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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JUNE 16, 2020

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The Advisory Board met via teleconference, Steven 

Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

JOHN DEMENT

GEORGE FRIEDMAN-JIMENEZ

MAREK MIKULSKI

KENNETH SILVER

MEDICAL COMMUNITY

MANIJEH BERENJI

ROSE GOLDMAN

STEVEN MARKOWITZ, Chair

CARRIE A. REDLICH

CLAIMANT COMMUNITY

KIRK DOMINA

RON MAHS

DURONDA POPE

CALIN TEBAY

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
Welcome/Introductions:

Mr. Chance called the meeting to order at 12:12 p.m. and noted 

that the meeting was conducted via teleconference as a 

precaution against the COVID-19 pandemic. He reminded board 

members that the specific content of some materials provided to 

them in their capacity as special government employees could not 

be shared or discussed publicly during the meeting.

The above-listed board members were in attendance. After a round 

of introductions, Steven Markowitz, Board Chair, welcomed 

participants and outlined the day’s agenda. He noted that the 

current board’s term expires in July 2020 and that during this 

meeting they hoped to vote on certain recommendations and 

discuss remaining issues, then complete additional work over the 

remaining four weeks of their term so that they could hand off 

various items to the next board.

DEEOIC Updates

Rachel Pond, Director of the Division of Energy Employees 

Occupational Illness Compensation (DEEOIC), presented updates 

from the DEEOIC program. She summarized the program’s new case 

assignment process, which assigns cases to district offices 

based on a round robin system rather than by jurisdiction. All 

district office staff members have transitioned to complete 

telework in response to COVID-19, and an interactive voice 

response system transfers incoming calls to claims examiners’ 

phone lines. Quality and timeliness remain fairly constant, 

though some record centers and physicians are not able to 

provide materials as quickly as they could before the pandemic. 

The program has published bulletins to allow the temporary use 

of telemedicine, including telemedicine appointments for home 

health care, and under certain circumstances routine physician 

appointments. Resource center hours have changed, but staff 

members have been able to continue teleworking. Starting in June 

at least one staff member will be in the office each day to 

process claims and answer phones. All hearings are currently 

conducted via WebEx or telephone rather than in person.

Due to COVID-19, the program has not conducted their normal 

level of outreach, but they planned to hold a webinar on June 25

to provide updates to stakeholders. The program received the 

board’s recommendations from its last meeting related to the 

occupational health questionnaire (OHQ). As of the current 

meeting, the recommendations were in clearance within the 

Department of Labor, but Ms. Pond said that the program was 
making changes to the OHQ, and they hoped to start piloting 

those changes soon. They have also made some changes to the 

language in Exhibit 15-4 related to asthma, specifically 

removing the reference to mechanism of disease as the board 

suggested in its March 5 letter. In response to the board’s data 

requests, the program provided IH reports on lung cancer and 

post-1995 claims. They have also provided the board with 

examples of physician development letters. Recently the program

provided the contracts that the board requested, and they are 

working on gathering information related to the board’s site 

exposure matrices (SEM) data request. 

Chair Markowitz asked whether the new case assignment process 

could lead to a loss of site-specific expertise developed by 

district offices. Ms. Pond said that the program had considered 

this and they conducted extensive training prior to implementing 

the change. Specialists from each district office gave 

presentations to the other district offices to teach them what 

to look for at certain sites. Those points of contact have also 

been maintained so that claims examiners around the country can 

contact those individuals with questions. They have also shared 

books containing specific site information with each district 

office.

Parkinson’s and Related Diseases – Report and Review of Proposed 

Recommendation

Member Mikulski led the discussion on proposed recommendations 

for Parkinson’s and related diseases. The board developed these 

recommendations in response to several sets of questions from 

the Department. The first set of questions related to the 

diagnosis and terminology of Parkinsonian-type disorders and the 

differentiation between Parkinsonism versus Parkinson’s disease. 

Member Mikulski summarized the board’s recommendation for these 

questions: for purposes of claim adjudication, the clinical 

diagnosis of Parkinsonism should be treated the same as the 

diagnosis of Parkinson’s disease. This recommendation was based 

on the lack of valid clinical diagnostic tests to allow 

differentiation between the disorders. The board also provided 

ICD-9 and ICD-10 codes to assist with the adjudication process. 

The next set of questions from the Department was related to 

exposures associated with the diagnosis of Parkinsonism, with 

specific emphasis on causation and presumptions. For these 

questions, Member Mikulski summarized the board’s recommendation

that in addition to carbon monoxide and manganese products, 

exposure to carbon disulfide and trichloroethylene (TCE) should
be presumed to cause, contribute to, or aggravate Parkinsonism. 

This recommendation was based on ample evidence that these 

exposures were historically common throughout the DOE weapons 

complex and human studies that found an association with 

increased risk of Parkinson’s disease. Epidemiological studies

formed the basis for the board’s recommendation to include the 

minimum exposure duration of eight years. They did not feel that 

there was strong enough evidence to issue a recommendation 

around solvents including methanol, n-hexane, toluene, 

polychlorinated biphenyls, and pesticides. Because this is an 

evolving field, DOL should perform a periodic review of human 

studies to update the list of toxicants associated with 

Parkinson’s diagnoses. The recommendation also included a 

statement to help clarify the recommended use of causation 

presumptions throughout the claim adjudications process.

Member Goldman made a motion to accept the recommendation, and 

the motion was seconded by Member Dement. Chair Markowitz opened 

the floor for discussion. Member Redlich asked about methods to 

determine whether or not a claimant had sufficient exposure to 

the solvents in question. Member Mikulski said that there was no 

quantification of exposure in the studies, but most of them were 

low chronic exposures, which would have been typical for most 

DOE operations. Member Goldman added that the eight-year 

recommendation came from one study that looked at workers with 

long-term exposure. Member Redlich asked if skin exposure was 

another contributing factor, and Member Mikulski said that the 

two main routes of exposure would have been inhalational and 

dermal. Member Goldman noted that the recommendation did not 

specify that the exposure needed to be inhalational. After some 

discussion, board members decided to amend the recommendation to 

specifically include skin exposure as well as inhalation. 

Board Recommendation

After some discussion, the board voted unanimously to submit the 

following formal recommendations to DOL: 

1) “The board recommends that the clinical diagnosis of 

Parkinsonism, as established primarily but not exclusively by a 

neurologist, is treated the same as the diagnosis of Parkinson 

disease throughout the EEOICP claim adjudication process, with 

respective entries of both terms and aliases recommended in the 

DOL’s Site Exposure Matrix (SEM). The board has identified the 

following aliases that are in use for both terms with 

corresponding ICD-9 and ICD-10 codes: 
- ICD-9 332 – Parkinson’s disease

- ICD-9 332.0 – Paralysis agitans, Parkinsonism or Parkinson’s 

disease NOS - not otherwise specified, idiopathic, primary

- ICD-9 332.1 – Secondary Parkinsonism

- ICD-10 G20 – Parkinson’s disease, Hemiparkinsonism, Idiopathic 

Parkinsonism, Paralysis agitans, Primary Parkinsonism

- ICD-10 G21 – Secondary Parkinsonism.”

2) “The board recommends that in addition to carbon monoxide and 

steel/manganese products already included in the EEOICPA 

Procedure Manual and DOL Site Exposure Matrix, exposures to 

carbon disulfide (CS2) and trichloroethylene (TCE) be presumed 

to cause, contribute, or aggravate Parkinsonism. These exposures 

were present in the DOE weapons complex and have been shown to 

be associated with increased risk of Parkinsonism in human 

studies. The board also recommends, based on epidemiologic 

studies, a minimum exposure duration of eight (8) years, either 

through inhalation and/or skin absorption, for Part E causation 

in adjudicating Parkinsonism claims with exposures to carbon 

disulfide and trichloroethylene.”

“At present, the board issues no recommendations for methanol, 

toluene, n-hexane, and polychlorinated biphenyls (PCBs), or 

other work–related exposures common throughout the DOE weapons 

complex. The board also issues no recommendation for pesticides 

or specific pesticide products that may have been used on DOE 

installations. Current evidence is not sufficient to support a 

presumption of these additional agents with regard to 

Parkinsonism. As new research is emerging, the board recommends 

a periodic review of human studies literature on risk factors 

for Parkinsonism for DOL to provide updates in this field. 

Presumption of causation implies the judgment that the 

literature at the current time is sufficient to support the 

statement that the exposure can contribute to causation of the 

disease or aggravate the course of the disease in exposed 

populations, and the judgment that the degree of exposure in the 

individual is sufficient to have produced this contribution to 

causation in that individual.”

“This use of presumptions is intended to identify the subset of 

people with the straightforward presentations to streamline the 

compensation process by eliminating the need for detailed causal 

evaluation by the physician and industrial hygienist. It must be 

emphasized that if an individual does not meet the criteria for 

the presumption of causation, this does not imply that there is 

not sufficient evidence of causation. It simply means that 

individuals who do not meet these presumptive criteria and would 
need to be evaluated through a fact-based process entailing 

industrial hygiene and medical review to make the judgment 

whether the exposure contributed to causation of the disease.”

Asbestos Job Titles – Report and Review of Proposed 

Recommendation

Chair Markowitz summarized the proposed recommendation that the 

Department evaluate the SEM job categories and revise its list 

of occupations with presumed pre-1995 asbestos exposure. He 

presented a list of the current job titles in the Procedure 

Manual (PM) that are presumed to have had significant asbestos 

exposure and summarized the board’s engagement with this issue. 

One publication that the board looked at examined death 

certificate data compiled by NIOSH and provided proportionate 

mortality ratios (PMRs) for different job categories. While in 

2000 very few occupations were identified as having excess risk 

of malignant mesothelioma (a cancer almost always associated 

with asbestos exposure), a 2016 study conducted with more 

extensive data identified more job titles as having excess risk. 

After reviewing this literature, the working group used a larger 

data set from the National Occupational Mortality System (NOMS) 

to look at malignant mesothelioma risk. Compared to the 17 job 

titles that were found to have higher risk in the 2016 study, 

the NOMS identified 64 individual job titles with increased 

malignant mesothelioma risk, based on deaths from 1999-2014. The 

PMR rates were also far higher than those from the previous 

studies. Chair Markowitz said that based on these data, it was 

reasonable to interpret that there was sufficient exposure to 

asbestos in each occupation such that a broad look at malignant 

mesothelioma rates in those occupations showed significant 

elevation. 

Member Silver made a motion to accept the proposed 

recommendation. Member Mahs seconded the motion, and Chair 

Markowitz opened the floor for discussion. Member Dement noted 

that the current list of jobs with asbestos exposure came from 

an older set of the same data that the board was currently 

looking at. The current data set provides more focused attention 

to specific jobs and more data on which to base determinations.

Chair Markowitz added that even though some occupations did not 

appear to have excess risk based on thesee data, individual 

workers who did those jobs could still have elevated risk.

Member Goldman asked if custodians, whose low level chronic 

asbestos exposure was often overlooked, would fall under the 
category of maintenance. Chair Markowitz said that they would be 

included in a group called janitors and building cleaners, but 

that group did not appear to be listed as having an increased 

risk of mesothelioma. He and Member Goldman agreed to add 

language to the recommendation clarifying that even if a 

claimant does not meet the presumptive criteria, a close look at 

the claimant’s prior exposures should be undertaken in order to 

ascertain whether causation exists. Member Silver suggested that 

they add a sentence advising DOL to continue monitoring the 

occupational epidemiological literature for occupations that 

meet the same criteria. Member Dement suggested that they add

that point to the rationale, and Member Silver agreed.

Board Recommendation

After some discussion, the board voted unanimously to submit the 

following formal recommendation to DOL: 

“We recommend that the Department of Labor evaluate the job 

categories and associated aliases for all DOE sites in the Site 

Exposure Matrices and revise its list of occupations with 

presumed pre-1995 asbestos exposure (Exhibit 15-4) to reflect 

current knowledge as summarized in the rationale provided below 

and associated data and references. Supervisors of the listed 

job categories should also be considered for inclusion. For 

people who have other job titles with claims in relation to 

asbestos exposure, a careful investigation of possible 

occupational sources of asbestos exposure should be undertaken. 

In the case of mesothelioma, with greater than 90 percent

linkage to asbestos exposure, all cases should have additional 

inquiry into potential asbestos exposure, even if not among job 

titles for presumed asbestos exposure. A committee of the board 

should work with the Department to conduct this exercise and 

achieve a consensus on a revised list of occupations with 

presumed pre-1995 asbestos exposure.”

SEM – IARC Group 2A Carcinogen – Report 

Member Berenji led the discussion on IARC Group 2A carcinogens. 

She summarized the working group’s previous discussions and 

their review of Group 2A carcinogens, which specifically focused 

on 22 of the most recent agents reviewed by IARC. Member 

Friedman-Jimenez gave his feedback on the quality of IARC’s 

analyses. He suggested that they include a statement, similar to 

those in the previous two recommendations, clarifying what the 

board means by presumption of causation. This statement should 

emphasize the fact that presumption of causation is a tool to 
streamline the process for evaluating cases. He also noted that 

the EPA’s process for establishing causation for chemicals did 

not seem to be as detailed, well-documented or transparent as 

those of IARC or the National Toxicology Program (NTP).

Member Goldman commented on her review of malathion and 

diazinon, both of which were categorized as 2A probable 

carcinogens by IARC in 2014 despite the fact that EPA and ATSDR 

do not list them as carcinogenic. Member Goldman said that based 

on these varying analyses, it was difficult to develop a clear 

cut presumption, though it might be beneficial to suggest added 

history-taking for claimants who used these pesticides in order

to establish causal connections. Member Friedman-Jimenez said 

that making a presumption of causation involved a presumption of 

general causation in populations as well as a presumption of 

exposure in the individual. He said that he was concerned about 

including 2A carcinogens under presumption because by 

definition, it was uncertain whether Group 2A agents caused 

cancer in humans and which organs they affected.

Member Dement said that DOL was asking the board whether there 

was sufficient evidence to link exposures to 2A carcinogens to 

cancers in the SEM, not to establish a presumption. Member 

Friedman-Jimenez agreed that there was a difference between 

having a substance listed in the SEM and having a presumption

spelled out in the PM. Ms. Pond agreed with Member Dement’s 

summary of the program’s request from the board. Chair Markowitz 

said that if IARC rated Group 2A agents as probable human 

carcinogens, the board should take that at face value. He said 

that the only piece of the working group’s review that needed to 

be developed further was to determine which cancer sites could

be reasonably related to the 2A carcinogens. Member Berenji 

agreed that that would be relatively easy to do before the 

board’s term ends in July.

Board Resources Request – Report

Chair Markowitz began a discussion on the board’s request for

additional resources from the Department. The board needs 

assistance in two areas, the first of which is organizing, 

reviewing, and abstracting data from claims and analyzing those 

data. This would involve tasks such as organizing and developing 

a database for abstracted claims data; organizing and indexing 

claims for review; reviewing and abstracting selected data from 

claims; entering and organizing data; and analyzing and 

describing data. These tasks would require certain skills and 

expertise, including administrative assistance, occupational 
medical and epidemiological expertise, IH expertise, and limited 

data analysis and description. 

The board also requires assistance to conduct and describe

scientific and technical reviews on selected topics. For this 

the required tasks would be searching and identifying relevant 

scientific and technical literature in response to board 

requests, and reading and objectively summarizing relevant 

literature with provisional conclusions to board queries. The 

expertise needed would be research assistance, occupational 

medicine, epidemiology, and IH expertise. Member Dement 

commented that these categories captured the board’s most timeconsuming tasks and suggested adding data management as another 

area of expertise. 

Member Friedman-Jimenez said that the people with occupational 

medicine and epidemiology expertise should be able to critically 

evaluate the literature in addition to reading and summarizing. 

Member Dement added that the IH experts should be industrial 

hygienists who are familiar with epidemiology and causation.

Chair Markowitz suggested adding exposure assessment to the 

skills required, and Member Dement agreed. Member Silver 

suggested adding familiarity with the DOE complex as another 

item under the skills and expertise category. Chair Markowitz 

said that at some point a future board would need to make an 

official request for resources, and at that time the write-up 

that this board compiled would help to identify core functions. 

CMC and IH Assessment – Report

Chair Markowitz summarized the working group’s discussions about 

CMC and IH assessments. During their deliberations the working

group realized that the board needed to understand the specifics 

of the program’s current evaluations of CMCs and IHs. This led 

them to request that the Department provide the specific 

language of IH and CMC contracts with Banda Group International 

(BGI) and QTC respectively. Chair Markowitz presented the 

preliminary recommendation: “The board recommends that the 

Department develop an ongoing independent third party-based 

system of periodic evaluation of the objectivity, quality and 

consistency of individual claims assessments provided by program 

industrial hygienists and physicians.”

In the rationale, the working group noted that the program 

currently assessed aspects of the quality of CMC reports through 

a quarterly review of approximately 50 claims by the EEOICP 

medical director. They included a table summarizing the total 
number of each type of review as well as the number of reviews 

that were found to need improvement. As the board had discussed 

previously, while causation reviews did not detect any problems, 

a high percentage of other reports needed improvement. The board 

was still seeking clarification from the Department about the 

extent to which generic problems identified through the CMC 

review were addressed more broadly. The IH assessments do not go 

through a periodic analysis to evaluate patterns of errors; 

instead they are reviewed one by one by federal industrial 

hygienists as they are submitted during the claims evaluation 

process. The board awaits additional information on quality 

assessments of IH reports by BGI. 

Member Dement agreed that there should be an independent 

assessment of CMCs and IHs to eliminate systematic errors. 

Member Silver agreed and asked if, after a DOE denial was 

reversed, the CMC or IH received feedback on what new evidence 

or interpretation was presented to overturn their work. Ms. Pond 

said that the program did not usually send treating physicians’ 

rebuttals back to CMCs, though they did conduct follow-up calls 

with CMCs on a regular basis. Chair Markowitz said that the 

working group will look at the provisions of the contracts and 

incorporate that into the rationale of a draft recommendation, 

which will go to the next board. 

Claims Review (lung cancer, post-1995 claims)

In response to a request from the board, the Department provided 

several lung cancer claims and post-1995 claims. Member Dement

shared one of the lung cancer claims that he reviewed with the 

last four digits 0541. The claimant worked at the Idaho National 

Lab for 11 years between 1980 and 2012 as a heavy equipment 

operator, operating engineer, and working operator foreman. The 

SEM identified asbestos as an exposure, as well as silica, 

diesel, cadmium, nickel, and beryllium. The IH found that 

exposures after 1995 would not be in excess of applicable 

standards under the regulations. The CMC report confused diesel 

fuel with diesel exhaust exposure and misstated the IARC 

categorization of multiple agents. Member Dement said that the 

CMC seemed to cut and paste materials from the Internet, and the 

report should be looked at in detail. 

Chair Markowitz discussed a claim with the last four digits 

1985, where the claimant was a cafeteria worker who was 

misreported as a laborer. He also reviewed a claim ending in 

0932 involving a roofer and janitor who worked at DOE from 2003 

to 2014 and did not meet the criteria for latency. The statement 
of accepted facts (SOAF) stated that the exposures were within 

regulatory limits, and that fact was accepted by the CMC and 

stated as the reason that there would be no occupational 

contribution. The claimant’s personal physician wrote a report 

in opposition to the CMC’s conclusion, and the district office 

director overrode the denial. Chair Markowitz shared another 

claim ending in 5648, which was denied due to the short period 

of time that the claimant worked at DOE. He said that he could 

not find a link in the SEM between the glazier job title and 

lung cancer, but Exhibit 15-4 recognized that job title as 

having significant exposure to asbestos prior to 1995. 

Member Silver said that he reviewed two lung cancer claims where 

the CMCs asserted that because there was no radiographic 

evidence of asbestosis or pleural plaques, the lung cancer could 

not have arisen from asbestos exposure. Chair Markowitz said 

that it was widely accepted that scarring was not necessary to 

confirm asbestos exposure and therefore a causal association 

between lung cancer and asbestos did not require the presence of 

asbestosis or pleural plaques. He presented a claim ending in 

7497 where the claimant spent nine months as a carpenter and did 

not meet the presumption of 250 days of exposure to asbestos. 

The CMC cited a lack of air monitoring results as the reason 

that causality could not be determined, which was an 

unreasonable criterion on which to base the decision. The CMC 

also cited cigarette smoking as critical to the development of 

lung cancer, even though the program has stated that 

consideration of the claims should not include cigarette 

smoking. 

Chair Markowitz presented another lung cancer claim ending in 

6018. The claimant was an iron worker who met the 250-day 

presumption criterion for asbestos but did not meet the 15-year 

latency requirement. Chair Markowitz commented that if they gave 

that case to several different CMCs, they would probably see 

half deciding one way and half deciding the other way, which is 

problematic for consistency. He said that his take-away from 

these reviews was that there is considerable variation in the 

quality of the CMCs, some of which is due to the inadequacy of 

some CMCs.

Member Dement presented several post-1995 claims that he 

reviewed. In a COPD claim ending in 5756, the claimant was a 

non-smoker who worked as a pipefitter at Portsmouth. Most of his 

work took place after 1995, and in the OHQ he mentioned 

exposures to welding fumes while welding in an unventilated shop 

and other confined spaces. The IH assessment relied on the SEM,
and the CMC used the IH report to find lack of causation. Member 

Dement said that he found the assessment to be flawed due to the 

CMC’s assumptions about occupational health and safety 

standards, and the failure of the IH to consider specific 

exposure circumstances. In a case ending in 4550, the claimant 

worked in data quality control near Yucca Mountain and was 

required to come on to the site several times each month and 

enter the exploratory studies facility. The claimant, who was 

diagnosed with silicosis based on a chest x ray and a B read, 

described dusty conditions while driving to the facility and 

inside the facility itself. A supporting physician’s report 

ruled out other causes and identified exposure to silica at 

Yucca Mountain as at least contributory to the claimant’s 

silicosis. Member Dement commented that IHs need to look closely 

at more than just the SEM and the claimant’s job description 

when making claim determinations.

Member Redlich noted that several of the post-1995 claims 

contained themes that the board has seen before. In a COPD claim 

ending in 2876, the SEM acknowledged exposure to asbestos dust, 

cement, diesel exhaust, crystal silica, and welding fumes, but 

the IH opined that exposures past March 11, 1996 would not have 

exceeded regulatory standards, and the CMC agreed that the 

exposures were not a significant factor in causing or 

contributing to COPD. The claimant appealed and gave a 

description of the work that they performed, and Member Redlich 

said that what they described seemed like sufficient exposure to 

establish causation. Member Silver agreed that the board has 

raised many of these issues in the past. Member Dement noted 

that there were a number of claims with four or five different 

exposures identified in the SEM as related to the relevant job 

category and linked to COPD, and the totality of those exposures 

was not taken into account. Chair Markowitz said that the 

default for the CMCs is to look at the IH report or the SOAF, 

which makes their decision much easier. 

Member Silver suggested that while the Department was not open 

to including vapors, gases, dust and fumes in the PM, a middle 

ground approach could be guidance to the IH and CMC in cases of 

COPD to consider as many credibly-documented exposures as 

possible. He cited a claim ending in 4457, where a lab 

technician at Portsmouth was only allowed ammonia, asbestos and 

chlorine exposures in the SEM, even though his case file 

contained evidence that he was exposed to hydrogen fluoride and 

other substances. Chair Markowitz said that the board members’ 

comments on these lung cancer and post-1995 cases could be 

incorporated into the board’s report on the consistency, quality 
and objectivity of IH and CMC reports. He suggested that board 

members follow up on the suggested COPD exposure guidance to IHs 

and CMCs offline and include it in the exit report for the next 

board. 

DOL Request for Assistance – Provider Outreach

Chair Markowitz reminded the board that DOL requested their 

guidance on how to elicit responses from providers. The board 

members looked at examples of development letters provided by 

the Department, including a one-page letter on Parkinson’s 

disease which Chair Markowitz presented as a positive example

because it was concise and provided the necessary information.

In contrast, he presented a letter about neuropathy, which was 

lengthy and full of bureaucratic language. Member Goldman

commented that sometimes it might be helpful to include more 

details so that physicians know what the Department is asking 

them to do, and Chair Markowitz agreed that that could be 

helpful either in the body of the letter or as an attachment. He 

commented that these development letters are labor-intensive and 

should be constructed in such a way that the provider can 

extract the relevant details and insert them into their response 

letters.

Member Dement commented that many of the letters limited the 

assessments of exposures of interest to those that were 

identified by the IH or the SEM. He suggested that the 

development letters should be left more open-ended in case the 

physician had experience with other exposures. Member Redlich 

agreed that the board has raised this issue before, and the 

physician should be asked whether the claimant’s DOE-covered 

work contributed to or caused the disease, rather than presupposing specific exposures. Chair Markowitz pointed out that 

that the language does not include the words “caused, aggravated 

or contributed to by toxic substances,” which the law requires. 

Member Redlich said that the question could still be more openended to account for the information that the Department has 

provided as well as the physician’s own interview of the 

patient.

Additional Issues

Chair Markowitz noted that the current board did not address the 

issue of pre-publication policy revisions. The next board should 

develop a mechanism to make sure that the policy revisions are 

discussed by the board.