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U.S. DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES 

AND WORKER HEALTH

+ + + + +

MEETING

+ + + + +

THURSDAY

APRIL 16, 2020

+ + + + +

The Board met telephonically at 11:00 

a.m. Eastern Daylight Time, Steven Markowitz, 

Chair, presiding.

MEMBERS

SCIENTIFIC COMMUNITY

JOHN M. DEMENT

GEORGE FRIEDMAN-JIMENEZ

MAREK MIKULSKI

KENNETH Z. SILVER

MEDICAL COMMUNITY

MANIJEH BERENJI

ROSE GOLDMAN

STEVEN MARKOWITZ

CARRIE A. REDLICH
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CLAIMANT COMMUNITY 

KIRK D. DOMINA

RON MAHS

DURONDA M. POPE

CALIN TEBAY

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE
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C-O-N-T-E-N-T-S

Welcome and Introductions ..................... 4

Review of Agenda ............................. 13

Occupational Health Questionnaire Revision ... 13

Site-wide Job Titles in SEM: Recommendations

and DOL Response ............................. 34

Assessment of the CMC and Industrial

Hygiene Performance .......................... 55

Revisions in EEOICP Procedure Manual

and Bulletins ................................ 81

Update on Expanding Asbestos Job Titles in

Procedure Manual ............................. 82

Review of Public Comments .................... 83

New Issues ................................... 93

Timetable to Complete Work by July .......... 106

Adjournment ................................. 116
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P-R-O-C-E-E-D-I-N-G-S

(11:03 a.m.)

MR. CHANCE: Good morning, everyone, 

and welcome to Day 2 of the teleconference 

meeting of the Department of Labor's Advisory 

Board on Toxic Substances and Worker Health. My 

name is Michael Chance. I'm the Board's 

Designated Federal Officer, or DFO.

As always, we appreciate the work of 

the Board in preparation for the forthcoming 

deliberation. We are scheduled to meet today 

from 11:00 a.m. until 2:00 p.m. Eastern Time. 

And the agenda may have moved around a little 

bit, but it is on display for everyone to see.

As you all are aware, this meeting is 

a completely virtual meeting in response to the 

COVID-19 pandemic. I am joined virtually by 

Carrie Rhoads from DOL and Kevin Bird. Kevin and 

Carrie will be available to members of the Board 

if you are encountering technical difficulties. 

Yesterday we had to go an extra line to 

accommodate additional people. Now we're using 
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two different lines, so hopefully we won't run 

into that problem today.

The timing, you know, just as 

yesterday, we had breaks throughout the day, and 

we can do that as time permits, but I think there 

are still several topics that need to be 

discussed.

Copies of all meeting materials and 

public comments are or will be available at the 

Board's website under the heading "Meetings." 

These documents will also be up on the WebEx 

screen so everyone can follow along with the 

discussion.

If you need to go to the website, go 

to dol.gov/owcp/energy/regs/compliance/advisory

board.htm. If you haven't visited the website, 

I'd strongly encourage you to do so. There is a 

page dedicated entirely to this meeting. The 

webpage maintains publicly available materials 

submitted to us in advance. We will publish any 

materials that are provided to the site.

You should also find, as I said, 
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today's agenda. If you're having problems with 

any of this, or any technical assistance, please 

email our standard energyadvisoryboard@dol.gov.

If you're joining via WebEx, please 

note that this session is for viewing only and 

will not be interactive. Phones will also be 

muted for non-Advisory Board members. We did 

pretty good with that yesterday.

Please note that this is a new way of 

conducting these meetings, as I said, and so bear 

with us for any technological issues that might 

unfold. Again, I think yesterday went pretty 

good for the first time doing something like 

this.

About meeting transcripts, transcripts 

will be prepared for today. Minutes will be 

prepared for today's meeting. During Board 

discussion today, as you are on a teleconference 

line, please make sure to speak clearly and 

identify yourself when you begin to make remarks.

As the DFO, I see that the minutes are 

prepared and ensure that they're certified by the 
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Chair. Minutes of today's meeting will available 

on the Board's website no later than 90 calendar 

days from today, per FACA regulations. If we 

have it sooner, they will be made available 

before that time.

Also, although formal minutes will be 

prepared, we will also be publishing verbatim 

transcripts, which is why it's very important to 

speak clearly, which are obviously more detailed 

in nature. Those transcripts should be available 

on the Board's website within 30 days.

As yesterday, I won't go through the 

whole thing, but for all the Board members, you 

know that there are certain documents and 

personally identifiable information related to 

specific cases, facilities, doctors and that sort 

of thing. So we must be mindful, with members on 

the public on the line, that we have to be very 

careful with, you know, discussing that type of 

information.

So, thank you for bearing with me. I 

needed to get all of that into the record. And 
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with that, I convene this meeting, Day 2, and 

will turn it over to Dr. Markowitz.

CHAIR MARKOWITZ: Thank you. So, 

welcome back to Day 2. Things are improving in 

New York, 50 to 70 percent decrease in cases, 

hospitalizations, and deaths. So that's better, 

at least.

In place of introductions, I'd like to 

save a little time, if possible. Maybe we can go 

in reverse and ask the public to -- and Kevin, if 

you could open the mic and the lines and allow 

the public to introduce who's on the line.

MR. BIRD: Absolutely. Just give me 

one second.

(Simultaneous speaking.)

CHAIR MARKOWITZ: Sure. So, if there 

are members of the public who are on the line 

attending today's meeting, could you just briefly 

introduce yourselves by name?

(Simultaneous speaking.)

MS. CISCO: This is Jeanne Cisco from 

the Portsmouth Gaseous Diffusion Plant, Workers 
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Health Protection Program.

MS. FALLON: This is Amanda Fallon 

from the Office of the Ombudsman.

MS. HAND: This is Donna Hand --

MR. LEWIS: This is Greg Lewis -- go 

ahead. Sorry, Donna. Go ahead.

MS. HAND: That's all right. This is 

Donna Hand, worker advocate.

MR. LEWIS: And this is Greg Lewis 

from DOE.

MS. BARRIE: And this is Terrie Barrie 

with ANWAG.

MS. JARISON: This is Deb Jarison with 

EECAP.

MS. WHITTEN: This is Dianne Whitten, 

worker advocate.

MR. NELSON: Good morning. This is 

Malcolm Nelson, the Ombudsman for the Energy 

Program.

CHAIR MARKOWITZ: Okay, thank you. 

And who from Department of Labor's on the line?

MR. VANCE: Hey, this is John Vance. 
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Good morning, everyone.

CHAIR MARKOWITZ: Good morning. There 

are some new members of the public on the line 

today as opposed to yesterday. So, as a matter 

of courtesy, I think we probably should just do a 

very quick introduction of Board members. 

Steven Markowitz. I'm an occupational 

medicine physician and epidemiologist from the 

City University of New York.

Calin?

MEMBER TEBAY: Calin Tebay, Hanford 

Workforce Engagement Center representative and 

site-wide beryllium health advocate.

CHAIR MARKOWITZ: Ken?

MEMBER SILVER: Ken Silver, associate 

professor of environmental health at East 

Tennessee State University College of Public 

Health.

CHAIR MARKOWITZ: Duronda?

MEMBER POPE: Duronda Pope, United 

Steelworkers Emergency Response Team, retired 

Rocky Flats worker.
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CHAIR MARKOWITZ: Marek?

MEMBER MIKULSKI: Marek Mikulski, 

University of Iowa, Iowa City, occupational 

epidemiology.

CHAIR MARKOWITZ: Ron?

MEMBER MAHS: Ron Mahs, claimant 

representative, former Oak Ridge worker. I 

represent the national building trades.

CHAIR MARKOWITZ: Rose?

MEMBER GOLDMAN: Dr. Rose Goldman, 

environmental health physician at Cambridge 

Health Alliance, and also associate professor of 

medicine and environmental health at Harvard 

University.

CHAIR MARKOWITZ: George?

MEMBER FRIEDMAN-JIMENEZ: Dr. George 

Friedman-Jimenez. I'm an occupational medicine 

physician and epidemiologist, and director of the 

Bellevue NYU Occupational Environmental Medicine 

Clinic in New York City.

CHAIR MARKOWITZ: Kirk?

MEMBER DOMINA: Kirk Domina, claimant 
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representative for the Hanford Atomic Metal 

Trades Council in Richland, Washington.

CHAIR MARKOWITZ: John?

MEMBER DEMENT: John Dement, professor 

emeritus, Duke University Medical Center and the 

Division of Occupational and Environmental 

Medicine.

CHAIR MARKOWITZ: Mani?

MEMBER BERENJI: Yes. Mani Berenji, 

occupational medicine physician, assistant 

professor at Boston University Medical Center.

CHAIR MARKOWITZ: And Carrie Redlich.

MEMBER REDLICH: Dr. Carrie Redlich. 

I'm an occupational medicine and pulmonary 

physician, and I'm a professor of medicine at 

Yale School of Medicine and director of the Yale 

Occupational and Environmental Medicine Program.

CHAIR MARKOWITZ: Okay, thank you. 

Carrie Rhoads is on the phone, as well. So, 

Kevin, is the public muted at this point?

MR. BIRD: Yes.

CHAIR MARKOWITZ: Okay. So, all 
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right, we're showing on the screen, if you could 

just move it up a little bit, a revised agenda 

for today. Same timeframe. I moved a couple of 

things from yesterday into today and I moved some 

timeframes. We're a little bit behind schedule, 

I think, but we will catch up. So these 

timeframes are approximate.

Can you move it up, Kevin, so people 

can see the entire day? And we will -- it 

doesn't include a break, but we will take a break 

at the appropriate time.

So, let's continue the discussion of 

the occupational health questionnaire. And I 

just wanted to say one thing. I looked back at 

the history of our discussion of this. This is 

exactly the third year anniversary of our 

recommendation to the Department of Labor that 

the occupational health questionnaire be improved 

in certain ways.

And we have been going and forth on 

the improvements during that three-year period of 

time, which is a long time. So, I really think 
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that we need to give our final comment and then 

let them move forward with piloting the 

questionnaire. So I just wanted to preface our 

discussion with that.

I think, getting a sense of the 

discussion yesterday, one was there seemed to be 

a sentiment by many people that it would behoove 

the process for the Department of Labor to send 

out either this questionnaire or a simplified 

version of this questionnaire, a worksheet, to 

claimants, so that they have the opportunity to 

gather their thoughts, even write down some of 

their memories about their occupational history 

prior to coming to the interview.

And then, secondly, there was, I 

think, a general consensus to add an additional 

question which would permit the claimants to add 

whatever history they want to with regard to 

exposures that was not necessarily covered by the 

structured questionnaire.

There was also some discussion back 

and forth about adding something about personal 
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protective equipment above and beyond what the 

questionnaire says at present. Although, 

frankly, we had previously recommended that PPE 

questions be removed from the questionnaire 

because we didn't think it was time that was well 

spent and there wasn't much learned from it.

So, I open it up for some further 

discussion, with the idea that we will come to a 

conclusion about this.

So, George, you want to discuss this 

question that appears on the screen now?

MEMBER FRIEDMAN-JIMENEZ: I'm not 

seeing the screen. It's the question I sent you 

this morning?

CHAIR MARKOWITZ: Yes, yes.

MEMBER FRIEDMAN-JIMENEZ: Okay.

CHAIR MARKOWITZ: I can read it, if 

that helps.

MEMBER FRIEDMAN-JIMENEZ: I can read 

it. I got it.

CHAIR MARKOWITZ: Okay.

MEMBER FRIEDMAN-JIMENEZ: The question 
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is, at the very end, it reads like, did we miss 

anything? For example, are you concerned about 

any exposures to toxic substances that were not 

adequately described in your responses in this 

questionnaire? Please describe your concern. 

For example, what types of substances these were, 

even if you don't know the technical name, when 

the exposures happened, what kind of PPE you used 

at the time, and whether you think these 

exposures are related to health problems for 

which you are applying for compensation.

CHAIR MARKOWITZ: Okay. Thank you. 

So, comments? First on this formulation of an 

additional question, open-ended question towards 

the end. Is this good? Should we recommend this 

language?

MEMBER DEMENT: This is John Dement. 

I like the idea of adding an open-ended question 

at the end. I think this probably does a pretty 

good job of trying to stimulate that recall. So 

I'm in favor of it.

CHAIR MARKOWITZ: Okay, other 
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comments?

(No audible response.)

CHAIR MARKOWITZ: Okay. I'm not sure 

if there are some people who are trying to speak 

who aren't able to speak. It's a little hard to 

figure out, but now let's go -- can we just 

return to the PPE discussion for a moment? 

Because there was some sentiment in favor of 

adding increased questioning about PPE, perhaps 

as an indicator of exposure rather than 

protection, and then there was some sentiment 

opposed to it.

MEMBER DEMENT: This is John again. I 

guess I'm not in great favor of adding a whole 

lot with regard to PPE in sort of the 

instructions and category of exposure, but you 

could add something in, to the extent that any 

PPE was used, to provide that. But I'd rather 

use the time talking about exposure than PPE.

CHAIR MARKOWITZ: Okay. Any other 

comments on the occupational health 

questionnaire?
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MEMBER GOLDMAN: This is Rose. I'm in 

favor of that final question that George added.

CHAIR MARKOWITZ: So, Kevin, I don't 

know whether we need to -- okay, what we see on 

the screen, is this a Word document that you can 

amend?

MR. BIRD: Yes. Let me -- here. Let 

me change it so that we can --

CHAIR MARKOWITZ: Okay. What I want 

to do is just formulate a recommendation that we 

can vote on. And it will essentially say that 

the Board -- but I guess I should wait for Kevin, 

then we can have any discussion.

MR. BIRD: Let me just turn this back 

on. Okay. Can you see the document now?

CHAIR MARKOWITZ: Yes. I can see it.

MR. BIRD: Okay, great.

CHAIR MARKOWITZ: Okay, so you can get 

rid of the first line that, I propose.

MR. BIRD: Okay.

CHAIR MARKOWITZ: Or rather, before 

that, actually. You can leave it. You can leave 
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it. Just start off saying that the Board 

recommends pilot testing of the OHQ -- we can 

spell it out later -- in its most recent version 

provided to the Board, with the following 

comment. A colon.

So, and then you can take the Item 1, 

and you can cut and paste the proposed general 

open-ended question, and then put it as Item 1. 

Okay, so it'd be right before "a 

proposed general." It says adding a general 

open-ended question. You need to just say adding 

and take out proposed.

Okay. And then we can go to Item 2. 

Item 2 is sending claimants, prior to the OHQ 

interview, either a copy of the OHQ or a 

simplified version or worksheet that the claimant 

could use to gather the occupational information 

prior to the interview.

MR. BIRD: I do say prior to the 

interview earlier. Do you want me to change 

that?

CHAIR MARKOWITZ: Oh, yes. No, that's 
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fine. It's fine. To gather their occupational 

information. Okay. All right. 

So, first, before we vote on the 

official proposal, is there any language here 

that anybody immediately wants to change? Okay. 

So, we need a proposal to discuss and adopt this 

recommendation.

MEMBER DEMENT: This is John again. I 

would propose that these be added, what we 

discussed.

CHAIR MARKOWITZ: Okay. Is there a 

second?

MEMBER SILVER: Second. Silver.

CHAIR MARKOWITZ: Okay, thank you.

Okay, so it's open for discussion. 

Okay, so if there's no discussion, I we need to 

go ahead with the vote.

Yes, go ahead.

MEMBER SILVER: Yesterday, John had 

the notion that there might be memory triggers 

that listed various processes. And I wonder if 

we need to explicitly recommend this be part of 
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what is sent to the workers in advance, under 

Number 2, incorporated into the worksheet, 

perhaps.

MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez. I agree that memory 

triggers are important. I think, pretty niche 

question, are these two questions at the end of 

the questionnaire largely used as a questionnaire 

to jog people's memories? I think that there's 

so many different exposures that I couldn't think 

of specific memory triggers that would be brief 

enough to include in the questionnaire. Do you 

have any recommendations for sort of overarching, 

you know, memory triggers?

MEMBER SILVER: Not the questionnaire, 

but in something that is sent to the worker ahead 

of the interview, incorporated into the 

worksheet, in Item Number 2.

MEMBER DEMENT: This is John again. 

We've tried a number of things in BTMed to send 

to workers to help as memory triggers. At one 

time we sent some of the site maps that had the 
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buildings and some information about it. We're 

not currently doing that. We're largely using 

the occupational history questionnaire, which 

does include, for our workers, at least, some 

pretty common tasks that construction and related 

workers do. And that's pretty much what we're 

using. And we're using former workers to do the 

interviews and they can often help workers 

remember sites and tasks in the past.

But my comment would be, and sort of 

what goes through to finish it, if you -- for 

example, if I take metal and metal exposures, I 

don't think it would hurt to have a paragraph in 

the information material, under metals, that, for 

example, would describe some things that workers 

might do to expose them to metals. Welding is an 

obvious one, and that's going to be pretty easy, 

but some of the other tasks, such as applying, or 

scraping, or welding on some of these protective 

coatings that have various metals, chromium and 

cadmium, in them, those are sources of exposure.

So, you know, I think it would be 
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helpful to enhance that a bit in the information 

material that goes to them, at least describing 

briefly some of the tasks that might be 

associated with some of these exposures.

Solvents, you could talk about 

solvents in degreasing and part cleaning. 

I think those are useful, at least 

for the construction worker side, maybe not so 

much for the production, but perhaps it is.

MEMBER GOLDMAN: This is Rose Goldman. 

I thought we were going to add, actually, welding 

as part of the questionnaire. But we discussed 

that yesterday, to add a question on welding.

MEMBER DEMENT: Well, we're not -- I 

think the discussion was in the area of metals to 

include, in that red description, if you recall 

it, welding or metals as just part of that little 

introduction.

CHAIR MARKOWITZ: So what if, in this 

recommendation, Item 3, right there it says 

worksheet, we were to add something like, 

"together with," and I'm not sure what the proper 
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term is, orienting materials or whatever kind of 

similar phrase that we use that would cause the 

Department to send some useful information?

MEMBER DEMENT: I would say to include 

some brief descriptions of work tasks that might 

be associated with these exposures. As examples. 

I mean, they're not inclusive, but they're 

examples.

CHAIR MARKOWITZ: So, how about 

together with brief examples of work tasks and 

processes?

MEMBER DEMENT: Yes. I guess we 

should add in there "common work tasks and 

processes," because, you know, we obviously 

cannot cover --

CHAIR MARKOWITZ: And so, Ken, does 

that cover what you were getting at?

MEMBER SILVER: Yes. Thank you very 

much.

CHAIR MARKOWITZ: And people who 

actually work with these questionnaires on the 

Board, is this helpful or are there some other 
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prompts that we need to include?

MEMBER DOMINA: Hey, this is Kirk. 

Yeah, I like that wording. I think that helps.

MEMBER POPE: This is Duronda. I 

think it helps, too. I know that we can't 

possibly think of everything, but it does point 

us in the right direction.

CHAIR MARKOWITZ: Great. Okay. Thank 

you. I know it is intended to trigger things, I 

mean, rather than cover the entire world.

MEMBER MIKULSKI: And this is Marek. 

I wonder if we should not add the timeline. 

Things may have changed over the years in 

processes and timeline.

CHAIR MARKOWITZ: Yeah. This is 

Steven. Once we start getting more specific, it 

kind of opens the door to many other things. A 

major important point of this is to not overwhelm 

the claimant but just begin the process of 

recalling and describing what happened. So I'm 

not very comfortable with starting to get a 

little more detail. But if other people want to, 
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you know, include additional language here, 

that's fine.

MEMBER DEMENT: This is John again. I 

agree with you, Steven. I think this just needs 

to be pretty broad sweep general guidance with 

some examples of common things that are there. 

And that will have to -- the timeline of when it 

was done will have to be sort of ferreted out as 

the case is reviewed by the hygienist.

CHAIR MARKOWITZ: Any other comments 

on it?

MEMBER POPE: I agree. This is 

Duronda. I agree, because I think when you get 

into timelines, I think that's more in-depth into 

the claimant's case. You'll find out that 

information as you continue to collect 

information from that claimant, as far as the 

timeline. But if I think it is added here, that 

might be too early in the process of developing 

the case.

CHAIR MARKOWITZ: Okay. Okay, thank 

you. So are there any closing comments on this? 
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Otherwise we'll take a vote. Okay. We'll take a 

vote. I'm not going to read the recommendation 

in front of us. So, Carrie, do you want to take 

a roll call vote?

MS. RHOADS: Mike, do you want to do 

it or you want me to do it?

MR. CHANCE: I can do it. I'll take 

this and you can take the next one. How about 

that?

MS. RHOADS: Okay.

MR. CHANCE: Okay. We'll work as a 

team. Okay. If everybody's ready.

Dr. Berenji?

MEMBER BERENJI: Yes.

MR. CHANCE: Dr. Dement?

MEMBER DEMENT: Yes.

MR. CHANCE: Mr. Domina?

MEMBER DOMINA: Yes.

MR. CHANCE: Okay. Dr. FriedmanJimenez?

MEMBER FRIEDMAN-JIMENEZ: Yes.

MR. CHANCE: Dr. Goldman?
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MEMBER GOLDMAN: Yes.

MR. CHANCE: Ron Mahs?

MEMBER MAHS: Yes.

MR. CHANCE: Dr. Markowitz?

CHAIR MARKOWITZ: Yes.

MR. CHANCE: Dr. Mikulski?

MEMBER MIKULSKI: Yes.

MR. CHANCE: Ms. Pope?

MEMBER POPE: Yes.

MR. CHANCE: Dr. Redlich?

MEMBER REDLICH: Yes.

MR. CHANCE: Dr. Silver?

MEMBER SILVER: Yes.

MR. CHANCE: Mr. Tebay?

MEMBER TEBAY: Yes.

MR. CHANCE: All right. Looks like 

that carries unanimously.

CHAIR MARKOWITZ: Okay. Thank you.

Kevin, we're going to move on to the 

next topic. Kevin, can you bring up the file 

that's entitled "DOL_Response Advisory Board"? 

So, as he does that, I can give you 
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the history. So, we made a recommendation, I'm 

not sure the exact -- yeah, I think this was in 

November, actually. Sounds like it. Or in any 

case, it was maybe January, but that certainly 

some job titles should be considered within the 

SEM, you know, within the sites where those 

people work as having many or most of the 

exposure to toxic substances within the job 

sites, within that particular DOE site.

And DOL responded to us March 26th, 

and I want to scroll down. You've all seen this, 

but I just want to focus on it as I'm going to 

point to the discussion.

If you could scroll down. The first 

couple of paragraphs is just acknowledging the 

recommendation and also summarizing what we 

recommended.

And could you scroll down, Kevin?

MR. BIRD: Onto Page 2? Or the bottom 

of Page 1?

CHAIR MARKOWITZ: Oh, I'm sorry. Oh, 

do I control that?
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MR. BIRD: Yes. I believe when I'm on 

the page, you control whatever you view on that.

CHAIR MARKOWITZ: Okay, perfect. 

Okay. Okay, great. Thanks. Yes, I just 

noticed. Okay.

So, the third paragraph, there's a 

couple of important -- this is really the core of 

the response. First, it says it's the core of 

each toxic substance and job category that was 

identified in the SEM based on specific data 

established at a specific job site depending 

what's at a given DOE site, and has specific 

toxic substances named with those job categories 

or at the site.

And it goes on, quote, "As such, the 

Department does not make broad determinations 

across DOE facilities about toxic substances or 

job categories." Then it goes on and says, "The 

Department relies on objective data to support 

each and every piece of information that is 

entered in to the SEM."

And then it goes on, Page 2, where --
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MEMBER GOLDMAN: Can you scroll down? 

Sorry. Can you scroll down, because it's not 

visible.

(Simultaneous speaking.)

MR. BIRD: So, in WebEx, you're able 

to control where you view on the page. I can 

bring you to the page, but you have to scroll 

down on your own in WebEx.

CHAIR MARKOWITZ: Oh. Rose, can you 

scroll down?

MEMBER GOLDMAN: Okay. I see it. I 

see it. Yes. Thanks.

CHAIR MARKOWITZ: Okay, great. So, 

Kevin, if you could just -- we're going to come 

back to this page, but if you'd just go to Page 2 

for a moment.

And then it says, basically, that the 

Department's ratification on an individual basis 

based on individual claimant information. And it 

requests that if we have any data or objective 

evidence to support our recommendation, they'd be 

happy to receive that evidence.
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So, that's fine. Let's go back to the 

previous page. So, and if you scroll down to the 

last paragraph, a couple of points. It appears 

that the Department thinks that we are -- well, 

we were recommending that for a certain few job 

titles that their exposures be standardized 

across the entire complex, meaning that a 

firefighter at Portsmouth, the thought was we 

were recommending that a firefighter at 

Portsmouth and a firefighter at Los Alamos be 

listed in the SEM as having the same exposures.

And, just to clarify, we were not 

recommending that. We were recommending that the 

firefighter at Portsmouth be considered as having 

a very broad set of exposures at Portsmouth. And 

likewise, that the firefighter at Los Alamos 

would be attributed many or most of the toxic 

substance exposures, or potentially, I think what 

it's about, potentially, at Los Alamos.

We were never recommending that, 

across the entire complex, that certain job 

titles be specific in having a standard set of 
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exposures. So, I wanted to clarify that.

Interestingly, if you see the 

unhighlighted sentence, "the Department does not 

make broad determinations across DOE facilities 

about toxic substances and job categories," I 

don't actually think that's entirely true.

For construction, within the SEM, if 

you go by site you can also look at a listing for 

"construction - all sites," and you can go to any 

number of job categories within the "construction 

- all sites," say plumber construction, laborer 

construction or the like, and you will see a set 

of toxic substances, potentially, with potential 

exposure, that is standardized across the 

complex.

Unless, of course, I misinterpret the 

SEM, but it would appear that, for construction 

job titles, that there is a broad determination 

across facilities with regard to their potential 

exposures to toxic substances. So, there, I 

think, you know, we could ask the Department for 

some clarification about that.
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But moving on to a second point, the 

issue of the SEM is based on specific data, 

objective data, that supports the list of all 

potential exposures for a job category.

So now I'd like to move to a different 

file, Kevin, which is entitled -- it's the Excel 

spreadsheet, DOL SEM site-wide job titles.

And so I decided that it was a good 

idea to try and look at data. The Board doesn't 

have access to original data from DOE sites. So, 

we don't have objective data from the site unless 

it's publicly available. We don't have the data 

that was used to input into the SEM, for 

instance.

So, I said, okay, fine, what kind of 

data do we actually have? And so I looked at 

certain of these job titles that was part of our 

recommendation. At different sites, these are 

data from the SEM. And if you could just make it 

bigger, there's a couple more sites listed in 

this spreadsheet. I don't know. I don't think I 

can see -- well, I can't control it. Okay. I 
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don't want to lose the top, though. Okay, let's 

start towards the top. Okay.

So what I did was simply take 

firefighters, security guards, health physics 

technicians, and some aliases, because different 

sites use different job titles, but they are 

fairly close across the sites. And then I looked 

at the number of agents listed in the SEM for 

those job titles at those sites.

And there's an interesting pattern. 

Basically, you can see, for firefighters, Y-12 

there was 11 agents, ORNL 13, Hanford 2091, 

Savannah River 26, Los Alamos 28, Portsmouth 24, 

Paducah 18.

So they -- oh, wait, actually -- so, 

especially for firefighters, there's a lot of 

similarity in the number of agents, like, given 

the heterogeneity of the sites, with the 

exception of Hanford. You know, Hanford's 

clearly an outlier here, right? So that's 

interesting. You'll see that Hanford is an 

outlier in another job title, which we will get 
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to.

For security guards, you had Y-12 13 

agents, ORNL 9, Hanford 12, Savannah River 19, 

Los Alamos 23, Portsmouth 61, and Paducah 29. 

So, largely, similar numbers, Portsmouth is 

highest. We'll come back to that, because I want 

to compare the gaseous diffusion plants.

But when you get to health physics 

technicians -- and here, for some of the sites I 

had to combine, actually, health physicists with 

the technicians, but it didn't appear to make 

much of a difference. 

There is substantial variation. Y-12, 

there are five agents listed in connection with 

that job title, whereas across the street in ORNL 

there are 86. So they don't entirely look alike, 

but some sites are different. Hanford, you see 

2,000-plus, Savannah River 152 agents, and Los 

Alamos 38, Paducah 18, and Oak Ridge 36. So, 

generally -- well there we see, besides this 

large gray box, yes, we see Hanford is an 

outlier, and we see some significant variation 
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otherwise.

If we look at Savannah River, 152 

agents, which I did, most of those agents are not 

radiologic. They are asbestos and beryllium, and 

all of the other sort of garden variety chemicals 

that we see in the SEM. They're not -- so, a 

fair amount of this variation is not due to the 

radiologics, which you'd expect to see, right, 

with the health physics technicians definition.

So, if you scroll a level down, and I 

want to look and now just compare the gaseous 

diffusion plants, which we have three. We have 

Portsmouth, Paducah, and Oak Ridge K-25. So, by 

way of background, they all did the same thing. 

K-25, in addition, had a pilot centrifuge 

operation, but most effort at all three places 

wasspent on gaseous diffusion.

And this is actually the -- I run the 

Former Worker Medical Screening Program at these 

sites, for the production workers, not the 

detection workers.

And Portsmouth and Paducah did very 
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similar things, although they enriched uranium to 

different degrees. And we see, for instance, 

among firefighters, a very similar number of 

agents: 24, 18 and 25.

And security guards, some variation, 

Oak Ridge/K-25 10 agents, and when I get to 

Portsmouth it's 51 agents. And then for the 

health physics technician, in Portsmouth there 

was just four, and when you move over to Oak 

Ridge and it was 36. So, some variation there as 

well.

Kevin, if you could put up another 

file, which is called -- it's a Word file. No, 

it's called "SEM List of Toxic Substances for 

Guards."

MR. BIRD: I'm pulling it up now.

CHAIR MARKOWITZ: Yes, that's it. So, 

then what I did was, if you look at guards for 

one job title -- okay, if you can make it smaller 

so we can compare them.

So, what I did was, for the three 

gaseous diffusion plants, picked the job title, 
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or the comparable job title at the various sites 

that was closest, and looked at the particular 

agents or toxic substances listed in the SEM. 

And so it was somewhat similar to K-25.

And so I took those ten, which are 

clearly related to use of guns, for the most 

part, and I put those in red so we can see where 

they appear at the other gaseous diffusion 

plants. And so in Paducah we had 29 agents.

And, Kevin, I don't know if you can 

make this smaller so we can see the full list of 

29. Either that or if you could just scroll down 

some.

And then on the right, in Portsmouth, 

there's 61 agents listed for security guards. 

And so the bottom line is that those 

agents listed in red for K-25, they appear in 

Paducah and Portsmouth. They are consistent. 

And obviously in Paducah and Portsmouth you have 

additional agents. And I would point out, for 

instance, in Portsmouth, you see benzene, you see 

-- okay, well, that's the whole thing, but it's a 
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little hard to read.

Can you just make it a little bit 

larger? A little bit more. Okay, that's good.

So, Portsmouth, the largest number, 

you see benzene, you see beryllium, you see 

asbestos, you see arsenic, hydrofluoric acid, 

some of the main hazards, actually, that existed 

for Portsmouth, particularly for our production 

workforce.

So, just to summarize from the 

spreadsheet, there is a clear outlier at Hanford. 

There is some variation in other job titles among 

the other sites, and even if you narrow down the 

type of facility, as I did here in the gaseous 

diffusion plants, you see considerable variation 

in the toxic substances listed.

So, I open the floor for comment.

MEMBER DEMENT: This is John. I think 

you've shown that, at least from my perspective, 

that unless the K-25 security guards never go 

into the plant, that they're never considered 

exposures. Plant process information at K-25, it 
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shows the inconsistency, in any event, across 

sites, that determines how this determination was 

made, at least in my view. I can imagine it 

being that greatly different.to here

CHAIR MARKOWITZ: Other comments?

MEMBER SILVER: Yeah, this is Ken. I 

do remember, in 2005, 2006, when DOL realized 

that they had to implement Part E, they went 

around to different DOE sites and asked the site 

experts and workers to submit information 

documenting exposures. And if memory serves, K25 was already in rubble by then.

So this kind of populous grass-roots 

process of submitting information for the SEM may 

not have been very robust at K-25. I mean, 

that's not helpful for our purposes going 

forward, but that could explain why.

CHAIR MARKOWITZ: This is Steven. You 

know, we started our former worker medical 

screening in 1997. That's when we did our needs 

assessment at K-25. And I don't recall as to 

what records were still available, but there were 
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-- workers were interviewed. There were plenty 

of workers still available. And we did those 

interviews, to a certain extent. Those were 

scripted by Mark Griffon as part of our needs 

assessment.

And so, I kind of agree with you, 

perhaps on the records side. I think on the, you 

know, memory side, I think there were resources. 

I don't know quite how that SEM work was done in 

2005, 2006.

MEMBER SILVER: Not very 

systematically.

MEMBER DOMINA: Hey, this is Kirk. 

Yes, and as I look at this, and even like the 

health physics tech for Hanford, because if you 

remember, it wasn't but a few years ago that job 

title didn't even show up in the SEM. And I was 

complaining about it.

But then if you look at the same thing 

between Idaho Falls or INL and Hanford, the 

discrepancy on the chemicals is like it is on the 

other slide show, and a hundred and some compared 
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to the 2,000 and some for Hanford now.

And I don't know how active some of 

these sites are on providing documentation to 

input into it, but it seems to me that some of 

them, it's kind of just fallen by the wayside 

because yes, the security guards were everywhere, 

you know, just like firemen.

And I think it's an injustice that it 

doesn't be looked at on the sites, for this, each 

site globally, because those guys are everywhere, 

and gals.

CHAIR MARKOWITZ: Actually, Kevin, can 

you bring back the full spreadsheet just so 

people can look at that as we discuss this some 

more? Other comments?

So here's a question. What -- what 

does the Board want to do as a next step on this? 

Really, evaluation of the SEM is one of the 

original four mandated tasks of the Board. And 

so we're, you know, well within our mission, our 

charter, to look further.

What do -- we could ask for the 
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objective data that went into the construction of 

the toxic substance profiles for certain sites 

and job titles, so that we have a better 

understanding of this. What do you all think?

MEMBER POPE: This is Duronda. I 

think that that's a good start, Steven, Dr. 

Markowitz. I think it, if we broadened that, at 

least we'll get a better idea of what are we 

looking at.

CHAIR MARKOWITZ: You mean, a better 

understanding of how they actually put together 

this picture of jobs and exposures.

MEMBER POPE: Right. Right.

CHAIR MARKOWITZ: I think it would 

also be useful to -- since, you know, the program 

and the industrial hygiene personnel have worked 

with SEM for 15 years, they clearly have some 

understanding of why there's this kind of 

variation. And so in addition to asking for data 

we could also ask them for their understanding of 

where this kind of variation comes from.

MEMBER GOLDMAN: This is Rose Goldman 
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again. I seem to recall also from perhaps the 

other meeting, something about that, I want to 

say, firefighters or some workers would go to 

different plants, like maybe in a time of need or 

-- so that would be one question I have.

If somebody is predominantly, let's 

say, at Paducah, but then as a firefighter, or 

even a security guard, there might be some times 

that they might go and travel to another location 

as well, if that's a factor here.

CHAIR MARKOWITZ: Well, you know, Mr. 

Vance, how is the -- in the claims evaluation 

process, if a worker is at multiple sites, 

doesn't the claims examiner look at the SEM for 

that job title for multiple sites?

MR. VANCE: Well, yes, absolutely. 

So, you know, they would basically do their steps 

in evaluating the information that was collected 

during the initiation of the claim.

So they would look at, you know, our 

records that we -- that's the records that we get 

from the Department of Energy that we might have 
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employment history on. We might get some 

industrial hygiene records. We might get medical 

records.

We would look at that information. We 

would look at site exposure matrices, doing 

filtered searches based on each facility. And 

then they would begin assembling the data about 

the exposures that they are, they're pulling out 

and extracting from that research.

Same thing with the occupational 

history questionnaire. And so, what I think is 

really important to understand is that the SEM is 

providing a generalized, you know, profile of the 

information we have that is based on specific 

documentation.

Whereas when they start looking at the 

customization of the exposure profile with regard 

to what Kirk was talking about, like let's say 

you had a security guard, the profile that we 

have in the site exposure matrices is going to 

identify the toxins that we know, based on 

documentation specific to that site, that that 
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security guard may have encountered as a part of 

their labor.

When we start looking at the 

individual characteristics of where that security 

guard may have been going based on the 

occupational history questionnaire, or other 

information, that's the kind of thing that may 

end up having to be profiled by the industrial 

hygienist, so that's where we have to sort of 

customize the exposure information based on what 

we get during our review process. If that helps, 

at all.

CHAIR MARKOWITZ: Sure. Thank you. 

That's good.

MEMBER DOMINA: Hey, this is Kirk.

CHAIR MARKOWITZ: Yes.

MEMBER DOMINA: One of the things, 

too, like with -- you know, I'd point out is 

between Hanford and Savannah River, we have, we 

had the same type of reactors, we had the same 

type of tank farms, but yet there's a huge 

discrepancy, like on any one of these chemicals 
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for any group of the workers that are listed 

here, which is -- it's kind of hard to figure out 

why that is, unless Savannah River just hasn't 

been providing input for X amount of years or 

whatever. I don't know.

And maybe Mr. Lewis can talk about 

that, or Mr. Vance, because of, like I spoke 

about earlier how it wasn't but a few years ago 

in our meetings when I brought up about not 

having health physicists for Hanford listed, when 

they were always the first ones in and the last 

ones out on any job, because rad was a major 

concern, and chemicals were not even thought 

about until you got into mostly the '90s.

MR. VANCE: This is John, and I don't 

know whether Greg's on the phone or not, but 

everybody has to remember that all of the 

information that's in the site exposure matrices 

was derived from some sort of documentation. So 

we probably have a lot more documentation with 

regard to Hanford relating to firemen or security 

personnel, versus other sites.
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So that's where you see a lot of that 

differential is just the information that we have 

available that feeds into the data that's in the 

site exposure matrices.

MR. LEWIS: And this is Greg. I'm on. 

I don't know if people can hear me. Is the line 

open?

CHAIR MARKOWITZ: Yes, we can hear 

you, Greg.

MR. LEWIS: Oh, okay. Yes, I mean, I 

would agree with John. I could, you know, 

probably get a better answer with a more specific 

question, but I do know that the site exposure 

matrix team has worked with, extensively with 

both Hanford and Savannah River. They've gotten 

quite a bit of information from both.

But having said that, you know, all 

DOE sites have slightly different ways of keeping 

records, both now and, you know, capturing that 

information in the past. And they may also have 

had different workers doing somewhat different, 

you know, tasks or again, the logging that are 
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capturing it in a different way.

So, even though they may have had very 

similar operations, the records may be different. 

Or, you know, the actual chemicals used or 

exposures could be somewhat different, depending 

on -- particularly with job categories, not so 

much with operations.

But, so that's about all I can add, to 

be honest. But there are tremendous variations 

between sites.

CHAIR MARKOWITZ: Okay. Thank you.

So, question for the Board, what's the 

next step here, do you think?

MEMBER DEMENT: Hi, this is John. You 

know, clearly we don't have access to the raw 

data that went into making the site exposure 

matrix. I guess it would be interesting to, at 

least to ask for some -- ask for the why, you 

know, why the large differences, at least across 

the gaseous diffusion plants for the job category 

that you have shown us.

We've got to understand how that, you 
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know, why there should be such a wide variation, 

and if it's purely because of lack of 

information, then that's one thing, but to 

include the material, the possible exposure, and 

what plants the other -- this level of 

inconsistency, I think, deserves a little bit 

more.

CHAIR MARKOWITZ: All right, so that 

would mean, I think, asking for the, some of the 

underlying documents that were used to construct 

the profiles.

MEMBER DEMENT: At least some 

discussions about -- I don't know exactly how, 

you know, how we're going to get access to some 

of that information. But I'd like to try to 

understand the process better. And I think the 

one that you started with the security guards at, 

you know, the three gaseous diffusion plants, 

which, you'd think they'd be somewhat similar, is 

probably a good example to take a look at.

CHAIR MARKOWITZ: Well I think getting 

a further explanation of the process, I think 
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it's going to be very useful and also fairly 

general, and may not ultimately answer those, our 

questions about the variation.

I wonder whether, as a limited step, 

we should request the underlying documentation 

for say the guards across the three gaseous 

diffusion plants, or perhaps one or two other 

comparisons across these sites that we're looking 

at, not so that we're overwhelmed with 

documentation, but so that we have a better 

understanding of how it works and where the 

variation might be coming from.

MEMBER DEMENT: I agree, Steven. I 

think that's certainly one of the areas that the 

Board was specifically charged to take a look at, 

was the SEM and how it was constructed. And 

specifically, I think underlying documentation 

for at least a limited example would be worthy of 

taking a look at.

CHAIR MARKOWITZ: Okay, other 

thoughts? So this is, this amounts to a request 

for data. And I'm not sure that we need to agree 
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at the meeting exactly on the language for that 

request. But there is a verbatim transcript of 

this meeting, and to summarize, it appears that 

the Board would request data or the underlying 

documentation with regards to the SEM, in 

relation to selected job titles and selected 

Department of Energy sites, with the goal of 

understanding better both how the SEM profile for 

that job at those sites was constructed, and also 

beginning to understand the variation that occurs 

across job titles and across sites.

In addition, the Board would 

appreciate to hear from the Department about its 

view on how, I guess, the variation occurs. Does 

that properly summarize what we think we want?

MEMBER SILVER: Is there a particular 

SEM administrator?

CHAIR MARKOWITZ: I think it's a 

question for Mr. Vance.

MR. VANCE: Yes. So, if the Board 

would make a request, what we would do is work 

with our SEM contractor to identify records, and 
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then we'd have to actually work with the 

Department of Energy to make sure that we have 

the okay to release that underlying data.

So we would go through that exercise 

of evaluating the request and what we could do to 

fulfill that request.

MEMBER SILVER: While that's in 

progress, is there someone at DOL who is seen as 

the person who administers the SEM, who could 

come and talk to us, and explain what documents 

they rely on? And if they're on an agenda of our 

next meeting, maybe we'll have some of the 

documents by then, but that person could provide 

us, you know, with at least some of the 

dimensions of the problem.

MR. VANCE: Yes. I think any request 

that would be made would be considered, and the 

Department of Labor would formulate the best way 

to respond, whether that be allowing a person to 

participate or discuss that with the Board, or 

provide some sort of written feedback.

CHAIR MARKOWITZ: Okay, thank you.
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So, are there any other comments on 

this topic? Okay. So, let's move on. The next 

topic on the agenda is the assessment of the CMC 

and the industrial hygiene performance. This is 

task number four of the Board, in its original 

charter.

And just to, you know, kick off this 

discussion, the aim here is to explore different 

ways in which we think the current assessments 

might be revised, with the goal of coming up, if 

necessary, with a recommendation for a modified 

method of assessing the quality, consistency and 

objectivity -- those are the key words, quality, 

objectivity and consistency of the IH and CMC. 

And those three terms are used in our charter.

So let me just kick it off and say 

that so, what have we learned about the current 

evaluation process?

The CMCs are employed by a contractor, 

and there are certain performance standards 

within that contract. In addition, the medical 

director of OWCP, at least for EEOICP reviews, I 
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think, 50 claims every quarter, I think it is, 

and submits a quarterly report to the Department, 

which isfurther reviewed by the Department.

And problems with the CMC reports are 

then -- there is feedback between the Department 

and the contractor, you know, expectations, 

improvements.

And then on the industrial hygiene 

side, that has a contractor, the contract 

contains certain performance standards. When the 

industrial hygienists of the contractor submit an 

evaluation, that's reviewed by the federal 

industrial hygienists for quality and 

consistency. And then a final, final industrial 

hygiene report is issued.

It is -- so, you see there's some 

difference between the methods of evaluation, in 

the case of -- on the medical side, there's a 

potential person who is taking a periodic look at 

these, the medical director, a quarterly look at 

a sample of the claims, whereas on the industrial 

hygiene side, the Department is looking at each 
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individual claim as they arise, and not taking a 

step back and taking a sort of a broader sample 

of IH reports and looking at them.

So, let me open the floor up for 

discussion. 

MEMBER DEMENT: This is John again. 

With regard to the IH process, I mean, I 

understand that the actual detailed review of the 

case, the determinations are done by a contract 

industrial hygienist. And then it's passed up 

through the chain, through the DOL industrial 

hygienist.

I mean, I don't recall how many DOL 

industrial hygienists there are, but I think 

maybe one or two, but I may be wrong. So there 

are two there, and so my question on the 

industrial hygiene side, I can't imagine that the 

DOL industrial hygienists are going into depth 

with regards to the actual determinations of 

exposures by the contract industrial hygienists.

I think it's at best a high-level 

review, and not an in-depth of what actually is 
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getting done. So I don't actually consider the 

DOL IH review to be what I'll call peer review, 

or in-depth review. If it is, then they're 

overworked and we don't -- I just, I can't 

imagine why we would need a contract if they can, 

in fact, do that level of detailed review.

So, I think there needs to be a 

different process for the industrial hygiene 

review. Maybe -- you know, maybe it is, you take 

a sample like the CMC reviews take and really do 

an in-depth review of what actually went into the 

determination, what the determination was and was 

it a fair and accurate determination.

So I don't -- you know, again, I don't 

consider the DOL review to be a peer review of 

the IH process itself.

CHAIR MARKOWITZ: Other comments? If 

there are other comments on industrial hygiene, 

now would be a good time.

Or other comments in general. Let me 

-- I had the information that we covered 

previously, just to remind you.
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So we -- and I think, Dr. Redlich, you 

looked, not recently, but I guess previously, at 

the medical director's quarterly reports. I 

don't know, Carrie, whether you want to give a 

summary of that? If not, I'd be happy to, but I 

talk enough.

MEMBER REDLICH: Well I just last night 

looked at the last three quarters of reports, and 

they summarize -- they each one reviewed, I 

think, about 50 cases. And I think a selection 

of cases were picked to -- that addressed 

different issues, such as causation, or 

impairment, or need for home care.

Of those that were selected as, I 

guess of those -- so approximately 50 each 

quarter times three, so it's about 150. And from 

those, I think it was about 25 that were noted to 

be sub-optimal, or could have been better, in 

terms of the review of the, basically the CMC, or 

the second opinion.

I think all but one of those addressed 

issues related to impairment or need for home 
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care. So only one out of the 50 noted a possible 

issue with causation. So I think that is 

different than our assessment of reviewing cases.

And I did also review the form that's 

used, and it does look at a number of appropriate 

issues in terms of, you know, the quality of the 

report, the accuracy of the information. I think 

it -- it doesn't get at some of the issues that 

we have raised, that I don't need to repeat, but 

that have led to concerns about the final 

adjudication as far as causation.

But Dr. Markowitz, you may want to add 

to that.

CHAIR MARKOWITZ: Well, I had looked 

at, you know, a lot of them for maybe six 

quarters of the medical director report and found 

the same thing, that there were substantial 

issues. Somewhere around 15 to 20 percent of the 

claims reviewed bore questions, some major, some 

minor, on -- you know, relating to impairment or 

some other issues.

And when I looked there was I think 
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one or two actually which raised questions about 

causation. And so I got the impression that, for 

whatever reason, causation wasn't really either 

the focus, or adequately assessed. Because when 

we looked at claims -- and those were respiratory 

disease claims -- and we looked at a fair number 

of claims, not in such a standardized way that we 

could necessarily aggregate the data, but 

definitely we could aggregate our impression, 

somewhat, which is that there were many CMC 

reports that were outstanding, that were 

excellent, that we would agree with their process 

and decisions.

But there were a minority that were 

problematic, and obviously problematic, actually. 

It wasn't sort of a nuanced difference, in our 

opinion. I noticed that that review sheet that 

you mentioned, it doesn't ask whether you agree 

with the CMC decision or not, which is something 

that we do take a look at. But I --

MEMBER REDLICH: I think it also 

didn't ask whether we agreed with the exposure 
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conclusions.

CHAIR MARKOWITZ: Right. Right. 

Basically, the questions that were looked at were 

the medical information, the quality and the 

review of the medical information. The questions 

came from the claims examiner and the like.

Other board member comments?

MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez. I have a recommendation 

that I would like to propose, and I'd like to 

discuss the rationale for that. It will take, I 

would guess, around five minutes. Can I present 

this idea?

CHAIR MARKOWITZ: Sure.

MEMBER FRIEDMAN-JIMENEZ: Okay. I 

suggest that the Advisory Board consider 

recommending that the EEOICP set up a review 

committee that would do performance assessment 

process in an ongoing way.

And my rationale is that, as Carrie 

was saying, the current assessment of CMC and IH 

performance seems focused more on impairment 
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ratings and levels of disability, and care need, 

than on the accuracy of determination of workrelated causation.

Maybe a reason for this is that 

there's no gold standard for determining workrelated causation. We have reviewed, members of 

the Board have reviewed a large number, samples 

of cases, and concluded that the determination of 

causation is often reasonably well done, but I 

think we had a consensus that there were too many 

cases in which we had concerns.

And the kinds of concerns that we had 

tended to be around individual level of exposure 

assessments, errors due to ambiguities in 

diagnostic terminology, missing exposure or 

medical information, difficulties in using the 

SEM, and really the overall process of 

determining work-related causation at the 

individual level.

In many cases, the determination comes 

down to a judgment process that includes some 

subjective and interpretive elements, as well as 
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some what is often called objective evidence, 

although there's some controversy about that.

The judgment component generally is a 

necessary part of the process. And for this 

reason I think there's often a perception by 

claimants and the general public, and sometimes 

this may be true, that the clinician's causation 

judgments may be influenced by a variety of 

factors that might lead to under-diagnosis of 

work-related causation, meaning incorrectly 

classifying work-related illness as not being 

work-related.

In addition, there's concern by others 

that contractors, maybe in efforts to be 

claimant-friendly, may be leading to overdiagnosis of work-related causation. And since 

these judgments, these determinations end up 

being judgment calls, often by the CMC and/or the 

IH, there's no quantitative method or algorithm 

that we can develop that would adequately assess 

this dimension of the performance of the CMC and 

the IH.
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So I think there's a need for 

performance assessment. But I don't think it can 

be done by a formulaic or algorithmic approach. 

So I propose that there be a committee to do 

these performance assessments on an ongoing 

basis. Determining work-related causation is 

fundamentally an interdisciplinary process. I 

think it makes sense to have a multi-disciplinary 

committee rather than a single position, like the 

medical director, doing these performance 

assessments.

The committee would ideally have 

representation from occupational medicine, 

industrial hygiene, exposure assessment, 

epidemiology, toxicology and biomedical research. 

And the cases could include either or both 

randomly sampled case with different diagnoses, 

even groups of diagnoses.

So we would review, or the committee 

would review a number of cases, as we did of 

asthma, or a number of cases of COPD, et cetera, 

and also specific individual disputed cases.
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And given that the judgment component 

of these determinations is unavoidable, and to 

avoid perception of one-sidedness of the 

committee, there would need to be some kind of an 

approval process by representatives from labor, 

from government, academia, of the committee 

members that participate in the process.

This would be a labor-intensive 

process. This is not a simple or -- a simple 

thing that we could do within the time 

availability of the members of the Advisory 

Board.

I think the committee members would 

need to be paid for their work. It would need to 

be a periodic process that was done on an ongoing 

basis. And it should be separate from but 

overseen by this Advisory Board.

So that's my proposal, that we have, 

we establish a committee that would do these 

performance assessments, because no single person 

knows all of this stuff in a way that, you know, 

as Steven and others have discussed before, that 
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we could assess impairment and care needs as well 

as causation and determination of exposure and 

all of these factors. So, I think a committee 

would make sense.

So that's my proposal, and I open it 

to discussion.

CHAIR MARKOWITZ: So, this is Steven. 

So to summarize, a multi-disciplinary peer review 

periodic assessment of the quality of the CMC and 

industrial hygiene evaluations within the claims 

process.

MEMBER FRIEDMAN-JIMENEZ: Yeah, pretty 

much, which would have two components, and we can 

talk about whether they're both needed. One 

would be group assessments, you know, of groups 

of particular disease diagnoses, and one would be 

individual disputed cases.

CHAIR MARKOWITZ: Well, yes that's a -

- I take it from, if I'm learning from the 

Department, a crucial distinction is that the 

latter gets into individual claims and 

adjudication of individual claims where the 
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former really is about performance of the 

program, and program elements. So we don't --

you know, I don't know that we need to get into 

that level of detail.

So, what do people think?

MEMBER POPE: This is Duronda Pope. I 

think it's a great idea. It enables us to get an 

idea of what's happening with the cases in 

somewhat detail, as much as we can. It gives us 

a broader idea of what's happening with those 

cases, and give us some insight of how the SEM 

and those other -- what's the word I'm trying to 

say? How those other components work within the 

program.

CHAIR MARKOWITZ: So, by independent, 

I take it that you mean independent of the 

current contractor and independent of the current 

the federal personnel. Is that right?

MEMBER FRIEDMAN-JIMENEZ: Yes. And, 

you know, I think the second component could 

probably be done by the medical director. But 

the first component would give the Advisory Board 
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real information on identifying what may be the 

limitations or the weak link in the process, 

specifically of causation determination but also 

the other components as well.

CHAIR MARKOWITZ: And more important 

to the Department.

MEMBER FRIEDMAN-JIMENEZ: Yes.

CHAIR MARKOWITZ: Other comments?

MEMBER MAHS: This is Ron. I agree 

with what he's got there, because it always 

bothered me why the IH doesn't have to show where 

he made the determination on the level of 

exposure. He may have never been in the plant, 

he doesn't know what the claimant worked in, in 

the 70s or 80s or 90s. How can he make that 

determination that the exposure level was too 

low?

MEMBER REDLICH: This Dr. Redlich. I 

guess I feel that, you know, we've been at this 

for several years. And I think we have a pretty 

good idea -- you know, as Dr. Markowitz said, a 

number of the cases are properly adjudicated. No 
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system is going to be completely perfect.

I mean, I think we have an idea of at 

least where some of the -- and we've, you know, 

we've looked at quite a bit of data in terms of, 

you know, where the greatest number of cases are, 

and what some of the issues are.

So, I've gotten hesitant about yet 

another resource committee. And I'm wondering, 

you know, maybe -- there is a review process in 

place. And you know, maybe if we met with the 

medical director and could, you know, directly 

discuss with him some of our findings and 

conclusions, and thoughts about how to improve 

the process and the oversight.

So, and I think that, you know, we 

have -- I think things -- we have made 

recommendations that have been implemented. Even 

my -- I did check that the pneumoconiosis is 

linked to pulmonary fibrosis and interstitial 

lung disease, which is appreciated.

So I mean, I think that there has been 

progress in a number of the, you know, issues we 
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had noted. So I'd be a little hesitant to add 

another body to review what is a quite 

complicated process.

MEMBER POPE: This is Duronda. Is 

there a current oversight committee that reviews 

and gives the findings within the program, within 

Department of Labor?

MR. VANCE: Was that question directed

to me? I wasn't sure.

MEMBER POPE: Oh.

CHAIR MARKOWITZ: Yes. I'm sorry. Is 

that for Mr. Vance?

MEMBER POPE: I believe so.

MR. VANCE: Yes.

MEMBER POPE: Yes.

MR. VANCE: Yes, okay. I'm sorry. 

Yes, I would say that we don't have any kind of 

-- if you're asking about some sort of 

independent oversight committee, the answer is 

no.

I mean, you know, Ms. Pond talked 

yesterday about the fact that we have our annual 
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accountability review process and we also have 

our internal quality assurance process which has 

started looking at the overall quality of the 

cases and the sufficiency of the decisions that 

are coming out of the process.

MEMBER POPE: Okay. Thank you.

CHAIR MARKOWITZ: Other comments?

MEMBER SILVER: This is Ken Silver. My 

sentiments are closer to Dr. Redlich's. I want 

to tip my hat towards George for thinking through 

something that's comprehensive.

I'm a pretty empirical, practical 

person, and we first asked for more resources to 

do things better almost four years ago, and 

rather than elaborate a Christmas wish list, I'd 

like to stay focused on a contractor to support 

the Board's various analyses so that the Board's 

brain power is used more efficiently.

And the contractor would, you know, 

organize the case files for us and keep things up 

so that the volunteer board members can do what 

they do best, and not spend as much time 
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shuffling paper and hunting for things in case 

files.

So, one step at a time, and I'd much 

rather stick with our first resource request.

CHAIR MARKOWITZ: This is Steven. So, 

I don't think a recommendation of an independent 

peer review process necessarily involves the 

Board at all. I mean, it could be that this is a 

recommendation for the Department, and the 

Department could consider that, whether they want 

to, you know, involve the Board in this, but this 

-- that would be an entirely new function.

Recommending an independent peer 

review process, they would try to figure out 

through contractors and whatever consultant 

arrangements to get independent input into their 

system.

And so it's clear the Board would like 

to know the results of that assessment, but it's 

not necessary that the Board itself do that, if 

that addresses your concerns, Ken.

MEMBER SILVER: I just think that 
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we're introducing competition over resources for, 

you know, between this fine new idea, and an idea 

we had four years ago and, you know, maybe coming 

off as ivory tower types seeking perfection, when 

we just heard from Dr. Redlich that it's probably 

good enough.

MEMBER REDLICH: So I would say that I 

do not disagree with the suggestion of an 

independent group to evaluate it. I think that 

one of the problems is the -- I think we're very 

good tools. We have the breadth of expertise 

that is needed for this. And I think there is a 

relatively limited number of people out there 

that would have that expertise.

And I think, you know, a number of the 

recommendations we've made have been implemented. 

I think one thing -- there's one thing about 

making a recommendation is that any such 

recommendation is -- getting that fully 

implemented throughout a system can be 

challenging.

I just am dealing with something way 
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simpler, putting face masks on people at my 

hospital, which still has not happened, 

universally. So, I feel it would be helpful for 

potentially a group like us that's already 

familiar and has made I think some good 

recommendations, ones that have been implemented, 

to see if those have had an impact.

You know, I think we -- they probably 

have, just from looking at some of the data. But 

you know, specific things related to COPD or 

asthma or, you know, some of the other 

conditions.

So, I would -- I think there could 

still be value in a group like us that has, you 

know, I think identified specific fixable things, 

and also sort of now seeing -- and I think with, 

you know, with any recommendation, it takes time 

to have it fully implemented.

So I would say I'm not opposed to the 

suggestion of that independent review group, 

which would probably be very good. I was just, 

in terms of resources and who -- that group will 
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be as good as the people on it. So that's sort 

of my hesitancy.

CHAIR MARKOWITZ: Yes, this is Steven. 

I don't think that resources should be a primary 

concern of ours. I mean, our charter is to 

provide advice to the Department about certain 

aspects of the program. And how to improve --

certain improvements, how to improve that 

program.

And what the resources are, where they 

come from, did they arrive, et cetera, is kind of 

separate from what we should be considering. 

It's not that I'm unaware of the resource issue, 

I don't mean to suggest that. It's just that we 

don't really know where resources go in this 

program, and we don't know what monies are spent 

for what. And we don't know, potentially, what's 

available.

And so, I think we should focus on 

what we know best, which is, you know, how to 

look at the program and make recommendations on 

certain parts of it.
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I'm also -- if I believed that a sitdown discussion with current personnel in the 

Department would correct these issues, then I'd 

be all for it. And I'm not opposed to that kind 

of sit-down.

But I think what we've seen is 

systematic issues, you know, the lack of a 

periodic assessment of the industrial hygiene 

process, the, as far as I can tell, neglect of 

the issue of causation in the medical assessment 

of the CMC.

And so, I'm skeptical that sit-downs 

are going to change that. And I'm skeptical that 

it's going to avoid the need, ultimate need for 

kind of an independent periodic review.

MEMBER REDLICH: Just for one point of 

clarification, of those 150, or about the 50 a 

quarter that were reviewed, I think a number were 

selected for review as far as causation. But of 

the ones that were identified as being lacking, 

there was only one that was related to causation.

So I think they were looking at 
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causation, I think it, those may have just been 

ones that, where there were no issues as far as 

causation, or it could be that the approach that 

they're using to review the CMC process is 

potentially missing some causation issues. And 

it's hard to know which of those options it is.

CHAIR MARKOWITZ: Right, sure.

MEMBER REDLICH: I'm just saying, I 

think there was an attempt to look at some 

causation cases. The end result is somewhat 

different than our experience.

CHAIR MARKOWITZ: So, we have a couple 

of choices, besides taking a break for ten 

minutes. One choice is to try to come to a 

conclusion about this and formulate a 

recommendation at this meeting.

Another choice is to think about it 

some more, likely have to have a small group toss 

around these issues a little bit further in May, 

and then come back at the end of June when we 

have our next telephonic meeting to try to 

formulate a recommendation that the majority 
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agree with.

So, why don't we take a 10-minute 

break, and then come back and then make a 

decision about that choice. Is that all right?

MEMBER FRIEDMAN-JIMENEZ: Sounds good.

CHAIR MARKOWITZ: Kevin, what time do 

you have, Kevin?

MR. BIRD: I have 12:43 Eastern.

CHAIR MARKOWITZ: Okay. So we'll 

reconvene at five of one, in ten minutes. We can 

just stay on the line, right?

MR. BIRD: Absolutely.

CHAIR MARKOWITZ: Okay.

(Whereupon, the above-entitled matter 

went off the record at 12:43 p.m. and resumed at 

12:59 p.m.)

CHAIR MARKOWITZ: Okay, this is 

Steven. So, my feeling about this issue on the IH 

and CMC performance is that this is one of the 

core tasks of the Board, and we have been looking 

into the issue for a couple of years, I would 

say. And we'd do best by having additional 
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discussion by a smaller group, in the next few 

weeks, and then returning for a formal look at a 

recommendation at the meeting at the end of June.

It's just too important an issue, and 

I think we need to have a fuller, maybe more 

relaxed discussion by a subset, and then see if 

we can arrive at a consensus. What do people 

think about that?

MEMBER FRIEDMAN-JIMENEZ: This is 

George. I agree. Yes, that's a good idea.

MEMBER REDLICH: This is Carrie. I 

also agree.

MEMBER GOLDMAN: Rose. I agree.

CHAIR MARKOWITZ: Okay.

MEMBER DEMENT: This is John. I agree 

as well.

MEMBER BERENJI: This is Mani Berenji, 

I agree.

CHAIR MARKOWITZ: Okay. So, let's go 

with that. We're going to put this back into a 

working group. You'll be happy to know that I 

have a running list of working groups, both 
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current and to be started by, within the next 

hour, and we'll review that in a few minutes.

So the next item on the agenda is the 

revisions in the EEOICP Procedure Manual and 

bulletins. All right. I put this on the agenda, 

really as a placeholder. It's like we are 

provided, I think, prepublication versions and 

notices, but in general, these bulletins come 

out, procedure manuals change, and so we've got 

to occasionally look at this.

I don't have any particular issues to 

discuss here, but if anybody has seen anything, 

any changes in the transmittal documents or 

whatever that they want to discuss, now is the 

time.

Okay. I do think, when develop a work 

plan, at the end of this meeting, that we should 

develop some plan around how we're going to 

address these short-notice prepublication 

documents that we're getting, and our ability to 

take a look at them, and provide comment in a 

timely fashion. But we'll get to that.
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Okay. Next item is also easy, it's 

the update on expanding asbestos job titles in 

the Procedure Manual. And just to remind the 

group, because just in case, I and some others on 

the committee, and I'm thinking about Ron Mahs, 

I'm thinking about John Dement, and maybe there 

was one other person.

I'm also thinking maybe Duronda Pope, 

but I usually think that Duronda Pope is 

involved, that we were asked by Department of 

Labor, we have proposed certain expansion of the 

asbestos job titles in the Procedure Manual, and 

we said -- they asked us for documentation for 

those titles, and we promised that we would 

provide that documentation.

And I have not been able to get to 

that. I know that Mr. Mahs sent me an email 

recently about this, but I have no update on 

this, and I -- but personally I think, it is my 

plan, and I think the Board should close this out 

by the end of this board term, so it's not a 

lingering issue.
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Any comments on this? Who was on that 

committee besides Ron and John and myself? 

Anybody else?

MEMBER POPE: I think I was. Duronda.

CHAIR MARKOWITZ: Yes. Exactly. 

Exactly. Okay, great. Okay, so we'll -- we're 

going to reconvene soon.

Okay. The next topic -- we're now on 

schedule -- is review of public comments. We had 

one written comment posted on our Board website 

as of yesterday. We had several verbal comments 

yesterday. And I'm wondering if people have, 

want to make any comments about the input that 

we're receiving.

Okay, I'll start off. I think that 

Stephanie Carroll's comment about the B reading, 

I think we addressed that in our advice to the 

Department of Labor, to the extent that we could, 

if I heard the comment correctly.

And I think she did mention something 

about glyphosate not being in the SEM as having 

any health effect and I think that will probably 
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be corrected after the SEM IARC working group 

provides its next report.

Then we had, Mr. Avery talked about 

hearing loss yesterday, and the Board has 

addressed the issue of hearing loss in the past.

Ms. Barrie raised the issue of faulty 

respirators, a couple of answers from myself, 

during a certain time period. And I think Mr. 

Vance asked the Board to look at claims.

Let me ask Mr. Vance, if you're there, 

so that claimant information, how is that 

integrated into the program during claim review?

MR. VANCE: First, are you talking 

about incidents, or involvement in incidents, or 

not --

CHAIR MARKOWITZ: So, it's -- yes, 

okay. So what -- I haven't read what she was 

referring to, but what was said was that during 

certain time periods, 2012 to 2016, and likewise 

in 2009 to 2012, but generally it was over a 

number of years where there was reports of faulty 

respirators, meaning that, you know, people might 
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have a lot more exposure than previously thought.

So my question is, so here you have a 

news report. I don't know what it's based on. 

So, how does the Department factor in that kind 

of information? Because if it's been verified, 

for instance, how will it impact the industrial 

hygiene evaluations during that, those time 

periods at those sites?

MR. VANCE: Yes, I mean, you know, 

what I always point out during any claim 

adjudication process is that the most information 

that we can get is what is going to be submitted 

to us. So if people have data or information, or 

monitoring, or any kind of information that helps 

profile their exposure, that's always going to be 

very helpful.

But from my interactions with our 

industrial hygienists, they generally don't look 

at personal protective equipment as swaying their 

opinion about the exposure to occupational toxins 

because they're -- you know, and I think folks 

have talked about this before in the board 
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meeting is that, you know, they have no assurance 

that people are using it correctly or that it 

was, you know, properly accommodating particular 

types of exposure.

So generally, while they'll look at 

PPE usage, they're not going to generally sway, 

that's not going to sway their characterization 

of the exposure to a toxin, in how they prepare 

their assessments.

So, you know, more information is 

always helpful. It's helpful to get that 

information, and have it available for review. 

But again, it's up to the industrial hygienists 

to look at that, and figure out how it influences 

their assessment of exposure.

And from my interactions with our 

industrial hygienists, they generally will argue 

that, you know, there was no way that they can 

basically say that this person was absolutely 

using it properly so that way they have no 

exposure.

They're generally looking at it and 
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saying, we're not going to render an opinion 

that, you know, puts a lot of weight behind the 

use of PPE, though it's acknowledged in the 

occupational history questionnaire, or even 

identified in the DAR records.

CHAIR MARKOWITZ: So, and in these 

circumstances, just to follow up, so was there a 

notice or a memo we put out to the contractor? 

And again, I understand this is a bit 

complicated, I think it is, at least for me, 

because I haven't looked at, you know, details 

about this episode, these episodes.

But I would, could and noticed one 

will be put out to the IH contractor to say hey, 

beware of this issue that occurred over a number 

of years and everything.

MR. VANCE: You know, anything's 

possible, but generally because of the 

administrative nature of how we handle these 

cases, we would be looking for that data specific 

to an employee, when we start looking through 

their case file.
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If there would be some sort of 

generalization about particular incidents or 

issues like that, we could potentially let that, 

you know, what's the objective evidence related 

to that, and it was something that we could 

potentially incorporate into the site exposure 

matrices, because we have that kind of ability to 

identify incidents or issues relating to 

occupational safety and health things that went 

on at the different sites.

CHAIR MARKOWITZ: Okay. Thank you.

Anybody else have any comments about 

the public comment?

MEMBER SILVER: Yes. This is Ken 

Silver. One aspect of Mr. Avery's comment 

yesterday is, later in his career he was a 

radiation monitor, and he hammered on the point 

that the ototoxins were not in his job category. 

So, he's kind of a name and a face that goes 

with our earlier discussion this morning on sitewide job titles. He wasn't at a gaseous diffusion 

plant, but as the Board revisits that issue of 
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site-wide job titles, he's an interesting case to 

keep in mind.

CHAIR MARKOWITZ: So, actually, just 

getting back to that respirator problem, I think 

there was a suggestion that the Board look at 

claims. Our goal has been to do that. We have a 

pending request that lung cancer claims, or post95 claims, and which hopefully come the next 

meeting before the Board's term, which we will 

then be quite busy there. So I hesitate to 

request more claims to look at.

Any other comments from board members 

on the public input? Okay. So, I think we're up 

to developing a work plan of the next three 

months.

I was supposed to remind you, I was 

asked to remind you that the board members who 

want to continue to serve on the Board in the 

next term, that Mr. Vance mentioned yesterday, 

applications coming up, so we post the 

applications in the Federal Register. And the 

last day to submit those are May 1st, or April
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30th?

What's the last day, Mr. Vance?

MR. VANCE: I think it's May 1.

MS. RHOADS: Yes. It's May 1.

CHAIR MARKOWITZ: Okay.

MR. VANCE: Yes, it's May 1.

CHAIR MARKOWITZ: Okay. So before we 

move on to the work plan, are there any issues 

that we said we'd get back to which I've 

forgotten about?

Okay. So, we're going to make up a 

list of the universe of concerns that we are --

let's see. If I can find it here. Let's see.

MR. BIRD: Yes, sorry. I'm just 

pulling it up so we can edit it.

CHAIR MARKOWITZ: This is a draft. 

And I want to just go through the full list 

first, before anybody starts volunteering for

things. So I'll go through, quickly, all of 

them, and then we'll return to them and see if 

time table appropriate and everything is done, 

personnel involved are the correct personnel.
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So, one we have the -- by the way, can 

you hear me okay?

MEMBER FRIEDMAN-JIMENEZ: I can, yes.

MEMBER DEMENT: Yes.

MEMBER GOLDMAN: I can.

CHAIR MARKOWITZ: What's that?

MEMBER GOLDMAN: Some crackling 

noises. I don't know, maybe that is just --

where it is coming from.

CHAIR MARKOWITZ: Maybe it's the tree 

coming down.

Okay, so the first one is, Parkinsonrelated disorders. The second issue is the SEM 

IARC Group 2A concerns. The third issue is what 

I just mentioned, the asbestos job titles. Fourth 

is our resources request, and that has to do 

with, we said we, which we will follow up on in 

the process outlined to us yesterday.

The next issue is, we're expecting 

some claims, 20 of lung cancer and 10 in post-95 

claims. We don't know when they might be ready. 

The next issue is the one we just discussed on 
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the CMC and industrial hygiene assessments.

And then, and if you could just scroll 

down. There's just one last -- you can see what 

the last one is a kind of wavy one, but we need, 

the Board needs a mechanism for how we address 

these notices of prepublication policy changes at 

the program, which we don't have now. Right. 

That's not, you know, much work to develop that 

procedure, but we do need to put it on the radar.

Okay, so let's go back up to the top.

MR. VANCE: Dr. Markowitz?

CHAIR MARKOWITZ: Yes.

MR. VANCE: I hate to interrupt, but I 

also would just remind you about that batch of 

development letters that are also going to be 

coming. Yes, I didn't see that on the list.

CHAIR MARKOWITZ: Okay, great. Okay. 

Thank you.

So, there's another task then, and I 

don't know, Kevin, can you write on this 

document?

MR. BIRD: Yes.
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CHAIR MARKOWITZ: Okay. So, it should 

be Item H, which is a response to DOL request for 

assistance in provider outreach. And just to 

remind the group that part of that request that 

came in from the Department in February, one of 

the items was to ask for our input into getting 

private providers to communicate more frequently 

or more on target with the program, regarding the 

claims.

And what the Department said was, 

could we provide that the development letters 

that are sent to the providers, the outreach 

material and the like, and this is so our -- they 

want our brain power in how that process -- how, 

if that process might be improved. 

We don't have those materials. 

They're going to provide various materials. We 

don't have them yet, so -- but I take it we 

probably will be getting them before mid-July. 

So it's on the radar now.

Thank you, Mr. Vance.

Okay, so let's go back to the 
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beginning. The Parkinson's disease, I think we 

have a plan. There's a scientific review that's 

going to occur over the next month or so. And 

then there'll be a full, at the full board 

meeting, there'll be a final recommendation that 

we can discuss and vote on.

And I have, from memory, the people 

listed on that group listed there. I'm not sure 

I got everybody, or I got everybody correctly, 

but it was Dr. Mikulski, Ms. Pope, Dr. Goldman, 

Dr. Friedman-Jimenez and Dr. Dement. Is that 

right?

MEMBER GOLDMAN: Correct, I believe.

CHAIR MARKOWITZ: Okay.

MEMBER GOLDMAN: This is Rose Goldman.

CHAIR MARKOWITZ: Yes, okay. Okay.

So, I take it that, Dr. Mikulski, that 

you'll, or maybe even have scheduled that working 

group meeting, and has -- and I know has sent 

around the ongoing articles that he used in his 

review. Bear with me.

Second item is continuation of the 
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work on the SEM, the input into the SEM, 

including IARC. And there is a working group 

meeting that will be scheduled. And let me ask, 

is it realistic that we might have, on the Group 

2A agent, a final recommendation by towards the 

end of June?

MEMBER BERENJI: This is Mani Berenji. 

I do feel that that is realistic. I've already 

done most of the leg work, at least for the 2A 

chemicals. We need to take a deeper dive with 

the pesticides, but I've also done the 

preliminary research on that. So, I honestly 

think this is realistic, but I defer to my 

colleagues.

MEMBER GOLDMAN: I have a question on 

where we left things, if you don't mind me 

asking. It's Rose Goldman again. I think there 

was a question about taking the Group 2A, which 

is probable human carcinogens, and breaking it 

into higher probability, medium and lower, and 

then maybe doing something with that.

Are we planning to put forth some 
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recommendation about either doing that, or our 

group doing that, and then maybe saying that we 

used the 2A ones that are the highest probability 

ones, or something along that line, so that we 

have a clear direction on the task?

MEMBER BERENJI: At least from our 

discussion yesterday, that was the plan, to tier 

the 2A chemicals into strong, moderate and weak 

evidence, at least with respect to human 

epidemiological evidence. Please correct me if 

I'm wrong, but --

MEMBER GOLDMAN: So we would do that 

for you. Well, our group would do that by sort 

of looking over the articles, not with a specific 

criteria but sort of a judgment on looking at how 

strong the evidence is to now further break them 

into tiers. Is that your concept, or our 

concept?

MEMBER BERENJI: That was my 

understanding. And I actually do have all the 

monographs from IARC, so I could disseminate that 

to the group via Google Drive or some other way, 
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because they're pretty large documents. We could 

review that, I mean, you know, based on our 

current assessment of how we review evidence, we 

could use that same basic logic, and we could 

tier the chemicals accordingly.

MEMBER GOLDMAN: Okay. And then, 

would the consequence of doing that be that, 

having done that, that the group would give sort 

of the rating of carcinogens to those things that 

fit into 2A and are high-tier? Would that be the 

direction we're going?

MEMBER BERENJI: At least from what I 

think we should give credence to the high 

evidence, high -- or strong evidence for 

carcinogenicity, especially for the high and 

moderate.

With respect to the weak tier, I know 

a lot of the cases, and papers that I reviewed 

were based on case reports. So we could rank 

that as a lower tier rating, but I do feel that 

all the 2A chemicals, at least in my humble 

opinion, should be considered and should be 
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incorporated into the SEM.

So, we could kind of tease that out in 

our working group, but at least this way we'll 

have a basic understanding of what's considered, 

you know, the most, you know, pressing, at least 

with respect to the 2A chemicals, which ones we 

should definitely be recommending to be in the 

SEM no matter what, and then we can tease out the 

moderate and the weaker ones.

MEMBER REDLICH: This is Carrie 

Redlich. When you do that, as you go through 

them again, in trying to categorize them, if 

there's some general sense of, you know, over ten 

years of duration of exposure, any other general 

guidelines such as that, I think that would be 

helpful.

MEMBER BERENJI: I think that's a 

great comment. Absolutely.

CHAIR MARKOWITZ: So, this is Steven. 

You know, each of our recommendations will 

require us to submit a rationale for them. And 

with respect to this topic, we are not going to 
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replicate the IARC evaluations. You know, the 

IARC evaluation process is transparent and 

stellar, and so I think, only to the specifics of 

how any recommended 2A carcinogen, it needs to be 

accommodated within the SEM, that could be 

justified.

But I don't think replicating the 

underlying, you know, even summarizing the 

underlying science behind the status of the 2A is 

necessary.

MEMBER REDLICH: Well I was just sort 

of thinking in terms of --

CHAIR MARKOWITZ: No, I agree. I 

agree totally with the issue of duration. I 

wasn't actually disagreeing. I was making a 

separate comment.

MEMBER REDLICH: So, and then also if 

it's, if yes, it may be a strong carcinogen, but 

was it in a setting that would be the type of 

setting that we would expect, you know, so that 

other piece.

You know, obviously there are lots of 
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exposure settings, but at least to try and get a 

sense -- I mean, because sometimes we have a 

literature that's based on more historic 

exposures or the like. So I think, just that 

additional piece would be helpful.

CHAIR MARKOWITZ: Sure. By the way, 

let me add something. It just occurs -- I think 

this is relevant, I think, to all these efforts. 

I think, if we can, we should circulate, two 

weeks before the full Board date, circulate the 

proposed document, so that people have time to 

take a look at it, and if it's relevant, possibly 

some of the key articles, so that we're not doing 

what we did this time with the Parkinson's. With 

two weeks' notice, we should be able to 

accommodate that.

MEMBER SILVER: This is Ken Silver. 

Steve, you brought up the excellent issue 

yesterday of the tumor site specificity of 

certain 2A chemicals. It's definitive evidence 

in animals, but does that really lead us to 

identifying the organ site likely to be affected 
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in humans, if I'm characterizing your question 

correctly.

CHAIR MARKOWITZ: Yes, yes, 

absolutely. Yes.

MEMBER SILVER: Yes.

CHAIR MARKOWITZ: Okay. Anything else 

on the SEM working group? And of course, any 

progress on the NTP reasonably anticipated to be 

a human carcinogen would be appreciated, but you 

may -- your workload may be full.

The asbestos job titles, so this is 

something that I think Ron and John and I will 

continue.

Was there -- Duronda, were you also on 

this group?

MEMBER DOMINA: Hey, this is Kirk. I 

think I'm on that group.

CHAIR MARKOWITZ: Oh, Kirk. Okay. 

good. Okay, okay.

So you could add Mr. Domina. Yes, 

thanks.

So we're just going to come up with 
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the documentation for the job titles that we 

think ought to be added.

The -- next is the board resources 

request. So, we have, a couple of times, 

requested resources for, to help with claims 

review or scientific background work. And we 

heard from the Department about the process and 

prospects.

And anyway, this Board's term ends, 

end of July. This is something that we need to 

address and hand off to the next Board. So, I 

think that we need a group to work up a statement 

of work, and the other elements, some of the 

other elements that were outlined to us.

Anyway, I would hope Mr. Vance will 

produce some interactions -- proceed with 

interactions in the next couple of months with 

the Department around this so we have a better 

understanding of what those elements are.

So, does anybody want to work on this? 

Besides me.

MEMBER SILVER: This is Ken. I really 
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want to see it happen, but from the description I 

heard yesterday of the requirements, I don't 

think I can make two phone calls without getting 

in trouble when it comes to government 

contracting rules. So I'd be happy to work with 

you on it, Steve.

CHAIR MARKOWITZ: Okay. So Kevin, if 

you could write on it, yes, if you could add 

myself and Dr. Silver. And so the coordinators 

will be there for certain. If anybody else wants 

to volunteer, if not, we can come back to it.

So, claims review, Mr. Vance, do you 

have any sense of when we might be getting 

claims? I'll give you a second. I just discussed 

it with the program, and clarified certain things 

a couple of weeks ago.

MR. VANCE: I can't give you a 

specific date, but I know that we are working on 

it. So we've got to get the -- you know, we got 

to get the extraction report, then we got to get 

the population and then the sample selected, and 

then we'll get the cases to you. But I don't 
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have a specific time frame, but we're working on 

it right now.

CHAIR MARKOWITZ: So, when these 

claims are ready, what we need to do -- and 

they're two separate lots. We need to figure out 

who is going to review which claims. We could 

use the evaluation form previously.

These are very -- as opposed to the 

previous reviewed claims, these are much more 

targeted. The lung cancer claims are all people 

who've been denied, who have essentially 

construction job titles. And they have a latency 

of at least 15 years. So they are high-suspect 

for having occupational lung cancer. And yet 

they were denied, and so we could, you know, see 

the details and figure out what's going on.

The post '95 claims are, we've 

requested ten and, you know, it's really focused 

on how the industrial hygiene assessment does the 

exposure.

Okay. If you could scroll up. Okay, 

that's good. Oh, please go back right there.
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MEMBER SILVER: This is Ken. I'm 

eager to sink my teeth into a few of those post 

'95 claims. Frankly, it seems like trying to 

coordinate it is an invitation to a very 

stressful experience. We've had claims that were 

passed at the last minute. So when they come in, 

count me in on looking at some of the post '95 

claims, but -- because I'll have time in late May 

and June.

CHAIR MARKOWITZ: Okay. Thanks.

So if you could write in Dr. Silver, 

post '95.

MEMBER DOMINA: This is Kirk Domina.

CHAIR MARKOWITZ: By the way, you 

know, if we -- yes, go ahead.

MEMBER DOMINA: I'll do that and I'm 

happy to help with lung cancer.

CHAIR MARKOWITZ: The lung cancer? 

Okay.

MEMBER DOMINA: Yes. Thank you.

MEMBER REDLICH: And I could look at a 

few of those too. It's Carrie Redlich.
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CHAIR MARKOWITZ: Okay. Okay. All 

right. And we can put my -- now it's safe to put 

my name down.

MEMBER REDLICH: I was just going to 

say, Steven --

CHAIR MARKOWITZ: The -- now, 

depending on when we get these, it's possible or 

likely that we're not going to finish this work 

by mid-July. So the goal then would be to hand 

off something to the next Board. But I think 

that, you know, having made this request and 

planned it out, and if we can make some progress, 

and then leave it in a reasonable state, then the 

work of the Board will be, you know, won't be 

interrupted.

The CMC and industrial hygiene 

assessment, so this is really just a discussion. 

We are really just tossing around, and we did 

today, a little bit more reasonably, maybe, 

around how this should -- how the Board should 

weigh in on this.

And I want to be involved with this 
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discussion, so you can write my name down. And 

I'm sure there's some others who also want to be 

involved with this discussion.

MEMBER MAHS: This is Ron. I'd like 

to be involved.

CHAIR MARKOWITZ: Let's add Mr. Mahs.

MEMBER DEMENT: This is John. I'd 

like to be involved with that.

MEMBER POPE: Duronda, I'd like to be 

involved.

CHAIR MARKOWITZ: Okay. By the way, 

we're open to people who have second thoughts and 

want to add their names. Now, we're not open to 

people who have second thoughts and want to 

subtract their names.

The next is keep developing a way for 

the Board to assess, weigh in on, and move on the 

policy changes. It may be that we actually don't 

need a separate group. It may be something that 

we can just discuss together, in June, and just 

devise, you know, a method.

You know, if there's someone who wants 
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to sketch out something, fine. Otherwise, it's 

here. We'll keep it on the radar. And we can 

just defer this to the end of June board meeting, 

and discuss it then.

Okay. So if you could write down, for 

the, instead of coordinators, you can write, 

deferred to full board meeting. Okay.

And then the final is, the DOL request 

for us to look at the development of and outreach 

materials to physicians and other providers, to 

try to enlist higher levels of compliance or to 

see things from those providers.

So this is really, consists of looking 

over the materials sent to us, that will be sent

to us, and brainstorming about ways in which the 

process might be improved. I'm not convinced 

that we'll be able to come up with a great 

invention here. But the Department has asked, 

and this really was a thing, a little bit the 

discussion that counts.

We could try to do this in some sort 

of working group, or defer it to the full board 
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meeting, or depending on what they look like, 

when they come in, we could just decide hey, 

we're going to spend a little bit of time at the 

next board meeting, and then, whatever ideas that 

people want to share.

What's your thinking? Anybody have 

any thinking or feeling about this?

(No audible response.)

CHAIR MARKOWITZ: Okay. So what we'll 

do is hold this, defer this to the full board 

meeting, and we'll see what the materials look 

like.

MR. VANCE: Yes. Dr. Markowitz? This 

is John Vance. I can give you a quick primer of 

what you're going to see. It's going to be a 

series of Department letters, usually about one 

or two pages long, and they're just going to be, 

you know, the standard kind of thing, engagement 

that we try to have in writing with physicians.

So, what we'd be looking for is just 

when it talks about, is it too much, too little, 

or ways to improve our written communications. 
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Just to give a sense of what it's looking like, 

that's what I was telling you the other day.

CHAIR MARKOWITZ: Okay. All right. 

Thanks. That helped. I mean, well that's 

certainly something that we can do at the next 

full board meeting. Okay. All right. Look at 

that in preparation, and share ideas. So I'm not 

sure that we need to do much before then. So 

thank you for that.

Okay. If we could just go up a little 

bit, and people can take a look at the work. And 

if anybody wants to add their name anywhere, at 

this moment, you're welcome to.

Carrie Rhoads will also circulate 

this, in the next couple of days. And if anybody 

wants to add their names at that point, you'd be 

welcome as well.

MEMBER SILVER: Has George left the 

call?

MEMBER FRIEDMAN-JIMENEZ: So, he seems 

to --

(Simultaneous speaking.)
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MEMBER SILVER: So, is F of interest 

to you?

MEMBER FRIEDMAN-JIMENEZ: Yes, it is. 

I mean, I made a proposal, and I think the 

response from Drs. Redlich and yourself are 

compelling, and we should come up with a 

recommendation. I'm happy to work with you.

Right now, with this COVID-19 thing, I 

am so over-extended, I hesitate to sign up for a 

third committee, but I'm happy to work with you.

MEMBER SILVER: No, no. I just 

thought I saw an omission on your F, but point 

taken. You're in New York. You're a pro. We'll 

see at the next piece.

CHAIR MARKOWITZ: Well, okay. Any 

other comments about this?

(No audible response.)

CHAIR MARKOWITZ: Okay. In that case, 

I don't have anything else on the agenda, or on 

my mind, that we need to discuss. Before we 

close the meeting, does anybody else have any 

issues they want to raise?
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MEMBER SILVER: Oh, this is Ken again. 

When we were discussing the occupational health 

questionnaire and the worksheet or work -- I 

think it would be advisable to get the Ombudsman 

involved in the pilot of the OHQ and the 

worksheet, just because they, you know, have this 

massive docket of all the problems that occurred 

in the program over the years, and they know the 

claimant community pretty well.

So I think their perspective would be 

very valuable in piloting and rolling out the new 

approach to the OHQ. So that's just a 

recommendation to the program.

CHAIR MARKOWITZ: So, yes. That's 

excellent. And what we'll do is we'll put that 

in the rationale when we -- the rationale is 

going to be short, because we're not really 

recommending much, by way of change, but we'll 

certainly add that to the rationale.

MEMBER FRIEDMAN-JIMENEZ: Hello? This 

is George. I have one other suggestion to add to 

Item H, the provider outreach. Given the COVID-
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19 move to virtually complete televisit format 

for our medical visits, in general, maybe we 

should discuss televisits as a part of the 

provider outreach, that would make possible the 

use of the pretty limited number of occupational 

medicine physicians in the country, more 

flexibly, to be involved with these cases, not 

just after the fact but as actual trained 

physicians in the beginning of the case.

CHAIR MARKOWITZ: So, Mr. Vance, can 

you just say this about the telemedicine and the 

compensation process?

MR. VANCE: Yes, sure. The Department 

of Labor did issue an expanded use of telework, 

or I'm sorry, telemedicine the other week. And 

it's actually up on our website, if you want to 

take a look at it. And it's basically allowing 

for telemedicine appointments to occur under very 

specific circumstances and applying a very 

specific criteria that will allow it, principally 

based on whether a physician is permitted to do 

it, based on, you know, state law or licensing 
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regulations, and also whether or not they even 

want to try to do it.

So the address is up on our website. 

There is a -- there's a highlight to it on our 

website. And I know that the Department is 

working on additional flexibilities because of 

the feedback that we're getting in conjunction 

the pandemic need to, you know, have more 

telemedicine kinds of flexibilities.

So we have something out there, and 

we'll continue to work on it.

MEMBER FRIEDMAN-JIMENEZ: Great. 

Thanks. We'll look at the, what you have.

CHAIRPERSON HILL: Okay. I think then 

that may close our meeting today. I want to 

thank, you know, the many people involved in one 

of two ways. I want to thank members of the 

public, who patiently sat in with us, and 

hopefully looked at the screen and were able to 

find our materials.

I want to thank Greg Lewis for hanging 

in there with us, Malcolm Nelson and Amanda 
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Fallon also, for being part of this board 

meeting. And of course, the Department of Labor, 

providing updates, and also Mr. Vance for, you 

know, answering questions on the spot, very 

helpful.

And I thank Carrie Rhoads and Michael 

Chance, our DFO and associate DFO. And finally, 

the board members, for being here, you know, 

almost all of this, both days, taking a break 

from COVID and the, both the work and anxiety 

that's prevalent. And we will get this work done, 

and I can close out this meeting of the Board on 

a very positive note.

Mr. Chance, do you have something you 

need to say?

MR. CHANCE: No. Thank you very much, 

Dr. Markowitz. That was a good summary. I 

wanted to wish all of the healthcare 

professionals the best of luck out there. I know 

you all are very busy doing important things. So 

be safe, and good luck. But otherwise, we'll be 

in touch.
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I think, Dr. Markowitz, Carrie and I 

wanted to talk to you later. I'm trying to find 

a time to do that. Maybe we'll send you a 

meeting notice here shortly.

CHAIR MARKOWITZ: Okay.

MR. CHANCE: Okay. Thank you so much, 

everybody. Bye-bye.

CHAIR MARKOWITZ: Okay. Thank you. 

And Kevin, thank you. Thank you, Kevin.

(Whereupon, the above-entitled matter 

went off the record at 1:45 p.m.)