UNITED STATES DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH

+ + + + +

SUBCOMMITTEE ON SITE EXPOSURE MATRICES (AREA #1)

+ + + + +

MEETING MINUTES

+ + + + +

MONDAY

JULY 11, 2016

+ + + + +

The Subcommittee met telephonically at 1:00 p.m. 

Eastern Time, Laura Welch, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MARK GRIFFON

MEDICAL COMMUNITY:

STEVEN MARKOWITZ

LAURA S. WELCH, Chair

CLAIMANT COMMUNITY:

KIRK D. DOMINA

GARRY M. WHITLEY

OTHER ADVISORY BOARD MEMBERS PRESENT:

FAYE VLIEGER
DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
Introductions and review of charge to the subcommittee

Ms. Rhoads opened the meeting at 1:05 p.m. The charge of the 

subcommittee is to advise the Department of Labor (DOL) on the

Site Exposure Matrices (SEM). The Institute of Medicine has 

already done a review of the SEM. That review is available to 

the board. DOL has asked the board to provide policy guidance 

on links between exposure and disease. The areas are 1) policy 

guidance on linkages between toxins and occupational disease;

2) specific diseases for which the DOL wants guidance about 

causation; 3) how to modify the SEM to better convey 

information and help DOL set up priorities for contractors and 

adding new data to the SEM. 

Defining issues and scope

The subcommittee toyed with the notion that they should change 

their name from the SEM Subcommittee to the Exposure Assessment 

Subcommittee. The subcommittee wants to look at the totality of 

the information that goes into the exposure assessment. The 

subcommittee should look at everything from the occupational 

history process to the process of obtaining that history and 

how the history is used in connection with the SEM for exposure 

assessment. The SEM also includes links to diseases. So, the 

subcommittee can go beyond exposure assessment to disease 

linkage as well. Member Domina pointed out that at the full 

board meeting, the board asked if it could have access to the 

version of the SEM used by claims examiners, not just the 

public SEM. There are also sites without SEMs. As far as 

getting disease-specific claims data, Ms. Rhoads said that DOL 

is still working on getting that information to the board. 

Regarding the Procedure Manual, the subcommittee wanted to 

emphasize the probative value of information that may not be in 

the SEM as it relates to particular claims. There can be 

exposures reported by workers that are not in the SEM and those 

types of instances need to be looked at by the subcommittee. 

Subcommittee members want to look at a number of claims to see 

how things work and identify the various pieces that are used 

to construct exposures and the role of the personnel in using 

and interpreting information from start to end. The 

subcommittee must examine the totality of the process.

If the subcommittee were to try to fix something related to the 
common diagnoses, it would probably end up improving the 

process for all of the claims. The subcommittee would really

like to see statistics on the kind of claims that are coming in 

and how many of those have been approved or denied.

Member Dement said the subcommittee should get the database on 

claims in its totality. With this database, the subcommittee 

can look at the frequency of acceptances and denials based on 

ICD codes. Then, stratified samples can be taken of the ones in

the major categories. Some of the less common diseases that 

people make claims for should also be looked at. Member Griffon 

proposed taking stratified samples based on sites. Within a few 

weeks, and before the next full board meeting, the subcommittee 

hopes to request a certain number of de-identified claims to 

read. The goal of looking at a sample is to help the board 

understand how the claims process works, what is going into the 

assessment of the individual exposures and then the 

exposure/causation link. Additionally, the subcommittee wants 

to understand what data points exist within the claims. Ideally 

these claims could be examined before the next meeting on 

September 20th. 

Chair Welch said that either the subcommittee could say that it 

wants to look at so many files of the top three diagnoses and 

so many files of the shorter list. Or, Chair Welch could choose 

some files once the spreadsheet becomes available. Or, once the 

data becomes available, Ms. Rhoads could send it to everyone 

and then individual subcommittee members could send Ms. Rhoads 

requests of what files they would like to review. Member 

Vlieger said it would be helpful if the entire subcommittee got 

a chance to look at the data. It's up to Ms. Rhoads to figure 

out how to pressure DOL to get the ICD code-specific data 

analysis of the claims. It was agreed that the subcommittee 

should move ahead on looking at presumptions. 

The subcommittee will look at the same cases and select a 

representative number of Department of Energy (DOE) sites. A 

COPD case from Rocky Flats may look very different than one 

from Los Alamos. Some of the smaller sites do not have a SEM. 

Some of the claims that the subcommittee will look at should 

come from non-SEM sites. Member Dement said that the 

occupational histories appear to be very incomplete. There is 

very little information with regard to description of tasks

performed during exposure. Member Vlieger said that the 

information one would expect workers to know about their 

exposures does not exist, and that regardless of what a worker 
puts on the questionnaire, it is not considered probative. 

Member Vlieger stated that the only information that the DOL 

considers valid is what they pull from the SEM. Member Dement 

thought that it would be helpful if an occupational history 

could provide some cues with regard to the worker, as to the 

tasks that are known to increase the risk of intense exposure. 

Member Markowitz thought that it would be very ambitious to get 

high-quality information from people's memories about job 

tasks. It will be a challenging undertaking. As the 

subcommittee moves forward, it should think about making 

recommendations to DOL about how to improve the questionnaire. 

Member Whitley thought that developing presumptions would be 

the most helpful step toward assisting the claims examiners. In 

order to get the right information out of a worker, the program 

would need interviewers who understand the particular sites and 

the processes that were used there. Even if a claimant does not 

meet the presumption, his case can be adjudicated based on more 

specific individual information. Member Vlieger said that at 

some point the subcommittee needs to address the fact that 

workers will describe exposures and the SEM describes exposures 

linked with those, and diseases linked with those exposures and 

the timeframe for when the exposures occurred. Member Domina 

said that sites often didn't monitor for certain exposures 

because those substances weren't considered hazards at the time

or the site was in a Cold War effort. 

Member Markowitz said that the presence or absence of 

monitoring data post-1995 is not going to be determinative of 

what needs to be done. Member Vlieger said that DOE did not 

provide DOL any exposure information for the post-1995 Toxic 

Exposure Circular. The subcommittee's recommendations as to how 

to improve exposure assessment is going to apply to the post1995 exposures as well as to the pre-1995 exposures. 

IOM Report

Chair Welch summarized the IOM report. DOL wanted IOM to focus 

on the link between exposure and disease in the SEM (which is 

derived from Haz-Map). IOM said that the Haz-Map was not meant 

to be used for the purpose of an establishing exposure/disease 

link as required by EEOICPA. Haz-Map and SEM do not handle 

complex mixtures or exposures well and Haz-Map is not very 

systematic. One point the report made was to urge incorporation 

of information from other sources beyond Haz-Map like the ATSDR 

Toxprofiles, data from EPA, IRIS, substance-specific reports 
from the National Toxicology Program, and information 

specifically from the California EPA. The report stated that 

the functionality of SEM could be improved in several ways: 1) 

there are ways to improve the search option for a worker that 

worked at multiple sites; 2) introducing quality assurance into 

the SEM; 3) there should be an expert advisory panel for SEM. 

The IOM report makes a case for having exposure links in SEM be 

created by more than one person and that there be a transparent 

process and expert review of such links. There are some 

recommendations out of IOM that DOL said cannot be implemented. 

The subcommittee is going to ask DOL to make a presentation of 

what they have and have not implemented from the IOM report at 

the next full board meeting. However, what the totality of what 

IOM recommends goes beyond the scope of the Toxic Substances 

Board. The full board should decide what it can feasibly do and 

recommend a plan. Member Markowitz noted that the IOM 

recommendations encompass an immense set of tasks. The board 

needs to describe how the tasks can be accomplished, what 

resources are required, and what the structure should look 

like. The Veterans Administration has an advisory board that 

only focuses on Agent Orange, and the people on that board 

struggle with this single agent. The IOM report is talking 

about 17,000 chemicals. How to move forward in this daunting 

process is going to require a lot of thought. 

Haz-Map may not be up to date on some cancers. In order to get 

into Haz-Map, causality for a cancer has to be in a textbook 

versus more contemporary literature. The subcommittee wants to 

look at what kind of delay there is between an excellent review 

coming out and when that information gets into SEM. DOL should 

have its own unit that monitors the literature or does some 

sort of expedited peer review with some supervision and then 

directly modifies its exposure/disease database so that it 

doesn't have to rely on Haz-Map. Having a disease link in the 

SEM is not enough unless there is also a presumption. In 

theory, a claimant could provide information that is not in the 

SEM, then that information could go to a contract medical 

consultant and they could award the claim based on their own 

review process. Member Whitley said that the subcommittee 

should review the training material that DOL provides to claims 

examiners and others: PowerPoints, written guidance, 

instructions, or procedures beyond those that are available on 

the website used by claims examiners, physicians, industrial 

hygienists, and whatever personnel process claims. Member 

Griffon agreed and said that it would be useful to look at the 

procedures claims examiners go through when assessing a claim.