(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

1

 UNITED STATES DEPARTMENT OF LABOR

 + + + + +

 ADVISORY BOARD ON TOXIC SUBSTANCES

 AND WORKER HEALTH

 + + + + +

 MEETING

 + + + + +

 WEDNESDAY

 APRIL 27, 2016

 + + + + +

 The Advisory Board met at the

Department of Labor, 200 Constitution Ave, N.W.,

Washington, D.C., at 8:30 a.m., Steven Markowitz,

Chair, presiding.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

2

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MARK GRIFFON

KENNETH Z. SILVER

GEORGE FRIEDMAN-JIMENEZ

LESLIE I. BODEN 

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

LAURA S. WELCH

ROSEMARY K SOKAS

CARRIE A. REDLICH

VICTORIA A. CASSANO

CLAIMANT COMMUNITY:

DURONDA M. POPE

KIRK D. DOMINA

GARRY M. WHITLEY

JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL

ANTONIO RIOS

PRESENTERS

RHONDA CHAPPELLE, Branch Chief, Outreach and 

 Technical Assistance, DEEOIC

CURTIS JOHNSON, Unit Chief, Policy, Regulations, 

 and Procedures, DEEOIC

RACHEL LEITON, Director, DEEOIC

JOHN VANCE, Branch Chief, DEEOIC Policy, 

 Regulations and Procedures
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

3

 TABLE OF CONTENTS

ITEM PAGE

Call to Order/Introductions. . . . . . . . . . . . 7

Use of Site Exposure Matrices

Presentation

 John Vance . . . . . . . . . . . . . . . . . 7

 Rachel Leiton. . . . . . . . . . . . . . . .36

IOM Report . . . . . . . . . . . . . . . . . . . .63

 Dr. Rosemary Sokas

Discussion Formation of Board Committees . . . . .84

 Dr. Steven Markowitz

Weighing Medical Evidence in Claims. . . . . . . 122

 Rhonda Chappelle

Discussion Formation of Board Committee. . . . . 176

 Dr. Steven Markowitz

EEOICPA Subtitle B Evidence Lung

Disease Claims

 Curtis Johnson . . . . . . . . . . . . . . 186

 John Vance . . . . . . . . . . . . . . . . 193

Discussion

Formation of Board Committee . . . . . . . . . . 241

 Dr. Steven Markowitz

Proposed Rule Changes Discussion . . . . . . . . 250

 Dr. Steven Markowitz

Public Comment . . . . . . . . . . . . . . . . . 326

Adjourn
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

4

1 P-R-O-C-E-E-D-I-N-G-S

2 8:37 a.m.

3 CHAIR MARKOWITZ: So, let's begin. 

4 This is our second day of the Advisory Board on

5 Toxic Substances and Worker Health.

6 There are some people participating by

7 WebEx and the internet. So, I thought we should

8 introduce ourselves again in case there are some

9 new people in the room or new people online.

10 So, George, do you want to start?

11 MEMBER FRIEDMAN-JIMENEZ: I'm George

12 Friedman-Jimenez. I'm the Medical Director of

13 the Occupational and Environmental Medicine

14 Clinic at Bellevue Hospital, NYU School of

15 Medicine.

16 MEMBER REDLICH: Carrie Redlich. I'm

17 Professor of Medicine and Director of the Yale

18 Occupational and Environmental Medicine Program

19 and, also, a pulmonary physician.

20 MEMBER GRIFFON: Mark Griffon. I'm an

21 Occupational Safety and Health Consultant.

22 MEMBER DEMENT: I'm John Dement. I'm
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

5

1 a Professor in the Division of Occupational and

2 Environmental Medicine at Duke University and an

3 industrial hygienist and epidemiologist.

4 MEMBER BODEN: I'm Les Boden. I'm

5 Professor in the Environmental Health Department

6 at Boston University School of Public Health. I

7 have spent a lot of time looking at workers'

8 compensation programs.

9 MEMBER CASSANO: Hi. I'm Tori

10 Cassano. I'm a retired Navy occupational

11 physician, industry medicine officer, radiation

12 health officer. Did a lot of work at VA,

13 environmental hazards and radiation compensation

14 claims for VA, and now I do private consulting.

15 MEMBER SILVER: Ken Silver, Associate

16 Professor of Environmental Health in the College

17 of Public Health at East Tennessee State

18 University.

19 CHAIR MARKOWITZ: Steven Markowitz. 

20 I'm an occupational medicine physician and

21 epidemiologist and Professor at City University

22 of New York.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

6

1 MEMBER SOKAS: Rosie Sokas, a

2 Professor and Chair of Human Science, Georgetown

3 University School of Nursing and Health Studies.

4 MEMBER VLIEGER: Good morning. Faye

5 Vlieger, Hanford worker/injured worker claimant.

6 MEMBER DOMINA: Kirk Domina, Employee

7 Health Advocate for the Hanford Atomic Trades

8 Council in Richland, Washington.

9 MEMBER WHITLEY: Garry Whitley. 

10 Worked in Oak Ridge for 42 years and worked with

11 the Worker Health Protection Program in Oak Ridge

12 for all plants.

13 MEMBER POPE: Duronda Pope. United

14 Steelworkers, former Rocky Flats worker, 25

15 years.

16 MEMBER TURNER: James Turner from

17 Rocky Flat plant, Denver, Colorado, with the

18 Beryllium Support Group since about 1992.

19 MEMBER WELCH: And Laurie Welch. I'm

20 an occupational physician. I'm the Medical

21 Director for the Building Trades Medical

22 Screening Program, one of the DOE-funded Former
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

7

1 Worker Programs.

2 CHAIR MARKOWITZ: Okay. Thank you.

3 So, we will begin our first

4 discussion. This is on the first area of the

5 assigned tasks from our mission or charter of the

6 Advisory Board. We will have John Vance, who is

7 Branch Chief, Policy, Regulations, and Procedures

8 of DEEOIC, and Rachel Leiton as well.

9 So, welcome back.

10 MR. VANCE: Hello, everybody. Can

11 everybody hear me all right?

12 So, I don't expect everybody to careen

13 over here to look at me in the corner. What I am

14 going to do is I am walk through the Site

15 Exposure Matrices. I have actually pulled up the

16 public variant of the Site Exposure Matrices.

17 What we are going to do is I am going

18 to talk a little bit about the history of the

19 Site Exposure Matrices. I am going to talk a

20 little bit about its functionality. This is a

21 publicly-available resource through our website. 

22 So, this is something that I would encourage you
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

8

1 on the Board to go and play around with. It is a

2 very interesting resource. It contains a huge

3 amount of information about the information that

4 we have collected over the years with regard to

5 the toxic substances that are at the sites that

6 are covered under Part E.

7 Many of you are probably familiar with

8 this, but I want to give you a little bit of

9 background if you do not. I had my folks work up

10 a relatively-descriptive series of talking points

11 or discussion points that I think are in your

12 binders. So, I am not going to really go through

13 it word by word, but I just want to touch on some

14 of the functionality that I think is important

15 for you to understand, some of the strengths, and

16 some of the weaknesses that are contained in the

17 Site Exposure Matrices.

18 So, it is a huge database. It is

19 basically a database that contains information

20 that organizes data about exposures at the

21 different worksites. And if you could just take

22 a look, you can look at just the basic initial
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

9

1 search criteria, which is basically predicated on

2 the substances that were at these sites, the

3 health effects which are the information about

4 diseases that we know are linked to particular

5 exposures and, then, work processes. But it gets

6 more detailed than that.

7 This version of the Site Exposure

8 Matrices, this public version, is not identical

9 to the one that the claims staff used in the

10 district offices, the reason being that, as our

11 contractor, Paragon, is developing information

12 relating to the Site Exposure Matrices, they are

13 incorporating it into a version that is cleared

14 for use by our claims examiners, but is not

15 cleared for public release.

16 So, what ends up happening is you have

17 a clearance process that every six months or so

18 we will have basically a freeze of the internal

19 Site Exposure Matrices for vetting by the

20 Department of Energy. They are going to

21 basically go in and evaluate the information to

22 make sure it is okay for public release.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

10

1 This is, of course, a publicly2 available resource. So, of course, there are

3 security concerns, and that is the issue that the

4 Department of Energy is interested in making sure

5 that there is no problems with any of the

6 information that is available through the Site

7 Exposure Matrices. We have users that are

8 accessing this resource around the world. That

9 is definitely a concern that we have to be aware

10 of and conscious of.

11 It is a very large database. I think

12 I had some information added in the discussion

13 about some of the amount of information that we

14 have in the Site Exposure Matrices. For example,

15 the Hanford site, we have tens of thousands of

16 rows of data of information about toxic

17 substances that were at the site on page 3. So,

18 huge volumes of information, 783 cells of data in

19 2010. That has increased to 921,000 cells of

20 data. This is just for the Hanford site.

21 Hanford, of course, is a very large

22 site, but you can imagine that, if we have this
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

11

1 amount of information just on Hanford, think

2 about some of these other large operations like

3 Savannah River, the facilities at Oak Ridge, you

4 know, Los Alamos, and some of these other

5 locations.

6 A huge volume of information is being

7 incorporated into the Site Exposure Matrices. 

8 So, it is a very, very valuable tool in the sense

9 that it does catalog a lot of data. Now, that

10 being said, it does not catalog everything. It

11 is basically a collection of information that our

12 contractor has gone out to the site and

13 collected.

14 So, basically, they have gone out, and

15 we talk a little bit about it in the write-up

16 here, the history of how they went about

17 searching these records. They went out and did

18 worker roundtable interviews. They met with

19 workers. They tried to identify sources where

20 the records were. They tried to get a framework

21 or an understanding of some of the work that was

22 occurring at the different sites. And then, the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

12

1 contractor went off to contact the different

2 sites and work with the Department of Energy to

3 collect data relating to exposures and work

4 processes at the sites. And so, this effort

5 resulted in the culmination of the Site Exposure

6 Matrices.

7 The data that is maintained in the

8 Site Exposure Matrices is directly affiliated

9 with documentation from the site. This is

10 materials that the contractor, our contractor,

11 Paragon, has collected and has assessed. They

12 are evaluating that documentation to determine

13 how best to report exposure data in the Site

14 Exposure Matrices.

15 So, the Paragon folks that are doing

16 this -- and we have a bio on the lead project

17 manager, Keith Stalnaker -- many of the folks

18 that are involved with the review and the

19 collection of this material actually have site

20 experience. There are experts in industrial

21 hygiene and epidemiology that are involved with

22 the SEM contractor and reviewing this material,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

13

1 and they have internal processes for evaluating

2 and assessing the documentation for use in the

3 Site Exposure Matrices.

4 The Site Exposure Matrices itself is

5 a collection of data that is primarily focused on

6 chemical and biological materials at the sites. 

7 It is not intended to collect radiological

8 information because that is generally viewed as

9 being part of the dose reconstruction modeling

10 that NIOSH does.

11 So, the Site Exposure Matrices really

12 focuses on biological and chemical toxins. As

13 you go through and look at some of the substances

14 that you can see in the Site Exposure Matrices,

15 you can just go see some of the thousands of

16 different substances that we have in here. So,

17 you can do very broad-based searches, and I will

18 just direct you to the main screen or the screen

19 over here in the front of the room.

20 Just huge amounts of information with

21 all these different toxins. If you can think

22 about the different types of materials that are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

14

1 involved with making nuclear weapons. There is

2 going to be a lot and there is going to be a lot

3 of very unique materials.

4 And so, as the Paragon contractor was

5 collecting data, they are looking for

6 information, identifying specific toxins,

7 tradename toxins and other types of things. And

8 then, they will begin looking at how was this

9 material used at a particular site.

10 And so, they will look for that data,

11 and it has to be a primary source document. They

12 are not going to be taking information without

13 some sort of affirmation through documentation

14 that they have collected.

15 Now, as we were talking about

16 yesterday several times, the reality is, of

17 course, there is missing documentation. If the

18 documentation doesn't exist, it can't be used to

19 populate data in the Site Exposure Matrices. So,

20 this represents a reflection of data that we have

21 been able to get our hands on.

22 And this effort is continuing. The
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

15

1 Site Exposure Matrices is not a static system. 

2 It is constantly being updated as the contractor

3 identifies new sources of information, as they

4 get additional information from either the

5 Department of Energy or submitted through public

6 channels.

7 We have a link on our website that

8 allows the public to submit information in their

9 possession for evaluation and consideration for

10 additional data into the Site Exposure Matrices. 

11 And we do get a fairly good clip of information

12 coming in. It is reviewed, catalogued, and it is

13 assessed for inclusion in the Site Exposure

14 Matrices.

15 As you can see, it is just thousands

16 of different toxins. I mean, it is a very broad17 based amount of information about toxic

18 substances that were available.

19 What is nice about the Site Exposure

20 Matrices, though, is the searching and filtering

21 functionality. So, when you go up and you

22 actually look at the different components of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

16

1 Site Exposure Matrices, the first thing you will

2 notice is that there are different kinds of

3 searches that you can do by DOE site, mines,

4 mills, or ore-buying stations, or transport, or

5 uranium transporting operations.

6 The main functionality, of course, is 

7 looking at the Department of Energy site. So,

8 that is going to be your default option for

9 searching the Site Exposure Matrices. As you can

10 see, you can go into the Site Exposure Matrices

11 and select what site it is that you are

12 interested in doing research on. I am just going

13 to use Hanford as an example because that is the

14 one I used in the handout.

15 As soon as you select a site, you are

16 going to immediately come up with additional

17 information and search criteria that can be

18 applied to the evaluation of a claim, right? And

19 so, let's talk a little bit about that.

20 The information in the Site Exposure

21 Matrices is a very broad collection of all the

22 information that we have about toxins. The one
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

17

1 big feature it does not include is temporal data,

2 which means we don't know and do have in the Site

3 Exposure Matrices any information about when this

4 material was utilized at the site, merely that at

5 some point there was a material toxic substance

6 that was utilized at the site and is going to be

7 recorded in the Site Exposure Matrices. All

8 right? And that is certainly a big issue for us

9 because that is a degree of specificity that

10 doesn't exist.

11 A lot of these toxins may have been

12 utilized in historical operations and were ceased

13 from use at certain periods of time. But that

14 would not be reflected in the Site Exposure

15 Matrices. We find, through our industrial

16 hygiene referrals and looking at some things, in

17 some instances toxic substances may have been

18 used for a singular work activity that may have

19 occurred at a singular point in time and was

20 never utilized again.

21 But, in looking at the Site Exposure

22 Matrices, you would think, okay, well, this was a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

18

1 material that was at the site, but you really

2 don't have any understanding or context as to the

3 extent of the use of that material, merely that

4 there was this material at the site at some point

5 between whatever the operation period is at the

6 facility you are doing research for. So, that is

7 certainly something that the Board could be

8 looking at with regard to specificity in the Site

9 Exposure Matrices.

10 You can take a look and see all the

11 different information that we have available on

12 facility-wide searches. So, you can search by

13 these different -- you can search by substance,

14 if you so choose. The health effect data, which

15 we will talk about, which is basically the

16 information about the diseases we know are linked

17 to particular toxins.

18 Work process is over here where you

19 are talking about site history, areas, buildings. 

20 Work processes is very important, search

21 criteria, labor categories. And then, we have

22 this incident thing. We talked a little bit
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

19

1 about that yesterday.

2 The point, we were talking a little

3 bit about that yesterday, and this is something

4 else that you might want to jot as an asterisk. 

5 Again, the Site Exposure Matrices is focusing on

6 biological or chemical exposures. If we have

7 radiological incidents that occurred, that is

8 probably not going to be something that we are

9 going to regularly be seeing in the Site Exposure

10 Matrices. Again, the context here is really

11 chemical and biological exposures.

12 So, we are looking at Hanford. The

13 claims examiner, once they have actually done --

14 if you are going to go back to yesterday's

15 discussion about the claim process, once they

16 know what disease they are dealing with, they are

17 going to start a correlation evaluation. They

18 are going to go back and look at the exposure and

19 employment history that has been presented by the

20 employee, and they are going to try to match data

21 that the employee or the case file has identified

22 to information on the Site Exposure Matrices.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

20

1 For example, if we are going to click

2 on disease or health effect, we can go in and

3 look for, let's use chronic obstructive pulmonary

4 disease because that is a very common one. These

5 are all the diseases the claims examiner can

6 utilize as essentially we know that there is a

7 toxic substance that causes or is affiliated with

8 one of these diseases.

9 So, you know, we have quite a list of

10 these things. This is information that is

11 populated from Haz-Map. There is a brief

12 discussion of that in the handout. This is also

13 material that is vetted and evaluated by Dr. Jay

14 Brown, who is basically the author or the editor

15 of the Haz-Map. This is clearly an area where I

16 think the Advisory Board could be instrumental in

17 looking at additional expansion of health effect

18 data in the Site Exposure Matrices and other

19 sources of information we could utilize to

20 populate the database.

21 Getting back to this, though, if we

22 look at chronic obstructive pulmonary disease, it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

21

1 is going to pull up a relatively-broad list of

2 data relating to the different kinds of things

3 that we know are affiliated with chronic

4 obstructive pulmonary disease.

5 As I scroll down, you will see the

6 different categories that are listed. So, you

7 can see the toxic substances that are linked to

8 that disease. You can look at some of the

9 disease links that are associated with that

10 exposure or that health effect.

11 And then, we can do other types of

12 search functionality. In other words, if a

13 claims examiner is seeing something where it

14 doesn't really match up very well with what is in

15 the Site Exposure Matrices, they can do these

16 alias searches where they are going to go in say,

17 what is pulmonary fibrosis? Is that an alias of

18 COPD? And they would generally see that that is.

19 So, it is a very interesting system in

20 the sense that it does have a lot of data. The

21 other neat feature about it that the claims

22 examiners do you utilize quite a bit is the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

22

1 filtering functionality. So, let's get out and

2 see if we can get to that.

3 You can actually go in and do

4 additional searching. So, let's say they want to

5 look at somebody that was a welder. This is the

6 example in your handout. So, they go in and they

7 say, "Here, let me look at all of the information

8 that we have about the different labor categories

9 at Hanford." And what they would be looking for

10 is information that correlates to data that the

11 employee has reported.

12 So, let's say the employee has

13 presented a claim saying, "Hey, I was a welder at

14 Hanford for whatever period of time." Well, the

15 first thing the claims examiner is going to do is

16 they are going in and say, "Okay, let's take a

17 look at welding or welders at Hanford and what we

18 are able to sort of establish as a link between

19 the welder labor category and the information

20 being provided by the employee.

21 So, you can see right away we already

22 have a list of toxins associated with welding. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

23

1 Some of the ones that you would obviously know

2 would be welders would be exposed to welding

3 fumes and other types of things.

4 But the CE is, then, going to start

5 trying to narrow that list down. Because we are

6 operating in essentially the absence of reliable

7 affirmative data specific to an employee, we are

8 basically having to recreate their exposure

9 history. This is the real challenge in this

10 program, is the absence of individual-level data.

11 So, the Site Exposure Matrices and the

12 functionality of the claims examiner is to try to

13 identify and prioritize exposures that have the

14 greatest likelihood of a positive outcome for the

15 case. In this case, we have a welder. Let's say

16 we are looking for welder who has made the claim

17 and has established a diagnosed chronic

18 obstructive pulmonary condition. So, the CE is

19 going to go in and say, "Okay, these are my two

20 filtering criteria." So, it would be "welder"

21 and "obstructive chronic pulmonary disease".

22 You can immediately see they have
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

24

1 whittled this down to two toxins. Okay? This

2 would be a relatively-good result because it is

3 basically limiting it to two identified toxins. 

4 So, this is one where you would see this is where

5 we would, then, turn to an industrial hygienist

6 to the answer question, what would be the level

7 and extent and duration of exposure for a welder,

8 for whatever period of time, at Hanford working

9 around these two specific toxins?

10 We would not go beyond that because

11 this is affirmative data that we have been able

12 to collect about welding at Hanford. Okay? So,

13 of course, the question would be, you know, well,

14 could there have been other toxins? There

15 certainly could have been. But we are trying to

16 identify the ones with the highest probability of

17 the employee coming in contact with. This

18 information would be based on specific data that

19 we have about welders at Hanford. Okay?

20 So, this information would be based

21 primarily on what the employee identified in

22 their employment history or any other kind of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

25

1 information in their DAR records, which is the

2 information we get from the Department of Energy

3 about their exposure history. We would also be

4 looking at their occupational history

5 questionnaire. All that information would also

6 be something that would be considered by the

7 industrial hygienist.

8 So, they would go and they would say,

9 if I am welder and I have described my work

10 activities as primarily welding, well, we can

11 basically assume that that person is going to

12 have a high level of exposure, but we are going

13 to want to make sure that the industrial

14 hygienist validates that kind of exposure.

15 I mean, this is a very good way of

16 looking at it. You can search further by

17 different kinds of work processes. Let's just

18 select "welding" here. So, you know, we can also

19 look at that.

20 So, let's say you have a laborer who

21 identifies on their occupational history

22 questionnaire, for example, that "Hey, I'm a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

26

1 welder, too. My job classification is laborer,

2 but I did a huge amount of welding at the site. 

3 I was a welder's assistant and I did a lot of

4 work with them." Well, then, you can start

5 searching by that labor category and, then, also

6 add in additional filters for, say, welding.

7 Common ones we see, the laborer one is

8 a good example because laborers are a very broad

9 classification of labor category. You oftentimes

10 have to search the labor category for a laborer,

11 but, then, refine it by work process, so that you

12 are limiting or trying to figure out which are

13 the ones that are associated with a laborer doing

14 that type of work activity. So, you could have a

15 laborer who was perhaps doing like demolition

16 activities, a laborer doing outside landscaping

17 and that sort of work. So, those kinds of things

18 are all captured in the Site Exposure Matrices.

19 So, it is a very good resource. I

20 don't want to spend a lot of time on it. But I

21 think it is definitely something that you all

22 should take some time to just play around with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

27

1 and have a good sense of the search-filtering

2 capabilities.

3 One of the things that I do want to

4 talk a little bit about is some of the things

5 that are basically not going to give you good

6 results. As I was talking about, as you filter

7 these results, there is a fine balance between

8 taking it too far or being too broad in your

9 search criteria. In other words, if you apply

10 every single one of the filters here up on your

11 screen, it could be that you are going to exclude

12 any data that is relevant to the case.

13 So, what we try to tell the CEs to do

14 is to really use multiple different filtering

15 techniques to try to identify those toxins that

16 are coming up in different variances or different

17 variables of a search criteria. In other words,

18 if you are looking at labor category, health

19 effect, facility, and let's say work process, and

20 you are identifying toxins, and then, you do a

21 similar search, but, then, are looking at a

22 laborer category, if you are starting to see
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

28

1 replication of those toxins, replication in your

2 search filter parameters are going to be ones

3 that you will definitely want to identify.

4 Some of the things that are

5 problematic -- somebody brought this up yesterday

6 -- is the scope of the searches when you are

7 talking about like building-level data. So, some

8 of these locations were huge industrial

9 operations. I am sure many of you are familiar

10 with these sites where you had lots of different

11 operations occurring in very large facilities.

12 One of the common misconceptions that

13 we get is that, as soon as you walk onto a site

14 and you go into the Site Exposure Matrices and do

15 a search for, let's say, all the toxins that were

16 at Hanford, does that necessarily mean that every

17 employee was exposed to every single one of those

18 toxins? No. We stress that a building-level

19 search is not very reliable on its own. Simply

20 because you have different operations that are

21 occurring throughout the site, you have to bring

22 the employee into contact with that material in
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

29

1 some way beyond just saying you were there.

2 So, when we are utilizing building3 level searches and that sort of thing, what we

4 are trying to do is add that into other filtering

5 functionality. If you are talking about health

6 effect, facility, work process, and building

7 location, that is a good search. But, if you are

8 simply saying, you know, this employee worked in

9 Building X-10, or whatever the building

10 designation is, we can't simply say, "Simply

11 because you walked in that building you were

12 exposed to every toxin that was in that site."

13 That has to do with the fact that, first of

14 all, we don't have the temporal data on that. 

15 These locations were very large. Think about

16 this building right now. We are in this room

17 having a conference, but there are people

18 upstairs doing work in the cafeteria that are

19 doing things that are probably involving exposure

20 to certain things that we will never be exposed

21 to. So, I mean, that is just a reality of

22 industrial operations, and that is something that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

30

1 we generally say is not a very reliable source of

2 information without additional filters, which is

3 that building-level search.

4 The other big thing that I did mention

5 before, you know, we are always looking for

6 additional information. This is an area where I

7 think the Board would be very helpful in looking

8 at this. If we have sources of information that

9 would be helpful to populate the data in the Site

10 Exposure Matrices, that is definitely a source of

11 information that we would be looking forward to

12 getting.

13 We are always interested in

14 information that I think would be helpful in

15 utilizing this in our claims education process. 

16 This is a very complex system with regard to the

17 development of these cases. As you can see,

18 there are a lot of different ways to go about

19 filtering and evaluating a case. That is what

20 makes this so complicated, is that we have to

21 utilize this data in a manner that corresponds

22 with information that we have on an employee. If
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

31

1 we have not a lot of information about the work

2 processes or the activities of the employee, this

3 is not going to be very helpful. So, the Site

4 Exposure Matrices can only really work when we

5 have data about what the employee was doing at a

6 site.

7 The Site Exposure Matrices is also not

8 very helpful when we don't have a health effect

9 that is listed in the database. So, if the CE

10 cannot identify a linkage between the disease

11 that has been diagnosed and something that is in

12 the Site Exposure Matrices, this system can't be

13 used. Okay. So, that is something that is an

14 issue with the Site Exposure Matrices that I

15 think that we would be looking for some input on.

16 The big drawback I think is the

17 temporal data. We really don't have a lot of

18 information about when these materials were

19 there. The more specificity that we get, you

20 know, that is a good thing. But, at the same

21 time, you also have to be conscious of the fact

22 that, as we get more data about the use of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

32

1 materials, as we get more information about

2 temporality in the system, then that could have

3 an effect on claims adjudication in a sense that,

4 if we are looking at cases and the Site Exposure

5 Matrices includes temporal data saying this

6 material was no longer at the site or utilized in

7 industrial operations after 1960, well, that

8 means that anybody that is filing a claim for

9 employment at the site after 1960 is not going to

10 be able to ever say that they were exposed to

11 that toxin. So, there are always going to be

12 pluses and minuses as you add additional

13 information in the system.

14 The other thing that I want to also

15 mention with regard to the addition of material,

16 this system is always, the Site Exposure Matrices

17 is always going to be changing with regard to how

18 the information is presented. So, as

19 clarification is obtained with regard to how

20 materials were used at the site, this could

21 change.

22 So, we have had instances where we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

33

1 have added information. There are instances

2 where we have taken information out as

3 documentation becomes available to our contractor

4 team and as they evaluate it. So, just because

5 it goes in doesn't mean it is going to stay there

6 forever.

7 For example, in your handout we talk

8 a little bit about the work that is going on with

9 tradenames where we talk about different types of

10 tradenames for like window-cleaning agents. We

11 talk about Windex and Clorox window-cleaner. 

12 Instead of calling them by tradenames, we have

13 reduced that down to glass cleaners as a general

14 search parameter.

15 In the handout we have also included

16 several different things that we are interested

17 in looking at. I have already touched on some of

18 those. Let me just go through them. I'm not

19 going to read through all this, but we definitely

20 would be looking at input and assistance in

21 identifying new health effect data to incorporate

22 into the Site Exposure Matrices. The list of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

34

1 items that you see here in your handout are items

2 that we have struggled with, folks have mentioned

3 in the past, and it is just issues that, from a

4 policy perspective, we don't have clear answers

5 for or there's lots of issues to consider with

6 regard to those.

7 The effect of geriatric problems on

8 these cases, you know, people are going to get

9 sick. They are going to develop diseases as they

10 get older. What is the connection between

11 geriatric illnesses and occupational exposures

12 that occurred in one's early working career? 

13 That is a very challenging topic for us to

14 address, and it is one where we see individuals

15 making claims for. So, you have individuals with

16 heart disease, other types of problems that you

17 would associate with age and that sort of thing,

18 but the claims are being made that there is some

19 effect of an occupational nature on those

20 diseases. And how do we evaluate and consider

21 those claims?

22 Yes?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

35

1 MS. LEITON: There is a title in what

2 he is reading from, and you are going to see this

3 in most representations. It is advice and

4 guidance, basically. I don't think it is called

5 exactly that.

6 But, when he is talking about this

7 list, this is the list of things that we think

8 the Board might be able to help us with or the

9 things that we struggle with the most that we

10 think you guys might be able to take a look at,

11 just for clarification in case anybody was

12 confused.

13 Thanks.

14 MR. VANCE: Right. And then, as I was

15 saying, you know, other types of things that are

16 obvious here are the issues with the data itself,

17 how it is presented in the Site Exposure

18 Matrices, how it could be utilized more

19 efficiently and effectively by our claims staff

20 to avoid problems, to make sure that there is

21 some sort of regimented process for doing this.

22 We have never been able to develop a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

36

1 formulaic way of doing some searches, simply

2 because there are just too many variables

3 involved with these subsearches. So, if you

4 prescribe a particular methodology for filtering,

5 well, then, is that really going to apply to

6 every single case that comes along and is it

7 going to produce a good, valid outcome? So, we

8 have struggled with that.

9 You know, just the mere categorization

10 of information. Is there information in here

11 that would be helpful to add in? Is there some

12 topic or some sort of information that would be

13 helpful to add to provide clarity to some of this

14 information in the Site Exposure Matrices?

15 Improved data descriptions or just the

16 general presentation of data or clarification of

17 like, say, generic toxic profiles, which we do do

18 to a certain extent in the Site Exposure

19 Matrices, but could we apply that more broad20 based across the board for certain labor

21 categories? Could we apply that in certain

22 temporal situations?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

37

1 The site contractor or the SEM

2 contractor, could we not identify areas where we

3 could prioritize what their search functionality

4 would be? Where should we be looking at data? 

5 You know, simply because we are out there

6 collecting data doesn't necessarily mean it is

7 going to be applicable to a lot of cases. The

8 more information we have, obviously, the better

9 off we will be, but does that necessarily mean

10 that we should be expending a lot of time and

11 resources trying to collect information on sites

12 where we don't have a lot of claims? So, I mean,

13 those are questions that I think certainly

14 warrant some consideration.

15 I don't know, Rachel, if you have more

16 to add to that?

17 MS. LEITON: No, I think you have

18 covered it. You guys, obviously, when you start

19 looking through the database, you will have ideas

20 and thoughts about how it can be improved and

21 that sort of thing. But these are just some of

22 our struggle points.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

38

1 MR. VANCE: So, questions at this

2 point?

3 MEMBER VLIEGER: John, when looking

4 through the example that you have on the screen,

5 I notice that solvents are not included under the

6 welders.

7 MR. VANCE: Uh-hum. Right. Like I

8 was saying before, when you are doing a search,

9 it is always going to produce data that relates

10 to information on a document that the Paragon

11 team has obtained in some way. So, in other

12 words, somewhere it is saying, for somebody doing

13 welding who has got -- let's use COPD and see

14 what we get -- it is going to produce whatever

15 information is available on a document that our

16 contractor has obtained at the site.

17 So, you know, somewhere they have

18 gotten information basically saying welding

19 produces two types of toxic substances that we

20 know are associated with that work process, and

21 what we have is asbestos and welding fumes. If

22 you are going to be talking about adding
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

39

1 solvents, we would have to look at, right now, if

2 we were to be adding solvents, we would have to

3 identify what are the solvents and what

4 documentation exists to support that, or what

5 information could you rely on to add that

6 information to the Site Exposure Matrices.

7 MS. LEITON: John, isn't this, though,

8 being filtered on COPD?

9 MR. VANCE: Yes.

10 MS. LEITON: So, if it was filtered on

11 hearing loss, you might get a different result,

12 correct?

13 MR. VANCE: Right.

14 MS. LEITON: But you still filter on

15 COPD here.

16 MR. VANCE: Right.

17 MEMBER VLIEGER: I think the issue --

18 excuse me -- I think the issue comes, John, from

19 you have another statement in your presentation

20 that, when there is a later development for a

21 labor category, that that supersedes data in the

22 SEM. But welding as a labor process has metal
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

40

1 cleaning in it, and that is where the solvents

2 come in. Anybody in the room here who has worked

3 on welding or welding projects knows that metal

4 cleaning is part of it, and that is solvents.

5 MR. VANCE: Right. So, you could

6 always look at whether or not this information

7 would be something that you could look at welding

8 fumes in general and just look at -- so, here's

9 welding fumes as a description, "to describe the

10 toxic materials that a person doing maintenance

11 welding of carbon steel, aluminum, stainless

12 steel would be exposed to. Thorium" -- and

13 whatever this is -- "are also constituents of

14 welding fumes."

15 So, you know, you are going to be

16 looking at this as the general profile for

17 welding. But, if you are talking about solvent

18 exposure, well, then, maybe that would be a

19 criteria you would apply separately, you know,

20 saying, okay, was this welder exposed to --

21 saying, "I was around all kinds of cleaning

22 solvents" or other types of activities that were
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

41

1 going on.

2 It really depends on the profile, and

3 that is what makes this so complicated, in the

4 sense that you have got to look at what the

5 employee is telling you. So, if the employee is

6 saying, you know, "I did this type of work," or

7 "I did this type of activity," then you have got

8 it all applied in the Site Exposure Matrices. If

9 that information isn't available, then the

10 employee has no basis on which to do the

11 filtering based on that data. And that is how

12 this works. It is the absence of information is

13 the challenge.

14 CHAIR MARKOWITZ: Dr. Redlich? And

15 then, Dr. Friedman-Jimenez.

16 MEMBER REDLICH: Yes, I don't know

17 where to begin, but it seems like you have got a

18 lot of COPD claims. There is very extensive

19 literature of occupational exposures increasing

20 risk, causing COPD. And those exposures and

21 those studies are generally vapors, gases, dust,

22 and fumes. There is not identified the specific
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

42

1 exposure that a welder has that causes COPD.

2 So, if you knew someone was a welder

3 for many years, stop, and none of this matrix is

4 relevant because that is actually not what the

5 occupational literature shows. It is extensive;

6 there are multiple reviews. And the specific

7 exposures that cause COPD have not been

8 identified, but the types of, you know, general

9 work in a dusty, dirty environment. So,

10 something like COPD, if one were to look at the

11 relevant literature, this just doesn't make

12 sense.

13 CHAIR MARKOWITZ: So, is there a

14 specific follow-up question to this on this

15 track, Dr. Welch?

16 MEMBER REDLICH: I think it would be

17 greatly simplified.

18 MEMBER WELCH: Well, I think that is

19 an important point. And I was going to say, I

20 mean, Steve asked me to chair the little

21 Subcommittee, which I'm excited to do. Maybe

22 you'll join?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

43

1 MEMBER REDLICH: Which Subcommittee?

2 MEMBER WELCH: The SEM Subcommittee.

3 MEMBER REDLICH: Oh.

4 MEMBER WELCH: The one that talks

5 about, well, it is really exposure

6 identification, because, I mean, I think that is

7 an important issue. I mean, I, for my life, have

8 been diagnosing people with occupational disease

9 without personal exposure information, sometimes

10 with material safety data sheets. But you can

11 tell by the occupational history the complex

12 exposures that they have had. And the concern

13 would be if this is leading the claims examiners

14 to think that you need to identify specific

15 exposures when, as Carrie was saying, the

16 literature supports generic category of complex

17 exposures.

18 And it is a problem that OSHA has

19 dealt with and we dealt with in Health Effects,

20 because many times it is hard to regulate

21 something that is a complex exposure. It is hard

22 to assess the components of a complex exposure,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

44

1 and we don't want to get lost in the weeds or

2 lost in the --- not see the forest for the trees

3 kind of thing.

4 MR. VANCE: Yes, and welding itself,

5 that is a fairly compensable labor category

6 simply because welders are going to be welding

7 and they are going to be exposed to a fairly high

8 level of welding fumes. What you also have to

9 consider is welding might be one where that would

10 be very true with regard to the general

11 information, but, then, you have to look at other

12 types of labor categories across the board and

13 how do you deal with that reality.

14 MS. LEITON: John, one thing you might

15 just want to mention here is the work process

16 search because the work process search is

17 something that we will look at and it is okay. 

18 We know that they were involved in this

19 particular job, this type of work. We are

20 working currently, I believe, on a circular that

21 will help the claims examiners say, well, if they

22 were involved in this work process, and there is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

45

1 a relation to a COP, or whatever it is, then we

2 can make certain assumptions. But that is a

3 different kind of filter that I think is a little

4 bit more specific to the type of work that they

5 were doing and might be relevant here.

6 MR. VANCE: Right. I mean, you know,

7 Rachel raises a good point. So, what we would

8 look for, too, is all the different kind of work

9 processes that we have in the Site Exposure

10 Matrices to further filter and resolve what do we

11 know about the activities of the employee based

12 on their information in their case file, based on

13 what we have in the Site Exposure Matrices.

14 So, you can just see for Hanford, I

15 mean, there is just a huge volume of different

16 work processes that individuals could be

17 associated with that we could, then, search

18 further on health effects and looking to see if

19 we can identify toxins that this person could

20 have been potentially exposed to.

21 CHAIR MARKOWITZ: Dr. Friedman22 Jimenez?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

46

1 MEMBER FRIEDMAN-JIMENEZ: I can see

2 the huge amount of work and information that has

3 gone into these Site Exposure Matrices. However,

4 there is a lot of missing information here. And

5 we understand that. We recognize that.

6 Nevertheless, it is probably better than a lot of

7 the information we get on many of our patients

8 that we make decisions on based on job title and

9 length/duration of exposure, et cetera.

10 So, my question is, the claims

11 examiners, a lot of this is going to depend on

12 the judgment of the claims examiners, I think. 

13 It doesn't make sense to have a formulaic

14 mathematical application of these to come up with

15 a conclusion because there is a very high

16 probability of getting a wrong answer.

17 So, my question is, what is the level

18 of training and the skill set of the claims

19 examiners? Who are the claims examiners and how

20 are they trained to use this information in a way

21 that reduces that high likelihood of error?

22 MR. VANCE: Well, the claims examiners
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

47

1 are exactly that; they examine information. They

2 are examining data in the case file. They are

3 trained to look at data. The way I have always

4 explained it when I have done training is that,

5 you know, our claims are words on paper. They

6 are evaluating information that is contained in

7 the case file. They don't necessarily have to

8 have industrial hygiene experience.

9 I mean, they are going to have

10 understanding of what the terms and terminology

11 are on the cases. They are going to have an

12 understanding of the facilities that they are

13 looking at. But their functionality is really

14 looking at and examining evidence. They are

15 going to be looking at what information do they

16 have about that employee in the case file and,

17 then, comparing it to what they are able to

18 obtain through the use of the Site Exposure

19 Matrices to identify and prioritize those

20 exposures.

21 MS. LEITON: And just to expand a

22 little bit on that, the claims examiners are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

48

1 going to be trained in looking at this. We go

2 out and do a lot of training on how you filter

3 what you are looking for and how you are going to

4 categorize it in order to send it to an expert. 

5 That is why we do rely right now on the

6 industrial hygienist to assist us in wrapping

7 that into a statement that we can, then, use for

8 a doctor to review, that we can say to the

9 doctor, "This is what we have determined based on

10 the evidence we have in the file that we have

11 gathered and the opinion of the industrial

12 hygienist." So, again, that is where they are

13 not experts, but that is why we rely on some

14 experts to help us with that.

15 CHAIR MARKOWITZ: So, I have a follow16 up question on this topic. You described the use

17 of this SEM as complicated. That was your word. 

18 Have you ever looked at the claims examiners'

19 ability to do these searches, their

20 repeatability? In other words, if a given claims

21 examiner does a search multiple times over

22 different time periods, or across claims
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

49

1 examiners, how different ones approach the same

2 questions, to what extent do they actually come

3 up with the same answers? Because it would be a

4 way of looking at their ability to do this

5 complicated task.

6 You probably haven't done that, but

7 their ability to penetrate this data source in a

8 way that is reliable is critical. And I don't

9 think it is just a function of -- I mean,

10 training and guidance and all that help, but

11 somehow there needs to be a way of measuring

12 that. Maybe you have done it. I don't know.

13 MR. VANCE: Well, let me make a couple

14 of points, and I am sure Rachel is going to want

15 to add something. Our claims process is designed

16 to have this two-step process of making a

17 recommended decision, having the employee present

18 their point of view with regard to how the CE

19 interprets this information, and then, having an

20 independent review by the final adjudication

21 board, where they are actually going to go in and 

22 they are required to go back and evaluate the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

50

1 Site Exposure Matrices again because of the fact

2 that it is constantly being updated. So, the

3 mere process of evaluation of a claim

4 necessitates two individuals looking at it and

5 agreeing that the Site Exposure Matrices is being

6 applied in an appropriate manner.

7 The other thing that I would like to

8 point out is we do annual audits of all our

9 district offices through our accountable review

10 process, whereby we have an independent review

11 team coming in and looking at -- one of the

12 categories that we look at is Part E case

13 adjudication, where we are looking at the quality

14 of the Site Exposure Matrices application, the

15 quality of the use of our medical physicians in

16 coming to the certain claim outcomes.

17 And the last point I would have, just

18 to make a mention, is that the GAO did just

19 conduct an audit of this process and identified

20 that we have done a fairly good job in keeping

21 with the policies and procedures of this program

22 with regard to the specific medical conditions
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

51

1 that they were looking at, which included some of

2 these Part E conditions that we really have

3 struggled with in the past.

4 I know Rachel might want to add

5 something.

6 MS. LEITON: Just real quick, in terms

7 of the Final Adjudication Branch review process,

8 first, the claims examiners, depending on their

9 journey level, whether they are new or not, they

10 will often have a senior examiner look at this

11 again before a decision will go out. And then,

12 at the Final Adjudication Branch, you might have

13 a CE doing an initial search and, then, a hearing

14 rep doing a final search when they do their

15 signoff.

16 And mentioning the GAO report, that is

17 one of the processes we are going to put in place

18 in terms of we are going to have another level of

19 review before a recommended decision and before a

20 final decision for hearing reps. That is one of

21 the procedures we are putting into place.

22 When John mentioned an independent
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

52

1 review team for the accountability review, the

2 team is made up of staff in the district office

3 and our Policy Branch, but they are from a

4 different district office looking at cases from

5 other district offices, with the direction of our

6 Policy Branch team.

7 CHAIR MARKOWITZ: Dr. Boden?

8 MEMBER BODEN: First, I wanted to

9 comment on Dr. Markowitz's point, which is what

10 you are talking about is good and I think

11 important, but I want to emphasize I think what

12 Steve was saying is something somewhat different,

13 which is, if you actually have two people looking

14 at the same case file independently -- that is,

15 not one person reviewing another person's case

16 file -- then how frequently they come up with the

17 same answer is not only a measure of how

18 consistent their reviews are, but it is a measure

19 of how good the Site Exposure Matrix is in

20 assisting them to do that. So, I would just say

21 what you are talking about is not exactly the

22 same thing.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

53

1 But, getting back to where I was going

2 to go originally, it seems to me that the Site

3 Exposure Matrix has two features. One is that it

4 helps us to learn something about potentially

5 specific exposures at specific sites. But the

6 other is it is kind of an expert system, right?

7 Independent of all that, it is supposed to help

8 people who are not occupational physicians or

9 industrial hygienists figure out what people's

10 likely exposure is.

11 It seems to me it would be an

12 important thing to think about as this group

13 reviews the Site Exposure Matrix, about whether

14 the way it is being used now really helps the

15 process. I kept thinking to myself, well,

16 wouldn't it be better to have, let's say, the

17 occupational physician who is interviewing the

18 person have information about the potential

19 exposures at the site, because, presumably, that

20 person would know that a welder is exposed to

21 solvents? And then, they could report to the

22 claims examiner without having things sort of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

54

1 filtered for them through the Site Exposure

2 Matrix. At least I think that is something that

3 we could try to think about as a group.

4 CHAIR MARKOWITZ: Dr. Dement?

5 MEMBER DEMENT: First of all, I think

6 the Site Exposure Matrix is useful to an extent. 

7 The issue that we have always faced with

8 exposures as an industrial hygienist, a labor

9 category is a very rough first-level cut. The

10 next cut really comes when we talk about specific

11 tasks that the individual does. What we have

12 found a lot of times is there's so much crossing

13 between labor categories in terms of work that is

14 actually done. Welding is a good example.

15 We have so many people on the DOE site

16 who are not welders who actually do a lot of

17 welding. And the same with the use of solvents,

18 welding on coated materials. So, you have a

19 metal exposure in addition to the welding thing.

20 So, my concern is how it is one thing

21 to go into this SEM with a labor category, but

22 how flexible is it for the person who is looking
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

55

1 at this information to say, "Well, this is a

2 welder, but they said they did solvent

3 cleaning."? Is there a way to actually put that

4 together?

5 I mean, I see that welders don't have

6 solvents as a potential exposure. If I go into

7 solvent cleaning, you know, a welder is somebody

8 who might have that.

9 MR. VANCE: Yes, it is going to depend

10 completely on what is in the Site Exposure

11 Matrices. So, if you --

12 MEMBER DEMENT: But, if it is not

13 there, how would they use the information? If it

14 is not in the SEM, how do they use that

15 information that is given to them by the

16 individual who is filing the claim?

17 MR. VANCE: Yes, well, I mean, they

18 are going to look at it and say, okay, in what

19 context is that information coming? So, in other

20 words, let's say we have a welder who in the

21 occupational history questionnaire is really

22 providing a lot of data about solvent use. That
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

56

1 is also something that is affirmed in

2 documentation that we have gotten from the

3 employer. That could certainly be something that

4 they could add into the profile documentation

5 that goes to the industrial hygienist.

6 The Site Exposure Matrices, though,

7 may not have that information because there is no

8 primary source information that they have

9 identified that specifies the use of solvents by

10 that labor code category at the site. That would

11 be --

12 MS. LEITON: But -- sorry.

13 MEMBER DEMENT: Go ahead.

14 MS. LEITON: But I think that the

15 bottom line is that, yes, we are going to use

16 this as a tool. Oftentimes, what we find is that

17 the claimants don't know. When we talk to them

18 or they have an occupational history

19 questionnaire, as I said earlier, particularly

20 survivors, they don't know this information.

21 So, we will look at whatever they have

22 described, especially if it is an employee who
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

57

1 knows what they did, but they don't know what

2 they were exposed to. That is where the work

3 process can come in. And if there were a work

4 process in here that said they were cleaning, you

5 know, they were using solvents or there was a

6 certain process, it may be in there that we would

7 look under that process. But, if it is not in

8 there and a person is specific, we can include

9 that in our Statement of Accepted Facts that goes

10 to the scientist or the doctor.

11 We are not going to exclude

12 information, particularly information that the

13 claimant does know and they are very specific. 

14 And we can say, "This is what this person says

15 they did." That is something we can move forward

16 to both the IH and/or the physician when we are

17 making that assessment.

18 So, we are not trying to say we are

19 going to ignore everything that the claimant

20 says. We are just saying that a lot of times the

21 claimants don't know very much. And so, it is a

22 starting point.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

58

1 MR. VANCE: Or there is conflicting

2 information between what the claimant is saying,

3 what our SEM is saying, and that raises issues

4 about how we can decide, okay, is this an

5 accurate portrayal of what the employer was

6 doing.

7 I think we are running low on time,

8 but I think that the Site Exposure Matrices is

9 obviously ripe with a lot of different options

10 for improvement, but I think that it is a good,

11 useful starting place. And the question would

12 be, where do we take this into the future in the

13 application of this data in the claim process?

14 CHAIR MARKOWITZ: Dr. Cassano?

15 MEMBER CASSANO: Hi. Dr. Cassano. 

16 Sort of a follow-up to Dr. Boden's comment. 

17 When I'm doing a claim, or many people

18 that are doing a claim, I like to see all of the

19 information that is available. What I see

20 happening here -- and I don't know if it is true

21 or not -- but what it looks like is that the

22 information gets narrowed and pigeonholed to a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

59

1 point that the industrial hygienist sees what the

2 claims examiner has specified they need to see. 

3 So, if it is a welder, they say, "Well, according

4 to SEM, they were exposed to asbestos and welding

5 fumes," and you go from there. And then, the

6 doctor sees even a more narrow view.

7 My first question, if somebody says

8 they are a welder, I say, "Okay. What were you

9 welding on and what was the flux?" And that

10 isn't included in this discussion because the

11 difference between galvanized steel and hard

12 steel or chromate steel is very, very big.

13 So, what I am trying to find out is

14 how much discretion does the industrial hygienist

15 or the physician have to say, "No, this is not a

16 nail. I can't hit it with a hammer. It's

17 actually a different problem or a broader

18 problem."

19 MS. LEITON: And I think that the

20 industrial hygienists, they are given the

21 occupational history questionnaire. They are

22 given whatever information we have gathered on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

60

1 exposure, whether it is from the claimant or from

2 some other source. They are given that. So,

3 they are provided the discretion to tell us those

4 things.

5 Now, obviously, you guys have a lot of

6 expertise? That, again, we think can really help

7 in that process.

8 But the industrial hygienist does --

9 it goes to a physician, and we do try to include

10 as much as we can in that assessment or that

11 Statement of Accepted Facts for the physician.

12 CHAIR MARKOWITZ: We are going to take

13 one last question and, then, move to something

14 else. But, after the break, we will continue

15 this discussion.

16 But Mr. Turner?

17 MEMBER TURNER: James Turner.

18 Okay. I'm thinking about your cutoff

19 dates, okay? I know you have to have a cutoff

20 date sometime or another, but your cutoff date to

21 me is not working.

22 Take, for instance, like at the Rocky
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

61

1 Flats Plant, they are destroying a lot of

2 beryllium, supposedly destroyed, cleaning up, but

3 beryllium is a very light metal. When it is

4 machined, it goes wherever, the high beam areas,

5 up in the ducts and ceilings. Years later when

6 they was tearing down these buildings, the

7 workers, they got exposures, okay? So, a few

8 days, years down the road, people are going to

9 come down with CBD, chronic beryllium disease. 

10 So, what are you going to do about that?

11 MS. LEITON: I'm not sure. We don't

12 have a cutoff. So, I'm not cure what you mean by

13 cutoff.

14 MEMBER TURNER: Well, you made mention

15 earlier that --

16 MR. VANCE: Yes, what I was suggesting 

17 is that is something for the Board to consider. 

18 Now that information, we don't have cutoff dates

19 in here now, but what you are raising is a very

20 valid point. And that would be something that

21 certainly would be considered.

22 The example that I tend to use is lead
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

62

1 paint. You know, they stopped using lead paint

2 years ago, but that doesn't mean that somewhere

3 at one of these sites there was a reserve of this

4 stuff that somehow got back into production

5 somehow. So, saying they stopped using it, or

6 let's say that they prohibited the use of that

7 material at a set period of time, doesn't mean

8 that that, in reality, they stopped using it. 

9 There could be circumstances where it continued

10 to be used, for whatever reason. Temporality is

11 an issue that the Board should consider as part

12 of this because it is not in the SEM right now.

13 CHAIR MARKOWITZ: Okay. We are going

14 to just take a break from this discussion and

15 hear from Dr. Rosemary Sokas, who served on the

16 Institute of Medicine Committee several years ago

17 which took a look at the SEM database and issued

18 a report three years ago, which is accessible

19 through our website. So, if you want to take a

20 look at the IOM report, you can see it through

21 our website.

22 Dr. Sokas, please.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

63

1 MEMBER SOKAS: Thank you. And IOM

2 reports, you can actually scroll through them

3 pretty much anytime you want to. You don't have

4 to actually purchase and download, but they will

5 let you look at it.

6 So, the Institute of Medicine, which

7 is now called something different which I don't

8 recall, the National Academy of Medicine, okay,

9 formed a committee in response to a DOL request

10 that met five times in 2012. The first two times

11 were public meetings and, then, the last three

12 times were really writing the stuff up. And

13 then, it got reviewed externally and, then, was

14 published in 2013.

15 So, this Committee was chaired by Mark

16 Utell. The staff person from the IOM was Rebecca

17 Koehler, who is a radiation expert.

18 I did want to just take a moment and 

19 recall in gratitude the work of Julia Quint, who

20 has since passed away, but who was an incredibly

21 active contributory member to this Committee.

22 So, the background for the Committee,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

64

1 which we were given actually before the first

2 meeting, was a 2010 GAO report that talked about

3 a number of things that will sound familiar. 

4 But, basically, what they recommended were to

5 strengthen the independent review, the quality

6 assurance and the independent review of the

7 claims process. Then, the second thing that they

8 wanted to do was to enhance the exposure input

9 information in the SEM and make it publicly

10 accessible and readily usable.

11 Then, they also wanted to create --

12 and this was the comment that Mr. Nelson made

13 yesterday -- that there had been an ombudsman

14 report that was never publicly addressed by the

15 Department of Labor. And so, that has changed

16 directly, it seems, in response to this GAO

17 report.

18 Those were the executive

19 recommendations from that report. They also had

20 a congressional recommendation, which was to form

21 an independent review board similar to the one

22 for radiation. So, that is why we are sitting
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

65

1 here now.

2 The second item that I would like to

3 share that was presented at the first meeting to

4 the Institute of Medicine, the first Committee

5 meeting, was actually a presentation by Ms.

6 Barrie and Dr. Fuortes from the Alliance of

7 Nuclear Workers advocacy group. It was focused

8 on Haz-Map really as a problem, because, as you

9 have seen this whole SEM, there is one source of

10 information for health outcomes and that is Haz11 Map. So, to look at Haz-Map, just to step aside

12 and take a look at it, Haz-Map was created by an

13 occupational physician who had previously

14 practiced for many years as a primary care

15 clinician, was really developing a tool, an

16 instrument for other primary care clinicians

17 without occupational health training to deal with

18 patients in their clinical practices.

19 And it is kind of like, if you look at

20 the old -- those of us of a certain age will

21 remember the old NIOSH Blue Book where you could

22 look up the activity; you could look up the job
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

66

1 category; you could look up the disease; you

2 could look up the exposure, and kind of work

3 backwards and forwards if you had somebody who

4 came up with something that you weren't quite

5 sure about.

6 That was actually the starting point

7 for this. And so, if you go to the National

8 Library of Medicine, you will find the Haz-Map

9 and it has got all these kinds of

10 functionalities.

11 Now the problem is, when a clinical

12 person sees someone in their office, they are

13 mostly worried about not calling zebras if it is

14 in North America and they hear hoof beats; they

15 are looking for horses, right?

16 (Laughter.)

17 MEMBER SOKAS: They have zero interest

18 -- zero, negative zero interest -- in any form of

19 compensation system and will run out of the room

20 screaming, typically, if anybody mentions that. 

21 So, it is apples and oranges.

22 So, having said that, the ANWAG group
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

67

1 gave a lovely presentation of all of the many

2 problems that derive from using that as the

3 single metric for health impact.

4 In addition, Rebecca Koehler sent

5 everybody on the Committee a memo that is

6 unsigned, but was, presumably, sent by Dr. Eugene

7 Schwartz prior to his departure as, I believe,

8 Medical Director for the program in 2009, where

9 he laid out two densely-written or three pages of

10 -- and I think I sent that link to Steve. So, it

11 could be part of what we look at.

12 But it is a very detailed look at what

13 all the different problems are with making use of

14 Haz-Map, in addition to some other items, making

15 use of Haz-Map for this particular purpose.

16 Okay. So now, getting into the IOM

17 meeting, I am going to go into -- I think people

18 have it. Wait a minute. Okay, the next one. 

19 Does it work? How do I get it to work? Oh, this

20 is the one. Okay, this is the one. If you can

21 expand that to just focus not on the front, not

22 on the top, but on the little bullets there? 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

68

1 Okay.

2 So, this is the task, and people have

3 this in their books right now. The task list

4 that was the negotiated scope of the work was

5 really around these particular questions, right? 

6 So, these questions, the eight questions that you

7 see in front of you -- and you can kind of like

8 enlarge them -- were really what we were allowed

9 even to ask about. So, if we strayed off into

10 quality assessment for the claims examiners or

11 for the review process or for anything else, we

12 could ask those questions, but, basically, would

13 be reminded by Rebecca that the Institute of

14 Medicine had agreed to answer these questions.

15 So, I am going to go through the task

16 that was assigned to us and what we were able to

17 do with that. In your handout, in the end of the

18 first summary section, there are longer answers

19 to each one of these questions, but I just wanted

20 to frame the questions for you.

21 One of the questions was, what are the

22 diseases that aren't in the SEM? There were a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

69

1 handful. Instead of going through -- at the time

2 there were 1300 chemical exposures listed in the

3 SEM; now there's something like 1700 -- so,

4 instead of doing an expansive look at all of

5 those chemicals, there were some sample ones done

6 where you looked for exposure disease outcomes,

7 where you thought that they should be there, and

8 they weren't.

9 So, the first one is the diseases. 

10 The second one was what are the links that seem

11 to be missing. And I am going to go into that in

12 one second. Again, it was a kind of a sampling

13 of, well, let's look at a few things and see what

14 we think is missing. Is there additional

15 information? And it was preferably from

16 epidemiology. So, there were a number of

17 epidemiologists on this panel, in addition to

18 toxicologists that should be used.

19 What other databases might be

20 included, and the Committee came up with a

21 laundry list of additional databases that would

22 have good information in them.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

70

1 What are the strengths and weaknesses

2 of the NIH/NLM peer-review process? Now here,

3 again, I mean, I am a little confused, I would

4 say, about whether any of the -- so, the

5 responses that I know got accepted from the

6 Committee report were some of the critiques of

7 the Haz-Map program for where it missed different

8 things. The person who organizes that, who runs

9 it, went back and included some. So, by the time

10 the report appeared, some of the deficiencies in

11 specific examples were corrected. But, apart

12 from that, it is not clear to me that any of the

13 other recommendations were actually acted upon.

14 And I particularly want to point out

15 this one about the NIH/NLM peer-review process

16 because there the NLM, the National Library of

17 Medicine, personnel responsible for putting up

18 that program came to the Committee and said, "We

19 do not do peer review on the content of this. 

20 All we do is an editorial review for language and

21 missing links." So, there is no peer review.

22 So, I am a little concerned that on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

71

1 page 4 of the handout we just looked at from the

2 SEM it still says that "Dr. Brown's work is then

3 submitted to NLM for review and editing." While

4 that is technically true, it has a completely

5 different meaning to people who read it than what

6 is actually the case.

7 So, that is technically true. They do

8 review and editing, but it is for things like

9 broken links and that is it. They don't do any

10 content.

11 There was another question about

12 synergistic effects. And so, there was a whole

13 little report, mini-report, in the document

14 about, well, what is the science behind

15 synergistic effects? We do know that they occur. 

16 What do we think is -- but there is a lot of

17 missing information on that. And so, it is a

18 ripe are for further investigation.

19 And then, what consistent process or

20 approach could be used to consider a disease or a

21 cancer? In fact, the group got into some

22 additional recommendations and suggestions.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

72

1 I would like to move to the next one. 

2 What did I do with the thing, the slide changer? 

3 Here it is. Okay, great. So, again, does this

4 change the slide? Yes. Okay, great. No, wait a

5 minute. Hold it. This one. Okay, great.

6 So, this one, again, if we could maybe

7 just expand the top piece, if people can see it? 

8 This is just an example. So, for example, the

9 exposure cancer links in the Haz-Map -- which

10 then are transported into SEM, right, so it is

11 now the same thing -- are only IARC 1

12 carcinogens, at least at that time, which is a

13 very strict rule. I mean, an IARC 1 carcinogen

14 doesn't include some of the OSHA standard

15 carcinogens, for example, right?

16 And so, the IARC 1 carcinogens that

17 were looked at, not all of those outcomes were

18 made. So, these are the missing IARC 1 exposures

19 and outcomes that were missing from Haz-Map;

20 therefore, missing from the SEM.

21 There is a whole other -- and again,

22 this is in the document itself -- there is a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

73

1 whole other table of IARC 2As, for example, that

2 are possibly human carcinogens for which there is

3 a body of evidence that was not included.

4 And then, there is another table that 

5 shows just, again, as a random sampling, looking

6 for exposure outcome links for cardiovascular

7 outcomes -- and, for example, at that time,

8 disulfide was missing as a cardiovascular

9 outcome.

10 So, there were enormous gaps. And

11 this is spot-checking. You know, we didn't have

12 subcontractors. We didn't have somebody to go

13 through 13,000 items.

14 So, this was kind of obvious

15 immediately. And then -- all of which is

16 documented earlier, but we kind of re-documented

17 it -- the quality assurance for this database is

18 that one individual with some subcontracting

19 reviews a handful of journals periodically and,

20 also, relies on textbooks which may be, as we all

21 know, years out of date. Again, it makes sense

22 if you are a primary care clinician who is trying
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

74

1 to figure out if this person's kidney disease

2 might or may not be due to their work, but was

3 shocking, in fact, to the members.

4 So, the clear recommendations are

5 pretty obvious. And so, we will go to the next

6 step, which if we can scroll down to the middle

7 of that, there are just basically three

8 recommendations.

9 If we go to those three

10 recommendations, let's just see. The first one

11 was to add supplemental sources of information on

12 health effects to supplement Haz-Map, to either

13 change Haz-Map and have it be the sole source of

14 health effects or you could add stuff, you know,

15 that somehow gets incorporated apart of Haz-Map. 

16 But you have to do something because, really, as

17 it stands, it is insufficient and it is not

18 appropriate.

19 Not saying that it is not a useful

20 thing to have up on the NIH website, because

21 primary care clinicians need this. You know, it

22 is useful for a lot of people, but it is just not
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

75

1 useful for this purpose.

2 The other concern was that the

3 structure and function of the SEM itself could be

4 a little easier to do. For example, if you are a

5 construction worker and you have worked at a

6 bunch of different sites, you have to kind of

7 flog through each one. This, again, was meant

8 for the public.

9 And this was a really -- I don't want

10 to speak for the industrial hygienists on the

11 Committee -- but there was a sense among them

12 that, through all of the DOE-funded studies that

13 were done in collaboration with NIOSH or with

14 other people, there should be a lot more

15 information because it is not clear to me yet

16 that the information that is in the SEM about

17 exposures is anything more than kind of a

18 purchase inventory and the MSDSs that go along

19 with it.

20 I mean, although it is described that

21 there are tons of sporadic, and often missing,

22 but there are places where exposure has been
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

76

1 assessed and other kinds of assessments have been

2 made. It is not clear how or whether that has

3 been incorporated in the SEM. So, that I don't

4 really understand.

5 And then, the third advice was use an

6 external advisory group for the health

7 information data on the SEM. So, it really was

8 not the whole SEM; it was really, you know, this

9 health information data. We don't think it is

10 going to be fixed real easy. So, you are going

11 to need a group.

12 By the way, 12 meetings, and et

13 cetera, we are not that group, said the IOM

14 Committee at the end of a year of doing this;

15 somebody else is going to have to do this, right?

16 And so, then, the next couple of

17 bullets I just wanted to go through. If we could

18 just scroll down to that first set of bullets? 

19 These are just some of the thoughts that the

20 Committee had about what an external advisory

21 group could do.

22 Now, again, I don't want to belabor
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

77

1 this, but the GAO report was in 2010. That one

2 memo was in 2009. This Committee met throughout

3 2012 and reported in 2013. So now, we are in

4 2016, but we are here.

5 So, these were the kinds of things

6 that we thought might be useful. People can read

7 through that. But it is you want to have

8 criteria for causal linkages that could be used,

9 and there was a lot of discussion about weight of

10 the evidence, that you could develop something

11 that is similar to IARC where you go from, yes,

12 we know this is true to, you know, we think it is

13 probably true, to, well, it could be true, and

14 then, we are really sure it is not. So, those

15 kinds of things the IOM has done in different

16 places.

17 And also, look at different sources of

18 information, again, beyond the handful of

19 journals and bunch of textbooks that are put into

20 the Haz-Map.

21 Develop some sort of a worksheet that

22 could, then, assist in making these
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

78

1 determinations. And then, there was some thought

2 that maybe the exposure information might be able

3 to be more robust through readily-available data,

4 but that is not clear that that is true. And I

5 would defer to people here who have done those

6 studies.

7 And then, again, they wanted to have

8 some other ongoing responsibility, which is peer

9 review of the new links, assessing occupational

10 diseases. This, I think, is exactly what the

11 list that we just saw kind of gets at, is where

12 there may be more information about some of these

13 exposure outcome relationships.

14 And as well, look at the existing

15 causal links. It wasn't all sins of omission;

16 there were actually one or two items where a link

17 was in there that was not clear from the data

18 where that link actually came from. And so, when

19 you see the word "link" here, it means really the

20 exposure outcome, exposure link. So, there was

21 probably a false-positive around, I think it was

22 hemolytic anemia that was in there. And then, a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

79

1 periodic review.

2 So, again, I don't want to beat this

3 to death, but I think there were fair amounts of

4 -- I mean, the IOM reports are always really

5 consensus documents. There was no disagreement. 

6 There was no separate appendix where people got a

7 chance to kind of say they didn't agree with it.

8 So, these recommendations were really

9 consensus. I think the information in the

10 document itself may be useful for people as the

11 Subcommittee moves forward on this. Again, the

12 list of some of the other databases that might be

13 useful, if that is of any interest.

14 But, as someone who spent five

15 meetings over a year when other stuff was going

16 on in my life, you know, I would have hoped to

17 have seen a little bit more specific responses to

18 some of this, but we're here.

19 CHAIR MARKOWITZ: Laura?

20 Thank you. We are here.

21 So, are there questions or comments?

22 Laurie?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

80

1 MEMBER WELCH: Laurie Welch.

2 It is partly a question for you, too,

3 Steven. Some of the things that Rosie mentioned

4 that the Committee had looked at, such as the

5 report from ANWAG and that letter from Gene

6 Schwartz, is that something that is available to

7 us? I mean, we have the IOM report, but the

8 background documents are generally not up on the

9 IOM website.

10 MEMBER SOKAS: They are publicly

11 available through -- you know, they keep a file. 

12 So, anything that they have used is publicly

13 available.

14 MEMBER WELCH: So, we could just go

15 back to the staff member and --

16 MEMBER SOKAS: And the Schwartz memo

17 is actually, when Rebecca sent it around, she

18 actually gave a link. So, I was able -- she had

19 accessed it in January of 2012. In preparation

20 for this meeting, I used her link and found it

21 again. So, it is out there. I emailed it to

22 Steve. So, you have that link.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

81

1 MEMBER WELCH: Okay.

2 CHAIR MARKOWITZ: Sure. I mean,

3 whatever documents, we can just make a request of

4 DOL to produce.

5 MEMBER SOKAS: Okay.

6 CHAIR MARKOWITZ: We have a few

7 minutes on this before we break.

8 Yes, Dr. Boden?

9 MEMBER BODEN: So, maybe some of you

10 have seen this, but I think it might be useful,

11 to me at least, to see what the report that goes

12 from the claims examiner to the evaluating

13 physician looks like. If we could get some

14 examples that are redacted adequately, so that

15 they didn't identify, you know, we couldn't

16 identify particular people, but we could get a

17 picture of what the information is that is

18 presented, I think that would be helpful.

19 MEMBER SOKAS: I agree, and that was

20 outside the scope.

21 (Laughter.)

22 MEMBER SOKAS: But it's not.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

82

1 CHAIR MARKOWITZ: Okay. So, I am told

2 we will have that tomorrow.

3 I would just like to make a comment on

4 the IOM report. It is extremely useful for us to

5 have this review and critique. You should take a

6 good look at this report. There are things that

7 they call for that probably we could assist with. 

8 There are other changes we call for which are

9 pretty fundamental and are probably beyond the

10 ability of this Advisory Board to achieve.

11 For those not familiar, the process of

12 reviewing a single agent and its ability, say, to

13 cause cancer, which is done routinely by or on a

14 regular basis by IARC, also by the National

15 Toxicology Program, is a multi-year process on a

16 single agent for which there is a lot of evidence

17 that it causes cancer. It is a protracted review

18 process by a number of peers. It goes back and

19 forth internal/external review. And so, it is

20 very complicated, and that is for a single agent

21 for a well-known outcome for which there are a

22 lot of studies.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

83

1 So, part of what the IOM report calls

2 for is this kind of injection of this peer-review

3 process into essentially what Haz-Map has taken

4 on, these exposure/disease links, on an ongoing

5 basis. That is an immense task. We are not

6 going to do that, I think, because that is not

7 really what we are capable of doing, but we could

8 probably help point the direction in this.

9 Other comments or questions?

10 (No response.)

11 CHAIR MARKOWITZ: So, let's take a

12 break. Oh, yes, Dr. Friedman-Jimenez?

13 MEMBER FRIEDMAN-JIMENEZ: Just a quick

14 general question. Did treating physicians have

15 access to this Site Exposure Matrix and all the

16 information on exposure?

17 MEMBER VLIEGER: They do have access

18 to it. Whether or not they want to take the time

19 to learn the intricacies to find adequate data,

20 although most of the physicians that I deal with,

21 with claimants or on my own claim, their eyes

22 glaze over as soon as I mention that there is a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

84

1 source.

2 CHAIR MARKOWITZ: Okay. We will take

3 a break for 15 minutes, and at 10:15 we will

4 start up again. Thank you.

5 (Whereupon, the above-entitled matter

6 went off the record at 9:58 a.m. and resumed at

7 10:17 a.m.)

8 CHAIR MARKOWITZ: We are going to

9 spend the next 45 minutes discussing the area of

10 our assignment, which, according to the Act, is

11 that we will advise the Secretary of Labor with

12 respect to the Site Exposure Matrices of the

13 Department of Labor.

14 For the next 45 minutes we would like

15 to begin discussion or resume discussion of some

16 of these issues among ourselves and, also, form a

17 committee to carry on the work beyond this three18 day meeting. We are going to form four

19 committees, one corresponding to each of the four

20 tasks given us by the Department of Labor.

21 So, think about which committee or

22 committees you would like to serve on. It would
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

85

1 be good to have representation from the various

2 communities represented on the Board, including

3 the claimant or the worker community, the

4 scientific community, and the medical community. 

5 You can serve on more than one committee if you

6 want, and you can make an initial volunteer today

7 and tomorrow as we form these committees, but we

8 will also allow you to switch your committees

9 over the next period of time, in case you change

10 your mind, or whatever.

11 So, there will be some flexibility,

12 but we would like to get to the point where we

13 have committees because we would like to schedule

14 committee meetings in the next couple of months

15 to continue the work that we are starting here.

16 So, it is open for discussion now

17 about the Site Exposure Matrices. I think there

18 may have been maybe Dr. Redlich or some people

19 from the previous session who had questions who

20 weren't able to ask those questions. If not, I

21 can --

22 MEMBER REDLICH: I'll wait.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

86

1 CHAIR MARKOWITZ: Okay. Yes, Mr.

2 Domina?

3 MEMBER DOMINA: I have a question for

4 Mr. Vance, if we are going to have access to the

5 SEM that the claims examiners have.

6 MR. RIOS: As I stated in the opening

7 statement on day one, if you have any questions

8 that require participation from the public,

9 please go through the Chair. Thank you.

10 MS. LEITON: So, your question was

11 that you want to know if you are going to get the

12 one that the claims examiners have. I'm going to

13 have to get back to you on that. I'll let you

14 know for sure exactly what we can provide to you.

15 CHAIR MARKOWITZ: So, while we have

16 Ms. Leiton and Mr. Vance here, any other

17 questions, in particular, for them, carryover

18 from the last session?

19 Go ahead, Dr. Boden.

20 MEMBER BODEN: Well, I just want to

21 follow up on the question that I raised from Dr.

22 Sokas' presentation, which is, is there a way
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

87

1 that we can have access to the claims examiner

2 reports that go to the physicians who are, then,

3 going to make initial decisions on the claims?

4 MS. LEITON: As part of our

5 presentation tomorrow from Jeff Kotsch, who is

6 our Industrial Hygienist, he is going to be --

7 I'm sorry, our Lead Health Physicist -- he is

8 going to be providing a sample of one of the

9 referral packages. At least we can start there

10 because he is going to have that redacted. He

11 has already used it other things.

12 So, we are going to provide you both

13 with the package that goes to the industrial

14 hygienists as well as a sample of the industrial

15 hygienist report that is written as a result of

16 it. So, we can start there tomorrow with that.

17 MEMBER BODEN: Okay. Then, we may

18 want to follow up with looking at more stuff to

19 get a more general sense.

20 CHAIR MARKOWITZ: Sure.

21 MEMBER GRIFFON: Steve?

22 CHAIR MARKOWITZ: Yes, sir, Mr.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

88

1 Griffon?

2 MEMBER GRIFFON: Yes, I just wanted --

3 I will direct it to you, Steve. A question about

4 the procedures that the claims examiners will use

5 in putting all this together.

6 So, they have the SEM as, I won't call

7 that a tool, but I am wondering if the procedures

8 -- and I looked online. There is this Procedures

9 Manual and there is a subsection on the SEM or

10 using the SEM.

11 Are there other procedures or guidance

12 that the claims examiners will use in compiling

13 this information before it goes to the medical

14 side?

15 I guess I am directing it to them.

16 CHAIR MARKOWITZ: Sure, sure. I'm not

17 sure I'm going to give you an informed answer. I

18 am going to turn that over to Mr. Vance and Ms.

19 Leiton.

20 MS. LEITON: So, the Procedural Manual

21 is the basis for what how they do their work. It

22 outlines step by step exactly what we expect them
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

89

1 to do. So, that chapter in the SEM is how they

2 are supposed to use the SEM. We have chapters on

3 referrals to the IHs. We have got chapters on

4 how they are going to write their recommended

5 decisions. So, each step of the process there is

6 an outline.

7 Outside of that, the training that has

8 been conducted and is conducted yearly by our

9 industrial hygienists and by our policy staff,

10 that is where we get more into, okay, so here's

11 where we're at; here's where you use it.

12 There are training resources out there

13 for them to use, but that is why we do a lot of

14 -- every year pretty much we go out and do hands15 on training with them to ensure that they

16 understand and that we are explaining things, and

17 as things change, they have an understanding of

18 that.

19 MR. VANCE: Yes, there is also on our

20 website, if you go to the SEM initial page, there

21 is also a SEM User Guide that will give you some

22 more technical information about how to utilize
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

90

1 SEM.

2 MEMBER GRIFFON: Okay. So, I mean, I

3 am just looking at those procedures. I mean,

4 they are useful, but they are pretty broad. I am

5 wondering, there is no site-specific guidelines? 

6 Say I work, I am a claims examiner and I'm in a

7 region where I get a lot of claims from Savannah

8 River. There is no site-specific guidelines that

9 might help for the consistency issue?

10 I know this has come up on the

11 radiation side. That is why they have a lot of

12 guidance that isn't necessarily published as

13 public procedures, but there are guidelines for

14 the dose reconstructors to have when they are

15 doing claims because there are areas of

16 professional judgment, and they are trying to

17 assure that there is at least some level of

18 consistency in how people interpret certain

19 pieces of evidence. So, I am wondering, is there

20 any such thing? Any guidance for sites?

21 MS. LEITON: We haven't had the

22 resources to have that kind of level of detail
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

91

1 for each site.

2 MEMBER GRIFFON: Okay. Yes.

3 MS. LEITON: But just keep in mind

4 that our administrative costs that we get are for

5 claims examiners and doing the claims process. 

6 And so, you know, Rosie talked a little bit about

7 the recommendations that were made there. A lot

8 of that would require a lot of resources that we

9 weren't given.

10 And so, over the years we have tried

11 to like get together either more IHs or a panel. 

12 First, we have got to get interest for a panel. 

13 This a lot of people don't want to touch, as you

14 can imagine, because it is rather complicated.

15 In addition, we have been trying to

16 get a contract, which now it looks like we are

17 going to get, and we have got this Board. But,

18 yes, it has taken years.

19 If we can get that level of detail,

20 that would be fantastic. We just haven't had the

21 resources to do that thus far.

22 MEMBER GRIFFON: Thank you.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

92

1 CHAIR MARKOWITZ: Dr. Cassano?

2 MEMBER CASSANO: I have a process

3 question and, then, I think a request for some

4 information. So, I will direct it in both

5 directions.

6 A claims examiner gets a statement

7 from a claimant that says, "I was exposed to"

8 this, this, this, and that, at such-and-such a

9 site. "I have this disease." The claims

10 examiner can't verify that in SEM.

11 I need to be closer. Usually, I can

12 bellow pretty good.

13 (Laughter.)

14 MEMBER CASSANO: Does the claim get

15 denied at that point or a recommendation for

16 denial go up to the Final Adjudication Board at

17 that point? Or does it go through an industrial

18 hygienist and a physician at that point who can

19 exercise a little bit more discretion or judgment

20 on the case? Or does it get denied at that

21 point?

22 MS. LEITON: If a claimant has
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

93

1 information, you know, it might not be in the

2 SEM, but they might have very detailed

3 information. And in some cases we have experts

4 that will provide us with this saying, "I'm an

5 industrial hygienist" or "I'm an HP" or "I have

6 this level of expertise, and I know this is a

7 process I was involved with." They can describe

8 exactly what.

9 Like sometimes we have incidents. 

10 Well, those sorts of things we will move forward

11 to NIH in some circumstances. Sometimes we get

12 medical reports along with that where the doctor

13 says, "I believe that these toxic substances this

14 person was exposed to were related to...," and we

15 will follow up on that. We are not going to just

16 outright deny it because it is not in SEM.

17 But there are certain other

18 circumstances where we have no, zero information,

19 zero detail. At that level, if we can't get

20 anything else, there will be circumstances where

21 it will be moved to a recommended denial.

22 MR. VANCE: Yes, and let me give you
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

94

1 a quick example of a real-life situation we just

2 encountered recently. Information in the

3 document acquisition request that we get from the

4 Department of Energy trumps any information that

5 might be in the Site Exposure Matrices. So,

6 recently, we had a case where there was some sort

7 of chemical incident at one of the sites. There

8 was no information in the Site Exposure Matrices

9 about this, but the DAR itself contained

10 information about this employee's exposure as

11 part of this incident. And we ended up looking

12 at that and saying, okay, well, that clearly is

13 documentation of an exposure that, while it might

14 not be in the Site Exposure Matrices, it is

15 clearly probative enough to us to accept that

16 that exposure occurred.

17 And because we already had the medical

18 documentation linking that exposure to a skin

19 problem, we ended up accepting that case. That

20 entire process existed to acceptance without the

21 use of the Site Exposure Matrices at all.

22 MEMBER CASSANO: And I think the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

95

1 request for information, it would be nice to be

2 able to see some data. It would be nice to be

3 able to see some data at what point claims are

4 denied and for what reasons. You know, if they

5 were denied before the industrial hygienist,

6 before the physician, at the claims examiner

7 level, and for what reasons. And then, at each

8 stage, what they were denied for.

9 CHAIR MARKOWITZ: We are keeping a

10 list -- Steve Markowitz -- a list of the

11 requests. And if anything is unclear after the

12 meeting, then we will get back to you about some

13 clarity.

14 Dr. Welch?

15 MEMBER WELCH: If you guys can

16 clarify, it is my understanding that using the

17 industrial hygienists as frequently as you are

18 now is a relatively new procedure. I think that

19 is a conversation we had when you were at our

20 building trades meeting.

21 MS. LEITON: Yes, we have been using

22 them more than we used to. As I tried to explain
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

96

1 yesterday a little bit, we are getting criticisms

2 for our claims examiners not really having

3 expertise to make any of these sorts of

4 judgments. And so, we were trying to balance

5 that with, okay, well, we don't want our claims

6 examiners who aren't IHs and aren't scientists or

7 doctors to be doing this. So, we started

8 referring more cases to the industrial hygienists

9 for their opinions. And as I indicated, I

10 believe we are very close today; maybe with

11 getting this contract tomorrow, we will know for

12 sure.

13 CHAIR MARKOWITZ: I am sorry, what

14 contract are you referring to?

15 MS. LEITON: We are getting a contract

16 of industrial hygienists that can help us with

17 the workload that we currently have. And so, we

18 are hoping to have official word on that this

19 week.

20 CHAIR MARKOWITZ: So, I have a follow21 up question to this about contractors. It seems

22 from the IOM report that one of the areas that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

97

1 needs some attention is the Haz-Map part of the

2 SEM. And we may be able to help in certain

3 respects with that.

4 What is the relationship between the

5 Haz-Map contractor, you know, creator,

6 maintainer, and the Department of Labor? Is

7 there a contract relationship?

8 MS. LEITON: Yes, we have a

9 contractual relationship with them. I think it

10 is a subcontract.

11 Tell them who you are.

12 MR. PENNINGTON: Sorry. Excuse me. 

13 My name is Douglas Pennington. I'm the Deputy

14 Director of the Energy Program. I won't give you

15 all the details I gave because I am going to make

16 this quick.

17 We have an MOU with another agency,

18 and Dr. Brown is a contractor with the other

19 agency that we fund through this MOU in what is

20 called an interagency agreement. And so, we do

21 fund his work, but it isn't through a direct

22 contract that we hold ourselves.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

98

1 CHAIR MARKOWITZ: And what is the

2 agency that you fund?

3 MR. PENNINGTON: It's HHS.

4 CHAIR MARKOWITZ: Oh, okay. Okay. Is

5 that the NLM?

6 MR. PENNINGTON: Yes.

7 CHAIR MARKOWITZ: Okay. So, you

8 contract with NLM who contracts with Jay Brown?

9 MR. PENNINGTON: Say it again?

10 CHAIR MARKOWITZ: You contract with

11 NLM who contracts with Jay Brown?

12 MR. PENNINGTON: Yes.

13 CHAIR MARKOWITZ: And what other

14 contractors are involved with the SEM? You

15 mentioned Paragon. They deal with exposure data. 

16 Are there other contractors involved at all with

17 the SEM?

18 MR. PENNINGTON: No.

19 MS. LEITON: Not currently.

20 CHAIR MARKOWITZ: Okay. Dr. Redlich? 

21 Thank you.

22 MEMBER REDLICH: I mean, obviously,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

99

1 this is a huge, complicated task where you are

2 trying to reconstruct years of historic

3 exposures, and you have people now presenting

4 with probably multiple chronic diseases. But I

5 think people present with diseases and not with

6 thousands of exposures. And so, I think more

7 information about the actual data, the number of

8 cases of COPD, cardiac disease, the major

9 cancers, in terms of just where you spent your

10 efforts. And then, for those major diseases,

11 what percentage of claims are accepted, denied,

12 reasons for denial? We would be able to at least

13 focus, prioritize efforts.

14 Because there are certain diseases

15 that there is just not a lot of association with

16 occupational exposures and there are other

17 diseases like the COPD where digging in the weeds

18 is not supported at all by the literature. So,

19 in terms of just where you would spend your

20 efforts.

21 MS. LEITON: Yes, and I think I got

22 that from you yesterday, and we have got it. We
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

100

1 are tracking what kinds of reports you want. We

2 might have to come back and ask you to be

3 specific, so we can build a report and get that

4 information and see what we can provide. So, we

5 will just have to further delve into those

6 requests for data.

7 MR. VANCE: Yes, let me add, too, I

8 want to share an experience for the Board because

9 I think it is an important one for you all to be

10 aware of. It relates specifically to your

11 question or your comment.

12 We have tried to do that in the past

13 by identifying -- you know, we have presumptive

14 standards. We have worked on trying to develop

15 information about health effect data.

16 We did have an experience where we

17 tried to go back and do exactly what you

18 suggested by identifying those diseases which

19 science really doesn't have any information

20 linking it to workplace exposures. And we

21 actually created a list at some point where we

22 said these are just conditions which we can't see
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

101

1 are in any way related to employment. And that

2 ended up just creating a firestorm that we ended

3 up having to rescind.

4 So, I just want to throw that out

5 there as a lesson learned from the program, that

6 while we did it for that very purpose, we got

7 ourselves stuck in this reality of how to deal

8 with that kind of a scenario.

9 MEMBER REDLICH: Yes, I would probably

10 word it as less data and not no data.

11 CHAIR MARKOWITZ: Yes, Mr. Whitley?

12 MEMBER WHITLEY: So, what I think I

13 just heard you say, a pipefitter that worked 25

14 years at a plant passed away with lung cancer. 

15 The spouse comes in and all that client has is a

16 death certificate that says lung cancer, and "I

17 know he worked 25 years at Y-12." Okay? So,

18 that is all the claims examiner is going to get. 

19 Where do they go from there? I mean, they have

20 got very little information.

21 MS. LEITON: That's all they got from

22 the claimant. That doesn't necessarily mean --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

102

1 as I have tried to explain, we do a lot to try to

2 develop a case like that. We will go to DOE

3 first and, then, we will try to get DAR records. 

4 We will look at the SEM. The SEM in that case

5 would probably give some more information. We

6 will go to an IH, based on what we can get.

7 You know, there will be circumstances

8 that there is nothing, but it is rare that we get

9 absolutely nothing. I mean, we will do whatever

10 we can to get more information on a case like

11 that.

12 MEMBER REDLICH: But I think this is

13 where some expert guidance -- you know, if a

14 pipefitter, and I'm not an industrial hygienist,

15 but was working in the fifties and sixties and

16 seventies and has lung cancer, I think there is a

17 high likelihood that there was asbestos exposure. 

18 And how much time and effort do you want to spend

19 trying to tease that out?

20 MS. LEITON: True, we could --

21 MEMBER REDLICH: But I guess the other

22 request as far as data, just because I am less
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

103

1 familiar with those whole program -- and maybe it

2 is somewhere -- would be it sounds like these

3 contractors are more challenging in terms of

4 records as far as employment. It might just be

5 helpful to have some summary idea of what the

6 major categories of the subcontractors. I don't

7 know if that is possible. You know, what are the

8 most common sort of subcontractor types of jobs,

9 if you have that or not?

10 The SEC, you know, the Special

11 Exposure Categories that are listed, those are

12 for the radiation and the cancers. That is

13 actually helpful for that side. But, my

14 understanding, that doesn't address the whole

15 issue of all the other exposures and the

16 subcontractors.

17 It does contractors? So, it is

18 subcontractors at -- okay. But it is cancer?

19 MS. LEITON: Okay. We will evaluate

20 the ask again and see what we have, what we can

21 provide.

22 MR. RIOS: Right. You are asking the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

104

1 agency for information, but I think your request

2 is amorphous, and we need very specific

3 parameters. If you are asking us to mine data

4 from a system, we need specific parameters. So,

5 I'm going to probably ask you, because you have

6 asked a couple of times for this, I am going to

7 ask you to actually write down your request, so

8 we can work with you and tell you whether what

9 you are requesting will get you what you need,

10 and whether it is sufficient for us to actually

11 mine data out of a system.

12 MEMBER REDLICH: Thank you.

13 CHAIR MARKOWITZ: Ms. Vlieger?

14 MEMBER VLIEGER: It may not help in

15 all instances, but we are dealing with different

16 departments' definition of what an incident is. 

17 The Department of Energy has very specific

18 definitions of what an incident, accident, and

19 off-normal occurrence is. Yet, in each state

20 that they operate, an incident, an accident is

21 defined by the state labor and industry

22 definitions.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

105

1 What we are seeing on the Site

2 Exposure Matrix mostly is the Department of

3 Energy definition of a radiological incident. 

4 What I would like to see, and my specific

5 request, is for the sites that are here -- and it

6 may be a request to the Department of Energy --

7 there is a database that they use to report, and

8 it is a more recent database called CAIRS, for

9 the accidents that actually occur onsite. And

10 more accidents are chemically-related than

11 radiologically-related.

12 Wouldn't you agree? Would you agree

13 with that, Kirk?

14 So, what I would like to see is that

15 lower-level reporting because we are dealing with

16 Part E here, is that accident reporting with the

17 chemicals, because that, I think, is what is not

18 being reflected in the Department of Labor's

19 data, whether it is on the SEM or anyplace else. 

20 And that data is not in the personnel records,

21 nor will it be in the personnel records. And so,

22 you can't even get it unless you know
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

106

1 specifically what to go ask the Department of

2 Energy for. But the Department of Energy has

3 those records because they report it to

4 headquarters DOE.

5 CHAIR MARKOWITZ: Other questions or

6 comments? Sure. Dr. Silver?

7 MEMBER SILVER: Having seen this

8 program grow up, revisiting some fundamental

9 assumptions, hearing the discussion. I think we

10 heard yesterday that the SEM grew out of a

11 statutory requirement for Site Profiles. No?

12 MS. LEITON: No.

13 MEMBER SILVER: No? How would you

14 rephrase it?

15 MS. LEITON: Our statute does not

16 require the Department of Labor to create Site

17 Profiles. That is not where our expertise is. 

18 Our statute requires the Department of Labor to

19 administer the program, to adjudicate claims, to

20 write recommended decisions. But we were never

21 provided with expert -- you know, the Site

22 Profiles was a NIOSH mandate. They were required
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

107

1 to do that, but we didn't have -- that wasn't our

2 mandate, is to create Site Profiles or the Site

3 Exposure Matrices.

4 This is something we did on our own

5 because we decided that, without it, we would be

6 denying a lot more claims, frankly. That was our

7 incentive for doing it.

8 So, you know, I will look into that

9 statement that was made yesterday about that, but

10 I know for a fact that we have never been

11 mandated to either create Site Exposure Matrices

12 or Site Profiles.

13 MEMBER SILVER: So, that's helpful, in

14 that there was a statutory requirement to

15 administer Part E for chemicals and the agency

16 used its discretion to create the SEM. Equally,

17 the agency could use its discretion to develop

18 another approach to toxic chemical exposures.

19 And broad categorical solutions, as

20 Dr. Redlich's remarks drive at, as Mr. Whitley's

21 remarks drive at, might be something for the

22 Committee to look at, back up out of the trees
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

108

1 and the weeds of the SEM and see if there is

2 another way to address people by job title,

3 location, and era.

4 MS. LEITON: I agree.

5 MEMBER SILVER: Okay.

6 CHAIR MARKOWITZ: Dr. Redlich?

7 MEMBER REDLICH: I won't ask for data

8 again, but could you just tell us what sort of

9 data systems you have? Like for the claims data,

10 what variables you have entered? So at least I

11 won't ask for something that doesn't exist.

12 And I think it is very important, even

13 whatever data systems you have now, what you

14 might want to put in place moving forward. 

15 Because to really sort of assess some of these

16 issues, that would be helpful.

17 MS. LEITON: So, we created our case

18 management system for the sole purpose of

19 tracking our claims process. When a claim comes

20 in, we are able to enter information about when

21 that claim came in, when we started development

22 on it, when that recommended decision is issued. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

109

1 We do record, usually, what type of recommended

2 decision it is; sometimes we have reasons behind

3 it. Final decisions.

4 So that when we are looking at it for

5 our purposes of managing a program full of claims

6 examiners, we can say it took 30 days, it took 60

7 days, it took 90 days. We can measure their

8 performance that way, and we can actually track

9 where we are in the process.

10 So, the database wasn't created for

11 reporting purposes, other than reporting on how,

12 for our purposes, because that's what our need

13 was immediately. And it continues to be our

14 need. We get a lot of requests for information. 

15 So, you know, we can go back and mine data in

16 certain way, but we can't always get information

17 for research purposes that is being requested at

18 all times.

19 So, there is where the challenge lies, 

20 that the database is created for a different

21 purpose than what a lot of people would like the

22 data for. So that's kind of why it was created
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

110

1 and how we use it.

2 CHAIR MARKOWITZ: So, can you provide

3 the variables in the database so we know what's

4 easier to look for than not?

5 MS. LEITON: What might be easier, I

6 mean, if you have a request, it might be easier

7 for us to tell you whether or not we can do it. 

8 We have a very large number of variables. The

9 data dictionary is humongous if you want to look

10 at every code that we enter in the system.

11 So, we do track when it goes to a

12 health physicist, when it goes to an industrial

13 hygienist. There's a lot of things we put in the

14 system. Whether we could pull a report on it is

15 another question. That's why, for us, it would

16 be a lot easier than to try to give you the

17 litany of every single thing if you give us a

18 request, and we can tell you yes or no and

19 whether or not we can -- how we can --

20 CHAIR MARKOWITZ: That's fine. That's

21 fine. Others? There were some hands over here

22 on the left.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

111

1 (No response.)

2 CHAIR MARKOWITZ: This is Steve

3 Markowitz. One follow-up to the issue of the

4 contractors. It would be useful to see the scope

5 of work for the contractors in the SEM. I'm not

6 interested in the administrative or financial

7 arrangements, but I'm thinking, in particular,

8 about the Haz-Map. If there's some interest in

9 trying to improve the quality of that process,

10 it'd be good to know what that contract -- well,

11 in this case, NLM -- but, you know, is presently

12 asked to do.

13 If you could find out, further,

14 whether NLM has a different kind of contract with

15 Jay Brown on a Haz-Map that the SEM would benefit

16 from. So, your contract with NLM may say "X, Y,

17 Z," but NLM has a broader set of tasks for Dr.

18 Brown. If you could get that, that would be

19 useful.

20 Where I am heading is that, in order

21 to improve that piece of it, it'd be nice to know

22 the extent to which the current vehicles can be
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

112

1 used to move ahead.

2 MS. LEITON: I'll find out what we can

3 give to you.

4 CHAIR MARKOWITZ: And if you need

5 greater specificity, let me know.

6 Okay. Any other comments or

7 questions? Yes, Mr. Turner?

8 MEMBER TURNER: I've been a claimant. 

9 I went through the process. What happened when I

10 would check with the claims examiners, each time

11 that I checked with them, it was a different

12 claims examiner. I would write their name down

13 each time.

14 So, I was wondering, it seems like

15 they have ones that they weren't currently

16 familiar with my case. And then it would take

17 time, it would take time, on and on and on and

18 on.

19 And my thing is, I was wondering, is

20 there a way that a claims examiner can take your

21 case and keep it, like from the cradle to the

22 grave? Is there such a thing?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

113

1 MS. LEITON: Actually, no, that's not

2 something we can do, because of the fact that we

3 do have turnover of our claims staff. People

4 leave. They retire. They come and go. So, we

5 don't have a way that -- if somebody starts on

6 your case and they leave, then we can't keep them

7 there. We can't make them stay and continue to

8 work on your case.

9 One of the things that we have talked

10 about doing is trying to inform you first in

11 advance when we change claims examiners. And I

12 think that some of our offices have been able to

13 come up with a mechanism for doing that.

14 And we do try to tell them, "Please

15 become familiar with the claims if you get a new

16 caseload." But, unfortunately, there is no way

17 to control for people coming and going and

18 fluctuations in staff.

19 MR. VANCE: Let me add, too, that in

20 an imaged environment, we actually can have staff

21 become very quickly familiar with material

22 anywhere in the country. So, all of our cases
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

114

1 are fully scanned for the most recent ones. Some

2 of our historical cases are hybrid between

3 physical and imaged case files.

4 So, we have systems in place that

5 allow people to completely understand what is

6 going on in cases, but this is a concern that I

7 think we've heard in the past and we try to

8 mitigate. But the reality of case management is

9 such that, when people leave or workloads shift,

10 we've got to change personnel around to make sure

11 that the work is distributed evenly amongst

12 available staff. Or there could be specialized,

13 prioritized case assignments that are, you know,

14 shifting the workload around, so that we can get

15 certain cohorts of cases processed quickly.

16 CHAIR MARKOWITZ: Other questions or

17 comments? Mr. Whitley?

18 MEMBER WHITLEY: Rachel, in the law is

19 there anything that says you can't have

20 presumptions like you do for hearing? Like for

21 chemical hearing loss, it says this many years,

22 this group, these chemicals. Is there anything
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

115

1 in the law that says you can't have presumptions?

2 MS. LEITON: No. In fact, I've got a

3 list of about a half a dozen bulletins or

4 circulars here where we've made assumptions. We

5 have been able to tell staff how to make those

6 assumptions.

7 And that is why when we talked earlier

8 about presumptions, if we can get this Board to

9 help us come up with more, it's just that the

10 statute doesn't give us any. They don't come out

11 and say you can make assumptions here and there. 

12 So, we have to kind of make that up as we go

13 along.

14 MR. VANCE: Well, let me also make

15 sure everybody is clear. The presumptions that

16 are enumerated in our policy are derived from the

17 Part E causation standard. So, it is an

18 interpretative question as far as what is the

19 program determining that fits into allowing us to

20 accept a case within that significant factor at

21 least as likely as not standard.

22 So, our presumptions are basically
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

116

1 saying, if you meet these standards, you have

2 satisfied that requirement. So, it's sort of a

3 dichotomy that you need to understand exists. 

4 All right?

5 CHAIR MARKOWITZ: Any other comments,

6 questions? So, at this point, I would like to

7 see who would like to serve on a subcommittee to

8 deal with Site Exposure Matrices. So, there will

9 be four subcommittees. They correspond to the

10 four areas that we have been asked to address. 

11 This is in Section 2, I think. Section 2 of the

12 briefing book, for the public on the phone and

13 for the attendees. These are the four areas set

14 out for us by the Department of Labor.

15 One is Site Exposure Matrices. Two is

16 medical guidance for claims examiners. Three is

17 evidentiary requirements for claims under

18 Subtitle B related to lung disease. And the

19 fourth is the work of the industrial hygienists

20 and staff physicians and consulting physicians to

21 ensure quality, objectivity, and consistency.

22 So, right now, we're talking about
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

117

1 Site Exposure Matrices. Okay. So, we've got

2 here John Dement. In our first three volunteers

3 -- Laurie Welch, John Dement, and Gary Whitley --

4 we've covered all three communities represented

5 on the Board. Okay. Mark Griffon. So far, I

6 have Laurie Welch, John Dement, Gary Whitley, Mr.

7 Domina, and Mark Griffon.

8 I intend, by the way, as Chair, to

9 participate in all the committees as much as

10 possible. So, you won't see me volunteer for any

11 particular one, but I will be present as much as

12 I can.

13 Okay, and, Laurie, you volunteered to

14 be the chair? Excellent.

15 Now I thought that we might just think

16 about what an agenda would be for the

17 subcommittee, actually, a generic, if we could,

18 agenda for the subcommittees as they move

19 forward.

20 And the expectation is that these

21 subcommittees will meet before the next in-person

22 meeting of the entire Board once or twice,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

118

1 depending on exactly how long it takes to get

2 notices in the Federal Register.

3 But we have to actually come back to

4 that point, which we will later, and make a

5 decision about public access to those

6 subcommittee meetings.

7 In any case, I thought as an initial

8 agenda for each subcommittee, it would be to

9 define the initial issues and scope, as we see

10 it, of the particular area that DOL has asked us

11 to look at. 

12 Secondly, to begin to define data or

13 information needs to understand that particular

14 area better. 

15 And thirdly, to draft an initial work

16 plan for the committee with a timetable, so that

17 we have some roadmap as to how that committee is

18 proceeding.

19 And my question is, does that suffice

20 or are there amendments to that? Or is it

21 complete enough? It is certainly non-specific

22 enough.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

119

1 MEMBER SOKAS: So, I would make it a

2 little more non-specific by saying data needs and

3 review, and/or review.

4 CHAIR MARKOWITZ: Okay. So, we have

5 the Committee here. We've got an agenda.

6 We've got a few minutes before 11

7 o'clock, before our next speaker. So, I would

8 like to return to the issue that we began to

9 discuss yesterday about how we are going to

10 conduct the subcommittee meetings and whether

11 they will be open. We've learned from FACA that

12 it's optional. We've learned from the Radiation

13 Advisory Board this is what they have done from

14 the beginning. We've learned from, I think, the

15 Department of Labor that it's essentially up to

16 us. And we also learned a little bit yesterday

17 about what steps we have to go through in order

18 to have a public meeting, meaning probably six

19 weeks or so advanced notice published in the

20 Federal Register.

21 So, it's open for discussion. I would

22 like to, if we can get to a vote before 11:00,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

120

1 fine; if not, we can resume this discussion. But

2 I'd like to come back to this issue.

3 Thoughts? Dr. Welch?

4 MEMBER WELCH: I think Mark's

5 discussion of what the Advisory Board does for

6 radiation convinced me that -- I mean, I probably

7 would have thought it anyway -- but I think the

8 subcommittees should be open. 

9 You know, I think that the public

10 input, that people can listen to the conversation

11 and then point us to things that we have missed,

12 would be so valuable. Because, although we have

13 representatives of the workers and the advocates

14 on the Committee, there are so many people who

15 have spent so long thinking about these issues, I

16 would hate to miss some great ideas. And I think

17 it is worth the work to make the subcommittees

18 open.

19 CHAIR MARKOWITZ: Okay. Other

20 comments? Okay. So, I just need a proposal

21 here, so we can vote on it.

22 MEMBER CASSANO: I move.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

121

1 CHAIR MARKOWITZ: Well, what do you

2 move exactly?

3 (Laughter.)

4 MEMBER CASSANO: I move to keep the 

5 subcommittee meetings open.

6 MEMBER BODEN: Second.

7 CHAIR MARKOWITZ: Okay. That was Dr.

8 Cassano, and there is a second by Dr. Boden.

9 Okay. So, any further discussion? 

10 All those in favor, please raise your hand.

11 (Show of hands.)

12 CHAIR MARKOWITZ: And I will, for the

13 people on the phone, indicate that everybody has

14 raised their hands. So, it's unanimous. Thank

15 you very much.

16 I think we are ready, actually, to go

17 with the next speaker a few minutes early. So,

18 we're moving on to the second area that the

19 Department of Labor has asked us to address.

20 While she's setting up, let me just

21 remind the people on the phone who may not have

22 access to this: this second area, according to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

122

1 our charter, is we would advise the Secretary of

2 Labor with respect to medical guidance for claims

3 examiners for claims under this Subtitle with

4 respect to the weighing of the medical evidence

5 of claims.

6 We'll start up in a minute. We are

7 just waiting for the setup.

8 It's no problem. I'm just telling the

9 people on the phone, that's all.

10 (Pause.)

11 CHAIR MARKOWITZ: So, let me introduce

12 Ms. Rhonda Chappelle, who's the Branch Chief of

13 Outreach and Technical Assistance in the Division

14 of EEOICP. Welcome.

15 MS. CHAPPELLE: Good morning.

16 MR. RIOS: Rhonda, I'm sorry. Thank

17 you. Yes, speak all the way into the microphone. 

18 Thank you. Or get it as close to you as

19 possible.

20 MS. CHAPPELLE: Okay. Good morning. 

21 It is a pleasure to be here to talk to you this

22 morning about weighing medical evidence in the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

123

1 claims process.

2 I started with the program about 10

3 years ago as a hearing representative, and then

4 became the Assistant Branch Chief over at the

5 Final Adjudication Branch, and then came here to

6 the Branch of Outreach and Technical Assistance

7 about four years ago.

8 So the first thing I would like to

9 talk about: there are various sources of medical

10 evidence when we are looking in a case file. So,

11 the first source of medical evidence, of course,

12 is the information that comes from the claimant's

13 healthcare provider. That will include documents

14 from the claimant's attending physician and any

15 other consulting experts that the attending

16 physician referred the claimant to, as well as

17 reports from hospitals or medical facilities

18 where there are laboratory tests or anything like

19 that performed.

20 The second source of medical evidence

21 in a file would be information from the

22 Department of Energy's medical screening
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

124

1 programs. These programs are located throughout

2 the country. And what they do, they maintain

3 examination records and exposure data on their

4 employees.

5 We also have information from the Oak

6 Ridge Institute for Science and Education, which

7 we refer to by the acronym of ORISE. And ORISE

8 offers extensive testing for chronic beryllium

9 disease and monitoring for people who've been

10 diagnosed with a positive beryllium sensitivity.

11 Then there are three other sources of

12 medical evidence, and those are usually from the

13 Department of Labor. And I say they are from the

14 Department of Labor because these are provided by

15 our contractors.

16 So, the first would be the contract

17 medical consultants, which I will talk a little

18 bit more in detail about a little later. We also

19 have contracts with physicians who render second

20 opinion evaluations. And we refer to them as

21 SECOP. So what they do, they will actually

22 sometimes examine the patient and review all the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

125

1 medical records before rendering a decision.

2 Then we have the referee specialists

3 who are also contracted by the Department of

4 Labor. And the referee specialist is chosen to

5 actually resolve a conflict, usually between an

6 attending physician and another physician, either

7 another specialty or another contract medical

8 consultant.

9 The referee specialists are chosen

10 according to their specialty, and they are chosen

11 at random. And they examine the employee, or

12 they may just review the case file.

13 So, incongruent with the sources of

14 medical evidence, I will talk a little bit about

15 the actual types of medical evidence. As I said,

16 the first source of medical records are records

17 from the employee. And those are usually the

18 records from the employee's treating physician,

19 the attending physician's notes, charts, various

20 things like that from actually examining the

21 patient.

22 The treatment records can also consist
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

126

1 of records from physicians that the attending

2 physician consulted, or, for instance, if the

3 employee went to have a second opinion or

4 independent evaluation.

5 Then the treatment records also

6 consist of diagnostic testing, such as X-rays,

7 EKGs, any other type of test. And then the

8 records from any hospitals or in-home healthcare

9 that's provided to the patient.

10 A second type of medical evidence

11 would be medical evaluations that are done for

12 reasons other than to actually treat or diagnose

13 the patient. So, this would include things like

14 reports from the Department of Energy's Former

15 Worker Program, such as pre-employment physicals

16 or termination physical exams.

17 These would also include examinations,

18 for instance, like from the VA if a person

19 applied for disability benefits with Social

20 Security or VA, those or other types of medical

21 evidence.

22 And then the third type of medical
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

127

1 evidence would be any type of medical report that

2 a person is instructed to undergo in regards to

3 the litigation of maybe a state or federal case.

4 A third type of medical evidence would

5 be reports produced in response to the Department

6 of Labor's referral to one of our contract

7 specialists, either to the CMC or the SECOP

8 position or to a referee specialist.

9 Then, lastly, we have a group that we

10 call other types of evidence. Those consist of

11 things like the Cancer Registry records, which we

12 can use in some cases to establish a diagnosis of

13 cancer or the date of diagnosis of cancer. 

14 Also, one of those other types are

15 death certificates. If the death certificate is

16 signed by a physician, we can use that

17 information to help establish a date of diagnosis

18 on the death certificate or even a cause of

19 diagnosis -- cause of disease or diagnosis --

20 cause of death. I'm sorry.

21 Then we have secondary evidence, and

22 this would be evidence that the actual attending
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

128

1 physician relies upon. And we call it secondary

2 because it's not evidence that the physician

3 himself finds, but he may have referred the

4 patient to another doctor and he's relying on

5 that information. So, it's secondary to that

6 particular physician.

7 And then, lastly, we can use

8 affidavits. Usually, these are used with regard

9 to date of diagnosis.

10 So, I'll talk about the contract

11 medical consultant referrals that we do. Of

12 course, the first thing that we do is rely on, as

13 I said, the evidence that is submitted by the

14 claimant. But we realize that oftentimes the

15 claimant isn't able to get the type of evidence

16 that's needed to prove his case. So, what we

17 did, we have a contract and we implemented this

18 as a way of helping the claimant. 

19 So, what we will do, we will refer the

20 case to either a CMC or SECOP or the medical

21 referee as a way of helping to develop the

22 medical evidence in the case file.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

129

1 So, some of the ways that the contract

2 medical consultant can assist would be confirming

3 a medical diagnosis, by assisting with providing

4 medical causation, and impairment evaluations can

5 be used so they can review the records and

6 actually give the percentage of whole-person

7 permanent impairment. We use them in wage loss

8 claims, and we use them in that manner to

9 determine the onset and the period of a specific

10 illness that's related to wage loss.

11 We also use them if we are looking for

12 medical treatment, if a person needs in-home

13 healthcare. If they need durable medical

14 equipment, we can use the CMCs for that purpose.

15 If a person has a consequential

16 illness, we can refer the case. If it it's not

17 clear, we can have a contract medical consultant

18 render an opinion on whether or not a condition

19 is a consequential illness to the originally20 accepted condition.

21 And then sometimes we just need the

22 CMC to give us clarification on a specific report
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

130

1 or test result.

2 And then, again, as I said, the last

3 one we would need, if there's a conflict in

4 medical opinion, we can use the CMC to resolve

5 that conflict.

6 So, developing medical evidence. The

7 initial responsibility -- or, actually, the total

8 responsibility for developing medical evidence

9 lies with the Department of Labor. The

10 claimant's responsibility is to submit medical

11 evidence that they have in their possession and

12 to respond to any inquiries that the claims

13 examiner may have. If the medical evidence on

14 file is not sufficient to establish the claim,

15 then the claims examiner's responsibility is to

16 develop the medical evidence.

17 So, the first thing that they will do

18 is look in the record. They will explain to the

19 claimant what is lacking, what the deficiencies

20 are, why the report isn't sufficient. If they do

21 that, then they can assist the claimant by

22 telling the claimant exactly what is needed to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

131

1 help support their case. Oftentimes, the claims

2 examiner will actually communicate directly with

3 the treating physician. If he needs to reach out

4 to get some clarification, he can reach out to

5 the treating physician himself.

6 And if he is unable to get the

7 information from the claimant or either from the

8 treating physician, then that is when the CE

9 would refer the case to a CMC, the contract

10 medical consultant, or either for a second

11 opinion or referee evaluation.

12 So, I want to talk a little bit about

13 the contents of medical reports. As you know,

14 all medical reports aren't the same. Usually, we

15 say a medical report has added value if it

16 follows the SOAP acronym, and that's S-O-A-P. 

17 Okay. So, if the report contains a subjective

18 section which uses information that is relayed to

19 the physician by the patient -- oh, I'm sorry. 

20 Yes, it should say SOAP, S-O-A-P.

21 So, the subjective section, as I said,

22 is what the patient is actually telling the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

132

1 physician. For instance, a subjective section

2 might say, "The patient comes in today to have us

3 look at a lump on his neck that has gotten larger

4 over the last month." So, that's strictly what

5 the patient is relaying to the physician.

6 The second section is the objective

7 section. That records the physician's findings

8 based on his or her observation. So, for

9 example, the objective section might read, "The

10 patient's breathing is labored and his X-ray

11 shows a spot on his left lung," because it's

12 actually what the physician himself is seeing and

13 observing.

14 We usually say there are three

15 different types of objective findings. The first

16 would be laboratory findings, such as bloodwork

17 or a tissue biopsy or what we use, like a

18 beryllium lymphocyte proliferation test.

19 A second type of objective finding

20 would be diagnostic procedures such as X-rays or

21 ultrasounds, CT scans, MRIs.

22 And then the third would be the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

133

1 physical findings that are actually noted by the

2 physician upon either visual inspection or

3 manipulation of the body. So, this would include

4 the description of the demeanor and readings of

5 temperature, pulse rates, respiration rates,

6 those types of things.

7 The assessment section of the medical

8 report contains the physician's opinions,

9 suspicions, and diagnosis, along with any medical

10 rationale.

11 And then, finally, the plan section

12 describes exactly what it says, the treatment

13 plan and the prognosis. So, the physician, for

14 example, may refer the patient for additional

15 testing or may prescribe medication.

16 We usually say that a good medical

17 report is one that follows the SOAP, and most

18 medical reports do, even if they don't

19 necessarily spell it out. Some physicians will

20 actually put "S" and then talk about the

21 subjective. But most of them will follow this

22 format even if they don't specifically say it is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

134

1 in that format.

2 So, that gets us to weighing evidence,

3 actually weighing medical reports. Some medical

4 reports we consider are more probative than

5 others. We would say that a medical report

6 that's based on an accurate and complete medical

7 and factual background has more probative value

8 than a report that is incomplete, that is

9 subjective, or is based on inaccurate

10 information.

11 For instance, if a physician knows

12 exactly where the employee worked, knew his job

13 duties, knew his exposures, his opinion would

14 generally be more probative or have more

15 probative value than a physician who didn't know

16 all of these things. An opinion that is based on

17 the definitive test is considered to have more

18 probative value than one that is incomplete or

19 subjective.

20 We use the term "rationalized

21 opinion," and you will sometimes hear the term

22 "reasoned" or "rationalized." That simply means
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

135

1 that the report -- that the medical findings are

2 supported, that the report is supported by the

3 medical findings on examination through a

4 thorough review of the medical records, and, if

5 appropriate, references scientific articles.

6 We need more than just an affirmation. 

7 We need an explanation of a cause and

8 relationship of the factors to the condition

9 and/or disability.

10 Also, the opinion of an expert is

11 usually considered to have more probative value

12 than an opinion of a general practitioner. So, a

13 board certification or an appropriate field

14 carries more weight. So, if a physician is,

15 like, a board-certified pulmonologist, his

16 opinion would carry more weight in terms of a

17 lung condition than just a general practitioner

18 or an internist.

19 Then sometimes we see medical reports

20 that use what we call vague or speculative

21 language. So, an opinion that is unequivocal is

22 given more weight than one that we consider vague
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

136

1 or speculative. So if the physician's offering a

2 clear, unequivocal opinion, it's more probative

3 value. And when you talk about vague or

4 speculative terms, when the physician uses terms

5 such as "could" or "may" or "might be". You

6 know, like you may say, "Well, it could be caused

7 by," "It might be caused by." If he says

8 "probably," that is a little less speculative. 

9 And if he says "medical probability," that is a

10 little better than if a doctor just says, "Well,

11 it's medically possible."

12 So, the ways in which we could use the

13 Board's assistance, we outlined four different

14 things that we could probably use your assistance

15 with. And that would be to help us to clarify

16 and make recommendations regarding the assessment

17 of medical opinions. For instance, if there are

18 some standardized triggers for requiring an

19 independent review or the review by a second

20 opinion specialist or a contract medical

21 consultant.

22 Another way would be to help us with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

137

1 the methodologies for improving physician

2 responsiveness to data requests, including

3 reviewing development letters, outreach efforts,

4 and any provider communication.

5 Another way that would help would be

6 training resources for improving the quality of

7 the medical review of medical evidence and

8 weighing these conflicting medical opinions.

9 And then, lastly, any application or

10 guidance relating to assessing that standard of

11 contribution to, or aggravation of, toxic

12 substance exposure.

13 CHAIR MARKOWITZ: So, thank you.

14 One comment I would have is that your

15 review addresses, really, two issues. One is,

16 does the claimant actually have the diagnosis. 

17 Set aside what caused it, but does that person

18 have the diagnosis? And, secondly, what that

19 disease is caused by.

20 And so, I was unclear, frankly, from

21 the language in the charter, whether this

22 particular issue actually covered the issue of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

138

1 causation, contribution, aggravation, in addition

2 to just weighing the medical evidence about

3 coming to the diagnosis. So, I'm glad for some

4 clarification about that. That's useful.

5 Comments? Questions? Dr. Silver?

6 MEMBER SILVER: Thank you very much

7 for participating. On page 5, weighing the

8 evidence, the first bullet gives an example. 

9 One physician assumes a higher level

10 of exposure, employment, and a causation analysis

11 than the claimant actually had. So, what's the

12 standard of actuality? The SEM? There is so

13 little industrial hygiene monitoring data, I

14 could see a claimant, a patient, telling the

15 doctor, "Doc, I was covered from head to toe. 

16 Whenever we did this certain maintenance

17 procedure, my kids called me the snowman." And

18 the doctor would assume high-level exposure.

19 (Laughter.)

20 MEMBER SILVER: You look at the

21 record. That doesn't say anything about the

22 snowman, but the doctor says, "High-level
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

139

1 exposure." What do you compare that to to arrive

2 at actual exposure?

3 MS. LEITON: I think that that

4 actually is -- it's a really situation, kind of. 

5 I mean, you will have claimants that will go in

6 and say, you know, "I was covered in all these

7 things," and the doctor will say, "Well, you said

8 you were. So, I'm going to assume that you

9 were."

10 We will look at the evidence and say,

11 "Well, actually, this person was employed there

12 for a couple of years. We don't have a lot of

13 evidence of exposure, heavy exposure to certain

14 toxic substances this doctor might have said."

15 What we would normally do in that

16 circumstance, especially if it was a treating

17 doctor, is go back and say, "Here's the evidence

18 that we have," if we have evidence to the

19 contrary or we have specific evidence we can

20 share with that doctor and say, you know, "This

21 is the amount of exposure." Because oftentimes

22 they'll assume they worked there for 20 years,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

140

1 when maybe they only worked there for two. 

2 That's one kind of very objective thing that we

3 can tell them that we know.

4 So, we can go back to that treating

5 and say we do know these X, Y, Z facts. That is

6 where either they will come back and say, "Okay,

7 well, that changes my opinion," or they won't

8 come back at all. And maybe at that point we

9 will go to a CMC to say, "Well, this doctor's

10 made these assumptions. Here's what we know. 

11 Please provide us an opinion." But we'll first

12 go back to that doctor, if it's their treating,

13 and provide them with more information, if we

14 have it.

15 CHAIR MARKOWITZ: Dr. Cassano?

16 MEMBER CASSANO: Yeah, I'm still a

17 little bit confused about how you determine that

18 one opinion is more correct than the other. But

19 let's say, in the medical opinion the person says

20 a higher level of exposure. If they give you a

21 good rationale for, not even the guy saying that

22 "I was covered in soot from head to toe," but
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

141

1 goes and gives you references of people that

2 worked in that same industry and indicated over a

3 certain period of time or what the dosing was at

4 that point, would that convince you more than the

5 evidence that you are getting from elsewhere?

6 MS. LEITON: If a doctor is going to

7 come back and talk to that level of detail,

8 oftentimes you might have doctors that actually

9 treat this on a regular basis, people in Hanford

10 or Oak Ridge. If we have that level of

11 information, definitely that report's going to

12 have more probative value than somebody that has

13 no idea or doesn't reference anything at all.

14 CHAIR MARKOWITZ: Dr. Boden?

15 MEMBER BODEN: I have a question about

16 what medical evidence means in this context. So,

17 it seems to me that, in order to make causation

18 decisions, you need evidence about employment,

19 exposure, and then the kind of stuff that doctors

20 normally do; that is, diagnosis.

21 Are we considering all three of those

22 as being part of medical evidence? I think so,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

142

1 but I just wanted a clarification on that. 

2 Because if a doctor gives a report, presumably,

3 he'll have to talk about all those things.

4 MS. LEITON: That's what we would hope

5 out of an ideal report, is that the doctor would

6 have those three elements in their reports. And

7 if they don't, that's when we would usually go

8 back and do something about it.

9 MEMBER BODEN: And there is something

10 else that we haven't talked about yet, that,

11 presumably, you need a doctor's input in also. 

12 And that's impairment. And so I'm wondering how

13 you currently get the AMA guide's impairment

14 information from physicians. I mean, most

15 physicians don't use the AMA guides, haven't

16 really been trained to use the AMA guides, and,

17 also, may have to perform tests that wouldn't

18 normally be covered by diagnosis or treatment of

19 disease. And I'm wondering how those tests get

20 paid for.

21 MS. LEITON: Okay. So, when an

22 individual claimant files for impairment, they
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

143

1 have to make a choice. First, they make a choice

2 whether they want this impairment rating to be

3 done by a physician of their choosing, or whether

4 they want us to have a contract medical

5 consultant who has been trained in the guides to

6 conduct it.

7 The first thing, if they choose their

8 own treating doctor, is we just require that the

9 doctor certify that they have knowledge of and

10 experience with the guides or hey have some sort

11 of ABIME certification or AADEP certification. 

12 So, that's what we first ask.

13 And in some cases we already know

14 which doctors have that. So, we don't keep

15 asking it every time. And so those doctors that

16 they're going to choose, they're going to have

17 the knowledge to use the guides.

18 If they don't choose to do that, or

19 they can't find a doctor in their area, we'll

20 have the CMC do it. If we do, then we request

21 certain -- there are certain tests, like,

22 depending on the condition they are claiming, if
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

144

1 it is a lung condition, we are going to require

2 them to have recent PFTs within the last year. 

3 And there are certain other tests that we outline

4 for each condition that they are claiming. But

5 then they would submit those results to our CMC

6 who can evaluate them. And if additional

7 information were to be required, that CMC would

8 reach back out.

9 MEMBER BODEN: And if their insurance

10 coverage doesn't pay for those tests, who would

11 pay for them?

12 MS. LEITON: We pay for those.

13 MEMBER BODEN: Okay. Thank you.

14 CHAIR MARKOWITZ: Dr. Sokas?

15 MEMBER SOKAS: So, just clarification

16 on that last, you only get to the limitations

17 evaluation once you have been accepted, right?

18 MS. LEITON: Yes.

19 MEMBER SOKAS: My comment is really

20 just a comment. It's, when I look at the

21 language, I mean, physicians are actively taught

22 in school to couch their language as "this person
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

145

1 may have lost their life due to" or their limb

2 due to the earthquake that just happened. You

3 know, so there is this -- I mean, I'm

4 exaggerating -- but there is this presupposition

5 in scientific research that there's always more

6 information out there. And so you always couch

7 it that way.

8 So, that's a little concerning, that

9 that language would be a flag, as opposed to

10 definitive, because, actually, people are taught

11 that you are not supposed to come to premature

12 conclusions. And so it's actually in conflict

13 with the way many people are trained.

14 And in truth, I mean, a lot of the

15 questions you have about getting good

16 information, getting people to answer your phone

17 calls, getting like all of this, it's like,

18 golly, if we could figure that out, we would be

19 in -- you know, it's a real hard nut to crack, as

20 I'm sure you know. But that last bullet was a

21 little concerning.

22 CHAIR MARKOWITZ: Dr. Friedman-
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

146

1 Jimenez?

2 MEMBER FRIEDMAN-JIMENEZ: Yeah, I want

3 to agree with what Rosie just said. Having

4 taught clinical epidemiology of diagnostic

5 testing for 20 years in the medical school, we

6 really focus on probabilistic diagnosis. And

7 even in mainstream medicine, it's not that common

8 that you get an unequivocal diagnosis or a

9 definitive test or what we would consider

10 completely accurate. In occupational medicine,

11 there's less evidence available. And so we're

12 even farther from these ideals.

13 So, I agree that setting ideals as the

14 standard to be reached, it's not often going to

15 be reached. In fact, I would expect diagnoses to

16 be couched with words like "probably" or

17 "possibly," and those subjective, non18 quantitative terms are about all that we have,

19 because we often don't have exact predictive

20 values for specific tests, especially for

21 causation. So, I think you're setting the

22 standard a little high for your ideal situation.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

147

1 CHAIR MARKOWITZ: Dr. Welch?

2 MEMBER WELCH: I have two comments,

3 one of which is, I disagree with both of you

4 guys, because I actually think they need

5 something they can hang their hat on. And the

6 language that the physician has to use is a

7 little cumbersome, but it's not more likely than

8 not. So that if we figure out a way during this

9 process to let the examining physicians know that

10 they basically have to say that the exposure was

11 a substantial factor, as opposed to causative, I

12 think that's enough of a "may." But it's a

13 question of how to get that into the language. I

14 mean, many treating physicians are not

15 comfortable making a causation statement at all. 

16 So, that's a different question.

17 But the question I had put my flag up

18 for was really now I think there is a lot of

19 overlap between these task and No. 4, because so

20 much of the weighing the medical evidence is

21 using consulting medical physicians, consulting

22 contract, the CMCs. I always forget what that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

148

1 stands for, consulting medical consultants? I

2 don't know.

3 (Laughter.)

4 MEMBER WELCH: Contract medical

5 consultants. Okay, I finally got it.

6 And I don't know if we want to combine

7 the two. We should probably think about that as

8 a group, because there is the process of getting

9 the diagnosis, and then there is the process of

10 making the causation statement. I'm not sure

11 that getting the diagnosis is all that hard for

12 you guys. 

13 But if you can't, I mean, it's really

14 whether there are records or not, not so much how

15 you necessarily weigh the records. I would

16 imagine it's generally -- and it's easier to get

17 physicians to make a statement about diagnosis

18 that seems probative or definitive.

19 But, anyway, just at a point, and

20 maybe some guidance from those of you who came up

21 with those four tasks, is there a way --

22 Congress?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

149

1 (Laughter.)

2 MEMBER WELCH: But probably just some

3 advice from within. You know, we're supposed to

4 be doing what you guys need us to do.

5 MS. LEITON: Yeah. No, I appreciate

6 that. What we will probably do is check with our

7 lawyers to see if there are some distinguishing

8 factors between the third and the fourth items,

9 to just give you guys some clarification.

10 CHAIR MARKOWITZ: Do you want to

11 respond? Dr. Sokas?

12 MEMBER SOKAS: Yeah. So, I mean, when

13 I saw the title of "weighing the evidence,"

14 again, it's, I think, what you said earlier. I

15 assumed that it was going to be something totally

16 different.

17 I mean, what you're saying is, how do

18 you evaluate the way the medical people write the

19 information? The weight of evidence that we

20 talked about in the earlier committee was quite

21 different. It was whether this toxic exposure

22 causes this health outcome with what level of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

150

1 reasonable possibility or probability. And I

2 don't know if that question is getting addressed

3 in the first working group with the SEM. It may

4 not be.

5 And that's actually a question -- I

6 would go back to, what did Congress mean then? I

7 mean, did they mean what you are describing, or

8 did they mean what the IOM meant when it was

9 talking about weight-of-evidence discussion? And

10 I don't know who wants to take that one.

11 CHAIR MARKOWITZ: If you want to

12 respond, Dr. Welch, and then we'll move on.

13 MEMBER WELCH: Well, just that, in the

14 end, what this program is doing is making a

15 decision of whether to compensate somebody for a

16 toxic exposure. So, it would seem that that

17 question of causation would be something within

18 the purview of this Board. And if we were to

19 interpret each of the questions to exclude that,

20 then maybe we're not going to be that valuable.

21 So, I think that either No. 2 or No.

22 4 has to address that question of how the system
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

151

1 is using all its available information to come to

2 a causation decision, in my opinion.

3 MS. LEITON: Right, and I think 4

4 could do that.

5 CHAIR MARKOWITZ: Well, Steve

6 Markowitz.

7 I agree that causation, contribution,

8 aggravation has to be at the heart of what the

9 Board does, because that's the most problematic,

10 difficult issue to address, and probably much of

11 what we have to offer, actually.

12 And I think weight of evidence means

13 different things in different contexts. In the

14 IOM report, it had to do with, you know, how do

15 you approach the issue of causal criteria? But

16 it means different things in terms of reviewing

17 medical records and deciding what diagnosis

18 people have.

19 But, Dr. Cassano?

20 MEMBER CASSANO: Tori Cassano again.

21 Laurie basically said most of what I

22 wanted to say about having those specifics. When
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

152

1 you look at a claim, that is exactly what you

2 see. But I also agree that most treating

3 physicians don't know how to do that and they're

4 uncomfortable doing it.

5 So, if the claimant is given some

6 information and is told, "Hey, when you go to

7 your treating physician, see if they can write

8 these statements at less than likely, at least as

9 likely as not," et cetera, as aggravating,

10 causative, et cetera, et cetera, et cetera, that

11 would be very helpful in setting that treating

12 physician up. And if you can't do it, then you

13 have to go to a CMC. But some might actually

14 want to do the research and look at it.

15 CHAIR MARKOWITZ: Dr. Boden? Oh,

16 yeah, sure. Oh, I'm sorry. Let me say that most

17 people are putting their name placards upright to

18 indicate.

19 MEMBER REDLICH: Mine is on the floor.

20 (Laughter.)

21 CHAIR MARKOWITZ: Okay. It's on the

22 floor, but it is upright. So, I missed that.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

153

1 (Laughter.)

2 CHAIR MARKOWITZ: I'm sorry about

3 that.

4 MEMBER REDLICH: I think I had a

5 related question that I think you were about to

6 answer. So, maybe you should respond.

7 MS. CHAPPELLE: Actually, that's what

8 I was going to say. When we talked about the

9 Department of Labor having the responsibility of

10 developing the medical evidence, we said that the 

11 claims examiner will often reach out to the

12 claimant and explain the deficiencies and what is

13 needed in the medical report. And sometimes if

14 the claimant cannot adequately convey that to the

15 physician, then the claims examiner will call the

16 physician himself, call the treating physician,

17 to try to clarify and explain what it is that we

18 need.

19 And we do recognize that, you're

20 right, most physicians are taught that they don't

21 want to come out and say, "Well, this is 100

22 percent caused by," you know, working at a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

154

1 particular place. So, that's why we do use those

2 terms like "probably" as opposed to "possibly". 

3 And, again, using the standard of the "at least

4 as likely as not," and did it contribute to or

5 did it aggravate? And it doesn't have to be a

6 specific, medically-caused condition.

7 CHAIR MARKOWITZ: I have a question,

8 actually. So, I co-direct one of the former

9 worker medical screening programs. And we've

10 done thousands of exams. And we don't routinely

11 -- we rarely get requests, actually, for our

12 report, our medical reports that we issue. Is

13 that because it's up to the claimants to bring in

14 the report that we give to them to the claims

15 process? Meaning the claimant has to initiate,

16 essentially, that transfer. It just doesn't

17 seem, at least in our program, it's routinely

18 done. I don't know about the other former worker

19 programs. But we almost never get requests from

20 DOL for these reports.

21 MS. LEITON: Usually, when we ask for

22 DAR records from the Department of Energy, the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

155

1 former worker programs screening or those reports

2 would be included. Oftentimes, they are

3 included. At least that's our assumption.

4 CHAIR MARKOWITZ: Let me clarify. So,

5 these are the reports that we --

6 MS. LEITON: Okay. Well, that's --

7 MS. CHAPPELLE: You know, from our

8 program, it's my understanding that the worker

9 takes the letter to the resource center. And

10 that is usually the basis of them filing a claim. 

11 But I don't know that it --

12 CHAIR MARKOWITZ: Right. Yeah, just

13 to clarify, the Department of Energy wouldn't

14 have our reports, just because these are

15 individual personal medical records. The only

16 person who gets them is the individual and their

17 physician, if the individual requests it. So,

18 those are the only parties who have it. So, I

19 understand, it's up to the claimant --

20 MS. LEITON: Yeah, so I was

21 misinformed. I was thinking about DAR records,

22 and they mentioned former worker program, but I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

156

1 think that's a different piece of the former

2 worker program that we get automatically. So, it

3 would be required that the claimant themselves

4 provide us with that.

5 CHAIR MARKOWITZ: Thank you. Ms.

6 Vlieger?

7 MS. CHAPPELLE: I mean, we do see a

8 lot of them in the case files. So, perhaps the

9 claimant is bringing them in, because there are a

10 lot of them in the case files that I've reviewed.

11 CHAIR MARKOWITZ: I'm glad they end up

12 there, actually.

13 (Laughter.)

14 MS. CHAPPELLE: Yes.

15 CHAIR MARKOWITZ: Ms. Vlieger?

16 MEMBER VLIEGER: So, a couple of

17 things. I've read a lot of the claimants'

18 records. I talk with a lot of the claimants. 

19 And many times, when those reports from the

20 former worker program are presented, the claimant

21 is told, "This will not be accepted as primary

22 evidence. You must get a specialist of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

157

1 appropriate system or body part to opine on

2 this."

3 So, then we run into the problem,

4 particularly with the few number of specialists

5 that will even talk to you for this program, we

6 run into the issue of not having adequate medical

7 insurance for the tests that are required.

8 And then, if you find a specialist who

9 is willing to do this, the proximity to the

10 worker is usually not there. So, the whole

11 concept of saying that you are accepting the

12 former worker records, I find to not be factual

13 in all cases, or at least in the majority that I

14 have seen.

15 I guess I go back to in our briefing

16 book this page on weighing evidence. Did this

17 come as kind of a mutation from FECA or another

18 program? What is the basis for these

19 presumptions of what evidence is adequate?

20 MS. LEITON: We do weigh medical

21 evidence at all four of our -- or at least three

22 of our Office of Workers' Compensation programs. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

158

1 And so, yes, a lot of that language comes from

2 the years, the hundred years of experience we

3 have had in OWCP with evaluating medical evidence

4 and weighing medical evidence. And that's where

5 a lot of these standards came from.

6 CHAIR MARKOWITZ: Ms. Pope?

7 MEMBER POPE: Duronda Pope. I was

8 just trying to envision the claimant submitting

9 this information to their physician, their

10 treating physician, and then how that claim --

11 the CE calling the physician and asking them,

12 "Did you mean, when you wrote down this

13 diagnosis, did you mean this?" And do they say,

14 "Well, you need to put this information in"?

15 MS. CHAPPELLE: I don't think it works

16 exactly that way. The idea is that the claimant,

17 the CE is advising the claimant what they need to

18 prove their case, the type of medical evidence

19 that is needed, and if they have medical

20 evidence, for instance, they will tell them, you

21 know, "Well, your doctor needs to at least render

22 an opinion whether or not it is possible," or not
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

159

1 possible, "it's probably or at least as likely as

2 not that your condition is related."

3 The CE can call the treating physician

4 if the claimant is having a difficult time

5 getting the medical evidence that is necessary. 

6 They don't always do that. That is why sometimes

7 they may, and then, sometimes it is just easier

8 to refer them to the contract medical consultant

9 to have them to review all of the medical

10 information that the claimant already has and

11 then render an opinion.

12 CHAIR MARKOWITZ: Dr. Boden?

13 MEMBER BODEN: So, the way this is

14 focused is you've got these different pieces of

15 medical evidence and you need to figure out how

16 to weigh them. But there is, I think, another

17 way of thinking about the issue of weighing the

18 medical evidence, which is providing a framework

19 for the evidence that you get.

20 So, we have talked a little bit about

21 the idea of possibly developing presumptions for

22 certain cases. In fact, I think you have
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

160

1 developed some of them. Well, that is a way of

2 -- a presumption can, also, then, be provided to

3 the physician who is treating the person as a way

4 of telling them what you need from them to

5 fulfill your needs for the causation, right?

6 And there are other things that I

7 think we can probably think about that would help

8 the Department of Labor process the evidence that

9 they are getting. For example, providing the

10 treating physicians with words that, if they use

11 them, won't be helpful and words that, if they

12 use them, will be helpful.

13 Unless somebody is a professional who

14 does a lot of workers' compensation cases, they

15 are not going to know that they need to use these

16 kinds of words in order to get the response that

17 they think they are going to get for their

18 patient.

19 So, I think that, as part of this, we

20 want to think about things that your organization

21 can do to help you get the evidence that you can

22 weigh appropriately, and not just passively take
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

161

1 in the evidence and, then, try to figure out what

2 it means.

3 CHAIR MARKOWITZ: Dr. Welch?

4 MEMBER WELCH: I just wanted to have

5 you guys clarify that, if a treating physician

6 doesn't provide a causation statement, then the

7 claims examiner can weigh the evidence and

8 potentially make a decision him or herself or use

9 the consultants? So, getting the information

10 from the treating physician is not necessarily an

11 impediment to the claim. It might make it easier

12 because, then, you don't have to go out to your

13 outside consultants. But you wouldn't turn down

14 a claim because you can't get the physician to

15 give a causation opinion, if you have got the

16 diagnostic information?

17 MS. LEITON: It depends on what we

18 have in the case file. If we don't have any

19 information at all that would lead to any

20 suggestion of causation, there was a limited

21 amount of exposure, the doctor really might have

22 said something else like "I believe that this is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

162

1 related to" X, Y, and Z "that isn't related to

2 this," sometimes the word "idiopathic" is an

3 indication; we will follow up on it.

4 I am not going to tell you that we are

5 not going to deny cases if we don't get enough

6 something at the beginning to lead us in the next

7 direction. But we will, if there is some

8 indication there might be a causation link

9 anywhere in the case, if we can't get it from the

10 treating, we will go to a CMC.

11 CHAIR MARKOWITZ: Dr. Redlich?

12 MEMBER REDLICH: Just a related

13 question. So, this back-and-forth that might go

14 on between the claims administrator and a

15 physician, is there a standard, templated letter

16 or wording that is used? Because the way the

17 question is framed can very much determine. 

18 Like, "Do you think that this was caused by...,"

19 or "Do you think that there was a contributing

20 factor?"

21 I'm just curious, because the doc is

22 likely to get a standard letter that says, you
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

163

1 know, "Your patient has applied for" X. "We

2 would like your opinion on...," and how it is

3 actually worded. Or is this more verbal? If it

4 is written, if there is an example of it --

5 MS. CHAPPELLE: We do have, when a

6 case first comes in and when a claimant first

7 files the claim, a development letter is sent to

8 the claimant, and it will talk about the

9 employment evidence that is needed, the medical

10 evidence that is needed. And so, that kind of

11 lays out exactly what is needed and it will talk

12 about causation.

13 MS. LEITON: We do. We have given

14 them examples on many occasions of, "Ask the

15 doctor, is it at least as likely as not a

16 significant factor in causing, contributing to,

17 or aggravating?" That is language we use in our

18 development letters. Sometimes that is to the

19 claimant, but sometimes it is in a letter to the

20 doctor where we say, "We understand you are the

21 treating physician. Here's what we need in this

22 case, and here's the question that we need
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

164

1 answered." We will send that out.

2 When you say "templates," I mean, we

3 do try to cater our letters to the case at hand. 

4 So, I don't have like a form letter that we send

5 out to them, but we do send out those letters. 

6 Our procedures lay out that we are supposed to be

7 asking those sorts of questions.

8 CHAIR MARKOWITZ: Dr. Welch? No? 

9 You're done? That's good.

10 And Dr. Boden is done. That leaves

11 Dr. Silver.

12 MEMBER SILVER: Do you have any

13 success stories of specialists or GPs who don't

14 have a lot of training in occupational medicine? 

15 A typical scenario around one of these DOE sites

16 is a worker goes to see an oncologist, the best

17 in the region. And the oncologist takes off

18 their glasses, puts their pen down, and says,

19 "You're from" fill in the blank, Los Alamos. 

20 "You are the fifth person I've seen. This is

21 work-related."

22 A few weeks or months later, they ask
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

165

1 the doctor for a letter for this program. 

2 Frankly, the letter stinks.

3 (Laughter.)

4 MEMBER SILVER: Have you cultivated

5 anyone like that who is not an occ doc and

6 brought them along and taught them how to be

7 helpful, and now might be helpful to the medical

8 community saying, "Hey, it's easy. I learned how

9 to do it."?

10 MS. LEITON: Actually, I think that,

11 since we are not located locally, I believe that

12 some of the advocates have been able to cultivate

13 those relationships with the physicians to help

14 them understand what is needed and provide us

15 with the evidence that we need. Also, we have

16 authorized reps. We have attorneys that have

17 done that and cultivated those relationships, and

18 have been able to get, frankly, you know, some of

19 these doctors who understand the program. And

20 that happens.

21 MEMBER SILVER: I have worked with

22 primary care folks in Tennessee. There isn't an
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

166

1 occ doc for miles around, at least not one who

2 workers could trust. There are some who come to

3 Tennessee periodically, but on a day-to-day basis

4 I am thinking of a peer education approach.

5 The primary care or rural

6 practitioners talk to occ docs, and they get kind

7 of overwhelmed with everything they ought to be

8 doing. But from oncologist to oncologist or

9 primary care doc to primary care doc, it might be

10 easier to spread the word of how to get these

11 cases done.

12 MS. CHAPPELLE: One of the things that

13 we have done, we started back in 2012, was trying

14 to reach out to the medical community, to

15 physicians, to educate them. For instance, we

16 went out to Shiprock and met with the hospital

17 staff there to talk about things that we needed,

18 because that is a very small and closed

19 community. So, we talked about what it is that

20 we need in terms of medical evidence, medical

21 reports.

22 And we have been trying to expand that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

167

1 throughout, and we have had several outreach

2 events that we have focused on the physicians,

3 trying to educate them and let them know what it

4 is that we need.

5 We have what we call an email

6 subscription medical blast that we send out

7 monthly that we will take a specific topic and we

8 talk about it. So, we have some various things,

9 and we are always open to other ideas in terms of

10 trying to reach the medical community, because

11 that is one of the difficult things because they

12 are busy. And so, just trying to get them and

13 get them engaged, to let them know what we need

14 and what would be helpful to the claimants.

15 CHAIR MARKOWITZ: So, I see there are

16 a couple of more questions. But let me just ask

17 whether, after lunch at 12:45, Ms. Chappelle and

18 Ms. Leiton, are you available to return in case

19 there are additional questions?

20 MS. LEITON: Sure.

21 CHAIR MARKOWITZ: Okay. So, that

22 should relieve some of the pressure.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

168

1 Dr. Cassano, the last question before

2 lunch.

3 MEMBER CASSANO: I am still a little

4 bit confused between what you stated about the

5 development letter and the fact that you are very

6 specific about the language that is needed by the

7 physician. And then, what you said when you

8 stated, "Well, we explain the deficiencies, and

9 if the claimant can't still explain to the doc,"

10 and I don't understand that piece.

11 If you have gotten something that has

12 been written out very specifically as to what is

13 needed, and if you have explained the

14 deficiencies in a letter, rather than a phone

15 call to the claimant, why there is this seemingly

16 disconnect between what is said to the claimant

17 or written to the claimant? I mean, most of the

18 time, the claimant just brings that letter from

19 the agency to their doc and says, "This is what

20 you have to do." So, I don't understand the

21 disconnect.

22 MS. LEITON: Usually, that is the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

169

1 case, you're right. A letter that we send to the

2 claimant saying, "This is the medical evidence we

3 need." They will take it to their physician.

4 You know, in some cases, the claimant

5 might not take it to their physician, and the

6 physician, therefore, never got this information. 

7 We may follow up then and either write to the

8 doctor, forward the letter to the doctor, or call

9 the doctor.

10 MEMBER CASSANO: Okay.

11 CHAIR MARKOWITZ: Okay. Thank you. 

12 Thank you.

13 It is 11:45. We are going to break

14 for lunch. We will be back at 12:45.

15 (Whereupon, the above-entitled matter

16 went off the record at 11:45 a.m. and resumed at

17 12:56 p.m.)

18 CHAIR MARKOWITZ: We are going to get

19 started. It's five of 1:00. We are missing one

20 member, two members. I'm sorry. Three members. 

21 But let's get started anyway.

22 So, we are discussing weighing medical
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

170

1 evidence. We have another 35 minutes, actually,

2 to ask questions or make comments, have

3 discussion.

4 Anybody have anything they wanted to

5 raise?

6 (No response.)

7 CHAIR MARKOWITZ: So, I can start off. 

8 I tend to ask "how frequently" questions, like

9 how frequently does this occur, does that occur. 

10 I appreciate that that is not necessarily known

11 or looked at.

12 But I am interested in the use not

13 just of the contract medical physicians, but the

14 second-opinion physicians and the referee

15 specialists. So, the second-opinion physicians,

16 how often do you use them? Under what

17 circumstances do you use them? It is just not

18 clear to me.

19 MS. LEITON: This is Rachel. So, we

20 use the CMCs a lot more. I don't have numbers

21 for you right now. We might be able to get those

22 figures for you. But we use the CMCs a lot more
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

171

1 because there are more things that we will refer

2 to a CMC. That would be like diagnoses and

3 impairment and clarification on causation, things

4 like that.

5 We go to a second opinion only when we

6 really feel a physical examination is necessary. 

7 So, for example, there is a need for home

8 healthcare, for example, and the treating hasn't

9 really given us enough information to go by, but

10 we know that we can't have a CMC evaluate a

11 patient on an issue like that because they really

12 need to see the patient to know what is going on

13 with them. So, we will refer it to a second

14 opinion if we feel it is necessary at that point. 

15 But it is rare that will go to a second opinion.

16 We will go to a referee when there is

17 a conflict, only when there is a conflict in the

18 evidence. So, let's say we have a treating

19 doctor saying one thing, we have a second opinion

20 saying another thing, and we might need to refer

21 the claimant to another, a third independent

22 doctor who looks at everything, looks at the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

172

1 patient, and provides us with another opinion. 

2 And we can weigh the medical evidence between

3 those three at that point. So, a referee is even

4 more there than a second opinion, but it is

5 occasionally something that we do.

6 CHAIR MARKOWITZ: And is the issue of

7 causation, aggravation, contribution, is that a

8 main reason for using second opinions or

9 referees? Or is it more diagnosis and

10 impairment?

11 MS. LEITON: So, I would say second12 opinion referees are rarely used for those

13 purposes. I mean, I would say probably

14 aggravation/causation might be a second opinion,

15 but the CMCs are usually used more for all those

16 purposes.

17 But the impairment, we do have a lot

18 of referrals for impairment because there aren't

19 a lot of doctors out there that do impairments on

20 their own or are qualified to do them. So, a lot

21 of our claimants will opt to get a CMC to do

22 impairment ratings. And so, a lot of our
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

173

1 business is there.

2 But, again, I don't have the

3 specifics. I might be able to break out the

4 reasons for all that. That would have to be

5 something I would look into.

6 CHAIR MARKOWITZ: Dr. Friedman7 Jimenez?

8 MEMBER FRIEDMAN-JIMENEZ: I have one

9 concern. I think between probably five or six of

10 us we have spent over 100 physician-years trying

11 to teach doctors how to diagnose occupational

12 diseases. And it is very difficult. I think

13 everyone would agree with me it is very

14 difficult, and the vast majority of physicians

15 are not trained in any way to make causation

16 judgments.

17 And the boards in internal medicine,

18 in pulmonary, I don't think there are ever any

19 questions on causation. And so, I think that the

20 emphasis on board certification may not be in the

21 claimant's favor because that doesn't in any way

22 ensure that those physicians have the proper
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

174

1 knowledge and skills to make these judgments.

2 There are several specialties that do

3 get trained in that. Occupational medicine is

4 probably the main one, and I think there probably

5 should be more emphasis on using people that have

6 specific formal training in toxicology,

7 epidemiology, and judgment of causation,

8 epidemiology and biostatistics, as well as just

9 the experience doing it. So, that is my concern

10 about the language here in terms of weighing the

11 evidence.

12 MS. LEITON: I understand your

13 concern. It is really a challenge for us because

14 there aren't a lot of people with those

15 specialties. So, if we don't go to the treating

16 doctor, you know -- and when you say "board17 certified," I mean, most of them are board18 certified, depending on the specialty, whatever.

19 I think that, as I said, our first

20 avenue is going to go to a treating because the

21 claimant chose that doctor to be their doctor or

22 they have been treating them for a long time. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

175

1 And so, our first avenue would be we want to

2 allow them to go to that doctor if that is who

3 they want to go to, instead of saying, "Well,

4 we're going to ignore your doctor altogether and

5 we are just going to go to an occ med doctor that

6 we have contracted with."

7 That is where it gets a little tricky

8 for us because we don't want to say, "Well, your

9 medical evidence isn't good enough because your

10 doctor isn't trained in doing this." So, that is

11 where our balancing-act hat is with all that.

12 I don't know if that answers your

13 question, but that is kind of where we are.

14 CHAIR MARKOWITZ: Dr. Cassano?

15 MEMBER CASSANO: Sort of along those

16 lines, though, what is the expertise of your

17 contract medical consultants? Are you going to

18 those who are boarded in the particular body part

19 specialty or disease specialty? Or you are going

20 to people like occupational physicians that have

21 more broad understanding of cause/effect?

22 MS. LEITON: The majority of our
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

176

1 contractors are occ med doctors, but there are

2 questions that we have sometimes with regard to a

3 cancer diagnosis or a pulmonary condition, CBD

4 issues, that aren't necessarily about causation. 

5 And so, we will go to a specialist for those

6 questions.

7 CHAIR MARKOWITZ: Other questions or

8 comments?

9 (No response.)

10 CHAIR MARKOWITZ: So, thank you to Ms.

11 Chappelle and, also, Ms. Leiton on this issue.

12 We need to form a Committee. There

13 was, I think, some discussion about whether there

14 was a lot of overlap between this task and the

15 fourth task on our list. Maybe we should discuss

16 that for a moment to try to clarify. My

17 preference, I think, is to try to keep two

18 separate Subcommittees, so at least we can make

19 sure at the end of the day we actually respond to

20 DOL's requests of us.

21 But the one we are discussing now is

22 medical guidance for claims examiners for claims
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

177

1 under this Subtitle with respect to the weighing

2 of the medical evidence of claimants. And the

3 fourth task is, quote, "The work of industrial

4 hygienists and staff physicians and consulting

5 physicians of the Department and reports of such

6 hygienists and physicians to ensure quality,

7 objectivity, and consistency."

8 I see No. 4 as really focusing on the

9 use of experts and how they operate, how their

10 opinions enter the process, how their opinions

11 are relied upon in the process, and specifically

12 looking at the validity of their work,

13 objectivity, and consistency. So, that is pretty

14 easy for us to at least identify, not easy to do,

15 but easy to identify as a relatively specific

16 thing to look at.

17 Whereas, this Item No. 2, looking at

18 providing medical guidance for claims examiners,

19 weighing the medical evidence, is a broader issue

20 into which the industrial hygiene and the

21 occupational or the contract medical physicians,

22 whatever, that is a subset. That is a piece of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

178

1 the weighing of the medical evidence, as defined

2 here, "medical evidence" meaning not just

3 addressing diagnosis, but also aggravation,

4 contribution, and causation.

5 So, thoughts about that?

6 Ken?

7 MEMBER SILVER: I think the intuitive

8 appeal of combining them is that we spent time

9 this morning discussing the Site Exposure Matrix

10 and Haz-Map which not entirely, but they kind of

11 smack of general causation. Can X cause Y on a

12 hypothetical worker who was exposed to X? 

13 Whereas, B and C are more specific causation. 

14 Does DOL in deciding in a particular case? That

15 is just my intuition on why B and D tend to fit

16 together.

17 CHAIR MARKOWITZ: Dr. Cassano?

18 MEMBER CASSANO: I think there is some

19 overlap in those two, as I think I said to you

20 earlier, between 2 and 4. But I also see them as

21 more distinct tasks. As you just said, I think 2

22 is a little bit broader in that we are focusing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

179

1 more on the claims examiner and how they should

2 be looking at the evidence and what that evidence

3 should be. And I think No. 4 is more about where

4 should some experts be inserted into this system.

5 I think maybe there is a way,

6 obviously, to keep the two Committees separate,

7 but even before it gets to the -- and I don't

8 know if this is allowed -- but even before those

9 two Committees report to the main Committee,

10 maybe they deconflict or combine their

11 recommendations or not and, then, move it

12 forward, because there is some overlap between

13 the two.

14 CHAIR MARKOWITZ: Other thoughts? 

15 Comments?

16 Dr. Redlich?

17 MEMBER REDLICH: Well, it just seems

18 that these two activities are so intertwined, but

19 I am not sure it would either create more work or

20 it seems to me that putting them together might

21 make more sense. I mean, I realize that they are

22 separate, but they are so dependent on each other
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

180

1 and the information that exists. Maybe after we

2 learn more about everything, we would at that

3 point decide that there was a need for a smaller

4 group to work on a specific area. But I feel

5 like at least it would be premature.

6 CHAIR MARKOWITZ: Dr. Welch?

7 MEMBER WELCH: I think I might, even

8 though I was the one who suggested combining

9 them, I might say keep them separate and then see

10 if they come together. Because there are many

11 different steps in the process from when the

12 medical diagnosis information starts to come in

13 to when the final adjudication is made. If one

14 group starts with the role of the experts and

15 kind of moves backwards, and one starts with the

16 medical information coming in and moves forwards,

17 you come together where it overlaps. I think it

18 would make sure that everything is getting

19 covered to keep it in two different groups,

20 because there are so many pieces in there.

21 MEMBER REDLICH: Well, assume there

22 will be fewer pieces when we are done.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

181

1 (Laughter.)

2 MEMBER WELCH: Well, or more ways to

3 move quickly through some parts of it anyway.

4 CHAIR MARKOWITZ: Dr. Friedman5 Jimenez?

6 MEMBER FRIEDMAN-JIMENEZ: I think the

7 unifying theme here is judgment of causation,

8 causation used in its broader meaning to include

9 aggravation, contributing to, and what is usually

10 thought of as cause. And then, the two subsets

11 of this are as done by the treating physician,

12 medical practitioners, consultants, and as done

13 by the claims examiners, which the logic is

14 similar, but they are somewhat different

15 processes because there are different information

16 sets available to them.

17 So, you might think about structuring

18 the Committees both around the concept of

19 judgment of causation, but one focusing on the

20 claims examiners and one focusing on the treating

21 physicians and consultants.

22 CHAIR MARKOWITZ: Comments?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

182

1 I agree with you George, that both

2 areas have to address/include aggravation,

3 contribution, and causation. My feeling about

4 Task No. 4 is that that group is likely to zero5 in on the experts; whereas, No. 2 is larger and

6 looks at how the claims examiner is going to use

7 that expert information, and how it is integrated

8 with SEM or with other information.

9 Many of us, being experts, will zero10 in on what is easy for us, which is the

11 expertise, right, and then, neglect the process. 

12 That is the reason I would like to at least start

13 with two separate Committees, to make sure that

14 the larger process gets sufficient attention.

15 Ms. Vlieger?

16 MEMBER VLIEGER: I agree with you, Dr.

17 Markowitz, it needs to be two separate areas. We

18 are dealing with a set of lay people who do not

19 have medical expertise, and we need to provide

20 them the guidance of how to review the things,

21 what is important and what is not. Because what

22 is important to one claims examiner may not
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

183

1 actually seem important to another claims

2 examiner.

3 And this is not just in reviewing the

4 medical evidence, but it is the evidence of the

5 file that is provided to them from the Document

6 Acquisition Request, called the DAR, and from

7 their records that they provide of their own work

8 experience.

9 So, I think the guidance to the claims

10 examiners for what they are looking at and

11 whether or not it is relevant, and what the

12 different names could be, because it is different

13 from site to site. There is a lot of jargon,

14 too. And so, I think it is important to keep

15 them separate.

16 CHAIR MARKOWITZ: So, there are a

17 couple of people with vertical name tags, but --

18 (Laughter.)

19 CHAIR MARKOWITZ: Other comments,

20 questions?

21 (No response.)

22 CHAIR MARKOWITZ: So, should we move
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

184

1 on this issue of two separate Committees or one

2 Committee, not necessarily for the record, but

3 just to make it clear where people stand? Is

4 there a motion?

5 MEMBER VLIEGER: I move to keep the

6 Committees separate.

7 CHAIR MARKOWITZ: Second?

8 MEMBER BODEN: Second.

9 CHAIR MARKOWITZ: Oh, Dr. Boden, okay. 

10 All right. Any further discussion?

11 (No response.)

12 CHAIR MARKOWITZ: So, all in favor of

13 keeping two separate Committees to address B and

14 D raise your hand.

15 (Show of hands.)

16 CHAIR MARKOWITZ: So, for the record,

17 it is unanimous, yes. Yes, I think it is almost

18 unanimous, but it is certainly the majority. I

19 can't see everybody's hands.

20 So, let's form a Committee now. Who

21 is interested in addressing this?

22 Ms. Vlieger. Let's get this down
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

185

1 here. Okay. We have got Les Boden, Ken Silver,

2 Tori Cassano, Ms. Vlieger.

3 And do we have anybody who would like

4 to actually chair this Committee? Okay. Thank

5 you, yes.

6 Again, we have sort of set out the

7 generic agenda for this Committee, as we did for

8 the last one.

9 We should move on now. We are a

10 little bit ahead, which is great.

11 I am hoping Mr. Curtis Johnson is

12 here.

13 We are going to be discussing, while

14 he sets up, we are going to be discussing Area 3,

15 which I will read to you from our charter, which

16 is, "Advise the Secretary of Labor with respect

17 to evidentiary requirements for claims under

18 Subtitle B related to lung disease."

19 And so, I would like to welcome Mr.

20 Curtis Johnson, who is the Unit Chief of Policy,

21 Regulations, and Procedures in the Division, and

22 welcome back, Mr. Vance.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

186

1 MR. JOHNSON: Thank you very much. 

2 Thank you.

3 Good afternoon, everyone.

4 Just a little bit about my background

5 before we get started, my background is pretty

6 much similar to that of John Vance and Rachel

7 Leiton. I started with OWCP in October of 1994

8 at the FECA office in New York. Since 1996, I

9 worked as a claims adjudicator, as a claims

10 examiner, senior claims examiner, and supervisory

11 claims examiner. In June of 2005, I came to the

12 Energy Program as a hearing representative for

13 the Final Adjudication Branch, worked in that

14 capacity until October of 2013, into the current

15 position that I am working in now.

16 One issue/concern that I just had the

17 Board -- and I am really relieved to see that

18 Part B is something that the Board is going to

19 initiate or take action on right now -- Part B is

20 really the legacy of our program. As Rachel

21 mentioned in her presentation before, if it

22 wasn't for Part E and the work that we did on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

187

1 Part E, Part E actually wouldn't have come to our

2 program. So, I am really grateful that the Board

3 is really going to be taking some action

4 immediately to look at the Part B aspects of our

5 claim.

6 During the EEOICPA 101 presentation

7 yesterday, you were all given the conditions that

8 are covered under Part B. What I am going to do

9 today is talk a little bit more specifically

10 about chronic beryllium disease and silicosis.

11 Before I start with those particular

12 items, I really need to include one other

13 condition that is covered under Part B, beryllium

14 sensitivity. The reason why it is important to

15 discuss beryllium sensitivity is because there is

16 obviously a link between beryllium sensitivity

17 and chronic beryllium disease and, also, our

18 procedures and our statute really mandate that a

19 discussion of beryllium sensitivity take place.

20 So, first, we are going to start off

21 with beryllium sensitivity. Basically, beryllium

22 sensitivity is simply an allergic reaction to the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

188

1 immune system that is the result of the presence

2 of beryllium in either the blood or based on

3 exposure to beryllium.

4 The requirements for beryllium

5 sensitivity, the exposure requirements, you

6 simply need one day of employment at either a

7 Department of Energy facility or with a covered

8 beryllium vendor.

9 Mr. Turner, you had an issue earlier

10 today regarding beryllium at the Rocky Flats

11 Plant. I don't know if your question was

12 answered, but let me just reassure you of one

13 thing. The Department of Energy Covered Facility

14 List does acknowledge that beryllium was present

15 at Rocky Flats as well as all Department of

16 Energy facilities. And beryllium was present not

17 only during the operation of the plant, but also

18 during the residual period of the plant and

19 during the decontamination process of the plant.

20 So, as long as an individual worked at

21 Rocky Flats, as long as they have one day of

22 employment, we know for sure without a doubt that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

189

1 there is evidence of beryllium exposure. So, I

2 just wanted to make sure that you understand that

3 part of the deal.

4 As far as diagnostic evidence for

5 beryllium sensitivity, the statute requires one

6 abnormal beryllium test. That test can come in

7 the form of a lymphocyte proliferation test or a

8 lymphocyte transformation test.

9 Once again, I just want to reiterate

10 that the statute allow one, only one, test, and

11 it only has to be an abnormal test. It doesn't

12 have to be borderline normal. It has to be

13 abnormal.

14 In addition to the testing that I

15 mentioned, we would also accept beryllium skin

16 patch testing. If there is a positive skin patch

17 test for beryllium, we would accept that as

18 medical evidence as well.

19 Once we establish the medical, the

20 employment criteria for beryllium sensitivity, if

21 a claim is accepted for beryllium sensitivity, we

22 would pay for medical treatment. Unlike other
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

190

1 Part B conditions where there is lump-sum

2 compensation, we would only pay for medical

3 monitoring for beryllium sensitivity.

4 Although the requirements for

5 accepting claims for beryllium sensitivity are

6 straightforward, there are still issues and

7 concerns that we would like for the Board to take

8 into consideration.

9 The first issue that we have is the

10 consistency in testing results from different

11 facilities. This may be simply due to the

12 calibration of equipment or monitoring data, but

13 that sometimes has an issue or concern where one

14 site might consider something normal and another

15 site may not consider something normal. So, that

16 is one issue that we would like for the Board to

17 consider.

18 Another issue we would like for the

19 Board to consider is what happens in instances

20 when one physician interprets the results of a

21 beryllium test as normal and another physician

22 reviews those tests and finds that they are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

191

1 abnormal. Once again, this issue might even be

2 related to the calibration or the methods that

3 are used in the testing, but, once again, that is

4 something that we also have a concern and issue

5 about as well.

6 The next issue that we have is whether

7 or not there is any new scientific data that is

8 used to establish a diagnosis of beryllium

9 sensitivity. The lymphocyte proliferation test

10 is pretty much the gold standard, so to speak,

11 and we know those testing methods are out there. 

12 We just don't know if there are any other

13 specific testing mechanisms that are out there

14 that would help us in determining a diagnosis of

15 beryllium sensitivity.

16 The last item that we have is

17 basically what should we consider as medical

18 monitoring for beryllium sensitivity. We would

19 pay for any treatment that we feel is going to be

20 related to establishing a diagnosis of chronic

21 beryllium disease. That would include any chest

22 x-rays, any lung biopsies, any type of testing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

192

1 that would be done. We are just interested in

2 seeing if there are any other topics or issues of

3 concern that we should be considering for a

4 medical.

5 And that is everything for beryllium

6 sensitivity. Before I go on to chronic beryllium

7 disease, are there any questions? Any questions?

8 CHAIR MARKOWITZ: Yes. Steve

9 Markowitz.

10 I have a question. I didn't quite

11 understand the last item, definition of beryllium

12 medical monitoring. If people are sensitive now,

13 and their claim is accepted, they are in a

14 monitoring program, which is determined probably

15 mostly by the physicians they are seeing. So,

16 what exactly are you asking for here?

17 MR. JOHNSON: We are really looking at

18 this point for testing to show whether or not an

19 individual will develop chronic beryllium

20 disease. Beryllium sensitivity is really one of

21 the main monikers that is used to determine

22 whether or not an individual is diagnosed with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

193

1 chronic beryllium disease or some other form of

2 pulmonary illness. So, at that point, our

3 efforts are really focused on testing to make

4 sure that we detect chronic beryllium disease as

5 soon as possible.

6 MR. VANCE: Yes, this is John Vance.

7 The thing that we see with medical

8 monitoring is what are the expected tests and

9 diagnostic regimen to follow for an individual

10 who has been sensitized to beryllium. What is

11 the frequency of that testing?

12 We really get a wide, diverse range of

13 suggestions about, well, this should be done

14 annually, biannually. And so, you have

15 individuals with beryllium sensitivity going all

16 over the country to different facilities to have

17 different types of tests performed. And so, we

18 take a very liberal approach right now with

19 regard to what is defined as medical monitoring,

20 but we can certainly be looking for, you know,

21 what is a good course of care for somebody with

22 beryllium sensitivity with regard to what do we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

194

1 mean by medical monitoring. Right now, it is a

2 very broad meaning, and there are lots of

3 different interpretations about what that means.

4 So, I hope that adds some clarity to

5 that issue.

6 CHAIR MARKOWITZ: Right. So, you are

7 looking for advice on an appropriate monitoring

8 protocol for progression to disease?

9 MR. JOHNSON: Correct.

10 CHAIR MARKOWITZ: Thank you.

11 MR. JOHNSON: The next condition I am

12 going to talk about is chronic beryllium disease. 

13 From a claims adjudication standpoint, chronic

14 beryllium disease is probably one of the, if not

15 the, most difficult claims to adjudicate. 

16 Normally, it is claims examiners, when we are

17 establishing a diagnosis for a medical condition,

18 we are normally keying on a specific medical

19 report or some type of specific medical evidence

20 where we could say this is what we are going to

21 use to establish a diagnosis of beryllium

22 sensitivity.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

195

1 Actually, the way that the statute

2 reads -- and we will go into the specifics a

3 little bit later -- for the Part B aspects of the

4 program, you don't necessarily have to have a

5 diagnosis of chronic beryllium disease per se. 

6 It is based on the concept, if it looks like CBD

7 and it talks like CBD, we assume, assumption of

8 causation, that it is CBD.

9 First of all, the requirements for

10 establishing a diagnosis of chronic beryllium

11 disease, similar to the criteria for beryllium

12 sensitivity, one day of exposure to beryllium at

13 a Department of Energy facility or with a

14 beryllium vendor. Once that information is

15 established, the statute mandates that the

16 criteria are reviewed based on a diagnosis

17 chronic beryllium disease either before or after

18 1993. Once again, this is something that the

19 statute set in place.

20 MR. VANCE: Let me interject real

21 quick. Let me make a point of clarification

22 here. When Curtis is talking about a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

196

1 presumption, what we are talking about is the

2 statute lays out very strict requirements for

3 what constitutes the establishment of chronic

4 beryllium disease. And you will notice I am

5 saying "the establishment of chronic beryllium

6 disease," not necessarily the diagnosis of

7 chronic beryllium disease.

8 So, I just want to make that clear,

9 that the statute lays out specific diagnostic

10 criteria for establishing chronic beryllium

11 disease, dependent on whether or not an

12 individual has a pre- or post-1993 evidence of a

13 chronic -- there is a test that goes into

14 determine whether you are going to apply the

15 criteria for a pre-1993 standard for chronic

16 beryllium disease or a post-1993 standard. Okay? 

17 And we'll talk about that because that is an

18 important function of making a determination of

19 the establishment of chronic beryllium disease.

20 MR. JOHNSON: For establishing the

21 pre- or post-1993 standard, normally, what we

22 would look at first is the actual claim form
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

197

1 where the claimant will actually identify when

2 they were diagnosed or when they believe that

3 they were diagnosed with the illness. That would

4 be the first marker that we are looking for to

5 determine whether or not we are going to use the

6 pre- or post-1993 standards.

7 If there is no identifying factor as

8 to when the diagnosis took place, what we would

9 be looking at, we would make a determination

10 based on the medical evidence of when an

11 individual was first treated or received

12 treatment for a chronic respiratory disorder.

13 If we establish that the treatment

14 took place before 1993, we would use the pre-1993

15 criteria. If it is established after 1993, we

16 would use the post-1993 criteria.

17 The pre-1993 criteria, it is based on

18 five particular elements. In order to have an

19 acceptable claim, you must meet three of those

20 particular five elements.

21 The first element that we are looking

22 at is the characteristics of the chest
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

198

1 radiographs. This includes any chest x-rays, any

2 CT scans, any CAT scans. The claims examiner

3 reviews that particular element, and we are

4 looking for, as John mentioned, we are looking

5 for specific findings or criteria in those chest

6 x-rays.

7 And what I want to make sure that it

8 is really clear is that this is something where

9 the claims examiner does not make an

10 interpretation on their own. If the evaluation

11 report does not identify these particular items

12 and terms, then we make the determination that

13 this information may need to go to the treating

14 physician to ask whether the characteristics are

15 similar to or found in CBD, or we would go to a

16 CMC to get that information.

17 There are some target words that we do

18 look at. One of the biggest terms is "non19 caseating granulomas". That is one term that we

20 determined that is synonymous or consistent

21 characteristics with chronic beryllium disease. 

22 If those findings are noted in the x-ray report,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

199

1 then the claims examiner should feel comfortable

2 in stating this particular piece of criteria is

3 met.

4 There are also other conditions. Once

5 again, this is something that really the Board

6 would really, really be able to give us help on: 

7 what other characteristics in chest radiographs

8 should we be looking at to establish

9 characteristics of CBD?

10 MR. VANCE: Yes. So, in the handout

11 -- I think we don't need to re-read each one of

12 these -- but the test for the pre- and the post13 are laid out. So, what Curtis is talking about

14 is, you know, this is an interpretation of

15 evidence by a physician looking to the diagnostic

16 test results and applying the criteria from the

17 statute. So, in other words, you know, are we

18 looking at x-ray results that are characteristic

19 with chronic beryllium disease? Again, you are

20 looking at an interpretative question that a

21 physician evaluating the evidence makes an

22 opinion as to whether or not this particular test
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

200

1 is showing you a result that he or she feels is

2 consistent with chronic beryllium disease. And

3 that sort of runs throughout here.

4 So, the pre-1993 standard is a little

5 bit more generalized; whereas, the post-1993

6 standard is a little bit more specific as to what

7 evidence needs to exist to establish chronic

8 beryllium disease.

9 And so, it is not a matter of the CE

10 looking at diagnostic evidence and saying, "Hey,

11 this is characteristic with chronic beryllium

12 disease. It is a physician's determination. So,

13 a physician has to look at this information and

14 make that judgment based on what it is that they

15 have seen or see in the evidence of record.

16 And then, what the claims examiner is

17 doing is basically saying, do I have the

18 diagnostic results or the interpretation of the

19 evidence that satisfies these three of the five

20 criteria for the pre- or the criteria for the

21 post-? So, they are looking for a physician who

22 has opined on these things and do the diagnostic
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

201

1 test results correspond with what is required by

2 the statute.

3 And what we have as issues here is, of

4 course, the genuine question that we always have,

5 which is interpretative differential, where you

6 have one physician who can look at it and say,

7 "This is clearly characteristic of chronic

8 beryllium disease." Another physician says,

9 "Well, that really is just characteristics of

10 obstructive pulmonary disease, pulmonary

11 fibrosis." And it is impossible to differentiate

12 between that type of a disease and chronic

13 beryllium disease.

14 So, what we would be looking for is

15 help in saying, what are the markers that can

16 consistently be seen for chronic beryllium

17 disease? Or is that even possible? Or other

18 types of clarifications for how we can apply the

19 evidence in a way consistently to always say this

20 is what you will see if you are talking about the

21 establishment of chronic beryllium disease. 

22 These are the types of diagnostic findings or
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

202

1 other types of x-ray results that you would see

2 with that. It is really a question of what would

3 be the standard of creating consistency in that.

4 Some of the other quick things are

5 that this test of the pre- or post-1993 standard

6 is dependent on the definition of what we mean by

7 chronic respiratory disorder. Okay? It is

8 purely a definitional question, because the

9 statute basically says that the test is evidence

10 of a chronic respiratory disease prior to 1993. 

11 And so, we have to know, well, what does that

12 mean? Does that mean one x-ray result that has

13 an abnormal finding or is it truly a situation

14 where a doctor has identified a chronic disease

15 process?

16 So, we get questions, you know, where

17 we get claims where people are saying, "Hey,

18 here's my occupational x-ray that was performed

19 in 1974 where it shows a mild restrictive

20 problem." Does that equate into a chronic

21 respiratory disorder that turns the program on

22 having to apply the pre-1993 standard or not? 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

203

1 So, that is one area that I think is really kind

2 of an issue for us to try to figure out how to

3 apply that in a consistent manner that is

4 medically-valid. And we have struggled with that

5 for quite some time.

6 On your handout, we talk about

7 clarification of the diagnostic interpretative

8 meaning of characteristic of CBD. This also sort

9 of plays into No. 4 there, obtaining clarity on

10 the specific diagnostic markers required for the

11 establishment of chronic beryllium disease,

12 whether it is pre- or post-.

13 And then, we have in the past had

14 issues with regard to how we look at sarcoidosis

15 and how that can be commonly misinterpreted as

16 CBD. So, in other words, somebody is presenting

17 with pulmonary sarcoidosis. How do you treat

18 that, where a lot of physicians would opine that

19 a diagnosis of pulmonary sarcoidosis in the

20 presence of an exposure to beryllium could

21 actually be masking a true chronic beryllium

22 disease situation.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

204

1 And then, we also have this question

2 of the beryllium LPT issue, which is that the

3 statute requires the presentation of an abnormal

4 beryllium lymphocytic proliferation test when you

5 are dealing with a post-1993 diagnosis of or the

6 establishment of chronic beryllium disease.

7 So, we have commonly seen a lot of

8 physicians contesting the use of the beryllium

9 lymphocytic test to do that, and a lot of times

10 that test can be masked by the use of different

11 kinds of steroidal medications and other reasons

12 where you would end up with a situation where a

13 positive or a normal test result is being masked

14 by medication. And can we not create better

15 rules or processes for evaluating that? And what

16 are some of the considerations that can be used

17 to say, in this scenario where you do have a

18 normal BeLPT, you know, a beryllium lymphocytic

19 test, what are the characteristics that would

20 allow us to say that is actually, that is really

21 an abnormal result, due to other factors or other

22 considerations?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

205

1 MR. JOHNSON: This is Curtis Johnson

2 again.

3 After the chest radiographs, the next

4 criteria that we look at after the chest

5 radiograph, we look for evidence of restrictive

6 or obstructive lung physiology. This is

7 basically a review of the pulmonary function

8 test. Once again, the interpretation for the

9 pulmonary function test, it specifically has to

10 state that there is either a restrictive

11 disorder, an obstructive lung disorder, or some

12 sort of diffused lung effect. And once again,

13 this is something that the claims examiner does

14 not make that interpretation their own. This

15 actually has to be in the results of the test

16 itself.

17 Okay. And what we are going to do, we

18 are going to continue on because the next issues

19 that we talk about, the lung pathology, the

20 clinical course, all that information we have

21 really already discussed. And we are going to go

22 through it again in the post-1993 criteria.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

206

1 MR. VANCE: What we are going to do is 

2 I am assuming you guys can read the criteria for

3 the pre- and the post, so we are not going to

4 rehash that whole thing.

5 What I did want to say is, are there

6 any questions at this point about the Part B CBD

7 criteria?

8 CHAIR MARKOWITZ: It is Ms. Vlieger.

9 MEMBER VLIEGER: One of the things

10 that I wrestle with with the medical providers

11 and for the claimants is that the doctors are

12 taught the Beryllium Case Registry criteria as

13 part of their studies. And when it comes to this

14 program, it is more lenient criteria number than

15 Beryllium Case Registry.

16 And so, is there any explanation given

17 to the CMCs in detail, that they have to

18 acknowledge that they understand there is a

19 difference, and to the medical providers that you

20 are in contact with, that there is a distinct

21 difference between the criteria under this

22 program and what is defined as chronic beryllium
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

207

1 disease under the Beryllium Case Registry

2 criteria?

3 MR. VANCE: Now, what we would do is

4 communicate and convey the information that is

5 statutorily required under our provision, under

6 our statute. So, in other words, if we are going

7 to be developing a case where we are going out to

8 a treating physician, we are going to say, "This

9 is what our statute stipulates as the

10 requirement." So, therefore, we would be seeking

11 information relating to the statutory

12 requirements. We are not going to go out and

13 compare other types of provisions that may exist

14 with regard to the assessment of chronic

15 beryllium disease.

16 So, this is what is unique about this

17 particular condition in a Part B claim, is that

18 the statute identifies specific diagnostic

19 criteria. So, any other legal provisions really

20 have no effect on our test for chronic beryllium

21 disease. We have to apply this standard.

22 And where we can have wiggle room is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

208

1 the definition of certain things such as, what do

2 you mean by a chronic respiratory disorder for

3 determining whether you are going to apply the

4 pre- or post- standard?

5 CHAIR MARKOWITZ: I have a question. 

6 Steven Markowitz.

7 So, when you say that a physician --

8 the claims examiner isn't making the

9 determination of the presence of each of these

10 items? It is from a physician report or the

11 like. Is it the case that the physician has to

12 say that, yes, there are three of these five

13 items present and specify what they are? So, the

14 physician is essentially putting the case

15 together and calling this CBD according to your

16 definition? Or is it that the physician merely

17 needs to indicate that, yes, barometry shows

18 restriction; chest x-ray shows interstitial

19 fibrosis, or whatever?

20 And then, the claims examiner says,

21 "Yes, I see the physician said restriction. I

22 see basic chest x-ray finding compatible with,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

209

1 and I see a history of chronic respiratory

2 disorder." And the claims examiner, then, is

3 putting those three pieces together and saying

4 this is CBD?

5 MR. VANCE: No. It has to be the

6 doctor evaluating the evidence, identifying the

7 characteristics of the test results that are

8 abnormal, and that in the opinion of that

9 physician can be interpreted as being consistent

10 with chronic beryllium disease.

11 MS. LEITON: But I think the

12 expression, we ask the doctor, "Is this

13 characteristic of...?"

14 MR. VANCE: Right.

15 MS. LEITON: And the doctor says yes. 

16 Then, we put three pieces together.

17 MR. VANCE: Right. Well, right. So,

18 what Rachel was saying is that, basically, you

19 know, we will advise the doctor, "These are the

20 requirements." And then, the doctor is going to

21 respond, and we are going to get information

22 relating to different components of the chronic
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

210

1 beryllium disease standard.

2 As long as the doctor is providing an

3 opinion that is characterizing the interpretation

4 of the test to meet that standard, whatever the

5 criteria around the statute, then, yes, we would

6 have the CE looking at that and accepting that,

7 as long as the doctor has interpreted that

8 evidence in a way that satisfies the statutory

9 requirement.

10 CHAIR MARKOWITZ: All right. So, the

11 assembling of the pieces, the doctor-certified

12 pieces, can be done by the examiner to include?

13 MR. VANCE: Yes.

14 CHAIR MARKOWITZ: Thank you.

15 MR. VANCE: So, basically, the CE is

16 making sure do we have the pieces that allow us

17 to accept it, but the source of that material

18 needs to come from the physician and the

19 interpretation of that evidence needs to be done

20 by the physician.

21 CHAIR MARKOWITZ: Okay. Thank you.

22 Dr. Welch?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

211

1 MEMBER WELCH: Are you still getting

2 claims where the pre-1993 applies?

3 MS. LEITON: Oh, yes.

4 MR. VANCE: Oh, yes, I think that is

5 the most common ones we are seeing now. A lot of

6 our cases are -- the pre-standard is a little bit

7 more liberal. So, of course, that is where you

8 are going to have a lot of people trying to

9 persuade the program that that is the applicable

10 standard to apply in their case. So, we see a

11 lot of that. I think a majority of our cases now

12 are more pre-1993 than post-.

13 MEMBER WELCH: So, are you seeing

14 people who are having their first BeLPT in 2016,

15 and that is positive, but they have a long

16 history of chronic respiratory disease that

17 predates the 1993 date?

18 MR. VANCE: No. The LPT now is

19 negative, and they are trying to argue that the

20 evidence of a chronic respiratory disorder that

21 started way before 1993 allows for the

22 application of the pre-1993 standard.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

212

1 Rachel was saying that we are seeing

2 it; we are seeing both, but because it is an

3 easier standard, that is where the claims are

4 going to go to.

5 CHAIR MARKOWITZ: Dr. Redlich?

6 MEMBER REDLICH: Yes, I understand

7 some of the problems. I am quite familiar with

8 many of the issues around beryllium.

9 So, in the post-1993, for people who

10 aren't familiar with all of these issues, there

11 are multiple reasons why someone may not end up

12 getting a tissue diagnosis or a lavage in terms

13 of being too sick. There are also reasons why

14 the BeLPT might be false, the blood one might be

15 false or negative, depending on medications or

16 even whether the person had the opportunity to

17 have it done, or if something happened in the

18 sample when it went out to National Jewish.

19 But how many labs are you using for

20 the tests now?

21 MR. VANCE: We don't actually specify

22 or prescribe particular testing facilities. And
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

213

1 that relates back to the question or the issue

2 that Curtis was mentioning before.

3 MEMBER REDLICH: Okay.

4 MR. VANCE: It is that different

5 testing facilities where claimants can go to may

6 have different standards by which they apply to

7 say this is a normal versus an abnormal test. 

8 And so, we end up, you know --

9 MEMBER REDLICH: Yes. No, I'm aware,

10 yes.

11 MR. VANCE: So, we don't have specific

12 testing facilities that are utilized by the

13 program. Claimants are free to pick and choose

14 which facilities that they would like to go to.

15 MEMBER REDLICH: Okay. So, there

16 aren't a ton.

17 And how strict is this? I was looking

18 for wiggle room in terms of the -- you know, you

19 sort of have the problem, the potential problem,

20 that the pre-1993, since it is three of those

21 five criteria, you don't have to actually have

22 sensitization, and there is a lot of lung disease
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

214

1 in people, given how common COPD and lung disease

2 is. So, I could understand --

3 MR. VANCE: You're absolutely correct,

4 yes.

5 MEMBER REDLICH: I understand that.

6 And then, you have almost the reverse

7 issue with the post-1993 in terms of being maybe

8 overly-strict in that it isn't leaving a lot of

9 leeway in terms of wanting some either lavage or

10 tissue.

11 MR. VANCE: Right. And that will

12 never change unless they change the law itself. 

13 So, what I need to really stress is these can't

14 be changed without a legislative change. These

15 are specifically enumerated in the statute

16 itself, rightly or wrongly.

17 (Laughter.)

18 MEMBER REDLICH: Okay. But someone

19 could conceivably write, a physician could give

20 an opinion that they think this is CBD, based on

21 A, B, and C, despite the fact that there was

22 never a biopsy, or not?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

215

1 MR. VANCE: It depends on the

2 combination. As long as the doctor can provide

3 the information that is statutorily required --

4 so, in other words, if you have the positive

5 beryllium test and you have a biopsy showing this

6 on the first one that the doctor has interpreted

7 as saying, yes, this is showing a bronchial or

8 interstitial lung tissue problem that they can

9 interpret as being chronic beryllium disease.

10 MEMBER REDLICH: Okay. But I have

11 just diagnosed CBD without tissue, but that

12 doesn't seem to be in --

13 MR. VANCE: Yes, and I think the

14 statute allows for that to occur.

15 MS. LEITON: Blood testing.

16 MEMBER REDLICH: No, no, but it is

17 lavage.

18 MR. VANCE: Right. It can be a lung

19 biopsy. It can be a lavage.

20 MEMBER REDLICH: I know, but that is

21 still an invasive procedure.

22 MR. VANCE: Oh, yes, and that is one
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

216

1 of the issues that we have on our list --

2 MEMBER REDLICH: Okay.

3 MR. VANCE: -- is the fact that that

4 reality exists.

5 MEMBER REDLICH: Yes, I'm saying I've

6 made the diagnosis absent of those, because one

7 was unable to obtain them. But you are saying

8 that, right now, there isn't wiggle room for

9 that? Okay.

10 MR. VANCE: No, not under the post11 1993 criteria. It basically is exactly this. 

12 You have got to meet these criteria. You know,

13 it is just statutorily required.

14 CHAIR MARKOWITZ: Dr. Welch?

15 MEMBER WELCH: Could someone, if they

16 don't meet the Part B criteria, pursue it under

17 Part E, a claim for CBD? Or is it excluded under

18 E?

19 MR. VANCE: No, it would be something

20 we could consider under Part E.

21 MEMBER WELCH: So, then, your kind of

22 case is where you might have a CT scan that shows
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

217

1 characteristic CBD and you have sensitization. 

2 It could potentially go under Part E without a

3 biopsy?

4 CHAIR MARKOWITZ: So, I have a

5 question. Is this a follow-up?

6 MEMBER VLIEGER: Yes.

7 CHAIR MARKOWITZ: Oh, go ahead. Go

8 ahead.

9 MEMBER VLIEGER: Just a clarification

10 on the information in our briefing book. It

11 doesn't exactly follow the wording from the

12 statute. So, my question is, just for

13 clarification for the other Board members, could

14 you enumerate the quantity of criteria needed

15 under a post-1993 diagnostic definition for the

16 Department?

17 MR. JOHNSON: First, you would need a

18 diagnosis of beryllium sensitivity. That is No.

19 1. And the second component is that you would

20 need lung pathology consistent with chronic

21 beryllium disease.

22 We will come back to it.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

218

1 CHAIR MARKOWITZ: Steve Markowitz.

2 Since you have chronic respiratory

3 disorder, so it must be potentially confusing for

4 claims examiners because it encompasses a broad

5 range of illnesses and, also, is a fairly non6 specific term. So, is there written guidance for

7 the claims examiners on what is a chronic

8 respiratory disorder or when it needs to have

9 appeared, or the like?

10 MR. VANCE: Yes. In our Procedure

11 Manual, we define it as a problem that is chronic

12 in nature, which means that it is something that

13 exists for a period of time, that a physician is

14 interpreting as being a chronic disease process.

15 I am not sure of the exact wording,

16 but we do talk about the fact that, you know, a

17 single diagnostic test may not necessarily

18 establish chronic respiratory disease. It is a

19 question that a physician needs to address.

20 So, we have that language in our non21 cancer condition chapter in our Procedure Manual,

22 and we do try to spell that out. But, again, we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

219

1 are still left with the question of, is that

2 definition that we have in our procedures too

3 strict, too conservative, or too liberal? And

4 that is why we would certainly be looking for the

5 Board to assist with helping in clarifying that

6 issue, because a lot of people are really

7 concerned about that, simply because, then, that

8 sort of sets in motion whether we are going to

9 apply that pre-1993 standard, which is a little

10 bit more easier to do than the post-.

11 So, that is the focus of a lot of

12 stakeholders and a lot of claimants, is, how do

13 you want to define that? And the words are

14 "chronic respiratory disorder". So, our program

15 has sort of taken the view that it is something

16 that is diagnosed as a long-term respiratory

17 problem.

18 CHAIR MARKOWITZ: Thank you.

19 Dr. Silver?

20 MEMBER SILVER: If I understood your

21 question a little while ago, there is a Beryllium

22 Case Registry that many of the leading physicians
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

220

1 in this area participate in, and it has certain

2 criteria that are above and beyond DOL's.

3 I am reminded of an early nuclear

4 worker advocate, before there were many, Bob

5 Alvarez, who at the inception of this program

6 went around the country reinforcing the idea that

7 a program like this is social policy first,

8 informed by science. And the scientists are in

9 the backseat giving a little bit of advice, but

10 Congress decided on a claimant-friendly program.

11 And one of the things we have been

12 doing all along is reminding people that

13 scientists, when among themselves, can apply

14 their normal standards of proof. But, for a

15 program like this which is mainly social policy,

16 different standards apply.

17 So, because the group of doctors who

18 do beryllium disease as a specialty is so small,

19 I really think this is an opportunity for us to

20 put out an explicit reminder that, fine, you

21 know, the NIH study section, when you are

22 figuring out who is going to get money to do the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

221

1 next molecular marker in the Case Registry, apply

2 your sky-high criteria, but a little tap on the

3 shoulder here: when you are seeing people for

4 the purposes of compensation, the standards are

5 different. Is that kind of the issue that you

6 are getting at?

7 MEMBER VLIEGER: Yes, and then, we see

8 it chronically because physicians aren't taught

9 this standard according to this program. So,

10 they rely on their education, which is what they

11 do; it is their job.

12 But the requirements under this

13 program, when the worker says, "Well, I think I u

14 qualify," and the doctor goes, "No, that's not

15 what I was taught," that is what they write to.

16 MEMBER SILVER: Are there specific

17 items that are on the doctors' scientific list of

18 criteria that get injected into determinations

19 for this program inappropriately?

20 MEMBER VLIEGER: From time to time,

21 the doctors will say, "Well, I'm not going to do

22 a biopsy because I don't think you have it. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

222

1 Well, that's not required."

2 And then, on the post-1993 diagnoses,

3 it is not required at all, but the doctors were

4 not trained to opine on something less than

5 definitive evidence from a biopsy or from

6 something, a lavage.

7 And I agreed with Dr. Redlich; the

8 intrusive procedures in many cases are

9 unwarranted, and in older patients you just can't

10 do them. So, with the post-1993 criteria, which

11 is what we see a lot of from the Hanford site,

12 the doctors don't understand that there is a

13 less-restrictive criteria they can write to.

14 MEMBER REDLICH: But, actually, the

15 problem is also that the 1993 criteria are

16 actually stricter than the American Thoracic

17 Society recently, or in 2004, came out with

18 official guidelines, and theirs are actually less

19 strict than this 1993 because they leave some

20 wiggle room. What it says is that, basically, a

21 probably diagnosis of CBD can be based on imaging

22 consistent with sarcoidosis or a BAL
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

223

1 lymphocytosis, meaning you could have a

2 positive -- so, it is actually this is a stricter

3 criteria than the current ATS guidelines.

4 I think that was -- I was involved in

5 reviewing this whole document -- because for

6 physicians seeing these patients, realizing that

7 there are times when one is unable, for various

8 reasons, to get the sampling that would be

9 needed.

10 And even something like a biopsy, you

11 can have three pathologists look at a biopsy and

12 come up with a different description of that

13 pathology; the same with a CT scan.

14 CHAIR MARKOWITZ: So, that kind of

15 raises the issue of something you mentioned

16 before, whether Part E might actually solve a

17 little bit of this problem, where the doctors

18 have a different set of criteria for CBD diagnose

19 than the Congress people. If somebody doesn't

20 meet Part B requirements, they don't have the

21 biopsy, and you could under Part E compensate

22 them, do you move them over? Can you move them? 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

224

1 Is that a solution to the problem?

2 MR. VANCE: Well, this is where it

3 gets fascinating. Under Part E, we do require

4 for a Part E claim for chronic beryllium disease

5 that they have to have a positive beryllium

6 lymphocytic test.

7 The issue there is that, you know,

8 then you are no longer dealing with a pre- or

9 post- standard anymore. So, you could have

10 someone who is trying to get a claim through on

11 Part B for the pre-1993 standard. But, then,

12 when you flip over, and let's say that gets

13 denied, then you flip over to the E side. They

14 might change the story and say, "Well, it was

15 always chronic obstructive pulmonary disease,"

16 and that is where they go with their case. So,

17 it really depends.

18 So, under Part E, it is a little bit

19 different. This is where you get this

20 differential between what happens under Part B

21 and E, because the standards are different. So,

22 it depends on how an individual is going to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

225

1 pursue their case.

2 CHAIR MARKOWITZ: But the post-1993

3 cases, right, in which there is no biopsy, so it

4 can't go under B, it won't be recognized under B. 

5 No biopsy, but Dr. Redlich certifies it is CBD. 

6 Could that come under -- this is post-1993 --

7 could that come under Part E and be compensated?

8 MR. VANCE: Yes. Yes, it can.

9 CHAIR MARKOWITZ: Thank you.

10 MS. LEITON: You can't go backwards,

11 though. You can't go E back to B.

12 CHAIR MARKOWITZ: Okay. Okay.

13 MR. VANCE: So, Rachel was just adding

14 an elaboration that it can't go from E to B, but

15 it can go from B to E. I love that combination,

16 by the way, the E-B.

17 MEMBER REDLICH: So, it solves part of

18 the problem. It solves the scenario of the

19 positive BeLPT where you don't have tissue --

20 MR. VANCE: Correct.

21 MEMBER REDLICH: -- where you, let's

22 say, have a CT scan that is classic and a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

226

1 positive BeLPT and a history of exposure, and it

2 solves that problem.

3 MR. VANCE: Right.

4 MEMBER REDLICH: The one problem it

5 doesn't solve is where you might have tissue that

6 is classic and a good exposure story, and the

7 person on a lot of steroids and stuff, and then,

8 they get a BeLPT. So, that little thing isn't

9 solved, but it is solves part of it? Is that

10 right?

11 MR. VANCE: I think you have a pretty

12 good read on it.

13 MEMBER REDLICH: There is every

14 combination, permutation of these.

15 (Laughter.)

16 MR. VANCE: Right. There's lots of

17 different combinations of how this can play out.

18 MEMBER REDLICH: Yes.

19 MR. VANCE: And that is what makes

20 this component of the Part B lung disease, that

21 is what makes it so entertaining, is just there's

22 lots of different issues that are buried in a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

227

1 very clear statutory provision. And so, that is

2 what we are pointing out here.

3 MEMBER REDLICH: How many new claims

4 a year do you get?

5 MR. VANCE: So, the question is how

6 many new claims we get, and I can't answer that.

7 MEMBER REDLICH: Or getting tortured

8 by the old claims that keep coming back?

9 MR. VANCE: Yes, we would have to get

10 back to you on that.

11 MEMBER REDLICH: Okay.

12 MR. VANCE: I just don't know.

13 MEMBER REDLICH: I was just trying to

14 get a sense of it, because part of how you

15 address it is really what the magnitude of the

16 problem is.

17 CHAIR MARKOWITZ: Dr. Boden?

18 MEMBER BODEN: So, you may have

19 answered this, but I can't remember if you did or

20 not. Under Part B, if you have a physician

21 report that meets your criteria, but the

22 physician says it doesn't say that they think
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

228

1 that it is CBD, do you act in a positive way on

2 that claim?

3 MR. VANCE: Could you restate that? 

4 I didn't hear the first part.

5 MEMBER BODEN: Oh, okay. So, you got

6 a physician's report. The physician gives you a

7 report with specifics that meet your Part B

8 criteria, but they say it doesn't meet their

9 standard for being chronic beryllium disease. Do

10 you pay that claim?

11 MR. VANCE: Yes, as long as the doctor

12 is fulfilling the requirements of the statute, we

13 will pay it.

14 MEMBER BODEN: So, even if they say

15 it's not --

16 MR. VANCE: So, let's say, for

17 example, you have a doctor that says, "The

18 standard that is being applied here is completely

19 wrong. I have no idea what Congress was doing

20 when they put this in here, but I am going to

21 opine that this patient does meet the post-1993

22 standard," the case will be paid.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

229

1 MEMBER BODEN: But if they give you

2 the test results that meet the standard --

3 MR. VANCE: Yes, as long as the

4 standard in the statute is satisfied --

5 MEMBER BODEN: -- they just don't say

6 it --

7 MR. VANCE: -- the justification of

8 that from a physician, or whatever their opinion

9 is about that --

10 MEMBER BODEN: Good.

11 MR. VANCE: -- it is really sort of

12 inconsequential.

13 CHAIR MARKOWITZ: Other questions,

14 comments?

15 Are you moving on to silicosis or --

16 MR. JOHNSON: When you are ready to.

17 CHAIR MARKOWITZ: Okay. So, I have a

18 question.

19 I'm sorry, there are a couple of name

20 cards that are vertical.

21 There are some proposed rule changes

22 that are relevant to this issue of pre- and post-
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

230

1 1993. I couldn't understand the importance of --

2 I'm not sure I even understood the change, but I

3 didn't understand the importance of the change.

4 So, what was happening that caused you to propose

5 changes to the regulations and what are these

6 changes exactly?

7 MR. VANCE: Well, yes, unfortunately,

8 I am not in a position to be able to comment on

9 the regulations at all. I think that is going to

10 be something that you are going to have to

11 deliberate on your own to decide what your

12 feelings are on that issue as a deliberative

13 body.

14 MEMBER REDLICH: The pre-1993 is much

15 more liberal.

16 CHAIR MARKOWITZ: Right. No, I get

17 that. Okay, fine. Okay. Thank you. I forgot,

18 actually. Other questions or comments?

19 (No response.)

20 CHAIR MARKOWITZ: Okay. So, let's

21 proceed.

22 MR. JOHNSON: And the last condition
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

231

1 that we are going to talk about is chronic

2 silicosis. Once again, the statute mandates that

3 under Part B chronic silicosis is the only

4 silicosis that is covered.

5 The exposure requirements are simply

6 an individual must have 250 days of employment

7 during the mining of tunnels or exposure to

8 silica, I should say, 250 days of exposure to

9 silica as a result of mining in the tunnels of a

10 DOE facility in Nebraska -- I'm sorry; in

11 Nebraska? In Nevada or Alaska. Excuse me.

12 (Laughter.)

13 MR. JOHNSON: The medical requirements

14 -- and once again, this is strictly for chronic

15 silicosis -- there has to be a latency period of

16 10 years between the initial date of exposure to

17 silica and the date of diagnosis for chronic

18 silicosis.

19 As far as the diagnostic criteria

20 goes, what we see mostly is the results of a

21 B-reader chest, a NIOSH B-reader chest x-ray. 

22 The results of those x-rays have to note the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

232

1 existence of pneumoconiosis at a level of 1 over

2 zero or higher. That is what we see in most

3 instances as the determining medical evidence. 

4 We would also accept if we receive some sort of

5 pathology or chest x-ray evidence of, evidence

6 consistent with chronic silicosis. We would

7 accept claims for silicosis on that basis as

8 well.

9 One particular issue that we would

10 like for the Board to consider regarding chronic

11 silicosis is the validity of the B-reader x-rays. 

12 The x-ray form itself does not have a particular

13 field, or whatever you want to call it, for a

14 physician to sign the form and identify himself

15 as the actual B-reader. The only requirement is

16 that the physician's initials appear on the form

17 and that the address of the physician appears on

18 the form.

19 Our question is, how do we determine

20 what the validity of that B-reader's credentials

21 are and how do we actually identify that

22 particular physician as a B-reader physician?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

233

1 MR. VANCE: This is an issue that just

2 pops up periodically, as far as making sure that

3 we know that that is a valid B-read and that it

4 can be applied in the case. It might not be that

5 complicated, but we just get ourselves into this

6 situation where we get B-reads where there is

7 some question as to whether or not that is a true

8 B-read or is that a reinterpretation of a B-read,

9 or what have you?

10 So, it is just a question of, what it

11 is that marks a valid B-reading? And that is

12 sort of the issue. Silicosis is not one where we

13 have a lot of issues, and that was one that we

14 looked at. We were trying to look at what are

15 some issues that we could identify for

16 consideration, and that is just one that

17 periodically pops up with discussions with

18 external stakeholders.

19 Any other questions at this point

20 regarding beryllium sensitivity, chronic

21 beryllium disease, or silicosis?

22 MEMBER VLIEGER: Dr. Markowitz?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

234

1 CHAIR MARKOWITZ: Yes?

2 MEMBER VLIEGER: I know that sites for

3 this, I believe that sites for the silicosis are

4 determined by NIOSH, is that correct?

5 MR. VANCE: You mean silicosis --

6 MEMBER VLIEGER: Where silicosis

7 applies? Because silicosis doesn't apply to all

8 of the sites.

9 MR. VANCE: Well, again, we are

10 talking about Part B lung disease. So, silicosis

11 is specifically named as a statutory provision,

12 and the statute, just like chronic beryllium

13 disease, sets out specific criteria that have to

14 be satisfied.

15 Under Part E, it can apply to

16 anything. So, silicosis can be claimed and does

17 not have to meet the same standard that exists

18 under Part B.

19 MEMBER VLIEGER: Okay. And so, the

20 explanation for why some sites that could have

21 silicosis claims at them that are not considered

22 to have silicosis under B, is that still a NIOSH
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

235

1 determination?

2 MR. VANCE: No. I mean, that is a

3 determination of our normal exposure analysis for

4 a Part E case. In other words, if you are a

5 miner who is filing a claim under Part E, you

6 know, it doesn't matter. Any mine where you are

7 working where there could be silica -- the same

8 thing could be applied at any of the DOE

9 facilities under Part E, you know, where there

10 was a silica exposure and an employee has

11 silicosis.

12 MEMBER VLIEGER: Okay. Thank you.

13 CHAIR MARKOWITZ: Dr. Welch?

14 MEMBER WELCH: I actually didn't go

15 back and look at the statute, but does the

16 statute say they had to be exposed to silica for

17 an aggregate of 250 days? And how do you accept

18 a demonstration of silica exposure at the site?

19 MR. VANCE: It is 250 days of

20 exposure, and we just presume that if you were

21 there at one of these sites, you are going to

22 have that exposure.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

236

1 MEMBER WELCH: Okay.

2 MR. VANCE: And I think Amchitka

3 Island it is even a lesser standard. I think it

4 is only like one day, were you at Amchitka

5 Island.

6 MEMBER WELCH: Okay. Okay. Good.

7 CHAIR MARKOWITZ: Other comments or

8 questions?

9 (No response.)

10 CHAIR MARKOWITZ: Okay. Thank you

11 very much, Mr. Vance and Mr. Johnson.

12 MR. VANCE: Thank you.

13 CHAIR MARKOWITZ: So, is there any

14 discussion on these issues that the Board would

15 like to have before we designate a Committee,

16 volunteer for a Committee, and the like?

17 Dr. Cassano?

18 MEMBER CASSANO: I just have one

19 question on it. They talked about the fact that

20 this was a congressional mandate. And so, I

21 don't know if it is within the purview of the

22 Board that if after deliberation we find that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

237

1 there is no good way to squeeze this lemon from

2 Part B to Part E, if it is within the purview of

3 the Board to recommend that DOL ask for some

4 statutory relief in changing the standard and the

5 statute.

6 CHAIR MARKOWITZ: Dr. Welch?

7 I mean, I think just to comment on

8 that, if we are looking at this issue, these

9 couple of issues, we can make certainly

10 observations about weaknesses or deficiencies. 

11 We could probably make some recommendations in

12 general, though not necessarily to the Secretary,

13 about how such a situation might be improved.

14 Dr. Dement?

15 MEMBER DEMENT: Yes, it looks like

16 Task No. 3 is very specific to Subpart B. So, we

17 are not dealing with what I think is a much

18 broader issue, and that is all the other lung

19 diseases that occur beyond the very few we

20 discuss here. Where do we get to those? Do we

21 get to those in Task 2? I mean, where does this

22 come in? For example, where do we consider
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

238

1 criteria for COPD?

2 CHAIR MARKOWITZ: Dr. Welch?

3 MEMBER WELCH: Well, I think that in

4 some ways it could go into 1 or 2 because,

5 really, the issue with COPD is how much exposure,

6 what kind of exposures and how much exposure do

7 you need, and what documentation for that do you

8 need, to determine that it is work-related under

9 the statute? I see the discussion of SEM as

10 really the discussion of exposure assessment

11 rather than the SEM as part of that. So, that

12 could go there.

13 It is kind of where would you put, if

14 we were going to help the agency write a

15 presumption for COPD, where would that go? But

16 that probably goes under 2.

17 CHAIR MARKOWITZ: Yes. Yes, probably

18 2.

19 Dr. Redlich?

20 MEMBER REDLICH: Well, I was hoping

21 John wouldn't raise that question because I was

22 going to offer to see with the more limited
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

239

1 version of addressing beryllium and sarcoid, but

2 it is --

3 CHAIR MARKOWITZ: But I think what Dr.

4 Welch was saying is that C is more limited. 

5 Subtitle B, lung disease issues. And I think

6 John wanted to make sure that we didn't forget

7 about the rest more than where we were going to

8 put it. It is not going to be in C. So, you

9 shouldn't be discouraged.

10 (Laughter.)

11 MEMBER VLIEGER: Dr. Redlich, you

12 could volunteer for more than one Committee.

13 (Laughter.)

14 CHAIR MARKOWITZ: Mr. Whitley?

15 MEMBER WHITLEY: Yes. It is Garry

16 Whitley.

17 From a medical side of the house, is

18 there anything besides the LPT test that -- I see

19 it is kind of like, he said, the gold standard. 

20 But we have people that have eight inconclusives. 

21 You never get an abnormal, but they got eight

22 inconclusives. I was just talking to Kirk. He
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

240

1 said they had the same thing, eight or nine

2 times. They never get a negative; they never get

3 a positive. Is there anything else? I mean, I

4 don't know.

5 MEMBER DEMENT: Yes, people with CBD

6 will never get a positive BeLPT.

7 CHAIR MARKOWITZ: Dr. Welch?

8 MEMBER WELCH: Well, it is kind of a

9 technical question. But, if what they are

10 getting is an indeterminate result, then the

11 people at ORISE recommend you do a test with

12 autologous serum, as opposed to just continuing

13 to do the same test. You do a different kind of

14 test. And that should come out positive or

15 negative and not indeterminate. So, those people

16 could talk to the ORISE experts or I can tell you

17 how. Because we have a process where, if we get

18 two indeterminates, we don't run the test again. 

19 We do a whole different system.

20 CHAIR MARKOWITZ: Other comments?

21 MEMBER REDLICH: I think there have

22 been issues with some of the different labs.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

241

1 MEMBER WELCH: Yes, that's true.

2 CHAIR MARKOWITZ: So, who would like

3 to serve on this Committee, besides Dr. Redlich? 

4 MEMBER REDLICH: Laura has a lot of

5 experience.

6 CHAIR MARKOWITZ: That covers the

7 medical side.

8 MEMBER REDLICH: Someone on the

9 exposure side, I think. No, I think I would like

10 some input on what issues --

11 MEMBER DOMINA: Just for your

12 information, back in June of 2008, the Department

13 of Energy told Hanford, "You need to have one

14 beryllium program." We are in 2016 and we are

15 still fighting with the contractors to come up

16 with what that program is going to be.

17 And we do have a different standard to

18 be more protective for the worker, and that is

19 why I am kind of concerned, based on the rewrite

20 of 10 CFR 850, of doing something here, and then,

21 850 saying something different. And that is why

22 I asked Pat Worthington yesterday, just like I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

242

1 did a month ago in Denver, about it, because this

2 rewrite was supposed to come out three years ago. 

3 And so, I have a concern with that.

4 MEMBER REDLICH: Not to keep going on

5 with beryllium, but how many of the actual

6 workers are machinist type? Are there many or

7 not?

8 MEMBER DOMINA: No.

9 MEMBER REDLICH: Okay.

10 MEMBER DOMINA: We have janitors. We

11 get, right now, at Hanford over the last couple

12 of years, we have been getting like three, two to

13 three, four newly-diagnosed workers a month

14 sensitized, some CBD, and these are not long-term

15 workers. These are workers that are 10 to 15

16 years. Okay?

17 And that is one of the other issues we

18 are having, especially in the D&D world, where

19 they are saying, you know, that we believe that

20 the exposure that people can get needs to be a

21 lot lower than what it has been previously,

22 because of all the sensitization and the CBD that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

243

1 we are getting.

2 CHAIR MARKOWITZ: You know, I think if

3 Ms. Leiton could actually just review the

4 statutory requirements for us, it would help.

5 MS. LEITON: Sorry, I just want to

6 clarify. Ms. Vlieger made a good observation

7 there, and I apologize that the slides themselves

8 probably should have specifically outlined what

9 is in the statute in terms of pre- and post-.

10 For post-1993 beryllium disease, the

11 statute requires any of the following: so, it is

12 basically beryllium sensitivity together with

13 lung pathology consistent with chronic beryllium

14 disease, including the three things. And we will

15 replace your slides.

16 But, first, it is lung biopsy showing

17 granulomas or lymphocytic process consistent with

18 CBD and a CT -- or, no -- a Computerized Axial

19 Tomography scan showing changes consistent with

20 chronic beryllium disease, or pulmonary function

21 or exercise testing showing pulmonary deficits

22 consistent with CBD. So, those are the three. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

244

1 One of the three, the lung biopsy, the CT scan,

2 or a PT test showing pulmonary deficit consistent

3 with CBD. That is post-1993, and that is where

4 it specifically says it has to be consistent with

5 CBD.

6 So, our question is, right now, we go

7 to the doctor. The doctor has to come back to us

8 and say, "This lung pathology is consistent with

9 CBD."

10 MEMBER REDLICH: I get it. We can

11 define that.

12 MS. LEITON: So, how do we get them to

13 help us do that?

14 MEMBER REDLICH: That is a fixable

15 problem.

16 MS. LEITON: So, that is what I am

17 thinking. I just want to make sure, those are

18 the statutes we have to abide by, but we have the

19 wiggle room where, how do we get that definition

20 from the doctor?

21 So, for pre-1993, you have to have the

22 presence of the history, the epidemiological
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

245

1 evidence, beryllium exposure, which we pretty

2 much assume, and any three of the following

3 criteria: characteristic chest radiograph or

4 Computed Tomography, CT, abnormalities. And I

5 think this is right on the slides, but just to

6 reiterate: restrictive or obstructive lung

7 physiology testing or diffusing lung capacity

8 defect, lung pathology consistent with chronic

9 beryllium disease, clinical course consistent

10 with a chronic respiratory disorder,

11 immunological tests showing beryllium

12 sensitivity, which could be a skin patch or a

13 beryllium blood test preferred.

14 So, here's where some of this says

15 specifically lung pathology consistent with CBD. 

16 But, if you don't have that, if the doctors

17 aren't going to tell you that, this gets back to

18 your point, Dr. Boden, where you said, if the

19 doctor doesn't say that, that you could have

20 three of the other ones, like restrictive lung

21 physiology testing, clinical course consistent

22 with a chronic respiratory disorder, and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

246

1 immunological tests showing beryllium

2 sensitivity. Those three don't say anything

3 about CBD necessarily.

4 But, then, you have got the lung

5 pathology consistent with CBD and you have

6 characteristic chest radiograph. What does that

7 mean? How do we define "characteristic"? What

8 do we look for in the reports from the doctor? 

9 And how can the doctors help us with those

10 criteria when we are actually trying to outline

11 what that means?

12 So, that is where we think you guys

13 might be able to really help us figure out, as a

14 claims examiner, what do we say to the doctor? 

15 Well, is this characteristic of CBD? Are they

16 going to come back and say, "Yes, it is

17 characteristic of CBD."? That is where the use

18 of the term "CBD" or just "characteristic chest

19 radiograph," where is our wiggle room? What do

20 we really need to be looking at? What specific

21 objective findings can we use to apply these

22 tests?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

247

1 Now we have procedures; we have ways

2 of doing it now. But this is why I believe that

3 this was one of the topics they wanted the Board

4 to look at, because it is so restrictive, but it

5 is also like, where can we find the middle ground

6 somewhere in these two statutory criteria that we

7 really can't change?

8 So, I hope that like clarifies.

9 CHAIR MARKOWITZ: Thank you.

10 Dr. Welch?

11 MEMBER WELCH: But now I am a little

12 confused because I think you just said that the

13 post-1993 criteria are completely different than

14 what is written here.

15 MS. LEITON: Yes.

16 MEMBER WELCH: Okay. So, I would like

17 this page --

18 MS. LEITON: I apologize for that. We

19 are going to fix it. We are fixing it.

20 MEMBER WELCH: -- corrected and

21 replaced in everybody's book.

22 MS. LEITON: We will. We are doing
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

248

1 it.

2 MEMBER WELCH: Because if this starts

3 to float, I mean --

4 MS. LEITON: We will have it replaced

5 by tomorrow.

6 MEMBER WELCH: Then, you could

7 sometime explain to me how someone could possibly

8 have done that.

9 MS. LEITON: I think a lot of that

10 came from our Procedure Manual in terms of how we

11 were interpreting some of the tests or what some

12 of the tests mean and what we could be looking at

13 in those test results to come up with pathology

14 or the definition.

15 So, I will correct that tonight --

16 MEMBER WELCH: Okay.

17 MS. LEITON: -- make sure you have the

18 correct page. But I apologize.

19 MEMBER REDLICH: So, it actually is

20 pretty consistent with the ATS guideline and

21 there is some --

22 MS. LEITON: But it is still kind of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

249

1 restrictive.

2 MEMBER VLIEGER: If I might?

3 CHAIR MARKOWITZ: Sure.

4 MEMBER VLIEGER: This just goes to

5 show you the different problems we have when we

6 approach the positions, because they have read an

7 article somewhere; they have read a study that is

8 not accepted yet. It just makes this whole

9 process of CBD claims and the discussion with the

10 medical community and the discussion with the

11 unions about protecting the workers so much more

12 difficult because we don't have a level playing

13 field of understanding.

14 CHAIR MARKOWITZ: Are there any

15 additional comments or questions on this topic?

16 On the Committee we have Dr. Redlich,

17 Dr. Welch, and Mr. Domina. And if other

18 volunteers appear, that's great. I see some

19 negotiations over there.

20 (Laughter.)

21 CHAIR MARKOWITZ: Okay. So, what we

22 are going to do, we need to set up for the next
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

250

1 session. All right. We are going to take a

2 five-minute break, just so we can set things up. 

3 So, please be back in five minutes. Thanks.

4 (Whereupon, the above-entitled matter

5 went off the record at 2:16 p.m. and resumed at

6 2:30 p.m.)

7 CHAIR MARKOWITZ: We are going to

8 start the next session here.

9 So, this is the Board's opportunity --

10 we also have a session tomorrow -- to provide DOL

11 with input on proposed changes in regulations. 

12 Let me give a little bit of background. The

13 Board knows this because you have participated in

14 our discussions on Subcommittees so far, but I

15 think the other attendees and the public who

16 might be on the phone aren't aware. So, let me

17 just give a little bit of background.

18 Several weeks ago the Department of

19 Labor reopened the record for comments on the

20 proposed rules. And part of that reopening was

21 essentially an invitation to us to look at the

22 proposed rules and make comments on proposals
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

251

1 that related, in particular, to the Scope of Work

2 that has been assigned to the Board.

3 The way we went about that was we

4 received a briefing on the phone by the Associate

5 Solicitor -- thank you -- here at the Department

6 of Labor, who essentially just went over the

7 proposed changes with us. It was not a

8 discussion, if you recall. It certainly wasn't a

9 discussion among the Board. It was really just

10 letting us know what the proposed changes were.

11 We, then, scheduled a number of phone

12 calls and had these transient Subcommittees which

13 were formed not by theme or by particular

14 proposed changes, but just by convenience, who

15 could be on the phone at what time. And so, we

16 had three phone calls, different sized groups

17 among the Board, in which we discussed the

18 proposed changes and ideas about those changes. 

19 And each group had a scribe and recorded our

20 thoughts about the proposed changes. There was a

21 lot of similarity among the different groups in

22 terms of the thinking.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

252

1 Our task now is to look at those

2 changes again and, if we can, come to some

3 consensus about recommendations we would make or

4 input we would make to the Department of Labor

5 about the proposed changes.

6 The comment period is open until May

7 9th. So that, essentially, if we don't provide

8 input today or tomorrow, then we are not

9 providing input as a Board, because to meet again

10 as a Board before May 9th by phone requires six

11 weeks' notice, as we know.

12 (Laughter.)

13 CHAIR MARKOWITZ: And let me count the

14 days. It is not six weeks until May 9th.

15 So, that means we basically have today

16 and tomorrow in order to consider changes as a

17 group, as a Board, and then, make

18 recommendations, if we want.

19 Now I should say that Board members,

20 as individuals, are certainly free to submit

21 comments to the record by May 9th regarding

22 proposed changes. That is apart from your Board
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

253

1 activity. But, as members of the public, they

2 are entitled to do that.

3 So, if, say, we vote on something and

4 you feel very strongly otherwise, or if there is

5 something that we haven't covered that you think

6 should be covered, by all means, that is up to

7 you whether you want to submit the comment or

8 not.

9 Another consideration, I would just

10 say that this is a fairly challenging task for us

11 to do in a number of ways. One is the Board, we

12 started talking about these proposed changes

13 before even the Board had met, before we had been

14 oriented by DOL about the program. The education

15 we have gotten over the past day and we will

16 continue to get.

17 So, the Board has members of varying

18 levels of knowledge about the program. And we

19 are all, though, even those more knowledgeable

20 are still very much getting up-to-speed about

21 this. We are providing input, making changes in

22 a program that we are just learning about. I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

254

1 consider that to be challenging.

2 The other aspect is that it is a very

3 compressed timeframe for looking at these

4 changes. We have done what we could to look at

5 the changes considered relevant and are going to

6 provide input, I hope, by consensus.

7 One piece of the process I neglected

8 to mention is that the Department of Labor did

9 provide us with some unofficial guidance, I would

10 say, about proposed changes that were within the

11 scope of the charter of the Board and those that

12 were not within the scope.

13 But that was not entirely

14 prescriptive. We could certainly take changes

15 from the second list, the list that was not

16 considered to be within our scope, and move them

17 over to within our scope. It was very clear that

18 we could do that. In fact, we did that. So,

19 that was helpful, but not in any way mandated to

20 us, just to be transparent about the process.

21 Tony, anything I forgot about the

22 process?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

255

1 MR. RIOS: No.

2 CHAIR MARKOWITZ: Okay. So, what we

3 would like to do now is --

4 MEMBER REDLICH: What has prompted the

5 changes at this time? Or is there some reason

6 for the timing right now?

7 CHAIR MARKOWITZ: I can't answer that. 

8 I don't know the answer to that question. 

9 Because of the rules under the Administrative Act

10 regarding the proposed rulemaking process, there

11 can be very limited information that we can at

12 this point get out of DOL about the proposed

13 rules. That is just the matter of what the

14 governing rules are about the rulemaking process.

15 Now whether DOL can answer that

16 question, I don't know, but I would turn that

17 over to Mr. Rios.

18 MEMBER REDLICH: When was the last

19 time? How often are these rules changed?

20 MR. RIOS: Yes. So, we are very much

21 ahead of schedule right now. I had asked that

22 the Associate Solicitor, who gave you all the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

256

1 briefing -- if you remember, Tom Giblin -- I

2 asked him to be present for this part of the

3 conversation. But, because we are so ahead of

4 schedule and he was scheduled in other meetings,

5 I am trying to pull him out of the meeting that

6 he is in right now. So, he will be here in less

7 than five minutes. He can tell you the

8 Department's position.

9 CHAIR MARKOWITZ: So, any other

10 comments or questions?

11 (No response.)

12 CHAIR MARKOWITZ: All right. So, the

13 way this is going to work is that we are going to

14 identify certain issues. We are going to put

15 them up on the screen. Well, first, we are going

16 to show you the language from the proposed

17 changes. It is in blue, and the black is the

18 current regulations.

19 We will simply describe what provision

20 we are looking at, so it is understood. Then,

21 each of the three groups from the scribe will

22 give us summary comments about that particular
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

257

1 proposed change. We will have some discussion

2 about that change.

3 And then, I have taken it upon myself

4 to actually draft, in the interest of time, draft

5 written recommendations based on the three

6 groups' discussions, which we will, then, put on

7 the screen and further discuss, alter, and,

8 ultimately, decide whether we want to endorse

9 those recommendations or not. So, is that

10 reasonably clear?

11 Now I would say, for the people who

12 are sitting way back, I have asked on the screens

13 for the text to be large as much as possible. 

14 You may not be able to see it. You may have to

15 move up, if you want to see it. But, as opposed

16 to maybe some of the other things we have shown

17 on the screen, it will be hard to follow along

18 unless you are able to see what we have on the

19 screen. Okay?

20 Board members have, if you want, in

21 your books, in your briefing books you have a

22 tracked-change version of the proposed changes. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

258

1 It is in Section 7. So, if it is any easier,

2 then you can follow along in the written form.

3 MR. RIOS: Just entering into the room

4 is Tom Giblin, the Associate Solicitor.

5 Tom, you can have a seat. And if you

6 will hold the microphone, that would be better. 

7 Thanks.

8 MR. GIBLIN: All right.

9 MR. RIOS: Okay. He is ready for

10 questions. No, I'm kidding.

11 (Laughter.)

12 MR. GIBLIN: Fire away. I'll give you

13 my best lawyer answer.

14 MR. RIOS: Carrie, do you want to ask

15 your question again?

16 MEMBER REDLICH: Well, I was just

17 wondering what prompted changes at this time.

18 MR. GIBLIN: Well, the last two

19 changes occurred as a result of statutory

20 changes. You know, we got the EEOICPA statute in

21 2001 and got Part E in 2004. So, we have been in

22 the program now for close to 10 years. So, it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

259

1 was a process of going through and looking at our

2 regs again to see what we thought could be

3 changed or needed to be changed. So, it was just

4 good government, I guess would be the best way to

5 describe it.

6 CHAIR MARKOWITZ: Are there other

7 questions?

8 (No response.)

9 CHAIR MARKOWITZ: Let me say -- this

10 is Steve Markowitz -- I mistakenly asked before

11 when you were here about the rationale a certain

12 particular change that was being proposed, and I

13 was told that at this point it really can't be

14 discussed by the Department of Labor. We are

15 free to discuss it among ourselves. So, I just

16 wanted to clarify that point, if there is

17 anything else that I need to know?

18 MR. GIBLIN: No. I mean, we really,

19 because we are in the open comment period, we

20 really have to stick with providing the

21 information that we have already provided to the

22 public; in particular, the preamble to the NPRM. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

260

1 That really sets out the basis for the changes.

2 CHAIR MARKOWITZ: Okay. Thank you.

3 MR. GIBLIN: Thank you.

4 CHAIR MARKOWITZ: And another comment

5 I forgot to mention is that we are going to

6 review about 10 proposed changes that we have

7 identified as relevant to us, to our charter. I

8 have invited Board members on other proposed

9 changes over the last few weeks to bring them to

10 our attention, so we could look at them and think

11 about them. That hasn't been done, which is

12 fine. We have until tomorrow, if there are

13 additional changes. I'm not inviting; I'm just

14 saying that that is the timetable. But, again, I

15 would remind you they really have to fall within

16 the scope of what we are supposed to do.

17 So, let's turn to the first one. I

18 think that probably the easiest way of doing this

19 is if one of us reads, actually. This is on page

20 40, for those of you looking at the print. It is

21 Section 30.231. It is about approving employment

22 and, ultimately, exposure.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

261

1 I just want to read the first one. 

2 (a), the current language is, quote, "Proof of

3 employment may be established by any trustworthy

4 records that on their face, or in conjunction

5 with other such records, establish that the

6 employee was so employed and the written time

7 periods of such employment."

8 And so, the new language, which

9 doesn't replace but augments the current

10 language, is, quote, "If the only evidence of

11 covered employment is a written affidavit or a

12 declaration, subject to penalty of perjury by the

13 employee, survivor, or any other person, and DoD

14 or another entity either disagrees with the

15 assertion of covered employment or cannot concur

16 or disagree with the assertion of covered

17 employment, then OWCP will evaluate the probative

18 value of the affidavit in conjunction with the

19 other evidence of employment, and may determine

20 that the claimant has not met his or her burden

21 of proof under Section 30.111."

22 So, the recorder for each of the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

262

1 groups, Laurie Welch, maybe you could start?

2 MEMBER WELCH: Okay. When our little

3 group discussed this, we had some kind of

4 specific concerns, one of which was in the new

5 highlighted evidence. In one place it says, "If

6 the only evidence of covered employment," et

7 cetera, et cetera, "then OWCP will evaluate the

8 probative evidence of the affidavit in

9 conjunction with the other evidence of

10 employment."

11 So, it is internally inconsistent

12 because it is talking as if there is only an

13 affidavit, but, then, refers to other evidence of

14 employment.

15 Overall, we understand this change to

16 make a worker's affidavit less valuable or it

17 implies that the affidavit is less valuable by

18 describing it that way. And I think it was this

19 section, of our group, we felt that the

20 claimant's occupational history in affidavit form

21 should be an item that can be used to demonstrate

22 exposure and employment. Essentially, that a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

263

1 detailed affidavit about employment, job tasks,

2 activities, should be considered a valuable piece

3 of information. And our understanding of this

4 change is it is a way to discount an affidavit if

5 it is the only thing available. That is in (a).

6 So, do we want to discuss (a)'s --

7 CHAIR MARKOWITZ: We are just

8 discussing (a).

9 MEMBER WELCH: -- separately from the

10 SEM groups? Okay.

11 CHAIR MARKOWITZ: Yes.

12 Mark?

13 MEMBER GRIFFON: Yes. Our group,

14 which was me and John Dement and Steve, a very

15 small group, came up with similar stuff.

16 I mean, one specific question in (a)

17 that we asked for further information was there

18 is also a phrase "another entity" which refers, I

19 think, to -- it says, "DOE or another entity

20 demonstrate or challenge the employment in that

21 time period". And we just wanted to know what

22 "another entity" would be.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

264

1 And then, defining "probative value,"

2 I think that comes up in several sections as we

3 went on. I think that came up again.

4 And can the OWCP give further

5 guidelines on what elements should be included in

6 an affidavit to improve its utility? So,

7 overlapping, I guess.

8 MEMBER WELCH: Similar.

9 MEMBER GRIFFON: Yes.

10 CHAIR MARKOWITZ: And Ken?

11 MEMBER SILVER: Yes. We had a fairly

12 large subcommittee. And now, for something

13 completely different, our consensus I think was

14 that the proposed change represents a slight

15 improvement for claimants because consideration

16 of affidavits is made explicit. Affidavits are

17 not mentioned in the old language. It may be

18 that our subcommittee was just kind of finding

19 its legs. This is the first issue we brought up.

20 CHAIR MARKOWITZ: So, other comments

21 from Board members on this?

22 (No response.)
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

265

1 CHAIR MARKOWITZ: Actually, if you

2 could switch to the draft recommendation? Let me

3 read this. So, it will give you a moment to

4 understand it.

5 "The Board finds that the proposed new

6 language is vague and contradictory. The Board

7 recommends that DOL specify what is meant by" --

8 quote -- "`another entity'" -- end of quote --

9 "that the term `probative value' may be further

10 defined, and that the term `disagrees' be more

11 readily understandable.

12 "The Board notes that the proposed new

13 language contradicts Section 30.111(c) in a

14 manner that limits the value of affidavits. If

15 the goal is to increase the likelihood that

16 affidavits are valid, then guidelines on what

17 elements need to be included in an affidavit

18 should be issued to clarify the claimant's task

19 of proving an employment history in the absence

20 of other evidence.

21 "The Board further recommends that the

22 apparent contradictions in the proposed rule
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

266

1 changes be resolved. That is, the proposed

2 language sets out conditions when the affidavit

3 is" -- quote -- "`the only evidence'" -- end of

4 quote -- "and later states that OWCP will

5 evaluate the" -- quote -- "`affidavit in

6 conjunction with the other evidence of

7 employment.'" End of quote.

8 So, comments, corrections?

9 Dr. Redlich?

10 MEMBER REDLICH: Well, just from an

11 occupational physician point of view and

12 occupational history, especially when you are

13 dealing with many, many years of exposure and

14 more chronic disease, is really considered

15 probably the best available way to assess

16 exposure. So, I wouldn't want any wording that

17 minimized that evidence, as Laura said.

18 CHAIR MARKOWITZ: If you turn to page

19 26, I just want to point out 30.111, Section (c),

20 because it is directly relevant to this. 

21 Frankly, the new language appears to contradict

22 it. So, let me just read it, although in the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

267

1 near future there should be some other readers

2 here.

3 I'm not sure, can you go back? 

4 Actually, it is page 26 and it is 30.111(c). Go

5 down a little, a few paragraphs. There, you are

6 almost there. Okay. Let's see. Yes.

7 So, it says, quote, "Written

8 affidavits or declarations, subject to penalty

9 for perjury by the employee, survivor, or any

10 other person, will be accepted as evidence of

11 employment history and survivor relationship for

12 the purposes of establishing eligibility and may

13 be relied on in determining whether a claim meets

14 the requirements of the Act for benefits if, and

15 only if, such person attests that due diligence

16 was used to obtain records in support of the

17 claim, but that no records exist."

18 So, this paragraph addresses the value

19 and the conditions under which affidavits will be

20 accepted without really any limitation, except

21 for the fact that the claimant has to exercise

22 due diligence in finding the appropriate records,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

268

1 unless I misunderstand this paragraph.

2 And so, the proposed change appears to

3 move away from that and appears to set some

4 optional restrictions on the use of affidavits.

5 Dr. Boden?

6 MEMBER BODEN: So, a couple of

7 comments. One is, actually, the last line or two

8 of the proposed change is also odd in that it

9 sort of limits it to ignoring the affidavit

10 rather than saying that they could either approve

11 or disapprove of the affidavit.

12 I would actually suggest a different

13 approach to this, a simpler approach, that says,

14 maybe with some preamble, that we would suggest

15 that that change be eliminated, and maybe with

16 the same preamble. But it just seems to me, now

17 that we have taken a second look at it, that it

18 really doesn't enhance the ability of DOL to

19 either accept or reject on a reasonable basis the

20 affidavit. But it puts the affidavit in a rather

21 negative light.

22 CHAIR MARKOWITZ: Other comments,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

269

1 questions?

2 Yes, Dr. Cassano.

3 MEMBER CASSANO: Tori Cassano.

4 I agree with Dr. Boden and the comment

5 about the internal inconsistency. If they wanted

6 to make any kind of qualification about the

7 affidavit, my suggestion would, basically, be to

8 take out that whole middle part and, essentially,

9 say after "subject to penalty of perjury by the

10 employee," yada, yada, yada, take out all the

11 rest and just say, "then OWCP will evaluate the

12 probative value of the affidavit." Period. And

13 be silent on the biased statement about disagree

14 versus agree or deny versus accept.

15 CHAIR MARKOWITZ: Dr. Welch?

16 MEMBER WELCH: The problem with your

17 suggestion is, then, it is just really clearly in

18 contrast or in opposition to the 30.111(c)

19 because that says an affidavit is sufficient.

20 MEMBER CASSANO: Yes.

21 MEMBER WELCH: And then, you're saying

22 OWCP could decide, if it is the only evidence,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

270

1 that it is not sufficient. So, I think I am

2 coming down to going with Les' suggestion.

3 I mean, what this is saying is that,

4 if the affidavit is the only evidence and DOE

5 disagrees, then the claims examiner can make some

6 decision. Well, maybe that is okay, I mean if

7 there is contradictory evidence. But it goes on

8 to say "disagrees or cannot concur," you know,

9 which is different. That's different, right,

10 cannot occur or disagree, meaning DOE has no

11 evidence. So, I think the simplest thing would

12 be to eliminate it because, under the statute,

13 the examiners and the agency have the ability to

14 weigh conflicting evidence, if there is

15 conflicting evidence with the affidavit. But we

16 would have to get concurrence on that idea from

17 everybody.

18 CHAIR MARKOWITZ: So, other comments?

19 (No response.)

20 CHAIR MARKOWITZ: So, we need a

21 motion, actually.

22 MEMBER BODEN: Can you go back to the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

271

1 original change?

2 CHAIR MARKOWITZ: Sure.

3 MEMBER WELCH: Les, if you want to

4 read it, it is in your briefing book.

5 MEMBER BODEN: I mean, our suggestion.

6 MEMBER WELCH: Or our suggestion? 

7 Yes.

8 CHAIR MARKOWITZ: The draft

9 recommendation?

10 MEMBER BODEN: The draft whatever that

11 was called.

12 MR. RIOS: So, you want what Steve

13 wrote? Okay. That was up there, yes. There it

14 is right there.

15 MEMBER BODEN: So, I would recommend

16 that we keep the initial paragraph. Well, let's

17 see. Let's read it again. That we keep the

18 initial two sentences of the paragraph and simply

19 say that the Board recommends that the changes --

20 I'm not quite sure of the wording, but that the

21 changes, recommends that the changes not be made. 

22 So, maybe somebody can help me with the wording
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

272

1 on that.

2 CHAIR MARKOWITZ: Dr. Friedman3 Jimenez?

4 MEMBER FRIEDMAN-JIMENEZ: If you

5 remove the change and go back to the original

6 language, essentially, what it says is, "Proof of

7 employment may be established by any trustworthy

8 records that established that the employee was so

9 employed." It is kind of redundant and it

10 doesn't really say much. And I think that we are

11 trying to give some specificity to it. So, maybe

12 we might want to suggest some more clear way of

13 specifying what kind of records will prove

14 employment.

15 CHAIR MARKOWITZ: Well, you know,

16 that's really a different issue. The proposed

17 change really focuses on the issue of the

18 affidavit and how they are going to look at the

19 affidavit. It is not on the whole set of sources

20 they go to, which we have heard about, to prove

21 employment.

22 So, it is recommending detail here on
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

273

1 the other sources is not on the table. I

2 understand your point, and it is in the

3 documentation that DOL provides, but it doesn't

4 relate to the proposed change.

5 MEMBER FRIEDMAN-JIMENEZ: What I am

6 saying is that we should keep something in it

7 that includes mentioning the affidavit.

8 MEMBER WELCH: Yes, that's in the

9 previous section, 30.111 and 30.112.

10 MEMBER FRIEDMAN-JIMENEZ: One eleven.

11 MEMBER WELCH: And 112.

12 CHAIR MARKOWITZ: Yes, which is on

13 page 26.

14 CHAIR MARKOWITZ: Dr. Cassano?

15 MEMBER CASSANO: Actually, taking up

16 what was just said and trying to revise what I

17 said before, actually, if you take that first

18 sentence, put a comma after "such employment,"

19 and say -- I'm sorry. If you took that first

20 sentence under "Proof of Employment," and put a

21 comma after that first sentence, "including an

22 affidavit as defined under 30.111(c) and 30." --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

274

1 or whatever else it is. And that is all you

2 need.

3 MEMBER WELCH: I don't think you need

4 it.

5 MEMBER CASSANO: I don't know. I

6 think you do because somebody may decide that it

7 is not a trusted record. I don't know.

8 CHAIR MARKOWITZ: Dr. Welch?

9 MEMBER WELCH: So, what this paragraph

10 30.231 is about is proving employment-related

11 exposure to a toxic substance. That is the

12 heading. So, to do that, first, they have to

13 demonstrate they were employed. And then, they

14 have to demonstrate there was proof of toxic

15 substances.

16 So, one option for (a) is to refer

17 back to the previous section where it talk about

18 how they demonstrate that they are employed,

19 which would solve what, George, I think you were

20 thinking that first paragraph (a) was a little,

21 the first sentence in (a) was kind of redundant

22 and unnecessary. But it is defined previously,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

275

1 you know. So, proof of employment may be

2 established as specified under 30.111. Because

3 this paragraph is really, the heading is really

4 about (b), but, obviously, you can't prove toxic

5 exposure unless you first prove that you were

6 employed. I mean, it is stepwise.

7 CHAIR MARKOWITZ: So, let me ask Mr.

8 Giblin a question here about what we are

9 permitted to do. We're looking at the proposed

10 changes and trying to provide input on specific

11 new language. Are we also permitted to provide

12 input on existing language which is not up for

13 revision or add language such as being proposed

14 here? Add language which is, again, not already

15 in the proposed changes?

16 MR. GIBLIN: The comments really need

17 to be limited to the proposed changes. I mean,

18 that is the purpose of the exercise under the

19 APA, is that we notify folks of what changes we

20 are making and let people comment on those. If

21 you were to comment on changes that were made

22 and, then, we agreed with them, we would probably
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

276

1 have to go through another rulemaking because,

2 see, people wouldn't have notice that we made the

3 change. And so, it is kind of circular.

4 MEMBER WELCH: Right. Right. That

5 makes sense.

6 CHAIR MARKOWITZ: Okay. So, that is

7 very helpful because it restricts our attention

8 to new language. So, that's good.

9 What are we back to? Take a step back

10 here.

11 MEMBER REDLICH: Could we just make

12 sure that whatever change, because this is also

13 referred to on page 27, and I'm having a little

14 trouble telling what's new and what's crossed out

15 between the blue color and the line through the

16 blue color. I'm a little confused. But, if

17 someone just can make sure it is consistent?

18 MR. RIOS: Yes, that is how tracked19 changes works.

20 CHAIR MARKOWITZ: Right. So, looking

21 at this language on page 27, it's Section 30.112,

22 paragraph (3), or I don't know what you call
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

277

1 these subsections. But it contains the same

2 contradictory language; whereas, the only

3 evidence it starts off of is a written affidavit. 

4 Then, skipping down, "OWCP will evaluate the

5 probative value of the affidavit in conjunction

6 with other evidence of employment."

7 Okay. Well, let's decide first on

8 231(a) and, then, we can go back to that language

9 and provide input.

10 MEMBER BODEN: I had to write it down

11 first. It is better that way.

12 So, my suggestion is, going back to

13 the changes that were proposed, the

14 recommendation that we would make is to keep the

15 first two sentences of that recommendation and to

16 follow those sentences with "The Board recommends

17 that the proposed changes not be made."

18 CHAIR MARKOWITZ: I'm sorry, is that

19 a motion?

20 MEMBER BODEN: That's motion.

21 CHAIR MARKOWITZ: Okay. So, I need a

22 second.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

278

1 (Seconded.)

2 CHAIR MARKOWITZ: So, discussion?

3 If you strike the new language,

4 proposed language, then what sense is it to

5 retain the second sentence of that

6 recommendation, that the Board recommends that

7 DOL specify what is meant by another entity --

8 MEMBER BODEN: No, I'm sorry. I guess

9 I counted the sentences wrong. The first four

10 lines; the first sentence, not the first two

11 sentences.

12 CHAIR MARKOWITZ: Retain the first

13 sentence?

14 MEMBER BODEN: No, there are the first

15 two sentences. The first sentence is "The Board

16 finds that the proposed new language is vague and

17 contradictory." Oh, right, and that would be the

18 only sentence that we would keep. And then, we

19 would say, "The Board recommends that the changes

20 not be made."

21 CHAIR MARKOWITZ: Excuse me. Dr.

22 Welch?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

279

1 MEMBER WELCH: I think including the

2 first three sentences there, going down through

3 "notes the proposed language contradicts Section

4 30.111(c)," that is our reason for recommending

5 that the language be eliminated --

6 MEMBER BODEN: Okay.

7 MEMBER WELCH: -- is those first

8 three. So, I would do the first three and, then,

9 put your language in.

10 MEMBER BODEN: I totally agree.

11 MEMBER WELCH: Friendly amendment to

12 your proposal?

13 MEMBER BODEN: Friendly, very

14 friendly.

15 MEMBER WELCH: Okay. Thank you.

16 (Laughter.)

17 CHAIR MARKOWITZ: I'm not quite

18 understanding. You would retain the second

19 sentence? "The Board recommends that DOL specify

20 what is meant by `another entity'" and the term

21 "probative value" be further defined?

22 That is language which the motion is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

280

1 to eliminate that language. So, it wouldn't make

2 any sense to retain the second sentence.

3 MEMBER BODEN: Okay. So, the first

4 and the third sentences.

5 CHAIR MARKOWITZ: Thank you. Okay.

6 MEMBER BODEN: We got it.

7 (Laughter.)

8 CHAIR MARKOWITZ: Yes, Mr. Griffon?

9 MEMBER GRIFFON: Yes, I just want to

10 bring our attention back to page 27 because, I

11 mean, I just want to be careful what I'm voting

12 on here. I mean, if you go back to the old

13 language, if we are saying we want to eliminate

14 this, we would probably have to do the same thing

15 in this section.

16 CHAIR MARKOWITZ: Yes.

17 MEMBER GRIFFON: And so, Section 3

18 would then read, "If the only evidence for the

19 covered employment is a self-serving affidavit,

20 and DOE or another entity either disagrees or,"

21 duh-duh-duh-duh-duh, "then the OWCP may reject

22 the claim based upon a lack of evidence of
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

281

1 covered employment." That's the old language.

2 CHAIR MARKOWITZ: Okay. So, we will

3 get --

4 MEMBER GRIFFON: Okay. Okay. All

5 right. All right. We'll get to that.

6 CHAIR MARKOWITZ: We will get to that.

7 MEMBER GRIFFON: I just want to make

8 sure we know. Okay.

9 CHAIR MARKOWITZ: We will get to that

10 next.

11 MEMBER GRIFFON: All right. Sorry.

12 MEMBER WELCH: That was my concern

13 over here.

14 MEMBER GRIFFON: Yes, yes, yes. Okay. 

15 Yes.

16 CHAIR MARKOWITZ: So, if we could go

17 back to the -- question: since retaining the

18 first sentence and the third sentence has

19 something to do with providing some rationale for

20 our recommendation, right, the fourth sentence,

21 should we consider retaining that?

22 I quote: "If the goal is to increase
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

282

1 the likelihood that affidavits are valid, then

2 the guidelines of what elements need to be

3 included the affidavit should be issued to

4 clarify the claimant's task of proving an

5 employment history in the absence of other

6 evidence." Or is that not really necessary?

7 Dr. Welch?

8 MEMBER WELCH: Well, I think we can't

9 do that because that would be adding language to

10 the statute, adding new changes that aren't

11 there.

12 CHAIR MARKOWITZ: No, I'm sorry. This

13 is part of the --

14 MEMBER WELCH: Oh, you talking about

15 guidance?

16 CHAIR MARKOWITZ: -- rationale for our

17 proposal. This would be in line with sentences

18 one and three.

19 MEMBER WELCH: Right, but it says, it

20 is suggesting guidelines. But I guess the

21 guidelines could be not in the statute.

22 CHAIR MARKOWITZ: Right.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

283

1 MEMBER WELCH: Not statutory.

2 CHAIR MARKOWITZ: Well, it could be

3 procedural, not regulatory.

4 MEMBER WELCH: Right.

5 CHAIR MARKOWITZ: We could add, then,

6 procedural guidelines or something, which

7 actually already exist, right, to some extent?

8 MEMBER WELCH: I think that is

9 reasonable.

10 CHAIR MARKOWITZ: So, we are on the

11 friendly amendment phase, I think.

12 MEMBER BODEN: Yes.

13 CHAIR MARKOWITZ: So, one friendly

14 amendment was to include the first sentence and

15 the third sentence. And the next is to include

16 this sentence which was just highlighted, the

17 fourth sentence, amended to say, then,

18 "procedural guidelines" under what elements, to

19 make it clear that we are not talking about

20 regulatory guidelines. Does that capture it?

21 MEMBER BODEN: How about just saying,

22 then, "information on what elements need to" --
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

284

1 because procedural guidelines is also maybe, it

2 is not clear what that means.

3 CHAIR MARKOWITZ: Yes, yes. Okay.

4 MEMBER SILVER: I think, as someone

5 who has spent time around the Federal Register

6 and administrative law, knows that there are

7 regulations that are binding and, then, there are

8 guidelines, guidance, that are just suggestive. 

9 So, I think it is fine the way it is.

10 CHAIR MARKOWITZ: Any other comments

11 on that sentence?

12 (No response.)

13 CHAIR MARKOWITZ: And we look at the

14 next paragraph, which is unnecessary because we

15 are recommending that the whole section be

16 struck. Okay.

17 So, I am going to just ask Kevin if

18 you could delete the second sentence and the last

19 paragraph? Right. Or you could strike through

20 it, whichever it. You can delete it. Okay. And

21 then, delete the last paragraph. Okay.

22 Okay. And we can add now Les' motion,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

285

1 which is, "The Board recommends that" --

2 MEMBER BODEN: "The proposed changes

3 not be made."

4 CHAIR MARKOWITZ: Okay.

5 MEMBER BODEN: "The proposed changes

6 not be made."

7 CHAIR MARKOWITZ: Okay. So, we're now

8 looking at the language of the motion with its

9 rationale or preamble. Any further comments or

10 discussion on this before we take a vote?

11 Sure. Mark?

12 MEMBER GRIFFON: I just have a process

13 question. Do we want to vote on these one at a

14 time or are we going to vote on a set of comments

15 that we're submitting as the Board to DOL? I

16 mean, it might be worth going through all of them

17 and sort of drafting, getting the sense of the

18 Board and, then, saving our votes for tomorrow. 

19 That way, we can look over them if we have any

20 final thoughts or deliberations tomorrow. Just a

21 thought, you know --

22 CHAIR MARKOWITZ: Right, right, right,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

286

1 right.

2 MEMBER GRIFFON: -- in terms of

3 process.

4 CHAIR MARKOWITZ: Right. Yes.

5 Anybody have any thoughts about that? 

6 I think the question is hold off on the vote

7 until tomorrow --

8 MEMBER GRIFFON: Yes. I guess two

9 questions. One is I don't know if we are going

10 to submit comments from the Board, if I vote on

11 each individual one and I disagree with one, what

12 does that mean?

13 CHAIR MARKOWITZ: Right, right.

14 MEMBER GRIFFON: Are we just going to

15 vote on one set of recommendations or are we

16 going to --

17 CHAIR MARKOWITZ: Right. I think we

18 should vote on them individually because there

19 may be difference of opinions.

20 MEMBER GRIFFON: But the plan is

21 saving the votes for tomorrow.

22 CHAIR MARKOWITZ: Right, right.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

287

1 MEMBER GRIFFON: Getting the sense of

2 our language today and, then, maybe sort of

3 emailing it to everyone, so we can look at it,

4 look it over tonight before we do our final

5 votes.

6 CHAIR MARKOWITZ: Mr. Rios is simply

7 saying that, yes, we could, when we reconvene

8 tomorrow, go over these and vote. We can't meet

9 tonight and discuss them as the Board.

10 MEMBER VLIEGER: I think the intent of

11 the comment was assigning us homework tonight,

12 separately and individually in our own little

13 rooms with our own little computers, not to have

14 a meeting. So, I have to contradict the intent

15 that we are going to try to have a meeting.

16 MR. RIOS: He asked me if that was

17 okay, and I told him as long as you don't go back

18 to the hotel and review these in groups. So,

19 there was no intent behind that.

20 (Laughter.)

21 MR. RIOS: It was a response to a

22 question.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

288

1 CHAIR MARKOWITZ: So, we interrupted

2 the vote or the discussion on this to consider

3 another question. Fine. A question of process. 

4 And that is, should we delay votes until tomorrow

5 to give people time to think and consider? Any

6 comments on that?

7 Yes, Ken?

8 MEMBER SILVER: Bonus, we get to hear

9 from folks during the public comment period with

10 our draft comments up there.

11 CHAIR MARKOWITZ: The only thing I

12 would say is that tomorrow we have an hour-and-a13 half scheduled for this, beginning at 10:45. So,

14 Ms. Pope is going to be speaking downstairs

15 tomorrow at around 10:40, 10:45, as part of

16 Workers' Memorial Day. There is a half-hour of

17 speeches, and whatnot, in recognition of Workers'

18 Memorial Day between 10:30 and 11:00. And she

19 couldn't attend part of this. And so, if we can

20 afford the time, we will take that half-hour to

21 be downstairs and participate, which would leave

22 -- it's a half-hour -- leave us an hour tomorrow.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

289

1 So, from my point of view, the only

2 consideration is a practical one. Can we take

3 all the votes tomorrow on all the issues?

4 Dr. Cassano?

5 MEMBER CASSANO: Can we split the

6 difference and sort of, if there's still some

7 question, then maybe we will table a vote on any

8 one issue until tomorrow? But, if we are pretty

9 much in concurrence and we feel that we can go to

10 a vote on an issue today, we do that.

11 CHAIR MARKOWITZ: I do think that

12 there are about 10 items on our list, but many of

13 them are fairly straightforward, on which we

14 could take the vote and not feel a need to think

15 about it, and others on which it would be good to

16 have some time.

17 So, I guess the proposal, then, is to

18 decide, with each proposed change that we look

19 at, whether we want to discuss it today, settle

20 on language, but, then, vote on it tomorrow.

21 Les?

22 MEMBER BODEN: Just one alternate
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

290

1 suggestion, if this would work procedurally,

2 which is, we vote on them today, and if there are

3 any we want to reconsider tomorrow, we bring them

4 up.

5 CHAIR MARKOWITZ: Well, that is a

6 variation.

7 (Laughter.)

8 CHAIR MARKOWITZ: That is noted.

9 MEMBER BODEN: I just prefer moving

10 along and voting --

11 CHAIR MARKOWITZ: Right.

12 MEMBER BODEN: -- on things, but I

13 appreciate the concern.

14 CHAIR MARKOWITZ: Right, right.

15 MEMBER BODEN: So, I was just trying

16 to figure it out.

17 CHAIR MARKOWITZ: Right. Dr. Welch?

18 MEMBER WELCH: Well, I would want to

19 make some more comments on this tomorrow after I

20 read all the sections before, because I think we

21 are going to have to edit this based on the

22 previous -- what I am just reading now. So, I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

291

1 would like to hold off on this one, but let's

2 maybe move on.

3 Some little nuances. I mean, I would

4 still say that we wouldn't want to make the

5 proposed changes, but --

6 CHAIR MARKOWITZ: Okay.

7 MEMBER GRIFFON: I think I can live

8 with that compromise, that some might be really

9 straightforward. This one, I want to make sure

10 we have got the language correct, yes. Yes.

11 CHAIR MARKOWITZ: Okay. So, I guess

12 the motion is whether we vote on them

13 individually, whether we are going to decide them

14 today or tomorrow, right? So, is there any

15 further discussion on that?

16 (No response.)

17 CHAIR MARKOWITZ: All in favor of,

18 when we visit each of these proposed changes,

19 that we simultaneously decide whether we are

20 going to vote today or tomorrow. All those in

21 favor of that?

22 (Show of hands.)
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

292

1 CHAIR MARKOWITZ: Okay, it is in

2 favor. Okay. So now, let's revisit this

3 proposed change. The question, I guess, is, the

4 motion is to --

5

6 MEMBER CASSANO: Motion to table.

7 CHAIR MARKOWITZ: Second?

8 (Seconded.)

9 CHAIR MARKOWITZ: Okay. Any further

10 discussion on this?

11 (No response.)

12 CHAIR MARKOWITZ: Okay. All those in

13 favor?

14 (Show of hands.)

15 CHAIR MARKOWITZ: Okay, it is the

16 majority. All those opposed, I guess? 

17 Abstentions?

18 So, we have this language which we

19 will revisit tomorrow.

20 Let's move on. Now I think we should

21 go to this page 27, to this language. It is very

22 closely related. It wasn't discussed separately
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

293

1 by each of the committees that met on this. And

2 it is Item No. 3.

3 Does someone want to read this aloud,

4 just for people in the back who can't see it or

5 people on the phone who don't have access to it?

6 Dr. Cassano?

7 MEMBER CASSANO: "If the only evidence

8 of covered employment is" -- and I am going to

9 read the new language, not the old language --

10 "is a written affidavit or declaration, subject

11 to penalty of perjury by the employee, survivor,

12 or any other person, and DoD or another entity

13 either disagrees with the assertion of covered

14 employment or cannot concur or disagree with the

15 assertion of covered employment, then OWCP will

16 evaluate the probative value of the affidavit in

17 conjunction with the other evidence of

18 employment, and may determine that the claimant

19 has not met his or her burden of proof under

20 Section 30.111."

21 CHAIR MARKOWITZ: Dr. Welch?

22 MEMBER WELCH: But I think, for
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

294

1 purposes of our work, we need to also read the

2 old language because the old language -- I guess

3 what it is is --

4 CHAIR MARKOWITZ: Could you read that?

5 MEMBER WELCH: The way it was read

6 before was, "If the only evidence of covered

7 employment is a self-serving affidavit, and DOE

8 or another entity either disagrees with the

9 assertion of covered employment or cannot concur

10 or disagree with the assertion of covered

11 employment, then OWCP may reject the claim based

12 on a lack of evidence of covered employment."

13 CHAIR MARKOWITZ: Dr. Boden?

14 MEMBER BODEN: So, I have a suggestion

15 about a rewording of the change. All right? 

16 Which would be -- and I will read this. So, it

17 starts out the same.

18 "If the only evidence of covered

19 employment is a" -- cross out "self-serving" --

20 "written affidavit or declaration, subject to

21 penalty of perjury by the employee, survivor, or

22 any other person," then continue down to "then
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

295

1 OWCP will evaluate the probative value of the

2 affidavit in conjunction" -- well, it can't be in

3 conjunction -- "will evaluate the probative value

4 of the affidavit." Period.

5 CHAIR MARKOWITZ: Okay.

6 MEMBER BODEN: So, that is a change. 

7 It strikes the "self-serving" from the old

8 language. It includes the declaration subject to

9 the penalty of perjury, and then, it doesn't say

10 that it may determine that it is bad. It just

11 says it will evaluate it, which seems all that is

12 really necessary.

13 And then, it is consistent, I think,

14 with the change that we recommended in the

15 section that we just discussed.

16 CHAIR MARKOWITZ: So, I think it is

17 important that we see what Les has proposed. So,

18 I've just asked for this section to be copied,

19 moved over to the draft recommendations, and

20 then, we can review those changes --

21 MEMBER BODEN: Okay.

22 CHAIR MARKOWITZ: -- so we can all
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

296

1 look at the language that we are discussing.

2 MR. RIOS: I would like to make a

3 request. Since you're putting together your

4 write-ups that you are going to submit, as my

5 role as a DFO, I am required to ensure that the

6 Board stays within the objectives and the

7 statutory scope, specifically, the four subject

8 matter areas.

9 So, if you are going to make any

10 recommendations on a particular reg, I would like

11 for the Chair to describe how the particular reg

12 on which you're going to make a recommendation

13 falls within your statutory authority.

14 CHAIR MARKOWITZ: You want me to do

15 that now with regard to this proposal, or you are

16 saying in general?

17 MR. RIOS: So, each one of these, if

18 you can evaluate which of the four subject matter

19 areas it falls under, it would be helpful.

20 CHAIR MARKOWITZ: Okay. Well, I can

21 tell you this issue of covered employment

22 certainly relates to SEM and it relates to the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

297

1 evaluation of medical evidence used to judge

2 claims.

3 MEMBER BODEN: So, would you like me

4 to go over my proposal with you?

5 So, we start the same. "If the only

6 evidence of covered employment is a" -- cross out

7 "self-serving".

8 (Pause.)

9 MEMBER BODEN: Okay. So, "If the only

10 evidence of covered employment is a" -- cross out

11 "self-serving". Then, it would say, "written

12 affidavit or declaration, subject to penalty of

13 perjury by the employee, survivor, or any other

14 person," and then, cross out everything until

15 "then OWCP". "Then, OWCP" -- and then, cross out

16 "may reject the claim based upon a lack of

17 evidence of covered employment". Yes. And then,

18 keep "will evaluate the probative value of the

19 affidavit." Period, and cross out the rest.

20 That's it.

21 MEMBER WELCH: Les, weren't you going

22 to leave in the part about the old language, "DOE
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

298

1 or another entity agrees or disagrees"? Because

2 I don't know that we can strike that.

3 MEMBER BODEN: Oh, no, sorry. I'm

4 sorry.

5 MEMBER WELCH: I think we have to

6 leave that in because it's not a change. I would

7 love to strike it, but I don't think we can.

8 (Laughter.)

9 MEMBER BODEN: Yes, okay. I think we

10 can't. I think you are right. I think we can't

11 strike it, as much as I would like to, yes. 

12 Thank you, Laura.

13 Take out "may reject the claim based

14 on a lack of evidence of covered employment,"

15 right.

16 "Then OWCP will evaluate the probative

17 value of the affidavit in conjunction with the

18 other evidence of employment." But it is the

19 only evidence. So, there can't be any other

20 evidence, right? So, take that out. Period.

21 CHAIR MARKOWITZ: No, you took out not

22 only the citation of the other evidence, you also
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

299

1 took out -- just clarifying whether you meant to

2 do this -- take out the language that says, "may

3 determine that the claimant has not met his or

4 her burden of proof under 30.111."

5 MEMBER BODEN: Yes, I did, because I

6 think that is -- so, if that is unnecessary

7 because it is already evaluating the probative

8 evidence --

9 CHAIR MARKOWITZ: Okay.

10 MEMBER BODEN: -- the probative

11 value --

12 CHAIR MARKOWITZ: I wasn't asking why. 

13 I was just asking --

14 MEMBER BODEN: Yes, but I do want to

15 say, I actually do want to say why, right? 

16 Because this, again, gives it that negative

17 twist, right, that says -- because if it says,

18 "may evaluate the probative evidence," that means

19 it could be good; it could be bad. We'll have to

20 decide. But if you say, "will determine that it

21 hasn't met," then it is pushing you in the

22 direction of, well, it would be bad.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

300

1 MEMBER CASSANO: Just a friendly

2 amendment which I think might solve the problem

3 of getting the language about 30.111 in there is

4 to say "as it relates to Section 30.111." 

5 Because, without that, you don't know what the

6 probative evidence you have there is being used

7 to do.

8 MEMBER BODEN: Okay. Right. So, we

9 could, then, put back in, "under paragraph

10 30.111" --

11 MEMBER CASSANO: Or "as it relates to

12 30.111".

13 MEMBER BODEN: Well, I think we should

14 leave their language as much as possible.

15 MEMBER CASSANO: Okay.

16 MEMBER BODEN: So, that is their

17 language.

18 So, it would read then, "the probative

19 value of the affidavit" 

20 MEMBER WELCH: "Under" --

21 MEMBER BODEN: -- "under paragraph" or

22 "Section 30.111".
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

301

1 MEMBER WELCH: Yes.

2 MEMBER BODEN: I am just trying to

3 keep their language as much as we can.

4 CHAIR MARKOWITZ: Okay. So, we need

5 a motion. We will discuss this some more, but we

6 do need a motion around this.

7 Yes?

8 MEMBER WELCH: One little amendment. 

9 We have to reference where we are editing the

10 document because we didn't have that in our -- I

11 mean, this isn't a heading that we had before. 

12 So, we have to be sure to add the 30.112 --

13 MEMBER BODEN: .112.

14 MEMBER WELCH: -- heading there.

15 MEMBER BODEN: Yes, yes. So, I think

16 we replaced the 30.231(b) there with 30.112.

17 MEMBER WELCH: But it has a different

18 title, too.

19 MEMBER BODEN: Right.

20 CHAIR MARKOWITZ: 30.112(b)(3), right?

21 MEMBER BODEN: Yes, (b)(3).

22 CHAIR MARKOWITZ: And if you just take
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

302

1 out the title, I'll replace it.

2 MEMBER WELCH: Okay. Yes. Okay. And

3 do you want to highlight it, so you remember that

4 you need to change it?

5 CHAIR MARKOWITZ: Sure.

6 MEMBER BODEN: Just delete it.

7 CHAIR MARKOWITZ: You can delete that,

8 but just highlight the 30.112(b). Okay. Thanks.

9 So, I'm sorry, what is the motion?

10 MEMBER CASSANO: The motion is to

11 accept the proposed language unless there is a

12 motion to table, I guess, first.

13 CHAIR MARKOWITZ: Okay. The motion is

14 to recommend this language with the changes,

15 right?

16 MEMBER CASSANO: Yes.

17 CHAIR MARKOWITZ: Okay. Is there a

18 second?

19 (Seconded.)

20 CHAIR MARKOWITZ: Okay. So now,

21 discussion? Further discussion?

22 (No response.)
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

303

1 CHAIR MARKOWITZ: Okay. So now, let's

2 decide whether we want to vote on this today or

3 tomorrow. Is there a motion to table this until

4 tomorrow, as in the previous one?

5 I'm sorry, I'm not making myself

6 clear. We have a motion. We can vote on this

7 proposed change or we can table the vote and vote

8 on it tomorrow.

9 And my question is whether you want to

10 vote on now or whether you want to table it and

11 vote on it tomorrow.

12 MEMBER TURNER: I was thinking about

13 earlier we had made mention that we ought to let

14 the public have their comments and, then, we can

15 kind of get some more thoughts and vote on it

16 tomorrow.

17 MEMBER VLIEGER: Dr. Markowitz, I move

18 that we table it until tomorrow.

19 MEMBER TURNER: Second.

20 CHAIR MARKOWITZ: Okay. So, the

21 motion is to table. Fine. Any discussion on

22 that motion?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

304

1 (No response.)

2 CHAIR MARKOWITZ: If not, let's vote

3 on whether -- the motion is to table the vote on

4 this particular recommendation until tomorrow. 

5 All those in favor raise your hand.

6 (Show of hands.)

7 CHAIR MARKOWITZ: All those opposed? 

8 And any abstentions?

9 Okay. So, that passes. So, that is

10 tabled. Let's move on to the next. We finished

11 the first one. That's good.

12 (Laughter.)

13 CHAIR MARKOWITZ: The first is the

14 toughest or maybe the second. I'm not sure. 

15 Maybe the third. But they do get easier; I will

16 say that.

17 Anyway, this is the following item. 

18 It is on page 40, for the Board members, if you

19 are looking at the print copy. Otherwise, it is

20 coming up on the screen. It is proof of exposure

21 to a toxic substance. If you are online or on

22 the phone, it is Item (b) under 30.231.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

305

1 And I think, again, it would probably

2 help if we have someone read this.

3 MEMBER CASSANO: I will be the

4 designated reader then.

5 CHAIR MARKOWITZ: Okay.

6 MEMBER CASSANO: And I'll read both

7 languages, old and new, if it makes any sense.

8 "Proof of exposure to a toxic

9 substance may be established by the submission of

10 an appropriate document or information that is

11 evidence that such substance was present at the

12 facility" -- strike "in which"; substitute

13 "where" -- "the employee was employed and that

14 the employee came into contact with such

15 substance." Strike "OWC Site Exposure Matrices,"

16 is stricken out. And then, "Information from the

17 following sources may be -- strike out "used to

18 provide" and substitute "considered" -- "as

19 probative factual evidence" -- strike out "that"

20 -- "for purposes of establishing an employee's

21 exposure to a toxic substance". And then, it

22 says, "was present at a DOE facility or a RECA
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

306

1 Section 5 facility".

2 Do you want me to go through the 1, 2,

3 and 3?

4 CHAIR MARKOWITZ: Yes.

5 MEMBER CASSANO: No. 1, "To the

6 extent" -- and this is new language -- "To the

7 extent practicable and appropriate from DOE, a

8 DOE-sponsored Former Worker Program, or an entity

9 that acted as a contractor or subcontractor to

10 DOE;"

11 Two, "OWPC Site Exposure Matrices;"

12 Or, three, "any other entity deemed by

13 OWPC to be a reliable source of information

14 necessary to establish that the employee was

15 exposed to a toxic substance at a DOE facility or

16 RECA Section 5 facility."

17 CHAIR MARKOWITZ: Okay. So, we have

18 just the comments from each of the three groups.

19 Laura, do you want to go first?

20 MEMBER WELCH: Sure. Our discussion,

21 what I would summarize from our discussion was

22 that we were unhappy with the vague -- Item No. 3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

307

1 seemed to be vague, and we wanted the whole

2 Committee to discuss it.

3 My opinion, now that I am reading it,

4 the fact that it is very open, which is a good

5 thing, but it allows other sources to come in. 

6 So, I personally don't have the same concern we

7 had when we discussed it on the phone.

8 CHAIR MARKOWITZ: Mark?

9 MEMBER GRIFFON: Yes, we had the same

10 comment, although I think we also said that

11 guidelines, either regulatory or procedural

12 guidelines, should be established to identify

13 what other reliable sources of information might

14 be. And in my own opinion on that, it might be

15 better to put that sort of in a procedure, rather

16 than a regulation, because it might be involved;

17 it is probably going to change anyway.

18 CHAIR MARKOWITZ: Ken?

19 MEMBER SILVER: Before the meeting, I

20 grabbed the law dictionary off the shelf and saw

21 that the word "entity" doesn't apply to

22 individuals. But, as a group, our recommendation
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

308

1 was in (b)(3) to drop the word "entity". So, it

2 reads, "any other source of information deemed

3 reliable".

4 CHAIR MARKOWITZ: Okay. So, if you

5 could put up the draft recommendation, which is

6 what I drafted from the various subcommittee

7 comments?

8 I forgot to say, are there other

9 comments at this point that people wanted to

10 make?

11 (No response.)

12 CHAIR MARKOWITZ: Okay. Yes, Dr.

13 Friedman-Jimenez?

14 MEMBER FRIEDMAN-JIMENEZ: A very quick

15 grammatical question. After Item 1, is it

16 understood that there is an "or" there?

17 CHAIR MARKOWITZ: Yes, I don't know. 

18 I don't know the answer to that.

19 I neglected to say why the Board is

20 justified in looking at this proposed change in

21 terms of our mandate, and this particular issue

22 of proof of exposure to toxic substances relates
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

309

1 to (a) and (b) really, both the Site Exposure

2 Matrices, because this is the information that is

3 used, well, it actually specifies Site Exposure

4 Matrices, but also the medical values which

5 includes information about exposures.

6 So, let me read this language of this

7 draft recommendation.

8 "The Board recommends that DOL

9 change," quote, "`entity'", end of quote, "to",

10 quote, "`entity or other information source'",

11 end of quote, "guidelines (regulations or

12 procedures) on how OWCP determines reliability of

13 the sources of information should be established. 

14 The occupational history from the claimant or an

15 affidavit with relevant exposure information from

16 a coworker should be considered evidence of

17 exposure. In addition, exposure information

18 obtained from an occupational or other health

19 provider who is not affiliated with a Former

20 Worker Program should be accepted."

21 So, let me comment on this, actually. 

22 The changes recommended under this section expand
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

310

1 and specify the sources of information used to

2 obtain evidence of exposure. The old language is

3 less specific and the new language now goes and

4 lists the sources of information for proof of

5 exposure. Those that are listed are DOE, the

6 Former Worker Program, other entities that were

7 contractors or subcontractors of DOE. It adds

8 the Site Exposure Matrices, and then, it adds any

9 other entity deemed by OWCP to be a reliable

10 source of information.

11 It doesn't, however, recognize that

12 the claimant himself and coworkers have this

13 exposure information. That is actually where we

14 normally get it from in conducting an

15 occupational medicine evaluation. So, I

16 understand that there may be a wish to complement

17 that information with other sources, but its

18 absence here I think is problematic.

19 And then, the last sentence of this

20 recommendation relates to naming other health

21 providers other than those at the Former Worker

22 Program as having useful information.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

311

1 Dr. Boden?

2 MEMBER BODEN: I like this. I wonder

3 if -- and this is sort of my thinking, trying to

4 think like a lawyer, which is hard for me --

5 whether saying "should be considered as evidence"

6 should be changed to "may be considered as

7 probative", which is what the rest of the

8 language is. I don't know for sure, but saying

9 "should be considered as evidence" means that you

10 take it as valid in all circumstances, which may

11 be limiting.

12 CHAIR MARKOWITZ: So, I have to ask

13 Mr. Giblin a question I have already asked, but

14 appear to have forgotten the answer. This

15 recommendation, this draft recommendation,

16 actually proposes new language. For instance, it

17 revises "entity" to "entity or other information

18 source". That would be new proposed change in

19 the regulation. And at this point, you can't add

20 that language to the regulation, can you?

21 MR. GIBLIN: I am not quite sure I

22 understand your question, but looking at this
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

312

1 change here --

2 MEMBER WELCH: Right now, it says

3 "entity".

4 MR. GIBLIN: You can change, you can

5 suggest changes to the language, yes, within the

6 -- yes, you certainly can.

7 CHAIR MARKOWITZ: So, we are not

8 limited to revisions or suggested deletions of

9 the new language or reversals of struck language?

10 MR. GIBLIN: No, you're not.

11 CHAIR MARKOWITZ: Okay. Thank you.

12 Dr. Welch?

13 MEMBER WELCH: I think one way to

14 format those insertions of specific other

15 information sources would to be add them in the

16 numbered list. Because says, "Information from

17 the following sources may be considered as

18 probative factual value." And so, we have one,

19 two, three. So, in between two and three, we

20 could insert "the activation list of the

21 claimant, an affidavit of relevant exposure

22 information", and sort of add those to the list. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

313

1 Then, we are basically using the language that is

2 already proposed in the statute.

3 CHAIR MARKOWITZ: Dr. Cassano?

4 MEMBER CASSANO: I would recommend

5 that we do that as an "e.g." rather than as

6 examples. Because if you put it in as the list,

7 then if it is not on the list, then it is

8 excluded. So, in parentheses, we could say

9 "e.g.", such-and-such and such-and-such.

10 CHAIR MARKOWITZ: Dr. Dement, do you

11 have a comment on Dr. Cassano's remark?

12 MEMBER DEMENT: If I can get the

13 microphone on.

14 (Laughter.)

15 MEMBER DEMENT: It's hard to see the

16 light. Yes, it's on. Button-pushing 101 is not

17 my forte.

18 (Laughter.)

19 CHAIR MARKOWITZ: I think it seems to

20 be limited to this side of the room.

21 (Laughter.)

22 MEMBER DEMENT: Yes, we are very
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

314

1 limited on this side.

2 (Laughter.)

3 CHAIR MARKOWITZ: Okay. Dr. Dement

4 has the floor.

5 MEMBER DEMENT: I think we cover that

6 concern in not using "e.g.". I think it would

7 actually be more prescriptive in the list because

8 at the end we have other information. With this

9 change from "entity" to "other sources of

10 information", I think we have covered that well.

11 CHAIR MARKOWITZ: Yes, personally, the

12 "e.g." is "for example". That seems quite

13 optional. It doesn't have the weight that

14 actually naming/listing does. So, I would agree

15 with that.

16 Other comments, suggestions?

17 Yes, Dr. Silver?

18 MEMBER SILVER: Maybe during the

19 public comment period the folks who have worked

20 as Authorized Representatives can tell us -- I

21 don't know. I thought about when I started on

22 this work and had some interactions, pro bono
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

315

1 only. I am sure I earned a reputation with

2 people who work in the district offices as being

3 a long list of adjectives, unreliable maybe being

4 one of them. But I was supplying really good

5 information from old DOE reports, from peer6 reviewed journal articles, from the things that a

7 document hound comes up with.

8 So, is it the provider of the

9 information or is it the information itself? And

10 I just want to make sure our formulation doesn't

11 impair the ability of self-taught Authorized

12 Representatives to deliver smoking-gun

13 documentation.

14 CHAIR MARKOWITZ: Additional comments?

15 Yes, Dr. Boden?

16 MEMBER BODEN: Hopefully, just to

17 respond to Ken's comment, maybe what we want to

18 say is "any other information deemed by OWCP to

19 be reliable" rather than to name the source of

20 the information. I think that is a good point. 

21 What is a reliable source of information?

22 CHAIR MARKOWITZ: Okay. So, you are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

316

1 going to need to propose some language that

2 modifies what we are looking at to accommodate

3 that.

4 Let me ask a question of Dr. Welch. 

5 You thought that it would be more effective if we

6 actually provided the language of Item No. 4, the

7 occupational history or affidavit from the

8 claimant or coworker; No. 5, any other health

9 provider.

10 Do you think that it is necessary or

11 preferred that we provide that language as

12 opposed to what we are looking at now in which we

13 say that we recommend that these sources be

14 included among the sources?

15 MEMBER WELCH: Well, I think if we put

16 it in a paragraph the way we have it now, we have

17 to be careful about the terms that we use when we

18 describe it, such as "should be considered", "the

19 occupational history or affidavit should be

20 considered evidence of exposure". Do we need to

21 say, "considered probative evidence of exposure"? 

22 And then, in the last sentence, it says, "should
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

317

1 be accepted", but "accepted" is not a term that

2 is used in that paragraph.

3 So, I was thinking if we specifically

4 said insert these as part of the list --

5 CHAIR MARKOWITZ: Right, right.

6 MEMBER WELCH: -- then we are using --

7 we don't have to try to match the language where

8 we are making some mistake that makes these sound

9 less valuable, like just an add-on.

10 CHAIR MARKOWITZ: Okay. Okay.

11 MEMBER WELCH: And it wouldn't be

12 four, five, six. The No. 3 would be the last

13 one.

14 CHAIR MARKOWITZ: Right. I get that. 

15 I get that, yes. Yes

16 MEMBER WELCH: So, it would be we

17 would move down the numbering.

18 CHAIR MARKOWITZ: Okay. So, yes, Dr.

19 Friedman-Jimenez?

20 MEMBER FRIEDMAN-JIMENEZ: The language

21 "should be considered evidence of exposure" might

22 be misconstrued as saying, "should be considered
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

318

1 sufficient evidence of exposure", which it is

2 really not. And that could cause them to say,

3 "Let's just delete it." So, maybe we should say,

4 "should be considered sources of probative

5 evidence of exposure", or something like that. 

6 So that they are included among the sources --

7 CHAIR MARKOWITZ: Right.

8 MEMBER FRIEDMAN-JIMENEZ: -- but we're

9 not saying that that is automatically proving

10 exposure.

11 CHAIR MARKOWITZ: So, the

12 recommendation is that we add, as an item number,

13 a new Item No. 3, the occupational history

14 obtained from the claimant or an affidavit of the

15 claimant containing the same information. And

16 then, add a new Item No. 4, which would be

17 "information from occupational and other health

18 provider who is not affiliated with the Former

19 Worker Program". Those enter the list.

20 What precedes that is this language,

21 George. "The following sources" -- quote -- "may

22 be considered as probative factual evidence for
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

319

1 the purposes of establishing an employee's

2 exposure to a toxic substance at a DOE facility". 

3 So, that is the language that would apply to

4 these new items on the list. And I think that

5 addresses your concern.

6 MEMBER FRIEDMAN-JIMENEZ: Yes.

7 CHAIR MARKOWITZ: Okay. Okay.

8 MEMBER CASSANO: Just a question. So,

9 the recommendation is to add those two as Items 3

10 and Items 4 and keep current Item No. 3 as Item

11 5?

12 CHAIR MARKOWITZ: Correct.

13 MEMBER CASSANO: Okay. Then, I'm cool

14 with that.

15 CHAIR MARKOWITZ: Okay.

16 MEMBER GRIFFON: Just one more

17 clarification, Steve. When you say,

18 "occupational history from the claimant", are you

19 talking specifically about the occupational

20 history questionnaire that they do through the

21 Resource Center or any occupational -- because I

22 think that might, well, in my opinion, that ought
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

320

1 to be listed, the occupational history

2 questionnaire.

3 CHAIR MARKOWITZ: You want to list

4 that specific --

5 MEMBER GRIFFON: Well, maybe not.

6 CHAIR MARKOWITZ: Right.

7 MEMBER GRIFFON: I'm asking, what did

8 you mean by your language?

9 CHAIR MARKOWITZ: Right, right.

10 Well, here I'm a little lost because

11 the answer really depends on how the program

12 operates, because you have the occupational

13 health questionnaire and, then, the history

14 questionnaire and, then, you probably have some

15 supplemental affidavits that are sometimes

16 submitted --

17 MEMBER GRIFFON: Yes, right.

18 CHAIR MARKOWITZ: -- by either the

19 claimant or coworkers, right? So, all that

20 information should enter into the calculations.

21 I can come up with some language

22 tonight that we can look at tomorrow. It will
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

321

1 say something like "occupational history

2 information obtained from either the occupational

3 history questionnaire or comparable affidavit",

4 or something like that, something that is general

5 enough to include all sources.

6 Yes, Dr. Boden?

7 MEMBER BODEN: So, I have some

8 specific language to address Ken's concern.

9 CHAIR MARKOWITZ: Okay.

10 MEMBER BODEN: This is what is

11 currently No. 3 and now is going to be No. 6 or

12 7, or whatever it is. And it would state, "any

13 other information deemed by OWCP to be reliable

14 for purposes of establishing that the employee

15 was exposed to a toxic substance at a DOE

16 facility", et cetera. So, it removes "source",

17 but keeps "information", essentially.

18 CHAIR MARKOWITZ: So, you're replacing

19 the language --

20 MEMBER BODEN: Yes.

21 CHAIR MARKOWITZ: -- the existing

22 language of three? Is that what you are saying?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

322

1 MEMBER BODEN: Right. I'm replacing

2 it. Essentially, it has to be somewhat

3 reformulated to give the idea that it is

4 information rather than source.

5 CHAIR MARKOWITZ: Right, right. So,

6 you can get his language on the draft

7 recommendation.

8 MEMBER BODEN: So, I will say it

9 slowly. It is "any other information" -- oh,

10 sorry.

11 CHAIR MARKOWITZ: Dr. Welch?

12 MEMBER WELCH: I mean, I actually

13 think it is okay to have "reliable sources"

14 because really what is above there are sources of

15 information. So, if something comes from the

16 Former Worker Program, this is saying it's a

17 source that can be used, and you don't

18 necessarily have to independently assess the

19 value of the information.

20 Now what you are suggesting is that,

21 in addition to sources and information, some

22 information itself can be of probative factual
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

323

1 value. But I don't I necessarily want to take

2 out the "other entity deemed to be a reliable

3 source of information", because it is sort of

4 like, you know, an affidavit from an industrial

5 hygienist who used to work at the plant. Okay? 

6 So, they could deem that to be a reliable source

7 of information. I guess that is what I am

8 saying. It is like there is an advantage to

9 saying "sources", and it seems like that is what

10 this paragraph is about. It is how the

11 information gets into the program.

12 I mean, I don't know that I'm saying

13 I don't agree with your changes, but I don't

14 think it is that simple. What do you think, Ken?

15 MEMBER SILVER: I think there are

16 highly incentivized, increasingly sophisticated

17 Authorized Representatives who aren't part of an

18 entity who hit the stacks and know every document

19 archived in the public arena, laid down by CDC

20 over the years, whomever, and that is where they

21 find reliable information.

22 And the District Office may have them,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

324

1 you know, on sort of a black list, and they

2 shouldn't be judged because of their past battles

3 with the District Office; a four-square piece of

4 paper should be judged.

5 CHAIR MARKOWITZ: But what if you just

6 took the existing language that says, "any other

7 entity deemed by OWCP to be reliable" and say,

8 "any other entity or information source which

9 provides information that is deemed to be

10 reliable by OWCP"? Would that combine the two

11 thoughts?

12 MEMBER CASSANO: Yes, I think it is

13 almost too complicated at that point. I think

14 just basically saying, "any other entity or

15 source of information deemed reliable by OWCP",

16 which is what we have originally --

17 MEMBER BODEN: But that is what Steve

18 just said.

19 MEMBER CASSANO: Yes. Okay.

20 MEMBER SILVER: That's cool, yes.

21 MEMBER CASSANO: No, he added in a

22 different source of information deemed reliable.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

325

1 MEMBER BODEN: Oh, I see.

2 MEMBER CASSANO: Yes.

3 CHAIR MARKOWITZ: We have to see the

4 change. If you could scroll up a little bit,

5 just so we can see? Okay.

6 So, I think the language was "any

7 other entity or source deemed by OWCP to provide

8 information that is reliable". Okay. So, that

9 switches it. What is reliable is the

10 information, not the source. So, if you could,

11 "any other entity or source that is deemed by

12 OWCP to provide information that is reliable".

13 MEMBER WELCH: Or "to provide reliable

14 information"?

15 CHAIR MARKOWITZ: Yes, "to provide

16 reliable information". That's fine. And then,

17 you can take out "necessary". Okay.

18 Does that now capture it? Okay. So,

19 any other?

20 (No response.)

21 CHAIR MARKOWITZ: Again, on listing

22 the occupational history and the other
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

326

1 occupational health provider, I will refashion

2 the language into a list, so it mimics what is in

3 the current proposed changes.

4 Any other changes?

5 (No response.)

6 CHAIR MARKOWITZ: Okay. So, is there

7 a motion to table a vote on this proposal until

8 tomorrow?

9 (Motion.)

10 CHAIR MARKOWITZ: And is there a

11 second?

12 (Seconded.)

13 CHAIR MARKOWITZ: Okay. Any further

14 discussion?

15 (No response.)

16 CHAIR MARKOWITZ: So, all those in

17 favor of tabling the vote on this until tomorrow?

18 (Show of hands.)

19 CHAIR MARKOWITZ: All those opposed? 

20 And any abstentions? Thank you.

21 Okay. So, let me just say it is four

22 o'clock. We are going to have a public comment
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

327

1 period at five o'clock. We are going to take a

2 break. The question is, when do you want to take

3 that break? Do you want to take it right before

4 the public comment period or do you want to take

5 it now?

6 Yes, okay. We are going to take a

7 break now. Be back in 15 minutes. Thank you. 

8 4:15.

9 (Whereupon, the above-entitled matter

10 went off the record at 3:59 p.m. and resumed at

11 4:17 p.m.)

12 CHAIR MARKOWITZ: We are now going to

13 focus on the next proposed change which is

14 Section -- it's on page 40, for those of you who

15 have the written document. It is being brought

16 up on the screens. And it's Section 30.232.

17 This falls within the scope of the

18 Board's mandate because this issue addresses the

19 question of causation, the connection between

20 exposure and disease, and that clearly fits

21 within at least (a) and (b) of our assigned

22 tasks.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

328

1 So, Section 20.232, and the title of

2 the Section is "How does a claimant establish

3 that the employee has been diagnosed with a

4 covered illness or sustained an injury, illness,

5 impairment, or disease as a consequence of a

6 covered illness?"

7 So, Tori is going to read. Large

8 sections of this are struck out. We are not

9 going to read the sections that are struck out,

10 just for the sake of time. You can see the

11 section there, and if you scroll down on the next

12 page, it continues and new language is what we

13 will read.

14 MEMBER CASSANO: So, the new language

15 reads, "To establish that the employee has been

16 diagnosed with the covered illnesses required

17 under Section 30.230(d), the employee or his or

18 her survivors must provide the following:

19 "(1) Written medical evidence

20 containing a physician's diagnosis of the

21 employee's covered illness (as that term is

22 defined in Section 30.5(s)) and the physician's
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

329

1 reasoning for his or her opinion regarding

2 causation, and

3 "(2) Any other evidence OWCP may deem

4 necessary to show that the employee has or had an

5 illness that resulted from an exposure to a toxic

6 substance while working at either a DOE facility

7 or a RECA Section 5 facility." Period.

8 CHAIR MARKOWITZ: So now, the reports

9 from the various subcommittees.

10 Ken, do you want to go first this

11 time?

12 MEMBER SILVER: Sure. Our

13 subcommittee felt that the phrase "any other

14 evidence OWCP may deem necessary" should be

15 removed, feeling that it is overly-broad, not

16 necessary, and could form the basis for

17 adversarial interactions between OWCP and

18 claimants.

19 Further suggestion to consider

20 replacing the phrase "physician's reasoning" with

21 "physician's rationale".

22 I'll leave it at that.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

330

1 CHAIR MARKOWITZ: Okay. Mark?

2 MEMBER GRIFFON: We had a similar

3 comment on that and said this is too vague,

4 asking, also, is there where OWCP may ask for a

5 second opinion?

6 And the second comment we had was

7 asking for a written opinion, including the,

8 quote, "the physician's reasoning for his or her

9 opinion regarding causation", end quote, puts too

10 great of an onus on the claimant at this stage of

11 the claim's process, as many conditions will have

12 been diagnosed by a general practitioner who may

13 be incapable or unwilling to provide the report

14 being required.

15 CHAIR MARKOWITZ: Thank you.

16 Laurie?

17 MEMBER WELCH: Yes, our group had a

18 similar assessment to what Mark had just said. 

19 We were under the impression that this change was

20 saying that all new claims or incoming claims now

21 require a written physician opinion on causation

22 from the person's treating physician, when the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

331

1 practice has been that the claims examiners could

2 award, could determine if it was a covered

3 illness using other information without the

4 treating physician's opinion on causation.

5 And so, again thinking that this is a

6 burden on the claimant, and it also seems to be a

7 really big change to the process, as the way the

8 whole program has been running, the way our group

9 understood the change.

10 CHAIR MARKOWITZ: Okay. Comments from

11 other Board members?

12 (No response.)

13 CHAIR MARKOWITZ: So, if you could

14 bring up the draft recommendation? Let me read

15 this.

16 "The Board recommends that DOL remove

17 the requirement that the claimant must produce

18 written medical evidence where a physician

19 describes the" -- quote -- "`reasoning for his

20 her opinion regarding causation'" End of quote. 

21 "The Board believes that sufficient expertise in

22 the causation of occupational illness is unlikely
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

332

1 to be available in DOE communities, and the time

2 commitment for physicians to produce such a

3 documented report makes this requirement

4 unrealistic and places too great a burden on the

5 claimants.

6 "In addition, the Board is concerned

7 that" -- quote -- "`any other evidence the OWCP

8 may deem necessary'" -- end of quote -- "is

9 overly-broad, unnecessary, and may form the basis

10 for adversarial interactions between OWCP and

11 claimants."

12 Comments?

13 (No response.)

14 CHAIR MARKOWITZ: It's late, but we've

15 got to get there. We've got to get there.

16 (Laughter.)

17 CHAIR MARKOWITZ: Dr. Dement?

18 MEMBER DEMENT: So, what is our

19 recommendation? I mean, are we recommending the

20 language that has been proposed be removed and

21 the existing language retained? I guess the

22 concern at this point of the process of filing a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

333

1 claim, a lot of times it is simply a diagnosis of

2 a disease and may or may not have all this other

3 written opinions, which will be developed as the

4 claims process goes forward. Frankly, I don't

5 see the reasoning for the changes.

6 CHAIR MARKOWITZ: Dr. Cassano?

7 MEMBER CASSANO: Yes. In looking at

8 the old language, I mean, that seems incredibly

9 onerous. I think the piece about -- I don't

10 think requiring the written medical evidence with

11 the rationale, as I look at this from writing a

12 regulation, I don't think that basically says, if

13 it is not there, the claim is going to be

14 immediately denied. They are still going to

15 develop it.

16 But I think if you remove that, then

17 there is no basis for the treating physician to

18 even try to give a rationale. And so, I have got

19 mixed emotions on that first one. I fully agree

20 with the fact that the second one is way too

21 broad and could be horribly interpreted.

22 But I think we need to include -- and
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

334

1 maybe the answer is to say, "and where possible,

2 the physician's reasoning or rationale" or "where

3 applicable". Because they are going to have to

4 develop a medical opinion. I mean, that is the

5 whole point. You've still got to get to less

6 than likely, at least as likely or not, or more

7 than likely. And if we remove this, then there

8 is no a priori need for the treating physician to

9 even try to do it.

10 CHAIR MARKOWITZ: Dr. Welch?

11 MEMBER WELCH: Well, I think you can

12 run a really adequate comp program and never get

13 a causation opinion from the treating physician. 

14 So, I guess I disagree. I mean, if they can do

15 it, fine. But most of them don't know how, and

16 if they are going to do it, they are going write

17 language that is not probative.

18 I mean, what was there before

19 basically said the claimant provides information

20 for the physician that could provide information

21 on the diagnosis, and some other source brings in

22 an occupational history. And then, OWCP asks for
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

335

1 other information.

2 But if what you get is all the right

3 inputs, then the claims examiner with the

4 consultant can make the causation decision. So,

5 you don't have to have the treating physician.

6 And the way it is written now, it says

7 the claimant must provide.

8 CHAIR MARKOWITZ: You are talking

9 about the proposed language?

10 MEMBER WELCH: The proposed language

11 is the claimant must provide. So, if they don't

12 provide a physician's diagnosis and the

13 physician's reasoning, you're done. That's the

14 way this is written now.

15 CHAIR MARKOWITZ: I agree.

16 Other comments?

17 Dr. Boden?

18 MEMBER BODEN: I think there is

19 another problem with this, in that the Act does

20 not require, as we have talked about before,

21 causation, right? It requires whatever the words

22 are, aggravated, contributed to, et cetera, et
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

336

1 cetera. So, an opinion on causation is not

2 required by the Act.

3 CHAIR MARKOWITZ: But that specific

4 point can be addressed simply by replacing

5 "causation" with "aggravation, contribution, and

6 causation", if I get your point correct.

7 MEMBER BODEN: Right. I guess what I

8 am saying is, however we decide to address this,

9 we ought to in our reasoning include the fact

10 that this is overly-restrictive because --

11 CHAIR MARKOWITZ: By discussing only

12 causation?

13 MEMBER BODEN: By discussing only

14 causation.

15 CHAIR MARKOWITZ: Dr. Redlich?

16 MEMBER REDLICH: Just in general, many

17 of the points that we are bringing up relate to

18 the tasks that we were asked to address on this. 

19 So, is there an urgency to change the rules now? 

20 It just seems like the order of this is sort of

21 reversed.

22 (Laughter.)
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

337

1 MEMBER REDLICH: I mean I am just

2 confused.

3 CHAIR MARKOWITZ: Okay. The timetable

4 is not of our making. The question is whether we

5 can contribute something really.

6 MEMBER REDLICH: Okay, but can it be

7 postponed --

8 PARTICIPANT: No.

9 MEMBER REDLICH: -- or just the wheels

10 have to turn? Okay. Okay.

11 CHAIR MARKOWITZ: Other comments?

12 MEMBER CASSANO: Just one, and I don't

13 know if it would be acceptable because this is

14 not language that was changed. But, if you go to

15 Part A, if you go to the subtitle under A,

16 changing one word and making the changes about

17 causation in there would make this acceptable. 

18 And instead of saying "must", you could put

19 "should". And then, it would not be a dead-end

20 and they would still continue to develop it.

21 I mean, this is from somebody that

22 writes this stuff, wrote this stuff. I have real
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

338

1 problems taking that whole requirement out

2 because I really think, No. 1, it will never go

3 through and, No. 2, basically, then all you need

4 is a diagnosis from an EHR or a medical record. 

5 And there is nothing that says that a physician

6 has to at least address the concept of the effect

7 of the exposure on the medical condition. And I

8 think that weakens things a lot.

9 And I am trying not to be hard-hearted

10 here. I am trying to look at this from a

11 practical perspective of somebody who is going to

12 be looking at this regulation and making a

13 decision.

14 CHAIR MARKOWITZ: Dr. Welch?

15 MEMBER WELCH: One thing I think would

16 be useful for our Board to do, or to make

17 recommendations for, is to help OWCP develop

18 presumptions for some of the common illnesses. 

19 So, if there were a presumption of how you are

20 diagnosed with asbestos-related disease, you

21 wouldn't need the treating physician's opinion. 

22 So, we don't want to end up requiring that in all
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

339

1 the cases anyway.

2 Like I said, I mean, there's a lot to

3 -- I'm familiar with the trust funds that

4 administer asbestos claims, for example, and they

5 don't require physicians' opinions. They require

6 these 10 pieces of information that, then, lead

7 to presumption in 90 percent of the cases that

8 come in. But we already discussed that

9 particular point. But I think we should be

10 careful about requiring an opinion from the

11 treating physician.

12 CHAIR MARKOWITZ: So, Dr. Whitley?

13 MEMBER WHITLEY: Why couldn't you just

14 stop it after 30.5(s)? Written evidence, you

15 know, containing physician's diagnosis of

16 employee's covered illness as divined by 30.5(s). 

17 Why do you need that other part in there?

18 MEMBER FRIEDMAN-JIMENEZ: It's

19 implied.

20 MEMBER WHITLEY: That he has to give

21 the opinion?

22 MEMBER BODEN: I have a proposal.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

340

1 CHAIR MARKOWITZ: Okay. Yes, Dr.

2 Boden.

3 MEMBER BODEN: Yes. My proposal is

4 that we have a preamble that I think includes the

5 stuff that is up there and, also, includes some

6 language about the causation of illness being too

7 limiting, and then, says that something to the

8 effect that we don't think the changes should be

9 made.

10 That is, I don't know if people object

11 to anything in the original language. It would

12 seem to be much less restrictive. But, then,

13 that's fine. Then, we should talk about that.

14 Go ahead.

15 MEMBER POPE: As Garry was stating, I

16 don't see what is wrong with stopping right there

17 after the 30.5(s).

18 CHAIR MARKOWITZ: So, I understand

19 that suggestion. Do you mean to suggest that the

20 physician should be addressing the issue of

21 aggravation, contribution, or causation? Or are

22 you simply saying that the physician should
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

341

1 simply provide evidence for the medical

2 diagnosis, what the disease is? It is the latter

3 one, right? The "covered" part is misleading in

4 that sense, though.

5 Yes, Dr. Friedman-Jimenez.

6 MEMBER FRIEDMAN-JIMENEZ: The original

7 language, in the first paragraph, paragraph 1,

8 the last sentence, it says, "and to the extent

9 practicable, a copy of the diagnosis and summary

10 of the information upon which the diagnosis is

11 based". That phrase "and to the extent

12 practicable" I think gives the leeway that, if

13 they can't find a physician that is willing to

14 comment or state their opinion on causality, then

15 it is not going to throw out the case. It will

16 just have to go to the contracted medical -- the

17 CMC.

18 But, if we just stop it after 30.5(s),

19 then that still will require them to give an

20 opinion because it says, "covered illness". And

21 covered illness is defined as an illness that is

22 caused by the toxic exposure. So, that would
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

342

1 imply that the physician would still have to give

2 his opinion or her opinion on why it was a

3 covered illness.

4 So, I think adding that phrase "to the

5 extent practicable" gives that degree of

6 flexibility, and maybe we should suggest that

7 they do that.

8 CHAIR MARKOWITZ: If you could remove

9 the word "covered", that would address that

10 concern.

11 MEMBER FRIEDMAN-JIMENEZ: Remove the

12 word "covered"?

13 CHAIR MARKOWITZ: Yes. I am just

14 saying if we remove the word "covered" in

15 30.5(s), it is clear that the interest is in the

16 diagnosis, not the causation aspect.

17 MEMBER REDLICH: But, then, the next

18 part of the sentence it goes on and says it

19 again. In No. (2)(b), it is restated. It is

20 sort of repetitive. Or is that something

21 different?

22 CHAIR MARKOWITZ: That's a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

343

1 consequential -- yes, it is a different category

2 than this issue.

3 MEMBER WELCH: So, Carrie, it says,

4 "an injury, illness, impairment, or disease

5 sustains the consequence of a covered illness".

6 MEMBER REDLICH: Oh, I'm sorry.

7 MEMBER WELCH: Yes.

8 MEMBER REDLICH: I'm sorry.

9 MEMBER CASSANO: Okay. Take the word

10 "covered" out and strike the end of it on "the

11 physician's reasoning" or put "to the extent

12 practicable, the physician's reasoning".

13 MEMBER BODEN: I don't think you can

14 take the word "covered" out because that just

15 says that the physician has diagnosed you with

16 some illness. I mean, it could be the flu that

17 you had last week, right? I mean, it sort of

18 doesn't make any sense in this context.

19 MEMBER CASSANO: But Part E is any

20 illness anyway. So, under Part E, any illness is

21 covered. So, I would just take out --

22 MEMBER BODEN: Is that right?
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

344

1 CHAIR MARKOWITZ: So, Dr. Welch?

2 MEMBER WELCH: I think if you leave

3 the word "covered illness", that means a specific

4 condition that has been established to be caused

5 by toxic exposures. So, I think we might want to

6 try as best we can within this language to

7 separate the medical diagnosis, the diagnosis of

8 a specific medical condition, from the

9 determination of work-relatedness or toxic10 relatedness. "Covered illness" puts them both in

11 one phrase.

12 So, if what we want the physician to

13 provide is documentation that supports the

14 specific diagnosis, the specific medical

15 diagnosis, you could make that, you know,

16 "written medical evidence containing a

17 physician's medical diagnosis for the illness

18 that is claimed", or however. Or just leave it

19 that way. But, in a way, that is what the old

20 language did.

21 MEMBER CASSANO: Yes, but it just went

22 on and on and on. The old language is "and",
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

345

1 "and", "and". So, they had to provide all of

2 that. It wasn't "or".

3 MEMBER WELCH: But it is not providing

4 very much, in my opinion. I mean, that is

5 something that the advocates could weigh-in on

6 because they have dealt with that. But it is

7 providing the name and address of the physician

8 who can provide the diagnosis, a medical release

9 for other records, an occupational history, and

10 other things OWCP asks for.

11 CHAIR MARKOWITZ: Mr. Giblin?

12 MR. GIBLIN: Yes. Just to clarify,

13 and you can see this in the preamble, this used

14 to be for Part D, which is no longer in

15 existence. And that is why we had all the

16 language that was in there. So, that is why it

17 is being replaced. This is now for establishing

18 a covered illness for Part E. So, I just wanted

19 you to understand what prompted this change.

20 CHAIR MARKOWITZ: Ms. Vlieger?

21 MEMBER VLIEGER: If we go back to the

22 definition -- and that's on page 15 -- "covered
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

346

1 illness means, under Part E of the Act relating

2 to exposures, at a DOE facility or a RECA Section

3 5 facility, an illness or death resulting from

4 exposures to a toxic substance."

5 So, it has got a slightly different

6 definitive term under these rules than commonly

7 what you would think. "Covered" means you are

8 covered by insurance. This means an illness that

9 will be considered. Now that is my opinion of

10 what it means.

11 CHAIR MARKOWITZ: So, let me summarize

12 where I think we are at and see if we can direct

13 things. It seems that there is some agreement

14 that the absolute requirement that the claimant

15 produce a physician's report that contains a

16 rationale around causation, aggravation, and

17 attribution, the requirement meaning must produce

18 is excessive, right?

19 We also seem to agree that, if the

20 treating physician or examining physician can

21 produce such a rationalized report, that that

22 would be useful to the process. And so,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

347

1 therefore, it should be permitted, perhaps even

2 encouraged, right?

3 So, we are in agreement about those

4 points, right? Now we just have to come up with

5 language.

6 (Laughter.)

7 CHAIR MARKOWITZ: Dr. Friedman8 Jimenez?

9 MEMBER FRIEDMAN-JIMENEZ: Carrie had

10 her hand up first.

11 CHAIR MARKOWITZ: Yes, Carrie?

12 MEMBER REDLICH: I guess while we are

13 on this sort of wording, every time it refers to

14 cause or resulting from the toxic exposure,

15 previously, we have been told that that could be

16 a contributing factor and not simply caused by. 

17 And so, is that just implied in all the wording

18 every time it is used? All it needs to be is

19 stated once, that that is the implication.

20 CHAIR MARKOWITZ: Yes. No, I think we

21 should point it out whenever we see it, actually. 

22 It would probably be helpful. But I agree with
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

348

1 you.

2 Okay. So, other comments? I need 

3 some specific suggestions now on what we are

4 going to propose around the language, either the

5 new language or the old language, that consensus

6 that I described just now.

7 MEMBER WHITLEY: I think since it is

8 part of the definition, that you leave the

9 "covered" in there and just say, "written medical

10 evidence containing physician's diagnosis of the

11 employee's covered illness as 30.5", just like it

12 is, and stop.

13 CHAIR MARKOWITZ: Well, that to me

14 implies that the claimant has to produce a report

15 from a physician that not only gives a diagnosis,

16 but the reason why it is a covered illness. So,

17 it is a backdoor into the issue of causation. 

18 And so, that is why. But, if you take out

19 "covered", all you are left with is the doctor

20 just has to produce a diagnosis, period.

21 MEMBER WHITLEY: That will work.

22 (Laughter.)
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

349

1 CHAIR MARKOWITZ: George?

2 MEMBER FRIEDMAN-JIMENEZ: It seems to

3 me that the fundamental problem is that, as I

4 understand it, the process is either a treating

5 physician provides the rationale for causation,

6 and causation meaning cause including

7 exacerbation, aggravation, or contribution, or

8 the CMC provides it. Is that correct? Or am I

9 wrong on that?

10 CHAIR MARKOWITZ: Yes, the --

11 MEMBER FRIEDMAN-JIMENEZ: If the

12 treating physician doesn't provide it, who does? 

13 The CMC?

14 CHAIR MARKOWITZ: Or whatever, right. 

15 You know, there are various routes.

16 MEMBER WELCH: It is my understanding

17 there are certain circumstances that the claims

18 examiner can accept a claim without sending it to

19 the CMC, if there is strong evidence and there is

20 a presumption or a procedure that allows that. 

21 So, not everything has to have a written

22 physician opinion that summarizes it. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

350

1 Toxicologists might. The industrial hygienists

2 might.

3 MEMBER FRIEDMAN-JIMENEZ: Because this

4 paragraph is entitled, "How does a claimant

5 establish that the employee has been diagnosed

6 with a covered illness?" And so, that has to be

7 established somehow. Now you are saying there

8 are three ways, the treating physician or the CMC

9 or the claims examiner, is that right? So, those

10 are the only three ways that it can get

11 established?

12 CHAIR MARKOWITZ: Well, there may be

13 other ways. But go ahead. Continue making your

14 point.

15 MEMBER FRIEDMAN-JIMENEZ: So, the best

16 that I can see, using a combination of the

17 previous language and the current proposed

18 language, is to just add in the phrase "to the

19 extent practicable", which they had in the

20 previous language, and use that to sort of soften

21 the requirement. And then, if they can't find a

22 physician that they can produce or is willing to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

351

1 state that they think that it was a causation,

2 then the CMC or the claims examiner will do it.

3 But we can't just take it all out, and

4 then, it won't be recommending any way for the

5 claimant to prove that it was caused.

6 CHAIR MARKOWITZ: So, to say that the

7 claimant must provide to the extent practicable

8 leans on the side of the claimant is expected to

9 produce such a report. I mean, that is the way I

10 would interpret that.

11 So, I don't think that is the sense of

12 what we are discussing here. I think the sense

13 is that, when it is possible, the claimant may

14 produce -- it will help his case, right? -- may

15 produce such a reasoned report, right, but must

16 produce evidence of the diagnosis? So, the

17 "must" applies to the underlying diagnosis, and

18 the "may" applies to the rationale of the

19 physician that this is occupationally-related,

20 right?

21 MEMBER CASSANO: So, it might be

22 appropriate, instead of saying, "to the extent
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

352

1 practicable", to say, "and, if possible, a

2 physician's rationale relating the medical

3 condition to a toxic exposure", whatever the

4 language is about substantially affect and

5 causative and aggravated, and all that sort of

6 stuff. And I can work on language, if you like,

7 tonight, with Laurie's permission.

8 CHAIR MARKOWITZ: But my question is

9 whether we should or are advocating striking the

10 old language as is proposed and, then, tweaking

11 the current language to soften it, so that it is

12 not an absolute requirement, or are we talking

13 about maybe deleting, suggesting deleting the new

14 language and going back to the old language? 

15 Because that is like a big dividing line.

16 MEMBER CASSANO: No.

17 CHAIR MARKOWITZ: I'm sorry, I said,

18 "A or B?", and you said no.

19 (Laughter.)

20 MEMBER WELCH: Do not go back to the

21 old one.

22 CHAIR MARKOWITZ: You do not want the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

353

1 old? So, agree with striking the old language. 

2 So, the sense is we should tweak the proposed

3 language to soften it, essentially. Let's not do

4 that right now. Vickie, you could do that. And

5 we will, then, appear tomorrow morning with

6 language that reflects that sentiment.

7 We don't have a proposal to vote on. 

8 We don't have the language. So, there is no

9 motion to, there is no proposal to vote on, if

10 I've even got that right.

11 Okay. We only have a few more

12 minutes, but we have an easy one coming up. So,

13 let's deal with it.

14 (Laughter.)

15 CHAIR MARKOWITZ: No, I knew the other

16 ones were hard. So, this is page 39. Let me say

17 this is Section -- it is 39 at the bottom -- it

18 is Section 30.230(d)(2)(3).

19 And this, by the way, this is not a

20 change, a proposed change by DOL. This is us

21 noticing that there is a phrase which says,

22 quote, "caused or aggravated", end of quote, but
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

354

1 it is missing "contributed". So, this gets back

2 to the point that Dr. Redlich was raising.

3 MEMBER REDLICH: Consistency.

4 CHAIR MARKOWITZ: Yes. Okay. So, the

5 proposal is -- now this is not a proposed change

6 by DOL. So, this is us adding our two cents to

7 the process, and I don't know where that fits

8 into the NPRM, but here it is.

9 (Laughter.)

10 CHAIR MARKOWITZ: By the way, I should

11 say that this is relevant to the Board's scope

12 because it addresses A and B, which relates to

13 really causation and aggravation and contribution

14 to a work-related illness.

15 So, I'm reading. "The Board notes the

16 phrase `an opinion of a qualified physician's

17 expertise in treating, diagnosing, and

18 researching the illness claimed to be caused or

19 aggravated by the alleged exposure' and differs

20 from a phrase, actually, about 10 lines, which

21 was, quote, "was a significant factor in

22 aggravating, contributing to, or causing the
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

355

1 illness". End of quote. And it should be made

2 consistent with that language.

3 So, we don't have to go through the

4 subcommittees here because we all agreed on this

5 one. But any comments on this?

6 (No response.)

7 CHAIR MARKOWITZ: Okay. So, do I have

8 a motion?

9 MEMBER VLIEGER: So moved.

10 CHAIR MARKOWITZ: Okay. Second?

11 (Seconded.)

12 CHAIR MARKOWITZ: Okay. Any

13 discussion?

14 (No response.)

15 CHAIR MARKOWITZ: Okay. All those in

16 favor of this raise your hand.

17 (Show of hands.)

18 CHAIR MARKOWITZ: All those opposed? 

19 And any abstentions?

20 Okay. So, we need to break at five of

21 5:00. I recommend that, just for a few minutes

22 before the public comment period, I do think we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

356

1 should, however, start the next one because we

2 are short of time tomorrow.

3 So, let me point this out. This is on

4 page 54. It has to do with the requirements

5 about changing physicians. Okay, I'm sorry, it

6 is page 55. It is Section 30.405, Item (b) and

7 (c).

8 If you could bring that up? And,

9 Tori, if you could read this?

10 MEMBER CASSANO: Oh, I'm sorry, I

11 forgot my job. So, both sections at the same

12 time, (b) and (c)?

13 CHAIR MARKOWITZ: Yes.

14 MEMBER CASSANO: Okay. "After

15 selecting a treating physician, may an employee

16 choose to be treated by another physician

17 instead?"

18 Item (b) says, "OWCP will approve the

19 request if it determines that the reasons

20 submitted are" -- cross out "sufficient"; add

21 "credible" -- "and supported by probative factual

22 and/or medical evidence, as appropriate. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

357

1 Requests that are often approved include those

2 for transfer of care from a general practitioner

3 to a physician who specializes in treating the

4 occupational illness or covered illness, covered

5 by EEOICPA, or the need for a new physician when

6 an employee has moved."

7 And (c), strike out "If a claimant

8 disagrees with the decision of...," and "then

9 OWCP" -- this is not going to make any sense --

10 strike out that -- "insufficient reasons for...." 

11 Basically, it says OWCP may deny the requested

12 change of physician if it determines that the

13 reasons submitted are not both credible and

14 supported by probative evidence.

15 "If a claimant disagrees with such an

16 informal denial, he or she may utilize the

17 adjudicatory process described in Subpart (d) of

18 this part."

19 CHAIR MARKOWITZ: And that last

20 paragraph that she read was the new proposed

21 language, to make it clear.

22 MEMBER CASSANO: Right.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

358

1 CHAIR MARKOWITZ: Can we hear from the

2 subcommittees first?

3 Mark, do you want to go first?

4 MEMBER GRIFFON: Sure. Subpart (b),

5 we basically said that the new language we didn't

6 think clarified or further added anything to the

7 original phrase. This notion of medical evidence

8 seemed like an implausible requirement.

9 And for Section (c), we said it seemed

10 okay. The change, the proposed changes seemed

11 okay.

12 CHAIR MARKOWITZ: Laurie?

13 MEMBER WELCH: We pretty much agreed

14 with what Mark said. We couldn't understand what

15 would be medical evidence, factual medical

16 evidence that would support the change of a

17 physician. And all the physicians couldn't

18 figure out what that was talking about.

19 (Laughter.)

20 MEMBER WELCH: So, it really doesn't

21 make any sense. We would go back to the old

22 language in (b) and, also, take out that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

359

1 "credible and supported by probative evidence" in

2 (c).

3 (c) sort of repeats (b), except that

4 it says the claimant has the right to appeal the

5 decision or disagree with the decision using the

6 adjudicatory process. So, I don't think it is

7 necessary to insert that new language. I would

8 go back to the old (c), just to be able to get

9 rid of the probative evidence.

10 We think that the claimants should be

11 able to change physicians if they don't like the

12 physician they are being treated with, and that

13 is not probative evidence. They just might want

14 to see somebody else. I think it is within

15 OWCP's authority probably to limit the number of

16 times that happens without having to write it

17 into the statute.

18 MEMBER SILVER: Our group did not like

19 the phrase "credible and supported by probative"

20 in (c), vague and unnecessary. Overall, too much

21 emphasis on medical necessity while lacking

22 specificity.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

360

1 Further suggestion that there should

2 be a specified period of time within which OWCP

3 approves or denies the request, say two weeks

4 from receipt. Otherwise, it is considered

5 approved.

6 And special concern about changing

7 oncologists. Imagine that.

8 CHAIR MARKOWITZ: So, let me just

9 address a point that I forgot to address, which

10 was how is this issue relevant to our mandate. 

11 The past (b) and (c) for us relate to the

12 collection and use of medical evidence in either

13 establishing claims or related to Subpart B or

14 Subpart E.

15 And the issue of which physician that

16 the claimant uses has to do with who they go to

17 for evidence of either consequential illness or

18 issues of impairment. And so, there is some

19 relation, I think, to the scope of what we have

20 been asked to do.

21 Okay. Let me lead and, then, we are

22 going to stop for a break and continue tomorrow. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

361

1 But let me read draft language that reflects the

2 sentiment of the various subcommittees.

3 "The Board notes that the added

4 language does not clarify what the claimants need

5 to produce and finds it implausible that

6 claimants can provide medical or factual evidence

7 in support of a request to change physicians. 

8 The Board recommends that claimants be permitted

9 to change physicians without requesting

10 permission from OWCP."

11 So, that is a clear statement, and

12 then, whether people divulge from that or from

13 that statement, we can discuss tomorrow. Okay?

14 So, let me call for a break now. And

15 then, we will reconvene just a minute before 5:00

16 because, then, we have got to start the public

17 comment period. Thank you.

18 (Whereupon, the above-entitled matter

19 went off the record at 4:56 p.m. and resumed at

20 5:02 p.m.)

21 CHAIR MARKOWITZ: Thank you. We will

22 now begin the public comment section. We have
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

362

1 eight speakers, all of whom are here in person. 

2 So, there are none on the phone who will be

3 speaking.

4 Almost all of our time has been

5 requested, actually. So, I don't think we are

6 going to have any extra time to accommodate

7 additional speakers.

8 Apparently, I have to turn it over to

9 the moderator now. So, can Terrie Barrie come

10 forward?

11 MS. BARRIE: Thank you. Thank you

12 again for giving me time to make a few comments

13 tonight to the Board. I have to commend you. 

14 Your work so far is astounding, and I thank you

15 for this.

16 One thing I would like to remind you,

17 especially for the people who aren't very

18 familiar with this program, Congress enacted this

19 program to take the burden of proof off the

20 claimants. Okay? The records aren't there. 

21 There needs to be some kind of assumption that

22 they were exposed to the toxic soup I mentioned
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

363

1 yesterday.

2 I have four more remarks here. This

3 is just kind of bringing up things I noticed

4 between yesterday and today.

5 Probative evidence -- nope, I'm sorry. 

6 There was a discussion about the development of

7 claims by the claims examiners and that the

8 claims examiners, if the claimant doesn't provide

9 medical evidence, that the claims examiner will

10 help the claimant develop the medical evidence or

11 whatever is needed to support the claim.

12 In the regulations today, it does say

13 that each and every criteria must be met by the

14 claimant and be provided by the claimant for the

15 claim to be processed, basically. So, I am not

16 sure how that fits with what was said today. I

17 have never heard -- and you could probably poll

18 the Authorized Reps who are here today -- of

19 claims examiners actually calling the claimant

20 and saying, "We need this piece of paper" or "We

21 need that." They might say, "You don't have

22 sufficient evidence," but I don't think they are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

364

1 very specific on, "Well, you need to get me this

2 test for your heart disease or you PFT." But,

3 like I said, check with the other ones.

4 We heard a lot yesterday and today

5 about the weight given to the personal

6 physicians' reports. I think yesterday it was

7 said that the wage loss claims, the Department of

8 Labor actually relies on the personal physician

9 since they know how much they can work and, you

10 know, they actually do the physical evaluation.

11 I know of two instances of wage loss

12 claims where the personal physician's letter,

13 whether it was well-rationalized or not, one was

14 actually rejected outright. And the other one

15 was completely ignored. It was never given any

16 weight whatsoever. And, you know, both of those

17 claims have been denied.

18 So, maybe what you heard is what the

19 ideal is, but when it translates down to the

20 individual CEs, that is not always what is

21 happening. So, I am hopeful that when the Board

22 gets a chance to take a review of some of these
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

365

1 claims, they can audit that or check it out to

2 see if it is prevalent, if it is common, or if

3 these two claims were unique.

4 This also applies when it comes to

5 personal physicians. I was really happy when

6 somebody talked about having a template for the

7 personal physicians to follow, because they are

8 not familiar with the program. It saves a lot of

9 time for them if they know what the Department of

10 Labor requires.

11 Well, this has been tried by -- and

12 please don't think that I am a front for the home

13 healthcare people -- but this was tried by home

14 healthcare agencies. They knew what the

15 Department of Labor requires to approve home

16 healthcare, and they developed a letter. It has

17 been circulated for other physicians to use.

18 I didn't see that as a bad thing. I

19 mean, as long as the information provided by the

20 physician is true and accurate, there is nothing

21 wrong with that. But the Department of Labor,

22 there was a big fuss about that during our Denver
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

366

1 meeting. So, they didn't seem to be very

2 appreciative of having the same type of letter

3 submitted from different doctors from across the

4 country.

5 But that doesn't mean that those

6 letters are fraudulent. Okay? It is just an

7 easy way to get the necessary care to these

8 workers.

9 And when it comes to home healthcare,

10 like I said, I am not a front. I don't get paid

11 by them. I work with every person who tries to

12 help the workers.

13 The reason you need home healthcare,

14 I am going to read you just a short email I got

15 from a spouse. It says, "Sorry, I did not get

16 you the facts last night. It was a downhill day. 

17 I had to bathe, shave, and dress my husband. He

18 fell on me. He pinned me between the floor,

19 sofa, and coffee table."

20 Now, if this worker had home

21 healthcare because of a covered disease -- and,

22 apparently, he did not -- there would have been
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

367

1 someone there to help the spouse. Okay.

2 All medical things that the worker

3 needs is covered by this program and needs to be

4 given to the workers who are covered.

5 And I think that is all I have for

6 tonight. Again, I thank you very much.

7 CHAIR MARKOWITZ: Thank you.

8 Next will be Deb Jerison who has

9 requested 10 minutes.

10 As we are approaching the time limit,

11 I may -- I haven't done this so far -- but I may

12 just give you a little bit of notice.

13 MS. JERISON: Please do.

14 I had two things I wanted to speak to

15 today. I'm really glad that you are taking a

16 look at Final Circular 1505. I'm not going to

17 get into it in a lot of detail, but I did have

18 some information I had come up with that I

19 thought could be useful. I will leave the full

20 report.

21 But the average compensation paid to

22 each worker before Final Circular 1505 came out,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

368

1 I think it was December of 2014, the average

2 compensation was $157,861. Now there was only

3 eight months of data I had after that document

4 was released or the Circular came out, but the

5 average compensation that was paid to each worker

6 after the Circular came out was $17,743. 

7 Seventy-two percent of the cases were approved

8 before Final Circular 1505 was released. Sixty9 five percent were approved after the release of

10 it.

11 Final Circular 1505 only has 57 jobs 

12 that are covered in that Circular. Before that,

13 there were 123 jobs with approved claims before

14 that. Those jobs were self-reported, so there

15 could be some discrepancies there.

16 But I also wanted to speak a little

17 bit about the rules and some of the changes, if I

18 can get to the right version. I was really happy

19 that you're getting a chance to review the rules

20 and you are doing a great job. The discussion

21 was really interesting to listen to.

22 I think there may be more time that is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

369

1 needed than doing it before early May. A lot of

2 the implications of these changes aren't

3 immediately obvious, and it will take a lot of

4 work to truly understand how the changes will

5 impact the sick workers. I encourage you to talk

6 to advocates, if you need any on-the-ground kind

7 of information.

8 EECAP has already made several

9 detailed public comments on the rules changes,

10 but here is some additional information on

11 several sections.

12 Section 30.5(x) restricts the

13 definition of who is eligible for EEOICPA by

14 removing workers who provided delivery and

15 removal of goods from the premises of a DOE

16 facility. A look at previous claims shows that

17 around 1,080 claims filed for people delivering

18 or removing goods have been adjudicated, with 347

19 of those claims being approved and 589 being

20 denied. These previously-approved claims have

21 paid $77,739,510 in compensation and $14,058,821

22 in medical benefits to these sick workers. It
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

370

1 seems arbitrary and capricious to restrict

2 eligibilities for workers transporting goods so

3 late in the program's history.

4 Then, 30.205 and 30.206 redefine who

5 is covered for beryllium claims by removing the

6 phase "or a facility owned, operated, or occupied

7 by a beryllium vendor", unquote, and changing it

8 to "a facility owned and operated by a beryllium

9 vendor".

10 A review of the current beryllium

11 vendors shows this wording would remove 80

12 percent of them from EEOICPA. Of the current 75

13 beryllium vendor sites, only 15 of them are a

14 facility owned and operated by a beryllium

15 vendor.

16 30.230 and 30.5(w) offer different

17 dates, August 13th and January 1st, 1942, to be

18 used as the earliest any claimant can claim

19 coverage under EEOICPA. The Einstein-Szilard

20 letter to President Roosevelt recommending the

21 U.S. begin the nuclear program was dated August

22 2nd, 1939. According to DOE's Manhattan District
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

371

1 history, Book 1, Volume 1, a memo dated February

2 20th, 1940, discussed the first transfer of funds

3 for the Manhattan Project. I suggest either of

4 these dates would be better than DOL's suggested

5 dates if it is appropriate to dictate a start

6 date to eligibility.

7 In reviewing the data, there have been

8 251 claims filed with Employment between January

9 1939 and August 1942. Of those claims, 124 were

10 approved and 96 were denied. Setting a 1942

11 employment start date is inequitable for the

12 claimants with work in the early years who

13 haven't filed claims yet.

14 Just a mention on Section 30.231. I

15 would just like to note that I provided district

16 offices specific DOE document proving exposure

17 for claims, and these have always been considered

18 irrelevant and non-probative by the CEs.

19 30.232(b) requires a fully20 rationalized medical report. We got into this

21 quite a bit. Doctors who have written these

22 reports say that such a report takes between six
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

372

1 and ten hours to write. Sometimes that is with

2 grad students. However, most doctors don't have

3 the experience, let alone the time, to provide a

4 report that meets the EEOIC's requirements. This

5 means many valid claims are denied. This is a

6 major stumbling block for most claimants, and the

7 CMC reports just don't always stack up, either.

8 EECAP investigated Parkinson's disease

9 claims from June 27th, 2006 through February

10 2014, and found that no personal physicians'

11 reports led to any claims approval. In October

12 2014, DEEOIC finally approved one Parkinson's

13 claim based on a non-DOL physician's letter, and

14 that is the one that took grad students. This

15 claim is especially interesting because DEEOIC

16 had previously denied it numerous times based on

17 CMC reports. It took 10 years.

18 The first report came from a Dr. Hunt

19 in 2008. Two reports, then, came from a Dr.

20 Orgel. One in 2013 came from a Dr. Gresh. 

21 Between the letters from Dr. Orgel and Dr. Gresh,

22 an independent physician that the claimant had to
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

373

1 pay to do the letter provided a report

2 recommending the claim be approved, which DEEOIC

3 found not probative enough, partly because of

4 spelling and cut-and-paste errors. Unlike the

5 letter from Dr. Orgel, the claims examiner did

6 not ask this doctor for a clarification. In many

7 ways, this letter was more detailed than the CMC

8 reports.

9 DOL's document recommendation proposed

10 changes not within the scope of the Advisory

11 Board discusses changes in Section 30.70 to

12 30.726. And OWCP states that these changes are

13 being made to conform to the existing FECA

14 regulatory schemes.

15 EEOICPA and FECA are very different

16 programs. EEOICPA is a remedial statute and must

17 be interpreted more liberally than FECA, which is

18 not remedial. While I know it is a pain for OWCP

19 to have to administer these two programs

20 differently, it is improper to cut claimants'

21 benefits and increase the claimants' burden of

22 proof for their administrative convenience.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

374

1 Also, Section 30.805 increases the

2 sick worker's burden of proof for wage loss and

3 adds a threat of discontinuing the claim when a

4 person cannot meet any step. As of July 2015,

5 only 1,210 wage loss claims have been paid. So,

6 I even wonder why this change would be necessary.

7 CHAIR MARKOWITZ: I'm sorry, one more

8 minute, if you would.

9 MS. JERISON: I'm sorry?

10 CHAIR MARKOWITZ: One more minute, if

11 you would.

12 MS. JERISON: Okay. For additional

13 comments on EECAP's proposed rules changes, you

14 can check the Radioactive Daughter Blog.

15 Thank you.

16 CHAIR MARKOWITZ: Thank you.

17 Next we will hear from Ms. Stephanie

18 Carroll, who has requested 10 minutes.

19 MS. CARROLL: Thank you.

20 It was hard to prepare for this

21 because I had so many different things I wanted

22 to make comments on today.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

375

1 But what I would like to say is this

2 program was intended to be fair and equitable,

3 and the claims should have a uniform application

4 of the law.

5 CHAIR MARKOWITZ: Hand it to her.

6 MS. CARROLL: Okay. Hello. Okay.

7 Anyway, it was intended to have a

8 uniform application of the law.

9 I also believe, because I am a

10 specialist in chronic beryllium disease, that

11 Congress intended for the program to establish

12 chronic beryllium disease, to establish beryllium

13 sensitivity. Beryllium sensitization is

14 established by one abnormal beryllium blood test

15 or a lavage showing a positive response. That is

16 not the current medical diagnostic criteria. You

17 could not get a doctor to say that someone has a

18 diagnosis of beryllium sensitization with one

19 beryllium blood test.

20 Beryllium sensitization is a beryllium

21 illness under the program, along with chronic

22 beryllium disease and any other illnesses that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

376

1 are consequential to those first two illnesses. 

2 So, they should be looked at the same. They are

3 kind of put together in the Act.

4 So, what is happening now is a huge

5 change in the program when it comes to chronic

6 beryllium disease. Now it looks like, page 32 of

7 the new rules, they are asking for -- well, let

8 me just tell you what is happening, once I look

9 at my notes. I can't even think.

10 Anyway, as it used to be and what I

11 thought that Congress demanded was, yes, medical

12 evidence is needed to establish CBD, medical

13 evidence being a pulmonary function test showing

14 obstruction and, yes, I agree, a physician should

15 weigh-in on if there is obstruction found on a

16 pulmonary function test. But I don't think any

17 physician can write a well-rationalized medical

18 report describing how they came to the conclusion

19 that this person meets the current diagnostic

20 criteria, medical diagnostic criteria, for

21 chronic beryllium disease. And that is what is

22 being asked.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

377

1 A physician cannot write that if they

2 are going by current medical diagnostic criteria. 

3 The only way you can establish chronic beryllium

4 disease is to see if they meet the medical

5 requirements. You know, they have got specific

6 findings on CT. That's okay to have a doctor

7 review the CT exam and see if there are

8 granulomas found, honeycombing, ground glass, any

9 other number of other things that are listed in

10 the Procedure Manual.

11 If a physician finds those, well, has

12 findings of those criteria, of course, it would

13 be on the report. So, there is your weighing-in

14 of the medical professionals.

15 But it is up to the claims examiners,

16 and they have it in the Procedure Manual, the

17 list of criteria that they have to meet to

18 establish chronic beryllium disease. And this

19 isn't happening right now.

20 I literally am one of the only people

21 that gets chronic beryllium disease approved in

22 this program. Now, if you want data, this is
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

378

1 what you ask for. You ask for the V81.4

2 Diagnostic Code. That is beryllium

3 sensitization, and that starts our poor beryllium

4 workers on this journey of being monitored for

5 beryllium sensitization and getting an enormous

6 amount of invasive diagnostic tests that never

7 actually meet the current medical diagnostic

8 requirements to establish CBD.

9 So, people are not getting diagnosed

10 with CBD anymore, since about 2006. So, lots of

11 beryllium sensitization, so the stats will look

12 like you have got a lot of people being approved

13 under Part B for beryllium. No, not for chronic

14 beryllium disease.

15 Now, when it looks like people aren't

16 being diagnosed with CBD, people onsite may

17 assume, oh, some of these safety measures might

18 be working now because nobody is getting

19 diagnosed anymore. There's 300 people sensitized

20 at Rocky Flats. There has probably been 80

21 people approved under the program. And when you

22 are sensitized, Lee Newman said in 1992,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

379

1 sensitization is preclinical chronic beryllium

2 disease. You have the illness when you are

3 sensitized.

4 So, my workers are going through this

5 monitoring, and they are getting yearly or every6 other-year CT scans, PFTs, chest x-rays, exercise

7 tests, no matter how sick they are, and they

8 always qualify for a lavage biopsy, always. It

9 doesn't matter what the tests say or what their

10 health issues are. And they continue to not get

11 diagnosed.

12 Now I'm so worried about the fact that

13 even I may not be able to get people diagnosed

14 anymore, because what is going to happen is they

15 are now asking for, even if a doctor says the CT

16 scan is consistent with CBD, I was just told they

17 are not going to accept that, even though it is

18 mandated; it is in the law that they should

19 accept that statement. Now they are going to

20 want a well-rationalized letter to explain how

21 this doctor came up with that statement. And

22 that is outrageous, and I'm telling you, nobody
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

380

1 else is getting people approved for this illness.

2 This Act came about, first and

3 foremost, for chronic beryllium disease. This is

4 what drove this Act, and it is being ignored and

5 nobody is getting diagnosed. And it is very sad. 

6 People beryllium sensitized, never smoked, have

7 pulmonary fibrosis, positive B-reads, findings on

8 CT scans that are consistent with CBD,

9 obstruction. They are on oxygen 24 hours a day,

10 and they are not getting even a statement that

11 says that their clinical findings are consistent

12 with CBD.

13 But they are contributing a lot of

14 their specimens to research. So, that is, I

15 guess, one of the good things to come out of

16 this, if you can call is that.

17 So, I really want to stress that the

18 beryllium disease issue needs to be covered. And

19 the rule on page 32 actually says -- it has

20 always been if you were treated, tested, or

21 diagnosed with a chronic respiratory disorder,

22 you would fit into the pre-1993 CBD.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

381

1 Arbitrarily, about a year-and-a-half

2 ago, the program decided to get rid of -- not

3 test it anymore. You got treated or diagnosed

4 with a chronic respiratory disorder. And then,

5 they decided you had to be diagnosed and have

6 long-term treatment for a chronic respiratory

7 disorder prior to 1993.

8 These arbitrary new policies really

9 affect people's ability to get approved and get

10 recognition for an occupational illness they are

11 suffering from. Now it looks like you are going

12 to have a chronic respiratory disorder, No. 2 on

13 page 32, "If the earliest dated medical evidence

14 shows that the employee was either treated for or

15 diagnosed" -- we got "tested" out of there --

16 with a chronic respiratory disorder on or after

17 1993, "the criteria set forth of this section

18 must be used." So now, you have to have a

19 chronic respiratory disorder before you can even

20 use post-1993 CBD criteria? I don't know where

21 that came from.

22 So, well, I wish you all had more
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

382

1 time. I think it is absolutely outrageous and

2 un-American to not allow this Board to have more

3 time to look at these rules. I think it is just

4 outrageous.

5 CHAIR MARKOWITZ: I'm sorry, one more

6 minute.

7 MS. CARROLL: Yes. I am just so

8 pleased that you are here, and you give me hope. 

9 So, thank you very much.

10 CHAIR MARKOWITZ: Thank you.

11 So, I would like to welcome Jeanne

12 Cisco. Ms. Cisco has requested 10 minutes.

13 Welcome, Jeanne.

14 MS. CISCO: Thank you. Hi.

15 Is it on?

16 I'm Jeanne Cisco from Portsmouth. 

17 I've worked at a gaseous diffusion plant for over

18 41 years, and I am here to talk to you about the

19 SEM and some of the things collectively that the

20 Worker Health Protection Program Coordinators

21 came up with that we would like to have you look

22 up.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

383

1 We think that the Department of Labor

2 needs to have transparency when chemicals and

3 other items are added or removed from the SEM, as

4 well as an auditing process of the addition and

5 deletion to the SEM, with the rationale and

6 documentation used to justify the action.

7 At Portsmouth, I submitted probably --

8 I don't know -- thousands of chemicals in 2011. 

9 Many claims were processed up to that point, but

10 very few chemicals were on the SEM there. We got

11 the list of MSDS sheets from the current

12 contractor in 2011 and submitted those.

13 The Department of Labor came back. 

14 They said they needed to know where they were at,

15 what buildings and departments, in order to put

16 them in. To make a long story short, I worked

17 with the Department of Labor for over a year

18 trying to get those chemicals added to the SEM,

19 and I got a statement from the contractor to

20 prove that those chemicals -- it is difficult for

21 the Department of Labor to put into that SEM the

22 chemicals in what building and what department
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

384

1 because the processes are not identified -- okay?

2 -- well enough. And I heard today they don't

3 have those resources. I heard the Department of

4 Labor say that.

5 That is essential for someone who is

6 filing a claim to get the right -- well, for one,

7 we were never monitored for chemical exposures at

8 Portsmouth ever. Okay? So, how could they tell

9 the frequency, duration, all those things on

10 exposures, and then, the Department of Labor has

11 to use the SEM that does not describe the work

12 processes and the many classifications that go

13 into these chemicals. That's impossible for

14 anyone to do that with what they are doing today.

15 I just think that I was involved in

16 the beginning, when this program started, when

17 they came to Portsmouth and they asked on the

18 different processes. And I can remember looking

19 at the retirees answering the questions on

20 radiation, and I'm thinking chemicals. But, you

21 know, they never told us the chemicals. We did

22 not have a need to know.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

385

1 We now at Portsmouth at a list of MSDS

2 sheets. Not all of those were added. Some have

3 been removed. They are not assigned to the

4 proper classifications. I have a letter from the

5 plant that I submitted and did not get a response

6 on, and it basically states what I'm telling you. 

7 All classifications worked in buildings together

8 around those chemicals, and my guess is it's that

9 way throughout the industry.

10 One thing that concerned me today that

11 I heard is that you're thinking about presumption

12 and you're going to use scientific research on

13 the chemicals. And to try to help this process

14 along, I want you to understand that in the

15 nuclear industry you can't use typical other

16 scientific facts. You need to know what we did

17 and the specific chemicals and things that we had

18 to use.

19 Now DOE does not release everything;

20 they can't for national security, but there are

21 ways to find out those things. You can get on

22 the Manhattan Project website. They release
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

386

1 important things daily or often. They just

2 released on nickel dust that is not in our SEM. 

3 It should be in there. It wouldn't be hard to

4 win a COPD claim if that was in our SEM, and

5 probably throughout the industry.

6 So, the Coordinators felt that, when

7 you add something or delete something, we should

8 know what it is and why. And when we propose to

9 add something to it like our independent

10 investigations by NIOSH -- Ken spoke today on

11 some language that you're starting to write there

12 or suggest. The Department of Labor should

13 accept those types of reports. They are done by

14 NIOSH. They are done by OSHA. They are done by

15 credible agencies that describe the processes in

16 these plants.

17 We have Site Profiles. Okay? That

18 was come up with to help for Subtitle B. And

19 they could use those. There's a lot of

20 information in those on the processes and the

21 chemicals.

22 Okay. Several of the reviews that I
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

387

1 have read have suggested that the Department of

2 Labor incorporate other databases. All of that

3 should be done, in my opinion.

4 Like I said, the processes, my

5 coworker will cover that a little better.

6 Once you even submit into the SEM the

7 chemicals, they never get to the classification

8 because there is the break. You've got the

9 processes and the classifications, and many

10 worked in this, and the SEM doesn't capture that. 

11 So, you have got your work cut out for you.

12 I think that the Department of Labor

13 would welcome any and all information that they

14 could get. DOE has a Computerized Accident

15 Injury Reporting System, CAIRS I think, that was

16 mentioned today.

17 You have many people at these sites

18 that would help in any way we can to help make

19 this better for the sick people. Something that

20 bothered me is that they did not go back prior to

21 2011 and review the people whose claims went

22 through. If there's any changes, I think that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

388

1 that needs to be looked at and made retroactive

2 back to any improvements to the program.

3 I think another area was medical

4 guidance for the claims examiners.

5 CHAIR MARKOWITZ: One second. One

6 more minute. Okay?

7 MS. CISCO: One minute?

8 CHAIR MARKOWITZ: Yes.

9 MS. CISCO: Okay. Medical guidance

10 for the claims examiners; health physics people,

11 they only had two across all of the DOE

12 complexes. So, how many claims went there? They

13 didn't.

14 I can't do this under pressure. I'll

15 submit more later.

16 CHAIR MARKOWITZ: Okay.

17 MS. CISCO: The health physicists I

18 don't think were used, District Medical

19 Consultants. Usually, the Former Worker Program

20 medical reports and a personal physician's report

21 that uses the proper language of cause,

22 contributed to, or aggravated, that was spelled
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

389

1 out. That's ignored and it is sent to the CMC,

2 and then, they make a ruling.

3 CHAIR MARKOWITZ: So, thank you.

4 I might add that there is another

5 public comment period tomorrow, and there may be

6 time on the schedule if you want to cover

7 additional points, just so you know.

8 Thank you.

9 Next is Paige Gibson who has requested

10 five minutes.

11 MS. GIBSON: As he stated, my name is

12 Paige Gibson. I worked at the Mound Miamisburg

13 Plant for 13 years. My father worked there for

14 23 years.

15 While I was at Mound, I was a decon B

16 worker. I was the Health and Safety Rep for the

17 Union, and I taught HAZWOPER. I am currently a

18 nurse and a Coordinator for the WHPP program,

19 and, proudly, a worker advocate.

20 As Jeanne stated, I am going to cover

21 some other points that the Coordinators were

22 concerned about and that we're facing every day
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

390

1 out there.

2 First of all, there should be user3 friendly published guidelines on what happens

4 during the claim process. From my understanding

5 today and from other issues, the claims examiners

6 are gods in the process of a person's claim. 

7 This person who has a high school education and

8 two months of in-house training is making medical

9 decisions and denying or agreeing with a

10 claimant.

11 When they say that we have to have or

12 we should have a doctor's diagnosis on a covered

13 condition, it is you have to. The claims

14 examiner will tell you, "You have to supply me

15 with more likely than not." The explanation is a

16 bonus, if you can get a doctor to do that. But

17 sending a template with my workers to the doctors

18 that says, "Please have your doctor say that you

19 are more likely than not got this disease because

20 you were exposed to toxins at Mound," or at GE,

21 or one of the subcontractors in my area, the

22 doctors don't have a clue what is at Mound. We,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

391

1 as workers, didn't have a clue until recently.

2 Mound is closed, and they have access

3 to me or to a reading room that gives them access

4 to the exposures, because the majority of them

5 don't use the computer. They haven't, unless you

6 walk them step by step, they don't use computers. 

7 So, you have to provide that for them.

8 When you talk to them to get your

9 claim going in your regional office -- Portsmouth

10 would be ours -- the job classification, I don't

11 exist according to DOL. There is no such thing

12 as a decontamination worker B. And then, I

13 became a demolition technician. I didn't exist

14 at Mound. So, I don't have a record.

15 And I love the fact that DOE is

16 working with DOL now to get our records. There

17 is a problem with that, though. Our incident

18 records aren't there. They for Mound were

19 buried. For others, they just were destroyed and

20 never made it into our files. Our exposures

21 aren't there.

22 So, if they don't exist and DOL is not
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

392

1 recognizing my affidavit or other workers'

2 affidavits, how are they going to know? And that

3 is the crux of those affidavits. All along, up

4 until yesterday, I thought they were great. I

5 knew that on the worker's occupational history

6 that was taken that you could put down dead

7 people because they didn't call them. The claims

8 examiners never called them to get any more

9 information.

10 So, I submitted affidavits, thinking

11 that these would hold value, and they don't. 

12 They are ignored because they aren't proven by

13 DOE records which don't exist. It's a quandary

14 that every worker advocate faces out there.

15 Job classifications don't exist. We

16 don't have doctors who are willing to get

17 involved or have the experience or knowledge of

18 these sites.

19 I tell my workers, when they go to get

20 their letter, there's three things. It is not

21 tell your doctor. It is not workman's comp. 

22 It's not a lawsuit. And nobody will call them. 
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

393

1 Just sign the letter. And we get letters. And

2 it is a shame that you have to tell a doctor

3 that, but I understand the process of lawsuits

4 and whatnot.

5 Another big concern across the nation,

6 not just at Mound, unless there is an SEC in

7 place, is that somehow DOE decided that January

8 1st, 1980, all sites became safe. I process

9 hundreds of claims, either as an Authorized Rep

10 or as just helping or as a witness, and 1980 is

11 the cutoff date. I can't figure out why. It is

12 through Circular 1506 that it is mentioned. 

13 There is mention of 1995 and the Tiger Teams

14 coming into place.

15 A real quick story about Tiger Teams. 

16 The first six months I was at Mound, they said,

17 "Tiger Team is coming. Overtime." Great. So,

18 our bosses would take us around to buildings and

19 labs and say, "Everything in there in the

20 dumpster." It was a brand-new camera still in

21 the box. "Hey, if you're throwing this away, can

22 I have it?" "No, no, throw it away. Throw it
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

394

1 away."

2 Chemicals that were stacked high,

3 throw them away. One jug, that's it. Throw them

4 away. And I could never understand why, until

5 later, that we don't want the Tiger Team to have 

6 find you, and then, the contractor has to pay. 

7 It wasn't a surprise like OSHA shows up. Tiger

8 Team let the company know, "We're coming." So,

9 all these things disappeared.

10 CHAIR MARKOWITZ: Excuse me. One more

11 minute.

12 MS. GIBSON: Okay. Just to state that

13 the 1980 date is very important. In the 1980s is

14 when Reagan took over; Star Wars was big, and

15 there was a boon in hiring in the DOE complex. 

16 The effect on thousands and thousands of people

17 not being process through the claims because they

18 started after that date has got to be changed.

19 Exposures happened after that date,

20 accidents, and people are sick. And those dates

21 and the job classifications have to be changed.

22 I thank you. I think you guys are
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

395

1 doing a wonderful job. You've jumped off running

2 at this Board, and I appreciate your work. Thank

3 you.

4 CHAIR MARKOWITZ: Thank you.

5 Next we'll hear from Donna Hand, who

6 has requested five minutes.

7 MS. HAND: Okay. In the very

8 beginning, we were talking about weighing medical

9 evidence and the physicians had to have a

10 definitive everything. Again, I remember we go

11 back to the statute and the regulations, and it

12 says it is not that high of a standard. 

13 Congressional intent and findings have stated

14 you're not going that high of a standard; there's

15 not medical certainty.

16 So, that "maybe", "probability", you

17 know "plausible", those wordings can be used by

18 the physicians and should still be accepted

19 underneath this program, because that still fits

20 that standard that Congress in the statute and in

21 the regulations, at the Secretary's discretion in

22 2006, used. So, that part there.
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

396

1 Also, the case examiners, they write

2 what they call a Statement of Accepted Facts. 

3 The Statement of Accepted Facts is, then, being

4 sent to the contract medical consultants, along

5 with the specific questions, not general

6 questions, specific questions.

7 With that Statement of Accepted Facts,

8 they said, "We have accepted their employment. 

9 We have accepted the exposure here. We have

10 accepted the medical evidence."

11 Why can't these Statements of Accepted

12 Facts also be sent to the treating physician? 

13 Also, why can't that standard of aggravating,

14 contributing, causing also be sent, along with

15 the definitions that are used to the treating

16 physician? That would help explain a little bit

17 more of, oh, yes, I can say that. I can't say

18 with medical certainty because that is really

19 what causation is. I can't say. I don't know

20 what specific chemical it was.

21 But if all I have to say, was it

22 plausible, yes, I can do that. You have already
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

397

1 determined he was exposed to this chemical, this

2 chemical, and this chemical. And I know that

3 that chemical does it. Yes, I can say that then.

4 But that is not what is done. In

5 other words, the treating physician sees the

6 medical part, the diagnostic, you know, the

7 pulmonary function test, the lab work. You know,

8 they see that.

9 The contract medical consultants just

10 see what the Department of Labor has sent to

11 them, which is we have accepted this medical

12 condition. How much of it, you know, they don't

13 know. So, was it a progressive disease? Was it

14 slowly? Was it mild at first and, then, severe

15 now? They didn't see any of that.

16 So, why can't that Statement of

17 Accepted Facts, which whether the CMC agrees with

18 or not, they still have to accept it, everything,

19 be sent to both the treating physician, instead

20 of a verbal phone call and say, "Hey, we don't

21 understand. This is our issue. But this is what

22 we have accepted. This is the criteria of our
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

398

1 program. Can you give us an opinion now?"

2 Again, the statute did state that the

3 Secretary can use physicians to help determine

4 Part E. However, those physicians are to be

5 experts in treating or researching in that

6 particular issue. So, it is just pulmonology, or

7 whatever. So, if you are not treating it, you

8 are not researching it, you are not writing it,

9 you're really not considered an expert to the

10 Secretary. Really, it wobbles down to the final

11 decision, no matter what, is the Secretary's

12 decision, which is, again, the DEEOIC.

13 Again, experts can only issue opinions

14 within their own field. So, if you are an IH,

15 you can only address, you know, whatever IH can

16 address. They cannot address the medical. They

17 can't address the legal. A medical can't address

18 the legal. So, you can do it as a personal

19 opinion, but you can't do it as an expert

20 opinion.

21 Interpretative questions, you know,

22 and administrative questions and legal questions,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

399

1 it all comes down to specifically Part B, chronic

2 beryllium disease. It is established.

3 And in the very beginning of the

4 program, since 2004, they have said that the pre5 1993, you can use that if it was treated for,

6 tested for, or diagnosed with a chronic

7 respiratory condition before 1993. Then, you use

8 that criteria.

9 However, the chest x-rays, the

10 pulmonary function tests can all be after that. 

11 And they have issued decisions of that. So, you

12 can have a pulmonary function test from work

13 showing a mild obstruction. Okay, that meets the

14 pre-1993 criteria. Then, you can have the chest

15 x-ray in 2000. You can the rest of it, the other

16 two criteria. So, you can have all the three

17 criterias later on. It doesn't have to.

18 And there have been several, several

19 decisions from 2004 on doing that. Then, all of

20 a sudden, in September of 2015, they changed

21 their policy.

22 And the skin patch test, I agree we
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

400

1 need to have more non-invasive tests to do

2 chronic beryllium disease. The skin patch test

3 is being done for people that have exposure to

4 hip replacements. The Mayo Clinic, Johns

5 Hopkins, and several of them, have done the metal

6 testing for the hip replacements, and they did it

7 with a skin patch test. And it is more accurate

8 than the allergic patch test where you do the

9 prick on the back, everything. So, why isn't

10 there something like that for beryllium?

11 Again, the main thing is the reports. 

12 Like I've used chronic -- the Collaborative on

13 Health and the Environment.

14 CHAIR MARKOWITZ: One more minute.

15 MS. HAND: Okay. And in that report,

16 you know, it says the causes for COPD, and it has

17 strong and it has good and it has limited. This

18 evidence has been turned down. I've established

19 that, well, this is proof that there has been

20 peer-reviewed studies, but they won't accept it.

21 There are other languages, you know,

22 and the World Health Organization has defined
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

401

1 chronic respiratory diseases and lists allergic

2 rhinitis as a chronic respiratory disease. They

3 won't accept that.

4 I've listed -- in the DMC Handbook,

5 OWCP has a list of reference materials that they

6 approved for their contract medical consultants

7 to use. I've used those same reference

8 materials. They said, "No. Won't use them. 

9 Won't accept them."

10 So, again, thank you so much, and

11 discuss more tomorrow.

12 CHAIR MARKOWITZ: Okay. Thank you

13 very much.

14 Tim Larew, who has requested three

15 minutes.

16 MR. LAREW: Thank you, Dr. Markowitz.

17 My name is Tim Larew. I serve as

18 Chairperson for Cold War Patriots, a national

19 association of more than 36,000 former and

20 current nuclear complex workers and their

21 families, as well as miners, millers, and

22 transporters. Our mission at Cold War Patriots
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

402

1 is to connect the men and women of our nuclear

2 complex and their families to the information and

3 resources they may need if they suffered a work4 related illness, and honor them for their

5 sacrifice and their service.

6 The enactment of this Advisory Board

7 has been a long-time legislative goal of our

8 organization, and we are encouraged by your

9 efforts on behalf of the worker community that

10 you have begun here in our nation's capital this

11 week.

12 Over the past several years, I have

13 had the privilege of meeting the several thousand

14 former nuclear complex workers and hundreds of

15 EEOICPA claimants that have been approved and

16 hundreds more that have been denied.

17 The message I convey to you on their

18 behalf today is this: any nuclear complex worker

19 would gladly forego the compensation and medical

20 benefits provided by EEOICPA if they could simply

21 be restored to good health. Since this is not

22 possible, these sick former workers do ask that
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

403

1 the intent of the law to provide compassionate

2 compensation and medical benefits in a timely

3 manner be respected and honored by all those

4 entrusted with faithful administration of the

5 Act.

6 You on this Board will now play a very

7 significant role as you apply your individual

8 skills and experiences in fulfilling the promise

9 of EEOICPA. Cold War Patriots welcomes the good

10 work you are now undertaking, and we will support

11 you fully in your important mission.

12 Thank you.

13 CHAIR MARKOWITZ: Thank you.

14 Next, actually, our last speaker is

15 going to be Mr. Hugh Stephens, who has requested

16 five minutes.

17 MR. STEPHENS: Thank you, Dr.

18 Markowitz.

19 I just wanted to say a few words about

20 causation. We have been talking about causation

21 in the program. One thing I want to say is,

22 first of all, the normal causation standard,
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

404

1 preponderance of the evidence, is applicable in

2 the program for most things; if you need to

3 supply a birth certificate to show that you are a

4 survivor, for example.

5 So, the preponderance of the evidence

6 is the typical standard and it is at work within

7 the program. I think, under Part B and E, the

8 idea is that we need a reduced standard, the

9 50/50 standard, the tie-goes-to-the-runner

10 standard, because of the lack of evidence and the

11 difficulty that you run into determining whether

12 radiation caused your cancer or whether your

13 exposure to occupational hazardous substances in

14 your occupation caused your illness.

15 And so, when you look at causation

16 under Part B, we have the 50/50 standard. And

17 so, under Part B, if the dose reconstruction

18 shows that radiation is at least as likely as not

19 to have caused your cancer, then you are paid.

20 The causation standard under Part E

21 that we have talked a lot about includes

22 contribution and aggravation, and so, is a
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

405

1 further reduced standard. And it is a more

2 typical standard that you run into in the

3 workers' compensation context, the idea being

4 that workers should be compensated more liberally

5 probably than in the civil litigation system. 

6 And so, I think we can all agree that Part E is a

7 reduced standard.

8 But, when it comes to radiation and

9 whether it is considered under Part E as a

10 potential hazardous substance causing,

11 contributing to, or aggravating a cancer or

12 another illness -- and I think there is

13 increasing evidence that radiation can cause, can

14 be a contributing cause of both malignancies and

15 other types of illnesses or conditions. And we

16 have been able to have at least one claim

17 approved where radiation was identified, in

18 addition to asbestos, as potentially contributing

19 to a claim for cancer.

20 And so, I think this is becoming more

21 important. And what I would like to throw out

22 there as just the idea is, when they determine
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

406

1 that radiation is at least as likely as not, and

2 that is defined as causing your cancer or enough

3 to consider it to have caused your cancer, the

4 problem is they are also in this program treating

5 that same evidence, the fact that you did not

6 reach the 50-percent threshold in the dose

7 reconstruction, as meaning that radiation did not

8 contribute to or aggravate, primarily contribute

9 to.

10 And I think there is within the

11 program this conflation of the idea of

12 contribution into causation, because I think

13 there is a sense that, if it doesn't cause it,

14 how can it contribute to it?

15 But we know that there are

16 contributory portions of the process. I think we

17 are understanding the process of how cancer comes

18 about better and how radiation might play a role

19 in the many steps leading up to cancer.

20 And so, one thing we can consider is

21 maybe for my clients I would prefer that the

22 threshold be 1 percent. If you have 1 percent
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

407

1 probability of causation, you ought to get paid

2 under Part E, even though you fail under Part B.

3 For the Department of Labor, who knows

4 what it is? But somewhere between 1 percent and

5 49.9 percent, we might have -- there is a reduced

6 standard. And so, under Part E, we should

7 consider at what point with significant

8 radioactive radiation exposure acknowledged in

9 the dose reconstruction, when could it be

10 considered to have contributed?

11 With that, I will let everybody go

12 home. Thank you very much. I appreciate all

13 your work.

14 CHAIR MARKOWITZ: Thank you.

15 And this concludes our public comment

16 session. It also concludes day two. We will

17 meet tomorrow morning at 8:30. Thank you.

18 (Whereupon, the above-entitled matter

19 went off the record at 6:01 p.m.)

20

21

22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

408

A

a)'s 263:6

a.m 1:20 4:2 84:6,7

169:16

AADEP 143:11

abide 244:18

ability 48:19 49:4,7

82:10,12 268:18

270:13 315:11 381:9

ABIME 143:11

able 14:21 22:18 24:11

32:10 35:8,10,22

47:17 68:16 78:2

80:18 85:20 95:2,3

97:2 99:12 108:20

113:12 115:5 128:15

165:12,18 170:21

173:3 199:6 230:8

246:13 257:14,18

359:8,11 379:13

405:16

abnormal 189:6,11,13

191:1 202:13 204:3

204:21 209:8 213:7

239:21 375:14

abnormalities 245:4

above-entitled 84:5

169:15 250:4 327:9

361:18 407:18

absence 23:6,10 41:12

265:19 282:5 310:18

absent 216:6

absolute 346:14 352:12

absolutely 102:9 214:3

382:1

abstentions 292:17

304:8 326:20 355:19

Academy 63:8

accept 94:15 115:20

189:15,17 210:17

232:4,7 235:17

268:19 269:14 302:11

349:18 379:17,19

386:13 397:18 400:20

401:3,9

acceptable 197:19

337:13,17

acceptance 94:20

accepted 57:9 60:11

70:5 99:11 129:20

144:17 156:21 189:21

192:13 249:8 267:10

267:20 309:20 317:1

317:1 395:18 396:2,3

396:7,8,9,10,11

397:11,17,22

accepting 94:19 157:11

190:5 210:6

access 83:15,17 86:4

87:1 118:5 121:22

293:5 391:2,3

accessed 80:19

accessible 62:18 64:10

accessing 10:8

accident 104:18,20

105:16 387:14

accidents 105:9,10

394:20

accommodate 316:2

362:6

accountability 52:1

accountable 50:9

accurate 58:5 134:6

146:10 365:20 400:7

achieve 82:10

acknowledge 188:14

206:18

acknowledged 407:8

acquisition 94:3 183:6

acronym 124:7 131:16

act 84:10 228:1 255:9

267:14 335:19 336:2

346:1 376:3 380:2,4

403:5

acted 70:13 306:9

action 186:19 187:3

383:6

activation 312:20

active 63:21

actively 144:21

activities 25:10 26:16

31:2 40:22 45:11

179:18 263:2

activity 17:18 26:14

41:7 65:22 253:1

actual 99:7 125:15

127:22 139:2 196:22

232:15 242:5

actuality 138:12

add 26:6 29:4 32:12

36:11,13 37:16 39:5

49:15 51:4 56:4 74:11

74:14 100:7 113:19

275:13,14 283:5

284:22 301:12 311:19

312:15,22 318:12,16

319:9 350:18 356:20

386:7,9 389:4

add-on 317:9

added 10:12 33:1

131:15 324:21 358:6

361:3 383:3,18 385:2

adding 38:22 39:2

225:13 282:9,10

342:4 354:6

addition 32:15 54:19

67:4,14 69:17 91:15

138:1 189:14 309:17

322:21 332:6 383:4

405:18

additional 15:4,10

16:16 20:17 22:4 26:6

30:2,6 32:12 69:14,21

71:22 133:14 144:6

167:19 249:15 260:13

315:14 362:7 369:10

374:12 389:7

address 34:14 103:14

108:2 116:10 121:19

150:22 151:10 184:13

218:19 227:15 232:17

321:8 336:8,18 338:6

342:9 345:7 360:9,9

398:15,16,16,17,17

address/include 182:2

addressed 64:14 150:2

336:4

addresses 137:15

267:18 319:5 327:18

354:12

addressing 178:3

184:21 239:1 340:20

adds 194:4 310:7,8

374:3

adequate 83:19 157:6

157:19 334:12

adequately 81:14

153:14

adjectives 315:3

Adjourn 3:20

adjudicate 106:19

194:15

adjudicated 369:18

adjudication 32:3 49:20

50:13 51:7,12 92:16

123:5 180:13 186:13

194:13

adjudicator 186:9

adjudicatory 357:17

359:6

administer 106:19

107:15 339:4 373:19

administration 403:4

administrative 91:4

111:6 255:9 284:6

373:22 398:22

administrator 162:14

advance 113:11

advanced 119:19

advantage 323:8

adversarial 329:17

332:10

advice 35:3 76:5 149:3

194:7 220:9

advise 84:11 122:1

185:16 209:19

advising 158:17

advisory 1:3,18 4:4 7:6

20:16 76:6,20 82:10

119:13 120:5 373:10

402:6

advocacy 65:7

advocate 6:7 220:4

389:19 392:14

advocates 120:13

165:12 345:5 369:6

advocating 352:9

affect 352:4 381:9

affidavit 261:11,18

262:8,13,16,17,20

263:1,4 264:6 265:17

266:2,5 268:9,11,20

268:20 269:7,12,19

270:4,15 272:18,19

273:7,22 277:3,5

280:19 282:3 293:10

293:16 294:7,20

295:2,4 297:12,19

298:17 300:19 309:15

312:21 316:7,19

318:14 321:3 323:4

392:1

affidavits 128:8 264:16

264:16 265:14,16

267:8,19 268:4 282:1

320:15 392:2,3,10

affiliated 12:8 20:7 21:3

309:19 318:18

affirmation 14:13 135:6

affirmative 23:7 24:11

affirmed 56:1

afford 288:20

afternoon 186:3

age 34:17 65:20

agencies 365:14

386:15

agency 97:17,19 98:2

104:1 107:15,17

168:19 238:14 270:13

agenda 117:16,18

118:8 119:5 185:7

agent 82:12,16,20

agents 33:10

aggravate 154:5 406:8

aggravated 335:22

352:5 353:22 354:19

388:22

aggravating 152:9

163:17 354:22 396:13

405:11

aggravation 137:11

138:1 151:8 172:7
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

409

178:3 181:9 182:2

336:5 340:21 346:16

349:7 354:13 404:22

aggravation/causation

172:14

aggregate 235:17

ago 62:2,16,18 123:3,7

219:21 242:1,2

250:18 381:2

agree 79:7 81:19

105:12,12 108:4

146:3,13 151:7 152:2

173:13 182:1,16

269:4,14 279:10

314:14 323:13 333:19

335:15 346:19 347:22

353:1 376:14 399:22

405:6

agreed 68:14 222:7

275:22 355:4 358:13

agreeing 50:5 390:9

agreement 97:20

346:13 347:3

agrees 298:1 397:17

ahead 56:13 86:19

112:1 185:10 217:7,8

255:21 256:3 340:14

350:13

Alamos 11:4 164:19

Alaska 231:11

alias 21:16,17

alleged 354:19

allergic 187:22 400:8

401:1

Alliance 65:6

allow 85:8 114:5 175:2

189:10 204:20 210:16

382:2

allowed 68:8 179:8

allowing 115:19

allows 15:8 211:21

215:14 307:5 349:20

aloud 293:3

alter 257:7

alternate 289:22

altogether 175:4

aluminum 40:11

Alvarez 220:5

AMA 142:13,15,16

Amchitka 236:2,4

amended 283:17

amendment 279:11

283:11,14 300:2

301:8

amendments 118:20

America 66:14

American 222:16

amorphous 104:2

amount 8:3 10:13 11:1

15:17 26:2 46:2

139:21 161:21 378:6

amounts 13:20 79:3

analysis 138:10 235:3

and/or 57:16 119:3

135:9 356:22

anemia 78:22

annual 50:8

annually 193:14

answer 24:6 46:16

52:17 68:14 88:17

145:16 153:6 227:6

255:7,8,15 258:13

308:18 311:14 320:11

334:1

answered 164:1 188:12

227:19

answering 384:19

answers 34:4 49:3

68:18 175:12

ANTONIO 2:15

ANWAG 66:22 80:5

anybody 32:8 35:11

40:2 66:20 170:4

185:3 286:5

anymore 224:9 378:10

378:19 379:14 381:3

anyplace 105:19

anytime 63:3

anyway 120:7 148:19

169:21 181:3 304:17

307:17 339:1 343:20

375:7 376:10

APA 275:19

apart 70:11 74:15

252:22

apologize 243:7 247:18

248:18

apparent 265:22

apparently 362:8

366:22

appeal 178:8 359:4

appear 232:16 249:18

311:14 353:5

appeared 70:10 218:9

appears 232:17 266:21

268:2,3

appendix 79:6

apples 66:21

applicable 37:7 211:9

334:3 404:1

application 46:14 50:14

58:13 137:9 211:22

375:3,8

applied 16:18 41:8 50:6

126:19 163:1 228:18

233:4 235:8

applies 211:2 234:7

351:17,18 365:4

apply 27:9 36:5,19,21

40:19 196:14 201:18

202:22 203:3 207:21

208:3 211:10 213:6

219:9 220:13,16

221:1 234:7,15

246:21 307:21 319:3

403:7

applying 199:16

appreciate 149:5

170:10 290:13 395:2

407:12

appreciative 366:2

approach 49:1 71:20

107:18 151:15 166:4

193:18 249:6 268:13

268:13

approaching 367:10

appropriate 50:6 74:18

135:5,13 157:1 194:7

267:22 305:10 306:7

351:22 356:22 371:5

appropriately 160:22

approval 372:11

approve 268:10 356:18

365:15

approved 357:1 360:5

368:7,9,13 369:19

371:10 372:12 373:2

377:21 378:12,21

380:1 381:9 401:6

402:15 405:17

approves 360:3

approving 260:21

APRIL 1:12

Arbitrarily 381:1

arbitrary 370:1 381:8

archived 323:19

area 7:4 20:15 30:6

84:9 118:10,14

121:18,22 143:19

180:4 185:14 203:1

220:1 388:3 390:21

areas 18:19 37:2 61:4

90:15 96:22 116:10

116:13 182:2,17

296:8,19

arena 323:19

argue 211:19

arrangements 111:7

arrive 139:1

article 249:7

articles 135:5 315:6

asbestos 38:21 59:4

102:17 339:4 405:18

asbestos-related

338:20

aside 65:11 137:17

asked 42:20 104:6

111:12 116:10 118:10

121:19 241:22 255:21

256:2 257:12 259:10

263:17 287:16 295:18

311:13 336:18 360:20

376:22 384:17

asking 103:22 104:3

143:15 158:11 164:7

192:16 299:12,13

320:7 330:4,7 376:7

379:15

asks 334:22 345:10

aspect 254:2 342:16

aspects 187:4 195:3

assembling 210:11

assertion 261:15,16

293:13,15 294:9,10

assess 43:22 108:15

266:15 322:18

assessed 12:11 15:13

76:1

assessing 13:2 78:9

137:10

assessment 57:17

60:10 68:10 133:7

136:16 207:14 238:10

330:18

assessments 76:1

assigned 7:5 68:16

251:2 327:21 385:3

assigning 287:11

assignment 84:10

assignments 114:13

assist 48:6 77:22 82:7

129:2 130:21 219:5

assistance 2:17 33:20

122:13 123:6 136:13

136:14

assistant 26:3 123:4

assisting 52:20 129:3

associate 5:15 34:17

251:4 255:22 258:4

associated 21:9 22:22

26:13 38:20 45:17

association 99:15

401:19

assume 25:11 138:18

139:8,22 180:21

195:7 245:2 378:17

assumed 149:15

assumes 138:9

assuming 206:2

assumption 155:3

195:7 362:21

assumptions 45:2
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

410

106:9 115:4,6,11

140:10

assurance 64:6 73:17

assure 90:17

asterisk 19:4

astounding 362:14

Atomic 6:7

ATS 223:3 248:20

attend 288:19

attendees 116:13

250:15

attending 123:14,15

125:6,19 126:1

127:22

attention 97:1 182:14

260:10 276:7 280:10

attests 267:15

attorneys 165:16

attribution 346:17

audit 50:19 365:1

auditing 383:4

audits 50:8

augments 261:9

August 370:17,21

371:9

author 20:14

authority 296:13

359:15

authorized 165:16

314:20 315:11 323:17

363:18 393:9

autologous 240:12

automatically 156:2

318:9

available 10:2,6 15:18

18:11 33:3 38:15 41:9

58:19 80:6,11,13

114:12 146:11 151:1

167:18 181:16 263:5

266:15 332:1

Ave 1:19

avenue 174:20 175:1

average 367:21 368:1,5

avoid 35:20

award 331:2

aware 10:9 100:10

213:9 250:16

Axial 243:18

B

b 3:13 116:18 178:13,15

184:13 185:18 186:18

186:19 187:4,8,13

190:1 195:3 206:6

207:17 214:21 216:16

223:20 224:11,20

225:4,4,11,14,15

226:20 227:20 228:7

231:3 234:10,18,22

237:2,16 239:5 275:4

301:21 304:22 308:1

309:1 327:21 342:19

352:18 354:12 356:6

356:12,18 358:4,22

359:3 360:11,13

378:13 386:18 389:15

391:12 399:1 404:7

404:16,17 407:2

B-read 233:3,8,8

B-reader 231:21,21

232:11,15,22

B-reader's 232:20

B-reading 233:11

B-reads 233:6 380:7

back 7:9 19:14,18 20:21

49:22 53:1 62:4 70:9

80:15 82:18 86:13

95:12 100:2,17

107:22 109:15 118:3

120:2 139:17 140:4,6

140:8,12 141:7 142:8

144:8 150:6 157:15

166:13 169:14 185:22

213:1 217:22 225:11

227:8,10 235:15

241:12 244:7 245:17

246:16 250:3 257:12

267:3 270:22 272:5

274:17 276:9,9 277:8

277:12 280:10,12

281:17 287:17 293:4

300:9 327:7 345:21

352:14,20 354:1

358:21 359:8 383:13

387:20 388:2 395:11

400:9

back-and-forth 162:13

backdoor 348:17

background 8:9 63:22

80:8 134:7 186:4,5

250:12,17

backseat 220:9

backwards 66:3 180:15

225:10

bad 295:10 299:19,22

365:18

BAL 222:22

balance 27:7 96:4

balancing-act 175:11

barometry 208:17

Barrie 65:6 362:9,11

based 15:17 24:18,20

36:20 41:11 45:11,12

46:8 48:9 102:6 132:8

134:6,9,16 188:2

195:6,16 197:10,17

200:14 214:20 222:21

241:19 257:5 280:22

290:21 294:11 297:16

298:13 341:11 372:13

372:16

basic 8:22 208:22

basically 8:19 9:1,18,21

11:11,14 18:15 20:14

23:8 24:3 25:11 27:5

35:4 38:18 64:4 68:12

74:7 115:22 147:10

151:21 187:21 191:17

200:17 202:9 205:7

209:18 210:15 216:11

222:20 243:12 252:15

269:7 313:1 324:14

333:12 334:19 338:3

357:11 358:5 363:15

385:6

basis 41:10 82:14 83:5

88:21 141:9 155:10

157:18 166:3 232:7

260:1 268:19 329:16

332:9 333:17

bathe 366:17

battles 324:2

beam 61:4

beat 79:2

beats 66:14

becoming 405:20

began 119:8

beginning 119:14 162:6

288:13 384:16 395:8

399:3

begun 402:10

behalf 402:9,18

belabor 76:22

believe 44:20 67:7

93:13 96:10 161:22

165:11 197:2 234:3

242:19 247:2 375:9

believes 331:21

Bellevue 4:14

bellow 92:12

BeLPT 204:18 211:14

212:14 225:19 226:1

226:8 240:6

benefit 111:15

benefits 126:19 267:14

369:22 373:21 402:20

403:2

beryllium 6:18 61:2,3,9

124:8,10 132:18

187:10,13,15,16,17

187:19,21,21 188:2,3

188:4,8,10,14,16

189:1,5,6,15,17,20,21

190:3,5,21 191:8,15

191:18,21 192:5,6,11

192:19,20 193:1,4,10

193:15,22 194:12,14

194:21 195:5,10,11

195:12,14,17 196:4,5

196:7,10,16,19

198:21 199:19 200:2

200:8,11 201:8,13,16

201:21 203:11,20,21

204:2,4,6,8,18 206:12

206:15,22 207:1,15

207:20 209:10 210:1

212:8 215:5,9 217:18

217:21 219:21 220:18

224:4,5 228:9 233:20

233:21 234:12 239:1

241:14 242:5 243:10

243:12,13,20 245:1,9

245:11,13 246:1

370:5,7,8,10,13,14

375:10,12,12,13,14

375:18,19,20,20,22

376:6,21 377:3,18,21

378:2,3,5,11,13,14

379:1 380:3,6,18

399:2 400:2,10

best 12:13 164:16

258:13 259:4 266:15

344:6 350:15

better 37:8 46:6 53:16

118:14 136:10 204:14

258:6 277:11 307:15

371:4 387:5,19

406:18

beyond 24:10 29:1

77:18 82:9 84:17

220:2 237:19

biannually 193:14

biased 269:13

big 17:1,8 30:4 31:16

59:12 331:7 352:15

365:22 393:5 394:14

biggest 198:18

binders 8:12

binding 284:7

bio 12:16

biological 13:6,12 19:6

19:11

biopsies 191:22

biopsy 132:17 214:22

215:5,19 217:3

221:22 222:5 223:10

223:11,21 225:3,5

243:16 244:1 379:8

biostatistics 174:8

birth 404:3

bit 7:18,20 8:8 11:15

16:19 18:22 19:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

411

21:22 27:4 33:8 45:4

47:22 79:17 91:6

92:19 96:1 119:16

124:18 125:14 131:12

140:17 159:20 168:4

178:22 185:10 186:4

187:9 195:3 200:5,6

211:6 219:10 220:9

223:17 224:18 250:12

250:17 325:4 367:12

368:17 371:21 396:16

black 256:17 324:1

blank 164:19

blast 167:6

block 372:6

Blog 374:14

blood 188:2 212:14

215:15 245:13 375:14

375:19

bloodwork 132:16

blue 65:21 256:17

276:15,16

board 1:3,18 3:8,11,16

4:4 7:6 8:1 18:7 20:16

30:7 35:8 36:20 44:12

49:21 61:17 62:11

64:21 82:10 85:2

91:17 92:16 100:8

115:8 117:5,22

119:13 120:5 135:13

150:18 151:9 173:20

186:17,18 187:2

190:7,16,19 199:5

217:13 219:5 232:10

236:14,22 237:3

247:3 250:13 251:2,9

251:17 252:9,10,17

252:19,22 253:11,13

253:17 254:11 257:20

260:8 264:21 265:5,6

265:12,21 271:19

277:16 278:6,15,19

279:19 285:1,15,18

286:10 287:9 296:6

304:18 308:19 309:8

331:11,16,21 332:6

338:16 354:15 361:3

361:8 362:13 364:21

373:11 382:2 395:2

402:6 403:6

Board's 136:13 250:9

327:18 354:11

board- 174:16,17

board-certified 135:15

boarded 175:18

boards 173:17

Bob 220:4

Boden 2:5 5:4,4 52:7,8

81:8,9 86:19,20 87:17

121:6,8 141:14,15

142:9 144:9,13

152:15 159:12,13

164:10 184:8,9 185:1

227:17,18 228:5,14

229:1,5,10 245:18

268:5,6 269:4 270:22

271:5,10,15 277:10

277:20 278:8,14

279:6,10,13 280:3,6

283:12,21 285:2,5

289:22 290:9,12,15

294:13,14 295:6,21

297:3,9 298:3,9 299:5

299:10,14 300:8,13

300:16,21 301:2,13

301:15,19,21 302:6

311:1,2 315:15,16

321:6,7,10,20 322:1,8

324:17 325:1 335:17

335:18 336:7,13

339:22 340:2,3

343:13,22

Boden's 58:16

body 73:3 133:3 157:1

175:18 230:13

bono 314:22

bonus 288:8 390:16

book 65:21 116:12

157:16 217:10 247:21

271:4 371:1

books 68:3 257:21,21

boon 394:15

borderline 189:12

bosses 393:18

Boston 5:6

bothered 387:20

bottom 56:15 353:17

box 393:21

Branch 2:17,20 7:7

51:7,12 52:3,6 122:12

123:4,5,6 186:13

brand-new 393:20

break 60:14 62:14 81:7

83:12 84:3 169:13

173:3 250:2 327:2,3,7

355:20 360:22 361:14

387:8

breathing 132:10

brief 20:11

briefing 116:12 157:15

217:10 251:4 256:1

257:21 271:4

bring 28:21 154:13

260:9 280:10 290:3

331:14 356:8

bringing 156:9 336:17

363:3

brings 168:18 334:21

broad 16:21 26:8 27:8

90:4 107:19 175:21

194:2 218:4 333:21

broad- 15:16 36:19

broad-based 13:17

broader 59:17 111:17

177:19 178:22 181:8

237:18

broken 71:9

bronchial 215:7

brought 28:5 165:6

264:19 327:15

Brown 20:14 97:18 98:8

98:11 111:15,18

Brown's 71:2

build 100:3

building 6:21 29:6,9,9

29:11,16 95:20

383:22

building- 29:2

building-level 28:7,18

30:3

buildings 18:19 61:6

383:15 385:7 393:18

bullet 138:8 145:20

bulletins 115:3

bullets 67:22 76:17,18

bunch 75:6 77:19

burden 261:20 293:19

299:4 331:6 332:4

362:19 373:21 374:2

buried 226:22 391:19

business 173:1

busy 167:12

Button-pushing 313:16

C

c 178:13 214:21 239:4,8

266:19 356:7,12

357:7 358:9 359:2,3,8

359:20 360:11

cafeteria 29:18

CAIRS 105:8 387:15

calculations 320:20

calibration 190:12

191:2

call 3:3 82:7,8 88:6

127:10 128:1 135:20

153:15,16 159:3

167:5 168:15 169:8

232:13 276:22 361:14

380:16 392:7,22

396:2 397:20

called 35:4 63:7 97:20

105:8 138:17 183:6

271:11 392:8

calling 33:12 66:13

158:11 208:15 363:19

calls 83:1 145:17

251:12,16

camera 393:20

cancer 71:21 72:9

82:13,17 101:14,16

102:16 103:18 127:11

127:13,13 176:3

218:21 404:12,19

405:11,19 406:2,3,17

406:19

cancers 99:9 103:12

capabilities 27:2

capable 83:7

capacity 186:14 245:7

capital 402:10

capricious 370:1

capture 283:20 325:18

387:10

captured 26:18

carbon 40:11

carcinogen 72:13

carcinogens 72:12,15

72:16 73:2

cardiac 99:8

cardiovascular 73:6,8

cards 229:20

care 65:14,16 73:22

74:21 165:22 166:5,9

166:9 193:21 357:2

366:7

careen 7:12

career 34:12

careful 280:11 316:17

339:10

Carrie 2:8 4:16 43:15

258:14 343:3 347:9

347:11

carries 135:14

Carroll 374:18,19 375:6

382:7

carry 84:17 135:16

carryover 86:17

case 4:8 19:21 23:15,15

27:12 30:19 35:11

36:6 45:12 47:2,7,16

50:12 52:14,15 71:6

85:9 92:20 94:6,19

102:2,4,10 108:17

111:11 112:16,21

113:6,8 114:3,8,13

115:20 118:7 123:10

125:12 127:3 128:16

128:20,22 129:16

131:1,9 156:8,10

158:18 161:18 162:9

163:6,22 164:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

412

167:18 169:1 178:14

206:12,15 207:1,7

208:11,14 211:10

216:22 219:22 221:1

224:16 225:1 228:22

233:4 235:4 341:15

351:14 396:1

caseating 198:19

caseload 113:16

cases 30:17 32:4 34:8

37:7 47:11 52:4 93:3

96:8 99:8 113:22

114:2,6,15 127:12

143:13 157:13 159:22

160:14 162:5 166:11

169:4 211:6,11 222:8

225:3 339:1,7 368:7

Cassano 2:9 5:9,10

58:14,15,15 92:1,2,14

94:22 120:22 121:4,8

140:15,16 151:19,20

151:20 168:1,3

169:10 175:14,15

178:17,18 185:2

236:17,18 269:2,3,3

269:20 273:14,15

274:5 289:4,5 292:6

293:6,7 300:1,11,15

302:10,16 305:3,6

306:5 313:3,4 319:8

319:13 324:12,19,21

325:2 328:14 333:6,7

337:12 343:9,19

344:21 351:21 352:16

356:10,14 357:22

Cassano's 313:11

CAT 198:2

catalog 11:9,10

catalogued 15:12

categorical 107:19

categories 18:21 21:6

22:8 36:21 44:12

50:12 54:13 103:6,11

categorization 36:9

categorize 48:4

category 22:19 26:5,9

26:10 27:18,22 39:21

43:16 44:5 54:9,21

56:10 66:1 343:1

cater 164:3

causal 77:8 78:15

151:15

causality 341:14

causation 115:17 129:4

138:1,10 141:17

146:21 147:15 148:10

150:17 151:2,7 160:5

161:6,15,20 162:8

163:12 171:3 172:7

173:15,19 174:7

176:4 178:4,11,13

181:7,8,19 182:3

195:8 327:19 329:2

330:9,21 331:4,22

334:13 335:4,21

336:1,5,6,12,14

337:17 340:6,21

342:16 346:16 348:17

349:5,6 351:1 354:13

396:19 403:20,20,22

404:15,20 406:12

407:1

causation' 331:20

causative 147:11

152:10 352:5

cause 42:7 82:13

127:18,19,20 135:7

178:11 181:10 318:2

347:14 349:6 388:21

405:13,14 406:13

cause/effect 175:21

caused 136:6,7 137:17

137:19 153:22 162:18

230:4 341:22 344:4

347:16 351:5 353:22

354:18 404:12,14,19

406:3

causes 20:7 42:1 82:17

149:22 400:16

causing 41:20 163:16

354:22 396:14 405:10

406:2

CBD 61:9 176:3 195:6,7

195:8 198:15 199:9

203:8,16 206:6

208:15 209:4 214:20

215:11 216:17 217:1

222:21 223:18 225:5

228:1 240:5 242:14

242:22 243:18,22

244:3,5,9 245:15

246:3,5,15,17,18

249:9 376:12 378:8

378:10,16 379:16

380:8,12,22 381:20

CDC 323:19

CE 23:4,18 31:9 49:18

51:13 131:8 158:11

158:17 159:3 200:9

210:6,15

ceased 17:12

ceilings 61:5

cells 10:18,19

center 155:9 319:21

cents 354:6

certain 17:13 29:20

36:18,20,21 45:2

50:16 57:6 65:20

90:18 93:17 97:2

99:14 109:16 114:15

138:16 139:13 141:3

143:21,21 144:3

159:22 208:1 220:1

256:14 259:11 349:17

certainly 17:8 18:7

24:15 37:13 56:3

61:21 118:21 184:18

193:20 219:4 237:9

251:8 252:20 254:14

296:22 312:6

certainty 395:15 396:18

certificate 101:16

127:15,18 404:3

certificates 127:15

certification 135:13

143:11,11 173:20

certified 174:17,18

certifies 225:5

certify 143:9

CEs 27:13 364:20

371:18

cetera 46:9 76:13 152:9

152:10,10,10 262:7,7

321:16 335:22 336:1

CFR 241:20

chair 1:21 2:7 4:3 5:19

6:2 7:2 41:14 42:13

42:20 45:21 48:15

52:7 54:4 58:14 60:12

62:13 79:19 81:2,6

82:1 83:11 84:2,8

86:1,9,15 87:20,22

88:16 92:1 95:9 96:13

96:20 98:1,4,7,10,13

98:20 101:11 104:13

106:5 108:6 110:2,20

111:2 112:4 114:16

116:5 117:8,14 119:4

120:19 121:1,7,12

122:11 137:13 140:15

141:14 144:14 145:22

147:1 149:10 150:11

151:5 152:15,21

153:2 154:7 155:4,12

156:5,11,15 158:6

159:12 161:3 162:11

164:8 167:15,21

169:11,18 170:7

172:6 173:6 175:14

176:7,10 178:17

179:14 180:6 181:4

181:22 183:16,19,22

184:7,9,12,16 185:4

192:8 194:6,10 206:8

208:5 210:10,14,21

212:5 216:14 217:4,7

218:1 219:18 223:14

225:2,9,12 227:17

229:13,17 230:16,20

234:1 235:13 236:7

236:10,13 237:6

238:2,17 239:3,14

240:7,20 241:2,6

243:2 247:9 249:3,14

249:21 250:7 252:13

255:2,7 256:9,12

259:6,9 260:2,4 263:7

263:11 264:10,20

265:1 266:18 268:22

269:15 270:18,20

271:2,8 272:2,15

273:12,14 274:8

275:7 276:6,20

277:18,21 278:2,12

278:21 279:17 280:5

280:8,16 281:2,6,9,16

282:12,16,22 283:2,5

283:10,13 284:3,10

284:13 285:4,7,22

286:4,13,17,22 287:6

288:1,11 289:11

290:5,8,11,14,17

291:6,11,17 292:1,7,9

292:12,15 293:21

294:4,13 295:5,16,22

296:11,14,20 298:21

299:9,12 301:4,20,22

302:5,7,13,17,20

303:1,20 304:2,7,13

305:5 306:4,17 307:8

307:18 308:4,12,17

311:12 312:7,11

313:3,10,19 314:3,11

315:14,22 317:5,10

317:14,18 318:7,11

319:7,12,15 320:3,6,9

320:18 321:9,18,21

322:5,11 324:5 325:3

325:15,21 326:6,10

326:13,16,19 327:12

329:8 330:1,15

331:10,13 332:14,17

333:6 334:10 335:8

335:15 336:3,11,15

337:3,11 338:14

339:12 340:1,18

342:8,13,22 344:1

345:11,20 346:11

347:7,11,20 348:13

349:1,10,14 350:12

351:6 352:8,17,22

353:15 354:4,10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

413

355:7,10,12,15,18

356:13 357:19 358:1

358:12 360:8 361:21

367:7 374:7,10,16

375:5 382:5,10 388:5

388:8,16 389:3

394:10 395:4 400:14

401:12 403:13 407:14

chaired 63:15

Chairperson 401:18

challenge 23:9 41:13

109:19 174:13 263:20

challenging 34:13

103:3 253:10 254:1

chance 79:7 364:22

368:19

change 32:21 72:4

74:13 85:9 89:17

113:11 114:10 214:12

214:12,14 224:14

230:2,3 247:7 257:1,2

259:12 262:15 263:4

264:14 268:2,8,15

271:1 272:5,17 273:4

276:3,12 289:18

292:3 294:15 295:6

295:14 298:6 302:4

303:7 307:17 308:20

309:9 311:18 312:1,4

314:9 325:4 327:13

330:19 331:7,9

336:19 345:19 353:20

353:20 354:5 357:12

358:10,16 359:11

361:7,9 374:6 376:5

changed 64:15 214:14

255:19 259:3,3 311:6

337:14 394:18,21

399:20

changer 72:2

changes 3:17 82:8

140:7 229:21 230:5,6

243:19 250:11 251:7

251:10,14,18,18,20

252:2,5,16,22 253:12

253:21 254:4,5,10,14

255:5 256:17 257:22

258:17,19,20 260:1,6

260:9,13 266:1

271:19,21,21 275:10

275:15,17,19,21

276:19 277:13,17

278:19 282:10 285:2

285:5 291:5,18

295:20 302:14 309:22

312:5 323:13 326:3,4

333:5 337:16 340:8

358:10 368:17 369:2

369:4,9 373:10,11,12

374:13 387:22

changing 32:17 237:4

337:16 356:5 360:6

370:7

channels 15:6

Chappelle 2:17 3:10

122:12,15,20 153:7

155:7 156:7,14

158:15 163:5 166:12

167:17 176:11

chapter 89:1 218:21

chapters 89:2,3

characteristic 199:18

200:11 201:7 203:8

209:13 217:1 245:3

246:6,7,15,17,18

characteristics 197:22

198:14,21 199:7,9

201:9 204:19 209:7

characterizing 210:3

charter 7:5 122:1

137:21 185:15 254:11

260:7

charts 125:19

check 112:10 149:6

364:3 365:1 374:14

checked 112:11

chemical 13:6,12 19:6

19:11 69:2 94:7

107:18 114:21 384:7

396:20 397:1,2,2,3

chemically-related

105:10

chemicals 69:5 105:17

107:15 114:22 383:2

383:8,10,18,20,22

384:13,20,21 385:8

385:13,17 386:21

387:7 394:2

chest 191:21 197:22

198:1,5 199:7 205:3,4

208:18,22 231:21,21

232:5 245:3 246:6,18

379:6 399:9,14

Chief 2:17,18,20 7:7

122:12 123:4 185:20

choice 143:1,1

choose 18:14 143:7,16

143:18 213:13 356:16

choosing 143:3

chose 174:21

chosen 125:4,9,10

chromate 59:12

chronic 20:3,22 21:3

23:17,21 61:9 99:4

124:8 187:10,17

191:20 192:6,19

193:1,4 194:12,13

195:5,10,17 196:3,5,7

196:10,13,15,19

197:12 198:21 199:19

200:2,7,11 201:7,12

201:16,21 202:7,10

202:14,20 203:11,21

204:6 206:22 207:14

207:20 208:2 209:1

209:10,22 211:16,20

215:9 217:20 218:2,7

218:11,14,18 219:14

224:4,15 228:9 231:1

231:3,14,17 232:6,10

233:20 234:12 243:13

243:20 245:8,10,22

266:14 375:10,12,21

376:5,21 377:3,18,21

378:13 379:1 380:3

380:21 381:4,6,12,16

381:19 399:1,6 400:2

400:12 401:1,2

chronically 221:8

circular 44:20 276:3

367:16,22 368:4,6,8

368:11,12 393:12

circulars 115:4

circulated 365:17

circumstance 139:16

circumstances 62:9

93:11,18,20 102:7

170:17 311:10 349:17

Cisco 382:12,12,14,16

388:7,9,17

citation 298:22

City 5:21

civil 405:5

claim 16:18 19:15 22:13

23:16 32:8 50:3,16

55:16 58:13,17,18

83:21 92:14 108:19

108:21 130:14 152:1

155:10 158:10 161:11

161:14 163:7 187:5

189:21 192:13 196:22

197:19 207:17 216:17

224:4,10 228:2,10

235:5 267:13,17

280:22 294:11 297:16

298:13 333:1,13

349:18 363:11,15

370:18 372:13,15

373:2 374:3 384:6

386:4 390:4,6 391:9

405:16,19

claim's 330:11

claimant 2:10 6:5 57:13

57:19 58:2 60:1 85:3

92:7,22 101:22 112:8

123:16 128:14,15,18

130:19,21,22 131:7

137:16 138:11,14

142:22 152:5 153:12

153:14 154:15 155:19

156:3,9,20 158:8,16

158:17 159:4,10

163:6,8,19 168:9,15

168:16,17,18 169:2,4

171:21 174:21 197:1

261:20 267:21 293:18

299:3 309:14 310:12

312:21 316:8 318:14

318:15 319:18 320:19

328:2 330:10 331:6

331:17 334:19 335:7

335:11 346:14 348:14

350:4 351:5,7,8,13

357:7,15 359:4

360:16 363:8,10,14

363:14,19 370:18

372:22 390:10

claimant's 123:12,14

130:10 173:21 262:20

265:18 282:4

claimant-friendly

220:10

claimants 56:17 57:21

83:21 139:5 154:13

156:18 167:14 172:21

177:2 206:11 213:5

213:13 219:12 264:15

329:18 332:5,11

359:10 361:4,6,8

362:20 371:12 372:6

402:15

claimants' 156:17

373:20,21

claimed 234:16 344:18

354:18

claiming 143:22 144:4

claims 3:10,13 5:14 9:9

9:14 19:13 20:5 21:13

21:21 22:15 23:12

30:15 32:3 34:15,18

34:21 35:19 37:12

41:18 43:13 44:21

46:10,12,18,19,22

47:5,22 48:18,20,22

49:15 51:8 53:22 59:2

64:7 68:10 81:12 86:5

86:12 87:1,3 88:4,12

90:6,7,15 91:5,5 92:6

92:9 95:3,6 96:2,5

99:11 101:18 106:19

107:6 108:9,19 109:5

112:10,12,20 113:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

414

113:11,15 116:16,17

122:2,3,5 123:1 129:8

130:12,15 131:1

153:11,15 154:14

161:7 162:14 176:22

176:22 177:18 179:1

181:13,20 182:6,22

183:1,9 185:17 186:9

186:9,10,11 190:5

194:13,15,16 198:2,9

199:1 200:16 202:17

205:13 208:8,20

209:2 211:2 212:3

218:4,7 227:3,6,8

232:7 234:21 246:14

249:9 270:5 297:2

330:20,20 331:1

333:4 335:3 339:4

349:17 350:9 351:2

360:13 363:7,7,8,9,19

364:7,12,17 365:1,3

368:13 369:16,17,19

369:20 370:5 371:8,9

371:13,17 372:5,9,11

373:5 374:5 375:3

377:15 383:9 387:21

388:4,10,12 390:5,13

392:7 393:9 394:17

clarification 32:19

35:11 36:16 129:22

131:4 138:4 142:1

144:15 149:9 171:3

195:21 203:7 217:9

217:13 319:17 373:6

clarifications 201:18

clarified 358:6

clarifies 247:8

clarify 95:16 136:15

153:17 155:4,13

161:5 176:16 243:6

259:16 265:18 282:4

345:12 361:4

clarifying 219:5 299:1

clarity 36:13 95:13

194:4 203:9

classic 225:22 226:6

classification 26:1,9

387:7 391:10

classifications 384:12

385:4,7 387:9 392:15

394:21

cleaners 33:13

cleaning 40:1,4,21 55:3

55:7 57:4 61:2

clear 34:4 70:12 74:4

75:15 76:2 78:4,17

115:15 129:17 136:2

170:18 184:3 196:8

198:8 227:1 254:17

257:10 272:12 283:19

284:2 303:6 342:15

357:21 361:11

clearance 9:17

cleared 9:13,15

clearly 20:15 94:12,15

201:7 269:17 327:20

click 20:1

client 101:15

clients 406:21

Clinic 4:14 400:4

clinical 65:18 66:11

146:4 205:20 245:9

245:21 380:11

clinician 65:15 73:22

clinicians 65:16 74:21

clip 15:11

Clorox 33:11

close 96:10 122:18

258:22

closed 166:18 391:2

closely 292:22

closer 92:11

clue 390:22 391:1

CMC 127:7 128:20

129:22 130:4 131:9

140:9 143:20 144:5,7

152:13 162:10 171:2

171:10 172:21 198:16

341:17 349:8,13,19

350:8 351:2 372:7,17

373:7 389:1 397:17

CMCs 129:14 147:22

170:20,22 172:15

206:17

co-direct 154:8

coated 54:18

code 56:10 110:10

378:2

coffee 366:19

cohorts 114:15

Cold 401:18,22 403:9

collaboration 75:13

Collaborative 400:12

collect 12:3 13:7 24:12

37:11

collected 8:4 11:13

12:11 14:14

collecting 14:5 37:6

collection 11:11 12:19

13:5 16:21 360:12

collectively 382:19

College 5:16

color 276:15,16

Colorado 6:17

combination 215:2

225:15 226:14 350:16

combinations 226:17

combine 148:6 179:10

324:10

combining 178:8 180:8

come 16:16 40:2 46:14

49:2 52:16 57:3 61:9

90:10 100:2 113:4,13

115:9,10 118:3 120:2

140:6,8 141:7 145:11

151:1 153:21 157:17

166:2 180:10,12,17

187:1 189:6 210:18

217:22 223:12 225:6

225:7 237:22 240:14

241:15 242:2 244:7

246:16 248:13 252:2

307:5 320:21 339:8

347:4 362:9 367:18

380:15 386:18

comes 36:6 39:18

54:10 101:15 108:19

123:12 132:2 158:1

163:6 206:13 264:2

315:7 322:15 365:4

366:9 376:5 399:1

405:8 406:17

comfortable 147:15

199:1

coming 15:12 24:17

27:16 50:11,16 55:19

113:17 138:3 180:16

227:8 270:2 304:20

353:12 393:14,17

394:8

comma 273:18,21

commend 362:13

comment 3:19 52:9

58:16 64:12 82:3

100:11 137:14 144:19

144:20 230:8 237:7

252:6 253:7 259:19

260:4 269:4 275:20

275:21 287:11 288:9

307:10 309:21 313:11

314:19 315:17 326:22

327:4 330:3,6 341:14

355:22 361:17,22

389:5 407:15

comments 79:21 83:9

106:6 112:6 114:17

116:5 120:20 138:5

147:2 170:2 176:8

179:15 181:22 183:19

229:14 230:18 236:7

240:20 249:15 250:19

250:22 252:21 256:10

256:22 264:20 266:8

268:7,22 270:18

275:16 284:10 285:9

285:14 286:10 288:6

288:10 290:19 303:14

306:18 308:7,9

314:16 315:14 331:10

332:12 335:16 337:11

348:2 355:5 362:12

369:9 374:13,22

commitment 332:2

committee 3:11,16

62:16 63:9,15,21,22

65:4 67:5 69:20 70:6

70:18 75:11 76:14,20

77:2 80:4 84:17,21

85:5,14 107:22

118:16,17 119:5

120:14 149:20 176:12

179:9 184:2,20 185:4

185:7 236:15,16

239:12 241:3 249:16

307:2

committees 3:8 84:19

84:22 85:7,8,13 117:9

179:6,9 181:18

182:13 184:1,6,13

293:1

common 20:4 26:7

28:12 103:8 146:7

211:5 214:1 338:18

365:2

commonly 203:15

204:7 346:6

communicate 131:2

207:4

communication 137:4

communities 85:2

117:4 332:1

community 2:2,6,10

85:3,4,4 165:8 166:14

166:19 167:10 249:10

402:9

comp 334:12 392:21

company 394:8

comparable 321:3

compare 139:1 207:13

comparing 47:17

compassionate 403:1

compatible 208:22

compensable 44:5

compensate 150:15

223:21

compensated 225:7

405:4

compensation 5:8,13

66:19 157:22 160:14

190:2 221:4 367:21

368:2,5 369:21

402:19 403:2 405:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

415

compiling 88:12

complement 310:16

complete 118:21 134:6

completely 55:10 71:4

114:5 146:10 228:18

247:13 264:13 364:15

complex 30:16 43:11

43:16,21,22 394:15

401:20 402:2,14,18

complexes 388:12

complicated 30:20 41:3

48:17 49:5 82:20

91:14 99:1 233:5

324:13

component 217:19

226:20

components 15:22

43:22 209:22

compressed 254:3

compromise 291:8

Computed 245:4

computer 391:5

Computerized 243:18

387:14

computers 287:13

391:6

conceivably 214:19

concept 157:11 181:18

195:6 338:6

concern 10:9 43:12

54:20 75:2 114:6

173:9 174:9,13

190:13 191:4 192:3

242:3 281:12 290:13

307:6 314:6 319:5

321:8 332:22 342:10

360:6 393:5

concerned 70:22 219:7

241:19 332:6 385:10

389:22

concerning 145:8,21

concerns 10:3 190:7

262:4

concludes 407:15,16

conclusion 46:15

376:18

conclusions 145:12

concur 261:15 270:8

293:14 294:9

concurrence 270:16

289:9

condition 23:18 129:18

129:20 135:8,17

143:22 144:1,4 154:6

159:2 176:3 187:13

194:11,17 207:17

218:21 230:22 338:7

344:4,8 352:3 390:13

397:12 399:7

conditions 50:22 51:2

100:22 187:7 190:1

199:4 266:2 267:19

330:11 405:15

conduct 50:19 119:10

143:6

conducted 89:8,8

conducting 310:14

conference 29:17

confirming 129:2

conflation 406:11

conflict 125:5 130:3,5

145:12 171:17,17

conflicting 58:1 137:8

270:14,15

conform 373:13

confused 35:12 70:3

140:17 168:4 247:12

276:16 337:2

confusing 218:3

Congress 148:22 150:6

220:10 223:19 228:19

362:18 375:11 376:11

395:20

congressional 64:20

236:20 395:13

conjunction 261:4,18

262:9 266:6 277:5

293:17 295:2,3

298:17

connect 402:1

connection 34:10

327:19

conscious 10:10 31:21

consensus 79:5,9

252:3 254:6 264:13

348:5

consequence 328:5

343:5

consequential 129:15

129:19 343:1 360:17

376:1

conservative 219:3

consider 34:5,20 44:9

61:17 62:11 71:20

134:4 135:22 146:9

190:14,15,17,19

191:17 216:20 232:10

237:22 252:16 254:1

281:21 288:2,5

329:19 406:3,20

407:7

consideration 15:9

37:14 190:8 233:16

253:9 264:15 289:2

considerations 204:16

204:22

considered 25:6 61:21

134:17 135:11 234:21

254:5,16 263:2

266:14 305:18 309:16

311:5,6,9 312:17

316:18,20,21 317:21

317:22 318:4,22

346:9 360:4 371:17

398:9 405:9 407:10

considering 141:21

192:3

consist 125:22 126:6

127:10

consistency 90:9,18

116:21 177:7,13

190:10 202:3 354:3

consistent 52:18 71:19

198:20 200:2 203:3

209:9 217:20 222:22

232:6 243:13,17,19

243:22 244:2,4,8

245:8,9,15,21 246:5

248:20 276:17 295:13

355:2 379:16 380:8

380:11

consistently 201:16,19

constantly 15:2 50:2

constituents 40:13

constitutes 196:3

Constitution 1:19

construction 75:5

consultant 4:21 125:8

128:11 129:2,17

131:10 136:21 143:5

159:8 335:4

consultants 124:17

148:1,5 161:9,13

175:17 181:12,21

388:19 396:4 397:9

401:6

consulted 126:2

consulting 5:14 116:20

123:15 147:21,21

148:1 177:4

contact 12:1 24:17

28:22 206:20 305:14

contained 8:16 47:6

94:9

containing 318:15

328:20 339:15 344:16

348:10

contains 8:2,19 131:17

133:8 277:1 346:15

content 70:19 71:10

contents 3:1 131:13

contesting 204:8

context 18:2 19:10

55:19 141:16 343:18

405:3

contexts 151:13

continue 60:14 85:15

113:7 205:18 253:16

294:22 337:20 350:13

360:22 379:10

continued 62:9

continues 109:13

328:12

continuing 14:22

240:12

contract 91:16 96:11,14

96:15 97:7,22 98:8,10

111:10,14,16 124:16

125:7 127:6 128:10

128:17 129:1,17

131:9 136:20 143:4

147:22 148:4 159:8

170:13 175:17 177:21

396:4 397:9 401:6

contracted 125:3 175:6

341:16

contractor 9:11 11:12

12:1,10,10,22 14:4

15:2 33:3 37:1,2

38:16 97:5,18 306:9

383:12,19 394:6

contractors 96:21

98:14,16 103:3,17

111:4,5 124:15 176:1

241:15 310:7

contracts 98:8,11

124:19

contractual 97:9

contradict 266:21

287:14

contradictions 265:22

contradictory 265:6

270:7 277:2 278:17

contradicts 265:13

279:3

contrary 139:19

contrast 269:18

contribute 154:4 337:5

406:8,8,14

contributed 335:22

354:1 388:22 407:10

contributing 162:19

163:16 181:9 347:16

354:22 380:13 396:14

405:11,14,18

contribution 137:11

138:1 151:7 172:7

178:4 182:3 336:5

340:21 349:7 354:13

404:22 406:12

contributory 63:21

406:16
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

416

control 113:17

convenience 251:14

373:22

conversation 95:19

120:10 256:3

convey 153:14 207:4

402:17

convince 141:4

convinced 120:6

cool 319:13 324:20

Coordinator 389:18

Coordinators 382:20

386:6 389:21

COP 45:1

COPD 21:18 38:13 39:8

39:15 41:18,20 42:1,7

42:10 99:8,17 214:1

238:1,5,15 386:4

400:16

copied 295:18

copy 304:19 341:9

corner 7:13

correct 39:12 140:18

194:9 214:3 225:20

234:4 248:15,18

291:10 319:12 336:6

349:8

corrected 70:11 247:20

corrections 266:8

correlates 22:10

correlation 19:17

correspond 116:9

201:1

corresponding 84:19

corresponds 30:21

costs 91:4

couch 144:22 145:6

couched 146:16

Council 6:8

count 252:13

counted 278:9

country 113:22 124:2

193:16 220:6 366:4

couple 49:13 76:16

85:14 104:6 139:12

156:16 167:16 183:17

229:19 237:9 242:11

268:6

course 10:1,2,21 14:17

16:6 24:13 123:11

128:12 193:21 201:4

205:20 211:7 245:9

245:21 377:12

cover 314:5 387:5

389:6,20

coverage 144:10

370:19

covered 8:6 37:18

117:4 137:22 138:15

139:6 140:22 142:18

180:19 187:8,13

188:7,13 231:4 253:5

253:6 261:11,15,16

262:6 280:19 281:1

293:8,13,15 294:6,9

294:10,12,18 296:21

297:6,10,17 298:14

314:10 328:4,6,16,21

331:2 339:16 341:3

341:20,21 342:3,9,12

342:14 343:5,10,14

343:21 344:3,10

345:18,22 346:7,8

348:9,11,16,19 350:6

357:4,4 366:21 367:3

367:4 368:12 370:5

380:18 390:12

covers 241:6

coworker 309:16 316:8

387:5

coworkers 310:12

320:19

crack 145:19

cradle 112:21

create 64:11 106:16

107:2,11,16 179:19

204:14

created 65:12 100:21

108:17 109:10,20,22

creating 101:2 202:3

creator 97:5

credentials 232:20

credible 356:21 357:13

359:1,19 386:15

criteria 9:1 16:17 18:21

23:20 27:9,17 40:19

77:8 151:15 189:20

195:11,16 196:10,15

197:15,16,17 198:5

199:2,16 200:20,20

205:4,22 206:2,7,12

206:14,21 207:2,19

210:5 213:21 216:11

216:12,16 217:14

220:2 221:2,18

222:10,13,15 223:3

223:18 227:21 228:8

231:19 234:13 238:1

245:3 246:10 247:6

247:13 363:13 375:16

376:20,20 377:2,12

377:17 381:17,20

397:22 399:8,14,16

criterias 399:17

critical 49:8

criticisms 96:1

critique 82:5

critiques 70:6

cross 294:19 297:6,10

297:14,15,19 356:20

crossed 276:14

crossing 54:12

crux 392:3

CT 132:21 198:2 216:22

223:13 225:22 243:18

244:1 245:4 377:6,7

379:6,15 380:8

culmination 12:5

cultivate 165:12

cultivated 165:4,17

cumbersome 147:7

cure 61:12

curious 162:21

current 111:22 186:14

223:3 256:18 261:2,9

319:10 326:3 350:17

352:11 370:10,12

375:16 376:19 377:2

378:7 383:11 401:20

currently 44:20 96:17

98:19 112:15 142:13

321:11 389:17

Curtis 2:18 3:14 185:11

185:20 195:22 199:13

205:1 213:2

cut 54:9,10 373:20

387:11

cut-and-paste 373:4

cutoff 60:18,19,20

61:12,13,18 393:11

D

d 2:11 178:15 184:14

345:14 357:17

D&D 242:18

D.C 1:20

daily 386:1

DAR 25:1 94:9 102:3

154:22 155:21 183:6

data 8:20 10:16,18,20

11:9 12:3,7,13 13:5

14:5,10,19,20 15:10

17:1 18:14 19:20

20:18 21:2,20 22:10

23:7,10 24:11,18

27:12 28:7 29:14 30:9

30:21 31:5,17,22 32:5

33:21 35:16 36:15,16

37:4,6 38:9 39:21

41:11 43:10 47:2,3

49:7 55:22 58:13 76:7

76:9 78:3,17 83:19

95:2,3 98:15 99:7

100:6,15 101:10,10

102:22 104:3,11

105:19,20 108:7,9,9

108:13 109:15,22

110:9 118:12 119:2

124:3 137:2 138:13

190:12 191:7 368:3

371:7 377:22

database 8:18,19 10:11

20:20 31:9 37:19

62:17 73:17 105:7,8

109:10,20 110:3

databases 69:19,21

79:12 387:2

date 60:20,20 73:21

127:13,17 128:9

211:17 231:16,17

371:6,11 393:11

394:13,18,19

dated 370:21 371:1

381:13

dates 60:19 61:18

370:17 371:4,5

394:20

Daughter 374:14

day 4:4 84:18 86:7

176:19 188:6,21

195:12 236:4 253:15

288:16,18 366:16

380:9 389:22 407:16

day-to-day 166:3

days 61:8 109:6,7,7

231:6,8 235:17,19

252:14

dead 392:6

dead-end 337:19

deal 44:13 65:17 83:20

98:15 101:7 116:8

189:3 353:13

dealing 19:16 104:15

105:15 182:18 204:5

224:8 237:17 266:13

dealt 43:19,19 345:6

death 79:3 101:16

127:15,15,18,20

346:3

Deb 367:8

December 368:1

decide 58:4 180:3

230:11 257:8 269:22

274:6 277:7 289:18

291:13,19 299:20

303:2 336:8

decided 107:5 220:10

381:2,5 393:7

deciding 151:17 178:14

decision 49:17 51:11

51:19,20 108:22

109:2 118:5 125:1
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

417

150:15 151:2 161:8

270:6 335:4 338:13

357:8 359:5,5 398:11

398:12

decisions 46:8 87:3

89:5 106:20 109:3

141:18 390:9 399:11

399:19

declaration 261:12

293:10 294:20 295:8

297:12

declarations 267:8

decon 389:15

deconflict 179:10

decontamination

188:19 391:12

deem 323:6 329:3,14

332:8

deemed 306:12 308:2

310:9 315:18 321:13

323:2 324:7,9,15,22

325:7,11

DEEOIC 2:17,18,19,20

7:8 372:12,15 373:2

398:12

default 16:8

defect 245:8

defer 78:5

deficiencies 70:10

130:19 153:12 168:8

168:14 237:10

deficit 244:2

deficits 243:21

define 118:9,12 218:11

219:13 244:11 246:7

defined 104:21 178:1

193:19 206:22 265:10

273:22 274:22 279:21

328:22 341:21 400:22

406:2

defining 264:1

definitely 10:9 26:21

28:3 30:10 33:19

141:11

definition 104:16 105:3

192:11 202:6 208:1

208:16 217:15 219:2

244:19 248:14 345:22

348:8 369:13

definitional 202:8

definitions 104:18,22

396:15

definitive 134:17

145:10 146:9 148:18

222:5 346:6 395:10

degree 17:9 342:5

delay 288:4

delete 284:18,20,21

302:6,7 318:3 386:7

deleting 352:13,13

deletion 383:5

deletions 312:8

deliberate 230:11

deliberation 236:22

deliberations 285:20

deliberative 230:12

deliver 315:12

delivering 369:17

delivery 369:14

delve 100:5

demanded 376:11

demeanor 133:4

Dement 2:3 4:22,22

54:4,5 55:12 56:13

117:2,3,6 237:14,15

240:5 263:14 313:10

313:12,15,22 314:3,5

332:17,18

demolition 26:15

391:13

demonstrate 262:21

263:20 274:13,14,18

demonstration 235:18

denial 92:16 93:21

99:12 357:16

denied 92:15,20 95:4,5

95:8 99:11 224:13

333:14 364:17 369:20

371:10 372:5,16

402:16

denies 360:3

densely-written 67:9

Denver 6:17 242:1

365:22

deny 93:16 162:5

269:14 357:11

denying 107:6 390:9

department 1:1,19 5:5

9:20 10:4 12:2 15:5

16:7 25:2 64:15 84:13

84:20 94:4 97:6

104:17 105:2,6,18

106:1,2,16,18 116:14

119:15 121:19 123:22

124:13,14 125:3

126:14 127:5 130:9

153:9 154:22 155:13

160:8 177:5 188:7,13

188:15 195:13 217:16

241:12 250:18 251:5

252:4 254:8 259:14

364:7 365:9,15,21

383:1,13,17,21,22

384:3,10 386:12

387:1,12 397:10

407:3

Department's 256:8

departments 383:15

departments' 104:16

departure 67:7

depend 46:11 55:9

dependent 179:22

196:11 202:6

depending 51:8 118:1

143:22 174:18 212:15

depends 41:2 161:17

215:1 224:17,22

320:11

Deputy 97:13

derive 67:2

derived 115:16

describe 40:9 93:7

256:19 259:5 296:11

316:18 384:11 386:15

described 25:9 48:16

56:22 75:20 348:6

357:17

describes 133:12

331:19

describing 150:7

262:18 376:18

description 40:9 133:4

223:12

descriptions 36:15

designate 236:15

designated 2:14 305:4

designation 29:10

designed 49:15

despite 214:21

destroyed 61:2 391:19

destroying 61:1

detail 90:22 91:19

93:19 124:18 141:7

206:17 272:22 367:17

detailed 9:6 67:12 93:2

263:1 369:9 373:7

details 97:15

detect 193:4

determination 196:18

197:9 198:12 200:12

208:9 235:1,3 344:9

determinations 78:1

221:18

determine 12:12 129:9

140:17 162:17 192:21

196:14 197:5 232:19

238:8 261:19 293:18

295:10 299:3,20

331:2 398:3 405:22

determined 48:9

192:14 198:20 234:4

397:1

determines 309:12

356:19 357:12

determining 115:19

191:14 208:3 232:3

267:13 404:11

develop 34:9 35:22

77:10,21 100:14

102:2 107:17 128:21

130:16 192:19 333:15

334:4 337:20 338:17

363:10

developed 160:1 333:3

365:16

developing 9:11 65:15

130:6,8 153:10

159:21 207:7

development 30:17

39:20 108:21 137:3

163:7,18 168:5 363:6

DFO 296:5

diagnose 126:12

173:11 223:18

diagnosed 23:17 31:11

124:10 192:22 197:2

197:3 215:11 219:16

328:3,16 330:12

338:20 343:15 350:5

378:9,16,19 379:11

379:13 380:5,21

381:3,5,15 399:6

diagnoses 146:15

171:2 222:2

diagnosing 43:8 354:17

diagnosis 127:12,13,17

127:19,19 128:9

129:3 133:9 137:16

137:18 138:3 141:20

142:18 146:6,8 148:9

148:11,17 151:17

158:13 172:9 176:3

178:3 180:12 191:8

191:14,20 194:17,21

195:5,10,16 196:6

197:8 203:19 204:5

212:12 216:6 217:18

222:21 231:17 328:20

333:1 334:21 335:12

338:4 339:15 341:2,9

341:10 342:16 344:7

344:7,14,15,17 345:8

348:10,15,20 351:16

351:17 375:18 390:12

diagnostic 126:6

132:20 146:4 161:16

189:4 193:9 196:9

199:15 200:10,18,22

201:22 203:7,10

207:18 217:15 218:17

231:19 375:16 376:19

376:20 377:2 378:2,6
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

418

378:7 397:6

dichotomy 116:3

dictate 371:5

dictionary 110:9 307:20

difference 59:11 206:19

206:21 286:19 289:6

different 8:21 11:22

12:1 13:16,21,22

15:16,22 16:2 18:11

18:13 21:2,6 22:8

25:17 27:14,16,16

28:10,20 30:18 33:9

33:16 39:11 45:3,8,15

48:22 49:1 52:4,12

58:9 59:17 63:7 67:13

70:7 71:5 75:6 77:15

77:17 104:15 109:20

111:14 112:11 132:15

136:13 147:16 149:16

149:21 151:13,13,16

156:1 159:14 180:11

180:19 181:14,15

183:12,12 190:10

193:16,17 194:3

204:10 209:22 213:4

213:6 220:16 221:5

223:12,18 224:19,21

226:17,22 240:13,19

240:22 241:17,21

247:13 249:5 251:16

251:21 264:13 268:12

270:9,9 272:16

301:17 324:22 342:21

343:1 346:5 366:3

370:16 373:15 374:21

384:18

differential 201:5

224:20

differentiate 201:11

differently 373:20

differs 354:19

difficult 151:10 159:4

167:11 173:12,14

194:15 249:12 383:20

difficulty 404:11

diffused 205:12

diffusing 245:7

diffusion 382:17

digging 99:17

diligence 267:15,22

direct 13:18 88:3 92:4

97:21 346:12

directing 88:15

direction 52:5 83:8

162:7 299:22

directions 92:5

directly 12:8 64:16

131:2 266:20

Director 2:19 4:12,17

6:21 67:8 97:14

dirty 42:9

disability 126:19 135:9

disagree 147:3 261:16

269:13 270:10 286:11

293:14 294:10 334:14

359:5

disagreement 79:5

disagrees 261:14 270:5

270:8 280:20 293:13

294:8 298:1 357:8,15

disagrees' 265:10

disappeared 394:9

disapprove 268:11

disconnect 168:16,21

discontinuing 374:3

discount 263:4

discouraged 239:9

discrepancies 368:15

discretion 59:14 60:3

92:19 107:16,17

395:21

discuss 119:9 176:15

187:15 237:20 257:7

259:15 263:6 287:9

289:19 301:5 307:2

361:13 401:11

discussed 205:21

251:17 259:14 262:3

292:22 295:15 307:7

339:8 371:2

discusses 373:11

discussing 84:9 169:22

176:21 178:9 185:13

185:14 263:8 296:1

336:11,13 351:12

discussion 3:8,11,15

3:17 7:4 8:11 10:12

19:15 20:12 59:10

60:15 62:14 77:9

84:15,15 85:16 106:9

119:21 120:1,5 121:9

150:9 170:3 176:13

184:10 187:19 236:14

238:9,10 249:9,10

251:8,9 257:1 278:2

285:10 288:2 291:15

292:10 302:21,21

303:21 306:20,21

326:14 355:13 363:6

368:20

discussions 233:17

250:14 257:6

disease 3:13 19:16 20:2

20:4,22 21:4,8,9

23:21 31:10 34:16

43:8 61:9 66:1 69:6

71:20 74:1 92:9 99:8

116:18 124:9 127:19

137:19 142:19 175:19

185:18 187:10,17

191:21 192:7,20

193:1,4 194:8,12,14

195:5,11,17 196:4,6,7

196:11,16,19 198:21

199:19 200:2,8,12

201:8,10,12,13,17,21

202:10,14 203:11,22

204:6 207:1,15,21

209:10 210:1 211:16

213:22 214:1 215:9

217:21 218:14,18

220:18 224:4,15

226:20 228:9 233:21

234:10,13 239:5

243:10,14,20 245:9

266:14 327:20 328:5

333:2 338:20 341:2

343:4 364:2 366:21

372:8 375:10,12,22

376:6,21 377:4,18,21

378:14 379:2 380:3

380:18 390:19 397:13

399:2 400:2 401:2

diseases 9:4 18:16 20:5

20:8 34:9,20 68:22

69:9 78:10 99:4,5,10

99:14,17 100:18

173:12 237:19 401:1

disorder 197:12 202:7

202:21 205:11,11

208:2 209:2 211:20

218:3,8 219:14

245:10,22 380:21

381:4,7,12,16,19

distinct 178:21 206:20

distinguishing 149:7

distributed 114:11

district 9:10 50:9 52:2,4

52:5 315:2 323:22

324:3 370:22 371:15

388:18

disulfide 73:8

diverse 193:12

dividing 352:15

divined 339:16

Division 5:1 122:13

185:21

divulge 361:12

DMC 401:4

doc 138:15 162:21

165:5 166:1,9,9 168:9

168:19

docs 166:6

doctor 48:8,9 57:10

59:6 93:12 128:4

136:10 138:15,18,22

139:7,14,17,20

140:12 141:6 142:2,5

143:8,9,19 158:21

161:21 163:15,20

165:1 169:8,8,9

171:19,22 174:16,21

174:21 175:2,4,5,10

202:14 209:6,12,15

209:19,20 210:2,7

215:2,6 221:14

228:11,17 244:7,7,20

245:19 246:8,14

348:19 373:6 375:17

377:6 379:15,21

390:16,18 392:21

393:2

doctor's 140:9 142:11

390:12

doctor-certified 210:11

doctors 96:7 141:8,19

143:14,15 165:19

172:19 173:11 176:1

206:11 220:17 221:21

222:3,12 223:17

245:16 246:9 366:3

371:21 372:2 390:17

390:22 392:16

doctors' 221:17

document 14:11 38:10

38:15 71:13 72:22

79:10 94:3 183:5

223:5 301:10 305:10

315:7 323:18 327:15

368:3 371:16 373:9

documentation 12:9,12

13:2 14:13,17,18 33:3

39:4 56:2,4 94:13,18

238:7 273:3 315:13

344:13 383:6

documented 73:16

332:3

documents 79:5 80:8

81:3 123:13

DoD 261:13 293:12

DOE 16:3 54:15 102:2

106:4 164:15 231:10

235:8 263:19 270:4

270:10 280:20 294:7

297:22 305:22 306:7

306:10,15 310:5,7

315:5 319:2 321:15

329:6 332:1 346:2

369:15 371:16 385:19

387:14 388:11 391:15

392:13 393:7 394:15

DOE's 370:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

419

DOE-funded 6:22 75:12

DOE-sponsored 306:8

doing 12:15 16:12 18:6

26:13,15,16 29:18,19

31:5 35:21 36:1 38:8

38:12 40:10 45:5

51:13,14 58:6,17,18

69:4 76:14 83:7 90:15

91:5 96:7 107:7

113:10,13 149:4

150:14 152:4 166:8

174:9 175:10 200:17

220:12 228:19 241:20

247:2,22 260:18

368:20 369:1 384:14

395:1 399:19

DOL 63:9 81:4 118:10

154:20 178:14 237:3

250:10 253:14 255:12

255:15 265:7 268:18

273:3 278:7 279:19

285:15 309:8 331:16

353:20 354:6 391:11

391:16,22

DOL's 176:20 220:2

371:4 373:9

Domina 2:11 6:6,6 86:2

86:3 117:7 241:11

242:8,10 249:17

Donna 395:5

dose 13:9 90:14 404:17

406:6 407:9

dosing 141:3

doubt 188:22

Douglas 97:13

downhill 366:16

download 63:4

downstairs 288:14,21

dozen 115:3

Dr 3:7,8,12,16,18 20:13

41:14,15 42:15 45:21

52:7,9 54:4 58:14,15

58:16 62:15,22 65:6

67:6 71:2 81:8 83:12

85:18 86:19,21 92:1

95:14 97:18 98:20

106:6 107:20 108:6

111:17 120:3 121:7,8

138:5 140:15 141:14

144:14 145:22 147:1

149:11 150:12 151:19

152:15 159:12 161:3

162:11 164:8,10,11

168:1 173:6 175:14

178:17 179:16 180:6

181:4 182:16 184:9

210:22 212:5 216:14

219:19 222:7 225:5

227:17 233:22 235:13

236:17 237:6,14

238:2,19 239:3,11

240:7 241:3 245:18

247:10 249:16,17

266:9 268:5 269:2,4

269:15 272:2 273:14

274:8 278:21 282:7

289:4 290:17 293:6

293:21 294:13 303:17

308:12 311:1 312:12

313:3,10,11 314:3,17

315:15 316:4 317:18

321:6 322:11 332:17

333:6 334:10 335:17

336:15 338:14 339:12

340:1 341:5 344:1

347:7 354:2 372:18

372:19,20,21,21

373:5 401:16 403:17

draft 118:15 257:4,4

265:2 271:8,10

288:10 295:19 308:5

309:7 311:15 322:6

331:14 361:1

drafted 308:6

drafting 285:17

drawback 31:16

dress 366:17

drive 107:20,21

drop 308:1

drove 380:4

ducts 61:5

due 74:2 145:1,2

190:11 204:21 267:15

267:22

duh-duh-duh-duh-duh

280:21

Duke 5:2

dumpster 393:20

durable 129:13

duration 24:7 384:9

Duronda 2:11 6:13

158:7

dust 41:21 386:2

dusty 42:9

duties 134:13

E

E 8:6 50:12 51:2 105:16

107:15 115:17 186:22

187:1,1 216:17,18,20

217:2 223:16,21

224:3,4,13,18,21

225:7,11,14,15

234:15 235:4,5,9

237:2 258:21 343:19

343:20 345:18 346:1

360:14 398:4 404:7

404:20 405:6,9 407:2

407:6

E-B 225:16

e.g 313:5,9 314:6,12

earlier 56:19 61:15

73:16 115:7 149:14

149:20 178:20 188:9

303:13

earliest 370:18 381:13

early 34:12 121:17

220:3 369:1 371:12

earned 315:1

earthquake 145:2

easier 75:4 110:4,5,6

110:16 148:16 159:7

161:11 166:10 212:3

219:10 258:1 304:15

easiest 260:18

East 5:17

easy 76:10 165:8

177:14,14,15 182:10

353:12 366:7

edit 290:21

editing 71:3,8 301:9

editor 20:14

editorial 70:20

educate 166:15 167:3

education 30:15 124:6

166:4 221:10 253:14

390:7

EECAP 369:8 372:8

EECAP's 374:13

EEOIC's 372:4

EEOICP 122:14

EEOICPA 3:13 187:6

258:20 357:5 369:13

370:12,19 373:15,16

402:15,20 403:9

effect 18:14 20:2,17

21:10 27:19 29:6 31:8

32:3 33:21 34:7,19

100:15 205:12 207:20

338:6 340:8 394:16

effective 316:5

effectively 35:19

effects 9:3 43:19 45:18

71:12,15 74:12,14

efficiently 35:19

effort 12:4 14:22 102:18

efforts 99:10,13,20

137:3 193:3 402:9

EHR 338:4

eight 68:6 239:20,21

240:1 362:1 368:3

Einstein-Szilard 370:19

either 15:4 74:12 91:11

107:11 125:6 127:7

128:20 131:7,10

133:2 140:6 150:21

169:7 179:19 188:2,6

195:17 205:10 214:9

261:14 268:10,19

280:20 293:13 294:8

307:11 320:18 321:2

329:6 348:4 349:4

360:12,17 371:3

372:7 381:14 393:9

EKGs 126:7

elaboration 225:14

element 197:21 198:3

elements 142:6 197:18

197:20 264:5 265:17

282:2 283:18,22

eleven 273:10

eligibilities 370:2

eligibility 267:12 371:6

eligible 369:13

eliminate 270:12 280:1

280:13

eliminated 268:15

279:5

email 167:5 366:14

emailed 80:21

emailing 287:3

emotions 333:19

emphasis 173:20 174:5

359:21

emphasize 52:11

employed 139:11 261:6

272:9 274:13,18

275:6 305:13

employee 6:6 19:20,21

22:11,12,20 23:7

24:17,21 28:17,22

29:8 30:22 31:2,5

41:5,5,10 45:11 47:16

49:17 56:22 125:11

125:17 126:3 134:12

235:10 261:6,13

267:9 269:10 272:8

293:11 294:21 297:13

305:13,14 306:14

321:14 328:3,15,17

329:4 350:5 356:15

357:6 381:14

employee's 94:10

125:18 305:20 319:1

328:21 339:16 348:11

employees 124:4

employer 56:3 58:5

employment 19:19

24:22 32:9 101:1

103:4 138:10 141:18

163:9 188:6,22

189:20 231:6 260:21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

420

261:3,7,11,15,17,19

262:6,10,14,22 263:1

263:20 265:19 267:11

272:7,14,21 273:18

273:20 275:1 277:6

280:19 281:1 282:5

293:8,14,15,18 294:7

294:9,11,12,19

296:21 297:6,10,17

298:14,18 371:8,11

396:8

employment-related

274:10

employment.' 266:7

enacted 362:18

enactment 402:6

encompasses 218:4

encountered 94:2

encourage 7:22 369:5

encouraged 347:2

402:8

ended 94:11,19 101:2,2

endorse 257:8

ends 9:16

Energy 9:20 10:4 12:2

15:5 16:7 25:2 94:4

97:14 104:17 105:3,6

106:2,2 154:22

155:13 186:12 188:7

188:13,16 195:13

241:13

Energy's 123:22 126:14

engaged 167:13

enhance 64:8 268:18

enlarge 68:8

enormous 73:10 378:5

ensure 89:15 116:21

173:22 177:6 296:5

enter 108:20 110:10

177:10 318:19 320:20

entered 108:10

entering 258:3

entertaining 226:21

entire 94:20 117:22

entirely 178:10 254:13

entities 310:6

entitled 253:2 350:4

entity 261:14 263:18,19

263:22 278:7 280:20

293:12 294:8 298:1

306:8,12 307:21

308:1 309:10 310:9

311:17,17 312:3

314:9 323:2,18 324:7

324:8,14 325:7,11

entity' 265:8 279:20

309:9

entrusted 403:4

enumerate 217:14

enumerated 115:16

214:15

environment 42:9

113:20 400:13

environmental 4:13,18

5:2,5,13,16

envision 158:8

epidemiological 244:22

epidemiologist 5:3,21

epidemiologists 69:17

epidemiology 12:21

69:16 146:4 174:7,8

Equally 107:16

equate 202:20

equipment 129:14

190:12

equitable 375:2

era 108:3

error 46:21

errors 373:4

especially 56:22 139:16

146:20 242:18 266:12

362:17 372:15

essential 384:5

essentially 20:6 23:6

83:3 119:15 154:16

208:14 250:21 251:6

252:7 262:22 269:8

272:6 321:17 322:2

353:3

establish 22:18 127:12

127:17 130:14 189:19

191:8 194:21 197:13

199:8 200:7 218:18

261:5 306:14 328:2

328:15 350:5 375:11

375:12 376:12 377:3

377:18 378:8

established 23:17

195:15 197:15 261:3

272:7,8 275:2 305:9

307:12 309:13 344:4

350:7,11 375:14

399:2 400:18

establishing 191:20

194:17 195:10 196:10

196:20 267:12 305:20

319:1 321:14 345:17

360:13

establishment 196:3,5

196:19 201:21 203:11

204:6

et 46:9 76:12 152:9,10

152:10,10 262:6,7

321:16 335:22,22

Eugene 67:6

evaluate 9:21 33:4

34:20 49:22 103:19

144:6 149:18 171:10

261:17 262:7 266:5

269:11 277:4 293:16

295:1,3,11 296:18

297:18 298:16 299:18

evaluated 20:13

evaluating 12:12 13:1

30:19 47:6 81:12

158:3 199:21 204:15

209:6 299:7

evaluation 15:9 16:18

19:17 50:3 126:4

131:11 144:17 198:10

297:1 310:15 364:10

evaluations 124:20

126:11 129:4

evenly 114:11

events 167:2

every- 379:5

everybody 7:10,11,12

67:5 115:15 121:13

270:17 407:11

everybody's 184:19

247:21

evidence 3:10,13 47:14

48:10 73:3 77:10

82:16 90:19 122:4,22

123:10,11,20 124:12

125:14,15 126:10,21

127:1,4,10,21,22

128:2,13,15,22 130:6

130:8,11,13,16 134:2

137:7 138:2,8 139:10

139:13,17,18,19

141:5,16,18,22

146:11 147:20 149:13

149:19 151:12 153:10

156:22 157:16,19,21

158:3,4,18,20 159:5

159:15,18,19 160:8

160:21 161:1,7 163:9

163:10 165:15 166:20

169:2 170:1 171:18

172:2 174:11 175:9

177:2,19 178:1,2

179:2,2 183:4,4 189:1

189:4,18 194:19

196:12 197:10 199:15

199:21 200:7,10,15

200:19 201:19 202:9

205:5 209:6 210:8,19

211:20 222:5 232:3,5

232:5 245:1 261:10

261:19 262:5,6,8,9,13

265:20 266:6,17

267:10 269:22 270:4

270:7,11,14,15 277:3

277:6 280:18,22

282:6 293:7,17 294:6

294:12,18 297:1,6,10

297:17 298:14,18,19

298:20,22 299:8,18

300:6 305:11,19

309:16 310:2 311:5,9

316:20,21 317:21

318:1,5,22 328:19

329:3,14 331:18

332:7 333:10 339:14

341:1 344:16 348:10

349:19 351:16 356:22

357:14 358:7,15,16

359:1,9,13 360:12,17

361:6 363:5,9,10,22

376:12,13 381:13

395:9 396:10 400:18

404:1,5,10 405:13

406:5

evidence' 266:3

evidentiary 116:17

185:17

exacerbation 349:7

exact 146:19 218:15

exactly 35:5 47:1 52:21

78:10 86:14 88:22

93:8 100:17 118:1

121:2 130:22 133:12

134:12 152:1 158:16

163:11 192:16 216:11

217:11 230:6

exaggerating 145:4

exam 377:7

examination 124:3

135:3 171:6

examinations 126:17

examine 47:1 124:22

125:11

examiner 19:13 20:5

21:13 22:15 23:12

48:21 51:10 53:22

59:2 81:12 87:1 90:6

92:6,10 95:6 101:18

112:12,20 130:13

131:2 153:11,15

161:7 179:1 182:6,22

183:2 186:10,10,11

198:2,9 199:1 200:16

205:13 208:8,20

209:2 210:12 246:14

270:5 335:3 349:18

350:9 351:2 363:9

373:5 390:14

examiner's 130:15

examiners 9:14 21:22

43:13 44:21 46:11,12

46:19,19,22 47:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

421

49:1 51:8 68:10 86:5

86:12 88:4,12 91:5

96:2,6 109:6 112:10

113:11 116:16 122:3

176:22 177:18 181:13

181:20 183:10 194:16

218:4,7 270:13 331:1

363:7,8,19 377:15

388:4,10 390:5 392:8

396:1

examiners' 48:18

examining 47:2,14

125:20 147:9 346:20

example 10:14 16:13

20:1 22:6 25:22 26:8

33:7 38:4 54:14 61:22

72:8,8,15 73:1,7 75:4

94:1 132:9 133:14

138:8 160:9 163:4

171:7,8 228:17

237:22 314:12 339:4

404:4

examples 70:11 81:14

163:14 313:6

exams 126:16 154:10

Excellent 117:14

excessive 346:18

excited 42:21

exclude 27:11 57:11

150:19

excluded 216:17 313:8

excuse 39:18 97:12

231:11 278:21 394:10

executive 64:18

exercise 92:19 243:21

267:21 275:18 379:6

exist 14:18 17:10

108:11 200:7 207:13

267:17 283:7 391:11

391:13,22 392:13,15

existed 94:20

existence 232:1 345:15

existing 78:14 275:12

321:21 324:6 332:21

373:13

exists 39:4 116:3 180:1

216:4 218:13 234:17

expand 47:21 67:21

72:7 166:22 309:22

expansion 20:17

expansive 69:4

expect 7:12 88:22

146:15

expectation 117:20

expected 193:8 351:8

expending 37:10

experience 12:20 47:8

100:8,16 143:10

158:2 174:9 183:8

241:5 372:3 392:17

experiences 403:8

expert 48:4 53:6 63:17

102:13 106:21 135:10

182:7 398:9,19

expertise 60:6 93:6

96:3 106:17 175:16

182:11,19 331:21

354:17

experts 12:20 48:13,14

93:3 123:15 177:9

179:4 180:14 182:5,9

240:16 398:5,13

explain 95:22 102:1

130:18 153:12,17

168:8,9 248:7 379:20

396:16

explained 47:4 168:13

explaining 89:16

explanation 135:7

206:16 234:20 390:15

explicit 220:20 264:16

exposed 23:2 28:17

29:12,20 32:10 40:12

40:20 44:7 45:20

53:20 57:2 59:4 92:7

93:14 178:12 235:16

306:15 321:15 362:22

390:20 397:1

exposure 3:4 7:15,16

7:19 8:17 9:7,12,19

10:7,14 11:7 12:5,8

12:13,14 13:3,4,11,14

14:19 15:1,10,13,19

16:1,9,10,20 17:3,7

17:14,21 18:9 19:5,9

19:18,22 20:18 21:10

21:15 23:8,11 24:7

25:3,12,14 26:18

28:14 29:19 30:10

31:4,7,12,14 32:4,16

33:22 35:17 36:14,18

39:6 40:18 41:8 42:1

43:5,9,21,22 45:9,13

46:3,9 47:18 50:1,5

50:14 52:19 53:3,10

53:13 54:1,6,19 55:6

55:10 56:6 58:8 60:1

64:8 66:2 69:6 72:9

73:6 75:22 78:2,13,20

78:20 83:15,16 84:12

85:17 94:5,8,10,13,14

94:16,18,21 98:15

102:17 103:11 105:2

107:3,11 116:8,15

117:1 124:3 137:12

138:10,18 139:1,2,13

139:13,21 140:20

141:19 147:10 149:21

150:16 161:21 178:9

188:3,5 189:1 195:12

203:20 226:1,6 231:5

231:7,8,16 235:3,10

235:18,20,22 238:5,6

238:10 241:9 242:20

245:1 260:22 262:22

266:13,16 274:11

275:5 304:20 305:8

305:15,21 306:11

308:22 309:1,3,15,17

309:17 310:2,5,8,13

312:21 316:20,21

317:21 318:1,5,10

319:2 327:20 329:5

338:7 341:22 347:14

352:3 371:16 396:9

400:3 404:13 407:8

exposure' 354:19

exposure/disease 83:4

exposures 8:20 9:5

12:3 19:6,11 23:13

34:11 41:19,20 42:7

43:12,15,17 47:20

53:5,19 54:8 61:7

69:2 72:18 75:17 99:3

99:6,16 100:20

103:15 107:18 134:13

238:6 309:5 344:5

346:2,4 384:7,10

391:4,20 394:19

expression 209:12

extensive 41:18 42:5

124:8

extent 18:3 24:7 36:18

49:2 54:6 111:22

283:7 306:6,7 341:8

341:11 342:5 343:11

350:19 351:7,22

external 76:6,20 233:18

externally 63:13

extra 362:6

extremely 82:4

eyes 83:21

F

FACA 119:11

face 261:4

faced 54:7

faces 392:14

facilities 11:3 28:11

47:12 123:17 188:16

190:11 193:16 212:22

213:5,12,14 235:9

facility 18:6 27:19 29:6

188:7,13 195:13

231:10 305:12,22

306:1,15,16 319:2

321:16 329:6,7 346:2

346:3 369:16 370:6,8

370:14

facility-wide 18:12

facing 389:22

fact 29:13 31:21 50:1

71:21 74:3 107:10

113:2 115:2 146:15

159:22 168:5 214:21

216:3 218:16 236:19

254:18 267:21 307:4

333:20 336:9 379:12

391:15 406:5

factor 115:20 147:11

162:20 163:16 197:7

347:16 354:21

factors 135:8 149:8

204:21

facts 57:9 60:11 140:5

366:16 385:16 396:2

396:3,7,12 397:17

factual 134:7 157:12

305:19 312:18 318:22

322:22 356:21 358:15

361:6

fail 407:2

fair 79:3 375:2

fairly 15:11 44:5,7

50:20 218:5 253:10

264:11 289:13

faithful 403:4

fall 260:15

falls 296:13,19 327:17

false 212:14,15

false-positive 78:21

familiar 8:7 28:9 64:3

82:11 103:1 112:16

113:15,21 212:7,10

339:3 362:18 365:8

families 401:21 402:2

fantastic 91:20

far 27:8 91:21 102:22

103:4 115:18 117:5

189:4 231:19 233:2

250:14 362:14 367:11

farther 146:12

fascinating 224:3

father 389:13

favor 121:10 173:21

184:12 291:17,21

292:2,13 304:5

326:17 355:16

Faye 2:13 6:4

feature 17:1 21:21

features 53:3

February 371:1 372:9
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

422

FECA 157:17 186:8

373:13,15,17

federal 2:14 118:2

119:20 127:3 284:5

feel 171:6,14 180:4

191:19 199:1 253:4

289:9,14

feeling 182:3 329:15

feelings 230:12

feels 200:1

fell 366:18

felt 262:19 329:13

386:6

fewer 180:22

fibrosis 21:17 201:11

208:19 380:7

field 135:13 232:13

249:13 398:14

fifth 164:20

fifties 102:15

fighting 241:15

figure 26:12 53:9 74:1

145:18 147:8 159:15

161:1 203:2 246:13

290:16 358:18 393:11

figures 170:22

figuring 220:22

file 19:21 45:12 47:2,7

47:16 48:10 52:14,16

80:11 123:10,21

125:12 128:22 130:14

161:18 183:5

filed 369:17 371:8,13

files 114:3 142:22 156:8

156:10 163:7 391:20

filing 32:8 55:16 155:10

235:5 332:22 384:6

fill 164:19

filter 27:6 28:2 39:14

45:3,10 48:2

filtered 39:8,10 54:1

filtering 15:20 22:1

23:20 27:14 29:4

30:19 36:4 41:11

filters 26:6 27:10 30:2

final 49:20 51:7,12,14

51:20 92:16 109:3

123:5 180:13 186:13

285:20 287:4 367:16

367:22 368:8,11

398:10

finally 133:11 148:5

372:12

financial 111:6

find 17:15 56:16 59:13

66:8 83:19 111:13

112:2 143:19 157:8

157:12 236:22 247:5

323:21 341:13 350:21

385:21 394:6

finding 132:19 202:13

208:22 264:18 267:22

findings 132:7,15,16

133:1 135:1,3 198:5

198:22 201:22 246:21

377:6,12 380:7,11

395:13

finds 128:3 190:22

265:5 278:16 361:5

377:11

fine 27:7 110:20,21

120:1 220:20 230:17

260:12 284:9 288:3

303:21 325:16 334:15

340:13

finished 304:10

Fire 258:12

firestorm 101:2

first 7:3,4 16:1 22:15

29:13 51:8 52:8 54:5

59:7 63:10 64:1 65:3

65:4 68:18 69:9 74:10

76:18 91:12 102:3

113:10 117:2 123:8

123:11 124:16 125:16

128:12 130:17 132:15

138:8 140:11 143:1,7

143:12 150:3 163:6,6

174:19 175:1 187:20

190:9 195:9 196:22

197:4,11,21 211:14

215:6 217:17 220:7

228:4 243:16 256:15

260:17 261:1 264:19

273:17,19,21 274:12

274:20,21 275:5

277:7,11,15 278:9,10

278:10,12,14,15

279:2,7,8 280:3

281:18 283:14 302:12

304:11,13 306:19

329:10 333:19 341:7

347:10 358:2,3 371:2

372:18 376:1 380:2

390:2 393:16 397:14

403:22

first-level 54:9

fit 178:15 380:22

fits 115:19 327:20

354:7 363:16 395:19

five 63:10 79:14 169:19

173:9 197:18,20

200:19 208:12 213:21

250:3 256:7 317:12

327:1 355:20 368:9

389:10 395:6 403:16

five-minute 250:2

fix 247:19

fixable 244:14

fixed 76:10

fixing 247:19

flag 145:9 147:17

Flat 6:17

Flats 6:14 61:1 188:10

188:15,21 378:20

flexibility 85:11 342:6

flexible 54:22

flip 224:12,13

float 248:3

flog 75:7

floor 152:19,22 314:4

366:18

flu 343:16

fluctuations 113:18

flux 59:9

focus 67:21 99:13

146:6 219:11 327:13

focused 13:5 65:7

159:14 167:2 193:3

focuses 13:12 272:17

focusing 19:5 177:8

178:22 181:19,20

folks 8:9 12:15,17 34:2

165:22 275:19 288:9

314:19

follow 86:21 87:18

93:15 133:21 162:3

169:7 193:9 217:11

257:17 258:2 277:16

365:7

follow- 48:15 96:20

follow-up 42:14 58:16

111:3 217:5

following 243:11 245:2

304:17 305:17 312:17

318:21 328:18

follows 131:16 133:17

forego 402:19

foremost 380:3

forest 44:2

forever 33:6

forget 147:22 239:6

forgot 230:17 254:21

260:5 308:8 356:11

360:9

forgotten 311:14

form 64:20 66:18 84:16

84:18 85:7 164:4

176:12 184:20 189:7

193:1 196:22 232:12

232:14,16,18 258:2

262:20 329:16 332:9

formal 174:6

format 133:22 134:1

312:14

Formation 3:8,11,16

formed 63:9 251:13

former 6:14,22 126:14

154:8,18 155:1,22

156:1,20 157:12

306:8 309:19 310:6

310:21 318:18 322:16

388:19 401:19 402:14

402:22

formulaic 36:1 46:13

formulation 315:10

forte 313:17

forth 82:19 381:17

forward 30:11 57:15

79:11 93:10 108:14

117:19 169:8 179:12

333:4 362:10

forwards 66:3 180:16

found 54:12 80:20

198:15 372:10 373:3

376:15 377:8

four 84:18,19 116:9,10

116:13 123:7 136:13

148:21 157:21 242:13

278:9 296:7,18

317:12 326:21 363:2

four-square 324:3

fourth 116:19 149:8

176:15 177:3 281:20

283:17

frame 68:20

framed 162:17

framework 11:20

159:18

frankly 107:6 137:20

165:2,18 266:21

333:4

fraudulent 366:6

free 213:13 252:20

259:15

freeze 9:18

frequency 193:11 384:9

frequently 52:16 95:17

170:8,9

Friedman- 45:21

145:22 173:6 181:4

272:2 347:7

Friedman-Jimenez 2:4

4:11,12 41:15 46:1

83:12,13 146:2 173:8

181:6 272:4 273:5,10

308:13,14 317:19,20

318:8 319:6 339:18

341:5,6 342:11 347:9

349:2,11 350:3,15

friendly 279:11,13,14

283:11,13 300:1
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

423

390:3

front 13:19 67:21 68:7

365:12 366:10

fulfill 160:5

fulfilling 228:12 403:8

full 109:5 367:19

fully 114:1 333:19

403:11

fully- 371:19

fumes 23:3 38:21 40:8

40:9,14 41:22 44:8

59:5

function 49:9 75:3

196:18 205:7,9

243:20 376:13,16

397:7 399:10,12

functionalities 66:10

functionality 7:20 8:14

15:21 16:6 21:12 22:1

23:12 29:5 37:3 47:13

fund 97:19,21 98:2

fundamental 82:9

106:8 349:3

funds 339:3 371:2

Fuortes 65:6

further 25:16 45:10,18

71:18 100:5 111:13

121:9 184:10 257:7

263:17 264:4 265:9

265:21 279:21 285:9

291:15 292:9 302:21

326:13 329:19 358:6

360:1 405:1

fuss 365:22

future 58:12 267:1

G

galvanized 59:11

GAO 50:18 51:16 64:2

64:16 77:1

gaps 73:10

Garry 2:12 6:9 239:15

340:15

Gary 117:3,6

gaseous 382:17

gases 41:21

gathered 48:11 59:22

GE 390:20

Gene 80:5

general 33:13 36:16

40:8,16 42:8 44:10

83:14 87:19 135:12

135:17 178:11 237:12

296:16 321:4 330:12

336:16 357:2 396:5

generalized 200:5

generally 13:8 21:18

30:1 41:21 80:8

134:14 148:16

generic 36:17 43:16

117:17 185:7

genuine 201:4

George 2:4 4:10,11

182:1 274:19 318:21

349:1

Georgetown 6:2

geriatric 34:7,11

getting 20:21 30:12

46:16 53:1 67:16 96:1

96:11,15 141:5

145:15,16,17 148:8

148:11 150:2 159:5

160:9 161:9 180:18

211:1 212:12 221:6

227:7 240:10 242:12

243:1 253:20 285:17

287:1 300:3 368:19

378:5,9,18 379:5

380:1,5,10

Giblin 256:1 258:4,8,12

258:18 259:18 260:3

275:8,16 311:13,21

312:4,10 345:11,12

Gibson 389:9,11,12

394:12

give 8:8 27:5 88:17

89:21 93:22 97:14

102:5 110:16,17

112:3 115:10 129:6

129:22 140:20 149:9

154:14 161:15 199:6

214:19 229:1 250:12

250:17 256:22 258:12

264:4 265:3 272:11

288:5 322:3 333:18

339:20 341:19 342:1

367:12 382:8 398:1

given 48:20 55:15

59:20,22 60:2 64:1

84:20 91:9 135:22

152:5 163:13 171:9

187:7 206:16 214:1

364:5,15 367:4

gives 138:8 141:1 142:2

228:6 299:16 341:12

342:5 348:15 391:3

giving 220:9 362:12

glad 138:3 156:11

367:15

gladly 402:19

glass 33:13 377:8

glasses 164:18

glaze 83:22

go 8:1,12 9:21 13:13,15

15:21 16:10 19:14,18

20:2 21:16 22:3,6

23:19 24:10 25:8

28:14 30:18 33:18

48:1 49:21,22 51:11

53:2 54:21 55:6 56:13

59:5 66:7 67:17 68:15

69:11 73:12 74:5,9

75:18 76:17 77:11

80:14 86:9,19 87:2

89:14,20 92:16,17

100:17 101:19 102:2

102:6 106:1 109:15

113:4 115:12 119:17

121:16 139:5,17

140:4,9,12 142:7

150:6 152:6,13

157:15 161:12 162:10

162:13 171:5,9,15,16

174:15,20 175:2,3,5

176:5 192:6 195:2

198:13,15 205:21

207:12 212:4 213:5

213:14 217:2,7,7

224:16 225:4,10,11

225:14,15 235:14

238:4,12,15 244:6

267:3,4 270:22 272:5

272:20 276:1 277:8

280:12 281:16 287:8

287:17 289:9 292:21

297:4 306:2,19

329:10 337:14,15

338:2 340:14 341:16

345:21 350:13 352:20

355:3 358:3,21 359:8

360:16 384:12 387:20

392:19 395:10 407:11

goal 265:15 281:22

402:7

gods 390:6

goes 33:5 56:5 57:9

60:9 61:4 81:11 82:18

87:13 88:13 110:11

110:12 141:1 164:16

196:13 221:14 231:20

238:16 249:4 270:7

310:3 333:4 342:18

going 7:14,17,17,19

8:12 9:20 14:2,2,12

16:8,12,16 17:6 19:8

19:9,14,17,18,20 20:1

21:1,16 22:15,16 23:4

23:19 25:11,12 27:5

27:11 28:2 31:3 32:9

32:11,17 33:5,8,19

34:8,9 35:2 36:5,7

37:7 38:9,14,22 40:15

41:1 42:19 44:6,7

46:11 47:9,11,15 48:1

48:3 49:14,21 51:17

51:18 53:1 55:9,18

56:15 57:11,19 60:12

61:8,10 62:13 67:17

68:15 69:1,11 76:10

76:10,15 79:15 83:6

84:8,18 86:4,11,12

87:3,6,8,10,12 88:17

88:18 89:4 91:17

93:15 97:15 101:18

104:5,6 113:17 114:6

119:9 139:8 141:6,11

143:16,16 144:1

146:14 149:15 150:20

153:8 160:15,17

162:4,5 169:13,18

171:12 174:20 175:4

175:5,17,19 182:6

185:13,14 186:18

187:3,8,20 191:19

193:15 194:12,20

196:14 197:5 205:17

205:18,21 206:1,3

207:6,7,8,12 208:3

209:20,21 211:8

212:4 219:8 220:22

221:21 224:22 228:20

230:9,10 231:1

235:21 238:14,22

239:7,8 241:16 242:4

245:17 246:16 247:19

249:22 250:1,7 254:5

256:13,13,14,15

259:1 260:5 270:2

272:18 277:12 279:2

284:17 285:14,16

286:9,14,16 287:15

288:14 290:21 291:13

291:20 293:8 296:4,9

296:12 297:21 307:17

316:1 321:11 326:22

327:1,6,12 328:7,9

333:13,14 334:3,16

334:16 338:11 341:15

348:4 352:14 357:9

360:22 362:6 366:14

367:16 377:2 379:4

379:14,17,19 381:11

385:12 389:20 391:9

392:2 395:14 403:15

gold 191:10 239:19

golly 145:18

good 6:4 15:11 25:15

26:8,19 27:1,5 29:7

31:20 36:7 45:7 50:20

52:10,19 54:14 58:10

69:22 82:6 85:1 92:12

111:10 122:15,20
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

424

133:16 140:21 145:15

164:9 175:9 186:3

193:21 226:6,12

229:10 236:6 237:1

243:6 259:4 276:8

289:15 299:19 304:11

307:4 315:4,20

380:15 400:17 402:21

403:9

goods 369:15,18 370:2

gotten 38:18 56:2 132:3

168:11 253:15

governing 255:14

government 259:4

GPs 164:13

grabbed 307:20

grad 372:2,14

grammatical 308:15

granulomas 198:19

243:17 377:8

grateful 187:2

gratitude 63:19

grave 112:22

great 72:3,4,5 120:16

185:10 249:18 330:10

332:4 368:20 392:4

393:17

greater 112:5

greatest 23:14

greatly 42:17

Gresh 372:20,21

grew 106:10

Griffon 2:3 4:20,20

87:21 88:1,2 90:2

91:2,22 117:5,7

263:13 264:9 280:8,9

280:17 281:4,7,11,14

285:12 286:2,8,14,20

287:1 291:7 307:9

319:16 320:5,7,17

330:2 358:4

ground 247:5 377:8

group 6:18 53:12 54:3

65:7 66:22 71:21 76:6

76:11,13,21 114:22

127:9 148:8 150:3

180:4,14 182:4

220:17 251:19 252:17

262:3,19 263:13,15

307:22 330:17 331:8

359:18

groups 180:19 251:16

251:21 256:21 262:1

263:10 287:18 306:18

groups' 257:6

grow 106:8

guess 88:15 102:21

157:15 259:4 264:7

278:8 282:20 286:8

289:17 291:11 292:3

292:16 294:2 302:12

323:7 332:21 334:14

336:7 347:12 380:15

385:8

guidance 35:4 49:10

88:11 90:12,20

102:13 116:16 122:2

137:10 148:20 176:22

177:18 182:20 183:9

218:6 254:9 282:15

284:8 388:4,9

Guide 89:21

guide's 142:13

guideline 248:20

guidelines 90:5,8,13

222:18 223:3 264:5

265:16 282:2,20,21

283:6,18,20 284:1,8

307:11,12 309:11

390:3

guides 142:15,16 143:5

143:10,17

guy 140:21

guys 35:10 37:18 60:5

95:15 147:4 148:12

149:4,9 161:5 206:2

246:12 394:22

H

H 2:12

half 115:3 288:13

half-hour 288:16,20,22

hammer 59:16

hand 121:10 164:3

184:14 304:5 347:10

355:16 375:5 395:5,7

400:15

Handbook 401:4

handful 69:1 73:19

77:18

handout 16:14 20:12

22:6 33:7,15 34:1

68:17 71:1 199:10

203:6

hands 14:21 110:21

121:11,14 184:15,19

291:22 292:14 304:6

326:18 355:17

hands- 89:14

Hanford 6:5,7 10:15,20

10:21 11:1 16:13

19:12 22:9,14,17 24:8

24:12,19 28:16 45:14

141:9 222:11 241:13

242:11

hang 147:5

happen 379:14

happened 112:9 145:2

212:17 394:19

happening 9:16 58:20

230:4 364:21 376:4,8

377:19

happens 165:20 190:19

224:20 359:16 390:3

happy 365:5 368:18

hard 43:20,21 59:11

145:19 148:11 257:17

311:4 313:15 353:16

374:20 386:3

hard-hearted 338:9

hat 147:5 175:11

hate 120:16

Haz- 65:10

Haz-Map 20:11,15 65:8

65:11,12 66:8 67:14

67:15 70:7 72:9,19

74:12,13,15 77:20

83:3 97:1,5 111:8,15

178:10

hazardous 404:13

405:10

hazards 5:13

HAZWOPER 389:17

he'll 142:3

head 138:15 140:22

heading 111:20 274:12

275:3 301:11,14

headquarters 106:4

health 1:3 4:5,21 5:5,6

5:12,16,17 6:3,7,11

9:3 18:14 20:2,17

21:10 27:18 29:5 31:8

33:21 43:19 45:18

65:10,17 67:3 74:12

74:14 76:6,9 87:7

100:15 110:12 149:22

309:18 310:20 316:8

318:17 320:13 326:1

379:10 382:20 388:10

388:17 389:16 400:13

400:22 402:21

healthcare 123:13

126:8 129:13 171:8

365:13,14,16 366:9

366:13,21

hear 7:11 62:15 66:14

134:21 228:4 288:8

358:1 374:17 395:5

heard 101:13 106:10

114:7 272:20 363:17

364:4,18 384:2,3

385:11

hearing 39:11 51:13,20

106:9 114:20,21

123:3 186:12

heart 34:16 151:8 364:2

heavy 139:13

Hello 7:10 375:6

help 35:8 44:21 48:14

49:10 53:7 60:6 83:8

90:9 96:16 97:2

104:14 115:9 127:17

131:1 136:15,22

137:5 160:7,21

165:13 191:14 199:6

201:15 238:14 243:4

244:13 246:9,13

271:22 305:2 338:17

351:14 363:10 366:12

367:1 385:13 386:18

387:18,18 396:16

398:3

helpful 30:7,9,14 31:3,8

36:11,13 81:18 103:5

103:13 107:13 108:16

152:11 160:11,12

165:7,7 167:14

254:19 276:7 296:19

347:22

helping 128:18,21

219:5 393:10

helps 53:4,14

hemolytic 78:22

hey 22:13 25:22 143:10

152:6 165:8 200:10

202:17 393:21 397:20

HHS 98:3

Hi 5:9 58:15 382:14

high 25:12 44:7 46:15

46:21 61:4 102:17

146:22 390:7 394:2

395:12,14

high-level 138:18,22

higher 138:9 140:20

232:2

highest 24:16

highlight 302:3,8

highlighted 262:5

283:16

highly 323:16

hip 400:4,6

hiring 394:15

historic 99:2

historical 17:12 114:2

history 7:18 11:16

18:19 19:19 23:9

24:22 25:3,4,21 43:11

55:21 56:18 59:21

209:1 211:16 226:1

244:22 262:20 265:19

266:12 267:11 282:5

309:14 316:7,19
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

425

318:13 319:18,20

320:1,13 321:1,3

325:22 334:22 345:9

370:3 371:1 392:5

hit 59:16 323:18

hold 72:5 97:22 258:6

286:6 291:1 392:11

home 171:7 365:12,13

365:15 366:9,13,20

407:12

homework 287:11

honeycombing 377:8

honor 402:4

honored 403:3

hoof 66:14

hope 142:4 194:4 247:8

254:6 382:8

hoped 79:16

hopeful 364:21

Hopefully 315:16

hoping 96:18 185:11

238:20

Hopkins 400:5

horribly 333:21

horses 66:15

hospital 4:14 166:16

hospitals 123:17 126:8

hotel 287:18

hound 315:7

hour 288:22

hour-and-a- 288:12

hours 372:1 380:9

house 239:17

HP 93:5

huge 8:2,18 10:18 11:6

13:20 26:2 28:8 45:15

46:2 99:1 376:4

Hugh 403:15

human 6:2 73:2

humongous 110:9

hundred 158:2

hundreds 393:9 402:14

402:16

Hunt 372:18

husband 366:17

hybrid 114:2

hygiene 12:21 17:16

47:8 138:13 177:20

hygienist 5:3 24:5 25:7

25:14 48:6,12 54:8

56:5 59:1,14 60:8

87:6,15 92:18 93:5

95:5 102:14 110:13

323:5

hygienists 53:9 59:20

75:10 87:14 89:9

95:17 96:8,16 116:19

177:4,6 350:1

hypothetical 178:12

I

IARC 72:11,13,16,18

73:1 77:11 82:14

idea 103:5 141:13

158:16 159:21 220:6

228:19 270:16 322:3

404:8 405:3,22

406:11

ideal 142:5 146:22

364:19

ideals 146:12,13

ideas 37:19 120:16

167:9 251:18

identical 9:8

identification 43:6

identified 19:21 24:3,21

41:22 42:8 50:19 56:9

202:14 260:7 384:1

405:17

identifies 15:3 25:21

207:18

identify 11:19 23:13

24:16 27:15 28:3

31:10 37:2 39:3 43:14

45:19 47:19 81:15,16

177:14,15 197:1

198:11 232:14,21

233:15 256:14 307:12

identifying 14:6 27:20

33:21 100:13,18

197:7 209:6

idiopathic 162:2

ignore 57:19 175:4

ignored 364:15 380:4

389:1 392:12

ignoring 268:9

IH 57:16 102:6 398:14

398:15

IHs 89:3 91:11 96:6

illness 129:10,16,19

193:2 197:3 328:4,4,6

328:21 329:5 331:3

331:22 339:16 340:6

341:20,21,21 342:3

343:4,5,16,20,20

344:3,10,17 345:18

346:1,3,8 348:11,16

350:6 354:14,18

355:1 357:4,4 360:17

375:21 379:2 380:1

381:10 402:4 404:14

405:12

illnesses 34:11 218:5

328:16 338:18 375:22

376:1 405:15

imaged 113:20 114:3

imagine 10:22 91:14

148:16 360:7

imaging 222:21

immediately 16:16

23:22 73:15 109:13

187:4 333:14 369:3

immense 83:5

immune 188:1

immunological 245:11

246:1

impact 67:3 369:5

impair 315:11

impairment 129:4,7

142:12,13,22 143:2

171:3 172:10,17,18

172:22 328:5 343:4

360:18

impairments 172:19

impediment 161:11

implausible 358:8

361:5

implemented 128:17

implication 347:19

implications 369:2

implied 339:19 347:17

implies 262:17 348:14

imply 342:1

importance 230:1,3

important 8:14 18:20

42:19 43:7 52:11

53:12 100:9 108:12

182:21,22 183:1,14

187:14 196:18 295:17

386:1 394:13 403:11

405:21

impossible 201:11

384:13

impression 330:19

improper 373:20

improve 111:9,21 264:6

improved 36:15 37:20

237:13

improvement 58:10

264:15

improvements 388:2

improving 137:1,6

in-home 126:8 129:12

in-house 390:8

in-person 117:21

inaccurate 134:9

inappropriately 221:19

incapable 330:13

incentive 107:7

incentivized 323:16

inception 220:5

incident 18:22 94:7,11

104:16,18,20 105:3

391:17

incidents 19:7 93:9

include 17:1 57:8 60:9

72:14 123:13 126:13

126:17 133:3 181:8

187:12 191:21 210:12

283:14,15 321:5

333:22 336:9 357:1

included 33:15 38:5

51:1 59:10 69:20 70:9

73:3 155:2,3 264:5

265:17 282:3 316:14

318:6

includes 32:5 198:1

273:7 295:8 309:5

340:4,5 404:21

including 85:2 137:2

243:14 273:21 279:1

330:7 349:6

inclusion 15:13

incoming 330:20

incomplete 134:8,18

inconclusives 239:20

239:22

incongruent 125:13

inconsequential

229:12

inconsistency 269:5

inconsistent 262:11

incorporate 33:21

387:2

incorporated 11:7

74:15 76:3

incorporating 9:13

increase 265:15 281:22

373:21

increased 10:19

increases 374:1

increasing 41:19

405:13

increasingly 323:16

incredibly 63:20 333:8

independent 49:20

50:10 51:22 53:7 64:5

64:6,21 126:4 136:19

171:21 372:22 386:9

independently 52:14

322:18

indeterminate 240:10

240:15

indeterminates 240:18

indicate 121:13 152:18

208:17

indicated 96:9 141:2

indication 162:3,8

individual 54:11 55:16

73:18 142:22 155:15

155:16,17 188:20

192:19,22 193:9
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

426

196:12 197:11 224:22

231:6 286:11 364:20

403:7

individual-level 23:10

individually 286:18

287:12 291:13

individuals 34:14,15

45:16 50:4 193:15

252:20 307:22

industrial 5:3 12:20

17:15 24:5 25:7,13

28:8 29:22 32:7 47:8

48:6,11 53:9 54:8

56:5 59:1,14,20 60:8

75:10 87:6,13,14 89:9

92:17 93:5 95:5,17

96:8,16 102:14

110:12 116:19 138:13

177:3,20 323:4 350:1

industry 5:11 104:21

141:2 385:9,15 386:5

inequitable 371:11

inform 113:10

informal 357:16

information 8:3,3,19

9:3,11,21 10:6,12,13

10:16,18 11:1,6,11

13:8,20 14:6,12 15:3

15:4,8,11,17 16:17,20

16:22 17:3 18:11,16

19:22 20:10,19 22:7

22:10,19 24:18,20

25:1,2,5 30:2,6,8,11

30:14,22 31:1,18 32:1

32:13,18 33:1,2 36:10

36:10,12,14 37:8,11

38:10,15,18 39:5,6

40:6 41:9,12 43:9

44:11 45:12 46:2,4,7

46:20 47:1,6,15 49:19

53:18 55:1,13,15,19

56:7,8,20 57:12,12

58:2,19,22 59:22

61:18 64:9 65:10

69:15,22 71:17 74:11

75:15,16 76:7,9 77:18

78:2,12 79:9 81:17

83:16 88:13 89:22

92:4 93:1,3,18 94:2,4

94:8,10 95:1 99:7

100:4,15,19 101:20

102:5,10 104:1

108:20 109:14,16

118:13 123:12,21

124:5 127:17 128:5

131:7,18 134:10

140:13 141:11 142:14

144:7 145:6,16

149:19 151:1 152:6

158:9,14 159:10

161:9,16,19 169:6

171:9 180:1,12,16

181:15 182:7,8

195:14 198:13,16

200:13 205:20 207:4

207:11 209:21 215:3

217:10 241:12 255:11

259:21 263:3,17

283:22 305:10,16

306:13 307:13 308:2

309:2,5,10,13,15,17

310:1,4,10,13,17,22

311:17 312:15,16,22

314:8,10 315:5,9,9,18

315:20,21 318:15,17

320:20 321:2,13,17

322:4,9,15,19,21,22

323:3,7,11,21 324:8,9

324:15,22 325:8,10

325:12,14,16 331:3

334:19,20 335:1

339:6 341:10 365:19

367:18 369:7,10

386:20 387:13 392:9

402:2

informed 88:17 220:8

initial 8:22 51:13 85:6

87:3 89:20 118:7,9,15

130:7 231:16 271:16

271:18

initials 232:16

initiate 154:15 186:19

injected 221:18

injection 83:2

injury 328:4 343:4

387:15

input 31:15 33:20 64:8

120:10 142:11 241:10

250:11 252:4,8,9

253:21 254:6 275:10

275:12 277:9

inputs 335:3

inquiries 130:12

insert 312:20 317:4

359:7

inserted 179:4

insertions 312:14

inspection 133:2

instance 60:22 126:2

126:18 132:1 134:11

136:17 158:20 166:15

311:16

instances 17:17 32:22

33:1 104:15 190:19

232:3 364:11

Institute 62:16 63:6

65:4 68:13 124:6

instructed 127:2

instrument 65:16

instrumental 20:16

insufficient 74:17

357:10

insurance 144:9 157:7

346:8

integrated 182:7

intend 117:8

intended 13:7 375:2,7

375:11

intent 287:10,14,19

395:13 403:1

interactions 314:22

329:17 332:10

interagency 97:20

interest 66:17,18 79:13

91:12 111:8 257:4

342:15

interested 10:4 16:12

30:13 33:16 111:6

170:12 184:21 192:1

interesting 8:2 21:19

368:21 372:15

interject 195:20

internal 9:18 13:1

173:17 269:5

internal/external 82:19

internally 262:11

internet 4:7

internist 135:18

interpret 90:18 150:19

215:9 351:10

interpretation 198:10

199:14 200:18 205:8

205:14 210:3,19

interpretations 194:3

interpretative 115:18

199:20 201:5 203:7

398:21

interpreted 209:9 210:7

215:6 333:21 373:17

interpreting 218:14

248:11

interprets 49:19 190:20

interrupted 288:1

interstitial 208:18 215:8

intertwined 179:18

interviewing 53:17

interviews 11:18

intricacies 83:19

introduce 4:8 122:11

intrusive 222:8

intuition 178:15

intuitive 178:7

invasive 215:21 378:6

inventory 75:18

investigated 372:8

investigation 71:18

investigations 386:10

invitation 250:21

invited 260:8

inviting 260:13

involved 12:18,21 14:1

36:3 44:18,22 93:7

98:14,16 223:4

307:16 384:15 392:17

involving 29:19

IOM 3:6 62:20 63:1,16

67:16 76:13 77:15

79:4 80:7,9 82:4 83:1

96:22 150:8 151:14

irrelevant 371:18

Island 236:3,5

issue 10:3 17:8 31:14

39:17,18 43:7 54:7

62:11 90:9 103:15

111:3 119:8 120:2

137:22,22 151:10,15

154:12 157:6 159:17

171:11 172:6 176:11

177:19 184:1 188:9

190:9,13,16,18 191:1

191:4,6 194:5 203:2

204:2 213:1 214:7

219:6 221:5 223:15

224:7 229:22 230:12

232:9 233:1,12 237:8

237:18 238:5 264:19

272:16,17 289:8,10

296:21 308:21 327:18

340:20 343:2 348:17

360:10,15 380:18

397:21 398:6,13

issue/concern 186:16

issued 62:17 108:22

265:18 282:3 399:11

issues 34:3,5 35:16

58:3 84:16 108:16

118:9 120:15 137:15

176:4 190:6 192:2

201:3 203:14 205:18

212:8,10 216:1

226:22 233:13,15

236:14 237:9 239:5

240:22 241:10 242:17

256:14 289:3 360:18

379:10 390:5

it'd 111:10,21

item 3:2 65:2 177:17

191:16 192:11 262:21

293:2 304:17,22

306:22 308:15 316:6

318:12,13,16 319:10

319:10 356:6,18
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

427

items 34:1,1 67:14

73:13 78:16 149:8

187:12 198:11 208:10

208:13 221:17 289:12

319:4,9,10 383:3

J

James 2:12 6:16 60:17

janitors 242:10

January 80:19 370:17

371:8 393:7

jargon 183:13

Jay 20:13 98:8,11

111:15

Jeanne 382:11,13,16

389:20

Jeff 87:5

Jerison 367:8,13 374:9

374:12

Jewish 212:18

Jimenez 45:22 146:1

173:7 181:5 272:3

347:8

job 26:1 44:19 46:8

50:20 65:22 108:2

134:12 221:11 263:1

356:11 368:20 391:10

392:15 394:21 395:1

jobs 103:8 368:11,13

368:14

John 2:3,20 3:5,14 4:22

7:6 38:3 39:7,18

44:14 51:22 117:2,3,6

186:6 193:6 198:4

238:21 239:6 263:14

Johns 400:4

Johnson 2:18 3:14

185:11,20 186:1

192:17 194:9,11

196:20 205:1,1

217:17 229:16 230:22

231:13 236:11

join 42:22

jot 19:4

journal 315:6

journals 73:19 77:19

journey 51:9 378:4

judge 297:1

judged 324:2,4

judgment 46:12 90:16

92:19 174:7 181:7,19

200:14

judgments 96:4 173:16

174:1

jug 394:3

Julia 63:19

July 374:4

jumped 395:1

June 186:11 241:12

372:9

justification 229:7

justified 308:20

justify 383:6

K

K 2:8

keep 80:11 91:3 112:21

113:6 121:4 143:14

176:17 179:6 180:9

180:19 183:14 184:5

227:8 242:4 271:16

271:17 273:6 277:14

278:18 297:18 301:3

319:10

keeping 50:20 95:9

184:13

keeps 321:17

Keith 12:17

Ken 5:15 178:6 185:1

264:10 288:7 307:18

323:14 329:10 386:10

Ken's 315:17 321:8

KENNETH 2:4

kept 53:15

Kevin 284:17

keying 194:18

kidding 258:10

kidney 74:1

kids 138:17

kind 24:22 25:14 44:3

45:3,8 53:6 65:19

66:2 68:7 69:12 73:14

73:16 75:6,17 78:11

79:7 83:2 90:22 101:8

109:22 111:14 115:12

139:4 140:2 141:19

157:17 163:10 166:6

175:13 178:10 180:15

203:1 216:21 221:5

223:14 238:6,13

239:19 240:8,13

241:19 248:22 262:3

264:18 269:6 272:9

272:13 274:21 276:3

303:15 362:21 363:3

369:6 376:3

kinds 16:2 21:2 25:17

26:17 40:21 66:9 76:1

77:5,15 100:1 160:16

204:11

Kirk 2:11 6:6 105:13

239:22

knew 42:2 134:12,13

353:15 365:14 392:5

know 9:4 11:4 17:2

18:16 19:16 20:6,9

21:3 23:1 24:13 25:18

29:8 30:5 31:20 34:8

35:15 36:9 37:5,15

38:17,20 40:15,19

41:6,16 42:8 44:18

45:6,11 47:5 49:12

51:4 53:20 55:7 56:17

56:20 57:1,5,13,21

58:20 60:19 62:1 70:5

71:15 73:11,21 74:14

74:21 76:8 77:12,12

79:16 80:11 81:15

86:11,14 90:10 91:6

93:1,6 95:4 96:11

97:5 100:13 101:17

102:7,13 103:7,7,10

105:22 106:21 107:8

107:10 109:15 110:3

111:10,11,21 112:5

114:13 120:9 131:13

134:15 136:6 139:6

139:20 140:3,5,10

143:13 145:3,19,20

147:9 148:2,6 149:3

150:2,10 151:14

152:3 153:22 154:18

155:7,11 158:21

160:15 163:1 165:18

167:3,13 169:4

171:10,12 174:16

175:12 179:8 188:11

188:22 191:11,12

193:20 199:14,17

202:11,16 204:18

209:19 213:8,18

215:20 216:12 218:16

220:21 224:7 227:12

233:3 234:2 235:6,9

236:21 240:4 242:19

243:2 251:10 252:11

255:8,16 258:20

259:17 263:21 270:8

272:15 274:5,7 275:1

276:22 281:8 285:21

286:9 298:2 300:5

308:17,18 311:8

314:21 323:4,12,18

324:1 334:15 337:13

339:15 340:10 344:15

349:15 354:7 364:9

364:10,11,16 365:9

373:18 377:5 381:20

383:8,14 384:21,22

385:16 386:8 389:7

392:2 394:8 395:17

396:19 397:2,6,7,12

397:13 398:15,21

400:16,21 406:15

knowledge 143:9,17

174:1 253:18 392:17

knowledgeable 253:19

known 170:10

knows 40:3 57:1 134:11

250:13 284:6 407:3

Koehler 63:17 67:4

Kotsch 87:5

L

lab 397:7

labor 1:1,19 18:21 22:8

22:19 26:5,9,10 27:18

36:20 39:21,22 44:5

44:12 54:8,13,21

56:10 64:15 84:11,13

84:20 97:6 104:21

106:16,18 116:14

119:15 121:19 122:2

124:13,14 125:4

130:9 153:9 160:8

185:16 250:19 251:6

252:4 254:8 259:14

364:8 365:10,15,21

383:1,13,17,21 384:4

384:10 386:12 387:2

387:12 397:10 407:3

Labor's 105:18 127:6

laboratory 123:18

132:16

labored 132:10

laborer 25:20 26:1,7,10

26:13,15,16 27:22

laborers 26:8

labs 212:19 240:22

393:19

lack 280:22 294:12

297:16 298:14 404:10

lacking 130:19 359:21

laid 67:9 199:13 323:19

landscaping 26:16

language 70:20 135:21

137:21 144:21,22

145:9 147:6,13 158:1

163:17 168:6 174:10

218:20 256:16 261:2

261:8,10 264:17

265:6,13 266:2,21

272:6 275:11,12,13

275:14 276:8,21

277:2,8 278:3,4,16

279:3,5,9,22 280:1,13

281:1 282:9 285:8

287:2 289:20 291:10

292:18,21 293:9,9

294:2,2 295:8 296:1

297:22 299:2 300:3

300:14,17 301:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

428

302:11,14 306:6

309:6 310:2,3 311:8

311:16,20 312:5,9,9

313:1 316:1,6,11

317:7,20 318:20

319:3 320:8,21 321:8

321:19,22 322:6

324:6 325:6 326:2

328:12,14 332:20,21

333:8 334:17 335:9

335:10 337:14 340:6

340:11 341:7 344:6

344:20,22 345:16

347:5 348:4,5,5

350:17,18,20 352:4,6

352:10,11,14,14

353:1,3,6,8 355:2

357:21 358:5,22

359:7 361:1,4 386:11

388:21

languages 305:7

400:21

Larew 401:14,16,17

large 10:11,21 11:2

28:11 29:15 110:8

257:13 264:12 328:7

larger 132:3 182:5,14

lastly 127:9 128:7 137:9

late 332:14 370:3

latency 231:15

Laughter 66:16 81:21

92:13 121:3 138:19

148:3 149:1 152:20

153:1 156:13 165:3

181:1 183:18 214:17

226:15 231:12 239:10

239:13 249:20 252:12

258:11 279:16 280:7

287:20 290:7 298:8

304:12 313:14,18,21

314:2 332:16 336:22

347:6 348:22 352:19

353:14 354:9 358:19

laundry 69:21

Laura 2:7 79:19 241:4

266:17 298:12 306:19

Laurie 6:19 79:22 80:1

117:3,6,13 151:21

262:1 330:16 358:12

Laurie's 352:7

lavage 212:12 214:9

215:17,19 222:6

375:15 379:8

law 114:18 115:1

214:12 284:6 307:20

375:4,8 379:18 403:1

lawsuit 392:22

lawsuits 393:3

lawyer 258:13 311:4

lawyers 149:7

lay 164:6 182:18

lays 163:11 196:2,9

lead 12:16 61:22 62:1

87:7 161:19 162:6

339:6 360:21

leading 43:13 219:22

406:19

leans 351:8

learn 53:4 83:19 180:2

learned 101:5 119:11

119:12,14,16 165:8

learning 253:22

leave 113:4,6 114:9

222:19 288:21,22

297:22 298:6 300:14

329:22 344:2,18

348:8 367:19

leaves 164:10

leaving 214:8

led 372:11

Lee 378:22

leeway 214:9 341:12

left 110:22 132:11

219:1 348:19

legacy 186:20

legal 207:19 398:17,18

398:22

legislative 214:14

402:7

legs 264:19

Leiton 2:19 3:5 7:8 35:1

37:17 39:7,10,14

44:14 47:21 51:6

56:12,14 59:19 61:11

86:10,16 87:4 88:19

88:20 90:21 91:3

92:22 95:21 96:15

97:8 98:19 99:21

101:21 102:20 103:19

106:12,15 108:4,17

110:5 112:2 113:1

115:2 139:3 141:6

142:4,21 144:12,18

149:5 151:3 154:21

155:6,20 157:20

161:17 163:13 165:10

167:18,20 168:22

170:19 172:11 174:12

175:22 176:11 186:7

209:11,15 211:3

215:15 225:10 243:3

243:5 244:12,16

247:15,18,22 248:4,9

248:17,22

lemon 237:1

length/duration 46:9

lenient 206:14

Les 5:4 185:1 271:3

289:21 295:17 297:21

Les' 270:2 284:22

LESLIE 2:5

less-restrictive 222:13

lesser 236:3

lesson 101:5

let's 4:3 16:19 20:3 22:1

22:4,12,16 23:15

25:17,20 27:19 28:15

38:13 53:16 55:20

62:6 69:13 74:10

83:11 140:19 169:21

171:18 184:20,22

224:12 225:21 228:16

230:20 260:17 267:6

271:16,17 277:7

291:1 292:2,20 303:1

304:2,10 318:3 353:3

353:13

letter 80:5 155:9 162:15

162:22 163:7,19

164:4 165:1,2 168:5

168:14,18 169:1,8

364:12 365:16 366:2

370:20 372:13 373:1

373:5,7 379:20 385:4

392:20 393:1

letters 137:3 163:18

164:3,5 366:6 372:21

393:1

letting 251:10

level 24:6 25:12 29:3

44:8 46:17 51:9,18

90:17,22 91:19 93:6

93:19 95:7 138:9

140:20 141:7,10

149:22 232:1 249:12

levels 253:18

liberal 193:18 211:7

219:3 230:15

liberally 373:17 405:4

Library 66:8 70:16

lies 109:19 130:9

life 43:7 79:16 145:1

light 61:3 268:21

313:16

likelihood 23:14 46:21

102:17 265:15 282:1

limb 145:1

limit 359:15 367:10

limitation 267:20

limitations 144:16

limited 161:20 238:22

239:4 255:11 275:17

312:8 313:20 314:1

400:17

limiting 24:3 26:12

311:11 340:7

limits 265:14 268:9

line 56:15 268:7 276:15

282:17 352:15

lines 175:16 278:10

354:20

link 15:7 22:18 67:10

78:16,18,19,20 80:18

80:20,22 162:8

187:16

linkage 31:10

linkages 77:8

linked 9:4 18:16 21:7

linking 94:18 100:20

links 21:9 69:10 70:21

71:9 72:9 73:6 78:9

78:15 83:4

list 20:9 21:1 22:22 23:5

33:22 35:7,7 68:3

69:21 78:11 79:12

95:10,10 100:21

115:3 176:15 188:14

216:1 221:17 254:15

254:15 289:12 312:16

312:20,22 313:6,7

314:7 315:3 317:4

318:19 319:4 320:3

324:1 326:2 377:17

383:11 385:1 401:5

listed 21:6 31:9 69:2

103:11 310:5 320:1

377:9 401:4

listen 120:10 368:21

listing 325:21

lists 310:4 401:1

litany 110:17

literally 377:20

literature 41:19 42:5,11

43:16 99:18

litigation 127:3 405:5

little 7:18,20 8:8 11:15

16:19 18:22 19:2 27:4

33:8 42:20 45:3 47:22

67:22 70:3,22 71:13

75:4 79:17 91:6 92:19

96:1 101:20 119:2,16

124:17,18 125:14

131:12 136:8,10

138:13 140:17 145:8

145:21 146:22 147:7

159:20 168:3 175:7

178:22 185:10 186:4

187:9 195:3 200:4,6

211:6 219:9,21 220:9

221:2 223:17 224:18

226:8 247:11 250:12

250:17 262:2 267:5
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

429

274:20 276:13,16

287:12,13 291:3

301:8 320:10 325:4

367:12 368:16 387:5

396:16

live 291:7

locally 165:11

located 124:1 165:11

location 29:7 108:3

locations 11:5 28:8

29:15

logic 181:13

long 118:1 120:15

174:22 188:20,21

210:2,7 211:15 215:2

228:11 229:3 287:17

315:3 365:19 383:16

long-term 219:16

242:14 381:6

long-time 402:7

longer 32:6 68:18 224:8

345:14

look 7:13 8:22,22 13:13

14:10 15:22 18:10

19:18 20:3,22 21:8

22:5,7,17 25:19 35:10

39:1 40:6,7,8 41:4

42:10 44:11,17 45:8

47:3 50:12 51:10

55:18 56:21 57:7

62:17,20 63:5 65:11

65:12,19,22,22 66:1,2

67:11,12 69:4,13

77:17 78:14 82:6

102:4 107:8,22 110:4

110:9 118:11 130:18

132:3 138:20 139:10

144:20 152:1,14

173:5 177:16 187:4

196:22 198:18 200:13

201:6 203:14 205:4,5

223:11 233:14 235:15

246:8 247:4 250:21

252:1 254:4 260:10

268:17 272:18 284:13

285:19 287:3,4

289:18 296:1 320:22

333:11 338:10 367:16

369:16 376:8 378:11

382:3,21 404:15

looked 48:18 69:6 71:1

72:17 80:4 88:8

170:11 233:14 376:2

388:1

looking 5:7 14:5,8 16:7

17:16,21 18:8 19:12

20:17 22:9 23:16 25:4

25:16 27:18,21 30:5,7

30:11 31:15 32:4

33:17,20 37:4,19 38:3

40:16 45:18 47:13,14

47:15 48:1,3 49:4

50:4,11,13 51:1 52:4

52:13 54:22 66:15

73:5 87:18 90:3 94:11

109:4 123:10 129:11

177:12,17 179:2

183:10 192:17 193:20

194:7 197:4,9,21

198:4,4 199:8,15,18

199:20 200:10,21

201:14 210:6 213:17

219:4 237:8 246:20

248:12 254:3 256:20

259:1 260:20 275:9

276:20 285:8 304:19

308:20 311:22 316:2

316:12 333:7 338:12

384:18

looks 58:21 81:13

91:16 171:22,22

182:6 195:6 237:15

376:6 378:15 381:11

Los 11:4 164:19

loss 39:11 114:21 129:7

129:10 364:7,11

374:2,5

lost 44:1,2 145:1

320:10

lot 5:7,12 11:9 14:2,2

17:11 21:20 26:3,20

30:18 31:1,17 37:7,10

37:12 41:18 46:4,6,11

48:2 54:12,16 55:22

57:20 58:9 60:5 61:1

71:16 74:22 75:14

77:9 82:16,22 89:13

90:7,11 91:7,8,13

99:15 102:1 107:6

109:14,21 110:13,16

139:12 145:14 147:18

156:8,10,17,18 158:1

158:5 160:14 164:14

170:20,22 172:17,19

172:20,22 174:14

176:14 183:13 203:18

204:7,9 211:5,8,11

213:22 214:8 219:6

219:11,12 222:11

226:7 233:13 241:4

242:21 248:9 251:21

333:1 338:8 339:2

364:4 365:8 367:17

369:1,3 378:12

380:13 386:19 404:21

lots 28:10 34:5 194:2

226:16,22 378:10

love 225:15 298:7

391:15

lovely 67:1

low 58:7

lower 242:21

lower-level 105:15

LPT 204:2 211:18

239:18

lump 132:3

lump-sum 190:1

lunch 167:17 168:2

169:14

lung 3:13 101:14,16

102:16 116:18 132:11

135:17 144:1 185:18

191:22 205:6,11,12

205:19 213:22 214:1

215:8,18 217:20

226:20 234:10 237:18

239:5 243:13,16

244:1,8 245:6,7,8,15

245:20 246:4

lymphocyte 132:18

189:7,8 191:9

lymphocytic 204:4,9,18

224:6 243:17

lymphocytosis 223:1

M

M 2:3,11,12

machined 61:4

machinist 242:6

magnitude 227:15

main 13:18 16:6 172:8

174:4 179:9 192:21

400:11

mainstream 146:7

maintain 124:2

maintained 12:7

maintainer 97:6

maintenance 40:10

138:16

major 99:8,10 103:6

372:6

majority 157:13 173:14

175:22 184:18 211:11

292:16 391:4

making 10:4 14:1 34:15

49:16 57:17 67:13,14

77:22 147:15 148:10

150:14 196:18 208:8

210:16 233:2 253:21

275:20 303:5 317:8

337:4,16 338:12

350:13 390:8

malignancies 405:14

management 108:18

114:8

manager 12:17

managing 109:5

mandate 106:22 107:2

187:18 236:20 308:21

327:18 360:10

mandated 107:11

254:19 379:18

mandates 195:15 231:2

Manhattan 370:22

371:3 385:22

manipulation 133:3

manner 30:21 50:6

129:8 203:3 265:14

403:3

Manual 88:9,20 218:11

218:21 248:10 377:10

377:16

Map 65:11

Mark 2:3 4:20 63:15

117:5,7 263:12

285:11 307:8 330:1

330:18 358:3,14

Mark's 120:4

marker 197:4 221:1

markers 201:15 203:10

Markowitz 1:20 2:7 3:8

3:12,16,18 4:3 5:19

5:19 7:2 41:14 42:13

45:21 48:15 52:7 54:4

58:14 60:12 62:13

79:19 81:2,6 82:1

83:11 84:2,8 86:1,15

87:20,22 88:16 92:1

95:9,10 96:13,20 98:1

98:4,7,10,13,20

101:11 104:13 106:5

108:6 110:2,20 111:2

111:3 112:4 114:16

116:5 119:4 120:19

121:1,7,12 122:11

137:13 140:15 141:14

144:14 145:22 147:1

149:10 150:11 151:5

151:6 152:15,21

153:2 154:7 155:4,12

156:5,11,15 158:6

159:12 161:3 162:11

164:8 167:15,21

169:11,18 170:7

172:6 173:6 175:14

176:7,10 178:17

179:14 180:6 181:4

181:22 182:17 183:16

183:19,22 184:7,9,12

184:16 192:8,9 194:6

194:10 206:8 208:5,6

210:10,14,21 212:5
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

430

216:14 217:4,7 218:1

218:1 219:18 223:14

225:2,9,12 227:17

229:13,17 230:16,20

233:22 234:1 235:13

236:7,10,13 237:6

238:2,17 239:3,14

240:7,20 241:2,6

243:2 247:9 249:3,14

249:21 250:7 252:13

255:2,7 256:9,12

259:6,9,10 260:2,4

263:7,11 264:10,20

265:1 266:18 268:22

269:15 270:18,20

271:2,8 272:2,15

273:12,14 274:8

275:7 276:6,20

277:18,21 278:2,12

278:21 279:17 280:5

280:8,16 281:2,6,9,16

282:12,16,22 283:2,5

283:10,13 284:3,10

284:13 285:4,7,22

286:4,13,17,22 287:6

288:1,11 289:11

290:5,8,11,14,17

291:6,11,17 292:1,7,9

292:12,15 293:21

294:4,13 295:5,16,22

296:14,20 298:21

299:9,12 301:4,20,22

302:5,7,13,17,20

303:1,17,20 304:2,7

304:13 305:5 306:4

306:17 307:8,18

308:4,12,17 311:12

312:7,11 313:3,10,19

314:3,11 315:14,22

317:5,10,14,18 318:7

318:11 319:7,12,15

320:3,6,9,18 321:9,18

321:21 322:5,11

324:5 325:3,15,21

326:6,10,13,16,19

327:12 329:8 330:1

330:15 331:10,13

332:14,17 333:6

334:10 335:8,15

336:3,11,15 337:3,11

338:14 339:12 340:1

340:18 342:8,13,22

344:1 345:11,20

346:11 347:7,11,20

348:13 349:1,10,14

350:12 351:6 352:8

352:17,22 353:15

354:4,10 355:7,10,12

355:15,18 356:13

357:19 358:1,12

360:8 361:21 367:7

374:7,10,16 375:5

382:5,10 388:5,8,16

389:3 394:10 395:4

400:14 401:12,16

403:13,18 407:14

Markowitz's 52:9

marks 233:11

masked 204:10,13

masking 203:21

match 19:20 21:14

317:7

material 12:19,22 14:9

17:4,5 18:1,3,4 20:13

28:22 32:6,15 43:10

62:7 113:21 210:17

materials 12:10 13:6,22

14:3 31:18 32:1,20

40:10 54:18 401:5,8

mathematical 46:14

Matrices 3:4 7:15,16,19

8:17 9:8,12,19 10:7

10:14 11:7 12:6,8,14

13:3,4,11,14 14:19

15:1,10,14,20 16:1,9

16:10,21 17:3,7,15,22

18:9 19:5,10,22 20:18

21:15 23:11 26:18

28:14 30:10 31:4,7,12

31:14 32:5,16 33:22

35:18 36:14,19 39:6

41:8 45:10,13 46:3

47:19 50:1,5,14 55:11

56:6 58:8 84:12 85:17

94:5,8,14,21 107:3,11

116:8,15 117:1

305:15 306:11 309:2

309:4 310:8

matrix 42:3 52:19 53:3

53:13 54:2,6 83:15

105:2 178:9

matter 84:5 169:15

200:9 235:6 250:4

255:13 296:8,18

327:9 361:18 379:7,9

398:11 407:18

Mayo 400:4

mean 15:16 25:15

28:16 29:21 33:5 37:6

37:9,12 42:20 43:6,7

45:6,15 47:9 49:9

55:5,17 61:12 62:2,7

70:3 72:13 75:20 79:4

80:7 81:2 90:2,3

98:22 101:19,22

102:9 110:6 120:6

139:5 142:14 144:21

145:3,14 147:14

148:13 149:12,17

150:6,7,7,8 156:7

158:12,13 164:2

168:17 172:13 174:17

179:21 194:1 202:6

202:12,12 208:2

234:5 235:2 237:7,21

240:3 246:7 248:3,12

259:18 263:16 270:3

270:6 271:5 275:6,17

280:11,12 285:16

286:12 291:3 301:11

320:8 322:12 323:12

332:19 333:8 334:4

334:14,18 337:1,21

339:2 340:19 343:16

343:17 345:4 351:9

365:19 366:5

meaning 71:5 119:18

154:15 178:2 181:8

194:2 203:8 223:1

270:10 346:17 349:6

406:7

means 17:2 32:8 78:19

134:22 141:16 151:12

151:16 161:2 194:3

218:12 246:11 252:15

253:6 284:2 299:18

311:9 344:3 346:1,7,8

346:10 372:5

meant 75:7 150:8 265:7

278:7 279:20 299:1

measure 52:17,18

109:7

measures 378:17

measuring 49:11

mechanism 113:13

mechanisms 191:13

med 175:5 176:1

medical 2:6 3:10 4:12

6:20,21 50:15,22 67:8

85:4 88:13 93:12

94:17 116:16 122:2,4

122:22 123:9,11,17

123:20,22 124:12,17

125:1,7,14,15,16

126:10,11,20,22

127:1,4 128:11,20,22

129:2,3,4,12,13,17

130:4,6,8,10,13,16

131:10,13,14,15

133:7,9,16,18 134:3,3

134:5,6 135:1,3,4,19

136:9,17,20 137:7,7,8

138:2 140:19 141:16

141:22 143:4 146:5

147:20,21 148:1,4

149:18 151:17 153:10

153:13 154:9,12

155:15 157:6,20

158:3,4,18,19 159:5,8

159:9,15,18 163:9

165:7 166:14,20,20

167:6,10 169:2,22

170:13 172:2 175:9

175:17 176:22 177:2

177:18,19,21 178:1,2

180:12,16 181:12

182:19 183:4 189:18

189:19,22 190:2

191:17 192:4,12

193:7,19 194:1,17,18

194:19 197:10 206:10

206:19 231:13 232:3

239:17 241:7 249:10

297:1 309:4 328:19

331:18 333:10 334:4

338:4,7 341:1,16

344:7,8,14,16,17

345:8 348:9 352:2

356:22 358:7,15,15

359:21 360:12 361:6

363:9,10 367:2

369:22 371:20 375:16

376:11,12,17,20

377:2,4,14 378:7

381:13 388:3,9,18,20

390:8 395:8,15 396:4

396:10,18 397:6,9,11

398:16,17 401:6

402:19 403:2

medically 136:11

medically-caused

154:6

medically-valid 203:4

medication 133:15

204:14

medications 204:11

212:15

medicine 4:13,15,17,18

5:2,11,20 62:16 63:6

63:8 65:4 66:8 68:14

70:17 146:7,10

164:14 173:17 174:3

310:15

meet 116:1 117:21

197:19 210:4 216:12

216:16 223:20 228:7

228:8,21 229:2

234:17 252:9 287:8

374:4 377:4,17 378:7

407:17

meeting 1:7 64:2 65:3,5

67:17 80:20 84:18
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

431

95:12,20 117:22

119:18 256:5 287:14

287:15 307:19 366:1

402:13

meetings 63:11 76:12

79:15 85:14 118:6

119:10 121:5 256:4

meets 227:21 267:13

372:4 376:19 399:13

member 4:11,16,20,22

5:4,9,15 6:1,4,6,9,13

6:16,19 38:3 39:17

41:16 42:16,18 43:1,2

43:3,4 46:1 52:8 54:5

55:12 56:13 58:15

60:17 61:14 63:1,21

66:17 80:1,10,14,15

80:16 81:1,5,9,19,22

83:13,17 85:22 86:3

86:20 87:17,21 88:2

90:2 91:2,22 92:2,14

94:22 95:15 98:22

101:9,12 102:12,21

104:12,14 106:7,13

107:13 108:5,7 112:8

114:18 119:1 120:4

120:22 121:4,6 138:6

138:20 140:16 141:15

142:9 144:9,13,15,19

146:2 147:2 148:4

149:2,12 150:13

151:20 152:19 153:4

156:16 158:7 159:13

161:4 162:12 164:12

165:4,21 168:3

169:10,20 173:8

175:15 178:7,18

179:17 180:7,21

181:2,6 182:16 184:5

184:8 206:9 211:1,13

212:6 213:3,9,15

214:5,18 215:10,16

215:20 216:2,5,15,21

217:6,9 219:20 221:7

221:16,20 222:14

225:17,21 226:4,13

226:18 227:3,7,11,13

227:18 228:5,14

229:1,5,10 230:14

233:22 234:2,6,19

235:12,14 236:1,6,18

237:15 238:3,20

239:11,15 240:5,8,21

241:1,4,8,11 242:4,8

242:9,10 244:10,14

247:11,16,20 248:2,6

248:16,19 249:2,4

255:4,18 258:16

262:2 263:9,13 264:8

264:9,11 266:10

268:6 269:3,16,20,21

270:22 271:3,5,6,10

271:15 272:4 273:5,8

273:10,11,15 274:3,5

274:9 276:4,11

277:10,20 278:8,14

279:1,6,7,10,11,13,15

280:3,6,9,17 281:4,7

281:11,12,14 282:8

282:14,19 283:1,4,8

283:12,21 284:4

285:2,5,12 286:2,8,14

286:20 287:1,10

288:8 289:5,22 290:9

290:12,15,18 291:7

292:6 293:7,22 294:5

294:14 295:6,21

297:3,9,21 298:3,5,9

299:5,10,14 300:1,8

300:11,13,15,16,20

300:21 301:1,2,8,13

301:14,15,17,19,21

302:2,6,10,16 303:12

303:17,19 305:3,6

306:5,20 307:9,19

308:14 311:2 312:2

312:13 313:4,12,15

313:22 314:5,18

315:16 316:15 317:6

317:11,16,20 318:8

319:6,8,13,16 320:5,7

320:17 321:7,10,20

322:1,8,12 323:15

324:12,17,19,20,21

325:1,2,13 328:14

329:12 330:2,17

332:18 333:7 334:11

335:10,18 336:7,13

336:16 337:1,6,9,12

338:15 339:13,18,20

339:22 340:3,15

341:6 342:11,17

343:3,6,7,8,9,13,19

343:22 344:2,21

345:3,21 347:9,12

348:7,21 349:2,11,16

350:3,15 351:21

352:16,20 354:3

355:9 356:10,14

357:22 358:4,13,20

359:18

members 2:1 74:3

169:20,20 217:13

252:19 253:1,17

257:20 260:8 264:21

304:18 331:11

memo 67:5 77:2 80:16

371:1

Memorial 288:16,18

men 402:1

mention 30:4 32:15

44:15 50:18 61:14

83:22 254:8 260:5

303:13 371:14 393:13

mentioned 34:2 51:22

80:3 98:15 155:22

186:21 189:15 198:4

223:15 264:17 362:22

387:16 393:12

mentioning 51:16

213:2 273:7

mentions 66:20

mere 36:9 50:3

merely 17:4 18:3

208:16

message 402:17

met 1:18 11:18 63:10

77:2 166:16 199:3

253:13 261:20 293:1

293:19 299:3,21

363:13

metal 39:22 40:3 54:19

61:3 400:5

methodologies 137:1

methodology 36:4

methods 191:2,11

metric 67:3

Miamisburg 389:12

microphone 122:17

258:6 313:13

middle 74:6 247:5

269:8

mild 202:19 397:14

399:13

miles 166:1

millers 401:21

mills 16:4

mimics 326:2

mind 85:10 91:3

mine 104:3,11 109:15

152:19 235:6

miner 235:5

miners 401:21

mines 16:3

mini-report 71:13

minimized 266:17

mining 231:7,9

minuses 32:12

minute 67:18 72:5

122:6 361:15 374:8

374:10 382:6 388:6,7

394:11 400:14

minutes 81:7 84:3,9,14

119:6 121:17 170:1

250:3 256:7 327:7

353:12 355:21 367:9

374:18 382:12 389:10

395:6 401:15 403:16

misconceptions 28:12

misconstrued 317:22

misinformed 155:21

misinterpreted 203:15

misleading 341:3

missed 70:7 120:11

152:22

missing 14:17 46:4

69:11,14 70:21 71:17

72:18,19,20 73:8

75:21 169:19 354:1

mission 7:5 401:22

403:11

mistake 317:8

mistakenly 259:10

misunderstand 268:1

mitigate 114:8

mixed 333:19

modeling 13:9

moderator 362:9

modifies 316:2

molecular 221:1

moment 63:18 176:16

265:3

money 220:22

monikers 192:21

monitored 378:4 384:7

monitoring 124:9

138:13 190:3,12

191:18 192:12,14

193:8,19 194:1,7

379:5

month 132:4 242:1,13

monthly 167:7

months 9:17 85:14

164:22 368:3 390:8

393:16

morning 6:4 122:15,20

122:22 178:9 353:5

407:17

motion 184:4 219:8

270:21 277:19,20

279:22 284:22 285:8

291:12 292:4,6 301:5

301:6 302:9,10,12,13

303:3,6,21,22 304:3

326:7,9 353:9 355:8

MOU 97:17,19

Mound 389:12,15

390:20,22 391:2,14

391:18 393:6,16

move 57:15 60:13 72:1

93:10 112:1 117:18

120:22 121:2,4
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

432

150:12 179:11 181:3

183:22 184:5 185:9

223:22,22 254:16

257:15 268:3 291:2

292:20 303:17 304:10

317:17

moved 93:21 295:19

355:9 357:6

moves 79:11 180:15,16

moving 108:14 121:18

229:15 290:9

MRIs 132:21

MSDS 383:11 385:1

MSDSs 75:18

multi-year 82:15

multiple 27:14 42:6

48:21 99:4 212:11

mutation 157:17

N

N.W 1:19

nail 59:16

name 97:13 112:12

152:17 183:17 229:19

315:19 345:7 389:11

401:17

named 234:11

names 183:12

naming 310:20

naming/listing 314:14

narrow 23:5 59:6

narrowed 58:22

nation 393:5

nation's 402:10

national 63:8 66:7

70:16 82:14 212:18

385:20 401:18

nature 34:19 218:12

Navy 5:10

near 267:1

neat 21:21

Nebraska 231:10,11

necessarily 28:16 37:6

37:9 47:7 90:12

101:22 133:19 148:15

161:10 170:10 176:4

184:2 195:4 196:6

218:17 237:12 246:3

322:18 323:1

necessary 159:5 171:6

171:14 282:6 295:12

306:14 316:10 325:17

329:4,14,16 359:7

366:7 374:6

necessary' 332:8

necessitates 50:4

necessity 359:21

neck 132:3

need 43:14 59:2 74:21

76:11 92:11 104:2,4,9

109:12,14 112:4

116:3 120:20 129:13

129:21 130:3 135:6,7

141:18 142:11 147:4

149:4 153:18 158:14

158:17 159:15 160:4

160:15 163:21,22

165:15 166:20 167:4

167:13 169:3 171:7

171:12,20 176:12

180:3 182:19 187:12

188:6 198:13 199:11

214:13 217:17,20

238:7,8 241:13

246:20 249:22 259:17

265:17 270:20 274:2

274:3 275:16 277:21

282:2 283:22 289:14

294:1 301:4,6 302:4

316:1,20 333:22

334:8 338:3,21

339:17 348:2 355:20

357:5 361:4 363:20

363:21 364:1 366:13

369:6 384:22 385:16

400:1 402:3 404:2,8

needed 128:16 130:22

153:13 158:19 163:9

163:10,11 165:14

166:17 168:6,13

217:14 223:9 259:3

363:11 369:1 376:12

383:14

needs 49:11 97:1

118:13 119:2 129:12

131:3 158:21 160:5

182:17 200:7 208:17

210:18,19 218:8,19

242:20 347:18 362:21

367:3,3 380:18 383:2

388:1

negative 66:18 211:19

212:15 240:2,15

268:21 299:16

neglect 182:11

neglected 254:7 308:19

negotiated 68:4

negotiations 249:19

Nelson 64:12

Nevada 231:11

never 17:20 29:20

35:22 64:14 106:20

107:10 154:19 169:6

214:12,22 239:21

240:2,2,6 334:12

338:2 363:17 364:15

378:6 380:6 384:7,21

387:7 391:20 392:8

394:4

Nevertheless 46:6

new 4:9,9 5:22 15:3

33:21 51:9 78:9 95:18

113:15 186:8 191:7

227:3,6 261:8 262:4

265:5,12 266:21

275:11 276:8,14

278:3,16 282:10

293:9 305:7 306:6

310:3 311:16,18

312:9 318:13,16

319:4 328:12,14

330:20 348:5 352:13

357:5,20 358:5 359:7

376:7 381:8

newly-diagnosed

242:13

Newman 378:22

nice 15:19 95:1,2

111:21

nickel 386:2

night 366:16

NIH 74:20 93:11 220:21

NIH/NLM 70:2,15

nine 240:1

NIOSH 13:10 65:21

75:13 106:22 231:21

234:4,22 386:10,14

NLM 70:16 71:3 98:5,8

98:11 111:11,14,16

111:17

non- 146:17 198:18

218:5,20

non-DOL 372:13

non-invasive 400:1

non-probative 371:18

non-specific 118:21

119:2

nope 363:5

normal 189:12 190:14

190:15,21 204:13,18

213:7 220:14 235:3

403:22

normally 139:15 141:20

142:18 194:16,18

196:21 310:14

North 66:14

note 231:22 371:15

noted 133:1 198:22

290:8

notes 125:19 265:12

279:3 354:15 361:3

376:9

notice 16:2 38:5 119:19

196:4 252:11 276:2

367:12

noticed 363:3

notices 118:2

noticing 353:21

notify 275:19

notion 358:7

NPRM 259:22 354:8

nuances 291:3

nuclear 14:1 65:7 220:3

370:21 385:15 401:20

402:1,14,18

number 64:3 69:16

82:18 99:7 110:8

157:4 206:14 251:11

253:11 318:12 359:15

377:9

numbered 312:16

numbering 317:17

numbers 170:20

numerous 372:16

nurse 389:18

Nursing 6:3

nut 145:19

NYU 4:14

O

o'clock 119:7 326:22

327:1

Oak 6:10,11 11:3 124:5

141:10

object 340:10

objective 132:6,9,15,19

140:2 246:21

objectives 296:6

objectivity 116:21

177:7,13

observation 132:8

243:6

observations 237:10

observing 132:13

obstruction 376:14,15

380:9 399:13

obstructive 20:3,22

21:4 23:18,21 201:10

205:6,11 224:15

245:6

obtain 47:18 216:7

267:16 310:2

obtained 32:19 38:11

38:16 309:18 318:14

321:2

obtaining 203:9

obvious 35:16 73:14

74:5 369:3

obviously 23:1 37:8,18

58:9 60:5 98:22 179:6

187:16 275:4

occ 165:5 166:1,6 175:5
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

433

176:1

occasionally 172:5

occasions 163:14

occupation 404:14

occupational 4:13,18

4:21 5:1,10,20 6:20

25:4,21 34:11,19

41:19 42:5 43:8,11

53:8,17 55:21 56:18

59:21 65:13,17 78:9

99:16 146:10 164:14

173:11 174:3 175:20

177:21 202:18 262:20

266:11,12 309:14,18

310:15 316:7,19

318:13,17 319:18,19

319:21 320:1,12

321:1,2 325:22 326:1

331:22 334:22 345:9

357:4 381:10 392:5

404:13

occupationally-related

351:19

occupied 370:6

occur 71:15 105:9

170:9,9 215:14

237:19 270:10

occurred 17:19 19:7

34:12 94:16 258:19

occurrence 104:19

occurring 11:22 28:11

28:21

October 186:7,14

372:11

odd 268:8

off-normal 104:19

offer 151:11 238:22

370:16

offering 136:1

offers 124:8

office 52:2,4 66:12

157:22 186:8 323:22

324:3 391:9

officer 5:11,12

offices 9:10 50:9 52:5

113:12 315:2 371:16

official 2:14 96:18

222:18

oftentimes 26:9 56:16

128:14 131:1 139:21

141:8 155:2

oh 43:3 67:19 83:12

98:4 131:19 152:15

152:16 184:9 211:3,4

215:22 217:7 228:5

278:17 282:14 298:3

322:9 325:1 343:6

356:10 378:17 396:17

okay 7:2 9:22 17:22

22:16 23:19 24:1,12

24:19 31:13 40:20

44:17 55:18 58:4 59:8

60:18,19 61:7 62:13

63:8 67:16,18,20 68:1

72:3,4,5 81:1,5 82:1

84:2 86:1 87:17 89:10

90:2 91:2 94:12 96:5

98:4,4,7,20 101:17

103:18,19 108:5

112:6 117:1,5,13

119:4 120:19,20

121:7,9 122:20

131:17 140:6 142:21

144:13 148:5 152:21

155:6 167:21 169:10

169:11 184:9 185:1,4

196:16 202:7 205:17

210:21 213:3,15

214:18 215:10 216:2

216:9 225:12,12

227:11 228:5 229:17

230:17,17,20 234:19

235:12 236:1,6,6,10

242:9,16 247:16

248:16 249:21 255:2

257:19 258:9 260:2

262:2 263:10 267:6

270:6 271:13 276:6

277:7,21 279:6,15

280:3,5 281:2,4,4,8

281:14 284:3,16,20

284:21,22 285:4,7

287:17 291:6,11

292:1,2,9,12,15 295:5

295:21 296:20 297:9

298:9 299:9 300:8,15

301:4 302:2,2,8,13,17

302:20 303:1,20

304:9 305:5 306:17

308:4,12 312:11

314:3 315:22 317:10

317:10,18 319:7,7,13

319:15 321:9 322:13

323:5 324:19 325:5,8

325:17,18 326:6,13

326:21 327:6 330:1

331:10 337:3,6,10,10

340:1 343:9 348:2

353:11 354:4 355:7

355:10,12,15,20

356:5,14 358:10,11

360:21 361:13 362:20

366:6 367:1 374:12

375:6,6 377:6 384:1,8

386:17,22 388:6,9,16

394:12 395:7 399:13

400:15 401:12

old 65:20,21 227:8

264:17 280:12 281:1

293:9 294:2,2 295:7

297:22 305:7 310:2

315:5 333:8 344:19

344:22 348:5 352:10

352:14,21 353:1,1

358:21 359:8

older 34:10 222:9

ombudsman 64:13

omission 78:15

on-the-ground 369:6

once 19:13,15 117:22

144:17 189:9,19

191:1,3 195:14,18

199:4 205:8,12 231:2

231:14 347:19 376:8

387:6

oncologist 164:16,17

166:8,8

oncologists 360:7

one's 34:12

onerous 333:9

ones 23:1 24:16 26:7

26:13 28:2 49:1 69:5

112:15 114:1 211:5

245:20 353:16 364:3

ongoing 78:8 83:4

online 4:9 88:8 304:21

onset 129:9

onsite 105:9 378:16

onus 330:10

open 85:16 119:11,21

120:8,18 121:5 167:9

252:6 259:19 307:4

opening 86:6

operate 104:20 177:9

operated 370:6,8,14

operates 320:12

operating 23:6

operation 18:5 188:17

operations 11:2 16:5

17:12 28:9,11,20

29:22 32:7

opine 157:1 203:18

222:4 228:21

opined 200:22

opinion 48:11 124:20

126:3 129:18 130:4

131:11 134:13,16,21

135:10,12,16,21

136:2,20 140:7,11,18

140:19 151:2 158:22

159:11 161:15 163:2

171:5,14,15,19 172:1

172:4,12,14 199:22

209:8 210:3 214:20

229:8 307:3,14

319:22 329:1 330:5,7

330:9,21 331:4,20

334:4,13 336:1

338:21 339:10,21

341:14,20 342:2,2

345:4 346:9 349:22

354:16 387:3 398:1

398:19,20

opinions 96:9 133:8

136:17 137:8 172:8

177:10,10 286:19

333:3 339:5 398:13

opportunity 212:16

220:19 250:9

opposed 145:9 147:11

154:2 240:12 257:15

292:16 304:7 316:12

326:19 355:18

opposition 269:18

opt 172:21

option 16:8 274:16

optional 119:12 268:4

314:13

options 58:9

oranges 66:21

order 48:4 111:20

119:17 141:17 160:16

197:18 252:16 336:20

383:15

Order/Introductions

3:3

ore-buying 16:4

organization 160:20

400:22 402:8

organizes 8:20 70:8

Orgel 372:20,21 373:5

oriented 253:14

original 271:1 272:5

340:11 341:6 358:7

originally 53:2 324:16

originally- 129:19

ORISE 124:7,7 240:11

240:16

OSHA 43:18 72:14

386:14 394:7

other-year 379:6

ought 166:7 303:13

319:22 336:9 407:1

outcome 23:14 36:7

73:6,9 78:13,20 82:21

149:22

outcomes 50:16 65:10

69:6 72:17,19 73:7

outline 89:6 144:3

246:10

outlined 136:13 243:8

outlines 88:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

434

outrageous 379:22

382:1,4

outreach 2:17 122:13

123:6 137:3 167:1

outright 93:16 364:14

outside 26:16 81:20

89:7 161:13

Overall 262:15 359:20

overlap 147:19 176:14

178:19 179:12

overlapping 264:7

overlaps 180:17

overly-broad 329:15

332:9

overly-restrictive

336:10

overly-strict 214:8

Overtime 393:17

overwhelmed 166:7

OWC 305:15

OWCP 158:3 186:7

261:17 262:7 264:4

266:4 269:11,22

277:4 280:21 293:15

294:11 295:1 297:15

297:15 298:16 309:12

310:9 315:18 321:13

324:7,10,15 325:7,12

329:3,14,17 330:4

332:7,10 334:22

338:17 345:10 356:18

357:9,11 360:2

361:10 373:12,18

401:5

OWCP's 359:15

owned 370:6,8,14

OWPC 306:11,13

oxygen 380:9

P

P-R-O-C-E-E-D-I-N-G-S

4:1

p.m 169:17 250:5,6

327:10,11 361:19,20

407:19

package 87:13

packages 87:9

page 3:2 10:17 71:1

89:20 138:7 157:16

247:17 248:18 260:19

266:18 267:4 273:13

276:13,21 280:10

292:21 304:18 327:14

328:12 345:22 353:16

356:4,6 376:6 380:19

381:13

pages 67:9

paid 142:20 228:22

366:10 367:21 368:5

369:21 374:5 404:19

407:1

Paige 389:9,12

pain 373:18

paint 62:1,1

panel 69:17 91:11,12

paper 47:5 324:4

363:20

Paragon 9:11 12:11,15

14:4 38:10 98:15

paragraph 267:18

268:1 271:16,18

274:9,20 275:3

276:22 284:14,19,21

300:9,21 316:16

317:2 323:10 341:7,7

350:4 357:20

paragraphs 267:5

parameter 33:14

parameters 28:2 104:3

104:4

parentheses 313:8

Parkinson's 372:8,12

part 8:6 13:9 40:4 50:12

51:2 62:11 67:11 83:1

87:4 94:11 97:1

105:16 107:15 115:17

141:22 157:1 160:19

175:18 186:18,19,22

187:1,1,4,8,13 189:3

190:1 195:3 206:6,13

207:17 216:16,17,20

217:2 223:16,20,21

224:3,4,11,18,20

225:7,17 226:9,20

227:14,20 228:4,7

231:3 234:10,15,18

235:4,5,9 237:2,2

238:11 250:20 256:2

258:21 269:8 282:13

288:15,19 297:22

317:4 323:17 337:15

339:17 341:3 342:18

343:19,20 345:14,18

346:1 348:8 357:18

378:13 395:22 397:6

398:4 399:1 404:7,16

404:17,20 405:6,9

407:2,2,6

PARTICIPANT 337:8

participate 117:9 220:1

288:21

participated 250:13

participating 4:6 138:7

participation 86:8

particular 9:4 14:9

18:17 36:4 44:19

67:15 68:5 81:16

86:17 111:7 117:11

118:10,13 128:6

137:22 154:1 175:18

178:14 187:11 197:18

197:20 198:3,11

199:2,22 207:17

212:22 232:9,12,22

251:1,13 256:22

259:12,22 296:10,11

304:4 308:21 339:9

398:6

particularly 56:19

57:12 70:14 157:4

parties 155:18

partly 80:2 373:3

parts 181:3

passed 63:20 101:14

passes 304:9

passively 160:22

Pat 241:22

patch 189:16,16 245:12

399:22 400:2,7,8

pathologists 223:11

pathology 205:19

217:20 223:13 232:5

243:13 244:8 245:8

245:15 246:5 248:13

patient 124:22 125:21

126:9,13 128:4

131:19,22 132:2,5

133:14 138:14 160:18

163:1 171:11,12

172:1 228:21

patient's 132:10

patients 46:7 65:18

222:9 223:6

Patriots 401:18,22

403:9

Pause 122:10 297:8

pay 144:10,11,12

189:22 190:2 191:19

228:10,13 373:1

394:6

peer 70:19,21 78:8

166:4

peer- 315:5

peer-review 70:2,15

83:2

peer-reviewed 400:20

peers 82:18

pen 164:18

penalty 261:12 267:8

269:9 293:11 294:21

295:9 297:12

penetrate 49:7

Pennington 97:12,13

98:3,6,9,12,18

people 4:6,9,9 29:17

34:8 43:8 52:13 53:8

54:15 58:17 61:8

67:17 68:2 71:5 72:7

74:22 75:14 77:6 78:5

79:6,10 81:16 85:18

90:18 91:13 99:3,5

108:2 109:21 113:3

113:17 114:5,9

120:10,14 121:13,21

122:9 124:9 141:1,9

145:10,13,16 149:18

151:18 152:17 174:5

174:14 175:20 182:18

183:17 184:3 192:12

202:17 211:8,14

212:9 214:1 219:6

220:12 221:3 223:19

239:20 240:5,11,15

242:20 257:11 275:20

276:2 288:5 293:4,5

308:9 315:2 340:10

361:12 362:17 365:13

369:17 377:20 378:9

378:12,15,16,19,21

379:13 380:1,6

387:17,19,21 388:10

392:7 394:16,20

400:3

people's 53:9 381:9

percent 153:22 339:7

368:7,9 370:12

406:22,22 407:4,5

percentage 99:11 129:6

perform 142:17

performance 109:8

performed 123:19

193:17 202:18

period 18:5 22:14 24:8

62:7 85:9 129:9 141:3

188:18 218:13 231:15

252:6 259:19 263:21

269:12 288:9 295:4

297:19 298:20 314:19

327:1,4 329:7 348:20

355:22 360:2 361:17

389:5

periodic 79:1

periodically 73:19

166:3 233:2,17

periods 17:13 48:22

261:7

perjury 261:12 267:9

269:9 293:11 294:21

295:9 297:13

permanent 129:7

permission 352:7

361:10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

435

permitted 275:9,11

347:1 361:8

permutation 226:14

person 25:11 40:10

45:19 52:15 53:18,20

54:22 57:8,14 63:16

66:12 70:8 93:14

126:18 127:2 129:12

129:15 137:17 139:11

140:19 144:22 155:16

160:3 164:20 212:16

226:7 261:13 267:10

267:15 293:12 294:22

297:14 362:1 366:11

374:4 376:19 390:7

person's 52:15 74:1

330:22 390:6

personal 43:9 155:15

364:5,8,12 365:5,7

372:10 388:20 398:18

personally 307:6

314:11

personnel 70:17 105:20

105:21 114:10

perspective 34:4

338:11

persuade 211:9

PFT 364:2

PFTs 144:2 379:6

phase 283:11 370:6

phone 116:12 121:13

121:21 122:9 145:16

168:14 250:16 251:4

251:11,15,16 252:10

293:5 304:22 307:7

362:2 397:20

phrase 263:18 329:13

329:20 341:11 342:4

344:11 350:18 353:21

354:16,20 358:7

359:19

physical 114:3 126:16

133:1 171:6 364:10

physicals 126:15

physician 4:19 5:11,20

6:20 53:17 57:16

59:15 60:9,11 65:13

81:13 92:18 95:6

123:14,16 125:6,6,18

126:2 127:16 128:1,2

128:6 131:3,5,8,19

132:1,5,12 133:2,13

134:11,15 135:14

136:4 137:1 138:9

143:3 147:6 152:7,12

153:15,16,16 155:17

158:9,10,11 159:3

160:3 161:5,10,14

162:15 163:21 168:7

169:3,5,6 181:11

190:20,21 198:14

199:15,21 200:13,21

201:6,8 207:8 208:7

208:10,11,14,16,21

209:9 210:18,20

214:19 218:13,19

227:20,22 228:6

229:8 232:14,17,22

232:22 266:11 330:21

330:22 331:18 333:17

334:8,13,20 335:5

338:5 339:11 340:20

340:22 341:13 342:1

343:15 344:12 345:7

346:20,20 348:15

349:5,12,22 350:8,22

351:19 356:15,16

357:3,5,12 358:17

359:12 360:15 364:8

365:20 372:22 376:14

376:17 377:1,11

396:12,16 397:5,19

physician's 125:19

132:7 133:8 136:1

200:12 228:6 232:16

328:20,22 329:20,21

330:8 331:4 334:2

335:12,13 338:21

339:15 343:11,12

344:17 346:15 348:10

352:2 354:16 364:12

372:13 388:20

physician-years 173:10

physicians 50:15 53:8

83:14,20 87:2 116:20

116:20 124:19 126:1

133:19 142:14,15

144:21 147:9,14,21

148:17 152:3 153:20

160:10 165:13 166:15

167:2 170:13,14,15

173:14,22 175:20

177:4,5,6,21 181:21

192:15 203:18 204:8

219:22 221:8 223:6

332:2 356:5 358:17

359:11 361:7,9 365:5

365:7,17 395:9,18

398:3,4

physicians' 339:5

364:6 372:10

physicist 87:7 110:12

physicists 388:17

physics 388:10

physiology 205:6 245:7

245:21

pick 213:13

picture 81:17

piece 72:7 111:21 156:1

168:10 177:22 199:2

254:7 263:2 324:3

333:9 363:20

pieces 90:19 159:14

180:20,22 209:3,16

210:11,12,16 339:6

pigeonholed 58:22

pinned 366:18

pipefitter 101:13

102:14

placards 152:17

place 51:17,21 58:11

108:14 114:4 154:1

187:19 195:19 197:8

197:14 262:5 393:7

393:14

places 75:22 77:16

332:4

plan 118:16 133:11,13

286:20

plant 6:17 61:1 101:14

188:11,17,18,19

323:5 382:17 385:5

389:13

plants 6:12 386:16

plausible 395:17

396:22

play 8:1 26:22 226:17

403:6 406:18

playing 249:12

plays 203:9

please 62:22 86:9

113:14 121:10 140:11

250:3 365:12 367:13

390:18

pleased 382:8

pleasure 122:21

pluses 32:12

pneumoconiosis 232:1

point 17:5,19 18:4 19:2

38:2 42:19 45:7 49:18

50:8,17 52:9 57:22

59:1 61:20 66:6 70:14

83:8 85:12 92:15,17

92:18,21 95:3 100:21

116:6 118:4 120:11

140:8 141:4 148:19

171:14 172:3 180:3

192:18 193:2 195:21

206:6 233:19 245:18

255:12 259:13,16

266:11,19 273:2

289:1 308:9 311:19

315:20 324:13 332:22

334:5 336:4,6 339:9

347:21 350:14 354:2

356:3 360:9 383:9

407:7

pointing 227:2

points 8:10,11 37:22

49:14 336:17 347:4

389:7,21

policies 50:21 381:8

policy 2:18,20 7:7 34:4

52:3,6 89:9 115:16

185:20 220:7,15

399:21

poll 363:17

poor 378:3

Pope 2:11 6:13,13

158:6,7,7 288:14

340:15

pops 233:2,17

populate 14:19 20:20

30:9

populated 20:11

portions 406:16

portrayal 58:5

Portsmouth 382:16

383:7 384:8,17 385:1

391:9

position 127:8 186:15

230:8 256:8

positions 249:6

positive 23:14 124:10

189:16 204:13 211:15

215:4 223:2 224:5

225:19 226:1 228:1

240:3,6,14 375:15

380:7

possession 15:9

130:11

possibility 150:1

possible 103:7 117:10

122:19 136:11 158:22

159:1 193:5 201:17

257:13 300:14 334:1

351:13 352:1 402:22

possibly 73:2 146:17

154:2 159:21 248:7

post 206:3

post- 199:12 200:21

203:12 208:4 211:12

216:10 219:10 224:9

229:22 243:9

post-1993 196:12,16,21

197:6,16 200:5 202:5

204:5 205:22 212:9

214:7 217:15 222:2

222:10 225:2,6

228:21 243:10 244:3

247:13 381:20

postponed 337:7
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

436

potential 53:18 55:6

213:19 405:10

potentially 45:20 53:4

161:8 217:2 218:3

405:18

practicable 306:7 341:9

341:12 342:5 343:12

350:19 351:7 352:1

practical 289:2 338:11

practice 331:1

practiced 65:14

practices 65:18

practitioner 135:12,17

330:12 357:2

practitioners 166:6

181:12

pre- 196:12,21 197:6

199:12 200:20 202:5

203:12 206:3 208:4

224:8 229:22 243:9

399:4

pre-1993 196:15 197:14

197:17 200:4 202:22

211:2,12,22 213:20

219:9 224:11 230:14

244:21 380:22 399:14

pre-employment

126:15

pre-standard 211:6

preamble 259:22

268:14,16 285:9

340:4 345:13

precedes 318:20

preclinical 379:1

predates 211:17

predicated 9:1

predictive 146:19

prefer 290:9 406:21

preferably 69:15

preference 176:17

preferred 245:13

316:11

premature 145:11

180:5

premises 369:15

preparation 80:19

prepare 374:20

preponderance 404:1,5

prescribe 36:4 133:15

212:22

prescriptive 254:14

314:7

presence 188:1 203:20

208:9 244:22

present 49:17 99:5

117:11 188:14,16

208:13 256:2 305:11

305:22

presentation 3:4 36:16

39:19 65:5 67:1 86:22

87:5 186:21 187:6

204:3

presented 19:19 22:13

32:18 35:17 65:3

81:18 156:20

PRESENTERS 2:16

presenting 99:3 203:16

presently 111:11

President 370:20

presiding 1:21

pressure 167:22 388:14

presumably 53:19 67:6

142:2,11

presume 235:20

presumption 160:2

196:1 238:15 338:19

339:7 349:20 385:11

presumptions 114:20

115:1,8,15,22 157:19

159:21 338:18

presumptive 100:13

presupposition 145:4

pretty 63:3 74:5 82:9

89:14 90:4 92:12

177:13 186:5 191:10

226:11 245:1 248:20

289:8 358:13

prevalent 365:2

previous 85:19 273:9

274:17 290:22 303:4

350:17,20 369:16

previously 65:13

242:21 274:22 347:15

372:16

previously-approved

369:20

prick 400:9

primarily 13:5 24:21

25:10 406:8

primary 14:11 56:8

65:14,16 73:22 74:21

156:21 165:22 166:5

166:9,9

print 260:20 304:19

prior 67:7 202:10 381:7

387:20

priori 334:8

prioritize 23:13 37:3

47:19 99:13

prioritized 114:13

private 5:14

privilege 402:13

pro 314:22

probabilistic 146:6

probability 24:16 46:16

136:9 150:1 395:16

407:1

probably 8:7 19:8 29:19

46:6 49:6 77:13 78:21

82:7,9 83:8 99:4

101:9 102:5 104:5

119:18 120:6 136:8

136:14 146:16 148:7

149:2,6 151:10 154:2

159:1 160:7 172:13

173:9 174:4,4 192:14

194:14 222:21 237:11

238:16,17 243:8

260:18 266:15 275:22

280:14 305:1 307:17

320:14 347:22 359:15

363:17 378:20 383:7

386:5 405:5

probative 94:15 134:4,7

134:14,15,18 135:11

136:2 141:12 148:18

261:17 262:8 264:1

265:9 269:12 277:5

279:21 293:16 295:1

295:3 297:18 298:16

299:7,10,18 300:6,18

305:19 311:7 312:18

316:21 318:4,22

322:22 334:17 356:21

357:14 359:1,9,13,19

363:5 373:3

problem 43:18 59:17,18

65:8 66:11 94:19

122:8 157:3 202:20

213:19,19 215:8

218:11 219:17 222:15

223:17 224:1 225:18

226:2,4 227:16

244:15 269:16 300:2

335:19 349:3 391:17

406:4

problematic 28:5 151:9

310:18

problems 10:5 34:7,16

35:20 67:2,13 212:7

249:5 338:1

procedural 88:20 283:3

283:6,18 284:1

307:11

procedurally 290:1

procedure 95:18

138:17 215:21 218:10

218:21 248:10 307:15

349:20 377:10,16

procedures 2:18,21 7:7

50:21 51:21 88:4,7,8

88:11 90:3,13 132:20

164:6 185:21 187:18

219:2 222:8 247:1

309:12

proceed 230:21

proceeding 118:18

process 9:17 18:18

19:15 26:11 27:19

29:6 30:15 35:21

38:20 39:22 44:15,16

44:22 49:15,16 50:3

50:10,19 51:7 53:15

57:3,4,6,7 58:13 60:7

64:7 68:11 70:2,15

71:19 82:11,15,18

83:3 89:5 91:5 92:2

93:7 94:20 108:19

109:9 111:9 112:9

123:1 147:9 148:8,9

154:15 160:8 177:10

177:11 180:11 182:11

182:14 188:19 202:15

218:14 240:17 243:17

249:9 254:7,20,22

255:10,14 259:1

285:12 286:3 288:3

330:11 331:7 332:22

333:4 346:22 349:4

354:7 357:17 359:6

383:4 385:13 390:4,6

393:3,8 394:17

406:16,17

processed 114:15

363:15 383:9

processes 9:5 12:4

13:1 18:20 25:17 31:2

45:9,16 51:17 181:15

204:15 384:1,12,18

386:15,20 387:4,9

produce 36:7 38:9,14

81:4 331:17 332:2

346:15,17,21 348:14

348:20 350:22 351:9

351:14,15,16 361:5

produced 127:5

produces 38:19

production 62:4

professional 90:16

160:13

professionals 377:14

Professor 4:17 5:1,5,16

5:21 6:2

profile 40:16 41:2 56:4

profiles 36:17 106:11

106:17,22 107:2,12

386:17

prognosis 133:13

program 4:18 6:11,22

23:10 50:21 67:8 70:7

70:18 82:15 97:14

101:5 103:1 106:8,19
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

437

109:5 115:19 123:2

126:15 150:14 154:17

155:8,22 156:2,20

157:5,18 165:1,19

186:12,20 187:2

192:14 195:4 202:21

206:14,22 211:9

213:13 219:14 220:5

220:7,10,15 221:9,13

221:19 241:14,16

253:14,18,22 258:22

306:8 309:20 310:6

310:22 318:19 320:11

322:16 323:11 331:8

334:12 362:18,19

365:8 367:3 370:21

375:2,11,21 376:5

377:22 378:21 381:2

382:20 384:16 388:2

388:19 389:18 395:19

398:1 399:4 403:21

404:2,7 406:4,11

program's 370:3

programs 5:8 7:1 124:1

124:1 154:9,19 155:1

157:22 373:16,19

progression 194:8

progressive 397:13

prohibited 62:6

project 12:16 371:3

385:22

projects 40:3

proliferation 132:18

189:7 191:9 204:4

promise 403:8

prompted 255:4 258:17

345:19

proof 220:14 261:2,21

272:6 273:20 274:14

275:1 293:19 299:4

304:20 305:8 308:22

310:4 362:19 373:22

374:2 400:19

proper 173:22 385:4

388:21

proposal 120:20 279:12

282:17 289:17 296:15

297:4 326:7 339:22

340:3 353:7,9 354:5

proposals 250:22

propose 230:4 316:1

348:4 386:8

proposed 3:17 229:21

250:11,20,22 251:7

251:10,14,18,20

252:5,22 253:12

254:10 255:10,12

256:16 257:1,22

259:12 260:6,8

264:14 265:5,12,22

266:1 268:2,8 272:16

273:4 275:9,13,15,17

277:13,17 278:4,16

279:3 285:2,5 289:18

291:5,18 292:3

295:17 302:11 303:7

308:20 311:18 313:2

326:3 327:13 332:20

335:9,10 350:17

352:10 353:2,20

354:5 357:20 358:10

373:9 374:13

proposes 311:16

protecting 249:11

Protection 6:11 382:20

protective 241:18

protocol 194:8

protracted 82:17

proudly 389:19

prove 128:16 158:18

272:13,20 275:4,5

351:5 383:20

proven 392:12

provide 36:13 86:14

87:12 93:4 100:4

103:21 110:2 140:11

140:13 156:4 161:6

165:14 182:19 183:7

215:2 250:10 252:7

254:6,9 275:10,11

277:9 305:18 316:11

325:7,12,13,15

328:18 330:13 334:20

335:7,11,12 341:1

344:13 345:1,8

349:12 351:7 361:6

363:8 372:3 391:7

403:1

provided 22:20 60:3

106:21 124:14 126:9

160:2 183:5 259:21

316:6 363:14 365:19

369:14 371:15 373:1

402:20

provider 123:13 137:4

309:19 315:8 316:9

318:18 326:1

providers 206:10,19

310:21

provides 172:1 273:3

324:9 334:19 349:5,8

providing 55:22 87:8

129:3 159:18 160:9

177:18 210:2 252:9

253:21 259:20 281:19

345:3,7

proving 265:19 274:10

282:4 318:9 371:16

provision 207:5 227:1

234:11 256:19

provisions 207:13,19

proximity 157:9

PT 244:2

public 3:19 5:6,17 7:16

9:8,15,22 15:5,8

63:11 75:8 86:8 90:13

116:12 118:5 119:18

120:9 250:15 253:1

259:22 288:9 303:14

314:19 323:19 326:22

327:4 355:22 361:16

361:22 369:9 389:5

407:15

publicly 64:9,14 80:10

80:12

publicly- 10:1

publicly-available 7:21

published 63:14 90:12

119:19 390:3

pull 21:1 110:14 256:5

pulled 7:15

pulmonary 4:19 20:3

20:22 21:4,17 23:18

23:21 173:18 176:3

193:2 201:10,10

203:17,19 205:7,9

224:15 243:20,21

244:2 376:13,16

380:7 397:7 399:10

399:12

pulmonologist 135:15

pulmonology 398:6

pulse 133:5

purchase 63:4 75:18

purely 202:8

purpose 67:15 75:1

101:6 108:18 109:21

129:14 275:18

purposes 109:5,11,12

109:17 172:13,16

221:4 267:12 294:1

305:20 319:1 321:14

pursue 216:16 225:1

purview 150:18 236:21

237:2

pushing 299:21

put 51:17 55:3 77:19

108:14 110:13 133:20

147:17 158:14 209:16

220:20 228:20 238:13

239:8 256:14 257:6

273:18,20 279:9

300:9 307:15 308:5

313:6 316:15 337:18

343:11 376:3 383:15

383:21 392:6

puts 164:18 268:20

330:9 344:10

putting 51:21 70:17

88:5 152:17 179:20

208:14 209:3 296:3

Q

qualification 269:6

qualified 172:20 354:16

qualify 221:14 379:8

quality 50:13,15 64:5

68:10 73:17 111:9

116:21 137:6 177:6

quandary 392:13

quantitative 146:18

quantity 217:14

question 24:6,13 42:14

46:10,17 48:16 58:11

59:7 60:13 71:11 80:2

83:14 86:3,10,21 88:3

92:3 96:21 100:11

110:15 115:18 118:19

141:15 147:13,16,17

150:2,5,17,22 153:5

154:7 162:13,17

163:22 168:1 175:13

188:11 192:10 199:20

201:4 202:2,8 204:1

208:5 213:1 217:5,12

218:19 219:1,21

227:5 229:18 232:19

233:7,10 236:19

238:21 240:9 244:6

255:8,16 258:15

263:16 275:8 281:17

285:13 286:6 287:22

288:3,3 289:7 292:3

303:9 308:15 311:13

311:22 316:4 319:8

327:2,19 337:4 352:8

questionnaire 25:5,22

55:21 56:19 59:21

319:20 320:2,13,14

321:3

questions 37:13 38:1

49:2 68:5,6,6,12,14

68:19,20,21 79:21

83:9 85:19,20 86:7,17

106:5 112:7 114:16

116:6 138:5 145:15

150:19 164:7 167:16

167:19 170:2,8

173:19 176:2,6,7

183:20 192:7,7

202:16 206:6 229:13

230:18 233:19 236:8
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

438

249:15 256:10 258:10

259:7 269:1 286:9

384:19 396:5,6,6

398:21,22,22

quick 51:6 83:13 94:1

97:16 195:21 202:4

308:14 393:15

quickly 113:21 114:15

181:3

Quint 63:19

quite 20:9 21:22 66:4

149:20 192:10 203:5

212:7 271:20 279:17

311:21 314:12 371:21

quote 177:3 261:2,10

265:8,8 266:3,4,5,7

267:7 281:22 309:9,9

309:10,11 318:21

330:8,9 331:19,20

332:7,8 353:22,22

354:21 355:1

R

Rachel 2:19 3:5 7:8

37:15 45:7 49:14 51:4

114:18 170:19 186:6

186:20 209:18 212:1

225:13

radiation 5:11,13 63:17

64:22 90:11 103:12

119:12 120:6 384:20

404:12,18 405:8,13

405:17 406:1,7,18

407:8

radioactive 374:14

407:8

radiograph 205:5 245:3

246:6,19

radiographs 198:1

199:7 205:3

radiological 13:7 19:7

105:3

radiologically-related

105:11

raise 121:10 170:5

184:14 238:21 304:5

355:16

raised 86:21 121:14

raises 45:7 58:3 223:15

raising 61:19 354:2

random 73:5 125:11

range 193:12 218:5

rare 102:8 171:15

rarely 154:11 172:12

rates 133:5,5

rating 143:2

ratings 172:22

rationale 133:10 140:21

259:11 281:19 282:16

285:9 329:21 333:11

333:18 334:2 346:16

349:5 351:18 352:2

383:5

rationalized 134:20,22

346:21 371:20

re-documented 73:16

re-read 199:11

reach 131:3,4 144:8

153:11 166:14 167:10

406:6

reached 146:14,15

reaction 187:22

read 33:19 71:5 77:6

132:9 156:17 185:15

206:2 226:12 249:6,7

261:1 265:3 266:22

271:4,17 280:18

290:20 293:3,9 294:1

294:4,5,16 300:18

305:2,6 309:6 328:7,9

328:13 331:14 356:9

357:20 361:1 366:14

387:1

reader 305:4

readers 267:1

readily 64:10 265:11

readily-available 78:3

reading 35:2 290:22

307:3 354:15 391:3

readings 133:4

reads 195:2 260:19

308:2 328:15

ready 121:16 229:16

258:9

Reagan 394:14

real 23:9 51:6 76:10

145:19 195:20 337:22

393:15

real-life 94:1

reality 14:16 29:21

44:13 62:8 101:7

114:8 216:4

realize 128:14 179:21

realizing 223:6

really 8:12 13:11 18:1

19:10 21:14 27:14

31:4,17 36:5 41:2

43:5 47:13 51:2 53:14

54:10 55:21 60:6

63:12 65:8,15 68:5,8

74:16 75:9 76:4,7,8

77:14 78:19 79:4,8

83:7 96:2 100:19

108:15 137:15 139:4

142:16 144:19 146:6

147:18 148:13 161:21

171:6,9,11 174:13

177:8 186:17,20

187:2,3,12,18 192:17

192:20 193:3,12

198:8 199:5,6,6 201:9

202:2 203:1 204:20

205:21 207:19 214:13

219:6 220:19 224:17

227:15 229:11 238:5

238:10 246:13,20

247:7 251:9 259:13

259:18,20 260:1,15

266:14 267:20 268:18

269:17 272:10,16,17

275:3,3,16 282:6

291:8 295:12 309:1

315:4 318:2 320:11

322:14 331:7 334:12

337:5 338:2 354:13

358:20 365:5 367:15

368:18,21 380:17

381:8 396:18 398:9

398:10

reason 9:10 62:10

172:8 182:12 187:14

255:5 279:4 348:16

366:13

reasonable 150:1

268:19 283:9

reasonably 257:10

reasoned 134:22

351:15

reasoning 329:1,20

330:8 331:19 333:5

334:2 335:13 336:9

343:11,12

reasons 95:4,7 99:12

109:2 126:12 173:4

204:11 212:11,13

223:8 356:19 357:10

357:13

reassure 188:12

Rebecca 63:16 67:4

68:13 80:17

RECA 305:22 306:16

329:7 346:2

recall 63:8,19 251:8

receipt 360:4

receive 232:4

received 197:11 251:4

recognition 288:17

381:10

recognize 46:5 153:19

310:11

recognized 225:4

recognizing 392:1

recommend 237:3

240:11 271:15 302:14

313:4 316:13 355:21

recommendation 64:20

92:15 265:2 271:9

277:14,15 278:6

281:20 296:12 304:4

307:22 308:5 309:7

310:20 311:15,15

318:12 319:9 322:7

331:14 332:19 373:9

recommendations

64:19 70:13 71:22

74:4,8,10 79:8 91:7

136:16 179:11 237:11

252:3,18 257:5,9

286:15 295:19 296:10

338:17

recommended 49:17

51:19 64:4 89:4 93:21

106:20 108:22 109:1

295:14 309:22

recommending 272:22

279:4 284:15 332:19

351:4 370:20 373:2

recommends 265:7,21

271:19,21 277:16

278:6,19 279:19

285:1 309:8 331:16

361:8

reconsider 290:3

reconstruct 99:2

reconstruction 13:9

404:17 406:7 407:9

reconstructors 90:14

reconvene 287:7

361:15

record 84:6 109:1

130:18 138:21 169:16

184:2,16 200:15

250:5,19 252:21

274:7 327:10 338:4

361:19 391:14 407:19

recorded 17:7 251:19

recorder 261:22

records 11:17,20 25:1

102:3 103:4 105:20

105:21 106:3 124:3

125:1,16,16,18,22

126:1,5,8 127:11

129:5 132:7 135:4

148:14,15 151:17

154:22 155:15,21

156:18 157:12 183:7

261:4,5 267:16,17,22

272:8,13 345:9

362:20 391:16,18

392:13

recreate 23:8

redacted 81:14 87:10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

439

redefine 370:4

Redlich 2:8 4:16,16

41:14,16 42:16 43:1,3

85:18,22 98:20,22

101:9 102:12,21

104:12 108:6,7

152:19 153:4 162:11

162:12 179:16,17

180:21 212:5,6 213:3

213:9,15 214:5,18

215:10,16,20 216:2,5

222:7,14 225:5,17,21

226:4,13,18 227:3,7

227:11,13 230:14

238:19,20 239:11

240:21 241:3,4,8

242:4,9 244:10,14

248:19 249:16 255:4

255:18 258:16 266:9

266:10 276:11 336:15

336:16 337:1,6,9

342:17 343:6,8

347:12 354:2,3

Redlich's 107:20

reduced 33:13 404:8

405:1,7 407:5

reduces 46:21

redundant 272:9

274:21

refashion 326:1

refer 124:7,20 128:19

129:16 131:9 133:14

159:8 171:1,13,20

274:16

referee 125:2,4,9 127:8

128:21 131:11 170:14

171:16 172:3

referees 172:9,12

reference 141:13 301:9

401:5,7

references 135:5 141:1

referral 87:9 127:6

referrals 17:16 89:3

128:11 172:18

referred 123:16 128:3

276:13

referring 96:8,14

refers 262:13 263:18

347:13

refine 26:11

reflected 17:14 105:18

reflection 14:20

reflects 353:6 361:1

reformulated 322:3

reg 296:10,11

regard 8:4 18:8 30:16

32:15,17,19 34:6

44:10 49:18 50:22

128:8 176:2 193:19

193:22 203:14 207:14

296:15

regarding 136:16

188:10 232:10 233:20

252:21 255:10 329:1

330:9 331:20

regards 127:2

regimen 193:9

regimented 35:21

region 90:7 164:17

regional 391:9

Register 118:2 119:20

284:5

Registry 127:11 206:12

206:15 207:1 219:22

221:1

regs 259:2

regular 82:14 141:9

regularly 19:9

regulate 43:20

regulation 307:16

311:19,20 333:12

338:12

regulations 2:18,21 7:7

185:21 230:5,9

250:11 256:18 284:7

309:11 363:12 395:11

395:21

regulatory 283:3,20

307:11 373:14

rehash 206:4

reinforcing 220:6

reinterpretation 233:8

reiterate 189:9 245:6

reject 268:19 280:21

294:11 297:16 298:13

rejected 364:14

relate 273:4 336:17

360:11

related 93:14 101:1

116:18 129:10 153:5

159:2 162:1,1,12

185:18 191:2,20

251:1 292:22 360:13

402:4

relatedness 344:10

relates 38:9 100:10

213:1 296:22,22

300:4,11 308:22

310:20 354:12

relating 9:12 12:3 21:2

137:10 207:11 209:22

346:1 352:2

relation 45:1 360:19

relationship 97:4,7,9

135:8 267:11

relationships 78:13

165:13,17

relatively 95:18 177:15

relatively-broad 21:1

relatively-descriptive

8:10

relatively-good 24:2

relayed 131:18

relaying 132:5

release 9:15,22 345:8

368:9 385:19,22

released 368:4,8 386:2

relevant 27:12 42:4,11

45:5 183:11 229:22

254:5 260:7 266:20

309:15 312:21 354:11

360:10

reliability 309:12

reliable 23:6 28:19 30:1

49:8 306:13 307:13

308:3 310:9 315:19

315:21 321:13 322:13

323:2,6,21 324:7,10

324:15,22 325:8,9,12

325:13,16

relied 177:11 267:13

relief 237:4

relies 73:20 128:1

364:8

relieve 167:22

relieved 186:17

rely 39:5 48:5,13

128:12 221:10

relying 128:4

remark 313:11

remarks 107:20,21

363:2

remedial 373:16,18

remember 65:21

227:19 256:1 302:3

384:18 395:10

remind 121:21 260:15

362:16

reminded 68:13 220:3

reminder 220:20

reminding 220:12

removal 369:15

remove 272:5 331:16

333:16 334:7 342:8

342:11,14 370:11

removed 329:15 332:20

383:3 385:3

removes 321:16

removing 369:14,18

370:5

render 124:19 129:18

158:21 159:11

rendering 125:1

reopened 250:19

reopening 250:20

rep 51:14 389:16 393:9

repeatability 48:20

repeats 359:3

repetitive 342:20

rephrase 106:14

replace 243:15 261:9

302:1

replaced 247:21 248:4

301:16 345:17

replacements 400:4,6

replacing 321:18 322:1

329:20 336:4

replication 28:1,1

report 3:6 12:13 51:16

53:21 62:18,20 64:2

64:14,17,19 70:6,10

71:13 77:1 80:5,7

81:11 82:4,6 83:1

87:15 96:22 100:3

105:7 106:3 110:14

127:1 129:22 130:20

131:15,17 133:8,17

134:5,8 135:1,2 142:2

142:5 151:14 153:13

154:12,14 179:9

194:19 198:11,22

208:10 227:21 228:6

228:7 330:13 332:3

346:15,21 348:14

351:9,15 367:20

371:20,22 372:4,18

373:1 376:18 377:13

388:20 400:15

report's 141:11

reported 22:11 77:3

reporting 105:15,16

109:11,11 387:15

reports 63:2 79:4 87:2

93:12 100:1 123:17

126:14 127:5 131:13

131:14 133:18 134:3

134:4 135:19 142:6

154:12,20 155:1,5,14

156:19 166:21 177:5

246:8 315:5 329:8

364:6 371:22 372:7

372:11,17,19 373:8

386:13 388:20 400:11

representation 85:1

representations 35:3

representative 123:3

186:12

representatives 120:13

314:20 315:12 323:17

represented 85:2 117:4

represents 14:20

264:14
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

440

reps 51:20 165:16

363:18

reputation 315:1

request 63:9 81:3 92:3

94:3 95:1 102:22

104:1,7 105:5,6 110:6

110:18 143:20 183:6

296:3 356:19 360:3

361:7

requested 109:17

357:11 362:5 367:9

374:18 382:12 389:9

395:6 401:14 403:15

requesting 104:9 361:9

requests 95:11 100:6

109:14 137:2 154:11

154:19 155:17 176:20

357:1

require 86:8 91:8

106:16 143:8 144:1

224:3 330:21 335:20

339:5,5 341:19

required 49:22 106:22

144:7 156:3 157:7

201:1 203:10 207:5

215:3 216:13 222:1,3

296:5 328:16 330:14

336:2

requirement 106:11

107:14 116:2 207:10

210:9 232:15 331:17

332:3 338:1 346:14

346:17 350:21 352:12

358:8

requirements 116:17

185:17 188:4,5 190:4

195:9 196:2 207:12

209:20 221:12 223:20

228:12 231:5,13

243:4 267:14 356:4

372:4 377:5 378:8

requires 106:18 189:5

204:3 243:11 252:10

335:21 365:10,15

371:19

requiring 136:18

333:10 338:22 339:10

rescind 101:3

research 16:12 18:6

109:17 145:5 152:14

380:14 385:12

researching 354:18

398:5,8

reserve 62:3

residual 188:18

resolve 45:10 125:5

130:4

resolved 266:1

resource 7:21 8:2 10:2

10:8 26:19 155:9

319:21

resources 37:11 89:12

90:22 91:8,21 137:6

384:3 402:3

respect 84:12 122:2,4

177:1 185:16

respected 403:3

respects 97:3

respiration 133:5

respiratory 197:12

202:7,10,21 208:2

209:1 211:16,20

218:2,8,18 219:14,16

245:10,22 380:21

381:4,6,12,16,19

399:7 401:1,2

respond 130:12 149:11

150:12 153:6 176:19

209:21 315:17

response 63:9 64:16

83:10 111:1 127:5

160:16 170:6 176:9

183:21 184:11 230:19

236:9 256:11 259:8

264:22 270:19 284:12

287:21 291:16 292:11

302:22 304:1 308:11

325:20 326:5,15

331:12 332:13 355:6

355:14 375:15 385:5

responses 70:5 79:17

responsibility 78:8

130:7,8,10,15 153:9

responsible 70:17

responsiveness 137:2

rest 239:7 269:11

297:19 311:7 399:15

restate 228:3

restated 342:19

restored 402:21

restrict 370:1

restriction 208:18,21

restrictions 268:4

restrictive 202:19 205:5

205:10 245:6,20

247:4 249:1 340:12

restricts 276:7 369:12

result 24:2 39:11 87:15

130:1 188:1 200:1

202:12 204:13,21

231:9 240:10 258:19

resulted 12:5 329:5

resulting 346:3 347:14

results 27:6,7 144:5

190:10,20 199:16,18

200:18 201:1 202:1

205:15 209:7 229:2

231:20,22 248:13

resume 84:15 120:1

resumed 84:6 169:16

250:5 327:10 361:19

retain 278:5,12 279:18

280:2

retained 332:21

retaining 281:17,21

retire 113:4

retired 5:10

retirees 384:19

retroactive 388:1

return 119:8 167:18

reversals 312:9

reverse 214:6

reversed 336:21

review 12:18 48:8 49:20

50:9,10 51:7,19 52:1

52:1 64:5,6,21 68:11

70:19,20,21 71:3,8

78:9 79:1 82:5,17,19

119:3,3 124:22

125:12 129:5 135:4

136:19,19 137:7,15

159:9 182:20 205:7

243:3 260:6 287:18

295:20 364:22 368:19

370:10 377:7 387:21

reviewed 15:12 63:13

156:10 195:16 315:6

reviewing 12:22 52:15

82:12 137:3 151:16

183:3 223:5 371:7

reviews 42:6 52:18

53:13 73:19 190:22

198:3 386:22

revise 273:16

revises 311:17

revision 275:13

revisions 312:8

revisit 292:2,19

revisiting 106:8

rewording 294:15

rewrite 241:19 242:2

rhinitis 401:2

Rhonda 2:17 3:10

122:12,16

Richland 6:8

rid 359:9 381:2

Ridge 6:10,11 11:3

124:6 141:10

right 7:11 16:18 17:8

22:21 29:16 35:14

38:7 39:1,13,16 40:5

45:6 48:5 53:6 62:12

66:15 68:3,5 72:10,15

76:15 103:22 116:4

116:22 144:17 151:3

153:20 155:12 160:5

169:1 170:21 182:11

184:10 186:19 193:18

194:1,6 209:14,17,17

210:10 214:11 215:18

216:8 225:3 226:3,10

226:16 230:16 242:11

244:6 245:5 250:1

255:6,21 256:6,12

258:8 270:9 271:14

276:4,4,20 278:17

281:5,5,11,20 282:19

282:22 283:4,7

284:19 285:22,22,22

286:1,4,13,13,17,22

286:22 290:11,14,14

290:17 291:14 294:15

298:10,15,20 299:15

299:17 300:8 301:19

301:20 302:15 312:2

317:5,5,14 318:7

320:6,9,9,17,19 322:1

322:5,5 327:3 335:2

335:21 336:7 340:16

341:3 343:17,22

346:18 347:2,4

349:14 350:9 351:14

351:15,20 353:4,10

357:22 359:4 368:18

377:19 384:6

rightly 214:16

Rios 2:15 86:6 103:22

122:16 255:1,17,20

258:3,9,14 271:12

276:18 287:6,16,21

296:2,17

ripe 58:9 71:18

risk 41:20

River 11:3 90:8

road 61:8

roadmap 118:17

robust 78:3

Rocky 6:14,17 60:22

188:10,15,21 378:20

role 180:14 296:5 403:7

406:18

room 4:9 13:19 29:16

40:2 66:19 207:22

213:18 216:8 222:20

244:19 246:19 258:3

313:20 391:3

rooms 287:13

Roosevelt 370:20

Rosemary 2:8 3:7

62:15

Rosie 6:1 80:3 91:6

146:3
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

441

rough 54:9

roundtable 11:18

routes 349:15

routinely 82:13 154:10

154:17

rows 10:16

rule 3:17 72:13 229:21

265:22 380:19

rulemaking 255:10,14

276:1

rules 204:15 250:20,22

255:9,13,14,19

336:19 346:6 368:17

368:19 369:9 374:13

376:7 382:3

ruling 389:2

run 66:19 157:3,6

240:18 334:12 404:11

405:2

running 58:7 331:8

395:1

runs 70:8 200:3

rural 166:5

S

S 2:7 133:20

S-O-A-P 131:16,20

sacrifice 402:5

sad 380:5

safe 393:8

safety 4:21 43:10

378:17 389:16

sake 328:10

sample 69:5 87:8,14

212:18

sampling 69:12 73:5

223:8

sarcoid 239:1

sarcoidosis 203:14,17

203:19 222:22

satisfied 116:2 229:4

234:14

satisfies 200:19 210:8

Savannah 11:3 90:7

saves 365:8

saving 285:18 286:21

saw 78:11 149:13

307:20

saying 22:13 29:1,8

32:5 35:15 38:8,12,18

40:20,21 41:6 43:15

52:12 57:20 58:2,3

62:5 74:19 93:4 94:12

116:1 119:2 140:21

149:17 157:11 165:8

169:2 171:19,20

175:3 196:5 200:10

200:17 201:15 202:17

209:3,18 212:1 215:7

216:5,7 239:4 241:21

242:19 260:14 268:10

269:21 270:3 273:6

280:13 283:21 287:7

296:16 311:5,8

317:22 318:9 321:22

322:16 323:8,9,12

324:14 330:20 336:8

337:18 340:22 342:14

350:7 351:22 363:20

says 57:14,20 59:7 71:2

92:7 93:13 101:16

114:19,21 115:1

133:12 136:7,9,10

138:22 140:19 162:22

164:18 168:19 201:8

202:9 208:20 209:15

221:13 222:20 227:22

228:17 244:4 245:14

262:5 263:19 267:7

268:13 269:19 272:6

282:19 295:11 299:2

299:17,17 305:22

312:2,16 316:22

324:6 333:12 335:6

338:5 340:7 341:8,20

342:18 343:3,15

353:21 356:18 357:11

359:4 366:15 379:15

380:11,19 390:18

395:12 400:16

scan 216:22 223:13

225:22 243:19 244:1

379:16

scanned 114:1

scans 132:21 198:2,2

379:6 380:8

scenario 101:8 164:15

204:17 225:18

schedule 85:13 255:21

256:4 389:6

scheduled 251:11

256:4 288:13

schemes 373:14

school 4:14 5:6 6:3

144:22 146:5 390:7

Schwartz 67:7 80:6,16

science 6:2 71:14

100:19 124:6 220:8

scientific 2:2 85:4

135:5 145:5 191:7

221:17 385:12,16

scientist 57:10

scientists 96:6 220:8

220:13

scope 28:6 68:4 81:20

111:4 118:9 251:1

254:11,12,16,17

260:16 296:7 327:17

354:11 360:19 373:10

screaming 66:20

screen 13:18,18 27:11

38:4 256:15 257:7,17

257:19 304:20

screening 6:22 123:22

154:9 155:1

screens 257:12 327:16

scribe 251:19 256:21

scroll 21:5 63:2 74:6

76:18 325:4 328:11

se 195:5

search 9:1 16:17 18:12

18:13,20 21:12 25:16

26:10 27:9,17,21 28:2

28:15,19 29:7 30:3

33:14 37:3 38:8 44:16

44:16 45:17 48:21

51:13,14

search-filtering 27:1

searches 13:17 16:3

18:12 21:16 28:6 29:3

36:1 48:19

searching 11:17 15:20

16:9 22:4 26:5

seat 258:5

SEC 103:10 393:6

second 4:4 64:7 65:2

69:10,12 121:6,8,18

121:22 123:20 124:19

126:3,10 131:10

132:6,19 136:19

171:5,13,15,19 172:4

172:8,14 184:7,8

217:19 254:15 268:17

277:22 278:5 279:18

280:2 284:18 292:7

302:18 303:19 304:14

326:11 330:5,6

333:20 355:10 388:5

second- 172:11

second-opinion 170:14

170:15

secondary 127:21

128:1,5

Seconded 278:1 292:8

302:19 326:12 355:11

secondly 118:12

137:18

SECOP 124:21 127:7

128:20

Secretary 84:11 122:1

185:16 237:12 398:3

398:10

Secretary's 395:21

398:11

section 68:18 116:11

116:11 131:18,21

132:1,6,7,9 133:7,11

220:21 258:1 260:21

261:21 262:19 265:13

266:19 273:9 274:17

276:21 279:3 280:15

280:17 284:15 293:20

295:15,18 300:4,22

306:1,16 309:22

327:14,16 328:1,2,11

328:17,22 329:7

346:2 353:17,18

356:6 358:9 361:22

369:12 371:14 373:11

374:1 381:17

sections 264:2 290:20

328:8,9 356:11

369:11

security 10:3 126:20

385:20

see 13:14,15 15:15

16:10 18:10 21:5,7,18

22:2,21 23:22 24:4

26:7 27:22 30:17 34:1

34:14 35:2 38:13 44:2

45:14,18 46:1 55:5

58:18,19 59:2 62:20

68:7 69:13 72:7 74:10

78:19 81:11 95:2,3

100:4,22 103:20

105:4,14 108:1 111:4

116:7 117:10 118:9

135:19 138:14 149:7

152:2,7 156:7 164:16

167:15 171:12 177:8

178:20 180:9 184:19

186:17 193:7 200:15

201:20 202:1 208:21

208:22 209:1 211:10

221:7 222:11 231:20

232:2 238:9,22

239:18 249:18 257:14

257:15,18 259:2

267:6 271:17 276:2

293:4 295:17 313:15

325:1,3,5 328:10

333:5 340:16 345:13

346:12 347:21 350:16

359:14 365:2,18

377:4,7 397:8,10,15

seeing 19:9 21:13

105:1 132:12 192:2

192:15 211:5,13

212:1,2 221:3 223:6

seeking 207:10

seemingly 168:15

seen 65:9 79:17 81:10
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

442

106:7 157:14 164:20

200:15 201:16 204:7

sees 59:1,6 66:12 397:5

select 16:11,15 25:18

selecting 356:15

self-reported 368:14

self-serving 280:19

294:7,19 295:7 297:7

297:11

self-taught 315:11

SEM 12:22 37:1 39:22

43:2 48:17 54:21

55:14 58:3 59:4 62:12

62:17 64:9 65:9 68:22

69:3 71:2 72:10,20

75:3,16 76:3,7,8 86:5

88:6,9,10 89:1,2,20

89:21 90:1 92:10 93:2

93:16 97:2 98:14,17

102:4,4 105:19

106:10 107:16 108:1

111:5,15 138:12

150:3 182:8 238:9,11

263:10 296:22 382:19

383:3,5,10,18,21

384:11 386:2,4 387:6

387:10

send 48:4 164:1,4,5

167:6 169:1

sending 349:18 390:17

senior 51:10 186:10

sense 11:8 21:20 27:1

32:3 41:4 42:12 46:13

73:21 75:11 87:19

179:21 227:14 276:5

278:4 280:2 285:17

287:1 305:7 341:4

343:18 351:11,12

353:2 357:9 358:21

406:13

sensitive 192:12

sensitivity 124:10

187:14,15,16,19,21

187:22 188:5 189:5

189:20,21 190:3,5

191:9,15,18 192:6,20

193:15,22 194:22

195:12 217:18 233:20

243:12 245:12 246:2

375:13

sensitization 213:22

217:1 242:22 375:13

375:18,20 378:3,5,11

379:1

sensitized 193:10

242:14 378:19,22

379:3 380:6

sent 67:4,6,10 80:17

163:7 389:1 396:4,12

396:14 397:10,19

sentence 273:18,20,21

274:21 278:5,10,13

278:15,18 279:19

280:2 281:18,18,20

283:14,15,16,17

284:11,18 310:19

316:22 341:8 342:18

sentences 271:18

277:15,16 278:9,11

278:15 279:2 280:4

282:17

sentiment 353:6 361:2

separate 79:6 176:18

179:6,22 180:9

182:13,17 183:15

184:1,6,13 344:7

separately 40:19 263:9

287:12 292:22

September 399:20

series 8:10

serum 240:12

serve 84:22 85:5 116:7

241:3 401:17

served 62:15

service 402:5

session 85:19 86:18

250:1,8,10 407:16

set 46:18 62:7 76:18

111:17 116:13 137:17

182:18 185:6 195:19

223:18 249:22 250:2

268:3 272:19 285:14

286:15 381:17

sets 181:16 185:14

219:8 234:13 260:1

266:2

setting 121:20 146:13

146:21 152:11 371:10

settle 289:19

setup 122:7

seventies 102:16

Seventy-two 368:7

severe 397:14

shame 393:2

share 65:3 100:8

139:20

shave 366:17

sheets 43:10 383:11

385:2

shelf 307:20

shift 114:9

shifting 114:14

Shiprock 166:16

shocking 74:3

short 356:2 366:14

383:16

shoulder 221:3

show 121:11 184:15

192:18 249:5 256:16

291:22 292:14 304:6

326:18 329:4 355:17

404:3

showing 200:1 215:5,7

243:16,19,21 244:2

245:11 246:1 375:15

376:13 399:13

shown 257:16

shows 42:5 73:5 132:11

202:19 208:17,18

216:22 369:16 370:11

381:14 394:7 404:18

sick 34:9 212:13 369:5

369:22 374:2 379:7

387:19 394:20 402:22

side 88:14 90:11 103:13

224:13 239:17 241:7

241:9 313:20 314:1

351:8

sign 232:14 393:1

signed 127:16

significant 115:20

163:16 354:21 403:7

407:7

signoff 51:15

silent 269:13

silica 231:8,9,17 235:7

235:10,16,18

silicosis 187:10 229:15

231:2,3,4,15,18 232:6

232:7,11 233:12,21

234:3,5,6,7,10,16,21

234:22 235:11

Silver 2:4 5:15,15 106:6

106:7,13 107:13

108:5 138:5,6,20

164:11,12 165:4,21

178:7 185:1 219:19

219:20 221:16 264:11

284:4 288:8 307:19

314:17,18 323:15

324:20 329:12 359:18

similar 27:21 64:21

77:11 181:14 186:6

195:11 198:15 263:15

264:8 330:2,18

similarity 251:21

simple 323:14

simpler 268:13

simplest 270:11

simplified 42:17

simply 28:19 29:8,10

29:10 36:1 37:5 44:6

134:22 187:22 188:6

190:11 219:7 231:5

256:19 271:18 287:6

333:1 336:4 340:22

341:1 347:16 402:20

simultaneously 291:19

single 27:10 28:17 36:6

67:3 82:12,16,20

110:17 218:17

singular 17:18,19

sins 78:15

sir 87:22

site 3:4 7:14,16,19 8:17

9:7,12,19 10:6,14,15

10:17,20,22 11:7,12

12:5,8,9,13,19 13:3,4

13:11,14 14:9,19 15:1

15:10,13,19 16:1,3,7

16:9,10,11,15,20 17:2

17:4,6,7,14,21 18:1,4

18:8,19 19:5,9,22

20:18 21:15 23:11

26:2,18 28:13,14,21

29:12 30:9 31:3,6,7

31:12,14 32:4,6,9,16

32:20 33:22 35:17

36:14,18 37:1 38:16

39:6 41:8 45:9,13

46:3 47:18 50:1,5,14

52:19 53:2,13,19 54:1

54:6,15 55:10 56:6,10

58:8 83:15 84:12

85:17 91:1 92:9 94:5

94:8,14,21 105:1

106:11,16,21 107:2,2

107:11,12 116:8,15

117:1 178:9 183:13

183:13 190:14,15

222:11 235:18 305:15

306:11 309:1,3 310:8

386:17

site-specific 90:5,8

sites 8:5 9:2 11:22 12:2

12:4 13:6 28:10 37:11

53:5 62:3 75:6 90:20

94:7 105:5 164:15

234:2,3,8,20 235:21

370:13 387:17 392:18

393:8

sitting 64:22 257:12

situation 94:1 139:4

146:22 202:13 203:22

204:12 233:6 237:13

situations 36:22

six 9:17 119:18 173:9

252:10,14 317:12

371:22 393:16

sixties 102:15

Sixty- 368:8

sized 251:16
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

443

skill 46:18

skills 174:1 403:8

skin 94:18 189:15,16

245:12 399:22 400:2

400:7

skipping 277:4

sky-high 221:2

slide 72:2,4

slides 243:7,15 245:5

slight 264:14

slightly 346:5

slowly 322:9 397:14

smack 178:11

small 166:18 220:18

263:15

smaller 180:3

smoked 380:6

smoking-gun 315:12

snowman 138:17,22

SOAP 131:16,20 133:17

social 126:19 220:7,15

Society 222:17

sofa 366:19

soften 350:20 352:11

353:3

Sokas 2:8 3:7 6:1,1

62:15,22 63:1 66:17

80:10,16 81:5,19,22

119:1 144:14,15,19

149:11,12

Sokas' 86:22

sole 74:13 108:18

Solicitor 251:5 255:22

258:4

solution 224:1

solutions 107:19

solve 223:16 226:5

274:19 300:2

solved 226:9

solvent 40:17 55:2,7,22

solvents 38:5 39:1,2,3

40:1,4,22 53:21 54:17

55:6 56:9 57:5

solves 225:17,18 226:2

226:9

somebody 22:5 28:5

38:12 55:7 59:7 66:3

73:12 76:15 113:5

141:12 150:15 160:13

193:21 203:16 223:19

271:22 274:6 337:21

338:11 359:14 365:6

somewhat 52:12

181:14 322:2

soon 16:15 28:13 83:22

193:5

soot 140:22

sophisticated 323:16

sorry 56:12 87:7 96:13

97:12 122:16 127:20

131:19 152:16 153:2

169:20 229:19 231:10

243:5 273:19 277:18

278:8 281:11 282:12

298:3,4 302:9 303:5

322:10 343:6,8

352:17 356:5,10

363:5 366:15 374:7,9

382:5

sort 14:13 22:18 26:17

29:3 34:17 35:21

36:12 37:21 53:22

58:16 77:21 94:6

103:8 108:8,15 116:2

143:10 175:15 185:6

200:3 203:8 205:12

213:19 219:8,15

229:11 232:4 233:12

268:9 285:17 287:2

289:6 307:15 311:3

312:22 323:3 324:1

336:20 342:20 343:17

347:13 350:20 352:5

359:3

sorts 93:10 96:3 164:7

sound 64:3 317:8

sounds 103:2

soup 362:22

source 14:11 30:1,10

49:7 56:8 60:2 65:9

74:13 84:1 123:11,20

125:16 210:17 306:13

308:2 310:10 311:18

315:19,21 321:16

322:4,17 323:3,6

324:8,15,22 325:7,10

325:11 334:21

source' 309:10

sources 11:19 15:3

20:19 30:8 74:11

77:17 123:9 124:11

125:13 272:19 273:1

305:17 307:5,13

309:13 310:1,4,17

312:15,17 314:9

316:13,14 318:4,6,21

321:5 322:13,14,21

323:9

speak 75:10 122:17

191:10 367:14 368:16

speaker 119:7 121:17

403:14

speakers 362:1,7

speaking 288:14 362:3

special 103:10 360:6

specialist 125:4 127:8

136:20 156:22 157:8

176:5 375:10

specialists 125:2,9

127:7 157:4 164:13

170:15

specialized 114:12

specializes 357:3

specialties 174:2,15

specialty 125:7,10

174:18 175:19,19

220:18

specific 14:6 23:7 24:9

24:18 41:22 42:6,14

43:14 45:4 50:22 53:5

53:5 54:10 57:8,13

70:11 79:17 100:3

104:2,4,17 105:4

129:9,22 139:19

146:20 154:6 167:7

168:6 174:6 177:15

178:13 180:4 191:13

194:18,19 196:9

198:5 200:6 203:10

207:18 213:11 218:6

221:16 234:13 237:16

246:20 262:4 263:16

275:10 310:3 312:14

320:4 321:8 336:3

344:3,8,14,14 348:3

364:1 371:16 377:5

385:17 396:5,6,20

specifically 100:10

106:1 133:22 168:12

177:11 187:9 205:9

214:15 234:11 243:8

244:4 245:15 296:7

317:3 319:19 399:1

specificity 17:9 18:8

31:19 112:5 272:11

359:22

specifics 151:22 173:3

195:2 228:7

specified 59:2 275:2

360:2

specifies 56:9 309:3

specify 208:13 212:21

265:7 278:7 279:19

310:1

specifying 272:13

specimens 380:14

speculative 135:20

136:1,4,8

speeches 288:17

spell 133:19 218:22

spelled 388:22

spelling 373:4

spend 26:20 84:9 99:19

102:18

spent 5:7 79:14 99:9

120:15 173:10 178:8

284:5

split 289:5

spoke 386:10

sporadic 75:21

spot 132:11

spot-checking 73:11

spouse 101:15 366:15

367:1

spread 166:10

squeeze 237:1

stack 372:7

stacked 394:2

stacks 323:18

staff 9:9 35:19 52:2

63:16 80:15 89:9

113:3,18,20 114:12

115:5 116:20 166:17

177:4

stage 95:8 330:10

stainless 40:11

stakeholders 219:12

233:18

Stalnaker 12:17

stand 184:3

standard 72:14 115:17

115:21 137:10 138:12

146:14,22 154:3

162:15,22 191:10

196:15,16,21 200:4,6

202:3,5,22 207:21

208:4 210:1,4 211:10

211:22 212:3 219:9

221:9 224:9,11 228:9

228:18,22 229:2,4

234:17 236:3 237:4

239:19 241:17 395:12

395:14,20 396:13

403:22 404:6,8,9,10

404:16,20 405:1,2,7

407:6

standardized 136:18

standards 100:14 116:1

158:5 197:6 213:6

220:14,16 221:4

224:21

standpoint 194:13

stands 74:17 148:1

Star 394:14

start 4:10 19:17 23:4

26:4 37:18 84:4 87:9

87:16 122:6 170:7

182:12 187:11,20

250:8 262:1 297:5

356:1 361:16 371:5

371:11

started 96:7 108:21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

444

123:2 166:13 169:19

169:21 186:5,7

211:21 253:12 314:21

384:16 394:18

starting 27:22 57:22

58:11 66:6 85:15

386:11

starts 113:5 180:12,14

180:15 248:2 277:3

294:17 378:3

state 5:17 104:19,21

127:3 205:10 321:12

341:14 351:1 394:12

398:2

stated 86:6 168:4,8

347:19 389:11,20

395:13

statement 39:19 48:7

57:9 60:11 86:7 92:6

107:9 147:15 148:10

148:17 161:6 269:13

361:11,13 379:19,21

380:10 383:19 396:2

396:3,7 397:16

statements 152:8

396:11

states 1:1 266:4 373:12

385:6

static 15:1

stating 199:2 340:15

stations 16:4

stats 378:11

statute 106:15,18

115:10 187:18 189:5

189:10 195:1,15,19

196:2,9 199:17 201:2

202:9 204:3 207:6,9

207:18 210:5 214:15

215:14 217:12 228:12

229:4 231:2 234:12

235:15,16 237:5

238:9 243:9,11

258:20 270:12 282:10

282:21 313:2 359:17

373:16 395:11,20

398:2

statutes 244:18

statutorily 207:5 215:3

216:13

statutory 106:11

107:14 207:11 210:8

227:1 234:11 237:4

243:4 247:6 258:19

283:1 296:7,13

stay 33:5 113:7

stays 296:6

steel 40:11,12 59:11,12

59:12

Steelworkers 6:14

step 65:11 74:6 88:22

88:22 89:5 276:9

374:4 391:6,6

Stephanie 374:17

Stephens 403:15,17

steps 119:17 180:11

406:19

stepwise 275:6

steroidal 204:11

steroids 226:7

Steve 42:20 52:12

67:10 80:22 87:21

88:3 95:10 111:2

151:5 192:8 218:1

259:10 263:14 271:12

319:17 324:17

Steven 1:20 2:7 3:8,12

3:16,18 5:19 80:3

208:6

stick 259:20

stinks 165:2

stipulates 207:9

stop 42:3 339:14

341:18 348:12 360:22

stopped 62:1,5,8

stopping 340:16

stories 164:13

story 224:14 226:6

383:16 393:15

straightforward 190:6

289:13 291:9

strayed 68:9

strengthen 64:5

strengths 8:15 70:1

stress 28:18 214:13

380:17

stricken 305:16

strict 72:13 196:2

213:17 219:3 222:19

stricter 222:16 223:2

strictly 132:4 231:14

strike 278:3 284:19

298:2,7,11 305:12,15

305:17,19 343:10

357:7,10

strikes 295:7

striking 352:9 353:1

strong 349:19 400:17

strongly 253:4

struck 284:16 312:9

328:8,9

structure 75:3

structuring 181:17

struggle 35:9 37:22

struggled 34:2 36:8

51:3 203:4

stuck 101:7

students 372:2,14

studies 6:3 41:21 75:12

78:6 82:22 206:13

400:20

study 220:21 249:7

stuff 62:4 63:12 74:14

79:15 87:18 141:19

226:7 263:15 337:22

337:22 340:5 352:6

stumbling 372:6

subcommittee 42:21

43:1,2 79:11 116:7

117:17 118:6,8

119:10 121:5 264:12

264:18 308:6 329:13

subcommittees 116:9

117:18,21 120:8,17

176:18 250:14 251:12

329:9 355:4 358:2

361:2

subcontract 97:10

subcontracting 73:18

subcontractor 103:8

306:9

subcontractors 73:12

103:6,16,18 310:7

390:21

subject 261:12 267:8

269:9 293:10 294:20

295:8 296:7,18

297:12

subjective 131:17,21

132:1 133:21 134:9

134:19 146:17

submission 305:9

submit 15:8 130:10

144:5 252:20 253:7

286:10 296:4 387:6

388:15

submitted 15:5 71:3

128:13 320:16 356:20

357:13 366:3 383:7

383:12 385:5 392:10

submitting 158:8

285:15

Subpart 237:16 357:17

358:4 360:13,14

subscription 167:6

subsearches 36:3

subsection 88:9

subsections 277:1

subset 177:22

subsets 181:10

substance 17:5 18:13

20:7 137:12 274:11

304:21 305:9,11,15

305:21 306:15 319:2

321:15 329:6 346:4

405:10

substances 1:3 4:5 8:5

9:2 10:17 13:13,16

15:18 17:17 21:7

38:19 93:13 139:14

274:15 308:22 404:13

substantial 147:11

substantially 352:4

substitute 305:12,18

subtitle 3:13 116:18

122:3 177:1 185:18

239:5 337:15 386:18

success 164:13

such-and-such 92:8

313:9,9

sudden 399:20

suffered 402:3

suffering 381:11

suffice 118:19

sufficient 104:10

130:14,20 182:14

269:19 270:1 318:1

331:21 356:20 363:22

suggest 268:12,14

272:12 312:5 340:19

342:6 371:3 386:12

suggested 100:18

180:8 312:8 371:4

387:1

suggesting 61:16

282:20 322:20 352:13

suggestion 161:20

269:7,17 270:2 271:5

271:6 277:12 290:1

294:14 329:19 340:19

360:1

suggestions 71:22

193:13 314:16 348:3

suggestive 284:8

summarize 306:21

346:11

summarizes 349:22

summary 68:18 103:5

256:22 341:9

supersedes 39:21

supervisory 186:10

supplement 74:12

supplemental 74:11

320:15

supply 390:14 404:3

supplying 315:4

support 6:18 39:4

131:1 267:16 358:16

361:7 363:11 403:10

supported 99:18 135:2

135:2 356:21 357:14

359:1,19

supports 43:16 344:13
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

445

supposed 53:7 89:2

145:11 149:3 164:6

242:2 260:16

supposedly 61:2

sure 9:22 10:4 25:13

28:9 35:20 49:14

61:11 66:5 77:14 81:2

86:14 87:20 88:16,16

88:17 96:12 106:6

114:10 115:15 145:20

148:10 152:16 167:20

176:19 179:19 180:18

182:13 188:22 189:2

193:4 198:7 210:16

218:15 230:2 233:2

239:6 244:17 248:17

249:3 267:3 271:2,20

276:12,17 281:8

285:11 291:9 301:12

302:5 304:14 306:20

311:8,21 315:1,10

329:12 358:4 363:16

surprise 394:7

survivor 261:13 267:9

267:11 293:11 294:21

297:13 404:4

survivors 56:20 328:18

suspicions 133:9

sustained 328:4

sustains 343:5

switch 85:8 265:2

switches 325:9

synergistic 71:12,15

synonymous 198:20

system 15:1 21:19

30:16 31:12 32:2,13

32:16 53:6 66:19

104:4,11 108:18

110:10,14 150:22

157:1 179:4 188:1

240:19 387:15 405:5

systems 108:9,13

114:4

T

table 3:1 73:1,4 273:1

289:7 292:6 302:12

303:3,7,10,18,21

304:3 326:7 366:19

tabled 304:10

tabling 326:17

tags 183:17

take 8:21 18:10 22:16

26:22 35:10 58:12

60:12,22 62:14,19

63:18 65:12 82:5

83:11,18 84:2 112:16

112:17,20 150:10

160:22 167:7 169:3,5

186:19 187:19 190:7

193:18 250:1 254:14

269:8,10 273:17

276:9 285:10 288:20

289:2,14 298:13,20

299:2 301:22 311:10

323:1 325:17 327:1,2

327:3,4,6 343:9,14,21

348:18 351:3 358:22

362:19 364:22 369:3

393:18

taken 33:2 83:3 91:18

219:15 257:3 268:17

392:6

takes 118:1 155:9

164:17 371:22

talk 7:18,19 11:15 16:19

18:15 27:4 33:7,9,11

54:10 56:17 122:21

123:9 124:17 125:14

128:10 131:12 133:20

136:3 141:7 142:3

156:18 157:5 163:8

163:11 166:6,17

167:8 187:9 194:12

196:17 203:6 205:19

218:16 231:1 240:16

274:17 340:13 369:5

382:18 391:8

talked 18:22 64:2 91:6

113:9 115:7 142:10

149:20 153:8 159:20

166:19 236:19 335:20

365:6 404:21

talking 8:10 14:15

18:19 19:2 27:6 28:7

29:5 35:6 38:22 40:17

52:10,21 116:22

150:9 195:22 196:1

199:13 201:20 234:10

239:22 253:12 262:12

282:14 283:19 319:19

335:8 352:12 358:18

395:8 403:20

talks 43:4 195:7

tap 221:2

target 198:17

task 49:5 68:2,3,15 83:5

99:1 147:19 176:14

176:15 177:3 182:4

237:16,21 252:1

253:10 265:18 282:4

tasks 7:5 54:11 84:20

111:17 148:21 178:21

263:1 327:22 336:18

taught 144:21 145:10

146:4 153:20 165:6

206:12 221:8,15

389:17

teach 173:11

team 33:4 38:11 50:11

52:1,2,6 393:17 394:5

394:8

Teams 393:13,15

tearing 61:6

tease 102:19

technical 2:17 89:22

122:13 123:6 240:9

technically 71:4,7

technician 391:13

techniques 27:15

tell 27:13 43:11 60:3

97:11 104:8 108:8

110:7,18 113:14

115:5 140:3 158:20

162:4 240:16 245:17

256:7 296:21 314:20

376:8 384:8 390:14

392:19,21 393:2

telling 41:5 122:8

130:22 131:22 138:14

160:4 276:14 379:22

385:6

temperature 133:5

template 365:6 390:17

templated 162:15

templates 164:2

temporal 17:1 29:14

31:17 32:5 36:22

temporality 32:2 62:10

ten 372:1

tend 61:22 170:8

178:15

Tennessee 5:17 165:22

166:3

tens 10:15

term 134:20,21 198:19

218:6 246:18 265:9

265:10 279:20 317:1

328:21 346:6

termination 126:16

terminology 47:10

terms 47:10 51:6,18

54:13 99:9,19 103:3

135:16 136:4,4

146:18 151:16 154:2

166:20 167:9 174:10

198:12,18 212:12

213:18 214:7,9 243:9

248:10 251:22 286:2

308:21 316:17

Terrie 362:9

test 126:7 130:1 132:18

134:17 146:9 189:6,6

189:7,8,10,11,17

190:21 191:9 196:13

199:12,16,22 201:1

202:5,9 204:4,9,10,13

204:19 205:8,9,15

207:20 209:7 210:4

213:7 215:5 218:17

224:6 229:2 239:18

240:11,13,14,18

244:2 245:13 248:13

364:2 375:14,19

376:13,16 381:3

397:7 399:12,22

400:2,7,8

tested 380:20 381:15

399:6

testing 124:8 126:6

133:15 146:5 189:14

189:16 190:10 191:3

191:11,13,22 192:18

193:3,11 212:22

213:5,12 215:15

243:21 245:7,21

400:6

tests 123:18 142:17,19

143:21 144:3,10

146:20 157:7 190:22

193:8,17 212:20

245:11 246:1,22

248:11,12 378:6

379:7,9 399:10 400:1

text 257:13

textbooks 73:20 77:19

thank 7:2 63:1 79:20

84:4 86:9 91:22 98:21

104:12 121:14 122:16

122:18 137:13 138:6

144:13 156:5 169:11

169:12 176:10 185:4

186:1,2 194:10

210:14,21 219:18

225:9 230:17 235:12

236:10,12 247:9

251:5 260:2,3 279:15

280:5 298:12 312:11

326:20 327:7 330:15

361:17,21 362:11,11

362:14 367:6,7

374:15,16,19 382:9

382:10,14 389:3,8

394:22 395:2,4

401:10,12,16 403:12

403:13,17 407:12,14

407:17

Thanks 35:13 250:3

258:7 302:8

theirs 222:18

theme 181:7 251:13

thing 16:1 18:22 22:15
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

446

29:3 30:4 31:20 32:14

34:17 37:21 44:3,14

50:7 52:22 53:12

54:19,20 64:7 72:2,11

74:20 90:20 110:17

112:19,22 123:8

128:12 130:17 140:2

143:7 171:19,20

177:16 188:13 193:7

206:4 226:8 235:8

240:1 263:5 270:11

280:14 288:11 307:5

338:15 362:16 365:18

385:10 391:11 400:11

403:21 406:20

things 14:7 17:16 20:10

21:2 23:3 26:17 27:3

27:4 28:4 29:19,20

33:16 35:7,9,15 53:22

60:4 64:3 69:13 70:8

71:8 77:5,15 80:3

82:6 87:11 89:16,17

93:10 110:13 113:9

120:11 125:20 126:13

127:11 133:6 134:16

136:14 139:7 142:3

151:13,16 156:17

160:6,20 166:12,17

167:8,11 171:1,3

182:20 200:22 202:4

206:9 208:1 220:11

243:14 250:2 257:16

290:12 315:6 338:8

345:10 346:13 363:3

367:2,14 374:21

377:9 380:15 382:19

384:9 385:17,21

386:1 392:20 394:9

404:2

think 8:11,14 10:11

11:1 13:21 17:22

20:16 26:21 29:15

30:7,14 31:15,16 35:4

35:7,10 37:13,17

39:17,18 42:16,18

43:6,14 45:3 46:12

49:9 52:10,11 53:12

54:2,3,5 56:14 58:7,8

58:10 59:19 60:6

67:10,17 69:14 71:16

76:9 77:12 78:10,21

79:3,9 81:10,18 83:6

84:21 85:17 92:3

94:22 95:18 97:9 99:5

99:6,21 100:9 101:12

102:12,16 104:1

105:17 106:9 108:12

113:12 114:7 116:11

117:15 119:14 120:4

120:7,9,16 121:16

139:3 141:22 146:21

147:4,12,18 148:7

149:14 150:21 151:3

151:12 153:4,5 156:1

158:15 159:16,22

160:7,7,17,19,20

162:18,19 165:10

173:9,12,18,19 174:4

174:19 176:13,17

178:7,18,19,21 179:3

179:5 180:7,17 181:6

181:17 183:9,14

184:17 199:11 203:1

209:11 211:4,11

214:20 215:13 220:19

221:13,22 223:4

226:11 227:22 230:9

236:2,3 237:7,17

238:3 239:3,5 240:21

241:9,9 243:2 245:5

246:12 247:12 248:9

250:15 253:5 260:10

260:18 262:18 263:19

264:2,3,13 270:1,11

272:10 274:3,6,19

279:1 282:8 283:8,11

284:4,9 286:6,17

287:10 288:5 289:11

289:14 290:20 291:7

292:20 293:22 295:13

295:16 298:5,7,9,10

298:10 299:6 300:2

300:13 301:15 305:1

307:10 310:18 311:4

312:13 313:19 314:5

314:6,10 315:20

316:10,15 319:4,22

322:13 323:14,14,15

324:12,13 325:6

333:9,10,12,16,22

334:11 335:18 338:2

338:8,15 339:9 340:4

340:8 341:12 342:4

343:13 344:2,5 346:7

346:12 347:20 348:7

351:1,11,12 355:22

358:6 359:6,10,14

360:19 362:5 363:22

364:6 365:12 367:5

368:1,22 376:9,16

382:1,3 383:1 384:15

387:12,15,22 388:3

388:18 394:22 404:7

405:6,12,20 406:10

406:12,16

thinking 53:15 60:18

111:7 120:15 155:21

159:17 166:4 244:17

251:22 274:20 303:12

311:3 317:3 331:5

384:20 385:11 392:10

third 76:5 126:22 127:4

132:22 149:8 171:21

280:4 281:18 283:15

304:15

thirdly 118:15

Thoracic 222:16

Thorium 40:12

thorough 135:4

thought 4:7 69:7 77:6

78:1 117:15 118:7

120:7 181:10 259:2

285:21 314:21 316:5

367:19 376:11 392:4

thoughts 37:20 76:19

120:3 178:5 179:14

251:20 285:20 286:5

303:15 324:11

thousand 402:13

thousands 10:15 13:15

15:15 99:6 154:10

383:8 394:16,16

threat 374:3

three 62:18 63:11 67:9

74:7,9 116:16 117:2,4

124:11 132:14 141:21

142:6 157:21 169:20

172:3 197:19 200:19

208:12 209:3,16

213:20 223:11 242:2

242:12,13 243:14,22

244:1 245:2,20 246:2

251:16 256:21 257:5

279:2,8,8 282:18

306:12,18 312:19,19

321:22 350:8,10

392:20 399:16 401:14

three- 84:17

threshold 406:6,22

throw 101:4 341:15

393:22,22 394:3,3

405:21

throwing 393:21

tie-goes-to-the-runner

404:9

Tiger 393:13,15,17

394:5,7

Tim 401:14,17

time 5:7 17:13,19 22:14

24:8 26:20,22 31:21

37:10 48:22 58:7 62:7

69:1 70:9 72:12 73:7

83:18 85:9 102:18

112:10,13,17,17

141:3 143:15 159:4

168:18 174:22 178:8

203:5 218:13 221:20

221:20 251:15 255:5

255:19 257:4 258:17

261:6 263:21 284:5

285:14 288:5,20

289:16 328:10 329:11

332:1 347:13,18

356:2,12 360:2 362:4

362:6,12 365:9

367:10 368:22 372:3

382:1,3 389:6

timeframe 254:3

timely 403:2

times 14:16 43:20

48:21 54:12 57:20

63:10,10,12 104:6

109:18 156:19 204:9

223:7 240:2 333:1

359:16 372:16

timetable 118:16

260:14 337:3

timing 255:6

tissue 132:17 212:12

214:10 215:8,11

225:19 226:5

title 35:1 46:8 108:2

149:13 301:18 302:1

328:1

today 85:6 96:10 132:2

187:9 188:10 252:8

252:15 287:2 289:10

289:19 290:2 291:14

291:20 303:2 363:4

363:12,16,18 364:4

367:15 374:22 384:2

384:14 385:10 386:10

387:16 390:5 402:18

toe 138:15 140:22

told 82:1 152:6 156:21

241:13 259:13 287:17

347:15 379:16 384:21

Tom 256:1 258:4,5

Tomography 243:19

245:4

tomorrow 82:2 85:7

87:5,16 96:11 248:5

250:10 252:8,16

260:12 285:18,20

286:7,21 287:8 288:4

288:12,15,22 289:3,8

289:20 290:3,19

291:14,20 292:19

303:3,4,8,11,16,18

304:4 320:22 326:8

326:17 353:5 356:2

360:22 361:13 389:5
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

447

401:11 407:17

ton 213:16

tonight 248:15 287:4,9

287:11 320:22 352:7

362:13 367:6

tons 75:21

Tony 254:21

tool 11:8 56:16 65:15

88:7

top 67:22 72:7

topic 34:13 36:12 48:16

167:7 249:15

topics 192:2 247:3

Tori 5:9 151:20 185:2

269:3 328:7 356:9

tortured 227:7

total 130:7

totally 149:15 279:10

touch 8:13 91:13

touched 33:17

toughest 304:14

toxic 1:3 4:5 8:5 10:16

15:17 17:5,17 20:7

21:7 36:17 38:19

40:10 93:13 107:18

137:11 139:14 149:21

150:16 274:11,14

275:4 304:21 305:8

305:21 306:15 308:22

319:2 321:15 329:5

341:22 344:5 346:4

347:14 352:3 362:22

toxic- 344:9

toxicologists 69:18

350:1

toxicology 82:15 174:6

toxin 29:12 32:11

toxins 13:12,21 14:6,7

15:16 16:22 17:11

18:17 22:22 24:1,3,9

24:14 27:15,20 28:1

28:15,18 45:19

390:20

track 42:15 109:8

110:11

tracked- 276:18

tracked-change 257:22

tracking 100:1 108:19

tradename 14:7

tradenames 33:9,10,12

trades 6:7,21 95:20

trained 46:20 47:3 48:1

142:16 143:5 145:13

173:15 174:3 175:10

222:4

training 46:18 47:4 48:2

49:10 65:17 89:7,12

89:15 137:6 164:14

174:6 390:8

transfer 154:16 357:2

371:2

transformation 189:8

transient 251:12

translates 364:19

transparency 383:2

transparent 254:20

transport 16:4

transported 72:10

transporters 401:22

transporting 16:5 370:2

treat 126:12 141:9

203:17

treated 197:11 356:16

359:12 380:20 381:3

381:14 399:5

treating 83:14 125:18

131:3,5,8 139:16

140:4,12 143:8

147:14 152:2,7,11

153:16 158:10 159:3

160:3,10 161:5,10

162:10 163:21 171:8

171:18 174:15,20,22

181:11,20 198:13

207:8 330:22 331:4

333:17 334:8,13

335:5 338:21 339:11

346:20 349:4,12

350:8 354:17 356:15

357:3 396:12,15

397:5,19 398:5,7

406:4

treatment 125:22 126:5

129:12 133:12 142:18

189:22 191:19 197:12

197:13 381:6

trees 44:2 107:22

tricky 175:7

tried 11:19,20 91:10

95:22 100:12,17

102:1 365:11,13

tries 366:11

triggers 136:18

trouble 276:14

true 44:10 58:20 71:4,7

77:12,13,13 78:4

102:20 203:21 233:7

241:1 365:20

truly 202:13 369:4

trumps 94:4

trust 166:2 339:3

trusted 274:7

trustworthy 261:3

272:7

truth 145:14

try 19:20 23:12 27:13

27:15 54:3 60:9 102:1

102:3 110:16 113:14

114:7 153:17 161:1

164:3 176:16,17

203:2 218:22 287:15

317:7 333:18 334:9

344:6 385:13

trying 23:5 24:15 26:12

29:4 37:11 57:18

59:13 73:22 90:16

91:15 96:4 99:2

100:14 102:19 111:9

113:10 158:8 166:13

166:22 167:3,10,12

173:10 211:8,19

224:10 227:13 233:14

246:10 256:5 272:11

273:16 275:10 290:15

301:2 311:3 338:9,10

383:18

tunnels 231:7,9

turn 24:5 88:18 161:13

255:16 260:17 266:18

337:10 362:8

turned 400:18

Turner 2:12 6:16,16

60:16,17,17 61:14

112:7,8 188:9 303:12

303:19

turnover 113:3

turns 202:21

tweak 353:2

tweaking 352:10

twice 117:22

twist 299:17

two 23:19 24:1,3,9

38:19 50:4 52:13 53:3

63:10 67:9 78:16

116:15 137:15 140:1

147:2 148:7 169:20

176:17 178:19 179:6

179:9,13,18 180:19

181:10 182:13,17

184:1,13 240:18

242:12 247:6 258:18

268:7 271:18 277:15

278:10,15 286:8

306:11 312:19,19

319:9 324:10 354:6

360:3 364:11 365:3

367:14 372:19 373:19

376:1 388:11 390:8

399:16 407:16

two-step 49:16

type 26:14 41:6,7 44:19

45:4 109:1 126:7,10

126:22 127:1,4

128:15 132:19 158:18

191:22 194:19 201:12

242:6 366:2

types 13:22 14:7 21:11

23:3 33:9 34:16 35:15

38:19 40:22 42:8

44:12 103:8 125:15

126:20 127:10,14

132:15 133:6 193:17

201:18,22 202:1

207:13 386:13 405:15

typical 164:15 385:15

404:6 405:2

typically 66:20

U

u 221:13

U.S 370:21

Uh-hum 38:7

ultimately 257:8 260:22

ultrasounds 132:21

un-American 382:2

unable 131:6 216:7

223:7

unanimous 121:14

184:17,18

unclear 95:11 137:20

uncomfortable 152:4

undergo 127:2

underlying 351:17

underneath 395:19

understand 8:15 46:5

76:4 89:16 114:5

116:3 118:13 155:19

163:20 165:14,19

168:10,20 174:12

189:2 192:11 206:18

212:6 214:2,5 222:12

230:1,3 262:15 265:4

273:2 310:16 311:22

340:18 345:19 349:4

358:14 369:4 385:14

393:3 394:4 397:21

understandable 265:11

understanding 11:21

18:2 47:10,12 89:17

95:16 103:14 155:8

175:21 249:13 263:3

279:18 349:16 390:4

406:17

understood 219:20

230:2 256:20 308:16

331:9

undertaking 403:10

unequivocal 135:21

136:2 146:8

unfortunately 113:16

230:7

unhappy 306:22
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

448

uniform 375:3,8

unifying 181:7

Union 389:17

unions 249:11

unique 14:3 207:16

365:3

Unit 2:18 185:20

United 1:1 6:13

University 5:2,6,18,21

6:3

unnecessary 274:22

284:14 299:6 332:9

359:20

unofficial 254:9

unquote 370:7

unrealistic 332:4

unreliable 315:3

unsigned 67:6

unwarranted 222:9

unwilling 330:13

up-to-speed 253:20

updated 15:2 50:2

upright 152:17,22

upstairs 29:18

uranium 16:5

urgency 336:19

usable 64:10

use 3:4 9:14 13:2 16:13

17:13 18:3 20:3 27:14

31:22 38:13 46:20

47:18 48:7,16 50:15

54:17 55:13,14,22

56:9,15 61:22 62:6

67:13,15 76:5 88:4,12

89:2,11,13 94:21

105:7 107:17 110:1

127:12,16 128:7

129:7,8,11,14 130:4

132:17 134:20 135:20

136:12,14 142:15,16

143:17 147:6 154:1

160:10,12,15 161:8

163:17 170:12,16,17

170:20,22 177:9

182:6 194:21 197:5

197:14,16 204:8,10

246:17,21 268:4

316:17 350:20 360:12

365:17 381:20 384:11

385:12,15,18 386:19

391:5,6 398:3 399:5,7

401:7,8

useful 54:6 58:11 74:19

74:22 75:1 77:6 79:10

79:13 81:10 82:4 90:4

111:4,19 138:4

310:22 338:16 346:22

367:19

User 89:21

user- 390:2

users 10:7

uses 131:18 136:4

360:16 388:21

usually 92:11 109:1

124:12 125:5,17

128:8 131:14 132:14

133:16 135:11 142:7

154:21 155:10 157:10

168:22 172:15 181:9

388:19

Utell 63:16

utility 264:6

utilize 20:6,19 21:22

30:21 89:22 357:16

utilized 17:4,6,12,20

32:6 35:18 213:12

utilizing 29:2 30:15

V

V81.4 378:1

VA 5:12,14 126:18,20

vague 135:20,22 136:3

265:6 278:16 306:22

307:1 330:3 359:20

valid 36:7 61:20 233:3

233:11 265:16 282:1

311:10 372:5

validates 25:14

validity 177:12 232:11

232:20

valuable 11:8 120:12

150:20 262:16,17

263:2 317:9

value 131:15 134:7,15

134:18 135:11 136:3

141:12 261:18 264:1

265:14 267:18 269:12

277:5 279:21 293:16

295:1,3 297:18

298:17 299:11 300:19

312:18 322:19 323:1

392:11

value' 265:9

values 146:20 309:4

Vance 2:20 3:5,14 7:6

7:10 35:14 38:1,7

39:9,13,16 40:5 44:4

45:6 46:22 49:13 55:9

55:17 58:1 61:16 86:4

86:16 88:18 89:19

93:22 100:7 113:19

115:14 185:22 186:6

193:6,6 195:20

199:10 206:1 207:3

209:5,14,17 210:13

210:15 211:4,18

212:21 213:4,11

214:3,11 215:1,13,18

215:22 216:3,10,19

218:10 224:2 225:8

225:13,20 226:3,11

226:16,19 227:5,9,12

228:3,11,16 229:3,7

229:11 230:7 233:1

234:5,9 235:2,19

236:2,11,12

vapors 41:21

variables 27:17 36:2

108:10 110:3,8

variances 27:16

variant 7:16

variation 290:6

various 85:1 123:9

125:19 167:8 223:7

308:6 329:9 349:15

361:2

varying 253:17

vast 173:14

vehicles 111:22

vendor 188:8 195:14

370:7,9,13,15

vendors 370:11

verbal 163:3 397:20

verify 92:10

version 9:7,8,13 239:1

257:22 368:18

versus 213:7 269:14,14

vertical 183:17 229:20

vetted 20:13

vetting 9:19

Vickie 353:4

VICTORIA 2:9

view 49:18 59:6 219:15

266:11 289:1

viewed 13:8

visit 291:18

visual 133:2

Vlieger 2:13 6:4,5 38:3

39:17 83:17 104:13

104:14 156:6,15,16

182:15,16 184:5,22

185:2 206:8,9 217:6,9

221:7,20 233:22

234:2,6,19 235:12

239:11 243:6 249:2,4

287:10 303:17 345:20

345:21 355:9

volume 11:6 45:15

371:1

volumes 10:18

volunteer 85:6 117:10

236:16 239:12

volunteered 117:13

volunteers 117:2

249:18

vote 119:22 120:21

253:3 285:10,13,14

286:6,10,15,18 287:8

288:2 289:7,10,14,20

290:2 291:12,20

303:2,6,7,7,10,11,15

304:2,3 326:7,17

353:7,9

votes 285:18 286:21

287:5 288:4 289:3

voting 280:11 290:10

W

wage 129:7,10 364:7,11

374:2,5

wait 67:18 72:4 85:22

waiting 122:7

walk 7:14 28:13 391:6

walked 29:11

want 4:10 8:8,13 19:4

22:4 25:13 26:20 27:3

28:3 32:14 44:1,15

49:14 51:4 52:11

62:19 63:3,18 70:14

75:9 76:22 77:7 79:2

83:18 85:6 86:11,20

87:18 91:13 96:5

100:1,8 101:4 102:18

108:14 110:9 131:12

143:2,4 146:2 148:6

149:10 150:11 152:14

153:21 160:20 175:1

175:3,8 189:9 196:8

198:7 206:5 219:13

232:13 243:5 244:17

252:18 253:7 257:8

257:15,20 258:14

261:1 263:6 266:16

266:19 271:3,12

272:12 280:9,11,13

281:7 285:13 289:19

290:3,18 291:4,9

293:3 296:14 299:14

299:15 302:3 303:2,9

303:10 306:2,19

315:10,17 320:3

323:1 327:2,3,4

329:10 338:22 344:5

344:12 352:22 358:3

359:13 377:22 379:20

380:17 385:14 389:6

394:5 403:21

wanted 52:8 64:8,11

68:19 76:17 78:7 88:2

142:1 151:22 161:4

170:4 189:2 239:6

247:3 259:16 263:21
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

449

269:5 307:1 308:9

345:18 367:14 368:16

374:21 403:19

wanting 214:9

wants 150:10

War 401:18,22 403:9

warrant 37:14

Wars 394:14

Washington 1:20 6:8

wasn't 78:15 107:1

109:10 186:22 251:8

292:22 299:12 345:2

394:7

way 25:15 29:1 36:1

38:11 46:20 47:3 49:4

49:8,11 53:14 55:3

76:12 86:22 101:1

108:2 109:8,16

112:20 113:5,16

117:8 122:17 128:18

128:21 136:22 137:5

145:7,13 147:8

148:21 149:18 158:16

159:13,17 160:1,3

162:16 173:15,21

179:5 195:1 201:19

210:8 211:21 225:16

228:1 237:1 251:3

254:19 256:13 257:12

259:4 260:18 262:18

263:4 266:15 272:12

277:11 284:9 285:19

294:5 312:13 316:16

331:7,8 333:20 335:6

335:14 344:19,19

351:4,9 353:19

354:10 366:7 377:3

385:9 387:18

ways 30:18 129:1

136:12 181:2 238:4

247:1 253:11 350:8

350:10,13 373:7

385:21

we'll 122:6 140:11

143:19 150:12 196:17

281:5 299:19 395:5

we're 79:18 89:11

116:22 121:18 146:11

149:3 150:20 175:4

275:9 285:7,15 318:8

389:22 394:8

we've 114:7,10 115:4

117:1,4 119:5,6,11,12

119:14 154:9 332:14

332:15

weakens 338:8

weaknesses 8:16 70:1

237:10

weapons 14:1

WebEx 4:7

website 7:21 15:7 62:19

62:21 74:20 80:9

89:20 385:22

WEDNESDAY 1:11

weeds 44:1 99:17 108:1

week 96:19 343:17

402:11

weeks 119:19 164:22

250:18 252:14 260:9

360:3

weeks' 252:11

weigh 148:15 157:20

159:16 160:22 161:7

172:2 270:14

weigh-in 345:5 376:15

weighing 3:10 122:4,22

134:2,3 137:8 138:2,7

147:20 149:13 157:16

158:4 159:17 169:22

174:10 177:1,19

178:1 395:8

weighing-in 377:13

weight 77:9 135:14,16

135:22 149:19 151:12

314:13 364:5,16

weight-of-evidence

150:9

Welch 2:7 6:19,19

42:15,18 43:2,4 80:1

80:1,14 81:1 95:14,15

117:3,6 120:3,4 147:1

147:2 148:4 149:2

150:12,13 161:3,4

164:8 180:6,7 181:2

210:22 211:1,13

216:14,15,21 235:13

235:14 236:1,6 237:6

238:2,3 239:4 240:7,8

241:1 247:10,11,16

247:20 248:2,6,16

249:17 262:1,2 263:9

264:8 269:15,16,21

271:3,6 273:8,11

274:3,8,9 276:4

278:22 279:1,7,11,15

281:12 282:7,8,14,19

283:1,4,8 290:17,18

293:21,22 294:5

297:21 298:5 300:20

301:1,8,14,17 302:2

306:20 312:2,12,13

316:4,15 317:6,11,16

322:11,12 325:13

330:17 334:10,11

335:10 338:14,15

343:3,7 344:1,2 345:3

349:16 352:20 358:13

358:20

welcome 7:9 122:14

185:19,22 382:11,13

387:13

welcomes 403:9

welder 22:5,13,19

23:15,16,20 24:7 25:9

26:1 40:20 42:1,2

53:20 55:2,7,20 59:3

59:8

welder's 26:3

welders 22:17 23:2

24:19 38:6 44:6 54:16

55:5

welding 22:17,22 23:2

24:12 25:10,18 26:2,6

38:13,18,21 39:22

40:3,3,7,9,11,14,17

44:4,6,8,9 54:14,17

54:18,19 59:4,9

well-known 82:21

well-rationalized

364:13 376:17 379:20

went 11:16,17 12:1 70:9

84:6 112:9 126:3

166:16 169:16 212:18

220:6 250:5 251:3,6

264:3 327:10 344:21

361:19 387:21 388:12

407:19

weren't 66:4 69:8 85:20

91:9 112:15 297:21

whatnot 288:17 393:4

whatsoever 364:16

wheels 337:9

whichever 284:20

Whitley 2:12 6:9,9

101:11,12 114:17,18

117:3,6 239:14,15,16

339:12,13,20 348:7

348:21

Whitley's 107:20

whittled 24:1

who've 124:9

whole-person 129:6

WHPP 389:18

wide 193:12

wiggle 207:22 213:18

216:8 222:20 244:19

246:19

willing 157:9 341:13

350:22 392:16

win 386:4

Windex 33:11

window-cleaner 33:11

window-cleaning 33:10

wish 310:16 381:22

witness 393:10

wobbles 398:10

women 402:1

wonder 311:2 374:6

wonderful 395:1

wondering 88:7 90:5,19

112:14,19 142:12,19

258:17

word 8:13,13 48:17

78:19 96:18 101:10

162:2 166:10 307:21

308:1 337:16 342:9

342:12,14 343:9,14

344:3

worded 163:3

wording 162:16 217:11

218:15 266:16 271:20

271:22 347:13,17

370:11

wordings 395:17

words 21:12 27:9,17

38:12 47:5 48:20

55:20 146:16 160:10

160:11,16 198:17

199:17 203:16 207:6

215:4 219:13 235:4

335:21 397:5 403:19

work 5:12 8:9 9:5 11:21

12:2,3 17:18 18:18,20

25:9,17 26:4,11,14,17

27:19 29:6,18 31:1,4

33:8 38:20 41:6 42:9

44:15,16,19,22 45:4,8

45:16 46:2 54:13 57:2

57:3 63:19 66:2 67:19

67:19 68:4 71:2 74:2

84:17 85:15 88:21

90:6 97:21 104:8

111:5 113:8 114:11

116:19 118:15 120:17

177:3,12 179:19

180:4 183:7 186:22

251:1 256:13 290:1

294:1 314:22 315:2

323:5 348:21 352:6

362:14 364:9 366:11

369:4 371:12 384:11

387:11 395:2 397:7

399:12 403:10 404:6

407:13

work- 402:3

work-related 164:21

238:8 354:14

work-relatedness

344:9

worked 6:10,10 29:8

40:2 75:5 100:14

101:13,17 134:12
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

450

139:22 140:1 141:2

165:21 186:9,13

188:20 314:19 382:17

383:16 385:7 387:10

389:12,13

worker 1:3 4:5 6:5,11

6:14 7:1 11:18 75:5

85:3 126:15 154:9,18

155:1,8,22 156:2,20

157:10,12 164:16

178:12 220:4 221:13

241:18 306:8 309:20

310:6,21 318:19

322:16 366:20 367:2

367:22 368:5 382:20

388:19 389:16,19

391:12 392:14 402:9

402:18

worker's 262:16 374:2

392:5

worker/injured 6:5

workers 11:19 61:7

65:7 120:13 166:2

242:6,13,15,15

249:11 366:8,12

367:4 369:5,14,22

370:2 378:4 379:4

390:17 391:1 392:19

401:20 402:14,22

405:4

workers' 5:7 157:22

160:14 288:16,17

392:1 405:3

working 24:8 34:12

44:20 60:21 102:15

150:3 153:22 186:15

235:7 329:6 378:18

391:16

workload 96:17 114:14

workloads 114:9

workman's 392:21

workplace 100:20

works 41:12 158:15

276:19

worksheet 77:21

worksites 8:21

world 10:8 242:18

400:22

worried 66:13 379:12

worth 120:17 285:16

Worthington 241:22

wouldn't 53:16 105:12

142:17 155:13 161:13

187:1 238:21 266:16

276:2 280:1 291:4

317:11 338:21 386:3

wrapping 48:6

wrestle 206:10

write 89:4 104:7 106:20

112:12 149:18 152:7

169:7 214:19 221:15

222:13 238:14 277:10

334:16 359:16 372:1

376:17 377:1 386:11

396:1

write-up 11:15

write-ups 296:4

writes 337:22

writing 63:12 333:11

398:8

written 87:15 163:4

168:12,17 218:6

247:14 257:5 258:2

261:6,11 267:7 277:3

293:10 294:20 297:11

327:15 328:19 330:7

330:21 331:18 333:3

333:10 335:6,14

339:14 344:16 348:9

349:21 371:21

wrong 46:16 228:19

278:9 340:16 349:9

365:21

wrongly 214:16

wrote 158:12 271:13

337:22

X

X 111:16 140:5 162:1

163:1 178:11,12

X-10 29:9

x-ray 132:10 198:22

199:18 202:1,12,18

208:18,22 231:21

232:5,12 399:15

x-rays 126:6 132:20

191:22 198:1,6

231:22 232:11 379:6

399:9

Y

Y 111:16 140:5 162:1

178:11

Y-12 101:17

yada 269:10,10,10

Yale 4:17

yeah 140:16 146:2

149:5,12 152:16

155:12,20

year 76:14 79:15 89:14

144:2 227:4 383:17

year-and-a-half 381:1

yearly 89:8 379:5

years 6:10,15 8:4 42:3

61:5,8 62:2,16,18

65:14 73:21 91:10,18

99:2 101:14,17

114:21 123:3,7

139:12,22 146:5

158:2,2 231:16 242:2

242:12,16 258:22

266:13 323:20 371:12

372:17 382:18 389:13

389:14 402:12

yesterday 14:16 19:1,3

28:5 64:13 96:1 99:22

106:10 107:9 119:9

119:16 187:7 241:22

363:1,4 364:4,6 392:4

yesterday's 19:14

York 5:22 186:8

Z

Z 2:4 111:17 140:5

162:1

zebras 66:13

zero 66:17,18,18 93:18

93:19 232:2

zero- 182:4,9

0

1

1 72:11,13,16,18 217:19

232:1 238:4 306:2,5

308:15 328:19 338:2

341:7 371:1,1 406:22

406:22 407:4

1,080 369:17

1,210 374:5

1:00 169:19

10 123:2 231:16 241:20

242:15 258:22 260:6

289:12 339:6 354:20

367:9 372:17 374:18

382:12

10:15 84:3

10:17 84:7

10:30 288:18

10:40 288:15

10:45 288:13,15

100 153:21 173:10

101 187:6 313:16

11 119:6

11:00 119:22 288:18

11:45 169:13,16

112 273:11 301:13

12 76:12

12:45 167:17 169:14

12:56 169:17

122 3:10

123 368:13

124 371:9

13 389:13

13,000 73:13

1300 69:2

13th 370:17

14,058,821 369:21

15 84:3 242:15 327:7

345:22 370:13

1505 367:16,22 368:8

368:11

1506 393:12

157,861 368:2

17,743 368:6

1700 69:3

176 3:11

186 3:14

193 3:14

1939 370:22 371:9

1940 371:2

1942 370:17 371:9,10

1960 32:7,9

1974 202:19

1980 393:8,10 394:13

1980s 394:13

1992 6:18 378:22

1993 195:18 197:14,15

202:10 211:17,21

216:11 222:15,19

230:1 381:7,17 399:5

399:7

1994 186:7

1995 393:13

1996 186:8

1st 370:17 393:8

2

2 116:11,11 150:21

177:17 178:20,21

182:5 237:21 238:4

238:16,18 306:2

329:3 338:3 342:19

381:12

2:16 250:5

2:30 250:6

20 139:22 146:5

20.232 328:1

200 1:19

2000 399:15

2001 258:21

2004 222:17 258:21

399:4,19

2005 186:11

2006 372:9 378:10

395:22

2008 241:12 372:19

2009 67:8 77:2

2010 10:19 64:2 77:1

2011 383:8,12 387:21

2012 63:10 77:3 80:19

166:13
(202) 234-4433 Washington DC www.nealrgross.com

Neal R. Gross and Co., Inc.

451

2013 63:14 77:3 186:14

372:20

2014 368:1 372:10,12

2015 374:4 399:20

2016 1:12 77:4 211:14

241:14

20th 371:2

23 389:14

231(a) 277:8

24 380:9

241 3:16

25 6:14 101:13,17

250 3:17 231:6,8 235:17

235:19

251 371:8

26 266:19 267:4 273:13

27 1:12 276:13,21

280:10 292:21

27th 372:9

2As 73:1

2nd 370:22

3

3 10:17 185:14 237:16

276:22 280:17 293:2

301:21 306:3,22

308:1 317:12 318:13

319:9,10 321:11

3:59 327:10

30 109:6 273:22

30.111 261:21 266:19

273:9 275:2 293:20

299:4 300:3,4,10,12

300:22

30.111(c) 265:13 267:4

269:18 273:22 279:4

30.112 273:9 276:21

301:12,16

30.112(b) 302:8

30.112(b)(3) 301:20

30.205 370:4

30.206 370:4

30.230 370:16

30.230(d) 328:17

30.230(d)(2)(3) 353:18

30.231 260:21 274:10

304:22 371:14

30.231(b) 301:16

30.232 327:16

30.232(b) 371:19

30.405 356:6

30.5 348:11

30.5(s) 339:14,16

340:17 341:18 342:15

30.5(s)) 328:22

30.5(w) 370:16

30.5(x) 369:12

30.70 373:11

30.726 373:12

30.805 374:1

300 378:19

32 376:6 380:19 381:13

326 3:19

347 369:18

35 170:1

36 3:5

36,000 401:19

39 353:16,17

4

4 71:1 147:19 150:22

151:3 177:8 178:20

179:3 182:4 203:9

316:6 318:16 319:10

4:15 327:8

4:17 327:11

4:56 361:19

40 260:20 304:18

327:14

41 382:18

42 6:10

45 84:9,14

49.9 407:5

5

5 138:7 306:1,16 316:8

319:11 329:7 346:3

5:00 355:21 361:15

5:02 361:20

50-percent 406:6

50/50 404:9,16

54 356:4

55 356:6

57 368:11

589 369:19

6

6 321:11

6:01 407:19

60 109:6

63 3:6

7

7 3:3,5 258:1 321:12

75 370:12

77,739,510 369:21

783 10:18

8

8:30 1:20 407:17

8:37 4:2

80 370:11 378:20

84 3:8

850 241:20,21

9

9:58 84:6

90 109:7 339:7

921,000 10:19

96 371:10

9th 252:7,10,14,21
NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE., N.W. 

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

C E R T I F I C A T E

This is to certify that the foregoing transcript 

In the matter of: 

Before: 

Date: 

Place: 

was duly recorded and accurately transcribed under 

my direction; further, that said transcript is a 

true and accurate record of the proceedings. 

 

 ----------------------- Court Reporter 

452

Meeting of the Advisory Board on

Toxic Substances and Worker Health

US DOL

04-27-16

Washington, DC