EEOICPA BULLETIN NO.06-10
Issue Date: June 2, 2006
Effective Date: June 2, 2006
Expiration Date: June 2, 2007
Subject: Illnesses that presently have no known causal link to toxic substances.
Background: Given the complexity and number of claims presented under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOIPCA), means to expedite the claims adjudication process are being developed to assist the Claims Examiner (CE). The Division of Energy Employees Occupational Illness Compensation (DEEOIC) National Office (NO) established criteria for the presumption of causation in certain specific situations outlined in EEOICPA Bulletin NO. 06-08. In conducting research to establish these criteria, a number of claimed illnesses were identified for which DEEOIC was unable to find scientific information demonstrating an association with exposures to toxic substances. DEEOIC has established criteria for handling claims where there is no known relationship between certain illnesses and occupational exposure to toxic substances under Part E of the EEOICPA.
DEEOIC specialists researched authoritative scientific publications, medical literature, and occupational exposure records for information to identify medical illnesses for which current scientific knowledge does not show a relationship or an etiology due to biological or chemical exposure. The findings of these specialists are incorporated into this bulletin to assist the CE in rendering timely and accurate claim determinations under Part E of the EEOICPA.
While the information in this bulletin provides guidance relative to certain claimed medical conditions, it in no way precludes the claimant’s ability to present evidence that refutes the conclusions of the DEEOIC specialists. To challenge the scientific conclusions presented, compelling and probative evidence must establish exposure to a toxic substance has been shown to cause, contribute, or aggravate an occupational illness. This bulletin does not affect existing procedures in place for establishing causation based upon radiation exposure for cancer.
References: Energy Employees Occupational Illness Compensation Act of 2000, 42 U.S.C. § 7384 et seq.; 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 guidance on handling claims where certain claimed medical conditions have no known relationship to a toxic substance.
Applicability: All staff.
1. The DEEOIC has identified certain illnesses with no known causal link to toxic substance exposure. Attachment 1 to this bulletin lists specific medical conditions and their associated ICD-9 codes where there is presently no known relationship to toxic substance exposure. Therefore, extensive development of the claim is not required. This Attachment may be up dated periodically with additional information.
2. Initial development of the medical evidence is conducted based upon established procedures as set out in EEOICPA PM 2-300 and E-500. Medical evidence must establish a covered employee was diagnosed with the disease or illness being claimed. Once the CE has confirmed the existence of a diagnosed illness, he or she should determine if it corresponds to one of the conditions listed in Attachment 1.
3. If it is determined the diagnosed illness corresponds to one listed on Attachment 1, the CE prepares a letter to the claimant(s) listed in the case file. The letter should notify the claimant(s) that the condition being claimed is not scientifically recognized as having any known link to exposure to a toxic substance (Attachment 2). If the claimed condition listed in this Attachment is cancer, the claimant is advised that DEEOIC will assess the claim based upon exposure to radiation. This is done either through membership in a Special Exposure Cohort (SEC) class or the dose reconstruction process and the resultant Probability of Causation (POC). If the outcome of the SEC or POC is negative, the claimant must produce evidence that the cancer is affiliated with a biological or chemical exposure. If the claimed condition in this Attachment is not cancer, the claimant is specifically informed there is no known scientific link between exposure to radiation and the listed condition. The claimant is further advised the DEEOIC will evaluate any argument, medical, or scientific evidence submitted in support of a causal relationship between the claimed illness and a toxic substance exposure. The letter is to allow the claimant(s) thirty days to provide a response. If additional time is required to obtain information, the claimant should notify the claims examiner. The CE will permit any reasonable request for an extension of the deadline for evidence submission.
4. Upon receipt of any evidence from the claimant(s), the CE must evaluate it to determine if there is any compelling or probative basis for DEEOIC specialist review. Items of particular interest would reference human epidemiological studies or other scientific findings suggesting a causal relationship between an illness (referenced on Attachment 1) and a toxic substance. Any well-rationalized opinion from a board-certified physician or other specialist attesting to such relationship would also be a sufficient basis for referral to the DEEOIC specialists. Evidence that does not warrant a referral to a DEEOIC specialist includes: unsubstantiated statements of causal relationship; speculative or equivocal medical/specialist opinions; scientific literature or other documents that do not reference the illness under evaluation; and general news articles from print or the Internet. When evaluating evidence of this nature, the CE consults with his/her Senior Claims Examiner or Supervisor and, if necessary, the DEEOIC Medical Director for guidance.
5. If, after reasonable development, the CE has determined the response from the claimant(s) is insufficient to warrant review by a DEEOIC specialist, a finding of causation can be rendered with regard to toxic exposure. The CE will make the finding that an exposure to a toxic exposure was not “as least as likely as not a significant factor in aggravating, contributing to or causing the diagnosed illness.” While it may be necessary to await a dose reconstruction and POC calculation regarding a diagnosed cancer, all non-cancerous conditions immediately receive a recommended decision denying compensation for the illness under the EEOICPA. If any of the non-cancer conditions are consequential to the cancer, a decision on those conditions should not be rendered until the cancer decision is made. The recommended decision includes a citation to this bulletin. A copy of the attachment is inserted into the case record.
6. The following wording is to be included in the Conclusions of Law in both the recommended and final decisions:
The evidence of record establishes that the claimed medical condition, [insert condition], neither has a known scientific relationship to toxic substances nor is “at least as likely as not” caused by such exposure at a covered DOE facility during a covered time period.
Disposition: Retain until superceded 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