Matrix for Confirming Sufficient Evidence of Non-Cancerous Covered Illnesses

 

SILICOSIS, CHRONIC

 

Criteria

Sufficient evidence of covered illness

Sufficient evidence of possible covered illness, requires physician review

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

And

Additional information is needed**

Latency*

 10  years or more

 5-10 years

Medical Evidence for  illness and diagnostic testing criteria

 

1.  A written diagnosis of silicosis made by a medical doctor

 

And

2.  Any one of the following three criteria

a.  A chest radiograph, interpreted by NIOSH certified B reader classifying the existence of pneumoconioses of category 1/0 or higher; or

b.  Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with silicosis

·             Such as  nodules, or fibrosis  usually with upper lung zone predominance

c.  Lung biopsy findings consistent with silicosis

·          Such as silicotic nodules

Some, but not all criteria to establish the illness are met**

 
Or

Medical record (includes any provider report, results of imaging studies, surgical or pathology reports, or other acceptable record) mention of silicosis, possible silicosis, restrictive lung disease, fibrosis, or pneumoconiosis

 Or

Death certificate mention of silicosis, possible silicosis, restrictive lung disease, fibrosis or pneumoconiosis

Or

A chest radiograph, interpreted by NIOSH certified B reader classifying the existence of pneumoconioses of category 0/1

Or

Lung biopsy findings suggestive of silicosis

 

Additional considerations for causation

 
None needed
 
None needed

* The actual latency period for disease development is a function of the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

*** References utilized include American Thoracic Society consensus statement.


SILICOSIS, ACUTE

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

And

Additional information is needed**

Latency*

 Weeks to months

 Weeks to months

Medical Evidence for  illness and diagnostic testing criteria

 

 

1.  Any one of the following two criteria; and

a.  A written diagnosis of acute silicosis made by a medical doctor; or

b.  Death certificate or other acceptable documentation of death due to acute silicosis

 

And

2.  The medical record contains no other diagnoses, such that would otherwise account for the acute sudden severe lung illness, such as other infection or ARDS

 

Some, but not all criteria to establish the illness are met**

Or

Written evidence of sudden lung illness causing death or severe, overwhelming lung illness, even if attributed to tuberculosis or other illness or infection

Or

Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are suggestive of acute silicosis

·          Such as: air space obliteration, alveolar filling pattern, pulmonary edema, pulmonary hemorrhage, infiltrate, alveolar proteinosis 
Or

Results of lung function testing (PFT or spirometry) showing sudden worsening

Or

Lung biopsy findings suggestive of  acute silicosis

·          Such as alveoli filled with proteinaceous material

Additional considerations for causation

 
None needed
 
None needed

* The actual latency period for the development is a function of the exposure’s duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

***References utilized include American Thoracic Society consensus statement.


SILICOSIS, ACCELERATED

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 

And

Additional information is needed**

Latency*

 2-5  years

 < 2years or > 5 years

Medical Evidence for  illness and diagnostic testing criteria

 

 

1.  A written diagnosis of accelerated silicosis made by a medical doctor

 

And

2.  Any one of the following three criteria

a.  A chest radiograph, interpreted by NIOSH certified B reader classifying the existence of pneumoconioses of category 1/0 or higher; or

b.  Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with silicosis

·          Such as  nodules or fibrosis usually with upper lung zone predominance

c.  Lung biopsy findings consistent with silicosis

·          Such as silicotic nodules

Some, but not all criteria to establish the illness are met**

 

Or

Medical record (includes any provider report, results of imaging studies, surgical or pathology reports, or other acceptable record) mention of accelerated silicosis, silicosis, possible silicosis, restrictive lung disease, fibrosis, or pneumoconiosis

 Or

Death certificate mention of silicosis, possible silicosis, restrictive lung disease, fibrosis or pneumoconiosis

 
Or

A chest radiograph, interpreted by NIOSH certified B reader classifying the existence of pneumoconioses of category 0/1

 
Or

Lung biopsy findings suggestive of silicosis

 

Additional considerations for causation

 
None needed
 
None needed

* The actual latency period for the development of this disease is a function of the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

*** References utilized include American Thoracic Society consensus statement.


SILICOSIS, COMPLICATED

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

Additional information is needed**

Latency*

 Years to decades

 Years to decades

Medical Evidence for  illness and diagnostic testing criteria

 

 

1.  A written diagnosis of progressive massive fibrosis (PMF) or complicated silicosis made by a medical doctor

 
And

2.  Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with PMF

·          Progression and coalescence of the upper lung zone nodules to form masses (conglomerate lesions) 

·          When they cause contraction of the lobes, an “angel wing pattern” can be seen

 

Some, but not all criteria to establish the illness are met**

 

 

Additional considerations for causation

 
None needed
 
None needed

* The actual latency period for the development of this disease is a function of the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

*** References utilized include American Thoracic Society consensus statement.


PNEUMOCONIOSIS

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 

And

Additional information is needed**

Latency*

Years

Years

Medical Evidence for  illness and diagnostic testing criteria

 

 

1.  Written evidence of one of the following two criteria

a.  A written diagnosis of pneumoconiosis made by a medical doctor; or

b.  Results of breathing tests (PFTs or spirometry) showing a restrictive lung pattern

FVC < 80% predicted

 

And

2.  Any one of the following three criteria

a.  A chest radiograph, interpreted by NIOSH certified B reader classifying the existence of pneumoconiosis of category 1/0 or higher; or

b.  Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with asbestosis and/or findings of pleural plaques or rounded atelectasis; or

c.  Lung biopsy findings consistent with pneumoconiosis 

Some, but not all criteria to establish the illness are met**

Or

Medical record (includes any provider report, results of imaging studies, surgical or pathology reports, or other acceptable record) of silicosis, possible asbestosis, restrictive lung disease, or pneumoconiosis

Or

Death certificate mention of silicosis, possible asbestosis, restrictive lung disease, or pneumoconiosis

Or

A chest radiograph, interpreted by NIOSH certified B reader classifying the existence of pneumoconiosis of category 0/1

Or

Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are suggestive of pneumoconiosis. 

Additional considerations for causation

 
None needed
 
None needed

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.


ASBESTOS RELATED DISORDERS

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

 

Additional information is needed**

Latency*

Pleural plaques: 20 or more years

Pleural effusions: 5-30 years

 

Pleural plaques: < 20 years

Pleural effusions: <5  or > 30 years

Medical Evidence for  illness and diagnostic testing criteria

 

 

Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with these disorders

·          Pleural plaques

·          Pleural thickening, not associated with an area of prior surgery or trauma

·          Rounded atelectasis

·          Bilateral pleural effusions, also called benign asbestos related pleural effusion

 

Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with these disorders

·          Pleural thickening in an area of prior surgery or trauma

·          Pleural effusion, if the record does not indicate that there is another disease process that would otherwise account for the effusion, such as congestive heart failure (CHF), cancer, or other lung disease

 

Additional considerations for causation

 
 None needed
 
None needed

*  The actual latency period for the development of this disease is a function  of the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

*** References utilized include American Thoracic Society consensus statement.


LUNG FIBROSIS

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

Additional information is needed**

Latency*

Years

Years

Medical Evidence for  illness and diagnostic testing criteria

 

 

1.  A written diagnosis of lung fibrosis made by a medical doctor

 

And

2.   Any one of the following three criteria

a.  Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are consistent with fibrosis

·          Such as small lung fields or volumes, minimal ground glass opacities, and/or bibasilar reticular abnormalities

b.  Results of breathing tests (PFTs or spirometry) showing a restrictive or mixed pattern

·          Such as FVC <80% predicted

c.  Lung biopsy findings consistent with fibrosis

And

3.  There is no evidence in the medical record that the lung fibrosis is present due to another disease process.

Some, but not all criteria to establish the illness are met**

 
Or

Medical record (includes any provider report, results of imaging studies, surgical or pathology reports, or other acceptable record) of lung fibrosis

Or

Death certificate mention of fibrosis

Or

Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are suggestive of fibrosis

 

 

 

Additional considerations for causation

 
None needed
 
None needed

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.


CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

And

Additional information is needed**

Latency*

 Years

 Months or years

Medical Evidence for  illness and diagnostic testing criteria

 

1.  Any one of the following three criteria

a.  A written diagnosis of COPD or chronic bronchitis made by a medical doctor

·          Chronic bronchitis is defined as the presence of chronic productive cough for 3 months in each of two successive years and other causes of cough have been excluded

b.  Results of PFTs or spirometry showing an obstructive or mixed pattern

·          FEV1/FVC< 70% and FEV1<80% predicted. 

c.  Results from a chest x-ray or other imaging technique that are consistent with COPD

·          Such as air trapping, flattening of diaphragms, enlarged lung fields. 

And

2.  The employee has a history of being a never smoker***

And

3.  There is no other lung disease present that would account for the findings

Some, but not all criteria to establish the illness are met**

 

Emphysema is caused by only a small subset of the toxic substances associated with chronic bronchitis, however it may be aggravated by the others on this list.

 

 

Additional considerations for causation

There is currently no medical testing or means to distinguish COPD due to any of the above toxic substance exposures and COPD due to other causes.  Physician review is required. 
 Physician review is required.  Also, if all criteria are otherwise met, individuals with Alpha-1 Antitrypsin Deficiency (AAT Deficiency) may be considered to have a covered illness.

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

***ATS criterion for a never smoker, or non-smoker, is < 20 packs of cigarettes in a lifetime, but this piece of information may not be found in most medical records.


MESOTHELIOMA

 

Criteria

Sufficient evidence to establish a covered illness.  If some but not all criteria are met, physician review recommended

Evidence that suggests a covered illness exists and that physician review is recommended

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 

And

Additional information is needed**

Latency*

 30-50  years

20-29  or > 50 years

Medical Evidence for  illness and diagnostic testing criteria

 

1.  A written diagnosis of mesothelioma made by a medical doctor

 

And

2. Pathology report consistent with mesothelioma from surgical or biopsy specimen

 

Some, but not all criteria to establish the illness are met**

 

Or

Medical record (includes any provider report, results of imaging studies, surgical or pathology reports, or other acceptable record) or death certificate mention of mesothelioma or pleural malignancy

 

Or 

Results from a chest x-ray or computer assisted tomography (CT) or other imaging technique that are suggestive of mesothelioma

·          Such as large, unilateral pleural effusion, pleural mass, pleural rind, or diffuse pleural thickening

Additional considerations for causation

None needed

None needed

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

*** References utilized include American Thoracic Society consensus statement.


KIDNEY DISEASE

 

Criteria

Sufficient evidence to establish a covered illness.  If some but not all criteria are met, physician review recommended

Evidence that suggests a covered illness exists and that physician review is recommended

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 

And

Additional information is needed**

Latency*

Months or years

 Days, months, or years

Medical Evidence for  illness and diagnostic testing criteria

 

1.  Any one of the following two criteria

a.  A written diagnosis of kidney disease made by a medical doctor

·          Other terms are chronic renal disease, chronic renal failure, renal insufficiency

b.  The worker required dialysis 

 

And

2.  The worker does not have high blood pressure or diabetes

 

And

3.  The type of kidney disease diagnosed is consistent with one known to be caused by the identified toxic substance.

Some, but not all criteria to establish the illness are met**

 

Additional considerations for causation

Additional testing may be required to help establish a causal link between a toxic substance and a specific kidney disease.  This may include additional urine testing, such as β 2-microglobulin or retinol binding protein and/or biological tests to detect residual evidence of the toxic substance in the body.  The need for this additional testing should be determined by the reviewing physician.  
Physician review is required.
 
Physician review is required. 

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.


ASTHMA, OCCUPATIONAL

 

 Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

And

Additional information is needed**

Latency*

 Weeks, months, or years

 Weeks, months, or years

Medical Evidence for  illness and diagnostic testing criteria

 

1. The following three criteria:

i.  Onset of asthma occurring after first DOE exposure (except resolved asthma childhood) 

And

ii.  A written diagnosis of occupational asthma or asthma caused by  toxic substance made by a medical doctor

And

iii.  The diagnosis of asthma was made based on any one of the following criteria

a.  Methacholine challenge test results showing a PC20 ≤ 8 mg/ml; or

b.  Post-bronchocodialator reversibility of FEV1 ≥ 12% and 200 ml; or

c.  Post-bronchocodialator reversibility of FEV1 ≥ 12% , but <20  ml, with subsequent improvement in FEV1 ≥ 20% after steroid trial

And

Some, but not all criteria to establish the illness are met**

 

Occupational asthma via sensitization to a new agent in the workplace can occur in workers with pre-existing asthma.

 

Additional testing that can be consistent with the diagnosis, but does not establish the diagnosis.

1. Positive skin prick testing or serologic IgE (RAST) testing to the toxic substance

Additional considerations for causation

1.  An association between symptoms of asthma and work, including wheeze and/or shortness of breath that are better on days away from work, especially on holiday or vacation.

And

2.  One or more of the following criteria:

a.  work-related change in FEV1 or PEF rate; or

b.  work-related change in bronchial hyperresponsiveness; or

c.  positive response to specific inhalation challenge test (note this is not recommended if not already performed)

None needed

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers request for additional information from the worker for exposure and/or diagnostic testing criteria.  This request should also be made if there is insufficient information to establish exposure or illness.


ASTHMA, IRRITANT INDUCED

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

Additional information is needed**

Latency*

 Days, months, or years

 Days, months, or years

Medical Evidence for  illness and diagnostic testing criteria

 

1.  The three following criteria:

a.  Onset of asthma occurring after first DOE exposure (except resolved asthma childhood)

 
And

b.  A written diagnosis of occupational asthma, irritant induced asthma,  or asthma caused by  toxic substance made by a medical doctor

 
And

Some, but not all criteria to establish the illness are met**

 

 

Additional considerations for causation

1.  An association between symptoms of asthma and work, including wheeze and/or shortness of breath are better on days away from work, especially on holiday or vacation.

And

2.  One or more of the following criteria:

a.  work-related change in FEV1 or PEF rate; or

b.  positive response to specific inhalation challenge test (note this is not recommended if not already performed); or

c. Onset of asthma in clear association with a symptomatic exposure to an irritant agent in the workplace.  This includes RADS, occurring after a single exposure to a substance with irritant properties present in a very high concentration, if other disease processes have been ruled out.

None needed

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.


ASTHMA, IRRITANT AGGRAVATED

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

Additional information is needed**

Latency*

 Days or months

Days or months

Medical Evidence for  illness and diagnostic testing criteria

 

1.  History of asthma as an adult prior to DOE exposure

 

 

 

 

 

 And

Some, but not all criteria to establish the illness are met**

 

 

Additional considerations for causation

1.  The two following criteria

a.  An association between symptoms of asthma and work, including wheeze and/or shortness of breath are better on days away from work, especially on holiday or vacation.

And

2.  The worker was symptomatic or required medication before and had increase in symptoms or medication requirement after beginning to work with the above substance.

None needed

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.


HEART ATTACK

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

Additional information is needed**

Latency*

 Weeks, months, or years

Weeks, months, or years

Medical Evidence for  illness and diagnostic testing criteria

 

1. A written diagnosis of heart attack or sudden death due to heart disease by a medical doctor

 
And

2.  The heart attack or sudden death occurred  after being away from nitrate exposure for a couple of days following a number of days of regular nitrate exposure (classically on a Monday morning).

Some, but not all criteria to establish the illness are met**

 

This is strongly supported by a history of recurrent headaches following a similar pattern

Additional considerations for causation

Due to high prevalence of heart disease and heart attacks, physician review is recommended for determination of causation.

 

 
Physician review recommended

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.

 

 

For nitrates only.


NEUROPATHY, TOXIC

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

And

Additional information is needed**

Latency*

 Days, months, or years

Days, months, or years

Medical Evidence for  illness and diagnostic testing criteria

 

1. A written diagnosis of peripheral neuropathy,  toxic neuropathy, or neuropathy due to a toxic substance.

And
2.  The physician’s diagnosis was made by all three of the following criteria.  Note: the definition of the classic syndrome will vary among the different toxic substances. 
a.  Symptoms consistent with the classic syndrome caused by the specific toxic substance

·          Sensory; or

·          Motor; or

·          Sensorimotor

b.  Signs consistent with the classic syndrome caused by the specific toxic substance
·          Decreased or abnormal distal sensation

a.     Such as stocking-glove numbness, allodynia, and/or hyperalgesia

·          Decreased or absent distal reflexes

·          Distal muscle weakness and/or atrophy

 

c.  Results of electrodiagnostic studies consistent with a neuropathy caused by the specific toxic substance.

·          Should include both needle EMG and nerve conduction studies (NCS)

Some, but not all criteria to establish the illness are met**

 

 

Additional considerations for causation

Electrodiagnostic testing can distinguish some but not all toxic neuropathies from those due to other causes.  There are many medical causes of peripheral neuropathy, especially sensorimotor neuropathies.  Physician review required.  

 
Physician review is required.

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers request for additional information from the worker for exposure and/or diagnostic testing criteria.  This request should also be made if there is insufficient information establish a possible exposure or illness.


ENCEPHALOPATHY, CHRONIC TOXIC

 

Criteria

Sufficient evidence to establish a covered illness

Sufficient evidence to establish a possible illness requiring physician review.

DOE exposure criteria*

DOE Facilities

Specific job titles/ processes

Applicable dates

DOE Facilities

Specific job titles/ processes

Applicable dates

 
And

Additional information is needed**

Latency*

Years

Days, months, or years

Medical Evidence for  illness and diagnostic testing criteria

 

1.  A written diagnosis of chronic toxic encephalopathy (ICD9 code 349.82 or analogous conditions) made by a medical doctor

 
And

2. A formal neuropsychological assessment that included a battery of neurobehavioral tests is consistent with the diagnosis.

 

3. Appropriate neuroimaging studies (e.g. brain MRI, head CT) have been performed to investigate findings consistent with the diagnosis, or suggestive of unrelated causes.

 

Additional considerations for causation

Some patterns on the history and neurobehavioral test profile may be more consistent with chronic toxic encephalopathy than with unrelated causes (e.g. greater decrements in performance vs. verbal IQ). Physician review is required.
 
Physician review is required.

* The actual latency period for the development of this disease is a function of the specific causative toxic substance as well as the duration and intensity of exposure.

** Triggers DOL request for additional information from the worker for exposure and/or diagnostic testing criteria elements.  A request for additional information should also be made if there is insufficient information present to establish a possible exposure or illness.