Employee:
File Number:
JOE CLAIMANT
1234 W. MAIN STREET
WASHINGTON, DC
Dear Mr. Claimant:
This letter is in reference to your claim for compensation under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or Act). We have reviewed the claim and found that the employee/you was/were diagnosed with [Insert medical condition(s)].
As part of the claim adjudication process, evidence must be presented to establish a relationship between exposure to a toxic substance and an employee’s illness or death. A “toxic substance” is defined as any material that has the potential to cause illness or death because of its radioactive, chemical, or biological nature. Moreover, the Act requires a finding that it is “at least as likely as not” that such exposure at a covered facility during a covered time period was a significant factor in aggravating, contributing to, or causing the employee’s illness or death, and that it is “at least as likely as not” that exposure to a toxic substance(s) was related to employment at a facility for compensation to be paid.
To assist in the resolution of claims, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) has compiled a list of medical conditions currently not considered by the scientific community as having a known relationship to toxic substance exposure (other than radiation and cancers). The list was based on the evaluation of authoritative scientific publications, medical literature, and occupational exposure data by specialists in the field of toxicology, health physics, and occupational medicine.
Upon review of the evidence provided with your claim, the claimed [insert medical conditions] is/are not scientifically recognized as having a known relationship to exposure to a toxic substance. However, you may provide further evidence in support of the claim. In particular, it is necessary to submit factual or medical documentation to show a relationship between the claimed medical condition(s) and exposure to a toxic substance.
Option 1 (Diagnosed Cancer):
For claims involving a diagnosed cancer, be aware the DEEOIC will process the claim for a determination of causation based on radiation exposure. There are two methods to establish causation due to radiation exposure. The first is a determination of causation based upon a dose reconstruction performed by the National Institute for Occupational Safety and Health (NIOSH). Depending on the level and extent of radiation exposure reported in a dose reconstruction, the type of cancer diagnosed, and other factors, a probability of causation (POC) is assessed. POC is a calculation of the likelihood that a diagnosed cancer is a result of radiation exposure. Any POC equal to or greater than 50% results in a finding that radiation caused a diagnosed cancer. The second method for establishing causation is membership in a Special Exposure Cohort (SEC) class. SEC classes are identified through the EEOICPA or are designated by NIOSH and require certain specific medical and employment criteria be satisfied. Membership in a SEC class results in a presumption that radiation caused a diagnosed cancer and do not undergo a POC calculation.
The DEEOIC will process every cancer claim based on either the POC process or possible inclusion in a SEC class. However, if you have already received a decision regarding a POC less than 50% and/or denial of SEC membership, this means that radiation was not accepted as the cause of the diagnosed cancer. As such, to pursue a claim under Part E of the Act, evidence must show that the cancer is due to some other biological or chemical exposure. If you are claiming a cancer that appears on Attachment 1 and radiation has been excluded as a causal factor due to an SEC or POC determination, the DEEOIC is currently unable to identify any biological or chemical substance linked to causing cancer. Accordingly, if you believe that the diagnosed cancer is affiliated a biological or chemical exposure, you must present evidence to substantiate such a connection.
Option 2 (Non Cancer Conditions)–
If your claim is based on a diagnosed non-cancerous condition, and you feel that the condition is due to a biological, chemical, or radiological exposure, you must present the evidence to substantiate such a connection.
This letter is meant to afford you the opportunity to submit relevant and substantive information in support of your claim. Under the Act, it is ultimately your responsibility to submit the necessary information to establish a claim under the EEOICPA. A period of 30 days is granted for you to provide a response to this letter. If you need additional time to collect relevant evidence with regard to your claim, please contact your assigned claims examiner. Reasonable requests for an extension of the 30 days will be granted. Otherwise, after the expiration of thirty days, the DEEOIC will proceed with an evaluation of your case and the issuance of a recommended determination.
If you have any questions or concerns, please contact the District Office at XXX-XXX-XXXX or fax XXX-XXX-XXXX.
Sincerely,
Claims Examiner