OFFICE OF THE OMBUDSMAN FOR THE 

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

2021 ANNUAL REPORT TO CONGRESS

OFFICE OF THE OMBUDSMAN

UNITED STATES DEPARTMENT OF LABOR
Cover Photo: Y-12 worker at Beta-3 control panel. c. 1945

Cover Photo Credit: courtesy of the U.S. Department of Energy via Flickr.
U.S. Department of Labor 

July 29, 2022 

The Honorable Kamala D. Harris 

President 

United States Senate 

Washington, DC 20510 

Dear Madam President: 

Ombudsman 

Energy Employees Compensation Program 

Washington, D.C. 20210 

I am pleased to present the 2021 Annual Report of the Ombudsman for the Energy Employees 

Occupational Illness Compensation Program of the United States Department of Labor. 

Sincerely, 

JtYcfuh S.-B~g~s

Acting Ombudsman for the Energy Employees 

Occupational Illness Compensation Program 

Enclosure 
U.S. Department of Labor 

July 29, 2022 

The Honorable Nancy Pelosi 

Speaker 

U.S. House of Representatives 

Washington, DC 20515 

Dear Speaker Pelosi: 

I am pleased to present the 2021 Annual Repo1t of the Ombudsman for the Energy Employees 

Occupational Illness Compensation Program of the United States Department of Labor. 

Ombudsman 

Energy Employees Compensation Program 

Washington, D.C. 20210 

Sincerely, 

Judith S. Boggs

Acting Ombudsman for the Energy Employees 

Occupational Illness Compensation Program 

Enclosure 
TABLE OF CONTENTS

PREFACE TO THE REPORT.....................................................................................................................................ii

INTRODUCTION......................................................................................................................................................1

SUMMARY OF ISSUES AND RECOMMENDATIONS ..........................................................................................5

TABLES....................................................................................................................................................................10

TABLE 1 — COMPLAINTS, GRIEVANCES, AND REQUESTS FOR ASSISTANCE BY 

 NATURE OF COMPLAINT.......................................................................................................................................... 11

TABLE 2 — COMPLAINTS BY FACILITY...................................................................................................................13

CHAPTER 1 — EEEOICPA AWARENESS AND OUTREACH EFFORTS .............................................................15

CHAPTER 2 — MEDICAL BILLING AND TREATMENT AUTHORIZATION ISSUES ......................................18

A. COMPLAINTS RELATED TO THE NEW MEDICAL BILLING CONTRACTOR .......................................... 18

B. INADEQUATE ASSISTANCE WITH MEDICAL BILL CODING ISSUES .........................................................21

C. DIFFICULTIES OBTAINING ASSISTANCE WITH MEDICAL BILLING .........................................................22

D. DIFFICULTIES FINDING AND KEEPING HEALTH CARE PROVIDERS ........................................................23

E. DIFFICULTIES AND DELAYS IN RECEIVING MEDICAL CARE ......................................................................25

CHAPTER 3 — DIFFICULTIES WITH PART E CLAIMS ..................................................................................... 28

A. OCCUPATIONAL HISTORY QUESTIONNAIRE ................................................................................................28

B. SITE EXPOSURE MATRICES (SEM) DATABASE ...............................................................................................30

C. INDUSTRIAL HYGIENISTS RELIANCE UPON LANGUAGE SIMILAR TO 

 RESCINDED CIRCULAR NO. 15-06 ..........................................................................................................................31

D. ERRORS IN EXPERT OPINION REPORTS ...........................................................................................................33

E. CONSEQUENTIAL ILLNESSES ...............................................................................................................................34

CHAPTER 4 — DELAYS, CUSTOMER SERVICE, AND OTHER ADMINISTRATIVE ISSUES ......................... 36

A. DELAYS........................................................................................................................................................................36

B. CUSTOMER SERVICE...............................................................................................................................................39

C. OTHER ADMINISTRATIVE ISSUES ......................................................................................................................42

CHAPTER 5 — ISSUES RELATED TO IMPAIRMENT CLAIMS .........................................................................44

APPENDIX 1 — ACRONYMS (ABBREVIATIONS) USED IN THIS REPORT ................................................... 47

Office of the Ombudsman | ANNUAL REPORT TO CONGRESS i
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PREFACE TO THE REPORT

In this Annual Report to Congress, the Ombudsman for the Energy Employees Occupational Illness Compensation 

Program sets forth the complaints, grievances, and requests for assistance received during calendar year 2021, 

and provides an assessment of the most common difficulties encountered by claimants and potential claimants 

in that year. However, before addressing the complaints, grievances and requests for assistance received in 2021, 

we would like to acknowledge some of the efforts undertaken by the Division of Energy Employees Occupational 

Illness Compensation (DEEOIC) in calendar year 2021 to assist claimants in filing and processing claims under the 

Energy Employees Occupational Illness Compensation Program Act (EEOICPA):

• DEEOIC published two updates, Version 5.0 and 5.1 of the Procedure Manual. The changes to the Procedure 

Manual included:

• Clarity about the scope of the Special Exposure Cohort class coverage at the Oak Ridge K-25 plant. 

(Version 5.0). 

• Complete revision of the process by which the Final Adjudication Branch (FAB) schedules hearings. 

(Version 5.0). 

• Identifying the Medical Benefits Adjudication Unit (MBAU) as the National District Office. (Version 5.1).

• Providing new procedures for the handling of Privacy Act requests. (Version 5.1). 

• Clarification that a six-minute walk test is an acceptable mechanism in rating impairment for respiratory 

disorders. (Version 5.1).

• Updated and enhanced guidance on the evaluation of impairment reports. (Version 5.1). 

• Reissuance of Chapter 28 – Medical Bill Process in its entirety. (Version 5.1). 

• Renaming and reissuing Chapter 29 – Ancillary Medical Benefits in its entirety. (Version 5.1).

• Updating the address to which claimants return a Form EN-20 for the payment of compensation benefits. 

(Version 5.1). 

• The following webinars were hosted by DEEOIC: 

• Establishing Survivorship Under Part B and Part E on January 27, 2021, 

• District Office Roles and Responsibilities on February 24, 2021,

• Final Adjudication Branch Roles and Responsibilities on March 24, 2021,

• Medical Benefits Coverage on April 21, 2021,

• Policy Discussion on May 19, 2021, 

• Medical Bill/Reimbursement Processing on June 30, 2021,

• Stakeholder Update on July 14, 2021,

• Office of the Ombudsman for EEOICP and for NIOSH on August 25, 2021, 

• The Role of the Health Physicist and Toxicologist on September 22, 2021, and

• The Role of the Industrial Hygienist and Nurse Consultant on October 27, 2021.

In addition, we wish to acknowledge the many instances throughout the year where members of DEEOIC staff 

assisted claimants and our Office in resolving matters brought to their attention.
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INTRODUCTION

Section 7385s-15 of the Energy Employees Occupational Illness Compensation Program Act of 2000, 

as amended, requires the Office of the Ombudsman for the Energy Employees Occupational Illness 

Compensation Program (the Office) to submit an annual report to Congress. See 42 U.S.C. § 7385s-15. In 

this annual report, we are to set forth: (a) the numbers and types of complaints, grievances, and requests 

for assistance received by the Office during the preceding year; and (b) an assessment of the most common 

difficulties encountered by claimants and potential claimants during that year. See 42 U.S.C. § 7385s-15(e). 

The following is the Office’s annual report for calendar year 2021.

I. An Overview of the Energy Employees Occupational Illness Compensation Program Act (the 

EEOICPA)

Congress enacted the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) as 

Title XXXVI of Public Law 106-398, the Floyd D. Spence National Defense Authorization Act for Fiscal Year 

2001, on October 30, 2000. The purpose of the EEOICPA is to provide for timely, uniform, and adequate 

compensation of covered employees, and where applicable, survivors of such employees, suffering from 

illnesses incurred by such employees in the performance of duty for the Department of Energy (DOE) and 

certain of its contractors and subcontractors. 42 U.S.C. § 7384d(b). 

In enacting this program, Congress recognized that:

1. Since World War II, Federal nuclear activities have been explicitly recognized under Federal law as 

activities that are ultra-hazardous. Nuclear weapon production and testing have involved unique 

dangers, including potential catastrophic nuclear accidents that private insurance carriers have not 

covered and recurring exposures to radioactive substances and beryllium that, even in small amounts, 

can cause medical harm.

2. Since the inception of the nuclear weapons program and for several decades afterwards, a large number 

of nuclear weapons workers at sites of the Department of Energy and at sites of vendors who supplied 

the Cold War effort were put at risk without their knowledge and consent for reasons that, documents 

reveal, were driven by fears of adverse publicity, liability, and employee demands for hazardous duty pay.

3. Many previously secret records have documented unmonitored exposures to radiation and beryllium 

and continuing problems at these sites across the Nation, at which the Department of Energy and its 

predecessor agencies have been, since World War II, self-regulating with respect to nuclear safety and 

occupational safety and health. No other hazardous Federal activity has been permitted to be carried out 

under such sweeping powers of self-regulation.

See 42 U.S.C. § 7384(a)(1), (2), and (3). 
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As originally enacted in October 2000, the EEOICPA contained two parts, Part B and Part D. Part B, which is 

administered by the Department of Labor (DOL), provides the following compensation and benefits:

• Lump-sum payment of $150,000 and the payment of medical expenses (for the accepted illness starting as 

of the date of filing) for:

a) Employees of the DOE, as well as its contractors, subcontractors, and employees of atomic weapons 

employers (AWEs) with radiation-induced cancer if: (a) the employee developed cancer after working at 

a covered facility; and (b) the cancer is “at least as likely as not” related to covered employment.1

b) Employees who are members of Special Exposure Cohort (SEC) and who develop one of the specified 

cancers outlined in 42 U.S.C. § 7484l(17).2

c) All federal employees, as well as employees of the DOE, its contractors and subcontractors, or 

designated beryllium vendors who worked at a covered facility where they were exposed to beryllium 

and who develop Chronic Beryllium Disease (CBD).

d) Employees of the DOE or its contractors and subcontractors who worked at least 250 days during the 

mining of tunnels at underground nuclear weapons test sites in Nevada or Alaska and who develop 

chronic silicosis. 

If the employee is no longer living, eligible survivors of the employees listed above are entitled to 

$150,000 in lump sum compensation under Part B.

• Uranium miners, millers, and ore transporters, or their survivors, who are awarded $100,000 under Section 5 

of the Radiation Exposure Compensation Act (RECA), 42 U.S.C. § 2210 note, are entitled under the EEOICPA 

to a lump-sum payment of $50,000 and to medical expenses for the accepted illness. 

• All federal employees, as well as employees of the DOE, and its contractors and subcontractors, or 

designated beryllium vendors who worked at a covered facility where they were exposed to beryllium and 

whose claims for beryllium sensitivity are accepted under Part B are entitled to medical monitoring to check 

for the development of CBD. 

• Part D of the EEOICPA required the DOE to establish a system by which DOE contractor employees and their 

eligible survivors could seek assistance in obtaining state workers’ compensation benefits if a Physicians 

Panel determined that the employee sustained an accepted illness as a result of work-related exposure to 

a toxic substance at a DOE facility. On October 28, 2004, Congress abolished Part D and created Part E as 

Subtitle E of Title XXXI of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005, 

Public Law 108-375, 118 Stat. 1811, 2178 (October 28, 2004). Part E is administered by DOL.

The compensation and benefits allowable under Part E are as follows:

• DOE contractor and subcontractor employees who develop an illness due to exposure to toxic substances 

at certain DOE facilities are entitled to medical expenses and may receive monetary compensation of up to 

$250,000 for impairment and/or wage-loss.

1

 An atomic weapons employer is an entity, other than the United States, that: (A) processed or produced, for use by the United States, material that 

emitted radiation and was used in the production of an atomic weapon, excluding uranium mining and milling; and (B) is designated by the Secretary of 

Energy as an atomic weapons employer for purposes of the compensation program [EEOICPA]. See 42 U.S.C. § 7384l(4). 2

 If a claimant qualifies for inclusion in a SEC class and develops one of the specified cancers, that claimant receives compensation for that specified cancer 

without the completion of a radiation dose reconstruction by the National Institute for Occupational Safety and Health, and without a determination by 

DOL of the probability of causation that the cancer was caused by exposure to radiation at a covered facility.
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• Eligible survivors of DOE contractor and subcontractor employees receive compensation of $125,000 if 

the employee’s death was caused, contributed to, or aggravated by the covered illness. If the employee had 

between 10 and 19 years of wage-loss, the survivor receives an additional $25,000. If the worker had 20 or 

more years of wage-loss, the survivor receives an additional $50,000.

• Uranium miners, millers, and ore transporters are eligible for medical benefits, as well as up to $250,000 

in monetary compensation for impairment and/or wage-loss, if they develop an illness as a result of toxic 

exposure at a facility covered under Section 5 of RECA. (These uranium miners, millers, or ore transporters 

are eligible for compensation and medical benefits under Part E even if they did not receive compensation 

under RECA).

DOL has primary authority for administering Part B and Part E of the EEOICPA. However, other federal agencies 

are also involved with the administration of this program.

• The DOE ensures that all available worker and facility records and data are provided to DOL. This includes: 

(1) providing DOL and/or the National Institute for Occupational Safety and Health (NIOSH) with information 

related to individual claims such as employment verification and exposure records; (2) supporting DOL, 

NIOSH, and the Advisory Board on Radiation and Worker Health with large-scale records research and 

retrieval efforts at various DOE sites; (3) conducting research, in coordination with DOL and NIOSH, on 

issues related to covered facility designations; and (4) hosting the Secure Electronic Records Transfer (SERT) 

system, a DOE hosted environment where DOL, NIOSH, and DOE can securely share records and data.

• NIOSH conducts activities to assist claimants and supports the role of the Secretary of Health and Human 

Services (HHS) under EEOICPA. These activities include: (1) developing scientific guidelines for determining 

whether a cancer is related to the worker’s occupational exposure to radiation; (2) developing methods 

to estimate worker exposure to radiation (dose reconstruction) and using those methods to prepare dose 

reconstructions for claimants; (3) recommending that classes of workers be considered for inclusion in a SEC 

class; and (4) providing staff support for the independent Advisory Board on Radiation and Worker Health 

that advises HHS and NIOSH on dose reconstructions and SEC petitions.

• The Ombudsman to NIOSH helps individuals with a variety of issues related to the SEC petition process and 

the dose reconstruction process. The Ombudsman to NIOSH also conducts outreach to promote a better 

understanding of the EEOICPA, as well as the claims process.

II. The Office of the Ombudsman

Public Law 108-375, which was enacted on October 28, 2004, also established within the DOL an Office of 

the Ombudsman. The National Defense Authorization Act for 2021, which became effective January 1, 2021, 

amended the EEOICPA to provide for the permanent extension of the Office of the Ombudsman within DOL. 

Public Law 116-283, § 3145 (Jan. 1, 2021). The EEOICPA outlines four (4) specific duties for the Office:

1. Provide information to claimants and potential claimants on the benefits available under Part B and Part 

E, and on the requirements and procedures applicable to the provision of such benefits.

2. Provide guidance and assistance to claimants.

3. Make recommendations to the Secretary of Labor regarding the location of resource centers for the 

acceptance and development of EEOICPA claims. 

4. Carry out such other duties as the Secretary specifies.

See 42 U.S.C. § 7385s-15(c). 
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The EEOICPA also requires the Office to submit an annual report to Congress which sets forth:

1. The number and types of complaints, grievances, and requests for assistance received by the Office 

during the preceding year; and

2. An assessment of the most common difficulties encountered by claimants and potential claimants during 

the preceding year.

See 42 U.S.C. § 7385s-15(e)(2). 

Additionally, not later than 180 days after the submission to Congress of the annual report, the Secretary shall 

submit to Congress in writing, and post on the public Internet website of the Department of Labor, a response to 

the report that— 

(A) includes a statement of whether the Secretary agrees or disagrees with the specific issues raised by 

the Ombudsman in the report; 

(B) if the Secretary agrees with the Ombudsman on those issues, describes the actions to be taken to 

correct those issues; and 

(C) if the Secretary does not agree with the Ombudsman on those issues, describes the reasons the 

Secretary does not agree.

See 42 U.S.C. § 7385s-15(e)(4).
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SUMMARY OF ISSUES AND RECOMMENDATIONS

1. EEOICPA Awareness and Outreach Efforts: Given the COVID-19 pandemic-related challenges to conducting 

outreach over the past two years, DEEOIC is to be commended for its efforts to provide outreach via monthly 

online webinars. At ten webinars held in 2021, attendees were provided information regarding various aspects 

of the EEOICPA, including the roles of specific offices within DEEOIC, the Office of the Ombudsman for 

the EEOICPA, and the NIOSH Ombudsman. Attendees were also able to submit written, non-case specific, 

questions to the panelists during each webinar. However, as noted in our 2020 annual report, those with 

limited or no internet access were unlikely to be aware of the webinars or able to participate in them. 

In order to promote awareness of the EEOICPA, our recommendation is for DEEOIC to expand its outreach 

efforts by coordinating with DOE and the DOE’s Former Worker Programs to utilize the FWPs mailing lists of 

DOE employees. DEEOIC has acknowledged coordination with the DOE FWPs to utilize such mailing lists to 

notify former DOE workers of in-person outreach events in their area. However, this limited use of the mailing 

lists should be expanded to provide notice of the EEOICPA to any/all former DOE workers, regardless of their 

proximity to in-person outreach meetings. Former DOE workers who do not live close to DEEOIC Resource 

Centers or near locations where in-person outreach events are conducted are much less likely to learn of the 

EEOICPA. We make this recommendation based upon the need for as many potential claimants as possible to 

be informed of the EEOICPA in a timely manner. 

In response to the 2020 Annual Report to Congress, DEEOIC described its commitment to providing outreach 

to current and former employees, as well as the surviving family members, of employees of AWE facilities, 

beryllium vendors, uranium mines, uranium mills, and uranium ore transporters. Without the ability to utilize 

mailing lists of former workers to connect with these individuals, the challenge of notifying them of the 

EEOICPA requires greater creativity and, in some instances, resources. Given the positive feedback often 

received following in-person outreach events, our recommendation is for DEEOIC to plan events in areas of 

the country where these facilities are located, particularly areas where DEEOIC has previously not hosted 

events. 

2. Medical Billing and Treatment Authorization Issues: The two common threads that developed in our 

discussions of medical billing and payment issues were: 1) a lack of communication and transparency for 

claimants and providers when systemic issues were impacting DEEOIC and its bill processing contractors’ 

ability to provide timely service; and 2) the lack of a logical, streamlined process by which claimants and 

authorized representatives can understand who to contact for assistance and under what circumstances. 

When medical bill issues arise, claimants and providers need better guidance and assistance. Many of the 

medical bill issues that we encountered involved “coding problems.” In our experience, simply informing 

the claimant or provider that there was a coding problem did not provide the claimant or provider with the 

information needed to resolve the problem. Rather, claimants and providers often needed to be directed to 

someone who could explain why the code was wrong and the steps to fix it. 
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In addition, resolving medical bill issues often required explaining the matter to those who were in a position 

to resolve the issue. The claimants who approached us with medical bill issues often found it frustrating to be 

placed in the middle of a dispute between DEEOIC, Client Network Services, Inc. (CNSI), and the provider. Thus, 

in contacting our Office, claimants with medical bill issues oftentimes were simply looking for a way to get the 

parties involved to talk to each other, as opposed to using the claimant as the intermediary. More effort needs to be 

undertaken by DEEOIC to work directly with the other parties to resolve coding problems and other medical billing 

issues. 

In 2021, claimants expressed frustration and concerns regarding difficulties in finding a doctor or other qualified 

health care provider who would accept DEEOIC medical benefits coverage as payment. Claimants who were aware 

of the Resource Centers sometimes sought assistance there and were directed to an online portal containing 

contact information for health care providers who have registered to receive payment from DEEOIC. However, 

some claimants were unsuccessful in searching the database and others were unsuccessful finding the appropriate 

type of provider in the database. OWCP acknowledged efforts by CNSI and the Division of Administration and 

Operations (DAO) to conduct general and targeted recruitment activities in the areas identified as being deficient 

in access to medical providers. It was also shared that CNSI outreach staff conduct enrollment reviews for potential 

“desert” areas of medical coverage. We are encouraged by this information and encourage DEEOIC to report further 

on these efforts and the impact such efforts have had to date. 

Based upon the cases brought to our attention in 2021, we observed that medical benefits delayed were sometimes 

medical benefits denied, either because the treating physician had not responded to DEEOIC’s multiple requests 

for additional evidence, or the claimant was held to a higher standard than required. The common themes in 

the requests for assistance we received illustrate the need for consistency and efficiency. When one authorized 

representative complains of receiving letters from different claims examiners and medical benefits examiners on 

different cases involving similar requests for medical treatment and the development letters from those examiners 

are quite different, the lack of consistency is concerning. When claimants and authorized representatives continue 

to reach out to our office not fully understanding why they have not heard back from their claims examiner or 

medical benefits examiner, the need for greater communication and efficiency is apparent. 

3. Difficulties with Part E Claims: The complaints received involving Part E claims in 2021 highlighted the need 

for better communication between DEEOIC and claimants, as well as increased consistency during the claims 

adjudication process. The cases brought to our attention involved the use of the Site Exposure Matrices (SEM) 

database, industrial hygiene reports, and consequential illnesses. Other claimants brought concerns involving 

the occupational history questionnaire (OHQ) and the Statement of Accepted Facts (SOAF) sent from claims 

examiners to DEEOIC experts. 

The OHQ is a document based entirely upon the claimant’s recollection of his/her own work history at covered 

DOE facilities, and therefore it is assumed by DEEOIC that the claimant will recall or have all of this information 

readily available to share, during an interview that sometimes takes hours to complete. While claimants are 

informed in advance of the topics the OHQ will cover it would be helpful for them to be provided a copy of the OHQ 

prior to the interview so that they could perhaps take notes or give their responses some thought ahead of time. 

Likewise, one of the initial developmental steps taken by a claims examiner in a Part E claim is requesting 

documentation from DOE with respect to the claimant’s employment at a covered DOE facility. This highly 

probative evidence, which most claimants are unaware of, would assist them at the earliest stages in the 

adjudication of their claims to recall more specific information about their workplace history and/or exposures. 
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Additionally, because some claimants do not know the names of the specific toxins they worked with or around, 

and may have never seen their DOE personnel records, it would be helpful for them to see what is, and is not, 

part of their DOE employment files. Incorporating these records into the DEEOIC claim file but not informing 

the claimant of their existence or providing them a copy, significantly limits claimant access to some of the most 

personal, probative evidence.

The SEM database is a valuable tool in the adjudication process; however, it must be used as prescribed in the 

DEEOIC Procedure Manual (PM) or the results may not be accurate. Moreover, SEM database searches that 

follow the guidance in the PM may reveal additional probative evidence that could impact the outcome of a claim. 

Consequently, we recommend DEEOIC’s performance management branch consider compliance with the SEM 

database search guidance found in the PM as a topic for individual claim reviews. 

Furthermore, when a specific illness or labor category is not listed in the SEM database, it should be clear when 

the omission from the database is deliberate, i.e., it has been determined that the illness or toxic substance 

should not be listed in the database. For example, hearing loss and asthma are illnesses that are not listed in the 

SEM database. This is different from a search of the SEM database that yields no results for a listed illness or 

toxic substance. Claimants and authorized representatives should be made aware of this distinction in written 

correspondence and decisions from DEEOIC in order to fully understand the limitations of the SEM database, as 

well as narrow the focus of claimants and authorized representatives as they seek to obtain evidence to perfect 

their claims.

Another ongoing area of concern for claimants and their authorized representatives is the continued use of 

language by DEEOIC contracted industrial hygienists (IH) that is similar in form and intent to the language in 

rescinded DEEOIC Circular No. 15-06. Many IH expert opinion reports continue to rely upon almost identical 

language. We recommend this practice be discontinued in accordance with Circular No. 17-04 and the potential 

for toxic substance exposure in all claims must be evaluated based upon established program procedure and the 

evidence presented in support of a claim. See EEOICPA Circular No. 17-04, Rescinding EEOICPA Circular No. 15-06, 

Post-1995 Occupational Toxic Exposure Guidance and its corresponding Program Memorandum dated February 

20, 2015 (February 2, 2017). Our recommendation is consistent with the Advisory Board on Toxic Substances and 

Worker Health’s (ABTSWH) November 2016 recommendation which made clear that the language of EEOICPA 

Circular No. 15-06 should be rescinded with respect to the adjudication of claims under the EEOICPA. See

ABTSWH Recommendations Adopted at October 17-19, 2016, Meeting (November 4, 2016).

DEEOIC contractor expert opinion reports are based upon information and evidence that the claims examiner 

sends to the expert, along with specific questions to be answered by the expert. When an expert opinion report 

contains incorrect information, it can sometimes be traced back to the information and/or evidence provided to 

the expert. When incorrect information is incorporated into an expert opinion report, the incorrect information can 

then be relied upon by subsequent experts and DEEOIC staff. Similarly, failure to provide information or evidence 

to an expert can produce a less than adequate expert opinion report. And finally, because a claimant’s first 

opportunity to review an expert opinion report is when it accompanies a decision recommending the denial of their 

claim, some claimants have expressed that it feels as if it is too late to surmount a challenge to the opinion of the 

expert. We recommend that expert opinions be fact-checked to accurately reflect the evidence of record. We also 

recommend claimants be provided with a copy of the expert opinion and be provided an opportunity to respond 

prior to a recommended denial. While it is understandable that errors will be made from time to time, greater 

consistency in the review of these reports would go a long way towards ensuring such errors are caught early and 

have not been permitted to perpetuate through the claims adjudication process. 
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Finally, most claimants are not aware of the fact that they will be required to file a new claim form for any additional 

new medical conditions, consequential conditions, or compensation they wish to claim. It is our suggestion that 

DEEOIC further streamline its adjudication process and provide greater transparency to claimants regarding how 

and why certain medical conditions must be filed separately as consequential conditions. It would also be helpful 

for claimants to have a separate claim form or a space on the existing Worker’s Claim for Benefits Under the 

EEOICPA (Form EE-1) dedicated solely to claims for consequential conditions. 

4. Delays, Customer Service, and Other Administrative Issues: Some of the complaints and concerns relayed 

to our office in 2021 pertained to the ongoing impact of the COVID-19 pandemic on agencies such as the DOE 

and Social Security Administration (SSA). Other complaints pertained to the Department of Health and Human 

Services, National Institute for Occupational Safety and Health’s (NIOSH) pause on performing radiation dose 

reconstructions for claimants with Part B claims. Our office also received complaints regarding delays in DEEOIC’s 

processing of medical treatment authorizations, medical bill payments and compensation payments, as well as 

issuance of decisions. Moreover, both claimants and authorized representatives complained of insensitive and 

sometimes rude behavior by DEEOIC or DEEOIC contractor staff, and difficulties interacting with and obtaining 

assistance through the online portals and databases utilized by DEEOIC. 

When a sizable portion of DEEOIC claims were simultaneously impacted because dose reconstructions stopped 

being processed by NIOSH for a period of time, claimants and authorized representatives found it incredibly 

frustrating not to receive more case-specific, timely information from DEEOIC. It is our understanding that DEEOIC 

knew the details of the cases it had referred to NIOSH (or were pending referral) that were impacted by the pause, 

and therefore the question remains why more was not done to communicate this information directly to affected 

claimants. Furthermore, as a result of the COVID-19 pandemic’s impact on their agencies, both DOE and SSA 

experienced delays in providing information and/or documentation to DEEOIC. While DEEOIC cannot control the 

availability of records from other federal agencies, the concern raised by claimants and authorized representatives 

is that DEEOIC had continued to adjudicate claims without relevant evidence, and in doing so, had not fully 

informed claimants of the unavailability of records that are routinely provided to DEEOIC. We recommend that 

DEEOIC inform all impacted claimants and their authorized representatives in writing, ideally in the development 

letter, when it is unable to obtain evidence from specific agencies. Such notification would prevent claimants 

from unknowingly spending time and resources requesting information from the agencies unable to provide the 

documentation and allow them to focus on other ways to potentially obtain evidence.

Claimants are required to submit evidence under specific deadlines set by DEEOIC. However, it appears to be 

entirely up to the claims examiner to determine what and when information as to the timing of activities in the 

adjudicatory process will be shared with claimants. We suggest DEEOIC consider sharing with claimants the 

timelines for the issuance of decisions as well as routinely update claimants regarding the status of their claims, 

particularly when there are delays in the adjudication process. This would enable claimants to have a reasonable 

expectation regarding when they would receive a decision or move on to the next phase of their claims adjudication. 

This would also help claimants to be prepared for the next steps in their claims and less anxious regarding 

their claim status. Increased communication would create greater transparency and promote greater claimant 

understanding, as well as trust in the process.

In 2021, DEEOIC created a Customer Experience Team (CX) within the Branch of Outreach and Technical 

Assistance (BOTA) consisting of a Stakeholder Engagement Analyst and a Customer Experience Strategist. 

According to DEEOIC, the mission of this team includes soliciting feedback from stakeholders, conducting analysis 
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of data, and making data-driven recommendations for programmatic and procedural improvements. Consistent 

with our recommendations in this and previous annual reports to Congress, we encourage DEEOIC to create 

a single point of contact to receive complaints from stakeholders. Now that DEEOIC has implemented the CX 

Team, we suggest DEEOIC utilize the CX Team as that single point of contact. This team should, at a minimum, 

acknowledge receipt of complaints and provide the complainant with a response. In doing so, the single point of 

contact could help alleviate concerns of retaliation expressed by claimants and authorized representatives despite 

our assurances that DEEOIC is committed to hearing and addressing their complaints. A single point of contact 

could give claimants confidence that their complaints would be received, acknowledged, responded to, and kept in 

confidence. 

5. Issues Related to Impairment Claims: Any physician who wishes to provide an impairment rating for a DEEOIC 

claimant must submit credentials to DEEOIC that verify their qualifications to conduct an impairment rating 

consistent with the AMA’s Guides to the Evaluation of Permanent Impairment, 5th edition. It was brought to our 

attention in 2021 that DEEOIC nurse consultants were analyzing the impairment evaluation reports submitted by 

physicians whose qualifications to conduct impairment ratings had already been approved by DEEOIC. We are 

concerned that claimants and their authorized representatives are not being provided copies of notes or guidance 

provided by nurse consultants as part of the claims adjudication process. Absent the ability to read and potentially 

rebut the opinion of a nurse consultant, claimants appear to be at a disadvantage as they seek to understand the 

posture of their claim. Claimants and their authorized representatives find it helpful to be aware of contradictory 

opinions and/or information that may impact their claim for benefits. Moreover, it is important for them to 

understand when and who has provided that information and be afforded an opportunity to review and respond 

prior to a decision being issued in their case. 
10 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

TABLES

Background

The Office of the Ombudsman is required to submit to Congress an Annual Report that sets forth: (1) the number 

and types of complaints, grievances, and requests for assistance that we receive in the preceding year, and (2) an 

assessment of the most common difficulties encountered by claimants and potential claimants received in the 

preceding year. 42 U.S.C. § 7385s-15(e)(2). Setting forth the number and types of complaints, grievances, and 

requests for assistance that we receive in the calendar year is often a challenge.

First, each claimant we encounter comes with their own unique set of problems which they articulate to us in their 

own unique manner. Under these circumstances identifying the type or nature of a complaint can be difficult since 

claimants rarely express their concerns using the terms and phrases commonly utilized by those who administer 

the program.

Second, the Office typically attends 20-25 in-person outreach events each year, and at those events we hear from 

many potential claimants, claimants, authorized representatives (AR), and health care providers. Meeting in person 

affords us the time to connect with individuals and hear not only their initial questions or concerns, but their whole 

story, which frequently reveals additional questions, concerns, and requests for assistance. During 2021, as a result 

of all in-person outreach events being cancelled, our opportunities to connect with and to assist the claimant 

community at in-person outreach events were eliminated. 

Moreover, when our Office hosts in-person outreach events, we routinely provide notice to those living in a large 

geographical area around each event location. While those who live farther away from the event location may not 

be able to attend the event itself, we have found that many people contact our Office by telephone or email after 

receiving notice of the event. And it is in these conversations that we also hear the questions and complaints of 

claimants in that particular area of the country. Furthermore, identifying the specific complaints, grievances, and/

or requests for assistance raised by claimants is generally achieved by asking questions, and obtaining additional 

documents that shed light on the claimants’ concerns. Unfortunately, the inability of our Office to attend or host inperson outreach events had an impact on the number of individuals we communicated with and assisted in 2021.

In the table that follows, the focus is on the concerns or requests that prompted the claimant to contact us, 

not every issue that was discussed in the conversations that ensued in order to provide the claimant with a full 

understanding of the EEOICPA and the EEOICPA claims process.
11 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

table continued on next page

NATURE OF COMPLAINT NUMBER OF 

COMPLAINTS

Difficulties collecting records/evidence

Employment records 8

Exposure records 11

Concerns with the dose reconstruction 4

Concerns with information found in SEM 6

Difficulties establishing terminal status 4

Difficulties establishing causation 27

Request for assistance 48

Request for status of claim 26

Issues involving interactions with staff of DEEOIC

Telephone calls not returned/cannot get through 23

Rude and/or insensitive behavior 9

Complaints involving claims for impairment 13

Complaints regarding Contract Medical Consultants and Industrial Hygienists 15

Complaint concerning the cap on benefits 1

Requests for assistance with issues concerning RECA claims 1

Medical Benefits

Difficulties obtaining authorization for and/or complaints regarding the denial of a 

requested medical benefits 

12

Issues involving home health care benefits 13

Complaints alleging a delay in the processing of a claim 23

Claimant needed assistance verifying that he/she was a covered employee or 

worked at a covered facility

5

Difficulties establishing survivor eligibility 6

Difficulties establishing eligibility in a SEC class 2

Difficulties obtaining payment of a medical bill 34

Difficulties with use of medical benefits card 13

TABLE 1

COMPLAINTS, GRIEVANCES, AND REQUESTS FOR ASSISTANCE BY NATURE OF 

COMPLAINT
12 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

NATURE OF COMPLAINT NUMBER OF 

COMPLAINTS

Difficulties establishing diagnosed illness/consequential illness 8

Reopening/Reconsideration issues 5

Take home toxins 1

Miscellaneous 26

TOTAL 344

TABLE 1, cont’d.
13 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

table continued on next page

TABLE 2

COMPLAINTS BY FACILITY

In order to assist claimants, it is not always necessary to identify the facility where the worker was employed. 

Moreover, even when identifying the facility is necessary, this does not suggest any fault on the part of the facility. 

Rather, the intent of the Table of Facilities is to illustrate the reach of this program and the need for more outreach. 

Claimants who worked at facilities all across this country contact us with complaints, grievances, and requests 

for assistance. Some of the facilities on this Table employed large numbers of employees, while others employed 

smaller numbers. Some operated as covered facilities for many years, while others engaged in covered employment 

for a relatively short period of time. Yet, regardless of the size of the facility or the number of years it operated as a 

covered facility, there are those who work, or once worked, at these facilities, who have questions and concerns that 

need to be addressed. 

FACILITY LOCATION NUMBER OF 

COMPLAINTS

Amchitka Island Test Site Amchitka Island, AK 1

Area IV of the Santa Susana Field Laboratory Santa Susana, CA 6

Electro Metallurgical Niagra Falls, NY 1

Feed Materials Production Center Fernald, OH 4

General Electric Company Cincinnati/Evendale, OH 1

Hanford Richland, WA 11

Idaho National Laboratory Scovile, ID 5

Kansas City Plant Kansas City, MO 1

Kerr-McGee Crescent, OK 1

Lake Ontario Ordnance Works Niagara Falls, NY 1

Los Alamos National Laboratory Los Alamos, NM 2

Nevada Test Site Mercury, NV 1

Oak Ridge Oak Ridge, TN 1

Oak Ridge Gaseous Diffusion Plant (K-25) Oak Ridge, TN 4

Oak Ridge National Laboratory (X-10) Oak Ridge, TN 3

Oak Ridge Y-12 Plant Oak Ridge, TN 4

Ore Buying Station at Grants, NM Grants, NM 1

Pacific Proving Ground Marshall Islands 1

Paducah Gaseous Diffusion Plant Paducah, KY 7

Pinellas Plant Clearwater, FL 1

Portsmouth Gaseous Diffusion Plant Piketon, OH 6

Rocky Flats Plant Golden, CO 3
14 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

TABLE 2, cont’d.

FACILITY LOCATION NUMBER OF 

COMPLAINTS

Savannah River Site Aiken, SC 8

Simonds Saw & Steel Co. Lockport, NY 1

Uranium Mines Various Locations 2

TOTAL 77
15 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

CHAPTER I. 

EEOICPA AWARENESS AND OUTREACH EFFORTS 

For individuals who worked, or continue to work, in service of our nation’s nuclear weapons program, awareness of 

the EEOICPA is contingent upon a variety of factors, including where they worked, when they worked, and whether 

they continue to live in the vicinity of the nuclear weapons facility/employer. A primary means of learning of the 

EEOICPA has been in-person outreach efforts conducted by DEEOIC, the Joint Outreach Task Group (JOTG)3

, and 

associated federal agencies. Unfortunately, in 2021, the COVID-19 pandemic continued to prohibit all in-person 

outreach efforts. As in 2020, DEEOIC maintained a schedule of monthly webinars. In total, DEEOIC hosted ten 

webinars from January through October 2021, with the Offices of the Ombudsman for the EEOICP and NIOSH 

providing the content for one of the webinars. These webinars afforded attendees an opportunity to learn about 

specific EEOICPA-related topics and pose written questions to the panelists. However, it is unlikely those without 

reliable internet access learned of the webinars or were able to attend. This is particularly true for areas of the 

country where internet service is spotty or for those who cannot afford internet service or the devices necessary to 

participate in online events. Claimants of advanced age have also frequently informed our office that they do not 

own or use personal computers or other such devices. 

In addition to the lack of in-person outreach events in 2021, DEEOIC Resource Centers were also closed to 

visitors through April, which prevented claimants and potential claimants from receiving in-person assistance. In 

approximately May of 2021, the Resource Centers reopened to visitors by appointment only and remained in that 

posture through the end of 2021. While necessary, such limitations undoubtedly impacted the ability of claimants 

and potential claimants who live in the vicinity of one of the eleven Resource Centers to stop in to speak with 

Resource Center staff and/or review documents with them. Thus, the unprecedented challenges of providing inperson contact in 2021 returned our attention to the ongoing need for alternative avenues of outreach to inform as 

many potential claimants as possible of the existence of the EEOICPA. 

Regardless of the circumstances, one of the most effective ways for potential claimants to learn of the EEOICPA 

is to be notified directly. By way of background, since 2013 this office has reported about DOE employee rosters 

maintained by the Department of Energy’s Former Worker Medical Screening Programs (FWP) that have been 

utilized to notify potential EEOICPA claimants of in-person outreach events.4 See Office of the Ombudsman 2013 

Annual Report to Congress, p. 16 (August 12, 2014). Our office has consistently recommended that DEEOIC, the 

DOE and the DOE FWPs work together to more broadly utilize these rosters to directly inform any/all potential 

claimants of the existence of the EEOICPA, regardless of whether an outreach event has been scheduled near them.

To put the issue in context, beginning in 2014, DEEOIC seemingly refuted that updated DOE rosters existed, stating, 

Unfortunately, neither DOL nor DOE has access to the current addresses of many employees who worked for the 

hundreds of contractors and subcontractors in the nuclear weapons complex starting in 1942. In fact, no such 

compilation of updated addresses is known to exist so direct outreach to potential claimants could not be done. 

See DOL’s Response to the Ombudsman’s 2014 Annual Report to Congress, p. 2 (October 14, 2016).

3

 The Joint Outreach Task Group is comprised of DEEOIC, DOE, DOE FWPs, DOJ, NIOSH, the Office of the Ombudsman for the EEOICPA, and the 

Ombudsman for NIOSH.

4 The DOE employee rosters have primarily been used by the FWPs to communicate the opportunity for free medical screenings to former DOE workers.
16 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

DEEOIC’s refutation was confusing in light of the 2014 DOE FWP Annual Report which stated, 

To locate former workers who may be eligible to participate in the [FWP] program, EHSS works closely with 

DOE Headquarters program offices to obtain rosters of former workers from site contractors, as well as field 

and site offices. Rosters are lists of names, along with other identifying information, of former DOE workers 

that may be available from employers or DOE.

**********

Invitations are sent by the FWP projects to employees on the rosters they receive from DOE, using the last known 

addresses. When addresses are found to be outdated or inaccurate, supplemental outreach methods are used 

by FWP projects; these include address-update services, such as credit bureaus, or Internal Revenue Service 

mailing services. [T]he availability of rosters varies greatly by site.

**********

The FWP projects provided support for seven outreach events sponsored by DOL. The assistance included 

mailing invitations to former workers regarding the upcoming events, distributing outreach materials for the 

events in the local communities, locating facilities where the events could be held, as well as having FWP project 

staff attend the events to support DOL and provide information regarding the FWP. See Former Worker Medical 

Screening Program 2014 Annual Report, p. 5-6, 18.

Over the years, our office continued to recommend in each annual report to Congress that DEEOIC work in 

conjunction with DOE and the DOE FWPs to send notices and information regarding the EEOICPA directly to 

former workers. DEEOIC’s responses to such recommendations have pointed to the other forms of outreach it 

conducted5

; to its inability to use the mailing lists and rosters due to privacy concerns6; its reliance upon the FWP 

mailing lists when appropriate for an outreach event7; and to utilizing the mailing lists to send more than 54,300 

invitations, letters and postcards8.

In their response to the Office of the Ombudsman’s 2020 Annual Report to Congress, the Office of Workers’ 

Compensation Programs (OWCP) and DEEOIC stated they would continue to look for ways to conduct more 

in-person outreach as the pandemic comes to a close and would work with the former worker programs to have 

targeted mailings advertising such outreach events in order to reach those without internet access. See OWCP 

Response to the Office of the Ombudsman’s 2020 Annual Report to Congress, p. 2 (December 29, 2021). 

DEEOIC’s intention to work with the FWPs to conduct targeted mailings for outreach events remains helpful but 

is insufficient when limited to advertising in-person outreach events which may not be feasible due to pandemic 

concerns or limited resources. Therefore, the Office of the Ombudsman again recommends coordination 

between DEEOIC and the DOE FWPs to provide notice and information directly to former workers (potential 

claimants) for whom the DOE FWPs have updated mailing lists and/or employee rosters. 

It is important to note that the FWP 2014 Annual Report indicated that as of September 30, 2014, the FWP 

projects had attempted to contact over 800,000 potential FWP applicants. See Former Worker Medical 

Screening Program 2014 Annual Report, p. 6. On the other hand, DEEOIC customarily only sends invitations to 

individuals who have already filed a claim for benefits and the scale of such contacts on an annual basis is smaller 

than that reported by the FWPs. It is our belief that over the past two decades, had DEEOIC forged an agreement 

or understanding with the DOE FWPs to mail notices and information directly to all the former workers on its 

rosters, it is likely that far more individuals and/or their survivors would have learned of the EEOICPA.

5 See DOL’s Response to the Office of the Ombudsman’s 2015 and 2017 Annual Reports to Congress. 6 See DOL’s Response to the Office of the Ombudsman’s 2016 Annual Report to Congress. 7 See DOL’s Response to the Office of the Ombudsman’s 2018 Annual Report to Congress. 8 See DOL’s Response to the Office of the Ombudsman’s 2019 Annual Report to Congress.
17 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Based upon the feedback and complaints received by our office, for those potential claimants who do not reside 

within the mailing radius to receive notice of an in-person outreach event, the effect is that they may never learn 

of the EEOICPA or may be delayed in learning of the EEOICPA. These individuals face a number of consequences 

as the result of delayed notification of the EEOICPA, including being unable to obtain medical and/or employment 

records that are necessary to prove their claim.9 Moreover, coverage for medical benefits under the EEOICPA does 

not begin until the date the claim for benefits is filed. Therefore, the longer it takes an individual to file a claim, 

the less medical benefits coverage that person is entitled to for an accepted medical condition. Finally, by virtue 

of statutory limitations, some children of former workers who filed claims for survivor benefits are ineligible for 

benefits under Part E, and such limitations would not have negatively impacted a claim filed by the former worker 

and/or their surviving spouse had they received prompt notice of the EEOICPA. 

As in 2020, our recommendation is for DEEOIC to expand its efforts to directly contact those who do not live 

within the mailing radius for an in-person outreach event by contacting them directly utilizing the DOE FWP 

rosters. While contacting as many of the thousands of former workers as possible is the goal, it is one that can be 

achieved in stages with thoughtful planning and hopefully with the highest priority given to those areas where no 

outreach has been conducted to date. Given the challenges of the past two years it is imperative for DEEOIC to 

move beyond its previous efforts to provide timely notice of the EEOICPA to all workers and their families. 

Unfortunately, the DOE does not have rosters for those who worked at Atomic Weapons Employer (AWE) facilities 

or for Beryllium Vendors. This means that DEEOIC cannot rely upon DOE for assistance in contacting the current 

and former workers of these 193 AWE facilities or 74 beryllium vendors.10 As such, our Office encourages DEEOIC 

to continue expanding its outreach efforts directly to those who worked for these employers.

9

 It is our understanding that most hospital and medical providers follow record retention laws set by the state and many of these laws do not require retention 

of records beyond 5-7 years.

10 The DOE created a Facility List database to provide public access to summaries of information collected on the facilities listed in the Federal Register. The 

summary for each facility includes the facility name, state, location, time period, facility type, and facility description. https://ehss.energy.gov/Search/

Facility/findfacility.aspx.
18 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

CHAPTER II.

MEDICAL BILLING AND TREATMENT 

AUTHORIZATION ISSUES 

Claimants appreciate and value the EEOICPA medical benefits coverage for accepted covered illnesses. Medical 

benefits coverage begins on the date a claim is filed for an illness that is later accepted under Part B or Part 

E and covers all related medical expenses without co-payments or deductibles. Unfortunately, over the past 

few years, claimants have begun to question the value of this benefit considering the growing list of hurdles 

they must sometimes overcome in order to receive authorization for medical treatment and/or payment of 

medical expenses. Claimants also question the value of DEEOIC medical benefits when they are unable to find 

a physician, hospital, home health care company, or other medical provider to treat them who will participate in 

DEEOIC medical benefits processes.11 In addition, claimants, their family members, authorized representatives, 

and health care providers filed complaints with our office in 2021 regarding what was described by one as a 

byzantine struggle for information and assistance.

The EEOICPA states that a claimant with an accepted covered illness shall be furnished with the services, 

appliances, and supplies prescribed or recommended by a qualified physician for a covered illness that the 

President considers likely to give cure, relief, or reduce the degree or period of that illness. See 42 U.S.C. § 

7384t(a). The EEOICPA also provides for necessary and reasonable transportation and expenses incident to the 

securing of such services, appliances, and supplies. See 42 U.S.C. § 7384t(c). 

For the past ten years, claimants have complained of difficulties finding health care providers, as well as what 

some have characterized as a decline in the number of health care providers who accept payment for medical 

services from the DEEOIC.12 As discussed in our 2020 Annual Report to Congress, the transition to a new medical 

bill processor for the payment of all non-pharmacy related medical bills resulted in confusion and significant 

delays in payments.13 Problems with the new medical bill processor for DEEOIC continued into 2021. And 

finally, for claimants and authorized representatives seeking assistance with obtaining authorization for medical 

treatment or payment of medical bills, our office received complaints regarding difficulties in identifying and 

communicating with those who could provide meaningful assistance. 

A. Complaints Related to the New Medical Billing Contractor 

In April 2020, DEEOIC transitioned to a new medical bill processing contractor, CNSI. As discussed in the 

2020 Annual Report to Congress, the transition did not go quite as smoothly as planned and our office received 

complaints from various stakeholders. In 2021, a little over a year following the transition to CNSI, our office 

received a complaint from a large health care system comprised of multiple hospitals. The health care system’s 

accounting office stated that their collective hospitals had almost $20 million dollars in unpaid claims and that 

much of the unpaid amounts related directly to CNSI computer programming issues that had not been disclosed. 

Because the health care system had already engaged with CNSI in an effort to resolve the problems, a detailed 

description of their issues was provided to the Office of the Ombudsman as follows:

11 Depending on the type of medical treatment recommended, the claimant and their physician may have to engage in a process to obtain authorization from 

DEEOIC for the claimant to receive the treatment. 

12 See 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, and 2020 Office of the Ombudsman Annual Reports to Congress. https://www.dol.gov/agencies/

ombudsman

13 In April 2020, DEEOIC transitioned to a new medical bill processor, CNSI, but maintained its contract with Conduent for processing claims for prescription 

medication.
19 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Our office received notification that we could begin submitting electronic claims to CNSI in August of 2020... 

After attempts to submit electronic claims for several months, we questioned why these claims were consistently 

rejected. In January 2021, we discovered through our claims clearing house vendor that no provider in the 

United States had successfully submitted and received payment on an electronic claim through CNSI. 

In April [2021], CNSI representatives agreed to have regular calls (twice a week) to work through claims 

processing issues...In the interim, CNSI offered to implement a process to circumvent the issue that entailed 

CNSI manually adding information to electronic claims to force them through their system. This process has 

proved cumbersome and difficult to monitor.

Prior to getting CNSI’s acknowledgment and workaround, any provider wishing to have claims processed and 

paid by CNSI was forced to revert to a paper claim and medical records submission. This process is extremely 

costly and time consuming in labor, paper, and postage. Many medical records are hundreds of pages, and we 

must send certified mail. We ended up submitting nearly a thousand claims via paper as we could not get 

electronic claims to process with CNSI. In addition, due to CNSI losing portions of multiple-page claims, their 

representatives advised our office to suspend submitting multiple-page claims. Multiple page claims inherently 

contain large volumes of services, representing greater charges for services. Stopping these claims meant providers 

had no claim submission alternative for those higher cost services.

**********

The transition to CNSI has proven a significant undue burden on healthcare providers who are treating the 

employees covered under the DOL workers compensation program. (April 2021 email from health system executive.) 

The complainant confirmed during a subsequent communication that EEOICPA claims represented a large 

portion of their outstanding claims, for example, of 709 outstanding claims between April 1 and April 29, 2021, 

667 were EEOICPA claims.14 It was also shared that the number would be much larger if all outstanding claims 

prior to April 1, 2021, and all outstanding Conduent claims were included. 

In addition to health care providers, authorized representatives and claimant advocates brought their concerns 

regarding payment of medical bills to OWCP, DEEOIC, and our office in 2021. Their perception was that DEEOIC 

views these issues one-at-a-time and suggested that instead it would be useful for DEEOIC and CNSI to audit bill 

processing performance, identify areas of wasted energy and repeatedly denied bills, and take affirmative action 

to get ahead of the issues rather than putting out individual fires. (May 20, 2021, letter from Alliance of Nuclear 

Worker Advocacy Groups (ANWAG) to the Director of OWCP.) They also provided examples of outstanding 

medical bills that had been referred to collection agencies despite the efforts of authorized representatives to 

resolve the issues with DEEOIC and CNSI. OWCP responded, in part, that “...neither DEEOIC nor OWCP can 

control a provider’s decision to institute collections efforts against a claimant when bill payment is delayed. 

DEEOIC, DAO, and CNSI have been working diligently to resolve identified issues with the bill payment process 

and have been working one-on-one with many providers to help them resolve issues with their internal billing 

systems and protocols.” (July 13, 2021, correspondence from OWCP to ANWAG.) OWCP further stated, “Under 

DEEOIC regulations, OWCP is the first biller for medical services related to an accepted clam. Neither OWCP nor 

CNSI are able to address billing issues that stem from a provider’s decision to bill other carriers rather than the 

primary payer on accepted cases.” (July 13, 2021, correspondence from OWCP to ANWAG.) While the responses 

14 CNSI, Inc. is the medical bill processing contractor for all OWCP programs, which includes the Federal Employees’ Compensation Act (FECA) Program, 

the Longshore and Harbor Workers’ Compensation Act Program, and the Black Lung Benefits Program. 
20 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

from OWCP are accurate, claimants and authorized representatives reported that it would nonetheless be helpful 

to receive additional assistance from DEEOIC and CNSI when their outstanding medical bills were referred to 

Medicare, private insurance, or collections. 

Another institutional provider contacted our office for assistance when they began to see an increasing number 

of medical bill claims denied as “procedures not related” to a covered illness. The provider noted, 

We appeal these without success showing the eligibility or CPT/Crosswalk and have called repeatedly but 

the customer service representatives will not send claims back for review saying we must complete an online 

adjustment even when there is not an adjustment to make. They do not have many answers to our questions. 

Processing of claims has changed completely with the change to CNSI, and not in a good way unfortunately, 

and we would appreciate some information about how we can help the difficulties with getting these claims 

processed that are supposed to be processed by the DOL. (May 19, 2021, email from health care provider.) 

A physical therapy provider reached out to complain after receiving authorization to provide treatment for 

multiple claimants from an MBE but later learned that the bills for treatment had been denied by CNSI. The 

provider indicated that when they were able to reach someone at CNSI, they were informed that the claims had 

been escalated, only to find out later that they had not. In contacting our office, the provider conveyed that it 

was most frustrating not knowing who to contact outside of CNSI for help. It seemed to this provider that CNSI 

was not familiar with DEEOIC policies and procedures. While continuing to provide services to claimants with 

authorization for physical therapy, the associated delays in payment had an impact on the provider’s ability to 

meet payroll. The provider also alluded to software problems with CNSI and inquired if our office was aware of 

any such problems.

Later in 2021, an authorized representative contacted our office with over $15,000 in unpaid, out-of-pocket nursing 

home expenses and seeking assistance to determine why CNSI was taking so long to pay the bills. The authorized 

representative relayed that he/she had made numerous telephone calls to CNSI and to the DEEOIC MBE and 

that while the MBE was able to assist him/her with some previous bills, the MBE was now no longer responsive. 

Moreover, CNSI repeatedly informed the authorized representative that the paperwork submitted with the medical 

bills was correct and that the bills were “in process.” However, the payments were not received by the claimant, 

and the authorized representative found that the CNSI personnel who answered customer service questions 

were unable to provide an explanation regarding his/her specific billing issues. The CNSI personnel purportedly 

described their role as “simply a call center” and unable to provide more in-depth assistance. It was the 

authorized representative’s observation that the only input CNSI had into the process was to refer a bill back to 

another office for review and to repeatedly delay payment to the person entitled to DEEOIC benefits. (September 

8, 2021, email from authorized representative.) With the permission of the authorized representative, our office 

sought assistance from DEEOIC. It is our understanding that the outstanding bills were ultimately paid, but we 

were not informed of the exact nature of the problems nor the process by which they were resolved.

And finally, an authorized representative for a claimant with neuropathy contacted us after three of his/her 

medical bills were rejected by CNSI. According to the Workers’ Compensation Medical Bill Process (WCMBP) 

online portal the claimant’s approval codes were accurate but the billing codes for services rendered were 

rejected, and the provider was allegedly unable to speak with anyone at CNSI who could assist them. The 

provider had informed the authorized representative that the claimant’s family would have to pay out-of-pocket 

if payment were not received from DEEOIC prior to the next billing cycle. It was unclear why CNSI was not able 

to directly assist the provider and/or authorized representative. It was also unclear whether CNSI had contacted 

DEEOIC for assistance or clarification of any relevant billing information.
21 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

B. Inadequate Assistance with Medical Bill Coding Issues

Medical bill coding issues are some of the more complex problems for claimants to understand, let alone resolve. 

However, when a claimant’s name is on the medical bill and it remains unpaid, regardless of the reason, they are 

held responsible for payment. In 2021, we received complaints regarding coding issues in a variety of cases with 

the following general scenarios:

• the health care provider made an error in the medical bill coding. 

• the health care provider used an ICD-10 code for a covered illness that had been accepted under an ICD-9 code. 

• complete and accurate coding was not entered into the DEEOIC database.

• the transition from Conduent to CNSI impacted the codes appearing as accepted.

• CNSI programming rejected all codes submitted electronically for a period of time.

For some claimants, more than one of the scenarios listed above were at play in their claim, and for all claimants, 

assistance was necessary to resolve the problem. One claimant had two identical procedures performed on 

the same day for two accepted cancers. The bills were rejected by DEEOIC/CNSI and ultimately referred for 

collection. Claimant’s authorized representative was unable to determine the specific reason for the denial and 

later received detailed information from DEEOIC to relay to the health care provider. Unfortunately, the health 

care provider had already referred the outstanding bills to Medicare, which added another level of complexity to 

the requirements set forth to resolve the problem. 

Another claimant had a number of billing issues related to ICD coding problems. The claimant believed the 

problems had been resolved until they began to receive collection notices. It appeared the problem stemmed from 

both the conversion/migration to CNSI as well as the provider using an incorrect ICD code. In two other cases 

outstanding medical bills were sent to collections by the health care providers. In one case, CNSI did not have 

the correct ICD-10 code assigned to the claim by DEEOIC. In the other case, the provider did not use the correct 

ICD-10 code for the accepted medical condition. The Resource Center was solicited to provide assistance with the 

coding issues in these cases and endeavored to bring DEEOIC, CNSI and the provider onto the same page in order 

to resolve the issues. The ultimate outcome of the Resource Center’s efforts was not reported to our office.

One authorized representative brought to our attention the fact that while the Workers’ Compensation Medical 

Bill Processing Portal permits claimants to view medical eligibility, authorization, case status and bill status, it 

appeared to him/her as if the system was not designed for claimants to self-diagnose billing issues. Likewise, 

the authorized representative conveyed that it did not seem as if the Resource Center staff, who always strive 

to be helpful, were trained to identify and address the specific coding issues that were at the root of some of the 

rejected medical bills. It was reported that while the Resource Center staff did provide information and direction 

for claimants when they spoke to their health care providers, MBEs, and/or CNSI, it would be helpful for a more 

systemic approach to be implemented with an eye towards more instruction and proactive involvement of the 

Resource Center or other relevant DEEOIC offices. 

The problem of outstanding medical bills being referred to collection agencies was an issue that became more 

apparent in 2021. For claimants and their families who are navigating the health care system in order to receive 

timely and appropriate medical treatment for a covered illness, the appearance of a collection notice from one 

of their health care providers was a cause of immediate, added stress. While some may question why a claimant 

would consent to pay a deductible or co-payment to Medicare or a private insurance company for medical 

services that are covered 100% under the EEOICPA, the answer becomes a bit clearer when it is understood that 

the alternative may mean spending significant time and energy delving into the world of medical bill coding and/

or frequent communication with the various offices that play a role in medical bill processing, not to mention the 

threat of ruined credit that has a broader impact on the claimant and their family. 
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C. Difficulties Obtaining Assistance with Medical Billing

Ultimately, each outstanding medical bill from a hospital, physician, or other medical provider represents an 

EEOICPA claimant whose medical bills are unpaid. The challenge for claimants and providers alike is determining 

how to resolve unpaid bills. It is our understanding that some health care providers worked directly with CNSI and 

Conduent regarding billing issues, yet others processed the outstanding bills through other insurance such as the 

claimant’s private health insurance or Medicare. Other providers referred outstanding bills to collection agencies. 

It has been our experience that when claimants learn of outstanding medical bills that they believe should have 

been paid by DEEOIC, they are uncertain who to contact for assistance. Some claimants contact their claims 

examiner or medical benefits examiner. Others may contact a Resource Center or CNSI/Conduent directly. And 

others contact our office when they do not know who to contact or feel they have been given the run-around. 

In 2021, claimants continued to report feeling that they were “getting the run-around” because they were unable 

to speak to someone who could promptly resolve their problem, or they were informed that they needed to speak 

to another person or another office. Frequently claimants who contacted our office had been informed to have 

another party take action to resolve the problem, but upon contacting that party were informed that the party did 

not have all the information needed to address the problem or did not know how to address it. 

Another point made to our office was, “...many claimants and medical providers decide to [submit] medical bills 

through Medicare or private insurance rather than dealing with DEEOIC’s bureaucracy. They would rather pay 

their Medicare/private insurance deductible and co-pay than deal with the often, lengthy process with DEEOIC.” 

May 20, 2021, letter from Alliance of Nuclear Worker Advocacy Groups (ANWAG) to the Director of OWCP. 

At least two claimants who contacted our office seeking assistance in 2021 had received letters from Medicare 

regarding medical bills paid by Medicare for treatment that Medicare believed was related to their accepted 

covered illnesses under the EEOICPA. The claimants were somewhat relieved when we informed them of Circular 

21-01, Reimbursement Letter to Government Entities or Insurance Carriers (August 4, 2021). Upon receiving 

correspondence from a claimant, this circular instructs the payment systems manager of the DEEOIC Medical 

Bill Processing Unit to send a letter to the government entity (e.g., Medicare) or the private insurance carrier 

instructing them to submit all reimbursable charges, including a copy of the original bill and proof of payment, to 

the bill-processing contractor (CNSI). This letter should allow for DEEOIC to obtain the necessary documentation 

to reimburse the government entity or insurance carrier for any medical bills related to claimant’s accepted 

covered illness(es). However, since informing the claimants of this circular we have yet to learn whether DEEOIC 

has written such letters to a government entity or private insurance carrier, or whether DEEOIC has reimbursed 

Medicare and any other private insurance company for payments related to accepted covered illnesses. 

A claimant with a consequential illness that resulted in the complete loss of his/her teeth contacted us when the 

completion of the dental restoration procedures was cancelled due to the amount of unpaid invoices for prior 

treatment. The claimant indicated he/she was unable to eat properly, and that his/her nutrition and health status 

was impacted by the delayed treatment. After the claimant’s authorized representative contacted our office for 

assistance the provider was informed by DEEOIC that the issue involved the type of form the provider had used 

to submit the medical expenses. It is unclear how many patients with DEEOIC medical benefits coverage are 

treated by this provider, but it is apparent that the claimant, the claimant’s authorized representative, and the 

provider were unable to identify the nature of this issue and find the solution absent DEEOIC’s assistance.
23 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

We also heard from a claimant who in November 2020 received medical tests as part of the impairment 

evaluation process for his/her accepted illness. Our office was contacted in April 2021 after the claimant received 

a $1,700 bill in the mail for those medical tests. The claimant explained that prior to obtaining the tests DEEOIC 

had specifically authorized them. However, unbeknownst to the claimant, the licensing information for the 

health care provider had expired and therefore CNSI denied payment for the bills. The next few months involved 

communication between the claimant, our office, the DEEOIC Medical Bill Processing Unit and the health care 

provider before the bill was eventually paid in mid-August 2021. Prior to contacting our office, the claimant had 

no understanding of the issue or how to get it resolved. We appreciate the efforts of the Medical Bill Processing 

Unit in this case and hope that similarly situated claimants receive assistance in resolving such issues. 

The two common threads that developed in our discussions of medical billing and payment issues were, 1) a 

lack of communication and transparency for claimants and providers when systemic issues were impacting 

DEEOIC and its contractors’ ability to provide timely service; and 2) the lack of a logical, streamlined process by 

which claimants and authorized representatives can understand who to contact for assistance and under what 

circumstances. 

During the time period from April 2020 through December 2021, we are unaware of any information displayed 

on the DEEOIC homepage regarding systemic issues that were impacting DEEOIC or its medical bill processing 

agent’s ability to provide timely service. Likewise, we are unaware of any information available to claimants 

other than the instruction to contact a Resource Center when they have medical billing questions or send an 

email to DEEOICbillinquiries@dol.gov.

15 Unfortunately, while the Resource Center staff does what it can to 

assist claimants, in our experience it is not uncommon for the resolution of medical billing issues to also involve 

assistance from MBEs, Medical Bill Processing Unit managers, CNSI staff, Conduent staff, and/or the medical 

provider’s billing staff. The claimant is the least experienced person in this equation yet suffers the consequences 

when those involved do not assist in resolving the problem in a timely manner. 

D. Difficulties Finding and Keeping Health Care Providers

The matter of finding a health care provider who can provide timely, competent care is of paramount importance 

to those with illnesses accepted under the EEOICPA. Most claimants had access to some level of health care in 

order to receive the diagnosis of an illness, however, fewer already have relationships with the specialty health 

care providers required to treat their illness. And an even smaller percentage already have relationships with 

home health care provides, durable medical equipment providers, and/or nursing homes. Claimants may access 

a portal on the DEEOIC website to see names of health care providers who have enrolled to receive payment 

from DEEOIC, and the Resource Centers have committed to directing claimants to this information on the 

DEEOIC website as well. However, some claimants were unsuccessful in searching the database and others 

were unsuccessful in finding the appropriate type of health care provider in the database. Despite the availability 

of this information on the DEEOIC website, our office received complaints from claimants and authorized 

representatives in 2021 who reported difficulties finding and keeping health care providers who accepted 

payment from DEEOIC. 

15 This DEEOIC billing inquiries email address is not available on DEEOIC’s website but was shared by DEEOIC during the question-and-answer session 

of the DEEOIC 2021 Stakeholder Update Webinar on July 14, 2021. It would be helpful to claimants and health care providers if this email address was 

displayed on DEEOIC’s website as an additional contact/resource.
24 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

A claimant residing in Alaska reported a four-hour trip each way for medical care that was complicated when “no 

one wants to take the EEOICPA card.” The claimant described spending significant time on the telephone trying 

to reach various providers who accepted payment from DEEOIC. He/she also described providing the DEEOIC 

medical benefits card at hospitals only to be informed that the provider would instead bill Medicare or his/her 

private health insurance. Another claimant relocated from California to Texas and contacted our office when he/

she did not know how to find medical facilities in the area that accepted payment from DEEOIC. And finally, a 

claimant contacted our office after unsuccessfully attempting to find a home health care provider in his/her area. 

When we directed claimant to the DEEOIC portal the claimant indicated the portal did not contain the names of 

any such providers in his/her area. In this situation we suggested the claimant contact the Resource Center or 

MBE for further assistance. 

When claimant advocates and authorized representatives brought these issues to the attention of OWCP, they 

received the following response,

The OWCP Division of Administration and Operations (DAO) oversees the contractual requirements of the 

central bill processing vendor, CNSI. Contractual responsibilities include, but are not limited to, provider and 

claimant outreach activities. Although stakeholders have raised the topic of providers’ reluctance to register 

or accept the Medical Benefits Identification Card (MBIC) during DEEOIC presentations or outreach events, 

DAO has not received any communication from claimants or medical providers regarding the above-referenced 

issues. DEEOIC, CNSI, and DAO staff work closely to ensure that OWCP claimant and provider enrollment 

concerns are addressed in an efficient and effective manner. Claimants and providers who contact DEEOIC or 

the DEEOIC Resource Centers to request help will receive one-on-one assistance with the registration and billing 

problems they present. In addition, CNSI outreach staff conduct and report weekly on their analysis of issues 

encountered via the IVR call center and incoming provider/claimant email communications. Quality control 

measures have been instituted via DAO staff review of incoming email communications submitted to the CNSI 

outreach email. 

**********

With regard to recruitment of medical providers, CNSI and DAO are active in conducting general and targeted 

recruitment activities in areas identified as being deficient in access to medical providers/services. These areas 

are identified via the process referenced above and by the OWCP program reporting deficiency and need to DAO 

and/or CNSI. Additionally, CNSI outreach staff conduct enrollment reviews for potential “desert” areas of medical 

service coverage. (July 13, 2021, correspondence from OWCP to ANWAG.)

This acknowledgment of the issues by OWCP is constructive and following this correspondence the authorized 

representative and claimant community have expressed interest in learning more about the efforts undertaken by 

CNSI and DAO to address these issues.
25 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

E. Difficulties and Delays in Receiving Medical Care

As is often the case, when a claimant or their authorized representative contacts our office with what appears 

to be one question or concern, by the end of the conversation it is apparent that there are multiple issues. This is 

particularly true when we are contacted by those with questions or concerns regarding authorization for medical 

treatment. The following are examples of claimants who contacted our office in 2021 and had multiple questions 

and concerns regarding their receipt of medical benefits and requested assistance after their efforts to receive 

assistance elsewhere had fallen short.

A claimant with laryngeal cancer contacted our office after his/her electrolarynx broke, rendering him/

her unable to speak. The claimant’s claims examiner directed the claimant to work with a medical benefits 

examiner to obtain a replacement electrolarynx. Because the original electrolarynx had been covered by the 

claimant’s EEOICPA medical benefits, the claimant expressed frustration that it took months for him/her to 

secure a new one. The claimant explained that the supplier of the device contacted the MBE on his/her behalf 

and was informed the claimant’s treating physician was required to write a letter of medical necessity before 

authorization for the replacement would be granted. This process was confusing and frustrating for the claimant 

whose efforts to assist in providing the requested documentation to DEEOIC were further hampered by his/

her lack of a printer or fax machine.16 Although not the initial reason for contacting our office, the claimant 

also shared that he/she had requested home health care benefits on August 3, 2021, and had not received 

a response by September 28, 2021. On October 4, 2021, after an inquiry was submitted by our office the 

claimant’s home health care benefits were approved. 

In mid-July 2021, a claimant’s spouse contacted our office for assistance with home health care benefits for a 

claimant who had lung cancer with metastasis to the brain. The claim for home health care benefits had been 

filed on June 11, 2021, and the claimant’s condition was terminal. The claimant’s spouse had already experienced 

frustration in speaking with the claimant’s MBE and a supervisor in the Medical Benefits Adjudication unit, in 

part, because the claimant had an authorized representative who was not involved with the claim for home health 

care benefits and therefore the claimant’s spouse was unable to obtain information from DEEOIC regarding the 

claim. The claimant’s spouse relayed that he/she was informed the claim was under review but that no further 

specific information was shared. In seeking to assist this claimant our office explained that DEEOIC required we 

obtain a Privacy Act Waiver signed by either the claimant or his/her authorized representative. Rather than delay 

matters any further, the claimant’s spouse assisted him/her in signing a Privacy Act Waiver for our office. Following 

our office’s contact with DEEOIC, the claimant’s home health care benefits were approved on July 22, 2021. 

A claimant in need of an air purifier to aid in the treatment of his/her symptoms from chronic beryllium disease 

(CBD)17 contacted our office through his/her authorized representative after receiving a copy of the letter 

DEEOIC sent to his/her treating physician. The letter sent to the treating physician who prescribed the air purifier 

took issue with the physician’s justification for the air purifier for the following reasons:

• You did not adequately explain the level of dust particles, nor did you identify “other contaminants that are 

found in the natural air” of the claimant’s home.

• Lack of objective evidence showing that the level of dust particles are outside acceptable ranges. 

• Lack of objective evidence showing that the air purifier is required based on current medical need and how it 

will treat the covered condition. 

16 Claimant shared that their child had to print documents for them, and their child lived 10 miles away.

17 CBD is a chronic respiratory illness for which there is no cure, and the illness normally progresses and worsens over time, eventually leading to severe 

respiratory compromise.
26 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

The MBE instructed the physician to respond to the issues listed above as well as provide a certified air quality 

assessment of the air inside the claimant’s home with the proper number of tests timed out appropriately. The 

physician was to then provide the reference range for each reading and identify which pollutants were out of 

range (beyond the “good” and “moderate” ranges), along with explanations as to how the out-of-range values 

were affecting the accepted conditions. The physician was asked to provide the requested information within 

15 days of the date of the letter. The authorized representative took exception to the requests made by the MBE 

for unspecified air quality testing to be identified and performed, with the results made available to DEEOIC 

accompanied by an explanation of the findings within 15 days of the MBE’s letter. The authorized representative 

further requested that DEEOIC issue a recommended decision denying the air purifier that included specific 

references based on scientific medical data that an air purifier would not likely give relief or reduce the degree of 

respiratory symptoms related to claimant’s CBD. 

This claim is an example of what some claimants and authorized representatives have characterized as DEEOIC 

seemingly “moving the goal posts” with respect to the medical evidence needed to support the treating 

physician’s request for medical treatment and/or durable medical equipment. Chapter 29 of the Federal 

(EEOICPA) Procedure Manual (PM) addresses ancillary medical benefits, which includes durable medical 

equipment such as an air purifier. See Federal (EEOICPA) PM Chapter 29, Version 5.0 (April 2, 2021). The PM 

outlines the developmental steps the MBE is to take in determining whether to authorize the requested durable 

medical equipment (DME). For more costly and complex services and equipment, DEEOIC provides detailed 

instructions regarding the evidence necessary to approve the authorization. However, in the list of equipment 

and services outlined by DEEOIC, an air purifier is not included, nor is the air quality testing detailed in the MBE’s 

letter to the physician in the example above.18 Claimants, authorized representatives, and physicians rarely seek 

out specific information in the 700+ page DEEOIC Procedure Manual, but instead they have an understanding of 

the type of medical evidence DEEOIC routinely seeks when determining whether to authorize particular services 

or equipment. In this case, both the claimant and the authorized representative complained that the nature of the 

evidence required by DEEOIC was beyond what was routinely sought for an item such as an air purifier. 

It also is unclear from the letter sent to the physician why such in-depth air quality testing is required to authorize 

an air purifier. Similarly, the reasonableness of the expectation that the physician would be able to comply with 

the testing requirements and provide the results within 15 days from the date of the letter is questionable.

In another instance involving durable medical equipment, the MBE wrote to the claimant that the evidence had 

failed to present a clear and convincing argument as to why the DME was indicated for his/her accepted covered 

conditions. The EEOICPA Regulations at 20 C.F.R. § 30.111(a) state that the claimant bears the burden of proving, 

by a preponderance of evidence, the existence of all criteria necessary to establish eligibility under the EEOICPA, 

and that proof by a preponderance of the evidence means that it is more likely than not that the proposition to 

be proved is true. Thus, the requirement that claimant submit a clear and convincing argument appears to hold 

the claimant to a higher burden than required by the regulations. This is another example in which claimants 

and their authorized representatives believed that the goal posts had been moved with respect to the criteria by 

which DEEOIC reviews their claims. 

Finally, our office was contacted by the authorized representative for a claimant with a terminal illness who was 

residing in a nursing home and wished to return home with home health care services. When we were contacted 

the request for home health services had been pending for 6 weeks and the authorized representative reported 

having contacted the claims examiner, the MBE, and the MBE’s supervisor in an effort to obtain authorization. 

18 Subsequent versions of the PM released on September 20, 2021, and April 4, 2022, also do not discuss the necessity for home air quality testing in order 

to authorize an air purifier. See Federal (EEOICPA) PM Version 5.1 (September 20, 2021) and Version 6.0 (April 4, 2022).
27 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Unfortunately, the claimant passed away prior to our office being able to determine whether he/she was able to 

receive the requested home health care services. 

Based upon the cases brought to our attention in 2021 we observed that medical benefits delayed were 

sometimes medical benefits denied, either because the treating physician had not responded to DEEOIC’s 

multiple requests for additional evidence, or the claimant was held to a higher standard than required. The 

common themes in the requests for assistance we received illustrate the need for consistency and efficiency. 

When an authorized representative complains of receiving letters from different claims examiners and medical 

benefits examiners on different cases involving similar requests for medical treatment and the development 

letters from those claims examiners and medical benefits examiners are quite different, the lack of consistency is 

concerning. When claimants and authorized representatives continue to reach out to our office knowing that they 

need assistance, and not fully understanding why they have not heard back from their claims examiner or medical 

benefits examiner, the need for greater efficiency is apparent. Among the priorities involved with managing life 

while dealing with a work-related illness, the added time and energy required to obtain the medical benefits that 

claimants believe they are entitled to under the EEOICPA has become an unwelcome burden. 
28 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

CHAPTER III.

DIFFICULTIES WITH PART E CLAIMS 

As in 2020, the vast majority of the contacts received in 2021 were from individuals who connected with us via 

mail, telephone, or email.19 Many of these individuals contacted us with questions, complaints, or requests for 

assistance concerning an ongoing claim or a claim that had been denied. The complaints received involving Part 

E claims highlighted the need for better communication between DEEOIC and claimants, as well as increased 

consistency during the claims adjudication process. The cases brought to our attention involved the use of 

the SEM database, industrial hygiene reports, and consequential illnesses. Other claimants brought concerns 

involving the occupational history questionnaire and the Statement of Accepted Facts (SOAF) sent from claims 

examiners to DEEOIC experts. 

A. Occupational History Questionnaire

The Occupational History Questionnaire (OHQ) is a form completed by Resource Center staff during an 

interview with a claimant who has filed a claim under Part E of the EEOICPA. According to the DEEOIC, 

Resource Center staff have 14 calendar days to complete the interview, which typically takes 2-3 hours 

to complete. The purpose of the OHQ is to collect relevant information from the claimant about the 

employee’s work history involving atomic weapons, including the employee’s work locations, job titles, 

work processes, and/or contact with specific toxic substances. See Federal (EEOICPA) PM Chapter 

10.5(a)(1), Version 5.1 (September 20, 2021). During the initial interaction with the claimant to schedule 

an OHQ, the RC staff is to advise the claimant that an authorized representative may be present during 

the OHQ as long as the claimant has registered their designated authorized representative with the 

DEEOIC. See Federal (EEOICPA) PM Chapter 10.5(a)(2), Version 5.1 (September 20, 2021). The RC 

interviewer will record narrative information collected during the interview in an electronic format 

that will enable the interviewer to print a completed OHQ at the conclusion of the interview. The RC 

interviewer is to record narrative responses in as accurate a manner as possible based on the verbal 

responses provided by the claimant. See Federal (EEOICPA) PM Chapter 10.5(b), Version 5.1 (September 

20, 2021). The following examples indicate the issues raised with our office regarding the OHQ:

An authorized representative shared a complaint with our office regarding inaccuracies in an OHQ 

as well as less than acceptable behavior by the RC staff who conducted the interview. The authorized 

representative described the unpleasant behavior by the RC staff in detail and indicated it caused 

inaccuracies in the information provided by the claimant as a result of him/her feeling pressured, rushed, 

and belittled at times. The authorized representative also pointed out a significant number of inaccuracies 

in the information recorded by the RC staff, some of which coincided with statements made by the RC 

staff discrediting the information provided by the claimant. 

As a result of the authorized representative contacting the office manager of the Resource Center and the 

DEEOIC National Office, an immediate response was provided to address the concerns raised involving 

the RC staff and the OHQ. However, the authorized representative noted, 

19 The COVID-19 pandemic safety precautions prevented the Office and other agencies involved with the EEOICPA from conducting any in-person outreach 

in 2021.
29 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

I appreciate everyone’s efforts and quick response regarding this situation. Honestly, [claimant] 

is older and ill, [he/she] often cannot think of things “on the spot” and often will remember things 

after the fact. I am so thankful I was present when the interview happened, as well as being able to 

assist [him/her] with reviewing the OHQ when we received it in the mail. This is exactly why AR’s, 

advocates, etc. should be allowed to assist with OHQs, because being ill and/or having cognitive issues 

may not always make for the best of recollections. I hope to see this issue as a whole addressed someday. 

(June 9, 2021, email from authorized representative.) 

The OHQ is a document based entirely upon the claimant’s recollection of his/her own work history at 

covered DOE facilities. It is used and relied upon by DEEOIC for many aspects of claims adjudication. 

DEEOIC assumes that the claimant will recall or have all of this information readily available to share 

during an interview that sometimes takes hours to complete. Almost all claimants are ill, many are 

elderly, and some have cognitive issues that may make it challenging for them to remember very specific 

facts regarding every aspect of the work they performed over the course of their DOE career. While 

claimants are informed in advance of the topics the OHQ will cover, it would be helpful for them to be 

provided a copy of the OHQ form prior to the interview, and as recommended by the ABTSWH, so that 

they could take notes and give their responses some thought ahead of time in order to respond fully and 

accurately to the questions. See ABTSWH Recommendations to Secretary of Labor, Recommendation 

No. 2 (April 20, 2020).20 Having a copy of the OHQ form would also help the claimants understand 

the questions being posed. It has also been reported to our office that RC representatives have denied 

claimants a blank copy of the OHQ for the claimant to follow along with during his/her OHQ interview. 

Many of the claimants who have contacted our office over the years were not aware of how the OHQ 

would be used in the adjudication of their claim, nor did they know how important it was to provide 

additional information to their claims examiner should they think of it after the OHQ was completed.21

We recommend DEEOIC also advise claimants how the information they share during their OHQ 

interview will be used in the adjudication of their claim, and inform them that they can review and amend 

their responses at any time by contacting their claims examiner.22

One source of information that would help claimants to refresh their recollection of their workplace 

exposures is the individual claimant’s employment records that DEEOIC requests and obtains from DOE 

at the beginning of the claims adjudication process. One of the initial developmental steps taken by a 

claims examiner in a Part E claim is requesting documentation from DOE with respect to the claimant’s 

employment, including medical records, personnel records, industrial hygiene records, incident and 

accident reports, and radiological and dose records. “The CE uses this evidence to establish any likely 

exposures the employee had to toxic substances. This evidence has very high probative value because 

it is documentation from DOE dated at the time of employment/exposure, (not documentation created 

years later or in conjunction with an EEOICPA claim).” (Emphasis supplied). Federal (EEOICPA) PM 

Chapter 15.5(c), Version 5.1 (September 20, 2021). We have found that most claimants are unaware 

that this evidence has been requested and obtained by DEEOIC and almost all express frustration when 

20 The Director of OWCP responded to this ABTSWH recommendation, stating, “DEEOIC agrees with the Board that providing claimants with better 

information about the OHQ process may also improve exposure data. Accordingly, DEEOIC will work to produce a notice or summary document to help 

claimants prepare for an OHQ. This process will be included in standard operating procedures for the Resource Centers this summer.” See DOL Response to 

the Recommendations from the April 2020 meeting of the ABTSWH (June 19, 2020). Based upon this response and feedback received from claimants, it 

appears that DEEOIC has not changed its policy to provide claimant’s a copy of the OHQ form prior to their interview. 

21 See Federal (EEOICPA) PM Chapter 15.5(e), Version 5.1 (September 20, 2021) for further information regarding the use of the OHQ in the claims 

adjudication process.

22 Following the interview, the OHQ is sent to the claims examiner assigned to the claim. Any further changes or amendments to the OHQ should be sent to 

the claims examiner for incorporation into the claim file.
30 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

informed by our office for the first time that they are entitled to a copy of this information at any time as 

long as they send a written request to their claims examiner. This highly probative evidence would assist 

claimants at the earliest stages in the adjudication of their claims to recall more specific information 

about their workplace history and exposures. Additionally, because some claimants do not know the 

names of the specific toxins they worked with or around, and may have never seen their DOE personnel 

records, it would be helpful for them to see what is, and is not, part of their DOE employment files. Also, 

with this documentation in hand, claimants could easily review their OHQ responses and provide any 

relevant updates to their claims examiner and/or treating physician. 

B. Site Exposure Matrices (SEM) Database

Sometimes the loved ones of claimants reach out to our office with questions and in need of assistance 

following the passing of a claimant. For example, in 2021, the surviving spouse of a claimant reached out 

to our office with questions regarding what to do following the claimant’s death. The claimant’s claim for 

interstitial lung disease had previously been denied and his/her spouse was uncertain about filing a claim 

for survivor’s benefits. Upon review of the recommended and final decisions it was apparent that the 

claims examiner relied, in part, upon the absence of any toxic substances associated with the interstitial 

lung disease in the SEM database. It was also apparent that the SEM database searches by the district 

office and final adjudication branch did not necessarily conform to the guidance in the Procedure Manual 

in two respects: one, the name of the illness searched in the SEM was inconsistent with PM guidance; and 

two, the scope of the search in the SEM was overly narrow according to PM guidance. The SEM database 

should not be solely relied upon to deny a claim for benefits, and where a toxic substance, disease or 

health effect, and labor category or work process overlap, the claim should usually be further developed. 

With respect to the first concern, the claims examiner is to treat pneumoconiosis, pulmonary fibrosis, 

and interstitial lung disease as being equivalents for purposes of claims adjudication. For SEM searches, 

the appropriate search term for each of these is “pneumoconiosis, other.” Federal (EEOICPA) PM 

Chapter 18.13, Version 5.1 (September 20, 2021). Here, both the district office and the final adjudication 

branch used the search term “interstitial lung disease” instead of “pneumoconiosis, other” and because 

interstitial lung disease is not in the SEM database no toxic substances were identified as causing this 

illness. With respect to the second concern, the district office and the final adjudication branch both 

only searched the claimant’s “labor category” of machinist in the SEM and because this labor category 

is not in the SEM database for the DOE facility where the claimant worked, no toxic substances were 

identified. However, per the PM, the claims examiner (CE) is to utilize other filtering functions as a means 

to further refine the search as a way of honing in on those toxins most closely associated with work 

performed by the employee that are also linked to the diagnosed condition. Filtering by work processes 

and building(s) as part of this effort is encouraged when the facts of the case allow this level of detailed 

searching. See Federal (EEOICPA) PM Chapter 15.8(e)(1), Version 5.1 (September 20, 2021). In this case, 

when the work process “machining” is searched along with the health effect of “pneumoconiosis, other”, 

two toxic substances are identified that the claimant was potentially exposed to during the course of 

his/her employment. Neither of these toxic substances were identified when the terms “interstitial lung 

disease” and “machinist” were searched by DEEOIC since as noted, neither of these terms are in the SEM 

database for the DOE facility involved in this case. Toxic substance results such as these should qualify as 

compelling facts that require additional development by a claims examiner. 
31 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

The SEM database is a valuable tool in the adjudication process; however, it must be used as prescribed 

in the DEEOIC PM or the results may not be accurate. Moreover, SEM database searches that follow the 

guidance in the PM may reveal additional probative evidence that could impact the outcome of a claim. 

Consequently, we recommend DEEOIC’s performance management branch consider compliance with the 

SEM database search guidance found in the PM as a topic for individual claim reviews. 

Furthermore, when a specific illness or labor category is not listed in the database, it should be clear 

when the omission from the database is deliberate, i.e., it has been determined that the illness or toxic 

substance should not be listed in the database. This is different from a search of the SEM database 

that yields no results for a listed illness or toxic substance for other reasons. Claimants and authorized 

representatives should be made aware of this distinction in written correspondence and decisions from 

DEEOIC in order to fully understand the limitations of the SEM database, as well as narrow the focus of 

claimants and authorized representatives as they seek to obtain evidence to perfect their claims.

C. Industrial Hygienists Reliance Upon Language Similar to Rescinded Circular 

No. 15-06

An ongoing area of concern for claimants and their authorized representatives is the continued use 

of language by DEEOIC contracted industrial hygienists (IH) that is similar in form and intent to the 

language in rescinded Circular No. 15-06. The relevant language of rescinded Circular No. 15-06 is, 

As a result, the claims examiner (CE) can accept the following: For employees diagnosed with an 

illness with a known health effect associated with any toxic substance present at a DOE facility 

after 1995, it is accepted that any potential exposures that they might have received would have 

been maintained within existing regulatory standards and/or guidelines.” EEOICPA Circular 

No. 15-06, Post-1995 Occupational Toxic Exposure Guidance (December 17, 2014).

Following the recommendation of the Advisory Board on Toxic Substances and Worker Health 

(ABTSWH) in October 2016, Circular No. 15-06 was rescinded. The ABTSWH criticized Circular No. 

15-06 because an empirical basis for the policy was not provided, nor did the ABTSWH think it was 

likely empirical support could be provided. Furthermore, the ABTSWH found it doubtful that sufficient 

industrial hygiene monitoring was performed throughout the DOE complex from 1995 to the present to 

substantiate a broad claim that all exposures were routinely kept below existing standards. The ABTSWH 

also noted that the last paragraph of Circular No. 15-06 acknowledged that even minimal exposure to 

some toxins may lead to illness, and in that case, the circular contradicts its own principal conclusion 

that post-1995 exposures are to be considered, as a rule, insignificant. See ABTSWH Recommendation #1 

(Adopted at October 17-19, 2016, Meeting.)

Circular No. 17-04 not only rescinded Circular No. 15-06 and its corresponding Memorandum dated 

February 20, 2015, it stated that the potential for toxic substance exposure in all claims must be 

evaluated based upon established program procedure and the evidence presented in support of a claim. 

See EEOICPA Circular No. 17-04 (February 2, 2017).
32 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Below is a sample of the language currently used by contract IHs in their expert opinion reports, 

There is no available evidence (i.e., person and/or area industrial hygiene monitoring data) 

to support that, after the mid-1990s, [his/her] exposures would have exceeded existing 

regulatory standards.

DEEOIC routinely shares the IH reports with a claimant’s physician or contract medical consultant 

(CMC) as part of the evidence to be relied upon when opining on whether the claimant has satisfied their 

burden of proof under Part E. Therefore, the continued use of this language can lead CMCs and treating 

physicians to believe that even if a claimant established they were exposed to a toxic substance at a 

DOE facility with a known link to the claimed illness, unless the claimant submitted documentation of an 

exposure beyond the undefined regulatory standards or guidelines, the claimant has not satisfied their 

burden of proof. For claimants with covered employment during the last approximately 30 years, this 

language, when relied upon by contract IHs can be as detrimental to claimants’ claims as the language 

of rescinded Circular No. 15-06. It simply changes from being guidance provided by DEEOIC to its claims 

examiners to guidance followed by contract IHs, and the adoption of the language by IHs fails to address 

the underlying concerns raised by the ABTSWH. Some might argue that it is more damaging to claimant’s 

ability to satisfy their burden of proof to establish toxic substance exposure when this language is relied 

upon by a DEEOIC expert versus a claims examiner. 

For example, one of the complaints filed with our office in 2021 revealed an IH report that relied upon 

the above-referenced language to describe a claimant’s exposure to each of the seven toxic substances23 

the IH was asked to evaluate. For this claimant, who was employed at a DOE covered facility from 

the Fall of 1983 through the Summer of 2020, the period from the mid-1990s through the Summer of 

2020 accounted for approximately 25 of the 36+ years of covered DOE employment. Thus, because 

the claimant did not have access to personal or area industrial hygiene monitoring data to demonstrate 

that his/her exposures to those seven toxic substances exceeded the undefined regulatory standards 

of the time, it was assumed by the IH that the exposures were within normal limits. This opinion was 

then forwarded to a CMC who relied upon it, in part, to opine that it was not as least as likely as not 

that exposure to toxic substance at a DOE facility was a significant factor in causing, contributing to, 

or aggravating the claimed illness. While the IH and CMC reports were certainly not the only evidence 

analyzed by the claims examiners, they were heavily relied upon in the decisions to deny the claim. 

Claimants and their authorized representatives have requested an explanation for the continued use of 

this language to include:

1. What specific regulatory standards are the IHs referring to for each toxic substance at each DOE 

facility during the time periods that claimants worked at such facilities?

2. Do the IHs have access to the industrial hygiene monitoring that was performed throughout the DOE 

complex from the mid-1990s to the present to substantiate the broad claim that all exposures did not 

exceed existing standards?

23 While a search of the SEM database revealed 13 toxic substances linked to the claimant’s labor category and the claimed medical condition, only seven 

toxic substances were referred to and considered by the IH. This is likely due to the PM guidance which states, “No more than seven (7) toxic substances 

should be identified. However, if the CE established more than seven (7) toxins during the exposure development, the CE would have consulted with the 

National Office IH to identify which toxins were most likely to have been encountered and which would likely have the greatest impact on the claimant’s 

claim. Based on this consult, the CE will include as many of the toxins as necessary.” See Federal (EEOICPA) PM Appendix 1 – Exhibit 15-5, Version 5.1 

(September 20, 2021). It is unclear whether the CE consulted with the National Office IH when the decision was made to refer seven of the 13 toxic 

substances to the IH in this claim.
33 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

3. If IHs have access to the existing regulatory standard for each toxic substance, why isn’t this 

information cited by the IHs in their expert opinion reports?

4. Can the claimant be advised and provided a copy of the existing regulatory standards for each toxic 

substance they were exposed to after the mid-1990s in order to attempt to obtain evidence to 

establish that their exposures exceeded the existing regulatory standards?

For the reasons previously articulated by the ABTSWH, we recommend IHs be instructed not to rely 

upon this language and instead assess all toxic substance exposures based upon established program 

procedure and the evidence presented in support of a claim. Where IHs do rely upon any known 

regulatory standards, the specific standards relied upon should be identified in their expert opinion 

reports. 

D. Errors in Expert Opinion Reports 

Expert opinion reports relied upon by DEEOIC may include those written by DEEOIC health physicists, 

and DEEOIC toxicologists, as well as contract IHs, and contract CMCs. When a claim is recommended 

for denial, the claims examiner is to include the expert opinion report(s) with the recommended decision 

when it is mailed to the claimant and their authorized representative. See Federal (EEOICPA) Chapter 

24.7, Version 5.1 (September 20, 2021). These expert opinion reports are based upon information and 

evidence that the claims examiner sends to the expert, along with specific questions to be answered by 

the expert. When the expert opinion report is based on incorrect information, it can sometimes be traced 

back to the information and/or evidence provided to the expert. The information, evidence, and questions 

are presented to the expert in a document called a Statement of Accepted Facts (SOAF). DEEOIC has 

identified the format and content of the SOAF in various PM chapters. 

When incorrect information is incorporated into an expert opinion report, the incorrect information may 

then be relied upon by subsequent experts, e.g., when an error in an IH report is later relied upon by a 

CMC, claims examiner, and hearing representative. Similarly, failure to provide relevant information or 

evidence to an expert can have the effect of producing a less than adequate expert opinion report. And 

finally, because a claimant’s first opportunity to review an expert opinion report is when it accompanies 

a recommended decision to deny their claim, some claimants have expressed that it feels as if it is too 

late to challenge the opinion of the expert. Claimants do not always know how to challenge an expert’s 

opinion and many doubt they have sufficient time to obtain the necessary evidence to refute the expert’s 

opinion with an expert opinion of their own, since they must object to the recommended decision within 

60 days of receipt. 

In 2021, we received a number of complaints from claimants and authorized representatives who 

identified incorrect information in their expert opinion reports. More than one claimant contacted us to 

complain that the expert report incorrectly referred to their history of smoking. A claimant who had never 

smoked saw that the CMC wrote that he/she had been a smoker and thus his/her smoking habit played a 

role in the development of the claimed illness.24 An authorized representative identified information that 

24 An individual’s smoking history is irrelevant in the adjudication of Part E claims. Therefore, even had the claimant been a smoker, it would not have been 

appropriate for the CMC to consider the claimant’s smoking history in opining whether it was at least as likely as not that exposure to a toxic substance at a 

covered DOE facility was a significant factor in causing, contributing to, or aggravating the claimed illness.
34 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

did not pertain to the claimant’s claimed medical condition and was subsequently relied upon by more 

than one expert and the claims examiner when adjudicating the claim. 

The concern expressed by one authorized representative was that each of the expert opinion reports were 

required to be reviewed for accuracy, and it was unclear why such factual errors had not been identified 

and corrected prior to being relied upon in a decision. A group of claimant advocates expressed concern 

to OWCP and DEEOIC over what they characterized as a lack of effort to provide standardization and 

training for consistency. The group pointed out that different CMCs reviewing the same medical files for 

a claimant sometimes reach opposite conclusions in response to causation questions, and IHs often use 

template reports with similar language. The OWCP responded to the concerns raised by stating,

The DEEOIC has procedures and guidelines in place outlining when and how each type of referral 

should be made to medical and scientific professionals. These professionals provide reports which 

become part of the case file evidence to be weighed by the DEEOIC claims examiners when they 

render a decision on a given case. DEEOIC trains all claims examiners how to weigh evidence 

(including professional reports), but DEEOIC cannot establish standards and dictate specific 

outcomes which would encompass all the variables of each case. Thus, although professional 

reports may seem similar, cases are decided differently due to the unique circumstances of 

each case. See July 13, 2021, OWCP response to ANWAG.

Undoubtedly, each claim should be examined based upon the individual facts of the case. However, it 

would be helpful for claimants to know that documents such as SOAFs and expert opinion reports are 

fact-checked prior to being relied upon. While it is understandable that errors will be made from time 

to time, greater consistency in the review of these reports would go a long way to ensuring those errors 

are caught early and not permitted to perpetuate through the claims adjudication process. Additionally, 

claimants should be given a copy of the expert report in order to respond to it to correct any errors before 

the recommended decision is made.

E. Consequential Illnesses

The effect of an accepted occupational illness under Part B and/or covered illness under Part E in causing, 

contributing to or aggravating an injury, illness, impairment, or disease is considered a consequential 

condition. A claims examiner is to accept as compensable any claimed consequential condition(s) that 

is documented properly by substantive, well-rationalized medical evidence. See Federal (EEOICPA) PM 

Chapter 23.2, Version 5.1 (September 20, 2021). The topic of consequential conditions has appeared 

in previous annual reports as a result of reported confusion surrounding how to file a claim for a 

consequential condition, as well as when to file and what evidence is necessary to prove the claim.25 This 

continues to be an issue.

For example, a claimant who had filed a claim for cancer and consequential conditions resulting from 

the treatment for the cancer contacted our office to file a complaint and seek assistance. The claimed 

cancer had been accepted, as well as several of the claimed consequential medical conditions. However, 

because a claim for impairment benefits was accepted in the same decision that deferred other 

consequential conditions, and then the deferred consequential conditions were adjudicated in further 

separate decisions, it was challenging for the claimant to keep up with the adjudicatory status of his/

25 See 2018, 2019, and 2020 Office of the Ombudsman Annual Reports to Congress. 
35 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

her outstanding claimed consequential conditions. The claimant also complained that his/her claims 

examiner was discouraging him/her from filing claims for consequential conditions despite the fact that 

the treatment for the accepted cancer had been extensive. When the claimant submitted additional 

evidence regarding a consequential condition that had previously been denied, he/she was not advised 

that they were required to submit a request to have the denied claim reopened until after contacting our 

office. The claimant in this case expressed frustration that the claims examiner seemed to expect the 

claimant to have a more sophisticated understanding of the DEEOIC claims adjudication process than the 

claimant had. 

In fact, it is not unusual for a claimant to describe their claim as being “settled” when they first speak to 

our office after having received a decision accepting their initial claim for benefits under the EEOICPA. 

Most claimants are not aware of the fact that they will be required to file a new claim form for each 

additional medical condition they wish to claim, for any additional compensation they wish to claim, and/

or for any consequential conditions they wish to claim. Those seeking to claim a consequential condition 

must file a Worker’s Claim for Benefits Under the EEOICPA (Form EE-1). It is up to the claimant to write 

on the claim form that it is a “consequential condition”. If the claimant fails to specifically indicate on the 

Form EE-1 that the medical illness being claimed is a “consequential condition” the DEEOIC will adjudicate 

the claim as a primary illness which delays the claimant’s ability to potentially receive benefits. Claimants 

are further confused by the fact that different additional claim forms are required to be filed with DEEOIC 

depending upon the nature of the claim.26

We suggest that DEEOIC further streamline its adjudication process and provide greater transparency 

to claimants regarding how and why certain medical conditions are being adjudicated separately from 

others. It would be helpful for claimants to have a separate claim form or a space on the existing Form 

EE-1 dedicated solely to claims for consequential conditions. 

26 For example, different types of claim forms must be submitted to DEEOIC in order to claim impairment benefits (Form EE/EN11-A), wage-loss benefits 

(Form EE/EN-11B), or Additional Wage-Loss and/or Impairment under the EEOICPA (Form EE-10).
36 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

CHAPTER IV.

DELAYS, CUSTOMER SERVICE, AND OTHER 

ADMINISTRATIVE ISSUES

In 2021, claimants and their authorized representatives reached out to our office when experiencing what they 

believed were delays in communication and/or progress in their claims. It was not unusual for claimants to ask us 

for assistance with determining the status of a claim, or to complain when they were unable to communicate with 

DEEOIC staff or a DEEOIC contractor. Some of the complaints pertained to the ongoing impact of the COVID-19 

pandemic on agencies such as the DOE and SSA. Other complaints pertained to the Department of Health and 

Human Services, National Institute for Occupational Safety and Health’s pause on performing radiation dose 

reconstructions for claimants with Part B claims. And finally, our office received complaints regarding delays 

in DEEOIC’s processing of medical treatment authorizations, medical bill payments, processing compensation 

payments, and issuing decisions. We also received complaints from claimants and authorized representatives of 

insensitive and sometimes rude behavior by DEEOIC or DEEOIC contractor staff, and difficulties interacting and 

obtaining assistance with the online portals and databases provided by DEEOIC. 

A. Delays

Generally speaking, under Part B of the EEOICPA, claims for all but 22 “specified” primary cancers are 

referred by DEEOIC to NIOSH for a radiation dose reconstruction.27 Following NIOSH’s completion 

and return of the radiation dose reconstruction to DEEOIC, a claims examiner uses the radiation dose 

reconstruction to calculate the probability of causation that the claimant’s cancer was related to his/her 

covered employment. Should the probability of causation calculation equal 50% or higher, the claim will 

be accepted under Part B. See 20 C.F.R. § 30.213(b), and Federal (EEOICPA) PM Chapter 17.15, Version 5.1 

(September 20, 2021).

On May 3, 2021, NIOSH announced that effective immediately it would place a hold on:

• receiving new or rework case referrals from DOL,

• returning completed dose reconstructions to DOL, and

• receiving individual and site-specific dosimetry information from DOE.

According to NIOSH, the pause was estimated to last two to four months. The effect of this 

announcement was that NIOSH dose reconstructions were halted for DEEOIC claimants with nonspecified cancers. DEEOIC posted an announcement/link on its website entitled, “How NIOSH’s 

Cybersecurity Modernization Initiative Affects You.” The content stated that NIOSH had begun to update 

its cybersecurity, which delayed its ability to process dose reconstructions. It further stated that by 

law, DEEOIC could not make determinations for certain cancers under Part B of the Act until it received 

individual dose reconstructions from NIOSH. (https://www.dol.gov/sites/dolgov/files/OWCP/energy/

regs/compliance/DEEOIC_Response_NIOSH_Cybersecurity_Modernization.pdf.) 

27 The list of 22 specified cancers can be found on DEEOIC’s website at https://www.dol.gov/agencies/owcp/energy/regs/compliance/law/SECEmployees.
37 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

It was brought to our attention that the title of the announcement on DEEOIC’s website was unclear 

regarding the impact of NIOSH’s inability to conduct radiation dose reconstructions for DEEOIC 

claimants. Essentially, claimants who experienced delays in the processing of their Part B cancer claims 

may not have known that this was why their claim was delayed and the title of DEEOIC’s announcement 

would not necessarily have lead them to click on a link describing NIOSH’s “cybersecurity modernization” 

efforts in order to find out why their cancer claim was delayed. It was also unclear if DEEOIC directly 

informed each claimant who required a NIOSH dose reconstruction and was impacted by NIOSH’s pause 

that their claim was delayed, why it was delayed, and when they might expect it to proceed. 

In response to an inquiry from our office to DEEOIC regarding whether any steps had been taken to notify 

claimants impacted by the NIOSH dose reconstruction pause, DEEOIC responded, “DOL and NIOSH are 

looking at options for communicating to claimants about the pause in the NIOSH dose reconstruction 

process. The best information I can provide now is the information available on the NIOSH website...

We’ll keep you updated as events unfold.” (May 18, 2021, email from DEEOIC to the Office of the 

Ombudsman.) No further updates were provided to our office. 

However, during the August 18, 2021, meeting of the NIOSH Advisory Board on Radiation and Worker 

Health, NIOSH reported that it was still manually processing dose reconstructions for cases referred by 

DOL with claimants who had been diagnosed with a terminal illness. See CDC NIOSH Advisory Board 

on Radiation and Worker Health 141st Meeting, pgs. 935-36 (August 18, 2021). The DOE reported that 

it was in weekly meetings with DOL and NIOSH to discuss NIOSH’s IT modernization effort. The DOE 

further reported that DOL continued to send lists to DOE every two weeks with the cases they would 

have referred to NIOSH in order for DOE to gather records so when NIOSH came back online and started 

to make electronic requests for records from DOE, most of the records would be ready to send. See CDC 

NIOSH Advisory Board on Radiation and Worker Health 141st Meeting, pgs. 21-22 (August 18, 2021). 

On September 3, 2021, NIOSH announced that it was testing new technology that allowed for secure 

data transfer between NIOSH, DEEOIC, and DOE. NIOSH anticipated claims processing would increase 

as new automation and data management capabilities were implemented through late January 2022, 

with the expectation that NIOSH would have full functionality by the end of June 2022. DEEOIC did not 

provide any additional updates to its website regarding this information. 

On September 15, 2021, NIOSH announced,

NIOSH recognizes the hardship that a delay in radiation dose reconstructions and claims 

processing has placed on claimants and their families. We are working diligently to improve 

the processes needed to achieve steady-state production and timely claims processing.

**********

While it was estimated to take two to four months, unforeseen challenges arose in aligning the 

DOL and CDC IT environments. NIOSH resolved these challenges and is now exchanging files with 

DOL within a secure workspace. We are making every effort to address the backlog of claims as quickly 

as possible by reassigning staff and adding additional resources. Dose reconstructions for claimants with 

terminal diagnoses continue even during the pause and remain our highest priority. 

(NIOSH Cybersecurity Modernization homepage, https://www.cdc.gov/niosh/ocas/headlines/hl-2021/hl-050321.html.) 
38 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

From May 2021 to date, no additional updates or announcements were posted on the DEEOIC website 

regarding the ongoing delays, and it is unclear if DEEOIC or NIOSH provided any written notification 

or updates to individual claimants regarding the extended period of time during which their dose 

reconstructions were potentially delayed. 

When a sizable portion of DEEOIC claims were simultaneously impacted to the extent that dose 

reconstructions stopped being processed by NIOSH for a period of time, claimants and authorized 

representatives found it frustrating not to receive more case-specific, timely information from DEEOIC. 

It is our understanding that DEEOIC knew the details of the cases it had referred to NIOSH (or were 

pending referral) that were impacted by the pause, and therefore the question remains why more was not 

done to communicate this information directly to effected claimants.28 

Furthermore, as a result of the COVID-19 pandemic’s impact on their agencies, both DOE and SSA 

experienced delays in providing information and/or documentation to DEEOIC. Our office heard from 

an authorized representative that DOE was unable to timely verify employment at some DOE facilities 

or provide DEEOIC documentation from individual claimant’s employment files. Moreover, SSA also 

experienced difficulties in providing wage earning records to DEEOIC. These records are relied upon 

to verify employment and adjudicate wage-loss claims. It was reported to our office that it was taking 

over a year for DEEOIC to receive records from SSA. While DEEOIC cannot control the availability of 

records from other federal agencies, the concern raised by claimants and authorized representatives is 

that DEEOIC had continued to adjudicate claims without relevant evidence, and in doing so, had not fully 

informed claimants of the unavailability of records that are routinely provided to DEEOIC. 

When a claim is being adjudicated and additional evidence is needed to establish an element of the 

claim, DEEOIC sends the claimant what is called a “development letter” informing the claimant that 

certain evidence must be submitted to prove their claim. See Federal (EEOICPA) PM Chapter 11.4, 

Version 5.1 (September 20, 2021). The complaint was that instead of providing notification to claimants 

in the development letter that DOE or SSA records were delayed or unavailable, DEEOIC simply shifted 

the burden to claimants to provide the evidence. Thus, claimants who were also unable to obtain 

documentation from the same agencies that DEEOIC was unable to obtain records from, were required to 

proceed with the adjudication of claims without knowing records from DOE and SSA were unavailable. 

We recommend that DEEOIC inform all impacted claimants and their authorized representatives in 

writing, ideally in the development letter, when it is unable to obtain evidence from specific agencies. 

Such notification would prevent claimants from unknowingly spending time and resources requesting 

information from the agencies unable to provide the documentation and allow them to focus on other 

ways to potentially obtain evidence. Moreover, should DEEOIC proceed to issue a recommended 

decision to deny a claim based upon lack of evidence from DOE or SSA, the claimant should be advised 

by DEEOIC that it wasn’t a matter of those agencies not possessing the evidence, but simply that the 

agencies were delayed in providing a response to DEEOIC. 

28 As noted above, while dose reconstructions were paused by NIOSH, DOL was still receiving claims and then compiling lists of claimants, along with their 

personally identifiable information and employer information, and forwarding that information to DOE. DOE then collected the information so that when 

the NIOSH turned the “valve” back on, there wouldn’t be a delay from DOL and DOE. See Centers for Disease Control (CDC) NIOSH Advisory Board on 

Radiation and Worker Health 140th Meeting, pgs. 35-36 (June 23, 2021).
39 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Another set of complaints involved the instructions accompanying final decisions awarding 

compensation benefits to claimants. After the PM was updated on September 20, 2021, the cover letter 

sent to claimants accompanying the final decision instructed them to return their signed Acceptance of 

Payment Form EN-20 to the DEEOIC central mail room in London, KY, instead of to their district office of 

record. See Federal (EEOICPA) PM Chapter 33.3, version 5.0 (April 2, 2021) and version 5.1 (September 

20, 2021). We received concerns from claimants about sending a form containing their banking 

information to a third-party contractor instead of to the DEEOIC district office. In addition, we received 

a complaint that sending the EN-20 to DEEOIC central mail processing added a step to the payment 

process because the form then had to be scanned into the DEEOIC system and routed to the proper 

party, which delayed payment to claimants. We also received complaints of EN-20 forms getting lost at 

the central mail room and delaying payment of benefits to the claimant. 

Other complaints brought to our office concerned delays in some claimants receiving their medical 

benefits cards following a final decision to accept an illness, as well as confusion surrounding whether a 

medical benefits examiner or CNSI could replace a medical benefits card. Ultimately it was determined 

that the medical benefits examiner orders replacement medical benefits cards. We also received 

complaints about improper delays in the process, for example, an authorized representative complained 

of instances where certain claims did not seem to be proceeding through the adjudication process, 

only to later learn that the individual adjudicating the claim had failed to take all of the necessary steps 

within DEEOIC’s computer system to have the claim file documents sent to the claimant. In one case, the 

authorized representative indicated that a claimant had not received correspondence from DEEOIC from 

November 2020 through mid-June 2021. 

The obvious concern in cases such as those described above is that compensation or medical benefits 

to which claimants were entitled was delayed without being based upon a written DEEOIC policy or 

procedure. DEEOIC claimants must submit evidence under specific deadlines. However, it appears to be 

entirely up to the claims examiner to determine what and when information about the timing of claims 

processing, including any delays, will be shared with claimants. We suggest DEEOIC consider sharing 

with claimants the timelines for the issuance of decisions and routinely update claimants regarding the 

status of their claims, particularly when there are delays in the adjudication process. This would give 

claimants an expectation regarding when they would receive a decision or move on to the next phase of 

their claims adjudication. Consequently, they could be more to be prepared for the next step in the claims 

process and less anxious regarding the status of their claim. Increased communication would create 

greater transparency and promote greater claimant understanding, as well as trust in the process.

B. Customer Service

In 2021, claimants and authorized representatives reported customer service issues that included 

difficulties communicating with DEEOIC staff, inappropriate or rude behavior by DEEOIC staff, difficulties 

finding the correct person to address their questions, and difficulties assisting claimants who had been 

diagnosed with a terminal medical condition. 

Also, our office received complaints regarding difficulties being able to speak with a claims examiner 

or medical benefits examiner. We were informed of telephone messages left for claims examiners and 

medical benefits examiners that were not returned, as well as voicemail messages left for the claimant 

which usually involved the claimant calling back, leaving another message, and then waiting an additional 

two days before they were able to speak with DEEOIC staff. Additionally, claimants contacted our office 

when they did not hear back from DEEOIC staff who had said they would be responding to the claimant. 
40| Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Some examples follow:

In the past when claimants or authorized representatives have expressed frustration with their 

interactions with DEEOIC staff, DEEOIC has instructed claimants to contact the supervisor of the DEEOIC 

staff person with whom they are experiencing difficulties. While most claimants are reluctant to do so 

out of fear of retaliation, a claimant in 2021 provided written comments to the supervisor as well as a 

voicemail message. According to the claimant, the supervisor did not respond, but instead delegated 

the responsibility for responding to the claimant to the DEEOIC staff member complained about. The 

claimant expressed frustration in “getting the run around in this complicated process” and asked why the 

supervisor did not respond directly to his/her voicemail and letter. (Email from claimant to Office of the 

Ombudsman, June 23, 2021). 

Another claimant wrote to us,

The staff I am dealing with are rude, condescending, and clearly are obfuscating the process and any 

attempt I make to move my claim along to approval. I truly believe that the intention of this program, as 

approved by Congress is a good faith effort to support those of us impaired by working at government 

nuclear facilities. However, the Administrators of EEOICPA have lost focus on the program’s intent. As a 

Claimant, I should not be required to hire a Personal Advocate or Attorney to usher my claims through 

the process. This program is to compensate the injured workers, not create another layer of representation 

who take large percentages of the compensation which is needed by those actually impaired.

(Email from claimant to Office of the Ombudsman, June 23, 2021). 

In January 2021, a claimant contacted us and described his/her inability to get a response to their 

telephone calls after leaving messages for his/her claims examiner of record and then another claims 

examiner who was filling in for his/her claims examiner. The claimant then contacted our office after 

his/her unsuccessful efforts to speak with a second claims examiner. Another claimant reached out 

after “being shuffled” between a Resource Center and two district offices in an attempt to obtain 

reimbursement for travel-related medical expenses after having submitted a letter of medical necessity 

for his/her travel companion. 

Claimants are entitled to copies of any/all records in their DEEOIC claim file. In order to obtain copies of 

any claim file information, the claimant must submit a written request for the records to DEEOIC.29 There 

can be delays in provision of records and the process is not as clear as it should be. For example, in June 

2021 a claimant reported that he/she had been waiting for over one year for his/her employment records 

from DEEOIC. To make matters more frustrating for the claimant, he/she stated that despite not receiving 

the requested documents, his/her claim had been unfavorably decided. The claimant further commented,

• To file my claim, I have expended over 5k, and have aged 2-3 years beyond my almost 75 years of age. 

• Ideally, a flowchart of the steps to filing a claim, and the check points that must be satisfied to move forward. 

• Otherwise, former workers should be discouraged from filing claims. 

• The difficulty obtaining medical evidence of cancer can represent a practical time limit where medical records are 

not available because they cannot be located or have been destroyed in the time between the onset of the cancer 

and the filing of the claim – a period that sometimes exceeds 30 years. 

(Email from claimant to the Office of the Ombudsman, June 29, 2021.)

29 Claimants are still not informed by DEEOIC that they may request a copy of any/all of their claim file information. It is our continued suggestion that 

DEEOIC notify all claimants of their right to request any documentation in their file provided they send a letter to DEEOIC requesting the documents.
41 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

We concur with claimant’s assessment that it would be helpful for claimants to have a flowchart of the 

steps to filing a claim and the evidentiary requirements that must be met as claimants move through the 

adjudication process. While DEEOIC sends development letters to claimants when evidence is needed 

to satisfy an element of a claim, the development letter only addresses the evidence necessary to satisfy 

specific element(s). What is missing is an overview of the process particular to the specific claimant. 

The policies and procedures regarding expedited service for terminal illness should be clarified and 

made consistent. Claimants and authorized representatives expressed concerns to us about being told 

there were specific timeframes for prognosis that did not reflect a consistent policy. For example, an 

authorized representative informed our office that a claims examiner had informed him/her that a letter 

from the claimant’s treating physician was required to state that the claimant had three months or less 

to live in order for the claim to be expedited. The authorized representative also relayed that approval 

for expedited processing now required two levels of review by DEEOIC, and he/she was informed 

that DEEOIC was overwhelmed by requests for expedited claims processing. It was suggested by the 

authorized representative that DEEOIC publish its policies and procedures regarding how such cases 

are reviewed in order for claimants and authorized representatives to better navigate this sensitive 

issue. Given the frequency with which this issue was raised by claimants’ families and authorized 

representatives, additional information regarding how DEEOIC determines which claims qualify for 

expedited adjudication is needed. The PM does not indicate a life expectancy timeframe for the physician 

to include in their letter addressing the claimant’s prognosis. Moreover, a letter from the claimant’s 

treating physician is only required if the claimant’s terminal medical status is unclear. See Federal 

(EEOICPA) PM Chapter 11.8(a), Version 5.1 (September 20, 2021). Thus, the type of evidence that may 

be accepted to establish a claimant’s terminal diagnosis appears to be broader than the requirements 

reported to our office. In the event a more specific timeframe is required, it should be communicated 

broadly to claimants and authorized representatives, ideally in the PM and other written guidance.

In 2021, DEEOIC created a Customer Experience Team (CX) within the Branch of Outreach and Technical 

Assistance (BOTA) consisting of a Stakeholder Engagement Analyst and a Customer Experience 

Strategist. According to DEEOIC, the mission of this team includes soliciting feedback from stakeholders, 

conducting analysis of data, and making data-driven recommendations for programmatic and procedural 

improvements. See CX Survey Results and Recommendations, July 2021. An initial survey conducted by 

the team sought feedback from 2,000 claimants who received final decisions between March 2021 and 

May 2021. The recommendations the CX team drew from the survey results included:

• Editing the format of recommended and final decisions because “[s]ome claimants did not 

understand why they were denied because the letters were not clear, and the message was lost in the 

statement of the case.”

• Plain Language Refresher training courses so that claimants could better understand letters from 

DEEOIC.

• Providing estimated processing times to claimants in order to set expectations and reduce the anxiety 

claimants feel when they go for an extended period without hearing anything about their claim. 

• Verbal reminders to staff and ensuring that training stresses the need to clearly explain decisions or 

requests from DEEOIC in order to counter claimant’s lack of trust and feelings of uneasiness. 

• Develop phone call best practices such as informing claimant in a voicemail message when DEEOIC 

staff will call back so the person can plan to be available for the call.

• Take annual training on difficult conversations. 

• Avoid discussing potential outcomes with claimants. 
42 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

 See CX Survey Results and Recommendations, July 2021. https://www.dol.gov/sites/dolgov/files/

OWCP/energy/regs/compliance/public_reading_room/final_decision_survey_report072021.pdf

We commend DEEOIC for dedicating resources to improve stakeholder’s interactions with the program. 

Consistent with our recommendations in this and previous annual reports to Congress, we encourage 

DEEOIC to create a single point of contact to receive complaints from stakeholders. Now that DEEOIC 

has implemented the CX Team, we suggest DEEOIC utilize the CX Team as that single point of contact. 

This team should, at a minimum, acknowledge receipt of complaints and provide the complainant with a 

response. In doing so, the single point of contact could help alleviate concerns of retaliation expressed by 

claimants and authorized representatives despite our assurances that DEEOIC is committed to hearing 

and addressing their complaints. A single point of contact could give claimants confidence that their 

complaints would be received, acknowledged, responded to, and kept in confidence. 

C. Other Administrative Issues

For the past few years, DEEOIC has provided claimants the option to upload documents to their claim 

files online by using the Electronic Document Portal (EDP). Once uploaded, the claims examiner 

associated with the case should have immediate access to the uploaded documents. In 2021, DEEOIC 

began permitting claimants to access their claim file information online via the Employees’ Compensation 

Operations & Management Portal (ECOMP). Claimants were informed that ECOMP would permit them 

to access the status of their claims, including the status of their medical and pharmacy bills, as well as 

to view and download their case file documents. Unfortunately, our office received complaints from 

claimants that ECOMP did not function as described by DEEOIC. 

Our office heard from multiple claimants and authorized representatives that the claim status page did 

not accurately reflect the status, nor did it contain any detail with respect to the claim status history. 

Other claimants reported that when they attempted to access pages in ECOMP they received the notice, 

“Page Not Found.” Still others voiced concerns when the claimed medical conditions were not accurately 

identified as accepted or denied.

For example, a claimant experiencing problems with both the EDP and ECOMP reached out to us for 

assistance after uploading medical records and letters in the EDP that sought answers to questions 

posed to his/her claims examiner. The claimant notified our office that it took five weeks for him/her to 

be informed that the medical records uploaded to the EDP were unable to be opened by DEEOIC staff. 

Claimant also asked our office to assist in obtaining a response to his/her request for information from 

DEEOIC regarding the employee’s delayed SSA records. The claimant described some of the technical 

and other issues as follows,

We have yet again entered items into the portal after this letter was received by the CE days ago, 

and whether received properly in the portal system is unknown. The portal could benefit the people 

submitting evidence by enabling submitters (us) to see the images of what was submitted, as it only 

allows the submitter to see the name of the file and see zero images. Seeing the file name only and 

whether it was received does not help the submitter to ever see the image presented in the system 

thus the quality of the image. 

**********
43 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Coupled with the lack of communication (failure to return calls or respond to requests), the 

lack of respectful communication, refusal to answer oral and even written submitted questions 

makes for a beyond frustrating experience. 

(Email from claimant to Office of the Ombudsman, February 17, 2021.)

After our office received a response from DEEOIC, the claimant contacted us again a couple of weeks 

later with additional complaints regarding lack of communication from the claims examiner and his/her 

inability to access the claim status in ECOMP.

Another claimant reported that when a document is uploaded to the EDP it is given a document 

control number (DCN) that is the only description of the document available to a claimant. When this 

particular claimant uploaded a document and then printed the page to confirm that the document had 

been processed, the printed page cut off the DCN, thus rendering the claimant unable to log back in to 

check the status of the document. The claimant expressed frustration that the EDP made it difficult to 

track documents and that our office could not access the EDP to determine if the document had been 

successfully uploaded. 

The delays, customer service, and technology issues reported in 2021 were from those who had 

already spent time and resources attempting to find information, take action, or have their questions 

answered by a variety of people and resources. Almost every claimant who contacted us had already 

made efforts to speak with someone in DEEOIC or a DEEOIC contractor. Many had also spoken with 

health care providers, authorized representatives, and family members as they sought assistance. By 

the time most claimants reached us, they were in need of immediate information and assistance. And 

while we endeavored to provide that information and assistance in a timely fashion, we likewise had to 

inform them that our office does not have access to any of the online claim file databases or systems to 

which their claims examiner, medical benefits examiner, or DEEOIC contractor has access, and that in 

order for us to obtain any information from DEEOIC regarding their claim, they had to sign a Privacy Act 

waiver before DEEOIC would release any claim specific information. For some claimants the prospect of 

arranging for us to send them a Privacy Act waiver, sign it, and then return it to our office was a barrier 

to proceeding to obtain assistance – it was time consuming on top of everything else they felt needed to 

be done. Other claimants who initially seemed interested in obtaining assistance from our office likewise 

expressed hesitancy to complete additional paperwork. Finally, other claimants simply did not have 

the means to complete the task. Consistent with the mission and statutory duties of our office, we look 

forward to exploring ways we can work with DEEOIC to more efficiently serve this program’s stakeholder 

community in 2022. 
44 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

CHAPTER V.

ISSUES RELATED TO IMPAIRMENT CLAIMS

In 2021, claimants and their authorized representatives contacted our office with concerns and requests 

for assistance regarding delays in the processing of impairment claims as well as complaints regarding the 

adjudication process itself. By way of background, under Part E of the EEOICPA, once a physician has determined 

that a claimant’s accepted covered illness has reached maximum medical improvement, the claimant may be 

entitled to impairment benefits.30 The impairment evaluation must be performed by a qualified physician31 and 

must include the percentage of whole-person impairment for each accepted covered illness. The compensation 

payment is calculated by multiplying $2,500 by each percentage of whole-person impairment. A claimant may file 

a claim for increased impairment compensation every two years, and benefits are payable only if the impairment 

evaluation concludes that the covered illness has worsened, as expressed by an increased impairment rating. In 

2021, we received a number of complaints related to delays in the processing of impairment claims. 

For example, an authorized representative reached out for assistance after submitting an impairment evaluation 

report to DEEOIC and not receiving a recommended decision for impairment benefits after three months. 

The reasons the claims examiners purportedly provided to the authorized representative for not issuing the 

recommended decision were: 1) the claims examiner had been pulled away to work on several other high priority 

cases, and 2) the Final Adjudication Branch was going to possibly issue a decision to accept a new medical 

condition, and if it did so prior to the recommended decision for impairment being issued, then the claimant 

would have to wait for an impairment evaluation on the new medical condition in order for both medical 

conditions to be adjudicated together. Prior to receiving a response from DEEOIC regarding the above-referenced 

concerns, the authorized representative received the final decision to accept the new medical condition. Shortly 

thereafter the authorized representative was further informed by the claims examiner that a new waiting period 

would begin in order for the new medical condition to be evaluated for permanent impairment. Given the 

delay in receiving an impairment decision for the first accepted illness, the authorized representative sought 

to know if there was a new policy of delaying a claimant’s impairment compensation pending the acceptance 

of and an impairment evaluation for an additional medical condition. Our review of the PM did not result in the 

identification of such a policy. 

Another authorized representative reached out to our office to share that the claimant became eligible for 

increased impairment benefits in October 2020 and despite submitting repeated requests for reevaluation of 

his/her impairment they had yet to receive the necessary documents from DEEOIC some four months later. The 

authorized representative wrote to us that he/she contacted the claims examiner in September 2020 and was 

assured that the impairment forms would be sent to the claimant immediately. Numerous unanswered voicemail 

messages were left for the claims examiner and the authorized representative was increasingly concerned due to 

the claimant’s diagnosis of stage 4 cancer and COVID-19. 

30 A claimant must file a separate claim for impairment benefits using Form EE/EN-11A. While these forms are not available on the DEEOIC website, a 

claims examiner or Resource Center can provide them to claimants.

31 The claimant indicates on Form EE/EN-11A whether they wish to choose the physician to conduct their impairment evaluation or have the DEEOIC provide 

documents from their claim file to a CMC in order to provide an impairment evaluation. A primary difference between the two options is that the claimant’s 

evaluation with their physician may be in-person, whereas the CMC will only review the documents provided to him/her by the CE.
45 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

In the 2020 Annual Report to Congress, we reported on a new subset of complaints regarding impairment 

evaluation reports that had been prepared by physicians of the claimant’s choosing and then refuted by DEEOIC 

after the OWCP Medical Director provided his opinion. An authorized representative complained at the time 

that the Medical Director’s involvement in specific impairment claims was evidence of DEEOIC National Office 

inserting itself into the claims adjudication process without the claimant being informed. The complaint was 

also made that claimants were not provided a copy of the Medical Director’s written opinion, and the Medical 

Director’s role in the impairment evaluation process was not mentioned in the EEOICP Procedure Manual. 

Subsequently, during testimony before the ABTSWH regarding updates to the DEEOIC PM, the Policy Branch 

Chief commented, 

And so, what the procedures do now, is make it very clear that the Department of Labor is going to evaluate 

impairment ratings based solely, or very explicitly on what is the words in the AMA Guides[.]

********** 

The update also made it very clear that this is not going to be something that we will engage with our 

internal physician. We are no longer referring to our medical director, as a medical director. We’re calling 

that individual now, just a medical officer. But that person, who will no longer have a role in the impairment

process, if there would be development issues or concerns with the sufficiency of an impairment rating. 

We would give the rating physician the opportunity to clarify if that was an option. And then if that does 

not overcome whatever defect presents in the case file, that would be a standard referral to a contract 

medical consultant. 

And so, the procedure is basically stipulating that our staff is really going to have to take a look at the words 

that are being presented by a rating physician to make sure that it conforms to the explicit instruction and 

guidance from the AMA Guides. (Emphasis added). (Advisory Board on Toxic Substances and Worker Health Videoconference 

Board Meeting, November 8, 2021, pgs. 53-55.) 

In 2021, our office received complaints regarding a similar, but not identical, issue regarding the use of 

DEEOIC nurse consultants. For example, an authorized representative contacted our office after more than 

one impairment claim had been remanded following questions raised by a DEEOIC nurse consultant about a 

physician’s impairment rating report. When we were asked whether a role for DEEOIC nurse consultants in the 

assessment of impairment ratings was documented in the PM, we were unable to provide an affirmative answer. 

The only instance of a DEEOIC nurse consultant referenced in the PM chapter on impairment ratings was found 

in the section regarding additional filings for increase impairment benefits where it says, “The CE may seek 

the input of a DEEOIC nurse consultant or CMC to assist in assessing whether a substantive basis exists for 

granting a waiver of the two-year rule.” Federal (EEOICPA) PM Chapter 21.16(a)(1)(ii), Version 5.1 (September 20, 

2021). This particular language narrowly addresses the situation where a claimant wishes to have an additional 

impairment rating prior to two years from the date of his/her last impairment award and does not address the 

concerns brought to our attention. Otherwise, nurse consultants are defined in the PM chapter on home and 

residential health care as those who function as subject matter experts in assessing medical evidence to ensure it 

reasonably correlates to the prescribed type, level, frequency, or duration of home health care, as prescribed by a 

qualified physician. See Federal (EEOICPA) PM Chapter 30.2(q), Version 5.1 (September 20, 2021). Thus, we were 

unable to offer any specific written support for a DEEOIC nurse consultant assessing the validity of a physician’s 

evaluation in the impairment rating process. 
46 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

Questions have been raised regarding the use of a nurse consultant to conduct reviews since a physician who 

wishes to provide an impairment rating for a DEEOIC claimant must submit credentials to DEEOIC that verify 

their qualifications to conduct an impairment rating consistent with the AMA’s Guides to the Evaluation of 

Permanent Impairment, 5th edition. It would be helpful for the qualifications and role of the nurse consultants who 

review physician’s impairment ratings to be included in the PM so that claimants and authorized representatives 

could have a better understanding of the purpose and scope of the review activity. 

We are concerned that claimants and their authorized representatives may not be receiving notice that their 

claim has been reviewed by a nurse consultant and are not provided with copies of a nurse consultant’s notes or 

guidance as part of the claims adjudication process. Absent the ability to read and potentially rebut the opinion 

of a nurse consultant, claimants appear to be at a disadvantage as they seek to understand the posture of their 

impairment claim. Claimants and their authorized representatives find it helpful to be aware of opinions and 

information that may impact their claim for benefits. Moreover, it is important for them to understand who provides 

information to CEs and be afforded an opportunity to review and respond to it prior to a decision being issued in 

their case. 
47 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

APPENDIX 1 

ACRONYMS (ABBREVIATIONS) USED IN 

THIS REPORT

ABTSWH Advisory Board on Toxic Substances and Worker Health

AEC Atomic Energy Commission

AR Authorized Representative

AWE Atomic Weapons Employer

BeLPT Beryllium Lymphocyte Proliferation Test 

CBD Chronic Beryllium Disease

CE Claims Examiner

CMC Contract Medical Consultant (formerly known as District Medical Consultant)

CPWR Center for Construction Research and Training

CX Team Customer Experience Team

DCMWC Division of Coal Mine Workers’ Compensation

DEEOIC Division of Energy Employees Occupational Illness Compensation

DFEC Division of Federal Employees’ Compensation

DLHWC Division of Longshore and Harbor Workers’ Compensation

DME Durable Medical Equipment

DOD Department of Defense

DOE Department of Energy

DOJ Department of Justice

DOL Department of Labor

EEOICPA Energy Employees Occupational Illness Compensation Program Act

FAB Final Adjudication Branch

FECA Federal Employees Compensation Act

FOIA Freedom of Information Act

FWP Former Worker Medical Screening Program

HHS Department of Health and Human Services

HR Hearing Representative

ICD-10 International Classification of Diseases, 10th Edition 

IH Industrial Hygienist

JOTG Joint Outreach Task Group
48 | Office of the Ombudsman | ANNUAL REPORT TO CONGRESS

MBE Medical Benefits Examiner

MED U.S. Army Corps of Engineers Manhattan Engineer District

NDAA National Defense Authorization Act 

NIOSH National Institute for Occupational Safety and Health

NO National Office

OWCP Office of Workers’ Compensation Programs

PM Procedure Manual

PoC Probability of Causation

RECA Radiation Exposure Compensation Act

RESEP Radiation Employees Screening and Education Program

RC Resource Center

SEC Special Exposure Cohort

SEM Site Exposure Matrices

SSA Social Security Administration

The Act Energy Employees Occupational Illness Compensation Program Act

The Office Office of the Ombudsman, U.S. Department of Labor
NNUAL REPORT TO CON

dol.gov/agencies/ombudsman

OFFICE OF THE OMBUDSMAN

UNITED STATES DEPARTMENT OF LABOR