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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NOVEMBER 8-9, 2021

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The Advisory Board met via videoconference, Steven 

Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN

KENNETH SILVER

MIKE VAN DYKE

MEDICAL COMMUNITY

GEORGE FRIEDMAN-JIMENEZ

ROSE GOLDMAN

STEVEN MARKOWITZ, Chair

MAREK MIKULSKI

CLAIMANT COMMUNITY

JIM KEY

DURONDA POPE

CALIN TEBAY

DIANE WHITTEN

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
MONDAY, NOVEMBER 8, 2021

Welcome/Introductions:

Michael Chance called the meeting to order at 1:03 p.m. The 

meeting was conducted via videoconference as a precaution 

against the COVID-19 pandemic. Mr. Chance reminded Board members 

that some of the materials they received in their capacity as 

special government employees should not be shared or discussed 

publicly. He also noted that the two-year terms of all Board 

members will expire July 2022. Current Board members will be 

eligible for re-nomination when the Office of Workers’ 

Compensation Programs (OWCP) conducts the nomination process in 

the spring. Chair Steven Markowitz welcomed Advisory Board 

members, Department of Labor (DOL) staff, and members of the 

public. He called for introductions and briefly reviewed the 

meeting’s agenda.

DEEOIC Updates: Program Highlights, Information Items since 

April 2021:

Rachel Pond, Director, Division of Energy Employees Occupational 

Illness Compensation (DEEOIC), discussed changes to DEEOIC’s 

quality review process. The Performance Management Branch now 

reviews work on an ongoing basis for each stage of the process

and then prepares a quarterly report on their findings and

recommendations. DEEOIC has also implemented a more robust 

sampling process with enhanced feedback mechanisms. Because of 

the switch to ongoing reviews, they have eliminated

accountability reviews with the exception of those for payment 

processing. DEEOIC has converted to entirely digital files, 

which has allowed for greater telework capability and downsizing 

of physical space. They have begun providing electronic case 

files to claimants and are beginning the process of allowing

authorized representatives to have the same access. DEEOIC has 

not been able to conduct in-person outreach due to the pandemic, 

but has utilized their mailing list for digital outreach 

efforts. They have also hosted about one public session a month 

on their website, which usually have 150-200 attendees. Ms. Pond 

also described some of the various employee trainings DEEOIC has

offered.

John Vance, Chief, Branch of Policy, Regulations and Procedures,

DEEOIC, discussed policy changes, procedure manual updates, and 

how DOL has acted upon the Board’s recommendations. Bulletins 

issued in 2021 included guidance on how to handle and adjudicate 

cases for COVID-19 as a consequential illness, allowances for 
providers to utilize telemedicine for routine and home and 

residential health care, and a review of cases that may be 

impacted by a new Special Exposure Cohort Class. He highlighted 

some of the changes in Version 5.1 of the Staff Procedure 

Manual, including an update to credentialing for impairment 

raters, adding the allowance of the six-minute walk test, 

substantial changes to how claims examiners go about evaluating 

impairment ratings from physicians and contract medical 

consultants (CMCs), as well as several administrative updates 

and technical modifications. The biggest changes in the manual

were to chapters concerning medical bill processing instructions 

and ancillary medical benefits. DOL has accepted the 

recommendations from the Board to add a group of health effects 

based information from the International Agency for Research on 

Cancer (IARC) and recommendations with regarding the addition of 

health effect data to the Site Exposure Matrices (SEM). Two 

other recommendations from the Board concerning cancer 

categories were returned for clarification and will be addressed 

later in this meeting. Following another Board recommendation, 

DOL has added explicit language on the SEM webpage stating that 

they accept input from IARC and the National Toxicology Program 

(NTP). DOL agreed with the Board’s recommendation on continuing 

collaboration between the Board and the Department with regard 

to utilizing the IARC and NTP. DOL evaluated the Board’s 

comments regarding how the Department evaluates job titles and 

different kinds of exposure information and found there were no 

changes they could make, but did provide feedback for the Board 

to consider. The addition of IARC Group 2A will likely be 

incorporated into the next release of the public SEM in 

November.

Chair Markowitz was pleased to see the digitization of case 

files and was interested in getting feedback from claimants to 

see how useful it is. Duronda Pope asked if the digital case 

files were read only or if they were interactive. Ms. Pond said 

that they are read only, but anyone associated with the claim 

will be able to upload documents to the file. It is still in the 

early stages and they have not yet determined what capabilities 

they may seek to add to it.

Chair Markowitz asked if DOL had any results from the changes in 

the quality review process that the Board could review. Ms. Pond 

said they are looking at ways to organize it in a way that would 

be beneficial and should have something for the Board to review

this quarter. Chair Markowitz asked if they can make available 

the methodology they are using to assess the quality review 

processes. Ms. Ponds said that should be possible and she will 
follow up with the Board on the subject. Chair Markowitz asked 

if any of the modifications address the issue of the quality of 

industrial hygienists’ work and physician input into the claims 

process. Ms. Pond said the quality review will look at the 

reports themselves and ensure they are in compliance with the 

process, but they are working on a new methodology for reviewing 

the work of CMCs. Every report done by a contract industrial 

hygienist (IH) is reviewed by at least one federal employee. The 

Department has not yet decided if more needs to be done, but

they will share the methodology with the Board as soon as it is 

finished.

Chair Markowitz asked if there were any significant changes in 

the new procedures manual related to impairment. Mr. Vance said 

the manual now makes it very clear that DOL is going to evaluate 

impairment ratings based explicitly on the language in the AMA 

guides. It also makes clear that this is something DOL will not 

be engaging with their internal physician on; if there are 

concerns with the sufficiency of an impairment rating, the 

rating physician would have an opportunity to clarify their 

position. If this does not sufficiently address the concerns,

the matter will be referred to a CMC and the Department will

weigh the competing opinions in their final determination of an 

impairment rating.

Chair Markowitz asked if DEEOIC has had any COVID claims. Ms. 

Pond said there have been fewer than five and they have

typically been entered as consequential to other conditions. Mr. 

Vance added that he was familiar with cases in which COVID-19 

was a direct factor in the deaths of claimants, and the circular

on COVID-19 has played a large role in getting benefits out in 

those cases.

Review of ABTSWH Charter and MBP Renewed June 2021

Chair Markowitz asked if there were any changes to the Advisory 

Board’s charter. Carrie Rhoads said the only changes were to the 

standard language that is required of all charters. Chair 

Markowitz reviewed some of the more important aspects of the

ABTSWH charter.

DOL Response to April 2021 Board Recommendations; 

Aldrin/Dieldrin:

Chair Markowitz reviewed the Board’s recommendations to DOL, 

including that agents that qualify as 2A carcinogens under IARC 

and for which there was some limited human epidemiologic 
evidence be included in the SEM; that the SEM specify that IARC 

and NTP evaluations have been used in updating the SEM links 

between exposure and disease; and that any new 2A carcinogens or 

NTP equivalent listings should be evaluated and added to the 

SEM. DOL agreed to each of these recommendations and to continue 

regular collaboration with the Board on evaluating updated 

health effect data from various scientific organizations. Chair 

Markowitz asked if this was an invitation for the Board to 

periodically survey these or if DOL plans to do that in-house. 

Mr. Vance said DOL’s in-house toxicologist and epidemiologist 

will continue to look at these, but additional input from the 

Board is welcome. Chair Markowitz said IARC and NTP 

classifications are not frequently updated, but the inclusion of 

other scientific organizations may require a fair amount of 

work.

Rose Goldman commented that keeping DOL up-to-date on the latest 

medical findings and advances would be a huge undertaking for 

the Board. She asked if this refers only to 2A carcinogens or 

all outcomes. Ms. Pond said DOL looks at health effects on a 

regular basis, but they do not have a research arm. Hopefully 

the Board’s contractor will be able to help with some of the 

work. The request was broad, but the Board could narrow it down 

to particular conditions or types they would want to look at. 

Dr. Goldman asked if anyone in the program is surveying new 

findings on non-carcinogenic effects. George Friedman-Jimenez 

said IARC and NTP are expert review panels made up of 

multidisciplinary reviewers weighing in to reach a final 

conclusion. He was not aware of another organization besides NTP 

that has an expert panel for non-cancer outcomes, so there might 

not be that much for the Board to review. Ms. Pond said part of 

DOL’s current dilemma is that there is not a lot of been peer 

reviewed data, which is why they often have to rely on 

individual case files. She would be happy to work with the Board 

to help hone in on specific areas they may want to focus on.

Chair Markowitz asked if Haz-Map is updated and, if so, are 

those updates integrated into the SEM. Ms. Pond said that when 

there are updates they are integrated into the SEM. There is not 

much work going into that now, so DEEOIC incorporates other 

reviews. Mr. Vance added that it takes a lot to get to consensus

viewpoints on established new human health effects, but they 

will update the SEM when that kind of information becomes 

available.

Dr. Friedman-Jimenez said determining the causal relationship 

for an individual requires understanding their exposure, which
will be different for every case. It is a complicated process 

and most cases will have to be decided on their own or in groups 

based on presumptions. Using precedents, as in the legal 

profession, would not be applicable to this situation.

DOL requested clarification from the Board on whether both 

aldrin and dieldrin should be listed when discussing breast 

cancer health effects, since dieldrin as a metabolite of aldrin. 

They further asked if an occupational exposure to dieldrin is 

the same as having the body produce it from aldrin intake. There 

is limited evidence for linking dieldrin to cancer of the 

breast, but the evidence for aldrin is inadequate. Dr. Goldman 

said the evidence was marked inadequate because there are 

limited human data, but there are some animal data for linking 

aldrin. From a compensation point of view, one could assume that 

a claimant with exposure to aldrin also had exposure to 

dieldrin, which is why the group recommended both toxins be 

included. Aaron Bowman agreed and theorized that part of the 

reason for the limited evidence is because aldrin is converted 

to dieldrin so rapidly in the body. Chair Markowitz also 

concurred, adding that what matters is not what is ingested or 

absorbed through the skin, but what makes it to the target 

tissue or organ. Mr. Vance said the Department’s concern is from 

an occupational exposure standpoint and asked if the Board is

saying that both of these have the same breast cancer health 

effect. Chair Markowitz said yes, both toxins should be 

separately linked to breast cancer. Ms. Pond said they will take 

the transcript of this discussion to the contractor for review.

Chair Markowitz discussed the other issue sent back to the Board 

for clarification. Lymphohematopoietic malignancies were 

proposed to be added to the SEM under styrene. DOL asked if the 

diseases are limited to acute myelogenous leukemia and T-cell 

lymphoma or if the linkage is broader. DOL’s response had not 

been circulated prior to the meeting, but the Board will try to 

get an answer to DOL in the near future.

Review of SEM Generic Profiles:

Chair Markowitz led a discussion on DOL’s response to the 

Board’s recommendations on asbestos. The Department agreed to 

coordinate a re-evaluation of the noted job titles with its 

contractor Paragon Technical Services (PTS) and make agreed-to 

alterations to the list of labor categories with a presumption 

of significant exposure to asbestos. This re-evaluation has not 

yet been completed and the Board reviewed their progress todate. The generic profile acknowledges that certain job titles
(e.g., janitors, laundry workers, and power line communication 

maintenance) have potential asbestos exposure; however, PTS 

found these were not subject to presumptions due to the nature, 

frequency, and duration of exposure. The Board previously noted 

that NIOSH occupational mortality data (NOMS database) showed 

several job titles had significant risk of mesothelioma, which 

is synonymous with asbestos exposure, and proposed using this 

data to modify the presumption list in the DOL procedure manual. 

PTS argued that some of these job titles had relatively small 

numbers of deaths, minimal increased risk, and that it is 

reasonable that they do not appear in the DOE complex. This was 

persuasive to the Board, but it noted that there is both a 

significant number of mesothelioma deaths and an increase in 

risk of mesothelioma death in the NIOSH NOMS database for 

chemical engineers, industrial health and safety engineers, and 

mechanical engineers. This indicates that the risk of asbestos 

is probably broadly shared across industries for these selected 

job titles. The Board noted that the PTS’ recommendation that 

death certificates be reviewed for the three occupations of

layout workers, molding and casting machine operators, and 

materials engineers would take significant effort and was 

unlikely to be very fruitful. On a related matter PTS stated 

that the SEM recognizes bystander exposure when IH sampling 

provides evidence. Chair Markowitz commented that it seems 

unlikely that bystander exposure would be documented by air 

sampling in the field. PTS’ response appears to address asbestos 

abatement workers, while the Board is focused more broadly on 

workers who had less controlled exposure to asbestos and who may 

have had continued incidental or unknowing exposure both before 

and after the issuance of DOL directives.

Dr. Goldman noted that anyone that comes forward with a 

mesothelioma diagnosis would be assumed to have had some level 

of asbestos exposure. That is, as long as other employment can 

be excluded as a source, it should be presumed that the exposure 

is related to a claimant’s employment at a covered facility. Mr. 

Vance said that a claimant with a mesothelioma diagnosis that 

worked at a covered site would very likely have their case 

approved. Dr. Goldman added that the issue has less to do with 

dose than latency. 

Mark Catlin said the Board was concerned with broader issues 

that may be related to asbestos exposure. The Board used 

mesothelioma-job title associations as a means of identifying 

job titles that were likely to have had significant asbestos 

exposure. They were hoping DOL would identify asbestos exposure 

in job categories that are not currently on the program PM list 
of presumptively exposed job titles. Chair Markowitz agreed that

if these job categories with sufficient asbestos exposure made

it to the presumption list, then it would cover mesothelioma as 

well as lung cancer, asbestosis, and pleural plaques, and the

decision-making for these job titles would be much easier.

Chair Markowitz asked the Board about the likelihood of

bystander exposure documentation. Kenneth Silver said that the

asbestos abatement industry which might conduct area monitoring 

on the perimeter of a job site, but their findings may not be 

reported to the facility. Mike Van Dyke said there have been 

many asbestos exposures that were likely not caught for the 

people doing the jobs, much less the bystanders, so the odds of 

there being any IH measurements of bystanders are very low. 

Chair Markowitz said bystander exposure would be a very 

challenging issue for the SEM to address, given the lack of data 

around it, but it an important topic.

Chair Markowitz said that the Board will await a response on 

PTS’ position on adding the three job titles to the presumption 

list.

DOL Responses to Board Information Requests: IH/CMC and Public 

Comment:

Chair Markowitz led a discussion of DOL’s responses to two 

ABTSWH working group questions and requests for clarification.

Public Comment Working Group questions

DOL’s response to a question about the timeliness of claims 

involving impairment evaluation over the past several years was 

not sufficiently clear. The Board specified that they were

interested in finding out if the time metric used for advancing 

claims involving impairment evaluations is different from other 

claims or if there is an inordinate delay in those involving 

impairment evaluations. Mr. Vance said adjudication time for 

cases involving impairment depends on many variables. DOL needs

a better understanding of what it is the working group is asking 

for and whether DOL can provide the data in a way that will be 

useful. Ms. Pond said this question came from a public comment 

that did not offer much context, which makes it difficult to 

respond to. The process for a claim involving impairment can 

include delays for a variety of reasons and the question is too 

open-ended for DOL to provide an objective response. Chair 

Markowitz suggested the working group reconvene and draft a more 

specific request for information from DOL.
DOL said that the working group’s question on overall timeliness 

of claims evaluation over the last two years was vague and 

required clarification. Ms. Pond said the program has operation 

plan goals around timeframes for each of the steps of the claim 

process, which they will provide to the Board, but DOL needs 

more specifics to know what data the working group is looking to 

assess.

The working group expressed its concern about the perception of 

a declining number of medical providers accepting the EEOICP 

benefit medical cards. They requested a count of the number 

participating over time in order to look at trends and what 

possible reasons providers may have for dropping out of the 

program. DOL said it does not collect this information directly 

and when providers drop out, DOL has no way of knowing their

reasons. Ms. Pond said some providers have indicated a 

frustration with the process but she has not noticed an acute

drop in the participation rate.

The working group asked how many claimant occupational health 

interviews the contractor and federal IHs have conducted over 

the past two years. DOL’s response was two. Ms. Pond indicated

they were not happening more frequently because claimants are 

not requesting interviews and industrial hygienists are not 

initiating interviews. Mr. Vance added that they have 

communicated to staff the importance of having this option 

available, but it is up to the claims examiner to decide whether

there is an issue they think will be rectified by conducting an 

interview. Chair Markowitz understood why claims examiners might 

not initiate interviews, but would expect industrial hygienists 

to do so in order to get a more complete picture of a claimant’s 

exposure. Mr. Vance said that the contextual framework is driven 

by the claims examiner’s need for additional information, so it 

falls on them to identify the need and not the industrial 

hygienists. IHs are not prevented from requesting interviews, 

but it has not been a common practice. Diane Whitten said it is 

not surprising there have only been two. She has seen many 

claims in which the CMC reports that an employee was not exposed 

to toxic substances above a known amount without having called 

the claimant to ask them. Mr. Catlin said claims examiners are 

not the best people to say that the interviews ought to be done.

It would be useful to have a process in which claims examiners 

decide they do not need an interview and a certain number get 

done anyway to see how much additional information can be pulled 

out and if it would be helpful. Dr. Silver suggested that the 

explanation for the small number of interviews may be that 
Occupational Health Questionnaires are soliciting more and 

better information than they did previously.

The working group requested more detail on the role of the EEOIC 

Medical Director/Medical Officer. DOL pointed to Chapter 29 of 

the procedure manual where it states that the Medical Officer 

reviews organ transplant and experimental treatment requests. 

Chair Markowitz said there is very little in the Procedure 

Manual about the role of the Medical Officer and asked if that 

indicates that they have a small role in claims evaluations. Ms. 

Pond said this is correct and that the Medical Officer usually 

looks at the broader picture of medical issues across the 

program. Medical Officer input is becoming less common because 

DOL is increasingly using CMCs or going back to the treating 

physician. Mr. Vance added that they have been working on 

clarifying that the role of Medical Officer is the

interpretation of the evidence by a medical physician, which is 

then compared to other opinions in a case.

The working group asked if DOL has attempted to aggregate data 

from prior claims decisions to ensure consistency in decisionmaking. The Department does not do that kind of data 

aggregation. With the appropriate resources, this is something 

the Board could look at in the future.

In response to a question about hiring another physician, Ms. 

Pond said that DOL is not currently hiring any additional Energy

Employee-specific medical expert, but will continue to rely more 

on the treating doctors and CMCs when there is a question or 

concern in a particular case. 

The working group asked what percentage of claims CMCs and IHs 

recommend denial. DOL responded that CMCs and IHs only provide 

professional advice to the claims examiner and do not recommend 

acceptance or denial. Chair Markowitz believed this question was 

based on a misperception on the Board’s part and they may have a 

more refined question following their claim reviews.

The working group asked what percentage of claims CMCs and IHs 

find minimal exposure. DOL does not collect these data.

IH/CMC Working Group questions

The working group asked similar questions about the role of the 

Medical Officer as previously discussed. They also asked how the 

Medical Officer communicates their input into the claims 

evaluation process. Chair Markowitz outlined the process and Mr. 
Vance confirmed: when the program requests a case-specific 

review from the Medical Officer, the Medical Officer will 

communicate a response in writing, which DOL uploads into the 

permanent case record. When reviewing claims in the future, the 

Board may occasionally see these communications. Going forward, 

very little will trigger an impairment claim review by the 

Medical Officer.

Mr. Chance said he and Ms. Rhoads would set up a meeting to 

discuss the topic of the Board getting clarification on public 

comments.

Dr. Silver said the discussion around these questions makes 

plain the need for an ombudsman that can refine the questions 

and get the data needed to answer them promptly and directly. 

Chair Markowitz asked about the status of replacing the 

ombudsman position. Ms. Pond said there is currently an acting 

ombudsman, but could provide little other information since the 

position is located in a different office.

Chair Markowitz read from Chapter 29 of the procedure manual on 

the role of the Medical Officer. He noted that the description 

applies to organ transplant and experimental treatment requests 

and appears to only apply to those occasions. Mr. Vance said the

Medical Officer has other functions in OWCP, but for DEEOIC’s 

purposes, this is what they ask the Medical Officer to 

participate in. He said that “experimental treatments” refers to 

treatments that are not recognized as normal and routine 

treatment modalities for a particular condition. Dr. FriedmanJimenez said that the term “experimental” could potentially be 

problematic, as it could change depending on the opinion of the 

Medical Officer. Experimental also has a precise medical meaning 

which is not necessarily the definition used in this context.

Public Comment:

Terrie Barrie, Alliance of Nuclear Worker Advocacy Groups, 

commented on a letter she sent the Board earlier in the year 

concerning rescinded cancers. Her request is more appropriate 

for the ABTSWH than NIOSH’s Advisory Board on Radiation and 

Worker Health because it is within this Board’s purview to 

provide advice to DEEOIC on the claims adjudication process 

generally. She asked the Board to review the original and 

rescinded final circulars and consider recommending to DEEOIC 

that the five cancers identified, as well as the SLL/CLL issue 

raised by D’Lanie Blaze in her written comments, do qualify as 

specified cancers. She was pleased to hear that DEEOIC has 
issued a request for proposal to provide a support contractor to 

the Board, but could not understand why it has taken three years

to do so. Ms. Barrie suggested that the Board ask for the number 

of cases that were filed for mesothelioma to get a better idea 

of how frequently they were approved or denied. She was also 

curious about the amount of time it takes from the physician 

submitting their findings to DEEOIC until a final decision is 

issued. This would help to determine if there is a problem with 

claims examiners issuing these decisions.

Donna Hand said the specified diseases designated in EEOICPA 

refer to physiological conditions that are recognized by the

National Cancer Institute (NCI) under their current names or any 

previously accepted or commonly used names/nomenclature. NCI 

should be asked to review the specified cancers and include 

those that have been rescinded from the list. Chronic 

lymphocytic leukemia may require a technical or legal change to 

be covered. She said that many day-to-day activities are not 

being considered in impairment decisions. This needs to be 

addressed and made consistent across the board. Lastly, she 

noted that Haz-Map is no longer part of the National Institutes 

of Health and asked why it cannot be used to address

Environmental Health Perspective and their database, 

Collaborative on Health. She will submit further details on this 

database.

Stephanie Carroll commented that EEOICPA is clear in discussing 

medical benefits for this program and it is important to pay 

attention to the language of the Act when determining if workers 

are going to be furnished the medical benefits their physician 

orders or recommends. The steep criteria for getting 

authorization for treatments that would provide relief or reduce 

the degree/duration of an illness should not be acceptable. The 

criteria must be consistent no matter the cost of the treatment. 

Regarding nomenclature with NCI, the Act has been very clear,

and something has changed in the program. Ms. Carroll said she 

has had difficulty getting people with secondary bone cancer 

related to the prostate covered for their treatments, which has 

not been the case in the past. Ms. Carroll commented on doctors 

weighing in on decisions for statutory diseases. A doctor is not 

a claims examiner, and if they are going to be used as such they 

should be listed as a part of the program. She said that 

Econometrica has addressed many of the issues the ABTSWH has now 

taken up and they should review the 2005 report concerning

presumptions or exposures that are expected to be at the site. 

She noted that official production at Rocky Flats stopped in 

1989, but they continued processing waste and other activities 
that were the same as during production. She expressed concern 

about using the earlier date to make changes to the SEM. The SEM 

has a library of documents that have been used to verify that 

exposures occurred onsite for covered facilities. She suggested 

the Board request the SEM library index from DOL.

TUESDAY, NOVEMBER 9, 2021

Call to Order:

Chair Markowitz called the second day of the meeting to order at 

1:02 p.m.

Board Request for Resources:

Chair Markowitz provided an update on the DOL’s response to the 

Board’s request for resources. DOL has been working to secure a 

contractor to assist in the performance of certain tasks and 

have issued a request for information which received a number of 

responses from potential contractors. Board members reviewed 

these responses and a performance work statement with DOL staff 

and provided feedback. Board members said that experience in 

occupational health would be very helpful and estimated that 

there could be 3-5 scientific and/or technical reviews per year

that should be based on existing consensus or expert reviews of 

a particular area. The Board will provide specific direction in 

the claims review process undertaken by the contractor and 

recommended job titles they would like to see in the responses

to their request for proposals.

Mr. Chance emphasized that DOL is moving on this as quickly as 

possible, though government contracting requires extensive due 

diligence. 

Plan for Review of Limited Number of Claims by Spring 2022:

Chair Markowitz led a discussion on the Board’s work plan over 

the coming year. While the contractor procurement process is 

underway, the Board can engage in developing a plan for looking 

at claims addressing specific questions. It would be a good idea 

for the Board to request a limited number of claims to review 

and get a better understanding of what kind of information they 

would want to see from future claims. Because of the time it 

takes for DOL to de-identify claims before Board members can 

review them, they will need to formulate a request soon in order 

to obtain the claims prior to the Board’s spring meeting. Chair 

Markowitz asked the Board how many claims to request and what 
specifics they would be interested in (i.e., what years, what 

conditions, geographical representation, ratio of accepted-todenied claims, issues involving causation or impairment, and/or

consequential conditions).

Dr. Bowman said unique cases may not be as helpful as 

representative cases and they will want to review both accepted 

and denied claims.

Rose Goldman asked if there were outstanding questions or issues 

from the last time the Board conducted claims reviews. In the 

past, it was difficult to go through claims papers because they 

were not organized by different categories. Chair Markowitz 

agreed that the lack of indexing for the claims was a problem 

and said that he will find out if the performance work statement 

included that as part of the contractor’s deliverable. Mr. Vance 

said there’s no indexing DOL can do based on the extraction of 

the material from their case files. Doing so would require an 

extremely time-consuming manual process. Previously, DOL has 

provided a PDF of the entirety of the file in whatever order it 

is presented in their imaging system. Dr. Friedman-Jimenez said 

the claims they have received in the past were very large, 

unsearchable PDFs. If the Board cannot get an index, his 

preference would be a PDF file that has been run through a 

character recognition program to make it searchable.

Dr. Silver said more recent cases that receive IH referrals 

would be of interest because, even after the guidance was 

withdrawn, claims examiners were still applying the assumption 

that if exposure occurred after 1995 they would be at or below 

OSHA’s standards. He would also like to see recent claims to see 

how the new OHQ is performing.

Chair Markowitz said they want completed claims so they can 

review the entire process, including the decision. He asked if 

there would be many claims from 2020 or later that have been 

decided. Ms. Pond said there were probably several very recent 

claims that have final decisions. DOL will have to run a report 

to find out how many and if they can sort them by the data 

points the Board is looking for. Mr. Vance said the key thing 

with data requests is specificity. Chair Markowitz asked if 

claims handled during the pandemic might be unrepresentative of 

the broader process. Ms. Pond replied that the claims have been 

processed the same during this period.

Chair Markowitz asked if claims with an IH report will 

automatically have a CMC report and vice versa. Ms. Pond said 
this is not always the case. In more recent claims, DOL has 

increasingly gone back to the treating physician first and if 

they provide enough information DOL will not go to a CMC. She 

assumed the Board would want to see an IH report regardless of 

whether it went to a CMC or not.

Dr. Bowman said it would be good to get an approved claim and a 

denied claim for emergency responders. Ms. Pond said they are 

unable to search by job category. Dr. Bowman suggested 

reviewing denied-to-accepted claims at a ratio of 2-to-1 or 3-

to-1. Regarding health conditions, Chair Markowitz suggested 

reviewing some claims involving impairment but mostly not. He 

did not think it would be necessary to review consequential 

claims since they piggyback on accepted claims.

Dr. Goldman said she would be interested in claims with a 

Parkinson’s disease condition and cancer. This would help them 

see how the Board’s work connects with what is happening on the 

ground. Chair Markowitz asked if cancer claims accepted under 

Part B are automatically accepted under Part E. Ms. Pond said 

they would be as long as it is a Part E covered site. Chair 

Markowitz said it would be helpful to look at cancers that are 

Part E only. Dr. Silver pointed out that claims that are solely 

Part E are not likely to involve much radiation exposure.

Jim Key raised the issue of a case he recently became aware of 

concerning a Part B cancer claim from the Gaseous Diffusion 

Plant SEC in which the claimant was told a dose reconstruction

was required. Ms. Pond said staff will seek out more information 

and discuss the matter offline.

Mr. Catlin said it would be interesting to look at cases that 

met the initial criteria but in which the examiner decided an IH 

review was not necessary and still denied the claim. Mr. Vance 

said a lack of viable health effect data would be a probable 

reason for denial in these situations and expressed uncertainty

if the data could be manipulated to identify such cases.

Chair Markowitz said it would be worth familiarizing Board 

members with claims involving beryllium disease and pulmonary 

disease. He asked how many claims the Board members could review 

without being overburdened. Dr. Silver said it depended on how 

much time they had between receipt of the case files and the 

working group report-out date. Dr. Goldman said it would be 

helpful if Board members had access to previous work done by the 

Board connecting certain exposures and diagnoses and then 

reviewed more recent claims to see if those findings have been
incorporated into decisions. Chair Markowitz noted that the

point of this is not to identify problems in the process, but it 

would be worthwhile to learn what they can about these issues.

Chair Markowitz asked if DOL, after the Board has submitted 

their request, would give them feedback on what additional 

details they need in order to locate the cases. It would be best 

is claims are reviewed by multiple Board members. Dr. Goldman 

suggested 3 to 5 claims for each member to review, depending on 

how complex they are. Chair Markowitz will draft the request and 

circulate it to Board members for further input.

EEOICP Program Metrics: Additional indicators of EEOICP claim 

status outcome:

Chair Markowitz reviewed the data available in the DEEOIC Public 

Reading Room in order to familiarize Board members with the 

kinds of data that are publicly available and what additional 

data might be useful to the Board. He reviewed the records in 

each of the headings listed on the webpage. Mr. Vance reviewed 

reasons for denial for chronic silicosis Part B claims. The 

majority of denials were due to an employee not being covered, 

but some had negative causation. The issue of causation appears 

to be key in the claims evaluation process for a sizable portion 

of denied claims. There was considerable variation in acceptance 

rates for different cancers.

Dr. Bowman said he would be interested in seeing an approved and 

a denied Alzheimer’s claim to get a sense of what factors into 

those decisions. Dr. Goldman asked if the Alzheimer’s category

meant Alzheimer’s alone or if it included any dementia. She 

noted that peripheral nerve disorders are not caused by many 

chemicals and yet there were 44 claims listed with 17 accepted. 

Mr. Vance clarified that DOL can accept cases based on the 

weight of medical evidence assigned by a treating physician 

regarding how an exposure is reasonably contributing to the 

onset of a disease. Ms. Pond added that more physicians are 

addressing aggravation and contribution rather than causation. 

Dr. Silver suggested adding a link for users to get back to 

state and facilities data in order to provide a more integrated 

experience for the Public Reading Room. He also asked if the 

Board has considered going directly to claims examiners and 

asking them about recent claims that may meet the Board’s 

criteria for requesting claims for review. Mr. Vance said this 

would be possible. Ms. Pond said she would talk to the District 

Directors about how useful it would be. They will also discuss 
internally the possibility of adding a link to the facilities 

data.

New Business:

Chair Markowitz raised the issue of whether the Board was 

recommending linking aldrin and dieldrin to both male and female 

breast cancer. Dr. Friedman-Jimenez said male breast cancer 

cases are extremely rare and there is very little known about 

the environmental causes. There is not sufficient information 

available to say that they behave any differently and he did not 

see a basis for differentiating them. Considering them both to 

have the same determinants is a reasonable position for the 

Board. Dr. Bowman said IARC does not specify male or female.

Chair Markowitz presented Dr. Bowman’s summary language on the 

styrene issue. Dr. Friedman-Jimenez’ extensive commentary and 

review in support of the final statement was much appreciated. 

Chair Markowitz noted that the World Health Organization renewed 

its classification of lymphomas in 2017 and there are now 70 

subtypes. Dr. Goldman said that that if a worker had styrene 

exposure and had any kind of leukemia or lymphoma, it should be 

compensable. Mr. Vance said he believed the response was

sufficient, but will discuss the matter further internally. 

Ensuring they had the proper classification coding for that type 

of malignancy would be his only concern. Dr. Goldman said this 

will be a problem when they go to the ICD-10 coding because 

there are so many diagnostic codes and subgroups that would fit 

under lymphoma and leukemia. Mr. Vance said DOL can take the 

recommendation back to PTS to see what they think can be done 

based on the current structure of the SEM. They will reach out 

to the Board if further information is needed. After reviewing 

the Veterans and Agent Orange Update, Dr. Friedman-Jimenez said 

that ICD-9 maps into ICD-10 very neatly so it should not be an 

issue. 

Chair Markowitz briefly raised a couple of issues related to 

written comments the Board had received. Terrie Barrie cited 

certain cancers for which DOL had asked NCI for clarification on 

whether or not they were synonymous with the 22 cancers listed 

in the statute. Chair Markowitz asked if justification for what 

the list includes or excludes is within the ABTSWH’s purview. 

Ms. Pond said she would discuss this with Mr. Chance after the 

meeting, but did not believe it would be within the Board’s 

purview. The reasons DOL has changed its stance on certain 

cancers have been legal in nature. Mr. Vance said this topic has 

been discussed by the Board in the past and DOL provided a 
written response, which Ms. Rhoads will share with the Board. 

Another issue raised was that chronic lymphocytic leukemia (CLL)

was not one included in the 22 specified cancers, but lymphoma 

was. Now that CLL has been reclassified as a lymphoma in the 

2017 WHO classification system, it should be considered as one 

of the 22 cancers. This may be a nomenclature issue that NCI 

could clarify. Ms. Pond believed the statute refers to CLL as 

nonradiogenic, but it does not have a specific designation in 

the statute. Mr. Vance added that Congress explicitly excluded 

CLL from consideration in its legislation. DOL needs to have a 

clear interpretation of the evidence as to whether a physician 

has diagnosed CLL or small lymphocytic lymphoma; however, many 

physicians are now combining the two.

Board Work Plan:

Chair Markowitz summarized the upcoming tasks for the working 

groups. The IH/CMC and public comments working groups will 

reconvene to review DOL’s responses. They will track the 

progress on the issue of contractors for the Board and will 

provide any additional information. Chair Markowitz will send 

out a formulation of the claims request in the coming week to be 

refined and finalized. In the past, it generally took around 

three months to get batches of claims, which should provide 

ample time for review them before the next Board meeting.

Close of Meeting:

Mr. Chance adjourned the meeting at 3:26 p.m.