EEOICPA Bulletin No. 09-04
Issued Date: December 4, 2008
Effective Date: December 4, 2008
Expiration Date: December 4, 2009
Note: This Bulletin provides guidance on ECMS
coding for Individual Program Evaluation Reports(PER)/Individual Case
Evaluations (ICE) received from the National Institute for Occupational Safety
and Health (NIOSH) related to OCAS-PER-016, entitled “Implementation of IREP procedures
for claims near 50% probability of causation” and OCAS-PER-018, entitled “
Subject: “LNR” coding in ECMS for ICEs related to OCAS-PER-016, IREP procedures and OCAS-PER-018, Los Alamos National Laboratory (LANL).
Background: On October 29, 2007, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) issued EEOICPA Bulletin No. 08-05, NIOSH’s OCAS-PER-018, entitled “Los Alamos National Laboratory TBD Revision.” Bulletin 08-05 provided steps for returning certain cases to NIOSH for a new dose reconstruction.
On January 23, 2008, the DEEOIC issued EEOICPA Bulletin No. 08-13, NIOSH’s OCAS-PER-016, entitled “Implementation of IREP procedures for claims near 50% probability of causation.” Bulletin 08-13 included steps for identifying those cases that should be returned to NIOSH for a new dose reconstruction. EEOICPA Bulletin 08-16, issued on March 21, 2008, provided supplemental guidance for identifying those cases potentially impacted by the release of OCAS-PER-016.
In the Spring of 2008, NIOSH provided the DEEOIC with several thousand case specific PERs/ICEs for cases potentially affected by the release of the many PERs that NIOSH issued (i.e. Super S, Construction Trade Workers).
The National Office printed and sorted the majority of the PER/ICEs and distributed them to the district/FAB offices. A copy of these PERs/ICEs has also been placed on the DEEOIC Shared Drive to be retrieved by the district/FAB offices. Upon review of the PER/ICEs received from NIOSH, it was determined that NIOSH also provided the DEEOIC with case specific PER/ICEs related to OCAS-PER-016 and OCAS-PER-018.
However, since Bulletins 08-05, 08-13 and 08-16 were released prior to the receipt of the letters from NIOSH, guidance on coding ECMS to indicate that an individual PER/ICE had been received from NIOSH was omitted. This is due to the fact that at the time EEOICPA Bulletins 08-05, 08-13 and 08-16 were issued, it was not known that these case specific evaluations related to PERs would be provided to the DEEOIC. As such, this bulletin provides the procedures for ECMS coding associated with the receipt of ICE/PER from NIOSH and subsequent actions as it relates to the release of OCAS-PER-016 and OCAS-PER-018.
For those PER related EEOICPA Bulletins issued after the receipt of the case specific PERs/ICEs from NIOSH, appropriate ECMS coding instruction pertaining to the “LNR” status code and subsequent actions were included.
References: NIOSH document, OCAS-PER-016, “Implementation of IREP procedures for claims near 50% probability of causation,” effective September 25, 2007, found at http://126.96.36.199/niosh/ocas/pdfs/pers/oc-per16-r0.pdf.
Purpose: To provide guidance on ECMS coding for ICEs received from NIOSH related to OCAS-PER-16, Implementation of IREP Procedures for Claims near 50% Probability of Causation and OCAS-PER-018, Los Alamos National Laboratory TBD Revision.
Applicability: All staff.
1. For those cases where NIOSH provides the DEEOIC with individual PERs/ICEs related to the release of OCAS-PER-016 (IREP procedures) or OCAS-PER-018 (LANL), the individual PER/ICE will serve as documentation that the case file has been reviewed by NIOSH and that NIOSH has determined that:
· the change outlined in the PER affects the outcome of the claim and a return to NIOSH for a new dose reconstruction is necessary, or
· there are multiple changes that affect the dose reconstruction and a return to NIOSH for a new dose reconstruction is necessary, or
· the change outlined in the PER does not affect the dose reconstruction, nor do any other changes affect the dose reconstruction and a return to NIOSH is not necessary.
For those cases where NIOSH provided DEEOIC with an individual case PER or ICE referencing OCAS-PER-016, the CE enters the code “LNR” (Letter/Response Received from NIOSH) and selects the “813” reason code from the reason code drop down menu in ECMS B. For those cases where NIOSH provided DEEOIC with an individual case PER or ICE referencing OCAS-PER-018, the CE enters the code “LNR” and selects the “805” reason code from the reason code drop down menu in ECMS B. The claim status date of the code is the date the response is received in the appropriate office, which is the date of the date stamp. The “LNR” status code is not input into ECMS E unless the “NI” (Sent to NIOSH) status code had previously been entered into ECMS E.
If the individual case PER or ICE indicates that the case should “Return to NIOSH” for a new dose reconstruction, the case must be reviewed to determine whether it was previously returned to NIOSH as a result of the release of OCAS-PER-016 or OCAS-PER-018(there should be an amended NRSD on file). If the case was already referred to NIOSH as a result of OCAS-PER-016 or OCAS-PER-018, then the only action required is to ensure that the “LNR” status code and appropriate reason code has been entered into ECMS.
If the case has not already been returned to NIOSH as a result of OCAS-PER-016 or OCAS-PR-018, then the District Director issues a Director’s Order (if appropriate) reopening the case. Upon reopening, the district office refers the case to NIOSH for a new dose reconstruction. EEOICPA Bulletins 08-05 and 08-13 delegate the reopening authority to the District Directors and also provides guidance on referring cases back to NIOSH for a new dose reconstruction.
If the individual case PER or ICE indicates that the case was “Evaluated with No Change” but does not include a dispositive statement, the District Director issues a Director’s Order reopening the case (if appropriate) and refers the case to NIOSH for a new dose reconstruction (see instructions provided in EEOICPA Bulletin 08-13) if the case has not previously been referred to NIOSH as a result of OCAS-PER-016 or OCAS-PER-018. In order to be dispositive, NIOSH must indicate that they have evaluated the case against the PER and any other changes, and determined that a new dose reconstruction is not necessary.
If the individual case PER or ICE is dispositive, then no action is necessary. The CE must review ECMS to determine whether the “NA” code has already been entered. If the “NA” status code is already entered into ECMS B, it is not necessary to enter another “NA” status code. However, if the “NA” status code has not been entered, then the CE enters the “NA” status code and appropriate reason code into ECMS B. The “NA” reason code for OCAS-PER-016 is “13P” and the “NA” reason code for OCAS-PER-018 is “805.” The status effective date of the “NA” code is the date of the memo to the file stating review is complete and the CE has determined there is no further action necessary.
2. Its possible that some PER/ICEs have already been associated with the appropriate file but ECMS has not been coded to indicate that a PER/ICE has been received from NIOSH. As such, the district/FAB office is to backfill ECMS with the “LNR” status code and appropriate reason code to indicate the receipt of the PER/ICE. This means that the district/FAB office is to review the file to determine if a PER/ICE has been associated with the file and if so, then an “LNR” status code is to be entered into ECMS. Furthermore, if not already done, the appropriate action must be taken on the case as instructed in Action Item #1.
To assist with identifying the OCAS-PER-16 and OCAS-PER-018 related cases to be reviewed for “LNR” coding, a list of the cases where NIOSH provided the DEEOIC with case specific PERs/ICEs will be distributed to the district/FAB offices.
Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.
Rachel P. Leiton
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,
Hearing Representatives, District Office Mail & File Section,