Addressee
Address
City, State, Zip
Dear
I am writing in reference to your claim for benefits under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA).
The Department of Labor recently obtained guidance from the National Cancer Institute (NCI) that (cancer of the larynx or the bone form of solitary plasmacytoma, as appropriate) can be considered a specified cancer under the Special Exposure Cohort (SEC) provision. Under the EEOICPA, if the name of a cancer is not cited in the regulations as a specified cancer, we are required by law to obtain guidance from NCI on whether it meets the physiological conditions that would allow it to be grouped with a specified cancer. NCI stated that (name of cancer) can be grouped with (cancer of the pharynx or bone cancer, as appropriate), which is a specified cancer.
Our records indicate that you claimed (insert claimed condition) under Part B (and E if appropriate). Therefore, we are in the process of re-examining your case to determine if your claim meets the SEC criteria.
In order to begin this process, I must first vacate our previous decision(s) and reopen your case. The attached Director’s Order explains the reason why the prior decision(s) is being vacated and your case reopened. Please read this Order very carefully. If any of the basic information has changed since your final decision was issued, such as medical condition(s) or employment dates, please contact this office immediately and ask for your assigned claims examiner. Your information will be incorporated into your case file and considered in our decision. Once we have completed a review of your file, a new recommended decision will be issued concerning your eligibility under the SEC provision.
If you have any questions about the Director’s Order, please feel free to call my office, toll free, at: (xxx) xx-xxxx.
Sincerely,
{Name of District Director}
District Director
EMPLOYEE: [Employee Name]
CLAIMANT: [Claimant(s) Name]
FILE NUMBER: [File Number]
DOCKET NUMBER: [Docket Number]
DIRECTOR’S ORDER
On {date} you were issued a final decision denying your claim for benefits under [Part B/E] of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or the Act). A final decision may be reopened at any time on motion of the Director of the Division of Energy Employees Occupational Illness Compensation (DEEOIC). Because of new developments which are described in this Director’s Order, the {date} Final Decision under [Part B/E] of the Act is hereby vacated and your case reopened.
BACKGROUND
{Provide a concise and accurate synopsis of the claim’s history. Some sample paragraphs are provided here, though these should be altered to tailor-fit the specifics of the case.}
On {date}, {claimant name} filed Form [EE-1 or 2] (Claim for [Survivor] Benefits under the EEOICPA) under Part B [and/or E, as appropriate}, claiming that {he or she or the employee, as appropriate} {employee name, if appropriate} developed {cancer type} as a result of employment at (name of facility) in (location). Medical documentation established the claimed condition.
Under the Act, all cancer cases that do not meet the provisions of a Special Exposure Cohort (SEC) class must be referred to the National Institute for Occupational Safety and Health (NIOSH), a division of the Department of Health and Human Services (HHS) for completion of a dose reconstruction. Upon receipt of the dose reconstruction analysis, the DEEOIC runs a software program that provides a number called the probability of causation (PoC). Under Part B of the Act, a compensable cancer claim is one that is “at least as likely as not” related to employment at a covered facility, and would require a PoC of 50% or greater. In your case, the PoC was calculated to be {XX.XX%}.
As a result, on {date}, the district office issued a recommended decision denying the claim under Part B of the Act, because the PoC was less than 50%. The recommended decision was forwarded to the Final Adjudication Branch (FAB) in accordance with our procedures for an independent assessment and issuance of a final decision. On {date}, the FAB issued a Final Decision, affirming the recommended decision to deny the claim. [If there is also a claim for Part E – explain the decision in the next paragraph.]
DISCUSSION
Under the Act, the SEC provision allows for payment of cases regardless of the PoC. To be included in a class of the SEC, the employee must have worked at a facility designated in the Act, or subsequently designated by the Secretary of HHS, during the SEC timeframe for 250 aggregate workdays. In addition, the employee must have a diagnosis of one of the specified cancers.
The SEC specified cancers, which are listed in the regulations at 20 CFR § 30.5(ff), are described as the physiological conditions that are recognized by NCI under those names. If the name of a cancer is not cited in the regulations, we are required to obtain guidance from NCI on whether it meets certain physiological conditions that would allow it to be grouped with a specified cancer. We recently obtained such guidance from NCI regarding (cancer of the larynx, cancer of the cartilage of the larynx, or solitary plasmacytoma, as appropriate). NCI stated that it can be grouped with (name of specified cancer) and considered a specified cancer.
CONCLUSION (Note: This paragraph is particularly important)
Based on the inclusion of (name of cancer) as a specified cancer, the district office has reviewed your case file and finds there is sufficient evidence to warrant reopening of this claim. The evidence of record shows that the employee was diagnosed with (name of cancer), and worked {describe evidence that shows the employee worked for at least 250 aggregate workdays at a SEC site during the designated years}. These findings indicate potential eligibility as a member of a SEC class.
Accordingly, the Final Decision under Part B [and/or Part E] [is/are] hereby vacated, and the case is reopened so that a new recommended decision can be issued. If you disagree with the recommended decision, you will have the opportunity to file an objection and request an oral hearing or a review of the written record.
{city of district office}
{Name of District Director}
District Director
CERTIFICATE OF SERVICE
I hereby certify that on a copy of the Director’s Order was sent by regular mail to the following:
Addressee
Address
City, State, Zip
{Name of District Director}
District Director