The EEOICPA was passed in 2000. It provides compensation to workers who became ill as a result of their employment manufacturing nuclear weapons in the USA, as well as their spouses, children, and grandchildren.

Are you eligible for compensation? If you or a family member worked at any of the Atomic Weapons Employer (AWE) and Department of Energy (DOE) Covered Facilities listed on this website and became ill, you may be entitled to compensation of up to $400K plus medical benefits. Call EEOICPA Counsel Hugh Stephens at 1-855-548-4494 or fill out our free claim evaluation, We can help even if you’ve already filed, even if your claim was denied!

In these pages, we present general definitions of Illnesses covered by the Act, followed by specific references to the disease from the EEOICPA Procedure Manual, Bulletins, and Final Decisions of the Final Adjudication Board to clarify how these maldies might relate to the Energy Employees Occupational Illness Compensation Program Act.

Urinary Bladder Cancer

 
Below we have collected specific references to urinary bladder cancer from the DEEOIC Procedure Manual, Bulletins, and Final Decisions, to illustrate how this illness is viewed under the EEOICPA.

Bladder Cancer

The bladder is a hollow organ in your lower abdomen that stores urine. Bladder cancer occurs in the lining of the bladder. It is the sixth most common type of cancer in the United States.

Symptoms include

  • Blood in your urine
  • A frequent urge to urinate
  • Pain when you urinate
  • Low back pain

Risk factors for developing bladder cancer include smoking and exposure to certain chemicals in the workplace. People with a family history of bladder cancer or who are older, white, or male have a higher risk.

Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and biologic therapy. Biologic therapy boosts your body’s own ability to fight cancer.

NIH: National Cancer Institute

Procedure Manual

Page 47

uu.  Specified Cancers are listed in Section 30.5(ff) of the regulations.  An employee must be diagnosed with one of these specific types of cancer to be considered eligible for benefits as a member of the Special Exposure Cohort (SEC).  The list of specified cancers, which is derived from section 4(b)(2) of the RECA Amendments of 2000, is as follows:

(5) The following diseases, provided onset was at least five years after first occupational exposure:

(c)  Primary cancer of the:

(xi) Urinary bladder (due to biological and etiological similarities, Ureter cancer and Urethral cancer are included);

Page 176

e. Other Diseases. For the following diseases, onset must have been at least five years after initial exposure during qualifying SEC employment:

(3) Primary cancer of the:

(k) Urinary bladder (including ureter and urethra);

 

Page 292

2. RECA Background.

c. Section 4 of RECA.

(1) Downwinders.

(b) Covered Illnesses: Leukemia (other than chronic lymphocytic leukemia), multiple myeloma, lymphomas (other than Hodgkin’s disease), and primary cancer of the thyroid, male or female breast, esophagus, stomach, pharynx, small intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary bladder, brain, colon, ovary, liver (except if cirrhosis or hepatitis B is indicated), or lung.

 

 

Bulletins

 

Page 753

03-32 Certification by NCI of Certain Primary Cancers

EEOICPA BULLETIN NO.03-32 

Issue Date: August 27, 2003

________________________________________________________________

Effective Date: August 27, 2003

________________________________________________________________

Expiration Date: August 27, 2004

________________________________________________________________

Subject:  Clarification by NCI of Certain Primary Cancers

Background:   20 CFR 30.5 (dd)(6) states that specified cancers are “the physiological condition or conditions that are recognized by the National Cancer Institute under those names or nomenclature, or under any previously accepted or commonly used names or nomenclature.”  The Department of Labor (DOL) forwarded five issues to the National Cancer Institute (NCI) for their review and classification to determine which conditions could be considered as cancers under the EEOICPA.  The five issues sent to NCI were:

– Definition of brain cancer;

–  Cancers of the pleura and the lung;

–  Considering cancer of the urethra as a cancer of the urinary bladder; and

–  Clarification of the terminology related to a diagnosis of polycythemia
vera.

–  Clarification regarding the classification of essential thromobocytosis.

The NCI’s responses to these five issues are as follows.

Regarding the definition of brain cancer, it is appropriate to consider only malignancies of the brain under this category, excluding intracranial endocrine glands and other parts of the central nervous system (CNS).  Under this definition, the brain is the part of the central nervous system contained within the skull, i.e., the intracranial part of the CNS consisting of the cerebrum, cerebellum, brain stem, and diencephalon.  Benign and borderline tumors of the brain would be excluded from this definition, including borderline astrocytomas.

Cancers of the pleura are different from lung cancers.  NCI noted that the tissues of these two organs are different as well as the etiologies of their malignancies.  Accordingly, the pleura and the lung are separate organs and a cancer of the pleura is not lung cancer.

Concerning the urethra, it is contiguous with the urinary bladder and is lined by the same type of urothelial cells as the bladder.  NCI noted that urethral cancer is so similar to bladder cancer from epidemiologic, biologic, and clinical perspectives that it is appropriate to consider cancer of the urethra as a cancer of the urinary bladder.

In Bulletin 03-11, polycythemia rubra vera and its variant polycythemia vera with leukocytosis and thrombocytosis were considered as bone cancer.  We requested clarification as to whether all of the descriptors were necessary in a diagnosis of polycythemia vera.  Leukocytosis and thrombocytosis are supplemental descriptors of polycythemia vera.  NCI noted that a diagnosis of polycythemia vera (also called polycythemia rubra vera, P. vera, primary polycythemia, proliferative polycythemia, spent-phase polycythemia, or primary erythremia) is sufficient by itself to be classified as a malignancy of the bone marrow.

Our final question for clarification involves the classification of essential thrombocytosis.  NCI recognizes essential thrombocytosis as a synonym of essential thrombocythemia.  The current NCI tumor coding book (ICD-O-3) identifies essential thrombocythemia as a malignancy.  It is in the same category as polycythemia vera, which DOL considered to be a bone cancer (see Bulletin 03-11).  Since essential thrombocytosis is a malignancy of the bone marrow, it should be considered as bone cancer.

Reference: Energy Employees Occupational Illness Compensation Program Act of 2000, As Amended, 42 U.S.C. § 7384 et seq., Section 7384l(17); 20 CFR Part 30, Section 30.5 (dd); and letters from A. Fritz, NCI, to P. Turcic, DOL, dated April 28, 2003, and Dr. E. G. Fiegal, NCI, to J. Kotsch, DOL, dated July 28, 2003.

Purpose: To notify District Offices of the clarification of five medical conditions as primary cancers.

Applicability: All staff. 

Actions:

1.  The Claims Examiners (CEs) in the district offices and FAB, as well as the FAB Hearing Representatives (HRs) must consider brain cancer, per EEOICPA Section 7384l(17), to include only malignancies of the brain, excluding intracranial endocrine glands and other parts of the central nervous system (CNS).  Under this definition, the brain is the part of the CNS contained within the skull, i.e., the intracranial part of the CNS consisting of the cerebrum, cerebellum, brain stem, and diencephalon.  Benign and borderline tumors of the brain are excluded from this definition, including borderline astrocytomas.

2.  Cancers of the pleura and the lung are separate organs.  A cancer of the pleura is not lung cancer.  If cancer of the pleura is claimed, the CE/HR does not consider this malignancy as lung cancer, which is a specified cancer (per EEOICPA Section 7384l(17)). 

3.  Cancer of the urethra should be considered by the CE/HR as a cancer of the urinary bladder, which is a specified cancer per EEOICPA Section 7384l(17).

4.  The CE/HR must consider a diagnosis of primary polycythemia vera (also called polycythemia rubra vera, P. vera, primary polycythemia, proliferative polycythemia, spent-phase polycythemia, or primary erythremia) to be bone cancer, which is a specified primary cancer per EEOICPA Section 7384l(17)(B).

5.  The CE/HR must consider essential thrombocytosis or essential thrombocythemia as bone cancer, which is a specified primary cancer per EEOICPA Section 7384l(17)(B).

6.  The CE/HR must look for any other cases of the medical conditions discussed above that could make the claimant eligible for benefits, either as a member of the SEC or through dose reconstruction.  The District Office/FAB must perform a review of the ECMS to determine which cases may have already been denied or sent to NIOSH.  Using the results of that review, the District Office/FAB must pull any cases for review in accordance with this bulletin.  If modification orders are required, the District Office/FAB must send the case to the National Office.

7.  The CE/HR must continue to distinguish these medical conditions from other specified cancers, as appropriate, using the appropriate ICD-9 codes on all paperwork and in ECMS.

For the conditions to be considered as cancer of the urinary bladder, the ICD-9 codes are 189.3 and 188.9 for the urethra and urinary bladder, respectively.

For the conditions to be considered as bone cancers, the ICD-9 code for polycythemia rubra vera and its variant polycythemia vera with leukocytosis and thrombocytosis is 238.4, essential thrombocytosis is 238.7, and essential thrombocythemia is 289.9.  The ICD-9 code for malignant neoplasm of the bone is 170.

Disposition:  Retain until incorporated in the Federal (EEOICPA) Procedure Manual

PETER M. TURCIC

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, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections 

Page 847

02-16 Ureter Cancer as a Specified Primary Cancer

EEOICPA BULLETIN NO.02-16   

Issue Date: July 15, 2002

________________________________________________________________

Effective Date: June 12, 2002

________________________________________________________________

Expiration Date: June 12, 2003

________________________________________________________________

Subject:  Ureter Cancer as a Specified Primary Cancer

Background: The Department of Labor (DOL) recently forwarded the medical evidence in a case file to the National Cancer Institute (NCI) for their review and opinion to determine if, for purposes of being considered a specified cancer under the EEOICPA, ureter cancer can be considered urinary bladder cancer.

The expert medical opinion obtained from the NCI indicates that superficial transitional cell carcinomas of the urinary epithelium are biologically identical wherever they arise within the urinary tract and indeed, they are often multifocal.  The etiologic (including environmental) influences on urothelial carcinogenesis and the tendency of patients who have developed a tumor in one location to develop additional tumors elsewhere in the urinary tract point to the clinical interchangeability of bladder and upper-tract transitional cell tumors.   The NCI expert’s opinion, therefore, is that it is logically inconsistent to treat those that arise within the bladder differently than those arising in the ureter or renal pelvis. 

For these reasons, the NCI expert considers that the ureter tumor belongs in the category with tumors of the urinary bladder.

Reference: Energy Employees Occupational Illness Compensation Program Act of 2000, As Amended, 42 U.S.C. § 7384 et seq., Sections 7384l (14) and (17) and a letter from Dr. R. Kaplan, NCI, to Dr. V. Miller, DOL, dated June 12, 2002, addressing this ureter cancer case (see Docket No.4216-2002).

Purpose: To notify District Offices that ureter cancer is considered a urinary bladder cancer, which is a specified primary cancer for eligible SEC claimants under the EEOICPA.

Applicability: All staff. 

Actions:

  1. The CE should consider ureter cancer as a urinary bladder cancer, which is a specified primary cancer per EEOICPA Section 7384l(17).

  1. The CE should look for any other cases with this type cancer that could be eligible as members of the SEC.  A preliminary review of the ECMS searching for ICD-9 code 189.2 did not find any other employees at SEC sites, however the cancer may have not been entered into ECMS using this code. 

  1. The CE should review all incoming SEC claims for this condition.  If found, and all other relevant SEC criteria have been met, issue a Recommended Decision for acceptance of the claim as urinary bladder cancer.

  1. The CE should continue to distinguish ureter cancer from urinary bladder cancers using the appropriate ICD-9 codes on all paperwork and in ECMS. For example, the ICD-9 code for a malignant neoplasm of the ureter is 189.2, and for the urinary bladder it is 188.

Disposition:  Retain until incorporated in the Federal

(EEOICPA) Procedure Manual

  PETER M. TURCIC

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, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections 

Final Decisions

Page 647

EEOICPA Fin. Dec. No. 4216-2002 (Dep’t of Labor, April 18, 2005)

FINAL DECISION AFTER A REVIEW OF WRITTEN RECORD

This is the decision of the Final Adjudication Branch (FAB) concerning your claim for compensation under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA or the Act).  42 U.S.C. § 7384 et seq. 

Since you filed a letter of objection, but did not specifically request a hearing, a review of the written record was performed, in accordance with 20 C.F.R. § 30.312 of the implementing regulations.  A claimant who receives a recommended denial from the district office is entitled to file objections to the decision, in accordance with 20 C.F.R. § 30.310 of the implementing regulations.  The same section of the regulations provides that in filing objections, the claimant must identify his/her objections as specifically as possible.  In reviewing any objections submitted, under 20 C.F.R. § 30.313 of the implementing regulations, the Final Adjudication Branch will review the written record, any additional evidence or argument submitted by the claimant, and conduct any additional investigation determined to be warranted in the case.

For the reasons set forth below, the FAB accepts your claim for medical benefits for the conditions of bladder cancer to include the carcinoma in situ of the right distal ureter; and reverses the decision of the district office denying entitlement to medical benefits for prostate cancer.  Thus the FAB also accepts your claim for medical benefits for metastatic prostate cancer. 

STATEMENT OF THE CASE

You were previously awarded benefits under the EEOICPA which included a lump sum payment of $150,000, and medical benefits effective July 31, 2001, for bladder cancer (specifically papillary transitional cell carcinoma of the left ureter).

You subsequently submitted a new Form EE-1 (Claim for Benefits under the EEOICPA) on July 21, 2004, which identified bladder cancer diagnosed on May 30, 2004, and prostate cancer diagnosed on June 3, 2004.  You submitted medical evidence which included a surgical pathology consultation from the Mayo Clinic, dated June 12, 2004, based on a biopsy of the bladder on May 30, 2004, and prostate chips from a transurethral resection, obtained on June 3, 2004, that shows final diagnoses of urothelial carcinoma in situ and non-invasive papillary urothelial carcinoma of the urinary bladder; and invasive grade 3 urothelial carcinoma of the prostate chips.  A narrative report from Daniel W. Visscher, M.D., at the Mayo Clinic, dated June 11, 2004, was also submitted in which he discusses that they agree with the assessment that the focus of invasive carcinoma in the prostate chips correspond to a urothelial carcinoma, and the fact that they did not identify any areas of conventional prostatic adenocarcinoma.  A narrative report from Dr. Christopher Schmidt, dated October 21, 2004, noted that you underwent a transurethral resection of the prostate on June 3, 2004, and noted that the pathology report revealed a microscopic focus of invasive urothelial carcinoma.  He noted that in summary, you now had a transitional cell carcinoma that had spread from the bladder and was now invasive into the prostatic ducts. 

You previously had submitted your employment history on Form EE-3, indicating that you worked at the Portsmouth Gaseous Diffusion Plant (GDP) in Piketon, Ohio, from November 1980 to October 1994, and that you did wear a dosimetry badge.  On September 21, 2001, the Department of Energy verified your employment at Portsmouth GDP from November 3, 1980 to November 30, 1994.  The Portsmouth Gaseous Diffusion Plant in Piketon, Ohio is recognized as a Department of Energy facility from 1954 to July 28, 1998; from July 29, 1998 to present (remediation); and from May 2001 to present (cold standby).  See Department of Energy, Office of Worker Advocacy Facilities List. 

On December 22, 2004, the Cleveland district office issued a recommended decision that concluded you are a member of the Special Exposure Cohort, as defined 42 U.S.C. § 7384l(14)(A).  Further, the district office concluded that you were diagnosed with bladder cancer, which is a specified cancer as defined by 42 U.S.C. § 7384l(17)(A).  In addition, the district office concluded that since you were previously compensated in the amount of $150,000, pursuant to 42 U.S.C. § 7384s(a)(1), for left ureter cancer, you are not eligible for an additional payment.  The district office concluded that you are entitled to medical benefits for bladder cancer, effective July 21, 2004, pursuant to 42 U.S.C. § 7384t.  The district office also concluded that they did not receive evidence, required by 20 C.F.R. §§ 30.211 and 30.214, to establish that you had prostate cancer, and thus you are not established as a covered employee with prostate cancer as shown in 42 U.S.C. § 7384l(9). 

OBJECTIONS

On February 2, 2005, the Final Adjudication Branch received your written objection to the recommended decision.  You indicated that you disagreed with the conclusion of law in the recommended decision that the district office did not receive evidence that you had prostate cancer.  You indicated that the bladder cancer had invaded the prostate and that only option was surgery to remove both the bladder and the prostate due to the bladder cancer.  You noted that you had surgery on January 6, 2005, to remove the bladder and the prostate.  You indicated that Dr. Hafez, University of Michigan Medical Center, was the doctor who performed your surgery.  You stated “We feel [Employee] should have coverage for anything pertaining to his prostate due to the bladder cancer that invaded the prostate”.  Dr. Khaled Hafez M.D. signed your objection and stated that he “was in agreement with the above letter and am available for any further information regarding this case.”  You also attached additional medical evidence to your objection that included a copy of a surgical pathology report, from biopsies of the bladder and prostate, obtained on November 18, 2004, that shows diagnoses of urothelial carcinoma (CIS) of the bladder; and invasive high grade urolthelial carcinoma, and flat carcinoma in situ of the prostate.  You also submitted an operative report that shows you underwent a radical cystoprostatectomy, right pelvic lymph node dissection, and ileal conduit urinary diversion on January 6, 2005.  You also submitted the subsequent surgical pathology report, from these procedures performed on January 6, 2005, that shows diagnoses of urothelial carcinoma in situ of the right distal ureter; and invasive urothelial carcinoma and flat carcinoma in situ, of the urinary bladder and prostate. 

FINDINGS OF FACT 

  1. You filed a claim for employee benefits under the EEOICPA based on bladder and prostate cancer on July 21, 2004. 
  1. You were employed at the Portsmouth GDP in Piketon, Ohio, from November 3, 1980 to November 30, 1994. 
  1. You were employed at the Portsmouth GDP for a number of work days aggregating at least 250 work days prior to February 1, 1992, and during such employment was monitored through the use of dosimetry badges. 
  1. On May 30, 2004, you were diagnosed with urothelial carcinoma in situ, and non-invasive papillary urothelial carcinoma of the urinary bladder; on June 3, 2004, with invasive urothelial carcinoma of the prostate; and on January 6, 2005, with urothelial carcinoma in situ of the right distal ureter. 

CONCLUSIONS OF LAW

In order for you to be considered a “member of the Special Exposure Cohort,” you must have been a Department of Energy (DOE) employee, DOE contractor employee, or an atomic weapons employee who was so employed for a number of work days aggregating at least 250 work days before February 1, 1992, at a gaseous diffusion plant located in Paducah, Kentucky, Portsmouth, Ohio, or Oak Ridge, Tennessee, and, during such employment worked in a job that was monitored through the use of dosimetry badges for exposure at the plant of the external parts of employee’s body; or had exposures comparable to a job that is or was monitored through the use of dosimetry badges, as outlined in 42 U.S.C. § 7384l(14)(A). 

The evidence of record establishes that you worked in covered employment at the Portsmouth GDP from November 3, 1980 to November 30, 1994.  Portsmouth GDP is a covered facility beginning on September 1, 1954.  Consequently, you met the requirement of working more than an aggregate 250 days at a covered facility.  See 42 U.S.C. § 7384l(14)(A).  On your employment history (Form EE-3) you stated that you did wear a dosimetry badge and DOE confirmed that you wore a dosimetry badge to monitor for radiation exposure while employed at the facility.  On that basis, you are found to meet the dosimetry badge requirement. 

Bladder cancer (specifically urothelial carcinoma of the bladder diagnosed on May 30, 2004, and urothelial carcinoma in situ of the right distal ureter diagnosed on January 6, 2005) are specified cancers under the Act and the medical evidence of record establishes a diagnosis of these bladder cancers.  Therefore, you are a member of the Special Exposure Cohort, who was diagnosed with a specified cancer.  See 42 U.S.C. § 7384l(17)(A).  Although prostate cancer is not a specified cancer, the medical evidence clearly establishes that you were diagnosed with invasive urothelial carcinoma of the prostate on June 3, 2004, due to the spread of the urothelial carcinoma of the bladder that invaded the prostate.  Therefore, based on the additional medical evidence submitted with your objection, and the signed statement from Dr. Dr. Khaled Hafez M.D. contained in your objection, I find that the prostate cancer is a consequential disease under 20 C.F.R. §§ 30.210(c) and 30.214(b), because the evidence shows that it metastasized from your urothelial carcinoma of the bladder. 

For the reasons stated above, I accept your claim for benefits based on bladder cancer to include the right distal ureter cancer, and prostate cancer.  You are not entitled to any additional payment since you were previously compensated in the amount of $150,000, for your bladder cancer (specifically papillary transitional cell carcinoma of the left ureter previously diagnosed on September 20, 1996) , pursuant to 42 U.S.C. § 7384s.  You are entitled to medical benefits for your additional bladder cancers (specifically urothelial carcinoma of the urinary bladder, and urothelial carcinoma in situ of the right distal ureter) and for your prostate cancer that metastasized from your bladder cancer, effective July 21, 2004.  See 42 U.S.C. § 7384t. 

Cleveland, Ohio

Debra A. Benedict

District Manager

Final Adjudication Branch

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