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UNITED STATES DEPARTMENT OF LABOR

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ADVISORY BOARD ON TOXIC SUBSTANCES

AND WORKER HEALTH

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SUBCOMMITTEE ON THE SITE EXPOSURE

MATRICES (AREA #1)

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MEETING

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FRIDAY,

JANUARY 6, 2017

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The Subcommittee met telephonically at 

1:00 p.m. Eastern Time, Laura S. Welch, Chair, 

presiding.

MEMBERS

SCIENTIFIC COMMUNITY:

JOHN M. DEMENT

MEDICAL COMMUNITY:

LAURA S. WELCH, Chair

CLAIMANT COMMUNITY:

KIRK D. DOMINA

GARRY M. WHITLEY
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OTHER ADVISORY BOARD MEMBERS PRESENT

FAYE VLIEGER

DESIGNATED FEDERAL OFFICIAL:

CARRIE RHOADS
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A G E N D A

Improvement of the OHQ in collaboration 

with DEEOIC .................................. 10

Review of COPD cases from DEEOIC, and the

COPD presumption ............................. 38

Recommendations for a model for exposure

assessment at sites without SEM .............. 45

Discussion of hearing loss presumption ....... 55

Other items in follow-up to October ABTSWH

in Oak Ridge TN .............................. 56

New business as proposed by subcommittee 

members ...................................... 65

Adjourn ...................................... 95
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1 P-R-O-C-E-E-D-I-N-G-S

2 1:05 p.m.

3 OPERATOR: Thank you all for standing 

4 by. Welcome to today's conference call. At this 

5 time the lines have been placed on listen-only for 

6 today's conference. Your lines will be on 

7 listen-only for the duration of today's 

8 conference. The conference is being recorded. If 

9 you have any objection, please disconnect at this 

10 time.

11 I will now turn the conference over to 

12 our host, Ms. Carrie Rhoads. Ma'am, you may 

13 proceed.

14 MS. RHOADS: Thank you. Good morning or 

15 afternoon, everybody. My name is Carrie Rhoads, and 

16 I'd like to welcome you to today's conference 

17 meeting of the Department of Labor's Advisory Board 

18 on Toxic Substances and Worker Health, the 

19 Subcommittee on the Site Exposure Matrices, or SEM. 

20 I'm the Board's Designated Federal 

21 Officer, or DFO for today's meeting.

22 We do appreciate the time and the work 
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1 of our Board Members in preparing for the meeting 

2 and for the work they'll do afterwards. I'll do a 

3 quick roll call of the Subcommittee Members, 

4 please. Dr. Laura Welch is the Chair of the 

5 Subcommittee.

6 (Roll Call)

7 MS. RHOADS: Regarding meeting 

8 operations today, I don't think we'll need to take 

9 a break, although Dr. Welch can chime in on that 

10 if she'd like to take one. Copies of all meeting 

11 materials and any written public comments are or 

12 will be available on the Board's website under the 

13 heading "Meetings," and the listing for this 

14 Subcommittee meeting. The documents will also be 

15 up on the WebEx stream so everyone can follow along 

16 with the discussion.

17 The Board's website can be found at 

18 DOL.gov/OWCP/energy/regs/compliance/advisoryboa

19 rd.htm. I encourage you to visit the website if you 

20 have not done so. After you click on today's meeting 

21 you'll see a page dedicated entirely to today's 

22 meeting. These contain publicly available material 
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1 submitted to us in advance of the meeting and we'll 

2 publish anything that is provided to the 

3 Subcommittee. You should also find today's agenda, 

4 as well as instructions for participating 

5 remotely. 

6 If you are participating remotely and 

7 you're having a problem, please email us at 

8 EnergyAdvisoryBoard@DOL.gov. If you are joining by 

9 WebEx please note the discussion is for viewing 

10 only and will not be interactive. The phones will 

11 also be muted for non-Advisory Board Members. 

12 Please note that we do not have a 

13 scheduled public comment session today. The call 

14 -in information has been posted on the Advisory 

15 Board website so the public may listen in, but not 

16 participate in the subcommittee's discussion. 

17 The Advisory Board voted at its April 

18 2016 meeting that subcommittee meetings should be 

19 open to the public. A transcript and Minutes will 

20 be prepared from today's meeting. 

21 During the Board discussion as we're on 

22 a teleconference line, please speak clearly enough 
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1 for the transcriber to understand. When you begin 

2 speaking especially at the start of the meeting 

3 please state your name so we can get an accurate 

4 record of the discussion. Also, please ask our 

5 transcriber to please let us know if you are having 

6 an issue with hearing or with the recording. As DFO, 

7 I see that the meeting -- the minutes of the meeting 

8 are prepared and insure that they're certified by 

9 the Chair. The minutes of today's meeting will be 

10 available on the Board's website no later than 90 

11 calendar days from today per FACA regulations. If 

12 they are available sooner, they will be published 

13 sooner.

14 Also, although formal Minutes will be 

15 prepared, we'll also be publishing verbatim 

16 transcripts which are obviously more detailed in 

17 nature. Those transcripts should be available on 

18 the Board's website within 30 days. 

19 I would like to remind the Advisory 

20 Board Members that there are some materials that 

21 have been provided to you in your capacity as 

22 special government employees and members of the 
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1 Board which are not for public disclosure and 

2 cannot be shared or discussed publicly, including 

3 in this meeting. Please be aware of this as we 

4 continue with the meeting today. These materials 

5 can be discussed in a general way which does not 

6 include using any personally identifiable 

7 information, such as names, addresses, specific 

8 facilities if a case is being discussed, or 

9 doctor's names. 

10 And with that, I convene this meeting 

11 of the Advisory Board on Toxic Substances and 

12 Worker Health, Subcommittee on the SEM. I'll now 

13 turn it over to Dr. Welch, who is the Chair.

14 CHAIR WELCH: Thank you, Carrie, and 

15 thanks, everybody, for being on the call. 

16 I have two questions before we get to 

17 the agenda. We had received a copy of the Draft 

18 Occupational Health Questionnaire which doesn't 

19 have any personal identifiers in it, but it is also 

20 not because it's a draft made publicly available, 

21 so how can -- what level discussion can we have 

22 about that document on this call in the context the 
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1 fact that it's not publicly available?

2 MS. RHOADS: I think most of the 

3 discussion should be okay about that.

4 CHAIR WELCH: Okay. 

5 MS. RHOADS: I'll jump in if I think that 

6 anything is -- shouldn't be discussed further. 

7 CHAIR WELCH: Okay. And then, John, the 

8 reason I had wanted you on the call is to talk about 

9 the sites that are not in SEM. And that was like 

10 I think -- that's down the agenda but we can address 

11 that first if you want to deal with the question 

12 we had for you and then go to something else. If 

13 you want to stay on the call the whole time and 

14 listen to that discussion about the OHQ, that would 

15 be fine, too, so just let me know what you prefer, 

16 what you want us to do. 

17 MR. VANCE: I'm pretty much at your 

18 disposal. I am slated for the entire meeting to be 

19 here. 

20 CHAIR WELCH: Okay. Okay, that's great. 

21 Okay, so why don't we just look through the agenda. 

22 I put five things and then we'll option for new 
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1 business on the agenda. The five items are -- we're 

2 probably not going to get through them all in any 

3 case, but does anyone have something that's new 

4 business they want to make sure we get around to 

5 talking to today before we work through what I have 

6 already written down? Okay, good. 

7 So the first item was for us to develop 

8 a process for the collaboration that we've agreed 

9 to with the Department on improving the 

10 Occupational Health Questionnaire. And I hadn't 

11 realized because I hadn't opened that the disk that 

12 the draft was on there, but I was able to do that 

13 yesterday and got a look at that. And I had 

14 circulated to everyone the questionnaire that we 

15 used in the BTMed program. So we have some time both 

16 to discuss the questionnaire, get the -- and we want 

17 to make sure we have some time left over to talk 

18 to -- scan the comments with the rest of the Board 

19 and get the comments back to the Department. Does 

20 everybody have a clear look at the draft 

21 questionnaire that we got from the Department?

22 MEMBER DEMENT: Yes. 
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1 CHAIR WELCH: So any comments on that in 

2 particular?

3 MEMBER DEMENT: John Dement. I -- my 

4 major comment is that unless there's something that 

5 I didn't see in the draft, it looks like it's 

6 largely just a place to enter free text rather than 

7 having places where you specifically ask about 

8 exposures, such as on the current questionnaire. 

9 So it's -- I'm not so sure -- this is just my first 

10 take on it. I'm not so sure that the new 

11 questionnaire is going to stimulate a lot of 

12 specific recall on the part of workers, nor 

13 necessarily the individuals who are doing the 

14 administration of the interview. And it's really 

15 just some categories of exposure and they ask for 

16 a lot of free text. I'm not opposed to free text 

17 because I think it adds a lot, but my major concern 

18 is it doesn't ask about specific exposures that are 

19 known to occur among at least certain trades and 

20 some they're maybe even pretty much DOE specific. 

21 CHAIR WELCH: Yes, I agree with that, 

22 too. Comparing with the old one there were specific 
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1 exposures that were on the current draft, and now 

2 it looks like it's -- instead of asking about 

3 specific ones it's actually a little bit 

4 open-ended, so I agree with you on that. 

5 MEMBER DEMENT: So I guess I'm not sure 

6 that it's actually going to improve things. That's 

7 my major concern. You know, I'd like to hear from 

8 others for what their thought on this is. 

9 CHAIR WELCH: I know that -- this is 

10 Laura Welch, again. One of the things that we had 

11 talked about in our March/April meeting was the 

12 value of asking about tasks, as well, which would 

13 be a challenge to develop a list of tasks for all 

14 the different tasks, but I think that would be a 

15 good addition, in addition to specific agents, 

16 exposure situations, to ask about tasks because 

17 that's where industrial hygienists think that you 

18 can always get a sense of the intensity overall dose 

19 that one would -- how the material -- how exposure 

20 to material occurs. And as it is now, that 

21 information about how the individual is exposed to 

22 materials is asked in the free text. That gives you 
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1 a window to tell us how you were exposed to them, 

2 so I think we can also add some information on 

3 tasks. 

4 MEMBER DEMENT: Yes. Well, you know, I 

5 think the collection of free text information which 

6 often includes a description of how the work is done 

7 and the associated tasks. I think it's helpful but, 

8 you know, one of the problems we've had all along 

9 in the Former Worker Program is how you stimulate 

10 recall of workers who are trying to recall 

11 exposures that happened 20, 30, even 40 years 

12 earlier. And sometimes, you know, just a list of 

13 task -- certainly a list of materials helps, as 

14 well. You know, it has the potential for a worker 

15 checking everything which is not useful, but it 

16 also I think -- on counterbalancing I think it 

17 stimulates some degree of recall. 

18 You know, I would continue to ask the 

19 questions about materials that are -- I believe 

20 it's on the other questionnaire. I don't think it's 

21 that bad, maybe add here and there, and modify that 

22 a bit more by asking more about the task, as Laura 
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1 said, but preserving the possibility of workers 

2 entering just their own descriptions in free text. 

3 The other sort of -- and to me in 

4 reviewing the questionnaire and the cases that we 

5 have, the COPD cases, there's a -- you know, 

6 there's the issue of what the questionnaire is, but 

7 also how the questionnaire is administered and 

8 subsequently used. And I think we ought to talk 

9 about that, as well. No matter how good we make this 

10 questionnaire, it's never going to be perfect. 

11 There's going to be recall issues. They'll always 

12 be there so we have to just do as good a job as we 

13 can, but I think we need to think about the process 

14 of how this is integrated in there, and the whole 

15 process for kinds of adjudication because I don't 

16 -- I can't see this actually used very much 

17 currently except for getting the information about 

18 occupations and time frames and sites. 

19 MEMBER DOMINA: Hey, this is Kirk. I've 

20 got a -- just a comment. Like when this starts out 

21 about, you know, where you worked, or assessed 

22 production, or construction, it needs to be and/or 
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1 or put both in there because I'll tell you straight 

2 up, half of our workforce used to be construction, 

3 now they're on the production side, or it can be 

4 vice versa, or they go back and forth two, or three, 

5 or four different times. And I think it's important 

6 to capture that so that people understand what 

7 people do because some of the jurisdiction is 

8 different based on what side of the fence you're 

9 on, and your exposures can be also. Sometimes, 

10 sometimes not, but I don't want somebody who is 

11 looking at this that does not understand the work 

12 that goes on at these different sites, look at it 

13 and say well, you can be both and try and put them 

14 into just one category, because you can't. And I 

15 believe it's important. 

16 MEMBER DEMENT: So I don't know how to 

17 proceed with this. Do others find this 

18 questionnaire to have improved on what we've done 

19 before? My view is it doesn't. 

20 MEMBER WHITLEY: This is Garry here. I 

21 don't think it has, and I'm -- a lot of our -- the 

22 majority of our people worked construction, then 
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1 switched over to maintenance for years. Another 

2 thing is, keep in mind that a lot of times a family 

3 member, a spouse, or family member is the one who's 

4 trying to do these and they really don't have a 

5 clue. Now it's pretty clear on the questions that 

6 -- even the ones that are filled out by workers, 

7 they don't recall a whole bunch. 

8 MEMBER DEMENT: Correct. 

9 CHAIR WELCH: Yes, I agree with you, 

10 John. I don't think it's an improvement, and I 

11 think, you know, there's lots of stuff that you have 

12 to get by picking up the different agents. I guess 

13 one question that John has is if our Subcommittee 

14 will make a list of recommendations, but how 

15 specific would you want the recommendations to be 

16 to go back to the Department and you can share them. 

17 Do we have to develop a pretty specific draft or 

18 -

19 MR. VANCE: I mean I -- this is John, and 

20 my take on this is that, you know, what we're trying 

21 to do is collect information; however that 

22 information can be input into the case file that 
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1 allows us to evaluate that in conjunction with 

2 other pieces of information. So in response to 

3 John, you know, how we use this. This is another 

4 data point where we are trying to collect 

5 information and then trying to correlate that 

6 information to other sources of information, such 

7 as information that we're gleaning out of the Site 

8 Exposure Matrices or correlating the direct 

9 information that we're receiving from the site 

10 itself, so this is seen as sort of a complementary 

11 piece of information in case analysis. It also 

12 leads us down paths of development that may not be 

13 easily identified in employment records we get from 

14 the Department of Energy, so just to clarify that 

15 point. 

16 But as far as I'm concerned, you know, 

17 the team that's working on this is open to getting 

18 very specific recommendations as to what can be 

19 done to improve the quality of the information that 

20 we're receiving. And I think Garry it was, was 

21 making a good point. You have to also keep in mind 

22 that the folks that are completing this form are 
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1 oftentimes survivors of deceased employees. 

2 They're not going to have a lot of information about 

3 specific toxins. And, you know, the defaults we 

4 find a lot of times is that people say they don't 

5 know or may have been exposed to specific things 

6 when we identify them. And often times, and this 

7 is just my personal view, a lot of times people are 

8 unfamiliar with a lot of the very highly technical 

9 toxins that are identified in some of our forms and 

10 such, so that's also an experience I think that 

11 we've encountered. 

12 But, Dr. Welch, I think that my view 

13 going forward would be, you know, if you have 

14 specific recommendations about how we can go about 

15 how we can go about improving on the current version 

16 of the Occupational History Questionnaire in 

17 conjunction with the drafts that we're messing 

18 around with right now, I would definitely ask that 

19 that happen with as much specificity as possible, 

20 really. 

21 CHAIR WELCH: Okay. And then I asked, on 

22 Monday, I was interested in input from Mark 
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1 Griffon, and I can go to him after our call, was 

2 if we wanted to develop a list of tasks and if they 

3 have that on the production side. And I think that's 

4 a big project, from my point of view, it's a big 

5 project. 

6 COURT REPORTER: Sorry, this is the 

7 transcriber. Could you repeat that?

8 CHAIR WELCH: Sorry, I put my hand by my 

9 microphone. I think developing a list of tasks for 

10 the production side is a big job, but it may be that 

11 the people who understand that production side may 

12 know that, but I don't. Have an idea in their head 

13 of what some of the overarching tasks are so nothing 

14 achievable. 

15 Okay, the language I would propose is 

16 that I'll send the committee a list of what we've 

17 discussed and what I remember we discussed when the 

18 full Board was together with specific suggestions, 

19 and you can all add to those suggestions, and you 

20 can -- it may turn out that that will come out to 

21 a specific list of recommendations which would be 

22 great, or we may have to triage out a little bit 
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1 more work to get a final list of suggestions for 

2 the proposed draft.

3 But, John Dement, I want to circle back 

4 to something you said about how not just what's on 

5 the questionnaire but how it's used. Do you think 

6 --

7 MEMBER DEMENT: Yes. Let me elaborate on 

8 that a bit, if I can because --

9 CHAIR WELCH: Yes.

10 MEMBER DEMENT: -- I think what 

11 -- certainly the case I reviewed -- I didn't review 

12 all of these cases for COPD, but I reviewed a fair 

13 number of them; I think enough to get a pretty good 

14 sense of what's happening. 

15 To me what's happening is this OHQ is 

16 prepared. They get it to the claims examiner. They 

17 took off information with regard --certainly with 

18 regard to sites and covered employment and label 

19 category, immediately go into the Site Exposure 

20 Matrix based on the labor category and site and 

21 determine -- to come up with a statement of 

22 accepted facts on exposures two things are 
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1 required. What is the labor category and site has 

2 to specifically list an exposure and, two, those 

3 exposures have to be linked in the SEM to the 

4 condition being claimed, e.g., COPD. If either one 

5 of those conditions aren't met then it doesn't top 

6 out as an exposure to be considered by either the 

7 industrial hygienist or the CMC. And so I don't see 

8 that the Occupational History Questionnaire is 

9 being given much weight at all. Even if they have 

10 a lot of detailed descriptions in it, I don't think 

11 it would get much weight. So it seems to me the 

12 process is not in the right order. 

13 It seems to me the industrial hygienist 

14 and a knowledgeable individual with regard to 

15 exposure needs to be early on in that process for 

16 determining, first of all, which exposures are 

17 going to be considered. The SEM is a tool, of 

18 course, but I don't think it should be the only tool 

19 that's used. In our review of what's going on, the 

20 SEM is driving pretty much everything with COPD. 

21 That's my biggest concern with the 

22 process as it exists. The hygienist and the CMC, 
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1 I think their hands are tied based on what the

2 claims examiner picks out of the SEM. 

3 MEMBER WHITLEY: Garry here. I think 

4 you're exactly right; it's not just for COPD. 

5 Pretty much the way I see it is exactly what you're 

6 saying, and they use the -- they get the DOE 

7 records, and they use those DOE records which gives 

8 them the job categories he worked, and the years 

9 and all of that, of course, employment records from 

10 DOE. And they take that straight to the SEM and use 

11 the SEM to decide whether you were exposed to those 

12 chemicals or not. That's -- I think the 

13 questionnaire is, of course, used, but the SEM is 

14 driving everything. 

15 MEMBER DEMENT: Well, the workers, you 

16 know -- this information, the decision, 

17 recommended decisions are given back to the worker 

18 and they're provided the opportunity to dig back 

19 in and provide more information, but unfortunately 

20 they are at a great loss. 

21 And I think if everybody would take a 

22 look to find a case number, I think it's Case Number 
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1 Five on the list in the COPD cases, to me that 

2 particular one exemplifies the whole process 

3 problem with COPD in particular, and I assume they 

4 extend to the others. This is a case of an 

5 individual who had long periods of work at the site, 

6 ended up having only a couple of exposures that are 

7 considered by the Site Exposure Matrix. Those 

8 exposures were independently assessed with regard 

9 to COPD and then the decision was made, so a 

10 hygienist and the CMC only had the opportunity to 

11 look at two exposures. To me this case, after 

12 reviewing -- I think I reviewed about a dozen of 

13 these cases. This case just exemplifies to me, 

14 first of all, the difficulty of the task but also 

15 the problems I see in the process. 

16 CHAIR WELCH: Yes, and I think I've 

17 looked at a number of COPD cases over the years, 

18 and I would agree with you on that, and we saw that 

19 in some of the other cases as well. Specific 

20 exposures that come out of the trends are not 

21 necessarily representative of the totality of 

22 exposures, and there are some kinds of exposures 
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1 that particularly, for COPD, that aren't captured. 

2 In fact, that specific metric can't be captured in 

3 this one.

4 MEMBER DEMENT: Yes, I think the -- you 

5 know, I'm not saying the SEM is not a useful tool, 

6 just in many cases there's not much information to 

7 go on at all. But where there is and the worker has 

8 had an opportunity to develop this questionnaire, 

9 seems to me it ought to be given a little more 

10 weight. And, you know, we talked about the IH having 

11 access to the worker along the process assessing 

12 exposures. Why are they only accepting exposures 

13 that are given to them by the SEM and not exposures 

14 -- totality of exposures that are given on the OHQ 

15 and the SEM? Yes, discussions with the worker, but 

16 the worker at that point would probably clarify a 

17 lot of issues. 

18 CHAIR WELCH: Right. So here's the 

19 question back to John Vance. I know that the overall 

20 stated approach is to use exposures that come from 

21 -- use information that comes from other sources, 

22 but when they see that the case at hand, it's really 
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1 focusing on SEM, and maybe unintentionally 

2 limiting what gets through to them. Is there a 

3 procedure that --- I think I want to say, to insure 

4 that the industrial hygienist and the CMC see all 

5 the exposure information that was collected, not 

6 just what is accepted. And I guess some of the 

7 recommendations the Board made about having the 

8 whole case file could fix that, but there may be 

9 some other way in which we could make a 

10 recommendation in the structure or approach to 

11 claims adjudication. So we kind of need to say our 

12 recommendation is to have an industrial hygienist, 

13 the other materials and also recommend that they 

14 talk to the worker. But is there anything more 

15 specific we could recommend that would get the 

16 claims information to the SEM?

17 MR. VANCE: You know, I'm certain 

18 -- this is John. I certainly would welcome any kind 

19 of feedback that the Board has or the subcommittee 

20 has on how we evaluate information. I think John 

21 does have a very good point in that, you know, it's 

22 a question of how do you value, or how do you assess 
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1 the accuracy of the information that's been 

2 reported on the Occupational History 

3 Questionnaire? You know, the current methodology 

4 is that the information and forms are evaluation 

5 of a claim and it is looked at in conjunction with 

6 the Site Exposure Matrices. You know, but how do 

7 you weigh that information? How can you validate 

8 that the information being reported by an employee 

9 or survivor is an accurate representation of what 

10 occurred? What we do is then look at, you know, 

11 -- collaborate -- you know, basically correlating 

12 information that we're getting from that employee 

13 like I said before and looking at, okay, if the 

14 employee is saying X, and this is complemented by 

15 information we have in the Site Exposure Matrices, 

16 and is also supported by information that we have 

17 in the DAR, we're in a much better position to 

18 rationally and reasonably say that's a factual 

19 finding that the Department can make with regard 

20 to this case. Okay?

21 If you're saying that we should be 

22 valuing the Occupational History Questionnaire 
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1 more so than we are, then the criterion that the 

2 Board would need to focus on is identifying for 

3 claims examiners, you know, how do you weigh this 

4 information if the employee checks off every single 

5 exposure on the Occupational Questionnaire that 

6 they think they came in contact with, do we accept 

7 that as factually accurate? Do we ever question 

8 that? You know, how reliable is that information, 

9 and how does the CE make a judgment as to what is 

10 a reliable piece of information reported on the 

11 Occupational Questionnaire versus something that

12 may be dubious for whatever reason? And that's 

13 going to be challenge. 

14 And the other thing, of course, is 

15 -- John's got a very good point, as well, is the 

16 sequence about development. Is there some change 

17 in our process that could occur that would allow 

18 us to get a better feel for the information or a 

19 more reliable outcome? And the -- you know, having 

20 a total evaluation of a case with a complete and 

21 comprehensive understanding of every single toxic 

22 substance exposure that an employee may have 
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1 encountered, that is a very good and noble goal, 

2 but you also have to keep in mind that this is a 

3 case adjudication process. And the longer that we 

4 take in developing a case means that the longer the 

5 employee is going to be waiting for us to actually 

6 reach a decision. 

7 So while we do implement these 

8 prioritizations and we do focus on certain things 

9 in these case files, we're trying to focus on the 

10 things that are going to try to produce the best 

11 possible outcome for the claimant. So could there 

12 be suggestions and recommendations made about, you 

13 know, how we could change that process to produce 

14 better outcomes within a certain set of prioritized 

15 considerations in these cases, because I think the 

16 concept of doing a comprehensive evaluation of 

17 everything to produce the most complete exposure 

18 profile is a very big challenge for a program that 

19 deals with lots and lots of claims.

20 CHAIR WELCH: Okay. That's actually very 

21 useful because I think that -- I mean, I can decide 

22 which exposures are relevant. And then the other 
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1 thing I wanted to mention, too, is that 

2 presumptions factor, and when the exposures are 

3 going to be captured in the SEM. 

4 MR. VANCE: This is John real quick. I 

5 do want to chime in on that. That would probably 

6 be the best recommendation I can make for making 

7 this process more smoother and more 

8 claimant-oriented, is if looking at how we are 

9 evaluating COPD from these claims, and if you're 

10 seeing a trend then that -- you know, a lot of the 

11 cases have certain criteria that you're looking at 

12 and saying geez, these cases should have probably 

13 just been approved or what have you based on 

14 whatever scientific or medical merits that you guys 

15 can arrive at. That would be something that would 

16 be really critical because that would be the 

17 quickest path to getting cases to a positive 

18 outcome. Changes to process, changes to, you know, 

19 procedure and all that sort of stuff has a much 

20 longer path to getting those kinds of outcomes; 

21 whereas, a presumptive change is a quick thing that 

22 the program can do to immediately say this cohort 
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1 of cases, if we meet those criteria and move that 

2 to an accepted, you're going to have a very quicker 

3 -- you're going to have a much quicker pathway to 

4 approvals.

5 MEMBER DEMENT: John -- this is John 

6 Dement, again. I agree with you, and also agree with 

7 you on the difficulty of coming up with criteria 

8 to look at to evaluate this Occupational History 

9 Questionnaire.

10 I just -- you know, we've already, I 

11 think, made a recommendation that the industrial 

12 hygienist at least have access to the worker in the 

13 process of reviewing exposure, evaluating the 

14 degree and severity of exposure. 

15 I guess, you know, the other part of 

16 that recommendation I would recommend is that the 

17 hygienist have at his access the OHQ at the time 

18 they make contact with the worker to clarify some 

19 issues with regard to exposure. And we can't 

20 eliminate professional judgment here at all. 

21 There's going to have to be a judgment on the part 

22 of the hygienist on which exposures are more 
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1 likelier than not going to have some relationship 

2 to the outcome, and at least give the hygienist the 

3 ability to query more about some of those that the 

4 worker has listed as opposed to just those that pop 

5 out of the SEM. 

6 There's no way we're going to ever 

7 eliminate -- first of all, there's no way we ever 

8 can be perfect. There's also not going to be a way 

9 we'll ever eliminate some workers and some people 

10 who have been workers dismissing everything, every 

11 disease known to man, and etching out every 

12 exposure which doesn't help. It stifles the 

13 process, and it really doesn't -- in my view 

14 somebody who is helping a worker and checks off 

15 every known disease does not help that particular 

16 worker either. So, you know, I guess I would get 

17 -- I just want the knowledgeable individual to have 

18 access to the OHQ to at least consider that as part 

19 of the exposure assessment and not be constrained 

20 to what the claims examiner has given them to 

21 review. 

22 MEMBER DOMINA: This is Kirk. What John 
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1 Dement was saying about the OHQ that you're filling 

2 out which could be 10 years after you retire, or 

3 whatever the case might be, some of the sites have 

4 work history questionnaires that are filled out 

5 annually to go with your annual physicals, and 

6 maybe some of those need to be tapped out of these 

7 because, you know, as time goes by people forget, 

8 and site-specific ones could be of more help than 

9 lack of a better term, a generic one that's given 

10 later on. And if those are being passed on for an 

11 IH to review, because some of them -- and then some 

12 of the other things that your physical is based on 

13 are specific on some of the hazards and the amount 

14 of time that you're exposed to those hazards, it 

15 could be more helpful to help frame what the 

16 individual's job exposures were, if that makes 

17 sense. 

18 MEMBER DEMENT: It does make sense, and 

19 some of the -- you know, again I review a fair 

20 number of the COPD cases. Some of the cases that 

21 we have in this file have that in there. They have 

22 the annual physical and the questionnaire that was 
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1 filled out with the annual physical, and some 

2 actually have some determinations by the site in 

3 terms of which categories, like if you have 

4 certifications they need. I think those are 

5 actually pretty helpful and most cases really 

6 supported the exposures that I saw occurring by the 

7 worker. And, frankly, in those cases they also 

8 supported the exposures that popped out of the SEM, 

9 as well. But I think they are useful, and I think 

10 as a hygienist you -- whatever you can get your 

11 hands on with regard to the history of that person's 

12 exposure. And if it already exists it ought to be 

13 part of what the IH sees.

14 MEMBER DOMINA: This is Kirk, again. And 

15 I agree and, you know, some of these different forms 

16 and stuff that came on line for like when you're 

17 talking about a hazardous waste worker, some 

18 -- that training didn't start until the late '80s, 

19 you know. 

20 MEMBER DEMENT: That's right. 

21 MEMBER DOMINA: And so anything past 

22 that, you know, we've got to look at that, because 
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1 I can even look at like my private medical stuff 

2 and what your physical was based on is pretty 

3 limited, you know. And it varied out here at Hanford 

4 at that point in time because we, basically, had 

5 three different things going on at one time based 

6 on what area you worked for, or which contractor. 

7 And so when an individual says that they do -- did 

8 these certain tasks or whatever, you can't rule 

9 that out just because you may or may not have some 

10 document for that, you know, because there was 

11 limited information. You know, and I know it's a 

12 balance but, you know, like I have no problem 

13 sharing my file with people on the Board to look 

14 at so you can understand what I'm explaining, 

15 because my physical and stuff back in the '80s was 

16 based on this little one-page thing which was very 

17 generic that the supervisor basically filled in 

18 some blanks, you know, and that was it. 

19 CHAIR WELCH: And another thing is what 

20 we would like to have happen. That doesn't include 

21 the industrial hygienist information.

22 COURT REPORTER: This is the 
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1 transcriber. You're a bit muffled. 

2 CHAIR WELCH: Oh, okay, let me just 

3 -- I'm afraid if I unplug my -- I'll just try it 

4 again. Does that sound better now? Hello? Can you 

5 hear me?

6 MEMBER DEMENT: Yes, I think that's 

7 better for me. It's not as muffled. 

8 CHAIR WELCH: Okay.

9 COURT REPORTER: Yes, that's a little 

10 better.

11 CHAIR WELCH: Okay. So what I was saying 

12 is we want to find a way to recommend to the 

13 Department that these other information sources 

14 not in summary be precluded from the Statement of 

15 Accepted Facts, that they're acceptable and 

16 available to the industrial hygienist and the CMC 

17 to look at when they're looking at the claims. And 

18 that would -- even if we have a presumption that 

19 the many other cases for which that recommendation 

20 would apply. I think we'll make that recommendation 

21 and then if there are specific things to have 

22 implemented, I don't think that that takes longer 
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1 than those other sources of exposure information 

2 in the file and they should carry forward from the 

3 claims examiner to the CMC and the industrial 

4 hygienist. And then there's some caveats with all 

5 of them as we get exposure information.

6 MEMBER DEMENT: Yes, to me it does. I 

7 think the assumptions are a way to help out the 

8 process. But I expressed a concern about 

9 presumptions based, again, on reviewing these 

10 files. And I'm afraid the presumptions for COPD, 

11 and particularly with regard to the asbestos issue 

12 has become a de facto threshold for -- you know, 

13 if you don't, for example, have asbestos-related 

14 chest x-ray changes of some form, then they do not 

15 attribute COPD to asbestos, even in the presence 

16 of a fairly prolonged exposure. 

17 CHAIR WELCH: Yes, it's a difficult 

18 problem when the -- I mean, I think we can, for COPD 

19 doesn't focus that much on asbestos. And there's 

20 a bigger problem among the cases that I review, the 

21 CMC is not real knowledgeable. 

22 Let's turn to the files and the COPD 
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1 presumptions. And, again, fix everything that we 

2 want to fix, but we can come up with a couple of 

3 ideas of how to do that. 

4 John, you already mentioned some of the 

5 things that you found in the case files. Does 

6 anybody else have any comments on the COPD case 

7 files? 

8 MEMBER DEMENT: I think, you know, I've 

9 sort of summarized and I guess I could go through 

10 them all and probably see the same patterns, but 

11 I think there is a couple of issues where the 

12 presumption might help. One is, you know, we think 

13 COPD is not related to just asbestos related to the 

14 cumulative exposures to these vapors, gas, dust, 

15 and fumes, and so, you know, we need to act in a 

16 way that's meaningful. 

17 The other issue, and I think you've 

18 touched on it, was the CMC. Some of them have some 

19 strange ways of making these determinations. Some 

20 determinations are very difficult because of short 

21 exposure. You know, some exposures were a year or 

22 two, or even less, and so those become problematic 
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1 for anybody to review and to make an attribution 

2 to, but there's some strange things that seem to 

3 be just so inconsistent across the CMCs. 

4 One of the cases I reviewed, the CMC 

5 looked at an exposure of about a year, and I think 

6 it was to diesel and said well, you know, that may 

7 -- you know, if that could be long compared to 

8 normal aging, so he calculated that this person 

9 would have about a 13ml total based on the one-year 

10 exposure, and then a finding that it wasn't 

11 related. To me, just that process of doing that was 

12 so counter-scientific. First of all, this is for 

13 exposure but to say that the person immediately, 

14 or it's going to cease having an impact after 

15 exposure ceases is just foreign to me. 

16 I mean, somewhere along the way these 

17 -- there has to be some process for the CMC applying 

18 some criteria that are consistent across 

19 themselves. 

20 CHAIR WELCH: Yes, you know, there was 

21 another committee. 

22 MEMBER DEMENT: I know there is history 
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1 with the SEM that looks -- that for some reason the 

2 CMC - now COPD is obviously diagnosed late in life 

3 and it occurs to everybody late in life no matter 

4 what you do. If you're a smoker, you don't usually 

5 have COPD, and some of these -- not necessarily in 

6 your 50s, you have it later. So we focus on 

7 exposures that occurred early on in their work 

8 life. Then there were many years that passed and 

9 they're diagnosed with the COPD later, and the CMC 

10 says well, he should have seen it, you know, soon 

11 after the exposure if it was related to exposure, 

12 which is just total nonsense. A smoker, and all you 

13 have to -- just think rationally, a smoker is not 

14 going to have COPD early on right after they're 

15 first starting to smoke, even 20 years of smoking. 

16 It's going to occur late in life. So I don't know, 

17 you know -- and I was just frustrated trying to get 

18 to the rationale behind some of these CMC 

19 decisions. 

20 CHAIR WELCH: Yes, I'm with you on that. 

21 It's a very big burden on the worker to have to go 

22 back and get another expert opinion, and CMC was 
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1 incorrect for that and it's not always even 

2 accepted. 

3 So, you know, I think we can send 

4 comments on -- if you make notes on the and make 

5 it -

6 MEMBER DEMENT: I've got my own short 

7 form and made notes on some of these cases I've been 

8 going through. I can send it to -

9 CHAIR WELCH: That would be great, 

10 because then I think we can send them -

11 (Simultaneous speaking)

12 CHAIR WELCH: All those cases were 

13 available to the other committee so we could point 

14 out ones for them to look at that would be 

15 informative in terms of the committee that's 

16 looking at the CMC questions, so that would be 

17 great. 

18 MS. RHOADS: Hi, this is Carrie. Just as 

19 a reminder, if you're going to be preparing 

20 documents for emailing around be very careful about 

21 how you identify the cases, that there's no PII in 

22 your documents. Thanks.
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1 CHAIR WELCH: Thanks you for the 

2 reminder. So, I mean, I'm a big fan of the new 

3 presumption for COPD. What I have sent around was 

4 the current presumption and then some comments on 

5 that. And within the comments we did make 

6 recommendations of how to improve the -- how to 

7 adjust some of the criteria within the current 

8 presumption. So if others had a chance to look at 

9 that and want to comment on it? I guess what I would 

10 like to see is either now in the call or after the 

11 call but everyone on the Subcommittee would review 

12 that document that was submitted. Does anybody now 

13 have any comments on the -- on both the 

14 presumptions? Are you guys all still there? Am I 

15 still here?

16 MEMBER DEMENT: Yes, I'm still here, 

17 Laura.

18 CHAIR WELCH: Okay. I think about it, and 

19 I guess it's Garry or Kirk wanted to speak on the 

20 medical causation part. 

21 MEMBER WHITLEY: Garry here. I agree 

22 with you 100 percent. I think this is a good 
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1 starting point, and we can use that. 

2 CHAIR WELCH: Okay, great. 

3 MEMBER VLIEGER: This is Faye. And just 

4 you know, Dr. Redlich has sent in an email to 

5 everyone that she wanted included in the 

6 discussion. 

7 CHAIR WELCH: Yes, I took a quick look 

8 at it, but I sometimes find it hard to understand 

9 specifically what she wants us to discuss, so I 

10 think what I'll do is I'll call her afterwards. I 

11 think she would be aligned with what we were talking 

12 about earlier exposure information. So I'll touch 

13 base with her. 

14 Okay, so in terms of the presumptions, 

15 what I think I'll do is see how specific she would 

16 like it at Hanford. 

17 So number two was how the Department 

18 currently does exposure assessments and some 

19 comments on that. And I don't know if everyone got 

20 a chance to see it, but John was saying that on other 

21 information like the employment records and 

22 claimant testimonies. 
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1 So, Kirk, I think this is something that 

2 you thought was important, that we have a 

3 discussion. Can you tell us?

4 MEMBER DOMINA: Yes, I was going through 

5 some of it just this morning because I have had 

6 computer problems the last couple of weeks, and 

7 some of them I'm going to have to look at, you know, 

8 more specifically because just like the one I 

9 glanced at this morning when you were talking about 

10 Grand Junction. It said to refer to the mills, you 

11 know, around there. And one of them has 34 

12 chemicals, one has 80 some, the other has 90 some 

13 but, you know, they're talking specifically about 

14 the Grand Junction facility, and that obviously 

15 they made yellow cake there. And I need to do a 

16 comparison to see all the chemicals, and I don't 

17 fully understand -- I understand it's a smaller 

18 operation there, but yet they have an SEC that runs 

19 from 1943 to 1985 currently, to make sure that all 

20 the chemicals are covered.

21 CHAIR WELCH: And that's having a SEM.

22 MEMBER DOMINA: No, it does not have a 
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1 SEM, but they -- John sent out a thing and said it's 

2 listed under the mills and the mines for around 

3 there, and so I was just trying to wrap my head 

4 around how they came up with that, or how somebody 

5 is supposed to know that. Because if you just go 

6 to the SEM site and you don't know that, you're not 

7 going to get there. And then which one of the three 

8 do they pick for Grand Junction operations, you 

9 know? And so it's not real clear, or are they just 

10 using all three of them? And, you know, if I'm 

11 wrong, you know, John, I know, you're probably 

12 there, you can say something because, you know, I'm 

13 just trying to figure it out this morning for the 

14 first time. And I think I just -- it just seems odd 

15 to me when we have SECs at places because they can't 

16 reconstruct dose but yet, you know, it's -- you 

17 know, there's no SEM that it could -- or could be 

18 used against somebody. And I just think like 

19 Hanford when they put PNNL separate in '05 and 

20 there's no SEM for PNNL right now, and so like you 

21 could have an individual who did construction, who 

22 did production on the non-PNNL side, could be at 
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1 the PNNL side, or gone back and forth, and if you 

2 need to get into that, what are you going to do is 

3 it's post-2005, what are you going to use for a SEM? 

4 I mean, it's just trying to understand the logic 

5 of some of it because especially the way that some 

6 of them read when they say there's nothing in the 

7 Site Exposure Matrix. 

8 MR. VANCE: Kirk, this is John. Yes, it 

9 is undoubtedly a challenge, especially if you have 

10 trade workers that are jumping between sites. We 

11 try to engineer as much information as we can about 

12 the different sites so you'll see the Grand 

13 Junction facilities, but if you look up you'll see 

14 we have something on the Climax uranium mill in 

15 Grand Junction. So, you know, yes, it's very 

16 complicated I would say with regard to the mines 

17 and the mill and a level of complexity that doesn't 

18 exist for some of the big sites. We have set up in 

19 the Site Exposure Matrices that you can go in and 

20 do your searches depending on whether you're 

21 looking for a DOE facility and the exposure 

22 information that we maintain on that, or you're 
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1 going to look at a separate link to the uranium 

2 mines or mill. So this is a complete comprehensive 

3 listing of all of our registered DOE facility data. 

4 This doesn't necessarily break it down into the 

5 mines and mills. I don't think it does to the level 

6 of specificity that we have a mapped site, but it 

7 does have a lot of information in here about 

8 virtually all the DOE sites. 

9 And I would just clarify that, you know, 

10 the reason you would -- and just a level of context. 

11 The reason you would see that we don't have 

12 information on a site is because Paragon, the 

13 contractor doing the facility research, you know, 

14 they populate data in the Site Exposure Matrices 

15 based upon chemical and biological toxins that are 

16 recorded on primary source documentation from the 

17 site or the Department of Energy. If we have no 

18 employment records about what was going on at the 

19 site, if we have no exposure data about what was 

20 going on onthe site, then Paragon is in no position 

21 to actually provide a profile for that facility. 

22 So that's why vast majority of these that are listed 
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1 as not in SEM are like that, is because when we've 

2 gone and done our research and our data collection 

3 efforts we've come back empty-handed with regard 

4 to some of these sites. Most of these sites that 

5 are listed here as not having information are very 

6 small sites that had very limited engagement with 

7 the Department of Energy and the Atomic Weapons 

8 program, or they were facilities that were run by 

9 like the federal government, like the Albuquerque 

10 Operations Office. We find that most of the 

11 employees there were federal so they're not going 

12 to have a lot of coverage under Part E because that 

13 classification of employee is uncovered. So it 

14 really is at the end of the day mostly about not 

15 having access to records. 

16 We have functionality that allows 

17 people to submit information that they have on 

18 these sites. If there's no information that we have 

19 on a particular site and someone has that kind of 

20 data, we do have the mechanism for them to submit 

21 that information.

22 But yes, again, Kirk, you're right, 
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1 though. It's a challenge. You have to look at the 

2 history of the worker, and then you have to try to

3 correspond what they're telling you with regard to 

4 their employment history when you're doing your 

5 analysis of the exposure utilizing the Site 

6 Exposure Matrices. So, this is as comprehensive a 

7 list that we've been able to put together, but we're 

8 always willing to take more information on any of 

9 these sites and to improve our data collection 

10 efforts for exposure analysis. 

11 MEMBER DOMINA: I just want to make sure, 

12 because -- and I understand some of these sites are 

13 old, and they were small but, you know, when a same 

14 individual is from one of those sites and does have 

15 issues caused by working there, I guess I just look 

16 at it as I don't want to make it -- the little guy 

17 still needs to have the same chance as somebody 

18 that's a big guy, you know, and still operating, 

19 has a bunch of people there with knowledge and 

20 there's more information. I just want to make sure 

21 that it still gets the same amount of scrutiny, if 

22 not more, because of maybe some of the evidence, 
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1 and so somebody does due diligence to look at it 

2 and try and understand some of the history. Because 

3 when you get into some of those it is in the details, 

4 and I just -- you know, I don't want them to feel 

5 like they got left out. 

6 MR. VANCE: Yes, this is John, again. 

7 Just to make sure that you understand that even if 

8 they -- you know, the Site Exposure Matrices, while 

9 it's a very important and vital tool to our process, 

10 in the absence of information in the Site Exposure 

11 Matrices, claims examiners are still going to 

12 evaluate all the other information that we get in 

13 the case. So, you know, we would look, we would go 

14 through the normal process of asking the claimant 

15 in the Occupational History Questionnaire to give 

16 us data about what they encountered or what they

17 were doing at the site.

18 We would ask DOE to supply any 

19 information they have in their records. We would 

20 still try to do the research to make sure that there 

21 aren't other sites that the employee may have 

22 worked in that we do have information in the Site 
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1 Exposure Matrices, and we do consult with our 

2 industrial hygienist, where necessary, to say 

3 okay, if we have somebody that was working at a site 

4 who's identifying the type of work activity, we 

5 have no information in our Site Exposure Matrices, 

6 you know, can we formulate some sort of exposure 

7 finding to apply in their analysis of the claim? 

8 So we do go through a process of evaluating those 

9 cases, it's just that it's being done in the absence 

10 of any data from the Site Exposure Matrices. 

11

12 CHAIR WELCH: This is Laura Welch. In 

13 that case the work of an industrial hygienist is 

14 particularly important because, you know, if you 

15 have an Occupational Questionnaire that talks 

16 about some exposures or some tasks, like we said 

17 earlier, we'd like to have that to be able to 

18 corroborate, or some DNA records, you're not going 

19 to have it. So maybe there's some way to get -- in 

20 a small number of cases, to get a hygienist review 

21 sooner rather than later, because the kind of work 

22 the individual did could be associated with SEM. 
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1 But if trying to create a SEM doesn't make any 

2 sense, you guys have tried. And we've already 

3 talked about having information outside of the SEM 

4 is much more technical or complicated and it's 

5 subject to recall, would be subject to 

6 over-reporting so you really need expert input 

7 there. So I don't know the -- I mean nothing the 

8 group could think about recommending that for a 

9 site without a SEM that the industrial hygienist 

10 be asked to look at all the exposure information 

11 early on in the process. I don't know how you guys 

12 would do that. But that could go to personnel. That 

13 somehow gives the worker instructions about what 

14 they need, you know, like their history, and then 

15 they're going to need an affidavit or something so 

16 that the whole exposure effect doesn't get lost in 

17 a couple of years in trying to develop evidence. 

18 So two ideas have a hygienist, you know, give the 

19 worker some kind of template how to develop their 

20 own exposure profile. 

21 Does that sound like something that 

22 could happen, John, or are they too out of the 
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1 ordinary?

2 MR. VANCE: I think those all are very 

3 good ideas. You know, I'm going to always default 

4 to Dr. Welch; do whatever you think is appropriate 

5 to recommend. My only thing is specificity is 

6 always very important for us. You know, identifying 

7 a problem is one thing, but offering a very good 

8 specific solution and a recommendation as to how 

9 to make that process work better is always very 

10 welcome. 

11 CHAIR WELCH: Okay. Okay.

12 MEMBER WHITLEY: Garry here. I think the 

13 recommendation of this is not a SEM that the 

14 let's-work-on-it kind of claims examiner -- don't 

15 have a SEM. This information is really hard to 

16 get. They ask a lot of times for worker affidavits 

17 or affidavits from coworkers. A lot of these sites 

18 are closed and small, and a long time ago, so there 

19 probably is not very many coworkers. And then from 

20 what experience I've had, an affidavit don't carry 

21 a lot of weight. I've even had some claims examiners 

22 tell me that it's getting very little weight, 
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1 because I've had people fill out their forms and 

2 send them in and didn't have complaints. I think 

3 you're having it involve -- it is not a SEM, and 

4 would be helpful to the claimant. 

5 MR. VANCE: This is John, again. You 

6 know, Garry, in regard to -- in response to your 

7 point, you know, one of the things that you can 

8 certainly consider as part of your discussion with 

9 the subcommittee is, you know, if there is a problem 

10 with weighing or evaluating affidavits, that 

11 speaks to exactly what we were talking about with 

12 the Occupational History Questionnaire. Are there 

13 recommendations that you can make with regard to 

14 how can the program feasibly look at valuing an 

15 affidavit and providing a basis for a factual 

16 finding in a claim? In other words, is there a 

17 methodology that you could recommend saying if this 

18 affidavit meets these criteria, it can be 

19 considered to a very probative piece of information 

20 versus something that is not? 

21 CHAIR WELCH: Do -- so I think -- now 

22 Garry likes the idea of having the cases that don't 
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1 have a SEM go to the industrial hygienist to develop 

2 the exposure assessment. 

3 The next item is discussion of the 

4 hearing loss presumption. And after I talked to 

5 Steven Markowitz earlier in the week, we figured 

6 you could leave the presumption today. And I 

7 thought it -- we thought it was a good idea to have 

8 more than one committee; some would work on COPD, 

9 but since the whole Board has looked at the hearing 

10 presumption we think we can let presumption 

11 committee go with that. 

12 Then the next item, the questions that 

13 -- I think some people had talked about that asked 

14 about one of the subcommittees that had asked about 

15 the specific issues, and had Carrie send that list 

16 to me. And I had attached it to the agenda, 

17 priority questions. And I think that some of the 

18 questions that were asked were questions of 

19 causation. Are these causally related prostate 

20 cancer? But as with any question that has to do with 

21 causation, it has to do with exposure assessment. 

22 I have really got through these things well enough 
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1 to figure out how the exposure assessment fits in. 

2 I think that one of the recommendations, you know, 

3 one of the recommendations that were identified. 

4 That would help with this question because there 

5 is an established link between prostate cancer and 

6 what causes it, the SEM. The question then would 

7 come up whether the exposure was sufficient to be 

8 considered positive or contributory. And I don't 

9 know that there's anything, a particular attribute 

10 needs to be added to this list. I don't know if 

11 you've had a chance to look through it, but any 

12 comments or any thoughts about the role the

13 Committee could play in moving it all forward to 

14 address these questions that the Department has 

15 asked before. 

16 MEMBER DEMENT: Laura, this is John. It 

17 seems to me for most of these 14 items, a major issue 

18 in some cases is the link with occupational 

19 exposures. And I think using the links that are 

20 established in the literature from these sources 

21 within the SEM itself would help clarify some of 

22 this. But short of -- I mean, these are reviews, 
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1 authoritative reviews that have been done for the 

2 most part, and in my view, an authoritative review 

3 that's pretty much accepted in the literature. If 

4 that has not made that link, then I think the 

5 Committee is not going to do much else.

6 Short of that, it would require, in my 

7 view, a detailed assessment for some of these 

8 conditions and the possibility of a link with 

9 occupational exposure. That seems like it's passed 

10 for some of it. For example, lupus and other kinds 

11 of autoimmune disorders in occupational exposures. 

12 You know, that literature is pretty current in 

13 those cases. There's some suggestions for things 

14 but it's relatively thin for the most part. It's 

15 been looked at pretty closely by authoritative 

16 sources. So I don't -- you know, what else do we 

17 add to that process?

18 MR. VANCE: Dr. Welch, this is John.

19 CHAIR WELCH: Yes.

20 MR. VANCE: I actually have a suggestion 

21 that came up from our analysis of some of these 

22 websites, and I thought I'd throw it out there just 
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1 for folks to think about, if you don't mind.

2 So the question of health effects data, 

3 one of the things that we utilize are the IARC 

4 Monographs. We use the Group One that is reporting 

5 the Site Exposure Matrices, but the folks that 

6 we're looking at at the websites pointed out that, 

7 you know, the IARC groups actually have other 

8 groups that are not part of the health effect data 

9 reported in the Site Exposure Matrices. And the 

10 ones that they identified were Group 2A. These are 

11 toxins that are probably carcinogenic to human 

12 populations, and then Group 2B, possibly 

13 carcinogenic to humans. And the thought that we had 

14 was that, you know, if folks could look at that and 

15 advise or make a recommendation as to, you know, 

16 this is -- if the Board would look at that and say 

17 is it sufficient enough or close enough that we can 

18 add that in as viable health effects links based 

19 on those reported probable or possible 

20 carcinogens, that would be something that would 

21 greatly expand the information in the Site Exposure 

22 Matrices based more so on what we already have, 
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1 which is just that Group 1, which is the 

2 carcinogenic to human finding from the IOM. Just 

3 to throw it out there as a thought. 

4 CHAIR WELCH: And that's an easy task and 

5 --

6 (Simultaneous speaking)

7 MR. VANCE: I'm going to say that would 

8 be something that we -- when we were looking at that 

9 right now does not presently exist in the Site 

10 Exposure Matrices. We focus on Group 1 Monographs, 

11 that's what's pulled in from Haz-Map but looking 

12 -- you know, if the Committee or the Subcommittee 

13 could look at, you know, Group 2A and Group 2B and 

14 make a recommendation as to whether or not there 

15 is sufficient scientific basis to say for the 

16 application in our program recommending the use of 

17 those monographs would be something that would be 

18 helpful. But, you know, that's a simple request 

19 that may have a much more involved analysis, but 

20 that was just something that we thought might be 

21 something to sort of focus on. If you were looking 

22 for something that's sort of a -- what we would 
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1 think to be a big effect. I think some of the things 

2 in Group 2A are probably touched on in this big 

3 group of 14. 

4 MEMBER DEMENT: Yes, they are. 

5 MR. VANCE: Yes.

6 MEMBER DEMENT: Yes. I think the other 

7 issue is somewhat of this, you know, what's the 

8 reason for classification 2A, and whether or not 

9 it's actually very site-specific? May be 

10 carcinogenic but, you know, all the specific sites 

11 where it results in 2A classification for 

12 carcinogenicity. And that's another issue that 

13 you've probably looked at. 

14 CHAIR WELCH: I think that that was 

15 -- the Board had only proposed trying to take notes 

16 down into a monograph for the SEM. I mean, we had 

17 recommended that the Department get expert advice 

18 that's not necessarily a board, but I understand 

19 that that's a process could take a long time. So 

20 I think that that system has to kind of guide us 

21 further. We want to take on a certain part of it, 

22 and how to turn those into SEM. And there's been 
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1 no valuable one with the biggest value to the 

2 Department with the guidelines for how to address

3 the IARC Monographs, but some of you folks can 

4 probably do it. 

5 MEMBER DEMENT: Laura, this is John, 

6 again. Some of these issues are quite similar to 

7 the issues that have been faced by the World Trade 

8 Center compensation programs, as well. Like 

9 prostate cancer has been one that we worked for for 

10 a few years, so I think it's the one that's being 

11 wrestled with a lot with that process. So we might 

12 take a look at some of the issues in terms of 

13 presumptions that are used there. 

14 CHAIR WELCH: Do you know -- do they show 

15 analysis of the progress of presumptions?

16 MEMBER DEMENT: Some of them do. I know 

17 we went through a process of at least looking at 

18 some of that literature with regard -- I 

19 specifically remember prostate cancer. And, also, 

20 I think the issue of Non-Hodgkin's lymphoma and 

21 solvent exposures, particularly trichloroethylene 

22 and benzene. 
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1 CHAIR WELCH: Yes, okay. I think -

2 MEMBER DEMENT: It's a very similar 

3 process where, you know, exposures are pretty 

4 -- they're just based on surrogates rather than 

5 actual exposures, and so there has to be a process 

6 for coming up with awards, new awards. 

7 CHAIR WELCH: Okay. Was George 

8 Friedman-Jimenez on that committee, too; on the WTC 

9 Board, because I know he --

10 MEMBER DEMENT: I'm sorry?

11 CHAIR WELCH: I was wondering if George 

12 Friedman-Jimenez had been on the World Trade Center 

13 Board? I can ask him.

14 MEMBER DEMENT: He has been. I'm not sure 

15 if he's currently on. I've been off of it about two 

16 years. 

17 CHAIR WELCH: Okay. But that's a good 

18 idea. This raises that same question of how to 

19 expand what's in the SEM, so I think we have to 

20 attack that problem, but also recommendations, so 

21 that I can learn and share it with you all.

22 MEMBER DEMENT: Is Dr. Markowitz still 
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1 on that panel, as well?

2 CHAIR WELCH: You know what, I don't 

3 know. I don't know if he's on it.

4 MEMBER WHITLEY: Garry here. I don't 

5 know if he's on it or not, but I know at one time 

6 the Queens College was the one that was doing some 

7 of the physicals and research and the health 

8 programs.

9 MEMBER DEMENT: You know, I'm not 

10 saying, Laura, a tremendous amount but there's some 

11 similarities that we probably ought to take a look 

12 at and see if we can make some similar types of 

13 presumptions for this process, or non-links. You 

14 know, some of the diseases that were claimed were 

15 not linked to long-term exposures.

16 CHAIR WELCH: My thought was we 

17 recommended that the Department incorporate 

18 complements from the list, indicating that those 

19 would be sufficient, that we weren't recommending 

20 that someone acquire compensation for what hasn't 

21 been accepted by the Agency. I -- the assessments 

22 because then there are 13 or 14 different 
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1 resources, kind of the ball park and it would be 

2 sufficient. But there are options in that Group 2 

3 as to how they would be used. And as you're pointing 

4 out --

5 COURT REPORTER: This is the 

6 transcriber. I didn't catch any of that. 

7 CHAIR WELCH: Oh, I'm so sorry. I don't 

8 know what I'm doing, except I have a bad cold so 

9 I'm probably kind of breathing heavily. I will 

10 summarize what I said. Are you getting it now?

11 The issue of how to incorporate the data 

12 and whether the Department has an obligation to go 

13 beyond that with the claims they've submitted so 

14 far that's not in the sources. And that looking at 

15 how the World Trade Center developed their 

16 presumptions would help us approach that task of 

17 getting more in this one. 

18 MR. VANCE: And, Dr. Welch, just to also 

19 suggest that, you know, the focus needs to be on 

20 the occupational component of this because I think 

21 some of the World Trade Center issues did not 

22 necessarily link back to occupational exposures. 
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1 CHAIR WELCH: Yes. 

2 MEMBER WHITLEY: Garry here. The 

3 Veterans Administration have several 

4 presumptions. I don't have a clue how they came up 

5 with them, but they have several presumptions if 

6 you worked at certain places with certain stuff. 

7 CHAIR WELCH: Sometimes those were 

8 because they developed them. I know they did that 

9 with the Gulf War exposures so the exposures could 

10 be considered causal. And it's a great process that 

11 this Department can do. If there have been more 

12 exposures we can look. 

13 So if we turn to our agenda. 

14 What I -- I'll summarize it, and I know the 

15 transcriber has been doing stuff to capture what 

16 I'm saying and we're going to have some shorter 

17 notes. So I'll summarize those and get them out to 

18 you all. And I thought we would schedule one more 

19 call before the big meeting in April because we have 

20 enough time to do a federal. So for that we could 

21 work on -- let's see what I have. I think I've 

22 summarized something that they're going to 
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1 recommend about how to work on improvements to the 

2 Occupational Health Questionnaire and how to do 

3 more effectively -- it sounds quite necessary. And 

4 so it is unlikely to include information that may 

5 be positive, and we talked a little bit about that. 

6 MEMBER WHITLEY: Garry here. We need to 

7 look at -- if you put in a request for change to 

8 the SEM. For instance, that a certain job category 

9 uses certain chemicals, and the claimant. What 

10 happens, it goes to the SEM, and one of the things 

11 happening, they're going back to the contractor and 

12 asking questions, is this true, and is that, and 

13 whatever. Well, sometimes the contractor now is not 

14 current enough -- they not getting the right 

15 answers from the contractor. I mean, I met with a 

16 claimant the other day to do that, and the 

17 contractor told him no, that wasn't true. And I had 

18 the contracts in my hand that say it was true, so 

19 I -- if a person could tend to have a SEM database 

20 modified change as far as job categories and/or 

21 chemicals, was the process that you go to the 

22 contractor and they make the final decision? My 
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1 question. 

2

3 MR. VANCE: Yes, this is John Vance. What 

4 happens is, when that information is submitted it's 

5 going to always depend on the nature of the data 

6 and the supporting exhibits that are submitted 

7 along with that. What's going to happen is it's 

8 going to be in the purview of our SEM contractor 

9 to evaluate the value of what the information is, 

10 and they will work with their records archives to 

11 go back and check to see how that information 

12 correlates to what they already have. They will 

13 engage in cases with a site to ask for their input 

14 on these things. And, of course, you know, I 

15 -- we're going to have situations where the site 

16 is going to agree this is correct, or this is 

17 incorrect, and then you're going to be left with 

18 well, how do you make that judgment? So we try to 

19 make the best possible information available in the 

20 Site Exposure Matrices, and for the most part we 

21 will default to primary source information. So if 

22 you're submitting data about exposures at these 
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1 sites, the best source is always going to be primary 

2 sourced information. So if you have data such as 

3 a contract or other types of good sourced material, 

4 that should be submitted with your request because 

5 that's what is going to be the real basis for us 

6 to warrant a change of the Site Exposure Matrices. 

7 But it is a very challenging situation if we're 

8 getting reports of exposures that can't be 

9 confirmed by documentation or site affirmation. 

10 MEMBER DEMENT: Thanks, John.

11 MEMBER DOMINA: This is Kirk Domina. 

12 Hey, I agree with Garry on that, because I've had 

13 the same situation that had to do with a job 

14 category, and they asked for data, and we sent them 

15 the current collective bargaining agreement that 

16 showed this job title exists, and it comes back and 

17 says that job title doesn't exist at Hanford. 

18 CHAIR WELCH: I know in the individual 

19 claims that you can ask for a hearing or is the 

20 contractor coming back and can we appeal that?

21 MR. VANCE: Not for that individual fact 

22 finding by Paragon, but it can certainly be an issue 
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1 to start up adjudication of the case. The other 

2 component of this is that if it is raised in an 

3 adjudication, the claims examiner also has the 

4 ability to go directly to Paragon and ask specific 

5 questions through a mail box functionality and ask 

6 the Site Exposure Matrices folks, you know, what 

7 is their take on specific questions like that. And, 

8 Kirk, I don't know the circumstances of your 

9 situation but, you know, you also have to remember 

10 the temporal issues that are involved with regard 

11 to information collection. And so it really does 

12 depend on what information it is that they're 

13 looking at, and are there contradictions that 

14 Paragon is having to wrestle with because that 

15 makes it a challenge when you have one record that 

16 says X, and then they're getting something else 

17 that says the exact opposite, and how do you make 

18 those kinds of judgments? So that's a consideration 

19 to keep in mind. 

20 CHAIR WELCH: So you're saying it's a way 

21 for the claimant to get somebody else to take 

22 another look at it. 
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1 MR. VANCE: Exactly. 

2 MEMBER VLIEGER: John, this is Faye. I'd 

3 like to interject that if the claimant can't come 

4 up with any records to say that this is wrong, there 

5 is no adjudication. They simply say no evidence was 

6 provided. So then with no personnel records they 

7 strictly say what their job category was, where 

8 they were assigned to work, what they were 

9 precisely doing, and what processes they were 

10 assigned to, we go back to the situation where there 

11 is no evidence to provide; therefore, it didn't 

12 exist, and that's the way it's adjudicated. No one 

13 ever believes the claimant on face value. It's 

14 always go back to provide evidence. Well, you go 

15 back to the same situation where there are no 

16 exposure records to put in the personnel records, 

17 so they can't tell you what they were exposed to, 

18 and they can't tell you at what level they were 

19 exposed; therefore, it doesn't exist. And we have 

20 to get around this problem somehow. 

21 MR. VANCE: Well, yes. I mean, I -- we're 

22 going to look at all the information, Faye. And I 
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1 know that when claimants submit information, I do 

2 know that their input on these cases is very 

3 critical, and actually is a very important 

4 component of how we adjudicate the cases. Simply 

5 because a claimant says something doesn't 

6 necessarily mean it's habitually ignored. That is 

7 not the case. We actually will look at what is that 

8 information, and how is it correlating to other 

9 pieces of information, and how does it inform our 

10 analysis in getting to that outcome? So if a 

11 claimant is providing information that is 

12 supported by other pieces of information in the 

13 case file, or they're offering information that can 

14 be utilized to help reach a good informed decision, 

15 that will be used.

16 Same as we were talking about before, 

17 you know, when somebody submits an affidavit or 

18 some sort of personal attestation of exposure, that 

19 is going to be something that's considered. That 

20 is going to be something that's looked at, and is 

21 not going to be discarded out of hand. 

22 MEMBER VLIEGER: John, I beg to differ. 
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1 This is Faye, again. If they cannot provide 

2 evidence and, just like Jerry said, if there's 

3 nobody can sign an affidavit, if people are gone, 

4 if memories are not good, the information provided 

5 by the workers without evidence from the DOE site, 

6 from their personnel records, from exposure, it is 

7 discarded out of hand because they consider it 

8 self-serving. 

9

10 CHAIR WELCH: You know, in some ways 

11 that's not completely unreasonable. It depends on 

12 what information it is. I know in some cases that 

13 some say that the SEM is not going to adequately 

14 assess exposures. And that's what we're talking 

15 about here by including all the other different 

16 exposure information, and relying on the index and 

17 the degree of their expert assessment of that. What 

18 you're talking about here, to me, it seems like the 

19 devil is in the details, and you have a lot of 

20 construction workers in particular who report they 

21 worked at a site and we can't verify it. And there's 

22 just nothing we can do about that. You know it's 
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1 got another category, there should be some way to 

2 fix that, and as you get further into each case then 

3 every -- depending on what information is listed, 

4 there's probably a different approach to it. But 

5 I think that what's missing is this exposure 

6 information, where someone says, you know, I 

7 started five things, and there's no industrial 

8 hygienist, nothing in the SEM that says the worker 

9 was exposed to those five things. So the Department 

10 of Labor is saying well, we can't just take the 

11 worker's report that they were exposed, and that's 

12 a policy but, you know, I mean, I think I would 

13 probably agree with that because if someone ---

14 usually when you hear something about it that the 

15 worker said they were exposed to and look 

16 differently to get that. So, what we're talking 

17 about really very kind of nitty gritty complicated 

18 questions about when do you give the worker the 

19 benefit of the doubt in the absence of other 

20 information. I think we have to kind of look at 

21 individual cases, you do want to look at some cases, 

22 too, and it's outrageous, and that would be 
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1 interesting for us to look at because they may 

2 identify a process problem they can fix.

3 MEMBER VLIEGER: This is Faye, again. 

4 This goes back to what Kirk was trying to explain 

5 to you, is that worker categories don't exist on 

6 the SEM. The exposures for the worker's categories 

7 are somehow limited to the process of Paragon and 

8 the Site Exposure Matrix. We don't understand how 

9 things get removed from the SEM, labor categories 

10 come and go, mostly they disappear, and so the 

11 worker is backed up against the SEM. And we saw that 

12 in a number of the cases, the COPD cases, and the 

13 cases we saw on Disk 2, should be Disk 3 and Disk 

14 4. So I'm -- I don't know how to fix this entirely, 

15 but it really comes down to somebody admitting they 

16 do not have exposure records for the workers, and 

17 to date they are not doing that. 

18 CHAIR WELCH: So when you say a worker 

19 category doesn't exist in the SEM, is that because 

20 there's no identified exposures for that worker 

21 category?

22 MEMBER VLIEGER: I would like to say 
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1 that; however, my labor category at the Hanford 

2 site still doesn't exist. The planner scheduler's 

3 job is to go into the field to get that to assess 

4 the job that needs to be planned and scheduled. 

5 We're out there many times with field work 

6 supervisors right next to them doing similar work 

7 to figure out how to safely plan the job. And my 

8 labor category doesn't exist, so ask any planner 

9 scheduler for any site, you don't sit in your ivory 

10 tower and come up with these plans on how to do work. 

11 Some of the times we have the same issues with 

12 engineers. We have the same issues with laboratory 

13 chemists, particularly experimental chemists that 

14 are working. And they say well, they couldn't 

15 possibly have any exposure, but they've written 

16 peer reviewed papers that said this is what I did 

17 to come up with this result. And to do that they 

18 discussed their chemical process, but that 

19 evidence isn't accepted by the Department of Labor 

20 because it's bounced off of the SEM. 

21 CHAIR WELCH: But is it right to assume 

22 it's not in the SEM because there wasn't -- because 
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1 Paragon couldn't necessarily link that job to that 

2 exposure in the SEM? And what we would get would 

3 be, if the SEM says that -- the industrial 

4 hygienist on site might see exposures in the 

5 planner is nothing like that. Something I want to 

6 clarify for myself, the reason it doesn't appear 

7 in the SEM, I understand it's because there's no 

8 specific exposure information about that job 

9 category. 

10 MEMBER VLIEGER: You can say that, but 

11 then when you go back to more current workers 

12 there's a document called the EJTA, the Employee 

13 Job Task Analysis, and they make groups to tie 

14 associates that they expect you to be exposed to, 

15 and then the training they would have you do to have 

16 you be aware of that hazards. Even those more 

17 current records are not accepted by the Department 

18 of Labor. What I was told at a recent hearing was 

19 oh, that's just that they maybe could possibly be 

20 exposed to, that's not an expected hazard, but 

21 that's not the basis for what that document is. So, 

22 when we look at the historical evidence, it's not 
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1 there, and there was no exposure monitoring for the 

2 employee records. Then you look at things that 

3 happened after the '80s when we started 

4 implementing some of the paperwork to make it look 

5 like they were actually willing to prevent these 

6 type of incidents and accidents for the workers. 

7 And then those documents are not in the records. 

8 Then we come a more current status, and Kirk will 

9 have to tell me exactly what year the EJTA started. 

10 I started work at the Hanford site when 

11 it was formed in 2001, but the EJTA says 

12 specifically what types of hazards the worker is 

13 going to have: physical, mechanical, electrical, 

14 and chemical. But then when you take that into the 

15 Department of Labor -- and I'm sorry, John, this 

16 is what has happened. They say well, that's just 

17 a possibility list; that's not a probability list. 

18 And that's just not what it is, because you're 

19 trained against what your hazards are going to be. 

20 CHAIR WELCH: I mean, this is another 

21 place where I think that it would be hard to fix 

22 the SEM, but if we can effectively guard this and 
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1 have the exposure assessed by looking at the 

2 Occupational Health Questionnaire, have an 

3 industrial hygienist evaluate that, we might be 

4 able to capture some of these other exposures. So 

5 just because you say if you look at the current 

6 -- in the current Occupational Health 

7 Questionnaire or the draft new ones and see if you 

8 think that a good way to try to capture what we think 

9 needs to be there. By asking about other job tasks 

10 you worked around, would it be captured in the free 

11 text, like if you were describing work you did on 

12 the site many years ago, do you think important 

13 exposures could be captured in that free text 

14 process that they're using? I think that's the 

15 opportunity to capture more detail about jobs where 

16 the exposure is often not able to be captured. Do 

17 you think that would help? Do you think that would 

18 help, to implement a questionnaire that would help 

19 fix this problem?

20 MEMBER VLIEGER: I think insuring that 

21 a question on it says what type of hazards were you 

22 trained for, because people remember that 
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1 training, they remember if they had HAZ worker 

2 training, they remember if they had RAD worker 1, 

3 2, or 3 training, and that training is only given 

4 to those workers who are expected to be in those 

5 situations. It's not given to everybody just 

6 because they can. It's not like CPR training, 

7 because those trainings are expensive. So I think 

8 the training aspect has not looked at it, and it's 

9 not -- I don't see it happening in a DAR. I sent 

10 an email to Gail Stutz, the local representative 

11 from the Department of Energy, to ask why I'm not 

12 seeing those records in the document acquisition 

13 request, so that's part of it. 

14 And I'm sorry, I'm going to beat this 

15 drum one more time. The Department of Energy has 

16 said there are no exposure records to go in the 

17 personnel records. And the Department of Labor 

18 knows about this. I've been in discussions with

19 them about this, and they are refusing to address 

20 the Department of Energy's statement that they do 

21 not have individual monitoring records or even 

22 monitoring records from jobs that go in individual 
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1 worker's records. Here again, Kirk can correct me 

2 if I'm wrong, but it's still not happening even 

3 though those regulations are more than 12 years 

4 old. 

5 CHAIR WELCH: I think I missed what you 

6 said, that the information that would document an 

7 individual's exposure is not included?

8 MEMBER VLIEGER: That they are not being 

9 put in the personnel records. Records exist when 

10 we do a job. When you go out, there's pre-job 

11 monitoring and there's job monitoring depending on 

12 the hazard. They're not monitoring for most of the 

13 chemical exposures, what they're more concerned 

14 with is radiation. But even the records that they 

15 have for a particular job are not ending up in the 

16 personnel records of the workers who are in on that 

17 job, the people that were physically doing the 

18 work. And Department of Energy has said this, and 

19 we need it addressed because they constantly bump 

20 us against the worker and say well, provide us your 

21 exposure records. We don't have any; therefore, it 

22 didn't exist. And the records don't exist, so it's 
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1 a catch-22. You're never going to get them because 

2 they don't exist. 

3 On the rare occasions where there's an 

4 incident or an accident where it has been obvious 

5 that something happened, or more than three people 

6 were involved, then there may be some paper trail 

7 that after a while ends up in the personnel records, 

8 but when it's one or two people that get hurt, the 

9 DOE regulations say they don't even have to do an 

10 accident investigation unless they want to. So it 

11 has to be more than three people and then they have 

12 to do an accident investigation.

13 So to go back constantly and say well, 

14 they need to provide the evidence, the evidence 

15 doesn't exist. DOE does not have the evidence to 

16 put in the files, and so something has to be done 

17 to address that. Instead of saying need probative 

18 evidence to prove this or something to link it, when 

19 all of these links are being held by the people 

20 running the SEM, it's not -- it's a vicious circle 

21 and we're just chasing our tail. 

22 CHAIR WELCH: But are there -- is there 
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1 exposure information like, within the last ten 

2 years, exposure to chemicals for jobs at the sites 

3 that are not going into SEM, or is more that they're 

4 not examples for it?

5 MEMBER VLIEGER: The SEM for the overall 

6 site is pretty complete.

7 CHAIR WELCH: Okay.

8 MEMBER VLIEGER: But when they break it 

9 down by labor categories they lose the nuances of 

10 what's going on. And we're not talking laboratory 

11 situations, we're talking open areas. When you have 

12 the site tour you'll see more of what goes on at 

13 a real processing facility versus a laboratory. So 

14 when monitoring is done, it could be area 

15 monitoring, it could be routine monitoring, it 

16 could be monitoring for pre-job, it could be 

17 monitoring during a job. None of that is tied to 

18 the worker. It's all tied to facilities, and those 

19 facility files -- while they exist and are 

20 permanent records --- are never attached to the 

21 worker unless there's been an accident which 

22 warranted an investigation. 
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1 CHAIR WELCH: But that would end up in 

2 the SEM so that the location would work. Right?

3 MEMBER VLIEGER: Yes, yes. But even some 

4 of -- when you look at buildings and what they say 

5 is in the buildings, it's not accurate. You can go 

6 to the OSTI site and you can look at chemical 

7 characterization and process reports for all of the 

8 different sites. And when you're putting input into 

9 the SEM 2004-2005, the Hanford site originally had 

10 168 chemicals which everybody laughed at, and I got 

11 pretty upset about it and sent a number of the CDs 

12 to Paragon with 24 of the papers from the OSTI site, 

13 and then we jumped about 1,000 chemicals and it's 

14 increased since then. But to try and link them to 

15 individual people or processes when once you have 

16 a security badge and you're authorized to be out 

17 there doing what you're doing in the area for that 

18 security badge, you're dispatched all over the 

19 place. And then to say well, because of your labor 

20 category you're not exposed even though you're 

21 standing next to a guy who would be able to be 

22 exposed by his labor category. It makes no sense. 
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1 CHAIR WELCH: Well, it's a question of 

2 how -- what's the best way to have that appear in 

3 the file. And ---

4 MEMBER VLIEGER: I think if we're 

5 looking at presumptive diseases, we need to look 

6 at presumptive exposures. And they need to be 

7 broader, the labor categories. 

8 MEMBER DOMINA: One of the other issues 

9 that you have with that currently, because I know 

10 everybody's heard about the tank farm vapor issues 

11 and what's going on, because -- and that's why, 

12 you know, HAMTC had issued a stop work because you 

13 have these cyclone fences that separate these 

14 areas, and so what's happened is we've had people 

15 exposed outside what's supposed to be a safe 

16 boundary, but they also worked for a different 

17 contractor. They don't work for the contractor who 

18 manages the tank farms. So you have this other issue 

19 of how, you know, that would even play into it 

20 because they're not an employee of the said 

21 contractor who runs the tank farm. So you've got 

22 to know what's going on at each site, and different 
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1 things are going on at different times, and to be 

2 able to I guess truly understand, it is complex but 

3 you've got to drill down into the weeds to get there 

4 and look at some of these, like I had mentioned 

5 earlier, because they're not all the same. 

6 CHAIR WELCH: And could the -- you think 

7 that the worker could adequately report it, and 

8 then the issue is that if DOL looks for some other 

9 verification of what the worker is reporting, and 

10 they can't find that, in the event they go forward, 

11 is that a problem? Because how are you going to 

12 identify those exposures occurred?

13 MEMBER DOMINA: Right.

14 CHAIR WELCH: It has to come from the 

15 worker.

16 MEMBER DOMINA: Right, but part of that 

17 is, too, just like Faye said, that there has to be 

18 some presumption on the chemical because at this 

19 point in time, you know, they're just starting to 

20 put real-time monitoring in. And it didn't exist, 

21 you know, and so you're looking at well, you know, 

22 they're going to say they went out, and the times 
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1 may have been 45 minutes to an hour later, and so 

2 we didn't find nothing. So then the worker is left, 

3 you know, basically floundering because they're 

4 saying it didn't happen. 

5 CHAIR WELCH: Right.

6 (Simultaneous speaking)

7 MEMBER DOMINA: When you come out here 

8 in April and you see some of these workers and 

9 you're going to notice this like Frank, I've said 

10 it before. They all have this weird cough, they've 

11 had an exposure out there that you don't hear or 

12 see anywhere else. 

13 CHAIR WELCH: I think the tank farm would 

14 be one of the hardest --- I mean, I couldn't say 

15 it's the hardest problem. There's certainly been 

16 a lot of excellent advice about it, but I got 

17 -- what I'm -- I'm not quite sure how to address 

18 the questions you guys are talking about, but 

19 obviously it would have to start with the worker 

20 saying I was exposed to this, and I think that 

21 exposure caused my disease. And if we have a process 

22 for the SEM to talk about that occupational history 
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1 is available to the industrial hygienist and the 

2 CMC, and not just about a Statement of Accepted 

3 Facts, that could help. I guess the question is 

4 whether even an industrial hygienist would be able 

5 to look at the work history and know enough about 

6 the exposure that occurred to provide some exposure 

7 assessment. But I don't know any other way to do 

8 it. And if the worker says, for example, I think 

9 that the exposure is --- you know, talking about 

10 what the exposure is -- but there's a planner who's 

11 working walking around outside, managing the lift, 

12 and the worker gets exposed but the planner does, 

13 too. And that may or may not be exposed to specific 

14 incidents in the record, but may or may not be 

15 corroborated by the other worker. 

16 You see what I'm trying to get at? I'm 

17 trying to figure out where to file it. The worker 

18 files a claim; the company no exposure in SEM, but 

19 would including the work history in a more up-front 

20 fashion fix the problem in some sense, or do you 

21 think that would leave something out in addition? 

22 I feel like I'm --
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1 MEMBER VLIEGER: Sorry, I had to get away 

2 from some notes. This is Faye. The OHQ on its own 

3 because it's self-reported falls into the same 

4 situation as self-reporting anything during an 

5 objection, is it's considered self-serving. So my 

6 opinion is that you're going to have to come up with 

7 presumptive exposures. For DOE to constantly say 

8 that we have to have this data to corroborate what 

9 the worker is saying, puts it back on the worker 

10 in a catch-22 when no records exist, so in order 

11 to avoid that some consensus for presumptive 

12 exposures.

13 Now, I know it's going to be easy to 

14 start with welders and sheet metal workers, and 

15 plumbers and pipefitters, and maybe that's what we 

16 need to do. We need to start with the obvious ones 

17 and move forward, but I think that's the only way 

18 we're going to address this problem where a lack 

19 of records is what's denying the claim. And the lack 

20 of records is not on the employee's part, it's that 

21 the functionary government department does not 

22 have the records, did not have the records, will 
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1 never have the records, and so the claim is denied 

2 because there's no corroborated evidence. That's 

3 my opinion, but I see a lot of these claims go 

4 through the same thing. 

5

6 CHAIR WELCH: I get what you are saying 

7 with respect to the exposures. I mean, I tend to 

8 think of them similar to tasks, so if you talk to 

9 -- you know, if somebody is an asbestos insulator 

10 and they work in a certain period of time, you can 

11 presume their exposure to asbestos, but there 

12 aren't too many that you can do just looking at any 

13 broad job title, but if you ask them what 

14 construction, what task they do, they don't need 

15 to tell me how many times that the exposure was 

16 because we know that exposure is inherent in that 

17 task. And that kind of gets dealt into this 

18 presumption for the disease because it would say 

19 if someone describes this exposure, this task, this 

20 kind of work for a certain period of time and they 

21 have the right diagnosis and what could be made into 

22 a right aid. So that is the presumption or disease 
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1 could be under a exposure presumption. It's not 

2 like presuming that they have the disease; it's 

3 presuming that there was additional exposure and 

4 it was relative to that causation. So you can do 

5 that for jobs and tasks for which there is available 

6 research where papers have been published, people 

7 in other settings have gone and done industrial 

8 hygiene monitors, so it may not be in the SEM but 

9 it's been established that that job or that task 

10 is exposed to that exposure. And I'm sure we can 

11 kind of push that forward. When you get to jobs 

12 where there's no information in the SEM or in the 

13 medical literature about the kind of exposures they 

14 have, you can look harder. And then what I was 

15 asking was, well basically on the Occupational 

16 Health Questionnaire, getting that Occupational 

17 Health Questionnaire to the industrial hygienist, 

18 the industrial hygienist may be able to say yes, 

19 that's reasonable, because this may have occurred 

20 based on the tasking. And you get an individual 

21 assessment by the hygienist which would then 

22 essentially presume exposures. And I think we don't 
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1 have that approach now, but I recommend it, and from 

2 this call today, we're adding some details to what 

3 we had already. 

4 Yes, I think that our marketing 

5 department would have to push that approach of 

6 trying to have the workers for whom there is no SEM 

7 who have been to that site. There's a SEM for that 

8 site but it doesn't address the job titles, who can 

9 go to occupational history, but it gets an 

10 industrial hygiene evaluation up front rather than 

11 going through the fact that it comes through and 

12 says there's no exposures in the SEM. I think that 

13 what we were talking about now, the case that you're 

14 talking about, ties into what we saw for that site 

15 overall. Does that seem like a reasonable approach 

16 to you?

17 MEMBER VLIEGER: I think so. I think so. 

18 If we can just get out of this circular dance that 

19 we're doing about, you know, provide the records 

20 if there's no records. So, you know, your 

21 statements are self-serving, so yes. 

22 CHAIR WELCH: Okay, I got it. But I want 
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1 to add that current scenario to what we talked about 

2 when we saying the SEM -- we talked about SEM needed 

3 expert input early on, and for the job titles where 

4 there's no information of record. 

5 MEMBER DEMENT: Just to round out that 

6 discussion, all the cases where I reviewed the SEM 

7 and the worker's reported exposures really weren't 

8 that far off. I mean, they were pretty close. In 

9 those cases, you know, I think having the 

10 industrial hygienist dive into it at that point is 

11 probably okay and they go to the claims examiner. 

12 So, you know, there's some -- I guess that what I'm 

13 saying is there's some decision to be made based 

14 on the occupational history early on in the SEM.

15 CHAIR WELCH: Yes, I see what you mean. 

16 Okay. That's good. Okay. I think we're done. 

17 Thanks, guys, for just bringing up that last 

18 discussion. I think that was very helpful, about 

19 looking at the individuals for whom the SEM is not 

20 helpful for a range of things, I think that's really 

21 important when we talk about this in a broader 

22 context. So I will get back to you with all the 
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1 things we talked about and things we worked on for 

2 how we're going to propose this, and finish the OHQ 

3 comments before next meeting. And, Carrie, could 

4 you work on scheduling another call before the --

5 MS. RHOADS: Yes. I'll send out an email 

6 about availability for another call. 

7 CHAIR WELCH: Fantastic. Thank you. 

8 Anybody last comments before we end here? Great. 

9 All right. Thank you very much.

10 MS. RHOADS: Thanks, everybody. 

11 (Whereupon, the proceedings went off 

12 the record at 3:05 p.m.) 

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