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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TUESDAY,

JANUARY 30, 2018

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

Steven Markowitz, Chair, presiding. 

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MARK GRIFFON

KENNETH Z. SILVER

GEORGE FRIEDMAN-JIMENEZ

LESLIE I. BODEN

MEDICAL COMMUNITY:

STEVEN MARKOWITZ, Chair

LAURA S. WELCH

ROSEMARY K. SOKAS

CARRIE A. REDLICH

VICTORIA A. CASSANO

CLAIMANT COMMUNITY:

DURONDA M. POPE

KIRK D. DOMINA

GARRY M. WHITLEY
JAMES H. TURNER

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

DOUG FITZGERALD

ALSO PRESENT:

KEVIN BIRD, SIDEM

CARRIE RHOADS, Alternate DFO
Call to order and introductions:

Mr. Fitzgerald called the meeting to order at 1:07 p.m. Eastern 

Time. The above-listed board members were in attendance and Mr. 

Fitzgerald called the roll. Chair Markowitz made note of the 

passing of Dr. Jim Melius, an occupational medical physician who 

served as the Chair of the Department of Energy’s Radiation 

Advisory Board. Dr. Melius was instrumental in creating health 

and compensation programs for World Trade Center workers and he 

will be greatly missed.

Chair Markowitz outlined the agenda for the call, including a 

review of and votes on the Board’s draft replies to the 

Department of Labor’s comments on the Board’s recommendations.

Time permitting, the agenda would include subcommittee reports 

and discussion of topics for the next Board to take up. He noted 

that almost all of the board members’ terms would end on

February 16, with Member Vlieger’s term continuing for several 

weeks afterward.

Response to program’s recommendation responses and requests for 

information

Draft on IOM databases (#2, October 2016)

The Board suggested incorporating reports from IARC,the EPA’s 

IRIS database, and the National Toxicology Program to expand the 

causal links between exposure and disease in the Site Exposure 

Matrix (SEM).

Chair Markowitz suggested adding the term “peer reviewed” to 

describe these data sources and clarifying that competence in 

epidemiology and occupational medicine should be requirements 

for the implementation team identified by DEEOIC. Member 

Friedman-Jimenez voiced his support. Chair Markowitz said that 

it was unclear where epidemiological expertise existed in the

Office of Workers’ Compensation Programs (OWCP), as it seemed

that the contractor Paragon mostly focused on exposure, and the 

National Office had expertise in toxicology and occupational 

medicine. Member Friedman-Jimenez asked about adding industrial 

hygiene as well, and Member Welch replied that they did not want 

people to second-guess all of these sources that have already 

been peer-reviewed. Members Cassano and Silver added their 

agreement. Members Friedman-Jimenez and Welch proposed 

specifying that the SEM include exposure-disease links for IARC 

groupGroup 2A. The Board voted to accept the draft.

Draft on hiring former workers (#3, October 2016)
The Board recommended hiring former DOE workers to administer 

OHQs at the Resource Centers and DOL agreed that this would be 

beneficial. Chair Markowitz suggested some more detailed 

questions about how former DOE workers were used in the recent 

past, including: how much time they spent administering OHQs; 

how many OHQs were administered by former DOE workers; what job 

titles these workers had when they worked at DOE; whether any 

Resource Centers were not accomplishing their goals of hiring 

former DOE workers; and whether Resource Centers who were 

recruiting specifically addressed the desire to hire former DOE 

workers.

Dr. Cassano suggested looking at the relevant Requests for 

Proposal (RFPs) and contract language to find out whether they 

prioritized hiring former DOE workers over other applicants.

The Board voted to accept the draft.

Draft on physicians/organization’s structure (#7, October 2016)

The Board suggested that occupational medicine physicians 

working on EEOICP be blended with physicians working on other 

compensation programs. Creating a more collegial environment 

could improve the quality of work and in particular alleviate 

concerns about physicians practicing in isolation. The Board 

awaits further information from the program, and, essentially,

this was an information request to provoke continued discussion. 

The Board voted to accept the draft.

Draft on IH/CMC viewing entire case file (#8, October 2016)

The Board’s suggestion that CMCs and IHs receive the entire 

claims file for cases they are reviewing was rejected by the 

Department as inappropriate and impractical. The revised 

recommendation consists of the Board’s responses to each 

concern. 

The addition of a case map to each file would make it less 

cumbersome for professionals to look through the entire record. 

The Board felt that unless the CMCs and IHs were able to review 

pertinent documents it was inappropriate to ask them to form an 

opinion. When these professionals provide expert medical 

opinions to other federal agencies, those contracts require them 

to have the entire record. 
Member Boden addressed the Department’s concern that the claims 

examiner’s (CE’s) position as the finder of fact would be 

undermined by sending additional information to the CMCs and 

IHs. Finders of fact in other realms such as the justice system 

often rely on experts and weigh their evidence to come to a 

conclusion, and this does not undermine their authority. In 

addition, access to the entire case file would not affect the 

CE’s ability to ask the experts specific questions; it would 

merely expand the scope of the information that the expert could

draw upon to answer those questions, even if that information 

was not recognized as relevant by the CE. 

The Board voted to accept the draft.

Draft on asbestos recommendation (#1, April 2017)

Chair Markowitz said that on the issue of asbestos, the 

Department and the Board were largely in agreement. The DOL 

agreed that in the past they had not recognized in writing the 

issue of asbestos and lung cancer, and that certain time 

parameters were important. The Board revised this recommendation 

to include specifics that they would like to see for asbestosrelated disease. 

The Board used the term exposure criteria to talk about what is 

sufficient to be causal if the person has the disease in 

question, whereas the DOL was more focused on whether or not the 

exposure is significant. Using the term “exposure” versus 

“causation” presumption was mostly a linguistic difference 

between the approaches of the Board and the DEEOIC rather than a 

substantive difference in definition. 

The DOL also wanted more documentation about the list of job

titles, which the Board will provide. The Board’s recommendation 

was for all construction and maintenance workers, which is 

broader than the List A currently in use. Chair Markowitz 

wondered why DOL does not use the Standard Occupational Category 

(SOC) classification system, which is the federal standard. He 

questioned the Board’s proposed inclusion of the SOC system and 

whether it was a useful part of this recommendation, since the 

DOL has its own lists of jobs and categories that it has been 

using. 

The Board recommended that if workers performed maintenance and 

construction tasks for 250 days or more prior to 2005, it should 

be presumed that they have sufficient asbestos-related exposure 

to aggravate, contribute to, or cause asbestos-related disease.
DOL requested documentation that 2005 was an important year in 

terms of exposure, such as inspection data or a change in DOE 

policy and procedure. Chair Markowitz said that as of this 

meeting they had been unable to find such documentation. He 

recommended that the Board use 1995 for the date of presumption,

since the DOE issued Order 440.1 in that year. While the order 

did not immediately make it mandatory for contractors to change 

their procedures, it did provide a plausible marker in time, 

which is an important part of establishing a presumption for 

asbestos that would cover a great number of people. 

Member Welch said including the SOC jobs would be a good idea 

because they often hear requests from OWCP to provide a more 

specific list of job titles. Member Domina said that he was fine 

with using these job titles but that everyone needed to be aware 

that they were not inclusive and that the way that Paragon 

grouped job titles together was not necessarily correct. Chair 

Markowitz said that he agreed but that this was just a list of 

construction and maintenance titles but that it would be 

difficult to compile a list of all job titles for which a 

presumption of asbestos exposure could be developed.

Member Dement said that the only way the SOC list would be 

useful is if people who used it could map their job titles into 

one or more SOC titles. Member Cassano agreed and added that as 

they have seen in the past, if a worker’s job title is not 

covered under the presumption their claim is likely to get 

denied. She suggested that if they are not covered under the 

presumption their claim needs to be evaluated by an IH or CMC.

Member Boden wondered if listing the SOCs helped the DOL 

determine whether someone is a construction or maintenance 

worker and suggested that it might be good to get feedback on 

this topic from someone at DOL.

Chair Markowitz said that he shared Member Welch’s thoughts 

about the incomplete nature of previous lists but he did not 

want the issue of switching to use of the SOC system to distract 

from adopting a presumption about asbestos. Member Whitley said 

that they are reminded over and over that the SEM is not used to 

deny cases. Member Vlieger said that that is inaccurate and that 

they do need to be more specific. There are many job titles that 

are required to be in the field but are not on the list and this 

should be addressed. Chair Markowitz said that the problem is 

defining the boundaries of that category and that it was 

important to achieve that first.Member Cassano said that an 

incremental response would be best and suggested that if they 

got this simpler version passed, then they or a future board 
could revisit it at a later date.

Member Silver asked if the Board could get data from DOL about 

people who didn’t meet the presumption, because their exposure 

occurred after 1995. He and Chair Markowitz agreed that it would 

be good to get a system in place to track this. Chair Markowitz 

suggested that, in the interest of keeping it simple, they 

remove reference to the SOC. Member Domina expressed his concern 

that some workers who worked with asbestos would still be left 

out, and Member Pope voiced her agreement.

The Board voted to accept the draft.

Draft on work-related asthma (#2, April 2017)

Member Redlich explained that this recommendation was already 

incorporated into the last manual, and that she looked not only 

at the DOL’s comments but at how the recommendation was 

implemented. The DOL agreed that “work-related asthma” should 

include both new onset asthma and work-exacerbated asthma, and 

the recommendation was appropriately incorporated into the 

revised manual. 

Criteria such as a physician’s diagnosis or assigned asthma 

medication was considered to be just as sufficient as a 

demonstration of reversible airflow obstruction to make a 

diagnosis of asthma. Some of the wording in the revised manual 

could be improved. Establishing a careful history and temporal 

relationship between work and asthma is important when 

determining an association, and while there could be a specific 

triggering event, it is more common to have repeated and mixed 

types of exposure. In this draft the Board tried to clarify the 

meaning of what a toxic substance is, emphasizing the fact that 

it is often a mixture of substances.

Chair Markowitz asked whether the CE has to identify a specific 

toxic substance during the claims evaluation process. Member 

Redlich confirmed that they do not. She added that since it is 

difficult to teach practitioners how to diagnose work-related 

asthma, the training materials need attention.

The Board voted to accept the draft.

Draft on COPD (#3, April 2017)

The OWCP did not accept the Board’s recommendation on exposure 

to vapors, gases, dust, and fumes (VGDF) and cited several
objections. Presumption and compensation would have to be due to 

a specific toxic substance, and according to the program’s 

definition of toxic substance, VGDF is too broad. The Board’s 

recommendation of five years of exposure as sufficient in a 

presumption was inconsistent with the current presumption of 20 

years for COPD, and OWCP requested clarification of the job

categories. 

Member Welch introduced new language that named more specific 

agents in relation to VGDF. There are multiple ways that a 

presumption of significant exposure can be accepted as causing 

COPD, including: five years of work with any on a list of

specific agents; five years of work in one of the job titles 

encompassed by major job categories; or five years of exposure 

with agents that fall into one of the toxic substance groups in 

the SEM.

Chair Markowitz said that he thought this amendment overcame the 

principal reluctance that DOL had about VGDF. He and Member 

Welch agreed that the language around job titles and 

construction and maintenance should be parallel to the asbestos 

recommendation. Member Welch added that Item 2 sections a), b), 

and c) may seem to be redundant, but the idea was to be 

redundant so that no categories slip between the cracks. Member 

Dement pointed out that the categories in Item 2c were broad but 

not always inclusive of all toxic substances. Member Redlich 

noted that the latest version of the procedure manual needed

review and revision around the medical criteria for COPD

diagnosis. Chair Markowitz said that this should be a topic of 

review for the next Board.

The Board voted to accept the draft.

Draft on OHQ changes (#4, April 2017)

OWCP believed that they had already updated the OHQ and stated 

again that they did not accept the recommendation on VGDF. The 

Board felt that they should retain questions of task-based 

exposures and reiterated their view that the OHQ should gather

as much information as possible that is useful to the 

hygienists. Chair Markowitz asked how the Board’s recommendation 

differed from what the DOL is doing, and Member Dement said that 

the difference was in how the Board asked about the task that is 

generating the exposure. If a worker flagged an exposure, they 

could respond to the question of how they were exposed with a 

free text description. The nature of certain tasks, combined 

with the frequency and duration of the worker’s participation in 
the tasks, may be a good predictor of disease outcomes. Member 

Silver added his support for the importance of free text 

descriptions.

The Board voted to accept the draft.

Draft on science/technical capacity (#5, April 2017)

The DOL agreed that it would be useful to have additional 

capability. Chair Markowitz said that despite the program’s 

resources, based upon the Board’s review of the program there 

were gaps, including: the IOM report; the contract with Haz-Map, 

which links exposure with disease; and the evaluation of claims 

for conditions with evolving knowledge bases. The Board can 

assist with these, but there should also be a sustained function 

within the organization above and beyond what exists now. 

The Board voted to accept the draft.

Draft on quality assessment CMC/IH (#7, April 2017)

Chair Markowitz said that one of the Board’s four tasks is to 

look at the work of IHs, staff physicians and consulting 

physicians to ensure quality, objectivity, and consistency. The 

Board cannot do this unless they can oversee the examination of 

a siazable number of relevant reports and reach their own 

conclusions. The DOL’s medical director conducted audits and 

found problems in 13 out of 82 reviewed reports. Member Welch

added these were not all causation cases. Chair Markowitz said 

that there were certain issues that the medical director’s

report did not address, and that the Board needs to look at 

several hundred claims or reports, not just 50 as was previously 

suggested.

Member Sokas said that there were also specific problems with 

the audits themselves; the audit instrument was inadequate, and 

the medical examiner seemed to have a narrow focus. She proposed 

some items for the Board to include in their response, including 

the need for a medical director’s assessment of whether or not 

the CMC’s determination is correct and for a second person in 

addition to the medical director to conduct reviews. Chair 

Markowitz asked if the items that Member Sokas listed were her 

only concerns, and she said that she saw those as the 

immediately fixable problems. 

The Board voted to accept the draft.
Subcommittees (items not covered above)

There were no subcommittee reports.

Administrative issues

Chair Markowitz introduced a list of nine possible issues and 

goals that the next Board may wish to take on, which he compiled 

from the minutes of the November 2017 Board meeting. 

1. Make additional progress on the issue of what it means 

to apply a standard of aggravated, contributed to, or 

caused by an exposure.

2. Revisit the SEM and relook at exposure assessment in 

the claims process.

3. Look more deeply at available claims data.

4. Look at the topic of durable medical equipment 

authorization.

5. Look at the program’s performance on impairment 

ratings.

6. Gather additional data on the most commonly denied 

types of claims.

7. Take a closer look at neurologic illnesses. 

8. Interact more with the physicians from DOL.

9. Have initial presentations from DOL to understand the 

program from the inception of the new Board.

Member Dement said that they had previously recommended a pilot 

process to evaluate the redrafted OHQ and the use of former DOE 

workers, and said that the new Board should be involved in the 

review of the pilot data. Chair Markowitz suggested Item 11,

following up on Board recommendations made to date, and Item 12, 

monitoring the outcomes of changes made by DOL in response to 

Board recommendations. Member Boden added his support for this 

last item. 

Member Cassano suggested adding non-respiratory cancers, like 

urological and hematologic cancers, to Item 7. Member Welch 

suggested having a process by which the DOL continues their 

relationship with the National Library of Medicine and Haz-Map. 

She said that Haz-Map is currently being updated. Chair 

Markowitz asked about other categories of illness that should be 

named, and Member Cassano suggested endocrine conditions. 

Member Silver mentioned growing the internal talent pool of 

OWCP’s claims examiners by offering credentialing and continuing 

education. Member Boden asked if there is a promotion ladder 
within the program for CEs to move up, and Member Cassano said 

they had asked about education and career progression before and 

it was a good item to return to.

Chair Markowitz suggested they encourage the next Board to make 

sure that public comments are appropriately tracked and 

integrated into Board discussions. Member Sokas reiterated the 

fact that there are inconsistencies between the procedure manual 

and the training materials which should be addressed. Chair 

Markowitz said that that should be its own separate item, and 

Members Sokas and Cassano agreed. Member Friedman-Jimenez 

suggested that Item 2 should include IARC and NTP. Member Welch 

said that they did not need to include these sources because 

they were already addressed in one of the Board’s other 

recommendations.

Member Boden expressed his thanks to Chair Markowitz for his 

work as chairman of the Board, and the other members echoed his 

sentiments. Chair Markowitz said that they had all worked well 

together and been productive during their time on the Board. He 

thanked the Department of Labor and SIDEM, and the members of 

the public who participated in Board meetings.

Member Redlich asked about the plan going forward. Chair 

Markowitz said that after these recommendations were edited they 

would be submitted to the DOL by February 9th, one week before 

the terms of most members will expire.

Mr. Fitzgerald said that he and Ms. Rhoads appreciated all of 

the Board’s work and thanked Chair Markowitz for his leadership. 

Member Vlieger asked whether they knew the date for the 

announcement of the new members, and Mr. Fitzgerald said that he

did not know. Member Redlich said that they had previously 

mentioned compiling lists of cases whose decisions they had 

questions about, and asked what they should do with those lists. 

Ms. Rhoads said that she would send an email about that.