UNITED STATES DEPARTMENT OF LABOR 

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH

+ + + + +

SUMMARY MINUTES

+ + + + +

NOVEMBER 20-21, 2019 

+ + + + +

The Advisory Board met in River Room A, Holiday Inn 

Paducah Riverfront, 600 N 4th Street, Paducah, Kentucky, 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 (via telephone) 

DESIGNATED FEDERAL OFFICIAL

DOUG FITZGERALD
WEDNESDAY, NOVEMBER 20, 2019

Welcome and Introductions:

Mr. Fitzgerald called the meeting to order at 9:11 a.m. 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. 

Board Operation Update and Status of Recommendations:

Mr. Fitzgerald noted that recommendations from the board’s last 

meeting are still pending review by the Secretary of Labor.

DEEOIC Updates, John Vance, DEEOIC Branch Chief, Policy, 

Regulations, and Procedures:

The program continues to receive a large number of claims on a 

weekly basis, with 626 cases submitted between September 28 and 

October 25, 2019. Among their new initiatives for 2020, the 

program plans to centralize their medical benefit authorization 

process, which manages post-adjudication case activities 

relating to claims with a living employee receiving medical 

benefits. In addition to its current focus on home health care,

this group will transition to take care of ancillary services 

such as durable medical equipment. The program also has an 

integrity group, which evaluates claims for waste, fraud and 

abuse. The quality assurance program, which operates through 

existing managerial oversight, will be expanded with the 

addition of a group of staff whose singular focus is decision 

quality. 

There will be two additions to the Special Exposure Cohort (SEC) 

class. The Y-12 Oak Ridge class has been designated for the 

period of January 1, 1977 through July 31, 1979, and preliminary 

assessment indicates that approximately 280 claims are affected

by this new class. The West Valley Demonstration Project site in 

New York has also been added to the SEC class, with a designated 

period of January 1, 1969 through December 31, 1973 and 

approximately 20 potentially affected claims.

The public has been making significant use of the Site Exposure 

Matrices (SEM), with approximately 1,300 unique IP addresses

accessing the website in the past month. The program’s SEM 

contractor evaluates facility information submitted by the 

public and makes additions and updates to the SEM. The SEM
currently has 129 DOE site profiles and information on over 

16,400 unique toxic materials used in facilities covered under 

Part E. In the past year four new site profiles have been added, 

profiles have been developed for over 3,500 uranium mines, and 

the program has done work in conjunction with DOE site closure 

profiles. The SEM team recently completed the profile for the 

Paducah DUF6 facility, adding nearly 100 toxic substances and 

120 labor categories and aliases. Mr. Vance outlined some of the 

updates and changes in Procedure Manual (PM) 4.0, including 

several changes that were made in response to input from the

board.

Modifications to the PM:

-requiring claimant signatures on claim forms

-an instruction that allows the IH staff to interact with 

claimants

-modified labor categories with regard to asbestos exposure

-clarification for CEs on the issue of diagnosis versus symptoms

-clarified guidance regarding SEM searches for pneumoconiosis, 

pulmonary fibrosis and interstitial lung disease

-inclusion of asbestos, coal dust, and silica in the list of 

toxins for pneumoconiosis/other

-updates to the role of medical benefit examiners and evaluating 

claims for medical benefits

Interstitial lung disease (ILD), pneumoconiosis, and pulmonary 

fibrosis can all be searched under the term pneumoconiosis/other

to identify toxins linked to those diseases. If a claims 

examiner (CE) sees that an employee has a diagnosis of ILD, 

asbestosis, et cetera they will be able to search under the 

pneumoconiosis/other category to find the toxins associated with 

that employee’s work. Member Redlich noted that the SEM often 

produces results that are closely related to the questions that 

the CE asks the Contract Medical Consultant (CMC). 

In PM 4.0 there will be an optional process when there is an 

identified need for the IH to engage with the claimant. The CE 

will be responsible for arranging a call with the claimant. The 

IH will monitor the call and ask a series of probing questions 

about the nature of the claimant’s work with certain materials. 

The CE and the IH will use that information to construct a memo 

and a federal IH will consider whether or not their original 

characterization of exposure was accurate. The program is 

looking for input from the board when it comes to applying 

specific definitions or changing the IHs’ current methodology.
With regard to obtaining better quality decisional outcomes, the 

IH will be asking probative questions to determine the accuracy 

of claimants’ information in alignment with the information in 

the case file and apply an adjudicatory process. Claimant 

interviews can be critically important to add context to 

exposures that would not necessarily appear in the case file.

Member Redlich noted that while the SEM produces a long list, 

there are a limited number of exposures that actually cause 

these diseases. If IHs understood that, they would know what to 

focus on.

Mr. Vance will provide the board with information on the number 

of public submissions to the SEM and the revision work that has 

been done in conjunction with those submissions. He will also 

provide them with the total number of claims that go to a CMC in 

a given month, complete with rationale.

Review of Action Items and Department Responses:

Chair Markowitz discussed recent action items. There were

multiple public comments at a past meeting about suggested 

additions to the SEM, including neptunium. In response, the 

board requested that the public be informed about the procedure 

for submitting those additions. As a result of the evolution of 

the PM and the partial acceptance of several presumptions a 

number of claims were reopened. The Department of Labor (DOL)

promised to provide the board with updates on the outcome of 

those reopened claims, and the board continues to request that 

update. 

Chair Markowitz reviewed the cumulative recommendations made by 

the board since 2016 and the department’s responses to those 

recommendations.

Rescinding Circular 15-16

DOL has rescinded the circular. 

Adding Institute of Medicine (IOM) information to the SEM

Several years ago the IOM produced a report on the SEM to DOL

and the board recommended that the department incorporate a

subset of a table of sources from the IOM report into the SEM. 

The department agreed to do so in a limited fashion. Member 

Berenji volunteered to be a point person for DOL and assist them 

in identifying other resources.
Involving former workers in conducting occupational health 

interviews at the Resource Centers

DOL agreed, to the extent that the department has control over

the hiring process.

Allowing industrial hygienists to interview claimants

The response to this recommendation was covered in Mr. Vance’s 

update.

Making notes from DOL’s national policy calls public

DOL did not agree with this recommendation.

Making case files available to claimants through a public portal

DOL agreed and is currently working to make electronic records 

available.

DOL should enhance its scientific and technical capabilities

The department did not agree with this recommendation.

Making entire case files available to the CMC or the IH

The department felt that this would be excessive.

Altering the PM to ensure that asbestos presumptions reflected 

current medical knowledge about asbestos

The department accepted this recommendation, though the board 

still had questions around the completeness of the list of job 

categories for asbestos presumption. Several board members 

volunteered to take another look at the list of job categories.

Modifying the PM language around occupational asthma 

presumptions

The department agreed with many of the changes proposed by the 

board, and Member Redlich will review the language of PM 4.0 in 

the near future.

Presumptions for chronic obstructive pulmonary disease (COPD)

Ultimately, DOL and the board do not agree on a presumption for 

COPD.
Occupational Health Questionnaire (OHQ) revisions

A redrafted OHQ, structured around the board’s recommendations,

is currently being scrutinized by DOL. It is in a draft status 

and will probably undergo a pilot phase before being 

implemented. Chair Markowitz requested that the Board be 

provided with the redrafted OHQ in time to provide input before 

it is released.

Borderline Beryllium Lymphocyte Proliferation Tests (BeLPTs)

The DOL did not accept the board’s recommendation that two 

BeLPTs be considered the equivalent of one positive BeLPT for 

the purposes of claims adjudication.

CMC reports

The board requested a sample of CMC reports or claims to 

examine. DOL has provided those reports. The board’s request for 

resources to review a larger set of claims is still pending.

Claims Status Data, 2016-2019 Provided by DOL:

The board requested data from DOL for claims accepted and denied 

for the most common health conditions, as well as the reason for 

denial, for the past three years. The board reviewed a 

spreadsheet of the top twenty health conditions, organized by 

ICD 10 codes, and the number of claims approved, denied, and 

pending. Chair Markowitz went through the list and provided

context on the magnitude of claims, the salient conditions, 

degrees of approval, and main reasons why some claims are not 

approved. Member Berenji requested clarification on how long the 

pending claims had been in pending status. Member Goldman 

mentioned a paper about how to grade chronic encephalopathy 

related to past solvent exposures and promised to share it with 

the Board. Member Berenji noted that the dearth of cognitive 

impairment claims was most likely due to lack of education among 

workers. Chair Markowitz said that former worker programs do not 

address this issue, partly because it is difficult to address in 

a screening examination. Member Domina pointed out that it takes 

mental stamina to follow through with the claims process, and 

many of these claimants may be lost because their condition 

prevents them from being able to continue the process.

Reopened Claims Data:
The department has a process in which the medical director 

reviews approximately 50 completed claims per quarter. Those 

claims are then sent to the policy branch, which evaluates the 

medical director’s audits and prescribes actions to correct any 

problems that the medical director has found. Chair Markowitz 

summarized these data for the past five quarters, during which

the medical director evaluated approximately 250 claims. Of 

those, 100 were for impairment; the medical director found that 

28 of those needed improvement. He looked at 83 claims for 

causation and found only one claim that needed improvement. A 

total of 60 claims were examined for various other issues; of 

those 60, approximately one quarter needed improvement. 

Claims Review: Asthma, ILD, CBD, Sarcoidosis:

Member Dement reviewed an ILD case of a long-time sheet metal 

worker at Rocky Flats. The worker filed a claim for ILD based on 

a CT scan and the initial review by the CE and the SEM did not 

identify asbestos exposures. The IH received the statement of 

facts, which listed aluminum synthetic vitreous fibers and 

diesel as exposures. They were also sent the OHQ, which said 

that the individual had a minimum of two years of direct 

asbestos exposure, but this was not considered in the IH review. 

The CMC also failed to identify asbestos exposure. The claimant 

received a former worker exam, and the examining physician 

identified asbestosis, told him to file a claim, and the claim 

was awarded based on the asbestos presumption. This case had 

several fatal flaws, some of which may be addressed by the SEM 

update, but there were several missed opportunities to identify 

the asbestos exposure. 

Chair Markowitz introduced a pulmonary fibrosis case, 1504, that 

was denied and said that he agreed with that decision. The 

claimant was a decontamination worker and then a draftsman 

designer, and the statement of accepted facts (SOAF) was well 

written. The physician looked at the OHQ but ultimately relied 

on the IH’s assessment of the dose of exposure, which was low to 

very low. Chair Markowitz noted that there seems to be a 

standard set of references that are used almost independent of 

the case. The CE’s SOAF seems to itemize which documents are 

sent to the IH, and it is hard to tell whether the IH actually 

looks at the OHQ in each case. 

Member Silver discussed cases 1346 and 0411, both of which 

involved uranium mill and mine worker exposure. When the Part E 

amendments passed in 2004, miners and millers originally covered 

by the Radiation Exposure Compensation Act (RECA) were written 
into Part E for an additional $50,000 reimbursement. These 

claims are initially filed with the Department of Justice (DOJ) 

and then reviewed by DOL. Both of these pulmonary fibrosis 

claims were approved by DOJ and issued supplements by DOL, and 

neither case was sent to an IH or CMC. 

Member Mahs had a COPD and occupational asthma case with the 

last two digits 67. The claimant submitted an EE-3 form, and a 

DOE representative verified that he worked at Hanford and 

various DOE contractor and subcontractor sites between 1976 and 

2005. The claimant did not submit medical evidence, but the 

Seattle District Office obtained employment documentation from 

DOE. None of the records indicated a diagnosis of COPD or any 

other chronic respiratory conditions, and the claim was denied 

for lack of medical information. In 2018, the claimant obtained 

an authorized representative who assisted him in gathering the 

proper medical evidence, and the claim was accepted in 2019. 

Member Mahs noted that many claimants are more successful in 

winning their cases once they have an authorized representative 

to assist them. 

Member Dement presented the case of a Paducah worker with a 

complex work history and several job categories. Claims for 

asthma, acute bronchitis, and COPD were all denied. Member 

Dement agreed with most of the record of denial, partly because 

the medical evidence was not built up well. The CE worked hard 

to track all of the job titles through the SEM and arrive at 

exposures, and the IH came up with low exposures. There was a 

DAR request for use of respirators for the claimant, with a 

stated reason of acid gases. The CMC’s review of the case was 

very factual, but did not seem to consider the combination of 

all of the different exposures contributing to COPD. Member 

Goldman said that it seemed like the claimant could have had 

exposure to irritants as an exacerbating factor and it did not 

seem like that was considered.

Member Friedman-Jimenez said that he agreed with the final 

decision in asthma cases 5938, 0125, and 1066, but he noted that 

the SEM does not seem to reflect the causes of asthma. Chair 

Markowitz said that the PM acknowledges that any exposure can 

aggravate, cause, or contribute to asthma in the workplace and 

therefore they do not link it to any of the 250 known causes. 

Mr. Vance added that the threshold for asthma claim approval is 

very low and mostly relies on the medical information from a 

physician rather than an IH’s assessment of exposure. Chair 

Markowitz asked about a case where CE says that a claimant has 

asthma and asks whether it is occupational in nature, but the 
CMC looks at the available records and concludes that the 

claimant does not have asthma at all. Mr. Vance said that it is 

important for CMCs and CEs to ask the right questions because if 

they receive answers to questions that they should not have 

asked, it can lead to further problems. Physicians should ask 

the CE to clarify rather than answering questions when they are 

unclear about the facts. Chair Markowitz noted that the 

physician has greater expertise around disease than the CE does. 

Member Pope agreed with Chair Markowitz and mentioned case 3767, 

where a COPD claim was approved but asthma was denied. There was 

supporting information from the attending physician as well as 

the work history to prove that the claimant was exposed to dust 

and other irritants. 

Member Mikulski talked about case 536, a Hanford worker who held 

mostly administrative positions and was diagnosed with asthma 

based on bronchodilator tests. The primary care physician opined 

that based on the review of work history it was most likely 

occupational asthma, as did a second physician. The CMC agreed 

initially, but then said that based on the scarce medical 

history the asthma seemed seasonal, and the claim was denied. 

Member Silver presented two cases of occupational asthma from 

Oak Ridge, 1633 and 0073. Both cases were evaluated by a 

pulmonologist who knows the site very well, and in both cases 

the CE relied on the physician’s opinion and medical evidence 

rather than identification of a specific agent. In one case the 

CE sent the impairment evaluation back to the independent 

medical examiner when they noticed an error, and both claims 

were eventually accepted.

Chair Markowitz had a case for COPD where he agreed with the IH 

report and the final decision to deny, but there was a problem 

with the logic of the CMC report. The CMC denied the claim 

because they reasoned that the lack of asbestosis prevented them 

from linking asbestos to COPD, which is not true. 

Member Redlich summarized a recent publication from the American 

Thoracic Society about the burden of idiopathic lung disease due 

to occupational exposures. This research focused on ILD and 

sarcoid, for which the occupational burden had not previously 

been estimated in an evidence-based fashion.

Member Berenji presented a CBD case, 334, and noted that items 

like the SOAF and IH and CMC reports were not included. The 

claimant worked at Savannah River as a laborer, and his OHQ was 
very telling because he described packing contaminated dirt into 

bags as part of his work activities. Given the missing materials 

and limited medical documentation, this qualitative information 

was especially important. The claimant had a history of 

sarcoidosis, but there was not enough information to determine 

how it developed. This case could benefit from reassessment 

given that the claim denial was based on a lack of appropriate 

medical information.

Member Dement reviewed a claim of COPD, sarcoid, and sleep apnea 

from a claimant who worked at several DOE sites and was exposed 

to beryllium. Several tests for beryllium sensitivity came back 

negative, and the claim was denied. One physician noted that the 

individual was on steroids, which could have masked the 

beryllium sensitivity, but some lymphocyte proliferation tests 

(LPTs) were administered prior to steroid use. 

Member Redlich introduced a sarcoid/COPD case with a claimant 

who worked at Savannah River for 49 years. The CE noted that 

there was a pre-1993 diagnosis of CBD and there was preemployment documentation that the employee did not have CBD. The 

SOAF noted that the potential for beryllium existed at Savannah 

River throughout its operation. The CMC was asked if employment 

at the site was a significant factor in the claimant’s diagnosis 

of sarcoidosis, and the first CMC thought that instead of 

sarcoidosis the claimant had CBD. The CE then sent the case to a 

different CMC, who answered the original question in the 

affirmative. While it is good that the claim was accepted, 

beryllium does not cause sarcoid, so the answer to the question 

could easily have been no. Member Friedman-Jimenez said that 

training CEs in this specific circumstance could be useful, and 

Chair Markowitz said that the PM does address the potential for 

misdiagnosis of CBD as sarcoidosis. Mr. Vance agreed that the 

sarcoidosis/CBD question is tricky, but the statute lays out the 

precise requirements for establishing a viable CBD case, which 

relies heavily on a medical opinion of a chronic respiratory 

disorder consistent with a CBD condition.

Member Mahs presented case 3034, a CBD claim where the claimant 

worked at Coors Porcelain and participated in a beryllium 

screening program while employed there. She provided affidavits 

from coworkers attesting to which buildings she worked in, and 

she was a covered employee for one year. Member Domina noted 

that under 10 CFFR 850, employees only need to have worked at a 

covered site for one day in order to be accepted.

Member Mikulski presented a pre-1993 sarcoidosis CBD case with 
the last three digits 580. There was an unusually fast turnover 

between the questions posed to the CMC and their response, given 

the large volume of documentation provided. The worker performed

various jobs at Y-12 and K-25 over a period of 40 years and was 

diagnosed with pulmonary sarcoidosis in 1978. Following a 

diagnosis of prostate cancer, they filed claims for cancer and 

lung disease under Subtitle B and Subtitle E, and both claims 

were denied. The CE specifically asked the CMC whether the 

medical evidence on record met the pre-1993 diagnosis 

guidelines, and the CMC’s opinion was based on a mix of pre- and 

post-1993 criteria. Despite meeting all of the pre-1993 

criteria, the claim was denied. Several members agreed that this 

case should be re-reviewed. Member Silver asked whether CMCs are 

paid by the case or by the hour, and Mr. Vance said that they 

are paid by the case. 

Member Berenji reviewed a survivor claim with the last three 

digits 048. The worker had filed a claim for beryllium 

sensitivity, and it was accepted in 2015. He passed away in 

2016, and his significant other filed for benefits claiming CBD 

instead of beryllium sensitivity. This was a case where 

terminology was very important; because the terminology was 

different in the two cases and the CE determined that there was 

not enough medical documentation for CBD, the survivor’s 

benefits were denied.

Member Redlich presented a case of an electrician from Savannah 

River who was diagnosed with sarcoidosis with pulmonary 

involvement and conjunctival eye involvement, as well as ILD. 

She has been on high doses of prednisone since that time. More 

recently she had a BeLPT that was negative, though that could be 

a side effect of steroids. The SOAF acknowledged her diagnosis 

but claimed that she did not have evidence of active disease. 

The SEM showed no exposure for sarcoidosis, and her claim was 

denied. This is an example of a case where a false negative 

BeLPT and lack of tissue diagnosis could both be explained and a 

CT scan and pulmonary test both supported the claim. 

Member Silver presented another CBD case with a claimant who 

worked at Los Alamos. His last ten years were spent as a 

supervisor for a process that is notorious for intensive work 

with plutonium. After his CBD claim was denied, he developed 

prostate cancer, cataracts, and narrow-angle glaucoma, but his 

dose to the eye was below NIOSH’s minimum limit. The claimant 

also developed colon polyps and hearing loss, but his audiogram 

was never reviewed by a physician, so he was not compensated for 

hearing loss. 
Chair Markowitz introduced a discussion of the limitations of 

the claims that the board has reviewed. This falls under Task 4

for the board: to evaluate the objectivity, consistency, and 

quality of the industrial and medical input into claims 

evaluation. Member Dement said that it is important to remember 

that IH assessments are qualitative in nature and predicated on 

the IHs’ experiences. The scope of knowledge with regard to a 

particular job and exposure should be identified, and IHs should 

explain their basis for assigning a low, medium, or high level 

of exposure. 

Member Redlich noted a theme around the concentration of 

exposure versus the years of employment. There is a difference 

between one to two years and twenty years, and CEs and CMCs 

should take into consideration the duration of exposure as well 

as the estimated amount. Member Berenji said that as an 

independent medical examiner, insurance companies often asked 

her to opine on certain questions. She felt that if she, or the 

CMC in these cases, sees something that does not add up and 

needs additional insight for the case, it is their obligation to 

provide those additional medical facts. Chair Markowitz said 

that they needed to accept that the professional expertise of 

the IH plays a role, but what is missing is insight from the 

claimant and their experience at the workplace. Few IHs seem to 

cite this in their reports. Member Dement added that even the 

worker themselves often cannot relate an accurate picture of 

their exposure since they are asked to recount many years and 

many different sites. Hopefully the new OHQ will help to 

alleviate this issue.

Member Berenji mentioned DOL’s determination not to provide the 

entire case file to the CMC and encouraged the department to 

reconsider. Member Friedman-Jimenez added that the concern about 

giving the CMC too much material to sort through could be 

addressed by a good indexing system. Chair Markowitz noted that 

some of the CMC evaluations are excellent, while there is 

another, smaller group of reports that are unacceptably poor. He 

asked whether the contractor, QTC, has a quality assurance 

process in place. Mr. Vance said that QTC did have an internal 

process that was informed by DOL’s auditing process. There have 

been times in the past when they have removed physicians and 

implemented remediation training, and they welcomed input from 

the board on how to better screen problematic reports. Chair 

Markowitz said that his concern was that the review of causation 

competence in the CMC report was incomplete and it was probably 

not the emphasis of the medical director. Member Pope added that 
there was a similar concern with CEs, who are the ones building 

the case and flagging documents for the CMC and the IH to look 

at. Member Domina agreed and said that if a mistake is made 

early on, that mistake only tends to get bigger as the review 

process continues. 

Member Redlich said that in a number of claims where she had 

issues with the final decision, the physician was not asked the 

right question. Chair Markowitz pointed out that the CE who is 

formulating the questions has a limited set of knowledge and 

sometimes their questions will not be right. When they refer 

those questions to the IH or the CMC, there should be a 

corrective process to allow the SOAF to be corrected over time. 

Member Goldman proposed that there could be a system where a 

random sample of all the rejected claims was reviewed again by a 

different CE, and Member Dement agreed. Member Redlich asked 

about the total number of CEs, and Mr. Vance said that there 

were approximately 250 and they are trained to apply the 

criteria of the statute to whatever cases they come across. 

Member Redlich suggested that there should be a group of CEs 

specifically trained to handle issues like the beryllium/sarcoid 

identification.

Public Comments:

Terrie Barrie, Alliance of Nuclear Workers Advocacy Groups

Ms. Barrie referenced the EEOICPA Ombudsman’s recent report to 

Congress, which includes recommendations to improve the program. 

She drew the Board’s attention to concerns that the SEM does not 

list all of the buildings, incidents, and/or toxic substances 

that first responders encounter in the course of their job 

duties. She said that she was glad to hear about the new quality 

assurance program to review claims, although she had some 

concerns about it interfering with the board’s statutory 

responsibilities. In light of the recent Adams v. DOL decision, 

she suggested that the board could provide guidance to DEEOIC on 

the relationship between elevation of risk and aggravation of 

disease. She also raised concerns about the new version of the 

PM.

Vina Colley, Co-founder of National Nuclear Workers for Justice

Ms. Colley said that her union compiled specific data on 

buildings and exposures, and she wanted the board to look at the 

SEM to make sure that those figures were included. She also 

wanted the board to look at a radiological chemical report by 
Kenton J. Moody from January 1995 for its information on 

Paducah, Portsmouth, and Metropolis, all of which handled 

reactor fuel from Russia. Americium has been found in air 

filters and has shut down one school in Piketon, Ohio. She cited 

a case of a worker with cancer who went to the union to request 

his records, only to be told that DOL had taken them. Ms. Colley 

also clarified that the Resource Center employees are not 

certified advocates and they need help to put records and claims 

together.

Stephen McFadden

Mr. McFadden talked about his history and his family’s history 

working at DOE and ERDA sites. He raised occupational health 

concerns relating to students, interns, and summer workers 

working with potential exposure to exotic toxics. SEC exposure 

cohorts require 250 days of work, but students may work less 

than that. EEOICPA was passed in 2000, which is six decades into 

the nuclear weapons program, and was formulated presuming that 

other benefits were accessible. 

Evelyn Jeffords

Ms. Jeffords’s husband Robert worked at the Paducah Gaseous 

Diffusion Plant. Ms. Jeffords’s claim was denied for three of 

the five statutory requirements for beryllium disease, and her 

authorized representative, Gary Vander Boegh, explained that 

claims examiners in the area often deny claims based on 

procedures rather than statutory requirements. They hope to 

reopen her claim, along with others, in front of Judge Thomas B. 

Russell. 

Gary Vander Boegh

Mr. Vander Boegh is one of the only authorized representatives 

in the Paducah area, and many claimants come to him for help 

because he is also a sick nuclear worker. He explained his 

family’s history working at nuclear sites as well as his own 

work history with Lockheed Martin and as an advocate for 

claimants. Mr. Vander Boegh was a whistleblower, and he was 

among the Paducah workers who found plutonium at the plant, even 

though that is not documented in the SEM. There is plutonium at 

several other sites as well, and there is a pattern of workers 

at these sites being misdiagnosed. 

Donna Hand
Ms. Hand talked about the SEM and its statutory definition of 

toxic substances. The language mentions substances with the 

potential to cause harm, not just those that are definitively 

proven to cause harm. In 2005 OWCP determined references that 

CMCs could use, including PubMed. Now CMCs do not use many of 

these same resources because they claim they are not wellrationalized, even though treating physicians use those 

references. She asked if, since NIOSH and OSHA have both 

informed the public about target organs affected by toxic 

substances, a claimant could use the target organ of a toxic 

substance to provide a scientifically-known link between 

exposure and claimed illness. She also asked the board to 

consider what constitutes a well-rationalized report. 

Deb Jerison, Energy Employees Claims Assistance Project

Ms. Jerison relayed concerns that she has heard through her work 

at EECAP. Regarding expedition of terminal claims, DOL is now 

requesting that a doctor’s letter state that a claimant’s death 

is imminent, rather than terminal. Hospice patients have varying 

experiences, and they and their families often face emotional 

distress when told that death is imminent. National office 

medical benefits examiners can help claimants with medical 

billing issues, but most claimants are not savvy enough to find 

them. Claimants and doctors need more help and resources to 

handle the problems associated with medical bills. It would be 

helpful if DOL could develop clear, concise directions written 

for lay people to explain how to deal with these issues.

David Nelson

Mr. Nelson filed two claims, one for asthma and one for cancer, 

and both were denied. He worked for two years in roofing at the 

Paducah site without any personal protective equipment. After he 

wore his work clothes home, his wife developed thyroid problems, 

and his son passed away from cancer. Mr. Nelson felt that his 

claims should be reexamined. 

Howard Cook

Mr. Cook worked at multiple DOE sites and had a claim denied. He 

said that Honeywell does not seem to receive as much attention 

as other sites in the sick worker program. At his plant, the 

only thing that they use for dose reconstruction is urinalysis. 

Minnie Donald
Ms. Donald has fourteen illnesses approved, after initially 

being denied for most of her claims. Her CBD claim was denied 

with one authorized representative, but was recently approved 

with a different representative even though they submitted the 

exact same information. There are limits on impairment rating 

and wage loss, but those are combined, so Ms. Donald is still 

owed several years’ worth of wage loss and cannot get any more 

impairment ratings.

Mike Driver

Mr. Driver is a former Paducah worker. He worked at the plant 

because that job had the best benefits, but no one told him how 

dangerous it would be. He worked as a crew lead packing up drums 

of UF4 uranium which were contaminated with plutonium, arsenic, 

lead, silver, nickel, and mercury, even though industrial 

hygienists denied that any of those elements existed in the 

plant. He has applied for lost wages three times and has been 

denied all three times and told that he does not qualify.

Adjournment: 

Chair Markowitz adjourned the meeting for the day at 6:08 p.m.

THURSDAY, NOVEMBER 21, 2019

Call to Order:

Chair Markowitz called the meeting to order at 8:34 a.m.

DEEOIC Ombudsman, Malcolm Nelson:

Mr. Nelson thanked the board for their work and gave his 

perspective on issues that arose during the first day. He agreed 

that there needs to be more education about the program for 

claimants. Many claimants do not know how to develop medical 

evidence or how to interpret the SEM. Often they think that they 

need to develop their case before submitting the claim, when in 

reality the opposite is true. Concerns emerged regarding the 

reasonableness of asking for imminent death to be defined, as 

well as consequential illnesses and which ones are automatically 

covered. From the program’s point of view, if they have a large 

number of hospice patients, they want to be able to prioritize 

cases. On the other hand, it is too much to ask both the medical 

community and families to bear the determination that death is 

imminent. The way that EEOICPA is interpreted, employees of 

beryllium vendors are only covered under Part B, and under Part 
B they are only covered for CBD and beryllium sensitivity. 

Beryllium is now a known carcinogen, so there is some question 

of why the program does not cover cancers caused by beryllium 

exposure. Chair Markowitz said that beryllium is recognized as a 

known carcinogen under Part E.

Report from Parkinson-Related Disease Working Group:

At the beginning of the current board’s term, the department 

asked for their assistance in examining which toxins are known 

to produce Parkinson’s disorders. Member Mikulski gave an update 

on the working group’s recent work and a summary of the 

presentation that the group gave earlier this year. Research on 

Parkinson’s is going in several ways; some focuses on hereditary 

etiology, while other research efforts aim to establish clinical 

testing to identify Parkinson’s in the early stage. There are 

attempts to investigate potential risk factors that have been 

shown in animal models in epidemiology studies in a human 

population. Multiple epidemiological reports provide evidence in 

support of the association between Parkinson’s disease and 

exposures to pesticides, solvents, polychlorinated biphenyls and 

metals. However, these studies do not provide quantitative 

exposure assessments, nor do they answer questions of latency 

and temporality. Right now, it is premature to make any 

causation presumptions. The working group hoped that a brief 

document they compiled could provide a basis for recommendations 

to DOL on diagnostic questions. Chair Markowitz suggested that 

before the next meeting, the board should aim to fully consider 

other toxins and their causality and develop a recommendation to 

the department.

Review of Public Comments:

Board members highlighted public comments from the previous day. 

Ms. Barrie’s point about firefighters’ exposures missing from 

the SEM is part of the wider issue of job titles that should be 

considered as site-wide workers. Chair Markowitz asked whether 

certain job categories that have site-wide jurisdiction could be 

developed as a class in the SEM that is recognized to have 

potential exposure to any toxin at the site. Mr. Vance said that 

anything was possible, and they would welcome the board’s 

advice. 

Board Recommendation:

Chair Markowitz drafted a recommendation, and after some 

discussion the board voted unanimously to submit the following 
as a formal recommendation to DOL: “The Board recommends that 

the Department, as part of the Site Exposure Matrices, identify 

job categories at DOE sites that likely have worked throughout 

the applicable sites and would have had potential exposure to 

many or all listed toxic substances at those facilities.”

Review of Board Tasks, Structure and Work Agenda:

The board revisited its discussion of the quality, objectivity, 

and consistency of the IH and medical evaluations, which falls 

under Task 4. Twenty-eight percent of the claims evaluated for 

impairment were considered to need improvement. Chair Markowitz 

said that it seems like there is a quality problem with the 

contractor’s impairment evaluations. Mr. Vance summarized his 

staff’s post-audit analysis of the medical director’s report and 

the subsequent discussions that they have with QTC. Member 

Dement pointed out that there are still claims that have not 

been examined by any board members and suggested that they 

compile and distribute a list of those claims. 

Chair Markowitz asked if there was a similar audit process for 

IH reports, and Mr. Vance said that there was not. Chair 

Markowitz suggested that the board consider whether that process 

should take place. Member Berenji said that she had already 

started to draft that process and would take the lead in 

formalizing it. Chair Markowitz requested that DOL provide the 

board with the set of questions that the IH uses for 

occupational health interviews. Not every case requires a oneon-one interview, but it would be helpful to have a process in 

place for those that do need them. Several members agreed that 

it would be helpful to have a list of search terms that would 

automatically trigger an IH review. 

Task 2 of the board is to look at how CEs weigh medical 

evidence. The board revisited comments about the challenge for 

CEs with limited backgrounds in occupational health whose 

statements of accepted facts are contradicted by the CMC. Member 

Pope asked if there is a senior CE who reviews a sample of 

claims that the CEs submit. Mr. Vance explained that each CE 

receives performance assessments. There is also a supervisory 

review process and an annual accountability review process, 

where they go to each jurisdictional district office and conduct 

a team review. At Member Domina’s suggestion the board looked at 

the new PM’s language around terminal illness. 

Chair Markowitz led a discussion about the board’s work going 

forward. The board’s current term will end in July of 2020, and 
there will be two meetings before that time. One will be a 

telephonic meeting where the members come back to the issues of 

Parkinson’s disease and firefighter exposures in the SEM and 

potentially make recommendations on these two topics to DOL. 

They will continue to look at claims review and begin to 

formulate recommendations regarding IH and CMC evaluations with 

respect to objectivity, consistency, and quality, and 

potentially a recommendation around CEs’ weighing of medical 

evidence. There will also be an in-person board meeting in the 

spring of 2020.

Continued Review of Public Comments:

Ms. Rhoads has compiled a spreadsheet of public comments, and 

she will continue to update it going forward. Chair Markowitz 

referenced Donna Hand’s comment from the day before about a list 

of authoritative sources for CEs and CMCs. He asked if sources 

outside of that list could be acceptable in a well-rationalized 

report if they address the issue of causation in the case, and 

Mr. Vance said that they could be. Chair Markowitz said that in 

the interest of transparency it might be helpful to encourage 

the IH and physicians to list all of the sources that they use. 

Continued Review of Board Tasks, Structure and Work Agenda:

Chair Markowitz requested that DOL inform the board of what 

changes in the exposure-disease links have been made in the SEM 

from January 2018 to the present. Member Dement mentioned that 

the only presumption for COPD was 20 years of asbestos exposure, 

which is very limiting. The board will continue to discuss this 

topic in the future. Chair Markowitz asked the department to 

provide the board with a certain number of occupational lung 

cancer claims to be reevaluated, and several other members 

expressed interest. Member Redlich said that she had compiled a 

list of issues for the board to address in the future, and Chair 

Markowitz said that they would use it as background for the 

upcoming telephonic meeting. 

Adjournment: 

Mr. Fitzgerald adjourned the meeting at 10:58 a.m.