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U.S. DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES

AND WORKER HEALTH

+ + + + +

THURSDAY

MAY 18, 2023

+ + + + +

The Advisory Board met in the Snake 

River Room at the Holiday Inn and Suites Idaho 

Falls, 3005 South Fork Boulevard, Idaho Falls, 

ID, at 8:30 a.m. MDT, Steven Markowitz, Chair, 

presiding.

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN*

GEORGE FRIEDMAN-JIMENEZ*

MIKE VAN DYKE

MEDICAL COMMUNITY

MARIANNE CLOEREN

STEVEN MARKOWITZ, Chair

MAREK MIKULSKI* 

KEVIN VLAHOVICH*

CLAIMANT COMMUNITY

JIM H. KEY

GAIL SPLETT

DIANNE WHITTEN

DESIGNATED FEDERAL OFFICIAL

RYAN JANSEN
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ALSO PRESENT

KEVIN BIRD, SIDEM

CARRIE RHOADS, DOL

JOHN VANCE, DOL*

*Present via video teleconference
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P-R-O-C-E-E-D-I-N-G-S

(8:30 a.m.)

MR. JANSEN: All right. Let's get 

started. Good morning, everyone. My name is Ryan 

Jansen. I'm the Designated Federal Office for the 

Department of Labor Advisory Board on Toxic 

Substances.

I'd like to welcome you to Day 2 of 

this meeting of the Advisory Board here in Idaho 

Falls, Idaho. Today is Thursday, May 18th, 2023. 

We are scheduled to meet from 8:30 a.m. to 11:30 

a.m. Mountain Time. There will no public comment 

period today.

The Board's website, which can be 

found at dol. gov / owecp / energy / regs / 

compliance/advisoryboard.htm has a page dedicated 

to this meeting. The page contains all materials 

submitted to us in advance of the meeting, and 

will include any materials that are provided by 

our presenters today.

There you can also find today's 

agenda, as well as instructions for participating 
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remotely. If any of the virtual participants have 

technical difficulties during the meeting please 

email us at nrgadvisoryboard@dol.gov.

If you are joining by WebEx this 

session is reviewing only, and microphones will 

be muted for non-Advisory Board members. So, the 

public may listen in but not participate in the 

Board's discussion during the meeting.

A transcript and minutes will be 

prepared from today's meeting. As the Designated 

Federal Officer I see that the minutes are 

prepared, and ensure that they are certified by 

the Chair.

The minutes of today's meeting will be 

available on the Board's website no later than 90 

calendar days from today. But if they're 

available sooner they'll posted sooner.

Although formal minutes will be 

prepared according to the regulations we also 

prepare verbatim transcripts, and they should be 

available on the Board's website within 30 days.

During the discussions today please 
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speak clearly enough for the transcriber to 

understand. When you begin speaking, especially 

at the start of the meeting, make sure you state 

your name so that it's clear who is saying what.

Also, I would like to ask that our 

transcriber please let us know if you have 

trouble hearing anyone or any of the information 

that is being provided.

I'd also like to mention that there is 

currently one vacant position on the Board, and 

as such we have invited interested parties to 

submit nominations for individuals to serve on 

the Board.

The selected nominee will serve as a 

member from the Claimant Community under the 

Board's statute and charter.

Nominations for individuals to serve 

on the Board must be submitted by May 27th, 2023. 

For further information including details about 

how to submit a nomination please visit the 

Board's website.

As always I would like to remind 
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Advisory Board members that there are some 

materials that have been provided to you in your 

capacity as special Government employees and 

members of the Board, which are not suitable for 

public disclosure, and cannot be shared or 

discussed publicly, including during this 

meeting.

Please be aware of this throughout the 

discussions today. The materials can be discussed 

in a general way which does not include any 

personally identifiable information or PII, such 

as names, addresses, or a doctor's name if we are 

discussing a case.

And with that I convene this meeting 

of the Advisory Board on Toxic Substances and 

Worker Health. I will now turn it over to Dr. 

Markowitz for introductions.

CHAIR MARKOWITZ: Welcome to the Board 

members who are here, who are online. Welcome to 

the public, and the public who are participating 

remotely as well.

So, let's do introductions, and then 
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we'll move on. I'm Steven Markowitz. I'm an 

occupational medicine physician, epidemiologist 

from the City University of New York.

And for the last 25 years run the 

largest former worker program for the Department 

of Energy, with the United Steel Workers, and 

also the Atomic Trade Labor Council at 14 

different sites, seven different states, for 

former, mostly former DOE workers. Ms. Whitten.

MEMBER WHITTEN: Good morning. Dianne 

Whitten. I'm the health advocate for the Hanford 

Atomic Metal Trades Council. I've been a radcon 

tech at Hanford for, well, since 1988.

MEMBER BOWMAN: Good morning. My name 

is Aaron Bowman. I'm a toxicologist. And I'm also 

a professor and head of the School of Health 

Sciences at Purdue University.

MEMBER VAN DYKE: Good morning. Mike 

Van Dyke, industrial hygienist and associate 

professor at the Colorado School of Public 

Health.

MEMBER SPLETT: I'm Gail Splett. I'm 
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retired from the Hanford site as a DOE employee. 

Right before I retired I was the EEOICPA program 

manager for Hanford.

MEMBER KEY: Good morning. I'm Jim 

Key, labor climate community representative on 

the Board. I'm President of the United Steel 

Workers International Union Atomic Energy Workers 

Council in Washington, DC.

I'm also a cold war veteran, having 

served 48 years at the Paducah Gaseous Diffusion 

Facility. Look forward to the Board's discussions 

and interactions today.

MEMBER CLOEREN: Marianne Cloeren. I'm 

an associate professor at the University of 

Maryland School of Medicine Occupational Medicine 

and Internal Medicine, and a medical director for 

the BTMed Former Worker Program.

CHAIR MARKOWITZ: Dr. Mikulski.

MEMBER MIKULSKI: Good morning. Marek 

Mikulski, University of Iowa, occupational 

epidemiologist. I direct the Iowa Former Worker 

Program for former DOE workers from the state.
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CHAIR MARKOWITZ: Dr. Friedman-Jimenez.

MEMBER FRIEDMAN-JIMENEZ: Hi. I'm 

George Friedman-Jimenez. I'm an occupational 

medicine physician and epidemiologist. And I 

direct the Bellevue/NYU Occupational 

Environmental Medicine Clinic for the last 32 

years.

CHAIR MARKOWITZ: Dr. Vlahovich.

MEMBER FRIEDMAN-JIMENEZ: You're on 

mute.

CHAIR MARKOWITZ: Dr. Vlahovich, we 

couldn't hear you if you said anything. So, yes.

MEMBER VLAHOVICH: I'm Kevin 

Vlahovich. I'm an assistant professor at the 

University of New Mexico, and an occupational 

medicine physician.

CHAIR MARKOWITZ: Okay. Thanks. And, 

Mr. Catlin, the remaining Board member, wrote in 

that he's going to be a few minutes late. So, 

he'll be here later. Mr. Vance.

MR. VANCE: Good morning, everybody. 

My name is John Vance. I'm the policy branch 
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chief for the Energy Compensation Program.

CHAIR MARKOWITZ: Okay. So, if we can 

do the people in the room here in Idaho Falls.

MR. FISHER: Good morning. Good 

morning. This is Miles Fisher, the assistant 

director of Building Trades National Medical 

Screening Program, known as BTMed. And we offer 

free medical exams to construction workers that 

worked on DOE facilities.

CHAIR MARKOWITZ: No advertising, 

Miles. No advertising.

MR. DOMINA: I'm Kurt Domina. I'm a 

retired Hanford worker.

MS. HUNT: I'm Annette Hunt. I'm a 

benefits specialist for United Energy Workers.

MR. TOWLER: Steve Towler. I'm just a 

local citizen.

MR. LARSON: Dave Larson, local DOE 

employee.

MR. CUNNINGHAM: John Cunningham. I 

work at AMWTP out at the site.

CHAIR MARKOWITZ: And Carrie Rhoads, 
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without whom we wouldn't be here today.

MS. RHOADS: Hi. I'm Carrie Rhoads. 

I'm the alternate DFO for the Board at the 

Department of Labor.

CHAIR MARKOWITZ: Okay. So, we have, 

we're scheduled to continue until 11:30 today. 

Let me ask the Board members who are here whether 

anyone needs to leave earlier than that because 

of an airplane, or whatever. So, Mr. Key, what 

time roughly do you think you need to leave to --

Okay. Okay.

So, the agenda for today, we're going 

to switch around a little bit. I thought we would 

discuss public comments from yesterday, and the 

written comment that came in. Because sometimes 

we don't get a chance to discuss that if we leave 

it to the end. So, we would start off with that.

And then we'd continue with the case 

review. The Board has looked at a number of 

claims of cases that were submitted and completed 

over the last several years, in order to 

understand the claims review process and to raise 
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questions to improve our understanding of that 

process.

And I thought then that we would look 

at, go back to some of the issues from yesterday 

that were raised. Actually, there's one issue I 

would like to discuss after we do the public 

comments, before we go into the case review.

In any event, in any event the public 

comments. So, there was one written public 

comment that's come in that's on our website. Ms. 

Rhoads did any additional written comments come 

in?

(Off-microphone comments.)

CHAIR MARKOWITZ: Okay. So, we haven't 

seen those. But we will look at those. The one 

comment that came in had to do with, it was from 

Donna Hand, who I think is an authorized 

representative.

Had to do with the medical findings of 

chronic beryllium disease. And it was an excerpt 

from the Agency for Toxic Disease, Toxic 

Substances Disease Registry, ATSDR's profile on 
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beryllium.

And it was simply a listing of the 

medical findings. And no comment was made on 

those medical findings. I think the implication 

was that the findings are broader than what's in 

the Act, or what's used by the program.

But I advise the Board members to take 

a look at that and see if, see what meaning you 

attach to it.

So, we had a number of public comments 

yesterday. Any thoughts on those comments? Dr. 

Bowman.

MEMBER BOWMAN: Yes. This is Aaron 

Bowman. One of the, a theme that I thought that 

arose from the public comments, including even 

the large amount of comments about the accident.

But there was a theme that came out of 

a need for IH or CE to reach out to claimants to 

get additional information. And I think that was 

one of the underlying themes of what was being 

asked for relating to the accident. But that was 

a much broader incident.
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But in addition, some of the other 

public commenters I think brought that up. And we 

talked about that as a Board as well yesterday. 

And so, I thought that sort of emphasized that 

discussion as well.

CHAIR MARKOWITZ: This is Steve 

Markowitz. There was a comment from a former 

industrial hygienist at the site. One of the 

first, I think it was the second public 

commenter, who talked about when he first started 

in 1981 I think it was.

And was surprised by some of the 

conditions he found, the relative lack of control 

of exposure to salient toxic substances.

And it made me wonder, you know, how 

much of that is actually captured in the DOE 

records, or the contractor records, which DOE 

would have, and is documented for the purposes of 

claims review.

And not just those particular 

episodes. It's really anecdotes. But in general I 

was surprised that into the '80s, early '80s that 
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there was what appeared to be a pretty severe 

lack of controls for some obvious toxins.

In any event, I don't want to read too 

much into it. But I was struck by that. Any other 

comments or thoughts? Okay.

So, before we go to the case review I 

wanted to raise something that we had discussed 

briefly yesterday. And really for the purposes of 

brainstorming and exploration, not necessarily 

for the purposes of developing a recommendation.

Which is, when changes in the SEM are 

made, when knowledge, new data become available 

from DOE about, historical data about what was 

used in various sites, various buildings, and 

that new information could support finding of 

causation for claims, the challenges of using 

that new information retrospectively, or for 

people who had been through the claims process 

and had been denied years before.

And someone mentioned that in the 

special, on the radiation side of the program, 

which is not our business. We're on the toxic 
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substances disease site.

But on the SEC, the special exposure 

cohort side, the original Act had really I think 

three special exposure cohorts. They were the 

gaseous diffusion plants.

But since that, but identified a way 

to add special exposure cohorts where, for those 

of you who are unfamiliar, it's a way of adding 

groups of workers at various sites who meet 

certain criteria.

They worked for a certain amount of 

time, certain years at particular sites or at 

particular places within those sites, who would 

have been, or should have been monitored for 

exposure to radioactive materials.

That's roughly the criteria for an 

SEC. They're more specifically written. But in 

any case, when there have been some 110, 120 new 

SECs, I think there are probably some people here 

who know the exact number, developed over the 

last 30 years since, 20 years since the Act was 

passed in 2000.
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And when they pass a new SEC the DOL 

actually informs people who would submit from 

those special exposure cohorts or from those 

sites who may now be available, may now be 

eligible for compensation.

The DOL affirmatively, proactively 

informs those previously denied claimants of the 

special exposure cohort and their possible 

eligibility at present, given the change.

That seems to be a very appropriate 

and claimant friendly process that when you 

change the policy, develop new information, that 

you go back retroactively and inform claimants 

that they may be eligible. And they may want to 

resubmit a claim.

It also strikes me as something pretty 

easy to do, at least from the outside. Because 

you know a lot about that claimant already. You 

know where they worked. You know the years that 

they worked.

And so, it's probably relatively easy 

to identify who's likely to be now newly eligible 
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based on that special exposure cohort. Because 

you know what that worker did, where they did it. 

It's in the file of their original claim, which 

site, what years, et cetera.

So, whether they are likely to be now 

eligible under the special exposure cohort 

criteria is mostly known from available data, 

data available to DOL.

And so, when they reach back they do 

so based on knowledge about that claimant, and a 

fairly high likelihood that the claimant is now 

going to be eligible. That's a very favorable 

situation.

Now, let's move on to our side of 

this, which is toxic substances and occupational 

diseases. And now the SEM is continually 

improved, right, with new understanding, new data 

became available from DOE, from the contractors 

on the various sites.

We learned a little bit about that 

yesterday. And it's an ongoing process. It may 

not be perfect. We'll talk more about that I 
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think going forward.

But when that new information is 

integrated into the SEM we've learned that a 

parallel process of going back and informing 

claimants previously denied, that they may now be 

eligible based on the new knowledge in the SEM 

about the sites, that that is, that that's not 

done. The Department of Labor doesn't proactively 

go back and inform previously denied claimants 

that they may now be eligible.

And I think we've heard, we haven't 

really discussed that. But I think it was written 

in one of the communications to us. And also, we 

heard very briefly yesterday that part of the 

problem is that they don't, either they don't 

have the data or they don't have, the data aren't 

available in order to make that decision.

And, I mean, we could ask for some 

clarification about that. But I would think part 

of the problem is, I mean, picture it. A toxic 

substance disease claim, a person based on their 

job title, based on their exposure submits a 
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claim. Various toxins are identified in the 

process, some by the claims examiner through the 

SEM, and others through information provided by 

the claimant.

And then you would need to have that 

information available, and good information about 

the health condition, the medical condition, in 

order to identify who might be eligible looking 

back, who might be newly eligible based on those 

data.

And it makes sense to me that it would 

be a challenge for the program to be able to 

identify those data from the previous claim in a 

way that, in a comparable way to the radiation 

side where, you know, there's a fairly high 

likelihood that you're newly eligible for 

compensation based on this new information.

So, I really just wanted to open that 

up for discussion. Because it struck me as, first 

of all, there's this like obvious difference 

between the two parts of the program.

On the radiation side they can go back 
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and inform claimants that they may be newly 

eligible. And there, it's very challenging. And 

there's no, or it seems to be little intent or 

actually implementation of going back based on 

new information on the toxic substances side.

And it struck that that kind of 

asymmetry, whether it's possible to bridge that 

somehow. That the toxic substance side could do a 

better job comparable to what's done on the 

radiation side. So, Ms. Whitten.

MEMBER WHITTEN: I agree with you. And 

I think a good example of that will be when and 

if Patty Murray's bill gets passed in the Senate 

to line up the Department of Labor's beryllium 

sensitivity testing to mirror Washington state's 

and DOE's. There should be a mechanism for the 

Department of Labor to go back to all those 

denied claims and make those right.

CHAIR MARKOWITZ: Mr. Key.

MEMBER KEY: Yes. I agree with your 

comments. One of the main problems that I see 

from the claimant community and the Worker Health 
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Protection Program coordinators, and us even as 

Board members, when changes are made to the SEM.

We have discussed yesterday several 

omissions that we have made to the Department of 

Whereof, correction of those have not occurred. 

We also had this discussion at our fall meeting.

When any changes to a SEM is made, it 

is my opinion and belief that those proposed 

changes should first come to this Board. And 

after that, prior to implementation a bulletin 

needs to be issued by the Department advising of 

the specific changes.

Because without having that knowledge 

we stumble upon these changes as we're going 

through and trying to file or help assist 

someone, a claimant, in filing a claim. And we 

discover that this information's not included or 

has been removed. Or something else has been 

added.

You have to understand, from a 

claimant in a Worker Health Protection Program 

coordinators the SEM is the bible that they use 
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in preparation of the claimant's claim prior to 

them taking it to any resource, regional resource 

office to be filed.

So, if they don't have the accurate 

information, of course the claim goes through the 

process, is denied. So yes. There needs to be 

major program improvements to that issue.

CHAIR MARKOWITZ: Other comments? Dr. 

Van Dyke.

MEMBER VAN DYKE: So, getting back to 

your, do we need to go back and review claims 

based on new information? I mean, I definitely 

see that as, you know, radiation and toxic 

substances are similar, but a lot different.

And I think at a minimum, you know, if 

something like this beryllium bill passes, or if 

there are new exposure disease relationships, 

those should be looked at. Because you could just 

look at the diagnosis and go back at claims that 

were denied based on a particular diagnosis.

But I think trying to figure out a way 

to do that when the SEM is changed, you know, 
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there's so many variations of what could happen 

with the SEM changing. I think that makes it more 

difficult. But I agree. Something needs to be 

done to look at denied claims when things change.

CHAIR MARKOWITZ: Ms. Cloeren.

MEMBER CLOEREN: I agree very much 

with Mike. I think it would be impractical to try 

to do this based on changes in the SEM. That 

said, I think we need more visibility about how 

the SEM is changing.

And I wonder about the change plan. 

There's probably, I believe in the responses that 

there is like the change plan. It would be good 

to review that so that we could maybe identify 

like big chunks of deletions that need to be 

looked into further.

But I think when the policy changes 

that would change eligibility, that I think that 

is much more practical and really should be done, 

you know, looking at denied claims that would be 

affected by policy changes.

CHAIR MARKOWITZ: Yes. It's Steve 
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Markowitz. I think most changes in the SEM would 

not lead to previously denied claims being 

accepted. Because they're probably not either so 

informative or so universally applicable that 

they're going to affect the vast majority of 

claims.

I do worry if, you know, for instance, 

if the Department were to, when they make a 

change in the SEM at a given site send a letter 

to all previously denied claimants. We've changed 

the SEM. You may want to, you know, look into 

whether you want to resubmit a claim.

But that would lead to an enormous 

number of disappointed claimants. Because for the 

most part the information is not going to really 

change the outcome. In some cases it does, it 

would. But probably not in the majority.

And you're sort of setting up a lot of 

people for disappointment. That strikes me as a 

definite down side to this.

But while we're discussing the SEM, 

and we're going to continue the SEM Working 
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Group. And I take it the SEM Working Group would 

probably welcome some new members of that Working 

Group to discuss SEM issues. So, if there's 

anybody on the Board who would like to join that 

group I'm sure you would be welcome. So, think 

about it.

MEMBER FRIEDMAN-JIMENEZ: One comment 

I'd like to make. George Friedman-Jimenez. I put 

my hand up. But I don't know if --

CHAIR MARKOWITZ: Yes. I'm sorry, 

George. I'm not paying attention to the Board. 

So, this is true for all of you. Just break in as 

you did. So, thanks.

MEMBER FRIEDMAN-JIMENEZ: Okay. My 

comment. I don't entirely agree with what you 

just said about that you don't think that changes 

to the SEM would affect compensability for the 

majority of claimants.

There is one change to the SEM that we 

have made based on recommendation in the past, 

which is adding IARC Group 2A probable 

carcinogens, to the list in the SEM, when 
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previously it had only been Group 1 known 

carcinogens.

And I think this is a substantial 

change that could potentially affect 

compensability of people with cancer. The 2A list 

is at least, it's longer than the Group 1 list.

So, there are some people whose 

cancers might now be considered potentially 

caused by toxic exposures that previously 

weren't. So, I just want to make that comment.

Incidentally, in my case review I did 

find that for prostate cancer, malathion, which 

is a Group 2A probable carcinogen, has been added 

to the SEM. So, that's one encouraging data 

point. 

But I think it would be good to review 

the SEM, and see if all of the 2A carcinogens 

have been added yet, and discuss this.

Does anyone from the Department of 

Labor happen to know how complete this addition 

process for the probable carcinogens is to date?

Has it been completed? Or is it in progress? 
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What's the status?

MR. VANCE: Dr. Friedman-Jimenez, this 

is John Vance. We made the changes that the Board 

had recommended for all the added health effect 

information the Board had agreed on, I want to 

say quite a while ago.

We did provide a written response to 

the Board about those changes. But I know the 

prostate cancer one was added. We added some 

health effect data on a series of lymphomas. We 

added a breast cancer one, I believe.

There was a series that the Board had 

recommended. And we did make those changes. And I 

think we confirmed that in a written response to 

the Board.

MEMBER FRIEDMAN-JIMENEZ: Excellent. 

Thank you.

CHAIR MARKOWITZ: Other Board 

comments. So, yes, go ahead Ms. Splett.

MEMBER SPLETT: I was involved at 

Hanford when the Part B SECs were changed. And 

the Department of Labor did indeed come to the 
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Tri-Cities and hold public meetings. 

And they independently reached out to 

every claimant in telling them about those 

meetings and what process they should follow. Not 

that they individually had to open or reopen 

their claim. But the Department of Labor was 

doing that directly.

And so, something similar could be 

done. Because to expect someone, a member of the 

public, depending on their age and other kind of 

status, to follow the SEM changes and 

understanding whether a certain toxin was, status 

was changed, is really not very plausible.

I think there would be such a small 

percentage, unless the Department of Labor 

independently reached out to those claimants.

CHAIR MARKOWITZ: But, Steve 

Markowitz. But, you know, it so clearly 

demonstrates the Department understands and 

believes in the value of reaching back to people 

who may be newly eligible, and assisting them. 

Dr. Van Dyke.
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MEMBER VAN DYKE: So, this is a new 

topic. But based on public comments. Are you 

ready for a new topic, Mr. Chairman?

CHAIR MARKOWITZ: Let's just close 

this out if we could first --

MEMBER VAN DYKE: Come back.

CHAIR MARKOWITZ: -- for a couple of 

minutes. Yes. So, I want to just ask Mr. Vance, 

what is the complexity? What are the challenges 

involved with doing, with reaching back to people 

on the toxic substances side of the ledger when 

the SEM is changed?

MR. VANCE: I mean, you're, Dr. 

Markowitz, you're aware of how fun dealing with 

data analytics is with this program, just in how 

we adjudicate our cases and the information we 

maintain about that case management process.

So, the challenge is always going to 

be I think the things that you've touched on, is 

it's going to be very difficult for the 

Department of Labor to do some sort of automatic 

kind of data screening to determine which cases 
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are potentially impacted by a change in the Site 

Exposure Matrices.

What you're generally going to be 

talking about if we're even going to be in a 

position to do that, you're talking about a 

manual review.

Somehow identifying cases potentially 

impacted, having individual claims examiners 

taken off the normal process of case adjudication 

to go back and look at whatever this inventory of 

cases are that are impacted.

You'd then have to determine whether 

or not there's a likelihood that something that 

has changed in the Site Exposure Matrices is 

going to potentially positively impact that case.

And don't forget that this is an 

exposure component. This is not necessarily going 

to be something that's going to change the entire 

dynamic of the case unless we would potentially 

be looking at a triggering of a presumptive 

standard. So, you have a lot of these variables 

and parameters that you're going to have to think 
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about in doing it.

And if you're going to take an entire 

category of denied cases since the inception of 

the program under Part B for a particular type of 

cancer, you're going to have to figure out the 

criteria that you're going to want to apply to 

look at those cases, to determine what's the 

likelihood that this data change is going to 

affect the outcome of the case.

Because that's going to take time for 

the Department to reopen those cases, to go 

through the process of redoing the exposure 

analysis, and then sending that off to a 

physician, or obtaining information from the 

claimant's physician as to whether or not that 

data in some way changes their interpretation of 

causality, given that we probably previously 

denied the case.

So, you have a lot of these very 

complicating factors that you have to think 

about. And you have to be aware of the production 

side, and the administrative challenge of doing 
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this work and determining what the benefit versus 

the cost might be for that.

And the Site Exposure Matrices is a 

gigantic database. So, if you're talking about 

the type of changes that are occurring, you know, 

you could be talking about very small minor 

issues that are being updated, additional toxins 

being added.

You know, there could be wholesale 

information being added about labor categories or 

what have you. So, you also have that dynamic as 

well. What is the impact of those changes? Are 

they significant, insignificant? You know, where 

is your cut off?

So, you have a lot of issues that are 

involved with this kind of thing. And I think the 

Department's position would be, you know, where 

we can feasibly do something, and we think it's 

going to produce a good benefit for the claimant 

population, we're going to do that.

So, I think that would be something 

the Board would have to consider in any 
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recommendation about this topic.

CHAIR MARKOWITZ: Thank you. Actually, 

Dr. Van Dyke's idea of identifying a subset of 

claims that are more likely to be impacted, for 

instance, as an example let's say at a given 

site, Pantex, we've learned that 

trichloroethylene was used, certain buildings, 

certain operations, certain job titles over a 

certain period of time.

And we didn't know that before. And 

there were say, since trichloroethylene is 

associated with kidney cancer, and there were 

claims that came in for kidney cancer previously, 

now learning that trichloroethylene was at the 

site in a significant way, one might reach back 

to previously denied kidney cancer cases and 

raise the issue about resubmission based on 

potential exposure to trichloroethylene.

So it may be subsets that would be 

feasible, given the way the data are established. 

But we probably should move on. So, my question 

really for the Board is, is this a topic that we 
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want to continue to discuss?

So we don't need to vote on this. But 

for the Board members who are online, the people 

in the room here are shaking their heads yes, by 

and large. What do you all think online, Dr. 

Vlahovich, Mikulski, and Friedman-Jimenez?

MEMBER FRIEDMAN-JIMENEZ: I think 

following through on this to make sure that 

recommendations that have been accepted in the 

past are actually implemented is worthwhile.

It sounds like the Department of Labor 

is already well on the way to doing that. But I 

think we do need to discuss how the addition, for 

example, of the 2A carcinogens should be 

disseminated or acted upon retrospectively.

You know, moving forward into the 

future it's clear. But past cases it's not clear 

how people would find out, and whether cases 

should be reopened.

And doing it in an efficient way I 

think is important. But I think it's important to 

do it.
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CHAIR MARKOWITZ: Okay. I think we 

should move this topic into the SEM Working 

Group, which again invites new members to assist 

with this.

But I think one of the first steps 

should be to engage with the Department more, and 

get a deeper understanding of the challenges 

here. Because clearly they would be formidable.

And we don't want to make any 

recommendations that really are so off target 

that they're unlikely to be accepted just because 

they're totally unrealistic. So, let's move on. 

Dr. Van Dyke.

MEMBER VAN DYKE: So, I just had one 

more thing based on public comments yesterday. 

Mr. Tebay made comments about use of an interview 

system.

And I think we've talked about that as 

Board over and over, that we think an interview 

is a really good way of collecting the data about 

exposures in jobs.

I mean, the public comments seem to 
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indicate that the exposure interview process was 

not being used. So, is there any place to really 

ask that question of the Department, around, you 

know, are these IH interviews or CMC interviews 

being done?

CHAIR MARKOWITZ: Yes. We can ask, but 

the procedure is that if an interview is 

requested either by the industrial hygienist or 

by the claimant, that it's the claims examiner 

who acts as the traffic cop.

And I think the procedure reads that 

the industrial hygienist actually submits 

questions to the claims examiner, who conducts 

the interview. I don't think the CMC is even part 

of the picture.

But when we last asked about this 

mechanism it was very rarely used. I think there 

were, when we last asked probably like one to two 

years ago they cited maybe there were a total of 

two to three interviews done.

Mr. Vance, has that changed at all? Is 

the interview being used any more than it was 
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previously?

MR. VANCE: It's being used primarily 

where we have relatively contentious arguments 

over the extent of exposure. I've talked to our 

industrial hygienist team. I've been encouraging 

its use. And I'm going to say a couple of things 

about that process.

We have used it to resolve questions 

about exposure in some contentious situations. 

And I will say that has resulted in positive 

outcomes for certain cases.

In other situations the interview has 

actually sort of worked against the claimant. 

Because when they are asking specific questions 

about the extent of their exposure, their 

proximity to particular materials, the IHs are 

also collecting information that's not 

necessarily going to be beneficial to the claim.

So, keep in mind that that dynamic may 

also exist, that our industrial hygienists, when 

given the opportunity to ask really specific 

questions about, how did you actually use this 
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material, how close were you to this material, 

the answers may not actually be amplifying a 

significant exposure. So, we've encountered that 

as well.

So, I think that the IH interview 

process can be useful where we are, you know, 

encountering something that's really contentious. 

But it has just not been something that has been 

used frequently by the Department of Labor, 

because the process is working relatively 

efficiently based on the information that we do 

get.

And that's why it's so important and 

so critical for folks to be providing as much 

information up front in their occupational 

history questionnaire, or any information that 

they're supplying to the Former Worker Program.

Because all of that information would 

be really setting the framework for industrial 

hygienists to have a pretty good understanding 

about the extent of exposure that they would 

characterize in the first place.
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So, I think that whatever the Board 

would recommend, just be aware of those 

contingencies there. Because the interview 

process may not always work to the advantage of 

the claimant.

CHAIR MARKOWITZ: Thank you. I 

personally believe that the claims should be 

decided based on the best available information, 

however that information rolls. So, you know, so 

be it.

Let me make a request though, that we, 

the Department provide, not now, but provide us 

with the number of these interviews, either 

initiated by the Department, by the program, or 

by the claimant that have been conducted each 

year over the last three years, so we have an 

understanding.

But I have just one last comment. One 

of the changes in the Procedure Manual is this, 

on the level of exposure by the industrial 

hygienist.

It used to be there was either 
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incidental, meaning, you know, unimportant 

exposure. Or it was significant, and then 

significant was divided into low, medium, and 

high.

And now there's a new category, which 

is between incidental and significant. And my 

concern is that without good information it's 

hard to make that determination of where the 

exposure belongs.

And I suspect this new category, given 

insufficient information is going to be used a 

lot. And this is new to the program.

So this, I think, intensifies the need 

for as good information as they can get in terms 

of characterizing the exposure. Dr. Cloeren.

MEMBER CLOEREN: Hi. Marianne Cloeren. 

If the logistics are actually that the industrial 

hygienist submits questions for the claims 

examiner to ask the claimant, then I think we're 

missing a good opportunity for the industrial 

hygienist to be able to ask follow-up questions.

So, I would hope that there's an 
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opportunity for maybe the claims examiner and the 

industrial hygienist to participate in a 

conference call with the claimant.

CHAIR MARKOWITZ: So that's, yes, a 

factual question. Mr. Vance, how does it actually 

work? Is the IH on the phone with the 

interviewer, or with the claimant?

MR. VANCE: The industrial hygienist 

is part of the conversation that they have with 

the claimant. Because there's a lot of 

interaction and dynamic questioning that can flow 

from that interview.

So, the claims examiner and the 

industrial hygienist coordinate with regard to 

what it is that they are going to be seeking 

information about, whatever the particular topic 

of contention might be, or whatever it is that 

they want to know about.

They then have the call. The 

industrial hygienist will go through whatever 

questions or issues and follow-up that they have 

with the claimant. The CE will be participating 
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to be aware of what the nature of the 

conversation is.

The CE is then responsible for 

recording the conversation, or the facts of the 

discussion in some sort of memorandum that will 

then be forwarded back to the industrial 

hygienist for them to consider, as far as, you 

know, conducting any kind of reassessment of the 

level of exposure.

So, it is going to generally inform 

what the industrial hygienist will be doing as 

far as characterizing the exposure.

And in most of the interviews that I 

think that I'm aware of, the interview has always 

been some sort of argument over the extent of 

exposure that has been previously assigned by an 

industrial hygienist.

And they're trying to seek 

clarification because of some concern or issue 

that the claimant has raised in the adjudication 

process. And they want to talk to the claimant 

about that.
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CHAIR MARKOWITZ: Thank you. Mr. Key.

MEMBER KEY: Yes. Jim Key. Is the 

claimant provided with the list of questions 

prior to the telephone interview, to allow them 

to recall their memory, to allow them to better 

inform the CE and the industrial hygienist of the 

activities that they performed?

MR. VANCE: Mr. Key, I'm not 100 

percent certain that they would notify the 

claimant up front. I do know that they schedule 

the call, and they do alert the claimant or their 

representative about the nature of what it is 

they're going to be talking about.

So, they will have a semblance of an 

idea as to what it is that they're going to be 

calling and talking about. Whether or not they 

provide the specific list of questions that 

they're going to be pursuing, I'm not certain of 

that.

I think my general understanding would 

be, no they don't. But I'd have to check and 

follow up with our folks in the field, and just 
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take a look at the procedure again. I just don't 

remember off the top of my head if they provide 

those questions before the call.

MEMBER KEY: Yes. Jim Key again. I 

would expect if I'm going to be conducting a 

telephone interview on my exposures or past work 

histories, I would expect to have the opportunity 

to have that list of questions a week before any 

telephone conference.

CHAIR MARKOWITZ: Steve Markowitz. I 

would agree. I mean, we're asking people to 

recall events, circumstances from years and 

decades ago.

And if the claims examiner has a list 

of written questions that they're going to ask it 

seems kind of straightforward that those 

questions would be provided to the claimant 

before the interview. Dr. Van Dyke.

MEMBER VAN DYKE: So, this is about 

the more than incidental but less than 

significant. Are we ready to talk about that?

CHAIR MARKOWITZ: Yes. I think we are 
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ready to talk about that.

MEMBER VAN DYKE: Okay. So, you know, 

we had a long discussion about this yesterday. 

And I feel like we've talked more about 

significant than I've ever talked about in 

statistics class. And I feel like adding this 

category just paints it even more grey.

And if you look at the case reviews 

that we've done, most of the time what you see in 

the exposure is you see significant low to very 

low. That seems to be something that you see 

over, and over, and over.

I feel like this category really 

replaces the very low significant exposure. And 

the discussion yesterday really focused on, we 

needed to be very sure whether it was significant 

or incidental, that that was very much of a 

trigger for other things.

And now in this policy, you know, the 

Department, I'm not sure why, has added a layer 

of grey between those two.

So, my question would be for the 
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Department, really, you know, why this change? 

And how did this come about? And what purpose is 

it serving?

CHAIR MARKOWITZ: I don't, Mr. Vance, 

do you want to answer those questions?

MR. VANCE: I can try to provide sort 

of a summary description of what occurred here. 

So, I think what we're dealing with is we're 

touching on the reality of the history of the 

atomic weapons production process.

And the issues that are involved with 

these claims that we received that involve sort 

of more recent claims involving toxic substance 

exposures.

And we've always hovered around this 

sort of like understanding that in the 1990s is 

where we sort of settled, is that the Department 

of Energy had a much more rigorous set of 

occupational safety and health standards which 

they applied, you know, in protecting worker 

health.

Now, that being said, that does not 
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mean that there were not instances where 

employees, you know, starting in the 1990s and 

all the way through to the present could have 

been put in a situation where they were being 

exposed harmfully to toxic materials.

But, you know, in our discussions with 

our industrial hygienists and in discussions with 

the Board in the past, we've tried to wrestle 

with this reality.

And the Board had expressed some real 

concerns about this language that the industrial 

hygienists were trying to use to communicate 

that, you know, starting in the 1990s it's hard 

for them to say that there would have been a 

consistent type of exposure by a lot of employees 

that would have put people into some sort of 

occupational threat or hazard without somebody 

knowing about it, without there being some sort 

of record or monitoring.

And so, they used this language that 

the Board didn't like that spoke to, within 

regulatory limits. And that definitely had some 
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flaws. And so, the Board had asked the Department 

of Labor to take a look at how we could address 

this.

And so, what we did was we spent a 

good chunk of time trying to figure out how do we 

characterize this exposure in such a way that 

makes sense from an industrial hygiene 

perspective.

And so, what you saw was the 

production of this admittedly hard to define kind 

of concept. But what the industrial hygienists 

with the Department of Labor sort of agreed on is 

that you're going to have these situations where 

you're going to have employees that really are 

working with materials quite frequently.

But there are going to be probably 

pretty rigorous occupational safety and health 

standards in place that are not going to allow 

that person to be put into a situation where 

they're inhaling large amounts of dangerous 

material, or they're going to be exposed 

externally to this material, or ingesting this 
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material.

And so they were trying to come up 

with some classification of that type of 

environment. And so what you'll see in our 

existing procedure is this sort of language that 

says, well, they weren't not working with this 

stuff in an incidental way.

In other words, they were working with 

this material. But it wasn't some sort of nonroutine kind of contact. It's routine contact. 

But it's not something that they can say this 

person was routinely inhaling and being dermally 

exposed to this material, or ingesting this 

material.

And so, they can't really argue that 

that's a significant exposure. So, you have this 

kind of weird middle ground where it's, you were 

routinely working with this stuff, but not in a 

way that was going to result in a significant 

exposure.

Because there were mitigation 

thresholds that were existing at the site that 
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prevented that from occurring. There were 

personal protective equipment standards that were 

much more rigorous, and that sort of thing.

And that's what our industrial 

hygienists are doing now. They're looking at the 

data and they're saying, do we see any issues 

here? Do we see any evidence of violations of the 

protocols?

Because generally there would have 

been much more rigorous safety, reporting of 

violations involved. There would be monitoring 

data.

So, they're basically looking at the 

data and saying, is there any evidence there that 

there was an exposure that could have been a 

threat to the employee from an occupational 

standard.

And so, that's what that language is 

trying to get to, is that you have workers after 

the 1990s that were working in environments where 

there could have been hazardous materials.

But how do you communicate that we 
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don't think that there was a significant threat 

to that individual, because there were 

significant occupational safety and health 

thresholds that were in place to prevent that 

type of dangerous exposure?

At the same time acknowledging there 

could have been instances where violations did 

occur. And we have seen that. And that's what the 

industrial hygienist would be looking for, 

examples or monitoring data in the record that 

would suggest that there was some sort of threat 

that occurred because of an exposure. 

And that's what they would report out 

as like, if that is occurring in case evidence, 

then that's probably a finding that the 

industrial hygienist would say, that's a 

significant exposure because that person went 

beyond what was in place at the time, and 

recognize it as an occupational and safety 

threat.

So, it's a very complicated topic. We 

have amended our Procedure Manual. And I think 
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the focus should be of the Board looking at that 

language and trying to ascertain how to deal with 

this reality that the Department is trying to 

wrestle with, with regard to profiling and 

characterizing these exposures in a way that's 

not the same as you would look at somebody from 

the 1940s, '50s, and '60s, all the way through 

history.

So, you've got to look at that sort of 

like that flow, the history of the production 

complex. So, hopefully that gives you a little 

bit of a better understanding. It's definitely 

something that is complicated. And I know that 

our industrial hygiene team has really wrestled 

with this.

And the production of our Procedure 

Manual edition that includes this new language is 

the outcome of our discussion about it. But I'm 

certain we would welcome any kind of input or 

thoughts about the topic from the Board.

CHAIR MARKOWITZ: Thank you. Dr. Van 

Dyke.
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MEMBER VAN DYKE: I was just going to 

say that it sounds like your industrial hygienist 

staff hates the word significant just as much as

we do, and is really struggling with how to 

define that. So --

MR. VANCE: I'll just say no comment 

on that.

MEMBER VAN DYKE: So, yes. I don't 

know what else to add about that.

CHAIR MARKOWITZ: Yes, Steve 

Markowitz. This feels a little bit like whack a 

mole, I have to say. Because previously the 

program used 1995 as a dividing line that there 

was a new Executive Order, DOE 440.1 I think it 

was, 1995.

And the assumption was post '95 the 

conditions of work were cleaner. People had fewer 

exposures. And, you know, you had to prove to the 

program you had exposure.

Then the Board pointed out that seemed 

a little arbitrary to us. Maybe it didn't 

correspond to reality. And so, they took that 
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away. And they started using does not exceed 

regulatory standards.

But that was problematic for a number 

of reasons we don't need to go into, program 

agreed. And they took away use of that term. And 

now we have yet another category which is, the 

exposure wasn't significant. It was there, but it 

wasn't significant.

Significant is a very important word 

in this program because it triggers some 

presumptions, triggers the way in which the claim 

is evaluated.

So, I understand the problem the 

program had, which is you either had incidental 

exposure, which is essentially nothing, or you 

had significant exposure. It was either/or.

So now they have this intermediate 

term, which we don't really have a good name for. 

It's called more than incidental but less than 

significant, where you can park a lot of 

exposures, which means that, I think that 

categorization of exposure is going to 
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communicate to the CMC this is not an important 

exposure. You don't have to worry about this.

I mean, as a CMC, as a physician 

that's the way I would interpret that, and 

probably correctly so.

So, I come back to, to me the 

challenge is you've got the reality of what the 

person did in the workplace, whatever that 

entailed in terms of exposures.

And then we're struggling with, we 

have the industrial hygienist's representation of 

that, their understanding of what happened, 

right, based on their knowledge, expertise, 

judgment. Based on the occupational health 

questionnaire and the like.

And the struggle is how to get that, 

what the IH understands as close to what the 

worker actually did as possible. And I'm not sure 

that this new categorization is an advance on 

that. Dr. Bowman.

MEMBER BOWMAN: Yes, Dr. Markowitz. I 

was actually going to make a comment directly 
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related to what you were saying about how the CMC 

or other physician might interpret this term of 

between significant and incidental.

And as I understand this term is used 

mostly then for an exposure that might otherwise 

have been significant if there weren't controls 

in place.

And so I think having some 

specification that that's what that means, then 

if a CMC sees a medical condition that is highly 

consistent with exposure to that substance, that 

would imply that the controls did not work, I 

think.

And so, but saying this other term 

just between, I think that might leave it 

unclear, was there even the absence of any 

controls, of chance for an exposure that could 

lead to a disease.

But if it's in fact cases where there 

could be an exposure, but the belief is they were 

controlled, and, you know, we know from 

everything we have heard that there are 
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potentially many instances in which those 

controls may not have worked, even though there 

may not be evidence against that.

But I think something about the 

terminology should imply. Because we're talking 

about, all of yesterday with what we did with the 

form is to better inform the CMC to make a good 

judgment call on causation.

And knowing that an individual was 

working in an environment that had chemicals, and 

if those chemicals happen to be directly relating 

to the medical condition, at the heart of it 

knowing that just the failure of those controls 

could have contributed, they might conclude that.

CHAIR MARKOWITZ: Other comments, or 

the Board members who are on the phone? Ms. 

Whitten.

MEMBER WHITTEN: This is Dianne 

Whitten. I disagree with the 1990 date that it 

seems the Department is training the IHs to 

understand that there were better controls 

possibly implemented by DOE.
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But even on our tour Tuesday we found 

that up into 2011 there were no beryllium 

controls in one of the facilities that we 

visited.

And being from the tank farms, it 

wasn't until 2015, 2014 that our council had to 

do a stop work because we had so many, many vapor 

exposures. And the company wasn't doing anything 

to protect our workers.

So, to keep throwing this 1990 date 

out there that there were better controls, it 

just to me, it seems like it's teaching the IHs 

to disregard what was actually happening. Just a 

comment.

CHAIR MARKOWITZ: Ms. Splett. And 

after Ms. Splett I think Dr. Friedman-Jimenez 

wanted to make a comment. But, Ms. Splett.

MEMBER SPLETT: I have a question. Who 

makes the determination, or the call whether it's 

significant or not? On that form I was expecting 

to see a bottom line that said significant low, 

significant high. Does the IH make that call? Or 
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does the CMC make that call?

CHAIR MARKOWITZ: The IH.

MEMBER SPLETT: And is that 

communicated in writing to the CMC?

CHAIR MARKOWITZ: In most of the IH 

reports I've seen there's a description of the 

exposure. And then there's some use of the word 

significant or not, attached to low, medium, 

high, or not.

MEMBER SPLETT: Thank you.

CHAIR MARKOWITZ: Dr. FriedmanJimenez.

MEMBER FRIEDMAN-JIMENEZ: Yes. I think 

that the significant incidental classification is 

in practice a part of the larger causation 

analysis. Because in essence significant is being 

defined as sufficient to be a possible causal 

contributing or aggravating factor.

And it's not just a function of how 

much or the type of exposure, but rather whether 

that exposure is potentially sufficient to cause 

the disease.
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And this is being assigned now by the 

industrial hygienist. And there are other members 

of the team that should have input into the 

causation decision. And I will give one example, 

which is admittedly an extreme example, but I 

think can be extrapolated to others.

For example, the term incidental. 

Exposure to a few drops of dimethylmercury 

solution to a gloved hand of a chemistry 

professor could easily meet the definition of 

incidental, or at least between incidental and 

significant, based on the IH evaluation.

However, this level of exposure has 

been reported to be fatal in at least one case 

that was published, which gave strong autopsy 

evidence of causation.

Causation was proven. And it was a few 

drops not even to the skin, but to a gloved hand. 

So, this could apply to incidental exposures of 

say, asbestos in mesothelioma cases. So we have 

to see it in a larger context I think.

I think that the discussion on how to 
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use the terms significant and incidental should 

be tabled for now. And we should include that in 

a larger deep dive discussion by the Board, or a 

Working Group that focuses on the causation 

analysis in the compensation process.

I think that we can't isolate this, in 

isolation discuss this without discussing the 

larger process of determining causation. And this 

is done by the team, including the industrial 

hygienist and the CMC, and the treating 

physician, and auditors that look at the cases 

later.

So, I think that I would ask the Board 

to consider forming a Working Group to focus on 

the causation analysis. Because I don't think you 

can in isolation define these terms significant 

and incidental without looking at the bigger 

picture.

CHAIR MARKOWITZ: Steve Markowitz. Can 

we just wrap that into the current Working Group 

on significance? It's significance by another 

name. Will it be --
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(Simultaneous speaking.)

CHAIR MARKOWITZ: Let me rephrase 

that. Does anybody not think we should wrap that 

into the Significance Working Group? Okay. So, we 

accept the advice here to suspend this 

discussion, unless anybody has other comments, 

and then put this back in the Working Group for 

further discussion.

MR. VANCE: Dr. Markowitz, can I add a 

really quick comment --

CHAIR MARKOWITZ: Sure.

MR. VANCE: -- and just to make a 

point here is that even with this 

characterization of exposure that the Department 

of Labor is utilizing, you know, we are receiving 

medical opinions from physicians that do argue 

that even at that level of not incidental but not 

significant could have been a factor in the 

development of disease.

And I do know that the Department of 

Labor, you know, works with physicians, 

claimants' physicians and RNCMCs. And we've seen 
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instances where that is not necessarily going to 

result in a denial.

So, remember the distinction here 

between the exposure analysis and the

interpretation of that evidence by a physician. 

So, simply because the Department of Labor 

characterizes an exposure using this criteria 

that we now have in the procedure does not mean 

that a physician can't interpret that in a way 

that would allow for a compensable finding.

It's just going to depend on how well 

the doctor would be able to formulate an argument 

supporting that the exposure, in whatever way 

it's characterized, was a contributing factor.

So, going back to the example that was 

just talked about, an incident where you have a 

very incidental level of exposure to mercury, 

that the doctor's like, hey, this mechanism of 

exposure, whatever it was, was probably a 

significant factor in causing this significant 

illness.

If the doctor can fashion an 
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explanation of that, that reasonably convinces 

the adjudicator that there's a compelling 

relationship, that case is going to be approved.

And I know personally of many cases 

where we're seeing doctors arguing that, you 

know, some, any level of asbestos exposure, 

whether it's incidental or not, could potentially 

be a significant factor in developing all sorts 

of disease. And those are the types of arguments 

that are being made.

So, just make sure that, I just want 

to make sure to, that everybody on the Board 

understands, the question really is, how can we 

communicate this information to a physician so 

that they are well informed, to allow them to 

come to a good interpretation of that evidence.

So, just be mindful of that dynamic 

that exists. And that's it. Thanks.

CHAIR MARKOWITZ: Okay. Thank you. Mr. 

Key.

MEMBER KEY: Yes. Jim Key. I just want 

to add on to Ms. Whitten's comments. DOE and 
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their contractors have always, speaking from 

personal experience since 1974, have been slow to 

implement any regulatory change of outside 

agencies.

Therefore, the IH, contracted IH 

personnel and the CMCs need to understand that 

just because a chemical was outlawed for whatever 

reason and pulled off the market, the Department 

of Energy and its contractors had voluminous 

inventory of some of these chemicals.

And when that announcement was made, 

don't be so naive to think that the DOE directed 

the contractors to conduct an inventory within 

their facility, and to go and pick up all of 

these chemicals at various locations for 

disposal. That did not happen.

These products were continued to be 

used up and through, safe to say 2008, until one, 

a replacement solvent could be purchased, and 

two, the existing inventory was then depleted.

So, I have a feeling that these IH 

consultants and CMCs are evaluating the 
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information based upon anything, as Ms. Whitten 

said, this 1995 date and above, which in 

actuality that did not occur. Those chemicals 

continued to be used.

CHAIR MARKOWITZ: Thank you.

MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez.

CHAIR MARKOWITZ: Sure. Go ahead.

MEMBER FRIEDMAN-JIMENEZ: I would like 

to respond to Mr. Vance's point. I think that's 

an excellent point that you make, that the 

physicians do have independence and are able to 

take whatever the classification of exposure was 

by the IH and consider if that could be causal.

That was a large part of the intent of 

creating the exposure assessment reporting form 

in a way that would allow it to serve as a tool 

for the CMC or the other physicians to quickly 

find the documentation of exposure in this huge 

non-searchable medical record PDF file.

But I think if an exposure is called 

incidental, or even incidental, between 
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incidental and significant, this would push the 

physician who's making the causation judgment 

toward saying that it's non-causal.

Because it's actually fairly rare that 

an incidental exposure would be more likely than 

not a cause or contributing factor, or 

aggravating factor for the disease.

But it's not, it does happen. So, that 

was my argument for saying let's not use the 

words significant or incidental. But I understand 

that there is a potential role for them to keep 

them. But I think it's a complicated issue that 

we should explore in detail. Because it's loaded 

with a lot of baggage for those words.

CHAIR MARKOWITZ: Steve Markowitz. I 

would agree. I don't think the doctor, the CMC, 

is looking at the occupational health 

questionnaire. I don't think they're looking at 

the form that the claimant fills out about their 

occupational history. I don't think they're 

getting their exposure information directly from 

those sources.
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I think for the most part the CMC is 

probably just using the industrial hygiene 

report. Because they think, well, that's the 

expert on exposure. And they've looked at all the 

primary sources. So, I can just rely on whatever 

the IH says.

And if the IH says it's not 

significant, meaning it's below significant low, 

then it's not a meaningful exposure, except in 

the rare, you know, instance. So, these 

categorizations are very important.

I think that just reinforces what 

you're saying, Dr. Friedman-Jimenez. And I think 

that we should, we can move, we should move on. 

We should put this back into the Significance 

Working Group, which probably also welcomes new 

members, I might add, if anybody wants to join 

that group. Mr. Key is smiling, by the way. So, I 

think he might be a candidate.

In any event I think that's the end of 

this discussion, unless anybody else has anything 

else. It's a quarter of 10:00. Question to the 
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group. Do you want to take a ten minute break? Or 

do you want to start in on case reviews and take 

a break in 15 minutes? Okay. Okay. We have a five 

minute break. Okay. So, we'll come back at ten of 

10:00.

(Whereupon, the above-entitled matter 

went off the record at 9:42 a.m. and resumed at 

9:51 a.m.)

CHAIR MARKOWITZ: So we reviewed a 

number of cases yesterday, but we still have a 

number more to go. Does anyone want to start off 

by reviewing a case or have a good particular 

case to review? Or shall I just call on you?

MEMBER FRIEDMAN-JIMENEZ: I could 

start off with 7855.

CHAIR MARKOWITZ: Okay, great. Let me 

just find 7855.

MEMBER FRIEDMAN-JIMENEZ: It's a 

cancer case.

CHAIR MARKOWITZ: What kind of --

MEMBER FRIEDMAN-JIMENEZ: It's the one 

--
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CHAIR MARKOWITZ: Oh, it's a cancer, 

with Ms. Whitten?

MEMBER FRIEDMAN-JIMENEZ: Yes.

CHAIR MARKOWITZ: With Ms. Whitten. 

Okay, go ahead.

MEMBER FRIEDMAN-JIMENEZ: Ms. Whitten, 

is it okay if I start off?

MEMBER WHITTEN: Yes, please.

MEMBER FRIEDMAN-JIMENEZ: Would you 

like to start off? I didn't hear you.

CHAIR MARKOWITZ: Yes, she said yes, 

George.

MEMBER FRIEDMAN-JIMENEZ: Okay, great. 

Okay, this is a case of a 73-year-old man with 

prostate cancer and squamous cell cancer of the 

skin on his ear, who also had asthma. And he 

worked as a clerk and administrative assistant 

for Union Carbide at the Y-12 facility from 1970 

through 1976.

He was listed -- he listed himself as 

assistant statistician as his first job in 1970 

and then assembly auditor as his second job from 
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'72 to '76. But they called him a clerk and 

administrative assistant.

Anyway, he did not report any job that 

is likely to entail possible exposure to 

Malathion, which is the only toxic substance that 

has been associated with prostate cancer. The 

causes of prostate cancer have been quite 

thoroughly investigated in many, many studies, 

and very few toxic substances have been 

associated with it in reports. And really the 

only one that has emerged as, you know, a 

probable human carcinogen causing prostate cancer 

is Malathion, which is a pesticide.

He also did not report any job likely 

to entail possible occupational exposure to 

ultra-violet light or to arsenic or coal tar, 

which are the two toxic substances that have been 

causally associated with squamous cell carcinoma 

of the skin. He did not check the box on 

herbicides and pesticides.

He did have documented exposure to 

ionizing radiation, which was separately 
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evaluated by the Part B Board and the NIOSH dose 

reconstruction and calculations for both cancers 

combined yielded an estimate of 99 percent upper 

bound of the credible interval for the assigned 

share, which was interpreted as a 1.38 percent 

total probability that either one or both of his 

cancers was caused by that radiation exposure.

So this is far less than the 50 

percent threshold, which is required for the more 

likely than not causation criterion. It's not 

even close. And so I think that the radiation is 

far from being accepted as a more likely than not 

cause. So focusing on the toxic substances for 

prostate cancer, I think it's pretty clear that 

this is not work-related.

There were no known or probable 

carcinogens identified in the SEM as causes of 

prostate cancer except Malathion which, as I 

mentioned before, is an IARC Group 2A, i.e. a 

probable human carcinogen. And this was recently 

added. And although it actually wasn't mentioned 

in his report, but he did not have documentation 
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of potential Malathion exposure. I believe the 

report was done before the 2A carcinogens were 

added to the SEM. But there's no change there.

But I think it's encouraging to see 

that the 2A carcinogen is in the SEM and, looking 

forward into the future, will be available to the 

claims examiners, CMCs, IHs, and others looking 

for chemical causes of prostate cancer.

Likewise, there is no documentation

that I found in the 402-page record of jobs with 

potential occupational exposure to sunlight or 

other sources of ultraviolet light or arsenic or 

coal tar. So I agree with the cancer claim 

decision in summary.

I do have an editorial comment on my 

review of this case, which I think now is 

probably a good time to mention it. I noted that 

a large fraction of the time that I spent 

searching the medical record file was scrolling 

manually through this 402-page file looking for 

relevant information such as the statement of 

accepted facts, the occupational health 
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questionnaire, IH report, CMC report.

This time could have been reduced 

substantially if the file were a searchable PDF 

file. More importantly, I am not entirely 

confident that I found all of the information 

that's relevant to the exposure assessment or to 

the causation analysis and decision. I mean, this 

was a little bit haphazard in my scrolling 

multiple times through parts of this 402-page 

file.

So I would think that it would be more 

efficient if either there were a table of 

contents that would be constructed by the 

Department of Labor to assist staff and others 

who need to review the medical record quickly and 

thoroughly, or the PDF file could be converted to 

a searchable PDF file. And I've raised this 

before. It wasn't clear what the problem was with 

converting the files to searchable PDFs.

The table of contents approach may be 

more labor-intensive than converting to the PDF 

searchable format. And it still would not ensure 
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complete inclusion of all the relevant and 

important information for each of the reviewers, 

the IH, the CMC, medical director, external 

auditors. So that's a comment that I would make 

on the process of reviewing this case. So that's 

my take on this case.

CHAIR MARKOWITZ: Okay, thank you. Ms. 

Whitten?

MEMBER WHITTEN: This is Dianne 

Whitten. I believe that they wrongly assigned his 

job as a clerk. For his facility, if you look up 

clerk, there are no chemicals associated with 

that position. I was going through his file, and 

I noticed he had radiation exposure. And I was, 

like, not too many clerks get radiation exposure.

So I did a little deep dive into it, 

and he was actually a QA person that would go 

into the area where they were doing top secret 

stuff. And he would have to, like, inventory 

every little piece that went on this thing that 

they were making. So when they sent the stuff to 

the IH, I don't believe they had the right 
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information to send to the IH.

He also filed for asthma. They did ask 

the IH about his asthma claim. But I don't 

believe they asked about his skin cancer either. 

So I just think they could have done a better job 

of doing a little more deep dive into his actual 

job classification.

CHAIR MARKOWITZ: Okay. Thank you. 

Let's move on to Case 7904, Parkinson's disease. 

Dr. Vlahovich and Mr. Catlin. That's 7904.

And after that we'll do 8666, Dr. 

Bowman and me.

MEMBER VLAHOVICH: So Catlin, did you 

want me to start, or would you like to go first?

MEMBER CATLIN: Sure, why don't you 

start, please?

MEMBER VLAHOVICH: All right. So this 

individual was a security guard at Oak Ridge and 

had worked there for 28 years, five months. The 

claim was for Parkinson's disease as well as 

chronic encephalopathy and toxic neuropathy, with 

the exposure of interest being lead. And this 
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case was accepted for those three conditions as 

well as coronary artery disease.

Let's see, it was sent to an IH for 

review. I would agree with their assessment of 

it. Mr. Catlin, did you have anything else to 

add?

MEMBER CATLIN: No, thank you. That's 

-- it seemed pretty straightforward after you got 

through the 1000th page of the report.

MEMBER VLAHOVICH: Yeah.

MEMBER CATLIN: A couple of things I 

found interesting compared to the few other cases 

I've looked at is I liked the language the IH 

used. He used two separate sentences in 

summarizing exposure. He first said exposure to 

lead he thought was significant. And then he used 

a separate sentence to say that the exposure 

level was low.

And I thought separating those out 

made it -- when I read that it's, like, oh, if 

I'm reading this he's given his first opinion on 

significance very clearly, and then he's 
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describing the level of exposure. And I thought 

it was really helpful to separate those two out. 

I've not seen that language before.

The other thing I liked was I think it 

was in the Parkinson's case. The claims examiner 

sent the IH report back to the patient's 

physician, and then the patient's physician was 

able to write a stronger medical report that was 

then accepted. And I think that -- I had not seen 

that before either. So those were two interesting 

facts in addition to what doctors described.

CHAIR MARKOWITZ: Steve Markowitz, I 

have a question. This is a Parkinson's disease 

case which was ascribed to lead exposure?

MEMBER VLAHOVICH: Yes.

CHAIR MARKOWITZ: And was there a CMC 

involved?

MEMBER VLAHOVICH: I believe there 

was, yes.

CHAIR MARKOWITZ: Okay, thanks.

Does anybody remember whether lead is 

associated with Parkinson's disease in the SEM? 
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Remember, Dr. Mikulski, we looked into this when 

we were looking at Parkinson's disease two, 

three, four years ago?

MEMBER MIKULSKI: No, we have not 

added that in the recommendation. There was very 

limited evidence on metals exposures in 

Parkinson's.

MEMBER CATLIN: I believe, I'm sorry, 

Dr. Markowitz, I believe they used -- the reports 

used Parkinson's disease, but I think they used 

kind of a larger or a broader description of, 

like, Parkinson-like illness.

CHAIR MARKOWITZ: Yes.

MEMBER CATLIN: But didn't that also 

include a toxic encephalopathy and toxic 

neuropathy kind of all together? Am I accurate in 

that?

MEMBER VLAHOVICH: That's how I recall 

it, yeah.

CHAIR MARKOWITZ: Okay. So probably it 

was lead encephalopathy that --

MEMBER VLAHOVICH: Yeah, toxic 
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encephalopathy.

CHAIR MARKOWITZ: Okay. Thank you.

MR. VANCE: Dr. Markowitz, this is 

John Vance. I just looked at it. It's not listed 

in the Parkinsonism health effect category.

CHAIR MARKOWITZ: Yeah. So it was 

probably the neuropathy and the encephalopathy 

that swung the day. Okay, thank you.

I think we're going to do 8666, 

Parkinson's disease, Dr. Bowman and me. Do you 

want to -- this is a, yeah.

MEMBER BOWMAN: This is Parkinson's --

CHAIR MARKOWITZ: Yeah.

MEMBER BOWMAN: Parkinson's --

CHAIR MARKOWITZ: Why don't you start, 

Dr. Bowman?

MEMBER BOWMAN: This is a Parkinson's 

deny case.

CHAIR MARKOWITZ: Yeah.

MEMBER BOWMAN: I have just a brief 

summary of the case from my notes. This is a 

former worker classified as a chemist, worked for 
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a period of about eight years during the '70s. 

They also had a denial case for hearing loss, 

which I know we talked about yesterday in 

general, and that was for insufficient amount of 

time. Following the work period of about eight 

years, there was a much longer period of 

intermittent visits as well to the same site.

So this definition of chemist led to 

three chemicals being focused on in the context 

of the IH. These include monel, steel, and 

trichloroethylene, TCE. I did wonder if there 

might have been additional relevant chemicals for 

anyone working as a chemist in terms of their 

relationship to Parkinson's disease.

The IH report indicated exposure 

classified as occasional and very low levels not 

exceeding the regulatory standards. Then the 

causation took this into account but made a 

determination of does not rise to the level of at 

least as likely as not.

And this was based in part on the 

statement that approximately one third of 
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individuals of this age have Parkinsonian 

features or, as actually stated, quote, "symptoms 

of Parkinson's disease." The latency of 23 years 

was noted as well in the context of the negative 

causation decision.

There is, of course, a fairly high 

incidence of Parkinsonism. In this particular 

case, it's a Parkinson disease diagnosis, which 

is not a third of individuals at that age in 

question.

I wonder if this might be one of the 

cases where you can have two reasonable opinions 

on either side, and some might have concluded the 

other way around, given that this is Parkinson's 

disease and not just a claim for Parkinsonianlike features.

Dr. Markowitz, do you have any other 

comments?

CHAIR MARKOWITZ: So I think the real 

exposure in play here is trichloroethylene. And 

the industrial hygienist is a chemist for nine 

years. Industrial hygienists characterize the 
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trichloroethylene exposure as frequent, very low 

to low.

And I likewise had trouble with the 

medical report, the CMC report here, which gives 

a short but broad overview of toxins and 

Parkinson's disease but doesn't really focus in 

on trichloroethylene, which is the exposure of 

relevance. You know, I think the fact that the 

physician claims that a third of patients have 

symptoms of Parkinson's disease when they're 65 

or over, it is news to me and of no real 

relevance.

The CMC said that the exposures were 

within regulatory standards and therefore are not 

significant. Because they are said to cause harm 

in no more than one in a million exposed people, 

which I think is not universally true of 

regulatory standards.

And then the medical report says that 

the latency is 23 years which is too long. And I 

don't recall that we have a good handle on 

latency in Parkinson's disease. I don't know.
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Dr. Mikulski, do you remember when we 

looked at this, whether the latency on 

Parkinson's disease was well characterized or 

not? So I think the -- do you remember, Dr. 

Mikulski? Did we address the issue of latency?

MEMBER MIKULSKI: No. This issue was 

not addressed in the recommendation, as there was 

very limited data on the latency for occupational 

causes of Parkinson's disease. But we did address 

the issue of prodromal stage of Parkinson's, 

which can precede the Parkinson by over 20 years, 

which certainly implies a longer latency than 

what the studies would have shown.

And with regards to the case that 

you've just talked about, I took the liberty of 

looking up the CMC report. And it is a word-toword, exact copy with the exception, of course, 

of personal identifying information.

Of the report that I looked at and 

reviewed in the Parkinson's case yesterday, this 

claim, this CMC uses exactly the same statements 

to support her argument of this not being as 
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likely as caused by the occupational exposures. 

So it is truly a word-to-word copy of what we 

found in other use.

CHAIR MARKOWITZ: Well, maybe she was 

dealing with universal truths. But let me just 

make one quick response to this. I think my 

problem here, aside from the generalities in this 

report that are not wholly relevant, is that I 

don't see that the doctor is actually taking all 

the issues seriously about the trichloroethylene 

exposure. There may be no causation, but deal

with the issue, deal with the relevant issue at 

least, address it, discuss it.

And so I think, frankly, this report 

is not one that falls within reasonable 

differences. I think it doesn't meet the well 

rationalized standard, because it doesn't -- it's 

long enough, but it doesn't really target the key 

issue.

Dr. Bowman?

MEMBER BOWMAN: Sorry, just on the 

issue of latency in terms of occupational 
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exposure, there is, I would consider it strong, 

epidemiological-based evidence of agricultural 

workers with exposures to various insecticides 

and pesticides of heightened risk for Parkinson's 

disease diagnosis.

And that occurs over very long periods 

of time, multiple decades even between the start 

of exposure and when disease begins to commence. 

So I think there is clear evidence, at least 

within the occupation of agricultural workers, of 

a long latency for Parkinson's disease associated 

with exposures.

And then, you know, I also thought 

potentially monel was a potential link as well in 

addition to the TCE, because there's a number of 

metals in that alloy that have been linked at 

epidemiologically to Parkinson's disease.

Where I was coming from, Dr. 

Markowitz, in terms of your last comment about is 

this -- could people, reasonable people go either 

way on this case, I do agree that this was not a 

good, spelled-out rationale.
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But I am aware, just back when I was a 

basic scientist in a neurology department, that 

there are a number of neurologists that would 

point to this more as age-related and tend to 

ignore, I would disagree with that, but tend to 

ignore the environmental impact. And so that's 

where I was coming from.

CHAIR MARKOWITZ: Sure.

MEMBER BOWMAN: I know there are 

physicians who would tend to ignore that.

CHAIR MARKOWITZ: Okay. Yeah. And let 

me just say that for the issue of latency, 

latency is the time period, the gap between first 

onset of exposure to the material of interest, 

and later clinical diagnosis of disease. It's 

usually very long for the toxins that produce 

chronic diseases.

It's best characterized for cancers. 

And for most other chronic diseases we don't 

really have such a good handle on latency. And I 

mention that in particular because there was a 

case we looked at with COPD in which the, I think 
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it was the CMC said the latency was too long for 

COPD. And frankly, we don't have really good 

information about latency, toxic exposure, and 

COPD. So in any case, anything else on this case 

or --- okay.

MEMBER BOWMAN: No.

CHAIR MARKOWITZ: Okay. I don't know, 

did people have -- I think Dr. Friedman-Jimenez 

and Mr. Key, you had 2282. I don't know whether 

you had a chance to review that one or a chance 

to look at the file or not. But if so, that's one 

of the ones we're -- 2282 and 8472 are ones we 

haven't reviewed.

MEMBER FRIEDMAN-JIMENEZ: 2282 I 

looked at. Mr. Key, would you mind starting off 

on this or I could -- I don't have a wellorganized presentation, but I have reviewed most 

of this case. And I have some thoughts that I 

want add. But I could start with that or if you 

want to present, that would be fine too.

MEMBER KEY: No, sir, Doctor, I will 

defer to you.
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MEMBER FRIEDMAN-JIMENEZ: Okay. This 

is a gentleman that worked for five months as an 

electrician in the [facility name redacted] Plant 

in 1999. He was diagnosed with COPD and emphysema 

in 2019, 20 years later. And the exposure that 

was considered as a potential compensable cause 

of his COPD was asbestos.

So I would agree with the decision to 

deny this claim based on his very low asbestos 

exposure. However, there is a very substantial 

literature that has found that about 15 percent 

of COPD, and higher in non-smokers or ex-smokers, 

is caused by occupational exposures to vapors, 

gases, dusts, and fumes which are not precisely 

characterized as individual toxicants with known 

molecules that have been studied but are mixtures 

and unmeasured or unidentified dusts.

And we've had discussions about this 

in the past of why, they call it VGDF, vapor, 

gas, dust, fumes, exposures are not admissible as 

possible causes in this compensation program.

However, in my view, I believe that 
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this policy is problematic, and it's too facile a 

dismissal of quite a substantial literature by 

now that does support this as a causal 

relationship, in spite of the heterogeneity, the 

variety, variability of the exposures in 

different work places. Even dusts, the dusts are 

of different chemical composition in the 

different workplaces.

But clearly, not all COPD is caused by 

smoking or only by smoking. In this particular 

guy, after about 15 minutes, I found the smoking 

history. I still haven't found a good, thorough 

smoking history in the chart. But he's an exsmoker who quit in 1986. I did not find a 

pack/year quantification of how much he smoked or 

how long he smoked. But he quit 13 years prior to 

starting his DOE work.

And the COPD was diagnosed in 2019 

which is 34 years, is that right, 35 years after 

he quit smoking. So it seems to me that it's 

reasonably likely that he had other contributing 

causes and certainly aggravating causes for his 
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COPD.

You know, his five months work as an 

electrician, it could be argued that no matter 

what he was exposed to it was a low exposure and 

maybe not sufficient to cause COPD. But I do 

think that at some point we should reopen the 

discussion on the VGDF exposure and the 

literature on COPD. Because this is a -- it's an 

easy dismissal, but I think that there is 

something there, there's a real signal.

But I can't make a strong argument in 

this case, because he had five months of work in, 

you know, 20 years before his COPD diagnosis with 

very small asbestos exposure and unmentioned VGDF 

exposure. So I can't really argue with that. I'm 

just raising a problem with the policy.

CHAIR MARKOWITZ: Mr. Key?

MEMBER KEY: Yeah, Jim Key. What I 

found difficult to figure out in this case, the 

Claimant had put down different dates of work 

when he started and then when his employment 

ended. We did a Social Security search and found 
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these quoted five years.

Then I had a little bit of problem 

about the latency period. All of us are different 

in our biological makeups. And so I would 

question the decision on the latency period 

relating to this case.

Also as an electrician, which has been 

my occupation for 48 years also, I would have to 

question if all of his work was in the 

underground at [facility name redacted] where 

there were apparent ventilation problems, even to 

today for installing the new vent system there, 

and the exchange of air.

If his exposure to asbestos, be it 

probable asbestos, was of a low magnitude, though 

he did not have sufficient air flow in the 

underground, that would, to me, raise his 

exposure level to a higher level.

So there's a lot of questions with 

this case that we don't have the information to 

which drives the questions that I have about it.

CHAIR MARKOWITZ: This is Steve 
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Markowitz. I actually looked at this case. And I 

just want to raise an issue, I think it's a 

general issue about latency. Because the CMC said 

that the occurred in the year 1999. And the COPD 

was diagnosed in 2016. And that's 17 years 

between exposure and diagnosis. And that's too 

long for occupational COPD.

And actually that's a tough question. 

I don't think that there's necessarily a 

consensus in occupational medicine about latency 

and COPD. We do know that many people have COPD 

for years before it's diagnosed. Because it's 

gradual in onset, it's slow in onset, and people 

tolerate shortness of breath.

They think I'm just out of shape, you 

know, I can't do what I used to. But that's 

called getting old. And so there's often a delay 

in the diagnosis of COPD. So if you use the time

that the doctor says yes, you have COPD, that may 

be late, not late but well along in the process. 

So that's one thing.

Second thing, we know from smokers and 
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COPD that it is the natural history of what 

happens to the airways is that it takes years for 

the cigarette smoke, from the initial inhalation 

and irritation, for cellular changes to develop 

and advance to the point where a person actually 

had some obstruction, physiologic change in the 

lung.

And so we know that the process of 

developing COPD takes years, at least from 

cigarette smoking. And with occupational agents 

it would be most likely the same thing. So 

latency is a tough issue with COPD. And we faced 

it in our own Former Worker Program, because we 

have many people with COPD.

And we puzzled about the attribution. 

You know, they stopped work in 1990, and their 

COPD was diagnosed 10 years, 20 years later. 

Should we say they were contributed, aggravated, 

or caused?

And our thinking is that it's just 

like the cigarette smoking. If a person was a 

heavy smoker, and they quit 15 years ago, and 
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then they were diagnosed with COPD, chances are 

cigarette smoke contributed to that in some 

respect, even though I'm not sure that latency 

for cigarette smokers is well defined. But I 

think the same logic would apply to occupational.

And what I wonder is, it's not just 

relevant to this case, but I think the 

occupational medicine docs or the CMCs are going 

to --- their opinions are going to be all over 

the place on this issue. In this case it was 17 

years is too long a latency. And I think in 

another case a physician could come to a 

different opinion. And it's probably within the 

realm of reasonable differences.

But the question is whether the 

program should actually have some guidance in the 

Procedure Manual for the CMC in saying, you know, 

if X amount of time has elapsed since last 

exposure to the DOE site, we would consider this 

to, you know, be aggravating or contributing to 

it. So it's nothing we need to resolve, but it 

may be an issue that we could advise the 
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Department on.

Dr. Bowman?

MEMBER BOWMAN: Dr. Markowitz, thank 

you. This issue of latency came up in the 

previous one that we talked about. There are some 

ones that are maybe on the docket for us to 

discuss as well.

This has come up so many times. And 

with the differences of opinion, I wonder if we 

might consider, maybe some deliberation is needed 

first, but consider some sort of a 

recommendation, when the principle basis of a 

denial is a latency issue, that a second opinion 

may be worthwhile, given that there could be a 

large variability in opinion when latency is the 

only issue.

CHAIR MARKOWITZ: That's interesting. 

Other comments on this issue?

MEMBER FRIEDMAN-JIMENEZ: Yeah. I 

think there's generally an inverse relationship 

between the magnitude of the exposure and the 

latency. In other words people that are really 
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highly exposed tend to have earlier onset of 

disease with a shorter latency. And people with 

lower exposures, it can often take longer.

And so I can't see how 17 or 20 years 

is too long a latency. That just, I don't think 

there's evidence to support that statement. So I 

agree with you, Steven. And I think that's not an 

adequate reason.

But five months is quite short 

relative -- and given that it was probably a low 

to moderate level of exposure, Mr. Key, it's 

really helpful to hear your personal take on the 

exposures of electricians. Because it's something 

that doesn't come across in the data that are 

available. And that's very valuable.

So yes, I mean, he can have a moderate 

exposure. Five months is fairly short, and you do 

need a pretty substantial asbestos exposure, I 

think, to cause COPD, as opposed to mesothelioma 

which could occur at much lower exposures. But 

I'm still not sure that we have a viable case to 

reverse this decision. But I think there are some 
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problems here that we're discussing.

CHAIR MARKOWITZ: Okay. So I think we 

will keep the latency issue on our to do list to 

look at again without putting it into a working 

group.

Are there other cases that we haven't 

looked at? Yes, Ms. Splett, what number is it?

MEMBER SPLETT: 8474, Parkinson's. And 

the issue is latency.

CHAIR MARKOWITZ: I'm sorry, 8472?

MEMBER SPLETT: Yes.

CHAIR MARKOWITZ: Okay. And, Dr. 

Friedman-Jimenez, if you have something to say on 

that, I don't know who wants to begin.

MEMBER FRIEDMAN-JIMENEZ: I have not 

reviewed that case in detail, and I apologize. 

I've had so much on my plate in the last week and 

a half, I haven't had time to prepare that case.

CHAIR MARKOWITZ: Not a problem. We're 

not going to dock your pay for that.

And for those who don't know, actually 

we don't get paid. So that's another reason we're 
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not going to dock your pay.

Ms. Splett?

MEMBER SPLETT: The file was 863 

pages. It's an individual who's 79 currently, the 

claim was denied, almost 19 years at Los Alamos 

and Lawrence Berkeley as a mechanical technician, 

liaison specialist, and maintenance machinist.

He filed for stroke and Parkinson's 

disease. The Parkinson's was reviewed for bronze, 

carbon, steel, and stainless steel. The IH did 

say significant exposure to all three of those 

metals, but the claim was denied.

His doctor came back for consideration 

under TCE exposure. The CMC's final decision was 

that it was latency. It wasn't diagnosed for 22 

years after last toxic exposure and 37 years 

after significant exposure. And that was the 

basis for the denial.

But I did notice in the letter to the 

Claimant that was never mentioned. It just said, 

the CMC said it's not related, so it's denied. 

But they never talked about the latency period, 
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but that was the crux of the diagnosis, or the 

decision, excuse me.

CHAIR MARKOWITZ: And when you say it 

was the crux, because the IH made it --

(Simultaneous speaking.)

MEMBER SPLETT: The CMC did. The IH 

referred and said there was significant exposure 

that was well documented, all the materials that 

he had worked with, but the CMC finally, after 

reviewing all the documentation, just said it was 

too long, the exposure wasn't linked.

But again, they did not tell the 

Claimant that. I noticed that in either the 

recommendation letter or the FAB evaluation. It 

just said the CMC denied it.

CHAIR MARKOWITZ: That's interesting, 

because I would have been skeptical of there 

being decisions made only on the basis of 

latency, but here's an example of that.

Dr. Bowman?

MEMBER SPLETT: Again, not a 

physician, but that's just -- as a lay person 
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reading it, that's what I got.

CHAIR MARKOWITZ: Okay. Dr. Bowman?

MEMBER BOWMAN: Yes, thank you, Dr. 

Markowitz, Aaron Bowman. I only gave a cursory 

overview of this, just given the Parkinson's 

disease and association. And there's an 

interesting note, given our conversation from the 

previous case in Parkinson's disease, relating to 

TCE exposure.

There was an IH determination in this 

case that there is no causal link between 

occupational exposures of TCE and Parkinson's 

disease. And that was in the final. And so TCE 

was not considered as a relevant toxic in the 

context of this case, rather a few of the metals 

that were listed were what was considered. And it 

was for that that the latency decision was made 

by the CMC with very little reference, from what 

I could tell in my skimming, to the TCE exposure.

CHAIR MARKOWITZ: I think the TCE, 

Steve Markowitz, the TCE Parkinson's disease or 

syndrome link was only added relatively recently 
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to the SEM. I think that may explain where Dr. 

Bowman --

MEMBER BOWMAN: Yeah, sorry, in that 

context there was -- the official term is, but 

there was a rebuttal to the decision in this case 

that I saw in which relatively new literature 

pointing to the link between TCE and Parkinson's 

disease was cited which was then re-reviewed by 

the IH in this case and deemed to be 

insufficient, because it wasn't population-wide 

in its evaluation. And so I thought that was an 

interesting opinion to express.

CHAIR MARKOWITZ: Yes, interesting.

Dr. Cloeren?

MEMBER CLOEREN: Marianne Cloeren. It 

doesn't sound like it's the right person to be 

weighing in on that, but anyway, what I was -- I 

have a question that's actually, I guess, more of 

a question than fact, how are the CMCs, via the 

contract company, informed when there is kind of 

a change, like the change related to Parkinsonism 

and relation to specific toxicants?
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CHAIR MARKOWITZ: Mr. Vance?

MR. VANCE: I mean, any information 

that we would be providing to the CMC is going to 

be incorporated into a referral. Now how well the 

CMC is aware of specific procedural changes or 

that sort of thing, we don't provide that kind of 

notification to the CMC.

So in other words, if we would go and 

issue a, you know, issue a referral to a CMC, and 

that CMC comes back and something changes in the 

future when we would resubmit that, we would 

update it based on the new data that we had 

collected, including any new health effect or 

exposure data that would be going to the doctor 

for consideration.

CHAIR MARKOWITZ: Other comments? Are 

there other cases that we looked at that we 

haven't had a chance to discuss?

Dr. Bowman?

MEMBER BOWMAN: Sorry, just one other 

feature of this particular case, the 18472, the 

CMC report rests on old data, quite old. I'm
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going back to the 1950s, 70s. And it's focused on 

the levels of metals, the ones implicated in the 

IH report, in the brains of patients, and not the 

evidence of exposure, risk links to Parkinson's 

disease and references that there's a lack of 

evidence in this area.

But at the time this done, there was a 

plethora of evidence. It just pre-dated the 1980s 

or so which is, like, almost the not very current 

literature that was cited.

CHAIR MARKOWITZ: Is that the same CMC 

that had the same opinion and the same 

rationalization in two separate reports?

MEMBER BOWMAN: No, I don't think so.

CHAIR MARKOWITZ: Okay. What claim was 

that?

MEMBER BOWMAN: This one here, I'm 

talking about the one that we were just talking 

about.

CHAIR MARKOWITZ: Oh, I see.

MEMBER BOWMAN: The 18472.

CHAIR MARKOWITZ: Oh, I see. Okay.
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MEMBER BOWMAN: Yeah.

CHAIR MARKOWITZ: Okay. So I know I 

see Mr. Key is getting ready to leave. I think 

that actually we've covered most of the items on 

our agenda, or all the items on our agenda, or 

any new items that we came up with.

In terms of the working groups, we 

have two working groups, Significance and SEM. 

They welcome new members. I suspect they want new 

members of the working groups.

Dr. Bowman?

MEMBER BOWMAN: So I was wondering if 

I might move groups to the SEM group. Because I 

think potentially, since the SEM group is 

discussing the addition of toxicants to the SEM, 

that I could be of help to that working group.

And while I very much enjoy the 

conversations about significance, I think there 

is some redundancy in our expertise. And so I'm 

not certain it is as critical.

CHAIR MARKOWITZ: Okay, sounds good.

Mr. Key?
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MEMBER KEY: Yeah, I would like to 

join that SEM working group, because we get to 

receive the appropriate answers that we have been 

asking for since last fall, and evidence while 

we're out at this meeting regarding changes in 

missing information. So yeah, I would volunteer 

to be a part of that.

CHAIR MARKOWITZ: Okay. So, Dr. 

Bowman?

MEMBER BOWMAN: Sorry, just on that 

similar -- my understanding is it's Gail, Dianne, 

now Jim, and myself. Is that the entire group?

CHAIR MARKOWITZ: Correct.

MEMBER BOWMAN: I think it would be 

helpful to have a member from the medical 

community on that group.

CHAIR MARKOWITZ: Sure. That's an 

excellent suggestion. And a medical member will 

volunteer to join that group once the medical 

members caucus and elect one of our own.

So the working groups should meet 

before the next meeting. I warn you that summer 
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is coming, and so finding a time when the working 

groups can get together on phone may be 

challenging. So I encourage you to schedule it 

sooner rather than later, like in the next week 

or so. It would make sense to set a date for 

meeting.

Whatever action items or items that 

come out of this meeting won't be ready for a 

while, because it takes a while for us to get a 

draft of the minutes and a transcript of the 

program. But that will be coming along. I don't 

know that we've -- I'll have to check those to 

see if we have any new information requests from 

the Department or not.

In terms of the recommendations we've 

elaborated to, I'll write up the rationalization 

for the CMC, the quality assessment, and then the 

other evaluation having to do with the industrial 

hygiene exposure assessment.

I think a member of that committee 

should take the current writing, which is 

considerable, and probably edit it for a 
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rationale for that. And if you all will let me 

know who's going to take the lead on that, that 

would be good.

I think we should submit those within 

the next couple of weeks. The recommendations are 

done. The question only is really the rationale. 

And I encourage a relatively short rationale, 

because most things can be expressed succinctly 

and maybe are best received if they're relatively 

succinct.

If you want to send around the 

rationale to other people on the Board you can, 

for input. And if you have any questions about 

whether you've appropriately captured the 

rationale, then you probably should send it to 

the other Board members for review.

I think, actually. let me -- it think 

you should send the rationale to all the Board 

members. Some may choose not to look at it, but 

just everybody can take look at the rationale for 

each of the recommendations to decide whether 

it's on target or not. Yeah, okay. And then 
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ultimately I submit the recommendation to the 

Department with the rationale.

Any other, oh, when we're going to 

meet is going to be in the fall. Where we're 

going to meet remains to be determined. Normally 

we pick sites. We run down the list of sites 

since 2017 when we began, where many of the 

claims came from to give the public the 

opportunity to participate in person.

And we've gone to most of the larger 

sites for sure. So we'll have to figure out what 

the most profitable site is to go to in terms of 

access to the public and also the ability for the 

Board to do our work.

So are there any other remaining items 

that need some closure?

MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez. I think we should deal 

with the issue of non-searchable PDF files for 

the medical records. We've discussed it before. I 

don't remember if there was a formal 

recommendation made and denied, or if this was 
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just a discussion that we had.

But I think we have a good reason to 

ask for this. It basically would shift a 

substantial part of the workload from the IH, 

CMC, medical director to the claims evaluator and 

clerical staff of the Department of Labor. And 

this would be both cost effective but, more 

importantly, would help us to ensure thoroughness 

in searching these medical records for relevant 

information which could be anything from exposure 

history to smoking history, to the various 

reports from the IH, CMC, et cetera.

So whether we should make a formal 

recommendation or just ask again, I would leave 

it up to you. But I think that this is an issue 

that could be addressed and should be addressed.

CHAIR MARKOWITZ: Well, you know, my 

question about that is, first of all, I think you 

don't mean just medical records. You mean the 

records of the file, right? Because there are 

many records that are part of the file that 

aren't medical records.
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MEMBER FRIEDMAN-JIMENEZ: Yes, these 

large PDFs that we get that, frankly, are very 

time consuming and unwieldy to search efficiently 

for the pieces of information that we need in 

order to evaluate the case. And I'm sure that 

everyone struggles to some degree with that.

But I still don't remember what the --

if there was a clear rationale why they are not 

searchable PDF files. I know some of it is 

handwritten and couldn't be easily converted. But 

most of it is typed text and could be converted 

to searchable PDFs.

MR. VANCE: Dr. Markowitz, I can sort 

of elaborate a little bit, so ---

CHAIR MARKOWITZ: Go ahead.

MR. VANCE: What the Board is getting 

is actually image copies of records out of our 

OWCP imaging system. So what you're getting is 

basically the metadata that we have which is, 

like, the raw information that's contained.

When I have the administrative folks 

that are assembling these case files, they are 
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basically going in and saying just print out 

everything or download everything in the case 

file

And so what you get is this one single 

PDF within the imaging system that we maintain. 

We do have an indexing capability, but that does 

not get reflected in the material that the Board 

is provided.

Yes, it is possible to do an optical 

recognition conversion on some of these, but 

we've tried that in the past. And it is a 

laborious and very resource-intensive effort to 

convert these files

Because as you know, these files are 

very large and actually contain a lot of handwritten notes that would not convert over to an 

optically recognized text.

So just be aware that we do maintain 

these records in an index format, that we break 

them out by different kinds of categories and 

subjects

But just the mechanism of providing 
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that information to the Board, what you're 

getting is just the documentation in whatever 

order it is downloaded into a single PDF. So I 

just thought I'd elaborate on that.

CHAIR MARKOWITZ: Yeah. Dr. Bowman.

MEMBER BOWMAN: Yeah. This is Dr. 

Bowman. John, just a quick clarity on that. When 

it's converted to a single PDF, is it multiple 

PDFs that are just merged? And I'm just 

wondering, is there a file name system?

Even if in the merging you maintain 

the file names of the clusters, if that file name 

is remotely useful, like a CMC is labeled CMC, 

some numbers, just that alone could be very 

helpful.

MR. VANCE: I know, I totally 

understand. And if there was an easy way for me 

to facilitate that, in providing this information 

to the Board, we would have done that. It's 

simply not something that would be easily done in 

a timeframe that we need in order to collect all 

of the case files that did go to the Board.
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I mean, we've looked at different 

options, but the only way that we really can do 

it and facilitate it in a timely manner is this 

sort of raw download of all the material. And 

basically, the system allows us to just say give 

us everything, put it into a PDF, and then we 

transmit it.

It doesn't allow us to categorize the 

material in any kind of download that we do. It 

would be an extremely laborious process to try to 

convert what is in OIS with its categories and 

indexing into something like what I know the 

Board is looking for. So it's just not something 

that is easily done.

We've looked at a couple of different 

things but they're just -- but nothing is 

workable. So, yeah, what you see here is just the 

raw, thousands of pages of some of these cases

And I knew that that was going to make 

some minds melt. But because this was a random 

sample, we did try to limit some of the cases to 

something that we thought was workable by the 
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Board.

But these cases, as you can see, have 

a tremendous amount of paperwork. I think that we 

had some restriction saying let's not make it one 

of these cases with, you know, tens of thousands 

of pages of material. But we do have that. And so 

I understand the concern.

CHAIR MARKOWITZ: So this is Steve 

Markowitz, one solution for us, the Board, if we 

ask to review additional cases is to request that 

those cases be received with a table of contents 

with the documents that we really care about 

identified. And that would require some work by 

the Department. But that work would be finite and 

would help us a lot.

Any further comments on this?

So there is an issue from previous 

meetings that we need to discuss a little bit. 

You may recall that the Board has requested a 

supporting contractor for two types of work. One 

was to review a significant number of claims so 

we could understand more generally issues 
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involving claims in cases.

And the second was to provide some 

scientific support so we could assist the 

Department in updating exposure-disease links or 

the like. And Mr. Jansen has an update on that 

status.

MR. JANSEN: Thank you, Dr. Markowitz. 

It's probably not the news that the Board wants 

to hear, but the bottom line is that, because 

funding for a technical support contractor was 

not approved this fiscal year, OWCP is not in a 

position to move forward with efforts to secure a 

contractor for the Board at this time.

Until funding is made available, we 

will continue to support the Board in furtherance 

of its important mission but without a 

contractor.

CHAIR MARKOWITZ: And so just let me 

ask you, what's the time of year, or when can 

that be revisited for next fiscal year?

MR. JANSEN: Yeah, there are normal 

budget cycles that we go through each year. And 
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that's something that we can talk about.

CHAIR MARKOWITZ: So I'm sorry, this 

is May. I'm just asking when in the budget cycle 

we should raise this again, that's all.

MR. JANSEN: I think it normally 

starts again over the summer.

CHAIR MARKOWITZ: So is this something 

that the Board could wait until our fall meeting 

to discuss, or do we need to discuss it before 

the fall meeting?

MR. JANSEN: It might be something to 

discuss before the fall meeting, I would think.

CHAIR MARKOWITZ: Okay. Comments? Dr. 

Van Dyke?

MEMBER VAN DYKE: So do we need to 

make a specific request for a budget now in terms 

of a recommendation?

CHAIR MARKOWITZ: I'm sorry, could you 

repeat the question?

MEMBER VAN DYKE: So should we, in our 

recommendations, should there be a request that 

not only do we get a contractor but we get a 
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budget for that contractor as well?

CHAIR MARKOWITZ: Yeah, that would be 

a question for the Department, whether a request 

for contractor support is sufficient or whether 

that request has to explicitly say that the 

funding for that contractor should be provided.

MEMBER VAN DYKE: I mean I think it's 

up to the Board about what type of recommendation 

you want to make. I think we understand that 

obtaining a support contractor is important for 

the Board.

CHAIR MARKOWITZ: Dr. Bowman?

MEMBER BOWMAN: If I understand, there 

was no line item in the budget for such a 

contractor. Does DOL make requests for the 

budget, and was a line item for that requested? 

And then that request was denied or -- just a 

little bit more about that.

MR. JANSEN: Yeah. All I can really 

say right now is that the funding was not 

approved.

CHAIR MARKOWITZ: Ms. Splett?
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MEMBER SPLETT: Would it be preferable 

for the budget request to be very specific about 

what sort of -- not just we want a contractor, 

but we want a contractor with this ability, 

because we want these four or five tasks 

accomplished?

I would think the more specific 

itemizing that need would be more influential in 

getting a budget versus we just want a 

contractor.

CHAIR MARKOWITZ: Let me just say that 

if we come back and make that request, we will 

provide some specificity for sure. That would be 

part of our rationale.

All right, anybody else? Ms. Whitten?

MEMBER WHITTEN: I believe the Board 

made a request, and it was approved. And they did 

send out a request for contractors. And I 

remember seeing that. So do we have to make that 

request again?

CHAIR MARKOWITZ: I think if we 

continue to be interested in securing that 
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assistance that it would behoove us to make that 

request again, sure, that we remain interested in 

those functions and getting support to do that 

work.

Other comments? Dr. Bowman?

MEMBER BOWMAN: I believe at some 

point this Board's term expires. Is that next 

year?

CHAIR MARKOWITZ: July, 2024, I think.

MEMBER BOWMAN: Is there, at some 

point --

(Audio interference.)

CHAIR MARKOWITZ: I'm sorry, say that 

again?

COURT REPORTER: December, the Board 

is established through December 2024.

CHAIR MARKOWITZ: Okay.

MEMBER BOWMAN: And that would be --

that's not up to the Department, right? This is 

up to Congress. That is a congressional thing.

Is there a reason for our Board to 

make some report to Congress to say this is what 
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we've accomplished, and we believe we might have 

additional services, that the Board might remain 

useful. Is there a reason for that? Or shall we 

submit something like that to the Department of 

Labor that they would then pass along?

I just, is there some way we could 

communicate whether or not we think the Board 

might remain useful past December of 2024?

CHAIR MARKOWITZ: So is the December 

2024, is that the date of this two-year, the end 

date of this two-year term? That's the ten-year 

end date of the -- yeah.

Well, you know, we communicate with, 

by charter we provide advice to the Secretary of 

Labor. So if we think that it's worthwhile to 

continue the Board beyond December '24, we could 

communicate that to the Department.

Ms. Whitten?

MEMBER WHITTEN: Dianne Whitten. I 

believe in Patty Murray's bill that included the 

beryllium sensitivity testing, she requested to 

extend the Board until 2029.
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CHAIR MARKOWITZ: Again, that would be 

the overall charter, I think, for the Board. I 

remind the Board members that we serve at twoyear terms. And you're not destined to be here 

until 2029.

Dr. Van Dyke?

MEMBER VAN DYKE: Just for 

clarification, the only way the Board gets 

extended is through legislation. Is that correct?

CHAIR MARKOWITZ: Yes, I think that's 

correct, that Congress has to extend the charter 

of the Board.

MEMBER VAN DYKE: So that would mean 

that people that like the Board should contact 

their people about that, right?

CHAIR MARKOWITZ: I don't know that I 

have the wherewithal to answer that question.

Other comments or questions?

So, you know, we should -- it sounds 

like if we want to request a contractor that we 

might consider a relatively brief telephone Board 

meeting during the summer to discuss that and 
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make that recommendation if we want.

Otherwise, if we wait until the fall, 

that might be too far into the budget process. It 

would be a short meeting. And I think probably an 

open meeting, right? Right, an open meeting, 

which is fine, it just means more advance notice.

But in any case, we may move forward 

with that, to resolve that issue.

Comments, questions?

Okay, I think that concludes our 

business for this meeting. Do you officially 

adjourn?

MR. JANSEN: The meeting is adjourned.

CHAIR MARKOWITZ: Thank you.

(Whereupon, the above-entitled matter 

went off the record at 10:56 a.m.)