EEOICPA CIRCULAR NO. 13-06 February 21, 2013
SUBJECT: Review of Denied Bladder Cancer Cases under Part E.
The purpose of this Circular is to notify all Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff of the first set of cases to be reviewed under Bulletin No. 13-02, “Systematic Review of Denied Part E Cases.”
An important component of adjudicating claims under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) is the Site Exposure Matrix (SEM). SEM identifies toxic substances that were present at Department of Energy (DOE) facilities and Radiation Exposure Compensation Act (RECA) uranium mines and mills. Moreover, the information contained in the SEM identifies scientifically known relational connections between particular chemical or biological exposures and specific illnesses. The SEM labels these relational connections as toxic “health effects.”
The source of health effect findings referenced in SEM is the National Library of Medicine’s (NLM) Haz-Map database. Haz-Map is an occupational health database designed to provide information about the adverse effects of workplace exposures to chemical and biological agents. These links are derived from current scientific evidence.
Recently, Haz-Map was updated to reflect the latest scientific recommendations of the International Agency for Research on Cancer (IARC). The subject of this Circular is bladder cancer because Haz-Map now identifies exposures to the following substances as being causally linked to bladder cancer: Direct Black 38 (1937-37-7) (identified in SEM as Cholorazole BlackE), Benzo(a)pyrene (50-32-8), 4,4’-Methylenebis-(2-chloroanaline)[hereafter MOCA] and o-Toluidine (95-53-4). A pull list has been assembled that contains a list of all denied Part E bladder cancer claims.
The cases on this list are to be reviewed as per the policies and procedures outlined in Bulletin No. 13-02, and in conjunction with the instructions provided in this Circular, including completion of the worksheet which is provided in Attachment 1. Cases reviewed using the guidance in this Circular are to have the related screening actions recorded in ECS, as outlined in Bulletin No. 13-02. The “Initial Screening Reason” to be selected with the Initial Screening date and result (and “No Action Necessary,” if needed) is “Rvwd per Circular 13-06, Bladder Part E.” The completed worksheet and related SEM search(es) are to be placed in the case file.
In terms of the scientific studies utilized to conclude that these additional toxins are now linked to bladder cancer, none were studies of DOE worker populations but involve other worker populations. The following paragraphs will provide an overview of these substances to provide context for making exposure determinations, including some information about worker populations and how this can be extended to DOE workers. In all instances a thorough SEM search is to be conducted in conjunction with a review of the DAR/OHQ and any other potentially relevant material in the case file. Additionally, the IH referral process is available to help assess potential exposure levels.
The link between Direct Black and Bladder Cancer is largely based upon dye industry workers, especially the dyestuff workers in northern Italy. There are no dye works at DOE. However, this substance was used at DOE in limited research and laboratory activities at Brookhaven National Laboratory and the Savannah River Site.
The link between MOCA and Bladder Cancer was based upon genotoxicity studies and not on specific epidemiological work related to MOCA. Currently only identified as being present at a dozen DOE facilities, MOCA is typically associated with explosives work and with plastics, adhesives and epoxy preparation.
Benzo(a)pyrene is in the family of chemicals known as polycyclic aromatic hydrocarbons(PAH) and its link to bladder cancer is based upon genotoxicity studies for the PAH family. The industries in which PAH’s (but not necessarily Benzo(a)pyrene), were studied included coal liquefaction, coal gasification, coke production, wood preservation with creosote, aluminum production and more. Additionally, Benzo(a)pyrene is an extremely common substance. It is even found in trace amounts in all engine exhaust, both gasoline and diesel. This means all people will have some exposure to this substance. With common substances such as this, the key to a finding of significant exposure is the level, duration and intensity of that exposure. Although there was an elevated risk in the aluminum industry for even one year of work, none of the many DOE jobs in which there is some Benzo(a)pyrene exposure come close to having the constant, indoor, high level exposure to Benzo(a)pyrene as workers in the aluminum production industry would have. Of the jobs associated with Benzo(a)pyrene at DOE facilities, the only industries studied (as part of the PAH study) pertinent to DOE facilities are roofing and paving. Roofing and paving are performed outdoors and as a consequence have lower exposures than those experienced by an aluminum production worker. Nevertheless, someone who spent almost all their time for multiple years working on massive DOE roofing projects might very well have the exposure needed for a finding of significant exposure. Other types of jobs associated with Benzo(a)pyrene exposure at DOE facilities include firefighter training and sheet metal fabrication. These cases, and others that show potential for exposure, all need to be assessed on a case-by-case bases to determine whether exposure to Benzo(a)pyrene was significant.
Benzo(a)pyrene was also used extensively at the Lovelace Respiratory Research Institute for various inhalation studies and therefore, those involved in research work at this institute can be assumed to have had significant exposure.
The link between o-Toluidine and Bladder cancer was based upon studies of workers in the production of rubber additives which found an increased risk for those who had long-term exposure (more than 10 years). Currently, o-Toluidine is identified as being present at nine DOE facilities in various laboratory and other miscellaneous activities.
With any solid cancerous tumor, such as bladder cancer, the minimum exposure time period associated with increased cancer risk is a full working year. This means that employees need to work in a labor category associated with regular, routine exposure to the substance for a full working year as a baseline for favorable determinations under this Circular. This Circular also is a reminder that CE’s have the authority and discretion to make determinations regarding nature, extent and duration of exposure and that the information presented here is not intended to alter guidance on establishing exposure to toxic substances at DOE facilities, but rather is to provide information on new links and giving the scientific context of that information.
Be reminded that Bulletin No. 13-02 calls for a thorough review of all cases on the list. Additionally, all non-approved Part E diagnoses are to be reviewed for each case on the list, not just bladder cancer and not just the toxins identified in this Circular. The review being conducted, while focused on bladder cancer, is intended to provide a comprehensive review of Part E case adjudication. CEs are to review the case in such a way that any subsequent updates to SEM or the case are considered since its denial. SEM is constantly updated. Toxins are added at facility locations on a daily basis and searches from past years may now be obsolete. A worksheet is provided in conjunction with this Circular to help guide staff through the process of case reassessment.
RACHEL P. LEITON
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 Section
 Clarksville Modification Center, Iowa Ordnance Plant, Kansas City Plant, Lawrence Livermore National Laboratory, Los Alamos National Laboratory, Mound Plant, Nevada Site Office, Oak Ridge Gaseous Diffusion Plant (K-25), Pantex, Pinellas Plant, Sandia National Laboratories – Albuquerque and Y-12.
 Brookhaven National Laboratory, Hanford, Idaho National Laboratory, Lovelace Respiratory Research Institute, Nevada Test Site, Pacific Northwest National Laboratory, Rocky Flats Plant, Savannah River Site, Shippingport Atomic Power Plant.