EEOICPA BULLETIN NO.07-07   

 

Issue Date:  February 9, 2007

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Effective Date:  February 9, 2007

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Expiration Date:  February 9, 2008

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Subject:  Procedures for rating impairment due to mental disorders under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).

 

Background:  Section 7385s-2(b) of EEOICPA requires that a minimum impairment rating be determined in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA’s Guides).  This requirement is reflected in 20 C.F.R. § 30.901(b), which states the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will determine a minimum impairment rating using the current edition of the Guides.  The 5th edition of the Guides states the following regarding mental impairment ratings:

 

Percentages are not provided to estimate mental impairment in this edition of the Guides.  Unlike cases with some organ systems, there are no precise measures of impairment in mental disorders.  The use of percentages implies a certainty that does not exist.  Percentages are likely to be used inflexibly by adjudicators, who then are less likely to take into account the many factors that influence mental and behavioral impairment.  In addition, the authors are unaware of data that show the reliability of the impairment percentages.  After considering this difficult matter, the Committee on Disability and Rehabilitation of the American Psychiatric Association advised Guides contributors against the use of percentages in the chapter on mental and behavioral disorders of the fourth edition, and that remains the opinion of the authors of the present chapter.  Guides to the Evaluation of Permanent Impairment, 5th Edition, Chapter 14.3, pg. 361.

 

However, the Guides does allow for rating impairment due to emotional or behavioral disorders that are associated with ratable neurological conditions that result from exposures to toxic substances, and as such the physician conducting the impairment is directed to Chapter 13 of the Guides

 

References:  42 U.S.C. § 7385s-2(b); 20 C.F.R. §§ 30.901 and 30.910 (2005).

 

Purpose:  To provide procedures to develop claims for impairment ratings due to mental disorders associated with neurological conditions under Part E of EEOICPA.

 

Applicability:  All staff.

 

Actions:

 

1.   Upon receipt of a claim for a mental impairment, the CE must determine whether the claimed impairment is due to a purely psychological condition or is a consequence of an exposure to a toxic substance that caused neurobehavioral sequelae. 

 

2.   Once it has been established that an employee’s mental impairment is related to a documented physical dysfunction of the nervous system, the employee should obtain an impairment evaluation from the physician based on Table 13-8 of Chapter 13 in the 5th edition of the AMA’s Guides.

 

3.   If the mental impairment is not related to a documented physical dysfunction of the nervous system, the CE should then communicate with the claimant regarding the non-ratability of the condition per 5th edition of the Guides.  The CE should provide the claimant with a 30-day period to submit documentation from their personal physician if s/he believes there is a link between the employee’s exposure to a toxic substance at the covered facility and the development of a mental impairment.  The report from the individual’s physician must contain rationalized medical evidence establishing that the mental impairment is related to  neurological damage due to an accepted toxic exposure. Speculation or unequivocal statements from the physician should reduce the probative value of a physician’s report, and in such cases the CE may find it necessary to refer the case to a DMC or the DEEOIC toxicologist to determine whether a toxic exposure caused an emotional or behavioral disorder.

 

4.   While an individual’s mental impairment due to a purely psychological condition will not be included in an impairment rating for Part E purposes, such a “non-ratable” condition may be accepted as a consequence of another compensable covered illness, provided that the case file contains rationalized medical evidence in support of causation.  For example, depression is often an added diagnosis in terminally ill cancer patients.  When this occurs, a compensable consequential psychological condition may be used to pay for medical treatment and qualifying calendar years of wage-loss under Part E.

 

Disposition: Retain until incorporated in the Federal

(EEOICPA) Procedure Manual.

 

 

 

 

PETER M. TURCIC

Director, Division of Energy Employees

Occupational Illness Compensation

 

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