Review of the Department of Labor's Site Exposure Matrix Database (2013) / Chapter Skim
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In response to worker concerns, the U.S. Congress in 2000 authorized compensation for DOE workers in the Energy Employees Occupational Illness Compensation Program Act (EEOICPA)
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Originally developed for DOL claims examiners, the database is available to the public, and individuals can submit site-related and toxic substance–related information to it. However, the database has been criticized by claimants and their advocates, particularly regarding the accuracy of its substance–disease links.
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review process with re gard to Haz-Map, and the review process used by Haz-Map developer when including information in the Haz-Map database. Haz-Map is an occupational health database about the health effects of exposures to chemicals and biologicals at work; it links jobs and hazardous tasks with occupational diseases and their symptoms.
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, where it is periodically updated for content with revisions provided by the Haz-Map developer. The committee appreciates the enormous amount of work that has gone into the development and maintenance of Haz-Map to assist health providers in identifying and possibly preventing occupational diseases, but it identified several limitations of the database and focused on its use for SEM in the context of the EEOICPA compensation system.
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EEOICPA states that an illness or a disease may be compensable if "it is at least as likely as not that exposure to a toxic substance at a DOE facility was a significant factor in aggravating, contributing to, or causing the illness." However, the "Diseases" field of Haz-Map, which contains the toxic substance–occupational diseases links used in SEM, does not capture information on exposures that aggravate or contribute to disease; rather, it contains only links between exposure and disease that are designated as causative by its developer. SITE EXPOSURE MATRIX Overview SEM is a key resource for the EEOICPA Part E compensation program.
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Nevertheless, the committee came to three overarching recommendations for improving the toxic substance–disease links in SEM: 1. Add supplemental information sources to the health effects information imported from Haz-Map.
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Among the databases and documents that evaluate health effects of individual toxic substances or groups of related chemicals are the EPA's IRIS database and background documents, the Agency for Toxic Substances and Disease Registry (ATSDR) toxicologic profiles, NTP toxicology studies, the background document for the preamble to the Occupational Safety and Health Administration's permissible exposure limits, IARC monographs, the California Environmental Protection Agency Office of Environmental Health Hazard Assessment (Cal/ EPA OEHHA)
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First, the committee believes that the current links between toxic substances and occupational diseases must include appropriate bibliographic references in both SEM and Haz-Map. The committee spent considerable time in attempting to determine the evidence used to make the links in Haz-Map and thus in SEM and in many cases was unable to do so.
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The committee also recommends that the advisory panel include representation of the claimants and their advocacy organizations. The expert advisory panel would have several immediate tasks: • Establish the criteria for the evidence base for causal links between exposure to a toxic substance and an occupational disease; criteria might be expanded to include a category of "evidence of no association" as is used by IOM and IARC.
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The committee also acknowledges that several approaches may be used to institute a peer review process for SEM, all of which have advantages and disadvantages. These approaches might include having the expert advisory panel review contractor assessments of the evidence available on toxic substance, having the expert advisory panel review the available evidence on a substance that was gathered by a contractor, or having the available evidence assessed by an internal expert advisory panel and then having the assessments reviewed by external experts.
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The recommended expert advisory panel could provide advice on the best way to incorporate the epidemiologic studies conducted in DOE worker populations; the exposures of these workers are directly relevant to the claimant populations.
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Haz-Map is used for SEM because it provides causal toxic substance– occupational disease links in an easily captured field. Haz-Map is a unique database, and the committee was unable to identify any other databases that explicitly link occupational exposures to toxic substances to occupational diseases.
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As discussed above, the committee strongly recommends that an expert advisory panel be established to review the evidence on any potential toxic substance–disease link. Such a panel, using a weight-of-evidence approach, could determine how to assess inconclusive, inconsistent, or conflicted studies for purposes of evaluating whether there is a causal link.
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