UNITED STATES DEPARTMENT OF LABOR 

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH 

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SUMMARY MINUTES 

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JANUARY 28, 2020 

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

Steven Markowitz, Chair, presiding. 

MEMBERS 

SCIENTIFIC COMMUNITY 

JOHN DEMENT 

GEORGE FRIEDMAN-JIMENEZ 

MAREK MIKULSKI 

KENNETH SILVER 

MEDICAL COMMUNITY 

MANIJEH BERENJI 

ROSE GOLDMAN 

STEVEN MARKOWITZ, Chair 

CARRIE A. REDLICH 

CLAIMANT COMMUNITY 

KIRK D. DOMINA 

RON MAHS 

DURONDA M. POPE 

CALIN TEBAY 

DESIGNATED FEDERAL OFFICIAL 

MICHAEL CHANCE 
Welcome and Introductions: 

Mr. Chance called the meeting to order at 1:04 p.m. Eastern 

Time. The above-listed board members were in attendance. After a 

round of introductions, Steven Markowitz, Board Chair, welcomed 

participants and outlined the day’s agenda. 

Review of DOL Responses to Board Recommendations, December 18, 

2019: 

Board members discussed their recommendations to the Department 

of Labor from December 18, 2019, and DOL’s responses to those 

recommendations. 

Asthma 

Member Redlich summarized the Board’s four recommendations 

regarding work-related asthma. DOL generally agreed with and 

incorporated three of the recommendations regarding the 

definition and diagnosis of occupational asthma. On the fourth 

recommendation, concerning the Procedure Manual’s wording and 

the criteria used to diagnose work-related asthma, DOL disagreed 

and preferred to maintain the existing language used in the PM. 

Member Redlich said that a good ending to this discussion would 

be to state that the Advisory Board and the DOL respectfully 

differ in their interpretation of a toxic substance. Chair 

Markowitz said that the issue is actually the word “mechanism” 

and not “toxic substance.” After some discussion, the Board 

voted unanimously to recommend that in Item 2 of the relevant 

section of the PM new modified language conforming to the 

following should be used to replace existing language as 

indicated: The qualified physician must provide a wellrationalized explanation for his or her conclusions. The 

qualified physician must provide a well-rationalized explanation 

with specific information on the mechanism for causing, 

contributing to, or aggravating the conditions. 

Asbestos 

Chair Markowitz said that most of the Board’s recommendation was 

accepted by DOL. The pending issue is whether there should be an 

amended list or table in the PM with additional occupational 

titles and job categories that are presumed to have asbestos 

exposure. Several Board members submitted additional job titles 

that should be included in the list. DOL asked them to provide 

published references and scientific rationale supporting these 

suggestions, and members will present on this topic at the 
Board’s next meeting in April. 

Occupational Health Questionnaire 

Member Dement reviewed the history of the Board’s OHQ 

recommendation and said that while the Board has not yet been 

provided with a copy of the redrafted OHQ, members are hopeful 

that their recommendations will be incorporated. This included 

the suggestion that information to stimulate claimants’ recall 

of exposures be added to the OHQ, as well as substances for 

direct disease links in the SEM. The relationship of exposures 

to COPD is a topic that the Board has addressed throughout its 

existence. In DOL’s response, they said that they did not feel 

it was appropriate to have a linkage between a specific toxic 

substance and a disease in the OHQ. Member Dement pointed out 

that that is not what the Board recommended; the Board was 

suggesting that substances that are known to be related to COPD 

should be added to the OHQ. Chair Markowitz asked about the 

timetable for the draft OHQ, and Ms. Leiton said that it should 

be available by the time of the next Board meeting, but pilot 

testing will probably begin before then. 

Resources for Claims Review 

Chair Markowitz reminded the Board of their request for 

resources to assist in claims review. DOL’s response was that 

they would confer with Chair Markowitz to explore options for 

providing contractor support. 

Industrial Hygiene Reports Text 

Member Dement summarized the Board’s observation that industrial 

hygienist (IH) reports consistently use language that assumes 

that exposures after 1995 were within regulatory limits. The 

Board’s recommendation to DOL was to omit this language in IH 

reports. DOL maintained that in the absence of definitive 

monitoring data it is not appropriate to assume that a much 

higher exposure would occur. Member Dement said that the Board 

is not recommending a presumption of exposure to toxic 

substances after the mid-1990s, but it should also not be 

assumed that all exposures were within regulatory limits during 

that period. The current language places individuals whose 

exposures were predominantly post-1995 at a higher burden of 

proof. Member Dement said that he would like to review some 

claims that were denied based on lack of exposure post-1995 and 

recommended reaffirming the Board’s position on this issue. 
Chair Markowitz commented that CMCs often use IH reports as 

their expert source of information on exposure and this language 

has a real, practical impact. He suggested that they authorize a 

subset of the Board to write a response to DOL summarizing all 

of these points. Member Dement said that this type of case 

requires the IH to dive deeper and talk to the worker about how 

the exposure occurred. 

New Board Duties per Amendments to EEOICPA (December 30, 2019 

Letter from DOL): 

Chair Markowitz explained that as a result of Congressional 

amendments to the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA), the Board has been given 

additional duties. They are tasked with providing advice on the 

claims adjudication process. Member Silver said that he 

interpreted the language to mean that Congress has confidence in 

the Board’s work and hopes to extend its scope. He expressed 

concern about the language in the DOL letter that says OWCP will 

publish changes within ten days of submitting them to the Board, 

and several members agreed that this was a very tight time 

frame. Chair Markowitz commented that a real example of this 

short time frame was Bulletin 20-02, a 69-page document that the 

Board received the day before the meeting and which is scheduled 

to be published on February 10th. It is unlikely that the Board 

as a whole will be able to fully discuss the document and make 

recommendations within the 10-day period, and this process may 

require the Board to work in a different way. After some 

discussion, the Board decided that it would postpone the 

formation of a subgroup to look at Bulletin 20-02. 

In addition, as part of the EEOICPA amendments, OWCP is now 

required to make the medical director, toxicologist, IH, and 

support contractors available to respond to questions from the 

Board. Chair Markowitz asked if these consist only of written 

interactions, and Ms. Leiton said that the initial conversation 

would be in writing, while follow-up questions requiring further 

interaction could possibly involve face-to-face meetings. The 

Secretary of Labor will respond to the Board’s recommendations 

within 60 days of submission, and the Board will advise the 

Secretary with respect to other matters that the Secretary deems 

appropriate. 

Review of Public Comments: 

Chair Markowitz reviewed several public comments received at the 

last Board meeting in November 2019. Ms. Terrie Barrie submitted 
a comment concerning letters of medical necessity, which the 

Board will discuss later as it pertains to Bulletin 20-02. She 

also commented on part of the PM, Exhibit 18-1, which is a 

matrix devised by Econometrica. Board members have raised 

concerns in the past about this Exhibit because it is 

increasingly discrepant with other areas of the PM. Board 

members opined that the Program should take a serious look at 

Exhibit 18-1 and consider either correcting it or removing it. 

Ms. Faye Vlieger raised the issue of an inordinate delay in the 

receipt of well-rationalized medical opinions from personal 

physicians. Ms. Leiton said that the Program asks for these 

early on, because they want to give claimants the opportunity to 

provide opinions from their own doctors, and the Program’s 

statistics do not show that this results in delays to the claims 

process. 

DOL’s Responses to Board’s Information Requests, November 2019 

Meeting: 

Request to review 20 lung cancer claims from 2013 to present 

denied under Part E 

DOL responded that their system does not permit them to retrieve 

these cases without a manual review. Chair Markowitz noted that 

Report 682 (provided by OWCP) lists denied lung cancer claims 

from the time period, along with job title and earliest date of 

employment, and questioned why it would require manual review to 

find those cases. He arranged to follow up on this question 

after the meeting with Ms. Leiton and John Vance. 

Does DOL have a guide for treating physicians on how to use the 

SEM? 

DOL does not have a guide, but there are resources available 

online. Multiple Board members agreed that it was not likely 

that treating physicians would go looking for information in the 

SEM. Member Goldman suggested that it might be easier for 

treating physicians to look at the new OHQ that is being 

developed. 

How many public submissions were made to the SEM in 2019? What 

was the outcome for those submissions? 

There were 32 toxic substance inputs and 8 disease inputs in 

2019, and DOL provided information on the outcome of each 

submission. 
From 2018 to the present, what changes have been made to the SEM 

regarding exposure-disease links? 

DOL provided a table of the changes made. There were 32 actions 

taken; in 22 of those instances some disease-exposure link was 

added, and in 10 they were deleted. 

How many CMC reports were issued each month in 2019? 

DOL provided the number of CMC reports issued by month, with a 

total of almost 2,400 reports. 

Request for an update on the status of re-opened cases 

DOL provided a chart detailing the status of cases that were reopened in part as a result of Board recommendations. 

In DOL RPT 1158, how old are the “pending claims”? 

DOL’s response was that they are unable to answer the question 

and they requested that the Board develop a more specific 

inquiry. Chair Markowitz said that he was not inclined to pursue 

this item. 

How is a quality assessment evaluation of the work of industrial 

hygienists performed? How will it be done under the new 

contract? 

The IH contractor, BGI, completes industrial hygienist 

evaluations, which are reviewed and corrected internally. Those 

reports are sent to the National Office, where federal 

hygienists check them for technical accuracy and consistency. 

Review of Action Items for Board, November 2019 Meeting: 

Follow-up on adding IOM-recommended information to SEM 

The Board has a working group dedicated to authoritative sources 

for use by the Department in updating SEM, and the working group 

expects to have an update by the April Board meeting. Chair 

Markowitz asked the working group to consider whether IARC’s 

Group 2A carcinogens meet EEOICPA’s standard (“at least as 

likely as not that exposure to the toxic substance...was a 

significant factor in aggravating, contributing to, or causing 

the illness”) and whether they should be included in the SEM as 

exposure-disease links. Member Berenji, the chair of the working 

group, said that the group needed to look at the IARC approach 
and evaluations in detail and compare it to other data sources 

that the DOL currently references, including HazMap. 

Assessing Quality, Objectivity and Consistency of Industrial 

Hygiene and Contract Medical Physicians in EEOIP Claims 

Evaluations: 

Chair Markowitz summarized for the Board his previous findings 

around the OWCP Medical Director evaluations and training for 

CMCs. He also reviewed the obligations of the contractor, QTC, 

with regard to quality control of CMCs. The performance 

threshold is that no more than five percent of the medical 

evaluations will need clarification, correction, completion, or 

re-performance, but this does not align with the Medical 

Director’s finding that at least 25 percent from the last five 

quarters needed correction. Chair Markowitz asked for future 

clarification from the Program about this discrepancy. The Board 

is also interested in looking at the results of the periodic 

evaluations that the contractor is required to perform. Member 

Dement said that he would like to see the QC plan that the 

contractor is required to develop. Ms. Leiton said that some of 

these inquiries probably could not be answered because of 

contractual obligations. 

Chair Markowitz asked the Board what a quality assessment 

program for CMCs would look like if the Board help to redesign 

it. Member Dement said that it might involve looking at a sample 

of CMC reports, as the Board is currently doing. He also said 

that there should be a peer-review component involving outside 

individuals with the expertise to review the cases, and several 

members agreed that there should be some sort of independent 

entity involved to provide more objectivity. Chair Markowitz 

added that it was difficult for one person to have broad enough 

set of knowledge to cover all of the areas encompassed by the 

Program. External entities could draw on experts from many 

different areas of knowledge. 

Chair Markowitz returned briefly to DOL’s response about quality 

assessment of industrial hygienists. He requested that DOL 

provide the Board with information about performance metrics 

such as those in the QTC contract. He also noted that 

consistency does not appear to be a problem in the IH reports. 

Member Dement said that these assessments depend on the 

knowledge and experience of the IHs who conduct them and they 

would also benefit from a peer-review process. Member Silver 

said that he was struck by the consistency of the cited sources. 

Chair Markowitz noted that if the OHQ is modified and more IH 
interviews are conducted, it will be possible for the IH 

evaluations to have better information and less consistency, 

with more insight into likely levels of exposure. 

Request for Information from DOL: 

Member Dement presented draft language for a request for 

information from DOL. The Board would like to examine ten cases 

of workers whose first employment at a DOE-covered site occurred 

after 1995 and who had their claims denied due to negative 

causation. Member Dement suggested that they focus on four 

diseases in particular and requested that the Board receive some 

kind of index that would allow them to find key documents 

easily. Chair Markowitz seconded the proposal and it was 

approved unanimously. 

Parkinson’s Disease: Update 

Member Mikulski updated the Board on the activities of the 

Parkinson’s working group. They provided Board members with a 

write-up during the November meeting which provided answers to 

some of DOL’s questions for the Board on definitions, 

symptomatology, and classification coding for Parkinsonism and 

Parkinson’s, among other topics. They have also done a thorough 

review of the literature on the main risk factors associated 

with Parkinsonism and Parkinson’s and reviewed a number of 

Parkinson’s claims in the context of disease exposure. The 

working group is in the process of formulating final 

recommendations for DOL, which they plan to present at the April 

meeting. 

Next Board Meeting: 

Chair Markowitz said that staff were looking at the last two 

weeks in April for the Board’s next in-person meeting. This 

provides some time to publish a notice in the Federal Register 

in the event that a telephonic meeting is necessary to close out 

final Board issues prior to mid-July, when the current Board’s 

term will end. The Board has previously chosen meeting locations 

according to which sites have the most cases and claims, and, if 

they follow this pattern, the April meeting will take place in 

Las Vegas, Nevada. Member Domina requested that the Board avoid 

scheduling their meeting for the third week of April because the 

Advisory Board on Radiation and Worker Health will be meeting in 

Hanford that week.