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Attribution of COPD to Occupational Exposures in DOE FWP

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EEOICPA CIRCULARNO.15- 05SUBJECT:  Occupational ExposureGuidanceRelating toAsbestosDecember17, 2014
Asbestos-related diseases (ARD)AsbestosisAsbestos-related pleural diseaseLung cancerMesothelioma (chest, abdomen)Cancer of larynxCancer of ovaryCOPD
EEOICPA CIRCULAR NO.15- 05
For DOE worker with ARD, post 1986 work:Assume potential exposure to asbestos but at levels below accepted standards, except for 19 occupations on List A, who have potential for greater asbestos exposure between 1986 and 1995For DOE worker with ARD and who worked at a job on List A between 1986 and 1995, it is accepted that they were “potentially exposed” to asbestos but ”likely” at “low levels.”
EEOICPA CIRCULAR NO.15- 05
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- 05

If evidence is suggestive of exposure “above the guidelines,” then CE contacts EEOICP IH regarding industrial hygiene referral.
EEOICPA CIRCULAR NO.15- 05
“Anyfindings 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- 05
Summary1. No presumptions on pre-1986 asbestos exposure2. Post 1986, assume asbestos exposure was below accepted standard, except for List A workers3. For List A workers, 1986-1995 work, assume potential asbestosexposure“likely” at low levels.
EEOICPA CIRCULAR NO.15- 05
Summary3. For List A workers, 1986-1995 work, assumepotential asbestosexposure“likely” at low levels.4. To show greater than low level asbestos exposurein post-1986DOE work, need “definitiveandcompellingevidence” to show thathad“consistent,unprotectedcontact with asbestos or ACM”
EEOICPA CIRCULAR NO.15- 05
Summary5. If evidence of #4, screening referral to industrialhygienist.6. Any finding of exposure requires physicianreview.
EEOICPA CIRCULAR NO.15- 05
Issues1. No pre-1986 presumptions2. List A work between 1986 and 1995: “likelylow exposure” is not evidence-based.3. Designation of List A 1986-1995 work asinvolving “likely low” exposure does notfacilitate decision-making.
EEOICPA CIRCULAR NO.15- 05
Issues4. CE has to judge whether submitted evidencemeets a vague threshold for IH referral:“consistent, unprotected contactwith asbestos orACM”5. Exposure-based CE decision-making iscontradicted by stated basis for physicianreview.
EEOICPA CIRCULAR NO.15- 05
Possible remedies for claims of ARDs1. Amend List A2. Presume List A DOE workers who workedprior to the late 1980’s hadsignificantexposureto asbestos exposure, whichcontributed theto the claimed ARD.3. For all other claims, have industrial hygienistand/or OM physician review exposure evidenceand decide on significance of exposure..
EEOICPA CIRCULAR NO.15- 05
Possible remedies for claims of ARDs4. Consider including exposure duration andlatency minimums in presumptions.5. Specify terms of review for claimants who donot meet presumptions.
EEOICPA CIRCULAR NO.15- 05

Extra slides
Asbestos and Ovarian CancerExposure presumption:250 days of significant asbestos exposure(worked in a job title in List A),i.e., 1 year prior to 1986, and20 years latency period from first DOEexposure to asbestosOr diagnosis of asbestosis or mesothelioma4.
EEOICPABulletin No. 13-02
Asbestos and Ovarian CancerClaims which do not meet exposurepresumptions are referred for industrial hygienereview.
EEOICPABulletin No. 13-02

“AssessingasbestosisclaimsDEEOICaccepts thatasbestoswas a common toxic substancethat existed throughoutall 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.”
EEOICP Procedures Manual, Chapter 2
Surgeon GeneralSecond hand smoke and lung cancer(52 spousal studies, 25 workplace studies)RR= 1.20Conclusion:“Exposureof adults to secondhand smoke… causes ….lungcancer.”
2006 Surgeon General’s Reporthttps://www.ncbi.nlm.nih.gov/books/NBK44330/#rpt-smokeexp.ch7.s2

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Attribution of COPD to Occupational Exposures in DOE FWP