1 

NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 

1716 14TH ST., N.W., STE 200 

(202) 234-4433 WASHINGTON, D.C. 20009-4309 www.nealrgross.com 

U.S. DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES 

AND WORKER HEALTH

+ + + + +

WEDNESDAY

NOVEMBER 15, 2023

+ + + + +

The Advisory Board met at the 

Eldorado Hotel & Spa, Zia Boardrooms, 309 W San 

Francisco Street, Santa Fe, New Mexico, at 9:00 

a.m., Steven Markowitz, Chair, presiding.

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN

GEORGE FRIEDMAN-JIMENEZ*

MIKE VAN DYKE

MEDICAL COMMUNITY

MARIANNE CLOEREN

STEVEN MARKOWITZ, Chair

MAREK MIKULSKI

KEVIN VLAHOVICH

CLAIMANT COMMUNITY

JIM H. KEY

GAIL SPLETT

KIRK DOMINA

DESIGNATED FEDERAL OFFICIAL

RYAN JANSEN

 
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COURT REPORTERS AND TRANSCRIBERS 

1716 14TH ST., N.W., STE 200 

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ALSO PRESENT

KEVIN BIRD, SIDEM

D'LANIE BLAZE, CORE Advocacy for Nuclear & 

Aerospace Workers

SOPHIA CALBAZA, DOL

AMANDA FALLON, DOL

TYLER GREEN, DOL

DEB JERISON, Energy Employees Claimant

Assistance Project

REGINA GRIEGO-KELLEHER, DOE

GREG LEWIS, DOE

MATT MILLER, Field Representative, 

Congresswoman Teresa Leger Fernandez

RACHEL POND, DOL

CARRIE RHOADS, DOL 

TONYA TAYLOR, DOL

PETER TURCIC, Paragon*

JOHN VANCE, DOL*

*Present via video-teleconference
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COURT REPORTERS AND TRANSCRIBERS

1716 14TH ST., N.W., STE 200

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C-O-N-T-E-N-T-S

Item Page

Introductions 8

Review of Agenda 9

Welcome 18

Program and Policy Update

Site Exposure Matrices 43

Response to ABTSHW IH Recommendation 65

"Significance" of DOE Exposures 171

Public Comment Period 255

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

2 (9:01 a.m.)

3 MR. JANSEN: Good morning, everyone. 

4 My name is Ryan Jansen, and I'm the Designated 

5 Federal Officer for the Department of Labor's 

6 Advisory Board on Toxic Substances and Worker 

7 Health. I would like to welcome you to today's 

8 meeting of the Advisory Board here in Santa Fe, 

9 New Mexico. Today is Wednesday, November 15th, 

10 2023, and we are scheduled to meet from 9:00 

11 a.m. to 5:00 p.m. Mountain Time.

12 At the outset, I'd like to express 

13 my appreciation for the hard work of the Board

14 members in preparing for this meeting, and 

15 their forthcoming deliberations. I'd also like 

16 to thank Carrie Rhoads, from the Department of 

17 Labor, and Kevin Bird, our logistics 

18 contractor, who are both with me here today, 

19 for their work organizing this meeting.

20 The Board's website, which can be 

21 found at dol.gov/owcp/energy/regs/

22 compliance/advisoryboard.htm, has a page 
5 

NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 

1716 14TH ST., N.W., STE 200 

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1 dedicated to this meeting. The page contains 

2 materials submitted to us in advance of the 

3 meeting, and will include any materials that 

4 are provided by our presenters throughout the 

5 next day and a half. There, you can also find 

6 today's agenda, as well as instructions for 

7 participating remotely in both the meeting and 

8 the public comment period later today.

9 If any of the virtual participants 

10 have technical difficulties during this 

11 meeting, please email us at 

12 energyadvisoryboard@dol.gov. If you are 

13 joining by Webex, please note that outside of 

14 the public comment period this afternoon, this 

15 session is for viewing only, and microphones 

16 will be muted for non-advisory Board members. 

17 So the public may listen in, but not 

18 participate in the Board's discussion during 

19 the meeting.

20 If you are participating remotely 

21 and wish to provide a public comment, please 

22 email energyadvisoryboard@dol.gov and request 
6

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COURT REPORTERS AND TRANSCRIBERS

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1 to make a comment. Be sure to include your 

2 name in the request. If you are participating 

3 remotely and need to provide your comment via 

4 telephone, not Webex, please include the phone 

5 number that you will be dialing in from so that 

6 we can unmute your line when it is your turn to 

7 make a public comment.

8 The public comment period opens at 

9 4:15 p.m. Mountain Time this afternoon. Please 

10 note that the public comment period isn't a 

11 question and answer session, but rather an 

12 opportunity for the public to provide comments 

13 about the topics being discussed and considered 

14 by the Board. If for any reason the Board 

15 members require clarification on an issue that 

16 requires participation from the public, the 

17 Board may request such information through the 

18 Chair or myself.

19 A transcript in meetings will be 

20 prepared from today's meeting. As the 

21 Designated Federal Officer, I see that the 

22 minutes are prepared and ensure that they are 
7

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COURT REPORTERS AND TRANSCRIBERS

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1 certified by the Chair. The minutes of today's 

2 meeting will be available on the Board's 

3 website no later than 90 calendar days from 

4 today, but if they're available sooner, they'll 

5 be posted sooner. Although formal minutes will 

6 be prepared according to the regulations, we 

7 also prepare verbatim transcripts, and they 

8 should be available on the Board's website 

9 within 30 days.

10 During the discussions today, please 

11 speak clearly enough for the transcriber to 

12 understand. When you begin speaking, 

13 especially at the start of the meeting, make 

14 sure that you state your name so that it's 

15 clear who is saying what. I would also like to 

16 ask that our transcriber please let us know if 

17 you have trouble hearing anyone or any of the 

18 information that is being provided.

19 As always, I would like to remind 

20 Advisory Board members that there are some 

21 materials that have been provided to you in 

22 your capacity as special government employees 
8

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1 and members of the Board which are not suitable 

2 for public disclosure and cannot be shared or 

3 discussed publicly, including during this 

4 meeting. Please be aware of this throughout 

5 the discussions today and tomorrow. The 

6 materials can be discussed in a general way

7 which does not include any personally 

8 identifiable information, or PII, such as 

9 names, addresses, or a doctor's name if we are 

10 discussing a case.

11 I'm looking forward to working with 

12 everyone at this meeting and hearing the next 

13 discussions over the next day and a half. And 

14 with that, I convene this meeting of the 

15 Advisory Board on Toxic Substances and Worker 

16 Health. I will now turn it over to Dr. 

17 Markowitz for introductions.

18 CHAIR MARKOWITZ: Good morning. 

19 Welcome, members of the Board, members of the 

20 public, people from the Department of Labor, 

21 people from the Department of Energy, and 

22 members of the public who are online as well. 
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COURT REPORTERS AND TRANSCRIBERS

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1 And see Dr. Friedman-Jimenez, as you -- we can 

2 see you loud and clear. So that's excellent.

3 I want to thank Kevin Bird and his 

4 crew for putting this together, and of course 

5 to Ryan Jansen and Carrie Rhoads for all the 

6 preparation for this -- for today's meeting. I 

7 also want to thank -- I don't see Greg Lewis 

8 here yet, from the Department of Energy, but he 

9 arranged for us to have a tour yesterday, which 

10 was a very good tour of Los Alamos. We were 

11 lucky enough to get an excellent historian who 

12 had a lot to say, I would -- you know, and 

13 about the history, that -- particularly the 

14 early history of Los Alamos and the Manhattan 

15 Project.

16 And also, we had an excellent visit 

17 with the occupational medicine department at 

18 Los Alamos, which is something, actually, the 

19 Board hasn't done on previous tours. I thought 

20 that was useful. So thank you, Greg.

21 Let's do introductions, and then 

22 we'll quickly review the agenda. So my name is 
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1 Steven Markowitz. I'm an occupational medicine 

2 physician, epidemiologist, from City University 

3 of New York, and since 1997 have been running 

4 the former worker program, medical screening 

5 program for Department of Energy workers, now 

6 at 12 sites throughout the complex. Mark.

7 MEMBER CATLIN: Hi, my name is Mark 

8 Catlin. I'm a retired industrial hygienist. I 

9 spent many years working with different 

10 organizations at different DOE sites, and happy 

11 to be on the Board.

12 MEMBER VAN DYKE: Is that -- oh, 

13 there we go. It was already on. Good morning. 

14 My name is Mike Van Dyke. I'm an associate 

15 professor and industrial hygienist at the 

16 Colorado School of Public Health. I've spent 

17 many years doing research and working on 

18 several sites, mostly around beryllium 

19 exposure.

20 MEMBER CLOEREN: I'm -- I'm going to 

21 go through the same thing. You're hearing me? 

22 I'm Marianne Cloeren. I'm an occupational 
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1 medicine physician and associate professor at 

2 the University of Maryland School of Medicine. 

3 I have some background with federal 

4 compensation programs, and I guess this is my 

5 second year on the Board. Happy to be here.

6 MEMBER DOMINA: Good morning. My 

7 name is Kirk Domina. I'm a retired Hanford 

8 worker. I was reactor operations, nuclear 

9 chemical operator, and the employee health 

10 advocate for the bargaining agent. I was at 

11 Hanford for 38 years.

12 MEMBER MIKULSKI: I'm an 

13 occupational epidemiologist with the University 

14 of Iowa, Occupational and Environmental Health. 

15 I direct the former worker program for the 

16 former DOE workers from the State of Iowa.

17 MEMBER SPLETT: I'm Gail Splett. 

18 I've retired from the Department of Energy at 

19 the Hanford Site after 45 years. In that time, 

20 I served as a Freedom of Information Privacy 

21 Act Officer, technical information officer, 

22 litigation manager, senior records official, 
12

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1 and the EEOICPA program manager.

2 MEMBER BOWMAN: Hello, my name is 

3 Aaron Bowman. I'm a professor of toxicology at 

4 Purdue University. I'm in my second term on 

5 the Board.

6 MEMBER VLAHOVICH: Good morning, my 

7 name is Kevin Vlahovich. I'm an occupational 

8 medicine physician at the University of New 

9 Mexico.

10 MEMBER KEY: Good morning. I'm Jim 

11 Key, a 49 year plus employee at the Paducah, 

12 Kentucky Gaseous Diffusion Uranium Enrichment 

13 Facility. Having been on ground zero at the 

14 start and inception of this program, providing 

15 congressional testimony, and lobbying those in 

16 congress at the time for its passage, I look 

17 forward to the interactions of the Board 

18 members today, their insight, and how we can 

19 continue to streamline this convoluted program, 

20 correct the inaccuracies within it, and supply 

21 those claimants with the intent of Congress at 

22 its passage.
13

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1 I would also like to point out to 

2 you today, or inform you, this is the 

3 anniversary of Bill -- former Department of 

4 Energy Secretary Bill Richardson's birthday. 

5 As you may know, he passed away a couple of 

6 weeks -- months ago and was very instrumental 

7 in providing the FOIA documents that created 

8 this program. The help of him, along with Dr. 

9 David Michaels and others, we wouldn't be here 

10 today if it wasn't for him. So I just wanted 

11 to bring that to your attention.

12 CHAIR MARKOWITZ: Thank you. Dr. 

13 Friedman-Jimenez.

14 MEMBER FRIEDMAN-JIMENEZ: Good 

15 morning. I'm George Friedman-Jimenez. I'm an 

16 occupational medicine physician and 

17 epidemiologist at Bellevue Hospital, New York 

18 University School of Medicine Occupational 

19 Medicine Clinic, and this is my third cycle on 

20 the Board.

21 CHAIR MARKOWITZ: Okay, thank you. 

22 Could we -- we have a mic for members of the 
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1 audience. If you could introduce yourselves, 

2 that'd be great.

3 MS. CALABAZA: Hello. Sophia 

4 Calabaza. I'm from the EEOICPA program at the 

5 Los Alamos Field Office.

6 MS. TAYLOR: Hi, good morning. My 

7 name is Tonya Taylor. I am a policy analyst 

8 with the ombudsman's office for the EEOICPA.

9 MS. FALLON: Good morning. My name 

10 is Amanda Fallon. I'm the ombudsman for the 

11 Energy Employees Occupational Illness 

12 Compensation Program.

13 MS. GRIEGO-KELLEHER: Good morning. 

14 I am Regina Griego-Kelleher, and I am the 

15 EEOICPA program manager for the U.S. Department 

16 of Energy.

17 MS. JERISON: I'm Deb Jerison with 

18 the Energy Employees Claimant Assistance 

19 Project.

20 MR. GREEN: Hello. I'm Tyler Green, 

21 chief of staff for OWCP.

22 MR. MILLER: Good morning. I'm Matt 
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1 Miller, field representative with Congresswoman 

2 Teresa Leger Fernandez.

3 MS. POND: Good morning. I'm Rachel 

4 Pond. I'm the director of the Energy Program 

5 of the Department of Labor.

6 CHAIR MARKOWITZ: Carrie, did you 

7 introduce yourself, Carrie?

8 MS. RHOADS: I'm Carrie Rhoads. I'm 

9 the liaison to the Board for DOL and OWCP.

10 CHAIR MARKOWITZ: Okay. And then we 

11 have Kevin Bird and his group that -- who 

12 largely prefer to remain anonymous. So okay. 

13 Thank you. Let's discuss the agenda. Of 

14 course, we remind ourselves, our role is to 

15 provide advice to the secretary of labor

16 regarding the EEOICP program, in particular, 

17 their five areas in our charter, which we all 

18 know very well.

19 This is going to be an interesting 

20 meeting, I think, because we're going to have a 

21 lot of discussion about important topics. 

22 We're going to -- uh -- Chris Godfrey 
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1 unfortunately couldn't be here. He's the 

2 director of OWCP. Or he was here, but had to 

3 leave for a family emergency. So we're not 

4 going to receive a welcome from him, but we 

5 hope that everything works out well for him.

6 And we're going to hear from Ms. 

7 Rachel Pond, an update on the program. And 

8 then we're going to get into the site exposure 

9 matrices, which is, I think, actually, probably 

10 the number one task assigned to the Board if 

11 you look at our charter. And over the -- since 

12 2016, the formation of the Board, we have 

13 recurrently discussed the site exposure 

14 matrices, but we come back in the -- to that 

15 topic in the hope of providing additional 

16 advice.

17 And then we're going to talk about 

18 our responses to some recommendations the Board 

19 made; two recommendations at our meeting six 

20 months ago to the Department, which we received 

21 responses to those recommendations, and we're 

22 going to discuss our responses to those 
17

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1 responses.

2 Later today, we're going to discuss 

3 -- begin the discussion about the term 

4 significance and what that means in terms of 

5 how it's described in the procedure manual and 

6 how it's used, both in the industrial hygiene 

7 analyses of claims, and presumably in the 

8 medical consultant reports as well.

9 The timing on all of these topics, a 

10 little bit uncertain, because it's not clear 

11 how long discussions will last. But we'll be 

12 flexible about that. And then tomorrow, we've 

13 received a request from Department to look at 

14 some new probable human carcinogens identified 

15 by the International Agency for Research on 

16 Cancer that have been worked up by Paragon, and 

17 we've been asked to weigh in on whether those 

18 should be added to the site exposure matrices. 

19 So we'll begin a discussion of that tomorrow.

20 And then I'll get into miscellaneous 

21 topics regarding any changes in program 

22 policies and procedures, touch on new issues. 
18

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1 We would like to, if there are public comments, 

2 we'd like to discuss them here, to the extent 

3 that they relate to our charter, and then 

4 develop a plan for work over the next six 

5 months before our next meeting.

6 So are any -- any additions or 

7 corrections or suggestions about the agenda 

8 from Board members? Okay. Great. So let me 

9 welcome Ms. Pond to the speaker's table.

10 MS. POND: Can everyone hear me 

11 okay? Welcome, everyone. Welcome, Board 

12 Members. Thank you again for all of the work 

13 that you do to help us with our program. There 

14 -- this is not a simple program, as you all 

15 know. There are a lot of nuances and 

16 interpretations that are required, and a lot of 

17 science that's still yet to be developed. So 

18 we really do appreciate the time and effort 

19 that you all put into the work of the Board and 

20 the assistance that you provide us.

21 Today I'm going to walk through just 

22 some of our updates, kind of an overview of 
19

NEAL R. GROSS

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1 what we've been doing, a little bit about our 

2 policies and procedures, updates to that. And 

3 I think John Vance is on the line. He may or 

4 may not jump in. But after I talk, I will be 

5 happy to take questions before our program 

6 manager for the site exposure matrices comes on 

7 the line.

8 He was actually on his way here to 

9 be here in person with you, but the flights 

10 just did not cooperate all day long. He waited 

11 for flights, and they kept getting cancelled, 

12 and at the end of the day, he couldn't make it. 

13 So he will be here virtually.

14 So just a little update about new 

15 claims that we've had this -- it seems like 

16 we've had a little bit of an uptick in new 

17 claims in this last year, ranging about --

18 especially over the last couple of weeks, we've 

19 ranged about 300 new claims per week, a lot of 

20 those coming out of our New Mexico resource 

21 facility. I'm not sure what that is attributed 

22 to, but we have been able to do a lot more 
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1 outreach this year, to make people known about 

2 the program. And so that might be part of it.

3 We have -- cumulative total we've 

4 paid in the last -- in 2023 was $2.3 billion. 

5 Over half of that is -- goes to medical 

6 benefits. You know, with our elderly 

7 population and the rising cost -- and the costs 

8 of their care, a lot of it is home healthcare 

9 and medical, you know, other medical benefits, 

10 ancillary medical benefits. Home healthcare 

11 benefits continued to rise over the last 

12 several years. We've gone from about 9,000 

13 unique home healthcare payments in 2021 to 

14 12,000, over 12,000 in 2023.

15 And we -- as a result of these 

16 rising costs, and also just the rising 

17 benefits, we've really ramped up, in 2023, our 

18 medical benefits branch. We doubled the staff 

19 in that branch to handle all of the ancillary 

20 medical equipment and home healthcare requests 

21 that have been coming in. We've adjudicated 

22 over 54,000 claims for ancillary medical 
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1 benefits and home healthcare.

2 We have a new unit manager in that 

3 branch. We have a -- like, a total of six 

4 supervisory medical benefits examiners, and 52 

5 medical benefits examiners now, which is a 

6 significant increase to what we had in the 

7 past.

8 And something that -- the way that 

9 the medical benefits branch works is that the 

10 claims examiners' units, which are located in 

11 the district offices, they handle all the 

12 claims that are incoming, the development 

13 steps, all the steps before adjudication. The 

14 also will handle impairment and wage loss 

15 claims for benefits that come in after.

16 But there's a -- kind of a 

17 maintenance period after a claim is accepted, 

18 where the medical benefits need to be managed, 

19 and we need to make sure we're approving 

20 benefits as they come in. So that's why we 

21 created this other branch, so they could focus 

22 on that piece of it and our claims staff could 
22

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1 focus on the incoming, making sure we're 

2 getting decisions out the door.

3 And then we of course have our final 

4 adjudication branch, which is made up of our 

5 hearing representatives who handle the claims 

6 for after the recommended decision before a 

7 final decision.

8 We actually, you know, we have a 

9 very robust operational plan, meaning we have 

10 very tight timeframes for our claim staff to 

11 follow. It's in our operational plan, it's in 

12 the Department of Labor's agency management 

13 plan to make sure that we are moving these 

14 cases as quickly as possible while still 

15 maintaining the quality. And so one of our 

16 goals is to complete initial adjudication 

17 within 145 days 92 -- 90 percent of the time --

18 92 percent of the time, and we met that goal 

19 last year.

20 Final decisions on certain types of 

21 cases within 30 days, 99 percent. Within 75 

22 days, again, we are at 99 percent. A lot of 
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1 our final decision processing went a lot more 

2 quickly this year, partly due to the fact that 

3 we were able to hire up a little bit more, and 

4 we were able to redistribute the claims in 

5 certain ways. Our lump sum awards have been 

6 awarded within -- 99 percent within 14 days as 

7 well.

8 So that's just some of our 

9 statistics. I'll talk -- I'm going to talk 

10 just a little bit about the site exposure 

11 matrices before we bring on the project 

12 manager. But there have been 33 sent data sets 

13 updated for 33 sites in 2023. Department of 

14 Labor assumes sponsorship for Paragon's --

15 that's the contractor's name -- security 

16 clearances from DOE.

17 The appearance of silicosis 

18 diseases, some were updated to better support 

19 DOL procedures. So it now is silicosis acute, 

20 silicosis complicated, and silicosis simple. 

21 And their alias is combined under the same 

22 disease name, silicosis. The public internet 
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1 accessible site was updated on June 13th, 2023, 

2 and the next update is scheduled to occur on 

3 November 16th, 2023, which is today, I believe.

4 Fourteen sites changed since the 

5 last update on November 16th, 2022, including 

6 significant additions to Canoga Avenue 

7 Facility, Chupadera Mesa, Climax Uranium Mill, 

8 Connecticut aircraft Nuclear Engine Laboratory, 

9 Portsmouth Gaseous Diffusion Plant, S-50 Oak 

10 Ridge Thermal Diffusion Plant, Sacandaga 

11 Facility, Savannah River Site, and Uranium Mill 

12 and Disposal South.

13 I also just want to talk a minute 

14 about some changes that were made to our 

15 beryllium vendor coverage. We published a 

16 Federal Register notice on September 14th, 

17 2023, and we added a beryllium mill in Delta, 

18 Utah as a covered beryllium vendor facility. 

19 We extended coverage at beryllium mill in 

20 Delta, Utah, beryllium mine at Topaz-Spor 

21 Mountain in Utah, and Shoemaker's plant, 

22 Pennsylvania.
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1 This was -- basically has to do with 

2 the definition of Brush-Wellman, which in the 

3 site -- in the statute itself, it just says 

4 Brush-Wellman Incorporated, and including 

5 predecessors of such entities. So we had some 

6 questions arise as to what that actually means 

7 in the last year.

8 And so we've clarified that by 

9 adding these particular facilities. Brush

10 beryllium -- and we've identified these as 

11 Brush Beryllium Company, 1969 to 1971; Brush12 Wellman Incorporated, 1971 to January 23rd, 

13 2001; Brush Resources Incorporated, January 

14 23rd, 2001, to March 8, 2011; and Materion 

15 Natural Resources Incorporated, March 8, 2011, 

16 to the present.

17 And was the biggest, I think, one 

18 that kind of impacted these other beryllium 

19 vendors that we've accepted, and will impact 

20 future ones if we determine that they're part 

21 of this Materion Natural Resources.

22 We've also made some updates with 
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1 regard to our IT, our forms initiatives. There 

2 is a medical form called the 957 medical travel 

3 refund. This is basically for individuals who 

4 travel for medical appointments and that sort 

5 of thing. And they've been able to file this 

6 form manually for years, that's now electronic.

7 And this'll be followed by the 

8 addition of the EN-10 and EN-11B forms for 

9 impairment and wage loss, meaning people will 

10 be able to file those now electronically, and 

11 not just through the mail.

12 We are also this year in the process 

13 of developing a new consequential illness form. 

14 This is something that had been suggested by 

15 the ombudsman office for DOL. It's also some -

16 - from surveys we've received, public outcry 

17 about differentiating between an initial 

18 condition that has been filed and a new 

19 condition that is a result of that condition. 

20 And so that, I think, will be a welcome 

21 addition to our forms process, and will be 

22 coming out this year.
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1 We are also working to add more 

2 single sign on functionality for our systems, 

3 which really doesn't impact the public or you 

4 guys, but it just means it'll be a little bit 

5 easier for our staff to sign into various 

6 systems, ECS, SEM, OIS, that sort of thing.

7 And we're also looking to -- we're 

8 working for the Office of Worker's Compensation 

9 Programs and their administrative officer to 

10 change the provider enrollment form, just 

11 because we've found that a lot of the providers 

12 say that it's complicated, it's over -- it's 

13 excessive.

14 So we're trying to -- this is not 

15 our form for energy, you know, like, ourselves. 

16 But it is an OWCP form, so based on the 

17 feedback we've received from various surveys 

18 and from providers, we are going to try and 

19 simplify that form, make it a little bit easier 

20 to understand. Again, that's something that 

21 we're working on this year.

22 We're also going to continue to do 
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1 more outreach to the providers to help them 

2 understand the process, and to make sure that, 

3 you know, they're aware of the benefits that we 

4 do provide, and make it as simple as possible 

5 for them to understand so that we can get 

6 people to enroll in our program, doctors. As 

7 you know, there's a difficulty for claimants 

8 sometimes to find doctors who are willing to 

9 work with us. So we're going to continue to 

10 try to reach out to them.

11 As -- in terms of outreach, we were 

12 fortunate enough in 2023 to be able to go out 

13 and talk to people in person, and that was 

14 something that, you know, the pandemic had 

15 prevented us from being able to do. So in 

16 2023, we held nine joint outreach task force 

17 group town hall events, which is the events 

18 that we have with DOE, Department of Justice, 

19 and NIOSH. And that brought in about -- over 

20 1,300 stakeholders.

21 In 2024, we plan to hold four joint

22 events with the joint outreach task force 
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1 group. Those will include presentations from 

2 the various agencies, followed by Q&A, which is 

3 the way it typically is.

4 And then as a part of a broader 

5 strategy of targeted outreach, we're going to 

6 continue to reach out to underserved 

7 communities, locations identified through 

8 research we've done with the census bureau as 

9 having high populations of underserved 

10 communities. And we're going to prioritize 

11 those.

12 We also did, in fiscal year 2023, 

13 added two remote Navajo speaking caseworker 

14 positions to our resource centers as a part of 

15 our targeted outreach plan. They've -- they 

16 went to some of the -- they're going to 

17 continue to do outreach, and they can help us 

18 do translations when we do go out to the Navajo

19 regions. And I think it's going to be a really 

20 good, big benefit to us in terms of reaching 

21 out to that community.

22 We're also -- in this fiscal year, 
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1 we're going to be hosting smaller in-person 

2 outreach events throughout '24. This'll 

3 include our staff, research center staff, 

4 who'll present information to provide 

5 assistance to stakeholders. We're going to 

6 work with the JOTG on some of those events, but 

7 then we're all going to kind of try to find 

8 areas where we haven't been, which is always a 

9 challenge, continue to work with Department of 

10 Energy, with their lists that they have of 

11 former workers, to reach out to these areas. 

12 And we're going to come up with a calendar in 

13 the coming months to determine exactly where 

14 we're going to be.

15 We're also going to continue to 

16 sponsor webinars. We -- during the pandemic, 

17 we started to do webinars, since we couldn't do 

18 outreach to the public. And these webinars are 

19 basically people who've -- can subscribe online 

20 to get emails from us about policy or various 

21 other topics. We also publicize them.

22 But they're to count -- they're to 
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1 provide information to anybody who's interested 

2 on medical benefits, survivorship, covered 

3 employment, impairment, wage loss, our FAB 

4 operations, various tools and resources we have 

5 available, and that sort of thing.

6 We also continue to do -- in the 

7 last couple of years, we've started a very 

8 robust customer experience program. We have a 

9 series of staff dedicated to this, and we do 

10 surveys throughout the year, which we'll send 

11 out to our claimant population. Sometimes 

12 we'll send out after a certain type of 

13 development was set out, or we'll send it out 

14 after they've received a certain type of 

15 medical care, or an impairment, or wage loss, 

16 to ask them how it went, what we can do better.

17 And we've really been able to get a 

18 lot of information out of these in terms of 

19 what we can do to improve, how we can -- you 

20 know, where we can target our resources to make 

21 the lives of the claimants and other 

22 stakeholders better. We're going to continue 
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1 to do that in fiscal year '24.

2 We're also going to be updating our 

3 website to be more customer friendly. You 

4 know, some people say that it's hard to 

5 navigate our website, they don't know where to 

6 find things. So we're going to continue to try 

7 to make that better. And we're continuing to 

8 do what we call journey maps, which kind of 

9 gives you an idea of where -- how the claim 

10 process goes throughout the system. We're 

11 going to do another one of those on 

12 consequential illness claims in '24.

13 We also have a very robust quality 

14 control plan. We have an entire unit devoted 

15 to quality control. They review various types 

16 of decisions throughout the year, meaning they 

17 will look at the FAB decisions, our final 

18 adjudication branch decisions, medical benefits 

19 decisions, and claims examiners decisions, to 

20 determine accuracy, the quality of the case, 

21 the decisions that are being written and the 

22 development letters that are being written.
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1 And in addition to that, our -- all 

2 of our supervisors throughout the country do a 

3 very robust sampling, meaning every month, they 

4 review at least three cases a month, per CE, to 

5 see the quality of the work. It will, at the 

6 end of the day, impact their performance 

7 evaluations.

8 And we've continued our contract 

9 medical consultants and IH reviews. Those 

10 reviews encompass whether or not the contractor 

11 is adhering to the standards in the contract, 

12 but also whether or not our claims staff are 

13 referring claims in such a manner that it's 

14 understandable to the IH's or the CMC's who are 

15 receiving the request for information.

16 I'll go into a little bit of the 

17 federal procedure manual updates that we have 

18 made. In 2023, in March, we included guidance 

19 about references and links to all relevant 

20 former worker program websites. The part B 

21 silicosis, employment, and exposure criteria 

22 update for Nevada Test Site, industrial hygiene 
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1 exposure reporting language modification.

2 New chronic silicosis causal 

3 presumptions under part E, employment 

4 development requirements, to include cross5 reference of DOE, covered facility -- they're -

6 - I'm sorry. It's basically the -- how to 

7 cross-reference the covered facility database 

8 with this employee pathways overview document, 

9 which is a document we have for our claims 

10 staff that kind of goes into some detail about 

11 the various facilities and helps them to 

12 adjudicate their claims.

13 And then we are releasing, probably 

14 the end of this week, the latest procedure 

15 manual update. And that covers organ 

16 transplants as an accepted consequential 

17 condition. Claimant's eligibility for an 

18 impairment award not extinguished awaiting 

19 transplant. So it has to do with the 

20 transplants and their impairment awards.

21 The procedure for handling claimant 

22 delays and scheduling impairment ratings, so 
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1 we've found that for impairment ratings, 

2 claimants often times can't get a doctor very 

3 quickly who are willing to do these. So 

4 instead of just holding that case open, we're 

5 going to provide them with some options and 

6 tell them if they want to delay or defer that 

7 impairment instead of us denying it, they'll be 

8 allowed to do that for up to a period of a 

9 year. So that's in there.

10 There's some information about 

11 directed medical examinations, and we're also, 

12 you know, making sure that any impacted 

13 providers are provided copies of all decisions 

14 related to medical benefits that are relevant 

15 for that physician to have.

16 And then there's some guidance about 

17 the necessary -- where it's necessary to have a 

18 raised stamp for certain legal documents, and 

19 some follow-up actions for EN-20 forms, which 

20 is our payment forms, and how to make sure that 

21 those are getting returned. We've found that 

22 there have been a number of EN-20 forms, people 
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1 who have not returned their payment forms over 

2 periods of time.

3 And we've -- you know, want to make 

4 sure we're following through with those people 

5 to see -- make sure they understood that it's a 

6 payment form, that they -- if they return it, 

7 they will get money. I mean, in some cases, 

8 people don't necessarily want to complete that 

9 form because they have other conflicts like 

10 state worker's comp or tort.

11 But for the most part, you know, 

12 we've been seeing -- we've found that there are 

13 people that maybe just haven't been aware. So 

14 we're going to make sure that they're aware 

15 that that form we sent out is their payment 

16 form, to return it and they will get their 

17 payment.

18 We are also still working on the --

19 the Board has asked for access to our case 

20 files electronically, and we'll -- we are 

21 still, I think, in conversations with you guys 

22 about how to do that, how to make that happen, 
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1 and what it would look like. It would -- there 

2 is a ECOMP system that can get you through into 

3 our system in a way that would make it maybe 

4 easier to do overall. So we're still looking 

5 at that issue.

6 John, did you want to elaborate on 

7 anything that I said on the procedure manual 

8 updates?

9 MR. VANCE: The only thing that I 

10 would add is just on the comment on the 

11 beryllium vendor register notice, that was 

12 actually a Department of Energy publication. 

13 And that was something that we had worked with 

14 cooperatively with the Department of Energy to 

15 ensure that we had resolved a question of 

16 coverage for those beryllium vendor sites.

17 And I'd also like to add that for 

18 those affected cases, we have gone back to 

19 reevaluate cases that are now going to be 

20 getting coverage because of the changes, those 

21 beryllium vendor changes to the sites.

22 This is also something that we are 
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1 going, with regard to the presumptive standards 

2 that Rachel had mentioned, with the hearing 

3 loss and the silicosis, we're wrapping up our 

4 reevaluation of all of the potentially affected 

5 cases.

6 And we did that as a program to make 

7 sure that any change to those presumptions for 

8 the silicosis and the Nevada Test Site, and our 

9 hearing loss changes would also be reevaluated 

10 by the program. And I think we're wrapping 

11 that up. It's been a lot of cases looked at 

12 for the hearing loss we've reviewed. And 

13 that's all I had to add, Rachel.

14 MS. POND: Thank you. Questions?

15 CHAIR MARKOWITZ: Any Board members 

16 have questions? Go ahead, Dr. Cloeren.

17 MEMBER CLOEREN: Hi, Marianne 

18 Cloeren from the University of Maryland. I 

19 wanted to follow up on something you said. I 

20 wanted to make sure I understood it. The 

21 impairment ratings, the claimant is responsible 

22 for obtaining their own impairment rating exam? 
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1 Is there not an option to get a referral 

2 through the consultant network?

3 MS. POND: There -- yes. The 

4 claimants have a couple of options. Sometimes 

5 they want to go to their own doctor, and they 

6 know of a doctor they want to go to. And if 

7 they want -- if they choose that route, 

8 sometimes those doctors they want to go to are 

9 backed up for months. And so that's where 

10 sometimes that delay comes in.

11 We also will tell them, if you want 

12 to, at this point, have one of our contract 

13 medical consultants do this, you can. They 

14 would only have to go get a certain test, 

15 depending on the kind of, you know, impairment 

16 it is. But yeah, they do have the option, but 

17 often times they want to go with their own 

18 doctor.

19 MEMBER CLOEREN: Thanks.

20 MS. POND: Mm-hm.

21 CHAIR MARKOWITZ: Other questions? 

22 Actually, I have a few questions. So 500 -- or 
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1 excuse me, 300 new claims per week. That's 

2 15,000 a year. So we're 23 years into EEOICPA, 

3 we're 18 years after 2005 amendment. So that's 

4 a lot of activity.

5 And I'm just wondering if you have a 

6 sense of what all these new claims are about. 

7 Are these previous claimants who are coming in 

8 with new conditions? Are they people whose 

9 impairment rating has changed, their health 

10 status has changed, new requests for various 

11 types of medical benefits? Any --

12 consequential conditions. Any sense of that?

13 MS. POND: Yes. I think that a lot 

14 of them are more new conditions that are being 

15 filed from the same claimants. I think there's 

16 -- that could either be consequential or 

17 another separate condition. A lot of it is 

18 from ongoing, current, existent claimants.

19 That said, it's hard to say, you 

20 know, where that trend's going to go. And we 

21 still are seeing new people, new claimants, 

22 just not as many. I think a lot of this is 
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1 from recurring claimants.

2 CHAIR MARKOWITZ: And since we're 

3 here in New Mexico, and it seems to be a lot of 

4 new claims coming out of New Mexico, do you 

5 have any sense of what that's about?

6 MS. POND: Maybe just the outreach 

7 that we've been doing in that area. I mean, we 

8 did come out this direction last year and did 

9 some robust outreach to the Navajo area, and 

10 we've been doing some targeted outreach that 

11 way. But that's the only thing I can really 

12 say that I would be aware of that is moving it 

13 forward or making these cases more robust. 

14 John, do you think -- can you think of 

15 anything?

16 MR. VANCE: Yeah, hello everyone. I 

17 should have introduced myself. My name is John 

18 Vance. I'm the policy branch chief, so I'm --

19 CHAIR MARKOWITZ: John --

20 MR. VANCE: -- actually, Rachel --

21 CHAIR MARKOWITZ: -- it's Steven. 

22 If you'd just speak a little bit more slowly, 
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1 because you're coming through at super speed.

2 MR. VANCE: Okay. Good afternoon --

3 well, good morning, everyone. My name is John 

4 Vance. I should have introduced myself before. 

5 I am the policy branch chief.

6 My research and my inquiries into 

7 this, I think, is that you have particular 

8 representatives that are serving clients, and 

9 they are driving a lot of the work, at least 

10 from my ad hoc understanding of what's going on 

11 in New Mexico.

12 You have a couple of, or a few 

13 representatives who are just very active in 

14 submitting new claims for their clients and 

15 actually reaching out to their previously 

16 accepted claimants to have them file for 

17 additional conditions.

18 CHAIR MARKOWITZ: So are these 

19 workers from Los Alamos and Sandia here in New 

20 Mexico, or are these in part from people who 

21 have retired to New Mexico, they're from other 

22 facilities and retired here? Any sense of 
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1 that?

2 MR. VANCE: No, no. It just is that 

3 the resource center is the one with the intake 

4 of the claim, and so that would suggest that 

5 you're dealing with individuals that have 

6 either worked in New Mexico in either mining or 

7 Los Alamos or one of the sites approximate to 

8 New Mexico.

9 But really don't have any clear 

10 details on the genesis of this, other than the 

11 commonality of generally this means particular 

12 authorized representatives are driving a lot of 

13 the claims.

14 CHAIR MARKOWITZ: So -- thanks. Ms. 

15 Pond, you mentioned quickly about accelerated 

16 silicosis, chronic silicosis, acute silicosis. 

17 I didn't quite get what you were saying there.

18 MS. POND: John, do you want to go 

19 into that a little bit more?

20 MR. VANCE: Yeah. I'll just keep 

21 coming back for it. So when you -- what we did 

22 was -- we used to have, in the site exposure 
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1 matrices, these different variants of silicosis 

2 listed out separately. What we did was we just 

3 consolidated them all under a health effect for 

4 chronic silicosis, and then used all of these 

5 other aliases to sort of define what chronic 

6 silicosis is.

7 So now when you go into the site 

8 exposure matrices, you should be able to see --

9 or you'll see that chronic silicosis is listed 

10 there, and all these subsets of it are listed 

11 as aliases. It's just a method for simplifying 

12 the research that's done for those claims.

13 CHAIR MARKOWITZ: And that applies 

14 to part B and part E, right?

15 MR. VANCE: Principally, it's --

16 MS. POND: It's E.

17 MR. VANCE: -- the change that 

18 applies to the site exposure matrices, so it's 

19 going to be part E primarily. It doesn't 

20 affect how we evaluate the part B claims, 

21 because those are really rigorously set by the 

22 statutory provisions for silicosis.
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1 CHAIR MARKOWITZ: So the Board has 

2 never really focused much on consequential 

3 conditions. So these would be claims that come 

4 in for new ailments that are caused or somehow 

5 related, aggravated, contributed to by prior 

6 ailments that -- for which claims were 

7 submitted.

8 And I would imagine over time, in 

9 particular as claimants age, that consequential 

10 conditions would become more and more 

11 important. So I don't know whether this is 

12 something that the Board needs to take a closer 

13 look at or not. We've touched on it in the 

14 past.

15 The -- but if you could just explain 

16 why there was a need for a new consequential 

17 condition form, and who fills out that form, 

18 and what function it serves, that would be 

19 helpful.

20 MS. POND: Absolutely. The -- so in 

21 general, as you point out, we were getting just 

22 initial claims for new claims, new conditions, 
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1 and we were adjudicating those. And then we 

2 started seeing more claims being filed that had 

3 other conditions on there, and we couldn't 

4 always distinguish between whether that was a 

5 new condition that they're saying was related 

6 to their toxic substance exposure in the 

7 workplace, or that that was related to 

8 something we had already accepted, and they 

9 were saying it's related.

10 So that distinction was kind of 

11 difficult to navigate sometimes when we'd get 

12 these new claim forms in for -- under a same 

13 claimant name. And also, people were getting a 

14 little bit confused when filing these forms. 

15 They were just like well, I don't know. Do I 

16 file for a new condition? Do I just submit a 

17 letter from my doctor saying it's related and 

18 then it's accepted?

19 And we found we do need a new claim 

20 form, for certain legal reasons, to -- for them 

21 to file for any condition that they're going to 

22 file for. So they were being told okay, well 
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1 you still need to file a new claim form. And 

2 then the confusion into what are we developing 

3 for here, came into play.

4 For consequentials, it's a lot 

5 different. The process for accepting and 

6 developing a claim for consequentials is 

7 obviously a lot simpler, because we've already 

8 verified employment, we've already established 

9 causation for the other condition, that it's 

10 related to toxic substance exposure. And this 

11 is just a matter of having -- getting a report 

12 from a doctor linking that condition to the one 

13 that we've already accepted.

14 And so, you know, knowing right off 

15 the bat, when we get that claim in, that this 

16 is for consequential, it's going to take it 

17 down another path of review. And so making 

18 that distinction is important not only for 

19 claimants to understand, but also for our 

20 claims staff when they're getting these claims 

21 to know which direction to take it.

22 CHAIR MARKOWITZ: So I would assume 
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1 that a personal physician of the claimant is 

2 providing some documentation, some rationale 

3 for why this is -- the new ailment or whatever 

4 is a consequence of the prior. So are these --

5 do these often go the CMC for additional input, 

6 or are these usually settled at the level of 

7 the claims examiner, having had the input from 

8 the personal physician?

9 MS. POND: Typically, we don't -- a 

10 lot of these don't go to a CMC necessarily, 

11 unless there's some big question about the 

12 relationship between the condition and the one 

13 that we've already accepted. You know, if a 

14 doctor just says it's related and doesn't give 

15 us any other information about how or, you 

16 know, how it -- the nexus there, then we'll go 

17 back to the treating physician usually, and 

18 usually they can provide us more information. 

19 If they can't, then at some -- in some cases, 

20 we'll take it to a CMC to kind of help us 

21 determine that.

22 CHAIR MARKOWITZ: Mr. Key.
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1 MEMBER KEY: Rachel, you mentioned 

2 the outreach to the Native American. Good step 

3 forward with that -- with adding that 

4 translator, it's my understanding there's 20 

5 other tribes and Pueblos who also need to be 

6 considered with appropriate outreach and 

7 translators of their own.

8 MS. POND: Yeah. We are, as I said, 

9 it's actually a focus not only of the energy 

10 program, but we have a community of practice --

11 we're working with other agencies across the 

12 government, we're working with other agencies 

13 within Department of Labor to determine the 

14 best way to reach out to the tribal nations 

15 across the country in various ways of -- not 

16 only for the EEOICPA, but for other ways to 

17 reach out to them and to provide them with 

18 government benefits. So thank you for that.

19 CHAIR MARKOWITZ: So I have another 

20 question. The reevaluation, going back and 

21 looking at prior claims from a change in 

22 policy, of the program, that's very 
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1 interesting. That sounds very challenging and 

2 extremely useful to the claimants. And you 

3 mentioned the change in the hearing loss 

4 criteria, and also the change in silicosis.

5 So I know you're in the midst of 

6 doing that, but I would request that the Board 

7 receive the results of the reevaluation, how 

8 many people were affected, what the outcome of 

9 the relook was for -- both for hearing loss and 

10 for silicosis, because that's very interesting.

11 MS. POND: We can do that. I think 

12 that, you know, it's something we do anytime 

13 that there might be a change from a denial to 

14 an acceptance. Any time the Board makes 

15 recommendations that creates new, you know, 

16 links for us, we'll go back and look at those 

17 cases. And we do the same thing with the 

18 special exposure cohorts. So we'll definitely 

19 give you the results of that.

20 CHAIR MARKOWITZ: Okay. Any other 

21 Board comments or questions? Mr. Catlin.

22 MEMBER CATLIN: Thank you, Ms. 
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1 Ponds, for the report. You mentioned a claims 

2 manager quality control program, that monthly 

3 they review a small number of claims from other 

4 claimants. Did I understand that right? If 

5 you could describe that in more detail for us.

6 MS. POND: Sure. We -- in the 

7 national office, we have a group of -- well, we 

8 have a branch called the performance -- it's 

9 the -- our performance management branch. And 

10 within that branch, there is a unit of quality 

11 assurance or quality review analysts. And in 

12 the last few years, three or four years, we've 

13 created this unit in order to do a second level 

14 of kind of review of individual claims.

15 So these reviewers are not claims 

16 examiners. They are not associated with a 

17 district office. And they will take -- every 

18 month, they take a sample of cases in each 

19 category, a sample of cases from the final 

20 adjudication branch, medical benefits units, 

21 and our claims staff. They'll look at 

22 recommended decisions, final decisions, 
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1 development letters, and letter decisions that 

2 are issued.

3 And they've got a list of questions 

4 that they actually use them in our quality --

5 we've got a database that kind of captures it 

6 all. And they'll go through a list of all the 

7 different things to look for in the development 

8 of the case, in the final decision itself. And 

9 they'll categorize each case and determine 

10 whether there were deficiencies.

11 And at the end of each -- actually, 

12 the claims staff is given an opportunity, the 

13 supervisors, to go back and look at those each 

14 month to say oh, I'm looking at this case to 

15 see if there's a problem, if we need to fix it, 

16 or if I disagree. At the end of each quarter, 

17 we get quarterly reports based on these 

18 analyses throughout the year to provide us with 

19 that kind of real time evaluation of the claims 

20 and the quality thereof.

21 We used to do what we called annual 

22 accountability reviews. So we'd get a group of 
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1 staff together once a year, we'd review a 

2 sample of cases from these various categories. 

3 But there was only, like, maybe a small amount 

4 that we were looking at each year, and it only 

5 gave us a snippet in time. So we changed the 

6 process so we could actually see what's 

7 happening within the last month, within the 

8 last quarter.

9 MEMBER CATLIN: Thank you. Is that 

10 -- Dr. Markowitz, is that something we've seen? 

11 I don't -- that doesn't seem like reports that 

12 we've -- that the --

13 MS. POND: I --

14 MEMBER CATLIN: -- Board has seen.

15 CHAIR MARKOWITZ: You know, I don't 

16 know. I don't know.

17 MS. POND: I'm not sure.

18 MEMBER CATLIN: If not, is that 

19 something -- are there summaries or reports of 

20 that that we could be reviewing?

21 MS. POND: I believe so. I will --

22 MEMBER CATLIN: Okay.
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1 MS. POND: -- double check on that.

2 MEMBER CATLIN: Thank you very much.

3 CHAIR MARKOWITZ: Yeah, Dr. Cloeren.

4 MEMBER CLOEREN: I have another 

5 request, Ms. Pond. Would it be possible for us 

6 to review the questions that they're responding 

7 to? That'd --

8 MS. POND: Yes.

9 MEMBER CLOEREN: -- be helpful. 

10 Thank you.

11 CHAIR MARKOWITZ: Okay. Well thank 

12 you very much, Ms. Pond. Thank you, by the 

13 way, for coming here in person as well. And 

14 throughout our meeting, if you have additional 

15 comments or we have questions, feel free to 

16 participate. Thank you.

17 MS. POND: Absolutely. And I'll be 

18 here all day today. I am leaving tomorrow, but 

19 John will be online in the morning if you need 

20 --

21 CHAIR MARKOWITZ: Okay.

22 MS. POND: -- additional questions -
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1 -

2 CHAIR MARKOWITZ: Okay.

3 MS. POND: -- answered. Before we 

4 go on to the project manager for the SEM, I --

5 no? Do you want me to move to that or --

6 CHAIR MARKOWITZ: No, no. I just 

7 have one comment. Dr. Friedman-Jimenez.

8 MEMBER FRIEDMAN-JIMENEZ: Yes, thank 

9 you. I want to raise an issue that has become 

10 clear to me over the last several years, which 

11 is sensorineural hearing loss. And I think 

12 this is a policy issue because we've had 

13 discussions on this in the past.

14 This is common, it's debilitating, 

15 it's preventable, it's treatable with hearing 

16 aids, which are not generally covered by 

17 medical insurance or Medicare. And it can be 

18 caused by chemical exposure to a variety of 

19 toxic substances in the SEM, as well as noise 

20 exposure, which is not in the SEM, and combined 

21 causal effect of chemicals and noise exposure, 

22 as well as other things like ototoxic drugs 
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1 that are not work-related.

2 But it doesn't fit easily into 

3 either the SEM, because the SEM is qualitative; 

4 it's not quantitative. And sensorineural 

5 hearing loss is really dose-dependent. It's 

6 probably related most closely to the frequency 

7 of exposure to extremely high noise levels, 

8 peak dose, in essence. It doesn't fit easily 

9 into part B because it's not ionizing radiation 

10 and it's not consistently measured. There's no 

11 individual dosimetry conducted.

12 So in reviewing the SEM for the 

13 chemical causes of hearing loss, which we did 

14 several years ago, it became clear to me that 

15 there were many people likely that had noise16 induced hearing loss, or hearing loss due to 

17 the combined effects of noise and toxic 

18 substances.

19 So my question is, is there a way 

20 that this issue can be revisited? I understand 

21 that it's a legislative issue. It sort of 

22 falls between the cracks of part B and part E. 
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1 But I think that there are a lot of people that 

2 could be helped if noise-induced hearing loss 

3 combined with chemically induced hearing loss 

4 were incorporated into the program and people 

5 could at least get their hearing aids paid for.

6 It is debilitating, and hearing loss 

7 has been associated with cognitive loss. 

8 Whether it's causal or consequential isn't 

9 completely clear. But that's my question. Is 

10 there a way that we can revisit this, that the 

11 Board can suggest that this issue be raised to 

12 a level that it'd be discussed, and this be 

13 addressed by the occupational worker's comp 

14 program?

15 MS. POND: So I -- noise -- my 

16 understanding, in working with our lawyers, 

17 noise by itself is not something that's going 

18 to be covered under the statute the way it's 

19 written right now. But we do consider solvents 

20 and noise exposure together already in our 

21 policy and procedure.

22 And, you know, we've looked at this 
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1 over the years several times, and it's -- we do 

2 have a pretty specific way of evaluating it, 

3 based on numbers of years, based on the 

4 research we've done, based on, in fact, some of 

5 your input, the Board's input, we've changed 

6 that definition over the years.

7 But we are -- our hands are tied at 

8 a certain point when it comes to just noise, 

9 and we would have to have a combined with toxic 

10 substance exposure, solvents exposure with the 

11 noise. But, you know, we're always open to 

12 additional information or additional guidance 

13 that the Board may provide us on this issue.

14 MEMBER FRIEDMAN-JIMENEZ: So that 

15 raises the question, if someone did have purely 

16 noise-induced hearing loss, and they were a 

17 member of this program, what could they do? 

18 Could they file for worker's comp through their 

19 state where they were working, or is that 

20 precluded by their being in the OWCP? What 

21 would be their options to get some relief, and 

22 maybe get their hearing aids paid for, for 
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1 example, if it's not part of the EEOICPA 

2 program?

3 MS. POND: There are other options. 

4 I mean if -- just because they file for us, if 

5 we deny it, they can go to their state, they 

6 can go to their company, file for, you know, 

7 state worker's compensation, tort claims. If 

8 we do accept -- if we do end up accepting 

9 hearing loss, sensorineural hearing loss, and 

10 it is the combined, we will pay for their 

11 hearing aids.

12 But yeah, they're not precluded from 

13 filing in other areas. It's just there might 

14 be some offset if there's a dual benefit there.

15 CHAIR MARKOWITZ: This is Steven --

16 MEMBER FRIEDMAN-JIMENEZ: All right. 

17 So there's really no other additional action 

18 that can be taken because it's at the 

19 legislative level, and we're not prepared to go 

20 to that level. That's essentially the 

21 response?

22 MS. POND: I can't make those 
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1 suggestions at that level.

2 MEMBER FRIEDMAN-JIMENEZ: Okay. All 

3 right. I understand. Thank you.

4 MS. POND: Mm-hm.

5 CHAIR MARKOWITZ: This is Steven 

6 Markowitz. I just want to -- in 2017, the 

7 Board actually made a recommendation to the 

8 program regarding noise and solvent-related 

9 hearing loss. At that time, the requirement in 

10 the procedure manual was 10 consecutive years 

11 in a -- one or more particular list of 

12 occupations prior to 1990.

13 And we recommended that actually the 

14 number of years be reduced from 10 to 7, and 

15 also that the -- it not necessarily be 

16 consecutive, because it's cumulative without 

17 necessarily being consecutive. And I think we 

18 believed that the 1990 time -- date in 

19 particular seemed arbitrary.

20 I think -- I'm not -- I think our 

21 recommendation was largely not accepted, but 

22 there has been evolution in the program since 
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1 that time. So I think, for instance, the list 

2 of accepted occupations has been either 

3 broadened or there's been the provision that if 

4 the claimant could demonstrate that their job 

5 title was the equivalent of one or more of 

6 those on that list, in terms of noise and 

7 solvent exposure, that they would be eligible. 

8 And I think that the 1990 date has been also 

9 eliminated. 

10 MS. POND: I believe so.

11 CHAIR MARKOWITZ: So I would say 

12 that the program's slowly coming our way. 

13 Having said that, I think we could revisit 

14 this. Because the issue of 10 consecutive 

15 years, again, still seems arbitrary to me. And 

16 then the question of what the minimum number of 

17 years should be. Should it be 10 or should it 

18 be less than 10? 

19 So I would think this is fair game 

20 for the Board to relook at. Comments? Other 

21 Board members? Dr. Cloeren.

22 MEMBER CLOEREN: Yeah, I totally 
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1 agree. I mean, I gave a webinar on this topic 

2 about a week ago and was able to look at some 

3 of the just kind of changes in research. And I 

4 know our recommendations need to be evidence5 based, and I think there may be different 

6 evidence at this point that's worth taking a 

7 look at that might help support changes in some 

8 things. Maybe the list of jobs, maybe the 

9 timing. Is that me?

10 MEMBER SPLETT: Gail Splett. The 

11 other concern that I had, I did enjoy Dr. 

12 Cloeren's webinar very much, was the term 

13 consecutive years. On -- at least on the 

14 Hanford Site, a lot of our electricians, for 

15 example, are subcontractors. They're onsite, 

16 they're offsite, they're onsite, they're 

17 offsite. And what did that mean, absolutely 

18 consecutive? Is it 10 years combined, or does 

19 it truly need to be consecutive?

20 CHAIR MARKOWITZ: Well -- Steve 

21 Markowitz. I interpret the word consecutive to 

22 mean consecutive. But that's something we 
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1 should look at again. Mr. Key.

2 MEMBER KEY: Yeah, I'm Jim Key. 

3 Although changes have been made based upon the 

4 Board's suggestion, we are still seeing 

5 inconsistent interpretation of the new hearing 

6 loss guidelines. The CE's are not following 

7 the new hearing loss 7.0.

8 CHAIR MARKOWITZ: Dr. Bowman.

9 MEMBER BOWMAN: Yeah. This is --

10 thank you, Steven. I just want to second what 

11 Marianne said, and think given the amount of 

12 time passed, it definitely would be worthwhile 

13 looking at new evidence in the literature, and 

14 looking at that, I'd be happy to be involved in 

15 something like that.

16 CHAIR MARKOWITZ: You know actually, 

17 sir, while we're volunteering for this, I know 

18 that Dr. Friedman-Jimenez has an abiding 

19 interest in this topic. So I'm sure he's --

20 would be willing to participate, Dr. Bowman. I 

21 would as well. I think I was part of that 

22 recommendation in 2017. Anyway, if other Board 
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1 members -- you don't have to now, but if you 

2 decide you want to volunteer, you would be 

3 welcome.

4 Other comments or questions? So let 

5 me again thank Ms. Pond. Actually, welcome, 

6 additional people who have come into the room 

7 since we started. In particular, Mr. Greg 

8 Lewis from the Department of Energy. He's head 

9 of the unit that deals with EEOICPA information 

10 issues, and also the former worker screening 

11 program.

12 And Greg, before I -- in your 

13 absence, I thanked you for the tour --

14 arranging for our tour yesterday. It was a 

15 very informative historian, and a great visit 

16 to the occupational medicine program, so 

17 thanks.

18 Okay. Should we move on?

19 MS. POND: Sorry, yes. Before we 

20 introduce the program manager for the site 

21 exposure matrices, I think Ryan was going to 

22 say a few words. And then I want to answer one 
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1 of the questions on this before we go to him, 

2 because it was really directed to us. So go 

3 ahead, Ryan.

4 MR. JANSEN: Yeah. Thanks, Rachel. 

5 I just wanted to briefly outline the structure 

6 for this session. So the program manager for 

7 Paragon is here to provide responses to the 

8 written questions previously submitted by the 

9 Board. And the Board can certainly ask follow10 up questions of the program manger as necessary 

11 to clarify any of his responses.

12 However, if the Board has new 

13 questions on new topics, the Board will be able 

14 to submit those questions in writing after the 

15 meeting and receive those responses at a later 

16 date. Thank you.

17 MS. POND: Thank you, Ryan. I also 

18 just wanted to mention, and Dr. Markowitz, 

19 maybe we can discuss this, but he had suggested 

20 that maybe we could -- they could do a demo to 

21 small group of Board members, if you want to 

22 take that into consideration, of the SEM 
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1 itself, and kind of walk through some of that 

2 at a future date, maybe in one of your 

3 subcommittees or something like that, just to 

4 kind of give them a better understanding of the 

5 ins and outs of it.

6 I know you've got some demos, but it 

7 might be something you want to talk about and 

8 consider in -- just because in a smaller group 

9 and not a public meeting, if that's possible, 

10 that might be helpful to --

11 CHAIR MARKOWITZ: Sure. That'd be 

12 great. The offer is accepted.

13 MS. POND: Okay, great. The first -

14 - before we move on, the first question just 

15 asked about the status of -- you guys had asked 

16 for certain documents, like the contract for 

17 Paragon. We are still awaiting information 

18 from our procurement people at Department of 

19 Labor.

20 We did follow up with them just 

21 before I got here. I will follow up with them 

22 again on Friday when I return to the -- to D.C. 
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1 to ask them about this and elevate it as 

2 necessary. I apologize for the length of time 

3 it's taken to get you an answer on that, and 

4 hope to get you something very shortly about 

5 what we can and cannot give you regarding that 

6 contract. Ms. Splett?

7 MEMBER SPLETT: Gail Splett. One of 

8 the things that we talked about this morning is 

9 one of the things we're not interested in in a 

10 contract are any financial arrangements --

11 MS. POND: Okay.

12 MEMBER SPLETT: -- how the 

13 contractor's paid, how they're paid, what 

14 they're paid is not really of interest to us.

15 MS. POND: Okay. So we can make a 

16 note of that. Okay. So without further ado, 

17 as I indicated, unfortunately he couldn't be 

18 here in person, but is on the -- online. Mr. 

19 Pete Turcic is the program manager for the site 

20 exposure matrices.

21 He has extensive experience with 

22 this program. As many of you may know, he used 
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1 to be the director of the energy program at 

2 Department of Labor before me. He also has 

3 extensive scientific experience over his long 

4 career at various agencies. And I will turn it 

5 over to him. Pete.

6 MR. TURCIC: Thank you, Rachel. Can 

7 you hear me?

8 MS. POND: Yes.

9 MR. TURCIC: Okay. Thank you. Like 

10 Rachel said, I really -- I'm sorry that I 

11 couldn't, you know, make it out there to be 

12 with you in person. It'd be a lot simpler. 

13 But United Airlines just wouldn't cooperate 

14 yesterday.

15 I guess I'll just go through these 

16 additional questions. The second one regarding 

17 the -- that SEM includes 132 substances with 

18 152 disease links not in HAZMAT. And the Board 

19 is requesting that this -- for the list of 

20 those associations.

21 Our chemical manager put together a 

22 list for me. I just received it. Basically, 
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1 it gives you an idea of what those substances 

2 are and the links. A hundred eleven substances 

3 are tied to Parkinsonism in SEM, which is not 

4 in HAZMAT. HAZMAT does not recognize 

5 Parkinsonism, and so there were 111 substances 

6 that are tied to that disease.

7 The remaining of those 132 

8 substances, there was 21 substances tied to 41 

9 diseases that are not in HAZMAT, and those are 

10 all based on the Board's recommendation to 

11 include the IR2A links. So that's -- that is 

12 the genesis of those substances that -- and 

13 disease links that are in SEM.

14 And I just got that, as I said, I 

15 just got that list. I'll be submitting it to 

16 DOL, and then, you know, for response, you 

17 know, back to the Board. Any other questions 

18 on those differences?

19 CHAIR MARKOWITZ: Dr. Bowman.

20 MEMBER BOWMAN: Yes. This is Aaron 

21 Bowman. I just -- I obviously will wait until 

22 we get the actual list. But of the 111 that 
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1 are tied to Parkinsonism, which seems very 

2 reasonable, there are actually a large number 

3 of chemicals tied to Parkinsonism, could you 

4 talk to me about sort of the timing of when 

5 those got added and the rationale, just like 

6 you just did for the IR related --

7 MR. TURCIC: Yeah. The rationale 

8 for that was based on, as you know, HAZMAT does 

9 not recognize Parkinsonism. And at DOL's 

10 direction, Parkinsonism was going to be 

11 recognized and linked. And so we went through 

12 and tied 111 substances to Parkinsonism.

13 MS. POND: And this is Rachel. Just 

14 to clarify, our toxicologist did some research 

15 on that, and we had various -- and that was 

16 part of the reason.

17 MR. TURCIC: Yeah.

18 MEMBER BOWMAN: And just sort of the 

19 timing on that.

20 MS. POND: We'd have to go back and 

21 look at the exact time when those were added. 

22 I don't have that off the top of my head. 
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1 Pete, you don't either, I'm assuming.

2 MR. TURCIC: No, I don't know 

3 exactly. It was quite a while ago.

4 MS. POND: Yeah. It's been a while.

5 MEMBER BOWMAN: That's fine.

6 CHAIR MARKOWITZ: Steve Markowitz. 

7 Excuse me. Actually, I think I remember. The 

8 Board made a recommendation around Parkinson's 

9 disease --

10 MS. POND: Yes.

11 CHAIR MARKOWITZ: And also the 

12 second set that Mr. Turcic mentioned, the IR2A 

13 carcinogens. That was June 2020. Dr. Mikulski 

14 led the group that looked at Parkinson's 

15 disease within the Board, he made a certain 

16 recommendation, and that was accepted by the 

17 program.

18 And so thereafter it became 

19 operational, they had to determine which 

20 particular agents would be covered. And 

21 actually, I don't think we've ever seen that 

22 list. So we welcome seeing that list. So 
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1 that's the genesis. It would have occurred --

2 would have happened over the past three years.

3 MR. TURCIC: Okay. As I said, I'm -

4 - I just got the list, and I'll be, you know, 

5 submitting that to DOL.

6 MS. POND: So the --

7 MR. TURCIC: Any other questions?

8 MS. POND: Sorry. This is Rachel. 

9 Before Pete goes on, the next -- number three 

10 question you guys had was that you indicated 

11 that the SEM links for the four closure sites 

12 didn't work. And, you know, we did go back in 

13 and basically tried to reenact getting to those 

14 links, and were able to successfully use the 

15 closure links for Rocky Flats and K-25.

16 Again, maybe that demonstration that 

17 we've talked about can help with that. And 

18 Pete, you can add to that if you have anything 

19 to add to that.

20 MR. TURCIC: Yes. I just wanted to 

21 add that if -- the way it is presented in the 

22 IAS, or the internet accessible SEM, is there's 
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1 a -- up on the right-hand side, when you pull 

2 up the site, it'll say, you know, search a 

3 specific to the selected site, and like, for 

4 example, it'll say Oak Ridge Gaseous Diffusion 

5 Plant, and then below, in a -- in blue 

6 lettering would be, you know, to see the 

7 closure profile, and you just click on it for 

8 the closure from 1988 and beyond.

9 And then when you click on that, 

10 that brings up -- that'll bring up, in IAS, 

11 that'll bring up the closure profile for K-25, 

12 for example. And then the blue below would be 

13 -- would give a warning -- not a -- I mean an 

14 indication to return to the main Oak Ridge 

15 Gaseous Diffusion Plant profile, all pre 1988 

16 plant operations, and 1988 to 2020 basic site 

17 services. And then you click on that and it 

18 takes you back to the operational site profile.

19 That may be confusing, but it is 

20 explained in the -- if you go to the guidelines 

21 that are on the public SEM, it'll explain how 

22 you go back and forth on those.
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1 CHAIR MARKOWITZ: Okay. Thank you.

2 MR. TURCIC: On question four, 

3 seeing the change logs was useful. And for 

4 nondisclosure sites, it was unclear how SEM 

5 captures the changing nature of toxic substance 

6 exposures by job category buildings over time.

7 Here again, a demonstration would 

8 probably be the most useful. But in responding 

9 and putting together, you know, the response 

10 for that, we -- I tried to look for some 

11 examples to use as a -- to demonstrate.

12 And a very good example to show you 

13 what -- how things, you know, stay in SEM 

14 throughout the life cycle of a particular 

15 element, a good example is the Hanford B 

16 reactor. You know, it is now a National 

17 Historic Landmark at the Hanford site. But it 

18 was the world's first plutonium producing 

19 reactor created in the Manhattan Project.

20 At that building, the construction 

21 for B reactor began in 1943. And it was 

22 initially shut down at the end of 1946, but 
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1 then restarted in '48 to continue to support 

2 the production of plutonium for the Cold War, 

3 and it operated until 1967.

4 As I said, the B reactor is now a 

5 museum. And in fact, the Department of Energy 

6 offers public tours at it. If you go into SEM 

7 and you look at B reactor, basically what it'll 

8 show you, that there are 44 toxic substances 

9 listed as potential exposures in building 105C, 

10 which is now listed as an alias of the B 

11 reactor museum.

12 If you look at some of those 44 

13 contaminants, they include things like carpet 

14 cleaners, floor strippers, floor waxes, and 

15 other commercial cleaning products that you 

16 would expect, you know, to see in something 

17 like the museum. But then there's also present 

18 a whole host of contaminants that you would 

19 expect to see at a operating reactor or a, you 

20 know, during the decommissioning and 

21 decontamination of the reactor building.

22 And for -- like for example, there -
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1 - the site, the work processes, activities that 

2 are listed in that include things like asbestos 

3 assessment and abatement, cleanup equipment 

4 with solvents, decontamination and deactivation 

5 commissioning, D&D activities, museum and 

6 visitor support activities, reactor operations, 

7 and bell pit operations.

8 And also, you know, some of the 

9 labor categories that are there span that whole 

10 life cycle also, asbestos worker, 

11 decontamination and decommissioning worker, D&D 

12 worker, D&D operator, laborer, operator of 

13 nuclear plant, operator of nuclear process, and 

14 health physics technician.

15 That was just one example of what is 

16 attempted, and any information that we get that 

17 we apply to a building or a work process, that 

18 stays in SEM and does not come out. And then 

19 it's just factored in in the, you know, during 

20 the adjudication process of, you know, what 

21 contaminants may be applicable to a given labor 

22 category or work process.
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1 There's many other examples. And I 

2 think, again, I think some demonstration may be 

3 well worth it to, you know, to show how things 

4 that people have specific questions about 

5 specific sites, in that we could go through and 

6 demonstrate and see what is in SEM now.

7 If we had identified a document that 

8 -- and something was added to SEM, we don't 

9 take it out when, you know, when the nature of 

10 the building changes. Any other questions on 

11 that?

12 CHAIR MARKOWITZ: This is Steve 

13 Markowitz. So under what circumstances do you 

14 remove information from the SEM?

15 MR. TURCIC: The only time we remove 

16 information is if we find information that is 

17 an obvious error. To give you an example, we 

18 recently, in the spreadsheet in the SEM 

19 display, the SEM profile for ORISE included for 

20 the labor category for the security guards, 

21 included information, the generic profile 

22 information for, you know, weapons work. 
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1 Cleaning weapons, target practice, there -- a 

2 whole -- there was a whole profile or a generic 

3 profile for weapons work.

4 Well, in a SEM mailbox question, and 

5 in contact with the -- with DOE at the site, we 

6 came to find out that the guards at ORISE never 

7 carried weapons. So that was one example of, 

8 you know, substances that would be removed. We 

9 don't remove things, and anything that's taken 

10 out is, you know, is coordinated with DOL.

11 CHAIR MARKOWITZ: Other comments, 

12 questions from Board members? Mr. Key.

13 MEMBER KEY: So explain to me, if 

14 you will, how we have a SEM database for the 

15 Paducah Gaseous Diffusion Plant that had its 

16 own fluorine sale operation, and when you go to 

17 that building, fluorine is not a listed 

18 chemical under it. There's no chemical 

19 relation or chemical stated for that building 

20 at all. How is that possible?

21 MR. TURCIC: It would depend on how 

22 -- so you're saying fluorine don't show up at 
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1 all in the -- or for the building or that work 

2 process?

3 MEMBER KEY: I'm sorry. I didn't 

4 understand your statement.

5 MR. TURCIC: If you look under the 

6 work process, would fluorine show up for that 

7 labor category?

8 MEMBER KEY: No, it does not.

9 MR. TURCIC: I would have to look 

10 into that. And which building is that?

11 CHAIR MARKOWITZ: Are there more 

12 comments, questions?

13 MR. TURCIC: Which building was it 

14 in Paducah?

15 MEMBER KEY: It was the C410, K, and 

16 D building.

17 MR. TURCIC: C4 --

18 MEMBER KEY: C410 -- 4, 1, zero, D, 

19 and K building.

20 MR. TURCIC: We'll look into that 

21 and provide a response to, you know, to DOL 

22 that they can pass it on to the Board, then.
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1 CHAIR MARKOWITZ: So this is Steve 

2 Markowitz. I have a question.

3 MR. TURCIC: Sure.

4 CHAIR MARKOWITZ: So I think I 

5 understand closure sites and how the SEM 

6 addresses them for -- et cetera, that --

7 MR. TURCIC: Yeah.

8 CHAIR MARKOWITZ: -- there's a 

9 description of -- there's inclusion of job 

10 titles, work processes, agents, buildings, et 

11 cetera, facilities that are applicable when the 

12 site was active, and then you can --

13 MR. TURCIC: Mm-hm.

14 CHAIR MARKOWITZ: -- delineate 

15 pretty clearly the period of time when the D&D 

16 occurred and it was closed, and what the 

17 potential exposures were during that time 

18 period with associated --

19 MR. TURCIC: Mm-hm.

20 CHAIR MARKOWITZ: -- job titles and 

21 the like. So I think I get that. I'm not sure 

22 I accessed every one, but I think I get the 
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1 approach.

2 But what I still don't understand is 

3 all these sites evolve over time in terms of 

4 what they do, what their function is. They 

5 take on special projects during certain 

6 periods. And the SEM by and large doesn't 

7 contain dates. It doesn't really date when 

8 certain activities occurred. There might be 

9 closure dates --

10 MR. TURCIC: Right.

11 CHAIR MARKOWITZ: -- but generally 

12 speaking, there aren't dates. And I understand 

13 why there are not dates, because probably the 

14 underlying information didn't allow you to put 

15 in dates accurately, with confidence. So I get 

16 that.

17 But as the mission of a site, the 

18 activities, what it does evolves over the 

19 decades, I don't quite get how the SEM contains 

20 the information about how potential exposures 

21 might evolve over that period. Again, I'm not 

22 talking about closure activities. I'm talking 
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1 about a site that was active, still active for 

2 decades, in a given building, and they did one 

3 thing in the '70s and something else in the 

4 '90s. Even the same job title could change in 

5 terms of the insulators work with asbestos in 

6 the '70s, and in the '90s it was fiberglass. 

7 So how does the SEM deal with that kind of 

8 evolution?

9 MR. TURCIC: It -- all of the 

10 substances, SEM is basically validating that 

11 there was some document identified that some 

12 toxic substance was potentially present. So if 

13 it was present, it stays in SEM. And SEM 

14 cannot identify -- you're absolutely right 

15 about dates. There's -- that's next to an 

16 impossibility, to identify dates.

17 As an example, you know, there are a 

18 lot of refrigerants and things like that that 

19 changed over time, and SEM contains them all. 

20 And then during the claims process is where it 

21 is worked out what is the likelihood, you know, 

22 of some contaminant.
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1 But like I'm saying, we -- if we 

2 document and validate a substance was present, 

3 it stays there. The example that I was talking 

4 about is a perfect example, is that reactor B. 

5 There's information in SEM today that covers 

6 that reactor B through the whole life cycle, 

7 when it was a reactor being constructed, when 

8 it was operating as a reactor, when it was 

9 decommissioned, and now that it's a museum. 

10 And that's the general principle that is 

11 applied to SEM.

12 Dates are -- and as you know, dates 

13 can be very misleading. For example, when a 

14 building goes into operation, that's usually 

15 the date or, you know that is in documents that 

16 something became operational. But in the DOE 

17 process, those processes were tested prior to, 

18 you know, before there was readiness reviews, 

19 things like that.

20 And so there were potential 

21 exposures, and that's why we put -- when we 

22 identify a potential exposure for a process or 
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1 a building or a labor category, it goes into 

2 SEM and it remains there, again, unless we find 

3 out that there was some error.

4 CHAIR MARKOWITZ: So by the way, 

5 another example, just to probe a little here --

6 and Mr. Key, I may need some help. But in the 

7 '70s, in Paducah, there was a period of time 

8 when they were undergoing major renovation, or 

9 some major redo of some -- yeah, okay. And so 

10 that was time -- that was a time-limited 

11 project, right? That occurred over whatever 

12 number, three, four, five years -- eight years. 

13 Okay. And that was in the '70s right, roughly?

14 And so that special process entailed 

15 -- well this is a question, actually. Would it 

16 have entailed, perhaps, different exposures 

17 than occurred otherwise, either before or after 

18 that at Paducah?

19 MEMBER KEY: Well, certainly, any 

20 exposures that occurred during that time, 

21 because they were tearing down and rebuilding a 

22 cascading enrichment cell, one per week. You 
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1 had three basic labor categories. They're 

2 tearing it apart and putting it back together.

3 This is when the 40-foot converters 

4 were cut out and lifted up above the workers, 

5 taken down a crane rail, hitting lead air, 

6 thereby producing HF where you couldn't even 

7 see the crane operator operating a crane.

8 And after that Sitka Cascade 

9 Improvement Project, those exposures, you know, 

10 decreased significantly. There were still 

11 some. There was still some HF exposure and 

12 equipment leaks. But by and large, during that 

13 phase of the cascade improvement process is 

14 when you had the potential and the likelihood 

15 of the greatest exposure period, with exception 

16 to the plutonium exposure that the federal 

17 investigative DOE team came into Paducah and 

18 created EEOICPA.

19 CHAIR MARKOWITZ: Okay. So I take 

20 it then that certain exposures might have been 

21 more intense, but SEM doesn't deal with 

22 intensity of exposure.
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1 MR. TURCIC: Right.

2 CHAIR MARKOWITZ: But if there were 

3 some chemicals that were used in the eight year 

4 period that weren't used previously or 

5 thereafter, so they would be unique to that 

6 operation, that period of time at Paducah, so 

7 the question really is, then, for Mr. Turcic is 

8 so how do you deal with that in the SEM? 

9 Because Paducah operated from '53 -- yeah, '52 

10 to '20.

11 MR. TURCIC: The way we deal with 

12 that is that we're always updating and getting 

13 -- if we got documents, and I'm sure if it was 

14 a major project that they probably had 

15 documents identified -- that identified that as 

16 a process, and then that information would be 

17 in SEM.

18 And the way we deal with that on a 

19 continuing basis is when we are trying to 

20 update all these active -- the large active 

21 sites on a five to 10 year cycle, and the way 

22 we try to do that is we have a two-tier 
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1 process. The initial request for documents is 

2 we'll ask for very high level documents.

3 Like we're in some reviews now that 

4 the last major review was in 2015. So our 

5 first initial document request from DOE would 

6 be high level documents, like their -- asking 

7 for their capital projects back to 2015, and 

8 asking for their industrial hygiene surveys, 

9 and other 851 required, you know, documentation 

10 back to that time. We asked for information on 

11 maps, the most current map. And then our 

12 researchers look at that information and 

13 identify things that, you know, that we may not 

14 have in SEM currently.

15 And then our -- we go with our 

16 second document request, where we get more 

17 specific, you know, input. Well, we don't have 

18 this process, so can you give us the procedures 

19 related to that, the health and safety analysis 

20 reports related to that, and so forth?

21 So we're always trying to, you know, 

22 update things. And we try to keep track of 
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1 major projects that are going on in the DOE 

2 facility. And when things change, we try to, 

3 you know, to schedule an update in order to add 

4 the new facilities and things like that.

5 We've been doing that for quite a 

6 while now, and that seems to be the best way we 

7 know how of, you know, keeping up with changes 

8 at sites, because there's changes all the time.

9 CHAIR MARKOWITZ: Mr. Key.

10 MEMBER KEY: Yeah. Mr. Turcic, back 

11 to my initial question to you regarding the 

12 C410 D --

13 MR. TURCIC: Yes.

14 MEMBER KEY: -- and C410 K 

15 buildings. Fluorine is listed --

16 MR. TURCIC: Yeah.

17 MEMBER KEY: -- but when you go down 

18 to the labor category involved, it has none. I 

19 have a group of workers who most recently, 

20 within the last year and a half, were running a 

21 special project, and we will be filing their 

22 claims as a group, not as individuals. They're 
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1 -- this was a specific project. They all 

2 received high exposure from fluorine, and one 

3 had to be treated in the hospital for four 

4 days.

5 So when we pull up the SEM, or when 

6 someone submits a claim and the CE pulls the 

7 SEM up and there's no labor category involved 

8 in this building location, then they're 

9 automatically denied.

10 MR. TURCIC: That's -- I would be 

11 surprised if that's the case. First of all, 

12 you've got to realize that SEM is basically a 

13 relational database. And if that -- those 

14 chemicals were tied to that labor category, it 

15 would show up as that labor category. And then 

16 if that labor category is shown working in that 

17 building, then that's how it gets tied in, you 

18 know, to tie it into that building.

19 MEMBER KEY: To my point exactly. 

20 There is no labor category listed.

21 MS. POND: Okay. This is Rachel --

22 MR. TURCIC: What do you mean 
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1 there's no labor --

2 MS. POND: This is Rachel. I just 

3 wanted to add here that, you know, the SEM 

4 isn't a decisional database. The claims 

5 examiners don't go to SEM and say this will 

6 determine whether or not a case is accepted or 

7 not. But we look at all the other evidence in 

8 the case file, any statements that are 

9 submitted, affidavits, we utilize our 

10 industrial hygienists.

11 You know, so yes, the SEM is built 

12 as a tool to assist our claim staff in 

13 adjudicating claims, in helping them guide 

14 their -- the direction of the claim. However, 

15 they look at everything that's submitted in the 

16 case file and take that a whole. So I just 

17 wanted to make sure we're keeping that in mind 

18 when we say, you know, oh, it's not in SEM, and 

19 therefore it's going to be denied.

20 Also, the SEM is always evolving. 

21 It's not going to be -- have everything in it 

22 from day one. That's why we're constantly 
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1 updating it. As we get more information, we 

2 can submit things through the SEM mailbox and 

3 they will review those incidents, accidents, 

4 things like that.

5 So all of that can be added if we 

6 don't already have information about it. And 

7 when we're looking at an individual case, we're 

8 looking at the whole. So I just wanted to 

9 clarify that.

10 MR. TURCIC: Rachel, can I add 

11 something there? I can give you a direct --

12 recent example that Rachel is mentioning, that 

13 in a case that was filed, a claims examiner had 

14 a question, and some of the -- a DAR request, 

15 the document access request that a claims 

16 examiner gets from DOE had information that was 

17 not in SEM.

18 So they sent a question to the SEM 

19 mailbox, and information from a medical record 

20 that was in that claim was then used to add 

21 that to SEM. And we add -- you know, you had a 

22 question -- the Board had a question about the 
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1 difference between minor and major updates. 

2 Most of the minor updates are things where we 

3 get documents through the SEM mailbox, or come 

4 through the IAS, that has information not in 

5 SEM that we then update that profile to add 

6 that information.

7 CHAIR MARKOWITZ: This is Steve 

8 Markowitz. So I know you're updating the SEM 

9 all the time, but how much new information do 

10 you really get about the old processes, you 

11 know, going back to the '60s, '70s, '80s. Are 

12 you really receiving new documents regarding 

13 those -- that era in terms of updating the SEM, 

14 or is most of the update really framed around 

15 the current or recent activity, say over the 

16 past 10 years?

17 MR. TURCIC: The -- more the 

18 current, recent, over the past 10 years. 

19 However, our library has thousands of records 

20 that were received initially, and then in 

21 subsequent, you know, updates from the DOE 

22 sites. You know, we're always receiving 
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1 documents from the DOE sites.

2 Again, you're right. Most of the 

3 records were -- from years back were received 

4 in the initial development of SEM, where the 

5 researchers went to the -- right to the sites 

6 and obtained records, and those are all in our 

7 -- in the library. But there's very few -- we 

8 very seldom get new records that are dealing 

9 with, you know, from years ago.

10 CHAIR MARKOWITZ: Are there 

11 comments, questions from the Board? Ms. 

12 Splett.

13 MEMBER SPLETT: Are we going to go 

14 to the original questions that we sent to 

15 Department of Labor, or just these supplemental 

16 ones?

17 CHAIR MARKOWITZ: We may go through 

18 whatever we want to go through. So if we're 

19 going to start on a series of questions, we 

20 might take our break for a few minutes and then 

21 start. Maybe that'd make some sense.

22 MS. POND: Doctor Markowitz, we have 
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1 this set of questions still, which there's 

2 only, I think, four more questions on here. We 

3 can go back through those other responses. I 

4 just -- there was a lot of them, so just keep 

5 that in mind.

6 CHAIR MARKOWITZ: Right, right.

7 MS. POND: That was like 10 pages 

8 worth of questions. I'm not sure you're going 

9 to be able to go through all 10 of them --

10 CHAIR MARKOWITZ: Right.

11 MS. POND: -- today. But --

12 CHAIR MARKOWITZ: We'll try to speak 

13 quickly.

14 MS. POND: All right, thanks.

15 CHAIR MARKOWITZ: Okay. So it's 

16 quarter of 11:00, so let's take a 15 minute 

17 break, reconvene at 11:00 a.m. Thanks.

18 (Whereupon, the above-entitled 

19 matter went off the record at 10:42 a.m. and 

20 resumed at 11:01 a.m.)

21 CHAIR MARKOWITZ: Okay, let's 

22 resume. I want to remind the Board members, 
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1 having not reminded you before, that when you 

2 have a comment or you want to speak, just if 

3 you could take your name board and put it 

4 vertical so I -- otherwise, I'm just looking 

5 around the room.

6 So Ms. Splett, you had some 

7 responses or questions you wanted to follow up 

8 on.

9 MEMBER SPLETT: I do. I have some 

10 questions of -- after I got those answered --

11 CHAIR MARKOWITZ: Is your mic on?

12 MEMBER SPLETT: -- whether the rest 

13 of the team wants to go through the Board --

14 CHAIR MARKOWITZ: Is your mic on?

15 MEMBER SPLETT: Yes, it is. Pardon? 

16 Okay. I do have some follow on questions, and 

17 then if the rest of the Board wants to go 

18 through the detailed questions, we certainly 

19 can.

20 But I have some kind of specific 

21 questions, one of which is, is the majority of 

22 the SEM in Excel spreadsheets or is there a 
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1 relational database, SQL or ACCESS that is 

2 being utilized, or is it mainly just in Excel?

3 MR. TURCIC: No, it's a combination. 

4 The spreadsheets are Excel spreadsheets, but 

5 that's just the raw data. Then there's a huge 

6 relational database, with a lot of coding that 

7 goes into it, that -- and that's done in, I 

8 believe it's ColdFusion.

9 MEMBER SPLETT: One of the things 

10 that I was concerned about reading some of 

11 this, it talked about Paragon owning some of 

12 the data, and that was some of the concerns 

13 about releasing the spreadsheets. Is that what 

14 the ownership of records clause says with DOL 

15 and their -- contract, or is that something 

16 that you're comfortable answering right now?

17 MR. TURCIC: Our concern with the 

18 spreadsheets themselves is -- really gets to 

19 proprietary information, and also an issue, a 

20 potential classification issue.

21 MEMBER SPLETT: Okay. So if we ask 

22 for the spreadsheets that have earlier been 
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1 released and published, they've been classified 

2 reviewed, so they were already released. 

3 They're not proprietary because they're already 

4 in the public domain. But I think many of us 

5 did not think to copy those at the time.

6 But if we ask for the spreadsheets 

7 for K-25 or PFP, excuse me, the Plutonium 

8 Finishing Plant, for those spreadsheets that 

9 have already been published, there should not 

10 be any classification review or concern or any 

11 proprietary concern. Is that correct?

12 MEMBER SPLETT: No, it's not, and 

13 here's why. Let me explain. What goes through 

14 classification review is the display, the SEM 

15 display. So it's a combination of the 

16 spreadsheet, plus the coding in -- the SEM hard 

17 coding.

18 One of the big concerns from a 

19 classification standpoint is the, you know, the 

20 presence of a mosaic effect. Now, what that 

21 means is that there can be several pieces of 

22 non-classified information that when put 
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1 together, becomes classified.

2 DOE office of classification does 

3 not -- has not reviewed the spreadsheets 

4 themselves. They review the changes that we 

5 make and the outcome. And the important 

6 difference is that there are some issues, and 

7 that's what I explained in my -- I have to be a 

8 little careful in my -- in the response that 

9 DOL sent through, I explained that how we 

10 handle that information is all provided in a 

11 secret document, and I really can't go into 

12 details on that. But --

13 MEMBER SPLETT: So --

14 MR. TURCIC: But what --

15 MEMBER SPLETT: -- I guess my 

16 question is --

17 MR. TURCIC: But --

18 MEMBER SPLETT: -- what has shown up 

19 for the SEM, the public view, and if we asked 

20 for that historically, the public view of that 

21 SEM for a particular facility --

22 MR. TURCIC: Oh.
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1 MEMBER SPLETT: -- from when you 

2 first started it, can you share that with us?

3 MR. TURCIC: No, because we don't 

4 have them. When it changes -- that would mean 

5 making a complete copy of every SEM version and 

6 keeping it.

7 MEMBER SPLETT: You don't have a 

8 record copy of all of the changes and how you 

9 publish them?

10 MR. TURCIC: Oh, we have a copy of 

11 all the changes that we made in the 

12 spreadsheets. But what you're asking for is 

13 the SEM display.

14 MEMBER SPLETT: Correct.

15 MR. TURCIC: It -- the SEM -- we 

16 don't keep the complete SEM display. It's a 

17 whole database. That would be keeping a copy 

18 of, you know, the -- every SEM version every 

19 time there's a little change made. We just 

20 don't keep those.

21 MEMBER SPLETT: I -- okay. I guess 

22 I'm a little bit surprised that you have not 
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1 maintained that. But could we do a couple of 

2 examples of things we've -- questions we'd like 

3 to ask you on the SEM, Dr. Markowitz? Is that 

4 okay, or do you have other questions you want 

5 to ask?

6 CHAIR MARKOWITZ: No, no. I don't 

7 have any questions. Go ahead. Dr. Bowman, did 

8 you want to chime in here?

9 MEMBER BOWMAN: Sorry. This is just 

10 a quick follow-up to the keeping of past 

11 versions of the display of the SEM. What is 

12 the size of the database in question here that 

13 we would be talking about being kept? Are we 

14 talking about terabytes, gigabytes, more than 

15 gigabytes?

16 MR. TURCIC: You'd have to -- I'd 

17 have to get that -- the size from, you know, 

18 our IT people. But just as an example, just 

19 the spreadsheet alone for Hanford is something 

20 like 140 or 150,000 lines of data --

21 MEMBER BOWMAN: Okay.

22 MR. TURCIC: -- and, you know, every 
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1 version.

2 MEMBER BOWMAN: If you could ask the 

3 IT what the total size is, and then backup was 

4 a relatively -- you know, if it's less than a 

5 terabyte, that would not be very onerous, I 

6 wouldn't think. And that length you described 

7 would, I think, in my mind, be well less than a 

8 terabyte. Could -- would it be possible to 

9 keep those going forward?

10 MR. TURCIC: That's one spreadsheet.

11 MEMBER BOWMAN: Yeah.

12 MR. TURCIC: Multiply that by 140.

13 MEMBER BOWMAN: Sure.

14 MS. POND: I'm not sure what you're 

15 asking.

16 MR. TURCIC: I'll --

17 MS. POND: We -- this is Rachel. 

18 I'm sorry. I mean, we keep a -- we keep track 

19 of the changes. To say that every time we make 

20 a change, and we have to keep an entire new 

21 copy of the entire database, it's not really a 

22 feasible way to do it. We have all the 
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1 information about what changed in the 

2 documents, and we have a record of all of that. 

3 But we revise it every six months and republish 

4 it every six months.

5 So to say oh, we're just -- instead 

6 of continuing to publish based on the database 

7 that was there and increase it, you want us to 

8 keep a picture of all these databases for the 

9 last ten or plus years so that we can go back 

10 into 2000 and, you know, six and say oh, this 

11 is what it looked like then, it's just not a 

12 feasible way -- we haven't done it that way. 

13 We do have a record to show what changed.

14 MEMBER BOWMAN: Sure. I guess I was 

15 just asking because I was -- I got the 

16 impression that the record of what changed is 

17 not accessible, that the Board can't view that 

18 because it has the proprietary information. So 

19 therefore, the only way the Board could 

20 evaluate it is the public version.

21 MS. POND: I believe that it's 

22 something that is currently under review, how 
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1 we -- what we can provide to you. That's 

2 something that's currently with our 

3 procurement, as I indicated earlier.

4 MEMBER BOWMAN: Yeah. I think the 

5 Board is only interested in just trying to see 

6 the changes over time. And just if the -- if 

7 the way were talking about it is not possible, 

8 then an obvious possibility would be just to 

9 save a mirror image of the database. And data 

10 storage is really inexpensive.

11 So I don't understand the full 

12 details, but I would think data storage is 

13 super inexpensive and easy to do. So that 

14 would be another solution, should the first 

15 solution not work.

16 MS. POND: So it may just be the way 

17 we're wording what you want. I mean, I -- you 

18 know, the changes over time versus the 

19 spreadsheets from this many times -- all -- I 

20 think that we maybe should talk about how to 

21 word that request.

22 MEMBER BOWMAN: Okay.
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1 CHAIR MARKOWITZ: Ms. Splett.

2 MEMBER SPLETT: I've got a couple of 

3 examples of something I got out of Oak Ridge 

4 that I'd like to ask a couple of specific 

5 questions, if that's allowable, from the SEM. 

6 Mr. Domina, do you want to help over on this --

7 MEMBER DOMINA: Yeah.

8 MS. POND: If they're going to be 

9 new, just keep in mind we may or may not be 

10 able to answer them off the cuff here today, 

11 and we might have to take them back.

12 MEMBER SPLETT: I will say that they 

13 are SEM printouts for a couple of specifics 

14 that show no entries or limited entries, and 

15 the year, the two years before that, there were 

16 multiple entries. And we're just trying to 

17 understand -- we've been told that things 

18 aren't being taken out. I think we have 

19 multiple examples of where that has happened.

20 We're just trying to understand why 

21 that is, and how that's logged, and who's made 

22 the decision. It's not intended to be a 
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1 "gotcha" moment. We just are really struggling 

2 with that.

3 CHAIR MARKOWITZ: Yeah. So we're --

4 I guess the Board members, we're going to raise 

5 an issue here. And whether we get a definitive 

6 answer or not at this moment is uncertain.

7 MS. POND: Okay.

8 CHAIR MARKOWITZ: But we'll raise 

9 the issue, try to clarify the issue. And then 

10 if we can get a response now, fine. If it's a 

11 little bit later, that's fine too.

12 MEMBER SPLETT: Why don't you put 

13 105(c) up and why don't you talk to that one, 

14 okay? That's the K-25 labor category laborer. 

15 K-25. That would be in Oak Ridge.

16 MR. TURCIC: Okay.

17 MS. POND: Are you able to see the 

18 screen? Pete?

19 MR. TURCIC: Yeah. I -- what's the 

20 question?

21 MS. POND: Yeah. I just want to 

22 make sure you can see the screen as he's 
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1 scrolling to it.

2 MR. TURCIC: Oh, no. I can't see 

3 the screen at all. I haven't seen any screen.

4 MEMBER SPLETT: Okay. Let's put the 

5 labor category labor anyway.

6 CHAIR MARKOWITZ: Well, we're --

7 we're looking at the SEM. Which facility, K8 25?

9 MEMBER SPLETT: K-25, labor 

10 category, laborer.

11 CHAIR MARKOWITZ: Yeah, okay. K-25, 

12 then you get labor category, laborer, then 

13 you'll be looking at what we're looking at. 

14 And I might add that the added benefit is that 

15 Kevin Bird is now getting proficient at using 

16 the SEM.

17 MEMBER SPLETT: It should show 21 

18 matching criteria for toxic chemicals. Is that 

19 right?

20 MR. TURCIC: I can't see any of 

21 that.

22 MS. POND: Right. I think that Pete 
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1 isn't actually on the Webex. He's just on the 

2 phone.

3 MR. TURCIC: No, I'm on the Webex, 

4 but the -- the screen is just black. It's been 

5 black.

6 MEMBER SPLETT: Okay. The same 

7 search that somebody printed out 4/13 of '21 

8 shows 63 criteria. So the question is between 

9 '21 and '23, what happened to 42 mentioned 

10 criteria? I mean I -- we're putting you on the 

11 spot, because you don't have the specifics.

12 So that -- we've got multiple 

13 examples. And just -- we just are really 

14 trying to understand it. With the change 

15 longs, that we took this chemical off for this 

16 reason, this chemical off for this reason, what 

17 would that change log look like?

18 MR. TURCIC: Well, first of all, I'd 

19 have to see -- I would have to see the labor --

20 so you're saying labor category, laborer --

21 MEMBER SPLETT: Correct.

22 MR. TURCIC: And when you say -- you 
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1 said that at some point there was 21?

2 MEMBER SPLETT: There are currently 

3 21.

4 MR. TURCIC: Twenty-one what?

5 CHAIR MARKOWITZ: The hazardous 

6 chemicals.

7 MEMBER SPLETT: We're looking at the 

8 potentially encountered by labor category.

9 MR. TURCIC: Okay.

10 MEMBER SPLETT: And two years ago, 

11 that same number was 63.

12 MR. TURCIC: Oh, okay.

13 MEMBER SPLETT: Now, could you go to 

14 --

15 (Simultaneous speaking.)

16 MR. TURCIC: I -- go ahead, I'm 

17 sorry.

18 MEMBER SPLETT: Okay. Would you go 

19 to Y-12, Kevin?

20 MS. POND: Yeah, Pete, I think that 

21 we're just going to take their questions and 

22 then take them back and respond to them once we 
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1 have a chance to look into it.

2 MR. TURCIC: I think that's the 

3 best, Rachel, because, you know --

4 MEMBER SPLETT: Because I don't 

5 expect you to have that stuff at your --

6 MS. POND: Sure.

7 MEMBER SPLETT: -- fingertips.

8 MS. POND: Right, right.

9 MEMBER SPLETT: We understand that.

10 MR. TURCIC: Right.

11 MEMBER SPLETT: But these just came 

12 in. I just got these very recently. So are 

13 you at Y-12? Y-12, all the way down to the 

14 bottom. It's right above Yucca Mountain, and 

15 sheet metal worker.

16 MR. VANCE: Dr. Markowitz, can I 

17 chime in real quick and provide a clarification 

18 that might help slightly, and then maybe Pete 

19 can talk to it.

20 CHAIR MARKOWITZ: Sure.

21 MR. VANCE: So don't forget, there's 

22 also a separate category for construction sites 
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1 all, which is a generic profile.

2 MR. TURCIC: Right.

3 MR. VANCE: And I believe there are 

4 categories for both laborer and sheet metal 

5 workers that may have a substantially larger 

6 number of toxins associated with the labor 

7 category. So if you're looking at the Y-12 or 

8 the Oak Ridge, you may get a refined list. But 

9 if you go to that construction site's all list 

10 for subcontractors, you may get a substantially 

11 larger number of toxins.

12 Pete, do you want to talk about that 

13 construction sites all profile? That might 

14 actually help explain this.

15 MR. TURCIC: Yeah. If -- for anyone 

16 -- for workers who worked for a construction 

17 company, labor categories, you know, for all 

18 construction sites have the information that's 

19 supplied through that labor category in the 

20 construction process.

21 Now, for -- and that would be 

22 covered by, you know, a contractor, a 
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1 construction contractor, if they worked for a 

2 construction contractor. And so you would go 

3 to the all sites construction profile.

4 If they worked for a primary prime 

5 contractor doing construction work, you have a 

6 lot of the similar labor categories. And for 

7 people who may have worked for both, the list -

8 - you know, the claims examiners would combine 

9 those lists.

10 MEMBER SPLETT: But I'm looking at 

11 exactly the same top of the spreadsheet where 

12 there's no indication go to construction, 

13 categories, or anything else. So as this 

14 shows, no hazardous chemicals. And in January 

15 19th of '21, it showed 21 matching chemicals.

16 And there's no explanation. If 

17 somebody off the street is searching or an 

18 authorized representative is searching, this is 

19 not intuitively that perhaps there's another 

20 place that they need to search. There's no 

21 annotation on the form to do that. And again, 

22 probably not expecting an answer right now.
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1 Mr. Domina, did you have something 

2 you wanted -- did you want to --

3 MR. TURCIC: What were those years? 

4 What were those years again?

5 MEMBER SPLETT: Obviously, the 

6 current one and the previous one. There was in 

7 January 19th of '21 and May 13th of '20 that 

8 showed 21 matching criteria. And then in '23, 

9 there's --

10 MR. TURCIC: And '23, this year?

11 MEMBER SPLETT: Yes. Yeah, of this 

12 year. Yes. October 19th of '23.

13 MS. POND: Dr. Markowitz, it's 

14 Rachel. I'm assuming we can get these in 

15 writing following this sub-lecture --

16 MR. TURCIC: Yeah.

17 MS. POND: -- we get it, correct?

18 CHAIR MARKOWITZ: Yeah. We --

19 (Simultaneous speaking.)

20 MR. TURCIC: Yeah.

21 CHAIR MARKOWITZ: -- will submit 

22 these examples with related questions in 
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1 writing. We're not expecting any real answers 

2 at the moment. It's really just helpful to 

3 have a little bit back and forth so that we can 

4 clarify and make sure we're asking questions 

5 that make sense to you. That's our goal at the 

6 moment.

7 For instance, this distinction 

8 between crafts trades, which are treated in two 

9 separate places, one is construction workers, 

10 and otherwise, at the main facility site. So 

11 sheet metal workers are going to appear on both 

12 places because --

13 MR. TURCIC: Right.

14 CHAIR MARKOWITZ: -- they might be 

15 employed full time at the site. They're going 

16 to be then by the site if it's by construction 

17 contractor, or there'll be elsewhere. So that 

18 clarification helps us with our questions.

19 MR. JANSEN: And I'll just add, it 

20 would be helpful to get a copy of the SEM 

21 printouts so we could potentially put them on 

22 the website.
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1 MEMBER SPLETT: Dr. Markowitz, 

2 that's the majority of my comments. We have 

3 other examples that we can provide, but those 

4 are really my overriding questions. I don't 

5 know if the rest of the Board wants to go 

6 through the larger documents. Up to the 

7 remainder of the Board.

8 CHAIR MARKOWITZ: Well -- Dr. 

9 Bowman.

10 MEMBER BOWMAN: Sorry. Just on the 

11 additional examples, I think it could be 

12 helpful to go through some of the additional 

13 examples if you think the sort of initial 

14 ideas, like we just talked about, that there 

15 might be different types of related categories 

16 if that could help us revise them. If they're 

17 categorically identical, I would maybe not. 

18 But if there's some of your examples that are 

19 categorically different, we might get some 

20 insight to help.

21 (Off-microphone comments.) 

22 MEMBER SPLETT: Excuse me. We were 
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1 just looking at some of the reactors from 

2 Hanford, and about some of the information is 

3 assuming to be inconsistent. And even the 

4 function of the reactors and the current titles 

5 seem to be inconsistent. But I think that we 

6 do need to provide that to DOL in writing. I, 

7 you know, want to catch people off base.

8 One of the things that I have to 

9 personally take some humor to it. Apparently 

10 we have rats and mice in one reactor, but five 

11 miles away, the other reactors, all through the 

12 Hanford site, that's apparently, they all just 

13 congregated at one reactor. That obviously was 

14 the only one that got identified.

15 (Off-microphone comments.)

16 MEMBER SPLETT: Yes.

17 (Simultaneous speaking.)

18 MR. TURCIC: Well, let me explain 

19 that. I'll tell you exactly how that happens. 

20 All we put in SEM is information that we can 

21 validate and verify. So --

22 MEMBER SPLETT: Well, to verify --
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1 MR. TURCIC: -- there must be --

2 (Simultaneous speaking.)

3 MEMBER SPLETT: -- there's mice at 

4 the other reactors.

5 MR. TURCIC: Well, but we need a 

6 document. If you can -- if you have a document 

7 that shows us some way, then we would, you 

8 know, that would be put in.

9 MEMBER SPLETT: Mr. Turcic, I'm 

10 sorry, that was -- it was a joke. I apologize. 

11 But we can also -- I can also tell you having 

12 been in multiple facilities, we also have 

13 snakes in there, so. But I don't have any 

14 documents, but I have seen them and didn't 

15 enjoy that, so.

16 CHAIR MARKOWITZ: Yeah. Mr. Domina.

17 MEMBER DOMINA: I just have a 

18 comment on what Mr. Turcic said about having to 

19 have a document. I'll just give you an example 

20 for something, like when they're going to some 

21 of the reactors that we're decommissioning and 

22 they're digging up burial stuff, many, many 
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1 times over the years, they've stumbled across, 

2 quote, suspect fuel. And I'll clarify that 

3 because it's really fuel, it's just that it's 

4 not in the DOE inventory. And so then when it 

5 goes from whatever place and it -- most 

6 recently, it would get splashed at one of the K 

7 East or K West basins, then all of a sudden 

8 it's called fuel.

9 But when you have a worker digging 

10 it up, what they would do, they would have 

11 operations go over and identify it, and you 

12 would see a laborer or someone holding a white 

13 piece of paper with his bare hand behind this 

14 piece of fuel. And then all of a sudden, yeah, 

15 we got to handle it, get it stored. And then 

16 as soon as it goes in the basin and splashed 

17 into water, it's considered fuel. But in the 

18 meantime, the guy could put it in pocket, you 

19 know? And I think that the way some of this is 

20 done, you have to know more specifics on how 

21 things were done at each site.

22 And just like earlier, Mr. Turcic 
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1 brought up when he was talking about the last 

2 big review was in 2015, and then he talked 

3 about CFR 851. Well, 851 didn't come in till 

4 1995. So it raises a lot of questions for me 

5 on what they did prior to 1995 because we know 

6 there's a lot of issues when 851 was actually 

7 implemented at different places on different 

8 sites.

9 Just like the problem with we have 

10 CFR 850 with beryllium, a lot of these sites 

11 still don't have a comprehensive beryllium 

12 program. We've been fighting in Hanford since 

13 2008 with it when DOE sent the thing out to 

14 have a program where it's the same across site.

15 MR. TURCIC: But that's exactly why 

16 -- that's exactly the point I was making. That 

17 is why what SEM is intended to be is the 

18 validation of information. And, for example, 

19 the SEM would not add in that a site had a 

20 beryllium program or anything else unless we 

21 had a document that showed that it was 

22 implemented.
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1 And as far as -- you're absolutely 

2 right, there's a lot of ways people were 

3 exposed to things that aren't in SEM, and 

4 that's why the processes, the claims process, 

5 is, you know, DOL has processes to handle that 

6 kind of information.

7 CHAIR MARKOWITZ: This is Steven 

8 Markowitz. Meaning the occupational health 

9 questionnaire in the interview, any affidavits 

10 or coworker affidavits would be where that 

11 information would be contained, right?

12 MS. POND: Yes. I believe so.

13 CHAIR MARKOWITZ: Right. Right. I 

14 think we'll probably get back to that a little 

15 bit later.

16 MR. TURCIC: And, Dr. Markowitz, I 

17 can point out that when we get -- when we get 

18 occupational health histories as part of the 

19 DAR request in a SEM mailbox, that information 

20 goes into the response in that mailbox, and 

21 that often ends up being an addition -- a 

22 revision to that profile.
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1 CHAIR MARKOWITZ: So, Mr. Turcic, 

2 this is Steven Markowitz. So you're meaning an 

3 individual claimant's occupational health 

4 questionnaire might end up in your mailbox as -

5 -

6 MR. TURCIC: Yes. We get it every -

7 -

8 (Simultaneous speaking)

9 CHAIR MARKOWITZ: -- as submitted by 

10 the claimant I mean?

11 MR. TURCIC: No, no. It's submitted 

12 by the district. When the district office --

13 very often, it will be things like labor 

14 categories where labor categories, a claimant 

15 in the occupational history said that, you 

16 know, this is what labor category they had. A 

17 very recent one was a transportation certifying 

18 official, and the SEM did not have a 

19 transportation certifying official as a labor 

20 category.

21 Based on the information in the DAR, 

22 which included information that DOE in the 
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1 claims verification and the occupational 

2 history, we were able to combine that, and now 

3 that is currently being added so that the 

4 transportation certification official is being 

5 added as an alias to a base management 

6 specialist at that site because of the 

7 information that was, you know, provided in 

8 those documents. And that happens quite often. 

9 We get probably eight to ten SEM mailbox 

10 questions a month.

11 CHAIR MARKOWITZ: And the source of 

12 that information is -- are the claims examiners 

13 or their claimants?

14 MR. TURCIC: Claims examiners and 

15 information that are in the claimant's file 

16 they send to us, you know, to support when 

17 they're asking their question. But the exact 

18 same process is available and has happened a 

19 lot. I'll give you a perfect example where 

20 information we received through the IAS through 

21 the Internet Accessible SEM where the public 

22 submitted information relative to 
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1 trichloroethylene.

2 And what happened was the public 

3 submitted information that trichloroethylene 

4 was used as a degreaser by not only the 

5 electrical maintenance folks but also the 

6 instrument technicians and the electronics 

7 technicians. Based on that information, we 

8 looked at all the sites and identified that TCE 

9 was used at a lot of sites as a degreaser and 

10 primarily by the electrical maintenance people.

11 But based on the information that 

12 was submitted through the public, by the 

13 public, we put together a white paper and 

14 suggested that TCE be added also to the 

15 electronics technician and the instruction 

16 technicians. That went to DOL. DOL agreed 

17 based on the information we had. And so we 

18 went back through all the sites that did not 

19 have TCE in the electronics technician 

20 category, labor categories, and added that in. 

21 So that was about seven sites where that 

22 happened, and that was recently.
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1 CHAIR MARKOWITZ: And just a quick 

2 follow up. Steve Markowitz. Just a quick 

3 follow up to that. The public information that 

4 you received, were those DOE documents, 

5 contractor documents? Or were those the 

6 observations or perceptions of, say, former 

7 workers?

8 MR. TURCIC: It started out as the 

9 observation, and then, in our research, we 

10 found information. We got information from DOE 

11 that, you know, helped for us to justify in 

12 that white paper to make that change.

13 CHAIR MARKOWITZ: Okay. Thank you. 

14 Other Board members have questions, comments? 

15 Ms. Splett.

16 MEMBER SPLETT: I would really like 

17 to take Rachel up -- or excuse me, Ms. Pond up 

18 on her recommendation to have an in-person demo 

19 because there's nothing I would like better to 

20 feel like the SEM was totally responsive and I 

21 just didn't know how to operate it properly. 

22 Again, back to the construction workers versus 
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1 --

2 CHAIR MARKOWITZ: Right.

3 MEMBER SPLETT: -- a specific 

4 facility. So I think there is a lot of us that 

5 would really like to do that. And I don't know 

6 whether that's something that could be done 

7 before our next six month meeting or not, but I 

8 do believe it needs to be done in person.

9 CHAIR MARKOWITZ: Well, we can do it 

10 before the next six month meeting. Yeah.

11 MEMBER SPLETT: But thank you for 

12 the offer.

13 MS. POND: Absolutely. I think 

14 it'll help with a lot of these questions to 

15 kind of understand that. There's a lot of 

16 nuances, and that's why we often have a lot of 

17 trainings. We try to have webinars for the 

18 public to understand how to search it and that 

19 sort of thing. But, yes, we'll set that up.

20 CHAIR MARKOWITZ: So are there other 

21 questions relating to the SEM while we have Mr. 

22 Turcic on the line? 
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1 Well, let me just -- first of all, 

2 Mr. Turcic, thank you, both for your effort to 

3 get here, which, unfortunately, wasn't 

4 successful. But also for being on the line 

5 today, and to be willing to --

6 MR. TURCIC: You're welcome.

7 CHAIR MARKOWITZ: -- engage in 

8 clarifying discussions. So thank you for that. 

9 Were there any other additional comments you 

10 wanted to make, Mr. Turcic?

11 MR. TURCIC: No. Not right now.

12 CHAIR MARKOWITZ: Okay. So then we 

13 should move on, I think. We're running a 

14 little bit ahead on the schedule. That's good. 

15 I think we can go to the industrial hygiene 

16 recommendation that we made previously, and 

17 Department of Labor did not fully accept that 

18 recommendation, so we wanted to discuss our 

19 views on that and whether there was some 

20 modification or some improvement we can make. 

21 I think there's a PowerPoint here. Dr. 

22 Cloeren.
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1 (Off-microphone comments.)

2 CHAIR MARKOWITZ: So if -- just for 

3 clarification, this is the -- we're moving on 

4 to the topic that we had scheduled for 1:15, 

5 so.

6 MEMBER CLOEREN: I sent it to Kevin, 

7 but Kevin's out of the room.

8 CHAIR MARKOWITZ: Oh, great. So you 

9 should have -- Stefan, you have it.

10 MR. STEFAN: That's it, right? The 

11 one I'm showing.

12 CHAIR MARKOWITZ: No. No. It's the 

13 other one. It's the Cloeren one.

14 MR. STEFAN: Okay.

15 (Off-microphone comments.)

16 CHAIR MARKOWITZ: No, that's the 

17 medical one.

18 MR. STEFAN: Oh, okay. One second. 

19 The industrial hygiene report?

20 MEMBER CLOEREN: Right.

21 MR. STEFAN: Okay.

22 MEMBER CLOEREN: Okay. By way of 
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1 background, in May, we did recommend modifying 

2 the expectations around the industrial hygiene 

3 report to include more details about what data 

4 was reviewed, what was available to review, 

5 what it showed. We also recommended referring 

6 to the case file where there were data to 

7 support the conclusions.

8 We recommended that there be the 

9 expectation of an explicit statement about any, 

10 like, lack of case-relevant data beyond what's 

11 available in the site exposure matrix and to 

12 share that information in kind of an organized 

13 way, a new table format.

14 Just to remind everybody, the 

15 current procedural guidance is that the 

16 industrial hygienist will review all the 

17 information, and using a combination of the 

18 information and their experience, characterize 

19 the exposure to whichever, you know, maybe a 

20 variety of chemicals, and a variety of jobs, 

21 and a variety of different time periods, but to 

22 characterize each of those as significant, 
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1 between significant -- or between incidental 

2 and significant, or incidental, or no exposure, 

3 no evidence of any exposure. And then within 

4 significant, to then whether or not the 

5 exposure is high, moderate, or low. So those 

6 are kind of the categories that the industrial 

7 hygienist can use in the current procedural 

8 guidance to classify the exposure.

9 The rationale for our recommendation 

10 is that by synthesizing either a whole lot of 

11 data, which, I think is rare, but it's 

12 possible, along with the site exposure matrix, 

13 you know, findings, and then combining that 

14 with the industrial hygienist's knowledge into 

15 a conclusion, that misses the opportunity to 

16 share details with other experienced people, 

17 like the claims examiner and the contract 

18 medical consultant, that would provide more 

19 information about the type of exposure, the 

20 route of exposure, you know, inhalation, 

21 ingestion, skin absorption, intensity, 

22 frequency, duration. 
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1 All of these are used, you know, in 

2 industrial hygiene thinking, basically. Also, 

3 calendar timing, use of PPE if that's 

4 available, which, you know, may not be in some 

5 cases.

6 But, anyhow, we thought that the 

7 synthesis of pulling together all the 

8 information and spitting out a conclusion about 

9 significant high, significant moderate, and 

10 significant low, incidental, between 

11 significant and incidental, or no exposure 

12 missed the opportunity to share important 

13 information about the details. How is that 

14 conclusion reached? Next slide.

15 This, just to remind everybody, was 

16 kind of what we proposed in a table format, you 

17 know, providing information about each of the 

18 exposures. And so it would provide details 

19 about each of these things. And then we also -

20 - in the version that we actually submitted, 

21 this is an older version of it, we included the 

22 request that kind of page numbers from the file 
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1 be included. Like, where did you find this 

2 information? Next slide.

3 And so the response was an agreement 

4 that the new table format, or something along 

5 these lines, would be helpful if the industrial 

6 hygienist found an exposure to be significant, 

7 but not in other cases. Not if they did not 

8 find it to be significant. And there was also 

9 agreement to add a data field that explains the 

10 type of exposure, whether it was direct, 

11 bystander, or in the area when it was used.

12 But, basically, there was 

13 disagreement with other recommendations, 

14 including specifying where in the various 

15 sources of data that were reviewed, the data 

16 supporting the conclusions were found. And we 

17 also received an example of an IH report, a 

18 redacted industrial hygiene report that was a 

19 lot more detailed than the usual industrial 

20 hygiene report.

21 And I've reviewed, you know, several 

22 of them over the years, and I thought it was a 
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1 pretty good IH report that provided a lot more 

2 detail than we typically see. So I'm not sure 

3 it was a typical one, but even though it was 

4 more detailed than the typical one, I think 

5 there were still some problems that maybe 

6 demonstrate what we're trying to persuade the 

7 Department about. Next slide.

8 So this is an excerpt from the 

9 report, and one of the things that we wanted to 

10 point out is that the industrial hygienist had 

11 been asked about whether any of the pre-1990 

12 jobs could be -- and this was related to a 

13 hearing loss claim, and so the question was 

14 about solvent exposure and whether the claimant 

15 was in one of the covered job categories. And 

16 so the question was whether any of the jobs 

17 that the person had been in would be synonymous 

18 with some of the covered job categories. And 

19 the industrial hygienist consultant said that 

20 it was beyond the scope of the referral and 

21 can't be addressed.

22 We felt that, yeah, there is an 
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1 opportunity to interview the worker. We don't 

2 see this done very often. Actually, I don't 

3 think I've ever seen any evidence of an 

4 interview. But an interview would be a really 

5 good way to try to clarify whether the, you 

6 know, the jobs that were listed are synonymous 

7 just by going through with the person, what it 

8 was they were doing. So just a comment. Next 

9 slide.

10 The industrial hygienist also used 

11 the language that we understood they were no 

12 longer supposed to be using about how, you 

13 know, the problems really existed before the 

14 mid-'90s, and after the mid-'90s things were 

15 safer. So we thought that was a problem, and 

16 we thought that that was not really supposed to 

17 be used in the reports anymore, especially when 

18 there's not data from a facility to support 

19 that, wow, you know, at this facility, 

20 everything got, you know, much better after the 

21 mid-'90s. Next slide.

22 The industrial hygiene report also 
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1 said -- and this is, I think for myself, at 

2 least, speaking for myself -- this is a problem 

3 area because in almost every industrial hygiene 

4 report I've read, they refer to many different 

5 sources of information, and then summarize, I 

6 reviewed all this stuff, and my finding is 

7 this. But they don't really say what they 

8 found, what each of the documents that they 

9 reviewed had, and I think that that is actually 

10 really relevant.

11 You know, I reviewed the 

12 occupational health questionnaire, well, okay, 

13 but what did it say? I reviewed the EE3. 

14 Okay. So that tells the job categories. I 

15 reviewed the site exposure matrix and the 

16 physician's letter. But the industrial 

17 hygienist in this report is not sharing 

18 anything from those sources with other people 

19 with expertise to maybe process some of that 

20 information. Next slide. And also the DAR 

21 wasn't listed for whatever reason.

22 And so I wanted to just throw out 
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1 this example to you. That paragraph -- or 

2 actually, that industrial hygiene report would 

3 apply to either of these situations. A 

4 situation where there may be a DAR that shows 

5 monitoring for the work area where the claimant 

6 was working with no problem exposures. I mean 

7 that would be -- that would be very important 

8 information if that information were available.

9 That the OHQ exposure information 

10 was explored with an interview. That the site 

11 exposure matrix indicated plausible exposure 

12 opportunities. And that the conclusion 

13 includes the site exposure matrix, but it's 

14 corroborated with other data sources.

15 And this is what the CMC's maybe 

16 believing when they get their industrial 

17 hygiene reports because there's implication 

18 that I reviewed all these sources of data, and 

19 all these sources of data helped me draw my 

20 conclusion. But the reality, honestly, is 

21 that, most of the time, it's the site exposure 

22 matrix information. But that's not explicit, 
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1 right, in the reports.

2 And speaking as an occupational 

3 medicine physician, I would always want to 

4 review an occupational health questionnaire 

5 myself. I wouldn't want someone else to review 

6 it and tell me, you know, what I need to know 

7 from it. And I think that's a disservice to 

8 the whole system to not share the OHQ. But in 

9 any event.

10 So the reality is there's usually no 

11 relevant DAR data. Who knows what the OHQ is 

12 saying. And this -- I'm sure the site exposure 

13 matrix is used, you know, very carefully and 

14 thoughtfully by the consultants. Next slide. 

15 But these are two different situations, right? 

16 And so if the end user of the report is making 

17 the assumptions on the left, they may draw much 

18 different conclusions than if they understood 

19 that all they're really going on is what's in 

20 the site exposure matrix. Next slide.

21 So this is important. And this is 

22 basically what I just said. And I think that, 
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1 if we had a transparent process, that would 

2 make clear what was found in each of the 

3 different sources, including there was no 

4 specific site information. There was no 

5 monitoring records, you know, from the site. 

6 And I think that's the last slide. So that's 

7 just for discussion.

8 CHAIR MARKOWITZ: Okay. Thank you. 

9 That was very clear. Board members have 

10 comments, questions? So -- Steve Markowitz --

11 so you're saying that in the IH report, that if 

12 there is specific information in these other 

13 sources aside from the SEM, that that 

14 information should not -- should be 

15 specifically noted in the report, and the 

16 source should be identified?

17 MEMBER CLOEREN: Correct.

18 CHAIR MARKOWITZ: And likewise, if 

19 those other sources don't have any useful 

20 information, that should also be specified?

21 MEMBER CLOEREN: Correct.

22 CHAIR MARKOWITZ: All right.
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1 MEMBER CLOEREN: And I think that --

2 and that's more often the case, right?

3 CHAIR MARKOWITZ: Right, right. 

4 That seems like a pretty straight forward thing 

5 to do, actually. Could you go back to Excerpt 

6 2 for slide? So I think you pointed this out 

7 that this is an excerpt that contains reference 

8 to the mid-1990s, that after the mid-1990s, 

9 programs were well developed fully implemented, 

10 and, later, it says that the likelihood of 

11 significant exposures was greatly reduced after 

12 the mid-1990s. And this statement is included 

13 as a general statement. It's not in this 

14 particular case substantiated by any monitoring 

15 data or any other data.

16 And this is a not-so distant cousin 

17 from previous language that centered on 1995, 

18 which the Department actually rescinded in 

19 2017. The Board pointed this out that this was 

20 an arbitrary kind of cutoff date, and it was 

21 prejudicial. And the Department agreed and 

22 rescinded that. And this is a somewhat softer 
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1 version of the same language.

2 And I guess, in the absence of data 

3 to support that statement, the question is, 

4 what real value, real truth value, can you 

5 attribute to this general statement? And the 

6 problem is, of course, that there's rarely any 

7 real data from the worksite if you're just 

8 talking about industrial hygiene monitoring 

9 data one way or the other, that there was 

10 exposure, there wasn't exposure.

11 I don't think there should be a 

12 prejudice that in the absence of industrial 

13 hygiene data, there was over exposure. I don't 

14 think that should be the assumption because why 

15 would you make that assumption. And likewise, 

16 on the flip side, I don't think in absence of 

17 industrial hygiene data, you could assume that 

18 everything was fine.

19 But the reality is that those data 

20 don't exist for -- and they probably still 

21 don't exist, you know, at the various 

22 worksites. So then what do we do with this 
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1 observation, which we've seen repeatedly in 

2 industrial hygiene reports that the things got 

3 better throughout the '90s.

4 And the implication is that, to 

5 quote this excerpt, the second to the -- second 

6 line from the bottom, circumstances leading to 

7 a significant exposure would likely have been 

8 identified or documented in employment records, 

9 end of quote.

10 Is that true that it would have been 

11 identified in employment records? I'm 

12 skeptical about that. So I don't think the 

13 prejudice should go in either direction around 

14 a given timeframe.

15 And by the way, for people who 

16 worked at these facilities who are on the 

17 Board, I mean over the decades, conditions did 

18 get -- health and safety conditions did, 

19 generally speaking, get better. Is that right? 

20 That doesn't mean that every particular 

21 situation, every given task or job title, et 

22 cetera, you know, experienced no important 
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1 exposures. But, in general, conditions did get 

2 better. The question is can you really 

3 translate that into a determination for an 

4 individual claimant in an IH analysis? 

5 Personally, I'm skeptical. But I'd like other 

6 people's opinions. Dr. Van Dyke.

7 MEMBER VAN DYKE: This is Mike Van 

8 Dyke. I agree with what you're saying. I 

9 don't think that these things were very well 

10 documented, and they were definitely not well 

11 documented in employment records themselves. I 

12 think it's hard to get away from the bias as an 

13 IH that things did get better. And I think 

14 that, in their minds, in the minds of 

15 evaluators, they're going to use that in their 

16 minds.

17 However, I think that, you know, the 

18 lack of documentation cannot be interpreted as 

19 lack of exposure. And even if they said 

20 something like this and they ended it with the 

21 lack of documentation cannot be interpreted as 

22 lack of exposure, it would be much better. But 
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1 this does leave the CMC down the road of, oh, 

2 things were great, good record keeping, must be 

3 no exposure. And that's a very biased trial to 

4 lead someone down.

5 CHAIR MARKOWITZ: Mr. Key.

6 MEMBER KEY: Yeah. I think we've 

7 lost our focus here. Some may have never had 

8 it because we go back to the original 

9 legislation and the intent of Congress, again, 

10 where there was no documentation at the site 

11 IH, health visits. Otherwise, there's specific 

12 language put in the statute that should direct 

13 all of us in our activities as an illness that 

14 was as least as likely as not that occupational 

15 exposure or a toxin created the causation, 

16 correlation, or illness.

17 And that specific language was put 

18 in there for a reason, so where there is 

19 absence of data. This is very vague, this IH 

20 report statement here. That provides no basis 

21 for approval or denial. I think you need to go 

22 back to the intent of the act and that specific 
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1 language.

2 CHAIR MARKOWITZ: The other thing --

3 Steve Markowitz -- is that it's one thing to 

4 think that conditions may have likely improved 

5 over time, but actually, that's not really the 

6 point of interest when examining an individual 

7 claim. Here's a person who has an illness, a 

8 particular person with a particular -- his job 

9 history who has an illness. And so the 

10 question is did this person have exposures that 

11 may have been significant or not? And for 

12 that, you need to know as much as you can about 

13 that particular person and their own history.

14 And so what was generally occurring 

15 in the facility is one thing, but it may be 

16 quite different what this individual person 

17 experienced. And, frankly, you know, the 

18 source of that really is going to be the 

19 occupational health questionnaire, the 

20 interview, the like, you know, what that 

21 particular person reports.

22 But let me ask Mr. Key something, 
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1 and I don't mean to ask you, but since there 

2 was very little objective industrial hygiene 

3 data showing one way or the other, over 

4 exposure or, you know, insignificant exposure. 

5 So to me, in the absence of information to lean 

6 in the favor of the claimant, does that mean --

7 which I appreciate, that was part of the 

8 original act. In fact, the whole establishment 

9 of the three gaseous diffusion plants as we 

10 didn't know what the radiation levels were, so 

11 therefore, we're going to compensate them for 

12 one of, whatever, 22 cancers or whatever. That 

13 was part of the act.

14 But what does that mean, in general, 

15 for toxic substances? Does that mean everybody 

16 gets compensated because we're going to lean in 

17 their direction? And this is not directed 

18 towards you, per say. I'm just saying in 

19 general, then how do you approach this if you 

20 say that, well, okay, we're going to be 

21 favorable to the claimant and we don't have any 

22 real data, and so, okay.
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1 MEMBER KEY: I don't think you have 

2 to approach it that way. There is numerous 

3 incidents where workers were exposed, including 

4 myself, to asbestos. At the end of the day 

5 going to the shower room, completely covered 

6 white with asbestos dust, no industrial hygiene 

7 monitoring on the jobsite.

8 Our industrial hygiene department 

9 consisted of one person until the late 1980s, 

10 and then it had grew to three. There was no 

11 field monitoring, job-specific scope and 

12 monitoring going on. That did not even come 

13 into play, especially, and I can speak for the 

14 Paducah gaseous diffusion plant, until the mid15 2000s where there was a robust build up an 

16 industrial hygienist and health visits 

17 technicians.

18 And also, just because a chemical 

19 had been outlawed and a contractor was aware of 

20 that, that did not mean that the contractor had 

21 the workers go out and secure all of those 

22 banned chemicals and bring them in and out of 
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1 the available inventory to use. Quite the 

2 opposite. They left them out there and used 

3 all of them in the meantime trying to find a 

4 replacement to bring on site.

5 So I think it has to be in favor of 

6 the claimant, especially up until, as I stated, 

7 the late 2000s where you had a more robust, on8 job site health visits and industrial hygiene 

9 technicians.

10 CHAIR MARKOWITZ: So can we get 

11 other comments, questions? Oh, yeah, I'm 

12 sorry. Mr. Domina.

13 MEMBER DOMINA: I think you have to, 

14 you know, when you work at these sites and put 

15 stuff into perspective, a prime example is we 

16 would have more one of the national labs, 

17 Pacific Northwest National Lab, come out, like, 

18 in a building where we worked to try and 

19 replicate the way the air moves, ventilation 

20 because of issues with contamination, with 

21 uptakes of everything. It's never the same 

22 twice.
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1 And it's no different than during 

2 these times when we're working. The reason 

3 they don't monitor -- because they don't want 

4 to know the answer. And, you know, I mean when 

5 you can -- when it's snowing asbestos on a 

6 reactor startup, and I know you may think I'm 

7 blowing smoke, but when you see it yourself, 

8 you think they're going to put a monitor in 

9 there? And then you're doing that every 28 

10 days. It never goes away. You know, and then 

11 you're out there sweeping it on, you know, to 

12 clean it up. And like I said, we ventilated. 

13 In these old building, it ventilated to 

14 atmosphere.

15 But there's no filtered monitoring. 

16 We've had issues where people are standing 

17 shoulder-to-shoulder having lapel monitors and 

18 then an area monitor, and people end up with 

19 ingestion, inhalation, and the person next to 

20 them got nothing.

21 You know, this is, you know, we 

22 signed up for this, we got that, you know, but 
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1 the type of work that we do, there's certain 

2 things they didn't want a monitor like stuff at 

3 the tank farms, the industrial hygiene didn't 

4 get real decent until about 2016, '17 when the 

5 Labor, you know, HAMTC did a stop work for any 

6 work on the farms unless you're wearing 

7 supplied air, SCBA. But then that causes a 

8 host of other issues. People slipping and 

9 falling in the winter, hurting their back when 

10 they land on one. Or some people, you know, 

11 the SCBA weighing half their body weight.

12 And then when they started 

13 monitoring some of these things, I mean if you 

14 go out there now, there's stacks. They spent 

15 millions of dollars to ventilate some of this, 

16 they knew it was bad. But you can't measure 

17 that in these people except when their health 

18 is declining and then you're going to say that 

19 they didn't have any exposure.

20 I mean I understand both sides of 

21 this table. There's a scale for monitoring, 

22 not monitoring, and, yeah, you don't give it 
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1 all to the people and you also don't give it 

2 all to the other side. But it doesn't seem 

3 like the scale's very even.

4 CHAIR MARKOWITZ: Mr. Key.

5 MEMBER KEY: Yes. Kirk jogged my 

6 memory a little bit. I'll give you an incident 

7 that just happened within the last two years 

8 which I related to earlier today of the 

9 exposure to fluorine to approximately 16 

10 workers working a special project.

11 They had area monitors. They had 

12 lapel monitors. But they were instructed when 

13 the area monitor or lapel monitor went off, to 

14 turn on the industrial fans, to remove that as 

15 the engineering control away from them and to 

16 silence the monitors.

17 This group that we're going to file 

18 for, we have the documentation. It had to be 

19 reported to DOE either through their ORPS 

20 system, or their CARE system because one of the 

21 individuals suffered three days of blindness, 

22 had to be transported from the facility in a 
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1 hospital -- or in an ambulance and stayed in a 

2 hospital for three days until his sight came 

3 back, and then repeated just migraines for like 

4 four months.

5 So, you know, has it improved? 

6 Certainly it's improved to a degree since the 

7 '50s and '60s. But we still have instances 

8 where, as Kirk said, monitoring is sometimes 

9 not done because the contractor doesn't want to 

10 know. If it hits a threshold, then that's a 

11 reporting requirement.

12 CHAIR MARKOWITZ: Mr. Catlin and 

13 then Dr. Cloeren, she's -- oh, go ahead. 

14 Marianne.

15 MEMBER CLOEREN: Yep. Dr. Cloeren 

16 here. I want to go back to the OHQ. I don't 

17 understand why that is not shared with the CMC. 

18 And I wonder -- I don't wonder, can I propose 

19 that the OH questionnaire be included with the 

20 packet to the CMC? And also I don't know 

21 whether -- can the CMC request the industrial 

22 hygiene consultant to do an interview if 
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1 there's a conflict, for example, between the 

2 industrial hygiene conclusion on review of the 

3 SEM and what is being stated in the OHQ? Is 

4 there a mechanism for trying to resolve, you 

5 know, that difference and get some more 

6 information? Because like what you said about 

7 the SCBAs is really interesting, you're not 

8 going to get that from any place but the 

9 employee.

10 CHAIR MARKOWITZ: Steve Markowitz --

11 oh, go ahead.

12 MEMBER CATLIN: Go ahead.

13 CHAIR MARKOWITZ: No, just to follow 

14 up to what she said. Yeah, I think 

15 recommending that the OHQ be given by the CE to 

16 the CMC as part of their evaluation in addition 

17 to the industrial hygiene report, that's a 

18 perfectly valid recommendation for the Board to 

19 make.

20 MEMBER CATLIN: Thanks, Mark Catlin. 

21 Yeah. I actually view the occupational health 

22 questionnaire that the Department -- the 
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1 improved one the Department accepted a couple 

2 years ago from this Board really ought to be 

3 part of the IH report. I mean I think it 

4 should also go to the CMC. But in the IH 

5 report, they really ought to say -- they really 

6 ought to address what they saw in that report. 

7 And if they can refute it because they have 

8 data or if it doesn't make sense.

9 But I think a lot of times in the 

10 claims that I've looked at in my prior 

11 experience, the worker information in that good 

12 questionnaire will support the claim, and then 

13 there wouldn't be anything to refute it from 

14 the Department side. And then you would decide 

15 that there was some exposure. And I think 

16 that's a perfectly easy way to do it.

17 But in the IH reports I've reviewed, 

18 as you've described, they're usually very --

19 like we've reviewed everything, but it seems 

20 like there's no problem here. And they don't 

21 really say they reviewed the questionnaire, and 

22 I know I've looked at some of the claims where 
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1 you look at the IH report, and then you go 

2 through the questionnaire. And there's all 

3 sorts of potential exposures that are never 

4 addressed, and they just sort of get blanket 

5 kind of rejected.

6 So I think as the recommendation was 

7 to kind of make this more clear and make it 

8 more clean, I think the questionnaire ought to 

9 be -- ought to be something IHs have to address 

10 and not just sort of miss it. And I still 

11 think it should go to the docs, and the claims 

12 examiners should review it, too. But the IH 

13 has a way to look at those responses and weigh 

14 in on them, and maybe doing the interview also 

15 is, if there's any sort of questions. So 

16 thanks.

17 CHAIR MARKOWITZ: Dr. Bowman.

18 MEMBER BOWMAN: Yes. Thank you. I 

19 was just going to -- Mark, I think you make a 

20 very good point there with the IHQ being 

21 shared. I think the question that would easily 

22 come up in the mind of the CMC is what does the 
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1 IH think about this element of the IHQ? And so 

2 making sure that those elements are addressed 

3 in the IH report would help with the clarity. 

4 We don't want to cause even more confusion and 

5 more -- potentially even delays in the 

6 processing of a claim if there has to be a 

7 bunch of back and forth.

8 So I think maybe with a 

9 recommendation to share the IHQ, we should say 

10 that it should be -- that the contents of that 

11 should be specifically addressed by the IH.

12 CHAIR MARKOWITZ: Steve Markowitz. 

13 I mean I understand the perception that, you 

14 know, you give the exposure information to the 

15 exposure expert, that's the IH. They look at 

16 everything. They interpret it. They prepare 

17 a, more or less, concise report. And then that 

18 expert report is handed over to the medical 

19 expert who now has the exposure expert input, 

20 and then takes it, combines it with the 

21 medical. And then makes a decision about 

22 causation or whatever.
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1 But actually, in reality -- that's, 

2 obviously, a useful thing. But in reality, the 

3 doc wants to see the primary information. And 

4 the OHQ is limited in amount, so it's not an 

5 overwhelming, certainly not a burden to the 

6 doctor.

7 And so, yeah, I mean they should see 

8 the OHQ in addition to the IH report because 

9 it's not one expert to the next. You know, the 

10 OM doc is an expert also in exposure. Not as 

11 much as the IH in measurement, but 

12 interpretation, probably. So that's why we 

13 need to see the OHQ. Okay. Having said all 

14 that, Dr. Van Dyke.

15 MEMBER VAN DYKE: No, there's always 

16 the physicians thinking they're industrial 

17 hygienists, right? No. I want to push back on 

18 that a little bit. I mean I think that that's 

19 true for many occupational medicine physicians, 

20 but I would like to know if you think that 

21 that's broadly true for the people that are 

22 doing these evaluations.
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1 CHAIR MARKOWITZ: Yeah. That's hard 

2 to know. I mean I think if you give those CMCs 

3 both the industrial hygiene report and the OHQ, 

4 that, you know, they'll decide what they're 

5 going to look at, pay attention to, and I'm 

6 sure there's variation in that. I don't see 

7 any downside in giving them the OHQ. If they 

8 ignore it, they ignore it, right? But at least 

9 having the primary data in addition to the 

10 industrial hygiene report I think would be 

11 useful.

12 Let me just say something else about 

13 the, you know, we have an example report that 

14 was sent to us in response to this 

15 recommendation that was nine pages long, a 

16 little bit longer than most of the IH reports 

17 we've looked at. Speaking as a physician, I 

18 don't generally read line by line every nine 

19 pages of an evaluation. I'm going to focus in 

20 on the summary table. And I realize that, you 

21 know, the advantage of a text narrative is that 

22 you can put in, I think, nuance.
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1 But it'll be very interesting to 

2 test what the CMCs actually use because -- and 

3 I know that was part of the DOL response is to 

4 look at what the CMCs, how they react to 

5 whatever. But I think that summary table is 

6 really key, and what's included and not 

7 included in that summary table because even if 

8 you read the whole nine page report, when 

9 you're sitting there making a decision, you're 

10 going to back to that summary table in terms of 

11 what your understanding is, unless someone 

12 disagrees with me about that. Dr. Van Dyke. 

13 Good. Disagreement.

14 MEMBER VAN DYKE: No. I'm circling 

15 back. I mean I think that, you know, what Dr. 

16 Bowman said around the IH should be required to 

17 respond to the reported exposures in the 

18 questionnaire I think is absolutely critical. 

19 And I think it's critical from the perspective 

20 of the claimant because the claimant, if they 

21 are not -- if those are not responded to, they 

22 feel like they're being ignored. And I also 
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1 think it's important because there is a piece 

2 that, you know, there's a misinterpretation or 

3 a misunderstanding about what people are 

4 exposed to sometimes.

5 So providing that list of they 

6 reported that they were exposed to X, Y, and Z, 

7 and saying whether that is substantiated or not 

8 in the SEM would be really helpful. And there 

9 might even be an opinion on whether this is 

10 possible given what we know about their work 

11 history. So I think that that disconnect where 

12 they're just feeling like they're not responded 

13 to at all is the big problem here.

14 CHAIR MARKOWITZ: Yeah. Steve 

15 Markowitz. I think that's a good point. I 

16 also think that, and I don't know, Dr. Cloeren 

17 where exactly you were heading here, but I 

18 think we could fine tune, modify the 

19 recommendation to hit on some of these specific 

20 points that would add some specificity to the 

21 prior recommendation and might help the 

22 Department.
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1 So we don't have to do that right 

2 now in the four minutes before lunch, but we do 

3 have time -- would have time this afternoon and 

4 tomorrow morning to look at language and then 

5 discuss it and perhaps vote on it. Mr. Key.

6 MEMBER KEY: Yeah. Before we break 

7 for lunch, I guess this is a question to Rachel 

8 because I don't know the answer. Does the 

9 Department have access to the Department of 

10 Energy's ORPS reporting base and the other one 

11 where reports were filed at these locations on 

12 exposure, and if a claimant files a claim that 

13 occurred with an incident, let's arbitrarily 

14 say in the 1980s, do you have or do your CEs or 

15 someone within DOL have access that they can go 

16 into the DOE reporting systems and back to that 

17 timeframe to see the documentation that may 

18 possibly be there?

19 MS. POND: No. We don't have direct 

20 access to reports that DOE has. What we can do 

21 is ask for a DAR, which is a document 

22 acquisition request, which provides us with 
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1 more detail about their exposures and any 

2 records that Department of Energy has, they can 

3 come back and provide us with that information.

4 And so when we do have, you know, 

5 reports like that, we will do whatever 

6 investigation we can, go back to DOE with a DAR 

7 request for more information. But that's the 

8 extent of it, and I don't know if Gail wants to 

9 elaborate on that, but our access is limited to 

10 what we can get from DOE. We don't have direct 

11 access to their records.

12 MEMBER KEY: Okay. I guess a 

13 follow-up. Can the claimant then -- is there a 

14 DOE representative that the claimant can 

15 contact that knows a specific incident, that 

16 they can get that information, thereby, submit 

17 it also with their claim?

18 MS. POND: I don't have the answer 

19 to that, but maybe Gail can help.

20 MEMBER KEY: I mean there's -- it 

21 intrigued me yesterday on our tour that the 

22 site medical director listed the guards and the 
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1 fire department personnel as the top two labor 

2 categories on site for the EEOICPA program and 

3 going through their physicals. When we have 

4 these other sites across that firefighters and 

5 guards, you pull up their labor category, 

6 there's no exposures when we know that on site, 

7 not only did they fight fires that occurred on 

8 site, they went off site mutual aid agreement 

9 with the facility. And also they had the 

10 annual firefighting training that they 

11 intentionally set a specially built facility on 

12 fire to respond to that. So I mean there's 

13 exposures there, we know that. But yet, 

14 they're not included in the SEMs, being exposed 

15 to any chemicals whatsoever.

16 CHAIR MARKOWITZ: So -- oh, yeah. 

17 Ms. Splett. Go ahead.

18 MEMBER SPLETT: This is Gail Splett. 

19 I am not sure at Hanford when they do the DAR, 

20 if those CARES and ORPS reports are identified 

21 by individual names so that the staff could 

22 link to those, or how deep they would have to 
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1 dig. I will find that out. Do you know if the 

2 reports, or Mr. Domina, if they have specific 

3 names in them or they talk about like employee 

4 one, employee two? I don't know the answer to 

5 that. But it's --

6 MEMBER DOMINA: Well --

7 MEMBER SPLETT: -- a great question.

8 MEMBER DOMINA: -- the other part 

9 that would play into that is a PAAA violation 

10 because I've had them try to -- let's see, make 

11 sure to use the right wording here -- suspend 

12 some of my guys that I represented because of a 

13 AAA violation, and then you come to find out 

14 it's the contractor's fault once you get a copy 

15 of the report. And to me this can also prove 

16 that a certain event or something did actually 

17 take place.

18 MEMBER SPLETT: What kind of 

19 violation? Did you say triple --

20 MEMBER DOMINA: Price-Anderson 

21 Amendment Act. When the DOE fines a contractor 

22 for --
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1 MEMBER SPLETT: Got you.

2 MEMBER DOMINA: -- a screw up.

3 MEMBER KEY: Yeah. I don't know the 

4 answer to your question, you know, if it lists 

5 the individual's name. But if we can get to a 

6 date and a location, and to me that's 

7 documented evidence that this person was, in 

8 fact, involved in that and submit that with 

9 their claim, absent of any monitoring data.

10 MEMBER SPLETT: I know that the Part 

11 B Board and NIOSH have requested from Hanford 

12 all the ORPS data, and we provided it all to 

13 them. But I don't know whether it was 

14 retrievable by individual's name or linked to a 

15 DAR when it was requested. But I will ask --

16 find that question because I think it is 

17 something if it was retrievable, that that 

18 could be something that could be added to the 

19 DARs for the various sites.

20 CHAIR MARKOWITZ: Any other last 

21 comment, question before lunch? Yeah. Dr. 

22 Bowman.
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1 MEMBER BOWMAN: Yeah. I just wanted 

2 to link something that Jim and Marianne both 

3 said. At one point in time, Jim, you 

4 referenced the statutory setting of the 

5 criteria as being at least as likely as not. 

6 In my mind, that is highly similar to what 

7 Marianne was saying that in the absence of 

8 data, and also what Steven was saying, in the 

9 absence of data, we should not prejudice to 

10 either one way or the other.

11 I think there's a lot of 

12 similarities in at least as likely as not and 

13 to say there is an absence of data, so 

14 therefore, we cannot conclude an exposure or 

15 not an exposure. To me, those are very 

16 comparable. And so I think it's good to point 

17 that out that that links with that.

18 MEMBER CATLIN: But when you say 

19 absence of data, would you include the 

20 occupational health questionnaire as a piece of 

21 data, as data in the claim?

22 MEMBER BOWMAN: Yeah. I suppose it 
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1 would, and this is why it's very important for 

2 that data to be commented upon. Yeah.

3 CHAIR MARKOWITZ: Okay. So we're 

4 going to break for lunch. We'll resume at 

5 1:15. Thank you.

6 (Whereupon, the above-entitled 

7 matter went off the record at 12:17 p.m. and 

8 resumed at 1:17 p.m.)

9 CHAIR MARKOWITZ: We can get started 

10 again. Dr. Friedman-Jimenez, you can hear us?

11 MEMBER FRIEDMAN-JIMENEZ: Yes, I 

12 can.

13 CHAIR MARKOWITZ: Okay. Good. 

14 Okay. So we're going to actually for a few 

15 minutes go back to the same topic, try to 

16 identify some elements of the discussion that 

17 might be used to form a new recommendation for 

18 the Board. We're not actually going to write 

19 that recommendation in committee right this 

20 moment. We just need to identify what pieces 

21 we want to put in it, and then later a written 

22 version will magically appear that we can 
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1 modify and vote on. So, Dr. Cloeren, you want 

2 to start off this?

3 MEMBER CLOEREN: Sure. Okay. So 

4 there were several things in the letter back 

5 from the director. One of them had to do with 

6 agreeing with our proposal to use a summary 

7 table only if the industrial hygienist found --

8 only for the exposures that were found to be 

9 significant. And I think that we could agree 

10 that that makes sense. It doesn't make sense 

11 to have a table about duration, et cetera, et 

12 cetera, for things that were incidental or not 

13 found to be exposures. So I think that's the 

14 first point of discussion.

15 CHAIR MARKOWITZ: Sure.

16 MEMBER CLOEREN: Everybody -- okay. 

17 The second --

18 MEMBER FRIEDMAN-JIMENEZ: Do you 

19 want it now or wait to the --

20 MEMBER CLOEREN: I don't know. How 

21 do you want to do this?

22 CHAIR MARKOWITZ: No, no. What do 
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1 we have, what, maybe three or four points, 

2 right?

3 MEMBER CLOEREN: Three or four 

4 points. You want to go through them all? 

5 Okay.

6 CHAIR MARKOWITZ: Well, why don't 

7 you just briefly go down the three or four 

8 points.

9 MEMBER CLOEREN: Okay.

10 CHAIR MARKOWITZ: And then we'll --

11 MEMBER CLOEREN: Okay.

12 CHAIR MARKOWITZ: -- handle them one 

13 by one.

14 MEMBER CLOEREN: As we discussed 

15 earlier, we would like to recommend that the 

16 industrial hygienist should address all of the 

17 exposures that were claimed in the occupational 

18 health questionnaire, or otherwise by the 

19 claimant, whether that's in the doctor letter 

20 or claimant letter, or whatever. But that the 

21 industrial hygienist should specifically 

22 address what was purported, you know, by the 
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1 claimant, the former worker.

2 That the industrial hygienist should 

3 specify what data was found in each of the 

4 sources that were listed as reviewed. Right 

5 now, we sort of lump it all together, I 

6 reviewed all these things and my conclusion is 

7 this. And so I think we feel pretty strongly 

8 that there's an obligation out of transparency 

9 to state, you know, what was found in the DAR, 

10 if the DAR was there, you know, what was found 

11 in the OHQ, what was found in, you know, 

12 whatever other documents may have been listed.

13 And if there was no other 

14 information, no information found in specific 

15 documents, then that should be explicitly 

16 stated that there was no exposure information 

17 available because I think right now, lumping 

18 them all together and saying I reviewed all of 

19 these things, and my conclusions are blah, 

20 blah, blah, can imply that there was some 

21 information where there was none. Right? Did 

22 I capture your thoughts pretty well? Okay.
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1 And then finally, the OHQ should be 

2 shared with the CMC, or whatever doctor the --

3 whatever doctor the claims examiner may be 

4 sending the industrial hygiene report to that 

5 the OHQ should be part of that transmittal 

6 because sometimes they'll send the industrial 

7 hygiene report back to the treating doctor, or, 

8 you know, the former worker program doctor, and 

9 the OHQ should be part of that. I think that's 

10 it.

11 CHAIR MARKOWITZ: Okay. So you want 

12 to just start with the first one, which was?

13 MEMBER CLOEREN: The table is only 

14 needed if exposures are found to have been 

15 significant. But even if they don't find --

16 well, so the second point was whether it was 

17 found to be significant or not, the IH report 

18 should be addressing what was claimed.

19 CHAIR MARKOWITZ: Okay.

20 MEMBER CLOEREN: But the table only 

21 needs to include the data for exposures that 

22 were in any of the three significant groups.
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1 CHAIR MARKOWITZ: Low, medium, or 

2 high significant, right?

3 MEMBER CLOEREN: Yes.

4 CHAIR MARKOWITZ: Okay. Comments, 

5 discussion? Dr. Friedman-Jimenez?

6 MEMBER FRIEDMAN-JIMENEZ: Friedman7 Jimenez, I'd like to respond to that. I think 

8 that part of the issue here that I think is 

9 important is transparency so that the claimant 

10 and their representatives all understand the 

11 rationale for a case being accepted or denied. 

12 And in particular, denied.

13 And so if the exposures that are 

14 classified as incidental are not included in 

15 the table, then that doesn't allow the claimant 

16 to understand the rationale for saying that the 

17 exposure was non-causal. And I would argue 

18 that there are some cases in which incidental 

19 exposures can cause disease.

20 For example, someone that has 

21 isocyanate exposure and occupational asthma, 

22 and become sensitized to isocyanates may be in 
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1 a facility where the air levels are extremely 

2 low, even not measurable, and still get asthma 

3 attacks from that isocyanate and wind up having 

4 to leave their job. And so it has a 

5 significant -- quote, "significant" impact on 

6 their life. But it could easily be classified 

7 as an incidental exposure by an industrial 

8 hygienist because it doesn't have a classic 

9 dose response curve.

10 So I think that it leaves the door 

11 open for some real misunderstandings if we 

12 agree that the negative exposures or the 

13 incidental exposures don't need to be justified 

14 in any detail. I agree that you can't say, you 

15 know, how long is the duration as easily, but 

16 sometimes something is called incidental 

17 because it's a very, very low level, but over a 

18 long duration. And depending on the 

19 pathophysiology, that could be medically 

20 significant, although, industrial hygiene-wise, 

21 may seem insignificant. So I think the problem 

22 is with the word incidental.
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1 CHAIR MARKOWITZ: Actually -- this 

2 is Steve Markowitz -- I just want to follow up 

3 specifically on that, and there's also the 

4 category of more than incidental but less than 

5 significant, right? So it's not just the 

6 incidental ones that we're talking about.

7 I think the CMC should have access 

8 to that because it's a judgment as to whether 

9 an exposure was -- at what level it occurred. 

10 And the IH expresses their judgment. But for 

11 the CMC, we only have the universe of 

12 possibilities, and maybe I'm just repeating the 

13 comment that Dr. Friedman is making that they 

14 need to have that included in that universe. 

15 They may come -- they're likely to come to the 

16 same conclusion about its significance, but 

17 perhaps not. Dr. Bowman.

18 MEMBER BOWMAN: I was just going to 

19 comment further on this topic. I think that 

20 the table, of course, that the Board 

21 recommended use, you know, broke down various 

22 critical elements and are part of an overall 
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1 exposure assessment duration amount, and so 

2 forth. And I think part of the reason that I 

3 interpreted the Department did not accept the 

4 recommendation was one of practicality in terms 

5 of being able to answer that.

6 So you can imagine a situation in 

7 which -- and George, I 100 percent agree with 

8 you an incidental exposure can, in fact, be 

9 causative of illness. I completely agree with 

10 that statement. But it may not be possible or 

11 as possible to fill out all those details if 

12 the information is missing. And so to require 

13 -- to ask for a requirement of details in which 

14 it's because of an absence of information, the 

15 IH is trying to make their best guess, that 

16 might be difficult to do with all the level of 

17 detail we asked in the table because I wouldn't 

18 say that -- I mean could we not consider, you 

19 know, we don't want to say an IH should not use 

20 the table unless it's significant. Just it 

21 becomes harder when it's incidental depending 

22 on the nature of the incidental.
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1 CHAIR MARKOWITZ: Dr. Vlahovich.

2 MEMBER VLAHOVICH: Kevin Vlahovich. 

3 I would just be concerned that if there was an 

4 exposure that was claimed to have happened, and 

5 then was not even mentioned at all in the 

6 summary table, that that would be an omission 

7 that would be fairly significant.

8 (Off-microphone comments.)

9 MEMBER VLAHOVICH: We're not going 

10 to go into that.

11 MEMBER BOWMAN: Right.

12 CHAIR MARKOWITZ: Seems to be some 

13 general agreement around this point, so I think 

14 we can probably move on to the next point 

15 unless there are further comments.

16 MEMBER CLOEREN: What do you think 

17 the agreement is?

18 CHAIR MARKOWITZ: Dr. Van Dyke.

19 MEMBER VAN DYKE: I really hesitate 

20 to say this because I'm actually coming around 

21 to the significant incidental, you know, 

22 classification because it is, you know, I think 
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1 that the way the statute's written, that's the 

2 only bar is significant or incidental. And 

3 while I still think the frequency and duration 

4 is important, maybe what we're heading towards 

5 is they have to address all the exposures. 

6 They have to cite where they got -- where they 

7 found the information, whether or not it's 

8 significant or incidental. Maybe we need a new 

9 table that's an easier table to address with 

10 just those things. See, I knew that was going 

11 to be difficult.

12 CHAIR MARKOWITZ: Just a comment on 

13 the. I don't think the act says significant 

14 exposure. I think it says that a significant 

15 exposure has to be a significant factor and 

16 contributing, aggravating, or causing. Correct 

17 me if I'm wrong, Ms. Pond. So that word 

18 significant is not attached to exposure, at 

19 least in the act. Just by way of 

20 clarification.

21 MS. POND: I know that it's used --

22 significant exposure -- I'm sorry, this is 
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1 Rachel. It is a significant factor in causing, 

2 contributing to, or aggravating. I don't know 

3 if it's used at all with the exposure, but I'll 

4 double check. I don't think it is. But let me 

5 check and get back to you.

6 CHAIR MARKOWITZ: So, Dr. Van Dyke, 

7 can you just repeat your thought here?

8 MEMBER VAN DYKE: Yes. This is Mike 

9 Van Dyke. So my thought was it's an agreement 

10 that we need to address all the exposures that 

11 are listed in the OHQ as well as what's 

12 identified in the SEM. We need to be able to 

13 say whether each one of those are incidental or 

14 significant. And I think we need to say where 

15 that information came from.

16 Now there will be incidents where 

17 you have something that's identified in the OHQ 

18 that there is no information to corroborate 

19 that or to, you know, provide additional 

20 information. And I think that that information 

21 in itself is probably important to the CMC as 

22 well is that, you know, we looked for this. We 
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1 couldn't corroborate this exposure. That says 

2 we looked, you know, there's no information out 

3 there.

4 So what I was proposing is that we 

5 put that into -- I mean a table would be 

6 helpful to be able to say all those things, and 

7 a table could be pretty simple. So that was my 

8 suggestion.

9 I want to add one more thing that in 

10 order to make this -- just tweak it a touch, it 

11 has to be a relevant exposure. So it has to be 

12 some exposure that has been associated with the 

13 disease. So I can foresee this OHQ having, you 

14 know, hundreds of chemicals on it and, you 

15 know, 89 of them are irrelevant to the 

16 particular disease. I don't think that the IH 

17 should have to go through those. So any 

18 relevant chemicals should be put in a table. 

19 And those relevant chemicals are identified 

20 through those relationships in the SEM.

21 CHAIR MARKOWITZ: That strikes me as 

22 complicated to actually do it. So the claims 
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1 examiner who is entering the SEM to identify 

2 the exposures, and that person may or may not 

3 be necessarily using the OHQ to do that. So 

4 then the statement of accepted facts, the 

5 claims examiner hands over the relevant 

6 exposures according to their way of looking, 

7 and the SEM to the IH. So it needs to be 

8 workable. So you're suggesting that the IH 

9 look at the OHQ and decide, above and beyond 

10 the statement of accepted facts, which 

11 additional exposures might be relevant? Yeah, 

12 Dr. Van Dyke.

13 MEMBER VAN DYKE: So Mike Van Dyke 

14 again. I'm all right with the claims examiner 

15 doing that. But we have to be very -- it has 

16 to be very clear that they're looking at the 

17 exposures on the questionnaire as well as what 

18 they're identifying on the SEM.

19 CHAIR MARKOWITZ: All right. But --

20 MEMBER VAN DYKE: I don't know -- I 

21 don't know if we could trust that.

22 CHAIR MARKOWITZ: Yeah. But the 
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1 problem is I, you know, is the claims examiner 

2 really qualified to decide, above and beyond 

3 the SEM from the OHQ, which are medically 

4 relevant or not? I'd be skeptical about that.

5 MEMBER VAN DYKE: Well, aren't all 

6 the exposure disease relationships -- I mean 

7 most of those are outlined in the SEM, right, 

8 from HAZMAT.

9 CHAIR MARKOWITZ: Right, presumably. 

10 But then you're saying the CE takes the 

11 exposures above and beyond what they found in 

12 the SEM in relation to job title, the exposures 

13 from the OHQ submits them through the SEM to 

14 determine whether they're medically -- whether 

15 they're in the ballpark. And then if they are, 

16 then move them on to the IH.

17 MEMBER VAN DYKE: Seems complicated.

18 CHAIR MARKOWITZ: Yeah. That's what 

19 I was thinking. Yeah.

20 MEMBER FRIEDMAN-JIMENEZ: This is 

21 George Friedman-Jimenez. One comment to 

22 respond to this. I think the flow of events 
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1 went from determining what the disease is, and 

2 then from that disease what are the -- what's 

3 the short list of toxic substances that have 

4 been reported to cause that disease. And 

5 usually it's a short list, or none.

6 And so I think that's what Mike is 

7 referring to, and I would agree with that. 

8 That if you have someone with pulmonary 

9 fibrosis, you don't need to be looking at lead 

10 and, you know, a lot of organic solvents. 

11 You're looking at the three main causes of 

12 pneumoconiosis. And so those are the relevant 

13 exposures as defined by the disease and the 

14 disease exposure relationships that are listed 

15 in the SEM.

16 So then the question becomes is the 

17 SEM complete enough? Is it reliable enough to 

18 depend on it for an untrained person like a 

19 claims examiner to make that determination 

20 rather than it having to be made by a CMC or an 

21 occupational physician who is trained in that?

22 So I think it could be made into a 
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1 simple workflow where the disease is identified 

2 first, and then the exposure that's -- the 

3 exposures that are relevant to that disease are 

4 defined by what is known -- what's the science 

5 that's known about the causation of that 

6 particular disease and toxic substances. So 

7 then we get down to what is the -- how good is 

8 the SEM for that use so that -- I'd like to 

9 know what people think about that.

10 CHAIR MARKOWITZ: Dr. Cloeren.

11 MEMBER CLOEREN: This may not be --

12 this is an interesting example, I may be coming 

13 around to what George is saying. If you look -

14 - if you look up beryllium, and I know that we 

15 have a test that lets you know there's 

16 somebody's sensitized to beryllium so that 

17 makes it kind of easier. But if you look up 

18 construction workers in relation to beryllium, 

19 you don't find that they're exposed to it. And 

20 we've got plenty of construction workers in the 

21 BTMed program that have beryllium sensitivity 

22 and, you know, several with chronic beryllium 
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1 disease as well.

2 So relying on the SEM to identify --

3 like they were exposed somehow, right? And 

4 there's increased risk at certain sites, you 

5 know, and that, you know, there's other 

6 evidence. You know, I don't think it's -- it's 

7 not a routine exposure for construction workers 

8 outside of DOE. But it's not reflected for 

9 that job in the SEM.

10 And so relying on the SEM to come up 

11 with potential associations for -- Beryllium is 

12 a pretty good example of something that where 

13 an incidental exposure, you know, could wind up 

14 causing disease down the road because it's not 

15 the classic dose response. So I'm not sure how 

16 to handle it, but I thought I'd share that 

17 example.

18 CHAIR MARKOWITZ: Yeah. Yeah. I 

19 don't see either the claims examiner or the 

20 industrial hygienist making a judgment about 

21 the medical relevance of potential exposures. 

22 I mean I think to keep it straight forward, 
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1 that we should recommend the industrial 

2 hygienist look at the OHQ, and if there are 

3 exposures they consider to be important, that 

4 they be included in the table. And that be 

5 passed along to the CMC, and the CMC decides 

6 the medical relevance.

7 Otherwise, we're in a circular 

8 situation where the SEM has undue importance in 

9 determining medical relevance. And the whole 

10 point of the OHQ is to get beyond the SEM to 

11 understand what the person was really exposed 

12 to. Dr. Cloeren.

13 MEMBER CLOEREN: So I think we're in 

14 agreement on kind of the principles of our 

15 response. What I think still needs to be 

16 worked out is kind of how the process might 

17 work, I mean the flow. I mean a lot of that is 

18 up to the Department to figure out. But we 

19 also don't want to be recommending something 

20 that is like totally impractical.

21 So the table may be hanging us up a 

22 little bit where I think that we are in 
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1 agreement about addressing the elements in the 

2 OHQ. We are in agreement with sharing the OHQ. 

3 I think we are in agreement about stating what 

4 data was found in each of the different sources 

5 that were reviewed or not found, you know, 

6 explicitly. So I think that, you know, we have 

7 overall agreement about that. It's mostly the 

8 table idea that I think is hanging us up.

9 CHAIR MARKOWITZ: Yeah. We 

10 definitely -- it's not our job to get into, you 

11 know, how this might be implemented, right? I 

12 mean we -- on the hand, we shouldn't recommend 

13 something that's totally unworkable, right? 

14 But we definitely don't have to get into the 

15 weeds about that because that's what the 

16 program does, so. But I would agree with you, 

17 what you say. Comments, questions?

18 MS. POND: I do have that definition 

19 if you want it. It's in 7385(s)(4) in the 

20 statute. It says, "Department of Energy 

21 contractor employees shall be determined for 

22 purposes of this part to have contracted a 
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1 coverage on this through exposure at a DOE 

2 facility if, A, it is as least as likely as not 

3 that exposure to a toxic substance at a 

4 Department of Energy facility was a significant 

5 factor in aggravating, contributing to, or 

6 causing the illness; and B, it is as least as 

7 likely as not that the exposure to such toxic 

8 substance was related to employment at a DOE 

9 facility."

10 CHAIR MARKOWITZ: Right. Yeah. And 

11 I think Ms. Hand, who is sometimes here in the 

12 audience, who's not here today. Maybe she's 

13 listening. But she has repeatedly pointed this 

14 out to the Board over the years, this 

15 distinction between significant exposure and 

16 significant factor. The act says significant 

17 factor, so. So what else do we have, Dr. 

18 Cloeren, on this? Yeah. Or we're ready to 

19 assemble? Okay.

20 MEMBER CLOEREN: All my cards are on 

21 the table.

22 CHAIR MARKOWITZ: Okay. So let's 
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1 move on, and there should be a PowerPoint that 

2 says Markowitz. So the Board made a 

3 recommendation last time, and I have an excerpt 

4 of that recommendation. I don't have the -- I 

5 didn't put the rationale on a slide, so if we 

6 need -- if we need to revisit the rationale, we 

7 can just discuss it.

8 But I highlighted the key phrase 

9 that we recommended that the program develop a 

10 mechanism to evaluate the validity and accuracy 

11 of the opinions and rationales expressed by the 

12 CMC in their reports. Then we went on to say 

13 that it should be done in a way that respects 

14 conflict of interest with, you know, the 

15 parties that are currently responsible for the 

16 CMC reports. And so this was not accepted by 

17 the program, and if we could go to the next 

18 slide.

19 So this is excerpts from the 

20 departmental response, and in order to fit it 

21 on a slide, I just really took kind of the key 

22 words or key elements of that. First, the 
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1 current adjudication procedures provide claims 

2 examiners with the necessary guidance to assist 

3 the weight of medical evidence in determining 

4 the validity and accuracy of medical opinions 

5 submitted by a CMC.

6 And then, above and beyond that, 

7 there are additional program safeguards. First 

8 the CEs are required to demand additional input 

9 from the CMC when the rationale or the 

10 foundation for their analysis is found to be 

11 insufficient by the CE.

12 Secondly, the program has clearly 

13 defined mechanisms to assure quality and 

14 accuracy. And third, that, actually, the 

15 program has staff who are dedicated solely to 

16 assessing quality assurance including, 

17 presumably, this issue of CMC. And the risk of 

18 another layer of review is that it would lead 

19 to duplication and delay. So if you can go to 

20 the next slide for a moment.

21 And then at the end, then, the 

22 Department requests that the Board provide 
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1 specific guidance or references. I want to --

2 I want you to pay attention to this text 

3 because I need some help here understanding 

4 this. To medical health science data that can 

5 be communicated to staff or CMCs about medical 

6 standards or epidemiologic data that could 

7 serve to eliminate or reduce instances of gross 

8 errors. That was the term that we had used in 

9 our rationale as mentioned by the Board.

10 So the request to us is that we 

11 identify guidance or references to medical 

12 health science data that they could use to 

13 communicate to staff, to CMCs concerning 

14 medical standards or epidemiologic data that 

15 can serve to eliminate or reduce instances.

16 So I don't want -- I want to get to 

17 this because -- not right away, I want to go 

18 back and look at the other elements of their 

19 response. But I do want to get to this because 

20 I don't -- yeah, I have my own opinion about 

21 this, which I'll express in a moment. But next 

22 slide.
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1 Okay. So let's back up two slides 

2 if we could. Okay. So the first point is that 

3 there are procedures in place that provide CEs 

4 with the necessary guidance to assess weight of 

5 medical evidence in determining validity and 

6 accuracy. So I understand this to mean that we 

7 have in the procedure manual, and maybe 

8 otherwise, but in the procedure manual 

9 presumably, some specific directions to the 

10 claims examiner in order for them to determine 

11 whether the CMC is producing a valid and 

12 accurate opinion. And I want to discuss what 

13 these procedures are.

14 I think the question is whether they 

15 achieve what is purported to achieve here. But 

16 just to, again, review the one, two, three 

17 point, CEs are required to demand additional 

18 input when the CMC, the rationale, or 

19 foundation is insufficient. So that's a good 

20 thing, right, if a CMC produces a report and 

21 it's clearly inadequate, that they give the CMC 

22 another chance to actually beef up their 
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1 reports so that, you know, it's well 

2 rationalized.

3 And then the program has clearly 

4 defined mechanism, but I think actually this, 

5 in part, refers back to these adjudication 

6 procedures, and in part to the quality 

7 assurance program. And then the idea that they 

8 have staff dedicated to quality assurance, 

9 which is a good thing, but I don't think those 

10 staff -- and you can correct me if I'm wrong 

11 here, I don't think we're talking about 

12 healthcare providers who are doing that quality 

13 assurance exercise. I don't think it's being 

14 done by physicians or other healthcare 

15 providers. They're analysts in the policy 

16 branch who are doing the quality assurance, 

17 this part, and other parts of the quality 

18 assurance. So let's go ahead two slides.

19 And at some point, I realized in 

20 looking at this and trying to understand how 

21 the program views this and how we view this is 

22 that I think actually we have different ideas 
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1 about what accuracy and validity are. Like I'm 

2 basically wondering did the CMC get it right. 

3 Given the facts, did their interpretation, 

4 their opinion they expressed, is it correct? 

5 Or within a range of acceptable 

6 interpretations? It may not be exactly what I 

7 think for instance, but is it within the range 

8 of reasonable doctors would agree or disagree 

9 about it? Or is it outside that and they're 

10 just plain -- they're just wrong? I mean it 

11 happens, right?

12 And so that's what I think about. 

13 But I don't think that's the way the -- at 

14 least in the description I could find the way 

15 the program really zeros in on quality and 

16 validity. So from the procedure manual, Page 

17 129, specifically, a well-rationalized 

18 causation opinion, and that's what the CMC is 

19 supposed to produce, you know, that's what the 

20 -- that's what the product is, from a qualified 

21 physician. By the way, it can be produced by 

22 the personal physicians, but we're really 
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1 talking here about the CMC report.

2 It communicates accurate 

3 understanding of the employee's toxic substance 

4 exposure, discusses in the employee's medical 

5 history pertinent diagnostic evidence, and then 

6 applies reasonable medical judgment informed by 

7 relevant, credible medical health science 

8 information.

9 So the CMC is required to apply 

10 reasonable medical judgment. So who's in the 

11 position of determining whether the CMC is 

12 applying reasonable medical judgment? And, 

13 frankly, can non-healthcare providers really 

14 make an accurate assessment of whether what the 

15 CMC is saying is a reasonable medical judgment?

16 And it's supposed to be backed up by 

17 references by medical health science 

18 information. Presumably, those are references 

19 in the report, right, and we've seen them. We 

20 seem the in the IH report. Frankly, the claims 

21 we've seen, a lot of the references that we've 

22 seen in these reports are extremely generic. I 
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1 mean we saw it again in the fictitious IH 

2 report that they sent us in relation to the I 

3 have. There are textbooks, there are a variety 

4 of sources that aren't specific to a particular 

5 case or exposure. Anyway, next. So that's 

6 what the procedure manual says.

7 And then to go on, this is -- now 

8 these are the instructions for the claims 

9 examiner, and I'm almost finished with my 

10 little monologue here, so. But instruction to 

11 the claims examiner, and I picked out I think 

12 the most relevant part. If anybody wants to 

13 see the context, we can just bring up the 

14 procedure manual, Page 137, and see the other 

15 elements.

16 So a well-rationalized opinion, 

17 well, the claims examiner is supposed to prefer 

18 the following: A well-rationalized opinion 

19 over one that is unsupported. Rationalized 

20 means supported by an explanation of how the 

21 conclusions are reached, including appropriate 

22 citations or studies. We just discussed that.
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1 And the well-rationalized is a 

2 convincing argument that is reasonably 

3 justified -- represents a reasonably justified 

4 analysis of relevant evidence. And then it 

5 gives an example of where an opinion that is 

6 supported by interpretation of diagnostic 

7 evidence, relevant and scientific medical 

8 literature is well-rationalized. If it's not, 

9 then the conclusion that's reached is not well 

10 rationalized. And next slide. And this may be 

11 the last slide I have.

12 Okay. So we can back up. So my 

13 problem with all this is that the quality 

14 assurance procedures for CMC reports relate to 

15 timeliness of the report. These are the 

16 requirements of the contractor, the CMC 

17 contractor. The timeliness of the report, 

18 whether it has a well-rationalized argument in 

19 the report, whether it faithfully reflects the 

20 facts of the case, whether it appropriately 

21 addresses the statement of accepted facts, and 

22 some other elements of the report.
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1 But unless I'm missing something, 

2 what I don't see is this head-on determination 

3 about whether the well-rationalized argument is 

4 actually correct or not. And the reason why 

5 it's important is when we did review claims 

6 over the years, that there were some, a small 

7 proportion I would say somewhere 10 and 20 

8 percent, in which the CMC report was just plain 

9 off.

10 And it was striking because it was a 

11 shame. You know, the person was not going to 

12 get compensated because, you know, it was the 

13 CMC to do the report. And the procedures, the 

14 system had no way of catching that. They could 

15 catch it if the report was late, if it was 

16 absent of any argument, if it didn't have 

17 references, and other aspects of the appearance 

18 of the report. But the actual judgment itself 

19 that there wasn't a head on analysis of that.

20 Now I think there used to be because 

21 going back a few years, I think it's true that 

22 the physician associated with the program did 
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1 quarterly assessments of CMC reports, 

2 impairment, causation, and the like. And then 

3 would look at that issue of causation. But 

4 they rarely found any problems, and I think --

5 personally, I think the issue here -- and they 

6 frequently found problems with the impairment 

7 reports, about 20 percent of the time. Some of 

8 you may remember that when we looked at that 

9 because we've looked at that previously.

10 But I think they rarely found 

11 causation problems because OccMed people around 

12 the table understand this, but others should 

13 understand, too, within occupational medicine, 

14 there are various niches and, you know, I'm not 

15 an impairment evaluator so you wouldn't send me 

16 an impairment. You wouldn't have me go be a 

17 corporate medical doc for a company because I'm 

18 clueless about what they do. You wouldn't ask 

19 me to do supervised drug testing because I 

20 don't know anything about that. But if it 

21 comes to a question like epidemiology or 

22 causation, then, you know, we want Dr. 
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1 Friedman-Jimenez because that's what he does in 

2 life, right?

3 And there are these separate niches 

4 in occupational medicine that people specialize 

5 in or not. And so I think what's going on, in 

6 part, is there's some CMCs who this is not 

7 really their expertise, but they get -- they're 

8 placed in a position of doing causation 

9 reports. And that it seems like a problem that 

10 is detectable and addressable. End of my 

11 monologue. Dr. Cloeren.

12 MEMBER CLOEREN: This is all so kind 

13 of hypothetical. I want to give a case example 

14 that I think everybody could probably relate 

15 to. We saw a case of somebody that had 

16 asbestos exposure and had interstitial lung 

17 disease consistent with asbestosis ,and the CMC 

18 in the determination that there was not a 

19 causal relationship made the statement that you 

20 can't have asbestosis without pleural plaques.

21 And so that was kind of like a 

22 statement of -- an incorrect statement stated 
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1 as if it was a medical fact, and it's a common2 enough condition that it might be one where the 

3 claims examiner might have thought to 

4 themselves, wow, you know, I've already 

5 adjudicated a bunch of claims of asbestosis 

6 without plaques, you know, were those wrong.

7 But I think if the requirement is 

8 that the CMC back up statements like that, that 

9 would at least maybe cause the CMC to look up, 

10 you know, what proportion of asbestosis cases 

11 show up without pleural plaque, and maybe that 

12 would be useful. Maybe requiring something to 

13 back them up because I think that's a really 

14 blatant one where I think we can all agree 

15 that's a problem.

16 CHAIR MARKOWITZ: But there is 

17 currently a requirement that the well18 rationalized argument be supported by reference 

19 to the medical health science literature. 

20 That's in the current procedure.

21 MEMBER CLOEREN: I don't think this 

22 one has --
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1 (Off-microphone comments.)

2 CHAIR MARKOWITZ: Well, I think --

3 you're probably a little bit more hopeful about 

4 the amount of time that you think that doctor 

5 will put into that question than I am. But --

6 MEMBER CLOEREN: I think that this 

7 CMC, this is a belief by this CMC that is 

8 probably used time after time after time in 

9 that CMC's report, and there ought to be a way 

10 to counter that kind of like misinformation 

11 that is shared, which I think is rare. I don't 

12 think it's not the norm by any means. But it's 

13 something that there ought to be some kind of 

14 way to address, and I don't know what that is, 

15 but.

16 CHAIR MARKOWITZ: Comments, ideas?

17 MEMBER CLOEREN: So actually did see 

18 that twice by the same CMC in two different 

19 claims, that's why I think it might --

20 CHAIR MARKOWITZ: Yeah.

21 MEMBER CLOEREN: -- a pattern.

22 CHAIR MARKOWITZ: And you didn't 
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1 review that many claims, right?

2 MEMBER CLOEREN: No.

3 CHAIR MARKOWITZ: Yeah. Yeah. Dr. 

4 Bowman, you look like you want to say 

5 something. Sorry. You just have that look on 

6 your face. Dr. Friedman-Jimenez?

7 MEMBER FRIEDMAN-JIMENEZ: Well, you 

8 know, what's making this difficult is that 

9 there's no gold standard. It's not like, you 

10 know, a blood lead level that you can measure 

11 whether you're right or wrong. Now there's an 

12 element of judgment that is necessarily 

13 involved in these determinations. And so I 

14 think it's not a simple thing, and it has to 

15 be, I think, accompanied by some set of 

16 presumptions of exposure and of causation that 

17 claims examiners can apply who are not trained 

18 in making these judgments at a medical level.

19 But it also has to include detailed 

20 causation analyses by occupational physicians 

21 who are trained in that subset of cases for 

22 which there are complicating factors, or it's 
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1 not a clear cut exposure, it's not a clear cut 

2 diagnosis, et cetera.

3 So I think that we should really 

4 discuss this further. And, you know, I would 

5 propose that we have a working group to focus 

6 on the causation assessment. You know, 

7 certainly the exposure assessment is a major 

8 part of this. That's actually probably the 

9 weakest link. But I think there's a separate 

10 causation assessment that needs to be done that 

11 can be done in some cases by presumption in the 

12 extreme cases where it's a clear cut case, but 

13 which also needs to be done very analytically 

14 by trained occupational physicians, and 

15 hopefully then in the minority of cases where 

16 it's not so clear cut.

17 So I think that we do need to 

18 discuss this more. I think that we need to 

19 come up with a workable set of recommendations 

20 for streamlining this causation assessment in a 

21 way that's practical and that can be applied. 

22 And I don't think we're there yet, and I don't 
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1 think we have time at this meeting to make that 

2 recommendation. So I think a working group 

3 could address this.

4 CHAIR MARKOWITZ: I would say --

5 Steve Markowitz. I would say on the 

6 presumption front that the Board has provided 

7 advice to the program on presumptions in 

8 several areas over the years, and those have 

9 been largely accepted by the program. And if 

10 there are other issues that are ripe for 

11 presumptions that we should or the program 

12 wants us to look at, that we should address 

13 them because presumptions are very helpful to 

14 the program. But I haven't been able to think 

15 of any additional areas that we might help them 

16 develop presumptions for.

17 And so this really involves the non18 presumption cases, right, the ones where you're 

19 looking at all the individual information and 

20 then trying to make a decision. You know, 

21 the -- so on this slide now, the Board is 

22 requesting that -- or excuse me, the Department 
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1 requests the Board provide specific guidance or 

2 references, medical health science data to be 

3 communicated to CEs or CMCs about medical 

4 standards or epidemiologic data.

5 I can't think of any way to do that. 

6 I can't think of any textbook, database, or a 

7 set of medical consensus documents, joint 

8 statements that would fulfill that purpose. I 

9 don't think it exists. And, you know, we can 

10 go into the reasons, but regardless. So I 

11 don't think there's any way really of complying 

12 with this request. But maybe other people have 

13 ideas. Dr. Bowman.

14 MEMBER BOWMAN: Steve, I agree with 

15 your assessment there. I used PubMed to look 

16 up if there's review articles on causation 

17 assessment with exposures to toxins and 

18 occupational health. And the only examples I 

19 could find are very specific to specific toxins 

20 directly with specific disease. And so the 

21 library of such articles that would be relevant 

22 would just be too vast to be something that we 
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1 could respond to.

2 But a second thing, going back to 

3 what you said earlier about you'd want to ask 

4 the right person for the opinion because of the 

5 nature of specialization in OccMed, and that's 

6 true for scientific fields as well. And I was 

7 thinking I don't know and maybe the Department 

8 can tell us, maybe someone on the Board knows, 

9 how is CMC expertise taken into account or not 

10 in selecting which CMC evaluates a case?

11 CHAIR MARKOWITZ: Well, I can just 

12 give an initial response, and if I'm wrong, the 

13 -- they try to pick the medical discipline 

14 that's most relevant to the questions of the 

15 claims examiner. So could be orthopedic, it 

16 could be pulmonary. It could be cancer, 

17 oncology. It could be occupational medicine or 

18 the like. And they try to match it up. I 

19 think the contractor's obligation is to try to 

20 match up what the questions are with the 

21 relevant discipline. Did I get that right?

22 MS. POND: Yes, that's correct.
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1 CHAIR MARKOWITZ: Dr. Van Dyke.

2 MEMBER VAN DYKE: Mike Van Dyke. So 

3 I'm, you know, sitting here thinking about this 

4 with no gold standard, this is the art of 

5 medicine, right? I mean this is that undefined 

6 part that you have to put all those pieces of 

7 information together to get the right answer. 

8 And I'm skeptical that there's any way to do 

9 that given the breadth of the conditions and 

10 the breadth of the exposures because it's going 

11 to be a little bit different for many of them.

12 So I don't have a great answer for 

13 you. But I don't know if we have a good answer 

14 on the size of the problem either. So I think 

15 that if we could get some information around, 

16 you know, denial of claims and reasons they're 

17 denied in some sort of way that we could say, 

18 you know, 10 percent of claims are denied based 

19 on inability of the CMC to establish causation, 

20 you know, then at least we know it's 10 percent 

21 that we're looking at and it's not 50.

22 So I think that would be helpful as 
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1 a start. And then we might be able to dig into 

2 some of those because we might be able to 

3 identify specific diseases or specific 

4 exposures where you're consistently seeing more 

5 problems than others. But as a holistic 

6 problem, I'm a little skeptical that you can 

7 find a good answer.

8 CHAIR MARKOWITZ: The Department has 

9 provided for us, I think at two separate times, 

10 tables on the most common health conditions for 

11 which there are claims by organ system or 

12 sometimes by disease type, cancer. And then 

13 the number of claims in a given time period, 

14 how many were accepted, how many were denied, 

15 and then the reason for the denial, and it 

16 could be any number of things. Causation's one 

17 of them. But there are other reasons as well, 

18 ineligible and this and that.

19 And so it would be helpful to have 

20 an update on that table, actually, since the 

21 last one that was provided to us. Probably 

22 it's only a year's worth of data, but it would 
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1 be of interest. It may also be of interest 

2 relevant to the fluctuation in the number of 

3 claims.

4 I don't think that's going to answer 

5 the question because it tells you sort of the 

6 outer limit of the problem. But all you have 

7 is the percentage of claims that are denied by 

8 virtue of ineligibility or no employment 

9 verification or causation. And then within 

10 that, a lot of those causation opinions are 

11 going to correct, right? And then some portion 

12 are incorrect, and those are the ones we're 

13 worried about. But it'll give you some sense 

14 of magnitude of the problem. So I think we 

15 should request that and that might help the 

16 discussion.

17 But I mean to say about -- let me 

18 just respond to the art. I actually don't 

19 think this is a question of art. I think these 

20 are cases in which, you know, the doctor made 

21 the incorrect conclusion based on what we know 

22 about the medical science. And it wasn't a 
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1 question of art at all. It was a question of 

2 science, and they just got it wrong. And, you 

3 know, we can talk about the gold standard in a 

4 minute because it's not like I consider myself 

5 to be the gold standard. It sounds like it, 

6 but it's not. But, you know, there, you know, 

7 sometimes doctors are wrong, right? Dr. 

8 Cloeren.

9 MEMBER CLOEREN: What if in a few 

10 cases it's not about the art of science, but 

11 about bias of a particular CMC, or one or more? 

12 I wonder if the Department has ever looked or 

13 would think about looking at the kind of trends 

14 among CMCs in agreeing with, like, saying yes, 

15 caused and no, didn't to see if there's any 

16 bias in a particular direction.

17 MS. POND: This is Rachel. Yes, we 

18 have looked at that after some of the Board 

19 actually reviewed some cases and had brought 

20 some things to our attention. So we have 

21 looked at those trends to a certain extent. 

22 You know, we didn't find anything really 
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1 significant. I think there may have been one 

2 or two that we kind of had to look at more 

3 closely and talk to the contractor about.

4 But, in general, we didn't see 

5 anything specifically that would lead us to 

6 believe there was a particular bias other than 

7 there might be trends like you found in the one 

8 report about, well, this doctor consistently 

9 says this. And the trouble with claims 

10 examiners, they can weigh medical evidence, but 

11 they can't know if the medical veracity is 

12 wrong necessarily.

13 And that's where I think Dr. 

14 Markowitz is talking about that complication 

15 for us because we have to weigh the medical 

16 evidence, and we have to look at the quality of 

17 these reports. But different doctors at 

18 different times are going to say I don't agree 

19 or I do agree, and that's where we get into 

20 this kind of rub as to figuring out when it's 

21 the report that's just wrong and how we would 

22 know that as claims staff.
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1 So our claims staff do the best they 

2 can in trying to look at the various opinions. 

3 Actually read through the references that are 

4 provided because we get these reports, not just 

5 from CMCs, but we're not getting a lot of them 

6 from treating physicians, authorized reps 

7 physicians that, you know, have been providing 

8 these reports.

9 So we have to shift through them in 

10 all those facets to review the references, are 

11 they relevant? Do they make sense to this 

12 actual situation? So it is a very complicated, 

13 as you all know, problem to have, and looking 

14 at the whether it's right or not in the face of 

15 it, the medical veracity of it, that's where we 

16 struggle and that's why we're where we are, I 

17 believe, with this topic.

18 CHAIR MARKOWITZ: Dr. Vlahovich.

19 CHAIR MARKOWITZ: Kevin Vlahovich. 

20 Similar to what Dr. Cloeren was just talking 

21 about, about whether a CMC is the appropriate 

22 person to review a study, or if there's bias 
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1 present. Even in the example that Dr. Cloeren 

2 gave about someone having no pleural plaques, 

3 but asbestosis. I'm sure that if you looked up 

4 PubMed, you could probably find some studies 

5 that will say that is true, you know, when the 

6 99 percent of these might not.

7 Is there a way when reviewing 

8 evidence that has been cited to verify the 

9 accuracy or veracity of that? Like what impact 

10 study, the journal cited, or what types of 

11 studies have been cited, whether it's 

12 systematic review or case study? And I don't 

13 know if there's an answer to these questions, 

14 but --

15 MS. POND: Yeah. I don't know if 

16 that was necessarily a question for me. This 

17 is Rachel. I'm sorry. But in terms of when we 

18 do look at the citations that are provided, if 

19 we have -- if our claims staff have questions, 

20 or they say this seems kind of right but 

21 they're not sure, they'll go to the 

22 toxicologist oftentimes to provide us with some 
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1 more information about those articles of what 

2 they mean and try to give us some 

3 interpretation.

4 If there's a question that, you 

5 know, we can re-ask, go back to the doctor 

6 whether it's a CMC or the treating doctor, 

7 we'll do that and say we're not really sure 

8 what this means or where this comes from, we 

9 can do that. But that's where knowing when to 

10 ask those questions, when not to ask those 

11 questions becomes a challenge.

12 CHAIR MARKOWITZ: If we looked again 

13 at this slide about whether the Board can help 

14 find guidance, references, medical health 

15 science data, medical standards, or 

16 epidemiologic data, so, you know, I can think 

17 in the cancer field, if we're talking about 

18 oncology, how to do that, you know, you would 

19 go to the standard of care set out by the 

20 National Comprehensive Cancer Network, NCCN. 

21 They have treatment recommendations. And you 

22 can, if you were diagnosed with cancer, 
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1 whatever type of cancer, that's where the 

2 oncology community would agree, kind of a 

3 starting place for what treatments you give. 

4 And these are consensus treatment 

5 recommendations.

6 We don't have anything like that in 

7 occupational medicine. We don't have a 

8 textbook like that. We don't, you know, have a 

9 set of guidance documents or -- can anybody 

10 think of any response to this request from the 

11 Department that might be helpful?

12 MEMBER FRIEDMAN-JIMENEZ: Yeah. 

13 This is George Friedman-Jimenez. I've reviewed 

14 a small number of cases, and I would say I 

15 agreed with most of the causation analyses. 

16 But I saw several that I disagreed with, and 

17 that I think were in error. And in both 

18 directions, both denying causation when I 

19 thought that it was likely, and in one or two 

20 cases supporting causation when I thought it 

21 was not likely, which we didn't make an issue 

22 because we didn't want to overturn a settled 
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1 case. But I think those are in the minority, 

2 but it does occur in both ways.

3 And I think that there are some ways 

4 that we could identify implementable 

5 recommendations that would reduce the 

6 likelihood of these kinds of misinterpretations 

7 that lead to this likely errors. And I say 

8 likely errors because I'm not, you know, a gold 

9 standard either. These would be disagreements 

10 among physicians.

11 But I think we could improve on some 

12 of the literature reviews. They could be 

13 updated that are done to support some of the 

14 decisions. We could improve on understanding 

15 of multiple factors contributing to causation. 

16 There are a number of ways that we could 

17 improve on the accuracy of these causation 

18 determinations, and I think it would be worth 

19 looking at them.

20 And, you know, we're not going to 

21 solve the entire problem, and, in fact, we 

22 don't have a gold standard, as I said. And so 
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1 we're never going to be able to measure the 

2 sensitivity and specificity exactly of the 

3 causation determination compared to the actual 

4 truth.

5 But we can, you know, use the 

6 expertise of toxicologists, of industrial 

7 hygienists, of epidemiologists and clinical 

8 occupational physicians to come up with a best 

9 judgment in some cases that would differ from 

10 the judgment of a single CE or a CMC that made 

11 a determination that was based on either 

12 misinterpretation of data or not considering 

13 some of the available information on exposure 

14 or other disease-related factors.

15 So I think that there is some room 

16 for improving the accuracy of these 

17 determinations, and I think it would be worth 

18 reviewing that and seeing what we can suggest 

19 that would be practical and likely to make 

20 incremental improvements. Again, we're not 

21 going to completely eliminate errors in 

22 causation judgements, but I think we can make 
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1 some improvements based on the small number of 

2 cases I've seen.

3 Now many of you have seen a lot 

4 more -- reviewed a lot more cases than I have, 

5 and so I'd be interested to know what you 

6 think, if you've seen causation analyses that 

7 you think are incorrect or that there's some 

8 clear error that was made that could be avoided 

9 in future cases.

10 CHAIR MARKOWITZ: Well, one idea of 

11 approaching this would be kind of in parallel 

12 with the way that the program currently does 

13 quality assessment where they take a certain 

14 number of cases, a certain number of claims. 

15 Right now I think it's about 50 per quarter, 

16 and they're divided equally among different 

17 types of medical reports.

18 Some of them are CMC reports. 

19 Others are what are called file review reports 

20 and other types of reports. And those are 

21 reviewed by the dedicated policy analyst staff 

22 for various aspects of quality that we talked 
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1 about before, but not directly head on is this 

2 opinion correct or not.

3 And why not develop a small panel of 

4 causation physicians, that's what their 

5 expertise is, occupational medicine, but this 

6 is what they specialize in, who would 

7 participate in that quarterly assessment? And 

8 what their job would be would be to look at the 

9 causation claims, but the same could be applied 

10 to impairment, you know, impairment 

11 specialists, right, who look at the impairment 

12 claims. And look at whether, you know, look at 

13 whether it's valid, whether the opinion was 

14 valid or not.

15 And if there's a disagreement with 

16 the CMC, then you might hand it over to a 

17 second causation physician sort of as the 

18 referee, right, so that you're not wholly 

19 relying on a single person and their own set of 

20 knowledge, et cetera.

21 But to identify a small panel that 

22 could do this on a quarterly basis. It could 
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1 be, you know, I mean I don't know of the 

2 mechanism. Could be embedded I suppose within 

3 the current contract, CMC contract a separate 

4 panel of causation physicians within that 

5 contract, or the Department could do it itself, 

6 you know, that's a mechanism that's up to them.

7 And it would be an improvement on 

8 what there is now because it would be a direct 

9 assessment about whether the causation opinion 

10 was correct or not. And it would be a way of 

11 identifying certain CMCs who are repeat 

12 offenders because if you looked at a certain 

13 number of claims over time, you could see 

14 whether there are people who, you know, 

15 frankly, they shouldn't be doing the CMC 

16 evaluations. It's just not their -- it's not 

17 their strength.

18 So identify the rate of the problem, 

19 monitor that, and it could help identify some 

20 CMCs who, perhaps, shouldn't be part of the 

21 process. So that strikes me as maybe 

22 ambitious, but doable in terms of the way the 
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1 Department approaches quality assurance now. 

2 And having achieved unanimous consensus with 

3 this idea. No, seriously, people have any 

4 thoughts or reactions, or --

5 MEMBER BOWMAN: Steven. This is 

6 Aaron Bowman. I agree with what you just 

7 mentioned, and I think your use of the word 

8 consensus earlier is an important part of why I 

9 agree. Right? Like in the scientific 

10 community, we'll assess the quality of data 

11 being presented and whatever by a peer review 

12 process. So there is no, quote, "Gold 

13 Standard." Therefore, the standard is the 

14 consensus of the community.

15 So having other CMCs or relevantly 

16 trained experts to look at this, I would be --

17 I think, in fact, is the gold standard of how 

18 you assess right or wrong. And if something 

19 can be tied in with existing QA processes and 

20 procedures, that would be good as well.

21 CHAIR MARKOWITZ: So peer review is 

22 the --
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1 MEMBER BOWMAN: Mm-hmm.

2 CHAIR MARKOWITZ: -- right, is the 

3 mechanism essentially? Right. Yeah. Other 

4 comments or -- okay. Well, Dr. Cloeren.

5 MEMBER CLOEREN: I think that sounds 

6 like a great idea. I suspect the problem is 

7 not as big as we may, you know, I think that, 

8 you know, when I used to federal worker's comp 

9 case management, you know, the cases that were 

10 going bad were the ones that I saw. And so 

11 like you get this skewed idea that everything's 

12 gone bad, and that's not the case. Almost, you 

13 know, almost everything is going well.

14 And so having a systematic peer 

15 review process would be helpful in documenting 

16 kind of the degree of the problem, and come up 

17 with some solutions, you know, to it if 

18 problems are identified. I think that's a good 

19 idea.

20 CHAIR MARKOWITZ: Yeah. It may not 

21 be, you know, we don't know, really, the 

22 magnitude. But the point is that the program 
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1 cares a lot about quality assurance. You know, 

2 it went through a redesign of quality assurance 

3 of many aspects of many actors in the whole 

4 process. And this is an omission, and it's an 

5 omission that can be rectified. So it's not a 

6 special effort, I think. It's just to fill out 

7 or complete the quality assurance process. And 

8 Ms. Pond is nodding her head yes, so I think we 

9 can move on.

10 MS. POND: I don't think I did that.

11 CHAIR MARKOWITZ: Oh, maybe she was 

12 thinking about something else. George, I was 

13 making a joke, just to be clear. Okay. Okay. 

14 So we've exhausted that for the moment. We can 

15 come back to it tomorrow morning if we want. 

16 But we've exhausted that for the moment. If 

17 there are any last comments or questions about 

18 this, otherwise we'll move on.

19 Okay. Okay. Speeding along here, 

20 are we ready to revisit the significance 

21 question, or should we take a little bit of a 

22 break at this point and -- okay. I hear two 
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1 nods in favor of breaks. So we're going to 

2 take -- it's 2:20, let's reconvene at 20 of 

3 3:00, in 20 minutes.

4 (Whereupon, the above-entitled 

5 matter went off the record at 2:20 p.m. and 

6 resumed at 2:43 p.m.)

7 CHAIR MARKOWITZ: Okay, let's get 

8 started again. So the schedule for this 

9 afternoon, we've got one more topic, actually, 

10 to address by our agenda, and then we have the 

11 public comment period. So, as it stands now, 

12 we have no people requesting to make public 

13 comments, but the Board needs to be available 

14 at 4:15 in case anybody does come forth. 

15 And let me just say for the public, 

16 to the extent the public is participating in 

17 this, you're welcome to make a public comment 

18 starting 4:15. The way in which you would 

19 communicate your desire to make a public 

20 comment would be, Ryan?

21 MR. JANSEN: 

22 Energyadvisoryboard@dol.gov. Just send a 
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1 message to that email address and we will put 

2 you on the list. 

3 CHAIR MARKOWITZ: Okay, so now we're 

4 going to return to a topic that the Board

5 discussed at a meeting or two ago about some 

6 language from the procedure manual relevant to 

7 what we were discussing before, which is 

8 basically different levels of exposure that 

9 industrial hygienists can estimate for use in 

10 claims evaluations. So what I've done is 

11 actually bring up from the procedure manual the 

12 part, page 127, procedure manual 7.1, which 

13 deals with this, but let me turn it over to Dr. 

14 Cloeren.

15 MEMBER CLOEREN: Okay, well I think 

16 everybody can see it. This is just kind of a 

17 quick review, I guess, that the levels -- so 

18 I'll just read parts of it. The IH will assign 

19 a level of exposure to each toxic substance as 

20 incidental, significant or more than 

21 incidental, but less than significant. I think 

22 there's kind of implied in there or none, 
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1 right? 

2 So, if there's an exposure it's 

3 incidental, significant, or more than 

4 incidental but less than significant and then 

5 within -- well, I guess we could look at what 

6 incidental is. It's generally kind of in 

7 passing, intermittent, infrequent. Thank you, 

8 that's helpful. And, usually without a 

9 connection to their normal work.

10 Significant, then, is further broken 

11 down into three potential categories - high, 

12 moderate or low. So this would be for each 

13 exposure that's relevant. Then, in 

14 categorizing it, they take into account their 

15 job classification, their work tasks, the 

16 presence or absence of exposure monitoring 

17 data, and I think that's actually really 

18 important that that's in there. They take that 

19 into account and I'm sure that weighs into 

20 their decisions, but the reports don't tend to 

21 be explicit about what is available about 

22 exposure monitoring.
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1 Frequency of activities, and I think 

2 a lot of what the industrial hygienist does, I 

3 believe, is makes a judgment call based on 

4 their own experience, rather than having any 

5 actually written evidence of how often, how 

6 long, etc., and without having interviewed the 

7 worker, which would be helpful. Then, any 

8 information that is known about what's going on 

9 at the site at the time, use of personal 

10 protective equipment, and use of personal 

11 protective equipment, I think, is assumed in 

12 most cases. If there's not documentation of 

13 it, the worker might have information about it, 

14 how reliable is the information, you know, I 

15 don't know, but that may be the best way to get 

16 that information in most cases.

17 Then, in thinking about all of this, 

18 the industrial hygienist uses their knowledge 

19 and judgment to assign a level of significance. 

20 The procedure manual goes down and defines each 

21 of the categories, so more than incidental but 

22 less than significant and I think this is part 
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1 of what Dr. Friedman-Jimenez is pointing out, 

2 that you can have incidental exposures that are 

3 still clinically significant and as written it 

4 doesn't take that into account too well. 

5 All right, we can go down to the 

6 next page. So that was the only thing that's 

7 really described. It doesn't really describe 

8 the low, moderate, and high. The reason we 

9 keep on coming back to this is because the word 

10 significant is used in the statute in two 

11 different ways, and the conclusion of the 

12 industrial hygienist that an exposure is 

13 significant can easily be interpreted as that 

14 it was a significant contributor to the medical 

15 condition which is not something that is really 

16 within the industrial hygienist's purview.

17 CHAIR MARKOWITZ: Steve Markowitz, I 

18 have a question. You just said that the act 

19 uses the word significant in two different 

20 ways.

21 MEMBER CLOEREN: Well, I think from 

22 what Ms. Pond read earlier, it's both 
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1 significant exposure and significant 

2 contribution to the illness. I think it's in 

3 both parts right? No?

4 CHAIR MARKOWITZ: The act says it 

5 has to be a significant factor.

6 MEMBER CLOEREN: Okay, but isn't it 

7 also exposure? Maybe I misheard.

8 MS. POND: The act does use the term 

9 twice, but I think significant is only in there 

10 once and that's at the beginning of that phrase 

11 where it's a significant factor and the second 

12 part of exposure is that the exposure has to be 

13 related to DOE employment. So, first it says 

14 the exposure must be a significant factor in 

15 causing/contributing to or aggravating and then 

16 it says that the exposure has to be related to 

17 employment and that phrase in the act itself.

18 MEMBER CLOEREN: Okay, so in the act 

19 significant is connected with causation. The 

20 causation decision, whereas in the procedural 

21 manual, well I think it's both ways if we were 

22 to do a search for significant, it shows up in 
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1 a lot of different ways in the procedure 

2 manual, but most importantly for our purposes 

3 right now, it's used to describe the exposure, 

4 which can be -- it would not be surprising to I 

5 guess learn that people may interpret the 

6 significant exposure and kind of add that 

7 therefore it's causally related or not a 

8 significant exposure and therefore not causally 

9 related, right?

10 CHAIR MARKOWITZ: So my reaction, 

11 Steve Markowitz, is that as an occupational 

12 medicine physician, is you've got six 

13 categories of exposure, right? You have none, 

14 incidental, more than incidental, and then 

15 three levels of significant and based on either 

16 the report of the patient, the participant or 

17 usually no real industrial hygiene data, 

18 monitoring data. You might have the data of 

19 the occupational health questionnaire, right? 

20 Represents data. I'm hard pressed to divide 

21 the exposures into six different grades based 

22 on that kind of information. 
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1 MEMBER CLOEREN: Marianne Cloeren. 

2 Yeah, I agree. I mean I think that the kind of 

3 the fine parsing out of the different levels 

4 suggests that it's based on data and there's 

5 not a lot of data on which to base the 

6 determinations anyway. So, I agree.

7 CHAIR MARKOWITZ: But what do the 

8 industrial hygienists think of this? Dr. 

9 Industrial Hygienist?

10 (Laughter.)

11 MEMBER VAN DYKE: Mike Van Dyke.

12 Since you asked, I mean, I think, to me, one of 

13 the problems is that they don't really define 

14 high, moderate and low very well, for one. So, 

15 it kind of leaves it up to the judgment of the 

16 industrial hygienist, and I'll tell you from 

17 experience that industrial hygienists think 

18 very differently about low, medium and high. I 

19 think that's a problem in itself. 

20 I mean, I think it gives you a 

21 framework, it gives you a scale. You can work 

22 with a scale. I don't like the words 
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1 necessarily, but there is a scale there. 

2 Probably too fine of a scale, but sometimes 

3 industrial hygienists like precision, 

4 unjustified precision, I should say.

5 CHAIR MARKOWITZ: Preferably 

6 precision based on facts, right, yeah. Mr. 

7 Domina?

8 MEMBER DOMINA: I think different 

9 than you guys do, just because of my 

10 experience, but I also have problems with that 

11 in passing only with the low, medium and high 

12 in our world, let's just say 10 is low, 15 is 

13 medium, 20 high, well, now you can't get your 

14 work done. So, now all of a sudden 10 goes to 

15 20 or 30 or 50 on some measurement that you're 

16 doing, if they're measuring it at all. That 

17 becomes problematic because, you know, like now 

18 everything's run to failure. Well, just 

19 because a light turns on, doesn't mean that 

20 whole thing hasn't failed. 

21 You know, same thing, 100 percent 

22 used to be here, 100 percent's here now and you 
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1 have to look at it differently. Because that 

2 in passing only is problematic for me. 

3 Somebody could be beryllium sensitized in 

4 passing only, but there's a test to measure 

5 that. It's the same thing as I've had people 

6 go out on the tank farms, four people together 

7 in one instance. Two of them are 5 foot 

8 nothing, two of them are 6 foot 4. The two for 

9 5 foot nothing end up on the ground based on 

10 atmosphere, different stuff pushing the vapors 

11 down, and that stuffs not measured. So, a lot 

12 of this where somebody who has no experience of 

13 being in the field, making a decision that it's 

14 in passing only, it's low but not significant 

15 is not correct. Without them talking to the 

16 people and understanding the type of work --

17 like I spoke earlier today, when we're talking 

18 about tank farm vapors where you got in 

19 respiratory protection, well they spent 

20 millions and millions of dollars to put stacks 

21 in to get it away from the people, but certain 

22 times of year, the spring and the fall, when 
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1 the air gets dense that stuff can get pushed to 

2 the ground. So, that's my two cents.

3 CHAIR MARKOWITZ: Mr. Key?

4 MEMBER KEY: Yeah, I echo Kirk's 

5 concern and summation on it. A low chronic 

6 over a period of time to an individual 

7 certainly could be the causation as opposed to 

8 a significant short burst effect.

9 CHAIR MARKOWITZ: Peak, peak 

10 exposure right?

11 MEMBER KEY: And so that presents a 

12 problem I don't know what the determining 

13 factor or person is thinking. If they see that 

14 it's low significant, but don't have that 

15 worker health questionnaire that that exposure 

16 being low was chronic over a period of 15 

17 years.

18 CHAIR MARKOWITZ: Mr. Catlin.

19 MEMBER CATLIN: Mark Catlin. I have 

20 two thoughts that concern me and I'm not sure 

21 how to deal with them. One is I guess from my 

22 own experience, I've seen the hygiene 
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1 definition of significance where it's 

2 interpreted by medical people who aren't 

3 occupational medicine docs and they interpret 

4 that to mean there couldn't have been a 

5 disease, based on that exposure. So, it's 

6 giving industrial hygiene a little more credit 

7 than it should in terms of causation.

8 So I'm concerned if that is --

9 (Simultaneous speaking.) 

10 MEMBER CATLIN: Oh, I'm sorry.

11 CHAIR MARKOWITZ: Could you repeat 

12 that?

13 MEMBER CATLIN: Yeah, and shorten 

14 it. So, I guess I have two concerns and one is 

15 the word significant, how the hygienists field 

16 uses it versus occupational medicine or 

17 medicine. I've just seen in my own experience 

18 where non-occupational medicine docs have 

19 sometimes interpreted industrial hygiene 

20 definition of like low exposure meaning the 

21 person couldn't have disease related to work 

22 and so the claims would be denied in a Workers'
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1 Comp system. So, I don't know if that's 

2 something that's happening here with both the 

3 CMCs and/or the claims examiners and I would be 

4 concerned about that and figure out if we can 

5 address it.

6 The other one is before coming to 

7 the meeting, I was looking through this in 

8 different ways, and I saw some historical 

9 references to exposures, you know, problem 

10 events that were listed. They would have the 

11 short summary that exposure was very low or 

12 exposure was below legal limits, but you also 

13 look at the dates and so some of these are like 

14 1964, some of them are like 1986, and we've 

15 seen this in some of the claims examining where 

16 it's not clear when the IH report will say the 

17 exposures were within legal limits, you're not 

18 sure what time frame, what limits they're 

19 talking about, so that could be incredibly 

20 confusing and misleading, too.

21 MEMBER CLOEREN: Can I just --

22 CHAIR MARKOWITZ: Sure, sure go 
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1 ahead.

2 MEMBER CLOEREN: I just want to 

3 embellish a little bit. For people that may 

4 not be aware, I think what Mr. Catlin's getting 

5 to is that the standards at the time may have 

6 not been exceeded, but today that would have 

7 been definitely exceeded because the standards 

8 have changed over time. We know that lower 

9 levels are more dangerous than it used to be 

10 thought. Is that what you were getting at? 

11 Yeah. Thanks.

12 CHAIR MARKOWITZ: I think there were 

13 some comments on this side.

14 MEMBER BOWMAN: Yes, thank you. Aaron 

15 Bowman. Actually, skip ahead, Mark, to your 

16 point, I think that on your first point that 

17 is, in fact, the concern that some of the 

18 claims that we examined had that exact thing 

19 where a CMC stated, IH says this is low, 

20 therefore, it cannot cause disease. So that's 

21 what we're trying to point out. 

22 Then back to the point that Jim was 
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1 making earlier, you made a point about chronic 

2 versus acute basically. That's exactly why we 

3 made the new table because to just use one term 

4 to describe an exposure, ignores all of 

5 exposure science and that's why we had the 

6 table, right, which was now maybe not fully 

7 going to be used, but it's for those exact 

8 reasons, because the nature of the exposure 

9 makes a difference and it's not -- presumably, 

10 I guess maybe there's one term because we're 

11 leaving it up to the IH to determine an amalgam 

12 of all those things whether it was significant, 

13 which is why we had this working group of what 

14 significance means in the first place. 

15 So, we are all the way back to 

16 square one, but we don't want to go around the 

17 same circle again, so it might be helpful to 

18 think about any recommendation we made in the 

19 context of learning what recommendations we 

20 have previously made were not effective and 

21 thinking more forward about them.

22 CHAIR MARKOWITZ: Dr. Van Dyke?
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1 MEMBER VAN DYKE: Mike Van Dyke. 

2 Yes, I agree with you Dr. Bowman. We feel like 

3 we're running around the same exact circle 

4 again and I was kind of hesitant to jump on 

5 that track, but I agree with the duration, 

6 frequency and intensity of exposure are the 

7 important constructs of exposure. I think I've 

8 said this before, the industrial hygienists and 

9 physicians don't necessarily speak the same 

10 language, and trying to think what the other 

11 person is saying based on a term that's not 

12 defined, is difficult. I think that if we 

13 could get more defined terms, we might get to a 

14 better place because at least there's some 

15 common place people could go to look for that 

16 definition, but without defined terms, we're 

17 going to kind of miss each other in the night a 

18 lot of times.

19 CHAIR MARKOWITZ: Dr. Cloeren?

20 MEMBER CLOEREN: I wonder if -- I 

21 have no idea whether this is already done, but 

22 guidance to the CMCs kind of pointing out the 
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1 different ways the terminology is used and 

2 providing examples where low exposure might 

3 still mean clinically significant, whether that 

4 might be something that's considered unless 

5 something like that already takes place.

6 MS. POND: This is Rachel Pond. We 

7 don't necessarily send out guidance to the CMCs 

8 that say that exactly, but we also have to keep 

9 in mind that it's not just CMCs that are 

10 issuing these causation determinations, it's 

11 treating physicians. But yeah, we give them a 

12 certain amount of guidance. We have a manual 

13 for them in general terms, but I don't think 

14 that we've laid it out exactly as you've 

15 indicated. 

16 CHAIR MARKOWITZ: I just have a 

17 question of clarification. Mr. Vance explained 

18 this to us previously, but I don't recall, 

19 there's something about the word significant 

20 here that's relevant in terms of other 

21 provisions of the procedure manual. If you are 

22 deemed to have a significant exposure of 
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1 whatever -- low, medium, high, it gets you 

2 eligible for something. I think it's a 

3 presumption and that's important because the 

4 presumption is a facilitated pathway towards a 

5 successful claim.

6 So, you want it to retain the use of 

7 the word significant because it makes you 

8 eligible for a prize and yet, I guess, the 

9 program decided that you needed something less 

10 than significant in which to characterize 

11 exposure. Did I get that right?

12 MS. POND: This is Rachel. Yes, 

13 that's correct. And some of these presumptions 

14 that are in Exhibit 15 of the procedure manual, 

15 you'll see where it says you had to have had a 

16 significant amount of exposure for this 

17 prolonged period of time or whatever it is 

18 depending on the condition and that is why we 

19 do look for the word significant in the IH 

20 reports when we're looking specifically for 

21 presumptions.

22 CHAIR MARKOWITZ: So that's why it 
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1 makes this hard for us to recommend somehow 

2 getting rid of the use of the word significant 

3 here because it ties into other parts of the 

4 procedure manual. My concern about the 

5 relatively new category of more than incidental 

6 but not quite significant is that it's a place 

7 to park a lot of exposures that you don't 

8 understand what they meant. You don't know 

9 what their levels were, and the CMC is going to 

10 interpret that usually as being unimportant.

11 And if it were based on underlying 

12 facts, okay, but it's based on a gestalt and an 

13 impression about what went on. That's a 

14 problem, I think. Dr. Bowman?

15 MEMBER BOWMAN: Yes, thank you. In 

16 terms of these elements and how to utilize the 

17 terminology and the idea that the word 

18 significant is important for many reasons, I 

19 think part of the concerns about the table that 

20 the Department mentioned was just that there's 

21 value to the narrative explanation as well, I 

22 believe that's what I recall from reading in 
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1 their response. Maybe if the IH -- we talked 

2 about defining the word significant and the 

3 different definitions of this word across 

4 different fields, perhaps at least whether it's 

5 in the narrative or in the table, if the IH 

6 says, this is significant low, they should 

7 define what elements of the exposure made them 

8 say that. That could help, that way therefore 

9 it's internally defined in the document that 

10 the physician is looking at.

11 CHAIR MARKOWITZ: Michael Van Dyke?

12 MEMBER VAN DYKE: Mike Van Dyke. 

13 Dr. Bowman, I agree. I mean, I think 

14 significant is defined here. That is one term 

15 that's defined. The terms that aren't defined 

16 are low, medium and high. I think that if you 

17 asked any occupational medicine physician, you 

18 know, if they're going to make a causation 

19 determination, what do they need to know? They 

20 need to know level of exposure, how often they 

21 were exposed and for how many years because 

22 most of these things are chronic long term 
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1 exposures.

2 We've kind of excluded two of those 

3 from this situation right here, so to expect a 

4 CMC to make a decision based on just the 

5 gestalt is pretty difficult. And I'll add that 

6 industrial hygienists don't necessarily know 

7 the answer. I mean, they don't think that -- I 

8 know it takes 10 years, and I'm making this up 

9 by the way. We don't think about, we know it 

10 takes 10 years to get asbestosis from exposure. 

11 That's not the way we think. We think, you 

12 know, we know there's an asbestos standard. We 

13 know what the level of exposure is in relation 

14 to this standard and we know how long a person 

15 is exposed. So, it's definitely a different 

16 thinking process as well.

17 CHAIR MARKOWITZ: Steve Markowitz. 

18 There's a point you made I didn't understand. 

19 You said they are missing two factors? The 

20 rubric is missing two elements?

21 MEMBER VAN DYKE: Frequency and 

22 duration.
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1 CHAIR MARKOWITZ: But isn't low, 

2 medium, high a compilation of -- doesn't it 

3 represent dose, a combination of frequency, 

4 intensity and duration?

5 MEMBER VAN DYKE: Somehow, in a way 

6 that's not defined.

7 CHAIR MARKOWITZ: But would a 

8 definition look like? Because it's going to be 

9 different for each toxic substance.

10 MEMBER CLOEREN: It would look like 

11 a table.

12 (Laughter.) 

13 MEMBER VAN DYKE: It'd look like a 

14 table, like we've been --

15 (Simultaneous speaking.) 

16 CHAIR MARKOWITZ: It would look like 

17 table, an improved table.

18 (Laughter.) 

19 MEMBER VAN DYKE: They use intensity 

20 terms to have the gestalt for all three of 

21 those in one term.

22 CHAIR MARKOWITZ: Right. Go ahead, 
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1 Dr. Cloeren.

2 MEMBER CLOEREN: Marianne Cloeren. 

3 I think there was agreement to use the table if 

4 it was determined that an exposure was 

5 significant. I think we got that far for the 

6 significant, which is good. I just had a 

7 follow-up thought related to something somebody 

8 said, maybe Mark, maybe something Jim said. I 

9 don't remember seeing reference in IH reports -

10 - and I may have missed it, or it may not have 

11 been relevant -- to changing standards. I 

12 think that would be very important to include 

13 as well, like that the standards at the time 

14 this person worked allowed a much higher level 

15 than is considered safe today.

16 CHAIR MARKOWITZ: Dr. Bowman?

17 MEMBER BOWMAN: I know we had talked 

18 about a recommendation along those lines, but 

19 just if a standard is referred to, the date of 

20 that standard, you shouldn't refer to a 

21 standard without staying what the standard is 

22 you're referring to.
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1 MEMBER CLOEREN: Marianne Cloeren. 

2 But also, I think a lot of people reading it 

3 may not take the time to look up whether that 

4 standard changed, so I think it would be 

5 helpful for the IH report to point out that the 

6 standard today is ten percent, you know, of 

7 what it was at the time that things were within 

8 limits. 

9 CHAIR MARKOWITZ: Mr. Catlin?

10 MEMBER CATLIN: Yeah, Mark Catlin. 

11 If I can just give an example. I was looking 

12 in the SCM and it was at Los Alamos exposures 

13 to asbestos and there was a report from -- I 

14 think it was '86, and it said that the 

15 exposures were below the OSHA standard from the 

16 summary report. Well, '86 was actually right 

17 at the time the standard was changing so were 

18 had the standard changed from, I'm trying to 

19 remember the numbers, but it changed by a 

20 factor of 10 or more and so it would be really 

21 crucial for that to be in there.

22 CHAIR MARKOWITZ: Dr. Van Dyke?
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1 MEMBER VAN DYKE: I think when we 

2 originally talked about this, we talked about 

3 most of us think in terms of today's 

4 contemporary standards in terms of low, medium 

5 and high. So, if we're going to come up with 

6 some sort of definition, it needs to be 

7 relevant to today's standards and I think that 

8 Dr. Cloeren mentioned that by saying that the 

9 standards were much higher than they were 

10 before, now we're adding another one of those 

11 1995 statements that we don't want to bias it 

12 that way. Just because the standards were 

13 higher doesn't mean they were exposed to more. 

14 MEMBER CLOEREN: That's true, yeah.

15 MEMBER VAN DYKE: So, we don't want 

16 to bias it the other direction either.

17 CHAIR MARKOWITZ: Yeah, Steven 

18 Markowitz, the other problem is that I mean if 

19 you're going by OSHA, they've changed very few 

20 standards over the years, and they have very 

21 few specific standards. If you're going by --

22 I don't know how DOE standards have evolved 
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1 specifically, I don't know what they were 

2 before 1995, but if you're going by the 

3 industrial hygiene community which has lowered 

4 recommended standards over the years, so which 

5 standards? I think it's too much information, 

6 and there's too limited coverage by legal 

7 standards to make it relevant.

8 But here's my question: You know, 

9 given what Mr. Domina was saying before, does 

10 it really make any sense to have a distinction 

11 between incidental and more than incidental? 

12 Both of which reside below low. Dr. Cloeren?

13 MEMBER CLOEREN: Do we know why that 

14 change was made? Was it in response to 

15 something we recommended?

16 (Laughter.) 

17 CHAIR MARKOWITZ: Right, I think we 

18 know that, no.

19 (Laughter.)

20 CHAIR MARKOWITZ: I don't know, Ms. 

21 Pond, whether you or Mr. Vance want to respond 

22 to that or not. If not, that's fine.
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1 MS. POND: I don't know for sure. I 

2 wouldn't want to admit -- I wouldn't want to 

3 confirm or deny that statement.

4 (Laughter.) 

5 CHAIR MARKOWITZ: I know Mr. Vance 

6 gave us an explanation before actually.

7 MS. POND: John, did you want to 

8 address that?

9 MR. VANCE: Yeah, I mean this was 

10 our attempt to -- we were getting rid of the 

11 language that spoke to regulatory limits 

12 because there was a very big concern about 

13 trying to explain what that meant so we had to 

14 come up with some other type of way to describe 

15 this that took into consideration lots of 

16 different factors and so the industrial 

17 hygienists when they were looking at this and 

18 considering how to deal with this reality of, 

19 yes, we don't really know what standard applied 

20 at what time. 

21 You have to look at the totality of 

22 the information that you have in front of you 
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1 and sort of come to some sort of estimate about 

2 what the industrial hygienist thinks could have 

3 been likely occurring and as they got into the 

4 discussion about like from the '90s on, really 

5 you would expect to see things in the file and 

6 that doesn't necessarily mean that it was a 

7 completely safe operating circumstance, it's 

8 just we've got to see something. We want to 

9 see something more compelling or convincing to 

10 show us that there was something that would've 

11 been an occupational risk or a hazard for this 

12 individual employee and then this language sort 

13 of came out of those discussions. 

14 There was a lot of debate about it 

15 and I think that just from the discussion, this 

16 is not easy. There's no easy answer. Our 

17 folks and the scientists that work on this 

18 struggled with this quite a bit to try to come 

19 up with something that sort of melded all the 

20 viewpoints that have been out there. I think 

21 it was informed a little bit about the 

22 conversations the Board had.
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1 CHAIR MARKOWITZ: Thank you. Any 

2 further comments on this issue? I mean I 

3 wanted to come back to this because we had 

4 begun this discussion and I think it's 

5 important. We don't need to formulate a 

6 recommendation, although we could, not this 

7 moment, but by tomorrow morning, for example, 

8 if we thought there was a direction we wanted 

9 to head in.

10 I remain bothered by the fact that 

11 there are six levels. There is very little 

12 quantitative data, and there's the occupational 

13 questionnaire and yet the industrial hygienist 

14 is tasked with choosing one of six different 

15 levels to pass along to the CMC to make a 

16 decision.

17 Okay, so if there are no further 

18 comments or questions, we're going to take a 

19 break actually. Let's just discuss tomorrow 

20 morning for the moment. It's 3:15 now, our 

21 public comment period starts at 4:15, we would 

22 come back at 4:15 in case any public commenters 
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1 show up, but there are a few things we're going 

2 to deal with tomorrow. One is, hopefully, 

3 we'll have, I think, a recommendation or at 

4 least a response on the issue of industrial 

5 hygiene on the table and the characterization 

6 that we discussed earlier.

7 I think we should consider either a 

8 response or a recommendation regarding CMCs and 

9 quality and validity. Again, it could be -- if 

10 we can agree on a path, it could be a 

11 recommendation, or it could be agreement on 

12 various elements of a response whereby we 

13 disagree and why we disagree with the decision 

14 the Department made in response to our 

15 recommendation. So, we would address those two 

16 things.

17 I think if there's something that we 

18 want to say about this issue of significance, 

19 we could formulate that tomorrow. Then a brief 

20 discussion, we've been requested to look at the 

21 IARC 2A Carcinogens and I think Paragon has 

22 identified them, including the candidate human 
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1 cancers that would be concluded in this SEM and 

2 the request is that we review that not at this 

3 meeting, but sometime in the coming months and 

4 then weigh in with the Department about our 

5 proposal. 

6 Are there any other issues that we 

7 should discuss? Because we will have time 

8 tomorrow to open up new issues. Again, if you 

9 think of any tonight, we can raise them 

10 tomorrow, it's fine. Dr. Bowman?

11 MEMBER BOWMAN: I was just going to 

12 say in your list of to-do items for the Board, 

13 one of them, which, I'm sorry if I didn't hear 

14 it, we were going to provide some additional 

15 follow-up questions on the SEM.

16 CHAIR MARKOWITZ: Right.

17 MEMBER BOWMAN: With examples?

18 CHAIR MARKOWITZ: Right. Now that 

19 was going to be done after the demonstration of 

20 the SEM or?

21 MEMBER SPLETT: Probably before.

22 CHAIR MARKOWITZ: Okay. And do we 
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1 need further discussion at this meeting about 

2 that, or is that something that -- tomorrow? 

3 Okay fine. 

4 MS. POND: This is Rachel. We do 

5 have, there were a couple of questions from the 

6 follow-up questions that we still had. We can 

7 provide you those in writing. There were only 

8 like two left, I think, on that list so we were 

9 planning to provide those responses that we 

10 talked about today in writing as well, so we'll 

11 do that before the next subcommittee meets and 

12 does the demonstration.

13 CHAIR MARKOWITZ: Okay. 

14 MEMBER BOWMAN: For example, the 

15 examples, Gail, that you walked us through the 

16 differences and since if we need full Board

17 approval to put those in in order to get a 

18 response for us to evaluate, it would be good, 

19 I think, to have that written up tomorrow and 

20 voted on. If we can submit the questions 

21 without the full Board approval then not.

22 CHAIR MARKOWITZ: Yeah, I don't 
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1 think we need full Board weigh in on the 

2 questions.

3 MEMBER BOWMAN: Okay.

4 (Off-microphone comments.)

5 CHAIR MARKOWITZ: And when we have 

6 the demonstration, it needs to be a subset of 

7 the Board. It can't be the entire Board, which 

8 means that it can be all but one Board member, 

9 so as many people as want to participate. I'm 

10 sure there will be at least one who will be 

11 otherwise busy, so there won't be a problem. 

12 Yeah, Dr. Cloeren?

13 MEMBER CLOEREN: I do think it's 

14 important for that demo that it be set up in a 

15 way that it permits both Paragon and Gail and 

16 other --

17 CHAIR MARKOWITZ: Board members. 

18 MEMBER CLOEREN: Yeah, Board 

19 members, to be able to show. I think the demo 

20 of how it works is great, but I think the demo 

21 of the problems that people are finding, I 

22 think, would be just as important. So, I think 
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1 it should be a two-way interactive 

2 demonstration if that's possible. 

3 CHAIR MARKOWITZ: Does that seem 

4 possible, Ms. Pond?

5 MS. POND: Yes, I think so. I mean 

6 I know she has examples already, so it will be 

7 interactive, especially if we can do it face8 to-face. There will be an opportunity for 

9 that, more opportunity for that.

10 CHAIR MARKOWITZ: Face-to-face? 

11 MS. POND: If not, I mean, we can 

12 probably work it out through WebEx or 

13 something. I don't know exactly what the plan 

14 would be.

15 CHAIR MARKOWITZ: Yeah, okay. Okay, 

16 so if there are no other comments or questions 

17 then why don't we suspend until 4:15.

18 (Whereupon, the above-entitled 

19 matter went off the record at 3:21 p.m. and 

20 resumed at 4:15 p.m.)

21 CHAIR MARKOWITZ: Okay, let's begin 

22 the new session. So the public comment session 
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1 is now open. For those of you who are online 

2 participating, if, as members of the public, 

3 you wish to make a comment, you're welcome to 

4 do so. If you could indicate on the WebEx, I 

5 think, by raising your hand then the people 

6 here can see you and then we can put you on the 

7 schedule, which is quite short at this point, 

8 so please indicate if you'd like to speak 

9 within the next five minutes or so. 

10 So, let me welcome Ms. D'Lanie Blaze 

11 as our first speaker.

12 MS. BLAZE: How's that?

13 CHAIR MARKOWITZ: Good.

14 MS. BLAZE: Thank you. I'm D'Lanie 

15 Blaze of CORE Advocacy for Nuclear and 

16 Aerospace Workers. I mainly represent 

17 claimants who are affiliated with Santa Susana 

18 Field Laboratory and its related work sites, 

19 Canoga and DeSoto Facility, near Los Angeles, 

20 California. It's a privilege, as always, to 

21 address the Board and I thank you all for 

22 traveling to be here and for offering the 
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1 opportunity to provide public comment.

2 Today, I want to talk about the 

3 removal of information from the SEM for Area 4 

4 of Santa Susana. In 2017, the propulsion 

5 workers and related activities were removed 

6 from the SEM in response to a FOIA where I 

7 requested information about the directive and 

8 the rationale to remove this information. The 

9 contractor, Paragon, indicated that it had 

10 removed propulsion workers and activities 

11 because these employees are not considered to 

12 be eligible for the program under Part E, but 

13 this is incorrect. These workers have always 

14 been eligible for the program. Not only is 

15 this incorrect, no other information was 

16 provided regarding where the directive to 

17 remove the information had originated or what 

18 documentation was used to support the removal.

19 Mr. Turcic had authored the 

20 Established Eligibility Decision for Area 4 

21 Santa Susana during his time as the program 

22 director in 2005. In his decision, the 
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1 propulsion workers certainly were never 

2 excluded. In fact, the decision that he issued 

3 provides that any Department of Energy 

4 contractor employee who can establish 

5 employment for the company at a location where 

6 DOE conducted operations may be considered to 

7 be eligible for the EEOICPA, and that means any 

8 DOE contractor or subcontractor employee who 

9 performed job duties inside Area 4.

10 Based on the multiple Department of 

11 Energy-funded propulsion programs that occurred 

12 in Area 4, which began in the 1950s, there was 

13 no basis to remove these workers and their 

14 activities from the SEM. These DOE funded 

15 operations began in the '50s, the locations 

16 where the work occurred in Area 4 are still 

17 included in the SEM and Paragon is in 

18 possession of worker DARs showing verified Area 

19 4 employment among propulsion workers, who 

20 performed associated activities inside the 

21 covered area.

22 So, it was shocking that this 
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1 information was removed, and to date, Paragon 

2 has not disclosed at whose direction this 

3 occurred or provided any information as to what 

4 information was used to support this move. We 

5 have had some issues with Santa Susana since 

6 the program's outset. Mr. Turcic indicated in 

7 the 2005 eligibility decision that it had been 

8 DOE and Boeing's goal in 2002 to limit the 

9 number of Santa Susana workers who would be 

10 considered covered under the EEOICPA. 

11 This resulted in a three-year 

12 argument with Department of Labor during which 

13 all claims associated with Santa Susana, Canoga 

14 and DeSoto were placed into pending status. 

15 During this period, several workers died 

16 without ever understanding why their claims had 

17 stalled. Since then, we have had multiple 

18 incidents, all verified by DOE and the national 

19 office, where Boeing has been found to 

20 routinely submit incomplete and misleading 

21 information during the employment verification 

22 process, resulting in the summary 
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1 disqualification of workers who clearly qualify 

2 for compensation and medical benefits under 

3 both Part E and Part B.

4 There's no shortage of well5 documented examples, and I can keep you guys 

6 here for a week going over them in detail, but 

7 suffice to say, from establishing covered 

8 employment to providing incomplete information 

9 during the creation of the NIOSH site profile 

10 that resulted in the omission of nearly 50 

11 radiological facilities that operated at Area 4 

12 in excess of 50 years, all verified by the 

13 Federal EPA during their historical site 

14 assessment of Area 4, we have documented 

15 efforts by the contractor to seriously engage 

16 in instruction of the program. 

17 It came as no surprise to me to 

18 discover that the propulsion workers who were 

19 removed from the SEM seemed to make up the 

20 largest number of employees who DOE and Boeing 

21 had initially hoped to exclude from the EEOICPA 

22 back in 2002 and this raises some concerns 
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1 about Paragon's failure to disclose where the 

2 information came from to support the removal of 

3 the information from the SEM.

4 So I would respectfully encourage 

5 all involved to ensure that no information is 

6 ever removed from the SEM based on a 

7 contractor's assertion or those of any agency, 

8 but rather through the careful and objective 

9 evaluation of documentation that effectively 

10 contradicts that which was initially used to 

11 justify the inclusion of the data in the first 

12 place. 

13 Ideally, it is my humble opinion 

14 that such an objective and qualified evaluation 

15 would probably be best conducted by the Board. 

16 So those were my prepared comments, 

17 but since I'm the only commenter present, I 

18 wonder if I might touch on a few other topics 

19 just very briefly, if I can take some extra 

20 time? 

21 I think that it is quite valuable to 

22 have leadership here, but my observation is 
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1 that they're very adept at informing all of us 

2 about how things should be happening, and 

3 that's not how things are actually happening at 

4 the claims examiner and the authorized 

5 representative and the claimant levels. For 

6 example, the DARs are still not being reviewed 

7 thoroughly, and since we have witnessed the 

8 death of institutional knowledge with the 

9 decision to divert claims away from seasoned, 

10 experienced claims reviewers and create a 

11 situation where claims examiners are, for the 

12 most part, totally confused because they lack 

13 familiarity with site specifics and the unique 

14 complexities associated with so many work 

15 sites.

16 CEs routinely express that they're 

17 just completely overwhelmed. They're making 

18 inappropriate decisions that require a hearing, 

19 oftentimes resulting in the need to re-do dose 

20 reconstructions multiple times or re-do IH 

21 evaluations because of information that they 

22 missed either by not reviewing the DAR or by 
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1 not understands how to identify covered 

2 employment or other information that is 

3 significant and relevant. 

4 In my review of my current case load 

5 of Santa Susana cases, for example, we used to 

6 always have our claims adjudicated by Seattle 

7 District Office, but now it appears that the 

8 majority of my cases have been routed to 

9 Jacksonville District Office, which does not 

10 have the benefit of established institutional 

11 knowledge over the course of the program. 

12 Every claim, even SCC claims, are now routinely 

13 heading for hearings and even when we're at a 

14 hearing, we still have to educate the hearing 

15 reps about site complexities and the published 

16 guidance from the national office about which 

17 they remain unaware and we're five years into 

18 the removal of the jurisdictional purview. 

19 So I reiterate that the decision to 

20 divert claims away from the regional district 

21 offices was the single most damaging decision 

22 that could have been made for the claimants. 
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1 They can no longer count on qualified, thorough 

2 review of their cases.

3 Lastly, speaking of Jacksonville 

4 District Office, I currently have a claim there 

5 where the claimant was coded terminal back in 

6 March, and when I spoke to the claim examiner 

7 to encourage his swift correction of several 

8 errors in this claim, he responded by saying 

9 that since the claimant was coded terminal so 

10 long ago, but still hadn't died, it was the 

11 District Office's position that he was never 

12 actually terminal and he had no impetus to move 

13 quickly on the claimant's behalf. He requested 

14 a deathbed terminal statement from hospice, and 

15 they indicated that they're ethically 

16 prohibited from making such a specific 

17 declaration and could only provide a letter 

18 indicating that the claimant has six months or 

19 less to live.

20 I called that CE on Friday to 

21 discuss the urgent remount order issued by FAB 

22 in the second hearing that we've had on this 
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1 case. Today is Wednesday, and as of yet, I 

2 have not received a return phone call on behalf 

3 of this claimant. He's also had two dose 

4 reconstructions due to overlooked covered 

5 employment and other errors that have occurred 

6 during the claims process, and I think if we 

7 had a more seasoned and experienced claims 

8 examiner at the very beginning, this claimant 

9 would not be experiencing this level of delay.

10 So, I respectfully submit the 

11 jurisdictional purview should be restored. The 

12 claimants deserve thorough and qualified review 

13 by seasoned CEs who have some familiarity with 

14 their work sites and five years into this, 

15 we're still seeing examples of why this was a 

16 really bad idea. That's it for me today. As 

17 always, thanks for the opportunity to bring 

18 information.

19 CHAIR MARKOWITZ: Thank you. Will 

20 you be submitting written comments?

21 MS. BLAZE: If you'd like.

22 CHAIR MARKOWITZ: Well, certainly 
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1 the SEM part.

2 MS. BLAZE: Okay.

3 CHAIR MARKOWITZ: Let me ask, 

4 Carrie, do we get a verbatim transcript of the 

5 public commentary?

6 MS. RHOADS: Yes.

7 CHAIR MARKOWITZ: But, still,

8 because we may be having our demonstration with 

9 the SEM sooner rather than later, formulating 

10 our questions, if you could submit the written 

11 comments about the SEM sooner rather than 

12 later, that would be helpful.

13 MS. BLAZE: Certainly.

14 CHAIR MARKOWITZ: Thank you.

15 MS. BLAZE: Thanks. 

16 CHAIR MARKOWITZ: Carrie, anybody 

17 else?

18 MS. RHOADS: No, I think that's it. 

19 CHAIR MARKOWITZ: Okay. So then we 

20 are finished for today. Tomorrow, I don't have 

21 the agenda in front of me. What time will we? 

22 8:30, I think, tomorrow? Yeah, 8:30 tomorrow. 
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1 Anything you need to say, Ryan, at the close of 

2 the meeting today?

3 MR. JANSEN: No, I think that's it. 

4 The meeting is adjourned.

5 CHAIR MARKOWITZ: Thank you, all.

6 (Whereupon, the above-entitled 

7 matter went off the record at 4:27 p.m.)

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