PFAS at Yakima Training Centre, WashingtonOctober 11, 2023
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) made the following changes to the publication of the Federal (EEOICPA) Procedure Manual (PM) in the latest version 7.1 (v7.1) released on March 15, 2023. The DEEOIC Procedure Manual 2023 Changes appear as follows:
Chapter 11 Initial Development
Ch. 11.7c has been updated to reference relevant websites for each Former Worker Program (FWP) that can assist with collecting claim evidence. In the previous procedure manual, CEs would get claimant information from the DEEOIC-listed FWP POCs, prepare and mail them a package that includes a cover letter, a letter to the FWP, a cover memo, Form EE-1 or EE-2, and EE-3.
In the DEEOIC Procedure Manual 2023 Changes, the DEEOIC provides various websites where CEs can find information and contact FWPs directly to request the needed records. There are two nationwide and four regional FWPs. Some covered facilities are serviced by nationwide and regional FWPs, requiring the claims staff to coordinate with national and regional FWPs for effective information collection and identification.
There are two nationwide FWPs: the National Supplemental Screening Program (NSSP) and the Building Trades National Medical Screening Program (BTMed).
National Supplemental Screening Program (NSSP) FWPs include:
- Argonne National Laboratory
- Fermi National Accelerator Laboratory
- Hanford Site
- Kansas City National Security Campus
- Princeton Plasma Physics Laboratory
- Pinellas Plant, Rocky Flats Plant
- Savannah River Site
Building Trades National Medical Screening Program (BTMed) FWPs are:
- Amchitka Island
- De Soto Avenue Facility
- Downey Facility
- Area IV, Santa Susana Field Lab;
- Canoga Avenue Facility;
- Rocky Flats; Pinellas Plant;
- Savannah River Site;
- Argonne National Laboratories-West;
- Idaho National Laboratory;
- Kansas City Plant;
- Paducah Gaseous Diffusion Plant;
- Adrian Facility (Bridgeport Brass);
- Weldon Spring Site;
- Yucca Mountain Nuclear Waste Repository;
- Waste Isolation Pilot Plant;
- Brookhaven National Laboratory;
- Knolls Atomic Power Laboratory;
- West Valley Demonstration Project;
- Extrusion Plant (Reactive Metals-Ashtabula);
- Brush Luckey;
- Battelle Laboratories-King Avenue and West Jefferson;
- Portsmouth Gaseous Diffusion Plant;
- Mound Plant; GE Evendale;
- Feed Materials Production Center;
- Albany Research Center;
- Shippingport Atomic Power Plant;
- National Energy Technology Laboratories;
- Oak Ridge Reservation (K-25, X-10, and Y-12);
- Hanford Nuclear Reservation;
- Huntington Pilot Plant
There are four regional FWPs and they include:
- Los Alamos and Sandia National Laboratories
- Worker Health Protection Program (WHPP) -with several FWPs
- Iowa Army Ammunition Plant (IAAP) and Ames Laboratory
Section 11.7d advises CEs to review the FWP webpage to identify the appropriate POC(s). The contact details are often listed at the bottom of each DOE website listed above. If not listed on the site, the claims staff can call to request the appropriate contact’s name and mailing information. After obtaining the information, the CE prepares and mails a package that includes a cover letter, a letter to the FWP, a cover memo, Form EE-1 or EE-2, and EE-3 to the designated POC.
Chapter 13 – Establishing Covered Employment
The first paragraph of Ch. 13.3 has been updated to instruct claims staff to cross-reference both the Department of Energy (DOE) Covered Facilities Database and the Employment Pathways Overview Document (EPOD) as part of their employment comparison, as follows;
When comparing the initially claimed employment to the covered facilities database– The CE assesses covered employment by checking the EE-3 Employment History form for claimed employment corresponding with a covered AWE, Beryllium Vendor, or DOE facility from the DOE EEOICPA Covered Facilities Database. The link to the database is often listed on the DEEOIC public website. Covered facilities are also available at the EPOD. Alternatively, the CE can get the information through other claimants’ written submissions.
As updated in v7.1, the covered facilities database can be located here. CEs should cross reference the database information with that on the EPOD and report any discrepancy to local management and EPOD POC.
Chapter 15 – Establishing Toxic Substance Exposure and Causation
According to the DEEOIC Procedure Manual 2023 Changes, Ch.15.11e now incorporates information on EEOICPA Bulletin No. 23-02, Industrial Hygiene Reporting of Exposure Levels. The previous version broadly separated exposure levels into either significant or incidental. Significant exposures were categorized as low, medium, and high.
In the updated PM v7.1, DEEOIC IH staff should explain their analysis of the available evidence to assign a characterization of exposure for each targeted toxic substance as incidental, significant, or more than incidental but less than significant.
Incidental is also described as “in passing only.” It is the lowest reasonable level of contact with a toxic substance, absent a finding of no exposure. It occurs intermittently or infrequently, not connected to performing a particular job.
Significant exposure is related to the work performed by the employee at some interval of routine frequency and intensity by inhalation, ingestion, or absorption.
After reviewing the available evidence, the IH will categorize significant exposure further as high, moderate, or low based on:
- The employee’s type of work and labor classification, if they have exposure monitoring data, work frequency, and exposure proximity.
- Information about workplace conditions, such as using personal protective equipment or workplace mitigation strategies to reduce health risks.
After considering all the factors, IH applies his/her professional knowledge and judgment to assign significance.
More than incidental but less than significant describes incidences where the IH interprets the evidence and concludes that the employee duties led to contact with a toxic substance, but there is no documented evidence indicating work exposure, and the claimant has not provided substantive evidence of significant exposure or the evidence provides documentation of proper safety mitigation parameters, such as the use of PPE).
Exhibit 15-4, Exposure and Causation Presumptions with Development Guidance for Certain Conditions, now incorporates EEOICPA Bulletin No. 23-01, Causal Presumption for Chronic Silicosis Under Part E, under the new Section 8. The subsequent sections of Exhibit 15-4 have been renumbered.
Chapter 16 – Developing and Weighing Medical Evidence
According to DEEOIC Procedure Manual 2023 Changes, Ch. 16.9 includes a formal procedural requirement to upload any Contract Medical Consultant (CMC) referral into the Office of Workers’ Compensation Imaging System (OIS), thus becoming part of the claim record.
The DEEOIC uses reviews by a CMC to coordinate referrals of cases to qualified medical specialists. A CMC is a contracted physician who reviews case records for opinions and answers medical questions. They also clarify claims situations without pertinent medical evidence supporting the claim, without validating the claimant’s chosen treating physician’s probative input. The CMC medical opinions are essential to resolving claims of ambiguous causation, lacking medical evidence, and unique exposures.
As updated in the latest version 7.1 Ch. 16.9, when a CE, HR, or MBE makes any CMC referral (whether the originator is from field operations, FAB, or the MBAU), all the referral package documentation must be uploaded into OIS as a single PDF file. The referral package contains the referral e-mail, service referral form, SOAF, the questions posed to the CMC, and the relevant documents included for the CMC consideration, such as relevant medical records and IH opinions. All these items should be merged into a single PDF file and uploaded to OIS on the same date the referral is sent to the CMC and indexed clearly as the material submitted to the CMC for consideration.
Ch. 16.11b now identifies the items making up a CMC referral package or those to be uploaded into OIS. The CE should scan and create an electronic image of the copy of the completed referral package as a single PDF file and attach the file to the referral email. The package to be scanned and uploaded into the imaged case file in OIS includes the referral e-mail, service referral form, SOAF, questions, and all documents submitted to the CMC for review.
Chapter 17 – Development of Radiogenic Cancer Claims
The updated Ch. 17.6a-b only claimed primary cancers are included in the National Institute for Occupational Safety and Health (NIOSH) Referral Summary Document (NRSD).
In Ch. 17.6, Non-SEC Cancers and Dose Reconstruction– any primary cancer not specified is non-SEC cancer. If the employee is diagnosed with non-SEC cancer and covered employment, the CE prepares the NIOSH claim for dose reconstruction. There is a valid claim form for each cancer, and CEs should only report a secondary cancer in the absence of the primary cancer.
No changes have been made to Ch. 17.6a Claimant Not SEC Member– that states- when the employee is not a SEC member or the employment was outside the designated SEC period or did not work the necessary workdays at an SEC site, the CE forwards the claim to NIOSH for dose reconstruction, after the confirmation of a cancer diagnosis and covered employment.
Under Ch. 17.6b, SEC Case with Award– for SEC cases awarded for a specified cancer, any additional claimed non-SEC cancers must be forwarded to NIOSH for dose reconstruction to determine their non-SEC primary cancers eligibility for medical benefits. In these SEC cases, as updated in the latest version, all claimed cancers are listed on the NIOSH NRSD.
According to the new procedure manual, Ch. 17.7, only claimed primary cancers are included on the NRSD in NIOSH referrals.
Preparing Non-SEC Cancer Claim Files for Referral to NIOSH– the NRSD (Exhibit 17-1) is a tabular form containing the medical and employment information the CE accepts as factual. It provides NIOSH with the necessary information for dose reconstruction. The revised 7.1 version further explains that CEs should not refer cancer conditions to NIOSH before receiving properly filed claim forms for the diagnosed cancer. If other unclaimed cancers are discovered in the medical record of an employee or survivor, the CE must notify the claimant of this discovery and advise them to submit Form EE-1/2 claiming the newly discovered cancer(s) for consideration.
Additional cancers may positively contribute to the POC calculation under Part B, which impacts the adjudication outcome under Part E. For survivors, if the CE concludes that one of the cancers included in a POC calculation of at least 50% contributed to the employee’s death, survivors may be eligible for Part E compensation.
In the latest version, 7.1, Exhibit 17-2, Instructions for Completing the NRSD includes the website address of the DOE Office of Worker Advocacy (OWA) Covered Facility List.
Exhibit 17-3, NIOSH Referral Letter to Claimant, includes the new guidelines as updated in Ch. 17.7, requiring claimants to submit a new signed Form EE-1/2 to consider each additional cancer.
Chapter 18 – Eligibility Criteria for Non-Cancerous Conditions
DEEOIC Procedure Manual 2023 Changes in Ch. 18.12a (2) incorporates EEOICPA Bulletin No. 23-04, Silicosis Employment and Exposure Criteria Under Part B for the Nevada Test Site.
Ch. 18.12a (2) Now states Present for an aggregate of at least 250 workdays during the mining of tunnels at a DOE facility located in Nevada or Alaska for tests or experiments related to an atomic weapon (Part B claims only). Since the October 1992 unilateral moratorium on nuclear weapons testing went into effect, a stockpile stewardship program that involves the mining of tunnels related to noncritical atomic weapons testing and experiments has continued through the present day at the Nevada Test Site.
Ch. 18.12c-d is now updated to incorporate EEOCIPA Bulletin No. 23-01, Causal Presumption for Chronic Silicosis Under Part E.
Updated Ch. 18.12c Silicosis Employment and Exposure Criteria, Part E– The provisions for separate chronic silicosis treatment outlined in §7384r of the Act for Part B do not apply to Part E. Unless a Part E contractor qualifies for coverage based on the acceptance of a Part B claim for chronic silicosis, the CE proceeds to evaluate the claim similar to Part E claim. However, the employee must be verified as a DOE contractor or subcontractor employee with potential exposure to silica. The CE must establish potential exposure by carefully examining relevant case evidence, such as information communicated in the DAR records, DOE FWP records, SEM, employment records, OHQ, affidavits, and claimant’s written submissions. With the establishment of potential exposure to silica, the CE may refer the case to an Industrial Hygienist (IH) to characterize the level, extent, and frequency of exposure. CEs should assess exposure for other applicable Part E presumptive causation standards, including chronic silicosis.
Ch. 18.12 d Medical Evidence, Part E– defines silicosis as a nonmalignant respiratory disease diagnosed with different characterizations and references the nature of the disease as acute, accelerated, chronic, or complicated. Like other Part E illnesses, the medical evidence must contain a written diagnosis for silicosis with initial onset dates. Diagnosis for silicosis is based on a qualified physician’s interpretation of available clinical or diagnostic evidence. CEs can obtain the evidence from the claimant or their physician or refer the issue to a CMC.
To determine if the silicosis is under Part E, absent the acceptance of the claim for the illness under Part B, the CE should assess any presumptive causal standard in program procedure or obtain a medical opinion from a physician that documents that it is “at least as likely as not” that exposure to a toxic substance at a DOE facility was a significant factor in aggravating, contributing to, or causing the employee’s silicosis and it must be “at least as likely as not” that the exposure to such toxic substance was related to employment at a DOE facility.
If presumptive standards don’t apply, and medical evidence is needed, the CE should allow the claimant to obtain such evidence from a physician of their choice before referring them to a CMC. The CE then weighs the physician’s opinion to determine if it applies to the program procedure.
Chapter 21 – Impairment Ratings
Ch. 21.5b (3)(c) in DEEOIC Procedure Manual 2023 Changes addresses conflicting claimant requests.
Employees can only choose one physician or CMC to conduct an impairment evaluation. If the EN-11A form doesn’t state whom the employee would like to perform the evaluation, or in case of a discrepancy, such as multiple EN-11A forms, the CE should call the employee for clarification. The CE should also advise the employee to write the matter, sign and submit it to the DEEOIC CMR address.
Chapter 24 – Recommended Decisions
Ch. 24.7a (5) now requires recommended decision (RD) signature blocks to include an issuance date.
It states that the signature block must bear the name, job title, location, and office of whoever prepared the recommendation and the issuance date.
Chapter 29 – Ancillary Medical Benefits
Ch. 29.5n now addresses an exception for Food and Drug Administration (FDA) approved cannabis-related drug products.
The Marijuana (cannabis) Reimbursement Policy– states that marijuana or cannabis containing the active ingredient tetrahydrocannabinol (THC), is considered a Schedule I controlled substance by the U.S. Drug Enforcement Administration (DEA), thus not eligible for payment or reimbursement. FDA doesn’t approve cannabis marketing applications for medicinal purposes. However, there are FDA-approved derived or synthetic cannabis drugs available on prescription from licensed healthcare providers. DEEOIC may reimburse for these and other FDA-approved products if prescribed by a licensed physician, for an accepted illness that is accompanied by medical evidence.
Chapter 30 – Home and Residential Health Care
According to DEEOIC Procedure Manual 2023 Changes, Exhibit 30-4, Billing Codes in the procedure manual v7.1 incorporates EEOICPA Bulletin No. 23-03, New Billing Authorization Codes for Home and Residential Health Care (HRHC).
Chapter 33 – Compensation Payments
Ch. 33.3 has been updated to include the electronic submission of an EN-20 electronically Energy Document Portal (EDP).
Processing the EN-20– after issuing FD awarding compensation, the FAB should enter the AOP amount in ECS, which generates the EN-20 (Acceptance of Payment Form) and the EE-20 award letter. FAB mails these documents to the claimant, along with the FD. ECS automatically assigns an AOP with a sent date corresponding with the FD issuance date. The appropriate staff person will electronically image (a/k/a bronze) the cover letter, FD, and a copy of the EN/EE-20 for viewing in OIS as part of the electronic document retention process. If the claimant requests another EN-20, they can send them a photocopy or facsimile. However, for signatures, the EN-20 copy must be returned by mail, originally signed by the payee, without any alterations to the information.
Claimants can return the completed Form EN-20 to the CMR as instructed by FD Cover Letter. The other option is for the claimant to complete, date, and electronically sign Form EN-20 via the Energy Document Portal (EDP), which is faster. If the EN-20 is returned to an RC, the RC staff should forward the form via mail to the CMR. When a completed EN-20 arrives at the DO, the DO mailroom must upload the form into OIS. FOs should ensure that the DO mailroom retains the hardcopy Form EN-20 as per the agency record retention guidelines. DEEOIC keeps the imaged version of Form EN-20 permanently in OIS.
Claimants should return the completed Form EN-20 to the CMR address or submit it through the EDP, as the FD Cover Letter instructed. If a claimant or AR, inadvertently returns an EN-20 to a DEEOIC RC, the RC should mail the form to the CMR. If a claimant mails completed EN-20 to a DO address, the DO mailroom should upload an electronic image of the form into OIS and index it by Category then forward it to DO fiscal operations, who maintain the hardcopy form according to their agency record retention and disposal policies. The OIS permanently maintains the imaged version.