UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER HEALTH

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SUMMARY MINUTES

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NOVEMBER 5-6, 2020

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The Advisory Board met via teleconference, Steven 

Markowitz, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN

KENNETH SILVER

MIKE VAN DYKE

MEDICAL COMMUNITY

GEORGE FRIEDMAN-JIMENEZ

ROSE GOLDMAN

STEVEN MARKOWITZ, Chair

MAREK MIKULSKI

CLAIMANT COMMUNITY

JIM KEY

DURONDA POPE

CALIN TEBAY

DIANNE WHITTEN

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
THURSDAY, NOVEMBER 5, 2020

Introductions:

Mr. Chance called the meeting to order at 11:12 a.m. and 

welcomed returning and newly-appointed Board members. He noted 

that several guest speakers from the Office of Workers’ 

Compensation Programs (OWCP) and the Office of the Solicitor

(SOL) were scheduled to address the Board and provide helpful 

information to new members. This meeting was conducted via 

teleconference as a precaution against the COVID-19 pandemic.

Mr. Chance reminded Board members that some of the materials 

they received in their capacity as special government employees, 

including private contracts, could not be shared or discussed 

publicly. Steven Markowitz, Board Chair, shared a brief overview 

of the Energy Employees Occupational Illness Compensation 

Program (EEOICP) and its purpose for the benefit of new Board 

members.

Welcome:

Julia Hearthway, Director of the Office of Workers’ Compensation 

Programs, welcomed the Board members and outlined the work of 

claims examiners in adjudicating cases. She summarized some of 

OWCP’s recent activities, including an increased focus on 

individual employee performance through case action sample 

reviews and the addition of a quality assurance analyst, who 

will conduct quality reviews on a weekly basis to help guide 

policy and training management. 

Review of Agenda:

The above-listed Board members were in attendance. After a round 

of introductions, Chair Markowitz outlined the day’s agenda. He 

noted that in addition to the items noted on the agenda, Gregory 

Lewis from the Office of Health and Safety at the Department of 

Energy (DOE) would be addressing DOE’s role in relation to the 

compensation program.

FACA Review:

Joe Plick, Counsel for FOIA and Information Law from the

Solicitor’s Office, presented an overview of the Federal 

Advisory Committee Act (FACA) and its requirements. Under FACA, 

each committee’s charter must be approved by the General 

Services Administration (GSA). Meetings are generally open to 

the public, and detailed minutes of those meetings must be kept.
The statute also requires that members of the public be allowed 

to provide written comments before or shortly after each 

meeting. 

Under FACA, agencies must maintain several positions with 

respect to committees, including the Designated Federal 

Official, who is required to attend all meetings, perform

administrative functions, and has the authority to approve, call 

and adjourn meetings and approve the agenda. The agency is also 

responsible for collaborating with the committee to set 

priorities and objectives for its work and ensure that the 

committee’s advice is independent. 

While most meetings are open to the public, committees may hold 

closed meetings in accordance with exemptions in the Freedom of 

Information Act (FOIA). Closed meetings, which could be convened 

to discuss personal matters or national security concerns, 

require approval from the head of the agency and the general 

counsel and must be noticed 30 days in advance. Subcommittees 

are also permitted by FACA and are not subject to FACA 

requirements. 

Energy Statute/Creation of the Board:

Tom Gilbin, Associate Solicitor for the Federal Employees’ and 

Energy Workers’ Compensation (FEEWC) Division in SOL, discussed 

the history of the EEOICP program and its governing statute.

EEOICPA was enacted in 2000 to provide medical compensation and 

benefits for workers in the nuclear weapons industry. It 

contains two parts that outline the compensation available for 

covered employees and their survivors. Part B provides uniform 

lump sum payments and benefits and covers employees at DOE, its 

predecessor agencies, certain vendors, contractors and 

subcontractors. It also provides smaller lump sum payments and 

benefits to individuals found eligible by the Department of 

Justice (DOJ) under Section 5 of the Radiation Exposure 

Compensation Act (RECA). Part E provides variable lump sum 

payments based on workers’ permanent impairments of the whole 

body or qualifying calendar years of established wage loss. Part 

E covers DOE contractor employees and their survivors and 

provides the same benefits to uranium miners, millers and ore 

transporters covered by Section 5 of RECA. 

Congress originally assigned responsibility for EEOICPA to 

President Bill Clinton, who delegated primary authority to DOL 

to administer the program, with additional responsibilities 

given to the Department of Health and Human Services (HHS), DOE, 
and DOJ. The Secretary of Labor was given direct authority to 

administer Part E when it was created in 2004. OWCP adjudicates 

claims and pays benefits under EEOICPA, while HHS’ National 

Institute for Occupational Safety and Health (NIOSH) estimates 

the amount of radiation received by employees who are alleged to 

have sustained cancer as a result of exposure and establishes 

guidelines followed by OWCP. 

The Advisory Board on Toxic Substances and Worker Health was 

created under a provision in the 2015 National Defense 

Authorization Act (NDAA). The provision was amended in 2018 to 

extend the life of the Board by five years, and again in 2020 to 

expand the Board’s duties and mandate certain actions. One of 

the Board’s primary duties is to give advice on five subjects: 

the Site Exposure Matrices in DOL; medical guidance for claims 

examiners reviewing claims under Part E; evidentiary 

requirements for claims under Part B related to lung disease; 

the work of industrial hygienists (IHs), staff physicians and 

consulting physicians in DOL and reports of the IHs and 

physicians to ensure quality, objectivity and consistency; and 

the claims adjudication process, including review of Procedure 

Manual (PM) changes. The Board is also responsible for 

coordinating and exchanging data and findings with HHS’ Advisory 

Board on Radiation and Worker Health.

Amendments to the statute in 2020 mandated that the Secretary of 

Labor provide the Board with access to information that the 

Board considers relevant to carry out its responsibilities. It 

also required that the Secretary publicly state whether they 

accept or reject the Board’s recommendations, and provide either 

a timeline for implementing the recommendations or a rationale 

for disagreement. 

Ethics Rules:

Zachary Mancher, Senior Ethics Attorney in the Ethics Division 

of the Solicitor’s Office, gave an overview of the ethics rules 

for special government employees (SGEs). He outlined the 

financial conflict of interest statute, which prevents SGEs from 

participating in matters that would have direct and predictable 

effects on their financial interests or those of people close to 

them, with some exceptions. He also summarized the appearance of 

bias rule.

Mr. Mancher explained that SGEs could engage in non-government 

activities, including for pay, as long as those activities did 

not create a conflict with their official duties. The rule also
allows Board members to teach as long as it is part of the 

regularly established curriculum at an accredited institution.

When it comes to politics, the Hatch Act prevents SGEs from 

participating in partisan political activities while on duty, in 

a federal building, or using federal resources. It also prevents

SGEs from fundraising, soliciting, accepting, or receiving 

political contributions on days when they are serving in their 

official capacity. 

Board members may not serve as expert witnesses in cases 

involving their participation on the Board unless it has been 

approved by the Solicitor’s Office. As federal employees, they 

may not contact other federal officials to influence government 

actions, though the rules in this area are limited in their 

application to SGEs. Mr. Mancher summarized the policies on 

bribes, salary supplementations, and the optics concerns about 

the appearance of favoritism or impropriety. He also addressed 

restrictions related to the receipt of gifts and many relevant 

exceptions that apply to SGEs, as well as misuse of government 

resources.

Member Friedman-Jimenez asked Mr. Mancher to define the word 

bias in the context of his presentation. Mr. Mancher said that 

the appearance of bias rule dictated that SGEs could not work on 

any particular matter involving specific parties when a 

reasonable person would question the SGEs’ impartiality in the 

matter. Member Bowman asked if it was appropriate for Board 

members to list their position on the Advisory Board on their 

curriculum vitae, and Mr. Mancher said that it was appropriate. 

Member Goldman asked if signing a petition as an individual 

would be problematic, and Mr. Mancher said that he would need 

more information to make a definitive statement but that the 

rule was narrow in its restrictions on SGEs. 

Overview of EEOICPA Statutory Areas for the Board:

Rachel Pond, Director of the Division of Energy Employees 

Occupational Illness Compensation (DEEOIC), gave an overview of 

the program’s work and the Board’s statutory duties under 

EEOICPA. The energy program administers EEOICPA and provides 

lump sum compensation and medical benefits to current and former 

nuclear weapons workers and their survivors. The program uses 

employment evidence, medical evidence and survivors’ evidence to 

evaluate claims, and the evaluation and adjudication of those 

claims differs under Parts B and E. The majority of the Board’s 

duties are related to Part E. Four categories of conditions 

arecovered under Part B: cancer, covered beryllium illness, 
chronic silicosis, and RECA Section 5 awardees. Part E covers

any condition where exposure is a significant factor in causing, 

contributing to or aggravating the claimant’s condition. 

Benefits for employees and survivors are also calculated and 

administered differently under the two parts.

Under Part B Congress established four Special Exposure Cohorts 

(SEC), including gaseous diffusion plants (GDPs) and Amchitka 

Island. Workers in SECs have a presumption of causation and do 

not have to undergo the dose reconstruction process. To qualify 

for SEC designation workers must show that they worked in a 

specific location or at a specific job for 250 work days during 

the period that the facility was designated in a class, and they 

must have one of 22 specified cancers named in EEOICPA. 

Individuals can petition NIOSH to add a class of employees to 

the SEC, and if NIOSH determines that they cannot do a dose 

reconstruction at a particular site, they can add an SEC. Since 

the original four SECs were established, NIOSH has added over

130 new classes. The dose reconstruction process, conducted by 

NIOSH for cancer claims that do not fit into an SEC, involves an 

interview process, review of records from individual sites, and 

a final report. Based on this final report, the energy program 

determines whether there is a 50 percent or higher likelihood 

that the individual had sufficient radiation exposure to receive 

benefits under the program. 

The program created the Site Exposure Matrices (SEM), a 

repository of information on toxic substances that were present 

at DOE and RECA sites covered under Part E, to assist claimants 

in determining which substances they may have been exposed to on 

the job. The SEM includes information about particular toxic 

substances at each site, as well as scientific links between 

toxic substances and certain illnesses. 

In the claims process the burden of proof lies with the 

claimant, who must submit relevant records and information 

requested by the program. The program has several mechanisms to 

help with successful claims applications, including 11 Resource 

Centers across the country, four District Office locations, and 

the DEEOIC website. The Resource Centers provide many services 

including claim intake, guiding claimants through the EEOICPA 

process, maintaining communication with DOL, and administering 

the Occupational History Questionnaire (OHQ). The OHQ is used in 

Part E cases to obtain information from claimants about where 

they worked and which substances they may have been exposed to. 

Once a claim is submitted, the Resource Center or District 

Office requests employment verification from DOE. 
The District Office then begins claim development, which 

consists of obtaining medical evidence, including diagnosis and 

causation, and employment information. The program communicates 

with treating physicians to learn more about possible exposures 

and causal relationships. If more information is needed, they 

will prepare a Statement of Accepted Facts (SOAF) and refer it 

to DEEOIC specialists, including IHs and contract medical 

consultants (CMCs). The program employs two federal IHs as well 

as an IH contractor to assist in evaluating the extent and 

frequency of exposure. Industrial hygienists gather records 

provided by DOE, the SOAF, the OHQ, and the program’s review of 

the SEM and refer these materials to CMCs, who send back 

detailed reports. Federal industrial hygienists evaluate those 

reports for consistency and send them to claims examiners, who 

review them in the course of evaluating the case and making 

their determination. The program consults CMCs on a variety of 

topics including causation assessment, impairment, wage loss, 

and medical diagnosis. 

Once all of the relevant information is collected, the District 

Office issues a recommended decision and sends it to the 

claimant, who has the right to object to the decision. The case 

then goes to the Final Adjudication Branch (FAB), where hearing 

representatives review the facts and the claimant is able to 

discuss their objections or submit additional information. The 

FAB then affirms, remands, or reverses the decision. If the 

claimant still wishes to object they may ask for the case to be 

reconsidered or reopened. 

Ms. Pond outlined the Board’s statutory duties under EEOICPA and 

addressed conflicts between different medical opinions on

impairment. The program uses the AMA Guide to the Evaluation of 

Permanent Impairment to determine an employee’s percentage of 

whole body impairment based on a covered condition. The 

evaluation of this whole body impairment is performed by the 

treating physician or a CMC, and claims examiners often consult 

the program’s Medical Director if questions arise. The program 

has found conflicts with regard to tests used to determine 

different classes of impairment. In November of 2020 the program 

sent a letter to the Board which laid out the issues and posed a 

series of questions to solicit the Board’s advice.

Member Bowman asked what percentages of cases are referred to 

IHs and CMCs, and how the program decides which cases to refer. 

Ms. Pond said that IHs only review cases covered under Part E, 

and the program refers most cases that have at least some 
information about exposure and conditions. Chair Markowitz 

outlined the various types of documentation that claims 

examiners receive and summarized the Board’s previous request 

for IHs to be allowed to conduct occupational health interviews.

Member Silver asked whether the program had ever gone back and 

reexamined claims after Board-recommended changes to the PM were 

accepted. Ms. Pond confirmed that whenever substantive changes 

were made, the program went back to review claims whose outcomes 

may have been affected by those changes. Chair Markowitz asked 

if the program had transitioned to a new IH contractor within 

the past year, and John Vance, DEEOIC Branch Chief for Policy, 

Regulations, and Procedures, confirmed that they had and that 

the new contractor also consisted of several IHs with previous 

experience in the DOE complex. 

Chair Markowitz presented a spreadsheet of data that the 

Department had previously made available to the Board in 

response to a request for information about claimed conditions. 

The spreadsheet contained claims submitted from 2016 to 2019 for 

conditions including cancers, respiratory illnesses, neurologic 

diseases, renal diseases, beryllium sensitivity, and chronic 

silicosis. For each condition the table listed the number of 

claims submitted and what percentage of those claims were 

accepted, as well as the explanation for those that were denied. 

Chair Markowitz asked the program whether consequential 

conditions were included in the table of claims data, or if it 

was limited to the primary claimed diagnosis. Mr. Vance said 

that it would most likely include both primary and secondary 

diagnoses. 

Member Whitten asked if the program recorded the time from the 

initial claim filing to the final decision. Ms. Pond said that 

they had a robust system for measuring the length of claims

evaluations. Member Bowman asked if the program tracked the 

frequency of the submittal of certain types of claims from 

certain populations with the aim of someday conducting a 

retroactive examination. Ms. Pond said that ideally the program 

would have a research arm to evaluate that data, but all of 

their resources are dedicated to adjudication. 

Program Updates, Last 12 Months:

Mr. Vance gave the Board an overview of the program’s activities 

and interactions with the Board over the previous year. He 

explained that the Procedure Manual is a public-facing, living 

document that provides information about the claims evaluation 
process. It helps the program with the difficult task of 

recreating work histories and occupational exposure histories 

for cases as far back as 1942. Much of the Board’s work on the 

PM has focused on Chapter 15 and Part E causation analysis.

Version 4.3 of the PM was published on September 14, 2020 and 

contains several revisions. Cases are now assigned to District 

Offices on an equitable rotation basis rather than by the last 

location of covered employment. After receiving feedback from 

the Board, the program updated the PM to include Parkinsonism as 

an alias for Parkinson’s disease, paralysis agitans, and hemiparkinsonism. Input from the Board also prompted the program to 

add language to the asthma presumptive standard. The new 

language requires a qualified physician to provide a wellrationalized explanation identifying the mechanism for causing 

or contributing to a condition.

The program also revised the OHQ, which can be found at Exhibit 

10-1 of the PM. It is now geared toward a more robust data 

collection effort, with a free-flowing structure and more broad 

and open-ended questions. The program has begun implementing the 

new OHQ, and since July of 2020 they have completed over 612 OHQ 

interviews with the new format. Language which previously 

suggested that an employee needed to count a certain number of 

exposure days was revised for clarity. The program deleted 

Exhibit 18-1, a matrix listing common characteristics of 

diseases and their diagnostic criteria, in response to confusion 

about requirements for claimant diagnoses. They also added a 

more detailed outline for assessment of requests for home and 

vehicle modifications. 

In response to an earlier question from Chair Markowitz, Mr. 

Vance said that he was not aware of a substantial number of IH 

interviews with claimants, and that the additional information 

collected from OHQs was helping to characterize claimants’ 

understanding of their exposures. In Exhibit 15-4, presumptive 

standards, the program has revised definitions for conditions 

such as chronic respiratory disorder and added new presumptive 

standards to other conditions, including non-Hodgkin’s lymphoma.

In response to a request from the Board, the SEM contractor,

Paragon, has conducted an asbestos labor analysis. 

Member Whitten asked how the program continued to fully utilize 

site-specific data accumulated over time under their new case 

assignment system. Mr. Vance said that CEs use the SEM to 

establish a factual framework of their cases no matter which 

site they originated from. Ms. Pond added that when they 
switched to the new system some District Offices had accumulated 

knowledge of the particularities of certain sites. The program 

conducted in-depth training for the CEs with experts on each 

site, and they maintain points of contact (POCs) in the District 

Offices to answer site-specific questions. 

Member Silver asked whether any of the claimant interviews

conducted using the new OHQ were for cases that were 

originallyadjudicated using the old OHQ. Mr. Vance said that all 

of the new OHQ interviews conducted so far were for new, 

incoming cases. Member Silver asked whether the program would be 

open to re-interviewing claimants using the new OHQ. Ms. Pond 

said that it would be difficult to pull all of those cases and 

re-interview claimants at a systematic level, though individual 

claimants could ask to re-open their cases at any time. Chair 

Markowitz asked about the program’s plan to evaluate the 

effectiveness of the new OHQ, and Ms. Pond said that they would 

consult the Resource Centers for feedback. 

Public Comment Period:

Terrie Barrie, Alliance of Nuclear Worker Advocacy Groups

Ms. Barrie noted that the agency did not seem able to realize 

the full scope of the job responsibilities of guards and first 

responders. She suggested that the SEM administrator schedule 

teleconferences with first responders to understand the 

exposures involved in those employees’ work experience. She also 

noted that the statute requires DOL to supply the Board with 

requested documentation, and that requiring the Board to provide 

a rationale for each request only delayed their work. Similarly, 

the Board has requested a technical contractor for several years 

and has only recently been asked to provide written 

justification. Ms. Barrie praised former EEOICPA Ombudsman 

Malcolm Nelson and his staff for their assistance to the 

claimant community and to DOL. 

In a recent FOIA request concerning impairment claims, ANWAG 

requested copies of any documents discussing audits of the 

independent physicians who submit impairment rating reports.

DEEOIC stated that they did not have any such documents and 

referred ANWAG to Chapter 21 of the PM. Ms. Barrie commented 

that it seemed unlikely that the program did not have these 

documents, given that numerous impairment ratings from the same 

physician had been reviewed by the Medical Director. 
Faye Vlieger

Ms. Vlieger focused her comments on recent actions taken by Ms. 

Pond and the program’s Medical Director, Dr. Armstrong. In March 

of 2020 Ms. Vlieger became aware that impairment rating reports 

from an independent physician were sent to Dr. Armstrong per his 

request. He has since instructed CEs and District Offices to 

send him any impairment rating reports that contain certain 

words and phrases that are, according to Dr. Armstrong, not in 

accordance with the fifth edition of the AMA Guide. Ms. Vlieger 

filed a FOIA request, to which DEEOIC responded that they could 

not release documents related to claimant files. She requested 

that the Board review Dr. Armstrong’s directives, 

communications, and personal opinions within the claims 

adjudication process and make recommendations to address issues 

of undue influence.

Donna Hand

Ms. Hand spoke about the issue of impairment ratings. She noted 

that Dr. Brigham, the author of the AMA Guide, said that most 

impairment doctors do not use Chapters 1 and 2 of the guide when 

making their determinations. In 2006 several senators wrote to 

the Department to specify that all impairments must be included 

in the rating. Despite this directive, and the fact that some 

states, including California, use the Global Assessment of 

Functioning Scale to measure psychiatric impairments, many 

physicians continue to state that they cannot include certain 

conditions. She also requested clarification around the 

definition of a well-rationalized report. 

Department of Energy Presentation to the Advisory Board on Toxic 

Substances and Worker Health:

Greg Lewis, Director of the Office of Worker Screening and 

Compensation Support at the Department of Energy, gave an 

overview of the relationship between DOE and the program. Mr. 

Lewis’ office administers the Former Worker Medical Screening 

Program and supports DOL and NIOSH in implementing the 

compensation program. They provide records and information 

related to individual claims, support larger-scale site 

characterization projects like the SEM, and conduct research on 

issues related to covered facility designations.

For individual claims the office obtains employment verification 

for DOL, radiological dose records for NIOSH in Part B claims, 

and Document Acquisition Requests (DAR) for DOL. Each DOE site 
has a site POC to spearhead the record acquisition process, 

facilitate worker interviews, and provide onsite EEOICPA 

information to workers. These POCs receive individual claims 

through the Secure Electronic Records Transfer (SERT) system and 

send requests to responsive records areas at the relevant DOE 

sites. Each record area conducts a search of their holdings, 

which can include many different electronic and physical 

locations for each type of record. 

The office conducts approximately 16,000 records responses per 

year across all three areas of work, from over 25 different DOE 

locations. In FY19 DOE had a 98 percent on-time response rate 

with a 60-day goal, though FY20 numbers will be different due to 

the COVID-19 pandemic. Mr. Lewis summarized DOE’s role in the 

creation of the SEM and the review of the SEM for classification 

and release to the public in 2009. DOE continues to support DOL 

in adding data to the SEM and participates in the Joint Outreach 

Task Group meetings with DOL, NIOSH, DOL’s Ombudsman and the 

Former Worker Medical Screening Program. The latter was

established in 1996 to identify and notify former workers at 

risk for occupational disease and offer them medical screening 

that can lead to early detection and treatment. 

Member Goldman asked about the focus of the Former Worker 

Medical Screening Program. Chair Markowitz said that they 

primarily screen for general occupational diseases such as 

chronic lung disease, hearing loss, beryllium sensitivity or 

disease, and some cancers. Member Silver asked how frequently 

DOE was contacted by individuals or advocacy groups outside of 

the DOL to DOE line of communication. Mr. Lewis said that they 

were contacted on a weekly basis, and when they receive those 

communications they do their best to go back and find 

information that they may have missed. 

Adjournment: 

Chair Markowitz adjourned the meeting for the day at 4:31 p.m.

FRIDAY, NOVEMBER 6, 2020

Call to Order:

Chair Markowitz called the meeting to order at 11:07 a.m.

SEM Demonstration:

Mr. Vance presented information about the SEM and its role in 
the case adjudication process. The SEM is a searchable database 

with facility-specific inventories of toxic substances used 

during production of atomic weapons. The data in the SEM are

derived from historical documentation describing operations that 

occurred at each weapons facility. Along with other case 

evidence and claimant-submitted information, the SEM assists in 

establishing the factual framework of an employee’s likely toxic 

substances exposure profile. Physicians consider this profile 

when establishing a causal relationship. DOL’s contractor, 

Paragon, manages the collection of information and maintenance 

of the SEM. The SEM has two variants: the internal version is 

available to employees and is constantly updated with new 

information, which is then reviewed by DOE and updated on the 

public SEM every six months.

Mr. Vance summarized best SEM usage practices, which can be 

found in Chapter 15 of the PM and on DEEOIC’s website. Searches 

must reasonably connect unique features of claim information to 

SEM data filters, and search criteria should correspond 

specifically to information relevant to the claimant. The SEM 

contains a large amount of very unique, customized data related 

to the facilities, and searches should balance the need for 

accurate information and detailed analysis with the need to 

compensate claimants in a timely manner. The SEM does not 

provide temporal toxic data or data on levels of exposure, and 

the latter is often left up to the judgment of the IH. In 

addition to the SEM, DOL has a portal that allows claimants, 

toxicologists, and epidemiologists to submit information about 

toxins, facilities, and disease-specific information. Mr. Vance 

demonstrated a basic SEM search process for the Board. He noted 

that the SEM is not a decision-making tool; it is an information 

resource that can be utilized to help inform the factual 

framework of a case.

Member Goldman asked about workers with exposure to toxins that 

were not necessarily linked to their job category, such as

security guards who were exposed to welding fumes. Mr. Vance 

said that in that scenario he would look for information in the 

SEM about the employee’s tasks and duties that brought them into 

proximity with those toxins. Rather than searching the SEM by 

labor category, a claims examiner could search by work process

to find a reasonable connection to the exposure and turn to the 

IH to further define the extent and nature of the exposure.

Member Whitten said that every time the SEM was updated 

chemicals disappeared from certain facilities. She asked if it 

would be beneficial to add a date range filter to the search 

function. Mr. Vance said that adding more temporal data to the 
SEM would be very complicated and might actually be to the 

detriment of certain claimants. 

Member Catlin asked how DOL ensures consistency among CEs using 

the SEM. Mr. Vance said that given the unique nature of most 

cases, the program uses mechanisms like independent reviews and 

quality assurance to look for consistent application of the 

process rather than consistent outcomes. Member Bowman echoed 

Member Whitten’s question about the decreasing number of 

chemicals at certain sites. Mr. Vance said that the same toxic 

substances remain in the SEM, but as the Department receives

more information about those substances, connections to certain 

filtering criteria may be removed. Member Bowman asked how the 

program weighs different types of studies submitted as evidence.

Mr. Vance said that in addition to human epidemiological data

that establishes causal relationships, the program allows 

physicians to submit data that meets the more flexible standard 

of contributing to or aggravating conditions. 

Board Discussion:

Chair Markowitz noted that in the past, the Board has used 

subcommittees and working groups as mechanisms to continue work 

between full Board meetings. Subcommittees are broader in scope, 

subject to FACA rules, and formulate options for the full Board 

to discuss. Working groups are not subject to FACA, typically 

focus on one specific issue, and can review and discuss 

documents that are not open to the public. The Board’s work 

products include recommendations to DOL and data requests for 

claims to review, both of which require written rationales. 

a. Board request for SEM documentation for selected job titles

Chair Markowitz outlined the Board’s past recommendation that 

DOL identify certain site-wide job titles and incorporate them 

into the SEM. He also shared DOL’s response and summarized the 

Board’s decision to look at cases from the GDPs. The Board 

observed that these job titles, which performed very similar 

functions, had differing numbers of agents listed in the SEM for 

the same job categories. Chair Markowitz presented the agents 

listed as security guards for all three GDP plants and noted 

that while the discrepancy in numbers was presumably due to 

different levels of documentation available to the SEM, it was 

unlikely that guards at the three sites had very different 

exposures in reality. After they reviewed the data, in April 

2020 the Board requested the SEM documentation in order to 

better understand this issue. In November 2020 the DOL provided
the Board with a list of 258 sources of information on toxins 

for guards and health physics technicians at the GDPs.

Chair Markowitz noted that the Board did not have the resources 

to examine 258 sources and that the SEM is constructed based on 

available documentation. The issue is not the level of 

documentation that exists for these job categories, which varies 

widely between DOE sites; the issue is whether or not a claims 

examiner can make exposure presumptions for a limited number of 

site-wide job titles (e.g., security guards, firefighters).

Member Key suggested that the fire department should be added to 

the list of job titles for Paducah. Chair Markowitz said that 

the idea of exposure presumptions was built into the statute, 

and it was important because it made up for some of the 

limitations of the SEM. Member Catlin asked if there was a list 

of agreed-upon site-wide job categories. Chair Markowitz said 

that there was not a list, but if the recommendation was 

accepted, then the Department would most likely identify the job 

categories with the Board’s input. 

Member Catlin asked whether this recommendation would result in 

cases going to the IH for review rather than being filtered 

through the SEM. Mr. Vance said that the CEs were responsible 

for evaluating the evidence and identifying the toxins that were 

most likely connected to the claimed disease. The IH would then 

profile those toxins and provide additional details which the 

physician could consider when weighing an opinion on a causal 

relationship. Member Whitten asked if the Board would be able to 

review the language of the presumptions before they were 

implemented. Mr. Vance said that if DOL agrees to the 

recommendation, they will act on it as efficiently as possible 

and then take further feedback from the Board. 

Board Recommendation:

Chair Markowitz drafted a recommendation and after some 

discussion, the Board voted unanimously to submit the following 

as a formal recommendation to DOL: “The Board recommends that 

the Department develop and implement exposure presumptions 

indicating that job categories at DOE sites whose workers likely 

worked throughout their individual sites had potential exposure 

to all listed toxic substances at those facilities.”

b. Board request for resources

Chair Markowitz reviewed the Board’s previous request for 
resources and said that while he was not sure whether or not the 

recommendation was ever officially accepted, DOL did advise the 

Board on the process of acquiring resources and asked for a 

statement of work. He shared a document in which the Board 

previously identified a need for assistance in fulfilling 

functions such as organizing and reviewing claims and evaluating 

certain scientific, technical, and medical aspects of the 

program. The document also listed the tasks involved and 

expertise required for each area. Chair Markowitz noted that the 

Board considered this outline to be a statement of work and that 

the goal at the current meeting was to move forward into an 

iterative process with the Department.

c. Draft Board report on integration of IARC 2A carcinogens into 

SEM

Chair Markowitz explained that the Board had previously raised 

the issue of whether the SEM and underlying Haz-Map database was 

fully inclusive of recognized relationships between carcinogens 

and human cancer. The Department asked for the Board’s 

assistance in analyzing several recognized authoritative sources 

for possible integration into the SEM, including the 

International Agency for Research on Cancer (IARC). IARC’s Group 

2A contains 88 agents that are considered to be probably 

carcinogenic to humans.

The working group examined the most recent 22 agents to be added 

to Group 2A as well as other sources such as the National 

Toxicology Program (NTP) and the current exposure links in the 

SEM. They eliminated some substances and highlighted others that 

were more likely to be used by workers. During this process they 

noted that outside workers would occasionally come to DOE sites 

to apply pesticides, and this exposure was not always recorded.

Member Goldman demonstrated the working group’s method for 

researching agents and searching for information in the SEM.

Given the large volume of information available in various 

sources, the group felt that it would be more effective to focus 

on IARC, which has very detailed data.

At the Board’s spring 2020 meeting, the working group 

recommended that IARC 2A agents should be incorporated in the 

SEM along with their respective associations with certain 

cancers based on IARC monographs. Member Friedman-Jimenez agreed 

that it was reasonable to include 2A carcinogens in the SEM, and 

added that it may require further review by the physician to 

account for the degree of uncertainty about causation. He noted 

that both IARC and NTP are multidisciplinary, and there is a 
fair amount of overlap between the two sources, so it may not be 

necessary to include NTP’s list of chemicals reasonably 

anticipated to be human carcinogens. He added that only a small 

number of the Group 2A carcinogens, those that were deemed 

relevant to occupational exposure, would be added to the SEM. 

Chair Markowitz noted that the statute set out a standard that a 

toxic substance needed to be at least as likely as not to cause, 

contribute to or aggravate a condition, and 2A carcinogens could 

be reasonably construed to surpass that threshold. He noted that 

the SEM links particular agents to particular cancer sites, and 

the 2A carcinogens would only be useful if they named the cancer 

sites related to each exposure, which was difficult. Member 

Goldman said that IARC did name specific cancers for some of the 

agents, and they could use those as a starting point. Member 

Friedman-Jimenez added that it was difficult to extrapolate from 

animal studies to humans and vice versa, and the toxins should 

be examined on a case-by-case basis. Chair Markowitz said that 

the Department may not be able to act on the recommendation 

unless the human cancer sites are identified, and the Department 

may not have the resources to identify them. 

Member Goldman said that an article by Dana Loomis, et al., 

contained a list of occupational agents and several associated 

cancers. She suggested that the Board review that article and 

select some higher-priority agents that have more information 

about effects on human organs for inclusion in the SEM. Chair 

Markowitz suggested that the working group reconvene to examine 

the issue of specific cancer sites, and several members agreed. 

Member Goldman invited Member Bowman to join the working group, 

and Member Bowman accepted the invitation.

d. Assessment of the quality, objectivity, and consistency of 

physicians and industrial hygienists in the claims process

Chair Markowitz explained that this assessment is one of the 

Board’s core tasks from the charter. He presented a summary of 

the quarterly CMC reports audited by the program’s Medical 

Director from 2018 to 2019. The majority of the CMC reports were 

causation and impairment reviews; the Medical Director found 

that very few of the causation reports needed improvement, while 

almost one-third of the impairment reviews needed improvement. 

The Board previously drafted a recommendation that DOL develop 

an ongoing, independent third-party based system of evaluation 

for IHs and physicians, and implement a periodic audit of IH 

reports to provide another layer of quality assessment. Based on 

its past review of claims, the Board concluded that the Medical 
Director likely underestimated the number of problematic 

causation judgements. The Board also questioned the persistently 

high level of faulty impairment ratings, and noted that there 

may be a sizable number of impairment claims that the Medical 

Director did not review that also need improvement. 

Members Silver and Mikulski agreed with Chair Markowitz’s 

summary of the issue. Member Friedman-Jimenez suggested that

they add a recommendation for DOL to formally compile a report 

of the audits as they are completed so that the Board can see 

how the assessments change over time, and Chair Markowitz agreed

and said that he would add that language to the rationale.

Board Recommendation:

Chair Markowitz drafted a recommendation and after some 

discussion, the Board voted unanimously to submit the following 

as a formal recommendation to DOL: “The Board recommends that 

the Department develop an ongoing independent third party-based 

system of reasonably frequent periodic evaluation of the 

objectivity, quality and consistency of both the individual 

claim reports and the aggregate audits of program industrial 

hygienists and physicians. The Board also recommends that the 

Department implement a periodic audit of the industrial hygiene 

reports and the industrial hygiene review process. The results 

of these evaluations and analyses should be reported to the 

Board in a timely and systematic fashion.”

e. Follow-up on prior Board recommendations

Chair Markowitz noted that the Board had recently received a 

report from the program’s SEM contractor concerning asbestos. He 

summarized the Board’s past recommendation that additional job 

titles be added to the list of jobs that were presumed to have 

significant exposure to asbestos. The Board consulted the U.S. 

National Occupational Mortality Database and provided a review 

of relevant studies to the Department’s SEM contractor, which 

endorsed some of the Board’s suggested job titles and rejected 

others. Chair Markowitz proposed that several Board members 

review the contractor’s report and, if necessary, prepare a 

response. Members Van Dyke, Catlin and Whitten volunteered to 

join Chair Markowitz in working on this issue. 

Chair Markowitz asked program representatives if they had any 

further remarks about the new OHQ. Mr. Vance said that he spoke 

to the contracting officer in charge of the Resource Centers, 

and they are reporting that the new OHQ provides a much better 
information collection process. Chair Markowitz suggested that 

it would be helpful to collect feedback from IHs and claims 

examiners as well. He asked Ms. Rhoads to note that request as 

an action item. Ms. Pond agreed that such an evaluation method 

would be useful. 

f. Additional and new issues

Chair Markowitz summarized a letter from the Department to the 

Board dated November 3, 2020. The Department requested the 

Board’s guidance concerning medical data used to make 

evaluations of pulmonary impairment, particularly the use of the 

VO2 max calculation versus pulmonary function tests. Members

Mikulski and Friedman-Jimenez volunteered to join Chair 

Markowitz in drafting a response to the Department.

Chair Markowitz referenced Faye Vlieger’s remarks from the 

previous day which involved impairment claims. He said that some 

of the issues raised were particular to the claims review 

process and to one or two providers, which was not necessarily 

within the Board’s purview. He also noted that it is in the 

Board’s charter to assess consistency and quality of medical 

input and the claims adjudication process. He proposed that a 

small group of Board members should look at the relevant 

documents that Ms. Vlieger provided and decide what role, if 

any, the Board should assume. Members Tebay and Pope volunteered 

to assist Chair Markowitz in reviewing the materials.

Review of Public Comments:

In addition to the public comments on the issue of impairment, 

the Board discussed comments sent in by the Alliance of Nuclear 

Worker Advocacy Groups (ANWAG). ANWAG commented on the vague 

definition of significant exposure in a recent IH report and the 

fact that the importance of bystander exposure seemed to be 

minimized. 

Board Work Plan:

Chair Markowitz summarized the upcoming work tasks for the 

working groups on asbestos, IARC Group 2A carcinogens, DOL’s 

request for input into the impairment process, and public 

comments about impairment. The full Board will meet again within 

six months, with a possible meeting in three months depending on 

the working groups’ progress. He asked that all of the working 

groups meet telephonically within four weeks of the current

meeting to discuss their various tasks. Member Silver echoed