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 19-20, 2017

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The Advisory Board met at 8:30 a.m. Pacific Time, at 

the Red Lion Hanford House, 802 George Washington Way, Richland, 

Washington, Steven Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMEN

MARK GRIFFON*

KENNETH Z. SILVER

GEORGE FRIEDMAN-JIMENEZ

LESLIE I. BODEN

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

LAURA S. WELCH

ROSEMARY K SOKAS*

CARRIE A. REDLICH
VICTORIA A. CASSANO

CLAIMANT COMMUNITY:

DURONDA M. POPE

KIRK D. DOMINA

GARRY M. WHITLEY

JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

DOUG FITZGERALD

*Participating via telephone
Introductions

Doug Fitzgerald, the Designated Federal Official, opened the 

meeting at 8:36 a.m. Chair Markowitz reviewed the agenda and 

introduced Rachel Leiton from DOL. 

DOL Presentation to the Board

Ms. Leiton, Director of DEEOIC, gave a presentation to the 

Board. Ms. Leiton read a supportive statement from Gary 

Steinberg, Deputy Director of the Office of Workers’ 

Compensation Programs, who wanted to attend the Board meeting 

but was unable to. Ms. Leiton said that DOL has delayed its 

response to the Board’s recommendations due to the lack of a 

Secretary. DOL has sent an interim response. DOL has already 

rescinded one circular regarding the Post-1995 Exposures. DOL 

would like to request that the Board narrow the list of IOM 

recommendations. With regard to presumptions, Ms. Leiton said 

that DOL wants the input of industrial hygienists whenever it 

can get them, but when DOL can avoid it the process can move 

along a little more smoothly. The Board’s discussions during 

this meeting could impact DOL’s draft document on presumptions.

To date, DOL has paid out $13.6 billion in compensation benefits 

with $1.36 billion being paid out for Hanford claimants alone. 

DOL has been active with its Joint Outreach Task Force Group in 

getting the word out about the program and taking questions. DOL 

is currently working on a PDF of its Procedure Manual. DOL also 

has a subscriber list for email blasts for information about 

medical benefits and changes. DOL has also started doing 

quarterly teleconference calls with medical providers.

SEM Subcommittee

Member Welch gave two presentations, one on the Occupational 

Health Questionnaire (OHQ) and one on COPD. The SEM 

subcommittee recommended retaining the list of hazards/exposures 

on the current OHQ and expanding that list by adding the list of 

hazards/materials from BTMed. The subcommittee felt these lists 

can help people recall the work that they did. Workers should 

be asked what materials they were exposed to, with an emphasis 

on the tasks associated with the exposure, captured in free 

text. The worker would also be asked to rate the frequency of 
exposure to each hazard, using the scale from the BTMed 

questionnaire. DOL should assess if the worker used the material 

directly or was exposed as a bystander. A focus on task is 

essential for application of Bulletin 16-03 and the subcommittee 

believes that the OHQ, if revised as recommended, would meet 

this standard. 

The committee discussed the feasibility of creating a list of 

tasks for production workers, similar to what BTMed uses for 

construction workers, but felt that would be almost impossible 

given the wide range of tasks over the years in the DOE complex. 

The alternative of getting a more detailed occupational history 

from each worker will provide the comparable information.

The subcommittee recommended adding a specific question to the 

OHQ regarding vapors, gases, dusts, and fumes (VGDF). For 

example: “Have you been exposed to vapors, gases, dusts and 

fumes in your work at DOE?” If the answer is “yes”, the worker 

should be asked about frequency of exposure to VGDF overall 

using the same scale recommended above. If the answer is “yes,” 

the worker is then asked “Have you already reported all 

exposures to vapors, gases, dust and fumes in your answers 

above?” If not, additional information should be elicited. 

Since it is necessary to assess VGDF exposure outside of the DOE 

complex (see COPD presumption for the rationale), the worker 

should be asked to describe how he/she was exposed to same or 

similar materials in work prior to or after DOE work. The 

subcommittee recommended that the version of the OHQ developed 

in response to these recommendations be pre-tested for ease of 

use and face validity. 

With regard to COPD, the subcommittee recommended that DOL 

replace the presumption it has established in 16-02 with “Any 

claimant with a physician’s diagnosis of COPD who worked in any 

covered facility, either in any of the labor categories in 

Attachment 1 (with addition of all construction and maintenance

job titles) for at least 5 years cumulative (including non-DOE 

work) or with reported exposure to VGDF on the OHQ for a period 

which in aggregate totals at least 5 years cumulative (including 

non-DOE work) is presumed to have experienced sufficient 

exposure to toxic agents to aggravate, contribute to, or cause 

COPD.” Additionally, claims examiners should not deny claims for 
COPD if the worker had fewer than 5 years of exposure. Claims 

that do not meet the requirements set forth here but do have 

reported exposure to VGDF should be sent for IH and/or CMC 

review under the policy established in Bulletin 16-03.

In addition to aggregate exposure to VGDF, when a worker reports 

the following specific exposures on the OHQ, separately or in 

combination for a period of 5 years, these agents should be 

presumed to cause, contribute, or aggravate COPD as they impose 

a risk for COPD that is as great as the risk found by DEEOIC in 

Bulletin 16-02 to be presumptive for asbestos: asbestos, silica, 

cement dust, engine exhausts, acids and caustics, welding, 

thermal cutting, soldering, brazing, metal cutting/grinding, 

machining aerosols, isocyanates, organic solvents, wood dust,

and molds and spores.

The subcommittee made several points with regard to timing and 

duration of exposure. As to timing of exposure, because these 

exposures continue to take place on DOE sites, many of which are 

unregulated, it should be presumed that relevant reported 

exposures at any period of employment covered by EEOICPA, up to 

the present time, are contributory. 

For duration of exposure, based on the evidence presented in the 

Dement 2015 study, a duration of 5 years of reported exposures 

to VGDF should be presumed to aggravate, contribute to, or cause 

COPD. The 5 years can be accumulated by a combination of DOE 

employment and employment outside of DOE (Note comments on this 

issue on the following day).

The subcommittee does not recommend specifying time since last 

exposure. COPD is a slowly progressive disease; individuals are 

often not diagnosed until the disease is advanced. Since it 

would not be possible to determine in retrospect when a case of 

COPD could have been first diagnosed, it is reasonable to assume 

that VGDF contributed to any diagnosed case even if the disease 

is diagnosed after the worker has left employment. Exposures 

outside the DOE complex should be considered when determining if 

a minimal length of exposure has occurred to meet a presumption

(Note comments on this issue on the following day).

There were two rationales for requiring 5 years of cumulative 

exposure to VGDF or specific agents: 1) Lowest observed 
duration associated with COPD, as described in Dement 2015, a 

study of DOE construction workers, and 2) a systematic review 

suggests safe occupational exposure limits for low toxicity 

dusts should be 1 mg m−3 of respirable dust. This also is the 

limit set by the German government. 

Discussion

The idea that inhaled dust exposures or dust and fume exposures 

can cause COPD goes back many decades and the American Thoracic 

Society has published on this topic in 2003. Member Dement said 

that there is a growing and now well-accepted body of 

information and scientific studies that support the concept that 

particulates that have been considered relatively low toxicity 

with regard to regulations are nevertheless contributory to 

COPD. 

There is a growing body of data that supports the concept that 

particles that have been traditionally disregarded with respect 

to occupational regulations are contributory to lung diseases. 

Chair Markowitz said that the challenge was to figure out how to 

consider the totality of exposure. Member Dement said that a 

worker’s cumulative lifetime exposures lead to the development 

of disease. The DOE work that a worker undertook would satisfy 

the issue of contributing to that worker’s disease. Member Welch 

said that she didn’t think that smoking belonged on an OHQ. Ms. 

Leiton said that DOL actually tried to not consider smoking as 

part of causation because of the aggravation and contribution. 

This is something that is addressed in training with the claims 

examiners. Chair Markowitz said that, on balance, ignoring 

smoking has been a claimant-friendly approach. Member Dement 

said that one of the most important things that the SEM 

committee considered was the ability of the industrial hygienist 

to go back to the worker and directly ask follow-up questions. 

With regard to BTMed, Chair Markowitz explained that it was the 

Former Worker Medical Screening Program supported by the 

Department of Energy for the last 20 years in which the CPWR has 

examined 30,000 construction workers and has assisted 

individuals in understanding their illnesses. It has also 

published studies about their experience regarding COPD and 

other diseases in the DOE population.
Recommendations and discussion

The Board unanimously approved the following recommendations: 1) 

We recommend retaining the list of hazards/exposures/materials 

on the current OHQ, and expanding that list by adding the list 

of hazards/materials from BTMed. 2) We recommend adding the list 

of tasks in BTMed, even knowing that it is incomplete.

The Board approved the following recommendation with one 

negative vote: 3) We recommend adding a specific question 

regarding vapors, gases, dusts and fumes (VGDF).

The Board unanimously approved the following recommendation: 4) 

We recommend that the version of the OHQ developed in response 

to these recommendations be pre-tested for ease of use and face 

validity. 

Member Silver said that the Board had a recommendation a year 

ago to rearrange the organizational chart for the occupational 

medicine person assigned to the program to create more 

interaction between them and their peers in other parts of DOL. 

Member Silver also raised the idea that the Board could hire a 

contractor to help with the ongoing technical and scientific 

work, similar to the Advisory Board on Radiation and Worker 

Health. 

The Board approved the following recommendation with one 

abstention: The Board recommends that the DEEOICP enhance its 

scientific and technical capabilities to support the development 

of program policies and procedures to improve decision-making on 

individual claims and to inform its assessment of the merit of 

the work of its consulting physicians and industrial hygienists.

Weighing Medical Evidence

Member Cassano gave the report. The task of the committee was to 

review, evaluate, and make recommendations pertaining to the 

materials available to assist CEs in determining the development 

and adjudication of medical claims. The committee examined the 

logic and processes used by the CEs in determining what medical 

information was valid and what was not. It also evaluated the 

training materials available on specific toxicants outside of 

the SEM.
Based on the committee's review of the information, they made a 

recommendation to the full committee that the entire case file

should be sent to the IH and/or CMC when a review is requested.

The committee also asked to review Part E claims and to receive 

the entire case files. In addition, the committee asked to 

review the training materials provided to the CEs. Finally, the 

committee believed it necessary to speak with claims examiners 

to understand how they used all the information they were given 

and the logic by which they made decisions.

The committee thought that, overall, the training documents were 

excellent. It noted several discrepancies between what the 

training documents required and what was accomplished in the 

district offices. Specifically, the training material states to 

use OHQ, SEM, CMC, and IH/toxicology review to determine 

exposure and causation; SEM is never to be used as a sole reason 

for a denial. ORISE, OHQ, DEMMP, and Former Worker Programs all 

are considered acceptable sources of medical evidence.

The training material states that no CMC review is necessary if 

there is no known exposure to a toxic substance, or no plausible 

scientific association between a toxin and disease. How does the

CE know this?

The training material states that searches of labor processes, 

buildings, and areas should be used when a person’s labor 

category is not listed in the SEM. Before 2000, FWP records are 

usable without corroboration. After EEOICPA was passed, the FWP 

records must be corroborated with “other evidence.” OHQ evidence 

must be corroborated by other evidence. Only the SOAF goes to 

the IH/toxicologist or CMC. The committee has already 

recommended that the entire case file go. SOAF precludes the 

consultant from making their own findings of fact. 

Member Cassano discussed the committee’s review of case files. 

Some of the findings included: Not all conditions listed on the 

EE1 were adjudicated even though medical evidence was provided 

verifying diagnosis. Not all exposures that could cause a 

particular medical condition were evaluated by the CE. The 

information in the Occupational Questionnaire was not utilized 

by the CE unless corroborated. It was not clear to the committee

how this is accomplished. Claims denied by the CE using only the 
SEM without sending them to either the IH or the CMC is contrary 

to what the training materials instruct CEs to do. This is 

particularly troubling for worksites without a SEM. Some 

conditions were either accepted or denied despite whether or not 

the job listed was in the criteria for acceptance. CMCs were 

only asked to comment on one or two conditions despite more 

conditions being claimed. In claims where SEM clearly supported 

an association between exposure and claimed medical condition, 

the claims were sent to an IH anyway.

There were cases where district offices commented on a known 

exposure/outcome relationship (COPD), yet never asked a CMC to 

review the claim and the claim was denied.

There were claims where the IH stated that there is no evidence 

for an association between TCE and Parkinson’s disease, which is 

not quite where the literature is at this point. They did not 

consider other exposures, such as synergistic exposures.

Four members of the subcommittee will have a meeting at the 

Seattle District Office on April 21, 2017. Representatives from 

district offices will be present, along with Joleen Smith, the 

District Director. Committee members along with program 

representatives will use this opportunity to ask questions about 

specific cases chosen by committee members and supervisors from 

the district offices. The content of the discussion will be 

general questions about the process. The point is to find out 

how to make the process more equitable based on the evaluation 

of the case files. The committee thought that it would be a good 

idea to look at some of the cases retrospectively and see how 

presumptions would have assisted in the development of the 

claims. The committee is also going to look at the use of the 

word “significant” in the IH and CMC reports. Another question 

the committee wants to look at is how to compensate for wage 

loss prior to a claimant having a definitive diagnosis. 

Discussion

Member Boden said that, looking at some of the cases, it seemed 

like the person making the claim was not medically or legally 

sophisticated and that the claim failed in part because the 

claimant didn't provide the necessary records. It would help if 
there was a way for DOL to inform claimants about what is 

missing in their file, instead of simply rejecting a claim. 

Member Cassano said that it might be good to have a validated 

survey go out to CEs with non-identifiable information.

Ms. Leiton said that the claims examiners can email the lead 

industrial hygienists or talk to them on the phone. CEs are 

trained to look at what they have and make sure they understand 

as best they can what additional information they need to ask 

for. Member Vlieger said that the letters to the claimants have 

improved significantly since the beginning of the program. 

Member Vlieger also thought that there are letters from certain 

district offices that are obviously boilerplate. 

The Board discussed how to determine wage loss over a period of 

time prior to definitive diagnosis, where the wage loss should 

be considered in those conditions that are slowly progressive or 

not diagnosed properly for a period of time from when symptoms 

develop. Ms. Leiton said that DOL looks for medical evidence 

establishing that the individual lost wages as a result of the 

condition that is covered. The doctor has to say that the 

claimant was unable to earn a certain amount of wages as a 

result of their covered condition beginning on a certain date. 

IH & CMC Subcommittee

Member Sokas gave the report. The purpose of the subcommittee 

was to evaluate the work of the hygienists and physicians to 

ensure quality, objectivity, and consistency. Previous 

recommendations of the subcommittee include the following: 1) 

That DEEOIC establishes a process where the industrial 

hygienists interview the claimant directly. 2) That the DEEOIC 

policy teleconference notes taken by DOL be redacted and made 

searchable and publicly available. 3) That DEEOIC make the 

entire claimant case files available to the claimant online. 4)

That DOL create a departmental occupational medicine resource 

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

the Solicitor of Labor. 5) That the entire case file be made 

available to the industrial hygienists and CMCs. 

The subcommittee discussed several issues at its 12/16 meeting. 

These included: 1) Having DOL personnel and the Ombudsman 
present at Board meetings and able to provide immediate 

responses. 2) Developing a formal approach to tracking and 

responding to comments, similar to the Radiation Board (ABRWH). 

3) Reviewing and revising DOL policy requiring claimants to 

travel up to 200 miles for DOL directed medical evaluations. 

With regard to the issue of IH review, three issues arose: 1) It 

is not clear whether IH review is triggered in all cases where 

it would be beneficial. 2) It is not clear whether the IH 

review, when triggered, involves a review of all relevant data. 

3) Claimant records easily run several hundred to a thousand 

pages and are poorly organized. 

The subcommittee's review of CMCs came to the following 

conclusions: CMC qualifications appear to be solid, but some 

reviewers use their own standards of causation rather than the 

accepted DEEOIC standard that work exposure must have caused, 

contributed to, or aggravated the medical condition being 

considered. The claimant records sometimes are several hundred 

to a thousand pages, are poorly organized, and are nonsearchable PDF files. It appears that this is an obstacle 

preventing some CMCs from accessing the entire record.

Member Sokas presented a few recommendations for discussion. One 

suggestion was to organize claimant records into sections and 

make the records searchable PDFs. Another was to conduct QI for 

a sample of past CMC letters resulting in denials utilizing 

worker-centered occupational physicians (consider AOEC 

subcontract). Based on the results of the QI review, guidance 

materials could be developed for CMCs. In addition, a briefing 

package could be provided for CMCs that emphasizes the DEEOIC 

standard that the work exposure must cause, contribute to, or 

aggravate the medical condition being considered, along with

program definitions and presumptions for each illness. CMCs 

should be given online access to the entire record. 

Discussion

Ms. Leiton said that DOL is working with their contractor to get 

more physicians in rural areas to participate in the program. 

Member Cassano suggested that telemedicine might be a good 

option for some of these cases. Chair Markowitz added that the 

Former Worker Medical Screening Program, which uses local 
facilities and physicians, could be a potential resource. Also, 

BTMed and the National Supplemental Program may serve as 

resources. Member Vlieger urged DOL to consider the infirm and 

the aged and the struggles they endure in making medical 

appointments. Ms. Leiton noted that DOL will pay the 

transportation cost of getting someone to an appointment for a 

second opinion evaluation. 

Member Friedman-Jimenez said that he was struck by the 

inconsistency of how the standard of causation is applied in the 

denied claims that he reviewed. He also said that the files are 

massive, often 1,000 pages, and currently not searchable. Ms. 

Leiton added that in terms of what the claims examiners see, the 

database is divided. Documents are indexed by type, whether it's 

an IH report, medical report, decision, or development letter. 

The information is organized for the claims examiners. When 

documents are referred to a CMC, they get whatever is medically 

relevant. Member Boden said that it would be worth looking at 

what the CMCs see. Member Pope said that DOL needs to make sure 

there is enough information in the CMC file to make a claimantfriendly decision. The process is dependent on the CE earmarking 

which documents the CMCs are going to see. Member Sokas said 

that there were clear examples of poor quality in terms of 

content and decision-making within some of the CMC files. 

Member Cassano floated the idea of having a combined 

subcommittee meeting with her subcommittee and Member Sokas' 

subcommittee to discuss overlapping issues.

The Board members decided to discuss formal recommendations on 

reviewing claims the following day.

Presumptions Working Group

Member Markowitz gave the update. The group thinks that 

presumptions would enhance fairness. An aspect of fairness is 

that there wasn't a lot of information about exposure across the 

DOE complex; absence of exposure information should not work 

against appropriate claims. Another advantage of presumptions is 

that it lends consistency to the process and makes decisionmaking more straightforward and simple. The presumptions should 

be based on as much science as is available. Presumptions were 
incorporated into the original Act. Job title is a good proxy 

for trying to understand how intense exposures might have been. 

Chair Markowitz went through DEEOIC's use of presumptions in 

detail, as covered in the EEOICPA Procedure Manual, EEOICPA 

Bulletin No. 13-02, and EEOICPA Circular No. 15-05. Chair 

Markowitz also spoke about the various facets of presumptions, 

including fairness, consistency, timeliness, efficiency, error 

threshold, and positive vs. negative presumptions. 

Proposed recommendations with regard to presumptions

The Board recommends that the DEEOICP enhance its scientific and 

technical capabilities to support the development of program 

policies and procedures, to enhance decision-making on 

individual claims, and to inform its assessment of the merit of 

the work of its consulting physicians and industrial hygienists.

The Board has observed that numerous current EEOICP policies 

involving important diseases and exposure-disease links, 

including chronic obstructive lung disease, asbestos-related 

diseases, asthma, and others, are not based fully on state-ofthe-art scientific knowledge. The Board is willing to assist the 

Department of Labor in implementing this recommendation.

For asbestos-related diseases, the Board made several 

recommendations: 

1) All DOE workers who worked as a maintenance or construction 

worker at a DOE site for 250 days or more prior to January 1, 

2005 and who are diagnosed 15 years or more after the initiation 

of such work with any of 5 asbestos-associated conditions will 

be presumed to have had sufficient asbestos exposure that it was 

at least as likely as not that asbestos exposure was a 

significant factor in aggravating, contributing to, or causing 

such asbestos-associated conditions. The five asbestosassociated conditions are asbestosis, asbestos-related pleural 

disease, lung cancer, and cancer of ovary and larynx. This 

recommendation was passed unanimously.

2) All DOE workers who worked as a maintenance or construction 

worker at a DOE site for 30 days or more and who are diagnosed 

15 years or more after the onset of such work with malignant 

mesothelioma of any bodily site will be presumed to have had 
sufficient asbestos exposure that it was at least as likely as 

not that asbestos exposure was a significant factor in 

aggravating, contributing to, or causing the malignant 

mesothelioma. This recommendation was passed unanimously.

3) All claims for one of the six asbestos-associated conditions 

named above that do not meet the exposure criteria described in 

items #1 and #2 above will be referred to an industrial 

hygienist for exposure assessment and to a CMC for evaluation of 

medical documentation and causation. These six conditions are 

asbestosis, asbestos-related pleural disease, malignant 

mesothelioma, lung cancer, and cancer of ovary and larynx. This 

recommendation was passed with 14 votes in favor and one 

abstention. 

4) Chronic obstructive pulmonary disease may have a contribution 

from asbestos exposure. However, claims for this disease should 

be evaluated as part of a broader set of presumptions for 

chronic obstructive pulmonary disease. This recommendation was 

unanimously approved. 

Discussion

Member Domina said that he did not like the 2005 cut-off on 

asbestos and felt it should be later. Several other members 

agreed that 2005 seemed arbitrary. Member Welch said that having 

a date is reasonable as long as there is a process where people 

who had injurious exposure after 2005 can have their case 

reviewed without the process being extremely burdensome. After 

some discussion, Chair Markowitz pointed out that there is going 

to be a balancing act between certainty on the medical criteria 

side and certainty on the presumption side. The sticking point 

of the discussion was the calendar year issue. 

Voting on the revisions to the proposed recommendations from the 

Work Group

1) The Board recommends that there be no calendar year reference 

for five asbestos-related diseases, excluding malignant 

mesothelioma. The recommendation had four in favor, one 

abstention, and eleven no. 

2) The Board recommends that the exposure presumptions for 

asbestos with DOE workers who otherwise meet exposure criteria 
that the Board will set out, who had this significant exposure 

to asbestos prior to January 1, 2005, will be judged to have 

substantial exposure sufficient to be a significant factor in 

causing, contributing, or aggravating one of the five asbestosrelated conditions, excluding malignant mesothelioma. The 

recommendation had seven votes in favor, six opposed, and two 

abstentions. After some discussion over the purpose of having a 

calendar year, this recommendation was re-voted on. The outcome 

of that vote was ten in favor with one opposed – enough for a 

consensus. Several members abstained. 

3) The Board repeated the above recommendation but with January 

1, 2015 being the key date in determining the significant 

asbestos exposure. The recommendation had seven in favor, seven 

no, and one abstention. 

Public Comment

Terrie Barrie – Founder of ANWAG. Ms. Barrie commented on the 

good work that the Board has done in the previous year and 

lauded their accomplishments. Ms. Barrie was concerned about the 

delay in implementing the Board's recommendations. Ms. Barrie 

highlighted the barriers to claimants actually getting approved 

for wage loss. She urged the Board to review some of the wage 

loss claims.

Deb Jerison – Director of the Energy Employees Claimant 

Assistance Project. Ms. Jerison encouraged the Board to get 

input from lower level claims examiners. The idea of an 

anonymous survey is a good one. She also recommended using a 

coworker model to provide exposure information for facilities 

without a Site Exposure Matrix.

Calin Tebay – MSA employee health advocate at Hanford and the 

site-wide beryllium health advocate at Hanford. Mr. Tebay wanted 

the Board to review the current DOL criteria for chronic 

beryllium disease. He encouraged that the Board compare the 

current DOL criteria with the guidelines developed by the 

Department of Labor and Industries in 2015.

Steve Peterson – Manager for a Hanford contractor. As someone 

who went through the claims process, he wanted to know how DOL 

could work better with other agencies. 
Don Slaugh – Union Hanford site representative. Mr. Slaugh had 

three concerns: 1) Old HEPA filters, 2) excavations in the tank 

farms and associated contamination, and 3) chemical vapors. Mr. 

Slaugh wanted DOL to take his specific concerns about these 

issues into consideration when considering individual claims.

D'Lanie Blaze – CORE Advocacy for Nuclear and Aerospace Workers. 

Ms. Blaze was primarily concerned about the lack of information 

in the SEM about coal gasification and exposures at Santa Susana 

which apply to both Area I and Area IV workers. 

Elnora Bing – Savannah River employee for 33 years. Ms. Bing was 

diagnosed with sarcoidosis and was accepted under Part B of the 

program, but withdrew her acceptance letter after a DOL 

representative told her that she should file under Part E. After 

she filed for Part E, she was denied. Ms. Bing felt that she was 

tricked out of her claim by the Department.

Stephanie Carroll – Professional representative specializing in 

claims for occupational lung disease. Ms. Carroll said that she 

was concerned that without an authorized representative, 

claimants are misled and denied claims that are viable under the 

program. Claims examiners seem to be demoralized and are 

evaluated by the timeliness in which they complete the 

adjudication of claims and not by the quality of their work. Ms. 

Carroll was disappointed that the Weighing of Medical Evidence 

Subcommittee will not be reviewing the weighing of evidence for 

Part B, CBD, or sarcoidosis. She was pleased that the 

subcommittee on lung disease will be addressing these issues. 

Ms. Carroll thought that the claims examiners were not being 

trained consistent with the procedure manual. 

Shirley Kennedy – Ms. Kennedy asked why radionuclides are not 

listed in the SEM. She said that she could not obtain the raw 

data she needs in order to successfully complete her claim. 

Tee Lea Ong –Professional Case Management. Ms. Ong expressed 

concern over the Board's recommendations not being implemented 

swiftly enough and the timeframe that the Board has to complete 

its task not being long enough to finish all of the work that 

the Board needs to do.
Jerry Ferson – Safety representative for Hanford tank farms. Mr. 

Ferson received significant exposures and lost his nursing care

due to his case worker submitting “some paperwork that DOL did 

not like.” Mr. Ferson felt like the resources provided to assist 

claimants were inadequate or untrustworthy. 

Tom Moore – Former Hanford worker. Mr. Moore didn't think the 

department was consistent in its approach to evaluating exposure 

as it relates to getting a claim accepted. He also thought that 

engineers should be included in the list of job descriptions for 

presumptions. Mr. Moore cautioned that job titles don't tell you 

everything you need to know about what someone's exposures are. 

Richard Bloom – Hanford employee since 1980. Mr. Bloom suggested 

that the Board get around to defining what maintenance workers 

are. He said that people who worked in buildings built prior to 

a certain date would have asbestos falling on their desks. Mr. 

Bloom said that he was beryllium sensitized, but he was a 

“pencil pusher.” People that worked in these buildings may not 

have been production workers, but they were also exposed. 

Donna Hand – Professional claimant advocate. Ms. Hand wanted to 

know why the target organs that are defined in the NIOSH pocket 

chemical guide are not also displayed in the SEM. She argued 

that the level of exposure is never to be addressed. What should 

be considered is the frequency of exposure or frequency of job 

task. Ms. Hand cautioned the Board about the definitions of 

terms like “significant.” Having clear definitions of terms and 

criteria is critical.

Ms. Diane Leist – Former Hanford worker. Ms. Leist asked if 

medical studies that link certain cancers to particular types of 

exposure could be placed in the SEM. 

Gary Vander Boegh – Design engineer. Mr. Vander Boegh detailed 

his experiences with permitting, investigations, and waste 

falsifications – specifically at the Paducah Gaseous Diffusion 

Plant. Mr. Vander Boegh emphasized consistency and awareness of 

significant factors. 

April 20

Introductions and roll call
Mr. Fitzgerald called the meeting to order at 8:05 a.m. The 

Board members introduced themselves.

Discussion on Work Outside of DOE concerning COPD

Member Welch had originally included work outside of DOE as part 

of the exposure criteria. Member Welch proposed as the final 

COPD presumption everything that was mentioned yesterday, but 

with no mention of outside exposures. Member Silver said that a 

rationale statement will accompany the recommended set of 

presumptions and that that's the place to elaborate on non-DOE 

exposures. 

Presumptions Work Group Presentation and Recommendations 

continued

For work-related asthma, the Board made the following 

recommendations:

1) DOL should use the generally accepted unifying term “workrelated asthma” (WRA) for claims evaluation and decision-making. 

Work-related asthma includes a) occupational asthma (OA), or new 

onset asthma that is initiated by an occupational agent; and b) 

work-exacerbated asthma (WEA), which is established asthma that 

is worsened by workplace exposures. 

2) Medical criteria for the diagnosis of asthma. The diagnosis 

of asthma by a treating or evaluating physician should be 

sufficient for the recognition that the claimant has asthma. 

Bronchodilator reversibility of FEV1 and/or a positive 

methacholine challenge test may be helpful but should not be 

required to accept the diagnosis of asthma, which is made by a 

health care provider.

3) Work-related asthma, whether OA or WEA, is defined as the 

presence of medically-diagnosed asthma that is associated with 

worsening of any one or more of the following in relation to 

work: asthma-related symptoms, asthma medication usage 

temporally related to work, or peak flows. Such a history should 

be documented by a treating or evaluating health care provider, 

or addressed by a CMC if consulted in a claim evaluation. The 

same criteria for WRA should be used in evaluating asthma claims 

whether the claim is made contemporaneous with the period of DOE 

employment or after the end of that period of employment. A 
specific triggering event causing onset of WRA may occur but is 

not typical or necessary. Inciting exposures such as dusts, 

fumes, heat, or cold or others should be specifically identified 

when possible, but should not be required for the diagnosis of 

WRA.

Discussion

Member Welch strongly supported the use of well-developed, peer 

reviewed criteria for the diagnosis of asthma. Member Redlich 

said that the great majority of asthmatics in the United States 

and elsewhere have a clinical diagnosis of asthma but have not 

had spirometry, let alone spirometry that shows a 12 to 15 

percent improvement following an inhaled bronchodilator. The 

test can be falsely negative. There are common misconceptions in 

some of the guidelines when they get applied to current day 

workers. The current guidelines need major revisions. The 

existence of a negative test should not be an automatic denial. 

Member Friedman-Jimenez suggested that many doctors are not 

aware of work-exacerbated asthma. Ms. Leiton noted that if the 

Board's recommendations change any of the presumptions then DOL 

will need to change in conformity with the recommendations. 

Bulletins or circulars will be updated with the Board's 

recommendations. The above recommendations were unanimously 

approved by the Board.

Assessment of quality, objectivity, and consistency of CMC work

The Board requests that the DOL provide the Board with resources 

to conduct a quality assessment of a sample of 50 CMC 

evaluations that have been associated with claim denials. The 

quality review will assess the nature of the medical information

reviewed by the CMC, the use of standards of causation, the 

reasoning of the CMC, the scientific basis for the CMC 

conclusions, among other items. The assessment will likely 

require contracted services of worker-centered occupational 

physicians who are not associated with the current CMC contract. 

The review may lead to recommendations, including the 

development of guidance materials.

The above recommendation was unanimously approved by the Board.

Part B Lung Diseases Subcommittee
Member Redlich gave the presentation. Member Redlich reviewed 

the subcommittee's discussions on Part B cases, sarcoid 

presumptions, clarification of beryllium exposure and responses 

to DOL's (and others') questions regarding chronic respiratory 

conditions, the procedure manual, and borderline BeLPT. 

With regard to Part B cases, there were many common reasons for 

incorrectly adjudicated cases. For sarcoidosis and CBD claims, 

these reasons include: 1) Misapplication/understanding of the 

sarcoid presumption, 2) CMCs narrowly interpreting the data, 3) 

beryllium exposure being denied for unclear reasons, 4) there 

was eventually a correct decision on a claim, but it came many 

years later. 

Common reasons for incorrectly adjudicated cases involving 

pneumoconiosis and chronic silicosis include 1) Eligibility 

issues, and 2) the SEM identified limited exposure.

Recommendations

1) We recommend a presumption of chronic beryllium disease (CBD) 

in situations with a diagnosis of pulmonary sarcoidosis in an 

individual who meets the definition of a “covered beryllium 

employee” under Part E or Part B. (This is a recommendation to 

confirm the current DOL policy, so no vote was necessary.)

2) The finding of two borderline BeLPT tests shall be considered 

the equivalent of one positive BeLPT for the purposes of claims 

adjudication under subpart B and subpart E of EEOICPA. This 

recommendation had 13 votes in favor and one abstention. 

Ms. Leiton reminded the Board that the recommendations with 

regard to presumptions, if accepted, will be included in a 

revised procedures manual. 

Recommendation on solvents and hearing loss

Member Welch gave a brief overview of current DOL criteria for 

solvent-related hearing loss and proposed a recommendation for 

the Board's consideration. Her subcommittee recommended that the 

DOL develop direct disease work links for tasks with exposure to 

certain solvents (toluene, styrene, xylene, trichlorethylene, 

methyl ethyl ketone, methyl isobutyl ketone, ethyl benzene) in 

the range of the OEL. The committee recommended that a claimant 
work for at least 10 cumulative years in any of the job titles 

on a list in the current presumption, or have reported exposure 

to styrene toluene, xylene, ethylbenzene, TCE, carbon disulfide 

on OHQ, or evidence for exposure to those solvents in the SEM, 

for at least 10 years cumulative. Or have reported exposures to 

solvent mixtures on OHQ, or evidence for exposure to those 

solvent mixtures in the SEM, for at least 10 years cumulative. 

Or have exposure for 10 years cumulative, established through 

work history and DDWLP. 

Additionally, claims examiners should not routinely deny claims 

for solvent-induced hearing loss if the worker has had fewer 

than 10 years of exposure, does not have a DDWL for task, or is 

not in a labor category on the list. Claims that do not meet the 

requirements set forth, but do have reported exposure to organic 

solvents for at least 5 years cumulative should be sent for IH 

and/or CMC review.

The Board decided to have a July teleconference to discuss the 

above recommendation. Member Welch said that her subcommittee 

would look at the recommendation and submit comments. Member 

Welch will provide a rationale for the recommendation to the 

Board. 

Mr. Fitzgerald closed the meeting at 10:55 a.m.