Summary of Combined Advisory Board Teleconference

By Terrie Barrie

The Subcommittee on the Weighing of Medical Evidence and the Subcommittee on the Review of contract medical consultants (CMC) and industrial hygienists (IH) reports held a joint teleconference on June 27, 2017. The reason for this was that some of the tasks are shared by both subcommittees. For instance, the Subcommittee on the Weighing of Medical Evidence is responsible for advising claims examiners (CE) how to determine the weight of evidence in the case file. The documents they review include reports from the Division of Energy Employees Occupational Illness Compensation’s (DEEOIC) contracted CMCs, IHs and DEEOIC staff physicians, which are also reviewed by the second subcommittee. The two groups agreed that the two subcommittees should be combined. They will pursue ways to assign tasks equitably.

Concerns were again raised about the lack of implementation of the recommendations the Board has made to DEEOIC. The designated federal official relayed that the recommendations made in October 2016 were before the Secretary of Labor. DEEOIC is currently working on their response to the recommendations made during the April 2017 meeting. When those are finalized the recommendations will be submitted to the Secretary for his decision.

After the April board meeting, four board members traveled to the Seattle District Office to review 20 claims. They were disappointed that the claims did not appear to be randomly selective or adequately represent the adjudication process. The board members were impressed with DEEOIC’s imaging system. This an electronic system which stores the evidence provided for each claim. Dr. Cassano mentioned that the files on the imaging system were well organized and easier to search for the documents. They plan to request DEEOIC provide access to this imaging system.

The four board members noticed that the word “significant”, as used by the CMCs and IHs with regards to exposure, has no clear definition. It was suggested that the CMCs and IHs be provided with guidance on what “significant” means under this program.

There was a discussion that perhaps the CEs use the CMCs and IHs more frequently since they have the scientific expertise that CEs do not possess. Dr. Silver voiced a long-standing concern of his that a “cottage-industry” would develop to reconstruct dose for chemical exposure. The other members understood his concern. Dr. Cassano suggested that if the presumptions the board recommended for lung diseases and hearing loss are adopted, that should alleviate the need for many claims being referred to the DEEOIC experts.

Dr. Silver suggested that if DEEOIC accepts the presumptive diseases the board may want, in the future, to review denied cases to determine if the presumptions would have helped the denied claims. Dr. Markowitz agreed that this should remain on the board’s radar.

Dr. Cassano acknowledged that DEEOIC will have a lot of work to do to reopen the denied claims to see if the presumptions would result in a positive outcome. The Subcommittees agreed that a process should be developed to ensure that any accepted presumptions are implemented correctly.

Faye Vlieger raised the issue of synergistic effects of chemicals. She explained that the workers were exposed to a “toxic soup” on a daily basis. Dr. Markowitz explained the science isn’t there to accept synergistic effects, however, the science is there to base decisions on additive effects. Dr. Friedman-Jimenez added that there are scientific models that toxicologists use and that it is reasonable to presume that exposures to multiple chemicals would have an additive effect. This will be discussed further.