Use of Presumptions in EEOICP - PowerPoint Presentation

Slide1

Use of Presumptions in EEOICP

Other Federal compensation programsPresumptions in EEOICPA, 2001Asbestos-related diseasesAsthmaCOPDHearing loss and solvent exposureCBD and sarcoidosis

Steven Markowitz MD, DrPH, March 14, 2017Slide2

Program/ Aspects

Presumed ExposureOccupation/

Individual

Calendar TimeDuration TimePlaceBlack Lung ProgramCoal dustMiners, construction workers, & transportation workers.N/AFor presumption, 10 years minimum with 15 and 25 year clauses.Coal dust related work areas.VCPWTCFatalities, injuries, and/or dust from the debris.Respondents and non-respondents living in the area.Sept 11, 2001 to July 31st, 2002 at ground zero.Varies. No minimum or maximum.NYC Ground Zero, Pentagon site, Shanksville, PA site, barges or Fresh kills, or being killed due to the plane crash.Atomic Veterans Comp.Ionizing radiationVeteransBetween 1945 and 1962 (atmosphere tests), before Jan. 1, 1974 (Amchitka Island, AK), before Feb. 1, 1992 (Gaseous plants), or during occupation/nuclear bombing of Japan. N/AAlaska, Japan, atmospheric, and test sites.Vets Agent Orange Comp.Agent Orange (blend of dioxin containing herbicides.)VeteransBetween January 9, 1962 and May 7, 1975 (Vietnam) & between April 1, 1968 and August 31, 1971 (Korean DMZ.)N/AVietnam and Korean DMZ.Gulf War Comp.Chemical and environ agents(vaccinations, pyridostigmine bromide, pesticides, depleted uranium, infectious diseases, oil well fires, etc.)VeteransAugust 2, 1990 to present.N/AGulf War Theater. (Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, United Arab Emirates, Oman, sea and airspace.)Slide3

EEOICPA

Exposure presumptions in Act1. Special exposure cohort: > 250 days work in GDP before 2/1/92 in a job where dosimetry monitoring was performed or in comparable job2. Silica exposure: “was present > 250 days during mining

of tunnels” at DOE facility in NV or AK Slide4

Presumption elements

Exposure:DurationJob title (proxy for intensity and frequency)Calender yearsLatency

Disease: diagnostic criteriaSlide5

Exposure Presumptions, Part B in EEOICPA, 2000

Exposure criteriaCancerSilicaComments Duration> 250 days> 250 days

NTS, Amchitka

Job titleIf dosimetry was performed or comparable job“present during mining” Calender yearsBefore 2/92When mining was active Latency--Slide6

Asbestos EEOICP Procedures Manual, Chapter 2: 1000 0-700, Exhibit 3 (added post-Circ. 15-05)

EEOICPA

Bulletin No. 13-02 EEOICPA Circular No. 15- 05 Slide7

Asbestos-related diseases (ARD)

Asbestosis Asbestos-related pleural disease Lung cancer Mesothelioma (chest, abdomen) Cancer of larynx Cancer of ovary COPD

EEOICPA CIRCULAR NO.15- 05Slide8

Asbestos Exposure: “Assessing asbestosis claims: DEEOIC

accepts that

asbestos was a common toxic substance that existed throughout all DOE facilities.  While asbestos did exist at DOE facilities, the nature of an employee’s exposure would have varied based on different factors such as the period that the employee worked, the type of work performed, and the location of employment.”  Disease: focuses on medical criteriaEEOICP Procedures Manual, Chapter 2Slide9

Asbestos and Ovarian CancerExposure presumption: 250 days of significant asbestos exposure (worked in a job title in List A), or 1 year, prior to 1986, and 20 years latency period from initial DOE exposure to asbestos Or diagnosis of asbestosis or mesothelioma

EEOICPA Bulletin No. 13-02 Slide10

Significant Asbestos Exposure: Associated Labor Categories and Job Tasks

(ATSDR 2014) Automotive mechanic; Vehicle mechanic; Vehicle maintenance mechanicBoilermakerCarpenter; Dry waller; PlastererDemolition technician; LaborerElectrical mechanic; Electrician; Floor covering workerFurnace & saw operator; Furnace builder; Furnace operator; Furnace puller; Furnace technician; Furnace tender; Furnace unloaderGlazier; Glass installer; GlazerGrinder operator; Mason (concrete grinding); Tool grinder; Maintenance mechanic (general grinding); Welder (general grinding); Machinist (machine grinding)Insulation worker; Insulation trade worker; InsulatorIronworker; Ironworker-riggerMaintenance mechanic; Electrician; Insulator;Mason; Brick & tile mason; Concrete and terrazzo worker; Bricklayer,

Tilesetter

MillwrightHeavy equipment operator; Operating EngineerPainterPipefitter, Plumber steamfitter; Plumber/pipefitter; Plumbing & pipefitting mechanic; Plumbing technician, SteamfitterRooferSheet metal mechanic; Sheet metal fabricator/installerWelder; Welder burner; Welder mechanic Slide11

AsbestosisExposure presumption: > 250 days of asbestos exposure 10 years latency period from initial DOE employment

EEOICP Procedures Manual, Chapter 2

0-700, Exhibit 3 (added post-Circ. 15-05)Slide12

Ovarian Cancer and AsbestosisClaims that do not meet exposure presumption criteria are reviewed by CE and,when needed, referred for industrial hygiene review.For claims with more limited evidence of asbestos exposure, refer for medical opinion.

EEOICPA Bulletin No.

13-02 EEOICPA Procedure Manual, Ch 2-0700 Slide13

Exposure Presumptions, Asbestos

Exposure criteriaCancer of the Ovary (2013)Asbestosis (2015 or 2016)COPD(2016) Duration250 days> 250 days

20 years

Job titleList ANot specified (?List A)List A* Calender yearsBefore 1986-Prior to 1980 LatencyMin. 20 yearsMin. 10 years*or IH rationaleSlide14

EEOICPA CIRCULAR

NO.15- 05 (December 17, 2014)               SUBJECT:  Occupational Exposure Guidance Relating to Asbestos Slide15

Asbestos-related diseases (ARD)

Asbestosis Asbestos-related pleural disease Lung cancer Mesothelioma (chest, abdomen) Cancer of larynx Cancer of ovary COPD EEOICPA CIRCULAR NO.15- 05Slide16

For DOE worker with ARD, Post-1986 DOE work, assume potential exposure to asbestos but at levels below accepted standards However, for 19 occupations on List A, who have potential for greater asbestos exposure between 1986 and 1995, it is accepted that they were “potentially exposed” to asbestos but ”likely” at “low levels.” EEOICPA CIRCULAR NO.15- 05Slide17

Significant Asbestos Exposure: Associated Labor Categories and Job Tasks

(ATSDR 2014) Automotive mechanic; Vehicle mechanic; Vehicle maintenance mechanicBoilermakerCarpenter; Dry waller; PlastererDemolition technician; LaborerElectrical mechanic; Electrician; Floor covering workerFurnace & saw operator; Furnace builder; Furnace operator; Furnace puller; Furnace technician; Furnace tender; Furnace unloaderGlazier; Glass installer; GlazerGrinder operator; Mason (concrete grinding); Tool grinder; Maintenance mechanic (general grinding); Welder (general grinding); Machinist (machine grinding)Insulation worker; Insulation trade worker; InsulatorIronworker; Ironworker-riggerMaintenance mechanic; Electrician; Insulator;Mason; Brick & tile mason; Concrete and terrazzo worker; Bricklayer,

Tilesetter

MillwrightHeavy equipment operator; Operating EngineerPainterPipefitter, Plumber steamfitter; Plumber/pipefitter; Plumbing & pipefitting mechanic; Plumbing technician, SteamfitterRooferSheet metal mechanic; Sheet metal fabricator/installerWelder; Welder burner; Welder mechanic Slide18

For CE to accept level of exposure above low level, there must be “definitive and compelling evidence” to show that post-1986 DOE work had “consistent, unprotected contact with asbestos or ACM”Evidence includes: IH monitoring, incident reports, documented abatement breaches, testimony or affidavits, or position descriptions.

EEOICPA CIRCULAR NO.15- 05Slide19

If evidence is suggestive of exposure “above the guidelines,” then CE contacts IH regarding industrial hygiene referral.EEOICPA CIRCULAR NO.15- 05Slide20

Final Paragraph:

“Any findings of exposure, including infrequent, incidental exposure, require review of a physician to opine on the possibility of causation. This is necessary as even minimal exposure to some toxins may have a significant “aggravating or contributing” relationship to the diagnosed illness.”EEOICPA CIRCULAR NO.15- 05Slide21

Summary1. No presumptions on pre-1986 asbestos exposure2. Post-1986, assume asbestos exposure was below accepted standard, except for List A workersEEOICPA CIRCULAR NO.15- 05Slide22

Summary3. For List A workers, 1986-1995 work, assume potential asbestos exposure “likely” at low levels.4. To show greater than low level asbestos exposure in post-1986 DOE work , need “definitive and compelling evidence” to show that

had

“consistent, unprotected contact with asbestos or ACM”EEOICPA CIRCULAR NO.15- 05Slide23

Summary5. If evidence of #4, screening referral to industrial hygienist.6. Any finding of exposure requires physician review.EEOICPA CIRCULAR NO.15- 05Slide24

Issues1. Pre-1986 presumptions?2. List A work between 1986 and 1995: “likely low exposure” is not evidence-based.3. Designation of 1986-1995 List A work as involving “likely low” exposure does not facilitate decision-making.

EEOICPA CIRCULAR NO.15- 05Slide25

Issues4. CE has to judge whether submitted evidence meets a vague threshold for IH referral: “consistent, unprotected contact with asbestos or ACM”5. Exposure-based CE decision-making is contradicted by stated basis for physician

review.EEOICPA CIRCULAR NO.15- 05Slide26

Possible remedies for claims of ARDs1. Expand List A2. Rescind presumption of low exposure post-19863. Pick calender year as cutoff that has a

safety margin.

4. Consider including minimum exposure duration and latency in presumptions for all ARD’s.EEOICPA CIRCULAR NO.15- 05Slide27

Possible remedies for claims of ARDs5. For all claims that do not meet presumption criteria, have IH and/or CMC review and decide on significance of exposure.

EEOICPA CIRCULAR NO.15- 05Slide28

Possible Exposure Presumptions, Asbestos

Exposure criteriaAsbestos-specific diseases (Chest scarring,MesotheliomaNonspecific Asbestos-related diseases (LC, Ca of ovary and larynxComments Duration

>

250 days> 250 days Job titlesmaintenance, construction, production, engineeringmaintenance, construction, production, engineering Calender yearsPre-2005 maintenance, construction, Pre-1995 production, engineeringPre-2005 maintenance, construction, Pre-1995 production, engineering LatencyMin. 15 yearsMin. 15 yearsSlide29

For claimants for ARD’s who do not meet presumptive criteria, CE should obtain IH opinion and, if needed, CMC opinion.Should there a minimum threshold of exposure before CE refers claim to IH or MD?Slide30

EEOICP Procedure ManualAsthmaExhibit 1: Matrix for Confirming Sufficient Evidence of Non-Cancerous Covered Illnesses Slide31

EEOICPA BULLETIN NO: 16-01 (Oct 2015)

 AsthmaIf medical evidence of “occupational asthma,” no need for exposure assessment or reference to SEM.2. OA claims filed after DOE work ends

require well-supported report by MD. If not, referral to CMC after CE collects exposure information.Slide32

EEOICPA BULLETIN NO: 16-01 (Oct 2015)

 Asthma3. For asthma claims w/o work-related rationale, CE develops claim and consults CMC.2. Adoption of this policy in 2015 required review of claims previously denied on the

basis of causation. Slide33

COPD

(chronic obstructive pulmonary disease) Slide34

EEOICP Procedure Manual Chapter 2-1000, Exhibit 1: Matrix

COPD1. MD diagnosis and abnormal medical tests2. “The employee has a history of being a never smoker”2. Absence of other lung diseases that

can explain the findings.Slide35

EEOICP Procedure ManualChapter 2-1000, Exhibit 1: Matrix

COPD beyond CE expertise1. MD diagnosis and abnormal medical tests2. “The employee has a history of being a never smoker”

incorrect

2. Absence of other lung diseases that can explain the findings. beyond CE expertiseSlide36

COPD and Asbestos Exposure

Exposure CriteriaWorked > 20 years prior to 1980 at job on List A or IH support for > 20 years significant asbestos exposureOtherwise review by MD

EEOICP Bulletin 16-02Slide37

Significant Asbestos Exposure: Associated Labor Categories and Job Tasks

(ATSDR 2014)Automotive mechanic; Vehicle mechanic; Vehicle maintenance mechanicBoilermakerCarpenter; Dry waller; PlastererDemolition technician; LaborerElectrical mechanic; Electrician; Floor covering workerFurnace & saw operator; Furnace builder; Furnace operator; Furnace puller; Furnace technician; Furnace tender; Furnace unloaderGlazier; Glass installer; GlazerGrinder operator; Mason (concrete grinding); Tool grinder; Maintenance mechanic (general grinding); Welder (general grinding); Machinist (machine grinding)Insulation worker; Insulation trade worker; InsulatorIronworker; Ironworker-riggerMaintenance mechanic; Electrician; Insulator;Mason; Brick & tile mason; Concrete and terrazzo worker; Bricklayer,

Tilesetter

MillwrightHeavy equipment operator; Operating EngineerPainterPipefitter, Plumber steamfitter; Plumber/pipefitter; Plumbing & pipefitting mechanic; Plumbing technician, SteamfitterRooferSheet metal mechanic; Sheet metal fabricator/installerWelder; Welder burner; Welder mechanic Slide38

COPD: Presumptive Issues

1. Expand set of causal exposures “vapors, gases, dusts or fumes”2. Duration – 5 years?3. Calender years – relevant?4. Latency – None (cause, contribute or aggravate)5. Time since cessation of exposure- w/i 5 years?Slide39

Exposure Presumptions, Asbestos

Exposure criteriaCOPD and Asbestos(Bulletin 16-02) COPDProposed? Duration20 years

5 years?

Job titleList A*Exposure to VGDF Calender yearsPrior to 1980Any Latency-0*or IH rationaleTime since end DOE work – 5 years?Slide40

Solvents and Hearing Loss Slide41

Solvents and Hearing Loss: Current Criteria

1. Duration – 10 years2. Calender years – Prior to 19903. Solvents – 7 identified common agents4. 22 job titles – many very common3. Latency – None4. Time since cessation of exposure- not specified

EEOICP Procedure Manual, Chapter 2-0-700, Exhibit 3Slide42

Job titles, Solvents and Hearing Loss

BoilermakerChemical OperatorChemistElectrician/Electrical Maintenance/LinemanElectroplater/Electroplating TechnicianGarage/Auto/Equipment MechanicGuard/Security Officer/Security Patrol Officer (i.e. firearm cleaning activities)Instrument Mechanic/Instrument TechnicianJanitorLaboratory Analyst/AideLaboratory Technician/TechnologistLubricatorMachinistMaintenance MechanicMillwrightOperator (most any kind)

Painter

PipefitterPrinter/Reproduction ClerkRefrigeration Mechanic/HVAC MechanicSheet Metal WorkerUtility OperatorSlide43

Memo, Dr. Stokes to Mr. V

anceDecember 23, 20161. Reviews published studies on HL and solvent exposures, 1993-20072. Cites individual studies show that < 8 years of solvent exposure does not lead to HL.3. HL demonstrated at average 12.3 years of solvent exposure in 1 study

4. Assumes mechanism of hearing loss is same for all

7 solventsSlide44

Solvent-related Hearing Loss

Exposure criteriaHearing lossCurrent criteria Hearing lossPossible new criteria Job title

22 job titles*

Add titles or related titles? Solvent exposure7 specified solvents*^Broader set of analogous solvents Calender yearsPrior to 1990? Duration10 consecutive years-? total years*Both criteria must be met^Other solvents must be reviewed by National Office EEOICP Procedure Manual, Chapter 2-0-700, Exhibit 3Slide45

Additional candidate conditions for presumptionsSlide46

Timetable for continued work on presumptions