UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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SUBCOMMITTEE ON EVIDENTIARY REQUIREMENTS FOR PART B LUNG 

CONDITIONS (AREA #3)

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MEETING MINUTES

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WEDNESDAY,

DECEMBER 21, 2016

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The Subcommittee met telephonically at 2:30 p.m. 

Eastern Time, Carrie A. Redlich, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MEDICAL COMMUNITY:

CARRIE A. REDLICH, Chair

LAURA WELCH

CLAIMANT COMMUNITY:

KIRK D. DOMINA

OTHER ADVISORY BOARD MEMBERS PRESENT

STEVEN MARKOWITZ
FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS

Introductions and Part B recommendation – sarcoid presumption

and Part B case reviews

Ms. Rhoads called the meeting to order at 2:35 pm. Chair 

Redlich suggested beginning with the case reviews. The cases

addressed sarcoid and beryllium presumptions. The cases were 

reviewed in chronological order, with the beryllium sensitivity 

cases being the most straightforward. The question of 

determination on the beryllium cases will be left for later

discussion. The cases as discussed:

1) The first case was an example of where the sarcoid 

presumption was somewhat used and illustrates some of the 

problems where a more clear-cut presumption would be helpful. 

This case was from Los Alamos, and the sarcoid diagnosis was 

made in 2010. The claimant applied for CBD and was denied 

because the BeLPT was negative with granulomas on the lung. In 

2014 the claim was finally accepted. A number of similar cases 

ended up being denied because there were not enough 

knowledgeable pulmonologists to get those claims accepted. The 

director’s letter in this case explained how the case was 

accepted. 

2) This case was accepted for CBD and the person had a positive 

BeLPT. The key point to be drawn from this case was that if a 

claimant has a positive BeLPT and has evidence of interstitial 

lung disease, then the claimant has “pretty much” met the 

criteria. This person was not in a surveillance program. The 

claimant’s pulmonary doctor obtained the claimant’s history and 

personally sent off the BeLPT to the department. 

3) This case involved acute berylliosis from 1946 with CBD 

diagnosed a year later. A successful claim was filed by the 

survivors in 2014. 

4) This case was a sarcoid CBD; it was from Savannah River with 

a BeLPT that was negative. The sarcoid diagnosis was made years 

before the CBD was recognized. A pulmonologist wrote a strong 
letter that the person had a diagnosis of CBD. It was accepted 

because there was pulmonary sarcoid. 

5) There were several silicosis ILDs (interstitial lung disease)

that the committee did not go through individually, but instead 

discussed the issue of exposure. Member Dement noted that in

uranium mining and silicosis the SEM did not list silica 

exposure during uranium mining. But the SEM found aluminum 

exposure in two of the cases. Based on that, the CMC (contract 

medical consultant) opined that the claimants’ conditions were

not related to aluminum exposure even though chest x-ray 

information showed changes that would be consistent with 

pneumoconiosis. The SEM committee needs to look at why silica 

isn’t associated with uranium mining and why a diagnosis of 

pneumoconiosis would not suffice for silicosis. Including silica 

in the SEM would make the process easier. In some of these 

cases, silica exposure was not properly identified in the 

exposure assessment as being relevant. Silicosis is covered 

under RECA. In many of these instances, one particular CMC came 

up with bad conclusions. A simple solution to this issue could 

be to have a presumption for certain job titles related to 

silicosis. Some of these cases will be passed on to the CMC 

committee. There needs to be a process to review the decisionmaking of the CMCs. If a claimant has a history of exposure and 

granulomas, should there be a presumption for that claimant?

Sarcoid cases

Some of the reviewed cases revealed confusion around when the 

lung is involved in having a claim accepted. A lymph node biopsy 

is not a lung biopsy. The committee agreed that a lymph node 

biopsy should be accepted as the standard of proof, not just a

lung biopsy. If there is a positive BeLPT wherever the biopsy is 

from, then it’s CBD. A more common scenario is when there is 

extrapulmonary disease and the BeLPT is negative. 

The committee thought about defining what it means to say

“pulmonary involvement” or “pulmonary disease.” Finding typical 

granulomas at other sites should be considered the same as 

finding them inside the lung. A CT scan that shows hilar

adenopathy consistent with sarcoid could be a kind of 

presumption as well. The committee will pass these thoughts on 

presumptions to the department.
Another case had a diagnosis of sarcoid with a lung biopsy with 

no BeLPT. It was a clerical worker that worked in multiple 

buildings at Savannah River and the conclusion was that there 

was no beryllium exposure. Beryllium exposure is separate from 

the SEM. There was not a lot of beryllium used at Savannah 

River. To get a diagnosis of CBD under the legislation, there 

needs to be lung involvement. One criterion of the post-93 

criteria is the need for a lung biopsy. Member Markowitz said 

that the department asked that the advisory committee help 

define phrases like “consistent with” and “characteristic of.” 

Recommendation for presumptions

The committee’s recommendations are in the current documents.

The committee’s understanding of presumptions is essentially

beryllium exposure and a clear diagnosis of sarcoid involving 

the lung. The committee wants to present a presumption to the 

department based on beryllium exposure and a diagnosis of 

sarcoid and see how the department responds. 

Borderline BeLPT

There is modeling that suggests that three borderline BeLPTs are 

the equivalent of one abnormal and one borderline. The committee 

could recommend that either three borderlines or two borderlines 

are the equivalent of a single positive BeLPT. 

Other items

The committee decided that it would point out inconsistencies in 

the EEOICPA circular and PowerPoint description. 

Member Markowitz said that a lot of the problems that DOL had in 

the past have stemmed from the language in the statute being 

translated into the procedure manual. Particular problems arise

with phrases like “consistent with” or “characteristic of.” 

There are a few areas where there could be clarification. 

Problems in the past have stemmed from CBD cases being denied. 

The issue was that the CBD claims did not meet the criteria. The 

most common denials among the cases examined by the committee 

were interstitial lung disease and sarcoid with negative BeLPT. 

All of the denied claims that physicians sent to Chair Redlich 

were in the setting of a negative BeLPT.
The committee did not want to review additional cases and 

instead wanted to spend time putting “things on paper.” The 

department needs to clarify how it applies documented beryllium 

exposure. The committee has looked at ten denied CBD cases. 

Member Markowitz said it would be helpful to get a summary of 

the public comments on beryllium. If there is a finding of 

incompetence on behalf of the CMCs, it should be pointed out and 

corrected. 

Member Vlieger said that the department is funneling CBD cases 

to one or two doctors and that the outcome from those doctors 

has been claim denial. There are good CMCs out there, but they 

may not have been given the guidance they need to “do good

adjudication” under the program. Specific CMC reports that the 

committee has concerns about will be passed to the CMC 

committee. 

I hereby certify that, to the best of my knowledge, the 

foregoing minutes are on accurate summary of the meeting.

Submitted by:

__________________________

Carrie Redlich, MD, MPH

Chair, Subcommittee on Part B Lung Conditions

Advisory Board on Toxic Substances and Worker Health

Date: 3/21/2016