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_-Attribution of COPD to Occupational Exposures in DOE FWP

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ABTSWH Presumptions Working GroupMeeting, June 21, 2017
Recommendations, EEOICP Presumptions,ABTSWH
COPD (exposure)Asbestos-related diseases (exposure)Work-related asthma (exposure and disease)Solvents and hearing loss (exposure)Cessation of post-1995 exposure presumptionEndorsed current CBD-sarcoidosis presumption
EEOICP recognizes:
Non-malignant asbestos-related diseaseAsbestosisPleural plaques and pleural thickeningBenign asbestos-related pleural effusion
Malignant asbestos-related diseaseMalignant mesotheliomaLung CancerCancer of ovaryCancer of larynx
MedicalEvidenceofAsbestosis
Sources of evidence:Opinionof qualified MDbased on CXR, CT, MRI, PFT, or lung biopsy.DOE FWP physician finding3. Death certificate
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
MedicalEvidenceofAsbestosis
Sources of evidence:Opinionof qualified MDbased on CXR, CT, MRI, PFT, or lung biopsy.DOE FWP physician finding3. Death certificate
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
MedicalEvidenceofAsbestosis
1. Opinionof qualifiedMD:CXR - pulmonary interstitial fibrosis+heartenlargementCT/MRI - lung scarring, pleural thickening,heart enlargementPFT - restriction;requiresMD interpretationLung biopsy - “sputum cytology or bronchiallavage often show asbestosbodies” but “notdefinitive”
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
MedicalEvidenceofAsbestosis
2.DOEFWPPhysicianassessment of asbestosis orasbestos-related lungdisease
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
MedicalEvidenceofAsbestosis
3.Death certificateCites“asbestosis” as cause or contributing factor.IfDC cites diagnosis other than “asbestosis,”needevidence to support the diagnosis of asbestosis.
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
Mesothelioma of pleura“confirmed diagnosis”
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
Pleural plaques (PP), Pleural effusions (PE)
Supportive medical evidence:MD diagnosisCXR, CT or other imaging evidence of PP or pleural thickening (PT) not due to surgery or traumaRounded atelectasisBilateral pleural effusions
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
CE is to consult with treating MD or CMC if:
Evidence is inconclusivePT is in area of surgery or traumaEvidence for other causes of PE is present
Pleural plaques, pleural effusions
EEOICPAProcedureManual Chapter18 –Eligibility Criteria forNon-Cancerous Conditions
Former Worker Medical Screening ProgramSurveillance case definitions
Asbestosis:areported history of exposure toasbestos, or job title with a reasonablelikelihoodof asbestos exposure+a B-reading of standard PA chestfilmdemonstrating bilateral irregularparenchymalopacities (shape and size:s,t,u) with profusion score of1/0 orgreater
Former Worker Medical Screening ProgramSurveillance case definitions
Asbestos-related pleuraldisease:a reported history of exposure toasbestos, or job title with a reasonablelikelihoodof asbestos exposure+a B-reader notation of findings ofunilateralor bilateral pleuralthickening consistentwith pneumoconiosis
Proposed DiagnosticCriteriaAsbestosis #1:
History of asbestos exposure, andRadiography (CXR or CT):Bilateraldiffuse interstitial fibrosis affectinganycombination of mid- and lower lung zones.If ILO scoring is used,>1/0 s, t, or u opacities
Proposed DiagnosticCriteriaAsbestosis #2:
DOEFWP physician finding
Proposed DiagnosticCriteriaAsbestosis #3:
History of asbestos exposure, andPathology:Histologic evidence ofdiffuse interstitialfibrosis of the lung
Proposed Diagnostic CriteriaAsbestosis:
As an alternative to ahistory of asbestos exposure, asbestos exposure can be documented if lung tissue burden finds concentrations of asbestos fibers or asbestos bodies consistent withexcessiveasbestosexposure by the examining laboratory.
Proposed Diagnostic CriteriaAsbestos-related pleural disease
History of asbestos exposure, andRadiography (CXR or CT):Unilateral or bilateral pleural thickening orplaques that is not readily explained by anothercause
Proposed Diagnostic CriteriaAsbestos-related pleural effusion
History of asbestos exposure, andDiagnosis of unilateral or bilateral pleural effusionsthat arenotreadily explainedby another cause
Proposed Diagnostic CriteriaMesothelioma (pleural), Cancer of Lung, Ovary, and Larynx1. Documented by pathology, or2. Clinical and radiological presentation thatfavors malignant mesothelioma of pleura orcancer of lung, ovary, or larynx, or3. Death certificate: cause, underlying orprimary or contributing factor
Additional Candidate Issues forEEOICP PresumptionsABTSWH
Parkinsonism?Other neurologic diseases?Kidney disease?Others

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_-Attribution of COPD to Occupational Exposures in DOE FWP