EEOICPA CIRCULAR NO. 13-12 August 29, 2013
SUBJECT: Review of Denied Ovarian Cancer Cases under Part E.
The purpose of this Circular is to notify all Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff of another 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 ovarian cancer because Haz-Map now identifies exposure to asbestos as being causally linked to ovarian cancer. A pull list has been assembled that contains a list of all denied Part E ovarian 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. Additionally, staff are to use the guidance for ECS coding described 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 13-12, Ovarian Cancer Part E.” The completed worksheet and related SEM search(es) are to be placed in the case file.
In its review of the scientific studies utilized to conclude that there is a link between asbestos and ovarian cancer, the IARC noted that a causal association between exposure to asbestos and cancer of the ovary was clearly established based on five strongly positive cohort mortality studies of women with heavy occupational exposure to asbestos.
Implementing Bulletin No. 13-02 states (at action item 7) that in addition to a finding of exposure, cases require a finding of medical causation for cases reviewed under this guidance. However, because of the scientific evidence regarding the nature of the link between asbestos and ovarian cancer, the requirement of a medical opinion on causation is waived for cases meeting the following criteria:
· Workers who have 250 days or more of significant exposure to asbestos (all fiber types) at a covered facility and
· who have a latency period of 20 years from first exposure to asbestos (all fiber types)as a covered employee with a diagnosis of ovarian cancer.
Cases that meet these bulleted criteria are to be coded “ISL,” which means “likely acceptance,” and then the district office is to proceed with reopening the case, as outlined in DEEOIC Bulletin No. 13-02, item 9.
In making determinations as to whether the asbestos exposure was significant, Attachment 2 is provided. This list contains labor categories and job tasks associated with high levels of asebestos exposure. In reviewing cases, for employees with one year of DOE contractor employment prior to 1986 in some combination of any of the labor categories and/or job tasks identified in Attachment 2, the CE can assume significant asbestos exposure. Additionally, for employees who do not fit into any of these categories, the CE should review the file for other demonstrable evidence of asbestos exposure, such as DOE monitoring information or other information in the DAR response that indicates asbestos exposure. Other demonstrable evidence of asbestos exposure includes a diagnosis of asbestosis or mesothelioma. For these cases, the CE can likewise assume significant asbestos exposure, (in conjunction with at least one year of DOE contractor employment.) All other cases require an IH assessment for a determination regarding the level of asbestos exposure.
For cases that have some indicators of asbestos exposure and a diagnosis of ovarian cancer, but do not have significant exposure for at least one year prior to 1986 in conjunction with a 20 year latency period, the CE is to obtain a medical opinion on causation.
Cases reviewed under this circular which require either an IH or medical review are to be coded “ISD” for “development needed.”
Be reminded that Bulletin No. 13-02 calls for a thorough review of all cases on the list for all denied Part E diagnoses, not just ovarian cancer. The review being conducted, while focused on ovarian 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 it was denied. 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
 1986 has been selected because it marks the issuance of separate, comprehensive asbestos standards for general industry and construction. The 1986 standard reduced levels under prior standards, some of which were issued as early as 1971. Although it is understood that compliance with the standard was not instantaneous, levels after this date are appropriate for an IH referral and this, along with other factors, will be considered.