UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH

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SUMMARY MINUTES

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APRIL 15-16, 2020

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The Advisory Board met via teleconference, Steven 

Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

JOHN DEMENT

GEORGE FRIEDMAN-JIMENEZ

MAREK MIKULSKI

KENNETH SILVER

MEDICAL COMMUNITY

MANIJEH BERENJI

ROSE GOLDMAN

STEVEN MARKOWITZ, Chair

CARRIE A. REDLICH

CLAIMANT COMMUNITY

KIRK DOMINA

RON MAHS

DURONDA POPE

CALIN TEBAY

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
WEDNESDAY, APRIL 15, 2020

Welcome and Introductions:

Mr. Chance called the meeting to order at 11:11 a.m. and noted 

that the meeting was conducted via teleconference as a 

precaution against the COVID-19 pandemic. He summarized a call 

which took place between himself, Dr. Markowitz and Douglas 

Pennington, Deputy Director of the Division of Energy Employees 

Occupational Illness Compensation (DEEOIC), on April 2, 2020. 

During this call they discussed the board’s request for 

resources, the process for resource allocations, and associated 

challenges. The increase in competition for resources during the 

COVID-19 pandemic was noted. The board will need to determine 

the mission and logistics of all desired resources and design a

comprehensive statement of work. Mr. Chance added that the 

budget formulations for FY 2021 are already complete and it 

would be very difficult to add requests for that year. 

The above-listed board members were in attendance. After a round 

of introductions, Steven Markowitz, Board Chair, welcomed 

participants and outlined the day’s agenda. He noted that the 

current board’s term expires in July 2020 and suggested that 

they keep this timeframe in mind when discussing new board 

tasks. 

Status of Recommendations and Solicitation of Nominations:

Mr. Chance reminded board members that they are all eligible to 

participate in the open nomination period, which ends on May 1, 

2020. He updated the board on the status of its latest 

recommendation on asthma, which is currently in the Secretary’s 

Office and is due out on May 5, 2020. Carrie Rhoads confirmed 

that the rest of the recommendation responses were available 

online.

DEEOIC Updates: Program Highlights

Rachel Pond, Director, DEEOIC, presented updates from the DEEOIC 

program. Since the program’s inception they have paid almost $18 

billion in nearly 300,000 claims. Almost $6 billion of that has 

been in medical claims, which have increased steadily in the 

past five years due to an aging claimant population with more 

consequential conditions. Ms. Pond summarized the program’s new 

case assignment process, effective April 1. While they used to 

assign cases to district offices by jurisdiction, as the program 

evolved it became clear that they receive more cases from some 
areas than others. As a result, the program has now implemented

a round robin assignment process across the country; this 

process has had positive results in the final adjudication 

branch.

Ms. Pond addressed the program’s consistent process for sampling 

work in the final adjudication branch, the medical benefits 

branch, and the district offices. Each supervisor reviews a 

random selection of cases on a monthly basis, meeting with 

claims examiners (CEs) to discuss strengths and weaknesses of 

their work. The program has also hired quality review analysts 

to work for the national office and evaluate several categories 

of work on a weekly basis. This feedback loop provides 

supervisors and claims examiners with information about the need 

for additional training and policy changes. The program will 

still conduct annual accountability reviews, though these may 

not take place in person for some time. As part of 

recommendations made by the Government Accountability Office 

(GAO) several years ago they also continue to evaluate 10% of 

claims before they are sent out.

Ms. Pond outlined certain changes that the program has made in 

response to the COVID-19 pandemic. Given that the claimant 

population is particularly susceptible, the program has relaxed 

deadlines for physician visits and providing claim information. 

Bulletin 20-03 addresses changes specific to home health care, 

including extensions via letters of medical necessity for 

existing levels of care and telemedicine for new requests.

Hearings are conducted via telephone and WebEx rather than in 

person, and resource centers are closed to the public but staff 

are still answering phone questions and collecting mail. 

Chair Markowitz asked if any of the program’s quality review 

activities addressed the Contract Medical Consultant (CMC) or 

industrial hygiene (IH) evaluations, and Ms. Pond said that they 

were mostly a review of the claims examiners’ work. Member

Domina asked about more leeway for claimants seeking new home 

health coverage who might be hesitant to allow new people into 

their home during the pandemic. Mr. Pennington said that the 

program’s intention was to have one trained medical professional 

conduct a visit and safely examine the claimant to assess the 

risk of bringing health care aides into the home. Ms. Pond added 

that they were constantly reevaluating ways to be as flexible as 

possible. Chair Markowitz asked if the program had received any 

claims specifically for COVID. Mr. Pennington said that they had 

not and noted that any claims for COVID would be for 

consequential conditions.
Ms. Pond addressed the board’s request for a public portal where 

cases could be made available and said that the program still 

plans to make case files available to claimants. They have 

received feedback about the occupational health questionnaire

(OHQ) and are moving towards a database format that the resource 

centers can access. The program is also in the process of 

fulfilling the board’s data requests for post-1995 lung cancer 

claims and development letters. Chair Markowitz requested 

clarification on how the interviews between IHs and claimants

were initiated. Ms. Pond said that in some cases the claimants

asked for the interviews and in other instances the IHs

expressed a desire for more information from the claimants.

Chair Markowitz asked if the claimant community was aware that

they could request these interviews and Ms. Pond said that there 

was no formal notification, but the information is available on 

the program’s website and claims examiners are aware of the 

process. 

Changes in DEEOIC, Procedure Manual:

Mr. Vance summarized recent changes in Procedure Manual (PM)

4.1, which was released on March 31, 2020.

Modifications to the PM:

-incorporating a bulletin on updated guidance for processing and 

adjudicating medical benefit claims

-changes in guidance on reporting to the national incident 

criminal background check, specifically related to people who 

could be prohibited from obtaining firearms

-updated guidance on centralization of customer service 

interactions with resource centers

-updated version of Exhibit 15-4 related to presumptive 

standards in adjudicating Part E cases

-elimination of recommended decision cover letters 

-simplification of the waiver process 

-updated guidance regarding reimbursed costs for eyewear 

-memorialized guidance regarding medical marijuana 

Mr. Vance noted that the next version of the PM is currently in 

process and will encapsulate the transition to a new medical 

bill processing contractor. 

DEEOIC Response to Issues from Jan. 28, 2020 meeting (SEM issues 

raised by Dr. Redlich; PM Exhibit 18-1 smoking language):
Mr. Vance reviewed the program’s responses to issues raised by 

the board at its January 28, 2020 meeting. The board had 

concerns about the way that chronic obstructive pulmonary 

disease (COPD) was listed in the Site Exposure Matrices (SEM). 

While COPD is listed in the SEM with multiple aliases, the SEM 

does not apply separate determinations that the program makes 

with regard to the application of procedural guidance. The 

program instructs its staff that when they are evaluating claims 

for interstitial lung disease and pulmonary fibrosis they should 

go to the SEM and use “pneumoconiosis, other” as the health 

effect for those conditions. Similar guidance exists for 

individuals with idiopathic pulmonary fibrosis; claims examiners 

are instructed to treat this as a potentially work-related 

condition. 

Mr. Vance addressed the issue of reporting sarcoidosis in the 

SEM and suggested that the board could continue to explore known 

exposures linked to this diagnosis. The PM does contain guidance 

that sarcoidosis can represent a misdiagnosis of chronic 

beryllium disease (CBD). Mr. Vance confirmed that asbestos has 

been added to the pneumoconiosis health profile in the SEM in 

response to the board’s recommendation. Member Redlich commented 

that given the fact that sarcoidosis and CBD were clinically 

indistinguishable, it made sense to link beryllium to sarcoid in 

the SEM. Ms. Pond said that while they have heard similar 

feedback from clinicians, they did not want claims examiners to 

assume that all claimants diagnosed with sarcoidosis actually 

have CBD instead. Member Redlich said that in her experience the 

disease/exposure association in the SEM was just one of many 

factors the CE or CMC considered when making their decision.

Member Goldman noted that for interstitial fibrosis, there is a 

link in the SEM to potential asbestos. Member Redlich suggested 

that the board could discuss a possible recommendation about the 

appropriate exposures to list under pneumoconiosis. Member 

Domina asked whether the CEs have access to a different SEM and 

Mr. Vance said that while the filtering functions are different, 

most of the data in the CEs’ SEM is the same as the public SEM.

Mr. Vance addressed the board’s concerns about Exhibit 18-1 and

the relevance of asking claimants about smoking when evaluating 

them for pulmonary conditions. Mr. Vance said that they do not 

consider smoking as part of an occupational pulmonary disease,

and due to multiple problems with Exhibit 18-1 the Department 

has decided to remove it entirely. 

Responses to Issues from Jan. 28, 2020 meeting (Timeline and 
quality control provisions of new CMC contract; Quality control 

language of existing IH contract):

Mr. Pennington spoke about the CMC contract, which ends in 

August of 2021. He explained that the program will begin working 

with DOL’s contracting office a year in advance to develop a 

statement of work in time for the re-competition of the 

contract. Member Berenji asked if an audit of CMC reports was 

conducted as part of this process. Mr. Pennington said that the 

contract has a provision for the staff medical director to 

perform regular audits of a sampling of reports. 

Mr. Pennington continued with a summary of the contract IH 

quality control language. Every IH referral that is sent to the 

IH contractor is quality controlled by their staff using several 

criteria. The certified IHs on the federal staff review 100% of 

the reports that the program receives for compliance, accuracy, 

and consistency. 

Chair Markowitz asked for a summary of the time table for 

resource requests. Mr. Chance reiterated his earlier remarks 

about the 2021 budget and said that formulations for FY 2022 

will be discussed over the next few months and finalized by 

early fall of 2020. Mr. Pennington added that after the budget 

has been vetted by DOL’s budget office and submitted to the 

Office of Management and Budget (OMB) it is passed back to DOL, 

reviewed, and then presented back to OMB and then to Congress to 

be voted on at the beginning of the 2022 fiscal year. Off-cycle 

budget requests typically need to be emergency requests and 

require substantial justification. 

Member Friedman-Jimenez asked how the budget process accounted 

for possible impacts of COVID-19. Mr. Pennington said that all 

of the discussions so far have focused on the administrative 

budget, which consists of everything except the benefit fund. 

The benefit fund is a permanent, unlimited appropriation that 

does not require decisions from Congress. If an individual files 

a claim saying that they contracted COVID as a direct 

consequence of their accepted condition(s) and the Department 

approves that claim, then DOL will pay for benefits associated 

with COVID. 

Proposed Recommendation: Parkinson’s and Related Diseases

Member Mikulski led the discussion on four proposed 

recommendations for Parkinson’s disease and related disorders. 

The working group formulated these proposed recommendations in 
response to four questions submitted to the board by the 

Department of Labor.

Question 1a): In response to DOL’s question about appropriate 

aliases, the working group recommended: Parkinsonian Syndrome, 

Parkinsonian Disorder, and Secondary Parkinsonism as aliases for

Parkinsonism; and Paralysis Agitans, Idiopathic Parkinsonism, 

Primary Parkinsonism, and Hemiparkinsonism as aliases for 

Parkinson’s disease.

Question 1b): DOL asked the board whether Parkinsonism and/or 

Manganism should be treated the same as Parkinson’s disease. 

While they do share common clinical characteristics, 

Parkinsonian disorders may differ from each other in clinical 

onset, symptomatology, progression, and risk factors. The 

working group recommended that the clinical diagnosis of 

Parkinsonism and/or Parkinson disease, with ICD codes, should be 

used to differentiate between disorders in the claims 

adjudication process.

Questions 2) and 3): The Department asked the board about toxins 

associated with Parkinsonism diagnoses and presumptions 

regarding worker exposure to those toxins. The working group 

identified several case reports describing Parkinsonian-type 

symptomatology following exposures to solvents including carbon 

disulfide, methanol, and toluene, all of which were commonly 

used in DOE weapons operations. Similarly, exposure to common 

solvents trichloroethylene (TCE) and polychlorinated biphenyls 

(PCBs) have also been linked to increased risk for Parkinson’s 

disease in epidemiological studies.

Question 4): In response to the Department’s questions about 

causation presumptions, the working group noted that while there 

is a growing body of peer-reviewed research showing increased 

risk for Parkinson’s disease with specific exposures, causal 

relationships have yet to be established. The working group 

feels that due to the number of positive studies as well as the 

strength of the association between exposure to TCE and PCBs and 

Parkinson’s disease, TCE and PCBs should be considered at least 

as likely as not to contribute to or aggravate the risk of 

Parkinson’s disease throughout the claims adjudication process. 

They also recommend that the duration of exposure to these toxic 

substances be taken into account when adjudicating Parkinson’s 

claims. 

Chair Markowitz commented that the Department of Veterans 

Affairs recognizes that exposure to TCE-contaminated water at 
Camp Lejeune is associated with Parkinson’s disorder as a matter 

of presumption. Member Goldman said that one of the important 

points highlighted in this recommendation is that chronic longterm exposure to certain agents leads to an increased risk of 

developing Parkinson’s-type disorders. Chair Markowitz asked if 

the working group’s intention was for these causal links to be 

applied to Parkinson-Plus disorders. Member Mikulski said that 

that was not their intention.

After some discussion, the board modified the language of the 

working group’s response to Question 1(b) to read: “The board 

recommends that the clinical diagnosis of Parkinsonism and/or 

Parkinson disease, with respective ICD-9 or ICD-10 codes, as 

listed in the following rationale, be used in differentiation 

among Parkinsonian disorders in the process of adjudication of 

EEOICPA claims.” Chair Markowitz also suggested that they 

include the ICD codes in the body of the recommendation itself 

as well as in the rationale.

Member Dement asked whether they should include information 

about Parkinsonism and methanol given that there were only one 

or two case reports on this topic. Member Friedman-Jimenez said 

that he thought those case reports needed further review because 

they appear to discuss ingestion rather than inhalation of 

methanol. Member Mikulski agreed that methanol and toluene were 

the weakest exposures in the rationale. 

Chair Markowitz asked if the board members felt comfortable 

enough with the write-up on the other exposures to vote on that 

particular recommendation. Several members expressed interest in 

reviewing the case studies that informed this recommendation to 

get a better understanding of the strength of the evidence. 

Chair Markowitz asked what that process would look like. Member 

Friedman-Jimenez suggested that a subset of the board, 

consisting of the working group and additional board members,

review the literature and have a journal club-type discussion to 

ensure that their recommendations are evidence-based. Members 

Goldman, Friedman-Jimenez, and Dement and Chair Markowitz 

volunteered to take part in this process. Chair Markowitz said 

that the resulting discussion should take place four to five 

weeks after the April meeting, towards the end of May. He 

suggested that rather than discuss the proposed recommendation 

around presumptions and latency period at the current meeting, 

the working group could consider these issues when they reviewed

the case studies.

Adding IARC 2A Carcinogens to SEM, Evaluation of Other IOM 
Sources:

Member Berenji, the Chair of the SEM Working Group, led the 

discussion. The working group was tasked with reviewing the 

International Agency for Research on Cancer (IARC’s) list of 2A

carcinogens, examining other sources such as the National 

Toxicology Program (NTP) and Haz-Map, and looking at current 

exposure links in the SEM. As of March 2020, IARC has updated 

their Group 2A list to include 22 chemicals. Member Berenji 

explained that she had examined the IARC monograph and 

identified several chemicals that had the most connections to 

the workers the board is focused on. Member Goldman added that 

the working group discussed DOE groundskeepers and their 

possible exposures to pesticides, a job title that is often 

overlooked. Members Pope and Silver said that during their time 

at Rocky Flats and Oak Ridge, respectively, the groundskeepers 

did use a variety of toxic chemicals. Ms. Pond said that the 

program did include groundskeepers as a job category for 

consideration of exposures.

Chair Markowitz asked if the public could search the SEM for a 

particular chemical at a particular site, and Ms. Pond said that 

that was possible. Member Goldman suggested that the working

group might end up looking at some of the pesticides that have

been used in the last 20 or 30 years, and Member Berenji agreed. 

Member Berenji summarized her preliminary research on the most 

relevant chemicals in Group 2A, including: PBBs; 

tetrafluoroethylene; silicon carbide whiskers; dichloromethane 

(methylene chloride); 2-Mercaptobenzothiazole; hydrazine; N, NDimethylformamide; tetrabromobisphenol A; styrene; styrene-7, 8-

oxide; and glycidyl methacrylate. For most of the chemicals, 

there is demonstrable evidence that exposure can lead to the 

development of a variety of cancers. 

Member Berenji shared her research on the NTP’s fourteenth 

report, released in 2016, which cites 62 known carcinogens and 

186 substances that are reasonably anticipated to be human 

carcinogens. Member Goldman asked how many of the 62 known 

carcinogens DOE dealt with, and Member Berenji said that she had 

not had the time to explore that further. Member FriedmanJimenez said that there is significant overlap between IARC 

Class 1 and NTP known carcinogens, and the reasonably 

anticipated carcinogens category includes mostly Groups 2A and 

2B. Chair Markowitz noted that many of NTP’s reasonably 

anticipated carcinogens are not occupational agents. Member 

Berenji presented Haz-Map’s most recent updates and noted that 

their site is very user-friendly, which is helpful for educating 
the public about worker exposures. In contrast, the SEM is not 

user-friendly and should be made more accessible for both 

claimants and claims examiners.

Member Goldman asked if physicians consult the SEM, and Ms. Pond 

said that they do not usually look at it and the program 

provides them with the information that they need from the SEM. 

Member Friedman-Jimenez pointed out that the SEM serves several 

different functions and it might be too much to ask it to also 

determine causal relationships. He suggested that the working 

group look at how to design a more user-friendly process using 

the SEM as one of several resources. Chair Markowitz pointed out 

that the SEM is an important resource in the claims evaluation 

process, a fact which is unlikely to change. He said that one 

challenge with the 2A group is that by definition the 2A 

chemicals are more likely than not to have weaker 

epidemiological evidence. In response to DOL’s request, he 

challenged the SEM Working Group to consider which 2A agents 

could be most closely connected to particular human cancer 

sites.

Member Berenji said that they could come up with a tiered system 

to identify the 2A chemicals with strong, moderate, and weak 

epidemiological evidence. Ms. Pond commented that DOL uses Group 

1 chemicals in the SEM because they are relying on causation, 

while the board’s recommendations about chemicals can be put

into policy in terms of contribution and aggravation. She said 

that a tiered approach would fit well into that system. Chair 

Markowitz suggested that this issue go back to the working group 

and Member Berenji agreed that they would reconvene before the 

full board meeting in June. 

Status of DOL Requests to Board (B Reading, Provider Outreach):

Chair Markowitz summarized DOL’s questions to the board about B 

readers. The Department asked the board to weigh in on B 

readers’ certification requirements and how claims staff can 

verify that test results originated from a qualified B reader. 

Chair Markowitz presented a draft response to DOL, which he had 

previously circulated to the physicians on the board for their 

initial feedback. After completing an examination, during which 

they are asked to examine radiographic films and determine which 

ones represent diseases of the lungs, B readers are certified by 

NIOSH. All 176 currently certified B readers are publicly 

identified on the NIOSH website. If a claims examiner is 

uncertain whether a given claim was actually completed by a B 

reader, they can check the physician’s name on the B read 
against the list of certified B readers. While there have been 

some well-publicized incidents of B reader abuse over the years, 

to the board’s knowledge there is no highly prevalent pattern of 

abuse. NIOSH has proposed a provision that would allow them to 

examine incidents representing possible abuse and disqualify B 

readers who are consistently inaccurate.

Chair Markowitz said that while there is no standard way for a B 

reader to label their B read, there is a standard B reading 

form. B reading on its own is not diagnostic and is designed to 

be used in association with research and information about 

exposure. Claims examiners cannot directly verify B readings 

themselves; any discrepancy between B reading results and 

another physician’s opinion needs to be resolved by a qualified 

CMC. Ms. Pond said that part of the reason DOL asked about B 

reading is because they have had cases where a current physician 

examining a claim disagrees with a B read from the same claim 

that was done ten years ago, and they want to make sure that 

they are getting an accurate diagnosis. Member Goldman noted 

that ten years ago B reading was done on x ray films, and there 

has been a recent transition to digital film. Member Redlich 

commented that in recent years the number of certified B readers 

has decreased, and this is a problem. Member Silver asked if a B 

read of digital film was more likely to detect pathology that 

would have been missed on a traditional x ray ten years ago. 

Member Redlich said that she did not think that was the case. 

Chair Markowitz asked for proposed changes to the draft response 

to DOL. Member Silver asked if they should include language to 

the effect that discordant results between B readers should be 

resolved in favor of the claimant. Chair Markowitz said that 

given the fact that B reads should not be considered in 

isolation, discordant results should be resolved by CMCs. Member 

Redlich agreed and said that this problem predates digital film. 

Member Redlich proposed that the board adopt this response to 

DOL’s request. The proposal was seconded by Member Berenji and 

unanimously approved.

Public Comment Period:

Terrie Barrie, Alliance of Nuclear Workers Advocacy Groups

Ms. Barrie cited a recent investigative report by The Seattle 

Times concerning leaking respirators used by Hanford workers. 

The DOE contractor at Hanford admitted to the defects and 

identified over 500 workers who were affected. A similar 
situation occurred with improperly cleaned respirators at Y-12 

from 2009 to 2012. Ms. Barrie referenced past concerns over 

contracted IH reports and boilerplate language. She requested 

that the board obtain a sample of claims from Hanford and Y-12 

workers during the time of the faulty respirators in order to 

review the IH reports and the documents that DOE provided on the 

cases. Ms. Barrie also expressed concerns about DOL’s failure to 

provide a support contractor to the board and about the 10-day 

review period for the board to review policy changes. She 

suggested that the board form a working group for the purpose of 

reviewing proposed policy changes.

Ronald Avery

Mr. Avery spoke about his experience as a worker at the Rocky 

Flats Plant. From February 1970 to March 1989 Mr. Avery worked 

in plutonium recovery and was at various times a chemical 

operator, radiation monitor, and technical foreman. He was 

diagnosed with hearing loss but did not have ten consecutive 

years of work under the relevant job title, even though all of 

his jobs involved the same level of exposure to toxins. 

Chair Markowitz said that several years ago the board 

recommended that DOL reduce the required ten years to seven 

years of work, eliminate the consecutiveness requirement, and 

expand the number of accepted job titles. The Department did not 

agree with this recommendation. 

Vina Colley, Portsmouth Gaseous Diffusion Plant

Chair Markowitz summarized Ms. Colley’s written comments on the 

board’s website. Ms. Colley submitted a letter from 2008 from 

SC&A, the contractor to the Radiation Advisory Board, which 

refers to a review of the site profile for Portsmouth and a 

summary of site expert interviews. Chair Markowitz said that Ms. 

Colley wished to bring the board’s attention to the fact that 

these records have still not been made public. 

Stephanie Carroll

Ms. Carroll, an authorized representative specializing in lung 

disease, shared her comments on B reading. She cited the case of 

B reads conducted by Johns Hopkins several years ago, almost 

none of which found significant disease among the coal miner 

population they examined. She also talked about her experience 

with a NIOSH B reader who was bullied out of the program. She 

addressed the conflict between past and current B readers and 
linked this to a recent uptick in claimants hiring their own B 

readers to look at chest x rays. Ms. Carroll said that DOL has a 

library of documents and studies that support the information in 

the SEM and suggested that it would be a useful resource for the 

SEM Working Group.

Occupational Health Questionnaire Revision:

Member Dement led a discussion on the revised drafts of the OHQ 

that DOL provided to the board. He went through the draft and 

noted several positive changes, but expressed concern that

workers would not recall the level of detail requested by the 

form. He also said that including more free text responses in 

the OHQ places more burden on the interviewer to have a 

consistent, scripted approach when asking questions. Member 

Dement noted that the Exposure Information section would present 

a particular challenge when writing scripts and training 

interviewers to ask appropriately detailed questions. He 

suggested that it would be helpful to provide the workers with 

some sort of material to fill out prior to the interview in 

order to jog their memory. He also suggested listing tasks under 

each exposure category for the same purpose.

Chair Markowitz asked whether the IH would get the necessary

information about form and method of exposure by asking 

questions about tasks. Member Dement said that the original 

recommendation from the working group was to make the OHQ more 

task-oriented. He reiterated his belief that the format of the 

interviewer’s script was extremely important and noted as an 

example that welding is not mentioned as a method of exposure 

anywhere on the OHQ. He added that as part of the BTMed program 

all of the tasks are compiled on a single page and sent to 

interviewees before the interview. Chair Markowitz asked how he 

would change the OHQ form, and Member Dement said that the 

scripted questions need to be thought out very carefully and 

work tasks need to be mentioned.

Chair Markowitz said that given the enormous diversity of job 

titles among claimants, it was difficult to think of a generic 

list of tasks that could be used in the OHQ to cover all of the 

titles. Member Dement agreed that no list could cover everyone, 

but argued that there are several tasks that are very 

consistent. Member Friedman-Jimenez suggested adding a question 

to the OHQ about out-of-title work; if a claimant said that they 

performed out-of-title work it would trigger the IH to ask for a 

more open-ended occupational history. Member Tebay said that at 

the Hanford Workforce Engagement Center they instruct claimants 
to write an addendum of everything they can remember about their 

work history before they go in for an interview. It is crucial 

to extract as much information from claimants as possible 

because the OHQ impacts the rest of the claims process. Member

Friedman-Jimenez said that the key was to identify people for 

whom the OHQ does not represent all possible exposures relevant 

to their health conditions. 

Member Silver said that short of a training program aimed at 

workers before they go to answer the OHQ, a brochure from DOL 

about what to expect on the OHQ would be helpful. Chair 

Markowitz asked if they should propose sending a worksheet to 

the claimant prior to the interview, and several board members 

expressed support for this idea. Member Dement added that the 

training of IHs and interviewers is key in order to make sure 

that they understand the exposures and can drill down with 

additional questions where needed. He said that at BTMed, hiring 

former workers to conduct interviews has been beneficial. 

Member Domina said that under Part B, claimants receive copies 

of the computer-assisted telephone interview (CATI) questions 

from NIOSH ahead of time, and he was not sure why the same could 

not be done for the OHQ. Chair Markowitz said that this would be 

the simplest solution and asked if the OHQ was user-friendly 

enough for people to fill out themselves. Member Domina said 

that it needs work, but it is a starting point. Member Dement 

quoted a section of DOL’s response and said that DOL seems to be 

concerned that supplying information to claimants will lead to 

“unreliable and unauthentic outcomes” in claimed exposures. 

Several members agreed that that has not been their experience

and that one of the reasons to supply questions ahead of time is 

to give the claimant time to think about their work history.

Chair Markowitz said there seemed to be general agreement that 

the board will recommend that DOL send out the OHQ or a 

simplified version of it to claimants prior to interviews. He 

noted that if DOL was set against sending out the exact OHQ, a 

simplified and user-friendly version would still serve the 

purpose of triggering claimants’ memories. Member Dement said 

that if the current version of the OHQ is sent out there should 

be an addendum attached that explains how exposures might occur. 

He also said that welding should be added under the Metals 

category and solvent degreasing should be added to the 

descriptive information under the Solvents category. Chair 

Markowitz said that he thought asking about the form of toxic 

substances and how claimants were exposed was a waste of time

because that information will be drawn out by other questions. 
He said that instead he would augment the question about uses of 

a substance with a question about what tasks a claimant 

performed with the substance. Member Redlich said that she found 

the mention of PPE to be more of an indication that there were 

hazardous circumstances requiring PPE rather than reassurance 

that the worker was adequately protected. Chair Markowitz 

reminded board members that they had previously recommended 

removing questions concerning PPE. Member Dement commented that 

on the previous OHQ the references to PPE were numerous, whereas 

it appears less frequently and is not objectionable in the 

current version. 

Member Tebay suggested that questions about PPE could provide an 

opportunity to document the lack of PPE in situations where it 

should have been provided, and Member Pope agreed. Chair 

Markowitz said that the current OHQ’s mention of PPE in an 

example question is a soft trigger, and he thought that was 

sufficient because it reminds the claimant to mention PPE if 

they want to but does not give specific information that could 

be misinterpreted in the claims evaluation process. Member 

Friedman-Jimenez suggested asking questions that are harder to 

misinterpret; for example, asking claimants if they worked in 

situations where PPE would be necessary, followed by a question

about whether or not they were provided with the proper PPE.

Member Friedman-Jimenez volunteered to draft questions about PPE 

and edit the Additional Information section for the board’s 

consideration during the second day of the meeting. 

THURSDAY, APRIL 16, 2020 

Call to Order: 

Chair Markowitz called the meeting to order at 11:03 a.m.

Occupational Health Questionnaire Revision (continued):

Chair Markowitz noted that this meeting marked the third 

anniversary of the board’s recommendation to improve the OHQ. He 

summarized the previous day’s discussion and said that it was 

time for the board to give its final comments and let DOL move 

forward with piloting the questionnaire.

Member Friedman-Jimenez presented draft language for a general, 

open-ended question to be added to the end of the OHQ. 

Board Recommendation:
After some discussion, the board voted unanimously to submit the 

following as a formal recommendation to DOL: 

“The Board recommends pilot testing of the OHQ in its most 

recent version provided to the Board with the following 

comments:

1). Adding a general open-ended question for the end of the OHQ: 

“Did we miss anything? For example, are you concerned about any 

exposures to toxic substances that were not adequately described 

in your responses in this questionnaire? Please describe your 

concern, for example what types of substances these were (even 

if you don’t know the technical name), when the exposures 

happened, what kind of PPE you used at the time and whether you 

think these exposures are related to the health problem for 

which you are applying for compensation.” 

2). Sending claimants, prior to the OHQ interview, either a copy 

of the OHQ or a simplified version or worksheet together with 

brief examples of common work tasks and processes that the 

clamant could use to gather their occupational information.” 

Site-Wide Job Titles in SEM: Recommendation and DOL Response

Chair Markowitz reminded board members that they had previously 

made a recommendation about job titles in the SEM and summarized 

DOL’s response. He said that DOL appeared to think the board was 

recommending the standardization of the exposures of certain job 

titles across the entire complex, e.g., a firefighter at 

Portsmouth and a firefighter at Los Alamos should be listed in 

the SEM as having the same exposures. In reality, the board was 

recommending that a firefighter at Portsmouth be considered to 

have a very broad set of exposures at Portsmouth, and likewise 

for Los Alamos firefighters and a broad set of exposures at Los 

Alamos. He also referenced DOL’s statement that the Department 

does not make broad determinations about toxic substances or job 

categories across DOE facilities. He pointed out that this is 

not necessarily true; within the SEM one can search within the 

category of “construction, all sites,” select a job category and 

receive a set of toxic substances for potential exposure that is 

standardized across the complex. Chair Markowitz said that the 

board will ask DOL for clarification around this issue.

Chair Markowitz highlighted a second point in DOL’s response 

where they assert that the SEM is based on objective data that 

supports the listing of potential exposures. He summarized his 

review of SEM data on certain job titles included in the board’s 
recommendation (firefighter, security guard, health physics 

technician, and aliases). Hanford is a clear outlier, with some 

variation in other job titles among other sites. Even when the 

type of facility is narrowed down, for example focusing on 

gaseous diffusion plants in particular, there is considerable 

variation in the toxic substances listed. Member Dement 

commented that this review showed the inconsistency across sites 

in terms of how exposures are determined.

Chair Markowitz asked board members what action they wanted to 

take on this matter, noting that evaluation of the SEM was one 

of the board’s original four mandated tasks. He suggested that 

they could ask for the objective data that went into the 

construction of the toxic substance profiles for certain sites 

and job titles. They could also ask the program’s industrial 

hygiene personnel about their understanding of what causes this 

variation. Member Goldman reminded the board of a previous 

discussion about firefighters and other workers who would go to 

different plants in times of need. Mr. Vance said that the SEM 

provides a generalized profile of information based on 

documentation specific to each site. Individual characteristics 

of where a firefighter or other claimant worked would need to be 

profiled by the IH and exposure information would need to be 

customized based on what is uncovered in the review process.

Chair Markowitz summarized the result of the board’s discussion: 

the board requests data for the SEM’s underlying documentation 

in relation to selected job titles and DOE sites. The goal of

this request is to better understand how the SEM profiles for 

jobs at those sites were constructed and also the variation that 

occurs across job titles and sites. Chair Markowitz added that 

the board would appreciate hearing DOL’s view on why this 

variation occurs. 

Assessments of CMC and IH Performance:

Chair Markowitz said that this item was on the agenda to allow 

the board to explore ways in which the current CMC and IH 

assessments might be revised and, if necessary, come up with a 

recommendation for a modified method of assessing the quality, 

objectivity and consistency of IHs and CMCs. Member Dement said 

that he did not consider the DOL IH review to be an in-depth 

review, and if it was, the DOL IHs were overworked. He said that 

there should be a different process for the IH review, such as 

the CMC reviews that take a sample and do an in-depth review of 

the fairness and accuracy of claim determinations.
Member Friedman-Jimenez said that the board’s consensus after 

their previous review of cases was that there were too many 

cases that raised concerns for the board. He also agreed with 

previous comments that current assessments seem to focus more on 

impairment ratings and level of care needs rather than the 

accuracy of the determination of work-related causation. Member 

Friedman-Jimenez proposed that the board recommend that EEOICP 

set up a multidisciplinary committee to conduct periodic peerreviewed performance assessments of the quality of IH and CMC 

evaluations.

Member Redlich noted that the board has been working on this

effort for several years and has made recommendations on these 

assessments in the past that have been implemented. She said 

that she was hesitant to suggest forming another committee. 

Member Silver agreed and said that he would rather stick with 

their first resource request for a contractor to support the 

board’s analyses. Chair Markowitz said that he did not think a 

recommendation for an independent peer review process

necessarily involved the board at all. He said that the board’s 

charter is to provide advice to the Department, and while they 

are all aware of the resource constraints, the board does not 

know what exactly the resources are and where they come from, 

and they should focus on the areas where they are knowledgeable. 

Chair Markowitz suggested that the board delegate this issue to 

a smaller group for further discussion in the coming weeks, with 

a formal recommendation to be presented at the June meeting.

Several board members expressed their agreement.

Revisions in EEOICP Procedure Manual and Bulletins:

Chair Markowitz said that during the development of the work 

plan the board should develop a strategy for addressing the 

short notice pre-publication documents provided to them by DOL.

Update on Expanding Asbestos Job Titles in the PM: 

Chair Markowitz reminded the board that he and Members Mahs, 

Dement and Pope were asked by DOL to provide documentation for 

the expansion of asbestos job titles in the PM. He said that 

they had not been able to address this matter as of yet but it 

should be closed out by the end of this board term.

Review of Public Comments:

Chair Markowitz referenced Stephanie Carroll’s comment about B 
reading and said that the board had addressed that issue in 

their earlier advice to DOL. Mr. Avery’s comments about hearing 

loss have also been addressed. Member Silver noted that Mr. 

Avery was a name and a face to go with the board’s earlier 

discussion on site-wide job titles. Chair Markowitz summarized 

Terrie Barrie’s comments about news reports of faulty 

respirators and her suggestion that the board review claims. 

Chair Markowitz said that he was hesitant to request more claims 

to look at. He asked how DOL incorporates news reports like 

those about the faulty respirators into the claims process. Mr. 

Vance said that in his experience the IHs do not look at PPE 

when forming their opinion about exposure to occupational 

toxins.

Timetable to Complete Work by July:

Chair Markowitz read through the items on the board’s work 

agenda. Board members discussed the timeline for each item and 

which members will work on each task. Chair Markowitz suggested 

that they circulate all proposed documents two weeks before the 

June meeting. 

Parkinson-related disorders

Members Mikulski, Pope, Goldman, Friedman-Jimenez, and Dement 

will conduct the scientific review over the next month, with a 

final recommendation to be discussed and voted on at the June 

meeting. 

SEM-IARC Group 2A chemicals 

Members Berenji, Pope, Goldman, and Friedman-Jimenez will meet 

in the coming weeks and present a final recommendation by the 

end of June. 

Asbestos job titles

Members Dement, Mahs and Domina and Chair Markowitz will 

continue to look for documentation for the job titles that 

should be added.

Board’s resources request

Chair Markowitz asked for a group to draft a statement of work 

and he and Member Silver volunteered to coordinate this effort. 

Review of post-1995 lung cancer claims