EEOICPA CIRCULAR NO. 11-02                 March 8, 2011

 

SUBJECT:  Consideration of mediastinal lymph node biopsy as medical evidence of lung pathology consistent with chronic beryllium disease (CBD).

 

The purpose of this circular is to notify all Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff how to consider a mediastinal lymph node biopsy as a diagnostic tool for the purpose of establishing lung pathology consistent with CBD under Part B of the EEOICPA in both the pre and post 1993 requirements.

 

Under 42 U.S.C. § 7384l(13), a Part B claim for CBD has the  following requirements –

 

(A)  For diagnoses on or after January 1, 1993, beryllium sensitivity (as established in accordance with paragraph (8)(A)), together with lung pathology consistent with chronic beryllium disease, including—

 

(i)  a lung biopsy showing granulomas or a lymphocytic process consistent with chronic beryllium disease;

(ii)  a computerized axial tomography scan showing changes consistent with chronic beryllium disease; or

(iii)  pulmonary function or exercise testing showing pulmonary deficits consistent with chronic beryllium disease.

 

(B)  For diagnoses before January 1, 1993, the presence of—

 

(i)  occupational or environmental history, or epidemiologic evidence of beryllium exposure; and

(ii)  any three of the following criteria:

 

(I)  Characteristic chest radiographic (or computed tomography (CT)) abnormalities.

(II)  Restrictive or obstructive lung physiology testing or diffusing lung capacity defect.

(III)  Lung pathology consistent with chronic beryllium disease.

(IV)  Clinical course consistent with a chronic respiratory disorder.

(V)  Immunologic tests showing beryllium sensitivity (skin patch test or beryllium blood test preferred).

 

A mediastinal lymph node biopsy interpreted by a physician as evidence of “lung pathology consistent with CBD” may be used to establish CBD in addition to the existing three criteria identified under  § 7384l(13)(A) for a diagnosis after January 1, 1993. The CE should be aware that a mediastinal lymph node biopsy is not the equivalent of a “lung biopsy” and, as such, does not substitute for such in the assessment of a post-1993 CBD claim. 

 

For a diagnosis before January 1, 1993, a mediastinal lymph node biopsy interpreted by a physician as evidence of “lung pathology consistent with CBD” may be used to satisfy the diagnostic criteria at § 7384l(13)(B)(ii)(III).  

 

With reference to claims under Part E, as there is no statutory requirement regarding the diagnostic criteria necessary to substantiate diagnosed CBD, this guidance is relevant only in so far as the program recognizes that the results of a mediastinal biopsy may be applicable to the assessment of CBD. 

 

 

 

RACHEL P. LEITON

Director, Division of Energy Employees

Occupational Illness Compensation

 

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