UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES AND WORKER

HEALTH

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SUBCOMMITTEE ON THE SITE EXPOSURE MATRICES (AREA #1)

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SUMMARY MINUTES

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FRIDAY,

JANUARY 6, 2017

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

Time, Laura S. Welch, Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MEDICAL COMMUNITY:

LAURA S. WELCH, Chair

CLAIMANT COMMUNITY:

KIRK D. DOMINA

GARRY M. WHITLEY

OTHER ADVISORY BOARD MEMBERS PRESENT

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
Introductions and improvement of the OHQ in collaboration with DEEOIC

Ms. Rhoads opened the meeting at 1:05 p.m. Chair Welch and all of the 

committee members had an opportunity to look at the new draft 

occupational health questionnaire (OHQ) from the agency. Member 

Dement said that the new draft may not actually be an improvement, as 

it does not ask about specific exposures and may not stimulate much

precise recall from workers or from those who administer the 

interviews. It would be a good idea to insert something about 

specific job tasks in the OHQ. A list of tasks and materials can help 

a worker recall their work and to what they may have been exposed. 

The questionnaire is never going to be perfect, but the committee 

needs to think about how the OHQ is integrated into the entire 

process of claims adjudication. Member Domina suggested an “and/or” 

option in the OHQ on the question of construction/production in terms 

of where a worker worked. Some workers fall into multiple categories. 

The committee members agreed that the new draft questionnaire is not 

an improvement.

Mr. Vance said that the agency is trying to collect information. The 

OHQ is used as a complementary data point and is correlated to other 

sources of information. The team working on the OHQ is open to 

getting specific recommendations. Many times the people filling out 

the OHQ are not workers but survivors and may lack detailed knowledge 

about exposure to substances/tasks.

Chair Welch will send a summary of suggestions to committee members. 

From these suggestions, a set of specific recommendations to the 

agency will arise. The agency welcomes feedback on how it weighs 

information. Having a set of presumptions would also help move claims 

toward a positive outcome more quickly than changing policies and 

procedures. 

Member Dement said that the OHQ doesn't seem to be given much weight. 

The industrial hygienists (IHs) need to be involved earlier in the 

process, and the Site Exposure Matrices (SEMs) cannot be the only 

tool used to evaluate claims. The contract medical consultants (CMCs) 

and IHs have their hands tied by the SEM. The IHs and CMCs need to 

have access to all of the information. Member Domina suggested that 

site-specific physicals for workers be passed on. Some of the OHQs 

contain the physicals.

Review of COPD cases from DEEOIC, and the COPD presumption

Member Dement said that the presumption for asbestos-linked COPD is 

basically a threshold. Member Welch suggested recommending a process 

for fixing that. COPD is not related just to asbestos or silica; it 

is related to the cumulative exposures that workers have. This issue 

needs to be addressed in a meaningful way. Some of the exposures were 
of a relatively short duration, sometimes just a year. There needs to 

be consistent criteria that the CMCs can apply across cases. For 

example, some CMCs would say things like, “since the COPD didn't 

manifest right away in a claimant, then their COPD was not related to 

their work.” It's a big burden on the claimants to get another 

medical opinion to explain why the CMCs were wrong about their COPD. 

Chair Welch said that she would ask Dr. Markowitz how specific the 

committee's recommendations for improving the criteria need to be.

Recommendations for a model for exposure assessment at sites without 

the SEM

Mr. Vance said that it is a challenge to get data for trade workers 

who moved between sites. The situation at Grand Junction, with regard 

to the mines and the mills, is complicated. The contractor (Paragon) 

compiles data in the SEM based on chemical and biological toxins that 

are recorded on primary source documentation from the site or from 

DOE. DOL has no employment records about what was going on at the 

site and no exposure data from the site. The fundamental difficulty 

is the lack of records. 

Chair Welch suggested that the IHs look at all of the exposure data 

early on in the process when evaluating cases that involve sites 

without a SEM. Also, the claimants could be instructed about what 

they need to provide to the agency to have a better chance of having 

a successful claim. The question arose as to what criteria the agency 

should use in evaluating and weighing affidavits. Perhaps the 

committee could give input on what criteria to use. 

Recommendations for a model for exposure assessment

The committee discussed the sources for causation links recommended 

by the IOM and may not need to make many additions to the list of 14 

items in the table. One of the main issues is the links of 

occupational exposure; this has been looked at closely by the 

authoritative sources recommended by the IOM. Mr. Vance said that the 

agency focused on group 1 monographs pulled from Haz-Map. However, it 

would be helpful if the committee could look at groups 2A and 2B and 

make a recommendation as to whether or not there is sufficient 

scientific basis for their application in the agency's program. Chair 

Welch said that figuring out how to pull the monographs into the SEM 

may take some time. 

Some of these issues are similar to the issues that have been faced 

by the World Trade Center program. Literature from that program 

contains suggestions about how to establish presumptions. Chair Welch 

said that she will explore the World Trade Center information and get 

back to the committee. Mr. Vance said that the focus needs to be on 

the occupational component. Many of the World Trade Center issues are 
not necessarily linked to occupational exposures. 

Other issues

Chair Welch thought that the committee could do one more call before 

the board meeting in April. 

Member Whitley asked about conflicts between the SEM and other 

information. Mr. Vance said that decisions will depend on the nature 

of the data and any supporting exhibits that are submitted. Thus, it 

is the purview of the SEM contractor to evaluate the information. For 

the most part, the agency will default to primary source information. 

The claims examiners are able to go to Paragon and ask specific 

questions. 

Member Vlieger said that if the claimant can't come up with any 

records, there is no adjudication, and the agency just considers that 

lack of evidence. No one believes the claimant on face value. Mr. 

Vance said that if a claimant is providing information that is 

supported by other material in the case file or if they are offering 

information that can be used to reach a good and informed decision, 

then that claimant-provided information will be considered.

The underlying question here is about the circumstances in which the

agency should give the worker the benefit of the doubt.

Member Vlieger said that the exposures for the worker categories are 

limited through the process of Paragon and the SEMs. Labor categories 

disappear from the SEM without explanation. This may be because there 

is not specific exposure information about particular job categories. 

Perhaps including a question on the OHQ concerning for which specific 

hazards workers were trained would help round out claimant records. 

Member Vlieger said that information about personal exposures are not 

being put in the personnel records. The SEM for the overall sites is 

fairly complete, but the SEM loses its nuance when broken down by 

labor category. 

Member Domina said that there has to be some presumption on the 

chemical exposures because monitoring for chemicals didn't exist in 

the past. Perhaps including the work history would help solve the 

problem.

Member Vlieger said that the committee is going to need to come up 

with presumptive exposures. The agency needs to get out of the 

circular dance of “There are no records; please provide the records.” 

Member Dement said that in the cases he reviewed, the SEM and the 

worker-reported exposures weren't that far off...

The meeting was adjourned at 3:05 p.m.