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DEPARTMENT OF LABOR

+ + + + +

ADVISORY BOARD ON TOXIC SUBSTANCES 

AND WORKER HEALTH

+ + + + +

MEETING

+ + + + +

MONDAY

NOVEMBER 8, 2021

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The Board met via Videoconference, at 

1:00 p.m. EST, Steven Markowitz, Chair, 

presiding.

MEMBERS

SCIENTIFIC COMMUNITY

AARON BOWMAN

MARK CATLIN

KENNETH Z. SILVER

MIKE VAN DYKE

MEDICAL COMMUNITY

GEORGE FRIEDMAN-JIMENEZ

ROSE GOLDMAN

STEVEN MARKOWITZ

MAREK MIKULSKI
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CLAIMANT COMMUNITY 

JIM H. KEY

DURONDA M. POPE

CALIN TEBAY

DIANNE WHITTEN

DESIGNATED FEDERAL OFFICIAL

MICHAEL CHANCE

ALSO PRESENT

KEVIN BIRD, SIDEM

RACHEL POND, DOL

CARRIE RHOADS, DOL

JOHN VANCE, DOL
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C-O-N-T-E-N-T-S

Welcome:

Michael Chance, Board DFO .............. 4

Dr. Steven Markowitz, Board Chair ..... 10

Introductions:

Dr. Steven Markowitz, Board Chair ..... 12

Review of Agenda:

Dr. Steven Markowitz, Board Members ... 16

DEEOIC Updates:

Program Highlights .................... 21

Rachel Pond, DEEOIC Director

Information Items since April 2021.......... 33

John Vance, Policy Branch Chief

Review of ABTSWH Charter and MBP

Renewed June 2021 ..................... 62

Dr. Steven Markowitz

DOL Response to April 2021 Board 

Recommendations;

Aldrin/Dieldrin............................. 86

Dr. Steven Markowitz

Review of SEM Generic Profiles.............. 86

Dr. Steven Markowitz

DOL Responses to Board Information Requests:

IH/CMC and Public Comment................. 113

Public Comment period...................... 155
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P-R-O-C-E-E-D-I-N-G-S

1:03 p.m.

MR. CHANCE: Thank you. Before I 

begin, I want to confirm that you can hear me.

CHAIR MARKOWITZ: Yes.

MS. POND: We can hear you.

MR. CHANCE: Okay. All right, 

because I need to read through my script. Okay, 

thank you.

Good afternoon, or morning, depending 

on where you are everyone. Today is November 

8th, 2021. And welcome to Day 1 of the 

teleconference meeting of the Department of 

Labor's Advisory Board on Toxic Substances and 

Worker Health. My name is Michael Chance, and 

I'm the Board's Designated Federal Officer, or 

DFO.

We appreciate the Board Member's 

participation in this meeting today. We are 

scheduled to meet today from 1:00 p.m. Eastern 

time to 5:00 p.m. Eastern time. And today there 

will be a public comment period. I believe 
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commencing around 4:15.

Today, this meeting is completely 

virtual, as a precaution against the COVID-19 

pandemic. I hope everyone is staying safe out 

there, taking the proper precautions as this 

format is designed to ensure.

On my team, as the DFO, I'm joined 

virtually by Ms. Carrie Rhoads from the 

Department of Labor, and Mr. Kevin Bird from 

SIDEM, our contractor.

A few notes regarding meeting 

operations, timing, there's an agenda to the 

meeting that has been posted. We will break as 

needed throughout the day, as proceedings can be 

lengthy. And so, please consult the agenda and 

generally, Dr. Markowitz does a nice job of 

keeping that moving.

Copies of all meeting materials and 

any written public comments are or will be 

available on the Board's website through the 

heading, meetings. And the listing there for 

this, for any subcommittee meetings.
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The documents will also be up on the 

Webex screen, so everyone can follow along with 

the discussion. So, please log in order to see 

that. You can enter the Board webpage for 

additional information, where after clicking on 

today's meeting date, you'll see a page 

dedicated entirely to today's meeting.

The webpage contains publicly 

available materials submitted to us in advance 

of the meeting. We will publish any materials 

that are provided to the subcommittee. There you 

will also find today's agenda, as I mentioned, 

as well as instructions for participating 

remotely.

If you are having a problem, please 

email us at EnergyAdvisoryBoard@DOL.gov. If 

you're joining by Webex, please note that the 

session is for viewing only, and will not be 

interactive. I think this was mentioned before, 

but it's important to note that phones will be 

muted for non-Advisory Board Members.

For those of us who are on the 
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speaking group, make sure to mute yourself in 

and out as needed. If you are running into any 

kind of problems, you may contact Ms. Rhoads or 

Mr. Bird at both systems throughout the meeting.

A few notes on the minutes and the 

transcription, a transcript and minutes will be 

prepared from today's meeting. During Board 

discussions today, as we are on a teleconference 

line, please speak clearly enough for the 

transcriber to understand.

When you begin speaking, especially 

at the start of the meeting, please try to 

remember to state your name, so we can get an 

accurate record of the discussion, and who was 

participating.

Also, they've asked our transcriber 

to please let us know if you are having trouble 

hearing anyone, or understanding anyone, and 

that is hampering the recording in any way.

As DFO, I see that the minutes are 

prepared, and ensure they are certified by the 

Chair. The minutes of today's meeting will be 
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available on the Board's website no later than 

90 calendar days from today per FACA regulation. 

But if available sooner, we will post them 

before that 90-day mark.

Also, although formal minutes will be 

prepared, we'll also be publishing verbatim 

transcripts, which are obviously more detailed 

in nature. Those transcripts should be available 

on the Board's website within 30 days.

I'd also like to remind Advisory 

Board Members that there are some materials that 

have been provided to you in your capacity as a 

Special Government Employee and Members of the 

Board, which are not for public disclosure, and 

cannot be shared or discussed publicly, 

including in this meeting. Please, be aware of 

this as we continue with the meeting today.

And it's important to remember these 

materials can be discussed in a general way, 

which would not include any personal identified 

information, PII, such as names, addresses, 

specific facilities, if a case is being 
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discussed, or the use of a doctor's name 

specifically.

And finally, more germane to our 

times. I also want to note for everyone's 

information that the two-year terms of all of 

our Board Members will expire July 2022. And in 

the spring, OWCP will conduct another membership 

nomination process. Current Board Members wound 

be eligible for renomination as always. OWCP 

will announce that process sometime in the 

spring.

And as I mentioned, more germane to 

our times, I also want to remind that the Board 

Members who have not completed their financial 

disclosure forms, they're required. Please 

complete them as soon as possible.

And this is also true about COVID 

vaccine information. That is required of federal 

workers, including Special Government Employees, 

which all the Board Members are. If you've not 

submitted your COVID vaccination information, 

please submit it to us as soon as possible.
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So, I appreciate you bearing with me 

as I read all of that into the record. And with 

that, I now convene this meeting of the Advisory 

Board on Toxic Substances and Worker Health, and 

turn the opening of the discussion over to Dr. 

Steven Markowitz. Dr. Markowitz.

CHAIR MARKOWITZ: Yes, all right. 

Thank you, Mr. Chance. And I add to Mr. Chances' 

welcome to everybody, the Board Members.

Also, we have DOL OWCP leadership 

here, I see. Ms. Pond, Mr. Vance, and perhaps 

others by phone, although I don't see any Webex 

indication.

I want to welcome everybody. Welcome 

the members of the public who are participating. 

And I know Mr. Chance gave you the website, or 

where you could find some of the documents, both 

the agenda and some of the documents that we 

will be looking at today.

If for some reason, you aren't able 

to get into Webex, where we will be looking at

these documents, almost all of the documents are 
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also available on our website. So, you could, if 

you're looking at a screen, find the same 

documents that way. And I'll try to indicate 

which ones they are so you can find them.

Let's do -- I'm going to review the 

agenda in a few minutes, but let's do some 

introductions. Although, I would like to thank 

Kevin Bird, and whoever is assisting Mr. Bird 

today, and tomorrow, for your work in making all 

this happen. It's much appreciated.

So, introductions. What I'm going to 

do is I think I'll just call people's names. 

That'll be easiest. By the way, during this 

meeting, if you want to say something, if you 

look on the Webex, at the bottom right, you'll 

see an oval that says Participants.

And if you click on that, you'll see 

a list of the participants, and you'll see at 

the bottom right, there's a little hand. You can 

click on the hand to indicate that you want to 

speak. And then after you're done, if you 

wouldn't mind clicking the hand again, to lower 
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your hand. That would be helpful.

So, I will start, I'm Steven 

Markowitz. I'm and occupational medicine 

physician and epidemiologist at the City 

University of New York. I've been involved with 

the Board since 2016. And I run the largest 

former worker medical screening program, you 

know, for DOE workers. Dr. Bowman.

MEMBER BOWMAN: Yes, I'm Aaron 

Bowman, I am professor and head of the School of 

Health Sciences at Purdue University. I am also 

a toxicologist, and I do work related to 

environmental health as well. Thank you.

CHAIR MARKOWITZ: Mr. Tebay.

MR. TEBAY: Calin Tebay, Hanford 

Workforce Engagement Center. Beryllium health 

advocate site-wide, at Hanford.

CHAIR MARKOWITZ: Thank you, Ms. 

Whitten.

MS. WHITTEN: Good morning. This is 

Dianne Whitten. I'm the Hanford Atomic Metal 

Trades Council, Health Advocate and a member of 
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the IBEW, like Local 984.

CHAIR MARKOWITZ: Ms. Pope.

MEMBER POPE: Hello, my name is 

Duronda Pope. I am a retired Rocky Flats worker. 

Worked there 25 years. I am currently, United 

Steel Workers Director of the Emergency Response 

Team.

CHAIR MARKOWITZ: Dr. 

Friedman-Jimenez.

MEMBER FRIEDMAN-JIMENEZ: Hi. I'm 

George Friedman-Jimenez. I'm an occupational 

medicine physician, and an epidemiologist at

Bellevue NYU Occupational Medicine Clinic in New 

York City.

CHAIR MARKOWITZ: Dr. Silver.

MEMBER SILVER: Hi, Ken Sliver. I've 

spent the last couple of decades on the 

environmental health faculty at East Tennessee 

State University in the College of Public

Health, before that my dissertation work.

I was on historical emissions and 

exposures at DoD sites. A big focus on Los 
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Alamos National Laboratory and worked there 

closely with workers and families when the 

compensation initiative was kicked off by New 

Mexico's former Congressman, and Energy 

Secretary, Bill Richardson, and our friend, 

David Michaels.

CHAIR MARKOWITZ: Dr. Mikulski.

MEMBER MIKULSKI: Good afternoon, 

Marek Mikulski, I'm an occupational 

epidemiologist, and an adjunct faculty of the 

University of Iowa, Occupational and 

Environmental Health. I direct a former worker 

program for workers from two sites in Iowa.

CHAIR MARKOWITZ: And Mr. Catlin.

MEMBER CATLIN: Hello. I'm Mark 

Catlin. I'm an industrial hygienist. I retired 

in 2018 from, as Health and Safety Director for 

the Service Employees International Union. I'm 

now consulting part-time. Thanks.

CHAIR MARKOWITZ: And Dr. Goldman.

MEMBER GOLDMAN: Hi. I'm Rose 

Goldman. I'm an academic occupational 
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environmental medicine physician with a practice 

at Cambridge Health Alliance. And an academic 

appointment as associate professor at Harvard 

Medical School, and environmental health at 

Harvard T.H. Chan School of Public Health.

CHAIR MARKOWITZ: Okay, thank you. 

And then for the sake of the public, I just want 

to call on Ms. Pond and Mr. Vance to introduce 

yourselves. Although everybody knows who you 

are. Ms. Pond.

MS. POND: Hello everyone. I'm Rachel 

Pond. I'm the Director of the Energy Program at 

Department of Labor.

MR. VANCE: And good afternoon, 

everyone. My name is John Vance. I'm the Policy 

Branch Chief for the Energy Compensation 

Program.

CHAIR MARKOWITZ: Okay, great. Thank 

you. So, let me just --

MEMBER VAN DYKE: Mike Van Dyke, you 

forgot me, but that's all right.

CHAIR MARKOWITZ: You know --
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MEMBER VAN DYKE: Mike Van Dyke, 

associate professor University of Colorado.

CHAIR MARKOWITZ: Yes, thanks. You 

know, I don't see you on the list, the 

participant list. And so, I apologize for that. 

But I'm not, I'm concerned that I'm not seeing 

you, because then I don't know how I'm going to 

see you raise your hand to make a comment.

Is anybody else seeing Mike on the 

list?

MR. BIRD: Yes, just added. You 

should see him in a second here.

CHAIR MARKOWITZ: Oh, okay. Oh, yes, 

okay, okay. Well, yes, welcome.

Okay. So, let me go through the 

agenda. And if there are questions, comments or 

additions let me know. This meeting is going to 

be a little bit more of, I would say information 

exchange, report back, more of a brain stormings 

and planning session, than a vote on 

recommendations to the OWCP.

We're going to hear from the 
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Department of Labor on program highlights first, 

as we always do. I'm going to spend just a few 

minutes reviewing our charter, and the selection 

plan, because it was renewed since the last 

meeting. And actually, a few minutes will help 

remind us of the purpose of this Board.

We're going to discuss the 

department's responses to our recommendations 

from the last meeting, including a couple of 

questions that they, really clarifications that 

they requested from us. Having to do with 

aldrin, dieldrin and one on styrene.

And then after a break, we're going 

to look at generic profiles briefly. We have 

requested that we have the opportunity to look 

at these. They've been referred to and I'll 

explain more when we get to that point in the 

agenda.

And then in -- we're going to discuss 

department's responses to requests for 

information that were made by the two working 

groups that met over the summer, the Industrial 
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Hygienist Medical Working Group and also the 

Public Comment Working Group.

We don't really have or need report 

backs from those groups. What we have are 

questions that we submitted to the department, 

and we've received responses to those. And so, 

we'll discuss that. And then we'll have a public 

comment period.

Now, I can't recall, Mr. Chance, did 

you actually announce instructions for public 

commenters if they want to add their names to 

the public comment session?

MR. CHANCE: I admit it, Steven, I 

did not. And it might be better for Kevin or 

Carrie to take that.

MR. BIRD: Sure, absolutely. So, 

Carrie, correct me if I'm wrong. But I believe 

they should contact you at the moment, correct?

MS. RHOADS: That's right. The best 

way is to send an email to the Energy Advisory 

Board inbox. Let me know that you want to 

comment today during the public comment session. 
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There's also, there will also be a way to make 

yourself known during the public comment 

session, to our moderator. So, either way of 

those, either one of those we're fine.

CHAIR MARKOWITZ: So, Carrie, could 

you give them the email address if they want to 

email you?

MS. RHOADS: Yes, it's posted on the 

website as well.

It's EnergyAdvisoryBoard@DOL.gov.

CHAIR MARKOWITZ: Okay. And you said 

they could contact the moderator. How would they 

do that during the public comment period?

(Simultaneous speaking.)

MS. RHOADS: Uh --

MR. BIRD: Dr. Markowitz.

CHAIR MARKOWITZ: Yes.

MR. BIRD: Yes, I think we will push 

people to contact Carrie with that email address 

ahead of time, but once we get to the public 

comment period, if there's a last-minute 

request, you would notify the moderator by 
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pressing *1. But we, I think, would like to try 

to get as many of these noted, ahead of time so 

that we can plan everything out.

CHAIR MARKOWITZ: Okay, great. And 

then, so just to continue on. The agenda 

actually, and if you could, Kevin, go to Page 2 

on the agenda, Day 2. So, we're, yes.

So, we're going to review the Board's 

request for resources from the department in 

order to do our work more effectively. And part 

of that request is to get some help with 

reviewing claims.

So, I thought it would be a good time 

for us to begin to talk about what kind of 

information we would want to get from claims. 

And actually, I realize that some Board Members 

have looked at some claims, others have not. And 

we should do some consideration to actually 

requesting a limited number of claims between 

now and the spring, so that we can approach 

claim review with a little bit more knowledge.

And then we'll talk about, brainstorm 
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really, we'll look at the kind of data that 

department posts in the public reading room, 

which is ample. But think through whether there 

are other indicators or other data that the 

Board might want to take a look at?

I don't know that we're going to come 

to any conclusions at this meeting, but I 

thought it would be a good thing to kick off 

that discussion. And then if you could scroll up 

a little bit, Kevin? We have whatever new 

business arises during the meeting. And then 

we'll do a little bit of planning for the next 

meeting.

And that's about it. Any questions, 

comments or additions?

Okay. And by the way, if I, I don't 

always look at the participant list in terms of 

hand raising, so if you want to say something, 

just unmute yourself and break in. That's just 

fine.

Okay. So, let me turn it over to Ms. 

Pond and Mr. Vance for program highlights, 
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updates regarding the overall compensation 

program.

MS. POND: Great. Thank you, Dr. 

Markowitz. This is Rachel Pond. I'm going to run 

through some overall program updates. Just kind 

of what we've been up to in the last year. And 

then I'm going to turn it over to John to go 

into a little bit more detail about some of the 

policy changes we've had, and procedure matter 

updates.

I just do want to first thank you all 

for being here. I know that this takes time out 

of your days and your, the overall projects that 

you're all working on. And so, I appreciate the 

time and effort that you put in to the 

recommendations that you make and the actual 

meetings that you attend biannually. So, thank 

you for that.

So, I'm just going to start with, I 

wanted to talk a little bit about our quality 

review process. I think I've mentioned this in 

prior meetings. But I wanted to kind of talk 
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about the fact that this year, we've gone, we're 

going into a little bit more detail.

We set some quality review processes 

up in place prior to this year, in 2021. And 

this year we've been following up even more to 

make sure that we are reviewing everything that 

we can.

So, there are four different ways 

that we review our work. The first is, and this 

is the newest way that we've been doing this, 

and that is we have a branch, from a standard 

branch, made up of analysts to review work on an 

ongoing basis.

Meaning, they'll review cases every 

-- throughout the year. And they'll just like 

two weeks after something's been done and 

action's been taken on a case, they'll review 

it. And then they do these quarterly reports.

So, while they're reviewing the case, 

they're going to be looking for multiple 

different kinds of things for each section of 

the work that we do. So, we have the work of our 
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claim examiners, which includes development and 

recommended decisions. Then we have the work of 

our final adjudication branch. They do the final 

decisions. And then we have the work of our 

medical benefits examiners, who do the employee 

medical benefits and home health care.

So, what they're going to be looking 

at when they do this sampling, is they look at 

the various stages of development. They look for 

quality. And then at each quarter, this branch 

will provide a quarterly report to the 

management of the programs to kind of say, 

here's what our recommendations are, here's what 

we found.

The supervisors can also look 

throughout the year at the spreadsheet that's 

put in this particular system that we recently 

created. That they can kind of check and see 

what kinds of mistakes they're making on a 

regular basis.

And then there's a whole presentation 

of this report with the managers of each of 
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these different sections. And there's a feedback 

loop, for here's what we think, here's what the 

recommendations are.

And a lot of times those 

recommendations are training, individual case 

reviews as appropriate, and any changes that 

they think should happen in policy, based on the 

reviews that they're undertaking. We found this 

to be very helpful in managing our work 

throughout the year.

We also in the last couple of years, 

we started a more robust sampling process. Our 

supervisors throughout the country, review a 

sample every single month of every claim the 

examiners work. And that again is for the 

offices, our final adjudication branch, and our 

medical benefits examiners.

These samples, when they meet with 

the claimants, or I'm sorry, the employee, they 

will kind of go over, here's what we found this 

month and talk through that feedback with the 

employee. That process and the items that they 
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review is the development, decisions, payments, 

coding, all those sorts of things.

We also review, our supervisors 

review about 10 percent of our recommended and 

final decisions before they're issued. So, we 

can catch errors before those decisions go out 

the door. And then we, this year we did 

eliminate the accountability review. We used to 

do accountability review every year on a variety 

of different subjects.

But that was eliminated because of 

the fact that we're doing this ongoing quality 

quarterly review, except for the payment 

process. We continue to do the accountability 

review for the payments, to make sure that those 

are being processed properly.

The next thing I just to briefly 

touch on, is this last year we eliminated, 

totally, all of our paper files. We had started 

that process and made significant progress in 

2020. In 2021, we finally finished all of the 

paper files. We are completely digital now, 
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which has allowed for us to have greater 

telework capabilities.

We've been able, we're working on 

eliminating some space in the federal buildings. 

And just moving space around because of the fact 

that we will be able to telework greater, more 

so in, even when things turn to normal, and 

federal offices are open. Our OWCP has been able 

to show that we can telework successfully. And 

so, part of that is this elimination of paper 

case files.

I also wanted to, I'm really excited 

that we have started the process of providing 

electronic case files to claimants. In 2021, at 

the very end we were able to finalize allowing 

employees claimants, meaning it has to be a 

living employee, can have access to their case 

file, electronically.

Instead of having us go through and 

copy all the case files, we are going to be able 

to allow these individuals to go into a 

multifactor authentication process, to look at 
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their case files. That is something that, one of 

the things the Board had recommended, so I'm 

really excited that we're starting that process.

Now, we will continue that throughout 

this year and next year to make it so that 

authorized representatives will be able to have 

that access through this same multifactor 

authentication process. And then we're going to 

move to sole survivors, and they will be able to 

access the case files also. That's a little bit 

more complicated just because of privacy 

concerns.

And looking at other claim survivors 

in a case file, we have to make sure that we're 

restricting it to only the survivor who filed 

the claim. So, that's going to be a little bit 

more complicated. And we're hoping to have that, 

that piece of it for at least sole survivors by 

the end of the fiscal year.

Outreach has been a challenge this 

year, and past because of the pandemic. We have 

not been able to go out and do in person 
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outreach. So, we've been modifying basically 

what we do, to at least try to reach out to who 

we can. And that is based a mailing list that we 

actually started creating a couple years ago.

People can sign up to get policy 

updates or, I think, on medical benefits. And 

when people sign up for that, they will see and 

get an invitation to, well basically our website 

will let them sign up for any, for the outreach 

that we're doing. All of our outreach events are 

on our website, posted on our website. Anybody 

in the public can attend them.

We've been doing virtual since the 

beginning of the pandemic pretty much. We've 

been doing about one session a month. We 

actually found that we're getting about 150 to 

200 plus people attending these virtual events. 

So, that's a good thing. They're mostly events 

that will just talk about different pieces of 

the process, the adjudication process.

And within the department we've also 

worked with the Joint Network Taskforce Group. 
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And we've had the ombudsman from, our ombudsman 

at DOL, as well as the ombudsman from NIOSH. 

We've had the Resource Center speak. We've also 

had sessions on the Site Exposure Matrices. So, 

we're trying to change it up as much as we can.

Department of Energy did a session, 

NIOSH did a session. Just to kind of continue to 

inform the program -- the public, about what 

we're doing, what direction we're going. And 

even just to detail processes.

I am hoping, you know, when the world 

opens up a little bit more, I'm hoping that 

we'll be able to do some in-person outreach 

again. You know, the benefit of that is those 

who don't know about the program, that's where 

we try to reach out to them.

Go out to the areas where the DOE 

sites are and, you know, provide information 

about the program to people who are not aware of 

the program. So, we're hoping to get there when 

we can. When everything kind of gets a little 

bit, hopefully, back to normal.
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And then we've done a lot of employee 

training this year. You know, we've had some new 

staff, especially in our Medical Benefits 

Examination Units. We've added some factor five 

and some one factor in district offices just to 

handle all of the work that is going on with 

regard to medical benefits, consequential 

conditions, and just in general.

We, since we've had that additional 

staff, we've been making sure that our training 

opportunities are up to date. We've had virtual 

training also, mainly through what we call 

Learning Link, we've got a whole set of modules, 

that I know some of the Board Members have seen 

before, kind of going through the basics of how 

to do these claims. How to adjudicate them at 

all stages of the program.

And then we are also working on kind 

of more individual ongoing training for those 

who've been around in the program, but there's 

new topics. For example, this last summer, our 

Medical Health Science Unit did a training 
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session on exposures again, for different 

sessions throughout the different regions.

So, individuals could sign up for 

this training at different times throughout the 

week. And it was conducted, you know, kind of 

face to face. Well, if face to face can happen 

through Webex. Through, you know, other 

mechanisms like Microsoft Teams to kind of have 

actual conversations about, you know, exposures, 

and with them, and various other aspects of 

exposure analysis.

So, that was actually really well 

received. And we're hoping to do more that 

style. So, we'll have a little bit of virtual, 

or have a little bit of classroom kind of stuff, 

and even it's remote classroom training, coming 

up this year. Hopefully, to look at, you know, 

recommended and final decisions, those sources, 

just quality reviews. Maybe walking through case 

files, which we've found to be very successful 

in the past.

We also had a pretty extensive 
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training this year on customer service: how to 

answer phone calls, how to record those phone 

calls, you know, the proper way to talk to 

claimants and other stakeholders. So, we also 

had soft skills training, which included things 

like civility in the workplace, how to work 

through, you know, at home, various things that 

are kind of relevant to what employees are 

encountering on a regular basis.

So, that's just kind of the general 

overview. What I can do, is I can, if you have 

any questions for me, or what I was thinking 

actually, is I'll just have John Vance go 

through his. And then if you have questions for 

either of us on the content of what we've just 

said, then we'll take them at that point, if 

that works for you, Dr. Markowitz?

CHAIR MARKOWITZ: Yes, that's fine. 

Thank you.

MS. POND: Okay. I will turn it over 

to John. Thank you all for your attention.

MR. VANCE: Well, thank you Rachel. 
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This is John Vance. I'm the Policy Branch Chief 

for the Energy Compensation Program. Good 

afternoon.

So, what I'll do, is I'm going to 

just run through some updates for the Board, 

regarding some of our policies and procedures. 

And also, I'll just go through some of the work 

that we've been doing in conjunction with the 

last set of recommendations from the Board.

But I do want to start off by just 

pointing out that with regard to the Webinars, 

that Rachel mentioned before, if anybody does 

have an interest in just seeing the past events. 

If you go to our upcoming events link on our 

website, there's actually a link that will take 

you to our outreach presentations.

It's not a recording of the 

presentations, but it's the material that was 

used. And again, we've been trying to keep up 

with that. And I think the next session of the 

Webinars will be reinstituted in January. So, 

we're taking a part and we'll start up again in 
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the beginning of the year.

So, let me get into, just giving an 

overview of some of the important updates from a

procedural standpoint, that I think the Board 

might be interested in. And I'm just going to 

start in with our bulletins that were issued in 

2021.

One of the first ones I'll mention, 

was a bulletin, 2104, which is actually a 

product of a recommendation of the Board, with 

regard to instructing our staff on how to handle 

and adjudicate cases for COVID-19, as a 

consequential illness. So, that was published 

and that has now been put into production. And 

that was a direct consequence of a Board 

recommendation.

We have two bulletins that were 

issued in 2021 that are, is continuing to extend 

allowances by the program for providers to 

utilize telemedicine for routine and home 

residential health care examinations and 

interactions with patients. And that's going to 
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continue through March of 2022. And then would 

be reevaluated around that time.

We also had a new Special Exposure 

Cohort Class that was designated by NIOSH, that 

we actually issued a circular for, Circular 

2103, put into production. A review of those 

cases potentially impacted by that Special 

Exposure Cohort Class, and that was instituted 

over the summer.

Our big update, from a procedural 

standpoint, was our publication of our staff 

procedure manual. Again, this is a document that 

is designed to provide instruction and guidance 

to our staff on how to adjudicate cases, that 

are presented under the act.

Version 5.1 was released for our 

staff in the late summer, early fall. And it 

provides substantial edit throughout our 

procedure manual. I'm just going to highlight 

big ticket items I think you might be interested

in. And I'm just going to run through my bullet 

points here.
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There were a ton of administrative 

updates and other technical issues that we have 

updated the procedure manual on. All of the 

chances that we report, as far as the 

administrative and technical, and actually any 

content changes in the procedure manual, are 

going to be reported out in a transmittal 

document.

Will be available for review on our 

website, if you view our policies and procedures 

section, and just go to the most recent addition 

of our procedure manual. You'll see a document 

that sort of will highlight and summarize all 

the changes in each addition.

So, this transmittal notified our 

staff about lots of little updates with regard 

to administrative changes. We also had updated 

two chapters throughout.

We did an update to reflect current 

credentialing for impairment raters. We added a 

reference to the allowance of a six-minute-walk 

test, in our impairment chapter. This was 
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specific to a Board recommendation. So that has 

now been incorporated into the staff procedure 

manual.

We also, had a rather substantial 

change to our instructions for Claims Examiners, 

and how they go about evaluating impairment 

ratings from physicians and CMCs. Clarified the 

weighing of evidence to support ratings that are 

submitted by physicians, and to ensure that 

those ratings conform to the explicit guidance 

in the AMA Guides, 5th edition.

The major changes that we had for 

this past publication, occurred to two chapters 

in the procedure manual, Chapter 28, our medical 

bill processing instructions, and also, Chapter 

28, our ancillary medical benefits chapter.

I'm not going to run through all of 

them, but the medical bill pay process chapter, 

you know, we had a lot of changes that updated 

guidance and provided new qualifications for our 

Medical Bill Processing Unit. How they engage 

with our staff. How they conduct oversight for 
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the medical bill processing systems. How they 

handle transaction coding and interact with our 

bill processing contractor.

So, very technical stuff, but very 

important instructions for how our Medical Bill 

Processing Unit functions to support bill 

processing.

For our ancillary medical benefits 

procedures, we provided really substantial 

updates to consolidation on how we go about 

developing medical evidence, and documentation 

of medical necessity for the various types of 

things that folks request in conjunction with 

their accepted work-related illnesses.

So, we really did try to simplify and 

clarify. So, we got rid of a lot of redundancy. 

We tried to incorporate clear instructions on 

how to handle different kinds of adjudication 

engagements over different kinds of services 

that folks request, such as durable medical 

equipment, ops unit equipment, all kinds of 

therapeutic services, massage therapy, speech 
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therapy, occupational therapy.

All of those things are now better 

communicated as far as how do you go about 

evaluating and weighing evidence to support 

those requests.

And then we have just an update to 

our payment processing chapter. We had a lot of

minor, I would say relatively minor change and 

clarifications about how we process payments and 

verify and validate payments to ensure that we 

have an accurate payment going out, in response 

to a decision that's been issued in a case. So, 

those are our main updates as far as our 

procedures are concerned.

Moving over to the recommendations 

from the Board. I've already touched on a few of 

these, but I'm just going to run through them 

relatively quickly here. So, there had been a 

recommendation of the Board to add a group of 

health effects based upon information from an 

organization that makes recommendations for the 

carcinogenicity of cancers.
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That is IARC. There was a 

recommendation from the Board to add a series of 

health-effect -- recommendations with regard to 

adding health-effect added to the Site Exposure 

Matrices. We agreed to do that. And that did

occur.

As Dr. Markowitz mentioned, we did 

have two items that are being returned to the 

Board for clarification. Because when we had, 

Paragon and DOL were engaging in how to make 

this change happen, we just had questions about 

some of the wording and terminology, and the 

science behind a couple of those recommendations 

on two of the cancer categories. So, I think, 

Dr. Markowitz has mentioned that he's going to 

be discussing that at a later time today.

There was a recommendation to add 

some wording with regard to IARC and the 

National Toxicology Program. There was a 

recommendation that we make it more clear, that 

we do accept those kinds of organizational 

input. And we did, we actually added language to 
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our Site Exposure Matrices webpage that 

specifically makes reference to both 

organizations, International Association for 

Research on Cancer, and National Toxicology 

Program and Health. Both referenced as sources

of health-effect data on our SEM webpage.

The recommendation with regard to 

just the continuing collaboration between the 

Board and DOL with regard to utilizing IARC and 

the National Toxicology Program. And the 

Department of Labor does agree that we will

continue to do that. And as updates are 

occurring, we will be, or evaluating that for 

updates to help perfect data that is 

communicated in the Site Exposure Matrices.

As I mentioned before, there had been 

a recommendation for adding a presumptive 

standard for the evaluation of COVID-19 as a 

consequential illness, to an accepted 

work-related illness. We did agree to that and 

we did issue a bulletin that has been published, 

and is available for our staff to implement.
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There was also a series of questions, 

I think it's two questions, that regarded, that 

were in regards to how the Department of Labor 

would evaluate job titles, and different kinds 

of exposure information. And the Board had 

recommended that we ask Paragon to evaluate 

changes based on the recommendations of the 

Board.

Department of Labor and Paragon did 

engage on that, and we have submitted feedback 

to the Board. There was no changes that we could 

make, but we did provide some feedback that I 

think will be a topic of discussion by the 

Board. And I've provided all of the feedback 

from Paragon to Dr. Markowitz.

That also includes a request for a 

generic profile data that had been requested by 

the Board. So, that is in the possession of Dr. 

Markowitz. And I think it's been shared with the 

group.

And then finally, I mentioned this 

earlier, we did make a change for our procedure 
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manual, identifying explicitly, that the 

six-minute walk test would be a viable method 

for calculating, or assisting in the calculation 

of impairments for respiratory disorders.

So, those are the main updates from 

the last set of recommendations. I just have one 

highlight here. That the addition of the IARC 

Group 2A, listed health effect data, will likely 

be updated as far as our next release of the 

public SEM, which will be occurring in November. 

It looks like that process begins November 16th. 

So, that become publicly available, but it has 

already been changed for the employee variation 

of the Site Exposure Matrices.

So, our internal staff are utilizing 

that, that new health-effect data. But it will 

be publicly available in the next public 

release, that should start, that process, on 

November 16th.

And those are the updates that I had 

for everyone.

MS. POND: Thanks, John, appreciate 
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it. And just if you have any questions let us 

know. Also, John or I, or both of us, will be 

here throughout the rest of today, and tomorrow, 

for any questions that you may have throughout 

the couple of days.

CHAIR MARKOWITZ: Okay, great, great. 

Thank you very much. So, any Members of the 

Board, have any comments or questions?

I don't see any hands, but I have a 

few. So, let me start off and maybe people will 

come up with some.

So, one comment on the digitization 

of the claims, materials and making it available 

to the claimants. That's a great thing, I know 

it's taken years, but that's the nature of that 

kind of work. So, it's great that you've gotten 

there.

MS. POND: Thank you.

CHAIR MARKOWITZ: It would be really 

interesting to see, to get some feedback from 

some claimants to see how much it's actually 

used. It may be easier when the authorized reps 
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come on board, but the ease of use, whether it's 

organized in a way that's understandable to 

people. And I don't know if there's a mechanism 

to get feedback from your customer, so to speak, 

but that would be a good thing to do at some 

point.

MS. POND: Yes, we just started it. 

So, I mean literally we, at the very end of 

September 30th it went live. So, we're still 

going to be working and doing some outreach. 

Make sure that people are aware of it. You know,

make sure that we're sending them communication 

about how to access it, and all of that.

So, it's going to be, you know, we're 

ramping it up now. This year should be the test. 

And we'll, we are doing a lot of, stakeholder 

engagement in terms of, we've done some surveys.

The last, we've actually done one 

survey over the summer, and we're working on 

another one. We've hired a couple of, our 

experienced individual, and we have a 

stakeholder's strategist now. And we hired those 
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two individuals last year.

So, they're really going to help us 

with some of that, obtaining feedback. We've got 

really good results from our, or at least we got 

a pretty substantial result of people responding 

to the last survey, which we sent out after they 

received, I believe it was a recommended 

decision.

Kind of saying, how was your 

communication? Please provide us with feedback. 

And then we were able to make phone calls to 

anybody who left their phone number and asked to 

be called. Our folks here in national office 

called them up and tried to get additional 

feedback.

So, we're really hoping with this new 

kind of more robust stakeholder engagement part 

of the national office, we're going to get some 

pretty real feedback from the employees, I mean 

the claimants and stakeholders from the program. 

So, we will keep you informed as we move forward 

with getting those kinds, that kind of feedback.
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CHAIR MARKOWITZ: Okay, great. So, 

the, you know, for a couple of Board meetings 

now, actually let me turn it over to Ms. Pope. 

She may have a follow-up question to that. Ms. 

Pope.

MEMBER POPE: Yes, I'm also pleased 

to hear about the electronic or digital 

capability for the claimants. I was curious as 

to, is this program, view only, or interactive?

MS. POND: Well, in terms of getting 

access to the case file, it's going to be view 

only. But what you can do, part of our process 

is, right now people can upload documents to 

their case files.

So, we have a system called the, 

Energy Document Portal where even -- we've been 

able to do this for a while, anybody associated 

with the claim, can upload documents. Then for 

the viewing the actual case files, you'll just 

have view only. As if you were receiving a copy 

of your case file.

We don't have the ability right now 
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to like have chats or anything in that system, 

but basically this provides you with the entire 

case file, so that you will be able to see it.

MEMBER POPE: Is that part of the 

plan? To be able to have a chat, so to speak?

MS. POND: I don't think we're there 

yet. I think right now, we're just --

(Simultaneous speaking.)

MEMBER POPE: Okay, I was just 

curious. I know it's in the beginning stages but 

it sounds great. Thank you.

MS. POND: All right, thank you.

CHAIR MARKOWITZ: I'm sorry, can you 

hear me now?

MS. POND: Yes.

MR. BIRD: Yes, we can.

CHAIR MARKOWITZ: Yes, okay, sorry. I 

got my mute mixed up. It's Steven.

So, a couple of Board meetings now 

actually, there's been discussion of the changes 

in the quality review organization process, 

tools et cetera. And I'm wondering if any of the 
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results of those, of that work are currently or 

could be made available to the Board?

Perhaps, on our public reading room 

page, so that we can look at some of that?

MS. POND: Yes, we're working on ways 

to organize it in such a fashion that it would 

be beneficial, or you guys could look at it. And 

I hope to have it, we should have something this 

quarter pulled together for how you can look at 

those results. At least for the quality reviews, 

the quarterly.

Obviously, we can't do that with the 

sampling, because that gets into individual 

employee's performance. But we can definitely 

provide you with some of that, in terms of the 

quarterly reports that we're doing.

CHAIR MARKOWITZ: And could you also 

make, and it's possible that you've done this in 

the past, but I don't recall. Can you make 

available the methodology that you're using for 

these quality review processes?

MS. POND: We can probably do that. 
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I'll need to, I'll talk to you about it.

CHAIR MARKOWITZ: Okay.

MS. POND: But we can, we have 

documents that kind of lays out how we do them. 

So, that probably shouldn't be a problem.

CHAIR MARKOWITZ: Okay, okay, great. 

So, you know, one of the Board's tasks is to 

look at, weigh in, help on the quality 

assessment of the industrial hygienist work, and 

the medical physician input into the claims 

process. So, is any of this quality review, 

modifications that you've made, have any of them 

addressed the issue of the industrial hygienist, 

or the physicians?

MS. POND: The quality review will 

look at the reports themselves and make sure 

they're in compliance with the processes. But 

we, that is not a part of the process where 

we're doing the actual reviews. We are still 

working, John and I working on a methodology, a 

different, a new methodology for reviewing the 

work of the CMC.
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You know, the work of the industrial 

hygienist, the contract -- every single report 

that's done by a contract medical, or a contract 

industrial hygienist, is reviewed by a federal 

employee, at least one. It might even be two. 

John, correct me if I'm wrong.

So, you know, given that they're 

reviewed already, so that process we're still 

kind of trying to figure out the best way to do 

that. But we will share it with you as soon as 

we come up with our methodology.

CHAIR MARKOWITZ: Okay, thank you. 

Mr. Vance, some of the pages on the transmittal, 

of the changes in the new version of the PM, 

related to impairment. And I'm just wondering if 

there's anything significant? Significant 

changes that the Board should know about with 

relation to whatever was changed on impairment.

I can't quite, couldn't quite tell 

what was different. But if you, if you know 

offhand, that would be helpful.

MR. VANCE: Yes, I have some. I'm 
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very familiar actually.

So, a few of the things that we did 

was the changes that were incorporated, were a 

consequence of some of the actual engagement we 

had with the Board before. Where we were asking 

about the conformity of ratings that are being 

presented to the department, that are 

interpretations of the AMA Guides.

So, in other words, you know, what 

should the department's role be in evaluating 

medical documentation and rationale that's being 

submitted in support of an impairment rating?

And, you know, this was a discussion 

we had had about the role of our medical 

directorate, and that sort of thing. And so, 

what the procedures now do, is make it very 

clear that the Department of Labor is going to 

evaluate impairment ratings based solely, or 

very explicitly on what is the words in the AMA 

Guides?

So, if there is something that is 

specifically communicated in the guide, saying 
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this is a requirement of the guide, that is how 

the examiner is to evaluate the sufficiency of 

an impairment rating. So, the instruction gives 

the Claims Examiner the ability to weigh 

information that's being submitted in support of 

an impairment rating.

It gives instructions for how that 

Claims Examiner is to do their comparative 

analysis between what the rating position is 

stating, the information in the case file that 

supports that rating, and then also the 

communication that's in the AMA Guides.

The update also made it very clear 

that this is not going to be something that we 

will engage with our internal physician. We are 

no longer referring to our medical director, as 

a medical director. We're calling that 

individual now, just a medical officer.

But that person, who will no longer 

have a role in our impairment process, if there 

would be development issues or concerns with the 

sufficiency of an impairment rating. We would 
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give the rating physician the opportunity to 

clarify if that was an option. And then if that 

does not overcome whatever defect presents in 

the case file, that would be a standard referral 

to a contract medical consultant. 

And so, the procedure is basically 

stipulating that our staff is really going to 

have to take a look at the words that are being 

presented by a rating physician to make sure

that it conforms to the explicit instruction and 

guidance from the AMA Guides.

And where it does not, and we've 

given that doctor the opportunity to, to clarify 

their opinion, we will refer the matter to a 

CMC. And then we'll be in a position to weigh 

those competing opinions to decide which carries 

the weight of medical evidence in determining 

the final outcome on an impairment rating.

CHAIR MARKOWITZ: Okay. Great, yes, 

that's very helpful actually. So, actually what 

you're describing sounds like it conforms with 

the routine process you used for --
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MR. VANCE: Yes.

CHAIR MARKOWITZ: -- sticking points, 

when the claims examiner encounters sticking 

points, what they do, where they get help.

MR. VANCE: Right, and that the 

preeminent reference is going to be the AMA 

Guides. Where the AMA Guides does not clearly 

provide guidance as to what it expects, then 

we're going to generally defer to the judgment 

of the rating physician.

CHAIR MARKOWITZ: Okay, great. By the 

way, I, this is Steven again. Have you had many 

COVID claims? I know we, you know, the Board 

discussed the criteria and made a 

recommendation, but I was just curious whether 

the extent to which COVID claims have come in. 

Do you have any sense?

MS. POND: Yes, some --

(Simultaneous speaking.)

MR. VANCE: I know that we -- well, I 

know that we've gotten sporadic cases. But I'm 

not sure, I don't have a count. But I've heard 
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of them coming through the process. I'm not sure 

if Rachel has additional updates on that.

MS. POND: Yes, actually I think 

we've only had like less than five. We really 

haven't had a lot that come through. Because 

they normally would just come through as 

consequential to other conditions. And it is, I 

guess, it's a little bit defining given the fact 

that, you know, we have so many lung conditions. 

But we haven't gotten a lot of claims for them 

yet.

MR. VANCE: I will say that of the 

ones that I know, that COVID-19 was a direct 

factor in individuals that passed away. So, that 

did play, that circular has, or bulletin has 

played a very large role in getting benefits out 

on those cases that it has affected.

CHAIR MARKOWITZ: Yes, okay. Thank 

you. So, to the Board Members, anybody else have 

any comments or questions?

Okay. Some of, a few of these issues 

may arise again when we go through our agenda 
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items. Let's move on then.

Kevin, we want to look at the 

charter. And while John brings it up, the 

language of the charter looked very familiar to 

me. So, let me ask Ms. Pond or Mr. Vance, were 

there any changes? Offhand do you know of any 

--

(Simultaneous speaking.)

MS. POND: This is Rachel. I think 

that's a question for Mike or Carrie.

MS. RHOADS: Yes, this is Carrie. 

There are only changes in, like the standard 

language that's required of all the charters. We 

didn't change any of terms that are specific to 

our Board.

CHAIR MARKOWITZ: That's fine.

MR. CHANCE: Yes, otherwise it's 

pretty, it is pretty much the way it was.

CHAIR MARKOWITZ: Okay. That's great. 

And Kevin, if you could scroll up, I just want 

to skim through this to highlight the important 

things to Board Members.
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MR. BIRD: And Dr. Markowitz, you 

have control. So, I have control over the page, 

but you have control over --

CHAIR MARKOWITZ: Oh, yes, okay.

MR. BIRD: -- where on the page you 

--

CHAIR MARKOWITZ: Okay, great.

MR. BIRD: -- you view.

CHAIR MARKOWITZ: Okay, great, 

perfect. Thank you.

So, yes, there's the preamble. The 

rationale for the entire program, actually. And 

then set out the five or so tasks that we have. 

The first, to look at the SEM and make 

recommendations. The second, medical guidance 

for claims examiners for claims within the 

program. Third, is an issue that we, that the 

Board addressed earlier on, earlier versions of 

the Board. The lung disease covered under Part 

B, less so in the last couple of years or so.

And Kevin, can I go to the second 

page, or -- I'll hold on. Something I need to 
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do?

MR. BIRD: Yes, you're able to do it, 

but if I do it, it helps keep everyone on the 

same page.

CHAIR MARKOWITZ: Oh, so okay. And 

then we need to provide advice on quality, 

objectivity, and consistency of the work of 

industrial hygienists, physicians.

And then a task that was added more 

recently, although not in the past six months, 

that we get to provide advice on the claims 

adjudication process generally, including 

reviewing procedure manual changes prior to 

incorporation, and then additional matters that 

the Secretary of Labor deems to be appropriate.

Support that the OWCP provides, 

administrative support to us under FACA. The 

operating cost, 2.5 person-years of staff 

support, DFO. Okay, let me see, next page.

Okay. Meet twice per year and 

otherwise as needed. And then there was some 

clarification, actually. This has to do with 
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membership, but we're going to go over a 

different document, which repeats the same 

things, actually.

And that we are Special Government 

Employees, high degree of independence is 

important to maintain trust. Offer opinions 

independently of the DOL compensation program. 

Two years terms -- oh, we form subcommittees and 

informal work groups that are governed by the, 

governed by FACA. And those entities have to 

report back to the entire Board, not directly to 

the Secretary.

Okay. So, that's it, unless there are 

any questions about any of these things. And 

Kevin, if you could just pull up the next 

document, the membership, which to me looks like 

a new document. But maybe I just hadn't seen it 

before. But it's worth taking a look at.

What it does actually, is just 

describes how the meeting should be composed, 

Membership Balance Plan. And here the basic idea 

is that there's a nice balance between the 
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claimant community, scientific community, 

medical community, and it just goes through our 

functions again.

The relative distribution balance. A 

total 12-15 members, and also considerations 

which are listed here, with relation to 

demography, ethnicity, geography, economic 

aspects and the like. And I think there is a 

Page 3. No, this is just the process for 

identifying candidates et cetera.

So, just wanted to remind you -- I 

don't know why it flipped back to Page 2, but 

here's Page 3 again. And we, okay --

Okay. Any questions or comments on 

this? Okay, fine. Let's move on then.

We're going to go to the, Kevin, you 

need to bring up DOL response to our Board 

recommendations. That should be on our, our page 

for this meeting.

MR. BIRD: Yes, sorry. Just pulling 

it up now.

CHAIR MARKOWITZ: Yes, that's fine, 
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that's fine.

MR. BIRD: You should be seeing it in 

a second here, just confirm it was the correct 

document.

CHAIR MARKOWITZ: Yes, and -- yes, 

June 29th. And Mr. Vance went over some of this, 

but I, I just wanted to, we should just together 

look at the responses from the department, and 

if there are any points of discussion, 

clarification.

But basically, we recommended that 

agents that qualified as 2A carcinogens under 

IARC, and for which there was some limited human 

epidemiological evidence, that those be included 

in the SEM. And that's been agreed to by the 

department.

And then we recommended that the SEM 

should specify that IARC and NTP evaluations 

have been used in updating the SEM links between 

exposure and disease. And that has been done. I 

mean, it's been explicitly stated, that that's 

been done.
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And then there's on, an annual basis, 

at least, that any new 2A carcinogens, or the 

equivalent in their NTP, should be evaluated and 

added to the SEM. And in case everybody doesn't 

know, actually the 2A carcinogen designation is 

IARC. NTP doesn't -- it has a text version of 

those. We, and the Board focused on the IARC 2As 

rather than the NTP per se. They're very 

similar, but just for clarification.

The next -- oh, and I see, I can 

operate the page here. Yes. So --

MR. BIRD: Sorry, just a head's up, 

that when you change the page, it doesn't change 

it for everybody. So, I'm happy to follow along 

with you, if you just want to prompt me.

CHAIR MARKOWITZ: Well, okay. Okay, 

yes, thanks for telling me. And so, the 

department agreed to continue regular 

collaboration with the Board on evaluating 

updated health-effect data from different 

scientific organizations including IARC and the 

NTP.
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Which suggests to me that -- and Ms. 

Pond or Mr. Vance can give me an interpretation. 

Is that an invitation for the Board to 

periodically look at these? Or do you think, 

are you going to do that in-house, and bring us 

your thinking about that?

MS. POND: John, do you want to 

address that?

MR. VANCE: I think the response is, 

that we would be happy if the Board could 

continue to make recommendations with regard to 

anything that it thinks is of scientific merit 

to evaluate. And that's exactly why we had gone 

to the Board requesting a look at this, the 

Group 2A from IARC. Because that was something 

that we felt that the Board was perfectly 

positioned to be able to look at, and make a 

recommendation on.

So, our in-house toxicologist and 

epidemiologist continue to look. But, you know, 

we're always looking for additional input from 

the Board on these health-effect connections.
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CHAIR MARKOWITZ: Okay, so, Ms. 

Rhoads, if you could just include that on an 

action list for this meeting. I think that, 

well, I would open that up to the Board for 

comment. It does look like sometime in 2022, the 

Board will hopefully have access to a contractor 

that could do some of that work.

Not thinking so much of that IARC and 

NTP, because I think those are, all that 

frequently updated, so there's not that much 

new. But if there were additional scientific 

organizations that were to be included, that 

would constitute some work.

But are there any Members of the 

Board that have any comments or observation 

about this.

MEMBER GOLDMAN: This is Rose 

Goldman. Can I comment or ask a question?

CHAIR MARKOWITZ: Sure.

MEMBER GOLDMAN: This seems like a 

huge expectation because I don't know if this 

just relates to cancer or the way it's written 
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or that the Board should take it upon itself to, 

sort of, be responsible for updating or calling 

attention to the Department of Labor, maybe some 

advances in any of the things they have.

So I mean, that's, sort of, an 

enormous expectation so I just wanted to 

clarify. Is this just on 2A that we're going to 

update people or on carcinogens or on all of the 

outcomes that are currently in the booklet?

MS. POND: So I'm not sure if that 

was a question for us or for Dr. Markowitz, but 

basically, you know, we do look at health 

effects on a regular basis. I mean, we don't 

have a, we don't have a research arm, though, to 

do a lot of research.

So that's why when Dr. Markowitz 

mentioned your contractor that you're hopefully 

going to get them to be able to help with some 

of that. You know, it really, it's, kind of, 

broad like you said, but you guys could maybe 

come up with certain particular conditions or 

types that you want to look at to help, you 
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know, kind of, narrow it down, you know, whether 

it's a particular lung disease or something like 

that.

And then, you know, we could work 

with you on whatever you guys come up with. 

Again, we do, we have a toxicologist. We have --

but that's about what we have. We don't have a 

series of scientists or positions that go 

through this because our mandate is really to 

adjudicate claims and, you know, as they come 

up.

So as John said, we would be looking 

toward whatever recommendations you guys might 

have, but it could be as narrow or as broad as, 

I guess, the Board would define it.

(Pause.)

MR. BIRD: Is anyone on mute maybe --

CHAIR MARKOWITZ: I'm sorry, was I 

just on mute? This is Steven.

MR. BIRD: Yes, you are.

CHAIR MARKOWITZ: Yeah, yeah, sorry. 

Yeah, I agree with Dr. Goldman that for us to 
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take on non-cancer outcomes would be an enormous 

task but, I mean, it is doable to look at 

selected things, for instance, when we looked at 

Parkinsonism.

And I think with having a contractor 

to help us that it will facilitate that. I 

think, you know, going, I mean, I'd like to hear 

other people's opinion. IARC and NTP don't 

really add that much new on an annual basis.

They don't change designations all 

that frequently of various agents. So I think 

that's something we probably could take on to 

assist, to advise the department. But if, you 

know, if other people differ please speak up but 

to go beyond IRC and NTP to some of the other 

consensus organization, driven organizations 

about carcinogens that that might be a bit much 

for us to take on.

MEMBER GOLDMAN: This is Rose again. 

But what about the non-carcinogenic effects? 

That's what I was also asking about. Who's 

looking to see if there's something new coming 
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up with one of the other things?

Do we wait for somebody who makes a 

claim or are we or is somebody supposed to be 

surveying the various exposures and that there 

are some new findings? I mean, how is that 

happening?

CHAIR MARKOWITZ: No, well, that's a 

question for the department that relates to 

whether Haz-Map is updated or whether the SEM's 

underlying effects, health effects data are 

updated.

MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez. I'd like to respond to 

that question that Rose just asked.

CHAIR MARKOWITZ: Yeah.

MEMBER FRIEDMAN-JIMENEZ: Yeah, IRC 

and the National Toxicology Program are expert 

review panels that include multidisciplinary 

experts, toxicologists, molecular mechanism 

experts, epidemiologists, biostatisticians, 

clinical positions.

And so the real advantage of using 
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IRC and NTP evaluations for carcinogens that you 

have this multidisciplinary review panel that 

weighs in on all of these disciplines together 

and discusses the interaction of them and comes 

up with a final conclusion. And there not too 

many diseases for which there exist these kind 

of expert review panel.

IRC doesn't do non-cancer outcomes. 

However, the National Toxicology Program does. 

While I was on their Board they started doing 

reproductive outcomes, neurological outcomes. So 

they have started using the same concept of a 

multidisciplinary review panel to branch out, so 

there is some possibility.

However, I'm not aware of another 

organization that has such a deep 

multidisciplinary expert panel for non-cancer 

outcomes. The NTP is the only one that I know of 

and it's not really very well systematized 

because there's so few. They can only do a few 

reviews in a year.

So I think there is some possibility 
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but I don't think there's going to be much that

you can find for non-cancer outcomes.

MS. POND: Yeah, this is Rachel. You 

know, that's our dilemma overall with this 

program is there just aren't -- there's not a 

lot of information out there that's been peerreviewed or there's a panel that, kind of, 

reviews in general these conditions.

And that's why we have to realize so 

often on those individual case files. We, you 

know, for each state Haz-Map we update the SEM 

when we get more information. You know, there 

are some contractor reviews. They are 

consistently and constantly reviewing DOE 

records but that's for exposure, causation or 

cause effects. That's become more of a 

challenge because, you know, there isn't this 

broad-based, you know, scientific community 

that's evaluating these sorts of conditions 

other than they do at -- Dr. Jimenez --

Friedman-Jimenez has mentioned.

So, you know, while we're happy to, 
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you know, work with you or, you know, help you 

guys hone-in on particular areas you might want 

to have a contractor look at once you have one, 

but that is the current dilemma.

CHAIR MARKOWITZ: This is Steven. Is 

Haz-Map updated and by, you know, the author and 

the National Library of Medicine contract with 

them? And are those updates integrated into the 

SEM?

MS. POND: When there are updates 

they are integrated into the SEM. It is not -- I 

don't think that there's as much work going into 

that right now, so we try to incorporate other 

reviews. Like, we have a series, a set of cases 

that goes to our toxicologist, a lot of times 

we'll do that through policy or sometimes we'll 

be able to add it to the SEM.

John, do you have any additional 

information on that?

MR. BIRD: No. I mean, the way Rachel 

is describing it is correct. You know, as we do 

have new information that becomes available 
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showing humanistic health effects, you know, 

that's something that we would review and update 

into the Site Exclusion Matrices, but those 

kinds of consensus viewpoints on established new 

humanistic health effects, you know, that takes 

a lot to get to that point.

And, you know, we have our 

epidemiologists and looking at these things, but 

again, it's like as I heard some comments before 

it's there's a lot out there.

And you could pick and choose 

whatever you want to take a look at but it's, 

and that's the challenge is that, you know, you 

could spend a lot of time looking at this 

information to decide whether it's going to be 

enough to trigger an update under the Site 

Exposure Matrices as a generalization of health 

effect.

And that's, sort of, the problem that 

we have. So I think the answer is, yes, we will 

update it when we have that kind of information 

become available, but again, it's few and far 
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between when we see that type of information 

that's actionable.

CHAIR MARKOWITZ: Yeah, this is 

Steven. Yeah, it's a problem in the field. And 

Dr. Friedman-Jimenez is right that, you know, 

it's really done routinely mainly for cancer and 

then, you know, sporadically for other, either 

other diseases or other systems. So it's a 

challenge.

Any other comments from Board members 

Okay, so Dr. Friedman-Jimenez --

MEMBER FRIEDMAN-JIMENEZ: This is 

George Friedman-Jimenez, one more comment. The 

legal profession does it by precedent. In other 

words, when they decide a case that's on the 

legal record and it's a precedent that other 

lawyers can look at later.

It's not very applicable to our 

situation because determining the causal 

relationship for an individual really requires 

understanding their exposure and every 

individual is going to be different for their 
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exposure.

The review of the literature may be 

similar unless new articles come out in between, 

but the actual process requires assessing the 

exposure to see if they had enough exposure for 

long enough, enough latency period, the timing 

was right, et cetera, to be able to call it a 

causal relationship.

So it's quite complicated and 

unfortunately I think a lot of these cases are 

still going to have to be decided either one-onone, case-by-case or as presumptions in groups 

based on years of exposure as we're doing with 

asbestos-related diseases.

MS. POND: That's right, so 

absolutely that is, you said that very well 

because that is the dilemma that we face and 

that's why we do have so many individual reviews 

by, you know, of the exposure of that individual 

person and then the review by the physician.

MR. BIRD: Dr. Markowitz, are you 

muted?
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CHAIR MARKOWITZ: Yeah, I'm sorry. 

Yeah, the -- I remember you brought Parkinson's 

disease to us and I assume that was because you 

had a fair number of claims and you were 

puzzling over what to do with it.

So I suspect, you know, you have 

aggregation of certain claims in the future on 

common outcomes that you were puzzled about that 

those will probably come to the Board.

And from the Board side, you know, if 

there are salient issues in occupational 

medicine where there are, you know, noncancer 

consensus on important illnesses, those kind of 

things we could, we could bring to the program, 

too, as something that should be updated.

It's not a substitute for, you know, 

routine updating of Haz-Map, but it is, it 

should help to keep the program more current.

Dr. Freidman-Jimenez, if you don't 

have a -- your hand's up so I can't tell if you 

-- another commenter or what.

Okay. So let's continue. The next 
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recommendation was about COVID as a 

consequential condition. The department accepted 

our recommendation. I just advanced the page 

there, Kevin, the six-minute walk test.

They accepted our recommendation 

around the six-minute walk test, so basically --

and that's the end of that letter. Basically 

they accepted all of our recommendations that 

were included, so that's good.

There were couple questions that had 

been brought to us and Kevin, there are two 

emails that I sent you or Carrie sent you 

earlier today. So let me just, while he brings 

them up, that this came out of the IRQA 

discussion.

One was around aldrin and dieldrin 

and the question has to do with aldrin as a 

metabolite. If I remember it correctly, aldrin 

is metabolized to dieldrin, okay.

So here's the query to us. At Line 3, 

the Board mentions two toxins when discussing 

breast cancer health effects. We're not sure 
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whether both toxins listed by the Board should 

be included, aldrin and dieldrin.

Both are listed in the SEM as 

occupational toxins but not, I take it not 

linked to breast cancer.

MEMBER GOLDMAN: Do you want me to 

answer that?

CHAIR MARKOWITZ: I'm sorry, unclear 

what we are to do about reference to dieldrin 

being a metabolite of aldrin. And so skipping 

down a few lines, the reference from the Board 

that connects dieldrin to breast cancer, the 

question is what toxin from an occupational 

exposure connects to breast cancer?

Is an occupational exposure to 

dieldrin the same as having the body produce it 

from aldrin uptake -- intake, excuse me.

And we are also not quite sure what 

the reference to inadequate evidence for aldrin 

means. So they didn't want to make any 

assumptions. They wanted -- they brought it back 

to us and then here it's in our table, the Table 
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1 that we included, the aldrin metabolite 

dieldrin, inadequate evidence for aldrin but 

limited evidence for dieldrin, cancer of the 

breast.

So are there comments from the Board 

members on this issue?

R: This is Rose as I'm speaking for 

our group, so the challenge here is that there 

was reasonable evidence. So the evidence depends 

on what studies you're doing and what's 

available.

So if IRC did the review there was 

enough evidence both, you know, they look at 

animal, human and mechanistic data for dieldrin 

being a carcinogen. And enough of the evidence 

pointing to an increased risk for human breast 

cancer.

Now, the problem with aldrin is there 

wasn't really as much human data. There was some 

animal data that it was a carcinogen so it was 

marked down as inadequate. It doesn't mean that 

it's not a carcinogen. It's just that there was 
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inadequate data.

However, they do make a point of 

knowing that anytime you have exposure to 

aldrin, you metabolize to create dieldrin. So 

then the issue then is if every time you get 

exposure to aldrin you basically have exposure 

to dieldrin.

So it just seemed that from a 

compensation point of view, if somebody had 

exposure to aldrin one could assume that they 

did have exposure to dieldrin. So that's why I 

think, and I'll also ask the other people on the 

2A committee, I think we were thinking that 

actually we would put forth both of them just 

because whenever you have aldrin exposure you're 

going to have dieldrin.

So I'll stop there and see if anybody 

else wants to comment.

CHAIR MARKOWITZ: Yeah, Dr. Bowman?

MEMBER BOWMAN: Yes, thank you. Let 

me put down my hand, too, so I don't leave it up 

accidentally. I would concur with Rose. In fact, 
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just taking from the IRC monograph on this, the 

statement that, quote, "However, since aldrin 

rapidly converts to dieldrin in the body, 

exposure to aldrin inevitably entails internal 

exposure to dieldrin."

I'm guessing part of the limited 

evidence in humans is the fact that it is 

converted so rapidly. So if you needed to secure 

doing an internal exposure assessment, you would 

never detect the aldrin because it's metabolized 

so rapidly.

So I would concur as a member of that 

subgroup as well that both should be included.

CHAIR MARKOWITZ: Are there other 

comments? This is Steven. I agree that what 

matters to the target tissue is what it's 

actually seeing, not what's ingested or absorbed 

through the skin but what actually makes it to 

the target tissue.

And if that's dieldrin and it's 

carcinogenic then there's no distinction 

actually, or not much distinction between having 
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dieldrin being absorbed into the body or 

ingested and it being converted from aldrin.

And there's another example. There's 

actually benzidine-based dyes. Benzidine causes 

bladder cancer. Dyes when ingested or absorbed 

are rapidly broken down to benzidine, which then 

causes bladder cancer.

So it's a well-known, kind of, a 

well-known mechanism.

So I think that, any other comments? 

Otherwise I think that should answer your 

question. But my question to Mr. Vance, does it?

MR. VANCE: I'm following along and 

all I can say is that remember that the Site 

Exposure Matrices, and I don't know the science 

and that's where I can be happy to say that. Our 

concern is that from an occupational exposure 

standpoint, so that means if you're encountering 

one of these toxins in an occupational setting, 

are we talking about both of these having the 

same health effect?

So whether you're, you know, exposed 
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to aldrin or dieldrin in an occupational setting 

are -- is that mechanism going to be triggering 

that breast cancer health effect? Because 

that's -- and that's people are confusing those 

with metabolite reference.

CHAIR MARKOWITZ: And the answer, I 

think I'm representing the answer, the answer is 

yes. So both aldrin and dieldrin separately 

should be linked to breast cancer in the SEM.

MS. POND: Right, so we can take that 

response and probably use the transcript 

discussion that you guys just had back to the 

contractor for their review. And that should --

I would imagine that that would clarify things.

MR. VANCE: Yes, I agree.

CHAIR MARKOWITZ: Okay, great. The 

next one, Kevin, is the other email regarding 

styrene. And so let me, if I remember the issue 

correctly, so styrene in our table, we -- oh, 

I'm sorry. Actually, yeah, this is fine.

So a proposed disease to be added to 

the SEM under styrene was lymphohematopoietic 
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malignancies. These are blood and lymph cancers.

And with relation to styrene they're 

not in the SEM or Haz-Map at present. And the 

question, I think, to us was are diseases 

limited to acute myelogenous leukemia and T-cell 

lymphoma or is the linkage broader than that?

And I think in the fourth column, the 

middle column is what we had submitted to the 

department, which is that the 

lymphohematopoietic malignancies were linked but 

the evidence was stronger, more consistent for 

acute myelogenous leukemia and T-cell lymphoma.

So the department is asking us 

whether a recommendation on disease titles and 

ICD-9, 10 diagnostic codes would apply.

Now, I'm not sure we're able to do 

that at this meeting because I failed to 

circulate this request in time, but the floor is 

open if people have thoughts or recollection 

from when you looked at styrene.

So I looked back at the report that 

we prepared that the working group, the 2A 
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working group, prepared and it was a very nice, 

kind of, summary report that didn't in and of 

itself go into, sort of, this level of detail. 

And so I couldn't find an answer from that 

report to this.

But there, I think there is some 

underlying review that that working group did 

when you looked at these studies. And so if 

there's time, if we -- if some people have a 

chance to look at this maybe we could revisit 

this tomorrow afternoon and see if we can 

provide an answer? Otherwise, you know, we can 

do it after the meeting and then get back, I 

think, to the department relatively quickly.

Any thoughts? Okay.

MR. VANCE: And I think that sounds 

fine to come back to that.

CHAIR MARKOWITZ: And when you get 

into lymphomas it's a complicated topic. So 

we'll see. Okay.

So let's move on. We actually are at 

-- we're supposed to be at break but let me just 
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continue with the generic profiles because this 

is not a long, this is not a long topic. Unless 

do people want to break now or do you want to 

spend 15 more minutes?

PARTICIPANT: Let's spend 15 more 

minutes.

CHAIR MARKOWITZ: Okay, good, so the 

majority rules. So the generic profiles, and 

Kevin, I think you have these and I think these 

were also on our meeting website. So these were

provided by, just to give you the history here, 

the Board and the department have gone back and 

forth on asbestos issues.

And the department's contractor, 

Paragon, had referred to in their response to 

the Board's recommendation they had referred to 

generic profiles. And we had never seen these 

going back to 2016.

And so we requested to take a look at 

these to see what they are and how they're used. 

And to me it looks like part of what goes into 

the SEM. So now these are, this is -- Mr. Vance, 
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this is an updated version, right?

MR. VANCE: Yeah, so there was a set 

that I had gotten over the summer and then when 

we were just checking with Paragon I got an 

updated submission from them, so I forwarded 

that to Carrie. So Carrie, I'm assuming that's 

the most up-to-date one?

MS. RHOADS: Yeah, this is -- this 

should be the most up-to-date one.

CHAIR MARKOWITZ: Yeah.

MR. VANCE: Okay.

MS. RHOADS: That's the update.

MR. VANCE: Yeah, so that should be 

up there.

CHAIR MARKOWITZ: Yeah. So you can 

see what this does here. It matches up work 

processes with labor categories with particular 

toxins, and when you go into the SEM you can go 

in through any of these routes by DOE site.

And so I assume that these linkages 

are what exist in the SEM. The reason why we 

were interested, aside the fact that it helps us 
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understand the SEM better and what the thinking 

in the program is, is when we have a particular 

question around asbestos and Paragon's response 

to us, they -- there was some note that certain 

workers like laundry workers, janitors and one 

other I'm forgetting were exposed to asbestos.

And but they're not in the procedure 

manual on the presumptive list of people exposed 

to asbestos. So that was puzzling.

You go to that presumptive list you 

may remember in Exhibit 15-4 there's a list of 

about 25 job titles, plumbers, carpenters, 

painters and the light who, for whom it's 

presumed that they have significant exposure to 

asbestos.

And there were, there are other 

workers, like laundry workers, janitors and I 

think there were power cable workers for whom 

the generic profile we're looking at recognizes 

that they have exposure to asbestos, but they 

don't make it to that presumption list.

And I think the Paragon's response to 
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this was it's one thing to recognize that they 

had exposure to asbestos, but it's quite another 

thing to have a level of certitude that allows 

you to presume that they had significant 

exposure to asbestos. That was, I think, the 

thinking that I took away from the Paragon 

response.

But I have to say that this version 

of the generic profile which I think we received 

today, I'm not quite used to looking at, so I'm 

not sure I actually -- maybe I'll take a look at 

it overnight and see if we come back to it 

tomorrow.

I wanted to look, for instance, at 

now I'm changing. I'm moving pages. Are you 

seeing the page change? I'm up to Page 6, for 

instance. Is that happening on your --

MR. BIRD: No, Dr. Markowitz, if you 

want to change the page just let me know or I 

can just make you the presenter here.

CHAIR MARKOWITZ: Well, no. I'm 

looking for the page that includes the janitors 
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and the laundry workers in the like.

MR. BIRD: And there are two 

documents. One is the generic profile DOL 

closure and the other is the generic profile DOL 

operations. We're currently viewing the generic 

profile DOL closure document. I don't know if 

that's the correct one.

CHAIR MARKOWITZ: Okay, yeah. Okay, 

yeah, thanks. So yeah, let's move to the 

operations not the closure. But actually while 

we're on that, Mr. Vance, what's the difference 

between the closure profiles and the operations 

profiles?

MR. VANCE: It's just after the sites 

shut down there was a period where they were 

doing maintenance or remediation activities. So 

the closure profile is relating to the closure 

of a particular site or facility, whereas 

operations is just that.

That's when there was actual 

production and operations occurring at the site.

CHAIR MARKOWITZ: Okay, so Mound, 
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Fernald, K-25, these are closure sites --

MR. VANCE: Right.

CHAIR MARKOWITZ: -- and that would 

apply to them. And ORNL and Idaho, INL, et 

cetera, these are operational sites. Okay. So 

yeah, this, so if we look and I can't see how 

many pages there are in this document, but if we 

look, the --

MR. BIRD: I think there's 60, 60 

something pages to the document.

CHAIR MARKOWITZ: Yeah, okay. But now 

that is looking -- could you put the page right 

side up? I don't know what you're seeing, but 

I'm looking at a page on its side.

MR. BIRD: Which -- that's going to 

have to be done manually. Which page are you on?

CHAIR MARKOWITZ: Oh, okay. Well, 

yeah, but let's try Page 3, for instance.

MR. BIRD: Give me one second. I'm 

going to share it in a different way that might 

help.

CHAIR MARKOWITZ: Okay. Yeah, now 
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it's right side up. That's nice. It's also a 

very small --

MR. BIRD: You do have control over 

the Zoon, just so you know.

CHAIR MARKOWITZ: Yeah, yeah, yeah, I 

got that. Okay. And now I can't figure out how 

to, oh, how to change the pages.

MR. BIRD: So it won't work with the 

way I'm currently sharing, and I have control 

now. I don't know if you have a problem.

CHAIR MARKOWITZ: Okay. Well, so let 

me just summarize what I saw when I looked at it 

earlier, which is I looked for the janitors and 

the laundry workers to see how they were dealt 

with in this generic profile since that's what 

Paragon had referred to.

And what it said in the last version 

of the generic profile was that up until 1981 

laundry workers had exposure to asbestos. 

However, that was in the notes column, same for 

the janitors and no comment on after 1981.

So presumably those job titles don't 
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make the presumption list, and we're not 

arguing. We don't -- we didn't argue that they 

necessarily should make the presumption list. We 

just wanted to understand how the department was 

making decisions about that.

So I'm going to take a look at this 

and if you can -- is this version, Carrie, on 

our website now for the meeting?

MR. VANCE: Yes, this is --

MS. RHOADS: Yes, I did it.

MR. VANCE: -- this is what's on the 

website.

CHAIR MARKOWITZ: Okay, okay. So I'll 

take a look overnight and see if there's 

anything else, and if anybody else wants to take 

a look and see if there's anything else that we 

can learn from this.

But I take it, Mr. Vance, that these 

connections we're looking at here between job 

category, work process and toxin, these are 

entirely built into the SEM?

MR. VANCE: Yes because this is what 
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would be informing the toxicological connections 

to these activities. So in other words, yes, 

these activities and those toxins are what would 

be reported out in the Site Exposure Matrices.

CHAIR MARKOWITZ: Okay. Okay, good. 

Fine, so let's take a break. It's 2:40. Let's 

take a break for 15 minutes and we'll resume at 

2:55.

(Whereupon, the above-entitled matter 

went off the record at 2:40 p.m. and resumed at 

2:59 p.m.) 

CHAIR MARKOWITZ: Okay, welcome back. 

Can you hear me okay?

MR. BIRD: Yes, we can.

CHAIR MARKOWITZ: Okay. So if, we're 

going to pick up where we left off. This is --

so what we're looking at now is response to one 

of our recommendations on asbestos. And this 

response was drafted, written by the Paragon 

Technical Services which is the DOL contractor 

that deals with the SEM and these issues.

And so if you scroll up a little bit, 
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okay. No, we want to go back to the previous 

page. The first point in the response is that 

the department agreed to coordinate a reevaluation of the noted job titles with the PTS 

and make agreed-to alterations to the list of 

Labor categories with a presumption of 

significant exposure to asbestos.

So as far as I can tell, the reevaluation hasn't been completed yet and so this 

is, kind of, an ongoing thing but let's, we're 

going to review the response to see how far PTS 

or Paragon has got.

So the first item we're looking at is 

this generic profile that included information 

about asbestos. And if you can scroll down a 

little bit without changing the page? Yeah, 

there we go. Okay, that's good, yeah.

So we raised the issue of the 

janitors and laundry workers and power 

communication line maintenance. And, in fact, 

they do appear in the generic profile, and 

Paragon's response was that in the generic 
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profile it's acknowledged that those job titles 

had potential exposure to asbestos but that they 

weren't subject to presumptions as the other job 

titles in Exhibit 15-4, the carpenters, the 

insulators, et cetera, due to this issue of 

nature, frequency and duration of exposure.

And the generic profile doesn't 

really provide information about those details 

around exposure, and that's the reason why there 

is on a surface level a discrepancy between the 

generic profile and this presumptive list that 

occurs in the procedure manual.

And that's understandable. If you see 

in the second paragraph there, the one that 

starts with addition of asbestos prior to 1981, 

the sum profiles was made by DOL direction in 

March 2010.

And I think that's what we see next 

to the janitors and the laundry workers in the 

generic profiles but that is not the same as 

sufficient evidence to make the presumption

list. So at least what they've done is a little 
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bit clearer.

Okay, I want to move on to item 

Number 2 and so let me give you the background, 

remind you really of the background here. Dr. 

Jonathan Mends and I had looked at national 

information on mesothelioma a couple of years 

ago, and this is from the NIOSH database that 

they keep.

And we saw a lot of job titles that 

showed significant risk of mesothelioma and 

mesothelioma is synonymous with having asbestos 

exposure. And so we proposed that that kind of 

information, since it was high quality, it was a 

national database very specific to asbestos, 

could be used to modify the presumption list 

that the DOL keeps in the procedure manual.

And so this provoked a back and forth 

with Paragon and they made the point, and 

correctly I think, actually, that there are

certain job titles in this national database 

where there were relatively small numbers of 

deaths and not much of an increased risk.
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And it's reasonable that those job 

titles don't appear in the DOE complex. And I 

thought that we've reviewed this before, that we 

thought that actually was persuasive.

And so the Board came back and said, 

okay, but there are some job titles, and these 

are listed in this paragraph we're looking at if 

you look down at the bottom two lines, three 

lines, chemical engineers, industrial health and 

safety engineers and mechanical engineers, for 

whom the increase in risk in the national 

databases is very significant. It's with a PMR 

449 means a four and a half -- that the chemical 

engineers had four and a half times the risk of 

general population, more or less and same with 

the industrial health and safety engineers.

And so, yeah, okay, we're looking at 

a slightly different version. This is the same 

version. I just highlighted certain things.

So the risks were increased for 

those, and furthermore, there were a lot of 

deaths in the national database, at least 30 
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deaths for each of those job titles. The point 

being that what that meant to us was that the 

risk of asbestos that this indicates is probably 

broadly shared across industries for these job 

titles, meaning chemical engineers in general 

demonstrated they likely had significant 

exposure to asbestos, given the level of 

increase in risk and given the number of deaths, 

mesothelioma deaths.

And so we made that point to PTS and 

here's the PTS response, if you're with me, was 

actually that, oh, their recommendation that the 

department or some entity look at death 

certificates for three occupations, the layout 

workers, molding and casting machine operators 

and materials engineers.

So that was one way of figuring out 

whether that's applicable to DOE or not. 

Actually, the Board already conceded that those, 

there were two few deaths in those particular 

job titles to really bring to a presumption by 

the department.
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And so PTS is saying actually, you 

know, you could look at these death certificates 

for this. It wouldn't be a real big problem with 

PII. There aren't that many deaths, et cetera, 

but frankly, there's no reason to move ahead 

with looking at the death certificate if we 

agreed, the Board agrees with the logic that 

these particular job titles with just not enough 

information from this national database to 

justify including them.

So I'm not sure what Paragon was 

pushing back against because we had already 

agreed on those job titles, that there wasn't 

enough there.

So if we can scroll up to item Number 

3? Okay, and then just one last issue here 

which is that the Board, and actually this is a 

PTS restatement of the Board's own 

recommendation or comments, which is that the 

Board stated uncertainty of the SEM routinely 

recognizes bystander exposures.

This issue has come up, and it is, 
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for instance, could be that the three 

occupations we're insistent on, the chemical 

engineers, the mechanical engineers and the 

industrial safety engineers, that it's possible 

that their predominant or even exclusive 

asbestos exposure is through bystander exposure.

And so the Paragon's response is, and 

I want to read this because I need some help 

here understanding this response. "The SEM does 

recognize bystander exposure when documentation 

such as industrial hygiene sampling demonstrates 

that potential asbestos exposure exists."

"SEM does not rely solely on Labor 

categories to decide to include or exclude 

asbestos in the profile. Further asbestos work 

usually establishes boundaries within which all 

workers, regardless of Labor category, have to 

wear proper PPE to protect against asbestos."

So what I don't understand about that 

response is that the SEM recognizes bystander 

exposure when industrial hygiene sampling 

provides evidence. But what I wonder is who is 
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ever doing any bystander exposure industrial 

hygiene sampling?

And if you look at the asbestos 

literature, you're hard-pressed to find much in, 

you know, in the academic study of asbestos. The 

idea that it's actually being done in the field 

looking at what bystanders are exposed to in 

terms of asbestos. It seems a little 

implausible.

And then the second point I want to 

make is just that establishing boundaries within 

which all workers -- I think they're talking 

about essentially asbestos abatement -- and our 

concern is not really with the abatement workers 

here. It's really with other kind of workers 

who, you know, prior to, you know, better 

awareness and DOE policy directives had less 

controlled exposure to asbestos, but who, 

frankly, you know, even after the policy 

directives continue to have incidental or 

unknowing exposure to asbestos.

So anyway, I'm interested in what 
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other people think of this? Yeah, Dr. Goldman?

MEMBER GOLDMAN: Well, this is very 

interesting. The thing about mesothelioma, which 

is really different from other things, as Steve 

mentioned, is almost always if you look hard 

enough linked to asbestos exposure.

And you're right, it could be a 

janitor, somebody walking by pipes that are just 

flaking and just in that area for a long time. 

And so I'm just wondering, and maybe this is, 

sort of, simplistic that almost anybody who 

comes forward with a diagnosis of mesothelioma, 

I mean, it would be assumed that it would be 

related to some level of asbestos exposure, you 

know, whether it's, you know, bystander or 

whatever, as long as you've excluded that they 

didn't get it specifically from another job.

So to me, maybe this again is 

oversimplistic, the presumption would be if 

anybody got mesothelioma the presumption is it's 

due to asbestos. And if they didn't get it 

somewhere else and they're even around anywhere, 
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a janitor or firefighter whatever and working at 

in these settings here, that it would be assumed 

to be work-related.

CHAIR MARKOWITZ: This is Steven. 

Yeah, that's an excellent point. And so let me 

ask Mr. Vance to respond to either as a matter 

of policy or whether you just know offhand, 

because I can't recall how the procedure manual, 

what it specifically says about mesothelioma.

But and I'm sure you don't have many 

cases because it's a rare disease but do you 

know? Are the mesotheliomas routinely 

compensated because the process concludes that 

they likely had asbestos exposure in the 

complex?

MR. VANCE: Yeah, it would be 

compensated. It would be compensable because 

it's a known health effect of asbestos exposure, 

so the likelihood of someone showing up with 

mesothelioma and some sort of asbestos exposure 

on the sites would likely mean that case, if 

they had a long enough exposure.
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And I don't know at the top of my 

head with the duration of exposure is required 

for the presumption, but more than likely that 

case would be approved. You would see that with 

mesothelioma and asbestos. That's, sort of, 

following in that same, sort of, category.

So but it's generally a highly 

compensable situation with mesothelioma.

MEMBER GOLDMAN: And actually it's 

not a huge dose. It's much more an issue, my 

understanding, is of latency, that, you know, 

they had the exposure long enough ago. Even a 

summer exposure working in construction has been 

related in some people to getting mesothelioma. 

So it's much more an issue of latency.

CHAIR MARKOWITZ: Yeah. I mean, my 

hunch is that the claims examiner, if they find 

asbestos in the SEM as being an exposure for the 

person with mesothelioma that it's likely going 

to be compensated without necessarily going to 

the official presumption route.

If they're not on the list of 20 or 
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25 occupations for whom significant exposure to 

asbestos is assumed but if it merely exists in 

the SEM, my hunch is that, particularly if it 

makes it through the CMC that it's going to be 

compensated.

But that's then, you know, that's, 

kind of, an empirical question whether it is or 

not. Mr. Catlin?

MEMBER CATLIN: Yeah, thanks. As byer 

-- and I may be wrong, as I recall we were 

looking at the trying to identify the potential 

asbestos exposure issue. So and I think that was 

broader than just looking at mesothelioma 

because if someone comes in with mesothelioma 

that's an easier case to make.

But I think we were concerned also 

about lung cancer and maybe some other cancers 

that wouldn't be recognized by the SEM because 

these bystander exposures weren't tested.

CHAIR MARKOWITZ: Yeah, I agree that 

it's a broader issue than just mesothelioma. And 

lung cancer is much more common and much and 
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more difficult to address, I think, in the 

claims evaluation process I would guess. And 

where it says, where that presumption list 

really, probably really matters.

MEMBER CATLIN: Yeah. Yeah, this is 

Mark Catlin again. And I think we used the

mesothelioma as a surrogate for some, you know, 

cases where we knew there was likely enough 

asbestos exposure for to show up as disease. But 

so I think what, so that we're really trying to 

get them to look at is to identify asbestos 

exposure, right, in some of these categories 

that they're not currently there.

CHAIR MARKOWITZ: This is Steven. 

That's exactly the point, which is that it was a 

proxy for a high level of confidence that the 

person had asbestos exposure. And so if the 

chemical engineers and the mechanical engineers 

and the safety industrial hiking engineers make 

it to the presumption list for asbestos, then it 

would cover mesothelioma, lung cancer, 

asbestosis and pleural plaques.
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And that that would, you know, make 

decision-making on those job titles a little bit 

easier. But, you know, the, I'm wondering about 

this bystander exposure issue where 

documentation such as industrial hygiene 

sampling demonstrates exposure.

For those of you who do industrial 

hygiene, is it, do you feel like it's likely 

that there was bystander, documentation of 

bystander exposure? I mean, it would be very 

unusual in any industrial setting to do that 

except if you were doing some sort of special 

study.

MEMBER SILVER: This is Ken Silver. 

As you mentioned, there is a special case of 

asbestos abatement and there's a cottage 

industry of firms, and if it fits within the 

regulations there is often area monitoring going 

on on the perimeter of the job site.

My impression of the way they operate 

in this part of the country is always that if 

they get a hit they wouldn't report it to the 
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facility. And I can't imagine DOE back in the 

day was any better.

So I wouldn't wait for evidence from 

the asbestos abatement industry. It's probably -

-

CHAIR MARKOWITZ: And Dr. Van Dyke?

MEMBER VAN DYKE: Well, I think that, 

I mean, I think that assumes that all the 

exposure was due to asbestos abatement, which 

there's lots of exposures to asbestos that were 

likely not recognized early on.

And they didn't even recognize it in 

the people doing the jobs, much less the 

bystanders. So I think the -- the odds of there 

being any sort of IH measurements of bystanders 

is really low for asbestos or anything else.

So I would agree with what you're 

saying, Steve.

CHAIR MARKOWITZ: Yeah, yeah. Mr. 

Catlin, did you have another comment because --

or you just took your hand down.

MEMBER CATLIN: Yeah, I was going to 
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repeat what was just said, so --

CHAIR MARKOWITZ: Yeah. Well, the --

it's Steven -- I think for us what the 

unresolved issue is that we would wait to hear 

back from the department is about those job 

titles and what Paragon's position is on those 

three job titles.

We don't have to resolve the issue of 

the how much bystander exposure documentation 

there was, although I have to say as a side 

comment I think bystander exposure is a really 

challenging, would be a really challenging issue 

for the SEM to address, given the lack of data, 

really, around this.

So it's not unimportant. Others? So 

other comments on this issue before we move on? 

Okay. So, Carrie, the action item is, you know, 

awaiting additional response on the asbestos job 

titles.

Okay, then let's move on.

MS. POND: Dr. Markowitz, this is 

Rachel. Can I just clarify? Is this something -
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- do you want us to respond to it based on the 

transcript or are we going to get something else 

or --

CHAIR MARKOWITZ: Well --

MS. POND: I just want to make sure 

we can respond the right way to the questions.

CHAIR MARKOWITZ: No, the -- but at 

the beginning of this killer, Kevin, if you 

could go up to the top of this Page 1? Yeah, 

okay.

What's highlighted is that the 

department agrees to coordinate a re-evaluation 

of the noted job titles with PTS and make 

agreed-to alterations to the list.

MS. POND: Okay, great.

CHAIR MARKOWITZ: And what is still 

outstanding is the opinion of PTS on our 

recommendation that chemical engineers, mechanic 

engineers and industrial safety engineers be 

added to the presumption list in Exhibit 15-4 of 

the procedure manual.

MS. POND: Okay, that's helpful, 
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thank you.

CHAIR MARKOWITZ: Yeah. Okay, so 

let's move on to next agenda item, which is 

another -- this is on our website meeting page, 

and it -- Kevin, let me give you the name of it 

because there's several items actually listed 

there. It's the IH/CMC and public comment DOL 

responses to those information requests. If you 

could bring that up?

So by way of, while he's doing that, 

by way of background, since the last meeting 

we've had two working groups looking at, okay. 

So looking at --

MR. BIRD: Sorry, Dr. Markowitz, are 

you looking for the response to this from DOL?

CHAIR MARKOWITZ: Yes, let's go to 

the response.

MR. BIRD: Okay.

CHAIR MARKOWITZ: Because the 

response has the questions.

MR. BIRD: And I believe this is it, 

correct?
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CHAIR MARKOWITZ: Yes, yeah. Okay. So 

by way of background, two working groups, one 

looking at talking through issues of industrial 

hygiene, medical input into the claims process 

and the Board's potential advice on that 

objectivity, consistency and quality of those.

That was one working group, and the 

second one had to review, looked at public 

comments over the last 24 months, which we had 

not systematically done and Ray brought forward 

certainly questions that we thought we could get 

some clarification on from the department.

I should say that part of the public 

comment working group was there were some 

aspects limited, but some aspects of the 

questions raised by the public that we couldn't 

quite understand from the written comments.

And so we asked the department 

whether we could ask those public commenters for 

to clarify their questions or their comments to 

us. And that was an issue that, I think, the 

department was going to get back to us on 
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because normally on these committees there's 

just not a lot of back and forth between the 

public commenters and members of the Board.

So I don't know what the status of 

that is from the department's perspective, but 

if there's no answer yet today, maybe tomorrow 

we can revisit that.

But in any event, there were 

questions that we directed to the department and 

so we wanted to just go through it, and this 

document actually has both the questions from 

the IH/CMC working group and from the public 

comment working group.

And I think we start off with, I 

think it's the CMC/IH working group or vice 

versa. I'm not quite sure because it's not 

labeled. But in any event, it probably doesn't 

matter.

So we were, there was a question 

about the timeliness of claims involving 

impairment evaluation over the past several 

years. And so we asked for information on counts 
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by year, resident state of the claimant and by 

consulting impairment MD.

And so the responses to the question 

was unclear. Clarification, different ways of 

measuring timeliness endpoints, what two 

endpoints are we talking about?

So I -- if anybody on one of the 

working groups who that came up with this 

question wants to chime in?

So this is Steven. I -- the issue 

was, and this may have come from public 

commenters, I'm not quite sure where it came 

from, but that for some period of time there was 

a lot of time between when the impairment 

evaluation was submitted and when the claim 

finally moved forward.

And so the Board's interest was on 

particular claims that involved impairment 

evaluations was or is the -- whatever time 

metric is used for advancing claims was it 

different from other claims? Or was there an 

inordinate delay in impairment evaluations 
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during that, setting aside the issue of the 

pandemic, of course, in the impairment 

evaluations?

And was this in certain parts of the 

country or certain areas, certain types of 

claimants? What's known about that?

And the question, I guess, for Mr. 

Vance is is there any -- do you have any sense 

of the issues with impairment that could shed 

light on this for us?

MR. VANCE: Well, are you talking 

about, like, the timeliness of case adjudication 

involving impairments?

CHAIR MARKOWITZ: Right.

MR. VANCE: I mean, you know, it's 

going to be dependent on lots of different 

variables and how you'd want to look at it. And 

that's what makes data requests so complicated

is because it really depends on the context and 

the framework of the, of what it is that you're 

trying to get to.

I mean, you and I, and I'm sure the 
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Board is aware, you know, we do collect a lot of 

information and sometimes it can be evaluated 

and analyzed to provide data that may be -- may 

be useful in responding to or informing a 

particular issue.

But, you know, it would really depend 

on what it is specifically that you're looking 

for and then, sort of, negotiating over, you 

know, what data do we have that could even be 

used as, sort of, that benchmark for when do you 

want to start versus when you want to end?

It really is a challenge, and that's 

why this is, that our response is like that 

because we just need to have a better 

understanding of exactly what it is, A, you're 

asking for and then once we look at it, whether 

we're going to be able to, B, provide that data 

in a way that can be useful.

So and that's what, that's why this 

is difficult. We just -- I just didn't 

understand nor did we understand what the 

context was for this.
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MS. POND: Yeah, this is Rachel.

CHAIR MARKOWITZ: Sure.

MS. POND: I think that this set of 

questions are the ones that came from the 

public. So I mean, I, kind of, imagine that 

maybe you got the questions from the public and 

there wasn't a whole lot of context. So it makes 

it a little bit more challenging for us to 

answer it.

I mean, there's various stages of an 

impairment. You know, we send out a notice right 

after final decision to accept something under 

Part E, and we say you can file and this is how 

you file for impairment.

Then they can come back with a claim 

for impairment. Then they can choose whether 

they want they have their own physician do it or 

they want to have a claim, a CMC do it. And 

sometimes when they have their own claimant do 

it, I mean, their own physician do it, that 

physician is backlogged. So they will wait until 

that physician that they want to go to is ready 
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and so that can take time.

We will give, you know, extensions 

and say, well, you know, typically just to work 

on the letter to that doctor and say here's what 

we need from you in order to make this 

calculation. And sometimes the doctors will get 

right on it. Sometimes they'll wait. The 

appointments have been spread out for, you know, 

months sometimes because claimants want to go to 

a particular doctor.

So that's going to affect timeliness. 

Now, you know, there is a certain point which 

we'll say, well, you know, if we don't get a 

response we're going to go ahead and either, you 

know -- they'll sometimes withdraw it or they'll 

come back and say I want to do this later or 

we'll deny it and then they, you know, appeal 

it.

So there's just a lot of different --

there's different things that could happen in an 

impairment. If it's a CMC, we have very specific 

timelines. The CMC has to provide us with the 
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report, but we also need to get test results 

from the claimant that we can send to the 

doctors.

So and that's where the timeline can 

change. Now, we do have specific ops plan goals 

to have, you know, an initial decision done on 

an impairment. I think it's, like, 200 days or 

something.

But again, it's really sometimes 

they'll withdraw, they'll pull back. They'll 

say, oh, it hasn't been two years. I want to, 

you know, wait and it -- so it gets challenging. 

That's why this question's a little bit openended for us to, kind of, give you anything 

objective.

CHAIR MARKOWITZ: Okay, so I think 

that if -- I think we should that the committee, 

the working group that raised this question, if 

we want to drill into it further and reconvene 

and try to get more specific about what's being 

requested? I think that's reasonable.

And let me just ask Carrie to make 
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notes about it, aside from the transcript, about 

what we're doing with these questions and we're 

pursuing them or not?

So okay, that's just the overall 

timeline of claims evaluations over the past two 

years. And the question is big and requires 

clarification, what is meant by claims 

evaluation.

So the -- you -- the program has 

goals around timeliness of the various steps of 

the claims process. Is that right?

MS. POND: Yes, absolutely. We have 

operational plan goals that outline all the 

different timeframes that we expect that the 

district offices will make then, that that 

trickles down to what is put in performance 

evaluations.

But we've, you know, so that's pretty 

much outlined but in a lot of the different 

steps so we have the time it takes from the time 

we get a claim to the time we issue a 

recommended decision or it goes to NIOSH is that 
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the time it takes between a recommended decision 

and a final decision.

We've got a timeline for impairment 

and wage loss. We've got timelines for, you 

know, evaluation of home healthcare. So really 

there's a lot of different steps that we have 

timelines for which we can provide you, too, but 

we just need to know what particular piece 

you're looking for.

CHAIR MARKOWITZ: Well, so can you --

this is Steven -- can you share, not on this 

call, but I mean, can you share with us what 

your goals are in terms of timeliness? What 

periods of time, what percentage reaching that 

those periods of time for the various steps so 

we have a better understanding of what's 

actually looked at?

So we're not asking for data per se. 

We're asking for just --

MS. POND: You're asking for the 

operational angles, right?

CHAIR MARKOWITZ: Yeah, yeah.
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MS. POND: I don't think that should 

be a problem. I will double-check. I don't want 

to make a solid commitment unless there's some 

reason that there's an issue with it, but I 

don't think that should be a problem and we'll 

get back to you.

CHAIR MARKOWITZ: Okay. Because if, 

you know, at least need to understand what, you 

know, what the goals process are and if we -- if 

there's more information requested then we can 

request from --

MS. POND: Yes.

CHAIR MARKOWITZ: -- or inform the 

inform position.

MS. POND: Absolutely.

CHAIR MARKOWITZ: Question three, and 

I'm going to try to unsuccessfully to move the 

page down, but maybe Kevin you can do it? So 

this was -- is addressed to medical providers 

accepting the EEOICPA benefit medical card. I 

think the perception was that medical providers 

were decreasing, the ones who accepted the card.
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And so this question had to do with 

the last several years of the count of providers 

who accepted it over time so we could look at 

the trend and if it -- and what are the reasons 

why providers drop out of the program.

So again, the scene I'm looking at --

okay. Can you all see the answer to that now on 

the screen?

MR. BIRD: Dr. Markowitz, everyone 

should be able to scroll on the page down.

CHAIR MARKOWITZ: I see. I mean, 

individually we can all scroll?

MR. BIRD: That's correct.

CHAIR MARKOWITZ: Okay. Okay, so 

basically it sounds like the department doesn't 

really have this information directly. They have 

an inventory of medical providers enrolled in 

the program who may receive payment, but that's 

there's a lag between those that receive payment 

and those that drop out of a program. So that it 

wouldn't permit a timely look at trends. I think 

that's what -- that's the way I read this as the 
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reason.

If the providers who drop out, the 

department has no real way of knowing why they 

would drop out.

MS. POND: Dr. Markowitz, this is 

Rachel. I just got confirmation that we can 

provide you with the ops plan goals, our 

operational plan goals, so we will do that.

CHAIR MARKOWITZ: Okay. So let me ask 

then, is it the impression, Mr. Vance or Ms. 

Pond, that that there are decreasing numbers of 

medical providers who accept the card? Or it's 

clearly no?

MS. POND: I mean, I think that 

there's sometimes might be a perception of that. 

There are some that have indicated that they're 

frustrated with the process, but I haven't 

noticed a trend where we're seeing a whole lot 

of people just dropping out of the program.

You know, I think that with any 

bureaucracy it can be a frustrating process for 

doctors when they're being asked, especially for 
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with this comp limiting being asked a lot of 

questions, like, about causation, follow-up 

questions.

So, you know, there are physicians 

that might not want to, you know, be involved 

with the program for that reason but there's, 

you know, overall I haven't noticed a huge drop 

in the participation rate of doctors.

CHAIR MARKOWITZ: Okay. By the way, 

if any Board members want to chime in feel free. 

We ask how many claimant occupational health 

interviews have the contractor and federal IH 

has done over the past two years? And the 

answer is two, so that's a pretty easy 

calculation, one per year.

So by way of background, this was a 

recommendation from the Board some years ago 

that this mechanism be developed to try to 

improve the exposure information that is used by 

the industrial hygienist for when they evaluate 

a claim and trying to make, trying to fair weigh 

in on the significance of the exposure that the 
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person might have had.

And so my question, since it's rarely 

occurring, is is it -- presumably that's because 

claimants are not requesting to have an 

interview and the industrial hygienists are not 

initiating an interview? I think it's from both 

ends that that's not happening. Is that right?

MS. POND: That's correct.

CHAIR MARKOWITZ: Yeah.

MR. VANCE: Well, and I'd like --

this is John Vance -- let me just add, you know, 

the mechanism that we describe in our procedure 

manual is one where the claims examiner can 

initiate the review of this when there's a 

purpose or a reason for wanting to have 

additional information.

And we certainly communicate it to 

our staff the importance of having this option 

available, but it's related to the claims 

examiner to make a judgment as to whether or not 

there's some issue or concern in the case file 

that they think will be rectified by having 
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these kinds of interviews.

And so it does not seem to be 

something that claims examiners are initiating. 

And I know that we've covered this, and in fact, 

when Rachel did her introduction we had had a 

training session with all of our staff over this 

summer, and we were making it clear that this is 

an option if there were concerns being raised 

about exposure that we wanted to explore 

further.

And it's just not producing the kind 

of referrals that we would have thought,

CHAIR MARKOWITZ: You know, that's --

this is Steven -- and I can understand why the 

claims examiner might want not initiate the 

interview, but there's, when they send over a 

claim to an industrial hygienist with a 

statement of accepted facts and then they have 

questions for that industrial hygienist, 

essentially about the relevance and significance 

of the claimant's exposures, and then the 

industrial hygienist sifts through whatever 
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available records there are from the claim file 

or more generally and then weighs in with their 

report, it's that industrial -- I would think 

it's the industrial hygienist who might realize, 

hey, I'm getting a picture of what this claimant 

might have been exposed to but not a complete 

picture.

And not a good enough picture that 

lets me really describe appropriately their 

exposure. And so it's the industrial hygienist 

who might want to conduct that interview now, 

because they would -- they are the ones who 

realize what's, you know, what they don't have 

in order to weigh in here.

And so is that offer of an interview 

made also to the industrial hygienist, not just 

the -- the claims examiner?

MR. VANCE: The conceptual framework 

for that procedure is driven by the claims 

examiner's need for additional information. So 

it really is the impetus of the claims examiner 

to communicate to an industrial hygienist the 
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need for some sort of engagement to get 

clarifying evidence.

It's not really the IH that, or the 

industrial hygienist that would be triggering or 

initiating that kind of development. What they 

would be looking at is whatever documentation 

that they had available to them in writing to 

profile their exposures that they're doing.

Now, if there would be some reason 

for that, that -- I don't think the IHs are 

prevented from doing that, but it's just not a 

common occurrence if we've only done two over 

the past few years.

MS. POND: Yeah, and I think also the 

extent was that the IHs could do that if they 

want to. You know, if they, like, Dr. Markowitz 

was saying, if they see, oh, well, it would be 

helpful to have more information, they can do --

they can initiate that interview.

CHAIR MARKOWITZ: Yeah, okay. Any 

comments any Board members want to make on this?

MS. WHITTEN: This is Diane Whitten.
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CHAIR MARKOWITZ: Go ahead.

MS. WHITTEN: It's not really 

surprising to me that there's only been two. I 

have seen, you know, a lot of claims from coworkers, retirees and it's just corny when the 

IH data says the CMC will report that, you know, 

they weren't exposed to toxic substances over a 

known amount when in reality they haven't even 

called the claimant to ask them if and when they 

were exposed and to what.

So I hope we can fix this.

MS. POND: Well, the OHQ is used for 

that purpose, the occupational history 

questionnaire used to try to get as much 

information as we can from the claimant in 

addition to the records that we get from DOE.

CHAIR MARKOWITZ: Yeah. Any other 

comments? Mr. Catlin, yeah.

MEMBER CATLIN: Thanks, this is Mark. 

Yeah, I just recall from my experience in 

Washington State as -- I did a lot of these 

interviews in my work at the University 
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Washington for a number of years and it's, you 

know, it's the if the claims examiner is 

probably not really the best one to be looking 

to say that these have got to be done.

It would be useful to maybe have a 

process where of claims managers or claims 

examiners decide there's -- they don't need to 

have an interview done and a certain number of 

those get done anyway by the industrial 

hygienist to see if there's -- how much 

additional information can be pulled out and 

whether or not that's going to be helpful.

So some way to, sort of, look at this 

to try to help increase the number of 

interviews, because I was actually shocked to 

see this number of only one per year.

CHAIR MARKOWITZ: I want it on the 

record that that's not New York City. Yeah, go 

ahead.

MEMBER SILVER: Here's a devil's 

advocate benign interpretation. Out there at the 

Resource Centers the new occupational health 
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questionnaire is capturing much better data than 

in years past.

So the contractor in federal IHs have 

less reason to go back and plug the claimant for 

more details is a possible interpretation of 

reality or way off base.

MS. POND: No, that's correct. I 

would agree with that assessment.

MEMBER SILVER: Well, it would be 

interesting to have some empirical data to see 

if that's really true. I mean, I'm skeptical 

but, you know, logically the thought hopped into 

my head.

CHAIR MARKOWITZ: Well, yeah, this is 

-- I don't know if people who still have their 

hands up want to say something else here or 

what.

This is Steven. My hunch is that the 

routine, the claims have a customary level of 

exposure information and not a ton and hopefully 

not too frequently very little, and that the 

industrial hygienists are producing their 
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reports given what the customary amount of 

information they get is.

And then it's they don't really see 

the occasion to pursue additional specific 

information from individuals. I can understand 

that.

I think that actually Mr. Catlin's 

idea of essentially a pilot project where, you 

know, say, 20 interviews are done by the IHs and 

to see if well, you know, see if it's a useful 

thing or not. You know, a limited effort that 

wouldn't take a ton of time, but to see whether 

in fact it does improve the quality is something 

that I don't know the Board can think about a 

little bit more.

But I think we should move on unless 

there are other comments on this?

MEMBER SILVER: I just wanted to 

second Mark's idea.

CHAIR MARKOWITZ: Go ahead. What's 

that?

MEMBER SILVER: Ken Silver. I second 
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Mark's idea.

CHAIR MARKOWITZ: Yeah. Okay, so the 

next question is the more detailed role the 

EEOICPA Medical director and the program being 

added to the procedure manual, and the answer is 

that in the procedure manual, specifically 

around Chapter 29, Ancillary Medical Benefits, 

that the Medical Officer reviews organ 

transplant and experimental treatment requests, 

which hopefully is pretty infrequent.

So I take that to mean that -- and 

I've looked at the procedure manual to look for 

the specific language around the medical 

director's role in it, and it's there's very 

little actually given to the medical director.

And I said, and this is -- this is a 

question. The procedure manual is for -- is a 

guide for the claims examiners and it's the fact 

that the medical director doesn't appear very 

frequently in the procedure manual means that 

the fact the medical director or Medical Officer 

has a very small role specifically in claims 
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evaluations. Is that correct?

RP Yes, that's correct. The medical 

director is a medical, I mean, the Medical 

Officer, he's of DEEOIC. He looks at more of the 

broad space, I mean, overall. He's looking at 

the, you know, how we are getting billed and how 

we're processing overall, you know, medical 

issues related to all of our EEOICPA programs. 

So we're a piece of it.

He's had, you know, less. Sometimes 

we will go to him with specific questions like 

VLC organ transplants and things like that in 

there that we need to have him look at for, from 

a program perspective. But it is rare and it's 

becoming more and more rare because we're using 

CMCs or going back to the treating physician 

more often.

CHAIR MARKOWITZ: And while we're on 

this topic, actually, because the language is 

between Medical Officer versus medical director. 

Is that the same person?

MS. POND: Yeah, that title changed 
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in the last year or two years --

CHAIR MARKOWITZ: Okay.

MS. POND: -- there, so --

CHAIR MARKOWITZ: And is there a 

second physician in the office that's dealing 

with some of these issues?

MS. POND: I think the state keeps 

(audio interference) to work with him for other 

OWCP as well, but that's recent and so I'm not 

exactly sure what that role is going to be for 

us.

There's also a pharmacist who looks 

at other types of issues for OWCP overall. 

Again, that's for all of the workers 

compensation programs at Labor.

CHAIR MARKOWITZ: Thank you.

MR. VANCE: Yeah, and this is John 

Vance, and let me just clarify as well, because 

one of the things that we have been doing in the 

procedure manual is making it very clear that 

the position of our Medical Officer is that of 

an interpretation of the evidence by a medical 
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physician.

And that represents his or her 

interpretation of the evidence, and then that 

would be something we would compare to other 

opinions in the case and have to weigh.

So I think it's part of the 

contention may have been that we were giving 

some sort of special weight to the 

interpretation of the evidence by the medical 

director, and we're trying to make it clear that 

his or her opinion is just that.

It's an opinion that the department 

letter obtains in some these cases and would 

have to be considered in comparison to other 

medical input that we get from other physicians.

CHAIR MARKOWITZ: But this is Steven, 

let me just say that what you just described I 

couldn't find in the procedure manual. I think 

it's --

MR. VANCE: Actually it's -- Dr. 

Markowitz, it's in -- I know it's in Chapter 29 

now, but when we are assessing, especially for 
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these organ transplants and the experimental 

medication, there's now specific language that 

the opinion of our Medical Officer serves as an 

interpretation that must be weighed against 

other information being obtained by the 

Department of Labor.

CHAIR MARKOWITZ: But is that only 

relevant to the issue of organ transplant and 

experimental treatments? Or is it you're saying 

-- or is that true in general?

MR. VANCE: In general that's the way 

that we're going to approach this because that's 

the way the procedure that -- we're trying to 

consolidate all of our procedures so that when 

we're weighing medical evidence that's the way 

that the claims examiner would approach it.

But if there are conflicting medical 

opinions that the opinion of a Medical Officer 

from the Department of Labor is just that. It's 

another interpretation of the evidence.

I can send Carrie the language so you 

can take a look at it.
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CHAIR MARKOWITZ: Yeah, that would be 

great. That would be great. Not that I get lost 

in the 711 pages of the procedure manual, but --

MS. RHOADS: I can't imagine why you 

would. It's so simple.

CHAIR MARKOWITZ: Okay. So the next 

question, again, if there's Board members who 

want to chime in and just feel free, but here it 

is is that there's been an attempt to aggregate 

data from prior claims decisions to ensure 

consistency in decision-making.

For example, one could look at 

decisions on beryllium sensitivity, you know, 

for different job titles to see if there's 

variation in claims outcomes for the same job 

titles.

And the short answer to this is that, 

no, that they don't, the department really 

doesn't do that kind of data aggregation, which 

is useful to know because I think that it's one 

of -- it's something that the Board with 

resources could look at, talking about it 
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sometime in 2022.

But could look at it to address the 

issue of consistency. But any comments or 

questions?

Okay, question seven, what are 

current and future changes in occupational 

medicine at the EEOICPA? I guess it's really, 

someone had mentioned I think at one of the 

Board meetings that you were going to hire 

another physician. I think that was where this 

question came from.

MS. POND: Yeah, we're not. We're not 

hiring any energy per se. The Medical Officer 

for the (audio interference). And that's what 

we've got in terms of the -- the medical 

expertise at DOL, but that's why, as I said, 

we're trying to make sure that we're relying 

more on the treating doctors and if there's some 

question or concern on a particular case that we 

go through to a CNC.

CHAIR MARKOWITZ: Okay, next 

question, for what percentage of claims through 
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its CMCs and IHs recommend denial? And the 

answer is zero because they only provide 

professional advice to the claims examiner that 

the claims examiner uses to weigh in 

adjudicating a claim.

They don't recommend a denial or not, 

so that is -- was a misconception, I think, on 

our part.

Although, I think, you know, when we 

get to look at some claims and drill in on IH 

and CNC, I think maybe we'll get a better, more 

refined question.

Same with the next one, question 

nine, for what percentage of claims do we see 

CNC writes is fine minimal exposure provided by 

GM -- by individual CMC and IH. And the 

department doesn't keep that kind of data.

Okay, so the second set of questions 

came from the CMC IH working group and first 

question was about the National Office's Medical 

Director's role in claims evaluation.

And we've already discussed this.
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We're going to look at Chapter 29 and 

see what it says. Well, essentially there's a 

very limited role in individual claims 

evaluations.

What procedures does the medical 

director follow? I think that question, too, 

actually is derivative from question one. So if 

there's little role in claims evaluation then 

procedures aren't really relevant.

Question three, how does the medical 

director communicate his or her input into the 

claims evaluation process? And so when the 

program requests a case-specific review from the 

Medical Officer, the Medical Officer will 

communicate a response in writing and the 

department then uploads that written response 

into the information system for it to be part of 

the permanent case record.

Okay. So then when we look at claims 

in the future, we may on occasion see these 

communications. Is that right?

MR. VANCE: Yes, but it would be very 
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rare.

CHAIR MARKOWITZ: Okay. But we don't, 

hopefully we won't look at that many claims that 

we'll find very rare events.

Question for --

MS. POND: I just want to say we did 

change some of that, as you'll see here. We in 

the most recent part of the procedure manual, so 

there, you know, we might have more input in the 

past. We've evaluated some of that and make, we 

want to make sure that we're putting it more, 

putting any specific claims evaluations, like 

this next question on impairment, to either 

treating or the CNC folks.

So you may have seen some of that. 

That's probably where question came from, but 

you will see that.

CHAIR MARKOWITZ: Right, and then, in 

fact, that's what Mr. Vance said earlier 

regarding the changes in the transmittal 

document with the PM 5.1 around impairment.

Okay. So then what triggers an 
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impairment claim review by medical director and 

going forward very little it seems.

And okay, so I think, so those are 

the questions that we had posed and so let me 

just ask on this other issue of about getting 

some clarification on limited number of public 

comments about whether there's a way in which we 

can do that.

This came out of an information 

request, and I had to do it with FACA and the 

rules and all that, and I think the department 

was going to --

MR. BIRD: Yes, Steven, we're 

probably going to have to talk about that 

offline.

CHAIR MARKOWITZ: Okay. Okay, fair 

enough.

MR. BIRD: So Carrie and I will set 

up a time that works for you to talk about that, 

okay?

CHAIR MARKOWITZ: Sure, sure.

MR. BIRD: Thank you.
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CHAIR MARKOWITZ: Okay. We have 15 

minutes until the public comment period. Dr. 

Silver,?

MEMBER SILVER: Yes, the last 30 

minutes of discussion or so around these 

questions makes me feel a hole in my heart for 

the lack of it an ombudsman. None of the datarelated questions, you know, might be answerable 

through an iterative process of someone right 

there in the department going back and forth 

with the program staff to frame the question, 

you know, the one about to refine the hypothesis 

and, you know, eventually get hands on the data 

to answer it.

And similarly when the public 

comments and the Board feels the need to get 

clarification and it becomes a big, complicated 

thing in FACA, it would be nice to have someone 

in the ombudsman's office to, you know, deal 

with it a little more promptly and directly.

So I know it's not exactly in our 

charter but the personnel of the ombudsman's 
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office brought a lot of high-quality commentary 

to our meetings, and it would be nice to have 

someone in that role participating again.

CHAIR MARKOWITZ: Okay. Speaking of 

the ombudsman, actually, is there a timetable or 

a plan to replace the ombudsman or what exactly 

is the status?

MS. POND: This is Rachel. We don't 

have -- that's a separate office from us so we 

don't really have any control or say of whatever 

happens over there.

I know there's currently an acting. 

That's all I really know, sorry.

CHAIR MARKOWITZ: Yeah, that's okay. 

So, Carrie, you just sent the language from Mr. 

Vance around, the Medical Officer. I'm wondering 

whether if you could send that to Kevin and we 

could take a look at it, just to close out that 

discussion?

MS. RHOADS: Yep, I'm sending it to 

Kevin right now.

CHAIR MARKOWITZ: And so let me also 
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ask how many public commenters do we have so 

far? Do we know?

MS. RHOADS: I still have two.

CHAIR MARKOWITZ: Two? Okay.

MS. RHOADS: Yes.

MR. BIRD: Thank you, Carrie. I 

received your email. I am pulling it up in a 

second. Hold on one second.

(Pause.)

CHAIR MARKOWITZ: Okay. Now if you 

could -- yeah, great. Okay, that's good. That's 

good.

So just to walk through this, this is 

from the Procedure Manual Chapter 29 of Part B, 

Disapproval by the DEEOIC Medical Officer. In 

the event that the DEEOIC Medical Officer does 

not agree with a medical necessity for the 

requested organ transplant procedure or opines 

that the medical evidence is insufficient to 

support proposed experimental treatment for an 

accepted condition, the Medical Officer returns 

the case to the MBPU with a memorandum 
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explaining his or her decision.

And depending upon the opinion of the 

Medical Officer, the MBE takes one of the 

following actions: One, Medical Officer 

requests further information, the MBE proceeds 

with development to obtain the information 

needed for the opinion from the Medical Officer; 

or two, when the Medical Officer provides an 

opinion that the medical evidence does not 

support the medical need for an organ transplant 

or experimental treatment, the MBE treats the 

matter as a conflict of medical opinion between 

the prescribing physician and the Medical 

Officer, the MBE must assess competing opinions 

to determine the one that the MBE can assign the 

weight of the medical evidence to decide to 

claim.

If the MBE assigns equal weight to 

the opposing opinion, the MBE is to obtain a 

refereed medical opinion. Okay.

So that sounds reasonable, to me 

anyway, but more to the point all this applies 
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to organ transplant requests and experimental 

treatment and appears to only apply to those 

occasions. Is that right?

MR. VANCE: Yes. Yes, for this 

procedure chapter this is what this relates to. 

Now, the Medical Officer within MBE has lots of 

other functionality but for our purposes this is 

what we are asking the Medical Officer to 

participate in with reviews.

CHAIR MARKOWITZ: Okay, okay. So are 

these the only claim types in which when we look 

at claims we're likely to see the Medical 

Officer actually have a written, some sort of 

written opinion that makes it into the record?

MR. VANCE: Yes.

CHAIR MARKOWITZ: Okay, okay. Okay, 

thank you. That clarifies. Comments from the 

Board, questions?

Okay.

MEMBER FRIEDMAN-JIMENEZ: Yes, this 

is Dr. Friedman-Jimenez. What is meant by 

experimental treatment? Does that refer 
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strictly to medical experiments, i.e., 

randomized clinical trials where there is a 

treatment group and a placebo group or a 

standard care group and it's an actual 

experiment?

Or is that referring, sort of, 

loosely to treatments that haven't yet been 

approved by insurance companies?

MR. VANCE: I think it's more of the 

second. It's more of a loose standard that it's 

something unusual or not particularly falling 

within a routine type of medical care.

So the ones that I've seen that I 

know about are generally going to be involving, 

like, medical marijuana and those types of, you 

know, CBD oils and that sort of thing where it's 

some, sort of, treatment that is not recognized 

as a normal and routine type of treatment 

modality for a particular condition.

MS. POND: Or we have to have them 

weigh in because of the federal rules and 

whatever, particularly when testing medical 
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marijuana.

But I think it's bad in itself and 

it's also just, you know, something that they've 

even, the doctor himself has said this is not a 

particular, this is something we, that we don't 

normally do but here's the reason behind it so 

we get our Medical Officers to take a look at 

it.

MEMBER FRIEDMAN-JIMENEZ: Okay. If 

that's the case, I think that that word 

experimental can be potentially problematic 

because that could be changed depending on the 

opinion of the Medical Officer.

I think it would make sense to change 

that to a different word. Experimental has a 

pretty precise medical meaning and it means 

generally in a medical experiment, a randomized 

trial.

And I think you should either say 

unapproved treatment or some other word beside 

experimental because otherwise I think there are 

going to be problems of differing 
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interpretations of that word.

MR. VANCE: Yeah, this is John Vance. 

I think we define it earlier in that section 

somewhere. I hope to go back, I just -- and, of 

course, I just closed it, but I'm pretty sure 

that we do have some sort of description of what 

is meant by experimental treatment. So I'll have 

to -- I will pull that up and -- and circulate 

that.

MEMBER FRIEDMAN-JIMENEZ: Okay, 

because we've similar problems coming up in the 

World Trade Center program that people actually 

have, you know, a cancer treatment that they 

feel their life depends on and it's denied 

because it's so-called experimental. And it can 

really lead to problems.

MR. VANCE: Yeah, this is John again, 

so obtaining evidence for evaluation of requests 

to participate in experimental treatments, also 

known as investigatorial protocols or clinical 

trials, experimental treatment.

So this is wording from our procedure 
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manual, experimental treatment is a treatment 

that is not generally accepted by the medical 

community that has a proven efficacy.

So again, it's a very, a relatively 

loose definition. But that's how it's defined in 

the procedure manual.

MEMBER FRIEDMAN-JIMENEZ: I think you 

should consider looking for another word there 

because I know it may not be that often but it 

can lead to pretty, pretty bad problems and bad 

feelings.

MS. POND: Okay, we can look into it.

CHAIR MARKOWITZ: Okay, so let's --

I'm sorry, Dr. Goldman, do you have another 

comment?

MEMBER GOLDMAN: Just to go along 

with George, like, that is confusing. What about 

somebody who might have cancer or something 

where they're part of a, you know, drug trial 

where the only way you can get treatment is that 

you participate in one of those, you know, drug 

trials that they're doing with cancer, with 
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cancer patients. Would that be considered 

experimental?

Because that's not that uncommon that 

people, you know, sign up for those kinds of 

drug trials with chemo.

MR. VANCE: Well, I think what you're 

talking about is all of these are basically 

exception processes that involve a special level 

of review. And so what you're calling it, you 

know, like, an experimental treatment or I think 

in that particular case what you're talking 

about it is an exception process for a 

prescription medication, it's going to have to 

really be dependent on the specific issues that 

are involved with that particular case.

You know, so we do have exception 

processing procedures for drug, for prescription 

medications. I think this is separate from that, 

this discussion of experimental treatment.

MEMBER GOLDMAN: But those type of 

things would probably not be something that 

would be automatically paid for in a medical 
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bill system and would raise a flag that they 

would have to look at and then determine, you 

know, is there something more we need or 

whatever?

And so it really will depend on the 

specific request, but if it is not paid at the 

bill pay level it will raise a flag for our 

medical benefits during its review.

CHAIR MARKOWITZ: Okay, any other 

comments, questions? Okay, so we're done this. 

We have just a couple minutes before we start 

the public comment period.

We have two commenters, so the public 

comment period is not going to last that long. 

And my question to the Board members is if the 

public comment period is relatively short 

whether we should continue with one 15-minute 

item, the first 15-minute item from tomorrow?

Or whether we should just finish for 

the day and resume tomorrow 1:00 p.m.

MEMBER BOWMAN: This is Aaron. I 

would vote for finishing with the agenda as is 
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and resuming tomorrow. It would give a little 

bit of time for some Board members on the -- for 

us to think about the issue with the IARC, for 

example.

CHAIR MARKOWITZ: Okay, other 

comments?

MEMBER GOLDMAN: I agree.

CHAIR MARKOWITZ: So the vocal 

minority wins. And what we'll do is after the 

public comment period we will adjourn for the 

day and then resume tomorrow at 1 o'clock.

So with that, I turn it over to I 

guess Carrie or the moderator? I'm not quite 

sure.

MS. RHOADS: Kevin, can you tell if 

the FRC's public commenters are online?

MR. BIRD: Yes, so right now I 

believe it's only Terrie Barrie is on the line. 

I do not see D'Lanie Blaze.

MS. RHOADS: Okay.

CHAIR MARKOWITZ: Well, why don't we 

have a couple of -- we have a couple in a couple 
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minutes to break until 4:15 probably, to be 

fair.

MS. RHOADS: That's right. Does the 

moderator have to change something in the format 

so we can hear the public comments?

MR. BIRD: Nope, just whenever you're 

ready just ask for that person and we will put 

them through.

MS. RHOADS: Okay.

CHAIR MARKOWITZ: So while we're 

waiting, for tomorrow's discussions on looking 

at data that's available from DOL and whether 

additional data might of interest, Carrie's 

sending around an email with the link to the 

program's public reading room.

And that has various files and it 

won't take very long, but in about 20 minutes or 

so you can open a number of those and see what 

kind of data the program routinely provides. And 

so that we can work from there and see whether 

there's additional data that might be of

interest.
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And it's 4:15 so we can get started 

with the public comment period.

MR. BIRD: And Dr. Markowitz, I 

already jumped in but I just would remind 

everyone on the line that if you were not 

scheduled to make a public comment but would 

like to please press star one to make that 

known. I will go back to you, Dr. Markowitz for 

jumping in.

CHAIR MARKOWITZ: Okay. Okay, so we 

can start with Ms. Barrie.

MS. BARRIE: Hello, this is Terrie 

Barrie. Can you hear me?

MR. BIRD: Yes, we can.

CHAIR MARKOWITZ: Yes, we can.

MS. BARRIE: You can. All right. 

Well, good afternoon, Dr. Markowitz and members 

of the Board this is Terrie Barrie and I'm the 

founding member of the Alliance of Nuclear 

Worker Advocacy Group. I want to thank you for 

your continued service and for the opportunity 

to provide these comments.
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I provided a letter from ANWAG, oh, 

earlier this summer concerning the cancers that 

were rescinded, and I'd like to clarify why this 

request would fall under this Board's purview 

instead of the Advisory Board on Radiation and 

Worker Health.

First, under the statute, the 

Radiation Board is not permitted to provide 

advice to the DEEOIC, but this Board can. I 

guess they could provide advice, but, you know, 

the department wouldn't consider it, I imagine, 

but this Board can.

It was DEEOIC that initiated the 

dialogue with the National Cancer Institute on 

whether cancers could be considered a specified 

cancer and therefore compensable if a claimant 

qualified under the special exposure cohort.

When NCI came back with a positive 

answer and the reasons behind it, DEEOIC began 

processing SEC claims to include this subset of 

cancer. Then someone at DOL noticed that the 

statute only allowed DEEOIC to consult with NCI 
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only about the names and nomenclature of 

potential cancers, not if a type of cancer can 

be considered a specified cancer.

I guess I can almost understand 

DEEOIC's reasoning. However, the fact remains 

that NCI had determined that the five cancers in 

question are specified cancers. The statute 

allows this Board to provide advice on the 

claims adjudication process generally.

For example, I've noted earlier today 

the Board provided the recommendation that

parkinsonism should be treated as Parkinson's 

disease. Respectfully, I ask the Board to review 

the original and rescinded final circulars and 

consider recommending to DEEOIC that the five 

cancers identified in those circulars, as well 

as the SLL/CLL issue Ms. D'Lanie Blaze raised in 

her written comments do qualify as a specified 

cancer.

NCI has already done the heavy 

lifting. DEEOIC, of course, can reject your 

recommendation, which I hope they do not, but at 
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least they will know that if they do they will 

not be violating the statute if they accept this 

Board's recommendation.

I am hoping the discussion tomorrow 

will reveal that DEEOIC has finally issued a 

request for proposal which will provide a 

support contractor to the Board. The Board has 

mentioned the need many times over the years but 

wasn't informed that a formal recommendation was 

necessary until about 2019.

Still, it's astounding that it has 

taken almost three years just to issue a request 

for proposal. I cannot understand why it has 

taken so long to provide the Board with the 

resources they need and requested.

The Department of Labor had the 

personnel and infrastructure in place and the 

interim rules, the interim final rules to 

process claims a mere eight months after 

Congress passed the law in -- on October 30th, 

2000.

I don't understand why they're having 
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such a difficult time with finding an 

appropriate contractor for the Board.

From today's conversation and 

discussion, I would recommend, or suggest, not 

recommend, but I would suggest that the Board 

ask for the number of cases that were filed for

mesothelioma. That will give you an idea of how 

frequently the cases were approved or 

disapproved.

When it comes to the impairment 

rating decisions, I'd be curious to find out how 

long it takes for a recommended decision should 

be issued from the time the impairment rating 

physician submits everything to DEEOIC and when 

the final decision is finally issued.

I'm hearing still that these claims 

are being delayed by months and months. So that 

would help figure out that there's a problem 

with claims examiners issuing these decisions.

And that's all I have for today, and 

I thank you again for this opportunity.

CHAIR MARKOWITZ: Okay, thank you. 
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The -- did Ms. Blaze get on the line?

MR. BIRD: Not yet, no.

CHAIR MARKOWITZ: Okay, okay, fine. 

So let's move to Ms. Donna Hand?

MS. HAND: Yes, can you hear me?

CHAIR MARKOWITZ: Yes.

MS. HAND: Okay. My issues are the 

same as Ms. Blaze, as well as Ms. Barrie 

according to the, you know, specified diseases 

or specified cancer. That has been defined in 

the act as you know, you know, and they list 

certain cancers that are listed as specified.

But part of the option is is the 

specified diseases designated in this section 

means a physiological condition or conditions 

that are recognized by the National Cancer 

Institute under those names or nomenclature or 

under any previous accepted or commonly used 

names or nomenclature.

So whenever that was added in there, 

that gave the duty for Department of EEOICPA to, 

you know, assist the claimant in developing or 
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going to the National Cancer Institute and say, 

well, since CLL is a leukemia it, does that --

is that nomenclature?

Is the spinal cord cancer the same 

thing is a brain cancer because they did that 

with the myelodysplasia syndrome, and the

policy, you know, says random.

You know, so again is the parathyroid 

and the thyroid, is it the same underneath the 

recognized condition for the National Cancer 

Institute? That, you know, so that right there 

is what we need to have done is that the 

National Cancer Institute is to be addressed or 

to be asked, you know, to add these into.

I know that the CLL is in the statute 

that says it's not a radiogenic cancer, but then 

the (audio interference) changed that. So that 

may be a technical or, you know, a legal thing 

that may have to be changed as well.

The other issue is the impairment 

that's being done. A lot of the activities of 

daily living are not being addressed and not 
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being added into the impairment. So (audio 

interference) before they would get an 

impairment of 35 percent, now they have home 

health care and they're only 36 percent.

And so the consistency of adding 

those impairments in addressing activities of 

daily living needs to be addressed and be 

consistent as well as in all the reports.

The -- before they would also give a 

three percent for chronic pain and the fifth 

guide does allow three percent for chronic pain, 

and they do not do that for the impairment 

anymore.

Also the depression and anxiety, the 

fifth guy has it listed at three percent also 

for that, and that's not even addressed because 

they said there's nothing there to give the 

impairment for.

The other issue that I have is that 

Haz Map is no longer part of the National 

Institute of Health so why can't we use and 

address the environmental health perspective and 
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their database, the Collaborative on Health, 

because it is very claimant friendly.

You can put in a health effect or you 

can put in a disease or you can put in a toxic 

substance and they list three separate 

categories of, you know, good evidence, of 

medium evidence or limited evidence. And they 

use the same studies and everything for 

occupational to, like, you know, environmental 

reports and studies that is used in the CMC 

report.

So that should be, you know, 

addressed as too, so then the non-cancer 

illnesses are in that database and they list the 

toxic substances.

So thank you very much for your time.

CHAIR MARKOWITZ: Thank you. This is 

Steven Markowitz, a point of clarification. So I 

know you've mentioned this in previous public 

comment. What is this database that you're 

referring to? What is it specifically?

MS. HAND: The Collaborative of 
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Health and it's within the Environmental Health 

Perspectives. I sent you an email with a link to 

it.

CHAIR MARKOWITZ: Environmental 

Health Perspectives is a journal, so you're 

saying that the Collaborative on Health is a --

MS. HAND: A toxic diseases database 

within their website.

CHAIR MARKOWITZ: Okay. Well, I don't 

know if you -- I'll take a look, but if you 

wouldn't mind sending in the details as a 

written comment so in case we have trouble 

finding it. That would be helpful.

MS. HAND: Will do.

CHAIR MARKOWITZ: Yeah, thank you. 

Okay, Ms. Carroll is next?

MS. CARROLL: This is Stephanie 

Carroll. I am an authorized rep here in Denver 

and I specialize in beryllium disease claims, 

and I just have a few comments just from hearing 

the meeting today. Thank you so much for 

accepting my comments today.
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So what I would like to first just 

point out is the Act was and Congress were very 

clear and unambiguous in the language when 

discussing medical benefits for this program. 

Under medical benefits in the Act, the 

commencement of benefits reads, an individual 

receiving benefits under this section shall be 

furnished those benefits as of the date on which 

that individual submitted the claim for those 

benefits in accordance with this subchapter.

In other words, when they put in a 

claim for Part B or Part E that's when they're 

putting in a claim for medical benefits and 

that's when they shall be furnished.

Also medical benefits that are 

provided, quote, "the United states all furnish 

to an individual receiving medical benefits 

under the section for an illness the services, 

appliances and supplies prescribed or 

recommended by a qualified physician for that 

illness, which the president considers likely to 

cure, give relief or reduced the degree or the 
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period of that illness.

I think it's very important to pay 

attention to the clear and unambiguous language 

of the Act when determining if workers are going 

to be furnished the medical benefits that their 

physician orders or recommends.

I think that the language by saying 

recommends and that the president considers 

likely to not just cure or treat, but to give 

relief or to reduce the degree or the period of 

that illness should be paid attention to 

because, you know, changing the meaning of the 

Act in a procedure manual by saying that if a 

doctor recommends a lung transplant we all have 

to determine if it will reduce the degree or the 

period of that illness. I think it would and why 

are we accepting this very steep criteria to get 

authorization for treatment? Now, to be 

consistent, if they're relying on the fact that 

a lung transplant is experimental, yet they are 

approving the drug treatment for COVID right 

now, which those drug treatments are often 
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experimental at this point, then it's not 

consistent to say that they're going to run 

people through mill here if they want a lung 

transplant but if they have COVID they're going 

to allow them to get this experimental 

treatment.

So I think it has to be consistent no 

matter the cost of the treatment.

The other thing is when it comes to 

nomenclature with the NCI, of course, the Act 

has been very clear on that which, thank you 

Donna for reading the Act's language into the 

record today, something has changed in the 

program.

My grandfather was actually approved 

for secondary bone cancer but it wasn't called 

secondary bone cancer. He was actually approved 

for prostate cancer metastatic to the bone.

When I contacted right now, they are 

not treating the underlying cancer. It's 

secondary bone cancer is approved in this 

program. Before they used to count the primary 
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cancer which would be prostate or blast or 

melanoma that has gone to the bone, they would 

actually include that cancer as an approved 

cancer in this program.

They don't do that anymore. They only 

approve something called secondary bone cancer. 

When I called, contacted NCI and said I'd like 

some treatment record or treatment papers for 

secondary bone cancer, there is no such thing. 

Secondary bone cancer is not a cancer that can 

be treated. It is only treated when it is 

referred to as metastatic from another primary 

area.

So it's prostate cancer secondary to 

the bone or melanoma and so forth. So that is a 

very big concern because I've been having 

problems getting people that have secondary bone 

cancer related to the prostate covered for their 

treatments. And it's really been awful.

So that's something that's changed 

and the law has not changed, but the procedure 

manual has changed on that.
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And then, let's see, I'm having a 

problem still with Dr. Hoffman. He is actually 

being asked questions by the claims examiners 

concerning chronic beryllium disease which the 

Act actually does not -- it does address using 

physicians, but not for Part B because it's a 

statutory diagnosis.

So Dr. Hoffman is being asked 

questions about the statutory criteria for 

chronic beryllium disease and if workers meet 

that criteria. And then when you look at his 

references, his reference is the procedure 

manual.

So he is actually weighing in on an 

approval for statutory disease or not. He's not 

getting questions such as does his PFP show 

obstruction. No, he's getting asked does this 

person have pre-93 or post-93 CBD.

I don't think a doctor should weigh 

in on that. I think the doctor is not a claims 

examiner and if they are going to start using 

him as such then we should, you know, actually 
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list him as part of the program as a claims 

examiner, because he is weighing in on people 

getting their claims approved or not. And 

nothing seems to be done about that physician.

And then one more thing is 

Econometrica in 2005 addressed so many of the 

issues that you are being asked to address. And 

what I'm concerned about is when we do these 

illnesses that are presumed, sometimes they are, 

well, the presumption is more stringent than the 

Act ever intended.

So you have to pay really close 

attention to what the Act and Congress intended. 

And then also all of the work that was done by 

Econometrica you may be doing work right now 

chasing after this very big projects that 

they're giving, maybe to distract you from the 

stuff that's more important.

But go back to Econometrica, I think 

a lot of your work was done in that report in 

2005 when it comes to presumptions or exposures 

that are expected to be at the site.
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The other thing, when it comes to 

Rocky Flats and the dates of production until 

1989, yes, production, official production 

stopped at 1989 but after '89 they were 

processing waste. They were doing all kinds of

processes that were the same as during 

production.

So I'm very concerned about those 

then changing in the sun based on that, and also 

the SEM does have in library of documents that 

have already been used to verify that those, 

that those exposures are on site and the DOE 

gave over those documents. I can't get copies of 

them, but asbestos has a library full of 

documents that there, that's provide exposure 

information.

So you could ask for that library 

index from Department of Labor. There is a SEM 

library, all of the documents that support each 

part of SEM have SEM or have DOL library numbers 

connected to them if you look at the old SEM.

So that's all I have to say but thank 
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you so much for listening. I appreciate all of 

the work that you do. Thank you, bye-bye.

CHAIR MARKOWITZ: Okay, thank you. 

Are there other public commenters?

MR. BIRD: There are not, no.

CHAIR MARKOWITZ: Okay. So let me 

then, I think we've done our business for today. 

Let me turn it over to Mr. Chance.

MEMBER CATLIN: Yes. Yes, thank you, 

Dr. Markowitz and all the public commenters, 

everyone who took part in the meeting today. We 

will adjourn at 4:34 and resume at 1 o'clock 

Eastern Time tomorrow.

Everyone enjoy your evening.

CHAIR MARKOWITZ: Okay, thank you 

very much.

(Whereupon, the above-entitled matter 

went off the record at 4:34 p.m.)