UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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COMBINED MEETING OF THE SUBCOMMITTEE ON MEDICAL ADVICE RE: WEIGHING 

MEDICAL EVIDENCE (AREA #2) AND THE SUBCOMMITTEE ON IH & CMC AND THEIR 

REPORTS (AREA #4)

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SUMMARY MINUTES

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MONDAY,

OCTOBER 23, 2017

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The Subcommittees met telephonically at 1:00 p.m. Eastern

Time, Victoria A. Cassano and Rosemary K. Sokas, Co-Chairs, 

presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

LESLIE I. BODEN

KENNETH Z. SILVER

MEDICAL COMMUNITY:

STEVEN MARKOWITZ

VICTORIA A. CASSANO, Co-Chair

ROSEMARY K. SOKAS, Co-Chair

CLAIMANT COMMUNITY:

FAYE VLIEGER

DESIGNATED FEDERAL OFFICER:
CARRIE RHOADS 
Call to order and roll call

Ms. Rhoads, the DFO for the committee, called the meeting to order at 

1:07 p.m. She called the roll and noted that at its April 2016 

meeting the board voted that subcommittee meetings should be open to 

the public. Co-Chair Sokas outlined the committee’s agenda items for 

the call, including an overview of the July 11 2017 meeting with the 

Department of Labor and a discussion about the merger of the two 

subcommittees, to be further addressed at the upcoming full board 

meeting.

Results of meeting with DEEOIC medical and industrial hygiene experts

Co-Chair Sokas noted that she, Co-Chair Cassano and Member Silver all 

participated in a meeting on July 11th that allowed members of the

two subcommittees to talk with Dr. Christopher Armstrong and Mr. 

David Levitt. Dr. Armstrong is the medical director for the Division 

of Energy Employees Occupational Illness Compensation, and Mr. Levitt 

is the division’s lead industrial hygienist. Other attendees at the 

meeting included Ms. Rachel Leiton, Mr. Doug Pennington, Ms. Carrie 

Rhoads, and Mr. John Vance.

Co-Chair Sokas characterized the group’s discussion on the review of 

Contract Medical Consultants (CMCs) and industrial hygiene as useful,

and she made note of the fact that Dr. Armstrong has been reviewing 

some CMC reports. The subcommittees and the full board had made 

previous inquiries and received information about the process of 

compiling the CMC and IH reports, but they had not received access to 

evaluations of the content of those reports. These evaluations by Dr. 

Armstrong and Mr. Vance are now publicly available on the Department 

of Labor’s website, and Co-Chair Sokas noted that it would be 

beneficial for board members to look over the reviews themselves and 

said that she would propose this at the next full board meeting.

Co-Chair Cassano raised the question of what information the CMCs and 

industrial hygienists (IHs) receive and use to formulate their 

opinions, and mentioned some uncertainty amongst the subcommittee 

members about how the claims examiners are able to sift through the 

information provided and extract relevant data without extensive 

medical and/or industrial hygiene knowledge. She said that this 

discussion will probably be included in the full board meeting and 

that the subcommittee will try to make sure that the CMCs and IHs 
receive all of the information that they need to produce high-quality 

reports.

Member Silver expressed concern that claims examiners are not 

incentivized to dig deeper and find more information for themselves 

before documents are passed along to CMCs and IHs. He noted that it 

seemed like the audit documents first began to appear around the time 

that the board was created, and asked whether the documents extend 

back in time prior to 2016. Co-Chair Sokas said that as far as she 

knows the process began with Dr. Armstrong, who was not here prior to 

2016. She asked Ms. Rhoads about enquiring into similar quality 

evaluations by previous medical directors, and Ms. Rhoads said that 

she would follow up on that question.

Planning for upcoming full-Board meeting

Co-Chair Sokas asked for discussion from everyone on the line about 

the question of merging the two subcommittees. Member Markowitz 

mentioned that the terms of almost all the board members expire in 

February and that it is uncertain how much turnover will occur at 

that time. He and Co-Chair Sokas reminded everyone that applications 

to serve on the board were due within two days following this meeting 

if anyone would like to reapply. Member Markowitz said that

significant turnover among the board members could result in a 

majority of new members who start their terms by focusing on learning 

about the board’s four tasks. Because the subcommittees are 

structured according to those tasks, combining these two 

subcommittees could divert attention from the issue of the CMCs and 

the IHs.

Co-Chair Sokas said that she was not concerned about this issue

receiving less attention if the subcommittees were merged; Co-Chair 

Cassano agreed, and added that it is logistically onerous to share 

information between the two subcommittees when the components of 

their collective task cannot be evaluated in isolation. Member 

Vlieger said that it would be wise to combine the subcommittees in 

the context of the meeting with DEEOIC and the idea of having someone 

with medical experience review the evidence. Co-Chair Cassano added 

that even if the subcommittees were combined, their tasks could still 

be classified by subject.

Co-Chair Sokas said that she didn’t see a need to vote on this issue 

and suggested that the group raise it as an agenda item at the full 
board meeting. Either way, the subcommittees will continue to 

collaborate. Member Silver pointed out that if the Department of 

Labor were to adopt the board’s recommendation and provide a 

contractor to do a file review of 50 cases, it would be easier for 

that person to report their results to one subcommittee than two. CoChair Sokas agreed and added that they based that recommendation on 

faulty input and it should be discussed further. Member Boden added 

his agreement.

Turning to the topic of the Department of Labor’s responses to the 

full board’s recommendations, Co-Chair Sokas introduced the items 

that were most relevant to the two subcommittees. Recommendation #2

was related to the Site Exposure Matrix (SEM). Recommendation #3 

concerned hiring former workers to administer the Occupational Health 

Questionnaire, and Co-Chair Sokas anticipated more discussion between

the board and the Department on this issue. Recommendation #4 

suggested that the IH and the claimant have more direct 

communication, and she asked Member Silver about deferring discussion 

on this recommendation to the full meeting. Member Silver suggested 

that members of the public might be able to add comments during the 

full board meeting. Member Markowitz noted that the Department of 

Labor seemed to want to include the claims examiner as much as 

possible in the collection of additional data, and that it is good 

for the claims examiner to be involved to minimize miscommunication.

Co-Chair Cassano added her agreement. Multiple members agreed that 

further clarification was needed on the intention behind this 

response.

Recommendation #5 was about making teleconference notes publicly 

available with redactions, and Co-Chair Sokas suggested that this 

item would also be expanded upon in the full board meeting. Member 

Markowitz clarified for any members of the public on the phone that 

the recommendations were made publicly available on the board’s 

website. Member Boden suggested that the Department’s intent behind 

their response to Recommendation #5 was to give them more freedom to 

discuss policy issues without making the full extent of these 

discussions public.

Recommendation #6 suggested making case files accessible to the 

claimant online, and received a positive response from the 

Department. Recommendation #8 was that the IHs and CMCs also receive

access to the full set of files and not just what was forwarded by 

the claims examiner, and Co-Chair Sokas said that she interpreted the 
Department’s response to this as negative. Co-Chair Cassano mentioned 

that she was in the process of drafting a response to the 

Department’s response and would send it to Member Markowitz, and 

Member Markowitz said that they would discuss the topic at the full 

board meeting. He also said that in the absence of more data on the 

quality of the claims examination process, the subcommittees’ 

arguments behind their recommendations would not be as persuasive. 

Co-Chair Cassano said that the recent trip to Seattle did help to 

clarify how well the claims examiners are doing their jobs, but she 

agreed that it is difficult to know exactly what the problem is

without seeing the entire picture. Co-Chair Sokas said that the 

subcommittees needed to discuss their recommendation regarding a case 

file review at the next meeting. Member Markowitz suggested that more 

than 50 claims should be examined in the review.

Recommendation #7 concerned reorganization of the Department, and 

several members agreed that it was not particularly relevant to the 

subcommittees. Co-Chair Cassano said that it is inefficient to put

time into developing recommendations without first receiving 

Department responses to previous sets of recommendations. She 

suggested making a request to the program that the board should 

receive Department responses to recommendations at least 30 days 

before the next full board meeting. Members Boden and Markowitz 

stated their agreement, and Member Markowitz said that they should 

raise this issue at the upcoming full board meeting.

Member Vlieger pointed out that although the subcommittees did not 

recommend that Circular 1505 on asbestos and presumption of exposure

go forward, the Department of Labor incorporated it into the new 

procedure manual. She suggested that this should be discussed at the 

next meeting. Member Markowitz suggested to Ms. Rhoads that at the 

board meeting in New Mexico a representative from the Department of

Labor should be prepared to clarify the chronology of the 

Department’s actions concerning Circular 1505 and other rescinded 

circulars, and Ms. Rhoads said that she would pass along that 

request.

Other items

Member Markowitz asked about the public availability of Dr. 

Armstrong’s audits and Mr. Vance’s memoranda, and Ms. Rhoads 

responded that both are posted in the public reading room of the 

DEEOIC website. Member Markowitz asked about discussing the audits 
and memoranda at the full board meeting, and Co-Chair Sokas said that 

she had envisioned providing those documents to the board in unredacted form as part of a reexamination of the subcommittees’ 

recommendation to have a subcontractor do a case file review. Member 

Markowitz pointed out that whether or not the all of the board 

members read those documents, members of the subcommittees could 

present that information and lead discussions at full board meetings.

Co-Chair Cassano said that as part of a robust review, in addition to 

looking at the files where Dr. Armstrong found problems, they also 

needed to examine cases where he did not find problems. She also 

suggested that some of the IHs and physicians reviewing the files 

should have access to the OIS imaging system. Co-Chair Sokas proposed 

that she and Co-Chair Cassano would work together to develop a 

presentation for the board meeting that places the audits in the

context of past recommendations and current knowledge.

Member Vlieger pointed out that when they are reviewing the audits,

subcommittee members do not know the training background for the 

auditors because the Department of Labor considers that information 

proprietary. Co-Chair Sokas suggested that they ask at the next board 

meeting about the existence of a publicly available template for CMC 

quality. If one does not exist, the board may want to create one. CoChair Cassano agreed and said that the subcommittee members should 

look at the template to make sure it covers areas that they consider 

to be important. Member Markowitz said that those templates have been 

circulated and asked Ms. Rhoads to send them to the subcommittee 

members.

Adjournment

Ms. Rhoads closed the meeting at 2:09 p.m.

I hereby certify that, to the best of my knowledge, the foregoing 

minutes are an accurate summary of the meeting. Submitted by:

______________________________ ___11/20/17________

Rosemary Sokas, MD, MOH, M.Sc Date

Chair, Subcommittee on IH & CMC and Their Reports
I hereby certify that, to the best of my knowledge, the foregoing 

minutes are an accurate summary of the meeting.

__________________________ ____11/27/17________

Victoria A. Cassano, MD, MPHIL, MPH. FACPM, Date

FACOEM

Chair, Subcommittee on Medical Advice re: Weighing Medical Evidence