TABLE OF CONTENTS
Paragraph and Subject Date Trans. No.
Chapter 0-0500 Definitions
Table of Contents. . . . . 09/15 15-05
1 Purpose and Scope. . . . . 09/15 15-05
2 Definitions. . . . . . . . 09/15 15-05
Exhibits
1 Abbreviations. . . . . . . 09/15 15-05
2 Forms. . . . . . . . . . . 09/15 15-05
1. Purpose and Scope. The purpose of this chapter is to define the most commonly used terms in the administration of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). The chapter also identifies the abbreviations and acronyms for those terms (Exhibit 1) and provides a listing of the forms used in the program (Exhibit 2).
2. Definitions. This section defines the principal terms used in the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Procedure Manual (PM).
a. Act or EEOICPA means the Energy Employees Occupational Illness Compensation Program Act of 2000, as amended, 42 U.S.C. § 7384 et seq.
b. Atomic Weapon means any device utilizing atomic energy, exclusive of the means for transporting or propelling the device (where such means is a separable and divisible part of the device), the principal purpose of which is for use as, or for development of, a weapon, a weapon prototype, or a weapon test device.
c. Atomic Weapons Employee means:
(1) An individual employed by an atomic weapons employer (AWE) during a period when the employer was processing or producing, for the use by the United States, material that emitted radiation and was used in the production of an atomic weapon, excluding uranium mining and milling; or
(2) An individual employed:
(a) At a facility that the National Institute for Occupational Safety and Health (NIOSH), in its report dated November 2002 and titled “Report on Residual Radioactive and Beryllium Contamination at Atomic Weapons Employer Facilities and Beryllium Vendor Facilities,” or any update, indicated had a potential for significant residual contamination outside of the period described in subparagraph (1) of this definition;
(b) By an atomic weapons employer or subsequent owner or operator of a facility referenced in subparagraph (a) of this definition; and
(c) During a period reported by NIOSH, in its report dated November 2002 and titled “Report on Residual Radioactive and Beryllium Contamination at Atomic Weapons Employer Facilities and Beryllium Vendor Facilities,” or any update to that report, to have a potential for significant residual radioactive contamination. This will be identified on the Department of Energy (DOE) facility database as the “residual contamination” period.
d. Atomic Weapons Employer (AWE) means any entity, other than the United States, that:
(1) Processed or produced, for use by the United States, material that emitted radiation and was used in the production of an atomic weapon, excluding uranium mining and milling; and
(2) The Secretary of Energy has designated as an AWE for purposes of the Act.
e. AWE Facility means a facility, owned by an AWE, that is or was used to process or produce, for use by the United States, material that emitted radiation and was used in the production of an atomic weapon, excluding uranium mining or milling.
f. Attorney General means the Attorney General of the United States or the United States Department of Justice (DOJ).
g. Average Annual Wage (AAW) means four times the average quarterly wages of a covered Part E employee for the 12 quarters preceding the quarter during which the employee first experienced wage-loss due to exposure to a toxic substance at a DOE facility or RECA section 5 facility, excluding any quarters during which the employee was unemployed.
Being “retired” is not equivalent to being “unemployed”; therefore, quarters during which an employee had no wages because of retirement will be included in the AAW calculation.
h. Benefit or Compensation means the money the United States Department of Labor (DOL) pays to or on behalf of either a covered employee under Part B, or a covered DOE contractor employee under Part E, from the Energy Employees Occupational Illness Compensation Fund. These terms may also include any other amount paid out of the Fund for medical benefits including but not limited to medical treatment, monitoring, examinations, services, appliances and supplies.
i. Beryllium Sensitization or Sensitivity means that the individual is sensitized to beryllium as demonstrated by any of the following:
(1) An abnormal beryllium lymphocyte proliferation test (LPT) or an abnormal lymphocyte transformation test (LTT) on either blood or lung lavage cells as interpreted by a medical doctor, for Part B and Part E claims;
(2) A positive physician panel determination as specified in section 7385s-4(b), for Part E claims only; or
(3) A determination that it is at least as likely as not that exposure to beryllium at a DOE facility or a RECA section 5 facility was a significant factor in aggravating, contributing to, or causing the beryllium sensitization or sensitivity; and it is at least as likely as not that the exposure to beryllium was related to employment at a DOE facility or a RECA section 5 facility as specified in sections 7385s-4(c) and 7385s-5(a), for Part E claims only.
j. Beryllium Vendor means any of the corporations and named predecessor corporations designated as beryllium vendors in section 7384l(6)(A)-(I) of the EEOICPA, or their corporate successors; and also those facilities designated as beryllium vendors in the list published in the Federal Register by the Department of Energy.
k. Bioassay means the determination of the kind, quantity, concentration, or the location of radioactive material in the human body, whether by direct measurement or by analysis and the evaluation of radioactive material excreted, eliminated, or removed from the body.
l. Chronic silicosis means a non-malignant lung disease as demonstrated by any of the following:
(1) The initial occupational exposure to silica dust preceded the onset of silicosis by at least 10 years and a written diagnosis of silicosis is made by a medical doctor and is accompanied by:
(a) A chest radiograph, interpreted by an individual certified by the National Institute for Occupational Safety and Health as a B reader, classifying the existence of pneumoconioses of category 1/0 or higher;
(b) Results from a computer assisted tomograph or other imaging technique that are consistent with silicosis; or
(c) Lung biopsy findings consistent with silicosis.
This evidence holds true for Part B and Part E claims;
(2) A positive physician panel determination as specified in section 7385s-4(b), for Part E claims only; or
(3) A determination that it is at least as likely as not that exposure to silica at a DOE facility or a RECA section 5 facility was a significant factor in aggravating, contributing to, or causing the chronic silicosis; and it is at least as likely as not that the exposure to silica was related to employment at a DOE facility or a RECA section 5 facility as specified in sections 7385s-4(c) and 7385s-5(a), for Part E claims only.
m. Claim means a written assertion to the Office of Workers’ Compensation Program (OWCP) of an individual’s entitlement to benefits under the EEOICPA, submitted in a manner authorized by the Act.
n. Claimant means an individual claiming compensation under the Act.
o. Compensation Fund or Fund means the fund established on the books of the Department of the Treasury for payment of benefits and compensation under EEOICPA.
p. Consequential Injury is any injury, illness, or impairment sustained by a covered employee as a result of an occupational illness, or sustained by a covered DOE contractor employee as a result of a covered illness.
q. Contemporaneous Record means any document created at or around the time of the event that is recorded in the document.
r. A Contract Medical Consultant (CMC) is a contracted physician who conducts a review of case records to render opinions on medical questions.
s. Coordination of Benefits with State Workers’ Compensation (SWC) is to be determined when a claimant has received benefits from a SWC program for the same covered illness(es) to which he or she is to be awarded compensation under Part E, resulting in a possible reduction in the Part E award.
t. Covered Child means, under Part E, a biological child, a stepchild who lived in a recognized parent-child relationship, or a legally adopted child of a covered DOE contractor employee, who at the time of the employee’s death:
(1) Had not attained the age of 18 years;
(2) Had not attained the age of 23 years and was a full-time student who had been continuously enrolled as a full-time student in one or more educational institutions since attaining the age of 18 years; or
(3) Had been incapable of self-support at any age.
This term should only be used in reference to claims under Part E.
u. Covered DOE Contractor Employee means, under Part E, a Department of Energy contractor or subcontractor employee, or a RECA section 5 uranium worker who has been determined by OWCP to have contracted a covered illness through exposure to a toxic substance at a Department of Energy facility or a RECA section 5 facility, as appropriate. This term should only be used in reference to claims under Part E.
v. Covered Employee means, under Part B, a covered beryllium employee, a covered employee with cancer, a covered employee with chronic silicosis, or a covered uranium employee. This term should only be used in reference to claims under Part B.
w. Covered Illness means, under Part E, an illness or death resulting from exposure to a toxic substance from employment at a DOE facility or a RECA section 5 facility. This term should only be used in reference to claims under Part E.
x. Covered Uranium Employee means, under Part B, an individual who has been determined by the Department of Justice to be entitled to an award under section 5 of RECA, whether or not the individual was the employee or the deceased employee’s survivor.
y. Department means the United States Department of Labor (DOL).
z. Department of Energy (DOE) includes the predecessor agencies of the DOE, such as the Atomic Energy Commission and the Manhattan Engineer District.
aa. DOE Contractor Employee means any of the following:
(1) An individual who is or was in residence at a DOE facility as a researcher for one or more periods aggregating at least 24 months; or
(2) An individual who is or was employed at a DOE facility by:
(a) An entity that contracted with the DOE to provide management and operation, management and integration, or environmental remediation at the facility; or
(b) A contractor or subcontractor that provided services, including construction and maintenance, at the facility.
bb. DOE Facility means any building, structure, or premise, including the grounds upon which such building, structure, or premise is located:
(1) In which operations are, or have been, conducted by, or on behalf of, the DOE (except for buildings, structures, premises, grounds, or operations covered by Executive Order 12344, dated February 1, 1982, pertaining to the Naval Nuclear Propulsion Program); and
(2) With regard to which the DOE has or had:
(a) A proprietary interest; or
(b) Entered into a contract with an entity to provide management and operation, management and integration, environmental remediation services, construction, or maintenance services.
cc. Disability means that OWCP has determined entitlement to payment of Part B benefits for the covered occupational illness of chronic beryllium disease, cancer or chronic silicosis. This term should only be used in reference to a claimant entitled to benefits under Part B.
dd. Dose Reconstructions (DRs) are used to estimate the radiation doses to which individual workers or groups of workers have been exposed, particularly when radiation monitoring is unavailable, incomplete, or of poor quality. These methods are applied to translate exposure to radiation into quantified radiation doses at the specific organs or tissues relevant to the types of cancer occurring among the workers.
ee. Durable Medical Equipment (DME) means the appliances that a qualified physician prescribes or recommends for a covered occupational illness or a covered illness which OWCP considers necessary to treat the illness. Examples of DMEs include walkers, wheelchairs, or hospital beds.
ff. Equivalent Dose means the absorbed dose in a tissue or organ multiplied by a radiation weighting factor to account for differences in the effectiveness of the radiation in inducing cancer.
gg. External Dose means the portion of the equivalent dose that is received from radiation sources outside of the body.
hh. The Freedom of Information Act (FOIA) means the law that generally provides for public access to documents maintained by the government. It requires the government to release those documents upon request, unless the request or documents fall within one of nine exceptions listed in the law.
The FOIA also requires the publication of indexes of specified agency documents and records; provides time limitations for responding to requests; establishes a system of penalties for non-compliance with the time limitations; requires identification of persons responsible for granting or denying requests; provides for court review of denials, including classified materials; and provides for the levying of charges for searching and copying requested materials.
ii. Gaseous Diffusion means a uranium enrichment process based on the difference in rates at which uranium isotopes in the form of gaseous uranium hexafluoride diffuse through a porous barrier.
jj. Impairment means a loss, loss of use, or derangement of any body part, organ system or organ functionality as it affects the whole body, as a result of the covered illness. An impairment rating is performed once the employee has reached Maximum Medical Improvement (MMI) or is terminal. [see paragraph(ll) below]. This term should only be used in reference to claims under Part E.
kk. Incapable of Self-Support means the inability to obtain or retain employment, or engage in self-employment that provides a sustained living wage as a consequence of a physical or mental condition, illness or disease.
ll. Internal Dose means the portion of the equivalent dose that is received from radioactive materials taken into the body.
mm. Maximum Medical Improvement (MMI) is when the covered illness is stabilized and is unlikely to improve with or without additional medical treatment.
nn. Occupational Illness means, under Part B, a covered beryllium illness, cancer sustained in the performance of duty, specified cancer, chronic silicosis, or an illness for which DOJ has awarded compensation under section 5 of RECA. This term should only be used in reference to an individual(s) entitled to benefits under Part B.
oo. Offset is a reduction of the claimant’s benefits under the Act. This is required if any person receives funds pursuant to a final judgment or settlement for the same accepted exposure that led to the accepted covered illness.
Benefits that are excluded from an offset include:
(1) Workers’ compensation benefits;
(2) Insurance policies; and
(3) A claim for loss of consortium filed by an individual other than the covered Part B or Part E employee.
pp. OWCP Medical Fee Schedule is a schedule of maximum allowable fees as determined by OWCP for the payment of medical and other health services furnished by physicians, hospitals, and other providers for an accepted occupational illness(es) and an accepted covered illness(es). The payment of fee for such service shall not exceed the maximum allowable charge with the exception of the following:
(1) Does not apply to charges for services provided in nursing homes; this does not include those charges for treatment furnished by a physician or other medical professionals in a nursing home; or
(2) Does not apply to charges for appliances, supplies, services or treatment furnished by medical facilities of the U.S. Public Health Service or the Departments of the Army, Navy, Air Force and Veterans Affairs.
qq. Physician means surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law.
The term "physician" includes chiropractors only to the extent that their reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist.
rr. The Privacy Act means the statute governing a citizen’s right to confidentiality of personal information, including financial and medical history, in records filed in a system of records under the individual’s own name. This law sets forth the government’s responsibility to properly maintain and restrict access to these records.
ss. Probability of Causation (PoC) means the probability or likelihood that a cancer was caused by radiation exposure incurred by a covered employee in the performance of duty. In statistical terms, it is the cancer risk attributable to radiation exposure divided by the sum of the baseline cancer risk (the risk to the general population) plus the cancer risk attributable to the radiation exposure. Other terms for this concept include "assigned share" and "attributable risk percent."
tt. Radiation means ionizing radiation in the form of alpha particles, beta particles, neutrons, gamma rays, X-rays, or accelerated ions or subatomic particles from accelerator machines.
uu. Radiation Exposure Compensation Act (RECA) of 1990, as amended, 42 U.S.C. § 2210 (noteTE), is a federal statute implemented by DOJ that provides monetary compensation to individuals who contracted certain cancers and a number of other specified diseases as a result of defined on-site/downwind exposure to radiation released during above-ground nuclear weapons tests or as a result of their exposure to radiation during employment as uranium miners, millers, or ore transporters.
(1) Section 4 of RECA provides benefits for individuals with cancer who were either proximate to atomic tests at the Nevada Test Site (downwinder) or participated at the site of an atmospheric atomic weapon test (onsite participant).
(2) Section 5 of RECA provides benefits for individuals who have contracted a covered illness through exposure to a toxic substance during covered employment at a section 5 facility as a uranium miner, uranium mill worker, or as a uranium ore transporter.
vv. Referee Opinion is an impartial physician review in cases where the weight of medical evidence is equal between the opinion of the treating doctor and that of a CMC or Second Opinion physician.
ww. A Second Opinion Examination is a medical referral arranged by the Division of Energy Employees Occupational Illness Compensation (DEEOIC) which requires an employee to undergo a physical examination. The results of that examination, along with the physician’s review of pertinent medical documentation, facilitate the production of a narrative medical report describing the physician’s independent medical opinion.
xx. Special Exposure Cohort (SEC) means the classes of employees designated by the EEOICPA, or by the Secretary of Health and Human Services, who when diagnosed with a specified cancer receive a presumption of causation that employment at a covered facility caused the specified cancer, without the need of a radiation dose reconstruction.
yy. Specified Cancers The following are specified cancers in accordance with 20 CFR § 30.5(ff):
(1) Leukemia. [Chronic lymphocytic leukemia (CLL) is excluded]. The onset is to have occurred at least two years after initial exposure at any covered facility during a covered time period.
(2) Primary or Secondary Lung Cancer. [In situ lung cancer that is discovered during or after a post-mortem exam is excluded.] The trachea and bronchi are included as part of the lungs. Sarcoma of the lung is a lung cancer. The pleura and lung are separate organs, so cancer of the pleura, such as mesothelioma, is not a specified cancer.
(3) Primary or Secondary Bone Cancer. This includes myelodysplastic syndrome, myelofibrosis with myeloid metaplasia, essential thrombocytosis or essential thrombocythemia, and primary polycythemia vera [also called polycythemia rubra vera, P. vera, primary polycythemia, proliferative polycythemia, spent-phase polycythemia, or primary erythremia]. A diagnosis of polycythemia vera (and the listed a/k/a nomenclature) is sufficient by itself to be classified as a malignancy of the bone marrow. Leukocytosis and thrombocytosis are supplemental descriptors of polycythemia vera. The bone type of solitary plasmacytoma (a/k/a solitary myeloma) is a form of cancer consistent with bone cancer. The soft tissue type of solitary plasmacytoma is not a type of bone cancer or the specified cancer of multiple myeloma. (Note: Cancer of the hard palate is not bone cancer.)
(4) Primary or Secondary Renal Cancers.
(5) Other Diseases. For the following diseases, onset must have been at least five years after initial exposure at any covered facility during a covered time period:
(a) Multiple myeloma (a malignant tumor formed by the cells of the bone marrow);
(b) Lymphomas (other than Hodgkin’s disease). Waldenstrom’s macroglobulinemia is considered to be a type of non-Hodgkin's lymphoma, when diagnosed by lymph node biopsy, can be called lymphoplasmacytoid lymphoma. (Note: Lymphoma Waldenstrom is used as a pseudonym for many other disorders not included as a specified cancer. The acceptance of this condition as a specified cancer is to be based on the ICD code presented in the medical evidence or upon diagnostic clarification from a physician).
(c) Primary cancer of the:
(i) Thyroid;
(ii) Male or female breast;
(iii)Esophagus;
(iv) Stomach;
(v) Pharynx – The pharynx has 3 parts - nasopharynx, oropharynx and hypopharynx. (The oropharynx includes the soft palate, the base of the tongue, and the tonsils);
(vi) Small intestine;
(vii)Pancreas;
(viii) Bile ducts (includes Ampulla of Vater, a/k/a hepatopancreatic ampulla);
(ix) Gallbladder;
(x) Salivary gland;
(xi) Urinary bladder;
(xii)Brain (malignancies only). The brain is the part of the central nervous system (CNS) contained within the skull, i.e., the intracranial part of the CNS consisting of the cerebrum, cerebellum, brain stem, and diencephalon. (The intracranial endocrine glands and other parts of the CNS, benign and borderline tumors of the brain, and borderline astrocytomas are excluded);
(xiii) Colon (including the rectum);
(xiv) Ovary;
(xv) Liver (except if cirrhosis or hepatitis B is indicated);
(d) Carcinoid Tumors. These tumors are considered primary cancers of the organs in which they are located. If the organ is one on the specified cancer list, the carcinoid tumor may be considered as a specified cancer. A Carcinoid tumor of the organs listed above may be considered as a specified cancer.
Carcinoid syndrome and monoclonal gammopathies of undetermined significance are not currently recognized as malignant conditions. Consequently, these conditions should not be considered as cancers.
The specified diseases designated in this section mean the physiological condition or conditions that are recognized by the National Cancer Institute (NCI) under those names or nomenclature, or under any previously accepted or commonly used names or nomenclature. The DEEOIC will consult with NCI only on issues pertaining to the name or nomenclature of a disease diagnosed at an anatomic location for the purpose of determining whether it constitutes a cancer.
zz. Spouse of a covered employee or covered DOE contractor employee means a wife or husband of that employee who was married to that individual for at least one year immediately before the death of that individual.
aaa. Survivor means:
(1) For claims under Part B, a surviving spouse, child, parent, grandchild and grandparent of a deceased covered employee; or
(2) For claims under Part E, a surviving spouse and covered child of a deceased covered DOE contractor employee.
bbb. Time of injury means:
(1) In regard to a claim arising out of exposure to beryllium or silica, the last date on which a covered Part B employee was exposed to such substance in the performance of duty as specified in sections 7384n(a) or 7384r(c); or
(2) In regard to a claim arising out of exposure to radiation under Part B, the last date on which a covered Part B employee was exposed to radiation in the performance of duty as specified in section 7384n(b); or
In the case of a member of the SEC under Part B, the last date on which the member of the SEC was employed at the DOE facility or the atomic weapons employer facility at which the member was exposed to radiation; or
(3) In regard to a claim arising out of exposure to a toxic substance under Part E, the last date on which a covered Part E employee was employed at the DOE facility or RECA section 5 facility, as appropriate, at which the exposure took place.
ccc. Toxic substance means any material that has the potential to cause illness or death because of its radioactive, chemical, or biological nature.
ddd. Uncertainty Distribution is a statistical term meaning a range of discrete or continuous values arrayed around a central estimate, where each value is assigned a probability of being correct.
eee. Wage-Loss is based on the number of calendar years that the covered DOE contractor employee was unable to work or sustained a reduction in wages as a result of the covered illness. Wage-loss compensation is payable for the years of lost wages occurring prior to the covered DOE contractor employee’s normal Social Security retirement age, as determined by his or her date of birth. This term should only be used in reference to claims under Part E.
fff. Workday means a single work shift, whether or not it occurred on more than one calendar day.
ggg. Worst-Case Assumption is a term used to describe a type of assumption used in certain instances for certain dose reconstructions. It assigns the highest reasonably possible value to a radiation dose of a covered employee based on reliable science, documented experience, and relevant data.