UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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WORKING GROUP ON PRESUMPTIONS

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SUMMARY MINUTES

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WEDNESDAY,

JUNE 21, 2017

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The Advisory Board met telephonically at 1:00 p.m. Eastern 

Time, Steven Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

KENNETH Z. SILVER

LESLIE I. BODEN

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

VICTORIA A. CASSANO

CLAIMANT COMMUNITY:

KIRK D. DOMINA

GARRY M. WHITLEY

FAYE VLIEGER

BOARD MEMBERS ALSO PRESENT:

KIRK DOMINA

DESIGNATED FEDERAL OFFICIAL:
CARRIE RHOADS
Call to order and roll call

Carrie Rhoads, the DFO for the work group, called the meeting to 

order at 1:05 p.m. The board members in attendance introduced 

themselves.

Use of presumptions for asbestos-related diseases

Chair Markowitz presented a slideshow summarizing what the board has 

already done regarding presumptions and proposed a path forward. So 

far the board has focused on exposure presumptions rather than 

helping DOL make determinations about how to recognize a diagnosis of 

disease. At the last meeting someone suggested that the board look at 

the medical side and see if there are some suggestions that the board 

can make to DOL about asbestos-related diseases.

EEOICP recognizes non-malignant asbestos-related diseases, like 

asbestosis, pleural plaques, pleural thickening, and benign asbestosrelated pleural effusion. EEOICP also recognizes malignant asbestosrelated diseases, such as malignant mesothelioma, lung cancer, cancer 

of the ovary, and cancer of the larynx. 

For a claim of asbestosis, the claims examiner (CE) is asked to look 

at several sources of evidence: 1) Opinion of qualified MD based on 

CXR, CT, MRI, PFT, or lung biopsy, 2) DOE FWP physician findings, 3) 

Death certificates. 

Opinion of qualified MD:

CXR - pulmonary interstitial fibrosis + heart enlargement

CT/MRI - lung scarring, pleural thickening, heart enlargement

PFT - restriction; requires MD interpretation

Lung biopsy - “sputum cytology or bronchial lavage often show 

asbestos bodies” but “not definitive” 

DOE FWP

Physician assessment of asbestosis or asbestos-related lung disease 

Death certificate (DC)

Cites “asbestosis” as cause or contributing factor. If DC cites 

diagnosis other than “asbestosis,” need evidence to support the 

diagnosis of asbestosis. 
The question of how much discretion the claims examiners have is one 

that the DOL will need to struggle with. Perhaps there needs to be 

guidance for pulmonologists who are treating people. The board will 

need to get clarification from DOL on how the CEs use diagnoses.

The procedure manual requires that the CE find confirmation of the 

diagnosis of mesothelioma of the pleura. With regard to pleural 

plaques (PP) and pleural effusions (PE), the supportive medical 

evidence includes the following: 1) MD diagnosis, 2) CXR, CT, or 

other imaging evidence of PP or pleural thickening (PT) not due to 

surgery or trauma, 3) Rounded atelectasis, and 4) Bilateral pleural 

effusions. 

The CE is to consult with a treating MD or contract medical 

consultant (CMC) if 1) Evidence is inconclusive, 2) PT is in an area 

of surgery or trauma, and 3) Evidence for other causes of PE is 

present. 

The Former Worker Medical Screening Program surveillance case 

definitions for asbestosis are 1) A reported history of exposure to 

asbestos or job title with a reasonable likelihood of asbestos 

exposure, or 2) A B-reading of standard PA chest film demonstrating 

bilateral irregular parenchymal opacities (shape and size: s,t,u) 

with profusion score of 1/0 or greater. Member Boden suggested that 

these criteria are rather restrictive. 

For asbestos-related pleural disease, the case definitions are 1) A 

reported history of exposure to asbestos or job title with a 

reasonable likelihood of asbestos exposure, and 2) A B-reader 

notation of findings of unilateral or bilateral pleural thickening 

consistent with pneumoconiosis. 

Proposed diagnostic criteria for asbestosis

1) History of asbestos-related exposure and radiography (CXR or CT): 

bilateral diffuse interstitial fibrosis affecting any combination of 

mid- and lower lung zones. If ILO scoring is used, scores of greater 

than or equal to 1/0 s, t, or u opacities are required. 2) DOE FWP 

physician finding (see above for details). 3) History of asbestos 

exposure and pathology (“pathology” being histologic evidence of 

diffuse interstitial fibrosis of the lung). 

Also, as an alternative to a history of asbestos exposure, asbestos 

exposure can be documented if lung tissue burden finds concentrations 

of asbestos fibers or asbestos bodies compatible with asbestosis by 

the examining laboratory. 

Proposed diagnostic criteria for asbestos-related pleural disease
1) History of asbestos exposure or 2) Radiography (CXR or CT) showing

a unilateral or bilateral pleural thickening or plaques that is not 

readily explained by another cause. 

Member Boden said that the board should consider what precisely 

“history of exposure” means. Member Whitley said that the CE is going 

to go to the SEM database to get their information. Following a 

comment by Member Cassano, Chair Markowitz said that if a person 

isn't in an expected or typical job title but has pleural plaques and 

interstitial fibrosis, then he would lean toward that person having 

asbestosis. 

Member Silver and Chair Markowitz suggested that the rationales be 

accessible to the treating physicians and CMCs. 

Proposed diagnostic criteria for asbestos-related pleural effusion

This is a rare condition. 1) History of asbestos exposure or 2) 

Diagnosis of unilateral or bilateral pleural effusions that are not 

readily explained by another cause. 

Proposed diagnostic criteria for mesothelioma (pleural), cancer of 

the lung, ovary, and larynx

1) Documented by pathology, 2) Clinical and radiological presentation 

that favors malignant mesothelioma of pleura or cancer of lung, 

ovary, and larynx, or 3) Death certificate: cause, underlying, or 

primary or contributing factor. 

The claims process does not take into consideration smoking, and 

treating physicians need to be made aware in the rationale that 

smoking does not contribute to mesothelioma, but it does to lung 

cancer, and it amplifies risk due to asbestos exposure. 

Member Vlieger said that no doctor is going to make any asbestosrelated diagnosis on a death certificate without an autopsy. 

Developing consensus guidelines will provide a basis for the making 

of more uniform decisions. Member Cassano will be drafting some 

helpful language on the topic of the death certificate and sending it 

back to the work group. 

Additional candidate issues for EEOICP presumptions

Some potential issues include Parkinsonism, neurologic diseases, and 

kidney diseases. Organic solvents are also on the radar. Member 

Vlieger said that she would send a list of the most-denied conditions 

by DOL to the board compiled by DIAB. Two of the things that were 

more routinely denied were peripheral neuropathy and chronic 

encephalopathy. The claims process does not recognize certain aspects 

of these diseases. The board will need to figure out what the