EEOICPA BULLETIN NO.06-08
Issue Date: April 25, 2006
Effective Date: April 25, 2006
Expiration Date: April 25, 2007
Subject: Establishing causation for specific medical conditions under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).
Background: Given the complexity and number of claims presented under Part E of the EEOICPA, means to expedite the claims adjudication process are being developed to assist the Claims Examiner (CE). As such, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) National Office (NO) has established criteria for the presumption of causation in certain specific situations.
The causal criteria described in this bulletin are based on findings by specialists in the field of Industrial Hygiene, Occupational Medicine and Toxicology. These specialists researched authoritative scientific publications, medical literature, and industrial processes and occupational exposure records to develop accepted causal relationships between specific known medical conditions and exposure to specific toxic substances. These findings are incorporated into this bulletin to assist the CE in rendering timely and accurate claim determinations under Part E of the EEOICPA. Periodically this bulletin will be updated as new conditions are researched and new presumptions can be made.
References: Energy Employees Occupational Illness Compensation Program Act of 2000, 42 U.S.C. § 7384 et seq.; Public Law 108-375; 20 C.F.R. §§ 30.111-30.114, 30.230-30.232, 30.300-30.320, 30.400-30.406, 30.420-30.422, 30.505, 30.700-30.726, 30.815, and 30.900-30.912; the Federal (EEOICPA) Procedure Manual: Part E, Chapter E-500 (Evidentiary Requirements for Causation); the EEOICP Site Exposure Matrices website; and the National Library of Medicine Haz-Map.
Purpose: To provide procedures for establishing causation for certain specific conditions identified by the DEEOIC.
Applicability: All staff.
1. The DEEOIC has developed specific criteria to establish a causal link between a diagnosed medical condition and toxic substance exposure. Attachment 1 to this bulletin lists specific criteria the CE uses when adjudicating certain claims for compensation under Part E of the EEOICPA. When elements of Attachment 1 are satisfied, the CE can accept that exposure to a listed toxic substance is at least as likely as not a significant factor in aggravating, contributing to or causing the medical illness. As noted previously, this attachment will be periodically updated with new conditions.
2. The CE evaluates causation pursuant to this guidance using the Attachment 1 criteria in conjunction with EEOICPA Procedure Manual Chapter E-500 (Evidentiary Requirements for Causation). The CE conducts a complete review of all evidence of the case file record and, when necessary, conducts development when the claimed medical condition corresponds to one of the toxic substances referenced in Attachment 1. All authorized evidentiary development tools, including the exposure data contained in the Site Exposure Matrices (SEM), are to be utilized. The SEM acts as a repository of information related to toxic substances potentially present at covered Department of Energy (DOE) and Radiation Exposure Compensation Act (RECA) sites, and is particularly helpful as an exposure development tool. SEM can assist the CE in verifying the presence of a toxic substance at a given building or during a given work process. Other sources of information may include contacting the claimant or seeking guidance from a DEEOIC technical specialist or District Medical Consultant (DMC).
3. The first step a CE takes in developing claims for causation using guidance pursuant to this bulletin is to verify the claimed medical condition. Medical evidence must establish the employee was diagnosed with the condition as identified by the specified ICD-9 code listed in the attachment. Initial development of the medical evidence is conducted based upon established procedures as set out in EEOICPA PM 2-300 and E-500.
5. The next action is to confirm exposure to the relevant toxic substance. The CE examines all information contained in the case record (i.e. DAR responses, DOE FWP records, employment records) that references exposure to the toxic substance listed in Attachment 1. The CE also searches SEM to determine whether or not it is possible that, given the employee’s labor category and the work processes engaged in, the employee was exposed to the toxic substance in the course of employment. The CE uses SEM to determine whether or not available data on the job title, location of employment, or job duties, is sufficient to reasonably establish exposure to the toxic substance. Since toxic substances may have more than one name and toxic substance names may vary by facility, the CE should also search SEM for toxic substance alias names when the true identity of the claimed substance is not known.
6. In addition to establishing exposure to a particular substance, the evidence must demonstrate the employee was likely exposed to the noted toxin for a particular duration of time. The required duration may vary depending on the toxic substance. The CE must evaluate the evidence to assess whether or not sufficient evidence exists to verify exposure for a period of time equal to or greater than the duration noted in Attachment 1. The evidence does not need to conclusively prove the employee was directly exposed to the toxic substance throughout the entire work-shift or the exposure was continuous, merely that it would be reasonable that the employee’s labor brought him or her into contact with the toxic substance on a day by day basis.
7. For certain covered illnesses, it may be necessary to also establish a period of latency between the initial exposure to a toxic substance and the date of diagnosis of the claimed illness. The CE evaluates the evidence to identify the date that exposure to the toxic substance first occurred. If the latency period is equal to or exceeds the time outlined in Attachment 1, the CE has satisfied the criteria. The CE relies on existing procedures as referenced in EEOICPA PM 2-300 to establish a diagnosis. EEOICPA PM E-500 provides guidance as to evaluating latency periods.
8. If the evidence of record is sufficient to establish all of the necessary criteria identified in the attachment then causation is presumed to exist. No further development for causation is required. A copy of the appropriate attachment is to be included in the case file as evidence of causation, and a recommended/final decision is issued. This bulletin is cited in the recommended/final decision as the guidance upon which the adjudication was based.
9. If the documentation in the case file does not allow verification of all of the identified criteria, additional development in accordance with established procedures is required. A claim for benefits is not denied simply on the basis that the evidence does not meet the requirements set forth in this bulletin. If at any time the CE determines that DMC or technical specialist referral is necessary for an evaluation of the evidence, such referrals are made pursuant to established guidance.
10. The DEEOIC will periodically update the Occupational Illness Exposure Matrix.
Disposition: Retain until superseded or incorporated into the Federal (EEOICPA) Procedure Manual
PETER M. TURCIC
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections