UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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SUBCOMMITTEE ON EVIDENTIARY REQUIREMENTS FOR PART B LUNG

CONDITIONS (AREA #3)

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MEETING

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SUMMARY MINUTES

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WEDNESDAY,

SEPTEMBER 21, 2016

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The Subcommittee met telephonically at 1:00 p.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

OTHER ADVISORY BOARD MEMBERS PRESENT:

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS

Introduction and Update on other subcommittees

Ms. Rhoads called the meeting to order at 1:05 p.m. Member Markowitz and Chair Redlich

agreed that there was a lot of overlap among the different subcommittees. The subcommittee

wants information on how many people file both a Part B and Part E claim.

Review questions to DOL and responses

Chair Redlich said that the subcommittee received reasonable responses from DOL. Member

Markowitz said that the Statement of Work from QTC was on the website under the April

meeting heading. Member Welch added that the board cannot see the proprietary CMC training

materials, and that the department has a contract where they specify certain things and leave it up

to the contractor to meet the specification. When the subcommittee sees the statement of work

they can see what the appropriate credentials are. 

Member Dement provided a summary of his findings to the subcommittee. The data shows

approval rates of 41% for CBD cases, 55% for beryllium sensitivity cases, and 67% for silicosis

claims. Asthma seems to get approved a little more than a third of the time. Interstitial lung

diseases are only getting approved about 25% of the time.

The reasons for denial ranged from an employee not being covered to a survivor not being

eligible. Under Part B, insufficient medical evidence accounts for 50% of denials; negative

causation accounts for 11%. For Part E, negative causation is about 50% of the reasons for
denial, and there is a higher proportion of a particular medical condition not being covered than

for Part B.

Chair Redlich proposed comparing the last two years to prior years to get a sense of how the

trends are changing. Member Dement could restrict his analysis to those cases that have single

medical conditions filed.

Member Markowitz said that the SEM subcommittee spent a lot of time talking about exposure

and the difficulties of identifying it. Under the Part B reasons for denial – for silica and

beryllium, the issue is predominantly medical and not exposure.

Member Welch said that Member Dement’s analysis had two components: 1) The overall

approval or denial and diagnosis, and 2) The reasons for approval/denial for the entire

population. Member Dement said that he was going to take the new data and break it down by

the more recent two-year period and look back.

Member Vlieger attributed the high denial numbers to the CMCs not being given the instructions

per the procedure manual. Chair Redlich said that a few of the cases that she looked at appeared

like they weren’t consistently using the stated criteria.

Discussion, next steps, timeline

Chair Redlich drafted a standard evaluation form to use while evaluating cases the subcommittee

had already reviewed. One thing that needs to be added is the distinction between pre- and post1993 CBD cases. It would be helpful to differentiate between cases where there is sufficient

information and where there is not. Member Welch pointed out that the final decision letter lays

out the facts of each case. The subcommittee vowed to keep an eye on consistency in the

evaluation of whether or not a case is approved/denied. Chair Redlich suggested a call between

now and the upcoming board meeting.

Member Welch pointed out that a claimant that does not get accepted as a CBD case could be

accepted as a sarcoidosis case. Member Markowitz suggested that the subcommittee report on its

provisional observations about the cases instead of in a systematic manner. Member Domina

suggested the subcommittee add the years that a claimant was working at a DOE site, and which

sites the claimant worked at, on the case evaluation form, and look at whether the department is

using lack of exposure data against claimants.

Member Vlieger said information sent to the CMCs was not always medically relevant to making

a decision. She added that the vetting by claims examiners was inadequate, and that DOL did not

seem to have specific criteria for making a diagnosis.