EEOICPA BULLETIN NO.03-32   

Issue Date: August 27, 2003

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Effective Date: August 27, 2003

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Expiration Date: August 27, 2004

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Subject:  Clarification by NCI of Certain Primary Cancers

Background:   20 CFR 30.5 (dd)(6) states that specified cancers are “the physiological condition or conditions that are recognized by the National Cancer Institute under those names or nomenclature, or under any previously accepted or commonly used names or nomenclature.”  The Department of Labor (DOL) forwarded five issues to the National Cancer Institute (NCI) for their review and classification to determine which conditions could be considered as cancers under the EEOICPA.  The five issues sent to NCI were:

·        Definition of brain cancer;

·        Cancers of the pleura and the lung;

·        Considering cancer of the urethra as a cancer of the urinary bladder; and

·        Clarification of the terminology related to a diagnosis of polycythemia
   vera.

·        Clarification regarding the classification of essential thromobocytosis.

The NCI’s responses to these five issues are as follows.

Regarding the definition of brain cancer, it is appropriate to consider only malignancies of the brain under this category, excluding intracranial endocrine glands and other parts of the central nervous system (CNS).  Under this definition, the brain is the part of the central nervous system contained within the skull, i.e., the intracranial part of the CNS consisting of the cerebrum, cerebellum, brain stem, and diencephalon.  Benign and borderline tumors of the brain would be excluded from this definition, including borderline astrocytomas.

Cancers of the pleura are different from lung cancers.  NCI noted that the tissues of these two organs are different as well as the etiologies of their malignancies.  Accordingly, the pleura and the lung are separate organs and a cancer of the pleura is not lung cancer.

Concerning the urethra, it is contiguous with the urinary bladder and is lined by the same type of urothelial cells as the bladder.  NCI noted that urethral cancer is so similar to bladder cancer from epidemiologic, biologic, and clinical perspectives that it is appropriate to consider cancer of the urethra as a cancer of the urinary bladder.

In Bulletin 03-11, polycythemia rubra vera and its variant polycythemia vera with leukocytosis and thrombocytosis were considered as bone cancer.  We requested clarification as to whether all of the descriptors were necessary in a diagnosis of polycythemia vera.  Leukocytosis and thrombocytosis are supplemental descriptors of polycythemia vera.  NCI noted that a diagnosis of polycythemia vera (also called polycythemia rubra vera, P. vera, primary polycythemia, proliferative polycythemia, spent-phase polycythemia, or primary erythremia) is sufficient by itself to be classified as a malignancy of the bone marrow.

Our final question for clarification involves the classification of essential thrombocytosis.  NCI recognizes essential thrombocytosis as a synonym of essential thrombocythemia.  The current NCI tumor coding book (ICD-O-3) identifies essential thrombocythemia as a malignancy.  It is in the same category as polycythemia vera, which DOL considered to be a bone cancer (see Bulletin 03-11).  Since essential thrombocytosis is a malignancy of the bone marrow, it should be considered as bone cancer.

Reference: Energy Employees Occupational Illness Compensation Program Act of 2000, As Amended, 42 U.S.C. § 7384 et seq., Section 7384l(17); 20 CFR Part 30, Section 30.5 (dd); and letters from A. Fritz, NCI, to P. Turcic, DOL, dated April 28, 2003, and Dr. E. G. Fiegal, NCI, to J. Kotsch, DOL, dated July 28, 2003.

Purpose: To notify District Offices of the clarification of five medical conditions as primary cancers.

Applicability: All staff. 

Actions:

1.  The Claims Examiners (CEs) in the district offices and FAB, as well as the FAB Hearing Representatives (HRs) must consider brain cancer, per EEOICPA Section 7384l(17), to include only malignancies of the brain, excluding intracranial endocrine glands and other parts of the central nervous system (CNS).  Under this definition, the brain is the part of the CNS contained within the skull, i.e., the intracranial part of the CNS consisting of the cerebrum, cerebellum, brain stem, and diencephalon.  Benign and borderline tumors of the brain are excluded from this definition, including borderline astrocytomas.

2.  Cancers of the pleura and the lung are separate organs.  A cancer of the pleura is not lung cancer.  If cancer of the pleura is claimed, the CE/HR does not consider this malignancy as lung cancer, which is a specified cancer (per EEOICPA Section 7384l(17)). 

3.  Cancer of the urethra should be considered by the CE/HR as a cancer of the urinary bladder, which is a specified cancer per EEOICPA Section 7384l(17).

4.  The CE/HR must consider a diagnosis of primary polycythemia vera (also called polycythemia rubra vera, P. vera, primary polycythemia, proliferative polycythemia, spent-phase polycythemia, or primary erythremia) to be bone cancer, which is a specified primary cancer per EEOICPA Section 7384l(17)(B).

5.  The CE/HR must consider essential thrombocytosis or essential thrombocythemia as bone cancer, which is a specified primary cancer per EEOICPA Section 7384l(17)(B).

6.  The CE/HR must look for any other cases of the medical conditions discussed above that could make the claimant eligible for benefits, either as a member of the SEC or through dose reconstruction.  The District Office/FAB must perform a review of the ECMS to determine which cases may have already been denied or sent to NIOSH.  Using the results of that review, the District Office/FAB must pull any cases for review in accordance with this bulletin.  If modification orders are required, the District Office/FAB must send the case to the National Office.

7.  The CE/HR must continue to distinguish these medical conditions from other specified cancers, as appropriate, using the appropriate ICD-9 codes on all paperwork and in ECMS.

For the conditions to be considered as cancer of the urinary bladder, the ICD-9 codes are 189.3 and 188.9 for the urethra and urinary bladder, respectively.

For the conditions to be considered as bone cancers, the ICD-9 code for polycythemia rubra vera and its variant polycythemia vera with leukocytosis and thrombocytosis is 238.4, essential thrombocytosis is 238.7, and essential thrombocythemia is 289.9.  The ICD-9 code for malignant neoplasm of the bone is 170.

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: Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections