OWCP’s Response to the National Institute of Medicine’s Report on the Site Exposure Matrix
The Office of Workers’ Compensation Programs’ Division of Energy Employees Occupational Illness Compensation contracted with the National Institute of Medicine (IOM) of the National Academies to conduct a study of its Site Exposure Matrix (SEM). The SEM is a key resource for the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Part E portion of the program. It contains valuable information about toxic substances that may have been present at covered Department of Energy (DOE) facilities, and the causal relationship between some of those toxic substances and certain medical conditions. It is a relational database and includes lists of toxic substances in DOE facilities by job category and building locations. The public has access to the SEM through the internet. The purpose of the study was to assess the accuracy and completeness of a database used to assist in adjudicating claims for EEOICPA benefits.
SEM is a tool that is available for claimants to use to gain information about their potential exposure to toxic substances during their employment at covered DOE facilities. The tool is also used by claims examiners to assist claimants in their attempts to establish exposure and causation. The SEM is only one tool that the claims examiners use to develop a case, and they rely on other information such as records from DOE, medical evidence provided by the claimants, and claimant statements of work history. It was developed shortly after the law that created Part E because OWCP recognized that it would be difficult for claimants to establish exposure and links to their medical conditions. While information in SEM can be used to accept a claim, the absence of a link in SEM between a toxic substance and a medical condition does not require denial of a claim, though it may obligate the claimant to provide other evidence of such a link in order to obtain benefits.
On March 27, 2013, IOM released its report, Review of the Department of Labor’s Site Exposure Matrix Database. The 122 page report contains three major recommendations. OWCP appreciates the time and effort the IOM committed to reviewing the SEM, and its response to the questions posed by OWCP at the study’s outset. IOM provided an overview of the strengths and weaknesses of both SEM and the Haz-Map database that forms the foundation for the causative links in the system.
The report “commends DOL for developing the SEM database to assist claims examiners and claimants to quickly determine the toxic substances to which a claimant may have been exposed during employment at a DOE EEOICPA covered facility and the occupational diseases that are associated with exposure to those substances.” Overall, IOM found many strengths within the SEM database, and indicated that SEM serves as a good initial resource for information. Thus, IOM recognized the value of the SEM to both the claimant community and claims examiners.
The IOM made three major recommendations in its report:
1. Use supplemental information sources for the Site Exposure Matrix database.
The committee provided several ideas for data sources, in addition to Haz-Map, that could be utilized to provide a more comprehensive picture of the adverse effects that may be associated with exposure to the toxic substances. They included ideas to expand the database to account for routes and levels of exposure.
We are currently conducting further research into the routes and levels of exposure. We intend to add this information to SEM as it is obtained. We also recognize that there may be other resources that could supplement the current system, and will reach out to our partner agencies, the National Institute for Occupational Safety & Health and DOE, to determine whether there are possibilities for collaboration or information gathering as a starting point. We will also take the other recommendations into consideration in further expansion of the database.
2. Improve the structure and function of the Site Exposure Matrix database.
This recommendation includes providing appropriate references in SEM when links are added, and changing the search functions from requiring the entry of a particular DOE facility as the starting point for a search.
The Haz-Map database does contain source references to each link that is in that database; however OWCP will review the specificity of these references. With regard to the current methodology for searching the database, the implication is that one should be able to search the database for toxic substances or job category and retrieve information for all of the numerous sites in the SEM at one time. The SEM is organized by DOE facility because of the nature of the evidence required to obtain EEOICPA benefits. Unlike the circumstances in some industries, each DOE facility is unique in that the particular job category at one facility may not serve the same function, or have the same exposures as the same job category in another facility. It is therefore important for adjudicating an EEOICPA claims (based on the details of an individual case, rather than for general research purposes) that the search function be conducted by facility.
3. Establish an expert advisory panel for the Site Exposure Matrix database.
The IOM stated in their report that the responsibilities of such a panel could include peer review of new links in SEM that are based on Haz-Map and supplemental information, and identify potential new links. The IOM acknowledged that several approaches may be used to institute a peer review process for SEM.
We recognize the value of a process for review of the SEM links and substances by a panel of scientific and medical experts. Over the course of the coming year, we will evaluate the options for developing such a process. There are a number of mechanisms through which OWCP could obtain the peer review recommended by the IOM. OWCP will determine whether it should obtain such peer review by contracting with a scientific or academic organization or another scientific or academic organization, by utilizing the services of scientific experts employed by other Federal agencies, or by creating a peer review process by individually selecting individuals with recognized scientific expertise to independently review the SEM.
Once again, we appreciate the IOM committee’s review of the SEM, Haz-Map and their detailed report. It confirms SEM’s usefulness as a tool for providing additional information for claimants to use to obtain information about exposure to toxic substances at covered DOE facilities and for claims examiners to assist claimants in the claims process. We are already in the process of developing plans to implement many of the recommendations as time and resources allow.