Roundup and multiple myeloma (MM) and non-Hodgkin’s lymphoma (NHL)October 7, 2023
Coordinating State Workers’ Compensation BenefitsOctober 8, 2023
EEOICPA defines some exposure presumptions in exhibit 15-4 of the procedure manual which make it easier for claimants to get compensation without having to prove the causation of their illnesses. These EEOICPA exposure and causation presumptions are periodically updated based on new scientific evidence and depend on the nature, frequency, and duration of exposure. They are also based on environmental health, industrial hygiene knowledge, and evidence among other work-related experiences.
If all the criteria are met as per the existing presumption, CEs apply them without the need for an industrial hygiene opinion on the level of exposure. Also, an IH opinion can only be sought if there is additional substantive evidence suggesting a higher level of exposure than that presumed.
Part E of the EEOICPA exposure and causation presumptions illnesses
Angiosarcoma also known as hemangiosarcoma of the liver is a form of cancer that forms within lymph vessels and blood vessel lining, and it causes lesions on the skin. The causation criteria for angiosarcoma presumption are as follows:
- The claimant’s medical file must show an angiosarcoma diagnosis.
- The employees must have been working for 250 days in a position where they were exposed to polyvinyl chloride, which can be determined through an IH.
- The illness must have been diagnosed at least 20 years after polyvinyl chloride exposure in a covered facility.
If the case has polyvinyl chloride exposure and the employee has been diagnosed with angiosarcoma/ hemangiosarcoma of the liver but does not meet all the above causation presumption requirements, the CE should pursue a medical opinion of the causation and an IH referral on the nature, extend and duration of polyvinyl chloride exposure.
This is a serious medical condition that affects the bone marrow interfering with its ability to make enough blood cells and can be associated with exposure to ionizing radiation. The criteria for the presumption for persons with the condition include:
- Medical evidence for the diagnosis
- A documented incident where the employee was exposed to high accidental radiation of at least 125 rem.
- The symptoms for the illness must have presented within six months following the exposure incident
For claimants exposed to radiation and diagnosed with aplastic anemia supported by evidence of the exposure incident, the case should be reviewed for causation determination by the National Office Health Physicist. If some documentation is missing, and the employee has been treated with radiation therapy for a recognized cancer, the CE should consider the case as a consequential illness.
Asbestos (exposure presumption)
Asbestos has been present in all DOE facilities for many years. EEOICPA exposure and causation presumptions for asbestos exposure through December 31 1995 apply to certain occupations, which include:
- Vehicle maintenance mechanics
- Carpenter, Drywaller, and Plasterer
- Demolition technician and Laborer
- Electrical mechanic, Electrician, and Floor covering worker
- Firefighters and their Supervisors
- Furnace related occupations
- Glass related occupations
- Grinder operators and concrete grinding occupations
- Heating, Ventilation, and Air Conditioning occupations
- Insulation workers and traders
- Ironworker and Ironworker-rigger
- Maintenance Mechanic and Electrician
- Brick & tile mason, and Concrete and terrazzo workers
- Heavy equipment operators and Operating Engineers
- Pipefitter and Plumbers
- Precision Instrument and Equipment Repairers
- Sheet metal mechanic and Sheet metal fabricator/installer
- Stationary Engineers
- Uranium Miner/Miller
For exposed employees who do not work in these occupations, the CE should assume they have some level of asbestos exposure. The cases should also be referred to an IH to determine the level, extent, nature, and frequency of exposure, and if the exposure was significant or not significant (high, moderate, or low) or (incidental – occurring in passing only).
Asbestosis is a long-term lung condition associated with asbestos exposure. Part E causation is presumed for asbestosis if the employee is been diagnosed with the illness after working in a position with a risk of asbestos exposure for at least 250 days. The exposure can be determined through an existing asbestos exposure presumption or IH assessment. The diagnosis must have been made at least ten years after the first asbestos exposure in a covered employment.
If an employee diagnosed with asbestosis does not meet the criterion, the CE should seek an IH referral and medical opinion on the causation.
Presumed asthmatic conditions include occupational asthma, which occurs from a work-related agent, and asthma which worsens from workplace exposures (work-exacerbated asthma). To determine if the asthma is presumptive, the CE should not apply a toxic substance exposure assessment. Instead, they determine compensability based on the diagnosis or medical evidence from a qualified physician.
For the employee to be eligible for Part E asthma claims, they should have worked in Part E covered employment as a contractor or subcontractor and have been diagnosed with asthma through the recognized medical procedures.
The medical diagnosis should have been made when it is possible to identify intermittent respiratory and physiologic evidence of reversible or variable airway obstruction. It could be through post-bronchodilator reversibility on spirometry or a positive methacholine challenge test. The physician can also examine the patient or rely on the employee’s medical history and medical documents to make the diagnosis.
If the employee meets the described criteria, a qualified physician who diagnosed the patient with the condition after a period of covered employment should provide evidence from their examination that the asthma resulted from occupational exposure to a toxic substance “at least as likely as not” a significant factor in causing, contributing to or aggravating the condition. The physician should also provide a detailed explanation of the toxic substance that likely led to or worsened the condition. The CE can seek further information from the treating physician or a CMC‘s opinion based on the relevant medical evidence collected, among other necessary employment exposure details.
EEOICPA exposure and causation presumptions for bladder cancer apply if the employee has a bladder cancer diagnosis, after working in a covered facility for at least one year. Bladder cancer occurs from exposure to certain toxic material, which the CE must establish, and they include:
- Direct black – a Benzidine-based azo dye used in DOE for research and laboratory activities
- MOCA- a chemical used to produce polyurethane for the manufacture of plastics, adhesives, and epoxy)
- Benzo(a)pyrene- extensively for inhalation studies used at the Lovelace Respiratory Research Institute, where participants are often exposed. Other areas of exposure include firefighting, roofing, etc
- O-Toluidine- commonly used in laboratory activities.
- Benzidine- used in the production of dyes and painting and can be inhaled, absorbed through the skin, eyes, or ingestion. Its production was banned by OSHA in 1973 but it is imported in small quantities for making benzidine-based dyes.
The presumption applies to employees who worked at covered facilities where these chemicals were produced or widely used and later diagnosed with bladder cancer, as opined by an IH
Chronic Obstructive Pulmonary Disease (COPD)
The presumption for Part E causation applies to employees of DOE-covered facilities who are diagnosed with COPD from employment exposure to asbestos. The employee must have worked in a position with significant exposure for 20 years before December 31, 1995. Some labor categories are recognized in the EEOICPA exposure and causation presumptions as listed in the asbestos presumption above.
An IH can also provide case-specific evidence of significant 20-year asbestos exposure related to the employee’s occupation. COPD diagnosis should have been made 20 years after the initial asbestos.
Criteria for chronic silicosis EEOICPA exposure and causation presumptions include employee medical diagnosis after working in a position with a risk of exposure to silica dust or crystalline silicon dioxide for at least 180 days. Exposure can be determined by an IH and there should be a ten-year lapse after exposure and the onset of the disease.
COVID-19 as a consequential illness
In this presumption, DEEOIC recognizes a physician-diagnosed Covid 19 as a part of a covered illness or consequential illness to a primary Part B occupational illness identified by the CDC as a risk factor for severe covid 19. CDC has listed underlying conditions that put one at an increased risk of developing severe covid 19 symptoms.
For the covid 19 to be presumptive as a consequential illness, DEEOIC has to verify that the claimant’s primary Part B or E illness is listed by the CDC as a severe COVID-risk factor. Eligibility begins on the date of COVID-19 diagnosis. Claims that don’t meet this eligibility are not presumptive and will require the opinion of the claimant’s physician or CMC to establish that Covid 19 was a consequential illness of the primary Part B or E illness.
Ten-year exposure to certain organic solvents and noise levels of above 85 decibels is associated with bilateral sensorineural hearing loss. This form of hearing loss is presumed under part E, however, hearing loss from noise without toxic exposure is not covered since noise is not considered a toxic substance.
The criteria for hearing loss presumption include a bilateral sensorineural hearing loss medical diagnosis, but not conductive hearing loss. There should also be evidence of ten-year employment-related exposure to certain chemicals, including Carbon Disulfide, Ethyl Benzene, Methyl Ethyl Ketone, Methyl Isobutyl Ketone, N-hexane, Styrene, Toluene, Trichloroethylene, and Xylene. The CE can determine exposure from the employee’s records provided in the case files or through the appropriate SEM search filters relating to the employee’s work. In some cases, the CE may require the help of DEEOIC IH to assess the employee’s exposure to the listed toxins.
For an employee to qualify for this presumption they must have served ten consecutive years in a role where they were potentially exposed to a highly toxic substance before 1990 at jobs believed to have noise exceeding 85 decibels.
These jobs include Boilermaker, Chemical Operator, Chemist, Electricians, Electroplater, Auto Mechanic, Security Officer and firearm cleaning activities, Instrument Technician, Janitor, Laboratory Analyst/Aide, Laboratory Technician, Lubricator, Machinist, Maintenance Mechanic, Millwright, Operator with potential for solvent exposure, Painter, Pipefitter, Printer, Refrigeration /HVAC Mechanic, Sheet Metal Worker and Utility Operators.
If the work is not listed here the CE may have to conduct a SEM search. Where SEM is not fruitful, they may refer to the SEM mailbox for the SEM officials to verify the claims from their documentation. The other option is through an IH referral, which reviews the submitted evidence and determines if the employee’s occupation is equivalent.
Once the CE has reviewed the case evidence, they can determine if the employee had a consecutive ten-year exposure to a toxic substance and refer the claim to an IH expert to determine if the claimant was exposed to noise levels exceeding 85 decibels.
Claims that do not meet the criteria described here do not qualify for presumption. However, the CE communicates with the claimant about their claim status and the option they have of challenging the DEEOIC Hearing Loss Standard through supporting probative epidemiological data. Once the claimant produces satisfactory research and scientific evidence, the CE may refer the case to the National Office MHSU for evaluation and consideration.
Presumptions for kidney cancer include a medical diagnosis for the disease, and a work period of five consecutive years in a position with trichloroethylene (TCE) exposure before 1990 when trichloroethylene was widely used for vapor degreasing and metalworking. The employee must have been diagnosed with the disease 20 years after the initial TCE work exposure.
Facilities recognized in this presumption include: Area IV of the Santa Susana Field Lab (ETEC), East and West Argonne National Lab, Brookhaven National Lab, Dana Heavy Water Plant, Dayton Project, Electro Metallurgical, Feed Materials Production Center (Fernald), Fermi National Accelerator Laboratory, General Electric Company in Ohio, Hanford/PNNL, High Energy Rate Forging Facility, Idaho National Lab, Iowa Ordnance Plant, Kansas City Plant, Lawrence Berkeley National Lab, Lawrence Livermore National Lab, Los Alamos National Lab, Mallinckrodt Chemical Co., Destrehan Street Facility, Mound Plant, Nevada Test Site, Oak Ridge GDP (K-25), Oak Ridge National Lab, Paducah GDP, Pantex Plant, Pinellas Plant, Portsmouth GDP, Reduction Pilot Plant (Huntington), Rocky Flats Plant, Sandia National Lab-Albuquerque, Sandia National Lab-Livermore, Savannah River Site, South Albuquerque Works, Stanford Linear Accelerator Center, Tonopah Test Range, Weldon Spring Plant at Mallinckrodt, West Valley Demonstration Project and Y-12 Plant
Cases that do not meet these criteria are referred to an IH expert and require the opinion of a medical expert on the causation.
For an employee to qualify for laryngeal cancer, they must have evidence of the diagnosis, made at least 15 years after the initial asbestos exposure. They also must have served in a position with asbestos exposure for at least 250 days, which can be determined through an IH assessment. If all the criteria are not met, the CE should seek the help of an IH and a causation medical opinion.
For leukemia presumption, the employee must have been diagnosed with the condition at least 365 days after the initial benzene exposure. The claimant must have served in a position with benzene exposure for at least 250 days, which can be determined through IH expert assessment. Claims that don’t meet these requirements are referred for IH assessment and to medical experts for causation.
Presumption for lung cancer requires the claimant to have been diagnosed with lung cancer at least 15 years after the initial asbestos exposure. Also, the employee must have worked in a position with asbestos exposure for at least 250 days, which can be determined through the defined asbestos presumption or through the IH assessment. If the criteria are not met, the claim can be referred to IH for asbestos exposure assessment and may require a medical opinion on causation.
Meningioma is presumed in cases where an employee diagnosed with the illness had been exposed to ionizing radiation of at least 1 sievert (SV). These cases must be reviewed by a National Office health physicist to establish the radiation levels.
Mesothelioma is presumed in employees suffering from the illness who have been exposed to asbestos at a covered facility for at least 30 days. The employee must have been diagnosed at least 15 years after the initial asbestos exposure, and the exposure can be determined through an IH assessment or based on the asbestos presumption. Cases that don’t meet the presumption requirements may require an IH assessment and a medical opinion.
EEOICPA exposure and causation presumptions for non-Hodgkin’s lymphoma require the claimant to have a medical diagnosis for the disease. The employee must also have worked in a position where they were at risk of significant exposure to lindane (1,2,3,4,5,6- Hexachlorocyclohexane) for at least 56 days and diagnosis made 20 years after the initial exposure. Or the claimant must have worked in a position where they might have been exposed to pentachlorophenol for at least two years, and diagnosed with non-Hodgkin’s lymphoma at least ten years after the initial exposure.
Presumption for ovarian cancer requires the employee diagnosed with the disease to have worked in a position with a high risk of asbestos exposure for at least 250 days. The diagnosis must have been made at least 15 years after the initial exposure. Cases that do not meet the criteria may require the assessment of an IH expert and a causation opinion from a qualified doctor.
Parkinsonism, Parkinson’s disease (PD), Paralysis Agitans, and Hemiparkinsonism follow the same claim development and are related to toxic exposure. The CE SEM searches to identify the toxin linked to the illness. Parkinsonism presumption requires a medical diagnosis for the illness and evidence of exposure to carbon monoxide associated with the onset of the illness. Cases that have some indicators of exposure are referred to an IH for assessment.
Also, the CE should review the file for evidence of exposure, based on the following criteria:
- An acute CO exposure incident, where the claimant lost consciousness
- Documented CO exposure incident with possible brain injury
- Documented lab tests of the blood gas levels that show a risk of brain injury (Carboxyhemoglobin of 20% or higher)or admission records related to CO exposure.
Toxic substances linked to Parkinsonism include Carbon monoxide, 1018 Steel, Alumel, Aluminum 3S alloy, Galvanized steel, Hastelloy, Kovar, Tool steel, Uranium manganese alloy, manganese, Manganese II chloride, Potassium permanganate. These toxins can be inhaled at the workplace by people working in the heating, mining, and machining of these toxins.
EEOICPA exposure and causation presumption for pleural plaques to apply the case must meet certain requirements. The diagnosed employee must have been working in a position with a high risk of asbestos exposure for 250 days. The exposure can be determined by an IH, and diagnosis must have been made at least ten years after the initial exposure. If the case does not meet the criteria, it should be assessed by an IH and referred to a medical expert for the establishment of causation.
Exposure to ionizing energy may lead to cataracts. In this presumption, the employee diagnosed with cataracts must have medical evidence of the diagnosis and must have been accidentally exposed to radiation of 500 to 800 rem on their eye lens. The event of the exposure must also be documented, and the diagnosis must have been made within a year of exposure. If there is evidence that a cataract-diagnosed employee was exposed to ionizing energy, but they don’t qualify for presumption, the case should be referred to the National Office Health Physicist for a causation assessment. Some cases can also be treated as a possible consequential illness for cancer patient employees treated with radiation therapy.
Acute Radiation Sickness EEOICPA Exposure and Causation Presumptions
This form of illness may occur from exposure to ionizing energy. For the presumption to apply, the employee must have evidence of the diagnosis and a documented incident of exposure to ionizing energy of 100-200 rem. The claimant must also have been diagnosed with the condition within two weeks of exposure, and the exposure should be documented accordingly. If the case does not qualify for this presumption, and there is documented exposure, it must be referred to the National Office of Health Physicists for determination. Cases, where the patient was treated with radiation therapy for an accepted cancer, are treated as consequential illnesses.