that the

7 questions forwarded or the information forwarded

8 to the IH was truncated. They were asked to

9 opine on certain things rather than the entire

10 claim -- the entire case. So again, how -- how

11 are these determinations made, and are -- are

12 they made in a consistent way I guess is another

13 question. 

14 And then this is the point Rosie just

15 asked me to expand on. The organization of the

16 case file in use, as I think was mentioned

17 earlier today, these case files are -- are

18 sometimes thousands of pages, and at least the

19 ones I looked at, they seem to be in no

20 particular order. And I am not sure if that's

21 the way we're receiving these, as one large PDF,

22 or if internally, they have them organized a bit
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

211

1 -- a bit better, but I know that -- that on the

2 radiation -- on NIOSH's side of the -- of the

3 program, they have done a pretty good job of

4 organizing these -- the claims files in their

5 database, and I think it allows for a couple

6 things.

7 It allows, number one, they can

8 section off information that is more important to

9 the industrial hygienist versus the physician. 

10 You know, you can separate it into different

11 folders. But also, I think on the NIOSH side, it

12 has allowed for a sort of checklist approach to

13 make sure that a claims file is complete, that

14 you have all the pieces in -- in a particular

15 file, and that is useful for the initial claims

16 review, but also if you're going to do a sort of

17 quality assurance program of any sort, or

18 process, I think that would be -- it would be

19 much more efficient if it was organized in some

20 fashion like that.

21 So then, you know, I guess the other

22 thing that I -- that I heard earlier, which we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

212

1 would agree with, is that -- and this is from the

2 Medical Evidence Subcommittee group mentioned

3 that the training documents and the procedures

4 therein didn't necessarily match some of what

5 they observed in the claims files, or the

6 practices that were being carried out by the

7 individual CE. And I guess that would make me

8 again ask the questions about consistency, about

9 fairness, and about, you know, some sort of

10 quality assurance approach needed to make sure

11 we're accounting for this across the board. 

12 And I think that's it, Rosie, if that

13 is --

14 MEMBER SOKAS: Yes, thanks, thanks,

15 Mark.

16 So the next piece I want to go through

17 a little bit are the CMC qualifications and the

18 qualities, and I want to remind everyone that we

19 were given a memorandum from February 17th, 2015

20 that was a contractor medical consultant and

21 second opinion audit, an informal audit. But I

22 wanted to remind everybody that that audit really
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

213

1 focused on whether the CMCs provided the

2 information the CEs needed, whether from the --

3 the CE perspective, they were able to, you know,

4 kind of get the -- the rationale that they were

5 asking for and the specific questions answered,

6 and I would really characterize that as a process

7 audit, that there was really no content

8 evaluation performed at all. So I want to -- to

9 clarify that. 

10 And so when we looked at it, we were

11 looking at it more from the perspective of the

12 quality of the CMC review, and one of the things

13 that struck me was the CMCs -- the people

14 conducting the CMCs, the ones who have been

15 hired, at least on a very small sample, appear to

16 be very well-credentialed. They are the kind of

17 people that you look at the quality of their

18 credentials in terms of board certification,

19 adjunct faculty participation, having actually

20 published peer-reviewed papers and that sort of

21 thing. 

22 The -- the contractor clearly seems to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

214

1 have done some work identifying people with --

2 with good credentials, right? I don't want to

3 say that for a large -- for -- I am sorry. I

4 don't want to say that for a -- you know, as a --

5 as a conclusion because we sampled so few cases,

6 but that that -- that that does not seem to be

7 where the problem was.

8 The problem in fact is that, for the

9 most part, they have a very different standard of

10 -- of looking at the outcomes, and they seem to

11 be following sort of standard workers' comp or

12 other -- other guidances that are different than

13 the guidances that are required for this

14 particular standard. And we did try to find out

15 whether they were being paid adequately to go

16 into depth because one of the things they also

17 didn't do was they did not deep dive into any of

18 the medical records. So there was information

19 buried in the medical records, in these thousand

20 pages, that clearly could have been of use that

21 were sometimes overlooked, but it would be, you

22 know, maybe two or three little notations in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

215

1 somebody's -- you know, the workplace clinic

2 where something happened. I mean, so -- so you

3 clearly had to spend some time looking. 

4 Now, in the middle of all this, we

5 tried to get a sense of that and were told that

6 it was -- that we couldn't find out what the

7 payments were to these clinicians or whether it

8 was on an hourly or on a per -- you know, per

9 letter basis because that might be a problem for

10 the contractor for their information, but we were

11 -- in the middle of all this, we were kind of

12 told by one of the -- just as a completely

13 separate piece of information, Terrie Barrie sent

14 us information about a medical consultant

15 guidance document that Dr. Schwartz had developed

16 in 2009, and in that document -- which -- which

17 she was referring to us for its guidance on the

18 level of certainty for either causation or

19 exacerbation or contribution, which is what we've

20 been talking about for the last year, so I don't

21 think we need to review that piece now -- but

22 they did in there have an enormous table for how
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

216

1 much the CMCs were to be able to bill, and it was

2 huge. I mean, it was like $75 per 15 minutes, up

3 to eight hours for complicated cases.

4 So I don't know if the contract is

5 differing from that, but it would seem that there

6 is no excuse for not spending more time really

7 looking and finding stuff, but we certainly

8 didn't see evidence that people had worked hard

9 to look and find stuff, and we were again

10 concerned that they were not following this

11 particular program's level of certainty, that

12 they were applying higher standards that are used

13 in other areas.

14 So -- whoops, I am sorry. So back to

15 where we were? I didn't mean to continue. If we

16 could go back to the CMC one? Thank you. That's

17 it.

18 And then just to sort of pile onto

19 what mark and others have said, that an

20 organizational structure to these records would

21 also be helpful. So the two pieces that seem to

22 be pretty apparent are that the CMC reviews are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

217

1 not really searching to try to find information

2 that would be, you know, hidden in records, and

3 they're also not using the appropriate standards

4 of causation. And I would like to ask Dr.

5 Friedman-Jimenez if he has -- if he would comment

6 on this as well.

7 DR. FRIEDMAN-JIMENEZ: Thanks, Rosie.

8 Yes, I looked at a number of denied

9 cases and was struck by the -- the inconsistency

10 in the -- what seemed to be the standard for

11 causation. And I am not sure what process by

12 which the CMCs are told what the standard is, and

13 I think that it needs to be made clear to them in

14 a formal way that the standard is that the work

15 exposure must have caused or aggravated or

16 contributed to the medical condition that is

17 being considered. I think -- from my small

18 review, it sounds like that was not the case in

19 some of the CMC reviews.

20 Also, in trying to go through some of

21 these records, they are very long, several

22 hundred to 1000 pages, sometimes more. In some
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

218

1 cases, they are poorly organized, but what --

2 what I found difficult is that they are not

3 searchable. They are PDF files that are like a

4 bitmapped picture of the record. They are not

5 transformed into searchable files, so if you want

6 to search for the CMC statement, you have to go

7 paging through it dozens or hundreds of pages at

8 a time.

9 I think -- would it be feasible to use

10 an optical character recognition program, scan

11 the records so that they are searchable PDF files

12 rather than non-searchable PDF files? I think

13 that would help a lot, both with CMC access and

14 our access to those records. 

15 So yes, I -- I agree with -- with what

16 Rosie is saying, and those are a couple of

17 additional comments. 

18 MEMBER SOKAS: Thanks, George. 

19 So I think we can go to our final

20 recommendations, and these are really

21 recommendations for discussion with the full

22 Board. The first was to really make a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

219

1 recommendation about the -- the organizing the

2 records into sections and making them searchable.

3 MEMBER CASSANO: I have a couple of

4 questions. Sorry. 

5 CHAIR MARKOWITZ: So this --

6 MEMBER SOKAS: I can't hear. 

7 CHAIR MARKOWITZ: Yes, no, no, there's

8 some comments on a previous slide that some

9 people want to make. 

10 MEMBER SOKAS: Well, I am sure. Okay.

11 MEMBER CASSANO: Okay. Sorry, Rosie,

12 I was listening. And I think I have three

13 comments.

14 First of all on Mark's question about

15 what triggers an IH review, just a quick

16 question. Is that something you want me to add

17 to the list of questions I'm going to ask on

18 Friday? Because that would be, that would be

19 something that we -- and we can easily do that.

20 Number two, regarding the

21 searchability. And I think we had asked in the -

22 - first of all, the CMC doesn't get the record. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

220

1 They get a SOAF and maybe some other

2 documentation and then some pointed questions. 

3 So, I think if the standard is not being met it's

4 because they don't have all the information that

5 they need to meet that standard.

6 But the other thing that we ask when

7 we ask that the whole record go to the CMC was

8 that the CE map the case. And that's very easily

9 done. No, you can't search for a particular

10 word, but you can certainly on the bookmark side

11 or on a case map, which is what I'm used to

12 seeing, it says, Dr. So-and-So, you know, pat

13 diagnosis for lung cancer, or whatever. And the

14 page and the record that it's at.

15 And that would suffice, rather than

16 going through the technologically difficult thing

17 of some of these things are handwritten or

18 scribbled or whatever and you're never going to

19 pick up on an OCR reader. But that would be the

20 happy medium for that.

21 And then the only other comment I had

22 was it seems, since there is so much overlap
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

221

1 between these, what these two committees -- and

2 we really are sort of dependent on each other --

3 I'm wondering if maybe some point after this,

4 instead of having an individual meeting, her

5 committee and my committee could have, like, a

6 combined subcommittee meeting and sort of discuss

7 the overlap and how to go forward with that.

8 CHAIR MARKOWITZ: Sure.

9 MEMBER SOKAS: Yes, I had the same

10 thoughts, Victoria.

11 So, but getting back to the -- so,

12 organizing the claimant files may be making them

13 entirely approachable. It might not be that

14 easy. But certainly putting them into the

15 different sections or folders should be

16 realistic.

17 I honestly thing that a CMC should

18 wade through the whole darn thing because I don't

19 think it's appropriate that -- I mean, the CE can

20 certainly point out and bookmark, but I, it

21 really is up to the CMC to be looking for that,

22 you know, repeat visit for pneumonia or
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

222

1 something, you know, that nobody ever wound up

2 diagnosing as asthma until 15 years later.

3 So those are the kinds of things that

4 I think the CMC really needs to pay attention to,

5 and have the entire record. And we have this

6 kind of -- I apologize, I'm trying to split them

7 rather than lump them -- but I think the goal is

8 to have both the CMC and the IH have the

9 information available to them. And if the record

10 is being created online so that the claimants can

11 have access to it, then that should be relatively

12 straightforward for the CMC and the IH referrals

13 as well.

14 The other point that we wanted to

15 really -- there's several other points, but

16 again, we can sort of lump them -- we really feel

17 that the quality of the CMC letters has to be

18 evaluated for content not just for format and not

19 just for did they, you know, kind of respond

20 using the code words that, you know, need to be

21 used.

22 And so I think there -- again, this
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

223

1 gets back a little bit to the recommendation that

2 Steve made that there be some additional

3 resources allocated in terms of, whether it's

4 through personnel or whether it's through

5 consultation, where you have a large enough

6 sample size for past CMC letters as well as

7 ongoing current ones to be able to do a formal

8 quality review for content by people who are

9 willing to put in the time and the effort to see,

10 you know, whether or not -- there's a ton of

11 different examples. I think we've heard some

12 already.

13 We had an example of someone who had

14 worked for -- in the laboratory with all kinds of

15 different solvent exposures for years and years,

16 developed an autoimmune disease. They had been

17 followed in a rheumatology clinic of a medical

18 center for years and years. And nevertheless,

19 the claim for anemia was not even forwarded, I

20 don't think, to the CMC. So it's one of those

21 things where -- or if it was forwarded, they

22 didn't do anything with it. They didn't -- they
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

224

1 may have gotten steered in a different direction

2 by the CE and so they didn't bother to look

3 through and find some of this other information.

4 So I think we would like to see a

5 contract separate from the one that is hiring the

6 CMC, that needs to be independent of that

7 particular contract. And we would like to see

8 somebody who's -- the reason I show in the

9 Association of Occupational Environmental Clinics

10 is because they actually have a criteria for

11 membership that includes a public health

12 perspective and a worker-centered perspective.

13 I'm sure there are other organizations

14 that, or academic groups, or whoever who could do

15 this. But to find someone who clearly

16 understands what the criteria for causation or

17 exacerbation should be and reviews the entire

18 charts along with the CMC letters. And then

19 based on that, we could come up with guidance for

20 briefing package materials that emphasize the

21 appropriate things for the CMC.

22 So, we have at least two
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

225

1 recommendations we'd like to move forward on. I

2 think organizing the claimant records and making

3 them available, the entire record available to

4 the IH and the CMC is the first one.

5 CHAIR MARKOWITZ: Okay. So, Dr.

6 Sokas, there's some comment. People would like

7 to make comments. Is this a good time?

8 MEMBER SOKAS: Oh, sure.

9 CHAIR MARKOWITZ: Okay. Dr. Welch.

10 MEMBER WELCH: I just want to say I

11 totally agree with your recommendation to have a

12 separate review of the content of the CMCs by

13 worker-centered occupational physicians. And I

14 think it will be, it will be really, really

15 useful. And in my review of claims over the

16 years, I have struggled with a way to figure out

17 how to, if it was up to me, how to improve the --

18 how to get consistency among the CMCs.

19 And I think understanding the cause,

20 contribute, and aggravate, and also requesting

21 the CMCs review the entire file would probably go

22 a very long way toward getting more consistency.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

226

1 CHAIR MARKOWITZ: Dr. Boden.

2 MEMBER BODEN: So, first of all, I

3 think your committee's done a great job. These

4 are excellent recommendations.

5 Having gone through some of the claim

6 files, I know the issues personally. And let me

7 just say a couple of things. One is that I think

8 it is technologically totally feasible to have

9 these be searchable files. It could be done on

10 computers without anybody around, just letting

11 the computers run overnight if necessary, or

12 however long, to make these files have optical

13 character recognition.

14 And it really does help. Because I

15 did that myself on some of these really large

16 files, and it made a huge difference in my being

17 able to go through them.

18 The second thing that I would suggest

19 is rather than have the entire record available

20 to the CMC, so I had one file that was over 1700

21 pages long, and it contained two copies of a 702-

22 page medical record. So it was -- and there were
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

227

1 other duplications as well. But just taking out

2 one of those copies would have almost made it

3 half as long.

4 And so, the one other suggestion that I would

5 make is if we're going to make the entire file

6 available, it should be the entire file with a

7 minimum of duplication, particularly of these

8 very, very long medical histories.

9 CHAIR MARKOWITZ: So, I have a

10 comment. I think the Board is charged to look at

11 the quality, objectivity, consistency of the work

12 of the industrial hygienists and the consulting

13 physicians. So I think the Board should conduct

14 a study of a sizeable sample of IH and CMC

15 reports and basically design the evaluation. We

16 would need resources or assistance in actually

17 going through a bunch of these and conducting the

18 study. But I, frankly, think it's something we

19 should do or play a large role in ourselves in

20 order to fulfill the mission of looking at the

21 quality, objectivity, and consistency.

22 MEMBER SOKAS: So I'm just going to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

228

1 push back a little bit by reminding you of how

2 you started out your recommendation, which was

3 that most of us have full-time jobs. And suggest

4 that in order to have -- I mean, so we, I can

5 right now tell you what I think; right? But how

6 many records have I reviewed? Maybe, you know,

7 five, ten. I can't remember now. But it kind of

8 -- maybe 12 -- but, but if you want to do it in a

9 meaningful way where every third one gets done,

10 or every fifth one, or every tenth one, then I

11 think you need to hire somebody to do it.

12 CHAIR MARKOWITZ: Ms. Leiton, did you

13 want to make a comment?

14 MS. LEITON: Yes, just a couple of

15 points that you may not be aware of.

16 In terms of what our claims examiners

17 see, we have a database that is divided. I mean

18 we index them by the type of document it is,

19 whether it's an IH report, whether it's a medical

20 report, whether it's a decision, whether it's a

21 development letter, all those things are indexed

22 as the information is either coming in or
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

229

1 leaving. And that's there and available for the

2 claims examiners in the process. So, it is

3 organized for them.

4 And I understand you guys didn't get

5 that. And it makes it a lot more difficult. But

6 I did want you to know that that is the way that

7 they can see the records.

8 When we refer documents to a CMC, we

9 do try to provide them with whatever relevant

10 medical is there. We don't just send them a SOAF

11 and that's it. The reason we look for relevant

12 information is because of the 4,000 records that

13 have -- you may have medical that is in

14 completely different condition, that was just a

15 medical note, lots of those. So we try to send

16 them the information that's about the condition

17 we're asking about or, if it's impairment, what's

18 relevant to impairment, those sorts of things.

19 I know you have a recommendation in

20 for already, for providing them access. And

21 that's something that's, you know, under

22 consideration. But I just wanted to make clear
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

230

1 that we do try to give them what's relevant,

2 along with the question that we're asking them.

3 MEMBER SOKAS: So, Ms. Leiton, just to

4 comment on that particular piece. It's really

5 hard for the CE to determine, unless they're sort

6 of focusing down ahead of time on one or two

7 diagnoses. But it may be the person who's doing

8 the pre-op clearance for the gall bladder surgery

9 who figures out that the person's got asthma;

10 right? I mean so, so it's hard to exclude whole

11 parts of -- I mean I, I really think that if

12 you've got the CMC looking through, you know,

13 their job is really to sift through everything.

14 MS. LEITON: I, I mean I can

15 understand that. We've gotten most of the

16 physicians and either CMCs and external

17 physicians have asked that we not provide them

18 with information that doesn't really relate to

19 what we're asking them. But, you know, we,

20 again, that's something you guys have already

21 asked, and we will be looking at it.

22 CHAIR MARKOWITZ: Dr. Boden.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

231

1 MEMBER BODEN: So this raises

2 something I hadn't thought about before which is

3 we've looked at the case files that you provided

4 us. We've had some idea in our heads about what

5 you provide the CMCs. It might be worth -- and I

6 ask this particularly of the physicians here on

7 the board -- whether it might be worth looking at

8 what the CMCs see. That was too many Cs, but you

9 get the idea.

10 MEMBER SOKAS: Yes.

11 MEMBER BODEN: Because I don't think

12 we really know what they see. And if we're going

13 to -- if we may -- I understand the perspective

14 of somebody who's a contract physician who wants

15 to look at as little as he can, and particularly

16 doesn't want to look at 2700 pages of whatever. 

17 But so I guess I'm asking people on the Board

18 whether they think it would be worth our while to

19 see for some of these cases what is provided to

20 their CMCs.

21 CHAIR MARKOWITZ: Dr. Welch.

22 DR. SOKAS: I think that --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

232

1 DR. WELCH: No, go ahead. Go ahead.

2 CHAIR MARKOWITZ: Go ahead, Dr. Sokas.

3 MEMBER SOKAS: Oh. I think that's a

4 great idea. I think we tried to do that and

5 wound up getting a set of other responses that

6 really weren't that. So I, for some reason I

7 thought we had done that. And then I think we

8 wound up not. But I think it's a great

9 suggestion.

10 The other, the other piece I would

11 really be interested in -- and again I realize

12 there's this whole question about confidentiality

13 of contracts and, you know, and that sort of

14 thing -- but it strikes me that if the CMC is

15 being paid by the hour then I don't really

16 understand their complete reluctance to go

17 through, you know, this step. I mean it just,

18 it's striking to me that they're reluctant to

19 really pay attention.

20 CHAIR MARKOWITZ: Dr. Welch and then

21 Ms. Pope.

22 DR. WELCH: What the CMC sees is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

233

1 somewhat related to the question of what the --

2 how the claims examiner structures the statement

3 of accepted facts. And when that question is

4 very narrow, then the CMC doesn't need very much

5 because they're answering one -- they're not

6 answering anything about the diagnosis.

7 You know, it's sort of like if we

8 broaden that, which I think is one of the things

9 that Dr. Cassano's committee is looking at, it

10 will be more necessary to include more medical

11 records if the question is broader. As it is

12 now, a lot of times the question is fairly

13 narrow.

14 So, you might want to comment on that,

15 too.

16 MEMBER CASSANO: Yes. I think part of

17 it -- we can ask again, you know, what was, you

18 know, we can ask it as a general question and

19 again on specific cases. Well, to get this

20 response from the industrial hygienist or to get

21 this response for the CMC, what did the claims

22 examiner actually send to them? And we might be
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

234

1 able to get a little bit of an idea from that.

2 But considering that, I mean,

3 sometimes the question is for when is meningioma

4 considered a cancer? And they didn't, I don't

5 think any information went to the CMC. And the

6 fact of the matter is it was a Stage 2 meningioma

7 which is, has some dysplastic characteristics to

8 it and can actually metastasize. But the answer

9 came back, no, it's not.

10 But this particular CMC said, however,

11 there is an association between a -- I'm now

12 forgetting what the exposure was -- and

13 meningioma. And, therefore, they then went back

14 to the industrial hygienist. But they didn't,

15 nobody asked the CMC is there any relationship

16 between meningioma and anything that this guy was

17 exposed to?

18 Luckily, this one particular CMC did

19 volunteer that. So, in that case the person was

20 lucky to a certain extent because the case was

21 still denied because the levels were considered

22 too low because they didn't look at aggravation
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

235

1 or contribution, they only looked at straight

2 causation.

3 So, I'm not quite sure how to -- it's

4 something we're going to have to think about is

5 how to say, well, if you don't want the whole

6 record, you have to get at least this. And just

7 looking at the stuff that's pertinent to the

8 diagnosis, not only based on what Dr. Welch or

9 Dr. Sokas said, but a lot of times there's other

10 information in other workups that are pertinent

11 to the development of the diagnosis. So someone

12 that doesn't have the medical expertise to parse

13 that really can't pick out what's relevant.

14 And but I don't know how to say it's

15 all or just a little bit. I don't.

16 CHAIR MARKOWITZ: Ms. Pope.

17 MEMBER POPE: I agree with that. I

18 think it's a sore point with a program that's

19 supposed to be claimant-friendly, and in so many

20 ways it's not. I agree with the fact that we

21 need to make sure that there is enough

22 information that file that the CMC is available
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

236

1 to be able to see, but not so much that it's so

2 daunting that they, you know, can't possibly get

3 through the whole file and make a decision about

4 what's going on with the claimant.

5 But I really believe that it all goes

6 back to that CE that is earmarking these

7 particular documents that's going to the CMC

8 where they're not really equipped to do that, to

9 be able to identify what goes to the CMC. It

10 keeps going back to that.

11 CHAIR MARKOWITZ: Dr. Silver.

12 MEMBER SILVER: Before there were PDF

13 files, there were big, fat hard-copy files that

14 each of us has probably had transmitted to us in

15 our work lives. Before there were Post-It Notes,

16 there were paperclips to flag key items of

17 concern. Because people wanted our opinion and

18 trusted what we knew, they gave us the entire

19 file to pursue our curiosity and ply our

20 discipline.

21 I don't claim to have medical

22 expertise, but a lot of us have public health
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

237

1 training. And to infer causality, temporality is

2 the sine qua non. And it's not always the

3 temporal relationship between the exposure and

4 the disease, though, that's necessary. Sometimes

5 it's the temporal relationship between acute

6 symptoms that were noted early on, preceding the

7 development of a chronic disease.

8 Isn't a classic teaching example a

9 skin rash? A lot of time goes by and lung

10 disease develops. So the CE may be so focused on

11 the lung disease and the relevant exposures, and

12 not appreciate the significance of the much

13 earlier skin rash. But a doctor who's trained in

14 occupational medicine would need that

15 information.

16 CHAIR MARKOWITZ: Ms. Vlieger.

17 MEMBER VLIEGER: In discussions at

18 final adjudication bench hearings with the

19 hearings examiners, when I ask pointedly, can you

20 tell me exactly what was sent to the CMC, and

21 the response has been, no. We have to go off of

22 the SOAF that's provided to the CMC.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

238

1 And so even within the department, on

2 a number of occasions they can't explain to me

3 how the CMC would have got -- what information

4 they got to reach their decision. So it is a

5 hole in the program somehow.

6 And I don't think a bibliography is

7 going to cut it because that's really labor8 intensive to do. So, this is going to be kind of

9 a hard answer. We don't want to overburden the

10 CMCs till they become so mind-numb with a case

11 that they aren't going to make a rational

12 decision. But on the other hand, many times they

13 aren't receiving the nuances of how we got from A

14 to B.

15 CHAIR MARKOWITZ: Dr. Welch.

16 Dr. Cassano.

17 MEMBER CASSANO: Just one more

18 comment. You can't really audit the quality of

19 the content of the CMC's report unless you know

20 what the content is of what they're working on. 

21 You can't blame the CMC for an incomplete or

22 incorrect report if they don't have the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

239

1 information necessary to make the appropriate

2 decision in the case.

3 And I would think that from a contract

4 perspective that the department -- that the

5 department would want to make sure that the

6 quality assurance process takes that into

7 account. Because you may be wrongly saying, well

8 the CMC didn't render the correct opinion in this

9 case, when actually, based on what they were

10 given, they did.

11 MEMBER SOKAS: Well, I'm going to push

12 back on that just a tiny bit, Dr. Cassano, just

13 because there was one who, a CMC evaluation who

14 went to great pains to explain why he did not in

15 particular believe that COPD was the result of

16 workplace exposures. And he cherry-picked some

17 weird references in order to do that.

18 So, so you -- which I admit, that's

19 kind of an extreme example. But there are a

20 number of other examples where it was also clear

21 that, with the information they had, they simply

22 did not get the nature of the standard of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

240

1 causation or exacerbation.

2 So, there are clear examples of poor

3 quality in terms of content and decision-making

4 within some of these files. Although I agree

5 that, you know, the other piece where maybe they

6 don't dig hard enough is, you can't really assess

7 that unless they had access to the full records.

8 CHAIR MARKOWITZ: So, I want to move

9 back to the recommendation we made at the last

10 meeting. And because we've been discussing this

11 topic for 15 or 20 minutes now, and the question

12 is, and we addressed some of these in this

13 recommendation; the question is whether we want

14 to modify this in some sense.

15 Our recommendation Number 8 was we

16 recommend that the entire case file should be

17 made available to both the industrial hygienist

18 and the contract medical consultants when a

19 referral is made to either, and not be restricted

20 to the information that the claims examiner

21 believes is relevant. The claims examiner should

22 map the file to indicate where relevant
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

241

1 information is to be.

2 So, my question is, are we in some

3 sense refining, adding, changing this

4 recommendation?

5 MEMBER SOKAS: So, I guess the

6 question, so it's mapping -- rather than, I mean

7 for the claims examiner maps it and the record

8 itself is organized into sections. And I think

9 that would do it.

10 CHAIR MARKOWITZ: I'm sorry. Could

11 someone just repeat what she said. I couldn't

12 understand everything she said.

13 DR. WELCH: Rosie, were you just

14 saying that, understanding what Ms. Leiton told

15 us, that the file is mapped into sections, and

16 that one recommendation?

17 MEMBER SOKAS: That is, as long as

18 that's how it's provided to the CMC and the IH,

19 yes.

20 DR. WELCH: Well, if that's available

21 that way to the claims examiner. But I don't

22 think it's available -- Yes, okay. So part of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

242

1 the recommendation that we already made was to

2 give them access to it in that format, yes.

3 CHAIR MARKOWITZ: Right.

4 MEMBER SOKAS: Okay. And that's then

5 searchable as well; right?

6 CHAIR MARKOWITZ: Well, we don't, we

7 haven't established that. Ms. Leiton, do you

8 know offhand, the material that's sent to the CMC

9 and the IH, is it searchable?

10 MS. LEITON: Well, there's two

11 different things. What's sent to them now is

12 not, obviously. But we give them certain, we

13 give them the medical or industrial hygienist

14 records.

15 What the recommendation, my

16 interpretation of your original recommendation

17 was that the CMC and the IHs would have access to

18 the entire case file, which to us would mean

19 access to what the CEs have access to, which is

20 already indexed. It's indexed by the type of

21 reports, usually incoming or outgoing. It is not

22 in PDF. So we cannot search it by word
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

243

1 necessarily, but we do -- it is indexed to as

2 much detail as possible.

3 It is indexed and then there's a

4 descriptor line that you can go through and you

5 can sort it however you want, but it's not PDF. 

6 Right now that's not the way our technology was

7 built.

8 CHAIR MARKOWITZ: Okay, thank you.

9 MEMBER SOKAS: Okay. I mean I think

10 that's, as long as that's available to them that

11 would be fine.

12 MEMBER CASSANO: Is it possible for us

13 to see what that looks like when we come out on

14 Friday, do you know?

15 MS. LEITON: I think that we -- let me

16 get back to you.

17 MEMBER CASSANO: Okay.

18 CHAIR MARKOWITZ: So, Dr. Sokas, I

19 know what we recommended last time, what you have

20 on the slide we're looking and the discussion. 

21 Is there any recommendation that should be made

22 here?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

244

1 MEMBER SOKAS: I think for that, your

2 online access to the entire record, no. We can

3 leave that go. And just, you know, kind of say

4 that we, this just emphasizes that we really,

5 really, really want it.

6 But the second piece we haven't really

7 decided on yet is whether we want to -- what kind

8 of recommendation we can make for quality of

9 content evaluation. And I would like to have at

10 least some understanding of whether this is going

11 to be us doing it, in which case we just, you

12 know, kind of say right now what we think, or

13 whether you want to do it in a formal way where

14 we're recommending that a subcontract we let in

15 order to do that.

16 CHAIR MARKOWITZ: Dr. Welch.

17 DR. WELCH: I think one thing to think

18 about as we discuss that question is once there

19 is a briefing package that's sent out that tries

20 to standardize the review and get people to hone

21 in and use the same standard, you'd want periodic

22 assessment after that. You want some ongoing QI
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

245

1 about the content, which is probably not

2 something the Board can commit to provide.

3 So I actually think sort of maybe a

4 hybrid of having the Board be in charge of the

5 initial review and putting together the briefing

6 book, but hopefully with some additional

7 resources to hire some other physicians to help

8 with the reviews. If we wanted to review 100

9 files, for example, or pick a year and review

10 some specified subset of a year of files, to have

11 a couple of other heads and hands would be

12 helpful.

13 So that would be my recommendation. 

14 We should pick a number and then because I'm not

15 so sure that -- unless the number, unless you

16 felt a number of, you know, 40 was fine. I don't

17 have an idea of what number we'd need to do. But

18 I think we could probably use a little extra

19 help.

20 CHAIR MARKOWITZ: Other comments? Dr.

21 Cassano?

22 MEMBER CASSANO: Yeah, I think,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

246

1 hinging on what Dr. Welch just said, that there

2 are four district offices. So if we looked at

3 ten from each office, or something like that, we

4 might be able to get a reasonable idea. And,

5 actually, some of the cases we already have would

6 be useful to actually go through with a fine7 tooth comb and look at them, if they have CMC

8 reports or IH reports.

9 CHAIR MARKOWITZ: But the CMCs and IH

10 consultations, are they done on a regional basis

11 or is that a national contractor, so that the

12 Seattle office could easily use a South Carolina

13 physician?

14 MS. LEITON: They are done on a

15 national basis. So it could be referred -- any

16 referral goes to the national office, then we

17 refer it to our contractor. And our contractor

18 then provides us with whatever doctor it's going

19 to be that will review the case.

20 So, I mean it won't matter. I mean we

21 could say by district, if you wanted to look at

22 certain types. But if you wanted to pull random
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

247

1 CMCs, depending on what our contract says about

2 that, I'm not going to make any promises right

3 now, but then we could probably do it that way.

4 CHAIR MARKOWITZ: Dr. Boden.

5 MEMBER BODEN: Yeah, I'm just trying

6 to make sure that I know where we are in terms of

7 this discussion. So, we have the online access. 

8 We've talked about that and clarified it. Have

9 we clarified recommendations as far as the

10 briefing package as far as other things on the

11 list for discussion?

12 CHAIR MARKOWITZ: So are you referring

13 to the slide we're looking at now?

14 MEMBER BODEN: Yes.

15 CHAIR MARKOWITZ: So the first and the

16 last bullet item we've already discussed.

17 MEMBER BODEN: Right.

18 CHAIR MARKOWITZ: The second, third,

19 and fourth are tied together. We're really

20 discussing the second at the moment. And the

21 third and the fourth flow from the second.

22 MEMBER BODEN: Okay, good.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

248

1 MEMBER CASSANO: The fourth one is

2 being removed, correct? The fourth bullet on the

3 recommendations is being removed, right?

4 CHAIR MARKOWITZ: Okay. So the

5 question, I guess, is whether or not we're

6 prepared to actually write the language of a

7 recommendation on this topic, or whether we

8 should do that now, whether we should re-look at

9 it probably tomorrow morning, and the specific

10 language. And I know, Dr. Sokas, you're not

11 available, but one of us here could do that.

12 MEMBER SOKAS: Yeah, I can send you --

13 I can, you know, just slap some language together

14 and send it to you tonight, and then you guys can

15 discuss it tomorrow.

16 CHAIR MARKOWITZ: Let's do that. 

17 Let's do that.

18 MEMBER SOKAS: Okay.

19 CHAIR MARKOWITZ: Because, to me, the

20 sticking point is the boundary between what the

21 Board does and what the department does, and to

22 what extent we have input into the review, and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

249

1 just make sure it answers the questions that we

2 have. At the same time recognizing we don't have

3 the resources within the Board to look at a

4 sizeable number of claims.

5 MEMBER SOKAS: Right.

6 CHAIR MARKOWITZ: So that would be

7 great, Dr. Sokas.

8 MEMBER SOKAS: All right then, thanks.

9 CHAIR MARKOWITZ: Is that the end of

10 your -- do you have anything else in your report?

11 MEMBER SOKAS: No, that was it.

12 CHAIR MARKOWITZ: Okay. So we're

13 going to move on to the Presumptions Working

14 Group. If you could bring up the slide, Kevin.

15 So, the working group was formed, I

16 think, at the last meeting. We've had two calls

17 since that time. And if you could go ahead a few

18 slides. Actually, it'd probably better off if I

19 work the slides. If I could have the remote. 

20 Oh, it's here. But if you could leave it up,

21 Kevin, to one of the first one that says

22 "Presumptions." Okay.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

250

1 So, I want to spend a moment

2 summarizing what Dr. Boden has taught us. And if

3 I get it wrong, Dr. Boden, I expect you'll

4 correct me. But, you know, we began to talk

5 about presumptions this morning, but I think it's

6 worth spending a couple minutes just talking

7 about why, why we think -- and the department

8 thinks, actually -- that use of presumptions

9 would be a good way to go.

10 The first issue is fairness. And

11 there are a few different elements to this

12 fairness. One of them, the principal one is the

13 fact that there simply wasn't a lot of

14 information about exposure at a DOE complex over

15 many decades. And the absence of exposure should

16 not work against appropriate claims. And this

17 was recognized in the act, in the original act in

18 2000 when the establishment of Special Exposure

19 Cohorts at the gaseous diffusion plants.

20 Those plants were not the highest

21 radiation plants in the complex. They had lower,

22 on average, exposure radiation than, say, Hanford
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

251

1 or Rocky Flats or Y-12. And, yet, those three

2 gaseous diffusion plants were grandfathered in as

3 the original Special Exposure Cohorts on the

4 radiation cancer side. And they're the only

5 facilities that were identified in the act.

6 And it was done because it was an

7 admission -- the scientific basis was an

8 admission that there wasn't enough radiation data

9 from those sites to be able to come to a proper

10 decision. So it was only fair then to treat them

11 by route of a presumption: 250 days prior to 1992

12 in relation to 22 cancers.

13 And as most of us know, there are now

14 110, 115 Special Exposure Cohorts. 127, thank

15 you. Okay, 121. So it's gone from three in the

16 original act to consideration of each of many,

17 many more petitions, and now to 121.

18 So this presumption route has been

19 adopted. And a central part of it is fairness,

20 given the absence of data.

21 The other advantage of presumptions is

22 that it lends consistency to the process. And it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

252

1 may be that a presumption could be consistently

2 wrong or consistently right. But there's

3 something to be said for consistency. And when

4 you use a national portfolio of CMCs and IHs,

5 it's quite likely that there's going to be a fair

6 amount of inconsistency. So presumptions

7 provides that kind -- and consistency, frankly,

8 is factor in fairness.

9 Third, presumptions should make

10 decision-making a lot more straightforward, and

11 then should be able to turn around claims a lot

12 more quickly. Now, I'm not saying that claims

13 turnaround is a problem at present. It certainly

14 there was a problem early in the program. But

15 it's certainly one of the outcomes that the

16 department looks for in judging its program,

17 which is timeliness.

18 And then, of course, presumptions make

19 the decision-making simpler and, therefore, more

20 efficient. And so there should be fewer moving

21 pieces in a claim which can be passed on

22 presumptions. And maybe will even lessen the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

253

1 burden on the industrial hygienist and the CMC

2 through application of presumptions.

3 Now, one of the difficult issues on

4 presumptions is that, depending on where you set

5 the bar, how much exposure automatically gets an

6 accepted claim, you're going to make an error. 

7 And you're going to make an error wherever you

8 set the bar. If you set the bar very high,

9 you're going to exclude people who should be

10 compensated. If you make the bar very low, you

11 risk compensating people who perhaps really don't

12 have causation.

13 And so in developing our presumptions

14 we try to do it based on as much science as is

15 available. But also are frank that, you know,

16 there's an error, wherever you put it there's an

17 error either way. And we should be frank about

18 that.

19 And then, finally, we mostly talk

20 about positive presumptions. If a claimant meets

21 certain exposure criteria, certain medical

22 criteria for a disease, then they get
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

254

1 compensated. But this reminds us that there are

2 also negative presumptions. And we hear,

3 actually, there are some elements of negative

4 presumptions. For instance, I'm going to talk

5 about asbestos, and in the current policy there's

6 a presumption about exposure after 1995 that it

7 wasn't essentially important exposure. That's

8 negative presumption.

9 And there was a negative presumption

10 in the post-1995 memo that was recently

11 rescinded, right, that exposures after '95 are

12 under control.

13 So there are some -- we don't

14 emphasize them -- but there are entities such as

15 negative presumption.

16 So, Dr. Boden, what have I forgotten

17 in this brief review?

18 MEMBER BODEN: You're perfect.

19 CHAIR MARKOWITZ: Okay. Like a

20 student of Dr. Boden.

21 Okay, so a reminder. Presumptions

22 were incorporated in the original act. And I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

255

1 have a summary up here of this. This is a

2 summary. I don't provide every detail in the

3 act, but there are examples of how the act

4 accepted the route of presumptions.

5 And I mentioned before the Special

6 Exposure Cohorts at the gaseous diffusion plants. 

7 If you worked one year prior to '92 where

8 dosimetry monitoring was part of your job or a

9 comparable job, and that was sufficient exposure

10 to be linked at one of 22 cancer sites.

11 And there was also an exposure on

12 silica for a different outcome for non-malignant

13 lung disease, silicosis. And there, again, an

14 exposure, kind of the exposure criteria was set

15 out, which was years of work near, during or near

16 the tunnels of the mines.

17 I'm going to talk a fair amount about

18 asbestos and then talk about asthma. And this

19 way of looking at things actually was reflected

20 in Dr. Welch's approach to COPD. And we'll hear

21 it again in relation to hearing loss.

22 But we try to capture, understand
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

256

1 elements of exposure whereby we can make the

2 judgment: was there sufficient exposure to cause,

3 contribute, or aggravate disease? And,

4 obviously, we look at how long a person did that. 

5 We are interested, to the extent we can, in which

6 calendar years. Exposures in the '60s were worse

7 than exposures in the 2000s.

8 Job title for us is really a proxy for

9 trying to understand how much, how intense the

10 exposure might have been, what the tasks would

11 be, and then the frequency of exposure.

12 And then, finally, latency. To the

13 extent we need to, we recognize that a typical

14 pattern for a chronic disease caused by

15 occupational factors is that the onset occurs at

16 one period of time, and the disease usually

17 doesn't occur, such as cancer, for 15 years or 20

18 years or 30 years or 40 years. And that gap in

19 time is called latency.

20 And Dr. Welch addressed it in the

21 COPD, essentially saying there was no latency in

22 the instance of that illness. But that's not
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

257

1 true for cancer.

2 So here I'll just summarize. I'm

3 going to use this kind of table later on to

4 discuss asbestos, so I just wanted to introduce

5 it here for cancer and silica. This is from the

6 original act. Duration, job title, or calendar

7 years, if they were specified, and the issue of

8 latency.

9 So asbestos appears in the procedures

10 manual, it appears in the bulletins, circulars. 

11 It's a popular topic, relatively popular topic in

12 the guidance provided by the department. And the

13 new draft on presumptions also addresses --

14 that's part of -- that's being elaborated by the

15 program also addresses asbestos and really

16 summarizes and somewhat changes these.

17 To remind you, we're talking about a

18 number of different diseases in relation to

19 asbestos. The ones you've all heard of, such as

20 asbestosis, which refers to scarring of the lung

21 tissue itself caused by asbestos; asbestos22 related pleural disease, which is scarring of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

258

1 lining of the lung called the pleura, which is a

2 non-malignant disease; and then lung cancer. 

3 Mesothelioma, which is a malignancy of the

4 pleura, although it can also occur in the abdomen

5 and a couple of other locations, and which is

6 fairly uniquely related to asbestos.

7 And then cancer of the larynx and

8 ovary, which have been related in repeated

9 studies of workers and others as having a high

10 association with asbestos exposure and considered

11 causally related.

12 And then, finally, COPD, which we'll

13 go into in a bit. But, really, in I think

14 looking at asbestos presumptions, frankly, COPD

15 ought to fall within the COPD presumption. It's

16 just much clearer if it does.

17 I have to spend a couple minutes

18 reviewing what the current procedures and

19 policies are. In order for us -- and I've done

20 this within the working group, and I apologize

21 for repeating some of this, but it's hard to

22 remember this, and we need to understand what it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

259

1 is that we're trying to simplify.

2 So the exposure, initial piece from

3 the procedures manual said that when the CE looks

4 at an asbestosis claim, the DEEOIC accepts the

5 asbestos was common in a complex. While asbestos

6 did exist at DOE facilities, the nature of

7 employees' exposure would have been varied based

8 on different factors during the period in which

9 they worked, type of work performed, and the

10 location of employment.

11 And so, then, and this is in Bulletin

12 No. 13-02, the program looks at asbestos

13 specifically around ovarian cancer. And this

14 came up, I think, just so you understand the

15 history, this came up because ovarian cancer was

16 declared in 2012 by the World Health

17 Organization, specifically the International

18 Agency for Research on Cancer, IARC, to be caused

19 by asbestos exposure. So that was the first kind

20 of consensus -- I think it's safe to say it's the

21 first consensus recognition that ovarian cancer

22 was caused by asbestos. And the department
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

260

1 elaborated this bulletin.

2 So the exposure presumption here is

3 the 250 days of significant asbestos exposure. 

4 So, a year. "Significant" is defined as having a

5 job title in List A. I showed List A before. 

6 I'll show it again, but it's a set of mostly

7 building trades-type job titles.

8 Prior to 1986. And there should be 20

9 years latency between onset of exposure to

10 asbestos and diagnosis of ovarian cancer. Or if

11 the woman has asbestosis or mesothelioma and then

12 has the terrible luck of also developing ovarian

13 cancer, that the exposure would be accepted

14 because they have this other evidence of

15 significant asbestos exposure. This must,

16 hopefully, be extremely rare.

17 Then here's -- I don't know if you can

18 read it on the big screen, but here's the list

19 and the reference from CDC, 2014, of the jobs

20 that are accepted as involving significant

21 exposure.

22 Moving on to asbestosis or the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

261

1 scarring of the lung tissue itself, the 250 days

2 of exposure is required, 10-year latency. And

3 perhaps this slide got out of order. We've

4 finished the ovarian cancer issue.

5 Claims that don't meet the exposure

6 presumption criteria will be treated individually

7 by the CE and, when needed, by the industrial

8 hygienist. So this is important because

9 presumptions are good and can help the process,

10 but if people don't meet the presumptions they

11 need to be evaluated individually to make sure

12 that they have their fair evaluation.

13 And then the instruction to the CE is,

14 for claims with more limited evidence of asbestos

15 exposure, refer to a medical opinion, which is

16 the CMC.

17 So here's a summary of these two -- of

18 the six asbestos-related diseases, cancer of the

19 ovary, asbestosis. Duration is the same, 250

20 days, 250 days.

21 Now, there is a more recent bulletin

22 relating to COPD and asbestos. And as Dr. Welch
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

262

1 noted this morning, you need 20 years of exposure

2 for there to be an accepted exposure and claim. 

3 And the job titles, they mostly come off of List

4 A. Although for COPD there is the option of

5 having the IH examine the claim.

6 And then for calendar years, for

7 ovarian cancer it's 1986 is the cut-off for

8 significant exposure. For COPD it's 1980. And

9 then latency, one is 20 years, asbestosis, 10

10 years. In COPD it's not elaborated.

11 So, this is Circular 15, which

12 addresses a number of asbestos-related diseases. 

13 That's what ARD stands for. And here is a

14 sequence of instructions around understanding the

15 exposure, which we believe should be simplified,

16 which is that post-1986 work at DOE, assume that

17 the potential exposure to asbestos, that there

18 was potential exposure, but at levels below

19 accepted standards. And accepted standards we

20 think refers to the OSHA standard or the

21 equivalent. So, after '86 there might be

22 exposure, but assume that it's under control.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

263

1 However, for the 19 occupations on

2 that list I just showed, they have potential for

3 greater exposure between '86 and '95, and so the

4 claims examiner is to accept that they were

5 potentially exposed to asbestos, but likely at

6 low levels.

7 So, for the claims examiner to accept

8 a level of asbestos exposure above the low level,

9 above the level that's assumed, there must be

10 definitive and compelling evidence to show that

11 exposure after '86 at DOE had consistent

12 unprotected contact with asbestos or asbestos13 containing materials. 

14 So what the CE is instructed to look

15 for here is, for exposures after 1986, that

16 somewhere in the record it shows that the worker

17 had consistent unprotected contact with asbestos

18 or asbestos-containing materials. And then the

19 CE is provided with a list of various sources to

20 look for this consistent unprotected contact.

21 And if the evidence is suggestive that

22 the exposure is above the guidelines, then the CE
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

264

1 contacts industrial hygiene regarding the

2 industrial hygienist's evaluation of the facts.

3 This circular says, at the end,

4 however, that any findings of exposure, including

5 infrequent, incidental exposure, require review

6 of physicians who opine on the possibility of

7 causation. This is necessary, as even minimal

8 exposure to some toxins may have significant

9 aggravating or contributing relationship to the

10 diagnosed illness. 

11 So the CE, having made some decision

12 about whether there was significant enough

13 exposure to refer to the IH, is instructed that

14 even if there is infrequent incidental exposure

15 which sounds like it's insignificant, that the

16 CMC should be involved.

17 And I don't know how this policy

18 actually played out in reality, but on paper it

19 appeared potentially a little confusing.

20 So just to summarize then. Elevated

21 exposure is greater than 250 days of work on List

22 A, prior to '86. That's recognized.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

265

1 Post-'86, assume asbestos exposure was

2 below the accepted standard, except for List A

3 workers.

4 And for those List A workers in the

5 following decade, assume they had potential

6 exposure but it was likely low.

7 And to demonstrate greater-than-low8 level exposure post-'86 you need definitive and

9 compelling evidence to show consistent,

10 unprotected contact with asbestos.

11 So if that condition exists, then

12 refer it to the industrial hygienist. But if you

13 find any exposure, it only requires the physician

14 review.

15 And so this raises a number of issues. 

16 One is it wasn't clear what are we presuming

17 about exposure prior to '86. The List A that was

18 constructed that likely had low exposure, this

19 was not necessarily -- this is not evidence20 based, certainly not based on evidence from

21 Department of Energy. We know where it came

22 from, but not specific, certainly, to DOE.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

266

1 Designation of exposure between '86

2 and '95 is deemed likely low. It doesn't really

3 facilitate decision-making about a claim.

4 And then, the CE has to use what is a

5 difficult-to-apply standard of consistent,

6 unprotected contact with asbestos-containing

7 material.

8 So, so remedies. Some items that we

9 can focus on in order to try to improve the

10 clarity of the asbestos presumptions. One is

11 that is List A big enough? Does it, is it all12 encompassing enough in terms of what we know

13 about asbestos exposure?

14 What do we know about likely post-1986

15 exposures to asbestos?

16 Can we settle on any calendar year

17 that's sensible? In our last meeting we voted on

18 a recommendation that DOL rescind the post'95

19 circular which basically says assume post'95

20 exposures in general were controlled. And part

21 of the rationale was that we thought that picking

22 a precise date really didn't reflect reality.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

267

1 And then can we consider a minimum

2 exposure duration and latency that is somehow

3 consistent across the asbestos-related diseases?

4 So, that's the background. And now

5 I'll get to the point.

6 I'm not going to give you the

7 recommendations first. I want to give you sort

8 of the rationale for them, which is asbestos9 related diseases are common at Department of

10 Energy. And my evidence is that in the Former

11 Worker Program we have examined 73,000 DOE

12 workers since the year 1998. And 12 percent of

13 them have evidence on the chest X-ray of

14 asbestos-related scarring. That's not cancer,

15 because we don't collect, in the Former Worker

16 Program we don't collect information about

17 asbestos-related cancers.

18 And then if you look at individual

19 sites -- Savannah River, Paducah, Hanford, et

20 cetera -- you can look at the percentage that

21 have, either on the construction site, or what

22 are called the production site. Production, as I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

268

1 said before, is everybody else on the site. So

2 it's maintenance, administration, engineering,

3 service, et cetera. That up to a quarter or a

4 third of those work forces have asbestos-related

5 scarring.

6 Now, it varies significantly across

7 the sites. In general, it's higher in

8 construction than in the production side. Some

9 of the production side it's 5 percent, 7 percent. 

10 I don't want to mislead by saying a quarter to a

11 third of all, because it is quite variable. But

12 it's remarkable that at some sites it's quite

13 common. And not just in construction, which in a

14 way we might expect, but also on the non15 construction side.

16 And this is evidence across the

17 complex at most or all of the sites that there is

18 asbestos-related disease.

19 I included a picture here from

20 yesterday's tour. We had a very nice tour,

21 thanks to Greg Lewis, Department of Energy,

22 actually for setting this up. And thank you to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

269

1 our hosts here at Hanford for showing us the

2 site. We spent seven or eight hours going around

3 the site yesterday, so we had a taste of what

4 goes on at Hanford.

5 And this picture is a picture I took

6 at B Reactor. Very nicely contained asbestos,

7 with a beautiful label on it. I'm sure it's not

8 a hazard to workers.

9 In general, Item Number 4 is not just

10 within the DOE complex, but in general decades of

11 research on asbestos has clearly demonstrated

12 that maintenance workers and construction workers

13 suffered asbestos-related diseases. That can be

14 in a refinery. It can be in a chemical plant. 

15 It can be in, you know, construction in New York

16 City. They have the same experience because of

17 how much asbestos that was routinely used in

18 different products in a variety of settings.

19 We also know that relatively modest

20 amounts of asbestos can cause asbestos-related

21 diseases. And it varies somewhat, depending on

22 the disease.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

270

1 And we also know, in general, the time

2 frames of asbestos use in the United States,

3 including DOE, which is that the use dramatically

4 dropped off in the 1980s. But there was a

5 tremendous amount of asbestos in place, and there

6 still is, after the time when asbestos was

7 stopped being, for the most part, introduced into

8 the workplace.

9 Asbestos has never been banned in the

10 U.S. Some uses have been banned. But to this

11 day we import small amounts. We import some

12 friction products, some textiles, some roofing

13 material. And, hopefully, someday it will be

14 banned.

15 So this is the recommendation. And

16 there are I think three or four slides. So let

17 me just read it, so then I have a summary slide.

18 That all DOE workers who worked as

19 maintenance or construction workers at a DOE site

20 for 250 days or more prior to January 1st, 2005,

21 and who are diagnosed 15 years or more after the

22 initiation of such work with one of five
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

271

1 asbestos-associated conditions, will be presumed

2 to have had sufficient asbestos exposure. But it

3 was at least as likely as not that asbestos

4 exposure was a significant factor in aggravating,

5 contributing to, or causing such asbestos6 associated conditions.

7 And the five conditions are

8 asbestosis, asbestos-related pleural disease,

9 lung cancer, cancer of the ovary, and cancer of

10 the larynx. So that I took mesothelioma out of

11 this because they have a somewhat different set

12 of exposure criteria.

13 So, 250 days or more prior to 2005,

14 diagnosed 15 years or more after onset of work

15 with asbestos will be presumed to have

16 significant exposure.

17 And I'm going to get into why we kind

18 of came on these particular numbers.

19 But for malignant mesothelioma, which

20 is the cancer of the lining of the lung or the

21 abdomen, and is known to be caused by quite

22 modest levels of exposure to asbestos, that here,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

272

1 for DOE workers that worked at maintenance or

2 construction DOE site for 30 days or more prior

3 to 2005, and who are diagnosed 15 years or more

4 after the onset of such work, and who are

5 diagnosed with malignant mesothelioma that they

6 are presumed to have sufficient exposure to meet

7 the standard, which I won't repeat.

8 And that all claims for one of the six

9 asbestos-associated conditions named above don't

10 meet these two exposure criteria will be referred

11 to industrial hygienist for exposure assessment

12 and to a consulting medical physician for

13 evaluation of medical documentation and

14 causation. And this is to recognize that workers

15 who did not work in construction or maintenance,

16 many of them had significant asbestos exposure,

17 we may not be able to make a presumption for

18 those categories of workers, but that they should

19 be evaluated carefully if they're claiming an

20 asbestos-related disease, both by the industrial

21 hygienist, who can hopefully clarify the extent

22 of their exposure, and also by the physician, who
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

273

1 can make a judgment about whether the quantity of

2 exposure justifies causation and claim

3 acceptance.

4 And then, finally, the chronic

5 obstructive pulmonary disease may have a

6 contribution from asbestos exposure. However,

7 claims for this disease should be evaluated as

8 part of a broader set of presumptions for chronic

9 obstructive pulmonary disease. Because there's

10 just so many other exposure agents that cause

11 COPD I couldn't really, I don't think there's a

12 strong rationale for separating it out from the

13 other agents, frankly.

14 And, so, a summary. This chart

15 summarizes for mesothelioma, which is the second

16 column. Third column is asbestosis and asbestos17 related pleural scarring. And then the final

18 column on the right is for lung cancer, cancer of

19 the ovary and larynx.

20 That the duration for mesothelioma

21 would be shorter, 30 days. The others it would

22 be one year.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

274

1 All job titles within maintenance and

2 construction would be included.

3 The calendar years would be prior to

4 2005, which I will discuss in a moment.

5 And the latency would be uniform

6 across them, which is 15 years.

7 You could have an asbestos-related

8 disease at 12 years of latency but it would be

9 uncommon. And it can be accepted through a non10 presumption route. It would be evaluated by an

11 industrial hygienist and a physician and a

12 decision would be made. It is a very uncommon --

13 it would occur very uncommonly.

14 So let me just close this. I think

15 this is -- yeah. A little monolog here on the

16 issue of calendar years.

17 So there's a choice to be made. You

18 could, as in the COPD recommendation, not specify

19 calendar years and just say if you worked for 250

20 days maintenance or construction and you

21 developed asbestosis 15 or more years ago, we're

22 going to compensate you. But the fact is, that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

275

1 doesn't really recognize the reality, that over

2 time asbestos exposure was reduced. It wasn't

3 reduced on a precise date, but over time it did,

4 it did become lower.

5 And 1995, the mid-'90s is not a bad

6 date for some demarcation of lowering of

7 exposure. First of all, asbestos use dropped

8 dramatically in the 1980s, not just at DOE but

9 across the country. And then it took a while,

10 then 1994 OSHA revised, made its revision of the

11 asbestos standards and it halved the allowable

12 asbestos. And I think there was a policy

13 document within DOE in the mid-'90s relating not

14 just to asbestos but to the set of exposures.

15 So, you know, as a Board we didn't

16 feel comfortable with the 1995 cutoff in terms of

17 the previous circular we looked at in the fall

18 because we thought that it wouldn't reflect

19 reality that a given date or given year that

20 exposure would go from important to unimportant. 

21 So the approach here is to say, okay, in the mid22 '90s, by the mid-'90s there probably was
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

276

1 considerable drop. But let's use a 10-year

2 safety margin.

3 Let's say that if the policies

4 changed, use dropped in the '80s and into the

5 mid-'90s, that it took an additional 10 years for

6 that to become routine practice in the complex,

7 for that dissemination, for the diffusion of

8 knowledge, and for general adoption by the work

9 force of methods of working that really meant

10 significantly less exposure to asbestos.

11 So this was sort of a compromise

12 between ignoring calendar years, which seemed

13 somehow not to reflect reality, and setting an

14 arbitrary, unrealistic calendar years demarcation

15 like 1995 in which a pronouncement would suddenly

16 lead to absence of exposure, and allow a 10-year

17 phase-in period where exposure would most likely

18 continue to drop, in part because workers accept

19 -- you know, were educated, accepted, and it was

20 accepted on the shop floor that you wouldn't work

21 with asbestos in an uncontrolled fashion.

22 So that's the proposal on asbestos.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

277

1 So, comments? Dr. Welch.

2 DR. WELCH: Although I did have the

3 chance to comment on this prior to the meeting, I

4 think I've just been thinking about it more. I

5 think like we may need, for the non-malignant

6 asbestos-related disease we may need some medical

7 diagnostic criteria to go with it. Because in a

8 way, when you build in, you know, if you build in

9 a really high exposure as your exposure criteria

10 you're saying if there's non-specific scarring in

11 the lung but somebody was an insulator who had 30

12 years of exposure before 1980, the chance that's

13 asbestosis is very high.

14 But as we lower the exposure

15 requirement, then the likelihood that an abnormal

16 finding on a B read is asbestosis is lower. But

17 the current system doesn't require the claimant

18 to come in with a specific medical diagnosis of

19 asbestosis. Generally they come in with findings

20 on a B read or a chest X-ray.

21 So, we might think about how we could

22 add some diagnostic criteria that would, which
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

278

1 would make the process easier. Because we're

2 saying asbestosis but I think the claims

3 examiners or the department is going to say,

4 well, how do we know what's asbestosis then in

5 the context of, this is new? And that's kind of

6 separating in your mind the exposure requirements

7 and the medical diagnostic requirements for those

8 two particular diseases they tend to, you know,

9 we can't diagnosis asbestosis unless you've had

10 enough asbestos exposure that it's likely that

11 the scarring is due to asbestos.

12 And 250 days is low for causing

13 asbestosis, if that was the only exposure. We

14 picked that number because it would certainly be

15 contributory with other exposures, but you have

16 to somehow know you've got the right diagnosis.

17 CHAIR MARKOWITZ: Sure. Dr. Cassano.

18 MEMBER CASSANO: I agree with Dr.

19 Welch on this because a couple of cases that we

20 looked at, pleural plaques -- and I know you

21 include pleural disease -- but pleural plaques in

22 and of themselves create no disability without
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

279

1 fibrosis or reduction in pulmonary function

2 tests. And yet I see people -- and I wasn't

3 going to say this -- but I see that people are

4 compensated just for the evidence that there are

5 pleural plaques, and compensated handsomely for

6 that. And not -- there's no real disease

7 diagnosis there.

8 So, I think that's something we may

9 want to look at.

10 CHAIR MARKOWITZ: Mr. Domina is next. 

11 But if you have a specific response to that, Dr.

12 Welch?

13 DR. WELCH: I do. In that the -- it's

14 my understanding under Part E what you get in

15 terms of compensation is medical and weight and

16 impairment rating. So that it's possible that

17 what you're seeing is someone who has two

18 conditions, they have asbestos-related pleural

19 plaque and they also have COPD. And the claim

20 has been accepted for asbestos-related pleural

21 plaque, and they end up getting an impairment

22 reading related to it.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

280

1 It's okay with me because they have

2 the underlying disease that's also related to the

3 same exposure. But it's not, you know, under

4 Part B there's cash awards. Under Part E there's

5 no cash award. So the -- you might want more

6 precision but I -- it's unlikely that people with

7 asbestos-related pleural scarring and normal

8 pulmonary function tests are getting a big

9 impairment rating. That would be extremely

10 unlikely.

11 So, but anyway, that's just my two

12 cents. I haven't looked at those same cases

13 before.

14 CHAIR MARKOWITZ: If I could just,

15 before I move on to Mr. Domina, just so people

16 are clear. Asbestos-related pleural disease is a

17 disease. It is pathology. The pleura is not

18 normal.

19 And if it's relatively small in

20 extent, then it's unlikely to affect pulmonary

21 function or provide symptoms. If it's extensive,

22 then it can clearly impact pulmonary function.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

281

1 I just didn't want people to think

2 that asbestos-related pleural disease is not a

3 disease. It is a disease.

4 All right, Mr. Domina.

5 MEMBER DOMINA: My comment has to do

6 with the year 2005. Because I don't know if I

7 can live with that. Because of, you know, the

8 late '90s everything went to performance-based

9 contracts. Yeah, maybe they didn't use asbestos

10 anymore, but they also didn't take care of it

11 based on funding or whatever because you look at

12 what's happened, like, during stimulus or what

13 goes on now when they have an asbestos issue,

14 there's had to have been stop works to take care

15 of it, or a certain contractor was fined into the

16 six figures when they imploded a building that

17 they videoed because of the amount of asbestos

18 they put in the air.

19 And so just, you know, it's -- I don't

20 know if 2005 is going to work for me. I think it

21 needs to go later just for the fact on how

22 things, business is conducted today. You know,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

282

1 and it's just like what we talked about a little

2 bit yesterday is that when you have run to

3 failure, how much stuff is already failed because

4 a switch turned something off? It's considered

5 still running.

6 And I just think that I don't believe

7 2005 is late enough.

8 CHAIR MARKOWITZ: So is that an

9 argument against using any calendar year? Or

10 would you simply move it to 2008 or 2010?

11 MEMBER DOMINA: Yeah, I'd probably go

12 to '12 or '15. I mean, just because of what I've

13 witnessed and some of the things that have

14 transpired. And if it's happening here, it's

15 happening across the complex.

16 CHAIR MARKOWITZ: Okay. Okay.

17 Ms. Vlieger.

18 MEMBER VLIEGER: I would like to agree

19 with Mr. Domina. As the planner at the Hanford

20 Site, even though I wasn't a maintenance craft, I

21 was in the field with the maintenance craft

22 planning my jobs, that we do walk down in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

283

1 contaminated areas. And the amount of asbestos

2 that's just there, and it's not going away, it's

3 not being replaced with something else because

4 it's too expensive to alleviate it.

5 And here in our climate we have a high

6 desert clime with temperature exchange and wind,

7 and the asbestos becomes friable. It's not

8 immediately fixed in your breathing zone. There

9 just, there you're told, well, just don't brush

10 up against it. But that's not sufficient.

11 And so until all of the sites go to

12 the ground, you know, they're leveled and no

13 longer exist, I think because of the age of the

14 buildings we're dealing with we have to consider

15 that the exposures are not going to go away.

16 And I really have a problem with what

17 is the definition of low level asbestos exposure? 

18 Because to my knowledge there is no safe level of

19 asbestos exposure, it just depends on your

20 personal physiology and DNA how you're going to

21 react to it. I'm not a physician, but that's my

22 understanding of it.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

284

1 So what exactly is low level or

2 insignificant.

3 CHAIR MARKOWITZ: So, let me ask, so

4 in this recommendation we remove any designation

5 of low level or insignificant.

6 MEMBER VLIEGER: Until you get to the

7 non-production workers. Until you get to the

8 other workers and then it's established by the IH

9 and CMC whether or not it's a significant factor. 

10 And there we go with significant again.

11 So, couple that with the fact that we

12 know there are no individual monitoring records

13 in the personnel records. So that when you go to

14 a non-production worker, I'm a non-production

15 worker at the site, and if I come up with one of

16 these diseases I have to prove, because I'm

17 outside this window, this presumption that we're

18 making, that I was exposed. It's nowhere in my

19 work records. It's nowhere in my performance

20 appraisal. I was not an asbestos worker, so it's

21 not in that medical record. And I would have to

22 prove by showing some monitoring data.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

285

1 We have no monitoring data. And

2 that's been corroborated by the Department of

3 Energy. They have it. It's not available to go

4 into personnel records.

5 And so we are creating a left-out

6 class, if you want to put it that way, of people

7 that are in the field side by side with the craft

8 workers on a daily basis.

9 CHAIR MARKOWITZ: Dr. Redlich.

10 MEMBER REDLICH: I am not sure this is

11 the correct solution, but there is different

12 overlap of asbestosis with the pneumoconiosis or

13 just pulmonary fibrosis in reality and also in

14 the current guidelines. And so because and I

15 think one of the issues for mesothelioma and lung

16 cancer and pleural plaques, I think that

17 recognition of those is relatively

18 straightforward.

19 I think the asbestosis becomes sort of

20 the most programmatic in, you know, is it ILO

21 reading on a chest X-ray? Is it restriction on

22 your pulmonary function test? Is it a low
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

286

1 diffusing capacity? And having reviewed some of

2 the pneumoconiosis claims, I think even if you

3 decide on a nice template, the implementation of

4 that very quickly gets sort of complicated.

5 So I don't -- wondering whether one

6 took the asbestosis piece and could have kept it

7 with the pneumoconiosis. I mean, because there

8 is -- I mean, if you wanted to take a presumption

9 approach, you know, pulmonary fibrosis

10 interstitial lung disease is relatively an

11 uncommon disease. And if you've been having a

12 lot of metal dust and particulates, you know,

13 that is an increased risk. And if you -- you

14 could have a presumption for pneumoconiosis that

15 would maybe simplify this whole group of the

16 asbestosis and the pneumoconiosis group.

17 CHAIR MARKOWITZ: So you, so --

18 MEMBER REDLICH: You know, I just

19 think that this piece, because, you know, I think

20 even if one settled on this, the actual decision21 making about what constituted asbestosis could

22 get sort of complicated and also overlap with the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

287

1 pneumoconiosis.

2 CHAIR MARKOWITZ: So you're arguing,

3 as Dr. Welch, for setting out medical criteria

4 for the diagnosis?

5 MEMBER REDLICH: Yes. Especially I

6 think the mesothelioma and the others are, but I

7 think the asbestosis is the one that.

8 CHAIR MARKOWITZ: Dr. Boden.

9 MEMBER BODEN: I'm trying to think

10 through this a bit, and also think about the

11 point that you raised at the very beginning about

12 presumptions we're trying to sort of balance

13 false positives and false negatives. And that's

14 always tricky. That's what the 2005 is trying to

15 do.

16 It does seem to me that you could

17 consider the diagnosis and the pre- or post-2005

18 as being sort of balancing things. So that if

19 you go more towards the medical diagnosis, maybe

20 you need the cutoff dates less. And if you go

21 with the cutoff date, maybe you need the

22 diagnosis less.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

288

1 Which means to me maybe you kind of

2 choose one or the other as a way of sort of

3 balancing these things out. That's, again I'm

4 not claiming expertise on the disease but just

5 trying to think about the balancing that we're

6 trying to do.

7 And I do think that you're right in

8 pointing out that there are workers that are left

9 out of this. And then the question is sort of

10 that shouldn't mean that they're left out of

11 being compensated for those illnesses. But it

12 might be that it's harder for them to get

13 compensated, and that maybe you need to show

14 somehow that there was uncontrolled asbestos

15 exposure. And I don't know how easy or hard that

16 is. You know much better than I do.

17 CHAIR MARKOWITZ: Dr. Cassano.

18 MEMBER CASSANO: I tend to agree with

19 the concept of removing the 2005. The way we

20 look at it in shipyard workers and in naval

21 vessels, as they said, these buildings are old. 

22 And the way it's looked at is any ship whose keel
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

289

1 was laid before 1978, you have to assume that

2 asbestosis was present and anybody on that ship

3 was basically exposed.

4 So, 2005 again is arbitrary. You have

5 a person that's working in a building that was

6 built in 1957 or even earlier than that, 1945,

7 they haven't removed that asbestos lagging. If

8 something happens or, you know, there was some

9 kind of incident where they had to get into the

10 pipe, I know for a fact that nobody ever goes

11 there and brings the, you know, takes a little

12 sample first and sends it off to industrial

13 hygienist. They rip the darn lagging out and

14 it's over and done with.

15 So I think 2005 is too arbitrary. 

16 Unless a building is so modern that it, you can

17 prove that it was built without the use of

18 asbestos in the lagging or the walls or whatever.

19 CHAIR MARKOWITZ: So we're going to

20 take one more comment, then we'll go on break.

21 Dr. Welch.

22 DR. WELCH: Well, I think, you know,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

290

1 if you remember that the presumption is a

2 presumption and that it's going to -- there are

3 some people who should be compensated but you

4 need an individual review to figure out who that

5 is. So even if there was exposure after 2005,

6 it's not -- it shouldn't -- I don't think we can

7 assume it's to everybody in the complex, which is

8 what we're saying. Maintenance and construction

9 before 2005 there's general exposure, and after

10 2005 it would be particular people but not

11 everybody.

12 So I think having a date is reasonable

13 as long as we have a process where the people who

14 had injurious exposure after 2005 can have their

15 case reviewed without it being extremely

16 burdensome. So we may have to think about that

17 as part of this and how we word that.

18 CHAIR MARKOWITZ: Okay. So we're

19 going to -- I'm sorry -- we're going to take a

20 break for 15 minutes. We'll reassemble at, 3:00,

21 roughly 3:20, 3:22.

22 Thank you.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

291

1 (Whereupon, the above-entitled matter

2 went off the record at 3:08 p.m. and resumed at

3 3:26 p.m.)

4 CHAIR MARKOWITZ: We're going to break

5 a few minutes before 4:30 to prepare for the

6 public comment session.

7 We have 15 people who have requested

8 time. So, today I ask you to -- we have a 90-

9 minute period to ask for public comment. Giving

10 a little bit of warning about this, to limit your

11 comments to about five or six minutes so that

12 everybody gets the same amount of time. I know

13 it's not much time, but concentrate your

14 thoughts, I guess.

15 Okay, so let's see, Dr. Welch. Do we

16 have Dr. Sokas on the line?

17 MEMBER SOKAS: Yes.

18 CHAIR MARKOWITZ: Okay. Mr. Griffon?

19 MEMBER GRIFFON: Yes, I'm here.

20 CHAIR MARKOWITZ: Okay. Thank you. 

21 And Dr. Welch, looks like she'll be back in a

22 minute.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

292

1 Okay, so let's continue the discussion

2 here. Mr. Whitley.

3 MEMBER WHITLEY: As we've talked about

4 presumptions, talked about what Les was talking

5 about, it's kind of a balance. And I would think

6 that from 2005 to present that the way we handle

7 asbestos, and especially asbestos abatement and

8 that kind of stuff, was with policy and all that

9 now.

10 The problem I've got is what they

11 said, there is groups like HPs and IHs, the

12 supervisors and other lot of groups, that this is

13 going to not put in the presumption. It doesn't

14 mean that they can't still file as they do today,

15 it just means they've got to prove it a little

16 different.

17 And for the presumption, the balance

18 the way it is, I can live with the way we've got

19 it.

20 CHAIR MARKOWITZ: Dr. Redlich.

21 I mean, I would point out, just to

22 follow up that the current policy on List A, the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

293

1 list of 19 or so specific job titles and closely

2 related job titles. And this proposal really

3 expands that quite considerably to encompass all

4 maintenance and construction workers. It's not

5 saying that others might not be exposed, it's

6 just saying it's a matter of presumption these

7 very broad groups would be presumed to be

8 exposed.

9 Dr. Silver.

10 MEMBER SILVER: Could I ask you to put

11 up the language for the IH and CMC evaluations of

12 people who don't fit? Okay.

13 I wonder if we could move in the

14 direction of Kirk Domina's concerns by borrowing

15 an idea from the statute itself. Under

16 definitions, member of the Special Exposure

17 Cohort for the original Paducah, Portsmouth, and

18 Oak Ridge includes the phrase "was monitored

19 through the use of dosimetry badges for exposure

20 at the plant of the external parts of the

21 employee's body to radiation, or worked in a job

22 that had exposures comparable to that."
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

294

1 By analogy, Congress didn't trust the

2 results of that monitoring that went on. And the

3 union proved and the Washington Post proved that

4 it was held. So just the fact that people were

5 monitored gets them into the Special Exposure

6 Cohort.

7 So, by analogy, we have reason not to

8 trust a lot of the asbestos abatement work that

9 has happened post-Cold War. What if instead of

10 letting the industrial hygienist look for

11 individual level monitoring data, we tweaked it

12 in a manner analogous to the SECs and say that

13 the person was on a job where area monitoring

14 took place for asbestos.

15 Why do you do area monitoring for

16 asbestos? Because there is abatement going on. 

17 And it doesn't matter what the results were. And

18 you certainly wouldn't have to show the

19 individual had exposure, but they were present in

20 the building that underwent asbestos abatement. 

21 How do we know? There was area monitoring.

22 CHAIR MARKOWITZ: Dr. Redlich.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

295

1 MEMBER REDLICH: So for workers who

2 are not in an ongoing asbestos surveillance

3 program they would present with chronic lung

4 disease, which basically would be either COPD or

5 some form of pulmonary fibrosis.

6 So, as you pointed out, the link, you

7 know, COPD would fall under whatever the COPD

8 presumption. So then you have workers who have

9 pulmonary fibrosis or pneumoconiosis. And the

10 question would be is that related to their

11 asbestos? Which, I mean I think what you would

12 want to ask is it just related to their work and

13 all the other exposures, machine work and

14 everything else?

15 So, I could imagine the scenario where

16 asbestosis is, you know, asbestos is denied

17 because for either, you know, one of these

18 reasons but where they might have a work

19 association.

20 So I just mention that. I think that

21 that group of diseases is problematic, both in

22 terms of determining what you're going to use as
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

296

1 criteria for having it, and also the association. 

2 You know, from -- and I probably know less about

3 all of the different processes, but from the two

4 site visits that we've been on, I have been very

5 impressed with the extent of machining work that

6 went on. And the occupation that is best

7 associated with "idiopathic pulmonary fibrosis"

8 is machinists and machining work. You know,

9 metal, separate from beryllium, just exposure to

10 metals.

11 So I'd just be concerned about this

12 framework. I think it's where there is a clear,

13 maybe, asbestos exposure but I think that -- and

14 this would partially depend on how the claims are

15 coming in -- but I think realistically it's going

16 to be, if you have chronic lung disease, it's

17 going to be either COPD or fibrosis.

18 CHAIR MARKOWITZ: I am not sure who's

19 next. Dr. Cassano?

20 MEMBER CASSANO: No, I'm fine.

21 CHAIR MARKOWITZ: Dr. Boden?

22 MEMBER BODEN: Well, again, I am just
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

297

1 asking questions to try to clarify. So what

2 you've just said, I'm trying to figure out what

3 the implications are of what you said. So are

4 you possibly suggesting that there be a pulmonary

5 fibrosis presumption that is parallel to the COPD

6 presumption, and that asbestosis would fall into

7 that?

8 Or what are the implications of what

9 you said?

10 MEMBER REDLICH: You know, I'm not,

11 I'm not sure what's best. All I'm saying is that

12 there currently is a category of pneumoconiosis. 

13 And so all I think is that in thinking about that

14 category we should just consider asbestosis also

15 being aware of the pneumoconiosis group. That's

16 all.

17 CHAIR MARKOWITZ: So, you know, my

18 view on this is that we know more about asbestos19 related diseases so we, to be more confident in

20 setting out some presumptions that we have

21 confidence in. Asbestosis is part of a larger

22 number of interstitial scarring diseases that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

298

1 you're raising. Maybe we should treat them as a

2 class in relation not just to asbestos exposure

3 but to a whole variety of other exposures.

4 To me that would be a different issue,

5 a different set of presumptions. And this could

6 be nested within that, but we know more about

7 asbestos than those others, and so I would argue

8 we continue with this. And then if we want to

9 look more generally at this interstitial scarring

10 disease we can.

11 MEMBER REDLICH: I think that's

12 reasonable.

13 CHAIR MARKOWITZ: Dr. Welch.

14 DR. WELCH: I just want to get back to

15 what Ken suggested in terms of people worked on a

16 job where there's monitoring. I think my concern

17 about asbestos in place is that people were

18 exposed without it being designated as an

19 abatement job. Where, you know, somebody knocks

20 into a pipe and whatever protective covering is

21 off, and that's not fixed for forever, and

22 there's just ongoing exposure from asbestos in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

299

1 place. Or there's some emergency response and,

2 you know, asbestos gets torn off. But there's no

3 monitoring done during that activity.

4 Because generally when there's

5 abatement going on there is control of a

6 exposure. So, I don't think you're -- I don't

7 think adding that would really address the

8 question of how you identify the people who would

9 have this intermittent, potentially, high dose,

10 short term exposure because of running into

11 asbestos in a place that hasn't been identified

12 or controlled properly.

13 CHAIR MARKOWITZ: Dr. Silver.

14 MEMBER SILVER: Point taken. I

15 thought it would be a step in the direction of

16 Kirk Domina's concerns, not getting all the way

17 there.

18 CHAIR MARKOWITZ: I thought it was

19 creative actually.

20 Dr. Dement.

21 MEMBER DEMENT: Yeah, I think in the

22 presumptions we need to acknowledge what the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

300

1 reality is I think exists. I think we can safely

2 say that asbestos exposures in the construction

3 industry, and in the construction industry on the

4 DOE sides, has decreased over time. Most of the

5 exposures lift from installation to treating

6 materials in place.

7 However, I think, as currently is

8 discussed, you know, there are situations where

9 even though we can say on average we decreased

10 exposures, there are unusual circumstances. And

11 they may be unusual but they may occur

12 frequently. But I don't know how to incorporate

13 those into a presumption. I think we have to be

14 very clear that this is a presumption, it's not a

15 value that you have to meet. There are other

16 routes to get to it.

17 Unfortunately, and based on some of

18 the reviews that I've done of the cases, I see

19 the presumption values being used as you must

20 meet these in order to qualify for compensation. 

21 So I just think we need to, if this is what we

22 settle on, word it in such a way that we do know
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

301

1 and we acknowledge that there are these

2 situations where even though controls are in

3 place and relatively efficient, there are

4 situations when they are not efficient and

5 workers are exposed.

6 CHAIR MARKOWITZ: Well, we can

7 certainly add that to the rationale.

8 I'm sorry. Ms. Pope.

9 MEMBER POPE: I have been involved in

10 situations where as a bargaining unit safety rep

11 where individuals have been exposed to acute

12 exposure through a safety concern. And there

13 have been many documentations of those events

14 happening, whether they be on a routine basis of

15 where something is supposed to operate in a

16 normal manner, or we're doing a decommissioning

17 of that building, those type situations did

18 occur.

19 So, being able to track that

20 information in terms of the people being exposed

21 to an extreme amount of exposure at a certain

22 time should be acknowledged as well.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

302

1 CHAIR MARKOWITZ: Other comments? Dr.

2 Sokas? Mr. Griffon?

3 MEMBER SOKAS: Nothing to add.

4 CHAIR MARKOWITZ: Okay, thanks.

5 So, the issue of setting out medical

6 criteria for presumption is not addressed in this

7 recommendation. And would be the subject, I

8 think, of another recommendation. It requires --

9 it's not as easy as it would seem on the surface. 

10 And it requires some thought, I think.

11 So it's not going to be ready by

12 tomorrow. So I would support considering

13 modifying or adopting this recommendation as an

14 exposure presumption recommendation. And then

15 coming back soon enough with some medical

16 criteria.

17 There is a balancing between the

18 certainty on the medical criteria side, as Dr.

19 Boden points out, and the certainty on the

20 presumption side. But there's going to be

21 uncertainty on both sides, and we'll just live

22 with it.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

303

1 So, it seems that I can leave the

2 language of the recommendation, but it seems like

3 the sticking point from the discussion here, or

4 the point of most disagreement, or perhaps the

5 only point of disagreement really is on the

6 calendar year issue, is whether we should specify

7 calendar year, whether we should use pre-2005 or

8 something more recent, 2010, 2015.

9 And so what I propose, actually, is we

10 delete -- that we vote on that separately, if it

11 makes sense, that we vote on the rest of the

12 recommendation and then vote on the calendar

13 year. The alternative is to set out two

14 alternatives with, one with -- or several

15 alternatives, one without calendar years or

16 different calendar years.

17 What's your preference, Dr. Boden?

18 MEMBER BODEN: I would suggest that's

19 a reasonable idea. But I would reverse the

20 order, try to see what level of agreement there

21 is about the calendar year first. And then if

22 there is substantial agreement -- I don't know if
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

304

1 there is -- then --

2 CHAIR MARKOWITZ: Okay.

3 MEMBER BODEN: -- it would be easier

4 to vote on the second one.

5 CHAIR MARKOWITZ: That's fine.

6 Yeah, Dr. Welch?

7 DR. WELCH: I was thinking of another

8 way to address it as well would be to make the

9 calendar year more current but add more to the

10 latency. Which would mean that exposures that

11 are occurring intermittently are considered

12 important but there would have been other

13 exposures. Because the latency is sort of saying

14 there had to have been exposures earlier that

15 were also causative.

16 See what I mean?

17 CHAIR MARKOWITZ: Yeah.

18 MEMBER BODEN: Or is that too

19 complicated? Just tell me forget it.

20 CHAIR MARKOWITZ: I think it's a

21 little bit complicated, personally.

22 MEMBER BODEN: Okay. Forget it. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

305

1 Never mind.

2 CHAIR MARKOWITZ: Dr. Redlich.

3 MEMBER REDLICH: No, nothing.

4 CHAIR MARKOWITZ: Okay. Okay. You

5 know, the nut of this is that there's -- that the

6 difference of opinion about the extent of

7 exposure to asbestos, say, between 2000 and 2017. 

8 And that something that exposure was probably a

9 lot less prevalent and others emphasize the fact

10 that for certain populations there was continued

11 significant exposure. That seems sort of the

12 spectrum of opinion.

13 So wondering how to phrase this.

14 MEMBER CASSANO: Actually I'm thinking

15 if we're talking about exposure that occurred

16 pre-2005, so it wouldn't apply to anything where

17 the last exposure was after 2005.

18 If you're talking about a latency of

19 15 years, somebody that was just exposed in 2005,

20 you're not going to be adjudicating this, I

21 think, until 2020. So I think we're kind of safe

22 with going with 2005 for that reason. Think
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

306

1 about it.

2 CHAIR MARKOWITZ: Yeah, I have thought

3 about it. I didn't think it was the best course

4 of action to build in something that could become

5 obsolescent in a few years, but.

6 MEMBER CASSANO: No, but what I'm

7 saying is --

8 CHAIR MARKOWITZ: I understand, yeah. 

9 No, I get it. Yeah. Kick the can down the road.

10 MEMBER CASSANO: Well, no, it's not

11 kicking the can down the road. But I think at

12 2020 if you're talking about an exposure pre13 2005, then if they -- if the injury -- if they

14 developed any of these diseases at all it would

15 be in 2020. So the exposure level at 2005 would

16 be much lower, is what I'm saying, at 2006 or

17 beyond.

18 We're not looking at a case that

19 develops in 2005, we're looking at the last

20 exposure being 2005.

21 CHAIR MARKOWITZ: So let's --

22 DR. WELCH: So, I think we'll vote,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

307

1 however.

2 MEMBER CASSANO: Fine.

3 CHAIR MARKOWITZ: What if we voted

4 this way, what if we took a vote on whether we

5 should put any calendar year reference in or not. 

6 And then if the vote is that we put a reference

7 year in, that we select a couple of choices and

8 then vote on that.

9 Does that sequence make sense?

10 DR. WELCH: Yeah.

11 CHAIR MARKOWITZ: Okay. So, then the

12 recommendation is that DOE workers who had or who

13 are presumed to have significant asbestos

14 exposure, to be defined in the subsequent

15 recommendation, prior to 2005, January 2st, 2005,

16 will be presumed to have sufficient exposure to

17 be at least as likely as not to be a significant

18 factor in aggravating, contributing, or causing

19 one of these five asbestos-related conditions.

20 Is that clear?

21 MEMBER CASSANO: That's clear.

22 DR. WELCH: Yeah.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

308

1 CHAIR MARKOWITZ: Okay. Okay.

2 So, I need a motion to, motion to --

3 MEMBER CASSANO: You're proposing it

4 with a vote on whether 2005 is the date?

5 CHAIR MARKOWITZ: That's right. The

6 only right here is whether we should use --

7 holding everything else the same, all the other

8 variables which we'll now vote on, we'll vote on

9 after this -- that we use the pre-two thousand --

10 January 1st, 2005, as the relevant time period.

11 MEMBER CASSANO: So moved.

12 PARTICIPANT: Second.

13 CHAIR MARKOWITZ: Okay. Any

14 discussion?

15 All those -- Yeah?

16 MEMBER BODEN: One quick comment. We

17 are clear in the rest of this that, that in no

18 way should be bad news for the people who don't

19 meet that criterion, that they're still allowed

20 to go forward? This is not a negative

21 presumption in any way?

22 CHAIR MARKOWITZ: No, actually now I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

309

1 just realized -- I had proposed that -- Hold on

2 one sec. I had proposed that we vote first on

3 whether there should be a calendar year, any

4 calendar year or not; right?

5 MEMBER CASSANO: That's right.

6 CHAIR MARKOWITZ: Okay. So I'm going

7 to re -- I'm going to withdraw that and reframe

8 that.

9 So, the proposal is whether the set of

10 exposure criteria should make reference to any

11 calendar year as representing a important

12 demarcation line in terms of identifying

13 significant exposure to asbestos. So that's the

14 recommendation at hand.

15 And I'm hoping, since we don't, we're

16 not seeing it up here, that we're actually

17 getting this somewhere. It's being recorded. 

18 Fine, we'll find it.

19 So, comments? Okay, yeah, go ahead.

20 MEMBER REDLICH: We may want to

21 consider the malignant. Because basically the

22 year is using that as a surrogate for amount or
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

310

1 dose of exposure. So for pleural plaques and

2 asbestosis there is more a dose response than

3 something like mesothelioma.

4 So I'm just wondering about the

5 rationale of that year, given that you, this is

6 something that would be going on into the future. 

7 If someone had, you know, worked around asbestos

8 at a DOE site and that was, you know, their main

9 employment and they got a mesothelioma, I

10 wouldn't care that much about whether it was pre11 2005 or post.

12 CHAIR MARKOWITZ: Okay. So you're

13 suggesting a friendly amendment that we exclude

14 mesothelioma from this recommendation.

15 Other comments on that?

16 (No response.)

17 CHAIR MARKOWITZ: So let's, is there

18 a -- well, I accept that as a proposed friendly

19 amendment. So let's vote on it.

20 All those in favor of revising the

21 proposal, the proposed recommendation so that any

22 calendar year demarcation applies only to the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

311

1 five other asbestos-related diseases, excluding,

2 if you look at the pink section, the last two

3 lines, it would exclude -- or include those five

4 conditions but it would exclude mesothelioma.

5 So all those in favor of that?

6 DR. WELCH: In favor of having no end

7 date?

8 MEMBER BODEN: Can I suggest an order?

9 CHAIR MARKOWITZ: Yeah.

10 MEMBER BODEN: Because actually there

11 are three things we're voting on.

12 CHAIR MARKOWITZ: Right.

13 MEMBER BODEN: One is the current

14 thing. The other is without mesothelioma. And

15 the third is nothing at all.

16 So I think we should vote on the

17 nothing at all first and then --

18 DR. WELCH: I just wasn't clear that

19 a yes vote --

20 MEMBER BODEN: Yeah. That's right.

21 DR. WELCH: So nothing --

22 MEMBER BODEN: For everything, right. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

312

1 And then once we've settled that then we can deal

2 with any other issues.

3 CHAIR MARKOWITZ: So the proposal, the

4 recommendation is that we consider a set of time5 related criteria which will be defined

6 subsequently. But no calendar year reference for

7 five asbestos-related diseases, excluding

8 malignant mesothelioma. Okay, so this is no

9 calendar year reference in the exposure criteria. 

10 Okay. Is that okay?

11 DR. WELCH: Yes.

12 CHAIR MARKOWITZ: Okay, any discussion

13 of that?

14 (No response.)

15 CHAIR MARKOWITZ: Okay. All those in

16 favor of that, raise your hand.

17 (Show of hands.)

18 CHAIR MARKOWITZ: One, two, three,

19 there are four present.

20 Dr. Sokas?

21 MEMBER SOKAS: No.

22 CHAIR MARKOWITZ: I'm sorry, what was
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

313

1 that? No. Okay.

2 And, Mr. Griffon?

3 MEMBER GRIFFON: No.

4 CHAIR MARKOWITZ: Okay. So there are

5 four -- how many abstentions are there? One,

6 okay.

7 So four in favor, one abstention.

8 How many noes? One, two, three, four,

9 five, six, seven, eight, nine, eleven -- right,

10 right, 11 noes. Eleven noes, 4 yeses and 1

11 abstention.

12 Okay, so that means that there's some

13 favorable opinion towards introducing a calendar

14 year.

15 Okay, so let's repeat this same

16 recommendation, that is to say that DOE workers

17 will be defined as having significant asbestos

18 exposure, details to be provided later, if they

19 had this exposure prior to January 1st, 2005.

20 Now, do we want to pick another

21 reference calendar year that some people are

22 comfortable with? Because there are a lot of --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

314

1 DR. WELCH: 2005 and 2010.

2 CHAIR MARKOWITZ: Right, right. So --

3 MEMBER SOKAS: So, Steve, we've

4 excluded mesothelioma; right?

5 CHAIR MARKOWITZ: Right now we're

6 excluding malignant mesothelioma.

7 MEMBER SOKAS: Okay, great.

8 CHAIR MARKOWITZ: Yeah. So those who

9 feel more comfortable with the later calendar

10 year, any -- Mr. Domina, you wanted closer to

11 2015 or something; right?

12 MEMBER DOMINA: Right. Go big or go

13 home.

14 (Laughter.)

15 CHAIR MARKOWITZ: Judging from what we

16 saw yesterday at Hanford, I think that happens a

17 lot at DOE.

18 MEMBER DOMINA: You know, I'm just

19 stating what I've witnessed, what I've seen. And

20 I know if it happens here, it happens across the

21 complex. And it's a concern with me because I

22 have a lot of younger folks that have causes
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

315

1 because of stuff that has transpired. And I also

2 look at the type of work that's being done here

3 and across the complex. And I also look at the

4 age of the current work force and how much it's

5 changing, and how many new people have hired on,

6 like say since 2010 or '12. And I don't want

7 people to be excluded.

8 I mean, I, I don't see -- yeah,

9 they're doing some monitoring stuff. Is stuff

10 being done safer? I don't know.

11 I mean, I also know you can monitor

12 not to find things, too. And we've all seen

13 that. I still think it goes on today. And I

14 mean I just, part of my job is to protect

15 everybody. And I just, my opinion.

16 CHAIR MARKOWITZ: Sure. But we need

17 a calendar year. We need --

18 MEMBER DOMINA: Go big or go home.

19 CHAIR MARKOWITZ: Okay, 2015, is that

20 big enough? So should I set the recommendation

21 or the proposal 2005 versus 2015? Is that

22 reasonable?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

316

1 PARTICIPANT: You have to pick one for

2 the vote.

3 CHAIR MARKOWITZ: No, I know, I get

4 that. But I just want to lay out what the

5 choices are.

6 MEMBER SOKAS: Yes.

7 CHAIR MARKOWITZ: Okay, fine.

8 Then the exposure presumptions for

9 asbestos with DOE workers who otherwise meet

10 exposure criteria, that we will set out

11 imminently, who had this significant exposure to

12 asbestos prior to January 1st, 2005, will be

13 judged to have substantial exposure sufficient to

14 be a significant factor in causing, contributing,

15 or aggravating one of the five asbestos-related

16 conditions, that is excluding malignant

17 mesothelioma.

18 So the first vote will be on 2005. 

19 And then we'll take a vote on 2015.

20 So any, any motions in acceptance.

21 PARTICIPANT: Move.

22 CHAIR MARKOWITZ: Second.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

317

1 PARTICIPANT: Second.

2 CHAIR MARKOWITZ: Any further

3 discussion?

4 (No response.)

5 CHAIR MARKOWITZ: Okay. So all in

6 favor for 2005, raise your hand.

7 (Show of hands.)

8 CHAIR MARKOWITZ: Okay, that's five

9 votes present.

10 Dr. Sokas?

11 MEMBER SOKAS: Yes.

12 CHAIR MARKOWITZ: And, Mr. Griffon.

13 MEMBER GRIFFON: Yes.

14 CHAIR MARKOWITZ: Okay, so that's

15 seven in favor.

16 How many opposed?

17 (Show of hands.)

18 CHAIR MARKOWITZ: Six opposed.

19 And how many abstentions?

20 (Show of hands.)

21 CHAIR MARKOWITZ: One, two. Two

22 abstentions. So that's 15.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

318

1 So that's 7 to 6 to 2.

2 I have to confer with the designated

3 federal official because we've never had a close

4 vote.

5 (Off-microphone comments.)

6 CHAIR MARKOWITZ: Okay, so that's

7 fine. So let's continue. We've got a consensus.

8 Now let's go with 2015. So that it's

9 the same recommendation using January 1st, 2015,

10 as the cutoff date. Second? I mean is there a

11 motion to --

12 PARTICIPANT: So moved.

13 CHAIR MARKOWITZ: And a second.

14 PARTICIPANT: Second.

15 CHAIR MARKOWITZ: Any discussion?

16 (No response.)

17 CHAIR MARKOWITZ: Okay. So all those

18 in favor of using 2015 as the key date in

19 determining the significant asbestos exposure,

20 using the same language as in the previous

21 recommendation, all those in favor of January

22 1st, 2015, please raise your hand.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

319

1 (Show of hands.)

2 CHAIR MARKOWITZ: Seven in favor.

3 Dr. Sokas?

4 MEMBER SOKAS: No.

5 CHAIR MARKOWITZ: And, Mr. Griffon?

6 MEMBER GRIFFON: No.

7 CHAIR MARKOWITZ: Thank you.

8 So all those opposed to using 2015,

9 raise your hand.

10 (Show of hands.)

11 CHAIR MARKOWITZ: Five present.

12 And, Dr. Sokas. Oh, she said no. 

13 Okay. And he said no.

14 So that's 7 to 7. But I'm missing a

15 vote. Oh, one abstention. Okay.

16 Okay, so I guess we'll try 2010. I'm

17 not sure what else to do.

18 Sure, Dr. Welch?

19 DR. WELCH: So, just to try to

20 convince people to come over to my point of view,

21 I've been managing a medical surveillance program

22 for sheet metal workers since 1985. And we have
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

320

1 looked at the change in asbestos-related disease

2 on the chest x-ray over time, and particularly

3 looking at people who started work after 1970,

4 which is earlier than we're talking about in

5 terms of disease.

6 But the EPA banned the spray-on

7 asbestos-containing materials in 1973, which for

8 sheet metal workers was the predominant exposure

9 for them, that and thermal insulation.

10 We don't see asbestos-related disease,

11 non-malignant asbestos-related disease in the

12 sheet metal workers anymore. We see no

13 asbestosis. And we see a tiny amount of pleural

14 disease. Which is why I feel comfortable saying,

15 you know, I'm saying we're looking at people

16 whose exposure started after 1970, and that group

17 of people. Here we're up to 2005.

18 So I think we have a pretty good

19 safety, margin of safety there. And the kind of

20 exposures -- and I might be wrong on this, but

21 the intermittent exposures that are happening

22 from asbestos in place, if those are the only
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

321

1 exposure someone has, they didn't have sustained

2 exposure to demolition, uncontrolled demolition

3 work or application work prior to 1973 or 1978, I

4 don't think it's going to be sufficient to cause

5 asbestosis.

6 It's definitely sufficient to

7 contribute to cause mesothelioma. And we're not

8 going to put in -- I think we've already had the

9 consensus around the table, we haven't voted on

10 it, there will be no cutoff date for

11 mesothelioma. And that's the disease that occurs

12 with much lower exposures.

13 So, I feel like the presumption will

14 work better because we're not requiring very much

15 exposure, you know, requiring a year of exposure

16 and saying that that can contribute to

17 asbestosis. And that's a low threshold for

18 asbestosis, even considering that we're including

19 years where exposure was pretty low.

20 So that's why, that's why I'm

21 comfortable with 2005.

22 CHAIR MARKOWITZ: Dr. Redlich.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

322

1 MEMBER SOKAS: And this is Rosie.

2 CHAIR MARKOWITZ: Dr. Sokas?

3 MEMBER SOKAS: I'd like to also echo

4 what Dr. Boden said earlier which is that we're

5 really counting on the fact that this is a

6 presumption and that failure to meet the

7 presumption does not mean you automatically get

8 booted out. We simply go into the full

9 evaluation.

10 CHAIR MARKOWITZ: Dr. Redlich.

11 MEMBER REDLICH: I agree with what

12 Laura said, that the likelihood of a new case of

13 asbestosis or pleural plaques at this point is

14 relatively low. But I do see, as a

15 pulmonologist, I get referred a huge number of

16 patients with interstitial lung disease related,

17 you know, with the question of, you know, work

18 exposure.

19 So I mean I think we should finish up

20 this discussion and pick a year. But I think in

21 practice and moving forward that the much more

22 common scenario will be that a patient develops
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

323

1 chronic either ILD, interstitial lung disease, or

2 COPD with a question of is their exposures at,

3 you know, one of these sites where asbestos was

4 probably not the major exposure.

5 CHAIR MARKOWITZ: Dr. Cassano.

6 MEMBER CASSANO: I just have a

7 question. We're concentrating on the pulmonary

8 diseases. Do we know that the same dose response

9 holds for ovarian cancer as well? Or is ovarian

10 cancer closer to mesothelioma in the dose

11 required, the dose, the minimal dose that would

12 cause ovarian cancer?

13 I don't know that answer. I don't

14 know if there's enough investigation been done on

15 ovarian cancer since its only been 2012 that it

16 was considered by IR. Do we know that for

17 certain?

18 CHAIR MARKOWITZ: No. But we can take

19 a look at those studies quickly enough.

20 But mesothelioma really is an

21 exception. And the nature of the studies are

22 such that there's a limited number of studies on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

324

1 ovarian cancer, and it's not possible that they

2 could have, given those studies, identified a

3 brief exposure to asbestos could cause ovarian

4 cancer. Whereas, we can say that about

5 mesothelioma, we can't say it about lung cancer.

6 MEMBER CASSANO: Okay.

7 CHAIR MARKOWITZ: I mean mesothelioma

8 differs from lung cancer in that respect. You

9 need more exposure to contribute to lung cancer.

10 Yes, Doctor, I'm sorry.

11 MEMBER BODEN: So I just wanted to say

12 that I've been abstaining but Dr. Welch has

13 convinced me. Just so you know. At least you

14 convinced one person. Probably the only one.

15 CHAIR MARKOWITZ: Ms. Vlieger.

16 MEMBER VLIEGER: I guess the question

17 here is harm in excluding or including extra

18 people. And so what harm does it cause to extend

19 the calendar year for this presumption, rather

20 than it being a matter of principle? But what

21 harm does it cause to potential claimants? Does

22 it really hurt anything to make the year further
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

325

1 out. It just means that there's longer time for

2 people to make the claims or be eligible for the

3 claims.

4 And I don't deal with anybody that

5 wants to walk into an asbestos exposure or say,

6 oh, well, you know I have asbestos disease and

7 they weren't exposed. So my question is why are

8 we at this point selecting a year.

9 CHAIR MARKOWITZ: I'll tell you what

10 I think. It's credibility. I think if we're not

11 making recommendations based on what we know

12 about this exposure or other exposures, then it's

13 not just our credibility as a Board but the

14 credibility of the program, frankly, for making

15 decisions based on scientific knowledge is

16 compromised. I think that's the real threat.

17 MEMBER VLIEGER: So what is the

18 current study, what does it say about asbestos at

19 the DOE worksites?

20 CHAIR MARKOWITZ: Well, no, what we're

21 doing is applying a broad literature. This

22 entity, this exposure, this agent's been more
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

326

1 studied than probably any other, with the

2 exception maybe of lead. And so we're applying

3 what we know of DOE sites and what we know in

4 general to these questions.

5 Do we know what the prevalence of

6 asbestos exposure at a DOE complex in 2005 or

7 2010 was? We don't know that.

8 MEMBER CASSANO: There's no area

9 monitoring for asbestos for those periods?

10 CHAIR MARKOWITZ: No, I'm sure there

11 was -- I'm sure there was some monitoring. 

12 Abatement requires monitoring --

13 MEMBER CASSANO: Right.

14 CHAIR MARKOWITZ: -- so I'm sure there

15 was monitoring. And I don't know the results of

16 that, but it'd be surprising if the monitoring17 based -- abatement-based monitoring showed much

18 excursion from low levels because that's when

19 they're paying attention.

20 Dr. Redlich?

21 MEMBER REDLICH: Yes. My voting

22 against the 2005 was more just sort of getting
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

327

1 tired of our nitpicking about years because it

2 seems that you have to have the diagnosis to

3 begin with. And so if you did have the

4 diagnosis, you know, whatever year you pick, so I

5 agree that, you know, the likelihood of getting

6 disease with more recent exposure is much lower.

7 I was just thinking more in terms of

8 minimizing the back and forth over years because

9 I think if you have to have the diagnosis. And

10 so, really, what we're -- you know, if someone

11 has bilateral pleural plaques, again, I think

12 that's pretty pathognomonic for asbestos. And

13 the other diagnosis we have here, we do have lung

14 cancer and then we have asbestosis. And so it

15 also -- I mean, it's -- anyway, I think we can

16 vote again and maybe get consensus now.

17 CHAIR MARKOWITZ: Yes. So is it fair

18 to retake a vote on 2005? Is that fair?

19 MEMBER CASSANO: Yes.

20 CHAIR MARKOWITZ: Okay, okay. So

21 we're going to revote on a recommendation --

22 whatever recommendation that is that DOE workers
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

328

1 will be considered to have significant asbestos

2 exposure as a matter of presumption with details

3 regarding aspects of the exposure to be provided

4 imminently in the next recommendation when that

5 exposure occurred according to those criteria

6 prior to January 1st, 2005. And that such

7 exposure will be considered as sufficient to be

8 at least as likely as not a significant factor in

9 contributing, aggravating, or causing any of the

10 five asbestos-related diseases that is excluding

11 malignant mesothelioma.

12 A motion to accept this?

13 MEMBER CASSANO: Yes.

14 CHAIR MARKOWITZ: Yes? Okay. Second? 

15 Okay. So any further discussion? Let's just

16 vote on this. All those in favor, raise your

17 hand. One, two, three, four, five, six, seven,

18 eight. There are eight hands raised. Dr. Sokas?

19 MEMBER SOKAS: Yes.

20 CHAIR MARKOWITZ: And Mr. Griffon?

21 MEMBER GRIFFON: Yes.

22 CHAIR MARKOWITZ: So that's ten. All
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

329

1 those opposed? One -- and one opposed. And how

2 many abstain?

3 CHAIR MARKOWITZ: Three people are too

4 tired to vote. Maybe four. Well, anyway, we

5 have ten votes -- ten in favor, so that's a

6 consensus enough, the maximum of five votes. 

7 Otherwise, do we need -- two-thirds. Okay, fine. 

8 Okay, okay.

9 So, now, let's move on then to the

10 rest of the exposure presumptions. And actually,

11 I guess we can look at what we're looking at now

12 which is that, here, if a DOE worker has worked

13 as a maintenance or construction worker at a DOE

14 site for 250 days or more prior to January 1st,

15 2005, diagnosed 15 years or more with one of the

16 five conditions: asbestosis, pleural disease,

17 lung cancer, cancer of the ovary and larynx; that

18 they would be accepted as having substantial

19 exposure for the basis of compensation.

20 Motion to accept and second? Okay. 

21 Any further comment?

22 MEMBER BODEN: Just a question. So
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

330

1 we're going to need to have a second bullet just

2 specifically for mesothelioma?

3 CHAIR MARKOWITZ: Yes.

4 MEMBER BODEN: That doesn't include

5 it?

6 CHAIR MARKOWITZ: Yes.

7 MEMBER BODEN: Okay.

8 CHAIR MARKOWITZ: Yes. Mr. Domina?

9 MEMBER DOMINA: I just want to make

10 sure it's clear. When you're talking

11 maintenance, you're talking about production

12 workers?

13 CHAIR MARKOWITZ: No, no. We're

14 talking about the maintenance worker workforce,

15 not the production workforce. Well, 

16 maintenance, full-time -- the maintenance

17 personnel employed by the prime contractor on

18 site, that's what --

19 MEMBER DOMINA: All right.

20 CHAIR MARKOWITZ: Or Garry, you guys

21 can explain to me better what a maintenance

22 worker is, but not the construction worker who
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

331

1 comes -- builds a new building, major renovation. 

2 We're talking about a maintenance worker on site.

3 MEMBER WHITLEY: Maintenance

4 production.

5 CHAIR MARKOWITZ: Yes. Okay,

6 maintenance production, fine. Okay. All those

7 in favor, raise your hand. Okay, so -- and

8 that's all the hands here and then Dr. Sokas?

9 MEMBER SOKAS: Yes.

10 CHAIR MARKOWITZ: And Mr. Griffon?

11 MEMBER GRIFFON: Yes.

12 CHAIR MARKOWITZ: So that's 15 votes

13 in favor. So, now, let's move on to

14 mesothelioma, and if someone could remind me what

15 we're changing for the mesothelioma presumption.

16 MEMBER CASSANO: We're getting rid of

17 the dates.

18 CHAIR MARKOWITZ: Getting rid of the

19 date? Okay, okay. So the recommendation then

20 would be all DOE workers who worked as

21 maintenance construction workers at a DOE site

22 for 30 days or more and who are diagnosed 15
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

332

1 years or more after the onset of such work with

2 malignant mesothelioma of any bodily site will be

3 presumed to have sufficient exposure to meet the

4 standard of causation under the Act.

5 Motion to accept? Second? Any

6 discussion? Okay. All those in favor, raise

7 your hand. And Dr. Sokas?

8 MEMBER SOKAS: Yes.

9 CHAIR MARKOWITZ: And Mr. Griffon?

10 MEMBER GRIFFON: Yes.

11 CHAIR MARKOWITZ: Okay. So that's 15

12 votes in favor of this. I'm sorry. Could you

13 just raise your request?

14 MEMBER BODEN: Sure. Can you change

15 this on this slide so we have the exact rating on

16 the slide for the record? Just deleting or more

17 -- or sorry -- prior to January 1st. That's what

18 you need to do.

19 CHAIR MARKOWITZ: Yes, thanks.

20 MEMBER BODEN: Okay. That's it.

21 CHAIR MARKOWITZ: Yes, yes.

22 MEMBER BODEN: Sorry. Can't use all
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

333

1 those signs.

2 (Pause.)

3 CHAIR MARKOWITZ: Yes. Okay. So if

4 -- and when you've done that, Kevin, if you could

5 move to the next slide. Okay.

6 So we should vote on this separately. 

7 Let me just read it. All claims for one of the

8 six asbestos-associated conditions named above

9 that do not meet the exposure criteria described

10 in Items 1 and 2 above will be referred to an

11 industrial hygienist for exposure assessment and

12 to a CMC for evaluation of medical documentation

13 and causation, and the six conditions are

14 itemized.

15 So motion to accept this? Second? 

16 Any further discussion on this? I think -- okay. 

17 So all those in favor, raise your hand. One,

18 two, three, four, five. Okay. Twelve votes. 

19 Dr. Sokas?

20 MEMBER SOKAS: Yes.

21 CHAIR MARKOWITZ: Mr. Griffon?

22 MEMBER GRIFFON: Yes.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

334

1 CHAIR MARKOWITZ: Okay. And all those

2 opposed? Any abstentions? Okay. So 14 votes in

3 favor and one abstention. Okay.

4 So the final recommendation in the

5 series regarding asbestos has to do with chronic

6 obstructive pulmonary disease. It may have a

7 contribution from asbestos exposure. However,

8 claims for this disease should be evaluated as

9 part of a broader set of presumptions for chronic

10 obstructive pulmonary disease.

11 So a discussion about this? Is there

12 a motion to accept and a second?

13 MEMBER CASSANO: Yes.

14 CHAIR MARKOWITZ: Okay. All those in

15 favor of this recommendation, raise your hand. 

16 One, two, three, four. And Dr. Sokas?

17 MEMBER SOKAS: Yes.

18 CHAIR MARKOWITZ: Mr. Griffon?

19 MEMBER GRIFFON: Yes.

20 CHAIR MARKOWITZ: Okay. So that's 15

21 votes in favor.

22 I think that we should take a break
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

335

1 before our 4:30 to 6 o'clock public comment

2 session. Are there any instructions before? 

3 We're going to start precisely at 4:30? We need

4 to start at 4:28? What's -- how does it work?

5 PARTICIPANT: 4:30.

6 CHAIR MARKOWITZ: 4:30? Okay. And

7 who will give us exact instructions at 4:30?

8 PARTICIPANT: You have a slide --

9 CHAIR MARKOWITZ: Okay, okay. So is

10 there --

11 MR. FITZGERALD: I just want to -- I

12 just want to remind everybody -- it's not on? 

13 There we go. I just want to remind everybody, if

14 you're interested in making a public comment and

15 haven't checked in with Carrie Rhoads yet, please

16 do so. And for those of you on the phone, we'll

17 be giving you instructions on the number to call

18 in. In fact, I have it right now, so I might as

19 well read it to you. It's 1-888-957-9863, and

20 the passcode is 1930221#. Thank you.

21 CHAIR MARKOWITZ: We will reassemble

22 at 4:28. Just please be prompt so we can begin
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

336

1 at 4:30.

2 (Whereupon, the above-entitled matter

3 went off the record at 4:15 p.m. and resumed at

4 4:30 p.m.)

5 CHAIR MARKOWITZ: So we're going to

6 begin the public comment session that goes till 6

7 o'clock. We have 18 people who have requested

8 speaking time, so 90 divided by 18 is 5. So

9 we're down, unfortunately, to five minutes for

10 each speaker. And there'll be people who have a

11 lot to say, so the problem really is it

12 encroaches on other people's time. So I'd ask

13 you to hold to five minutes, and I will,

14 unfortunately, have to interrupt you when you're

15 close to five minutes so you know that your time

16 is up.

17 But let's begin. Terrie Barrie is our

18 first speaker.

19 MS. BARRIE: Hello, Dr. Markowitz and

20 members of the Board. Thank you for providing

21 this opportunity for the public to make comments

22 and offer insight into their claims problem. My
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

337

1 name is Terrie Barrie, and I'm a founding member

2 of the Alliance of Nuclear Worker Advocacy

3 Groups. I want to commend all of you for the

4 excellent work you have done this past year and

5 the accomplishments you have made in providing

6 guidance to the Department of Labor.

7 To a degree, I'm concerned about the

8 delay of the recommendations that you made back

9 in October. And to a degree, I do understand the

10 issues, as Ms. Leiton explained. But I think

11 that in the future that there should be some kind

12 of timeline set or deadline set that's something

13 similar to what the Secretary of Health and Human

14 Services has for the Part B SEC petitions. So

15 I'd like to have somebody consider that possibly

16 needs to go to Congress itself. But I think in

17 order to make this program the best, that these

18 excellent recommendations that this Board makes

19 to Department of Labor needs to be acted on as

20 quickly as possible.

21 I want to thank you for discussing the

22 wage loss earlier today, and I think it would
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

338

1 help understand the issues if I gave you a little

2 bit of background on the problems with wage loss. 

3 First of all, I've had many advocates say, I

4 don't even recommend going -- or having my

5 claimants file for wage loss. They'll never get

6 it. This is what I've heard from, like, three or

7 four different people. And Ms. Leiton, you know,

8 explained what the procedure manual is and the

9 polices are, and like you've noticed in other

10 procedure manuals or training manuals, that

11 doesn't actually reflect reality.

12 Wage loss claims are based on the

13 claims examiners' evaluation of medical records

14 to determine whether a covered condition

15 contributed or caused wage loss. I am personally

16 aware of two separate claims where symptoms of

17 the disease were documented in the medical file

18 that was -- and it was evident before the

19 condition was diagnosed, and both of these claims

20 were denied.

21 In one case, the claims examiner, at

22 one point, demanded that the claimant provide
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

339

1 evidence, and I quote, of the frequency,

2 duration, and severity of the flare-ups of the

3 chronic condition, and this chronic condition was

4 accepted. It was accepted because there was a

5 documented incident of the worker ingesting

6 radioactive materials. The chronic condition was

7 not diagnosed until 1995, years after the

8 incident, and the consequential disease, which

9 was also symptomatic before the diagnosis and was

10 diagnosed in 1997.

11 But the claims examiner wanted, like,

12 more evidence. You know, how was this flare-up

13 happening? And the only way the claimant or the

14 worker could've provided that medical evidence

15 was to undergo an invasive medical procedure each

16 time that happened. And the frequency of that

17 was happening, like, once a week, and that's just

18 not medically sound or safe. And this evidence

19 that the claims examiner wanted was in addition

20 to the personal physician's -- three personal

21 physicians' letters that were also in the file

22 and submitted to Department of Labor.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

340

1 Another huge obstacle for the

2 claimants to overcome for the wage loss program

3 is the requirement that the employee must earn

4 wages before the claim trigger month. So if the

5 person has symptoms of, let's say, pneumonia in

6 January of 2006, but it wasn't diagnosed -- and

7 went out work but wasn't diagnosed until March of

8 2006, but he didn't work before his diagnosis, he

9 doesn't get paid because the policy is that they

10 must earn wages before the claim trigger month. 

11 And this is contrary to the clear language of the

12 law requirement.

13 I ask the Board to review some wage

14 loss claims -- there's not a lot -- and determine

15 if those claims are decided in consistent manner

16 and identify to DEEOIC if there are any problems

17 in implementing the procedure manual. I believe

18 the claims examiners will greatly benefit from

19 your advice about the nature of chronic condition

20 and whether symptoms prior to a disease or a

21 diagnosis of a disease would allow a wage loss

22 claim to be accepted.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

341

1 The legislation defines four specific

2 areas which the Board will offer advice to the

3 Secretary of Labor.

4 CHAIR MARKOWITZ: Ms. Barrie, just

5 sorry to interrupt, but we're approaching five

6 minutes.

7 MS. BARRIE: Okay. I'm almost done. 

8 I urge DEEOIC to consult with the Board while

9 developing any issues -- or prior to issuing

10 vital circulars, bulletins, or any changes in the

11 procedure manual that will fall within the

12 Board's responsibilities, and I thank you very

13 much for your service.

14 CHAIR MARKOWITZ: Thank you.

15 Deb Jerison?

16 MS. JERISON: Thanks again to Dr.

17 Markowitz and the Board Members for letting me

18 speak, and I really want to thank you all for the

19 wonderful job that you're doing. It's really

20 appreciated. My name is Deb Jerison. I'm the

21 director of the Energy Employees Claimant

22 Assistance Project.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

342

1 Recently, I heard from claimants that

2 claims examiners are sending people to the

3 National Cancer Registry to obtain additional

4 information on their cancers. It appears that

5 rather than one registry, each state has its own,

6 and the type of information available is going to

7 vary from state to state.

8 It's not an easy search for most

9 people to make. I'm wondering if it might be

10 more useful for the claims examiner to search

11 these sites rather than asking the sick workers

12 to do it. Is this something that the medical

13 evidence subcommittee could look into to see if

14 it's a worthwhile option for claimants needing

15 additional medical evidence?

16 I think that finding a way of getting

17 input from the lower level claims examiners is

18 very important. The Board needs to hear from the

19 people actually doing the claims as well as the

20 supervisors. I think that the idea of an

21 anonymous survey to gather this information is a

22 very good one. Another option might be to reach
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

343

1 out to former claims examiners to learn from

2 their experiences.

3 And I think it's a good idea of using

4 a coworker model to provide exposure information

5 for facilities without a Site Exposure Matrix. I

6 also wonder if looking into using some of the

7 existing NIOSH Part B technical basis documents

8 and Site Profiles might be useful. Thank you.

9 CHAIR MARKOWITZ: Thank you.

10 Next up is Calin Tebay.

11 MR. TEBAY: Good afternoon. My name

12 is Calin Tebay. I am currently the MSA employee

13 health advocate at Hanford. I am also the

14 sitewide beryllium health advocate at Hanford. 

15 I'm here today to discuss or request that the

16 Board review the current DOL criteria --

17 diagnosis criteria for chronic beryllium disease

18 and sensitivity. I have submitted a document to

19 Ms. Rhoads. I don't know if that was distributed

20 or not to everybody.

21 MS. RHOADS: It's up on the website.

22 MR. TEBAY: Okay. Basically, I wanted
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

344

1 to -- since we have not much time, I have

2 submitted the clinical guideline for diagnosis of

3 beryllium sensitization and chronic beryllium

4 disease that was developed by Department of Labor

5 and Industries in 2015. This document is the

6 most recent, complete, and accurate document that

7 we have that is aligned with the DOE complex.

8 A couple things you will find in this

9 document that's different from the DOL criteria

10 right now is, one, three borderline test results

11 are an accepted criteria for sensitization. 

12 Currently, DOL does not accept that.

13 Two, this draws a distinct line

14 between sarcoidosis and CBD. I also am a

15 beryllium-affected worker. I was diagnosed with

16 sarcoidosis early in 2005 and, through the

17 process, was eventually diagnosed with chronic

18 beryllium disease. And that was a very heavy

19 path to walk, and I kept getting told that there

20 was this fine line. Well, what I found out in

21 that process, that line is not that fine. They

22 are two very distinct, different diseases, and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

345

1 they can be differentiated with the right

2 testing.

3 That said, I'll give some other people

4 some time, but I would hope that the Board would

5 review this document in comparison with the

6 current DOL procedure manual diagnosis criteria. 

7 Maybe send that to your medical evidence

8 subcommittee and get some feedback on how we can

9 improve the current diagnosis criteria.

10 CHAIR MARKOWITZ: Okay. Thank you.

11 Next up is Steven Peterson, and after

12 Steven Peterson is Don Slaugh.

13 MR. PETERSON: Dr. Markowitz, members

14 of the Board, thank you for hearing from me

15 today. My name is Steve Peterson. I'm a manager

16 for one of the major contractors here at Hanford. 

17 Mine is more an observation. As a person who has

18 gone through the claims process, I'd like to know

19 how or what I could do to get the DOL to work

20 better with other federal agencies.

21 In my particular case, the DOL seems

22 to be maybe perhaps bureaucratic, and it does not
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

346

1 work outside its own agencies or coordinate well

2 with other agencies. Trying to get DOL to work

3 with, say, the Inspector General was very

4 difficult. So is there an avenue or a way that

5 claimants can -- not necessarily appeal their

6 claims but get DOL to communicate directly with

7 other federal agencies?

8 For example, I had asked OWCP to work

9 with the Inspector General, and I was -- the

10 answer I was given, well, if the Inspector

11 General sends us a request, we can certainly

12 respond. And when I went to the Inspector

13 General, they say, well, if DOL sends us a

14 request, we can respond. And a lot of letters

15 written in exchange, and I had -- some

16 individuals said, please call this agency and

17 they will then provide you additional

18 documentation. I could not get separate federal

19 agencies to talk to one another, and that seemed

20 to be problematic.

21 My case worker was very sympathetic

22 and very helpful, but I could not get DOL to make
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

347

1 a phone call. Even when I provided a name and a

2 phone number, I could not get them to communicate

3 with them. Is there anything that claimants can

4 do in that area? I received nice letters saying,

5 I'm sorry, but we don't function that way. 

6 That's not our -- I don't want to say,

7 responsibility -- but, that's not something that

8 we do.

9 CHAIR MARKOWITZ: Just a

10 clarification, we don't actually answer questions

11 or --

12 MR. PETERSON: Yes. I knew that.

13 CHAIR MARKOWITZ: -- engage in

14 discussion, just to let you know, but the comment

15 has certainly been clear.

16 MR. PETERSON: Is there someone that

17 claimants can work with to try to --

18 CHAIR MARKOWITZ: Well --

19 MR. PETERSON: -- encourage that

20 communication?

21 CHAIR MARKOWITZ: -- I would suggest

22 you either speak with Ms. Leiton or speak with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

348

1 Mr. Nelson, the Ombudsman, and have that

2 discussion.

3 MR. PETERSON: Very good. Thank you

4 very much.

5 CHAIR MARKOWITZ: Okay. Thank you.

6 Next is Don Slaugh, and next up after

7 Don Slaugh is D'Lanie Blaze.

8 MR. SLAUGH: Thank you, Mr. Chairman

9 and Board Members. I appreciate your time. My

10 name is Don Slaugh, and I've been a union site

11 rep for 12 years. I've been on site for 27, and

12 I've been nuclear -- or HPT senior health physics

13 technician for about -- going on 35 years, and

14 I've been at other DOE sites.

15 My purpose for this is to bring

16 awareness to when you look at claims and people

17 coming in, it's really difficult. You may have a

18 diagnosis of an injury of beryllium disease or

19 some airways disease type syndrome of very

20 limited data that might support that from a

21 workplace. And I wanted to show three areas of

22 concern that I've been looking at for the last
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

349

1 several years.

2 And there's -- so there's three, and

3 the first one is our HEPA filtration systems, and

4 some of these are legacy issues that we have. 

5 HEPA filtration systems on our tanks, which are

6 underground, are there to maintain safety for the

7 worker and the public, mainly from particulates

8 and radionuclides, nothing for the gas and

9 vapors.

10 One of our problems we're finding is

11 these filters have been in place for a very, very

12 long time, some greater than 29 years in service

13 life. We just have a current document that shows

14 every filter we have in place right now in

15 service, and they're way overdue for a change.

16 The issues we're finding out there

17 with the filters is -- and I'll just read this. 

18 These are some of the filters. Radio filters are

19 found to be saturated with water upon removal and

20 replacement. Water is consistently found in

21 other DSTs which is single-shell farms. Radio

22 filters have similar problems.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

350

1 So when we have this wetting in these

2 filters, they're not HEPA filters. And the

3 concern is particulate matter being re-suspended

4 out and being aerosolized out into our workers'

5 space, which we do not look at that type except

6 for the rate of allowable radionuclides. That's

7 the only thing we look at from a metal

8 standpoint, except for beryllium. There are some

9 others, but specifically unknowns, we look at

10 rad.

11 The next is -- oh, excuse me. One

12 other thing is we do -- in this current document

13 we have, we're trying to maintain our power to

14 ventilation systems at less than 50 -- or 70

15 percent humidity, but we don't have humidity

16 probes in our exhausters. That's one of the

17 recommendations that DOE has actually put in

18 place from the -- Missouri State University did

19 some testing on our finest filters and found that

20 we should put these humidity filters -- or

21 humidity probes in our filters, and I know

22 Savannah River has done that.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

351

1 The next point is excavations in our

2 tank farms. We do a lot of excavations in or

3 around outside. As a health physics technician,

4 what we've found over the years is we go out

5 there and we don't have health physics set up for

6 a job to go out and do that because we plan it as

7 a non-rad job. But then we come across it and

8 find that, guess what, we have contamination, and

9 we've actually purchased some equipment because

10 of those problems.

11 So because of that issue, we actually

12 have our rad planners required to go through what

13 is called QMap. The QMap is designed to identify

14 every pipeline unplanned release site that is on

15 site so that when they go in and excavate, they

16 can be aware of those hazards and take control.

17 The problem is our industrial

18 hygienists aren't even part of that permit. 

19 There's an excavation permit, and all it looks at

20 is environment for particulate matter which is

21 for an offsite exposure for particulate matter,

22 not for worker exposure. So we will look at rad
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

352

1 only in those cases.

2 I looked here recently at a couple of

3 different excavations we've done on the farms,

4 and they do have gases and vapors. But they're

5 not looking at any of the metal of the

6 contaminated waste that's actually been dumped

7 into the grounds that could be aerosolized or the

8 dermal exposure that could be there because we're

9 wetting down the grounds.

10 If you look at -- there's some data

11 that I provided. History-wise, I did a

12 comprehensive study to find out exactly how much

13 waste came to the tank farms from 2000 -- or

14 excuse me -- 1954 to 2004. And the total amount,

15 if you look at it, it's kind of staggering. We

16 look at -- the tank farms has approximately 56-57

17 million gallons in the tanks, about 200

18 megaliters. And in that summary, it'll actually

19 tell you how much waste was transferred to the

20 tank farms to cribs, ponds, ditches, and it's

21 about 270 billion gallons.

22 So there's a little bit of disparity
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

353

1 there with how much was dumped in the grounds,

2 and in comparison of the tanks to the high-level

3 waste, which is about 900 million gallons of

4 high-level waste that was dumped in or around the

5 grounds that are in our tank farms that we may

6 actually dig up.

7 I was going to bring a QMap with me

8 that shows you this map. It identifies -- if you

9 go to the QMap, which is maintained by another

10 contractor, you can actually click on that

11 unplanned release site and it'll tell you what

12 was dropped there, what was put into the ground

13 at that time, and you can get a lot of history.

14 Unfortunately, our industrial

15 hygienists don't have that in their program. 

16 They only have four areas they look at. They

17 look at the pipelines of the tanks, the stuff we

18 may buy, like caustics, and put in the tanks, and

19 then other materials that we might do for

20 maintenance. So that's a real concern that I

21 have, and --

22 CHAIR MARKOWITZ: If you could wrap it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

354

1 up.

2 MR. SLAUGH: Okay. The last thing is

3 our chemical vapors. So we have a lot of folks

4 who have come out and helped us. NIOSH, CTH, the

5 STC, and the TVAT have all recommended that we do

6 a -- look at the mixing of chemicals that could

7 be in our airspace and a toxicological study to

8 be able to look at if there's a synergistic

9 effect to these different chemicals and the other

10 possibility of other changes like ions, ozone,

11 chemical inorganics, organics, acid, bases that

12 are in the vapor phase.

13 Some of these things that we're not

14 looking at right now that we would like to look

15 at and continue to look at and hope you'd take

16 those into consideration when you're looking at

17 folks' claims that we do have a lot of things

18 that we're still learning about.

19 CHAIR MARKOWITZ: Okay. Thank you

20 very much.

21 MR. SLAUGH: Thank you very much.

22 CHAIR MARKOWITZ: Thank you.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

355

1 Next is D'Lance Blaze. If I have

2 mispronounced your name, forgive me. D'Lanie? 

3 D'Lanie.

4 MS. BLAZE: Hi, guys. I'm D'Lanie

5 Blaze of CORE Advocacy for Nuclear and Aerospace

6 Workers. CORE assists EEOICPA claimants and

7 workers at the Santa Susana Field Laboratory and

8 its associated sites. Thank you for the

9 opportunity to provide public comment.

10 Coal gasification has been established

11 to be a Department of Energy process at various

12 Rockwell International sites, including Hanford,

13 Rocky Flats, and Area IV of Santa Susana. The

14 Site Exposure Matrix, or the SEM, provides an

15 incomplete list of toxic substances associated

16 with coal gasification processes at Santa Susana. 

17 Only carbon and coal ash are listed.

18 As early as 1978, NIOSH issued

19 recommendations for safety standards that were

20 based on worker exposures associated with every

21 aspect of the coal gasification process and

22 including the potential for exposure to a number
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

356

1 of chemical compounds that can increase the risk

2 of cancer and other illnesses. More recent

3 studies link the process to skin cancer and

4 hearing loss and raises questions about

5 radionuclide and silica exposure as coal

6 gasification workers frequently present with

7 serious lung conditions and radiogenic cancers.

8 In addition, it appears some of

9 Department of Energy's coal gasification

10 facilities at Santa Susana were removed from the

11 SEM entirely when it was discovered that they

12 existed in Area I at a location known as the

13 Bowl. Currently, only Area IV of Santa Susana is

14 considered to be a covered facility under

15 EEOICPA.

16 It is troubling that the discovery of

17 Department of Energy operations, processes, and

18 facilities in Area I, which necessitated the

19 Bowl's removal from the SEM, did not prompt a

20 thorough review of DOE's contractual agreements

21 at Santa Susana. CORE Advocacy has obtained

22 copies of those contracts under the Freedom of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

357

1 Information Act, FOIA.

2 The contracts document Department of

3 Energy in Rockwell International's construction,

4 integration, modification, operation, and

5 remediation of DOE coal gasification process

6 development units, or PDUs, located at the Bowl

7 in Area I. Other documentation issued by DOE and

8 its contractors specify that the Bowl was located

9 on DOE auctioned land, had been allocated in its

10 entirety to serve DOE's Energy Technology

11 Engineering Center, known as ETEC, and that the

12 Bowl PDUs were contractually defined to be

13 government-owned property and remained so even

14 after the contract's conclusion.

15 In 2008, Sanford Cohen and Associates,

16 SC&A, issued their review of the NIOSH Site

17 Profile for Santa Susana. SC&A stated, quote,

18 the Department of Energy had operations and

19 facilities in Area I as well as Area IV of Santa

20 Susana. However, no consideration has been given

21 to potential exposure in Area I of Santa Susana

22 Field Laboratory such as potential exposures for
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

358

1 the coal gasification process, end quote.

2 The Area I facilities of the Bowl

3 appear to be among more than an additional 50

4 Department of Energy facilities that were

5 summarily excluded from the Santa Susana Site

6 Profile, the majority of which were located in

7 Area IV and considered to be among the primary

8 sources of site radioactivity.

9 The result has been a dramatically

10 downplayed perception of DOE operations and

11 worker exposures of the site which has hampered

12 EEOICPA eligibility, the dose reconstruction

13 process, claims under Part E, and the accuracy

14 and completeness of the SEM. Currently, DOE coal

15 gasification workers of Area I at the Bowl are

16 just summarily disqualified from EEOICPA.

17 I realize that it is not within the

18 Board's charter to classify a DOE facility under

19 the Act, but in an interesting paradox, the SEM's

20 accuracy and completeness is considered to be

21 among the Board's top priorities. And the SEM

22 cannot be accurate or complete when Department of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

359

1 Energy facilities are left out of EEOICPA or when

2 DOE operations, processes, hazardous materials,

3 and all corresponding data are not acknowledged.

4 I respectfully request the opportunity

5 to submit information on coal gasification and

6 worker exposures at Santa Susana which apply to

7 both Area I and Area IV workers. This

8 information may assist the Board in ensuring that

9 the SEM is accurate and complete.

10 Currently, Department of Labor and

11 Energy are reviewing CORE Advocacy's report on

12 DOE operations at the Bowl in Area I, and I'd

13 like to submit a copy of that report to you as

14 well. In addition, I believe coal gasification

15 workers squarely meet the VGDF exposure criteria

16 outlined in our meeting earlier today, and I

17 request their consideration as the Board focuses

18 on OHQ recommendations.

19 Thank you for the opportunity to

20 provide public comment on behalf of Santa Susana

21 employees and EEOICPA claimants.

22 CHAIR MARKOWITZ: Thank you very much.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

360

1 MS. BLAZE: Thanks.

2 CHAIR MARKOWITZ: Next is Elnora Bing

3 and then after Ms. Bing is Stephanie Carroll.

4 MS. BING: Hello. My name is Elnora

5 S. Bing. I would like to thank the Board, and I

6 would like to thank Ms. Stephanie Carroll for

7 giving me this opportunity to come before the

8 Board and let you know what I did at the Savannah

9 River Site and also my claim.

10 I worked at the site for 33 and a half

11 years. I was employed in 1972, and I had to

12 leave because of illness in 2005. I was

13 diagnosed with sarcoidosis, and I had previously

14 worked as a lab technician for approximately

15 seven to ten years handling liquid waste -- and

16 that was '72 -- Pu, Eu, neptunium, you name it,

17 cesium. I also, after that, left that lab, and I

18 went to a metallurgical laboratory, and we

19 handled different metals.

20 I have been affected by the

21 sarcoidosis I have over my lungs. And they say

22 it's sarcoidosis, but all of that I have been
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

361

1 around, I'm not sure about that. I filed a claim

2 for CBD Part B sarcoidosis, 2010. I received an

3 acceptance letter. When I received the

4 acceptance letter, I called a DOE rep because I

5 needed to know for the instructions -- DOL,

6 excuse me. 

7 I wanted further instructions, and the

8 DOL rep told me I'd be receiving a health card in

9 the mail. And then I felt kind of comfortable

10 with him, and I began to tell him some of the

11 things that I encountered at the site and what I

12 had worked with, the conditions, statistics of

13 the deaths and illnesses that were in my

14 building. People right next to me have died.

15 And he listened, but there was a

16 change in his tone. And he told me that -- he

17 said, well, maybe you will be eligible for

18 another part. Why don't you withdraw your Part

19 B? And I felt kind of comfortable at this point

20 because I was talking to him. He should be

21 knowing what he was telling me was true. He was

22 trying to help me, I thought.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

362

1 And so -- but I did notice something

2 when I began to tell him about all the sicknesses

3 and all the things that were going on, but he

4 encouraged me. He said, withdraw it because

5 there's compensation under another part. And, of

6 course, I know I deserved it, so I withdrew my

7 acceptance letter.

8 February 2nd was when I received my

9 acceptance letter. February 8th was when I

10 withdrew it and sent it in according to his

11 instructions because he told me that there would

12 be monetary value. And I knew it should be, but

13 I didn't know how to go about it.

14 The little bit I know, when I sent it

15 under Part E, refiled again, I came back flatly

16 denied. I was crushed. I couldn't believe it. 

17 I didn't understand what was going on. I tried

18 to call the DOE rep. Time after time, they told

19 me that he was out of his office, he could no

20 longer help me, and he was very callous. He

21 didn't really want to talk to me anymore.

22 And when I filed -- and I want to read
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

363

1 you my comment because I have been struggling for

2 the last seven years to get my voice heard, and

3 I'm finally getting it heard -- I was flatly

4 denied for sarcoidosis, CBD under Part B about

5 where for what I had just received an acceptance

6 letter for. I filed a hearing for COPD and was

7 denied over and over.

8 I finally realized I was tricked into

9 giving up my claim worth $150,000. I have since

10 refiled with the help of my advocate, Mrs.

11 Stephanie Carroll. My claim was under -- is

12 under reconsideration now. She ordered a copy of

13 my file, which I never was told I could do in the

14 whole seven years I have spent fighting on my

15 own. They never told me they had medical record

16 evidence on file from Savannah River Plant. They

17 just kept insisting that I provide the evidence,

18 and I did over and over.

19 My advocate has, at this point, some

20 evidence they had the whole time, which is chest

21 x-rays, the report showing profusion three or two

22 from a company doctor, pulmonary chest diagnosed
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

364

1 the restrictions as severe diffusing lung

2 capacity defect, PFT results as low as FVC and

3 FEV1 at 50 percent predicted -- excuse me -- 57

4 percent predicted and boxes showing blood in my

5 lungs.

6 I was told to get a beryllium test

7 without regard to the extent of medical evidence

8 on file documenting about the 15 years of

9 prednisone that I had to take because of my

10 condition --

11 CHAIR MARKOWITZ: Ms. Bing.

12 MS. BING: -- which would affect the

13 accuracy --

14 CHAIR MARKOWITZ: Ms. Bing.

15 MS. BING: -- of the test. And then

16 I was not even told about the test until after my

17 claims were denied. My doctor wrote a report

18 saying that the diagnosis with sarcoidosis was

19 not medically appropriate with a long-term

20 beryllium exposure. They lost the report, and I

21 had to resend it multiple times. It was on file

22 the whole time.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

365

1 I think they were using the doctors to

2 try to deny my lung disease. Why did they ignore

3 my doctor's report, I cannot understand. Why did

4 they ignore my work conditions that I told them

5 about what I did over and over, I don't

6 understand.

7 CHAIR MARKOWITZ: Ms. Bing. Ms. Bing.

8 MS. BING: Why did no one at the

9 Department of Labor help me understand the

10 process to be approved? No one helped me to be -

11 - helped me. They just told me -- that DOL rep

12 told me that. He really shouldn't have told me

13 anything if he knew I was going to be denied,

14 denied, denied. I don't understand that.

15 CHAIR MARKOWITZ: Mrs. Bing. Mrs.

16 Bing.

17 MS. BING: These reports should have

18 triggered a response from at least one of three

19 reports done by their doctors that I may have

20 pneumococcus. I know that beryllium or the other

21 metals -- like Eu, Pu, and aluminum -- had to

22 have contributed to my illness because that's
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

366

1 what I did. I ground samples as a metallurgical

2 laboratory technician. For the last seven to

3 eight years, that's what I did.

4 CHAIR MARKOWITZ: Mrs. Bing.

5 MS. BING: I cut rich uranium. I cut

6 depleted uranium. I cut beryllium. We cut all

7 of the metals that came from across the site. I

8 had two hearings that let people know what type

9 of work I did as a metallurgical laboratory

10 technician and a lab supervisor. And when I

11 became a lab supervisor, I was in the same

12 environment doing the same work.

13 CHAIR MARKOWITZ: Mrs. Bing.

14 MS. BING: I think they ignored my

15 testimony that I was still exposed to the same

16 toxins as a technician.

17 CHAIR MARKOWITZ: Mrs. Bing.

18 MS. BING: They wanted me to send them

19 a list of my exposures. How was I supposed to be

20 able to do this?

21 CHAIR MARKOWITZ: Mrs. Bing, thank you

22 very much for your comments.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

367

1 Next is Stephanie Carroll.

2 MS. CARROLL: My name is Stephanie

3 Carroll. Thank you for allowing me to submit

4 public comments today, and I thank you for the

5 excellent work that you're doing. This is the

6 best use of my time ever in this program is to be

7 at these meetings. They're very good.

8 I am a professional authorized rep

9 specializing in claims for occupational lung

10 disease. In the process of helping workers

11 circumvent the complexities of this program, I've

12 discovered serious problems with the

13 administration of the program.

14 I know that you are as concerned as I

15 am, that these issues be addressed in a

16 meaningful and efficient manner, and that the

17 EEOICPA achieve the mission that Congress

18 intended. Oftentimes, the program sees the

19 complaints of the ARs as a sign of our

20 frustration in being denied claims, which is

21 understandable. But my complaints are based on

22 the concern that, without an AR, claimants are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

368

1 being misled and denied claims that are viable

2 under the program requirements.

3 The bureaucratic culture within the

4 program is overly hostile to claimants. I don't

5 want to paint everyone who works for the EEOICPA

6 with a broad stroke because there are some very

7 dedicated employees trying to do the right thing. 

8 I do see a program where CEs are very

9 demoralized, inadequately trained, and not

10 rewarded for going the extra mile to approve

11 claims. First and foremost, they are evaluated

12 by the timeliness in which they complete the

13 adjudication of claims and not by the quality of

14 their work, which may be more difficult to

15 measure.

16 I have established CBD under the Act

17 for every ruling sensitized worker I've

18 encountered. I've experienced establishing CBD

19 under Part B for all claimants that were tested,

20 treated, or diagnosed with a chronic respiratory

21 disorder prior to 1993. The policy and the PM

22 have inexplicably changed. Now, pre-93 claims
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

369

1 must document, quote, prolonged long-term -- they

2 have to do that twice -- treatment for chronic

3 respiratory disorder prior to 1993, unquote, from

4 the procedure manual to qualify for further

5 adjudication of the claim under pre-1993

6 established chronic beryllium disease.

7 The law actually describes chronic

8 beryllium disease as a beryllium illness, and the

9 beryllium illness is established chronic

10 beryllium disease. And you will not see capital

11 letters on the CBD portion of it because it is a

12 statutory illness, and it's not chronic beryllium

13 disease under the modern diagnostic criteria that

14 we experience now. So it's important to pay

15 attention to those capitals. The removal or

16 addition of just two words from the procedure

17 manual or the training material can affect claims

18 adjudication profoundly.

19 I've reviewed the training slides

20 submitted to the Weighing of Medical Evidence

21 committee -- subcommittee. I was disappointed to

22 learn that the committee will not be reviewing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

370

1 the weighing of evidence for Part B, CBD, or

2 sarcoidosis. There is a great need for review of

3 the medical evidence as it relates to application

4 of the law. I am pleased that the committee on

5 lung disease will be addressing these issues.

6 In the training materials that I did

7 review, Slide 20, pre-1993 criteria, there is a

8 list of statutory criteria without access to the

9 underlying slides that were provided. So I would

10 like you to ask for the slides that once you

11 click on each criteria, you kind of get to see

12 details of what they expect to meet each

13 criteria, and that wasn't included in your

14 training that was provided to you from DOL.

15 A note at the bottom of the slide says

16 that at least one of the documents must show that

17 the claimant received treatment for a chronic

18 respiratory condition prior to 1993, which

19 contradicts the procedure manual and it confuses

20 the situation. So CEs are being trained with the

21 slides in a way that doesn't match the procedure

22 manual, and the procedure manual was changed with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

371

1 just, I don't know. Just, all of a sudden, they

2 got rid of some words in the criteria to

3 establish pre-93.

4 This PM policy has been added without

5 any explanation and changes the way the pre-93

6 cases have been adjudicated for at least 15

7 years. There are final decisions documenting

8 approval of a pre-93 CBD claim based on the date

9 that a claimant was tested, treated, or diagnosed

10 with a chronic respiratory disorder, not treated

11 long term and prolonged long-term treatment of a

12 chronic respiratory disorder. So that has

13 completely changed. I don't know what's going to

14 happen with pre-93.

15 The new policy is inconsistent and

16 unfair. It affects the outcome of workers'

17 claims based on when their claims were

18 adjudicated by the program. This policy was

19 established without explanation.

20 Slide 21, post-93, again, the criteria

21 does not include the underlying slides. Please

22 ask. See that the reference to CBD, all in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

372

1 capitals, which insinuates that a physician must

2 determine if the abnormalities are consistent

3 with modern-day chronic beryllium disease. The

4 loss specifically describes the illness as

5 established CBD. The PM lists medical findings

6 that the program has long determined to be

7 consistent with established CBD. Like BES, the

8 program specifically lays out the legal

9 definition of covered beryllium illness.

10 The only reason that a DMC should ever

11 be used for chronic beryllium disease is to

12 determine if the PFTs are showing obstruction,

13 not, is that obstruction consistent with CBD? A

14 physician cannot make that determination because

15 they're making a medical determination. They do

16 it all the time. They say, this person doesn't

17 have CBD. But when they sign the DMC report, it

18 actually reads that they're making their opinion

19 based on their known -- the known qualifications

20 of the program. So they're supposed to be

21 reviewing based on the program requirements, not

22 medical, but they never do that. And they get
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

373

1 paid about $2,000 to do that report.

2 CHAIR MARKOWITZ: Ms. Carroll, if you

3 could start to wrap it up.

4 MS. CARROLL: Okay.

5 CHAIR MARKOWITZ: Thank you.

6 MS. CARROLL: Okay. CBD under Part E

7 has added requirements for approval demanded by

8 the program but not required by law which is

9 unfair and inconsistent, with prior probative

10 final decisions. The PM demands abnormal BeLPTs

11 for Part E, but the training slides do not

12 include that. I don't know why.

13 And telephone conference calls, I

14 have a copy of one of the calls that I have

15 submitted that actually discusses -- first of

16 all, there's no PII in there. It discusses the

17 fact that they will use policy call notes for

18 final decisions, recommended decisions, and

19 development. If the CE quotes that in the final

20 decision, they are to turn that telephone

21 conference policy call over to the claimant.

22 They admit in this policy call that it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

374

1 is policy, and I would urge you to take a look at

2 my submission of the policy call so that you can

3 push hard to get a copy of those telephone

4 conference calls because that is policy, and it's

5 not fair that authorized reps or any of us can't

6 look at the program and determine if there's

7 consistencies or not. And I think that is the

8 key, get those telephone conference calls.

9 Thank you very much for listening --

10 CHAIR MARKOWITZ: Thank you.

11 MS. CARROLL: -- and I appreciate all

12 your work.

13 CHAIR MARKOWITZ: Okay. Thank you.

14 Next is Shirley Kennedy and then after

15 Ms. Kennedy will be Tee Lea Ong. Shirley

16 Kennedy, is she on the phone? No? Oh, okay.

17 MS. KENNEDY: I'd like to thank all

18 the Board, and this is the first time that I've

19 been here. My questions are, in the SEM,

20 specifically, why do they not list any

21 radionuclides? And the radionuclides that I have

22 concerns with personally are plutonium-238,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

375

1 plutonium-239, plutonium-240, americium-241.

2 I was exposed in 2007 of these

3 radionuclides, and I don't know if there was

4 because they only checked for these three. I

5 have COPD, thyroid in my lungs. And the man I

6 replaced doing the borehole job is Mark Anthony,

7 and he died in 2015 of cancer of the esophagus

8 and the stomach. I've had zoledronic acid IV on

9 January 27th because my spine is in the position

10 where my doctor thinks it will collapse just by

11 my weight, so I'm trying to keep my weight off,

12 and I've been denied.

13 The data that they gave me when they

14 did the diagnosis was wrong. I want each and

15 every person that's had an exposure to be able to

16 get their raw data. I cannot get that raw data,

17 and I want to know why. What words do I have to

18 put in a letter? Who do I have to talk to, to

19 get the 10 CFR 1910.1020? It says that I have

20 that right. Can anyone tell me how I get that

21 raw data?

22 CHAIR MARKOWITZ: Knowing -- I don't
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

376

1 think anybody on the Board can, but depending on

2 -- you're talking about the radiation data?

3 MS. KENNEDY: Yes. When -- my

4 bioassays, and I have five of them.

5 CHAIR MARKOWITZ: You know, I think

6 maybe the Ombudsman's office would be the best. 

7 Mr. Nelson or Mr. Levin might be able to help you

8 there, in the second row behind you.

9 MS. KENNEDY: Okay. And I just

10 encourage everybody to check because my birth

11 date was ten years off. The time that they said

12 I was exposed was two hours prior to the time the

13 job started. Thank you.

14 CHAIR MARKOWITZ: Thank you very much.

15 Next is Tee Lea Ong and then after is

16 Jill Allen.

17 MR. ONG: Hi. My name is Tee Lea Ong

18 with Professional Case Management. Thank you,

19 Chairman Markowitz, and the Board for allowing me

20 to comment.

21 I have brief, two interrelated

22 comments and, number one, of which is that the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

377

1 speed by which the recommendation -- really good

2 ones from this Board -- is being implemented by

3 the Department of Labor. And second one that's

4 related to that and it depends on the Board's

5 consideration of what you could do about it is,

6 how much time does the Board still have before

7 its sun sets, and how much work can be done in

8 terms of implementing the recommendations?

9 So with that said, the two comments. 

10 The first one of which is that the speed by which

11 the recommendation has been implemented. From

12 today's comments or conversation, it seems --

13 and, also, I've been following the publications

14 that the Board has put out. A lot of

15 tremendously good work has been done, so I

16 applaud you for that. And from -- based on

17 today's conversation, I also heard that the

18 Department of Labor has done a good job

19 supporting with the data and so on, so thank you

20 for that.

21 However, the question is that, from

22 what I could tell, there's only been one of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

378

1 recommendations from the Board, a substantive

2 one, that has been implemented since the sitting

3 of the Board, almost exactly a year ago in

4 Washington, D.C. It's about a week off, but

5 nonetheless. And the seating of the Board itself

6 has been delayed substantially, as most of you

7 know.

8 So on the current course and speed,

9 the question I have is that, what do you think

10 would be some possible alternatives to making

11 sure that all the hard work that's been put in,

12 as well as the hard work that's coming up, is

13 being implemented rigorously at the same pace

14 that the Board has been working? So the comment,

15 slash, question is, is there room to revisit how

16 the implementation of these recommendations are

17 conducted? Meaning that, is one of the

18 recommendations from the Board a change of how

19 these recommendations need to be adopted and

20 reviewed and implemented and, if not, reasons

21 offered as to why not? Or perhaps there's an

22 alternative body that the Board has to report out
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

379

1 to, to make further suggestions of how to

2 implement the recommendations.

3 Now, onto part two of my comment,

4 which is the time remaining for the Board to

5 continue to work and implement -- or recommend

6 implementation. With what we've seen, if the

7 current pace is one per roughly 12 months or so,

8 my question is, does that imply that we should

9 expect perhaps two to three more to be

10 implemented by the time the Board sunsets? And

11 if so, what is the -- what does the Board intuit

12 as the best way to prioritize the recommendations

13 so that the most impactful and claimant-friendly

14 topics are broached and the recommendation made

15 in order to make sure that the most relevant

16 topics are focused on and implemented?

17 That's all the comment I have. Thank

18 you.

19 CHAIR MARKOWITZ: Thank you.

20 Next is Jill Allen. No? Okay. We'll

21 move on while we're checking the phone.

22 Jerry Ferson is next. And I should
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

380

1 say -- actually, while he's getting settled in --

2 that the next will be Bertolla Bugarin.

3 MR. FERSON: My name is Jerry Ferson. 

4 I used to be very active out in the area. I was

5 one of the main safety reps and chairperson for

6 the tank farms. I am the one that built the

7 sampling truck to characterize all the tanks and

8 a number of filtration. I worked at a research

9 lab for a number of years prior to going to the

10 tank farms.

11 Tank farms though, I got exposed to a

12 lot of mercury. And the -- in 2007, I believe it

13 was, S102 tank, there was a spill. A hose broke

14 and there was a lot of people that were

15 consequently injured as far as mainly to

16 respirate their lungs and different things. One

17 of them who was working with me, he's over here.

18 But anyway, my B2 microglobulin went

19 up to 1,500. It's not supposed to be over 195. 

20 It does damage to the liver and the kidneys and

21 because of the damage there, it also causes a lot

22 of brain damage, nerve damage, whatever. I have
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

381

1 about seven or eight known or documented

2 conditions. I have 89 percent disability. I was

3 in a wheelchair for a number of years. I'm

4 fighting it and because of the good Lord -- I am

5 also a minister, by the way -- I'm retired.

6 I can't function. Like, my mind, I

7 can't keep it going right. And, anyway, I need

8 help. I'm disabled. My wife is disabled. We

9 take care of my mother-in-law. She is 91. She's

10 disabled. I used to have nursing 24/7 and

11 because of our case worker put in some paperwork

12 that DOL did not like, they dropped all my

13 nursing.

14 We have been trying to get nursing

15 back. We have tried and tried and tried. And,

16 finally, the gentleman, real nice and politely,

17 told my wife to forget it, quit bothering him,

18 says, when he goes on a breathing tube, you can

19 give me a call then. She said, well, we're not

20 going to call you because he has already stated

21 he will never go on a breathing tube.

22 There's a lot of people out here that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

382

1 are workers that I worked with that are trying to

2 get help, and there is no one, really, I'm going

3 to say. You can't say, well, you need to go see

4 this doctor or that doctor, because that's

5 showing favoritism, and I know we need help. We

6 need some guideline of where to go.

7 I went out and I looked for doctors,

8 one after another. And when I would tell them

9 who the insurance was going to be paid by, DOL,

10 they would drop me, one after another. When I

11 found the doctor, even in the big universities

12 and et cetera, I would ask the question, do you

13 know anything about chemicals, and they would

14 say, no.

15 And so for people that are starting

16 out, I try to help a lot and try to direct them. 

17 But I don't have, I'm going to say, good enough

18 answers to direct them because I don't know good,

19 you could say, doctors or resources they can go

20 to that is trustworthy.

21 I won't say who he was, but I went to

22 one of them at a university, and I told him, I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

383

1 said, you can't tell me that I've been exposed to

2 mercury. Oh, yes, I can. He says, if you have

3 this, this, this, this, or this, five things. He

4 says, if you have three of them, I can definitely

5 say you've been chemically exposed. I had four

6 of them, and you know what he said? Yes, but I

7 can't tell where you got it from. I have the

8 physical -- my physical records of the exposures

9 that I had. I had all the paperwork, but I'm

10 going to put it this way. He's in cahoots with

11 DOL.

12 CHAIR MARKOWITZ: Mr. Ferson, you need

13 to wrap it up, if you would.

14 MR. FERSON: Okay. But the people --

15 you can't imagine how many people are out there

16 that are needing help, and we need something or

17 some way of getting help and directing people. 

18 Thank you.

19 CHAIR MARKOWITZ: Thank you. Thank

20 you very much.

21 Next is Bertolla Bugarin.

22 MS. BUGARIN: I'll pass. My concerns
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

384

1 were addressed.

2 CHAIR MARKOWITZ: Okay. Thank you.

3 Jill Allen, did we identify whether

4 Jill Allen is on the phone? No? Okay. Next is

5 Tom Moore.

6 MR. MOORE: I've been impressed in

7 hearing what your Board is doing, and I thank you

8 for your work. My name is Tom Moore. I am a

9 former Hanford worker.

10 The comment -- the primary comment I

11 want to make has to do with consistency. In

12 2010, I was -- excuse me -- I was diagnosed with

13 prostate cancer. I was advised to go ahead and

14 make a claim on that, so I made the claim. And

15 in 2012, then I got a letter from the final

16 adjudication branch who basically summarized the

17 dose reconstruction report that they had

18 received, and, in it, they found that I was 40.66

19 percent Probability of Causation. I accepted

20 that. I mean, these are the experts.

21 So I went on. About four years later,

22 then I was diagnosed with MDS, and I'm not sure
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

385

1 whether I can say that properly but

2 myelodysplastic syndrome is close I can say it. 

3 I processed that. I was accepting. I guess

4 that's on the SEC list. Then about a year later,

5 I was diagnosed with COPD. At the same time we

6 made the claim for that, I made -- I was advised

7 to resubmit the prostate cancer because

8 additional cancers supposedly increase the

9 chances of being approved for claims.

10 When I got the dose reconstruction for

11 the second time, it was interesting to me that

12 every one of the previous dose estimates or the

13 dose findings they found decreased significantly,

14 one by a factor of 32. It was 32 times less than

15 the previous one, and the only explanation was it

16 had been grossly overestimated, and they used

17 more current things.

18 The interesting thing about it also is

19 that, in both of the documents, they, numerous

20 times, talk about being claimant favorable, and

21 that seems to be something that's mentioned quite

22 often is they try to be claimant favorable. And,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

386

1 yet, dose reconstruction, I'm not an expert in

2 it, but that's not something brand new. It's not

3 as if in the last few years, this -- in my

4 opinion, that we're all of a sudden doing things

5 we've never done before, so how can we get a

6 factor of 32 less for that?

7 So I think that this is an example of

8 some inconsistencies. I've been very pleased to

9 hear you folks talking about that.

10 One other comment I had with respect

11 to almost all of the things you've discussed

12 today had job titles being a significant factor

13 in the presumptions and so forth. I spent four

14 or five years as a machinist to start with and

15 then I went into engineering. I spent the last

16 19 years as an engineer, retired as an

17 engineering manager. I can tell you that none of

18 these documents that you displayed today included

19 engineers.

20 Our engineers in the groups that I was

21 a part of were in the field, I would say, almost

22 daily, some of us more than others, exposed to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

387

1 the same things as other folks. So I fully

2 support your concern that there are people out

3 there that when you look at these documents,

4 they're really not included. And I think that

5 plays a disproportionately strong influence on

6 how claims are adjudicated based on what your job

7 title was. Job titles don't tell you everything

8 you need to know about what your exposures are.

9 I thank you very much.

10 CHAIR MARKOWITZ: Thank you.

11 MR. MOORE: I think you're doing a

12 great job.

13 CHAIR MARKOWITZ: Thank you.

14 Next is Richard Bloom and then after

15 Richard Bloom will be Diane Leist.

16 MR. BLOOM: I made notes, so I want to

17 thank the Board. As an elected official, I serve

18 on a lot of Boards, so I don't want to take much

19 of your time. As -- my comment parallels what

20 was there. I've worked at Hanford since 1980. I

21 took six years off, worked at Rocky Flats for six

22 years tearing down -- tearing out buildings.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

388

1 I have personally been in 85 percent

2 of every building on the site over the course of

3 my years. I've been an engineer, I've been in

4 environmental, but I can tell you, the planner --

5 when I walked in, in 1980, the planner of the day

6 was the engineer, the engineering aide, the

7 operator, or the maintenance person who went out

8 there to figure out what was wrong and write down

9 what had to be fixed and investigate it and write

10 up what had to be done. So in your asbestos

11 considerations today, when you say maintenance

12 worker, you're leaving out, really, the ones that

13 got the firsthand look at it and were peeking.

14 Currently, I am assisting -- I've

15 retired, but I've been talked back a couple of

16 times. I'm assisting with the demolition of PFP,

17 and I'm intimate in the asbestos investigation to

18 prepare it for demolition. What we are finding

19 in that building that was built just before I was

20 born is very unique applications with asbestos

21 that people would never have known.

22 Asbestos in sheetrock; that sheetrock
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

389

1 had asbestos coating, but the one that looks just

2 like it didn't. I mean, it's really weird stuff

3 that we're finding: the extensive use of asbestos

4 in mastics, mastics in places we never expected

5 to find them.

6 So I do suggest that if you do get

7 around to defining what maintenance workers are,

8 maintenance workers are a lot broader than people

9 with tools and hammers. They include the RCTs,

10 the RadCon that went out there with them.

11 Secondly, what you've not included --

12 and it was alluded to for ships built before X

13 whatever -- people that worked in buildings built

14 prior to 1970 could potentially have had asbestos

15 falling on their desk. I have seen it in person.

16 We had old labs that were converted to

17 office buildings all over the 300 area and the

18 200 area. I remember going out and visiting an

19 engineering manager out at 225B -- if I remember

20 the building number correct -- and, oh, we can't

21 go in this area. The asbestos lagging fell off. 

22 They'll get to it. That was 1992. So I think a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

390

1 broader category to include workers, being

2 administrative, you know, clerks.

3 Also, I am beryllium sensitized, so in

4 my 30 years, I've done no work. I'm a pencil

5 pusher, right? I've been through all these

6 buildings. I've been exposed to all the stuff. 

7 But what we've found with beryllium, one of the

8 groups that we -- in the early days, that we

9 found that was high in exposure to beryllium were

10 firefighters because they went out and sprayed

11 the heads to check to make sure they were

12 working. When they sprayed it, what came down,

13 the beryllium. So the firefighters also spent a

14 lot of time in these buildings.

15 So when you look at these and you hear

16 the concerns of people applying for this and

17 trying to prove they were exposed, when you build

18 these cohorts, be very careful of how you

19 segregate it and how you explain what a

20 maintenance worker is. And then the other thing

21 I would suggest, a cohort for those that were

22 assigned to those buildings. There are records
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

391

1 out there, phone directories which list what

2 buildings everybody was in every year since I was

3 there in 1980. I know they go back to then and

4 they go back further.

5 So there are records of who was

6 assigned to what buildings over the years, and I

7 appreciate if you would consider them because

8 your job is to help the claims processors and

9 reduce the frustration for those that have to

10 apply for the claims. And I appreciate your time

11 and effort. I understand what you've put

12 yourself and volunteered for because I do that

13 myself.

14 CHAIR MARKOWITZ: Thank you.

15 MR. BLOOM: Bye.

16 CHAIR MARKOWITZ: Next is Donna Hand. 

17 I think Ms. Hand is on the phone.

18 MS. HAND: Hello?

19 CHAIR MARKOWITZ: Yes. We're here. 

20 We can hear you.

21 MS. HAND: Okay. I know it's getting

22 long and it's getting late. I just want to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

392

1 remind the Board, thank you very much for some of

2 your recommendations because now the SEM has

3 listed as a reference the NIOSH pocket chemical

4 guide. And so they list the loss of injury entry

5 now that we can use.

6 However, the SEM says, only diseases

7 covered by Part E are displayed in SEM. Well,

8 doesn't that cover all the diseases? How come

9 the target organs that are defined in the NIOSH

10 pocket chemical guide not also displayed in SEM

11 because they've been all peer reviewed as well as

12 the OSHA? OSHA regulations on chemicals also has

13 been peer reviewed and has set the court criteria

14 before they could even say, okay, you have to

15 have regulations on these.

16 The other issue is that you're in a

17 prime place to where some of the wording that the

18 Department of Labor uses is implied to be higher

19 than what it is such as significance. They never

20 defined it in their policy procedure manuals. 

21 They just underline it and says, it's got to be

22 significant.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

393

1 However, the regulations did define it

2 and they defined it in 2006 that significant will

3 be any factor. They also defined that the toxic

4 substance only has to have the potential. It

5 doesn't have to definitively do anything. Does

6 it have the potential because of its radiological

7 nature, its chemical nature, or its biological

8 nature?

9 Level of exposure is never to be

10 addressed nor was it required. That's a moot

11 issue because the thing is, is that OWCP has

12 stated in the regulations, you will consider. 

13 It's not mandated, but you must consider the

14 nature, the frequency, and the duration or the

15 nature of a toxic substance or the nature of the

16 job task. Either one, that's what you should

17 consider; the frequency of the exposure to the

18 chemical or toxic substance or the frequency of

19 the job task; the duration of the exposure to the

20 chemical or the duration of the job task.

21 That's it. That's what then should be

22 considered, and that's what they'll actually --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

394

1 that's in the regulations. So that's -- a big

2 presumption then is that if you meet those

3 criteria, that should be it.

4 I'd like to kind of paraphrase

5 something that was done on December of 2009 to a

6 case examiner from their own district medical

7 consultant. And it said, regarding possible

8 exposure, what is significant medically is judged

9 by a number of factors as potential for exposure,

10 administrative controls to minimize it, or any

11 PPE. It is the biological effects of significant

12 exposure and not exposure alone that is

13 significant.

14 So a puncture wound to the lung do not

15 equate to exposure to toxins or radiation. And

16 if that's the philosophy and the train of thought

17 or the peace of mind that their own DMC were

18 using and are still using, it requires a

19 definitive no. Again, you're applying causation. 

20 No. Aggravating and contributing to.

21 So within these parameters of the

22 actual law, which is binding, that's what the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

395

1 policy should be also implementing. And if the

2 words aren't defined, then let's define them

3 instead of everybody having subjective opinions

4 such as an upper respiratory infection. It's not

5 a chronic respiratory disorder. But according to

6 the World Health Organization, it would fit that

7 definition.

8 So, thank you, again, for your time,

9 and I really appreciate all that you guys are

10 doing. Thank you.

11 CHAIR MARKOWITZ: Thank you, Ms. Hand.

12 Is Diane Leist -- she was supposed to

13 be available.

14 MS. LEIST: I'm here.

15 CHAIR MARKOWITZ: Oh, okay. Sure. 

16 You can come on up and then we're going to go to

17 the phone to Ms. Vina Colley.

18 MS. LEIST: So I didn't have time to

19 really prepare too much because I had more

20 questions, but, in 2015, I was diagnosed with

21 breast cancer. Fortunately, it was something

22 that responded well to treatment.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

396

1 But I had worked out at Hanford

2 beginning in 1985 when we hired lots of young

3 people as a chemical technologist, or a lab tech,

4 and had worked in a number of the processing

5 facilities. When I wasn't a lab tech, I was also

6 working as an engineering tech additionally, so

7 all around the Hanford site.

8 And I did go ahead and apply, although

9 my dose reconstruction certainly had me well

10 below dose limits. And in the discussions and

11 subsequent six months' time when we spoke with

12 Department of Labor, it was pointed out the SEM. 

13 It was, like, hey, that is a pretty useful

14 database, or at least it's certainly a database

15 with a lot of information.

16 But there could be more in that

17 database because when I asked to be considered

18 for, oh, you know, perhaps, you know, some

19 chemical exposure during those analyses that we

20 run or the inventories we did or working in the

21 field might have affected that.

22 And when you looked in the SEM, it's
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

397

1 great. It does have listed your occupations and

2 areas you worked, so you can use that to sort on. 

3 But if you just look for breast cancer, it'll

4 show that there are none of those many, many

5 chemicals used at Hanford have not caused breast

6 cancer.

7 And I look at that and think, I'm not

8 entirely sure. I mean, the information I was

9 sent said, well, you can keep looking and see if

10 something comes up, and your claim will still be

11 there. But I look at some of the things that we

12 worked with routinely. Not exposed to it in any

13 sort of accident because that seems to be one of

14 the things that kept coming up. There were no

15 incidents or no accidents.

16 But if we worked with chemicals such

17 as -- and I'll just use three examples here

18 because people are familiar with the terms --

19 toluene, MEK, carbon tet, you know, routinely in

20 doing analysis. Those things -- there certainly

21 is nothing on there that says that they cause

22 breast cancer.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

398

1 But are there studies out there that

2 did look at these chemicals for -- just

3 specifically in my case or in my interest --

4 breast cancer? And if those studies are out

5 there, then is there a way -- or it would

6 certainly be more helpful to have that in the SEM

7 so you can say, okay, fair enough?

8 And I think that is -- just kind of

9 concludes my thought. If there is something out

10 there that disproves it, let us know because even

11 though some of us have great backgrounds -- I'm

12 not a chemist, but I am very familiar with

13 chemicals. I teach DOT transportation and look

14 at hazard class information all the time and MSDS

15 and things like that. But I don't know how to go

16 out there nor do I have the time or the resources

17 to contact every university and see if they've

18 done a study and that sort of thing.

19 So thank you.

20 CHAIR MARKOWITZ: Thank you very much.

21 The next speaker is Vina Colley on the

22 phone. She's not there? Okay.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

399

1 So I think that our last speaker

2 actually, unless there's someone else who

3 volunteers, is Gary Vander Boegh. I think he

4 might be on the phone.

5 MR. VANDER BOEGH: Thank you, Dr.

6 Markowitz. I want to thank the Board for all the

7 work that you're doing. I do notice when I have

8 time in between representing claimants -- I had

9 four hearings today, and they were very

10 interesting claims.

11 We at Paducah are proud. When I was

12 working at Paducah Gaseous Diffusion Plant, I'm

13 an engineer, so I associate with all the issues

14 at Hanford. Actually, Kirk and I have met many a

15 time to discuss the association of the

16 contractors, and I worked for Lockheed Martin. 

17 I'm very proud of what Lockheed did, but, again,

18 we really were working under a different contract

19 scenario back in the days that I was Lockheed

20 Martin. And that was probably -- it was Martin

21 Marietta, then Lockheed Martin, and you can kind

22 of follow Paducah issues.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

400

1 But unbeknownst to me, since I'm a

2 design engineer, I was hired for designing a new

3 14-million-dollar landfill -- contained landfill

4 that was state of the art. And I was the project

5 manager with Lockheed Martin engineers, my

6 coworkers, and my good friends, Jimmy Massey and

7 Dave Massey, leading this project.

8 And we got that permitted, used the

9 city leaders in Paducah to help us do that. 

10 There was a lot of permitting issues, as you're

11 very well aware, and Dr. Mark, which you and I

12 have talked many other times about the issues of

13 beryllium. And so therefore, when we were

14 operating the plant, all of you probably are

15 aware by now that a false claims was filed in the

16 plant, and we didn't know it.

17 And so as the investigation transpired

18 and my office was taken over by federal

19 government officials -- and I entered all this

20 into the hearing record today -- we thought that

21 was significant because I think everybody needs

22 to understand I got caught up in the same issues
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

401

1 that the nuclear workers got, and I'm a young man

2 who started in 1992 and never knew what was going

3 on at the Paducah plant other than somebody

4 handed me a project that I had to take over. And

5 as a design engineer, I was more than happy to

6 help them.

7 That project ended up weighing me two

8 President's awards under President Bill Clinton

9 and then I was able process waste out of the

10 plant. And I noticed that when I developed the

11 waste acceptance criteria, which was very intense

12 and detailed, project managers had to sign off

13 that everything was fine and everything was

14 acceptable -- Kirk will understand this --

15 everything was done properly. Lo and behold,

16 that's what the false claims was about.

17 Nobody knew that according to the

18 investigation under the Act that there was

19 falsifications of the waste going on, which meant

20 the new landfill, which was permitted under the

21 State of Kentucky, had just accepted contaminated

22 material that, as an engineer landfill manager,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

402

1 project manager for Lockheed, I was responsible

2 for the day-to-day activities. A landfill

3 manager title is just strictly a staff title. 

4 I'm a staff engineer, class 3, whatever that is. 

5 Kirk, I've been long enough that I've forgot.

6 But the point I'm making is, as waste

7 was generated out of Paducah Gaseous Diffusion

8 Plant that was hazardous, people falsified the

9 classifications of the waste. That's in the

10 news. You can see it. Lockheed Martin got

11 slapped on the wrist.

12 I still think the world of the

13 Lockheed Martin people: Mr. Van Hook and all

14 those top people at Lockheed. But that was what

15 triggered the investigation that led to the

16 uncovering of bad things that were happening to

17 workers including Chuck Deuschle, Bud Jenkins,

18 John Tillson, and the notorious Ron Fowler who

19 Ron was the nuclear whistleblower.

20 And we're not trying to take credit. 

21 We're just trying to bring everybody across the

22 nation in together and understand that when our
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

403

1 politicians take credit for the sick worker

2 program but then we learn that they're really not

3 wanting the program to be successful. We got to

4 look at the politics involved, and this Board is

5 the best thing that I've seen in a long time

6 because you're asking -- it's almost like, wow,

7 somebody was listening to me.

8 And so what we did was go out on a

9 limb, and we notified through our channels, and

10 I've got a lot of political connections. And we

11 just started looking at over 400 claims, and we

12 found a pattern; that there was a word -- and

13 Donna Hand has already stolen some of my thunder

14 on the pocket guide. As a nuclear worker, you're

15 licensed -- or you're required to follow 29 CFR

16 1910.120. Dr. Michael and I have talked many a

17 time, and I understand now he's with OSHA. And

18 so October 28, 2015, I put Dr. Michael on an

19 email, and we had a great conversation.

20 I then forwarded that to DOE at the

21 top level, and Monica Regalbuto then asked for

22 the resignation of the DOE site manager who, by
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

404

1 the way, people at Rocky Flats would probably

2 remember it, Bill Murphy.

3 Now, we know that Rachel has got a big

4 cast ahead of her. She's got to bring in all the

5 other agencies, but I was just going through the

6 NIOSH pocket guide that I mentioned to Dr.

7 Michael in October 28, and I put in the hearings

8 today. And, lo and behold, in the SEM has been

9 inserted the very thing that I've been writing

10 emails and arguing, but we didn't know this until

11 two days ago.

12 And so, if the Board is aware of the

13 requirements of 29 CFR 1910.120, 40-hour training

14 allows you to work in the DOE facility, and I'll

15 yield to Kirk to disagree with me but I know he

16 can't. We don't understand how these workers can

17 come in, give testimony that they've handled

18 hazardous waste and breathe the converter gases

19 and the TCE dumping out, as was discussed today. 

20 And then somebody at Lockheed Martin -- who used

21 to be our employer now -- who has bought the

22 company, QTC -- and that's an obvious conflict of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

405

1 interest -- is then brought in to deny the

2 claims.

3 Under a CMC, the need for a CMC, which

4 is really not needed because all of the chemicals

5 that we're talking about are in the SEM --

6 they're in the SEM. And we found shockingly

7 today that one claim was approved for the very

8 same thing the other three have been denied. So

9 there's not consistency.

10 I hate to be the bearer of bad news

11 here, but I'd like to retire somebody, and I did

12 this to help people who had had their claims

13 inappropriately denied. And I want to say that

14 I've met with Rachel and I've met with John

15 Vance. And, at that time, in 2010, in a meeting

16 in Washington, I thought I knew a lot more than I

17 really know now.

18 And so Dr. Markowitz, I can just

19 commend the Board for what they're doing, but we

20 got to look at this significant factor issue

21 because if you don't go tackle that issue, well,

22 DOL is -- DOE -- the EEOICPA director is just
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

406

1 strictly going to call Lockheed Martin and say,

2 hey, I need a denial and a significant factor,

3 and just tell them it's not significant.

4 Well, for goodness sakes, people. We

5 don't -- at Paducah, we don't want Lockheed

6 Martin CMCs being called in. And even we've got

7 12 cases in the United States Federal Board in

8 the Western District, and Judge Thomas B. Russell

9 and Judge Stivers have even ruled that it doesn't

10 matter what the CMC says.

11 As long as he makes an opinion -- and

12 Rachel, you'll appreciate this -- the people like

13 Lucero v. DOL in New Mexico, those cases are not

14 overriding what's happening here at Paducah. And

15 I believe we've got a situation where Senator

16 McConnell does not want claimants paid because of

17 the contamination that rivals anybody in the

18 nation.

19 But we're getting there, and I just

20 want to thank this Board for the work you've

21 done. And I don't have one note in front of me,

22 and I think Donna Hand has probably taken the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

407

1 pocket guide issue. And I'd like for somebody to

2 tell me, is the pocket guide -- Greg Lewis, I

3 believe -- I don't want to quote Greg, but where

4 does this stand?

5 We're all trained. Thousands of

6 workers are at the plant right now. Beryllium

7 everywhere. Dust has -- the dust is two inches

8 thick on the 40-acre process building that are

9 150-foot tall. Don't go in --

10 CHAIR MARKOWITZ: Mr. Vander Boegh.

11 MR. VANDER BOEGH: -- the buildings. 

12 I try to tell people, don't take tours of nuclear

13 facilities and especially those in the C-720

14 where two cases today, independent of each other,

15 talked about the converter dust and asbestos.

16 The heating systems are still there. 

17 It was raining down on me in '92. I asked them

18 what it was. They said, oh, don't worry about

19 it. Well, come to find out, that's where they're

20 machining beryllium, and I tell this same story,

21 and all the Paducah workers that I represent want

22 their transcripts provided to this Board.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

408

1 CHAIR MARKOWITZ: Mr. Vander Boegh.

2 MR. VANDER BOEGH: Thank you.

3 CHAIR MARKOWITZ: Thank you very much.

4 So is there anybody else who wishes to

5 speak in the last few minutes? Okay.

6 Well, this wraps up the public comment

7 session. Thank you very much for your

8 participation, and we'll resume tomorrow morning

9 at 8 o'clock.

10 MR. FITZGERALD: All right. This

11 meeting is adjourned. Thank you very much.

12 (Whereupon, the above-entitled matter

13 went off the record at 5:55 p.m.)

14

15

16

17

18

19

20

21

22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

409

A

A-F-T-E-R-N-O-O-N

183:1

a.m 1:11 4:2 16:8 89:13

89:14

abatement 292:7 294:8

294:16,20 298:19

299:5 326:12

abatement-based

326:17

abbreviations 81:18

abdomen 258:4 271:21

ability 84:14,16 153:2

203:19 205:8

able 14:17 22:2 24:9

27:13 42:5,6 53:13

103:15 105:13 111:16

133:8 134:16 152:16

153:16 166:12 172:18

191:20 192:12 193:16

195:4 203:6 204:19

206:5 213:3 216:1

223:7 226:17 234:1

236:1,9 246:4 251:9

252:11 272:17 301:19

354:8 366:20 375:15

376:7 401:9

abnormal 277:15

373:10

abnormalities 372:2

above-entitled 89:12

181:21 291:1 336:2

408:12

absence 250:15 251:20

276:16

absolutely 32:1 47:2

133:9 172:20 205:9

abstain 329:2

abstained 76:3

abstaining 324:12

abstention 139:17,22

140:10,18 313:7,11

319:15 334:3

abstentions 88:11

139:16 313:5 317:19

317:22 334:2

abuse 159:20

academic 224:14

accept 71:6 87:21

139:6 263:4,7 276:18

310:18 328:12 329:20

332:5 333:15 334:12

344:12

acceptable 145:21

186:12,15 401:14

acceptance 150:5

273:3 316:20 361:3,4

362:7,9 363:5 401:11

accepted 40:3,8 73:1

82:2 89:5 93:17 94:11

113:13 150:4,8

152:10 155:15 157:1

184:7 233:3 253:6

255:4 260:13,20

262:2,19,19 265:2

274:9 276:19,20

279:20 329:18 339:4

339:4 340:22 344:11

384:19 401:21

accepting 73:4 126:12

385:3

accepts 259:4

access 136:19 218:13

218:14 222:11 229:20

240:7 242:2,17,19,19

244:2 247:7 370:8

accessibility 66:18

accident 397:13

accidents 397:15

accompany 118:22

accomplish 130:21

accomplishments

337:5

account 55:22 239:7

accounting 212:11

accuracy 358:13,20

364:13

accurate 83:7 206:10

344:6 358:22 359:9

achieve 367:17

acid 354:11 375:8

acknowledge 4:19

299:22 301:1

acknowledged 301:22

359:3

acknowledgment

173:10

acquainted 81:17

acquisition 52:11 79:20

act 5:8 250:17,17 251:5

251:16 254:22 255:3

255:3 257:6 332:4

357:1 358:19 368:16

401:18

acted 337:19

action 32:11 197:5

306:4

active 25:6 380:4

activities 20:4,18

122:22 402:2

activity 299:3

actual 148:15 153:10

158:16 164:11 169:5

286:20 394:22

acute 185:8 237:5

301:11

add 9:1 31:16 41:19

45:7 50:5 53:4 57:20

65:20 87:13 93:19

100:14,21,21 101:15

108:13 110:11,16

122:1 136:2 138:1,5

159:10,11 162:9

168:4,18 170:13

188:8 190:12 219:16

277:22 301:7 302:3

304:9

added 42:8 71:2 111:11

371:4 373:7

addendum 65:18

171:20

adding 31:11 36:4 53:3

67:17 71:1,3 72:3

75:5 95:16 97:12 98:6

107:13 135:16 241:3

299:7

addition 15:4 21:10

44:18 51:6 58:15

63:15 125:11 208:7

339:19 356:8 359:14

369:16

additional 26:1 28:22

82:6 110:1 111:10

133:17 134:22 135:2

150:11 161:5 172:13

195:9 206:16 218:17

223:2 245:6 276:5

342:3,15 346:17

358:3 385:8

additionally 396:6

Additions 17:13

additive 56:1,3

address 10:10 15:3

17:7 45:2 62:14 137:5

189:9 299:7 304:8

addressed 41:2 187:4

197:19 240:12 256:20

302:6 367:15 384:1

393:10

addresses 75:8 257:13

257:15 262:12

addressing 370:5

adds 31:2

adequately 194:22

214:15

adjourned 408:11

adjourning 5:12

adjudicate 42:6

adjudicated 148:16

154:16 371:6,18

387:6

adjudicating 142:15

154:1 305:20

adjudication 20:7 44:7

81:12 113:1 150:1

153:10,15 237:18

368:13 369:5,18

384:16

adjunct 12:20 213:19

administering 40:19

administration 22:2

268:2 367:13

administrative 46:21

101:10 180:3 390:2

394:10

admission 251:7,8

admit 239:18 373:22

adopt 198:9

adopted 251:19 378:19

adopting 302:13

adoption 276:8

advance 6:13 172:9

advantage 251:21

advice 131:22 340:19

341:2

advised 384:13 385:6

advisory 1:3,11 4:6 5:8

6:5 8:19 123:6,21,22

164:4

Advocacy 337:2 355:5

356:21

Advocacy's 359:11

advocate 12:1,12 20:14

166:22 343:13,14

363:10,19

advocates 19:19 338:3

aerosol 42:20 95:19

aerosolized 350:4

352:7

Aerospace 355:5

affairs 144:20

affect 57:15 280:20

364:12 369:17

affidavit 53:5

affidavits 169:14

afternoon 15:18 343:11

age 189:22 283:13

315:4

aged 200:20 206:13,21

agencies 129:21

345:20 346:1,2,7,19

404:5

agency 5:13 130:12

133:2 151:12 161:1,3

197:15 259:18 346:16

agenda 3:4 5:12,16,18

5:19 6:16 10:19 14:9

17:12 34:17

agent's 325:22

agents 51:4,16 94:19

96:20,21 97:15,18,21

273:10,13
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

410

aggravate 64:4 94:20

95:11 225:20 256:3

aggravated 217:15

aggravating 54:3 109:8

264:9 271:4 307:18

316:15 328:9 394:20

aggravation 61:1,11

63:10,15,22 110:3

234:22

aggregate 94:3

ago 126:20 128:15

188:11 274:21 378:3

404:11

agree 58:20 63:18

68:17 82:16 83:17

105:2 109:5 112:14

131:1 132:13 133:14

136:9 139:18 205:9

207:16 212:1 218:15

225:11 235:17,20

240:4 278:18 282:18

288:18 322:11 327:5

agreed 109:6 154:3

agreement 19:11

303:20,22

agreements 356:20

aha 57:4

ahead 32:6 109:13

132:10 162:10 171:9

190:10 230:6 232:1,1

232:2 249:17 309:19

384:13 396:8 404:4

aide 388:6

air 49:11,12 96:18

281:18

airflow 90:19

airspace 354:7

airways 90:17,18

348:19

Al- 18:5

Al-Nabulsi 9:5

Alamos 11:22

aligned 344:7

all- 266:11

Allen 376:16 379:20

384:3,4

alleviate 283:4

Alliance 337:2

allocated 223:3 357:9

allow 195:9 276:16

340:21

allowable 275:11 350:6

allowed 211:12 308:19

allowing 367:3 376:19

allows 38:7 43:18 92:1

211:5,7 404:14

alluded 389:12

alternative 303:13

378:22

alternatives 303:14,15

378:10

aluminum 365:21

amend 82:21 83:1

124:15

amended 93:22

amending 106:11,17

107:4,5

amendment 87:19

137:6 310:13,19

American 47:18

americium-241 375:1

amount 35:5 43:20

113:12 142:12 176:21

189:3 252:6 255:17

270:5 281:17 283:1

291:12 301:21 309:22

320:13 352:14

amounts 269:20 270:11

analogous 294:12

analogously 105:5

analogy 294:1,7

analyses 396:19

analysis 61:6 128:19

397:20

ancillary 26:10

and/or 142:7 147:14

anecdote 176:5

anemia 223:19

announce 192:6

announcement 192:5

annual 19:19

anonymous 342:21

answer 7:15 78:10,21

102:2 112:3 150:15

171:12 172:18 234:8

238:9 323:13 346:10

347:10

answer's 42:16

answered 213:5

answering 233:5,6

answers 28:10 180:8

249:1 382:18

Anthony 375:6

anybody 13:22 66:8,11

76:2 101:17 102:3

106:16 119:21 121:8

128:21 149:3,4 162:9

166:9 190:18 226:10

289:2 325:4 376:1

406:17 408:4

anymore 281:10 320:12

362:21

anyway 117:10 198:10

280:11 327:15 329:4

380:18 381:7

AOC 132:17

apologize 222:6 258:20

apparent 216:22

apparently 138:17

153:9

appeal 346:5

appear 30:22 213:15

358:3

appeared 264:19

appears 31:1 100:6

257:9,10 342:4 356:8

applaud 377:16

applicable 204:3

application 114:1

167:11,13 206:11

253:2 321:3 370:3

applications 388:20

applies 106:10 310:22

apply 106:3,5 108:14

112:3 305:16 359:6

391:10 396:8

applying 216:12 325:21

326:2 390:16 394:19

appointment 207:2

appraisal 284:20

appreciate 18:10,12

190:19 193:18 237:12

348:9 374:11 391:7

391:10 395:9 406:12

appreciated 341:20

appreciation 4:17 19:3

193:7

approach 57:19 64:16

83:13 132:17 183:15

185:3 196:18 198:11

211:12 212:10 255:20

275:21 286:9

approachable 221:13

approached 133:10

approaches 45:20

194:20

approaching 341:5

appropriate 5:13 93:3

138:7 158:20 172:2

184:4 187:21 188:2

217:3 221:19 224:21

239:1 250:16 364:19

approval 371:8 373:7

approve 72:8 75:13

77:3 202:22 368:10

approved 32:6 53:7

165:6,10 172:14

365:10 385:9 405:7

approving 5:11 107:2

approximate 5:18

15:11

approximately 352:16

360:14

April 1:8 9:21,22

AR 367:22

arbitrary 276:14 289:4

289:15

ARD 262:13

area 45:14 101:13

111:9 163:12 178:4

294:13,15,21 326:8

347:4 355:13 356:12

356:13,18 357:7,19

357:19,21 358:2,7,15

359:7,7,12 380:4

389:17,18,21

areas 19:6 34:13

136:14 146:11 178:8

181:7 203:10 216:13

283:1 341:2 348:21

353:16 397:2

argue 298:7

arguing 130:4 287:2

404:10

argument 282:9

arrangements 5:3

ARs 367:19

art 400:4

artificially 135:6

asbestos- 126:2 257:21

263:12 267:8 271:5

273:16 297:18

asbestos-associated

271:1 272:9 333:8

asbestos-containing

263:18 266:6 320:7

asbestos-related

261:18 262:12 267:3

267:14,17 268:4,18

269:13,20 271:8

272:20 274:7 277:6

279:18,20 280:7,16

281:2 307:19 311:1

312:7 316:15 320:1

320:10,11 328:10

asbestosis 59:18

257:20 259:4 260:11

260:22 261:19 262:9

271:8 273:16 274:21

277:13,16,19 278:2,4

278:9,13 285:12,19

286:6,16,21 287:7

289:2 295:16 297:6

297:14,21 310:2

320:13 321:5,17,18

322:13 327:14 329:16

ascribe 123:20

ash 355:17

aside 164:3

asked 21:10 37:5 42:14

43:3 48:17 62:17

120:21 123:17 125:2
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

411

141:13,20 142:17

143:7 150:14 151:4

159:2 163:9 168:2

176:12,14 202:13

203:3,4 207:13 208:6

210:8,15 219:21

230:17,21 234:15

346:8 396:17 403:21

407:17

asking 78:7 84:5 98:7

149:10 153:22 161:20

170:3,6 207:14 213:5

229:17 230:2,19

231:17 297:1 342:11

403:6

asks 42:9 170:22

aspect 355:21

aspects 168:21 194:6

328:3

assertion 187:14,15

assertions 187:17

assess 37:21 42:7

56:17 93:3 133:22

240:6

assessing 94:18

102:11

assessment 43:1,18

90:4 94:17 97:4 109:7

119:14 122:9 127:5,9

137:9 139:3 244:22

272:11 333:11

assigned 15:14 126:22

132:1 161:8 162:13

165:4 390:22 391:6

assist 125:9 126:11

359:8

assistance 123:17

227:16 341:22

assistant 153:8

assisted 99:8 159:14

assisting 388:14,16

assists 355:6

associate 11:18 399:13

associated 38:9,10,11

271:6 296:7 355:8,15

355:20

Associates 357:15

association 146:5

151:9 224:9 234:11

258:10 295:19 296:1

399:15

assume 24:4 85:8

115:11 187:11 262:16

262:22 265:1,5

266:19 289:1 290:7

assumed 263:9

assuming 102:12 109:9

assumptions 23:5

assurance 211:17

212:10 239:6

asthma 126:3 134:6

222:2 230:9 255:18

Atomic 12:13

attachment 93:19,20,22

94:10 98:17 99:14

100:6,7,11 101:20

107:22 110:21

attempt 206:14

attend 18:16 28:4

attended 18:17

attention 177:6 222:4

232:19 326:19 369:15

attorneys 176:8

auctioned 357:9

audible 17:14 126:15

126:17 131:12 208:1

audience 120:22

audit 212:21,21,22

213:7 238:18

authoritative 123:15

authorized 367:8 374:5

autoimmune 223:16

autoimmunity 154:10

automatically 64:6

253:5 322:7

availability 128:9

available 6:1 8:7,10,16

14:9 36:7,12 41:21

111:15 123:3 131:6

141:17,18 142:16

144:16 145:4 156:7

194:18 195:11,14

196:1 210:1 222:9

225:3,3 226:19 227:6

229:1 235:22 240:17

241:20,22 243:10

248:11 253:15 285:3

342:6 395:13

avenue 346:4

average 250:22 300:9

avoid 23:19 61:8

207:15,16

award 280:5

awards 280:4 401:8

aware 228:15 297:15

338:16 351:16 400:11

400:15 404:12

awareness 348:16

B

B 15:21 160:1 238:14

269:6 277:16,20

280:4 337:14 343:7

361:2,19 363:4

368:19 370:1 406:8

B2 380:18

back 8:22 42:17 47:15

47:17 66:19 67:16

82:19 87:6 89:10

91:14 100:19 101:2

107:4 112:22 117:17

119:12 126:8 132:2

170:21 176:13 185:13

188:11 190:4,12

194:4 196:10 204:5

208:4 216:14,16

221:11 223:1 228:1

234:9,13 236:6,10

239:12 240:9 243:16

291:21 298:14 302:15

327:8 337:8 362:15

381:15 388:15 391:3

391:4 399:19

background 47:14

122:2 267:4 338:2

backgrounds 398:11

bad 116:15,16,19

185:17 275:5 308:18

402:16 405:10

badges 293:19

balance 64:10,14

287:12 292:5,17

balancing 287:18 288:3

288:5 302:17

ball 60:15

banned 270:9,10,14

320:6

bar 253:5,8,8,10

bargaining 164:12

301:10

Barrie 215:13 336:17

336:19 337:1 341:4,7

based 21:8 32:15 38:14

39:13 45:12,21 48:1

48:14 96:3 134:14

142:4 144:13 145:2

148:5 155:20 169:1

188:5 209:8,9 224:19

235:8 239:9 253:14

259:7 265:20,20

281:11 300:17 325:11

325:15 326:17 338:12

355:20 367:21 371:8

371:17 372:19,21

377:16 387:6

bases 354:11

basically 21:12 26:6

141:15 142:11 161:13

206:18 227:15 266:19

289:3 295:4 309:21

343:22 384:16

basis 95:3 124:3 215:9

246:10,15 251:7

285:8 301:14 329:19

343:7

batches 179:7

bearer 405:10

beautiful 269:7

began 115:16 250:4

361:10 362:2

beginning 36:18 67:16

77:18 112:19 177:9

180:11 189:4 192:9

195:7 197:8 287:11

396:2

behalf 4:16 9:14 359:20

behold 401:15 404:8

believe 10:7 14:17

35:12 66:21 115:7

127:3 144:21 153:4

154:11 164:17 187:8

189:1 236:5 239:15

262:15 282:6 340:17

359:14 362:16 380:12

406:15 407:3

believed 143:15

believes 240:21

Bellevue 12:6

belongs 56:12

BeLPTs 373:10

bench 137:1 237:18

beneficial 57:12

benefit 206:15,19

340:18

benefits 25:2 27:17

52:15

Bernardino 25:8

Bertolla 380:2 383:21

beryllium 11:7 107:18

144:6,7 296:9 343:14

343:17 344:3,3,18

348:18 350:8 364:6

364:20 365:20 366:6

369:6,8,8,9,10,12

372:3,9,11 390:3,7,9

390:13 400:13 407:6

407:20

beryllium-affected

344:15

BES 372:7

best 60:1 77:20 175:22

296:6 297:11 306:3

337:17 367:6 376:6

379:12 403:5

better 44:6 63:11 80:16

113:18,20 159:5

171:11 179:6 211:1

249:18 288:16 321:14

330:21 345:20

beyond 15:14 36:9

75:10 82:14 306:17

bibliography 238:6
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

412

big 24:1,8 27:5 44:13

44:14 48:20,22 49:2

74:13 98:8 157:8

236:13 260:18 266:11

280:8 314:12 315:18

315:20 382:11 394:1

404:3

bilateral 327:11

bill 26:11 216:1 401:8

404:2

billion 25:1,3,5 352:21

binding 394:22

Bing 360:2,3,4,5 364:11

364:12,14,15 365:7,7

365:8,15,16,17 366:4

366:5,13,14,17,18,21

bioassays 376:4

biological 60:8 393:7

394:11

biology 48:3 49:15

Bird 5:1

birth 376:10

bit 14:12,14 21:13,16

23:20 31:15,15 32:12

47:10,13 53:22 58:21

60:15 81:10 95:15

103:5 128:4 141:8,22

147:11,12 172:16

179:13 181:7 183:13

194:17 196:18 209:2

210:22 211:1 212:17

223:1 228:1 234:1

235:15 239:12 258:13

282:2 287:10 291:10

304:21 338:2 352:22

362:14

bitmapped 218:4

bladder 230:8

blame 64:11 238:21

blast 27:22

blasts 27:16

Blaze 348:7 355:1,4,5

360:1

blood 364:4

Bloom 387:14,15,16

391:15

blue 54:19

Board's 4:8,22 5:10 6:2

6:3,9 8:6,16 19:6,8

20:3,4 341:12 358:18

358:21 377:4

Boards 387:18

Boden 1:17 11:2,2 55:7

56:9,22 69:14 73:16

73:17 74:1 85:6,7

106:22 107:1 110:7,8

111:3,5 112:1 141:9

163:11,12 171:2

172:6 176:2,18 187:1

187:2,18,22 188:3

226:1,2 230:22 231:1

231:11 247:4,5,14,17

247:22 250:2,3

254:16,18,20 287:8,9

296:21,22 302:19

303:17,18 304:3,18

304:22 308:16 311:8

311:10,13,20,22

322:4 324:11 329:22

330:4,7 332:14,20,22

bodily 332:2

body 50:6,17 136:2

293:21 378:22

Boegh 399:3,5 407:10

407:11 408:1,2

boilerplate 178:10,10

bolded 69:9

bolts 194:9

book 34:17 245:6

bookmark 220:10

221:20

booted 322:8

borderline 344:10

borders 201:10

borehole 375:6

born 388:20

borrowing 293:14

boss 166:9

Boston 11:3

bother 224:2

bothering 381:17

bottom 100:22 101:6

138:6 370:15

bought 404:21

boundary 248:20

bounds 177:10,20

Bowl 356:13 357:6,8,12

358:2,15 359:12

Bowl's 356:19

boxes 364:4

brain 380:22

branch 113:1 384:16

brand 386:2

breadth 130:15 137:5

break 73:12 74:17

88:19 89:10 180:21

289:20 290:20 291:4

334:22

breaks 5:21 15:13

breast 395:21 397:3,5

397:22 398:4

breathe 404:18

breathing 283:8 381:18

381:21

brief 18:20 118:20

254:17 324:3 376:21

briefing 224:20 244:19

245:5 247:10

briefly 10:19 14:10

81:19

bring 98:21 119:12

120:19 127:11 129:15

204:20 249:14 348:15

353:7 402:21 404:4

brings 289:11

broached 379:14

broad 21:13 30:4 46:19

49:22 87:9 130:19

138:10 293:7 325:21

368:6

broaden 135:10,14

136:18 233:8

broader 80:8 127:22

138:5 161:11 169:7

197:17 233:11 273:8

334:9 389:8 390:1

broadly 87:5

broke 380:13

bronchitis 90:15

brought 130:13 132:19

196:8 405:1

brush 283:9

BTMed 36:5 37:20

41:16 45:3,11 71:2

84:4,12 96:3 99:1,2

205:19

Bud 402:17

Bugarin 380:2 383:21

383:22

build 135:13 277:8,8

306:4 390:17

building 36:20 91:6

173:9 260:7 281:16

289:5,16 294:20

301:17 331:1 361:14

388:2,19 389:20

407:8

buildings 146:11

167:17 283:14 288:21

387:22 389:13,17

390:6,14,22 391:2,6

407:11

builds 331:1

built 179:14 243:7

289:6,17 380:6

388:19 389:12,13

bullet 43:11 74:8 75:11

75:11 85:11 100:14

196:5 199:13 200:11

247:16 248:2 330:1

bulleted 75:8

bulletin 38:4 39:4,22

40:15 44:20 80:11

85:12 91:9 92:1,12,15

92:18 259:11 260:1

261:21

bulletins 60:13 62:1

257:10 341:10

bunch 112:20 158:19

227:17

burden 84:12 253:1

burdensome 201:1,2,3

201:4 290:16

bureaucratic 345:22

368:3

buried 214:19

business 19:1 65:14

163:1,8 202:22

281:22

buy 353:18

Bye 391:15

bystander 38:1 68:1

C

C 160:2

C-720 407:13

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

cadre 130:13 131:7

cage 101:12

cahoots 383:10

calendar 8:8 256:6

257:6 262:6 266:16

274:3,16,19 276:12

276:14 282:9 303:6,7

303:12,15,16,21

304:9 307:5 309:3,4

309:11 310:22 312:6

312:9 313:13,21

314:9 315:17 324:19

Calin 343:10,12

call 28:3 29:4 70:13

191:9 335:17 346:16

347:1 362:18 373:17

373:21,22 374:2

381:19,20 406:1

called 38:6 189:21

256:19 258:1 267:22

351:13 361:4 406:6

callous 362:20

calls 28:11 29:13,20,22

30:3,14 62:4 249:16

373:13,14 374:4,8

cancer 106:5 125:5,16

150:16,18 180:15

220:13 234:4 251:4

255:10 256:17 257:1

257:5 258:2,7 259:13

259:15,18,21 260:10

260:13 261:4,18

262:7 267:14 271:9,9

271:9,20 273:18,18

285:16 323:9,10,12
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

413

323:15 324:1,4,5,8,9

327:14 329:17,17

342:3 356:2,3 375:7

384:13 385:7 395:21

397:3,6,22 398:4

cancers 251:12 267:17

342:4 356:7 385:8

Cantwell 9:9 121:3

capabilities 122:6

135:11 138:22

capable 101:4

capacity 134:21 135:5

137:21 164:4 286:1

364:2

capital 369:10

capitals 369:15 372:1

capture 31:4 36:18 37:9

45:11 98:12 255:22

captured 37:7 42:16

78:2

captures 42:19

carbon 355:17 397:19

card 114:15 361:8

care 26:10 281:10,14

310:10 381:9

career 43:7

careful 143:4 390:18

carefully 125:21 272:19

Carolina 246:12

carpenter 54:5,7,9,10

carpentry 81:4

Carrie 1:21 4:21 9:13

9:16 11:13 16:19 17:3

29:1 144:7 200:7

335:15

carried 133:15 212:6

Carroll 360:3,6 363:11

367:1,2,3 373:2,4,6

374:11

case 30:6 44:4 57:12,13

92:18 112:22 114:11

119:16 120:22 142:6

142:18 143:3 147:7

148:11 150:22 151:22

154:10,11,13 155:21

156:2 158:12 160:7

165:1 170:22 180:16

184:11 187:11 194:18

195:5,12,14 204:1

210:10,16,17 217:18

220:8,11 231:3

234:19,20 238:10

239:2,9 240:16

242:18 244:11 246:19

290:15 306:18 322:12

338:21 345:21 346:21

376:18 381:11 394:6

398:3

case-specific 31:7 92:4

cases 24:18 29:22 31:6

58:2 59:12 62:16

64:12 79:12 95:6

112:21 113:3,10

114:10 142:20 144:12

150:22 152:3 154:5,9

154:16,19 155:5

157:16 158:21 159:13

161:5 162:12 163:16

164:9,20 165:4

169:13 178:22 204:18

209:8,12,22 214:5

216:3 217:9 218:1

231:19 233:19 246:5

278:19 280:12 300:18

352:1 371:6 406:7,13

407:14

cash 280:4,5

Cassano 1:21 3:14 13:2

13:2 57:21 78:18,19

84:19,20 99:19,21

100:18,20 101:5

102:4,14 103:3

108:10,11 129:6,7

130:6 135:8,9 136:17

141:4,5 143:7 163:11

165:14 167:4 168:4,6

168:10 171:15 174:8

177:2 179:3 180:19

181:3,10 183:11,12

184:5,14 185:1

186:10,13,19 190:11

191:8,11 194:14

204:15,16 219:3,11

233:16 238:16,17

239:12 243:12,17

245:21,22 248:1

278:17,18 288:17,18

296:19,20 305:14

306:6,10 307:2,21

308:3,11 309:5 323:5

323:6 324:6 326:8,13

327:19 328:13 331:16

334:13

Cassano's 191:1 233:9

cast 404:4

categories 43:2 91:11

92:9 93:19,22 94:5,10

101:16,20 102:1

112:8,12 152:8

167:18 171:22 272:18

category 43:8 50:1

53:10 92:7 93:21

96:15 104:9 115:5

119:19 146:12 150:10

162:21 297:12,14

390:1

caught 400:22

causal 123:7

causality 237:1

causally 258:11

causation 22:17 23:22

24:5 33:8 60:14,22

62:9 63:10,16,20

109:8 124:20 144:9

145:15 146:3 215:18

217:4,11 224:16

235:2 240:1 253:12

264:7 272:14 273:2

332:4 333:13 384:19

394:19

causative 304:15

cause 47:17 48:8 58:6,7

59:7 60:3 64:4 90:22

91:1,1 94:20 95:11,20

96:19 97:19 110:2,4

116:18 148:22 157:6

160:4 225:19 256:2

269:20 273:10 321:4

321:7 323:12 324:3

324:18,21 397:21

caused 42:4 57:4

217:15 256:14 257:21

259:18,22 271:21

338:15 397:5

causes 48:5 49:9,11

93:5,9 314:22 380:21

causing 49:20 55:22

271:5 278:12 307:18

316:14 328:9

caustics 353:18

caveat 100:21 101:6

CBD 344:14 361:2

363:4 368:16,18

369:11 370:1 371:8

371:22 372:5,7,13,17

373:6

CDC 260:19

CE 143:8 146:7 149:2,9

155:16 158:17 174:11

174:16 212:7 213:3

220:8 221:19 224:2

230:5 236:6 237:10

259:3 261:7,13

263:14,19,22 264:11

266:4 373:19

cement 98:4

center 12:22 13:1

223:18 357:11

centered 128:5

central 251:19

cents 280:12

certain 22:18 31:1,6

38:8 61:4 134:20

142:12 176:21 178:8

178:8 179:17 189:3

210:9 234:20 242:12

246:22 253:21,21

281:15 301:21 305:10

323:17

certainly 93:4 95:6

110:11 126:10 132:6

155:6 168:18 210:2

216:7 220:10 221:14

221:20 252:13,15

265:20,22 278:14

294:18 301:7 346:11

347:15 396:9,14

397:20 398:6

certainty 215:18 216:11

302:18,19

certification 213:18

certified 8:6

CEs 141:17,18 144:11

153:4,19 164:11,19

165:21 191:15 213:2

242:19 368:8 370:20

cesium 360:17

cetera 267:20 268:3

382:12

CFR 375:19 403:15

404:13

Chairman 8:18 118:6

348:8 376:19

chairperson 380:5

challenge 54:21 173:20

174:2

challenges 191:17

challenging 122:19

128:4

chance 23:3 34:20

81:20 277:3,12

chances 385:9

change 44:13,14 53:16

53:20 63:7,8 64:5

68:20 85:15 110:5

111:19 115:19 320:1

332:14 349:15 361:16

378:18

changed 111:20 115:11

209:20 276:4 368:22

370:22 371:13

changes 27:1,1,17,21

31:7,15 35:20 55:5

82:1 102:10 103:13

174:4 257:16 341:10

354:10 371:5

changing 241:3 315:5

331:15

channels 403:9

chapter 31:10 33:8

character 218:10

226:13
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

414

characteristics 234:7

characterize 213:6

380:7

charge 45:2 136:11

245:4

charged 227:10

Charles 153:7

chart 126:21 273:14

charter 15:1 358:18

charts 181:9 224:18

check 376:10 390:11

checked 335:15 375:4

checking 37:8 379:21

checklist 211:12

chemical 11:11 269:14

354:3,11 356:1 392:3

392:10 393:7,18,20

396:3,19

chemically 383:5

chemicals 354:6,9

382:13 392:12 397:5

397:16 398:2,13

405:4

chemist 398:12

cherry-picked 239:16

chest 267:13 277:20

285:21 320:2 363:20

363:22

chime 131:17

choice 58:10 274:17

choices 307:7 316:5

choose 288:2

choosing 200:17

chose 154:17

chosen 154:5

Christy 153:5

chronic 11:7 90:12,15

126:1 185:7 237:7

256:14 273:4,8 295:3

296:16 323:1 334:5,9

339:3,3,6 340:19

343:17 344:3,17

368:20 369:2,6,7,9,12

370:17 371:10,12

372:3,11 395:5

Chuck 402:17

cigarette 105:4

circle 42:17

circular 19:12 21:6

262:11 264:3 266:19

275:17

circulars 26:8 62:5

257:10 341:10

circumstances 179:17

202:18 300:10

circumvent 367:11

city 10:22 269:16 400:9

claim 38:7 52:7 113:13

142:13,15 148:15,15

149:8,9 151:5,8 152:9

152:10 153:22 159:15

163:18,19,22 164:7

167:11 174:18,20

175:2 179:5 184:8,19

197:16 210:10 223:19

226:5 236:21 252:21

253:6 259:4 262:2,5

266:3 273:2 279:19

340:4,10,22 360:9

361:1 363:9,11 369:5

371:8 384:14,14

385:6 397:10 405:7

claimant 2:7 44:5 93:13

94:21 148:6 152:1,1

167:10 174:10 180:8

186:16 187:5 190:3

193:16 194:18,19

200:16 206:19 207:6

208:12 221:12 225:2

236:4 253:20 277:17

338:22 339:13 341:21

370:17 371:9 373:21

385:20,22

claimant's 176:7

claimant-friendly 44:2

64:15 235:19 379:13

claimants 20:14 52:19

98:13 176:13 177:19

180:15 206:13,22

222:10 324:21 338:5

340:2 342:1,14 346:5

347:3,17 355:6

359:21 367:22 368:4

368:19 399:8 406:16

claimants' 178:12

claiming 272:19 288:4

clarification 7:19 66:15

68:7 130:4 188:19

189:14 347:10

clarifications 175:13

clarified 247:8,9

clarify 46:12 104:19

110:20 164:5 203:13

213:9 272:21 297:1

clarity 74:21 105:19

266:10

class 285:6 298:2

398:14 402:4

classes 26:7,8

classic 237:8

classification 169:4

classifications 402:9

classify 358:18

clause 135:2

clear 65:13 69:20 75:1

92:15 103:18 111:2

113:9 128:14 133:8

134:13 163:17 175:7

189:7 217:13 229:22

239:20 240:2 265:16

280:16 296:12 300:14

307:20,21 308:17

311:18 330:10 340:11

347:15

clearance 32:10 230:8

clearer 258:16

clearly 54:9 125:7

195:4 213:22 214:20

215:3 224:15 269:11

280:22

clerk 162:17,20 166:11

clerks 390:2

click 353:10 370:11

clicking 6:10

climate 283:5

clime 283:6

clinic 12:5 185:14 215:1

223:17

clinical 133:21 205:14

344:2

clinically 185:15

clinicians 215:7

clinics 205:15,18,21

206:4 224:9

Clinton 401:8

close 16:7 203:4 207:17

274:14 318:3 336:15

385:2

closed 197:21

closely 5:10 11:22

293:1

closer 314:10 323:10

clueless 134:4 183:14

CMC 3:16 15:17 79:9

95:8 119:18 132:15

142:7,11 145:13

146:3 147:6,14 148:1

149:11 150:13 151:5

156:7,11,19 159:19

160:2 165:2 203:22

212:17 213:12 216:16

216:22 217:19 218:6

218:13 219:22 220:7

221:17,21 222:4,8,12

222:17 223:6,20

224:6,18,21 225:4

226:20 227:14 229:8

230:12 232:14,22

233:4,21 234:5,10,15

234:18 235:22 236:7

236:9 237:20,22

238:3,21 239:8,13

241:18 242:8,17

246:7 253:1 261:16

264:16 284:9 293:11

333:12 405:3,3

406:10

CMC's 160:6 238:19

CMCs 61:9 62:16 63:12

179:16 191:22 213:1

213:13,14 216:1

217:12 225:12,18,21

230:16 231:5,8,20

238:10 246:9 247:1

252:4 406:6

coal 50:11,13 355:10,16

355:17,21 356:5,9

357:5 358:1,14 359:5

359:14

Coast 181:13

coating 389:1

code 222:20

Cohen 357:15

cohort 152:2 293:17

294:6 390:21

cohorts 131:22 250:19

251:3,14 255:6

390:18

coincide 184:6

cold 116:15

collapse 375:10

collar 54:19

collect 40:21 43:16

55:9 84:10,16 267:15

267:16

collected 44:15 94:7

collecting 42:1 44:6

67:20,21 74:11

collects 55:9

College 11:19

Colley 395:17 398:21

colloquy 180:11

column 273:16,16,18

comb 52:13 246:7

combination 90:14

97:22

combined 55:14 57:8

93:1 221:6

come 17:22 22:8 28:7

31:20 42:12 65:16

80:5 87:11 103:12

107:4 111:17 117:1

119:7 124:19 125:18

129:5 132:7 160:18

224:19 243:13 251:9

262:3 277:18,19

284:15 319:20 351:7

354:4 360:7 392:8

395:16 404:17 407:19

comes 63:19 173:11

331:1 397:10

comfortable 84:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

415

152:15 275:16 313:22

314:9 320:14 321:21

361:9,19

coming 9:11 30:8 39:15

40:16 65:13 165:11

165:12 228:22 296:15

302:15 348:17 378:12

397:14

commend 337:3 405:19

comment 3:22 6:18 7:6

7:9,13 10:1 16:9,17

16:22 17:2,6 29:15

64:9 65:11 69:18 85:8

109:21 128:10 131:14

136:5 138:14 146:17

150:14 163:3 169:18

181:1,5 192:8,12

193:22 195:18 199:2

201:11 206:9 217:5

220:21 225:6 227:10

228:13 230:4 233:14

238:18 277:3 281:5

289:20 291:6,9

308:16 329:21 335:1

335:14 336:6 347:14

355:9 359:20 363:1

376:20 378:14 379:3

379:17 384:10,10

386:10 387:19 408:6

commented 151:2

194:15

comments 6:1 7:16

17:1,12 18:5,22 46:10

65:5 68:5 70:6 87:16

88:5,5 126:14 177:3

180:17 190:8,18

194:2 195:20 196:7

197:4,6,11,17 200:5

207:22 218:17 219:8

219:13 225:7 245:20

277:1 291:11 302:1

309:19 310:15 318:5

336:21 366:22 367:4

376:22 377:9,12

commit 245:2

committed 194:5

committee 5:8 15:21

35:4,5,8 66:17,17

72:2 89:21 95:22

119:8,16 121:13

129:13,16 142:3,5

148:9 159:10 160:21

161:9 162:5 181:19

190:9 221:5,5 233:9

369:21,22 370:4

committee's 226:3

committees 15:6 221:1

common 90:20 91:4,5

259:5 267:9 268:13

322:22

communicate 191:21

346:6 347:2

communicated 9:15

communication 19:17

191:15 347:20

communications 19:22

20:13

community 1:14,18 2:7

20:14 28:9

community- 48:13

community-based

48:12

comp 214:11

company 363:22

404:22

comparable 169:10

255:9 293:22

compare 78:11 95:8

compared 14:13 50:16

comparison 345:5

353:2

compelling 263:10

265:9

compensate 161:20

274:22

compensated 253:10

254:1 279:4,5 288:11

288:13 290:3

compensating 253:11

compensation 10:12

18:15 25:2 54:6 55:20

60:11 122:5 176:7

179:10 279:15 300:20

329:19 362:5

compiled 114:12

compiling 30:19

complaint 185:5

complaints 367:19,21

complete 41:20 78:1

123:5 137:18 138:3

195:13 211:13 232:16

344:6 358:22 359:9

368:12

completely 64:7 215:12

229:14 371:13

completeness 358:14

358:20

completes 140:20

complex 12:18 38:15

38:17 43:14,22 44:4,8

54:16 111:16,19

112:13 117:15 120:1

250:14,21 259:5

268:17 269:10 276:6

282:15 290:7 314:21

315:3 326:6 344:7

complexities 367:11

complicated 28:18

61:15 111:18 216:3

286:4,22 304:19,21

components 51:13

compounds 356:1

comprehensive 352:12

compromise 276:11

compromised 166:1

325:16

computers 226:10,11

concentrate 291:13

concentrating 323:7

concept 50:7,18 63:14

110:3 288:19

concepts 193:19

concern 163:14 197:19

200:12 236:17 298:16

301:12 314:21 348:22

350:3 353:20 367:22

387:2

concerned 135:4

216:10 296:11 337:7

367:14

concerns 293:14

299:16 374:22 383:22

390:16

concluded 116:5

concludes 398:9

conclusion 214:5

357:14

conclusions 8:4

concrete 114:7 129:2

condition 24:6 130:9

149:1 174:21 185:7

188:21 189:4 217:16

229:14,16 265:11

338:14,19 339:3,3,6

340:19 364:10 370:18

conditions 15:21 22:18

106:3,6,11 108:16

125:22 134:5 148:13

150:3,15 165:5

183:19 190:2 271:1,6

271:7 272:9 279:18

307:19 311:4 316:16

329:16 333:8,13

356:7 361:12 365:4

381:2

conduct 227:13

conducted 281:22

378:17

conducting 213:14

227:17

confer 318:2

conference 373:13,21

374:4,8

confidence 297:21

confident 85:1 297:19

confidentiality 232:12

confirmed 19:9

conflict 404:22

confuses 370:19

confusing 147:18 170:7

264:19

Congress 294:1 337:16

367:17

conjunction 45:4

connecting 80:12

connection 171:8

connections 403:10

consensus 86:19

259:20,21 318:7

321:9 327:16 329:6

consensus-type 125:14

consequential 339:8

consequently 380:15

consider 19:21 43:21

54:22 60:6,21 61:20

65:17 76:13 106:8

107:16 151:14 180:5

210:2 267:1 283:14

287:17 297:14 309:21

312:4 337:15 391:7

393:12,13,17

considerable 276:1

considerably 293:3

consideration 75:9

190:6 229:22 251:16

354:16 357:20 359:17

377:5

considerations 108:15

388:11

considered 7:17 50:9

51:18 52:9,22 54:14

55:13,19 60:14 66:17

102:19 103:2 106:12

108:21 110:13 117:11

117:15 142:14 145:21

147:10 150:16 183:19

217:17 234:4,21

258:10 282:4 304:11

323:16 328:1,7

356:14 358:7,20

393:22 396:17

considering 53:19

198:8,10 234:2

302:12 321:18

consistencies 374:7

consistency 152:6

193:3,13 212:8

225:18,22 227:11,21

251:22 252:3,7

384:11 405:9

consistent 210:12

263:11,17,20 265:9
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

416

266:5 267:3 340:15

372:2,7,13

consistently 50:1 252:1

252:2 349:20

constituted 286:21

constructed 265:18

construction 13:1

41:17 45:15 46:13,16

54:17 87:3 93:20 94:5

96:4 99:6 100:14,16

101:8 103:22 111:1

112:15,16 113:10

115:15 205:20 267:21

268:8,13,15 269:12

269:15 270:19 272:2

272:15 274:2,20

290:8 293:4 300:2,3

329:13 330:22 331:21

357:3

consult 341:8

consultant 13:21 14:6

147:20 155:17 157:3

159:2 212:20 215:14

394:7

consultant's 156:17

consultants 202:3

240:18

consultation 223:5

consultations 246:10

Consultative 192:19

consulting 122:10

128:17 136:7 137:10

139:4 209:21 227:12

272:12

contact 187:5 263:12

263:17,20 265:10

266:6 398:17

contacted 197:15

contacts 264:1

contained 226:21 269:6

400:3

containing 263:13

contains 6:12

contaminated 283:1

352:6 401:21

contamination 351:8

406:17

content 155:7 213:7

222:18 223:8 225:12

238:19,20 240:3

244:9 245:1

contentions 154:14

158:6

contents 179:14

context 162:19 169:7

278:5

continually 124:12

continuation 200:18

continue 20:11 28:21

38:21 52:2 91:18

115:2 124:18 181:19

183:9,12 207:4

216:15 276:18 292:1

298:8 318:7 354:15

379:5

continued 93:6 174:9

305:10

continuing 190:2

continuous 130:7

contract 5:1 124:11,17

124:21 131:5 132:4

132:14,15 133:11

179:9 202:2,2 205:15

207:21 216:4 224:5,7

231:14 239:3 240:18

247:1 399:18

contract's 357:14

contracting 128:7

contractor 130:5

136:12 190:1 202:11

202:14 203:2,9 205:7

206:5 209:21 212:20

213:22 215:10 246:11

246:17,17 281:15

330:17 353:10

contractors 131:21

189:20 345:16 357:8

399:16

contracts 232:13 281:9

356:22 357:2

contractual 356:20

contractually 357:12

contradicts 370:19

contrary 340:11

contribute 52:3 64:4

94:20 95:11 186:7

225:20 256:3 321:7

321:16 324:9

contributed 59:19

116:3 217:16 338:15

365:22

contributing 54:2 55:22

60:5 105:3,4 109:8

110:1 264:9 271:5

307:18 316:14 328:9

394:20

contributing-aggrava...

57:6

contribution 61:1,11

63:22 110:3 215:19

235:1 273:6 334:7

contributions 63:10,14

contributory 50:10,21

55:11 115:9 117:13

278:15

control 122:13 128:8

254:12 262:22 299:5

351:16

controlled 266:20

299:12

controls 301:2 394:10

convene 8:18

conveniently 180:3

conversation 24:18

377:12,17 403:19

conversations 23:14

converted 389:16

converter 404:18

407:15

convey 19:2

convince 319:20

convinced 324:13,14

coordinate 346:1

COPD 42:3,3,6 43:9

46:4 47:17 48:6,8,19

49:9,12,20 50:2,10

52:1 55:11,20 56:8,17

56:18,19 57:3,4,15

58:13,17 59:1,3 89:22

90:6,10,12,16,22 91:4

92:12,13 93:5,10,14

94:20 95:20 96:4,7,20

97:19 99:10 100:8,13

103:20 106:4 112:21

114:10 115:16 116:2

116:9,14,18 117:6,13

126:2 134:6 151:1,4

161:15 185:10 239:15

255:20 256:21 258:12

258:14,15 261:22

262:4,8,10 273:11

274:18 279:19 295:4

295:7,7 296:17 297:5

323:2 363:6 375:5

385:5

copies 5:22 14:9

226:21 227:2 356:22

copy 359:13 363:12

373:14 374:3

core 124:14 355:5,6

356:21 359:11

correct 33:9,12 124:9

124:14 169:19 171:18

239:8 248:2 250:4

285:11 389:20

correction 85:10 104:9

correctly 134:17

correspondence 173:8

corresponding 359:3

corroborate 79:18

80:17

corroborated 79:3

146:21 147:3 188:15

285:2

could've 339:14

Council 12:13

counting 322:5

country 49:3 205:21

275:9

couple 4:9,20 20:22

21:5 22:1 26:6 46:10

57:21 83:20 107:17

114:20 120:21 142:21

151:21 154:14 159:6

159:9 183:7 187:2

198:2,3 211:5 218:16

219:3 226:7 228:14

245:11 250:6 258:5

258:17 278:19 284:11

307:7 344:8 352:2

388:15

course 10:12 29:1

84:11 131:3 252:18

306:3 362:6 378:8

388:2

court 392:13

cover 34:13 108:22

112:14 392:8

coverage 195:10

covered 45:9 93:15

188:22 189:4 338:14

356:14 372:9 392:7

covering 298:20

covers 28:14

coworker 169:13 343:4

coworkers 400:6

CPWR 99:5

craft 282:20,21 285:7

crafting 173:11

create 41:12 127:1

278:22

created 26:8 121:18

196:8 222:10

creates 58:8

creating 47:21 48:7

83:14 285:5

creative 299:19

credentials 213:18

214:2

credibility 325:10,13,14

credit 402:20 403:1

cribs 352:20

criteria 57:7 93:8 117:3

123:7 150:5 224:10

224:16 253:21,22

255:14 261:6 271:12

272:10 277:7,9,22

287:3 296:1 302:6,16

302:18 309:10 312:5

312:9 316:10 328:5

333:9 343:16,17

344:9,11 345:6,9
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

417

359:15 369:13 370:7

370:8,11,13 371:2,20

392:13 394:3 401:11

criterion 308:19

critical 23:19

cross 54:13

crosswalking 209:11

crushed 362:16

Cs 231:8

CTH 354:4

cubic 96:18

culture 63:4,7,8 110:5

368:3

cumulative 43:15 59:17

59:18 60:2 94:1,4

96:1,22 98:8

curiosity 236:19

current 12:14 24:22

30:22 31:1 35:15,21

36:4,9 39:8 44:1

51:12 52:2 68:16 91:9

93:8 125:22 126:4

133:8 144:20 223:7

254:5 258:18 277:17

285:14 292:22 304:9

311:13 315:4 325:18

343:16 345:6,9

349:13 350:12 378:8

379:7 385:17

currently 26:13 30:20

35:19 68:9 90:6 93:17

207:6 297:12 300:7

343:12 344:12 356:13

358:14 359:10 388:14

cut 178:11,15 238:7

366:5,5,6,6

cut-off 262:7

cutoff 93:2 115:10

275:16 287:20,21

318:10 321:10

cuts 15:5 168:20

cutting 98:10

D

D 2:10

D'Lance 355:1

D'Lanie 348:7 355:2,3,4

D.C 378:4

d.htm 6:5

daily 43:7 285:8 386:22

damage 58:8 380:20,21

380:22,22

DAR 79:3,19 81:1 149:6

162:13,15

darn 221:18 289:13

data 28:20 40:1 47:13

47:21 50:17 111:21

121:18 123:4,18

165:9 179:1 251:8,20

284:22 285:1 294:11

348:20 352:10 359:3

375:13,16,16,21

376:2 377:19

database 95:9 124:13

211:5 228:17 396:14

396:14,17

date 6:10 115:10

161:18 184:4,4,7,10

184:18,20,21,21

186:1,3,5,5,6 188:11

189:5 196:14 200:2,6

207:2 266:22 275:3,6

275:19 287:21 290:12

308:4 311:7 318:10

318:18 321:10 331:19

371:8 376:11

dates 287:20 331:17

daunting 236:2

Dave 400:7

day 6:19 7:1,13 8:11

10:14,15 14:22 16:12

16:14 85:8 180:18

270:11 388:5

day-and-a- 6:15 8:3

day-and-a-half 5:17

day-to-day 402:2

days 8:8 118:21 251:11

260:3 261:1,20,20

264:21 270:20 271:13

272:2 273:21 274:20

278:12 329:14 331:22

390:8 399:19 404:11

DD 24:19

de-emphasize 64:1

de-identify 194:11

deadline 337:12

deal 15:5,22 16:3,7 19:5

21:21 38:22 117:16

312:1 325:4

dealing 15:6 178:16

206:13 283:14

deaths 361:13

Deb 341:15,20

decade 265:5

decades 47:18 111:20

250:15 269:10

deceased 169:2

December 143:22

144:19 154:6 195:17

394:5

decent 180:2

decide 166:20 286:3

decided 41:11 117:22

244:7 340:15

decides 16:18

decision 121:19 150:6

153:20 158:9,9 163:1

228:20 236:3 238:4

238:12 239:2 251:10

264:11 274:12 373:20

decision- 286:20

decision-making

121:20 122:8 137:11

138:9 139:2 240:3

252:10,19 266:3

decisions 20:12 143:20

325:15 371:7 373:10

373:18,18

declared 259:16

decommissioning

301:16

decreased 300:4,9

385:13

decrements 50:14

dedicated 6:11 368:7

deemed 138:2 266:2

DEEOIC 259:4 340:16

341:8

DEEOICP 138:21

deep 214:17

deeper 137:1

defect 364:2

defend 45:19

define 393:1 395:2

defined 87:5 260:4

307:14 312:5 313:17

357:12 392:9,20

393:2,3 395:2

defines 341:1

defining 389:7

definitely 81:8 116:5

202:19 321:6 383:4

definition 283:17 372:9

395:7

definitions 293:16

definitive 161:21

183:17 263:10 265:8

394:19

definitively 393:5

degree 337:7,9

delay 337:8

delayed 21:2 378:6

delete 86:20 303:10

deleting 332:16

delved 103:7

demanded 338:22

373:7

demands 373:10

demarcation 275:6

276:14 309:12 310:22

Dement 1:15 12:8,8

45:1,8 50:3,4 59:10

59:11 66:13,14 67:3

68:5,6 83:16,17

130:17,18 131:1

168:19,20 299:20,21

demolition 321:2,2

388:16,18

demonstrate 265:7

demonstrated 269:11

demoralized 368:9

denial 145:16 406:2

denied 149:9 150:4,10

151:5 152:10 158:21

217:8 234:21 295:16

338:20 362:16 363:4

363:7 364:17 365:13

365:14,14 367:20

368:1 375:12 405:8

405:13

Denmark 48:17

Denver 19:20

deny 365:2 405:1

department 1:1 4:6,16

5:6 9:4,5,8 10:5,8

18:1 19:7 35:13 79:20

99:4 104:5 113:4

119:1 121:10 122:20

126:11 127:15 128:3

148:7 162:19 170:19

195:8,22 198:4

201:18 206:15 238:1

239:4,5 248:21 250:7

252:16 257:12 259:22

265:21 267:9 268:21

278:3 285:2 337:6,19

339:22 344:4 355:11

356:9,17 357:2,18

358:4,22 359:10

365:9 377:3,18

392:18 396:12

depend 80:18 205:6

296:14

dependent 160:22

221:2

depending 105:16

131:2 134:9 247:1

253:4 269:21 376:1

depends 32:19 283:19

377:4

depleted 366:6

depth 195:9,19 214:16

deputy 18:14

derive 184:19

dermal 352:8

describe 37:5 40:10

41:15 196:9 208:13

described 76:21 333:9

describes 369:7 372:4

describing 196:17

description 8:2

descriptor 243:4
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

418

desert 283:6

deserved 362:6

design 123:8 227:15

400:2 401:5

designated 2:17 4:8

207:2 298:18 318:2

designation 266:1

284:4

designed 351:13

designing 400:2

desk 389:15

despite 150:4

destruction 90:18

detail 39:19 40:4,9,10

40:14 48:21 78:8

80:18 95:13 243:2

255:2

detailed 8:15 40:7

78:11 145:1 401:12

details 35:6 67:22 80:9

313:18 328:2 370:12

determination 113:5

372:14,15

determinations 210:11

determine 76:20 86:4

95:9 145:14 155:16

156:8 158:17 183:16

183:16 230:5 338:14

340:14 372:2,12

374:6

determined 153:18

159:22 160:3 372:6

determines 157:3

determining 103:9

117:12 156:15 295:22

318:19

Deuschle 402:17

develop 45:22 58:16

78:16 95:7 166:15

183:21

developed 38:18 45:4

59:1,3,18 76:18 86:16

87:3 144:14 148:19

151:22 152:4 154:8

155:13 156:19 158:8

160:15 193:20 215:15

223:16 274:21 306:14

344:4 401:10

developing 84:3 128:6

157:17 168:8 253:13

260:12 341:9

development 22:17

59:20 90:17 122:7

135:17,22 139:1

144:9,10 146:3

159:15 173:11 174:4

194:21 228:21 235:11

237:7 357:6 373:19

develops 237:10

306:19 322:22

DFO 4:8 5:5 8:5

diabetes 154:13

diagnosed 11:7 165:6

183:20 185:6 186:2

188:22 190:6 264:10

270:21 271:14 272:3

272:5 329:15 331:22

338:19 339:7,10

340:6,7 344:15,17

360:13 363:22 368:20

371:9 384:12,22

385:5 395:20

diagnoses 148:19

230:7

diagnosing 134:4 222:2

diagnosis 92:12,13

93:14,16 116:2,14

148:17 161:16,18,21

183:18 184:7,9,9,18

184:22 186:1 220:13

233:6 235:8,11

260:10 277:18 278:9

278:16 279:7 287:4

287:17,19,22 327:2,4

327:9,13 339:9 340:8

340:21 343:17 344:2

345:6,9 348:18

364:18 375:14

diagnostic 277:7,22

278:7 369:13

diametrically 160:13

Diane 387:15 395:12

died 361:14 375:7

diesel 48:5 49:20 98:11

difference 226:16 305:6

different 6:22 41:9,10

56:5 57:18 64:1,22

70:1 78:17 79:13

93:12 100:6 108:8,16

109:11 121:15 152:8

152:9 157:9 163:13

168:21 186:5 194:6

205:21 211:10 214:9

214:12 221:15 223:11

223:15 224:1 229:14

242:11 250:11 255:12

257:18 259:8 269:18

271:11 285:11 292:16

296:3 298:4,5 303:16

338:7 344:9,22 352:3

354:9 360:19 380:16

399:18

differentiated 345:1

differently 67:13

differing 216:5

differs 324:8

difficult 218:2 220:16

229:5 253:3 346:4

348:17 368:14

difficult-to-apply 266:5

diffusing 286:1 364:1

diffusion 250:19 251:2

255:6 276:7 399:12

402:7

dig 240:6 353:6

diligent 4:18

dioxide 151:4

direct 38:6,19 39:9 68:1

102:20 382:16,18

directing 383:17

direction 224:1 293:14

299:15

directly 37:22 66:20

78:20 119:20 152:21

168:2 193:12,16

346:6

director 11:16 12:4

14:20 18:14 24:20

153:6,7,8 341:21

405:22

directories 39:22 391:1

directors 175:11

directs 200:16

disability 117:4 161:17

278:22 381:2

disabled 185:12 381:8

381:8,10

disagree 201:8 404:15

disagreement 303:4,5

disappointed 369:21

discipline 236:20

disconcerting 162:14

disconnect 158:16

discounted 53:1

discounts 85:3

discovered 356:11

367:12

discovery 356:16

discuss 16:4,19 53:21

102:17 107:3,10

120:3,6 154:19 172:5

189:16 221:6 244:18

248:15 257:4 274:4

343:15 399:15

discussed 8:3 18:3

30:1 94:13 106:1

114:21 161:10 197:16

247:16 300:8 386:11

404:19

discusses 373:15,16

discussing 81:21 96:1

108:18 154:18 240:10

247:20 337:21

discussion 62:3 68:19

69:16 70:6 71:11,14

72:13 75:14 77:8 92:4

97:6 104:20 106:20

108:13 118:3,9

121:14 139:9 155:7

159:4 181:7,19

183:13 194:4 204:12

218:21 243:20 247:7

247:11 292:1 303:3

308:14 312:12 317:3

318:15 322:20 328:15

332:6 333:16 334:11

347:14 348:2

discussions 7:8 10:16

237:17 396:10

diseases 46:4 50:21

63:20 64:12,14 82:5

99:10 126:3 133:20

257:18 261:18 262:12

267:3,9 269:13,21

278:8 284:16 295:21

297:19,22 306:14

311:1 312:7 323:8

328:10 344:22 392:6

392:8

disorder 368:21 369:3

371:10,12 395:5

disparity 352:22

displayed 386:18 392:7

392:10

disproportionately

387:5

disproves 398:10

disqualified 358:16

disregard 81:9

disregarded 50:19

156:19

dissemination 276:7

disservice 148:7

dissimilar 131:20

distance 200:13

distinct 344:13,22

distinction 24:1 46:13

46:14

distinctions 24:8

distributed 343:19

district 24:14,20 152:8

152:20 154:15,20

159:2 178:8,9 190:16

246:2,21 394:6 406:8

district's 151:1

ditches 352:20

dive 214:17

divide 173:4

divided 228:17 336:8

Division 122:4

DMC 372:10,17 394:17

DNA 283:20
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

419

doable 35:12

doctor 23:15 116:13,16

116:20 117:9 131:19

185:19 189:1 200:17

201:8,8,10 202:19

203:6 237:13 246:18

324:10 363:22 364:17

375:10 382:4,4,11

doctor's 156:11 365:3

doctors 28:4 61:2,8

63:5 64:11 114:12,12

185:4 205:8 365:1,19

382:7,19

document 24:2 30:19

30:21 31:17,22 32:10

52:11 62:12,14 69:8

74:17 79:20 95:12

96:2 144:5 155:9

168:16 215:15,16

228:18 275:13 343:18

344:5,6,9 345:5

349:13 350:12 357:2

369:1

documentation 79:4

80:16 134:10,11

146:20 158:10 172:3

190:4 220:2 272:13

333:12 346:18 357:7

documentations

301:13

documented 92:13

108:9 338:17 339:5

381:1

documenting 364:8

371:7

documents 40:5 61:16

66:10 79:2,22 92:12

143:12 144:22 145:7

145:8,12 146:9 149:6

156:1 159:1 212:3

229:8 236:7 343:7

370:16 385:19 386:18

387:3

DOD 129:14

DOE 10:2 42:11 43:14

43:17 44:3,8 53:19

54:5,7,8,11 55:2,9,9

55:14 57:8 59:13,14

59:21 60:4,9 74:12

75:10 80:16 88:20

103:21 104:10,10,17

109:10 111:16 112:13

115:3 118:2 151:19

189:20 190:1 250:14

259:6 262:16 263:11

265:22 267:11 269:10

270:3,18,19 272:1,2

275:8,13 300:4

307:12 310:8 313:16

314:17 316:9 325:19

326:3,6 327:22

329:12,13 331:20,21

344:7 348:14 350:17

357:5,7,9 358:10,14

358:18 359:2,12

361:4 362:18 403:20

403:22 404:14 405:22

DOE's 356:20 357:10

doing 22:2 25:22 27:15

27:19 28:2 30:5,8

36:21 41:9 45:2 48:22

58:18 78:17,22 101:4

120:20 127:8 129:17

134:15 148:6 157:9

168:17 172:10 230:7

244:11 301:16 315:9

325:21 341:19 342:19

366:12 367:5 375:6

384:7 386:4 387:11

395:10 397:20 399:7

405:19

DOL 3:7 10:13 35:16

38:21 39:16 43:22

78:16 87:5 93:17

113:20 114:12 119:16

123:14,16 127:2,7

128:16 130:4,20

163:16 164:5 179:4

193:21 198:8,10

199:7 200:15 266:18

343:16 344:9,12

345:6,19,21 346:2,6

346:13,22 361:5,8

365:11 370:14 381:12

382:9 383:11 405:22

406:13

DOL's 43:12 128:22

DOL-directed 200:14

dol.gov/owcp/energy...

6:4

dollar 129:19

Domina 2:10 12:11,11

279:10 280:15 281:4

281:5 282:11,19

314:10,12,18 315:18

330:8,9,19

Domina's 293:14

299:16

Don 345:12 348:6,7,10

Donna 391:16 403:13

406:22

door 105:22

dose 96:21,22,22 299:9

310:1,2 323:8,10,11

323:11 358:12 384:17

385:10,12,13 386:1

396:9,10

dosimetry 255:8 293:19

dot 17:9,10 398:13

dots 80:12

Doug 2:19 4:4 9:12

Douglas 3:2

downplayed 358:10

dozens 218:7

draft 31:9,17 33:14,15

33:17,19 35:17,18,21

36:1 44:18 69:20

257:13

dramatically 270:3

275:8 358:9

draws 344:13

drive 207:1

drop 31:1,16 276:1,18

382:10

dropped 149:7 270:4

275:7 276:4 353:12

381:12

DSTs 349:21

due 188:13 278:11

Duke 12:9

dumped 352:6 353:1,4

dumping 404:19

duplication 227:7

duplications 227:1

duration 114:22 115:12

115:21 257:6 261:19

267:2 273:20 339:2

393:14,19,20

Duronda 2:9 13:8

dust 42:4,10 43:15 47:6

47:16,16 48:19 50:11

50:12,13 51:5,19 56:2

82:8 91:2 95:19 96:7

98:4 104:3 108:1,4

115:2,17 286:12

407:7,7,15

dusts 93:1,6 115:4

dysplastic 234:7

E

E 58:3 142:17 144:12

152:3 279:14 280:4

358:13 362:15 373:6

373:11 392:7

earlier 30:18 58:13

66:22 80:2 91:4 115:3

118:12 165:16 179:6

184:8 186:5 208:21

210:17 211:22 237:13

289:6 304:14 320:4

322:4 337:22 359:16

early 16:2 157:19

189:21 237:6 252:14

344:16 355:18 390:8

earmarking 236:6

earn 189:2,3 340:3,10

ease 86:10,17,19

easier 26:20 27:11

40:20,21 111:6

112:11 133:2 278:1

304:3

easiest 172:3

easily 219:19 220:8

246:12

East 11:20 181:12

easy 47:11 55:3 221:14

288:15 302:9 342:8

echo 322:3

edit 118:3

educate 133:19

educated 276:19

education 145:19

180:18

educational 65:7

EE-1 143:1 148:13,14

158:7 167:12 168:15

168:16

EE-3 52:7,20 53:9,14

167:8,16 168:16

EEOICPA 10:5 146:18

355:6 356:15 358:12

358:16 359:1,21

367:17 368:5 405:22

effect 49:5 354:9

effective 164:9

effectively 191:21

effects 58:3 394:11

efficiency 113:20

efficient 211:19 252:20

301:3,4 367:16

efficiently 81:12

effort 223:9 391:11

efforts 4:18 18:12 63:11

eight 19:8 216:3 269:2

313:9 328:18,18

366:3 381:1

either 4:11 59:22 90:17

93:18 104:1 128:6

149:10 150:3 160:5,5

163:18 169:8 191:22

192:7 215:18 228:22

230:16 240:19 253:17

267:21 295:4,17

296:17 323:1 347:22

393:16

elaborate 137:7

elaborated 118:19

257:14 260:1 262:10

elected 387:17

element 136:21

elements 75:6 118:16

126:6 137:2 250:11
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

420

254:3 256:1

Elevated 264:20

eleven 313:9,10

eligibility 358:12

eligible 54:5 108:8

325:2 361:17

Elnora 360:2,4

Elsen 153:7

email 17:3,7 27:16,22

175:5 190:17 198:7

403:19

emails 198:6 404:10

emergency 4:11 13:9

299:1

emphasis 74:8

emphasize 110:2

224:20 254:14 305:9

emphasizes 244:4

emphysema 90:15

empirical 111:14,21

employed 206:22

330:17 360:11

employee 12:12 40:2

153:1 164:13 186:16

340:3 343:12

employee's 293:21

employees 14:20 122:4

129:1 341:21 359:21

368:7

employees' 259:7

employer 404:21

employment 52:10 55:5

58:1 79:21 93:16

104:5 115:9 184:13

185:18 190:1 259:10

310:9

encompass 93:8 293:3

encompasses 135:19

138:10

encompassing 266:12

encountered 361:11

368:18

encourage 6:9 347:19

376:10

encouraged 362:4

encroaches 336:12

endeavors 20:3

ended 124:11,16,22

154:4 401:7

ends 14:15

Energy 9:6 14:20 18:2

79:21 99:4 104:6

122:4 128:22 265:21

267:10 268:21 285:3

341:21 355:11 356:17

357:3,10,18 358:4

359:1,11

Energy's 356:9

energyadvisoryboar...

17:5,8

enforced 51:22

engage 130:4 347:13

engaged 19:4 110:19

engineer 386:16 388:3

388:6 399:13 400:2

401:5,22 402:4

engineering 268:2

357:11 386:15,17

388:6 389:19 396:6

engineers 46:21 386:19

386:20 400:5

enhance 20:5 122:5,8

135:9,12 136:18

137:1,2,4 138:21

139:2

enhanced 128:7 134:21

137:21 138:9

enhancements 20:7

enhancing 20:13

enormous 215:22

ensure 5:14 8:5 32:14

52:18 193:3

ensuring 5:7 359:8

entails 119:22

entered 52:7 200:5

400:19

enthusiasm 19:5

entire 142:6,6,18 143:2

147:7 194:18 195:4

195:12 210:9,10

222:5 224:17 225:3

225:21 226:19 227:5

227:6 236:18 240:16

242:18 244:2

entirely 6:11 133:1,21

221:13 356:11 397:8

entirety 206:12 357:10

entities 205:16 254:14

entity 128:21 325:22

entry 392:4

envelope 60:10

environment 37:15

351:20 366:12

environmental 4:14

11:15,17,19 12:5 13:6

224:9 388:4

EPA 320:6

epidemiologist 10:22

12:7

epidemiologists

132:20 160:9

epidemiology 12:10

136:22

equate 394:15

equipment 180:10

204:21 351:9

equipped 236:8

equitable 155:20

157:13

equivalent 262:21

error 253:6,7,16,17

errors 178:11,15

esophagus 375:7

especially 46:3 63:6

287:5 292:7 407:13

essentially 94:17 254:7

256:21

establish 123:7 371:3

established 54:12

146:19 149:17 151:12

193:15 242:7 284:8

355:10 368:16 369:6

369:9 371:19 372:5,7

establishing 188:20

368:18

establishment 250:18

estimate 38:1,2 115:19

estimates 46:1 385:12

estimating 96:16

et 267:19 268:3 382:12

etcetera 130:1 165:21

ETEC 357:11

ethics 5:14

Eu 360:16 365:21

evaluate 193:1 205:3

evaluated 95:2 149:1

222:18 261:11 272:19

273:7 274:10 334:8

368:11

evaluating 119:21

185:22

evaluation 200:14,17

200:18 213:8 227:15

239:13 244:9 261:12

264:2 272:13 322:9

333:12 338:13

evaluations 195:3

202:17 207:18 293:11

event 116:17

events 25:7 26:1

301:13

eventually 197:7,9

344:17

every-two-year 130:8

everybody 35:10 38:5

41:1 46:16 68:17 73:7

81:20 108:8 141:6

181:15 193:8 212:22

268:1 290:7,11

291:12 315:15 335:12

335:13 343:20 376:10

391:2 395:3 400:21

402:21

everybody's 73:4 76:4

107:11

evidence 3:13 15:10

24:13 80:13 92:4,11

92:13 93:9 102:6

141:3 144:5 145:22

146:20 147:3,4 148:6

148:17 151:9 158:7

158:14 164:7 168:21

168:22 173:3,4,5,5

175:8 180:5 183:10

187:10 188:16,20

208:22 212:2 216:8

260:14 261:14 263:10

263:21 265:9,20

267:10,13 268:16

279:4 339:1,12,14,18

342:13,15 345:7

363:16,17,20 364:7

369:20 370:1,3

evidence- 265:19

evident 338:18

exacerbation 215:19

224:17 240:1

exacerbations 185:9

exact 5:20 32:17 62:6

332:15 335:7

exactly 133:15 180:16

197:1 209:10 237:20

284:1 352:12 378:3

examinations 202:11

examine 262:5

examined 91:6 99:5

122:17 267:11

examiner 38:7 79:10

85:3 92:3 112:22

154:2 170:11,17,21

171:4,6 187:5 233:2

233:22 240:20,21

241:7,21 263:4,7

338:21 339:11,19

342:10 394:6

examiners 24:17 27:5

62:15 63:13 84:21

143:16 152:21 173:20

175:4,15 176:4

228:16 229:2 237:19

278:3 340:18 342:2

342:17 343:1

examiners' 338:13

examining 187:7

example 38:16 43:4

44:15 50:11 77:17

110:13 114:7 132:18

180:8 223:13 237:8

239:19 245:9 346:8

386:7

examples 61:18 170:20

171:1 198:2,3 223:11
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

421

239:20 240:2 255:3

397:17

exams 205:14

excavate 351:15

excavation 351:19

excavations 351:1,2

352:3

Excel 197:10

excellent 226:4 337:4

337:18 367:5

exception 323:21 326:2

exchange 204:5 283:6

346:15

excited 22:8

exclude 59:20,21 75:10

230:10 253:9 310:13

311:3,4

excluded 314:4 315:7

358:5

excluding 311:1 312:7

314:6 316:16 324:17

328:10

exclusion 58:9 64:13

excursion 326:18

excuse 75:7 184:10

216:6 350:11 352:14

361:6 364:3 384:12

exhaust 48:5 49:20

98:11

exhausted 84:14

exhausters 350:16

exist 30:20 112:13

259:6 283:13

existed 356:12

existing 343:7

exists 265:11 300:1

exit 4:12

exits 4:11,12

expand 36:4,12 38:22

210:15

expanded 36:8

expands 110:21 293:3

expect 26:13 250:3

268:14 370:12 379:9

expected 19:7 389:4

expense 206:16

expensive 283:4

experience 36:14 37:1

40:11 99:10 130:2

134:5 157:10 167:16

168:2 189:20 269:16

369:14

experienced 55:1

368:18

experiences 343:2

experiment 14:14

expert 78:10 123:6

386:1

expertise 128:7,7

130:15 131:3 150:11

235:12 236:22 288:4

experts 124:2 176:22

384:20

explain 81:19 90:10

98:22 119:11 176:9

238:2 239:14 330:21

390:19

explained 145:1 337:10

338:8

explanation 50:5 371:5

371:19 385:15

explanations 61:18

72:4 176:15

explicit 123:7 132:17

explicitly 44:21 145:15

exposed 24:4,6 37:6,9

37:10,22 40:14 42:9

48:18 49:22 59:4

108:4 150:19 162:17

162:21 234:17 263:5

284:18 289:3 293:5,8

298:18 301:5,11,20

305:19 325:7 366:15

375:2 376:12 380:11

383:1,5 386:22 390:6

390:17 397:12

exposures 21:8 36:3

37:15 38:15,16 39:18

42:15,20,20 43:17

44:3 47:16,17 48:2

49:12 50:14 52:2

53:19 54:9,20 55:5,14

59:17 60:9 62:7 68:16

71:3 75:9 76:14 93:5

95:19 96:5,12,14,17

96:19 98:7 105:7

108:17,21 115:1,8,17

117:14 124:21 148:22

151:14,16,17,17,19

152:7 167:16 169:6

180:14 223:15 237:11

239:16 254:11 256:6

256:7 263:15 266:15

266:20 275:14 278:15

283:15 293:22 295:13

298:3 300:2,5,10

304:10,13,14 320:20

320:21 321:12 323:2

325:12 355:20 357:22

358:11 359:6 366:19

383:8 387:8

express 4:17

extant 187:9

extend 324:18

extensive 36:20 280:21

389:3

extent 164:8 234:20

248:22 256:5,13

272:21 280:20 296:5

305:6 364:7

external 230:16 293:20

extra 90:18 245:18

324:17 368:10

extraordinary 204:17

extreme 239:19 301:21

extremely 35:7 129:8

260:16 280:9 290:15

F

FACA 5:8 8:1,9,13

face 65:21 84:2,9 86:18

86:20

face-to-face 9:20

facie 102:5 146:20

facilitate 266:3

facilitation 191:14

facilities 101:12 205:14

251:5 259:6 343:5

356:10,18 357:19

358:2,4 359:1 396:5

407:13

facility 93:15 356:14

358:18 404:14

fact 61:1 95:18 105:22

134:8 147:21 148:2

151:12 162:16 164:13

175:6 186:2 188:10

188:12 207:9 214:8

234:6 235:20 250:13

274:22 281:21 284:11

289:10 294:4 305:9

322:5 335:18 373:17

factor 55:11 61:11

252:8 271:4 284:9

307:18 316:14 328:8

385:14 386:6,12

393:3 405:20 406:2

factors 256:15 259:8

394:9

facts 155:15 233:3

264:2

factual 173:3,5

faculty 12:9,21 13:16

213:19

failed 163:20 282:3

failure 282:3 322:6

fair 58:16 113:8 114:1

154:2 251:10 252:5

255:17 261:12 327:17

327:18 374:5 398:7

fairly 41:11 50:11

197:10 209:22 233:12

258:6

fairness 212:9 250:10

250:12 251:19 252:8

fall 19:6 32:4 101:16

123:14 127:13 258:15

275:17 295:7 297:6

341:11

falling 389:15

falls 43:8

false 287:13,13 400:15

401:16

falsifications 401:19

falsified 402:8

familiar 397:18 398:12

families 12:1

family 65:13

far 79:8 103:8 135:16

146:14 166:1 202:9

209:11 247:9,10

380:15

farms 349:21 351:2

352:3,13,16,20 353:5

380:6,10,11

fascinating 18:18

fashion 179:6 211:20

276:21

fast 116:12

faster 27:12

fat 236:13

favor 70:13 71:14 72:15

73:7 75:17 76:11 88:8

139:12,22 140:9,17

310:20 311:5,6

312:16 313:7 317:6

317:15 318:18,21

319:2 328:16 329:5

331:7,13 332:6,12

333:17 334:3,15,21

favorable 313:13

385:20,22

favoritism 382:5

Faye 2:13 11:10 157:22

162:10 167:12 177:4

feasible 41:12 130:1

218:9 226:8

feature 179:14

February 212:19 362:8

362:9

federal 2:17 4:8 5:8

130:11 318:3 345:20

346:7,18 400:18

406:7

feedback 20:18 44:17

65:9 191:2,3 345:8

feel 29:5 45:12 84:21

85:1 116:16 129:7

152:14 160:20 166:1

166:8 222:16 275:16

314:9 320:14 321:13

feeling 154:21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

422

feels 66:8 166:3,10

fell 389:21

fellow 9:2 169:15

felt 45:12 116:19

162:18 163:7 245:16

361:9,19

Ferson 379:22 380:3,3

383:12,14

FEV1 364:3

fewer 95:1,7 252:20

fibrosis 279:1 285:13

286:9 295:5,9 296:7

296:17 297:5

field 282:21 285:7

355:7 357:22 386:21

396:21

Fifteen 140:16

fifth 88:19 228:10

fighting 363:14 381:4

figure 39:2 43:13 54:21

111:7 172:8 225:16

290:4 297:2 388:8

figures 230:9 281:16

figuring 176:21

file 142:6 143:3 147:7

158:12 165:9,10

178:12 179:17 194:18

195:5,12,14 210:16

211:13,15 225:21

226:20 227:5,6

235:22 236:3,19

240:16,22 241:15

242:18 292:14 338:5

338:17 339:21 363:13

363:16 364:8,21

filed 361:1 362:22

363:6 400:15

files 142:18 148:11

155:21 156:2 157:10

157:19 168:14 169:1

179:5,15 204:1

210:17 211:4 212:5

218:3,5,11,12 221:12

226:6,9,12,16 231:3

236:13,13 240:4

245:9,10

filing 148:16

fill 53:11

filter 349:14

filters 349:11,17,18,18

349:22 350:2,2,19,20

350:21

filtration 349:3,5 380:8

final 75:7 113:1 121:12

137:9,11 138:6 150:1

160:7 200:11 218:19

237:18 273:17 334:4

371:7 373:10,18,19

384:15

finally 143:15 161:7,16

185:6,9 253:19

256:12 258:12 273:4

363:3,8 381:16

find 6:16 27:3 49:5 62:6

80:16 84:12 149:21

155:19 164:15 171:11

200:21 201:8,12,13

202:1,10,20,22 203:6

207:3 214:14 215:6

216:9 217:1 224:3,15

265:13 309:18 315:12

344:8 351:8 352:12

389:5 407:19

finding 98:22 148:2

216:7 277:16 342:16

349:10,16 388:18

389:3

findings 147:21 264:4

277:19 372:5 385:13

fine 42:16 78:17 135:18

153:8 164:17 243:11

245:16 296:20 304:5

307:2 309:18 316:7

318:7 329:7 331:6

344:20,21 401:13

fine- 246:6

fined 281:15

finest 350:19

finish 64:20 322:19

finished 162:8 261:4

firefighters 390:10,13

firm 179:10

first 4:5,16 14:19 15:7

16:22 19:2 20:3 34:16

39:17 46:12 47:19

67:16 68:14 83:22

101:3 142:20 143:9

153:4 166:20 177:4

185:14 197:9 202:10

202:13 209:7 218:22

219:14,22 225:4

226:2 247:15 249:21

250:10 259:19,21

267:7 275:7 289:12

303:21 309:2 311:17

316:18 336:18 338:3

349:3 368:11 373:15

374:18 377:10

firsthand 388:13

fit 293:12 395:6

fits 39:7

Fitzgerald 2:19 3:2 4:3

4:4 9:12 335:11

408:10

five 54:4,12 94:1,4 95:1

95:4,7 96:1 97:1,3,22

98:4,5 101:6,22

103:21 104:2 109:4,5

109:11 115:19 185:5

228:7 270:22 271:7

291:11 307:19 311:1

311:3 312:7 313:9

316:15 317:8 319:11

328:10,17 329:6,16

333:18 336:9,13,15

341:5 376:4 383:3

386:14

five- 96:7

five-point 37:21

five-years 101:7

fixed 147:2 283:8

298:21 388:9

flag 180:13 236:16

flare-up 339:12

flare-ups 339:2

flatly 362:15 363:3

Flats 11:6 13:10 107:17

251:1 355:13 387:21

404:1

floor 276:20

flow 247:21

flu 116:15,18

focus 19:5 45:5 64:19

65:5 77:17 84:5 93:7

266:9

focused 193:4 213:1

237:10 379:16

focuses 359:17

focusing 230:6

FOIA 357:1

folder 79:8

folders 145:7 211:11

221:15

folks 314:22 354:3

386:9 387:1

folks' 354:17

follow 64:9 145:11

174:5 196:22 198:15

199:8 292:22 399:22

403:15

follow-up 109:19

128:10

followed 223:17

following 12:2 70:22

214:11 216:10 265:5

377:13

follows 51:3

footnote 94:21

force 25:7,10 129:3

276:9 315:4

forces 268:4

foremost 368:11

forever 298:21

forget 304:19,22 381:17

forgetting 234:12

forgive 355:2

forgot 191:7 402:5

forgotten 254:16

form 52:16 53:7,12 78:1

78:12 167:13 178:6

295:5

formal 8:12 19:7 22:3

30:16 79:7 83:12

162:8 196:7 198:13

199:5 217:14 223:7

244:13

formally 31:14

format 26:16 27:12

174:6 222:18 242:2

formed 249:15

former 10:2 11:10

12:17 13:10 46:15

91:5 99:3 110:14

145:20 146:18,19

155:22 156:3 205:12

267:10,15 343:1

384:9

forming 123:6

forms 19:21 52:19 53:5

124:13

formulate 88:22 89:2

formulating 164:20,22

formulation 104:4

forth 176:10 194:4

327:8 386:13

Fortunately 395:21

forum 19:17

forward 20:1,4,17 24:12

27:6 30:11 31:6 32:4

131:9 132:7 161:2

163:22 164:7 167:2

170:22 192:16 195:1

196:8 198:1,16 221:7

225:1 308:20 322:21

forwarded 210:7,7

223:19,21 403:20

found 6:3 10:4 49:8

82:3 142:10 165:3

209:2,3 218:2 344:20

349:19,20 350:19

351:4 382:11 384:18

385:13 390:7,9

403:12 405:6

founding 337:1

four 15:1,1,2 19:5 34:13

60:17 67:11 73:6

141:21 148:18 152:18

154:4 246:2 270:16

312:19 313:5,7,8

328:17 329:4 333:18

334:16 338:7 341:1

353:16 383:5 384:21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

423

386:13 399:9

Fourteen 140:17

fourth 73:18 74:8 75:11

247:19,21 248:1,2

Fowler 402:18

frame 16:12 32:8,17

163:15

frames 270:2

framework 296:12

frank 253:15,17

frankly 121:17 122:20

125:8 126:3 128:1

148:7 156:17 157:18

161:3 202:15 227:18

252:7 258:14 273:13

325:14

free 29:5 37:6 40:22

67:17 178:6

Freedom 356:22

frequency 37:19 39:20

42:21 43:2,4 68:1

256:11 339:1,16

393:14,17,18

frequently 300:12

356:6

friable 283:7

friction 270:12

Friday 24:14 152:12,19

154:19 160:16 167:8

172:5 190:13,15

219:18 243:14

Friedman- 62:21

109:16 114:3

Friedman-Jimenez

1:17 12:3,4 63:1 76:8

77:9,10 78:13 104:7

104:14,15,22 109:21

183:8 217:5,7

friend 176:6

friendly 87:19 310:13

310:18

friends 400:6

front 162:22 193:8

406:21

frustration 367:20

391:9

FTE 129:22

FTEs 129:9

fulfill 227:20

full 5:16 74:21 111:15

142:3,5 179:17

218:21 240:7 322:8

full-time 125:11 228:3

330:16

fully 126:4 387:1

fume 47:17

fumes 42:4,10 43:16

47:6 48:19 51:5 82:9

91:2 93:6 95:20 104:3

108:2,4 115:2

function 50:15 117:2

178:20 205:1 279:1

280:8,21,22 285:22

347:5 381:6

functioning 194:22

functions 123:22 124:1

127:18 133:7 134:20

135:3,7,16 138:2

141:21

fundamental 110:5

funding 129:22 281:11

fur 60:15

further 20:5 88:5 95:2

104:20 106:20 118:9

119:7 122:22 123:17

139:8 176:1 188:15

190:8 198:19 317:2

324:22 328:15 329:21

333:16 361:7 369:4

379:1 391:4

future 310:6 337:11

fuzzy 66:20

FVC 364:2

FWP 147:1

FYI 39:5

G

gall 230:8

gallons 352:17,21

353:3

gap 256:18

gaps 145:8

Garry 2:11 12:16

330:20

Gary 18:14 399:3

gas 42:4 43:15 47:6

51:5 82:8 95:19 104:3

108:1,4 349:8

gaseous 250:19 251:2

255:6 399:12 402:7

gases 42:10 48:19 91:2

93:6 115:2 352:4

404:18

gasification 355:10,16

355:21 356:6,9 357:5

358:1,15 359:5,14

gather 23:6 342:21

gee 150:17

general 30:11 58:1 61:7

87:15 93:21 144:21

151:15 155:8 157:15

158:11 159:4 174:19

175:16,20 202:9

233:18 266:20 268:7

269:9,10 270:1 276:8

290:9 326:4 346:3,9

346:11,13

generally 57:1 96:13

133:2 277:19 298:9

299:4

generated 48:5,6 402:7

generic 30:1

gentleman 381:16

George 1:12,17 12:3,21

218:18

Georgetown 13:16

getting 39:11,19 44:19

64:5 65:9 92:18 116:9

116:9,10 155:18

161:4,5 164:18

185:11 191:2,3

221:11 225:22 232:5

279:21 280:8 299:16

309:17 326:22 327:5

331:16,18 342:16

344:19 363:3 380:1

383:17 391:21,22

406:19

give 32:17 38:16 47:9

47:13 56:17 118:4

129:18 192:10 230:1

242:2,12,13 267:6,7

335:7 345:3 381:19

404:17

given 57:5 125:16

143:18 145:3 154:21

180:8 205:3 212:19

239:10 251:20 275:19

275:19 310:5 324:2

346:10 357:20

gives 15:1 92:5

giving 49:17 80:19

291:9 335:17 360:7

363:9

glad 18:19

glioblastoma 154:13

goal 222:7

goodness 406:4

Google 6:5

gotten 125:7 224:1

230:15

gov 17:9,10

government 178:14

198:7 206:18 400:19

government-owned

357:13

graduate 176:12

grandfathered 251:2

grateful 161:2 196:1

greater 263:3 264:21

349:12

greater-than-low265:7

greatly 171:17 340:18

Greg 268:21 407:2,3

grew 90:1

Griffon 1:16 13:19,20

13:21 14:2,2,5,5

70:17,19 71:17,18

72:18,19 75:21,22

88:13,14 126:16

131:16 140:6,11,14

193:9 196:4,9,17,20

196:21 198:17,22

204:7 208:6,15,16

291:18,19 302:2

313:2,3 317:12,13

319:5,6 328:20,21

331:10,11 332:9,10

333:21,22 334:18,19

grinding 98:10

grossly 385:16

ground 283:12 353:12

366:1

grounds 352:7,9 353:1

353:5

group 3:19 15:5,19

19:21 25:7,10 49:11

95:18 114:9 129:11

130:10 132:16 144:8

164:1 209:3 212:2

249:14,15 258:20

286:15,16 295:21

297:15 320:16

groups 45:5 77:17 84:5

135:14 224:14 292:11

292:12 293:7 337:3

386:20 390:8

growing 50:6,17

guess 4:15 15:11 45:19

73:8 105:14 113:8

138:8 143:3,13

168:14 210:12 211:21

212:7 231:17 241:5

248:5 291:14 319:16

324:16 329:11 351:8

385:3

guidance 22:15,17 62:6

215:15,17 224:19

257:12 337:6

guidances 214:12,13

guide 144:11 392:4,10

403:14 404:6 407:1,2

guideline 344:2 382:6

guidelines 51:13

134:13 263:22 285:14

H

H 2:12

half 6:16 7:13 8:4 84:13

227:3 360:10

halved 275:11
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

424

hammer 64:5

hammers 389:9

hampered 358:11

hand 70:14 71:15 72:16

75:17 76:4 88:8 121:4

124:6 139:13 199:20

238:12 309:14 312:16

317:6 318:22 319:9

328:17 331:7 332:7

333:17 334:15 391:16

391:17,18,21 395:11

403:13 406:22

handed 401:4

handful 48:9 114:10

handle 110:1 292:6

handled 194:9 208:13

360:19 404:17

handling 360:15

hands 70:15 71:16

72:17 75:18 76:5 88:9

139:14 199:3,4

245:11 312:17 317:7

317:17,20 319:1,10

328:18 331:8

handsomely 279:5

handwritten 220:17

Hanford 1:11 11:10

12:12 25:2 250:22

267:19 269:1,4

282:19 314:16 343:13

343:14 345:16 355:12

384:9 387:20 396:1,7

397:5 399:14

happen 27:7 158:22

166:8 194:20 371:14

happened 79:13 146:1

203:14 215:2 281:12

294:9 339:16

happening 145:10

196:2 282:14,15

301:14 320:21 339:13

339:17 402:16 406:14

happens 28:1 32:7

103:9 175:20 199:9

289:8 314:16,20,20

happy 40:15 44:21

61:17 220:20 401:5

hard 5:18 9:13,17 19:3

28:16 80:4 98:9 99:21

105:1,7 171:10 178:4

216:8 230:5,10 238:9

240:6 258:21 288:15

374:3 378:11,12

hard-copy 236:13

harder 44:4 63:8 288:12

harm 324:17,18,21

Harvard 49:11

hate 405:10

Haz-Map 124:13

hazard 39:18 269:8

398:14

hazardous 36:3 180:13

359:2 402:8 404:18

hazards 41:14 68:16

351:16

head 13:6 190:17

heading 6:2 82:15

heads 160:18 231:4

245:11 390:11

health 1:3 4:7 6:6 8:20

11:3,4,19,20 12:12

13:4,21 14:6 26:10

63:9 143:1 179:22

201:9 224:11 236:22

259:16 337:13 343:13

343:14 348:12 351:3

351:5 361:8 395:6

healthcare 202:18

203:16

healthy 117:2

hear 8:22 13:22 14:3,19

15:7,16,20 17:16

140:11,14 177:11

219:6 254:2 255:20

342:18 386:9 390:15

391:20

heard 28:9 65:2 132:22

146:14 202:7 211:22

223:11 257:19 338:6

342:1 363:2,3 377:17

hearing 20:17 255:21

345:14 356:4 363:6

384:7 400:20

hearings 237:18,19

366:8 399:9 404:7

heating 407:16

heavy 344:18

held 294:4

Hello 336:19 360:4

391:18

help 21:15 23:11 24:10

27:5 41:22 44:22 81:8

96:11 131:8 132:6

136:12 164:5 166:14

170:8 171:17 175:2

179:1 191:20 195:1

205:3 206:14 218:13

226:14 245:7,19

261:9 338:1 361:22

362:20 363:10 365:9

376:7 381:8 382:2,5

382:16 383:16,17

391:8 400:9 401:6

405:12

helped 4:20 151:7

354:4 365:10,11

helpful 10:4 21:16,22

24:19 31:13 35:7

36:19 37:2 45:5 80:12

80:21 81:2,11 138:2

209:6 216:21 245:12

346:22 398:6

helping 36:22 169:18

174:22 367:10

helps 36:15 37:14 38:1

81:6

HEPA 349:3,5 350:2

hesitation 58:21

hey 171:22 396:13

406:2

hi 13:15,20 355:4

376:17

hidden 217:2

high 51:12,20 93:4

253:8 258:9 277:9,13

283:5 299:9 390:9

high-level 353:2,4

higher 96:15 112:6

216:12 268:7 392:18

highest 250:20

highlight 194:16

hinder 167:2

hinging 246:1

hire 131:22 228:11

245:7

hired 195:10 213:15

315:5 396:2 400:2

hiring 224:5

histories 227:8

history 22:9 34:11,17

35:16 36:5,10 40:2,8

40:17,20 42:19 44:7

47:10 52:17 55:6,10

55:12,15 56:12,12

57:2 59:6 61:6,14

63:2 73:10 74:12

77:21,22 78:11 81:15

82:1 88:20 90:2 94:8

95:17 97:16 103:1

104:17 108:3 147:1

167:9 171:16,21

188:5,10 259:15

353:13

history's 65:13

History-wise 352:11

hit 108:5

hold 19:19 68:18 69:15

107:2 309:1 336:13

holding 308:7

holds 323:9

hole 238:5

home 26:10 200:18

201:9 202:12,18

203:4,16 207:17

314:13 315:18

hone 244:20

honestly 221:17

honorary 141:10

Hook 402:13

hope 20:16 207:4 345:4

354:15

hopefully 22:21 26:4

34:3 85:7 159:3 245:6

260:16 270:13 272:21

hoping 160:16 309:15

hose 380:13

hospital 117:1 204:20

hostile 368:4

hosts 269:1

hour 16:11 84:13

232:15

hour-and-a- 7:12

hour-and-a-half 16:14

hourly 215:8

hours 181:13 216:3

269:2 376:12

House 1:11

housekeeping 4:9

HPs 292:11

HPT 348:12

huge 111:18 129:15

216:2 226:16 322:15

340:1

Human 337:13

humidity 350:15,15,20

350:21

hundred 217:22

hundred-page 122:18

hundreds 218:7

hurt 324:22

hybrid 245:4

hygiene 12:9 15:17

37:17 95:3 127:19,21

128:19 136:20 192:19

264:1

hygienist 23:17 44:16

66:18 77:20 79:9 92:2

92:7 95:8 147:15

148:1 149:11,15

150:7 159:22 166:11

174:17 193:2,15

195:3 211:9 233:20

234:14 240:17 242:13

253:1 261:8 265:12

272:11,21 274:11

289:13 294:10 333:11

hygienist's 160:6 264:2

hygienists 23:18

119:17 122:11 132:21

136:8,15 139:5 152:9

175:5 210:1 227:12

351:18 353:15
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

425

I

IARC 259:18

idea 35:15 40:18 41:13

47:16 69:5 73:14

129:2 135:6 159:12

167:3 171:3 231:4,9

232:4 234:1 245:17

246:4 293:15 303:19

342:20 343:3

ideal 158:16

identical 165:4,5

identified 37:4 123:15

251:5 299:11 324:2

identifies 188:10 353:8

identify 84:2 120:22

123:10 236:9 299:8

340:16 351:13 384:3

identifying 184:3 214:1

309:12

idiopathic 296:7

ignorance 168:17

ignore 117:7,8 365:2,4

ignored 366:14

ignoring 64:10,14

276:12

IH 3:16 142:7,11 145:13

147:6,14 151:8

159:19 162:15 165:1

196:11 208:6,18

209:15,15,18,20

210:4,8 219:15 222:8

222:12 225:4 227:14

228:19 241:18 242:9

246:8,9 262:5 264:13

284:8 293:11

IHs 179:16 242:17

252:4 292:11

ILD 323:1

ill 200:20

illness 14:21 122:5

190:7 256:22 264:10

360:12 365:22 369:8

369:9,12 372:4,9

illnesses 99:9 288:11

356:2 361:13

ILO 285:20

imagine 193:6 295:15

383:15

immediately 283:8

imminently 316:11

328:4

impact 31:21 96:6

193:13 280:22

impactful 379:13

impairment 26:10

229:17,18 279:16,21

280:9

imperfect 45:21

implement 73:5 122:20

123:8 379:2,5

implementation 12:2

19:15 286:3 378:16

379:6

implemented 44:11

45:6 122:21 147:9

377:2,11 378:2,13,20

379:10,16

implementing 65:7

123:16 126:12,12

340:17 377:8 395:1

implications 297:3,8

implied 392:18

imploded 281:16

imply 379:8

import 270:11,11

importance 39:17

important 37:13 54:20

66:15,16 84:1 105:5

118:16,20 125:8,22

133:18 134:8 155:18

171:13 211:8 254:7

261:8 275:20 304:12

309:11 342:18 369:14

importantly 56:1

impossible 99:13

impressed 296:5 384:6

improve 20:11 35:14

128:18 152:17 225:17

266:9 345:9

improved 177:9,20

improvement 38:14

128:13

improvements 20:10

171:16

in-person 202:6 203:1

inability 186:8

inadequately 368:9

inappropriate 153:18

inappropriately 405:13

inception 19:4 177:19

inches 407:7

incident 289:9 339:5,8

incidental 264:5,14

incidents 397:15

include 8:2 44:3 67:19

92:22 95:19 104:5

105:20 119:18 127:19

135:14 233:10 278:21

311:3 330:4 371:21

373:12 389:9 390:1

included 51:16 62:18

75:6 93:1 107:21

112:16 115:4 118:17

123:2 194:1 209:15

268:19 274:2 370:13

386:18 387:4 389:11

includes 35:8 41:17

73:6 108:20 110:22

127:20 224:11 293:18

including 9:8 46:20,20

46:21 62:8 75:8 94:1

94:4 105:2 109:7

118:1 126:1 135:19

137:13 168:16 264:4

270:3 321:18 324:17

355:12,22 402:17

incoherent 21:14

incoming 242:21

incomplete 238:21

355:15

inconsistencies 157:5

164:19 386:8

inconsistency 217:9

252:6

inconsistent 21:14

371:15 373:9

incorporate 27:12 30:6

123:3 300:12

incorporated 27:10

254:22

incorrect 238:22

increase 356:1 385:8

increased 286:13

incumbent 186:16

independent 224:6

407:14

index 228:18

indexed 228:21 242:20

242:20 243:1,3

indicate 121:4 240:22

indicated 80:2

indicating 19:11

individual 10:2,16

37:10 38:15 48:2

84:13 87:12 95:3 97:4

109:1 122:9 138:9

139:3 144:2 157:14

157:16 162:12 164:4

188:20 197:14,16,22

212:7 221:4 267:18

284:12 290:4 294:11

294:19

individual's 207:17

individually 97:19

261:6,11

individuals 4:20 99:8

131:8 203:16 301:11

346:16

industrial 12:9 15:17

23:16,18 37:17 44:16

66:18 77:19 79:9 92:2

92:7 95:3,8 119:17

122:11 127:19,21

128:19 132:20 136:8

136:15,20 139:5

147:14,22 148:1

149:10,15 150:7

152:9 159:22 160:5

166:11 174:17 175:5

192:19 193:15 195:2

210:1 211:9 227:12

233:20 234:14 240:17

242:13 253:1 261:7

264:1,2 265:12

272:11,20 274:11

289:12 294:10 333:11

351:17 353:14

Industries 344:5

industry 10:9,9 48:16

49:3 121:10 300:3,3

inexplicably 368:22

infection 395:4

infections 185:11

infer 237:1

infirm 206:13

influence 153:19 387:5

inform 4:15 122:9 137:9

139:3

informal 212:21

informed 200:4

infrequent 264:5,14

ingesting 339:5

ingrained 63:3

inhaled 47:16

inherently 21:14

initial 19:8 83:10

148:15 167:10 211:15

245:5 259:2

initially 153:12

initiated 197:3

initiation 270:22

injured 11:11 380:15

injurious 290:14

injury 306:13 348:18

392:4

inorganics 354:11

input 23:17 31:11 35:7

35:11 43:12 45:13

125:3 150:11 161:11

162:5 248:22 342:17

inputs 19:22 20:8

inserted 404:9

inside 129:3,20 131:4

insight 336:22

insignificant 264:15

284:2,5

insinuates 372:1

insisting 363:17

Inspector 346:3,9,10,12

installation 300:5

instance 54:3 87:13

150:16 174:17 184:9
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

426

254:4 256:22

instances 149:8 150:2

Institute 122:16 123:19

145:18

instructed 61:2 263:14

264:13

instruction 261:13

instructions 6:17 7:2

262:14 335:2,7,17

361:5,7 362:11

insulation 320:9

insulator 277:11

insurance 382:9

intaking 25:11

integration 357:4

intended 367:18

intense 256:9 401:11

intensity 38:2 39:20

intensive 238:8

intentions 176:19

interacting 128:16

interaction 127:1

interactive 7:4

interest 147:15 398:3

405:1

interested 83:20 87:2

193:18 209:4 232:11

256:5 335:14

interesting 55:8 146:17

148:12 191:17 358:19

385:11,18 399:10

Interestingly 143:9

interfere 90:19

interim 19:10 21:4,4

intermittent 299:9

320:21

intermittently 304:11

internal 79:4 127:5,8

137:12 198:6

internally 128:6 130:2

130:16 210:3,22

International 259:17

355:12

International's 357:3

interpret 83:11 84:18

interpretation 83:10

242:16

interrelated 376:21

interrupt 336:14 341:5

interrupted 15:13

interstitial 286:10

297:22 298:9 322:16

323:1

intertwined 193:5

interview 167:7 176:12

193:16 204:21

intimate 388:17

intriguing 65:6

introduce 13:14 257:4

introduced 270:7

introducing 313:13

introduction 144:3

introductions 10:18

intuit 379:11

invasive 339:15

inventories 396:20

investigate 388:9

investigation 323:14

388:17 400:17 401:18

402:15

invite 18:5

invited 17:22

involved 54:20 63:13

191:16 264:16 301:9

403:4

involves 105:6

involving 125:22

260:20

IOM 21:12 129:12

ions 354:10

IR 323:16

irrational 160:14

irrelevant 56:20 59:5

63:19 64:7

isolated 101:14

issue 7:19 15:5 45:9

53:18 54:1 60:5 61:15

64:19 76:13 78:20

87:6 104:20,21 106:9

123:12 129:15 131:2

136:10 146:8 148:21

161:7,22 162:7 166:2

166:18,19 180:9

184:3 187:3 189:9

199:6 205:1 250:10

257:7 261:4 274:16

281:13 298:4 302:5

303:6 351:11 392:16

393:11 405:20,21

407:1

issued 355:18 357:7,16

issues 4:15 10:3,11

16:1,1,3,6 18:7 28:19

29:22 30:1 110:4

114:22 125:17 153:1

168:22 197:22 198:5

199:14 203:20 226:6

253:3 265:15 285:15

312:2 337:10 338:1

341:9 349:4,16

367:15 370:5 399:13

399:22 400:10,12,22

issuing 341:9

it'd 249:18 326:16

it'll 27:3 352:18 353:11

397:3

item 75:8,11,11 179:8

247:16 269:9

itemized 333:14

items 4:9 87:12 197:21

236:16 266:8 333:10

iterative 83:13

IV 355:13 356:13

357:19 358:7 359:7

375:8

J

James 2:12 11:5

January 270:20 307:15

308:10 313:19 316:12

318:9,21 328:6

329:14 332:17 340:6

375:9

Jenkins 402:17

Jerison 341:15,16,20

Jerry 379:22 380:3

Jill 376:16 379:20 384:3

384:4

Jimenez 62:22 109:17

114:4

Jimmy 400:6

job 41:4,6,6,8,9 53:10

98:18 103:22 108:7

111:1,19 112:2,5,6

119:21,22 150:4

152:22 169:4 171:22

181:16 211:3 226:3

230:13 255:8,9 256:8

257:6 260:5,7 262:3

274:1 293:1,2,21

294:13 298:16,19

315:14 341:19 351:6

351:7 375:6 376:13

377:18 386:12 387:6

387:7,12 391:8

393:16,19,20

jobs 54:18,18,20

104:17 228:3 260:19

282:22

John 1:15 12:8 45:1,7

51:4 402:18 405:14

joining 7:2

Joint 19:20 25:6,9

Joleen 153:6

Jolene 24:19

Judge 406:8,9

judged 316:13 394:8

judging 252:16 314:15

judgment 256:2 273:1

judgmental 148:9 157:7

165:12

July 142:1

jumping 35:21

justified 52:10

justifies 273:2

K

K 1:20

keel 288:22

keep 5:20 9:17 18:22

23:9 27:2 33:21 69:10

69:11 87:8 107:6

375:11 381:7 397:9

keeping 9:14

keeps 30:21 236:10

Ken 11:18 129:8 298:15

Kennedy 374:14,15,16

374:17 376:3,9

KENNETH 1:16

Kentucky 401:21

kept 286:6 344:19

363:17 397:14

Kevin 5:1 34:10 85:15

85:22 98:20 120:19

122:12 127:10 192:17

249:14,21 333:4

Kevin's 120:20

key 127:8 236:16

318:18 374:8

Kick 306:9

kicking 306:11

kidney 106:4

kidneys 380:20

kin 169:3

kinds 153:11 222:3

223:14

Kirk 2:10 12:11 293:14

299:16 399:14 401:14

402:5 404:15

knew 128:15 142:19

236:18 347:12 362:12

365:13 401:2,17

405:16

knocked 116:18

knocks 298:19

knowing 186:17 187:3

361:21 375:22

knowledge 126:5 276:8

283:18 325:15

known 97:18 123:5

146:4 151:2 271:21

356:12 357:11 372:19

372:19 381:1 388:21

knows 78:10

L

lab 360:14,17 366:10,11

380:9 396:3,5

label 269:7

labor 1:1 9:4,8 10:5,9,9

35:13 91:11 92:6,8

93:18,21 94:5,10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

427

101:20 102:1 104:9

113:5 119:1,18

121:10 122:21 126:11

127:16 146:11,12

162:19,20 167:17

198:4,18 337:6,19

339:22 341:3 344:4

359:10 365:9 377:3

377:18 392:18 396:12

Labor's 4:6

labor- 238:7

labor-intensive 129:8

laboratory 147:16

223:14 355:7 357:22

360:18 366:2,9

labs 389:16

lack 167:1 199:4

lagging 289:7,13,18

389:21

laid 133:1 179:7 289:1

land 181:15 357:9

landfill 400:3,3 401:20

401:22 402:2

Lang 153:5

language 31:1,2 54:2

81:14 83:2,12 85:14

85:16 118:13,14

119:4 120:7 124:10

124:14 137:22 139:19

170:1,14,15,18 171:1

191:16 248:6,10,13

293:11 303:2 318:20

340:11

large 49:22 95:18

210:21 214:3 223:5

226:15 227:19

largely 45:14

larger 96:22 297:21

larynx 258:7 271:10

273:19 329:17

late 183:6,7 281:8 282:7

391:22

latency 59:16 256:12

256:19,21 257:8

260:9 261:2 262:9

267:2 274:5,8 304:10

304:13 305:18

latest 134:14

Laughter 17:20 34:6

70:11 99:15 138:18

143:6 177:7,12,15

178:1 187:19 189:12

201:6 314:14

Laura 1:20 3:11 45:16

122:14 149:19 322:12

Laurie 12:19 17:16

124:5

law 12:1 147:22 180:3

340:12 369:7 370:4

373:8 394:22

lay 316:4

layer 188:9

laying 127:18

layperson's 174:2

lays 134:20 372:8

Lea 374:15 376:15,17

lead 175:5 276:16 326:2

leaders 400:9

leading 176:7 184:17

184:20 400:7

leads 152:5,11 165:7

leaps 177:10,20

learn 87:10 179:12

343:1 369:22 403:2

learned 189:19

learning 354:18

leather 103:10

leave 67:10 105:16

138:12 173:21 179:12

206:6 244:3 249:20

303:1 360:12

leaving 229:1 388:12

led 184:12 402:15

left 138:17 183:10

185:16 189:22 288:8

288:10 359:1 360:17

left-out 285:5

legacy 349:4

legal 57:5 372:8

legally 163:19 172:14

legislation 341:1

Leist 387:15 395:12,14

395:18

Leiton 3:8 14:19 17:19

17:21 18:8,9 29:10,17

30:2 31:4 32:1,9,19

33:1,17,19,21 34:2,3

60:20 62:10 69:17,19

70:4 79:15 124:9,16

172:20 175:3 176:17

177:13,17,21 188:17

188:18 189:11 193:19

199:2 201:19,21

203:18 205:6 207:7

208:3 228:12,14

230:3,14 241:14

242:7,10 243:15

246:14 337:10 338:7

347:22

lends 251:22

Les 11:1,2 109:3 163:11

169:18 292:4

LESLIE 1:17

lessen 252:22

let's 17:16 32:5 59:12

59:17 64:3 75:1 76:15

81:22 101:3 106:19

106:20 116:1 138:8

183:3 185:7 248:16

248:17 276:1,3

291:15 292:1 306:21

310:17,19 313:15

318:7,8 328:15 329:9

331:13 336:17 340:5

395:2

letter 170:6 173:11

174:5,7 215:9 228:21

361:3,4 362:7,9 363:6

375:18 384:15

letters 170:17 173:10

173:19 176:19 177:8

177:18 178:7 222:17

223:6 224:18 339:21

346:14 347:4 369:11

letting 226:10 294:10

341:17

level 58:9 96:5 103:8

167:22 193:20 194:3

195:9 215:18 216:11

263:8,8,9 265:8

283:17,18 284:1,5

294:11 303:20 306:15

342:17 393:9 403:21

leveled 283:12

levels 234:21 262:18

263:6 271:22 326:18

Levin 9:7 121:6 376:7

Lewis 268:21 407:2

liaison 5:5

library 124:12 173:8

licensed 403:15

life 349:13

lifetime 59:19 96:19

lift 300:5

lifting 22:16

likelihood 277:15

322:12 327:5

limb 403:9

limit 135:1,6 136:7,13

291:10

limitations 132:5

limited 261:14 323:22

348:20

limiting 136:6 138:1

limits 396:10

line 54:19 131:11 138:6

160:20 179:20 243:4

291:16 309:12 344:13

344:20,21

lines 311:3

lining 258:1 271:20

link 38:6,11,20 39:9,22

82:11 171:7,11 295:6

356:3

linked 38:13 255:10

linking 82:5 103:20

links 6:22 123:6,9,11

124:20 125:4 126:1

Lion 1:11 25:13

liquid 360:15

list 21:12,15,20,20

22:15 26:2 27:15 36:3

36:5,8,12 37:1 40:19

40:21 41:12,16,16,20

42:19 71:1,3,4 98:18

107:22 108:12 110:9

110:10,10,12,16,22

111:7 112:7 114:12

143:11 167:15,16

219:17 247:11 260:5

260:5,18 262:3 263:2

263:19 264:21 265:2

265:4,17 266:11

292:22 293:1 355:15

366:19 370:8 374:20

385:4 391:1 392:4

listed 146:13 148:13

150:5,9 355:17 392:3

397:1

listened 22:6 23:13

361:15

listening 219:12 374:9

403:7

listing 137:18 138:3

lists 36:15 146:14

170:14 372:5

literature 93:9 95:9,17

96:10 115:18 125:13

151:11 325:21

little 14:12,15 21:13,16

23:20 31:15,15 32:12

47:10,13 53:22 58:20

81:10 95:15 103:5

107:2 128:4 141:8,22

147:11,12 163:13

169:5 172:16 176:5

179:13 180:10 183:6

183:13 194:17 196:18

199:22 209:2,9

212:17 214:22 223:1

228:1 231:15 234:1

235:15 245:18 264:19

274:15 282:1 289:11

291:10 292:15 304:21

338:1 352:22 362:14

live 281:7 292:18

302:21

liver 380:20

lives 236:15

living 25:4

lo 401:15 404:8

loading 163:1
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

428

local 204:19,20 205:13

locally 201:8 206:14

located 357:6,8 358:6

location 259:10 356:12

locations 258:5

Lockheed 399:16,17,19

399:21 400:5 402:1

402:10,13,14 404:20

406:1,5

logic 141:17 153:16

155:13

logically 57:13

logistically 9:15

logistics 5:3

long 23:12 26:18 59:15

73:3 78:5 108:5 116:4

124:3 161:14 217:21

225:22 226:12,21

227:3,8 241:17

243:10 256:4 290:13

349:12 371:11 372:6

391:22 402:5 403:5

406:11

long-term 54:9 364:19

369:1 371:11

longer 14:16 16:10,10

16:13 40:19 91:1

188:12 283:13 325:1

362:20

looked 35:17 46:2 48:9

48:14 58:2,2,3,4

61:16 62:5 65:16

68:11 79:8 97:1 114:9

114:9 115:17 143:2

143:13,13 152:6

185:8 205:5 210:19

213:10 217:8 231:3

235:1 246:2 275:17

278:20 280:12 288:22

320:1 352:2 382:7

396:22

looking 23:9 24:12

25:21 27:2,6 48:15

52:14 58:11,19 61:14

70:14 83:18 84:16

96:4,5,9 99:18 110:18

115:15 127:20 142:13

148:20 163:16 165:3

169:10 173:14 181:16

205:2 213:11 214:10

215:3 216:7 221:21

227:20 230:12,21

231:7 233:9 235:7

243:20 247:13 255:19

258:14 306:18,19

320:3,15 329:11

343:6 348:22 352:5

354:14,16 397:9

403:11

looks 47:7 81:15

110:10 171:4 243:13

252:16 259:3,12

291:21 351:19 389:1

Lord 381:4

Los 11:22

lose 185:17

losing 78:6

loss 161:17,21 183:15

183:17,18 184:4,12

184:13,19 189:16

255:21 337:22 338:2

338:5,12,15 340:2,14

340:21 356:4 372:4

392:4

lost 188:20 364:20

lot 25:16 26:20 27:18

28:18 38:19 40:14

41:6 48:21 62:10

95:13 106:3,5 112:14

113:3,4,15 156:5,12

158:3 165:7,8 169:13

186:20 208:21,22

209:21 218:13 229:5

233:12 235:9 236:22

237:9 250:13 252:10

252:11 286:12 292:12

294:8 305:9 313:22

314:17,22 336:11

340:14 346:14 351:2

353:13 354:3,17

377:14 380:12,14,21

381:22 382:16 387:18

389:8 390:14 396:15

400:10 403:10 405:16

lots 48:2 49:20 157:9

197:4 229:15 396:2

love 44:11

low 50:9,12 103:8

234:22 253:10 263:6

263:8 265:6,18 266:2

278:12 283:17 284:1

284:5 285:22 321:17

321:19 322:14 326:18

364:2

lower 49:13 250:21

275:4 277:14,16

306:16 321:12 327:6

342:17

lowering 275:6

Lucero 406:13

luck 260:12

Luckily 234:18

lucky 157:22 234:20

lump 222:7,16

lunch 15:13,17 105:15

180:20

lung 15:21 50:15,21

63:6 90:20 117:2

133:20 178:22 220:13

237:9,11 255:13

257:20 258:1,2 261:1

271:9,20 273:18

277:11 285:15 286:10

295:3 296:16 322:16

323:1 324:5,8,9

327:13 329:17 356:7

364:1 365:2 367:9

370:5 394:14

lungs 360:21 364:5

375:5 380:16

lymphoma 125:4,17

154:10

M

M 1:15 2:9,11

ma'am 154:1,1

machine 295:13

machining 296:5,8

407:20

machinist 386:14

machinists 296:8

mail 361:9

mailings 25:22

main 310:8 380:5

maintain 349:6 350:13

maintained 121:18

353:9

maintenance 45:15

54:17 93:20 94:6

100:15,16 101:9

103:22 111:1 112:15

112:16 268:2 269:12

270:19 272:1,15

274:1,20 282:20,21

290:8 293:4 329:13

330:11,14,16,16,21

331:2,3,6,21 353:20

388:7,11 389:7,8

390:20

major 45:13 50:20 63:3

90:22 91:1,1 178:22

323:4 331:1 345:16

majority 52:8 203:21

358:6

making 27:6 30:13

40:18 69:22 123:2

131:6 147:20 153:20

163:2,8,18 174:3

219:2 221:12 225:2

284:18 286:21 325:11

325:14 335:14 372:15

372:18 378:10 402:6

Malcolm 9:6

malignancy 258:3

malignant 271:19 272:5

309:21 312:8 314:6

316:16 328:11 332:2

man 375:5 401:1

manage 98:12 179:11

Management 376:18

manager 345:15 386:17

389:19 400:5 401:22

402:1,3 403:22

managers 401:12

managing 319:21

mandated 393:13

manner 294:12 301:16

340:15 367:16

manual 26:9,14,15 30:7

62:2 143:10 257:10

259:3 338:8 340:17

341:11 345:6 369:4

369:17 370:19,22,22

manuals 209:12 338:10

338:10 392:20

map 220:8,11 240:22

353:8

mapped 241:15

mapping 241:6

maps 36:21 241:7

March 340:7

margin 276:2 320:19

Marietta 399:21

mark 1:16 13:18,20

14:1,2,5 53:6 140:6

140:16 196:21 208:11

208:16 212:15 216:19

375:6 400:11

Mark's 219:14

Martin 399:16,20,20,21

400:5 402:10,13

404:20 406:1,6

Massachusetts 176:8

Massey 400:6,7

Master 12:17

mastics 389:4,4

match 212:4 370:21

material 19:13 36:11

37:22 242:8 266:7

270:13 369:17 401:22

materials 5:22 6:12,14

36:3,9 37:4 41:14

42:13 50:16 67:21

68:9,16 79:12 141:16

141:18 143:8 144:1

161:4 224:20 263:13

263:18 300:6 320:7

339:6 353:19 359:2

370:6

mathematically 63:18

matrices 15:8 122:17

123:3 168:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

429

matrix 93:2 97:20 98:8

343:5 355:14

matter 10:15 16:20 48:4

48:6 74:20 79:6 85:4

89:12 151:11 181:21

234:6 246:20 291:1

293:6 294:17 324:20

328:2 336:2 350:3

351:20,21 406:10

408:12

matters 8:3

maximum 329:6

McConnell 406:16

MDS 384:22

mean 35:7 39:10 41:4

56:11,14 57:17,22

61:10 64:8,9 69:4

80:14 83:4,9 84:12

102:7,9,16 103:3

112:18 128:21 132:12

133:18 148:18,19

166:9 168:6 169:2

175:16 177:10 185:1

185:21 194:3 203:19

215:2 216:2,15

221:19 228:4,17

230:10,11,14 232:17

234:2 241:6 242:18

243:9 246:20,20

282:12 286:7,8

288:10 292:14,21

295:11 304:10,16

315:8,11,14 318:10

322:7,19 324:7

327:15 384:20 389:2

397:8

meaning 28:4 160:9,10

378:17

meaningful 228:9

367:16

means 46:18 135:13

137:1 178:21 288:1

292:15 313:12 325:1

meant 46:22 85:12

119:10 194:5 276:9

401:19

measure 368:15

measured 96:17

mechanism 27:8

medically 138:7 163:18

339:18 364:19 394:8

medicine 10:21 11:14

11:15,17 12:5,6 13:3

13:17 37:12 122:17

123:19 124:12 126:22

127:14,17 128:2

129:4 136:21 195:8

237:14

medium 220:20

meet 24:15 57:16 91:22

94:16,22 101:7 117:3

168:10,11 220:5

261:5,10 272:6,10

300:15,20 308:19

316:9 322:6 332:3

333:9 359:15 370:12

394:2

meeting 1:5 4:5,19,21

5:4,11,22 6:10,12,13

6:18 7:11 8:2,7,19

14:12,13,16,17 16:8

16:13 19:19 20:17

22:13 26:3 34:4 61:17

103:6 118:18,21

121:14 126:20 142:1

142:2,3 143:14,21

144:15 155:1,1

180:12 195:21 200:13

208:9 221:4,6 240:10

249:16 266:17 277:3

359:16 405:15 408:11

meetings 5:12 6:2 9:18

9:20 14:13 18:1 19:16

22:7 132:6 142:1

198:3 367:7

meets 103:10,10 113:9

253:20

megaliters 352:18

MEK 397:19

Melissa 5:1

members 1:13 7:18 9:3

9:3,9 10:4,10 13:13

14:8 24:15 76:2,11

81:16 89:16 118:18

125:10 133:6 139:12

139:21 140:9,16

141:9 159:10 180:22

181:11 183:5 190:13

192:6 193:7 336:20

341:17 345:13 348:9

membership 224:11

memo 254:10

memorandum 21:7

212:19

memory 36:19

meningioma 154:11,12

234:3,6,13,16

mention 4:10 22:5

27:14 46:9,17 191:2

295:20

mentioned 21:1,5 96:11

115:3 149:19 161:15

195:7 202:21 210:16

212:2 255:5 385:21

404:6

mentions 78:2

mercury 380:12 383:2

merit 122:10 127:6

137:10 139:4

mesothelioma 258:3

260:11 271:10,19

272:5 273:15,20

285:15 287:6 310:3,9

310:14 311:4,14

312:8 314:4,6 316:17

321:7,11 323:10,20

324:5,7 328:11 330:2

331:14,15 332:2

met 1:11 5:9 168:11

195:17 220:3 399:14

405:14,14

metal 12:13 98:10

103:10 286:12 296:9

319:22 320:8,12

350:7 352:5

metallurgical 360:18

366:1,9

metals 296:10 360:19

365:21 366:7

metastasize 234:8

meter 96:18

method 123:8

methods 276:9

Mexico 406:13

Michael 403:16,18

404:7

microglobulin 380:18

mid 15:22

mid- 275:21

mid-'90s 275:5,13,22

276:5

middle 40:1 101:13

215:4,11

mile 368:10

miles 200:19 202:1,5

military 13:4

milligrams 96:18

million 65:12 129:19

352:17 353:3

mind 23:9 33:21 77:12

77:13 78:16 107:11

128:13,18 196:17

278:6 305:1 381:6

394:17

mind-numb 238:10

mindful 5:21 7:1

mine 50:11,13 98:21

345:17

mines 255:16

minimal 264:7 323:11

minimize 394:10

minimizing 327:8

minimum 43:21 54:4

227:7 267:1

minister 381:5

minute 196:16 291:9,22

minutes 8:1,5,7,12

84:14 183:7 216:2

240:11 250:6 258:17

290:20 291:5,11

336:9,13,15 341:6

408:5

miscellaneous 16:1,6

mislead 268:10

misled 368:1

mispronounced 355:2

missed 176:4

missing 142:19 170:10

171:6 178:22 319:14

mission 227:20 367:17

missions 179:22

Missouri 350:18

mixing 354:6

mixtures 38:15,17 39:1

model 343:4

modern 289:16 369:13

modern-day 372:3

modest 269:19 271:22

modification 357:4

modify 79:16 85:5

240:14

modifying 302:13

moment 76:15 128:15

247:20 250:1 274:4

monetary 362:12

Monica 403:21

monitor 315:11

monitored 293:18

294:5

monitoring 37:17

145:20 255:8 284:12

284:22 285:1 294:2

294:11,13,15,21

298:16 299:3 315:9

326:9,11,12,15,17

monitoring- 326:16

monolog 274:15

month 340:4,10

months 188:11 198:2

206:10 379:7

months' 396:11

Moore 384:5,6,8 387:11

moot 78:22 393:10

morning 4:3 8:22 11:9

14:18 15:9,20,22 16:2

16:5 18:7 66:4 121:14

141:5 183:10 248:9

250:5 262:1 408:8

mother-in-law 381:9

motion 69:13 71:6 72:7

75:13,17 77:2 87:21

138:20 139:6 204:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

430

308:2,2 318:11

328:12 329:20 332:5

333:15 334:12

motions 316:20

motive 129:3

move 17:16 23:20

43:13 53:17 66:1

73:21 76:15 89:17

132:7 140:22 141:1

161:2 170:22 175:2

190:9,21 192:20

204:6 225:1 240:8

249:13 280:15 282:10

293:13 316:21 329:9

331:13 333:5 379:21

moved 31:6 32:4 64:21

69:14 71:7 72:9 77:4

88:1 139:7 308:11

318:12

movement 200:8

moving 20:1 30:11

121:12 167:2 195:1

199:7 252:20 260:22

322:21

MSA 343:12

MSDS 398:14

multiple 58:4 73:19

76:19 77:12 85:20,21

86:9 151:17 153:1,3

154:10 364:21

multiplicative 56:4

multiply 112:5

multitude 195:19

Murphy 404:2

Murray's 9:10 121:3

mute 132:9

muted 7:5

myelodysplastic 385:2

N

Nabulsi 18:6

name 4:4 46:9 192:11

337:1 341:20 343:11

345:15 347:1 348:10

355:2 360:4,16 367:2

376:17 380:3 384:8

named 272:9 333:8

names 174:19 205:18

206:1

narrative 77:21

narrow 21:15,19 93:8

233:4,13

nation 402:22 406:18

national 124:11 205:22

246:11,15,16 252:4

342:3

Nationwide 25:1

nature 21:19 55:6 78:7

116:6 239:22 259:6

323:21 340:19 393:7

393:7,8,14,15,15

naval 288:20

near 202:11 255:15,15

necessarily 49:1 81:17

94:7 145:17 194:2

212:4 243:1 265:19

346:5

necessary 44:18

143:16 146:4 164:6

197:12 201:17 203:1

203:21 226:11 233:10

237:4 239:1 264:7

necessitated 356:18

need 15:15 16:3 18:4

27:9 28:22 29:4 44:5

46:8,8 53:14 55:21

56:6 66:9 68:19 69:12

85:13 88:22 89:1

96:20,21,22 101:15

102:11 104:2 106:11

107:22 109:6 113:17

124:15 125:8,8 129:2

129:10 130:15 134:8

134:12 136:1 143:4

149:17 157:5 159:10

160:14 161:11 164:6

166:14,20 172:2

173:5 174:1,7,14

176:1 180:20 188:15

192:5 195:4 199:5

207:11 215:21 220:5

222:20 227:16 228:11

233:4 235:21 237:14

245:17 256:13 258:22

261:11 262:1 265:8

277:5,6 287:20,21

288:13 290:4 299:22

300:21 308:2 315:16

315:17 324:9 329:7

330:1 332:18 335:3

370:2 378:19 381:7

382:3,5,6 383:12,16

387:8 405:3 406:2

needed 65:19 66:3

124:2 133:7 145:1

163:21 173:6 176:10

212:10 213:2 261:7

361:5 405:4

needing 342:14 383:16

needs 131:2,3 198:13

217:13 222:4 224:6

281:21 337:16,19

342:18 400:21

negative 59:6 76:7,9,10

254:2,3,8,9,15 308:20

negatively 76:12

negatives 287:13

neglected 38:5

Nelson 9:6 121:6 348:1

376:7

neptunium 360:16

nerve 380:22

nested 298:6

never 58:4 145:16

151:4 156:1 158:22

175:18 220:18 270:9

305:1 318:3 338:5

363:13,15 372:22

381:21 386:5 388:21

389:4 392:19 393:9

401:2

nevertheless 194:10

223:18

new 10:22 12:6 26:6

30:8,18 31:2 38:4

40:15 73:13 81:15

82:4 83:2 85:14 108:2

123:10 179:9 257:13

269:15 278:5 315:5

322:12 331:1 371:15

386:2 400:2 401:20

406:13

newfound 127:7

newish 82:5

news 179:8 308:18

402:10 405:10

nexus 135:21 149:14

157:4

nice 43:5 179:13 200:21

200:22 268:20 286:3

347:4 381:16

nicely 269:6

night 168:11,12 181:14

nine 313:9

NIOSH 61:5 197:5,9

198:1 211:11 343:7

354:4 355:18 357:16

392:3,9 404:6

NIOSH's 211:2

nitpicking 327:1

nitrogen 151:3

noes 313:8,10,10

non 237:2

non- 50:15 268:14

274:9

non-construction 87:4

non-DOE 94:1,4 105:2

105:6,8,20 106:10,13

107:13 108:13,19

109:7 110:1

non-exempt 153:1

non-identifiable 165:21

non-malignant 255:12

258:2 277:5 320:11

Non-problem 189:13

non-production 284:7

284:14,14

non-rad 351:7

non-searchable 218:12

non-specific 277:10

Nope 70:8

normal 280:7,18 301:16

notations 214:22

note 5:17 7:3,14 9:1

145:6 229:15 370:15

406:21

noted 125:10 147:5

237:6 262:1

notes 194:1 236:15

373:17 387:16

notice 362:1 399:7

noticed 338:9 401:10

notified 403:9

notorious 402:18

NRC 129:13

nuances 238:13

nuclear 337:2 348:12

355:5 401:1 402:19

403:14 407:12

nuisance 51:19

number 51:15 57:15,16

59:14 60:13 68:8

87:12 96:12 106:10

111:18 112:5,6,21

163:17 169:22 187:6

187:6 209:22 211:7

217:8 219:20 238:2

239:20 240:15 245:14

245:15,16,17 249:4

257:18 262:12 265:15

269:9 278:14 297:22

322:15 323:22 335:17

347:2 355:22 376:22

380:8,9 381:3 389:20

394:9 396:4

numbers 6:21 271:18

numerous 16:16 125:3

385:19

nurses 175:11

nursing 381:10,13,14

nut 305:5

nuts 194:8

O

o'clock 335:1 336:7

408:9

O-F 3:1

Oak 9:22 145:18 180:11

293:18

object 106:16

objectivity 193:3,13

227:11,21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

431

observation 345:17

observed 125:20 212:5

obsolescent 306:5

obstacle 340:1

obstruction 372:12,13

obstructive 90:12

126:2 273:5,9 334:6

334:10

obtain 55:4 342:3

obtained 76:20 86:5

356:21

obvious 404:22

obviously 8:15 100:15

178:9,10 185:22

242:12 256:4

occ-doc 153:21

occ-docs 160:9

occasion 195:5 203:5

occasions 81:2 207:19

238:2

occupation 21:21 81:5

296:6

occupational 10:21

11:15,17 12:5,20 13:3

13:6,17 14:20 21:18

22:9 34:11,16 35:16

36:5,10 37:12 40:2,7

40:17,20 44:6 49:8,14

50:20 51:4,7 52:17

55:6,13 56:12 57:10

58:15,17 59:7 63:9

64:14 73:10 74:12

81:15,22 82:1 88:20

90:1 94:8 95:17,20

96:19 97:16 101:16

103:1 104:17 108:2

112:8,12 115:5 122:4

126:22 127:6,14,17

128:2,15 133:20

136:20 142:22 147:1

156:22 167:9 171:16

171:21 190:7 195:8

224:9 225:13 237:14

256:15 367:9

occupational-based

48:13

occupations 110:9

263:1 397:1

occur 256:17 258:4

274:13 300:11 301:18

occurred 26:3 54:11

305:15 328:5

occurring 304:11

occurs 121:20 256:15

321:11

OCR 220:19

October 9:21,21 26:4

202:4 203:15 337:9

403:18 404:7

Off-microphone 138:14

318:5

offer 336:22 341:2

offered 378:21

offhand 242:8

office 9:7,10 10:12

18:15 24:14,20 32:5

101:14 121:3,7

145:10 151:1 152:20

153:7,14 154:15

181:15 190:16 204:19

209:5 246:3,12,16

362:19 376:6 389:17

400:18

officer 4:8 13:5 179:9

officers 5:2

offices 152:8 154:20

173:4,6,22 178:8,9

246:2

official 2:17 318:3

387:17

officials 5:13 400:19

offsite 351:21

oftentimes 174:2

367:18

OHQ 36:4 37:7 39:8

42:8 43:16 44:16,22

46:6 52:20 53:3 64:19

65:6,14,17 66:19

68:10,16 76:18 78:22

79:2,6,16 86:15 88:17

94:2,13,15 97:21

101:21 102:5,10,18

103:14 104:18 105:8

145:13,19 147:3

149:4,5 155:10 156:2

158:13 180:9 359:18

old 116:11 288:21

389:16

ombudsman 9:7 10:12

195:22 348:1

Ombudsman's 121:7

376:6

once 32:9 103:6 112:14

118:3 180:21 203:14

244:18 312:1 339:17

370:10

one's 25:15

one-to-one 10:10

onerous 147:10

ones 16:11 113:2

134:22 162:12 210:19

213:14 223:7 257:19

377:2 388:12

Ong 374:15 376:15,17

376:17

ongoing 124:1,3 125:8

125:15 128:13 131:7

132:15 197:3 223:7

244:22 295:2 298:22

online 143:12 194:19

222:10 244:2 247:7

onset 184:11 186:4

187:8 256:15 260:9

271:14 272:4 332:1

open 19:17 30:14 69:16

71:10 72:12 97:5

105:21 126:14

open-ended 110:13

opening 5:12

operate 301:15

operating 400:14

operation 357:4

operationally 131:9

operations 5:9 356:17

357:18 358:10 359:2

359:12

operator 388:7

opine 210:9 264:6

opinion 56:2,18,21

111:12 148:5 149:11

149:16 156:6,11,13

156:18 157:1 164:22

199:11 202:4,6,17

203:1 207:18 212:21

236:17 239:8 261:15

305:6,12 313:13

315:15 372:18 386:4

406:11

opinions 164:20,22

203:15,20,22 395:3

opportunity 7:15 10:14

18:11,19 38:21 42:17

125:21 172:16 174:3

174:16 175:4 336:21

355:9 359:4,19 360:7

opposed 88:10 139:15

160:13 317:16,18

319:8 329:1,1 334:2

opposite 149:13

optical 218:10 226:12

option 262:4 342:14,22

options 138:11 185:21

207:6

oral 17:2

order 9:15 39:12 54:5

162:6 164:6 168:12

175:1 210:20 227:20

228:4 239:17 244:15

258:19 261:3 266:9

300:20 303:20 311:8

337:17 379:15

ordered 363:12

orders 206:18

organics 354:11

organization 210:15

259:17 395:6

organizational 126:21

216:20

organizations 224:13

organized 179:6 210:22

211:19 218:1 229:3

241:8

organizing 181:8 211:4

219:1 221:12 225:2

organs 392:9

original 242:16 250:17

251:3,16 254:22

257:6 293:17

originate 184:20

OSHA 262:20 275:10

392:12,12 403:17

ought 55:12,18 258:15

outcome 51:15 108:19

150:20 151:2 255:12

371:16

outcomes 46:2 214:10

252:15

outgoing 242:21

outlined 359:16

Outreach 19:21 25:7,9

outside 14:10 43:17

44:3,8 53:19 54:8,16

55:4,5 58:1 59:12

73:10 74:12 75:9

76:14 88:20 104:5,10

104:17 117:15 118:2

118:2 135:14 136:11

136:12 141:19 143:10

151:19 153:19 156:6

156:17 193:21 284:17

346:1 351:3

ovarian 259:13,15,21

260:10,12 261:4

262:7 323:9,9,12,15

324:1,3

ovary 258:8 261:19

271:9 273:19 329:17

overall 61:19 115:4

206:20

overburden 238:9

overcome 340:2

overdue 349:15

overestimated 385:16

overlap 209:2 220:22

221:7 285:12 286:22

overlapped 181:6

overlapping 98:3 127:3

overlooked 214:21

overly 47:7 368:4

overnight 16:4 226:11

overriding 406:14

oversee 128:17
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

432

overturned 113:3

OWCP 127:15 128:3

346:8 393:11

ozone 354:10

P

P-R-O-C-E-E-D-I-N-G-S

4:1

p.m 7:6 181:22 182:1

183:2 291:2,3 336:3,4

408:13

pace 378:13 379:7

Pacific 1:11

package 224:20 244:19

247:10

Paducah 267:19 293:17

399:11,12,22 400:9

401:3 402:7 406:5,14

407:21

page 6:11,12 220:14

226:22

pages 114:13 147:15

157:21 158:2,3

210:18 214:20 217:22

218:7 226:21 231:16

paging 218:7

paid 25:1 207:9,10

214:15 232:15 340:9

373:1 382:9 406:16

pains 239:14

paint 368:5

panel 123:6,21,22

Pantex 26:7

paper 264:18

paperclips 236:16

papers 213:20

paperwork 381:11

383:9

paradox 358:19

Paragon 35:22

paragraph 159:21

160:13

parallel 297:5

parallels 387:19

parameters 394:21

paraphrase 394:4

Pardon 199:18

parent 132:14

parenthetical 106:18

Parkinson's 151:10,13

parse 146:7 235:12

part 15:21 16:1 35:1

39:21 40:1 43:14

50:20 55:1 58:3 60:14

60:22 61:6 63:4 73:2

79:15 90:4,16 94:15

97:19 102:21,22

105:8 109:7 113:4

121:19 123:22 124:13

142:17 144:12 152:1

152:3 155:15 157:19

160:12 163:20 166:2

167:10 189:17 203:17

203:18 214:9 233:16

241:22 251:19 255:8

257:14 266:20 270:7

273:8 276:18 279:14

280:4,4 290:17

297:21 315:14 334:9

337:14 343:7 351:18

358:13 361:2,18,18

362:5,15 363:4

368:19 370:1 373:6

373:11 379:3 386:21

392:7

partially 131:4,4 296:14

Participant 17:9 71:7,9

72:9,11 77:4,6 88:1,3

91:12 139:7,18

144:10 172:17 181:1

206:3 308:12 316:1

316:21 317:1 318:12

318:14 335:5,8

participate 84:15

participating 2:21 6:17

6:20

participation 7:20

213:19 408:8

particles 50:8,18

particular 9:16 10:16

51:15 77:19 106:21

113:16 127:22 128:21

132:19 135:7 149:1

152:1 202:5,17

210:20 211:14 214:14

216:11 220:9 224:7

230:4 234:10,18

236:7 239:15 271:18

278:8 290:10 345:21

particularly 54:17 78:3

94:22 109:4 116:8

149:20 178:21 179:15

200:20 227:7 231:6

231:15 320:2

particulars 87:10

particulate 48:4,6 49:12

350:3 351:20,21

particulates 50:8 51:18

286:12 349:7

parts 127:2,7 230:11

293:20

party 190:3

Pasco 25:13

pass 383:22

passage 12:1

passcode 335:20

passed 127:3 252:21

paste 178:11,15

pat 220:12

path 344:19

pathognomonic 327:12

pathology 280:17

patient 188:6 322:22

patients 133:22 322:16

pattern 59:16 256:14

403:12

Pause 72:14 97:10

333:2

pay 177:6 207:8,12,13

222:4 232:19 369:14

paying 326:19

payments 215:7

PDF 26:14 30:8 53:12

210:21 218:3,11,12

236:12 242:22 243:5

PDUs 357:6,12

peace 394:17

pedal 103:10

peeking 388:13

peer 123:10 392:11,13

peer-reviewed 213:20

peers 127:2,7 128:16

pencil 390:4

pending 122:22 197:21

people's 36:19 55:10

189:22 336:12

percent 267:12 268:9,9

350:15 364:3,4 381:2

384:19 388:1

percentage 267:20

perception 166:5

358:10

perfect 254:18

perform 133:7

performance 284:19

performance-based

281:8

performed 9:13 40:6

41:18 213:8 259:9

period 6:18 7:6,9 10:1

15:14 16:9,17 17:6

18:4 94:3 97:22

101:22 115:9 161:14

183:17,21 256:16

259:8 276:17 291:9

308:10

periodic 29:13,18

244:21

periods 98:11 326:9

permanent-type 132:3

permit 351:18,19

permitted 400:8 401:20

permitting 400:10

person 58:12 59:17

77:20 94:9 118:19

119:20 121:11 126:22

138:16 150:9 151:18

156:3,20 161:20

163:18 164:4 171:8

186:2 188:7,11 189:2

203:22 205:3 230:7

234:19 256:4 289:5

294:13 324:14 340:5

345:17 372:16 375:15

388:7 389:15

person's 60:3 146:12

202:12 203:4 230:9

personal 40:3 58:17

151:19 164:22 180:10

283:20 339:20,20

personally 56:13 199:5

226:6 304:21 338:15

374:22 388:1

personnel 196:1 223:4

284:13 285:4 330:17

persons 101:15

perspective 213:3,11

224:12,12 231:13

239:4

pertaining 141:16

pertinent 163:9 235:7

235:10

Peterson 345:11,12,13

345:15 347:12,16,19

348:3

petitions 251:17 337:14

PFP 388:16

PFT 178:19 364:2

PFTs 372:12

phase 354:12

phase-in 276:17

philosophy 394:16

phlegm 90:18

phone 13:13 16:21 17:3

70:16 175:6 181:2

192:7 193:9 196:5

335:16 347:1,2

374:16 379:21 384:4

391:1,17 395:17

398:22 399:4

phones 7:5

phrase 128:14 201:18

293:18 305:13

physical 383:8,8

physically 89:17

physician 10:21 11:15

12:20 13:3,17 92:11

127:6 128:16 134:10

156:21,22 157:3

166:10 185:21,22

186:9,19 187:7,14

188:9 191:19 193:2
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

433

195:2,10 211:9

231:14 246:13 265:13

272:12,22 274:11

283:21 372:1,14

physician's 93:14

339:20

physicians 63:2,12

65:8 122:11 128:17

132:20 134:2,14

136:8,15 139:5

175:10 191:15,22

202:14,15 203:10

205:13 225:13 227:13

230:16,17 231:6

245:7 264:6

physicians' 339:21

physics 13:21 14:6

348:12 351:3,5

physiology 283:20

pick 220:19 235:13

245:9,14 313:20

316:1 322:20 327:4

picked 113:6 154:15,20

154:20 278:14

picking 266:21

picture 123:5 218:4

268:19 269:5,5

piece 65:7 102:19

137:11 138:8 193:5

212:16 215:13,21

230:4 232:10 240:5

244:6 259:2 286:6,19

pieces 179:1 194:7

211:14 216:21 252:21

PII 163:5 373:16

pile 216:18

pilot 77:14,16

pink 311:2

pipe 289:10 298:20

pipeline 351:14

pipelines 353:17

place 115:3 165:12,12

178:16 201:22 204:18

270:5 294:14 298:17

299:1,11 300:6 301:3

320:22 349:11,14

350:18 392:17

places 100:7 389:4

plan 17:6 105:9 107:20

108:7 351:6

planner 282:19 388:4,5

planners 351:12

planning 25:22 282:22

plant 269:14 293:20

363:16 399:12 400:14

400:16 401:3,10

402:8 407:6

plants 250:19,20,21

251:2 255:6

plaque 279:19,21

plaques 278:20,21

279:5 285:16 310:1

322:13 327:11

plausible 79:22 146:5

play 113:14 166:21

178:6 227:19

played 264:18

player 127:8

plays 387:5

please 4:12 7:1,2 29:4

60:19 88:8 139:13

140:2 162:10 192:21

193:10 318:22 335:15

335:22 346:16 371:21

pleased 20:2 370:4

386:8

pleasure 18:10

plenty 47:21

pleura 258:1,4 280:17

pleural 257:22 271:8

273:17 278:20,21,21

279:5,18,20 280:7,16

281:2 285:16 310:1

320:13 322:13 327:11

329:16

plutonium-238 374:22

plutonium-239 375:1

plutonium-240 375:1

ply 236:19

PM 368:21 371:4 372:5

373:10

pneumococcus 365:20

pneumoconiosis

285:12 286:2,7,14,16

287:1 295:9 297:12

297:15

pneumonia 117:5

221:22 340:5

pocket 392:3,10 403:14

404:6 407:1,2

point 6:21 17:11 23:8

25:9 41:1 45:10 48:1

51:3 52:5 60:12 61:12

66:14 67:12,16 68:6

68:14,15 73:9,18 74:9

74:13 83:5 84:20 85:1

105:1,10 106:17,21

109:17,19 112:18

114:8 116:19 117:14

120:21 121:9 133:10

143:4,11,15 148:20

151:11 161:9 166:19

167:7 174:16 184:1

185:18 186:7 188:13

188:18 196:6 198:8

199:13 208:12 209:7

210:5,14 221:3,20

222:14 235:18 248:20

267:5 287:11 292:21

299:14 303:3,4,5

319:20 322:13 325:8

338:22 351:1 361:19

363:19 402:6

pointed 180:12 220:2

295:6 396:12

pointedly 237:19

pointing 288:8

points 67:12 73:4,6

114:21 208:21 209:1

222:15 228:15 302:19

poker 113:14

polices 338:9

policies 30:22 31:2

122:7 125:22 126:4

135:17 136:1 139:1

258:19 276:3

policy 22:14 26:2,6

27:20,20,21 29:19

30:3,4,7,11 44:2 62:4

82:4,5,13,14 162:3

193:20 254:5 264:17

275:12 292:8,22

340:9 368:21 371:4

371:15,18 373:17,21

373:22 374:1,2,4

392:20 395:1

policy's 82:15

politely 381:16

political 403:10

politicians 403:1

politics 403:4

pollution 49:11,13

ponds 352:20

poor 240:2

poorly 218:1

Pope 2:9 13:8,8 141:10

164:10 207:5 232:21

235:16,17 301:8,9

popular 257:11,11

population 48:20 49:2

99:11

population-based

48:15 49:21 96:10

populations 305:10

portfolio 252:4

portion 162:15 207:12

369:11

Portsmouth 293:17

position 104:21 164:21

166:1 375:9

positions 125:11

positive 20:17 253:20

positively 102:2

positives 287:13

possibility 264:6

354:10

possible 4:21 7:10

31:19 32:16 44:9 67:7

85:15 99:16 123:9

125:3 134:1 136:2

173:13 203:5,5,11

207:20 243:2,12

279:16 324:1 337:20

378:10 394:7

possibly 236:2 297:4

337:15

post 294:3 310:11

post'95 266:18,19

post-'86 265:1,8

post-1986 262:16

266:14

post-1995 254:10

post-2005 287:17

post-93 371:20

post-95 21:7

post-Cold 294:9

Post-It 236:15

postponed 122:21

potential 19:15 20:6

172:1 262:17,18

263:2 265:5 324:21

355:22 357:21,22

393:4,6 394:9

potentially 263:5

264:19 299:9 389:14

power 350:13

PowerPoint 208:5,9

PPE 180:13 394:11

practically 117:4

practice 133:21 202:9

276:6 322:21

practices 212:6

practicing 133:19

pre- 287:17 306:12

310:10

pre-1993 369:5 370:7

pre-2005 303:7 305:16

pre-93 368:22 371:3,5,8

371:14

pre-op 230:8

pre-populated 172:13

pre-two 308:9

precede 184:18

preceding 208:5 237:6

precipitating 116:17

precise 266:22 275:3

precisely 335:3

precision 280:6

precluded 153:2

precludes 147:20

predict 41:7

predicted 48:19 60:8
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

434

364:3,4

predictive 46:2 50:2

predictor 59:6

prednisone 364:9

predominant 320:8

predominantly 134:5

prefer 137:3

preference 303:17

prepare 8:5 291:5

388:18 395:19

prepared 8:2,13 248:6

preparing 4:18 5:3

preponderance 180:5

prescribing 201:9

present 42:3 76:2 89:8

105:11 115:10 139:12

139:21 140:16 161:10

192:7 252:13 289:2

292:6 294:19 295:3

312:19 317:9 319:11

356:6

presentation 3:7 103:5

107:10 159:8

presentations 25:16

34:9,12

presented 39:1 185:14

presenters 6:15

President 401:8

President's 401:8

presiding 1:12

presumably 184:12

presume 94:9 185:18

presumed 94:6,18

115:8 271:1,15 272:6

293:7 307:13,16

332:3

presuming 265:16

presumption 42:3,5

43:10,19 54:4,12 55:2

56:5,8 57:17 89:22

90:7 91:22 93:12,13

94:12 95:5 96:13 97:3

98:15 100:8,13 102:9

103:20 105:21 108:6

109:1 111:17 113:7,9

114:1,8 117:21

121:16 151:13 251:11

251:18 252:1 254:6,8

254:9,15 258:15

260:2 261:6 272:17

274:10 284:17 286:8

286:14 290:1,2

292:13,17 293:6

295:8 297:5,6 300:13

300:14,19 302:6,14

302:20 308:21 321:13

322:6,7 324:19 328:2

331:15 394:2

presumptions 3:19

15:7,19 20:6 22:9,13

22:17 24:1,3,5 30:20

33:8 95:13 113:21

125:20 146:15 151:6

159:14 249:13,22

250:5,8 251:21 252:6

252:9,18,22 253:2,4

253:13,20 254:2,4,21

255:4 257:13 258:14

261:9,10 266:10

273:8 287:12 292:4

297:20 298:5 299:22

316:8 329:10 334:9

386:13

pretested 86:9,14,17

pretesting 87:11

pretty 28:17 36:20

50:19 56:19 68:11

84:14 90:20 91:4,4

92:19 97:2 205:13

211:3 216:22 320:18

321:19 327:12 396:13

prevalence 326:5

prevalent 305:9

prevented 190:2

previous 9:20 16:10

18:1 71:2 75:2 188:6

219:8 275:17 318:20

385:12,15

previously 16:11

193:14 194:13 360:13

prided 176:8

prima 102:5 146:20

primarily 59:13 83:20

primary 358:7 384:10

prime 330:17 392:17

principal 250:12

principle 324:20

print 53:12

prior 7:8 75:9 91:10

92:1,21 123:13 142:1

161:21 183:17 188:16

251:11 255:7 260:8

264:22 265:17 270:20

271:13 272:2 274:3

277:3 307:15 313:19

316:12 321:3 328:6

329:14 332:17 340:20

341:9 368:21 369:3

370:18 373:9 376:12

380:9 389:14

priorities 32:14 33:2

358:21

prioritize 379:12

privacy 198:5

private 179:10

Probability 384:19

probably 6:7 23:5 56:17

68:7 74:15 77:20

78:14 87:11 91:7

96:15,21,22 102:16

105:15 112:13 116:21

138:10 187:6 189:15

205:7 225:21 236:14

245:1,18 247:3 248:9

249:18 275:22 282:11

296:2 305:8 323:4

324:14 326:1 399:20

400:14 404:1 406:22

probative 156:8,16,18

373:9

probe 209:4

probes 350:16,21

problem 135:15 139:19

178:14 189:11 214:7

214:8 215:9 252:13

252:14 283:16 292:10

336:11,22 351:17

problematic 146:2

148:3 295:21 346:20

problems 145:5 161:14

161:22 191:16 338:2

340:16 349:10,22

351:10 367:12

procedural 62:14

procedure 26:9,14,15

30:7 62:2 74:20 103:1

143:10 338:8,10

339:15 340:17 341:11

345:6 369:4,16

370:19,21,22 392:20

procedures 122:8

135:18 139:2 189:6

209:11 212:3 257:9

258:18 259:3

proceed 118:7

process 20:7 23:15,20

26:11 35:14 36:21

38:6,18 39:10,15,20

39:22 41:22 42:18

48:7 76:21 78:3 79:1

79:3 80:22 81:4,12

82:4 84:15 86:6 87:11

102:21 113:22 114:11

121:21 131:9 137:12

141:17 143:18,19

144:4 147:12 152:15

153:15,16 155:8,13

155:20 159:5,16

167:8 168:7 172:7

176:9 177:1 193:14

200:1 208:19 211:18

213:6 217:11 229:2

239:6 251:22 261:9

278:1 290:13 344:17

344:21 345:18 355:11

355:21 356:3 357:5

358:1,13 365:10

367:10 401:9 407:8

processed 385:3

processes 38:20 80:4

80:10 81:7 146:11

296:3 355:16 356:17

359:2

processing 396:4

processors 391:8

produce 7:11 47:12

product 138:7

production 41:3,19

45:17 46:14,18,20

87:4 90:19 91:8

101:13 267:22,22

268:8,9 330:11,15

331:4,6

productive 20:16

products 269:18

270:12

professional 47:20

367:8 376:18

professor 11:3,14,19

Profile 357:17 358:6

Profiles 343:8

profoundly 369:18

profusion 363:21

program 10:6 11:17

14:21 15:7 19:18 20:6

20:8,10 28:5 46:15

79:7 91:7 99:3 122:5

122:7 123:8 124:3,11

125:2 127:1 128:6,8

129:1,3 135:4,17

136:19 138:2 139:1

145:20 146:18,20

156:1,4 157:8 177:10

177:19 178:5 189:21

194:6 195:11 203:17

205:22 206:19 211:3

211:17 218:10 235:18

238:5 252:14,16

257:15 259:12 267:11

267:16 295:3 319:21

325:14 337:17 340:2

353:15 367:6,11,13

367:18 368:2,4,8

371:18 372:6,8,20,21

373:8 374:6 403:2,3

program's 216:11

programmatic 194:3

285:20

programs 18:15 145:20

147:2 179:10,11

205:12

progressive 116:7
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

435

183:20

project 129:19 205:20

341:22 400:4,7 401:4

401:7,12 402:1

projects 26:12 110:15

prolonged 369:1

371:11

prominent 184:11

promises 247:2

prompt 36:19 335:22

356:19

prompting 171:18

pronouncement 276:15

proper 135:10 144:16

251:9

properly 9:14 16:20

183:20 299:12 385:1

401:15

property 357:13

proportionality 58:11

proposal 68:10 276:22

293:2 309:9 310:21

312:3 315:21

propose 303:9

proposed 85:14 309:1

309:2 310:18,21

proposing 308:3

prostate 125:5,16

384:13 385:7

protect 12:22 315:14

protective 51:14,21

180:10 298:20

protocol 205:16

proud 20:9 399:11,17

prove 284:16,22 289:17

292:15 390:17

proved 294:3,3

provide 7:16 19:7 23:4

23:11 28:10 29:1 61:5

61:18 74:18 92:3

111:10 113:17 123:4

125:3 163:9,21 164:6

170:10,20 171:1

172:2 187:9 205:17

206:1 229:9 230:17

231:5 245:2 255:2

280:21 338:22 343:4

346:17 355:9 359:20

363:17

provided 6:14 20:8

22:15 40:5 52:11,21

81:1 118:15 143:8

148:17 170:18 213:1

231:3,19 237:22

241:18 257:12 263:19

313:18 328:3 339:14

347:1 352:11 370:9

370:14 407:22

providers 28:3

provides 134:11 167:10

246:18 252:7 355:14

providing 138:3 174:10

179:5 186:6 229:20

336:20 337:5

provision 106:8 201:22

202:1

provisions 5:7

proxy 256:8

Pu 360:16 365:21

public 3:22 6:1,18 7:6,9

7:13,16,20 9:3 10:1

10:11 11:3,4,20 16:9

16:17,22 17:6 19:18

25:17 27:6 30:12,14

31:17 81:17 179:22

192:7,8 195:20 197:4

224:11 236:22 291:6

291:9 335:1,14 336:6

336:21 349:7 355:9

359:20 367:4 408:6

publications 377:13

publish 6:14 8:10

published 22:19,20

26:13 27:9 30:10

31:14 47:19 62:5

69:21 70:3 99:9

115:15 213:20

publishing 8:14

pull 246:22

pulled 22:19

pulmonary 90:12 126:2

134:6 178:20 273:5,9

279:1 280:8,20,22

285:13,22 286:9

295:5,9 296:7 297:4

323:7 334:6,10

363:22

pulmonologist 11:16

322:15

pulmonologists 133:20

133:22

punch 179:20

puncture 394:14

purchased 351:9

purpose 81:10 155:18

192:22 348:15

purposes 203:14

pursue 236:19

purview 19:6 62:7

147:17

push 228:1 239:11

374:3

pusher 390:5

put 35:22 36:7 53:13

57:7,9,11 66:11 96:2

102:21 104:20 105:13

114:14 117:4 144:17

155:14 160:7,18

174:7 186:19 187:3

193:6 201:16 223:9

253:16 281:18 285:6

292:13 293:10 307:5

307:6 321:8 350:17

350:20 353:12,18

375:18 377:14 378:11

381:11 383:10 391:11

403:18 404:7

putting 87:14 100:17

108:22 148:8 174:1

221:14 245:5

puzzled 65:21

Q

QI 244:22

QMap 351:13,13 353:7

353:9

QTC 404:22

qua 237:2

qualifications 212:17

372:19

qualified 92:11

qualify 300:20 369:4

qualitative 38:2 46:1

160:11

qualities 212:18

quality 20:12 128:13

137:3 193:3,4,13

211:17 212:10 213:12

213:17 222:17 223:8

227:11,21 238:18

239:6 240:3 244:8

368:13

quantified 50:14

quantitative 38:2

160:11

quantity 273:1

quarter 25:8 28:10

268:3,10

quarterly 28:2,10

question 7:14 21:11

29:8 30:17 32:3,20

33:7 39:1 41:2,3 42:8

47:6,8,8,12 48:18

49:16,18 55:8,17

56:11 72:3,4 73:6,17

74:2,8 77:11 81:13

84:10 95:16 97:12

102:2,11 104:16

110:8 119:13 134:18

134:21 137:9,15

152:6 153:11 158:11

158:13 161:12,19

167:20 171:13,13

174:19 175:18 184:22

185:2 191:1 197:4

198:12 201:18 207:5

209:16 210:2,13

219:14,16 230:2

232:12 233:1,3,11,12

233:18 234:3 240:11

240:13 241:2,6

244:18 248:5 288:9

295:10 299:8 322:17

323:2,7 324:16 325:7

329:22 377:21 378:9

378:15 379:8 382:12

questionnaire 22:10

34:17 35:16 36:6,10

37:20 45:3 48:17

52:18 56:13 75:5,6

77:15 78:5 81:16 82:1

83:5,6,19 90:2 94:8

97:17 103:1 108:3

143:1 147:1 171:17

171:21

questionnaires 84:4

questions 10:10 23:1

25:11,19 28:6,8 29:5

29:7 33:4 34:1,22

46:6,11 62:17 66:21

80:20 81:9 83:8,14,21

87:2 107:12 132:7

150:15 152:11,22

153:22 154:7,8 155:2

155:5,8,16 157:14,15

157:17 158:5 159:1

165:7 167:7 168:8,13

172:12 175:7,12

177:3 190:12,14

197:13 201:16 210:7

212:8 213:5 219:4,17

220:2 249:1 297:1

326:4 347:10 356:4

374:19 395:20

quick 4:9 61:22 65:4

219:15 308:16

quickly 27:10 32:11,16

41:11 208:20 252:12

286:4 323:19 337:20

quiet 7:10

quit 381:17

quite 45:9 58:16 124:10

134:3 138:10 146:7

148:7,12 149:12

150:6 151:10 156:17

157:18 161:3 169:15

170:7 176:11 178:10

180:2 181:7 183:14

183:22 235:3 252:5

268:11,12 271:21

293:3 385:21

quote 339:1 357:17
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

436

358:1 369:1 407:3

quotes 373:19

R

Rachel 3:8 17:18,19,21

60:18 61:22 78:21

79:14 103:14 172:17

177:6 201:11 404:3

405:14 406:12

rad 350:10 351:12,22

RadCon 389:10

radiation 13:4 131:21

151:22 196:18 197:1

208:14 211:2 250:21

250:22 251:4,8

293:21 376:2 394:15

Radio 349:18,21

radioactive 339:6

radioactivity 358:8

radiogenic 356:7

radiological 393:6

radionuclide 356:5

radionuclides 349:8

350:6 374:21,21

375:3

raining 407:17

raise 53:18 56:10,22

70:14 71:15 72:16

75:17 78:20 88:8

118:18 139:13 162:6

312:16 317:6 318:22

319:9 328:16 331:7

332:6,13 333:17

334:15

raised 119:13 158:6

159:18 161:8 199:14

199:19 200:12 208:22

287:11 328:18

raises 55:7 231:1

265:15 356:4

raising 121:4 137:15

298:1

random 203:3 246:22

range 42:20 46:19 96:8

123:20 131:3 204:22

rant 179:18

rare 203:11 204:1

260:16

rash 237:9,13

rate 37:18 350:6

rating 279:16 280:9

332:15

rational 238:11

rationale 34:18,22

53:21 69:10 74:18

87:14 95:14 96:2

118:15,15,17,21

119:5 122:1 126:7

156:14 160:5 213:4

266:21 267:8 273:12

301:7 310:5

rationalized 92:4

raw 375:16,16,21

RCTs 389:9

re-look 130:8 248:8

re-suspended 350:3

re-vote 75:3,12

reach 238:4 342:22

reached 8:4

react 283:21

Reactor 269:6

read 18:20 30:21 31:3

34:20 40:6 66:9 82:17

99:13,17 121:22

138:20 260:18 270:17

277:16,20 333:7

335:19 349:17 362:22

reader 220:19

readily 64:11 123:3

reading 171:5 208:7

279:22 285:21

readjust 44:9

reads 75:4 372:18

ready 103:16 196:11

302:11

real 160:19 194:8 279:6

325:16 353:20 381:16

realistic 221:16

realistically 296:15

reality 54:15 264:18

266:22 275:1,19

276:13 285:13 300:1

338:11

realize 174:12 232:11

358:17

realized 179:20 309:1

363:8

rearrange 126:21

reason 7:18 56:22

133:18 139:19 142:9

145:16 164:18 170:10

172:22 174:9 187:15

201:21 202:8 224:8

229:11 232:6 294:7

305:22 372:10

reasonable 51:9 95:5

97:2 148:5 176:20

246:4 290:12 298:12

303:19 315:22

reasonably 169:12

reasoning 165:13

reasons 79:16 152:13

295:18 378:20

reassemble 290:20

335:21

recall 36:15,22 122:16

receive 142:18 179:17

received 170:8 173:12

174:1 175:17 347:4

361:2,3 362:8 363:5

370:17 384:18

receiving 210:21

238:13 361:8

receptive 205:17

recognition 46:9

218:10 226:13 259:21

285:17

recognize 19:16 256:13

272:14 275:1

recognized 250:17

264:22

recognizing 249:2

recommend 39:3 71:1

73:8 76:17 77:18 82:2

82:11 85:18 86:15

92:17 105:12 127:13

147:13 179:16 240:16

338:4 379:5

recommendations 19:9

19:12,13 20:5 21:2,8

21:11 22:4,10 23:10

31:20 32:3,16 34:16

34:18,21 35:3 64:21

66:22 69:22 72:6

76:19 86:16 88:17

103:12 118:13,14

119:3 122:19 123:1

125:14 127:11 129:18

141:16,20 152:16

159:7 160:19 191:13

218:20,21 225:1

226:4 247:9 248:3

267:7 325:11 337:8

337:18 350:17 355:19

359:18 377:8 378:1

378:16,18,19 379:2

379:12 392:2

recommended 85:20

147:7 193:14 195:13

243:19 354:5 373:18

recommending 35:20

40:22 42:7 93:11

97:20 98:6 110:6

244:14

recommends 72:3

122:3 138:21

reconsideration 363:12

reconstruction 358:12

384:17 385:10 386:1

396:9

reconvene 181:20

record 18:21 20:21

89:13 181:22 186:1

186:20 187:4,10

188:8,14 218:4

219:22 220:7,14

222:5,9 225:3 226:19

226:22 235:6 241:7

244:2 263:16 284:21

291:2 332:16 336:3

363:15 400:20 408:13

recorded 309:17

recording 7:11

records 52:10 79:19

80:17 81:2 92:17

162:13,15 163:10,21

179:11 181:9,15

208:12 214:18,19

216:20 217:2,21

218:11,14 219:2

225:2 228:6 229:7,12

233:11 240:7 242:14

284:12,13,19 285:4

338:13 383:8 390:22

391:5

recurrent 185:8

recurring 178:13

red 1:11 25:13 180:13

Redlich 1:21 11:13,13

33:5,6,10,13,16,22

116:21 133:12,13

137:7,8,16,19 138:4

285:9,10 286:18

287:5 292:20 294:22

295:1 297:10 298:11

305:2,3 309:20

321:22 322:10,11

326:20,21

reduce 207:20 391:9

reduced 51:8 275:2,3

reduction 279:1

redundant 97:18 98:13

reeducate 63:12

refer 61:2 62:16 81:18

229:8 246:17 261:15

264:13 265:12

reference 19:12 105:20

260:19 307:5,6

309:10 312:6,9

313:21 371:22 392:3

references 23:2 156:13

239:17

referral 92:2 95:4

240:19 246:16

referrals 222:12

referred 30:18 99:2

133:22 246:15 272:10

322:15 333:10

referring 29:18 32:20

33:11 35:18 91:8

215:17 247:12

refers 85:11 257:20
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

437

262:20

refiled 362:15 363:10

refinery 269:14

refining 44:22 241:3

reflect 106:12 126:5

266:22 275:18 276:13

338:11

reflected 255:19

reform 127:4

reframe 309:7

Regalbuto 403:21

regard 21:11 30:13

45:10 50:9,19 80:11

124:20 202:18 364:7

regarding 5:9 19:18

20:18 21:7 26:9 33:7

72:3 99:10 103:14

155:13 219:20 264:1

328:3 334:5 394:7

regional 153:5 246:10

Register 130:11

registry 342:3,5

regular 124:3

regulated 51:18

regulations 5:15 8:9

50:10,20 147:22

392:12,15 393:1,12

394:1

regulatory 51:6,13

reiterate 141:8,22

rejected 68:12

relate 84:7 102:8

230:18

related 21:18 24:7

50:15 78:20 90:3,3

115:17 119:20 126:3

197:13 233:1 257:22

258:6,8,11 267:9

273:17 279:22 280:2

293:2 295:10,12

297:19 312:5 322:16

377:4

relates 121:16 370:3

relating 10:3 125:4,5

261:22 275:13

relation 251:12 255:21

257:18 298:2

relationship 108:18

125:6 130:10 150:18

151:3 234:15 237:3,5

264:9

relationships 135:21

relative 44:14

relatively 50:9,12,15

84:1 222:11 257:11

269:19 280:19 285:17

286:10 301:3 322:14

release 351:14 353:11

relevant 5:14 30:4,11

64:7 115:8 173:1

189:17 229:9,11,18

230:1 235:13 237:11

240:21,22 308:10

379:15

reliable 40:4,8 169:12

relocating 11:21

reluctance 232:16

reluctant 232:18

rely 124:17,19

relying 40:16

remain 7:10 194:12

remained 357:13

remaining 379:4

remains 193:17

remanded 113:2

remarkable 268:12

remarks 30:18

remediation 357:5

remedies 266:8

remember 41:4 87:21

154:12 197:1 228:7

258:22 290:1 389:18

389:19 404:2

remind 118:11 212:18

212:22 257:17 331:14

335:12,13 392:1

reminded 180:19

reminder 119:2 193:12

254:21

reminding 228:1

reminds 179:8 254:1

remiss 4:10

remote 249:19

remotely 6:17,20

removal 349:19 356:19

369:15

remove 104:16 284:4

removed 248:2,3 289:7

356:10

removing 65:6 106:8

288:19

render 148:5 149:11

239:8

rendered 78:22

renovation 331:1

reorganization 127:14

reorganizing 128:2

rep 301:10 348:11

361:4,8 362:18

365:11 367:8

repeat 86:13 195:6

221:22 241:11 272:7

313:15

repeated 258:8

repeatedly 99:7 125:17

repeating 258:21

replaced 93:12 283:3

375:6

replacement 349:20

report 15:12 87:5 89:18

94:12 98:4 108:1

122:18 132:2 140:20

160:6,6 162:8,22

228:19,20 238:19,22

249:10 359:11,13

363:21 364:17,20

365:3 372:17 373:1

378:22 384:17

reported 42:15 94:2,14

97:21 98:5 101:21

115:8 176:13

reporting 53:15 193:19

reports 14:22 159:19

188:6 192:20 227:15

242:21 246:8,8

365:17,19

represent 407:21

representation 35:9

representatives 9:4

121:2 152:19 155:4

representing 309:11

399:8

reps 374:5 380:5

republished 26:22

repugnant 201:13

207:3

request 7:9,21 52:12

125:10 166:22 172:19

194:13,17 195:6

199:7 332:13 343:15

346:11,14 359:4,17

requested 142:8 143:2

153:13 291:7 336:7

requesting 178:18

203:16 225:20

requests 16:16 28:21

79:20 169:22 172:12

174:9

require 7:19 32:12

264:5 277:17

required 8:13 145:9

175:14 214:13 261:2

323:11 351:12 373:8

393:10 403:15

requirement 55:19

60:11 277:15 340:3

340:12

requirements 61:4

94:22 129:22 278:6,7

368:2 372:21 373:7

404:13

requires 7:19 8:1 91:9

265:13 302:8,10

326:12 394:18

requiring 321:14,15

rescind 266:18

rescinded 21:6 254:11

research 13:1 259:18

269:11 380:8

resend 364:21

residual 48:7

resignation 403:22

resolution 198:14

resource 195:8 205:11

210:2

resources 32:12 127:14

128:9 165:18 166:16

166:20 167:1,2 223:3

227:16 245:7 249:3

382:19 398:16

respect 324:8 386:10

respectfully 359:4

respirate 380:16

respiratory 46:3 185:11

368:20 369:3 370:18

371:10,12 395:4,5

respond 127:12 136:17

155:2 165:14 171:2

222:19 346:12,14

responded 161:3

395:22

respondent 84:11

response 13:9 17:14

19:8,10 21:2,4,5 22:4

32:10 71:12 75:15

76:18 86:16 87:17

88:6 108:12 114:5

118:10 126:15,17

131:12 139:10 140:7

190:22 196:7 197:6

197:12,14 208:1

233:20,21 237:21

279:11 299:1 310:2

310:16 312:14 317:4

318:16 323:8 365:18

responses 232:5

responsibilities 341:12

responsibility 347:7

responsible 5:7,11

402:1

responsive 28:13,20

rest 86:21 111:22

203:17 303:11 308:17

329:10

restricted 240:19

restriction 285:21

restrictions 364:1

restroom 4:13

resubmit 385:7

result 144:18 188:21

189:4 239:15 358:9

results 20:2 294:2,17
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

438

326:15 344:10 364:2

resume 89:11 181:22

408:8

resumed 89:13 291:2

336:3

retain 36:2 68:8,15

Retaining 39:18

retake 74:20 327:18

retaliated 166:7

rethink 63:13

retire 405:11

retired 13:4 116:1 381:5

386:16 388:15

retirement 189:21

190:5

retroactive 161:18

retrospectively 159:13

returned 165:21

reverse 303:19

revert 14:16

review 3:4 10:18 62:1

83:5 119:8 123:10

124:18 129:11 134:13

141:12 142:4,7,17,19

143:8 145:14 146:3

148:11 151:5 158:21

162:13 169:1 175:17

189:16 192:22 196:11

208:6,18 209:10,15

209:16,18 210:5

211:16 213:12 215:21

217:18 219:15 223:8

225:12,15,21 244:20

245:5,8,9 246:19

248:22 254:17 264:5

265:14 290:4 340:13

343:16 345:5 356:20

357:16 370:2,7

reviewed 19:14 53:1

112:20,20 142:21

143:22 144:12 154:6

169:13 194:1 228:6

286:1 290:15 369:19

378:20 392:11,13

reviewer 56:15

reviewing 57:2 59:11

123:9 145:6 162:11

258:18 359:11 369:22

372:21

reviews 203:22 216:22

217:19 224:17 245:8

300:18

revised 35:17 87:19

275:10

revising 310:20

revision 275:10

revisit 378:15

revisiting 106:9

revote 327:21

rewarded 368:10

rewrite 138:16

rheumatology 223:17

Rhoads 4:21 9:13,16

16:19 335:15 343:19

343:21

rich 366:5

Richard 387:14,15

Richland 1:12 12:13

rid 92:18 331:16,18

371:2

Ridge 9:22 145:18

180:11 293:18

rightly 180:12

Rights 12:22

rigorously 378:13

rip 289:13

rise 193:20 194:2

risk 96:15 253:11

286:13 356:1

rivals 406:17

River 162:14 267:19

350:22 360:9 363:16

road 56:16 103:11

306:9,11

Rockwell 355:12 357:3

Rocky 11:6 13:10

107:16 251:1 355:13

387:21 404:1

role 166:21 208:18

227:19

rollout 200:2

Ron 402:18,19

roofing 270:12

room 4:12 7:10 81:20

138:17 378:15

root 157:6

Rosemary 1:20 3:17

13:13,15 29:9

Rosie 65:2,3 83:18

132:8 181:4 196:20

198:17 210:14 212:12

217:7 218:16 219:11

241:13 322:1

roughly 290:21 379:7

round 25:15

rounds 45:5

route 103:21 104:1,1,2

251:11,18 255:4

274:10

routes 103:19 300:16

routine 276:6 301:14

routinely 269:17 397:12

397:19

row 376:8

rubric 51:17

rule 174:5

ruled 406:9

rules 156:22 186:14

ruling 368:17

run 23:15,16 35:2 199:4

226:11 282:2 396:20

running 117:8 155:1

282:5 299:10

rural 203:10

Russell 406:8

S

S 1:20 360:5

S-E-S-S-I-O-N 183:1

S102 380:13

Sadie 153:8

safe 259:20 283:18

305:21 339:18

safely 300:1

safer 315:10

safety 4:15 13:4 276:2

301:10,12 320:19,19

349:6 355:19 380:5

sake 105:19

sakes 406:4

sample 209:8,13 210:6

213:15 223:6 227:14

289:12

sampled 214:5

samples 366:1

sampling 380:7

San 25:8

Sanford 357:15

Santa 26:7 355:7,13,16

356:10,13,21 357:17

357:19,21 358:5

359:6,20

sarcoidosis 344:14,16

360:13,21,22 361:2

363:4 364:18 370:2

satisfied 5:15 59:16

satisfies 60:4,4

satisfy 60:10

saturated 349:19

Savannah 162:14

267:19 350:22 360:8

363:16

save 180:17 181:6

saw 145:17 149:3,12

156:5 179:8 314:16

saying 40:7 51:7 58:12

80:18 92:20 109:3

130:5 171:6 176:16

178:18 200:21 218:16

239:7 241:14 252:12

256:21 268:10 277:10

278:2 290:8 293:5,6

297:11 304:13 306:7

306:16 320:14,15

321:16 347:4 364:18

says 33:19 38:12 40:1

85:20 92:12 100:14

101:17,19 102:22

108:18 135:3 145:18

155:9 156:3 171:21

185:10 220:12 247:1

249:21 264:3 266:19

370:15 375:19 381:18

383:2,4 392:6,21

397:21 406:10

SC&A 357:16,17

scale 37:20,21

scan 218:10

scarring 257:20,22

261:1 267:14 268:5

273:17 277:10 278:11

280:7 297:22 298:9

scenario 295:15 322:22

399:19

schedule 16:20 18:2

scheduled 7:12

school 11:4 12:6

179:22

Schroeder 5:1

Schwartz 215:15

science 23:6 63:21

145:19 253:14

scientific 1:14 50:6

122:6 124:1 125:12

126:5 127:5 135:11

136:2 138:22 141:14

146:5 251:7 325:15

scientifically 60:2

scope 40:5

screen 36:8 72:5 75:4,7

99:17 144:17 260:18

screening 46:15 99:3

205:12,14,16

scribbled 220:18

scrub 194:11

search 26:17,19,19

60:16 125:13 218:6

220:9 242:22 342:8

342:10

searchability 219:21

searchable 26:16 29:16

193:21 218:3,5,11

219:2 226:9 242:5,9

searched 30:9

searching 217:1

seating 378:5

Seattle 24:14,20 103:7

152:19 153:7,13

209:5 246:12

sec 26:7,7 309:2 337:14

385:4

second 42:2 58:7 65:10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

439

69:15,16 71:8,9 72:10

72:11 75:14 77:5,6

84:11 88:2,3 91:13

139:8 142:2 192:21

202:3,6,16 203:1,15

203:20,21 207:18

212:21 226:18 244:6

247:18,20,21 273:15

304:4 308:12 316:22

317:1 318:10,13,14

328:14 329:20 330:1

332:5 333:15 334:12

376:8 377:3 385:11

secondly 168:1 389:11

secretaries 101:10

107:17

secretary 19:10 21:3

30:15 337:13 341:3

secretary's 32:5

SECs 294:12

section 53:9 211:8

311:2

sections 219:2 221:15

241:8,15

security 12:17 117:3

152:22 189:22

seeing 79:11 99:22

220:12 279:17 309:16

seen 19:4 26:4 79:12

113:2 142:15 155:20

156:1,16 165:8

169:21 175:18 314:19

315:12 379:6 389:15

403:5

sees 232:22 367:18

segregate 390:19

select 307:7

selecting 325:8

self-serving 52:9,22

SEM 3:10 19:13 20:6

34:14 38:12,14 39:5

66:17 81:6 89:18 90:4

119:15,17 121:13,16

121:17,17 123:4,11

123:16 124:14 141:19

145:13,15 146:13

148:21 149:10,13,18

149:21,21 158:21

169:9 174:22 355:14

356:11,19 358:14,21

359:9 374:19 392:2,6

392:7,10 396:12,22

398:6 404:8 405:5,6

SEM's 358:19

semantic 135:12

Senator 9:9,10 121:3

406:15

send 17:3 19:10 21:3

22:3,12 26:2 28:7

38:5 147:18 149:15

156:7,9,9,10 229:10

229:15 233:22 248:12

248:14 345:7 366:18

sending 162:18 342:2

sends 119:16 289:12

346:11,13

senior 24:16 348:12

sense 83:8 100:13

102:18 113:15 129:18

138:13 200:7 215:5

240:14 241:3 303:11

307:9

sensible 266:17

sensitivity 343:18

sensitization 344:3,11

sensitized 368:17

390:3

sent 34:19 36:6 69:21

130:11 142:6 154:17

165:16 170:5 206:18

215:13 237:20 242:8

242:11 244:19 362:10

362:14 397:9

sentence 85:19 86:21

160:2

separate 105:11 211:10

215:13 224:5 225:12

296:9 338:16 346:18

separately 67:13 76:14

97:22 144:8 303:10

333:6

separating 273:12

278:6

September 142:2

sequence 60:7 262:14

307:9

sequentially 179:7

series 122:19 334:5

serious 356:7 367:12

seriously 19:14 54:1

serve 5:5 19:17 357:10

387:17

service 13:7 46:20

268:3 341:13 349:12

349:15

services 26:11 200:19

337:14

serving 125:11

session 3:22 7:3,15

144:4 192:8 291:6

335:2 336:6 408:7

sessions 6:22

set 18:4 25:18 41:9 44:2

51:6 52:14 54:3

111:12 123:19 142:20

192:3 197:9 232:5

253:4,8,8 255:14

260:6 271:11 273:8

275:14 298:5 303:13

309:9 312:4 315:20

316:10 334:9 337:12

337:12 351:5 392:13

sets 103:19 377:7

setting 43:19 95:20

268:22 276:13 287:3

297:20 302:5

settings 269:18

settle 266:16 300:22

settled 286:20 312:1

380:1

seven 185:5 269:2

313:9 317:15 319:2

328:17 360:15 363:2

363:14 366:2 381:1

severe 58:14 364:1

severity 339:2

shape 172:16

shared 198:8

she'll 291:21

sheet 319:22 320:8,12

sheetrock 388:22,22

ship 288:22 289:2

ships 389:12

shipyard 288:20

Shirley 374:14,15

shockingly 405:6

shop 276:20

shopping 201:10

202:20

short 18:22 32:13

189:22 299:10

shorter 14:12 273:21

shortly 183:8

show 70:15 71:16 72:17

75:18 76:5 88:9 107:9

109:13 139:14 224:8

260:6 263:10 265:9

288:13 294:18 312:17

317:7,17,20 319:1,10

348:21 370:16 397:4

showed 143:12 144:14

260:5 263:2 326:17

showing 269:1 284:22

363:21 364:4 372:12

382:5

shows 263:16 349:13

353:8

sick 342:11 403:1

sicknesses 362:2

side 4:11 45:17 192:10

197:1 211:2,11

220:10 251:4 268:8,9

268:15 285:7,7

302:18,20

sides 300:4 302:21

sidesteps 110:4

sift 230:13

sign 52:19,20 192:12

367:19 372:17 401:12

signal 115:16

signature 52:21 53:3,5

significance 237:12

392:19

significant 53:20 92:14

100:12 159:21 160:1

160:4,8 179:19

184:16,17 186:4

260:3,4,15,20 262:8

264:8,12 271:4,16

272:16 284:9,10

305:11 307:13,17

309:13 313:17 316:11

316:14 318:19 328:1

328:8 386:12 392:22

393:2 394:8,11,13

400:21 405:20 406:2

406:3

significantly 177:9

268:6 276:10 385:13

signs 333:1

silica 49:19 50:12,16

51:7 255:12 257:5

356:5

silicosis 255:13

Silver 1:16 11:18,18

86:22 87:1 114:6,7,15

126:18,19 128:12,22

141:11 159:18 179:3

179:4 189:14,15

194:15 236:11,12

293:9,10 299:13,14

Simi 25:8

similar 27:19 105:6

109:22 113:12 130:10

165:5 198:9,11

199:13 209:1 337:13

349:22

simple 47:5,7,12 107:6

137:4 197:10

simpler 107:2 170:2

252:19

simplified 262:15

simplify 23:14 259:1

286:15

simply 131:5 137:4

192:10 239:21 250:13

282:10 322:8

Simultaneous 100:2

109:15 177:16 199:15

204:10

sine 237:2

single 47:7 80:15
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

440

single-shell 349:21

sister 9:2

sit 36:16 160:18

site 6:2,3,9 8:8,17 11:11

12:15 15:8 17:4,17

26:5 46:17,19 59:14

111:20,20 113:11

122:17 123:2 130:9

162:14 163:7 168:3

267:21,22 268:1

269:2,3 270:19 272:2

282:20 284:15 296:4

310:8 329:14 330:18

331:2,21 332:2 343:5

343:8 348:10,11

351:14,15 353:11

355:14 357:16 358:5

358:8,11 360:9,10

361:11 366:7 388:2

396:7 403:22

sites 21:20 41:10 115:3

119:14,19 120:1

149:20 157:12 161:1

167:17 169:9 251:9

255:10 267:19 268:7

268:12,17 283:11

323:3 326:3 342:11

348:14 355:8,12

sitewide 343:14

sitting 84:5 101:12

153:21 378:2

situation 157:12 370:20

406:15

situations 156:16 198:9

204:3 205:5 300:8

301:2,4,10,17

six 185:5,5 206:10

261:18 272:8 281:16

291:11 313:9 317:18

328:17 333:8,13

387:21,21 396:11

size 223:6

sizeable 227:14 249:4

skin 180:15 237:9,13

356:3

slap 248:13

slapped 402:11

slash 378:15

Slaugh 345:12 348:6,7

348:8,10 354:2,21

sleep 116:12

slept 179:19

slide 34:9,12 46:5 69:3

73:13 90:8 97:9 98:16

99:13 101:3 105:10

105:13 107:9 109:14

117:19 118:4 119:10

119:12 122:12 124:5

124:6 159:8 192:21

196:15 200:11 219:8

243:20 247:13 249:14

261:3 270:17 332:15

332:16 333:5 335:8

370:7,15 371:20

slides 192:16 249:18,19

270:16 369:19 370:9

370:10,21 371:21

373:11

slightly 70:1

slot 192:13

slow 199:22

slowing 116:11

slowly 116:6 117:7

183:19

small 49:6 53:11 85:10

129:10 209:8,13,22

210:6 213:15 217:17

270:11 280:19

smaller 96:21 129:11

Smith 24:19 59:2 153:6

smoked 58:12,14 59:1

59:2

smoker 56:6,20

smoking 55:10,15,22

56:11 57:3,4,7,8 59:6

60:14,22 61:3,6,14,19

62:8,12 63:2,17,18

64:6,10,11,15 65:6

90:21,22 105:4

109:22

smoothly 23:21

So-And-So 58:22

220:12

SOAF 142:10,21 147:5

147:19 155:12 158:18

158:20 159:21 220:1

229:10 237:22

Social 117:3 189:22

society 47:18,20

sole 136:10 145:16

solution 285:11

solve 135:15

solved 189:11,13

solvent 223:15

solvents 37:9,10 43:5

somebody 36:16 57:8,9

101:6 116:1 127:4

164:3 166:3,14 181:3

185:4,10 202:20

224:8 228:11 231:14

277:11 298:19 305:19

337:15 401:3 403:7

404:20 405:11 407:1

somebody's 57:1,2,12

215:1

someday 270:13

somewhat 14:16 233:1

257:16 269:21 271:11

soon 26:14 27:19

302:15

sooner 8:10

soot 48:7

sophisticated 163:19

sore 235:18

sorry 17:18 51:19 59:9

67:19 86:12 90:9

91:12 104:12 109:18

131:19 177:13,17

191:13 196:10,12

199:17,17,21 201:20

204:8 214:3 216:14

219:4,11 241:10

290:19 301:8 312:22

324:10 332:12,17,22

341:5 347:5

sort 23:2 25:20 28:21

30:19 39:5 45:19

49:14 54:22 58:20

59:15 60:7 74:8 83:7

84:2,9 129:7 135:13

149:7 150:13 153:2

156:21 157:4 159:20

169:7 176:5 187:10

197:3,6,12,21 204:1

208:18,20 209:16

211:12,16,17 212:9

213:20 214:11 216:18

221:2,6 222:16 230:5

232:13 233:7 243:5

245:3 267:7 276:11

285:19 286:4,22

287:12,18 288:2,9

304:13 305:11 326:22

397:2,13 398:18

sorting 123:17

sorts 28:5 229:18

sound 120:10 339:18

sounds 199:12 217:18

264:15

source 121:19

sources 123:4,15,18

145:21 263:19 358:8

South 246:12

space 350:5

speak 16:17,18 18:11

46:8 60:18 126:9

143:16 152:21 164:12

166:4,19 169:2 191:3

192:10 341:18 347:22

347:22 408:5

speaker 336:10,18

398:21 399:1

speaking 100:2 109:15

153:3 177:16 199:15

204:10 336:8

special 131:22 152:2

250:18 251:3,14

255:5 293:16 294:5

specializing 367:9

specific 10:3 30:5,5,13

49:16,18 61:16,18

72:3 79:18 81:4,5

82:12,18 97:12,21

98:7 110:22 117:18

118:4,14 119:20

130:8,9 136:14

141:14,19 154:9

160:10 173:13 213:5

233:19 248:9 265:22

277:18 279:11 293:1

341:1

specifically 42:9,22

62:11 73:11 97:16

145:12 147:13 173:22

178:18 259:13,17

330:2 350:9 372:4,8

374:20 398:3

specifics 195:16

specified 245:10 257:7

specify 132:21 274:18

303:6 357:8

spectrum 111:15

305:12

speed 377:1,10 378:8

spend 144:6 215:3

250:1 258:17

spending 216:6 250:6

spent 25:1 35:5 54:8

63:11 95:22 133:19

269:2 363:14 386:13

386:15 390:13

spill 45:16 380:13

spine 375:9

split 222:6

spoke 396:11

spray-on 320:6

sprayed 390:10,12

spreadsheet 197:10

200:6

spreadsheets 198:4

squarely 359:15

SRS 162:13 163:7

staff 4:22 9:9 20:8

24:15,16 28:7 113:5

121:2 125:12 175:10

175:11,12 402:3,4

staffing 133:8

Stage 234:6

stages 31:18

staggering 352:15

stairs 116:12

stakeholders 20:1,15
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

441

stand 198:20 407:4

standard 51:6,7,17,20

51:22 64:3 95:5 115:5

170:15,18 179:21

214:9,11,14 217:10

217:12,14 220:3,5

239:22 244:21 262:20

265:2 266:5 272:7

332:4

standardize 244:20

standards 216:12 217:3

262:19,19 275:11

355:19

standpoint 350:8

stands 90:12 262:13

start 34:10,15 41:14

78:6 96:6 113:6 335:3

335:4 373:3 386:14

started 28:2 59:12

89:16 115:13,13

183:4 191:9 197:9

228:2 320:3,16

376:13 401:2 403:11

starting 23:8 382:15

state 10:8 11:20 25:3,4

44:20 121:9 144:20

145:12 146:10 342:5

342:7,7 350:18 400:4

401:21

state-of-the-art 126:5

stated 145:15 151:8

357:17 381:20 393:12

statement 18:20 20:19

21:1 47:21 55:17

138:5 143:3 155:14

160:7 162:16 163:2,8

218:6 233:2

statements 40:3 169:14

states 1:1 134:3,15

185:22 186:1 270:2

406:7

stating 55:16 314:19

statistical 83:19

statistically 50:1

statistics 24:22 202:7

206:9 361:12

statute 189:17 293:15

statutory 54:2 179:21

369:12 370:8

stay 5:19 196:16

STC 354:5

Steel 13:9

steered 224:1

Steinberg 18:14 20:20

21:1

step 232:17 299:15

Stephanie 360:3,6

363:11 367:1,2

Steve 33:6 140:11

223:2 314:3 345:15

Steven 1:12,19 3:3,5,20

9:6 10:20 68:3 345:11

345:12

sticking 248:20 303:3

stimulus 281:12

stipulation 200:19

Stivers 406:9

stolen 403:13

stomach 375:8

stop 178:3 281:14

stoppage 184:17,21

stopped 270:7

stopping 184:13

story 407:20

straight 235:1

straightforward 170:2

222:12 252:10 285:18

streamline 112:17

113:22

stress 173:12

stressed 172:21

strictly 127:16 402:3

406:1

strikes 232:14

striking 232:18

stroke 368:6

strong 273:12 387:5

strongly 6:9 90:3

133:14

struck 213:13 217:9

structure 15:3 57:5

216:20

structures 233:2

struggled 225:16

struggling 363:1

student 176:12 254:20

students 180:1

studied 326:1

studies 47:9 48:8,12,13

48:14,15,20 49:14,19

49:21 50:7,13 96:10

99:9 111:14 129:11

258:9 323:19,21,22

324:2 356:3 398:1,4

study 48:22 49:2,7

77:14 96:3 115:14

129:15 227:14,18

325:18 352:12 354:7

398:18

stuff 79:7 135:21 216:7

216:9 235:7 282:3

292:8 315:1,9,9

353:17 389:2 390:6

subcommittee 3:10,13

3:16 14:22 15:8,10,12

15:18 22:7 24:12

34:14 90:5 114:8

133:5,7 140:20 141:2

141:3,9,13 143:21

154:5 161:12 162:2,9

169:21 180:22 181:12

183:11 192:18 193:1

193:7 195:17 198:15

208:8,17,19,21,22

212:2 221:6 342:13

345:8 369:21

subcommittees 15:2,4

subcontract 132:13

244:14

subgroup 49:6

subgroups 35:9

subject 26:20 123:13

128:9 129:21 302:7

subjective 178:4 184:1

395:3

subjects 18:13

submission 118:22

374:2

submit 17:1 207:7

359:5,13 367:3

submitted 6:13 24:2

339:22 343:18 344:2

369:20 373:15

subscribe 28:1

subscriber 27:15

subscribers 27:18

subsequent 118:21

307:14 396:11

subsequently 312:6

subset 91:10 245:10

substance 31:9 146:5

393:4,15,18

substances 1:3 4:7 6:6

8:20 48:10,10 162:18

162:21 355:15

substantial 27:1 180:2

180:4 303:22 316:13

329:18

substantially 378:6

substantiate 116:22

substantive 378:1

substitute 180:2

successful 34:4 403:3

sudden 371:1 386:4

suddenly 276:15

suffered 55:1 269:13

suffice 220:15

sufficient 37:2 40:4

76:21 82:3,12 86:5

94:19 95:10 98:1

134:12 170:9 186:7

255:9 256:2 271:2

272:6 283:10 307:16

316:13 321:4,6 328:7

332:3

suggest 48:4 53:3

132:16 226:18 228:3

303:18 311:8 347:21

389:6 390:21

suggested 80:21 137:6

298:15

suggesting 297:4

310:13

suggestion 107:6 227:4

232:9

suggestions 379:1

suggestive 263:21

suicide 194:5

summarily 358:5,16

summarize 34:21 257:2

264:20

summarized 90:7

384:16

summarizes 257:16

273:15

summarizing 30:19

250:2

summary 255:1,2

261:17 270:17 273:14

352:18

sun 377:7

sunsets 379:10

supervisor 153:9 166:6

366:10,11

supervisors 164:17

190:15 292:12 342:20

supplement 169:8

supplemental 123:4

205:22

supplementing 169:11

supplied 40:1 170:5

support 9:18 47:22

49:19 50:7 76:21 82:3

82:12 86:5 96:13

101:11 122:6 125:12

139:1 302:12 348:20

387:2

supported 9:15 99:4

149:13

supporting 95:13

135:22 165:9 377:19

supportive 115:20

supports 49:15 50:18

95:18

supposed 121:8 146:10

146:15 148:2 235:19

301:15 366:19 372:20

380:19 395:12

supposedly 385:8

surface 302:9

surgery 230:8

surprising 326:16
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

442

surrogate 309:22

surveillance 295:2

319:21

survey 165:16,20

166:14,21 342:21

survivor 40:2

Susana 26:7 355:7,13

355:16 356:10,13,21

357:17,20,21 358:5

359:6,20

sustained 321:1

switch 282:4

sympathetic 346:21

symptom 188:7

symptomatic 339:9

symptoms 161:13

183:21 184:10,11,12

184:16,17,20 185:13

185:17 186:4,4,6

187:8 188:11,13

237:6 280:21 338:16

340:5,20

syndrome 348:19 385:2

synergistic 58:3 108:20

151:17 354:8

synergy 151:15

system 197:10,11,20

277:17

systems 349:3,5

350:14 407:16

T

T-A-B-L-E 3:1

table 14:10 16:3 17:22

25:16 179:14 215:22

257:3 321:9

tables 25:18

tackle 405:21

tailoring 173:19

taken 197:6 299:14

400:18 406:22

takes 176:20 196:19

239:6 289:11

talk 22:2 25:19 28:15,19

35:1 36:1 52:1 56:7

57:17 62:8,9,15 95:15

101:1,5 115:12 121:1

146:22 163:4 172:8

175:6 250:4 253:19

254:4 255:17,18

346:19 362:21 375:18

385:20

talked 40:18 117:16,19

150:21 163:14 165:15

169:9 247:8 282:1

292:3,4 388:15

400:12 403:16 407:15

talking 29:19 44:13

57:5 63:19,22 67:17

69:20 80:3,4 81:3

91:3 95:15 100:7

101:8 151:16,19

164:14,16 176:3

215:20 250:6 257:17

292:4 305:15,18

306:12 320:4 330:10

330:11,14 331:2

361:20 376:2 386:9

405:5

talks 135:22

tall 407:9

tank 351:2 352:13,16

352:20 353:5 380:6

380:10,11,13

tanks 349:5 352:17

353:2,17,18 380:7

target 392:9

task 19:21 25:7,9 36:11

37:8,13 38:8,8,10,12

39:8,13,13,17,19 40:9

40:16,19 42:1,13

44:19 45:19 52:6

67:22 84:6 130:21

132:1,19 136:12

141:12 393:16,19,20

task-specific 132:4

tasks 15:1,3 36:8 37:1

38:16 41:3,7,9,12,15

41:17,18,20 45:13,17

53:10 67:18 68:9 71:1

71:4 76:22 77:1 78:3

82:5,7 84:1 100:16

110:9 111:10 112:2,5

113:12 123:20 167:18

170:14 205:2 256:10

taste 269:3

taught 250:2

taxi 207:10

TCE 151:9,13 404:19

teach 398:13

teaching 237:8

team 13:10 20:10 23:6

23:7

tearing 387:22,22

Tebay 343:10,11,12,22

tech 396:3,5,6

technical 122:6 124:2

127:5 135:11 138:22

178:17 343:7

technical/scientific

131:7

technically 147:21

technician 348:13

351:3 360:14 366:2

366:10,16

technologically 220:16

226:8

technologist 396:3

technology 194:22

243:6 357:10

Tee 374:15 376:15,17

teleconference 28:3,11

29:22 194:1

teleconferences 28:5

194:8

telemedicine 204:18

telephone 2:21 6:21

29:13 373:13,20

374:3,8

tell 61:9 84:8 175:1

176:4 228:5 237:20

304:19 325:9 352:19

353:11 361:10 362:2

375:20 377:22 382:8

383:1,7 386:17 387:7

388:4 406:3 407:2,12

407:20

telling 52:15 130:20

148:10 361:21

tells 40:12

temperature 283:6

template 144:13 286:3

templates 172:14,22

174:5

temporal 237:3,5

temporality 237:1

ten 228:7 246:3 328:22

329:5,5 360:15

376:11

tend 278:8 288:18

Tennessee 11:20,21

tenth 228:10

term 23:12 90:13 124:4

299:10 371:11

terms 52:14 63:14

64:22 77:12 79:22

96:16 113:19 114:21

115:14 174:2 175:16

213:18 223:3 228:16

240:3 247:6 266:12

275:16 279:15 295:22

298:15 301:20 309:12

320:5 327:7 377:8

397:18

terrible 260:12

Terrie 215:13 336:17

337:1

test 44:18 178:20

285:22 344:10 364:6

364:15,16

tested 41:21 44:11

76:19 82:3 84:4 85:20

86:9 368:19 371:9

testimony 366:15

404:17

testing 73:19 77:11,12

77:14,16 80:20 82:11

84:22 345:2 350:19

tests 279:2 280:8

tet 397:19

text 37:6 40:22 67:17

102:21

textiles 270:12

thanks 9:1 47:4 181:10

212:14,14 217:7

218:18 249:8 268:21

302:4 332:19 341:16

360:1

thermal 320:9

they'd 97:4

thick 407:8

things 20:22 21:5,18,19

22:1,12,19,20 27:9

31:11 36:15,19 43:5

44:10 57:22 60:20

62:6 65:16,19 66:15

66:16,20 78:1,8 81:8

81:19 102:8 107:6

108:15 110:15 112:12

117:7 129:12,13

142:22 146:13 147:16

150:12 155:3 159:9

159:17 163:13 165:15

170:21 172:21 173:10

176:3,3 194:9 195:18

206:17 209:14 210:9

211:6 213:12 214:16

220:17 222:3 223:21

224:21 226:7 228:21

229:18 233:8 242:11

247:10 255:19 281:22

282:13 287:18 288:3

311:11 315:12 344:8

354:13,17 361:11

362:3 380:16 383:3

385:17 386:4,11

387:1 397:11,14,20

398:15 402:16

thinks 42:14 170:4

250:8 375:10

third 84:20 143:21

228:9 247:18,21

252:9 268:4,11

273:16 311:15

Thirteen 140:9

Thomas 406:8

Thoracic 47:18

thorough 356:20

thought 21:15 23:7

31:7 39:15 41:2 82:17

97:2 156:16 163:15

170:12 190:14 209:14
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

443

231:2 232:7 266:21

275:18 299:15,18

302:10 306:2 361:22

394:16 398:9 400:20

405:16

thoughtful 19:14

thoughtfulness 35:11

thoughts 109:1 187:2

221:10 291:14

thousand 214:19 308:9

thousands 210:18

407:5

threat 325:16

three 54:7 55:18 135:1

148:18 214:22 219:12

251:1,15 270:16

311:11 312:18 313:8

328:17 329:3 333:18

334:16 338:6 339:20

344:10 348:21 349:2

363:21 365:18 375:4

379:9 383:4 397:17

405:8

threshold 54:13 55:3

57:9,11 209:17

321:17

thunder 403:13

Thursday 168:12

thyroid 375:5

tied 189:6 247:19

till 238:10 336:6

Tillson 402:18

time- 312:4

time-consuming 28:17

timeline 337:12

timeliness 20:12

113:19 252:17 368:12

timely 113:7 199:9

times 5:18,20 15:11

25:16 39:2 44:12

65:12 73:20 76:19

77:13 84:3 85:20,21

86:9 112:21 151:21

156:12 178:11 197:17

202:21 233:12 235:9

238:12 364:21 385:14

385:20 388:16 400:12

timing 105:16 114:22

114:22

tiny 53:12,12 239:12

320:13

tired 327:1 329:4

tissue 257:21 261:1

title 41:6 69:2,6 103:22

256:8 257:6 260:5

387:7 402:3,3

titles 41:5,6,8,10 98:18

108:7 111:1,19 112:2

112:5 260:7 262:3

274:1 293:1,2 386:12

387:7

today 7:7 8:9 14:18

16:2 17:2 18:6,16

24:21 29:3 31:21

65:18 105:17 125:15

196:2 210:17 281:22

291:8 292:14 315:13

337:22 343:15 345:15

359:16 367:4 386:12

386:18 388:11 399:9

400:20 404:8,19

405:7 407:14

today's 6:10,16 8:7

377:12,17

told 90:14 143:9 154:22

158:15 194:19 215:5

215:12 217:12 241:14

283:9 344:19 361:8

361:16 362:11,18

363:13,15 364:6,16

365:4,11,12,12

381:17 382:22

toluene 397:19

Tom 384:5,8

tomorrow 14:18 15:20

16:2,4,7,8 18:6 25:13

29:4 31:21 66:4,12

73:12 105:15 179:12

248:9,15 302:12

408:8

ton 223:10

tone 361:16

tonight 248:14

tons 49:18

tools 389:9

tooth 246:7

top 190:17 196:14

358:21 402:14 403:21

topic 53:18 64:22 89:21

240:11 248:7 257:11

257:11

topics 7:16 379:14,16

Tori 191:9

torn 299:2

total 43:18 94:3 154:18

352:14

totality 54:22 80:13

142:13

totally 132:13 160:14

183:14,14 184:1

225:11 226:8

touch 9:17

tour 18:16,17 268:20,20

tours 407:12

toxic 1:3 4:7 6:6 8:19

31:9,10 50:16 62:7

94:19 146:4 160:1

162:17,21 355:15

393:3,15,18

toxicant 58:8,9

toxicants 58:4 141:19

toxicity 50:9,12

toxicological 354:7

toxicologist 132:18

toxicology 127:21

129:13,16 136:20

145:14

toxin 125:16 146:6

toxins 125:6 264:8

366:16 394:15

track 197:11 301:19

tracking 196:7 197:7,11

198:11

trades 12:13 36:20 87:3

91:6

trades-type 260:7

train 173:2 394:16

trained 175:21 237:13

368:9 370:20 407:5

training 13:1 62:11,15

63:2 79:1,12 141:18

143:8,12 144:1,4,22

145:7,12 146:9 155:9

158:22 161:4 178:13

180:17 209:12 212:3

237:1 338:10 369:17

369:19 370:6,14

373:11 404:13

transcripts 7:12 8:14

8:16 22:6 407:22

transferrable 87:4

transferred 352:19

transformed 218:5

transmitted 236:14

transmitting 204:20

transpired 282:14

315:1 400:17

transportation 398:13

travel 5:2 206:16 207:8

treat 251:10 298:1

treated 261:6 368:20

371:9,10

treating 134:2,10

156:20 157:2 185:21

191:22 300:5

treatment 369:2 370:17

371:11 395:22

tremendous 270:5

tremendously 377:15

trichloroethylene 106:4

tricked 363:8

tricky 287:14

tried 30:10 31:4 60:21

61:8 215:5 232:4

362:17 381:15,15,15

tries 244:19

trigger 340:4,10

triggered 209:10

365:18 402:15

triggers 219:15

trivial 85:8

troubleshoot 29:14

troubleshooting 29:19

troubling 149:20

356:16

truck 380:7

true 47:11 64:12 91:7

102:4,12 166:4

187:16 257:1 361:21

truncated 210:8

trust 294:1,8

trusted 236:18

trustworthy 382:20

truth 52:15

try 5:19,20 18:22 28:8

28:19 30:6 36:17

45:11 61:13,13,20

96:16 111:7 165:10

172:8 173:1,12 202:9

202:14 203:2,9

207:15,16 214:14

217:1 229:9,15 230:1

253:14 255:22 266:9

297:1 303:20 319:16

319:19 347:17 365:2

382:16,16 385:22

407:12

trying 23:14 24:8 26:18

27:20 28:12 41:15

45:22 56:17 63:7,8,12

63:16 64:2 80:6 84:18

130:12 133:19 165:13

181:14 200:21 207:20

217:20 222:6 247:5

256:9 259:1 287:9,12

287:14 288:5,6 297:2

346:2 350:13 361:22

368:7 375:11 381:14

382:1 390:17 402:20

402:21

tube 381:18,21

tunnel 142:12

tunneling 150:13

tunnels 255:16

turn 196:5 200:11

252:11 373:20

turnaround 252:13

turned 143:19 282:4

Turner 2:12 11:5,5

107:14,15

TVAT 354:5

tweaked 294:11
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

444

Twelve 333:18

twice 369:2

two 4:11 9:20 13:12

14:13,15 34:8,12 65:4

78:8 94:16 100:6

103:19 108:8 150:14

150:15 152:7,8,8

154:15 155:3 158:8

183:5 187:6 214:22

216:21 219:20 221:1

224:22 226:21 230:6

242:10 249:16 261:17

272:10 278:8 279:17

280:11 296:3 303:13

311:2 312:18 313:8

317:21,21 328:17

333:18 334:16 338:16

344:13,22 363:21

366:8 369:16 376:12

376:21 377:9 379:3,9

401:7 404:11 407:7

407:14

two-thirds 329:7

type 40:6 197:11

228:18 242:20 259:9

301:17 315:2 342:6

348:19 350:5 366:8

types 45:15 59:13

246:22

typical 256:13

typically 169:3

U

U.S 270:10

ultimate 59:19 60:6

umbrella 90:13

unable 189:2,3

unanimous 70:21 71:22

unaware 192:12

unbeknownst 400:1

uncertainty 302:21

unclear 197:5 209:9

uncommon 274:9,12

286:11

uncommonly 274:13

uncontrolled 276:21

288:14 321:2

uncovering 402:16

undergo 207:18 339:15

underground 349:6

underline 392:21

underlying 280:2 370:9

371:21

understand 37:15 44:1

44:6 83:15 84:6,17,18

92:19 98:9 113:17

134:9 143:17 153:21

165:11,13 175:22

176:16 184:3 185:2

229:4 230:15 231:13

232:16 241:12 255:22

256:9 258:22 259:14

306:8 337:9 338:1

362:17 365:3,6,9,14

391:11 400:22 401:14

402:22 403:17 404:16

understandable 367:21

understanding 78:4

81:21 99:8 152:15

157:11 174:13 198:10

209:19 225:19 241:14

244:10 262:14 279:14

283:22

understands 73:7

224:16

understood 111:3

176:15

undertake 202:10

underwent 294:20

unfair 371:16 373:9

unfortunately 134:2

300:17 336:9,14

353:14

uniform 274:5

unimportant 275:20

union 294:3 348:10

unique 388:20

uniquely 258:6

unit 164:12 301:10

United 1:1 13:9 134:3

134:15 270:2 406:7

units 357:6

universities 382:11

university 10:22 11:4

11:21 12:6,9,21 13:16

350:18 382:22 398:17

unknowns 350:9

unplanned 351:14

353:11

unprotected 263:12,17

263:20 265:10 266:6

unquote 369:3

unrealistic 276:14

unregulated 115:7

unsupported 187:12

unusual 300:10,11

up- 196:22

update 33:7 124:18

updates 26:2,5,9,16

27:20 28:1

updating 124:12

upper 185:11 395:4

uranium 366:5,6

urge 341:8 374:1

use 15:6 20:7 21:21

36:12 39:9 59:6 81:11

81:18 86:10,17,20

123:7,11,14 128:14

144:13 145:13 146:19

155:10,11,22 158:10

160:12 180:1 201:12

201:13,16 203:19

205:13,13 206:5

210:16 214:20 218:9

244:21 245:18 246:12

250:8 252:4 257:3

266:4 270:2,3 275:7

276:1,4 281:9 289:17

293:19 295:22 303:7

308:6,9 332:22 367:6

373:17 389:3 392:5

397:2,17

useful 41:21 43:9 44:16

77:18 82:7,9,13 85:2

111:10 119:21 135:3

159:16 171:10 194:10

204:5 209:14 211:15

225:15 246:6 342:10

343:8 396:13

user-friendly 83:9

uses 35:16 135:5

205:20 270:10 392:18

usual 187:13

usually 47:20 242:21

256:16

utilized 149:3,4 204:19

V

v 406:13

VA 13:5

vagaries 129:22

valid 47:12 102:19

validate 83:6

validated 47:8 165:20

166:13

validation 77:11,14

83:13,19

validity 73:5 84:3,9

86:18,20

Valley 25:8

valuable 169:16

value 300:15 362:12

values 300:19

Van 402:13

Vance 405:15

Vander 399:3,5 407:10

407:11 408:1,2

vapor 108:1 354:12

vapors 42:4,10 43:15

47:6 48:18 51:5 82:8

91:2 93:6 95:19 104:3

108:4 115:2 349:9

352:4 354:3

variable 268:11

variables 308:8

varied 259:7

varies 268:6 269:21

variety 269:18 298:3

various 18:13 27:3

157:12 205:15 263:19

355:11

vary 342:7

ventilation 350:14

ventilator 117:5

verb 137:4

verbatim 8:14

verification 79:21 93:16

verify 80:7,8

verifying 148:17

version 76:18 85:11

86:15

versions 27:3

versus 24:5 52:15

58:11 145:7 180:18

211:9 315:21

vessels 288:21

VGDF 49:8 51:14 72:4

74:12 75:5 93:1 94:2

94:12,18 95:16 96:14

97:13,20 98:6 101:21

102:11 117:12 359:15

viable 368:1

Victoria 1:21 3:14 13:2

221:10

videoed 281:17

view 59:15 60:4 297:18

319:20

viewing 7:3

Vina 395:17 398:21

vision 142:12 150:13

visit 221:22

visited 6:8

visiting 209:5 389:18

visits 188:7 296:4

vital 341:10

Vlieger 2:13 11:9,10

52:4,5 53:4 59:8,9

60:12 61:21,22 62:19

131:18,19 136:4,5

141:11 162:11 167:12

167:15,21 177:4,8,18

177:22 178:2 199:20

199:21 200:10,15

201:3,5,7 206:6,8

237:16,17 282:17,18

284:6 324:15,16

325:17

voice 363:2

voiding 75:2

volunteer 234:19

volunteered 120:16

391:12
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

445

volunteers 399:3

vote 64:20 66:2,3,5

67:7,12 68:2 70:13

73:11 74:21 75:2 76:7

76:9 89:5,7 104:16

105:17 107:12,13

109:4 118:1,1,13,15

119:2,4 120:3 140:1,9

303:10,11,12 304:4

306:22 307:4,6,8

308:4,8,8 309:2

310:19 311:16,19

316:2,18,19 318:4

319:15 327:16,18

328:16 329:4 333:6

voted 73:7 76:3,11,12

94:14 97:12 140:12

140:17 266:17 307:3

321:9

votes 70:17 139:21

317:9 329:5,6 331:12

332:12 333:18 334:2

334:21

voting 68:22 73:19

74:16,22 85:17

117:17 140:9 311:11

326:21

W

wade 221:18

wage 161:17,21 183:16

183:18 184:4,12,19

189:16 337:22 338:2

338:5,12,15 340:2,13

340:21

wages 188:21 189:2,3

340:4,10

wait 30:15 85:9,21

91:13,16

walk 25:18 116:11

282:22 325:5 344:19

walked 388:5

walls 289:18

wanted 4:17 18:15,16

19:2 20:20 22:5 24:11

27:14 28:15 29:11

34:15 42:22,22 52:5

65:11,12 67:6 78:19

105:1,12 131:13,16

141:12,22 152:21

153:16 162:6 163:2

169:17 183:12 190:12

196:5 206:8 212:22

222:14 229:22 236:17

245:8 246:21,22

257:4 286:8 314:10

324:11 339:11,19

343:22 348:21 361:7

366:18

wanting 403:3

wanton 159:20

wantonly 180:1

wants 45:1 66:9,10

78:16 83:3 103:14

164:2 231:14 325:5

War 294:9

warning 291:10

Washington 1:12,12

4:22 9:22 10:8 12:14

12:21 25:3,4 121:9

294:3 378:4 405:16

wasn't 18:2,3 41:12

127:17 149:6 150:17

168:15 197:8 250:13

251:8 254:7 265:16

275:2 279:2 282:20

311:18 340:6,7

370:13 396:5

waste 352:6,13,19

353:3,4 360:15 401:9

401:11,19 402:6,9

404:18

water 349:19,20

way 1:12 38:22 39:3,9

46:8 53:6 55:13 56:14

57:10 58:19 59:5 62:1

63:5 64:1 65:6 69:11

78:17 82:14 83:12,22

84:7,17 92:15 93:8,17

94:17 97:17 105:3

108:14,17 111:6

112:11 113:8 115:11

132:14 133:6 135:18

160:13,15 162:19

165:18,22 166:12

170:2,19 172:3,10

178:14 183:16,22

185:3,13 188:9

193:21 194:11 199:9

205:10 210:12,21

217:14 225:16,22

228:9 229:6 241:21

243:6 244:13 247:3

250:9 253:17 255:19

268:14 277:8 285:6

288:2,19,22 292:6,18

292:18 299:16 300:22

304:8 307:4 308:18

308:21 339:13 342:16

346:4 347:5 349:15

370:21 371:5 379:12

381:5 383:10,17

398:5 404:1

ways 20:5 21:13 36:21

39:14 57:18 78:15

108:9 111:8 160:21

164:3 197:18 235:20

wearing 180:13

web 6:2,3,9 8:8,16 17:4

26:5 52:14

WebEx 6:22 7:2

website 343:21

WEDNESDAY 1:7

wee 181:13

week 20:18 157:19

200:9 339:17 378:4

week's 6:12

weigh 124:2

weighing 3:13 15:9

24:13 141:2 144:5

369:20 370:1 401:7

weight 279:15 375:11

375:11

weird 239:17 389:2

Welch's 114:8 255:20

welcome 4:5 8:20 9:1

17:1 19:22 131:17

Welcome/Introductio...

3:2

welding 37:8 43:4

49:19

well- 92:3

well-credentialed

213:16

well-developed 156:12

went 22:14 89:13

142:11 144:15 150:12

165:20 181:22 197:7

234:5,13 239:14

281:8 291:2 294:2

296:6 336:3 340:7

346:12 360:18 380:18

382:7,21 384:21

386:15 388:7 389:10

390:10 408:13

weren't 107:21 150:8

185:6 232:6 325:7

Western 406:8

wetting 350:1 352:9

wheelchair 381:3

whistleblower 402:19

Whitley 2:11 12:16,16

292:2,3 331:3

whoops 196:12 216:14

wide 131:3

wife 381:8,17

willing 126:10 202:10

202:16 223:9

wind 283:6

window 284:17

wish 10:11 16:21

wishes 408:4

withdraw 309:7 361:18

362:4

withdrew 362:6,10

witnessed 282:13

314:19

woman 260:11

wonder 105:19 106:7

293:13 343:6

wonderful 341:19

wondering 74:4 82:10

110:9,12 111:5,8,11

174:8,15 221:3 286:5

305:13 310:4 342:9

word 25:10 26:17,19

101:17 108:14 135:10

136:18 137:3 159:20

160:11,11 179:18

200:21 201:12 220:10

242:22 290:17 300:22

403:12

worded 72:5 84:7

wording 31:15 58:21

84:9 85:10 187:13

392:17

words 39:11 222:20

369:16 371:2 375:17

395:2

work-related 56:19

57:3 134:1,4

worked 11:6,22 13:5

36:22 37:4 46:17 54:7

54:16 59:14 89:22

93:14 133:16 167:17

169:5 174:21 188:13

216:8 223:14 255:7

259:9 270:18 272:1

274:19 293:21 298:15

310:7 329:12 331:20

360:10,14 361:12

380:8 382:1 387:20

387:21 389:13 396:1

396:4 397:2,12,16

399:16

worker 1:3 4:7 6:6 8:20

11:10 12:14,17 13:10

37:18,22 42:14 46:15

52:13 59:12 66:19,21

77:22 78:2,6,11 84:1

99:3 110:14 145:20

146:18,19 155:22

156:4 164:13,14

169:15 170:1,4,5

205:12,20 263:16

267:11,15 284:14,15

284:20 329:12,13

330:14,22,22 331:2

337:2 339:5,14

344:15 346:21 349:7

351:22 355:20 358:11

359:6 368:17 381:11
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

446

384:9 388:12 390:20

403:1,14

worker's 43:1 59:18

worker-centered

132:17 224:12 225:13

workers 10:2,2 11:22

13:9 41:3,17,19 45:4

45:6 46:16,19,21

54:16 84:5 91:5,8

96:4 99:6 101:9

107:16,19,21 111:16

113:10,19 115:15

169:2,10,19 178:17

258:9 265:3,4 267:12

269:8,12,12 270:18

270:19 272:1,14,18

276:18 284:7,8 285:8

288:8,20 293:4 295:1

295:8 301:5 307:12

313:16 316:9 319:22

320:8,12 327:22

330:12 331:20,21

342:11 355:6,7 356:6

358:15 359:7,15

367:10 382:1 389:7,8

390:1 401:1 402:17

404:16 407:6,21

workers' 10:11 12:22

18:15 45:12 79:7

176:7 179:10 214:11

350:4 371:16

workforce 330:14,15

working 3:19 15:5,19

19:20 22:21 26:13

45:21 54:8 81:14 90:1

103:21 114:9 116:22

125:20 144:8 158:5

202:13 203:8 238:20

249:13,15 258:20

276:9 289:5 378:14

380:17 390:12 396:6

396:20 399:12,18

workplace 151:18

215:1 239:16 270:8

348:21

works 9:17 92:16

176:22 281:14 368:5

worksites 325:19

workups 235:10

world 91:3 259:16

395:6 402:12

Worldwide 90:22

worried 180:14

worry 191:6 407:18

worse 116:9 256:6

worth 74:16 231:5,7,18

250:6 363:9

Worthington 9:5 18:5

163:4

worthwhile 342:14

wouldn't 49:5 56:17

102:10 196:17 275:18

276:20 294:18 305:16

310:10

wound 222:1 232:5,8

394:14

wow 403:6

wrap 353:22 373:3

383:13

wraps 408:6

wrist 402:11

write 108:17 118:20

120:2,17 157:1

178:19,20 248:6

388:8,9

write-up 190:3

writes 170:17 186:2,9

188:14

writing 404:9

written 17:1 34:18 69:8

85:10 346:15

wrong 250:3 252:2

320:20 375:14 388:8

wrongly 239:7

wrote 122:18 124:8

364:17

X

X 112:5 389:12

x-ray 267:13 277:20

285:21 320:2

x-rays 363:21

Y

Y-12 12:17 251:1

Yale 11:14,16

year 18:13 19:20 20:3

25:21 51:9 96:8

126:20 215:20 245:9

245:10 255:7 260:4

266:16 267:12 273:22

275:19 281:6 282:9

303:6,7,13,21 304:9

307:5,7 309:3,4,11,22

310:5,22 312:6,9

313:14,21 314:10

315:17 321:15 322:20

324:19,22 325:8

327:4 337:4 378:3

385:4 391:2

yeses 313:10

yesterday 179:19 269:3

282:2 314:16

yesterday's 268:20

yield 404:15

York 10:22 12:6 269:15

young 396:2 401:1

younger 314:22

Z

Z 1:16

zoledronic 375:8

zone 283:8

0

1

1-888-957-9863 335:19

1,000 147:15 158:3

1,500 380:19

1,700 114:13

1.1 25:5

1.36 25:3

1:00 181:19 182:1

1:06 183:2

10 116:2 162:1 262:9

276:5 375:19

10-year 261:2 276:1,16

10,000 48:16

10:00 89:9

10:02 89:13

10:15 89:11

10:17 89:14

100 205:21 245:8

1000 217:22

11 313:10

11:00 16:8

110 251:14

115 251:14

12 139:21 154:19 228:8

267:12 274:8 282:12

315:6 348:11 379:7

406:7

12:00 181:18

12:02 181:22

121 251:15,17

127 251:14

12th 144:19

13 139:20

13-02 259:12

13.6 25:1

14 3:5 140:9 144:12

334:2

14-million-dollar 400:3

141 3:14

15 48:12 216:2 222:2

240:11 256:17 262:11

270:21 271:14 272:3

274:6,21 282:12

290:20 291:7 305:19

317:22 329:15 331:12

331:22 332:11 334:20

364:8 371:6

15-minute 89:10

150-foot 407:9

150,000 363:9

16-03 44:20 76:22 80:11

82:4 85:11

1700 226:20

17th 212:19

18 3:8 188:11 336:7,8

19 1:8 263:1 293:1

386:16

1910.1020 375:19

1910.120 403:16 404:13

192 3:17

1930221 335:20

1945 289:6

195 380:19

1954 352:14

1957 289:6

1970 320:3,16 389:14

1972 360:11

1973 320:7 321:3

1978 289:1 321:3

355:18

1980 91:10 92:1,21 93:2

93:6,7 262:8 277:12

387:20 388:5 391:3

1980s 270:4 275:8

1985 319:22 396:2

1986 260:8 262:7

263:15

1990 11:7

1992 251:11 389:22

401:2

1993 368:21 369:3

370:18

1994 275:10

1995 254:6 275:5,16

276:15 339:7

1997 339:10

1998 267:12

1st 270:20 308:10

313:19 316:12 318:9

318:22 328:6 329:14

332:17

2

2 234:6 318:1 333:10

2,000 373:1

2,500 158:3

2,700 158:1

20 54:8 91:9,22 92:5,13

92:20 99:5 240:11

256:17 260:8 262:1,9

370:7

20,000 41:5

200 200:19 202:1,5

352:17 389:18

200-mile 200:13

2000 146:21 250:18
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

447

305:7 352:13

2000s 256:7

2002 11:12

2003 47:19

2004 352:14

2005 270:20 271:13

272:3 274:4 281:6,20

282:7 287:14 288:19

289:4,15 290:5,9,10

290:14 292:6 305:17

305:19,22 306:13,15

306:19,20 307:15,15

308:4,10 310:11

313:19 314:1 315:21

316:12,18 317:6

320:17 321:21 326:6

326:22 327:18 328:6

329:15 344:16 360:12

2006 306:16 340:6,8

393:2

2007 375:2 380:12

2008 282:10 357:15

2009 215:16 394:5

2010 282:10 303:8

314:1 315:6 319:16

326:7 361:2 384:12

405:15

2012 259:16 323:15

384:15

2013 122:18

2014 260:19

2015 115:14 212:19

303:8 314:11 315:19

315:21 316:19 318:8

318:9,18,22 319:8

344:5 375:7 395:20

403:18

2016 142:2,3 143:22

202:4

2017 1:8 305:7

2020 305:21 306:12,15

20700 33:8

20th 8:17

21 371:20

22 251:12 255:10

225B 389:19

24 114:12

24/7 381:10

246 3:20

25 13:10 99:5 133:19

250 251:11 260:3 261:1

261:19,20 264:21

270:20 271:13 274:19

278:12 329:14

26 11:6

27 348:11

270 352:21

2700 231:16

27th 375:9

28 403:18 404:7

29 349:12 403:15

404:13

291 157:21

2nd 362:8

2st 307:15

3

3 402:4

3:00 290:20

3:08 291:2

3:20 290:21

3:22 290:21

3:26 291:3

30 256:18 272:2 273:21

277:11 331:22 390:4

30,000 99:6

300 389:17

32 385:14,14 386:6

329 3:22

33 3:11 360:10

34 12:15

35 348:13

4

4 3:2 75:11 154:20

269:9 313:10

4,000 229:12

4:15 336:3

4:28 335:4,22

4:30 7:6 192:9,13 291:5

335:1,3,5,6,7 336:1,4

40 245:16 256:18

40-acre 407:8

40-hour 404:13

40.66 384:18

400 27:18 403:11

42 12:18

45 84:13

5

5 161:22 268:9 336:8

5:55 408:13

50 350:14 358:3 364:3

56-57 352:16

57 364:3

6

6 318:1 335:1 336:6

6:00 7:6

60s 116:10 256:6

7

7 150:21 268:9 318:1

319:14,14

70 350:14

702- 226:21

72 360:16

73,000 267:11

7385s-2 189:17

75 216:2

8

8 3:3 154:19 240:15

408:9

8:30 1:11

8:36 4:2

802 1:11

80s 276:4

85 388:1

86 262:21 263:3,11

264:22 265:17 266:1

89 381:2

8th 362:9

9

90 8:8 336:8

90- 291:8

900 353:3

90s 275:22 281:8

90th 8:11

91 381:9

92 255:7 407:17

95 254:11 263:3 266:2
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 

448

Advisory Board on Toxic

Substances and Worker Health

US DOL

04-19-17

Richland, Washington