UNITED STATES DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES

AND WORKER HEALTH

+ + + + +

SUBCOMMITTEE ON IH and CMC AND THEIR REPORTS (AREA #4)

+ + + + +

MEETING MINUTES

+ + + + +

MONDAY

JULY 18, 2016

+ + + + +

The Subcommittee met telephonically at 2:00 p.m. 

Eastern Time, Rosemary Sokas, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

MARK GRIFFON

MEDICAL COMMUNITY:

STEVEN MARKOWITZ

ROSEMARY K. SOKAS, Chair

CLAIMANT COMMUNITY:

KIRK D. DOMINA

GARRY M. WHITLEY

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
Introductions/logistics

Ms. Rhoads called the meeting to order at 2:02 p.m. The 

subcommittee's task was to help ensure the quality, 

objectivity, and consistency of the work and written 

reports of industrial hygienists (IHs) and contract medical 

consultants (CMCs), and to make certain that their reports 

were as helpful as possible. 

Framing stakeholder issues/Post-1995 memo issues

Member Vlieger said that CMCs and IHs are only allowed to 

answer the specific questions that claims examiners (CEs) 

pose to them. In many cases there are a number of toxins 

appropriate for claimed conditions but the CEs winnow them 

down to two or three obscure ones and the DOL only analyzes 

those toxins in their pure form. Sometimes the CE does not 

question an IH report and there is no peer review. The IH 

does not look beyond what the CE provides. 

CMCs are given limited information on exposures and limited 

questions to answer. Claimants do not get a copy of the CMC 

letter or the CE's framing of the questions. The Procedural 

Manual should dictate that at each step of the process the 

claimant should receive a copy of what information is being 

requested by the CE. 

The subcommittee needs to examine whether IHs are looking 

at the validity of SEM searches. The SEM subcommittee will

look at the differences between the publicly available SEM 

and the SEM the CEs use. 

Member Whitley said he didn't think the IH and the medical 

examiners were getting enough information from the CEs. The 

subcommittee will examine the post-1995 toxic exposure and 

post-1995 hearing loss memos. 

Chair Sokas asked if the subcommittee could get a copy of 

the report from the DOE-OSHA collaboration. 

IH review cases

Member Griffon said that DOL is asking the board to assist 

with the definition of exposure levels by employees, 
recommendations on improving IH narratives, and proper 

assessment of employee toxic substance exposures in the 

absence of occupational safety and health monitoring data. 

The subcommittee needs to know whether there are other 

directives given to the IHs or the CEs regarding exposures. 

It also needs to know who is making the judgements along 

the process, how they are making those judgements, and how 

they are ensuring consistency.

The subcommittee needs to determine whether there are QA/QC 

procedures and if the CEs and IHs have site-specific 

experience. 

Before the subcommittee can make recommendations for 

improvement, it needs to have a full understanding of 

procedures. It wants to know how many claims were handled 

entirely by a CE, how many went to an IH, and if there was 

any effect on whether they were approved. 

The subcommittee will review a sample of claims. It intends 

to examine the entire claims file, see what the CE looked 

at, what they forwarded on, and what the IH looked at. 

Member Griffon said the board might need a contractor to 

assist. Chair Sokas proposed that each member of the 

subcommittee review five cases and report back. DOL should 

provide the subcommittee with a list of the top diagnoses 

and the main reasons that claims were denied or accepted. 

The request to the DOL is to provide a total of 30 cases to 

the subcommittee for review. Personal identifying 

information will need to be redacted. 

The subcommittee wanted to have examples of three major 

consequential illness diagnoses that have been both 

accepted and denied. 

DOL list of questions

·Medical opinions

The main challenge is to have “things fit into boxes” and 

be able to be assessed by someone who is not technically 

trained. The board could figure out better ways of 
fostering communication. Clearer connections between 

exposures and diagnoses are necessary. 

Member Vlieger proposed that the subcommittee review an 

Econometrica report about the most common diseases from the 

Former Worker Screening Program. 

·Sources of information describing the synergistic effects 

of chemical-radiological interventions and resulting health 

effects

IARC has done a large study of synergistic effects of 

radiation, radioactive materials, and chemicals. Each 

subcommittee member will devote time trying to find 

information on this topic prior to the full board meeting.

·Improving the quality of medical reviews of medical 

evidence in weighing conflicting evidence.

This question ought to go to the medical evidence committee 

as well. Member Vlieger noted that the CE and his 

supervisor decide whether or not medical evidence is 

sufficient. Many CEs are attorneys and base their decisions 

on legal training. They often adhere strictly to specific 

definitions. In some instances, the weighing of conflicting 

medical evidence goes to a referee physician. Referee 

reports seldom stray from the initial report. Chair Sokas 

wanted to know how many cases went to the second review or 

to the referee and how often those cases were overturned. 

·Generalization of prior IH and CMC findings pending 

adjudication actions

The subcommittee had difficulty interpreting this question 

meant. It felt it would need to do the quality assessment 

discussed earlier in the meeting. 

Responses to circulars

Circular 1505, the occupational exposure guidance relating 

to asbestos – Chair Sokas will work on a response. 
Circular 1506, post-1995 occupational toxic exposure 

guidance and hearing loss – Members Vlieger, Whitley, 

Domina, and Griffon will work on a response.

The subcommittee should have draft responses completed by 

the end of August so they can be presented as discussion 

pieces at the next full board meeting. 

The subcommittee does not know if a teleconference will be 

necessary prior to the full board meeting. 

The subcommittee adjourned at 4:02 p.m.

I hereby certify that, to the best of my knowledge, the foregoing minutes are on accurate summary of the meeting.

Submitted by:

__________________________

Rosemary K. Sokas, MD, MOH, M.Sc

Chair, Subcommittee on IH & CMC and Their Reports

Advisory Board on Toxic Substances and Worker Health

Date: 10/__/2016