Examples of Rework Request


These examples do not cover all scenarios.  Please use your professional judgment in conveying the most accurate and pertinent information necessary concerning how the DR was performed, and what modifications need to be made.  Also, ensure that the appropriate ICD code with the condition description is included.



1. Additional cancer reported to the DO (employment history  unchanged):


NIOSH DR for Karen Smith, 111-11-1111, (NIOSH 3450).  Ms. Smith was employed at the Paducah Gaseous Diffusion Plant for several periods between 09/28/55 to 12/28/79.  The DR was performed for two cancers:  BCC (left preaurical area), diagnosed on 01/28/02; and SCC in-situ right ear, diagnosed on 9/17/02.  The POC was 38.14%.


Subsequently, the DO received evidence of an additional verified cancer:  SCC (right posterior inferior pinna), diagnosed on 07/31/03.


2. Cancers were incorrectly reported in the NRSD (employment history has not changed):


John M. Jones, 222-22-2222, (NIOSH 5678).  Mr. Jones was employed at the Nevada Test Site from (09/01/65 to 03/3/73) and (11/19/79 to 09/30/87).  The DR was performed for two cancers: 


·   Prostate cancer, diagnosed on 01/01/98

·   Adenocarcinoma, Barrett’s Esophagus, diagnosed on 11/15/01


The POC was 36.39%.  We reviewed the case file and determined that the prostate diagnosis date and the Barrett’s Esophageal cancer were incorrectly reported.  The correct cancer information follows:


1.  Prostate cancer, diagnosed on 04/08/98 - (diagnosis 4 months later than reported)

2.  Adenocarcinoma, lower (distal) esophagus, diagnosed  on 11/15/01

3. Corrections to employment  (cancer unchanged)


Mary Smith, 333-33-3333 (NIOSH 91264).  Ms. Smith worked at NTS for four periods from the 1950s to the 1970s.  The DR was performed for astrocytoma, diagnosed on 03/19/77.  Based on the employment used in the DR, the POC was 35.57%.


The DR used the following NTS employment dates, as reported in the NRSD:   


1.  04/24/57 – 06/24/57

2.  07/09/60 – 01/18/63

3.  01/31/63 – 07/19/65

4.  07/26/55 – 02/01/74


Subsequent to submitting the NRSD report, we received additional employment evidence to determine that employment period 4 above, should actually be 07/26/65 - 02/01/74, resulting in about 5 years less verified employment than represented in the current DR.


4. Correction to cancers and employment history: 


Tom Doe, 444-44-4444 (NIOSH 23679).  The DO reported that Mr. Doe was employed at the Tonopah Test Range and Nevada Test Site (NTS) from 03/27/87 to 01/22/91.  The DR was performed for esophageal cancer, diagnosed on 03/26/93.  The POC was 2.35%. 


We reviewed the case file and found that the cancer and the employment site and dates reported in the original NRSD were incorrect.  Please replace the originally reported esophageal cancer, with the following two cancers: 


·   Squamous cell carcinoma of the right piriform fossa,  diagnosed on 01/31/90

·   Squamous cell carcinoma of the distal esophagus, diagnosed on 03/25/93


In addition, Mr. Doe was on leave without pay as of 01/22/90, although his actual termination date was 01/22/91.  Therefore, the correct employment is:  Solely at NTS (no Tonopah employment) from 03/27/87 to 01/22/90, one less year than originally reported.

5. Correction to reported cancers, and additional cancer (no changes to employment):


DR for James Johnson, 555-55-5555 (NIOSH 0432).  Mr. Johnson was employed at NTS intermittently from 09/07/54 to 12/31/95.  The NRSD reported 4 primary cancer sites for dose reconstruction: two (2) prostate cancers (right and left lobes), and two (2) BCCs, diagnosed in 10/97 and 04/99.  The resultant POC was 51.05%.


Upon further review of the medical evidence, we determined that the two prostate cancers should only be reported as one, as the pathology report for both lobes was reported within the same two weeks, and there is no indication that the two lobes are separate primaries.  We also determined that the 04/99 BCC was a recurrent cancer of the 10/97 BCC and should not be included in the DR.  In addition, we received additional medical evidence of another verified cancer:  SCC (scalp), diagnosed on 06/12/96.


Therefore the DR should be performed for the correct cancers as follows:


1.  Prostate, diagnosed on 10/14/84

2.  BCC (rt cheek), diagnosed on 10/23/97

3.  SCC (scalp), diagnosed on 06/12/96.


6. Deletion of several cancers from a list of multiple cancers (no change in employment):


DR for Pete James, 666-66-6666 (NIOSH 3495).  Mr. James was employed at the Pacific Northwest National Lab from 08/25/69 to 06/28/87.  The DR was performed for eleven (11) cancers.  The POC was 52.1%.


Upon further review of the medical evidence in the case file, we determined that only eight (8) of the original eleven (11) cancers are verifiable.  Below is the list of the 11 initially reported cancers; the three (3) erroneous cancers are identified by strikethrough:   


1.   Seminoma of the R. Testicle, 06/01/77

2.   BCC R. Shoulder, 10/30/97

3.   BCC R. Cheek, 10/30/97

4.   SCC in situ, L. Temple, 02/24/98

5.   SCC in situ, Scalp, 02/24/98

6.   SCC in situ, L. Forearm, 04/24/98

7.   SCC in Situ, L. Dorsal Forearm, 06/23/98

8.   SCC R. Cheek, 11/29/01

9.   BCC L. Chin, 11/29/01

10.  BCC L. Cheek, 02/07/02

11.  SCC in situ, L. Lateral Forearm, 06/30/03


The 8 DOL verified cancers are therefore: 


1.   Seminoma of the R. Testicle, 06/01/77

2.   BCC R. Cheek, 10/30/97

3.   SCC in situ, L. Temple, 02/24/98

4.   SCC in situ, Scalp, 02/24/98

5.   SCC in Situ, L. Dorsal Forearm, 06/23/98

6.   SCC R. Cheek, 11/29/01

7.   BCC L. Chin, 11/29/01

8.   SCC in situ, L. Lateral Forearm, 06/30/03


7. Additional verified employment periods (employment in NRSD correct):


DR for Sam Jones, 777-77-7777 (NIOSH 3254).  The DR was performed for liver cancer, diagnosed on 09/03/87.  The POC was 22%.  The DR Coversheet (dated 06/02/05) notes Mr. Jones’ Hanford employment as: “06/29/54-07/12/77 (eleven periods of employment).”  This is correct based on the employment originally reported in the NRSD by the DO.   


We have subsequently received evidence of additional verified Hanford employment periods: 


1.  01/01/53 to 12/31/53

2.  08/07/53 to 06/28/54

3.  01/30/62 to 04/15/62

4.  01/01/79 to 12/31/79

5.  01/01/80 to 12/31/80