1 

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 COURT REPORTERS AND TRANSCRIBERS 

 1323 RHODE ISLAND AVE., N.W. 

(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com 

 U.S. DEPARTMENT OF LABOR 

 + + + + + 

 ADVISORY BOARD ON TOXIC SUBSTANCES 

 AND WORKER HEALTH 

 + + + + + 

 MEETING 

 + + + + + 

 FRIDAY 

 NOVEMBER 6, 2020 

 + + + + + 

The Board met telephonically at 11:00 

a.m. Eastern Standard Time, Steven Markowitz, 

Chair, presiding. 

MEMBERS 

SCIENTIFIC COMMUNITY 

AARON BOWMAN 

MARK CATLIN 

KENNETH Z. SILVER 

MIKE VAN DYKE 

MEDICAL COMMUNITY 

GEORGE FRIEDMAN-JIMENEZ 

ROSE GOLDMAN 

STEVEN MARKOWITZ 

MAREK MIKULSKI 
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CLAIMANT COMMUNITY 

JIM KEY 

DURONDA M. POPE 

CALIN TEBAY 

DIANNE WHITTEN 

DESIGNATED FEDERAL OFFICIAL 

MICHAEL CHANCE 
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 CONTENTS 

Introductory Remarks 

Michael Chance, DFO ...................... 4 

SEM Demonstration 

 

John Vance, DEEOIC Branch Chief, 

Policy, Regulations, and Procedures ..... 11 

Board Discussion 

Dr. Steven Markowitz, Board Members ..... 64 

 a. Board request for SEM documentation 

 for selected Job titles ................. 69 

b. Board request for resources ......... 102 

Break ....................................... 109 

c. Draft Board report on integration of 

 IARC 2A carcinogens into site 

 exposure matrices ...................... 110 

d. Assessment of the quality, 

 objectivity, and consistency of 

 physicians and industrial hygienists 

 in claims process ...................... 153 

e. Follow-up on prior Board 

 recommendations ........................ 173 

f. Additional and new issues ........... 186 

Review of public comments 

Dr. Steven Markowitz ................... 189 

Board Work Plan ............................. 196 

Close of Meeting ............................ 201 
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 P-R-O-C-E-E-D-I-N-G-S 

 11:07 a.m. 

MR. CHANCE: Good morning. Can you 

hear me okay? I just want to make sure I can 

confirm. 

 MR. BIRD: Yes, we can. 

MR. CHANCE: All right. Thank you so 

much. 

Good morning, everyone. Today is 

November 6th, 2020. And welcome to day two of 

the teleconference meeting of the Department of 

Labor's Advisory Board on Toxic Substances and 

Worker Health. Once again, my name is Michael 

Chance. And I am the Board's designated federal 

official or DFO. 

As I mentioned yesterday, we 

appreciate the Board members participation in 

this meeting today, and continue to welcome those 

of you who are newly empaneled to serve on the 

Board. And we appreciate your time and attention 

to the materials that were presented yesterday 

and the materials that will be presented today. 
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 So we had good meeting yesterday and 

hope to wrap up with further fruitful discussion. 

We're scheduled to meet today from 11:00 a.m. to 

3:00 Eastern Time p.m. Today there will not be a 

public comment period. 

 Today, as you are aware, like our 

recent April and June meetings, this meeting will 

be completely virtual as a precaution against the 

COVID-19 pandemic. As always, I hope everyone is 

staying safe out there, taking the proper 

precautions. 

 And using this format is designed to 

ensure everybody on my team, as the DFO, I am 

joined virtually by Ms. Carrie Rhoads from the 

Department of Labor and Mr. Kevin Bird from SIDEM 

which is the contractor that assists us in 

managing Board activities. 

Much of what I am about to say was 

said yesterday. But please bear with me as I 

must make sure that all of this information is 

entered into the official record of today's 

transcript. 
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 Regarding meeting operations, 

planning, there is an agenda to the meeting which 

is posted. There are scheduled breaks. 

Yesterday we did really well, kept on time. So 

generally Dr. Markowitz, as the Chair, decides 

when those breaks are appropriate. So just bear 

in mind that we will be breaking a couple of 

times through the day to give everybody an 

opportunity to get a little break. 

 Copies of all meeting materials and 

any written public comments are or will be 

available on the Board's website under the 

heading meetings, and a listing there for the 

subcommittees. 

 The documents will also be up on the 

WebEx screen so everyone can follow along with 

the discussion. You can visit the Board webpage 

for additional information. After today's 

meeting, you'll see a page dedicated entirely to 

the day's meeting. 

 The webpage contains publicly 

available materials submitted to us in advance of 
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the meeting. And we appreciate that materials 

are submitted in advance, well in advance so that 

we have an opportunity to be able to post them 

properly and timely. 

We will publish any materials that are 

provided to the subcommittee. There you should 

also find today's agenda, as I mentioned, as well 

as instructions for remote participation. If 

anyone is having a problem, please email us at 

energyadvisoryboard, that's all one word, 

@dol.gov. 

 If you're joining us by WebEx, please 

note that the session is for viewing only, unless 

you're a panel participant, and will not be 

interactive. Phones will also be muted for nonAdvisory Board members. 

 Please note that this continues to be 

a new way of conducting these meetings. We ask 

that you be patient as we work through any 

technological issues that we may encounter. 

Fortunately, we didn't encounter any yesterday. 

And you may contact Ms. Rhoads or Mr. Bird for 
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any technical assistance throughout the meeting 

as needed. 

 A few notes on the transcripts and the 

minutes to the meetings. Transcripts and minutes 

will be prepared from the meeting today, and our 

discussions that evolve out of that. During 

Board discussions today, as we are on a 

teleconference line, please speak clearly enough 

for the transcriber to understand. There is a 

court reporter transcribing all of our 

statements, so please make sure that you are 

enunciating and speaking clearly. 

 When you begin speaking, especially at 

the start of the meeting, please state your name 

so we can get an accurate record of the 

discussions and who said what. Also I'd like to 

ask our transcriber to please let us know if 

you're having an issue with hearing anyone or 

with recording. 

 Yesterday we had a couple of problems 

with people. Primarily one of the big downsides 

to this mode of communication is cell phones 
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sometimes do cut out. So I ask the court 

reporter to please let us know if there are any 

problems with that. 

As the DFO, I see that the minutes are 

prepared and ensure they are certified by the 

Chair. The minutes of today's meeting will be 

available on the Board's website no later than 

90, I'm sorry, 90 calendar days from today per 

FACA regulations. And if available sooner, they 

will be published before the 90th day. 

 Also, although formal minutes will be 

prepared, we'll also be publishing verbatim 

transcripts which are obviously more detailed in 

nature. Those transcripts should be available on 

the Board's website within 30 days. 

 I would like to remind Advisory Board 

members that there are some materials, and I made 

this statement yesterday, there are some 

materials that have been provided to you, in your 

capacity as special government employees and 

members of the Board, which are not for public 

disclosure and cannot be shared or discussed 
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publicly, including in this meeting. Please be 

aware of this. 

As we continue with the meeting today, 

these materials can be discussed in a very 

general way, which does not include using any 

personal identifiable information such as names, 

addresses, specific facilities, this case that is 

being discussed, or also doctors' names. 

 Important reminder regarding 

non-disclosure agreements. Recently Board 

members have been granted access to redacted 

information, such as contract information. 

Please be mindful that Board members sign nondisclosure agreements to get access to this 

information and vital contract information. So 

the terms of the contract cannot be disclosed or 

discussed. So these are better discussed in a 

working group. Please keep that in mind as we 

proceed with the meeting today. 

 One final note on question and answer. 

 Again, like I stated, Dr. Markowitz has agreed 

to control the Q&A period. I do believe that we 
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have enabled a hand-raise mechanism. People can 

raise their hands. But I think it was helpful 

yesterday to have people hold their questions 

until the end of the presentation, so where that 

is possible. 

And with that, I appreciate your 

patience, because I had to kind of plow through 

all that. And at this moment, I formally convene 

this meeting of the Advisory Board on Toxic 

Substances and Workers Health. 

 I will now turn it over to the capable 

hands of Mr. John Vance, who will provide very 

valuable Site Exposure Matrices demonstration for 

you all. So I hope you find that very 

informative. Mr. Vance? 

MR. VANCE: Dr. Markowitz, I didn't 

know if you wanted to do any introductory 

comments today before I begin. 

CHAIR MARKOWITZ: No, that's fine. We 

can just begin. Thank you. 

MR. VANCE: All right. I'm going to 

go right into it then. So give me a second here 
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while we share the screen. All right, Kevin, can 

everyone see this? 

MR. BIRD: Yes, we can. 

 MR. VANCE: All right. So again, this 

is John Vance. I'm the Policy Branch Chief for 

the program. I'm going to be running through a 

very quick presentation on our site exposure 

matrices, which is a really important research 

tool that our staff utilizes in case adjudication 

activities. 

 And it's something that, as Board 

members, you definitely want to be familiar with. 

I know that the existing numbers have a pretty 

good comfort level with this. But for you folks, 

this is definitely something that you want to pay 

attention and know that this is a very important 

resource to understand and also use in our 

process of evaluating cases. 

So like I was explaining yesterday, 

you know, our process is really hindered by the 

lack of information in these cases when it comes 

to establishing exposure information, like what 
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are the toxic substances that employees encounter 

during the course of their employment. 

And so we very rarely have any kind of 

specific industrial hygiene monitoring data. 

Very rarely do we have any information at all. 

So the program, when it first initiated under 

Part E, we knew that there needed to be resources 

and efforts put to trying to collect information 

to assist claimants in their claims. 

 Because in the absence of any kind of 

factual information on exposures to toxins, it's 

left to the claimant to try to produce that 

information. And that was just going to be 

untenable. So the Department of Labor initiated 

the development of the site exposure matrices to 

assist claimants in processing cases through the 

legislative mandated criteria. 

And so what is the site exposure 

matrices? It's a database. At the end of the 

day, that's what it is. It's a searchable 

database that's got millions of lines of 

information about the different facilities that 
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are connected with work that was done in 

conjunction with the production atomic weapons. 

It is a huge, immense database. It is 

something that has evolved since 2004 when we 

first started collecting information with regard 

to these sites. We have a contractor that 

manages this resource, Paragon. It is a contract 

which has actually been renewed as of April of 

this year. 

 So Paragon continues to be the 

contractor that oversees not only the collection 

of information, but also the maintenance of the 

database and the maintenance of the documentation 

that supports the information that's reported in 

the database. 

The data that you will identify when 

you do your research in the site exposure 

matrices is derived from historical documentation 

describing operations that occurred at the 

different facilities around the country. 

So the contractor that runs this in 

cooperation with the Department of Labor, when 
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the site exposure matrices was being built out, 

we initially did a canvassing of different sites, 

meeting with workers, trying to collect 

information about the site. 

 We have tried to collect information 

and documentation regarding those activities so 

that we can begin populating this database with 

information identifying the toxic substances that 

were utilized at these sites and also being able 

to identify certain connections to those toxins 

based on different filtering criteria. 

 So what we have in this database now 

is a lot of information that is relational. It 

is something that we can go in and say okay, 

what do we know about this type of work activity, 

this type of health effect, and the type of 

activities that were occurring at different 

locations, and try to create a filtered list of 

toxins that we can associate with a particular 

case, okay. 

So in our discussion yesterday, when 

we were talking about the occupational history 
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questionnaire, and the ability of claimants to 

submit information in support of their case, that 

is what is critical in starting to build out the 

factual framework for the toxins that that person 

likely had encountered during their work. 

So when we first get a claim, we're 

going to ask that claimant, tell us all about 

what you did, what is it that you know about the 

different materials that you worked with. 

 And then what we will do is also look 

at other information that we collect through that 

document acquisition request that Rachel 

mentioned yesterday, that's all the employment 

data that we would get from the Department of 

Energy about the work activities of the employee. 

With that information, the claims 

examiner is then going to start trying to 

identify and build out information that we can 

then relay to a physician, or apply in some sort 

of presumptive standard in determining whether or 

not we can have information about the toxins that 

that person encountered, linked to their 
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condition, that are essentially creating that 

causal relationship, that your exposure to these 

toxins had some resulting health effect or 

disease. 

 In other words, if you're presenting a 

case for COPD and have worked at a particular 

facility, we need to be able to identify, okay, 

what were the toxins that you likely came into 

contact with that are linked to, that's linked to 

COPD. And we go about using these filtering 

criteria to do that. And you can see the 

filtering criteria that we have available. 

 And I'll run through a quick demo at 

the end of this in a particular situation. So it 

really is a terrific resource. And again, this 

is a Department of Labor sponsored resource tool. 

It is something that, you know, we not only 

finance but it's also something that we work 

with, with regard to continually evolving the 

information. 

 Every day, every week, the contractor 

is adding information as they collect new data. 
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We also have a portal, I'll show you that in a 

moment, where people can submit additional 

information for our contractor to evaluate for 

change and sending the information profiled in 

the site exposure matrices. 

Just a word of complexity here. There 

are actually two separate variants of the site 

exposure matrices. There is a variant that is 

available to employees that is updated on a real 

time basis. And about every six months, that 

system is frozen in place. And then a version of 

that is evaluated by the Department of Energy for 

a public release of that data. 

 And so then what happens is that 

frozen picture of the site exposure matrices is 

vetted for security purposes and then is 

published publicly on our site exposure matrices 

public website, which is what I'll show you 

today. 

 So just to understand, there are two 

variants of them, but they are reporting the same 

exact information. It's just that you might have 
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a six-month lag or shorter periods of time 

between the employee variant and then the public 

variant. 

 Like I mentioned, you know, in any 

kind of worker compensation situation, you're 

always trying to build out an accurate 

understanding of the factual circumstances of the 

case. That's the purpose of the site exposure 

matrices. It's to try to identify the specific 

toxic substances that the employee encountered 

that's linked to their disease, their claimed 

illness. 

And so that information is basically 

what the claims examiner is trying to build out 

as far as what are the toxins we need to focus 

on. Once we have that profile or that 

characterization, then it's up to the industrial 

hygienist to look at that data, to look at any 

monitoring information that we might have, or 

apply their own professional subject matter 

expertise to try to characterize the extent, 

nature, and duration of that exposure. 
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So you can sort of see what the 

function here is, as we go along, is to try to 

build out a good understanding, in the lack of 

any specific monitoring data, what the employee 

encountered in their work as far a toxic 

substance. 

 And I'll just mention, I say toxic 

substance. A lot of people may not understand 

that for the purposes of our statute and our 

regulatory definition, toxic substance just means 

any material that has a radiological, or 

chemical, or biological component that's linked 

to the development of an illness. 

 And that's actually covered in our 

Procedure Manual at Chapter 15, so I'll keep 

coming back to Chapter 15. That's the one that 

really is the focal point of our discussion or 

causal relationship under Part E. 

The really important thing here that 

folks need to understand is that this is a 

resource that is used as a comparative analysis 

tool. 
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 So what we're looking for is 

information that's supplied in the case file. 

We're trying to compare that information to what 

we have available in the site exposure matrices 

to sort of build out an accurate understanding of 

the person's exposure history. 

And so it's really important overall, 

simply because this is going to give us the 

ability to go to a physician, whether that's the 

claimant's physician or a contracted medical 

specialist, and ask them that question. Given 

this factual framework that we've been able to 

construct, do you believe that this exposure that 

the employee encountered was a significant factor 

in contributing to, or aggravating, or causing an 

illness? 

So that's sort of the real important 

feature of the site exposure matrices, is that 

factual information that would allow a physician 

to present a rationalized opinion as far as 

causal relationship. 

The site exposure matrices is a very 
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great, it's a great tool. I use it weekly in my 

reviews of case files. But it has some very 

distinct dos and don'ts. 

 What I would encourage you to do, and 

I'll show you the link when we get to it, the 

site exposure matrices, we do have training 

available on our website. There's also a lot of 

information, again in Chapter 15, speaking to the 

use of the site exposure matrices in sort of a 

broad manner by our claims staff. 

 Some of the things that are really 

important is making sure that you apply good data 

filtering, and I'll sort of show you that when we 

get to the demonstration, and making sure that 

the information that you're utilizing in your 

site exposure matrices' search criteria actually 

corresponds specifically to information relevant 

to the claimant. So we need to make those 

connections as we do our examination of the case 

file. 

 One of the big, important things that 

we try to train on, and that I do quite 
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frequently, is this database has no specific 

formulation for how you go about doing a search. 

Because you want to try to use lots of different 

criteria to try to make those connections. 

 So oftentimes, when I'm doing 

searches, I use lots of different filtering 

techniques to try to identify information in the 

case file to identify toxins that I can then say 

okay, there's probably a high likelihood that 

this employee had some contact with this 

material. And I then will let an IH sort of look 

at it and give me some sort of profile on it. 

So some of the important things, and 

I'll touch on these when we go to the demo, site 

exposure matrices is full of information. I mean 

you're talking about, you know, hundreds of sites 

that have lots of different information about the 

work activities unique to that site. 

 While there might be some sites that 

did very similar types of work activities in 

conjunction with the production of atomic 

weapons, oftentimes those sites had very specific 
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activities that were relating to what they were 

specifically doing. 

 So it's really important for folks to 

understand the site exposure matrices maintain 

very unique, customized data relating to the 

facilities. So when you're going in and looking 

for information, you can do all kinds of 

important, you know, filtering concepts and other 

kinds of things when it comes to your work. 

 You can look at information in a case 

file and say okay, here's this site. Do we have 

any information about common nomenclature that 

employees use? So we would maybe do some alias 

searches for different kinds of toxins and their 

names, how they're used, and we might search by 

aliases, by disease type. 

 That's a really important function, 

because you're looking at information in a case 

file trying to correspond that to information 

maintained in the site exposure matrices. 

 We generally recommend that when we 

are doing these searches, the more reasonable and 
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more filtered your search results, the more 

probative the information is, the more value it 

has in establishing that factual framework. 

When you do very global kinds of 

search results in the system, that's not 

necessarily going to help you in this process 

where the Department of Labor is trying to 

process through hundreds of cases. 

 We're an administrative agency trying 

to issue decisions in a case. You know, each one 

of these claims could turn into a very long 

research project. But we need to figure out how 

to balance the need for accurate information and 

detailed analysis versus the need to get 

compensation into the hands of folks that have 

work-related illnesses. 

 So you have to sort of balance that 

administrative reality versus the informational 

side of things. Because we could really spend a 

lot of time digging through these cases. 

The other part of this is that the 

site exposure matrices, one of the big drawbacks 
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is it really doesn't have temporal data. This is 

a research tool that just has basically a global 

inventory of every kind of toxic material that 

may have been utilized at a facility throughout 

the history of that particular site. 

 So you have to understand that what 

might have been occurring at Oak Ridge in the 

1940s and '50s may not involve the same toxins 

that were there in later years. But when you go 

into the site exposure matrices, what you're 

going to see is the list of any toxins that were 

worked with at Oak Ridge for the duration of that 

facility, with SK25 or one of the, you know, 

other sites in Oak Ridge. 

 So like I said, it's important for us 

to always be thinking about filters. What can we 

see from the case evidence that we can apply 

reasonably to our search filtering? And that is 

a very delicate and very involved process. 

Because you've really got to look at all the 

information that you have in the case file. And 

that's why that occupational history 
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questionnaire is so critically important, along 

with any other kind of information that may come 

in, into the case file. 

 The example I'm going to show you in a 

second talks a little bit about where we will 

sometimes find information that you wouldn't 

normally think, oh, that's not going to give me 

anything, when in fact that type of documentation 

is actually critically important. 

 The other thing that the site exposure 

matrices does not do, it doesn't give you much 

information at all, or it doesn't give you any 

information about the extent of exposure, the 

level of a particular amount of exposure that the 

employee had in a particular job. 

 All it's going to do is say hey, this 

person working in this job has the potential to 

be in contact with this material that we know has 

some linkage to this disease, has this health 

effect. It's up to an industrial hygienist to 

look at that information and try to profile or 

characterize the level and extent of exposure. 
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And that's oftentimes left to the judgment of the 

subject matter expert looking at that. 

 So I'm going to go through a very 

basic SEM search. I'm going to use the public 

site, but I want to sort of talk through this 

example. And this is, again, a very simplistic 

kind of example, but I thought it'd be better to 

start with something simple rather than go into 

something brutally complicated. 

So we would get a case from an 

employee. And that employee would give us 

certain kinds of information. And hopefully, 

this information would be provided in the 

initiating claim forms, either in their 

employment history form, it could be provided 

during an occupational history questionnaire, or 

it could be something that is provided to us in 

the information that we get from the Department 

of Energy in that data acquisition request. 

 You know, this information that we can 

get can be voluminous. We can get submissions of 

records from the Department of Energy that can be 
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hundreds, in some cases thousands of pages of 

documentation that we've got to go looking for 

information that is going to be something that we 

can build off of with regard to the site exposure 

matrices factual framing that we're going to try 

to do. 

 So in this particular situation, what 

do we know about this particular employee from 

the information that we've gotten during our 

initial development stage? 

 So we have an employee that worked at 

Savannah River in -- should be South Carolina. 

He also worked as a welder from 1972 to 1992. 

He's been diagnosed with chronic obstructive 

pulmonary disease. Once we know that that is 

established in the medical evidence, that allows 

us to move on to this exposure analysis part. 

We know from his occupational history 

questionnaire that the employee is saying that he 

worked at lots of different sites, but he keeps 

referencing he spent a lot of time in a 

laboratory. And here's where it gets kind of 
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interesting. 

 So when we get these reports of 

information from the employer, we get all kinds 

of records. We get employment records, we get 

pay and wage data, we'll get all kinds of 

performance review information. We'll also get 

records that are maintained by the medical, you 

know, division at some of these sites. And that 

will include a lot of incident reports. 

And so here, this is where we start 

making these logical, factual findings. So here 

you see we have a medical incident report 

identifying injury that occurred. And a lot of 

these incident reports will identify where the 

injury occurred. 

 So in this particular situation for 

this employee, it identifies as injury occurring 

at 773 Lab, all right. So now we know sort of 

like the framework of what we could maybe do in 

the site exposure matrices, which is we know the 

site, we know what illness is involved, we know 

the type of labor that he was doing, and we also 
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know sort of a good idea about the location. 

Because it's confirmed in his own statement about 

where was working. And it's also supported by 

other information from the Department of Energy. 

So let me go ahead and switch over. 

I'm going to switch from this presentation to the 

site exposure matrices website. So give me a 

second here. 

Here we go. All right, Kevin, can you 

guys see this, the website? 

MR. BIRD: Yes, we can. 

 MR. VANCE: All right. So here is the 

site exposure matrices. This is the public 

variant, this is not the DOL employee variant. 

But I wanted to sort of show you this. 

 So on our website, we have this 

introductory web page. And you can see right 

here, for the folks that are unfamiliar, I've 

never really gotten an opportunity to mess around 

with the site exposure matrices, we do have 

training that is available that you can go 

through. 
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 We have a lot of background 

information about the site exposure matrices 

that's here. And here is our link right here to 

the site exposure matrices. So we're going to 

click through to that. 

 Here, again, you're getting additional 

information about the site exposure matrices. 

And I'll just talk about a few features here. 

You can see this right here, DOL wants your 

input. We do have this portal that allows 

claimants to submit information about not only 

toxins that they might have information or 

documentation about, about one of the facilities. 

 We also are looking for any kind of 

disease-specific information that is something 

that needs to be evaluated. So this is where we 

get a lot of information from toxicologists and 

epidemiologists that are submitting information. 

 We also get information from claimants 

that are petitioning the Department of Labor to 

look at adding certain types of health effect 

data in the site exposure matrices. 
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And I'll just make a comment that, you 

know, we do get information that does alter the 

site exposure matrices. We've gotten, over the 

years, lots of information from some very 

interesting sources. 

 But we do encourage folks to give us 

information about the site exposure matrices, and 

we do review that. Every submission gets 

reviewed by our contractor, and a decision is 

made as to whether or not the information is 

probative enough for us to make an update to the 

site exposure matrices. 

And I'll just say that the information 

that we do try to use, whenever we're updating 

the site exposure matrices, has to generally be 

contemporaneous information that's directly from 

the site. We would be looking for any kind of 

record that speaks to work activities that engage 

with certain types of materials at the site that 

can help build out this information for the site 

exposure matrices. 

Just some other things, there is a 
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help guide here that can help provide a little 

bit more in depth kind of information about the 

site exposure matrices. It's not exactly the 

most, you know, compelling read, but it is a very 

technical discussion about the site exposure 

matrices. And so those are some of the big 

features that I think I want to point out. 

 So right here is the entrance into the 

actual database itself. And what you're brought 

up with is a screen. Again, this is the primary 

search screen for the site exposure matrices. 

And you can see that there's all kinds of 

different information that you can start 

searching on. 

 The primary one that we're going to be 

focusing on, because this is the major resource 

for our claims adjudicators, are the DOE sites. 

These uranium mines, mills, and ore mining 

stations, these are all relating to RECA cases 

and the coverage that's under the RECA program 

under Part E. So these are generally not used as 

frequently as the DOE site links. 
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 So here what we're going to do is 

we're going to talk a little bit about this 

particular employee. And this is what a claims 

examiner would do with regard to the case. Once 

they have all the information from the 

preliminary development in the case, they'll 

start screening though it to try to identify the 

toxins that we can link to this employee based on 

the information that's been supplied. 

So we know that Savannah River is the 

site. And you can just take a look. These are 

all the sites that we have information on with 

regard to toxic substance inventories at each one 

of these sites. So you can just see, this is a 

huge volume of facilities. 

 And the important thing to understand 

is that each one of these sites has its own 

individual inventory of toxic materials based on 

the site exposure matrices. Some are 

tremendously voluminous. 

 You know, for Hanford I know that 

there are just tens of thousands of pieces of 
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information in the spreadsheet for that 

particular site. And you can see some of these 

other larger ones that we have in here, Hanford, 

Oak Ridge, the gaseous diffusion plants. 

 There's just a huge volume of 

information available. Some of the other sites 

are a little bit smaller, might not have as much 

information. But we're going stick with Savannah 

River, because that's where the employee was 

working. 

 So once you've clicked there, you're 

going to get this other search criteria. And so 

what you're going to be thinking about here, as a 

claims examiner looking at evidence, you're going 

to be trying to tie information that you have 

available in the case file to different things in 

the site exposure matrices. 

 So the first thing we know about this 

person is the type of work that they do. We know 

that they were a welder. So here's all the 

different things that are available about labor 

categories at Savannah River. So you can just 
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see, it can be a voluminous amount of 

information. 

 And what the claims examiner is trying 

to do is trying to identify in the evidence, 

okay, which one of these types of jobs is best 

linked back to that employee? And that 

information can come from any of the records that 

we get at the initiation of the case with the 

occupational history questionnaire and the 

records from the employer. But in this case, 

we're pretty clear that this person was a welder. 

 So once we actually start building our 

case, we can already start seeing that the system 

is already starting to say, hey, we know that 

these are the toxins that this welding labor 

category were exposed to at the site. 

 But we also know that this is a lot of 

information that might not be specific to this 

particular employee. So we start trying to build 

on the information that we know about this 

particular employee. 

So we know that the employee had a 
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health effect which is chronic obstructive 

pulmonary disease. So here's the list of things 

that we have in the site exposure matrices which 

are known humanistic health effects. 

 These are things that Haz-Map is sort 

of our informative site for populating health 

effect data. This is the list of the conditions 

which we are confident have some sort of link to 

a particular toxic substance exposure. So this 

is all derived from human-based epidemiological 

data, this list of conditions. 

So here we see chronic obstructive 

pulmonary disease. So again, you can see every 

time we had a filtering function it's going to 

continue to reduce down to a particular toxin. 

You know, so a welder with pulmonary disease, we 

already have asbestos and welding fumes. 

 But we also want to take a look at, 

okay, what else do we know about that employee? 

Based on their information, they were working in 

the 773 Laboratory. We can also click on that 

and see if there's any kind of change to this. 
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 And so here is your profile based on 

just that information that we had from the 

employee. In the absence of any other monitoring 

data, we are pretty confident that that employee 

working at Savannah River as a welder would have 

had exposure to asbestos and welding fumes. 

 We would also look at any kind of 

other information about what we know about this 

particular employee, based on information that 

the employee may have provided or information in 

their case, to try to say did he engage in any of 

these very technically specific types of 

activities. Because we know that this type of 

work activity is directly associated with COPD. 

 This information is what then is going 

to populate into the profile or the 

characterization of the employee's exposure that 

would be then presented to either a physician, or 

it could even be something that the claims 

examiner would look at to determine whether or 

not, you know, a presumptive standard is met 

because of this exposure to asbestos. Because we 
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have a COPD presumptive standard. 

So again, you know, the important 

feature here, because I'm running up against 15 

minutes over a little bit, the important feature 

here is to get in here and really experiment with 

the site exposure matrices and be thinking about 

how would a claims examiner utilize information 

in a case file to build these kinds of profiles. 

 And there's lots of different ways 

that you can go about doing that. But we have to 

connect these search results from information 

specific to the employee. 

 And then once we get to the point 

where it goes to a physician, you know, what we 

would have done in this particular case, if it 

doesn't need a presumptive standard, we'd 

probably have an industrial hygienist go in and 

try to profile this asbestos and welding fume 

exposure or maybe talk a little bit about the 

extent of this kind of work activity that's 

linked back to that COPD condition. 

 So this is basically the function of 
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the site exposure matrices, just trying to get to 

these toxins that we can link to an employee. 

And I'm not going to go into a lot of the other 

details, but you know, it's just something that 

you have to sort of get a comfort level with in 

playing around. 

 But you can just see the sheer extent 

of information in here about asbestos and the 

different kinds of aliases that are available, 

same with welding fumes. And this exists for all 

of these sites. 

 So that's a very basic presentation. 

Hopefully, that's given you some sense of it. 

But I would definitely encourage folks to take a 

look at the training that's out there, also just 

get in here and start playing around with it. I 

think it's a terrific tool. It can help in a lot 

of cases. 

 And I will say that this tool is not a 

decision making tool. A lot of people get 

confused on this. This is merely an information 

resource that can be utilized to help inform the 
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factual framework on a case. 

 If we don't have information that's 

presented in the site exposure matrices, we can 

rely on data that we might have from the employee 

themselves, or information that corresponds with 

data specific to that employee in their 

employment records. 

 So if you don't have any history or 

information that the SEM can support in a case, 

we may turn to other information to support that. 

Oftentimes that occurs where you have a physician 

that might be identifying specific toxins that 

are, in that physician's opinion, linked to the 

condition but they don't correspond with the 

information in the site exposure matrices. 

 Under that circumstance, we would 

generally bypass the site exposure matrices, have 

an industrial hygienist, you know, characterize 

the exposures that the physician seemed to be 

focused on, and then ask that doctor, once they 

have an accurate understanding of the exposure 

level as far as their continuing belief, whether 
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the condition is work-related or not. 

 So I'm going to switch back over to 

the main page, Kevin. I see a question from Dr. 

Goldman. 

MEMBER GOLDMAN: Hi, thanks for taking 

my question. Wow, this is a huge effort, 

obviously. 

 I have a question. On your welding 

case, for example, and this came up a little bit 

last year, suppose the person isn't a welder, but 

they happen to be a construction worker who is 

working in the area where the welder is. So 

you've got -- 

MR. VANCE: Right. 

MEMBER GOLDMAN: -- a construction 

worker, and you get other exposures. But 

actually, the person is in that area and would 

have exposure to welding fumes. So what happens 

in that situation? 

MR. VANCE: Well when I would apply 

that kind of scenario, what I would be looking 

for is information about what is that employee 
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saying they were doing, and what was their 

engagement in activities that brought them into 

proximity with welding fumes? 

So in other words, if I'm looking at 

it and saying oh hey, this person in this job 

category, I don't see that coming up in their 

profile, well then like I said, there's lots of 

different filtering techniques. 

 So what I might do is, depending on 

the information in the case file, I might not 

search by labor category. I might search by work 

process. So in other words, hey, this person is 

in this labor category. But I'm not seeing that 

specific work function in that profile. But 

their information is convincing me that they were 

definitely engaged in some sort of activity that 

brought them into welding processing. 

 Well then I would search on the 

welding processing, not that labor category. And 

maybe I would search on, you know, the work 

process and the location. That might give me a 

sense of, you know, welding fume exposure. That 
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information then could be built into the factual 

framework I'm creating as a claims examiner. 

 And then an industrial hygienist would 

look at it and say okay, based on what their 

professional judgment is here, welding fume 

exposure is really dependent on your actual 

proximity to the actual worker, or however it's 

being evaluated by the industrial hygienist. 

 And they could look at it and say, 

well you weren't directly welding, so maybe your 

exposure level is moderate or, you know, whatever 

they want to do to characterize it. 

 But that's generally how it would 

work. We would first try to identify the toxin 

based on some sort of reasonable connection in 

the site exposure matrices to the data that we 

have from the employee. And then the industrial 

hygienist further refines that exposure, the 

extent and nature of exposure. Does that make 

sense? 

MEMBER GOLDMAN: It does, but it 

sounds like it's a lot of work, and you have to 
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have a good occupational health questionnaire and 

different pieces coming in to call attention to 

the fact that the person might have been in an 

area where there were welders. So it's 

complicated. 

MR. VANCE: Yes, it is a lot of work, 

and it is a lot of -- in the cases that I review, 

they're generally very complicated. You also 

have to consider the fact that you have to do 

this for every single location where an employee 

may have worked. 

 So you have a lot of employees like in 

areas where there are multiple sites where they 

might have been going to different locations. 

You have to actually do this based on lots of 

different factual information in the case file. 

 So yes, when you start looking at 

these cases and start getting a sense of what's 

involved, yes, you have to be very sequential in 

your evaluation of the case. And you have to be 

as thorough as you can in trying to figure out 

what's the most reasonable, factual presentation 
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of information that links back to these toxins. 

So it is a very laborious process. 

 CHAIR MARKOWITZ: Ms. Pope? 

MEMBER POPE: Yes. So my question was 

similar to Dr. Goldman's. I was thinking about 

guards, radiological technicians that oftentimes, 

many, many, many times, would require them to go 

into areas, all the areas, guards went to all the 

areas. 

 And most times, the radiological 

technicians went to all the areas too. And they 

were in different proximities of the work that 

was being done. So I was just curious how the 

SEM would be applied to build that case. 

 MR. VANCE: Yes. I mean the number 

one thing is understanding. And this is why it's 

so critical. And this is why I think we've 

worked with the Board quite a bit to try to 

improve those occupational history 

questionnaires. 

 You know, we would depend on the 

specificity of the information that we're getting 
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with regard to what locations are you talking 

about having gone into. If you have a global 

statement, just saying I was everywhere, well 

that's not going to be very helpful for us to be 

able to build out a factual framework. 

 You've got to be to say okay, give me 

a sense of where it was you were, what you were 

doing, you know, give me any information about 

how long of a timeframe you might have been 

engaged in whatever activities. 

 Because we do need to have some sort 

of understanding of that in order to start saying 

okay, it seems to be that this person definitely 

was doing this activity that had this sort of 

connection to a site that we then can start 

building out information or relational 

connections on the site exposure matrices. 

 And that can be very difficult when we 

don't have any kind of very specific information. 

This oftentimes happens in survivor cases where 

we have a survivor that knew that their spouse 

did something that involved something at the 
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site. Well that's not going to give us much to 

go on. 

 And unfortunately in this situation, 

if we have no way to sort of do anything with the 

information provided, that might not result in 

anything that we can do with a particular case. 

So it is really critical to really get good 

information on any kind of work activities at the 

site in order for us to start building out that 

kind of information. 

 CHAIR MARKOWITZ: Ms. Whitten? 

MEMBER WHITTEN: Hi. It seems to me 

that every time there's an update for the SEM 

that chemicals like drop off of certain 

facilities. Like you go to N Reactor now, 

there's less chemicals listed now as there were, 

you know, two years ago on the SEM. And -- 

MR. VANCE: Mm-hmm. 

MEMBER WHITTEN: -- would it be 

beneficial in some way to put a date range filter 

on there as well, say somebody worked there in 

the '80s, or the '90s? And then those chemicals 
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that were present at that time would be 

populated? I don't know. 

 MR. VANCE: Well okay. So let me 

respond to that in a way that -- I'm just going 

to say this as delicately as I can. The more 

information that you have in the site exposure 

matrices, the more work you're going to have to 

do to try to figure out did this employee meet 

that particular component. So adding more date 

information and temporal data could actually work 

to the detriment of certain claimants, okay. 

 Right now, when we do this, we're not 

really looking at temporal data. We're just 

saying, well it's certainly possible this person 

would have had this exposure based on the profile 

information we have in the site exposure 

matrices. 

 If we start putting temporal data in 

there, first of all, that is exponentially more 

complicated and adds an element of complexity 

that would be very difficult, simply because 

you're talking about having to do that for every 
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one of these sites. 

 The second thing is that could also 

work in the detriment of some claimants, because 

then you're just going to say, oh okay, well this 

material only was used there through 1952. Well 

you worked in the '80s, so therefore we're not 

even going to consider that type of exposure. 

 You just have to be kind of careful 

with how much information that you want to work 

with in these cases. It certainly is a 

possibility that the Board could consider making 

that kind of a recommendation. But you need to 

just think about what effect that might have in 

the actual administrative process or reviewing 

the cases. Does that respond to your question? 

MEMBER WHITTEN: Yes, that's something 

to consider. Thank you. 

CHAIR MARKOWITZ: Mr. Catlin? 

MEMBER CATLIN: Thank you. So 

fascinating database and work. What do you do to 

assure consistency between claims managers who 

are using this system that, given a lot of the 
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variety and the complexity of the searching, how 

do you try to ensure that, you know, there's 

consistency between what claims managers are 

finding? Or do you do some way of auditing that, 

or how do you ensure it? 

MR. VANCE: Yes. Well that's a great 

question. I appreciate you asking it. There's a 

lot of responses I can give to that. 

 So first of all, you know, these cases 

are presented with a lot of unique features. So 

we're looking at consistent application of the 

process, not necessarily consistent outcomes, 

okay. So what we're looking at here is looking 

at the unique features of this employee. And 

every employee is going to present with a lot of 

unique variables that we've got to evaluate, all 

right. 

 It's up to the claims examiner who is 

reviewing this to build out the best factual 

framework for the case, then have an industrial 

hygienist review that and build out an even more 

carefully constructed characterization of the 
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exposure, then have a physician evaluate that and 

provide an opinion, all right, and then for us to 

make a judgment. Does the criteria under the 

law, is it satisfied for us to pay compensation 

to a particular employee? 

 Now Rachel, in her presentation 

yesterday, was talking about our decision 

process. The initial step that we take in 

advising someone whether we're going to accept a 

case or not is a recommendation that hey, this is 

our assessment of the evidence. Here is what we 

think is the best outcome based on the 

information that we have in your particular case. 

 The claimant then has an opportunity 

to look at that and say, you know, I agree. This 

is as good as it's going to get, and I'm not 

going to contest this. Or they can provide 

additional information, or they can do whatever 

they want with regard to contesting that 

decision. 

 It then moves to another stage which 

is the review by our appeals board. They're 
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going to look at any new information that the 

claimant has submitted. They're going to look at 

the rationale for the decision, that 

recommendation by the District office. 

 And they're going to independently 

evaluate whether or not they feel that that 

decision represents the best outcome given the 

program's policies and procedures. So that 

independent review process is one mechanism we 

use to try to get to the best, most consistent 

outcome of the process, all right. 

 The claimant then has other additional 

features that they can exercise in challenging 

that outcome. They can request an appeal of that 

decision, and then they have an infinite number 

of times to come back to the program asking for a 

reopening of that decision. 

 And so we do have claimants that are 

bringing forth new information intermittently 

where we have to then go back and look at that 

decision. And that could lead to a reopening of 

the decision. So that's one way that we go about 
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ensuring the consistency of the process. 

 The other thing that we do is we do 

engage in quality assurance. We have a quality 

assurance team looking at the decisions to make 

sure they conform with our policies and 

procedures. 

 And also speaking to just qualitative 

features, do we communicate information clearly, 

are we issuing decisions of a compelling basis 

that are persuasive in what it is that we've done 

to try to get through this complicated process? 

 But the program also has annual 

accountability review processes where we go 

through systematically and do an independent 

evaluation of the quality of the work. Those are 

available on our website, where we're looking at 

qualitative measures to make sure, hey, do we -- 

as an independent auditing function looking at 

this, do we agree that that outcome was 

appropriate and based on a good evaluation of the 

available evidence? That includes looking at how 

the site exposure matrices were utilized in 
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supporting a decisional outcome. So does that 

answer your question? 

MEMBER CATLIN: Yes. I think you went 

much further than I was thinking about. 

(Laughter.) 

MEMBER CATLIN: So I appreciate that - 

 MR. VANCE: Well I want to make sure 

that, you know, I think there's a lot of 

confusion where people think, hey, well you made 

this decision in this case. Why, and this is a 

very similar situation, did it come to a 

different outcome? They are two distinctly 

different cases. And they can come to very 

different outcomes based on whatever variables 

are involved. 

MEMBER CATLIN: Right. I'm thinking 

more of the same case and claims managers coming 

to different information out of the SEM. But let 

me just -- if I can just ask one more short 

question. 

 So when this information and other 

information you gathered goes back to the 
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physician for their determination, is that also 

shared with the claimant, with the worker? Or is 

it encouraged that the physician talk with the 

worker? 

 Because I could see this information 

would generate lots of very good questions if you 

were doing a follow-up occupational health 

history from the initial history. And this could 

be very useful in clarifying a lot of things. 

MR. VANCE: Yes. I mean I agree. It 

would be very helpful if there could be 

definitely more opportunity to talk though a lot 

of these cases. And I would just say, like I 

said before, each one of these cases could be an 

endless opportunity to do all kinds of research. 

 But we've got to get through a process 

to get to that decision. So what we would do is 

give that factual framework that we've built to 

that physician. They are then on the hook to 

look at that information and render a decision. 

 So we need to have the best outcome 

that we can given the information that we have. 
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And we have to rely on the subject matter 

expertise of that qualified physician who is 

looking at the information and giving us sort of 

a compelling and convincing argument that, yes, 

this person's exposure, as you characterized it 

for the duration of time that they were working 

at the site, was definitely a significant factor 

in developing a disease. So it's a transactional 

kind of process. 

 MEMBER CATLIN: Okay. Thank you so 

much. 

CHAIR MARKOWITZ: This is Steven 

Markowitz. We're going to take one more question 

from Dr. Bowman. But I just want to make a 

comment, mostly for the new Board members. Not 

every claim goes to an industrial hygienist or to 

a contract medical physician. 

 But you know, a claims examiner 

gathers all the information to make a decision 

and may not ask for an evaluation by the 

industrial hygienist or the physician. So just 

so you know, it's not automatic that the SEM 
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acquired information that is passed along to a 

different kind of professional beyond the claims 

examiner. 

 But Dr. Bowman, you have a question? 

MEMBER BOWMAN: Yes, thank you. 

Actually there's two. One is, it's hopefully 

actually rather short, and it's a follow-up to 

the question that Ms. Whitten asked when she was 

asking about sort of whether or not there would 

be a temporal history in the SEM. 

 And then you explained that sort of 

there were certainly downsides to having 

complexities in the search process. But she made 

a, in essence, I think she said that over time 

the number of chemicals at some sites have been 

going down. 

 But as I understood your answer, that 

this is a -- there is no temporal, it's just a 

cumulative list of any chemical that's been at a 

site in history, can you -- I don't understand 

how a number of chemicals could go down then at a 

site. 
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 MR. VANCE: Well, I mean, it's going 

to depend on the information that we have 

available about particular materials. So, I 

mean, you can have information from a particular 

document that is talking about something that is 

clarified in a later document. 

 So it could be that, you know, hey, 

the toxins that are associated with this job is 

very expansive based on this information. But 

then when we have new data come in that is more 

reliable and provides clarification of that 

situation, it could very well be that these 

connections are uncoupled, that we're going to 

basically say, hey, what we had before is not 

really accurate anymore because of this new, more 

detailed information. So the toxic substance 

will always be there. It's just what are the 

connections that it has with particular filtering 

of -- 

MEMBER BOWMAN: Oh, I see. So it's 

not the chemical that's going away, it's the 

connection. And that actually does --- 
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MR. VANCE: Yes. 

MEMBER BOWMAN: -- lead me to my next 

question. You had showed us at the beginning of 

your presentation on the webpage that DOL is 

constantly seeking additional information and 

including information that would link toxic 

substances to disease. And there's certainly a 

good value of having those links on that site you 

showed us. Like, there was a great example being 

able to link those. 

 I was just wondering if you could talk 

about how, sort of how the merit of scientific 

information is deemed relevant. Is there a 

different type of data that is given more weight 

by the DOL and its contractors making those 

decisions, like a human epidemiological study 

versus an animal study, or in vitro studies? How 

is that weight of evidence looked at in the 

context of making that link on the SEM? 

MR. VANCE: Yes. I mean, the data 

that is provided as the health effect data in the 

site exposure matrices is human epidemiological 
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data, all right. And so if you go into the site 

exposure matrices, you can go in and click on any 

one of those health effects. That'll take you 

back to the Haz-Map information available, and 

it'll give you that sort of background 

information from where that human epidemiological 

data is originating from. 

 And that's what we sort of utilized in 

reporting information in the site exposure 

matrices. But what really is important to 

understand is that that is just one mechanism for 

getting causal relationship data, all right. 

 We do allow physicians to provide 

individualized data that may not have any 

connection to epidemiological health effect data. 

So we are looking at a physician who can come in 

on a case and look at something and say, hey, you 

know what, I can just use one that I've seen 

before where it's, like, prostate cancer. 

 You know, human epidemiology is not 

going to establish a clear agreement that 

particular toxins are associated with prostate 
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cancer, okay. And so we don't have that kind of 

information available in the site exposure 

matrices. 

 But that does not stop a physician 

from looking at the particular exposures that an 

employee had and rendering a professional opinion 

saying, you know what, this material that this 

person has is a carcinogenic material in my 

opinion. This exposure that this person had 

could certainly have aggravated or contributed to 

the development of prostate cancer, and speak to 

health, you know, medical health science data 

that supports that position. 

 Because our standard is not pure 

causation, it's causation, contribute, or 

aggravate. So this contribution and aggravation 

component is a much more flexible standard. So 

what the site exposure matrices is doing is 

telling you, hey, this is the data that we are 

confident in with regard to a relationship 

between disease and toxin. 

 But that does not prevent a physician 
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looking at other medical health science data, 

applying a very unique analysis of a particular 

employee, to come to that aggravation and 

contribution relationship. 

MEMBER BOWMAN: Got it. Thank you. 

MR. VANCE: Does that make sense? 

MEMBER BOWMAN: Yes, it does. 

 MR. VANCE: And what I would encourage 

you to do, there is a section in our procedure 

manual in Chapter 15 talking a little bit about 

that toxicological analysis that we go through. 

So I think that would be something you might want 

to check out. 

MEMBER BOWMAN: Thank you. 

CHAIR MARKOWITZ: All right. This is 

Steve Markowitz. Thank you very much, Mr. Vance. 

That was an excellent presentation of a 

complicated topic in a relatively short period of 

time. I'm sure there will be additional 

questions in the future. 

So we're going to move on to Board 

discussion. And the agenda shows a preliminary 
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list of the topics that we'll discuss. 

 I just want to preface our discussion 

of particular topics with a couple of things. 

One is, moving forward after this meeting, the 

Board has used in the past a couple of mechanisms 

to continue to work between full Board meetings. 

 One mechanism has been, the first 

Board, a couple of years ago, used subcommittees. 

Those subcommittees actually matched the four 

major tasks of the Board. Those subcommittees 

took on several different, multiple topics. They 

were sort of broader in scope than what the last 

Board used, which was working groups. 

 And those subcommittees explored 

various issues and would formulate options for 

the full Board to discuss. Those subcommittees 

were subject to FACA rules as described to us 

yesterday. Those were open meetings, the public 

could participate, meaning, in addition, that 

they were scheduled at least six weeks ahead of 

time, because those meetings have to be published 

in the Federal Register. 
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 And the second mechanism, which is the 

working group, took on more specific, and there 

were various working groups, they took on more 

specific issues, usually limited to a single 

issue. It didn't necessarily come up with 

options for the Board. But they did background 

research and explored particular issues. 

 And those working group meetings were 

not subject to FACA, they were not published in 

the Federal Register, meaning that there needn't 

be a six-week or more planning phase, providing 

additional flexibility, although they were not 

open to the public. 

 The other aspect of the working group 

is that, mind you, these are all subsets of the 

full Board. Whenever the full Board has a 

discussion, that's a full Board meeting. The 

aspect of the working group is that they could 

review documents and openly discuss them even if 

those documents would otherwise not be available 

to the public. 

 For those documents, that obviously 
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couldn't be, those couldn't be discussed in any 

particular way at an open meeting. So those are 

the two, our two options or any other options we 

might imagine. 

The other thing I just want to let you 

know is that typically the Board produces two 

kinds of products. One is recommendations to the 

Department. And that constitutes our advice to 

the Department regarding the program. 

 We formulate that language together. 

We vote on that specific language. And that's 

accompanied by a rationale which we usually 

discuss, although the particular wording of that 

rationale is not agreed upon by the full 

committee. It's drafted or then finalized by 

myself, or by another Board member. 

 Secondly, we submit data requests, or 

requests for claims to review, to the Department. 

And that is that there's a formal mechanism for 

that where we describe what we want, the 

rationale, and how it falls within the purview of 

the Board. So those are two mechanisms that we 
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use for communication with the Department. 

 Ms. Rhoads, typically during these 

meetings, she keeps track of our action items 

which mean recommendations, mean these data 

requests, or claims review requests, or the like. 

 So that said, let's move on to the 

topic. I have a PowerPoint. Now, some of these 

topics, actually all of them pretty much are left 

over from the past Board. We couldn't quite 

finish them out --- so Kevin, if you want to -- 

couldn't quite finish the matter, but we got very 

close. 

 And I appreciate that it's a little 

awkward for five new Board members to be seeing 

some of these issues or the first time. On the 

other hand, we would like to come to closure on 

some of these issues today. Let's not say that 

they're in your future. 

 If you could show the first slide. 

 So there was one recommendation that 

we made to the Department --- Kevin, can you move 

that ahead, okay --- on site-wide job titles. So 
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if you could go to the next slide. 

So a year ago we recommended that the 

Department, as part of the SEM, identify certain 

job titles as DOE sites that were likely to work 

throughout the site and would have potential 

exposure to many or all toxic substances at those 

facilities. And this topic came up just briefly 

in the last discussion with Mr. Vance. 

So we're talking about firefighters, 

we're talking about health physics technicians, 

we're talking about security guards who typically 

would, over time, go to different parts of their 

particular site. 

 So our response from the Department in 

March of this year was that actually the SEM is 

based on, and this is the highlighted area, 

specific data establishing that that particular 

job category at that particular site is related 

to specific toxic substances at that site, and 

that the Department relies on objective data that 

supports each and every piece of information 

that's entered into the SEM database. 
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 So the problem was, the problem became 

that thinking about these site-wide job titles, 

it was a question of really what was the level of 

documentation for those job titles at various 

sites. 

 And if you go to the next slide. 

 So what we did as the Board was to 

look at some of these job titles at some of the 

sites, figure just a few sites, several of the 

larger sites, actually. And previous Board 

members have seen this before, because we showed 

it before. 

But we looked at three sites in 

particular, Portsmouth, Paducah, and Oak Ridge 

K-25. Those were all gaseous diffusion plants. 

So they pretty much did the same thing. 

 At Oak Ridge there was also this pilot 

centrifuge operation. This is about separation 

of isotopes of uranium. But Portsmouth and 

Paducah were quite similar, and most of K-25 was 

quite similar to Portsmouth and Paducah. And 

together, they're called the gaseous diffusion 
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plants, the GDPs. 

 So if you look at the security guards, 

in Portsmouth in the SEM there is 61 agents that 

are listed as representing potential exposures. 

If you look at Paducah, it's 29. And if you 

looked at Oak Ridge, it's ten. So you have a 

six-fold difference in the same job title, job 

category at these very similar locations. 

Similarly, if you look at health 

physics technicians or health physicists, they're 

usually often combined at the sites. At 

Portsmouth, there are four agents listed as 

representing potential exposures, Paducah, 18, 

and Oak Ridge, 36. So it was about a nine-fold 

difference, again, among these three very similar 

work sites. 

And then actually I just, we included 

Savannah River and Hanford just to give you a 

sense of the variation. Those are very different 

operations from the GDPs. But you can see, for 

instance, Savannah River, the health physics 

technicians, 152 agents, and at Hanford, which 
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appears to be quite well documented, or at least 

there's a lot of documentation, that there were 

over 2,000 agents that were, that are listed in 

the SEM. 

 You can go to the next slide. 

 So let's just drill a little bit more 

into this issue of security guards with the three 

GDPs. And these are the agents that are listed 

for the GDPs, for the guards. Actually, in K-25, 

if you look at it, those make sense for a guard. 

Those actually seem to be, hopefully, very guardspecific kind of exposures. 

 In Paducah, and in red are indicated 

the overlap among the three GDPs in terms of the 

exposures. So the red text just indicates pretty 

much the same agents that are rotated at all 

three sites. 

In Paducah, there's acknowledgment 

that there's potential exposure to asbestos, and 

a number of uranium, and a number of 

transuranic, and some metals. And in Portsmouth, 

it gets even broader. And you can see the 
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diversity of agents that are referred, that are 

there. 

 Now, this presumably is due to 

different levels of documentation that are 

available to the SEM. Although, frankly, it's 

hard to understand why a security guard at very 

similar work sites would have this kind of 

diversity of exposures in reality, not in the 

level of documentation but in reality. 

Next slide. 

 So we then requested this 

documentation in the SEM so we could understand 

this better. And we requested it just for, I 

think, security guards and health physics 

technicians. This was in April of this year. 

 And next slide. 

 And we received a response in 

November, this month actually, that the DOL 

provided us a list, 258 sources of information on 

toxins for guards and health physics technicians 

at the GDPs. 

 So my first reaction to this is -- and 
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they gave us the list. We're not sharing it 

publicly, but they gave us the list. The Board 

obviously doesn't have the resources to examine 

258 sources to identify the information that's 

relevant to the questions, very targeted 

questions, but we don't have the resources, 

nonetheless. 

And then it occurs to me that actually 

what we're likely to find is exactly what the 

experts in the SEM say, which is that the SEM 

depends on objective data, objective information 

provided to them. And the level of documentation 

varies among the sites. Some sites are a lot 

better documented than others. 

 And therefore, what we're likely to 

find, if we were to look at the 258 sources, that 

we would find that there are tremendous 

variations. 

 And so the next slide. 

 So I think, personally I think it's 

not worth our while, actually, to examine that 

documentation or, rather, we would have to 
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request the Department's contractor to identify, 

within those 258 sources, where exactly security 

guards and health physics tech appear. And then 

we would review the work that they've done. That 

would take months, probably. 

 And so my thinking now is that the 

problem is that the SEM is constructed on 

available documentation. And the issue with 

these site-wide job titles is that there just 

isn't all that much documentation or that to the 

extent that it exists it's quite variable between 

DOE sites. 

 And so the issue really is not the 

level of documentation. But the issue is can we 

make an exposure presumption about those sitewide job titles. Can we presume that security 

guards, that firefighters, that health physics 

tech, presume that they, over a period time 

working there, visit many, many locations at the 

facility, at their particular facility, and that 

therefore they had potential exposure to many or 

all of the listed toxic substances at those 
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facilities. 

 Now, this would mean that, in effect, 

the claims examiner would likely bypass the SEM, 

or look at the SEM in conjunction with the 

exposure presumption, and then pass along the 

claim to an industrial hygienist whose job would 

be to figure out was there a sufficient dose, 

right, was there intensity, frequency, duration 

that would permit the causation opinion? 

But that determination of dose is 

separate. This is a question of recommending 

that there be a presumption as if they have 

exposure, a broad set of exposures at those 

facilities. So I would open it up for 

discussion. 

 And actually, I'm sorry, the people 

who have their hands raised from before, if you 

could lower your hands and then raise them again. 

That would be good. 

 Ms. Whitten, I see your hand up. Do 

you have a question or comment? 

MEMBER WHITTEN: No, sorry, just 
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forgot to take it down. 

 CHAIR MARKOWITZ: Yes, yes. So what 

do people think? And by the way, this is a 

recommendation that if possible, if we're 

comfortable, then I think we should vote on 

today. If not, then we can do it next time. But 

we've spent a fair amount of time on this issue, 

I have to say. 

Dr. Van Dyke? 

MEMBER VAN DYKE: So I just want 

clarification. When you say potential exposure, 

it's just they had the potential for exposure, 

and then it goes out to further discussion on 

matrix and infrequency? Or where does it go from 

there? 

CHAIR MARKOWITZ: Well, I mean, I'm 

going to, I think, I'm going to make a comment, 

and then ask Mr. Vance to amplify if necessary. 

 The SEM is about potential exposures. 

That's not my characterization. I think that's 

their characterization. And the issue of, so 

there's a categorical identification, this person 
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in this job title had that exposure, or had that 

potential exposure that, you know, is linked to a 

particular disease. 

 The question is, was there sufficient 

exposure, is not answered in the SEM. And if the 

claims examiner has that question, they then pass 

it along to an industrial hygienist or a contract 

physician to make that determination. I think 

that's the way it works. 

 MEMBER VAN DYKE: Okay. 

 CHAIR MARKOWITZ: Mr. Key? 

MEMBER KEY: Yes, Dr. Markowitz, I 

agree with your approach on the exposure 

presumptions. For those at Paducah, I would also 

list the fire department at Paducah. 

 We also, in the SEM at Paducah, have 

an operator technician classification. I don't 

know what that means. I've been there for 46 

years. I've negotiated several contracts. We 

had an operator B classification, but we have 

never negotiated an operator technician position 

or classification at Paducah. So why it's listed 
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in the SEM as that is unclear. 

 And also, contained within the SEM at 

Paducah for the laborer category, which is a down 

and dirty, hired in as a laborer under a lot of 

the jobs that those workers had to do, and then 

1,1,1-Trichloroethylene is not listed in the 

laborers matrix in the SEM, though it is in the 

janitorial. And that is not accurate. 

 But I do agree with your approach for 

the different sites and the worker classification 

and categories. Having six-fold differences, it 

needs to be corrected. 

 CHAIR MARKOWITZ: Thanks. So, Dr. 

Bowman, go ahead. 

 MEMBER BOWMAN: Yes, I just, one 

little bit of extra data, and then I was going to 

comment on this idea. If you could go back to 

Slide 5, that lists the three sites, and it has 

the overlapping color between the toxic agent. 

This one here, yes, thanks. 

 If I understand the proposal that you 

put forward just now, is that you would say that 
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someone with a job classification, for example a 

security guard, could be exposed to any chemical 

at that site, because they move throughout that 

site in the course of their job. 

 But what I was wondering in the 

context of this list, where you show the 

chemicals that are environmental factors that are 

shared between these three, is the ones in black, 

I just, is the absence of the ones in black, the 

ones that are unique because those chemicals 

aren't even listed as chemicals present at the 

site at all to anyone? 

 Or are there other chemicals like 

that, meaning there might be missing chemical 

data at the sites? Or is it only that it's not 

listed as a potential exposure for that job 

category at those sites? 

CHAIR MARKOWITZ: Well, so the GDPs 

were very similar. If you look at Portsmouth, 

you see a bunch of metals, including nickel, 

chromium, which were central to the GDPs process, 

certainly at K-25 and the other GDPs. And then 
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you see a bunch of solvents, and those were 

uranium, yes, those were used at K-25, to be 

sure. 

 And, you know, we could go to the SEM 

and look at it, but I'm sure we're going to find 

that those very common agents would be listed in 

the SEM, not for guards, because that's the 

issue. But they would be at that site. 

 So it's not the case that most of the 

agents that appear in black for Portsmouth did 

not exist, were not used at Paducah and K-25. 

 (Simultaneous speaking.) 

MEMBER BOWMAN: Yes, thank you. Yes, 

that answered that question. So then what I was 

going to suggest, so the proposal you have 

forward would be just for any chemicals listed 

for a site, that an individual in a job category 

that would be in many locations at that site 

would potentially be exposed to all chemicals at 

that site. Is that a correct summary of your 

proposal? 

CHAIR MARKOWITZ: Yes. If we could, 
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Kevin, if you just move ahead to the 

recommendations, we can look at the language. 

But, yes, that's the gist of it, which is that 

there are a limited number of job categories, by 

the way, that would fall into this. 

MEMBER BOWMAN: Right, right, right. 

CHAIR MARKOWITZ: But, yes, ones that 

are part of -- the nature of what they do 

involves likely transit throughout much of 

facility. 

 MEMBER BOWMAN: Right. 

CHAIR MARKOWITZ: Those are the 

people. 

 And let me just add one other aspect. 

You know, this idea of exposure presumption, 

which we'll keep coming back to, is very 

important. Because it gets over some of the 

limitations of the SEM. 

 MEMBER BOWMAN: Yes. 

CHAIR MARKOWITZ: And in fact, it's in 

the original Act. For the GDPs there was the 

presumption, because of lack of radiologic data, 
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the presumption that if they'd worked there for 

250 days or more prior to 1992, that they had 

significant exposure to radiation and that they 

would therefore receive compensation for one of 

22 cancers. 

 So the idea of exposure presumption 

was built into the Act. And in Chapter 15 of the 

procedure manual, there are any number of 

exposure and causation presumptions. So this is 

a familiar route, I think, for the program, to 

look at the situation. 

So other comments or questions? 

MEMBER BOWMAN: Right. So what I was 

wondering is on the sites that apparently have, 

that very likely then have better quality data, 

right, the site in which the security guards were 

listed as having more chemicals, it is likely 

just that quality of that data was better, to 

better represent the actual potential exposures. 

 But is there not a way to say these 

three sites are the same? And so therefore, 

security guards at any of those sites could be 
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deemed as potentially having exposure to whatever 

the most exhaustive list is, like basically the 

overlap of all the chemicals for all security 

guards across all three sites, any security guard 

at any of those sites might have been exposed to 

any of those chemicals. Therefore, yes, do you 

understand what I'm asking? 

CHAIR MARKOWITZ: Yes. Let me just 

comment and then move on. Yes, that's very 

clever actually. The problem is that approach 

isn't entirely generalizable, because most sites 

are pretty unique. I mean, Rocky Flats is not 

like Savannah River, is not like Hanford, is not 

like Los Alamos. The GDPs are the only ones that 

are fairly comparable. So we just couldn't 

generalize that approach elsewhere. 

 MEMBER BOWMAN: Got it. 

CHAIR MARKOWITZ: Dr. Silver? 

MEMBER SILVER: Yes, on the audio 

here. I think it's a brilliant approach. 

Because going way back we know that the Manhattan 

Project and then the AEC complex was designed 
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with redundancy in mind. So that if we got into 

a hot war with our adversaries, and missiles 

landed on one of the gaseous diffusion plants, 

there would be two more still working. 

 And if we can get this idea adopted 

here for the strongest case, there may be other 

unit processes that represent the redundancy of 

the DOE complex. I agree with you not as clear 

cut as this, but it may be an approach that holds 

promise for other things like plutonium 

metallurgy which was done at two or three sites. 

And one other comment, if we go back 

to the slide with the red and black ink for a 

moment, please. 

 CHAIR MARKOWITZ: No, but-- 

MEMBER SILVER: Yes, back -- 

 CHAIR MARKOWITZ: No ink used, but go 

ahead. 

 MEMBER SILVER: Okay. Going back to 

almost exactly a year ago on the morning before 

our tour of the Paducah plant, it was pretty well 

established in our conversation that massive 
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amounts of centered nickel were used at the 

Paducah gaseous diffusion plant. So it really 

strains credulity that someone who went through 

that plant on a regular basis would not have had 

nickel exposure. 

 It shows up at Portsmouth, so I think 

it really is a function of who submitted what at 

the SEM website and what DOL got when they went 

out and did the round tables. It doesn't really 

look like reality. 

 CHAIR MARKOWITZ: And what existed 

varied among the sites. Mr. Catlin? 

MEMBER CATLIN: Thank you. Yes, 

interesting idea. Did I miss it, is there an 

agreed-upon list of site-wide job categories, or 

at least a list that's generally agreed on? 

CHAIR MARKOWITZ: Yeah, that's an 

excellent question. 

 If you could just move the slides 

ahead to the recommendation. 

So no, there is not an agreed-upon 

list. And this recommendation doesn't specify 
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that. 

 MEMBER CATLIN: Okay. 

CHAIR MARKOWITZ: There are some 

obvious ones like firefighters, like guards, like 

health physics tech, and some others that Mr. 

Key, and Ms. Pope, et cetera, could probably name 

better than I. 

 If the Department accepts this, then 

they would presumably identify those job 

categories. And then we would get to weigh in on 

that or they would invite our opinion upon 

acceptance of the recommendation. And we could 

do so at that time. To identify those now would 

prolong the process. 

MEMBER CATLIN: No, I agree. Thank 

you. And let me just be clear. So the result of 

this recommendation really is that the case would 

then be kicked to the industrial hygienist to do 

a more in depth review without using the sort of 

filter of the SEM, where the case might not get 

kicked to an IH. Is that right? 

CHAIR MARKOWITZ: Well, I can't answer 
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that exactly. Mr. Vance maybe could a stab at 

that. But I'm going to put him on the spot 

because this would have -- 

MR. VANCE: No, I can answer that one. 

So the claims examiners in the case are the ones 

responsible for building out the framework. So 

they're basically going to identify, hey, here 

are the toxins that we think are the primary 

things that we need to be worrying about here 

with regard to the likelihood of there being a 

connection between the potential exposure to that 

toxin and the disease. 

 What the industrial hygienist is going 

to do is going to take those identifying toxins 

that the claims examiner has sort of done that 

due diligence in looking at, and then take that 

and provide additional details that the physician 

then can consider and weigh in an opinion on 

causal relationship. 

 So the claims examiner is the 

responsible party for evaluating the evidence and 

trying to identify and encapsulate the things 
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that are going to have the best likelihood of 

producing a positive outcome. They're going to 

have an industrial hygienist profile those and 

then have the physician evaluate that for that 

causal relationship opinion. 

CHAIR MARKOWITZ: Thank you. Dr. 

Friedman-Jimenez? Dr. Friedman-Jimenez, did you 

have your hand up? 

MEMBER FRIEDMAN-JIMENEZ: I did, but 

Mr. Vance actually answered the question. I was 

just concerned about the process after 

identifying a potential exposure. What then 

happens next? Does it go straight to the claims 

examiner? Or would it preempt the referral to 

the industrial hygienist, because now the 

exposure has been identified? Or would it 

actually cause referral to an industrial 

hygienist? 

So I think this is an important series 

of steps. And Mr. Vance explained it so -- 

 CHAIR MARKOWITZ: Great. Dr. Bowman? 

 MEMBER BOWMAN: Yes. So just, I think 
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there's a very strong rationale behind this 

recommendation. The one thing I wanted to note 

at the end, it says to many or all, which is a 

little, which is not very precise. 

 And I was wondering if we could 

instead think about changing it to all toxic 

substances at the facilities except substances 

that are at only very specific locations where 

this job category would never have been allowed 

to enter. 

 If there's something like that, you 

know, those would not need to be there. But 

literally say all unless, for those chemicals 

that are, you know, at only specific spots, that 

this entire job category would never have been 

able to access. So it's very precise. 

 CHAIR MARKOWITZ: Right, right. So 

this is a friendly amendment. And I understand 

the intent. And it makes sense to me. 

 My concern and question really is, in 

practice, thinking about firefighters, are there 

locations really where they're not permitted to 
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go? I'm sure there probably are some in those 

which, in certain radioactive substances. 

 And the question is who identifies, I 

mean, how much information do we really have to 

be able to identify those locations? So it's 

really the implementation which I think it might 

raise some problems. But let's hold on to that 

for a moment with further comments. And then we 

can look at it and fine tune the language. 

 Ms. Whitten? 

MEMBER WHITTEN: I just had a comment 

about whether the Board would be able to review 

the recommendations before they're implemented? 

CHAIR MARKOWITZ: So which 

recommendation? I mean, the one we're looking at 

now? Or are you talking about the --- 

MEMBER WHITTEN: I mean the 

presumptions, before they implement them. 

 CHAIR MARKOWITZ: So in other words, 

if we move ahead with this recommendation and 

it's accepted, and then the Department goes and 

identifies those job categories, are you asking 
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whether we would get a chance to look at their 

proposed job categories? 

MEMBER WHITTEN: Yeah, to get a chance 

to look at the presumptions that they put 

together. 

 CHAIR MARKOWITZ: Right, the language 

of the presumption. That's a question for Mr. 

Vance. 

MR. VANCE: You know, I think that in 

the interaction with the Board, you know, the 

recommendation is made, and then the Department 

of Labor would assess what they think or, you 

know, what we would think would be the 

appropriate response to that recommendation. 

 If it would be a recommendation that 

would be made that we agreed to, and then have a 

caveat about, like, additional effort in 

understanding the specific labor categories, that 

might be something that we would follow-up with 

the Board. 

 But if the Board makes a 

recommendation that is actionable by the 
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Department of Labor, and we agree to it, it could 

very well be that we would proceed with a 

procedural change. And then the Board could come 

back and take a look at that and say, well, okay, 

you didn't get exactly what we wanted, or yes, 

that's exactly what we intended. 

So my one comment is specificity is 

very helpful in any of these recommendations. 

And, you know, I think it's a collaborative 

process. So I would say we will take whatever 

recommendations and try to act on them as 

efficiently as possible if we feel that they are 

agreeable to, if that makes any kind of sense. 

CHAIR MARKOWITZ: Sure. So we're 

heading towards a vote on this. But I want to 

get back to Dr. Bowman's proposed modification. 

 So Kevin, can you get into this file 

and actually type in changes? 

MR. BIRD: I will pull up a word 

document right now. And we can -- 

CHAIR MARKOWITZ: Well, yes, it's a 

PowerPoint. 
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 MR. BIRD: Yes. I'm just going to, I 

just typed it out separately. So hold on one 

second. 

 CHAIR MARKOWITZ: Yes, okay. Okay, 

great. So if you could just make it a little 

larger. Perfect. 

 So, Dr. Bowman, let's entertain the 

language that you want to alter. 

 MEMBER BOWMAN: Yes. 

CHAIR MARKOWITZ: So it would be, yes, 

why don't you go ahead and play with it. 

 MEMBER BOWMAN: So I thought you made 

a good point, because it does relate on the 

quality of the data available to make that 

statement. And so I just thought that many or 

all was vague. And so if we could change it to, 

how about exposure to all listed toxic substances 

at those facilities, and then maybe except 

substances for which clear evidence is available 

to suggest exposure could not have occurred. 

 MR. BIRD: Sorry, can you run that 

back for me one more time? 
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MEMBER BOWMAN: Yes, except substances 

for which clear evidence is available to suggest 

exposure could not have occurred for that job 

category. So therefore it limits it to only 

things in which there is positive evidence to say 

it should come off. 

 MR. BIRD: Okay, I'm sorry, just one 

more time. You're --- 

MEMBER BOWMAN: Yes, sorry, except 

substances for which clear evidence is available 

to suggest exposure could not have occurred for 

that job category. Sorry, the word suggest is 

there twice or something. It could probably be 

wordsmithed a little bit more. That's just sort 

of the idea. 

 CHAIR MARKOWITZ: So, Steve, 

Markowitz, I get the logic of that. Where I get 

stuck is thinking about the availability of 

evidence. And so you'd have to have affirmative 

evidence that the guard could not have ever had 

exposure to a particular toxin. And I don't know 

what that evidence would look like. 
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 MEMBER MIKULSKI: I agree. This is 

Marek Mikulski. I don't think, from my knowledge 

and experience with the historic documentation 

and exposure information in any of these sites, I 

don't think that there is truly anything that 

would indicate that the exposure was not present 

in that particular job category. In other words, 

to me all listed toxic substances at those 

facilities suffices. 

 MEMBER BOWMAN: Yes. If that's the 

case, that there would not be such evidence, I 

would agree. I was thinking just broadly there 

may be categories where that individual in the 

job category could never have entered a 

particular room, and that room was the only place 

that chemical was found, it would then give that 

possibility for such examples. 

 But otherwise, because the language 

I'm suggesting would require positive evidence, 

for the most part that last phrase would not be 

used. It would just --- 

CHAIR MARKOWITZ: Yes. Steve 
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Markowitz again. You know, what happens at most 

of these sites it that there's partial 

information about use and exposure. And so 

there's a lot that's not known. 

But I think this issue you're raising 

would actually be addressed by the industrial 

hygienist in the evaluation. Because even if we 

moved it to all, and so we moved the most to all, 

and just used all --- 

MEMBER BOWMAN: Yes. 

CHAIR MARKOWITZ: -- so that would 

make it more clear. 

 MEMBER BOWMAN: It would. 

CHAIR MARKOWITZ: What's going to 

happen is the industrial hygienist is going to 

say, well, the --potentially all, but was it the 

sufficient dose? 

 And then they're going to say, well, 

probably not, because this particular radioactive 

material was only used in one location. And the 

firefighter never would have gone there. You 

know, that kind of judgment. 
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So I think that, I don't think we need 

to specify that here. Because I think it's going 

to be taken care of in the claims evaluation 

process. 

 MEMBER BOWMAN: Yes, okay. 

CHAIR MARKOWITZ: So further comments? 

 Well, actually, if you can remove the 

second paragraph, Kevin. 

And so I need someone to propose that 

the Board accept this recommendation. So we're 

going to move to further discussion. We're not 

closing out discussion. I just need to have 

this, as a matter of procedure I need to have it 

proposed that we accept and propose this. 

MEMBER BOWMAN: All right, this is 

Aaron Bowman. I propose it. 

 MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez. I move that we accept 

this proposal. 

CHAIR MARKOWITZ: Okay. Is there a 

second? 

 MEMBER BOWMAN: This is Aaron Bowman, 
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I second. 

 CHAIR MARKOWITZ: Okay, thank you. 

Okay, further and final discussion? Ms. Whitten? 

MEMBER WHITTEN: So are we just 

talking about certain job categories still? 

CHAIR MARKOWITZ: Well, yeah. The way 

it reads now it would be limited to job 

categories where the occupants of that category 

likely work throughout the individual sites, yes. 

We're not specifying what those are at this 

point, but yes. Go ahead. 

MEMBER WHITTEN: Painters, janitors, 

all of those different classifications? 

CHAIR MARKOWITZ: I'm sorry, could 

you, you're not coming through all that clearly. 

If you could -- 

MEMBER WHITTEN: Do you want to put 

certain job categories at certain DOE sites, or 

is that too vague? 

CHAIR MARKOWITZ: Well, personally, I 

think it should be at all the sites where these 

kind of site-wide job categories exist. So I 
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don't want to limit it to certain DOE sites, not 

in the Department's thinking about it. 

 And as a recommendation, we've now 

limited to the job categories those workers who 

likely worked throughout the individual sites. 

So that clause limits the job categories we're 

talking about. 

 MEMBER WHITTEN: Okay. 

CHAIR MARKOWITZ: Does that answer -- 

MEMBER WHITTEN: Yes. Thanks, thanks 

for that. 

CHAIR MARKOWITZ: Other comments, 

questions? 

Okay, so if not, then let's take a 

vote on the recommendation as we see it. For 

those perhaps members of the public who can't see 

what we're talking about, the recommendation is 

that the Board recommends that the Department 

develop and implement exposure presumption 

indicating the job categories at DOE sites whose 

workers likely worked throughout their individual 

sites, had potential exposure to all listed toxic 
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substances at those facilities. 

 So I think, Ms. Rhoads, if you do a 

roll call -- 

MS. RHOADS: Sure. Okay, we're voting 

 on this recommendation now. Dr. Bowman? 

MEMBER BOWMAN: Yes. 

MS. RHOADS: Mr. Catlin? 

MEMBER CATLIN: Yes. 

MS. RHOADS: Dr. Friedman-Jimenez? 

MEMBER FRIEDMAN-JIMENEZ: Yes. 

MS. RHOADS: Dr. Goldman? 

MEMBER GOLDMAN: Yes. 

 MS. RHOADS: Mr. Key? 

MEMBER KEY: Yes. 

MS. RHOADS: Dr. Markowitz? 

CHAIR MARKOWITZ: Yes. 

MS. RHOADS: Dr. Mikulski? 

MEMBER MIKULSKI: Yes. 

MS. RHOADS: Ms. Pope? 

MEMBER POPE: Yes. 

MS. RHOADS: Dr. Silver? 

MEMBER SILVER: Yes. 
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MS. RHOADS: Mr. Tebay? 

MEMBER TEBAY: Yes. 

MS. RHOADS: Dr. Van Dyke? 

MEMBER VAN DYKE: Yes. 

MS. RHOADS: Ms. Whitten? 

MEMBER WHITTEN: Yes. 

 MS. RHOADS: Okay, that's everyone. 

It's unanimous. 

 CHAIR MARKOWITZ: Okay. Thank you. 

So I'll write up a rationale for this. 

 If you could go back, Kevin, if you 

could go back to the PowerPoint, next slide. So 

the others, this is just a variation. We can go 

to that next slide. The second issue is, if 

could you go to the next slide, just so I can see 

what's next. Yes. 

 So the Board requested resources. The 

Board, at present, doesn't have any funding to 

secure any assistance under our direction to do 

background research with the claims and the like. 

And a year and a half ago, actually, the Board 

requested resources. 
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 This was our recommendation. We're 

not going to revisit this recommendation. What 

we're going to discuss really is the follow-up to 

this. But it's resources that would allow us to 

do our job, basically. 

 Next slide. And maybe, okay, so we're 

going to move to a Word file, Kevin, the one that 

says ABTSWH draft rec and, oh, I'm sorry, not 

that one, resource request, we asked resource 

request. So let me --- 

(Simultaneous speaking.) 

 MR. BIRD: Actually, I'm pulling it up 

now. 

 CHAIR MARKOWITZ: -- while you're 

doing that. Yes, fine. 

 So where this stands is that the 

Department has invited us -- I'm not sure whether 

this recommendation has ever been officially 

accepted or not. Mr. Vance may know. But they 

did invite us to, well, sort of advise us about 

the process, which is prolonged in terms of 

getting into the budget. 
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 But they asked us to produce a 

statement of work. And this is a page-plus of 

kind of the work that we envision, at least as it 

reflects prior Board activity. 

 And I don't think we need to walk 

through all this. The previous Board did look at 

this in April and commented on some aspects. And 

those comments were included in this description. 

 But there are several functions that we 

envision. 

One is to organize and review claims, 

abstract information for claims. It's very time 

consuming. The previous Boards looked at many 

claims of various categories, COPD, lung cancer, 

beryllium disease, sarcoidosis, silicosis. And 

while it's not on our meeting agenda, it may well 

come back to our agenda to review claims for 

whatever reason. 

 And it's extremely time consuming. 

And we would need some help to do that, not just 

that it's time consuming, but we could actually 

do, I think, a better, more systematic analysis 
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if we had the time and assistance. And we 

describe the tasks involved and the expertise 

required. 

 So if you go, scroll down a little 

bit. 

 The second major activity would be, I 

think, Dr. Goldman's, her presentation which is 

coming next year, see evidence of sort of this 

area which is that we're asked by the Department, 

and sometimes on our own, think that certain 

scientific, technical, medical aspects of the 

program need to be evaluated. 

 And for instance, the Department has a 

new request to us about impairment evaluation. 

Although I don't think we necessarily need 

support for that. But it's just an example of 

requests made of us that it'll be helpful if we 

had access to people who could help us look at 

that information. And then again, we list what 

kind of skills are required. 

 And then thirdly is a catch-all, which 

is other tasks as deemed necessary by the Board. 
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Because our work may evolve over time, and maybe 

that some additional assistance would be needed 

to do that work. So I guess we could spend a few 

minutes today, if necessary, if people have any 

questions about this, or any suggested language. 

 Our goal is to move this on to the 

Department. This is the statement of work as we 

perceive it for which we would need resources, 

and then get into a iterative process with them 

about whether any changes in this description are 

necessary, or what additional information is 

needed. 

So if you could scroll up, and people 

could look at this. 

I also think that if it's a question 

of fine tuning this language at all that, you 

know, I could receive, by way of email, some 

suggestions prior to finalizing this. But if 

there are any major omissions or questions, it 

would be useful to discuss now. 

 MEMBER BOWMAN: This is Aaron Bowman. 

 CHAIR MARKOWITZ: Yes. 
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MEMBER BOWMAN: I had a question. 

This seems very reasonable, and the rationale as 

well, in terms of assistance to the Board in this 

matter and the review of data and such. 

I was just wondering, in terms of our 

request, who would manage if, let's say, the 

request was fulfilled, who would manage the time 

of individuals working for it? Would that be the 

Board? And should there be some statement in 

here about the management of those staff that we 

might get to work in these matters? 

CHAIR MARKOWITZ: Yeah, no, that's an 

excellent question. And we really haven't 

explored the options for that. This is a 

statement of what we would actually do. I think 

what you're raising is an important issue of how 

it would happen. 

 I think our implied conception of this 

is that we would, the Board would control the 

agenda of these resources. And how exactly that 

happens administratively, I don't know. 

 So I think that is a very important 
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issue that we need to get to. And I think once 

we submit this and engage in some more back and 

forth with the Department, you know, let's figure 

out what the options are. 

 MEMBER BOWMAN: Okay. 

 CHAIR MARKOWITZ: Any other comments, 

questions? 

So again, we don't need to vote on 

this. But I plan on submitting it, I would say, 

within a week. So if you have any word changes 

or additions that don't substantially change 

this, please email them to me, and I'll 

incorporate those changes, and then send this to 

the Department. 

 MEMBER GOLDMAN: Is this going to be 

sent to us to look at, or do we already have it? 

MS. RHOADS: I think you already have 

it. But I can send it again in its own email if 

that's easier. 

 CHAIR MARKOWITZ: Yes. I think also, 

I think this is on our website. But there are so 

many sources of information coming to us in 
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different ways, so yes, Ms. Rhoads, if you could 

send it out, that would be great. 

 And in particular, look at the tasks 

and the expertise. If there's anything that's 

missing, then that would be useful. 

Okay, so if we go back to the 

PowerPoint, I don't think we'll -- the next topic 

is going to be the issue of the IARC Group 2A 

carcinogens. But it's five of 1:00. So I 

propose actually that we take a break. 

 And since we did run over on the SEM 

presentation, for good reason, I wondering 

whether we can shorten our break a little bit. 

It's five of 1:00. Do the people feel that 

coming back by 1:15 -- 

MEMBER BOWMAN: That sounds good. 

That's good for me. 

 CHAIR MARKOWITZ: Is there any major 

objection? 

Okay, so we'll do that. We'll 

reassemble at 1:15. Thank you. 

(Whereupon, the above-entitled matter 
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went off the record at 12:55 p.m. and resumed at 

1:15 p.m.) 

CHAIR MARKOWITZ: So, our next topic 

is going to be, the Boards looked at certain 

carcinogens, cancer-causing chemicals, or agents, 

identified in an authoritative source in the 

International Agency for Research on Cancer, 

IARC. 

And just a very brief background. 

Some time ago the Board raised the issue of 

whether we SEM database in the underlining HazMap database, which ties together exposures with 

diseases, was fully inclusive of recognized 

relationships between carcinogens and human 

cancer. 

And referred back to a 2013 report by 

the Institute of Medicine, which had looked at 

the SEM and recommended that certain recognized 

authoritative sources be included in the SEM. 

Including IARC, including the National Toxicology 

Program, documents including others from EPA, 

from the California Health Department and the 
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like. 

So, the Department of Labor asked us 

for assistance in wading through some of these 

sources. And the first was take a look at the 

IARC carcinogens. So now I will turn it over to 

Dr. Goldman. 

MEMBER GOLDMAN: Thanks very much. Do 

I have, should I show my own slides or is Kevin 

or somebody going to -- 

MR. BIRD: Yes. Dr. Goldman, this is 

Kevin. This is completely up to you. I'm happy 

to show the presentation and then you can just 

say next slide when you'd like to advance, or I 

can give you control. Whatever you prefer. 

MEMBER GOLDMAN: Okay. If you've 

loaded them, if I just hit the arrow key, can I 

now control it? 

MR. BIRD: Give it a try. I don't 

know if you can right now. But -- 

MEMBER GOLDMAN: No. That's okay. 

All right. 

MR. BIRD: I can make you -- 
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MEMBER GOLDMAN: Yes? 

MR. BIRD: Here, let me, I can go 

ahead and make you a presenter. So let's see. 

Go ahead and try it now. 

But you can also use, on the left-hand 

side of your screen, there is a little popup 

window that has the slide number when you move 

your mouse to the left. 

MEMBER GOLDMAN: Right, okay. Great, 

I've got it. 

Okay. So, thank you very much, Dr. 

Markowitz. I just want to say that the question 

that was presented when we had the subgroup, 

which was, and I'm going to discuss it a little 

bit more, what is meant, because some people may 

not be as familiar as others. 

But the question particularly that we 

were addressing is, should the IARC Group 2A 

carcinogens be added to the SEM, making them two 

specific cancers? 

And I want to acknowledge that this 

began last year. And I sort of came in on the 
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group about midway. 

And the leader on the group was Mani, 

Dr. Mani Berenji, who was phenomenal. And a lot 

of the work you're going to see she did. 

And also, we had two other people on 

the group, Duronda Pope and Dr. George FriedmanJimenez, who brought other points of expertise to 

this process. 

And, Dr. Berenji decided not to 

continue with the Committee this year, but I do 

want to thank her, because I think she did a 

tremendous job. And you'll see how much work 

there is to all this. 

So, basically I just want to introduce 

this. Even though the SEM is using the Haz-Map, 

we were looking at the International Agency for 

Research on Cancer. 

And this is a very well-established 

international group that brings quite an intense 

and comprehensive review of literature to answer 

questions about the level of risk from certain 

agents. 
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And this agency groups things, and 

actually, EPA and others tend to also at least 

use this grouping. Which is Group 1, is felt to 

be a carcinogenic to humans. Felt to be enough 

data, both from humans and/or animals, to make 

that a causal connection. 

Group 2A, which is what we're speaking 

about today, is considered, quote, probably 

carcinogenic to humans. And from their whole 

course of doing this there is 88 agents in that 

category, currently, as of October. Group 2B is 

possibly carcinogenic. Group 3, not 

classifiable. 

So, just to look a little bit more at 

this Group 2A, what do we mean by probably 

carcinogenic. And it means, limited evidence of 

carcinogenicity in humans. And that means there 

may be some good studies, but they may not be 

totally great because of bias or other 

limitations. 

But, if there is really very good 

evidence, sufficient evidence of carcinogenicity 
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in experimental animals. There may be inadequate 

evidence in carcinogenicity in humans, sufficient 

to animals, but strong evidence when you look at 

a mechanism of how it would induce 

carcinogenicity. 

And then it could be considered 

limited of carcinogenicity in humans but be long 

spaced on both mechanistic considerations and 

similar agents. And I'm going to give an example 

of those, that were classified as Group 1, to put 

this other agent in Group 2A. 

So, the tasks that we faced was, one, 

to look at this other database. The IARC 2A. 

And what Mani wisely decided to do, was not to 

try to tackle 88, but to look at the most recent 

ones, which came out to be 22. 

And then to also look briefly at other 

sources, national toxicology program, Haz-Map. 

And then to look at the current exposure links 

that we had in SEM. 

And we had some in-person meetings 

when we were together, but we really were trying 
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to work on this in our little subcommittee, 

February 18th, and April 7th. 

And what Mani did, and I really have 

to again commend her, is she downloaded the 

monographs for about 22 of these agents that were 

pertinent, to look at them, to be able to 

summarize them and present them to us. 

And then what she did, and I actually 

was playing around with last night, and I'm not 

an expert on searching the SEM, but maybe that's 

actually a good thing because maybe I would be 

looking at it, perhaps, somewhat like an 

employee, a worker. 

And then we also are trying to id the 

relationship between the toxic substances and the 

illness. Again, right now, SEM is using the HazMap database. And noting that everything that is 

approved for an SEM must be pre-approved by the 

Department of Energy. 

So, what first started, and then it 

created this spreadsheet for us to look at, was 

to make a list of what these 22 agents were. And 
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we're eliminating certain of them. For example, 

one that's medication, and also one that involved 

drinking a hot beverage. So you can see this is 

not totally a perfect system. 

We highlighted certain agents that 

appeared that they were more likely to be used 

here among this, these workers. But I also want 

to note that we ran into a situation where you'll 

see some pesticides. 

There are malathion and diazinon. And 

I think there was another one in here. 

Where perhaps we're not always noting 

the pesticide exposure on the Department of 

Energy workers, but you might have other workers 

who come to work to, for the grounds or who are 

spraying when there is a pest found. And perhaps 

that doesn't even get noted or not. But that 

some pesticides are coming up now on this 

database. 

So, what we wanted to do is to take a 

couple of these. What I wanted to do is take a 

couple of these to just illustrate how the 
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process would proceed looking at the agents. 

What do we know about it and then what would we 

found out about it in the SEM? 

And so, let's start with something, 

maybe people have heard about this polybrominated 

biphenyls, PBBs. They're very lipophilic, which 

means they get stored in the fat and they stay 

around for quite a long time. 

They bio-concentrate, they bioaccumulate. And these are contaminates 

worldwide. 

Some people may have heard of 

FireMaster FF-1. It's a flame retardant. And 

that's the one that basically contaminated quite 

a bit of materials in the State of Michigan. 

These fire retardants are used in 

textiles, they're used in various plastics. So 

they're very widely used. 

And if you looked at the data that was 

summarized here from the IARC, that it constantly 

induced benign and malignant hepatocellular, 

which are liver tumors in rats and mice. 
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And another kind, cholangiocarcinomas, 

in rats. Which is near the liver, sort of where 

the gallbladder is. 

But there was very limited 

epidemiological studies. But here's where this 

comparison comes in. 

There is another chemical, 

polychlorinated biphenyls. And these are also 

very widespread. They're oily substances that 

are good for keeping the heat down in their own 

transformers, and many other agents. 

And those have been looked at. And 

those have been found, more convincingly, to be 

carcinogens. And have been rated as a one from 

IARC, as well as EPA. And U.S. Health and Human 

Services has rated them as a Group 1 carcinogen. 

And so, if you've looked at the PBB 

and their type of evidence, and you combine that 

with the fact that they have sort of a similar 

structure to the PCBs, but what happened was, the 

polybrominated biphenyls got upgraded to Group 

2A, as a probably carcinogenic in humans. 
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So, if you do a search, now we're 

turning a little bit to SEM. And this is one 

that Mani did. And I sort of did it in a 

different way. 

She started out by saying, okay, what 

other names would you find for these. And this 

is a clip that you can see. 

There's many different names for these 

chemicals. And whether or not, if you put in 

polybrominated biphenyls, you might come up with 

all of these. But if you put in one of these 

other chemicals, might you come up to this screen 

or not. 

Here I just put in, not being an 

expert, I just went to the field that said toxic 

substance, and I put in polybrominated biphenyls. 

 And was very gratified to see that right away 

this came up. 

It gave me some of the aliases here. 

Some of the properties. 

But if you notice, for specific health 

effects, the one that it noted was a clinical 
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health effect called chloracne. But, it did not 

mention carcinogenicity. 

Another chemical, I'm just going to 

give a couple of examples here, 

tetrafluoroethylene. Again, these are exposures 

that occurred primarily in the manufacturer of 

tetrafluoroethylene. But also in polymerization 

processes. 

There was one human cohort study from 

cancer and selected non-malignant diseases that 

did show an increased risk in liver at 1.27, 

means it's increased about 27 percent. But with 

the range of just barely .55 to 2.51. Possible, 

also increased risk for kidney cancers and 

leukemia. 

So, going to the SEM. Again, Mani 

went through and looked at the alias search to 

see all the different names that would come up. 

And then I just put this chemical in to see what 

would happen if I put it in the toxic substance 

field. 

And something did pop up with all of 
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the other alias names. Something about the 

properties but really didn't talk about cancer. 

Just noted that it was a simple asphyxiant. 

I want to show one other example. 

This is a chemical, I usually think about it as 

methylene chloride. Another common name is 

dichloromethane. 

This is a solvent. It's used in many 

areas. Polycarbonate plastics, manufacturing of 

photoresist coatings, a solvent carrier for 

insecticides. 

But frankly, it's a common solvent 

that's even found in paint thinners. And even 

ink. So I wouldn't be surprised if this was used 

among the Department of Energy workers. 

And there have been a couple of cohort 

studies of workers exposed to dichloromethane, as 

well as other chemicals in the U.S., reports 

cancers of the liver and biliary track. But 

based on very small numbers. And so, that's why 

it probably does not have a Level 1 rating with 

the 2A. 
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Now here, Mani put in methylene 

chloride and came up with all these aliases. I 

have to say, I tried putting in methylene 

chloride in that toxic chemical field and I was 

not successful in coming up with much. Or 

anything. 

But when I put in the others name, 

which is dichloromethane, yes, I did come up with 

quite a bit of information. Which I actually 

want to compliment the SEM, that it's good that 

we're getting this much information. 

I think that's very helpful. Both in 

terms of identifying other agents that could be 

similarly named. And at least some of the basic 

properties. 

If we come down to the specific health 

effects, and I'm sorry if this was a bit hard for 

people to read, if we come down to the specific 

health effects, certainly the one about chronic 

solvent exposure and having dementia and chronic 

encephalopathy is there. 

If there is an acute toxic effects. 
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Headaches. I'm not sure what fumigants, but even 

a large exposure could lead to quite a serious 

reaction. 

And also, typical reactions for 

overdose for solvents. But again, in this 

situation here, no specific mention of cancer. 

So, going back to the past. One was 

to explore IARC and how we might use that. The 

second was to review other sources in National 

Toxicology Program and Haz-Map, which we did to a 

small degree. 

The National Toxicology Program has a 

website. They also rate agents in terms of their 

level of carcinogenicity. They've put out a 

report. The 14th Report on Carcinogens, which 

was released in 2016. 

They updated 248 substances. They 

classified 62 as known carcinogens. And then 

reasonable anticipated as a human carcinogen, 

186. 

So, the question is, do we enfold and 

bring this in, is it going to add anything more 
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than actually using IARC? 

There is the Haz-Map, which is 

currently the underpinnings, as I understand it, 

for SEM. And there you will find this 

exploration of the website, they note hazardous 

agents and symptoms and findings. And they're 

updating their website all of the time as well. 

I'm not an expert on this either. 

But when the Committee spoke to each 

other, and I have to say George has a lot of 

experience with IARC, that we felt that looking 

at all of these, it's sort of overwhelming to try 

to be looking at all of the databases, and you'll 

see how much work there is just working with 

IARC, we felt that it would be more effective to 

just focus on the IARC ratings and the 

information provided by IARC because it's so well 

vetted in great detail with the committees. 

And people can comment further maybe. 

George could comment further on that. But we 

were thinking that it would be the way to go to 

basically use IARC. 
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And so, the third thing we were 

looking at is, well, how about looking at current 

exposures and what that might link to in SEM. 

And also going the other way. If somebody has 

liver cancer, would you come up with any of these 

agents that are listed here, for example. 

So, there was another try at that. 

And just, again, to show people another way. And 

we heard about this earlier this morning. And, 

again, I'm not an expert on SEM, but this is what 

I understood. 

You could look at healthy SECs and try 

to find out if you have a health effect, like you 

had liver cancer or lung cancer, what might come 

up. And where might I get exposed. 

So here I just, since we had two 

agents, methylene chloride and the PBBs that 

cause liver cancer, I put liver cancer and 

thought, well, what did we come up with. 

And so, what we came up with were 

known agents that increase the risk for liver 

cancer. I suspect they're all number one. 
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Aflatoxins, Hepatitis B and vinyl chloride. 

Which is an industrial agent. 

Having come up with those, we don't 

see PBBS and we don't see methylene chloride. 

And we also don't see a link to any book process, 

where one might expect this health effect. And 

maybe I'm misinterpreting this playing field, but 

maybe we don't have the use of vinyl chloride 

here. And Aflatoxin is something from ingesting 

moldy food, like peanuts. 

Then I thought, okay, let's do bladder 

cancer. That is a very well documented 

occupational cancer. With, particularly the 

benzidine dyes and other things. 

And you can see there is a lot of 

agents. You probably can't read it here. 

And what I learned is that if you look 

at this field, about what process you might link 

it to, you probably don't get to the process this 

way. Probably what you have to do is say, oh, 

I'm exposed to this agent, and then put that 

agent in. And then see if that brings you to 
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where the work process is. 

I tried it on lung cancer. That's way 

too long to be able to printout. And what I 

found when I just put in lung cancer is there 

were many agents that were listed. 

Most of them, a lot of them were 

metal. Like chromium, cobalt, nickel, beryllium, 

cadmium, arsenic. And other known carcinogens, 

asbestos. 

 Some lead compounds. Usually the ones 

that were blended with arsenic or chromate. 

And then I went to that field, work 

processes linked to this health effect, and it 

was left blank. So my assumption, and we could 

discuss that, is that if you go to this field, 

that what a person would have to do is see if 

they had lung cancer, if anything they thought 

they were exposed to, any of those agents was on 

that list, and then perhaps put that agent in and 

see what were their work processes. 

So, it's a little bit harder going 

from the health effect back. 
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And let me see. And so, having gone 

through this very preliminary process of using, 

trying to use SEM and seeing how it would work, 

we came up with a bunch of questions. 

What about searching on health effects 

and going back, which ones are flawed, which ones 

are being used and not used. Are they being 

properly attributed. Which exposures are 

currently not in, that should be, which raises 

the whole issue of should we be adding some or 

all of these that are in the Group 2A. 

The other thing we found is that the 

SEM is not totally user friendly. I think it's a 

really powerful user, I mean, a powerful 

database. 

I'm trying to imagine if employees are 

supposed to be using this or other people who 

don't have a lot of experience with it. I know 

that it's being continually being improved. 

So, sometimes they have to obtain 

further clarification from a climate regarding 

the circumstances of their work, to see if 
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they're really getting in contact with that toxic 

substance, which are some of the things we've 

already talked about. 

So, I'm sorry this got a little cut 

off. I'm trying to make it a more beautiful 

presentation, but, what we recommended, and I 

want to show also, if we could, the draft report 

that we sent out. 

We recommended, after our Subcommittee 

spoke, and we presented this in the spring 

meeting, that we do list the IARC 2A agents being 

incorporated in the SEM and include their 

respective associations with the cancers, based 

primarily on the IARC monographs. And then as a 

supplement, to put in something else you could 

find from NTP. 

And this is, just to show people what 

we submitted last spring, and this was our 

secondary recommendation, that the process, why 

we justified this, that IARC has this very indepth process for evaluation and presumption of 

causality and causation. 
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And then this is just saying what the 

end of us doing with the Committee, this was the 

recommendation. And then there is a rationale, I 

don't know if you can go through this, we went 

substance, let me see, substance-by-substance. 

You can see a little summary here of 

each of the substances. The one glyphosate has 

been very controversial. 

There's been a lot of legal suits 

about this. And this is the one that causes 

Hodgkin's lymphoma. And that's a herbicide 

that's being used. Whether it's used here, I'm 

not sure. 

And then these other insecticides, 

which raises the whole point about who would be 

using it here and the job titles of those 

workers. And they're very commonly used. 

And then these are other agents that 

may come up. So we incorporated a quick summary 

from the IARC monograph to sort of support 

looking at, at least looking and considering, 

including these agents. 
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So, I'm going to stop there. I'm just 

wondering if the other two people who were on the 

Committee, Duronda or George Friedman, might want 

to add comment, or correct something, that I 

said. So, I'll go to you right now. 

MEMBER FRIEDMAN-JIMENEZ: Hi. This is 

George Friedman-Jimenez. Can you hear me? 

MEMBER GOLDMAN: Yes. 

MR. BIRD: Yes, we can. 

MEMBER FRIEDMAN-JIMENEZ: Okay, good. 

 A couple of comments. 

Rose, you asked me to comment on IARC 

and NTP. They largely overlap and do similar 

level evaluations. 

The important point here is not so 

much IARC versus NTP, or both, it's that both 

agencies are multi-disciplinary and there are 

expert review panels that include 

epidemiologists, toxicologists, experts in 

carcinogenic mechanisms and exposure assessments, 

statisticians, occupational environmental 

medicine physicians and other experts in 
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determining general causation. In other words, 

causal inference at the population level. So, 

can a certain agent cause cancer. 

I've served twice on the NTP review of 

carcinogens subcommittee of the Board of 

Scientific Counselors, but I have not served on 

IARC. And the determination of reasonably 

anticipated to be a human carcinogen, which is 

used by NTP, it's roughly, but not directly 

equivalent, to the IARC Group 2A. 

The categories of agents include, not 

just substances, which is the purview of our 

Board, but also types of radiation, processes, 

activities, like night shift work, and other 

types of exposures. And they're not directly 

comparable for some of the exposures. 

My feeling is, when you introduce a 

probable carcinogen into this process of 

determining causation as opposed to a known 

carcinogen, I know there is some level of 

arbitrariness in that determination, but you're 

introducing a little bit more uncertainty. 
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Of course, there are a lot of other 

sources of uncertainty in making these 

determinations. Mostly how much the individual 

person was exposed. But the uncertainty in 

whether a substance can cause cancer or not is 

significant. 

So, there is a lower level of 

knowledge, of certainty, for the 2A carcinogens 

than the one, the Group 1 IARC. 

And so, the physician or the claims 

examiner or the process determining causation in 

the individual, has to factor in this degree of 

uncertainty in the 2A versus the Group 1 category 

as well. 

So, I think it's reasonable to include 

the 2A carcinogens. And I think we're all in 

agreement on that. 

It may require further review by the 

physician to determine whether they thing, say, 

if someone is exposed to a 2A carcinogen they may 

want to be a little bit more sure about exposure 

or about level of exposure, latency, duration, 
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and have less uncertainty in that before they 

call it work related. 

So, it's not all together 

straightforward. But I would agree, that the 2A 

carcinogens, IARC Group 2A, would be good to 

include. 

Whether we should include NTP 

reasonably anticipated, as I said, there is a lot 

of overlap. Some of the Group 1 from IARC are in 

the reasonably anticipated and vice versa. 

But I think it's reasonable to start 

with Group 2A and then we can, maybe in the 

future, look at the reasonably anticipated and 

see if there are some additional ones that we may 

want to add. 

One last comment. Not all of these 

carcinogens, in fact, only the minority of them, 

are actually occupational exposures. Many are 

viruses or they're things that are not typically 

found in the workplace, not related to work. 

Dietary, that sort of thing. 

So, when you get down to which are the 
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actual occupational carcinogens, it's a much 

smaller number so there is less number that we're 

adding to the list. So that's my only comments 

on Rose's presentation which is, I think, really 

makes a good argument in favor of including the 

IARC Group 2A. 

MEMBER GOLDMAN: Thanks for the 

clarification on that. I'm sorry if I misstated 

about the NTP, but I'm sort of thinking of, I 

agree though, to start with IARC and then maybe 

use NTP to further supplement. But it's a lot to 

try to do both at the same time. 

MEMBER FRIEDMAN-JIMENEZ: I think the 

IARC 2A includes a lot of the occupational NTP 

reasonably anticipated, so I don't think we're 

missing much by not including them. 

But in the future, let's look at it 

and we'll see if there are any additional ones we 

want to suggest. 

But I think starting with 2A is well 

circumscribed and it's a good next move. 

CHAIR MARKOWITZ: Ms. Pope, you have 
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any, I think your hand is up. 

MEMBER POPE: Yes, it is. Thank you, 

Dr. Markowitz. 

I just want to thank Rose, Dr. 

Goldman, and Dr. Friedman-Jimenez and Dr. Mani, 

for all their work down on this Subcommittee. 

And Dr. Goldman for continuing the work and 

summarizing that report. 

I'm in agreement with her in terms of 

the SEM being user friendly for the worker going 

in there and trying to do navigate that system. 

It has its pros and cons and has evolved over the 

years. But I agree that sometimes it's literally 

difficult in terms of trying to extract some of 

that information out of that system. 

But thank you, Dr. Goldman. Excellent 

job on your summary. Your presentation. 

MEMBER GOLDMAN: Thank you. And I 

don't think you guys are off the hook yet, if we 

have to do more work. So we may still all be in 

it together. 

MEMBER POPE: Absolutely. 
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MEMBER FRIEDMAN-JIMENEZ: I hope so. 

CHAIR MARKOWITZ: Dr. Bowman. 

MEMBER BOWMAN: Yes, thank you. Just 

a question of clarification. Dr. FriedmanJimenez, from what I understand, your 

recommendation was to include the IARC 2A agents. 

And in looking at the draft, I was 

uncertain, is the recommendation that we're 

considering here, that we're talking about, to 

include all the IARC 2A agents or just those few 

listed that are a subset of the ones that were 

added between 2016 and 2019? 

MEMBER FRIEDMAN-JIMENEZ: Actually, 

neither. 

MEMBER BOWMAN: Okay. 

MEMBER FRIEDMAN-JIMENEZ: I think the 

subset that we're talking about is the subset 

that is likely to be occupational. And Dana 

Loomis et al reviewed that several years ago. 

So, I think we came up with 22, is 

that right, Rose, that were likely to be 

occupational, that are -- 
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MEMBER GOLDMAN: Right. 

MEMBER FRIEDMAN-JIMENEZ: -- in the 

IARC 2A, is that right? 

MEMBER GOLDMAN: Yes, that's correct. 

I thought we picked them from the Loomis article, 

which we can send out, which was very good. 

But then when I was looking over 

Mani's notes she said it was from the most 

recently reviewed. But there is a very god 

article that we can send out by Loomis where that 

author does list, looks at the 2A agents and then 

extracts out the ones that are most occupational. 

And I agree with George, I think that 

we should use that, perhaps a lens like that, as 

the starting point for saying, which of the 2A 

agents. And perhaps then we need to make our 

recommendations a bit clearer. 

Although the recommendation, I think 

doesn't just say the 22 but perhaps we should add 

that. 

MEMBER BOWMAN: Okay, thank you. I 

think I understand. So, it is agents, all of the 
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agents from IARC 2A, not just those from 26 or 

22, that are deemed to be relevant to an 

occupational exposure? 

MEMBER FRIEDMAN-JIMENEZ: Yes, I think 

that's summarizing it right. 

MEMBER BOWMAN: Okay. Yes, because in 

terms of the text here on the screen, I'm not 

certain that that's clear from that text, so we 

might consider a slight edit to that, to make it 

more clear. 

MEMBER GOLDMAN: That's a good idea. 

CHAIR MARKOWITZ: This is Steve 

Markowitz, I have a question. 

So, now the energy of employee's 

occupational illness, X, sets out a standard that 

the toxic substance needs to be, at least as 

likely, if not, a significant factor in 

aggravating, distributing or causing. So I think 

probable carcinogens or reasonably anticipated 

carcinogens should be construed as surpassing 

that threshold. 

But here's my question about the 2As. 
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You know, the SEM lists particular agents with 

particular cancer sites. So, if we want to add 

PBBs or PCBs, it's only really useful if we name 

what cancer site is related to that exposure. 

Now, that's straightforward with the 

group, pretty straightforward with the Group 1 

carcinogens. Especially since IARC actually 

specifies the organ sites. 

But Group 2A is a bit of a mystery 

because you're extrapolating from animal studies 

and the like. So, we can recommend that they 

include 2As, but the next question is, which 

cancers are related to which agents. 

So, what's your thinking about that? 

MEMBER GOLDMAN: It looked to me, I 

mean, George has done more with this, but for a 

lot of the agents, whether it was animal data or 

the few human studies, they did name some of the 

cancers, like the PBBs. They named liver cancer 

and gallbladder or cholangiocarcinoma. 

And then I'm just looking quickly 

through here on some of the others. You know, 
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glyphosates, for example, Hodgkin's lymphoma. 

So, I mean, I think what we could do 

is, it may not be all inclusive, but again, to 

look at it as a starting point, to take what 

seems to be the more obvious from which the basis 

of the 1A rating was done and put those down 

noting that in the future as more research 

studies come out, there may be more information 

that comes out. 

I mean, it looked to me that for most 

of these agents they did name some of them. I'd 

have to look more carefully. I see that for 

diazinon they did it based upon chromosomal 

damage. So that would be tough. 

But then they did, here is the limited 

evidence in humans for non-Hodgkin's lymphoma and 

lung cancer. So what I think we could do then is 

just base it upon what the limited evidence is to 

the best that we could and name those cancers. 

CHAIR MARKOWITZ: Dr. FriedmanJimenez? 

MEMBER FRIEDMAN-JIMENEZ: Yes. This 
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is a difficult point. When you're dealing with 

toxicology and epidemiology, there is a problem 

of interspecies extrapolation. 

In other words, what you find in an 

animal doesn't necessarily extrapolate to humans, 

and vice versa. 

There are examples of organs that 

don't exist in humans but that exist in 

laboratory animals or enzyme systems that are not 

the same. The doses are frequently very 

different. 

Actually, Dr. Bowman, I'd be 

interested in hearing what your perspective as a 

toxicologist is on this. But it's problematic 

sometimes to extrapolate from animals to humans. 

And so, we have to use the information that we 

have. And I think this needs to be done on a 

case-by-case basis. 

Frequently they'll find, say liver 

tumors in rats and mice and it's barely 

suggestive that we would be looking for liver 

tumors in humans, even if it's not sufficient 
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evidence in the epidemiology. 

But that may not be the case for a 

different agent. So, I think it has to be done, 

to some extent, on a case-by-case basis. 

MEMBER GOLDMAN: Well, I agree, I 

think it's a case-by-case basis. Some are human 

studies that are not, that have some flaws with 

them. 

But I think we would turn to the IARC, 

or NTP approach, about what they think are the 

highest probability cancers that the chemical is 

causing the increased risk. And then start with 

those. 

And so, I think when I look it over 

just briefly, it looks like there are certain 

cancers that are highlighted for many of these 

agents. 

And frankly, that's why there is so 

much work, just to follow up on this, to pursue 

this further, Dr. Markowitz, which is a really 

good point. 

If you really wanted to go that next 
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step, what it really requires is you have to do a 

more in-depth study and summary of these 

different chemicals. And what's the basis for 

the data. And when there is human data, to try 

to go with that as the one to bring up. 

And again, we're saying it's an issue 

of being a contributing factor, more probable 

than not, for increasing the risk of these 

cancers. And so, I think it would have to be put 

in that context. But there would be more work to 

be done. 

CHAIR MARKOWITZ: Yes, Steve 

Markowitz. Well, as it stands right now, I'm not 

sure the recommendation is actionable by the 

Department. 

Unless cancer sites are identified. 

Because obviously, that's what the claims 

evaluation process does, is link up specific 

exposures with the specific diseases. Specific 

cancer sites. 

The question is, whether the Board has 

the time to devote to identifying within those 22 
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agents what the candidate cancers would be or 

whether that's something that we leave for the 

Department? 

I don't think really the Department 

has currently the resources to do this 

identification of specific sites. And it's part 

of the reason why I think they asked us to help 

them out. 

So I'm not sure how we get out of this 

puzzle. But I guess the question is, whether we, 

on the Board, think we have the time, expertise, 

to attach specific sites with caveats obviously, 

because it's a probable standard, or do we have 

the time and expertise to identify these cancer 

studies? That's my question. 

MEMBER GOLDMAN: Well, I guess 

another thing, and I haven't read her article, 

this article in a while, is whether one could 

look at something like the Loomis article and say 

here, where there is a Table 3 in it, where there 

is a list of different cancers and then a list of 

agents that would be associated with that. 
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So, we could pass this out. And maybe 

it's something we need to discuss further. So, 

whether one could, in addition to doing the 

detailed, reading of all the IARC, here is 

somebody who listed the various different 

cancers, and then put forth the agent associated 

with, the occupation agent associated with that 

cancer. Whether that becomes a starting point. 

And we could, I can send that article 

to be distributed to other people, to see if that 

type of a review article, again, could be a 

starting point. 

CHAIR MARKOWITZ: Okay, Dr. Bowman. 

MEMBER BOWMAN: Yes, just a comment. 

I agree with Dr. Friedman-Jimenez about the 

complexities that are extrapolating between 

animal data and humans. And the differences in 

metabolism, the toxicokinetics to be very 

different. 

I would be worried we would not have a 

solid scientific basis for us to assign a 

specific cancer if all the data we're using to 
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assign to that is animal based. And it's likely 

the reason why these are in 2A, in part, I'm not 

cancer toxicologist, but just from a general 

toxicology point of view, there may be, and it 

seems like from this list there is a subset which 

there is at least some evidence of some specific 

cancers. 

I'm worried that in terms of being 

able to say there is strong scientific evidence, 

we might be limited to cutting this list down to 

a small list for which there is a, you know, a 

small sample size evidence of a specific human 

cancer. Otherwise, we could be linking just 

cancers that really aren't relevant. 

MEMBER GOLDMAN: Well, I mean, my 

understanding of 2A, and George can correct me, 

is that there is limited evidence of 

carcinogenicity in humans, I guess for most, for 

almost all of them. 

And in the situation where there 

isn't, and we could look for if there is a subset 

of those, there is strong animal evidence. Plus, 
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there is strong evidence for carcinogens, from 

some mechanism that operates in humans. 

So it's not totally left just to, oh, 

as it occurs in animals. So, there is some 

thinking that that same mechanism is in humans. 

Or, like with the case of PBBs and 

PCBs, that there is some limited evidence in one 

realm, but very strong evidence in a closely 

related chemical substance. 

So, true, it's not foolproof, but it 

looks to me that the choice would be, we either 

don't include any 2As, which would seem a pity 

not to acknowledge that there is some that would 

be useful to put in, or that we try some approach 

that might be, again, to go through in some 

manner and pick out at least some of the higher 

priority ones where there is some data from human 

and some information about the particular organ. 

MEMBER BOWMAN: Yes, I would agree. 

In fact, I think that's sort of what I was 

saying, that the subset in which there is at 

least some human evidence might be that subset 
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that we could do that for. If there is in fact, 

so, sorry, being so new, if in fact it is a 

requirement that we link it to a specific cancer 

as opposed to saying an agent is a probable 

causing cancer in humans unspecified. 

If that is not viable, then I would 

agree with you. There will be a subset for which 

we could do that. 

CHAIR MARKOWITZ: So, this is Steve 

Markowitz, we kind of need to move on. So can I 

suggest that the working group reconvene with 

additional members if desired to exam this issue 

of whether it can come up with some specific 

cancer sites. In relation to the 20 or so 2A 

carcinogens? 

That would really complete, I think, 

complete the task in an actionable way for the 

Department. Is that okay? 

MEMBER FRIEDMAN-JIMENEZ: This is 

George. 

MEMBER GOLDMAN: I'm willing. 

MEMBER FRIEDMAN-JIMENEZ: I think 
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that's exactly what we need. 

MEMBER GOLDMAN: Would Dr. Bowman 

like to join the group, because I think part of 

it would be, also sort of dividing up some of 

these different agents and tackling it, perhaps, 

agent-by-agent? 

MEMBER BOWMAN: Yes, that's fine. I'd 

be happy to. 

MEMBER GOLDMAN: Great. The other 

thing I want to -- 

CHAIR MARKOWITZ: Okay. So let me, 

I'm sorry, if we can bring this to closure, but 

go ahead, Dr. Goldman. 

MEMBER GOLDMAN: To lower the list a 

bit, is there a way that we could, if we went 

back to the whole list and try to lower it, is 

there a way to pre-screen what are ones that may 

never have been used among these workers or 

should we just take all of them and let the SEM 

tell us whether there is a potential for any 

exposure? 

CHAIR MARKOWITZ: My impression, I 
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think that, Steve Markotwitz, I think the most 

efficient approach in talking about 22 agents, 

all of which are described by IARC and the 

relevant literature summarized that any subset of 

them are going to have some limited epidemiology. 

I think the most efficient way, 

frankly, is just to look at the IARC list and go 

through that rather than trying to figure out 

from the SEM, or otherwise, to the extent to 

which they're used. 

MEMBER GOLDMAN: Okay. Okay, so 

we'll try to work on that. 

CHAIR MARKOWITZ: Okay. So the 

working group, Ms. Pope, will you continue to 

serve? 

MEMBER POPE: Sure. Absolutely. 

CHAIR MARKOWITZ: Okay. And if 

anybody else wants to join, you're welcome to. 

Either now or sometime in the future. 

So, thank you very much. We made some 

progress there. 

Kevin, could you put up my PowerPoint? 
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So we're going to talk about the recommendation 

and issue. 

Next slide. This is a core task from 

our charter. 

Next slide. So the issue is assessing 

these qualities, objectivity, and consistency of 

the physicians input into the process. 

And the charter is not specific on 

what physician, so we interpret that to being all 

physician input. Likewise for industrial 

hygienist. 

So the medical director of the program 

does quarterly audits on the contract medical 

consultant, CMC, reports. So the CMC is asked by 

claims examiner sometimes to evaluate the case. 

And usually issue a causation. Sometimes to 

issue disease confirmation or issues of 

impairment. 

And what the medical director does is 

every three months is take a little more or less 

50, a randomly selected claims and look at the 

CMC report. And then for the categorizes, I used 
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categories that the CMC, that the medical 

directors used in the summary of 2018 and 2019. 

I mean to say I assembled this from 

the quarterly reports for each of the past two 

years. I think these are the most recently 

available ones. 

And you can see that the type of 

review is causation impairment and then there is 

some other review. Other, there are a number of 

different things that are, consist of other 

reviews. But the majority, certainly, majority 

meaning about two-thirds, are from either 

causation or impairment. 

And you can see from 2018 that they 

were equally divided. And in one percent of the 

67 charge reviews for causation, or CMC report 

reviews for causation, the medical director found 

it needed improvement. In 2019, about 79 CMC 

reports done were deemed as requiring improvement 

or had some sort of error that required 

attention. 

On the impairment reviews in 2018, 
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over a third of them, of CMC reports, had issues 

that needed attention and led down, somewhat, 

2019, 27 percent. But if you look at the two 

years together, you see virtually no causation 

reports that were deemed to be questionable. 

And a third of the impairment reports. 

So, it appears to be feast or famine, in terms of 

the review here. 

And then the other category, which are 

a mix, and so it's a little hard to say much 

about this. 

So, Kevin, if you could go to the word 

file on this issue. And I, let me see what the 

name of that file is. ABTSWH draft rec and 

rationale findings. 

Now, let me say that the Board looked 

at a fair number of claims. I don't recall the 

number, but in the last two terms. 

And so we had an opportunity to 

develop our own opinion about the objectivity, 

consistency and quality of the CMC reports. If 

you can scroll down some. 
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MR. BIRD: Dr. Markowitz, do you want 

me to open this in an editable format? 

Also, I just want to give everyone a 

heads up that they should be able to scroll on 

this program. 

CHAIR MARKOWITZ: Oh, yes. 

MR. BIRD: They can scroll, they can 

zoom out, they can change pages, if I share it 

like this. But in this version it's not 

editable. So I don't know if you have a 

preference for how it gets shared right now. 

CHAIR MARKOWITZ: Well, we don't need 

to edit it at the moment. But let me actually, 

Kevin, hold on one sec. 

What I have here is a recommendation 

about this topic, then I'll continue with the 

rationale. I should have discussed this 

recommendation first. 

And the board, the previous board, 

looked at this recommendation. And really, at 

out last in-person meeting had simply decided 

that additional thought was required. 
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But this recommendation says, the 

board recommends the Department develop an 

ongoing, independent, third-party based system of 

periodic evaluation of the objectivity, quality, 

consistency of both industrial hygiene reports, 

I'm sorry, of both the individual claim reports 

and the aggregate audits of program and 

industrial hygienist and physicians. 

The board also recommends the 

Department implement a periodic audit of the 

industrial hygiene reports and the industrial 

hygiene review process. 

So, what we just talked about was the 

medical director's audit of the medical reports. 

They close out sort of the discussion about the 

audit, the assessment of the medical reports. 

And then I'll get into the industrial hygiene. 

Our sense of board members in the past 

is that one out of a 150, or whatever the number 

was exactly, claims with faulty causation 

analyses is a significant underestimate of the 

number of claims, or the proportion of claims, 
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that have a questionable causation judgments. 

That there are many claims we looked 

at in which the CMC report was excellent, well 

documented, came to the appropriate conclusion 

regarding causation. 

And there were a significant minority 

of reports in which frankly we disagreed with the 

causation judgment. And the methodology used was 

inadequate. 

I would say the, in my own review, and 

I think in some of the conversation, was that the 

majority of the reports were okay with reference 

to causation. But a significant proportion, a 

significant minority, were problematic. 

So our own look, be it non-random, 

about multiple physicians, and a significant 

number of claims, is that some, there is an 

inadequate look at the quality of the causation 

judgments. And that that needs attention. 

And that is part of the rationale for 

suggesting that an intended third-party based 

system be developed by the Department to look at 
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the same aspects of the individual claim report. 

Speaking about the CMCs for a moment. The 

physician reports. 

So that this question, or suspicion 

frankly, about not a fully adequate review of 

causation could be addressed. 

On the issue of impairment, a somewhat 

different issue. A third of the reports in the 

last couple of years, there have been the 

impairment reports, there have been the needs 

improvement. 

Some of that maybe major, some of 

that's minor. Look at that. 

But that's excessive on the face of 

it. And it is, I know that the contractor has 

given feedback about that. About the particular 

cases. 

But it raises two questions. One is, 

why should there be a persistent high level of 

false in impairment ratings, and the second 

question, and why isn't that corrected by the 

contractor. 
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The other problem with that is that, 

well, if a third of the 50 per quarter that the 

medical director looks at are inadequate, what 

about all the other claims that the medical 

director hasn't looked at, is there an equal 

level of needs improvement assessment of those 

claims, in which case there may be a significant 

proportion of claims in which the impairment 

rating is not judged to be known adequate done. 

We can't settle those issues. And I 

my say that the Board did not look at claims to 

date for the issue of impairment. 

Sorry, these observations are not 

based on our personal review of claims but just 

on the data that we're looking at. 

So, this, again, I think is a 

rationale to attend to this puzzle. To 

characterize it and then come up with some 

solutions that would support an independent 

third-party based system for periodic evaluation. 

If you could go to the next page. 

Just moving on to the industrial hygiene reports. 
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So, this is a somewhat different 

situation because the Department does not do a 

comparable audit. A periodic audit of industrial 

hygiene reports. 

And I think that it does, for the 

medical reports, is an excellent mechanism. And 

we said in the Board previously was that a 

similar kind of periodic audit should be done of 

the industrial hygiene reports as well. 

The current way of looking at the 

quality of industrial hygiene reports is that the 

contractor produces the report they're provided 

to the federal office. It's then reviewed by one 

our federal industrial hygienist to make sure 

that its reasonably consistent and makes sense at 

the like before it's passed on to the claim's 

examiner to look at it. 

But that's done on an individual basis 

claim basis, or rather, industrial report hygiene 

report basis. And there is no time in which 

anyone sits down and gathers 50, or whatever 

number of random reports, and then looks at 
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what's going on in that group, what's the 

quality, et cetera. 

So, we think that should be done 

because that would provide another layer of, I 

think, of understanding in quality assessments to 

the industrial hygiene report process. 

If you could scroll back up to the 

recommendation. And so, the other, the last part 

of this recommendation is that the periodic 

audit, assessed hygiene report, which would be 

new, would also look at the industrial hygiene 

review process. 

And this is a question of looking at 

how much information is available to the 

industrial hygiene. What kind of sources they're 

using to make their determinations, what kind of 

language is used in their reports. And how 

helpful their report is in the overall process. 

We think that should be looked at as well. 

So, I'm going to stop there. I'm sure 

board members from previous board remember this 

issue, so if you have any comments or amendments 
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to what I said, feel free to jump in. Or any 

board member, if you have comments or questions. 

Dr. Bowman, your hand is raised. I 

don't know whether that's from the previous topic 

or you're done with it. 

MEMBER BOWMAN: Yes, it was. I 

cleared it. 

CHAIR MARKOWITZ: So, for Board 

Members who recall reviewing some claims, do you 

think the way I've described some of the issues 

and the rationale behind this recommendation 

makes sense? Dr. Silver? 

MEMBER SILVER: I certainly do. For 

the new Board Members who haven't had a chance to 

review files, some of the low hanging fruit of an 

audit of the industrial hygiene reports would be 

the references and sources of information that 

the industrial hygienist used. 

This wasn't always true, but more than 

a few times I saw a standard reference list of 

books that you could find in any public health 

school library. And some of them were decades 
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old, but the reference list seemed to be a cut 

and paste job. 

And they didn't really seem to go deep 

in finding government contractor reports or NIOSH 

HHEs for analogous processes to render their 

judgments about low, medium or high exposures. 

And there was a little bit of that too 

in some of the CMC reports I'm sad to say. So, 

an audit of both sets of reports is in order. 

CHAIR MARKOWITZ: Dr. Mikulski, I'm 

wondering whether you recall the pleasure of 

reviewing previous claims and have any insight or 

opinion or comment? 

MEMBER MIKULSKI: I thought that this 

was a general understanding about both the 

industrial hygiene sections review of the claims 

as well as the medical. As Dr. Silver mentioned, 

for the most part where a simple job of a copy 

and paste of the standard, that type of 

assessments of the exposures, as well as degree 

and the level. 

As for the medical assessment, as far 
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the CMCs, we have not looked at that many 

impairment ratings. At least that's my 

recollection of the claims that I have been 

reviewed, to be able to say how many of them 

would have needed improvement. 

But in terms of historical access to 

historical records and review of the previous 

best exams, those were also the issues that were 

raised in quite a few of the reviews. Simple the 

CMCs did not review the totality of the medical 

evidence on file. And some of those reviews 

lacked this part of the review of the claim. 

CHAIR MARKOWITZ: Dr. Silver, your 

hand is still up, I don't know whether you took 

it down, lift it back up or -- 

Ideally, okay. So, ideally, for the 

new Board Members, this recommendation would make 

more sense if you had had the opportunity to 

review claims. 

The problem there is that that would 

probably be a six month process. Getting the 

claims, reviewing the claims and then discussing 
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the findings on the claims. 

Which would delay this recommendation 

that much, that much longer. Which is the 

discomfort, frankly, of turnover in board 

members, but we balance by the advantage of 

having new board members as well. 

So, Dr. Friedman-Jimenez? 

MEMBER FRIEDMAN-JIMENEZ: Yes. I'm 

wondering, is there an official way of compiling 

the results of the reviews? 

In other words, is there a report of 

the reviews that we can follow periodically over 

time? 

I think this is a process that is 

going to be ongoing for the next few years. This 

audit process. And we're hopeful that changes in 

the procedural manual, et cetera, will impact 

positively and improve both the causation, 

evaluations and the impairment evaluations. 

And we'd like to see, over time, how 

the assessments change. So, it seems to me that 

it would be good to have a formal mechanism for 
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recording and compiling and summarizing the 

reviews, the audits, as they're done. 

That we could follow, that would make 

it easier for the whole board to look at it at 

one point in time, one snapshot, and then 

longitudinally to see if we're having an impact. 

 It the change in procedural manual language, for 

example, has an impact. Or training, that sort 

of thing. 

CHAIR MARKOWITZ: Steve Markowitz. 

That would be a great idea. 

And we attempted to do that, to some 

extent in our claims review by using a standard 

form, but the truth is, the Board didn't really 

have the resources to be able to do that 

properly. I mean, not properly, but to do it 

systematically. To compile the responses and 

then to describe them. 

So, we had definite opinions, 

impressions. A number of Board Members, I think, 

reviewing a sizable number of claims, but we 

weren't able to do it systematically. We should, 
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and we'd like to, and when we get resources we 

will do that. 

So, then if we can take a vote on this 

recommendation. Let me read, particularly if any 

members of the public who aren't looking at the 

screen, I want to read the recommendation. And 

then if there are any suggested changes in 

language. 

Actually, I need a proposal to accept 

the recommendation. But the recommendation is 

that the Board recommends the Department develop 

an ongoing independent third-party based system 

of periodic evaluation of the objectivity, 

quality, consistency, of both the individual 

claim reports and the aggregate audits of program 

industrial hygienists and physicians. 

It would also recommend the Department 

implement a periodic audit of the industrial 

hygiene reports and the industrial hygiene review 

process. 

Is there a proposal to accept this 

recommendation? 
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MEMBER FRIEDMAN-JIMENEZ: Should we 

discuss now or after -- 

CHAIR MARKOWITZ: No. It's just a 

formal process. Is there anybody to propose that 

we accept this recommendation? 

MEMBER GOLDMAN: I'll propose it. 

Rose Goldman. 

CHAIR MARKOWITZ: Okay. Thank you. I 

need a second. 

MEMBER CATLIN: Mark Catlin. I will 

second. 

CHAIR MARKOWITZ: Okay. Thank you. 

Okay. Discussion? Go ahead, Dr. FriedmanJimenez. 

MEMBER FRIEDMAN-JIMENEZ: I think this 

would be a good place for us to recommend that 

the Department of Labor formally compile these 

third party audits. 

I mean they are going to be putting 

resources into the audits so it would make sense 

to have a formal way of not just compiling and 

recording and summarizing them but following them 
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up over time so that we can see how they change 

hopefully over the period of the Board. 

Maybe we could add a sentence or so in 

the recommendation that would be a recommendation 

for a formal record keeping process and reporting 

process of the audits that we can access as the 

Board. 

CHAIR MARKOWITZ: What if we added the 

sentence at the end that said that the results of 

these periodic evaluations and audits should be 

made available for review? 

MEMBER FRIEDMAN-JIMENEZ: Yes, but 

we'd like to have it designed in a way that they 

would be comparable over time so that we can make 

some judgment of whether changes that are 

implemented are having an impact. 

CHAIR MARKOWITZ: I mean your concern 

is that the method of evaluating say the medical 

reports would evolve, change over time? 

MEMBER FRIEDMAN-JIMENEZ: Like, for 

example, the table that you presented would be a 

good way of following over time. 
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We have a such a table at, you know, 

Audit Time 1, Audit Time 2, Audit Time 3. I mean 

it's not a big thing, I'm just saying that it 

should be a comparable method and designed with 

that in mind, not just to give us access to the -

- 

(Simultaneous speaking.) 

CHAIR MARKOWITZ: Okay. I can add 

that to the rationale. That makes sense. 

MEMBER MIKULSKI: This is Marek 

Mikulski. I am also thinking -- 

(Simultaneous speaking.) 

MEMBER MIKULSKI: -- implementing that 

what Dr. Friedman said maybe as a timeframe to 

conduct the other, to not to leave it up to the 

interpretation, a periodic, to some maybe and 

something different to others. 

CHAIR MARKOWITZ: What would you 

recommend as far as language? 

MEMBER MIKULSKI: Biannually. 

CHAIR MARKOWITZ: This is Steve 

Markowitz. I'd prefer to handle that in that 
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rationale and saying that the reasonable frequent 

-- Right now the audits on the medical side are 

quarterly. 

That's very useful. It's a lot of 

work, but it's very useful. So I'm not sure what 

the right interval is for this third party based 

system, but I think if we put in the rationale, 

you know, reasonably frequent that might address 

the issue. Would that satisfy, Dr. Mikulski? 

MEMBER MIKULSKI: Sure. 

CHAIR MARKOWITZ: Other comments? 

(No audible response.) 

CHAIR MARKOWITZ: Okay. So then we 

should take a vote. 

MS. RHOADS: Could we quiet down? 

CHAIR MARKOWITZ: Yes, especially 

since we are going to take a vote. Do I need to 

read this again or does everybody have access to 

looking at it or can we just vote on it? 

(No audible response.) 

CHAIR MARKOWITZ: Anybody unclear on 

what the recommendation says? 
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(No audible response.) 

CHAIR MARKOWITZ: Okay. So the 

language stands as it was proposed. Ms. Rhoads, 

do you want to take a vote? 

MS. RHOADS: Sure. 

MEMBER FRIEDMAN-JIMENEZ: Do we want 

to add the new language for the reasonable period 

before we vote? 

CHAIR MARKOWITZ: You mean reasonable 

frequency? 

MEMBER FRIEDMAN-JIMENEZ: Yes. 

CHAIR MARKOWITZ: So we could say 

third party based system of reasonably frequent 

periodic evaluations. Would that address it? 

(Off microphone comment.) 

CHAIR MARKOWITZ: I'm sorry, did 

someone make a comment? It wasn't quite coming 

through clearly. 

(No audible response.) 

CHAIR MARKOWITZ: Oh, Dr. Van Dyke, do 

you have a comment? 

MEMBER VAN DYKE: Don't we need to add 
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the language at the bottom in terms of required 

to report to the Board or make the information 

available to the Board? 

CHAIR MARKOWITZ: Sure, we can add 

that. Let's -- So you've converted this to a 

Word, we can now write on this, Kevin? 

MR. BIRD: Yes, that's correct. 

CHAIR MARKOWITZ: Okay, fine. So in 

the second line what if we added after system of 

to say reasonably frequent periodic evaluations, 

does that capture the proposal? 

MEMBER FRIEDMAN-JIMENEZ: This is 

George. I think it would be good to have a 

report a month or two prior to each Board meeting 

that way we'd be able to discuss it, look at it, 

think about it, discuss it at the Board meeting, 

and it's probably a semi-annual, twice a year, 

frequency that we are talking about. 

Because if it's biannual that might be 

considered reasonably frequent, but that would 

only give each Board one opportunity and I don't 

think that's frequent enough. 
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So I think before each semi-annual 

Board meeting would be a good timing that way 

we'd be able to use it and it would be effective. 

CHAIR MARKOWITZ: Steve Markowitz. 

Yes, you might -- This evaluation is really for 

the program. It's really for the Department. 

It's not really for our benefit, although, 

obviously, we would use it to do what we are 

assigned to do. 

And so I don't really know whether the 

system can be configured such that, you know, the 

evaluation would be available, you know, a month 

or so before. 

If it's reasonably frequent and the 

Board meets reasonably frequently then we'll have 

relatively up-to-date evaluations I would say. 

MEMBER FRIEDMAN-JIMENEZ: Okay. 

CHAIR MARKOWITZ: I just don't want to 

be unrealistically specific, that's all. But 

let's get back to the other language towards the 

end, which is that after process on the fifth 

line, and I'm trying to remember, the results of 
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these evaluations and analyses should be made 

available in a timely fashion to the Board. Was 

that what was proposed? 

(No audible response.) 

CHAIR MARKOWITZ: And if you could 

type in the results of these evaluations and 

analyses. So what was the thought here? Dr. Van 

Dyke, do you remember what you said five minutes 

ago? I can't. 

MEMBER VAN DYKE: All right. This is 

Mike Van Dyke again. 

CHAIR MARKOWITZ: Yes. Yes. 

MEMBER VAN DYKE: No, I think it was 

just that they are required to report these to 

the Board. 

CHAIR MARKOWITZ: I see, okay. 

(Simultaneous speaking.) 

MEMBER VAN DYKE: -- just specific. 

CHAIR MARKOWITZ: Yes, I know. Should 

be reported to the Board in a timely fashion, 

does that capture it? 

MEMBER VAN DYKE: Yes. 
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CHAIR MARKOWITZ: Now is that -- 

(Simultaneous speaking.) 

MEMBER FRIEDMAN-JIMENEZ: Timely and 

systematic fashion. 

CHAIR MARKOWITZ: Okay. Timely and 

systematic. Was there any other thought that we 

wanted to capture in this sentence? 

MEMBER FRIEDMAN-JIMENEZ: I think that 

captures it. 

CHAIR MARKOWITZ: Okay. Okay. So 

then let's proceed to a vote. 

MS. RHOADS: Okay. Dr. Bowman? 

MEMBER BOWMAN: Yes. 

MS. RHOADS: Mr. Catlin? 

MEMBER CATLIN: Yes. 

MS. RHOADS: Dr. Friedman-Jimenez? 

MEMBER FRIEDMAN-JIMENEZ 

MS. RHOADS: Dr. Goldman? 

MR. BIRD: Carrie, I believe she had 

to just take off but she did just send an email 

that she does vote in the affirmative to the 

resolution. 
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MS. RHOADS: Okay. Mr. Key? 

MEMBER KEY: Yes. 

MS. RHOADS: Dr. Markowitz? 

CHAIR MARKOWITZ: Yes. 

MS. RHOADS: Dr. Mikulski? 

MEMBER MIKULSKI: Yes. 

MS. RHOADS: Ms. Pope? 

MEMBER POPE: Yes. 

MS. RHOADS: Dr. Silver? 

MEMBER SILVER: Yes. 

MS. RHOADS: Mr. Tebay? 

MEMBER TEBAY: Yes. 

MS. RHOADS: Dr. Van Dyke? 

MEMBER VAN DYKE: Yes. 

MS. RHOADS: Ms. Whitten? 

MEMBER WHITTEN: Yes. 

MS. RHOADS: Okay. All votes for in 

the affirmative. 

CHAIR MARKOWITZ: Okay. Thank you. A 

question for Mr. Chance and Ms. Rhoads. It's 

almost 20 to 3:00. We are scheduled to close at 

3:00. If we went, I'm not sure we need to, but 
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if we went 15 minutes later does that violate any 

FACA rules? 

MR. CHANCE: No. No, that's fine 

CHAIR MARKOWITZ: Okay. 

MR. CHANCE: Maybe enough to wrap up, 

you know, on time, but if we need a little bit 

more that shouldn't be a problem. 

CHAIR MARKOWITZ: Okay, great. Thank 

you. And I don't think we -- I am not aware of 

any other recommendations we need to vote on so 

if for some reason any Board Member needs to 

leave then at least you don't have to worry about 

that. 

I want to just briefly -- And then 

rest of what we are going to do today is going to 

be concentrated, but if you could go back to my 

PowerPoint, Kevin. We have a -- next slide. 

Next slide. Okay, stop there. 

I have a question for Mr. Chance or 

Mr. Vance if you are on the phone and maybe for 

Ms. Pond, I'm not sure. Yesterday we received a 

report from the contractor, the industrial 
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hygiene contractor, or, I'm sorry, the SEM 

contractor, about asbestos. 

I wanted to show one paragraph from 

the executive summary just by way of summarizing 

what they found in that report. Is there any 

objection to me showing that? 

MS. POND: No. This is Rachel. That 

shouldn't be a problem. 

CHAIR MARKOWITZ: Okay, great. 

Thanks. So very briefly the background is, you 

know, the Board has been talking about asbestos 

for several years and made numerous 

recommendations, most of which have been accepted 

by the Department. 

Our latest recommendation or, rather, 

conversation centered around the procedure manual 

has a list of about 19 job titles that they 

recognize as presumed to have significant 

exposure to asbestos. 

These are, you know, the ones you 

would expect to find, mostly skilled trades, 

construction, and maintenance. The Board felt 
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that this was a good list but it wasn't complete. 

So we recommended that additional job 

titles be added and then the Department asked us 

for our literature, our rationale. We provided a 

nice write-up I think of a review of relevant 

studies. 

We have looked at actually the U.S. 

National Database on Occupational Mortality and 

identified a long list of job titles which from 

about 1999 to 2014 had shown excess mesothelioma. 

So we used this as an indicator of 

significant exposure to asbestos in the past. We 

made the recommendation and the Department has 

gone through that and I haven't had a chance to 

really assimilate this, but I looked at it 

briefly yesterday. 

If you go to the next slide it shows 

that for some of the job categories that we 

recommended they have endorsed them, that they be 

included as job titles with presumed exposure to 

asbestos. 

These are important job titles because 
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they are fairly numerous at the sites and you can 

see them here. I don't necessarily need to read 

them. 

There are others that they regarded as 

totally irrelevant, which was correct, meaning, 

for instance, marine engineers. That wouldn't be 

relevant to DOE, but there are other job 

categories that the consultant did not endorse. 

And so what I propose is that a few of 

us read that and see what sense it makes and then 

if necessary prepare a response or a set of 

comments with respect to that report. 

So I don't know how much discussion we 

can have at this point about this, but I would 

continue to work on this and if there are a 

couple of others who would help that would be 

useful. 

I think the last Board we had Dr. 

Dement, Mr. Mahs, and Ms. Pope, and so we've lost 

half of our committee. This is not really a 

committee, but just an issue-based working group. 

So if anybody wants to volunteer now 
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to review this, otherwise you are free to 

volunteer. Dr. Van Dyke, your hand is up. 

MEMBER VAN DYKE: I will volunteer. 

CHAIR MARKOWITZ: Okay. Thank you. 

And Mr. Catlin, okay, perfect. And at some point 

if we have a -- I am going to call for more 

volunteers for something else soon, so you might 

want to take your hands down. 

But we also need a member of the 

claimant community, but, again, you can think 

about it and decide to volunteer later. Ms. 

Whitten, do you want to volunteer? 

MEMBER WHITTEN: Yes, please. 

CHAIR MARKOWITZ: Okay, great. Okay, 

so we have four. If more want to join that's 

fine, that's fine, but we have enough. Thank you 

very much. 

So I want to raise the issue of the 

occupational health questionnaire, which we have 

heard about yesterday and to some extent today. 

It was revised. It has been applied, used, in a 

large number of claimants, which is excellent. 
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And so, I don't know if Mr. Vance is 

still on the call or not, but whether he has any, 

or, Ms. Pond, do you have anything else to add to 

what you said yesterday about the experience with 

the new OHQ? 

MR. VANCE: Well, this is John Vance 

again. I mean I had talks with the contracting 

officer that runs the Resource Center contract 

and that's where I got the information on the 600 

and whatever, 620 plus reviews. 

The feedback I have gotten from the 

work that's being done by the Resource Centers is 

that they think it's a much better information 

collection process, because we've not only 

changed the occupational issue questionnaire but 

we've also changed the process. 

We changed it in light of some input 

from the Board with regard to trying to get folks 

thinking about what they can give us prior to the 

actual interview itself and then also making sure 

that we are trying to draw out information during 

the actual interview itself. 
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So I think just from an ancillary 

standpoint, or anecdotal standpoint, we've gotten 

positive feedback. 

CHAIR MARKOWITZ: Great. And I know 

the previous Board there was some discussion 

about using this questionnaire for a period of 

time and then trying to make some assessment, not 

really necessarily a formal evaluation, but some 

assessment of its utility. 

I gather maybe there is no plan in 

place, but we might give some consideration, and 

other Board Members may have some additional 

ideas, but this questionnaire is going to be used 

by the claims examiner, it's going to be used by 

the industrial hygienist, it would be really 

interesting to get some feedback from them in 

terms of what's value-added or not there is from 

this new questionnaire or whether there are 

aspects that need to be further improved or 

clarified. 

Any other Board Members want to make a 

comment about this? 
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(No audible response.) 

CHAIR MARKOWITZ: This is Steve 

Markowitz. So this is not sort of I think an 

official recommendation or a request for data, 

but, Ms. Rhoads, if you could note this is an 

action item, that the Board would like some 

feedback about the utility of this new version of 

the OHQ from people who are administering it but 

also the users in the claims evaluation process. 

MS. POND: Dr. Markowitz, this is 

Rachel. I agree and I would like to develop some 

sort of mechanism to evaluate that. 

So, you know, once this gets going, I 

mean right now the Resource Centers can give us 

initial feedback, but we're probably not at a 

point we're going to have enough information from 

the IH's to provide that but we will put insights 

and mechanisms to evaluate it. 

CHAIR MARKOWITZ: Okay, great. Thank 

you. So let me move on to another item. The 

Department has made a request of the Board to 

look into a certain issue or set of issues with 
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respect to impairment. 

This was in a letter dated November 

three which, I'm not sure when Board Members 

received this, it might have been Wednesday, it 

might have been yesterday, but just to very 

briefly summarize it. The issue has to do with 

the kind of medical data that are used in making 

an impairment evaluation with respect to 

pulmonary impairment and use of a particular 

test, the VO2 max calculation versus I think use 

of pulmonary function tests. 

The Department wants some guidance 

from us on the relative value of these, the 

tests, and specifically let me just read the 

questions from the letter. 

The first question is What are the 

permissible testing, I think the next word is 

methodologies, that a physician may use in 

assigning a VO2 max for application in Table 5.12 

of the guides? 

The second question is If the 6MWT is 

a valid methodology for assigning a VO2 max for 
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application should the evidence document that the 

test conforms within a particular medical 

standard in validating the test outcome and what 

are the simple methods for calculating the VO2 

max from evaluated 6MWT results? End of quote. 

So you can see it is very specific 

detailed advice that's being sought on this 

issue. And so I need some members of the Board 

who are willing to help in assembling a response. 

Now if the Board does not have the 

expertise to do that then, fine, we will say so, 

but if we do after looking at it more closely 

then I think that we should be able to offer up a 

response to those questions. 

So my question to the Board really is 

does anybody want to take a look at this and 

decide whether we can and what kind of help we 

can provide? And let me just volunteer -- 

(Simultaneous speaking.) 

MEMBER MIKULSKI: This is Marek 

Mikulski. I think this is an issue worth looking 

into and I would be more than willing to work on 
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that within the working group if we do have any 

other volunteers to. 

CHAIR MARKOWITZ: This is Steve 

Markowitz. Yes, I would volunteer to work on you 

with this. Again, if anybody decides they want 

to join -- 

(Simultaneous speaking.) 

MEMBER FRIEDMAN-JIMENEZ: Is this just 

about the VO2 max or is this a more general 

request? 

CHAIR MARKOWITZ: Okay. So, yes, I 

want to move on. Well, right now it's just about 

this request of us from the Department, but I do 

want to discuss the public comment from yesterday 

made by Ms. Vlieger, and the written comments she 

provided very briefly to figure out whether the 

board has any role in addressing the issues that 

are raised and if we have some role how we would 

proceed. 

And so my view is that the issues 

raised, some of it is very particular to a claims 

review process and may be particular to one or a 
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couple of providers, and that the particularity 

of that is not necessarily something that the 

Board, is within the Board's purview to weigh in 

on. 

On the other hand, it's clearly a part 

of our charter that we are supposed to assess the 

consistency, which was one of the issues raised 

in that written comment, and quality of the 

medical input, and that the fifth task of the 

Board is to look at the claims adjudication 

process and I think an issue was raised about 

that. 

So I would like to hear what other 

people think, although, admittedly, we have not 

had a chance really to look at all of the 

material that is relevant to this question, but, 

you know, this is -- Okay, this is -- No, this is 

a separate matter. 

I think this is a comment that came in 

today. I'm not sure this relates to -- Okay. So 

my view is that a few people on the Board should 

take a look at the relevant documents and decide 
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what our role, if any, should be in weighing in 

on this, on these issues. 

This would be somewhat separate, but, 

you know, maybe related, depending on what the 

issues are. I am not even quite certain to the 

Department's request of us regarding, you know, 

impairment readings and methodologies used for 

that. 

So I think if a few us would volunteer 

to review the material that has been provided 

with regard to the issue raised by Ms. Vlieger, 

and I think Ms. Barrie may have raised it, too, I 

don't quite remember, then we can figure out 

what, if any, role we can play in this. 

So I see Mr. Tebay's hand is up. Does 

that mean you are volunteering? 

MEMBER TEBAY: Yes, sir. You know, 

some of the -- I have reviewed some of the 

documentation already and the specific impairment 

physician is pretty known in our area so I think 

I would be interested in being in that 

conversation. 
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CHAIR MARKOWITZ: Okay. Ms. Pope? 

MEMBER POPE: Yes, I would be 

interested in being a part of that conversation 

as well. 

CHAIR MARKOWITZ: Okay. And I would 

also volunteer to try to help sort things out. I 

mean if there is anybody on the Board who decides 

in looking at the material that there is any sort 

of conflict of interest then, obviously, that 

person would raise that. 

Dr. Friedman-Jimenez, your hand is up, 

are you volunteering? 

MEMBER FRIEDMAN-JIMENEZ: Yes, I'll do 

this. I have some expertise in diagnostic 

testing and interpretation and I think I could 

contribute here. 

CHAIR MARKOWITZ: Okay. Okay, so we 

have the two separate, the somewhat connected, 

but two separate groups, one consisting of Dr. 

Mikulski and myself to address the DOL request, 

and the other issue which four people have now 

volunteered to review and advise on any Board 
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input if called for. 

MEMBER FRIEDMAN-JIMENEZ: I am 

volunteering for the first group to look at the 

six-minute walk and the VO2 max. 

CHAIR MARKOWITZ: Okay. Okay. Okay, 

great. I think Ms. Rhoads probably has that. So 

we have on the schedule that we would review 

public comments, but, in fact, this issue of 

impairment rating was a principle public comment 

that was raised. 

Actually, Kevin, if you could bring up 

that other one that I think was posted today on 

our website. I just want to see if there are any 

issues there that we need to -- 

MR. BIRD: And that was not the one 

that I showed before, it was a different one? 

CHAIR MARKOWITZ: Yes. It was the one 

you just had up, yes. 

MR. BIRD: Okay, perfect. 

CHAIR MARKOWITZ: I read it briefly 

today but I don't recall exactly. If you could 

scroll up. Oh, okay, yes, I remember. Oh, yes, 
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there you go. Okay. 

So this I think was sent by the 

Alliance of Nuclear Worker Advocacy Groups. I 

think Ms. Barrie's name is on this if I recall 

correctly. This is information sharing that in a 

recent, in at least one recent report, there was 

some language, which I think Board Members should 

go over at your leisure. 

I think the issue being raised here is 

that the industrial hygiene expert refers to 

significant exposures, but it's at a minimum 

vague what constitutes a significant exposure. 

I think the other point was that 

bystander exposure seems to be minimized, the 

importance of bystander exposure seems to be 

minimized in this evaluation. 

This is just one claim and so I'm not 

going to generalize. I think the point of this 

comment was just to make us aware of this 

language in an industrial hygiene report. 

And for the new Board Members I think 

the background here is that we have looked at and 
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commented on as a Board some of the industrial 

hygiene language that has been used in some of 

the claims. 

In fact, we had a recommendation about 

certain stereotypic language that was used. So I 

think that's where this sort of fits in, but just 

sort of keeping, I guess keeping us apprised of 

something. 

I am going to check my notes for a 

moment, but does anybody else have any issues 

that are lingering or that we said we were going 

to take up but -- Yes, I don't see anything 

further from my notes about issues. 

So just to summarize then for the next 

period of time, we've got several working groups, 

one I think is going to work on asbestos, one is 

going to continue to work on IARC 2A carcinogens. 

We are going to look at the DOL's 

request for input into the impairment process. 

We have a group looking at the public comment 

issue regarding impairment. I think that's the 

four groups we have at the moment. 
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As a Board at a minimum we would meet 

in six months, meaning the first half of April. 

The question whether we would have a three month 

meeting -- We used to have the face-to-face 

meetings every six months and the telephone 

meetings every three months, but now it's all 

telephone I guess. 

But it would be a short -- If we do 

one in three months it's to maintain some 

momentum on some of these issues and it's a much 

shorter meeting because we just focus in on 

really the ongoing issues unless something new 

arises. 

So I am a little bit unclear at the 

moment whether we need a three month meeting. I 

think it depends on progress that we would make 

in the four working groups. 

Anybody have any comments on this or 

requests? 

(No audible response.) 

CHAIR MARKOWITZ: So my request is 

that the working groups, which will not be 
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subject to publication in the Federal Register, 

and, um, that they meet within the next four 

weeks, meet within the next four weeks to make 

further progress on their issues, and if you 

could communicate that progress then we can 

together decide whether we need a telephone 

meeting in three months or not. 

Okay, so you can expect some 

communication over the next week really just 

confirming the working groups. If there are any 

materials that have not been sent out yet then 

they will be shared, although they come from the 

Department of Labor, not from us, but I assume 

that we will make sure that everything is shared 

within the next week or so. 

Any Board Members have any closing 

comments, questions? 

(No audible response.) 

CHAIR MARKOWITZ: So then let me just 

thank the Board Members, thank the Department, 

thank Mr. Chance and Ms. Rhoads and, of course, 

SIDEM, Mr. Bird, and whoever is working with Mr. 
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Bird, for this meeting, and, of course, the 

members of the public who made public comments 

and were listening in on this. 

I think it's been a good meeting. I 

hope that the new members feel well apprised of 

the program and well oriented as to the work that 

the Board has been recently working on and how we 

will make progress in the future. 

Mr. Chance, is there any -- Or, let me 

ask the Board Members whether there is any 

closing comments they want to make. Otherwise, 

I'll turn it over to Mr. Chance. Dr. Silver? 

MEMBER SILVER: Thank you. People 

heard Teri Barrie announce that Malcolm Nelson, 

the ombudsman, is retiring. Every time he spoke 

to the Board we learned things we didn't know 

about the program. 

In my opinion he was an exemplary 

public servant over his long career and I can 

point to a particular Los Alamos claimant who had 

a miserable experience until he met Malcolm 

Nelson. 
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If it's okay with the Chair and Ms. 

Rhoads I would like to send out to the Board the 

accumulated annual reports of the Ombudsman's 

Office. 

If you just skim them you will get a 

sense of what this program is like from the 

standpoint of claimants. The link on the website 

is all I am talking about. 

CHAIR MARKOWITZ: Yes, interesting. 

Steve Markowitz. I wonder, Ken, whether if it's 

within our right to issue a statement recognizing 

his contributions and congratulating him on 

retirement, but also, you know, praising him for 

his long-time dedication to nuclear weapons 

workers and assisting them in the compensation 

process. Is there something that you would like 

-- 

(Simultaneous speaking.) 

MEMBER SILVER: Conditionally I would 

be delighted to work on it and if anyone else 

wants to, but I think I heard in your statement 

that you would need to check out whether it's 
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within our purview, but I am more than happy to 

get it started. 

CHAIR MARKOWITZ: Well, okay. Now so, 

Mr. Chance, is there anything off limits about 

the Board issuing a statement to honor Mr. 

Nelson? 

MR. CHANCE: Yes, let me see if that 

is okay to do. 

CHAIR MARKOWITZ: Okay. 

MR. CHANCE: I would have to check. I 

would have to look into that but I can get back 

with you. 

CHAIR MARKOWITZ: That's fine. So is 

that -- If it's permissible is that something 

that we could draft up and send around to the 

Board and get their sign off on or is this 

somehow subject to a telephone vote? 

MR. CHANCE: Let me do some research 

on that and see if you can do it and I will get 

back to you as soon as I find out, okay? 

CHAIR MARKOWITZ: Yes, sure, okay. 

Excellent, excellent suggestion, Dr. Silver. 
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Okay, Mr. Chance, do you have any closing 

comments you want to make or need to make? 

MR. CHANCE: No. I just wanted to 

thank everybody from the Board, the returning 

members, the new members, welcome once again, and 

I wanted to especially thank the folks from the 

program who I think provide some really valuable 

information and members of the public who took 

the time to sit in on our discussion, so I wanted 

to thank everybody. 

We actually finished pretty much on 

time and didn't have any major technical 

difficulties, which is always good. So thanks so 

much, everybody. Stay safe out there. This 

meeting is adjourned. Thank you. 

CHAIR MARKOWITZ: All right. Thank 

you. 

(Whereupon, the above-entitled matter 

went off the record at 3:06 p.m.)