UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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SUBCOMMITTEE ON IH & CMC AND THEIR REPORTS

(AREA #4)

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MEETING MINUTES

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FRIDAY,

DECEMBER 16, 2016

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The Subcommittee met telephonically at 12:00 p.m.

Eastern Time, Rosemary K. Sokas, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

MARK GRIFFON

GEORGE FRIEDMAN-JIMENEZ

MEDICAL COMMUNITY:

STEVEN MARKOWITZ

ROSEMARY K. SOKAS, Chair

CLAIMANT COMMUNITY:
KIRK D. DOMINA

GARRY M. WHITLEY

FAYE VLIEGER

OTHER ADVISORY BOARD MEMBERS PRESENT:

CARRIE A. REDLICH

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS

Introductions and update on initial recommendations

Ms. Rhoads called the meeting to order at 12:05 p.m. Member

Markowitz said that after the October meeting, the committee

sent its eight recommendations to the agency. The

recommendations were:

1) That circular 1506, regarding the Post-1995 Occupational

Toxic Exposure Guidance, be rescinded. That guidance instructed

claims examiners that post-1995 exposures were likely to be de

minimis unless otherwise proven.

2) That the DEEOIC ensure that the disease exposure links that

are part of the Site Exposure Matrix (SEM) are at a minimum

brought up to date with readily available and authoritative

sources listed in the IOM report.

3) That former DOE workers be used in the DEEOIC Resource

Centers to administer the Occupational Health Questionnaire.

4) That DEEOIC establishes a process where the industrial

hygienists interview the claimant directly.

5) That the DEEOIC policy teleconference notes taken by DOL be

redacted and made searchable and publicly available.

6) That DEEOIC make the entire claimant case files available to

the claimant online.
7) That DOL create a departmental occupational medicine resource

that serves the agencies in a manner similar to the office of

the Solicitor of Labor.

8) That the entire case file be made available to the industrial

hygienists and CMCs.

The agency has not given Member Markowitz a specific timetable

for responses, but he will continue to pursue that. Some of the

recommendations involve several different considerations.

Discussion about follow-up of public comments from October full

board meeting

Member Vlieger said that most comments were that claims were not

handled looking at all of the possible contaminants and were

limited by what was on the SEM. The SEM did not consider where

claimants worked, what their labor category was, and the

processes in place on the job sites. Several comments said

there were exposures that were never considered. There were a

few outliers concerning the processing of claims.

One worker spoke of cyanide compounds lining the sewer lines at

Oak Ridge. Materials poured into the sewer, released cyanide

compounds in gases all over the site. Some people talked about

the definition of reasonable suspicion and preponderance of

evidence. There was confusion around claims processing and how

DOL justified acceptance and denials.

Another major concern raised in the public meeting was the

expanded 200 mile travel limit, a source of hardship for many.

Chair Sokas noted that individuals also raised concerns about

the requirement for ten consecutive years of exposure to obtain

approval for claims of solvent-related hearing loss. The

committee wanted a more reasonable presumption about solventrelated hearing loss. An additional issue raised by the public

concerned the repeated requirements for beryllium testing when

Member Redlich had clearly stated that repeated inconclusives

should be treated as positive. Member Markowitz said the Part B

committee would examine the inconclusive beryllium tests. Member

Markowitz suggested the board catalog the public comments.

Member Griffon said the Radiation Board’s method of dealing with
public comments was to report back at subsequent board meetings

and if necessary, follow-up with individual commenters.

Review of status of board requests

Ms. Rhoads said that responses were sent to board members on

disks via certified mail. The disks contained the latest OHQ

draft, including cases requested by the SEM Subcommittee. There

were 25 or 26 COPD cases. The requests made by this

subcommittee should have all been responded to. If there is

something missing please let Ms. Rhoads know.

Discussion of review of additional case files

On the first case, Chair Sokas was concerned the information

forwarded to the physician was limited to only the anemia and

related toxic substances that were identified in the SEM and

asked Member Griffon whether the IH information was potentially

consistent with the extensive documentation of autoimmune health

outcomes in the claimant’s record. Member Griffon affirmed that

solvent exposure is of concern in a number of autoimmune

disorders and that the chart lacked appropriate IH information. 

Chair Sokas raised concerns that the well-documented

relationship between autoimmune disorders and anemia was a basic

failure of medical chart review, and that other charts, although

restricted to COPD cases, also demonstrated failure of the CMC

to explore potential relationships thoroughly.

Member Griffon commented on the lack of IH information, and

reported on additional cases reviewed, including the case in

which a SEC was in place during the time the claimant appears to

have been denied. Member Griffon also commented on the

challenges in this record and others stemming from an absence of

record organization.

NIOSH breaks up communications with the claimant into separate

folders. When it finds additional records in the course of

review, it adds them to the Site Research Database.

Individual claimants are asked to submit information, to DEEOIC,

they think is pertinent to their case. They often submit general

articles related to disease and exposure, and there might be

studies useful to inform other cases. The committee supported

properly organizing the files, and automatically reassessing
previous cases if the agency changes methods. Member Griffon

raised concerns about consistency among claims examiners.

Member Griffon said that the industrial hygienist should be able

to follow up with the claimant. Member Markowitz raised the

question about the expansion of IH contractor work, how the use

of industrial hygienists was changing, and on what information

the IH was relying. The committee should request whatever

information is available from DOL. Member Vlieger asked if the

agency would look at claims denied because of the 15-06 Circular

guidelines. Chair Sokas proposed a quality check for denied

cases. The committee has not yet reviewed the audits of the

industrial hygienists and CMCs. Members of the committee use the

existing reports gathered for other committees that focus on

respiratory issues, but requested files with additional medical

outcomes to review. Chair Sokas noted that the previous effort

to review the CMC and IH reviews focused on process and not

outcomes, and did not include medical or IH experts in the

conduct of the review. She emphasized that the communications

gap between the program and both treating and consulting

physicians needs improvement.

The committee found the letters on the third disk labeled IH/CMC

inadequate and confusing. One apparent typograph8ical error

appeared to reverse a claims decision, and the form letters

themselves were not user-friendly. The initial request was

actually for the information the IH and CHC members are using,

but instead, this group of letters seems to be ones sent to

claimants to ask them for additional information or to notify

them of determinations. 

ACTION ITEMS:

1. Members Vleiger, Whitley and Domina will explore the issue

of the 200-mile limit. A request was made to DOL to report

the rationale for the change and the numbers of claimants

impacted.

2. Member Markowitz will take the solvent-induced hearing loss

issue to the Presumptions working group and the Beryllium

question to that group.
3. Member Griffon will work with Ms. Rhoads to identify and

distribute examples of formalized follow-up of public

comments as conducted by the Radiation Board.

4. Members were in agreement that the ombudsman’s

participation at public meetings along with the presence of

national and regional program representatives was helpful

and should continue.

5. Member Griffon will review additional cases and will

explore the need to allow IH interviews of claimants

directly.

6. Members Sokas and Friedman-Jimenez will review additional

cases and develop suggestions for review of the quality of

the medical input into case decisions.

I hereby certify that, to the best of my knowledge, the foregoing minutes are on accurate

summary of the meeting.

Submitted by:

__________________________

Rosemary Sokas, MD, MOH, M.Sc

Chair, Subcommittee on IH & CMC and Their Reports

Advisory Board on Toxic Substances and Worker Health

Date: 3/__/2017