EEOICPA BULLETIN NO.08-30
Issue Date: June 16, 2008
Effective Date: June 16, 2008
Expiration Date: June 16, 2009
Subject: OCAS-PER-012, Super S Program Evaluation Report.
Background: On March 29, 2007, the National Institute for Occupational Safety and Health (NIOSH) released OCAS-PEP-012 Rev-00, entitled “Program Evaluation Plan (PEP): Evaluation of Highly Insoluble Plutonium Compounds.” NIOSH’s OCAS-PEP-012 stated that “due to the increased doses assigned to workers exposed to Type Super S plutonium, previously completed claims that were assigned plutonium doses at sites where this material is potentially available for exposure need to be reexamined to determine the impact (if any) on the dose assessment.” The PEP outlined NIOSH’s plan for evaluating claims with the potential for exposure to highly insoluble forms of plutonium (Type Super S) at several facilities.
In response to NIOSH’s PEP, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) issued EEOICPA Bulletin No. 07-19, Processing Cases Affected by the National Institute for Occupational Safety and Health’s (NIOSH) “Program Evaluation Plan (PEP): Evaluation of Highly Insoluble Plutonium Compounds.” EEOICPA Bulletin 07-19, issued on May 16, 2007, provided guidance on handling those cases affected by NIOSH’s PEP that are in the adjudication process and have no final decision.
On August 7, 2007, NIOSH released OCAS-PER-012, “Evaluation of Highly Insoluble Plutonium Compounds.” The Program Evaluation Report (PER) provides NIOSH’s findings on the effect of type Super S plutonium on certain cases with a dose reconstruction.
Following the release of NIOSH’s PER, the DEEOIC issued EEOICPA Bulletin No. 07-27, Supplemental Guidance on Processing Cases Affected by OCAS-PER-012, entitled “Evaluation of Highly Insoluble Plutonium Compounds.” EEOICPA Bulletin No. 07-27, issued on August 7, 2007, delegated reopening authority to the District Directors to reopen those cases specifically identified by NIOSH as needing reevaluation. Guidance was also provided on a subset of cases that were not specifically identified by NIOSH as needing reevaluation but for which DEEOIC determined may be affected by the PER. In this instance, instructions were given to send a letter to NIOSH inquiring about whether OCAS-PER-012, and any other changes NIOSH made, may affect the dose reconstruction. While the DEEOIC has received responses from NIOSH requesting the return of certain cases for a new dose reconstruction, there are many more for which NIOSH has not provided a dispositive statement or response concerning changes to the dose reconstruction.
This bulletin is necessary to provide guidance to claims staff on the appropriate handling of the subset of cases in EEOICPA Bulletin No. 07-27 for which NIOSH has not provided appropriate guidance on the effect of OCAS-PER-012 on an existing dose reconstruction.
References: NIOSH document, OCAS-PEP-012 Rev-00, “Program Evaluation Plan: Evaluation of Highly Insoluble Plutonium Compounds,” approved on March 29, 2007, viewed at http://www.cdc.gov/niosh/ocas/pdfs/peps/oc-pep12-r0.pdf; OCAS-PER-012, “Evaluation of Highly Insoluble Plutonium Compounds.”
Purpose: To provide procedures for processing claims with a final decision to deny that may be affected by NIOSH’s OCAS-PER-012.
Applicability: All staff.
1. For the cases identified on the subset list of cases identified in EEOICPA Bulletin No. 07-27, regardless of whether or not a letter was sent to NIOSH inquiring on the applicability of OCAS-PER-012 and any other changes, NIOSH may supply National Office with individual Program Evaluation Reports (PER) or Individual Case Evaluations (ICE). The individual PER or ICE will serve as documentation that the case file has been reviewed by NIOSH and that NIOSH has determined that:
· the change outlined in the PER affects the outcome of the claim and a return to NIOSH for a new dose reconstruction is necessary, or
· there are multiple changes that affect the dose reconstruction and a return to NIOSH for a new dose reconstruction is necessary, or
· the change outlined in the PER does not affect the dose reconstruction, nor do any other changes affect the dose reconstruction and a return to NIOSH is not necessary.
If NIOSH provides DEEOIC with an individual case PER or ICE, the CE enters the code “LNR” (Letter/Response Received from NIOSH) and “830” reason code from the reason code drop down menu into ECMS B. The claim status date of the code is the date the response is received in the appropriate office, which is the date of the date stamp. No “LNR” status code is input in ECMS E unless the “NI” (Sent to NIOSH) status code had previously been entered. Therefore, if the “NI” status code had previously been entered in ECMS E, the CE also enters codes “LNR” and “830” into ECMS E.
If the individual case PER or ICE indicates that the case should “Return to NIOSH” for a new dose reconstruction, the District Director issues a Director’s Order (if appropriate) reopening the case and refers the case to NIOSH as outlined in this bulletin.
If the individual case PER or ICE indicates that the case was “Evaluated with No Change,” but does not include a dispositive statement, the District Director issues a Director’s Order reopening the case for a referral to NIOSH for a new dose reconstruction. In order to be dispositive, NIOSH must indicate that they have evaluated the case against this PER and any other changes, and determined that a new dose reconstruction is not necessary.
If the individual case PER or ICE is dispositive, then no action is necessary and the CE enters the “NA” (No Action
Necessary) status code an appropriate reason code into ECMS B as instructed in Action Item #5.
Individual case PERs or ICEs received in the National Office, will be forwarded to the appropriate district office for inclusion in the case file.
2. In the exercise of the Director’s discretion over the reopening process, the Director is delegating limited authority to the District Director to sign Director’s Orders for reopening. This delegated authority is limited to reopenings for those cases that are affected by the PER established for exposure to highly insoluble forms of plutonium. The Director is retaining sole signature authority for all other types of reopenings not otherwise delegated. If the District Director is unsure of whether the delegated authority to reopen applies, the case should be referred to the National Office.
3. For each case on the subset list of cases from EEOICPA Bulletin 07-27, regardless of whether or not a letter was sent to NIOSH inquiring on the applicability of OCAS-PER-012 on the dose reconstruction, the CE must determine whether a new dose reconstruction is needed. For those cases where:
the responsible District Director issues a Director’s Order vacating the final decision and reopening the claim. The Director’s Order states that the case is being reopened as a result of the change in scientific methodology by which the dose reconstruction is performed by NIOSH, and that a new dose reconstruction is necessary based on guidance provided in OCAS-PER-012.
The District Director enters the status code “MN” (NO Initiates Review for Reopening) into ECMS B with a status
effective date as the effective date of this bulletin. If the District Director is also reopening Part E, the “MN” code is also input in ECMS E.
For all reopenings per this bulletin, upon completing the Director’s Order to reopen the claim, the District Director enters status code “MD” (Claim Reopened – File Returned to DO) into ECMS B to reflect that the case has been reopened and is in the district office’s jurisdiction. (The “MZ” status code is not necessary.) The status effective date of the “MD” code is the date of the Director’s Order. If the Director’s Order reopens the Part E claim, the “MD” code is also input in ECMS E.
Please note that while the “MD” code is generally input by National Office staff, entry of this code has been delegated to the District Director, just as the authority to grant reopenings has been in this specific circumstance.
If the case does not meet the parameters for a new dose reconstruction (as described in the bulleted items above), no action is necessary and the CE enters the “NA” (No Action Necessary) status code and appropriate reason code into ECMS B as instructed in Action Item #5.
4. Once the claim has been reopened, the responsible CE is to refer the case to NIOSH for a new dose reconstruction. For cases affected by this bulletin, a request to the National Office Health Physicist is not required. Instead, the Claims Examiner (CE) should complete an amended NIOSH Referral Summary Document (ANRSD) and forward the ANRSD to the Public Health Advisor (PHA) assigned to the district office at NIOSH. The ANRSD should include the following statement in the “DOL Information” section, “Rework request due to OCAS-PER-012 and any other changes.” The CE should also:
a. Send a letter to the claimant explaining that the case has been returned to NIOSH for a rework of the dose reconstruction as a result of a change in the dose reconstruction methodology as outlined in the OCAS-PER-012. A sample letter to the claimant is included as Attachment 2.
b. Send a copy of this letter to the PHA at NIOSH assigned to the DO along with the weekly DO submissions to NIOSH. The dates on the ANRSD and the letter to the claimant must both be the same,
c. since this will be the date used for the status code entry into ECMS. The CE enters status code “NI” (Sent to NIOSH) into ECMS B and selects the “PEP” (Rework based on Program Evaluation Plan) reason code.
The “NI” status code should only be entered in ECMS E after toxic exposure development is complete and the CE cannot accept causation. In that case the CE creates a memorandum to file stating that toxic exposure development is complete. The CE then enters status code “NI-PEP” into ECMS E with the date of the memorandum as the status effective date.
(Since this is considered a new dose reconstruction, the CE should not change the existing NR/DR status code to NR/RW as typically done for rework cases. Furthermore, if a POC value is already entered into ECMS, the CE should not delete the POC. The new POC will be updated once it is calculated.)
Upon receipt of the revised dose reconstruction report, the CE proceeds in the usual manner and prepares a recommended decision. The CE enters status code “NR” (Received from NIOSH) into ECMS B and selects the “DR” (Dose Reconstruction Received-POC) reason code. The status effective date is the date the dose reconstruction is date stamped into the district office. If the CE had previously entered “NI” in ECMS E, the CE also enters codes “NR” and “DR” into ECMS E. If the case is an E/B case, the CE enters the Probability of Causation into ECMS B and ECMS E regardless of whether an “NI” status code had previously been entered.
5. Each case on the subset list of cases from EEOICPA Bulletin 07-27 must be reviewed to determine if it meets the criteria to return to NIOSH for a new dose reconstruction. If after review, the adjudicator determines that a case on the list does not require any action to be taken, the CE/FAB HR must write a brief memo to the file that explains the case was reviewed under this bulletin, no additional action is necessary, and why. A case classified as not requiring any action is a case that does not meet the criteria for a return to NIOSH, the case is already at NIOSH, or NIOSH has determined that a dose reconstruction is not necessary.
The CE must then code “NA” (No Action Necessary) and select the appropriate reason code from the reason code drop down list. The “NA” coding is specifically tied to the review list generated by DEEOIC and the “NA” code is restricted to ECMS B only because the review list is derived from Part B data. For cases that were reviewed under this bulletin and require no additional action, the reason code that must be selected is “30P” (Reviewed under Bulletin 08-30). Even if the case is an E/B case, the NA-30P must be coded into ECMS B only. The status effective date of the “NA” code is the date of the memo to the file stating review is complete and the CE has determined there is no further action necessary.
Please note that if the CE discovers that the claimant(s) is/are deceased, the CE must still enter the “NA-30P” code in addition to the closure code. The status effective date for the “NA” coding is the date of the memorandum to file.
6. For data integrity, EEOICPA Bulletin 08-02 supplemented EEOICPA Bulletin No. 07-27 by providing instructions on coding “LNS” (Letter Sent to NIOSH) and “LNR” (Letter/Response Received from NIOSH) in ECMS. If a letter was previously sent to NIOSH inquiring as to the applicability of OCAS-PER-012 and any other changes on the dose reconstruction, and the “LNS” status code was not coded into ECMS B, the CE enters the “LNS” status code in ECMS B. The status effective date is the date of the letter to NIOSH. If the “NI” status code had previously been entered in ECMS E, the CE also enters code “LNS” into ECMS E with the status effective date as the date of the letter to NIOSH. Similarly, as discussed above in Action Item #1, if a response was received from NIOSH, and the “LNR” code was not coded in ECMS, the CE is to enter the “LNR-830” status code into ECMS B. A review of the file will be necessary to determine whether a letter was sent to NIOSH inquiring on the applicability of OCAS-PER-012 and/or whether an individual case PER or ICE has been received from NIOSH.
7. For all cases with no final decision issued, the CE should take the appropriate action to refer the case back to NIOSH for a new dose reconstruction. This guidance is provided in EEOICPA Bulletin No. 07-19.
8. When reviewing cases under this Bulletin, CEs must keep in mind other changes that might affect the case and take the action that is appropriate under the circumstances.
For example, if a case should be reopened and accepted under a new Special Exposure Cohort class, the CE should take the action that will result in the most expedient positive outcome.
9. In carrying out the policy outlined in this Bulletin, personnel must understand that the comprehensive list not only provides the "to do" list of cases requiring attention, but it also serves as a means of tracking progress. As part of tracking progress, the list becomes the "pending" list and it is the goal to successfully and accurately review cases and enter appropriate ECMS coding which will result in “the case being removed from the list” (in other words, will result in an indicator for reporting purposes showing that the initial review was completed and/or that subsequent action was taken). ECMS coding is at the claim level and so the failure to input a code that will remove the case from the pending list on even one claim associated with a case, will result in the case still showing up as still pending review or action. In terms of ECMS coding, it is crucial to be thorough and precise. The most obvious example of this is the use of the “C2” (administrative closure) code. “C2” will not remove a case from the pending list; the "NA" code must be entered for each claim to which it applies after input of the “C2” code. In terms of codes that will remove cases off the pending list, any “NI” code entered after the bulletin effective date will remove it and proper use of the “NA” code will remove it from the pending list. These are not the only codes that will remove cases from the pending list, but rather are provided as examples to show their importance. Any additional questions regarding proper ECMS coding must be directed to the Policy Branch.
10. The operational plan goal for the lists of cases identified for review as part of a new SEC class, PEP, or PER is to complete the Part B recommended decision, return to NIOSH, or determine that no action is necessary within 45 days of the date of this Bulletin for at least 50% of the cases, and within 90 days for 95% of the cases. All cases requiring action due to this Bulletin should be completed within 120 days.
Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.
PETER M. TURCIC
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: All DEEOIC Employees
Distribution List No. 7: Resource Centers