EEOICPA BULLETIN NO.02-26

 

Issue Date: September 13, 2002

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Effective Date: September 13, 2002

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Expiration Date: September 13, 2003

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Subject: Referrals to Dr. Lee Newman

 

Background: Section 78841 (8) (A) & (13) requires Claims Examiners (CEs)to adjudicate claims for Chronic Beryllium Disease (CBD) and Beryllium Sensitivity (BeS) based on certain criteria. Prior to January 1, 1993 standard medical terminology for Beryllium tests and diagnoses did not exist. This has made it difficult for the CEs in the District Offices to review and interpret medical evidence for CBD and BeS prior to January 1, 1993. Since the diagnosis of CBD is relatively new, ongoing research continues. Therefore, it is also sometimes difficult for CEs to apply the criteria for CBD to diagnoses that were made after 1/1/93.

 

The National Office has established a contractual and billing agreement with Dr. Lee Newman, of the National Jewish Medical and Research Center, to obtain medical opinions, services, advice, policy and translation of medical aspects of a claim. Therefore, in the event a CE is unable to interpret medical evidence for a Beryllium Sensitivity or Chronic Beryllium Disease case, and has no success with the claimants physician, Dr. Lee Newman may be consulted. Dr. Newman is not considered a second opinion. He is to be consulted for interpretation of medical evidence relevant to Beryllium cases.

 

For tracking and budgetary purposes the National Office will manage all referrals and completed evaluations.

 

Reference: Energy Employees Occupational Illness Compensation Program Act of 2000, As Amended, 42 U.S.C. 7384 et seq., Section 73841(8)(A) and (13).

 

Purpose: To notify the District Offices of the procedures for referring a claim to Dr. Lee Newman.

 

Applicability: Claims Examiners, Senior Claims Examiners, All Supervisors, Technical Assistants, and mail room staff

 

Actions:

 

1.     The CEs should consider consulting Dr. Newman if they are

unable to interpret medical evidence for a Beryllium Sensitivity or Chronic Beryllium Disease case, and have no success with clarification from the claimants physician. Examples of situations when a referral is needed may include:

 

         Pre 1993 medical evidence is submitted that includes a lung biopsy report that is inconclusive, a positive LPT and x-rays that show granulomas in the lungs.

         Medical tests are submitted which do not provide clear diagnosis or interpretation i.e. LPT, BAL LPT.

 

 

2.     When the CE determines Dr. Newman is to be consulted, a

package should be prepared for Dr. Newman that includes:

 

         Memo which is addressed to Dr. Newman and includes contact information for the CE and a return address for the National Office; states the reason for the referral detailing evidence being sent, and questions the CE needs answered. (See attachment for format)

         Copies of Medical Records in question.

 

3.  The CE should mail or fax the referral package to the

National Office.

 

U.S. Department of Labor

Attention: Anita Brooks

ESA/OWCP, DEEOIC

Room C4511

200 Constitution Avenue, N.W

Washington, DC 20210

 

Fax Number: (202) 693-1465 attn: Anita Brooks

 

4.  The CE should enter the code MS (Medical Consult Sent)

under the claims status screen in ECMS with the status effective date as the date sent to the National Office.

 

5.  The National Office will Federal Express or Fax completed

evaluations to the CE within 24 hours of receipt from Dr. Newman.

 

6.  Upon receipt of the report from the National Office, the CE

should enter the code MR (Medical Consult Received) under the claim status screen in ECMS with the status effective date as the date received from the National Office.

 

7. General questions regarding Beryllium can be e-mailed

to Anita Brooks in the National Office at abrooks@esa-dol.gov who will answer or forward to Dr. Newmans staff for assistance. Examples of questions may include; What does the acronym BALLPT mean? What type of symptoms do CBD patients normally exhibit? What are the possible side effects for steroid treatment?

 

8. All bills are to be handled by the National Office.

 

 

Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.

 

 

 

 

 

 

 

 

 

PETER M. TURCIC

Director, Division of Energy Employees

Occupational Illness Compensation


U. S. DEPARTMENT OF LABOR EMPLOYMENT STANDARDS ADMINISTRATION

OFFICE OF WORKERS COMPENSATION PROGRAMS

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL

ILLNESS COMPENSATION

200 CONSTITUTION AVE

ROOM C-4511

WASHINGTON DC 20210

TELEPHONE: (202) 693-0081

Request for Medical Evidence Consultation

 

To: Lee S. Newman, MD., M.A., F.C.C.P. From: {Claims Examiner}

Departmental Head, Division of Environment

and Occupational Health Sciences Phone Number: {CE phone #}

National Jewish Medical and Research Center

 

Re: {Claimant Name}

 

Date:

 

 

 


{insert reason for referral, medical evidence submitted and questions that need to be answered}

 

 

 

 

Please return your completed evaluation and billing information to the following address:

 

U.S. Department of Labor

Attention: Anita Brooks

ESA/OWCP, DEEOIC

Room C4511

200 Constitution Avenue, N.W

Washington, DC 20210

 

Thank you for your cooperation.

 

Sincerely,

 

 

 

Claims Examiner

 

 

For DOL National use only:

 

Date Materials Mailed to Consultant:

Date Materials Received from Consultant:

Date Final Evaluation Mailed to CE: