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U.S. DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES 

AND WORKER HEALTH

+ + + + +

MEETING

+ + + + +

THURSDAY

APRIL 22, 2021

+ + + + +

The Board met telephonically at 1:00 

p.m. Eastern Standard Time, Steven Markowitz, 

Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN

KENNETH Z. SILVER

MIKE VAN DYKE

MEDICAL COMMUNITY

GEORGE FRIEDMAN-JIMENEZ

ROSE GOLDMAN

STEVEN MARKOWITZ

MAREK MIKULSKI

CLAIMANT COMMUNITY 

JIM KEY

DURONDA M. POPE

CALIN TEBAY

DIANNE WHITTEN
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DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
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CONTENTS

Welcome/Introductions/

Review of Agenda .............................. 4

Re-Chartering ................................ 16

Message to the Board ......................... 32

DEEOIC Updates: Program Highlights,

Information Items from Nov. 2020 ............. 48

Update on Prior Recommendations

Sitewide Jobs, IH and MD evaluations ......... 86

ABTSWH Request for Resources ................. 33

IARC/NTP Carcinogens - Report and

Working Group Recommendation ................ 105

DOL Query on COVID .......................... 136

Public Comment period ....................... 149
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P-R-O-C-E-E-D-I-N-G-S

(1:07 p.m.)

MR. CHANCE: Good morning, everyone. 

My name is Michael Chance, and I'd like to 

welcome you to today's teleconference meeting of 

the Department of Labor's Advisory Board on Toxic 

Substances and Worker Health. I'm the Board's 

Designated Federal Officer or DFO. Today's date 

is April 22, 2021. And this is Day One of the 

two-day conference.

This afternoon, we have a special 

guest, Christopher Godfrey, who is the Director 

of OWCP. Chris would like to greet the members 

of the Board and introduce himself. He will join 

us at 1:30. That gives us time for me to read 

through my script and get us underway.

As always, we appreciate the time and 

diligent work of our Board members in preparing 

for this meeting and for their forthcoming 

deliberations. We are scheduled to meet today 

from 1:00 p.m. to 5:00 p.m. Eastern Time and to 

reconvene at 1:00 p.m. Eastern Time tomorrow.
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This meeting is a virtual conference 

as we have held since last April due to the COVID 

pandemic. On the line with me is also Carrie 

Rhoads from the Department of Labor and Kevin 

Bird from SIDEM, our logistics coordinator. None 

of us are in the meeting room together as we 

usually are to oversee teleconference vehicles. 

We are also having a moderator to call ourselves 

due to the current high volume at the conference 

line. Please be patient with any technical 

issues or extra time that we might take with the 

Webex documents. We are trying to run the 

meeting as efficiently as possible while keeping 

everyone safe and socially distant.

I'd like to note that there are 

several medical doctors on the Board and other 

Board members who deal with emergencies that we 

would like to extend them, and everyone else, our 

thanks for allowing them to make the time to have 

this Board meeting today. And thank you all for 

everything you've done over the past year, 

keeping the country safe.
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Regarding meeting operations for 

timing, we have, I believe, one break today. And 

for Board members, please just put your phone on 

mute for the break and unmute when we resume. 

This will make it easier for Kevin with making 

sure that everyone can participate in the 

discussion as we resume.

Copies of all meeting materials, any 

written public comments are or will be available 

on the Board's website under the heading Meetings 

and the listing there for this meeting, April 

22nd, and tomorrow's on the 23rd, 2021. 

Documents will also be up on the Webex screen so 

that everybody can follow along with the 

discussion. The Board's website can be found at 

dol.gov/OWCP/energy/regs/compliance/advisoryboard

.htm. If you haven't already visited the Board's 

website, I encourage you to do so. After 

clicking on today's meeting, you'll see a page 

dedicated entitled to the day's meeting.

The web page contains publicly 

available materials submitted to us in advance. 
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We will publish any materials that are provided 

to the subcommittee. You should also find 

today's agenda, as well as instructions for 

participating remotely. If you're participating 

remotely and you're having problems, please email us at energyadvisoryboard, all one word, 

@dol.gov. If you're joining by Webex, please 

note that the session is for viewing only and 

will not be interactive.

Please also note that the phones will 

be muted for non-Advisory Board members until the 

public comments session today. The call-in 

information has been posted on the Advisory 

Board's website so that the public may listen in 

but not participate in the Board's discussion 

during the meeting. The public may offer 

comments during the public comment session, which 

starts today at 4:15 p.m. Eastern Time. 

Depending on how many people want to make 

comments, the Chair will allocate sufficient time 

for everyone.

We will unmute your phone line when it 
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is time for you to make a comment. There is no 

public comment period in tomorrow's session. If 

you would like to make a comment during the 

public comment session, please e-mail us, again, 

at energyadvisoryboard@dol.gov. Let us know, and 

we will reserve some time for you.

About meeting minutes and transcripts, 

a transcript and minutes will be prepared from 

today's meeting. During Board discussions today 

as we are on telephone conference lines, please 

speak clearly enough for the transcriber to 

understand. When you begin speaking, especially 

at the start of the meeting, please state your

name so we can get an accurate record of the 

discussion. Also, I'd like to ask our 

transcribers, please let us know if you're having 

an issue with hearing anyone or with the 

recording.

As DFO, I see that the minutes are 

prepared and ensure that they're certified by the 

Chair. The minutes of today's meeting will be 

available on the Board's website no later than 90 
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calendar days from today per FACA regulations. 

If it's available sooner, we will publish before 

the 90th day. Also we will be publishing 

verbatim transcripts which are obviously more 

detailed in nature. Those transcripts should be 

available on the Board's website within 30 days.

I would like to remind the 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 for public disclosure and 

cannot be shared or discussed publicly, including 

in this meeting. Please be aware of this as we 

continue with the meeting today. These materials 

can be discussed in a general way, which does not 

include using any personal identifying 

information such as names, addresses, specific 

facilities for cases being discussed, or a 

doctor's name.

Thank you for bearing with me as I had 

to read all of that into the record. At this 

point, I will turn over the proceedings to Dr. 
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Markowitz for his welcome introduction. And then 

I will come back on with a few extra tidbits of 

information. And then I believe Kevin or 

someone, I hope is keeping an eye out for Chris. 

He's supposed to dial in at 1:30, and maybe just 

let us know when he's on so we can get him into 

the meeting. Thank you.

Dr. Markowitz?

CHAIR MARKOWITZ: Sure. Thank you, 

Mr. Chance. And in our sequence today, 

particularly the next hour if we need to 

interrupt what we're doing to hear from Mr. 

Godfrey, we'll interrupt and then come back to 

it.

In any case, I'd like to welcome 

everybody, Board members, the DFO staff, and 

leadership, the public, whoever else might be 

attending this meeting to -- I don't know what 

number meeting it is for the overall Board since 

2016, but we've had many meetings. This one, 

unfortunately, has to be done remotely. I'm 

hoping by the fall, by our next meeting, that at 
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a minimum, we will be able to have a hybrid 

meeting, but we'll see how that goes. One 

advantage, I guess, of some of this distance is 

that, in theory, more people can participate from 

the public.

I will go through the agenda in a 

moment, but let's do introductions first. I 

think it's probably easiest if I just call your 

names, and then you can just introduce yourself. 

And then I'll call the next person.

So Mr. Key.

MEMBER KEY: Dr. Markowitz, thank you. 

Jim Key, President of the United Steelworkers 

Atomic Energy Workers' Council and participant in 

an advocate of Worker Health Protection Program 

and of the EEOICPA since its origination.

CHAIR MARKOWITZ: Thank you.

Ms. Pope?

MEMBER POPE: Thank you, Dr. 

Markowitz. Duronda Pope, Director of Emergency 

Response Team, United Steelworkers. I am also a 

former worker of Rocky Flats. I worked out there 
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25 years.

CHAIR MARKOWITZ: All right. So Mr. 

Tebay?

MEMBER TEBAY: Calin Tebay, Local 55 

and HAMTC sheet metal worker, also on the William 

Health advocate and the HWEC. That's the Hanford 

Worker Engagement Center, representative at 

Hanford, been here about 25 years off and on.

CHAIR MARKOWITZ: Okay. Ms. Whitten.

MEMBER WHITTEN: Good morning. Dianne 

Whitten. I am with the Hanford Atomic Metal 

Trades Council. I'm a health advocate, recording 

secretary, a member of IBEW 984. I'm a grad 

contact at Hanford currently. And I've been here 

about 32 years.

CHAIR MARKOWITZ: I think that 

probably adds up to at least a hundred years of 

experience beside people we've just heard from.

Next Dr. Bowman?

MEMBER BOWMAN: Yes. I'm Aaron 

Bowman. I am professor and head of the School of 

Health Sciences at Purdue University, I am a 
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toxicologist by training.

CHAIR MARKOWITZ: Mr. Catlin?

MEMBER CATLIN: Thanks, Dr. Markowitz. 

My name is Mark Catlin. I'm an industrial 

hygienist, semi-retired and doing some 

consulting.

CHAIR MARKOWITZ: Thank you. I won't 

mispronounce your name again.

Dr. Silver?

MEMBER SILVER: Thank you. Ken 

Silver, associate professor of Environmental 

Health and College of Public Health at East 

Tennessee State University. My dissertation 

work, going back at least 20 years, was on 

historical emissions and exposures at Los Alamos 

National Laboratory. I worked very, very closely 

with the injured workers, sick workers and their 

families, to help bring the law into existence, 

and hardly feels like a lot of time has gone by.

CHAIR MARKOWITZ: Okay. Dr. Van Dyke?

MEMBER VAN DYKE: Good afternoon. 

Mike Van Dyke. I'm associate professor at the 
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Colorado School of Public Health, industrial 

hygienist by training and have a long history of 

repeated DOE sites and doing research there, 

particularly with beryllium.

CHAIR MARKOWITZ: Nice.

Dr. Friedman-Jimenez?

MEMBER FRIEDMAN-JIMENEZ: Hi. I'm 

George Friedman-Jimenez, occupational medicine 

physician, director and attending physician at 

the Bellevue-NYU Occupational Environmental 

Medicine Clinic. And I'm also an epidemiologist 

by training.

CHAIR MARKOWITZ: Dr. Goldman?

MEMBER GOLDMAN: Hi. I'm Dr. Rose 

Goldman. I, too, am an occupational 

environmental medicine physician and founder of 

the Occupational and Environmental Medicine 

program at Cambridge Health Alliance, also a 

medical educator and associate professor of 

environmental health at Harvard School of Public 

Health and associate professor of medicine at 

Harvard Medical School.
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CHAIR MARKOWITZ: Dr. Mikulski?

MEMBER MIKULSKI: Hi. I'm Marek 

Mikulski, occupational and environmental health, 

University of Iowa. I'm an occupational 

epidemiologist, and I also direct a former Iowa 

DOE worker medical screening program.

CHAIR MARKOWITZ: Thank you. And I'm 

Steven Markowitz. I am an occupational medicine 

physician and epidemiologist. I direct the Barry 

Commoner Center, City University of New York, and 

run, for over 20 years, the largest former worker 

medical screening program in the DOE complex 

called the Worker Health Protection Program.

So it's 1:20. And usually actually we 

have the public introduce themselves, but we 

can't do that in this mode of meeting. But in 

any event, let me ask you, Mr. Chance, it's 1:20. 

I can postpone review of the agenda if you want 

to move ahead with your items. Then I can go back 

to the agenda after Mr. Godfrey speaks, or I can 

do the agenda now. What's your preference?

MR. CHANCE: That's fine with me. You 
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know, in fact, I tried to move around some of the 

stuff that was later on in the afternoon, the 

resource part up to this and maybe save us a 

little bit of time anyway. So if that's okay 

with you, I can go ahead.

CHAIR MARKOWITZ: Sure. Go ahead.

MR. CHANCE: Okay. And it might not 

take me ten minutes, so let me start and then we 

can see where we are.

So the two items that I have before 

kind of some follow-up issues and some 

informational issues, particularly for people who 

are new to the Board, not existing Board members 

and certainly not you, Dr. Markowitz, is on the 

whole issue of chartering the Board. And so I 

just want to make a statement on that so that 

everybody is clear about what that is and what to 

expect.

So under the FACA, which is the rules 

by which we must govern ourselves under, in this 

environment, we must have a new charter for the 

Board every two years. The current charter is 
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expiring in June. We are in the process of 

getting our new secretary in line to approve it. 

At this point, we do not anticipate changes, and 

this should largely be a seamless process for 

members of the Board so more on that as we 

finalize the paperwork. But I don't know.

Steven, did you have any comments on 

that? You've been through that.

CHAIR MARKOWITZ: No. As far as I 

know, any changes in the charter seemed to not 

have come, from the point of the Board' 

perspective, internally from the Department, but 

from elsewhere. So if the charter doesn't 

change, then great. If you envision any changes, 

it would be nice to know when you know.

MR. CHANCE: Right. Understood. So 

we'll definitely let you know if we see anything, 

but at this point, we don't anticipate changes. 

I just wanted to make that little statement 

because there might be some people who aren't 

familiar with that. They may hear that come up 

and wonder what it is. So it's really nothing to 
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worry about. It's just part and parcel of how we 

have to do business under the law.

The next thing that I wanted to share 

with everyone -- and this might be some good news 

for many and especially, I think, you also 

Steven, and we've been working on this for a 

while -- is the issue of resources. And I think 

it's been maybe about a year since we started 

talking about a way that we can put together some 

sort of contract with expertise that will be 

available to the Board to be able to do some 

really more in-depth evaluations.

And the way that this will have to 

begin under the contract requirements that are 

set out under the federal regulations that govern 

contracts, we will be issuing something called a 

Request for Information, and that is an RFI. And 

I wanted to thank Carrie and others at the 

Department who did some heavy lifting work 

putting that together. And, Dr. Markowitz, you 

and I imagine others on the Board, took a look at 

the language that was shared with you. We 
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received your comments and have been working to 

incorporate those. Know that Carrie is 

continuing to help me work through that, finalize 

the document, but I can share that we are very 

close to being able to get the RFI out onto the 

street, and we expect it to be released shortly.

And then at that time the way that 

this will work and the way that we envision it 

working is that the Request for Information will 

determine if there are vendors and companies that 

are out there that are interested in this work in 

presenting a bid and what's called a Statement of 

Work. And that will also allow us to ascertain 

levels of resources that will be required to be 

able to do this. So I had 20 minutes on the 

agenda, and I don't think that I have 20 minutes 

worth of the material, so that's kind of the 

kernel of what I had to share.

So Dr. Markowitz, do you have 

questions?

CHAIR MARKOWITZ: So if you could just 

continue a little bit with the process and the 
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time frames.

MR. CHANCE: Well, the time frames 

might be something that I might need Carrie's 

help with on. I think the RFI goes out -- I 

don't want to misstate myself, but we might be 

able to talk about that offline.

And Carrie, unless you're there and 

you know the specific date, I don't want to say 

anything wrong.

MS. RHOADS: Yeah. I don't know any 

specific dates beyond the RFI. So we might need 

to talk about that.

MR. CHANCE: So, yeah, we don't want 

to commit to the time frame, but there are time 

frames that are set up. I just don't know them 

by heart, but we can certainly share those with 

you, Steven.

CHAIR MARKOWITZ: Did you say the RFI 

has been issued already?

MR. CHANCE: No, sir. It is still 

under review at the Department, but we are pretty 

hopeful we will be able to get it issued shortly.
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CHAIR MARKOWITZ: Okay.

MR. CHANCE: I don't have the time 

frame, but it should be soon.

CHAIR MARKOWITZ: When you issue it, 

can you send it to each of the Board members?

MR. CHANCE: I will see how that is 

done.

CHAIR MARKOWITZ: You know, just the 

link. I mean, it's going in --

(Simultaneous speaking.)

MR. CHANCE: I understand. Yes. 

We'll determine how notification can take place.

CHAIR MARKOWITZ: And one of the other 

background is that I think the Board would be 

interested in hearing about, was something that 

you and I discussed with Mr. Pennington, which is 

one of the complications of our request had to do 

with -- you know, our request was for help 

reviewing claims and also help on the scientific 

and technical side. And the reviewing claims 

posed a challenge because there was the question 

of possible need to set up a system of records. 
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I think that's the official term, but it's 

something close to that. And that was a big 

obstacle because that's a protracted process. 

And there was a second mechanism that sort of 

allowed us to not quite bypass, but to expedite 

that kind of work without establishing a new 

system of records. So I can't remember where we 

are on that particular issue.

MR. CHANCE: That might be something I 

need program help with.

John or Rachel, are you aware?

MS. POND: So this is Rachel. You're 

asking about where we are in the process with 

regard to the system of records or what that 

entails? I think the system of records has to do 

with a database that you guys wanted to create, 

and that, creating a new database with new 

information was an issue. So I haven't been 

involved in the actual procurement process, Mike, 

I'm not sure how that isn't being incorporated in 

the RFI of the Statement of Work or any of that.

MR. CHANCE: Right. Carrie, do you 
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have an answer to that? Or maybe it's something 

we should talk about offline.

MS. RHOADS: Yeah, maybe we should. I 

don't know specifically.

CHAIR MARKOWITZ: You know, that's 

fine. I mean, the issue was since setting up a 

new system of records is problematic and takes a 

long time, it was somehow to take advantage of 

the current system of records that would 

nonetheless allow us to, you know, perform that 

function of reviewing claims. And so we can get 

back to the details of this. I just wanted to 

know whether we had resolved or made any progress 

in resolving that question. That seemed to be a 

possible obstacle.

MS. POND: Yeah. This is Rachel 

again. I think that what we were going to try to 

do is instead of treating a whole database, we 

were going to try to create spreadsheets from the 

data that we already have, kind of like we have 

been. But it wouldn't -- we could do it in such 

a way that it wouldn't be a new system of 
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records. And that's where we're heading towards. 

I don't know that it actually has to be part of 

the RFI. It might just be something that we do 

once the contract is let, instead of -- but it 

will speed up the process to not have to worry 

about that piece of it.

MR. CHANCE: I think you're exactly 

right, Rachel. That's pretty much outside of the 

RFI and the contract. That's going to be 

something that has to be, you know, hammered out 

once the work is beginning, I think. Well, a 

little before that, you know, but it's something 

like that -- so the RFI is not going to be that 

specific.

CHAIR MARKOWITZ: Okay. Thanks. By 

the way, I forgot to mention, Ms. Rhoads, if you 

could, if it's possible to keep a running list of 

sort of action items from the meeting so we don't 

have to wait for the summary or the minutes, that 

would be very helpful.

MS. RHOADS: Yes, indeed, and that's 

the first one.
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CHAIR MARKOWITZ: Thank you. So are 

there -- other Board members have questions about 

what Mr. Chance has just discussed?

MEMBER GOLDMAN: This is Rose Goldman. 

I have a question. This RFI, if I understand, 

relates to when we've had to review a claims file 

where different components of the file in 

different locations and it's hard to pull it 

together. Would this mean that somebody would 

put the file together in such a way that medical 

reports were in one location and IH or other 

reports in a different location so you didn't 

have to go sort of trying to look all over to try 

to find things? Is that what this is about?

MR. CHANCE: No. I mean, I think I'd 

have to have some help from Rachel on what that 

is even all about. But, no, I mean, this is a 

resource contract to get experts together to be 

able to help you guys do your research work. But 

with regard to, like, case work, I don't know 

what that is.

MS. POND: I think what she's saying 
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is that, you know, part of what I anticipated 

when I saw what the Board is asking for in terms 

of resources was some sort of admin assistance 

help, what's, you know, going through some of the 

materials, some of the data, some of the reports 

that, the way that you review them. I think 

she's talking about is it's sometimes difficult 

to actually, you know, get through a case file 

because they're not organized in a certain 

fashion. I believe the way our case files are 

normally organized is based on the date of 

receipt.

And so, you know, that's also hard to 

say because it really depends on what kind of 

contract we get because I don't know if there's a 

mix of admin duties. I think there would be, 

especially if there's going to be data involved, 

and then the research side of it. So I would 

anticipate that. I don't know what the details 

of it looks like. I don't know what the contract 

is going to look like, but I would imagine there 

would be somebody to help with those sorts of 
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things.

MR. BIRD: Sorry to jump in. This is 

Kevin. I did want to let you know that Mr. 

Godfrey is now on the call.

CHAIR MARKOWITZ: So this is Steve 

Markowitz. So to answer your question, Dr. 

Goldman, we do envision getting assistance with 

that, whether that's, you know, by the contract 

or perhaps within the Department, remains to be 

seen, but we do plan on reviewing claims that are 

better organized or better detailed so that will 

facilitate claim review.

Mr. Chance, you want to continue? You 

want to go to Mr. Godfrey? What's your 

preference?

MR. CHANCE: Let's go to Mr. Godfrey. 

I think that some of the resource -- I think 

we've noted some of the questions that have come 

up, and maybe we could do a separate discussion 

on that once we've got together all the questions 

that you guys have. Because some of that's going 

to be related to specific contractual benchmarks 
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that are in the regulations that I don't want to 

commit to at this point.

CHAIR MARKOWITZ: Okay. And then we 

can entertain other questions from the Board 

members after Mr. Godfrey speaks.

MR. CHANCE: Sure. Sure. Sure.

MR. GODFREY: Okay. Mike, are you 

ready?

MR. CHANCE: I think so.

MR. GODFREY: Okay. Well, I want to 

thank Mike for the invitation to be here today. 

Also thank Rachel for inviting me to participate 

as well and the encouragement to participate, 

telling me a little bit about the Board and the 

things that you've done and accomplished.

So just to start off, I've been at 

Department of Labor now for quite some time, but 

specifically in the new position as Director and 

obviously new since January so I'm still starting 

to learn, you know, all of the multi-faceted 

things that happen within OWCP. And working with 

Rachel has been terrific in terms of learning the 
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energy program and the many people that are 

helped through the program. You know, both Mike 

and Rachel have been terrific administrators and 

made the job a lot easier as I transition into 

the position.

Before I was at OWCP, I was already 

with the Department of Labor as a judge in the 

FECA program, reviewing the final appeal 

decisions in FECA cases. Prior to that, I was 

the workers' compensation commissioner in the 

state of Iowa, and that was doing both 

administrative work and appellate legal work. 

And in that position, I was able to have an 

advisory board that assisted me primarily with 

legal matters more so than technical scientific 

type of work. But it gave me a great 

understanding that the role that advisory boards 

can have and the assistance that can be so 

crucial to be able to run a program.

Also, you know, the work history that 

I've done has just made it very important to me 

to work in and protect social insurance programs. 
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You know, I think it's very special when we can 

do work that, you know, really helps people that 

are in bad places, that also works to protect the 

system so the system is available to all the 

people that need it.

I just think that the work that 

happens, especially in the energy program, some 

of the stories that I've been told by Rachel, of 

people that have been assisted, these communities 

that have been helped, it's just so important, 

you know, the type of work that is being done.

So the main reason I'm here today is 

just to simply acknowledge the importance of your 

work. I've reviewed a lot of the materials and 

the recommendations that have made, and I really 

appreciate the technical assistance to the 

program. I can see the proactive nature of your 

work, and, you know, it's just very impressive. 

So I look forward to working with you all, 

learning more about what you do that -- I guess 

the things I would say is I pledge to be very 

respectful of your work. I want to be responsive 
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to your work. I look forward to the 

recommendations you make, and then working with 

Mike and Rachel as they make considerations and 

try to, you know, follow through on the things 

that you've done.

So I'm hopeful that your work and my 

administrative work within OWCP can really help 

us all help the Energy program and, you know, 

really help us to assist the people that need 

help and also protect the integrity of the 

system. So I really don't have a lot more to say 

other than just that brief introduction and the 

pledge to, you know, be responsive to the work 

that you all do and to be respectful and give 

you, you know, the independence that you need, 

but also hopefully the follow-up from the 

programs. And you know, hopefully working 

together, we can make some really good changes 

possible.

I don't know if anybody wants to ask 

any questions or share any information with me. 

I won't be able to stay on the meeting because of 
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prior commitments. But if there's any important 

information or messages that you'd like me to 

take away, I'd be happy to take a few questions 

or to listen.

CHAIR MARKOWITZ: This is Steven 

Markowitz. Thank you for those comments. We 

really appreciate your understanding of the work 

that we do, but also obviously the underlying 

program and how important and meaningful it is to 

so many people who have worked with DOE in the 

past.

Any Board members have any comments or 

questions they want to make at this point?

(No audible response.)

MR. GODFREY: Okay. Well, I can let 

you get back to your important work. But, again, 

thank you for the opportunity to speak with you 

all today, and thank you for the work that you 

do.

CHAIR MARKOWITZ: Okay. Thanks, Chris.

So this is Dr. Markowitz. Let's 

return to Mr. Chance. I don't know if there's 
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additional items he wanted to talk about or do 

any Board members have any further questions 

about the RFI or about our request for resources? 

Any comments or questions?

(No audible response.)

Okay. So, Mr. Chance, were there 

additional remarks you wanted to make?

MR. CHANCE: No, sir. I think that 

that's all I wanted to cover. You know, we'll be 

sharing information with you, Steven, about the 

RFI process as it moves forward, particularly 

timing once we know a little bit more. But, like 

I said, it's been a long time coming, but we are 

very close to getting this thing done. So I just 

wanted to share that with everybody. So let me -

- hold on a minute. Let me just take one look. 

I know you're going to go over this.

Okay. So it looks like we're doing 

pretty good on the agenda. It looks like Rachel 

is up soon, but if you wanted to go over the 

agenda items real quick, Steven, we can keep 

moving.
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CHAIR MARKOWITZ: Sure. Okay. Yeah, 

and we do appreciate the work on getting 

resources for the Board. We actually made this 

recommendation a couple years ago now, 2019, and 

in fact, the previous Board had also made the 

same request. So we're very happy to see 

progress here.

In fact, you know, during this 

meeting, we're going to be covering a lot of 

ground, and actually with some resources, some of 

our work probably could have been done more 

quickly, in a more timely way, working to the 

advantage of the claimants. Okay.

Let's just briefly review the agenda. 

If people have questions or they want to add 

things to the agenda, just chime in, please. 

Next, we're going to hear from Ms. Pond and Mr. 

Vance about the program, what's new. We've asked 

them to review the information items that I had 

abstracted from the last meeting that required 

some follow-up information or update or the like.

We'll take a break. We're going to 
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revisit a couple of recommendations that we made 

at the last meeting in November, and we have the 

January 2021 response from the Department. And 

so we have some comments and may have some 

questions about that.

And then we're going to move to the 

issue of the probable human carcinogen and 

whether there are some that legally should be, 

that we believe should be added to the SEM and, 

more importantly, to the decision-making by the 

program about what is compensable.

Of course, we couldn't avoid COVID 

forever. So in a few hours, we're going to be 

discussing, at the request of DOL, some issues 

related to COVID and I'm hoping that we are able 

to have a good discussion. It'll continue 

tomorrow, after our public comments today and 

that we are able to come up with a recommendation 

around COVID.

CHAIR MARKOWITZ: We have a public 

comment period later today. We have two -- so 

far, as of an hour go, two public commenters who 
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have signed up. There may be more. But speaking 

to the public, we welcome those comments. 

Tomorrow, same time we'll start, continue with 

the COVID discussion. We'll then move to 

asbestos. We've made a lot of progress in our 

interaction with the Department about how 

asbestos is viewed within the program. And 

there's just some more back -- a little bit more 

back-and-forth on asbestos that should be 

interesting.

We're then going to deal with a 

request from the Department they made to us in 

November about application of a way of measuring 

respiratory impairment, the six-minute walk test. 

A lot of work has been done on that, so we'll 

hear about that. And then we're going to 

discuss, sort of after the break tomorrow, issues 

of impairment more generally. This is more of an 

open discussion rather than any plans to get to a 

particular recommendation on that topic, but 

we'll see where the discussion goes.

And we have time for new business. I 
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always like to talk a little bit about Board 

process, if we can, ways of improving the Board 

process, communication, decisionmaking and the 

like. You can see from the agenda tomorrow that 

we have some extra time.

I don't know, Mr. Bird, whether you 

can move up the agenda on the screen so that 

people could be looking at tomorrow.

MR. BIRD: Everyone should have the 

ability to --

CHAIR MARKOWITZ: Okay. Yes.

(Simultaneous speaking.)

CHAIR MARKOWITZ: Yeah, yeah, sorry 

about that. Okay. So, yes, as you can see, we 

have some extra time tomorrow. So if one of our 

topics runs a little late during today, during 

tomorrow afternoon, we've got some extra time 

built in to deal with it, so not to worry about 

that.

Any comments, questions, or additions 

on the agenda?

Okay. So fine. Let's then move on to 
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Ms. Pond and Mr. Vance, and hear from them.

Welcome.

MS. POND: Hello. This is Rachel 

Pond. I'm the Director of the Energy 

Compensation Program here at Department of Labor 

for those of you who don't know in the public. 

And I am happy to be here, and thank you all for 

taking the time away from a lot that's going on 

in the world right now to be here to help us with 

this program.

I am going to cover some general 

program updates just to kind of give you guys an 

idea of what we've been doing the last few months 

since you last met. And then after that, John 

will be presenting on the follow-up 

recommendations that Dr. Markowitz was talking 

about earlier. I wanted to just first say that, 

if you have questions for me about any of what 

I'm going to say, probably best I just get 

through my part, and then before we go to John's, 

we can open it up for questions about any of the 

items that I've talked about in my little spiel.
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So first I wanted to talk a little bit 

about our operational plan goals. What that is, 

is we have about 30 different timeliness goals 

related to how quickly we get to a decision, the 

development steps in between, final decisions, 

and all of the sorts of steps that means when we 

-- how long it takes us to refer a case to NIOSH, 

how long it takes us to, you know, take initial 

development steps, how long it takes us to refer 

cases for other types of adjudication, how long 

it takes us to do industrial hygienist reports 

and contact medical consultants. It runs the 

gamut, our operational plan goals.

And so I just wanted to mention that 

in the last -- this year, this fiscal year, we've 

been exceeding just about all of them. All of 

them for -- I just sent that to our Final 

Adjudication Branch. And so I'm very happy that 

we've been able to do that. I will talk a little 

bit about how that funding may be impacted by 

COVID in a minute.

We've also instituted a new quality 
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process last year that we've really ramped up 

more this year. John is going to go into that a 

bit more since that's the follow-up for something 

we talked about before. One thing I wanted to 

mention about that, which he will -- this, 

actually, we used to have annual accountability 

reviews, which meant that we would review all the 

offices once a year and including our Final 

Adjudication Branch. With this new process of 

quality review, which is an ongoing immediate 

review of cases throughout the course of the 

year, that is going to replace our annual 

accountability reviews.

The annual accountability reviews were 

very helpful and very necessary at the beginning 

of our program, and they've been able to 

supplement our, you know, timeliness goals over 

the years.

But with these ongoing reviews and 

such, we found that the accountability reviews 

were becoming less and less useful because we 

were looking at a very small sample of cases over 
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an entire year. Not small but a representative 

sample, but it was over the course of a whole 

year. And this way we're going to be looking 

exclusively real time. So I just wanted to 

mention that because I know that accountability 

reviews were things that were published or that 

you guys were able to review. We will probably 

be working out some method of being able to share 

the information we're gathering from other types 

of quality reviews.

The other thing that we're doing to 

supplement the current quality reviews is we have 

more robust sampling for our claims staff in 

terms of our supervisors are reviewing more cases 

every month. They're giving feedback every month 

on the quality of the work to every claims 

examiner and Final Adjudication Branch staff in 

the country. So that process is now being 

captured very objectively. And it's really going 

to help us long term with the overall quality of 

our work.

The next thing I wanted to talk about 
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a bit is the pandemic and the results of what's 

been going on in the last year and how that 

impacted how we do our business and how we 

process our claims. I'm sure you're aware that --

I believe we talked about last time the bulletins 

that we published that allowed for telemedicine 

for routine and other medical appointments. That 

was something that, you know, we've got a process 

now so that people don't have to go to a doctor's 

office in order to be seen under certain 

circumstances. That has now been extended 

through September so that we can continue that 

practice. I know that some have asked if that 

will be a permanent practice. We are still 

looking at the options for that. But in the 

meantime, during this pandemic, we are going to 

continue that practice.

We've gotten some questions about 

paying for the COVID vaccine for employees. We 

have made a decision very recently to go ahead 

and pay for any COVID vaccine administration for 

employees that have been accepted into the 
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program and have conditions that we've accepted. 

Those will be paid automatically through our 

bill-processing agent. You know, in terms of 

that, we decided that, you know, we have a 

population that's more at risk than a lot of 

other programs may have, and it's important that 

we assist in any way we can in helping them get 

those vaccinations.

With regard to paying for 

consequential conditions when somebody actually 

has acquired COVID, that is usually something

that would have to be determined to be a 

consequence of an accepted condition. So, for 

example, if a person tested positive and they 

have a pulmonary condition, we have to have a 

physician's opinion advising us that the COVID 

was a consequence of the condition that we've 

accepted. And I know this is a topic that you 

are going to go into a lot more detail. And the 

reason that we asked for the Board's assistance 

on this is that if there are presumptions that we 

can make within that regard, then we would like 
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to be able to do that without having to go that 

extra step of getting a physician's opinion, if 

and when that's possible.

I mentioned that COVID may be causing 

some delays, so the delays that we're seeing 

right now are with obtaining records from the 

Federal Records Center, obtaining -- because a 

lot of those records centers are open for a 

little bit, and then they close again. And so if 

they're older records, people come back and they 

want to reopen a claim or they want to add to a 

claim, and we don't have the old records, we have 

to wait for those records to come back.

We've also had some delays with Social 

Security. Social Security assists us with 

obtaining wage information so that can help us 

with wage loss, but it also helps us sometimes in 

obtaining employment verification because, when 

the Department of Energy doesn't have records, we 

have to go to Social Security Administration to 

help the claimant determine, you know, when they 

worked, where they worked, and tie that into DOE 
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employment. So those are -- we're seeing some 

delays there.

And we are waiting for the SSA to come 

back on certain cases. And then we have some 

delays with medical appointments, particularly 

with regards to impairment. So if a physician 

needs to see a patient for an impairment 

evaluation and they're unavailable and there's a 

wait time, and for us to issue a determination, 

we have to wait for those medical opinions. 

Sometimes it's in the initial development where 

they need to see the patients and they haven't --

you know, they don't do telemedicine or, you 

know, they need to get additional records, that 

has been time-consuming.

And the final delay has been with the 

Department of Energy records. Now, some of their 

records centers are open and able to obtain 

information for us quickly and easily. Others 

are not open as much. They don't have as many 

employees working. And so it's been a challenge 

to get certain records from certain records 
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centers. What that ultimately means is that the 

claimants have to wait for us to adjudicate their 

claim. The actual way that we count timeliness 

is once a decision is made, then we can -- or a 

recommended decision is made, we can go back and 

look at the time it took for all of these 

actions.

And so when we start making these 

decisions, we will see a dip in those timeliness 

goals. But we are working with all of the 

agencies to get those records as soon as we can, 

and hopefully with more vaccinations and such, we 

will have some of these places opening up a 

little bit more, but it is a risk that is 

occurring at this time.

During the pandemic, we have been 

fortunate at Department of Labor to be able to 

telework. So 100 percent of our claims staff and 

final adjudication staff, most of our national 

office staff are working 100 percent at the 

current time. One of the ways that we've 

actually been able to do that is we did start a 
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project many years ago, back in 2013, to start 

digitizing our claims files, meaning we had paper 

from the very beginning, paper case files, stacks 

of paper and files and file them, and things like 

that. And the only way you can really review a 

case was to review the paper. And in 2013, we 

started slowly, but then as -- you know, in the 

last couple of years, and then particularly when 

COVID hit, we realized that we really wanted to 

be able to ramp that project up and, you know, to 

digitize as many cases as we possibly could.

We were very successful. Thankfully, 

we have contractors working around a -- you know, 

through this pandemic with social distancing to 

help us digitize these cases. And as of the end 

of March, we've digitized everything. So now our 

claims staff can review everything online, all 

case files, all the materials. So that's been 

very helpful during this time.

We have also had to close down our 

resource centers to the public, having one 

employee in the office per day, and then going 
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and picking up documents outside the door when 

somebody needed to submit something, and, you 

know, so that's been a challenge. They're still 

working. They're still answering phone calls, 

and they're still doing occupational history 

questionnaires virtually, and all of that. I'm 

hoping that, you know, maybe slowly we can start 

opening them with social distancing in the near 

future, just maybe to see claimants on an 

important basis or something like that, but 

that's something we're still working on.

The next thing I wanted to talk about 

is that we -- and I may have mentioned this the 

last time, but we have a new case assignment 

process. We started this in our Final 

Adjudication Branch in 2019. Then in 2020, we 

started the same process in the district office, 

which basically means we used to assign cases to 

our claims staff by jurisdiction. And so any 

cases where the employee last worked closer to 

the -- within the Jacksonville region, like Oak 

Ridge and Paducah, would go to our Jacksonville 
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office and so and so forth, moving across the 

country.

What we found was that that process 

was making it so that the workload distribution 

wasn't equal. And so you'd have more cases in 

Seattle and Jacksonville than you would in our 

Cleveland and Denver offices. So we decided to 

assign the cases randomly nationwide. And so, 

you know, I think that's going to allow us 

greater flexibility in terms of centralizing 

processes, making sure that we're being 

consistent across the country. You know, we've 

got a national administrator for our field 

offices, Christy Long, who can oversee all of the 

offices at the same time and has been creating 

some common physician descriptions, some common 

practices that they can use, and also it allows 

for greater flexibility in hiring and such.

During that process, we did extensive 

training, cross-training, with points of contact 

related to the Department of Energy facilities, 

because throughout the years, you know, the 
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Jacksonville district office, for example, would 

become more familiar with Paducah, and the 

Seattle office would become more familiar with 

Hanford. So we have done some cross-training 

there, both in the fed and in the district 

offices. We have resources that they can go to 

with regard to how to do employment verification.

And then I just wanted to talk about 

two other things that we've been working on and 

what we're planning to be working on. We did 

publish on April 2nd the Version 5.0 of the 

procedure manual, which just incorporated some of 

the bulletins that we'd had already and then had 

things like Authorized Representative Services 

were validating them in a special way in ECS so 

that we can have a consistent record of the 

correct addresses for authorized representatives 

and things like that.

We also, based on Bulletins 20-08 and 

21-01 and based on the information that we 

received from the Board, we did add it to the 

procedure manual, the presumptive language with 
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regard to asthma and Parkinsonism. We added the 

labor categories for the assessor's presumption 

of exposure, and we added the language related to 

non-Hodgkin's lymphoma. We also clarified some 

language in Chapter 16 regarding obtaining a 

medical diagnosis. In that chapter, there was a 

-- we said if you don't know -- if the evidence 

is not clear on the medical diagnosis, then you 

would refer the case to a CMC. We made it clear 

that the first place to ask for clarification 

would be with a treating physician.

And then we basically had 

clarification for the coverage for Oak Ridge at 

K-25. It was the clarification and the dates and 

what's covered under that SEC. There is a very 

detailed discussion of what that, is in that 

procedure manual in the transmittals, 21-01, so I 

kind of wanted to mention that it's out there.

We are also working on a system that 

will eventually -- and we're hoping by the end of 

the fiscal year to begin this process of allowing 

employee claimants access to their case file 
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digitally, meaning instead of having to ask for a 

copy of the case file, the employee claimant and 

their authorized representative, hopefully at 

that time as well, will be able to access the 

case file instead of having to have it copied and 

sent. And all of that is a pretty big project 

we're working on with our sister program, the 

Federal Employees Compensation Program on a 

system that they've developed to kind of add this 

feature in.

We're probably going to have to start 

with employees and then move to survivors due to 

some Privacy Act concerns. So after the end of 

this fiscal year, we'll move to working on 

getting that same access to survivors. But we 

need to make sure that the privacy of other 

survivors are protected so that's where we're 

going first with that project. But I'm very 

excited, and I think it's going to save a lot of 

people a lot of time and, you know, help them be 

able to see their records without having to ask 

for them specifically.
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We also had some SEM updates. In the 

last six months, there have been just some 

updates to Los Alamos, Savannah River, Oak Ridge 

25 and X-10, Sandia, and Yucca Mountain. You 

know, one of our mandates is to conduct outreach 

to let people know about our program. And we 

used to go around the country, you know, all the 

time to meet people and to talk to people about 

the program and provide updates and try to get 

the word out. That's been a little bit more 

difficult with the pandemic, but what we have 

been able to do is have virtual town-hall 

meetings.

And they've been very successful. 

We've been able to do one a month, and we've had 

200 to 300-plus people attend these outreach 

meetings. They're by Webex, and basically we've 

got a different topic every month. We've done 

medical benefits and survivorship, then the wage 

loss, impairment and, you know, the federal 

adjudication process, policy updates and 

discussion. And so we're continuing to do that.
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We've also worked with partner 

agencies, Department of Energy and NIOSH, on 

various presentations with regard to their pieces 

of the program, Department of Justice as well, 

and RECA. So it's been pretty good because at 

the end of each session, we have a question and 

answer period where people -- we can't interact 

with them directly as well as -- what they'll do 

is put in a question in a chat, and then we will 

answer them verbally. So that's not as ideal as 

being able to see people in person, but it 

actually has been able to reach more people than 

a lot of our town-hall meetings did because we 

went to individual regions. So that's been 

helpful.

We also have email blasts. We've got 

a couple of places where people can sign up to be 

either on an email blast for policy updates or 

email blast for medical updates. And we have a 

lot of people that are signed up for that. When 

we could get information just as things come up, 

we'll post them, and they can have access to it. 
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We've also been doing some newspaper ads and 

announcements where we can to try to reach those 

that are unaware of the program.

Finally, I just wanted to talk briefly 

about training. We are in the process -- we got 

a contractor last year to help us update all of 

our basic CE training, meaning when we have new 

claims examiners start, we have a package that 

they can go through, either with a mentor or with 

a virtual, you know, supervisor, virtually 

helping them walk through the training, or on 

their own. We've got these modules that is 

updated based on, you know, ongoing changes to 

policy.

We also supplement those trainings 

with additional training as issues arise. We 

have a training specialist right now. He works 

on various kinds of training. This year we're 

hoping to do a training with our staff on IH 

referrals, industrial hygienist referrals, 

causation and decision writing. That will be 

done probably in smaller groups and conducted by 
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staff in our policy branch.

So we're making progress. We continue 

to evaluate ourselves, evaluate what our needs 

are, and, you know, adjudicate claims as quickly 

as we can throughout the pandemic and moving 

forward. We're still also trying to make 

progress in, you know, the technology areas and 

ways in which we can be most successful and also 

provide the best service we can to our claimants.

That is all I have, and so I'm open to 

any questions you have about any of that before I 

turn it over to John.

CHAIR MARKOWITZ: This is Steven 

Markowitz. Any Board members have comments or 

questions? I have a couple, but I can let others 

go first.

MEMBER SILVER: This is Ken Silver. 

Ms. Pond, thank you very much for that overview. 

There does seem to be progress on a large number 

of standing issues, so thank you.

I'm particularly interested in your 

decision to randomly assign cases to field 
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offices. Do you know if any of the other OWCP 

programs that have offices around the country 

have experience with such a system? I'm thinking 

of FECA, in particular, which probably is all 

over the country.

MS. POND: They have 12 district 

offices, and I believe that they have done some 

centralization as well. I don't know the 

details, and I wouldn't want to speak out of 

turn, but I'm pretty sure that they've done some 

of that themselves.

And, Mike, could you speak for black 

lung on whether or not you've done some of that 

or are planning to?

MR. CHANCE: Yes. Can you hear me?

MS. POND: Yes.

MR. CHANCE: Okay. Hold on. My 

volume is messed up here. Yeah, so we began 

doing that readjustment for the very same reason 

in 2017. We were having backlogs that were 

building up in certain parts of the country. And 

in order to make more efficient use of our claims 
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examiners' time, we started that, you know, so 

now it's going on about four years, and it's been 

running very smoothly. We didn't have to do a 

lot of training, and Rachel says that, you know, 

that they're addressing that. So I think that as 

long as people, you know, understand the 

complexities of the different areas in the 

country that they have to serve, then it worked 

out fine for us.

MEMBER SILVER: Yeah. And I urge you 

to keep an ear to the rail because DOE sites are, 

you know, really, really complex, and having been 

involved with claimant families early on and the 

claimant advocates as the program grew up, I 

noticed that claimants in some parts of the 

country -- well, New Mexico is very comfortable 

with Denver just because of the similar culture, 

if you will. And over time, the staff builds up 

a reputation among the families and the claimant 

advocates for either knowing or not knowing the 

site. And the claimant advocates often play a 

role in educating and -- I know this may come as 
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a shock -- the claims examiners about specific 

quirks of the DOE site, and over time, they build 

a rapport, and that leads to efficiencies. So 

I'd urge you to really monitor this idea of 

sending claims to field offices that may not have 

the chops for a specific DOE site.

MS. POND: Yes. I am aware of the 

issue. And that is why we have, you know, points 

of contact, people who are more familiar with 

certain sites, and they have been reaching --

like claims examiners from other parts of the 

country do reach out to those POCs on a regular

basis. You know, I think that, you know, the 

danger of not doing this centralization is that 

certain offices would not be able to be 

maintained because they wouldn't have enough 

cases. We just have dwindling numbers of cases 

in certain jurisdictions. And so it really --

the pros to that process outweigh the cons. But 

I definitely am monitoring that, and I appreciate 

your comments.

MEMBER SILVER: Thank you.
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CHAIR MARKOWITZ: Other comments or 

questions?

I have a couple of questions, 

comments. So with digitization of the files with 

access by the claimants online, so this is 

something the Board had expressed an interest in 

from the beginning because we recommended that in 

2016. I think we were pushing on an open door, 

actually, but did you say that this calendar year 

you expect that to become a reality? Not for the 

survivors, per se, but for claimants?

MS. POND: That is the plan. We hope 

to have that access by the end of the fiscal 

year. Now, you know, it is an IT project, and we 

are dependent on some other factors, so don't 

hold me strictly to that, but that is our plan, 

and we are on track so far.

CHAIR MARKOWITZ: Okay. Thank you. 

Another question I have is on the quality 

assessment. So, you know, some things are easier 

to measure than others, timeliness, completion, 

completeness, things like that. You said that a 
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lot of good work has been done on timeliness and 

assessment. So we had heard that on some subset 

of impairment ratings that the claims evaluation 

or some subset had been prolonged longer than the 

expected time frames. Is that a problem? Is 

that an issue, or what's been the evolution on 

that?

MS. POND: For impairment claims, yes, 

the claimant has an opportunity to go to the 

physician of their choice. And so there are 

certain physicians that claimants want to go to 

in certain areas. So, for example, we've got one 

particular physician who has a long backlog of 

claimants that want to go to that particular 

physician. So they'll wait, and that means their 

impairments get delayed until that physician's 

available or ready to see them. That's one 

issue.

Another issue, as I said, is COVID has 

been an issue because doctors aren't seeing as 

many patients, and they've been slower to make 

appointments. You know, so we've been trying to 
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be flexible in terms of we have these deadlines 

that we have set up, you know, to try to make 

sure that we are being proactive on the 

impairments and that we make decisions as soon as 

we can. But in these cases, if the claimant 

wants to see a particular physician, well, if 

they want to go to one of our contract medical 

consultants, we can send them the records, and 

they can provide us with an opinion, but the 

claimant has that option.

So we will wait in some cases, or in 

some cases, we might say, well, we're going to 

make a decision at this point, but, you know, 

provided if you get an appointment, you get more 

information, you can come back and reopen that 

issue. So it really depends on the case, but a 

lot of that has been, at least from what I 

understand, that claimants want to go to 

particular physicians, and those physicians are 

backlogged.

CHAIR MARKOWITZ: So thanks. This is 

Steve Markowitz. That's understandable. I guess 
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my question is, once the impairment evaluation 

reaches the Department in the claims evaluation 

process, has there been a delay or, you know, a 

challenge to timeliness on these impairment 

ratings once the Department has the information?

MS. POND: So we have had some issues 

with diagnostic evidence supporting the 

impairment. I think we've come to you, and I 

think you're going to be talking about the sixminute walk test and looking at how that supports 

the rating. You know, there have been a very 

wide range of impairment ratings that may cause 

us to question, you know, what's the appropriate 

-- you know, whether they're using the right 

tables in the guides and things like that. So 

we've had to do some additional evaluation of 

that, and we are looking forward to, you know, 

the Board's discussion on that issue.

CHAIR MARKOWITZ: Okay. Thank you.

Other questions, comments?

So it's Steve Markowitz again. One 

last question. So for all the quality 
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assessments, do you ever -- how do you assess 

whether the claims examiner, when she or he makes 

their decision, how do you assess? And this may 

be -- I'd be maybe showing my naivete on this, 

but how do you assess whether the right decision 

was made?

MS. POND: Well, that's why we have 

these quality reviews. Because we've got a whole 

list of -- you know, there's like it's not a 

checklist, but we've got an actual database, that 

in the database, we've got different elements 

that you need to look for. How they developed 

the case. You know, did they go to evaluate the 

Site Exposure Matrices correctly? Did they look 

at the medical correctly? All of these pieces 

are all separated out and especially in the 

supervisory reviews, but also in these quality 

reviews that are being done by a quality 

assurance team. And so given that we have these 

very objective ways to look at a decision, the 

people that are reviewing it, it's going to be 

either a supervisor or it's going to be these 
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quality assurance analysts who are reviewing our 

procedures and making sure that they're being 

followed.

So at the end of the day, usually 

we're going to know this wasn't a correct 

determination. They made a mistake here in the 

development, or they didn't get enough 

information on employment, or, you know, they can 

easily pinpoint exactly where there might have 

been a problem. So at the end, if we see that 

there's an error in the actual decision itself, 

then we can point that out.

You know, we haven't seen a lot where 

it's just flat out wrong, but there are things 

that maybe they could have done differently. And 

when we see those things, particularly if it's 

case specific, we can go and say, you know, you 

need to go back and look at this case and reopen 

it or take additional development steps.

In other situations, we find trends 

that maybe they don't understand a certain 

concept, and we need to do training on it. So 
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that's kind of how we're utilizing both the 

sampling that's being conducted on a case-bycase, CE by CE, basis, but also on these quality 

reviews that are being conducted on an ongoing 

basis.

CHAIR MARKOWITZ: Okay. Thank you.

MS. POND: And I know John's going to 

talk a little bit more about that in follow-up to 

this if I haven't already covered it for him.

CHAIR MARKOWITZ: Okay. Thanks. If 

there are no other questions or comments, let's 

move on to Mr. Vance.

MS. POND: Thank you. And also I 

wanted to just mention that John or I or both of 

us will be on both days during the times that 

you're talking about, like, business stuff. Turn 

it over to John. Thanks.

CHAIR MARKOWITZ: Thank you.

MR. VANCE: All right, well good 

afternoon, everyone. I'm assuming everyone can 

hear me I hope.

MR. BIRD: Yes, we can.
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MR. VANCE: All right, good. You got 

me there for a second. Okay. So I think we were 

covering some discussion of something that we're 

going to start off with what Dr. Markowitz has 

asked the program to comment on. So right before 

or shortly before the Advisory Board meeting, we 

were sent some questions about some updates that 

I'm just going to run through. And I believe 

Carrie Rhoads has distributed this to the Board 

in writing, so I'm not going to read every 

response. I'm just going to try to summarize and 

elaborate as appropriate.

So one of the questions that you've 

already sort of talked through with Rachel is the 

fact that we have implemented this new quality 

assurance program. It is going to be replacing 

our accountability review process simply because 

of the amount of ongoing quality assurance that 

is conducted by the team.

So we do have four individuals that 

are conducting basically daily reviews of case 

files for quality assurance. The write-up
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explains that they are looking at different 

components of the decision, but basically they're 

looking at the quality, accuracy, and sufficiency 

of development relating to different activities 

being done by our District Office field 

operations, by our Final Adjudication Branch, and 

also by our Medical Benefits Adjudication Branch, 

which is dedicated to reviewing medical benefit 

claims made by individuals that have received 

(audio interference) illness.

So this is an ongoing activity with 

some, you know, the write-up that we did for it, 

and I can give you background about the fact that 

this is a ongoing review. This is very much 

different from our annual accountability reviews, 

that this is a static review of very limited 

number of cases. So the details of how much work 

is being done by the team is sort of laid out, 

comments with responses. And I believe that that 

will be probably put up on the website soon.

But just a quick verbal rundown, for 

recommended decisions, you know, we are looking 
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at, just for the period of 2020 -- fiscal year 

starting in 2020, we reviewed 1,248 cases, 416 

decisions, and we have a target -- I'm not going 

to run through all the details, fast forward May 

21, but it is in our write-up in response to 

that.

I've been involved with that QAC unit. 

They're very dedicated to looking for, you know, 

when you're talking about accuracy, what you're 

talking about is the proper application of 

program policy, proper interpretation of 

available evidence, quoting a particular 

decisional outcome. So it's basically another 

look at the case file. Keeping in mind that our 

actual decisional process is also set up for a 

recommendation to be made and then to be 

independently evaluated, considered by the Final 

Adjudication Branch.

So we're looking at both those, the 

quality and the accuracy of the decision-making 

at these Medical Benefit Adjudication Branches. 

So we're very hopeful this process is identifying 
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issues for our management to help improve the 

quality of decisional outcomes to identify 

issues, as Rachel mentioned in trend analysis, 

where we may need to focus training.

The next question that was posed to us 

is regarding the proportion of cases that are 

evaluated by industrial hygienists. The question 

spoke to how many of our new cases get reviewed 

by industrial hygienists. We don't really 

maintain that type of chronological data on, you 

know, the newness of the case and whether or not 

that -- whatever definition you want to apply for 

a new case. We just don't maintain that kind of 

data.

So when I was developing or coming 

back and taking a look at this, you know, what I 

can say is that an IH referral will occur where 

it is procedurally necessary or it is something 

that the claims adjudicator has looked at and 

decided that they need that kind of consultive or 

consultation with a industrial hygiene expert. 

So for the period of October 1, 2020 through 
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March 31, 2021, I was told that we've completed 

1,180 contractor IH reviews and 76 internal 

federal industrial hygiene reviews.

So, as you can see here, audit 

exposure analysis and characterization of toxins 

that employees encounter. And of course, that 

information feeds into our case adjudication 

process. That information is generally going to 

be reviewed either by a claimant's own physician 

or a contractor medical specialist in determining 

the quality of liability.

There's a question that was posed to 

the program with regard to the funding or the 

effort of the program to either develop or create 

certain claims data. You know, I think that we 

have talked about this before. I think this is a 

little separate than the discussion that was 

introduced at this meeting about the 

administrative support report. But the program 

has really taken the position that our mandate 

under our legislation is case adjudication 

activities. We don't have, in our view, a 
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mandate to do activities outside of the case 

adjudication process. We provided the 

legislative purpose of the program. And so we 

really are dedicating more of our appropriated 

funds to the function of adjudicated cases and 

anything that falls outside of that activity, 

which we consider to be -- the researcher and 

thus the Board has indicated this on behalf of 

the whole, that a mandate of that.

Something that I did do when I got 

this request, the Board had asked Dr. Markowitz a 

question about implementing a new occupational 

questionnaire committee process. And then at our 

last meeting, we had reported that we had 

completed over 600, 12 refused or thereabouts. 

The Board is interested in some feedback. So I 

did go out. I did talk to several contacts. I 

also asked for feedback. And I took the 

information that I did receive, and I assembled 

the summary table that's in the written response.

I also provided the Board written 

comments that I got, unabridged comments from our 
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field offices, also a research center. But you 

can get a sense of the feedback, and overall, the 

reception has been positive. There's definitely 

a lot more information that is captured that is 

much more relevant to the work history of the 

employee. It helps us more carefully adjust and 

adapt our research into exposures based on data 

we get from the employee as far as the 

identification of specific toxins that may be 

associated with the claimed illness. And so the 

overall comments that we received were helpful. 

I think that folks also recognized the fact that 

we're asking much more detailed information on 

the claimant versus the sort of checking boxes 

kind of thing. Fortunately, it better helps 

provide a little bit more reliable information.

The one thing that we're going to have 

to take a look at is the fact that we did have 

multiple comments about the formatting and the 

text size, that sort of thing. So we're going to 

go back and try and figure out what we can do to 

improve the overall readability of the form. I 
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did share with Carrie this morning -- I'm hoping 

that she sent that out -- the reference in the 

procedure manual to that Occupational Health 

Questionnaire, the sample in the procedure manual 

that should get circulated.

The fifth question related to the 

engagement with our medical director with regard 

to how he is utilized in evaluation of claims and 

what role he plays. We do have references in the 

procedure manual about the functions of the 

medical director. But the written response that 

we provided basically explains the fact that the 

medical director, much like any other science 

expert that we have on staff, is providing expert 

analysis, expert consultation. He is as an 

expert. He is a physician, qualified physician,

who we seek out his opinion and input on a 

variety of different adjudication functions. So 

that can have -- you know, that can touch on 

virtually any topic that, you know, that involves 

medicine. So it could be diagnostic, 

clarifications, questions on anatomy, 
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credentialing, medical credentialing, impairment, 

causation, and the medical necessity of services 

and supplies.

We view the opinion of the medical 

director much like any other expert that we rely 

on, that that is the opinion of that individual. 

And we have to weigh that information in helping 

us resolve or bring some sort of resolution to an 

outstanding case. The medical director for our 

program also does a lot of work in conjunction 

with the Office of Workers' Compensation in 

supporting our medical bill pay processing, 

activities, that has to do with, you know, 

treatment suites under which we pay medical 

bills. What is the viable costs to pay for 

particular types of care? He also is very 

involved with different kinds of coding issues 

relating to the implementation and the use of 

ICD-10 and CPT coding for billing purposes.

And finally, there was a question 

about bystander exposure, leading to how that's 

sort of evaluated, and there was a discussion 
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that somehow we are minimalizing bystander 

exposure. The response to that is that, you 

know, we have to evaluate cases based on the 

information we receive, whether that's contained 

in the Site Exposure Matrices, whether that's 

contained in the information that we get from the 

Department of Energy and all the sites that the 

employee worked at. And we also utilize the 

input of experts in the field of industrial 

hygiene. So if you have an individual who is 

providing data about the work activities and 

their contact with particular toxins, we're going 

to rely on that information and the input of 

experts to classify and characterize that 

exposure.

So if you do have individuals that had 

some sort of incidental exposure, that certainly 

can be identified and characterized in any kind 

of analysis that we do. If that is the case, 

then that information, whether it's incidental 

exposure or not, to particular toxins, that's 

going to be up to the physician who's evaluating 
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that exposure data to determine whether the 

exposure at the level reported or characterized 

by the industrial hygienist or determined by the 

Department of Labor is sufficient to meet that 

compensability standard under Part D.

So, you know, it's not that we 

minimalize any type of exposure. It is that we 

are characterizing the exposures based on the 

information that is received. And I will just 

make a comment that this is what is so important 

about that occupational history questionnaire. 

More data we have about the particular contact 

and work that an individual did in conjunction 

with the particular toxins, the more useful it is 

for industrial hygienists who evaluate that data 

in, to find and repair that.

So that is the six questions that we 

received. I'm sorry if I took more time than I 

thought I would, but the written responses are 

available. I have provided to report and you 

should be receiving the written responses also or 

feedback that we received from district offices 
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in regards to occupational history questionnaire 

feedback.

With that, I'd be happy to answer any 

other follow-up questions.

CHAIR MARKOWITZ: This is Steven 

Markowitz. Thank you very much, Mr. Vance. That 

was great.

Any comments or questions from Board 

members?

Steve Markowitz, again. I have a 

question or suggestion really. It's great to see 

the feedback, especially the positive feedback on 

the Occupational Health Questionnaire. The Board 

spent some time assisting the Department in 

revising the Occupational Health Questionnaire. 

So it's gratifying to see that it's appreciated 

in the field. You might -- I don't know, maybe 

you've done this already, but you might actually 

ask the industrial hygienists, both federal and 

the contractors, whether they're finding the new 

information that they're obtaining when they are 

looking at these new Occupational Health 
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Questionnaires that are completed, whether 

they're finding it more helpful, or whether they 

have any suggestions about how things might be 

modified. Because, ultimately, you know, sure, 

it's the claims examiners using it, but the IH is 

probably heavily depending on the OHQ for 

detailed information. So I would suggest you 

might -- if you haven't, you might ask the IHs 

how they see them, the new OHQ format.

MR. VANCE: Yeah, I am. Dr. 

Markowitz, this is John Vance again. I did have 

a conversation with our industrial hygienist. I 

was just talking through this very issue, and 

they said, you know, the Occupational History 

Questionnaire is always useful in helping them 

when they're trying to figure out something that 

they can't understand how the employee would've 

engaged in a particular toxin or engaged in a 

process relating to a particular toxin.

So they are using it. They are 

applying it in their analysis. And I think that 

they are encouraged by the fact that the work 
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process data that they get is often much more 

helpful than the checklist of all different 

toxins that the claimant used to be able to just 

sort of check off things and say, well, this is -

- here are all the toxins I exposed myself to. 

Wherein with the new occupational history 

questionnaire, they're getting more comprehensive 

and contextual data that helps them shape their 

opinion. They didn't provide any written 

responses. They brought me verbally responses.

CHAIR MARKOWITZ: Were those the feds, 

or are those the contracting IHs?

MR. VANCE: That was the federal 

staff.

CHAIR MARKOWITZ: I'd be interested to 

know how, you know, since the feds -- since the 

contractors are doing most of the -- be 

interesting how they do it. Something I don't 

remember, and maybe nobody remembers off the top 

of their head, is whether the OHQ actually 

addresses bystander exposure.

And maybe, Ms. Rhoads, at some point 
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during this meeting, if you could find a copy of 

the OHQ, we can see whether it does or doesn't. 

I just don't recall. I don't know whether --

MS. RHOADS: I just sent the link to 

the OHQ to the Board members' e-mail.

CHAIR MARKOWITZ: Oh, okay. Great, 

thanks. Okay. I'll take a look at it during 

break.

I have one final comment or question, 

but I just want to keep it open to the Board 

members if they have comments or questions.

Okay. So here's my question. I know 

we're a little bit overdue for our break. I'm 

looking at your language and your response for 

the role of the medical director. I'm trying to 

figure out how it actually works in practice, 

because, obviously, the medical director doesn't 

weigh in on every claim. And yet, you know, when 

the medical director does get involved, that 

person expresses an opinion which becomes part of 

the process. So I guess the question is, how is 

the medical director drawn into looking at 
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particular claims? Not in the audit process, I 

get that. But drawn into assisting claims 

evaluators or other personnel -- claims 

examiners, other personnel in looking at 

individual claims, what are the circumstances 

under which the medical director is called upon 

to get involved with individual claims?

MR. VANCE: Dr. Markowitz, it's John 

Vance. It's going to be dependent on the claims 

examiner working in conjunction with their 

management to determine whether or not there's an 

issue that they feel the medical director may be 

able to weigh in on that is going to help resolve 

some sort of outstanding question that the claims 

examiner has about something that they're 

evaluating in the case.

So a very relevant example is one 

where we do see the medical director involved 

quite frequently is where we're dealing with this 

very unique procedural reality where we have to 

look at whether or not a particular types of 

diagnosed cancer meets the anatomical definition 
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of a specified cancer under the Special Exposure 

Cohort definition under Part D. In other words, 

if you were presenting a pathology report and you 

want to know if does this qualify as a lymphoma, 

or does this qualify as a particular type of 

primary cancer? That's really up to, you know, a

medical expert to weigh in on that as far as 

whether anatomically that probably reported 

documenting a particular cancer that we could 

then characterize as a diagnosis for a specified 

cancer and thereby award an individual coverage 

under the Special Exposure Cohort. So they'll 

ask questions relating to that type of situation.

The other types of scenarios that we 

have seen the medical director ask about are 

questions where it's a matter of the claims 

examiner needing some sort of guidance or some 

sort of input as to whether or not there is 

something that the medical director can weigh in 

on to help inform or provide some sort of 

guidance to the claims examiner, what they should 

be thinking about as they evaluate a particular 
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claim. So whether that's, you know, does this 

diagnosis identified in a pathology report, does 

this actually report -- what type of cancer are 

we talking about here? Some of the pathology 

reports are very hard to interpret.

Also, they will ask the medical 

director questions about clinical and diagnostic 

evidence related to their diagnosis, whether 

there are sufficient documentation to support the 

diagnosis, or whether there should be additional 

development that's undertaken. So, I mean, it's 

really up to the claims examiner who is 

evaluating the case whether or not something that 

is really appropriate or not.

MS. POND: John, this is Rachel. Just 

to clarify, I believe that those recommend- --

any time they go to the medical director, they go 

through Policy first; is that correct?

MR. VANCE: Yes. When we do get some 

referrals, we have to make a judgment as to 

whether or not the medical director is the 

appropriate source to go to, or whether we would 
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recommend that just being sent to a contractor 

medical specialist.

MS. POND: Rachel again. Or back to 

the treating physician. The medical director 

also reviews transplants to make sure to approve 

those, and those usually get approved right away, 

but that is a conduit for transplants as well.

MR. VANCE: Yes.

CHAIR MARKOWITZ: Okay. Thank you. 

It's Markowitz. So is the opinion of the medical 

director, is it always put in writing? Is it a 

written opinion?

MR. VANCE: Yes. It's generally going 

to be a -- if we're submitting a request to the 

medical director responder case adjudication 

issue, then that opinion or that response is 

going to be uploaded in the case file.

CHAIR MARKOWITZ: Okay. Thanks.

Any other comments or questions?

Okay. Thank you very much. That was 

great. Thank you, Ms. Pond and also Mr. Vance.

We're going to go on break for ten 
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minutes, maybe even 13 minutes. We're going to 

resume at 2:50, according to my clock here.

I think, Mr. Chance, you wanted people 

to put their phones on mute or whatever. But in 

any event, please be prompt because we have some 

really interesting topics coming up.

(Whereupon, the above-entitled matter 

went off the record at 2:37 p.m. and resumed at 

2:54 p.m.)

CHAIR MARKOWITZ: Okay. Welcome back. 

Steve Markowitz. We're onto the next agenda 

item. And here we're going to talk about the 

couple of the recommendations that the Board made 

in November. And we have the Department's 

response to our recommendations, so we should 

discuss that. Next slide. 

Now we made a recommendation that we 

return to the issue of site-wide jobs, and we'd 

recommended that the Department develop and 

implement exposure presumptions for those job 

categories who would likely worked throughout the 

facility and had potential exposures to all 
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listed toxic substances at the facility. So just 

to remind you, we're talking about people like 

firefighters, security guards, health physics 

personnel, people who really over time moved 

around the facility in order to do their work.

So if we can go to the next slide. So 

I've excerpted the Department's response, and 

I've, in fact, put some highlights around the 

most important part. And basically, the 

Department's response is that it is quoted as 

inappropriate to assign its broad classification 

of exposure to specific labor categories in the 

absence of any underlying documentary support, 

end of quote. Basically, if I understand it 

correctly, the position is the data don't exist 

to support an exposure presumption for those job 

titles, therefore we can't make those 

presumptions. 

And so let me just kick off discussion 

of this. It's a little bit of a chicken and egg 

thing. We know that throughout the decades of 

operations, Department of Energy, that there's 
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been variable amount of documentation of the 

hazards. Certainly in the first few decades, 

relatively little documentation, and you know, 

even in the recent decades, selective 

documentation. I think that Department of -- I 

think if we had Greg Lewis here, he'd probably, 

I'm probably quoting him, actually, about this. 

And it varies from site to site. We looked 

earlier in the Board process at Hanford versus 

the Gaseous Diffusion Plants and at Hanford we 

saw an enormous number of toxic substances 

associated with some of these site-wide job 

titles. And we found relatively few with the 

gaseous diffusion plants. When we did the 

comparison within, between, or rather among the 

three gaseous diffusion plants, we found 

variation in the number of toxic substances for 

the same job title.

So the underlying problem is that 

there's limited documentary support. So the 

question is, what do you do in the absence of 

that, in the relative absence of that type of 
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documentation? And to stay with the Department's 

position here means that you are going to have 

essentially built-in variation, and sometimes 

variation that's a little hard to justify. 

Variation between various sites or between 

various job titles. And so my own feeling here 

is that, you know, we could look at firefighters 

at different sites and how their claims are 

evaluated and whether there is consistency across 

those claims. But what we're likely to find is 

that there's going to be a lot of variation in 

how firefighters and security guards recorded 

their exposures, because of what they do and how 

they deal with it in the light.

So my feeling is that it's more of a 

problem to tolerate the kind of variation in 

consideration of these claims than it is to 

tolerate the lack of documentary support. 

Knowing that frankly, over the years, the 

Department just varied and didn't have much 

documentation they provided for the hazards. 

Other comments of Board members?
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MEMBER KEY: Yes, this is Jim Key. I 

echo Dr. Markowitz's comments, especially when we 

are focusing on the origination of the 

legislation of the Energy Employees Illness 

Compensation Act, which I was a part of. The SEC 

was set up at that time for all three gaseous 

diffusion facilities as a result of no 

documentation. None could be found. Monitoring 

had got at the Paducah Gaseous Diffusion Plant in 

the arena of health physics and industrial 

hygiene of jobs out on the specific jobs for 

workers had exposure, did not even begin until 

the late 1980s. That's the end of my comment.

CHAIR MARKOWITZ: Other comments or --

MEMBER FRIEDMAN-JIMENEZ: This is Dr. 

Friedman-Jimenez. Another option would be to 

develop sort of a library of exposures. And as 

more cases were adjudicated, the information on 

each exposure, say for a firefighter in one plant 

versus another plant, would be added to this 

library, and eventually you would have pretty 

solid documentation of the level of exposure to 
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each agent and for firefighters and for 

maintenance workers and ground-keeping workers. 

The problem with that is that you then have a 

changing level of information over time. And 

then when you may compare to cases that are 

adjudicated in 2018 and 2024, and they'll have 

the same exact job, but a very different level of 

information and would wind up being adjudicated 

differently, which I don't think is what we want.

So I think Dr. Markowitz's proposal is 

the best way to address this high variability in 

the level of documentation. And we know that 

we're never going to have exact measurements on 

anyone. But this way, we can put together the 

best estimates of exposure once and have that be 

the set level. So I strongly agree with Dr. 

Markowtiz's proposal.

CHAIR MARKOWITZ: This is Steve 

Markowitz. So your idea of kind of a living 

exposure library is fascinating. The SEM is that 

in part because it does change over time. But 

your idea of incorporating claimants own 
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information into ongoing exposure considerations 

for others is fascinating. It's also, you know, 

as you say, you know, it just presents all kinds 

of challenges to a system that deals with 

compensation. So I agree with you. I don't 

think it's going to happen, but this is an 

interesting idea.

MEMBER FRIEDMAN-JIMENEZ: This 

essentially is a machine-learning approach. It 

is used a lot now with artificial intelligence. 

But it has this major downside, which is that 

you're going to have non-comparable adjudications 

over time as the level of information grows, 

which I don't think is acceptable.

MEMBER GOLDMAN: This is Rose Goldman. 

I have a question on this. I also agree with Dr. 

Markowitz that we need to address this. I mean, 

these are common problems that have come up with 

these kinds of job titles. And what I'm 

wondering, and I don't quite understand now is 

with the new questionnaire that we are using, if 

you have a firefighter, for example, who might be 
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able to say I went to fires if this person could 

remember, or at least I was covering our security 

guard, these buildings during this time period. 

I'm not sure why we can't go back and say, okay, 

this person spent hours in this area going 

through the various locations to be able to say 

from that building wherever the person remembered 

they were, that we would give them credit, as a 

bystander basically, to the exposures in that 

area.

CHAIR MARKOWITZ: So it's Steve 

Markowitz. I'm not sure how to proceed here 

because we have made the case, and the case has 

been rejected, and I can't really think of a new 

approach to providing any sort of empirical 

information. I think if we, probably, if we had 

a infrastructure within the Board to review 

claims, you know, conceivably we could look at 

any number of firefighter claims or security 

claims and guard claims and see how consistent or 

inconsistent they are in relation to the 

exposures across sites or within sites. But 
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that's a pretty big undertaking. And we don't 

have that infrastructure at the moment. So I 

don't see taking that approach. That would 

provide another level of information, but just 

don't see it happening. And I don't know whether 

there's any appeals process for the Board for 

reconsideration of recommendations. But unless 

I'm informed otherwise, I think we just have to 

stayed with this for the moment.

MEMBER GOLDMAN: This is Rose Goldman 

again. Given that we are looking forward to 

getting more resources to help with some things, 

perhaps one could say that in the future when 

there are more resources available to the Board, 

one could say, let's select several firefighters 

or security guards who made claims for certain 

areas and did fill in the new questionnaire. And 

to begin to put together something, maybe not as 

elegant as what Dr. Friedman-Jimenez suggested. 

But, you know, begin putting together at looking 

at those cases as individual ones and where they 

claim they were. And looking at the new 
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questionnaires and then beginning to put together 

what their exposures may have been and to revisit 

those cases sort of as examples. And then we

could make, if we got that kind of information, 

we could then make some suggestions about what 

could be some default or criteria for security 

guards or different people or methods for how to 

approach this once we had those extra resources. 

That's the end of my comment.

CHAIR MARKOWITZ: Steve Markowitz. 

So, you know, that postpones this by quite a bit 

of time. My other concern is that if the 

firefighter doesn't report these broad exposures 

because they don't know, and if the SEM doesn't 

have that breadth, because it doesn't, then we 

could easily examine claims and still come up 

with a lack of exposure-disease link that doesn't 

reflect reality. But we need to move on to the 

next thing. So are there any final comments on 

this issue?

MEMBER SILVER: Yes, Ken Silver here. 

I see a fundamental conceptual distinction 
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between firefighters and the other job 

categories. I think Dr. Goldman rightly referred 

to bystander exposures. A firefighter putting 

out a fire is hardly a bystander, and the nature 

of the agents that they're exposed to in a fire 

is way different from security guards passing 

through or what safety people do when they're 

doing their walk-arounds. And I just wonder if 

in the occupational epi literature, there are a 

handful of agents, chemicals, where there's welldocumented evidence of effects on bystanders that 

might form the basis for presumptions in these 

job categories.

So mesothelioma and asbestos, right, 

pretty much a slam-dunk for bystander exposure. 

Chronic beryllium disease, as long as we've known 

about beryllium in America there have been 

bystander cases. So I wonder if we could further 

develop the concept of bystander exposure from 

the empirical evidence that's maybe in the epi 

literature and deal with firefighters separately.

CHAIR MARKOWITZ: Well, you know what, 
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we can kick this back for Working Group to try to 

explorer further approaches. Because I don't 

think we're going to come up with a revision of 

the recommendation at the moment, unless someone 

disagrees. And we can talk about how they 

integrate bystander exposure into the 

considerations.

MEMBER SILVER: Thank you.

CHAIR MARKOWITZ: So let's move on, 

next slide. Another recommendation we made last 

November was that the Department develop a 

independent, third-party-based system of 

frequently evaluating the objectivity, quality, 

consistency, of individual claim reports, but 

actually I think more importantly, the audits of 

the program, industrial hygienists and 

physicians. And also that we recommended that 

the IH reports be audited in the same way that 

the physicians reports are audited and industrial 

hygiene review process be audited. 

So if we go to the next slide, we have 

the Department's response to that, which I think 
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mostly requires some clarification. The 

Department agreed to implement changes and 

quality control methods to enhance the 

independent evaluation of the objectivity, 

quality, consistency of industrial hygiene, and 

physician reporting. 

Next slide. I just literally took 

from their response to cases, highlighted the 

important parts. The Department designed 

additional methods of objective audit review for 

the IH evaluations. The Department will develop 

an audit process separate from the entities 

engaged in case adjudication to ensure outcomes 

conform to procedural, qualitative, and 

consistency standards.

Also, the Department will redesign the 

contract medical consultants review process to 

supplement current reviews that are conducted 

quarterly by the OWCP Medical Director. And 

they're going to fill an additional position, 

medical position in the office, that will allow 

for additional review of these reports from this 
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additional physician, and a higher degree of 

objectivity. So I guess my question to Ms. Pond 

and Mr. Vance is, where are we at with these 

changes? I realize that it was all of three 

months ago that this was written; but what's the 

current status?

MR. VANCE: Dr. Markowitz, this is 

John Vance. So we talked a lot about the QA 

process, I mean, that is a big change. That's 

actually been going on since last year. Again, 

we're looking at qualitative and policy 

application accuracy throughout our entire 

decisional process, whether that's at, you know, 

the District Office recommended decision stage or 

the final Adjudication Branch final decision 

stage. Separately we're looking at the medical 

adjudication process. So that process, I think, 

represents a real effort by the program to 

improve not only the volume of looking at audits 

for, you know, qualitative inaccuracy standards. 

And as part of that, they're looking at the 

sufficiency of the analysis of the decisions 
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utilizing medical health science in support 

decisional outcomes. So that's one thing.

We're also looking at, and we are 

working on, a redesign of our CMC review process. 

So we're looking at how we used to do the reviews 

and trying to bring in some more or more 

objective analysis of that process. So right now 

we've sort of mapped out some new auditing tools 

that's developing. We're going to try to look at 

what we can do to adjust our audit questions and 

the process that we utilize evaluating those 

cases. And there's going to have to be some 

internal discussions about who is going to do 

that and how can we infuse that objectivity that 

the Board is recommending. So it's a process in 

development right now. But I think that the 

quality assurance, you know, the process is 

definitely helpful in providing, you know, realtime feedback as they review cases.

MS. POND: And this is Rachel. With 

regard to the IH referral process and the audits

of those, it's presenting more of a challenge for 
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us, just because we have the audits of the 

reports within the contract, which is just the 

QA. And then we have every single report is 

reviewed by a federal IH. So, you know, so 

they're reviewing them every single time. So 

it's done by the contract person and then a 

federal person. We don't have IHs outside of our 

program to evaluate IHs. So we talked about 

having an effective, and I know I talked about 

this stuff, and we put this in the follow-up, but 

it's really kind of challenging for us to see our 

way to look at those reports of the IH without 

having additional IHs that are part of our 

program, if you understand what I'm saying. So I 

don't have an answer, a solid answer for you 

right now. We're still kind of contemplating how 

that would work outside of what we're already 

doing.

CHAIR MARKOWITZ: Okay. Thanks. Any 

Board members have comments or questions?

MEMBER VAN DYKE: This is Mike Van 

Dyke. I was just wondering is there a 
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possibility of being able to contract an IH group 

that doesn't do these outside evaluations to look 

at the quality?

MS. POND: Can you hear me now?

CHAIR MARKOWITZ: Yes.

MS. POND: Okay. This is Rachel. So 

that would mean contracting another contractor to 

audit the contract. I don't know that that's 

something that we can actually do. For a variety 

of contractual reasons, I think that would cause 

some complications. And again, then we're 

already another whole group of people to do the 

same work. And it just becomes expensive and it 

becomes, I believe there will be some contractual 

issue in that, but we will continue to evaluate 

the issue.

CHAIR MARKOWITZ: Other comments or 

questions? Steve Markowitz. So yeah, the Board 

actually, when we developed our recommendation, 

we kind of struggled with this. Because we 

understand how, you know, challenging these 

issues are and how to integrate that kind of 
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quality in decision-making. And the formulation 

we came up with was an independent third-party of 

the system. But the question that I really have 

is, you know, clearly that's kind of the start of 

this redesign and whether the Board, it's not a 

question we need an answer to now, but whether 

the Board can interact with the Department in a 

more frequent basis or more interactive process 

where we can kind of assist in this.

This is really a core task of the 

Board to assess the objectivity, quality, 

consistency of the work of industrial hygienists 

and the physician's task number 3, or number 4, 

of our charter. And we've looked at, you know, 

the Medical Director's audits and we've looked at 

claims and we see there are issues. So I guess 

my question is, is there a way that we can 

interact a little bit more frequently in 

providing the Department with the advice that 

we're supposed to be giving?

MS. POND: So I think that we've 

talked about this before and part of the problem 
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was resources on the Board's side. Having, you 

know, the ability to do those sorts of audits 

wasn't something that I thought you guys really 

had the bandwidth to do, because of the fact that 

you're volunteers and that sort of thing. Now, 

that being said, I know it's part of your tasks 

to do those sorts of things. So I would have to, 

you know, we can maybe talk further about it, you 

know, how something like that might work.

CHAIR MARKOWITZ: It's Steve 

Markowitz. I want to make clear, I wasn't 

volunteering the Board to do the reviews. What 

I'm saying is what you described in January, and 

the update seems to reflect this that you're 

thinking through developing how to improve the 

system, redesign is the word you used, design. 

And all I'm saying is next month, and the month 

after that, and the month after that, instead of 

waiting six months for us to get another report 

on what's happening, whether we could, the Board 

can interact, a subset of the Board can interact 

with Department more frequently to weigh in on 
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this issue.

MS. POND: I understand.

CHAIR MARKOWITZ: And I really don't 

need an answer right away. But it is logical way 

to proceed.

MR. CHANCE: Steve?

CHAIR MARKOWITZ: Yes?

MR. CHANCE: Steve, it's Mike. Hey, I 

think we're going to have to -- we'd have to 

evaluate what kind of implications that has on 

the whole FACA setup and all that. So I mean 

once, if you guys can come up with a 

recommendation, I think that it would have to go 

like, kind of a more formal route.

CHAIR MARKOWITZ: Yeah, I hear you. 

Okay. Any final comments? We need to move on, 

thank you. Any final comments or questions on 

this? 

Okay, so I'm going to turn it over to 

Dr. Goldman and the Working Group on Probable 

Human Carcinogens. And I think Kevin, you 

probably need to switch out the slide shows.
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MEMBER GOLDMAN: Thank you very much 

for this opportunity to present our work. I'm 

just going to, first of all, start by thanking 

the people on this Working Group, which is Dr. 

Aaron Bowman, Duronda Pope, and George FriedmanJimenez. And also to Dr. Steven Markowitz, who 

gave us some important guidance on how to 

approach the next step in the process. I'm just 

going to, you can go to the next slide, review a 

couple of things quickly to update some of the 

people who weren't on the Committee and take us 

from November to the present.

Which is, our task was to look at the 

IARC Group 2A, which is called the Probable Human 

Carcinogens, and to address whether or not they 

should be added to the SEM, linking them to 

specific cancers. We can go to the next one, 

please. 

So just as a further update since 

March 2021, that the Group 1, are the 

carcinogenic to humans. Group 2A, which is what 

we're addressing, there was a couple of more 
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agents added, 89, 2B, 318. And Group 3, was are 

not classifiable. So what we're really looking 

at is this Group 2A. Next please.

Again, just as a quick update, that 

the 2A probable carcinogenic in humans is based

upon limited evidence of carcinogenicity in 

humans and sufficient in experimental animals, or 

could be inadequate evidence of carcinogenicity 

in humans and sufficient and experimental 

animals. And another phase of things being 

brought in about mechanisms or limited 

carcinogenicity in humans but belonged, but based 

on mechanistic considerations to class of agents 

for which one or more members have been 

classified. So this is sort of hard to grasp. 

So I'm going to go into a little bit more detail 

and also with some illustrations. We can go to 

the next please.

So just basically what we started with 

last year, and this is started with the other 

Chair of this Working Group, Dr. Berenji, was to 

get a start on this was with 22 agents that had 
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been updated since 2016. And of those 22 agents, 

18 of them were toxic substances. And so the 

starting point here was with these 18. Could we 

go to the next, please. 

And this was the chart that we showed 

last year, I mean, last fall, about these 18 and 

some efforts to look at which ones were even in 

the SEM at all and which ones were not. So this 

is a preliminary effort to try to tackle this. 

And a lot of these agents were actually in the 

SEM, but not really coordinated with any cancers. 

Next, please.

So then the next task that we were 

really looking at for this year, was of these 18 

agents, which ones should be included in the SEM 

and what would be our basis for recommending 

that? And we did some looking at Group 1 agents. 

And then I think the approach that we took, with 

some guidance from Dr. Markowitz, was actually to 

start looking at which ones actually had some 

evidence for human cancer, so we would at least 

know which cancers to be recommending. Could we 
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go to the next one. 

So I just wanted, I think this raises 

the point of what the approach is here. That we 

were not going to go and read the primary 

epidemiological data, which is a vast task. And 

frankly, that's one that's already been done by 

IARC. And so I just wanted to show this graphic, 

which I really say speaks to the work that IARC 

does. To do this and it's, Kevin, could you just 

show that graphic please from IARC now.

MR. BIRD: It should be pulling up 

right now.

MEMBER GOLDMAN: Okay. So I just 

wanted to show that what happens through IARC is

for the agents that they select, they then go 

through a very detailed systematic review process 

of screening. They have external committees. 

They do review most of the literature. And then 

after reviewing all the literature, they rate how 

good it is. And they actually then do a 

synthesis of it and they look at what's the 

evidence for human cancers and which ones, what 
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is the evidence for animals and those response 

and looking at their quality of the studies. And 

then they also look at mechanistic data

synthesis. And here they're looking at the 

characteristics of the carcinogens, the relevance 

of the mechanisms and the study quality. And 

then yes, if we could --

So then what happens when they've gone 

through this process, they then note the 

evaluation, which is the evidence of cancer in 

humans, evidence of cancer in experimental 

animals, and then the mechanistic evidence. And 

now if we look at how do you get to be a Group 1? 

If you have sufficient human evidence, you're 

right there. Or even if you don't have that, if 

you have sufficient evidence in animals and very 

strong mechanistic evidence, you could land in 

this group.

Now, the important thing here for the 

Group 2A, is that there are two categories, two 

ways to get into it, and this is a little easier 

to see. Which is you could have limited human 
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evidence with sufficient evidence in cancer or 

limited human and strong mechanistic and get into 

Group 2A. But you could also have some agents 

that are in the Group 2A, where there's really 

not this limited cancer in humans. So you 

wouldn't know even which cancers to be able to 

give them worker compensation for, because we 

don't even know, we just know that the agents are 

potential carcinogens and more information could 

evolve in the future.

So could we go back to the main slide 

deck, Kevin, please? Right, so just again to 

show this more clearly, what our working Group 

was going to do is go through the 18, and see 

which ones fell into this category where there 

was some limited evidence in humans. And then 

see what we would find. Next please. 

So that's what we did. We reviewed 

the 18 toxic substances, and we mostly relied 

upon IARC because of the kind of review process 

they have done. And then from relying on IARC, 

we looked at each of those 18 and said which ones 
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had, as part of their supporting documentation 

for being a 2A, limited evidence of cancer in 

humans. And which ones and which cancers they 

thought there was limited evidence. And we also 

mentioned about the other supporting evidence. 

And I'm going to show you those tables in a 

minute. But the interesting thing is, out of the 

18, there were 11, that had limited evidence of 

cancer in humans and actually for specific sites. 

And then the other thing we've looked 

at as we went to the human health effects listing 

in SEM, which included various cancers and looked 

there to see if any of the 2As were there. And 

the answer was no. And there was no linkages of 

these 11, currently to cancers in the SEM. The 

other thing is IARC had linked some of these 

agents to breast, prostate, and testicular 

cancer, but those were not found in the SEM at 

all.

If we could go further. And well, we 

put together this chart, which we have sent out 

and as part of our recommendations, which details 
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what we found in terms of what the chemical 

substance is and what are the cancers that have 

been associated with it with limited evidence, 

and then what we found in the SEM or not. And go 

to the next slide, please. Okay. And then this 

is the continuation of the other 11. Next 

please. 

This is just showing you that for this 

time what we did was we grouped under each 

cancer, we're going the other way, which of the 

2A carcinogens would be associated with that 

cancer if we accepted the 2As. And you can see 

mostly in the lymphoma, non-Hodgkin's is a large 

category here, large numbers. But for most of 

them it's adding one or two in the categories. 

Next.

So what did we come up with for 

recommendations? The recommendations that we had 

is we thought that we should add these 11 toxic 

substances that are found to be probable human 

carcinogens in Group 2A, that did demonstrate 

limited human epidemiological evidence. And that 
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we should add them with linkages for those 

specific cancers that I just demonstrated in 

table 1. The other thing that we would recommend 

is that the SEM should specify that IARC and NTP 

evaluations are used in addition to the Haz-Map 

strategy and resource for the purpose of creating 

these linkages between toxic substances and the 

human cancer sites. And that for the future, 

because this is of course new information that is 

coming out over time, that the future IARC 2A 

substance-cancer linkages that are identified by 

IARC and also NTP, it should be incorporated in 

the SEM. And that this data should be used in 

addition to the Haz-Map for health effects and 

linkages and should be updated as we go along in 

the future.

And I think that's the end of our 

presentation. So we're open to, I guess 

questions and discussion. Well, I'll also 

invite, if any of our other members of the 

Working Group perhaps, have something you would 

like to add before we open it up for questions?
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MEMBER BOWMAN: Rose, this is Aaron. 

You did a fantastic job presenting our work, 

thank you so much. I just want to also 

acknowledge here, Rose is the leadership of our 

group, keeping us on task. Thank you so much.

MEMBER GOLDMAN: Thank you.

CHAIR MARKOWITZ: Steve Markowitz. I 

also thought this was a -- you really nailed 

this. This is a topic that was raised in 2016 or 

'17, by the Board because the IOM report in 2013, 

it pointed out that the SEM was incomplete with 

reference to taking all of the authoritative 

information it could from various sources. And I 

think the Department founded it was just too big 

a task. And then they asked us for help. And 

this is, at least for the probable human 

carcinogens, the end of that fairly long trail. 

And I think you've done, the Group has done an 

incredible job of summarizing.

There's also, for maybe the public, 

members of the public, who don't have this 

because it was just provided to the Department of 
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Labor within the past 24 hours. But there's a 

ten-page summary of the studies, agent by agent 

for the 11 agents for the various kinds of 

evidence that are available. That would go 

along, that would be submitted with this 

recommendation. And that will be made available 

online on our website pretty soon. So anyway, I 

personally, I think that I'm convinced looking at 

and reading that ten-page summary, knowing 

actually some of the underlying literature, I'm 

convinced that you all made the right decision on 

these 11 agents, that they are most likely human 

carcinogens, and there's enough data, enough 

studies pointing to specific sites to allow that 

to be integrated into the SEM. And I think, you 

know, when you think about language of the EEOICP 

Act, that, you know, more likely than not, a 

significant factor aggravating, contributing or 

causing, that these probable human carcinogens 

really make that grade.

MS. POND: Dr. Markowitz, this is 

Rachel. I just wanted to say this is very, I can 
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tell a lot of work went into it, and so I think 

it's going to be very helpful. So thank you very 

much.

MEMBER GOLDMAN: One thing, this is 

Rose Goldman again, I just want to say that it 

was great working with this Group, but as a 

starting point, we're only talking about 11. So 

it would seem to me too, that in terms of like 

taking what it first seemed like, where do we 

begin with this, but getting it down to at least 

the starting point of these 11. And saying what 

we could do with these 11. And also just saying 

we need to expand the database that they were 

working with which is IARC and bring it, mostly 

IARC but also NTP into it. Then seeing what we 

can do now and implement for 11. I mean, it 

makes the task, I think, a bit more doable. And 

then to see how that goes.

CHAIR MARKOWITZ: Steve Markowitz. I 

think I heard some volunteering effort there, but 

I'm not going to going to proceeded to that, Dr. 

Goldman, at the moment. So we have a 
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recommendation of --

MEMBER GOLDMAN: I volunteer the DOL, 

Dr. Markowitz, to take this forward to the next 

steps. 

CHAIR MARKOWITZ: Anyway, what we're 

looking at recommendation on the screen. And so 

we need to, what I'd like to do is have a formal 

motion to accept, to second, and then discuss it, 

and then if possible, vote on it.

MEMBER BOWMAN: This is Aaron Bowman. 

I put in a formal motion to accept the 

recommendations.

CHAIR MARKOWITZ: And is there a 

second?

MEMBER KEY: Jim Key, with a second.

CHAIR MARKOWITZ: Okay. Good, the 

floor is open to discussion. Steve Markowitz. I 

would point out while you're thinking about this, 

that I think this is really a, I can't think of a 

Workers Comp system frankly, that quite captures 

this amount of, you know, the universe on cancer. 

And so I think, you know, it's yet another way in 
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which the Energy Employees Occupational illness 

Compensation Program actually would be 

pioneering, appropriately so but pioneering 

properly evaluating the relationships between 

exposure and diseases in the workplace. So are 

there other comments or questions about this 

proposal; otherwise we can move to a vote?

MEMBER SILVER: This is Ken Silver. 

Really nice job. I remember when this discussion 

started and it was much more sprawling, and you 

really distilled it down to the crux of the 

matter. I wonder if, going forward, DOL should 

keep an eye on some of the alkylating agents for 

which is not yet evidence of specific cancer 

sites in humans. If I were claiming advocate for 

a worker who had exposure to styrene-7,8 oxide or 

hydrazine or 1,3-Propane sultone, I would advance 

an argument based on mechanism and animal 

literature and I would be very impatient if an 

epidemiological study came out that did identify 

specific organ sites. I'd be impatient for DOL 

to incorporate that into the SEM. So how do we 
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get DOL to keep an eye on the emerging literature 

for the chemicals that didn't make the cut but 

are sure suspicious?

MS. POND: I'm not sure if that's a 

question for DOL. This is Rachel. You know, 

we're constantly evaluating, SEM is constantly 

being updated and research is being conducted by 

a contractor on a regular basis. You know, we 

can make a note of the specifics that you just 

mentioned and have our contractor look it over.

MEMBER FRIEDMAN-JIMENEZ: This is Dr. 

Friedman-Jimenez. I agree with Dr. Silver that 

this should be a work-in-progress. And I think 

the path forward is clear. Once we've accepted 

IARC and to an extent, National Toxicology 

Program as the valid authorities on cancer risk 

identification, then I think revisiting, you 

know, every time a new agent is declared to be 

Class 1, or Class 2A carcinogen by IARC, then 

there should be an ongoing mechanism by which the 

SEM incorporates that information. Just as it 

incorporates information, new information on 
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toxicology of other substances that cause other 

diseases. So I think it's a bigger question of 

what is the structure of the SEM that we should 

modify to make it be an ongoing, growing body of 

information that responds to new science 

information as it comes out.

I think we have a pretty good bar for 

making the cut, which is that there's at least 

limited evidence in humans of carcinogenicity. 

And so I think it will be clear whether we should 

include it or not in the same way that we've done 

with these 11 agents out of the 18. So the 

question then is, how could the SEM be kept 

updated? What is the process by which it's 

updated? Are the industrial hygienists 

constantly looking at new literature? And so 

that's a question really for the program. How is 

the SEM updated, and how often and by what 

process?

MS. POND: John, do you want to take 

that, please? This is Rachel.

MR. VANCE: Yeah. So as we've 
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explained in the past the Site Exposure Matrices 

is an evolving database. We are, you know, we 

have folks at work with the Site Exposure 

Matrices through our contractor, Paragon. We're 

evaluating new information that's submitted by 

the public. There's new information that come to 

light through different scientific organizations. 

All that information is fed into the continual 

upgrades to the Site Exposure Matrices. So what 

Rachel mentioned at the beginning, we're getting 

constantly new data available about the exposures 

and toxins at different sites.

The same holds true for different 

kinds of health effects data. So health effect 

data is what the group was just discussing with 

regard to the IARC data. It's what is this that 

the program and communicate and generalize to its 

staff that we have the scientific confidence to 

say, this disease has a viable relationship to 

this toxin, okay? So it's a matter of lots of 

different inputs that Paragon and the program 

receives. So if we're getting input from the 
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Board, we're getting important from, you know, 

scientific bodies and other types of information

being submitted. All of that stuff has to be 

evaluated, considered by the program to determine 

whether or not we're going to add health effects 

data into the Site Exposure Matrices.

Because at the end of the day, the 

Site Exposure Matrices is a tool that's helping 

claims staff evaluate claims and collect and 

profile individuals about their contact with 

specific exposures that then are going to be 

reported to a physician to determine whether or 

not, you know, causation does exist under the 

party standard or to apply that data in 

establishing a standard. 

CHAIR MARKOWITZ: Steve Markowitz. 

Are there --

MEMBER FRIEDMAN-JIMENEZ: Can I just 

ask a follow-up question to that?

CHAIR MARKOWITZ: Go ahead.

MEMBER FRIEDMAN-JIMENEZ: So what I 

hear you saying is that largely the program 
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responds to requests from the public that 

different agents be added. I'm wondering if 

there might be an active surveillance mechanism 

built into the SEM that someone's job would be to 

keep up with the new publications from IARC and

from NTP and other toxicology publications to see 

whether they're new agents being added. 

Occasionally there are agents that were thought 

to be carcinogenic that get delisted. I know 

that's happened by NTP. So there are some 

changes that go on, and I think it would be good 

to have an active process rather than a passive 

process that only responds to requests from the 

outside. Is that something that you could 

entertain or is that something --

MR. VANCE: Yes, there is an active 

work group that is consequently discussing new 

information that's becoming available. And that 

team is comprised of individuals from Paragon, 

you know, if there is folks that are on that, in 

that work group from our program or a 

toxicologist participates in that discussion. 
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And so that's an evolving conversation about 

different medical science data that's becoming 

available that actually does do to a certain 

extent, what you're talking about. But what I 

think I'm trying to generally state, maybe not 

very clearly is, it's really a matter of what's 

out there. And there's tons of things out there, 

more information that we're getting, input from 

the public or the Advisory Board, or that our 

folks can look at and say, this is something to 

evaluate and consider, that's going to be 

helpful, and will inform our Site Exposure 

Matrices changes and updates. 

MEMBER GOLDMAN: This is Rose Goldman 

again. I think for this, you could just simplify 

this and just say that in Paragon's review, that 

they include checking the IARC website. Again, 

looking at it, just reviewing to make these 

slides from November to now, there were one or 

two more 2A carcinogens added and I didn't check 

to see if there was a toxic substances or 

something else. So I mean, the task is not 
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enormous here. They add maybe one Group 1, and 

maybe two or something every year to this. And I 

think if you'd put that on their checklist, you 

know, rather than trying to go and maybe review 

all of the thousands of articles that are coming 

out, but use that as a guide. And then go and 

see the articles that maybe IARC is giving more 

weight to if they feel the need to do that. But 

it certainly seems to me that's a totally doable 

task to put that on their checklist.

CHAIR MARKOWITZ: Steve Markowitz. 

Just a point of clarification. I think Paragon 

is probably mostly has expertise in exposure 

assessment and industrial hygiene. And I 

understand much of the evolution of the SEM has 

to do with adding different toxic substances, 

different places. But are you saying the disease 

exposure links in the SEM are routinely evaluated 

for improvement by Paragon, you know, with or 

without people from the program, the toxicologist 

--

MR. VANCE: I mean, the 
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recommendations or any kind of changes that would 

be permitted to by the Site Exposure, you know, 

in the Site Exposure Matrices would be evaluated 

by the program and we determine whether to add 

them. And I mean, this conversation, you know, 

originated from that effort where the question 

was whether or not these probable health effects 

that were reported by IARC, would this be 

something that the Board felt in their 

evaluation, would the Board be confident for the 

program to utilize those kinds of classifications 

and expanding guidance in the Site Exposure 

Matrices?

Because the standard that we've used 

in the past is basically, you know, there's an 

established humanistic relationship. And that's 

where I just don't know that proves that falls 

into that category. But that's basically it 

forms the Site Exposure Matrices. And so this 

group was meeting and talking and this is where 

that question came up from, in going to the Board 

and asking could we maybe look at the probables 
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and see whether or not, you know, the Board would 

feel comfortable adding new health effect data 

into the Site Exposure Matrices. So this sort of 

stems from that work we're doing.

CHAIR MARKOWITZ: Okay. Thank you. 

That's helpful. So let's go back to the 

recommendation, which we need to vote on. Any 

further comments on these recommendations?

MEMBER POPE: This is Duronda Pope. I 

just wanted to commend Dr. Goldman, Dr. Bowman, 

and Friedman-Jimenez, the work that they did. I 

had little to contribute, but this really adds to 

the help that the SEM needs to identify those 

carcinogens.

CHAIR MARKOWITZ: Thank you. Any 

final comments?

MEMBER FRIEDMAN-JIMENEZ: This is Dr. 

Friedman-Jimenez. I'm thinking maybe the third 

bullet should be modified to reflect an active 

process of identifying new changes in the IARC or 

NTP recommendations, because it just says that 

new linkages should be incorporated in the SEM, 
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but it doesn't say how. So maybe annually or 

semi-annually the IARC and NTP publication should 

be reviewed by the program to see if there are 

any changes, listing or delisting of agents that 

then would be incorporated into the SEM.

CHAIR MARKOWITZ: Steve Markowitz. 

You know, adding a time-frame that seems 

reasonable, you know, frequency. I'm not sure we 

need to tell them the sources because it's kind 

of self-evident in the way that it's written, 

right? Identified by IARC or NTP. But if you 

want to suggest a friendly amendment to the 

frequency, maybe Dr. Goldman would accept that.

MEMBER GOLDMAN: Sure. I don't know 

if you want to do it right now, you could pull up 

the Word document on that third, these 

recommendations were copied and pasted from the 

Word document and we could pull that up, thank 

you, Carrie. And we could, if you'd like, just 

do some wordsmithing right here. I don't know if 

I can, oops, wow, I can change it. Future 

linkages identified should be incorporated in the 
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SEM. So maybe we should say there should be 

surveillance or checking of these databases 

yearly, and that any new substance linkages 

described, because as George said, it could be 

delisted, should be incorporated.

I mean maybe the first sentence, I 

mean, the second sentence in this should become 

the first sentence, which is to say the data from 

IARC and NTP should be used in addition to HazMap. So we could put that as the first sentence 

of that. And then to give more specifics, say 

that at least on a yearly basis going forward, 

yearly basis, that IARC -- actually we should say 

because it would also apply to 1, even though 

we're not doing 1, that future IARC reports 

concerning Group 1 and 2A, substance-cancer 

linkages should be incorporated in the SEM.

Actually maybe the way the future 

rather than, yeah, we could say group. I know 

we're not speaking to 1, but I think the same 

process should be to 1, you know, that future 

IARC Group 1 and 2A cancer linkages should be 
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incorporated in the SEM. So we wouldn't have to 

repeat that. So future IARC Group 2A substancecancer linkages identified by IARC or NTP should 

be incorporated. I don't know, what do people 

think about that? It's a little wordy but it 

captures, I think, the point.

MEMBER BOWMAN: This is Aaron Bowman. 

I think that's fine. Yearly, I think seems like 

a reasonable occurrence given the very slow rate 

at which that happens, which of course occurs 

because of the very rigorous review process that 

goes into these assignments by IARC. Just maybe 

instead of substance-cancer linkages, substancecancer site linkages that sort of fits better 

with the first bullet, you know, it specifically 

cancer sites that we linked in our work on this.

MEMBER GOLDMAN: That's a good point.

MEMBER BOWMAN: Yes, it is substance, 

dash, cancer site linkages.

MR. BIRD: Sorry, Dr. Bowman, can you 

just let me know where exactly --

MEMBER BOWMAN: In that very last line 
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there's a word substance, hyphen, cancer, we want 

substance, hyphen, cancer site linkages.

MR. BIRD: Great. Thank you.

MEMBER BOWMAN: I do concur that Group 

1, here would be applicable, obviously, you know 

that the evidence is even more outstanding, 

right. So there's an obvious that doesn't even, 

the Group 1, are deemed, you know --

MEMBER GOLDMAN: Yeah.

MEMBER BOWMAN: Yeah.

MEMBER GOLDMAN: I would add, I know 

that we're not doing Group 1. Maybe the future 

IARC Group 2A and maybe in parenthesis as well as 

Group 1, close parenthesis, substance human, yes, 

substance human cancer site linkages because we 

base this on humans. There's animal data --

MEMBER BOWMAN: Absolutely, yeah, I 

agree. 

MEMBER GOLDMAN: Yes, substance, dash, 

human cancer site linkages.

MEMBER BOWMAN: Sorry, not there, not 

there. The other substance.
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MEMBER GOLDMAN: Yes, sorry. Yeah.

MEMBER BOWMAN: Yes.

MEMBER GOLDMAN: Yeah, I would say as 

well as yes, Group 1, substance-human cancer site 

linkages identified should be incorporated. 

Yeah, I think that makes sense just to proposing 

this process if we're putting forth this process 

recommendation that it would apply to also Group 

1.

MEMBER BOWMAN: Just to get back to 

the point that there are at times the linkage 

that becomes unlinked, so to speak.

We're talking about the future showing 

say, linkages and -- I just don't know how to add 

that wording there in a simple way. But 

obviously if something is, you know, taken off by 

IARC for that, we would support their 

conclusions.

CHAIR MARKOWITZ: This is Steve 

Markowitz. What we should do is instead of 

saying incorporated in the SEM, you could say 

updated in the SEM. And that way, if anything is 
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delinked that that would represent an update. I 

don't know if that solves the problem or not.

MEMBER BOWMAN: It solves it for me. 

MEMBER FRIEDMAN-JIMENEZ: Yeah, I 

agree.

MEMBER GOLDMAN: I agree.

CHAIR MARKOWITZ: Well, we should 

probably vote while everybody agrees. Are there 

any other comments? Okay. So we're going to 

take a vote here. I think Ms. Rhoads, I think I 

turn it over to you.

MS. RHOADS: Yeah, and just to be 

clear, we're voting on the three bullets all at 

once that are the screen right now that were just 

edited.

CHAIR MARKOWITZ: Correct.

MS. RHOADS: Okay. So Dr. Bowman?

MEMBER BOWMAN: Yes.

MS. RHOADS: Mr. Catlin?

MEMBER CATLIN: Yes.

MS. RHOADS: Dr. Friedman-Jimenez?

MEMBER FRIEDMAN-JIMENEZ: Yes.
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MS. RHOADS: Dr. Goldman?

MEMBER GOLDMAN: Yes.

MS. RHOADS: Mr. Key?

MEMBER KEY: Yes.

MEMBER POPE: Dr. Markowitz?

CHAIR MARKOWITZ: Yes.

MS. RHOADS: Dr. Mikulski?

MEMBER MIKULSKI: Yes.

MS. RHOADS: Ms. Pope?

MEMBER POPE: Yes.

MS. RHOADS: Dr. Silver?

MEMBER SILVER: Yes.

MS. RHOADS: Mr. Tebay?

MEMBER TEBAY: Yes.

MS. RHOADS: Dr. Van Dyke?

MEMBER VAN DYKE: Yes.

MS. RHOADS: And Ms. Whitten?

MEMBER WHITTEN: Yes.

MS. RHOADS: Okay. That's unanimous.

CHAIR MARKOWITZ: Okay. Thank you 

very much to the Working Group. We're going to 

move on. We're running a little bit late, but 
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that's okay. We do start our public comment 

session in 18 minutes. So what we're going to 

start is our COVID. Kevin, if you could go to my 

slide, slide 16. We're going to go to the COVID 

query to us by the Board, excuse me, by the 

Department. Actually, okay go to the next slide. 

So I tried to summarize what the questions to us 

are. But the Department, the program seeking 

input regarding whether it's reasonable under 

certain circumstances as supported by medical 

health science to presume that a certain type of 

accepted work-related illness, such as 

respiratory disease, will make the effect of a 

positive diagnosis of COVID-19 worse.

Under such a presumptive scenario, the 

program would be able to accept that COVID-19, is 

a compensable, consequential illness without 

further development. Otherwise, DEEOIC would 

seek out the opinion of a qualified physician to 

establish such a relationship as the attached. 

And then they give us some individual cases. So 

it's a question of presumption versus having to 
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evaluate individual case by individual case. And 

the presumption would be that there are certain 

health conditions that claimants have and with an 

accepted claim that if they then develop COVID19, the fact that the COVID-19 would be accepted 

as the consequences underlying program-recognized 

chronic illness.

So let's go to the next slide. I 

think that, you know, so I'm not sure we need to 

go through this. But we may, we have it to come 

back to it if we need to. You know, you have the 

accepted illness and then you have another, you 

know, COVID-19 that develops after. And then the 

question is, what underlying, previously 

recognized illnesses can COVID-19 be accepted 

automatically as a consequence of that illness. 

So next slide. And so what I did here was just 

for the, it's really a straw proposal, and I 

don't want to do well on the language right here, 

but this, you know, if we can conclude this 

discussion tomorrow, that we could come up with 

something that looks like this or a variation, 
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that we recommend that any chronic health 

condition that's listed by the CDC as being 

associated with severe COVID-19 disease by the 

various study types that's directly from the CDC 

website, be considered to be presumed to lead to 

COVID-19 disease. That is, the diagnosis of 

COVID-19 disease is a consequence of those 

health, chronic health conditions whether it 

falls or coincides with the onset of those 

conditions. So again, I don't want to get hung 

up on the specific language, but, you know, if 

it's appropriate, that's sort of the ballpark I 

think where we might consider. Next slide. So -

-

MEMBER GOLDMAN: Dr. Markowitz, could 

I just go back to that? This is Rose Goldman. 

Could we just go back to that?

CHAIR MARKOWITZ: Sure.

MEMBER GOLDMAN: The, not to wordsmith 

too much, but that is the diagnosis of COVID-19 

disease. I mean, I don't know that there's 

anything that would say you're more likely to get 
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the diagnosis. I think what's more likely is 

that having, and what I understood the question 

was, having one of these other work-related 

diagnoses led to a worsening of the COVID-19 

condition. Because the way it's written now it 

looks like having one of these conditions makes 

you more likely to catch it. And I don't know 

that we could say something like that. But 

having these conditions, what I've understood, 

gives you an increased risk for having a worse 

manifestation of the COVID-19.

MEMBER FRIEDMAN-JIMENEZ: This is Dr. 

Friedman-Jimenez. Dr. Bowman raised this 

question in e-mails of there's not a lot of 

evidence that suggests that underlying conditions 

increase the risk of infection with SARS-CoV-2. 

But there is good evidence that some underlying 

conditions increase the risk of severe COVID-19 

disease. So I think, and this is a new disease. 

So there's going to be evolution of our 

understanding of COVID over months and years. So 

right now, as I see it, and I spend a lot of my 
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day every day doing COVID-19 prevention, as I see 

it, the evidence supports saying that an 

underlying condition can contribute to or cause 

severe COVID-19.

And we don't have to specify whether 

it's the infection or the severity. It's going 

to be very difficult to find data. It's hard to 

study how underlying conditions change the risk 

of infection with COVID. But it is very clear if 

there are underlying conditions that do increase 

the incidence of severe COVID-19 disease. So I 

think we should just simply replace COVID-19 

disease with severe COVID-19 disease. And that 

will take into account the current evidence as it 

stands now.

MEMBER BOWMAN: This is, this is Aaron 

Bowman. I completely agree. Just adding that, 

we have the word severe up above in that first 

line, just adding the word severe in front of 

COVID in that last sentence should cover that.

CHAIR MARKOWITZ: So Kevin, if you 

could add that, I think you can. Yeah, I think 
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you could do that directly.

MEMBER GOLDMAN: And it increases --

CHAIR MARKOWITZ: And let's continue 

the discussion, go ahead.

MEMBER GOLDMAN: I was going to say 

maybe the, or I guess you could say, the 

diagnosis of severe COVID disease or the risks of 

getting it. But if you think diagnosis without 

having to say increased risk for it, but maybe 

this is okay. So just as you have it.

CHAIR MARKOWITZ: Yes.

MS. POND: But, Dr. Markowitz, this is 

Rachel. I just wanted to mention that for our 

purposes of compensation, the word severe isn't 

going to matter that much, so you can put it 

there. But I'm just saying if they've that the 

diagnosis we'll accept it and we'll accept 

whatever comes along with it, if it's a 

consequence of it.

MEMBER GOLDMAN: But what about 

symptomatic though? I mean, there are people who 

have asymptomatic conditions. Would you want the 
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word symptomatic of COVID-19 or not?

MS. POND: Well, at the end of the 

day, once we put in the ICD-9 code or ICD-10 code 

for COVID, any treatments or anything that 

results from that in terms of payment will be 

paid. So whether they have symptoms or not. If 

they don't have symptoms, they won't be billing 

for it. But if they do have symptoms, they will 

and they'll be paid because we will be able to 

approve the condition itself.

CHAIR MARKOWITZ: If you could go back 

to the PowerPoint slide for a moment. If you 

could go to the next slide. So I just wanted to 

show people who aren't quite following this issue 

as closely as others. That this is the CDC 

update as of three weeks ago on this issue of 

underlying medical conditions. And if you go to 

the next slide. And what it does is it provides 

us with what specific conditions there are and 

what the evidence is.

MS. POND: Okay. That's very helpful.

CHAIR MARKOWITZ: Yes, so we can 
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simply, for these purposes, adopt and recommend 

going forward, quote-unquote, that future medical 

conditions identified by CDC be incorporated. So 

these are the set that are supported by -- the 

CDC did sort of an odd way of categorizing this 

meta-analysis by doing reviews. Next slide. And 

then they have the next level. These are 

additional chronic medical conditions. Many of 

them are obviously not related to claims under 

EEOICPA, but these are conditions better 

supported by various types of analytic 

epidemiologic studies.

And then finally the next slide. They 

have a group and it's irrelevant, I think to the 

program, supported by mixed evidence and includes 

asthma. So what all this means is that some 

studies are positive and some studies are 

negative. And given the definition of, what's 

supported by mixed evidence means, that gets us 

into the previous discussion of 2A carcinogens. 

Next slide. You can go back to the previous 

slide.
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So I have a question. Well, I have a 

question but let me just open it up to other 

people first. So I think Ms. Pond may have 

relieved us of this problem of what do we do 

about mild COVID disease. Severe disease is 

generally defined as hospitalization or death. I 

think that's how the CDC defines it for the 

purpose of their analysis. But people have mild 

disease and people have asymptomatic disease. 

And sometimes that's followed by long-term 

symptoms. The onset of those symptoms can be 

delayed. A person may even have asymptomatic 

disease, laboratory confirmed, or they could have 

mild disease and then weeks later develop a 

problem. And that's being, you know, studied as 

we speak. And some of those people may appear 

among the claimants and link it to their accepted 

claim.

And even Dr. Friedman-Jimenez said we 

don't have right at present good evidence for 

whether these chronic health conditions are a 

risk factors for those, that profile of illness, 
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the mild or the long-haul disease. But I would 

argue actually, that if we know that the COPD 

makes the acquisition of the virus, makes it more 

likely that you develop severe disease, I would 

think it makes sense the person with COPD, when 

they acquire the infection, are less likely to 

have any symptomatic infection and more likely to 

have mild infection in addition to severe 

disease. In other words, some people do have 

severe. Some people will develop mild, perhaps 

long-haul disease.

Where, if they hadn't had COPD, that 

it might have been asymptomatic. In other words, 

so there's a whole continuum of severity of 

disease. And it's not just at the more severe 

end that these underlying chronic conditions play 

a role, but even at the less severe end. And 

maybe it's a moot scientific point given what Ms. 

Pond's just said, and I know that we don't have 

the evidence right now to demonstrate that. But 

I do think there's a real logic to it. 

MEMBER FRIEDMAN-JIMENEZ: So I'll take 
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that as a friendly amendment and let's maybe 

remove then severe and replace it was 

symptomatic. What do people think about that? 

Because I agree with you, Steven, it's a 

continuum. And this is a changing landscape as 

we get more evidence and learn more about COVID 

and long COVID in particular, which I think is 

going to be a major player over the next six 

months or a year and we'll learn more about it. 

So if we replaced severe COVID with symptomatic 

COVID, I think people that get asymptomatic 

COVID, SARS-CoV-2 infection, are not going to be 

filing compensation claims because they're not 

having symptoms.

CHAIR MARKOWITZ: Right.

MEMBER FRIEDMAN-JIMENEZ: So I don't 

think they're going to be claimed here. But 

symptomatic COVID, I think we could probably 

support that from the literature at this point.

MEMBER GOLDMAN: Although -- this is 

Rose, could you go back to the CDC website. 

Because I think those list of conditions, I mean, 
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this is a technicality basically and I would just 

go along with it. But just to say those are 

conditions that increase a person's risk of 

severe illness. So that's where that language 

comes from. So I think what we're saying is that 

we're going to take these conditions that the CDC 

listed as increasing a person's risk for severe 

illness and just adapting it to anybody who has 

these conditions. Because even if they don't 

have severe illness, it could go on to that. But 

technically, these are conditions that produce 

more of a risk or that's why I said the risk for 

severe illness. But so you're just adapting this 

to people who may just have symptomatic illness, 

not necessarily severe, but you're taking it from 

this data.

CHAIR MARKOWITZ: Steve Markowitz. 

Yeah, I mean, it's being upfront, and admitting 

that what the CDC has documented is for severe 

illness. But applying it more broadly to have, 

given the logic of continuum of, you know, the 

level of severity of the disease. But I mean, 
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let me say something else which is that we're 

going to begin our public comment session in 

three minutes. We have time, we have scheduled 

additional time tomorrow to continue this 

discussion. And I did that on purpose to start 

it today and give people time to think about it 

and we'll come back tomorrow and discuss it. So 

unless anybody has a final pressing comment on 

this topic, let's suspend it for tomorrow and 

then move to our public comment. Anybody want to 

make one last comment?

MEMBER BOWMAN: This is Aaron Bowman. 

I just happen to have one. Actually and it's a 

little related to the fact that I just got my 

second COVID vaccine shot so I'm worried that I 

might not make the call tomorrow if I get some 

symptomology. But I want to say that I concur 

with Rose's concern that the CDC uses the 

language severe, and since we're using that as 

our source of data, that I think reflecting that 

language is important for consistency. But since 

I believe it was Rachel that mentioned that the 
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application of this would be to all any way that 

would obviously cover symptomatic. I think it 

might a wise idea to continue to use CDC language 

given that that's our source of data, knowing 

that the program will apply it more broadly than 

that. 

CHAIR MARKOWITZ: Okay. Thank you. 

Understood. Okay. So let me ask Ms. Rhoads, how 

many people do we have signed up for the public 

comment session?

MS. RHOADS: We have three that have 

asked in advance to comment.

CHAIR MARKOWITZ: Okay. And is there 

some way if anybody's on the phone now and 

decided just in the last minute that they really 

want to make a public comment, is there any way 

that they can reach out to you?

MS. RHOADS: Yes, if they're on the 

line, press *1, and that will alert the moderator 

and then we can put you on the list.

CHAIR MARKOWITZ: So even on the 

instructions that we're staring at on the --
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MS. RHOADS: Oh, yes, the one that 

Kevin just put up, those. Yes. 

CHAIR MARKOWITZ: Okay. Well, what 

time, Ms. Rhoads, what time do you have?

MS. RHOADS: It's 4:14, but we can 

start if you like. There are at least two of the 

commenters on the line already.

CHAIR MARKOWITZ: Okay. And could you 

tell me their names?

MS. RHOADS: Terrie Barrie, D'Lanie 

Blaze, and Faye Vlieger.

CHAIR MARKOWITZ: The second one?

MS. RHOADS: D'Lanie Blaze.

CHAIR MARKOWITZ: Okay. Fine, if Ms. 

Barrie's ready, let's start.

MR. BIRD: Great, can the Operator 

please open up the line for Ms. Barrie. Oh, it 

looks like she should be open now.

MS. BARRIE: Okay. Can you hear me, I 

hate that phrase but --

CHAIR MARKOWITZ: Yes.

MS. BARRIE: All right, thank you. 
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Hello, Dr. Markowitz and members of the Board. 

My name is Terrie Barrie and I'm a founding 

member of the Alliance of Nuclear Worker Advocacy 

Groups. Thank you for all the work you do and 

for providing this time so that the stakeholders 

can share their thoughts with you about the 

program. The Radiation Exposure Compensation Act 

presumes that uranium workers who develop certain 

diseases should be compensated. The basic 

requirements are that they can prove employment 

for at least one year as a miner, miller or 

transporter at a covered facility, and has a firm 

diagnosis of the covered illness. The diseases 

RECA presumes for exposure to uranium for the 

miners, millers and transporters are lung cancer, 

fibrosis of the lung, pulmonary fibrosis, 

silicosis, pneumocon -- I cannot pronounce that 

word coniosis, sorry.

CHAIR MARKOWITZ: Pneumoconiosis, yes.

MS. BARRIE: That's it, yes. Cor 

pulmonale related to fibrosis of the lung, renal 

cancer and chronic renal disease including 
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nephritis and kidney tubal tissue injury is also 

presumed for uranium millers. A report issued by 

the World Health Organization states, and I 

quote, long-term studies of workers chronically 

exposed to uranium have provided impairment of 

the kidneys, in quotes or in parentheses, 

proximal tubular epithelium, end parentheses, 

that depended on the level of exposure. There is 

some evidence that kidney function returns to 

normal once a source of excessive uranium 

exposure has been removed. I'd like to read 

thoughts that D'Lanie Blaze shared with me about 

a problem adjudicating claims involving uranium 

exposure. I have her permission to do so.

Quote, uranium is a known nephrotoxin. 

At work sites were NIOSH has determined that it 

cannot estimate uranium exposure with sufficient 

accuracy, it seems illogical for an industrial 

hygienist to opine about an employee's potential 

uranium exposure when NIOSH has been unable to 

determine the amount, frequency, or duration. 

Uranium has both radiological and toxicological 
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properties. Yet the means of measuring uranium 

exposure were the same. Therefore, SEC classes 

should be applied to those workers who may have 

suffered toxic effects as opposed to radiological 

cancers from exposure to toxic radionuclides.

I was extremely thrilled to hear that 

you will be getting the support contractors that 

you've been asking for for years. And it may be 

beneficial to some claimants if the Board can 

determine if a presumption should be recommended 

for the non-cancerous diseases covered under RECA 

as to whether the radiological or chemical nature 

could contribute to the development of these noncancerous diseases. As for the lung and kidney 

cancer, could the chemical properties of uranium 

alone result in the development of these two 

cancers?

The last issue I want to raise is 

frankly, quite troubling. Certain concerns have 

been brought to my attention and I am working on 

getting an in-depth report which could show an 

emerging pattern of the claims examiners at FAB 
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cherry-picking evidence. It apparently has not 

been picked up with DEEOIC's new quality 

assurance process. For instance, take the 

example of the 14-year plight of a widow of a 

worker from Savannah River site. This was 

reported in the Aiken, South Carolina paper, The 

State. I won't go into the details about the 

early years of the case, but instead begin when 

the request for reconsideration was denied on 

September 28, 2020.

The FAB denied the request, quote, on 

the grounds that the representative's challenges 

were insufficient to change the June 8, 2020 

decision. The AR is an attorney and he filed a 

timely complaint in federal court mid to late 

November, asserting that, quote, FAB failed to 

discuss or meaningfully weigh any of the evidence 

of employment and simply concluded that the

District Office and the FAB have appropriately 

reviewed the complete file material in accordance 

with programmatic guidance, and determined that 

the submitted documentation does not establish 
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additional covered SRS employment for the 

employee, end quote. And then surprise, the 

complaint was withdrawn from the court. And on 

January 11, 2021, the Director of DEEOIC issued 

an order vacating FAB's June 8, 2020 final 

decision and the September 28, 2020 

reconsideration denial.

The most important statement of the 

March 5, 2021 final decision to finally accept 

the claim is, and I quote, after carefully 

considering the entirety of the evidence in the 

case file, end quote. The employment evidence is 

already in the case file before September 28, 

2020. Let me say that again, the evidence needed 

to approve this claim was in the case file, and 

the claims examiner and the FAB ignored it before 

a federal complaint was filed. As I've 

mentioned, I've heard of similar cases.

Now that the Board will have a 

contractor, I would respectfully ask that you 

audit final decisions to deny requests for 

reconsiderations, and decisions to deny the 
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reconsideration, to determine how prevalent it is 

for the claims examiner and FAB to ignore the 

evidence in the file. I will submit the report 

I'm awaiting on once I get it. And I thank you 

for your time and I will submit these comments to 

the website for posting to the meeting page. 

Thank you.

CHAIR MARKOWITZ: Thank you, Ms. 

Barrie. Next is Ms. D'Lanie Blaze.

MS. BLAZE: Can you guys hear me, this 

is D'Lanie Blaze?

CHAIR MARKOWITZ: Keep talking and 

then we'll tell you.

(Laughter.)

MS. BLAZE: This is D'Lanie Blaze, 

with CORE Advocacy.

CHAIR MARKOWITZ: Yes, we can hear 

you.

MS. BLAZE: Okay. Great. Thank you. 

I represent workers of Santa Susana, and it's 

related work sites, Canoga and the De Soto 

facility. Thank you for the opportunity to 
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address the Board. Today I'll talk about some 

major ongoing problems that I've noticed. 

Problems that have been repeatedly acknowledged 

by the National Office, but that have yet to be 

corrected. These issues persist and often 

present an unnavigable and even an adversarial 

situation for the claimants who rely on their 

claims examiners and of hearing reps for the fair 

and thorough evaluation under the Act that was 

promised by Congress.

Santa Susana, Canoga, and De Soto 

operated jointly under control of the same 

contractor and under the same Department of 

Energy contracts. Therefore, they present shared 

complexities that will require far more time than 

we have today. But I'm hopeful that the Board 

will recognize the need to engage in detailed 

review of the following issues which I believe 

have relevance to the claims process programwide. Today, Ms. Pond and the Board discussed 

the 2019, decision to divert claims away from the 

originating District Offices. Now this has gone 
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on long enough at this point so that we can see 

exactly why this is a really bad idea.

Claims are now being adjudicated by 

claims examiners and hearing reps who openly 

admit to never having heard of the worksite. 

They freely admit to their lack of familiarity 

with site operations and history. And 

subsequently, they're routinely missing the 

significance of detailed evidence that has 

bearing on the claim or even that supports a

favorable decision, even evidence that has been 

previously accepted by the originating District 

Office. This then results in decisions that are 

anything but consistent. Moreover, claims 

examiners and hearing reps are still pressed to 

be expedient and although Ms. Pond has clarified 

that they can call the originating District 

Office to ask for some guidance, here's something 

that has presented itself as a continuing 

problem.

CEs and HRs are so far out of their 

depth with the complexity of an unfamiliar 
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Department of Energy site, that they don't even 

know what questions to ask on the occasions that 

they realize the need for some adjudicatory 

guidance. There's now evaluative errors that 

blatantly contradict past final decisions 

resulting in inappropriate, erroneous and 

inconsistent decisions. And, adding insult to 

injury, this puts the claimant and the position 

of requesting and reconsideration, again, 

reviewed by someone who's likely unfamiliar with 

the worksite. This can add a year or more to 

process resulting in errors that are compounded 

and ultimately viable claims are being regularly 

denied unfairly.

The bottom line is that these work 

sites are highly complex and the evidence is 

frequently very detailed and specific and relies 

not only on a willingness to review all the 

evidence in the case file, but the ability to 

recognize the significance of that evidence, 

which could be as vague as job code, a building 

number, or reference to a particular project that 
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the worker participated in. Mr. Vance and Ms. 

Pond often tell us, rightly so, that every claim 

is unique. But I respectfully point out that 

this is largely because every worksite is unique. 

And that requires us to be able to recognize 

issues that are common among workers associated 

with a particular worksite.

Having District Offices that 

specialize and that are familiar in specific 

sites across the complex, complements this 

program and enables it to run efficiently for 

claimants who are often on borrowed time as it 

is.

Adding confusion makes it ineffective. 

Claimants should benefit from the expertise of 

seasoned and experienced adjudicators with 

institutional knowledge that has been gathered 

over 20 years of this program's administration. 

If we're here to serve them, we must demonstrate 

an eagerness to use what we've learned and to 

apply it to the review and adjudication of every 

unique claim.
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This brings me to issue two: a 

willingness to review evidence in the case file. 

The case file frequently includes employment 

records that reflect years or decades of 

additional covered employment that has been 

overlooked or disqualified in error in case after 

case. At Santa Susana, Canoga and De Soto, this 

problem persists throughout the majority of cases 

that I've reviewed over the past ten years. And 

it's continuing in new claims that are filed 

today, although the National Office recognized 

that this was a problem back in 2014. Now I've 

last count of the number of claims that I've 

reviewed where the case file contains handwritten 

letters from workers who've since died, letters 

pleading with the claims examiners please just 

review the employment records.

These case files demonstrate that 

considerable time has been spent drafting 

multiple letters of denial to the worker, and 

later to the widow, and later to the surviving 

children, when evidence showing that the worker 
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was telling the truth, has sat languishing in the 

case file without review since the outset of the 

claims process. I've looked at cases where this 

scenario has played itself out over the course of 

17 years. Multiple denials, but the evidence is 

right there the entire time. Moreover, this type 

of problem and relevant evidence is even less 

likely to be recognized by District Offices who 

are so unfamiliar with specifics of a worksite or 

even basic details of corporate contractor 

successorship, which brings me to the last issue 

that I'll just touch on today.

It appears that there's a need to make 

a correction in the BTComp database regarding 

contractor corporate successorship for Canoga. 

Ultimately, it has been established that Santa 

Susana, Canoga, and De Soto operated jointly by 

the same established contractors and their 

successors until 2005, and so the contractor 

information between these three sites should be 

consistent. The corporate verifier, which was 

Boeing, has provided written confirmation 
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indicating that North American Aviation is also 

known as Boeing North American, and that they 

were assigned the same tax identification number. 

These were Boeing's predecessors.

In 2016 and 2020, the originating 

District Office accepted Boeing's written 

confirmation as sufficient evidence to establish 

1950s-era employment at Canoga facility. But 

since BTComp does not reflect that information, 

today these other District Offices who lack 

familiarity are now denying Social Security 

Administration records. And they're not 

accepting Boeing's written confirmation. It 

doesn't help that newly assigned District Offices 

are totally unaware of the shared characteristics 

between these three worksites. And they're often 

unaware of the need to review the BTComp database 

or the SEM for all three worksites when 

adjudicating one claim for a single worker who 

rotated between these three sites in the 

performance of his or her job duties.

I think this probably wraps up my time 
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but, in closing, Santa Susana, Canoga and De 

Soto, our three worksites, that operated in 

unison, they're likely deserving of a 

reclassification as a combined worksite. And I 

intend to submit information in the future that 

would support such a decision. But for now, I'm 

hopeful that the Board will recommend to update 

the BTComp database so that these sites reflect 

the same contractor successorship, that all 

records in the case file will be reviewed without 

exception, and that adjudicatory jurisdiction may 

be restored to the originating District Offices 

that possess the expertise and institutional 

knowledge befitting of established site 

complexities.

I know I've covered a lot of ground in 

just a few minutes. But as always, it is a 

privilege to represent the claimants and to 

address the Board. Thank you.

CHAIR MARKOWITZ: Thank you. Will you 

submit your comments in writing?

MS. BLAZE: Yes.
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CHAIR MARKOWITZ: Okay. Great. Thank 

you. So I'd like to welcome, actually, welcome 

back Ms. Faye Vlieger. I say welcome back for 

the newer Board members because Ms. Vlieger used 

to be a member of the Board. But in any event, 

welcome, Ms. Vlieger.

MS. VLIEGER: Hello, Dr. Markowitz. 

Can everyone hear me?

CHAIR MARKOWITZ: Yes.

MS. VLIEGER: I'd like to greet the 

Board members, Mr. Chance, Director Pond, and 

John Vance, if they're still on the phone. I'd 

like to commend the Board on its extensive work, 

particularly with the IARC recommendations and 

also with looking at the audits that are done on 

claim files. I'd also like to commend the 

Department of Labor on its work to maintain the 

adjudication process of claims during the COVID 

situation. Let me give you a flyover of my 

experience with the claims adjudication process, 

despite COVID from the past year.

There are ongoing issues with the 
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Department of Labor District Offices, excuse me, 

claims examiners not reviewing the SEM data for 

all possible exposures to claimants, not only by 

labor category, but by the areas they worked. 

There is a direct conflict of information when 

it's said that this particular labor category 

worked in an area, yet the toxins for that area 

are not listed under that labor category. You 

have to go and look at the area itself. This is 

not being done. And a very cursory SEM review is 

being done on a number of claims. And I only see 

a small percentage of the claims that are 

processed as an authorized representative.

And just for those of you that don't 

know, all of my work that I do is word-of-mouth. 

I do not have an ad in the newspaper and nor do I 

want one. But from what I see, there's a 

consistent lack of claims examiners training in 

how to use the SEM when a claimant tells them 

quite clearly, I worked in this area, I used this 

chemical. SEM is also still not properly linked

to labor categories. Labor categories 
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consistently have no toxins associated with them. 

Yet, when you look at the claimant's evidence 

that they have provided at the work areas where 

they were in, if you look at their personnel 

records that are provided by the Department of 

Energy, and if you look at the EE-3 where they 

talk about what they did, where they did it, and 

when they did it, the toxins are there. But 

there's a complete flyover by the claims 

examiners of any of that information.

I see a lot of issues with new claims 

examiners not understanding that there has to be 

more than a cursory review of the SEM. Then when 

it goes for supervisory review these errors are 

not being caught. So when someone would say, 

hey, why aren't you letting the claims examiner 

know? They're not going to take the information 

from me because it was already presented to them 

in the claim, nor are they coming back to me and 

saying, well, where you think you're getting this 

from. So it has to come from DOL training. And 

I don't see that happening.
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Another one of the issues that has 

been ongoing for more than a year now, is the 

improper use of the Medical Director as a 

contract medical consultant opinion. The 

Department has weighed in on this. And they had 

said at this meeting that the Medical Director 

provides an expert opinion. But the Medical 

Director actually provides a memo of his thoughts 

on a claim. And the Medical Director is prompted 

to provide this memo by the Policy Branch who 

does a review of the claim and provides the 

Medical Director with specific questions on the 

limited information provided to him. I had 

experience with a particular claim that took more 

than a year and a half to adjudicate, and the 

Medical Director weighed in. Yet, the statement 

of facts provided to the Medical Director did not 

match the statement of accepted facts for the 

claim, and this was not caught by the Policy 

Branch when they referred it to the Medical 

Director, nor did the Medical Director find it 

necessary to look at the claim, to look at the 
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facts himself.

So the Medical Director's memo cited 

facts not in evidence and facts that had no 

bearing on what was being decided at the moment. 

In fact, in one particular claim, the Policy 

Branch told the Medical Director, that there were 

two other claims that had been approved for the 

client, and yet those claims were not approved by 

the client. And the Medical Director based his 

opinion on those claims already being in evidence 

and factual. So my experience has been that the 

referral to the Medical Director is not accurate, 

which leads to erroneous assumptions by the 

Medical Director. Because the Medical Director 

opinion was used as the contract medical 

consultant opinion, the claimant was denied a 

refereed contract medical consultant opinion 

because the Medical Director's opinion because 

used in its place.

While at this meeting, they have said 

that the Medical Director is an expert opinion. 

The Medical Director, per the Procedure Manual, 
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is not a contract medical consultant. Yes, his 

opinion can be sought according to the Procedure 

Manual when there are questions about evidence or 

questions about what is this disease, but nowhere 

in the Procedure Manual does it say that the 

Medical Director substitutes for a contract 

medical consultant report in the adjudication 

process. This needs to be straightened out 

between the Director, John Vance, the Policy 

Branch and the Medical Director. While the 

Medical Director have the place in the program, 

he is not a contract medical consultant per the 

procedure Manual.

While I have a lot of gripes from time 

to time. I do appreciate the ongoing 

improvements to the Energy Employees Program. 

I'm speaking from experience because I was a 

claimant back in 2004, and back then it took five 

years to get my claim approved. Things have 

improved immensely since that time and I wanted 

to commend the Department of Labor for that work. 

I look forward to resolving issues I have 
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mentioned today and future concerns. And I want 

to thank the Board for their work, and I miss you 

guys a lot. Anyhow, that's the end of my 

comment.

CHAIR MARKOWITZ: Okay. Thank you. 

You're intending on submitting written comments?

MS. VLIEGER: Yes, I had provided some 

of these issues to the Board in written comments 

last fall. And I will provide written comments 

to the Board again.

CHAIR MARKOWITZ: I just want to make 

sure you retain the last line about missing the 

Board. That's all.

MS. VLIEGER: I do miss the Board. I 

don't know if you guys miss me or not, but yes.

CHAIR MARKOWITZ: In fact, let me ask 

Ms. Rhoads, does the transcript include the 

couple of comments. It does, right?

MS. RHOADS: Yes, it does.

CHAIR MARKOWITZ: Okay. Well, then in 

that case, you know, we'll have a written record 

of the various comments so -- although when the 
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written comments come in, they get posted on our 

website, and that's not true of the transcript 

version. So there is some advantage to 

submitting written comments. Ms. Rhoads, is 

there any other public commenters?

MS. RHOADS: Yeah, there's one more 

person that we know, Jean Sisko.

CHAIR MARKOWITZ: Okay. Is she ready?

MS. RHOADS: She is.

CHAIR MARKOWITZ: Ms. Sisko.

MS. SISKO: Hello. My name is Jeannie 

Sisko. I'm with the Worker Health Protection 

Program at the Portsmouth site. I have been 

listening today and I just had a few comments on, 

I guess we'll start with the job descriptions. 

And it is a lot of work to get your hands around 

this, but that is what is really lacking in this 

claims process. For a person to talk about the 

questionnaire and I have not seen it, okay. But 

that the adjudicators of the claim go from the 

questionnaire. Well, a person that worked at 

Portsmouth, worked in all buildings if they were 
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in the bargaining unit. Our Collective 

Bargaining Agreement throughout the years prove 

that, we even had job descriptions I send in with 

the claims. Yet, they're not given credit for 

working in all buildings and around all of the 

chemicals.

I don't know if Mr. Vance remembers me 

or not, but I worked with you and Greg on adding 

hundreds of chemicals to the SEM at the 

Portsmouth site. And the way I did that is I 

talked to the contractor who gave me the MSDS 

sheets. Then you ask for the building where they 

were at, who was in charge. I gave you all of 

that. And you still wanted to know more 

information on what chemical a person was exposed 

to specifically within the building, within the 

classification. That contractor wrote a letter 

and I gave it to you in person at one of these 

meetings that said, all bargaining unit 

classifications worked in all buildings together 

because that's how we worked at Portsmouth.

You can look, you can take a 
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maintenance mechanic, okay, he's in the process 

building working on motors or compressors or 

converters. You have a process operator standing 

there with him, a chemical operator ready to 

clean it, an instrument guy working on the lines. 

And at our plant, we did a total change out. So 

that means the exposures to these chemicals, all 

of them, everyone had them. You evidently did 

not accept that letter from the contractor and it 

was from the United States Enrichment 

Corporation's safety person. I don't know how 

you're going to get past these work 

classifications, and I'm not just speaking for 

myself.

Paducah and Portsmouth are different 

in their Collective Bargaining Agreement on what 

they call people. You know, there's a 

maintenance mechanic might be called something 

else of Paducah. The only thing I can suggest is 

look at our Collective Bargaining Agreement 

because anybody that had a union, had job 

descriptions in them. They've got all of that 
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and I'm sure DOE has it. But because DOE has 

changed prime contractors so often, that's why 

you don't have any records. That's what I, you 

know, say six different prime contractors at 

Portsmouth. Once they're done, they take the 

records with them or they put them somewhere, you 

know, we don't even, I mean, they're not all put 

in one spot. DOE can't find that stuff. And 

it's extremely important because people are 

losing claims because you've got a claims 

examiner that he just reads all buildings and he 

thinks, oh that guy he's just trying to get as 

much exposure as he can. But it's the term. 

They don't, I don't know how to get anybody to 

believe us. That's one thing.

Two is, the -- changing the claims 

around to the other, you know, to all these 

centers. I think we lost what little bit we had 

of the knowledge of the plant by changing that. 

I understand you want them trained and crosstrained and all that. But I think the claims 

should stay, say like ours stay with Cleveland 
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and if you want your claims examiners to be 

trained, move one of them somewhere. You know, 

just keep rotating the claims examiners, not the 

claims. They can learn that way.

And what else was I going to say? I 

didn't write anything up. I'm thrilled that the 

Department of Labor has taken the position that 

they're going to allow a COVID class for COVID 

claim as a consequential illness or something to 

a claim if they have a lung, you know an approved 

lung condition. That's wonderful.

And I was listening to your talk on 

severe versus symptomatic. In workers comp, and 

I have a lot of experience in that, I don't think 

anything has to be severe as long as it could 

contribute to it or aggravate it. And so if a 

person had COPD, one condition through Department 

of Labor, they get COVID, their COPD is going to 

be worse, you know. So I hope you go with the 

symptomatic language and not the severe. And I 

want to say this, I know our union halls will 

help the Department of Labor figure out the job 
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classification and how to get their arms around 

that if you would let us. I don't know how else 

to say it. I've said it more than once. And the 

Board's doing an awesome job. I really 

appreciate your work and I thank you for your 

time.

CHAIR MARKOWITZ: Thank you, Ms. 

Sisko. Ms. Rhoads, anybody else who volunteered 

to speak?

MS. RHOADS: No, that was it.

MR. BIRD: Carrie, sorry, this is 

Kevin. We did have Gary Vanderbilt just raise 

his hands, so --

MS. RHOADS: Okay.

CHAIR MARKOWITZ: Okay. You want to 

put them on Mr. Vanderbilt?

MR. VANDERBILT: Yes, I'm here. Can 

you hear me?

CHAIR MARKOWITZ: Sure.

MR. VANDERBILT: Okay. This is Gary 

Vanderbilt from Paducah Gaseous Diffusion Plant, 

authorized representative for workers here and 
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across the nation. What I wanted to reiterate, I 

really wasn't going to make any comments, I've 

been delayed to get on the call, but I appreciate 

what you all are doing today. And I got word 

that I still had time to get on the call. Thank 

goodness. But what my counterpart there in 

Portsmouth has just especially emphasized what we 

have been preaching here at Paducah for the last, 

well, looking at my time frame is almost going on 

20 years since I started helping people and 

representing people as an IARC since 2006. Or 

that's what the classification was back in those 

days through the resource center. So we are the 

site and I have got the claimants that filed the 

false claims that led to the sick worker program 

nationwide.

Those people are my claimants now. 

They gave testimony with the Department of 

Justice. And now we're looking at situations 

where we know we were processing plutonium from 

spent reactor fuel. But when we brought this up 

a couple of years ago to the Director during a 
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presentation here in Paducah, that was not 

emphasized. When I asked the Director who 

decided to set the dates of February 1992, for 

the plutonium exposure termination date. Ms. 

Leiton Pond did not have a response other than 

that's what we were told. Now in our 

investigation, we're a company that I'm project 

delivery-trained for Lockheed Martin. And so 

when we did this job for 14 years, we've got 

thousands of workers at the Paducah Gaseous 

Diffusion Plant and our sister plant, Portsmouth. 

If you interview any of them working for 

multitude contractors like Bechtel, Four Rivers 

Partnership at this point, we then find that 

there's apparently somebody had their mute button 

on when these workers were interviewed.

In Illinois, we've discovered 

contracts that DOE and Fernald had with the 

company. And as you all know, they're not 

classified as a DOE facility. But now with the 

litigation going on that I'm not involved in at 

Metropolis, Illinois, these issues are very 
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important because we've got workers and the 

depositions have indicated they were processing 

and importing spent reactor fuel from Russia. 

And that material was fed into the systems 

without any personal protection. And even the 

NRC admitted that hearing in Paducah before the 

attorneys filed their lawsuit.

My point is, how do you do a dose 

reconstruction and you never bring up the 

plutonium exposures that Paducah, Portsmouth, and 

Honeywell, and Oak Ridge, and Savannah River? 

That's where the material is stored right now, 

the spent reactor fuel, Dr. Markowitz. You came 

to Paducah. We had witnesses that testified 

their claims are being blocked. They met the 

statutory criteria. They're all breathing 

beryllium every day. They had all the beryllium 

CBD requirements. The statutory requirements 

then were blocked and denials were issued. And 

it appeared, let's hope this is not the case, 

because Gary Vanderbilt is a nuclear worker 

that's sick when I've got illnesses now, myself. 
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We had to have them.

When I worked in the 720 building, 

there wasn't any record of anybody coming to bat 

for any worker in the 720 building. But I've 

organized a thousand nuclear workers here. And 

Portsmouth has the same footprint of 

contamination. For somebody to not even 

understand how the process worked, and I'm saying 

the nuclear enrichment process. In came the 

Russian plutonium. It was uploaded, taken in by 

USEC. USEC then, then loaded over a thousand 

cylinders of plutonium. The Board doesn't want 

to hear that. But that's where this whole 

process fails because you're not considering the 

toxic chemicals that I've just heard Terrie 

Barrie talk about, Faye Vlieger and the other 

young lady.

What we've got to do is figure out 

what does it take to convince the Director and 

Mr. Gerard O'Hara to allow his people to do their 

job. Because obviously, whenever my claims come 

in, they go straight to the Washington National 
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Office. And Mr. Vance, you were in Paducah, you, 

you heard the testimony, you promised the worker 

that was from Carlisle County, and he was a 

jailer and had a gun on which we allowed him in 

the room, but his testimony was shocking. You 

never called him back. The testimony of Minnie 

Donald. You did take care of Minnie's complaint, 

but ironically, going back to what Terrie Barrie 

said, her claim was reinstated. She met the 

criteria, I decided to pull back and not be the 

AR. Donna Hand then filed and made the same 

application that I did. And when I look further 

back into her records in 2004, nothing changed. 

Her x-rays were there in '04, they were there in 

'12 and Minnie Donald is a witness to this, and 

you all heard her personally.

So these are things that are 

frustrating. I appreciate the Board being in 

existence. Kirk was sitting right there, he 

said, he blurted out that you only had to be 

exposed to beryllium in Paducah plant one day. 

We'll try for years in the 720 building with it 
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raining down on your desk. That happened to me. 

I knew I would become a victim and now I'm on 

steroids because I can't breathe. But see, 

there's no sympathy for nuclear workers as we all

can see. All I can say is we need other people 

running the program that aren't issuing 

procedures as soon as we catch them in a 

violation. Procedures, according to Ed 

Whitfield, Mitch McConnell, and Malcolm Nelson, 

procedures don't override the statutes or the 

regulations.

There's numerous cases, and we were 

successful in an arbitrary secretions ruling. 

Ms. Barry's on the phone, she had the other one. 

Mine was chronic beryllium disease, Stone versus 

DOL. A federal judge in Paducah, Kentucky, ruled 

against the DOL that they were arbitrary or 

capricious. Now, when Gerard O'Hara got that 

ruling, his comment was and I want this on the 

record because, Judge Thomas B. Russell is not 

going to like it, he said, we don't care what the 

federal judges say. Now that makes me think the 
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government has already decided all of these 

cases. Now we got a new -- now we've got 

somebody besides Mitch McConnell as a majority 

leader. And yes, I live in Kentucky and I don't 

believe Mitch McConnell does anything to help the

nuclear world.

That's all I've got to say and I 

appreciate it. And I will submit these comments 

back to you. And I would like to request that 

John Vance communicate with David Nelson and 

Nelson Todd from Carlisle County. The claims 

have gone on too long. I'd say 14 to 20 years 

for Minnie Donald is absolutely atrocious. But 

she got paid. She's happy now because Gary's not 

involved. How's that? But I did it. I'm the 

one that did. I wanted to make sure we could 

show the biased treatment of claimants, unequal 

application, and loss of constitutional rights. 

But the Constitution does not fit. None of this 

is -- we're being forced into federal court on 

every claim.

That's not what the Lasero decision 
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said. You shall compensate. There's no shall in 

Paducah, Kentucky. My thought is Ron Ballard, 

Chuck Dechelle, Bud Jenkins and Don Gilson are 

the reason Paducah Gaseous Diffusion Plant 

workers are not getting compensated, especially 

if they belong to the wrong political party. 

Thank you, Dr. Markowitz.

CHAIR MARKOWITZ: Thank you. Okay. I 

think that concludes our public commenters. We 

will adjourn. I think I may have to turn over 

the Mr. Chance to officially adjourn. But we're 

going to adjourn now and we will resume tomorrow 

at 1:00 p.m. On the schedule tomorrow, we'll 

continue the COVID discussion, so Board members, 

please take a look if you haven't already at the 

very short asbestos document sent to you. The 

relatively short but chock-full of information, 

six-minute walk test, these are available on our 

website so the public can also take a look at 

them. And then we'll further our other 

discussions. Any questions or comments or shall 

I turn this over to Mr. Chance to adjourn?
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MR. CHANCE: Steve, I'm here.

CHAIR MARKOWITZ: Okay. Good. All 

yours.

MR. CHANCE: Okay. So I wanted to 

thank the members of the Board, members the 

public, for taking their time out of their day to 

share their thoughts. And the Board, I hope 

we've had a chance to format a little bit, so I 

hope that the more concentrated afternoon session 

proved useful. So we will see. You know, we're 

always kind of seeing how we can improve things. 

So thanks, Steven, and with that, we will 

adjourn.

(Whereupon, the above-entitled matter 

went off the record at 4:57 p.m.)