EEOICPA BULLETIN NO.03-11

Issue Date: November 19, 2002

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Effective Date: November 19, 2002

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Expiration Date: November 19, 2003

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Subject: Additional Cancers Considered as 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 a list of six medical conditions to the National Cancer Institute (NCI) for their review and classification to determine which conditions could be considered as cancers under the EEOICPA. The six medical conditions sent to NCI were:

myelofibrosis with myeloid metaplasia;

polycythemia vera with leukocytosis and thrombocytosis;

polycythemia rubra vera;

myelodysplastic syndromes;

carcinoid tumors or carcinoid syndrome; and

monoclonal gammopathies of undetermined significance.

On October 8, 2002, DOL received a letter from Dr. E. G. Fiegal, the Acting Director of NCI’s Division of Treatment and Diagnosis, detailing NCI’s evaluation of the above mentioned six medical conditions.

According to Dr. Fiegel, NCI recognizes myelofibrosis with myeloid metaplasia, polycythemia vera with leukocytosis and thrombocytosis, polycythemia rubra vera, and myelodysplastic syndromes as reportable cancers. These hematological conditions are not reportable as leukemia, non-Hodgkin’s lymphoma, or multiple myeloma, but have distinct categories (except in the case of polycythemia rubra vera and polycythemia vera with leukocytosis and thrombocytosis, which share the same category). One of the functions of bone is to manufacture blood cells in the bone marrow. Accordingly, myelofibrosis with myeloid metaplasia, polycythemia rubra vera and its variant polycythemia vera with leukocytosis and thrombocytosis, and myelodysplastic syndrome(s) should be considered as bone cancer for purposes of having a "specified cancer" as a member of the Special Exposure Cohort, since all are malignancies of the bone marrow.

Carcinoid syndrome and monoclonal gammopathies of undetermined significance are not currently recognized as malignant conditions by NCI. Consequently, these conditions should not be considered as cancers.

Carcinoid tumors, except of the appendix, are recognized as malignant conditions by NCI and should be considered to be primary cancers of the organs in which they are located. If the organ is one on the specified cancer list, the carcinoid tumor may be considered as a specified cancer. Carcinoid tumors are found in greatest amounts in the small intestine and then in decreasing frequency in the appendix, rectum, lung, pancreas and very rarely in the ovaries, testes, liver, bile ducts and other locations.

Reference: Energy Employees Occupational Illness Compensation Program Act of 2000, As Amended, 42 U.S.C. § 7384 et seq., Section 7384l(17); interim final rule 20 CFR Part 30, Section 30.5 (dd); and a letter from Dr. E. G. Fiegal, NCI, to R. Leiton, DOL, dated October 8, 2002.

Purpose: To notify District Offices of the classification of six additional medical conditions as primary cancers for eligible SEC claimants under the EEOICPA.

Applicability: All staff.

Actions:

The CE should consider: (1) myelofibrosis with myeloid metaplasia; (2) polycythemia rubra vera; (3) polycythemia vera with leukocytosis and thrombocytosis; and (4) myelodysplastic syndrome(s) to be bone cancer, which is a specified primary cancer per EEOICPA Section 7384l(17)(B).

2. Carcinoid tumors, except of the appendix, are recognized as malignant conditions by NCI. If the organ is one on the specified cancer list, the CE should consider the carcinoid tumor as a specified cancer (per EEOICPA Section 7384l(17)).

3. Carcinoid syndrome and monoclonal gammopathies of undetermined significance are not currently recognized as malignant conditions by NCI. Consequently, these conditions should not be considered cancers by the CE. If no other medical conditions are claimed that qualify the employee as having a covered condition, the claim should be denied.

The CE 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. A preliminary review of the ECMS is underway to determine which cases may have already been denied or sent to NIOSH. That list will be forwarded to each District Office under separate cover. Using that list, the District Office must pull any cases for review in accordance with this bulletin. If modification orders are required, the District Office should send the case to the National Office.

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

For the conditions to be considered as bone cancers, the ICD-9 code for a myeloid metaplasia is 289.8, polycythemia rubra vera and its variant polycythemia vera with leukocytosis and thrombocytosis is 238.4, and myelodysplastic syndrome is 238.7. The ICD-9 code for malignant neoplasm of the bone is 170.

Carcinoid tumors, except of the appendix, should be recorded by the organ of the specified cancer. For example, the CE should use the ICD-9 code of 170 for a carcinoid tumor in the small intestine.

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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