Summary: Advisory Board Meeting April 19-20, 2017

The Advisory Board of Toxic Substances and Worker Health met April 19-20, 2017 in Richland, Washington not far from the Hanford Site.

The Department of Labor (DOL) presented first. Director Leiton acknowledged that the Division of Energy Employees Occupational Illness Compensation (DEEOIC) has not yet responded to the bulk of the recommendations made by the Board. She said no action could be made until the new Secretary of Labor is confirmed.

Site Exposure Matrix (SEM) Subcommittee

The Subcommittee’s discussion began with ways the Occupational Health Questionnaire (OHQ) can be used to provide more robust information  throughout the claims process. The Subcommittee feels a more valuable determination of whether a worker was exposed to a toxic substance are the tasks the workers performed, not the official title they held. The subcommittee also discussed how exposure to vapors, gases, dust, and fumes were predictive of whether a worker would develop COPD.

This subcommittee made the following recommendations:

1. Retain the list of hazards, exposures, and materials in the current OHQ and expand it by incorporating the list of hazards and materials from the Building Trades National Medical Screening Program (BTMed).
2. Add a list of tasks from the BTMed questionnaire, even though it is incomplete.
3. Pre-test the version of the OHQ developed in response to these recommendations for ease of use and face validity.

The subcommittee then discussed how a presumption that vapors, gases, dust, and fumes cause COPD could incorporate up-to-date scientific research to improve the claim process. They feel that this presumption will make the process easier on the claims examiners and fairer for the claimants.

Next, they discussed using a co-worker model to provide information on toxic substances for facilities that do not have a Site Exposure Matrix (SEM). This would allow claims examiners to use chemicals from another facility for workers with the same job title when this information does not exist for a specific facility.

The subcommittee then discussed ways to support incorporating more up-to-date scientific research into the SEM, especially since the old contract to keep the SEM updated has ended.

The Subcommittee on Weighing Medical Evidence

The subcommittee discussed how the Contract Medical Consultants (CMC) and staff Industrial Hygienists (IH) do not routinely have access to all the information they need to make accurate determinations on claims. In reviewing the claims, the subcommittee found there was a problem with consistency between claims.

They also discussed the Board’s trip to the Seattle District Office to meet with senior claims examiners and see how a claim is adjudicated.

There was a general discussion on how to improve the claims process. Different ways to obtain information from lower-level claims examiners were discussed. The subcommittee members would have preferred to meet with the lower-level claims examiners because they could better identify the problems they face in adjudicating claims. This would help the Board understand the issues so they can offer advice to resolve the problems.

An extensive discussion was held on how to better adjudicate asthma claims and what the criteria for establishing an asthma claim should be. Hearing Loss presumptions were also discussed. Hopefully, the subcommittee will be making recommendations on this issue in the next few months.

There was a brief discussion on medical evidence and its relationship to wage loss and whether the subcommittee should provide guidance to DEEOIC. Ms. Leiton explained that the procedure manual provided that a rationalized letter from a physician would be sufficient to support a claim. The subcommittee was unsure what other advice they could offer. A member of the public provided more information on the issue during the public comment period.

Subcommittee on Part B Lung Conditions

This subcommittee updated the full Board on their work reviewing Chronic Beryllium Disease and Beryllium Sensitivity claims. They reviewed 60 claims and agreed with the medical consultants’ assessment 50% of the time. They noted that there were many internal inconsistencies in DEEOIC’s written policies. They suspect that some of the problems they identified in the Part B Lung Condition Claims are the result of the inconsistent guidance in the procedure manual.

They also identified one CMC who receives 57% of the claims and noted that this CMC had an “attitude,” which apparently was biased against the worker. One Board member offered that there is a study that measures “attitudes” of professionals and that the Board may want to consider looking into that further.

They recommended to the Board that if a worker has two BeLPT tests that this be accepted as a positive test. The Board unanimously voted to accept this recommendation and will submit the recommendation to DEEOIC.

Subcommittee on Review of Industrial Hygienists and Contract Medical Consultant Reports

This subcommittee reviewed several claims that were referred to an IH and/or CMC. The claim files the members received were not very organized. They needed to filter down through thousands of pages of documents, some of which are not related to the questions before the IH or CMC. There was a discussion of organizing the files so that the IH or CMC can simply access the documents related to their area of expertise.

Ms. Leiton said the files are organized in such a manner. The subcommittee reiterated the importance of these experts having access to the complete file. It is possible that there may be evidence of a compensable disease in the file, but that the CE omitted it from the Statement of Accepted Facts.

One member observed that the CMCs do not have a full understanding of the Part E causation standard of “at least as likely as not a significant factor in contributing to, aggravating or causing a disease.” It was offered that CMCs receive formal instruction as to the interpretation of this legislative standard.

The Board voted to recommend to DEEOIC that resources be allocated to the Subcommittee to perform an audit of the CMC reports.

Working Group on Presumptions

DEEOIC asked the Board to provide advice on streamlining the claims process. This can be done by utilizing presumptions for some diseases. DEEOIC has issued a few policy documents over the years which address this. However, the Board said some of the policies seemed restrictive and not necessarily based on science. After a lengthy discussion, the Board developed recommendations and guidance to DEEOIC for Chronic Obstructive Pulmonary Disease, Asbestos Related Diseases, and Asthma. The language for hearing loss was discussed but will not be voted on until the Board’s teleconference this summer.

Cold War Patriots will provide the actual language when it becomes available.

Miscellaneous

More than one subcommittee noted that written policies or training manuals are not always carried out during the adjudication process.

15 individuals made public comments to the Board, either in person or by calling in.

DEEOIC will institute a change in notifying the public when changes are made to the Procedure Manual. The public will be able to sign up for email notifications of any changes.

There is a concern with DEEOIC’s lack of implementing the recommendations made by the Board in April and October 2016. So far, only one recommendation has been implemented. One Board member asked that DEEOIC keep the Board informed on the status their recommendations.

The Board’s charter will need to be renewed soon. The Board membership also will be renewed. That process will begin in a few months.

The Board’s next in-person meeting will be in October or November 2017.