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DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES 

AND WORKER HEALTH

+ + + + +

MEETING

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TUESDAY

NOVEMBER 9, 2021

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The Board met via Videoconference, at 

1:00 p.m. EST, Steven Markowitz, 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 H. KEY

DURONDA M. POPE

CALIN TEBAY

DIANNE WHITTEN

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE

ALSO PRESENT

KEVIN BIRD, SIDEM

RACHEL POND, DOL

CARRIE RHOADS, DOL

JOHN VANCE, DOL
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C-O-N-T-E-N-T-S

Board Request for Resources

Dr. Steven Markowitz, Michael Chance........ 19

Plan for Review of Limited Number of

Claims by Spring 2022

Dr. Steven Markowitz and Board.............. 20

EEOICP Program Metrics: Additional indicators

of EEOICP claim status and outcome?

Dr. Steven Markowitz and Board.............. 28

New Business

Dr. Steven Markowitz....................... 115

Board Process and Next Board Meeting

Dr. Steven Markowitz....................... 118

Close of Meeting........................... 122
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P-R-O-C-E-E-D-I-N-G-S

(1:02 p.m.)

OPERATOR: Welcome and thank you for 

standing by. I'd like to inform all parties that 

today's conference is being recorded. If you 

have any objections, you may disconnect at this 

time.

I would now like to turn the 

conference over to your Host, Mr. Michael 

Chance. Thank you. You may begin.

MR. CHANCE: Thank you. Good 

afternoon, good morning everyone. Today is 

November 9th, 2021. Welcome to Day 2 of the 

teleconference meeting with the Department of 

Labor's Advisory Board on Toxic Substances and 

Worker Health.

My name is Michael Chance and I'm the 

Board Designated Federal Officer or DFO. We 

appreciate the Board's participation in this 

meeting today.

We are scheduled to meet today from 
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1:00 Eastern time to 4:00 Eastern time. And I 

believe there will be no public comment period 

today. We had one yesterday.

Both of our meetings, last few 

meetings, today's meeting is completely virtual 

as a precaution against the COVID-19 pandemic. I 

am joined here on my DFO team by Ms. Carrie 

Rhoads from the Department of Labor.

And Kevin Bird from Sidem, the 

contractor that has assessed with these matters. 

Please bear with me while I talk a little bit 

about some of the meeting operations.

As everybody, just so you know that 

there's an agenda available, we took a break, we 

took one break yesterday. We'll probably take a 

break today, a little bit of a shorter session.

Usually Dr. Markowitz helps to move 

that along quite nicely. Copies of all meeting 

materials and any written public comments are or 

will be available on the Board's website under 

headings, Meetings, and the listing for this 
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subcommittee. The documents will also be up on 

WebEx screens so everybody can follow along with 

the discussion.

You can visit the Board or webpage 

for additional information whereafter today, I'm 

sorry, whereafter posting on today's meeting 

date, you'll see a number of helpful items on 

the page dedicated to today's meeting.

The webpage contains publicly 

available materials submitted to us in advance 

or submitted to the Board in advance. We'll 

publish any materials are provided today.

There you will also find the agenda 

that I referenced above as well as instructions 

for Board participation. If you're having a 

problem, please email us at 

energyadvisoryboard@dol.gov.

If you're joining by WebEx which most 

of us are, please note that the session is for 

viewing only and will not be interactive. Phones 

will also be muted for non-advisory Board 
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members.

And please be aware for also you 

folks that are in the speaker room, that if 

you're not speaking, keep your phone on mute to 

minimize any kind of background distraction.

Throughout today's session, you may 

contact Ms. Rhoads or Mr. Bird for technical 

assistance. A few notes on meeting minutes and 

transcripts.

The transcript and minutes will be 

prepared from today's meeting. During Board 

discussions today as we are on teleconference 

line, please make sure that you speak clearly 

enough for the transcriber to understand.

When you begin speaking, especially 

at the start of the meeting, please state your 

name, so we can get an accurate record of the 

discussion and who was participating.

Also, I'd like to ask our transcriber 

to please let us know if you're having any issue 

hearing anyone or with the recording so that we 
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can fix that as we go along and don't miss 

anything.

As DFO, I see that the minutes are 

prepared and ensure they're certified by the 

Chair. The minutes of today's meeting will be 

available on the Board's website no later than 

90 calendar days from today per FACA 

regulations.

But if they're available sooner, they 

will be published prior to that 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 of this 

meeting. And last, I would like to remind all 

advisory Board members that there are some 

materials that have been provided to you in your 

capacity as special government employees, 

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. It's important 

to remember these materials can be discussed in 

a general way which does not include using 

personal identifiable information or PII such as 

names, addresses, specific facilities, if a case 

is being discussed, or the name of a doctor.

Thank you for bearing with me while I 

had to get all of that read into the record. And 

with that, I convene today's meeting of the 

Advisory Board on Toxic Substances of Worker 

Health and turn discussions over to Dr. 

Markowitz. Dr. Markowitz, please take it away.

CHAIR MARKOWITZ: Okay, thank you, 

Mr. Chance. Welcome to everybody. Welcome back. 

Welcome to the members of the public. Those who 

were here yesterday and those who joined us 

today.

We have no public comment period 

today, however, we always invite you to submit 
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written comments through our website which are 

then posted so.

That avenue is always open. I want to 

thank Kevin Bird and his group for supporting 

this meeting and, as always, Mr. Chance and Ms. 

Rhoades for working closing with us and the 

leadership of the Department of Labor, EOICP, 

who are on this call with whom we enjoy their 

enthusiastic cooperation, collaboration.

In any case, let's because there are 

some new members of the public today, I think we 

should just very quickly do introductions. We'll 

do it as we did yesterday.

Let me just, I'll call out your name, 

I'm Steven Markowitz, I'm an occupational 

medicine physician and epidemiologist at the 

City University of New York and I've been on the 

Board since 2016 and been experienced with the 

DOE health effects for a long time. Dr. Bowman?

MEMBER BOWMAN: Thank you, yes, I am 

Aaron Bowman, Environmental Health and 
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Toxicologist. I am also Professor and Head of 

the School of Health Sciences at Purdue 

University.

I've been on the Board now for about 

a year and a half. Thank you.

CHAIR MARKOWITZ: Okay. Who's next? 

Mr. Tebay?

MR. TEBAY: Calin Tebay. Sheetmetal 

worker, Hanford Workforce Engagement Center and 

Site-wide beryllium health advocate at Hanford.

CHAIR MARKOWITZ: Okay, and staying 

in Washington State, Ms. Whitten?

MS. WHITTEN: Hi, Dianne Whitten. I 

am the Health Advocate for the Hanford Atomic 

Metal Trades Council, also a member of IBEW 

Local 984. I've been at Hanford as a rad contact 

for 33 years.

CHAIR MARKOWITZ: Mr. Key?

MEMBER KEY: Yes, Jim Key. President 

of the United Steelworkers Atomic Energy 

Workers' Council of Washington, D.C.
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CHAIR MARKOWITZ: Dr. Silver?

MEMBER SILVER: Ken Silver, faculty 

in the Department of Environmental Health and 

the College of Public Health at East Tennessee 

State University. Long involvement in DOE worker 

health issues.

CHAIR MARKOWITZ: Dr. Mikulski?

MEMBER MIKULSKI: Marek Mikulski at 

University of Iowa, Occupational and 

Environmental Health. I also direct the Iowa 

Former Worker Program for Former Nuclear Weapons 

Workers from two sites in the State.

CHAIR MARKOWITZ: Mr. Catlin?

MEMBER CATLIN: Thanks, good to be 

here. I'm Mark Catlin. I'm an Industrial 

Hygienist. I retired in 2018 from the, as 

Program Director of the Service Employees 

International Safety and Health Department and 

I've been on the Board about a year and a half.

CHAIR MARKOWITZ: Dr. Van Dyke?

MEMBER VAN DYKE: Mike Van Dyke, 
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Industrial Hygienist and Associate Professor at 

the University of Colorado Anschutz Medical 

Center. I've been involved with DOE sites and 

beryllium, in particular, for many years.

CHAIR MARKOWITZ: Dr. Goldman? 

You're muted I think if you're speaking. Okay. 

We'll come back to Dr. Goldman. Dr. FriedmanJimenez, have you joined the call? I see. Okay, 

can you all hear me?

MR. BIRD: Yes, we can.

CHAIR MARKOWITZ: Okay. Fine, just 

wanted to make sure it wasn't my line. That's 

good. Okay, Ms. Pond?

MS. POND: Hi, this is Rachel Pond. 

I'm the Director of the Energy Program at the 

Department of Labor.

CHAIR MARKOWITZ: And, Mr. Vance?

MR. VANCE: Good afternoon, 

everybody. This is John Vance. I'm the Policy 

Branch Chief and Energy Compensation Program.

CHAIR MARKOWITZ: And thank you for 
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joining us today. Okay, Dr. Goldman? I don't 

know whether you're back or not, but when you 

speak first at the meeting, maybe I will have 

you introduce yourself.

So let me review quickly the agenda. 

We're going to have a brief discussion on the 

status of our request for resources. And then we 

will Segway into discussing whether we want to 

request a limited number of de-identified claims 

in order to prepare for having a contractor 

support to do a broader examination of claims.

We will then take a look at the 

public reading room which we've never done 

actually of the program. And look at the kind of 

information that program makes the publicly 

available.

And brainstorm a little bit. Although 

not too broadly, but about whether there are 

additional kinds of program metrics that we 

might find useful in our work.

Take a break, and then we're going to 
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come back to a couple of issues from yesterday. 

The program has asked us to clarify one issue 

around aldrin and dieldrin.

We're going to discuss briefly 

styrene, see if we can clear that up and then we 

may have a little bit of time to reflect on some 

of the public comments from yesterday.

Is there any other issue or topic 

that I haven't covered that we need to clear up 

today?

MEMBER GOLDMAN: Hi. This is Rose 

Goldman. I'm sorry my audio went off just when 

you came to me. I don't know if you want me to 

introduce myself.

CHAIR MARKOWITZ: Sure, please. 

Always.

MEMBER GOLDMAN: Oh, I'm also an 

academic Occupational and Environmental Medicine 

physician with a practice at Cambridge Health 

Alliance and I'm, this is my second term on the 

Board and I'm an Associate Professor of Medicine 
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at Harvard Medical School and Associate 

Professor of Environmental Health in Public 

School and Public Health. Thank you.

CHAIR MARKOWITZ: Okay. Thank you. 

And Dr. Friedman-Jimenez. I don't see him yet, 

but okay. So I want to just go over the status 

of our request for resources and Mr. Chance will 

add or comment or clarify or even correct what 

I'm going to say.

But so the Department has been 

working on securing us a contractor to perform 

certain tasks to help us in our work. There was 

a Request for Information that was issued a 

number of months ago in the Federal Register by 

the Department and a number of responses from 

potential contactors to that Request for 

Information.

And a subset of us after signing 

nondisclosure agreements, Dr. Bowman, Dr. 

Mikulski, Ms. Whitten and Mr. Catlin and I 

looked at the material that had been sent back 
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to the Department.

We looked at the actual responses, we 

looked at a summary of the responses for various 

potential contractors and some sorting out that 

had been done by Mr. Gardner I think in the 

contracting office.

We, the five of us, met on the phone 

a couple of weeks ago or so and provided the 

Department some feedback on the responses to the 

RFI, to the Request for Information, and more 

importantly, we looked at, or as importantly, we 

looked at a performance work statement which is 

a draft of what would go out when the Department 

issues a request for proposals to get responses 

for selection of a contractor.

So this performance work statement 

describes what it is that this Board would be 

using a contractor for and we gave some feedback 

to the Department just to give you flavor of the 

kind of comments we made.

We asked whether the Department 
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wanted the Contractor to be identified claims 

which is a lot of work so that actually when we 

want to, when the Board members want to go back 

and look at some of those same claims for 

details, they would already be identified and I 

think expedite our work.

We noticed that there was some 

variation among the RFI responses and the degree 

to which there was occupational Health expertise 

in the contractor organization for experience in 

that area and we suggested that prior experience 

in occupational health would be very helpful in 

understanding what it is that the Board wants.

We, looking down the list here, I 

don't think there was any detail provided on the 

number of scientific or technical reviews that 

we might require.

And obviously a budget would be based 

on, you know, what they expected, the magnitude 

of work. And so we estimated that there could be 

three to five scientific and, or technical 
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reviews per year as an estimate.

And we also emphasized that those 

should be based not on so much on an original 

very detailed review of the literature, but that 

it maximally stands possible on existing 

consensus or expert reviews of that area.

Because people have been involved in 

that kind of work before knowing that if we 

undertake, it would not be possible with or 

necessary to undertake in depth original reviews 

of topics about which a lot has been written.

So we're trying to provide some 

clarity in the performance work statement around 

that. And we emphasize that the Board wanted to 

provide specific direction in the claims review 

process undertaking by the contractor as well as 

in the scientific and technical reviews.

Finally, we had recommended some job 

titles that, you know, would be good to see in 

eventual responses to the RFP. Mr. Chance, 

anything I forgot or got wrong?
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MR. CHANCE: No. I, you would just 

have to keep the comments very general at this 

point. And, yes, the only thing that I could 

emphasize and I think that you could agree, 

Steven, that you know, we're moving this as 

quickly as we can.

I know that there are a lot of 

expectations surrounding this, but the 

Government contracting process is not the 

fastest process in the world.

There's a lot of due diligence and 

there are a lot of checks and balances along the 

way so good reason so, you know, we're moving 

this as quickly as we can and trying to get the 

best understanding for what your needs are 

moving forward to make whatever it is that we're 

able to put in place as useful as possible.

CHAIR MARKOWITZ: Okay. Thank you. 

And by the way, I forgot to mention that there 

is, we were provided with a rough timetable for 

various steps. Am I able to share that?
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MR. CHANCE: Yes, right. Yes, we 

shouldn't talk about that right now.

CHAIR MARKOWITZ: Okay.

MR. CHANCE: Yes. That timetable is 

very internal and there are a lot of things that 

could happen so we think that was just for your 

own edification and for the folks that signed 

the MBAs.

CHAIR MARKOWITZ: Okay, but we are 

discussing the foreseeable future so that's 

good.

MR. CHANCE: Right. And I mean, you 

know, we're trying to move this as quickly as we 

can.

CHAIR MARKOWITZ: Okay. So any 

comments from either the other people that took 

a look at the various materials or from other 

members of the Board? Okay. So let's move on.

The, you know, in thinking about the 

work plan of the Board over the next 6, 12 

months, it occurred to me that at some point, we 
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will have access to some resources.

And one of the things we're going to 

want to do is look at claims addressing some 

specific questions, but that while the issue of 

securing a contract is being resolved, there's 

some work we can do in preparation.

To develop a plan, I'm looking at

those claims, and realize that a good number of 

the members of the Board actually haven't seen 

any claims whatsoever.

So it would be a good idea for us to 

request some claims, a limited number, from the 

Department so that we can look at them with the 

idea of familiarizing ourselves with what the 

claims look like, are beginning to look at what 

kind of detailed information we would want from 

those claims.

And I should say that when we've done 

this in the past, then I think it's very useful. 

I think very interesting and formative.

It takes the Department quite some 
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time to de-identify claims for us to be able to 

look at them so weE need to formulate our 

request either today or in the very near future 

in order to realistically obtain claims in, you 

know, with some degree of notice prior to our 

next meeting in the spring.

So what I'd like to discuss is how 

many claims we should ask for, what kinds of 

claims, what years, what conditions, 

geographically, whether we are going to look at 

any particular sites, what's the ratio of 

accepted versus denied claims, issues involving 

causation or impairment, consequential 

conditions, and so that we can make a specific 

request to the Department. So anybody have any 

thoughts about this?

MEMBER BOWMAN: This is Aaron Bowman. 

I am one of the members of the Board that has 

not seen one of these yet. I just, I do want to 

second and support what you're saying, Dr. 

Markowitz.
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It would definitely be helpful for 

you to send what's going on. I would as diverse 

a possible representation of what's been going 

on, the sort of the details of the claim, unique 

cases may be less helpful.

I think we may be more about 

representative cases. Both those that are 

accepted and denied I think would be helpful.

CHAIR MARKOWITZ: Okay. And --

MEMBER GOLDMAN: Hi.

CHAIR MARKOWITZ: Go ahead.

MEMBER GOLDMAN: This is Rose. Yes, I 

came in on the tail end of the previous times 

that we did it so two comments. One is, at that 

last closure of having done these, what were the 

questions or issues that were still remaining 

which would be the reason we're going back to 

doing this?

That's one because maybe you remember 

or have notes about that. And secondly, in the 

few that I did, it was very difficult to go 
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through the claim papers because they weren't 

really organized by different categories.

And one of the things my recollection 

was that we said that if we were to go back to 

looking at these claims again, that there would 

be some efforts or there would be a consultant 

or somebody to organize these papers in a way 

that there was more order to them perhaps with 

exposure and medical records because it was all 

over the place.

And so you had to spend a lot of time 

clipping through the pdf to get to that. So I 

wonder if you could comment on those two points 

please.

CHAIR MARKOWITZ: Sure. Well let me 

first, this is Steven, let me first just open 

the floor to other people who may have some 

recollection of some of these issues.

I don't think anybody forgets the 

problem of the lack of indexing of the claims 

and which reminds me actually, something, Mr. 
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Chance we have to discuss is whether the 

performance work statement, I can't recall 

whether it specifically mentions the indexing of 

claims as work with the contractor.

But we'll get back to that 

separately. Any comments in response to Dr. 

Goldman or otherwise? The, so let me ask Ms. 

Pond or Mr. Vance, if we requested claims and 

some sort of index, the guide to the contents of 

the claims, which we did see at one point, there 

was someone from the Department who reviewed 

some claims with us which did have some 

organization to it. Is that doable?

MS. POND: This is Rachel. I'm trying 

to think back to, I'm trying to figure out 

exactly what data index we're talking about. 

Whether it's about a dictionary or whether --

CHAIR MARKOWITZ: Well, yes, sure. 

I'm sorry. Let me just explain a little bit. So 

you know, what I recall is the claims were, 

there was a lot of chronological order to it.
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But that there was a mix of, you 

know, the private physician's records with their 

recommended decisions with the, you know, the 

FAB decision with various EEE-1 completed forms 

and if these were somehow they were a one-page 

guide to where one could find these various 

things, that would be extremely helpful.

MS. POND: John, do you know how they 

were presented the last time? I think we just 

gave them the case files. Correct, or?

MR. VANCE: Yes, okay. So yes, this 

is John Vance. So I was very familiar with the 

prior submissions. So when we do the case pulls, 

what we are doing is we are extracting the 

paperwork from our electronic imaging system.

Now our OWCP imaging system has an 

index for the document so when you are 

electronically accessing the records through 

LIS, you can see the index.

However, for the Board, we don't 

create that in that we don't replicate that 
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index. What we do is we basically download the 

paperwork in whatever chronological order that 

it exists in LIS, and you're presented with that 

file.

So no, there's no indexing that we 

can do based on the extraction of all of that 

material from LIS. And if it would be a manual 

process, that would be extremely time-consuming

so in the past what we have done is just 

provided a pdf of the entirety of the file and 

in whatever order it is, it is presented in our 

imaging system.

CHAIR MARKOWITZ: Yes, it's Steven. 

You know we have some sense of how timeconsuming it is actually. But that is something 

that we're going to need to address in the 

performance work statement in the contract.

I see some hands here, Dr. Silver and 

then Dr. Friedman-Jimenez.

MEMBER SILVER: Thank you, Ken 

Silver. On the substantive aspect of what kinds 
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of claims we should resolve. More recent cases 

that received industrial hygiene referrals would 

interest me for two reasons.

I've been on the Board since 2016 and 

one of the first issues we took up was the 

Department circular that directed claims 

examiners to presume that if exposure occurred 

after 1995, those exposures would be presumed to 

be at or below OSHA's standards unless evidence 

to the contrary was presented.

So it took about a year before we 

convinced the Department to withdraw that 

guidance. But then I noticed in some of our 

subsequent claim reviews, it was like a dead 

horse that wouldn't lie down.

Claims examiners in some cases were 

still applying that assumption. That's one 

reason I'd like to look at some recent claims 

with IH referrals.

And then the second is, I'd really 

like to see how the new OHQ is performing. So 
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those would be very, very recent claims. Anyway, 

that's my take.

CHAIR MARKOWITZ: Dr. FriedmanJimenez?

MEMBER FRIEDMAN-JIMENEZ: Yes, I've 

gone through a number of these claims and I 

think we had 80 with respiratory diagnoses and 

typically they're several hundred up to several 

thousand pages of a pdf file which is a bitmap 

pdf file that is not searchable.

So if we cannot get an index of where 

the Statement of Facts is located, et cetera, a 

distant second to that would be to at least get 

a pdf file that has been run through a character 

recognition program to make it searchable.

That way, we can search for key words 

and it would greatly help getting through these 

huge files. I mean, they literally are often 

several thousand pages and there may only be 60 

or 100 pages out of that which are directly 

relevant to the case that summarize what we need 
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to know.

But finding those pages that are 

scattered in there, it can be really timeconsuming for us as well as Department of Labor 

so if you could please send us pdf files that 

are searchable, I think that would help a lot if 

we can't get indexing, but I agree indexing 

would be a first choice.

CHAIR MARKOWITZ: So we want 

completed, this is Steven, we want completed 

claims. Right? Because we want to see the 

entire process including the decision.

And so, let me ask the Department 

because we would like to see more recent claims, 

but we also want them completed. What is, would 

2000, would there be many claims, for instance, 

in 2020 that would have been completed by now?

MS. POND: Well, when you say 

completed, are you referring to a recommend 

decision, you want final decisions? I'm 

assuming you want final decisions?
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CHAIR MARKOWITZ: Yes, final, well 

ideally, the final decision would be --

MS. POND: Yes, I mean, we can 

probably, I'm sure we have final decisions. 

There's plenty of final decisions that were done 

in 2020. What we'll have to do is run a report 

to kind of to show, you know, how many there 

have been, you know, there might be ways to sort 

it where we could determine, you know, what type 

of decision.

Whether it was a causation 

determination, kind of wean it for you, but 

we'll have to kind of figure out exactly what 

data points you're going to, what specific 

things you're going to be looking for like an IH 

assessment.

We might be able to pull cases that 

had one of those that are, have a final 

decision. I won't be able to tell you exactly 

how many of those there are until we have the 

requirements, but I'm sure there will be 
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decisions with that in it in 2020.

CHAIR MARKOWITZ: Okay.

MR. VANCE: Yes, this is John Vance. 

The key thing for these data requests is 

specificity. So if you're looking for completed 

decisions with regard to particular illnesses or 

particular sites or facilities, it's always 

going to be very important to try to be as 

specific as to the data that you're looking for.

CHAIR MARKOWITZ: And the handling of 

the claims, I mean, we looked at claims that 

were being handled during the pandemic. Would 

they be in some sense, unrepresentative of the 

prior claim handling or we can just use claims 

from during the pandemic period and feel 

confident that we're looking at the broader 

process.

MS. POND: Yes, you can, we process 

claims the same. I mean the resource centers are 

still doing OHQs. During that period of time all 

of them were on the phone.
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So you know, I think the processes 

didn't change. We were just doing them remotely.

CHAIR MARKOWITZ: Dr. FriedmanJimenez, you have your hand up still. I don't 

know whether you want to add another comment or, 

but you're welcome to make it. Okay. So --

MEMBER FRIEDMAN-JIMENEZ: Again, I 

forgot to turn it off --

CHAIR MARKOWITZ: Yes.

MEMBER FRIEDMAN-JIMENEZ: -- after I 

started speaking. Sorry.

CHAIR MARKOWITZ: Yes.

MEMBER FRIEDMAN-JIMENEZ: It's off 

now.

CHAIR MARKOWITZ: So I, this is 

Steven, I think we do want to look at the 

industrial hygiene report and CMC reports. The, 

if we request or, if we request claims with an 

IH report, will they usually have a CMC report 

and vice versa?

Do they travel together I guess is my 
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question on claims?

MS. POND: Not all the time. Often 

times we will, I mean, especially more recently, 

we'll go back to the treating physician first.

Then if the treating physician 

provides us with enough information, then we 

won't go to a CMC, but if it's necessary to go 

to a CMC after an IH, we will.

So we really, we won't know that 

necessarily. We might be able to search by 

whether or not it went to a CMC, but I would 

imagine you'd want to see those with an IH 

report regardless of whether it went to a CMC or 

not.

CHAIR MARKOWITZ: A good point. This 

is Steven. What I'm thinking is this task of 

ours to look at the distance and quality and 

objectivity of both the IH and the medical input 

into the claims and so yes, we can certainly 

look at some claims that only have IH reports.

But you would also need a fair number 
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that have the CMC input as well, in particular 

in this sort of pilot work to get a broad view 

of claims evaluation process.

MS. POND: Yes.

CHAIR MARKOWITZ: Are there, yes, are 

there particular, oh, Dr. Bowman, yes.

MEMBER BOWMAN: I think the topic had 

come up in previous Board meetings about 

emergency responders, firefighters, et cetera. I 

would, if possible in this small set, it would 

be great to get a denied and an approved final 

decision claim from two emergency responders 

just because that would fit other conversations 

we've been having.

MS. POND: Unfortunately, our data 

base, we don't, we can't search by the job 

categories.

MEMBER BOWMAN: Oh.

CHAIR MARKOWITZ: The, so this does 

raise the issue of denied versus accepted claims 

and what's people's sense of the ratio that we 
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want?

I think before we ask for principally 

denied claims, but we did ask for a certain 

portion of accepted of successful claims.

MEMBER BOWMAN: I agree it's helpful 

to have both, but more denied could be more 

helpful maybe a two to one or three to one 

ratio.

But I'm, that's just a sense without 

really having as good of understanding as other 

members of Board.

CHAIR MARKOWITZ: Yes, this is 

Steven. I agree with you on that two to one or 

three to one would be fine. And how about 

particular health conditions?

Well, first of all, let me ask if 

causation or impairment versus others. My sense 

is we should probably look at some impairment 

because that issue's been raised.

But the majority of the claims we 

looked at would not be impairment. Are those 
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these, I'm going to ask the Department. Are 

those easy enough to sort out?

MS. POND: Impairment claims? Yes, I 

believe we have a code for that. John?

MR. VINCE: Yes.

CHAIR MARKOWITZ: Okay. And 

personally I don't think we necessarily need to 

look at consequential claims because those are, 

consequential claims are piggybacked on claims 

that have already been accepted.

And so they're coming back for 

another condition of they may be related to the 

successful claim. I think our, we have more 

interest in actually looking at original claims.

But that's a question for the 

Department. Can you explain once again for us 

the difference between cases and claims?

MS. POND: Well, a case is, when 

you're asking for a case first, to look at a 

case file, that's going to be all of the 

information in an employee's case.
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So cases of an employee could have 

multiple survivors in it. A claim is, can be, 

there's a couple of different ways to look at a 

claim.

A claim form for an initial condition 

and a consequential condition is considered a 

claim when you're capturing a claim, but when 

you're looking at a case file, all the claims, 

whether it's for one condition or multiple 

conditions are all going to be in there.

And if they're, even if they're 

submitted at different times so if you have an 

initial, you have a case and in that case you 

have an initial claim form whether it's from the 

employee or from one of the survivors for one 

condition.

If they filed for more, it's going to 

be in that case file. But they will be 

considered different claims. So basically, when 

you get a case file and you ask for a case file, 

you're going to see all of the different claims 
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that came in, in that case file. You understand?

CHAIR MARKOWITZ: So this is Steven. 

So a case is a person.

MS. POND: Yes, basically.

CHAIR MARKOWITZ: Okay. And that 

person may over time or even at any, at the time 

of the initial claim, initial submission, they 

may be claiming multiple conditions.

MS. POND: Correct. Or they could 

have multiple survivors claiming multiple 

conditions, multiple for different people.

CHAIR MARKOWITZ: And if a person 

files an initial claim and it's for multiple 

conditions, is that considered a single claim 

for multiple conditions?

MS. POND: Yes.

CHAIR MARKOWITZ: Each condition --

MS. POND: Yes.

CHAIR MARKOWITZ: -- has its own 

claim?

MS. POND: No. It's one claim.
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CHAIR MARKOWITZ: Okay. But if they 

come back at a different period of time with 

additional --

MS. POND: They might have additional 

--

CHAIR MARKOWITZ: That would be an 

additional claim.

MS. POND: Yes.

CHAIR MARKOWITZ: Okay. All right. 

Now I just have to wonder how long I'm going to 

be able to remember that this next one. Dr. 

Goldman?

MEMBER GOLDMAN: In the last couple 

of years, we've talked about Parkinson's Disease 

and we've also had a lot of discussion about 

cancer.

So I would be interested in seeing a 

claim particularly one that might have been 

refused or accepted with a Parkinson condition 

and one for some cancer.

I think that would help make our 
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recent discussions of some of those two things 

in putting our criteria sort of real. A reality 

check and see how, what we were doing really 

connects with the, what's happening on the 

ground.

CHAIR MARKOWITZ: Okay, this is 

Steven. Follow up on that, there's some cancer 

claims that come from the dose reconstruction 

side from Part B.

And when they're accepted under Part 

B, either it's a Special Exposure Cohort or dose 

reconstruction's been done and the claim was 

accepted for one of the 22 cancers. Is it 

automatically accepted under Part E?

MS. POND: Yes, as long as it is 

covered site under Part E. It has to be a DOE 

contractor or subcontractor.

CHAIR MARKOWITZ: Okay. So it's not 

as if you do any sort of repeat causation 

analysis of --

MS. POND: Correct.
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CHAIR MARKOWITZ: So then Dr. 

Goldman, if we're going to look at cancers, it 

strikes me we should look at cancers that are 

not, that are just Part E only and they didn't 

cross over from Part B. If that makes sense.

MEMBER GOLDMAN: I don't know if you 

were addressing that to me, I'm not sure about 

that.

CHAIR MARKOWITZ: Okay, well and so 

Mr. Vance that --

MEMBER GOLDMAN: I mean either, I 

mean whatever you think, if you think it would 

be better to just look at the Part E, wherever 

you think there might be some more issues that 

would relate to the recent work that we're 

doing. I guess that we say.

CHAIR MARKOWITZ: Yes, this is 

Steven. I see hands up. I see them, I'm going to 

be call on you in a moment, but just to clarify 

this point, I think Mr. Vance knows the answer 

to this.
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If we want to look at some cancer 

claims that are Part E only, is it possible for 

you to identify those?

MR. VANCE: Yes.

CHAIR MARKOWITZ: Okay.

MR. VANCE: Yes, we would be able to 

do that.

CHAIR MARKOWITZ: Okay. Thanks. Dr. 

Silver or maybe your hand went down.

MEMBER SILVER: Well, just to 

synopsize what you and John ran through, if

there is solely party, they won't likely involve 

much radiation.

There will more likely be just 

chemical exposures and chemical carcinogens at 

issue.

MR. VANCE: That's correct.

CHAIR MARKOWITZ: right. But the 

thing is that if we look at party chancers that 

are derivative from Part B, they won't go 

through the IH and the CMC because there's no 
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causation analysis.

MEMBER SILVER: Yes, I'm agreeing 

with you. We don't want those.

CHAIR MARKOWITZ: Yes, so I just mean 

it might be useful for impairment purposes, but 

not for, okay, so Dr. Bowman, and then Mr. Key 

and then Mr. Catlin. Dr. Bowman?

MEMBER BOWMAN: Thank you. I, it was 

just the hand was up back when you were asking 

about particular conditions. We just talked 

about cancer. It, just for my own sake I'll be 

going through a new time.

If it doesn't add too much to the 

burden. I know we want to try to keep this 

number down, but any claims related to 

commissions of Parkinson's disease or other 

neuro degenerative diseases might be helpful for 

me to familiarize myself with the claims given 

that I have a lot more knowledge in that area.

But again, I don't want to add too 

much to the burden to make this take, the 
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process takes too long.

CHAIR MARKOWITZ: Well, it would be, 

this is Steven. Let me respond. We're going to, 

the next item on the agenda, we're going to be 

looking at the comments, the most common 

neurologic claims so we can revisit that, your 

question or comment at that time.

MEMBER BOWMAN: Got it.

CHAIR MARKOWITZ: Mr. Key?

MEMBER KEY: Yes. Within the last 

month, I became aware and informed of a Part B 

cancer that stemmed from one of the original 

SEC, gaseous diffusion plants that is now 

required to go through a dose reconstruction.

I don't understand the change for 

that to be filed under B and have to go through 

dose reconstruction in E.

CHAIR MARKOWITZ: So you're saying, 

this is Steven, you're saying there's some, you 

talking about the gaseous diffusion plants so 

this is the original Special Exposure Cohort.
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But there's a cancer that's on the 

list of the 22 types of cancer that you're 

saying nonetheless had to go through with dose 

reconstruction?

MEMBER KEY: That's correct.

CHAIR MARKOWITZ: Oh. And --

MS. POND: We would need to see that.

That's not a, I mean, that shouldn't happen. So 

if that's a particular individual case, that 

could be something that could be sent up to look 

at.

MEMBER KEY: Yes, I thought that was 

very irregular or not needed for the original 

SECs.

CHAIR MARKOWITZ: So what do you want 

to have an offline conversation about that with 

Dr. Friedman-Jimenez.

MEMBER KEY: Yes, we can do that.

CHAIR MARKOWITZ: Okay. Mr. Catlin?

MEMBER CATLIN: Thanks. Wanted to 

follow up on Dr. Silver's support for looking at 
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the claims with IH review. Just in terms of the 

process, are there claims that would have been 

denied where there was no IH review and then 

claims a manager decided there wasn't a need for 

an IH review, but still denies the claim? Is 

that a subset that we might look at?

CHAIR MARKOWITZ: Well, I'm sure that 

occurs. So because then it would be interesting 

to look at claims where the claims manager 

didn't take advantage of the extra support to 

see how that looked.

CHAIR MARKOWITZ: There are those 

kind --

MS. PONDS: Yes, this is --

CHAIR MARKOWTIZ: -- yes, are they 

identifiable from the Department?

MS. POND: Well, we could do that, 

but I just need to understand that a lot of 

times we get in claims where there's no medical 

evidence of a diagnosis.

There's not an eligible survivor so, 
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you know, they can be denied for a lot of other 

reasons. There's no covered employment. So just 

because they don't have an IH doesn't mean 

that's the reason it was denied.

So it would be, you would be getting 

a lot of other things in there that could be 

completely unrelated to the exposure. Because we 

don't get to the exposure until we've confirmed 

the diagnosis, but there's covered employment, 

but there's covered survivorship in some 

instances so --

MEMBER CATLIN: Yes.

MS. POND: We identify if there's no 

IH, but you'd be getting a lot of other things.

MEMBER CATLIN: Yes, I appreciate 

that. No, I guess what I'm looking for is claims 

where there is a medical diagnosis. A person 

has, you know, the proper work history of the 

claims.

And I just know this from prior 

experience in workers' comp cases where the case 
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manager would not necessarily, they would decide 

they didn't need any additional support and they 

would just deny a claim for whatever reason.

And so, if that's occurring, then we 

ought to, that would be a subset we'd want to 

look at in our claims reviews.

MR. VANCE: Yes, this is John Vance. 

I think what you're speaking to is the 

establishment and the viable health effect 

because that's part of our claim adjudication 

process.

If we do have covered Part E 

employment, and a covered Part E illness, the 

first step in the review process is determining 

whether or not we have any viable health effect 

data either established through the Site 

Exposure Matrices or medical evidence specific 

to that employee.

Whether or not we could be able to 

identify cases that stop at that point because 

no health affect data is available for us and we 
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end up denying it on that basis, I think we'd 

have to take a look at what our requirements 

were, would be for identifying those cases if 

it's even possible.

MEMBER CATLIN: Okay. Thank you.

CHAIR MARKOWITZ: Yes, this is 

Steven. So Mr. Catlin, when you were thinking 

about a case in which the claims evaluator, 

examiner, the person has covered employment, 

they've gotten, you know, over the usual 

obstacles and that person's looked at, the 

examiner's looked at the SEM, perhaps not found 

any exposure that's relevant.

Or found something, but decided that 

the information was sufficient without sending 

to an IH and then made a decision. And you're 

wondering about the quality of that decision. Is 

that the --

MEMBER CATLIN: That's correct, yes.

CHAIR MARKOWITZ: Okay.

MEMBER CATLIN: Yes. Especially where 
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the claim might be denied as opposed to 

approved.

CHAIR MARKOWITZ: Right.

MEMBER CATLIN: If the claims manager 

felt like he had enough information she could 

support the claim, that's one issue. But the one 

that I would be more concerned about is the 

claims manager if they have that prerogative to 

not seek additional information and then deny a 

claim. I'd be interested in seeing those.

CHAIR MARKOWITZ: Right. So this is 

Steven. I have a question for the Department 

because we're going to look a table later on the 

public reading room which has, I think has this 

information or that or you provided previously 

to the Board.

You were able to sort through by a 

disease, the reason for the denial. It was, 

sometimes it was causation, sometimes it was 

various other not covered employment, various 

other things. And if you're able to, if you 
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recall, if you're able to sort by causation, the 

reason for denial and if you limit it to 

causation whether that would, the causation 

wasn't there.

Whether that would help sort through 

claims to get at what Mr. Catlin's driving at.

MS. POND: John, I'm going to let you 

answer that.

MR. VANCE: It's always certainly 

possible for us to go back and look at the 

nature of the request and try to figure out how 

we could utilize our coding scheme to try to 

identify a population of cases that may fit to 

that particular sample that's being sought. It 

really depends on the specificity of the 

request.

And yes, we do have lots of different 

coding combinations that explain justifications 

for denials, but again, it's going to depend on 

what it is that you're specifically looking for 

and then I'd have to go back or we'd have to go 
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back to our reporting and data analytics team to 

figure out whether there's some mechanism for us 

to extract that kind of data out of the system 

to identify cases that are potentially going to 

be fitting the specific request.

So is it possible? Yes. It just 

depends on what you're searching for and then 

what we're capable of doing within our system.

CHAIR MARKOWITZ: Okay, so it's 

Steven. Let me ask the Board members. We have 

this interest in Parkinson's disease or other 

neurologic illnesses. Is there some interest in 

cancers?

Other conditions that people have a 

particular interest in? I do think we should 

look at some beryllium disease. It's Part B so 

it's a little different.

And there's much more instruction in 

the statute around beryllium, but I think it's 

worth familiarizing the Board members with 

beryllium disease.
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And I think we should probably also 

look at some pulmonary disease because it's very 

common and a very high rate of relatively high 

rate of acceptance actually.

So let me ask, in terms of the 

numbers of claims that we want, because we 

definitely do not want to be overwhelmed here, 

and so I'm asking this really of the Board 

members who did have the opportunity in the past 

to look at claims.

How many do you think you personally 

would find not overly burdensome to look in the 

way that we did before. To look at critically 

and then a brief report back to the group on 

that claim?

I think we actually had 92 people to 

each claim. That was in part because we were 

trying to see to what extent there was a common 

agreement on some of the weaknesses or strengths 

of the claims that we looked at.

But for instance, Dr. Silver, Dr. 
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Friedman-Jimenez, Dr. Mikulski, would looking at 

three or four or five claims, would that be 

overly burdensome?

MEMBER SILVER: Ken Silver here. It 

depends how close to the report backdate at our 

next meeting or working group the claim files 

arrive.

I remember getting a disk like ten 

days or two weeks before a working group meeting 

and spending the entire Labor Day weekend 

getting my four or five claims done.

If it had been in hand a lot earlier, 

you know, I'd feel a lot better about having 

done those four or five claims and on a few 

occasions, yes. We had them well in advance so.

CHAIR MARKOWITZ: Yes.

MEMBER SILVER: The number is 

directly proportional to the amount of lead 

time.

CHAIR MARKOWITZ: Dr. Goldman?

MEMBER GOLDMAN: The other thing I'm 
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thinking for doing these, I agree with Dr. 

Silver, is like the specific question we're 

asking or looking for.

For example, on the pulmonary that 

you noted, I recall from the previous 

discussions, for example, that there were issues 

with asbestosis not being diagnosed because 

somebody had a diagnosis of interstitial lung 

disease.

And somehow, interstitial lung 

disease wasn't being connected that it could be 

asbestosis. Or there was a word fibrosis and it 

wasn't being connected back that it could be 

asbestosis.

So I'm wondering if, just so we're 

not totally rediscovering the wheel again, if 

there were these things that came up previously 

and I know that Carrie Redlich wrote that and I 

thought that some changes made then implemented 

to sort of connect now fibrosis to asbestosis if 

there was an asbestos exposure.
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I'm wondering if we could look back 

again at some of those issues that were 

identified in the past and then use this 

opportunity now if we're going to do a re-review 

of cases to say, okay this is something that was 

identified before.

So we want to pull out a case of 

interstitial lung disease and see if this issue, 

you know, was corrected or not corrected. So I 

think I'd like to see some building upon the 

past work.

CHAIR MARKOWITZ: This is Steven. 

That makes a lot of sense and what I think I'll 

do is go back and look at, I don't know if I 

have the stomach to look at the transcripts, but 

look back at some notes and see if we can 

identify some of those.

Although I have to say, the purpose 

of this look at the claims is not so much to 

identify problems in the process because I don't 

think we'll be looking at enough claims to 
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really be able to make much of a statement about 

that, but I agree with you.

Why not look at those issues and see 

what we can learn about those issues while we're 

doing that so I'll --

MEMBER GOLDMAN: This is Rose again. 

I don't know that you have to go through all of 

the transcripts per se. I think just from 

memory, I know that when I first came on, Carrie 

Redlich had put together a report for example on 

asbestos.

It was something she wrote and 

submitted. It was just a report and I think that 

we did a report on Parkinson. Dr. Mikulski and 

myself and others a year ago so I think looking 

at those past reports and saying, okay, let's 

pull a case of Parkinson's disease to see, you 

know, how that's being handled.

Let's pull a case of interstitial 

lung disease and seeing what's happening now 

with the, or a diagnosis of pulmonary fibrosis. 
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Is that, is there an attempt to connect that to 

an asbestos exposure or not.

So that I think in this process of 

just seeing where we are again, we could pull 

out a couple of these things that were brought 

up before and if particularly if we're going to 

pull cases from 2020 just see what the status is 

as long as we're going through the process as 

well as seeing if there has been a change from 

the past experience and what came forth.

CHAIR MARKOWITZ: Okay. Good idea. 

Dr. Silver, your hand's up. I don't know if you 

wanted to say something. Okay. So I'm taking 

notes here. Recent, relatively recent completed 

cases, mostly denied, some accepted. To the 

maximum extent possible inclusive of IH and CMC 

reports.

A mix of different diseases including 

neurologic, pulmonary, cancer and beryllium. The 

cancer cases shouldn't be a derivative from, 

except in Part B, cancers.
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And I think that's pretty much it. 

I'm sure that when we prepare our requests and 

submit it to the Department, if you could give 

us feedback on things that we, that you need to 

know in order to locate these, cases, that we 

can provide you with additional details on 

subsets or the like.

As we will, our past experience is 

they're always still some questions remaining 

given our distance from the administrative data 

base.

Anything else on this topic, 

otherwise we're going to move on in the agenda? 

Oh, so I never got an answer to the questions 

of how many claims is reasonable.

I'm, I don't know that we need to 

have, well, to make it easy on the Department, 

actually we should have a claim reviewed by 

multiple people for our purposes is to a large 

extent learning about the claims, then that 

learning can be done.
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That will also expedite things as it 

means we can request fewer claims. Is it 

reasonable for those of you have looked at 

claims in the past to consider that if there's 

sufficient time that by looking at three or four 

or five claims is a reasonable number?

MEMBER SILVER: Silver here. Yes.

CHAIR MARKOWITZ: Okay.

MEMBER MIKULSKI: I'd say yes. This 

is Marek and depending, of course, on the time 

involved and if it's at all possible to go the 

character recognition in that certain that Dr. 

Friedman-Jimenez had mentioned, that would be 

definitely much more helpful.

CHAIR MARKOWITZ: Okay. Good.

MEMBER GOLDMAN: I would say three 

depending on what they are, but no more than 

five.

CHAIR MARKOWITZ: Okay. Good. Well, 

yes, there are twelve members of the Board so 

we'll figure that out. Okay, let's, so I'm going 
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to, I'll draft the request and I will probably 

circulate, I guess I'll circulate it to the 

Board members.

If you could take a look and see if 

I've captured everything from the discussion 

today and then we'll submit it. Okay, let's move 

on to the next topic.

This topic is, I thought that we 

should take a look at program statistics data 

quickly. Not so much with the idea that we're 

going to dwell over each of these things that 

the program puts out as much as to understand 

the kind of data that are publicly shared and 

whether there are additional kinds of data 

limited, but additional kind of data that would 

be useful to us in doing our work.

And this in part, I remember for 

instance and those of you who are on the Board 

at the time when we got the top 10 conditions 

with the most number of claims, and then broken 

down by organ system, it was, I thought, 
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extremely illuminating about how the program 

operates.

So I've asked Kevin to pull up the 

publicly, the, bring us to the public reading 

room of the OWCP and then if we can look at any 

number of, if you would pull up, let's see 

Kevin, I think you, okay so Kevin, tell us do we 

have control over the page now or do you have?

MR. BIRD: No. Just let me know if 

you want to see. I have control. You should be 

able to zoom in, but other than that, I have 

control.

CHAIR MARKOWITZ: Okay. So the, let's 

just go in order. Some of them aren't going to 

take very long. Because it's very limited 

interest, but if you could go to the actuarial 

reports.

And we can go to the most recent one, 

2020 and see if it's available. Okay, so this is 

a 42-page document. If you go just down the 

page, you'll see this is just basically mostly 
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about funds.

It, there are data in here about the 

number of claims. If you scroll down a little 

bit, now Kevin, can you, I don't know if this 

is, can you make it a little, the font a little 

bit larger than just the view?

A little bit more. Okay, how's that? 

Okay. So just scroll down a little bit. I want 

to get to, there's a section in here which gets 

beyond money.

Although the money part is 

interesting, it shows you how much impact the 

program has had over the last 21 years. But 

there are some data here in, keep going, okay.

So you can stop there. Okay, so you 

see, if we could look at the graph. So this is 

just RICA approved cases by quarter. You can go 

to the next page because we're not concerned 

with the RICA cases. So here's, so beryllium 

disease cases approved by quarter under Part B 

and you can look at 2015 to the present.
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And you can see sort of the trend 

although I have to say I'm not sure what 

indicated versus prior selected, but I focus 

really on the blue or the actual number from 

past years.

So you can see the number berylliums 

of these cases. It varies, but it's going down 

over time. Sensitivity, it -- the vertical axis 

is, relatively small numbers in cases so there's 

some variation.

I'm not sure what it really means 

year to year. But you can see silicosis cases 

approved by quarter. So and if you could just 

make that a little bit larger, Kevin.

The bottom graph so we can see what 

actually the horizontal, okay so it's by year 

actually, by number of cases. So that's 

interesting.

Okay, we're not really discussing it 

so much at the moment to understand all of this 

just to see what's available, but number of 
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cases seem to have gone up quite dramatically 

actually in the last few years.

And Kevin, if you could keep going 

down. These are Part B SEC cancers. See these 

are Special Exposure Cohort cancers. And, going 

down per year, the beginning of 2015 of this 

graph, it was close to 400 now it's closer to 

300 or less.

A cancer non-SEC Part B, could I ask, 

Mr. Vance, what are those cancers? There's Part 

B, but there, oh I see. These are those with 

instruction cancers. Right?

MR. VANCE: Yes.

CHAIR MARKOWITZ: Yes, right. Okay. 

And then Part E, go to the next down page a 

little bit, Kevin. Okay. Part E cases approved 

by quarter. Okay.

So anyway, so that's what the 

actuarial data looks like. Let's go to the next 

and people can just chime in whenever with 

questions or comments.
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And the response to the Ombudsman 

Report, I don't think we need to see that. The 

staff training manuals of interest, but not at 

the moment. The, let's go to the fourth item, 

the contract medic consultants and second 

opinion.

Okay. So these are the quarterly 

audits. It's just got the most recent one which 

I think is the top one. And we've looked at 

these before.

And we can look at, let's go to the 

fourth quarter, let's go to the medical 

director's audit. And so what this is, that's 

just the, bring the page up a little bit and 

bring it down a little bit. Yes.

Okay, you can, yes, you can stop 

right there. So this is done quarterly. The 

medical director looks at close to 50 and in 

this report it was 48 randomly selected CMC 

reports and with four distinct services, 

causation analysis or impairment ratings or 
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second opinions or file reviews.

And the medical director then looks 

through those for essentially quality in terms 

of auditing and then in the second paragraph, 

you can see the other 48 reports, six exceeded 

expectations, 39 met requirements and three did 

not meet requirements and then if you go to the 

next page.

Okay, there's a, and what they what 

this report then does is what the defects that 

are found what the problem was and this case 

inappropriate application of the AMA guides and 

there was yes, and then the WPI rating.

Again an impairment related for two 

of the reports. So these three reports, there 

were problems. All had, they seemed to have 

impairment issues.

So in any case, so this is done every 

quarter and then if you go back one, Kevin, the 

CMC report, this audit is then goes, you can go 

to the audit analysis report. Just below that.
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So this goes to Mr. Vance. Oh, Susan, 

I'm sorry. Goes to Mr. Johnson who looks over 

these things besides on the audits and then what 

actions occur as a result of the audit.

So this is another level of review. 

It's where we would be more interested in 

frankly in the medical director's report than

here, but in any case, this lets you know this 

exists.

And okay, so we can go back and go 

back again and let's go back to the reading room 

and look at program summary statistics. And that 

we can just pick the most recent one.

The, yes, September 2021. And if you 

could make this a little bit larger. So this is 

the report for September for two months ago. A 

number of new claims, number of cases across the 

country, the part whether it's a B case or an E 

case and then they give year to date in addition 

to the month.

So this really captures kind of the 
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flow of claims, really the incidents of cases 

and claims broken down by Part E and D for given 

months.

So it is useful because it just tells 

you the volume of work that's going on. I mean, 

new cases fiscal year to date that 2,673, the 

number of new claims, 6,239 and this is 2021.

You know nine months to the end of

September. Okay, so if we can go back to the 

reading room. This is given for every month. And 

go back one more, Kevin.

Let's go to the next one, accepted 

claims cancer claims, data release. Okay so what 

we have here is a listing of accepted cancer 

claims by ICD code by, you know, the text 

correlate of the ICD code.

We're looking at a cancer of the lip, 

cancer of the tongue and what facility the 

person worked at or the dominate facility they 

worked at or whatever and then the year that it, 

the claim was accepted.
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This seems to be in order of the ICP 

code and this goes on. This is quite a large 

table. And so one could look at the number of 

successful cancer, accepted cancer claims by the 

DOE site by year.

And also the total number of cancer 

claims for any given ICD code or cluster. Okay. 

Let's move on. And let me oh, let me just ask, 

I'm sorry, let me just ask Mr. Vance I think or 

Ms. Pond.

Why did you produce this data 

release? Do you remember? I know it's five 

years ago, a long time ago, but --

MS. POND: Oftentimes we put these 

out in the public reading, I'm sorry, public 

reading room when we get a multiple file request 

for the same information.

That way when we get another request 

for that information, we can just point someone 

to the web site and also it provides us with an 

indication of the kind of information the public 
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is asking for in general.

That's probably why we created this. 

I can't say for sure that's the reason, but that 

would be my guess.

CHAIR MARKOWITZ: Okay. Thanks. 

Kevin, let's go back to the reading room. See 

what else we find. Oh, yes, the accountability 

review. This is rough.

I've started 2020 and then why don't 

we go to the top one, branch of, well, actually 

why don't we go to 2020 AR, close out memos and 

overall summaries? District Office.

Are they, no I'm sorry, the overall 

summary, the third one down. I'm sorry. Within, 

yes, --

MR. BIRD: This one?

CHAIR MARKOWITZ: -- that one. Let's 

look at that one. Oh, okay. So this is a quality 

review and correct me by the way if I make 

mistakes here, but which is done at the District 

Office level of a certain number of cases, a 
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large number of cases, are reviewed and they 

look if you can go down, you can look at the 

described findings.

It's one of the 90 percent 

acceptability rating. And they look at the 

quality of the work of the claims review. So 

there are a lot of these accountability reviews.

Mr. Vance, can you just explain to us 

what they're really focusing in on?

MR. VANCE: Well, let me start by 

saying that we are no longer doing the 

accountability reviews, but in the past what we 

have done, this is like a qualitative assessment 

of performance by our District Office.

Our final adjudication branch in our 

medical benefit unit and it's basically 

evaluating the qualitative satisfaction of 

particular standards with regard to, you know, 

development accuracy and quality and then 

decision making quality and accuracy.

And so this was reviewing a variety 
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of different criteria that would have been 

assessed by the audit team.

CHAIR MARKOWITZ: Okay. And this is 

part of your sort of renewed quality review 

process. You've replaced this with a, I think a 

different system you mentioned yesterday.

MR. VANCE: Yes. It's an ongoing 

process now by a quality insurance group.

CHAIR MARKOWITZ: Okay.

MS. POND: Yes, the difference, this 

is Rachel. The difference in this rate is with 

the annual reviews we collected a sample for the 

entire year and it was usually, you know, a 

lapse with at least a month sometimes more than 

that.

That we had to go back so now we're 

looking at real time places and that's where we 

find it to be more helpful in the annual once a 

year review that we were doing before.

CHAIR MARKOWITZ: Thanks. So let's go 

back to the reading room. Additional program 
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information. The next, third to the left. Okay. 

And this, so let's look at the third blue line, 

the top medical conditions.

Okay. So we're looking at, is that 

large enough for people to see? We're looking 

at chronic silicosis, 2016 to 2019 so the better 

part of four years.

ICT Code there are 885 claims, 60 

were approved, this is under Part B which has 

specific language on silicosis. And then certain 

number of claims pending, but 75 percent of the 

claims that have been resolved have been 

approved and here's the reasons for denial.

Actually this is what I referred to 

earlier, what I asked about. They can see that 

the majority of the denials were due to were you 

not covered and then there were some with 

negative causation.

But there's some other categories. 

Insufficient medical information, it's a 

survivor case that is not eligible, et cetera. 
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So Part B silicosis in those three plus years, 

75 percent approved. Okay. Let's go to the next 

one.

Health conditions, top 10. That's 

where we're looking at that, okay. And then if 

you could move it over. So if I'm correct, I 

think these tables were created at the request 

of the Board.

But it helps me to understand what 

the, what people were submitting claims for and 

what they were getting approved for. So this 

takes, this is all health conditions, top 20.

These are Part E claims so these are 

not Special Exposure Cohort or dose 

reconstruction cancers, it's not silicosis, it's 

not -- actually there's someone typing.

If you wouldn't mind just muting your 

phone there, that would be great. Thanks. And 

you can see that large numbers of claims, the 

Column E is the number of claims for skin 

cancer.
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Numbers, the second is for chronic 

obstructive pulmonary disease. And then cancer 

of the prostrate, hearing loss, et cetera. 

Actually when we looked at this, some of these 

rows kind of need to be aggregated, but for this 

purpose of understanding, and you can see on 

Column I the percent approved that it varies.

You know, prostate cancer was about 2 

percent, COPD was about 40 percent. If you go 

down to row 17, pleural plaque, 68 percent, 67 

percent were approved.

So a lot of cases approved and a lot 

of variation. And that's what we'd expect 

actually, a variation. Third line from the 

bottom, breast cancer 1 percent approved.

For whatever reason we seem, second 

row from the bottom, we see skin can -- oh it's 

melanoma and polyneuropathy, 39 percent. So 

anyway, this is through September 2019.

It's about three years old and then 

let's just look for the reasons for denial. And 
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you can see negative causation is the most 

important one for most of them, maybe even all 

of them actually.

With some medical information 

insufficient, but relatively few other reasons. 

But this issue of causation and the claims 

evaluation process of causation is key for a 

fair portion of the denied claims.

So let's keep going. Let's look at 

cancer top 10. And so we see skin cancer, 

prostate cancer, and et cetera. If you could 

look at Column Percent Approved, Column I, you 

can see that skin cancer 15 to 20 percent are 

approved, that lung cancer left 22 percent and 

other site cancers unspecified about 11 percent.

And then on the other hand, colon 

cancers is 3 percent, bladder is 9 percent. So 

considerable variation, some of the nature 

cancers, very little acceptance of the claim. 

And again --

MEMBER GOLDMAN: This is Rose Goldman 
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--

CHAIR MARKOWITZ: Yes.

MEMBER GOLDMAN: -- Goldman again. 

I'd like, --

CHAIR MARKOWITZ: Sure.

MEMBER GOLDMAN: When we looked it

over, I could be misremembering, but from the 

spring I think I looked up whether breast cancer 

was anywhere because it had come up with this 

diary and I didn't see it as a compensable 

anywhere on those guidelines.

So it's interesting to me that 

somewhere breast cancer was compensated. So I'm 

not even sure where that derived from.

CHAIR MARKOWITZ: Yes, there were 

three approved cases. Yes.

MEMBER GOLDMAN: Interesting.

CHAIR MARKOWITZ: All there. Yes. 

Let's skip ahead to neurologic actually and then 

we'll come back to respiratory. If you could go 

to the, yes.
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And the top claim is sleeping 

disorder. Now, there are question for Mr. Vance. 

Consequential conditions are in claims are 

included here. Right?

MS. POND: Yes, they are.

MR. VANCE: Yes.

MS. POND: They are.

CHAIR MARKOWITZ: Okay. Because my 

guess is a bunch of the sleeping disorders are a 

consequence of other conditions that people 

have.

MR. VANCE: Yes, that's a common 

consequential illness for pulmonary disorders 

that we accept.

CHAIR MARKOWITZ: And so you can see 

on Column I, percent approved, 34 percent are 

Parkinson's disease. A lot of the neuropathies, 

39 percent of polyneuropathies and it appears 

again with the Row 13, 41 percent of 

inflammatory polyneuropathies and, in fact, even 

line 12 other neuropathy, other peripheral 
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nervous system.

So a lot of neuropathies approve 8 

percent of Alzheimer's, et cetera. So there's a 

lot of claims and a lot of variation. And again, 

if you look at the Column K, causation is the 

most important I think.

And you've got to wonder about 

consistency in looking at these results. How 

consistent the determination is by frankly 

probably by the mostly by the CMC so.

But that's one of the things we might 

want to look at in the future. And then let's 

just go back to the respiratory, oh so I'm 

sorry.

Go back to neurology, because there 

was, when thinking about what kind of claims, we 

were going to ask for Parkinson's. Dr. Bowman, 

do you see another diagnostic category you think 

we should ask for?

MEMBER BOWMAN: I think Parkinson's 

is fine. For those that are not approved, I'd 
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like to focus on the negative causation and not 

the others.

CHAIR MARKOWITZ: All right. Okay.

MEMBER BOWMAN: I'd be curious to see 

an example of the Alzheimer's I suppose. 

Especially given the percent approved. It 

actually seems relatively appropriate given the 

incidents of that in the general population for 

that to be a lower percentage.

But it'd be nice to just get a sense 

of what is approved versus not approved so 

definitely an approved one versus nonapproved. 

And that could be good because again, I don't 

want to get too many of these points so it might 

be better when we have that group working with 

us.

CHAIR MARKOWITZ: Yes, okay. Thanks. 

Also I've made --

MEMBER GOLDMAN: This is Rose 

Goldman. What's interesting is Alzheimer's, do 

they mean Alzheimer's or is there a dementia 
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which is really the toxic encephalopathy?

The other thing that's interesting is 

peripheral nerve disorders which is actually 

there's not too many chemicals that can really 

cause that.

And yet, there were 44 claims, you 

know, 44 claims for it and 17 accepted which is 

sort of interesting.

MR. VANCE: Well, can I, this is John 

Vance. Let me clarify very quickly so everybody 

understands that we can actually accept cases 

such as Alzheimer's disease based not solely on 

information about known health affect data.

It can actually be accepted based on 

the weight of medical evidence assigned to a 

treating physician or a claimant physician 

offering a real rationalized explanation as to 

how in the view of the physician, a particular 

chemical or biological, radiological exposure is 

reasonably contributing to the onset of that 

disease.
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So in other words, if there's a 

physician who has either a salient argument to 

be made about different types of hard metals 

that are potentially affecting the brain in some 

way, then they can stash on a very well 

rationalized argument as to why in the opinion 

of that physician that could be a contributing 

factor to the development of the disease like 

Alzheimer's.

That could serve as a basis to accept 

the case. So I just want to make that point of 

clarification.

MS. POND: And this is Rachel. Just 

to piggyback on that, you know, a lot of 

physicians of particularly more recently are 

talking more about aggravation and contributions 

and causation.

And that's the argument that they're 

making in a lot of these cases now especially 

that they understand the difference between Part 

B which is solely causation and Part E which is, 
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includes aggravation contribution and they're 

saying in a lot of these reports, well, it 

didn't, I can't say that this caused that 

condition.

But I can say it contributed to it so 

we're getting more and more of that as well.

CHAIR MARKOWITZ: This is Steven. 

That's interesting because, you know, the thing 

about a painter chronically exposed to solvents 

who develops memory loss and then Alzheimer's 

then you can see how, you know, it would meet a 

contributory or aggravating standard for sure.

Okay, let's just look at respiratory 

and then we'll move on. And COPD, most by far 

most common 40 percent approved. And as almost 

50 percent approved. So a lot of and again, 

negative causation.

Although in a fair number of cases, 

this institution has more information so this is 

interesting. Okay, I think we can go back to the 

reading room unless somebody wants to say 
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something here.

And I think that we may be at the end 

of, yes, I don't think -- oh, I'm sorry. Could 

we go back to additional, the program 

information for one second and then go to the 

second line, count of living employees with 

accepted medical conditions.

So this is ordered by State and by 

ICD code. What I think each row is an individual 

and what their accepted condition is. Oh, I'm 

sorry, count, not individual, count of living 

employees. Okay.

Those are number per state per ICD 

code of living employees and so Ms. Pond or Mr. 

Vance, do you recall why this was produced or 

what this is used for?

MS. POND: I believe this was 

requested from a stakeholder through FOIA. You 

do know that this is from 2018 so a lot of these 

reports, they were run back then.

We said, oh, they've been asked for 
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from a number of different stakeholders through 

FOIAs and we put them out there. If you wanted 

updated, we could probably update some of these 

lists, but you know, we just have to update them 

and run that report was a new date.

CHAIR MARKOWITZ: Yes, I think the 

previous tables with the counts by ICD code were 

probably more useful to us, but this is 

interesting.

Dr. Goldman, you had your hand up. I 

don't know whether you, that's intentional or 

not. Okay. We can go back. I think that's it for

the reading room so.

MEMBER BOWMAN: This is Aaron.

CHAIR MARKOWITZ: Go ahead.

MEMBER BOWMAN: Look on that last 

table. I just want to make sure I understand 

what's being presented. It says of accepted 

medical conditions.

Does this mean of accepted claims for 

medical conditions? I just want to --
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MS. POND: Yes, this could be, the 

request I believe was for any living employees 

in these states, the numbers in each of these 

states with accepted conditions.

So basically, yes. These are people 

that would have accepted USS claims.

MEMBER BOWMAN: But would not be for 

example of a condition that existed, but was say 

rejected. Denied, per se, negative causation so 

it's not a summary of the illness of all 

employees currently. Is that correct?

It's just those with an accepted 

medical condition in which all of the criteria 

of acceptance has been met.

MS. POND: Correct.

MEMBER BOWMAN: Is it possible to 

create said document in which it, you know, not 

where there's not where there's insufficient 

medical information, or so.

But that would include some of the 

denials to get a sense for those, just the 
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overall health of the employees? Does, is that 

a doable type of information?

MS. POND: Well, we could train 

someone. I think we'd probably have to be 

specific about exactly when you say health of 

the overall health, you're, I'm not sure if 

you're meaning --

MEMBER BOWMAN: I'm sorry. I meant of 

say, of claim, of applications for claims 

regardless of whether or not they were accepted 

or denied.

MS. POND: So you want to list like 

this, maybe not by state, but well, however. We 

could probably work with you on something and 

one of the things I would suggest and I know Dr. 

Markowitz has done this in the past.

Is, when you phrase these Requests

for Information, we have discussions before you 

put them all in writing with either John or Doug 

or somebody in our program.

Just because that way we can make 
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sure we phrase it in such a way that we're 

capturing what you need.

MEMBER BOWMAN: All right. And thank 

you.

CHAIR MARKOWITZ: Okay, I, that's it 

for our visit to the public reading room. I 

think if anybody has any comments or ideas, I 

think it is useful background for being ahead of 

what we might learn from claims review, where to 

emphasize, you know, where there seems to be 

lack of unanimity in terms of approval versus 

denial.

Not suggesting there's inconsistency, 

but just that there's, that maybe that's where 

there may be variation. Dr. Silver, you have 

your hand up? Would you like to say --

MEMBER SILVER: Yes. Can you hear me?

MEMBER MARKOWITZ: Yes.

MEMBER SILVER: One suggestion and 

one question. A couple of weeks ago I got a 

request from a public interest group for site 
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specific claims statistics.

And he's a long time public reading 

room and FOIA warrior so he was in the part of 

the Department of Labor website that we just 

looked at.

But it didn't have what he was 

looking for. I was able to direct him back to 

the name OWCP/Energy website where down in the 

lower right corner there's a compilation of 

links called Statistics and Public Reading Room.

My suggestion to the program is that 

for the public reading room site, you provide a 

way for them to get back to the state and 

worksite and total benefits by facilities data.

You can't get there from here where 

we just were so it'd provide a more holistic 

integrated experience for the kinds of data that 

some advocates and stakeholders are looking for.

And if that was too confusing, for 

Mr. Vance and Ms. Pond, I'd be happy to follow 

up in an email. And my suggestion is, when the 
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Board makes these claims requests, have we ever 

considered an efficiency process where we go 

straight to the claims examiners and ask them 

about their recent claims that have passed by 

their desks that maybe meet the Board's 

criteria?

Wouldn't that be a little bit faster 

than going through the massive computer system?

CHAIR MARKOWITZ: Yes, this is 

Steven. I, frankly I would, if that's true, I 

would leave that choice to the Department. If 

they think that's a way of expediting, 

identifying the mix of claims that we want.

It depends on the relative, you know, 

difficulty of working with the data base versus 

your suggestion. They can certainly consider 

that.

MEMBER SILVER: Has it ever been 

done? I guess I should reframe the question.

CHAIR MARKOWITZ: This, so let me ask 

Mr. Vance. Does that make any, would that help 
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the process at all or?

MR. VANCE: By doing some sort of 

employee survey of some sort? Is that what 

you're suggesting Dr. Silver? Like what are 

their concerns? I'm not aware of us doing that.

MEMBER SILVER: No, if the Board goes 

through with something we batted around today, 

we want some recent party, chemical cases that 

have had industrial hygiene referrals and maybe

a mix of those that did and didn't.

Seems like a really efficient pathway 

to do it would be an all-points bulletin to the 

claims examiners and say, you got anything for 

us that has recently passed through your desk 

that meets these simple criteria?

You know, you may not get more than 

50 percent response, but you probably, you know, 

get a bunch --

MR. VANCE: I think, this is John. I 

think anything is possible. It would just depend 

on how well Rachel and the rest of the program 
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decided useful in responding.

But you know, we do that frequently 

where we're looking for different things. I 

mean, it's certainly possible.

MS. POND: Yes, this is Rachel. I 

got, I actually hung up and I apologize. So I 

think that what you're asking is instead of 

having trying to pull cases with certain 

criteria, maybe we just pull our claims 

examiners and say do you have any of these I the 

ones that you've completed.

I would have to kind of probably talk 

to our District Directors and see how useful 

that might be, what we might get out of it. 

Because a lot of times you guys are asking for 

final cases that go all the way through final 

decisions and our claim examiners are usually 

working in active cases.

So they'd have to kind of remember a 

recent one that that might be a challenge. But 

we could have further discussions about it 
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offline.

MEMBER SILVER: Thank you.

CHAIR MARKOWITZ: Dr. Bowman?

MEMBER BOWMAN: Nothing for me.

CHAIR MARKOWITZ: Okay. Sorry. Okay, 

so I think that concludes this part of the 

agenda. And, it's 2:40. Let's take a 10 minute 

break and then we're going to come back and 

clean up some things. So let's reconvene at 

2:50.

(Whereupon, the above-entitled matter 

went off the record at 2:41 p.m. and resumed at 

2:51 p.m.)

CHAIR MARKOWITZ: Okay, just to pick 

up the last point, and so the link that I just 

sent to you, so Dr. Silver sent me a link on 

some additional state and facility specific data 

that he thought was useful to, actually I'm just 

bringing up my WebEx here.

Okay. Yes, so these are program 

statistics and I guess and if you scroll down, 
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see you can access by state and then when you 

go, you'll pick a state, pick Colorado for 

example.

If you go into Colorado, you get to 

see a number of different facilities. You go 

into Rocky Flats about the middle of the list, 

and it gives you, if you scroll down part, you 

can get Part B, Part E, statistics, number of 

cases approved, denied, monetary value in 

relationship, et cetera.

So Dr. Silver, your point was that 

there should be a listing of events and a link 

into to the public reading room. Is that your 

point?

MEMBER SILVER: Right.

CHAIR MARKOWITZ: Okay. Well, sounds 

like a good idea.

MEMBER SILVER: I mean this needs to 

be really accessible on the main webpage, but 

putting myself in the shoes of a public interest 

information hound, some might go straight to the 
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public reading room and they would have no idea 

that these data exist on another webpage and 

that conceptually so closely related.

Let's just make it a little easier 

for them by putting the links on the public 

reading room.

CHAIR MARKOWITZ: Yes, okay. Mr. 

Vance, does that sound like something that could 

be done?

MR. VANCE: I always think anything 

can be done. It's just a question of looking at 

it and deciding whether or not the programs 

going to accept that as a change.

CHAIR MARKOWITZ: Yes, okay. All 

right.

MS. POND: We can talk about it. This 

is Rachel. Either, I mean, if you go onto our 

website and you see statistics, it's pretty 

straight forward, but you know, we can talk 

about it internally.

CHAIR MARKOWITZ: Yes, okay. Next 
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item, okay so let's go back to our agenda. There 

was a question, I think Kevin you had, oh on 

aldrin and dieldrin that was posed to us.

And while you're finding it, it was 

in an email. I think the issue, if I understand 

it, is that the question to us is does aldrin 

and dieldrin are we recommending it be linked to 

both female and male breast cancer or just male 

breast cancer?

I think that was the question. And 

then there's different ICD codes for male and 

female.

MR. BIRD: Is this what you're 

looking for. Correct, Dr. Markowitz?

CHAIR MARKOWITZ: Not that 

highlighted part, but if you go down, yes, the 

two questions there. Should the stem 

differentiate male versus female breast cancer.

Different ideas in linking it to 

Aldrin and dieldrin. So for those of you that 

looked at this literature, I'm guessing that 
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whatever was available was relevant to female 

breast cancer because male breast cancer is very 

rare.

MEMBER GOLDMAN: This is Rose. I 

would have to go back to the IARC. My 

recollection and maybe George is more familiar 

as they just noted breast cancer. I'd have to go 

back and see if the studies, you know, included 

males or female.

I mean, female is so much more 

common. I'm just not sure. I'd have to go back 

and --

CHAIR MARKOWITZ: Okay.

MEMBER GOLDMAN: -- perhaps look at 

the specific studies.

CHAIR MARKOWITZ: Okay. That --

MEMBER GOLDMAN: But --

CHAIR MARKOWITZ: And Dr. FriedmanJimenez, you don't remember do you?

MEMBER FRIEDMAN-JIMENEZ: Well, male 

breast cancer is much more rare than female. 
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Maybe 1 percent of breast cancers are male or 

less.

The few studies I've done that have 

had male breast cancer cases, they've been one 

or two cases. So there's really not a lot known 

about the environmental causes of male breast 

cancer.

And to look at the other side of the 

coin, I don't know that there's enough 

information to say that they behave any 

differently. You know, obviously the hormonal 

aspects are different, but I don't think we know 

enough about male breast cancer environmental 

causes to say that it's significantly different 

than female breast cancer.

So I don't see a basis for 

differentiating them.

CHAIR MARKOWITZ: So shall we, this 

is Steven. So we sort of consider this a little 

bit and look at the studies, consider it offline 

and then get back to the Department?
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MEMBER BOWMAN: We, this is Aaron 

Bowman. We could, I just recently looked up the 

IRAC volume on this and we are going by IRAC 

recommendations.

The statement is submitted evidence 

for breast cancer in humans. It does not specify 

sex. If that helps the conversation, but 

potentially some offline discussion would be 

helpful.

CHAIR MARKOWITZ: So how should we 

proceed on this?

MEMBER GOLDMAN: Well, if that's 

their conclusion, this is Rose Goldman again. I 

don't know that we would go to differentiate it 

if it's breast cancer in humans.

Men are human so I think rather than 

dig down and try to go into the various studies, 

they didn't distinguish breast cancer in 

females, they just said, breast cancer in 

humans.

So do we need to go down further than 
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that?

CHAIR MARKOWITZ: Okay so then the 

idea then is just to include both males and 

females in the association.

MEMBER BOWMAN: Yes, I think that 

would be consistent with IRAC and consistent 

with the philosophy that we took to this.

CHAIR MARKOWITZ: Okay.

MEMBER FRIEDMAN-JIMENEZ: This is 

George. I like Rose's agreement that men are 

human too. But I'd be willing to just take a 

quick look, I have a pile of epidemiology cancer 

epidemiology textbooks here.

I'll look through and I'll get back 

to you probably by the end of this meeting.

CHAIR MARKOWITZ: Okay.

MEMBER FRIEDMAN-JIMENEZ: Yes.

CHAIR MARKOWITZ: So we're leaning 

towards, we're leaning in one direction and 

we'll come back to this within the hour or so. 

Okay.
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MEMBER GOLDMAN: I still stress by 

the way that they could never fractionate it, 

you know, whatever studies they were looking at 

for male breast cancer and I guess one of the 

issues would be, you know, if they didn't even 

have any cases of male breast cancer because 

it's so rare, would that mean and I appreciate 

George going to look at this, would that mean 

that we would then not include male breast 

cancer since it's still breast tissue even 

though there are hormonal differences so.

I mean, I appreciate George doing it, 

but I think in the end, it's probably going to 

come down to another one of these judgment calls 

and decide to be more inclusive rather than 

exclusive in this setting.

CHAIR MARKOWITZ: Okay. Well, let's 

revisit this then in a little bit. We should be 

able to resolve it today. Let's move on to the 

styrene issue. And let me ask you, there's been 

some email exchange around this.
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Is it useful to show the summary 

language that Dr. Bowman came up with that 

people seem to endorse as a way of discussing 

this?

MEMBER GOLDMAN: That sounds like a 

good idea.

CHAIR MARKOWITZ: Okay. So --

MEMBER GOLDMAN: Do you have that 

email or I mean, you have the email. Should I 

try to forward it to Kevin or what would be the 

mechanism for doing that?

CHAIR MARKOWITZ: Yes, if you could, 

I also have it, but I'm going to forward it now 

to Kevin.

MEMBER GOLDMAN: Okay.

CHAIR MARKOWITZ: So that there --

MEMBER GOLDMAN: Yes, I think Dr. 

Bowman's succinct summary of our going back and 

forth and George's extensive, I want to shout 

out that George had done a very extensive indepth review of this and then it just got into 
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the summary sentence which I think it captures 

our opinions.

MEMBER BOWMAN: This Aaron Bowman. I 

agree. It was, George, thank you for that work. 

In terms of work of the subcommittee, maybe just 

send just my part of the summary.

Otherwise, is that just not part of 

the work of the subgroup. I just want to make 

sure we're doing that right.

CHAIR MARKOWITZ: Well, I sent, the 

top part of the email is, there's, Aaron's just 

are three lines.

MEMBER BOWMAN: Yes, okay.

MR. BIRD: So Dr. Markowitz, just to, 

can you just confirm for me what you would like 

to share here, which part of this email.

CHAIR MARKOWITZ: Just the top part 

of the email. The one that's limited to Dr. 

Bowman. And we can skip the parts where Dr. 

Goldman praises Dr. Friedman-Jimenez.

MR. BIRD: But the entire text in the 
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email from Dr. Bowman?

CHAIR MARKOWITZ: Right.

MR. BIRD: Okay.

CHAIR MARKOWITZ: It ends with the 

name Aaron.

MR. BIRD: Yes, okay, perfect.

MEMBER GOLDMAN: I don't know for the 

record, somewhere you want George's expensive 

commentary and review that went into support the 

final statement from Dr. Bowman.

That could go somewhere perhaps in a 

record, but for the -- or if you wanted to show 

that, but I think we all came from different 

views to the same conclusion that Dr. Bowman 

summarized.

CHAIR MARKOWITZ: So if I remember 

correctly, the question that, the clarification 

that the Department wanted was whether 

styrene's' impact referred only to AML, acute 

myelogenous leukemia and T-cell lymphoma or 

whether it was more general than that? Is that, 
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that was sort of the question I think.

MEMBER GOLDMAN: That's correct and -

-

CHAIR MARKOWITZ: Okay.

MEMBER GOLDMAN: -- this was, went 

back to our committee or subcommittee where we 

looked at it and came up, we looked at the way 

that IARC researched it and phrased it and then 

George did a really deep dive and basically came 

up with they couldn't separate it into different 

sub-cancers and just came up with a general

lymphohematogenous.

So that wouldn't mean that -- or 

lymphohematopoietic so that you would basically 

include all the leukemia and lymphoma. We 

couldn't separate it out.

CHAIR MARKOWITZ: Right. And this is 

Steven. Let me understand that WHO renewed its 

classification of lymphomas in 2017. And there 

are now 70 subtypes of lymphoma. So it's gotten 

to be an immensely complicated area.
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MEMBER GOLDMAN: Yes, I think this 

inclusion after you read what Aaron summarized 

so succinctly and quoting from IRAC is basically 

the practical application would be that if a 

worker had styrene exposure as, you know, 

however it's specified by latency and extent and 

they had any kind of leukemia or lymphoma that 

would be compensable.

CHAIR MARKOWITZ: Okay, that's very 

clearly stated. Any comments or questions about 

that? So I think that answers the 

Departmental's question. Mr. Vance, is that 

clear enough, or --

MR. VANCE: I believe so. We'll have 

to take a look at it a little bit more. I'll 

have our folks take a look, but I think that 

should.

MEMBER GOLDMAN: We can send you 

those text and more of the email, but that's 

basically supporting that both what I said and 

what George looked into in great depth.
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Basically that's what it comes down 

to and if people were unclear what this phrasing 

meant, my translation of it, I think would help 

perhaps to give the practical consequence of 

this phrase.

MR. VANCE: Yes, this is John. My 

only concern would just be the coding to make 

sure that we have the proper classification 

coding for that type of malignancy.

So if we can define that, in that 

phrasing, then that would be what we would use. 

So we might end up looking at the coding and 

making sure that if we do have some sort of 

classification of this as a group that the Board 

agrees that that's the proper coding 

classification for it.

Because that's what then would be 

utilized in assigning that to different cancers 

and some.

MEMBER GOLDMAN: Oh, that's going to 

be a real problem when you go to the ICG-10 
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coding because there's so many. I mean, you 

could take the higher level categories, but 

you're going to go down as Dr. Markowitz was 

just mentioning.

I mean there are so many subgroups 

and diagnostic codes that would fit under 

lymphoma and leukemia would be a lot.

MR. VANCE: Well, but if that's the 

classification using lymphoma as a key to this, 

I think that we don't have to look at what 

sticks for the site exposure matrices because we 

have those classifications in SEM so we can 

probably take this recommendation and go back to 

Paragon and ask them what they think can be done 

based on the current structure and the set 

exposure matrices.

But yes, I mean, I think we have 

something we can start that conversation with 

and see where it goes as long as we have a 

semblance of an idea as to what direction the 

Board wants us to go.
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So the devil is always in these 

things so more than likely what I would do is go 

back to Paragon and ask them to help and then 

they're going to come back and say well, does 

this mean well this is how we apply it and then 

depending on how that conversation goes, we may 

end up coming back to the Board to ask for 

additional clarification.

But each step of this process I think 

is helpful in taking us where we need to go.

CHAIR MARKOWITZ: Okay, this is 

Steven. So if you get back to us with the 

listing of the ICB codes and the correspondence 

to this, then we can advise them whether it's, 

you know, need or correct. That make sense?

MR. VANCE: Is that being directed to 

us or is that going back to --

CHAIR MARKOWITZ: No, I'm sorry. 

Sorry, Mr. Vance. It's to the Department.

MR. VANCE: Yes, what I was thinking 

is that what I can do is I can go back and take 
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a look and see within the framework of the set 

exposure matrices what we could use to apply 

this guidance and see if there's something that 

Paragon can do to say, okay, if that's what the 

Board is suggesting, then this is what we think 

is going to work within the confines of the 

existing structure of the site exposure 

matrices.

Then we would probably at that point, 

come back to the Board and say, this is the 

proposal that we think is going to work and then 

see if that's agreeable or not.

CHAIR MARKOWITZ: Okay, fine. So, 

yes. So if there's further clarification that is 

required, you know, we'd be happy to help. Dr. 

Friedman-Jimenez?

MEMBER FRIEDMAN-JIMENEZ: Yes, I'm 

just looking at the ICD-9 which is what was used 

in most of the cancer studies in the past and 

then the ICD-10 is more detailed than that.

Well, ICD-9 lymphohematopoietic 
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cancers is 200 through 208. That range, it's 

very simple. In the ICD-10, I don't know, I 

don't have it in front of me.

I have the ICD-9 in my hand. But I 

think that there must be a crosswalk between 

ICD-9 and ICD-10 and I think it's probably going 

to wind up being simpler than we're thinking.

Anyway, with so many classifications 

of lymphoma, that doesn't mean there are a lot 

of cases. It's still a pretty rare set of 

cancers so I think we can just look and see what 

the crosswalk says.

And I think it's going to wind up 

being fairly simple, but this is an important 

question. I think we should address it and I'd 

be happy to take that on and get back to you by 

email probably after the meeting.

CHAIR MARKOWITZ: Okay, great. Okay. 

So I think we have a plan here. I wanted to, we 

closed out the styrene, raised a couple of brief 

issues relating to a couple of the written 
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comments we've received and so Kevin, I sent you 

a link to essentially our meeting webpage for 

today.

And I wanted to go to the two written 

public comments that are listed. One is Terrie 

Barrie and the other is D'Lanie Blaze. And 

actually Ms. Barrie raised this on her verbal 

comments also.

I think she did maybe. I can't quite 

remember. If you go to Terrie Barrie, so the 

issue here is that there were certain cancers 

and, you know, and if you just scroll down some.

That's it right there. So there were 

certain cancers that I guess the Department 

asked clarification from NCI about whether they 

were essentially synonymous with the list of 

cancers on the 22 cancer list provided in the 

statute.

And for instance, looking at this, 

there was a previous bulletin Department had 

which added cancer of ureter as a specified 
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cancer and I guess in 2016, the Department 

withdrew these bulletins and decided that it 

would not be included because I guess the 

exchange between the Department and the NCI 

exceeded the allowable clarification around 

nomenclature essentially.

And, for instance, cancer of the 

pharynx is included in the 22, cancer of the 

larynx is not and so I went back and read some 

of the rationale from NCI for including some of 

these on the list as synonymous.

For instance, cancer of the ureter 

and the ureter connects the kidneys with the 

bladder and it's the same cell type as the 

bladder and it receives the same exposures as 

the bladder meaning whatever toxins are in the 

urine.

And I think the reasoning was by NCI 

that because of these similarities, it could be 

considered within the rubric of cancer of the 

bladder.
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And I think a similar logic was 

applied to cancer of the larynx. My question to 

the Department, this involves Special Exposure 

Cohort cancers and dose reconstruction. Is this 

question or even within the realm of the topics 

that our advisory Board can, should, is able to 

provide advice on?

Because if it's not, then it's not 

within our realm. Fair enough. And we don't need 

an answer to that today, but I just couldn't 

quite tell whether this fell within our domain 

or not.

MS. POND: This is Rachel. Yes, Mike 

and I can talk about this after, but I, my 

initial impression would be that it's not. The 

reason behind changing our stance on this were 

legal reasons.

And we normally will ask the treating 

physician if there's a question about specified 

cancers or we've been known to go to EMTs or in 

the past medical director, so I don't want to 
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give you a definitive answer right now.

But I would be inclined to say since 

this is really coming from a legal stance, it's 

probably not. So it --

MR. VANCE: And this is John Vance. 

And, Dr. Markowitz, I did send Carrie a, some 

discussion that had been between the Department

of Labor and the Board I want to say many years 

ago where this very topic came up.

So we did have a written response of 

this issue in the past.

CHAIR MARKOWITZ: Okay. Well anyway, 

that's fine. If you could just either remind us 

of what you said before or just let us know, 

that would be fine.

MR. VANCE: All right. Hey, Carrie, 

if you can share that, I think it explains it 

exactly. And we provide a written response, I 

don't know what it was, but it's an available 

written response that we provided to that, that 

Carrie has.
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MS. RHOADS: Okay, I'll take a look.

CHAIR MARKOWITZ: Okay. So, Kevin, if 

we could go back to our webpage. I just want to 

look at the other public comments for a moment, 

D'Lanie Blaze's public comment. It's a related 

issue that's why I thought and I think also 

related to the styrene discussion we just had.

So here the point is it's being 

raised is that chronic lymphocytic leukemia is 

not on the 22 specified cancers, but I think 

lymphoma is.

And I think the point being made here 

is that chronic lymphocytic leukemia has been 

reclassified as a lymphoma in the, well she 

doesn't say it here, but in the 2017 WHO 

classification system.

And so the question she's raising or 

the point she's raising is whether CLL 

considered as a lymphoma should therefore be 

considered as one of the 22 cancers.

And this might be a nomenclature 
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issue that the NCI might be able to clarify for 

the Department. It seems to me if it's 

classified as a lymphoma, then it would fall 

under the lymphomas.

But NCI should be able to give an 

authoritative opinion on this. The --

MS. POND: I think there's a specific 

reference. This is Rachel, Dr. Markowitz, in the 

statutes of CLL being non-radiogenic. I mean, 

we'll need to double check on that, but there is 

a specific designation for CLL in our statute.

CHAIR MARKOWITZ: Okay.

MR. VANCE: Yes, no, this John Vance. 

The exclusion actually falls under our specified 

cancer definition, that's set by law so 

Congress, when the legislation was passed, 

explicitly excuses clinic lymphocytic leukemia 

from consideration as a specified cancer.

So when we do development, we need to 

have a very clear interpretation of the evidence 

as to whether or not a physician is interpreting 
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the information as whether or not the person has 

the clinical lymphocytic leukemia or the other 

variant which is the SLL.

The problem is now you have many 

physicians that are basically combining the two. 

And unfortunately, just because that legal 

mechanism that exists in our statute, that can't 

be something that we accept where you're taking 

a diagnosis and basically treating it as the CLL 

SLL combination.

The doctor has got to tell us because 

of that legislative requirement whether you're 

dealing with CLL or SLL and so this has been an 

interesting challenge that we've been trying to 

work through.

But at the end of the day, we need to 

have a physician telling us definitively are we 

dealing with SLL or CLL.

CHAIR MARKOWITZ: Right.

MR. VANCE: So it's a challenging 

scenario.
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CHAIR MARKOWITZ: This is Steven. It 

appears to be the same entity so it may be the 

younger treating physicians with, we'll use the 

lymphopoietic lymphoma designation and the older 

ones will be used CLL because that's what we're 

used to.

To the advantage of some things I 

suppose. In any case, anyway, I just wanted to 

raise this issue that this was either a 

nomenclature issue, but clearly the statute has 

been specific about this.

So okay, the I don't know whether Dr. 

Friedman-Jimenez, I don't know whether you were 

going to look something up whether you were able 

to do that on this call or not and we can come 

back --

MEMBER FRIEDMAN-JIMENEZ: Yes, I 

actually found answers to both of the questions. 

The issue of ICD-9 versus ICD-10, in the Agent 

Orange report, which is online, there is a 

crosswalk table between ICD-9 and ICD-10 for all 
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the cancers.

And essentially the ICD-9 200 to 208 

range maps into the ICD-10 range from T-81.0 to 

C-96.9. There are some miscellaneous malignant 

neoplasms at the bottom and I'd have to go 

through them one by one to make sure that 

they're on, that they make sense and this put, 

essentially it looks like ICD-9 mapped into ICD10 fairly neatly.

So I don't think this is going to be 

a big issue. There may be a few exceptions 

similar to the CLL SLL thing that Mr. Vance 

raised, but I think this is not going to be a 

problem.

I can send you the reference. It's in 

the Veterans and Agent Orange update from 2012 

Table C-2. And I'll email you the link. 

Regarding the male breast cancer, I looked in 

Schottenfeld and Fraumeni's Cancer Epidemiology 

and Prevention, Fourth Edition which is fairly 

new, 2019 I think to 2020 which is the only one 
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that actually comments on sex as a factor in 

breast cancer.

And basically they say that because 

of the rarity of breast cancer in males, it's 

1/100th of the incidents of breast cancer in 

females.

The chapter basically can't 

differentiate between male breast cancer and 

female breast cancer. So no one has the data to 

really confidently say what the environmental 

determinants of male breast cancer are.

And even in female breast cancer 

there aren't many because it's just not what's 

coming up in the epidemiologic studies. So I 

think that considering them both to have the 

same determinants is a reasonable thing for our 

committee to say.

I can send you the exact wording from 

Schottenfeld and Fraumeni and Adami's textbook 

of cancer epidemiology didn't even comment on 

the issue.
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Ladou and Harrison in occupational 

medicine didn't comment on the issue and these 

are the most recent textbooks of the classics in 

the field.

So I think we're on pretty safe 

ground there. I'll send you the exact wording by 

email.

CHAIR MARKOWITZ: Okay. Great. So 

that closes the topics for our meeting. I want 

to discuss what we're going to do between now 

and our next meeting.

But are there any other issues that 

we promised to get back to or we haven't raised 

that we need to discuss? Okay. So I think we 

need to reconvene probably in short meetings of 

the two working groups that we've had since the 

last time.

One of them IH and CMC and the other 

on public comments to look at the DOL responses. 

There were a number of questions in which they 

asked for clarification. And I think we should 
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clarify or not by bringing those things to 

closure so I would ask those two groups to meet 

for a relatively brief period of time to look at 

those things.

You may want to wait for the 

transcript of the meeting because there were 

some things said about some of those questions 

or responses and the transcript I think is, Mr. 

Chance, what did you say in terms of the trans -

- is it the minutes and transcript in 30 days 

and the minutes in 90 days?

MS. POND: Yes.

MR. VANCE: Yes.

MS. POND: Transcript in 30 days.

CHAIR MARKOWITZ: Okay. You want to 

wait 30 days and wait for the transcript, 

otherwise, no need. We're going to track the 

issue of the progress on a contractor for the 

Board.

If there's some additional feedback 

they need then, I'll contact you to call a 
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meeting of the subgroup that made comments on 

the performance work statement and the responses 

previously received.

And then, I'm going to send around a 

formulation of the claims request to people. 

Hopefully next week and we can refine it and 

then send it in to DOL although I expect 

initially what we'll get back is, you know, some 

request for clarification which is fine.

And we'll finalize that. But the idea 

that we are, would get the claims, you know, a 

month in advance of our next meeting which from 

our perspective looks reasonable, but the holdup 

is always I think identifying the claims and deidentifying them.

And we know that takes time so we'll 

see about that. And what's, Mr. Vance, what's 

realistic I would say if we were to get a 

request to you say by the end of November an 

official request?

What's realistic in terms of us 
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seeing, you know, 20 or 30 claims, something in 

that range?

MR. VANCE: It's hard to predict 

until I can get the request and then understand 

what the requirements are going to be, work with 

our reporting and data analytics to build up the 

requirements and then to figure out from them 

how long it will be.

And then we have to do the logistics 

of pulling them and assembling them and putting 

on DVDs and sending them out to the Board. So 

there's lots of steps involved, but, you know, 

we would definitely try to move as quickly as we 

could with regard to fulfilling the request once 

it's agreed to.

CHAIR MARKOWITZ: Right and I'm, this 

is Steven, I recall doing this before when 

actually we got a lot more claims. It was in the 

range of, you know, three months or so.

So I think that works out that we 

would have ample time before our next meeting to 
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look at the claims and discuss it. Okay, was 

there any other and there are a few items on the 

action list that we'll pursue, but is there any, 

from the Board, any other issues that we need to 

follow up in an organized effort before our next 

so called in-person meeting?

Okay. Then, Mr. Chance, are there 

additional items you want to raise or say at the 

meeting?

MR. CHANCE: I don't have any, 

Steven. Carrie, do you have anything?

MS. RHOADS: Well, I think I have --

CHAIR MARKOWITZ: Well. Carrie?

MS. RHOADS: Sorry, no nothing else 

from me.

CHAIR MARKOWITZ: Yes, this is 

Steven. I want to thank everybody including 

obviously the Department of Labor and as always, 

Kevin and our EFO and Associate EFO.

And the public who have hopefully 

you're still in there listening to us. And we 
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will, you know, continue to do this work. That's 

it. Thank you.

MR. CHANCE: All right. Thank you 

everybody. Meeting adjourned.

CHAIR MARKOWITZ: Thanks everyone.

(Whereupon, the above-entitled matter 

went off the record at 3:26 p.m.)