Addressee

Address

City, State, Zip

 

Dear Mr./Ms./Claimant:

 

I am writing in reference to your claim for benefits under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).  On (date), your claim was denied, but since that date there have been new developments.  The purpose of this letter is to let you know that I am vacating the (date) denial because these recent developments may affect the outcome of your claim.  This means your claim will be reopened and reviewed and you will receive a new decision.

 

The reason for the reopening of your claim is that effective June 30, 2008, a class of workers at Horizons, Inc. was designated as members of the Special Exposure Cohort (SEC) for the timeframe of January 1, 1952 through December 31, 1956.  Our records indicate you have claimed employment at Horizons, Inc. during this timeframe, and we will therefore re-examine your case to determine if you qualify for benefits under the rules of the new class in the SEC.

 

The attached Director’s Order explains the reason why the prior decision is being vacated and your case reopened.  Please read this over carefully.  If any of the basic information (such as medical condition) changed since your final decision was issued, please contact this office immediately and ask for your assigned claims examiner.

 

If you have any questions about the Director’s Order, please feel free to call this district office at our toll-free number (xxx)xxx-xxxx.

 

Sincerely,

 

 

 

(Name of District Director)

District Director 

 


 

EMPLOYEE:

 

[Claimant(s) Name

CLAIMANT:

 

[Claimant(s) Name]

FILE NUMBER:

 

[File Number]

DOCKET NUMBER

 

[Insert Docket Number]

 

 

DIRECTOR’S ORDER

 

On (date), you were issued a final decision denying your claim for benefits under Part B of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or the Act).   A final decision may be reopened at any time on motion of the Director of the Division of Energy Employees Occupational Illness Compensation (DEEOIC).  Because of new developments described in this Director’s Order, the (date) final decision under Part B of the Act is hereby vacated and your case reopened under this provision.

 

BACKGROUND

 

(Provide a concise and accurate synopsis of the claim’s history.  Some sample paragraphs are provided here, though these should be altered to tailor-fit the specifics of the case.)

 

The evidence of record shows that (claimant name) filed Form EE-2 (Claim for Survivor Benefits under the EEOICPA) under Part B on (date).  It was asserted that (employee and relationship) developed (cancer type) as a result of employment at the Department of  Energy’s Horizons, Inc. Plant in Cleveland, Ohio.  Medical documentation established the claimed condition.

 

Under the Act, all cancer cases must be referred to the National Institute for Occupational Safety and Health (NIOSH), a division of the Department of Health and Human Services (HHS) in order to receive a dose reconstruction.  A dose reconstruction allows the Department of Labor to run a program that provides a number called the probability of causation (PoC).  Under Part B of the Act, a cancer is “at least as likely as not” related to employment at a covered facility if the PoC is 50% or greater.  In your case, the PoC was calculated to be (XX.XX%).  As a result, on (date), the district office issued a recommended decision denying the claim under Part B of the Act because the PoC was less than 50%.


 

The recommended decision was forwarded to the Final Adjudication Branch (FAB) in accordance with our procedures for an independent assessment and issuance of a final decision.  On (date), the FAB issued a final decision, affirming the recommended decision to deny the claim. 

 

DISCUSSION

 

Under the Act, there is a provision that allows for payment of some cases regardless of a previous PoC.  This provision becomes available when employees are included in a class of the Special Exposure Cohort (SEC).  To be included as a member in a class of the SEC, the employee must be diagnosed with a specified cancer and meet all the employment requirements of the SEC class.

 

In order for new classes of employees at a facility to be evaluated for inclusion in the SEC, individuals may submit petitions to NIOSH for review.  NIOSH evaluates the petitions, and determines whether a new SEC class will be added.  Effective June 29, 2008, NIOSH added to the SEC a new class of employees who worked at Horizons, Inc.  The designation states:

 

All Atomic Weapons Employer (AWE) employees who worked at the Horizons, Inc. facility from January 1, 1952 through December 31, 1956, for a number of work days aggregating at least 250 work days occurring either solely under this employment or in combination with work days within the parameters established for one or more other classes of employees in the Special Exposure Cohort.

 

Based on the designation of this new class into the SEC, the district office has reviewed the file and finds there is sufficient evidence to warrant reopening of this claim.  The evidence of record shows that the employee worked (describe evidence that shows the employee worked for at least 250 work days at Horizons, Inc. during the designated years for the new class in the SEC).  This demonstrates that the employee performed work at Horizons, Inc. for at least 250 work days within the designated time period for the SEC class.  Moreover, the evidence establishes the employee was diagnosed with (type of cancer), a SEC-specified cancer.

 


CONCLUSION

 

Therefore, the above findings indicate potential eligibility as a member of the SEC.  Accordingly, the final decision pursuant to Part B is hereby vacated, and the case is reopened so that a new recommended decision can be issued. 

 

If you disagree with the recommended decision, you will have the opportunity to file an objection and request an oral hearing or a review of the written record.

 

(city of District Office)

 

 

 

                                                                                    (Name of District Director)

                                                                                    District Director


CERTIFICATE OF SERVICE

 

I hereby certify that on                                              a copy of the Director’s Order was sent by regular mail to the following:

 

Addressee

Address

City, State, Zip

 

 

 

                                                                                    (Name of District Director)

                                                                                    District Director