review of this particular issue, but a consensus opinion from
the board to the DOL would be helpful.

Member Vlieger expressed her concerns about the convoluted
nature of the procedure manual as it relates to Part B lung
conditions and CBD, and the discrepancy between the criteria
for acceptance in the procedure manual and the information in
brochures at DOL resource centers.

The subcommittee settled on mid-September for another
conference call. Between now and the next telephone meeting,
the subcommittee members should have time to review the data
and the reports. Ms. Rhoads said that she would send the
subcommittee a list of the action items. The meeting was
adjourned at 1:24 p.m.

Thereby certify that, to the best of my knowledge, the foregoing minutes are on accurate summary of
the meeting.

Submitted by:

Carrie Redlich, MD, MPH

Chair, Subcommittee on Part B Lung Conditions
Advisory Board on Toxic Substances and Worker Health
Date: 9/23/2016



Markowitz suggested reaching out to the pulmonary community in
Oak Ridge during the next full board meeting and asking them
about their experiences with the claims process. One of the
problems with the statute is that there are some very vague
phrases and it is not clear how to apply those phrases. DOL is
looking for assistance in coming up with a consistent uniform
standard for what is a chronic respiratory disorder. Another
related issue that needs to be addressed is the clarity of the
procedural manual for claims examiners. The subcommittee would
also like to get a copy of the contract medical consultant
(CMC) manual.

The subcommittee wanted to know if there are specific criteria
for Part B cases in determining what CMCs are used and how many
different claims personnel are reviewing beryllium cases. The
subcommittee wanted to get a sense of who is writing the
reports and their qualifications and training. Member Welch
suggested looking at 10 sarcoid cases that were approved and 10
that were denied. Chair Redlich said that the subcommittee
wanted to know how many sarcoid claims were filed under both
Parts B and E. The goal in looking at the denied sarcoid claims
is to examine the level of evidence, whether or not the
claimant has any beryllium sensitivity or disease, and then
look at what affirmative evidence exists indicating that the
claimant actually has sarcoid. For exploratory purposes,
reviewing a small number of cases should suffice.

The subcommittee also wants to do the same with
ILD/pneumoconiosis - getting the most recent 10 pneumoconiosis
claims and making sure that a few of those claims include
positive BeLPT.

The subcommittee wanted to get a sense of how many people with
beryllium sensitization also have some other pulmonary
diagnosis. It is important to assess whether there are Part E
claimants that may be misdiagnosed or denied chronic beryllium
disease who actually have the disease. COPD and ILD can get
misdiagnosed.

Member Dement said that he would be able to turn around a
preliminary sorting of the data in about a week.

Member Markowitz mentioned that the subcommittee should develop
a plan for scientific issues related to sensitivity and CBD -
for instance, looking into the consistency of testing results
among different facilities. There is no need for a systematic



UNITED STATES DEPARTMENT OF LABOR
++ tt +
ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH
++ bt +

SUBCOMMITTEE ON EVIDENTIARY REQUIREMENTS FOR PART B LUNG
CONDITIONS (AREA #3)

tee tt
MEETING MINUTES
++ ett

WEDNESDAY
JUNE 29, 2016

+++ $4

The Subcommittee met telephonically at 10:00 a.m.
Eastern Time, Carrie Redlich, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:
JOHN M. DEMENT
MEDICAL COMMUNITY:
STEVEN MARKOWITZ
CARRIE A. REDLICH, Chair
LAURA S. WELCH
CLAIMANT COMMUNITY:
KIRK D. DOMINA

JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS



Introductions/Logistics

Carrie Rhoads, the DFO for the subcommittee, called the meeting
to order at 10:09 a.m.

Simplified Statement of the Problem

Chair Redlich said that the main focus of the subcommittee
meeting was to try to understand the issues, scope, and what
additional information the subcommittee needed to accomplish
its task. The EEOICPA Act defined specific criteria for
diagnosing beryllium sensitization and chronic beryllium
disease and this has been a challenging area to review and
adjudicate claims. There is substantial financial implication
between sensitization and chronic beryllium disease. The
magnitude of the claims process is enormous. The problem is how
to make the claims process specifically related to Part B lung
conditions.

Defining the Issues and Scope of the Subcommittee’s Topic Area

Clarification regarding specific diagnostic criteria use for
CBD, BS, CS:

Members agreed that the subcommittee should look at exposure
assessment for beryllium as it's defined in the statute
separately. Part E COPD issues will be addressed by other
subcommittees. The subcommittee is going to look at the
application of the evidentiary requirements in the claims
process. The information coming from the medical provider, how
the claims examiner looks at the issues, how evidence is
constructed, viewed, and applied are all fair game for this
subcommittee.

DOL has asked for specific help with diseases that could arise
as a result of the complications due to steroid treatment, and
that could apply to other lung diseases as well.

Data and Information Needs

The subcommittee has made a list of data requests and plans to
develop summary statistics on the beryllium cases in the DOL
database. Reasons for denial are missing in the data.
Subcommittee members wanted to delve into the claims process
and examine how the claims process is actually being applied.
It is going to be difficult to get into the meat of the data



without having some specific case studies. A lot of progress
could be made by just having access to the DOL's denial
rationales rather than the actual medical records.

The subcommittee's data must come from the DOL database so that
the subcommittee can have a comprehensive understanding of how
the DOL claims process works.

It is important to look at the entire population of claims, and
not just a selective sample, in order to draw broader
conclusions. Looking at 10 or 15 individual cases will provide
an insight into process, but will not allow for a definitive
overarching conclusion.

However, at some point the subcommittee is going to need to
review some claims and look at what specific information the
examining physician was given. The subcommittee is going to
look at the Excel spreadsheet and come up with additional
columns that it would like to see included. The subcommittee
needs to get a sense of what data is actually available and go
from there. Member Dement said that he would prepare some
preliminary summaries of the data in the spreadsheet.

In terms of understanding the claims process, Member Welch
suggested looking at the date of the initial decision and the
date of the file adjudication to get a sense of which cases
went through multiple levels of appeal. The documents on the
website are representative of what was voluntarily submitted by
workers. The subcommittee wants to know what parameters the DOL
tracks. A lot of the tracking probably has more to do with the
timeliness of the claims process rather than reasons for
denial. The subcommittee will look at a sample of cases to get
a better understanding of the kinds of information that are
compiled and used by claims examiners. The goals are to develop
a provisional understanding for recent claims and to better
comprehend the types of data that enter the system and are used
by various participants in the system to draw conclusions.

The subcommittee wants to get samples of recommended decisions
to deny or accept a claim, as well as samples of final
decisions. Ideally, the subcommittee could have a summary of
its thoughts on the issue of “reasons for denial” by the
October full board meeting.

Physicians often struggle to write documents that meet the
criteria that the Department of Labor will accept. Member