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 16-17, 2017

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The Advisory Board met at The Lodge at Santa Fe, 750 N. St. 

Francis Dr., Santa Fe, New Mexico, Steven Markowitz, Chair, 

presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

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
Introductions

Doug Fitzgerald called the meeting to order at 8:33 a.m. All Board 

members were present. Chair Markowitz welcomed everyone to the 

meeting and reviewed the meeting agenda.

Transition to new Advisory Board

Chair Markowitz said that the DOL will soon be appointing a new Board 

and that the current board needed to figure out how to finish its 

work and hand it off to the new Board. A new Board will be seated in 

February or March of 2018. 

Chair Markowitz reviewed that there have been almost 300,000 claims 

under the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA) since the beginning of the program with $4.2 

billion in compensation paid under Part E. There has been over $14 

billion in compensation paid under Parts B and E. 

Chair Markowitz said that the Board should agree on the major points 

of its responses to the DOL responses to the Board recommendations 

before the end of the meeting. The Board's responses will be written 

up by members of the Board. The content of those responses will be 

affirmed by a vote during a telephone meeting of the Board in January 

2018.

DOL Responses to the October 2016 Recommendations

Recommendation #1

DOL agreed with the recommendation. The Board did not entirely agree 

with the “higher burden of proof” rationale that DOL gave for 

agreeing with this recommendation but this point was moot in that 

both DOL and the Board agreed on the outcome, i.e, accepting the 

recommendation. Ms. Leiton said that DOL has no mechanism in place to

electronically review specific post-1995 cases that might be affected 

by the proposed change. There has been a manual process to make sure 

that the cases that “might” have been referred to an IH (industrial 

hygienist) have definitely been referred to an IH. 

DOL has identified a cohort of cases and provided lists of the claims 

to the claims staff. Since the recision of circular 15-06, any claim 

that was after the 1995 exposure analysis was referred to an IH. It 

would be helpful if DOL could provide the Board a report on how many 

claims have been reviewed and how many of those claims have been 

remanded to be re-reviewed. 

Also, the Board was concerned that presumptions may be viewed as a 
different burden of proof. Ms. Leiton said that she didn't think that 

the argument about burdens of proof undermines the development of 

positive presumptions. 

As far as tracking cases, Ms. Leiton said that DOL is going to want 

to show that it has systematically tracked the cases. Once a 

presumption is established, there will be a circular or a bulletin 

that tells the claims examiners about the new process. The problem 

with exposures and the date is that DOL does not have a way to search 

the claims tracking system for whether a claimant's only verified 

employment was 1995 forward, in the same was that there are ways to 

look in the system and find if a claim was denied for a particular 

cancer, for example.

Recommendation #2

The Office of Workers’ Compensation Programs (OWCP) agreed that a 

number of the references provided by the National Institute of

Medicine (IOM) might be useful. OWCP thought that the Board should 

narrow the list of references. The Board's response to the OWCP was 

discussed later in the meeting, during the SEM Subcommittee update.

Recommendation #3

OWCP agreed that it would be beneficial for former DOE workers to 

administer the Occupational Health Questionnaire (OHQ) interview. 

Member Boden suggested that preferential hiring be given to former 

DOE workers for these positions. Member Welch suggested that the 

Board look at this recommendation again in the context of the 

whole administration of the occupational history questionnaire, 

not just focus on whether the contract should be changed to 

encourage hiring DOE workers first. Chair Markowitz said that 

the Board should refine its recommendation, which wasn't 

specific enough. The goal of this recommendation is to improve 

exposure information for use by health professionals to 

determine whether a case is compensable or not. There's a need 

to develop additional credible sources of information beyond 

the SEM, particularly around exposure, but also around 

exposure-disease connections.

Ms. Leiton said that focusing on how DOL can train people even 

if they aren't the experts into drawing out relevant 

information is something that DOL can dig its heels into 

quickly. Member Cassano said that if DOL is not going to 

utilize the OHQ as prima facie evidence for exposure, then 

everything that the Board is doing is moot. 

Member Silver thought that former DOE employees who have 
administered the site-specific former worker program 

questionnaire might do a better job administering the OHQ 

because they've seen a lot of the details of the historical 

plant processes and exposures that are brought out by the 

former worker program questionnaires.

Recommendation #4 

OWCP agreed that there are certain circumstances in which it would be 

beneficial for the IH to speak directly with a claimant. Ms. Leiton 

said that DOL is asking the industrial hygienists, if they 

believe that there should be further discussion, to reach out 

to the claims examiner, and then the claims examiner will 

facilitate a discussion with the claimant. It's great education 

for the claims examiners because they would be listening in on 

detailed conversations about people's exposures in the plant 

and they're going to learn from that.

Recommendation #5

OWCP did not support reviewing policy teleconference notes, 

redacting confidential information, and posting that 

information in a publicly available database. The members 

discussed that this is a tradeoff between transparency and the 

need to think out loud without coming to a decision, the need 

to bat around ideas in a non-public setting, which is 

important. Ms. Leiton said that the program's policy branch is 

the one that reviews all of the notes, conducts the policy 

teleconference calls, updates the procedure manual, and writes 

the circulars. If something is a big change, the program puts 

out a circular about the change and goes back and looks at 

other cases. 

OWCP also has a database on its website that has precedentsetting decisions. There are specific cases in that database 

for things that are out of the ordinary. The process would get 

complicated if all of the changes to procedures had to undergo 

public scrutiny. That would be like a regulation that undergoes 

public comment, that requires DOL to respond to all those 

public comments. It would be a very large, bureaucratic 

nightmare to do that. DOL explains its circulars and the 

bulletins when changes are made and the background behind those 

changes.

Recommendation #6
OWCP agreed that claimants are entitled to access to their own case 

files. However, electronic access is not currently technically 

feasible, and OWCP will need additional resources in order to make 

this access possible. Ms. Leiton said that OWCP is going to piggyback 

on the Federal Employee Compensation Act (FECA) program's two factor 

authentication process and technology. The Department is working on 

making this happen.

Recommendation #8

OWCP did not agree with providing the entire case file to both the 

industrial hygienists and the CMCs (contract medical consultants). 

Member Cassano said that DOL should want the proper people to have 

access to the appropriate,relevant, and necessary facts for a 

claim to be adjudicated properly. The industrial hygienists 

and the CMC’s have a lot more experience in determining what 

those facts are in order to adjudicate the claims than the 

claims examiners. Member Welch added that the Board needs to 

make a firm statement that it does think that it's the role of 

industrial hygienists and the CMCs to go through the records to 

be sure that every relevant bit of information is being used in 

making the determination. There was strong agreement on the 

Board for making the entire claims file available. 

Chair Markowitz raised the issue of efficiency. Member Cassano 

said that the only cases that would go to the CMC would be the 

ones that that the claims examiner asks for an opinion on. Ms. 

Leiton said that DOL's recommended decision is what the 

department actually makes a decision on at the end of the day, 

and that's going to incorporate anything that the DOL received 

from a CMC or a treating physician. The DOL will revise its 

determination based on a CMC opinion, especially if it's going 

to impact a case in a positive way.

The Board was concerned about whether the CMCs and the IHs 

learn, understand, and are updated on the procedure manuals and 

policies, et cetera, of the program. Ms. Leiton said that when 

it comes to the training of the claims staff, there is a 

process for training on new circulars and bulletins as they 

come out. In the coming years, the DOL can look at the specific 

case files and at whether these policies and procedures have 

been incorporated.

Recommendation #7

While OWCP appreciated the Board's recommendation regarding the 

provision of medical advice specific to the EEOICPA program, 
OWCP believes that further information needs to be provided to 

the Board for it to have a fuller understanding of the current 

structure OWCP has in place to provide medical advice to the 

EEOICP program. The Board agreed that some sort of discussion 

is helpful both educationally and also to provide greater 

consistency, which is important for a compensation program. 

Occupational medicine is so broad and there are so many 

thousands of toxins and hundreds of diseases that no one can 

know everything. The expertise of multiple physicians should be 

made available to the CMCs. The Board wanted to know how many 

full-time physicians and Ph.D.-level people there are within 

the OWCP. Ms. Leiton said that she would get back to the Board 

with that information. 

DOL Responses to the April 2017 Recommendations

Recommendation #1

OWCP agrees that the 250-day aggregate duration of exposure is 

a reasonable standard to apply when assessing presumptive 

standards for asbestos-related health effects pertaining to the 

following five asbestos-associated conditions: asbestosis, 

asbestos-related pleural disease, lung cancer, and cancer of 

the ovary and larynx.

The Board generally agrees with OWCP on the issue of latency. 

More challenging is agreement on job categories that would be 

covered by a presumption. Someone has to do the work of 

aggregating the specific job titles into categories in order to 

work with the presumptions. It would make sense to have 

exposure presumptions that are relatively generous, because the

data (i.e, industrial hygiene measurements) generally do not 

exist to allow one to make a determination by specific job 

category. 

A exposure-disease presumption will likely include a limited 

number ofpeople who didn't have sufficient exposure. But it 

will include most of the people who did have a significant 

occupational exposure to asbestos. Including only a limited 

number of very specific job titles in a presumption would mean

excluding large categories of workers. There are many job 

titles that are very specific but that have not been studied 

due to inadequate resources, population size, etc. 

Notably, OWCP uses an Agency for Toxic Substances and Disease 

Registry (ATSDR) source document that doesn't list janitors and 
cleaners as heavily exposed to asbestos, but they are in the 

references that the ATSDR document cites ( NIOSH 2003-2008). 

Somewhere along the line these job titles were dropped from the 

list and were never carried forward.

With regard to the difference between significant exposure at 

high levels and low levels, Ms. Leiton said that for the '87, 

when OWCP says "significant" it's applying the exposure 

presumptions. If it says "significant," then DOL is going to 

use the exposure presumptions that are in the already existing 

policy because the problem with the word "significant" is that 

it's written in the law: "at least as likely as not significant

exposure to..." And so, that's why DOL continues to use the 

word "significant." In the context of the exposure presumptions 

if it fits into one of those two “significants,” whether it's 

high or low, DOL still applies those other presumptions.

In reference to the Board's Recommendation No. 1 to apply the 

asbestos presumption to “all DOE workers who worked as 

maintenance or construction workers at a DOE site,” OWCP needs 

additional information and clarification. Ms. Leiton said that 

DOL is being inclusive of maintenance workers, but it would be 

helpful if the Board provided more information about what 

should be included in that category. 

The Board's recommended presumption doesn't address the issue 

about lesser exposures to asbestos and at what level one would 

consider it significant. The Board’s recommendation defines by 

job category and time period, as listed in the table, those 

workers who are significantly exposed. 

OWCP agreed to changing current latency periods for all of the 

conditions as recommended and to changing the duration of 

mesothelioma to greater than or equal to 30 days. However, with 

regards to the 2005 date, OWCP seeks additional clarity as to 

the underlying research and the rationale supporting the 

selection of that date as a temporal basis for application in 

the Board's presumption. Finding a line in the sand will be a 

challenge.

Member Vlieger said that the rebuttals to the 15-06 circular 

came from the United Steel Workers and also from other 

organizations that cited DOE's own inspections and lack of 

compliance with the rules. The Board will need to take a look 

at this issue in the future.
Member Cassano said maybe the way to look at this 

recommendation is that instead of looking at the date of a 

claim, OWCP could say something like if a claimant was working 

in a building that was built before 1978 and there was no 

documentation that the asbestos present was abated, then the 

presumption should apply, because asbestos was supposedly not 

used after 1978.

OWCP agreed that all claims for the six asbestos-related 

associated conditions that do not meet the exposure criteria 

shall be referred to industrial hygienists and CMCs as 

appropriate.

Recommendation #2

OWCP agreed that a diagnosis of asthma by a treating physician 

should be sufficient without specific references to the tests 

listed in Recommendation 2-2. However, the physician's opinion 

should include an appropriate medical rationale based on 

objective findings to support the diagnosis as is required for 

any other diagnosis claimed under the program. The Board said 

that it would be helpful if DOL included an example that was 

something other than a breathing test example in the procedure 

manual. 

As to Recommendations 2-3 and 2-4, in its most recent update to 

Chapter 15 of the procedure manual, OWCP applies the policy 

regarding the assessment of work-related/occupational asthma 

that comports with these recommendations. Ms. Leiton said that 

a medical doctor stating that asthma was related to a toxic 

substance would be what DOL is looking for, rather than having 

the claims unit go through a whole IH SEM assessment. However, 

the update to the procedure manual needs more thought when it 

comes to vapors, gases, dust, and fumes. 

Member Redlich said that after years of research, there's still 

a lack of understanding of the mechanisms by which numerous 

agents cause asthma.

Member Griffon asked whether the statement that the CE does not 

apply a criterion about a toxic substance exposure to a claim 

for work related asthma include bypassing use of s the SEM or 

IH referral.. Any dust, vapor, gas, or fume has the potential 

to affect asthma. Does this mean that there's a presumed 

exposure at any DOE site for gas vapor or fumes? And,

therefore, the DOL is saying that a claimant doesn't get a
exposure assessment, because DOL is assuming any employee at 

any of the sites has a potential for significant exposure in 

one or any of those vapors, gases, dust, or fumes (VGDFs). Is 

that why DOL doesn't require the assessment? Ms. Leiton stated 

that DOL is not saying that - and that's why the chapter on 

VGDF is worded very carefully.

Recommendation #3

OWCP will consider modifications of the current COPD 

presumptive standards. However, OWCP had a number of questions 

and concerns with this recommendation as stated. Member Dement 

said that the recommendation is simply trying to bring this 

presumption in line with the vast body of scientific literature 

in this area. Member Sokas said that accepting the NIH 

definition of “toxic substance” would go a long way to helping 

with this particular recommendation.

Ms. Leiton said DOL's presumption is about exposure to asbestos 

versus exposure to VGDF. The biggest challenge is the 

suggestion that the Board provide DOL with a list of toxins, 

then explain how that list applies to the literature with 

regard to the duration of exposure. Chair Markowitz was 

skeptical about the Board's ability to come up with a fully 

inclusive list. It is clear from epidemiologic studies that 

exposure to VGDF to - aggravates, contributes, or causes -COPD, 

so that workers in the DOE complex who had routine exposure to 

VGDF can be accommodated with respect to COPD.

Member Welch said that there are groups of chemicals, 

respiratory irritants, and organic solvents that would be 

accepted under any NLM definition of toxic substance because 

they're considered a chemical class of some kind. If it's 

necessary to have a list, it would be better if the list is 

longer than just the 14 that are in the SEM. Then there would 

be people who don't fit but should go for an industrial hygiene 

evaluation. The precedent is already well accepted that 

mixtures are considered causative.

Recommendation #5

OWCP agreed that it would be useful to have additional 

scientific and technical capabilities to support the 

development of policies and enhance decision-making with 

respect to individual claims, and to inform the assessment of 

the merit of the work of the CMCs and the IHs. Ms. Leiton said 
that DOL will provide the Board with the credentials of the SEM 

team. Member Sokas noted that the NIOSH Radiation Board does 

have a technical contractor to assist them and perhaps the DOL 

Board could look into hiring a contractor. 

Recommendation #6

DOL did not support the recommendation that the finding of two 

borderline beryllium lymphocyte proliferation tests (BeLPTs) be 

considered to be equivalent to one abnormal BeLPT for the 

purposes of claims adjudication. The Board's recommended 

presumption seeks to equate two borderline BeLPTs with an 

abnormal BeLPT, which cannot be done under the language of the 

program’s statute.

There is an exception that's made under Part B for people who 

cannot develop an abnormal BeLPT due to taking steroids. The 

Board could develop that kind of a rationale. The literature 

supports that two borderline tests have a predictive value that 

is the equivalent of an abnormal BeLPT.

Recommendation #7

This recommendation is related to the quality assessment of 

CMCs. Member Sokas gave a brief recapitulation of the work done 

by the Subcommittees on Weighing Medical Evidence and CMCs and 

IHs. Member Sokas thought that the CMC form and the way it's 

being applied is too narrowly focused on the specifics of the 

American Medical Association (AMA) guidelines. Member Silver 

noted that the claimants and the advocate community had 

concerns that there are some CMCs who keep making the same 

mistakes over and over again for many years. Perhaps a bigger 

sample needs to be drawn. The CMCs are selected by the 

contractor, and there are various methods in place to review 

their work.

Member Redlich mentioned that the Part B Lung Disease 

Subcommittee had looked at about 60 cases that had a CMC 

report. And of those, over half of them were from the same 

CMC. Everyone on the subcommittee agreed that this particular 

CMC had appropriate credentials but also had a “bit of an 

attitude.” There was agreement that his cases accounted for 

almost all of the decisions that the subcommittee disagreed 

with. Also, Member Dement assembled a summary of the data from 

each year of the number of cases under different conditions 

that were accepted and denied. The numbers are not so huge that 
one couldn't target the CBD denials. It would be a manageable 

item to review. Ms. Leiton said that there is no formal process 

that Dr. Armstrong goes through in order to detect patterns 

after re-reviewing cases. Dr. Armstrong's reviews may be more 

verbal rather than formal and documented.

With regard to changing the form, Member Sokas said that the 

suggestion is to change the form itself to include both the 

methodology change that the reviewer would review the whole 

record and add the part about whether the CE sent the 

appropriate information. The next step would be to recommend 

changes to that process and an approach that encompasses 

alternative mechanisms for reviewing the reviewer. The original 

recommendation did recognize what was currently happening. The 

Board needed to see what was happening and then adapt the 

recommendation based on that. 

Chair Markowitz reminded the Board that one of its tasks is to 

evaluate the industrial hygiene function and that task should 

not go by the wayside. Ms. Leiton said that there is not currently 

a similar audit process of the industrial hygienists as there is for 

the CMCs.

Public Comments

Ms. Jacquez-Ortiz

Ms. Jacquez-Ortiz shared with the Board a statement from Senator 

Udall. DOL should prioritize Board recommendations intended to 

assist claimants. The community of claimants from the Cold War 

era is getting on in years. Many have already waited too long 

for their claims to be evaluated. Also, DOL should strongly 

consider providing the Board with a technical contractor to 

assist it.

Ms. Martha Trujillo

Ms. Trujillo's father passed away 10 years ago. He and her 

mother both fought for a number of years to get compensated. 

And about one month after her father passed away, he did 

receive his compensation. Ms. Trujillo thanked the Board for 

the hard work that they are doing.

Mr. Tim Lerew

Mr. Lerew is the chair of the Cold War Patriot Executive 
Committee. He spoke very briefly to presumptive causation. As 

Member Boden and others had noted, the positive effects of 

presumptive causation could help many with pulmonary and other 

illnesses. There is a willing partner in the Department of 

Labor for many of their 400 claims examiners to take the input 

that the Board has made and continue to carry that forward. 

That's already reflected in the policy and procedure manuals.

Mr. Raymond Singer

Mr. Singer is a doctor of neuropsychology. He spoke about the types 

of injuries that neurotoxicity can cause like anxiety, depression, 

psychosis, panic attacks, learning disabilities, memory 

disorder, and/or neurological degeneration that can be 

diagnosed as dementia, Alzheimer's disease, Parkinson's 

disease, and other motor disorders. Solvents are among the 

neurotoxic substances. Pesticides, metals, mercury, lead, and

many other metals as well as mold are neurotoxic substances. 

The Board should keep these substances in mind. 

Mr. Paul Griego

Mr. Griego is a former radiation worker. He was denied health 

screening program under the workers compensation program.The 

Pacific Proving Grounds have SEC years from 1947 to 1962. He 

filed a petition for an amendment to the special exposure 

cohort to include the 1977-1980 atomic cleanup of Enewetak 

Atoll with NIOSH. Mr. Griego went to speak with one of the 

NIOSH representatives present. 

Dr. Sood

Dr. Sood is board-certified in pulmonary medicine and 

occupational medicine and the only occupational pulmonologist 

at the University of New Mexico. Dr. Sood commented on the 

shortage of providers for DOE workers, asthma, COPD, and 

chronic beryllium disease. Dr. Sood really liked what the 

Advisory Board said about vapors, gases, dust, and fumes. As a 

risk factor, it's well recognized by the scientific literature 

and certainly something that was recommended by the Advisory 

Board. DOL should revise their stand on vapors, gases, dust,

and fume exposure. Dr. Sood thought that the Board's 

recommendations on asthma, COPD, sarcoidosis, and CBD were 

simple and practical. 

Ms. Maxine Pennington 
Ms. Pennington was a chemist at the Kansas City Plant. Ms. 

Pennington thought that 1990 was an inaccurate year to stop 

evaluating for exposure to chlorinated solvents. There are many 

toxic substances that were specific to nuclear weapon 

production. Exposure to polychlorinated biphenyls occurred way 

past 1979, the year when the transformers were taken out at the 

site. It went into the ’90’s. Many other mixtures are 

recognized as human carcinogens by NIOSH and others. But in 

the review of the cases of plastics workers at the site, there 

hasn't been a specific chemical compound or element linked to a 

specific target cancer. Because of this, those claims are being 

denied.

Ms. Jan Martinette

Ms. Martinette's husband worked at Kansas City Honeywell Plant 

for 44 years. He died 10 and a half years ago, and she has not 

received compensation. She has filed claims and been denied. 

Ms. Martinette said that PCBs (polychlorinated biphenyls) are 

cumulative. They will cause any kind of cancer. Her husband 

had been exposed to PCBs. She was encouraged to speak directly

with agency representatives who were present in the room 

following her comments.

Ms. Cathy Turpin

Ms. Turpin thanked the Board for its work and welcomed everyone 

to New Mexico. She acknowledged the immense task that lies

before the Board. 

Ms. Terrie Barrie

Ms. Barrie was worried that DEEOIC may be inadvertently 

duplicating some of the Board's responsibilities like 

conducting audits of the CMCs, determining whether or not 

individual claim evidence should be applied broadly as 

programmatic guidance, and deciding if it warrants the 

establishment of a new health effect or a modification to the 

causative threshold applied to the program guidance. Ms. Barrie 

also thought that it would be a good idea for the Board to use 

a technical contractor much like the NIOSH board does.

Mr. Eric Bustos

Mr. Bustos worked at Los Alamos and his father was a plumber 
there who recently died from liver cancer. Mr. Bustos said that 

NIOSH missed a scheduled meeting with his family. They never 

heard back from NIOSH about this missed meeting. 

Ms. Stephanie Carroll

Ms. Carroll thought that the Board should seek outside 

technical assistance from a technical contractor. Ms. Carroll 

commented on borderline and other BeLPT results. She said that 

requiring a positive BeLPT to accompany a physician-supported 

diagnosis of CBD approved under the program under Part E is 

unfair, arbitrary and capricious. She also objected to the new 

procedure manual. Everything that has gone into policy for this 

program should be put online, especially the telephone 

conference calls. Also, sarcoidosis should be in the Site 

Exposure Matrix (SEM). Getting yearly claim approval statistics 

for each site's beryllium sensitization claims and chronic 

beryllium disease claims would be helpful. 

Mr. Rendell Carter

Mr. Carter was a claimant who has been diagnosed with light 

chain deposition disease - a very rare condition that is 

closely related to multiple myeloma. Mr. Carter's claim was 

denied due to a lack of dialogue between the claims examiner 

and the contract medical consultant. Mr. Carter felt that the 

burden should fall on DOL to refute his physician's opinion, 

not the other way around. 

Ms. Marla Ortiz

Ms. Ortiz's dad worked for Los Alamos National Lab. His name 

was Dan Ortiz and he became ill after working with toxic 

substances during his employment. After leaving the lab on a 

mandated medical retirement and, despite having worked 

tirelessly to help establish the compensation program, he 

became a victim of the bureaucracy of the DOL claims process. 

After a decades-long road of suffering injustices and declining 

health, Ms. Ortiz's father's DOL claim finally went through 

about five and a half years later, and he received full 

compensation for his claim. Submitting a legitimate DOL claim 

should not be this difficult. Injured workers should have a 

much more streamlined process and not have to endure additional 

stress and anxiety.

Ms. Donna Hand
Ms. Hand said that recommendation number 4 needed corrected. It 

says “at least as likely as not that exposure to a specific 

toxic substance.” Specific is not in the statute at all nor is 

it in the regulation. 

Ms. Hand raised several issues, including: the definition of 

“significant factor”; DOL policy being discretionary; the 

ubiquity of asbestos at sites; the inability to narrow exposure 

by labor category; COPD; asthma; at least as likely as not 

criteria; and the concept of “a work day.”

Ms. Vina Colley

Ms. Colley raised the issue of uranium processing at Portsmouth 

and Paducah. She also mentioned radioactive oil at facilities 

in these two locations and the workers exposed to this oil. Ms. 

Colley asked why it was taking so long to get these workers 

compensated. The government admitted that they made the workers 

sick, and they admitted that Portsmouth and Paducah wasn't told 

that it had plutonium despite the fact that there's been 

plutonium there since 1953. Ms. Colley asked the Board to 

revisit these sites. 

Mr. Gary Van der Boegh

Mr. Van der Boegh, with Nuclear Whistleblowers Alliance, said 

the Board is doing a fabulous job. He said that former workers 

are not intimidated by anybody. Mr. Van der Boegh was sick of 

staff hearing officers. He suggested that the Board watch the 

November 2, 2017 episode of Tucker Carlson on Fox News. Mr. Van 

der Boegh said that workers are not getting compensated for 

beryllium. 

Chair Markowitz adjourned the meeting at 6:15 p.m.

FRIDAY, NOVEMBER 17, 2017

Introductions and review of recommendations

Mr. Fitzgerald opened the meeting at 8:00 a.m. and the Board 

continued its review of recommendations. Chair Markowitz assigned 

members to write responses to the various DOL responses to the 

Board's recommendations. With regard to Recommendation 5, DOL was not 

interested in publishing its policy teleconference notes, so no one 

was assigned to that. 
SEM Subcommittee

Member Welch said that the SEM Subcommittee recommended that DOL 

first integrate data into the SEM from the International Agency for 

Research on Cancer (IARC) and the EPA Integrated Risk Information

System (IRIS) database. EPA is very thorough and active in terms of 

the assessments of chemicals. EPA gets chemicals proposed to them by 

other agencies or by outside groups and they frame the scientific 

questions specific to the assessment. This information is then 

reviewed by health scientists within EPA and by interagency 

scientific consultants. Then the draft is reviewed for public 

comment. It goes through an external peer review process and those 

comments are incorporated into a final interagency science 

discussion. There are about 500 assessments within IRIS and 110 of 

those have an assessment for inhalation exposure. The assessments are 

done for the purpose of assessing environmental exposures that are 

highly applicable to the occupational environment. 

The IARC Group I carcinogens are accepted as known human carcinogens 

and are most likely already incorporated into SEM by virtue of SEM 

relying on Haz-Map. Since Haz-Map hasn’t been updated, the new IARC 

monographs have probably not been added to the SEM. The SEM 

Subcommittee also recommended that DOL incorporate the Group II IARC 

carcinogens as well. Other members supported adding the National 

Toxicology Program (NTP) data. The door should be open for using NTP 

evaluations for non-cancer outcomes, which could be very valuable 

because they do detailed reviews of neurotoxins, respiratory toxins, 

immunotoxins, and a variety of other non-cancer causing chemicals.

Chair Markowitz said that this is added information and evidence that 

there needs to be an enhanced capacity of EEOICP to have access to 

enhamced scientific, medical, industrial hygiene, and toxicological 

expertise in order to do this. Epidemiology is the key to 

interpreting the various databases and how to use them. 

Chair Markowitz asked Ms. Leiton to keep the Board abreast of DOL's 

plans to integrate the sources that the Board recommended into the 

SEM. The Board should also look critically at the job categories and 

the chemicals that those categories use in the SEM. Member Vlieger 

asked for rationale documents for when something is added or 

subtracted from the SEM. Ms. Leiton said that there is a process for 

altering the SEM. She is going to have to look at what documentation 

exists and what DOL can provide to the Board within their contract. 

She also noted that it is easier to add things to the SEM than to 

subtract things.

Occupational Health Questionnaire

This recommendation is about enhancing the occupational health 
questionnaire. The SEM really doesn’t contain information of 

frequency, duration, and intensity of exposure within the complex. 

That’s an issue for people who are trying to make a judgment about 

work-related diseases and relevant exposures. Member Dement said that 

the question is how best to get information from workers who may or 

may not have a good level of recall. The Building Trades National 

Medical Screening Program (BTMed) asks if a worker worked with a 

particular material and then, based on that experience over the last 

20 years, the workers are given a list of common tasks that 

construction trade workers would have done with the material and 

asked how frequently they worked with the material. Taking that 

information and relating it to specific health outcomes is a useful 

way of separating exposures and identifying higher and lower risk 

groups. 

Member Domina said some chemicals, like the ones that were used at 

Hanford, are so exotic that there are no health studies. And some of 

those chemicals are still not classified. The task really should be 

the focus. With regard to personal protective equipment (PPE), the 

Board recommended that OHQ drop questions about PPE. It's more of a 

marker of exposure than a marker of protection against exposure.

Member Welch said that the SEM Subcommittee could have a conference 

call to talk about the new OHQ draft in light of what the Board's 

goals have been with its recommendations and then make a proposal to 

the full Board about how to respond.

Part B Lung Disease Subcommittee Report

Member Redlich gave the report. She said that the subcommittee has 

reviewed 80 Part B cases, made three recommendations, and responded 

to a list of specific questions from DOL. Ms. Leiton asked if she 

could get the subcommittee's evaluation of the CMCs. This issue of 

CMCs using incorrect criteria relates to the Board's recommendation 

about taking a look at a sizable number of claims and identifying 

systematic issues. 

Presumptions Working Group

Chair Markowitz said that the working group still has a presumption 

recommendation on hearing loss that is outstanding from the June 2017 

meeting. Member Sokas reiterated that the presumptions are positive 

and not negative. If a claimant doesn't meet a presumption, it means 

that the claim goes to an industrial hygienist, not that the claim is 

automatically denied. 

Procedure Manual

A transmittal letter about the changes in the manual came out in