Attention: This bulletin has been superseded and is inactive.








Issue Date: July 11, 2016



Effective Date: July 11, 2016



Expiration Date: July 11, 2017



Subject: Instructions for Use of the Direct Disease Linked Work Processes (DDLWP) in the Site Exposure Matrices (SEM) under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).


Background: Part E of the EEOICPA provides compensation for employees of Department of Energy (DOE) contractors and subcontractors for whom it is found that it is at least as likely as not that exposure to a toxic substance at a covered DOE facility was a significant factor in aggravating, contributing to, or causing an illness. Uranium miners, millers and ore transporters are also eligible for benefits if they develop an illness as a result of occupational exposure to a toxic substance at a facility covered under Section 5 of the Radiation Exposure Compensation Act (RECA).


During the history of the Part E program, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) has developed resources to assist in evaluating the relationship between occupational exposure to toxic substances and diseases. DEEOIC has reviewed scientific literature examining certain job processes associated with certain occupational diseases so that Claims Examiners (CEs) may refer cases to a physician without the need for Industrial Hygienist (IH) review. In accordance with this research, DEEOIC has added information to SEM relating to scientifically established links between certain job processes and occupational diseases. SEM lists these links as Direct Disease Linked Work Process (DDLWP).


References: 42 U.S.C. § 7385s; 20 CFR Part 30


Purpose: To provide guidance on use of the Direct Disease Link Work Process (DDLWP) in adjudicating Part E claims.


Applicability: All Staff




1. When a claimant files a Part E claim, the CE develops the claim and reviews all documentation required to assess the employment and the related toxic exposures. This includes a thorough review of all material provided by the claimant, material from DOE and all medical evidence in the file.


In accordance with existing guidance regarding filtered SEM database results and the unique characteristic of each employee claim, the CE formulates SEM searches utilizing the employee’s verified DOE work history and diagnosed condition(s). Procedurally, the CE conducts such searches by combining multiple filters. For example, site and labor category plus diagnosis.


2. As part of his or her analysis, the CE also identifies any DDLWP that can be reasonably associated with the work performed by an employee at a particular site. In conducting the standard site-based filtered SEM search, in which the CE utilizes the health effect, the SEM will display work processes that may apply to the employee. DDLWP’s will only display for those searches that include a filter for health effect. SEM will display those work processes that are DDLWPs in red.


3. In evaluating whether to use a DDLWP, the CE is to consider:


a. Reasonable and compelling evidence in the case file that the employee performed one of the tasks in the DDLWP. Evidence that meets the caliber of being found compelling can include evidence that convinces the adjudicator the work occurred as alleged by a claimant. Information contained in employer-generated records, occupational safety and health records and industrial hygiene records specific to the employee are generally reliable sources of work process data. Data supplied by an employee or survivor in an occupational history or other personal statements can be accepted as reliable when sufficient detail or other information is provided that documents the scope and type of work performed. Vague statements with no supporting data may be viewed as less compelling to the adjudicator.


b. A facility-specific DDLWP associated in SEM with the employee’s labor category and disease. If there is a DDLWP that potentially applies to both the labor category and the health effect (diagnosis) in SEM, it will display in red in the “Processes/Activities performed by this labor category.” When this occurs and there is additional information in the file to document that the employee performed the DDLWP, the CE may accept the DDLWP as a factual finding as a surrogate for an IH exposure assessment.


As a caveat, not all persons employed in a labor category would have performed all the work processes associated with that labor category. This is particularly true for labor categories that are not specialized, such as a laborer (for whom the range of activities was much broader than a welder, for example). Therefore, the CE needs to carefully compare what job tasks the employee actually performed and not just base determinations on links in SEM which only indicate the potential for certain labor categories to have performed a variety of work processes.


c. If both (a) and (b) of this numbered item are met, the CE may accept that the DDLWP applies and can be used as a factual finding for exposure. If the evidence is lacking with regard to either (a) or (b), the CE can not use the DDLWP and proceeds with exposure development through standard development methods.


For cases in which the CE can use one or more DDLWP, the CE may accept the DDLWP as a factual finding and as a surrogate for an IH exposure assessment. This means that the CE can use evidence in the case file, in conjunction with a SEM search, to make a finding that an employee performed one or more work processes associated with a DDLWP for a given period of time while working as a DOE contractor. Information about the work process, including the period of time that the employee performed the work process can serve as the basis for a medical referral for causation without an IH review.


DEEOIC sees the use of the DDLWP to be of particular value in those cases involving workers with a COPD diagnosis whose career encompassed welding, carpentry, masonry and stone/tile workers as these trades are particularly well-represented in the DDLWPs.


4. Once the CE determines that one or more DDLWP(s) is/are appropriate to use in the case, the CE notes them and prints out the SEM pages utilized to link the labor category, occupational illness and DDLWP. In addition, the CE then must return to the main menu in SEM and choose “blank” DOE for site (this is the first option in the drop-down site menu). Use of the “blank” site will hide all the site-specific information. From this menu, the CE selects the DDLWP(s) that resulted from the earlier site-specific (or construction, all sites) searches. The CE must print this page for each DDLWP being utilized in a case as this constitutes part of the package going to the physician, and this is the only location that the DDLWP are referenced and underlying toxins are displayed. This is further explained in the example below.


To assist in explaining the use of the DDLWP, this Bulletin provides an example. In our example, we will assume that based upon a careful review of the case evidence and a consistent multi-tiered filtered SEM search(es), we can reasonably conclude the employee performed arc welding of aluminum. In our example, the employee has a diagnosis of COPD.


Having completed appropriate filtered SEM searches, the CE now goes back to the main SEM screen and chooses the blank site field. From here, the CE goes to the main menu on the screen and selects “Work Process information” from the links shown.


In our example, the DDLWP we are using is “Arc weld aluminum” so the CE selects it from the menu. The resulting information includes notable items including the relevant reference from Haz-Map, related chemicals from Haz-Map, specific health effects, other references and the record history (last update).



As noted earlier, the CE must print this page for each DDLWP utilized and include a printout of each DDLWP used in the referral to the physician.


5. In the scenario where the CE can document that one or more DDLWP encompasses the employee’s full range of work activity, CE may proceed directly to medical causation.


For example, an employee diagnosed with COPD who performed duties as a welder for their entire DOE career would be a good candidate for use of the DDLWP as there are multiple DDLWP(s) which apply to welders (with COPD) and there is a reasonable certainty that welders would have performed a wide array of welding processes. If the welder then became a manager or plant shift supervisory, the case is still a good candidate for use of DDLWP because those supervisory jobs would not likely add additional toxins or toxin-related work processes to their profile.


a) For cases in which the CE can reasonably conclude that one or more DDLWP(s) linked to the diagnosis(es) being adjudicated, and the identified DDLWP broadly encompass the totality of the employee’s DOE-based exposures, the CE can use the DDLWP as a surrogate for an IH referral and can proceed with obtaining a physician’s opinion on causation (Numbered item 6, below).


b) For cases in which there is one or more DDLWP associated with one or more diagnosis(es) undergoing adjudication, but there is notable additional employment which is not represented by the DDLPW, the CE can choose to obtain a medical opinion based solely on the DDLWP(s). However, if the resulting medical opinion on causation is negative, the case will then need a full review by an IH, so as to capture potential exposures represented by employment not incorporated into the DDLWP(s).


6. Once a CE decides to utilize one or more DDLWP’s in a case, the CE prepares a referral to a physician to obtain a medical opinion on causation. If the CE can work with the claimant and his or her personal physician on causation, that approach is preferred. If that approach is not feasible, a (Contract Medical Consultant (CMC) referral is appropriate.


a) In conjunction with the referral to a physician, the CE must also document the primary toxic substance(s) underlying the link, based upon the printout collected in #4 above, in the case file, as it may ultimately be used as part of the assessment for any tort offset in the case based upon the same exposure.


7. To obtain a causation opinion, the CE prepares a summary of the employment that specifically references how much time the employee spent working on one or more DDLWP and describes the work. The referral should also include a copy of the SEM printout of the DDLWP(s) being used (to include the scientific references as explained in #4), a letter posing the question regarding causation and, in the case of a referral to a CMC, a copy of all pertinent medical records. The standard format for the question to the physician is, “Based upon your review of this information, in your opinion, is it at least as likely as not that (employee’s name) work in (DDLWP) at (DOE facility) between (start date of performing DDLWP) and (end date of performing DDLWP) caused, contributed to, or aggravated his (diagnosis). Why or why not?”


a) In utilizing the DDLWP, the CE should understand that it is the CE’s detailed description of how long the employee performed the work process and how often the specific process was performed that replaces the need for an IH to opine on nature and extent and duration of exposure. Furthermore, this guidance only serves to provide presumptions on exposure. The CE still leaves it to a qualified physician to opine on causation. It is precisely because the physician must consider things such as latency and the length of the exposures in rendering his or her determination that the CE provides the physician with the references in SEM printout, which contain scientific information that the physician is encouraged to consider in making his or her opinion.


8. Once the physician returns an opinion, the CE processes the case in normal adjudicatory fashion. If the physician requests further clarification of the nature, frequency or duration of any accepted DDLWP exposure(s), the CE must consult an IH.


Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.






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, and District Office Mail & File Section