REVIEW OF THE
DEPARTMENT OF LABOR’S
SITE EXPOSURE
MATRIX DATABASE

Committee on the Review of the Department of Labor’s
Site Exposure Matrix (SEM) Database

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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REVIEW OF THE DEPARTMENT OF LABOR’S SITE EXPOSURE MATRIX DATABASE Committee on the Review of the Department of Labor’s Site Exposure Matrix (SEM) Database Board on the Health of Select Populations

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. DOLJ119E32292 between the National Acad- emy of Sciences and the Department of Labor. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-26869-1 International Standard Book Number-10: 0-309-26869-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www. iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Review of the Department of Labor’s Site Exposure Matrix Database. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examina- tion of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the Na- tional Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON THE REVIEW OF THE DEPARTMENT OF LABOR’S SITE EXPOSURE MATRIX (SEM) DATABASE MARK UTELL (Chair), Professor of Medicine and Environmental Medicine and Director of Occupational and Environmental Medicine, University of Rochester School of Medicine and Dentistry, NY JOHN R. BALMES, Professor of Medicine, University of California, San Francisco, School of Medicine; Professor of Environmental Health Sciences, School of Public Health, University of California, Berkeley STANLEY C. HAIMES, Medical Director, Center for Occupational and Environmental Health, Orlando, FL WILLIAM E. HALPERIN, Professor and Chair, Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Newark PHILIP I. HARBER, Professor of Public Health, Community, Environment and Policy, University of Arizona, Tucson FRANCINE LADEN, Mark and Catherine Winkler Associate Professor of Epidemiology, Departments of Environmental Health and Epidemiology, Harvard School of Public Health, Boston, MA EPHRAIM MASSAWE, Assistant Professor, Department of Computer Science and Industrial Technology, Southeastern Louisiana University, Hammond JULIA B. QUINT, Research Scientist and Section Chief (Retired), Ocupational Health Branch, California Department of Public Health, Berkeley DAVID RICHARDSON, Associate Professor of Epidemiology, University of North Carolina School of Global Public Health, Chapel Hill HOWARD E. ROCKETTE, Professor Emeritus, Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, PA MARA SEELEY, Senior Toxicologist, Gradient, Cambridge, MA ROSEMARY K. SOKAS, Professor and Chair, Department of Human Science, Georgetown University School of Nursing and Health Studies, Washington, DC IOM Staff REBECCA KOEHLER, Study Director ROBERTA WEDGE, Study Director CARY HAVER, Associate Program Officer JONATHAN SCHMELZER, Senior Program Assistant FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations v

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Reviewers T his report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with proce- dures approved by the National Research Council’s Report Review Com- mittee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectiv- ity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Donna Cragle, Occupational Exposure and Worker Health Programs, Oak Ridge Associated Universities John R. Froines, University of California, Los Angeles Linda A. McCauley, Emory University Michael S. Morgan, University of Washington John L. O’Donoghue, University of Rochester School of Medicine and Dentistry Joseph V. Rodricks, ENVIRON, Arlington, VA Glenn Talaska, University of Cincinnati Although the reviewers listed above have provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recom- mendations nor did they see the final draft of the report before its release. The vii

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viii REVIEWERS review of this report was overseen by Frank E. Speizer, Harvard Medical School, and Mark R. Cullen, Stanford University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Contents PREFACE xi SUMMARY 1 1 INTRODUCTION 15 Energy Employees Occupational Illness Compensation Program Act, 16 Site Exposure Matrix Database, 19 Committee’s Charge, 20 Committee’s Approach, 20 Organization of the Report, 23 References, 23 2 HAZ-MAP DATABASE 25 Development of Haz-Map, 25 Content of Haz-Map, 26 Haz-Map Information Sources, 31 Toxic Substance–Disease Links, 31 Strengths and Weaknesses of Haz-Map, 43 Summary, 48 References, 48 3 SITE EXPOSURE MATRIX DATABASE 51 Use of SEM in the EEOICPA Claims Process, 52 Development of SEM, 54 Content and Structure of SEM, 55 ix

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x CONTENTS Government Accountability Office Report, 63 Strengths of SEM, 64 Weaknesses of SEM, 65 Toxic Substance–Disease Links Not in SEM, 80 Summary, 89 References, 89 4 FINDINGS AND RECOMMENDATIONS 95 Haz-Map Findings, 96 SEM Findings, 96 Recommendations to Improve SEM, 97 Statement of Task Questions and Responses, 107 APPENDIXES A Biosketches of Committee Members 111 B Substances Evaluated by the Committee to Identify Toxic Substance–Occupational Disease Links Not Found in SEM 117 C Individuals Who Made Presentations to the Committee 121

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Preface T he Institute of Medicine (IOM) has a longstanding role in providing guid- ance to the federal government on improving and maintaining the health and well-being of people who have served the United States, both in the military and on the homefront. Service to our country includes those individuals who were instrumental in developing and manufacturing nuclear weapons before and during the Cold War. The Cold War has long since ended, but its effects remain. Workers who suffer from illnesses as a result of employment in the nuclear weapons industry are still seeking medical care and a means to pay for it. In response to a request from the Department of Labor (DOL), this study is the product of a concentrated and careful endeavor by this committee to evalu- ate the scientific rigor of DOL’s Site Exposure Matrix (SEM) database. SEM is used in support of the DOL claims process for former workers and contractors of the Department of Energy (DOE), as mandated in the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). Though comment- ing on the claims process itself was beyond the scope of the committee’s work, we believe that any effective compensation program should be based on sound scientific evidence. Therefore, we sought to provide guidance and a framework for DOL to create a better and more transparent system for identifying the most scientifically sound information to be included in SEM and thus improve the claims process. We are honored to have been of service to DOL and to the many men and women who worked at DOE facilities and their families and who helped maintain a secure nation. The committee appreciates the presentations made by DOL staff (Karoline Anders and Rachel Leiton) and its contractors (Keith Stalnaker and Jay Brown) and by staff of the National Library of Medicine (Florence Chang, Lucie Chen, xi

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xii PREFACE and Pertti Hakkinen) in providing information for the study. In addition, the committee would like to thank the many claimants and worker advocates for the presentations and statements they submitted to the committee, particularly Terrie Barrie, Laurence Fuortes, and Deb Jerison. Finally, I am deeply appreciative of the dedication of the committee members and the IOM staff who assisted them in producing this report. The committee trusts that it will assist not only DOL in its efforts to implement EEOICPA, but also will inform the broader research community. Mark Utell, Chair Committee on the Review of the Department of Labor’s Site Exposure Matrix (SEM) Database