EEOICPA BULLETIN NO. 05-05

 

 

 

 

Attention: This bulletin has been superseded and is inactive.

 

 

 

 

 

EEOICPA BULLETIN NO. 05-05

 

Issue Date: August 26, 2005

___________________________________________________________

 

Effective Date: August 26, 2005

___________________________________________________________

 

Expiration Date: August 26, 2006

___________________________________________________________

 

Subject: Resource Center Procedures for Employment Verification and Occupational History Questionnaires

 

Background:

 

This Bulletin provides background and new procedures outlining operational guidance to the Resource Centers (RC) assisting the Division of Energy Employees Occupational Illness Compensation (DEEOIC) in the implementation and administration of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). In particular, this bulletin provides specific instructions and a User Guide regarding RC Energy Case Management System (ECMS) access and usage. In addition, this bulletin imparts direction for RC employment verification and occupational history development functions in compliance with the outcome of a recent A-76 competition.

 

A contractor is responsible for RC management and conduct. Permanent RCs are situated in key geographic locations throughout the United States to provide assistance and information to the DEEOIC claimant community and other interested parties. Originally, RCs were designed to provide basic claims process and program information and to assist claimants in the completion of the necessary claim forms. Due to new program demands, RCs will now perform additional tasks, and procedures addressing certain new RC actions are necessary.

 

The RCs will now take initial employment verification steps for all new EEOICPA claims filed with the RC and occupational history development for certain employees. As a large portion of DEEOIC adjudication relies upon establishing covered employment and worksite exposure, detailed procedures governing these actions are necessary to ensure uniform claim development and equitable adjudication of claims filed under the EEOICPA.

 

References: ECMS User’s Reference Guide; Employment Verification and Occupational History Development Functions Performance Work Statement and Most Efficient Organization (MEO)Concept of Operations; EEOICPA Procedure Manual 2-400, 2-500, E-300 (Draft) E-400 (Draft), E-500 (Draft) and 2-1500; EEOICPA Bulletin 02-34 and Public Law 108-375.

 

Purpose: To provide guidance to the Resource Centers and District Offices on employment verification and occupational history development actions.

 

 

Applicability: All DEEOIC and RC staff.

 

Actions:

 

1. When interfacing with claimants and other interested parties (i.e. authorized representatives of claimants) RC staff must remain cognizant of individual privacy concerns and at all times maintain compliance with Privacy Act mandates. In all instances discussed herein, RC staff members are not permitted to provide information regarding an individual claim for benefits, or any other personal information, to anyone other than the identified claimant, or his or her duly authorized representative. In order for RC staff to release any information regarding a specific claim or claimant to an alleged authorized representative of that claimant, an authorization form signed by the claimant in question must be in the case file appointing such individual as the claimant’s authorized representative regarding his or her claim for benefits under the EEOICPA. Only one authorized representative may be appointed per claimant. Please see EEOICPA PM 2-1200 for a full discussion of the use and appointment of authorized representatives.

 

2. In all instances where information is sought that exceeds the RC’s ability to assist the claimant or duly appointed authorized representative, the RC staff refers the matter to the proper District Office (DO) Claims Examiner (CE) or Final Adjudication Branch (FAB) Hearing Representative (HR), denoted in ECMS as the primary case file designee. ECMS access is granted to the RC staff in order to memorialize claimant interaction and obtain claim status updates. Specific guidance regarding ECMS is provided in the attached ECMS User’s Reference Guide (Attachment 1). No ECMS coding access is granted to the RCs at this time.

 

3. Due to the privacy concerns outlined above and the sensitive nature of the records available for viewing in ECMS and other claim file documents (i.e. employment history, payment information, disease history, Social Security Numbers [SSN], and addresses) it is imperative that security measures govern access to the system and in general. Accordingly, when RC staff member employment is terminated for whatever reason, a process must exist that deletes the outgoing employee’s ECMS access in an efficient manner. Conversely, in the event that a RC staff member is added and ECMS access is required for that individual, a process must be in place to grant access as needed.

 

a. Memorandum from RC Manager. Upon employee termination or resignation, the RC manager must prepare a memorandum to the RC Project Manager at National Office (NO). The memorandum provides the departing RC employee’s name, title, employee number, and all other necessary information, including the date of the employee’s termination or resignation. The memorandum will request that the employee’s access to ECMS be terminated on a specified date (date of termination or resignation). The RC Project Manager then prepares a memorandum notifying the Branch Chief of the Branch of Outreach and Technical Assistance (BOTA) advising of the RC employee’s scheduled departure. The Branch Chief of BOTA advises Energy Technical Support of the need to delete ECMS access to the outgoing RC employee upon receipt of such notification.

 

In the event of the addition of new RC staff requiring ECMS access, the RC manager prepares a memorandum the RC Project Manager at NO. The RC Project Manager then prepares a memorandum to the Branch Chief of BOTA requesting such access and providing all pertinent employee information. The Branch Chief of BOTA reviews the request and advises Energy Technical Support of the need to grant access to an incoming RC employee.

 

4. In certain instances discussed herein, a RC staff member may either be a party to a claim under the EEOICPA or have some personal or familial interest in the outcome of a claim. When a RC staff member is a claimant or is the family member of a claimant or has some personal interest in a claim in question, the RC manager must immediately notify the BOTA Branch Chief in writing. Email notification will suffice. All claims filed by RC staff members themselves will undergo employment verification at the adjudicatory DO. Occupational history development is conducted at the nearest RC. The RC manager where the claim arises prepares a memorandum to the nearest RC manager requesting that the occupational history development task be conducted and forwarded to the appropriate DO upon completion. The RC assigned this development action has 14 calendar days upon the date the assignment is received to complete all initial activities and report to the DO as outlined herein.

 

5. One major customer service function performed by RC staff members is telephone contact with claimants and other interested parties. RC staff members receive incoming telephone calls, return telephone calls and place outbound telephone calls to claimants and various other individuals regarding questions and concerns arising out of the claims process. Each telephone call to or from a claimant is accurately entered into ECMS in accordance with the specific instructions contained in the attached ECMS User’s Reference Guide. Each telephone call entered into ECMS is accompanied by a written synopsis memorializing the discussion. Primarily, the RC staff member associated with the telephone call outlines the content of the discussion, the claimant request, if any, the guidance or solution offered, and the general outcome of the call or resolution of the issue at hand. The input of quality entries is of the utmost importance. The RC staff member strives to ensure accuracy and specificity of data input into the system. Once a telephone contact is captured in the telephone management system (TMS) in ECMS, the TMS screen is printed and the paper record of the activity is forwarded to the appropriate DO/FAB for association with the case file. Most employment verification and occupational history tasks performed by the RC staff will occur prior to case create at the DO and are not immediately tracked in ECMS; tracking of such activities is covered below. Occupational history development activity conducted on cases already created is entered into ECMS.

 

a. Telephone Management System (TMS). The TMS feature in ECMS allows the ECMS user to memorialize telephone conversations, place and obtain telephone messages within the system. It provides a mechanism by which telephone contact on a given case file is tracked and maintained. All incoming and outgoing telephone calls to and from the RC regarding a particular existing case file or claim must be entered into TMS to accurately capture and reflect telephonic activity. All telephonic activity related to occupational history development on cases that are already created must be logged into TMS.

 

b. Incoming Calls. RCs receive various different kinds of incoming calls. Generally, incoming calls are from claimants (or their duly appointed authorized representative) seeking claim status or guidance of some sort, or from potential claimants seeking program information and guidance regarding the claims process.

 

1) Claim Status. Claim status requests regarding initial employment verification or occupational history development fall within the purview of the RC staff. Other claim status requests, too, are fielded by RC staff members to assist claimants with general questions not requiring DO or FAB expertise or involvement. The RC staff member reviews ECMS status codes and answers claimant inquiries, memorializing such activities into the TMS screen whenever possible. If the claim status request is beyond the scope of the RC staff to address, the RC staff member determines the case file location in ECMS and directs the caller to the proper claims examiner (CE) or hearing representative (HR), as the case may be. Calls received from a claimant or authorized representative seeking claim statuses are referred to the adjudicatory DO CE, or the FAB HR if pending FAB review. When referring a claimant or authorized representative to a DO or FAB for further information, the RC provides the toll free number to the DO or FAB for use.

 

2) Program Information or Claim Process Guidance. If a potential claimant calls to inquire as to claim status and no claim is on file, the RC staff member informs the potential claimant of program filing requirements and available benefits. No referral to a DO or FAB is necessary. As no claim exists in the system, a note memorializing the telephone conversation is not entered into ECMS. In instances where a current claimant contacts the RC for basic guidance regarding the claim process (confirmation that a claim exists, questions regarding the submission of new evidence or a new claim for benefits), the RC can provide guidance to the claimant as needed without referral to the DO or FAB. In some instances, too, the RC staff may assist claimants in understanding the information being sought in DO development letters and explain the means by which such information may be obtained. Claim-specific conversations and guidance provided on claims existing in ECMS are entered into TMS.

 

c. Return Calls. Regardless of the issue at hand, a message to return a telephone call received in the RC is returned by a RC staff member within two (2) business days of receipt. All calls received in the RC related to claims currently existing in ECMS will be logged into the TMS and must be returned accordingly. All return calls must be memorialized in ECMS and coded correctly per the ECMS User’s Reference Guide. Additionally, all issues must be treated as outlined above in the incoming call discussion and the RC staff will refer all claim status type calls beyond the scope of their expertise or authority to the necessary DO or FAB for response.

 

d. Outgoing Calls. Outgoing calls are calls generated from the RC for a purpose other than returning a telephone call. In certain instances the DO may request RC assistance in obtaining evidence from a claimant or conducting some additional development on a case file. All outgoing calls regarding claims already created at the DO must be logged into the TMS in ECMS with a narrative memorializing the call. Many RC outgoing calls will be generated in the course of conducting employment verification and occupational history development.

 

6. Members of the RC staff can also enter notes into ECMS. Primarily, the notes field is accessed and populated when a claimant appears at the RC in person to submit evidence or claim forms, to make an inquiry or raise a concern, or to complete the occupational history questionnaire interview described below. In instances where a claimant appears in person at the RC, the RC staff member assisting the claimant memorializes the claimant’s visit in the notes field in ECMS, providing a synopsis of the conversation and a list of any evidence or new claim filed during the visit. The notes field captures all interface with the claimant, including instructions or guidance provided to the claimant by the RC. As always, the RC will only discuss information on a specific claimant with the claimant in question. As with telephone calls, the RC staff will assist the claimant as best as possible. Claimant referral to the designated CE or HR will be made when appropriate by supplying the toll free number for contact or placing a conference call with the handling CE. Once a note is placed in the system, the screen is printed and the printed record of the activity is forwarded to the appropriate DO/FAB for association with the case file. As noted previously in this bulletin, notes are not entered into ECMS regarding employment verification development activities and occupational history development conducted face-to-face at the RC when the case has yet to be created at the DO. Such interaction is tracked as outlined below. All face-to-face contact with the claimant at the RC regarding the completion of the occupational history questionnaire on created cases is captured in the ECMS Notes section by the RC staff member conducting the interview.

 

* ECMS Screen Usage: When creating an ECMS notes entry, make certain to select the ‘R FOR RESOURCE CENTER USE ONLY’ entry in the “Note Type” section in the upper left hand box of the screen.

 

7. RC staff members are equipped with the capability to edit entries populated into ECMS TMS and ECMS Notes. ECMS entries placed into the system by RC staff may be changed as needed by the RC ECMS user to correct errors, or at the request of the RC manager upon his/her final review of claim file material before it is forwarded to the DO. ECMS entries cannot be deleted. Accordingly, RC staff and RC managers must ensure that the data entered into ECMS is of high quality and free of errors prior to saving the entries into the system. Once an ECMS record is input at the RC level, only National Office (NO) DEEOIC staff may remove it. At the present time no capability to add or alter ECMS claim status codes has been granted to the RCs, and all coding operations related to RC activity on a case (aside from activities related to input in TMS or Notes as discussed above) are input at the DO level to correspond with the date of the activity. For this reason it will be important to include a very detailed check list coversheet to the DO as outlined below (See Attachment # 2).

 

8. In all instances discussed herein involving multiple worksites, the RC closest to the domicile of the claimant(s) performs the required development tasks. For instance, if employment is claimed at all 3 Gaseous Diffusion Plants, and the employee/claimant(s) reside in the Paducah, Kentucky, area, the Paducah RC will handle all required tasks with assistance from the other RCs as needed. If claimants reside in different states and the claim as a whole can be better served by utilizing more than one RC, RC involvement will occur as needed based upon the geographical location of the claimant. In all such cases, the RC forwards all documentation to the adjudicatory DO, even if the DO is not the DO with jurisdiction over the RC in question.

 

9. Most new EE-1/2 claim forms are filed directly with the RC located in the geographical area where the claimant(s) reside. EE-1/2s received directly in the DO undergo employment verification at the DO pursuant to procedural guidance already in place and such claims are only referred to the RC if the DO determines that an occupational history interview is required. Regardless of place of receipt, the date of filing for a claim is the earliest discernible date stamp or postmark (whichever is earliest) of a claim form or words of claim. Words of claim are any written statements received without a claim form that indicate a claimant’s intention to seek benefits under the EEOICPA.

 

10. In certain instances no RC action is required. Neither initial employment verification nor occupational history development is undertaken in instances where there is no eligible survivor under the statute. In instances where it is obvious that no eligible survivor exists (especially in the case of adult children under Part E) no additional RC action takes place. The DO reviews all survivorship evidence and can direct the RC to undertake certain tasks if deemed necessary at a later date. Further, since occupational history development is conducted exclusively on Part E claims, no action is necessary where Part E employment is not claimed or confirmed. If employment is claimed or confirmed at an atomic weapons employer (AWE) or a beryllium vendor (BV), no occupational history interview is conducted. As noted below, occupational history questionnaires are not conducted if the claimed conditions are as follows: beryllium illness or chronic silicosis. Finally, AWE contractors/subcontractors are not afforded coverage under the EEOICPA, and such claimed employment does not require occupational history development by the RC.

 

11. The RC staff takes initial employment verification actions on most new claims under the EEOICPA filed at a RC. The RC utilizes many DEEOIC tools, including procedures, bulletins, and employment verification updates and is given access to the DEEOIC Shared Drive for viewing of these materials. The RC conducts initial employment verification steps on claims submitted on behalf of Department of Energy (DOE) contractor/subcontractor, AWE, and BV employees for use by DEEOIC in the adjudication of claims filed under the EEOICPA. Additionally, the RCs are required to conduct occupational history interviews regarding certain claims filed under Part E of the EEOICPA as described herein. Prior to any development action (initial employment verification or occupational history development) the RC reviews ECMS to determine whether or not a claim already exists. If a claim does exist in ECMS B or E, the RC contacts the adjudicatory DO CE for guidance as to whether or not employment or occupational history development is required determined by the material already extant in the existing claim file. If documentation is present in the existing claim file to either confirm employment or properly document workplace exposure, the DO will advise the RC accordingly and no action is necessary at the RC level. This will be a case-by-case decision made at the DO level.

 

12. The RC does not conduct initial employment verification on claims submitted by Radiation Exposure Compensation Act (RECA) claimants. However, occupational history development is necessary on most RECA claims and should be attempted upon receipt of the EE-1/2 in the RC. Nonetheless, since the DO must begin employment verification with the Department of Justice (DOJ), all RECA claim forms are sent to the DO on the date of receipt in the RC for case create at the DO. Since the RECA claim forms are not held for 7 calendar days, as in most other cases, whenever possible the RC attempts to conclude the occupational history development on the date of receipt of the RECA claim forms prior to shipment to the DO. In instances where occupational history development cannot be completed at the RC on RECA claims upon the date of filing, the RC copies the RECA claim form documents and maintains a file at the RC while conducting occupational history development actions. In such instances the RC has 14 calendar days from the date the claim is received in the RC to conclude the occupational history development actions.

 

13. In all cases where employment verification is undertaken, the RC prepares a memorandum documenting all the dates on which employment verification actions were taken for each claimant. The memorandum is forwarded to the DO within seven (7) calendar days of receipt of the EE-1/2. The memo is accompanied by the Resource Center New Claim Check List (Attachment 2), listing all materials enclosed and further actions required. The RC manager verifies the contents of the referral package and signs the checklist. The dates in the memo are used for ECMS coding by the DO to correspond with the dates on which actions were taken at the RC. The RC strives to complete the occupational history interview within the same time frame if possible. Overall, the RC has 14 calendar days from the date of claim filing or DO assignment receipt in the RC to complete the occupational history development task. A great deal of information, evidence, and documentation will be provided to the RC in this new and expanded role, and the RC is to refrain from weighing evidence and making any determinations as to fact or law, or as to whether or not a claimant may or may not be entitled to benefits. All adjudicatory functions are retained by the DO.

 

14. Upon receipt of the initial claim file package (7 calendar days post filing) where additional DO development or follow up with the RC is required, the CE places a call up note into ECMS as a reminder that follow up actions are necessary. Additionally, the CE reviews the initial submission (and all material submitted from the RC thereafter) to determine whether or not additional tasks are necessary at the RC level. Materials received in the RC after the initial 7 calendar day memo are sent to the DO with the occupational history development package if such package can not be included with the 7 calendar day memo submission. All other evidence or documentation received at the RC after all development is concluded (including printouts of TMS and ECMS Notes records) are submitted based upon RC procedures currently in place for the submission of documentation to the DO. No memo or checklist is required for these materials. The RC will prepare a list of all materials being submitted on a transmittal sheet outlining the material being sent separated by claim number. All such documentation is associated with the proper case file upon receipt in the DO pursuant to current mail and file procedures.

 

15. In general, the RC reviews claim materials, conducts the occupational history interview (Attachments 3 & 4), and reviews all pertinent evidence and documents with the claimant in person at the RC at the time of filing. If possible, all initial employment verification actions and occupational history development should be completed when the claimant(s) file their EE-1/2 at the RC. If EE-1/2 forms are received via U.S. Mail at the RC, the RC staff member reviews the claimed employment and contacts the claimant(s) to schedule an in person interview to complete the occupational history questionnaire. The RC attempts to complete all development steps described herein within 7 calendar days of receipt of the EE-1/2 in the RC. If development is incomplete within 7 calendar days, the RC forwards all materials on hand to the DO for case create with the above-mentioned memo and checklist outlining development to date and future development required. Regardless, the RC must complete the occupational history development actions within 14 calendar days of receipt of the claim or the assignment from the DO unless an extension is granted from the CE as outlined below.

 

16. Upon receipt of a claim, the RC staff member first reviews the EE-1/2, EE-3, and EE-4 forms to discern the type of facility claimed (i.e. DOE, BV, or AWE). Such determination is initially made by consulting the DOE covered facility website. The DOE website lists all major covered facilities, covered dates, and in certain instances primary contractors that worked at those facilities. This review will also be helpful in determining the need for an occupational history interview, as AWE and BV employment is not covered under Part E and no interview is required. If employment is claimed at a covered facility listed on the website, the RC staff member will first determine whether or not employment can be verified through the Oak Ridge Institute for Science and Education (ORISE) database. The ORISE database contains employment information regarding over 400,000 employees who worked at certain facilities from the 1940’s to the early 1990’s. ORISE is accessed via ECMS. Complete usage instructions regarding the ORISE database are outlined in EEOICPA Bulletin 02-34. The Bulletin contains a list of facilities included in the ORISE database. If employment is claimed at a facility listed as being within the ORISE network, the RC staff member will first proceed to develop employment by accessing ORISE. If ORISE information is unavailable or inconclusive, additional development is pursued as outlined below. In either case, the RC staff member prints out the results found in ORISE as part of the evidence of file. If employment is listed at a facility not on the ORISE list, ORISE is not consulted for verification.

 

17. If the ORISE data matches claimed employment within 6 months, the RC prints the record and prepares a memo of findings (EEOICPA Bulletin 02-34, Attachment 2) and no additional development steps are required. The RC prints out the ORISE database query result, prepares a memorandum stating the date the ORISE action was taken, and forwards all available materials to the DO accompanied by the checklist discussed above. The findings and associated memoranda are subject to CE review and can potentially serve as a basis for verifying and accepting claimed employment under the EEOICPA. In general, only 1 day of verified employment is required for beryllium illness and 250 days of employment for the Special Exposure Cohort (SEC), except Amchitka Island which requires 1 day. Claims filed for silicosis in Nevada and Alaska require 250 days of employment, while silicosis claims filed in any other state requires 1 day of employment. If the claimed employment cannot be confirmed through ORISE, or is only partially confirmed, the RC prints the ORISE record and proceeds to determine if other sources of employment verification are available as outlined below.

 

* ECMS Coding: The DO CE enters the "OR" claim status code to correspond with the date the ORISE action was taken at the RC once the initial employment verification package is received in the DO and the case is created. The ECMS status effective date is the date the RC searched ORISE.

18. In addition to ORISE, employment under the EEOICPA is verified by other means. Four distinct lists exist to provide guidance when attempting to verify employment. The lists are broken down as follows: List 1 includes facilities for which DOE has no records with which to verify employment and no corporate verifier exists; List 2 includes facilities whereby employment is verified by a corporate verifier; List 3 includes facilities for which DOE possesses records with which to verify employment; List 4 includes facilities where employment verification queries are directed to DOE in Germantown, Maryland. List 1, 2, and 3 are found in EEOICPA PM 2-400 as Exhibits 1, 2, and 3, respectively. All four lists are found in the ECMS Worksites Referral Key available on the DEEOIC Shared Drive. The lists are updated periodically on the Shared Drive as verifiers change or relocate. Employment verification is handled differently depending upon which list contains the claimed facility. Certain corporate verifiers prefer email requests for verification, and it is of the utmost importance that the RC use the requested method for each entity queried. Most contractor and subcontractor employment is verified without use of the four lists as outlined below. The RC seeks to verify employment from the designated verifier or other identified entity by use of the EE-5 (DOE’s Response to Employment History for Claim under the EEOICPA) or other established verification request method.

19. Each adjudicatory DO District Director (DD) designates a primary RC employment verification Point of Contact (POC) and alternate designees in the case of absence of the primary, and provides the RC with this individual’s name and contact information. A general DO email address will be created for each respective DO and provided to the RCs for all email contact. The employment verification POC will serve as the primary contact for all responses regarding initial employment verification requests made by the RCs. All EE-5s generated from the RC requests that the verifier respond directly to the DO employment verification POC. The general DO POC email address is carbon copied on all email requests for verification (where such request is the desired method of inquiry) and the email itself will provide the POC’s name and contact information and request that the employment verification response be forwarded to the attention of the POC. As noted, the POC is designated by the DO DD, and the RC must be immediately informed if a POC replacement is made at the DO. The DO employment verification POC will review all employment verification responses, consult ECMS to determine the CE handling the claim in question, and will forward all employment responses to the handling CE within 1 calendar day of receipt of the response in the DO.

20. In instances where List 1 employment is claimed, the RC staff informs the claimant that DOE does not possess employment records for the facility claimed and no other knowledgeable source exists to verify employment. The RC advises the claimant to submit further evidence in support of his or her claimed employment directly to the adjudicatory DO. The following evidence, while certainly not exhaustive, may assist in evaluating the validity of a period of claimed employment: time and attendance forms; W-2 forms and other tax statements; wage and earnings statements; check stubs; correspondence from the employer addressed to the employee; notices of promotion, reassignment, layoff, etc; ID cards; minutes from employment related meetings; punch cards; sign in and out logs; security clearance applications; union records; letters and certificates of achievement or participation in a certain event. In addition, EE-4 forms (Employment Affidavit) from coworkers and others with first hand knowledge may be acceptable to establish employment in conjunction with other evidence, and the RC should assist the claimant in obtaining the EE-4 wherever possible. The RC prepares the claim package with the accompanying memo and check list outlining the actions taken and forwards all documents to the adjudicatory DO. The RC includes a copy of the DOE Verification of Employment Memorandum (see EEOICPA PM 2-400, Exhibit #5), which serves as acknowledgment that DOE has no employment information to provide. Finally, if the claimant is a walk-in at the RC, the RC requests the claimant sign a Social Security Administration (SSA)form, the SSA-581 (see EEOICPA PM 2-400, Exhibit #6) so that the DO may request SSA records in the future for use as a tool in additional employment development. The RC does not forward the SSA-581 to SSA, but sends it to the DO with the employment verification packet. This form is only provided to walk-in claimants until further guidance is provided and is not mailed to a claimant from the RC.

 

21. In instances where employment verification is possible (List #2, 3, or 4) the RC immediately prepares an EE-5 form, or other required verification method, and forwards it to each entity responsible for employment verification. The EE-1/2 and EE-3 accompanies the EE-5. Each request for verification requires that a response be forwarded to the adjudicatory DO POC as outlined in Action Item #19 above.

 

22. If employment is claimed with a contractor or subcontractor of DOE, the RC staff attempts to determine the DOE facility at which the claimed employment took place. The four lists described above are consulted for guidance and ORISE searches are conducted if possible. An EE-5 form (or other verification request) is sent to DOE with a request for a response to the adjudicatory DO employment verification POC. If the claimed employment is with a contractor or subcontractor of a BV, the RC staff identifies the BV. An EE-5 (or other verification request) is forwarded to the BV or corporate verifier with a request for a response to the adjudicatory DO employment verification POC. If no known verifier exists for the contractor/subcontractor, no further action is necessary at the RC level. Additionally, AWE contractors and subcontractors are not afforded coverage under the EEOICPA and no employment development is required. Once all required steps are completed, the RC forwards the memorandum, check list, and all associated materials to the DO for case create and additional development of employment.

 

23. As noted above, once all possible initial employment verification/occupational history development actions are concluded within the 7 calendar day post-assignment period in the RC, all claim forms, associated documentation, and the RC checklist is forwarded to the DO with a memorandum outlining RC activities to that point. Upon receipt of the 7 calendar day initial submission, the DO case create clerk reviews the claim material utilizing the case create check list (EEOICPA PM E-200, Exhibit #1) and creates the case in the DO. Once the case is created and the claim assigned to a CE, the CE reviews all claim file materials and employment verification/occupational history development materials for ECMS coding. The CE inputs coding in ECMS to correspond with the date on which the action actually took place at the RC. Please see below for general ECMS guidance for the DO CEs.

 

* ECMS Coding for Employment: Based on the documentation received from the RC, the CE enters the "ES" [with the appropriate Operations Center as the reason code] and/or "CS" claim status code, with a status effective date of the date on which such action(s) was taken in the RC in ECMS.

 

* ECMS Coding for Occupational History Development: The CE enters the "DO" claim status code, and selects the reason code "OH - Occupational History" with a status effective date of the date on which the occupational history questionnaire was completed by the RC as noted on the RC memo to the DO.

24. As noted above, the RCs are tasked with conducting occupational history development on Part E cases only regarding claims involving covered Part E employees and their eligible survivors. Whenever possible this step is conducted upfront during claim intake at the RC and the results forwarded to the DO within 7 calendar days of receipt of the claim or the assignment. Where this is not possible, the RC sends the claims package to the DO upon completion of employment verification within 7 calendar days of receipt of claim forms and proceeds to conduct the occupational history development. Occupational history development is not conducted if beryllium illness or chronic silicosis is being claimed, unless otherwise directed by the DO. In addition, as noted above no occupational history development is conducted in the case where only ineligible survivors are claiming benefits. In such instances, the claim file material is immediately forwarded to the DO upon completion of the employment verification portion and the DO will review for necessity of further occupational history development and assign development tasks to the RC as needed. Regardless, occupational history development must be conducted for all cancer claims arising out of Part E facilities.

25. The RC has a total of 14 calendar days from the date of receipt of the claim or receipt of the assignment from the DO to conclude the occupational history development steps. If all actions cannot be completed within that timeframe, the RC must advise the DO CE of the reason for the delay and outline a reasonable timeframe in which to finalize all necessary actions. If an additional 7 calendar days elapses after the 14 calendar day due date, the RC must telephone or email the DO CE requesting a time extension and providing an action plan as to completion. As soon as the occupational history task is complete, all documentation is immediately forwarded to the DO with a memo noting the date on which the interview(s) was conducted for association with the case file. The RC maintains a copy of all case file materials until the occupational history development process is complete. Once all employment verification and occupational history development actions are finalized and it is confirmed by telephone conversation or email with the CE that the DO does not require further assistance, the RC destroys its copy of the materials.

26. Depending upon the illness(es) claimed and the claimed or verified employment, the RC staff member determines whether or not a claim is being made under Part B or Part E of the EEOICPA, or both. By utilizing the DEEOIC case create worksheet (see EEOICPA PM E-200 [Draft] Exhibit # 1), the RC reviews the claim materials for a determination as to benefits being claimed to determine whether or not a claim is indeed a claim for Part E benefits. Claims submitted by AWE employees are excluded from Part E coverage unless such employment is claimed at a time in which the AWE was undergoing DOE remediation. DOE remediation periods can be ascertained by reviewing the DOE covered facility website mentioned above, but the RC should seek DO guidance before conducting an interview regarding such claims. Claims filed by contractors/subcontractors of DOE or Section 5 RECA workers are treated as Part E claims. At any time during this assessment period the RC may consult the DO for guidance as to whether or not an occupational history interview is necessary. The RC also reviews ECMS to determine whether or not a Part B case is already in existence. In such instances where a new Part E case is filed and a Part B case is found in ECMS, the RC contacts the DO to determine whether or not an occupational history interview is necessary. Sometimes DOE records will already exist in the Part B file that confirms occupational exposure, and further development is not necessary. Unless the DO instructs otherwise and until additional guidance is set forth regarding this matter, occupational history development is required in instances where a DOE Former Worker Program (FWP) screening was conducted. Occupational history development is not required if benefits are approved under Part B, or a positive DOE physician panel finding exists, or the claimed condition is beryllium illness or chronic silicosis. Nonetheless, in all cases the RC will consult ECMS for status of the Part B claim for acceptance and query the DO for guidance if a question arises as to whether or not an occupational history development action is required. Finally, if DOJ has accepted a RECA claim (views ECMS or contact DO CE to determine, or obtain such information from the claimant at time of filing) and the claim has yet to be accepted by DEEOIC, no occupational history development is necessary.

 

27. The main function of the RC staff member in his or her occupational history development role is to conduct the occupational history interview. Attachment 3 to this Bulletin is the interview format for DOE employees; Attachment 4 the format for RECA uranium workers. As noted above, in cases with multiple survivors all claimants must be interviewed, unless one or more claimants have been designated to represent all of the claimants with regard to the interview process. Sometimes one claimant will be more knowledgeable about possible worksite exposure, or more comfortable with consenting to a formal interview process than the other claimants. In such instances, a simple signed statement by the other claimants indicating their wish to designate a certain claimant to be interviewed in their stead will suffice. Such a signed statement is not a designation of an authorized representative and is only used in the interview process. Where an authorized representative has been appointed on a claim file with multiple claimants, there is no need to designate a claimant to participate in the interview process. Authorized representatives may determine how the interview process will be conducted, as they have been appointed by the claimant(s) to act in their capacity with regard to every aspect of their EEOICPA claim.

 

28. As noted above, much of the information gathered through the occupational history development process is sensitive in nature and is subject to Privacy Act mandates. Accordingly, the information developed may not be disclosed to any individual unless he/she is an authorized representative of the claimant or an authorized DEEOIC representative. As with ECMS and ORISE access, the RC staff has access to highly personal information regarding employees and claimants and it is imperative that this information and data remain secure and that the privacy of all individuals is guarded with the utmost care.

 

29. DEEOIC developed the DOE and RECA occupational history questionnaires for use by the RC staff and it is imperative that RC staff properly utilize the questionnaires so as to obtain the information DEEOIC requires in order to evaluate a claim for causation. The interview regarding the questionnaire may be conducted in person or via the telephone. On created cases, all telephonic activity regarding occupational history development is captured in the ECMS TMS screen; all in person activity conducted by RC staff is placed in the ECMS Notes screen. All required ECMS coding is input at the DO as outlined in Action Item # 14 above once the occupational history development task is complete and all documentation is returned to the DO.

 

30. The RC conducts and documents interviews and creates an electronic version of the interview to develop a detailed summary that includes, but is not limited to the following information: the jobs held and a summary of the duties or tasks performed; employer(s); dates of employment; the number of hours per week worked at a facility as well as the total estimated; which buildings/locations/facilities did the employee work in; the specific toxins exposed to; exposure level (direct, near, etc.); exposure frequency (every day, once a week, etc.); how many hours per week the job involved potential exposure to radiation and/or toxins; the type of biological monitoring done if any; exposure controls such as gloves, masks, etc.; medical screening performed on the employee; symptoms/illnesses, any other pertinent information regarding employment/disease/exposure; other relevant factors such as non-DOE work, etc. The RC reviews the case file materials and any CE instructions to determine exactly what information is relevant to the claim, including any identified non-claimed employment or illness. All pertinent information is saved in the occupational history development summary, and a CD and paper version of the summary and the interview notes are forwarded to the appropriate DEEOIC DO within 2 business days of completion. The RC saves the summary to CD in a specific naming convention – 1 for the first interview, last name of employee and last four of the employee’s SSN (1smith0000). Subsequent interviews are saved with the sequential number of the interview at the beginning of the file name (2smith0000).

 

 

31. The RC adheres to the script developed by DEEOIC when conducting interviews, completes the occupational history interview in detail, and takes notes to memorialize the conversation. The notes taken during the interview as well as the summary will become part of the official case file and is retained in the paper and electronic format summary and forwarded to DEEOIC upon completion of this task. Each interview should take approximately two to three hours. It is possible that multiple claimants will require an interview on one case file. It is of the utmost importance that all interviews follow the prepared script, but flexibility is allowed for appropriate follow-up questions that logically flow out of the results of the interview. If the interviewee has little or incomplete knowledge about a particular subject, the RC notes such deficiency in the notes and summary sections so that the DO is aware that information gathering was attempted regarding that topic. Overall, the RC interviewer is responsible for the proper conduct of the interview and for producing a comprehensive summary and questionnaire, including correct grammar and spelling. Finally, once the interview is completed, the RC staff member gives the claimant the interview confirmation letter (See Attachments 3 & 4) verifying the date of the interview and that the interview indeed took place.

 

32. The claims adjudication process has specific timeliness goals. Occupational history development is a very significant part of the process and requires timely scheduling and completion. It is imperative that an interview be scheduled and completed within the timeframes stated in this Bulletin, and that all reworks and follow-up interviews are conducted within 7 calendar days of receipt in the RC. In order to properly conduct the required interview, the RC staff will possess an understanding of work performed by DOE employees. Knowledge of the types of hazardous materials potentially present at DOE sites, the covered illness resulting from claimed exposures, the standard length of exposure for the illness to occur, and the medical diagnosis required to verify the illness is also necessary. The RC staff will possess sufficient knowledge of the EEOICPA, the DOE and Section 5 RECA sites, and hazardous materials to develop a comprehensive and logical summary. Tools are being developed by DEEOIC for use by the DOs and the RCs to better understand the relationship between certain toxins and certain diseases and to better identify which toxins were potentially present at which DOE/RECA Section 5 facilities. These tools, in the form of Exposure Matrices, will assist in the development of an employee’s occupational history as it relates to exposure and illness. Additional guidance regarding the use of the Exposure Matrices will be forthcoming from DEEOIC National Office (NO). The Exposure Matrices will be web based and available for viewing on the Internet. While the Exposure Matrices will provide a valuable tool for evaluation, the RC staff member will consult with the DO CE at all times where questions arise as to the meaning of the information provided. The RC will craft the interview based upon all available exposure information and CE guidance.

 

33. Once all occupational history development steps are complete, the RC manager ensures the accuracy of the data populating the interview and the narrative provided in the summary and forwards the entire package to the adjudicatory DO. Once the DO receives the occupational history development package, it is reviewed thoroughly by the CE. As noted above, any part of the package may be returned by the DO if a deficiency is identified or an additional interview is deemed necessary. The CE will review the materials and update ECMS coding where necessary to correspond with the date upon which the development action occurred at the RC level. The CE utilizes the information obtained during the occupational development as a key tool for establishing causation (based upon employment and the claimed covered illness) in the adjudication process. Additionally, the CE proceeds to develop the claim pursuant to current procedural guidance. Where necessary, the CE prepares the Document Acquisition Request (DAR) record request form as set out in EEOICPA PM E-400 (Draft) to obtain additional exposure evidence.

 

34. In addition to the new Part E claims, Part D/E claims filed prior to the issuance of this Bulletin could potentially require occupational history development at the RCs. The DO evaluates the older Part D/E claims on a case-by-case basis to determine whether or not a referral to the RC is required. When reviewing these cases, the CE examines the case file contents for the existence of DAR records, other DOE exposure records, and other employment records in general that might provide exposure evidence and eliminate the need for an occupational history interview. Additionally, the DO CE consults the web- based Exposure Matrices in conjunction with the case file material to ascertain the need for further development by the RC. If the CE determines that an occupational history interview is required due to a lack of other exposure and employment evidence in order to reach a decision as to causation, an assignment to the RC is made. Once the CE identifies that a Part D/E claim requires RC occupational history development, the DO refers the case file to the appropriate RC with precise instructions set out in a memo as to the information being sought in the interview. The RC has 14 calendar days from the date of receipt of the assignment from the DO to complete the occupational history development tasks outlined by the CE.

 

* ECMS Coding: The DO CE codes assignments made to the RC on identified existing cases that require occupational history development utilizing the ‘RC’ code as the claim status code. The CE then uses the drop down box reason code entitled “AS-Assignment.” The status effective date is the date of the DO memo to the RC outlining the assignment task.

 

* The ‘DO’ code is entered by the CE (see Action Item #23) once the occupational history assignment is completed and returned to the DO.

 

35. Upon review of a completed occupational history interview, the DO may determine that additional information is required and request the RC to conduct a follow-up interview, or identify an error that requires remedy as a rework of the interview. Follow-up interviews are conducted when the DO identifies additional issues through further development of the claim for causation that require RC assistance. Reworks are not generated out of an issue identified by the DO as an area in need of additional development, but arise when an error is found in the final product from the RC. Interview reworks are only conducted in instances where a deficiency (i.e. incomplete or inaccurate data) is identified by the CE. Follow-up assignments are made directly by the CE to the RC manager with an accompanying memo outlining instructions as to the required additional development needed. Reworks must be approved by a Senior CE and are forwarded to the RC manager by the DO DD with an accompanying memo outlining specific instructions as to the deficiency found and the required remedy. The RC must complete all follow-up and rework assignments from the DO within 7 calendar days of receipt in the RC. If additional time is needed for completion, the RC contacts the DO CE and the CE may grant reasonable time extensions.

 

* ECMS Coding for Follow-Up Assignment: The DO codes follow-up assignments made to the RC utilizing the ‘RC’ code as the claim status code. The CE then uses the drop down box reason code entitled “FW-Follow-up.” The status effective date is the date of the DO memo to the RC outlining the follow-up task.

 

* ECMS Coding for Rework Assignment: The DO codes rework assignments made to the RC utilizing the ‘RC’ code as the claim status code. The CE then uses the drop down box reason code entitled “RK-Rework.” The status effective date is the date of the DO DD’s memo to the RC outlining the rework task.

 

* The ‘DO’ code is entered by the CE (see Action Item #23) once the follow-up/rework assignment is completed and returned to the DO.

36. On a monthly basis, each RC manager provides a report to DEEOIC NO addressed to the BOTA Branch Chief that identifies the number of requests for interviews, the number of occupational histories scheduled, the number of occupational histories completed, the number of occupational history reports sent to DEEOIC, and the average length of the interviews in half hour increments. This report will also include the number of occupational history reworks and the average length of the rework.

 

37. RC tasks as outlined in this Bulletin are considered extensions of the DO and each DO DD and respective RC manager is responsible for the proper conduct of each task. In order to evaluate the effectiveness of the RCs and timeliness of task completion, DEEOIC will conduct yearly Accountability Reviews (AR) of each RC. The ARs are designed to gauge RC compliance with DEEOIC procedural guidance and to determine the accuracy and timeliness of RC functions as they relate to initial employment verification, occupational history development, and ECMS accuracy. The AR will serve as a tool to identify strengths and weaknesses within the RC process.

 

 

 

Disposition: Retain until finalized procedures are issued.

 

 

 

PETER M. TURCIC

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 Sections, and Resource Center Managers.

 

 

Attachment 1: ECMS User’s Reference Guide

Attachment 2: Resource Center New Claim Check List

Attachment 3: Occupational History Interview (DOE Facility)

Attachment 4: Occupational History Interview (Miners/Millers/Ore Transporters)