DOL Response — DOL did not intend to have the OHQ dropdown list capture the thousands
of job titles used throughout the DOE Complex. The dropdown list is designed to remind
the DOL Resource Center (RC) interviewer and the claimant of the most common labor
categories. DEEOIC will add another column to the table for the employee’s specific job
title. This way the claimant can provide the exact title(s) he/she had while working at DOE,
many of which are specific to the facility at which they worked.

Section 4(E): WORK AREAS AND ACTIVITIES

This section requests that a claimant provide a free text description of the work performed in
each job title from Section 4D to include----'Area, Facility, Building Number/Name or
Description; Work Activity; Labor Category/ Job Title; Toxins J Agents; Years of
Employment; Frequency (days / week, hours / month, etc.)'. The example provided
represents a good work summary; however, such detail is not realistic to expect for most
claimants by way of an unstructured response. The Board recommends more structure in
this section.

Section 6 of the current OHQ provides more structure for collecting information about work
areas and activities. The Board considers such structure to be an important aide to claimants
as they attempt to recall and organize information. The Board recommends that this
approximate structure be retained in the proposed OHQ. The column headings could be
modified to reflect the types of information requested (e.g. ‘Area, Facility or Building
Number/Name or Description’, 'Years of Employment’, Description of the Work Performed’,
‘Toxic Substance Exposures', 'Frequency of Exposure’). These suggested headings replicate
the items proposed in Section 4(E) of the DOL-revised draft OHQ.

While the frequency scale used in the current OHQ has been found useful for exposure
assessment, a less complex scale based on key words more easily understood by claimants
would be sufficient. A BTMED COPD case-control study found the following frequency
scale adequate for assessment of exposures among DOE construction workers:

Rarely: Less than once per month
Daily: Daily or almost every day
Monthly: 1-2 times per month

DOL Response — DOL agrees that the column format can be very helpful for claims staff
who review the form, as it helps to organize the information. It also serves to aid claimants
in their recall of relevant employment and exposure history. DOL will utilize a column
format for work areas and activities to include the frequency of exposure scale, as suggested
by the Board.

Section 5: EXPOSURE INFORMATION

This section of the draft revised OHQ differs from the current OHQ in that only broad
categories of toxic substances are listed, with exposure details relegated to free text

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 14 of 19


accepted as a compensable “covered illness” if “it is as least as likely as not that the
exposure to such toxic substance was related to employment at a Department of Energy
facility.” 42 U.S.C § 7385s-4(c)(1)(B). DOL understands that medical guidelines or
epidemiological standards may exist that provide a basis for alternative methods to assess
the relationship between asthma and materials encountered by workers at a covered
facility, however, the Act is the sole legal basis for judging the sufficiency of a claim for
compensability. DOL has no legal ability to modify statutory or regulatory requirements
through revisions to the PM. Therefore, DOL considers the existing PM language at
Exhibit 15-4.5cii that references a toxic substance trigger to align more accurately to the
statutory requirement of the Act, rather than a reference to a relationship between asthma
and the covered workplace.

Revised Asbestos Presumption Recommendation
(Adopted by the Advisory Board on Toxic Substances and Worker Health, February 28,
2019)

As a result of interchange between the Board and EEOICP, the EEOICP and the Board have
come to agreement on many aspects of EEOICP’s current policies for consideration of
claims for asbestos-related diseases. There is agreement on the set of diseases covered,
important time factors (duration of exposure; latency), and the use of 1995 as a key date for
presumption of significant asbestos exposure. There is also agreement that the asbestos-
related disease claims of DOE workers but who do not meet exposure and causation
presumption criteria adopted by EEOICP should be evaluated through the normal claims
adjudication process, including use of industrial hygiene and medical evaluations when
appropriate.

I. The Board notes the following provisions of Exhibit 15-4 (Exposure and Causation
Presumptions with Development Guidance for Certain Conditions) of the EEOICP
Procedure Manual V2.3:

A. Asbestos Exposure Presumptions

1. EEOICP presumes that the 19 labor categories designated on List 3a(1)
[Exhibit 15-04] had significant exposure to asbestos prior to 1996. No
other labor categories are presumed to have had significant exposure to
asbestos.

2. EEOICP makes presumptions about the levels of significant exposure to
asbestos (low, medium, and high). List 3a(l) categories are presumed to
have had high significant exposure to asbestos through 1986 and low
significant levels of exposure to asbestos from 1987 through 1995.

3. EEOICP presumes that labor categories other than those on List 3a(1) have
had exposure to asbestos between January 1, 1987 and December 31, 1995,
but makes no presumption about the significance of their level of asbestos
exposure. :

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 5 of 19


Recommendation #18
(Adopted by the Advisory Board on Toxic Substances and Worker Health, April 25, 2019)

The Advisory Board requests resources (such as an external contractor to provide personnel, IT
support, and additional resources as required) to assist the Board in order to conduct a timely
systematic evaluation of an appropriate number and variety of Energy Employees Occupational
Illness Compensation Program claims to assess and to ensure the objectivity, quality, and
consistency of the industrial hygiene and medical evaluations that are part of the claims process
(Board Task 4).

DOL Response — DOL will confer with the Board’s Chair to explore options for providing
contractor support to the Board in fulfilling its legislative mandate.

Recommendation #19
(Adopted by the Advisory Board on Toxic Substances and Worker Health, April 25, 2019)

The Board has observed, based on review of a limited number of recent claims, that recent
Energy Employees Occupational IlIness Compensation Program industrial hygienist assessments
frequently use stereotypic language that cite the absence of monitoring data above the
established regulatory levels in the mid-1990's. The Board recommends that this language be
omitted from the industrial hygienist report. The basis for a negative exposure determination
should be provided by the industrial hygienist in the report. Neither the absence of monitoring
data post-1995, nor the presence of data showing exposure levels below regulatory limits should
be interpreted as representing an absence of significant exposure or risk.

DOL Response — DOL does not agree to make the Board’s recommended changes.

In considering the Board’s recommendation, DOL has to rely on the professional judgment
of its team of Certified Industrial Hygienists in establishing reasonable parameters for
characterizing toxic substance exposure. In the absence of definitive monitoring data for
the thousands of chemical, biological or radiological materials that existed throughout the
DOE nuclear weapons complex, it is impossible to gauge individual exposure with the level
of accuracy that might otherwise be attainable. As such, the DOL Industrial Hygiene team
applies an exposure assignment methodology that in virtually all cases assumes a much
higher level of toxic substance exposure than would have been actually encountered by
DOE contractor or subcontractor employees. This is particularly true in cases involving
much later work histories. For these later work histories, the Board’s assumption that
significant employee exposures occurred absent any affirmative monitoring or other
occupational safety and health assessment information is not reasonable.

Given the changing dynamic of the nuclear weapons complex from one of active production
to one directed more toward maintenance and remediation, a general reduction in
significant operational exposure to toxins by workers is inevitable. Moreover, both
legislative and well-documented agency enhancements to workers’ safety cannot be viewed
as inconsequential or ineffective. Even the Board itself has referenced improving

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 18 of 19


Table 3. EEOICP Procedure Manual V2.3 List 3a(1), Exhibit 15-4

Automotive mechanic; Vehicle mechanic; Vehicle maintenance mechanic

Boilermaker

Carpenter; Drywaller; Plasterer

Demolition technician;

Laborer

Electrical mechanic; Electrician;

Floor covering worker

Furnace & saw operator; Furnace builder; Furnace operator; Furnace puller; Furnace
technician; Furnace tender, Furnace unloader

Glazier, Glass installer; Glazer

Grinder operator;

Tool grinder;

Maintenance mechanic (general grinding);

Welder (general grinding);

Machinist (machine grinding)

Insulation worker; Insulation trade worker; Insulator

lronworker;

lronworker rigger

Maintenance mechanic;

Electrician;

Insulator;

Mason (concrete grinding); Mason ; Brick & tile mason; Concrete and terrazzo worker;
Bricklayer, Tilesetter

Millwright

Heavy equipment operator; Operating Engineer

Painter

Pipefitter, Plumber steamfitter; Plumber/pipefitter; Plumbing & pipefitting mechanic;
Plumbing technician, Steamfitter

Roofer

Sheet metal mechanic; Sheet metal fabricator/installer

Welder; Welder burner; Welder mechanic

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 10 of 19


That is, the existing policy presumes that asbestos exposure attendant to these jobs
occurred but was not significant due to a low likelihood that exposures exceeded
established occupational health standards. The Board believes that this
presumption is not justified, because it assumes that occupational health standards
were fully protective and that DOE worksites were in full compliance with such
standards. Since the former is not true and the latter is not proven, the Procedure
Manual should take a more neutral stance on this issue and encourage an unbiased
industrial hygiene assessment to determine the importance of exposures in the
relevant claims. Thus, there should be no exposure presumption about the levels
of asbestos exposure and their significance for jobs other than those in List 3a(1)
between 1987 and 1996. When such claims are referred for an industrial hygiene
assessment, the industrial hygienist will determine the significance of exposure to
asbestos.

DOL Response — DOL applies a presumption of high exposure to asbestos for
any employee working one of the qualifying labor categories listed in PM 15-
4.3a(1) through December 31, 1987. As is noted in response to #2 above, DOL
assumes that asbestos exposure occurred by other labor categories; however, the
characterization of such exposure is dependent on an industrial hygienist
assessment. DOL considers the existing procedural guidance to accommodate
the Board’s recommendation.

. The asbestos diseases causation presumption adds a requirement of “day by day”
exposure for all but two asbestos disease categories. This measure of exposure
frequency should be presumed for claimants who meet the asbestos exposure
presumption of significant exposure noted above [List 3a(1)]. The Board
recommends that “day by day” be retained only for evaluating the claims that are
undergoing review by an industrial hygienist.

DOL Response — DOL agrees with the Board and it has already taken the
initiative to remove references to “day by day” exposure from the Procedure
Manual. EEOICPA Transmittal 19-02, dated May 16, 2019, revised the DEEOIC
Procedure Manual to version 3.1. As part of this revision, DOL revised Exhibit
15-4 to exclude reference to “day by day” exposure for the presumptive
standards. for angiosarcoma, asbestosis, laryngeal cancer, leukemia, lung cancer,
mesothelioma, ovarian cancer, and pleural plaques.

. List 3a(1) (Table 3) has many important maintenance and construction job
categories but lacks selected job titles that were reasonably presumed to have been
exposed to asbestos prior to 1997. An examination of the SEM-listed labor
categories from five DOE sites or labor groups (Hanford and PNNL, K-25, Y-12,
Idaho National Lab; and Construction) yielded a supplemental list (Table 4) as
determined by a subset of Board members. Examples of important exclusions
include janitor, HVAC mechanic, instrument mechanic, elevator mechanic, and

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 7 of 19


4. EEOICP presumes that all job titles other than those on List 3a(1) do not
have significant asbestos exposure after 1986.

These presumptions are summarized in Table 1.

B. Asbestos Disease Causation Presumptions

For any of the seven asbestos-related diseases, EEOICP requires as a matter of
a causation presumption that the clamant have a “significant level” of
exposure to asbestos. The level (high, medium, or low) of significant
exposure to asbestos is not specified with reference in the causation
presumption. See the summary in Table 2 below.

IL. The Board has several important residual concerns and recommended revisions:

1. Since the asbestos disease causation presumption criteria include “significant
exposure” (as defined by the exposure presumption) without regard to whether
such exposure is high, medium or low, the designation of asbestos exposure for
List 3a(1) labor categories as high, medium, or low in the exposure presumption is
not used and should be deleted from the Procedure Manual.

DOL Response — DOL agrees with the Board that the characterization of
exposure for application in the standard that exists in Exhibit 15-4.3 should be
limited to that exposure considered “significant” and that the standard should
not apply a further distinction with regard to high, medium, or low exposure.
Moreover, DOL will extend the temporal duration of the applicable standard for
the qualifying labor categories with “significant” exposure to December 31, 1995.

2. For labor categories other than those on List 3a(1), it is reasonable to retain the
presumption that they had “some level of exposure to asbestos” prior to 1987 and
that the industrial hygienist determine the significance of that exposure in
decision-making on claims.

DOL Response — DOL agrees and notes that this guidance exists in Exhibit 15-
4.3a(2) of PM v3.1:

(2) All other labor categories are assumed to have had some
level of exposure to asbestos. However, such levels are
ascertained by an IH. The IH will determine if the level of
exposure was significant (high, moderate, or low) or not
significant (incidental-occurring in passing only).

3. However, the Procedure Manual contains a clear negative presumption about
asbestos exposure for jobs other than those in List 3a(I) between 1987 and 1996.

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 6 of 19


occupational safety and health standards at DOE with the progression of time. DOE has
also taken other actions to enhance employee protections. For example, DOE typically
adheres to the American Conference of Governmental Industrial Hygienists (ACGIH)
Threshold Limit Values — Time Weighted Average (TLV-TWA) values, which are
generally more stringent than the OSHA Permissible Exposure Limits (PELs). This is
significant because PELS are OSHA enforceable legal standards. They are relevant in this
discussion because they reflect the language that is currently used in the industrial hygiene
reports regarding exposures after the mid-1990s (i.e., within existing regulatory standards).
In considering these realities, DOL Industrial Hygienists continue to assess exposures for
the entire work history of each employee, regardless of the temporality of that employment.
However, DOL Industrial Hygienists must use their best judgment and consider the
systemic changes that occurred in the mid-1990s that indicate that significant exposures to
toxic substances were less likely.

In its Industrial Hygiene assessments, DOL has never suggested that significant exposures
could not occur during any period of employment through the present. DOL’s Certified
Industrial Hygienists thoroughly review each industrial hygiene referral, including all
accompanying documentation (i.e., OHQ, EE-3 forms, additional work statements,
affidavits, site IH records, etc.). Where the evidence provides sufficient compelling
justification, the DOL Industrial Hygienists assign significant exposures to employees
regardless of when the employee worked. There are many instances, for example, where
post-1995 industrial hygiene personal data have shown excursions above the American
Conference of Governmental Industrial Hygienists Threshold Limit Values — Time
Weighted Average values for asbestos and/or lead. In these scenarios, DOL Industrial
Hygienists will describe such evidence in their reports and assign exposures for the
duration of the sampling events (despite the documented use of full PPE, including
respiratory protection, which exceeded the necessary protection factor). In other instances,
employee descriptions of specific work activities or other work processes will be of such
convincing quality to warrant affirmation of significant exposure even in the absence of
specific monitoring data.

DOL’s Industrial Hygienists take the position that unless there is some definitive evidence
of significant exposure past the mid-1990s, whether that is specific monitoring data or
other information of exposure, it is a disingenuous application of industrial hygiene
principles to make affirmative findings of significant exposure. Moreover, the assistance
that DOL provides in characterizing employee exposure is open to challenge during the
claim adjudication process. A claimant may choose to provide additional information that
supports an argument of higher exposure than assigned by a DOL Industrial Hygienist.
This includes evidence that significant exposure occurred for any period, whether that is
before or beyond the mid-1990s.

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 19 of 19


Table 1. EEOICP Procedure Manual V2.3, Exhibit 15-4, Asbestos Exposure Presumption

Time Job Overall Exposure Specific Exposure
period Category
. presumed to be .
pre-1987 3a(l) tist “significant” high
significance
pre-1987 other jobs presumed « have ned determined by
po industrial hygienist
(high moderate, low)
. presumed to be
1987-1995 3a(I) list “significant” low
1987-1995 other jobs presumed to be -
‘not significant”

Source. EEOCIP Procedure Manual V2.3

Table 2. EEOICP Procedure Manual V2.3: Exposure Criteria Required for Causation Presumption

Level of Exposure Duration Latency
Asbestosis significant “day by day” 2250 work days. 10 years
Pleural plaques significant “day by day” 2250 work days 10 years
COPD significant 20 years 20 years
Laryngeal cancer significant “day by day” 2250 work days 15 years
Lung cancer significant "day by day" 2250 work days 15 years
Mesothelioma significant "day by day" 230 work days 15 years
Ovarian cancer significant *teoueh s 15 years

1986

Source. EEOICP Procedure Manual V2.3

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 9 of 19


U.S. Department of Labor Office of Workers’ Compensation Programs
Washington, DC 20210

DEC 18 2019

Dr. Steven Markowitz

Chair

Advisory Board on Toxic Substances &
Worker Health

Queens College, Remsen Hall

65-30 Kissena Boulevard

Flushing, NY 11367

Dear Dr. Markowitz:

1 am pleased to provide you the Department of Labor’s response to the recommendations made
by the Advisory Board on Toxic Substances and Worker Health (Advisory Board or Board) at its
February and April 2019 public meetings. The Department appreciates the dedication and
expertise the Advisory Board provides to the Energy Employees Occupational Illness
Compensation Program and its stakeholders. Your important work is making a difference.

On behalf of the Department, the Office of Workers’ Compensation Programs, the Energy
program, and the communities we serve, I look forward to the continued efforts of the Advisory
Board.

Sincerely,
Oo ST
lulia K. Hearthway
Director

Office of Worke: ‘ompensation Programs

Enclosure


Revised Occupational Health Questionnaire Recommendation
(Adopted by the Advisory Board on Toxic Substances and Worker Health, February 28,
2019)

History

The Board adopted a specific recommendation to improve the Occupational History
Questionnaire (OHQ) at the April 2018 meeting. This recommendationincluded:

1. Inclusion of tasks associated with listed toxic materials as well as frequency of
exposure using a scale consistent with the current OHQ and the scale used by
BTMED.

2. Expansion of the hazardous materials list to specifically include a list of
hazards causing chronic obstructive pulmonary disease (COPD) and other health
conditions.

3. Addition of tasks currently used in the exposure assessment by BTMED.

4. Adding a specific question to the OHQ regarding exposure to vapors, gases,
dusts and fumes (VGDF), the most common cause of COPD in the current peer-
reviewed published literature.

In November 2017, the Department of Labor (DOL) provided written responses to the
Board's recommendation. The DOL did not accept the Board's recommendation concerning,
the OHQ revisions nor addition of questions concerning exposures to VGDF. OWCP
welcomed specific recommendations on a draft revised OHQ and- 'a list of toxic substances
that represents vapors, gases, dusts, and fumes.’

In February 2018, the Board considered the OWCP response and reviewed the draft
revised OHQ provided by OWCP. The Board concluded that the draft OHQ provided too
little detail and structure to serve as 'memory triggers' to help claimants recall specific tasks
and exposures at DOE sites. The Board also noted that the recommended OHQ revisions
were closely tied to other Board recommendations intended to improve the quality of
claimant- provided exposure information and use of this information during claim
adjudication.

In August 2018 the DEEOIC stated that it was ‘continuing to review revisions of the
OHQ and will consider the suggestions of the Board’.

RB Jations C ing the Draft Revised OHO

At the November 2018 Board meeting of the newly appointed Board, a working
group was established to further review the draft proposed OHQ. The working group has
performed a detailed review of the current OHQ and the DOL-revised draft OHQ. The

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 12 of 19


Table 4. Job Categories in 3a(I) List and Additional SEM Job Titles from Selected DOE Sites with Presumed Asbestos Exposure

Prior to 1997,

3a1 List

Job Titles that should be added to the 3a1 list*
(presumed asbestos exposure prior to 1997)

Automotive mechanic; Vehicle mechanic; Vehicle
maintenance mechanic

Asbestos Worker*

Boilermaker

‘Auto Body Mechanic’, Auto Body Repair/Painter, Auto Body Repairman,
Mechanic, Auto Paint and Body Repair; Technician, Auto Body

Carpenter; Drywaller; Plasterer

Blacksmith

Demolition technician; Boiler Operator

Laborer Construction Worker
Electrical mechanic; Electrician; Elevator Worker, Construction
Floor covering worker Escort, Construction

Furnace & saw operator, Furnace builder, Furnace operator; Furnace ESH Officer

puller; Furnace technician; Furnace tender; Furnace unloader

Glazier, Glass installer, Glazer Foreman, Crafts

Grinder operator,

Heat/AC, Construction*

Tool grinder;

Janitor, Janitor, Construction

Maintenance mechanic (general grinding);

Laborer; Laborer, Construction*

Welder (general grinding);

Maintenance Worker

Machinist (machine grinding)

Manager, Construction

Insulation worker; Insulation trade worker, Insulator

Mechanic, HVAC; Mechanic, HVAC/refrigeration; Mechanic, Air
Conditioning/Refrigeration; Mechanic, Refrigeration;
Refrigeration worker

lronworker, Mechanic, Instrument
Ironworker rigger Mechanic, Power Equipment
Maintenance mechanic; Mechanic, Service
Electrician; Mechanic, System*

Insulator; Mechanic, Vacuum Equipment

Mason (concrete grinding); Mason; Brick & tile mason;
Concrete and terrazzo worker; Bricklayer, Tilesetter

Technician, Welding*

Millwright Truck Driver, Construction

Heavy equipment operator; Operating Engineer Vehicle and Construction Equipment Mechanic, Construction*
Painter Construction Field Representative

Pipefitter, Plumber steamfitter; Plumber/pipefitter; Firefighter

Plumbing & pipefittingmechanic; Plumbingtechnician, Steamfitter

Roofer Crafts foreman

Sheet metal mechanic; Sheet metal fabricator/installer Lineman

Welder; Welder burner; Welder mechanic Maintenance Shop Laborer

Operator, Steam Plant

Technician, Mechanical

Technician, Instrument

Technician, Maintenance

Technician, Radiation

D&D workers (Deactivation and Decommissioning)

*Job Titles that may or may not already be included on the 3al list
**Selected from SEM job categories from Hanford, PNNL, INL, K-25, Y-12, and Construction

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 11 of 19



others.

DOL Response - DOL will consider additional changes to the list of qualifying
labor categories, however, the standard applies a generalization that extends to
SEM labor categorization without distinction to a particular work site. As DOL
explained in its November 9, 2017 response to the Board, the applicable list of
jobs referenced in the standard derive from research conducted and compiled by
the Agency for Toxic Substances and Disease Registry (ATSDR) in a June 29,
2014 booklet entitled Case Studies in Environmental Medicine, Asbestos Toxicity.
While it may be possible for DOL to add at least some of the recommended labor
categorizations (Table 4) to the asbestos exposure standard, it would be very
helpful for the Board to provide the underlying industrial hygiene or
epidemiological basis for how it determined that each of the additional labor
categories have had significant exposure to asbestos prior to 1995. DOL would
like to ensure a consistent and uniform process for assessing the addition of any
specific labor category to the asbestos exposure standard.

The Board recommends that a Board Committee work with the EEOICP and their
industrial hygiene contractor to examine all SEM job titles and aliases and identify
job titles that should be added to List 3a(1) for the purposes of a presumption of
asbestos exposure.

DOL Response — DOL welcomes any additional input or recommendation the
Board has with regard to the identification and classification of SEM job titles
that likely had a significant exposure to asbestos.

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 8 of 19


California, Massachusetts, Michigan, and New Jersey, 1993-1995. MMWR CDC Surveill Summ
1999; 48: 1-20.

2. Mazurek JM, Filios M, Willis R, Rosenman KD, Reilly MJ, McGreevy K, schill DP, Valiante D,
Pechter E, Davis L, Flattery J, Harrison R. Work-related asthma in the educational services
industry: California, Massachusetts, Michigan, and New Jersey, 1993-2000. Am J Ind Med 2008;
51: 47-59.

3. White GE, Seaman C, Filios MS, Mazurek JM, Flattery J, Harrison RJ, Reilly MJ, Rosenman
KD, Lumia ME, Stephens AC, Pechter E, Fitzsimmons K, Davis LK. Gender differences in
work-related asthma: surveillance data from California, Massachusetts, Michigan, and New
Jersey, 1993-2008. J Asthma 2014; 51: 691-702.

4. Talini D, Ciberti.A, Bartoli D, Del Guerra P, laia TE, Lemmi M, A, Di Pede F, Latorre M,
Carrozzi L, Paggiaro P. Work-related asthma in a sample of subjects with established asthma.
Respir Med 2017; 130: 85-91.

5. Anderson NJ, Fan ZJ, Reeb-Whitaker C, Bonauto DK, Rauser E. Distribution of asthma y
occupation: Washington State behavioral risk factor surveillance system data, 2006-2009. J
Asthma 2014; 51: 1035-1042.

6. Harber P, Redlich CA, Hines S, Filios M, Storey E. Recommendations for a clinical decision
support system for work-related asthma in primary care settings. JOEM 2017: 59;11: e231-235.

7. Tarlo SM, Balmes J, Balkissoon R, et al. Diagnosis and management of workrelated asthma:
American College of Chest Physicians Consensus Statement. Chest. 2008:134:1S-41S.

8. Henneberger PK, Redlich CA, Callahan DB, et al. An official American Thoracic Society
statement: work-exacerbated asthma. Am J Respir Crit Care Med. 2011;184:368-378.

9. Jolly AT, Klees JE, Pacheco KA, et al. Work-related asthma. J Occup Environ
Med.2015;57:e121-e129.

DOL Response — Since the Board’s recommendation was offered, the Division of Energy
Employees Occupational Illness has updated the Federal (EEOICPA) Procedure Manual
(PM) to version 3.1. However, the language the Board referenced in Exhibit 15-4.5cii
remains unchanged from version 2.3, the version the Board referenced in its
recommendation. After considering the Board’s input, DOL is unable to agree to the
proposed language change to the PM.

As the Board notes, the statutory requirement of the Act stipulates that a compensable
condition must result from exposure to a toxic substance. Moreover, as DOL explained in
its November 9, 2017, response to the Board (Recommendation #2 Presumption for Work-
Related Asthma), the standard for evaluating a claim under the Act requires evidence that
a toxic substance was the likely trigger for the condition because a condition can only be

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 4 of 19


descriptions to be provided by claimants. The Board recommends more structure in this
section to aide in claimant recall and assessment of toxic substance exposures based on
duration, frequency, and intensity of exposure. The Board specifically recommends the
following.

1. Within each broad category of toxic substance, a list of specific substances
should be provided similar to the current OHQ. The specific toxic substances
within each category should be carefully chosen to be representative of
exposures most common across DOE sites, with specific attention to toxic
substances associated with the direct disease link work process (DDLWP), to
link medical conditions to specific tasks (Chapter 15 and Appendix 1 of the
EEOICP Procedure Manual (Version 2.3)).

DOL Response — DOL agrees that providing some examples of each category
of toxic substances is useful and will re-incorporate this into the form for
pilot testing. However, our experience has been that it is unreasonable for
interviewers to read aloud long lists of chemicals and pick names. The
purpose of moving to a free form style interview is to give the claimant more
opportunity to describe his/her work in DOE facilities, while at the same time
identifying details of that work that are important to the claim and its
adjudication. DOL wants to obtain objective input from claimants that best
describes their recollection of an employee’s work and exposure history.
Applying techniques to supply pre-selected information that the employee
could attest to absent any corroborating connection to other evidence
obtained during development may produce unauthentic or unreliable
outcomes. The function of the OHQ is to obtain information specific to the
employee’s work and exposure history. Attempting to organize the
presentation of information in a manner that is “representative” of the
exposures that DOL assumes occurred for different pre-selected
categorizations may not result in the accurate capture of information about
the unique features of an employee’s exposure history. Respondents would
be more apt to classify themselves into pre-chosen categorizations rather
than providing their own unique work or exposure experience.

Board recommends that substances from the published literature and/or the
SEM causing or contributing to COPD be included in the specific toxic agents
by major category.

DOL Response — The free form interview technique gives claimants the
opportunity to identify substances linked to COPD and any other diagnosis
that they believe are associated with their DOE employment. Additionally,
the resource centers should not be making determinations or suggestions as to
linkages between toxic substances and diagnosis. The assessment of linkages
between diagnosis(es) and toxic substance exposure occurs during
adjudication process by DEEOIC federal staff. DOL also does not think it
appropriate to focus on one specific diagnosis (or group of diagnoses), such as

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 15 of 19


or liquid?).

The Board notes that radiological hazards are omitted in the broad categories of
exposure in the proposed OHQ. The rational for this exclusion is not clear.
The Board recommends that radiological hazards be retained in the revised
OHQ.

DOL Response — DOL agrees to add a radiological section to the OHQ that
will capture information about exposure to radiological toxic substances.

Section 6: PERSONAL PROTECTIVE EQUIPMENT (PPE)

The current OHQ and the draft revised OHQ both contain a rather extensive listing of
PPE and requests details of use. The Board understands the role of PPE in exposure
mitigation; however, the actual field protection factors provided PPE are often poor. This is
especially true historically when PPE may have been provided in the absence of an adequate
program for proper PPE selection, fitting, deployment, and maintenance. Given these
limitations, the Board recommends that this section of the OHQ be limited in scope or
eliminated. The Board does not believe that positive answers to having worn PPE should be
used as a factor in denying claims.

The Board recommends expedited review of this recommendation so the process of
revising, pilot-testing, and implementing a revised OHQ can proceed in a timely manner.

DOL Response — DOL agrees that there is little beneficial use of the PPE information
requested by the current OHQ. DOL agrees to eliminate this section of the OHQ.

Rationale

The current recommendations are similar in scope and intent as the Board's original
recommendations; therefore, the prior stated rational and references apply and are not
repeated. An additional reference is provided for the proposed exposure frequency scale as
well as a more general reference concerning the design of occupational exposure
questionnaires.” .

References

1. Dement J, Welch L, Ringen K, Quinn P, Chen A, Haas S. A case-control study of
airways obstruction among construction workers. American journal of industrial
medicine. 2015;58(10):1083-1097.

2. Nieuwenhuijsen MJ. Design of exposure questionnaires for epidemiological studies.
Occup Environ Med. 2005;62(4):272-280, 212-27.

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 17 of 19


~

work-related asthma remain poorly defined. Thus, the request that the physician identify the
mechanism of disease is not feasible and should be deleted.

We also recommend revising the description of “the strongest justification.” Most work-
related asthma is caused by a toxic substance, so such cases satisfy the relevant statutory
requirement noted above. However, in the great major of cases of work-related asthma, there are
usually multiple exposure events and toxic substances rather than a single specific incident, so
that singling out the one incident and agent that is a “most likely trigger” would be arbitrary and
not possible in the great majority of cases. Therefore, the scenario for the “strongest justification
for acceptance” outlined above is unrealistic and suggests a standard that could only be met by a
small minority of cases of work-related asthma. The effect will be to deny the claims of
legitimate cases of work-related asthma. It is also not a standard recommended in any of the
professional guideline documents related to work-related asthma.

The Board recommends the following revised wording for the Procedure Manual:

ii. After a period of covered employment, a qualified physician conducts an
examination of either the patient or available medical records and he or she
concludes that the evidence supports that the employee had asthma and
that an occupational exposure to a toxic substance was at least as likely as
not a significant factor in causing, contributing to or aggravating the
condition. The qualified physician must provide a well-rationalized
explanation with specific supporting information, including the basis for
diagnosing asthma or worsening asthma at the time of covered
employment and the basis for the relationship between asthma and the
covered workplace.* If the CE is unable to obtain the necessary medical
evidence from the treating physician to substantiate the claim for work-
related asthma, the CE will need to seek an opinion from a CMC. Ifa
CMC referral is required, the CE will need to provide the CMC with the
relevant medical evidence from the claim file and provide a detailed
description of the employee's covered employment which should include
each covered worksite, dates of covered employment, labor categories, and
details about the jobs performed.

* Note: examples of supporting information could be provided here or in training materials.

The Board also notes that the Table entitled Asthma, Occupational (Procedure Manual 2.3,
page 543; Appendix 18-1) has not been updated and requires revision to be consistent with the
relevant text in the revised Procedure Manual.

References:

. Jajosky RA, Harrison R, Reinisch F, Flattery J, Chan J, Tumpowsky C, Davis L, Reilly MJ,

Rosenman KD, Kalinowski D, Stanbury M, Schill DP, Wood J. Surveillance of work-related
asthma in selected U.S. states using surveillance guidelines for state health departments—

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 3 of 19


Revised Recommendation for Work-Related Asthma

(Adopted by the Advisory Board on Toxic Substances and Worker Health, February 28, 2019)

The Board recognizes the modifications made by EEOICP in the provisions relevant to
work-related asthma as reflected in the EEOICP Procedure Manual V2.3, Appendix 1. It is also
cognizant of the statutory requirement that a compensable condition under EEOICPA must be
aggravated, contributed to, or caused by a toxic substance.

However, there remains one section where the current language of the EEOICP Procedure
Manual is so divergent from current medical guidelines and practice that the Procedure Manual
requires correction (bolded language below).

Procedure Manual Appendix 1 (Exposure and Causation Presumptions with Development
Guidance for Certain Conditions), Section Sc(ii) includes the following (bolding language of
note):

ii. After a period of covered employment, a qualified physician conducts an
examination of either the patient or available medical records and he or she
concludes that the evidence supports that the employee had asthma and
that an occupational exposure to a toxic substance was at least as likely as
not a significant factor in causing, contributing to or aggravating the
condition. The qualified physician must provide a well-rationalized
explanation with specific information on the mechanism for causing,
contributing to, or aggravating the conditions. The strongest justification
for acceptance in this type of claims is when the physician can identify
the asthmatic incident(s) that occurred while the employee worked at
the covered work site and the most likely toxic substance trigger. A
physician's opinion that does not provide a clear basis for diagnosing
asthma at the time of covered employment or the physician provides a
vague or generalized opinion regarding the relationship between asthma
and occupational toxic substance exposure will require additional
development including the CE's request for the physician to offer further
support of the claim. If the CE is unable to obtain the necessary medical
evidence from the treating physician to substantiate the claim for work-
related asthma, the CE will need to seek an opinion from a CMC. Ifa
CMC referral is required, the CE will need to provide the CMC with the
relevant medical evidence from the claim file and provide a detailed
description of the employee's covered employment which must include
each covered worksite, dates of covered employment, labor categories, and
details about the jobs performed.

Physicians generally understand “mechanism of disease” to mean the cellular or
physiologic processes and mediators that cause a disease. As with most disease processes,
clinicians would not be able to identify a “mechanism” for work-related asthma, as clinical tools
generally do not identify mechanisms of disease, and in addition, because the mechanisms of

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 2 of 19


working group also considered the prior Board recommendations concerning the current
OHQ and the DOL responses.

The Board notes the following:

1. While free text descriptions of work and exposures are often extremely
valuable, it remains the Board's opinion that the draft revised OHQ lacks
sufficient structure and detail to help claimants recall and record toxic
substance exposures experienced at DOE sites.

2. The Board believes that some sections of the current OHQ that are omitted or
significantly modified in the DOL-revised draft OHQ provide information
potentially useful in claim evaluation and adjudication.

3. There are some sections of the draft revised OHQ that may require claimants
significant time to complete but provide information of marginal use in
evaluating claimed exposures. Therefore, Board recommends that some
sections be dropped or substantially reduced in scope.

The following are the Board's recommendations on the draft revised OHQ by section.
The Board has no recommendations for OHQ sections not discussed below.

DOL Response —- DOL appreciates the Board’s input with regard to improving the OHQ.
DOL notes that the Board asked DOL for an expedited review of the OHQ
recommendation so that the process of revising, pilot testing, and implementing a revised
OHQ can proceed in a timely manner. DOL agrees with this sentiment and it has already
been working with the SEM contractor to make updates to the OHQ. Once DOL develops
a revised OHQ, including changes suggested by the Board, DOL intends to conduct a pilot
test. DOL agrees with the Board on its recommendations that the OHQ include more
structure to content, adoption of a frequency scale, as well as adding a duration inquiry. In
response to each recommendation, DOL has provided further explanation to its position in
the following section. DOL expect further edits and changes to the OHQ based upon
results of pilot testing. Accordingly, adjustments may be needed which may differ in some
ways from what is discussed below.

Board Recommendations:

Section 4(0): LABOR CATEGORY (While employed at a DOE Facility)

The SEM plays an important role in the assessment of claimant exposures. Site and labor
category are used by the SEM as primary variables in determining claimant exposures.
While the labor categories and sub-categories in the Excel file dropdown list (or Attachment
3.A) seem appropriate for broad classification, it is not clear how these tie with the SEM jobs
and job aliases? These ties should be made as explicit as possible, realizing the large number
of jobs across DOE sites.

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 13 of 19


COPD, in the OHQ.

Claimants should be allowed to add other toxic substances not specifically
listed, with comparable data collected for these added substances.

DOL Response — DOL agrees that claimants be given this opportunity and
the planned OHQ improvements include this option.

The Board notes that the current OHQ has an extensive list of 'High
Explosives' and recommends that some attention be given to reducing the
number of listed materials to those most common across DOE sites.

DOL Response — DOL agrees that DOE did not use high explosive substances
extensively across the entire atomic weapons complex. Heavy use of these
materials occurred only at a few select sites. As a result, DOL agrees to
eliminate this section from the OHQ. Claimants who worked with such
materials should be able to identify them individually when responding to the
question relating to other toxic substance encountered.

Frequency of exposure to each toxic substances should be recorded ona
qualitative scale such as previously described (e.g. Rarely, Monthly, Weekly,
Daily).

DOL Response — DOL agrees to add a request for qualitative exposure
information.

Duration of exposure (e.g. years or months) should be recorded for each
reported exposure.

DOL Response — DOL agrees to modify the OHQ to include this information
in the interview, and will evaluate the efficacy of this approach during pilot

testing.

Exposure intensity should be addressed by allowing the claimant to describe
how they were exposed to each toxic substance, with an emphasis on specific
tasks preformed with or around toxic substances.

DOL Response — DOL agrees to modify the OHQ so the interviewer will ask
the claimant to explain the usage of each toxic substance referenced.

A check box should be added for each toxic substance to indicate if work with
or around the toxic material resulted in exposures to vapors, gases, dust, or
fumes (VGDF).

DOL Response — DOL will add a request to the OHQ to have the interviewee
report on the form of each toxic substance (e.g., is it a dust, gas, fume, solid

DOL Responses to Advisory Board February and April 2019 Meeting Recommendations
Page 16 of 19