Diagnostic Essentials: Physical Health Conditions

GUIDANCE TO THE VICTIM COMPENSATION FUND

FROM THE WORLD TRADE CENTER HEALTH PROGRAM

First Issued: 18 December 2013

Subsequently revised: April 2 2014, September 24, 2014, October 3, 2014, October 6, 2014, 

March 1, 2015, March 28, 2015, & May 19, 2015

Please note that the relevant policies pertaining to the medical professional 

determination on behalf of a claimant to the Victim Compensation Fund (VCF) may be 

found on the World Trade Center Health Program (WTCHP) website at 

http://www.cdc.gov/wtc/policies.html. The relevant policies include:

 Policy and Procedures to Certification of Physician Determination for Aerodigestive and Cancer 

Health Conditions

 Time Intervals for New Onset Aerodigestive Disorders

 Rare cancers

 Minimum Latency & Types or Categories of Cancer

 Making a Determination about Exposure Aggravating Pre-Existing Aerodigestive Disorders

 Health Conditions Medically Associated with WTC-Related Health Conditions. 

In general, the diagnosis of a health condition depends on a combination of medical 

history, physical examination, various types of diagnostic testing, including radiographic 

and other types of imaging, spirometry, and various laboratory and pathologic analyses. 

The WTCHP has recommended that diagnostic information listed in this document be 

utilized by the VCF to substantiate the diagnosis of claimed health conditions. 

For each category of health conditions, a star superscript (*) is listed next to the types of 

information considered essential to support the medical professional determination of 

the underlying condition. In some categories, the clinician has a choice of which type of 

essential information is available in the medical record. Other clinical information that is 

not listed with a star superscript (*) may support a diagnosis of a health condition. The 

VCF will then have a licensed medical professional make a determination regarding the 

health conditions and attest to the linkage of the conditions to the individual’s 9/11 

exposures. The determination is then submitted for a verification decision by the 

WTCHP in accordance with the policies and procedures of the WTCHP. The VCF renders 

the final decision regarding condition eligibility and subsequent consideration for 

compensation. 
Health Condition

Category1

Diagnostic Information 

Needed for Physician 

Determination

Reference Guidelines Supporting the 

Medical Basis for Diagnostic Information 

by Type of Condition

Interstitial Lung 

Disease2 Pulmonary disease:

 History (Symptoms) & Physical 

Exam Findings

 PFTs/Spirometry

 Radiographic/Imaging Evidence

for lung findings* 

 American Thoracic Society(ATS)/European 

Respiratory Society International 

Multidisciplinary Consensus Classification of 

the Idiopathic Interstitial Pneumonias (2002) 

 

http://www.thoracic.org/statements/resour

ces/ interstitial-lung-disease/idio02.pdf

 An Official American Thoracic 

Society(ATS)/European Respiratory Society 

Statement: Update of the International 

Multidisciplinary Classification of the 

Idiopathic Interstitial Pneumonias (2013)

 

http://www.thoracic.org/statements/resour

ces/ interstitial-lung-disease/classificationof-IIPs.pdf

 ATS Statement on Sarcoidosis (1999) 

http://www.thoracic.org/statements/resour

ces/interstitial-lung-disease/sarcoid1-20.pdf

 Vij R, Strek MA. Diagnosis and Treatment of 

Connective Tissue Disease-Associated 

Interstitial Lung Disease. CHEST 2013; 

143(3):814–824.

 Casian A, Jayne D. Current modalities in the 

diagnosis of pulmonary vasculitis. Expert 

Opin Med Diagn 2012; 6(6):499-516.

 

1The general categories of health conditions that are listed in this Table have been drawn from the List of Health Conditions 

for Responders found at 42 U.S.C. §§ 300mm-22(a)(3)(A) and 300mm—32(b)(1). 

2

Interstitial lung disease (ILD) is a term used to describe the pulmonary manifestation of more than 100 health conditions.

ILD is characterized by inflammation and/or fibrosis of the lungs. Some of the health conditions manifesting ILD may 

include, but are not limited to, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis, eosinophilic 

granuloma, bronchiolitis obliterans, pneumoconioses and certain systemic autoimmune diseases such as the connective 

tissue diseases (CTD), and small vessel vasculitides.
Obstructive airways 

disease, excluding 

asthma and reactive 

airways disease3

 History (Symptoms) & Physical 

Exam Findings* and/or

 PFTs/Spirometry*

 Radiographic/imaging

(required to support diagnosis of 

bronchiectasis4)

Note: For WTC-exacerbated 

Chronic Obstructive Pulmonary 

Disease (COPD), there must be 

evidence that COPD was present 

prior to September 11, 2001 and 

worsened after exposure.

5

 Standards for the diagnosis and treatment 

of patients with COPD: a summary of the 

ATS/ERS position paper (2004)

http://www.thoracic.org/statements/resou

rces/copd/copdexecsum.pdf

 Diagnosis and Management of Stable 

Chronic Obstructive Pulmonary Disease: A 

Clinical Practice Guideline from the 

American College of Physicians, American 

College of Chest Physicians, American 

Thoracic Society, and European Respiratory 

Society (2011)

http://www.thoracic.org/statements/resou

rces /copd/179full.pdf

Obstructive airways 

disease—asthma and 

reactive airways 

disease only

 History (Symptoms) & Physical 

Exam Findings* and/or

 PFTs/Spirometry*

 NIH National Heart, Lung and Blood 

Institute (NHLBI) Guidelines for the 

Diagnosis and Management of Asthma 

(National Asthma Education and Program 

(NAEPP)Expert Panel Report(EPR)-3, in 

2007)

 http://www.nhlbi.nih.gov/healthpro/guidelines/current/asthma-guidelines

 

3 Obstructive airways disease (OAD) is a broad category of respiratory diseases which are characterized by varying degrees 

of reversible and irreversible airways obstruction and include chronic respiratory disorder (fumes/vapors), chronic cough 

syndrome, WTC-exacerbated chronic obstructive pulmonary disease, asthma, and reactive airways dysfunction syndrome 

(RADS).

4 Bronchiectasis is certifiable as WTC-related chronic respiratory disorder (fumes/vapors) and/or as a medically associated 

health condition to a certifiable WTC-related health condition under certain lung disease categories.

5 Evidence supporting a diagnosis of WTC-exacerbated COPD consists of one or more of the following: (1) a record of 

physician diagnosis of COPD made prior to the individual’s 9/11 exposure; (2) history of symptoms of chronic cough, 

sputum production and/or dyspnea experienced prior to the individual’s 9/11 exposure; (3) a history of recurrent 

bronchopulmonary infections experienced prior to the individual’s 9/11 exposure; (4) a record of pulmonary function tests 

showing chronic airways obstruction existing prior to the individual’s 9/11 exposure; and/or (5) a record of imaging studies 

consistent with COPD existing prior to the individual’s 9/11 exposure.
Upper Airway 

Inflammatory 

Disorders6 

 History (Symptoms) & Physical 

Exam Findings*

 Radiographic/imaging (CT of 

the sinuses)

 American Association of Family Physicians 

 Diagnosing Rhinitis: Allergic vs. Nonallergic 

(2006) 

http://www.aafp.org/afp/2006/0501/p158

3.html

 American Academy of Otolaryngology/Head 

and Neck Surgery. Clinical Practice 

Guidelines on Adult Sinusitis(2007)

 

http://oto.sagepub.com/content/137/3/36

5.full

Gastroesophageal 

Reflux Disorder

 History (Symptoms) & Physical 

Findings* and/or

 Response to therapy* and/or

 Endoscopic evidence of 

esophagitis, stricture or 

Barrett’s metaplasia*

 American Gastroenterological Association 

(AGA) Medical Position Statement on the 

Management of Gastroesophageal Reflux 

Disease(2008) 

http://www.gastrojournal.org/article/S0016-

5085(08)01606-5/fulltext

Sleep Apnea

(Obstructive Sleep 

Apnea) "exacerbated 

by, or related to, a 

health condition" in 

Diagnostic Essentials, --

-excluding MSD and 

Malignant Neoplasms.

 History (Symptoms) & Physical 

Findings

 Interpretation of a 

polysomnogram or sleep study 

by a sleep medicine specialist 

or pulmonologist, showing 

evidence of Obstructive Sleep 

Apnea*

 American Academy of Sleep 

Medicine(AASM) Clinical Guideline for the 

Evaluation, Management and Long-term 

Care of Obstructive Sleep Apnea in Adults

(2009)

 http://www.aasmnet.org/Resources/clinical 

guidelines/OSA_Adults.pdf

Musculoskeletal 

Disorders (MSDs)—

Heavy Lifting or 

Repetitive Strain7 

 History (Symptoms) & Physical 

Findings* and/or

 Radiographic/Imaging 

Evidence* and/or

 Electrodiagnostic testing (e.g., 

Electromyography and Nerve 

Conduction Velocity study)

• American Academy of Orthopedic Surgeons 

(AAOS) Endorsed Guideline - American Pain 

Society Clinical Guideline for the Evaluation 

and Management of Low Back Pain

(Diagnosis and Treatment of Low Back Pain: 

A Joint Clinical Practice Guideline from the 

American College of Physicians and the 

American Pain Society)(2007) 

http://annals.org/article.aspx?article 

id=736814

 

6Upper airway inflammatory disorders is a broad category of health conditions; however, for the purpose of verification for 

VCF claims, the category is limited to include only the following conditions: chronic rhinosinusitis or chronic rhinitis (either 

irritant or allergic), chronic nasopharyngitis, chronic laryngitis, and upper airway hyperactivity. 

7

In the case of a WTC responder only (i.e., not in the case of a survivor) who received any treatment for a WTC-related musculoskeletal 

disorder on or before September 11, 2003, the list of health conditions that can be verified includes: (1) low back pain; (2) carpal tunnel 

syndrome (CTS); and (3) other musculoskeletal disorders. The term ‘WTC-related musculoskeletal disorder’ means a chronic or recurrent 

disorder of the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring 

during rescue or recovery efforts in the New York City disaster area in the aftermath of the September 11, 2001, terrorist attacks. See 42 

U.S.C. § 300mm-22(a)(4).
• American Academy of Orthopedic 

Surgeons(AAOS) Clinical Practice Guideline 

on the Diagnosis of Carpal Tunnel Syndrome 

(2007) http://www.aaos.org/ 

research/guidelines/CTS_guideline.pdf

Malignant Neoplasm: 

General

 History (Symptoms) & Physical 

Findings

 Radiographic/Imaging evidence

 Chemistry Laboratory 

 Tissue biopsy or pathology 

report*

Exception: Tissue biopsy is not 

required for certain neoplasms. 

See NCCN guidelines for 

information about these 

neoplasms.

 National Comprehensive Cancer Network 

(NCCN) guidelines 

http://www.nccn.org/professionals/ 

physician_gls/f_guidelines.asp

 National Cancer Institute (NCI)

http://www.cancer. gov/

cancertopics/factsheet/detection/pathology

-reports 

 Borowitz M, Westra W, Cooley LD, et al. 

Pathology and laboratory medicine. In: 

Abeloff MD, Armitage JO, Niederhuber JE, 

Kastan MB, McKenna WG, editors. Clinical 

Oncology. 3rd ed. London: Churchill 

Livingstone, 2004.

Malignant Neoplasm: 

In-Situ Neoplasm

 History (Symptoms) & Physical 

Findings

 Radiographic/Imaging evidence

 Chemistry Laboratory 

 Tissue biopsy or pathology 

report*

All malignant in-situ neoplasms 

are eligible for certification except 

the following: (1) lobular 

carcinoma in-situ of the breast 

(except pleomorphic lobular 

carcinoma); (2) in-situ carcinoma 

of the gallbladder; (3) colorectal 

adenomatous polyp with area of 

in-situ carcinoma; and (4) in-situ 

carcinoma of the cervix. 

 National Comprehensive Cancer Network 

(NCCN) guidelines 

http://www.nccn.org/professionals/physicia

n_gls/f_guidelines.asp

 National Cancer Institute (NCI) 

http://www.cancer.gov/cancertopics/factsh

eet/detection/pathology-reports 

Malignant Neoplasm: 

Unknown primary

 History (Symptoms) & Physical 

Findings

 Radiographic/Imaging evidence

 Chemistry Laboratory 

 Tissue biopsy or pathology 

report*

When the diagnosis under review 

is a metastatic neoplasm of an 

unknown primary, a diagnostic 

work-up summary is required to 

demonstrate that an appropriate 

 Ettinger DS, Agulnik M, Cates JM, Cristea M, 

Denlinger CS, Eaton KD, et al. Occult Primary. 

Clinical Practice Guidelines in Oncology. J 

Natl Compr Canc Netw. 2011;9(12):1358-95.
search for the primary malignancy 

was done. 

When the diagnostic work-up 

does not reveal a primary site, the 

neoplasm shall be classified as a 

neoplasm of the metastatic site.

When the diagnostic work-up 

does reveal a primary site, the 

neoplasm shall be classified as a 

neoplasm of the primary site.

To ensure clarity about the 

condition for which verification is 

requested, the medical 

determination should only state 

the final diagnosis and the date of 

this diagnosis.