April 2017 Version 1.0 

DEPARTMENT OF LABOR 

OFFICE OF WORKERS’ COMPENSATION PROGRAMS

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL

ILLNESS COMPENSATION

FEDERAL ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 

COMPENSATION PROGRAM ACT

PROCEDURE MANUAL

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TABLE OF CONTENTS

Introduction

Chapter 1 – Definitions 

Defines the most commonly used terms in the administration of the EEOICPA.

1.1 Purpose and Scope

1.2 Definitions

Chapter 2 – The EEOICPA 

Provides an overview of the EEOICPA program and the structure of the DEEOIC.

2.1 Purpose and Scope 

2.2 The EEOICPA

2.3 Organization

2.4 Responsibilities

2.5 Training

2.6 Jurisdiction

2.7 Resources

Chapter 3 - General Provisions

Summarizes the provisions and requirements of the EEOICPA and addresses its coverage. 

3.1 Purpose and Scope

3.2 Provisions of the EEOICPA

Chapter 4 - Customer Service

Describes the commitment of the DEEOIC to serving its internal and external customers. 

4.1 Purpose and Scope

4-2 DEEOIC Standards for Customer Service

4.3 Telephone Communications

4.4 Written Communications

Chapter 5- Program Directives

Describes the communications and directives system used by the DEEOIC.

5.1 Purpose and Scope

5.2 Directives

5.3 Procedure Manual

5.4 

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Chapter 6 – Processing Mail

Identifies the different types of mail received by the DEEOIC and outlines mail-processing 

procedures. 

6.1 Purpose and Scope

6.2 Types of Mail

6.3 Electronic Recordkeeping

6.4 Unreviewed Mail Notification

6.5 Handling Mail Received in DEEOIC Office

6.6 Physical Evidence

6.7 PII

6.8 Outgoing Mail

6.9 Returned Mail

Chapter 7 – Case Creation

Describes the role of DEEOIC staff in the case creation process. 

7.1 Purpose and Scope

7.2 New Cases

7.3 Receipt of a New Claim

7.4 Case Assignments

7.5 Creating Cases in ECS

7.6 CE Review

7.7 Creating a Claim under Part B Vs. Part E, or Both

7.8 New Claims in Existing Cases

7.9 Withdrawal of a Claim

Chapter 8 – Case Maintenance

Describes how case files are transferred, filed, and maintained within the DEEOIC. 

8.1 Purpose and Scope

8.2 Case Movement

8.3 Filing Cases 

8.4 Dividing Cases 

8.5 Multiple Survivors 

8.6 Repairing Cases

8.7 Reconstructing Cases

8.8 Updating, Correcting, and Adjusting the ECMS Database

8.9 FAB Docketing

Chapter 9 – Transfers and Loans

Describes the procedures for sending physical case files and electronic case records between

various offices within the DEEOIC.

9.1 Purpose and Scope

9.2 Responsibilities

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9.3 Electronic Transfer of Case Records in ECMS

9.4 Temporary Transfers (Loans)

9.5 Permanent Transfers

9.6 Referring Case Records to NIOSH

9.7 Referring Cases to Medical or Scientific Specialists in NO

Chapter 10 – Resource Centers

Describes the policies and procedures governing DEEOIC Resource Centers.

10.1 Purpose and Scope

10.2 Resource Center Functions

10.3 ECMS Usage in the RC

10.4 Security, Privacy, Conflict of Interest

10.5 Employment Verification

10.6 Occupational History Development

10.7 Transfer of Cases

10.8 Part D/E Claim Files

10.9 RC File Retention

10.10 Wage-Loss and Impairment Outreach

Chapter 11 – Initial Development

Explains the procedures to be used for the review and initial development of claims filed under 

the EEOICPA.

11.1 Purpose and Scope

11.2 RC Actions

11.3 Review by the DO for Potential Development

11.4 Reviewing a New Claim

11.5 Sources of Evidence

11.6 Advising the Claimant of Deficient Evidence

11.7 Requesting Evidence by Telephone

11.8 Initial Exposure Development

11.9 Former Part D Claims

11.10 Positive DOE Panels

11.11 Reviewing Part B/E Claims

11.12 DOE FWP

11.13 Terminally Ill Claimants

Chapter 12 – Representative Services

Discusses persons who represent the interests of claimants before the DEEOIC and provides 

guidance on the designation, roles and functions and fees charged by a representative.

12.1 Purpose and Scope

12.2 Authority

12.3 Length of Appointment

12.4 ARs Role

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12.5 Authority of an Attorney-in-Fact or Legal Conservator/Guardian

12.6 Interaction with Representatives

12.7 Representative Conflict of Interest Guidance

12.8 Representative Fees

12.9 Privacy Act Waivers

 

Chapter 13 – Establishing Covered Employment

Provides guidance for gathering and evaluating evidence to determine whether the criteria for 

covered employment are satisfied under the EEOICPA. 

13.1 Purpose and Scope

13.2 Facility Coverage

13.3 Comparing Initial Claimed Employment to the Covered Facilities Database

13.4 Matching Claimed Employment

13.5 Verification of Employment

13.6 EPOD

13.7 Using the ORISE Database

13.8 Contacting the DOE and use of the Secure Electronic Record Transfer (SERT)

13.9 Contacting Corporate Verifiers

13.10 Verifying Employment through the SSA

13.11 CPWR

13.12 Other Employment Evidence

13.13 Subcontractor Employment 

13.14 Researcher Employment at DOE Facilities

13.15 Employees of Federal or State Governments

13.16 Evaluating Evidence to Verify Employment

13.17 Developing Non-Covered Employment

13.18 Additions or Modifications to Facility Status

13.19 Special Circumstances

Chapter 14 – Establishing Special Exposure Cohort Status

Describes the procedures for establishing eligibility under the Special Exposure Cohort. 

14.1 Purpose and Scope

14.2 Identifying SEC Claims

14.3 Determining SEC Eligibility

14.4 Statutory SEC Classes

14.5 Additional SEC Classes

14.6 Workday Requirement

14.7 Specified Cancers

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Chapter 15 – Establishing Toxic Substance Exposure

Describes the procedures that the DEEOIC uses to establish toxic substance exposure under 

Part E of the EEOICPA.

15.1 Purpose and Scope

15.2 Rules for Establishing Exposure

15.3 Sources of Evidence

15.4 DAR

15.5 Requesting the DAR

15.6 Completion of DAR

15.7 DOE Remediation Employment

15.8 SEM

15.9 SEM Policy and Management

15.10 SEM Searches

15.11 SEM Inquiries

15.12 NO Specialist Review

Chapter 16 – Developing and Weighing Medical Evidence

Discusses the function of a Claims Examiner in developing and evaluating medical evidence and 

weighing conflicting medical opinions. 

16.1 Purpose and Scope

16.2 Sources of Medical Evidence

16.3 Types of Medical Evidence

16.4 Contents of a Medical Report

16.5 Developing Medical Evidence

16.6 Weighing Medical Evidence

16.7 Using Death Certificate to Establish Diagnosis

16.8 Using Affidavits to Establish Date of Diagnosis

16.9 Reviews by a CMC

16.10 Deciding on Need for a CMC Referral

16.11 Referral to CMC

16.12 Role of Medical Scheduler in CMC Referrals

16.13 Post Referral to CMC

16.14 Second Opinion Examinations

16.15 Referee Specialist Examinations

16.16 Failure to Undergo Second Opinion or Referee Specialist Examination

Chapter 17 – Development of Radiogenic Cancer Claims

Discusses the procedures for determining whether an employee has been diagnosed with a 

cancer and procedures for establishing causation as a result of occupational radiation exposure. 

17.1 Purpose and Scope

17.2 Identifying a Claim for Cancer

17.3 Medical Evidence of Cancer

17.4 Pre-Cancerous and Non-Malignant Conditions

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17.5 Specified Cancers

17.6 Non-SEC Cancers and Dose Reconstruction

17.7 Preparing Non-SEC Cancer Claim Files for Referral to NIOSH

17.8 Preparing Amendments to the NRSD for Non-SEC Cancer Claims

17.9 Cases Pulled While at NIOSH

17.10 NIOSH Actions

17.11 Receipt of Dose Reconstruction Results from NIOSH

17.12 Review of Claim for Rework of Dose Reconstruction

17.13 Procedures for Requesting Rework

17.14 Comments to Dose Reconstruction Submitted to FAB

17.15 Proving Causation Between Diagnosed Non-SEC Cancer and Covered 

 Employment

17.16 Calculation of PoC Using NIOSH-IREP Computer Program

17.17 Establishing Causation for Cancer under Part E

Chapter 18 – Eligibility Criteria for Non-Cancerous Conditions

Describes the eligibility criteria necessary for non-cancerous conditions covered under Part B 

and/or Part E of the EEOICPA; and discusses the steps undertaken in development of the causal 

relationship between toxic substance exposure at a covered facility and diagnosed noncancerous conditions. 

18.1 Purpose and Scope

18.2 Approved Part B Illnesses

18.3 Identifying Claimed Condition as Part B, Part E, or Both

18.4 Proof of Covered Employment for Beryllium Illness

18.5 Beryllium Sensitivity

18.6 Established CBD Before 1993, Part B

18.7 Established CBD On/After January 1, 1993, Part B

18.8 Established CBD Decisions, Part B

18.9 Beryllium Sensitivity and CBD, Part E

18.10 Presumption of CBD, Diagnosis of Sarcoidosis, History of Beryllium Exposure 

18.11 Consequential Illnesses from CBD or its Treatment

18.12 Silicosis

18.13 Pneumoconiosis, Part E

18.14 Asbestosis, Part E

18.15 Medical Conditions Associated with Asbestos Exposures

18.16 COPD

18.17 Parkinsonism

18.18 Other Conditions

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Chapter 19 – Eligibility Requirements for Certain Uranium Workers

Describes policies and procedures for processing claims involving uranium miners, millers, and 

ore transporters who worked at facilities covered by Section 5 of the RECA and, where 

applicable, the survivors of such employees. Also describes policies and procedures for 

processing claims involving claimants who applied for an award under Section 4 of the RECA. 

19.1 Purpose and Scope

19.2 RECA Background

19.3 How DOL Identifies a RECA Section 5 Uranium Worker

19.4 Determining Uranium Worker Eligibility

19.5 Developing RECA Section 5 Claims

19.6 Verifying RECA Section 5 Part E Employment

19.7 Verifying Part E Exposure for RECA Section 5 Claims

19.8 RECA Section 4 Claims

19.9 Interagency Consistency

Chapter 20 – Establishing Survivorship

Contains procedures for the development and review of survivor claims under the EEOICPA. 

20.1 Purpose and Scope

20.2 Policy

20.3 Eligible Survivors

20.4 Filing a Claim for Survivor Benefits

20.5 Establishing Employee’s Death

20.6 Linking Employee’s Death to an Occupational or Covered Illness

20.7 Surviving Spouse

20.8 Surviving Child

20.9 Parents, Grandchildren, Grandparents

20.10 Potential for Additional Survivors

20.11 Claims Involving Multiple Claimants

20.12 Issues During the Payment Process 

20.13 Alternative to Filing a Survivor Claim Under Part E

Chapter 21 – Impairment Ratings

Provides guidance on the procedures for evaluating a claim for permanent impairment. 

21.1 Purpose and Scope

21.2 Policy

21.3 Definition of Impairment

21.4 General Requirements for Impairment Ratings

21.5 How a Claimant Files an Impairment Claim

21.6 Impairment Ratings by the Employee’s Choice Physician 

21.7 Impairment Ratings by a CMC 

21.8 Impairment Ratings for Certain Conditions

21.9 Receipt of the Impairment Evaluation

21.10 Pre-RD Challenges

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21.11 Impairment Award

21.12 Impairment and Tort Offset/SWC

21.13 How to Calculate Increased Impairment Award with Tort Offset/SWC 

Coordination 

21.14 Issuance of a RD

21.15 FAB Development

21.16 Additional Filings for Impairment Benefits

21.17 Issues Involving Survivor Election

Chapter 22 - Wage-Loss Determinations

Provides procedures for evaluating a wage-loss claim under Part E and describes relevant 

terminology and definitions related to wage-loss. 

22.1 Purpose and Scope

22.2 Policy

22.3 Definitions

22.4 General Requirements for Wage-Loss

22.5 When Wage-Loss Is Not Covered

22.6 How to File Initial Wage-Loss Claims

22.7 How to File Subsequent Wage-Loss Claims

22.8 Development of Wage-Loss Claims

22.9 Medical Evidence to Establish Wage-Loss

22.10 Wage Evidence to Establish Wage-Loss

22.11 Wage-Loss Calculator

22.12 Calculation of AAW

22.13 Determination of Wage-Loss Percentage

22.14 Employee Wage-Loss Compensation

22.15 Survivor Wage-Loss Compensation

22.16 Maximum Aggregate Compensation

22.17 RDs and FDs

Chapter 23 – Consequential Conditions

Discusses the development of claims for consequential conditions and describes the types of 

injuries, illnesses, impairments, or diseases that may be considered consequential conditions. 

23.1 Purpose and Scope

23.2 Defining a Consequential Condition

23.3 Claims for Consequential Conditions

23.4 Claim Development

23.5 Metastasized Cancer(s)

23.6 Conditions Resulting from Medical Treatment

23.7 Independent Intervening Causes

23.8 Pre-existing Conditions

23.9 Psychological Conditions

23.10 Accepting or Denying the Consequential Condition

23.11 Impairment and Wage-Loss

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23.12 SWC Claims, Lawsuits and Fraud

Chapter 24 – Recommended Decisions

Describes the procedures for issuing a Recommended Decision.

24.1 Purpose and Scope

24.2 Authority

24.3 When a RD is Required

24.4 Administrative Closure

24.5 Who Receives a RD

24.6 Writing a RD

24.7 Content and Format

24.8 Types of RDs

24.9 Decision Issuance

24.10 Letter Decisions

24.11 Special Circumstances

Chapter 25 - FAB Review Process

Describes the functions of the Final Adjudication Branch, focusing on the administrative and 

preparatory aspects of its work under the EEOICPA. 

25.1 Purpose and Scope

25.2 Authority

25.3 Organization

25.4 Processing, Monitoring, and Transferring Case Files

25.5 Waivers

25.6 Objections and Review of the Written Record

25.7 Requests

25.8 Conduct of the Hearing

25.9 Post Hearing Actions

25.10 Receipt of New Medical Evidence or New Claim

25.11 One Year Requirement 

25.12 CE2 Designated to the FAB

Chapter 26 – FAB Decisions

Describes the process by which the Final Adjudication Branch performs a review and issues a 

Final Decision or Remand Order on claims filed pursuant to the EEOICPA; as well as its 

process following a claimant’s request for reconsideration. 

26.1 Purpose and Scope

26.2 FDs

26.3 Preparation of FDs

26.4 Remand Orders

26.5 Administrative Closure

26.6 Claimant Rights Following the Issuance of FAB FDs

26.7 Alternative Filing, Part E

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Chapter 27 – Reopening Process

Outlines the process by which the Director of the DEEOIC reopens claims for benefits under the 

EEOICPA and vacates decisions of the Final Adjudication Branch. 

27.1 Purpose and Scope

27.2 Authority

27.3 Claimant’s Explicit Request for Reopening

27.4 Claimant’s Nonspecific Correspondence or Evidence

27.5 Reopening and Vacating a FAB Decision

27.6 Reopening and Vacating a FAB Decision Following an Employee’s or Survivor’s 

 Death

27.7 Denying a Specific Request for Reopening

27.8 ECS Implications

Chapter 28 – Medical Bill Process

Addresses general medical bill processing within the DEEOIC. 

28.1 Purpose and Scope

28.2 Roles and Responsibilities

28.3 Parameters for Payment

28.4 Mailbox for Medical Bill Inquiries

28.5 Medical Records Procurement

28.6 Treatment Suites

28.7 Eligibility Files

28.8 ICD-CM Codes

28.9 Coding Software

28.10 Prompt Pay

28.11 Time Limitations for Submission of Medical Bills

28.12 Fee Schedule

28.13 Fee Schedule Appeal Process

Chapter 29 – Ancillary Medical Services and Related Expenses

Addresses entitlement to and payment for ancillary medical services. 

29.1 Purpose and Scope

29.2 Requests for Ancillary Medical Services and Related Expenses

29.3 DME

29.4 Oxygen Therapy DME and Oxygen Medical Supplies

29.5 Massage Therapy and Acupuncture Treatment 

29.6 Chiropractic Services 

29.7 Pulmonary Rehabilitation

29.8 Hearing Aids 

29.9 Organ Transplants

29.10 Mental or Psychiatric Illness Treatment 

29.11 Experimental Treatment 

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29.12 Sun Protective Clothing

29.13 Vehicle Modifications and Purchases 

29.14 Housing Modifications

29.15 Health Facility Membership and Spa Membership 

29.16 Medical Alert Systems

29.17 Medical Expense Reimbursement for Extended Travel

29.18 Ancillary Services or Expense Authorization RD

Chapter 30 – Home and Residential Health Care

30.1 Purpose and Scope 

30.2 In-Home Health Care Services (HHC)

30.3 Attendant Services Provided By Family Members

30.4 Conflict of Interest Policy

30.5 Hospice Care

30.6 Residential Care Facilities

30.7 Billing Procedures and Authorization Periods

Chapter 31 – Tort Action and Election of Remedies

Discusses lawsuits and the effects of recovery from them on payments of benefits under the 

EEOICPA.

31.1 Purpose and Scope

31.2 Authority

31.3 Signed Response Regarding Lawsuit, SWC Claim and Fraud

31.4 Developing for Lawsuit

31.5 Evaluating Lawsuit Documents

31.6 Election of Remedies, Part B

31.7 Tort Offset, Parts B and/or E

31.8 Pending Tort Settlement Payment

31.9 Required Tort Offset

31.10 Actions to Absorb Surplus

Chapter 32 – Coordinating State Workers’ Compensation Benefits

Addresses State Workers’ Compensation benefits and the effect of their receipt on EEOICPA 

benefits.

32.1 Purpose and Scope

32.2 Authority

32.3 SWC Benefits

32.4 When Coordination is Required

32.5 Exceptions

32.6 Signed Response Regarding SWC Claim, Lawsuit and Fraud

32.7 Verifying SWC Claims

32.8 Pending SWC Payment

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32.9 Calculate Amount to Coordinate

32.10 Actions to Absorb Surplus

32.11 ECMS Coding

32.12 Contact with SWC Office

Chapter 33 – Compensation Payments

Discusses payment of compensation, to include exception processing of payments to terminal 

claimants. 

33.1 Purpose and Scope

33.2 Responsibilities

33.3 Processing the EN-20

33.4 Creating the EFT Payment

33.5 Creating Check Payments

33.6 Completing the ECS Payment

33.7 Entering and Identifying Payments in OIS

33.8 Expedited and Exception Payments

33.9 Deleting Payments and Cancelling Transactions

33.10 Payment Reports

33.11 Substitutions Among Staff

33.12 Temporary Role Changes for Expedited Payments

33.13 Stolen Check Claims

33.14 Processing Payment Cancellations

33.15 ECS Payment Cancellation Process

33.16 Post Cancellation Actions

33.17 Death During Payment Process 

Chapter 34 – Post-Award Administration

Outlines the actions the CE takes on Part E cases after a claim has been approved for benefits. 

34.1 Purpose and Scope

34.2 Authority

34.3 CE Responsibilities

34.4 NO Responsibilities

Chapter 35 – Overpayment Process

Provides an overview of the overpayment process and describes the actions taken when an 

overpayment is identified. 

35.1 Purpose and Scope

35.2 Legislative Authority and Directives

35.3 Definition of Overpayment

35.4 Notification of EEOICPA Payment

35.5 Recovery of Funds by DO

35.6 Referral to NO

35.7 Identifying Overpayments

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35.8 Review and Initial Notification

35.9 Telephone Conferences

35.10 Consideration of Overpayment Waiver

35.11 Overpayment Decisions

35.12 Overpayment Database

35.13 TROR and Debt Collection Activities

Chapter 36 – Debt Liquidation

Outlines the DEEOIC debt collection process. 

36.1 Purpose and Scope

36.2 Responsibilities

36.3 Recovery

36.4 Assessment of Charges

36.5 Waiver of Interest and Other Charges

36.6 Compromise

36.7 Compromise to Limit Repayment Period 

36.8 Compromise in Consideration of Partial Payment

36.9 Collection Strategies

36.10 Recovery from Compensation Entitlement

36.11 Recovery in Cases with No Compensation Entitlement

36.12 Referring Debts to Department of Treasury

36.13 Termination of Collection Action (Write-off)

36.14 Recovery from Deceased Claimant’s Estate

36.15 Credit Reporting

35.16 Court Ordered Restitution in Fraud Cases

Appendix 1 - Exhibits

Appendix 2 – Catalog of Content Edits

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INTRODUCTION

The Energy Employees Occupational Illness Compensation Program Act (EEOICPA or Act) was 

enacted in October 2000. Part B of the EEOICPA, effective on July 31, 2001, compensates 

current or former employees (or their survivors) of the Department of Energy (DOE), its 

predecessor agencies, and certain of its vendors, contractors and subcontractors, who were 

diagnosed with a radiogenic cancer, chronic beryllium disease (CBD), beryllium sensitivity, or 

chronic silicosis, as a result of exposure to radiation, beryllium, or silica while employed at 

covered facilities. The EEOICPA also provides compensation to individuals (or their eligible 

survivors) awarded benefits by the Department of Justice (DOJ) under Section 5 of the Radiation 

Exposure Compensation Act (RECA). Part E of the EEOICPA (enacted October 28, 2004) 

compensates DOE contractor and subcontractor employees, eligible survivors of such 

employees, and uranium miners, millers, and ore transporters as defined by RECA Section 5, for 

any occupational illnesses that are causally linked to toxic exposures in the DOE or mining work 

environment. 

The following Procedure Manual (PM) is designed to provide an overview of the Division of 

Energy Employees Occupational Illness Compensation (DEEOIC) program and guidance 

regarding the general policies and procedures used by DEEOIC claims staff in the processing 

and adjudication of claims. The PM is supplemented by EEOICPA Bulletins and Circulars and is 

updated periodically.

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CHAPTER 1 - DEFINITIONS

1. Purpose and Scope. The purpose of this chapter is to define the most commonly used 

terms in the administration of the EEOICPA. The chapter also identifies the abbreviations and 

acronyms for those terms (Exhibit 1-1) and provides a listing of the forms used in the program 

(Exhibit 1-2).

2. Definitions. This section defines the principal terms used in the Federal EEOICPA PM. 

a. Act or EEOICPA means the Energy Employees Occupational Illness 

Compensation Program Act of 2000, as amended, 42 U.S.C. § 7384 et seq. 

b. Atomic Weapon means any device utilizing atomic energy, exclusive of the 

means for transporting or propelling the device (where such means is a separable 

and divisible part of the device), the principal purpose of which is for use as, or 

for development of, a weapon, a weapon prototype, or a weapon test device. 

c. Atomic Weapons Employee means: 

(1) An individual employed by an Atomic Weapons Employer (AWE) during 

a period when the employer was processing or producing, for the use by 

the United States, material that emitted radiation and was used in the 

production of an atomic weapon, excluding uranium mining and milling; 

or 

(2) An individual employed: 

(a) At a facility that the National Institute for Occupational Safety and 

Health (NIOSH), in its report dated November 2002 and titled 

“Report on Residual Radioactive and Beryllium Contamination at 

AWE Facilities and Beryllium Vendor Facilities,” or any update, 

indicated had a potential for significant residual contamination 

outside of the period described in subparagraph (1) of this 

definition; 

(b) By an AWE or subsequent owner or operator of a facility 

referenced in subparagraph (a) of this definition; and 

(c) During a period reported by NIOSH, in its report dated November 

2002 and titled “Report on Residual Radioactive and Beryllium 

Contamination at AWE Facilities and Beryllium Vendor 

Facilities,” or any update to that report, to have a potential for 

significant residual radioactive contamination. This will be 

identified on the DOE facility database as the “residual 

contamination” period. 

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(d) AWE means any entity, other than the United States, that:

(i) 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

(ii) The Secretary of Energy has designated as an AWE for 

purposes of the Act. 

e. AWE Facility means a facility, owned by an AWE, that is or was used to process 

or produce, for use by the United States, material that emitted radiation and was 

used in the production of an atomic weapon, excluding uranium mining or 

milling.

f. Attorney General means the Attorney General of the United States or the United 

States DOJ. 

g. Average Annual Wage (AAW) means four times the average quarterly wages of a 

covered Part E employee for the 12 quarters preceding the quarter during which 

the employee first experienced wage-loss due to exposure to a toxic substance at a 

DOE facility or RECA section 5 facility, excluding any quarters during which the 

employee was unemployed.

Being “retired” is not equivalent to being “unemployed”; therefore, quarters 

during which an employee had no wages because of retirement will be included in 

the AAW calculation.

h. Benefit or Compensation means the money the United States Department of 

Labor (DOL) pays to or on behalf of either a covered employee under Part B, or a 

covered DOE contractor employee under Part E, from the Energy Employees 

Occupational Illness Compensation Fund. These terms may also include any other 

amount paid out of the Fund for medical benefits including but not limited to 

medical treatment, monitoring, examinations, services, appliances and supplies. 

i. Beryllium Sensitization or Sensitivity means that the individual is sensitized to 

beryllium as demonstrated by any of the following:

(1) An abnormal beryllium lymphocyte proliferation test (BeLPT) or an 

abnormal lymphocyte transformation test (BeLTT) on either blood or lung 

lavage cells as interpreted by a medical doctor, for Part B and Part E 

claims;

(2) A positive physician panel determination as specified in section 7385s4(b), for Part E claims only; or 

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(3) A determination that it is at least as likely as not that exposure to 

beryllium at a DOE facility or a RECA section 5 facility was a significant 

factor in aggravating, contributing to, or causing the beryllium 

sensitization or sensitivity; and it is at least as likely as not that the 

exposure to beryllium was related to employment at a DOE facility or a 

RECA section 5 facility as specified in sections 7385s-4(c) and 7385s5(a), for Part E claims only.

j. Beryllium Vendor means any of the corporations and named predecessor 

corporations designated as beryllium vendors in section 7384l(6)(A)-(I) of the 

EEOICPA, or their corporate successors; and also those facilities designated as 

beryllium vendors in the list published in the Federal Register by the DOE. 

k. Bioassay means the determination of the kind, quantity, concentration, or the 

location of radioactive material in the human body, whether by direct 

measurement or by analysis and the evaluation of radioactive material excreted, 

eliminated, or removed from the body. 

l. Central Mail Room (CMR) is a centralized mail processing facility operated by 

contractor staff who are responsible for scanning and creating an electronic image 

of incoming hardcopy documentation. Once the CMR staff has imaged a paper 

document, he or she classifies the document based on a list of pre-chosen “index” 

categories. The CMR staff person then uploads the document into the OWCP 

Imaging System (OIS) and assigns it to the associated case file record. 

m. Chronic silicosis means a non-malignant lung disease as demonstrated by any of 

the following: 

(1) The initial occupational exposure to silica dust preceded the onset of 

silicosis by at least 10 years and a written diagnosis of silicosis is made by 

a medical doctor and is accompanied by:

(a) A chest radiograph, interpreted by an individual certified by the 

NIOSH as a B reader, classifying the existence of pneumoconiosis 

of category 1/0 or higher; 

(b) Results from a computer assisted tomography or other imaging 

technique that are consistent with silicosis; or

(c) Lung biopsy findings consistent with silicosis.

 This evidence holds true for Part B and Part E claims; 

(2) A positive physician panel determination as specified in section 7385s4(b), for Part E claims only; or 

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(3) A determination that it is at least as likely as not that exposure to silica at a 

DOE facility or a RECA section 5 facility was a significant factor in 

aggravating, contributing to, or causing the chronic silicosis; and it is at 

least as likely as not that the exposure to silica was related to employment 

at a DOE facility or a RECA section 5 facility as specified in sections 

7385s-4(c) and 7385s-5(a), for Part E claims only. 

n. Claim means a written assertion to the OWCP of an individual’s entitlement to 

benefits under the EEOICPA, submitted in a manner authorized by the Act. 

o. Claimant means an individual claiming compensation under the Act. 

p. Compensation Fund or Fund means the fund established on the books of the 

Department of the Treasury for payment of benefits and compensation under 

EEOICPA.

q. Consequential Injury is any injury, illness, or impairment by a covered employee 

as a result of an occupational illness, or sustained by a covered DOE contractor 

employee as a result of a covered illness.

r. Contemporaneous Record means any document created at or around the time of 

the event that is recorded in the document. 

s. A Contract Medical Consultant (CMC) is a contracted physician who conducts a 

review of case records to render opinions on medical questions. 

t. Coordination of Benefits with State Workers’ Compensation (SWC) is to be 

determined when a claimant has received benefits from a SWC program for the 

same covered illness (es) to which he or she is to be awarded compensation under 

Part E, resulting in a possible reduction in the Part E award. 

u. Covered Child means, under Part E, a biological child, a stepchild who lived in a 

recognized parent-child relationship, or a legally adopted child of a covered DOE 

contractor employee, who at the time of the employee’s death:

(1) Had not attained the age of 18 years; 

(2) Had not attained the age of 23 years and was a full-time student who had 

been continuously enrolled as a full-time student in one or more 

educational institutions since attaining the age of 18 years; or 

(3) Had been incapable of self-support at any age. 

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v. Covered DOE Contractor Employee means, under Part E, a DOE contractor or 

subcontractor employee, or a RECA section 5 uranium worker who has been 

determined by OWCP to have contracted a covered illness through exposure to a 

toxic substance at a DOE facility or a RECA section 5 facility, as appropriate. 

This term should only be used in reference to claims under Part E. 

w. Covered Employee means, under Part B, a covered beryllium employee, a 

covered employee with cancer, a covered employee with chronic silicosis, or a 

covered uranium employee. This term should only be used in reference to claims 

under Part B. 

x. Covered Illness means, under Part E, an illness or death resulting from exposure 

to a toxic substance from employment at a DOE facility or a RECA section 5 

facility. This term should only be used in reference to claims under Part E.

y. Covered Uranium Employee means, under Part B, an individual who has been 

determined by the DOJ to be entitled to an award under section 5 of RECA, 

whether or not the individual was the employee or the deceased employee’s 

survivor. 

z. Department means the United States Department of Labor (DOL).

aa. Department of Energy (DOE) includes the predecessor agencies of the DOE, such 

as the Atomic Energy Commission (AEC) and the Manhattan Engineer District.

bb. DOE Contractor Employee means any of the following:

(1) An individual who is or was in residence at a DOE facility as a researcher 

for one or more periods aggregating at least 24 months; or 

(2) An individual who is or was employed at a DOE facility by: 

(a) An entity that contracted with the DOE to provide management 

and operation, management and integration, or environmental 

remediation at the facility; or

(b) A contractor or subcontractor that provided services, including 

construction and maintenance, at the facility.

cc. DOE Facility means any building, structure, or premise, including the grounds 

upon which such building, structure, or premise is located: 

(1) In which operations are, or have been, conducted by, or on behalf of, the 

DOE (except for buildings, structures, premises, grounds, or operations 

covered by Executive Order 12344, dated February 1, 1982, pertaining to 

the Naval Nuclear Propulsion Program); and 

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(2) With regard to which the DOE has or had: 

(a) A proprietary interest; or

(b) Entered into a contract with an entity to provide management and 

operation, management and integration, environmental remediation 

services, construction, or maintenance services.

dd. Disability means that OWCP has determined entitlement to payment of Part B 

benefits for the covered occupational illness of CBD, cancer or chronic silicosis. 

This term should only be used in reference to a claimant entitled to benefits under 

Part B.

ee. Dose Reconstruction (DR) is used to estimate the radiation doses to which 

individual workers or groups of workers have been exposed, particularly when 

radiation monitoring is unavailable, incomplete, or of poor quality. These 

methods are applied to translate exposure to radiation into quantified radiation 

doses at the specific organs or tissues relevant to the types of cancer occurring 

among the workers. 

ff. Durable Medical Equipment (DME) means the appliances that a qualified 

physician prescribes or recommends for a covered occupational illness or a 

covered illness which OWCP considers necessary to treat the illness. Examples 

of DMEs include walkers, wheelchairs, or hospital beds. 

gg. Equivalent Dose means the absorbed dose in a tissue or organ multiplied by a 

radiation weighting factor to account for differences in the effectiveness of the 

radiation in inducing cancer. 

hh. External Dose means the portion of the equivalent dose that is received from 

radiation sources outside of the body. 

ii. Final Decision (FD). After reviewing all evidence of record and the RD, the FAB 

issues a FD, which is an independent written decision addressing the 

appropriateness of the Recommended Decision outcome, making findings of fact 

and conclusions of law that legally support the decision. 

jj. The Freedom of Information Act (FOIA) means the law that generally provides 

for public access to documents maintained by the government. It requires the 

government to release those documents upon request, unless the request or 

documents fall within one of nine exceptions listed in the law. 

The FOIA also requires the publication of indexes of specified agency documents 

and records; provides time limitations for responding to requests; establishes a 

system of penalties for non-compliance with the time limitations; requires 

identification of persons responsible for granting or denying requests; provides for 

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court review of denials, including classified materials; and provides for the 

levying of charges for searching and copying requested materials.

kk. Gaseous Diffusion means a uranium enrichment process based on the difference 

in rates at which uranium isotopes in the form of gaseous uranium hexafluoride 

diffuse through a porous barrier. 

ll. Impairment means a loss, loss of use, or derangement of any body part, organ 

system or organ functionality as it affects the whole body, as a result of the 

covered illness. An impairment rating is performed once the employee has 

reached Maximum Medical Improvement (MMI) or is terminal This term should 

only be used in reference to claims under Part E.

mm. Incapable of Self-Support means the inability to obtain or retain employment, or 

engage in self-employment that provides a sustained living wage as a 

consequence of a physical or mental condition, illness or disease. 

nn. Internal Dose means the portion of the equivalent dose that is received from 

radioactive materials taken into the body.

oo. Mail and File (M&F) Staff are responsible for maintaining paper case files located 

at the DO and FAB. They are also responsible for assisting with the physical 

movement of case files within the DO or FAB, including taking receipt of 

incoming files or transferring files to other district or FAB offices.

pp. Maximum Medical Improvement (MMI) is when the covered illness is stabilized 

and is unlikely to improve with or without additional medical treatment.

qq. Occupational Illness means, under Part B, a covered beryllium illness, cancer 

sustained in the performance of duty, specified cancer, chronic silicosis, or an 

illness for which DOJ has awarded compensation under section 5 of RECA. This 

term should only be used in reference to an individual(s) entitled to benefits under 

Part B.

rr. Offset is a reduction of the claimant’s benefits under the Act. This is required if 

any person receives funds pursuant to a final judgment or settlement for the same 

accepted exposure that led to the accepted covered illness. Benefits that are 

excluded from an offset include: 

(1) Workers’ compensation benefits; 

(2) Insurance policies; and

(3) A claim for loss of consortium filed by an individual other than the 

covered Part B or Part E employee.

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ss. OWCP Medical Fee Schedule is a schedule of maximum allowable fees as 

determined by OWCP for the payment of medical and other health services 

furnished by physicians, hospitals, and other providers for an accepted 

occupational illness(es) and an accepted covered illness(es). The payment of fee 

for such service shall not exceed the maximum allowable charge with the 

exception of the following: 

(1) Does not apply to charges for services provided in nursing homes; this 

does not include those charges for treatment furnished by a physician or 

other medical professionals in a nursing home; or 

(2) Does not apply to charges for appliances, supplies, services or treatment 

furnished by medical facilities of the U.S. Public Health Service or the 

Departments of the Army, Navy, Air Force and Veterans Affairs.

tt. Physician means surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their 

practice as defined by state law. 

The term "physician" includes chiropractors only to the extent that their 

reimbursable services are limited to treatment consisting of manual manipulation 

of the spine to correct a subluxation as demonstrated by x-ray to exist.

uu. The Privacy Act means the statute governing a citizen’s right to confidentiality of 

personal information, including financial and medical history, in records filed in a 

system of records under the individual’s own name. This law sets forth the 

government’s responsibility to properly maintain and restrict access to these 

records.

vv. Probability of Causation (PoC) means the probability or likelihood that a cancer 

was caused by radiation exposure incurred by a covered employee in the 

performance of duty. In statistical terms, it is the cancer risk attributable to 

radiation exposure divided by the sum of the baseline cancer risk (the risk to the 

general population) plus the cancer risk attributable to the radiation exposure. 

Other terms for this concept include "assigned share" and "attributable risk 

percent."

ww. Point of Contact (POC) means the individual or individuals serving within an 

agency or department who act as coordinator for the activity. 

xx. Radiation means ionizing radiation in the form of alpha particles, beta particles, 

neutrons, gamma rays, X-rays, or accelerated ions or subatomic particles from 

accelerator machines.

yy. Radiation Exposure Compensation Act (RECA) of 1990, as amended, 42 U.S.C. § 

2210 (noteTE), is a federal statute implemented by DOJ that provides monetary 

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compensation to individuals who contracted certain cancers and a number of other 

specified diseases as a result of defined on-site/downwind exposure to radiation 

released during above-ground nuclear weapons tests or as a result of their 

exposure to radiation during employment as uranium miners, millers, or ore 

transporters.

(1) Section 4 of RECA provides benefits for individuals with cancer who 

were either proximate to atomic tests at the Nevada Test Site 

(downwinder) or participated at the site of an atmospheric atomic weapon 

test (onsite participant).

(2) Section 5 of RECA provides benefits for individuals who have contracted 

a covered illness through exposure to a toxic substance during covered 

employment at a section 5 facility as a uranium miner, uranium mill 

worker, or as a uranium ore transporter. 

zz. Recommended Decision (RD). A RD is a written decision made by the CE 

regarding the eligibility of a claimant to receive compensation benefits available 

under the EEOICPA. As a recommendation, it does not represent the final 

program determination on claim compensability. It is a preliminary determination 

made by the CE that is subject to challenge by any claimant party to the decision. 

aaa. Referee Opinion is an impartial physician review in cases where the weight of 

medical evidence is equal between the opinion of the treating doctor and that of a 

CMC or Second Opinion physician. 

bbb. A Second Opinion Examination is a medical referral arranged by the DEEOIC

which requires an employee to undergo a physical examination. The results of 

that examination, along with the physician’s review of pertinent medical 

documentation, facilitate the production of a narrative medical report describing 

the physician’s independent medical opinion. 

ccc. Special Exposure Cohort (SEC) means the classes of employees designated by the 

EEOICPA, or by the Secretary of Health and Human Services (HHS), who when 

diagnosed with a specified cancer receive a presumption of causation that 

employment at a covered facility caused the specified cancer, without the need of 

a radiation dose reconstruction. 

ddd. Specified Cancers. The following are specified cancers in accordance with 20 

CFR § 30.5(ff): 

(1) Leukemia. [Chronic lymphocytic leukemia (CLL) is excluded]. The onset 

is to have occurred at least two years after initial exposure at any covered 

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(2) Primary or Secondary Lung Cancer. [In situ lung cancer that is discovered 

during or after a post-mortem exam is excluded.] The trachea and bronchi 

are included as part of the lungs. Sarcoma of the lung is a lung cancer. 

The pleura and lung are separate organs, so cancer of the pleura, such as 

mesothelioma, is not a specified cancer.

(3) Primary or Secondary Bone Cancer. This includes myelodysplastic 

syndrome, myelofibrosis with myeloid metaplasia, essential 

thrombocytosis or essential thrombocythemia, and primary polycythemia 

vera [also called polycythemia rubra vera, P. vera, primary polycythemia, 

proliferative polycythemia, spent-phase polycythemia, or primary 

erythremia]. A diagnosis of polycythemia vera (and the listed a/k/a 

nomenclature) is sufficient by itself to be classified as a malignancy of the 

bone marrow. Leukocytosis and thrombocytosis are supplemental 

descriptors of polycythemia vera. The bone type of solitary plasmacytoma 

(a/k/a solitary myeloma) is a form of cancer consistent with bone cancer. 

The soft tissue type of solitary plasmacytoma is not a type of bone cancer 

or the specified cancer of multiple myeloma. (Note: Cancer of the hard 

palate is not bone cancer.)

(4) Primary or Secondary Renal Cancers.

(5) Other Diseases. For the following diseases, onset 

must have been at least five years after initial exposure at any covered 

facility during a covered time period:

(a) Multiple myeloma (a malignant tumor formed by the cells of the 

bone marrow); 

(b) Lymphomas (other than Hodgkin’s disease). Waldenstrom’s 

macroglobulinemia is considered to be a type of non-Hodgkin's 

lymphoma, when diagnosed by lymph node biopsy, can be called 

lymphoplasmacytoid lymphoma. (Note: Lymphoma Waldenstrom 

is used as a pseudonym for many other disorders not included as a 

specified cancer. The acceptance of this condition as a specified 

cancer is to be based on the ICD code presented in the medical 

evidence or upon diagnostic clarification from a physician).

(c) Primary cancer of the:

(i) Thyroid; 

(ii) Male or female breast;

(iii) Esophagus; 

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(iv) Stomach;

(v) Pharynx – The pharynx has 3 parts - nasopharynx, 

oropharynx and hypopharynx. (The oropharynx includes 

the soft palate, the base of the tongue, and the tonsils); 

(vi) Small intestine;

(vii) Pancreas;

(viii) Bile ducts (includes Ampulla of Vater, a/k/a 

hepatopancreatic ampulla);

(ix) Gallbladder;

(x) Salivary gland;

(xi) Urinary bladder;

(xii) Brain (malignancies only). The brain is the part of the 

central nervous system (CNS) contained within the skull, 

i.e., the intracranial part of the CNS consisting of the 

cerebrum, cerebellum, brain stem, and diencephalon. (The 

intracranial endocrine glands and other parts of the CNS, 

benign and borderline tumors of the brain, and borderline 

astrocytoma are excluded);

(xiii) Colon (including the rectum); 

(xiv) Ovary;

(xv) Liver (except if cirrhosis or hepatitis B is indicated);

(d) Carcinoid Tumors. These tumors are considered primary cancers of the 

organs in which they are located. If the organ is one on the specified 

cancer list, the carcinoid tumor may be considered as a specified cancer. A 

Carcinoid tumor of the organs listed above may be considered as a 

specified cancer.

Carcinoid syndrome and monoclonal gammopathies of undetermined 

significance are not currently recognized as malignant conditions. 

Consequently, these conditions should not be considered as cancers.

The specified diseases designated in this section mean the physiological 

condition or conditions that are recognized by the National Cancer 

Institute (NCI) under those names or nomenclature, or under any 

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previously accepted or commonly used names or nomenclature. The 

DEEOIC will consult with NCI only on issues pertaining to the name or 

nomenclature of a disease diagnosed at an anatomic location for the 

purpose of determining whether it constitutes a cancer. 

eee. Site Exposure Matrices (SEM) is a relational database which acts as a repository 

of information related to toxic substances potentially present at covered DOE sites 

and has information regarding site investigations and occupational exposure to 

hazardous agents to assist in determining the existence of causal links between 

covered employment, exposure to toxic substances during such covered 

employment, and the resultant illnesses arising out of such exposure. 

fff. Spouse of a covered employee or covered DOE contractor employee means a wife 

or husband of that employee who was married to that individual for at least one 

year immediately before the death of that individual. 

ggg. Survivor means: 

(1) For claims under Part B, a surviving spouse, child, parent, grandchild and 

grandparent of a deceased covered employee; or 

(2) For claims under Part E, a surviving spouse and covered child of a 

deceased covered DOE contractor employee.

hhh. Time of injury means:

(1) In regard to a claim arising out of exposure to beryllium or silica, the last 

date on which a covered Part B employee was exposed to such substance 

in the performance of duty as specified in sections 7384n(a) or 7384r(c); 

or 

(2) In regard to a claim arising out of exposure to radiation under Part B, the 

last date on which a covered Part B employee was exposed to radiation in 

the performance of duty as specified in section 7384n(b); or 

In the case of a member of the SEC under Part B, the last date on which 

the member of the SEC was employed at the DOE facility or the AWE 

facility at which the member was exposed to radiation; or 

(3) In regard to a claim arising out of exposure to a toxic substance under Part 

E, the last date on which a covered Part E employee was employed at the 

DOE facility or RECA section 5 facility, as appropriate, at which the 

exposure took place. 

iii. Toxic substance means any material that has the potential to cause illness or death 

because of its radioactive, chemical, or biological nature.

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jjj. Uncertainty Distribution is a statistical term meaning a range of discrete or 

continuous values arrayed around a central estimate, where each value is assigned 

a probability of being correct.

kkk. Wage-Loss is based on the number of calendar years that the covered DOE 

contractor employee was unable to work or sustained a reduction in wages as a 

result of the covered illness. Wage-loss compensation is payable for the years of 

lost wages occurring prior to the covered DOE contractor employee’s normal 

Social Security retirement age, as determined by his or her date of birth. This 

term should only be used in reference to claims under Part E. 

lll. Workday means a single work shift, whether or not it occurred on more than one 

calendar day.

mmm. Worst-Case Assumption is a term used to describe a type of assumption used in 

certain instances for certain dose reconstructions. It assigns the highest 

reasonably possible value to a radiation dose of a covered employee based on 

reliable science, documented experience, and relevant data

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CHAPTER 2 – THE EEOICPA

1. Purpose and Scope. This chapter provides an overview of the EEOICPA program and 

the structure of the DEEOIC. It also addresses the relationships between DEEOIC and OWCP, 

the various components of the DEEOIC, and training for DEEOIC employees. 

2. The EEOICPA. The EEOICPA, as amended, 42 U.S.C. § 7384 et seq., was enacted as 

Title XXXVI of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001, 

Public Law 106-398. The Act originally had two parts, Part B and Part D. On October 28, 2004, 

the President signed into law an amendment that repealed Part D of the EEOICPA and created a 

new program called Part E. 

a. Part B. The purpose of Part B is to provide a lump-sum payment of $150,000 and 

medical benefits as compensation to covered employees suffering from 

occupational illnesses incurred as a result of their exposure to radiation, 

beryllium, or silica while in the performance of duty for the DOE and certain of 

its vendors, contractors and subcontractors. 

The legislation also provides for the payment of compensation to certain survivors 

of these covered employees, as well as for payment of a smaller lump-sum of 

$50,000 to individuals or their survivors who were determined to be eligible for 

compensation under Section 5 of RECA. Compensation for individuals with 

beryllium sensitivity is limited to medical monitoring and medical benefits.

b. Part E. The purpose of Part E is to provide variable amounts of compensation to 

DOE contractor employees or to their survivor(s) where it is at least as likely as 

not that exposure to a toxic substance while employed at a covered facility was a 

significant factor in aggravating, contributing to or causing the employee’s illness 

or death. Variable amounts of compensation up to an aggregate total of $250,000 

(for the employee and any survivors) are determined based on causation, wageloss, and impairment. 

3. Organization. This paragraph describes the structure and authority of the National, 

Regional, and District Offices (DOs). OWCP has seven divisions, of which DEEOIC is one. The 

others are the Division of Federal Employees’ Compensation (DFEC); the Division of Longshore 

and Harbor Workers' Compensation (DLHWC); the Division of Coal Mine Workers' 

Compensation (DCMWC); the Regional Directors (6 Regions), the Division of Administration 

and Operations, and the Division of Financial Administration. 

a. Regional Director. OWCP Programs, in each of its six regions, are administered 

by a Regional Director, who reports to the Director for OWCP. 

b. District Director (DD). DEEOIC has four DOs, which are located in Cleveland, 

Ohio; Denver, Colorado; Jacksonville, Florida; and Seattle, Washington. Each 

DO is managed by a DD, who reports to the Regional Director. (Exhibit 2-1

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contains a jurisdictional map. Exhibit 2-2 contains a list of addresses, telephone 

numbers, and fax numbers for the DOs.) 

4. Responsibilities. This paragraph describes the roles of the various components within the 

DEEOIC.

a. DOs. Within each DO there are a variety of roles:

(1) Claims Functions. Supervisory Claims Examiners (SCEs) manage units of 

Senior Claims Examiners (SrCEs) and Claims Examiners (CEs). Staff in 

these units adjudicate claims, authorize compensation and medical 

benefits, respond to inquiries from interested parties, and maintain case 

files.

(2) Fiscal Operations. Fiscal Officers (FOs) are designated for each DO. The 

primary responsibility of these individuals is to ensure the integrity of the 

compensation payment process. The FO is also responsible for 

monitoring financial management records and serves as the DO point of 

contact for medical billing issues.

(3) Medical Referrals. DEEOIC uses the services of a contractor to assist in 

obtaining medical opinions on a range of issues including causation, 

impairment, wage-loss, etc. The contractor is also responsible for the 

scheduling of second opinion medical examinations. Within each DO, a 

designated District Medical Scheduler (MS) is responsible for 

coordinating case referrals with the contractor. 

(4) M&F. Contract personnel in this area open, sort and place mail, compile 

case files, retire case records according to established schedules, image 

case files and documents, and transfer case files in and out of the DO. The 

CMR is the central location for incoming mail. The contract staff is 

responsible for opening mail, prepping the mail for scanning, scanning the 

mail, and assigning the digital image of the mail to the proper case in the 

OIS. 

(5) Contact and Technical Assistance. Customer Service Representatives are 

responsible for answering phones, referring calls within the DO and 

responding to general inquiries. Technical assistants are responsible for 

providing technical guidance and assistance to DO personnel and 

maintaining liaison with organizations outside the DO.

b. National Office (NO). The Director of DEEOIC has final authority to manage 

and administer the program. With the exception of the Final Adjudication Branch 

(FAB) Chief, who reports directly to the Director, the Deputy Director supervises 

the DEEOIC Branch Chiefs and serves as the Acting Director in the Director's 

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absence. Under the immediate jurisdiction of the Director and Deputy Director 

are the: 

(1) Policy Branch. Personnel in the Policy Branch consist of the Policy, 

Regulations and Procedures Units (PRPU), Secondary Claims Examiner 

(CE2) Unit, Medical Bill Processing Unit, and the Medical, Health & 

Science Unit (MHSU).

(a) The PRPU develop program policies and procedures to carry out 

the functions of the DEEOIC. In particular, PRPU staff: 

(i) Prepare and maintain the program’s PM and issue program 

Bulletins or Circulars, which entail significant coordination 

with the Office of the Solicitor for the DOL (SOL), 

especially with regard to statutory and regulatory changes;

(ii) Conduct accountability reviews; 

(iii) Participate in the development of training materials; 

(iv) Handle functions relating to employment verification and 

records, including the tracking of covered time frames for 

employment;

(v) Oversee the data collection and management of SEM that 

assists in determining the existence of causal links between 

covered employment, exposure to toxic substances during 

such covered employment, and the resultant illnesses 

arising out of such exposure; 

(vi) Review memoranda to the Director submitted by the FAB

and DO requesting the reopening of a claim or the vacating 

of a FAB decision based upon new and/or relevant 

evidence, by reviewing the case record and making a 

determination whether a reopening of the claim or the 

vacating of a FAB decision is warranted. The Director or 

the appropriately designated authority issues a denial letter 

to the party requesting the reopening; or a Director’s Order 

to the FAB or DO, setting the FAB decision or FAB 

Remand Order aside and outlining the course of action 

required to resolve the issue(s). 

(vii) Issue decisions regarding overpayments. 

(b) The CE2 Unit handles DO development and adjudication required 

while a case is pending review at the FAB. The CE2 Unit only 

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adjudicates issues that are outside the scope of the issue(s) being 

addressed by the FAB. In particular, CE2 staff: 

(i) Conduct all necessary development on outstanding claim 

elements not related to the RD currently in front of the 

FAB for review, and appropriately reflecting those actions 

in the Energy Compensation System (ECS) for the duration 

of the FAB review process;

(ii) Prepare a memorandum for the case file explaining what 

development actions have been taken and what future 

actions are required to address any outstanding issues; and 

(iii) Issue a RD whenever the case record contains enough 

evidence on file to support a RD on any of the outstanding 

claim elements.

 

(c) The MBPU is responsible for managing DEEOIC’s central bill 

processing day-to-day operations, payment certification, and 

overpayment recovery actions. The MBPU staff: 

Oversees the processes and procedures of the automated medical 

bill processing system and contractor activities for accuracy and 

timeliness that include provider enrollments, bill adjudication, bill 

adjustment, fee schedule appeals, medical authorization, and 

medical bill audits; 

(ii) Identify and resolve medical billing and payment issues and 

coordinates, develops, and implements strategies for 

recoupments of overpayments; and 

(iii) Prepares verified medical and compensation payments for 

proper data entry and certification through the Treasury 

payment applications. 

(d) The MHSU consists of a Medical Director, Health Physicists (HP), 

Industrial Hygienists (IH), Epidemiologist/Toxicologist (TOX), 

and support personnel. The MHSU function includes the 

following: 

(i) Review, research and respond to case referrals from the 

FAB, DOs and PRPU. Serve as the DEEOIC technical 

experts on medical, radiological, and toxicological 

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(ii) Serve as the liaison between the NIOSH and DEEOIC on 

all dose reconstruction related issues. 

(2) Branch of Outreach and Technical Assistance (BOTA). Personnel in the 

BOTA are responsible for technical assistance and outreach activities, 

including developing informational materials and maintaining the Web 

page. In particular, BOTA staff: 

(a) Develop and conduct training for DEEOIC staff; 

(b) Manage the program’s priority correspondence activity, including 

FOIA requests; preparing responses for the Secretary of Labor; 

Office of Congressional and Intergovernmental Affairs; OWCP 

Director, and the Director of the DEEOIC; 

(c) Facilitate development of comprehensive outreach plans; including 

local outreach by Resource Centers (RC); monitor and approve 

outreach expenses, conduct and arrange outreach events, and 

serves as the POC on the Joint Outreach Task Force Group 

(JOTG). The JOTG is comprised of representatives from the DOE, 

the DOE Former Worker Program (FWP), the NIOSH, and the 

DOL and NIOSH offices of the Ombudsman. These agencies work 

together to conduct joint outreach to current and former workers of 

the DOE workforce; and 

(d) Promote and maintain cooperative relations with individuals and 

groups having EEOICPA interests through technical assistance and 

public relations activities.

(3) Branch of Automated Data Processing Systems (BAS). Members of this 

Branch provide data processing and payment systems support services for 

the DEEOIC. In particular, the Branch is responsible for: 

(a) Developing and maintaining activities related to ECS and OIS;

(b) Providing statistical reports and data; and

(c) Providing overall computer services. 

(4) Management Unit. Members of this unit support the efficient operations of 

the DEEOIC by providing the following functions: 

(a) Oversee DEEOIC budget and ensure that budget limitations are not 

exceeded; 

(b) Monitor and manage personnel and procurement actions; and 

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(c) Provide administrative support to the Director and the Deputy 

Director.

 

c. FAB. Personnel in this Branch are responsible for issuing all FDs under the 

EEOICPA, except for decisions on overpayments. The FAB also processes all 

objections by holding oral hearings or reviewing the written record. FAB 

representatives issue FDs that affirm, remand, or reverse RDs issued by the 

DEEOIC DOs.

A FAB Office is located in Washington, D.C., and a FAB unit is co-located with, 

but independent from, each of the four DOs. The manager of each FAB DO 

reports to the FAB Chief. (Exhibit 2-2 contains a list of addresses, telephone 

numbers, and fax numbers for the FAB units.) 

5. Training. This paragraph describes the information new employees need and addresses

the kinds of training OWCP provides to its employees. 

a. Orientation. Orientation is provided to all new employees of the DO, FAB and 

NO. This orientation includes the following topics: 

(1) Organization of the DO, the Regional Office, the FAB, the NO, and 

OWCP, as appropriate; 

(2) Mission and objectives of the DEEOIC; 

(3) General description of duties; 

(4) Staffing pattern, chain of command; 

(5) Floor plan/physical layout of office, unit locations, emergency procedures, 

office security, etc.;

(6) Mail handling, paper and case flow;

(7) Working hours, breaks, lunch hour, sick and annual leave arrangements, 

flextime, telephone use, overtime authorization, etc.; 

(8) Introduction to staff; 

(9) Reference materials; and

(10) Role of partner agencies, e.g. NIOSH, DOE, DOJ, RCs, etc.

b. Courses. Three formal training courses have been developed for the DEEIOC 

staff. These include:

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(1) All Staff Members Orientation. This is a course designed by each DO, 

 FAB, and the NO to explain the basic concepts of the EEOICPA.

(2) CE Course. CEs, Senior CEs, Supervisors, and FAB Representatives take 

this course. 

It is delivered in a classroom or through self-instructional format. A 

resource person is available to respond to questions if the self-instructional 

format is used. 

The course, which requires about two weeks to complete, is designed to 

explain the claims adjudication process and to develop case management 

skills.

(3) Secondary Training. Additional training is provided to all claims 

personnel to address developing needs of the program (e.g., complex 

medical terminology/issues, facilities lists, exposure determination and 

SEM, precedent-setting decisions, RCs). This training may include 

advanced CE and FAB training. In addition, training on ECS is available. 

6. Jurisdiction. This paragraph describes the jurisdiction of the four DEEOIC DOs. The 

DO that handles a claim is determined by where the employee last worked as a covered 

employee. A DO acquires jurisdiction if the last covered facility is/was located within the 

geographical area it serves. (Exhibit 2-1 contains a DEEOIC Jurisdictional Map.) 

a. Survivor Claims. This rule applies to claims from survivors as well as those 

brought by the employee. 

b. Uranium Workers. Normally, all claims for uranium workers (or their survivors) 

who may have been awarded benefits under Section 5 of RECA are within the 

jurisdiction of the Denver DO. (However, if a worker filed for both RECA 

Section 5 and silicosis benefits, and the Nevada Test Site was the last place of 

employment, the case would go to the Seattle DO rather than the Denver DO). 

7. Resources: DEEOIC district and FAB offices have full access to a range of reference 

materials and programmatic resources that are available through a publically accessible website. 

In addition, DEEOIC makes locally available other material that assists its staff in adjudicating 

claims. A list of programmatic references and resources available to staff can be seen in Exhibit 

2-3. 

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CHAPTER 3 – GENERAL PROVISIONS

1. Purpose and Scope. This chapter summarizes the provisions and requirements of the 

EEOICPA and addresses its coverage. 

 

2. Provisions of the EEOICPA. 

a. Requirements for Part B Eligibility. A covered employee must satisfy criteria of 

eligibility for at least one of the following compensable categories under Part B:

(1) Beryllium sensitivity or CBD resulting from exposure to beryllium in the 

performance of duty.

(2) A specified cancer if the employee was a member of the SEC. 

(3) A non-specified cancer if the employee incurred a cancer that is at least as 

likely as not related to radiation exposure from employment at a covered 

facility.

(4) Chronic silicosis resulting from exposure to silica from covered 

employment at a DOE facility in Nevada or Alaska, aggregating at least 

250 work days during the mining of tunnels for tests or experiments 

related to atomic weapons.

(5) The U.S. Attorney General has determined entitlement to an award of 

$100,000 under RECA Section 5. 

b. Requirements for Part E Eligibility. A covered employee must establish that it is 

at least as likely as not that exposure to a toxic substance at a DOE facility was a 

significant factor in aggravating, contributing to, or causing the illness, and that it 

is at least as likely as not that the exposure to such toxic substance was related to 

employment at a DOE facility. 

c. Medical Care. An employee who meets the statutory conditions of coverage is 

entitled to medical care consisting of services, appliances, and supplies prescribed 

or recommended by a qualified physician considered likely to cure, give relief, or 

reduce the degree or the period of that condition, and which DEEOIC considers 

likely to cure, give relief, or reduce the degree or the period of that illness. 

Provider charges associated with the treatment of an accepted medical condition 

are paid from the compensation fund and are subject to a fee schedule. 

d. Monetary Compensation under Part B. An eligible employee or survivor is 

entitled to receive a lump-sum payment of $150,000, if found eligible under Part 

B of the EEOICPA. An eligible uranium worker or survivor is eligible for a 

lump-sum payment of $50,000. 

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e. Monetary Compensation under Part E. Maximum compensation up to $250,000 

is determined based on causation, wage-loss, and impairment. 

 

(1) Employee Benefits: Covered employee is eligible for compensation up to 

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

(a) Wage-loss is based on the number of calendar years that the 

employee sustained a reduction in wages as a result of the covered 

illness. Wage-loss compensation is payable for qualifying years 

occurring prior to the employee’s normal Social Security 

retirement age, determined by the employee’s date of birth. 

 

(b) Impairment is a loss, loss of use, or derangement of any body part, 

organ system or organ functionality as it affects the whole body, as 

a result of the covered illness. An impairment rating is performed 

once the employee has reached MMI (i.e., the covered illness is 

stabilized and is unlikely to improve with or without additional 

medical treatment). 

(2) Survivor Benefits: The survivor is eligible for compensation in the amount 

of up to $125,000 if the covered illness aggravated, contributed to, or 

caused the employee’s death. 

 

(a) Wage-Loss: The survivor may be entitled up to an additional 

$25,000 or $50,000 depending upon the amount of calendar years 

over 10 years that the deceased covered employee experienced 

compensable wage-loss prior to his or her normal Social Security 

retirement age. 

(b) Impairment: In general, the survivor is not entitled to impairment 

benefits under Part E. 

f. Survivor Eligibility under Part B. In the event of the death of an eligible 

employee, the Act provides for the disbursement of compensation in order of 

precedence and in proportion to the number of eligible survivors. The order of 

precedence is spouse, child, parent, grandchild, then grandparent. 

g. Survivor Eligibility under Part E. The only survivors eligible for benefits are the 

spouse, or children of the covered employee who are under the age of 18 years at 

the time of the employee’s death, or under the age of 23 years and a full time 

student at the time of the employee’s death, or any age and incapable of selfsupport at the time of the employee’s death. In limited circumstances, a spouse 

may elect to receive the compensation to which an employee would have been 

eligible prior to death.

 

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h. Third Party Liability. With the exceptions listed below, where an employee's 

compensable illness or death results from circumstances creating a legal liability 

on some party other than the United States, the cost of compensation and other 

benefits paid by the 

OWCP must be offset to reflect any settlement obtained. Exceptions include the 

following: 

(1) Workers’ compensation benefits are not offset under Part B; and 

(2) Insurance policy payments made to an employee or eligible surviving 

beneficiary, where the employee or eligible surviving beneficiary has 

purchased the policy, are not offset. 

i. Coordination of Benefits with SWC. When a claimant has received benefits from 

a SWC program for the same covered illness(es) to which he or she is to be 

awarded compensation under Part E, this requires a reduction in the award. 

Exceptions to this reduction include the following: 

(1) Medical and vocational rehabilitation benefits received from SWC for the 

same covered illness(es) are not included in the reduction; 

(2) The claimant has received SWC benefits for both a covered and a noncovered illness as a result of the same-work related incident; these benefits 

also will not be included in the reduction; and 

(3) Reasonable costs in obtaining SWC benefits incurred by the claimant, 

such as but not limited to attorney’s fees and specific itemized costs of 

suits, are not included in the reduction.

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CHAPTER 4 – CUSTOMER SERVICE

1. Purpose and Scope. This chapter describes the commitment of the DEEOIC to serving its 

internal and external customers with excellence. 

a. Internal Customers. These include but are not limited to NO staff, DO staff, and 

RC employees.

b. External Customers. These include, but are not limited to, authorized 

representatives (ARs), attorneys, advocacy groups, congressional officials, 

contractors, and other external agents who have a vested interest in the claims 

process.

2. DEEOIC Standards for Customer Service. The highest level of customer service is 

expected in all dealings with individuals conducting business with and within the DEEOIC. All 

staff are expected to be courteous, professional, flexible, honest and helpful. The program's 

Operational Plan includes standards for the performance, responsiveness and timeliness of 

customer service. DEEOIC's Customer Service Goals include the following:

a. Customers. DEEOIC customers are satisfied with our services;

b. Services. DEEOIC services are delivered to customers in a timely and accurate 

manner; and

c. Planning and Development. Customer needs are integrated into program planning 

and product development. 

3. Telephone Communications. DEEOIC staff speak to claimants, ARs, health care 

providers, employer organizations, RC personnel, governmental organizations, and others on a 

daily basis. 

a. Telephone Skills. Effective telephone skills are one of the keys to providing 

accurate, courteous, and timely information to callers. These skills include, but 

are not limited to, the following:

(1) Answer the telephone promptly; 

(2) Identify the caller’s needs; 

(3) Handle inquiries in a professional and pleasant (non-defensive) manner; 

(4) Provide prompt, informative responses; 

(5) Keep conversations brief but provide accurate, courteous, and timely 

information; and 

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(6) Give callers an accurate estimate of when a return call will be attempted, if 

necessary.

b. Inquiries Directed to RCs. RCs are situated in key geographic locations 

throughout the United States to provide assistance and information to the 

DEEOIC claimant community and other interested parties. The RCs play a 

limited but valuable role in the claims process and their duties include the 

following: 

(1) Provide information on claims process and program procedures to the 

DEEOIC claimant community;

(2) Assist claimants in the completion of the necessary claim forms;

(3) Take initial employment verification steps for 

all new EEOICPA claims filed with the RC; 

(4) Conduct occupational history development for certain employees; 

 

(5) Provide case-specific information and clarification to claimants and ARs; 

(6) Educate and assist the claimants regarding impairment and wage-loss 

benefits on cases with positive causation determinations; and 

(7) Provide medical bill payment assistance to claimants. 

For more information about the RCs, see Chapter 10 - Resource Centers. 

c. Documenting Phone Calls. The Phone Calls Screen in ECS allows the ECS user 

to memorialize telephone conversations. The Phone Calls screen in ECS also 

provides a mechanism by which incoming and outgoing telephone contact on a 

given case file is tracked and maintained. 

(1) The person who answers the phone must create the phone record in ECS, 

unless the call is immediately transferred to another person and that person 

picks up the phone and speaks with the caller. The second person then 

becomes responsible for creating the phone message record in ECS. A 

copy of the phone call note from ECS must be bronzed into OIS. 

(2) The person transferring the call must ensure that the call is picked up so 

that the caller is not inadvertently dropped or transferred to a voicemail 

message.

(3) Callers may be transferred to voicemail only with the caller’s explicit 

knowledge and consent. 

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4. Written Communications. DEEOIC staff must use good writing skills in all 

correspondence. Letters must be clear, concise, instructional, accurate, and tailored. Specific 

skills include:

a. Considering the Reader. Use language that the reader can understand and 

customize the correspondence accordingly, specifically for that reader. Avoid 

using abbreviations in the body of the correspondence, unless they have been 

written out at the beginning of the correspondence; 

b. Checking for Errors. Review correspondence before issuance to eliminate 

grammatical, spelling, template or other technical errors;

c. Choosing the Mode of Expression. Use natural and non-adversarial wording. To 

the extent possible, write politely, conversationally and employ commonly used 

words; 

d. Making Documents Visually Appealing. Present text in a way that highlights the 

main points to be communicated. Use bullets or numbered lists when providing 

instructions or identifying deficiencies. Avoid lengthy narrative explanations or 

too much usage of underlining or bolding of the text in the correspondence; and 

e. Tailoring the Letter to the Issue at Hand. Do not use lengthy, “laundry list” 

template letters when only certain information is being requested or provided. 

Identify what evidence has been submitted and the additional information that is 

needed in order to proceed with the adjudication of the claim in a timely manner.

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CHAPTER 5 – PROGRAM DIRECTIVES

1. Purpose and Scope. This chapter describes the communications and directives system 

used by the DEEOIC. It focuses on the structure of the PM governing claims under the 

EEOICPA, and addresses its relationship to the Program's other written directives. 

2. Directives. The publications relating to the EEOICPA include both external and internal 

releases, as follows:

a. External Directives. These may consist of either legal or informational releases. 

(1) The Federal Register contains “Notices” and “Rules” pertaining to new or 

revised policy. 

(a) “Notices” in the Federal Register advise the public of proposed 

changes and invite comments on them. 

(b) “Rules” in the Federal Register state the regulations adopted by the 

program. 

(2) Pamphlets and notices inform the public of the availability of EEOICPA 

benefits.

b. Internal Directives. There are three categories of directives; they are permanent 

(unless superseded), time-limited, and informational.

(1) Permanent directives include the following: 

(a) The Federal EEOICPA PM, which is updated by transmittals.

(b) Other guides, including the DOL Correspondence Guide (DLMS 

Handbook 1-2); the GPO Style Manual; Program Memoranda; 

OIS, and the ECS User’s Manual which provides users and 

operators of the ECS with guidelines for interacting with the 

system.

(2) Time-limited directives are issued as Bulletins. They may involve 

changes to procedures, special reports, or pilot programs. A Bulletin is 

effective until it is superseded by the PM or an updated Bulletin. 

(3) Informational directives are issued as Circulars and do not require specific 

action. They are used to meet the following objectives:

(a) To announce personnel changes, upcoming events or activities, or 

other items of informational value; 

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(b) To call attention to standing instructions or performance standards 

that may require compliance or improvement; 

(c) To announce proposed plans or anticipated program changes; or 

(d) To inform DOs of the activities and interests of the NO. 

3. Procedure Manual. The EEOICPA PM is accessible to all interested parties within and 

outside of the DEEOIC. 

4. Maintenance and Revision. EEOICPA Transmittals update the EEOICPA PM and are to 

be cited in the following manner: 

a. Citations to the PM. The EEOICPA PM has thirty-six chapters, which in turn are 

divided into paragraphs, subparagraphs, and sometimes sub-subparagraphs. 

Chapters and paragraphs should be cited as follows: 

Citation to a chapter: Federal (EEOICPA) PM Chapter 1.1 

Citation to a paragraph: Federal (EEOICPA) PM Chapter 1.1.1 

Citation to a subparagraph: Federal (EEOICPA) PM Chapter 1.1.1a 

 Citation to a sub-subparagraph: Federal (EEOICPA) PM Chapter 1.1.1a(1)

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CHAPTER 6 – PROCESSING MAIL

1. Purpose and Scope. This chapter identifies the different types of mail received by the 

DEEOIC and outlines mail-processing procedures. In addition, the chapter contains procedures 

for case mail association, outgoing mail processing and handling returned mail. Also provided is 

information regarding the handling of priority correspondence, including FOIA and Privacy Act 

requests, and the safeguarding of Personally Identifiable Information (PII) in the disclosure of 

claim records. 

The work of staff related to mail and file is tied closely to ECS functionality in tracking cases, 

managing case status and record keeping. Specific instructions for using ECS are set forth in user 

guidance available to staff.

2. Types of Mail. Most mail received by a DEEOIC Office is through the U.S. Postal 

Service (USPS). However, some mail is received by private overnight mail service, facsimile 

transmission (fax), electronic mail (e-mail), or by hand. Mail is grouped as follows: 

a. Priority Correspondence. DOL considers mail to and from the following parties 

as priority correspondence: 

(1) The President and White House Staff; 

(2) The Vice President and members of the Vice President's staff;

(3) The President Pro Tempore of the Senate;

(4) The Speaker of the House of Representatives; 

(5) Other Members of Congress; 

(6) Members of the Cabinet;

(7) Governors of States; 

(8) Foreign government officials (e.g., Prime Ministers, Cabinet-level 

officers, Ambassadors, etc.);

(9) Directors/Managers of employee organizations;

(10) Directors/Managers of national and international labor organizations; 

(11) Members of the press; and

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b. Primary Claim Forms. These documents, which contain information on new 

claims, include:

(1) EE-1, Claim for Benefits under the EEOICPA; 

(2) EE-2, Claim for Survivor Benefits under the EEOICPA; and 

(3) Any letter or document containing “words of claim” under the EEOICPA. 

“Words of claim” simply means that the individual is requesting benefits 

under the EEOICPA. 

c. Bills. Form OWCP-1500 is used to bill OWCP for medical services and supplies. 

Hospital bills are submitted on the Form OWCP-04. Form OWCP-915 is used for 

employee reimbursement of out-of-pocket medical expenses. Form OWCP-957 is 

used for employee reimbursement of medical travel expenses.

d. Fiscal Documents. Fiscal items may include an EN-20, payment transaction forms 

(PTF), payment cancellation forms, etc.

e. Routine Mail. Other types of mail typically received by the DEEOIC include:

(1) Documents from claimants and/or their AR, such as: medical records, 

employment records, exposure records, birth certificates, marriage 

certificates, death certificates, school records, affidavits, address changes, 

waivers, requests for an oral hearing, review of the written record, 

reconsideration, or reopening; 

(2) Documents from the DOE, contractors, and/or subcontractors; 

(3) Information from other agencies, such as HHS, NIOSH, DOJ, and the 

Social Security Administration (SSA);

(4) Medical reports from attending physicians;

(5) Mail from contractual sources, including reports from a CMC, Center for 

Construction Research and Training (CPWR), and second opinion and 

referee specialists; 

 

(6) Occupational/Exposure reports from an IH and TOX; 

(7) Requests for information from other Federal, state, and local government 

agencies; and

(8) Case-specific documents forwarded from other offices within DEEOIC, 

including a RC, for file association. 

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3. Electronic Recordkeeping. The DEEOIC maintains case file records in both paper and 

electronic form. Incoming paper mail is processed and scanned for electronic storage by a 

contractor at the CMR, located in London, Kentucky. The CMR date stamps the document(s) 

and its corresponding envelope, assesses the quality of the electronic image, and associates the 

document(s) with the appropriate case record in OIS. The electronic document(s) is then indexed 

according to predetermined subjects and categories. The subjects and categories into which mail 

is sorted and filed, and the types of documents included in each, can be found in Exhibit 6-1. 

4. Unreviewed Mail Notification. Once the CMR has imaged a document and associated it 

with an existing case file record, an electronic notification is sent through OIS to the appropriate 

CE, notifying him/her that mail has been received in a case for which he/she is assigned. The 

assigned CE is to verify that the unreviewed mail has been associated with the appropriate case 

file, that the document was indexed correctly into the appropriate subject/category, and must 

review the entirety of the document and ensure that proper action is taken in response to the 

information provided. It is important that the CE check OIS for new mail on a daily basis. 

5. Handling of Mail Received in a DEEOIC Office. While the CMR contractor handles the 

bulk of incoming mail for scanning and association with claim records, some mail and faxes will 

occasionally be received in DEEOIC offices. The M&F Clerk(s) in each office carefully inspect 

the contents of incoming envelopes to ensure that all contents are removed. For faxes, the M&F 

Clerk inspects the submission to make sure that it is complete and relates to a single claim. The 

envelope (or in case of fax, the top page of the document) must be date-stamped, indicating the 

DEEOIC office location in which the mail was received and the year, month, day, and time of 

receipt. Subsequently, the M&F Clerk forwards the faxes and mail to the CMR for incorporation 

into OIS. 

The nature of some correspondence may require action at the DEEOIC DO level to image 

documents into OIS locally, at the office’s discretion. Such documents may include, but are not 

limited to: 

a. EE/EN-20 Acceptance of Payment Under the EEOICPA. At the time a payment 

is Authorized by the DD (or an approved person with the DD role), all documents 

associated with the payment (i.e. EN-20, PTF, Payment Memo, Screen Print, etc.) 

are to be bronzed and saved as a “payment packet” in OIS. Once the payment 

packet is bronzed, the documents will be labeled with a unique identifier and filed 

under the Category: Forms and Claims; Subject: PTF. The payment packet will be 

described using a unique identifier consisting of the letters “PMT” followed by 

the first 4 letters of the payee’s last name, the last 4 numbers of the payee Social 

Security Number (SSN), and the Authorization Date as it appears on the PTF. For 

example, a payment to someone named Jones, with a “last 4” of 9876, and an 

Authorization Date of 01/01/2014 would be stored in OIS as follows: 

Category: Forms & Claims

Subject: PTF

Description: PMT JONE9876, 01-01-2014 

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b. SSA-581 Authorization to Obtain Earnings Data from the SSA. The SSA requires 

an original signed copy of the SSA-581. As such, a copy of the SSA-581 is to be 

bronzed into the appropriate case record in OIS, and the original is sent to SSA 

for processing. 

c. Documents Pertaining to a Terminal Claimant. Because documents in terminal 

cases are time-sensitive and require swift action, mail of this kind received at a 

DEEOIC office is directed to the assigned CE for immediate incorporation into 

OIS and appropriate handling. 

d. Priority Correspondence. Priority correspondence generally to the request for 

information and/or status of a claim from the claimant or an authorized third 

party. Consequently, priority correspondence is time sensitive and requires 

careful attention in its review and response. 

Of the priority correspondence listed in paragraph 2a above, the most are FOIA 

requests, Privacy Act requests, and Congressional inquiries. In instances when a 

third party makes such a request (other than a FOIA request), a waiver signed by 

the claimant or AR must be included. 

(1) FOIA Requests. FOIA requests allow third parties to request and gain 

access to existing Federal Government information, as outlined under 5 

U.S.C. §552. FOIA requests are highly time sensitive and require careful 

attention as they involve the disclosure of specific documentation 

pertaining to the DEEOIC and/or its claimants. Each DEEOIC Office is to 

have a FOIA coordinator to effectively facilitate the identification and 

processing of FOIA requests. 

Exhibit 6-2 shows a FOIA Process Flow Chart which identifies the steps 

to be taken in order to accurately and expeditiously process a FOIA 

request received in a DEEOIC office. 

 

(2) Congressional Inquiries. On behalf of their constituents, Congresspersons 

submit requests for information pertaining to a claimant’s EEOICPA 

claim. The responsible DO or FAB office is responsible for ensuring that 

these inquiries receive a comprehensive review and that a response is 

prepared in a timely manner. 

 

(3) Privacy Act. The Privacy Act of 1974, 5 U.S.C. §552a, applies to an 

individual seeking information about him or herself. The law provides an 

individual the right to access records maintained in federal systems of 

record (e.g., claim files) that are retrievable by his or her name or other 

personal identifiers. 

Examples of Privacy Act requests received by DEEOIC include requests 

for a copy of a case file or a specific document from a case file (e.g., CMC 

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report, SSA records). Privacy Act requests may be submitted by 

claimants, an AR or authorized third parties. 

(a) Handling document requests. In instances when a claimant, AR or 

authorized third party is seeking a copy of the entire case file 

record, or a specific document in a case file, the CE is to: 

(i) Access ECS to determine if the case file has an

imaged component. 

(ii) Copy relevant documents from the paper case file and/or 

OIS. 

(iii) Determine what information, if any, needs to be redacted.

 

(iv) Before copies are sent, the CE/FAB Hearing Representative 

(HR) reviews the case file and the redacted copies, and 

completes a Data Release Form (Exhibit 6-3). The CE/HR 

then provides a copy of the redacted case file to the 

appropriate Supervisory CE, Senior CE, or HR for review 

to ensure the documents are appropriately redacted. A 

cover letter outlining the claimant’s appeal rights is to be 

included. The CE/HR is only permitted to release 

documents that have been reviewed, and whose release has 

been approved by the appropriate Disclosure Officer or 

his/her designee. The Data Release Form is to be bronzed 

into the appropriate case record in OIS. 

6. Physical Evidence. Any documents or other physical evidence submitted by a claimant is 

to be retained by the Program as part of the case record. Program literature and other public 

notices are to include instruction to the claimants as to the appropriate types of evidence to 

submit in support of a claim. Claimants should not send original documents to the CMR (e.g., 

birth certificates, death certificates, marriage certificates). The CMR will scan these types of 

records, but it may not be possible to return them to the submitting claimant. 

a. Portable Media. The types of documents and evidence received by the DEEOIC 

in support of EEOICPA claims is varied and can occasionally consist of physical 

evidence which cannot be imaged into OIS, such as portable media, X-rays, etc. 

In such instances, the DO is to incorporate this information with the paper case 

file, making a notation in the electronic OIS record that physical evidence exists 

in the case. If no paper case file exists, a new file is to be created in which to store 

the physical evidence and is maintained by the DO. 

7. PII. PII is defined as information that can be used to distinguish or trace an individual’s 

identity, such as his or her name, SSN, or biometric records, alone or when combined with other 

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personal or identifying information that is linked or linkable to a specific individual, such as a 

date and place of birth or mother’s maiden name. 

During the adjudication process, the DEEOIC collects, maintains, and shares a large amount of 

data. It is of the utmost importance that all DEEOIC staff maintains the privacy of all claimants 

and safeguards PII contained within the case record from unauthorized and improper disclosure. 

a. Protected PII. Protected PII is information, which if disclosed, can result in harm 

to the individual whose name or identity is linked to that information. Examples 

of Protected PII include, but are not limited: SSN, credit card number, bank 

account number, biometric identifiers (e.g. image, fingerprint, and iris), date of 

birth, place of birth, mother’s maiden name, criminal records, medical records, 

and financial records.

b. Non-Sensitive PII. Non-sensitive PII is information, which if disclosed, cannot 

reasonably be expected to result in personal harm to the individual the 

information is linked to. Examples of non-sensitive PII that can become 

Protected PII if linked with other Protected PII include, but are not limited to: 

first/last name, e-mail address, business address, business telephone, and general 

education credentials.

c. Categories of PII that Indirectly Identify an Individual. 

(1) Any information where it is reasonably foreseeable that the information 

can be linked with other information to identify an individual; 

(2) Documentation not containing a name or SSN but containing a place of 

birth and mother’s maiden name, which when taken together, can identify 

a specific individual; and 

(3) Documentation containing the name or names of other individuals (e.g., 

names of co-workers).

d. Information Pertaining to Deceased Individuals. An individual’s right to privacy 

ends upon his or her death. Therefore, a deceased person’s name, address or SSN 

is not considered PII. However, documentation referring to a deceased person can 

contain PII regarding other living individuals. 

e. Information Pertaining to Living Individuals. All DEEOIC staff are to prevent 

the unauthorized release of PII contained in paper records, electronic records (e.g. 

e-mails), or any other material for any living individual. This includes materials 

received from NIOSH, DOE, CPWR, corporate verifiers, unions, or any other 

source.

(1) CDs from NIOSH and DOE may contain PII on other individuals. 

DEEOIC staff must thoroughly review all documents on a CD before 

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releasing the information. If a document contains PII on an individual 

other than the claimant, the document is printed and the appropriate PII is 

redacted. A photocopy is then made of the newly redacted record to ensure 

that the redacted information cannot be detected. This redacted document 

is then scanned into OIS. 

If the CD is identified as containing PII pertaining to individuals other 

than the claimant, DEEOIC staff will place a label on the CD that states:

NOTICE:

This CD and/or printed documents from the CD, includes confidential 

information on workers other than this employee. This information must 

be carefully reviewed and redacted before release, whether by electronic 

or printed version, pursuant to the Privacy Act. Monetary fines may be 

imposed on an individual government employee for release of confidential 

information or personally identifiable information.

f. E-Mail. All DEEOIC staff must comply with all prescribed OWCP concerning the 

use of e-mail containing PII. 

(1) E-mails sent from one DEEOIC employee to another through the internal 

OWCP wide-area network (WAN) are considered secure. E-mails to and 

from contractors who use the OWCP network (OWCP owned and 

properly configured equipment, including remote laptops that access the 

WAN) are also considered secure. Central Bill Process “threads” 

provided through the secure website of the Bill Processing Agent (BPA) 

conform to this policy, as they are also secured within an accredited 

network. 

DEEOIC staff are permitted to list the employee’s name and case file ID 

in the body of an e-mail message. However, the subject portion of the email may not contain both the employee’s name, combined with any 

identifier considered Protected PII, outlined above. 

(2) E-mails between DEEOIC employees and parties outside of the OWCP 

network (e.g., RCs, corporate verifiers, NIOSH, DOE) are not secure. As 

such, DEEOIC staff are not permitted to disclose any protected PII in any 

part of the e-mail message and any attachments containing protected PII 

must be password protected or encrypted. 

Therefore an e-mail message can contain the last name and Case ID 

number in the text of the message, as long as the SSN, full name, or other 

PII is not listed anywhere in the e-mail message. Accordingly, 

development letters must be faxed or mailed to corporate verifiers.

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(a) SSA Exception. Communications with the SSA are through digital 

fax, and as such, do not subject to the above restrictions. 

(3) Case specific e-mails received from an outside party containing Protected 

PII are to be printed and uploaded into the OIS case file. DEEOIC staff are 

permitted to reply with an acknowledgement e-mail, removing any PII 

from the sender’s message and also advising the sender (e.g., claimants, 

physicians, Congressional offices) that DEEOIC does not conduct claims 

communication via e-mail, but only by telephone or letter, as e-mail 

cannot be considered secure. 

In addition, DEEOIC staff are to remove protected PII in any e-mail 

message chain and their attachments prior to forwarding them outside of 

the OWCP network. However, if this is not possible, the documents 

should be faxed or sent via mail or courier. Packages containing extracts 

of multiple protected PII records (e.g. to CPWR, DOE, RC) sent via 

courier must be tracked (e.g., sent by Registered Mail, Return Receipt, Fed 

Ex).

(4) E-mail messages with the BPA concerning claimants may only include the 

claimant’s Central Bill Process Member ID. Claimant names are not to be 

included in the e-mail, unless in an encrypted attachment.

g. Protected PII and Portable Media. 

(1) Protected PII is only to be stored on portable media when absolutely 

necessary. Protected PII on portable media devices including laptops 

issued by DOL are to be protected with agency-approved encryption. All 

reasonable measures are to be taken to ensure that portable media 

containing protected PII are stored inside a safe or in a secured, locked 

cabinet, room, or area during periods when the media is not in transit or 

active use.

(2) Delivery of portable media containing protected PII, including CDs, 

DVDs, or other writable media is done through the USPS or other DOL 

authorized delivery service with the ability to track pickup, receipt, 

transfer, and delivery. The portable media must be encrypted according to 

DOL standards and then double-wrapped in an opaque package or 

container that is sufficiently sealed to prevent inadvertent opening or 

reveal signs of tampering. The decryption key is not included in the same 

package as the portable media, but instead sent in a separate package.

h. Disposal of Documents and Electronic Media Containing Protected PII. Hard 

copy documents and electronic media containing PII are not simply discarded in a 

wastebasket, but instead discarded in bins specifically designated for shredding or 

burning. 

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i. Improper Release of Protected PII. If protected PII is improperly released to an 

incorrect individual, or documentation sent to the correct individual contains 

protected PII of another individual that was not redacted, DEEOIC staff must: 

(1) Contact the individual via telephone and registered mail to request the 

return of the document. The DEEOIC staff member provides a selfaddressed, stamped envelope for the return of the material directly to the 

DEEOIC;

(2) Immediately notify Appropriate Management (DD, FAB Manager or FAB 

Branch Chief) who in turn notifies the Regional Director or NO, who 

complies with established departmental reporting requirements, 

documenting the type of PII disclosure, the circumstances surrounding the 

disclosure, how it was discovered, the appropriate actions taken to recover 

the document in question, and the disposition of the recovery effort; and 

(3) Track each PII recapture request within the Regional or FAB Office.

(a) If the recapture of the PII documentation is successful, the incident 

becomes closed with the incident record filed and maintained in 

OWCP.

(b) If the third party in possession of the improperly released 

documentation refuses to return it, the DEEOIC staff member 

reports the situation through the appropriate management, through 

the Regional Director (except FAB), to the NO, who will provide 

guidance.

8. Outgoing Mail. Outgoing mail is processed as follows: 

a. Envelopes. All envelopes show the addressee's full mailing address, including the 

ZIP code. If the addressee provides a P.O. Box and a street address, both are 

listed on the envelope. Some post offices require a further separation of local 

mail, and such requirements are honored. 

b. Postage. A postage meter is used to affix postage. Airmail letters for overseas 

delivery are bundled separately from regular mail.

c. Registered and Certified Mail. These types of mail are processed according to 

USPS regulations and specific procedures established in each DEEOIC office.

d. Overnight Express Mail. The services of the designated contractor are used at the 

discretion of the DEEOIC. 

9. Returned Mail. Occasionally, mail sent out by the DEEOIC is returned by the USPS as 

undeliverable. The effective handling of claims depends heavily on ensuring that the claimant 

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and/or AR receive the correspondence sent by a DEEOIC Office. Therefore, it is important that 

the DEEOIC maintain the current mailing address and phone number(s) of the claimant and/or 

AR. 

a. Inaccurate or Unreadable Mailing Address. On occasion, printing errors occur in 

which the mailing address contains a typo, is transposed, or is incomplete, and is 

thus returned as undeliverable. In such instances, the mailing address on the 

correspondence is examined and compared to the mailing address on file. If it is 

determined that a mistake was made by the DEEOIC, a corrected correspondence, 

with a new effective date, is prepared and resent to the correct mailing address 

and the release date is updated in ECS. 

b. Unknown Address. In such instances, sufficient attempts to obtain a correct 

address are made prior to administratively closing the claim.

(1) Check the Social Security Death Index to verify the recipient is alive. A 

print out of the search is to be imaged into the case record. 

(2) Call the claimant or AR and request the current mailing address be 

verified in writing. This request is also memorialized in writing.

 

(3) Review the case file in its entirety to determine if any new/different 

contact information for the claimant or AR exists in any of the evidence;

(4) Contact the RC to see if they have contact information on the claimant or 

AR. In instances of multiple claimants, they may also be contacted in an 

attempt to obtain updated contact information on the claimant or AR; 

(5) Send a letter to the USPS Postmaster. Exhibit 6-4 shows a sample USPS 

Postmaster Address Request Letter. Information regarding the appropriate 

postmaster to which this letter is to be sent can be obtained at 

http://www.usps.com/ under “Locate a Post Office”.

e. Administrative Closure of Claim. If all efforts are exhausted and no updated 

information is obtained, the claim is in posture for administrative closure. A 

memorandum is prepared outlining the unsuccessful efforts of obtaining a current 

address and that the claim is being administratively closed as a result. 

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CHAPTER 7 – CASE CREATION

1. Purpose and Scope. This chapter describes the role of the RC, CMR, DO, and FAB in 

the case creation process. In addition, the chapter covers the process of creating an EEOICPA 

case file electronically in OIS and ECS. The chapter contains instructions for deciding whether a 

new claim is considered filed under Part B and/or Part E of the EEOICPA. Finally, the chapter 

provides guidance regarding the proper handling of additional claims received during claim 

adjudication and the handling of withdrawn claims. 

2. New Cases. A new case usually consists of a Claim for Benefits, Form EE-1 or EE-2, 

with the accompanying Form EE-3, Employment History for a Claim Under the EEOICPA. A 

new case is created based on a signed written communication from the claimant; a claimant’s 

AR, or a person acting on behalf of the claimant (e.g., a relative or guardian). Any one of the 

following documents is considered a request for benefits: 

a. Form EE-1, Employee’s Claim for Benefits;

b. Form EE-2, Survivor’s Claim for Benefits; or 

c. Any letter or document containing “words of claim” under the EEOICPA. “Words 

of claim” means that the individual has communicated in writing his or her intent 

to seek benefits under the EEOICPA. 

3. Receipt of a New Claim. Designated DEEOIC staff at the DO or RC take new claim 

documentation, including the postmarked enveloped used to mail a claim form, and affix an 

inked date stamp on all documents. The date stamp is to identify the receiving office location and 

received date. Once date stamped, CMR contract staff then make an electronic image of the 

documents and upload them into the Energy Document Portal (EDP), which goes directly into 

the Case Create Queue in OIS. The CMR then send a notification to the Centralized Case Create 

(CCC) office of their action. The EDP also allows claimants, their attorneys, AR, family 

members, etc. to upload claim documentation into OIS. 

Case create clerks at the CCC are responsible for checking the Case Create Queue daily to 

identify new incoming claims. The CCC records the relevant demographic data relating to the 

claim into ECS, such as personal, medical, employment and other component data. Upon 

completion, a copy of the claim form is uploaded into OIS, which automatically generates a 

unique ECS Case Identification Number (Case ID number). 

a. Terminal Claims. In instances where a claim form is received by the DEEOIC 

office or a RC from, or on behalf of, a terminal claimant, the claim form and all 

supporting documentation is date-stamped, scanned, converted to a PDF 

attachment and immediately sent via e-mail to zzOWCP-DEEOIC-Centralized 

Case Create Group. 

The subject line for any e-mail concerning a terminal claim should include 

“Terminal Case Create” followed by the name of the office sending the email, the 

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claimant’s last name (or case number in case of an existing case). For example, a 

subject line would read: Terminal Case Create DEN Smith; or Terminal Case 

Create JAC 50100000. 

To comply with program procedure, DO staff prioritizes any claim with a 

terminal status. Should a DD or FAB Manager determine that even a short delay 

in processing the forms would adversely affect the claimant, they are to contact 

the OIS Coordinator or Cleveland DD by telephone.

(1) If a terminal claim is received in the RC, the RC uploads all claim 

documentation to the EDP. 

(2) The DD or designee reviews the documentation to determine whether the 

medical records necessitate the claim be expedited. If the claim is to be 

expedited, the DO follows the procedure described above. If the claim 

documentation does not support a designation of terminal status, the DO

forwards the claim documents to the CMR for processing. 

c. Occupational History Development. For Part E causation claims, staff completes 

an Occupational History Questionnaire (OHQ) by interviewing claimants about 

their knowledge of employee exposure to toxic substances. The RC staff 

completes the OHQ interview either in-person or telephonically within 14 days of 

assignment or receipt of claim. If the OHQ interview cannot be completed within 

14 days, the RC staff may request an extension with the jurisdictional DO. Once 

the OHQ interview is complete, the RC staff scans and uploads the completed 

OHQ interview to the case file, via the EDP along with the approved DEEOIC 

checklist. While the RC is generally the recipient of new incoming claims, 

occasionally the DO will receive new claim documentation. In these situations, 

the DO receiving the new claim coordinates with the appropriate RC to have it 

conduct an OHQ. 

4. Assignment of Claims to a DO. The assignment of a claim to a particular DO occurs 

based on the state where the employee’s most recent location of covered employment occurred, 

as listed on Form EE-3. Each DO is responsible for claims originating from a state for which it 

has jurisdictional responsibility. Information regarding DO jurisdictional boundaries is located 

on the DEEOIC main webpage. If the claimant does not submit a Form EE-3 with his claim, the 

CCC uses the claimant’s state of residence to make a DO assignment. Each DO is to provide the 

CCC with an up to date case create digit assignment list so that upon creation, the CCC directs 

the claim to appropriate CE. When CE digit assignments change, the DD or a designee is to 

email the updated list to zzOWCP-DEEOIC-Centralized Case Create Group. 

5. Creating Cases in ECS. The CCC enters into ECS information reported by the claimant 

from the incoming claim form, such as personal, medical, employment and any other relevant 

claim data. Important demographic information from the claim form necessary to create a claim 

include the employee/survivor name, SSN, mailing address, phone number, date of birth, sex, 

etc. The CCC also enters information concerning the nature of the claim to include the medical 

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conditions claimed as work-related, the employment history for the employee, and responses to 

the receipt of other award or other legal information. Once this information is entered and saved, 

ECS assigns a unique Case ID Number for the entire case file. 

In addition, each person who has filed a claim within a case is assigned a unique claimant 

identification number. If the CCC is processing a claim based on the submission of 

correspondence that contains words of claim, he or she is to enter as much information as 

possible to permit ECS to assign a Case and Claimant ID Number. At a minimum, ECS requires 

the entry of name and mailing address of the claimant (in the case of a survivor, it is necessary to 

name the employee) to permit the creation of a case. Once the CCC creates a claim under this 

circumstance, the matter is referred to the assigned CE to notify the claimant of the need to 

complete an EE-1 or 2 to allow for claim adjudication. A claimant signature is not necessary on 

any form or letter with words of claim for case creation to occur; however, for claim adjudication 

a signed EE-1 or EE-2 is required. Without a properly completed form, the claim is 

administratively closed. 

For a systematic guide to ECS case create procedures, refer to the Claim Form Entry and Initial 

Review (Red Pane Review) instructions located in the ECS Procedures folder available to DO

staff on the shared drive. 

a. Handling Alternative Filings. A non-covered spouse or child of a deceased DOE 

contractor employee or RECA Section 5 uranium worker may submit a written 

request for an informal evaluation of whether the employee contracted a covered 

illness as a result of employment at a covered facility. As no RDs or FDs are 

issued in these instances, an EE-2 is not required. Accordingly, alternative filing 

requests are entered into ECS as “Words of Claim” under the form EE-2. The 

alternative filing request will be processed in ECS as a survivor claim according 

to instructions provided in Chapter 13.13. 

6. CE Review. Once a new claim is received from the CCC, but prior to initial development 

and adjudication, the assigned CE reviews the claim forms, any employment and/or medical 

evidence, the claimed employment and occupational history development conducted by the RC 

and ECS to ensure ECS contains accurate information. If the claim requires additional follow up 

action by the RC, the CE may assign additional tasks to the RC as necessary.

a. Missing Information. If a claim form or document with “words of claim” is 

missing vital information (e.g., a diagnosed condition, employment information), 

the assigned CE requests the omitted information and/or the appropriate claim 

form from the claimant, or the designated AR. 

b. Acknowledgement Letter. Upon receipt of a new claim, the DO is responsible for 

sending the claimant a letter acknowledging the receipt of a new claim and

providing the claimant with a Case ID number and contact information should the 

claimant have questions regarding his/her claim. A sample acknowledgment letter 

is provided as Exhibit 7-1. 

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c. Corrective Action. In some instances, a CE or FAB CE/HR will identify a data 

entry error or receive information that warrants a revision to claimant 

demographic data recorded in ECS. ECS demographic data such as date of birth, 

date of death, gender, relationship type, phone numbers, Power of Attorney 

(POA) and AR names are editable by the assigned CE or FAB CE/HR. However, 

in other instances, critical data relating to the claimant, such as address changes or 

corrections to name, SSN or other payee data, requires extra steps to process. For 

ECS data changes that the assigned CE or FAB CE/HR cannot perform on his or 

her own authority, the DEEOIC requires two individuals to process an ECS data 

change: The person who requests an ECS change and a person who makes the 

change. This ensures information security and accountability for critical data 

changes that has the potential to affect payee outcomes. 

Should a CE or a FAB CE/HR identify a reason to modify ECS data that he or she 

cannot input on his or her own authority, they are to prepare an email with a 

subject line, “ECS Change Request – Case ID xxxx (insert Case ID Number).” In 

the body of the email, the requester will describe the nature of needed ECS 

change. In addition, he or she will reference the Document ID in OIS or attach as 

reference any document supporting the data change request (i.e. a claimant 

submitted signed address change request). The CE or FAB/CE forwards the 

email to the Payee Change Assistant (PCA) or other ECS data change agent 

designated with that functionality by the DD or FAB manager. The PCA or 

designated ECS data change agent is to process the ECS change request, unless 

there is some reason to seek clarification beforehand. Once completed, the PCA 

or designated ECS data change agent responds to the change request with an 

email confirming the data update. The receiving CE or FAB CE/HR confirms the 

change occurred as requested and then bronzes a copy of the email, along with 

any attachments, into OIS for recordkeeping. 

7. Creating a Claim Under Part B vs. Part E, or Both. Identifying when a claim is to be 

adjudicated under Part B, Part E, or both, it is first necessary to identify the claimed conditions. 

Conditions covered under Part B include CBD, beryllium sensitivity, chronic silicosis and 

radiogenic cancers. Claims for any other illness not covered under Part B are created and 

adjudicated solely under Part E, which covers any illness found related to occupational toxic 

substance exposure. 

a. Consideration of Employment. In addition to considering the claimed medical 

condition(s), claimed employment is also considered. Part B of the EEOICPA 

covers employees of the DOE, its contractors and subcontractors, beryllium 

vendors, AWEs and eligible survivors. Part E offers benefits to DOE contractors, 

subcontractors and their eligible survivors. 

For claims filed at the RC, the RC verifies employment through the Oak Ridge 

Institute for Science and Education (ORISE) and/or clarifies the nature of claimed 

employment.

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Example 1: If a claim identifies employment as a federal employee at a DOE 

facility and a Part B medical condition, the claim is adjudicated under Part B only, 

because a DOE federal employee is not a covered DOE contractor employee, as 

required under Part E. 

Example 2: If a claim identifies employment at an AWE or a beryllium vendor 

and a Part B/E medical condition, the claim is adjudicated under Part B only, 

because working at an AWE or beryllium vendor is not covered employment 

under Part E. (The exception to this is if it is indicated that the employee worked 

at an AWE or beryllium vendor that was designated as a DOE facility for 

remediation.) 

Example 3: If only Part B medical conditions are checked on the claim form 

(e.g., CBD, beryllium sensitivity, chronic silicosis, or radiogenic cancer) and 

DOE contractor employment is claimed, the claim will be adjudicated under both 

Part B and Part E. 

Example 4: Some AWE and beryllium vendor facilities are designated as DOE 

facilities during periods of remediation. If the claimant from Example 1 instead 

claims employment with an AWE or beryllium vendor during a period of 

remediation or identifies the AWE or beryllium vendor as a DOE facility on Form 

EE-3, the claim is to be adjudicated under both Part B and Part E. In such a case, 

additional development to establish covered Part E employment would be 

required. 

Example 5: To establish covered employment under Part E, the employee must 

have been a DOE contractor employee. If the claimant from Example 1 claims 

only employment as a DOE federal employee, the claim is adjudicated under only 

Part B. 

 

Example 6: If a non-Part B medical condition (e.g., asbestosis) and DOE 

contractor employment are claimed, the claim is treated as a Part E claim only.

Example 7: If the claimant claims diabetes (a non-Part B medical condition) and 

employment with an AWE or beryllium vendor during a period in which 

remediation did not occur, or does not identify the 

AWE or beryllium vendor as a DOE facility on the Form EE-3, the claim is 

adjudicated under only Part B, as the employee must be a DOE contractor 

employee to be covered under Part E.

Example 8: If an employee claims prostate cancer and DOE contractor 

employment, the claim is adjudicated under both Parts B and E. If the same 

employee claims both prostate cancer and asbestosis, the prostate cancer is treated 

as a Part B and Part E condition, while asbestosis is adjudicated under Part E 

only. 

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Example 9: If a claimant identifies chronic silicosis on the Form EE-2, the claim 

is evaluated under both Parts B and E only when the claimed employment was in 

underground tunnels in Nevada or Amchitka Island, Alaska. If the claimant 

employment is outside of these facilities, the claim is adjudicated under only Part 

E.

Example 10: All new RECA Section 5 claims are to be adjudicated under both 

Part B and Part E. 

8. New Claims in Existing Cases. In situations where there is an existing case record, if a 

DO or RC receives a new claim for an additional medical condition, or new survivor, the new 

claim form is date-stamped and forwarded to the CMR for processing, as outlined in Item 3 

above. 

a. Case Assignments. New claims in existing cases are assigned to the appropriate 

DO and CE, as outlined above in Item 4. However, if the case is found to be 

currently outside of the jurisdictional office (i.e. at FAB or NO), the new claim 

will be assigned to the DO CE assigned to the case. 

b. Medical Evidence Only. If the claimant submits medical evidence for an 

unclaimed condition (i.e., medical evidence indicating the presence of an illness 

which identified as being potentially work-related) without a claim form, or 

document with “words of claim” for a covered condition, the CE contacts the 

claimant to request the appropriate claim form. He or she can also forward the 

evidence to a RC for assistance in initiating a new claim. 

c. Survivorship Evidence Only. If a new survivor submits survivorship evidence 

(e.g., birth certificate, marriage certificate, school records) without a claim form, 

the DO or RC contacts the claimant to request he or she complete Form EE-2. 

d. Wage-Loss and Impairment Claims. In cases in which a claimant submits Form 

EE-10, Claim for Additional Wage-Loss and/or Impairment under the EEOICPA, 

the CMR does not submit the form into the Case Create Queue. Any EE-10 

received in the CMR is scanned as regular mail and appears in the assigned CE’s 

“Unreviewed Assigned” document queue, at which time the CE is responsible for 

reviewing the claim form, entering the appropriate information into ECS and 

completing appropriate development actions. This data entry process also applies 

when a claimant submits “words of claim” in lieu of Form EE-10 to requesting 

wage-loss and/or impairment benefits.

9. Withdrawal of a Claim. A claimant is able to withdraw his or her claim for benefits for 

any claimed condition(s), or wage-loss or impairment, prior to the issuance of a FD for the 

requested benefit(s). All requests to withdraw a claim for benefits must be in writing, signed by 

either the claimant or his or her AR, and specific in reference to what Part or Parts under the 

EEOICPA the claim is to be withdrawn. 

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CHAPTER 8 – CASE MAINTENANCE

1. Purpose and Scope. This chapter describes how case files are transferred between 

locations within the DEEOIC, filed, and maintained (including dividing a file’s contents, 

repairing damaged folders, and reconstructing lost case files). 

The chapter also describes how to update, correct, and adjust the electronic files in the Energy 

Case Management System (ECMS). Finally, the chapter addresses how the FAB assigns docket 

numbers to case files referred for their consideration and issuance of a FD or other order. 

2. Case Movement. Each DEEOIC staff member is responsible for ensuring that cases are 

delivered to their appropriate locations. The new location code is notated on the front of the case 

file jacket and entered in the “Case Update” screen of ECMS before the file is moved. 

a. Location Changes. As cases are moved to different locations within a DEEOIC 

Office, their location codes are changed in ECMS. Each location in a DEEOIC 

Office has its own location code, for example, “FIL” for the File Room, “CCJ”

for a CE), “FO1” for the Fiscal Officer, and “DMC”. 

b. Notations on Case Jackets. When ECMS coding is completed, the DEEOIC staff 

 member lists the new location code on the grid sheet on the front of each folder of 

the case file, dates each folder, and initials each folder. The DEEOIC staff 

 member then hand carries the file to its next location or places the folder in the 

 appropriate pick-up area for routing to the next location. 

c. Replacement Grid Sheets. When the jacket has been completely filled, it is 

 copied and the copy is placed on the inside cover of the left side of the case file. 

 A gummed grid sheet with spaces to enter new routing locations is then placed on 

 the front cover of the case file.

3. Filing Cases. Open cases (i.e., those cases needing further action) and closed cases are 

housed either in the File Room or in other locations throughout the DEEOIC Office. 

a. Method of Filing. Most case folders are kept in the file room on open shelves. 

(1) The 2x2 terminal digit system is used by the DEEOIC. The folders are 

 grouped together and filed using the last four digits of the file number 

 (hereafter referred to as “terminal digits”).

 The files are first grouped together in numerical order by the last two 

terminal digits (from XX00 to XX99). The first two terminal digits of a 

file determine the order of files with the same final two digits (00XX to 

 99XX). For example, files with the terminal digits 0034, 0234, 1001, 

 1034, 1234, 2001, and 3489 are filed as follows: 

Ending with 01: 1001, 2001 

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Ending with 34: 0034, 0234, 1034, 1234 

Ending with 89: 3489 

(2) The outside edge of each folder is labeled with the last four digits of the 

claimant’s file number (terminal digits). Each digit has a distinct, 

 brightly-colored background, allowing searchers to locate, retrieve and/or 

file the folders with greater ease and accuracy.

b. Cases Sent to the File Room. Case folders are not returned to the File Room 

 unless: 

(1) The File Room is the last location notated on the case folder along with 

the date transferred and the initials of the DEEOIC staff member initiating 

 the move; 

(2) ECMS is accurately coded to show the File Room (“FIL”) as the last 

 location; and 

(3) Any loose documents or mail are filed down on the spindle in the folder, 

 unless notated with the phrase "drop file," the date the document was drop 

 filed, and the initials of the DEEOIC staff member who had requested the 

 mail to be drop filed. 

c. Cases Outside of the File Room. When case files are located at a DEEOIC staff 

 member’s work station or some other location, they need to be organized so they 

can be quickly located. When files are separated into different piles for effective 

case management (e.g., under development, awaiting a RD), the DEEOIC staff 

member arranges each pile of cases in 2x2 terminal digit file number order.

d. Misfiled Cases. If a case is coded “FIL” in ECMS, but is not located in the File 

Room, a special search is required. This special search includes searching 

 throughout the File Room (sometimes cases get misfiled on the shelves), on 

 DEEOIC staff members’ workstations, the DEEOIC Office as a whole, and even 

other DEEOIC Offices. If the special search is unsuccessful, then DEEOIC staff 

 must reconstruct the file (See paragraph 7 below). 

4. Dividing Cases. When the contents of a case file become too thick to be contained in one 

folder, they are divided. Mail and File (M&F) staff divide files on their own when deemed 

appropriate, or at the request of a DEEOIC staff member. The M&F Clerk takes the following 

actions when dividing a case file: 

a. Prepare a New Folder.

(1) The M&F Clerk makes a duplicate folder with the same file number. The 

M&F Clerk writes the letter “A” at the bottom of the front cover of the 

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original case file. The M&F Clerk then writes the letter "B" at the bottom 

 of the front cover of the overflow folder. 

(2) On the bottom of the front cover of each folder, the M&F Clerk writes 

"This case is divided into A and B parts"; and 

b. Dividing the File. The M&F Clerk divides the contents of the file at a logical 

 point, considering the size of each part and the content and receipt date of the 

 documentation. 

(1) The M&F Clerk skims through the case file records and determines a 

cutoff date for the Part A folder.

(2) The M&F Clerk places all correspondence and other documents received 

 before the cutoff date in the Part A folder. All correspondence and 

 documents received after the cutoff date are placed in the Part B folder. 

 The M&F clerk files down Forms EE-1/2, EE-3, and copies of claim 

 forms under Part E (formerly Part D) on the spindle in the Part B folder. 

 Documents regarding any actions still pending and documents showing 

 compensation paid are also kept in the Part B (active) folder. 

(3) If it becomes necessary to divide the case more than once, the new 

overflow folders are labeled "AA", "AAA", etc.

(4) Part B is always the active folder and contains the most recent documents, 

the original Forms EE-1/2, DOE claim forms (formerly Part D), 

 documents containing words of claim for benefits under the EEOICPA, 

Employment History Form EE-3, any documentation showing 

 compensation paid, and all documents requiring further action. 

(5) When voluminous records are received from a single source (e.g., hospital 

 records, prior Part D records, responses to Document Acquisition 

 Requests) resulting in the case to be divided, they are filed down on a 

separate spindle, as long as the records are clearly identified as belonging 

to a single identifiable source.

5. Multiple Survivors. When the case file has multiple survivors, the Form EE-2 for the 

first survivor is on the bottom. The Form EE-2 for the second survivor is just above the first, and 

so forth, as reflected in ECMS under the “Claims” section in the “Case Update” screen. The 

correspondence, medical evidence, employment evidence, and other documents are placed on top 

of the claim and employment history forms (on the spindle), in chronological order of date 

received in the case file and are not divided by survivor. 

6. Repairing Cases. The M&F Clerk or other DEEOIC staff member designated by the DD, 

FAB Manager, or Policy Branch Chief, repairs the case folders and their contents that have 

become worn or unreadable due to wear and tear. 

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a. Loose Documents. The M&F Clerk or other designated DEEOIC staff member 

 repairs or strengthens documents that have torn loose from the spindle by using a 

 gummed or self-adhesive reinforcement, transparent tape, or other method 

 approved by the DD, FAB Manager, or Policy Branch Chief. 

b. Damaged Documents. If torn or damaged documents cannot be mended, and 

 there is the potential for further damage to occur, the M&F Clerk or other 

 designated DEEOIC staff member photocopies the documents so that the file 

 contains a readable copy. To protect from further damage, the torn or damaged 

documents are placed in a protective sleeve or envelope and placed in the case 

file.

7. Reconstructing Cases. When a case is lost and every effort to locate it within that 

DEEOIC Office and the other DEEOIC Offices is unsuccessful, the DEEOIC staff must 

reconstruct the case file. A Supervisory CE or Manager prepares a memorandum for the 

signature of the DD, FAB Branch Chief, or Policy Branch Chief, explaining the loss of the file 

and the necessary preparation of a new case jacket. The assigned CE, CE2, FAB Representative, 

or NO Representative then requests duplicates of all documents in the lost file. 

a. Memorandum and New Case Jacket. The Supervisory CE or Manager prepares 

and signs a memorandum describing the effort(s) taken to locate the original file 

and that a duplicate case jacket is necessary. Once approved and signed by the 

 DD, FAB Branch Chief, or Policy Branch Chief, the memo is then forwarded to 

the Case Create Clerk, who creates a new case jacket with the memo placed inside 

 and returns it to the assigned CE, CE2, FAB Representative, or NO 

Representative.

b. Requests for Records. The assigned CE, CE2, FAB Representative, or NO 

Representative prepares correspondence to all the claimants and authorized 

representatives associated with the case requesting a copy of any documents 

 pertinent to the case file. The assigned CE, CE2, FAB Representative, or NO 

 Representative also requests duplicate documents from medical providers, the 

 NIOSH, DOE, and any other identifiable source (e.g., CPWR, SSA, RC). The 

 memo and the letters requesting the documentation are filed down on the spindle 

in the new case folder. 

c. Electronic Records. If electronic copies of documents (e.g., development letters, 

RDs, FDs) or claim related e-mails from external customers (e.g., the claimant, 

 RC, DOE, corporate verifiers, Congressional Offices, NIOSH), that were in the 

case file have been maintained by the assigned CE, CE2, FAB Representative, or 

 NO Representative, they are to be copied and placed in chronological order in the 

file by when they were originally created.

d. Recovery of Original File. If the lost case file is found, the assigned CE, CE2, 

FAB Representative, or NO Representative incorporates all original and 

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unduplicated material into a single case jacket and discards the duplicate case 

information and case file jacket in a recycle bin for shredding. 

8. Updating, Correcting, and Adjusting the ECMS Database. Changes to ECMS are 

sometimes needed due to errors in data entry or updated changes to the claimant's address, etc.

a. Corrections to Data Elements. It is each DEEOIC staff member’s responsibility 

 to safeguard the integrity of the data in ECMS. Stakeholders and interested 

 parties (e.g., DEEOIC Offices, Congressional Offices, the Ombudsman 

 Office) are provided with performance reports compiled from ECMS data. 

Therefore it is especially important to ensure that the data entered in ECMS is 

correct and up to date. These elements include all name fields, claimed illness 

 information, claimed employment data, date of birth, date of death, and SSN. 

b. Change of Address. All requests for change of address are submitted in writing 

by the claimant, AR, or approved PoA. All such changes are referred to the 

 individual designated as the 

c. Payee Change Assistant (PCA). The PCA (or a designee who does not have the 

 authority to enter payments in ECMS) makes changes to names and addresses in 

 ECMS. Any change of address needs to be approved by the assigned CE, CE2, 

FAB Representative, or NO Representative prior to any changes in ECMS. 

(1) The request for a new address must contain an acceptable signature on the 

 document. The claimant’s signature, an AR’s signature, or the approved 

POAs signature is acceptable.

(2) If a written document contains a claimant’s new address, the assigned 

DEEOIC staff member calls and confirms with the claimant, authorized 

 representative, or the approved Power of Attorney whether the change is 

temporary or permanent. The call is then documented in the ECS, with a 

printed copy placed in the case file.

(3) A faxed request to change a claimant’s address or phone number is 

 acceptable, as long as it contains the signature of the claimant, authorized 

 representative, or the approved Power of Attorney requesting the change. 

(4) For payment purposes only, a “Payment Only” address is documented and 

 signed by the claimant or approved Power of Attorney on the original EN20 form. Faxes are not acceptable. 

9. FAB Docketing. A unique docket number is assigned under Part B and Part E, as 

applicable, to each claimant involved in the FAB review process. The assignment of a docket 

number allows FAB to track individual claimants who filed under Part B and/or Part E and to 

protect their privacy. 

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a. Docket Number Assignment. Any case that is forwarded to FAB for issuance of a 

FD or other order has a docket number assigned to each claimant identified in the 

RD under Parts B and E of the Act, as applicable. The docket number(s) assigned 

is generated randomly by ECMS within each local FAB Office. The docket 

 number is a numerical prefix followed by the year in which the docket number is 

assigned. Once a docket number is assigned to a claimant (a separate docket 

 number for Part B and Part E, as applicable), that document number remains the 

same, is always used to identify the claimant in future FD or other orders, and 

 does not change. 

b. Registering Docket Numbers in ECMS. Upon receipt of a RD, a FAB 

Representative enters “FD – FAB Received Recommended Decision” under the 

“Claim Status History” section in the “Claim Update” screen of ECMS. An

“FD” status code is entered for each claimant in ECMS who receives a RD. The 

entry of the “FD” status code in ECMS is what generates the random assignment 

 of the docket number. 

c. Duplicate Numbers. The individual entering the docket number must ensure that 

 he or she does not re-enter a new docket number for a claimant who has already 

 been assigned a docket number under that Part of the Act. If this occurs, the file 

 is referred to the local FAB Manager to have the second docket number removed 

 from ECMS.

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CHAPTER 9 – TRANSFERS AND LOANS

1. Purpose and Scope. This chapter describes the procedures for sending physical case files 

and electronic case records between the various offices within the DEEOIC, including the DO, 

the CE2 Unit, the FAB, and the NO. It also describes the procedures for sending the contents of 

a case file to the National Institute for Occupational Safety and Health (NIOSH) and to a medical 

or scientific specialist in NO.

2. Responsibilities. Mail and File (M&F) staff process all physical case files transferred 

temporarily or permanently among the DEEOIC Offices. The Chief of Operations, Supervisory 

CE, ADD, DD, FAB Manager, NO Representative, M&F Clerk, or designee transfers electronic 

records in the ECMS and notates the front of the case file jacket, accordingly, on all case files 

transferred temporarily or permanently.

3. Electronic Transfer of Case Records in ECMS. The electronic transfer of a case record in 

ECMS involves taking the following actions in the “Case Update” screen: enter the appropriate 

DEEOIC Office’s transferred out location code in the “Location” field (See Exhibit 1); click the 

“Save” button; click on the “Transfer Case” button; pick the appropriate DEEOIC Office in the 

“District Office” drop down menu field under the “Transfer To” section; and then click on the 

“Transfer Case” button. 

The electronic transfer of a case record in ECMS can be done in either ECMS system (ECMS B 

or ECMS E), and results in the transfer of the case record in both ECMS systems simultaneously.

a. Electronic Transfer to a CE2 Unit. The local CE2 Unit and the NO CE2 Unit are 

 not listed in the “District Office” drop down menu field under the “Transfer 

 To” section of ECMS. Instead, the designee must transfer the electronic case 

 record to the appropriate FAB Office in which the CE2 Unit resides with. 

 (1) Once electronically transferred to the appropriate FAB Office, a FAB 

 Representative selects the appropriate CE2 in the drop down menu of the 

 “CE2” field under the “FAB Co-located Development” section in the 

 “Case Update” screen of ECMS. Once the FAB Representative selects 

 the appropriate CE2, he or she tabs over to the “CE Assign Dt” field, 

 which automatically populates with the current date and time (this field 

 can be manually inputted if needed).

 In addition, the FAB Representative keys the case file to the CE2 by 

 entering the appropriate ECMS Case Location Code in the “Location” 

 field tabs over to the “Location Assign Dt” field, which automatically 

 populates with the current date and time (this field can be manually 

 inputted if needed), and then clicks the “Save” button. 

 Both the FAB Representative and the CE2 are able to make entries into 

 ECMS without having to transfer the case in the system.

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4. Temporary Transfers (Loans). Case files are temporarily transferred between DEEOIC 

Offices for a variety of reasons, including the review of a RD, a FD, a remand order, a request 

for reconsideration, a request for reopening, a DO or CE2 Unit pending action, a medical or 

scientific referral, or for a policy issue. Whenever a case file is transferred, it is sent in its 

entirety to the designated location. It is of utmost importance that if a case is misrouted to a 

DEEOIC Office from another DEEOIC Office, that it be transferred immediately to the 

appropriate DEEOIC Office.

a. Procedures Before the Loan. 

 (1) The CE, CE2, FAB Representative, or NO Representative completes all 

 applicable items listed on the case transfer sheet and attaches it to the 

 outside of the case jacket. This sheet identifies the case, the DEEOIC 

 Office the case is transferred to and from, and the reason for the transfer. 

 (2) If the CE, CE2, or NO Representative is transferring a case file, the 

 following boxes in the Reason for DO’s/CE2 Unit’s/NO’s Transfer field 

 is checked, as appropriate:

 (a) To the FAB, select the option FAB Review and any of the 

 following options below, as appropriate: 

 (i) For an RD, select the option Recommended Decision; or

 (ii) For a request for reconsideration, select the option 

 Reconsideration.

 (b) To and from the NO, select the option, Policy/Procedure and any 

 of the following options below, as appropriate:

 (i) For a request to reopen, select the option Reopen. For the 

 return response to a reopening request, select the option 

 Reopen and briefly explain whether the reopening was 

 granted or denied in the Comments/Other field; 

 (ii) For a submission of a remand challenge, select the option 

 Remand Challenge. For the return response to a remand 

challenge, select the option Remand Challenge and briefly 

 explain whether the remand challenge was granted or 

 denied in the Comments/Other field;

 (iii) For a policy issue (e.g., stepchildren, incapable of self- 

 support, employment verification), select the option Policy 

 Question and briefly explain the request in the 

Comments/Other field. For the return response to a policy 

 issue, select the option Policy Question and include a brief 

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 explanation in the Comments/Other field. This form does 

 not replace the WS/WR form;

 (iv) For a review by the Office of the Solicitor (e.g., power of 

 attorney, filed court documentation), select the option 

 Solicitor and include a brief explanation in the 

Comments/Other field. For the return response from the 

Solicitor, select the option Solicitor and include a brief 

 explanation in the Comments/Other field; or

 (v) For a medical or scientific review, including a referral to 

 the Medical Director, Industrial Hygienist (IH), 

 Toxicologist (TX), or the Health Physicist, select the 

 specific type of review, as appropriate. For the reviewer’s 

 return response, select the type of review provided and 

 include a brief explanation in the Comments/Other field, 

 as appropriate.

 (3) If the FAB Representative is transferring a case file, the following boxes 

 in the Reason for FAB’s Transfer field is checked, as appropriate: 

 (a) To the DO or CE2 Unit, in which the FAB vacates the RD and 

 issues a remand order, select the option Remand; 

 (b) To the DO or the CE2 Unit, in which the FAB reverses the RD, 

 select the option Reversal;

 

 (c) To the DO or CE2 Unit, in which the FAB affirms the RD, select 

 the option Affirmation; 

 (d) To the NO, select any of the following below, as appropriate: 

 

 (i) For a request to reopen, select the option Reopen; 

 (ii) For a policy issue (e.g., stepchildren, incapable of self- 

 support), select the option Policy Question and briefly 

 explain the request in the Comments/Other field. This 

 form does not replace the WS/WR form;

 (iii) For a review by the Office of the Solicitor (e.g., filed court 

 documentation), select the option Solicitor and include a 

 brief explanation in the Comments/Other field; or

 (iv) For a medical or scientific review, including a referral to 

 the Medical Director, Industrial Hygienist (IH), 

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 Toxicologist (TX), or the Health Physicist, select the 

 specific type of review, as appropriate. 

 (e) At the time of mailing the FD, the FAB Representative selects the 

 option Send Copy of Final Decision to with either NIOSH, DOJ 

 (RECA), and/or RC (with the specific RC name/location listed) 

 marked, as appropriate. 

 (4) The CE, CE2, or FAB Representative checks the following boxes, as 

 appropriate, when rendering an RD or FD, respectively: 

 (a) The type of RD or FD submitted (Part B and/or Part E); and 

 (b) The status of the RD or FD under that Part(s) (Accept, Deny, 

 and/or Defer)

 The FAB Representative notates the ECMS Final Decision 

 Coding under Part B and/or Part E and also the amount of any 

 compensation approved (AOP Amount) under Part B and/or Part 

 E in that field.

 For any issue not specified above, include a brief explanation in 

 the Comments/Other field. 

 (5) The Chief of Operations, FAB Manager, NO Unit Chief for Policies, 

 Regulations and Procedures, DD, ADD, Supervisory CE, Senior Claims 

 Examiner, or designee determines whether the case is in a posture for 

 transfer to another DEEOIC Office (e.g., the DO issued an RD that needs 

 to be sent to FAB for processing of the FD), and if so, then ensures that: 

 (a) Within reason, all pending actions have been taken and all 

 correspondence answered;

 (b) Mail is filed down on the spindle in order of date receipt; and 

 (c) The case file jacket is in good condition. 

 (6) The initiator and the authorizing signatory both sign and date the 

 completed case transfer sheet (sometimes this is the same person). The 

 NO Unit Chief for Policies, Regulations and Procedures, DD, and FAB 

 Manager designate the authorizing signatory within their respective office.

 All cases sent to the NO require the authorization of the DD, ADD, 

 Supervisory CE, FAB Manager, or designee. The NO Unit Chief for 

 Policies, Regulations and Procedures or designee authorizes case transfers 

 from the NO.

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 (7) The Chief of Operations, FAB Manager, NO Unit Chief for Policies, 

 Regulations and Procedures, DD, ADD, Supervisory CE, M&F Clerk, or 

 designee changes the location on the front of the case file jacket and in 

 ECMS to reflect the physical and electronic transfer of the case to another 

 DEEOIC Office (See paragraph 3 above). The location of individual case 

 files is tracked in ECMS through specific codes. 

 Maintaining accurate case location information in ECMS is essential. 

 Each time a file is physically transferred from one location to another 

 within a DEEOIC Office or from one DEEOIC Office to another, ECMS 

 must be updated to show the current location of the case file and the date 

 in which the change in location was made. This is also notated on the 

 front of the case file jacket.

 (8) M&F staff mail the case file, either by the designated express mail service 

 or through the United States Postal Service (USPS). 

 b. Procedures After the Loan.

 (1) Upon receipt of the transferred case, the receiving office files the case 

 transfer sheet down onto the spindle in the case file and takes the action 

 reflected on the case transfer sheet.

 

 (2) The receipt of individual case files is tracked in ECMS through specific 

 codes. When a physical case file arrives in the DEEOIC Office, M&F 

 staff date-stamp the case transfer sheet and deliver the case to the M&F 

 Clerk who enters the appropriate receiving/transferring in office and 

 location codes in the “Dist Office” and “Location” fields, respectively, in 

 the “Case Update” screen of ECMS. 

 The M&F Clerk also assigns the case in the “CE” field (See Exhibit 1). 

 The dates of the change in location and CE assignment are recorded in 

 ECMS by tabbing over to the “Location Assign Dt” and “CE Assign Dt”

 fields, respectively, which automatically populates with the current date 

 and time (these fields can be manually inputted if needed). The location 

 codes are also notated on the front of the case file jacket.

 (3) Any mail received for a case which is loaned or temporarily transferred is 

 forwarded to the appropriate DEEOIC Office that has the case file. 

c. Cases with Partial FDs for Compensation. There are instances when FAB issues a 

 partial FD allowing for the payment of benefits to a claimant while another 

 portion of the RD is held in abeyance as a result of the pending expiration of the 

 claimant’s 60 day allotted time frame to file objections, or the consideration of 

 objections or a request for a hearing already filed in reference to the pending 

 portion of the RD. To ensure the timely processing of compensating the claim by 

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 the DO and the timely review of the pending portion of the RD by FAB, the 

 following must be completed: 

 (1) The FAB Representative attaches a removable red label to the lower right 

 corner on the front of the case file jacket with the following information:

 (a) List the date of issuance of the pending RD and whether it pertains 

 to Part B and/or Part E; 

 (b) List the FAB Office the case needs to be returned to;

 (c) List the name of the FAB CE or FAB Hearing Representative to 

 whom the case is assigned; and

 (d) List a “no later than” date by which the case needs to be returned 

 to FAB, in order to ensure timely review. 

 (2) The FAB Representative also attaches on the front of the case file jacket a 

 case transfer sheet printed on red paper, with all applicable items 

 completed. 

 (3) The assigned FAB CE or FAB Hearing Representative puts a call up note 

 for the case in his or her Outlook calendar. 

 (a) The local FAB employees notify their Manager at least ten days 

 before the due date, if the case has not been returned by the DO. 

 The Manager contacts the DO to have the case transferred back to 

 his or her office. 

 (b) The NO FAB employees notify the Operations Specialist and their 

 Manager at least ten days before the due date, if the case has not 

 been returned by the DO. The Operations Specialist or the 

 Manager contacts the DO to have the case transferred back to the 

 NO FAB.

 (4) Once the DO has processed the claimant’s payment, the Chief of 

 Operations, DD, Supervisory CE, Fiscal Officer, or designee attaches on 

 the front of the case file jacket a case transfer sheet (see Exhibit 2) printed 

 on plain white paper, with all applicable items completed, including in the 

 Comments/Other field the name of the assigned FAB CE or FAB 

 Hearing Representative to whose attention the case is to be given, 

 identifying the claimant’s payment has been processed, and that the case is 

 returned back to FAB for their review of the pending portion of the RD. 

5. Permanent Transfers. Case files are permanently transferred between the DOs due to 

jurisdiction, based upon the employee’s last verified covered employment. There are instances 

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when changes in jurisdiction go into effect in order to balance the case/workload among the 

DOs. 

In reference to RECA claims, all RECA Section 5 claims are handled in the Denver DO and are 

transferred there accordingly. All Section 4 RECA claims are transferred to the DO which has 

jurisdiction, based upon the employee’s last covered employer. It is of utmost importance that if 

a case is misrouted to a DEEOIC Office from another DEEOIC Office, that it immediately be 

transferred to the appropriate DEEOIC Office.

a. Procedures for Permanent Transfers. After determining that a case needs to be 

 transferred, the following actions are taken by DEEOIC staff: 

 (1) Prepare a transfer letter for the DD, ADD, Supervisory CE, or designee’s 

 signature notifying the claimant and other interested parties (e.g., RC, AR)

 of the transfer and the contact address and phone number of the other 

 DEEOIC Office;

 (2) Prepare a case transfer sheet for the DD, ADD, Supervisory CE, or 

 designee’s signature (as discussed in paragraph 4 above) which is then 

 attached to the front of the case file jacket;

 (3) The DD, ADD, Supervisory CE, or designee ensures the case is in a 

 posture for permanent transfer (e.g., all pending actions have been taken, 

 correspondence has been answered, mail has been filed down on the 

 spindle, and the case file jacket is in good condition). The DD, ADD, 

 Supervisory CE, or designee then authorizes the transfer and signs the 

 notification of transfer letter and the case transfer sheet;

 (4) The Chief of Operations, DD, ADD, Supervisory CE, M&F Clerk, or 

 designee transfers the electronic case record by keying the appropriate 

 location code and DEEOIC Office in ECMS (See paragraph 3 above); 

 (5) The physical case file is sent either through a designated express mail 

 service or through the USPS; 

 (6) Permanent case transfers need to occur within 20 days of the date of the 

 last pending action taken; and 

 (7) If mail is received for the transferred case, the mail is forwarded to the 

 responsible DEEOIC Office that has the case file.

 b. Delays in Permanent Transfers. In some instances, a case file reviewed for 

 permanent transfer by the originating DO, is in a posture for an RD and needs to 

 be sent to FAB for processing of the FD. In this instance, the originating DO 

 prepares and issues the RD and transfers the case to FAB.

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 After taking all appropriate actions, FAB transfers the case back to the originating 

 DO, which is the office that issued the RD. 

 (1) If there are no remand actions to be taken, the originating DO proceeds 

 with the permanent transfer of the case to the DO which holds jurisdiction. 

 (a) The only exception to this is when FAB has determined that the 

 claim is to be compensated. FAB proceeds with the permanent 

 transfer of the case to the DO which holds jurisdiction (and not to 

 the DO which issued the RD) to ensure timely payment of the 

 claim. 

 (2) If there are remand actions to be taken, the originating DO completes the 

 actions stipulated in the remand order, reissues the RD, and transfers the 

 case to FAB. This also holds true when there is a change in jurisdiction 

 while the case is at FAB for review. Ultimately, the case file is transferred 

 to the originating DO for the completion of the actions stipulated in the 

 remand order and reissuance of the RD. 

c. Receipt of File. When a physical case file arrives in the DEEOIC Office, M&F 

 staff date-stamp the case transfer sheet and deliver the case to the M&F Clerk 

 who enters the appropriate receiving/transferring in office and location codes in 

 the “Dist Office” and “Location” fields, respectively, in the “Case Update” 

 screen of ECMS. 

 The M&F Clerk also assigns the case in the “CE” field. (See Exhibit 1). The 

 dates of the change in location and CE assignment are recorded in ECMS by 

 tabbing over to the “Location Assign Dt” and “CE Assign Dt” fields, 

 respectively, which automatically populates with the current date and time (these 

 fields can be manually inputted if needed). The location codes are also notated on 

 the front of the case file jacket.

6. Referring Case Records to NIOSH. As part of the dose reconstruction process, NIOSH 

reviews the employee’s medical and employment records. The entire case file is copied and 

forwarded to NIOSH. This is done with the utmost attention as all DEEOIC staff members must 

ensure that Personally Identifiable Information (PII) is safeguarded. The original case file 

remains in the DO or NO CE2 Unit. 

a. Case Records. On a summary sheet, the DO or NO CE2 Unit prepares a list of 

 the case files contained in the shipping package. The summary sheet clearly 

 identifies the cases referred to NIOSH for dose reconstruction. The DO or NO 

 CE2 Unit maintains a copy of the express mail shipping slip along with the 

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 b. Shipping Packages. The DO or NO CE2 Unit uses large express mail boxes when 

 possible, as the boxes are traceable. A copy of the summary sheet, listing the case 

 files being transferred, is inserted in each shipping package. 

c. Shipping Address. Boxes are sent to:

 National Institute for Occupational Safety and Health

 Office of Compensation Analysis and Support 

 4676 Columbia Parkway 

 MS C45 

 Cincinnati, OH 45226 

 d. Schedule. Each DO (together with their local CE2 Unit) must send cases on 

 designated days based on the following weekly schedule: 

 Tuesday: Jacksonville (Wednesday NIOSH receipt)

 Wednesday: Cleveland (Thursday NIOSH receipt)

 Thursday: Denver (Friday NIOSH receipt)

 Friday: Seattle (Monday NIOSH receipt) 

 Due to the volume of referrals generated, the NO CE2 Unit does not have a 

 designated day to send their cases to NIOSH. Instead, the NO CE2 Unit sends 

 their cases on an as needed basis.

e. Coordination with NIOSH. Each week, the DO or NO CE2 Unit sends an e-mail 

 to ocas@cdc.gov which lists the express mail tracking number for each box 

 shipped. If a shipment was not sent that week or was sent late, NIOSH must be 

 informed. This notification assists NIOSH with inventory control. 

f. NIOSH Point-of-Contact Phone Numbers. 

 Cleveland DO 513-533-8423 

 Denver DO 513-533-8426 

 Seattle DO 513-533-8424 

 Jacksonville DO 513-533-8425 

 NO CE2 Unit 513-533-8565 

7. Referring Cases to Medical or Scientific Specialists in NO. When a case file is referred 

for a review by a Medical Director, Industrial Hygienist, Toxicologist, or a Health Physicist, the 

case file or the medical records from the case file are copied and sent to the appropriate specialist 

in NO. 

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CHAPTER 10 – RESOURCE CENTERS

1. Purpose and Scope. This chapter describes the policies and procedures governing the 

DEEOIC RCs.

2. RC Functions. The RCs are situated in key geographic locations throughout the United 

States to provide assistance and information to the EEOICPA claimant community and other 

interested parties. The RCs gather substantial information and documentation, but they do not 

perform adjudicatory functions. The RCs provide claim development support and program 

outreach as well as initial claim intake.

The DO retains all adjudicatory and most additional development functions. The RCs perform 

only certain initial development and limited follow-up tasks as specifically outlined in these 

procedures. The RCs are staffed and managed by contractor staff. Each RC has a manager, and 

each manager reports to the RC Contractor Project Manager, who in turn, reports to the DEEOIC 

RC Coordinator located at the NO. The RC Coordinator is responsible for supervising the 

activities of all RC staff, nationwide.

The RC role as it pertains to initial employment verification and occupational history 

development includes the following: 

a. Claim Intake. Most new Forms EE-1/2 are filed directly with the RC located in 

 the geographical area where the claimant(s) reside. Forms EE-1/2 received 

 directly in the DO undergo employment verification at the DO and such claims 

 are referred to the RC only if the DO determines that an OHQ is required. 

 Regardless of place of receipt, the date of filing for a claim is the earliest 

 discernible date stamp or postmark of a claim form or words of claim. Words of 

 claim are any written statements received without a claim form that indicate a 

 claimant’s intention to seek benefits under the EEOICPA. 

 Whether filing by telephone or in person, RC staff relays information about the 

 program to the claimant. The RC explains the eligibility requirements, asks about 

 conditions that the claimant has developed, and begins the process of gathering 

 information for use in adjudication. 

 (1) Filing by Telephone. When a claimant files a claim telephonically with 

 RCs but then either refuses or fails to sign an actual claim form, the RCs 

 must proceed as follows: 

 (a) Two weeks after the call, the RC telephones the claimant, 

 informing him or her that the claim form must be signed to 

 complete the filing process, and then recording the contact in the 

 Telephone Management System (TMS) Energy Case Management 

 System.

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 (b) Two weeks after that initial follow-up call, the RC sends the 

 claimant a letter telling him or her that the unsigned claim form 

 will be forwarded to the DO assigned to adjudicate the claim, and 

 places a copy of the letter in the case file, but that the DO CE will 

 administratively close the claim because of the lack of a signed 

 claim form.

 (c) The RC then prepares a memo to the file documenting the times, 

 dates, and manner of the efforts made to get the form signed, and 

 of the warning that the claim will be closed administratively.

 b. Claim Status. Claim status requests regarding initial employment verification or 

 occupational history development fall within the purview of the RC staff, who 

 also field other claim status requests to assist claimants with general questions not 

 requiring DO or FAB involvement. 

 The RC staff member reviews ECMS status codes and answers claimant inquiries, 

 memorializing such activities into the TMS or Notes screen. If the claim status 

 request is beyond the scope of the RC staff to address, the RC staff member 

 determines the case file location in ECMS and directs the caller to the proper CE 

 or FAB HR. 

 Inquiries received from a claimant or authorized representative seeking claim 

 statuses are referred to the adjudicatory DO CE or the FAB HR as necessary. 

 When referring a claimant or authorized representative to a DO or FAB, the RC 

 provides the claimant/authorized representative with the toll-free number to the 

 DO or FAB. All RC Managers have full read only access to ECMS in order to 

 better assist claimants with inquiries. Any inquiries that cannot be addressed by 

 the RC staff/Manager go to the CE or FAB HR, as appropriate. 

c. Program Information. If a potential claimant calls for information and/or 

 guidance and no claim is on file, the RC staff member informs the potential 

 claimant of filing requirements and available benefits. No referral to a DO or 

 FAB is necessary. As no claim exists in the system, a note memorializing the 

 telephone conversation is not entered into ECMS. 

 Where a current claimant contacts the RC for guidance about the claims process 

 (e.g., confirmation that a claim exists, questions about submitting new evidence or 

 a new claim for benefits), the RC can provide guidance to the claimant as needed 

 without referral to the DO or FAB. A TMS memorializing the telephone 

 conversation is entered into ECMS 

 Also, RC staff may assist claimants in understanding the information being sought 

 in DO development letters, explain the means by which such information may be 

 obtained, and assist claimants in obtaining evidence. The RCs also assist 

 claimants with medical bills/documentation and enroll/educate medical providers 

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 to join and navigate the automated medical bill pay system. A TMS 

 memorializing the telephone conversation is entered into ECMS. 

 d. Initial Employment Verification. The RCs take initial employment verification 

 steps for all new claims (Part B, E, and B/E) filed with the RC that are not 

 covered under the RECA. The DO conducts initial employment verification on 

 claims filed directly with the DO (see section 5 below). 

 (1) Form EE-3 is the principal source for claimed employment information. 

 However, if a claim is filed without a Form EE-3, the RC does not solicit 

 it from the claimant. Rather, all claim materials are forwarded to the DO, 

 where initial employment verification occurs.

 (2) The RC uses DEEOIC tools, including procedures, bulletins, and 

 employment verification updates and is given access to the DEEOIC 

 Shared Drive to view these materials. The RC conducts initial 

 employment verification on claims submitted by DOE 

 contractor/subcontractor, AWE, and Beryllium Vendor employees for 

 use in the adjudication of claims filed under EEOICPA. 

e. Occupational History Questionnaire. RCs conduct occupational history 

 development on all new Part E claims and some previously filed Part D/E claims, 

 as discussed in section 6 below. 

3. ECMS Usage in the RC. ECMS access is granted to the RCs to record claimant 

interaction and obtain claim status updates. Such interaction is recorded in ECMS Notes or 

ECMS TMS. RCs cannot input ECMS case status codes. Specific technical guidance regarding 

ECMS is provided in the ECMS User’s Reference Guide. 

Some RC activity occurs prior to case creation in the DO, and ECMS data input is unavailable. 

RCs make ECMS entries only on created cases. Where the case is not yet created, the RC 

maintains a written account of all claim-related activity, including the date on which such 

activity took place. All pre-case create actions at the RC are recorded in the RC memorandum to 

the DO discussed in section 5 below. 

a. ECMS Notes. The ECMS Notes field is used for all face-to-face contact with a 

 claimant on a created case. For example, ECMS notes are used when a claimant 

 appears at the RC to submit evidence or claim forms, to make an inquiry or raise a 

 concern, or to complete the OHQ interview if the interview is done in person. 

 The RC staff member records the claimant’s visit in the notes field in ECMS, 

 providing a synopsis of the conversation and a description of any evidence or new 

 claim filed during the visit. The Notes entry outlines the interaction with the 

 claimant, including instructions or guidance the RC provides to the claimant. The 

 RC discusses only information on a specific claim with the claimant in question. 

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 Once a note is placed in the system, a hard copy is printed and forwarded to the 

 appropriate DO or FAB for association with the case file. 

 When creating an ECMS notes entry, the RC selects ‘R - RESOURCE CENTER 

 USE ONLY’ entry in the “Note Type” section in the upper left hand box of the 

 screen.

 b. TMS. The TMS feature in ECMS allows RC staff members to memorialize 

 telephone conversations and to access telephone messages for calls received in the 

 RC. TMS provides a mechanism to track and maintain telephone contacts on 

 given case files.

 RC staff members receive incoming telephone calls, return calls and place calls to 

 claimants and others regarding questions and concerns arising out of the claims 

 process.

 (1) RCs receive various kinds of direct calls. Generally, incoming calls are 

 from claimants (or their authorized representatives) seeking claim status or 

 guidance, or from potential claimants seeking program information and 

 guidance regarding the claims process.

 (2) A RC staff member returns a telephone call received in the RC within two 

 business days of receipt regardless of the issue at hand. All calls related to 

 claims in ECMS are logged into the TMS and must be returned 

 accordingly.

 (3) Outgoing calls are those generated from the RC for a purpose other than 

 returning a telephone call. The DO may request RC assistance in 

 obtaining evidence from a claimant or conducting some additional follow- 

 up on a case file. Many RC outgoing calls are generated in the course of 

 conducting employment verification and occupational history 

 development, and are memorialized in ECMS only on created cases.

c. Calls from Claimants. Each telephone call to or from a claimant must be 

 accurately entered into ECMS in accordance with the specific instructions 

 contained in the ECMS User’s Reference Guide. If RC staff members conduct 

 OHQ interviews (see below) by telephone, the OHQ interview must be 

 memorialized in TMS in the same manner as the in-person interview. 

 The RC staff member handling the telephone call outlines the content of the 

 discussion, the claimant request, if any, the guidance or solution offered, and the 

 outcome of the call or resolution of the issue at hand. Entry of quality data is of 

 the utmost importance, and the RC staff member strives to ensure accuracy and 

 specificity of data input when telephone contact is noted in TMS. 

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 As with ECMS notes, the RC prints a TMS record once completed. The printed 

 TMS record is forwarded to the appropriate DO for association with the case file.

 d. ECMS Entries. The RC ECMS user may change ECMS entries placed into the 

 system by RC staff as needed to correct errors, or at the request of the RC 

 manager upon his or her final review of claim file material before it is forwarded 

 to the DO. However, the RC cannot delete ECMS entries, so RC staff and 

 managers must ensure that the data entered into ECMS is of high quality and free 

 of errors prior to saving the entries into the system. 

 Once an ECMS record is input at the RC level, only NO DEEOIC staff may 

 remove it. No capability to add or alter ECMS claim status codes has been 

 granted to the RCs, and all coding operations related to RC activity on a case 

 (aside from activities related to input in TMS or ECMS Notes) are entered at the 

 DO to correspond with the date of the activity, as noted on the RC memorandum 

 that accompanies case file materials to the DO.

e. ECMS Security. Security measures govern access to the system due to the 

 sensitive nature of the records available in ECMS and other claim file documents 

 (e.g., employment history, payment information, disease history, Social Security 

 Numbers, and addresses). 

 When a RC staff member is hired, and ECMS access is required for that 

 individual, access must be granted. Conversely, when an RC staff member’s 

 employment is terminated, that person’s ECMS access must be disabled. 

 (1) To give a new RC staff member ECMS access, the RC manager prepares a 

 memorandum to the RC Contract Project Manager requesting such access 

 and providing all pertinent employee information. The RC Contract 

 Project Manager sends a memorandum to the DEEOIC RC Coordinator at 

 NO, who reviews the request and advises Energy Technical Support of the 

 need to grant access to an incoming RC employee. 

 (2) Upon termination or resignation of an employee, the RC Manager 

 prepares a memorandum to the RC Contract Project Manager. The 

 memorandum provides the former employee’s name, title, employee 

 number, and all other necessary information, including the date of the 

 employee’s termination or resignation. The memorandum requests that 

 the former employee’s access to ECMS be terminated on a specified date 

 (i.e., date of termination or resignation). 

 (3) The RC Contract Project Manager then prepares a memorandum notifying

 the DEEOIC RC Coordinator advising of the RC former employee’s 

 scheduled departure. The DEEOIC RC Coordinator advises Energy 

 Technical Support of the need to delete ECMS access to the outgoing RC 

 former employee upon receipt of such notification.

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4. Security, Privacy, Conflicts of Interest. 

a. RC Staff Member with Interest in a Claim. A RC staff member may be a party to 

 a claim under the EEOICPA or may have a personal or familial interest in the 

 outcome of a claim.

 (1) RCs must avoid conflicts of interest in processing claims and 

 should avoid even the appearance of impropriety in their work. Their 

 staffs must work without any bias or influence that would affect their 

 ability to render impartial service to the government in carrying out their 

 duties. 

 Therefore, RC staff cannot process claims or conduct either employment 

 verifications or occupational histories for immediate family members 

 (defined as spouses, children, siblings, grandparents, parents, or first or 

 second cousins) or for any other individuals with whom they would have 

 so close a relationship as to affect their judgment. 

 In such cases, the RC notifies the DEEOIC RC Coordinator at NO in 

 writing via e-mail memorandum and refers those cases to the nearest 

 alternate RC. After the conflict review process is completed, the RC 

 manager prepares a memorandum to the alternate RC manager asking that 

 the occupational history development or other task(s) be conducted and 

 forwarded to the next nearest DO that does not have jurisdiction over the 

 RC in question. 

 The RC assigned this development action has 14 calendar days upon the 

 receipt of the assignment to complete all these activities and to report to 

 the DO.

 (2) When a RC staff member has a claim of his or her own, or when the 

 situation meets the definition of a conflict of interest due to a relationship 

 as defined above, the DO case file in question is transferred to the nearest 

 DO for handling.

 For instance, a claim involving an RC staff member working at an RC 

 within the jurisdiction of the Denver DO is transferred to the Seattle DO 

 for handling, and vice versa. Claims involving a staff member working at 

 an RC within the jurisdiction of the Cleveland DO are transferred to the 

 Jacksonville DO, and vice versa. 

 b. Security and Individual Privacy Concerns. When interacting with claimants and 

 other interested parties (e.g., authorized representatives) RC staff must remain 

 aware of individual privacy concerns and maintain compliance with Privacy Act 

 mandates. Except as discussed below, RC staff members may not provide 

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 information about an individual claim for benefits, or any other personal 

 information, to anyone other than the identified claimant or his or her AR. 

 (1) For RC staff to release any information regarding a specific claim or 

 claimant to an alleged authorized representative of that claimant, an 

 authorization form signed by the claimant must be in the case file 

 appointing such individual as the claimant’s authorized representative 

 regarding his or her claim for benefits under the EEOICPA. 

 A claimant may authorize other third parties to receive claims information, 

 but may not authorize multiple authorized representatives. 

 (2) Where information is sought that exceeds the RC’s ability to assist the 

 claimant or authorized representative (e.g., specific development questions 

 regarding the relationship between toxic substances and illness), the RC 

 staff refers the matter to the proper DO CE or FAB HR, denoted in ECMS 

 as the primary CE.

c. Multiple Worksites. In all instances involving multiple worksites, the RC closest 

 to the residence of the claimant(s) performs the required development tasks. For 

 instance, if employment is claimed at all three Gaseous Diffusion Plants, and the 

 employee/claimant(s) reside in the Paducah, Kentucky area, the Paducah RC 

 handles all required tasks with assistance from the other RCs as needed. 

 d. Multiple Claimant Locations. If claimants reside in different states and the claim 

 as a whole can be better served by utilizing more than one RC, a RC will be 

 assigned based upon the geographical locations of the claimants. In such cases 

 the RC forwards documentation to the adjudicatory DO. 

5. Employment Verification. Detailed guidance on Employment Verification is found in the 

PM Chapter covering this subject. Below is an overview of those employment verification tasks 

with associated RC tasks.

a. Review of ECMS. When the RC is taking a claim and reviewing it for initial 

 action (employment verification or OHQ), the RC reviews ECMS to determine 

 whether a claim already exists in ECMS. If so, the RC contacts the adjudicatory 

 DO CE for guidance as to whether employment or occupational history 

 development is required. If documentation is present in the existing claim file to 

 either confirm employment or document workplace exposure, the DO advises the 

 RC accordingly and no action is needed by the RC. This is a case-by-case 

 decision made by the DO.

 b. Review of Case File. Upon receipt of a new claim, the RC staff member reviews 

 the Forms EE-1/2, EE-3, and EE-4 and the DOE covered facility website to 

 determine the type of facility claimed (e.g., DOE, BV, or AWE). The DOE 

 website lists all major covered facilities, applicable time frames, a description of 

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 the site operations, and in certain instances, the names of the major contractors 

 working at those facilities. This review also helps to determine the need for an 

 OHQ, as AWE, BV and DOE (including DOE predecessor agency) federal 

 employment is not covered under Part E and no interview is required. 

c. Determining Appropriate Subpart. The claim may be filed under Part B, Part E, 

 or both, depending upon the illness claimed and type of employment. The RC 

 uses the DEEOIC case create worksheet, and reviews the claim materials for a 

 determination as to benefits being sought and conditions claimed to determine 

 under which Part a claim is being filed. At any time the RC may consult the DO 

 for guidance as to whether an OHQ is necessary.

 (1) Claims submitted by AWE employees are excluded from Part E coverage 

 unless their employment occurred during a time when the AWE was 

 undergoing DOE remediation. DOE remediation periods can be 

 ascertained by reviewing the DOE covered facility website, but the RC 

 should seek DO guidance before conducting interviews about such claims. 

 (2) Claims filed by contractors or subcontractors of DOE or Section 5 RECA 

 workers are always treated as Part E claims for the purposes of conducting 

 an occupational history interview. 

 d. ORISE. If employment is claimed at a covered facility listed on the DOE 

 website, the RC staff member determines whether employment can be verified 

 through the ORISE database. This database, which is accessed via ECMS, 

 contains employment information for over 400,000 employees who worked at 

 certain facilities from the 1940s to the early 1990s. 

 Complete usage instructions regarding the ORISE database are discussed in the 

 ECMS release notes dated April 6, 2005, version 1.8.2.0. Since ORISE is part of 

 ECMS, the RC staff member obtains ORISE information by entering an 

 employee’s Social Security Number or name.

 RC staff determines whether appropriate data may be found in ORISE by 

 checking the Employment Pathways Overview Document (EPOD). If the facility 

 description includes the statement, “ORISE – yes,” then RC staff first develops 

 employment by accessing ORISE. If ORISE information is unavailable or 

 inconclusive, additional development is pursued as outlined below. 

 In either case, the RC staff member prints the results found in ORISE as part of 

 the evidence of file. If employment is listed at a facility not on the ORISE list, 

 ORISE is not consulted for verification. 

 (1) If the ORISE matches claimed employment within six months, no 

 additional development is required. The RC prints out the ORISE 

 database query result, prepares a memorandum stating the date the ORISE 

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 action was taken, and forwards all available materials to the DO with an 

 RC checklist (Exhibit 10-1).

 If an OHQ is required on a Part E claim, the RC attempts to complete the 

 OHQ to be forwarded with the RC checklist. The findings and associated 

 memoranda are subject to CE review and can potentially serve as a basis 

 for verifying and accepting claimed employment under the EEOICPA. 

 (2) If the claimed employment cannot be confirmed through ORISE, or is 

 only partially confirmed, the RC prints the ORISE record and determines 

 if other sources of employment verification are available as outlined 

 through the Employment Pathways Overview Document.

e. The EE-5 Process/DOE POC. Employment under the EEOICPA is also verified 

 using the EE-5 process. The EE-5 process is applicable to employment claimed at 

 DOE facilities, including contractor and subcontractor employment, as well as 

 Beryllium Vendor and AWE employees. The RC refers the EE-5 package 

 according to instructions in the PM. 

 For those instances in which employment is claimed for which there is no 

 applicable DOE operations office, the following steps are to be taken: 

 (1) Employment for which EPOD indicates that a corporate verifier is able to 

 confirm employment. For those instances in which a corporate verifier 

 has employment information, RC staff prepares the appropriate 

 correspondence to a corporate verifier. EPOD identifies the 

 information needed by each specific corporate verifier in order for them to 

 confirm employment. EPOD also contains the name and address for 

 corporate verifier contact persons from whom verification should be 

 requested.

 (2) If EPOD does not provide any pathway for employment verification at a 

 claimed facility, the RC center staff informs the claimant that DOE does 

 not possess employment records for the facility claimed and no other 

 knowledgeable source exists to verify employment. In writing or by 

 telephone, the RC advises the claimant to submit further evidence in 

 support of his or her claimed employment directly to the DO. If the 

 claimant is the employee or a clearly eligible survivor, the RC also asks 

 the claimant to sign Form SSA-581 so that the DO may request SSA 

 records. The RC does not forward Form SSA-581 to SSA, but sends it to 

 the DO with the employment verification packet. The RC does not mail 

 this form to a claimant.

 (3) The RC prepares a memorandum documenting the dates on which 

 employment verification actions were taken for each claimant. The 

 memorandum is forwarded to the DO within seven days of receipt of Form 

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 EE-1/2. The memorandum is accompanied by the RC Claim 

 Checklist listing all materials enclosed and further actions required.

 (4) Each adjudicatory DO DD designates primary and alternate RC 

 employment verification POCs and provides the RC with their names and 

 contact information. The DD must immediately inform the RC if a POC is 

 replaced.

 (a) Duties. The DO employment verification POC serves as the 

 primary contact for all responses regarding initial employment 

 verification requests made by the RCs. The POC reviews all 

 employment verification responses, consults ECMS to determine 

 the CE handling the claim in question, and forwards all 

 employment responses to the handling CE within one business day 

 of receipt of the response in the DO. 

 (b) E-Mail Contact. Each POC has access to e-mail for use in 

 verifying employment. The POC’s e-mail address is copied on all 

 e-mail requests for verification (where such request is the desired 

 method of inquiry) and the e-mail from the RC provides the POC’s 

 name and contact information and requests that the employment 

 verification response be forwarded to the attention of the POC.

 (5) The RC prepares the claim package with the accompanying memorandum 

 and checklist outlining the actions taken and forwards all documents to the 

 adjudicatory DO. The RC includes a copy of the DOE Verification of 

 Employment Memorandum, which serves to acknowledge that DOE has 

 no employment information to provide. 

 (a) Later submissions to the DO do not require a formal memorandum, 

 but should be accompanied by the RC Claim Checklist. Any 

 activity the RC took that needs to be captured by the DO in ECMS 

 can be outlined either on the Checklist or on a separate sheet of 

 paper.

 (b) The RC manager verifies the contents of the referral package and 

 signs the checklist. The RC manager is responsible for validating 

 that the information in the referral package(s) reflects the RC 

 actions taken and accurately reports the dates of all activities 

 conducted. 

 (c) The DO sometimes grants extensions of time in the face of 

 extenuating circumstances. When RC staff conduct large outreach 

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 mails the DO Employment Verification POC with all claim file 

 information requesting an extension of time and outlining the 

 reason behind the request. 

f. SSA-581 and Other Evidence. The following evidence, while not exhaustive, 

 may assist in evaluating the validity of a period of claimed employment. RC staff 

 should use judgment to determine which of the listed items staff should request 

 from claimants.

 (1) Time and attendance forms; W-2 forms and other tax statements; wage 

 and earnings statements; check stubs; correspondence from the employer 

 addressed to the employee; notices of promotion, reassignment, layoff, 

 etc.; ID cards; minutes from employment related meetings; punch cards; 

 sign in and out logs; security clearance applications; union records; letters 

 and certificates of achievement or participation in a certain event.

 (2) Also, Forms EE-4 (Employment Affidavit) from coworkers and others 

 with firsthand knowledge may be acceptable to establish employment in 

 conjunction with other evidence. The RC may assist the claimant in 

 preparing Form EE-4, but only contacts employment verifiers as identified 

 therein. The RC does not contact coworkers or other individuals or gather 

 employment or other evidence on behalf of the claimant.

 (3) If the claimant is a walk-in employee or a clearly eligible survivor, the RC 

 asks the claimant to sign Form SSA-581 so that the DO may request SSA 

 records for use as a tool in additional employment development. The RC 

 does not forward Form SSA-581 to SSA, but sends it to the DO with the 

 employment verification packet. The RC does not mail this form to a 

 claimant.

g. SEC/Newly Designated SEC. The Secretary of the Department of Health and 

 Human Services (HHS) has approved additional designations to the SEC class, 

 and other designations are anticipated in the future. Many new SEC designations 

 are/will be employment-specific and date-specific. HHS defines SEC inclusion 

 specifically in many instances, and it will be necessary to identify a person’s job 

 title, years of employment, place of employment, and other facts based upon the 

 specific language defining the SEC.

 Therefore, it is necessary to gather employment-specific information when 

 verifying employment at these sites. The Policy Branch issues Bulletins outlining 

 specific guidance for handling newly-designated SECs. The Policy Branch Chief 

 ensures that the RCs receive all Bulletins related to SEC class inclusion.

 Since Form EE-5 does not contain a section to list employment-specific 

 information, the RCs use the cover letter to DOE for this purpose. In the DOE 

 cover letter the RC requests specific duty station information to assist the DO 

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 when rendering determinations as to SEC class inclusion. The request is tailored 

 to meet the exact definition of SEC employment as set out by HHS and defined in 

 Bulletins issued by the Policy Branch.

6. Occupational History Development. In addition to initial employment verification, the 

RCs conduct initial occupational history development on Part E cases only regarding claims 

involving covered Part E employees and their eligible survivors. This is done in part by 

completion of the OHQ (Exhibit 10-2). There are two OHQs, one for RECA and one for nonRECA claims.

Whenever possible, this step occurs during claim intake at the RC, with the results forwarded to 

the DO within the seven day period in which the initial employment verification task is 

conducted. The RC may conduct the OHQ prior to receipt of the claim filing, but the OHQ is 

not to be sent to the DO until a signed claim form is received.

If no signed claim form is received, the RC returns the OHQ to the claimant with instructions to 

return to the RC with a signed claim form.

a. Time Frames. If the OHQ cannot be completed within the initial seven day 

 period, the RC sends the claims package to the DO immediately upon completion 

 of employment verification (within seven days of receipt of claim forms), and 

 then conducts the occupational history development. 

 (1) The RC has a total of 14 calendar days from the date of receipt of the 

 claim or receipt of the assignment from the DO to conclude the 

 occupational history development steps. 

 (2) If all actions cannot be completed within that time frame, the RC advises 

 the DO CE via e-mail of the reason for the delay and outlines a reasonable 

 timeframe in which to finalize all necessary actions.

 (3) If an additional seven calendar days elapse after the 14 calendar day due 

 date, the RC telephones or e-mails the DO CE requesting a time extension 

 and providing an action plan. 

 (4) As soon as the occupational history task is complete, and assuming that a 

 signed claim form has been received, all documentation is immediately 

 forwarded to the DO with a memo or Claim Checklist noting the date on 

 which the interview(s) was conducted. The RC maintains a copy of all 

 case file materials until the occupational history development process is 

 complete.

 (5) If the RC cannot conduct the OHQ within 30 days of receipt of assignment 

 and/or filing of the claim, the RC suspends all activities and reports to the 

 DO. No further action is taken. The DO CE sends a letter to the claimant 

 requesting a response once all materials are received in the DO. 

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 Depending upon the claimant‘s response, the CE can assign the OHQ task 

 to the RC. 

 b. Occupational History Development Not Conducted. Under the following 

 circumstances, no OHQ development occurs: 

 (1) If beryllium illness or chronic silicosis is the only condition claimed, 

 unless otherwise directed by the DO. In addition, no occupational history 

 development is conducted where only ineligible survivors are claiming 

 benefits. 

 In such instances, the claim file material is immediately forwarded to the 

 DO upon completion of the employment verification portion, the DO 

 reviews for necessity of further occupational history development, and 

 assigns development tasks to the RC as needed.

 (2) If benefits are approved under Part B, or a positive DOE physician panel 

 finding exists that DOE accepted under the Part D program and the 

 employee is a DOE contractor or subcontractor (not a federal employee) 

 then the employee is also covered under Part E for those approved 

 diagnosis. In all cases, the RC consults ECMS for the status of the Part B 

 claim for acceptance and queries the DO for guidance if a question arises 

 as to whether or not an occupational history development action is 

 required. 

 (3) If the DOJ has accepted a RECA Section 5 claim, no occupational history 

 development is necessary, unless the claim was filed by a survivor. All 

 other RECA claims generally require independent adjudication and require 

 an OHQ. Cancer claims submitted by Section 4 RECA claimants who do 

 not wish to file with DOJ require an OHQ. 

 d. Occupational History Questionnaire and Interview. The main function of the RC 

 staff member in his or her occupational history development role is to conduct the 

 OHQ interview. In cases with multiple survivors, all claimants are interviewed, 

 unless one or more claimants have been designated to represent all of the 

 claimants with regard to the interview process.

 (1) Sometimes one claimant will know more about possible worksite 

 exposure, or be more comfortable with a formal interview process, than 

 the others. In such instances, a simple signed statement by the other 

 claimants designating a certain claimant to be interviewed in his or her 

 stead will suffice.

 (2) Such a signed statement is not a designation of an authorized 

 representative, and is only used in the interview process. Where an 

 authorized representative has been appointed on a claim file with multiple 

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 claimants, there is no need to designate a claimant to participate in the 

 questionnaire process. Authorized representatives may determine how the 

 questionnaire process will be conducted. 

 (3) Much of the information gathered through occupational history 

 development is sensitive in nature and is subject to Privacy Act mandates. 

 Accordingly, the information developed may not be disclosed to any 

 individual unless he or she is an authorized representative of the claimant 

 or an authorized DEEOIC representative. 

e. Timeliness Goals. An interview must be scheduled and completed within the 

 timeframes stated in this document, and all reworks and follow-up interviews 

 must be conducted within seven days of receipt in the RC as noted above. 

 To properly conduct the interview, the RC staff must understand the work 

 performed by DOE employees. Knowledge of the types of hazardous materials 

 potentially present at DOE sites, the covered illness resulting from claimed 

 exposures, the standard length of exposure for the illness to occur, and the 

 medical diagnosis required to verify the illness is also necessary.

 The RC staff must also possess sufficient knowledge of the EEOICPA, the DOE 

 and RECA sites, and hazardous materials to record sufficient, valid data in 

 occupational history questionnaires as well as ECMS and TMS notes. 

f. Proper Use of OHQ. DEEOIC developed the DOE and RECA occupational 

 history questionnaires for use by the RC staff, who must properly use them to 

 obtain the information DEEOIC requires to evaluate a claim for causation. 

 The interview may be conducted in person or by telephone. On created cases, all 

 telephonic activity regarding occupational history development is captured in the 

 ECMS TMS screen, while all in-person activity is placed in the ECMS Notes 

 screen. All required ECMS coding is input at the DO once the occupational 

 history development task is complete and all documentation is returned to the DO. 

g. Use of Script. When conducting interviews, the RC adheres to the script prepared 

 by the DEEOIC. It is of the utmost importance that all interviews follow the 

 prepared script, but flexibility is allowed for follow-up questions that logically 

 flow out of the results of the interview. 

 If the interviewee has little or incomplete knowledge about a particular subject, 

 the RC notes such deficiencies so that the DO is aware that information-gathering 

 efforts were made.

 

 Each interview takes approximately two to three hours to complete. It is possible 

 that multiple claimants will require an interview for one case file.

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 (1) Overall, the RC interviewer is responsible for the proper conduct of the 

 interview and for producing a complete, comprehensive questionnaire, 

 including correct grammar and spelling. 

 (2) The RC makes certain to comply with specific requests for information 

 from the CE. For instance, if the CE wants specific exposure information 

 regarding solvents (e.g., benzene exposure) the RC follows up with a line 

 of questioning to satisfy the CE’s request. 

 (3) Once the interview is completed, the RC staff member gives the claimant 

 the interview confirmation letter (Exhibit 10-3) verifying that the 

 interview took place, and its date. A copy is sent with the OHQ for 

 inclusion in the case file.

 (4) All information is saved to the OHQ exactly as presented by the 

 interviewee without alteration, duplication, or summarization by the RC 

 interviewer, and the original paper version of the OHQ and a saved copy 

 on a CD is forwarded to the appropriate DO within two days of 

 completion. 

 (5) The RC interviewer in no way interprets the information presented by the 

 interviewee. The OHQ is a stand-alone document and only the CE may 

 interpret its meaning when using it as a development tool.

 h. No RC Action Required. Neither initial employment verification nor 

 occupational history development is undertaken where there is no eligible 

 survivor under the statute. Where it is obvious that no eligible survivor exists 

 (especially in the case of adult children under Part E) no additional RC action 

 takes place.

 (1) Since occupational history development is conducted exclusively on Part 

 E claims, no action is necessary where Part E employment is not claimed 

 or confirmed. If employment is claimed or confirmed at an AWE, a BV, 

 or the employee is a DOE (or predecessor agency) federal employee, no 

 occupational history interview is conducted. 

 (2) AWE contractors/subcontractors are not afforded coverage under the 

 EEOICPA, and such claimed employment does not require occupational 

 history development by the RC. 

 (3) The RC does not conduct initial employment verification on claims 

 submitted by RECA claimants. However, occupational history 

 development is necessary on most RECA claims and should be attempted 

 upon receipt of Form EE-1/2 in the RC. 

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 Since the DO must begin employment verification with the DOJ, all 

 RECA claim forms are sent to the DO on the date of receipt in the RC for 

 case create at the DO. Since the RECA claim forms are not held for seven 

 calendar days, as in most other cases, whenever possible the RC attempts 

 to conclude the occupational history development on the date of receipt of 

 the RECA claim forms prior to shipment to the DO.

 Where occupational history development cannot be completed at the RC 

 on RECA claims upon the date of filing, the RC copies the RECA claim 

 form documents and maintains a file at the RC while conducting 

 occupational history development actions. In such instances the RC has 

 14 calendar days from the date the claim is received in the RC to conclude 

 the occupational history development actions. 

 The RC prepares a list of all materials being submitted on a transmittal 

 sheet outlining the material being sent, separated by the claim number. 

 All such documentation is associated with the proper case file upon receipt 

 in the DO.

i. Materials Destroyed. Once all employment verification and occupational history 

 development actions are finalized and the CE confirms by telephone or e-mail that 

 the DO does not require further assistance, the RC destroys its file copy. 

j. Follow-Up or Reworks of Complete OHQs. Upon review of a completed OHQ, 

 the DO may determine that additional information is required or identify an error 

 that requires remedy.

 (1) Follow-up interviews are conducted when the DO identifies additional 

 issues through further development of the claim for causation that require 

 RC assistance. The CE makes follow-up assignments directly to the RC 

 manager with an accompanying memo outlining instructions as to the 

 required additional development needed. 

 

 (2) Reworks arise when an error is found in the final product from the RC. 

 Interview reworks are conducted only where the CE identifies a deficiency 

 (i.e., incomplete or inaccurate data). Reworks must be approved by a CE 

 and are forwarded to the RC manager by the DO DD with a memorandum 

 outlining specific instructions as to the deficiency found and the required 

 remedy.

 (3) The RC must complete all follow-up and rework assignments from the DO 

 within seven calendar days of receipt in the RC. 

7. Transfer of Cases. Once all possible initial employment verification/occupational history 

development actions are complete, the RC sends all claim forms, associated documents, and the 

RC checklist to the DO with a memorandum outlining RC activities to that point.

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Upon receipt of the initial submission, the case is created as set out in EEOICPA PM 1-0300. 

Once the case is created and the claim assigned to a CE, the CE reviews all claim file materials 

and employment verification/occupational history development materials for ECMS coding. 

a. Codes. The CE inputs coding in ECMS to correspond with the date on which the 

 action occurred at the RC.

 b. CE Review. The CE reviews the initial submission to determine whether 

 additional tasks are necessary at the RC level. As noted above, the DO may 

 return any part of the package if a deficiency is identified or an additional 

 interview is deemed necessary.

 The CE uses the information obtained during the occupational development as a 

 tool for establishing causation (based upon employment and the claimed covered 

 illness) in the adjudication process. Also, the CE proceeds to develop the claim. 

c. Receipt of Materials in the RC After Initial Seven Day Memo. Any such 

 materials are sent to the DO with the occupational history development package if 

 they cannot be included with the seven day memo submission. All other materials 

 received at the RC after all development is concluded (including printouts of TMS 

 and ECMS Notes records) are submitted without a memo or checklist. 

 d. Receipt of Material in the DO Prior to Case Create. In some cases the DO 

 receives documentation from the RC prior to receipt/filing of a claim form. The 

 DO maintains all such information in a dummy folder and retains it until the claim 

 form is received. When the case is created, RC actions are coded to correspond 

 with the day upon which they actually occurred, regardless of claim filing date. 

 ECMS coding must reflect the true date a RC action was taken.

8. Part D/E Claim Files. In the past, Part D/E claims potentially required occupational 

history development at the RCs. The CE evaluates the older Part D/E claims on a case-by-case 

basis to determine whether a referral to the RC is needed.

a. Exposure Evidence. The CE examines the case file for the existence of DAR 

 records, other DOE exposure records, and other employment records that might 

 provide exposure evidence and eliminate the need for an OHQ. 

 Also, the CE consults the SEM in conjunction with the case file material to 

 determine the need for further development by the RC. The CE must make the 

 OHQ assignment to the RC unless he or she can establish the plausibility of 

 exposure to a toxic substance by other means [e.g., the SEM, DAR records, other 

 employment evidence indicative of exposure]. 

 (1) If the CE determines that an OHQ is required due to a lack of other 

 exposure and employment evidence, an assignment to the RC is made. 

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 The RC has 14 calendar days from the date of receipt of the assignment 

 from the DO to complete the occupational history development tasks 

 outlined by the CE. 

 (2) The CE prepares a memorandum to the RC requesting that the OHQ be 

 completed. The CE lists any specific information (e.g., toxic exposure, 

 employment) that needs development. Any relevant case file material 

 (e.g., claim forms, employment and exposure records) is attached for RC 

 review. The CE includes precise instructions as to the information being 

 sought. The Senior CE or Supervisor reviews the memorandum and 

 approves the assignment before it is sent to the RC. 

 Upon receipt in the RC, the assignment is logged into ECMS Notes. Date 

 of receipt in the RC is the first day of the 14 calendar day period. 

 (3) Once the CE identifies the need for an OHQ and tasks the RC with an 

 assignment to conduct the interview, the DO sends a letter to the claimant. 

 The letter advises the claimant that the interview is conducted on behalf of 

 DOL, that it is different from any other prior interview the claimant may 

 have given, and that it is intended to provide the claimant with a thorough 

 and timely adjudication of his or her claim. 

 (4) The CE also “closes out” the OHQ assignment (or follow-up or rework) in 

 this manner if the RC attempted to complete the OHQ, but was 

 unsuccessful because the claimant could not be reached or refused to 

 complete it. The status effective date in this situation is the date of the RC 

 memo to the DO explaining why the OHQ could not be completed. 

9. RC File Retention. Depending upon the circumstances and the need for additional 

follow-up regarding a task described in this chapter, RCs retain or destroy file materials as 

necessary.

a. Office of Worker Advocacy (OWA) Files. There is no need to retain materials 

 related to old OWA claim files. The RCs may destroy any OWA materials on 

 hand. 

 b. Part D Files without Employment Verification (EV) or OHQ Information. This 

 material is disseminated from the DOs as necessary based upon DO review and 

 identified assignments to the RC. Any such material on hand at the RC can be 

 destroyed unless it is being used in the process of a DO assignment. Once 

 completion of the assignment is confirmed via the method outlined below, all 

 materials are to be destroyed. 

c. New Incoming Cases. Where only EV is conducted, the RC destroys case file 

 material upon completion of the EV task and DO confirmation of receipt of all 

 documents. Case file materials regarding Part E claims that require an OHQ are 

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 retained either until the OHQ process is complete and the DO confirms receipt of 

 the transmitted materials, or in cases where the OHQ cannot be conducted, as 

 described above.

 d. DO Transmittal. Upon receipt of the EV/OHQ and/or all other pertinent 

 documentation required of the RC, the DO checks off each item listed on the 

 transmittal and then faxes the transmittal to the appropriate RC instructing it to 

 destroy its case file materials. Upon receipt of the DO transmittal, all such 

 materials are destroyed. The transmittal may be sent by the DD or any individual 

 designated by the DD for such purpose. 

e. Receipt of Documents in the NO or FAB. If NO or FAB receives a RC 

 transmittal containing information for association to a case file at NO or FAB, the 

 Policy Analyst/Hearing Representative/CE (or designee at the discretion of 

 management) confirms receipt via fax to the appropriate RC, instructs the RC to 

 destroy their copy of the transmitted material, and associates the materials to the 

 case file. The faxed instruction sheet is also placed in the case file for record 

 keeping purposes. 

 If NO or FAB receives a transmittal from a RC, but the case file is 

 no longer at NO or FAB, the Policy Analyst/HR/CE (or designee at the discretion 

 of management) immediately forwards the materials and transmittal sheet to the 

 appropriate DO. When the DO receives the transmittal, the DO follows the 

 instructions above. 

10. Wage-Loss and Impairment Outreach. Due to the complex nature of the Part E benefit 

structure and the requirements necessary to qualify for lump-sum compensation, selected RCs

have been tasked to engage in an outreach effort to educate claimants on the requirements of 

filing for and obtaining impairment and/or wage-loss benefits. 

a. Outreach. To facilitate communication with eligible claimants who are also the 

 covered employee or worker (hereafter referred to as employees) certain DEEOIC 

 RCs are assigned responsibility for contacting identified employees by telephone 

 to explain the benefit provisions available under Part E. Assignments are as 

 follows: 

Jacksonville DO and FAB Savannah River RC

Cleveland DO and FAB Portsmouth RC

Denver DO and FAB Espanola RC

Seattle DO and FAB Hanford RC

 b. RC Referral. There are two types of Part E cases that are to be identified and 

 

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 (1) Cases at the FAB where a positive FD has been issued to a living 

 employee and there has not been a prior claim for impairment and/or 

 wage-loss.

 (2) Cases at the DO where a positive FD has been issued to a living employee 

 and initial development is underway for impairment and/or wage-loss.

c. Referral from FAB. For Part E cases at the FAB, when a FD is issued to a living 

 employee with a positive causation determination, a copy is to be prepared and 

 forwarded to the designated RC. This should be done only in situations where 

 there is no indication that a claim has been made for impairment and/or wage- 

 loss. Decisions that pertain strictly to survivors of a deceased employee are not to 

 be referred to the RC, but processed in the normal fashion. The Washington, DC 

 FAB sends FD that meet these guidelines to the appropriate RC, based on which 

 DO issued the RD on Part E. 

 d. Development. For any case at the DO that contains a FD with a 

 positive finding on causation issued to a living employee and where there has 

 been no claim for impairment and/or wage-loss, an initial development letter for 

 impairment and/or wage-loss benefits is completed and sent to the employee with 

 a copy of the letter sent to the assigned RC. 

e. Records. Upon receipt of a FD or a development letter in the RC, the 

 RC should take appropriate action to record its receipt. The RC is responsible for 

 ensuring that an appropriate system for recordkeeping is developed to track 

 referrals, and subsequent actions in accordance with the guidance provided here. 

 The RC uses a spreadsheet to record the date the FD or development 

 letter(s) was received in the RC, the employee’s name, claim number, the date 

 outreach was completed and whether or not the employee intends to pursue 

 impairment and/or wage-loss. In addition, the RC will also report on the 

 disposition of all referrals on a weekly basis to the DEEOIC RC Coordinator. This 

 data should be incorporated into the routine weekly RC activity report already 

 generated by the RC manager.

f. Contacting the Claimant. The RC staff should carefully review Procedure Manual 

 Chapters 2-1300 and 2-1400, which explain the eligibility requirements for 

 compensation benefits and the procedures DEEOIC follows for developing 

 impairment and wage-loss benefit claims. For each referral, the RC initiates a 

 telephone call to the employee identified. It is necessary for the RC to access 

 ECMS to obtain contact information for the employee. The purpose of this call is 

 to provide information about the potential impairment and/or wage-loss benefits 

 available, respond to questions, and solicit claims. 

 A script has been developed for use by the RC staff in explaining impairment 

 and/or wage-loss benefits to the employee at a general level. It is important the 

 RC staff adhere to the script. Given the complexity of the benefit structure under 

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 Part E, it is likely that the employee will have questions. The RC staff may 

 respond to general follow-up questions; for example, eligibility requirements or 

 program procedures to develop a claim for impairment and/or wage-loss benefits. 

 To help the RCs anticipate and answer some of the most common questions 

 regarding impairment and wage-loss benefits, DEEOIC has developed a Q & A 

 Sheet for use by the RCs.

 Claim-specific questions or questions that exceed the RC’s ability to assist the 

 employee must be referred to the assigned CE or FAB hearing 

 representative/claims examiner, per ECMS. No attempt should be made by the 

 RC representative to offer opinion or conjecture as to the likelihood of 

 entitlement. All adjudicatory functions are solely the responsibility of the 

 assigned CE.

g. Statement from the Claimant. During the telephone call, if the employee 

 expresses the intention to pursue impairment and/or wage-loss benefits or in cases 

 where the RC staff member believes the employee may qualify for these benefits, 

 the RC advises the employee to submit a signed statement or letter to the 

 appropriate DO stating his or her intention to pursue benefits. 

 h. Claimant Information. In cases where the employee expresses the intention to 

 pursue impairment and/or wage- loss benefits, the RC must also mail the 

 brochures titled “How Do I Qualify for an Impairment Award” (available on the 

 DEEOIC website) with an appropriate cover letter to the employee. These 

 brochures were developed to explain these two types of benefits and the 

 requirements that must be met to qualify for benefits.

i. TMS. All discussions with the employee about wage-loss and/or impairment is 

 memorialized into the ECMS via the TMS screen. In general, each TMS entry 

 contains a synopsis outline of the discussion; the employee’s question or request, 

 if any; the guidance or solution offered; and a notation as to whether the employee 

 intends to pursue impairment and/or wage-loss. The TMS screen is printed and 

 the paper record of the activity is forwarded to the appropriate DO/FAB daily for 

 association with the case file.

j. Special Instructions for Terminal Claimants. Designated RCs are responsible for 

 immediately notifying via email the DO POC and the assigned CE or FAB HR (as 

 denoted in ECMS), on any case needing prioritization, such as a terminally ill 

 employee who wants to claim impairment and/or wage-loss. The designated DO 

 POC is the same individual who handles the RC employment verification process. 

 The RC staff member still submits the printed copy of the telephone contact in 

 TMS to the appropriate DO/FAB for association with the case file. For easier 

 identification, these TMS records must be marked “Priority” on top of the page. 

 k. Follow Up with the Claimant. The designated RC has seven calendar days from 

 the RC’s receipt of the employee’s FD or initial development letter(s) to initiate 

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 telephone contact. In cases where the RC is unable to contact the employee within 

 seven calendar days, the RC continues to follow up with the employee and 

 documents the contact attempts in TMS until contact is successful or the RC 

 makes a reasonable determination that further attempts will not be productive. 

 The RC representative may use his or her discretion to determine when to cease 

 further contact attempts with the employee, but as a general rule, after three 

 recorded attempts in as many days has failed to garner employee contact, the RC 

 may cease outreach effort.

 (1) Disposing of the Decision. The RC is to shred the FD and/or 

 development letter after the employee has been successfully contacted or 

 after the RC has ceased outreach effort with the employee.

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CHAPTER 11 – INITIAL DEVELOPMENT

1. Purpose and Scope. This chapter explains the procedures to be used by the CE for the 

review and initial development of a Part B claim, a Part E claim, a Part B/E claim, and for a Part 

D claim that has been developed by the DOE, after receipt by the designated DO and entry in 

ECS. 

2. RC Actions. RC staff conduct initial employment verification on most non-RECA claims 

filed with the RC and occupational history interviews on all new Part E claims with covered 

employment and eligible survivors. The DO conducts initial employment verification only on 

claims filed directly with the DO. However, the CE closely reviews all initial development 

actions taken at the RC and determines what additional and follow-up measures are necessary.

3. Review by the DO for Potential Development. Regardless of the type of claim (i.e., B 

only, E only, B and E, or a Part D claim developed by the DOE), the CE first reviews the claim 

to determine what development is required to issue a RD. Key items the CE needs to review to 

determine whether sufficient evidence exists are listed below. These three factors are applied 

differently for each claim type.

a. Medical Condition(s). 

b. Employment History. Information provided by the RC will assist the CE in 

determining what additional development is required. 

c. Survivorship Eligibility, When Appropriate. This excludes employee claims and 

RECA claims for Part B only. 

4. Reviewing a New Claim. The initial review takes place upon the DO’s receipt of the new 

claim from Mail and Files (see Chapter 6 – Mail and Files). The CE reviews the claim as a 

whole, weighing employment, medical, and survivorship eligibility to properly categorize the 

claim and determine what development is required. The information contained in the RC packet 

assists the CE in planning additional development. 

When a deficiency in the evidence is identified, the CE must notify the claimant and request 

evidence needed to resolve the deficiency. The CE may also assist the claimant with his or her 

claim by requesting evidence from other sources.

a. Medical Development. The CE reviews the claimed medical condition(s) on 

Forms(s) EE-1/2 and the completed Case Create Worksheet to determine whether 

the claim is applicable under Part B, Part E, or both. Refer to Chapter 17 – 

Development of Radiogenic Cancer Claims for covered occupational illnesses 

under Part B and to Chapter 19 – Eligibility Requirements for Certain Uranium 

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Workers for covered illnesses under Part E.
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For example, the claimed condition of prostate cancer is applicable under both 

Part B and Part E but the claimed condition of asbestosis is applicable only under 

Part E.

(1) The CE must ensure that the condition claimed is covered under Part B, 

Part E, or both, based upon the claimed employment and the different 

criteria used to determine covered employment under each Part.

(2) The CE develops the medical condition(s), as needed, in accordance with 

Chapter 16 - Developing and Weighing Medical Evidence. 

b. Employment Development. At the same time, the CE reviews Form EE-3 and 

any employment verification request forms or evidence received from the RC to 

determine whether the claimed employment is applicable under Part B, Part E, or 

both. 

(1) Under Part B, the applicable facility types include DOE, AWE, beryllium 

vendors, and RECA mines or mills. AWE subcontractors are not covered 

under Part B or Part E.

(2) Under Part E, the only applicable facility type is DOE or a covered RECA 

Section 5 facility. Only DOE contractors/ subcontractors are covered; 

federal DOE employees at such sites are not covered Part E employees.

AWE and beryllium vendor employees are not covered under Part E. 

However, if employment is claimed at an AWE or BV during a time in 

which such facility was designated a DOE facility for remediation, the 

case file is forwarded to the NO for review. Chapter 13 - Establishing 

Covered Employment discusses DOE remediation in detail.

(3) The CE looks at the claimed facility types(s) (i.e., DOE, AWE, beryllium 

vendor, and covered RECA mines or mills), time period(s), job title(s), 

and ORISE printouts, if available. The CE then determines whether the 

claimed employment is applicable under Part B, Part E, or both, and then 

develops any employment evidence needed.

c. Eligible Survivor Development. When Form(s) EE-2 is received, the CE reviews 

the claim and determines whether all eligible survivors have been accounted for 

and given the opportunity to apply for survivor benefits. Also, the CE reviews the 

claim for sufficient evidence to support the relationship between the survivor and 

the employee.

(1) Under Part B, the eligible survivors are the surviving spouse, children, 

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(2) Under Part E, the eligible survivors are the surviving spouse and certain 

eligible children at the time of the employee’s death (see Chapter 20 - 

Establishing Survivorship. 

The RCs do not develop for employment or occupational history if it is 

clear that no eligible survivor exists (which occurs primarily in cases 

involving adult children under Part E). The CE must review the evidence 

of record to confirm the absence of an eligible survivor before issuing a 

RD based upon RC determination, because the RCs do not perform any 

adjudication functions. 

d. Verifying ECS Accuracy. After reviewing the claim, the CE reviews ECS to 

ensure that the claim was entered correctly.

5. Sources of Evidence. Decisions are based on the written evidence of record. Evidence 

may include (but is not limited to) forms, reports, letters, notes, personal statements, and 

affidavits. Most of the evidence required under the EEOICPA may be obtained from the 

following sources: 

a. Claimant. Any claimant filing for benefits under the Act is responsible for 

submitting the necessary evidence required for OWCP to adjudicate the claim.

b. DOE. The DOE, a federal agency, had contractual arrangements with employees, 

contractors, subcontractors, AWEs and beryllium vendors with respect to the 

United States Atomic Weapons Program. The Act requires DOE to provide the 

DOL with information relevant to EEOICPA claims. The DOE conducts medical 

screening of former DOE facility employees through its FWP. The procedures 

for obtaining employee-specific FWP records are set forth in Paragraph 12 of this 

chapter.

c. Corporate Verifiers. While it produced atomic weapons, the DOE maintained 

relationships with a wide variety of external entities such as contractors and 

subcontractors, beryllium vendors and AWEs. The CE may need to contact these 

entities to obtain information about a claim for compensation.

d. ORISE. Oak Ridge maintains the ORISE database, which may be accessed via 

the Internet. The ORISE database, which contains information for over 400,000 

employees from the 1940s until the early 1990s, is an effective source for 

verifying employment for individual claims. ORISE is accessible via ECS, and 

the initial ORISE search is generally conducted at the RC when a claim is filed.

e. NIOSH. NIOSH is an agency within the Department of HHS that is responsible 

for estimating the radiation exposure to DOE employees, contractors, 

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NIOSH researches site information for covered facilities and sends dose 

reconstruction reports to EEOICPA DOs. The DOs use the dose reconstruction 

reports to determine the probability of causation between a claimed cancer and 

exposure at a covered facility, based on the criteria established by NIOSH.

f. Medical Sources. These sources include reports from doctors and hospitals 

providing examination and/or treatment to covered employees. By signing Form 

EE-1 or EE-2, the claimant authorizes OWCP to collect medical documentation 

pertinent to his or her case. 

g. Center for Construction Research and Training. The Center for Construction 

Research and Training is a research, development, and training arm of the 

Building and Construction Trades Department (BCTD) of the AFL-CIO.

CPWR has direct access to 15 building and construction trade international 

unions, signatory contractors, and union health, welfare and pension funds. 

CPWR also has access to employment records, union rosters, and dispatch 

records. 

CPWR researches and provides employment information for construction and 

trade worker claims where DOL has been unable to obtain reliable information 

from other resources (e.g., DOE, corporate verifiers).

h. SEM. The SEM database may be accessed via the Internet. SEM is a source for 

obtaining evidence of potential exposures to toxic substances at many DOE 

facilities.

i. Other Sources. The OWCP may receive evidence from other sources, such as 

individuals completing employment affidavits, claimant representatives, and other 

state and federal agencies.

6. Advising the Claimant of Deficient Evidence. When the CE determines that additional 

development is required, the claimant must be advised of the deficiency and afforded an 

opportunity to respond. 

a. Initial 30-day Period. If the CE identifies a deficiency in the evidence that 

requires development, a letter is prepared which describes the deficiency and 

additional information necessary to overcome it. The CE thoroughly reviews the 

evidence in the file before writing the letter and tailors the letter to the individual 

case. Often 30 days will be sufficient time to allow for submission of additional 

evidence.

For example: If a claimant submits a claim for a non-covered condition and the 

evidence does not support a covered condition under the EEOICPA, the CE 

advises the claimant that a covered condition has not been claimed and that he or 

she is allowed 30 days to claim such a condition and to provide supporting 

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medical evidence. [If the claimant does not claim a covered condition and does 

not provide supporting evidence, the CE proceeds with a RD for denial.] 

b. Final Notice. If the claimant fails to submit the requested evidence within a 30-

day period, in most instances the CE sends a follow-up letter advising the 

claimant that OWCP has not received the requested evidence and that he or she 

will be provided with additional time to submit the evidence.

 

For example: If a covered condition is claimed, but the file is lacking medical 

documentation, the CE allows a reasonable period of time for submission of the 

appropriate evidence. In cases such as this, the CE makes at least two requests for 

medical documentation. 

c. Setting Deadlines. As the EEOICPA is non-adversarial, the CE uses care when 

setting deadlines. The information requested is not always easily obtained 

because most employees were exposed many years ago. Thus the CE must be as 

flexible as possible and advise the claimant that additional time will be granted if 

the claimant requests a reasonable extension of time. 

7. Requesting Evidence by Telephone. The CE may also use the telephone to gather 

evidence. Person-to-person contact often succeeds in obtaining information, addressing specific 

concerns, and defusing contentious situations. Any use of the telephone is to be conducted in a 

professional and courteous manner. 

a. Documenting Phone Calls. CEs document each call in ECS and place a copy of 

the automated telephone record in the case file. It is vital to enter a call summary 

right after the call, while the information is still fresh in the CE’s mind. 

8. Initial Exposure Development. RC staff conduct occupational history interviews on most 

new Part E claims filed after August 1, 2005, and on certain Part D/E claims filed before that 

date. In conjunction with this step, the CE queries the SEM, and prepares the DAR and forwards 

it to the proper DOE Operations Center or corporate verifier requesting exposure information to 

complement the RC findings. A DAR is not always necessary; the CE completes a DAR request 

based upon what medical evidence and exposure documentation is already contained in the case 

file. 

a. Occupational History Interview. Exposure information is partially obtained 

through the occupational history interview conducted at the RC. Two separate 

interview scripts (one for DOE employment, one for RECA) are available, and the 

findings outlined in these documents assist the CE in clarifying what further 

exposure development is needed as it relates to causation. 

b. Review of Evidence. The CE reviews the claimed employment, exposure 

documentation, the SEM and the claimed condition to determine the proper 

course of development for causation. 

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c. Assignment to RC. The CE reviews all former Part D cases, new Part E cases 

filed before August 1, 2005, and claims filed directly with the DO to determine 

whether an occupational history interview is required. Such evaluations are made 

on a case-by-case basis by reviewing the evidence in the file as a whole and the 

exposure evidence in particular. 

(1) If the evidence in the file is insufficient to develop for exposure, the CE 

assigns an occupational history development task to the RC via memo to 

the RC manager. 

(2) Upon receipt of such assignment, the RC has 14 calendar days to complete 

the occupational history interview and return the findings to the DO with a 

cover memorandum outlining all tasks and stating when they were 

conducted. 

 

9. Former Part D Claims. Former Part D claims have been incorporated into the existing 

Part B EEOICPA files. DOE may have gathered documents that are relevant to DEEOIC’s 

current development needs. The CE must review these claims for medical, employment, and 

survivorship information (if applicable). 

The case file may contain copies of records from a Part B claim (e.g., medical records, 

development letters, Forms EE-5, a NIOSH dose reconstruction report, a RD, a FD) and/or 

records that were gathered by the DOE Office of Worker Advocacy (OWA). 

As noted above, should an occupational history interview be required, the CE assigns the task to 

the RC. Any employment development is conducted at the DO; no RC assignment is necessary. 

The evidence in these claims may include:

a. Claim Forms.

(1) Form EE-1, EE-2, or EE-3. 

(2) Form 350.2, Employee Request for Review by Physician Panel. This is 

the primary application form for current or former DOE contract 

employees under Part D. 

 

(3) Form 350.3, Survivor Request for Review by Physician Panel. This is the 

primary application form for a survivor of a former DOE contract 

employee under Part D.

(4) Form KK-1, KK-2 - OWA1-7/6/01 Request for Review by Medical 

Panels. DOE used these forms initially for filing claims by the employee 

and by the survivor, respectively, and for the claims review by the Medical 

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Panels. These were internal forms used by OWA only. 
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Once the Office of Management and Budget (OMB) approved these 

forms, they became known as Form 350.2, Employee Request for Review 

by Physician Panel, and Form 350.3, Survivor Request for Review by 

Physician Panel, respectively.

If no DOE/OWA forms are located, the CE reviews the file for any 

correspondence from the claimant that may contain words of claim. As 

with Part B, any correspondence referring to a request for benefits or a 

request for review by a physician panel will be considered a claim filed 

under Part E. 

b. Highlight Sheet. This form provides a chronological description of adjudicative 

actions, follow-up information, and documented phone calls by the OWA. This 

information was entered in OWA’s Case Management System (CMS).

c. Medical Records. These records include medical narratives, pathology reports, 

clinical reports, and diagnostic reports. 

d. Survivorship Evidence. This includes marriage certificates, divorce decrees, birth 

certificates, adoption papers, death certificates, obituaries, and school records. 

e. Employment Evidence. This includes a DAR, which in turn includes employment 

records such as job position descriptions, personnel information, security 

clearance information, employment dates, medical records, accident/incident 

reports, radiation records, and dosimetry records. 

f. Occupational Medical Questionnaire. This form is in the case file if completed by 

an RC staff member and/or by an OWA staff nurse based on conversations with 

claimants.

g. Physician Panel Report. Some case files may contain this report, which consists 

of the OWA physician’s discussion, rationale, and conclusion as to whether a 

toxic substance aggravated, contributed to, or caused the claimed condition(s). 

Additional guidance as to the proper evaluation of these reports as they relate to 

causation is outlined in Paragraph 10 of this chapter. 

h. FWP Documents. As discussed in greater detail in Paragraph 12 of this chapter, 

DOE medically screens former DOE facility workers. The resulting studies 

document claimed illnesses and exposure. The CE may encounter DOE FWP 

documentation in the case file. The CE reviews DOE FWP findings together with 

all other evidence in file when evaluating for causation. 

i. AR Release Form. The claimant may have designated a representative to act on 

his or her behalf in the adjudication process with DOE. The CE contacts the 

claimant to determine whether this designation is still valid (see Chapter 12 – 

Representative Services). 

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j. Duplicate Records. The CE may find duplicate copies of records in the Part D 

case file. The CE maintains the integrity of the Part D case file by keeping it in 

the order that it was received in the DO. The CE does not remove any duplicate 

copies of individual records unless it is obvious that there is an exact duplicate 

photocopy of the entire case record in the file. In this instance the CE shreds the 

duplicate photocopy. 

10. Positive DOE Panels. 

a. Official Positive DOE Panels. If a positive DOE physician panel finding is 

present in a Part D case file and the DOE approval letter is signed by a DOE 

official, the physician panel finding is considered an official positive 

determination from DOE. Generally, such claims are in posture for acceptance of 

causation under Part E, but further development of survivorship and potential 

coordination and offset issues may be required of the CE before issuing a RD: 

(1) Eligible Survivor. In survivor claims the CE needs to determine whether 

the claimant is an eligible survivor under Part E and whether the accepted 

covered illness aggravated, caused, or contributed to the covered Part E 

employee’s death (see Chapter 20 – Establishing Survivorship). 

(2) SWC Benefits/Tort Offset. Also, the CE needs to determine whether the 

claimant received any compensation from a SWC plan (see Chapter 30 – 

Tort Action and Election of Remedies and Chapter 31 – Coordinating 

State Workers’ Compensation Benefits).

b. Unofficial Positive DOE Panels. If a positive DOE panel finding is present in the 

case file, but no accompanying approval letter signed by a DOE official is 

present, the case is not in posture for possible acceptance. In such a case, the 

physician panel report has not been sent to the claimant and the CE does not 

consider it an official positive determination from DOE. Therefore, the CE 

reviews the claim to determine if further development is needed concerning 

survivorship, medical, employment or exposure issues, as with any other claim. 

11. Reviewing Part B/E Claims. A claim accepted under Part B is also accepted for 

causation under Part E for the accepted Part B covered occupational illness, if all other 

appropriate criteria under Part E are met.

Unlike a Part E claim with an accepted Part B claim, a claim that has been accepted under Part E 

is not automatically accepted under Part B.

In developing these cases, the CE needs to be alert to the differences in medical, employment, 

and survivorship requirements between Part B and E claims (including RECA claims), since 

these differences can result in the need for additional development and/or non-approval of the 

claim under Part E, even though it has been approved under Part B. 

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a. Medical Differences Between Part B and E Claims. Covered illnesses under Part 

E include all the covered occupational illnesses under Part B (i.e., beryllium 

sensitivity, CBD, chronic silicosis, and cancer) plus additional covered illnesses 

(e.g., asbestosis). 

However, the covered occupational illnesses under Part B do not include all the 

covered illnesses under Part E (for example, asbestosis, peripheral neuropathy, 

and anemia).

b. Employment Differences in Facility Sites Between Part B and E Claims. Covered 

employment under Part B includes all covered employment under Part E (i.e., 

DOE contractor/ subcontractor, RECA). 

However, covered employment under Part E does not include all covered 

employment under Part B. Part E covers employment at a DOE or RECA Section 

5 facility. It also covers employment at AWE and beryllium vendor facilities only 

during a period when they were designated as DOE facilities or during DOE 

remediation periods. Part E does not cover employment for beryllium vendors or 

AWE facilities outside of the time they were considered DOE facilities.

c. Survivorship Differences Between Part B and E Claims. These issues are 

addressed in Chapter 20 – Establishing Survivorship. 

d. RECA Differences Between Part B and E Claims.

(1) An eligible survivor who is the child of the covered employee under 

RECA and under Part B is not an eligible survivor under Part E unless he 

or she meets the definition of “covered child.” 

(2) An employee who does not meet the employment and other requirements 

under RECA Section 5 (and therefore under Part B) may be eligible under 

Part E.

(3) An employee who does not meet the medical criteria for covered 

conditions under RECA Section 5 (and therefore under Part B) may still 

be eligible under Part E (i.e., all cancers, asbestosis, etc.)

e. Requirements for New Part E Claim Filing. If a former Part D claim exists, a 

claimant does not need to file a new claim under Part E. If there is a Part B 

acceptance on record, a claimant does not need to file a new claim for benefits 

under Part E. However, if a Part B denial is on record, or a Part B claim is 

pending a decision, the claimant must file a new claim form seeking benefits 

under Part E. 

12. DOE FWP. The FWP began in 1996 and is designed to evaluate the effects of DOE's 

past operations on the health of workers employed at DOE facilities. The program documents 

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medical conditions and workplace exposures that may help the CE develop and adjudicate 

claims.

In some instances, FWP records will appear in the Part D case file. If no records exist there, or a 

new Part E, B/E claim is filed, the CE requests FWP documents during initial development.

The CE reviews FWP records in light of the evidence in the file as a whole when evaluating a 

claim. Chapter 15 – Establishing Toxic Substance Exposure explains how the CE uses FWP 

records in assessing causation.

a. Medical Component. FWP records contain valuable information about medical 

conditions and can help the CE develop for a covered illness. 

(1) The FWP is a screening program and does not provide a final diagnosis 

for the medical conditions detected. If the screening tests identify a 

potential disease, the employee is referred to his or her treating physician 

for further medical workup and diagnosis. 

(2) Results of medical tests conducted by the FWP (e.g., pulmonary function 

tests, BeLPT, blood tests, X-rays with B reader interpretations, etc.) are 

valid when interpreted by certified medical professionals. Therefore, the 

CE may use such test results in evaluating records for a covered illness, 

provided a physician’s interpretation of the test result is present. 

b. Exposure Component. FWP medical screening is conducted to evaluate former 

DOE workers for adverse health outcomes related to occupational exposures to 

substances such as beryllium, asbestos, silica, welding fumes, lead, cadmium, 

chromium, and solvents. Therefore, these records contain valuable exposure 

information. The CE reviews FWP screening records along with the evidence in 

the file as a whole when evaluating claimed exposure.

Also, the FWP asks the former DOE employee to undergo a Work History 

Interview, which examines workplace exposure at DOE facilities. The CE uses 

the results of the interview when assessing work history and exposure. 

c. Existence of FWP Records. The CE must review the case file/claim forms to 

determine whether FWP records exist.

(1) Part D Cases. As indicated, some former Part D cases will contain FWP 

records. The CE searches the case file for cover memos or medical 

records provided by the FWP. The CE should also refer to DOE Form 

350.2, Employee Request for Review by Physician Panel, question 11, or 

Form 350.3, Survivor Request, question 11, to determine if the employee 

participated in the FWP. If records are not present, but there is some 

indication that they may exist, the CE obtains them as outlined below.

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(2) New B/E Claims. With regard to new claims, the CE must review Form 

EE-3 and/or section 5(B) of the DOL Occupational History Interview to 

determine if the employee participated in a FWP screening program at the 

claimed work site. If so, the CE prepares a request package to be sent to 

the appropriate FWP. 

d. Obtaining FWP Records. Where no records exist in a former Part D case, or a 

new Part E claim is filed, the CE requests the records from the appropriate FWP 

POC. The complete POC list is available for viewing on the shared drive by 

accessing the Part E folder, Former Worker Program subfolder. If the records are 

unavailable at a POC, the POC cannot be determined, or a new Form EE-3 is 

required (see below), the CE requests assistance from the claimant.

(1) POC Request. After determining that FWP records must be requested, the 

CE reviews the POC list to identify the appropriate POC. The CE 

prepares a package and a cover letter to the POC (Exhibit 11-1). The 

package includes a letter to the FWP, a cover memo, Form EE-1 or EE-2, 

and the new Form EE-3. 

The CE should state in the memo that an EEOICPA claim has been 

received for the named DOE employee, the employee participated in the 

specified FWP, and DOL is requesting a copy of all FWP records. The 

memo and package are faxed or mailed to the designated POC.

(2) New Form EE-3. FWPs will accept only a new Form EE-3 as a release. If 

the case file contains an old Form EE-3, the CE writes to the claimant 

asking the claimant to complete and sign a new Form EE-3. Once the new 

form is received, the CE prepares the request package as outlined above.

(3) No FWP Records. When the CE cannot locate FWP records, the CE 

contacts the claimant in writing to determine if the employee participated 

in a FWP at the claimed work site. The CE includes a new Form EE-3 

with the letter and instructs the claimant to complete, sign and return the 

new Form EE-3 to the DO only if the employee participated in the FWP.

e. Building Trades National Medical Screening Program Database. This database 

contains work history and medical test results for certain employees who worked 

at Amchitka Island, Savannah River, Oak Ridge, and Hanford and who filed Part 

D claims with DOE from 2000-2004. 

(1) The CE views medical data and work histories contained in the database 

by accessing the Shared Drive, Part E folder, Former Worker Program 

subfolder. The “read me” file in the FWP subfolder contains detailed 

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(2) The CE searches the database for medical information and prints the 

results. The medical results generated from the database do not contain a 

physician’s signature.

(a) A letter from the Building Trades FWP Medical Director, Dr. 

Laura Welch, describing the information obtained in the database 

search and attesting to its validity is located on the Shared Drive, 

Part E folder, FWP subfolder. 

(b) The CE prints Dr. Welch’s letter and attaches it to the search 

results. The CE places these documents into the case file and 

weighs the information with the evidence on file as a whole.

13. Terminally Ill Claimants. OWCP strives to process claims fairly and expeditiously for all 

claimants. However, claimants who are end-stage terminally ill must have priority processing. 

These claims should be handled swiftly and compassionately.

a. Claims Actions. DO and FAB CEs and HRs are instructed to watch for indicators 

of an end-stage terminally ill claimant any time they are reviewing a case file or 

preparing a decision. Indicators of end-stage terminally ill claimants include 

requests for hospice care, medical evidence stating that the claimant is at the endstage of an illness, or telephone calls or letters from RCs, congressional offices, 

ARs, family members, or medical providers regarding the claimant’s illness. 

Upon receipt of information concerning the end-stage of the claimant’s illness, the 

DD, ADD or FAB Manager (depending on where the file is located) must be 

notified immediately.

The DD/ADD or FAB Manager must use sound judgment in determining if 

priority handling is warranted. If medical documents or other information 

indicate that the claimant is in the end-stage of his/her illness, or that death is 

imminent, priority handling of the case is required. If the claimant’s medical 

status is unclear, a medical report that establishes that the claimant is in the endstage of a disease or illness must be obtained. Once this information is obtained, 

the DD/ADD of FAB Manager will determine whether priority handling is 

warranted.

Once it is determined that a claimant is in the end-stage of his/her illness, the 

DD/ADD or FAB Manager must enter the appropriate information into ECS and 

prepare the case file in accordance with Chapter 10 – Resource Centers. 

Priority handling for terminally ill claimants requires that the entire adjudication 

process be expedited. Whenever the file changes hands, the person receiving the 

file should be notified, verbally or in writing, of the claimant’s terminal status. 

The supervisor or DD/ADD should facilitate the expedited adjudication of the 

claim by requesting priority processing from any other agencies involved, such as 

the DOE, DOJ, and NIOSH. 

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If a case requires referral to the NO for reopening or policy clarification, the DO 

or FAB must identify the claimant as terminally ill in the memo to the Director. 

Procedures for expediting payment processes for terminally ill claimants can be 

found in the Chapter 32 – Compensation Payments.

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CHAPTER 12 – REPRESENTATIVE SERVICES

1. Purpose and Scope. This chapter contains a discussion regarding persons who represent 

the interests of claimants before the DEEOIC. It provides guidance to DO and FAB staff on the 

designation of a representative, the role and functions of a representative, and fees charged by 

representatives for their services. 

 

2. Authority. Under 20 C.F.R. §§ 30.600 and 30.601, a claimant may authorize any person, 

not otherwise prohibited by law, to represent him or her. The authorization includes allowances 

for communicating with claims staff, accessing case file documentation, receiving copies of 

decisions, submitting objection(s), filing appeals, and seeking medical authorizations. 

 

a. No Requirement for Representation. A claimant is not required to designate a 

representative to file a claim or receive any benefit available under the EEOICPA.

 

b. Exclusive Representation. If a claimant chooses to have an AR, he or she may 

appoint only one representative at a time. The claimant has the ultimate decisionmaking authority to designate or remove his or her representative from acting on 

his or her behalf with regard to his or her claim. He or she can exercise this 

authority at any time and for any reason. In situations where a POA or courtissued instrument exists that grants someone legal decision-making authority 

regarding the interest of the claimant, that person has authority to appoint or 

remove a DEEOIC representative.

c. Authorization in Writing. Any representative appointment must in writing. The 

information that is necessary for a claimant to appoint a representative is the 

representative’s name, mailing address, and telephone number. The claimant is to 

date and sign the request. The claimant may appoint a representative by filling 

out the “Authorization for Representation/Privacy Act Waiver” (Exhibit 12-1), 

but use of this is not required. If the appointing document does not contain the 

representative’s full name, telephone number and address, the CE obtains that 

information. Upon receipt of an AR notification, the CE or FAB staff person 

must enter the AR’s information into the ECS. 

d. Removal of Representative. A claimant may elect to either remove or change a 

representative at any time and for any reason. When removing a representative, 

the claimant is to submit a signed and dated written request that identifies clearly 

the person removed as representative. When replacing a representative, the 

claimant must state in writing that he or she is removing the previous

representative and replacing that person with another person. The claimant must 

name the previous representative and name the new representative, along with the 

new representative’s mailing address and telephone number. Once the claimant 

removes a person from serving as his or her representative, the assigned CE or 

FAB staff person is no longer to interact with that individual in relation to the 

claimant’s case file. A representative may also resign his or her appointment with 

a signed statement of such. 

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The CE or FAB staff person will update ECS regarding removal and/or change of 

representative. 

3. Length of Appointment. DEEOIC recognizes the authority of a properly appointed AR

throughout the entire claims process (including any hearing), unless or until the claimant 

removes the appointment, the representative withdraws, or the claimant dies. 

a. Death of the claimant. In the case of a claimant’s death, his or her DEEOIC 

representative appointment ceases. In addition, any appointment such as an 

attorney-in-fact under a POA or a conservator under a conservatorship ends. 

4. AR’s Role. The AR’s role in the claims process depends on the scope of the authority 

that the claimant grants him or her. Unless the claimant’s authorization specifies otherwise, a 

properly appointed AR has the authority, to the same extent as the claimant, to present or seek 

evidence, make factual or legal arguments, file claims or seek medical authorization, interact 

with DEEOIC staff, and obtain information from the case file. Any notice or other 

communication from the DEEOIC that relays a requirement for claim adjudication is considered 

satisfied, if the DEEOIC sends it to a properly designated AR. The DEEOIC considers any 

communication sent to an AR the same as communication to the claimant. In most situations, 

the CE or FAB staff person is to relay information or other communications directly to the AR, 

with a copy going to the claimant. Where claimant contact information is unavailable, the CE or 

FAB staff person communicates solely with the AR. However, the CE or FAB staff person may 

choose to contact the claimant directly, if an AR is unresponsive, provides unclear guidance or 

direction, or a contradiction exists between information received from an AR versus the 

claimant. In any situation, the claimant is the final arbiter of any matter involving his or her 

claim. An appointed AR for a DEEOIC claim, who does not possess legal authority through a 

POA or court document to act on behalf of a claimant, does not have the authority to sign an EN20 Payment Form for the claimant. 

5. Authority of an Attorney-in-Fact or Legal Conservator/Guardian. A person with POA to 

act in the name of the claimant is an “attorney-in-fact.” There are also other types of legal 

designations that may exist such as a conservator or guardian. In any of these situations, a 

written instrument has to exist that grants legal authority for someone to act on behalf of another. 

The written instrument will include language that describes the specific authorities granted for 

one person to act on behalf of another, and can be different from one situation to another. A 

general POA authorizes one person to have complete authority to act on someone’s behalf on all 

matters, including signing documents and forms. In a special or limited POA, the authority to 

act may be limited to particular topics. Therefore, if an individual claims to have POA or some 

other legal authority to act on behalf of a claimant, the CE or FAB staff person must obtain a 

copy of the document conferring such authority. He or she must carefully examine the document 

to determine the scope of the legal authority granted. The CE or FAB staff person is to 

recognize any POA or other legal appointment, if the document upon which that appointment is 

made, conveys broad powers for the appointee to act on behalf of the claimant. Once the CE or 

FAB staff person receives documentation supporting the claimant has a POA, they will then 

update ECS with the new POA information. In those situations where the CE or FAB staff 

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person determines that the legal authority of a person to act on behalf of a claimant is limited to a 

particular function that does not allow for engagement on the DEEOIC claim, he or she sends a 

letter to the claimant. The letter is to communicate what the concern(s) are regarding the 

appointment and is to specify what communication between the DEEOIC and the attorney-infact (or court-appointed representative) will and/or will not occur. In those situations where the 

CE or FAB staff person is unsure of the authority granted to a person to serve on behalf of a 

claimant or of the legal sufficiency of a document, he or she may consult with the Policy Branch 

for guidance. 

a. Form EN-20. In any situation where a person other than the specified payee is 

signing Form EN-20, the CE must submit the documents purporting to grant such 

power for review by the SOL to ensure that they are valid under the applicable 

state law. 

When preparing documents for review by the SOL, the referring CE or staff 

person is to include as part of the referral package, a routine or terminal memo for 

review by the SOL (Exhibit 12-2). The referring CE or staff person uploads the 

memo to OIS and also sends a notification via OIS to the designated NO staff 

person. Upon receiving the notification in OIS, the NO staff person verifies the 

information and refers a printed copy of the POA package to SOL. Once SOL 

processes the POA and returns the copy to the NO staff person, the NO staff 

person bronzes the Solicitor’s response into OIS, indexing the document(s) as 

Category “Adjudication Documents.” The Subject is “SOL opinion.” The 

Description is “POA review memo from SOL for (payee name).” The document 

is to be left in an Unreviewed status in OIS for identification by the assigned CE.

6. Interaction with Representatives. After a claimant properly appoints a representative to 

handle his or her DEEOIC claim, the CE or FAB staff person contacts the representative by letter 

(Exhibit 12-3). In the letter, the CE acknowledges the appointment and describes the extent to 

which the representative has an active role in the claims process. From that point forward, or 

until the claimant removes or changes the representative, the CE or FAB staff person will 

communicate with the designated representative and copy them on all written interactions 

intended for the claimant. 

7. Representative Conflict of Interest Guidance. The DEEOIC prohibits an AR of a 

claimant from having private, non-representational financial interests relating to a claim, other 

than the fee for serving as a representative. This ensures that ARs serve the interests of his or her 

client in a fair and unbiased manner. The DEEOIC will consider an AR to have a “conflict of 

interest” if the AR could directly benefit financially from an EEOICPA claim due to something 

other than the statutorily set fee for representing a client in connection with his or her EEOICPA 

claim. For example, an AR will be considered to have a conflict of interest if, in addition to 

being the client’s AR, she or he is also being paid by DEEOIC, directly or indirectly, as a 

provider of authorized medical services to the client. 

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a. Upon receipt of a signed notice of the appointment of an AR, the CE or FAB staff 

person sends an acknowledgment letter accompanied by the DEEOIC Conflict of 

Interest Policy (Exhibit 12-3). 

b. If during any interaction with an AR or in review of case evidence, the CE or 

FAB staff person ascertains that the AR may have a conflict of interest, the CE 

should take immediate action to address the matter. A conflict of interest may 

exist if there is evidence that the AR is receiving financial benefits associated 

with the claim aside from the authorized fee permitted under the law. An 

incidence of conflict of interest includes evidence showing the AR works for or is 

contracted by an individual, organization or entity that concurrently receives 

monetary payment from DEEOIC for services, supplies or other resources 

affiliated with the claim. This includes a representative who is a family member 

or other relative of the claimant receiving a wage, contractual payment, or fee 

from a medical service provider that the DEEOIC has granted authorization to 

provide in-home health services for that claimant. In any instance where a CE or 

FAB staff person is unclear as to the existence of a conflict of interest, he or she 

may refer the matter via a policy referral to the NO Policy Branch. Upon receipt, 

the Policy Branch will work with the SOL to provide a written response. 

(1) Upon receipt of credible evidence that a conflict of interest may exist, the 

CE or FAB staff person must prepare a notice to the designated AR, with a 

copy to the claimant (Exhibit 12-4). The notice is to include a descriptive 

explanation of the evidence that suggests that a conflict of interest may 

exist. The CE or FAB staff person is to request that the AR prepare a 

signed statement explaining his or her response to the evidence of a 

conflict of interest. Moreover, the CE is to state that if a conflict of 

interest does exist, the DEEOIC will no longer recognize the designation 

of the AR unless the conflict is eliminated. The letter is to include a 

statement allowing the AR 30 days to respond to the notice. 

 

(2) When in receipt of the AR’s response, the CE or FAB staff person must 

carefully evaluate the information provided, along with a review of the 

evidence of record, to determine whether a substantiated conflict of 

interest exists. If the AR acknowledges that a conflict of interest exists, he 

or she may resolve the conflict by either submitting a signed resignation as 

the AR, or submitting evidence of the relinquishment of whatever charges, 

position, job or duty creates a conflict with the role of AR. The claimant 

can also withdraw the authorization for that representative, in writing, and 

designate a new AR. Consent of the claimant will not remove a conflict of 

interest. 

 

(3) If the AR contends that the circumstances identified do not constitute a 

conflict of interest under DEEOIC’s policy, or no response is forthcoming 

within 30 days of the initial notification, the CE or FAB staff must 

carefully weigh the evidence of record. Should the AR provide sufficient 

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rationale that absolves him or her of any conflict of interest, the CE or 

FAB staff person notifies the representative, in writing, with a copy to the 

claimant, that no further action is necessary. However, if it is determined 

that there is compelling evidence of a conflict of interest, the CE or FAB 

staff person should conclude that DEEOIC will no longer recognize the 

designated AR as serving the interest of the claimant. Under this 

circumstance, the claimant is to be notified in writing that 

DEEOIC will no longer interact with the designated AR due to a conflict 

of interest. 

 

c. Once a CE or FAB staff person has determined that a conflict of interest exists 

that disqualifies a designated AR from representing the claimant and appropriate 

notification of such has been reported to the claimant, no further interaction with 

or disclosure of information to the AR is permitted. The CE or FAB staff person 

is to remove the AR information from the ECS. 

 

d. When a CE or FAB staff person removes a representative due to a conflict of 

interest, he or she should refer the name of the representative to the NO Policy 

Branch. Upon receipt, the NO Policy Branch will coordinate a review to 

determine if an additional investigation is required to assess potential conflict of 

interest in cases where the same representative exists. 

8. Representative Fees. A representative may charge a claimant a fee for services 

associated with representation before DEEOIC. Under 20 C.F.R. § 30.602, the OWCP is not 

responsible for any fee charged by a representative of an EEOICPA claimant, nor will it 

reimburse the claimant for any fees paid to the representative. Other than issues relating to the 

allowable fee under the EEOICPA, disputes over payment of fees, the quality of services 

rendered, or collection of monies owed are a personal matter between the claimant and his or her 

AR. 

a. Fee Limits. Under 20 C.F.R. § 30.603, for services rendered in connection with a 

claim pending before DEEOIC, a representative may not receive more than the 

following percentages of a lump-sum payment made to a claimant: 

(1) 2% for the filing of an initial claim with OWCP, provided that the 

representative was retained prior to the filing of the initial claim; plus

(2) 10% of the difference between the lump-sum payment made to the 

claimant and the amount proposed in the RD with respect to objections to 

a RD. 

b. Limitations. These maximum fee limitations apply even if the claimant and 

representative have agreed to other amounts in a contract or otherwise. Any such 

representative who violates this section shall be fined up to but not more than 

$5,000. Pub. L. 106-398, Title XXXVI, § 3648; Pub. L. 107-107, § 3151(a)(6) 

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c. A CE or FAB representative will refer any complaint of a violation of the fee 

schedule to the NO Policy Branch who will work with the SOL to determine if a 

referral to the DOJ is appropriate. 

9. Privacy Act Waivers. A Privacy Act waiver grants the DEEOIC permission to copy all 

documents from the case file and send them to a person of the claimant’s choosing. This person 

may be anyone the claimant wishes to receive material from the case file. The designated person 

will have no authority to make requests for additional information or sign documents on behalf 

of the claimant, unless the claimant submits additional documentation showing that the designee 

has such authority.

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CHAPTER 13 – ESTABLISHING COVERED EMPLOYMENT

1. Purpose and Scope. The EEOICPA lays out a set of employment criteria which must be 

satisfied before a claim can be considered for compensability. These criteria, taken together, 

form the basis of covered employment. This chapter provides guidance to CEs for gathering and 

evaluating evidence to determine whether the criteria for covered employment are satisfied under 

the EEOICPA.

a. OIS. DEEOIC employees responsible for claim management must image into 

OIS all documents received or created that relate to a claim. This guidance 

applies to all of the procedures described throughout this chapter. 

b. ECS. ECS is a claim status database used to manage case adjudication activities 

of the DEEOIC. Development of any employee case requires information input 

into ECS by CEs or FAB staff to record component-level data on claimed and 

verified employment. DEEOIC staff is to access ECS user guides and training 

material available through shared resources. 

2. Facility Coverage. The EEOICPA provides facility definitions that serve as the basis for 

determining covered employment. The following summaries provide a definition of each type of 

facility covered:

a. AWE Facilities. An AWE facility means a facility, owned by an AWE, that is or 

was used to process or produce, for use by the United States, material that emitted 

radiation and was used in the production of an atomic weapon, excluding uranium 

mining or milling. Coverage at the facility may be extended after the period of 

processing or production of radioactive material for use in a weapon, if there is a 

finding in a NIOSH report on residual radioactive contamination that the potential 

exists for residual radioactive contamination at that facility. This is the “residual 

radiation period.” DOE designates AWE facilities.

(1) Coverage extends only to the employees who worked directly for the 

AWE at the AWE facility. Contractor or subcontractor services provided 

on-site or off-site for an AWE facility are not covered. Additionally, 

coverage is not provided for those employees of wholly-owned 

subsidiaries of AWE employers. 

(2) The Joint Employer Doctrine does not apply. Courts have held that where 

the evidence shows that two or more employers exert significant control 

over the same employee, by jointly exercising the authority to determine 

the essential terms and conditions of employment to that employee, they 

can be held to be joint employers. However, this “joint employer 

doctrine” usually only applies in the labor law context, and is incompatible 

with the explicit intent of Congress, as expressed in the language of 

EEOICPA itself, to only extend coverage to employees of particular 

designated employers. This means that the evidence must establish that 

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the employee worked directly for the AWE. Evidence that an employee 

worked for a parent company or other corporate entity somehow related to 

the AWE employee does not establish employment by the AWE. 

(3) Atomic weapons employees are covered under Part B of the EEOICPA for 

cancer only. No coverage is afforded these employees under Part E of the 

EEOICPA.

(4) Designating additional AWE facilities is the responsibility of DOE; 

however, applicable time frames for AWE production activities at a 

particular facility are determined by the DOL.

(5) Determinations as to whether an AWE facility has a period of residual 

radioactive contamination, and the length of that period, are the 

responsibility of NIOSH. Periodic reports are issued by NIOSH that list 

affected sites. Facilities with residual radioactive contamination are 

covered as AWE facilities even if there is a change in the owner or 

operator of the facility. During the period of residual radiation, employees 

of subsequent owners or operators of the AWE facility are also defined as 

AWE employees and are afforded the same coverage under the EEOICPA. 

If there is a question regarding subsequent owners or operators of AWE 

facilities, the CE must refer the matter to the NO for evaluation. 

b. Beryllium Vendors. Beryllium Vendors are companies which are named in the 

Act, or DOE has determined processed or produced beryllium for sale to, or use 

by, DOE. The Act identifies some beryllium vendors by corporate name, and 

these are known as statutory beryllium vendors. Any employee of a statutory 

beryllium vendor who worked for the vendor during periods when the company 

was engaged in activities related to the production or processing of beryllium for 

sale to or use by DOE, has covered employment, regardless of work 

location. DOE, through publication in the Federal Register, designated other 

beryllium vendors, which are location-specific. DOE designated the final list of 

beryllium vendors on December 27, 2002. 

(1) Beryllium vendor coverage extends to direct employees of the vendor, its 

contractors or subcontractors and to any Federal employee who may have 

been exposed to beryllium at a facility owned or operated by the vendor. 

(2) Coverage for beryllium vendor employment is limited to those benefits 

available under Part B of the EEOICPA for beryllium sensitivity and 

CBD. 

c. DOE Facilities. A DOE facility means any building, structure, or premise, 

including the grounds upon which such building, structure, or premise is located, 

in which operations are, or have been, conducted by, or on behalf of DOE (except 

for buildings, structures, premises, grounds, or operations covered by Executive 

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Order 12344, dated February 1, 1982, pertaining to the Naval Nuclear Propulsion 

Program), and with regard to which DOE has or had either (A) a proprietary 

interest; or (B) entered into a contract with an entity to provide management and 

operation, management and integration, environmental remediation services, 

construction, or maintenance services. 

(1) The extent of benefits available to those who worked at DOE facilities is 

dependent upon the type of employment, specifically whether the 

employee was a DOE federal employee or an employee of a DOE 

contractor or subcontractor. Under Part B, coverage extends to both DOE 

federal employees and contractor or subcontractor employees working at 

the site, while under Part E coverage extends only to contractor or 

subcontractor employees.

(2) The definition of DOE includes its predecessor agencies: 

(a) Manhattan Engineer District (MED) (August 13, 1942-December 

31, 1946) 

(b) Atomic Energy Commission (AEC) (January 1, 1947 – January 18, 

1975) 

(c) Energy Research and Development Administration (ERDA) 

(January 19, 1975– September 31, 1977) 

(d) DOE (October 1, 1977 – present)

(3) Designations of DOE facilities or changes in DOE facility timeframes are 

the responsibility of DOL. Further information regarding how DOL 

assesses claims for DOE facility status is discussed later in this chapter.

d. Remediation Employment. At many AWE facilities, there is a period of 

remediation designated sometime after the years of active processing ended. 

When a facility is designated as a DOE facility for remediation only, in order to 

have covered employment at that location, the contractor performing the 

remediation work must have employed the employee. Any such remediation 

workers are eligible for the full range of benefits under both Parts B and E of the 

EEOICPA.

e. Facilities with multiple designations. Many facilities covered under the 

EEOICPA have multiple designations. Numerous combinations of AWE, 

Beryllium Vendor, and DOE facility designations may exist at the same facility. 

For those instances in which an employee works at such a facility during periods 

separately designated for different facility types, the employee will have 

eligibility for every category for which he/she has verified employment.

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f. RECA Section 5. This is a category of employment involving miners, millers and 

ore transporters at uranium mining facilities. For information regarding the 

handling of these claims, please refer to Chapter 19 – Eligibility Requirements for 

Certain Uranium Workers.

3. Comparing initial claimed employment to the covered facilities database. The first step 

the CE takes in assessing covered employment is determining which claimed employment listed 

on the EE-3 Employment History form corresponds with a covered AWE, Beryllium Vendor, or 

DOE facility. The CE does this by comparing what the claimant has communicated on the EE-3 

with the facilities identified on the DOE EEOICPA Covered Facilities Database. The link to 

access this database can be found on the DEEOIC website. It can also be found in the EPOD

which is referenced in paragraph 6 of this chapter. 

When performing the comparison between the claimed employment and the facility database, the 

CE must be diligent in assessing the evidence. While in many instances employment at a 

particular location or facility will be obvious, in other situations it may not. The CE reviews 

evidence presented by a claimant against the information stored in the database to assist in 

determining the location(s) where employment occurred. The CE must be mindful that often the 

name of a facility is different from the employer name provided by the claimant because multiple 

different operating contractors could have worked at DOE facilities over the years. Given these 

realities, the CE must cross-reference the data provided by the claimant with the information in 

the facility database. This can involve searching by facility name, state, location, employer name 

or contractor name using the key word search field. The “Find this Keyword” search feature is 

the broadest possible way to look for potential covered employment based on claimant 

statements.

The CE screens out certain employers from the review process if it is clear that it does not 

constitute covered employment. For example, employment as a shoe store clerk or department 

store cashier would not require action on the part of the CE as part of the review for potentially 

covered employment.

4. Matching Claimed Employment. The outcome of the initial employment facility 

screening will result in either part or all of the claimed employment having possibly occurred at a 

covered facility, or none of the claimed employment being linked to a facility. In any instance 

where the CE links all claimed periods of employment to a location identified on the facility 

database, he or she is to proceed to employment verification as discussed later in this chapter. 

Alternatively, if the CE is only able to match a portion of the claimed employment to a facility 

listed in the facility database, or there is no match found, he or she must communicate the 

findings to the claimant. The CE will contact the claimant to notify him or her who claimed 

employment may form the basis of a claim, and which does not appear to be linked to a covered 

facility. As part of this interaction, the CE is to give the claimant an opportunity to provide 

clarifying evidence. Paragraphs 16 and 17 of this chapter provide more information on the topic. 

This development may occur concurrently with other actions the CE takes on the claim, such as 

requests for additional medical or factual evidence.

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When there is sufficient evidence to conclude that employment might have occurred at a covered 

facility, the CE proceeds with verification of employment. If the claimant does not respond to 

the inquiry, or does not provide any type of clarifying evidence, the CE may proceed with 

adjudication of the claim based upon the evidence of record. If there is no match between any 

claimed employment and a covered facility, the CE denies the claim. The CE will describe the 

situation clearly in the “Explanation of Findings” section of the RD issued to the claimant.

5. Verification of Employment. Once the CE matches claimed employment and a covered 

facility, the next step is employment verification. Employment verification is the process by 

which the CE establishes the factual accuracy of the claimed employment history. The CE has to 

collect evidence to establish that:

a. The employer qualifies for consideration under the law as an AWE, Beryllium 

Vendor, DOE, or DOE contractor or subcontractor. 

b. The employee worked for the claimed employer.

c. The employee performed services on the premises of the covered AWE, 

Beryllium Vendor or DOE facility.

The process of employment verification is a difficult and challenging hurdle in many cases. 

Because the atomic weapons program dates back to the early 1940s, and involves a large number 

of public and private organizations, locating pertinent individual employment records can be 

difficult. Moreover, records may be missing, degraded, lost, or destroyed. 

As the statute allows latitude in the assessment of evidence, it is not necessary for the CE to 

collect evidence that establishes that the claimed employment is proven beyond a reasonable 

doubt, but merely that a reasoned basis exists to conclude that the employment occurred as 

alleged. 

This ensures that the claimant receives favorable treatment during the employment verification 

process. Once the CE has conducted an examination of the available factual evidence in support 

of the claimed employment, he or she must decide whether a sufficient basis exists to verify that 

each of the three elements of covered employment (5a, b and c above) is satisfied.

Furthermore, in matching claimed employment to covered employment, the CE is to be mindful 

that there are numerous classes in the SEC, described in Chapter 14 – Establishing Special 

Exposure Cohort Status. A CE always consults the most current list of SEC classes so that he or 

she promptly processes claims that contain evidence meeting SEC class definitions.

6. EPOD. The EPOD is a document that the NO Policy Branch created to assist CEs in 

identifying facility-specific contact persons and resources to use in obtaining employment 

verification. The EPOD lists every facility published in the Federal Register as a covered facility 

under the Act (except RECA facilities) and provides an outline of the identified methods for 

verifying claimed employment at each location. DEEOIC staff access the EPOD through a 

shared employee directory. 

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The resources listed in the EPOD do not provide an exhaustive list of means for verifying 

employment at a facility, but represent what constitutes best practices for verifying employment 

given the programmatic experience gained since passage of the Act in 2000. Specifically, the 

EPOD identifies which methods, or combinations thereof, are appropriate to pursue for 

verification of covered employment in the most expeditious manner possible. If the EPOD is 

silent on verification at a facility, the CE is to utilize Social Security Records (Paragraph 10, 

below) and “other employment evidence” (Paragraph 12, below). 

The facilities in the EPOD are listed alphabetically by state. On the first page of the EPOD, 

there is a list of states and, for those states with a large number of facilities; there are additional 

letters after the state name. These letters provide an index of the facilities in that state. The state 

names and letters allow the user to navigate through the document. For example, to navigate to 

South Carolina, the user places the cursor on South Carolina and presses “Ctrl + left click” at the 

same time and the utility will jump to South Carolina. Alternatively, if a user wants to view the 

S-50 Plant in Tennessee, the most expeditious method would be to move the curser over the 

letter “S” after Tennessee and then press “Ctrl + left click” at the same time and the utility will 

jump to S-50. 

7. Using the ORISE database. ORISE (the institute) developed a database as part of its 

mission to study the health and mortality of the DOE contractor work force. The database 

formed an important component of health studies, as it identified a significant portion of the 

population participating in these health studies. This database is instrumental in verifying 

covered employment for some employees. A CE will consider the data in ORISE accurate and 

valid employment information, even if it only provides partial affirmation of claimed 

employment. For every EEOICPA-covered facility for which there is some employment data in 

ORISE, the EPOD will indicate “ORISE – yes.” When this occurs, the CE conducts an ORISE 

search in ECS. If there is no mention of ORISE in the EPOD for the facility, the CE proceeds to 

the next recommended method for verifying employment noted in the facility description in the 

EPOD or in this chapter. In any case where a CE accesses ORISE to obtain evidence in a claim, 

he or she bronzes the output, whether negative or positive, into OIS. 

a. ORISE categorizes information in two sections, Employee Name and 

Employment. The Employee Name section identifies the employee’s last name, 

first name, and middle initial. The employment section contains five columns of 

information. The first column entitled “Facility” lists all the facilities or 

employers (for which data exists in ORISE) where the employee worked. The 

second column indicates whether the employee was hired or terminated, followed 

by columns showing the hire/termination date, Job Title, and Badge No. ORISE 

was not created for the purpose of adjudicating claims, so information may be 

incomplete. 

b. When using ORISE to assist with the adjudication of claims, the CE must 

consider the context of the information. For example, there may be data in 

ORISE confirming that an employee worked at a facility in 1949, but the CE must 

ensure that the covered period for this facility includes 1949. Additionally, for 

many employees, the information in ORISE is incomplete. For example, for 

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some employees the database may show the employee’s name and facility, but 

does not include specific hire and termination dates. If this is the case, the CE 

develops hire and termination dates using alternate methods described in 

paragraphs 8 through 12 in this chapter. 

Note: There may be instances when the ORISE database returns search results 

showing “SSA Records Only.” The DOE used this as an indicator, in the early 

days of the epidemiologic studies, to identify facilities for which requests were 

sent to SSA for information. It has no impact on the processing of claims under 

the EEOICPA and is only a vestige of DOE use of the data in the mid- 1980s. 

c. If the information from the ORISE database verifies any portion of employment, 

the CE bronzes a copy of the ORISE employment results into the OIS case file. 

d. The absence of data from ORISE cannot be used as the basis for finding that an 

employee did NOT work at a given facility either for the entire period claimed or 

for portions of claimed employment. 

e. Some non-covered employers and/or facilities are present in ORISE. The CE 

needs to review the ORISE results for non-covered employers. For example, the 

Puget Sound Shipyard, for which ORISE ascribed the acronym PSSY, is not 

covered under the EEOICPA. In the event that ORISE “confirms” non-covered 

employment, it does not render such employment as covered under the 

EEOICPA. 

8. Contacting DOE and using the Secure Electronic Record Transfer System (SERT). The 

CE transmits requests for employment verification electronically to DOE via the SERT system. 

The SERT is a DOE-hosted environment where DOL and NIOSH send and receive records and 

data in a secure manner. 

When the CE cannot verify claimed employment through use of ORISE, the CE uses Form EE-5 

to obtain employment information. To determine whether EE-5 referral to DOE is appropriate, 

the CE looks up the name of the facility(ies) and/or employers in the EPOD. If there is a 

notation in the EPOD indicating “EE-5 and DAR: SERT” for that facility, the CE proceeds with 

the EE-5 procedures specified in this paragraph. 

a. EE-5. The CE completes the top portion of the EE-5 by providing the employee 

name, SSN, claimed employer, and name of the claimed facility(ies). Only one 

completed EE-5 form per claimant request for employment verification is 

necessary. 

In some cases, employees traveled to other DOE facilities to work and are 

considered “visitors” on site. As such, employment records verifying that the 

employee worked for that facility may not exist. However, there may be records 

establishing that he/she was on site. It has been found that the DAR (the process 

by which the DO gathers DOE work records on specific employees) records have 

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been useful in establishing that the employee was on site. Therefore, under these 

circumstances, it is appropriate to request DAR records without the need for the 

EE-5 employment verification process. Refer to paragraph ‘i’ below on 

requesting DAR records. 

b. Submitting the request to DOE via the SERT. To prepare a request for 

employment verification, the CE scans and combines the EE-1 or EE-2, as 

appropriate, the EE-3, ORISE database search results and the EE-5 form as an 

Adobe PDF file and saves it to his/her computer. The CE then submits the 

completed package to DOE via the SERT. The SERT system contains a listing of 

the DOE POCs and DOE Operations Offices, which are managed and maintained 

in the SERT system. 

The CE accesses the SERT, creates a record request for the employee, uploads the 

PDF package, and sends the request to the appropriate DOE Operations Office(s). 

The SERT has the functionality to allow for the selection of multiple operations 

offices in cases where requests go to multiple facilities. The CE (requester) may 

also enter additional information in the ‘Comments’ section of the SERT that may 

be useful to the recipient (DOE) of the request. The field is also used for DOE to 

respond directly back to the DOL in response to comments. 

c. Once the request is sent through the SERT, the CE bronzes a copy of the request 

in the case file.

d. Subcontractor employment indicated. Where claim documentation indicates 

subcontractor employment, the CE reviews the EE-3 and makes a preliminary 

determination as to whether the employee is claiming DOE subcontractor 

employment. If so, the CE notes this in the ‘Comments’ section of the SERT and 

requests any information that DOE might have to help substantiate that the 

company was hired by DOE, or a DOE contractor, to provide a service on-site 

during the time period when the employment is claimed. 

Questions regarding subcontractor employment are referred to the same 

operations’ office(s) as the EE-5 package. 

e. Response from DOE. The CE will receive notification via email when DOE has 

the documents ready for download through SERT. The CE accesses the SERT, 

selects the applicable EE-5(s), downloads the file to his/her computer, and 

bronzes the response into OIS. 

f. Upon receipt of an EE-5 from DOE via SERT, the CE reviews it for 

completeness. DOE is responsible for selecting one of three options provided on 

the form and attaching any relevant information. In addition, the DOE 

representative completing the form must certify its accuracy. The CE returns any 

form that does not meet these requirements to DOE for correction. The three 

options available to DOE and the appropriate procedural responses are as follows: 

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(1) For any of the claimed employment in which DOE selects “Option 1 – 

Verified Employment,” the CE accepts this period as verified and no 

further action needs is required. 

(2) If DOE selects “Option 2 – No verification is possible, but other pertinent 

evidence exists,” this indicates that DOE has some information on the 

employee, generally suggesting that the individual was on site or 

somehow associated with the facility, but the information is insufficient 

for DOE to provide verification. The CE develops the case further for 

employment as outlined in this chapter. 

(3) If DOE selects “Option 3 – No evidence exists in regard to the claimed 

employment,” it means that DOE has no evidence at all regarding the 

claimed employment. The CE develops the case further for employment 

as outlined in this chapter. 

g. Timeframes. If the CE does not receive a response from DOE within thirty (30) 

days of the initial submission, the CE accesses the SERT system, enters the 

claimant’s information, locates and selects the request for employment 

verification, and sends a reminder to the DOE operations office, using the 

“reminder” button. A memo is not necessary, since the SERT system maintains 

the requestor’s or CE’s contact information and the initial request. The CE 

bronzes the notification in the case file. If DOE is ultimately unable to verify 

employment, the CE is to proceed with other available development actions. 

h. No Response from DOE. If the CE does not receive a response from the DOE 

within 60 days from the initial request, additional development is necessary. 

(1) Contact DOE by telephone. If no response is received, the CE contacts 

the appropriate Operations Office by telephone or emails the DOE POC 

and inquires about the request for employment verification. The CE asks 

the contact person whether a response to employment verification will be 

forthcoming. If DOE responds via telephone that they have no records to 

verify employment, the CE documents this in the case file with a memo 

outlining DOE’s response. This serves as the “EE-5” for purposes of a 

DOE response. 

(2) Contact the claimant. If, after 60 days there is no response from DOE, the 

CE contacts the claimant for additional employment information. In cases 

where a response from DOE is received indicating that no records are 

available, the CE may contact the claimant for additional employment 

information immediately. In this case, the CE does not wait for 60 days to 

lapse. 

 

i. DAR Process. For cases involving DOE contractor employees, the CE makes a 

request to DOE for records useful for developing information regarding toxic 

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exposures and other purposes. Although CEs use DAR records predominately in 

the adjudication of the toxic exposure component of Part E cases, DAR records 

can also contribute to the evidence of covered employment, especially in cases 

involving DOE subcontractor employment or employees who are on official 

travel from one DOE facility to another and considered by DOE to be “visiting” 

on site. DAR records can include site medical records, job descriptions, 

radiological records, incident or accident reports, and others. In the past, requests 

for DAR records were made of DOE once employment was confirmed. However, 

with the implementation of the SERT system, the CE initiates a DAR request at 

the same time as the EE-5, employment verification request. In situations where 

DAR records are needed, the assigned CE should include the request for those 

records in the EE-5 package that is submitted to DOE through the SERT system. 

For more details on the DAR process, refer to Chapter15 - Establishing Toxic 

Substance Exposure. 

j. Dosimetry Records. It is general program policy for NIOSH to obtain dosimetry 

records from DOE as part of the dose reconstruction process. The dosimetry 

records become associated with the file when the DO receives NIOSH’s final 

dose reconstruction report. Nevertheless, in cases where dose records may be 

useful for confirming that an individual was on-site, or was monitored for 

radiation exposure, the CE may request such records from DOE as part of 

employment development. Dosimetry records pertaining to different DOE 

facilities can represent different periods of site presence. If there is a question as 

to the dates of on-site presence represented by and employee’s dosimetry records, 

the CE should seek clarification from the Policy Branch. 

9. Contacting Corporate Verifiers. Private companies operate many of the facilities 

designated as AWE or beryllium vendor facilities under the EEOICPA. Neither DOE nor any of 

its predecessors have possession of these employment or personnel records. The DEEOIC refers 

to companies that have documentation pertaining to such covered facilities as corporate verifiers. 

Many of these companies are still in business, or have been bought by other companies that have 

retained records of past employees. Several of the companies retaining possession of relevant 

employee records have agreed to provide employment verification for purposes of adjudicating 

claims under the EEOICPA. For each facility that is identified as having a corporate verifier, the 

EPOD provides the name and contact information for the corporate verifier. The CE follows the 

instructions listed in the EPOD to obtain such employment information. General procedures for 

handling corporate verifiers include: 

a. Contact the corporate verifier via EPOD instructions. This involves providing 

them with the information and/or forms they need to answer questions about the 

claimed employment. This can include providing them with copies of the EE-1 or 

EE-2 and/or a letter providing the employee’s name, the case identification 

number (or the full SSN if required by the corporate verifier), date of birth, 

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b. Upon receipt of a response from the corporate verifier, the CE reviews it to 

determine if it is sufficient to verify the claimed period of employment. If the 

corporate verifier affirms the entire period of claimed employment, the CE 

accepts the period as factual. The CE obtains the verification from corporate 

verifiers in writing. While employment verification can be initiated through a 

phone call, there must be documentation from the verifier in the case file to 

substantiate a finding of covered employment. In some instances, a corporate 

verifier can verify that the employee worked for a specific company, but not the 

location of that employment. If the corporate verifier is unable to substantiate the 

claimed period of employment, or can only substantiate a portion of it, or can only 

substantiate employment with the company, but not at a covered location, the CE 

will need to request additional information from other sources. The CE can 

proceed with a request to the SSA for information as described in paragraph 10 of 

this chapter, and should ask the claimant for additional information, as outlined in 

paragraph 12 of this chapter, as appropriate. 

c. If verification is for beryllium sensitivity or CBD, the CE need not verify all 

employment, only enough employment sufficient to substantiate the exposure at 

any time during a covered time period. For additional information regarding 

development of beryllium claims, refer to Chapter 18 – Eligibility Criteria for 

Non-Cancerous Conditions. 

d. Corporate verifiers sometimes change. If a CE learns of a change in contact 

information or locates new contact information, this information must be sent to 

the NO Employment Contact in the Policy Branch.

10. Verifying Employment through the SSA. The SSA records provide a history of quarterly 

wages and earnings for each company the employee worked for during the course of his/her 

career. Absent confirmation of employment through ORISE, DOE, or a corporate verifier, the 

CE requests additional information from the SSA. Also, for those facilities for which the EPOD 

does not provide any suggested employment verification pathway, the CE requests records from 

the SSA by following the procedures outlined below: 

 

a. SSA earnings records are received from the claimant, if available, or the CE 

digitally faxes a completed Form SSA-581 to SSA to obtain this information. The 

form is located on the shared drive in the Forms folder within the Policies and 

Procedures folder). The process to obtain earnings records using Form SSA-581 is 

as follows: 

 

(1) The CE completes the top portion of the Number Holder’s Information 

section on the SSA-581. This includes the following information: name; 

SSN; date of birth of the employee; date of death of the employee (if 

applicable); and other name(s) used. The CE completes the form with the 

years deemed necessary to verify employment and/or establish wage-loss 

on the “Year(s) Requested” line. In the box entitled, Signature of 

Organization Official, the CE types his or her name (signature is not 

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required) and in the “Office” box, select the correct DO location from the 

drop down menu. The CE dates the form and lists his or her direct phone 

number, along with the DO fax number. The CE capitalizes all entries on 

the SSA-581. 

(2) The completed SSA-581 must be digitally faxed to SSA using fax number 

877-278-7067. A cover letter is not required with the SSA-581. The CE is 

responsible for bronzing into OIS the completed SSA-581 and fax 

receipt. 

(3) If the faxed SSA-581 is deficient, the SSA contacts the CE directly to 

explain the deficiency, or the SSA emails the DEEOIC designated POC 

with a list of rejected SSA-581s for each DO. This email will include the 

name of the employee, the employee’s SSN, and the reason(s) for the 

rejected SSA-581. The email list must be bronzed into OIS with redaction 

of names not related to the particular case. 

(4) The POC forwards the email of a rejected SSA-581 to the assigned CE. 

After making the necessary corrections, the CE digitally faxes the 

corrected SSA-581 to FAX number 410-594-2054. Cover sheet is not 

required for resubmission due to a reject. The CE is responsible for 

bronzing into OIS any document received or created in response to a 

rejected SSA-581. 

(5) Upon receipt and processing of a SSA-581, the SSA releases a statement 

of earnings, known as an SSA-L460. The SSA will mail the SSA-L460 to 

the DEEOIC CMR, located in London, Kentucky, where a contractor 

scans and indexes it into OIS. 

(6) If the CE does not receive a completed SSA-L460 within thirty (30) days 

of the faxed SSA-581, the CE calls the SSA to determine the status of the 

request. If the SSA indicates that the SSA-581 was not received, the CE 

must refax the SSA-581 in accordance with Step 4. After the SSA-581 is 

refaxed, the CE must follow-up with the SSA within 30 days. Otherwise, 

the CE obtains the status and monitors for SSA response. 

(7) Inquiries to the SSA are made by calling one of six phone numbers 

(Modules) depending upon the last four digits of the relevant SSN (See

Exhibit 13-1). When calling the SSA, the following information should be 

available to expedite the inquiry: 

(a) SSA-issued job code (8015). The four-digit job code appears in 

the “Requesting organization” section of the SSA-581 form. 

(b) Name of your organization. 

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(c) A copy of the SSA-581 or earnings statement in question. 

(d) The full SSN of the number holder (employee), or the control 

number from the earnings statement. 

(8) Upon receipt of a completed SSA-L460, the CE documents receipt of the 

SSA response in ECS. Should the SSA fail to submit an SSA-L460 after 

following up within the established procedures, the CE proceeds with 

claim adjudication based upon the evidence contained in the case record. 

11. Center for Construction Research and Training. The Center for Construction Research 

and Training, formerly known as the Center to Protect Workers’ Rights and which continues to 

utilize the acronym CPWR, is a research, development and training arm of the Building and 

Construction Trades Department (BCTD) of the American Federation of Labor-Congress of 

Industrial Organizations (AFL-CIO). The DEEOIC contracted with CPWR to maintain a 

database of contractor/subcontractor employers at certain DOE facilities. 

a. Web-accessible database. To substantiate the existence of a contract between 

DOE and a contractor, CPWR created a web-accessible database, which the CE 

can use in identifying and confirming the existence of contractor or subcontractor 

employers at certain covered facilities. Facilities for which CPWR has contractor 

and subcontractor information are identified in the EPOD as “CPWR.” If the CE 

determines that the claimed employment involves subcontractor employment at a 

facility in which the EPOD indicates “CPWR has contractor/subcontractor 

information,” the CE first reviews the EE-5, the Data Acquisition Request (DAR), 

and any material received from DOE. If this information is insufficient for a 

finding of covered employment, the CE reviews the CPWR database for any 

information linking the claimed employer to the claimed DOE facility, by 

following these instructions:

(1) The CE goes to www.btcomp.org. A log-on screen appears. Each DO has 

been assigned one original user name and password. 

(2) Upon access to the web site, a disclaimer notes that the database is a 

general information resource tool. It does not contain all of the documents 

that relate to DOE contractors and/or subcontractors. However, the 

DEEOIC considers the information available in the database to be accurate 

and correct. Once the CE accepts the disclaimer, the database opens into 

basic search mode. The database allows various ways to search for 

information: by subcontractor name; by site; or by scrolling down the 

subcontractor master list.

(3) To search by contractor/subcontractor name, the CE enters the name of the 

company identified in the evidence from the case record. The company 

name may be the current recognized employer name, an acronym for the 

employer, or a previous version of the name. The CE searches the 

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database using various combinations of spellings or any known aliases for 

the employer name. This increases the likelihood of a positive outcome 

and reduces the number of false negative results. For example, if a CE 

enters the name “Bowles Construction Company,” the database returns a 

negative result. However, if the CE enters “Bowles” or “Bowles 

Construction,” the employer appears in the return. 

(4) To search by site, i.e., covered facility, the CE clicks on the list box 

labeled “by site” on the left hand side of the screen and selects the facility 

for which he or she is seeking contractor or subcontractor information. 

This returns all employers known by CPWR linked to that facility. It may 

be necessary for the CE to scroll down to view all named employers. To 

view detail for a named employer, the CE merely needs to access the 

“view” link under the options category. In some instances, a contractor or 

subcontractor name might be linked to multiple covered facilities. In these 

instances, the detailed return for the employer is separated into sections by 

covered site.

(5) The CE may also search the comprehensive listing (master list) of all 

contractor employers listed in the database which appears if no name or 

site search criteria are applied, or if the option “show all” is selected. A 

unique document identification (Doc Id) has been assigned to each 

contractual finding. CPWR uses the Doc Id as a means of tracking. The 

Doc Id can also be used to search BtComp, if it is known. 

(6) After the CE has accessed the database and conducted appropriate 

research to locate a contractor/subcontractor, the CE documents the case 

file in OIS. In the case of a positive result, the CE prints a copy of the 

screen for OIS bronzing. The printout must show all the results of the 

database search, including the employer name; site name; contractual 

relationship indicator; dates verified; type of work performed; a 

description of evidence; document ID; and date of database update. 

Generally, this information must be printed using a “landscape” print 

mode setting. The printout should also list the date of the database search, 

the date of the latest update of a facility, and any of the pertinent facts. If 

no results are found from a database search, the CE completes a 

“Memorandum to the File,” noting the lack of information in the database 

for the claimed contractor/subcontractor. The CE bronzes the completed 

memo into OIS. 

(7) The sole purpose of the database is to establish a relationship between a 

DOE facility and a contractor or subcontractor employer. A positive result 

may return varying levels of information about an employer linked to a 

facility. For example, a database return may merely list that a contractor 

or subcontractor was linked to a particular facility, but not when. 

Furthermore, the existence of a contract between the company and the 

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DOE could be for a wide range of items or services. Under the EEOICPA, 

only contracts for services performed on the premises of the DOE facility 

are covered. Once a CE establishes that a contract existed between a 

company and the DOE, it is still necessary to establish that the contract 

was for a covered service, per paragraph 13 of this chapter. In addition to 

the database results, additional development may be needed independent 

of the database to ensure that such evidentiary gaps are filled. The CE may 

contact the NO Policy Branch regarding questions or other matters relating 

to the use of subcontractor database. 

(8) If the contractor or subcontractor is not listed in the database, additional 

development is necessary. The CE is not to assume that a search of the 

database that does not return any results establishes that the claimed 

employer was not a contractor or subcontractor. 

b. Requests for contractual information. In those instances in which BtComp.org 

does not return a positive result on a contractor or subcontractor, the DO POC 

will send a request via email to the CPWR designated point of contact at CPWR 

to research documentation supporting a contractual relationship with a DOE 

facility. (Note: This search will be at a facility level and not at the employee 

level. There will be no searches conducted for employee records). The request 

should include the name of the contractor/subcontractor, the name of the trade, the 

DOE site, and the time period of contracted work. The CPWR will research its 

records and respond directly to the DO POC, via email, with its findings within 20

business days of receipt of the request. 

c. Requests for supporting documentation. In cases where the CE conducts a search 

of BtComp, finds positive results, and needs a copy of the supporting 

documentation, the DOE POC sends the request to the to the NO, to submit the 

request to CPWR. In its request, the DO references the BtComp Document-ID 

number and the reason for the request. CEs request this documentation if it is 

being used to resolve a discrepancy in the case file, or if the documentation is 

needed for litigation purposes. The processing of this type of request will be at 

the discretion of the NO. The CPWR will respond with a copy of the 

documentation within 5 business days of the receipt of the request. 

d. Forwarding of contractual information. If a CE obtains documentation during 

case development that substantiates a contractual relationship between a 

contractor and/or subcontractor and a DOE facility not already included in the 

database, he or she is to forward a copy of that documentation to CPWR. The 

documentation is to be sent by the DO POC via USPS to the current CPWR 

contact person at CPWR located at 8484 Georgia Avenue, Suite 1000, Silver 

Spring, Maryland 20910, or scanned and emailed to the POC at CPWR that 

maintains these records. The CPWR will review the documentation, update 

BtComp, and retain the documentation in their files. 

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12. Other Employment Evidence. Evidence of employment by DOE, a DOE contractor, 

beryllium vendor, or AWE may be made by the submission of any trustworthy contemporaneous 

records that on their face, or in conjunction with other such records, establish that the employee 

was so employed, along with the location and time period of such employment. No single 

document noted in this section is likely to provide all elements needed for a finding of covered 

employment, but rather each piece of evidence can contribute valuable elements needed to make 

a finding of covered employment. 

Documentation from the following sources may be considered: 

a. Records or documents created by any federal government agency (including 

verified information submitted for security clearance and dosimetry badging), any 

tribal government or any state, county, city or local government office, agency, 

department, board or other entity or other public agency or office. 

b. Records or documents created as a byproduct of any regularly conducted business 

activity, or by an entity that acted as a contractor or subcontractor to DOE.

c. DEEOIC internal resources. The DEEOIC DOs each have gained experience 

with the facilities covered under this program. In the adjudication of claims, each 

office will accumulate documentation substantiating various subcontractor 

relationships. Once such a relationship has been established at a facility for a 

given time period, the CE can use this information in the adjudication of other 

cases in which the same subcontractor employment is claimed during the same 

time period. Therefore, as noted in paragraph 11, any such documentation 

accumulated during the course of adjudicating a claim that substantiates a 

contractual relationship with a covered DOE facility, must be forwarded to 

CPWR. CPWR will then update the BtComp database based on information 

substantiated by this documentation. 

d. Affidavits or other types of signed statements attesting to the accuracy of a claim. 

The CE requests that the claimant use the EE-4 Employment History Affidavit to 

collect statements from knowledgeable parties. Statements provided by way of an 

affidavit are considered in conjunction with other evidence submitted in support 

of a claim. Affidavits are particularly appropriate as a means of demonstrating 

that an employee worked at a particular location and are best used in concert other 

information, such as SSA records. Affidavits alone are usually insufficient to 

prove the existence of a contractual relationship between DOE and a company. 

The CE has the discretion to assign probative weight to different affidavits. For 

example, the CE may find that an affidavit from a former CEO of an employer 

has significantly more probative value than that of one from a temporary worker 

who had no reason to be well-informed on his/her employer’s contractual 

relationship with DOE or a DOE contractor. The CE must use his or her own 

judgment to ascertain what weight to give to any given piece of evidence, 

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including affidavits. The CE is to assess the probative value of affidavits by 

applying these general parameters: 

(1) Affiliation of affiant to employee (co-worker vs. family member). 

Affidavits from co-workers and managers carry more weight than those 

from family members, as they would be in a better position to provide 

details about work. 

(2) Descriptive vs. vague employment information. More detailed affidavits 

carry more weight than vague, generalized statements because more 

specific information is more easily corroborated than that which is 

ambiguous. 

(3) First-hand knowledge vs. second-hand knowledge. An affidavit not 

containing first-hand knowledge has very little probative value, as it is 

nothing more than hearsay. 

(4) Compliments other evidence from file vs. contradictions. When 

documentation in the file supports portions of an affidavit, the probative 

value of the remainder of the content of that affidavit is high. In the 

alternative, when an affidavit is in conflict with other material in the file, 

its probative value is diminished. 

13. Subcontractor Employment. Subcontractor employment at beryllium vendors and DOE 

facilities is covered under the Act, provided that certain developmental elements are met.

a. Definitions.

(1) Contractor. An entity engaged in a contractual business arrangement with 

DOE to provide services, produce material, or manage operations. 

(2) Subcontractor. An entity engaged in a contracted business arrangement 

with a DOE contractor to provide a service on-site.

(3) Service. In order for an individual working for a subcontractor to be 

determined to have performed a “service” at a covered facility, the 

individual must have performed work or labor for the benefit of DOE 

within the boundaries of the facility. Examples of workers providing such 

services include janitors, construction and maintenance workers. The 

delivery and loading or unloading of goods alone is not a service and is 

not covered for any occupation, including workers involved in the delivery 

and loading or unloading of goods for construction and/or maintenance 

activities.

(4) Contract. An agreement to perform a service in exchange for 

compensation, usually memorialized by a memorandum of understanding, 

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a cooperative agreement, an actual written contract, or any form of written 

or implied agreement, is considered a contract for the purpose of 

determining whether an entity is a “DOE contractor.” Only employees 

who are employed by the company named in the contracting 

documentation are covered. Employees of parent companies or 

subsidiaries companies of the contracting company are not covered and 

the joint employer doctrine also does not apply. 

b. Standard. Mere presence by the employee on the premises of a facility does not 

confer covered employment. There are three developmental components that 

must be met before a determination of covered subcontractor employment can be 

reached. These elements are:

(1) The claimed period of employment occurred during the covered time 

frame as alleged; and

(2) A contract to provide “covered services” existed between the claimed 

subcontractor and a DOE contractor at the facility or the identified vendor 

(during the covered time frame); and the employment activities (work or 

labor) took place on the premises of the covered facility.

c. Subcontractor employment at beryllium vendor facilities. Under the Act, persons 

providing a service on the premises of beryllium vendors during covered time 

periods are entitled to the same benefits as employees of the beryllium vendor 

during those same covered time periods. For some beryllium vendors, the 

corporate verifier for the vendor at which the subcontractor performed work has 

records of subcontractor employees and, therefore, in verifying beryllium vendor 

sub-contractor employment the CE first contacts the corporate verifier for any 

information he or she has on the individual and his or her subcontractor employer. 

In those situations in which an employee is alleging beryllium sub-contractor 

employment and the beryllium vendor is unable to confirm employment, the CE 

uses SSA records, affidavits and other evidence as described in this chapter. 

d. Subcontractor employment at DOE facilities. Because DOE generally did not 

keep records of employees of subcontractors, the CE is faced with particular 

evidentiary challenges in establishing subcontractor employment. To establish 

each of the elements needed, a CE generally will find it necessary to gather and 

evaluate documentation from multiple sources, including DOE, the SSA and 

CPWR. 

e. Developing subcontractor employment. The CE will likely have to use an 

assortment of documentary evidence to make a finding of covered subcontractor 

employment. For example, SSA records may show that the employee worked for 

Sentell Brothers, thus establishing verified earnings. Documentation from CPWR 

may show that Sentell Brothers was a subcontractor during the period of verified 

earnings at K-25, X-20, Y-12 and Oak Ridge in general. The DOE may also 

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provide documentation showing that the employee had a clearance to work at K25 doing construction or dosimetry badging information specific to K-25. In this 

situation, the CE likely has sufficient documentation to make a determination that 

the employee worked as a K-25 subcontractor employee during the time period 

for which the earnings, the contractual information and the presence on the 

premises requirements are all met. 

For all instances in which the CE is required to evaluate potential subcontractor 

employment, the CE writes a memo to the file delineating every period of claimed 

subcontractor employment and specifying the evidence in the case file that 

supports each of the following: 

(1) the claimed subcontractor was in a contractual relationship with a DOE 

contractor, 

(2) the subcontractor provided a service to DOE on the premises of the DOE 

facility, and 

(3) the employee was engaged in providing that service on site, including the 

number of days the employee was engaged in that service. 

The memo should also provide an explanation as to why the standard was or was 

not met (see Exhibit 13-2 for sample memo). 

14. Researcher Employment at DOE Facilities. A DOE contractor employee is also defined 

as “An individual who is or was in residence at a DOE facility as a researcher for one or more 

periods aggregating at least 24 months.” In order for an employee to meet the “researcher” 

provision under the Act, the following criteria must be met: 

a. Research. There needs to be probative evidence in the file that the individual was 

actually performing research on the premises of the DOE facility. Visiting the 

site, obtaining medical tests on-site, or similar non-work related reasons that 

people may have for being on-site at a DOE facility, does not qualify under this 

provision. Evidence useful in documenting that an individual was performing 

research on-site includes published journal articles, affidavits, or some other 

documentation affirming that the individual was engaged in research. 

b. Living on-site not required. Although some DOE facilities provide dormitorystyle accommodations which often house researchers, “in residence” can be 

satisfied by working “on the premises,” and the individual need not have been 

living on the premises of the DOE facility.

c. Research can be unpaid. There is no requirement that the researcher is/was paid 

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15. Employees of Federal or State governments other than DOE and its predecessors. 

Employees of federal and state governments, (other than direct employees of DOE, ERDA, the 

AEC or MED) can be DOE contractor employees, as outlined in this paragraph. 

a. Standard. A civilian employee of a state or federal government agency can be 

considered a “DOE contractor employee” if

(1) The government agency employing the individual is found to have entered 

into a contract with DOE for the accomplishment of one or more services 

on the premises of that DOE facility that such government agency was not 

statutorily obligated to perform, and 

(2) DOE compensated the agency for that service.

b. Proof of contract. The DO contacts the federal or state agency directly in an 

effort to obtain the desired information. The DD is responsible for managing any 

necessary coordination with federal and state agencies. Any time documentation 

is obtained from these agencies, copies are to be provided to the NO. The CE 

should not pressure a state or federal agency to produce employment or 

contractual records.

c. If the evidence is unclear as to whether employment by a state or federal agency 

can be determined to be DOE contractor employment using the guidance in this 

paragraph, the CE obtains clarification from the claimant. The CE reviews any 

documentation submitted by the claimant and undertakes any additional 

development necessary to clarify the individual’s employment status, including 

any needed input from the NO Policy Branch.

 

Upon finding that the employee does not meet the definition of a “DOE contractor 

employee” who worked for a state or federal agency, and where this is the sole 

employment listed on the Form EE-3, the CE issues a RD denying the claim on 

the basis that the employment by the state or federal agency does not qualify the 

claimant as a “DOE contractor employee” as defined in the EEOICPA.

d. Uniformed Members of the Military. A claimant cannot obtain EEOICPA 

benefits based upon service in the military. If the claimant provides information 

or identifies himself/herself as military personnel, the CE sends a letter to the 

claimant stating that uniformed military personnel are ineligible for benefits under 

the EEOICPA. Only civilian employees who performed services on the premises 

of DOE facilities, via contracts, are DOE contractor employees.

16. Evaluating Evidence to Verify Employment. Once the CE receives all available 

evidence, he or she has to determine if the evidence is sufficient to verify the three components 

of covered employment listed in paragraph 5 of this chapter. The CE evaluates all evidence 

carefully and uses discretion regarding documentation that reasonably establishes the presence of 

the employee at a particular facility during certain periods of time. Additionally, with regard to 

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subcontractor employment, the evidence must reasonably satisfy all the components necessary to 

establish covered employment. If employment with other state or federal entities is claimed, 

then all the components discussed in paragraph 15 of this chapter must be fulfilled. In weighing 

the evidence submitted in support of covered employment, the CE considers the totality of the 

evidence and draws reasonable conclusions. 

17. Developing non-covered employment. There will be instances in which the CE is only 

able to match a portion of the claimed employment to a facility and/or employer listed in the 

facility database, or there may be no match found. In these instances, the CE communicates this 

to the claimant. The CE prepares a letter to the claimant explaining which employment is 

covered under the Act and which is not, including any pertinent dates. A description of what 

constitutes an AWE facility, Beryllium Vendor facility or a DOE facility should be included in 

the letter. In the event that the claimant believes some of this non-covered employment should be 

covered under the Act, the CE asks the claimant to supply any pertinent evidence substantiating 

the claim. Namely, the CE asks the claimant to provide evidence demonstrating that the claimed 

place of work met the definition of an AWE, Beryllium Vendor or DOE facility during the years 

the employee worked there. For example, a CE may ask the claimant to submit evidence such as 

contractual documents, business reports, internal memos, purchase orders, news articles, 

affidavits, etc. A period of 30 days is granted to the claimant to submit evidence in support of 

extending covered employment to additional facilities/employers and/or years.

After appropriate development, the CE decides whether any evidence submitted warrants a 

referral to the NO. If the claimant submits pertinent evidence supportive of adding a 

facility/employer and/or years of coverage, the CE prepares a brief memo to the file explaining 

the circumstances of the situation and requests a review of the case file by the NO. The CE 

submits a request to the NO to make a determination regarding the new evidence of an additional 

covered facility/employer or years.

18. Additions or modifications to facility status. While the EEOICPA defines what 

constitutes an AWE facility, a Beryllium Vendor facility and a DOE facility, updates are 

periodically made to facility designations as new information becomes available. The NO Policy 

Branch is responsible for reviewing new evidence and deciding whether changes should occur to 

facility designations. As such, the Policy Branch is responsible for evaluating requests for 

changes to the covered facility listing or modification of facility designations, depending on the 

nature of facility evidence, the Policy Branch undertakes different actions. 

a. AWE Facility. New designations are the responsibility of DOE. Accordingly, 

requests for new AWE designations are referred to DOE.

(1) Time frame changes relating to specific years of processing at an AWE 

facility are the responsibility of DOL. Evidence must be presented clearly 

demonstrating that the AWE processed or produced material that emitted 

radiation and was used in the production of an atomic weapon at the AWE 

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b. Beryllium Vendor. The statutory deadline for adding additional Vendors was 

December 31, 2002, and therefore no additional Beryllium Vendors can be 

designated under the Act.

(1) Time frame changes relating to Be Vendors are the responsibility of DOL. 

Evidence must be presented clearly demonstrating that the Beryllium 

Vendor had a contractual agreement involving beryllium with DOE, or its 

predecessors, and that the company is performing/or did perform those 

beryllium-related contractual tasks in the years to be added to coverage.

c. DOE Facility. Facility and/or time frame changes relating to DOE facility listings 

are the responsibility of DOL. Under the EEOICPA, a DOE facility means any 

building, structure, or premise, including the grounds upon which such building, 

structure, or premise is located in which operations are, or have been, conducted 

by, or on behalf of, the DOE (except for buildings, structures, premises, grounds, 

or operations covered by 

Executive Order 12344, dated February 1, 1982, pertaining to the Naval Nuclear 

Propulsion Program); and with regard to which DOE has or had either (A) a 

proprietary interest; or (B) entered into a contract with an entity to provide 

management and operation, management and integration, environmental 

remediation services, construction, or maintenance services. 

Interpreting and applying the definition of a DOE facility is within the 

adjudicatory authority of the DEEOIC. To determine whether a facility is a DOE 

facility under the Act, certain parameters must be met.

(1) Operations. To show that operations were performed on behalf of DOE, 

the evidence must demonstrate that DOE paid for operations at that 

location. These operations are not limited to those involving radiation or 

weapons. Everyday operations such as providing library services in a 

technical library are sufficient to meet this statutory requirement.

(2) Proprietary Interest. To show that DOE had a proprietary interest, 

evidence that DOE owned the building, structure or premises, such as a 

deed or affirmative statement from DOE acknowledging ownership is 

required. Proprietary interest can also include instances in which DOE is 

contractually permitted a sufficient level of use and control over the 

property to support a determination that the property constituted a DOE 

facility. DOE ownership of intellectual property or equipment, regardless 

of size, does not fulfill the proprietary interest definition. Moreover, DOE 

permitting, safety oversight, or licensing of work relating to use of 

radioactive material does not convey propriety interest. 

(3) Contracts. To show that DOE entered into a contract with an entity to 

provide management and operation, management and integration, 

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environmental remediation services, construction, or maintenance 

services, the best possible evidence is to produce the contract. Typically, 

contracts with DOE or its predecessors identify the contract type on the 

first page, so in those cases in which contracts are located, it is generally 

not difficult to discern contract type. The contracts identified in this 

portion of the law are among the more common and significant contracts 

used throughout the DOE complex in the following ways: 

(a) Management and Operation (M&O) contracts are those contracts 

that DOE often had with major companies to manage and operate 

large DOE facilities, such as Union Carbide and Carbon at K-25 

and Y-12. 

(b) Management and Integration (M&I) contracts were also used by 

DOE to run major DOE sites, but an M&I contractor generally had 

numerous smaller site contractors for which the M&I’s job was to 

“integrate” the work of the smaller companies. The Idaho National 

Laboratory is an example of a DOE facility which has been run 

from time to time by M&I contract. Companies holding M&O and 

M&I contracts at DOE facilities are generally considered the

“prime contractor” for that facility, though sometimes facilities 

will change from the M&O model to the M&I model.

(c) Contracts for environmental remediation services, construction, or 

maintenance services are also common throughout DOE, but are 

generally smaller in size than the major M&O’s and M&I’s. DOE 

used remediation contracts to clean up radiation at numerous AWE 

facilities. In these instances, the locations are designated as DOE 

facilities for the period of remediation under the DOE contract and 

the remediation workers are covered.

(d) Some common types of contracts issued by DOE that do not meet 

the statutory definition include research & development, output, 

and procurement. 

19. Special Circumstances. There are some special circumstances regarding eligibility for 

benefits pertinent to the Naval Nuclear Propulsion Program and EEOICPA claims from citizens 

of the Republic of the Marshall Islands, as outlined below. 

a. Naval Nuclear Propulsion. As noted in the section above, the statutory definition 

of a DOE facility specifically excludes, “buildings, structures, premises, grounds, 

or operations covered by Executive Order No. 12344, dated February 1, 1982 (42 

U.S. C. 7158 note) pertaining to the Naval Nuclear Propulsion Program.” As a 

consequence of this exclusion, the DEEOIC is unable to find covered employment 

for those AEC employees and AEC contractors who worked at locations devoted 

to Naval Nuclear Propulsion operations. 

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b. Marshall Islands. The DEEOIC has received claims for compensation under the 

EEOICPA from citizens and nationals of the Republic of the Marshall Islands 

(RMI). The Marshallese base their claims on employment related exposure 

arising from the United States’ nuclear weapons testing program conducted in the 

RMI. The DOE facility known as the Pacific Proving Ground was a weapons test 

site in the South Pacific from 1946 to 1962. 

In 1986, the United States and the Marshall Islands terminated their trust territory 

relationship through enactment of the Compact of Free Association (Compact). 

The Compact is a comprehensive document encompassing a variety of 

agreements, including a number of socio-economic, agricultural, and monetary 

compensation programs. Under the Compact, the RMI became an independent 

sovereign nation and U.S. laws ceased to apply unless otherwise specified. 

For purposes of the administration of the EEOICPA, this Compact has been 

interpreted as precluding coverage for RMI citizens and nationals. If the CE 

determines that a claim for benefits is from a citizen or nationals of the Marshall 

Islands, the CE explains, in the conclusions of law portion of the RD, that there is 

no provision under the EEOICPA for coverage of claims based upon employment 

in the RMI by citizens or nationals of the RMI. The CE inserts the following 

wording in the conclusions of law as a summary of the DEEOIC policy: 

Since interpreting the EEOICPA to apply to claims by Republic of the Marshall 

Islands (RMI) citizens or Nationals based upon employment in the RMI would 

constitute an invasion of the sovereignty of the RMI, the presumption against 

applying a statute extraterritorially is invoked. Furthermore, there appears to be 

no contrary intent by Congress to rebut the presumption and, to the extent that 

Congress has expressed any intent, its approval of the Compact of Free 

Association between the United States and the RMI suggests that it did not intend 

for the EEOICPA to apply extraterritorially in this situation.

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CHAPTER 14 - ESTABLISHING SPECIAL EXPOSURE COHORT STATUS

1. Purpose and Scope. The EEOICPA established the SEC to compensate eligible members 

of the Cohort without the need for a radiation dose reconstruction and determination of the PoC. 

This means an employee who meets the necessary employment criteria to be included in a 

designated SEC class and is diagnosed with a specified cancer receives a presumption of 

causation that employment-related radiation caused the specified cancer. This chapter describes 

the procedures for establishing eligibility under the SEC. 

2. Identifying SEC Claims. The CE is to review the initial application forms carefully, 

including Form EE-3 - Employment History, to determine whether the potential exists for 

inclusion in one or more SEC classes. In addition, a claimant can identify employment at a 

covered worksite that may qualify for consideration for the SEC. 

3. Determining SEC Eligibility. To be eligible for benefits under the SEC provision, an 

employee must belong to a SEC class. In establishing the SEC, Congress designated four 

statutory SEC classes. The EEOICPA also allows for addition of new SEC classes based on 

analysis and determination by HHS. 

A SEC class can be based on a whole facility, limited to specific buildings in a facility, or even 

specific processes within a facility. In some cases, a SEC class may be limited to specific job 

titles or duties in a particular facility. In addition, each SEC class will have specific workday 

requirements that must be met; typically an employee has to have been employed for a number 

of workdays aggregating at least 250 workdays at one or more SEC worksites. The workday 

requirement at Amchitka, Alaska SEC class is met by any employee who spent any part of one 

workday at that facility, during which he or she was exposed to ionizing radiation in the 

performance of duty related to the Long Shot, Milrow, or Cannikin underground nuclear tests. 

Finally, to be eligible under the SEC, medical evidence has to document the employee’s 

diagnosis with at least one of twenty two (22) specified cancers as listed under paragraph 7. 

 

4. Statutory SEC Classes. The EEOICPA designated the following statutory SEC classes 

according to their respective covered facilities:

 

a. Gaseous Diffusion Plants (GDP) located in Paducah, Kentucky, Portsmouth, Ohio 

or Oak Ridge, Tennessee. A DOE employee, DOE contractor employee, or an 

employee of an AWE qualifies for inclusion in this SEC if he or she was: 

 

(1) Employed for an aggregate of 250 workdays prior to February 1, 1992, at 

one or more of the above GDPs; and 

 

(2) Monitored during such employment through the use of dosimetry badges 

for exposure to radiation, or worked in a job that had exposures 

comparable to a job that is or was monitored through the use of dosimetry 

badges. 

 

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(a) If the employee qualifies for possible inclusion in the SEC on the 

basis of work at a GDP, but Form EE-3 does not indicate whether a 

dosimeter was worn, the CE is to determine whether the employee 

had exposure during his or her employment that is comparable to a 

job that is or was monitored through the use of dosimetry badges. 

 

In making this determination, the CE assumes that the employee

had comparable radiation exposure if employment occurred during 

the following periods at the particular GDPs: 

 

Paducah GDP: 7/52 – 2/1/92 

Portsmouth GDP: 9/54 – 2/1/92 

Oak Ridge GDP (K-25): 9/44 – 12/87(not 2/1/92) 

Documentation shows the presence or active processing of 

materials that emitted radiation at the sites for these dates. 

2/1/1992 represents the date that DOE implemented uniform 

radiation protection practices consistent with current industry 

practices and regulations. The 12/1987 date referenced for the Oak 

Ridge K-25 plant corresponds to the cessation of uranium 

processing operations. 

 

b. Amchitka Island, Alaska. The EEOICPA grants SEC membership to DOE 

employees, DOE contractors or DOE subcontractors, who were employed prior to 

January 1, 1974 on Amchitka Island, Alaska, and were exposed to ionizing 

radiation in the performance of duty related to the Long Shot, Milrow, or 

Cannikin underground nuclear tests. The CE considers the following factors in 

determining whether the employee was exposed to radiation in the performance of 

duty: 

(1) Exposure to ionizing radiation from the Long Shot, Milrow, or Cannikin 

underground nuclear testing/explosions which occurred on Amchitka 

Island. The first detonation, Long Shot, occurred on October 29, 1965. 

The 80 kiloton underground nuclear explosion leaked radioactivity into 

the atmosphere. Radioactive contamination on Amchitka Island occurred 

as a result of activities related to the three underground nuclear tests and 

releases from Long Shot and Cannikin. 

 

(2) As a result of these airborne radioactive releases, employees who worked 

on Amchitka Island could have been exposed to ionizing radiation from 

the Long Shot underground nuclear test. It is believed that such exposure 

began approximately one month after the detonation occurred. Thus, for 

purposes of determining SEC employment, the period from approximately 

December 1, 1965 to January 1, 1974 is to be used, unless the claimant 

can show that the employee was exposed during the month immediately 

following the detonation. 

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(3) In contrast to other SEC classes with the 250 workday requirement, this 

SEC class requires that the employee worked at Amchitka Island for any 

length of time during the period from approximately December 1, 1965 to 

January 1, 1974, and was exposed to ionizing radiation from underground 

nuclear tests.

 

5. Additional SEC Classes. HHS has authority to designate additional classes of employees 

to be added to the SEC. A class of employees may be included in the SEC if HHS determines 

that it is not feasible to estimate with sufficient accuracy the radiation dose that members of the 

class received, and there is a reasonable likelihood that such radiation may have endangered the 

health of the members of the class.

 

a. Overview of the SEC Designation Process. The designation process begins with a 

petition submitted to the NIOSH, Division of Compensation Analysis and Support 

(DCAS). The petitioner may include one or more DOE employees (including 

DOE contractor or subcontractor employees), or AWE employees, who would be 

included in the proposed class of employees, or their survivors. Individuals or 

entities authorized by these employees in writing or labor organizations 

representing or formerly having represented these employees may also submit a 

petition.

 

NIOSH may also initiate a petition if it determines that it cannot complete a dose 

reconstruction for a class of employees.

 

(1) NIOSH evaluates the petition for inclusion in the SEC to determine if it 

contains the minimal qualification to proceed with the SEC designation 

process in accordance with 42 CFR § 83.13 or § 83.14. 

(2) If NIOSH determines that the minimum qualification for review and 

evaluation has been met, it forwards the petition to the Advisory Board on 

Radiation and Worker Health (Advisory Board) along with its evaluation. 

During one of its regular Board meetings, the Advisory Board reviews 

NIOSH’s evaluation, hears from the petitioners if they choose and other 

interested parties. The Advisory Board also reviews any other information 

it determines to be appropriate for the petition.

(3) The Advisory Board submits a recommendation on a new SEC class to the 

Secretary of HHS within 30 calendar days of the Board meeting. 

(4) The Secretary of HHS makes the final determination to add or deny a new 

class to the SEC based on the recommendation of the Advisory Board and 

the NIOSH evaluation. If the Secretary of HHS decides to add a new class 

to the SEC, he or she issues a designation letter to Congress with the 

definition of the class.

 

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(5) A new SEC class becomes effective 30 calendar days after Congress 

receives the Secretary’s designation letter, unless Congress objects or 

provides otherwise. 

 

6. Workday Requirement: Eligibility under the SEC provision typically requires 250 

workdays of eligible employment at one or more SEC worksites. In most cases, the 

determination of 250 workdays of employment is straightforward. However, there are some 

cases where the employee worked for less than a year, and additional guidance is required to 

calculate the 250 workdays. 

 

a. A workday is considered equivalent to a work shift. Additional hours worked as 

overtime will not add up to additional workdays, e.g., two hours overtime for four 

days is not equivalent to another (8-hour) workday. However, two work shifts 

worked back-to-back would be two work shifts, i.e., two workdays. For an 

employee whose work shift spans midnight, e.g., 11 PM to 7 AM shift, the work 

shift is still just one workday.

b. When the employment information shows that the employee worked for a 

particular period, the CE should not attempt to discern and deduct from the 

workdays any infrequent periods of non-presence or non-work, like sick leave, 

strikes, layoffs or vacation time that may be specified. However, if the 

employment evidence clearly establishes that the employee was not present and/or 

working at the SEC worksite for an extended period(s) while on the company 

payroll, this extended period(s) should not be credited towards meeting the 250 

workday requirement.

 

c. The period of 250 workdays starts with the worker’s first day of employment at 

the SEC worksite. There may be breaks in employment, but the workdays may 

only be accumulated at eligible SEC worksites.

 

d. Where the number of days is not apparent in the employee’s primary employment 

record, e.g., from the employer or union (records for pension, dues, union local 

records, etc.), the following table may be used for conversion: 

 

 

e

.

W

h

e

r

e

r

e

250 days =

50 five-day weeks, or

42 six-day weeks, or

12 months (five-day weeks), or

 

10 months (six-day weeks), or

2,000 hours

One month =

21 days (if evidence indicates six-day weeks, 25 

days

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cords of an employee’s earnings are available, such as W-2 Forms or Social 

Security earnings records, but the periods of employment are not, estimate the 250 

workdays as follows. Divide the annual wages earned at the SEC worksite by the 

employee’s hourly rate to determine the number of hours worked. If the number 

is greater than 2,000 hours, it meets the 250 workday requirement. The problem 

with converting dollar amounts to workdays is that they may be rough estimates 

of actual employment. As such, this method should only be used when all 

primary employment data is lacking.

 

f. There will be some situations where the above approach will not be applicable. 

These cases will need to be treated on a case-by-case basis, and if necessary, a 

referral to the NO Policy Unit may be required. 

7. Specified Cancers: In addition to satisfying the employment criteria under a SEC class, 

the employee must have been diagnosed with a specified cancer to be eligible for compensation 

under the SEC provision. As with any cancer claim, the employee’s occupational exposure to 

radiation must be before the initial date of diagnosis. For all specified cancers, first exposure can 

occur at any covered facility during a covered period, and does not need to be within a SEC 

covered period. The following are specified cancers in accordance with 20 CFR § 30.5(ff): 

a. Leukemia. (CLL is excluded). The onset is to have occurred at least two years 

after initial exposure at any covered facility during a covered time period.

 

b. Primary or Secondary Lung Cancer. (In situ lung cancer that is discovered during 

or after a post-mortem exam is excluded.) The trachea and bronchi are included 

as part of the lungs. Sarcoma of the lung is a lung cancer. The pleura and lung 

are separate organs, so cancer of the pleura, such as mesothelioma, is not a 

specified cancer.

c. Primary or Secondary Bone Cancer. This includes myelodysplastic syndrome, 

myelofibrosis with myeloid metaplasia, essential thrombocytosis or essential 

thrombocythemia, and primary polycythemia vera (also called polycythemia rubra 

vera, P. vera, primary polycythemia, proliferative polycythemia, spent-phase 

polycythemia, or primary erythremia). A diagnosis of polycythemia vera (and the 

listed a/k/a nomenclature) is sufficient by itself to be classified as a malignancy of 

the bone marrow. Leukocytosis and thrombocytosis are supplemental descriptors 

of polycythemia vera. The bone type of solitary plasmacytoma (a/k/a solitary 

myeloma) is a form of cancer consistent with bone cancer. The soft tissue type of 

solitary plasmacytoma is not a type of bone cancer or the specified cancer of 

multiple myeloma. (Note: Cancer of the hard palate is not bone cancer.)

d. Primary or Secondary Renal Cancers.

 

e. Other Diseases. For the following diseases, onset must have been at least five 

years after initial exposure at any covered facility during a covered time period: 

 

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(1) Multiple myeloma (a malignant tumor formed by the cells of the bone 

marrow);

 

(2) Lymphomas (other than Hodgkin’s disease). Waldenstrom’s 

macroglobulinemia is considered to be a type of non-Hodgkin's 

lymphoma. The ICD-10 code is C88.0. Waldenstrom’s 

macroglobulinemia, when diagnosed by lymph node biopsy, can be called 

lymphoplasmacytoid lymphoma (ICD-10 codes C83.00 – C83.98). (Note: 

Lymphoma Waldenstrom is used as a pseudonym for many other disorders 

not included as a specified cancer. The acceptance of this condition as a 

specified cancer is to be based on the ICD code presented in the medical 

evidence or upon diagnostic clarification from a physician). 

(3) Primary cancer of the:

 

(a) Thyroid; 

 

(b) Male or female breast;

 

(c) Esophagus; 

 

(d) Stomach;

 

(e) Pharynx – The pharynx has 3 parts - nasopharynx, oropharynx and 

hypopharynx. (The oropharynx includes the soft palate, the base of 

the tongue, and the tonsils); 

 

(f) Small intestine;

 

(g) Pancreas;

 

(h) Bile ducts (includes Ampulla of Vater, a/k/a hepatopancreatic 

ampulla);

 

(i) Gallbladder;

 

(j) Salivary gland;

 

(k) Urinary bladder;

 

(l) Brain (malignancies only). The brain is the part of the central 

nervous system (CNS) contained within the skull, i.e., the 

intracranial part of the CNS consisting of the cerebrum, 

cerebellum, brain stem, and diencephalon. (The intracranial 

endocrine glands and other parts of the CNS, benign and 

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borderline tumors of the brain, and borderline astrocytomas are 

excluded); 

(m) Colon (includes rectum and appendix); 

 

(n) Ovary;

 

(o) Liver (except if cirrhosis or hepatitis B is indicated);

 

f. Carcinoid Tumors. These tumors are considered primary cancers of the organs in 

which they are located. If the organ is one on the specified cancer list, the 

carcinoid tumor may be considered as a specified cancer.

Carcinoid tumors should be recorded by the organ of the specified cancer. For 

example, the CE should use the ICD-10 code of C7A.010 for a malignant 

carcinoid tumor in the duodenum section of the small intestine. 

 

Carcinoid syndrome and monoclonal gammopathies of undetermined significance 

are not currently recognized as malignant conditions. Consequently, these 

conditions should not be considered as cancers. 

 

g. Names or Nomenclature. The specified diseases designated in this section mean 

the physiological condition or conditions that are recognized by the NCI under 

those names or nomenclature, or under any previously accepted or commonly 

used names or nomenclature. The DEEOIC will consult with NCI only on issues 

pertaining to the name or nomenclature of a disease diagnosed at an anatomic 

location for the purpose of determining whether it constitutes a cancer. 

h. Identifying Specified Cancers. For cases where there is uncertainty as to whether 

a diagnosed cancer is a specified cancer, the CE is to refer the case file to PRPU 

for consideration. The examination of the record by PRPU will determine 

whether the diagnosed cancer originates within the anatomic structure of one of 

the listed “specified cancer” locations within the body, and conforms to the 

pertinent latency period, if any. 

i. Spread of Cancer. Where cancer has spread to various sites (organs) it may be 

difficult to identify the site of origin for the cancer. If the pathology report (or 

medical report) lists several alternatives and at least one site is considered a SEC 

cancer, the claim should be processed first as a SEC cancer claim.

8. Procedures for Processing SEC Claims. Processing SEC claims entails coordination 

between the PRPU and DO/FAB staff.

 

a. Role of the PRPU: 

 

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(1) Issues circulars with guidance on processing newly designated SEC 

classes. This will include specific instructions on how to evaluate evidence 

in the case file to determine SEC eligibility.

 

(2) Prepares a comprehensive list of all reported cases with claimed 

employment at a newly designated SEC worksite during the period of the 

SEC class. It will include pending cases, cases previously denied, and 

those at NIOSH. This comprehensive list will be provided to the DOs and 

FAB at the time of the issuance of the SEC circular.

 

(3) Unresolved questions on processing SEC claims, including questions on 

the definition of a SEC class, uncertainty as to whether a diagnosed cancer 

should be considered a specified cancer, or questions regarding calculation 

of the 250 workday requirement are referred to PRPU for guidance. 

 

b. Role of the CE: 

 

(1) Identifies a potential SEC claim by reviewing the information on the claim 

forms or other pertinent evidence in the case file to determine if there is 

sufficient evidence to suggest that an employee worked as a member of a 

named SEC class. For newly designated SEC classes, the CE is to review 

the comprehensive list provided by PRPU as noted in paragraph 8a(2).

 

(2) Reviews corresponding bulletins and circulars for designated SEC classes 

for procedures on evaluating evidence to determine if the SEC criteria are 

met.

 

(3) Completes an initial screening of cases on the comprehensive list provided 

by PRPU for a newly designated SEC class. A screening worksheet is 

included as Exhibit 14-1. The worksheet is to be completed for all cases 

on the comprehensive list. Upon completion, the worksheet is to be 

included in the case record.

 

Based upon the initial screening, the cases on the comprehensive list are 

grouped into three categories: those likely to be included in the SEC class 

(ISL); those unlikely to be included in the SEC class (ISU); and those for 

which development may be needed (ISD) to determine whether the case 

can be accepted into the new SEC class.

 

The purpose of this initial screening is to prioritize handling of cases that 

are likely to be included in the newly designated SEC class. This 

screening step is only applicable to cases on the comprehensive list. It is 

not applicable to new claims submitted after the list is generated or when a 

comprehensive list is not generated. Once screening and prioritization is 

complete, a more detailed review of all the cases (priority given to cases 

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that are likely to be included in the SEC class) and full development must 

take place to determine if a case is eligible for benefits under the SEC.

The SEC initial screening is a process to determine if cases on the 

comprehensive list meet the statutory requirements for inclusion in the 

SEC. If a claimant on the SEC comprehensive list is deceased, and the 

employment and medical criteria are met but survivorship development is 

needed, the CE will mark the initial screening worksheet “development 

needed”. 

 

(a) For cases on the comprehensive list at FAB, a designated CE2 or 

other FAB staff member is to conduct the initial screening and 

completion of the worksheet. 

 

(4) Evaluates medical evidence in the case file of a potential SEC case to 

determine if the employee has been diagnosed with a specified cancer. If 

a deceased employee meets the employment criteria for SEC class 

membership, but an explicit specified cancer diagnosis and diagnosis date 

are not stated in the employee’s medical records, a diagnosis and diagnosis 

date can be established based on the following:

(a) There is sufficient medical evidence for the employee that 

indicates a diagnosis of a specified cancer, but the diagnosis is not 

definitive, and 

(b) An expert opinion is provided to support that the deceased 

employee did have a specified cancer. The medical opinion is to 

provide sufficient details and rationale based on accepted medical 

knowledge to support the specified cancer diagnosis and diagnosis 

date. The medical opinion can be provided by the employee’s 

treating physician, a CMC, and/or an expert in a relevant medical 

field. 

 

(5) If the employee has a specified cancer, the CE is to verify that the 

employee meets all employment criteria in the SEC class designation, 

including the workday requirement. In determining whether the 

employment history meets the workday requirement, the CE can consider 

employment at a single SEC class, or in combination with workdays at 

other SEC classes.

 

The CE also reviews any documentation that NIOSH may have acquired 

or generated during the dose reconstruction process to determine if the 

employee satisfies the employment criteria of a SEC class(es).

 

(a) NIOSH will identify and return dose reconstruction analysis 

records for cases with specified cancers that may qualify under a 

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SEC class to the appropriate DO along with a CD for each case. 

The CD will contain all of the information generated to date, e.g., 

CATI report, correspondence, and dose information. The 

Correspondence Folder on the CD should include a copy of the 

NIOSH letter sent to each claimant informing the claimant of the 

new SEC class, and that his or her case is being returned to DOL 

for adjudication. The CE is to upload a copy of the NIOSH letter 

for each claimant into the case file.

(b) There may be some cases not identified by NIOSH that the CE 

determines may be included in the SEC class. If any such case 

qualifies under the SEC class and the case is with NIOSH for a 

dose reconstruction, the CE notifies the appropriate point of 

contact at NIOSH via e-mail to pend the dose reconstruction 

process and return dose reconstruction analysis records to the 

appropriate DO. The CE then uploads a copy of the “sent” e-mail 

into the case file (making sure the file copy documents the date it 

was sent). In addition, the CE is to write a letter to the claimant to 

advise that the case file has been withdrawn from NIOSH for 

evaluation under the SEC provision. 

 

(6) Proceeds in the usual manner for a compensable claim and prepares a RD

if the employee has a diagnosed specified cancer and meets the 

employment criteria of the SEC class. The CE notifies the appropriate 

POC at NIOSH via e-mail so that they may close their file. The CE then 

uploads a copy of the “sent” e-mail into the case file. 

(a) If a Part B claim is accepted as a SEC claim based solely upon 

AWE employment, and the employee has some period of DOE 

contractor employment (it does not matter where or when), the 

accepted Part B cancer can be accepted under Part E, even though 

the SEC acceptance is based solely on AWE employment. 

 

(7) Refers to NIOSH the SEC cases that were evaluated but do not qualify 

under the SEC provision, e.g. cases with non-specified cancers, specified 

cancers with insufficient latency period, or cases with insufficient SEC 

employment. NIOSH will conduct a full or partial dose reconstruction on 

the cases.

 

(a) For those cases which were previously submitted to NIOSH for 

dose reconstruction but were returned to the DO for consideration 

in a SEC class, a new NIOSH Referral Summary Document 

(NRSD) is not required. Instead, the CE notifies the appropriate 

point of contact at NIOSH via e-mail to proceed with the dose 

reconstruction. The CE then uploads a copy of the “sent” e-mail 

into the case file. The e-mail should include a brief statement of 

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why the case should proceed with dose reconstruction, e.g., nonspecified cancer, insufficient latency period or does not meet the 

250 workday requirement. 

 

The CE also notifies the claimant by letter that the case is returned 

to NIOSH for dose reconstruction and the reason(s) it does not 

qualify for the SEC class. The CE is to send a copy of this letter to 

NIOSH.

 

(b) If the claim meets the SEC employment criteria and includes both 

a specified cancer and a non-specified cancer, medical benefits are 

only paid for the specified cancer(s), any non-specified cancer(s) 

that has a probability of causation of 50 percent or greater, and any 

secondary cancers that are metastases of a compensable cancer.

 

For the non-specified cancer, the CE prepares a NRSD for a dose 

reconstruction to determine eligibility for medical benefits. In 

these SEC cases, all primary cancers are to be listed on the NRSD, 

including the specified cancer(s). 

 

(i) One exception to this rule is an accepted SEC claim where 

the specified cancer is a secondary cancer. Per regulation 

20 CFR § 30.400(a), “In situations where the accepted 

occupational illness or covered illness is a secondary 

cancer, such treatment may include treatment of the 

underlying primary cancer when it is medically necessary 

or related to treatment of the secondary cancer.” However, 

“payment for medical treatment of the underlying primary 

cancer under these circumstances does not constitute a 

determination by OWCP that the primary cancer is a 

covered illness under Part E of EEOICPA.” The CE is to 

send the claimant a letter with regard to payment of 

medical bills for the unaccepted condition. (See Exhibit 14-

2) 

For instance, prostate cancer (non-specified cancer) 

metastasizes to secondary bone cancer. If secondary bone 

cancer is accepted as a specified cancer under the SEC 

provision, medical benefits are provided for both primary 

and secondary cancers (prostate and bone cancer) under 

Part B.

As such, it may be necessary for the CE to refer the 

prostate cancer to NIOSH for dose reconstruction to 

determine eligibility for benefits under Part E. In this case, 

only prostate cancer is included in the NIOSH NRSD for a 

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dose reconstruction since the secondary bone cancer 

metastasized from the prostate cancer.

(8) If the CE determines that a case on the comprehensive list, which includes 

a FD, does not require any action, the CE writes a brief memo to the file 

indicating that the file was reviewed and noting the reason why no 

additional action is necessary. A case classified as not requiring any action 

is a case that does not meet the SEC criteria and there is no need to return 

it to NIOSH for dose reconstruction. 

 

c. Role of the DD: 

 

(1) The DDs have been delegated authority to sign a Director’s Order to 

reopen a denied FD if the evidence of record establishes that the employee 

is diagnosed with a specified cancer and likely to be included in the SEC 

class. If the DD is unsure whether the SEC is applicable to a case, the case 

is to be referred to PRPU.

 

(2) Once a Director’s Order is issued, the CE is responsible for issuing a new 

RD. 

 

d. Role of the HR: 

 

(1) Reviews cases pending a FD for possible inclusion under the SEC 

provision. If the employee qualifies under the SEC provision and the DO

issued a RD to deny, the HR is to reverse the DOs RD and accept the case.

 

Every effort should be taken to avoid a remand of a potential SEC claim to 

the DO. However, if the HR determines that the case cannot be approved 

based on the SEC designation and that referral to NIOSH is appropriate or 

additional significant development is necessary, the HR is to remand the 

case for DO action.

 

(2) All cases on the comprehensive list provided by PRPU that are located at a 

FAB office are to be reviewed for possible inclusion under the SEC 

provision. If no action is required, a designated CE2 or other FAB staff 

member is to write a brief memo to the file as noted under paragraph 

8b(8). 

 

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CHAPTER 15 – ESTABLISHING TOXIC SUBSTANCE EXPOSURE

1. Purpose and Scope. This chapter describes the procedures that the DEEOIC uses to 

establish toxic substance exposure under Part E of the EEOICPA. These procedures outline 

means to develop for exposure to toxic substances at a covered DOE and RECA Section 5 

facility. In particular, the chapter addresses the SEM and guidance for its use and explains 

required actions when SEM data is lacking or incomplete. 

2. Rules for Establishing Exposure. To establish that an employee was exposed to a toxic 

substance, the evidence of file must show evidence of potential or plausible exposure to a toxic 

substance and evidence of covered DOE contractor/subcontractor or uranium employment at a 

covered DOE/RECA facility during a covered time period. 

a. Documentation. Exposure to a toxic substance can be established by the 

submission of probative documentation that shows such substance was present at 

the facility where the employee worked, that there was a reasonable likelihood for 

employee exposure, and that the employee came into contact with such substance. 

b. Presence and Contact. Whenever possible, the CE considers such issues as 

whether the substance was present, not only in the facility, but in the specific 

building(s) and/or areas where the employee worked, and whether the substance 

was used during the processes involved as part of the employee’s job duties and 

exposure routes (e.g., a welder exposed to fumes). The SEM (discussed below) 

will be especially helpful in evaluating for the presence of a toxic substance in a 

certain building/area/work process. 

(1) Presence of toxic substance. The CE may look to the SEM, facility 

exposure records, DAR records, the OHQ, employee records, verified 

affidavits, DOE FWP screening records, NIOSH site profiles, employee 

submitted evidence, and other evidence that establishes a toxic substance 

was present at the facility where the employee worked. The CE may also 

use IH referrals as discussed below.

(2) Employee contact with a toxic substance. The CE’s review of the evidence 

described above may be sufficient to establish that the employee came in 

contact with the toxic substance. 

Information such as the claimant’s response to the OHQ performed by the 

RC, reviewed in conjunction with DAR records and the SEM, may help 

the CE decide what further development may be necessary (e.g., to 

determine whether contact was likely given the employee’s labor category, 

labor process, or given safety controls or risk factors that may have been 

present at the worksite).

(3) Plausibility. When evaluating the evidence to determine whether a toxic 

substance was potentially present at a given facility (by building, area, 

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work process, labor category) and whether it is likely that an employee 

came into contact with a toxic substance in the course of employment at a 

covered facility, the CE must determine whether such contact is plausible. 

To do so, the CE must review all evidence on file and decide whether it 

makes sense that the claimed exposure could have potentially occurred. 

Sometimes this evaluation will require a referral to an IH.

For example, if an employee is claiming lung cancer due to exposure to 

uranium metal maintained exclusively in a glove box (an enclosure to 

protect the worker from uranium exposure), the CE must examine whether 

or not an exposure route is plausible. 

Without evidence that the employee was involved in machining uranium 

or cleaning out the glove box, or that he or she was exposed in some other 

way such as a leak in the glove box, no exposure route (inhalation which 

would potentially be linked to lung cancer) is plausible. 

(4) Sample Evaluation of Presence and Contact. A chemical operator 

involved in cascade operations at K-25 claims peripheral neuropathy. His 

responses to the OHQ show he worked with a variety of toxic substances 

on a routine basis, including mercury. Information obtained through the 

DAR records confirms his worksite (K-33), which is located within K-25, 

and job duties. 

The CE searches SEM (see paragraph 10 below) and confirms the 

presence of mercury at the K-33 cascade building. Further, SEM supports 

a link between mercury and peripheral neuropathy. A physician’s report 

indicates a diagnosis of peripheral neuropathy and mentions that the 

employee has had tingling in his arms for approximately a year. An 

accident report notes a major mercury spill during the time in which the 

claimant worked at K-33. 

The evidence is sufficient to establish that the employee had peripheral 

neuropathy and potential exposure to mercury in the course of his 

employment at a covered DOE facility. The mercury spill accident report 

lends support to the finding that it is plausible, given the facts, to assume 

that the claimant encountered an occupational exposure to a toxic 

substance in the course of his work. 

Any question as to route of exposure (e.g., inhalation, absorption), even if 

presence is established, should be referred to an IH, as outlined in 

paragraph 12 below. 

c. Burden of Proof. If no medical evidence is submitted that would lend support to a 

connection between the claimed condition and potential exposure to a toxic 

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substance (and no such evidence is available from the sources referenced in the 

previous section), the CE requests such evidence from the claimant before issuing 

a denial. While the CE must exhaust all reasonable development prior to issuing 

a denial, the claimant does bear the overall burden of proving his or her claim. 

d. Causation Test for Toxic Exposure. The CE must develop the requisite 

employment and exposure evidence to render a causation determination. Specific 

causation requirements for cancer and other conditions are outlined in other 

chapters. In general, the CE develops the evidence on file and a determination is 

made based upon the “at least as likely as not” causation test.

While resources are provided to assist the CE, there is no simple one-step tool for 

making this determination. Instead, the CE must base the determination on the 

totality of evidence in the case file. The CE does not use studies or reports 

obtained from the Internet or other sources to justify case decisions, unless the 

NO has specifically authorized such usage. In addition, the CE may not base a 

decision on a vague reference to “medical literature.”

(1) Causation Test for Toxic Exposure. Evidence must establish a 

relationship between exposure to a toxic substance and an employee’s 

illness or death. The evidence must show that it is “at least as likely as 

not” that such exposure at a covered DOE/RECA facility during a covered 

time period was a significant factor in aggravating, contributing to, or 

causing the employee’s illness or death, and that it is “at least as likely as 

not” that exposure to a toxic substance(s) was related to employment at a 

covered DOE/RECA facility. 

(2) “At Least as Likely as Not.” Part E only requires proof that established 

exposure “at least as likely as not” was a significant factor in aggravating, 

contributing to or causing the employee’s illness, disease or death. As 

with Part B, “at least as likely as not” means 50% or greater likelihood. 

When a referral to NIOSH for a cancer claim related to radiation results in 

a PoC of greater than or equal to 50%, the regulations provide that this 

requirement has been met. In other cases the CE bases a determination on 

a review of the evidence of file as a whole, to determine if the “at least as 

likely as not” standard has been met. The CE weighs all of the evidence 

available and provides a clearly written rationale supporting his or her 

findings in the RD. 

(3) Significant factor. The CE evaluates the evidence as a whole when 

attempting to determine whether or not exposure to a toxic substance was 

indeed a significant factor in contributing to, aggravating, or causing the 

claimed illness or death of the employee. In most instances this evaluation 

will be done on a case-by-case basis.

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In some cases a CMC evaluation will be necessary. The CE looks at the 

claimed exposure, the presence of such exposure, the duration of the 

verified employment, and any other important exposure/employment 

factors when ascertaining the possible role the toxic substance exposure 

played in the onset of the covered illness. 

e. Using SEM to Evaluate Causation in General. The SEM is not used to establish 

or deny causation by itself, but is used as a tool to assist in the evaluation of 

causation in light of the evidence as a whole. The purpose of this searchable 

database is twofold. First, the database details many possible toxic substances 

that may have been present at a given facility. Second, the database describes the 

relationship between a specific toxic substance and a covered illness.

The CE reviews the database to assist in a determination of whether the claimed 

toxic substance was present at the facility where employment occurred and 

whether or not a relationship exists between exposure to a toxic substance and a 

particular covered illness. However, the database does not serve as a 

comprehensive list of all potential toxic substances that could be present at a 

facility, and the CE must confirm additional claimed toxic substances through 

employment records, DAR records, DOE FWP records, and other means. If the 

CE cannot confirm the presence of a toxic substance through these sources, the 

claimant should be notified and given an opportunity to present additional 

evidence that establishes the presence of such a toxic substance. Finally, once the 

CE completes all reasonable development and carefully weighs the evidence on 

the whole, including the SEM findings, the CE must determine whether or not a 

referral is needed to a CMC or IH/TOX to further evaluate causation. Procedures 

for this and other actions are outlined below. 

f. DOE Physician Panels. Cases with positive DOE physician panel findings 

approved by DOE (signed by a DOE official) under the old Part D are accepted 

for causation on the basis of those findings for all conditions claimed under Part E 

that were approved by the panel. The CE uses the DOE physician panel finding 

as the basis for the decision and no further development for causation is required. 

If the positive physician panel decision is not approved by DOE (not signed by a 

DOE official) it is not an approved finding, however, unsigned reports still may 

contain useful information for causation development such as medical and 

exposure evidence that might prove useful in reaching a causation decision based 

upon all of the other evidence of file. The CE reviews negative panel reports like 

any other piece of medical evidence in light of the weight of the evidence of file 

as a whole.

g. Evidentiary Requirements for Survivor Claims. The CE uses any and all of the 

medical evidence of file in order to develop for causation in a survivor claim. Not 

only must the evidence of file establish that it is at least as like as not that toxic 

exposure caused, contributed to, or aggravated a covered illness, the evidence 

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must also establish that the covered illness caused or contributed to the death of 

the covered employee.

h. Developing for Toxic Substance Exposure. When developing Part E cases the CE 

uses established development techniques in addition to certain other steps unique 

to the Part E adjudication process. The FAB develops medical conditions and 

employment where possible to avoid issuing a remand order for further 

development if such development can be conducted at the FAB with little 

additional effort. 

(1) Development Using Existing Case File Materials. In many 

instances, a Part E claim has a corresponding Part B and/or D case file 

already in existence. When an existing Part B and/or D case file exists, 

the CE examines the case file materials for medical, employment, and 

exposure evidence to assist in the causation development process. 

Under Part D, DOE collected exposure and employment data through 

DARs. The CE must examine all existing Part D case file material for 

DAR records and review all documentation presented with the new Part E 

claim filing and any corresponding Part B or D case file to render a 

causation determination. A filing under Part D is automatically 

considered a filing under Part E, without a requirement for the filing of 

another claim form.

(2) A General Rule about Reasonable Development. Given the 

complex nature of claim file development under Part E, it is necessary for 

the CE to judiciously determine whether or not the facts warrant issuing a 

decision or whether additional development is necessary. As a general 

rule, the CE utilizes the tools outlined in this chapter to the fullest extent 

possible and issues a decision once all development avenues have been

reasonably explored. While the CE issues decisions accepting claims for 

benefits as soon as the evidence support an acceptance and all statutory 

criteria are met, denial situations must be heavily weighed and decisions 

issued only when additional development is unlikely to produce the 

evidence needed to reach a decision. In essence, the CE evaluates all of 

the evidence of file to determine whether or not it is plausible that, given 

the evidence at hand, the claimed illness arose out of the claimed 

occupational exposure to a toxic substance at a covered facility.

When attempting to determine whether or not sufficient development has 

been conducted, the CE can look to the claimed condition and the 

evidence at hand to make an informed determination. If the claimed 

condition is generally a condition that arises out of occupational exposure, 

it is incumbent upon the CE to pursue additional development whenever 

possible. However, if the condition is one that is unlikely to be caused by 

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occupational exposure, the CE can be more certain that additional 

development might not be necessary and a decision can be issued. 

(3) Example. If the claimed illness is CBD, asbestosis, or 

another condition known to arise almost exclusively out of occupational 

exposure, but the evidence is not sufficient to accept the claim, the CE 

refrains from issuing a denial if additional development might establish 

the employee’s claim for benefits.

However, if the claimed illness is heart disease, diabetes, arteriosclerosis, 

thrombosis, or another disease that often is caused by non-occupational 

risk factors, the CE can send a development letter and allow the claimant 

an opportunity to present evidence. If no evidence is received, the CE 

may issue a decision after weighing the evidence as a whole and 

determining that no causal link exists between the claimed illness and the 

covered Part E employment.

3. Sources of Evidence. Establishing exposure to a toxic substance is a key element in 

developing claims filed under Part E. Developing for such exposure can be complex, and many 

tools are available to assist the CE in this endeavor. 

a. DAR records, which are obtained from DOE, contain a wealth of employment and 

exposure evidence. They contain a mixture of employment, medical, and 

exposure evidence. The CE prepares a DAR to DOE pursuant to the guidance in 

paragraphs 5 and 6 below. If the site information contained in SEM is reasonably 

complete and sufficient to establish the claimed exposure, no further exposure 

information should be sought from DOE through a DAR. The DAR can be used 

to obtain specific information if a claimant is alleging an incident that might not 

have been captured in SEM. 

b. The DOE FWP is an ongoing effort to evaluate the effects of occupational 

exposures (e.g., to beryllium, asbestos, silica) on the health of DOE workers. 

These records contain employment, medical, and exposure data. Exposure 

information obtained from FWP work history interviews taken after the enactment 

of the EEOICPA, in October 2000, should be used only when corroborated by 

other evidence that supports the claimed exposure (i.e., DAR information, SEM). 

c. The CPWR can provide data for use in verifying contractor/subcontractor 

employment and exposure. 

d. Employment and exposure evidence from the claimant or other sources, such as 

verified affidavits, facility records, is weighed along with the evidence as the 

whole. 

e. The SEM (see paragraph 8 below) provides site-specific exposure information, 

information about toxic substances and employment processes at a given site, and 

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some limited information concerning potential adverse health effects produced by 

exposure to certain toxic substances.

f. DOE Physician Panel findings are also a source of employment, medical, and 

exposure information. 

g. OHQ data obtained by the RC staff document the workplace exposure 

experienced by an employee. The OHQ is used as a piece of evidence to be 

evaluated along with the evidence of the file as a whole.

4. DAR. The DAR is the process by which the DO gathers DOE work records on a 

specified employee. The CE reviews the case file before deciding which documentation to 

request from the DOE on the DAR Questionnaire. The CE must carefully consider the specific 

data needs for the individual case. Information received in response to the DAR may vary from 

site to site, but will contain some or all of the following information:

a. Radiological Dose Records. These documents are radiation exposure records 

based on readings from dosimetry badges or similar personal recording devices. 

They are generally taken at regular intervals over the employee’s employment.

b. Incident or Accident Reports. Any abnormal incidents or large plant accidental 

substance releases affecting the employee are documented in these types of 

documents. 

c. Industrial Hygiene or Safety Records. Documents in these categories could 

contain periodic inspection reports for health and safety purposes. 

d. Pay and Salary Records. These documents include an employee’s pay, salary, 

any workers’ compensation claim or other documents affecting wages. 

Examples of records from the DOE database could include, but are not limited, to 

Official Personnel Files of Contractor Employees, Contractor Job Classification, 

Employee Awards Files, Notification of Personnel Actions, Classification 

Appraisals, Wage Survey Files, and Unemployment Compensation records. 

The CE generally does not need these types of documents unless wage-loss is 

either being claimed by the claimant or a wage-loss claim is obvious to the CE 

from the case file.

e. Job Descriptions. These are descriptions of the various employment positions at 

the plant and the duties required to perform the job. 

f. Medical Records. These include personal medical histories of the employee if 

that employee visited the plant infirmary (e.g., Health Unit Control Files, 

Employee Medical Folder).

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g. Other. This category includes any other documentation needed on a case-specific 

basis which does not fit into any of the other six categories. If this category is 

checked and a specific request is listed by the CE, DOE personnel may contact 

the DOL CE for clarification of the request. 

5. Requesting the DAR. After reviewing the case file, including the OHQ from the RC, the 

CE requests the DAR information. This is done concurrently with FWP development. The 

process for collecting the information differs slightly depending on whether DOE or a corporate 

verifier (CV) is receiving the DAR. The CE must also review SEM to determine what exposure 

information already has been assembled from DOE records and other sources. If exposure 

information necessary to develop the claim already exists in SEM, the CE does not request such 

information in the DAR. 

a. DAR POC List. This list can be found on the NO shared drive and is divided into 

two sections: DOE DAR POC and No Known Contact. Each DD is responsible 

for updating and maintaining these records. 

The DOE DAR POC is similar to the current DOE Operations Center POCs for 

employment verification. There are some differences, however, so the CE must 

use this list when requesting DAR documentation directly from the DOE. A DAR 

Cover Letter and DAR Questionnaire are sent only to a DOE DAR POC.

b. Sites with No Known DAR POC. For these sites, the CE undertakes alternate 

exposure development. Since no known contact exists, a DAR Questionnaire is 

not used. 

6. Completion of DAR. When appropriate, the CE completes a DAR Cover Letter and 

Questionnaire asking for toxic exposure evidence. If a particular DOE site does not have the 

ability to scan and submit documentation digitally on a CD, the DOE submits paper documents. 

a. Package to DOE. The package includes a cover letter (Exhibit 15-1) addressed to 

the DOE POC, DAR Questionnaire (Exhibit 15-2) completed by the CE, and 

copies of Forms EE-1/EE-2 and EE-3. 

(1) The CE prints or types the identifying information of the employee in 

Blocks 1 and 2 of the DAR. The CE annotates any maiden names in 

Block 1. 

(2) The CE indicates the DOE facility on Form EE-3 in Block 3 of the DAR 

and any employer name information in Block 4. If the claimant indicates 

on Form EE-3 that he or she worked for multiple subcontractors at the 

same DOE facility, the CE completes a separate DAR Questionnaire for 

each subcontractor. This process helps distinguish between contractors or 

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Similarly, if the claimant claims multiple DOE sites on Form EE-3, the CE 

completes a separate DAR for each DOE site, as the DAR POC may be 

different.

(3) After reviewing the case file, the CE requests the records that are relevant 

to the case by checking the appropriate box(es) in Block 5, “Types of 

Records Being Requested.” 

(4) If the CE has a specific question(s) that needs to be addressed which is not 

covered in the broader categories listed on the DAR request, the CE 

completes the “Site Specific Exposure Questions” section of the 

Questionnaire. The CE considers the condition(s) claimed as well as any 

specific alleged exposures.

For example, if the claim is for aplastic anemia, the CE may want to ask 

DOE if and when arsenic or benzene was used in a particular building at 

the site during a particular timeframe.

b. DAR Response. When DOE’s response is received, the CE documents receipt of 

the DAR in ECS.

(1) DOE will have collected the documents requested in Block 5. The DOE 

checks the corresponding box in Block 6 immediately to the right of the 

requested category, either “Included on CD” or “Unavailable”, depending 

on whether the DOE has any records related to that particular set of 

records. 

“Included on CD” also includes hard copy documentation in the event the 

DOE facility does not have imaging capability.

(2) Also, DOE will respond to any site-specific exposure questions posed by 

the CE in Block 8, confirming the exposure, denying the possibility of 

exposure, or indicating there is insufficient evidence to answer the 

question accurately. The DOE may attach a piece of evidence to the DAR 

which particularly answers a site-specific question or otherwise clarifies 

the DOE response to the question. In these instances, the DOE also 

checks the “SUP” or supplemental box signaling the special response. 

(3) Once the DAR response is received, the CE reviews both the questionnaire 

and the contents of the CD to confirm that all requested documents have 

been received and that the specific questions about exposure have been 

adequately answered. Any documents identified on the CD as material to 

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c. Follow-up with DOE. If DOE does not respond to the RC’s initial employment 

verification request or the DAR questionnaire, the CE contacts the DOE to 

determine the status of the request.

(1) The DOE is given 30 days to respond to the request (Form EE-5 or DAR). 

If the DOE does not respond within that time, the CE drafts an inquiry to 

the DOE, noting the date of the initial request and asking the DOE to 

respond as soon as possible. The CE provides his or her contact 

information so that the DOE can quickly respond. 

7. DOE Remediation Employment. Since Part E provides coverage for DOE 

contractor/subcontractor employees and their eligible survivors, a claimant alleging DOE 

contractor/subcontractor employment due to remediation must prove that a contract/subcontract 

in fact did exist between the claimed employer and DOE/DOE contractor to conduct remediation 

activities for DOE at the facility in question during the time when DOE was conducting 

remediation. When developing for exposure in a remediation case, the CE should follow the 

same steps as is used to develop for DOE contractors and subcontractors. 

8. SEM. The SEM is a web-based tool designed to assist the CE in developing for exposure 

to a toxic substance. The SEM identifies the toxic substances that were commonly used in each 

DOE and RECA Section 5 facility, and contains two general categories of information that may 

be searched: chemical profiles and site-specific information tailored to the covered facility or 

site.

Under no circumstances is SEM used as a stand-alone tool to deny a claim. Information in SEM 

can sometimes be used in conjunction with other supporting case file evidence to approve a 

claim.

a. Site-Specific Data. For a given covered facility or site, SEM provides 

information about the nature and location of work processes performed (e.g., fuel 

separation, instrument maintenance, or welding); the work groups involved (e.g., 

first line supervisor, instrument mechanic, or welder); the toxic substances used 

(e.g., plutonium nitrate, arsenic, or mercury); and site-specific aliases and 

potential exposure information about work processes, work groups, toxic 

substances, buildings, and areas.

b. Potential Nature of Exposure. Data from SEM is interpreted to mean that a 

worker had a potential for exposure to a toxic substance. The CE must review the 

information yielded from DAR responses, DOE FWP records searches, and the 

OHQ to hone the SEM search.

c. Employment Data. The CE must obtain as much background as possible to 

determine the type of work or process the employee performed, the dates of such 

work or process, the building(s) or area(s) involved, and the toxic substance(s) 

alleged to have been present to determine through SEM the type of chemicals an 

employee could potentially have been exposed to while working in a particular 

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building and/or performing a certain job or process. This information can be 

gathered from the OHQ, DAR, EE-5, or other sources. 

d. Validity of SEM. All information in SEM is considered valid and factual. The 

toxic substance, work process, and facility information in SEM is deemed verified 

by DOE or other sources, and if a certain toxic substance is listed as present in a 

given building or facility, the data is accepted as fact and no additional 

confirmation from DOE or any other source is necessary. 

e. Additions to SEM. The database is continually updated and does not contain 

100% of the toxic substances potentially present at a given facility. As a result, 

simply because certain information is absent from SEM does not warrant a claim 

denial and also does not warrant delaying adjudication until such information 

might be included in SEM. 

The CE conducts reasonable development by reviewing the evidence as a whole 

and issues decisions once such development allows the CE to adjudicate a claim. 

9. SEM Policy and Management. The following paragraphs provide a basic outline of SEM 

and its use as a developmental tool. See the “Site Exposure Matrices Website User Reference 

Guide” (available on the Shared Drive, Part E folder, SEM subfolder, or accessed through the 

SEM menu) for complete and detailed instructions as to the use of SEM. 

a. Policy. SEM is used as a tool to assist the CE in evaluating the evidence as a 

whole to determine the existence of a causal link between covered employment, 

exposure to a toxic substance during such covered employment, and a resultant 

illness arising out of such exposure. 

As noted above, in certain cases it will be possible to accept a claim based upon 

the information contained in SEM if such information can be coupled with 

approved policy guidance as outlined below. 

Under no circumstances is a claim for benefits denied solely due to a lack of 

information contained in SEM, because the data for each facility will never be 

100% complete. 

b. Management of SEM at NO. A NO SEM POC manages all issues arising out of 

SEM usage. Implementation questions, requests for access/denial of access to 

SEM, and any new evidence that might warrant inclusion into SEM are 

forwarded to the NO SEM POC.

(1) The NO SEM POC has a counterpart in the DO SEM POC, who, the DD 

appoints to interact with the NO.

When evidence of an exposure not listed in SEM is verified or strongly 

alleged (supported by documentation) at a facility, the DO SEM POC 

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prepares a memorandum to the NO SEM POC (for signature by the DD or 

designee) requesting IH review for possible inclusion of the toxic 

substance in SEM. All associated evidence of the presence of the toxic 

substance is attached to the memorandum.

The NO SEM POC will review the evidence with the NO IH and other NO 

staff (i.e., Medical Director, TOX, and HP) to determine whether the 

evidence should be included in SEM. If so, the NO POC advises the Web 

Site Administrator or appropriate individual to add the information to the 

database. 

In general, the DO SEM POC interacts with the NO SEM POC on all 

issues arising out of SEM operations. 

(2) The DO SEM POC obtains SEM access for DO staff by e-mailing the NO 

SEM POC with a request that a staff member be granted access to the 

system and providing the employee’s name, job title, and e-mail address. 

After review, the NO SEM POC advises the Web Site Administrator by email to grant access to the individual in question. 

The Web Site Administrator contacts all individuals with newly granted 

access through e-mail, providing access information such as a user name 

and a temporary password. 

(3) Access is disabled when an employee resigns or is terminated. The DO 

SEM POC provides an e-mail to the NO SEM POC with the name of the 

employee whose access is being disabled and the precise date upon which 

access must be denied. The NO SEM POC e-mails the Web Site 

Administrator requesting that the access be disabled on the requested date, 

and access is terminated. Due to the sensitive nature of the information 

housed in SEM, it is important that the DO SEM POC notify the NO SEM 

POC of the need to disable an account within 7 days of an employee’s 

departure.

c. Additions to SEM. DEEOIC encourages claimants and other interested parties to 

submit new site-related scientific research, studies, or information concerning the 

presence of toxic substances at covered facilities for evaluation and possible 

inclusion in SEM. The SEM website at https://dol-sem.com/Login.cfm contains a 

link for individuals to provide comments or documentation of toxic substance use 

at a particular facility.

10. SEM Searches. The CE reviews all evidence of file to properly craft his or her SEM 

query. The CE reviews employment evidence for job description and facility. Also, 

employment and exposure evidence in the case file (e.g., facility records, DAR records, OHQ 

responses, NIOSH/PHS/DOJ data about RECA claims) is reviewed to determine as best as 

possible exactly where the employee worked and what processes or toxic substances were used 

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in the building or area in which the employee worked. In order to effectuate a thorough and 

proper search, it is necessary for the CE to develop SEM queries from multiple criteria, 

including: labor category; process; and health effect. While labor category is the preferred field 

to begin a search, it is not the only field that should be investigated. 

a. Data Fields. Various fields in SEM hold an array of valuable data viewable by 

site: the number of toxic substances present (with information about each 

substance); health effects or diseases known to be associated with a toxic 

substance; site history; buildings; processes; labor categories; known incidents; 

and exposure factors.

All fields contain references to the document utilized by SEM to provide the 

given information. The CE navigates the search fields based upon the known 

evidence of file, triangulating on the necessary information required to assist in 

the development and determination of causation. 

A search based upon facility-wide information (e.g., all toxic substances known to 

have been present at the Nevada Test Site) generally will not be specific enough 

without other qualifiers such as work category and/or work process, and may not 

produce usable information for a causation determination. 

At a minimum, especially when searching DOE sites, the CE establishes the 

employee’s job category, work process, and/or building/area or employment 

before performing a SEM search. The more information a CE has about an 

employee’s occupational history when searching SEM, the more likely it is that 

the SEM search will prove useful in helping the CE determine causation. 

b. Searches of Universal Information. This set of fields contains the most recent 

scientifically based evidence about toxic substances and their relation to illnesses. 

The occupational disease links in SEM are imported from the widely accepted and 

well rationalized medical science database called Haz-Map, a database of the 

National Library of Medicine NLM). While the NLM database, Haz-Map, is 

often utilized in other circumstances as a resource, the CE must never use HazMap as a development or adjudicatory tool. Only SEM is acceptable for use in 

case file development and adjudication. It is unacceptable to base a decision, 

particularly a remand order, on any information contained in Haz-Map beyond the 

established links populated directly into SEM. Haz-Map serves many purposes 

for the public and medical professional fields and will often cite suggestive 

research that it has not accepted as a basis for finding a demonstrable link 

between a given substance and an occupational illness. 

(1) The “Toxic Substance Information” field is useful when the evidence 

indicates the toxic substance(s) to which the claimant was potentially 

exposed. When a toxic substance is selected, SEM provides a “chemical 

profile” of the substance, including its Chemical Abstracts Service (CAS) 

number, which identifies the chemical, aliases for the substance name, 

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chemical and physical properties (e.g., liquid or gas, odor, and color), and 

health hazard ratings assigned by sources routinely used by IH’s to 

evaluate workplace substances.

(2) The “Toxic Substance by Alias or Property” field is used to find a toxic 

substance using an unofficial name, or by a physical or chemical property. 

Using this link allows the CE to find the identity of toxic substances by 

keying in part or all of the name, unofficial name (alias), or description of 

a toxic substance using a physical or chemical property. The result may 

be no match, one match, or multiple matches. For example, searching for 

“yellow” will return a list which includes uranium dioxide, and searching 

for “yellowcake” will return a shorter list which still includes uranium 

dioxide. 

(3) The “Toxic Substance by Chemical Category” field is used to find a toxic 

substance by category, such as gases or metals. If the claimant is not 

specific about the substance to which he or she was exposed, but describes 

it in general terms, this link will allow the CE to review a list of 

substances to which the employee may have potentially been exposed. 

After selecting a chemical category from the drop down menu (gases, 

metals, acids, etc.), a listing of all toxic substances within that category at 

the site is shown. 

Example: The CE knows that the employee worked as a laborer in the 

pilot plant at the Feed Materials Production Center (Fernald) and is 

claiming chronic bronchitis. The OHQ indicates that the claimant does 

not recall exact exposures, but does recall a sharp, pungent odor and states 

that he “breathed in this gas all the time.” The CE selects “Gasses” from 

the chemical category drop down menu and all gasses known to have been 

present at Fernald are listed. The CE searches each gas and finds that 

sulfur dioxide was present in the pilot plant and that laborers are a labor 

category of possible exposure and that the gas has a pungent odor and that 

chronic bronchitis is a health effect of exposure. 

(4) SEM provides a list of known health effects produced by a given toxic 

substance. SEM can also be searched to determine whether or not a given 

facility contained a toxic substance that could produce the health effect 

claimed. When searching this way, the CE searches by the claimed illness 

(e.g., asthma, skin cancer) to determine what toxic substances at a given 

site could have potentially caused, contributed to, or aggravated the 

claimed condition. 

(a) The “Toxic substance by health effect” section displays the toxic 

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For example, the above-described laborer from the Fernald Pilot 

Plant claims chronic sinusitis as a result of his or her employment 

at Fernald. A search of the condition “chronic sinusitis” shows 

that no toxic substances contained within the Fernald database 

match the search criteria, meaning that no known substances 

involved in a work process at Fernald could have induced chronic 

sinusitis.

While this is not sufficient evidence to deny causation, the CE 

must evaluate other evidence to determine whether or not the 

employee’s condition was caused, contributed to, or aggravated by 

his or her employment. 

(b) The CE also can search SEM for toxic substances that cause a 

health effect by searching with a disease or health effect alias. 

That is, if the CE does not know the official name of the disease 

(e.g., pulmonary disease, chronic obstructive, a general term for 

lung ailments that can include emphysema, chronic bronchitis, and 

in some cases asthma) the CE can search by the word “lung.” This 

generates a search of all toxic substances present at a given facility 

that could affect lung function. 

The CE can review the list of substances to determine if they were 

present in the employee’s work process or building and whether 

these substances could potentially cause one of the lung diseases 

commonly referred to as C (COPD). 

(c) The CE uses the “Disease or Health Effect by Alias” search if the 

organ affected by the disease is known. Using this link opens a 

page which allows the CE to find health effects or diseases by 

keying in all or a portion of the formal name of a health effect or 

disease. The SEM provides a list of health effects or diseases, 

which contain the search text in their formal names. For example, 

searching for “liver” returns Hemangiosarcoma of the liver.

c. Searches Specific to Selected Site. This section contains the most recent 

information about covered DOE facilities, uranium mines, uranium mills, and 

uranium transport operations. The CE searches these site fields for specific 

information about a facility, the work processes performed there (e.g., PUREX 

fuel separation, instrument maintenance, welding), and the toxic substances 

involved in those work processes, broken down by labor category (e.g., welder, 

yellow cake operator, electrician).

This group of searchable fields assists the CE in evaluating whether or not the 

employee’s work history meets the presence and contact standard in the causation 

test for toxic substance exposure set out above. The CE searches site-specific 

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fields when the CE knows the site of employment and also when the CE knows 

the building/area of employment, the work process performed and/or the labor 

category claimed.

(1) Site History. This section contains unclassified references from official 

DOE or DOE contractor web sites providing a description of the DOE 

facility or uranium mine or uranium mill. It provides dates of operation, 

known owners/operators, and historical reference data about the site. This 

description is available in SEM for both DOE facilities and uranium mines 

and mills.

(2) Areas. This section is only displayed if the selected site has defined areas. 

All defined areas are viewable by selecting a drop down menu identifying 

each known area by number and/or title. This section is used when the CE 

knows the area in which the employee worked. Work processes, labor 

categories, toxic substances and incidents will be listed for each specified 

area at the site.

For example, the employee claims to have worked on the bull gang in 

Area 16 at the Nevada Test Site from 1966 to 1970 and is claiming 

occupational asthma. The CE searches the Nevada Test Site facility by 

Area and queries Area 16, which shows all known potential toxic 

substances in that area, all labor categories, and work processes.

A search of the toxic substances present at the time of the claimed 

employment shows that of all substances present, cobalt can cause 

occupational asthma. A further search indicates that the bull gang labor 

category, involved in the labor process of reentry and mineback 

operations, is shown as a risk factor for cobalt exposure during the time in 

which employment is claimed. Verification of the claimed employment 

by DOE is sufficient to establish potential exposure.

(3) Buildings. This section is searchable when the CE knows the official or 

unofficial name of the building in which the employee worked. This 

section lists all historical references to the building, hazardous chemicals 

present, the area where the building was located, work processes, labor 

categories, and known incidents involving the building. This search 

category is available only for DOE sites. Data for uranium mines and 

mills will simply state the site history, processes, and searchable labor 

categories.

(a) The building information subsection lists all the major buildings 

(by number and title) at the site (e.g. the K-33 Process Building 

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(b) The CE enters a building by alias, or common name, for a worksite 

that does not appear in the searchable buildings list (e.g., the K-33 

Process Building above is also known as the “Cascade Building”). 

SEM lists the proper names and numbers of buildings to which the 

slang or common name could refer. This search capacity assists in 

locating a building when no formal building name is identified in 

the employment history.

(4) Processes. This section lists all known processes at the 

site (e.g., carpentry, ash crushing, crane operations) and contains the 

related labor categories, timeframes, and toxic substances. This category 

is searchable for DOE facilities and uranium mines and mills. When 

searching for a labor process, the CE may know the type of process in 

which the employee was involved (e.g., welding, drillback core sampling, 

solvent recovery), but not the specific labor category involved. 

Knowing the work process can assist the CE in conducting a search for 

potential exposure to toxic substances, because sometimes several 

different job categories can be involved in one work process and a process 

might be spread out among several different buildings within a facility 

(e.g., a process operator at Portsmouth GDP involved in cascade 

operations could have worked in X-326, X-330 and X-333, all buildings in 

which the work process “cascade operations” took place).

(a) DOE facilities list all processes known to have occurred at the site. 

For instance, if the CE knows an employee worked in Building 

202-A at the Hanford Site, SEM indicates that the process in that 

building was PUREX fuel separation, lists all labor categories 

involved in this operation, and the toxic substance present when 

this operation took place. 

This assists the CE in determining the toxic substances to which an 

employee could potentially have been exposed, based upon the 

process listed and the timeframes in which the employee may have 

been involved in such processes. 

(b) For RECA mills, the following categories are examples of 

processes: laboratory, maintenance, and all other than laboratory 

and/or maintenance. Some mills did not have a laboratory 

component and therefore list fewer than three processes (e.g., Slick 

Rock in Colorado lists only maintenance and all processes other 

than maintenance). The CE must identify the labor sub category 

(actual work performed) whenever possible. 

For example, if the CE knows that an employee worked as a 

bulldozer operator at Grand Junction in Colorado, the CE searches 

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the labor subcategory field to identify that job title. Once it is 

identified, the CE clicks on the bulldozer labor subcategory and 

finds that a bulldozer operator is classified in the labor process “all 

other than laboratory and maintenance.” All potential toxic 

substance exposure for that subcategory and labor process group is 

listed, and the CE can match the findings against the 

claimed/verified illness and exposure. 

(c) Much of the work performed at RECA mines was fairly uniform 

and easily categorized with regard to process. While SEM does 

not list work processes for a RECA mine, labor categories exist as 

outlined below. Only exposure arising from processes and work 

that actually took place at a uranium mine or mill is considered 

when evaluating a claim for causation.

(d) Individuals employed in the transport of uranium ore or vanadiumuranium ore to and/or from covered RECA mines or mills are 

covered under the EEOICPA. However, when developing 

exposure for an ore transporter, the CE only counts exposure that 

could potentially have taken place on the premises of a covered 

RECA mine or mill.

Exposure that could have potentially occurred when the ore 

transporter was in transit is not covered under the EEOICPA and is 

not considered by the CE when developing for causation. See 

Chapter 19 for a more complete discussion of covered exposure 

under RECA. 

(5) Labor Categories. The CE can search by labor category if the employee’s 

job title or job title alias specific to a certain facility is known. It is 

important to narrow down employment verification requests and 

information obtained on Form EE-3 to determine the exact labor function 

performed by an employee if possible. 

The RC staff must make certain to obtain the most specific employment 

information that is available from the employee/survivor and the 

employment verifier entity when conducting initial employment 

verification.

The CE must conduct additional development where necessary to further 

identify the exact definition of the employee’s functions and the 

timeframe(s) of those functions at a given site, seeking the greatest 

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(a) Labor category information lists all the labor classifications or 

work group titles at the site (e.g., electrician, crane operator, 

barrier operator).

(b) If the employee’s job title does not appear on the drop down list of 

labor categories above, the entry on the claims form may be a 

slang or unofficial title. The CE may be able to find the official 

labor category, (e.g., maintenance mechanic) by keying in the 

slang or commonly used title (e.g., pipe fitter). 

(c) Construction worker exposures are separated into two categories: 

those due to toxic substances inherent to the construction craft, and 

those caused by performing the construction work on a DOE site. 

The CE must consider both exposure categories when assessing 

exposure for construction workers. 

Construction exposure is searched as its own category outside of 

the facility lists. As such, it does not matter where the construction 

took place. If the CE is searching SEM for a construction worker’s 

claim, the CE searches by toxic substance and by work process 

(e.g., adhesive work, brazing, carpentry) and labor category (e.g., 

electrician, millwright, iron worker). Searches for construction 

trade exposures contain the same toxic substances, work processes, 

and labor categories for all covered facilities. 

(d) For RECA mines, three labor categories are listed: prospecting, 

mining, and support/maintenance. The CE determines the duty 

performed (e.g., mining or maintenance) when searching SEM for 

information about a site listing more than one process. Some sites 

list only one possible work process and the CE need only confirm 

that employment is claimed or verified at the given site.

Once the work process is identified at the mine where employment 

took place, the CE can search a list of toxic substances to 

determine the one(s) to which an employee could have potentially 

been exposed while working at the mine. 

For instance, the Arrowhead #1 mine in Eagle County, Colorado, 

lists “prospecting, no mining” as the only work process performed 

at that site. This means that the only work process performed at 

the Arrowhead #1 site was prospecting for uranium and that no 

actual uranium mining operations took place at that site.

The Bay Mule mine in San Miguel County, Colorado, lists 

“mining” as its only work process. A mixture of possible work 

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processes will be listed for the RECA facilities depending upon 

what type of work activities actually occurred at the site.

 

(6) Incidents. The incident information field lists known major incidents and 

accidents experienced at the site. The entries provide a brief descriptive 

title of the incident, the year the incident occurred, and the location of the 

incident (building or area). An example would be: Uranium cylinder 

rupture and release, 1976, Building X-344. 

(a) This information may assist in corroborating a claim if the 

claimant has referred to a particular accident or incident as having 

caused acute or extreme exposure to a toxic substance. Facility 

incident and accident information may be found in DAR responses, 

employment records, DOE FWP records, and OHQ summaries. 

(b) The CE must evaluate incidents and accidents with regard to the 

evidence of file as a whole. Simply corroborating a claimed 

exposure is not sufficient to establish causation. The CE must 

review the medical evidence and, if necessary, seek the opinion of 

an IH or CMC about the possibility as to whether or not the type of 

incident or high exposure event (as viewed in association with the 

evidence as a whole) could prove a significant factor in causing, 

contributing to, or aggravating the claimed illness. Further, certain 

incidences of high or extreme exposure should be considered when 

evaluating whether or not a required disease latency period can be 

eased or waived entirely.

(7) Exposure Factors. This section lists the safety programs, risk factors and 

timeframes used to gauge an employee’s potential exposure as it relates to 

work process, labor category, building, and area. 

(a) Safety programs serve as controls that may have reduced the 

likelihood of employee exposure to toxic substances (e.g., through 

use of respirators, protective clothing). 

(b) Risk factors are conditions or practices that may have increased the 

likelihood of employee exposures to toxic substances, such as 

periods of time when employees were not properly protected. 

(c) Timeframes reflect known periods within which a known 

correlation exists. For example, certain timeframes outline the 

period in which it is known that a certain toxic substance was 

present in a certain building (e.g., from 1956 to 1988 ammonium 

fluoride was present in Area 200 East and involved in the work 

process of PUREX fuel separation activities).

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Also, timeframes outline periods in which certain safety programs 

or measures were in place at a given building or area. This 

information may assist the CE when evaluating the likelihood that 

a claimant was exposed to a toxic substance.

Safety Control Example: In 1999, DOE enforced beryllium 

controls such that work could only be performed in certain 

buildings. The employee claims beryllium illness from beryllium 

exposure in 2000, yet the employment evidence shows that he or 

she worked in a building where beryllium was never present due to 

DOE controls. When dealing with beryllium, the CE must be 

aware of the potential for residual contamination, and in this 

instance it must be unequivocally verified that beryllium was never 

present at the facility in question.

d. Links within Searchable Fields. Within SEM the various areas, facilities, 

buildings, processes, activities, labor categories, incidents and toxic substances 

which are known to have existed or occurred onsite are linked to one another. For 

example, such relationships expressed in the matrices might be:

(1) “Toxic xxx was in building aaa at some time;”

(2) “Activity bbb was performed by Labor Category ddd and involved work 

with Toxic yyy in Building lll;”

(3) “Activity bbb was performed during Labor Process ddd and involved work 

with Toxic zzz in Building lll;” and

(4) “Labor category ppp involved work at all parts of the site”). 

e. Sample SEM Search # 1. DOE verifies employment at the Portsmouth GDP from 

1955 to 1960. Form EE-3 indicates that the employee worked as an instrument 

mechanic in Building X-333 from 1955 to 1960. The verified diagnosed medical 

condition is aplastic anemia.

A search of the SEM by Health Effect shows that aplastic anemia can be caused 

by arsenic, benzene, and plutonium exposure. The CE further consults the HazMap database link which provides a description of aplastic anemia and indicates 

that arsenic, benzene, and plutonium are among the hazardous agents that can 

cause the disease. A latency period of weeks to years is indicated.

The Building information for Building X-333 lists all known chemicals used at 

that site, and arsenic, benzene, and plutonium are among them. The SEM further 

shows that the Labor Process of Instrument Maintenance took place in Building 

X-333 from 1953 to 1957 and lists the Labor Category Instrument Mechanic as 

involved in this process during this timeframe. 

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The CE reviews the SEM findings as well as other relevant evidence (medical 

opinions provided by qualified physicians that opine a link between the 

occupational exposure and the aplastic anemia, DAR records showing definite 

arsenic and benzene exposure, DOE FWP records, and OHQ results supporting a 

finding of potential occupational exposure to benzene, arsenic and plutonium) to 

determine whether sufficient evidence exists to accept the claim. In this instance, 

the evidence as a whole supports acceptance.

f. Sample SEM Search # 2. An employee claims employment as a chemical 

operator in Building X-705 at the Portsmouth GDP from 1966 to 1982. DOE 

confirms the employment. The employee is claiming asthma and chronic 

bronchitis, and medical evidence diagnosing COPD has been received. The CE 

reviews the OHQ and finds that the claimant indicated in his interview that he 

does not know specifically what chemicals he was exposed to, but does recall 

working with an acidic substance with a sour, vinegar-like odor. 

The CE reviews SEM, searching by labor category and building, and finds that 

acetic acid was used in the employee’s work process in Building X-705 and that it 

has a sour, vinegar-like odor. A SEM search for health effects for acetic acid 

shows that it is known to be associated with occupational asthma. The DAR 

record response does not show that the claimant worked with acetic acid in the 

course of his employment, but that he did come into contact with various solvents. 

The CE should follow up with the treating physician to clarify the diagnosis. The 

CE may consider referral to a CMC to review the evidence and determine whether 

or not the potential for acetic acid exposure caused the claimant’s lung condition. 

The CE will also want the CMC to try and specify the lung condition. 

g. RECA SEM Searches. When searching for a specific RECA location (mine or 

mill), the CE locates the facility by the state in which it operated, by its name, or 

by its alias. For instance, the uranium mill “Durango” can be found by searching 

mills in Colorado, by the name “Durango,” or by searching the site alias: 

Vanadium Corp of America, or VCA. RECA mines are also located in SEM by 

the county in which they operated. RECA mine and mill work process categories 

are more general than the DOE work process categories. The CE attempts to 

determine the exact labor category (specific job title or activity) whenever 

possible when conducting a SEM search about a RECA facility. 

Uranium mines are categorized as being either underground or surface mines, and 

typical mining operations include the following: drilling; blasting; shovel/machine 

digging; and hauling materials.

11. SEM Inquiries. Whenever a SEM query is conducted, the CE must document the case 

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a. Prior to issuing a RD denying benefits, the CE must ensure that the most updated 

version of the SEM data is contained in the case file and referenced properly in 

the decision. 

(1) This is done by double checking the search initially conducted to make 

certain that an element not found in the initial search (i.e., a toxic 

substance) has not been added to the SEM since the date of the initial 

search. The CE prints out the results of the new search immediately prior 

to issuing the RD. 

(2) The CE must make certain that the SEM record is properly preserved in 

the case file for FAB review. SEM will show the latest date on which an 

update was made to the system that changes the data available about a 

given facility.

(3) If the date listed in SEM remains the same as it was when the original 

search was conducted, the CE will know that no new information has been 

added to SEM and no new search is required. However, if the date has 

been changed since the date of the last search, the CE must search SEM 

again to determine whether additions or changes will change the outcome 

of the SEM search and potentially affect the outcome of the adjudication. 

b. Decisions Issued As Needed. Because SEM is a living document that is updated 

as data becomes available, the CE does not wait for information in SEM to be 

updated before issuing a decision. If a SEM search is conducted and no 

information is available, or the site is not yet complete or searchable in the 

database, the CE issues a decision after developing the case as completely as 

possible, pursuant to normal procedures. 

c. FAB Review. FAB ensures that the SEM search was conducted, where 

applicable, during the FAB review of the RD. 

(1) FAB may remand the case to the DO if a SEM search was needed but not 

conducted, or if the search was conducted improperly in a way that 

materially affects the outcome of the RD, or if the SEM data relied upon 

by the DO was changed or updated significantly enough to warrant 

additional development or a potentially different adjudicatory outcome. 

(2) Before issuing the FD, the FAB must ensure that the SEM record is the 

most complete and updated data available in SEM and that no significant 

changes (additions of toxic substances or changes in work process 

definitions or timeframes) have been made since the issuance of the RD. 

(3) This checking of the SEM search data to determine whether or not a new 

data element was added that will alter the outcome of the decision is 

conducted in the same manner as set out in 11.a above for denied RDs.. 

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(4) The FAB CE/ HR does not print out a copy of the new SEM search unless 

the search result differs from the search conducted by the DO CE. In this 

case, the FAB CE/HR prints a copy of the SEM results and scans to OIS. 

 

(5) If new evidence is uncovered that does alter the findings of the RD, a 

remand order may be necessary. However, if the SEM data is updated 

after the issuance of the RD or the DO SEM search, and such update does 

not affect the outcome of the decision, a remand is not warranted. 

(6) The FAB CE/HR must clearly indicate in all Remand Orders and FD’s 

that the FAB conducted its own SEM search. In the discussion, the FAB is 

to state whether the search validates the findings of the DO or that the 

search produced results that differ from the DO search. If the results differ 

from the DO search, then FAB is to briefly explain its potential impact on 

the outcome of the claim (i.e. the results are the same as the DO CE results 

and has no impact on the outcome, or the search results differ but has no 

impact on the final outcome, or the results differ from the DO CE search 

and possibly changes the outcome of the claim). 

d. Use of SEM Findings. When using SEM as a finding in an RD or a decision of 

the FAB, the CE/HR cites the technical document upon which the SEM data 

search result is founded, as well as SEM, in the decision. As always, the DO CE 

or FAB CE/HR clearly outlines the rationale for accepting or denying causation 

based upon all of the evidence weighed as a whole. Below is an example of the 

language approved for use when referencing SEM.

Decision Language Example: Source documents used to compile the SEM

establish that a person in the labor category of “Operator” at the Savannah River 

Site could potentially be exposed to the toxic substance asbestos. The SEM lists 

asbestosis as a possible specific health effect of exposure to asbestos and contains 

a list of the buildings at the Savannah River Site where that particular toxic 

substance is or was present during the years that the claimant worked there. The 

employment record provided by the DOE contains several numbers that appear to 

reference the employee’s work location including a number G160-235. The most 

comparable building listed in the SEM was 235F. Data contained in SEM for 

235F establishes that asbestos was used in this building and that the labor 

category of “Operator” is associated with this building.

12. NO Specialist Review. If the CE identifies an exposure issue that requires review by an 

IH, the CE alerts his or her supervisor. Prior to seeking NO assistance, the CE must exhaust all 

reasonable exposure development pursuant to the guidance set out in this Chapter. 

If the supervisor grants approval for the referral, the CE prepares an e-mail to the Health 

Services Program Analyst (HSPA) requesting review. The HSPA forwards the e-mail to a 

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MHSU specialist who reviews the contents and assigns the question to the appropriate specialist 

based upon their scientific discipline. 

However, if the MHSU specialist determines that the issue does not warrant a referral, the e-mail 

is returned instructing the CE to pursue further development. Once the issue is assigned to an IH 

for review, the IH conducts such review and responds to the CE in a timely manner. 

a. Questions for IH. The CE outlines succinctly what information is known about 

the issue (e.g., the employee was a stainless steel welder at Savannah River from 

1982 to 1985 who is diagnosed with asthma) and what is needed from the expert 

(could the employee have been exposed to nickel)? The CE uses the information 

in SEM and the case file as a whole to frame the question as carefully as possible 

based upon the claimed employment, process and illness. A Statement of 

Accepted Facts (SOAF) must accompany the referral to the IH. A sample SOAF 

is included as Exhibit 15.3. 

(1) The facility in question (narrowed down to building and area where 

possible) and the work performed is always a critical factor when querying 

the IH about exposure. The CE uses SEM whenever possible to assist in 

this narrowing process, but if no information exists in SEM, the CE crafts 

the question as best as possible based upon whatever evidence is available 

in the case file.

(2) The CE may also forward a general question about a facility when 

information cannot be found in SEM and the facility in question is either 

not yet uploaded to SEM or the data is incomplete. 

For instance, a CE may need to know whether asbestos was present as a 

general rule in the Clarksville facility. The CE may ask a general question 

such as this of the IH, but should include as much specificity in the query 

as possible, especially labor category, processes, and time periods. 

b. IH Review. The IH reviews the issue framed by the CE and determines whether 

more information from the case file is required to answer the question, or if the 

entire case file is needed. The IH role is to anticipate, recognize, and evaluate 

hazardous conditions in occupational environments, and to opine based upon his 

or her specialized knowledge. The IH strives to answer the question based upon 

the information outlined by the CE. 

However, if additional information is required, the IH may request whatever 

documentation from the case file is necessary. If required, the IH requests the 

entire case file if individual pieces of information from the file will not suffice to 

answer the question posed by the CE. 

(1) The IH mainly addresses issues about routes of exposure (e.g., whether or 

not a welder at a given facility could have been exposed to nickel). An IH 

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also may verify whether or not a toxic substance was/could have been 

present during a certain work process (e.g., welding, or instrument 

maintenance) at a given site, or if a certain labor category (e.g., welder, or 

instrument mechanic) could have come into contact with a given toxic 

substance in the performance of his or her duty at the site. 

The IH may also be asked to determine the plausibility that a certain toxic 

substance was present or that a claimed exposure could have occurred 

based upon the work history and/or accident/incident report.

(2) The IH also reviews SEM searches performed by the DO to determine 

whether or not they were performed correctly and accurately.

c. Request for Case File. If the IH requests the entire case file, the CE prepares the 

WS/WR memorandum for the DD’s signature. The WS/WR memorandum is 

addressed to the Policy Branch Chief at NO. Upon receipt of the case file, the 

Policy Branch Chief forwards the case file to the IH for review. 

 

d. IH Memorandum. The IH renders an expert opinion in the form of memorandum 

that addresses the issue as specifically as possible. The IH’s reply addresses the 

specific question posed by the CE in the e-mail/SOAF/WS/WR memorandum, 

and employs his or her specialized training to make findings based upon the 

evidence of file and clearly rationalized science.

e. CMC Referrals to IH. In certain instances, a case forwarded to a CMC may not 

contain enough information regarding occupational toxic exposure for the CMC 

to render an expert opinion. In these situations, the CMC should refer the case to 

an IH through the DO. 

(1) CMC referrals for causation which do not adequately identify a route and 

extent of exposure require the CMC to contact the Medical Scheduler 

(MS) via e-mail within 3 days of receipt of the referral package, and 

request an IH referral. If exposure data are inadequate due to an 

incomplete SEM profile, incomplete DOE records, or other missing 

information that makes a causation determination impossible without a 

clearer exposure evaluation, then an IH referral is warranted. 

If the Medical Scheduler is unavailable the CMC should then contact the 

assigned CE.

(2) The MS forwards the CMC’s IH referral request via email to the assigned 

CE for review. A copy of this email is placed in the case file. Telephone 

requests for an IH referral must be documented ECS. 

(3) Upon receipt of the email from the MS, the CE forwards the case file and 

SOAF to the Supervisor/Senior CE for review. If the Supervisor/Senior 

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CE concurs with the need for an IH referral, he or she sends an email with 

the SOAF attached to the HSPA located at the NO, requesting an IH 

review and places a copy of the SOAF and the sent email in the claimant’s 

file. The CE enters correspondence in ECS to document that the case was 

sent to the Policy Branch for review. The correspondence entry ensures 

that the time taken for review by an IH will not be counted as time 

necessary for CMC review.

(a) Upon receipt of the email from the Supervisor/Senior CE, the 

HSPA assigns the referral to an IH.

(b) The IH reviews the SOAF and any other relevant information that 

may be requested, and renders an expert opinion in the form of a 

memorandum based upon the facts of the claim, the information 

available through SEM, and professional judgment regarding the 

likelihood and extent of any exposure(s). The IH then emails a 

copy of the memorandum to the CE, Senior CE, and Supervisor. 

(c) The IH has 15 days from receipt of the referral to complete the 

memorandum. If 15 or more days pass without receipt of the 

memo, the CE notifies the Senior CE/Supervisor, who then follows 

up with an email to the HSPA.

(d) When the IH memo is received the CE reviews the opinion to 

ensure that the question asked has been sufficiently answered, 

gives a copy of the memorandum to the MS, and places a copy in 

the claimant’s file. The CE then enters the receipt date into ECS 

correspondence to indicate that the response was received from the 

Policy Branch. 

(e) The MS will FedEx a copy of the IH memorandum to the CMC for 

review and notify the CE, Senior CE, and the Supervisor via e-mail 

of when this action was taken. 

(4) The CE continues to monitor and track the file after the IH memorandum 

has been furnished to the CMC. 

(a) The CMC has 21 days from the date of receipt of the IH 

memorandum to return a completed report accompanied by a bill 

to the MS. If the CMC report is not received within 21 days from 

the date of the IH memorandum, the CE notifies the MS, who 

follows up with a phone call to the CMC. The call is documented 

in ECS. 

(b) If, upon review of the IH memorandum, the CMC has questions, 

the CMC contacts the IH via email.

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(5) If the Supervisor/Senior CE determines that the case does not warrant an 

IH referral after receiving the SOAF and file from the CE, the 

Supervisor/Senior CE returns the SOAF and case file to the CE with 

instructions to pursue further exposure development. 

(a) The CE notifies the MS via email that further exposure 

development is needed, places a copy of the sent email in the case 

file, and mails an exposure development letter to the claimant. In 

the letter to the claimant, the CE advises that exposure 

development is needed for adjudication. Upon mailing the request 

to the claimant the CE enters a note in ECS describing the action 

and inserts a 30-day call-up. 

(b) The MS notifies the CMC via phone that further exposure 

development is needed for the case. The call is documented in 

ECS.

(c) After 30 days has passed with no response from the claimant, the 

CE prepares a second letter to the claimant (accompanied by a 

copy of the initial letter), advising that following the initial letter, 

no additional information has been received. The CE advises that 

an additional period of 30 days will be granted for the submission 

of requested information, and if the information is not received a 

decision will be issued. 

(d) The CE notifies the MS via email that the requested information 

has not been received, places a copy of the sent email in the case 

file.

(e) Upon receipt of the email from the CE the MS prepares a letter to 

the CMC notifying that the requested information has not been 

received. In the letter, the MS requests the CMC to return or 

destroy the case material. A copy of this letter is placed in the case 

file.

(f) If the claimant submits relevant exposure data in response to the 

CE’s request, it must be reviewed to determine if it is of sufficient 

probative value to request an IH referral or return to the CMC. If 

the CE determines that there is insufficient evidence to warrant an 

IH referral, a decision can be issued. If the CE determines that the 

new information is sufficiently comprehensive to obviate the need 

for IH review, referral to the CMC can be completed.

f. Complex Referrals. Some referrals to NO will be so complex as to require IH and

medical or possibly toxicology review. In these instances, the NO Medical 

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Director and/or the NO TOX may also review the case materials/case file to assist 

in addressing the CE’s inquiry. The proper specialist will be determined by an 

MHSU specialist at NO upon review of the query and/or case file materials. The 

NO Medical Director and/or TOX will provide expert opinions in such cases 

where a review is necessary by more than one specialist at the same time.

If an issue referred to the NO contains elements that might require expertise in the 

field of occupational exposure, medicine, and/or toxicology, it is forwarded to NO 

as outlined above with an initial e-mail query. The appropriate specialist(s) will 

review the query and determine what additional information (including the case 

file) is necessary to resolve the issue at hand.

g. Synergistic or Additive Effect. In certain instances a physician might opine that a 

claimant’s radiation and toxic substance exposure together worked in tandem to 

produce a synergistic or additive effect that brought about a cancer. DOL has not 

found scientific evidence to date establishing a synergistic or additive effect 

between radiation and exposure to a toxic substance, and if the physician presents 

this finding he or she must provide actual scientific or medical research evidence 

to support the finding before the CE may consider the assertion. (Guidance 

regarding establishing causation for hearing loss and asbestosis is found in 

Exhibit 15-4.) 

If a physician makes this assertion the CE requests that the physician provide 

medical evidence of a synergistic or additive effect and a clearly rationalized 

medical opinion as to whether or not the effect is of a significant nature to 

establish that the combination of the radiation and the exposure to a toxic 

substance was “at least as likely as not” a significant factor in aggravating, 

contributing to, or causing the cancer. 

(1) If the physician provides rationalized scientific evidence revealing a 

synergistic or additive effect, the DO sends the case file to NO for review 

by a NO HP and/or the DEEOIC Medical Director. The HP reviews the 

physician report and all evidence of file and drafts a memorandum 

containing his or her professional opinion as to causation which is sent to 

the CE for use in issuing a determination in the case. 

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CHAPTER 16 – DEVELOPING AND WEIGHING MEDICAL EVIDENCE

1. Purpose and Scope. Proper development and weighing of medical evidence is essential 

to the sound adjudication of claims for benefits and to the comprehensive management of 

EEOICPA claims. This chapter discusses the function of a CE in developing and evaluating 

medical evidence and weighing conflicting medical opinions. 

2. Sources of Medical Evidence. Most medical reports come from one of these sources: 

a. Claimant's health care provider, which includes the attending physician, 

consulting experts, and medical facilities. The CE may consider treatment 

records from a clinic operated at an employing facility as medical evidence. 

b. The DOE Medical Monitoring Programs, administered by certain DOE facilities, 

maintain medical examination records and exposure data on their employees. For 

example, the DOE FWP began in 1996 and functions to evaluate the effect of the 

DOE's past operations on the health of former workers at DOE facilities, and to 

offer medical screening to former workers. 

c. ORISE administers the beryllium screening program by providing berylliumrelated testing at locations across the country. ORISE offers extensive testing for

CBD and medical monitoring to individuals testing positive for beryllium 

sensitivity. 

d. CMC. Furnishes medical opinions, guidance, and advice based upon review of the 

case file. Moreover, the physician provides independent and rationalized 

responses to CE questions regarding various medical issues that may arise during 

case adjudication, such as causation, impairment, wage-loss, or medical necessity 

of care. 

e. Second Opinion Physicians are physicians contracted by the DEEOIC to provide 

a narrative report describing the findings from physical examination of a patient 

and review of diagnostic testing or other medical records. 

f. Referee Specialists are physicians of an appropriate specialty, chosen randomly, 

to examine the employee or a case file and furnish a rationalized medical opinion, 

to resolve a conflict of medical opinion in a case between the employee’s 

physician and a CMC, Second Opinion Physician, or other medical specialist. 

3. Types of Medical Evidence. Medical evidence in EEOICPA cases consists of the 

following major categories:

a. Treatment records are the most prevalent form of medical evidence. They consist 

of any record made during the evaluation, diagnosis and treatment of a patient by 

his or her health care providers. They include: 

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(1) Attending physician records (e.g., chart notes, reports, etc.) which include 

records from medical consultants assisting the attending physician.

(2) Records of physicians consulted by the patient for an independent medical 

opinion. 

(3) Evidence of diagnostic testing (e.g., X-ray films, electrocardiogram (EKG) 

tracing, etc.) and the reports of medical providers interpreting the tests. 

For the purposes of interpreting tests, medical providers include 

physicians as defined in Section 30.5(dd) of the regulations. 

(4) Treatment records from hospitals, hospices, in-home health or residential 

health care facilities. 

b. Medical evaluations may occur for a variety of reasons other than to further the 

diagnosis and treatment of the patient. The purpose of the examination 

distinguishes medical evaluations from treatment records. Medical evaluations 

include: 

(1) Evidence from the DOE’s FWP (e.g., former worker screening records, 

pre-employment physicals, termination physicals, etc.)

(2) Examinations required under state or federal compensation programs [e.g., 

evaluations for SWC) claims, Social Security disability examination, 

Veterans’ Administration (VA) programs, etc.] 

(3) Medical reports or opinions obtained for litigation under state or federal 

rules of evidence.

(4) Reports produced in response to a DEEOIC referral to a CMC, Second 

Opinion physician, or Referee Specialist. 

d. Other types of evidence include:

(1) Cancer Registry records may be used in some cases to establish a 

diagnosis of cancer and date of diagnosis. 

(2) Death certificates which contain information about the cause of death or 

date of diagnosis. (See Section 7 of this chapter for additional information 

regarding death certificates.) 

(3) Secondary evidence relied upon by a physician in forming an opinion. For 

example, a doctor may rely upon the information provided by a medical 

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(4) Affidavits containing facts based on the knowledge of the affiant 

regarding the date of diagnosis. 

4. Contents of a Medical Report. The value of findings and conclusions contained in medical 

records varies.

a. Treatment Records. 

(1) A doctor’s report of examination usually contains a description of 

subjective complaints, objective findings, assessment, and a plan for 

follow up or treatment. The Subjective, Objective, Assessment and Plan 

format is often shown in the medical records by the letters S, O, A and P. 

Even where the “SOAP” abbreviation is not used, the records tend to 

follow this pattern.

(a) The subjective section records information obtained from the 

patient. It generally contains information about why he or she is 

seeking treatment, complaints, medical history and current 

treatment. A subjective section might state, for example, “Patient 

comes in today to have us look at a lump on his neck that has 

gotten larger over the last month.” 

(b) The objective section records the physician’s findings based on his 

or her observation, examination and testing. An objective section 

might state, for example, “The patient’s breathing is labored and 

his X-ray shows a spot on his left lung.” The three general classes 

of objective findings are: 

 

(i) Laboratory findings such as complete blood count (CBC), 

tissue biopsy, bone marrow smear or biopsy, BeLPT, etc. 

(ii) Diagnostic procedures such as X-rays, ultrasound, 

computerized axial tomography (CAT) scans, magnetic 

resonance imaging (MRI), electromyelogram (EMG) and 

similar techniques of visualizing or recording physiological 

conditions. Some objective tests are subject to greater 

interpretation by the physician. 

(iii) Physical findings that are noted by the physician’s visual 

inspection, palpation and manipulation of the body. They 

include description of demeanor, readings of temperature or 

pulse, description of respiration, observation of affect, etc. 

(c) The assessment section contains the physician’s opinions, 

suspicions and diagnoses. In most cases, the value of a medical 

report is determined by the quality and detail of the narrative 

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describing the physician’s assessment. The scope of the 

assessment will vary with the type of medical condition and its 

complexity. 

The assessment section may contain statements such as, “The 

pathology report was reviewed and showed the presence of small 

cell carcinoma of the lung.” or “Based on the patient’s rest tremor, 

balance problems and rigidity of muscles, he has Parkinson’s 

disease.” 

(d) The plan section describes the treatment plan and prognosis. The 

physician may, for example, prescribe medication, refer the patient 

to a specialist, or suggest additional testing. 

(2) Reports of tests and procedures should contain the employee’s name, date 

of the test, the objective data obtained, and the signature of the person 

responsible for conducting the test or procedure. Where appropriate, 

reports should include a physician’s interpretation of laboratory tests or 

diagnostic procedures. 

Tests for which interpretation is necessary include, but are not limited to, 

pathology reports, BeLPT, X-rays, MRI, CAT scans, Pulmonary Function 

Tests (PFT), Minnesota Multiphasic Personality Inventories (MMPIs), and 

the Beck Depression Inventory. In cases where the physician offers 

insufficient interpretation of medical evidence, the CE must seek 

clarification either from the source of the report, or a CMC referral, as 

appropriate. The CE is not to interpret test results, as that is a medical 

judgment to be made by a medical professional. 

(3) Hospital, hospice and clinic records will contain the same type of 

physicians’ records and diagnostic testing as outlined above. Also, the CE 

should review the admission summary, surgery reports, nursing notes, the 

discharge summary, autopsy reports, etc. 

b. Medical Evaluations. Generally, medical evaluation reports contain the following 

types of information: 

 

(1) An explanation as to why the physician is conducting an examination of 

the patient. The report may state, for example, “Mr. Smith is referred by 

the DOL for an independent medical evaluation regarding his claim for 

asbestosis.”

(2) A description of the information the physician has reviewed and relied 

upon in reaching his or her conclusions. This often includes a discussion 

of the course of treatment, which describes past treatment undergone by 

the patient, and the physician’s recommendation for present and future 

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care. References to studies and other medical or scientific data that 

supports the analysis may also be included. 

(3) A description of any examination and tests performed during the 

evaluation. 

(4) The opinion(s) of the evaluating physician with an explanation of the 

rationale supporting his or her conclusion. 

c. DEEOIC Referrals. The CMC, Second Opinion physician, or Referee Specialist 

reports should contain the same general information as any other medical 

assessment. In addition, the report should contain a well-reasoned response to 

questions presented by the CE, including a summary of the evidence and medical 

references used.

5. Developing Medical Evidence. Although it is ultimately the responsibility of the 

claimant to submit medical evidence in support of his or her claim, the CE is to assist the 

claimant in collecting evidence necessary to establish a compensable medical illness. This 

includes communicating with the claimant to explain deficiencies in case evidence, requesting 

supportive documentation, and allowing reasonable time for the claimant to provide a response. 

The CE also assists by taking affirmative action to obtain medical evidence through 

communications with treating physicians and/or other medical providers. Assistance can also be 

achieved with the use of Program resources to obtain clarifying medical evidence including the 

use of a CMC, Second Opinion physician, or Referee Specialist. The development of medical 

evidence is performed in various aspects of case adjudication: to establish diagnosis, to establish 

causation, to determine a percentage of impairment in impairment claims, to establish a causal 

relationship between a covered illness and wage-loss, and to resolve inconsistencies and conflicts 

in medical opinions. 

a. Physicians and chiropractors. Medical evidence must be from a physician. The 

definition of a physician includes surgeons, podiatrists, dentists, clinical 

psychologists, psychiatrists, occupational medicine practitioners, optometrists, 

and osteopathic practitioners within the scope of their practice as defined by state 

law. Chiropractors may only be considered physicians in EEOICPA cases for 

treatment of manual manipulation of the spine to correct a subluxation that is 

demonstrated to exist by X-ray (usually relevant only in consequential injuries.) 

However, chiropractic care may be authorized as treatment for an accepted 

condition. Any such treatment must be prescribed by the authorized treating 

physician, and the physician must provide rationale as to how the treatment in 

question relates to the covered condition. 

b. Deficient Evidence. During adjudication of a claim, there are many topics that 

require evaluation of medical evidence including: medical diagnosis, 

interpretation of diagnostic evidence, causal relationship between illness and 

occupational toxic substance exposure, permanent partial impairment, effect of 

illness on historical wages, and medical necessity of care or other service needs. 

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In each of these matters, legal, regulatory, or procedural guidance exists through 

on-line Programmatic resources (Bulletins, Circulars, EEOICPA Regulations, 

etc.) to instruct the CE on evaluating the sufficiency of evidence submitted in 

support of a claim. The CE is to adhere to these guidelines and to direct 

development in a manner that will best overcome evidence omissions or 

deficiencies. 

c. Telephone Requests. In many situations, a minor deficiency in medical evidence 

can be easily overcome with a telephone call to the physician’s office to request 

specific documents. If, however, a phone call does not produce an immediate 

result (i.e., a fax of the required documentation) the CE should send a written 

request. If the physician’s office indicates that the medical evidence will be 

mailed, the CE will follow-up with written correspondence memorializing the 

telephone call and noting the specific documents that are being requested. 

(1) The CE must document the call in ECS. 

 

(2) Statements made by the physician over the telephone do not constitute 

valid medical evidence.

d. Written Requests. The CE may decide that the best method of collecting the 

evidence is to submit a written inquiry directly to the physician (with a copy to 

the claimant). However, the CE has the authority to submit written requests for 

information to any possible source that may reasonably be able to provide a 

substantive response to a need for medical documentation. A written request for 

information is to communicate the identified defect, in a clear and concise 

fashion, and the various options available for presenting information or 

documentation that will best overcome the defect. 

(1) If records are requested from a treating physician or other sources, the 

Form EE-1/EE-2 submitted by the claimant serves as a medical release to 

obtain the requested medical information. 

(2) If a reply is not received within 30 days or the response does not resolve 

the deficiency, the CE considers other options for obtaining the required 

medical evidence (e.g., a CMC referral, cancer registry or death 

certificate). Reasonable time extensions may be granted by the CE. It 

may be helpful to initiate telephone contact with the recipient to gauge the 

likelihood for response, or to respond to questions or other concerns. 

e. Unavailable Medical Records. If the CE obtains information that pertinent 

medical records have been destroyed or are otherwise unavailable, the CE should 

attempt to obtain from the physician written confirmation which contains the 

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(1) An affirmation that the physician treated the employee for the claimed 

condition(s). 

(2) A statement that the requested medical records are no longer available. 

(3) A discussion that includes the diagnosis and date of diagnosis. 

(4) The physician’s signature and the date signed. 

6. Weighing Medical Evidence. When the CE receives medical evidence from more than 

one source, he or she must evaluate the relative value, or merit, of each piece of medical 

evidence. This is particularly important in cases where there is a conflict between the medical 

evidence received from a CMC and a treating physician. A thorough understanding of how to 

weigh medical evidence will assist the CE in determining when and how further medical 

development should be undertaken. The CE should also understand how to assign weight to the 

medical evidence received. 

a. How to Evaluate Evidence. In evaluating the merits of medical reports, the CE 

evaluates the probative value of the report and assigns greater value to:

 

(1) An opinion based on complete factual and medical information over an 

opinion based on incomplete, subjective or inaccurate information. 

Generally, a physician who has physically examined a patient, is 

knowledgeable of his or her medical history, and has based the opinion on 

an accurate factual basis, has weight over a physician conducting a file 

review. For example, a physician who opines that his patient’s lung 

cancer is related to exposure to diesel engine exhaust has less probative 

value if the opinion demonstrates no knowledge of the frequency or levels 

of exposure to diesel engine exhaust. 

(2) An opinion based on a definitive test(s) and includes the physician’s 

findings. Some medical conditions can be established by objective testing. 

A positive pathology report from a physician is sufficient evidence of the 

diagnosis of cancer. However, a physician’s opinion that a patient has 

cancer is of little probative value if the pathology report shows no 

malignancy. A physician’s report of a positive BeLPT or lung lavage cells 

showing abnormal findings is sufficient evidence of the diagnosis of 

beryllium sensitivity. 

It is important for the CE to undertake appropriate steps to work with a 

treating physician in the collection of evidence, before referring the case to 

a CMC. 

(3) A well-rationalized opinion over one that is unsupported by affirmative 

evidence. The term “rationalized” means that the statements of the 

physician are supported by an explanation of how his or her conclusions 

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are reached, including appropriate citations or studies. An opinion that is 

well-rationalized provides a convincing argument for a stated conclusion 

that is supported by the physician’s reasonably justified analysis of 

relevant evidence. For example, an opinion which is supported by the 

interpretation of diagnostic evidence and relevant medical or scientific 

literature is well-rationalized. Conversely, an opinion which states a 

conclusion without explaining the interpretation of evidence and reasoning 

that led to the conclusion is not well-rationalized. 

(4) The opinion of an expert over the opinion of a general practitioner or an 

expert in an unrelated field. For example, if a general practitioner has a 

patient with rest tremors, balance problems, and muscle rigidity, a 

diagnosis of alcohol abuse with dehydration may seem reasonable. 

However, if a conflicting report is received from a Board-Certified 

neurologist diagnosing Parkinson’s disease based on the same symptoms, 

it would carry greater weight because a neurologist is an expert on 

neurological disorders. This is particularly true for an illness like 

Parkinson’s disease that cannot be confirmed by an objective laboratory 

test. Conclusive statements of an expert without any underlying 

justification, other than affirmation of the physician’s expertise, are not to 

be viewed as carrying significant probative value.

(5) An unequivocal opinion over one that is vague or speculative. A 

physician offering a clear, unequivocal opinion on a medical matter is to 

be viewed as more probative compared to an opinion that waivers or 

hesitates in its presentation or, contains vague and speculative language. 

An opinion which contains verbiage such as “possibly could have” or 

“may have been” or provides a guess or estimation indicates speculation 

on the part of the physician. 

7. Using Death Certificate to Establish Diagnosis. Prior to considering the use of a death 

certificate to establish a diagnosis, the following actions must be undertaken: 

a. Claimant Advised. The CE must advise the claimant, in writing, of the medical 

evidence necessary to establish a diagnosis and grant him or her the opportunity 

to submit available medical records (See Chapter 11.6, Advising the Claimant of 

Deficient Evidence). The letter sent to the claimant is to include a statement 

describing the need to obtain medical evidence of a diagnosed condition. Medical 

evidence with the potential to identify a diagnosed illness include any hospital 

admission/discharge reports or reports describing an illness; inconclusive 

diagnostic testing results, or other medical records alluding to the existence of a 

potential illness. The function of this development is to ensure that the CE 

receives all available medical records for consideration. 

b. Diagnosis listed on death certificate. Once development is completed and it is 

unlikely any other affirmative medical evidence is available for review, a CE may 

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use a death certificate acknowledged by a physician or recognized by a state 

medical authority to establish a diagnosed illness. 

 

Nothing in this section should be interpreted as limiting the use of a death 

certificate for other purposes, such as evidence of the cause of death under Part E.

8. Using Affidavits to Establish Date of Diagnosis. While an affidavit cannot be used to 

establish a medical diagnosis, it can be used to establish a date of diagnosis after the CE has 

made a reasonable effort to establish the date of diagnosis from the medical records. CE actions 

should include the following: 

a. Advice to Claimant. The claimant must be advised, in writing, that medical 

evidence (i.e., pathology report, autopsy report, physician’s reports) should be 

submitted to establish a date of diagnosis. 

b. Additional Medical Development. If the claimant and the CE cannot obtain 

medical evidence to establish the date of diagnosis, the CE must notify the 

claimant of the need to submit copies of affidavits from those in a position to 

know the former worker’s condition during the illness. For example, a home 

health nurse or relative who provided care to the employee may provide an 

affidavit.

c. Death Certificate. If reliable affidavits are not received, then the CE may use the 

date of diagnosis (if shown) or date of death from the death certificate. The CE 

should not guess at a diagnosis date based on a death certificate’s “approximate 

interval between onset and death” as the date of onset is not necessarily the date 

of diagnosis. 

d. Medical Review. If an affidavit reveals evidence of a medical condition, but no 

physician’s diagnosis is contained in the file, the case may be forwarded to a 

CMC for review and confirmation of a diagnosis. 

 

9. Reviews by a CMC. DEEOIC uses the services of a contractor to coordinate referrals of 

cases to qualified medical specialists. A CMC is a contracted physician who conducts a review 

of case records to render opinions on medical questions. Medical opinions from a CMC are 

essential to the resolution of claims due to ambiguous causation, lack of medical evidence, 

unique exposures or other medical questions. The function of a CMC is to provide clarity to 

claims situations in the absence of pertinent or relevant medical evidence from other sources that 

support the claim. The function of a CMC is not to validate probative input by the claimant’s 

chosen treating physician. The description of appropriate reasons for CMC referral includes the 

following: 

a. Diagnosis. Clarification and confirmation of diagnosis. 

b. Causation. Assessment of exposure and medical documentation for the purpose 

of rendering an opinion on causation.

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c. Impairment. Percentage of permanent impairment to the whole person as a result 

of an accepted illness or illnesses. 

d. Onset Date. Onset and period of illness relating to reported wage-loss. 

e. Consequential Injuries. Determination of consequential illness/injury due to 

accepted illness or treatment of that illness. 

f. Treatment. Medical necessity of medical care, DME or home/auto modification.

 

g. Clarification. Interpretation of medical reports, test results or other medical 

evidence. 

 h. Conflict. Resolve conflict of medical opinions. 

10. Deciding on Need for a CMC Referral. The decision to refer a case to a CMC for review

is at the discretion of the assigned CE. An obvious defect in case evidence must exist, including 

the absence of affirmative medical evidence or other diagnostic evidence, for which a medical 

opinion is necessary. A CMC referral may also be necessary for review of impairment or wageloss issues. The CE should not view a medical referral as an automatic requirement for each 

claim, but an option available in situations where no other reasonable option exists to obtain a 

resolution to an outstanding medical question. 

 

a. Review Not Necessary. The following are examples of when a CMC referral may 

not be necessary:

(1) The CE determines that other action, such as requesting additional records 

from the claimant or treating physician, may be more appropriate. In most 

cases, the CE does not need to refer a claim to a CMC when a treating 

physician has provided a substantive, well-rationalized opinion in 

response to a claim question. Moreover, the CE should view the existence 

of a treating physician as the primary source of medical evidence before 

consideration of a CMC referral. Accordingly, the CE should typically 

give the treating physician the first opportunity to review medical 

evidence from the file, such as a SOAF and other documents, for the 

purpose of responding to claim questions. If the treating physician does 

not provide substantive responses to claim questions, the CE may consider 

the claim in posture for a CMC review. 

(2) The claim evidence renders a CMC opinion unnecessary, such as instances 

where a presumption of causation exists, or the circumstances of case 

development does not necessitate a medical opinion, such as when there is 

no evidence of exposure to a toxic substance or no plausible scientific 

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b. Appropriateness of Review. The following are some examples of when a CMC 

referral may be required: 

(1) The CE is unable to conclude whether pre-1993 medical evidence is 

sufficient to diagnose CBD. 

(2) Medical tests are submitted which do not provide clear diagnosis or 

interpretation (e.g., a BeLPT that does not clearly state that the test is 

positive or negative). 

(3) It is unclear whether a medical condition, unlisted on a death certificate, 

was a significant factor in causing, contributing to or aggravating an 

employee's death. For example, an employee dies of a heart condition, but 

the covered condition is asbestosis. 

(4) It is unclear whether the confirmed exposure to a toxic substance is linked 

to the illness claimed by the employee. 

(5) A treating physician has offered a speculative, or vague opinion, or one 

that is not substantiated by reasonable medical rationale, and the CE has 

undertaken reasonable steps identifying the defects to the physician, but he 

or she has not responded or responded unsatisfactorily. 

11. Referral to CMC. It is ultimately the responsibility of the jurisdictional DO to ensure that 

all the necessary components of a CMC referral are prepared accurately, the content of the 

referral is appropriate and specific to the issue under determination, and sufficient factual 

documentation is prepared to allow the CMC a clear understanding of the medical question(s) to 

be addressed. When guidance requires that email communication be prepared, a copy of the 

email is to scanned/bronzed into the case file in OIS. 

Interactions between DEEOIC staff and the CMC contractor occur through a secure internet 

portal, referred to as the Client Portal. All DEEOIC staff are to reference the “Client Portal User 

Guide” for additional information about using the Client Portal and referring cases to CMCs. 

Coordination of information between DEEOIC staff and the CMC contractor, including 

transmission of referral packages, is the responsibility of designated staff (i.e., Medical 

Scheduler). The CE, however, initiates the CMC referral process. 

a. Preparation of referral email. The CE sends an email to the Medical Scheduler 

indicating that a CMC review is required, and requesting referral to the CMC 

contractor. The body of the email should contain: 

(1) Claimant name.

(2) Claim number.

(3) Type of review requested.

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(4) Medical Specialty requested. The “Client Portal User Guide” contains a 

list of medical specialty types available for claims review. It is crucial that 

the CE selects the most appropriate preferred medical specialty to perform 

the review. The CE considers the following in determining the preferred 

medical specialty.

(a) Causation questions are best handled by occupational medicine 

specialists. Occupational medicine specialists can also evaluate 

the diagnosis and treatment of occupational lung conditions; such 

as asbestosis, silicosis, CBD, pneumoconiosis, and COPD. 

(b) Diagnosis or treatment questions are best handled by medical 

specialists for the condition or procedure under evaluation. 

Selecting generalist/internal medicine/family practice is 

appropriate if the condition involves a medical specialty not listed 

in the ”Client Portal User Guide.” 

(c) Impairment questions are best performed by specialists with 

experience in treating the particular organ system affected by the 

accepted work-related illness.

b. Scanning. The CE creates an electronic image of the following items as a single 

PDF file, and attaches the file to the referral email. A copy of the completed 

SOAF is to be scanned/bronzed to the case file in OIS. 

(1) A SOAF is a narrative summary of the factual framework of the case 

record. The SOAF logically conveys factual findings that have been 

decided by the CE upon examination of the case record, or application of 

Programmatic resources, such as the SEM. The CE makes factual 

findings derived from a reasonable interpretation of evidence contained in 

the case record, and not from undocumented sources. 

Factual findings presented in the SOAF are to be clearly stated. Simple 

words and direct statements reduce the potential for ambiguity or 

misinterpretation. The CE is to avoid using legal terms and Program 

jargon. Moreover, the CE must ensure that factual findings are presented 

in a logical order, and grouped chronologically within subject-specific 

sections relating to medical, employment, exposure, etc. The SOAF is to 

include the following information: 

(a) Identifying demographics, including the employee’s name, case 

file number and relevant personal information (e.g., employee’s 

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(b) Description of any accepted conditions or other diagnosed medical 

conditions. Medical information in the case file that is not relevant 

to the referral need not be reiterated in the SOAF.

 

(c) Detailed description of the employee’s employment history. This 

includes information about where the employee worked, dates of 

employment, and his or her job title and duties, if relevant to the 

referral. The CE will review Form EE-3 to assess the employee’s 

claimed employment; however, in preparing the SOAF, the CE 

should only include employment that has been verified by the 

DEEOIC and determined to be covered employment (See Chapter 

13 - Establishing Covered Employment).

The CE refers to the OHQ for more detailed descriptions of work 

processes and must be diligent to identify all relevant employment 

data that has been determined to be factually established from the 

case evidence. This is particularly true in referral situations 

involving causation, as there is a need to clearly understand job 

descriptions, duties performed, working conditions, etc. 

(d) For causation determinations, identification of the occupational 

toxic substance exposures encountered by the employee. The CE 

makes findings of toxic substance exposure based on a careful 

analysis of case evidence, and reference to Program resources such 

as researching the SEM, or seeking guidance from the IH or TOX

when appropriate (See Chapter 15 - Establishing Toxic Substance 

Exposure). Toxic substance exposures, reasonably established by 

available evidence, and shown to have a potential health effect to 

the diagnosed condition, are listed in the SOAF. When possible, 

the CE is also to provide relevant information on the nature, extent 

and duration of such exposures. 

Quantification might include levels of exposure, concentrations of 

asbestos fibers in the air, levels of noxious substances, the 

(approximate) number of times exposed, etc. The CE is to avoid 

the use of terms such as light, heavy, undue, severe, and abnormal 

because they are subject to great differences of interpretation. In 

certain situations, where the CE must provide an explanation as to 

how certain exposure findings are achieved, he or she is to 

document such analysis in the case file with a memorandum to the 

file. 

(e) The CE should include a brief history of the significant events that 

have transpired in the case (i.e., date of filing of Part B and/or Part 

E, date submitted to the NIOSH for dose reconstruction, date of 

denial/acceptance, etc.) if determined to be relevant to the referral. 

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(2) List of Questions for the CMC to address. (See Exhibit 16-1 for example). 

The questions put to the CMC must relate to a particular informational 

need that a physician is to address. The questions to a CMC should 

clearly communicate the information required. To this end, the questions 

should be straightforward and objectively stated. Avoid questions that are 

overly broad, or contain numerous subcomponents. In addition, questions 

that are leading or biased to a particular outcome are not appropriate. The 

CE is to limit the questions to the CMC to the relevant information 

necessary to address the particular claim for which a decision is required. 

A copy of the list of questions is to be scanned/bronzed to the case file in 

OIS. 

(a) For referrals under Part B, questions should be specific to a 

statutory requirement for any of the compensable occupational 

illnesses. Questions must be specific to a medical determination, 

rather than an adjudicatory standard. 

For example, in a pre-1993 CBD claim, a specific medical question 

is, “Does any X-ray show characteristic abnormalities consistent 

with CBD?” rather than, “Do the medical records support an 

acceptance of CBD under our Program requirements?” 

(b) For referrals under Part E, questions should identify the standard of 

proof required. For example, the CE asks, “Is it at least as likely as 

not that asbestos was a significant factor in causing, contributing to 

or aggravating the employee’s diagnosed illness?” 

In some instances, there may be two unrelated conditions that the 

CE determines require a review by two separate specialists. The 

CE will need to prepare one SOAF and specify the two specialists 

required for review. The CE will prepare separate questions for 

each specialist to address. 

(3) Medical Records relevant to the issues for which the CMC is to render an

opinion are to be imaged into a PDF formatted to the file and attached to 

the CMC referral email. For cases where an impairment rating is being 

sought, the CE may image the most pertinent or recent (two or three years 

old) medical records. For Second Opinion, Referee Specialist 

examination, or other case reviews, comprehensive medical records may 

need to be imaged. In some instances, the CE or designated staff person 

may need to divide the electronic images into several files to allow for 

electronic submission. The designated staff person should label each file 

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12. Role of Medical Scheduler in CMC Referrals. Each DD designates a Medical Scheduler 

who processes and tracks CMC referrals. The Medical Scheduler is also responsible for 

coordinating communication between DO staff and the CMC contractor. When guidance 

requires that email communication be prepared, a copy of the email is to be printed and placed in 

the case file. Upon receipt of a CMC referral submission from a CE, the Medical Scheduler is to 

take the following actions: 

a. Review of Referral. Conducts a thorough review of the referral package to ensure 

all required documentation is present, questions to the CMC are clear, and imaged 

records are legible. The SOAF should also be inspected to ensure that relevant 

factual findings have been reached that will allow for a comprehensive and 

reliable CMC analysis. Upon inspection, any referral package that is deemed to 

be incomplete or defective is returned to the CE for corrective action. The 

Medical Scheduler is to return the referral package to the originating CE with a 

memo describing the problem to be addressed before a referral can be initiated. 

 

b. Submission of Referral. Once the Medical Scheduler has determined that a 

referral is complete and ready for submission to the CMC contractor, he or she is 

to log onto the CMC contractor’s internet portal, and follow the steps in the 

“Client Portal User Guide” for creating a claimant referral. Using the referral tab 

on the Client Portal, the Medical Scheduler inputs the claimant’s information as 

needed, and uploads all relevant electronic documents to complete the transaction. 

c. Confirmation. Upon receipt of submission confirmation from the CMC 

contractor, the Medical Scheduler is to notify the originating CE via email that the 

referral is complete.

d. Processing for Payment. When the Medical Scheduler receives confirmation 

from the CE that the report is complete and accurate (see Section 13 of this 

chapter), the Medical Scheduler compares the referral sheet to the billing form 

submitted by the contractor to validate that the charged amount corresponds to the 

service request. The Medical Scheduler must ensure that the billing codes/units 

identified on the OWCP-1500 correspond appropriately to what the CE requested 

be performed by the contractor. The Medical Scheduler must be aware of the 

following when reviewing billing for CMC reports completed through the 

contractor process:

(1) For cases with multiple questions regarding the same or related conditions 

requiring the services of one specialist, (e.g., occupational medicine) one 

billable charge is permitted. 

(2) For cases with one or more unrelated conditions, requiring the services of 

a single specialist, (e.g., pulmonary or occupational medicine) one billable 

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(3) For cases with unrelated conditions requiring the services of multiple 

specialists, (e.g., oncology, pulmonary, dermatology) separate charges are 

appropriate for each referral to a different specialist. 

e. If the OWCP-1500 is correct, the Medical Scheduler prints the OWCP-1500 and 

stamps the document “Prompt Pay” in black ink, with a signature and date in 

black ink, in the top right hand corner of the OWCP-1500. The “Prompt Pay” 

date (date received in the DO plus 7 days) must be entered in block 11 of the 

OWCP-1500. The Medical Scheduler scans the stamped document, titles the bill 

using the last four digits of the employee’s SSN and the employee’s last name 

(e.g., 1234Smith). 

The Medical Scheduler does not attach the CMC report or other documents to the 

bill. The Medical Scheduler then submits the approved OWCP-1500 to the 

Contracting Officer Representative (COR) or alternate COR designee via email at 

the email group “DEEOIC-CMC-INVOICES.” The COR coordinates, 

communicates, and ensures cooperation among the contractor and associated 

Government personnel, for the purpose of anticipating and resolving difficulties, 

and ensuring satisfactory completion of contracts. For efficiency and 

management purposes, payable bills should be collected throughout each business 

day and electronically transmitted by batch in one email at the end of each work 

day. The Medical Scheduler should include in the body of the email a list of the 

bills that should be included as attachments to ensure that the COR or alternate 

COR designee receives an accurate listing of bills. The case file should contain a 

copy of the OWCP-1500 and the original medical report.

f. The Medical Scheduler will enter the following dates in ECS to ensure prompt 

payment of all physician referral bills: 1) Status Effective Date (enter the date 

listed in block 24A of the OWCP-1500); and 2) Eligibility End Date (enter the 

date of the physician’s response, i.e., the date of the report).

g. Once the COR or alternate COR designee receives the batch, the bills are to be 

certified by the designated COR by placing a signature stamp on each invoice. 

The office Administrative Assistant will then mail the bills to the Bill Pay Agent 

(BPA) for processing and payment. 

h. If a problem with the billing is identified, the Medical Scheduler communicates 

the issue with the contractor and copies the COR and alternate COR designee via 

e-mail.

i. Problems with Reports. The Medical Scheduler notifies the DD of any problems 

dealing with the CMC contractor.

13. Post Referral to CMC. Upon submission of a referral to the CMC contractor, the 

contractor will then assign a particular CMC to respond. The CMC selection is the function of 

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the CMC contractor, and DEEOIC has no input in the selection of the physician chosen to review 

the case, other than the preferred specialty of the physician. Once assigned, the CMC is to assess 

all submitted documentation, and prepare a comprehensive and responsive medical narrative to 

the questions posed by the referring CE. The CMC then submits his or her report back to the 

contractor. The contractor then undertakes a quality control review to ensure that the report is 

complete, rationalized, and fully responsive to the questions posed by the CE. Upon clearance 

for release, the CMC contractor will then post the completed report along with a completed Form 

OWCP-1500 on the Client Portal. 

To access the reports, the Medical Scheduler or designated staff logs into the Client Portal using 

the steps listed in the “Client Portal User Guide” and accesses the status for the relevant claim. 

The Medical Scheduler or designated staff downloads the CMC report and completed Form 

OWCP-1500 from the Client Portal. 

a. Completed Reports. Once the medical report is downloaded, the CE reviews it 

for accuracy and completeness. The review should include the CMC’s 

interpretation of test results, evaluation of medical reports submitted for review, 

answers to each question posed, and the CMC’s rationale showing how his or her 

opinion is supported by the evidence in the file. 

(1) If the medical report is accurate, appropriate and complete, the CE sends 

approval to the Medical Scheduler, via email, to authorize payment of the 

medical bill no later than the next business day. The CE indicates in the 

text of the email that the review completed by the CMC is acceptable. 

The email is scanned/bronzed to the case file in OIS.

(2) If the medical report is incomplete or incorrect, or not properly responsive 

to the questions posed, the CE notifies the Medical Scheduler, via email, 

of the issues with the medical report. The email is scanned/bronzed to the 

case file in OIS. The DD or designated staff will return the medical report 

to the contractor and request the contractor provide an additional report to 

correct the situation. The CMC shall provide the additional report within 

14 days of receipt of the request without additional charge. The DD will 

notify the contractor in writing of the request for the additional report. A 

copy of the notification should be scanned/bronzed to the case file in OIS. 

To ensure prompt payment of all physician referral bills to the BPA, (i.e., 

CMC, Second Opinion, Referee Specialist bills) the Medical Scheduler or 

designated staff records the referral and receipt of the medical 

report/billing in ECS. 

b. Request for Report. If the claimant requests a copy of the CMC’s report, the CE 

provides a copy of the report with a cover letter, which includes the following 

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Attached is a copy of the medical report that you requested. Please be advised 

that {Enter the CMC’s name} is a medical consultant for the Department of 

Labor. The Department of Labor will make the final decision in this claim. 

Please do not contact {Enter the CMC’s name} regarding this report. If you have 

additional evidence to submit in support of your claim or if you have any 

questions or concerns regarding this report, please contact me at {Enter the DO’s

toll-free number}. 

Staff may redact the CMC’s personal address, personal telephone number, and 

personal email address, but must give the CMC’s business telephone number, 

business address, and business email information.

A copy of the CMC’s IH/TOX report will be sent with all RDs denying a claim 

based on causation. 

c. Contract Compliance. Upon the identification of any systematic deficiencies or 

other problematic situations involving the CMC referral process, immediate 

action is to be taken to advise the DD or a designee and the NO COR. This would 

include situations involving consistently poor or low quality CMC reports, 

timeliness problems, or unresponsiveness to questions. 

14. Second Opinion Examinations. A Second Opinion examination is a type of medical 

referral arranged by the DEEOIC that requires the employee to undergo a physical examination. 

The results of that examination, along with the physician’s review of pertinent medical 

documentation, facilitate the production of a narrative medical report describing the physician’s 

independent medical opinion in response to questions raised by the assigned CE. 

To schedule Second Opinion examinations, the DEEOIC utilizes the CMC contractor with 

access to a database of physicians capable of performing in-person physical examinations by 

geographical location. Much like the CMC referral process, the decision to initiate a Second 

Opinion examination and the appropriate specialist falls to the CE assigned to the claim, but 

selection of the physician is the sole responsibility of the scheduling contractor. 

a. Role of the CE. The CE is responsible for deciding when a Second Opinion 

examination is necessary in lieu of obtaining information from other sources, such 

as inquiry to a treating physician or CMC referral. A Second Opinion 

examination should be reserved for situations for which an actual physical 

examination of the patient will assist with the resolution of an outstanding claim, 

such as those involving issues of medical necessity or in situations where 

claimants have difficulty obtaining information necessary for completion of an 

impairment rating.

b. Referral for Second Opinion Examination. As discussed in Section 11 of this 

chapter, interactions between the DEEOIC staff, the CMC, and physicians 

selected for Second Opinion examinations occur through the Client Portal. The 

Medical Scheduler or designated staff is responsible for the coordination of 

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information between DEEOIC staff and the contractor, including transmission of 

referral packages. The CE initiates the process for obtaining a Second Opinion 

examination and ensures all necessary referral and medical documentation is sent 

to the Medical Scheduler or designated staff.

Arranging for a Second Opinion examination follows the same basic referral steps 

listed as when making a CMC referral. 

(1) Preparation of referral email. The CE sends an email to the Medical 

Scheduler indicating that a Second Opinion examination is needed, and 

requesting referral to the CMC contractor. The body of the email should 

contain: 

(a) Claimant name.

(b) Claim number.

(c) Second Opinion review request. 

(d) Medical Specialty requested. Refer to Section 11.a(4)of this 

chapter for further discussion of medical specialty.

(e) Previous physicians involved in the case. 

(f) SOAF

(g) List of Questions for the Second Opinion physician to address. 

(Exhibit 16-2) 

(h) Medical Records.

 (i) Cover Letter to the claimant. (Exhibit 16-3) 

A copy of the referral email is scanned/bronzed to the case file in OIS. 

(2) Role of the Medical Scheduler. The Medical Scheduler follows the steps 

listed in Sections 11 and 12 of this chapter to transmit the Second Opinion 

examination request to the CMC contractor and perform follow-up 

actions. As is the case with the CMC referral process, the identification of 

any systematic deficiencies or other problematic situations involving the 

Second Opinion examination referral process, should be brought to the 

attention of the DD. 

Once the contractor has selected a physician to perform the Second 

Opinion examination, the contractor will notify the claimant, in writing, of 

the specialist’s name, address and telephone number, and date and time of 

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the appointment. The contractor will also send the claimant a copy of the 

cover letter (See Exhibit 16-3 for example). The contractor will follow-up 

with the claimant to ensure that the claimant attended the appointment.

In the event the claimant requests to reschedule the Second Opinion 

examination, the CE will determine whether the appointment should be 

changed, as outlined in Section 16 of this chapter. If the claimant does not 

attend the Second Opinion examination, the CE may suspend action on 

any open claims and administratively close the case until such time as the 

employee agrees to and attends the examination as outlined in Section 16. 

15. Referee Specialist Examinations. A conflict of medical opinion can arise between a 

physician selected by a claimant, and that of a CMC or Second Opinion physician. In most 

instances, the CE’s careful weighing of the medical evidence should permit the resolution of the 

conflict. However, where the weight of medical evidence is equal between the opinion of the 

treating doctor and that of the CMC or Second Opinion physician, a Referee Specialist opinion is 

necessary. The CE obtains a Referee Specialist opinion by requesting a third, impartial 

physician review the competing opinions presented. The assigned physician then evaluates both 

sides of the competing argument, and makes the deciding conclusion. 

a. Value of Referee’s Opinion. The probative value of a Referee’s opinion, if 

sufficiently rationalized and derived from careful examination of evidence from 

the competing physicians, is granted special weight. This means that once the 

Referee has fully considered the argument presented by both sides engaged in a 

conflict in medical opinion, and reached a rationalized conclusion regarding the 

matter, the CE is to consider the opinion of the Referee as the conclusive answer 

to the issue to be resolved. 

b. File review or physical examination. A Referee Specialist examination will 

consist of either a review of the case record or an actual physical examination of 

the employee. If a conflict exists between the medical opinion of the employee’s 

treating physician and the medical opinion of a CMC, a Referee referral file 

review is needed. However, if a conflict exists between the medical opinion of 

employee’s treating physician and the medical opinion of the Second Opinion 

physician, a Referee referral physical examination should be scheduled. 

c. Assignment of the Referee. The CE will utilize the same basic referral process 

for referral to a Referee examiner as is used for a Second Opinion, except for 

some notable differences. 

(1) In the referring email to the Medical Scheduler, the CE is to denote the 

type of review as a Referee Specialist examination. A copy of the email is 

to be scanned/bronzed to the case file in OIS. 

(2) The CE’s questions to the Referee Specialist are to be sufficiently detailed 

and narrow to resolve the conflict of medical evidence. The questions 

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should not introduce new or unique topics for the physician to address. 

The purpose of the Referee Specialist examination is limited to that which 

is necessary to resolve an existing conflict of medical opinion. 

16. Failure to Undergo Second Opinion or Referee Specialist Examination. The employee 

assigned to undergo either a Second Opinion or Referee Specialist examination is obligated to 

attend the examination. Moreover, the CE is responsible for evaluating any request to change 

the date or time of an appointment to determine if sufficient reasons exist to allow for such a 

change. The employee and/or claimant will not be authorized to change a scheduled Second

Opinion or Referee Specialist examination without providing a substantive and documented 

cause. The determination of whether an appointment should be changed is at the discretion of 

the CE who is responsible for initiating the referral. Generally, appointment changes should only 

be permitted in emergency situations, or when the employee has given a sufficiently convincing 

rationale for a need to change the appointment. Appointment changes that are necessary merely 

for the general convenience of the employee are usually not permitted. Once authorization for an 

appointment change is granted, the CE, through the Medical Scheduler, must notify the 

designated contractor. 

Once a Second Opinion or Referee Specialist examination has been scheduled, it is expected that 

the employee attend. Failure to attend a scheduled examination may result in suspension of 

action on any open claims and administrative closure until such time as the employee agrees to 

and attends the necessary examination.

a. Follow-up Action. If the employee was examined, the CE should expect a report 

within 21 days. This guideline also applies if a case is referred for a file review.

b. Failure to Appear. If the physician’s office reports that the employee did not 

appear for his or her scheduled appointment, the employee and any representative 

should be contacted by a documented phone call or in writing to request an 

explanation. If a reasonable explanation is provided, the CE re-schedules the 

examination, through the CMC Contractor. 

If the employee does not respond to the CE’s request for an explanation or if an 

explanation is provided and the CE determines good cause is not established, or if 

the employee fails to appear for the re-scheduled examination without good cause, 

the CE issues a letter advising the employee and representative that the issue to be 

resolved (i.e., adjudication of a consequential injury, request for surgery, medical 

supply, etc.) cannot be further adjudicated until the medical examination is 

completed.

The CE suspends any further action to adjudicate the outstanding issue and 

administratively closes the claim. Development may resume if the employee 

agrees to undergo a medical examination and undergoes it. 

c. Disruptions at the Medical Examination. If a medical examination cannot be 

completed due to disruptions caused by someone accompanying the employee, 

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the medical examination must be rescheduled with a different qualified physician. 

The employee will not be entitled to have anyone else present at this subsequent 

examination unless the CE determines that exceptional circumstances exist, for 

example, if a hearing impaired employee requires a sign language interpreter.

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CHAPTER 17 – DEVELOPMENT OF RADIOGENIC CANCER CLAIMS 

1. Purpose and Scope. This chapter includes a narrative discussion of the procedures for 

determining whether an employee has been diagnosed with a cancer and the procedures for 

establishing causation as a result of exposure to occupational radiation. 

2. Identifying a Claim for Cancer. The CE must first identify whether the claim is being 

made for cancer. If Form EE-1 or Form EE-2 is marked for a cancer, then a cancer claim is 

established. The claimant is asked to identify the specific type of diagnosed cancer on the claim 

form.

3. Medical Evidence of Cancer. EEOICPA regulations state that to establish a diagnosis of 

cancer, a claimant must submit medical evidence that sets forth the diagnosis and the date of the 

diagnosis. The CE verifies that sufficient medical evidence is in the case file that substantiates a 

diagnosis of cancer. 

a. Diagnosis of Cancer. The case record must include a medical report from a 

qualified physician that lists a cancer diagnosis. The CE can make referrals to a 

CMC to assist in interpreting medical evidence as establishing a diagnosis of 

cancer. Whether the evidence originates from a claimant’s physician or a CMC, a 

diagnosis generally derives from the following evidence: 

(1) Tissue examination is the most conclusive method for making a cancer 

diagnosis, as it provides the physician with the vital information listed 

below regarding the tumor or lesion. A testing facility reports the 

outcome of human tissue analysis in a pathology report. The pathology 

report follows from a biopsy undertaken by a physician during routine 

screening or post mortem (autopsy). The pathology report identifies 

particular data that are critical for making a cancer diagnosis.

(a) The tissue of origin (where the tumor or lesion originated); and 

(b) The status of the tested cellular tissue as benign, uncertain, or 

malignant. This chapter of the PM only addresses processing 

malignant (cancerous) tumors/lesions. 

(2) A diagnosis can sometimes be made using one or more of the following 

methods, which are listed in order of preference. If the CE is unable to 

identify an affirmative diagnosis based on the medical evidence submitted, 

the case may be referred to a CMC.

(a) Cytology report describing cells obtained by scraping (e.g., from 

bone marrow), or by washing (e.g., fluid from lungs). An 

examination conducted by one of these cytology methods is 

generally less conclusive than tissue examination because the 

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organization and extent of the tumor may not be as apparent. A 

positive cytology report would be a basis for further tests. 

(b) Imaging (e.g., X-ray, CAT Scan, MRI) are the least specific type 

of tests in the diagnosis of cancer. Generally, X-rays are used as a 

basis for further tests. Radiology tests are extremely beneficial in 

determining the spread of cancer and/or determining the effects of 

cancer treatments.

(3) If the employee is deceased or if a living employee is unable to undergo 

additional diagnostic testing for medical reasons, clinical evidence is 

needed which shows that a qualified physician has evaluated available 

medical evidence and has provided a well-rationalized opinion that 

interprets such evidence as establishing a diagnosis of cancer. 

Documentation that a physician can use for such a purpose includes 

hospital admission/discharge reports or reports describing a tumor or 

possible malignancy; inconclusive diagnostic testing results, or other 

medical records alluding to the existence of a potential cancer. 

(a) In the absence of other affirmative medical evidence collected 

during development, a CE may use a death certificate 

acknowledged by a physician or recognized by a state medical 

authority to establish a cancer diagnosis. 

b. Diagnosis of Multiple Primary Cancers.

(1) If a CE identifies more than one primary cancer in the medical evidence 

in the same organ with the same diagnosis date and a physician has 

classified each as the same type of cancer, the CE considers all as one 

primary cancer.

For example, a surgeon performs two biopsies of the left breast on the 

same date. Several days afterwards, a pathologist interprets the samples as 

showing infiltrating ductal carcinomas. In this case, the CE considers the 

results as diagnosing one primary cancer of the left breast.

Alternatively, if the pathologist interpreted the same biopsies as 

documenting a lobular carcinoma and an infiltrating ductal carcinoma, the 

CE considers these cancers as two primary cancers, since the cancer types 

are different.

The CE can only resolve issues relating to the number of primary cancers 

diagnosed from pathology or clinical evidence by obtaining the opinion of 

a qualified physician. In the absence of a well-rationalized opinion from a 

claimant’s treating physician, a CE refers such matters to a CMC for 

review. 

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(2) The above guidance applies only to multiple primary cancers of the same 

type in an organ. Situations involving bilateral organs are more 

complicated. Bilateral organs include the lungs, breasts, kidneys, 

adrenals, ovaries, and testes. 

Biopsies taken from the left and right lungs might indicate the same type 

of cancer, e.g., non-small cell adenocarcinoma, in the right and left lungs. 

While one cancer may actually be metastatic from the other lung, without 

any indication in the pathology report or other medical evidence, it would 

be difficult to determine whether these two adenocarcinomas are two 

primary cancers or just one cancer. In these situations, the CE requests 

clarification from either the treating physician or a CMC. 

c. Date of Diagnosis. The date of initial diagnosis is required in any claim for 

cancer. The date of diagnosis is also a critical element used in the IREP for 

calculating the PoC. The employee’s occupational exposure to radiation must be 

before the initial date of diagnosis for it to be compensable under Part B. While a 

claimant may list the date of diagnosis on Form EE-1 or Form EE-2, the CE 

reviews all of the medical evidence submitted in a claim package to determine the 

earliest date of cancer diagnosis.

(1) When using a pathology report to determine the date of diagnosis, the date 

that a physician biopsied the tissue is used as the date of diagnosis. 

(2) In certain claim situations, the CE will have to use reasonable discretion to 

decide the date of diagnosis. For example, if the employee is deceased, 

and the only documentation available to support the diagnosis of cancer is 

the employee’s death certificate signed by a physician, the CE may accept 

an affidavit from a survivor(s) and/or other individuals to establish that the 

employee’s diagnosis date is subsequent to the employee’s initial exposure 

to occupational radiation. 

For example, a home health nurse might indicate in an affidavit his or her 

knowledge that on a specified date, a physician made a diagnosis of the 

employee’s condition, as well as the circumstances under which he or she 

acquired such knowledge. 

d. Deficiency in Medical Evidence. The CE advises the claimant of any deficiency 

in medical evidence and allows the claimant a period of up to 60 days to submit 

additional medical evidence. All development communication from the CE must 

be clear and include understandable guidance of what evidence is required to 

support the claim. 

4. Pre-Cancerous and Non-Malignant Conditions. If the medical evidence provided by the 

claimant establishes a diagnosis of a condition in a pre-cancerous stage or is non-malignant, the 

CE cannot accept the condition as a cancer. However, the CE proceeds with development of the 

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condition for coverage under Part E. The receipt of a qualified physician’s opinion can only 

resolve the interpretation of whether a condition is a diagnosed cancer or not. If the CE cannot 

obtain clarification of such issues from the claimant’s chosen physician, he or she can refer the 

medical evidence to a CMC. 

5. Specified Cancers. Members of the SEC who are diagnosed with any of the 22 specified 

cancers are eligible for benefits without the need for a dose reconstruction. Eligible members of 

a SEC class have a presumption that the diagnosed specified cancer was caused by radiation 

exposure during their eligible SEC employment. 

6. Non-SEC Cancers and Dose Reconstruction. Any primary cancer that is not a specified 

cancer is a non-SEC cancer. Once the CE has determined that the employee has a diagnosed 

non-SEC cancer and covered employment, he or she prepares the claim for referral to the NIOSH

for a dose reconstruction. The CE is to report a secondary cancer only when the development of 

the claim has not resulted in the identification of the primary cancer. 

a. Claimant Not SEC Member. When the employee is not a SEC member (i.e., the 

 employment was outside the designated SEC period or the employee did not work 

the necessary workdays at an SEC site), the CE forwards the claim to NIOSH for 

 dose reconstruction, once a cancer diagnosis and covered employment are 

 confirmed. 

b. SEC Case with Award. For any SEC cases where an award has been made for a 

specified cancer, any non-SEC cancers for the case must be forwarded to NIOSH 

 for dose reconstruction to determine eligibility for medical benefits for the nonSEC primary cancers. In these SEC cases, all cancers are listed on the NIOSH 

NRSD, including the specified cancer(s). 

(1) An exception to this rule includes those SEC claims where a primary 

cancer, which is not a specified cancer, metastasizes to a secondary cancer 

site that a CE has decided is a specified cancer. For instance, prostate 

cancer (non-specified cancer) metastasizes to secondary bone cancer 

(specified cancer). If the bone cancer is accepted as a specified cancer 

 under the SEC provision, the claimant can receive medical benefits for 

 both primary and secondary cancers (prostate and bone cancer). 

 However, according to EEOICPA regulations, payment for medical 

 treatment of the underlying primary cancer...does not constitute a 

determination by OWCP that the primary cancer is a covered illness. As 

such, it will be necessary for the CE to refer the prostate cancer to NIOSH 

 for dose reconstruction to determine eligibility for benefits under Part E 

 for prostate cancer. In this situation, since the bone cancer is a secondary 

 cancer with known primary site (prostate), it is not included on the NIOSH 

NRSD. 

c. Multiple Skin Cancers. When a claimant provides evidence that the covered 

employee has a large number of skin cancers, the CE will proceed as follows:

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(1) The CE considers each malignant skin neoplasm (e.g., basal or squamous 

cell cancer) as a separate primary cancer, unless the medical records state 

that the neoplasm is a metastatic lesion. 

(2) For NIOSH dose calculations, the date of diagnosis and the location (e.g., 

arm, neck, back) of the skin cancer are important. The CE must include 

this information in the medical section of the NRSD.

d. Multiple Primary Cancers for Other Organs/Locations. If a CE identifies more 

than one primary cancer location for an organ in the medical records (e.g., 

multiple sites of primary cancer in the lung), the CE notes this information in the 

medical section of the NRSD, including the cancer locations within the organ and 

the diagnosis date. NIOSH will perform dose calculations for each primary 

cancer site in a specific organ. When NIOSH reports the dose reconstruction 

results, the CE calculates the PoC values for each of the primary cancers in that 

organ. 

7. Preparing Non-SEC Cancer Claim Files for Referral to NIOSH. The NRSD (Exhibit 17-

1) is a tabular form containing the medical and employment information accepted by the CE as 

factual. This form provides NIOSH with the necessary information to proceed with the dose 

reconstruction process. 

a. Instructions. Step-by-step instructions for completing the NRSD are included in 

Exhibit 17-2. 

b. Smoking History. The employee’s smoking history is required for cases that 

include primary lung cancer (including primary trachea, bronchus, and lung) or 

for secondary cancer with an unknown primary cancer that includes lung cancer 

as a possible primary cancer.

(1) The method used to gather smoking history is Form EE/EN-8. 

(2) Upon receipt of the information from the claimant, indicate the smoking 

level (at the time of cancer diagnosis) using the designations shown in the 

NRSD. If the case evidence contradicts information obtained on the 

questionnaire, the CE must clarify the discrepancy with the claimant prior 

to referral to NIOSH.

(3) If the claimant does not return the initial smoking questionnaire within 30 

days, the CE sends a follow-up letter advising the claimant that they are to 

return the questionnaire within the next 30 days or their case will be 

closed administratively. After a total of 60 days has elapsed, the CE 

administratively closes the claim and informs the claimant by letter that 

the claim is closed and no further action will be taken relating to the 

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claimed illness(es) under Part B. The CE proceeds with any necessary 

development relating to a Part E claim. 

 

(a) If the CE can obtain the relevant information from the employee’s 

medical or DAR records, the CE uses that information to complete 

the NRSD. The CE includes a memo to file explaining the source 

of the information. 

c. Ethnicity. Employee’s ethnicity is required for skin cancer cases.

(1) The method used to gather this information is Form EE/EN-9. 

(2) Upon receipt of the information from the claimant, indicate the ethnicity 

using the designations shown in the NRSD. 

(3) If the claimant does not return the initial ethnicity questionnaire within 30 

days, the CE follows the same steps required for collecting information 

relating to the employee’s smoking history (i.e., second request, 

administrative closure and notice). Like the guidance for obtaining an 

employee’s smoking history, if the CE can obtain the relevant ethnicity 

information from the employee’s medical or DAR records, the CE uses 

that information to complete the NRSD. The CE includes a memo to file 

explaining the source of the information. 

d. Case Referred to NIOSH.

(1) All findings made by the CE must be supported by the evidence in file and 

documented in the NRSD. The CE forwards a copy of the entire case file 

with the NRSD to NIOSH. 

(2) The CE advises the claimant in writing that he or she has sent the case to 

NIOSH for dose reconstruction (Exhibit 17-3).

8. Preparing Amendments to the NRSD for Non-SEC Cancer Claims. Sometimes CEs 

obtain additional information on a case after they refer it to NIOSH but before the completion of 

the dose reconstruction. This includes new information related to the employee’s employment, 

new medical condition(s), new AR, or other survivor-related information. The CE is to bronze 

into OIS all documentation created or received for a case file. 

When new information becomes available, the CE forwards this information to NIOSH so it is 

available for dose reconstruction. The CE identifies the portion of the NRSD that has changed 

based on new evidence reviewed by the DO. He or she also marks “Amendment” on the top of 

the NRSD and lists the employee's name, DOL case ID number, NIOSH tracking number, and 

DOL Information. The CE describes clearly and separates any “Amendment” NRSDs from 

NRSDs submitted with the DO’s weekly package to NIOSH. A CE or other designated staff 

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person ensures that any supplemental packages are separated from regular NRSDs for clear 

identification by NIOSH. 

a. NIOSH Reports. NIOSH provides weekly reports to the DOs listing the cases for 

which the NIOSH contractor started performing dose calculations in the past 

week. For any revisions to information contained in the original NRSD, the CE 

is to forward to NIOSH an amended NRSD clearly identifying the revised 

information. This will allow NIOSH to use the most accurate information in its 

dose reconstruction. 

b. “Supplement” NRSD. If the CE needs to submit additional evidence to NIOSH, 

such as additional medical information for the same reported cancer, the CE 

submits a NRSD marked “Supplement.” The CE lists on the referral the DOL 

Case ID number, NIOSH tracking number, and employee’s name. A CE uses a 

supplemental NRSD only for a submission that does not change the original 

information in the NRSD. 

9. Cases Pulled While at NIOSH. During the dose reconstruction process, it may be 

necessary for NIOSH to contact the CE to resolve a discrepancy, or request clarification. 

Normally, this contact is via e-mail or telephone. The CE handles all contacts from NIOSH as 

quickly as possible. If the CE cannot provide an answer to a question without further 

development, the CE advises NIOSH of the steps being taken to resolve the matter and an 

approximate period for completion. 

In cases where further development is needed as determined by NIOSH or DOL, NIOSH pulls 

the case from the dose reconstruction process and advises the CE by e-mail. NIOSH may also 

pull a case to allow DOL to determine if a case can be accepted under a SEC class. Since a 

pulled case stops the dose reconstruction process, the CE must proactively develop the case so 

the dose reconstruction process can proceed or a decision can be rendered on a SEC case. 

a. Cases Pulled by DOL. When DOL determines that further development is needed 

before a dose reconstruction can proceed, the supervisor, SrCE (or journey level 

CE), or DO NIOSH liaison sends an e-mail (with copies to the other two DO 

staff) to the NIOSH Public Health Advisor (PHA) with a request that NIOSH pull 

the case while DOL develops the case for additional information. The CE must 

advise the claimant in writing when a case is pulled by DOL from the dose 

reconstruction process. 

(1) The e-mail briefly explains the specific information the DO is attempting 

to clarify or obtain, e.g., employment, medical, smoking or race/ethnicity 

questionnaire, etc. 

(2) On receipt of the development information, the designated DOL staff 

person notifies the NIOSH PHA (with copies to the other two DO staff) by 

e-mail of the resolution of the issue and requests that the case be removed 

from pulled status. The DO also prepares and forwards, as necessary, an 

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amended NRSD containing the new information. The CE advises the 

claimant in writing that their case has been removed from pulled status 

and that the dose reconstruction is proceeding. 

b. Cases Pulled Due to SEC. NIOSH may identify cases submitted for dose 

reconstruction that are potentially eligible for inclusion in a SEC class. This may 

typically occur when a new SEC class is designated. NIOSH pulls these cases 

from the dose reconstruction process and returns these cases with the dose 

reconstruction records to the appropriate DO for further development. The CE 

handling the case ensures that any record received from NIOSH as part of the 

dose reconstruction process is bronzed into OIS or maintained by the DO as a 

permanent record of the case file. NIOSH will send the claimant a letter advising 

the claimant that it is returning the claim to DOL for adjudication. 

If DOL identifies a case that qualifies under the SEC provision but NIOSH did 

not pull it from the dose reconstruction process, the CE, through the SrCE or 

journey level CE, notifies the appropriate NIOSH PHA via e-mail to return the 

dose reconstruction records for further development. In these cases, the CE sends 

a letter to the claimant advising that his or her case is pulled from the dose 

reconstruction process for evaluation under the SEC provision. 

If it is determined that the case does not qualify for the SEC class, the CE, 

through the SrCE or journey level CE, notifies the appropriate NIOSH PHA via email to proceed with the dose reconstruction. The CE prints a copy of the “sent” 

e-mail and bronzes it into OIS. The e-mail includes a brief statement explaining 

why the case should proceed with dose reconstruction, e.g., non-specified cancer, 

insufficient latency period or does not meet the 250 workday requirement. In 

addition, the CE notifies the claimant by letter that the case is returned to NIOSH 

for dose reconstruction and the reason(s) it does not qualify for the SEC class. 

The CE also sends a copy of this letter to NIOSH. 

10. NIOSH Actions. Upon receipt of a claims package from DOL, NIOSH takes several 

actions to determine the employee’s radiation dose. NIOSH will request DOE records and 

interview the claimant(s) to identify any additional relevant information on employment history 

and develop detailed information on work tasks and radiological exposures. NIOSH will also 

apply dose reconstruction methods to estimate radiation doses for workers seeking compensation 

for cancer who were not monitored or inadequately monitored, or whose records are missing or 

incomplete for exposure to radiation at a DOE or AWE facility. NIOSH will then conduct a 

closing interview with the claimant(s) to review the dose reconstruction results and the basis 

upon which the results were calculated. 

a. Obtain Signature on Form OCAS-1. Subject to any additional information 

provided by the claimant, the claimant is required to sign and return Form OCAS1 to NIOSH within 60 days, certifying that he or she has no additional 

information and that the record for dose reconstruction should be closed. 

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Upon receipt of the signed Form OCAS-1 and completion of any changes in the 

dose reconstruction resulting from new information provided, NIOSH forwards a 

final dose reconstruction report, “NIOSH Report of Dose Reconstruction under 

EEOICPA”, to DOL and to the claimant. 

(1) NIOSH does not forward the dose reconstruction report to DOL for 

adjudication without receipt of Form OCAS-1 signed by the claimant or 

an AR of the claimant. 

(a) If the claimant or the AR does not sign and return Form OCAS-1 

within 60 days, NIOSH will administratively close the dose 

reconstruction and notify DOL of this action after notifying the 

claimant or the AR. 

(b) Upon receiving this notification by NIOSH, the CE records in ECS

the administrative closure of the affected Part B claim based on the 

lack of a signed Form OCAS-1. 

(c) If the employee meets the Part E employment requirements 

(contractor or subcontractor), prior to administrative closure, the 

CE determines if a causal link exists between the claimed illness 

and exposure to toxic substances (other than radiation) at a DOE 

facility or certain RECA facility. When a causal link is 

determined, the CE is able to accept the cancer under Part E. If no 

non-radiogenic toxic substance causal link is established, the CE 

administratively closes the case in ECS under Part E. 

(d) The CE advises the claimant by letter that the case is closed. If the 

claimant later decides to sign the Form OCAS-1, he or she needs to 

notify DOL, after which the CE returns the case to NIOSH for 

processing. 

(e) If additional information is submitted, NIOSH will review the 

evidence, prepare a new dose reconstruction report, and send a new 

Form OCAS-1 to the claimant and allow for an additional 60-day 

comment period. 

(2) If the case has multiple claimants, NIOSH will wait 60 days for receipt of 

all signed Forms OCAS-1. If, after 60 days, NIOSH does not receive Form 

OCAS-1 from any of the claimants, NIOSH will administratively close the 

dose reconstruction and notify DOL of this action after notifying the 

claimants or the AR. The CE also administratively closes the 

corresponding DEEOIC claim(s) in accordance with paragraph 10a(1). If, 

after 60 days, NIOSH receives only one signed Form OCAS-1, NIOSH 

will forward the dose reconstruction package to DOL. 

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(a) One signed Form OCAS-1 is sufficient to proceed with issuing a 

decision for all filing claimants.

11. Receipt of Dose Reconstruction Results from NIOSH. 

a. Content of NIOSH Report. The "NIOSH Report of Dose Reconstruction under 

EEOICPA" provides the information that the CE needs to perform a PoC 

calculation, which is necessary to render a decision on the claim. The NIOSH 

report includes the following information: 

(1) Annual dose estimates related to covered employment for each year from 

the date of initial radiation exposure at a covered facility to the date of 

cancer diagnosis; 

(2) Separate dose estimates for acute and chronic exposures, different types of 

ionizing radiation, and internal and external doses, providing dose 

information for the organ or tissue relevant to the primary cancer site(s) 

established in the claim;

(3) Uncertainty distributions associated with each dose estimated, as 

necessary;

(4) Explanation of each type of dose estimate included in terms of its 

relevance for estimating PoC;

(5) Identification of any information provided by the claimant relevant to dose 

estimation that NIOSH decided to omit from the basis for dose 

reconstruction, justification for the decision, and if possible, a quantitative 

estimate of the effect of the omission on the dose reconstruction results; 

and

(6) A summary and explanation of information and methods applied to 

produce the dose reconstruction estimates, including any factual findings 

and the evidence upon which those findings are based. 

b. NIOSH CD or Electronic Record. When NIOSH returns a dose reconstruction to 

DEEOIC, NIOSH will forward all case file documents via CD or as an electronic 

record, since NIOSH optically scans all documents referred to it for use in 

performing the dose reconstruction. The CD or electronic record will include the 

dose reconstruction input file (Excel spreadsheet) used for calculating the IREP

PoC. The CE bronzes into OIS or includes as a permanent record of the case file 

any record received from NIOSH as part of the dose reconstruction process. 

SUPERSEDED

(1) Information contained on the NIOSH CD or electronic record will include:
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(a) Dose reconstruction files; Computer Assisted Telephone Interview 

(CATI); dosimetry data; the NIOSH Report of Dose 

Reconstruction under EEOICPA; NIOSH’s PoC calculation; Form 

OCAS-1; the NIOSH-IREP input file; and pertinent AEC/DOE 

reports, journal articles or other documents. 

(b) Correspondence, including NIOSH letters to claimants, phone 

conversation notes, and e-mails. 

(c) DOE files (data files listed in order of importance on the CD), 

including DOE dose and work history information and other DOE 

documents that NIOSH requested, such as incident reports and 

special studies.

(d) DOL files, including a copy of the case file optically imaged by 

NIOSH and the OCAS tracking sheets (signatures and dates).

 

(2) NIOSH will incorporate information from the above sources into the dose 

reconstruction report. Publicly available documents will be referenced by 

citation. NIOSH will add documents not publicly available in the record 

and, as noted above, will be included on the CD or as part of the electronic 

record transferred to DEEOIC.

(3) The CE need not review all of the documents on the CD or electronic 

record. Those documents that normally will not require review include the 

DOE documents, the claimant interview, and the NIOSH-conducted 

closing interview. The CE must always run the IREP separately. 

c. NIOSH Unable to Perform Dose Reconstruction. In some cases, it may not be 

possible for NIOSH to complete a dose reconstruction because of insufficient 

information to reasonably estimate the occupational radiation dose received by the 

employee. In these situations, NIOSH notifies any claimant for whom it cannot 

complete a dose reconstruction and it describes the basis for this finding. NIOSH 

forwards its determination to DOL and the CE issues a RD to deny the claim 

based on NIOSH’s inability to complete the dose reconstruction. 

12. Review of Claim for Rework of Dose Reconstruction. The CE is responsible for 

comparing the dose reconstruction report to the evidence in the case file. If there are any 

significant discrepancies or changes between the information in the case file and the dose 

reconstruction report, including erroneous or incomplete information, or for which DEEOIC has 

received new information, the CE determines if rework may be necessary. 

Significant discrepancies or changes would include, for example, additional cancer identified or 

changed cancer site, changed employment facilities or dates, different diagnosis code, or change 

in date of cancer diagnosis. 

 

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a. Cancer Change Rework. 

(1) If additional cancer(s) is identified after the dose reconstruction is 

performed and:

(a) PoC is less than 50%, the CE submits a rework request to NIOSH. 

 

(b) PoC is 50% or greater, a rework is not required. All additional 

primary cancers would be eligible for medical benefits under Part 

B and Part E. The CE documents the newly identified cancer(s) in 

the case file.

(2) If two or more primary cancers are addressed in the dose reconstruction, 

and it is later determined that one or more of the cancers should not have 

been included in the dose reconstruction (e.g., the cancer was found to be 

a recurrent cancer or an erroneously reported cancer) and:

 

(a) PoC is less than 50%, a rework is not required. The PoC for the 

remaining cancers will still be below 50%. The CE must use the 

PoC as calculated as the PoC of record; document the discrepancy 

between the cancer(s) identified in the dose reconstruction and 

those determined by DOL to be cancers in the case file and in the 

RD; and notify the NIOSH PHA of the change to the cancer(s) 

status so that NIOSH can update its records.

If PoC is 50% or greater, submit a rework request to NIOSH. 

Also, if a primary cancer addressed in the dose reconstruction is 

found subsequently to be a secondary cancer with an unknown 

primary, submit a rework request to NIOSH. 

DOs cannot substitute newly identified cancers or additional 

cancers not used in the dose reconstruction, or their diagnosis 

dates, for incorrectly reported cancers found in the dose 

reconstruction. 

b. Smoking and Race/Ethnicity Changes Rework. If information related to 

race/ethnicity or smoking history changes after the dose reconstruction is 

performed, the CE re-runs IREP using the revised information. A rework is not 

required except for the following: 

 

(1) If the PoC is initially below 45% and then increases above 50% or greater 

after re-running IREP using the revised information, the CE submits a 

rework request to the DEEOIC HP. 

(2) If the PoC was above 50% and the change reduces the PoC below that 

threshold, the CE submits a rework request to the DEEOIC HP. 

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c. Diagnosis Code Changes Rework. Changes can affect the internal and/or external 

dose models used in the dose reconstruction and/or the IREP model. 

Accordingly, the CE submits a rework request for changes in diagnosis codes to 

the DEEOIC HP. If the diagnosis code changes for the following condition, no 

rework is required: 

(1) For carcinoma in situ skin, if the type of cancer is specified by DOL 

(Malignant melanoma or Non-melanoma skin-Squamous cell), NIOSH 

will use only the specified IREP model. If the cancer is not specified, 

NIOSH will run both IREP models and the model which results in the 

highest PoC will be used. 

d. NIOSH-IREP Changes Rework. If the diagnosis code changes, submit a rework 

request to the DEEOIC HP. 

e. Diagnosis Date Changes Rework. The net effect of a change in the diagnosis date 

depends mostly on the type of cancer, the worker’s age at the time of diagnosis, 

and whether or not the year of diagnosis falls within the latency period for 

development of the cancer (which, in turn, varies by IREP cancer model). 

Depending on the factors listed above, it is possible for an earlier diagnosis date 

to result in an increase in the PoC. For changes to the diagnosis date: 

(1) When the PoC is less than 40% and, 

(a) The diagnosis date is in the same calendar year, a rework is not 

required. 

(b) If the diagnosis date is found to be outside the calendar year (either 

earlier or later), the CE submits a rework request to NIOSH. 

(2) When the PoC is between 40% and 49.99%, and there is any change to the 

diagnosis date, the CE submits a rework request to the DEEOIC HP. 

(3) When the PoC is 50% or greater, 

(a) If the diagnosis date is found to be later, a rework is not required. 

(b) If the diagnosis date is found to be earlier, the CE submits a rework 

request to NIOSH. 

(c) The CE documents the difference in the diagnosis date in the case 

file and ensures that the difference in the diagnosis date used in the 

dose reconstruction is noted in the RD. 

(d) The CE notifies the NIOSH PHA of the change in the diagnosis 

date so that NIOSH can update its records. 

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f. Employment Changes Rework. 

(1) If the PoC is 50% or greater and the CE identifies additional DOL-verified 

employment, a rework is not required. 

 

(2) If the PoC is 50% or greater and the DOL-verified employment is found to 

be less than that used in the dose reconstruction, the CE submits a request 

for rework to the DEEOIC HP for review, and includes an electronic copy 

of the dose reconstruction report. 

(3) If the PoC is between 40% and 49.99%, and the CE identifies additional 

DOL-verified employment, the CE submits a request for rework to the 

DEEOIC HP for review, and includes an electronic copy of the dose 

reconstruction report. 

 

(4) If the PoC is less than 40%, and additional DOL-verified employment is 

identified:

(a) If all the additional employment falls within the same calendar 

year and the year is addressed in the dose reconstruction, a rework 

is not required. 

(b) If the additional employment extends into, or is wholly within 

another calendar year not addressed in the dose reconstruction, the 

CE submits a rework request to the NIOSH. 

(5) Some dose reconstructions contain more employment than originally 

verified by DOL in the NRSD. NIOSH may have DOE dosimetry or 

employment records for periods not identified by DOL, or the dose 

reconstruction may use a continuous period rather than considering 

numerous breaks in employment. 

(a) If the case is likely non-compensable, NIOSH may add the 

additional time period to the DOL-verified employment for the 

purpose of completing a dose reconstruction (unless it is military, 

navy nuclear, or non-DOE federal service) in a timely manner. 

(b) If the PoC is less than 50% and the dose reconstruction contains 

employment added by NIOSH, a rework is not required. However, 

the CE must write a memo to file that DOL did not verify part of 

the employment period assumed by NIOSH, but that the 

employment period was assumed correct for completing the dose 

reconstruction in a timely manner. 

Should new information arise to warrant performing the dose 

reconstruction again (e.g., additional cancer diagnosis, additional 

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employment at another site), only employment verified by DOL 

will be used, which may be more restrictive than that allowed in 

the current dose reconstruction. The CE ensures that he or she 

includes an explanation of this as part of the narrative analysis 

included in any forthcoming RD. 

If NIOSH has added employment to a claim that is likely 

compensable, NIOSH contacts the CE with the additional 

employment information for DOL review and verification. After 

verification, the CE submits an amended NRSD listing all accepted 

employment to NIOSH.

(c) If the PoC is 50% or greater and the dose reconstruction contains 

employment added by NIOSH but not approved by the DO, the CE 

submits a rework request to the DEEOIC HP. 

(6) If a CE identifies military, navy nuclear, or non-DOE federal service 

employment referenced in the dose reconstruction, the CE submits a 

rework request to the DEEOIC HP because this may mean that covered 

employment is not established. 

(7) For any PoC, if the CE identifies changes to the employment site(s), the 

CE submits a rework request to the DEEOIC HP because this may alter 

the applicable site profile used in assessing occupational radiation 

exposure. 

(8) When a rework is not required, the CE documents the changes to the 

employment in a memo to file and ensures that the difference(s) between 

the employment used in the dose reconstruction compared to the DOLverified employment is noted in the RD. Finally, the CE notifies the 

NIOSH PHA of the change(s) in employment so NIOSH can update its 

records. 

g. Additional Survivors (Claimants) Identified Rework.

(1) If the PoC is 50% or greater, NIOSH does not need to interview any newly 

identified claimants. A rework is not required. 

(2) If the PoC is less than 50%, a rework request is sent to NIOSH to 

interview the new claimant(s), at the claimant(s)’ request, to determine if 

there is some information that could significantly affect the dose 

reconstruction. 

13. Procedures for Requesting Rework. For cases in which the CE determines that a rework 

is necessary, the CE e-mails his or her assigned SCE, SrCE or journey level CE with the 

amended NRSD attached, noting the issues with the dose reconstruction. 

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a. The CE’s e-mail includes the following:

 

(1) Use an e-mail subject that is specific to the individual rework request. For 

example: DOL Case ID, NIOSH ID Number, DO, and “Rework”, i.e., 

1234-NIOSH ID #123456-Denver-Rework. 

 

(2) The CE briefly summarizes how he or she used the current dose 

reconstruction. Include the employment history used by NIOSH in the 

dose reconstruction; the cancer(s), diagnosis code(s) and diagnosis date(s) 

used in the dose reconstruction, and the PoC resulting from this 

information used in the dose reconstruction. 

(3) Describe the reason(s) for the rework request. For example, an additional 

cancer has been verified, the wrong cancer was reported in the NRSD, the 

primary cancer was determined for a secondary cancer reported as an 

“unknown primary,” more or less employment was determined, or the 

diagnosis date for one of the cancers in the dose reconstruction was found 

to be incorrect. 

 

(4) Determine whether the employment history and cancer information listed 

on the Dose Reconstruction Coversheet is the exact information used by 

NIOSH in the dose reconstruction. If the information reported in the 

NRSD does not match the information stated on the Dose Reconstruction 

Coversheet, review the dose reconstruction report, particularly in the 

sections “Dose Reconstruction Overview,” and “Information Used”, 

where NIOSH describes in more detail the information used to complete 

the dose reconstruction. This text may resolve an apparent discrepancy. 

 

(5) Refer to Exhibit 17-4 for examples of rework requests and types of 

information needed. 

b. The CE prepares an amended NRSD as necessary. 

c. To track the action, the CE records the rework request in ECS. 

d. The DEEOIC HP serves as the central liaison between NIOSH and DOL on all 

issues related to dose reconstruction. If the SCE, SrCE, or journey level CE 

agrees with the CE’s findings regarding rework, he or she forwards the CE’s email along with the amended NRSD to the DO NIOSH liaison. In turn, the DO 

NIOSH liaison sends the request along with the amended NRSD to the DEEOIC 

HP and copies the CE, SCE, SrCE or journey level CE, and DD. For instances 

where the CE determines that a rework request does not need to be forwarded to

the DEEOIC HP (e.g., non-compensable claim with an accepted cancer not 

included in the dose reconstruction), the CE is to forward the rework request 

directly to NIOSH. 

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(1) The DEEOIC HP reviews the request for rework and determines whether a 

rework is required. 

 

(2) If the DEEOIC HP needs additional information to make a determination, 

which may include requesting the case file, he or she contacts the CE.

e. Rework Not Needed. If the DEEOIC HP determines that the submitted 

information does not change the outcome of the dose reconstruction, he or she 

sends an e-mail to the DO NIOSH liaison, with a copy to the CE, or SCE, and 

DD, explaining the rationale for not continuing the review of the dose 

reconstruction. When the CE receives this response, he or she ensures the 

response is entered into ECS and proceeds with the IREP calculation. 

(1) Updating Records. The CE is responsible for documenting any change to 

the case records in OIS. This is true regardless of whether the CE submits 

the case for a rework review by the DEEOIC HP. The CE is to always 

document, with memos to file, any analysis that applies to assessing the 

sufficiency of a dose reconstruction, along with the guidelines used to 

make that determination. 

When the DO makes changes to information used in the NIOSH dose 

reconstruction, and no rework is required, the DO NIOSH liaison or other 

designated person sends an e-mail to the appropriate NIOSH PHA. This 

e-mail indicates what information changed, such as the diagnosis code, 

cancer name, employment dates, etc. 

This allows NIOSH to update its records for the case, which is most 

critical with respect to changes involving diagnosis codes and PoC values 

different from those initially generated by the dose reconstruction. 

Forwarding these changes also allows NIOSH to compile accurate 

statistics on the types of cancers addressed in EEOICPA decisions that 

required a NIOSH dose reconstruction. 

 

If a CE performs a new PoC calculation using new information without 

the need for rework, the DO NIOSH liaison must advise the NIOSH PHA 

via e-mail and attach the new IREP summary file. For example, in a case 

with an initial PoC less than 45%, the DEEOIC HP determined that a 

change in the diagnosis code did not require a rework of the dose 

reconstruction, but just a different NIOSH-IREP model run. If the new 

IREP run resulted in a PoC less than 45%, the CE uses the new IREP run 

and PoC as the value for the dose reconstruction but must advise NIOSH 

as noted above. 

(2) Any future dose reconstruction rework based on additional verified 

cancer(s) or employment is performed by NIOSH using only DOLverified information, which may be more restrictive than information used 

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in the previous dose reconstruction (i.e., in some likely non-compensable 

cases, NIOSH may assume a continuous employment period rather than 

considering numerous breaks in employment for the purpose of 

completing a dose reconstruction in a timely manner). Therefore, it is 

possible in some cases for the subsequent PoC to remain the same, 

increase only slightly, or even decrease to some degree if the dose 

reconstruction is reworked in the future. 

f. Rework Needed. If the DEEOIC HP determines that a rework is necessary, he or 

she e-mails the CE, SrCE or journey level CE, SCE, DD and the DO NIOSH 

liaison. In certain non-standard rework requests, the DEEOIC HP also copies the 

designated NIOSH Division of Compensation Analysis and Support (DCAS) 

contact person(s) on the e-mail. 

(1) The CE takes the following actions: 

(a) Forward the amended NRSD as an electronic attachment via email to the NIOSH PHA assigned to the DO.

(b) Send a letter to the claimant (Exhibit 17-5) explaining that the case 

has been returned to NIOSH for a review of the dose 

reconstruction. 

(c) Send a copy of this letter to the appropriate NIOSH PHA along 

with the weekly DO submissions to NIOSH. 

g. After a revised dose reconstruction report is completed, NIOSH sends it to the 

claimant along with another Form OCAS-1. The claimant has 60 days to sign and 

return the form.

14. Comments to Dose Reconstruction Submitted to FAB. A claimant may choose to present 

comments regarding the findings reported in the NIOSH dose reconstruction. Claimant 

comments may be submitted for consideration as part of the following circumstances: a request 

for a review of the written record, oral hearing, or reconsideration; testimony or presentation of 

exhibits for an oral hearing; or a request for reopening or other post-adjudication action. In these 

situations, the DEEOIC HP serves as the initial point of contact for addressing claimant-related 

comments to a NIOSH dose reconstruction. The CE or assigned DEEOIC FAB staff person 

takes the following steps to track dose reconstruction comments submitted for DEEOIC HP

review:

a. Prepares a memo to the DEEOIC HP that identifies all comments related to the 

NIOSH dose reconstruction. 

b. E-mails an electronic version of the memo to the DEEOIC HP. Attached to the email is a copy of the claimant’s comments/letter of objection, hearing transcript 

and applicable exhibits, if available. Copies of this e-mail are sent to the 

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supervisor of the assigned CE or DEEOIC FAB staff member and the Policy 

Branch Program Specialist. The e-mail message should contain the following 

information in the subject line: the assigned DEEOIC staff member’s FAB or DO 

location; “Tech Obj”; the DOL Case ID#; and the name of the covered facility, 

e.g., (FAB NO) Tech Obj-4112(Hanford). 

c. Bronzes a copy of the memo with associated documents attached into OIS to 

document the referral and the person completing the action documents ECS 

Notes, verifying that the aforementioned actions have been completed.

d. Upon receipt of the comments related to the dose reconstruction, the DEEOIC 

HP determines whether the issues raised require further review by NIOSH. As 

part of this review, he or she will review applicable documents from OIS 

including: the NIOSH dose reconstruction report, an IREP summary for each 

cancer, and CATI summary for each claimant from the NIOSH dose 

reconstruction documentation. If the DEEOIC HP determines that the issues 

raised are appropriate for NIOSH review, he or she compiles a package consisting 

of a copy of the memo from the assigned DEEOIC staff member, a summary of 

the concerns raised regarding the NIOSH dose reconstruction process or copy of 

pertinent transcript data from the oral hearing, including exhibits (if applicable), 

the comments/objection letter from the claimant, and any additional 

documentation (e.g., exposure data). The DEEOIC HP submits this package to 

NIOSH for review and written response. The DEEOIC HP can consult with 

NIOSH to clarify whether an issue is appropriate for NIOSH review. 

e. Upon receipt of NIOSH’s response, the DEEOIC HP reviews the response to 

confirm that it addresses the claimant’s concerns. He or she will add any 

additional comments, noting that the comments are from DEEOIC, and forward 

this information to the assigned DEEOIC staff member and his or her respective 

supervisor via e-mail. Upon receipt of the review of NIOSH’s response, the 

assigned DEEOIC staff member bronzes the responses into OIS. The assigned 

DEEOIC staff member incorporates the NIOSH findings into a FD/Remand or 

other post-adjudicatory decision (e.g., reconsideration, reopening, etc.). The 

FD/Remand or other post-adjudicatory decision must clearly summarize the 

claimant’s concerns regarding the dose reconstruction and include a detailed 

summary of NIOSH’s responses or, when appropriate to provide clarity, a 

verbatim recitation of NIOSH’s comment response. 

If the DEEOIC HP determines that the concerns do not warrant further review by 

NIOSH, the DEEOIC HP prepares an e-mail to the assigned DEEOIC staff 

member and his/her supervisor addressing the issues raised by the claimant 

regarding NIOSH dose reconstruction. In such instances, the assigned DEEOIC 

staff member incorporates the findings of the DEEOIC HP into either a 

FD/Remand or other post-adjudicatory decision. The FD/Remand or other postadjudicatory decision must summarize clearly the claimant’s concerns regarding 

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the dose reconstruction and include the DEEOIC HP’s comments to such 

concerns. 

 

15. Proving Causation Between Diagnosed Non-SEC Cancer and Covered Employment. 

Under Part B, a covered employee seeking compensation for cancer, other than as a member of 

the SEC seeking compensation for a specified cancer, is eligible for compensation if DOL 

determines that the cancer was "at least as likely as not" (that is, a 50% or greater probability) 

caused by radiation doses incurred in the performance of duty while working at a DOE facility 

and/or an AWE facility. DEEOIC uses an algorithmic calculation provided by NIOSH to 

determine the PoC. 

a. Cancers for Which the Primary Site is Unknown. Some claims involve cancers 

identified by their secondary sites (sites to which a malignant cancer has spread), 

where the primary site is unknown. 

(1) This situation most commonly arises when death certificate information is 

the primary source of a cancer diagnosis. It is accepted that cancercausing agents, such as ionizing radiation, produce primary cancers. In a 

case in which the primary site of cancer is unknown, this means that the 

primary site must be established by inference to estimate the PoC.

(2) For background purposes, Exhibit 17-6, which is produced from Table 1 

in 42 C.F.R. Part 81, indicates, for each secondary cancer, the set of 

primary cancers producing approximately 75% of that secondary cancer 

among the U.S. population (males and females were considered 

separately). NIOSH performs the dose reconstruction for the cancer site 

that yields the highest PoC. 

If the PoC yields a result greater than 50%, all of the secondary cancers 

are covered for medical benefits even if no dose reconstruction was 

performed for that secondary cancer. 

b. Cancers of the Lymph Node. The CE considers all secondary and unspecified 

cancers of the lymph node as secondary cancers (those resulting from metastasis 

of cancer from a primary site). For claims identifying cancers of the lymph node, 

Exhibit 17-6 provides guidance for assigning a primary site and calculating the 

PoC using NIOSH-IREP.

c. Claims with Two or More Primary Cancers. For these claims, DOL uses NIOSHIREP to calculate the estimated PoC for each cancer individually. The CE then 

performs an additional statistical procedure following the use of NIOSH-IREP to 

determine the probability that at least one of the cancers was caused by radiation 

(discussed further in the NIOSH-IREP procedures). This approach is important to 

the claimant because it determines a higher PoC than is determined for either 

cancer individually. 

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For cases involving multiple primary cancers where the PoC is greater than 50%, 

all of the primary cancers will be covered for medical benefits.

d. Claims for Certain Cancers. Sometimes NIOSH guidance requires that a CE run 

two or three NIOSH-IREP models for a particular cancer. This most often occurs 

with different types of leukemia. NIOSH only includes the NIOSH-IREP input 

and associated summary sheet providing the highest PoC in the "Dose 

Reconstruction Files" in the data sent to the DO. 

 

16. Calculation of PoC Using NIOSH-IREP Computer Program. DOL calculates the PoC for 

all cancers using NIOSH-IREP. The risk models developed by the NCI and the Center for 

Disease Control for NIOSH-IREP provide the primary basis for developing guidelines for 

estimating PoC under EEOICPA. They directly address 33 cancers and most types of radiation 

exposure relevant to claimants covered by EEOICPA. A glossary of cancer descriptions is 

provided in 42 C.F.R. Part 81 and is produced as Exhibit 17-7. 

a. NIOSH-IREP Operating Guide. The CE uses procedures specified in the 

NIOSH–IREP Operating Guide to calculate PoC estimates under EEOICPA. The 

guide provides step-by-step instructions for the operation of NIOSH–IREP. 

There are two user guides, one for cases with a PoC less than 45% or greater than 

52%; and another, termed the Enterprise Edition, for cases with PoCs of 45% to 

52%. Enterprise Edition cases can be identified by looking at the Excel input file 

name which would include the notation “EE.” 

(1) For cases with a PoC less than 45% or greater than 52%, the CE accesses 

NIOSH-IREP on the NIOSH website to perform the PoC calculation. The 

CE uses data from the CD or electronic record for the NIOSH-provided 

input file for each cancer.

When two or more cancers are present, the CE uses the multiple primary 

cancer equation to calculate the total PoC.

 

(2) For cases with POCs between 45% and 52%, another software program, 

called the NIOSH-IREP Enterprise Edition (NIOSH-IREP-EE), is used to 

perform the PoC calculation. The Enterprise Edition is used for this PoC 

range to achieve better statistical precision and further reduces the chance 

of denying a claim because of sampling error.

(3) For multiple primary cancers (or secondary cancers with no known 

primary), the CE performs the NIOSH-IREP-EE calculation for each 

cancer. 

17. Establishing Causation for Cancer Under Part E. EEOICPA presumes medical conditions 

approved under Part B are caused by exposure to a toxic substance under Part E, so long as there 

is covered contractor employment and in the case of deceased employees, which a survivor is 

found eligible. 

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CHAPTER 18 – ELIGIBILITY CRITERIA FOR NON-CANCEROUS CONDITIONS

1. Purpose and Scope. This chapter describes the criteria necessary to establish eligibility 

for non-cancerous conditions covered under Part B and/or Part E of the EEOICPA. The chapter 

provides a discussion of the steps the CE undertakes in the development of the causal 

relationship between toxic substance exposure at a covered facility and diagnosed non-cancerous 

conditions. 

2. Approved Part B Illnesses. The EEOICPA provides that a CE may presume an 

occupational illness approved under Part B relates to a toxic substance exposure under Part E, as 

long as the employee is a DOE contractor or subcontractor working at a covered DOE or RECA 

Section 5 facility under Part E. In all instances when issuing a Part E RD based on a Part B 

acceptance, the CE applies the factual findings of the original Part B FD. This includes the 

establishment of verified covered employment, diagnosed medical condition(s), and survivor (if 

applicable) relationship to the deceased employee. Survivors approved under Part B need to 

establish the distinct survivorship criteria under Part E and provide evidence that it is “at least as 

likely as not” that the employee’s exposure to a toxic substance was a significant factor that 

aggravated, contributed to, or caused his or her death. 

3. Identifying Claimed Condition as Part B, Part E, or Both. The CE first determines 

whether the type of claim filed is for employee benefits (i.e., Form EE-1) or for survivor benefits 

(i.e., Form EE-2). Then the CE reviews the condition(s) claimed, either marked or written on the 

form, and determines whether the claimed condition is potentially covered under Part B, Part E, 

or both. 

Those conditions covered under Part B are beryllium sensitivity, CBD, chronic silicosis, and 

cancer. Under Part E, consideration extends to any illness claimed as related to an occupational 

toxic substance exposure, including those covered under Part B. This includes, but is not limited 

to, diagnosed cancers, respiratory illnesses, cardiac illnesses, and also mental illnesses that 

originate from a physical condition, such as a neurological condition. An illness or injury that 

arises because of an accepted Part B or Part E condition is compensable as a consequential 

condition. 

To identify accurately a claimed condition as covered under Part B, Part E, or both, the CE has to 

evaluate initially the claimed employment, because that is indicative of the type of coverage that 

extends to the employee. Some types of qualifying employment under Part B do not qualify for 

coverage under Part E. For example, Part B coverage extends to atomic weapons employees, 

beryllium vendor employees, and DOE contractor/subcontractors and federal employees. 

Alternatively, Part E coverage extends to DOE subcontractor/contractor employees working at 

DOE facilities. Part E does not cover employees of AWE, beryllium vendors, or federal 

agencies, except if the employee worked at an AWE facility or with a beryllium vendor 

designated as a DOE facility for remediation and the employee worked for the remediation 

contractor. The CE has to assess properly each claimed medical condition, along with the type 

of employment claimed, to associate it to the respective Part B or E component. 

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4. Proof of Covered Employment for Beryllium Illness. For beryllium claims, exposure to 

beryllium is necessary. The DEEOIC recognizes that the potential for beryllium exposure 

existed at all beryllium vendor and DOE facilities. 

a. Under Part B. To satisfy the employment requirement, the evidence needs to 

establish either (1) that the employee had at least one day of verified employment 

at a DOE facility or (2) that the employee was present for at least one day at a 

DOE facility, or a facility owned and operated by a beryllium vendor. 

b. Under Part E. To satisfy the employment requirement under Part E, the employee 

must meet the same requirements as stated above for Part B, but the employee 

must be a DOE contractor or subcontractor employee. 

5. Beryllium Sensitivity. Beryllium sensitivity is an allergic reaction of the immune system 

to the presence of beryllium in the body because of contact with beryllium dust particles or 

fumes. The evidence required to establish beryllium sensitivity is described under 42 U.S.C. 

§7384l(8)(A) and the CE develops the beryllium claim accordingly, verifying whether or not the 

medical evidence submitted by the claimant is sufficient. 

 

a. Testing. A claimant establishes beryllium sensitivity under Part B and/or Part E 

by submitting the results of either one BeLPT or one BeLTT, performed on blood 

or lung lavage cells, which shows abnormal or positive findings. A claimant can 

also establish beryllium sensitivity by submitting the results of one beryllium 

patch test, which shows a positive reaction. The DEEOIC requirement to accept 

beryllium sensitivity is one abnormal test. 

b. Evaluation. A physician is required to validate the results of an abnormal 

BeLPT/BeLTT or beryllium patch test with his or her findings specifically 

outlined (e.g., abnormal response to beryllium). A BeLPT/BeLTT or beryllium 

patch test exhibiting a “borderline” result is not sufficient to establish beryllium 

sensitivity.

The CE does not attempt to interpret the findings of the BeLPT/BeLTT or the 

beryllium patch test. If the test is not accompanied by a physician’s 

interpretation, the CE obtains the interpretation from the physician who 

performed the test. If the testing physician is not available, the CE obtains an 

evaluation from another qualified physician (e.g., a CMC).

c. False Negative Results. If the claimant has a history of steroid use, a false 

negative result on the BeLPT/BeLTT or the beryllium patch test can occur. If 

there is evidence that this has occurred, then the CE requests that the employee 

undergo a repeat BeLPT/BeLTT or beryllium patch test. If the claimant is 

deceased, the CE should try to obtain as much information as possible on past 

LPT results and possible steroid use. If exhaustive efforts produce little or no 

results and the evidence of record contains the normal/borderline LPT result along 

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with a biopsy of the lung tissue showing the presence of granulomas, the CE may 

accept the claim.

 

d. Definitions. A BeLPT/BeLTT is a laboratory test that measures how a type of 

disease-fighting blood cell, called a lymphocyte, reacts to beryllium. The blood 

cells’ reaction to beryllium determines whether the test results are normal or 

abnormal. If the cells do not react sufficiently to beryllium, the test result is 

normal; if the cells react very strongly to beryllium, the test result is abnormal. 

The Bronchoalveolar Lavage LPT is a laboratory test performed on lung tissue 

that is washed from the lungs. The lung wash contains lung tissue obtained via an 

intranasal insertion of a bronchoscope into the lung. When the bronchoscope is 

lowered into the lower lung, a saline solution is washed into the airways and 

retrieved (lung washing). The retrieved solution is cultured in the presence of 

beryllium salts. A reaction or response to the beryllium salts represents a 

lymphocytic process and is sufficient to establish beryllium sensitivity.

e. Benefits Under Part B. Once the medical, employment, and causation criteria are 

satisfied for a beryllium sensitivity claim under Part B, the employee receives 

medical monitoring (which includes all tests for CBD), treatment, and therapy for 

the condition effective on the date of filing. Unlike for CBD, the Act provides for 

no lump-sum compensation for beryllium sensitivity under Part B. 

f. Benefits Under Part E. Once the medical, employment, and causation criteria are 

satisfied for a beryllium sensitivity claim under Part E, the employee receives 

medical monitoring, treatment, and therapy for the condition effective on the date 

of filing. In addition, the employee is eligible for lump-sum compensation for 

impairment and/or wage-loss if the CE finds that the criteria for those benefits are 

satisfied. 

6. Established CBD Before 1993, Part B. The evidence required to establish a claim for 

established CBD under Part B of the Act is described under 42 U.S.C. §7384l(13). Whether to 

use the pre- or post-1993 CBD criteria depends upon the totality of the medical evidence, 

including when the employee was tested for, diagnosed with, and/or treated for a chronic 

respiratory disorder. 

If the earliest dated document showing that the employee was either treated for or diagnosed 

with a chronic respiratory disorder is dated prior to January 1, 1993, the pre-1993 CBD criteria 

should be used. Evidence of a chronic respiratory disorder includes records communicating 

existence of a long term, prolonged pulmonary disease process. References to acute pulmonary 

conditions, such as short-term pulmonary distress associated with temporary viral or bacterial 

infection do not qualify as a chronic respiratory disorder. Pulmonary testing performed in 

occupational or medical settings, which identify abnormalities, are not appropriate to document a 

chronic respiratory disorder, unless interpreted as such by a physician. In situations where it is 

critical that the question of whether historical documentation communicates the existence of a 

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chronic respiratory disorder, the CE is to undertake development to allow for a physician chosen 

by the claimant to provide clarification, or when the claimant is unable to provide such evidence, 

seek the input of a CMC. 

If the earliest dated document showing a chronic respiratory disorder lists a date after January 1, 

1993, the post-1993 CBD criteria should be used. If the employee sought treatment before 1993, 

but the medical documentation relating to the treating document is dated on or after January 1, 

1993, the pre-1993 CBD criteria should be used. In this situation, the medical evidence is to 

clearly communicate the fact that treatment occurred prior to 1993. 

To establish pre-1993 CBD, the medical documentation is to include at least three of the 

following: characteristic chest radiographic [or computed tomography (CT)] abnormalities; 

restrictive or obstructive lung physiology testing or diffusing lung capacity defect; lung 

pathology consistent with CBD (including the results of an abnormal mediastinal lymph node 

biopsy); a clinical course consistent with a chronic respiratory disorder, or immunologic tests 

showing beryllium sensitivity (e.g., skin patch test or beryllium blood test preferred). 

The interpretation of whether a diagnostic test is “characteristic” or “consistent with” relate to a 

physician’s opinion as to whether the test is indicative of CBD. CEs are not to interpret 

medical/diagnostic tests. If no physician interpretation exists, or if the CE is unsure whether the 

findings are characteristic or consistent with CBD, he or she is to obtain clarification from the 

treating physician or a CMC. 

a. Characteristic Chest Radiograph (X-ray). In a chest X-ray, rays are emitted

through the chest and the image is projected onto film, creating a picture of the 

image. Chest X-ray findings that a physician may commonly communicate as 

characteristic of CBD include: 

(1) Small round areas of opacity distributed throughout all of the lung fields. 

Mixtures of round and irregular areas of opacity are also often seen. 

(2) Other characteristic X-ray findings include interstitial lung fibrosis, 

interstitial or pleural fibrosis (i.e., pleural fibrosis alone is not sufficient, as 

there have to be other findings present), and granulomas (i.e., noncalcified and non-caseating). 

(a) Caseating granulomas are sometimes considered characteristic; 

however, the treating physician or a CMC needs to review these 

findings for a determination. The term “caseating” identifies 

necrosis (i.e., decay) in the center of a granuloma. This term was 

originally applied to a granuloma associated with tuberculosis or a 

fungal infection. A non-caseating granuloma is one without 

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(b) Calcification in a granuloma is usually associated with the healing 

of the granuloma. A calcified granuloma is not characteristic of 

CBD. 

(3) Coarse linear fibrosis is sometimes found with advanced CBD which 

results in progressive loss of lung volume. 

b. CT Scan. A CT scan uses X-rays to produce detailed pictures of structures inside 

the body. Each X-ray pulse lasts only a fraction of a second and represents a 

“slice” of the organ or area being studied. A CT scan is sometimes referred to as 

a CAT (computed axial tomography) scan. CT scan abnormalities a physician 

may reference as indicative of CBD include the following:

(1) Consolidation, ground glass, septal thickening, diffuse nodules (different 

distributions), interstitial fibrosis, bronchiectasis, and honeycombing. 

(2) Other CT scan findings include parenchymal nodules, septal lines, patches 

of ground-glass attenuation, bronchial wall thickening, and thickening of 

the interlobular septa. Nodules are often seen clustered together around 

the bronchi or in the subpleural region. Subpleural clusters of nodules 

sometimes form pseudo plaques. In advanced CBD, large subpleural cysts 

are sometimes found. 

c. Radiographic Patterns. The following list represents radiographic (X-ray/CT) 

patterns that a physician may reference as characteristic of CBD: 

 

Chest X-ray CT/*HRCT

Alveolar Patterns Alveolar Patterns

- Consolidation - Consolidation

- Ground glass - Ground glass

Interstitial Patterns Interstitial Patterns

- Reticular (irregular lines) - Septal thickening

- Diffuse Nodules - Diffuse Nodules (different distributions)

- Reticulonodular - Ground glass

Interstitial Fibrosis Interstitial Fibrosis

- Honeycombing - Traction Bronchiectasis

- Upper lobe retraction - Honeycombing

*HRCT = high-resolution computed tomography

d. Restrictive or Obstructive Lung Physiology Testing or Diffusing Lung Capacity 

Defect. Obstruction, either severe or mild, is the most common abnormality 

found by spirometry. Severe obstruction prevents complete exhalation (i.e., air 

trapping). A definitive diagnosis of restriction (e.g., reduced lung volumes) 

through spirometry is not made without lung volumes. Generally, the pulmonary 

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function studies include the physician’s interpretation of whether there is 

restriction or obstruction. 

e. Arterial Blood Gas (ABG). An ABG test is not used in lieu of a PFT. There are 

many factors involved in interpreting an ABG test. If the CE is unable to obtain a 

PFT and the ABG test is the only test available, the treating physician or a CMC 

needs to review the ABG test results along with the medical evidence of record to 

determine whether it is indicative of a restrictive or an obstructive lung 

physiology. An ABG test result generally does not show a diffusing lung capacity 

defect. 

f. Pathology Report. A physician may reference the existence of lung pathology 

consistent with CBD in a pathology report. The opinion of the physician will 

generally result in his or her examination of specific diagnostic test results or 

other results from examination. If a pathology report does not include a 

physician’s interpretation, or if the CE is unsure whether the findings are 

consistent with CBD, the CE obtains clarification from the treating physician or a 

CMC.

g. Clinical course consistent with chronic respiratory disorder may include the 

following disorders and methods of treatment that a physician finds relevant in his 

or her assessment relating to CBD:

(1) Hypoxemia requires supplemental oxygen and supplies. 

(2) Air flow obstruction (e.g., COPD, emphysema) and asthma/wheezing-like 

symptoms require inhalers (e.g., Flovent, Advair, Serevent, Albuterol, 

etc.), corticosteroid drugs, bronchodilators, and oxygen therapy. 

(3) Right heart failure, Cor pulmonale: Cardiology consult and subsequent 

management, diuretics (e.g., Lasix, HCTZ, Spironolactone, etc.), 

supplemental oxygen. 

(4) Pulmonary Hypertension: Cardiology consult and subsequent 

management, supplemental oxygen. 

(5) Respiratory infections (pneumonia, acutebronchitis): Antibiotics, sputum 

cultures, blood cultures, sometimes bronchoscopy. 

(6) Sarcoidosis: corticosteroid drugs, such as Prednisone. 

h. Immunologic Tests. Examples of immunologic tests that establish beryllium 

sensitivity include skin patch tests and beryllium blood tests which involve the 

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7. Established CBD On/After January 1, 1993, Part B. The medical documentation needs to 

include an abnormal BeLPT/BeLTT performed on either blood or lung lavage cells or a positive 

beryllium patch test, in addition to evidence of lung pathology consistent with CBD. Proof of 

lung pathology consistent with CBD includes, but is not limited to: a lung biopsy showing 

granulomas or a lymphocytic process consistent with CBD; a CAT scan showing changes 

consistent with CBD; or a pulmonary function or exercise test showing pulmonary deficits 

consistent with CBD. 

In addition to the three criteria listed, a mediastinal lymph node biopsy interpreted by a physician 

as evidence of “lung pathology consistent with CBD” may be used to establish CBD. A 

mediastinal lymph node biopsy is not the equivalent of a “lung biopsy” and, as such, does not 

substitute for such in the assessment of a post-1993 CBD claim. The evidence has to be 

interpreted as “lung pathology.” A mediastinal lymph node is not dispositive proof of CBD in 

the same way as a lung biopsy. 

a. Lung Biopsy. 

(1) The term “lung biopsy” is any sampling of lung tissue to assess the 

possibility of disease. Lung tissue samples include any one of the 

following: 

(a) Lung tissue obtained from whole lung specimens at the time of an 

autopsy; 

(b) Lung tissue obtained by open or video-assisted thoracotomy; 

(c) Lung tissue obtained by bronchoscopic transbronchial biopsy; or 

(d) Lung tissue obtained by bronchoalveolar lavage, which includes 

alveolar and bronchial epithelial cells, macrophages, lymphocytes, 

neutrophils, eosinophils, and other lung cells. 

Tissue samples obtained by any one of these methods are used to 

document the presence of a lymphocytic process consistent with 

CBD.

(2) In claims that contain a normal or borderline LPT, and the lung tissue 

biopsy confirms the presence of granulomas consistent with CBD, the CE 

may accept the claim for CBD. The lung biopsy is considered the “gold 

standard.” However, the following steps must be followed before 

accepting a claim in this manner.

(a) If the claimant is living, the CE should contact the treating 

physician and obtain a detailed narrative report detailing the 

history of the claimant’s LPT results (if possible). Specifically, the 

physician should address whether the claimant has a history of 

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positive LPTs with recent normal or borderline LPT results. The 

CE should note that if the claimant has a history of steroid use, this 

may cause a false negative on the LPT result.

(b) If the claimant is deceased, the CE should try to obtain as much 

information as possible on past LPT results and possible steroid 

use. If exhaustive efforts produce little or no results and the claim 

contains the normal/borderline LPT results along with a biopsy of 

the lung tissue showing the presence of granulomas, the CE may 

accept the claim.

(c) If there is no LPT and the lung tissue biopsy confirms the presence 

of granulomas consistent with CBD, the CE may accept the claim. 

b. Lymphocytic Process. A lymphocytic process consistent with CBD is measured 

in the lung by any one of the following methods: 

(1) Biopsies showing lymphocytes (i.e., part of the population of so-called 

mononuclear cells) in bronchial or interstitial (alveolar) lung tissue; 

(2) Biopsies showing non-caseating granuloma; 

(3) Bronchoalveolar lavage showing an increase in the percentage of 

lymphocytes in the differential cell count (i.e., typically >15% 

lymphocytes is considered a BAL lymphocytosis, but physician 

interpretation is paramount); or 

(4) Bronchoalveolar lavage beryllium LPT showing that the lymphocytes 

washed from the lungs react/respond to beryllium salts. This includes an 

abnormal BeLPT/BeLTT, performed on either blood or lung lavage cells, 

or a positive beryllium patch test. 

c. CAT Scan. A CAT scan uses X-rays and computers to produce an image of a 

cross-section of the body. For post-1993 CBD claims, a physician evaluates the 

results of the CAT scan for a determination on whether the findings are consistent 

with CBD. 

d. Pulmonary Function or Exercise Testing. For this criterion, the treating physician 

or a CMC evaluates the results of the pulmonary function study or exercise tests 

for a determination on whether or not the deficits are consistent with CBD. 

8. Established CBD Decisions, Part B. The pre-1993 CBD criteria are recognized as 

generalized because before 1993, it was difficult to confirm beryllium sensitization. As such, the 

respiratory problems potentially related to beryllium were often misdiagnosed and thought to be 

related to other causal factors. After 1993, diagnostic measures reliably identified a patient’s 

sensitivity to beryllium and linked it to the potential onset of CBD. As such, the post-1993 CBD 

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criteria are significantly more accurate for confirming or negating the existence of beryllium 

sensitization and CBD. 

a. Conflicting Medical Evidence. During the adjudication process, there are 

instances when the CE encounters claims containing conflicts between the pre1993 and post-1993 standard. This will most commonly occur where the pre1993 criteria apply, but post-1993 evidence exists suggestive that an employee 

does not have CBD. For example, a claim contains a post-1993 BeLPT with 

normal results and medical evidence meeting the pre-1993 CBD criteria (i.e., 

evidence of chronic respiratory disorder prior to 1993 and three of the five 

diagnostic criteria). In these situations, the CE proceeds with acceptance, if the 

necessary criteria for a pre-1993 or post-1993 CBD claim are met. 

b. Referral to a CMC. CEs should refer claims to a CMC for a medical review after 

all means of obtaining the evidence from the treating physician is exhausted. The 

CE may also refer cases to a CMC when the medical reports and/or tests do not 

include a clear interpretation and/or if there is a specific question(s) about the 

medical evidence. When the CE makes a referral to a CMC, he or she is to send 

all the medical records in the case file to the CMC for review. Examples of 

situations when a referral is needed include:

(1) Assessment of pre-1993 medical evidence to determine if the claimant 

suffered from a chronic respiratory disorder; 

(2) Medical test results that do not provide a clear interpretation (e.g., 

pathology report, BeLPT, X-ray, CT scan); and 

(3) Pre-1993 and/or post-1993 CBD tests (e.g., chest X-ray, diffusion lung 

capacity defect, lung biopsy showing granulomas, lymphocytic process, or 

pulmonary function study) that do not denote abnormalities or defects, 

contain the finding “consistent with CBD”, or are inconclusive. 

The opinion of the CMC, when properly supported by medical rationale, carries 

significant probative value. However, the CE has to assess carefully the weight of 

medical evidence whenever there is a conflict between two physicians. The CE is 

to communicate clearly his or her assessment of the weight of medical evidence in 

any RD to clearly explain the reasons why one physician’s opinion takes 

precedence over another. 

c. Beryllium Sensitivity Decision When CBD Is Claimed. When CBD is claimed on 

Form EE-1 for a living employee, but evidence supports the existence of 

beryllium sensitivity only, the CE issues a RD to accept for beryllium sensitivity 

and deny the claim for CBD. If at a later date, the DO receives evidence that the 

employee’s beryllium sensitivity has progressed to CBD, it can initiate a 

reopening to resume development of the existing CBD claim. The claimant may 

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also file a reopening request to resume development of his or her CBD claim, if 

new medical evidence supports the claim. 

9. Beryllium Sensitivity and CBD, Part E. A BeLPT or BeLTT are definitive tests for 

confirming beryllium sensitivity. As such, a positive BeLPT or BeLTT is required for any Part E 

claim for CBD that cannot be processed based on a positive determination under Part B. For 

additional discussion regarding the requirements for establishing beryllium sensitivity, refer to 

Section 5 (Beryllium Sensitivity) of this chapter. 

a. Beryllium Sensitivity. As under Part B, beryllium sensitivity is established by 

submitting the results of one beryllium patch test, one abnormal beryllium LPT or 

LTT result indicating that an employee’s blood shows an abnormal proliferative 

response to beryllium sulfate. 

b. Physician Narrative. A Part B FD under the EEOICPA approving beryllium 

sensitivity or CBD is sufficient to establish the diagnosis and causation under Part 

E. However, if there is no Part B decision, in addition to a positive BeLPT or 

BeLTT, the claimant is to submit a rationalized medical report including a 

diagnosis of CBD from a qualified physician to establish CBD under Part E. The 

rationalized report should contain an evaluation of the employee’s medical 

condition and the physician’s opinion whether it is “at least as likely as not” that 

exposure to beryllium at a DOE covered facility was a significant factor in 

aggravating, contributing to, or causing the CBD. 

c. Referral to CMC. If the CE determines that the totality of the evidence is 

inconclusive in establishing the diagnosis or causation for the claimed condition, 

he or she is to refer the matter to a CMC for review. This is especially true if the 

treating physician is unavailable or unable to provide the necessary information. 

d. Causal Relationship, Survivor Development. When a survivor claim for CBD is 

accepted under Part B and an “Other Chronic Pulmonary Disease” is listed on the 

death certificate as contributing to or causing the employee’s death, the CE 

concludes that it is “at least as likely as not” that the presence of CBD, or the 

chronic respiratory disorder consistent with CBD, aggravated or contributed to the 

“Other Chronic Pulmonary Disease,” and therefore to the employee’s death. 

The accepted “Other Chronic Pulmonary Diseases” are:

(1) Asbestosis;

(2) Silicosis;

(3) COPD; 

(4) Emphysema; and

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(5) Pulmonary Fibrosis 

Once the CE has collected the medical, employment, and causation evidence necessary

for a beryllium sensitivity or CBD claim under Part E, the employee receives medical 

monitoring, treatment, and therapy for the condition(s) effective to the date of filing. In 

addition, the employee is eligible for lump-sum compensation for impairment and/or 

wage-loss. In the case of a deceased employee, if the evidence supports that he or she 

had work-related CBD that contributed to death, the employee’s qualified survivors are 

eligible for lump-sum compensation. 

10. Presumption of CBD, Diagnosis of Sarcoidosis, and History of Beryllium Exposure. 

Sarcoidosis is a disease that represents as inflammation of cells that form into nodules or 

granulomas. Sarcoidosis can occur in different organ systems. Under Part B, the DEEOIC 

recognizes that a diagnosis of pulmonary sarcoidosis, especially in cases with pre-1993 diagnosis 

dates, could represent a misdiagnosis for CBD. As such, a diagnosis of pulmonary sarcoidosis is 

not medically appropriate under Part B if there is a documented history of beryllium exposure. 

In those situations, a diagnosis of sarcoidosis is evaluated as a claim for beryllium sensitivity 

and/or CBD. Under Part E, if there is a diagnosis of pulmonary sarcoidosis, but no affirmative 

evidence in the form of a positive BeLPT or BeLTT exists, the CE adjudicates the condition as 

sarcoidosis, not CBD. 

Part B of the EEOICPA specifies diagnostic criteria necessary to qualify for compensation. As 

such, in the case of a diagnosed pulmonary sarcoidosis being treated as beryllium sensitivity or 

CBD, it is necessary for the CE to obtain the evidence satisfying pre-1993 or post-1993 CBD 

criteria enumerated under the Act. 

For a Part E claim, the CE can evaluate a pulmonary sarcoidosis claim as CBD; however, a 

positive BeLPT or BeLTT is necessary to accept a diagnosis of beryllium sensitivity/CBD under 

Part E. Without affirmative evidence in the form of a positive beryllium BeLPT or BeLTT, the 

CE is to proceed with the adjudication of the claim as one for a diagnosis of sarcoidosis. 

In cases where there is medical evidence that establishes a diagnosis of pulmonary sarcoidosis 

and a positive BeLPT or BeLTT, the CE is to obtain a physician’s opinion regarding whether it is 

“at least as likely as not” that exposure was a significant factor in aggravating, contributing to, or 

causing CBD.

11. Consequential Illnesses from CBD or its Treatment. For information about consequential 

illnesses from CBD, see Chapter 23, Consequential Conditions. 

12. Silicosis. Chronic silicosis is a non-malignant disease of the lung caused by prolonged 

exposure to silica dust. Under Part B, if all covered employment and exposure criteria are met, 

only chronic silicosis is covered. However under Part E, if all covered employment and 

exposure criteria are met, chronic silicosis, acute silicosis, accelerated silicosis, and complicated 

silicosis are covered.

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If chronic silicosis, acute silicosis, accelerated silicosis, or complicated silicosis is claimed on the 

Form EE-1 or EE-2, then the CE develops for that specific silicosis under the appropriate Part(s) 

of the Act.

a. Silicosis Employment and Exposure Criteria, Part B. 42 U.S.C. §7384r(c) and (d) 

describe the employment requirements for an employee diagnosed with chronic 

silicosis. The CE reviews the evidence to ensure that the employee was: 

(1) A DOE employee or a DOE contractor employee; and

(2) Present for an aggregate of at least 250 work days during the mining of 

tunnels at a DOE facility located in Nevada or Alaska for tests or 

experiments related to an atomic weapon (Part B claims only).

b. Medical Evidence. 42 U.S.C. §7384r(e) describes the medical evidence needed to 

establish a diagnosis of chronic silicosis. The CE verifies that all the necessary 

medical evidence is present in accordance with the requirements listed in the 

statute, as follows: 

(1) The initial occupational exposure to silica dust preceded the onset of 

chronic silicosis by at least 10 years; and

(2) A written medical narrative from a qualified physician that includes a 

diagnosis of chronic silicosis and the date of initial onset. In addition, one 

of the following is required: 

(a) A chest radiograph, interpreted by a physician certified by the 

NIOSH as a B-reader (physician’s signature not required), 

classifying the existence of pneumoconiosis of category 1/0 or 

higher; 

(b) Results from a computer assisted tomograph or other imaging 

technique that are consistent with chronic silicosis; or 

 

(c) Lung biopsy findings consistent with chronic silicosis. 

 

Upon review of the evidence submitted, the CE verifies the presence of the 

necessary medical and diagnostic evidence to support a diagnosis of chronic 

silicosis. If deficiencies are noted, the CE requests evidence from the claimant 

and/or the treating physician. 

c. Silicosis Employment and Exposure Criteria, Part E. Silica exposure in the 

performance of duty is assumed if the employee was present at a DOE or RECA 

Section 5 facility where silica is known to have been present. There are no 

required number of days of employment under Part E. The initial occupational 

exposure to silica dust needs to precede the onset of silicosis by at least 10 years. 

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However, there are instances where an employee’s initial occupational exposure 

to silica dust can be great enough to result in the onset of silicosis prior to 10 

years. Therefore, the CE reviews the employment evidence and weighs the 

exposure evidence, accordingly, when making causation determinations. 

The provisions regarding separate treatment for chronic silicosis set forth in 

§7384r of the Act for Part B do not apply to Part E. Therefore, for purposes of 

evaluating the employee’s Part E claim for silicosis, the element of causation is 

not presumed unless it was determined that the employee was entitled to 

compensation under Part B for silicosis (see §7385s-4(a)) or the Secretary of 

Energy has made a positive determination of causation (see §7385s-4(b)). In all 

other cases of claimed silicosis under Part E, the employment and exposure 

criteria applicable to all other claimed illnesses under Part E shall also apply to 

silicosis claims; that is, the employee must have been a DOE contractor employee 

and it must be “at least as likely as not” that exposure to a toxic substance at a 

DOE facility was a significant factor in aggravating, contributing to, or causing 

the employee’s silicosis and it must be “at least as likely as not” that the exposure 

to such toxic substance was related to employment at a DOE facility.

Silicosis is a nonmalignant respiratory disease covered under RECA Section 5. 

Therefore, for purposes of evaluating the Part E silicosis claim of a uranium 

employee covered under Section 5 of RECA, the DOJ verifies covered 

employment and the CE makes the causation determination under §7385s-4(c) as 

to whether the employee contracted silicosis through exposure to a toxic 

substance at a Section 5 mine or mill.

(1) Exceptions – Acute, Accelerated, and Complicated Silicosis. The extreme

nature, function, or duration of exposure can trigger various forms of 

silicosis. The CE determines whether or not the employee’s occupation 

entailed such exposure that the disease manifested into an acute, 

accelerated, or complicated form due to such exposure. These forms of 

silicosis are not covered under Part B, but are covered under Part E based 

upon the CE’s review of the totality of the evidence. 

(2) Employment and Exposure Evidence. The CE obtains evidence of 

employment and exposure from various sources. The DOJ verifies 

employment for RECA Section 5 claimants. The CE obtains other 

evidence from DAR records, DOE FWP records, SEM, employment 

records, OHQ findings, affidavits, and from the claimant. 

d. Medical Evidence, Part E. A physician’s written diagnosis and date of initial 

onset is required to establish silicosis. 

When there is insufficient evidence of exposure, diagnostic testing, and/or 

diagnosis, the CE requests additional information from the claimant and affords 

the claimant sufficient time to respond.

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Where no diagnosis exists, but the required employment element is met and 

evidence of a lung disease is presented, the CE requests additional medical 

evidence to establish the diagnosis of silicosis from either the claimant and/or the 

treating physician, or makes a referral to a CMC if the requested evidence is not 

submitted. The CE evaluates the CMC opinion and the evidence of file to make a 

factual determination as to the diagnosis and/or causation. 

13. Pneumoconiosis, Part E. Pneumoconiosis is the deposition of particulate matter, such as 

coal dust, asbestos, and silica in the lungs. Pneumoconiosis is oftentimes a broad categorization 

physician’s use for various subtypes of pulmonary disease. For example, asbestosis is a type of 

pneumoconiosis, as is silicosis. It is not appropriate for a CE to make assumptions that a 

diagnosis of pneumoconiosis is equivalent to any number of its subtypes without seeking 

clarification from a physician. Pneumoconiosis is a Part E covered illness only. A physician’s 

diagnosis of pneumoconiosis can be supported by clinical evidence from the physician, along 

with other affirmative diagnostic evidence including: 

a. A written diagnosis of pneumoconiosis made by a physician; 

b. Results from a breathing test (e.g., a PFT or spirometry) showing a restrictive 

lung pattern of an FVC less than 80% predicted; 

 

c. A chest radiograph, interpreted by a NIOSH certified B reader classifying the 

existence of pneumoconiosis of category 1/0 or higher; 

d. Results from a chest X-ray, CT or other imaging technique that are consistent 

with asbestosis and/or findings of pleural plaques or rounded atelectasis; or 

e. Lung biopsy findings consistent with pneumoconiosis. 

14. Asbestosis, Part E. Asbestosis or asbestos-related lung disease is a chronic, progressive 

pulmonary disease caused by the inhalation and accumulation of asbestos particles or fibers in 

the lungs. Asbestosis is a Part E covered illness only. 

Asbestosis is characterized by extensive pulmonary interstitial fibrosis (e.g., scarring) and pleural 

thickening. Progressive thickening and scar formation of the lung tissues occur along with 

associated loss of respiratory function. These developments are noticeable in the lower part of 

the lungs because this area of the lungs receives a greater part of the inhaled load of particulate 

matter. In assessing claims for an employee with a diagnosis of asbestosis, the CE is to consider 

several factors when adjudicating the claim:

a. Employment/Exposure Requirements. The CE verifies that the employee was a 

covered DOE contractor employee at a covered DOE or RECA Section 5 facility, 

during a covered time period, and in the course of employment was exposed to 

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b. Medical Evidence. Various types of medical evidence can support a physician’s 

asbestosis diagnosis. Not all types of medical evidence need to be present, and 

the CE weighs the evidence as a whole to make a determination. A diagnosis of 

asbestosis is established with the presentation of medical evidence that identifies 

the employee as having developed the condition, along with a date of diagnosis. 

Sources of evidence include:

(1) The opinion of a qualified physician that available medical and diagnostic 

evidence is sufficiently probative to document a diagnosis of asbestosis. 

In instances where the evidence is suggestive of an asbestos-related lung 

disease and further development with the claimant or treating physician 

has been unsuccessful, the CE is to refer the matter to a CMC for review. 

Diagnostic evidence that is indicative of asbestosis or asbestos-related 

lung disease includes: 

(a) Chest X-ray reports that show pulmonary interstitial fibrosis and 

cardiac enlargement are regarded as characteristic of asbestosis. 

The CE takes into account such findings as possibly indicative of 

asbestosis, based upon the totality of the evidence. However, 

cardiac enlargement is not always seen with asbestosis. Therefore, 

if cardiac enlargement is not noted in the chest X-ray report, the 

CE still considers the possibility of asbestosis, based upon the 

totality of the evidence. 

(b) CAT and MRI that show characteristic lung scarring, pleural 

thickening, and cardiac enlargement are also possible indications 

of asbestosis. 

(c) A PFT reveals pulmonary function and capacity. Asbestosis 

typically restricts pulmonary function; therefore, total lung 

capacity, vital capacity, compliance measurements, and pulmonary 

diffusing capacity are reduced if asbestosis is present. It is 

necessary that the CE obtains a physician evaluation of the PFT 

results.

 

(d) A lung biopsy is a sampling of lung tissue. Cytological 

examination of the sputum or bronchial lavage often shows the 

presence of asbestos bodies. This test is not considered as 

definitive for the diagnosis of asbestosis because it is commonly 

positive in cases of asbestos exposure alone and is seen in other 

populations such as hematite (i.e., iron ore) miners.

(2) DOE FWP results which document assessment with abnormal diagnostic 

findings and physician assessment resulting in a positive finding of 

asbestosis or asbestos-related lung disease. 

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(3) Asbestosis identified on the death certificate, signed by a physician, as a 

cause of or contributing factor to death establishes a diagnosis. If the 

death certificate shows any respiratory illness other than asbestosis, the 

CE needs to obtain a well-rationalized conclusion from a physician that 

asbestosis contributed to the death based on the totality of the medical 

evidence contained in the file. If the evidence supports a diagnosis of 

asbestosis and the death certificate lists the cause of death as 

pneumoconiosis, the CE is to presume that causation to death is 

established. 

c. Assessing asbestosis claims. DEEOIC accepts that asbestos was a common toxic 

substance that existed throughout all DOE facilities. While asbestos did exist at 

DOE facilities, the nature of an employee’s exposure would have varied based on 

different factors such as the period that the employee worked, the type of work 

performed, and the location of employment. 

 

15. Medical Conditions Associated with Asbestos Exposures. 

a. Mesothelioma. Mesothelioma is a rare cancer of the pleura that is caused almost 

exclusively by asbestos exposure. Because of this relationship to asbestos, any 

Part E claims involving a confirmed diagnosis of mesothelioma are accepted, 

given the requirements for asbestos exposure at a covered facility (e.g., medical 

and diagnostic requirements, employment/exposure requirements) have been met. 

b. Pleural Plaques and Pleural Effusions. Pleural plaques and pleural effusions are 

considered conditions caused by asbestos, but do not constitute an asbestosis 

diagnosis or finding. If a claim is made for asbestosis but only pleural plaques or 

pleural effusions can be accepted, the CE issues a RD to deny the claim for 

asbestosis and accept for pleural plaques or pleural effusions. 

If at a later date, the DO receives evidence that the employee’s pleural plaques or 

pleural effusions has progressed to asbestosis, it can initiate a reopening to resume 

development of the existing asbestosis claim. The claimant may also file a 

reopening request to resume development of his or her asbestosis claim, if new 

medical evidence supports the claim. In addition, it is possible for pleural plaques 

or pleural effusions to result in an impairment rating and/or wage- loss. 

(1) Medical evidence supporting a claim for pleural plaques and pleural 

effusions includes the following: 

(a) A diagnosis of pleural plaques or pleural effusions made by a 

physician; 

(b) Medical evidence as established by the results from a chest X-ray, 

CT scan, or other imaging technique that are consistent with 

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pleural plaques or pleural effusions, as evidenced by any of the 

following findings: 

 (i) Pleural plaques; 

(ii) Pleural thickening, not associated with an area of prior 

surgery or trauma; 

(iii) Rounded atelectasis; or 

(iv) Bilateral pleural effusions, also known as benign asbestosrelated pleural effusion.

(2) When development is to occur with the claimant’s physician or CMC:

(a) If the totality of the medical evidence is inconclusive or 

insufficient to establish a diagnosis of pleural plaques or pleural 

effusions. 

(b) If the results from a chest X-ray, CT, or other imaging technique 

are consistent with any of the following findings: 

 

(i) Pleural thickening in an area of prior surgery or trauma; or 

(ii) Pleural effusions, only if the record does not indicate that 

there is another disease process that would otherwise 

account for the effusion, such as congestive heart failure 

(CHF), cancer, or other lung disease; 

c. Lung Fibrosis (Pulmonary Fibrosis). Lung fibrosis is commonly referred to as 

scarring of the lung. With lung fibrosis, normal lung tissue is replaced by the 

accumulation of connective fibrosis tissue. 

(1) Medical Evidence of lung fibrosis. A diagnosis of lung fibrosis is made 

by a physician and is generally supported by diagnostic evidence 

including: 

(a) Results from a chest X-ray, CT scan, or other imaging technique 

that are consistent with fibrosis such as small lung fields or 

volumes, minimal ground glass opacities, and/or bibasilar reticular 

abnormalities; 

(b) Results of breathing tests (e.g., PFTs or spirometry) showing a 

restrictive or mixed pattern, such as FVC less than 80% predicted; 

or 

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 (c) Lung biopsy findings consistent with fibrosis; and 

(d) The medical evidence does not contain any indication that the lung 

fibrosis is present due to another disease process. 

(2) Idiopathic pulmonary fibrosis. “Idiopathic” means that the causative agent 

is unknown. In cases where a diagnosis of idiopathic pulmonary fibrosis 

is provided, with no other supportive clarifying medical evidence, the CE 

should not conduct an exposure analysis or refer the case file for an IH 

review. Cases of this type can be denied. 

(3) Synonymous fibrotic lung conditions. DEEOIC has determined that 

respiratory illnesses such a restrictive/interstitial lung disease, pulmonary 

fibrosis and/or pneumoconiosis generally refer to the same disease 

process. These illnesses include a process by which normal lung tissue is 

replaced by fibrotic (scar) tissue that interferes with normal lung 

functioning. This process results in the irreversible loss of oxygen 

diffusion, which is the capacity of the lung to transfer carbon dioxide in 

the bloodstream. As such, the DEEOIC made a programmatic 

determination to treat these terms/claimed conditions, for purposes of 

developing Part E cases under EEOICPA, synonymously. 

DEEOIC guidelines on fibrotic lung diagnoses provide that for 

synonymous and interchangeable diagnoses in terms of development and 

adjudication, the CE has been directed not to develop for each of these 

fibrotic lung conditions as a separate claim as they are essentially the same 

diagnosis to the same organ. The guidelines also note that if it is 

determined that “it is at least as likely as not that exposure to a toxic 

substance at a DOE facility was a significant factor in aggravating, 

contributing to or causing” the pneumoconiosis, pulmonary fibrosis, or 

interstitial lung disease of the employee, then accept all of the conditions, 

provided there is a valid medical diagnosis in the case file. 

 

16. COPD. COPD is a disease that causes airflow blockage and breathing-related problems. 

 

a. Evaluating Medical Evidence. Any one of the following tests below can provide 

an indication of COPD, but a diagnosis is not based solely on one of the following 

criteria. The CE weighs all the medical evidence before making a finding. 

All test results are to be accompanied by a physician’s interpretation in order to 

have probative value. If a physician’s interpretation is not available, the CE seeks 

such interpretation from either the treating physician or a CMC. 

(1) ABG Test. Abnormal results from the blood gas components include such 

findings as the body is not getting enough oxygen, is not getting rid of 

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enough carbon dioxide, or that there is a problem with kidney function. 

 

(2) Consistent Chest X-rays/CAT scans. Chest X-ray results vary and show 

interstitial patterns, scarring, and other abnormalities. 

(3) Abnormal Spirometry. The Spirometer measures air flow and air volume. 

An abnormal reading includes an indication of COPD or some other lung 

condition. 

(4) Bronchoscopy. A bronchoscopy is used by physicians to examine the 

major air passages of the lungs. A finding of an obstruction in the air 

passages includes an indication of COPD or some other lung condition. 

17. Parkinsonism. Parkinsonism is a neurological disorder or syndrome that can arise from a 

number or sources, including toxic exposure, drugs, and Parkinson’s disease (PD). There is no 

clinical test or method for distinguishing Parkinsonism from PD and the two terms are often used 

interchangeably since the symptoms are the same. For the purpose of claim adjudication under 

Part E, the CE is to consider the medical conditions of PD, Parkinsonism, or any other 

reasonable alias as synonymous. 

18. Other Conditions. Like asbestosis and the lung ailment COPD, there are a host of other 

non-cancerous conditions potentially covered under Part E that are not covered under Part B. 

With the wide variety of conditions claimed under Part E, this chapter cannot address diagnostic 

requirements of all possible conditions. However, the matrices in Exhibit 18-1 have been created 

to provide information relating to the assessment of the following conditions: kidney disease; 

occupational asthma; toxic neuropathy; and chronic toxic encephalopathy. Ultimately, the CE 

uses his or her best judgment in reviewing and evaluating the probative value of the medical 

evidence. 

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CHAPTER 19 – ELIGIBILITY REQUIREMENTS FOR CERTAIN URANIUM 

WORKERS 

1. Purpose and Scope. This chapter describes the policies and procedures for processing 

claims involving uranium miners, millers, and ore transporters who worked at facilities covered 

by Section 5 of the RECA and, where applicable, the survivors of such employees. This chapter 

also describes the policies and procedures for processing claims involving claimants who applied 

for an award under Section 4 of the RECA. 

2. RECA Background. 

a. DOJ Administered. On October 5, 1990, Congress passed the RECA, 42 U.S.C. § 

2210 note, providing for payments to individuals who contracted certain cancers 

and other serious diseases as a result of their exposure to radiation released during 

above-ground nuclear weapons tests or as a result of their exposure to radiation 

during covered employment. It was the intent of Congress in enacting EEOICPA 

to treat certain uranium workers covered under RECA the same as DOE workers 

under the EEOICPA. 

b. Section 5 of RECA. 

(1) Covered Employee. Uranium miners, uranium mill workers and uranium 

and vanadium-uranium ore transporters who transported ore from mines or 

mills.

(2) Covered States. Colorado, New Mexico, Arizona, Wyoming, South 

Dakota, Washington, Utah, Idaho, North Dakota, Oregon and Texas. 

(3) Covered Time Period. January 1, 1942 through December 31, 1971. 

(4) Covered Illnesses. Primary lung cancer, renal cancer, other chronic renal 

diseases including nephritis and kidney tubal tissue injury, and the 

following nonmalignant respiratory illnesses: pulmonary fibrosis, fibrosis 

of the lung, or pulmonale related to pulmonary fibrosis, silicosis and 

pneumoconiosis. 

(5) Benefits Payable by DOJ. A payment of $100,000 is available to eligible 

employees or their survivors. 

c. Section 4 of RECA. 

(1) Downwinders. 

(a) Coverage: Individuals who were physically present in one of the 

affected areas downwind of the Nevada Test Site during a period 

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of atmospheric nuclear testing, and later developed a covered 

illness.

(b) Covered Illnesses: Leukemia (other than CLL), multiple myeloma, 

lymphomas (other than Hodgkin’s disease), and primary cancer of 

the thyroid, male or female breast, esophagus, stomach, pharynx, 

small intestine, pancreas, bile ducts, gall bladder, salivary gland, 

urinary bladder, brain, colon, ovary, liver (except if cirrhosis or 

hepatitis B is indicated), or lung. 

(c) Benefits Payable by DOJ: A payment of $50,000 is available to 

eligible individuals.

(2) Onsite Participants.

(a) Coverage: Individuals who participated onsite in a test involving 

the atmospheric detonation of a nuclear device, and later developed 

a covered illness.

(b) Covered Illnesses: Same as downwinders. 

(c) Benefits Payable by DOJ: A payment of $75,000 is available to 

eligible individuals.

d. All claims identified as RECA claims, Section 4 or Section 5, should be referred 

to the Denver DO for adjudication regardless of the employee’s last place of 

employment.

3. How DOL Identifies a RECA Section 5 Uranium Worker. The CE can identify a claim 

submitted by a Section 5 RECA uranium worker, or an eligible surviving beneficiary of such 

uranium worker, by reviewing the information provided on the EE-1 or EE-2. If the claimant 

indicated on the EE-1 or EE-2 that the employee was a uranium worker, or that a Section 5 

RECA award was applied for or has been approved, the claim is to be developed in accordance 

with the guidance set out under this Chapter. In cases where the EE-1 or EE-2 does not specify if 

the employee was/is a uranium worker and/or the Section 5 RECA status, the CE will review the 

EE-3, if provided, for an indication of possible RECA employment. 

4. Determining Uranium Worker Eligibility. Under Part B, eligibility is entirely dependent 

upon a Section 5 RECA award. Under Part E, denial of a Section 5 award by the DOJ has no 

effect on a claimant’s eligibility. The CE must independently develop a claimant’s Part E claim 

as set forth in this chapter. 

a. Benefits Available Under Part B. 

(1) Award Letter from DOJ. 42 U.S.C. § 7384u describes the requirements for 

determining eligibility for benefits under Part B of the EEOICPA. An 

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individual is a “covered uranium employee” when the DOJ has determined 

that the employee or his or her survivor is entitled to payment of $100,000 

as compensation due under Section 5 of the RECA for a claim made under 

that statute and has issued a Section 5 RECA award. Receipt of payment is 

not required. DOJ advises DOL of Section 5 RECA awards in writing 

(Exhibit 19-1).

(2) No Additional Development. Once the CE receives confirmation of the 

Section 5 award, the Part B claim is in posture for acceptance. The illness 

awarded under RECA by DOJ must also be awarded under Part B of the 

EEOICPA. 

(3) Benefits Payable. If the Section 5 RECA recipient is a uranium worker 

and was approved for a lump-sum compensation payment of $100,000 

under Section 5 of the RECA, the additional lump-sum payment of 

$50,000 under Part B of the EEOICPA will be made to the uranium 

worker. The uranium worker is also eligible for medical benefits in 

relation to his or her accepted covered condition(s) per 42 U.S.C § 7384t. 

(a) If the Section 5 RECA recipient is deceased, the uranium worker’s 

eligible survivor(s) is entitled to the additional lump-sum payment 

of $50,000 compensation. The CE will review the claim for 

survivor benefits per 42 U.S.C. § 7384u(e). 

(b) If the Section 5 RECA recipient(s) was awarded benefits as 

surviving beneficiary(s) of a covered uranium worker, the 

additional lump-sum payment of $50,000 under the EEOICPA will 

be made to the same recipient(s). No survivorship development is 

conducted. For example, it is unnecessary to obtain a marriage 

certificate from a surviving spouse who has already received a 

Section 5 RECA award as a surviving beneficiary.

(c) If the uranium worker’s survivor(s) received the Section 5 RECA 

award and died, only the eligible survivor(s) of the uranium worker 

described in 42 U.S.C. § 7384u(e) are eligible for EEOICPA 

benefits. 

(4) Issuing RDs and FDs. A decision of acceptance of a Part B claim will 

address the fact that the additional lump-sum payment of $50,000 and 

medical benefits are awarded in addition to and as a result of Section 5 

RECA award of $100,000. 

b. Benefits Available Under Part E.

(1) NO DOJ Award Required. As noted above, a DOJ Section 5 award denial 

has no effect on a claimant’s eligibility under Part E due to expanded 

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definition of a covered uranium worker under Part E and coverage 

extending to any medical condition if it is determined to be related to 

exposure to toxic substances at a covered DOE facility or covered uranium 

mine or mill. The CE must independently develop a claimant’s Part E 

claim where there is no DOJ award.

(2) DOJ Award Letter / Part B Acceptance. In all instances other than awards 

involving survivors, an acceptance under Part B will correlate to an 

automatic acceptance under Part E as to the medical conditions accepted 

by DOJ and the CE can prepare a RD to accept the claim for benefits 

under the Act and proceed with whatever other development that is 

required (i.e. other claimed illnesses, impairment claims and wage-loss 

claims).

(a) Eligible survivors of Section 5 RECA award recipients, and 

survivors who are award recipients in their own right, are approved 

for benefits under Part B of the EEOICPA. However, such 

acceptance under Part B does not automatically translate to an 

acceptance under Part E. Survivors of Section 5 RECA award 

recipients, and survivors who are award recipients in their own 

right, must submit the requisite documents to establish 

survivorship eligibility under Part E. All Part E survivorship rules 

apply to RECA survivors. The CE develops all necessary 

requirements to establish survivorship eligibility as it is defined 

under Part E of the EEOICPA. 

(3) Benefits Payable. In addition to medical benefits, Part E of the Act grants 

covered employees compensation for impairment and/or wage-loss related 

to an accepted illness. 

5. Developing RECA Section 5 Claims. The CE must evaluate the status of the Part B and 

Part E claims as follows in order to proceed with adjudication. In all cases where employment 

verification is required, the CE proceeds under the guidance set forth under paragraph 6. In all 

instances where a uranium worker files a claim under EEOICPA without demonstrating a RECA 

award, DOL must write to DOJ for additional information. 

a. Section 5 RECA Covered Condition. Once a Section 5 RECA claim is identified, 

the CE prepares a letter to DOJ (Exhibit 19-2) notifying DOJ that a claim based 

on RECA has been submitted and requesting information concerning whether the 

claimant either received an award or filed a claim under Section 5 of the RECA. 

This letter provides DOJ with options for response depending on the status of the 

RECA claim. The initial inquiry to DOJ is not done via email. As discussed 

below, no further information is required of DOJ if a Section 5 RECA award has 

been approved for all claimed conditions. If a Section 5 RECA claim is pending, 

the letter requests that DOJ send a letter verifying employment and all medical, 

employment and survivorship evidence on file. If the Section 5 award is denied, 

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the letter requests the following: a copy of DOJ’s decision and all employment, 

medical and survivorship evidence available to DOJ. If no Section 5 RECA claim 

exists, the letter requests that DOJ send a letter verifying employment. 

 

b. Condition Not Covered Under RECA Section 5, But Claim Involves a Uranium 

Miner. The CE prepares a different letter to DOJ (Exhibit 19-3) if the claimed 

condition is not a covered RECA Section 5 illness. This letter requests that DOJ 

send all employment, medical and survivorship evidence available to DOL and a 

statement verifying employment regardless of the outcome of the Section 5 claim. 

c. If the claimant filed for a medical condition that is not covered under the RECA 

in addition to covered RECA conditions, the CE may send the standard request to 

DOJ (Exhibit 19-2) and defer the request for copy of records until additional 

development is conducted to avoid multiple requests for the same claim. The CE 

may also defer the request for copy of records based on the nature and quality of 

the medical evidence in the case file. Upon receipt of the requested 

documentation from DOJ, the CE can request whatever additional evidence 

deemed necessary for development at a later date via follow up email 

communication with DOJ. The CE attaches a copy of the EE-1 or EE-2 to the 

letter in all instances. The EE-1 or EE-2 signed by the claimant serves as a 

Privacy Act waiver allowing DOJ to release information to DOL regarding 

specific individuals. 

 

d. Response from DOJ. 

(1) DOJ Approves the Section 5 Award. DOJ advises DOL of Section 5 

RECA awards in writing (Exhibit 19-1). Once the CE receives 

confirmation of the award, the Part B claim is in posture for acceptance. 

(2) DOJ Award Adjudication Pending. If a Section 5 RECA claim is filed but 

pending DOJ adjudication, DOJ will provide DOL with a letter (Exhibit 

19-4). DOJ also provides DOL with the factual statement of employment 

as requested and all employment, medical and survivorship evidence 

available to DOJ. The CE proceeds to develop for benefits under Part E. 

Any factual statement provided by the DOJ verifying the uranium 

worker’s specific dates and places of employment covered under Section 5 

of the RECA suffices to verify employment as to those specific dates and 

places only. 

(3) DOJ Denies Section 5 Award. A DOJ Section 5 award denial 

automatically translates into a DOL denial under Part B. However, due to 

the expanded definition of a covered uranium worker and expanded 

covered conditions under Part E, a DOJ Section 5 award denial has no 

effect on Part E adjudication, and the CE continues to develop for 

coverage regardless of any negative determination or pending action on 

the part of DOJ. DOJ may deny Section 5 awards based upon RECA 

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employment requirements that have no bearing on the EEOICPA. 

Additionally, DOJ denies Section 5 awards if the claimed condition is not 

a covered condition under the RECA. Expanded covered conditions under 

Part E might allow for an acceptance where DOJ has denied a claim. 

Accordingly, the CE proceeds to develop for Part E benefits, obtains all 

information relevant to DOJ’s adjudication process from DOJ, and 

evaluates all available evidence to reach a determination as to coverage 

under the Act. 

(4) No DOJ Section 5 Claim Filed. If the DOJ responds (Exhibit 19-5) 

indicating the claimant has not filed for an award under Section 5 of the 

RECA, the CE will contact the claimant in writing (Exhibit 19-6) and 

advise the claimant that benefits may only be awarded under Part B of the 

EEOICPA if the covered employee or claimant has been approved for an 

award under Section 5 of the RECA. The letter also notifies the claimant 

their Part E claim is not dependent on a Section 5 RECA award and is 

being developed. In such cases, the CE requests employment verification 

from DOJ (See Exhibit19- 2 and Exhibit19-3). The letter should ask the 

DOJ to confirm the accuracy of the claimed employment and whether the 

reported employment is covered under the RECA. The CE completes 

development of the Part E claim and issues a RD as soon as all the 

required facts are examined and a coverage determination made. 

(5) If a claimant was denied due to having no Section 5 RECA award and 

later obtains an award and submits it to DEEOIC, there is no need to 

require the claimant to file a new claim. In this instance, the claim is 

simply reopened and adjudicated under the guidance set out in this 

chapter. 

e. Evaluating and Obtaining Evidence from DOJ. In some cases DOJ initially 

provides verification of RECA Section 5 employment in the form of a factual 

statement of employment. The initial communication with DOJ (Exhibit 19-2) 

indicates that additional evidence may be sought as claim adjudication proceeds. 

The DO CE seeks additional evidence from DOJ as necessary by contacting DOJ 

in writing (either by letter or email) requesting whatever additional documentation 

is required to adjudicate the claim under Part E. DOJ has requested that all 

medical, employment and survivorship (if applicable) evidence be requested at 

the same time to avoid multiple requests on the same claim. 

In cases where DOJ does not grant a Section 5 award based upon employment, 

the CE requests all employment and medical evidence in DOJ’s possession and 

renders an independent finding as to employment. The CE reviews all evidence 

obtained from DOJ to assist in reaching a decision regarding the acceptance or 

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denial of benefits under the EEOICPA. 
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Certain Uranium Workers 

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(1) Concurrent Development. While obtaining information from DOJ is 

important, the CE concurrently conducts independent development as 

needed to obtain employment, medical, survivorship and exposure 

evidence that assists the CE in adjudicating the claim under Part E. Such 

development should begin immediately upon receipt of the claim file in 

the DO if a medical condition is claimed that is not covered under the 

RECA or if the applicant indicates a RECA claim was not filed. The CE 

pursues additional evidence from the claimant, treating physicians, other 

health care providers, employers, and exhausts all other sources of 

information when developing for adjudication. The CE reviews and 

weighs all evidence obtained through the development process before 

issuing the RD. 

f. Cancer Claims. Based upon a diagnosed cancer not accepted under RECA and 

covered employment, the case file must be referred for dose reconstruction to the 

NIOSH. The dose reconstruction is used to determine the PoC between the 

diagnosed cancer and the radiation dose potentially received during the covered 

employment. If a cancer claim is accepted under Part E based on exposure to a 

chemical or biological toxic substance, there is no need to refer the case to the 

NIOSH. 

g. Issuing the RD / FD and Post Adjudication Actions. Once the CE receives 

confirmation of a Section 5 RECA award, a RD to accept the Part B claim should 

be issued. In all instances other than awards involving survivors, an acceptance 

under Part B will correlate to an acceptance under Part E as to the medical 

conditions accepted by DOJ and the CE can prepare a RD to accept the claim for 

benefits under the Act and proceed with whatever other development that is 

required (i.e. other claimed illnesses, impairment claims and wage-loss claims). 

The RD of acceptance will address the fact that the additional lump-sum payment 

of $50,000 and medical benefits when applicable, are awarded in addition to the 

Section 5 RECA award of $100,000. 

(1) Part E Claim in Posture for Denial. If after complete development, the CE 

determines that the Part E claim is in posture for denial, no RD denying 

benefits is issued until DOJ has issued its decision regarding the Section 5 

award, because a DOJ acceptance may prompt an automatic approval 

under Part B and Part E (except in certain survivorship cases). In such 

cases where the Part E EEOICPA claim is in posture for denial and is 

pending adjudication at DOJ, the CE may administratively close the claim 

for timeliness purposes and reopen once DOJ issues its decision. 

(2) Acceptances. If after complete development the CE determines that any 

part of the Part E EEOICPA claim is in posture for acceptance, a RD is 

issued accepting the claim under Part E. The CE must address the status 

of the Part B claim in the decision. 

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Certain Uranium Workers 

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(3) Part B Reopening. If a Part B claim is denied by the FAB because the 

claimant has not filed for or received an award under Section 5 of the 

RECA and the claimant later submits evidence showing a Section 5 award, 

a reopening should be initiated by the DO. 

6. Verifying RECA Section 5 Part E Employment. Under Part E, the CE must develop 

claimed employment if the employee or survivor claims a medical condition not included in the 

claimant’s RECA award. If not already submitted, the CE will send a Form EE-3 to the claimant 

so that all potentially eligible employment can be identified and developed. This should be done 

upon the initial review of the claim file if a medical condition is claimed that is not covered 

under the RECA. The CE does not need to develop employment under Part E where all claimed 

medical conditions were awarded under RECA. 

a. DOJ Employment Verification. Upon receipt of the notification letter that the 

DOL has received a RECA claim, DOJ searches its records. DOJ issues 

a letter to DOL regarding the status of the claimant’s Section 5 RECA claim. If 

requested, DOJ will also provide copies of all medical, employment and 

survivorship evidence on file for the employee. DOJ refers to survivorship 

documents as “identification” documents. 

(1) Employment Verified. In instances where employment is verified by a 

Section 5 RECA award, the CE accepts this as proof establishing covered 

employment under the EEOICPA for the medical conditions upon which 

the RECA award is based.

(2) Employment Not Verified. In cases where DOJ has denied a Section 5 

award based upon employment, the CE requests from DOJ (Exhibit 2) all 

evidence at its disposal that was used to determine that employment could 

not be verified. In instances where DOJ denies a Section 5 RECA claim 

because employment cannot be verified, or where no Section 5 RECA 

claim exists, the CE must independently develop employment. 

(a) Reasons for Failure to Verify: DOJ cannot verify employment if 

no record of employment exists or if claimed employment at a 

certain mine or mill falls outside of the period in which the mine or 

mill was in operation or outside of the covered time period. In 

such instances, the CE conducts further development and obtains 

additional evidence where available in an attempt to verify 

employment during the covered time period of January 1, 1942 

through December 31, 1971. 

b. Use of SEM for Employment Development. The SEM cannot by itself verify 

employment. However, SEM should be used to verify the claimed site of covered 

employment years of operation and known operating contractors during the 

period of claimed employment. SEM contains a list of uranium mines, uranium 

mills and vanadium-uranium ore transporters and the time period each was in 

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operation. By obtaining SSA earnings records, the CE can confirm the employee 

worked for the reported employer(s). However, an affidavit (such as a Form EE4) or verification from the DOJ is needed to place the worker at the covered site. 

Additionally, the SEM “Site History” section for each facility lists all prime 

operating entities and respective operating dates. The CE should attempt to match 

the operator’s name and dates to employment evidence as an additional 

corroborative step toward verifying employment.

c. Uranium Worker Employment Requirements. In developing a claim for a uranium 

worker, only one day of employment exposure is required, but additional 

employment may be necessary to satisfy certain causation criteria regarding

exposure as outlined in Chapter 15 - Establishing Toxic Substance Exposure. 

d. The CE assesses exposure for a uranium ore transporter based upon that 

individual’s confirmed presence at a uranium mine or mill. Claimed exposure in 

transit will not be considered when conducting a causation analysis. Only the time 

in which an ore transporter is actually physically present at a mine or mill will be 

counted as covered employment for exposure development purposes. 

7. Verifying Part E Exposure for RECA Section 5 Claims. The CE evaluates exposure for 

uranium workers based upon SEM and/or other data as outlined in Chapter 15 - Establishing 

Toxic Substance Exposure. The CE also verifies exposure through employment exposure records 

and supporting evidence submitted by the claimant. In addition, the RC calls the claimant to 

complete an OHQ on RECA claims to obtain information regarding exposure. 

a. Ensuring SEM Accuracy. - All covered RECA Section 5 uranium mines, mills 

and ore transporters should be listed in SEM because all such employment is 

covered under the EEOICPA. If the CE identifies a uranium mine, uranium mill 

or a vanadium-uranium ore transporter in operation during the covered time 

period but not listed in SEM, the CE should provide all pertinent facts regarding 

the omitted site or employer to the designated DO SEM POC. The DO SEM POC 

will contact the NO SEM POC via email. The NO SEM POC will then contact 

DOJ to determine coverage.

b. Employment Evidence. The CE uses employment records, where available, to 

evaluate for exposure. The CE obtains such evidence from either the claimant or 

the employer and reviews the totality of the evidence of file to determine whether 

or not it is established that the employee was exposed to a toxic substance. 

c. Occupational History Development. As noted above, the RC calls the claimant to 

complete an OHQ on most RECA claims involving the worker or eligible 

survivors. An OHQ is designed specifically to develop information regarding 

workplace exposure. The CE is to request that the RC conduct an OHQ interview 

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if one has not been conducted for an eligible claimant. 
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8. RECA Section 4 Claims. Some EEOICPA claimants may have filed a claim under 

Section 4 of the RECA. The statutory language in 42 U.S.C. § 7385j of the EEOICPA acts as a 

bar to any cancer claim filed by an individual under EEOICPA who has received compensation 

under Section 4 RECA. Section 4 of the RECA only provides benefits for cancer. As such, a 

claimant cannot receive an award under both Section 4 RECA and the EEOICPA for a cancer 

claim regardless of whether the claimant filed for different cancers under EEOICPA than 

awarded under RECA 4 or if the claimant filed for multiple cancers and one or more cancers is 

the same as the cancer awarded under RECA Section 4. If a claimant has not yet received a 

Section 4 RECA award and is eligible for an EEOICPA award, the claimant must choose 

between the Section 4 RECA award and the EEOICPA award. A RECA Section 4 award has no 

effect on non-cancerous conditions claimed under the EEOICPA. 

Under RECA, an individual cannot receive an award under both Section 4 and Section 5. 

Without an award under RECA section 5, a claim based on RECA employment will not meet the 

Part B requirements.

a. Identifying a Section 4 RECA Claimant. The CE can identify a claim submitted 

by a Section 4 RECA claimant by reviewing the information provided on the EE1 or EE-2. If the claimant checked the box indicating he or she applied for an 

award under Section 4 RECA, the claim is to be developed in accordance with the 

guidance set out in this section. 

b. Letter to DOJ – Section 4 RECA. Once a Section 4 RECA claim is identified, the 

CE prepares a letter to DOJ (Exhibit 19-7) requesting information concerning 

whether the claimant either received an award or filed a claim under Section 4 of 

the RECA. The CE attaches a copy of the EE-1 or EE-2 to the letter in all 

instances. 

c. DOJ Approves the Section 4 Award. Should cancer be the only claimed illness 

under the EEOICPA, and an acceptance of an award under RECA Section 4 is 

confirmed, the CE may proceed with a recommended denial of compensation 

under Part E. The denial of compensation should specifically reference the 

exclusion of benefits for cancer under both EEOICPA and RECA contained in 42 

U.S.C. § 7385j. 

d. DOJ Award Adjudication Pending. If the response from DOJ indicates that a 

RECA Section 4 decision is pending, the CE takes the following actions 

depending on the claimed conditions: 

(1) Cancer. - The CE must prepare a letter to the claimant(s), explaining that 

an EEOICPA and a RECA Section 4 cancer claim cannot be adjudicated 

concurrently. The claimant(s) must be asked to select which program they 

wish to pursue benefits under, for the claimed cancer(s). The claimant(s) 

must be notified that if they accept the RECA Section 4 award, they 

cannot receive an award under the EEOICPA for a cancer claim. The 

claimant(s) should be notified that if they either fail to respond within 30 

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days, or if they elect to pursue their cancer claim under RECA, their 

EEOICPA cancer claim will be denied. The claimant(s) should also be 

advised that if they wish to pursue their cancer claim under EEOICPA, 

they must formally withdraw their claim from RECA, and confirmation of 

such withdrawal must be obtained from DOJ. The letter should further 

state that if their RECA claim ultimately ends in a denial, then they may 

seek to have their EEOICPA cancer claim reopened.

Depending upon the response from the claimant(s), the CE will either 

proceed with the adjudication of the claimed cancer (upon confirmation of 

RECA Section 4 withdrawal) or will proceed with development of the 

case for non-cancerous conditions, and will issue a RD that includes a 

denial for the claimed cancer. Any RD that includes a denial of a claimed 

cancer, on the grounds that compensation cannot be awarded under both 

RECA Section 4 and EEOICPA, must reference 42 U.S.C. § 7385j. 

(2) Non-Cancer. Any non-cancerous condition will be treated like any other 

claim. 

e. Rejection of Section 4 RECA Award. If DOJ reports that a RECA-4 award has 

been granted, but the claimant has elected to reject the settlement, and if a copy of 

the Acceptance of Payment form confirms this, the CE can proceed with the 

adjudication of the cancer claim under the EEOICPA. 

9. Interagency Consistency. As noted above, since uranium workers and their survivors are 

treated and defined differently under Part E than Part B, and the universe of covered conditions 

has expanded significantly under Part E, uniform consistency in agency decision making is not 

always possible. Nonetheless, DOL and DOJ will inform each other when decisions are to be 

issued that are inconsistent with the other agency’s findings. Both DOJ and DOL will work to 

issue consistent decisions where employment verification findings are concerned, but this may 

not always be possible. As such, FAB supplies DOJ with copies of FDs issued to RECA 

claimants. DOJ will provide DEEOIC NO with copies of those decisions inconsistent with 

DEEOIC findings. Additionally, the SrCE in the DO will inform DOJ via email when a RD is 

being issued that is inconsistent with a DOJ decision. 

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CHAPTER 20 – ESTABLISHING SURVIVORSHIP

1. Purpose and Scope. This chapter contains procedures for the development and review of 

survivor claims under the EEOICPA. It also describes the process followed when a non-covered 

spouse or child opts for the alternative to filing a Part E claim.

2. Policy. The CE is responsible for processing survivor claims and ensuring that benefits 

are properly paid to eligible survivors under the provisions of 42 U.S.C. 7384s(e) and 7384u(e) 

for Part B and 42 U.S.C. 7385s-1(2), and 7385s-3 for Part E.

3. Eligible Survivors. If an employee eligible for EEOICPA benefits is deceased, one or 

more of the employee’s survivors may file a claim for compensation under the EEOICPA. The 

claimant documents his or her relationship to the covered employee. If he or she does not 

present evidence to establish survivorship, the CE writes to the claimant requesting the necessary 

evidence. When developing a survivorship claim, the CE sends letters to all survivors claiming 

benefits, requesting medical and employment evidence sufficient to establish eligibility of the 

deceased employee. However, a request for documentation necessary to support the eligibility of 

a specific claimant is sent to that claimant. 

When a survivor files a claim, the CE is responsible for adjudicating the claim(s) and for 

processing any compensation which may be payable in the order of eligibility outlined below. 

a. Part B. Compensation may be payable to eligible survivors in the following order: 

spouse, children, parents, grandchildren, and grandparents of the deceased covered Part B 

employee.

b. Part E. Compensation may be payable to eligible survivors in the following order: 

spouse; then children who were under the age of 18 years at the time of the employee’s 

death, or under the age of 23 years and continuously enrolled as a full-time student since 

attaining the age of 18 years at the time of the employee’s death, or were any age and 

incapable of self-support at the time of the employee’s death. 

Unlike Part B, the following claimants are not eligible for survivor benefits under Part E: 

adult children (with the exception of those meeting the requirements of incapable of selfsupport at the time of the covered employee’s death), parents, grandchildren, and 

grandparents of the deceased covered Part E employee.

c. Conviction of Fraud. A person convicted of fraud in the application for or receipt 

of benefits under the EEOICPA or any other federal or SWC law forfeits any 

entitlement to the EEOICPA benefits for any occupational illness or covered 

illness due to an exposure on or before the date of the conviction. 

4. Filing a Claim for Survivor Benefits. A claim for survivor benefits must be in writing. 

The DEEOIC considers any written communication that requests survivor benefits under the 

EEOICPA as a claim for purposes of case creation and claim development. However, a claimant 

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must submit a completed and signed Form EE-2 for DEEOIC to fully adjudicate the claim and 

issue a RD and FD. 

a. Acting on Survivor’s Behalf. A person acting with legal authority on behalf of a 

survivor may file a claim under the EEOICPA for that survivor including 

individuals serving as POA or Conservators. In the case of a minor child, it is 

preferable that a parent or legal guardian complete the form on the child’s behalf. 

A legal guardian is a person with the responsibility for providing care and 

management of a child and his or her affairs. 

b. No New Claim Needed for Part E. In some instances, a claimant may file for a 

Part B claim without knowledge that consideration exists for Part E benefits. In 

these situations, there is no need for a survivor to file a new claim for benefits 

under Part E when there is an existing, accepted Part B claim for that survivor, or 

when the survivor filed a Part D claim (Form 350.2) with the DOE. In these 

instances, the CE is to consider each survivor a claimant under both Part B and E. 

In any scenario where it is not clear as to the intent of a survivor to seek benefits 

under Part B or E, the CE must seek clarification from the survivor and, if 

necessary, obtain submission of a signed EE-2 claim form. 

c. Excluding Claims Due to Tort or SWC Benefit. A survivor may choose to 

exclude from his or her claim any condition caused by an exposure for which 

there has been a settlement from a tort action or, under Part E, any condition 

leading to receipt of a payment under a SWC program. This may preclude any 

need to reduce payable benefits. (Refer to Chapter 30 - Tort Action and Election 

of Remedies and Chapter 31 - Coordinating State Workers’ Compensation 

Benefits.) 

5. Establishing Employee’s Death. The first step a CE should take in a survivor claim is to 

obtain the necessary evidence to establish the death of an employee. 

a. Death Certificate. The document used to verify the death of an employee is a 

death certificate, typically issued by an official state or local governing agency. 

For the most part, a death certificate lists the name of the decedent, date of death, 

his or her marital status at time of death, usual occupation, and cause of death 

certified by a physician or some other official. In cases where a death certificate 

has not included all of the causes of death, the CE must conduct additional 

development (i.e., requesting medical records from the last 12 months of the 

employee’s life, referral to a CMC, etc.) to verify the additional causes of death. 

A death certificate is required to be submitted to confirm the death of an 

employee in a survivor claim filed under Parts B and E. 

(1) An official copy (stamped) of an employee’s death certificate is not 

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required. A copy can be accepted. 
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(2) Some states have implemented the use of electronic death certificates, 

 which may be used to establish the death of the employee. To be 

acceptable, a printed copy of the electronic record must be obtained that 

identifies the certifying official. If a physician is the certifying official, his 

 or her license number must also be included. 

6. Linking Employee’s Death to an Occupational or Covered Illness. For a compensable claim 

under Part B, it must be shown that the employee was diagnosed with an occupational illness 

including: cancer, CBD or chronic silicosis. The evidence does not need to show that any one of 

these conditions was linked to the employee’s death, merely that one or more was diagnosed. 

This also applies to an occupational illness that develops over the course of the employee’s life 

and resolves by way of medical treatment. 

However, for a compensable claim under Part E, the evidence must establish that an occupational 

exposure to a toxic substance was “at least as likely as not” a significant factor in causing, 

contributing to, or aggravating the death of the employee. For this determination, the CE may 

reference factual or medical evidence to assist in reaching a decision, including a death 

certificate or medical records proximate to the date of the employee’s death. The CE must also 

be ready to evaluate the effect that an accepted consequential illness had on the death of an 

employee. 

7. Surviving Spouse. For either a Part B or Part E claim for spousal survivorship, the 

necessary documentation to establish a viable claim usually consists of a copy of the marriage 

certificate issued or recognized by a State Authority or an Indian Tribe Authority. A “Certificate 

of Blessing of Marriage” from a church is not considered the equivalent of a marriage certificate. 

A marriage license is also unacceptable. To be an eligible surviving spouse, the spouse must 

have been married to the employee for one year immediately prior to the death of the employee. 

This prior year includes the date of marriage, through the day prior to the date of death. For 

example, if an employee married on September 4, 2004 and died on September 3, 2005, the CE 

does not include September 3, 2005 when calculating the required 365-day term. The CE counts 

each calendar day from September 4, 2004 up through and including September 2, 2005. 

a. In cases where evidence shows that the employee was previously married, it is not 

necessary to obtain proof of divorce. However, in the event that the evidence in a 

case raises concern as to the legitimacy of the marriage for which survivorship is 

being established, the CE must develop further and obtain a copy of the divorce 

decree (or death certificate if marriage ended due to death of spouse) validating 

that the marriage was dissolved. 

b. In some instances, a common-law marriage may exist between the employee and 

the surviving partner. When the evidence does not sufficiently establish that the 

claimant had a licensed/certified marriage with the employee for the 365 days 

immediately prior to the employee’s death – or where there is some evidence to 

suggest that the marriage was not valid – the CE may have to gather sufficient 

evidence to make a determination as to whether the parties established a commonlaw marriage in a state or other territory which authorizes such marriages. As a 

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general rule, in those states that legally permit it, the existence of a common-law 

marriage is determined by the law of the state where the alleged common-law 

marriage was allegedly entered into and that has the most significant relationship 

to both spouses and to the alleged marriage. If full development of the claim 

results in evidence that the alleged common law marriage occurred in a state that 

does not allow the creation of such marriages within its borders – and no other 

state is involved – the inquiry may end there. 

(1) The CE must develop evidence sufficient to establish that any claimed (or 

potential) common-law marriage meets two threshold issues. The first is 

when the common-law marriage was entered into, and the second is where 

it was entered into. 

(2) Once the “when and where” elements have been established, the CE 

proceeds with additional development to document the five standard 

elements of a common-law marriage outlined in the DEEOIC CommonLaw Marriage Handbook. 

(3) Evidence which may be used to document a common-law marriage may 

consist of the following items, as delineated in the handbook: affidavits, 

marriage and divorce documents, death certificates, children’s records, 

real estate documents, tax records, banking and loan documents, contracts 

including insurance documents, employment documents, medical records, 

tribal documents, wills, trusts, POA documents, utility bills, letters, and/or 

other significant formal or informal documents.

(4) The burden to produce all necessary evidence and to establish each 

element of their eligibility by a preponderance of the evidence rests with 

the claimant(s). The purpose of development regarding a claimed 

common-law marriage is to obtain sufficient information and probative 

evidence to support a determination regarding whether a common-law 

marriage was ever created, and if so, its duration. If the evidence is 

sufficient to reach a decision, the CE proceeds with adjudication. If the 

legality of the common-law marriage is not clear, or is in dispute, the case 

file, along with a memorandum of explanation, is referred to the NO

Policy Branch for guidance. 

8. Surviving Child. A “child” of an individual under both Parts B and E of the EEOICPA 

can only be a biological child, a stepchild, or an adopted child of that individual. A person who 

is or was a dependent of the employee but does not fit within the definition of a qualifying 

“child” is not an eligible survivor. In the vast majority of situations, a birth certificate showing 

the employee as the parent of a child is sufficient to establish survivorship. 

Where the claimant claims to be a child of the deceased employee and the birth certificate does 

not list the deceased employee as the father or mother of the claimant, the CE must undertake 

development to ascertain the circumstances of the claim. In those situations where evidence is 

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received that contradicts the paternity of the child or his or her connection to the employee, the 

CE must proceed with development. The CE must use discretion when evaluating evidence in 

support of a survivorship claim and weigh all evidence received in its totality.

 

a. Categories of eligible children.

 

(1) Biological Child. The term “biological child” is broad and refers to all 

persons with either a presumed or established genetic link to a deceased 

employee. Because a recognized natural child is presumed to have a 

genetic link to a deceased employee, a recognized natural child is one type 

of biological child. Another type of biological child is a person whose 

birth certificate lists the deceased employee as their mother or father, 

because these persons are also presumed to have a genetic link to their 

listed mother and father. However, these two presumptions may be 

rebutted if substantial evidence exists that rebuts the existence of the 

genetic links, consistent with 20 C.F.R. § 30.111(d). The final type of 

biological child is any person who can establish an actual genetic link to a 

deceased employee through the submission of probative DNA evidence 

that shows such a link. 

(2) Stepchildren. Claims for eligibility as a stepchild will be decided by the 

DO unless there is an issue that cannot be determined by the CE. In 

circumstances where the status of a stepchild as a potentially eligible 

survivor cannot be determined, the matter is referred to the NO Policy 

Branch. 

(a) A stepchild is defined as any individual who establishes a parentchild relationship with the employee through the marriage of their 

parent to the employee. This determination is made once the CE 

receives documentation from the stepchild in support of their 

claimed relationship. This must include evidence of the marriage 

between the employee and the parent of the stepchild. 

(b) Documentation supporting a regular parent-child relationship may 

include school records (e.g., report card) listing the employee as 

having a familial relationship to the stepchild, employment or tax 

returns showing that the covered employee claimed the stepchild 

as a dependent, photographs taken at family gatherings, newspaper 

articles, obituaries, insurance policies listing the stepchild as the 

son or daughter of the covered employee, wills, affidavits from 

biological children of the employee, and/or any other documents 

that refer to the stepchild and the deceased employee in a familial 

way. 

(c) Under Part B, where a stepchild was an adult at the time of the 

deceased employee’s marriage, the evidence will be considered on 

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a case-by-case basis. Evidence that may document eligibility 

includes records that the stepchild was the primary contact in 

medical dealings with the deceased employee, that the stepchild 

provided financial support for the deceased employee, and/or 

provided housing for the deceased employee, etc. Evidence 

consisting of medical reports, letters from the physician, or receipts 

showing that the stepchild purchased medical equipment, supplies 

or medication for the employee may be helpful. These items of 

evidence will be considered on a case-by-case basis and each is 

weighed together to fully evaluate the eligibility of the 

survivorship claim.

(d) There is no minimum time requirement for a stepchild to have 

lived in the same household as the covered employee or for their 

parent to have been married to the employee, merely that a parentchild relationship existed. To determine if a parent-child 

relationship existed, the CE or FAB representative must consider 

the above information in conjunction with the following: Did the 

stepchild visit the employee during the holidays?; Did the stepchild 

take care of the employee for days at a time?; and is it logical that 

the stepchild and employee stayed at one another’s home at any 

given time? As long as a reasonable basis exists to show that a 

parent-child relationship existed, the CE can make an affirmative 

finding. 

(e) For claims involving a divorce between the biological parent and 

the stepparent, the dissolution of the marriage does not terminate 

the parent-child relationship for eligibility purposes. As such, 

because a parent-child relationship did exist at one time, the child 

is considered an eligible stepchild. An ongoing parent-child 

relationship following divorce is not necessary. 

(f) The CE or FAB representative must consider the totality of the 

evidence when determining whether the stepchild qualifies, and 

must provide the rationale supporting whatever outcome in the RD

and/or FD. 

(3) Adopted Child. An adopted child is defined as a child that is not 

biologically related to the employee, but whose parental responsibilities 

have been permanently transferred by a legal mechanism to the employee. 

The CE obtains the relevant legal document(s), whether state, tribal, or 

otherwise, confirming the transfer of responsibility to the employee. 

(4) Posthumously Conceived Children. Advances in medicine and science 

have enabled the storage of human reproductive material (egg, sperm or 

embryo) as to allow for posthumous conception of children. DEEOIC 

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considers a posthumously conceived child of the employee to be an 

eligible survivor to the extent permitted by local or state law. In those 

survivor claims involving a posthumously conceived child, the assigned 

CE refers the case to the NO Policy Branch so it can obtain a legal opinion 

from the SOL of applicable local or state law in deciding the status of the 

child as an eligible survivor under the Act.

b. Qualifications for eligibility under Part B vs. E. 

(1) All Surviving Children. A surviving child is a biological, stepchild, or 

adopted child of the employee regardless of age. 

(2) Part E Surviving Child Only. Under Part E, a “covered child” must also 

have been, as of the date of the employee’s death: either under the age of 

18 years, under the age of 23 years and a full-time student who was 

continuously enrolled in one or more educational institutions since 

attaining the age of 18 years, or any age and incapable of self-support 

regardless of their marital status.

 

(a) Student Status. To be considered a full-time student at the time of 

the employee’s death, the child must have been continuously 

enrolled as a full-time student in one or more educational 

institutions since attaining the age of 18 years and must not have 

reached the age of 23 years, regardless of marital status or 

dependency on the employee for support. 

(i) Enrollment as a full-time student generally consists of a 12-

month period, with a break of no more than four months, 

during each year of post high school education. 

(ii) If the child’s status as a full-time student is uncertain, the 

CE consults the academic institution to determine what was 

considered to be the minimum number of hours required to 

qualify as “full-time” (versus part-time), at the time of the 

child’s enrollment, as this may vary from one institution to 

another. 

(iii) With certain programs such as co-op, intern, or graduate 

school programs, while the student might not actually be 

enrolled in any courses for a particular term, he/she could 

still be “registered” as a full-time student while fulfilling 

other requirements of the program. 

(iv) If a student is prevented by reasons beyond his or her 

control from continuing education for a period of 

reasonable duration, (such as a brief but incapacitating 

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illness) the CE has discretion to determine whether the 

student’s status as a continuously enrolled full-time student 

should be preserved. A suspension from school for a 

limited period should not affect the child’s status as a 

continuously enrolled full-time student. 

(v) Leaving school to care for a sick parent/employee, lack of 

funds to pay for school as a result of a parent/employee’s 

illness, or dropping/failing out of school is not a sufficient 

basis to maintain the child’s status as a continuously 

enrolled full-time student. 

(vi) Documentation to support eligibility includes transcripts 

from the accredited educational institution(s), school 

records, and affidavits. 

(b) Incapable of Self-Support. To establish eligibility for benefits as a 

covered child who was incapable of self-support at the time of the 

employee’s death, the child must have been physically or mentally 

incapable of self-support, regardless of marital status or 

dependency on the employee for support, regardless of the 

temporary or permanent nature of the incapacity.

(i) A child is incapable of self-support if, at the time of the 

employee’s death, his/her physical or mental condition was 

such that he/she was unable to obtain and retain a job or 

engage in self-employment that could provide him/her with 

a sustainable living wage. 

(ii) Medical evidence must show that the child was diagnosed 

with a medical condition establishing that he/she was 

physically/mentally incapable of self-support at the time of 

the employee’s death. 

(iii) Documentation to support the incapability of self-support 

can include medical records, social security disability 

records, tax returns showing that the covered child was 

claimed as a dependent, state guardianship documents, and 

affidavits.

SSA or State disability records alone, showing lack of selfsupport, should not be used to establish that the child is 

incapable of self-support. The CE must consider the 

evidence as a whole to determine if it demonstrates that the 

person was/is incapable of self-support for purposes of the 

EEOICPA.

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(iv) When medical evidence demonstrates incapacity for selfsupport, this determination will stand unless refuted by 

sustained work performance or other conflicting evidence. 

(v) A child is not incapable of self-support merely because of 

an inability to obtain employment due to economic 

conditions, lack of job skills, incarceration, etc. 

(vi) There is no specific timeframe required to establish that a 

child was incapable of self-support prior to the death of the 

employee (e.g., accident). It is only necessary to establish 

that the child was incapable of self-support on the day the 

employee died. 

(c) Non-spousal children. In certain situations, a special provision of 

the EEOICPA allows for the division of benefits between an 

eligible spouse and an employee’s child who is not related to the 

spouse. 

(i) Under Part B only. If there is at least one child of the 

employee who is a minor at the time of payment, and who 

is not a recognized natural child or adopted child of the 

spouse, half of the payment is made to the covered spouse 

and the other half is made in equal shares to each child of 

the employee who is a minor at the time of payment, 

without regard to whether the child is a spousal child, or 

non-spousal child. A recognized natural child is a child 

acknowledged by the employee as their own during their 

lifetime. The RD and FD must fully explain the 

distribution of compensation to the spouse and all children 

who have filed a claim. 

(ii) Under Part E only. If there is at least one child of the 

employee who is living at the time of payment, who 

qualifies as a “covered child” (i.e., under the age of 18 at 

the time of the employee’s death, between the ages of 18 

and 23 and continuously enrolled as a full-time student 

since attaining the age of 18 at the time of the employee’s 

death, or any age and incapable of self-support at the time 

of the employee’s death) and who is not a recognized 

natural or adopted child of the spouse, half of the payment 

is made to the covered spouse, and the other half is made in 

equal shares to each “covered child” of the employee, who 

is living at the time of payment, without regard to whether 

the child is a spousal child or non-spousal child. Refer to 

the definition of a recognized natural child found under 

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Part B above. The RD and FD must fully explain the 

distribution of compensation to the spouse and all children 

who have filed a claim. 

 

9. Parents, Grandchildren and Grandparents. Under Part B only, parents, grandchildren 

(including biological, adopted and step-grandchildren), and grandparents may be eligible for 

survivor benefits, provided there is no surviving spouse or living child who is eligible to receive 

compensation. When adjudicating a survivorship claim for a parent, grandchild, or grandparent, 

documentation must establish the relationship of the survivor to the deceased employee (i.e., 

employee’s birth certificate listing parent’s name, parent’s birth certificate showing 

grandparent’s name, etc.). As DEEOIC issues payment of lump-sum survivor benefits equally 

between eligible survivors, the CE must obtain evidence that establishes the status of all potential 

survivors in each category (parent, grandchild or grandparent). Parents, grandchildren and 

grandparents are not eligible for Part E survivor benefits. 

 

10. Potential for Additional Survivors. When an additional potential survivor is identified on 

Form EE-2 or through some other development action, the CE contacts the individual by letter 

explaining their right to file a survivor claim (Exhibit 20-1). 

a. Letter to Survivor. The letter to the survivor does not indicate whether the 

individual is qualified to receive benefits, as this is a function of the claims 

process. Rather, the letter outlines the general requirements for survivor 

eligibility. The CE explains that filing a claim does not guarantee that benefits 

will be payable, as both statutory and regulatory requirements must still be met 

before compensation can be awarded. 

b. Form EE-2. The CE encloses a blank Form EE-2 with the correspondence. The 

potential survivor is asked to complete and submit the form within 30 days. 

Additional information on handling non-filing claimants can be found in Chapter 

24 - Recommended Decisions. 

c. Additional Documentation. To ensure that compensation is paid to eligible 

survivors of the deceased employee, the CE may require the survivor(s) to 

provide documents, affidavits, or records sufficient to substantiate the veracity of 

their claim.

11. Claims Involving Multiple Claimants. When a claim is filed, it is created in the ECS 

based on claimed employment and claimed illness(es). In some cases, multiple claimants will 

file a claim for one or more illnesses. And in some of these cases, not all claimants will claim 

the same illness(es). Therefore, in cases involving multiple claimants, an illness claimed by one 

claimant will be considered claimed by all parties to the case [unless the claimant specifically 

states they do not wish to claim the additional illness(es)] and should be documented accordingly 

in ECS for each claimant. This means that all illnesses will be addressed for all claimants 

without the request for additional claim forms.

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a. Findings for Each Survivor. Once appropriate development is completed and 

review of evidence undertaken, one comprehensive RD addressing the claims of 

all filing parties is to be issued. Each party to the claim must receive an 

individual finding in the decision with respect to his or her eligibility. The 

decision references each survivor who has filed a claim and specifies whether 

they are entitled to receive compensation, the amount of compensation payable to 

each eligible survivor, and the basis for the conclusions reached. 

b. Reopening After a FD. Given the procedure requiring each individual in a multiclaimant case be party to a decision on entitlement of benefits, all claims 

associated with the case must be reopened before a new decision can be issued 

(Refer to Chapter 27 - Reopening Process). 

c. Individual Addresses. The RD does not include the addresses of the various 

claimants. Instead, a cover letter is addressed to each claimant and a copy of the 

decision is sent to all filing parties. 

d. Lack of Form EE-2. The CE may encounter a situation where a survivor has 

made a claim for benefits in writing but has not filed Form EE-2. Alternatively, 

the CE may have evidence indicating the existence of a potentially eligible 

survivor, but is unable to contact the survivor to obtain a completed Form EE-2. 

Under these circumstances, the CE issues a RD (See Chapter 24 - Recommended 

Decisions). 

 

12. Issues During the Payment Process. 

a. Death Before Payment. If the employee/survivor is alive when the FD is issued 

but dies before payment is received, the employee’s/survivor’s claim must be 

administratively closed. Receipt of payment is defined as the date the payee’s 

bank receives the Electronic Funds Transfer (EFT) or the date the payee or 

someone legally able to act for the employee in receiving the payment receives 

the paper check. 

Any compensation payment (whether check or EFT) received after the 

employee/survivor’s death must be returned to the Treasury Department, and the 

payment must be cancelled in ECS. (Refer to Chapter 32 - Compensation 

Payments, for the payment cancellation steps.) 

The CE appropriately develops any survivor claims and issues a new RD to all 

survivors who have filed a claim. 

b. Death Due to Non-Covered Illness, Part E. If a covered Part E employee dies 

after filing a claim but before any payment is received, and if the employee’s 

death was caused solely by a non-covered illness, the survivor (any survivor 

including the spouse) has the election of benefits option. The survivor may elect 

to receive compensation (wage-loss and/or impairment) that the employee would 

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have received had he not died prior to payment. It is not necessary for the 

employee to have filed a claim specifically for wage-loss or impairment in order 

to have the election of benefit option available. As long as the employee filed a 

Part E claim, claims for impairment and wage-loss are assumed. However, if the 

employee received any compensation for impairment or wage-loss, prior to his 

death, such payment voids the election of benefit option. 

(1) When an election of benefits is available, the CE contacts the survivor via 

telephone or letter advising the survivor of the option to receive the 

benefits that the employee would have received had he/she not died prior 

to receiving payment. The CE obtains a verbal response and follows with 

written confirmation of the survivor’s option. 

(2) The survivor could be awarded the impairment benefit the employee 

would have received, but only if the medical evidence meets all the 

criteria in the American Medical Association’s Guides to the Evaluation of 

Permanent Impairment, and conforms with the regulations regarding 

medical evidence used to support an award for impairment. (Refer to 

Chapter 21 - Impairment Ratings.) 

(3) Also, the survivor could be awarded the wage-loss benefit the employee 

would have received. (Refer to Chapter 22 - Wage-Loss Determinations.) 

(4) Under the election, survivor benefits are payable up to the aggregate limit 

under Part E. 

(5) The survivor is not entitled to the $125,000 lump-sum payment because 

death was not caused by the employee’s covered illness(es). 

c. Change in Child Status. Under Part B, a non-spousal child who is a minor at the 

time of filing may be advised in the FD that he or she be approved for 

compensation. While DEEOIC makes every effort to make lump-sum payment in 

a timely manner, if at the time of payment a child no longer meets the state law 

definition of a minor, the CE may not award. Under this unique situation, the CE 

takes action to vacate the FD so that a new decision may be issued finding that the 

non-spousal child is an ineligible survivor. DEEOIC staff is to take all necessary 

and appropriate steps to avoid this scenario. 

d. Survivor’s Death. An eligible survivor must be alive to receive any payment 

awarded under the Act. If one eligible survivor in a multiple survivor claim dies 

before payment is received, the CE administratively closes the deceased 

survivor’s claim and issues a new RD reapportioning compensation among the 

remaining eligible survivors. 

e. Survivor Compensation Part B. A survivor may receive one lump-sum payment 

under Part B for each employee for whom he/she qualifies as an eligible survivor. 

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If a survivor files a claim for benefits and a lump-sum payment has previously 

been paid to the employee, the CE denies the survivor’s claim because the 

maximum allowable benefit has already been paid. The maximum benefit under 

Part B is $150,000. 

f. Survivor Compensation, Part E. An eligible survivor is entitled to the basic lumpsum survivor compensation of $125,000 if it is determined that an accepted illness 

caused, contributed to, or aggravated the death of the employee. In the case of a 

claim with multiple eligible survivor payees, the CE must allocate the lump-sum 

survivor compensation based on who qualifies as a survivor. 

A survivor may receive more than the basic $125,000 survivor benefit if the 

deceased, covered Part E employee experienced compensable wage-loss as a 

result of any covered illness prior to his or her attainment of normal Social 

Security retirement age as defined by the Social Security Act. The additional 

benefit of $25,000 or $50,000 is dependent upon the number of years for which 

the employee experienced wage-loss (Refer to Chapter 22 - Wage-Loss 

Determinations). The maximum lump-sum survivor compensation under Part E is 

$175,000. 

g. Aggregate Compensation Payable under Part E. The total amount of 

compensation payable, excluding medical benefits, may not exceed $250,000 per 

covered employee. The CE does not develop for additional medical conditions in 

a survivor claim once the aggregate compensation amount is reached, unless the 

potential for covering medical expenses exists. If a survivor files a claim for 

benefits and the aggregate compensation amount has been reached, the CE must 

deny the survivor’s claim. 

13. Alternative to Filing a Survivor Claim Under Part E. A non-covered spouse or child of a 

deceased DOE contractor employee or RECA Section 5 uranium worker may submit a written 

request for an informal evaluation of whether the employee contracted a covered illness as a 

result of employment at a covered facility. Once the alternative filing review is complete, the CE 

issues a determination letter to the claimant. No RD or FD is required. 

a. Written Notice. An individual seeking a determination regarding the cause of an 

employee’s illness must send a letter to the DEEOIC requesting an alternative 

filing determination.

(1) Alternative filing requests may be submitted to the RCs or the DOs.

(2) Only individuals listed in Subtitle E of the EEOICPA as potential 

survivors (i.e., spouses or children of an employee) may seek a 

determination letter regarding an employee.

(3) The survivor seeking a determination letter must provide evidence of a 

familial relationship with the employee. 

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b. Acknowledgement Letter. The CE sends each requester a letter acknowledging 

receipt of their request to receive an alternative determination letter, upon 

submission of their filing (Exhibit 20-2). The acknowledgement letter serves to 

explain the alternative filing process and offers the requester the opportunity to 

pursue full adjudication of the claim. 

 

(1) The requester is notified that the alternative filing will result in the 

issuance of a determination letter, following development of the claim. 

The CE explains what will be contained in the determination letter and 

discusses the steps necessary to reach a determination on an alternative 

filing.

(2) If the requester has not already received a FD denying his or her claim, the 

acknowledgement letter gives the requester the opportunity to opt out of 

the alternative filing process and to pursue full adjudication of the claim 

leading to a RD/FD. Upon receipt of a requester’s decision requesting a

RD/FD, the CE sends a follow-up letter informing the requester that full 

development will be completed and outlines the evidence required to 

adjudicate the claim. If full adjudication of the claim is requested, the 

requester is to submit a completed form EE-2. 

(3) The “Alternative to Filing” letter must explicitly instruct the requester that 

the determination reached cannot be used in any claim for benefits under 

the EEOICPA. The CE instructs the requester that the information 

presented in the forthcoming determination letter does not represent a final 

agency decision on the illness or causation. 

c. Review of the Evidence. In accordance with the instructions contained in the 

EEOICPA PM, the CE undertakes full development of the alternative filing. The 

CE gathers any evidence necessary to arrive at a determination on the claim, 

including sending the case file to a CMC or NO Health Specialist for resolution of 

a question of exposure, diagnosis, or causation. 

d. Determination Letter. Upon completion of development on the alternative filing, 

the CE sends a determination letter to the requester (Exhibit 20-3).

(1) The CE prepares the written determination using clear language that the 

reader can easily understand. In the narrative of the decision, the CE 

provides sufficient discussion of the case evidence to describe the 

justification of the decisional outcome. The letter does not take the format 

of a RD, and no appeal rights or waiver is required. 

(2) The determination letter must reach a conclusion about whether the 

employee contracted an illness as a result of exposure while employed at a 

covered facility. 

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(3) The letter must state that the requester is not afforded any appeal or review 

rights as a result of the conclusion reached. 

(4) The CE reiterates that the determination cannot be used as evidence in a 

claim for benefits under EEOICPA.

(5) The CE explains that the requester may seek full adjudication on the 

claim, including issuance of a RD and FD, at any time.

(6) A SrCE or supervisor reviews the determination and prepares it for the 

DD’s signature. 

e. Receipt of Form EE-2. If the survivor files a Form EE-2, the CE renders a RD on 

eligibility, which is then reviewed by the FAB for issuance of a FD.

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CHAPTER 21 – IMPAIRMENT RATINGS 

 1. Purpose and Scope. This chapter provides procedures for evaluating a claim for 

permanent impairment. It explains the responsibilities of the CE in awarding a covered Part E 

employee impairment attributable to a covered illness. The chapter provides guidance on how to 

evaluate medical evidence relating to impairment and the evidence necessary to establish a 

ratable permanent impairment. The chapter includes a discussion on calculating an impairment 

award if the impairment award is subject to tort offset and/or SWC coordination. 

2. Policy. DEEOIC staff is responsible for processing impairment claims and ensuring that 

benefits are appropriately paid. In impairment decisions, DEEOIC staff explains the general 

requirements for impairment and provides a clear explanation of the calculations used to 

compute the impairment award. The assigned CE is responsible for bronzing into OIS all caserelated correspondence or other documentation generated or received during the development of 

an impairment rating. 

3. Definition of Impairment. The American Medical Association’s Guides to the Evaluation 

of Permanent Impairment (AMA’s Guides), 5th Edition, defines impairment as “a loss, loss of 

use or derangement of any body part, organ system or organ function.” Furthermore, 

“Impairment percentages or ratings developed by medical specialists are consensus-derived 

estimates that reflect the severity of the medical condition and the degree to which the 

impairment decreases an individual’s ability to perform common Activities of Daily Living 

(ADL), excluding work.” (Emphasis in original) The AMA’s Guides organize ratable organ or 

body function by chapter e.g., respiratory, cardiovascular, nervous, endocrine etc. 

4. General Requirements for Impairment Ratings. 

a. Covered Employees. The employee is a covered DOE contractor or subcontractor 

employee, or RECA Section 5 employee found to have contracted a covered 

illness through exposure to a toxic substance at a DOE facility or RECA section 5 

facility.

b. Claiming Impairment. The employee has to claim impairment in writing.

c. MMI. An impairment rating is to encompass each covered illness that has 

reached MMI according to the rating physician. MMI means the condition is 

unlikely to improve substantially with or without medical treatment. A CE may 

consider conditions that are progressive in nature and worsen over time, such as 

CBD, to have reached MMI when the condition is not likely to improve. 

(1) Terminal Employees. An exception to the MMI requirement exists for 

terminal employees undergoing treatment for an illness that has not 

reached MMI. In these situations, the terminal employee could die before 

the end of treatment and eligibility for an impairment award would be 

extinguished. Therefore, if the CE finds probative medical evidence that 

the employee is terminal, the CE includes the covered illness in the 

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impairment rating even if the covered illness has not reached MMI.

(2) MMI Has Not Been Reached. If the rating physician or the treating 

physician states that a condition is not at MMI, and the employee is not 

terminal, the CE cannot make an impairment determination. 

(a) If the CE does not make an impairment determination due to the 

employee not being at MMI, the CE sends a letter informing the 

employee that an impairment determination is not possible because 

the employee’s condition has not reached MMI and that the 

impairment claim is closed administratively. The letter includes a 

statement instructing the employee to contact the DO once he or 

she receives medical evidence that describes the condition is at 

MMI. (See Exhibit 21-1).

(b) Once the CE receives notice from the employee and medical 

evidence indicating that the employee is at MMI, the CE resumes 

development. 

(3) Multiple Covered Illnesses. In a case of multiple covered illnesses, where 

one condition is at MMI and another is not, the CE proceeds with a 

determination regarding impairment for the condition at MMI. If different 

covered illnesses affect the same organ or body function, and one 

condition is not at MMI, the CE cannot proceed with an impairment rating 

until all conditions in that organ or body function have reached MMI. 

d. Impairment Rating. An impairment evaluation performed by a qualified 

physician is the basis for the CE’s determination of impairment benefit 

entitlement. Therefore, the physician’s impairment rating report is to include 

narrative text that clearly communicates the physician’s opinion, and that 

provides a convincingly descriptive rationale in support of the stated impairment 

rating.

(1) Evaluation. An impairment evaluation of the employee must be based 

upon the 5th Edition of the AMA’s Guides. 

(2) Rating Physician Qualification. A physician who performs an impairment 

evaluation must satisfy certain criteria. In order for a CE to accept an 

impairment rating, the rating physician must hold a valid medical license 

and Board certification/eligibility in his/her field of expertise (e.g., 

toxicology, pulmonary, neurology, occupational medicine, etc.). In 

addition, the physician must meet at least one of the following criteria: 

certified by the American Board of Independent Medical Examiners 

(ABIME); certified by the American Academy of Disability Evaluating 

Physicians (AADEP); possess knowledge and experience in using the 

AMA’s Guides; or possess the requisite professional background and 

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work experience to conduct such ratings. 

(a) A CE may determine the qualifications of the physician upon 

receipt of a letter or a resume demonstrating that the physician has 

a medical license and meets the requisite program requirements. 

There is no need to submit copies of his/her medical license or 

other certification. 

(b) If a physician does not possess ABIME or AADEP certification, 

the physician must submit a statement certifying and explaining 

his/her familiarity and years of experience in using the AMA’s 

Guides. 

 

(3) Rating Percentage. The impairment rating is a percentage that represents 

the extent of a whole person impairment of the employee, based on the 

organ or body function affected by a covered illness or illnesses. A 

qualifying impairment rating must account for all Part E accepted covered 

illnesses claimed by the employee and must include all pre-existing 

conditions present in the claimed organ or body function at the time of the 

impairment evaluation. 

(4) Whole Person Impairment. The physician must specify the percentage 

points of whole person impairment resulting from all covered illnesses. 

This includes accepted consequential conditions. 

(a) In some instances, there are diseases or life style choices (e.g., 

smoking), in addition to the covered illness, that affect organ or 

body function. The DEEOIC does not apportion damage within 

the same organ or body function, thus the 

impairment rating should assess the functionality of the whole 

organ or body function regardless of other non-occupational 

factors that might cause impairment. 

(b) If an employee’s covered illness affects more than one organ or 

body function, the physician must specify the percentage points of 

impairment for each organ or body function affected by the 

employee’s covered illness. The physician references a combined 

value chart in the AMA’s Guides to calculate the aggregation of 

multiple organ or body function impairments into whole person 

impairment. 

 

(c) If the employee contracted more than one covered illness that 

affects the same organ or body function, the physician does not 

need to provide separate ratings for each covered illness since 

DEEOIC does not apportion damage within the same organ or 

body function. 

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(d) An impairment that is the result of any accepted covered illness 

that cannot be assigned a numerical impairment percentage using 

the 5th Edition of the AMA’s Guides will not be included in the 

employee’s impairment rating, and the physician performing the 

impairment evaluation must explain why a numerical impairment 

percentage cannot be assigned. 

e. Triggering Impairment. There first must be impairment to an organ or body 

function that is clearly due to a covered illness before the CE can give any 

consideration for additional impairment to that organ or body function resulting 

from any unaccepted illness or condition. For example, if the employee has an 

accepted Part E claim for COPD only, and the rating physician opined that the 

employee’s respiratory system has 0% impairment due to COPD, but 9% due to 

asthma (which has not been accepted), the CE is to deny the employee’s 

impairment claim for COPD. 

5. How a Claimant Files an Impairment Claim. After the FAB issues a Part E FD to an 

employee with a positive causation determination, the CE sends Form EE-11A/EN-11A to solicit 

impairment claims from employees who are potentially eligible for impairment benefits. See 

Section 16 of this chapter for developing a claim for increased impairment two years after the 

initial impairment FD. 

a. Impairment Letter and Response Form (Form EE-11A/EN-11A). Form EE-11A 

contains information explaining impairment benefits and that the employee may 

be eligible for an award based on permanent impairment. 

 

b. Words of Claim. If the employee submits written words of claim for impairment, 

the CE must follow up with the employee to obtain a signed Form EN-11A or 

Form EN-10. The impairment forms must be signed by the employee, the AR, or 

the employee’s POA. 

(1) Request for Impairment Claim. Form EE-11A provides information that 

the employee must advise the DEEOIC in writing as to whether or not 

he/she wishes to claim impairment for a covered illness or illnesses. Form 

EN-11A is a response form on which the employee claims impairment. 

(2) Physician Choice. Form EE-11A includes instruction that the employee 

may choose to have his/her own qualified physician or a CMC perform an 

impairment evaluation. CMCs are DEEOIC contracted physicians 

qualified to perform impairment evaluations. The employee indicates this 

choice on Form EN-11A. If the employee requests his/her own physician 

to perform the impairment rating, the employee must provide the 

physician’s name, address and phone number. Form EN-11A contains a 

space for this information. 

(3) Timeframe. The CE allots 60 days for the employee to respond to Form 

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EE-11A/EN-11A, with a follow up request sent to the employee at the first 

30-day interval. The CE uses Form EE-11A/EN-11A for the follow up 

request, but the form must be marked “Second Request.” The CE does not 

develop the impairment issue until he or she receives a completed Form 

EN-11A. 

 

(a) If the employee does not respond to Form EE-11A/EN-11A within 

60 days, the CE sends a final Form EE-11A/EN-11A marked as a 

“Final Request” to the employee. After the CE sends the final 

request Form EE-11A/EN-11A, the CE updates the ECS) to 

indicate the employee is not claiming impairment. If at any time, 

the employee informs the CE that he/she does not want to pursue a 

claim for impairment, the CE sends a letter to the employee 

advising that the DEEOIC will not undertake further development 

of the claim for impairment. The CE also notifies the employee of 

his/her right to claim impairment in the future (See Exhibit 21-2). 

(b) If the employee responds by Form EN-11A claiming impairment, 

the CE updates ECS appropriately. The impairment claim date is 

the postmark date of the form, if available, or the date the DO, 

FAB, CMR, or RC receives the form, whichever is the earliest 

determinable date. 

(c) If the employee does not indicate on the EN-11A form who he or 

she would like to perform the impairment evaluation, the CE calls 

the employee for this information. The CE advises the employee to 

document his or her choice in a written statement submitted to the 

DEEOIC CMR address. 

 

6. Impairment Ratings by the Employee’s Choice Physician. If the employee elects to have 

the physician of his/her choice perform the impairment rating, the CE must obtain evidence 

necessary to document that the physician is qualified as explained in Section 4. 

a. Letter to Selected Physician. The CE sends a letter (Exhibit 21-3) to the physician 

selected by the employee. In the letter, the CE notifies the physician of the 

employee’s eligibility, and the covered illness or illnesses with respective ICD9/10 code(s). The CE also explains in the letter that for the DEEOIC to pay for an 

impairment evaluation, the physician must perform the evaluation within one year 

of the report’s receipt by the DEEOIC. The letter includes reference to the 

requirement that the impairment evaluation is to be performed in accordance with 

the 5th Edition of the AMA’s Guides, and that the rating physician must cite the 

appropriate page numbers and tables applied from the AMA’s Guides. The letter 

explains that the physician must submit supporting documentation (e.g. medical 

reports, evaluation reports, assessment reports and diagnostic testing results) with 

the impairment report. The letter includes instructions for the physician to contact 

the DO if they need medical evidence from the case file. Lastly, the CE provides 

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URL links to the medical bill pay agent enrollment forms, which is to include: an 

OWCP-1500, Health Insurance Claim Form, OWCP-1168, the EEOICP Provider 

Enrollment Form, and a SF Form 3381. The OWCP-1168 contains a written 

explanation of how a physician enrolls with the medical bill pay agent. 

If a physician has previously enrolled with the DEEOIC, there is no need to enroll 

again. If the employee opts to select his/her physician to perform the impairment 

rating but does not know of one, the CE may direct the employee to the 

appropriate RC or the DEEOIC bill pay agent website for a list of physicians who 

are enrolled in the program. 

b. Scheduling an Appointment with the Selected Physician. Upon receipt of the 

employee’s written choice of physician, the CE sends a letter explaining that the 

employee is to schedule the impairment appointment within 30 days and the 

appointment is to occur within three months. The CE advises that the employee 

may request that the DO provide the rating physician with medical evidence in the 

case file to perform the impairment evaluation. The CE also explains that any 

appointment scheduled to occur later than three months may lead to denial of the 

impairment claim, unless there is a valid reason for the delay (for example, the 

earliest appointment available for a specialist was over three months). 

If after 30 days, the CE finds no evidence of an impairment evaluation or that the 

employee scheduled an appointment, the CE makes a phone call to determine the 

status of the appointment (whether it has been made or is in the process of being 

made, etc.). The CE advises the employee verbally of the need to schedule the 

appointment within the next 30 days and to provide written evidence of such to 

the CE. The CE also explains that if the appointment is not scheduled or the 

claimant has scheduled it to occur later than the three months period without a 

valid reason, a RD to deny the impairment claim may be issued. The CE records 

this discussion in the phone calls section of ECS. After this phone call, the CE 

sends a written summary of the call to the employee. 

If at the end of this total 60-day period no evidence exists to show progress in 

obtaining the necessary impairment evidence and the employee has not provided a 

valid reason for the delay (e.g. he/she was sick), the CE may issue a RD to deny 

the impairment claim. 

7. Impairment Ratings by a CMC. If the employee chooses the CMC option, the CE 

reviews the medical evidence in the case file to determine if the evidence is sufficient for a CMC 

to perform the impairment evaluation. 

a. Required Medical Evidence. Since the CMC will not conduct a physical 

examination, the employee’s ADL or equivalent information is required. The 

CMC or the employee’s physician can collect ADL information from a variety of 

sources, including the use of ADL worksheet (See Exhibit 21-4 for an example), 

patient interview, or other techniques. The ADL or equivalent information should 

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be completed within the last 12 months before the impairment evaluation. The CE 

also checks Xerox’s Stored Image Retrieval (SIR) system to provide the most 

current medical record to the CMC. If the employee is under nursing care, the CE 

provides all nursing notes from the past 30 days to the CMC for review. In 

addition to the ADL or its equivalent, some conditions require specific medical 

evidence before a CMC can complete the impairment evaluation, as outlined in 

Exhibit 21-5. If Exhibit 21-5 does not identify the condition to be rated, the CE is 

to consult with a CMC to determine what medical information is required as 

outlined in the AMA’s Guides. 

After receipt of the notice that the employee has chosen the CMC option, the CE 

sends a letter to the employee attaching a sample blank ADL or an ADL for breast 

cancer or skin cancer. The CE also includes the information regarding the 

required medical evidence for the covered illness(es). If the CE determines that 

additional evidence and/or diagnostic test(s) is required to conduct an impairment 

evaluation, the CE explains the requirement in this letter. The letter includes 

instruction for the employee to return the required evidence within 30 days. If 

after 30 days, the claimant does not submit the required evidence, the CE makes a 

phone call to determine the status of the evidence. The CE advises the employee 

verbally of the need to obtain this evidence. The CE explains that if the employee 

does not return the required evidence within 30 days, a RD to deny the 

impairment claim may be issued. The CE records this discussion in the phone 

calls section of ECS. After this phone call, the CE sends a second letter to the 

employee and includes a written summary of the phone call, blank ADL and 

information regarding the required medical evidence needed to conduct an 

impairment evaluation. 

If at the end of this total 60-day period no evidence exists to show progress in 

obtaining the necessary impairment evidence and the employee has not provided a 

valid reason for the delay, the CE may issue a RD to deny the impairment claim. 

b. Insufficient Evidence. If the CE determines that the submitted medical evidence 

is insufficient, the CE sends a follow-up development letter to the employee 

explaining the deficiency and the additional evidence and/or diagnostic test(s) 

required to conduct an impairment evaluation. 

c. Unavailability of Records. If the employee is unable to provide the necessary 

medical records, the CMC must decide if an impairment evaluation is possible in 

accordance with AMA’s Guides given the available evidence. The CE may 

proceed with a CMC referral to determine if the available records are sufficient to 

perform a rating. If the CMC is able to perform a rating based on the available 

medical evidence but states that additional testing could potentially increase the 

rating, the CE notifies the employee that additional testing may result in a higher 

rating and that the DEEOIC will pay for the additional testing. The CE sends the 

employee a letter and gives the employee the option of obtaining the necessary 

testing paid by DEEOIC, or notifying the CE in writing that a decision may 

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proceed based on the available medical evidence. If the employee does not 

respond, the CE proceeds with the impairment evaluation based on the available 

medical evidence.

d. Outdated Evidence. If the CE has provided the employee the opportunity to 

obtain current medical evidence but the claimant has not responded adequately, 

the CE may use medical evidence in the file that is older than 12 months to obtain 

an impairment rating from a CMC. In some instances, the CMC may not be able 

to render an opinion with older or missing medical records.

8. Impairment Ratings for Certain Conditions. 

a. Mental Disorders. 

 

(1) Upon receipt of a claim for a mental impairment, the CE must determine 

whether the claimed impairment originates from a documented physical 

dysfunction of the nervous system. 

(2) Once it has been established that an employee’s mental impairment is 

related to a documented physical dysfunction of the nervous system, the 

employee obtains an impairment evaluation from the physician based on 

Table 13-8 of Chapter 13 in the 5th Edition of the AMA’s Guides. 

(3) If the mental impairment is not related to a documented physical 

dysfunction of the nervous system, it cannot be rated using the 5th Edition 

of the AMA’s Guides. The CE explains this to the employee and provides 

the employee 30 days to submit documentation from a physician to 

establish a link between the exposure to a toxic substance at a covered 

facility and the development of a mental impairment. The report from the 

employee’s physician must contain rationalized medical analysis 

establishing that the mental impairment has a relationship to neurological 

damage due to a named toxic exposure. Speculation or unequivocal 

statements from the physician reduce the probative value of a physician’s 

report, and, in such situations, the CE may refer the case to an 

occupational CMC. 

 b. Breast Cancer. 

(1) Upon receipt of a claim for impairment for the breast in either a male or 

female, the CE submits a request to the physician undertaking the 

evaluation, explaining all the criteria that are to be considered and 

referenced in the impairment report (See Exhibit 21-6). For the purposes 

of considering impairment due to breast cancer in a female, childbearing 

age will not be a determining factor when issuing an impairment rating, as 

the AMA’s Guides do not define “child- bearing age.” 

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(2) When the physician returns a completed impairment evaluation, the CE is 

to review it to ensure that the physician has comprehensively addressed 

each of the factors necessary for an acceptable rating. The impairment 

evaluation is to contain written information to show that the physician has 

considered: 

 

 (a) The presence or absence of the breast(s);

(b) The loss of function of the upper extremity (or extremities if there 

is absence of both breasts due to cancer), including range of 

motion, neurological abnormalities and pain, lymphedema, etc.; 

(c) Skin disfigurement (may include notes older than a year and/or 

photos) and 

(d) Other physical impairments resulting from the breast cancer. The 

total percentage of permanent impairment of the whole person 

must be supported by medical rationale and references to the 

appropriate sections and tables (with page numbers) of the AMA’s 

Guides. 

(3) If the CE determines that the physician has not provided a complete rating 

for a claimed impairment of the breast, the CE sends a follow-up letter to 

the physician. The CE explains in the letter the noted deficiency in the 

assessment, and explains that a complete response ensures that the 

employee receives the maximum allowable rating provided by the AMA’s 

Guides. 

c. Pleural Plaques/Beryllium Sensitivity. 

(1) The CE may accept an impairment claim for pleural plaques/beryllium 

sensitivity if the rating physician provides medical rationale and 

references to the appropriate sections and tables (with page numbers) of 

the AMA’s Guides to justify the impairment rating. 

 d. Metastatic Bone Cancer. 

(1) In situations where the CE accepts a case under the SEC provision based 

on metastatic (secondary) cancer, i.e. metastatic bone or metastatic renal 

cancer, often the primary source of the metastatic cancer will prove to be 

the prostate. If the CE does not accept the prostate cancer due to a lack of 

a causative link and because prostate cancer is not an SEC-specified 

cancer, it is important that the CE ensure that a physician does not apply 

the non-covered prostate cancer in an impairment rating. A physician or 

CMC may only consider the accepted condition of SEC metastatic cancer 

for the impairment rating. 

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9. Receipt of the Impairment Evaluation. Upon completion of the impairment evaluation by 

a physician, the CE reviews the report to assure that it contains all the information necessary to 

meet DEEOIC’s criteria for a valid impairment. The CE reviews the impairment evaluation to 

determine the following: whether the opining physician possesses the requisite skills and 

requirements to provide a rating as set out in paragraph 4d(2); whether the evaluation was 

conducted within one year of receipt by the DEEOIC; whether the report addresses the covered 

illness or illnesses; whether the whole person percentage of impairment is explained with a 

clearly rationalized medical opinion as to its relationship to the covered illness or illnesses, and 

whether the medical opinion is supported by medical evidence in the case file. 

a. Incomplete Ratings. If the impairment rating report is unclear or lacks rationalized 

medical analysis in support of the offered conclusion, additional clarification is 

required. In such instances, the CE returns the impairment rating evaluation to 

the rating physician with a request for clarification, explaining what areas are in 

need of remedy. If the employee’s choice physician submitted the insufficient 

report and no response is received, or it is returned without sufficient clarification, 

the CE notifies the physician and the employee of the need for additional 

justification. If a response is not forthcoming, the CE may issue a RD to deny the 

impairment claim for an insufficient impairment report. If the CMC submits an 

incomplete report, the CE notifies the CMC of the deficiency and requests a more 

comprehensive report. 

10. Pre-RD Challenges. Upon request, the CE may provide the employee with a copy of the 

impairment rating report. The employee may submit written challenges to the impairment rating 

report and/or additional medical evidence of impairment. However, any additional impairment 

evaluations must meet the criteria discussed above in Section 9 before the CE can consider it 

when making impairment determinations. The DEEOIC will only pay for one impairment 

evaluation unless the DEEOIC directs the employee to undergo additional evaluations. The 

employee is responsible for the payment of any subsequent evaluations not directed by the 

DEEOIC. If the additional evaluation differs from the existing rating, the CE must review and 

weigh (See guidance provided in Chapter 16 – Developing and Weighing Medical Evidence) the 

two reports to determine which report has more probative value. If the reports appear to be of 

equal value and the impairment ratings are within 10% of each other, the CE accepts the higher 

rating impairment. 

a. Determining Probative Value. If the impairment reports appear to be of equal 

value and the ratings are not within 10% of each other, the CE must obtain an 

evaluation from a second opinion physician. 

 

11. Impairment Award. To calculate the impairment award, the CE multiplies the percentage 

points of the impairment rating of the employee’s covered illness or illnesses by $2,500.00. For 

example, if a physician assigns an impairment rating of 40% or 40 points, the CE multiplies 40 

by $2,500.00, to equal a $100,000.00 impairment award. 

a. Maximum Aggregate Compensation. The amount of monetary compensation 

provided under Part E (impairment and wage-loss compensation), excluding 

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medical benefits, cannot exceed $250,000.00. The CE considers any previous 

compensation awarded under Part E for impairment and/or wage-loss to 

determine if a subsequent award needs to be reduced to ensure that it does not 

exceed the $250,000.00 maximum aggregate compensation. In determining the 

aggregate compensation, the CE does not take into consideration the reduction of 

compensation based on SWC coordination or tort offset. For example, if the 

employee was previously awarded benefits for impairment in the amount of 

$100,000.00 but his compensation was reduced because of tort offset to 

$60,000.00, the amount of compensation used to determine the maximum 

aggregate compensation is $100,000.00 not $60.000.00. 

12. Impairment and Tort Offset/SWC Coordination. If there are impairment benefits due to 

multiple covered illnesses, and at least one of those illnesses is subject to a tort offset or 

coordination of SWC award, the CE must determine the impairment award by following the 

steps in this section. Since DEEOIC does not apportion impairment within the same organ or 

body function, if there are several covered illnesses affecting the same organ or body function 

and one illness from the same organ or body function is subject to coordination or offset, the 

entire rating for that affected organ or body function is subject to coordination or offset. 

 

a. Determine that coordination and/or offset is required. 

 

(1) SWC Coordination. In an impairment case with multiple covered 

illnesses, the CE confirms that at least one covered illness from the 

impairment award is the same illness that serves as the basis for SWC 

payment. 

(2) Tort Offset. In an impairment case based upon multiple covered illnesses, 

the CE confirms that at least one covered illness from the impairment 

award is associated with the same exposure to a toxic substance that a tort 

settlement references as causing illness. 

b. Identify the combined impairment rating and calculate the dollar amount. For 

example, John Doe has a 20% impairment due to his asbestosis and 7% 

impairment due to his skin cancer. The combined impairment rating according to 

the Combined Values Chart is 26%, and the potential impairment award is 

$65,000.00 (26% X $2,500.00 = $65,000.00). 

 

b. Determine the percentage of the combined impairment rating that each separate

impairment represents (apportionment) using these steps: 

(1) Determine the sum of the individual impairment rating. In the John Doe 

example case, the individual ratings are 20% due to his asbestosis (lung) 

and 7% due to his skin cancer, so the sum of his individual impairment 

ratings is 27% (20% + 7% = 27%) 

(2) Calculate the relative percentage of impairment for each organ or body 

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function. 

For asbestosis - Divide 20% by 27% to determine that 74.07% of the sum 

of the individual rating is attributable to asbestosis.

For skin cancer – Divide 7% by 27% to determine that 25.93% of the sum 

of the individual impairment rating is attributable to skin cancer. 

d. Calculate the dollar amount attributable for each organ or body function. In the 

John Doe example case, the calculation is as follows: 

For asbestosis – Multiply 74.07% (the percentage attributable to asbestosis) by the 

dollar amount of the combined impairment award of $65,000.00 to determine that 

$48,145.50 is the dollar amount attributable to asbestosis. 

For skin cancer – Multiply 25.93% (the percentage of impairment rating 

attributable to skin cancer) by $65,000.00 to determine that $16,854.50 is the 

dollar amount attributable to skin cancer. 

e. Subtract Offset/Coordination amount from the dollar amount attributable to the 

organ or body function subject to offset and/or coordination. 

Example 1: If the dollar amount attributable to John Doe’s lung impairment has to 

be reduced by $10,000.00 due to coordination (the eligible amount paid from a 

state workers’ compensation claim), $10,000.00 is subtracted from $48,145.50 

(the dollar amount attributable to asbestosis), which leaves $38,145.50 payable 

due to asbestosis after coordination of SWC benefits. 

 

Example 2: If the dollar amount attributable to John Doe’s lung impairment has to 

be reduced by $50,000.00 due to coordination, $50,000.00 must be subtracted 

from $48,145.50 (the dollar amount attributable to asbestosis), which leaves 

$1,854.50 as a surplus after coordination of SWC benefits. His surplus due to 

asbestosis will not affect his entitlement to benefits for skin cancer. 

f. Calculate the Payable Impairment Award. Add the dollar amounts for each organ 

or body function(after coordination and/or offset) to determine the amount of the 

impairment award. 

Example 1: Add $38,145.50 for asbestosis (after subtracting the coordination 

amount of $10,000.00) to $16,854.50 for skin cancer for a total impairment award 

of $55,000.00. 

Example 2: If the coordination amount to asbestosis is $50,000.00, the amount of 

the total impairment award is $16,854.50 from the skin portion of the combined 

impairment award if skin cancer is not subject to offset or coordination. The 

surplus of $1,854.50 after coordination of SWC benefits for asbestosis is NOT 

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subtracted from the skin cancer award. The CE absorbs this surplus from medical 

benefits for asbestosis and future compensation benefits for asbestosis. 

13. How to Calculate Increased Impairment Award with Tort Offset/SWC Coordination. For 

increased impairment claim involving tort offset and/or SWC coordination, the calculation must 

be based on the current impairment rating/award and not on the net increased impairment award. 

For example, John Doe had previously been awarded impairment for asbestosis and skin cancer 

for 26%. The current combined impairment rating is 40%, which comprised of 33% due to 

asbestosis and 10% due to skin cancer. Using the current impairment rating, follow the 

calculation in Section 12c to determine the relative percentage of impairment for each organ or 

body function and Section 12d to determine the dollar amount attributable for each organ or 

body function. The dollar amount attributable to each organ or body function must be based on 

the current impairment award of 40% or $100,000.00 and not on the net increase of 14% (40% - 

26% = 14%) or $35,000.00. As such, the increased impairment calculation is as follows: 

For asbestosis – Multiply 76.74% (the percentage attributable to asbestosis based on the 

current impairment rating) by the current impairment award of $100,000.00 to determine that 

$76,740.00 is the dollar amount attributable to asbestosis. 

For skin cancer – Multiply 23.26% (the percentage of current impairment rating attributable to 

skin cancer) by $100,000.00 to determine that $23,260.00 is the dollar amount attributable to 

skin cancer.

Since the CE calculates the increased impairment award based on the current impairment rating 

and not on the net increase, any previous award(s) of impairment and any SWC coordination/tort 

offset for that organ or body function must be subtracted from the current impairment award. 

Example: In the previous impairment decision issued to John Doe, the CE concluded that a 

surplus of $1,854.50 remained for asbestosis after coordination of SWC benefits for asbestosis in 

the amount of $50,000.00. The total impairment award was $16,854.50 from the skin portion of 

the combined impairment award. Since the previous impairment decision, the CE concluded that 

John Doe received an additional SWC coordination for asbestosis in the amount of $10,000.00 

for a total coordination amount of $60,000.00. 

To calculate the new impairment award, subtract the total coordination amount of $60,000.00 for 

asbestosis from the new dollar amount attributable to asbestosis ($76,740.00) which equals to 

$16,740.00 payable for asbestosis. From the new dollar amount attributable to skin cancer of 

$23,260.00, subtract the previous award of $16,854.50, which equals to $6,405.50. The CE adds 

the dollar amounts for each organ or body function to determine that the increased impairment 

award is $23,145.50($16,740.00 + $6,405.50 = $23,145.50) with no outstanding surplus. 

In any unique or challenging circumstance involving how best to apply SWC coordination or tort 

offset to a payable impairment, the CE consults with the NO Policy Branch. 

 

14. Issuance of a RD. The RD for impairment must contain a CE’s discussion of the relevant 

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impairment evidence submitted in deciding the claim. Moreover, the CE must explain the 

sufficiency (or insufficiency) of the evidence justifying the decision outcome. For example, the 

CE discusses the qualification of the physician to perform an impairment rating. In addition, the 

CE includes a description of the medical evidence that satisfy the necessary procedural 

requirements for a valid impairment including MMI, use of AMA’s Guides, calculation of rating, 

citation of AMA tables, etc. For any lump-sum award, the CE explains clearly the calculation of 

the award, including subtractions due to prior lump-sum impairment payments. If coordination 

and/or offset is required, the CE explains the steps and calculations performed to derive at the 

award. 

If a decision recommends denial of an impairment claim based upon an insufficient evaluation, 

or if the CE relies on one evaluation over another evaluation(s) in the file, the CE provides a 

detailed discussion regarding the probative value of the evaluation(s). In the case of competing 

medical opinions, the CE discusses the weight of medical evidence as to why one report is 

insufficient, and/or why one report offers more probative value. In other words, the CE has to 

explain how he or she selected one physician’s opinion over another. This is necessary in the 

event that the employee submits additional impairment evidence to FAB, as any additional 

impairment evidence submitted has to overcome the weight of medical evidence as assigned by 

the CE. 

15. FAB Development. Once the CE issues RD on impairment and the CE forwards it to 

FAB, the employee may submit new medical evidence and/or additional impairment evaluations 

to challenge the impairment determination discussed in the RD. 

a. Reviewing Ratings. The employee bears the burden of providing additional 

impairment evidence that shows an error of procedural application or that 

provides a probative medical argument to overcome the CE’s assignment of 

weight of medical evidence as discussed in the RD. However, if the evidence is 

not from a qualified physician who meets the requirements of paragraph 4d(2) of 

this chapter, the FAB HR or FAB CE will not consider it probative. 

b. FAB Review. The FAB CE or HR reviewing the case is to take into consideration 

the list of factors in section 9 when weighing impairment evaluations for 

probative value. In addition to the impairment rating(s), the FAB reviews all the 

relevant evidence of impairment in the case record and determines which 

evidence is most probative. If the employee’s file contains multiple impairment 

evaluations, the FAB CE or HR reviews each report to determine which provides 

the most probative value given the totality of the evidence. Any analysis by a 

FAB CE or HR relating to a contested impairment rating must include a careful 

consideration of the weight of medical evidence. The mere presentation of new 

medical evidence does not serve as a singular basis to invalidate the weight of 

medical evidence as assigned in a RD. The FAB may not remand impairment 

solely on the basis of receipt of new evidence. 

c. Development. When evaluating objection or new evidence in response to a 

recommendation relating to impairment, the FAB CE or HR must undertake any 

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reasonable development to resolve disputes. This includes submitting medical 

evidence received after the issuance of a RD to a CMC to determine the effect, if 

any, it has on an assigned impairment rating. 

d. FD. The FD must contain sufficient narrative to describe whether the FAB CE or 

HR feels that the recommended findings comply with the procedural requirements 

of the DEEOIC for a valid impairment award and that the findings derive 

reasonably from the medical evidence of record. The FAB CE or HR must 

independently validate any calculations of impairment, including any applicable 

SWC coordination or tort offsets. 

16. Additional Filings for Increased Impairment Benefits. An employee previously awarded 

impairment benefits may file a claim for increased impairment benefits for the same covered 

illness included in the previous award. For such a claim, the claimant must file using Form EN10. When a claim for increased impairment is developed but the medical evidence establishes 

lower whole person impairment than previously determined, the CE denies the claim for 

increased impairment. The CE takes no action to reopen a prior impairment determination in 

these circumstances because a claim filed for increased impairment after the two-year waiting 

period is a new claim. 

a. Timeframe. The employee may not submit a Form EN-10 for an increased 

impairment rating earlier than two years from the date of the last FD on 

impairment, except for the following reasons. 

 

(1) New Covered Illness. The CE waives the two-year time period 

requirement if the CE adjudicates an additional impairment claim based 

upon new covered illness not included in the previous award. A new 

covered illness must involve a different disease, organ, body function, 

illness, or injury that was not the basis of the original impairment rating. 

(2) New Consequential Illness. The CE waives the two- year time period 

requirement if the consequential condition affects an organ or body 

function that was not previously evaluated for impairment. For example, 

the primary accepted condition is lung cancer. The FAB issued a FD one 

year ago to award a 50% impairment due to whole person impairment 

rating to the respiratory system. A consequential illness is accepted for 

stomach ulcers because of medication required to treat the cancer. The CE 

may immediately proceed with a new impairment assessment because the 

consequential illness affects an organ or body function (digestive) that was 

not included in the prior impairment assessment. 

However, if the consequential illness involves an organ or body function 

previously included in an impairment assessment, the two-year time 

period requirement is not waived. 

 

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establishes that the employee is terminal, the CE has the discretion to 

waive the two- year period requirement. 

(4) 0% Rating. If FAB issues a 0% impairment rating FD and subsequently it 

or the DO obtains a new impairment rating greater than 0%, the two-year 

wait period does not apply. The new evidence for increased impairment is 

to be reviewed and either a DD with authority to do so or the Director 

should consider reopening the FD with the 0% impairment. However, if 

the two-year wait period has elapsed between the 0% rating and a request 

for increased impairment, a reopening is not required since a CE can treat 

the request as a new claim. 

The two-year wait period still applies if the employee is denied an 

impairment award because there is no increase in the impairment rating. 

For example, the FD denied the impairment claim because the rating of 

15% did not increase from the previous FD. In this situation, the employee 

must comply with the two-year wait period from the last FD that denied 

the impairment claim because of no increase in rating. 

b. Untimely Requests for Re-evaluation. If the two-year date is within three months 

or less of the two-year mark, the CE may initiate development of the impairment 

claim. However, a RD cannot be issued until the two-year mark. In this 

circumstance, the CE informs the employee in writing that he/she is not eligible 

for an impairment decision until at least the two-year mark. The language can be 

included with the development letter or as a separate letter if all development is 

completed. 

If the employee submits an untimely request for re-evaluation more than three 

months prior to the two-year mark, the CE administratively closes the impairment 

claim. This two-year wait period applies even if the employee submits a new 

impairment report with a rating that is higher than the previous impairment award. 

The CE sends a letter to the employee explaining the administrative closure and 

the two-year wait requirement. The letter informs the employee to resubmit a new 

claim at or after the two-year mark. 

17. Issues Involving Survivor Election. If a covered Part E employee dies after submitting a 

Part E impairment claim, but before that claim is paid, and death is caused solely by a noncovered illness or illnesses, the survivor may elect to receive the compensation that would have 

been payable to the employee (known as election of benefits), including impairment (refer to 

Chapter 20 – Establishing Survivorship. The survivor must file a written confirmation that he or 

she is seeking an election of benefits. The claim filing date of the election of benefits for 

impairment is the postmark date of the written confirmation, if available, or the date the DO, 

FAB, CMR, or RC receives the written confirmation, whichever is the earliest determinable date. 

a. Instances Where Impairment is Not Available to a Survivor. In some cases, an 

impairment rating is not possible in accordance with the AMA’s Guides because 

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the necessary diagnostic or medical evidence is unavailable. If new information 

cannot be collected following the death of the employee, the CE advises the 

survivor of the deficiency in a letter. The CE should also advise the survivor that 

he/she may be eligible to receive compensation for wage-loss. If the CE is 

uncertain as to whether there is sufficient medical evidence to perform an 

impairment rating following the death of the employee, the CE can refer the case 

to a CMC for consideration. The CE notifies the claimant of any deficiency that 

prevents the CMC from opining on the employee’s impairment and allow for the 

submission of supportive evidence. If an impairment rating cannot be performed 

due to lack of sufficient medical evidence, the CE denies the impairment claim. 

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CHAPTER 22 – WAGE-LOSS DETERMINATIONS

1. Purpose and Scope. This chapter provides procedures for evaluating a wage-loss claim 

under Part E and describes relevant terminology and definitions related to wage-loss. In addition, 

the chapter provides guidance on how to evaluate wage and medical evidence to determine if 

wage-loss compensation can be awarded. The chapter also explains how compensable wage-loss 

is calculated. 

a. OIS. Anyone undertaking development action with regard to a claim for wageloss is to ensure that documents generated or received during the evaluation 

process are properly bronzed/scanned into the OIS. This guidance applies to any 

of the procedures described throughout this chapter. 

2. Policy. DEEOIC staff is responsible for processing wage-loss determinations and 

ensuring that benefits are appropriately paid. Wage-loss decisions issued by DEEOIC staff are to 

explain each finding relevant to the applicable wage-loss decision, along with a clear description 

of the calculations used to compute any possible wage-loss benefit. 

3. Definitions. 

a. Average Annual Wage (AAW) refers to four times the average quarterly wages 

for the twelve quarters that preceded the quarter during which the covered Part E 

employee first experienced wage-loss due to a covered illness that was caused by 

exposure to a toxic substance at a DOE facility or RECA section 5 facility, 

excluding any quarter during which the employee was unemployed (See 

subparagraph f below). The calculated AAW is the baseline wage against which 

the CE measures a subsequent calendar year wage earned by a covered Part E 

employee. 

b. A calendar year is defined as the twelve-month period from January through 

December. 

c. The Consumer Price Index (CPI) is a measure of the average change over time in 

the prices paid by urban consumers for a market basket of consumer goods and 

services. The CPI is the most widely used measure of inflation. The CPI is often 

used to adjust benefit payments (for example, Social Security and Federal 

Employees’ Compensation Act payments) and income eligibility levels for 

government assistance, and to automatically provide cost-of-living wage 

adjustments.

d. Normal Social Security Retirement Age is the age at which an employee receives 

unreduced Social Security retirement benefits. This age varies by date of birth 

and is set by §216(1) of the Social Security Act, 42 U.S.C. §416(1). 

In general, persons born during or before 1937 are eligible for unreduced Social 

Security retirement benefits at age 65. The eligibility age increases in two-month 

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increments for persons born between 1937 and 1960 until it reaches 67, which is 

the age at which persons born during or after 1960 become eligible for unreduced 

Social Security retirement benefits. (See Exhibit 22.1) 

e. A quarter is defined as the three-month period of January through April, April 

through June, July through September, or October through December. 

f. A quarter during which the employee was unemployed (for purposes of 

determining AAW) is a quarter during which $700 (in constant 2005 dollars) or 

less in wages were earned by the employee, unless the quarter is one where the 

employee was retired. If the CE determines that the adjusted value is $700 or less, 

then the employee is considered to have been unemployed during that quarter and 

it will not be included in the calculation of the AAW. 

g. A quarter during which the employee was employed (for purposes of determining 

AAW) is a quarter in which the adjusted value of the employee’s wages for the 

quarter exceeds $700 in constant 2005 dollar values. For example, $700.01 in 

adjusted value is considered to be a quarter of employment. A quarter in which 

the employee was employed will be included in the AAW calculation. 

h. A year of wage-loss is defined as a calendar year in which the employee’s wages 

were less than the employee’s AAW, as a result of the covered illness that is due 

to the employee’s exposure to a toxic substance at a covered facility. Prior to 

making this finding, the CE adjusts the yearly wages for inflation to determine 

their values during the calendar year in which the employee first experienced 

wage-loss due to a covered illness. 

4. General Requirements for Wage-Loss. There are some general requirements that a CE 

has to establish before a case can be accepted for wage-loss: 

a. Covered Part E Employee. The employee is, or was, an employee of a covered 

DOE contractor or subcontractor; and 

b. Covered Illness. The employee developed a covered illness as a result of 

exposure to a toxic substance at a covered DOE facility or RECA section 5 

facility; and

c. Trigger Month. A particular year and month (trigger month) that the employee 

first experienced wage-loss as a result of the covered illness prior to his or her 

normal Social Security retirement age; and 

d. Causal Relationship. Wage-loss in the trigger month was causally related to the 

employee’s covered illness; and

e. Wage-Loss: Wage-loss occurred due to the covered illness. Wage-loss 

determinations are based upon the calendar years of wage-loss occurring up to 

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and including either the calendar year the employee reaches normal Social 

Security retirement age or the last calendar year of wage-loss prior to the 

submission of the wage-loss claim, whichever occurs first. 

5. When Wage-Loss Is Not Covered: Wage-loss benefit is to be denied in the following 

circumstances: 

a. Employee is not a covered Part E employee: If the employee worked for an AWE 

or for a beryllium vendor (unless the employee was employed during a period in 

which the facility was designated as a DOE facility for remediation and the 

employee was employed by a remediation contractor)he/she is not considered a 

covered Part E employee and is not entitled to wage-loss benefits. 

b. Wage-loss is not due to a covered illness: For example, if the employee was not 

earning wages because of a Reduction-In-Force at his job before the trigger 

month, wage-loss cannot be awarded because the wage-loss was due to a 

Reduction-In-Force and not due to a covered illness. 

c. Employee experiences wage-loss (as a result of a covered illness) after his or her 

normal Social Security retirement age.

d. Employee’s death occurs less than ten years before his or her normal Social 

Security retirement age and does not experience any wage-loss prior to his or her 

death (for survivor claims).

e. Employee did not earn wages before the trigger month. For example, if the 

employee did not work and was not earning wages before the trigger month, 

wage-loss is to be denied because the employee did not earn wages prior to the 

trigger month to be able to establish a reduction in wages. 

6. How to File Initial Wage-Loss Claims. After a Part E FD is issued to a claimant with a 

positive causation determination, the CE sends Form EE-11B/EN-11B to solicit wage-loss 

claims from claimants who are potentially eligible for wage-loss benefits. 

a. Wage-Loss Letter and Response Form (Form EE-11B/EN-11B): Form EE-11B 

lists the criteria to establish wage-loss. The form includes an explanation 

regarding earnings records for the twelve quarters prior to the first quarter of 

claimed wage-loss and contains a solicitation for earning records. Form EE-11B 

includes a statement that earnings records will be requested from the SSA. 

However, since SSA no longer requires the claimant’s signature on Form SSA581 to submit earnings records, the CE is no longer required to include Form 

SSA-581 (See paragraph 10a) with Form EE-11B. Form EE-11B also includes a 

request for additional employment evidence that supports the claimed wage-loss, 

along with medical evidence supporting a causal relationship between the covered 

illness and the wage-loss claimed. The form contains an instruction for the 

claimant to submit Form EN-11B (Wage-Loss Benefits Response Form) if he/she 

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is claiming wage-loss, and to identify the condition(s) for which he/she is 

claiming wage-loss, and provide the date (trigger month and year) of claimed 

wage-loss. 

b. Timeframe: The CE is to allot 60 days for the claimant to respond to Form EE11B/EN-11B, with a follow up request sent to the claimant at the first 30-day 

interval. The CE uses Form EE-11B/EN-11B for the follow up request, but marks 

the form “Second Request.” The CE does not develop for wage-loss until a 

completed Form EN-11B is received.

(1) If the claimant does not respond to Form EE-11B/EN-11B within 60 days, 

the CE sends a final Form EE-11B/EN-11B marked as a “Final Request” 

to the claimant. After the CE sends the final request Form EE-11B/EN11B, the CE updates the ECS to indicate that the claimant is not claiming 

wage-loss. 

If at any time the claimant informs the CE that he/she does not want to 

pursue a claim for wage-loss, the CE sends a letter to the claimant 

advising that the DEEOIC will not undertake further development of the 

claim for wage-loss at this time. The CE also notifies the claimant of the 

right to claim wage-loss in the future (See Exhibit 22-2). 

c. If the claimant submits Form EN-11B claiming wage-loss, the CE updates ECS to 

reflect the wage-loss claim. The wage-loss claim date is the postmark date of the 

form, if available, or the date the DO, FAB, CMR, or RC receives the form, 

whichever is the earliest determinable date. 

7. How to File Subsequent Wage-Loss Claims. An employee who has been previously 

awarded compensation for wage-loss may file a Form EN-10 for subsequent calendar years of 

wage-loss. The employee may file a Form EN-10 on a yearly basis, or for an aggregate of 

calendar years in which wage-loss is alleged. With the filing of an EN-10, the claimant is to 

submit sufficient employment and medical evidence to establish that the claimant is entitled to 

additional wage-loss benefits. 

8. Development of Wage-Loss Claims. Upon receipt of a signed Form EN-11B or Form 

EN-10 claiming wage-loss or subsequent wage- loss, respectively, the CE determines if there is 

sufficient medical and earnings evidence to support a claim for wage-loss. If not, the CE sends a 

letter requesting the required evidence from the claimant. If there is no response within 30 days, 

the CE contacts the claimant by telephone to assist the claimant with obtaining the required 

evidence. The CE advises the claimant verbally of the need to obtain this evidence. The CE 

explains that if the required evidence is not submitted within 30 days, a RD to deny the wageloss claim may be issued. It is important that the CE record this discussion carefully in the 

phone calls section of ECS. After this phone call, the CE sends a written summary of the call to 

the claimant. 

If at the end of this total 60-day period no evidence exists to show progress in obtaining the 

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necessary wage-loss evidence and the claimant has not provided a valid reason for the delay (e.g. 

he/she was sick), the CE is to issue a RD to deny the wage-loss claim. 

9. Medical Evidence to Establish Wage-Loss. The claimant is required to submit medical 

evidence of sufficient probative value to establish that the period of wage-loss claimed is 

causally related to the employee’s covered illness. 

There are instances when the medical evidence shows multiple conditions contributing to the 

wage-loss. As long as the evidence establishes that a covered illness contributed to the 

employee’s wage-loss, then the medical evidence is sufficient to prove causal relationship. 

An acceptance of Social Security Disability benefits alone is not sufficient evidence to establish 

a causal relationship, unless accompanied by supporting medical evidence. 

If a secondary cancer is the accepted covered illness but the primary is not accepted(e.g., 

secondary bone cancer is accepted but the primary prostate cancer is not accepted), the medical 

evidence needs to support that the wage-loss is causally related to the secondary cancer, because 

the causation requirement has not been met for the primary cancer. 

The CE develops the case for a causal relationship between the claimed years of wage-loss and 

the employee’s covered illness by requesting medical evidence from the claimant and/or medical 

provider. Medical evidence can include the following: 

a. Narrative Report from a Physician. A physician’s narrative report is to contain an 

explanation about the causal relationship between the covered illness and the 

period(s) of wage-loss and reference medical evidence that is contemporaneous to 

the claimed period(s) of wage-loss. A narrative report that is speculative in 

nature, or is not well-rationalized is not considered to be of sufficient probative 

value. 

b. Return to Work Slips Signed by a Physician. The work slip is to indicate that the 

return to work was from a covered illness. 

c. Physician’s Office Notes. Physician notes are to indicate that the employee had 

stopped working, reduced his work hours or missed work due to the covered 

illness.

d. CMC Opinion. The CE is to use discretion when determining if a CMC referral is 

warranted. For example, a referral to a CMC is not warranted when there is 

insufficient wage evidence to prove wage-loss. Additionally, the CE does not 

refer a case file to a CMC if the claimant and/or treating physician have not been 

contacted first for the requisite medical information. 

The CE is to request the opinion of a CMC on causal relationship between the 

covered illness and wage-loss if the evidence is inconclusive. The CMC may also 

provide an opinion regarding the period of illness-related wage-loss. In most 

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instances, wage-loss questions are best handled by a CMC who specializes in 

occupational medicine. In the CMC referral, the CE specifies the period of wageloss in question and identifies the accepted covered illness. The CE instructs the 

CMC to provide a detailed rationale for his or her opinion. The CE submits both 

medical and employment evidence for CMC evaluation. 

Example of a wage-loss question to CMC: Please review the case records to 

determine if the employee’s wage-loss for the period from June 1975 to August 

1999 is causally related to the accepted illness of asbestosis. If the available 

medical evidence is insufficient to make a wage-loss determination for a certain 

period, indicate the dates. Provide your rationale to support your conclusion. 

10. Wage Evidence to Establish Wage-Loss. Wages are defined as all monetary payments 

that the employee earns from employment or services that are taxed as income by the Internal 

Revenue Service. Salaries, overtime compensation, sick leave, vacation leave, tips, buyouts and 

bonuses received for employment services are considered wages. However, capital gains, IRA 

distributions, pensions, annuities, unemployment compensation, state workers’ compensation 

benefits, medical retirement benefits, and Social Security benefits are not considered wages. 

The CE obtains evidence of the employee’s wages for the calendar year(s) during the claimed 

period(s) of wage-loss and for the twelve quarters immediately preceding the first quarter of 

claimed wage-loss. These twelve quarters of wages immediately preceding the first quarter of 

claimed wage-loss are used to determine the AAW. (See paragraph 12) 

 

The CE generally relies upon the earnings information that has been reported to the SSA, but can 

also rely upon additional wage information submitted by the claimant. 

 

a. SSA earnings records are received from the claimant if available or the CE 

digitally faxes a completed Form SSA-581 to SSA to obtain this information. The 

form is located on the shared drive in the Forms folder under Policies and 

Procedures). The process to obtain earnings records using Form SSA-581 is as 

follows: 

 

(1) The CE is to complete the top portion of the Number Holder’s Information 

section on the SSA-581. This includes the following information: name; 

social security number; date of birth of employee; date of death of 

employee (if applicable); and other name(s) used. The CE completes the 

form with the years deemed necessary to verify employment and/or 

establish wage-loss on the “Periods Requested” line. In the box entitled, 

“Requesting Organization’s Information,” the CE types his or her name 

and identifies the DO under, “Signature of Organization Official.” The CE 

dates the form and lists his or her direct phone number, along with the DO

fax number. The CE is to capitalize all entries on the SSA-581. 

 

(2) The completed SSA-581 must be digitally faxed to SSA using fax number 

877-278-7067. A cover letter is not required, nor is it necessary to fax the 

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second page of the SSA-581 that contains the Privacy Act Statement. The 

CE is responsible for bronzing into OIS the completed SSA-581 and fax 

receipt. 

(3) If the faxed SSA-581 is deficient, the SSA contacts the CE directly to 

explain the deficiency, or the SSA emails the DEEOIC designated POC

with a list of rejected SSA-581s for each DO. This email will include the 

name of the employee, the employee’s social security number, SSA 

reference number, and the reason(s) for the rejected SSA-581. 

(4) The POC forwards the email of a rejected SSA-581 to the assigned CE. 

After making the necessary corrections, the CE digitally faxes the 

corrected SSA-581 with a cover sheet (Exhibit 22-3) to FAX number 410-

966-4210. The cover sheet must include the SSA reference number. The 

CE is responsible for bronzing into OIS any document received or created 

in response to a rejected SSA-581. 

(5) Upon receipt and processing of a SSA-581, the SSA releases a statement 

of earnings, known as an SSA-L460. The SSA will mail the SSA-L460 to 

the DEEOIC CMR, located in London, Kentucky, where it is scanned and 

indexed into OIS. 

(6) If the CE does not receive a completed SSA-L460 within thirty (30) days 

of the faxed SSA-581, the CE calls the SSA to determine the status of the 

request. If the SSA indicates that the SSA-581 has not been received, the 

CE must refax the SSA-581 in accordance with Step 4. After the SSA-581 

is refaxed, the CE must follow-up with the SSA within 30 days. 

Otherwise, the CE obtains the status and monitors for SSA response. 

(7) Inquiries to the SSA are made by calling one of six phone numbers 

(Modules) depending upon the last four digits of the relevant Social 

Security number (See Exhibit 22-4). When calling the SSA, the following 

information should be available to expedite the inquiry: 

(a) SSA-issued job code (8015). The four-digit job code appears in 

the “Requesting organization” section of the SSA-581 form. 

(b) Name of your organization. 

(c) A copy of the SSA-581 or earnings statement in question. 

(d) The full SSN of the number holder (employee), or the control 

number from the earnings statement. 

 

(8) Upon receipt of a completed SSA-L460, the CE documents receipt of the 

SSA response in ECS. Should the SSA fail to submit an SSA-L460 after 

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following up within the established procedures, the CE is to proceed with 

claim adjudication based upon the evidence contained in the case record or 

request other forms of wage information as noted below: 

b. Tax Returns and W2 Forms provide proof of the employee’s wages in instances 

where the employer did not report accurate and/or complete earnings to SSA, 

when the employee worked for an employer where there was no reporting of 

income to SSA, or where SSA earnings records indicates that the employee 

earned more than the maximum amount of taxable earnings (see paragraph 12c). 

If a W2 Form is submitted, the claimant is to submit an affidavit attesting that he 

or she has submitted all W2 Forms for that calendar year; 

c. Pay Stubs that provide proof of the employee’s wages; 

 d. Union records that provide proof of the employee’s wages; 

 

e. Pension records that provide proof of the employee’s wages; and 

f. DAR for Pay and Salary Records that provide an employee’s pay, salary, any 

workers’ compensation claim or other documents affecting wage. Examples of 

records from the DOE database include, but are not limited to, Official Personnel 

Files of Contractor Employees, Contractor Job Classification, Employee Awards 

Files, Notification of Personnel Actions, Classification Appraisals, Wage Survey 

Files, and Unemployment Compensation Records. 

11. Wage-Loss Calculator. The Wage-Loss Calculator in ECS is used to calculate wage-loss 

benefits. The CE enters the employee’s wages for all claimed years of wage-loss and the twelve

quarters immediately prior to the first quarter of experienced wage-loss into the Wage-Loss 

Calculator. The Wage-Loss Calculator calculates the AAW, determines the wage-loss percentage 

and calculates the wage-loss award. 

12. Calculation of AAW. The AAW is the baseline wage against which the Wage-Loss 

Calculator measures each claimed year of wage-loss to determine the wage-loss percentage. To 

determine the AAW, the Wage-Loss Calculator adds the wages from the quarters (up to twelve 

quarters) immediately prior to, but not including, the quarter where the employee first 

experiences wage-loss due to a covered illness. The sum of the total wages is divided by the 

number of quarters included in the sum to get the average quarterly wage. The Wage-Loss 

Calculator then multiplies the average quarterly wage by four to determine the AAW. 

The Wage-Loss Calculator will identify any quarter in which the employee earned $700 or less 

in constant 2005 dollars. The Wage-Loss Calculator determines the dollar value of any wages for 

any given year to reflect their value (buying power/worth) to 2005 dollar by using the CPI 

Inflation Calculator on the Bureau of Labor Statistics’ website 

http://www.bls.gov/data/inflation_calculator.htm. 

Example: If the CE enters that the employee earned $100 in a quarter of employment in 1963, 

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the Wage-Loss Calculator, using the CPI Inflation Calculator, determines that $100 in 1963 has 

the same adjusted value as $638.24 in 2005 dollars. Since the adjusted value of $638.24 is less 

than $700 in constant 2005 dollars, the Wage-Loss Calculator identifies this quarter for further 

review by the CE. The CE must identify the quarter as either unemployed or retired depending 

on the employee status for that quarter. 

a. Unemployed: If the CE considers the employee to have been unemployed for a 

particular quarter that quarter is excluded in the calculation of the AAW. 

Example: If an employee is unemployed for three quarters during the AAW 

period; the Wage-Loss Calculator adds the wages from the nine quarters of 

employment (excluding the wages from the three quarters of unemployment) and 

divides by nine rather than twelve to get the average quarterly wages. The WageLoss Calculator then multiplies the average quarterly wages by four to obtain the 

AAW. 

It should be noted that a wage-loss claim is denied if the employee did not earn 

any wages before the trigger month. To establish a claim for wage-loss, the 

employee first had to earn wages before the trigger month. 

b. Retired. If an employee is retired prior to his or her normal Social Security 

retirement age due to his covered condition, he/she is not considered unemployed 

under Part E. Even though the retired employee has no wages reported to SSA or 

the wages are less than $700 in constant 2005 dollars, this time period is not 

excluded from the calculation of the AAW. 

Example: If the CE determines that the employee was retired (prior to his or her 

normal Social Security retirement age), during the entire twelve quarters 

immediately preceding the quarter during which he or she first experienced 

wage-loss due to a covered illness, the AAW is $0. 

If the employee earned wages during any of the twelve quarters and then retired 

before the of the twelve quarters, those earned wages are included in the AAW 

calculation. 

Example: If the Wage-Loss Calculator identified two quarters as quarters with 

earnings less than $700 in constant 2005 dollars and the CE identified these two 

quarters were due to retirement, the Wage-Loss Calculator adds the wages for the 

twelve quarters including the two quarters of retirement and divides the sum by 

twelve to get the average quarterly wages. The CE then multiplies the average 

quarterly wages by four to obtain the AAW. 

c. Maximum Amount of Taxable Earnings. If the employee’s earnings meet SSA’s 

maximum amount of taxable earnings for that year, those earnings that exceed the 

maximum limit are not reflected in the SSA statement. The CE is to find the 

maximum amount of taxable earnings under the SSA for a specific year at the 

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SSA website: http://www.ssa.gov/OACT/COLA/cbb.html. 

(1) Multiple Employers. For any year in which the employee is employed by 

multiple employers, according to SSA, each of the employers withholds 

Social Security taxes on the wages without regard to what the other 

employers may have withheld. Therefore, the employee can potentially 

meet the maximum amount of taxable earnings under SSA from each 

employer for the same year in question. 

To determine if any additional wages have been unaccounted for in the 

SSA earnings summary, the CE contacts the claimant by telephone and 

requests evidence to support additional wages (see paragraph 10 for 

different types of wage evidence). The CE memorializes the claimant’s 

response in ECS. The CE follows up with a letter notifying the claimant 

of the earnings information included in the SSA earnings summary for the 

applicable year(s). In the letter, the CE requests that the claimant submit 

evidence of wages that may have been unaccounted for as a result of 

reaching the maximum amount of taxable earnings under the SSA. If the 

claimant does not submit additional evidence within 30 days of the letter, 

the CE is to proceed with claim adjudication based upon the evidence 

contained in the case record. 

d. Additional Wages. If there is evidence of wages based on records other than SSA, 

the CE adds any additional wages earned by the employee during those same 

quarters as supported by the submitted evidence. 

e. Annual SSA Earnings Report. In the late 1970’s, SSA began reporting yearly 

earnings summary instead of quarterly earnings summary. In instances when only 

a detailed SSA yearly earnings summary is available, the CE divides the yearly 

earnings by four (representing four quarters in a year) to estimate the quarterly 

earnings for each year. 

13. Determination of Wage-Loss Percentage. The Wage-Loss Calculator compares the 

AAW of an employee with his or her adjusted (for inflation) wages in later calendar years to 

determine the wage-loss percentage. The Wage-Loss Calculator begins with the calendar year 

that includes the quarter in which the claimed wage-loss commenced, and concludes with the last 

calendar year of claimed wage-loss, the calendar year in which the employee reached normal 

Social Security retirement age or the calendar year in which the employee would have reached 

his normal Social Security retirement age but for his covered illness-related death. 

a. Adjustment of Wages for Inflation. Wages are adjusted for inflation for each 

calendar year that wage-loss is claimed. The wages are adjusted for inflation to 

reflect the value (buy power/worth) during the calendar year in which the 

employee first experienced wage-loss due to a covered illness. The Wage-Loss 

Calculator performs this calculation by using the CPI Inflation Calculator.

Example: The employee claims wage-loss first commencing in 1993 and ending 

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in 2002 when the employee reaches normal Social Security retirement age. The 

Wage-Loss Calculator adjusts the yearly wages for inflation to reflect the value of 

the wages for the calendar year in which the wage-loss first commenced (which in 

this example is 1993). If the employee earned $38,000 in 1995, this wage is 

adjusted for inflation using the CPI Inflation Calculator to $36,030.18 to reflect 

the value in 1993 dollars. 

b. Comparison with the AAW. The Wage-Loss Calculator compares the AAW of 

the employee with his or her adjusted wages in later calendar years to ascertain 

the wage-loss percentage for each claimed year of wage-loss. For example, 

$36,030.18 (Adjusted Wage) ÷ $46,000 (AAW) = 78% (Wage-Loss Percentage). 

14. Employee Wage-Loss Compensation. The Wage-Loss Calculator uses the wage-loss 

percentage to determine the amount of the employee’s wage-loss compensation. 

a. If the employee’s adjusted wages during a claimed calendar year is greater than 

75% (X > 75%) of the AAW, then the employee is not considered to have wageloss for that calendar year and the employee is not awarded wage-loss benefits for 

that calendar year. 

 Example #1: AAW = $46,000.00 

 Adjusted wages = $36,030.18 

 Percentage of AAW = 78% 

b. $10,000 is awarded for each year in which the employee’s adjusted wages during 

a claimed calendar year is greater than 50% but less than or equal to 75% (50% < 

X < 75%) of the AAW.

Example #1: AAW = $46,000.00 

Adjusted wages = $34,662.00 

 Percentage of AAW = 75% 

Example #2: AAW = $46,000.00 

 Adjusted wages = $23,661.80 

 Percentage of AAW = 51% 

c. $15,000 is awarded for each year in which the employee’s adjusted wages during 

a claimed calendar year is equal to or less than 50% (X ≤ 50%) of the AAW. 

Example #1: AAW = $46,000.00 

Adjusted wages = $23,076.00 

 Percentage of AAW = 50% 

Example #2: AAW = $46,000.00 

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 Adjusted wages = $11,646.75 

 Percentage of AAW = 25% 

The following is an example of a Wage-Loss Calculation: 

AVERAGE ANNUAL WAGE: $46,000.00

Year Reported Earnings Adjusted Earnings Percentage Compensation

1993 $44,000.00 $44,000.00 96% $0

1994 $40,000.00 $39,001.30 85% $0

1995 $38,000.00 $36,030.20 78% $0

1996 $35,000.00 $32,233.90 70% $10,000.00

1997 $38,500.00 $34,662.00 75% $10,000.00

1998 $30,000.00 $26,595.10 58% $10,000.00

1999 $26,000.00 $22,551.00 49% $15,000.00

2000 $27,500.00 $23,076.00 50% $15,000.00

2001 $29,000.00 $23,661.80 51% $10,000.00

2002 $14,500.00 $11,646.75 25% $15,000.00

Wage-Loss Payable Compensation $85,000.00

15. Survivor Wage-Loss Compensation. The CE first determines whether the survivor is 

entitled to benefits under Part E of the EEOICPA. If the survivor is found to be entitled to 

survivor benefits, he/she may also be entitled to additional compensation for wages lost by the 

employee as a result of the covered illness. The CE undertakes the same medical and 

employment development and AAW calculation as if the employee had filed a claim. The 

difference is that the monetary benefit provided to a survivor is limited to an additional $25,000 

or $50,000 based on the number of years in which the employee’s adjusted wages during a 

claimed calendar year is equal to or less than 50% (X ≤ 50%) of his or her AAW.

a. Percentage of Loss: If the employee dies as a result of the covered illness prior to 

his or her normal Social Security retirement age, the Wage-Loss Calculator 

performs the same inflation adjustment calculation as an employee claim for each 

calendar year of wage-loss claimed through and including the calendar year of 

death to determine the percentage of loss. 

For the years after the employee’s death, the Wage-Loss Calculator assumes that 

the employee had no wages and therefore the adjusted wages were less than or 

equal to 50% of the AAW for each year after the year of the employee’s death up 

to and including the calendar year of his or her normal Social Security retirement 

age. 

In some instances, the employee may have lost wages due to a covered illness 

prior to his or her death. In this situation, the CE ensures that the Wage-Loss 

Calculator includes the period of wage-loss (prior to and including the calendar 

year of the employee’s death) and adds any calendar years in which adjusted 

wages were less than or equal to 50% of the employee’s AAW to the number of 

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calendar years after the year of the employee’s death up to and including the 

calendar year of his or her normal Social Security retirement age (based on the 

assumption that the employee did not earn any wages after his or her death) in 

order to determine the survivor’s entitlement.

(1) $25,000.00 Award. For the survivor to be awarded an additional 

 $25,000.00, the employee must have 10 to 19 years in which the 

employee’s adjusted wage is equal to or less than 50% (X ≤ 50%) of his or 

her AAW. 

(2) $50,000.00 Award. For the survivor to be awarded an additional 

$50,000.00, the employee must have 20 or more years in which the 

employee’s adjusted wage is equal to or less than 50% of his or her AAW. 

b. Survivor Election. If an employee dies after filing a claim, but before any 

payment is received, and if the employee’s death was caused solely by a noncovered illness, the survivor (any survivor including the spouse) has the election 

of benefits option. The survivor may elect to receive compensation that the 

employee would have received had he/she not died prior to payment. It is not 

necessary for the employee to have filed a claim specifically for wage-loss or 

impairment to have the election of benefit option available. As long as the 

employee filed a claim for Part E benefits, claims for impairment and wage-loss 

are assumed. However, if the employee received any compensation for 

impairment or wage-loss, prior to his death, such payment voids the election of 

benefit option. 

16. Maximum Aggregate Compensation. The amount of monetary compensation provided 

under Part E (impairment and wage-loss compensation), excluding medical benefits, cannot 

exceed $250,000.00. The CE considers any previous compensation awarded under Part E for 

impairment and/or wage-loss to determine if a subsequent award needs to be reduced to ensure 

that it does not exceed the $250,000.00 maximum aggregate compensation. In determining the 

aggregate compensation, reduction of compensation based on state workers’ compensation 

coordination or tort offset is not taken into consideration. For example, if the employee was 

previously awarded benefits for impairment in the amount of $100,000.00 but his compensation 

was reduced because of tort offset to $60,000.00, the amount of compensation used to determine 

the maximum aggregate compensation is $100,000.00. 

17. RDs and FDs. The CE first determines if the employee contracted a covered illness due 

to exposure to a toxic substance at a DOE facility or RECA section 5 facility prior to making a 

determination on wage-loss. The CE can develop for the wage-loss simultaneously with the 

development of other aspects of the case, but this development should not delay the issuance of a 

RD to award medical or impairment benefits. If a Part E claimant files a Form EE-11B or Form 

EN-10 claiming wage-loss or subsequent wage-loss, the CE develops the wage-loss claim and 

the CE issues a RD for potential wage-loss benefits. If the claimant formally files a claim for 

wage-loss and then subsequently submits a signed written request to withdraw the wage-loss 

claim, a RD on wage-loss benefits is not required. 

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In a RD to accept wage-loss benefits, the CE is to include a narrative explanation of all the 

relevant findings. The RD is to include an explanation of the trigger month and how it was 

determined, the causal relationship between the covered illness and wage-loss and how it was 

established, the AAW (including all figures used), the retirement age and the calendar year in 

which the employee would reach that age and its significance in wage-loss calculation. Prior to 

the issuance of a RD to award wage-loss benefits, the calculations performed by the Wage-Loss 

Calculator must be bronzed in OIS. The CE is to clearly explain all the figures used in the WageLoss Calculator and how the wage-loss award was calculated so that a claimant may request a 

hearing if he/she disagrees with the figures. 

In a RD denying wage-loss benefits, the CE is to explain which specific requirement(s) was not 

established to justify the wage-loss denial. 

For finalizing a wage-loss RD, the FAB Representative independently evaluates the CE findings 

and wage-loss calculations for accuracy. The FAB Representative ensures that a copy of the DO 

calculations is in OIS. Printouts of the calculation performed by the FAB Representative are also 

bronzed in OIS. If the FAB Representative cannot determine the basis for a wage-loss decision, 

the case file is remanded.

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CHAPTER 23 – CONSEQUENTIAL CONDITIONS

1. Purpose and Scope. This chapter discusses the CE’s role when developing claims for 

consequential conditions. It also discusses the types of injuries, illnesses, impairments, or 

diseases that may be considered as consequential conditions.

a. OIS. Anyone undertaking development action with regard to a claim for 

consequential conditions is to ensure that documents generated or received during 

the evaluation process for consequential conditions are properly bronzed/scanned 

into the OIS. This guidance applies to any of the procedures described throughout 

this chapter.

2. Defining a Consequential Condition. 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 CE is to accept 

as compensable any claimed consequential condition(s) that is documented properly by 

substantive, well-rationalized medical evidence. 

Consequential conditions can arise for any reason established as being medically linked to a 

previously accepted work-related illness. In some instances, a “chain of causation” can result in a 

series of injuries, illnesses, impairments, or diseases, which are a direct consequence of an 

accepted work-related illness. When medical evidence is present to establish such a scenario, the 

resulting consequential condition(s) in the causal chain are all compensable under the EEOICPA. 

The acceptance of a consequential condition(s) results in medical coverage for that condition(s) 

under Part B and/or Part E as appropriate. Additionally, under Part E, any diagnosed illness, 

injury, impairment, or disease shown by medical evidence to be a consequence of a covered Part 

E condition may affect the calculation of an impairment rating and/or wage-loss. 

3. Claims for Consequential Conditions. The claimant must file a claim for all 

consequential condition(s) in writing and may use any method of written notification. However, 

while documents containing written words of claim for a consequential condition(s) are 

acceptable to begin the adjudication process, the CE is to obtain a completed and signed Form 

EE-1/2 associated with the consequential claim before issuing a decision. A signed claim form is 

also required for all metastatic cancers. Ideally, the claimant should concurrently send a written 

statement identifying the specific nature of the consequential condition claimed, along with a 

signed EE-1/2. A signed EE-1/2 is required because it provides notice to the claimant of his or 

her responsibilities in filing for benefits under the Act. 

a. For each distinct medical condition claimed as a consequence of a previously 

accepted condition, the CE undertakes a careful examination of the evidence 

presented in support of the claim. If the evidence demonstrates the existence of a 

diagnosed consequential illness and the CE decides that the medical justification 

is sufficient to link reasonably the condition to a previously accepted condition, 

he or she proceeds with issuing a letter decision of acceptance (refer to 10a on 

acceptances). In those claims situations where insufficient evidence exists, after 

development, to establish a consequential claim, the CE issues a RD of denial. 

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There may be instances where a claimant files words of claim or an EE-1/2 for a 

condition but it is not clear whether the claimant’s intent was to file the condition 

as resulting from toxic substance exposure or as a consequential condition. In 

most cases, the condition will be processed as a primary diagnosed condition 

resulting from toxic substance exposure. However, if the medical or factual 

information provided with the words of claim or the EE-1/2 alludes to the fact that 

the condition may be a consequence of a previously approved condition, the CE is 

to contact the claimant to obtain clarification on whether he or she wants the 

claim to be processed as a primary condition or as a consequential condition. 

Once the CE obtains clarification, he or she documents the claimant’s intent in 

ECS and begins appropriate development for that condition. 

In those cases where only words of claim was filed, the CE requests that the 

claimant submit a completed and signed EE-1/2 clearly indicating that the 

condition is consequential, prior to issuing any decision. (Note: if a completed and 

signed EE-1/2 was already submitted and the CE just needed to seek clarification 

of the claimant’s intent, a new updated EE-1/2 is not needed). 

(1) For any consequential condition(s) where the CE has requested a 

completed and signed Form EE-1/2, the CE allows a period of 30 days for 

the claimant to submit the required documentation. After 30 days, the CE 

administratively closes the claim if the claimant has not submitted a 

signed EE-1/2 claim form. The CE is to mail a notice to the claimant(s) 

that no further action will occur on the claim for that medical condition 

until receipt of a completed and signed claim form. 

b. In some situations, the CE may find evidence contained in a case record that 

suggests that an unclaimed medical condition is consequential to an accepted 

condition. If there is sufficient reason to discern that the evidence of record 

communicates the existence of a likely consequential condition, the CE is to 

contact the claimant to ascertain whether he or she wants to claim that condition 

as consequential to a previously accepted illness. If the claimant states that he or 

she wants to file a claim for that condition, the CE instructs the claimant to submit 

a completed and signed EE-1/2 form. The mere fact that the CE identifies an 

unclaimed condition in the medical evidence is not sufficient reason to seek a new 

claim. Evidence has to be present in the case record to lead the CE to a reasonable 

conclusion that the condition is consequential to an approved primary condition. 

c. Where a claimant previously filed Form EE-1/2 for a condition due to toxic 

substance exposure that was denied, but later claims that the denied condition is 

consequential to an accepted condition, the claimant is to file a new Form EE-1/2 

claiming the condition as a consequential illness. In this scenario, the CE treats it 

as new claim filed under the EEOICPA. As this is a new claim filed under the 

EEOICPA, a Director’s Order vacating the prior denial of the same condition 

based on toxic substance exposure is unnecessary. 

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4. Claim Development. When assessing a claim for a consequential condition, medical 

evidence is required to document clearly the relationship that creates the nexus between a 

consequential condition and an accepted work related illness. The medical documentation is to 

contain information identifying the diagnosis of the consequential condition. In addition, the 

medical evidence is to include a physician’s opinion that presents a convincing and wellrationalized conclusion linking the consequential condition to a previously accepted illness. The 

opinion of the physician regarding a consequential condition is to be sufficiently probative and 

compelling to allow the CE to assign the weight of medical evidence to the conclusion offered. 

Physicians offering vague, equivocal, speculative positions on the relationship between a 

consequential condition and a work-related illness require additional investigation by the CE. 

Additional development is also required when a physician offers opinions that the CE considers 

to be unsupported by any reasonable medical justification. 

a. Exhibit 23-1 provides a sample listing of secondary medical conditions that are 

known to result from CBD (and treatment), silicosis, prednisone treatment, and 

other conditions. This list is not all-inclusive but serves as a guide for identifying 

some commonly known consequential illnesses. While Exhibit 23-1 serves as a 

guide and lists potential secondary illnesses, the CE is to exercise discretion when 

developing for these conditions. The fact that a condition appears as “secondary” 

in this appendix in no way establishes that the condition truly resulted from the 

claimant’s approved underlying condition. The CE is to ensure that the claimant 

submits sufficient medical evidence to substantiate the relationship between the 

underlying condition and the claimed consequential condition. 

5. Metastasized Cancer(s). Metastasized cancer(s) is a type of cancer that originates from a 

primary cancer site but spreads or invades other organ systems. Metastatic cancer has the same 

name and the same type of cancer cells as the original, or primary, cancer (under a microscope 

metastatic cancer cells generally look the same as cells of the original cancer). For example, 

breast cancer that spreads to the lung and forms a tumor is metastatic breast cancer, not lung 

cancer. In many situations, there will be evidence in the form of pathology or other diagnostic 

evidence that identifies a cancer as “metastatic” or “secondary” to a primary cancer type. A CE 

may accept a claimed metastatic cancer as a consequential condition if the diagnostic or other 

medical evidence is sufficiently descriptive to identify it as being caused by another primary 

cancer accepted as work-related. If the evidence is unclear or does not establish a relationship 

between the cancers, the CE undertakes additional development to include collecting the opinion 

of a treating physician or an assessment of the record by a CMC. 

a. The evidence relating to a metastatic cancer is to include the following:

(1) The diagnosis of each secondary cancer; and 

(2) The date of diagnosis for each secondary cancer(s).

If the medical evidence is inconclusive and the CE is unable to determine if the 

cancer is a metastasis, the CE seeks clarification from the treating physician 

and/or a CMC. 

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b. Examples of Metastasized Cancers. It is widely accepted that certain carcinomas 

and/or sarcomas metastasize from a primary site. For example:

(1) Carcinomas of the lung, breast, kidney, thyroid, and prostate tend to 

metastasize to the lungs, bone, and brain. 

(2) Carcinomas of the gastrointestinal tract, reproductive system, and 

abdomen tend to metastasize to the abdominal lymph nodes, liver, and 

lungs. Later in their course, these carcinomas can metastasize to the brain 

and other organs. 

(3) Sarcomas often first metastasize to the lungs and brain.

(4) Primary malignant tumors of the brain seldom metastasize to other organs, 

 but they can spread to the spinal cord. 

6. Conditions Resulting from Medical Treatment. Consequential conditions can arise from 

treatment modalities imposed on an employee because of an accepted work-related illness. This 

can include any injury, illness, impairment or disease arising from any form of medical 

treatment, including effects from prescription medication. 

a. Consequential Conditions Resulting from Medical Treatment for Accepted 

Conditions. As part of a patient’s medical treatment or protocol, a patient may 

undergo treatment and/or other drug therapy that will produce side effects that can 

be considered as common consequential conditions. 

Examples of such conditions are: 

(1) Radiation pneumonitis as a result of radiation treatment;

(2) Skin rashes and radiation burns because of radiation treatment; 

(3) Osteoporosis (which causes weakening of the bones and injuries such as 

 spontaneous hip fractures) as a result of steroid treatment.

b. Developing evidence for conditions resulting from medical treatment. When the 

CE receives a claim for a consequential condition caused by medical treatment of 

the accepted condition (also known as iatrogenic), the CE investigates the 

submitted documentation to ensure that the medical evidence supports the claim. 

(1) Medical evidence is to identify the medical diagnosis of an illness or 

injury that is due to the treatment of an accepted work-related illness. 

(2) A physician opinion or narrative is to be present that discusses the causal 

relationship between the consequential condition and a treatment modality 

made necessary because of the accepted condition. The physician’s 

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opinion should present a reasonable chronology of the onset of a 

consequential condition following a treatment regimen. In addition, the 

physician is to offer a well-rationalized position on the relationship that 

exists between a newly diagnosed problem and the treatment of an 

accepted illness. Vague, speculative or unsubstantiated positions taken by 

a physician require additional development including a review of the 

situation by a CMC, if necessary. 

7. Independent Intervening Causes. Consequential conditions can arise from an injury 

arising from an action or event that is reasonably linked to the accepted work-related illness. An 

example would be an injury sustained by the claimant as a result of a slip and fall on his or her 

way to or from a medical appointment for the accepted work-related illness. Other examples 

include injuries to the claimant resulting from accidents involving wheelchairs or scooters, 

improper DME use, medical transport, etc. When assessing claims of this sort, the CE is to 

collect documentation that describes the circumstances of the injury, along with the medical 

evidence that diagnoses a medical condition linked to the event. 

a. The CE is to obtain a signed written statement from the claimant that describes 

the circumstances of the event that resulted in an injury. For example, “I tripped 

down the stairs when exiting the doctor’s office and broke my arm.” The 

claimant’s statement is to be sufficiently descriptive to explain the circumstances 

of the event or accident, along with an explanation as to how it is linked to the 

accepted work-related illness. 

b. A physician opinion or narrative is to be present that discusses the causal 

relationship between the event or accident that is somehow linked to the accepted 

work-related illness and the onset of a new diagnosed medical condition. The 

physician is to explain the sequence of events that led to the consequential 

condition, along with his or her explanation as to how the event or accident is 

related to the accepted work-related illness. If the physician is unable to provide a 

rational explanation, or there are other contradictions in the evidence that lead the 

CE to question the sufficiency of the claim, additional development should occur, 

including a review of the situation by a CMC. In situations where the claimant 

sustains an injury on his or her way to a medical appointment, it may be necessary 

to confirm the date, time and location of the appointment to assist with 

determining that the claimant was in fact on his or her way to an appointment 

related to the accepted condition. 

(1) An independent intervening incident caused by, or attributed to, the 

employee’s own conduct. Injuries, illnesses, impairments or diseases 

suffered as a result of the employee’s own actions will not be accepted as 

consequential conditions. For example, if an employee is involved in an 

automobile accident on his or her way to a doctor’s appointment for 

treatment of an accepted condition, but it is determined through medical 

evidence/police report that the claimant was under the influence of drugs

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or alcohol at the time of the accident, then the results of the accident could 

not be considered as a consequential illness or injury. 

8. Pre-existing Conditions. Pre-existing conditions are conditions that pre-exist the 

diagnosis date of an accepted work-related condition. If medical evidence supports that the preexisting condition became aggravated or worsened by the accepted condition, it is considered a 

consequential condition. To accept a claimed pre-existing condition as a consequential illness, a 

medical report is required that includes the diagnosis of the pre-existing condition and a wellrationalized explanation of how the condition was worsened or aggravated by the accepted 

condition. The medical evidence has to support an increase in the symptoms or disability that 

would not have otherwise occurred, or treatment that would not have been necessary, but for the 

accepted condition. An example of a pre-existing condition affected by a covered condition 

includes COPD that aggravates a pre-existing heart disease such as Coronary Artery Disease. 

The “Eligibility Begin” date is the filing date of the underlying accepted condition.

9. Psychological Conditions. Psychological conditions can arise as a consequence of the 

accepted illness and/or treatment of that condition. They can also arise with no physiological 

basis. Depression, anxiety, and/or chemical imbalance are a few examples of psychological 

conditions that may have no physiological basis. In addition to a specific diagnosis, these 

conditions may be described as “psychogenic pain disorder,” “conversion disorder,” or 

“psychological syndrome.” However described, the symptom or pain is quite real to the 

individual involved although there is no demonstrable physical disorder. 

To accept a claimed psychological condition, the claimant must provide diagnostic evidence and 

a well-rationalized medical opinion from a qualified physician supporting a causal connection 

between the psychological condition and the covered condition. A qualified physician must be a 

clinical psychologist or psychiatrist. In situations where clarification on the causal relationship 

between the psychological condition and an accepted condition cannot be obtained from a 

qualified physician, the CE forwards the claimant’s case file to a CMC or refers the claimant to a 

qualified second opinion physician for evaluation and opinion concerning causal relationship. 

A CE may authorize social worker services for the treatment of a consequential psychological 

condition when prescribed under the supervision of a qualified physician. However, the 

physician is to specify the justification for such services, along with the submission of a narrative 

report that describes the plan of care with regard to the extent and duration of social services. 

10. Accepting or Denying the Consequential Condition. The CE is responsible for taking the 

appropriate steps in developing any claimed consequential condition. This includes notifying the 

claimant of any deficiencies in the evidence and allowing him or her the opportunity to respond 

and submit additional evidence. 

a. Acceptances. If the consequential condition is going to be accepted, the CE 

accepts the consequential condition under Parts B and E, if the primary 

underlying condition is also accepted under both Parts. The CE notifies the 

claimant in a letter decision. All letter decisions should contain two signature 

blocks; one for the CE who drafted the letter, and one for his or her supervisor (or 

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another management official designated by the DD), who will certify the 

sufficiency of the decisional outcome. Exhibit 23-2 provides a sample decision 

letter for approvals of consequential conditions. 

The CE should be aware that once he or she accepts a consequential condition by 

letter decision, any pending claim for that same condition being affiliated with a 

toxic substance exposure can be administratively closed. For example, when a 

letter accepting glaucoma as a consequential condition occurs, there is no need to 

then issue a recommended accept/deny for glaucoma based on toxic substance 

exposure. The “Eligibility Begin” date for consequential conditions is the filing 

date of the underlying accepted condition. 

b. Denials. If the CE has determined that insufficient medical evidence exists to 

accept a claim for consequential condition, and the CE provided the claimant the 

opportunity to submit supportive evidence, he or she issues a RD specifically 

denying the claim for a consequential illness. The CE does not issue a letter 

decision denying a consequential condition. A RD issued to deny a consequential 

condition must contain a clear explanation to the claimant of the deficiencies in 

the medical evidence, including any interpretation of medical opinion from a 

physician, which is not considered sufficiently well-rationalized to support the 

claim. 

c. Issuing the Decision. A CE cannot issue a letter decision accepting a 

consequential condition or a RD denying a consequential condition without a 

preceding FD accepting a primary covered condition. In those situations where a 

case is in posture for the CE to accept a primary covered condition and a potential 

consequential condition exists, the CE proceeds with the immediate release of a 

RD for the primary condition. A CE does not delay issuance of a RD accepting a 

primary covered condition while development occurs for a consequential 

condition. However, if the case is in posture for concurrent acceptance of both a 

primary and a consequential illness, the CE includes both in the RD. 

11. Impairment and Wage-Loss. Consequential conditions may cause additional impairment 

or wage-loss under Part E, but do not result in an additional lump-sum award under Part B. 

a. Impairment rating. An impairment rating assesses the functionality of the whole 

organ or system. The DEEOIC does not apportion impairment by disease (see 

Chapter 21 for further discussion of impairment ratings). The effect of this 

methodology means that an impairment rating encompasses all illnesses causing 

damage to an organ system, so long as one is an accepted work-related illness. For 

conditions accepted as consequential, the CE determines if the acceptance of a 

new consequential illness requires action to initiate an impairment rating under 

Part E. If the CE is reviewing case evidence to make a decision on an initial claim 

for impairment, he or she includes all accepted primary or consequential claims in 

the assessment of impairment. 

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(1) The acceptance of a consequential illness that involves an organ system 

previously included in an impairment rating will not trigger a new 

impairment evaluation if it is less than two years from the date of the FD 

awarding impairment benefits. 

 

(2) For situations where a new consequential illness is accepted after an initial 

impairment rating has occurred, the CE proceeds with a new impairment 

rating if the consequential condition affects an organ system that was not 

previously evaluated for impairment. For example, the primary accepted 

condition is lung cancer. FAB issued a FD one year ago to award a 50% 

impairment due to whole person impairment rating to the pulmonary 

system. 

A consequential illness is accepted for stomach ulcers as a result of 

medication required to treat the cancer. The CE may immediately proceed 

with a new impairment assessment because the consequential illness 

effects an organ system (digestive) that was not included in the prior 

impairment assessment. 

If the claimant’s treating physician or a CMC identifies a consequential 

illness during an impairment evaluation that is not included in the SOAF 

as an accepted condition (regardless of whether or not it is included in the 

impairment), the CE contacts the claimant and asks if he or she wants to 

file a claim for the condition (refer to paragraph 3). If the claimant 

answers in the affirmative, the CE instructs him/her to submit a completed 

and signed Form EE-1/2. The processing of the impairment claim should 

not be delayed if the condition is for the same organ/body system. 

b. Wage-Loss. With the acceptance of a new consequential illness the CE has to 

determine if sufficient evidence is present to undertake development for wageloss. CEs calculate wage-loss using the first day that the employee lost wages due 

to the covered illness and/or consequential illness (see Chapter 22 – Wage-Loss 

Determinations for further discussion of wage-loss). 

In certain instances, the consequential condition may be the initial cause of the 

employee’s wage-loss. For example, a claimant is approved for CBD due to 

beryllium exposure under Parts B and E. A year later, the claimant files a claim 

for pulmonary hypertension as a result of CBD. The medical evidence supports 

this finding and the assigned CE accepts the pulmonary hypertension as a 

consequential condition to the approved condition of CBD. The CE obtains 

evidence showing that the employee has had to stop work due to breathing and 

cardiac difficulties. The claimant is now entitled to wage-loss benefits under Part 

E for any lost wages due to pulmonary hypertension. 

12. SWC Claims, Lawsuits and Fraud. For each consequential injury that is to be accepted, 

the CE may need to obtain a newly signed Form EN-16 SWC/Tort/Fraud affidavit from the 

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claimant. The EN-16 is valid for one year from the date of claimant signature for all future 

claims related to that consequential condition, including claims for impairment and wage-loss.

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CHAPTER 24 – RECOMMENDED DECISIONS

1. Purpose and Scope. The DO issues RDs for claims filed under the EEOICPA. A RD is a 

written decision made by the CE regarding the eligibility of a claimant to receive compensation 

benefits available under the EEOICPA. As a recommendation, it does not represent the final 

program determination on claim compensability. It is a preliminary determination made by the 

CE that is subject to challenge by any claimant party to the decision. The FAB independently 

assesses each RD for finalization. This chapter describes the procedures for issuing a RD. 

2. Authority. 20 C.F.R. § 30.300 grants the DO authority to make determinations with 

regard to compensability and issue RDs with respect to EEOICPA claims. Under this section, 

the DO is to recommend the acceptance or denial of a claim for benefits under the EEOICPA. 

The DO forwards all RDs to the FAB for review.

3. When a RD is Required. A RD is required in situations where a claimant seeks an 

entitlement benefit provided for under either Part B or E of the EEOICPA. Entitlement benefits 

include medical benefits under Part B and/or E; lump-sum compensation under Part B; 

impairment or wage-loss awards under Part E; and lump-sum survivor compensation under Part 

E. In certain situations, as explained later in this chapter, exceptions to this guidance apply to 

decisions involving new cancer claims after a prior finding of PoC of 50% or greater, 

consequential illnesses, or approval or denial for medical procedures, equipment or other 

medically indicated necessities.

Claims made under Part B or E of the EEOICPA can involve multifaceted elements, filed at 

varying points in time, involving a multitude of medical conditions, or periodic claims for 

monetary lump-sum benefits, i.e. recurring wage-loss and impairment. The question of when a 

case element is in posture to be decided and a RD issued is dependent on several factors that the 

CE must consider. First, the CE must identify the parties seeking benefits, i.e., employee vs. 

survivor claims. This includes individuals who have filed claims or potential claimants who 

have not filed, but may be eligible. Secondly, the CE is to identify the actual claimed entitlement 

benefit for which a decision is required. In some instances, a claimant may be seeking multiple 

benefits under Part B and/or E, especially if the claimant is claiming more than one illness.

Based on examination of the evidence of record, development occurs to overcome any defect in 

the case evidence that does not satisfy the eligibility criteria for a claimed benefit. Once 

development is completed, the CE then performs an examination of the case evidence to 

determine if it is sufficient to accept or deny a claim for benefit entitlement. 

a. When a Claim is Submitted. Documents containing words of claim are 

acceptable to begin the adjudication process and set the effective date for the date 

of filing; however, the CE is to obtain a Form EE-1/2, as applicable, before 

issuing a RD. The CE notifies the claimant of the need to submit the required 

form. A period of 30 days is allotted for the claimant to submit the required 

documentation. If the appropriate form is not forthcoming, the CE 

administratively closes the claim. The CE is to provide notice to the claimant(s)

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that no further action will be taken on their claim until the proper claim form is 

submitted. 

(1) The CE has the discretion to conclude that a new claim has been 

adjudicated in a prior determination under the EEOICPA. For example, a 

claim for “lung disease” is filed and denied lacking any diagnosed 

condition. Subsequent filing is made for “lung problems.” While the exact 

wording of the claimed condition is dissimilar, the nature of the claim is 

the same and, in this situation, would not require new adjudication, unless 

the claimant provides evidence of a more specific diagnosis.

Additionally, no RD is needed if a FD has previously addressed a newly 

claimed condition. In such instances, the claimant is notified that the 

condition has previously been decided and no further action will be taken 

without a request from the claimant to reopen the prior FD. 

b. On the Initiative of the Director of the Division of the DEEOIC. Upon the 

issuance of a Director’s Order, the Director may instruct the DO to issue a new 

RD to address new evidence. 

c. At the Request of a Claimant. The claimant may request issuance of a RD either 

after or in lieu of a letter decision. This may occur in any of the letter decision 

situations discussed later in this chapter. 

4. Administrative Closures. Several situations exist that require administrative closure of a 

claim without the issuance of a RD. For example, situations where an administrative closure is 

necessary include (but are not limited to) the death of a claimant, failure to complete the OCAS1, withdrawal of claim prior to the issuance of a RD, and lack of response to a request for 

information regarding SWC or Tort payments. When the circumstances of the case lead to an 

administrative closure, a RD is not required for the affected claimant. Instead, when appropriate, 

the CE issues a letter to the claimant and/or his or her representative advising of the 

administrative closure, and the steps required to reactivate the claim.

When multiple claimants have filed for benefits and an administrative closure is required for one 

or more individual claims, the CE proceeds with the adjudication of the remaining active claims. 

The decision will describe the basis for any administrative closure, and the persons whose claims 

are closed will not be a party to the RD. If at a later date, the administrative closure ends and 

development resumes, the CE determines what affect the resumption of development may have 

on the case, including a potential need to vacate a prior FD to permit a new benefit entitlement 

decision involving all parties to the claim. 

5. Who Receives a RD. Each individual who files a claim under a case, and has not had 

their claim administratively closed, is required to be a party to a RD that decides a benefit 

entitlement.

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Given the variant benefit filings that may exist in a single case, the CE may divide benefit 

entitlement claims to be addressed by separate RDs. This will occur when the CE is able to 

decide one or more entitlement benefits based on the evidence of record, while concurrent 

development occurs on outstanding claimed components. For example, the CE may issue 

separate decisions awarding medical benefits for a cancer under Part E, and a subsequent 

decision for any impairment linked to that cancer. 

a. Multiple Claimant RDs. All claimants who have filed a claim under Parts B 

and/or E, and have not had their claim administratively closed, are to be parties to 

any RD deciding a benefit entitlement. This is necessary to ensure that any 

decision comprehensively addresses the entitlement for all claimants with an 

interest in the claim. Each claimant is provided with the information necessary to 

understand the outcome for all claims. Moreover, it grants all claimants equal 

opportunity to present objections, should they disagree with any particular aspect 

of the decision. A CE should not issue a RD determining any single individual 

claimant’s eligibility to receive benefits in a multiple person claim, except in the 

circumstance of a newly filing ineligible survivor. 

Once a FD is issued, should a new individual subsequently file a claim seeking 

benefits, the CE will undertake normal development to determine the claimant’s 

eligibility to benefits. Should the new claimant be deemed ineligible, a 

recommended denial of benefits that addresses his or her individual claim may be 

issued without reopening the previously decided claims. However, if the 

circumstances of the case develop to the point where a newly filing claimant may 

be eligible for benefits, or a denial would affect the benefits available to other 

parties to the claim, it will be necessary to reopen all claims and issue a new RD

addressing the eligibility of all claimants under the case record. 

b. Discretionary Authority in the Decision Process. The CE employs appropriate 

discretion to decide the most effective course to bring timely resolution to all 

entitlement claims. The CE should pay particular attention to benefit entitlement 

determinations that will result in a positive outcome. In these situations, the CE is 

not to delay the issuance of a RD, even if other benefit entitlements may exist that 

require development. For example, two survivors of an employee file for lumpsum compensation under Parts B and E. Development is undertaken and both are 

found eligible to a Part B benefit of $150,000 because the employee had lung 

cancer related to covered employment. However, under Part E, only one of the 

survivors has submitted evidence to establish that he or she was under the age of 

18 at the time of the employee’s death. The other survivor indicates he or she is 

having problems obtaining school transcripts to show full-time student status. In 

this situation, the CE issues a decision on the benefit entitlement of both claimants 

under Part B, but defers any decision on the Part E claim. 

c. Non-Filing Survivors. The situation may arise where the CE identifies a 

potentially eligible survivor through development, but whose whereabouts are 

unknown or who does not wish to seek benefits. This includes situations where a 

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survivor specifically notifies the CE that he or she does not wish to pursue 

benefits or states that he or she is clearly ineligible and will not file a claim. 

Under these circumstances, it is not possible for the CE to include them as party 

to a RD. The CE may proceed with the issuance of the RD to the remaining 

claimants; however, the CE’s decision is to reference the fact there is a potentially 

eligible survivor who has not filed a claim.

 

(1) In the situation where the non-filing survivor’s eligibility to benefits 

cannot be ascertained, any payable lump-sum compensation will be 

allocated with the presumption that the non-filing survivor is eligible. The 

potential survivor’s share of compensation is held in abeyance until a 

claim is filed, evidence is received establishing the survivor’s status as 

ineligible, or notice of his or her death is received. Should the CE obtain 

evidence establishing that the non-filing survivor is clearly ineligible or 

deceased, any payable compensation being held in abeyance can then be 

allocated among the remaining survivor(s). 

(2) When non-filing survivors have been advised of the requirements for 

establishing eligibility and have communicated to the CE that they will not 

file as they consider themselves ineligible, the CE attempts to obtain a 

signed, written statement confirming the survivors’ ineligible status. 

Development involving a non-filing survivor should not extend past a 

reasonable period, as to delay significantly the issuance of a RD to other 

claiming survivors. The CE should make a reasonable effort to obtain 

either a claim form or written confirmation of the non-filing survivor’s 

status. In most situations, the CE should allow 30 days to provide 

requested documentation. If written confirmation cannot be obtained, the 

CE must clearly document that the survivor intends not to file. Under this 

circumstance, unless the CE has reason to doubt the accuracy of the 

survivor’s ineligibility, the CE may proceed with the issuance of a RD 

regarding the eligibility of the remaining claimants. The fact that there is a 

non-filing, ineligible, survivor is to be noted in the decision. However, the 

non-filing survivor is not a party to the decision, is not to be named, and 

instead addressed as a non-filing survivor. In such a situation, the CE does 

not hold payable lump-sum compensation in abeyance. 

(3) Once a RD has been issued that involves a non-filing survivor, if the 

survivor later decides to file a claim form, it will be necessary to issue a 

new RD. Should development result in the claimant being found 

ineligible, a RD is permitted to be issued solely to the new claimant 

denying his or her claim. Under this circumstance, a reopening of any 

prior claims is unnecessary because the denial has no effect on the 

previously decided claims. Alternatively, if the claimant is found to be 

eligible to a benefit, a reopening of all previously decided claims is 

required to allow for the issuance of a new RD to all individuals who are 

party to the claim. 

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d. Non-Responsive Claimants. In situations in which a claim is filed and the 

claimant subsequently becomes unresponsive, reasonable steps should be taken to 

obtain confirmation of the non-responsive claimant’s status. However, 

development should not extend past a reasonable period. In most situations, the 

CE should allow 30 days to provide the requested documentation. When there is 

no response within the allotted time, the CE may proceed with adjudication of the 

claim and issuance of a RD based on the evidence present in the case record. 

In the situation where the non-responsive claimant is a party to a multiple 

survivor claim, and the non-responsive survivor’s eligibility cannot be 

ascertained, any payable lump-sum compensation will be allocated with the 

presumption that the non-responsive survivor is eligible; and his or her share of 

compensation is held in abeyance until such a time evidence is received 

establishing the survivor’s eligibility. In such cases, the non-responsive claimant 

is to be a party to the RD. Should the CE obtain evidence establishing that the 

non-responsive survivor is clearly ineligible or deceased, any payable 

compensation can then be allocated among the remaining survivor(s). 

6. Writing a RD. When the CE has completed development to allow for a decision 

involving an entitlement benefit, the CE issues a RD. The decision recommends acceptance or 

denial of entitlement benefits in accordance with the legal criteria set out under the EEOICPA. 

The CE is to defer on any outstanding claims. 

The CE ensures that any decision issued is well written, uses appropriate language to clearly 

communicate information, and addresses all facets of the evidence that led to the conclusion, 

including evidence the claimant submitted. The CE is to provide a robust, descriptive 

explanation of how the evidence satisfied or failed to satisfy the eligibility requirements of the 

EEOICPA, including any interpretive analysis the CE relied upon to justify the decision. 

Moreover, the discussion should address the actions taken to assist with the development of the 

case. 

a. Use Simple Words and Short Sentences. Avoid technical terms and bureaucratic 

"jargon”, and explain the first time any abbreviation that is used in the text. 

b. Divide Lengthy Discussions into Short Paragraphs. The progression of the text is 

to follow a logical and chronological pattern. 

 

c. Confine the Discussion to Relevant Issues. These are the issues before the CE 

that need to be resolved. It may be necessary to state an issue is being deferred 

pending further development, but there is no need to discuss it in detail. Extensive 

case history, which is inconsequential to the issue being decided, does not need to 

be discussed. 

d. Address All Matters Raised by the Claimant. This includes any issue or medical 

condition relevant to the decision, whether raised in the initial report of the claim 

or during adjudication. Make certain to address all claimed conditions being 

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decided in the introduction, discussion and conclusion. If the CE recommends 

acceptance of a covered condition, and the claimant has also claimed other 

conditions that are not covered, the non-covered conditions are to be denied. The 

CE also recommends denial of claimed conditions in survivor claims that have 

previously reached the maximum allowable benefit entitlement and no further 

compensation is payable. 

e. Mailing Addresses. The decision is to be addressed to each claimant who has 

filed a claim, and/or his or her AR. This ensures that each person who has filed a 

claim receives official notification of the decision and is granted the opportunity 

to object should any claimant disagree with any aspect of the conclusions. 

7. Content and Format. A RD is comprised of a cover letter, a written decision, a waiver, 

and an information sheet provided to a claimant explaining his or her right to challenge the 

recommendation. The CE is responsible for preparing the RD and all its component parts. The 

format and content of a RD is as follows:

a. Cover Letter. A cover letter summarizes the recommendation(s) of the DO to 

accept, deny or defer claimed benefit entitlement(s) under Part B, Part E or both; 

and lists the benefits being awarded, if any. It advises that the accompanying 

decision is a recommendation and that the case file has been forwarded to the 

FAB for review and the issuance of a FD. Further, the cover letter advises the 

claimant of his or her right to waive any objection or to file objections within 60 

days of the date of the RD. Finally, if the decision is issued using the opinion of a 

CMC, the cover letter must advise the claimant that the CMC report is available 

for review upon request. 

A separate cover letter is addressed to each individual party to the claim. In some 

instances, it may be necessary to tailor or individualize each cover letter to the 

specific circumstances affecting the claimant addressed. Exhibit 24-1 provides a 

sample cover letter.

b. Written Decision. The written decision is comprised of an Introduction, a 

Statement of the Case, Explanation of Findings, and Conclusions of Law. Exhibit 

24-2 and Exhibit 24-3 provide samples RDs. 

(1) Introduction. This portion of a RD succinctly summarizes what benefit 

entitlement is being recommended for acceptance, denial or deferral. 

Distinction is made between benefits addressed under Part B vs. Part E. 

(2) Statement of the Case. The Statement of the Case is a clear, 

chronological, and concise narrative of the relevant factual evidence

leading up to the decision. It describes the steps taken by the CE to 

develop evidence, the outcome of any development, and any other relevant 

information derived from examination of the case records. The Statement 

of the Case should not be overly technical covering every minute detail of 

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the case evidence, nor should it include interpretation of the evidence; as 

this is to be covered in the “Explanation of Findings” outlined below. 

Essentially, the Statement of the Case tells the relevant history of the case 

leading up to the present decision and includes basic information such as 

the relevant evidence submitted, development actions taken, and any other 

relevant information that correlates to the discussion and analysis in the 

Explanation of Findings. Basic information that may be covered in the 

Statement of the Case, when relevant, includes: 

(a) Name of the claimant or survivor, name of employee, and when 

the claim was filed;

(b) Benefit(s) the claimant is seeking. In the case of a survivor claim, 

the relationship of the claimant to the employee and documentation 

submitted in support of the relationship, if any; 

(c) Claimed employment and evidence submitted to establish covered 

employment, if any;

(d) Claimed medical condition and the pertinent medical evidence 

submitted to establish a diagnosed illness;

(e) In a recommended acceptance, pertinent issues may include 

specific medical documents received from the claimant or other 

sources, which confirm the diagnosis of the claimed condition, and 

evidence establishing the claimed employment and exposure. Also 

important for inclusion are the results of any searches conducted or 

documentation generated from the SEM, OHQ, records from the 

DOE FWP, and DAR records. The evidence and development 

actions discussed in the Statement of the Case should correlate 

with the discussion and analysis, which follows in the Explanation 

of Findings. 

In a recommended denial, the CE discusses what evidence he or 

she sought, how the CE advised the claimant of the deficiencies, 

any assistance provided to overcome a defect, and the claimant’s 

response. 

(3) Explanation of Findings. This section of the RD explains the CE’s 

analysis of the case evidence used to arrive at the various factual findings 

necessary to substantiate a conclusion on benefit entitlement. It is critical 

that the CE writing the decision include a compelling, robust justification 

of his or her decision to accept or deny a claim. CE findings made without 

any explanatory justification, or communicated in vague or overly broad 

language is not appropriate. A poorly written decision increases the 

likelihood that a claimant will not understand the outcome of the claim 

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and the probability of objection. Moreover, it serves to increase the 

potential objection by the claimant, or remand by the FAB. 

 

In writing the content of the Explanation of Findings, the CE follows a 

logical and sequential presentation of findings and explains the relevant 

legal, regulatory or procedural guidelines of DEEOIC claims adjudication, 

the relevant evidence, and how the evidence does or does not satisfy the 

referenced criteria. In this manner, the CE communicates to the claimant 

his or her interpretive analysis of available evidence in satisfying the legal 

requirement for claim acceptance or denial. Moreover, it provides the 

narrative content, which allows the FAB to properly conduct its role of 

independently assessing the sufficiency of the CE’s recommendation. 

Given the various types of benefit entitlements that may be involved, the 

content of this section will vary depending on the context of the matter 

under review. However, the CE is to communicate information pertinent 

to the issue for determination in a logical, comprehensive manner. For 

example, the logical presentation of findings for a new Part E claim for 

causation will follow this general order – diagnosis, employment, relation 

to employee (in survivor claims), exposure, and causation. However, a 

different presentation of findings is needed depending on the 

circumstances of the claim; such as with impairment, where the 

presentation of findings would follow a different order – accepted 

condition, evaluation for impairment, and outcome of evaluation with 

award or denial of impairment benefit. 

Given the disparate types of evidence that may exist in a claim record, 

there may be instances where the discussion is based exclusively on the 

presentation of undisputed evidence that clearly affirms findings leading 

to a conclusion. In other instances, there will be a need to use inference or 

extrapolation to support a finding. In either situation, the CE is to provide 

a compelling argument as to how the evidence is interpreted to support the 

various findings leading to acceptance or denial of benefit entitlement. 

This is particularly important in situations involving toxic chemical 

exposure analysis under Part E, conflicting medical opinion, or other 

complex procedural applications. The assessment will rest on various 

factors, such as the probative value of documentation, relevance to the 

issue under contention, weight of medical opinion, or the reliability of 

testimony, affidavits, or other circumstantial evidence. 

In instances where the claim is being denied, the discussion should focus 

on the first logical element that failed to meet the eligibility criteria. 

However, in multi-claimant cases, the reason for denial may differ for 

each claimant. In such instances, the CE should explain the basis of denial 

for each individual party to the claim. 

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Within the context of decision analysis, the CE is to maintain a claimantoriented perspective. This can be defined as decisions made within the 

scope of the law that have the effect or potential to produce a positive 

benefit to the claimant(s). 

(a) Contested Factual Items and Other Claim Disputes. Written 

analysis is particularly important when reaching judgment on a 

claim issue that differs from the position of the claimant or has 

negative consequences to the claim. The CE is to identify the 

differences, clearly note the decision made, and the evidence or 

argument that supports such a decision. This is frequently the case 

where there is disagreement over medical diagnosis, dates or 

location of employment, health effects of toxic exposure, 

interpretation of program procedure, or medical opinion on 

causation. In any instance where a dispute involves a decision 

based on the weight of medical evidence, the CE is to describe 

completely the weighing methodology in support of the chosen 

medical opinion. 

(b) Complex subject matter and other complicated evidentiary 

situations. Evidence presented in support of DEEOIC claims can 

often be open to a variety of interpretations, especially in situations 

involving complicated subject matter or in situations where 

evidence is vague. Whenever a CE is presented with a situation 

involving a complex set of issues for which a finding is necessary; 

e.g. establishing intermittent covered employment at multiple 

facilities, it is essential that the CE provide sufficient explanation 

as to how he or she chose to apply the evidence in arriving at a 

finding. Simply making a factual statement in these situations 

without providing the underlying rationale for making such a 

finding will not suffice. 

(c) Mathematical Calculations. In any decision involving a 

mathematical calculation, the CE fully explains the figures used to 

arrive at the finding listed. Situations where calculations need to be 

described include impairment or wage-loss, division of benefits 

between multiple claimants or Part B vs. Part E claims, aggregated 

workdays for SEC classes, latency periods for diseases, and offsets 

for State Worker’s Compensation or tort settlements.

For example, when accepting a claim for wage-loss, the CE is 

expected to provide a narrative explanation of how he or she 

arrived at the various components of the decision. Specifically, 

how the first date of wage-loss was determined, the evidence of 

wages used to calculate AAW, how the average annual wage was 

compared to future calendar years of wage-loss, and any 

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explanation of how the wage-loss benefit is calculated to arrive at 

the amount being awarded. 

(d) Application of Written Program Policy, Regulations, Procedure or 

case precedent. A CE may have to explain the use of policy 

guidance from various program resources in support of a decision 

being made in a claim. In these situations, the CE must clearly 

reference the resource being used, and if necessary, make a 

specific citation or reference. The program policy must pertain to 

the issue at hand and the CE must explain how it provides 

guidance in resolving a particular claim issue. 

(i) Case precedent. A CE is permitted to use only those case 

decisions that are specifically authorized and recognized as 

setting precedent. These can be found on the DEEOIC main 

web page and are updated periodically. It is not 

appropriate for a CE to generalize information or findings 

from a non-precedent setting case to address a separate case 

under review. 

 

(4) Conclusions of Law. This portion of the RD summarizes the 

determination of eligibility reached based on the discussion and analysis 

contained in the Explanation of Findings. The CE’s conclusion either 

accepts or rejects the claim in its entirety, or it may address a portion of 

the claim presented. The conclusions should be limited to a simple 

recommendation of acceptance or denial of the claim(s) under 

consideration under Part B and/or Part E. 

As a RD does not represent the final program determination regarding 

eligibility under the EEOICPA, it is not necessary to cite sections of the 

EEOICPA or its governing regulations in support of the conclusions 

reached. 

(a) When the conclusion is to accept a claim, the CE must include the 

amount of payable lump-sum compensation or award of medical 

benefits effective the date of filing, and under what Part of the Act 

the benefit is being awarded. 

(b) In a conclusion that results in a denial of benefits, the CE is to 

identify the denied claimed condition. The CE is not to state the 

lump-sum amount to be denied. 

(6) Signatory Line. The signature line must include the name, title, and 

signature of the person who prepared the recommendation and the name, 

title, and signature of the person who reviewed and certified the decision, 

when applicable.

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(7) Notice of Recommended Decision and Claimant’s Rights. Provides 

information about the claimant’s right to file specific objections to the RD 

and to request either a review of the written record or an oral hearing 

before the FAB. A sample Notice of Recommended Decision and 

Claimant’s Rights is included as part of Exhibit 24-4. 

(8) Waiver of Rights. A waiver form is sent with each RD and is to include 

the case ID number, name of the employee, name of the claimant, and the 

date of the decision in the upper right hand corner. The claimant may 

waive his or her right to a hearing or review of the written record and 

request that the FAB issue a FD. In this instance, the claimant is required 

to sign a waiver and return it to the FAB. Exhibit 24-5 contains a sample 

Waiver.

(a) Bifurcated Waivers. In many instances, the DO accepts one 

element of a claim and denies another, all within one RD. It is 

therefore possible for a claimant to waive the right to object to the 

acceptance portion of the decision and file an objection regarding 

the denied portion of the same decision. A claimant has 60 days 

from the date the RD is issued to file an objection, and may waive 

this right at any time.

Exhibit 24-6 provides a sample Bifurcated Waiver of Rights for a 

partial acceptance/partial denial. Option 1 allows the claimant to 

waive the right to object to the benefits awarded but reserve the 

right to object to the findings of fact or conclusions of law that led 

to the denial. Option 2 allows the claimant to waive the rights to 

object to all findings and conclusions. 

8. Types of RDs. Due to the wide variety of possible benefit entitlements available under 

Part B and Part E, various claim elements may be in different stages of development and 

adjudication at any given time. Following are examples of several types of RDs that may be 

necessary:

a. Acceptance. Where the entire case is in posture for acceptance and no 

outstanding claim elements (e.g., wage-loss, impairment, additional claimed 

illness, or a cancer claim pending dose reconstruction at the NIOSH) need further 

development, the CE issues a RD to accept in full. The narrative included in the 

decision should be sufficient to justify each element of the decision process that 

factored into the acceptance. 

b. Denial. If after development, criteria for a compensable claim have not been met, 

the CE issues a RD to deny the claim as a whole. The narrative justification for 

the recommended denial should communicate the singular basis serving as the 

first logical element that does not meet the necessary EEOICPA criteria. 

However, the CE may also relay other critical information in his or her decision 

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that will serve to assist the claimant in understanding other components of the 

case file that, while not directly tied to basis of claim denial, describe other 

potential shortcomings in the case evidence. For example, a claimant submits a 

claim for asthma, but provides no medical evidence of the diagnosis. The CE 

prepares a denial on the singular basis of insufficient medical evidence to support 

the claimed medical condition, but may also communicates that the claimed 

employment does not correspond to the information received from the employer, 

which would also need to be overcome in order for eventual claim acceptance. 

(1) Addressing all claimed elements. Once development has occurred, the CE 

is to proceed with the issuance of a RD that addresses as many claimed 

elements as can be addressed in the RD. Each specific claimed element 

that does not satisfy the requirements of the EEOICPA are to be 

consolidated into one RD and reasons supporting the recommendation to 

deny each element clearly explained. Elements that the CE cannot address 

are to be deferred for later action. 

c. Partial Accept/Partial Deny. If the CE determines that no further development is 

necessary on a case file and concludes that some claim elements should be 

recommended for acceptance and some for denial, the CE issues a RD that clearly 

sets forth those recommendations. 

For instance, if an illness that can be covered under both Part B and Part E of the 

EEOICPA (cancer, beryllium illness, chronic silicosis) is claimed and meets the 

evidentiary requirements only under Part E but not under Part B, the CE states 

that the Part E benefits are being accepted and the Part B benefits are being 

denied. 

(1) Example. A claimant files a claim for CBD and submits medical evidence 

that contains a medical diagnosis of CBD that is sufficient to meet the Part 

E causation burden, but not the statutory criteria under Part B; the CE 

issues a RD awarding benefits under Part E and denying benefits under 

Part B. In the denial under Part B, the CE should clearly outline the 

relevant Part B CBD criteria; explain what evidence was lacking and why 

the case is being denied. The CE clearly delineates the benefits being 

awarded and denied under Part B and Part E.

d. Partial Accept/Partial Develop. When a claim element is fully developed and 

ready for acceptance, but other elements remain for further development (e.g., 

wage-loss, impairment, another claimed illness, or a cancer pending NIOSH dose 

reconstruction), the CE issues a RD accepting the claimed illness and specifies all 

associated benefits awarded under the EEOICPA as a whole. With regard to other 

claim elements requiring further development, in the Introduction the CE advises 

that these elements are deferred until they are fully developed and adjudication is 

possible. Partial adjudication of a claim should be avoided whenever possible. In 

any instance where a part of a claim is deferred, it is the CE’s responsibility to 

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ensure that action is ultimately taken to address the outstanding claim by way of a 

RD or administrative closure, when appropriate. Development for a deferred 

claim may be required by the assigned CE2 unit while other components of the 

claim are addressed by the FAB. 

e. Partial Accept/Partial Deny/Partial Develop. If one portion of the claim is in 

posture for acceptance and another portion is in posture for denial, while yet a 

third portion requires additional development, the CE addresses all claim 

elements in one comprehensive RD. Where one or more claim elements are 

accepted and other elements are either denied or deferred for additional 

development, the CE must clearly outline the status of each element that is 

accepted, denied and deferred. 

9. Decision Issuance. After preparing a RD, the CE routes the decision and case file to the 

appropriate signatory for review, signature, date, and release. 

a. Clearing the RD for Release. The appropriate signatory reviews all RDs. 

(1) Deficiency Identified. If the appropriate signatory discovers a deficiency 

or other problem, the RD is returned to the CE with a detailed explanation 

of why the decision is not in posture for release. When the appropriate 

signatory has provided comments or has extensively edited the RD, the CE 

is to revise the decision accordingly. 

(2) Decision Approved. If the signatory agrees with the decision, he or she 

signs and dates the RD. The date shown on the RD must be the actual date 

on which the decision is mailed. 

b. Mailing the RD. The signed and dated RD is mailed to the claimant’s established 

address of record, and a copy is sent to the claimant’s designated representative, if 

any. Notification to either the claimant or the representative is considered 

notification to both parties. 

(1) A signed and dated copy of the RD is imaged into the electronic case file.

(2) The decision issuance is to be appropriately recorded in ECS. 

(3) The CE then forwards the case record to the appropriate FAB office.

10. Letter Decisions. In certain situations, an entitlement determination is addressed in a simple 

letter to the claimant. If a CE makes a decision in this format, the CE communicates the nature 

of the claim that was made, evaluates the evidence supporting the outcome and the conclusion. A 

formal RD is not necessary, unless the claimant submits a written request for one or objects to a 

letter decision. In some situations, including contentious or otherwise complicated issues for 

which the claimant is likely to contest a decisional outcome, the CE may exercise his or her 

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judgment in deciding to issue a RD in lieu of a letter decision without specific request for such 

by the claimant. Circumstances where a letter decision is permitted include:

a. Approval of additional claims for medical benefits for cancer: 

(1) Once a PoC value has been calculated at 50% or greater and a FD 

accepting the cancer has been issued, any subsequent new claim for cancer 

related to the same organ system will be presumed linked to occupational 

exposure to radiation under either Parts B or E of the EEOICPA.

(2) Once a FD accepting a specified cancer under an SEC class has been 

issued, any subsequent new claim for a specified cancer will be presumed 

linked to occupational exposure to radiation under either Parts B or E of 

the EEOICPA.

b. Consequential illness acceptance. 

c. Acceptance or denial of medical care or treatment, including home health care. 

d. Acceptance or denial of DME or housing/vehicle modification. 

e. Alternative filing determination (see Chapter 20 – Establishing Survivorship for 

further guidance)

11. Special Circumstances. As noted previously, there are disparate issues that confront the 

CE during the process of making a RD. This section provides guidance in certain unique 

situations that the CE may encounter. 

a. Cases Where the Maximum Aggregate Lump-Sum Compensation Has Been 

Attained. The maximum lump-sum compensation payable under Part B is 

$150,000, and $250,000 under Part E. Once the maximum aggregate 

compensation has been awarded, claims for any new medical condition(s) are to 

be addressed for medical benefit coverage only. Under Part E, once the 

maximum lump-sum figure has been reached, any new claim for impairment or 

wage-loss benefit is denied. 

(1) If the employee dies after receiving the maximum lump-sum 

compensation available to him or her, any subsequent claim by a survivor 

is denied as no additional compensation is payable. For guidance 

concerning Part E claims in which an employee dies subsequent to 

receiving a lump-sum payment less than the maximum aggregate 

allowable, refer to Chapter 20 – Establishing Survivorship. 

b. Death of Employee Prior to Claim Adjudication. In a scenario involving an 

employee who files for benefits, but dies prior to claim adjudication, the CE 

administratively closes the claim and no RD is issued. If a survivor claim is later 

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presented, the CE is to proceed with claim adjudication based on the condition(s) 

claimed only by the survivor. In this scenario, the CE is not to resume 

development for conditions previously claimed by the employee. Instead, the CE 

is to contact the survivor to discuss any potential benefit that may be derived from 

filing a claim for a condition previously filed by the employee, but for which the 

survivor has not claimed; e.g., such as a potentially compensable condition that 

may have contributed to the death of the employee. 

 

c. Forfeiture Due to Fraud. When a claimant pleads guilty to, or is found guilty of 

fraud, in connection with an application for or receipt of federal or state workers 

‘compensation, that claimant forfeits any entitlement to further benefits under the 

EEOICPA. In cases where there are other eligible claimants, the CE is to 

reallocate the forfeited amount to the remaining eligible claimants without 

holding the forfeited amount in abeyance. 

d. Issuing a RD After the Maximum Aggregate Compensation Has Been Paid in a 

Part B or E Survivor Claim. Once the maximum available compensation has been 

awarded in a survivor claim, i.e., $150,000 under Part B or $175,000 under Part 

E, and a new survivor presents a valid claim, the CE is to develop the claim to 

determine the new survivor’s eligibility. Should the survivor be deemed eligible, 

it will be necessary to vacate any prior decision to other survivors to allow for a 

new decision to all claimants. In the decision, the CE explains the circumstances 

of the new claim, the eligibility of the new survivor to receive benefits, and the 

reallocated award based on the number of qualifying survivors. The new survivor 

is awarded his or her share of payable compensation, regardless of the fact that 

the maximum payable compensation was previously paid. Once a FD has been 

issued with regard to this matter, the CE takes action to assess any survivor in the 

case who has a potential overpayment.

e. Issuing a RD when there is a Prior Overpayment. When there is an overpayment 

in a case, and the CE needs to issue a new RD, the case file is transferred to the 

Policy Branch at NO before the RD is issued. The NO will send the claimant(s) an 

initial overpayment notice advising them of the overpayment. The claimant then 

has 30 days to dispute the overpayment or request a waiver. After the NO sends 

the FD on the overpayment to the claimant(s), it will return the case to the DO for 

issuance of the RD. The NO will provide instruction on how to address the 

overpayment in the RD.

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CHAPTER 25 – FAB REVIEW PROCESS

1. Purpose and Scope. This chapter describes the functions of the FAB, focusing on the 

administrative and preparatory aspects of its work under the EEOICPA. 

2. Authority. The regulations governing the administration of EEOICPA specify at 20 

C.F.R. § 30.300 that each RD is to be forwarded to the FAB for issuance of a FD. Section 

30.310 allows a claimant to object, in writing, to all or part of the RD within 60 calendar days 

from the date the RD is issued. If a claimant requests a hearing within the 60 day time period, a 

FAB HR will conduct a hearing, pursuant to 20 C.F.R. § 30.314. Otherwise, the objections will 

be responded to by a review of the written record, pursuant to 20 C.F.R. § 30.312. 

Whether or not an objection is filed, the FAB reviews all RDs, all arguments and evidence of 

record, and issues a FD pursuant to 20 C.F.R. § 30.316 or a Remand Order returning the case to 

the DO for additional development, pursuant to 20 C.F.R. § 30.317. Also, the FAB reviews 

claimant requests for reconsideration of a FD under 20 C.F.R. § 30.319. FAB can also issue a 

FD reversing the findings and conclusions of the RD in certain circumstances. 

3. Organization. The FAB is a NO organization with DO locations (FAB-DOs) in: 

Jacksonville, Florida; Cleveland, Ohio; Denver, Colorado; and Seattle, Washington. The FABDO is a distinct entity with a separate operational and management structure. In addition to the 

FAB-DOs, a NO FAB (FAB-NO) is located in Washington, D.C. The FAB Chief is located in 

the Washington, D.C., office and oversees the operations of the FAB-NO and the four FABDOs. 

 

a. The FAB Chief and Assistant Branch Chiefs:

(1) Coordinate the administration of the four FAB-DOs and the FAB-NO. 

Oversee policy implementation, manage adjudication timeliness, and 

ensure general compliance with FAB procedures. 

 

Hearing requests received by FAB-DOs are sent to the FAB-NO for 

assignment. A hearing coordinator, as designated by the FAB Chief, 

manages the assignment of hearings nationwide. 

Reconsideration requests are forwarded to FAB-NO, Attn: FAB Ops, and 

are assigned to an office different from that which issued the FD. 

(2) Can redistribute certain case files at their discretion to ensure balanced 

case loads among the four FAB-DOs and the FAB-NO. 

b. FAB Offices: 

(1) Review RDs, conduct hearings, reviews of the written record, and issue 

FDs or Remand Orders on reviewed cases. The cases reviewed by FAB, 

and the cases for which FAB conducts hearings, can originate from any 

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DO. A FAB HR can be assigned a hearing anywhere in the nation; not just 

in his or her FAB office’s jurisdiction. 

(2) Processes requests for reconsideration of FDs. 

(3) Works with the CE2 who develops cases and issues RDs in certain cases 

with pending actions in the FAB unit. 

 

4. Processing, Monitoring, and Transferring Case Files. When a DO issues a RD, it will 

forward the entire case file to its affiliated FAB-DO or the FAB-NO, as directed, for review and 

issuance of a FD. Because each FAB office, including the FAB-NO, is separate and distinct from 

the DOs, each maintains a separate mail and file operation. 

Initial Screening/Review. A case file received from the DO is assigned and delivered to the 

responsible FAB CE or HR for initial review. The CE or HR timely reviews the RD for 

accuracy. The CE or HR reviews the evidence of record to ensure that all evidence and 

documentation referenced in the RD accurately describes what is in the file. The CE or HR also 

determines whether the claimant has filed a waiver, a written objection(s), or a request for a 

hearing. If some deficiency or defect is found which requires the case be remanded to the DO, 

the case is to be remanded immediately.

5. Waivers. A waiver gives a claimant(s) the opportunity to voluntarily relinquish their 

right to object to the findings and conclusions of law contained in a RD, either in part or in full. 

The FAB may issue a FD at any point after receiving a written notice of waiver. To expedite the 

FAB review process, the DO must immediately forward all signed waivers to FAB upon receipt. 

a. Implied Waivers. A claimant’s rights to object and/or to request a hearing are 

considered waived if not timely exercised. 

b. Signed Waivers. A claimant may waive his or her rights to object and to request a 

hearing by submitting a signed waiver form to the DO or the FAB within 60 

calendar days of the RD issuance date. The submission of a signed waiver 

denotes the claimant’s willingness to accept the findings of fact and conclusions 

of law reached by the DO in the RD.

However, in cases where the FAB has determined that the claimant is to be 

awarded less benefit than those identified in the RD, the FAB remands the claim 

to the DO for the issuance of a new RD. 

c. Bifurcated Waivers. By submitting a bifurcated waiver, a claimant may waive his 

or her rights to object to one portion of the decision while retaining his or her 

rights to object to another portion of the decision. 

If the claimant files a bifurcated waiver objecting to the denial of a claim, but 

waiving his right to object to another portion which has been accepted, the FAB 

issues a timely FD adjudicating the waived portion of the RD. FAB then issues a 

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separate FD adjudicating the objected-to portion of the RD after a review of the 

written record or a hearing, or upon the expiration of the 60-day period in which 

the claimant may submit objections or new evidence. However, in cases in which 

a claim is recommended for denial based on multiple components, and the 

claimant objects to one or more portions of the denial, the FAB must issue a 

single FD adjudicating all components of the RD. 

If FAB receives a bifurcated waiver that is unclear, or does not specify to which 

portion of the decision the claimant objects, FAB contacts the claimant for 

clarification prior to conducting its review and issuing its decision. 

6. Objections and Review of the Written Record. The regulations allow a claimant to file 

written objections to all or part of a RD. When the claimant has submitted a timely written 

objection to a RD, but has not requested a hearing, FAB conducts a review of the written record. 

 

a. Timeliness. A claimant has 60 calendar days from the date of the RD to file an 

objection in writing. The claimant does not need to specify the basis for the 

objection for it to be considered, but can merely state that he or she disagrees with 

a finding of fact, a conclusion of law, or the RD in general. 

A written objection is considered timely if the envelope containing it is 

postmarked no later than the 60th calendar day after the RD issuance date (the 

date of the RD is not included in the 60 calendar days). If the 60th day falls on a 

non-business day, the envelope must be postmarked by the next business day for 

the objection to be considered timely filed. If no postmark is available, the date 

of the objection is considered to be the earliest date it is received, as determined 

by the date stamp. As long as at least one objection is timely filed by a claimant, 

the FAB must consider ALL objections filed by that claimant, even objections 

raised after the 60-day period has expired. Any objection filed after the 60-day 

objection period has passed is reviewed by FAB to determine if it is material to 

the outcome of the claim.

b. Review of the Written Record. A review of the written record is an analysis of 

the documentation contained in the case file to determine if the conclusions 

reached in the RD are accurate in light of the objections filed and the 

requirements of the EEOICPA. 

If the claimant objects to one portion of the RD and agrees with the other portion, 

the FAB may issue a FD on the accepted portion and issue a separate “FD

Following a Review of the Written Record” on the objected portion. RDs 

addressing multiple claimants generally should be issued under one FD. 

(1) Acknowledgement. The FAB acknowledges receipt of the objection in 

writing. The letter to the claimant indicates that the claimant has an 

additional 20 calendar days from the date of the acknowledgement letter to 

submit new evidence in support of the objection. For claims involving 

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multiple claimants, a single objection from any one claimant is sufficient 

to warrant a review of the entire written record. Upon receipt of an 

objection in a case with multiple claimants, individual acknowledgments 

are sent to each claimant explaining the course of action to be undertaken. 

A sample acknowledgement letter is shown in Exhibit 25-1. It is the policy 

of the DEEOIC that the acknowledgment letter to the claimant(s) that did 

not submit the objection should indicate that an objection was received, 

but should not indicate the basis of the objection. Each claimant’s 

response to any objections is reflected in ECS. 

(2) Conduct of Review of the Written Record. Guidelines for conducting a 

review of the written record are set out in 20 C.F.R. § 30.313. The FAB 

representative considers the written record forwarded by the DO and any 

additional evidence and/or argument submitted by the claimant. 

After the review of the written record, FAB issues a FD, remands all or 

part of the case to the DO, or reverses all or a portion of the RD if 

advantageous to the claimant. A FD following a review of the written 

record contains a narrative summation of the claimant’s objections, and 

the HR/CEs assessment of the evidence in response to those objections. 

The HR/CE ensures that any decision is based on an objective analysis of 

the evidence; and applies well-reasoned judgment, sound exercise of 

discretion, and correct application of law, regulations, and DEEOIC policy 

and procedures. 

7. Hearing Requests. An oral hearing permits the claimant, his or her AR, and any 

witnesses to voice objections to a HR. 

 

a. Initial Handling of Hearing Requests. When a timely request for an oral hearing 

is received in the DO, action is immediately taken to forward the request to the 

FAB-NO. The referring office makes note of any special requests or needs of the 

claimant. The hearing scheduler tracks incoming requests for oral hearings and 

assigns the hearing to an HR in one of the five FAB offices. 

b. Acknowledgement. Following the assignment of a hearing request to a FAB 

hearing scheduler, the hearing scheduler sends an acknowledgement letter to the 

claimant and any AR confirming receipt of the hearing request. See Exhibit 25-2

for a sample acknowledgment letter. Each claimant party to the FD is to be sent 

an acknowledgment. The acknowledgement must be sent 30 days prior to the 

date of the hearing and includes the following notifications: 

(1) The hearing will be conducted within 200 miles roundtrip of the 

claimant’s residence, absent compelling reasons to the contrary. 

(2) All sworn testimony offered during the hearing will be transcribed for 

inclusion into the case file.

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(3) The FAB, at its discretion, may schedule a telephone or video conference 

hearing. See paragraph d(2) below. 

(4) If the claim involves multiple claimants, each is allowed to participate in 

the hearing. 

c. Hearing Assignments. The hearing scheduler may assign a hearing to an HR from 

any one of the five FAB offices. The hearing scheduler sends a hearing 

acknowledgment letter, schedules a date and time for the hearing, reserves the 

physical space for the proceedings, arranges for a court reporter to record the 

proceedings, and transmits the entire case file to the assigned HR. All pertinent 

information relating to the hearing and related correspondence is captured in ECS. 

d. Scheduling. Each claimant is provided written notice of the hearing at least 30 

days prior to the scheduled date (unless waived by the claimant); advised that a 

one week notice must be provided to the FAB should he or she desire a person(s) 

other than himself or herself and his or her AR to attend the hearing; and advised 

that no independent video or audio recording of the hearing is allowed. See 

Exhibit 25-3 and Exhibit 25-4 for Sample Hearing Notice letters.

(1) Travel to Hearing. While the FAB will try to set the hearing within a 

reasonable distance of the claimant, the claimant may be required to travel 

up to 200 miles roundtrip to attend the hearing. There is no 

reimbursement to the claimant for the expense of this travel. However, if 

an unusual circumstance causes the FAB to schedule a hearing that 

requires the claimant to travel more than 200 miles roundtrip, OWCP will 

reimburse him or her for reasonable and necessary travel expenses as 

outlined in 20 C.F.R 30.314(2). 

In instances when multiple claimants request a hearing, the hearing is 

scheduled nearest the first claimant who requested a hearing. The 

remaining claimants are given the option to attend the hearing in person or 

participate via telephone.

 

(2) Telephonic and Video Conference Hearings. A hearing may be conducted 

by telephone or video conference at the FAB’s discretion, or by claimant 

request. Only the hearing scheduler can schedule such a hearing, which 

will include all the aspects of an in-person hearing.

 

(3) Scheduling Changes. The FAB will entertain any reasonable request for 

scheduling the time and place of a hearing, but such requests should be 

made when the hearing is requested. The hearing scheduler will make 

every effort to accommodate the scheduling request of the claimant. An 

in-person hearing may be changed to a telephone hearing if a claimant or 

AR so requests. This change must be coordinated through the hearing 

scheduler.

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Once the hearing has been scheduled and written notice has been mailed, 

it cannot be postponed at the claimant’s request for any reason except as 

indicated in paragraph 4 below. However, the hearing scheduler may 

accommodate minor scheduling changes requested by a claimant or AR. 

HRs may not independently make changes to the scheduled hearing time 

or place without supervisory approval. The change request must be made 

to the HRs supervisor and the supervisor will contact the hearing 

scheduling unit supervisor. 

The HR contacts the claimant(s) by telephone prior to the hearing to 

confirm they are planning to attend the hearing at the arranged date, time 

and location. 

 

(4) Postponing a Hearing. The FAB may grant a postponement of a hearing 

when the claimant or his or her AR has a medical reason that prevents 

attendance or when the death of the claimant’s parent, spouse or child 

prevents attendance. The claimant or AR should provide at least 24 hours 

notice. The FAB will make every effort to accommodate timely requests 

to postpone a hearing. 

In such cases, a new hearing will be set for the next hearing trip. Hearing 

scheduling unit supervisor approval is needed to postpone a hearing. 

(5) Failure to Attend. If a claimant does not attend the hearing at the 

designated time and place, and makes no effort to contact the HR to 

request a rescheduling based on one of the reasons outlined in paragraph 

d(4) above, the claimant will not be allowed to reschedule his or her 

hearing. In such instances, the claimant will be considered to have 

withdrawn the hearing request, and a review of the written record will be 

undertaken. If new evidence or argument accompanied the objection, it 

will be reviewed in the review of the written record.

(6) Cancellation of Hearing. If upon review, the HR determines that an error 

or other deficiency in the RD or in the initial case adjudication precludes 

the need for a hearing, and the FAB supervisor agrees, the HR will notify 

the claimant that the hearing will not be scheduled and a Remand Order 

will be prepared. 

When a hearing is canceled for any reason, the FAB acknowledges the 

cancellation in writing and gives the claimant 10 days from the date of the 

acknowledgement to submit additional evidence. The FAB representative 

then conducts a review of the written record. 

e. Review of Case File. Prior to the hearing, the HR reviews the evidence of record, 

as well as any additional evidence or materials submitted by the claimant, and 

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conducts whatever additional investigation is deemed necessary to prepare for the 

proceedings. If the additional evidence received establishes compensability or the 

need for further development and the FAB supervisor agrees, the HR will notify 

the claimant and/or AR that the claim will be remanded and the hearing will be 

canceled. If the evidence is sufficient to warrant reversal in favor of the claimant, 

FAB may issue a reversal. 

f. Multiple RDs. Since more than one RD can be issued prior to a hearing and 

additional objections and hearing requests may result, measures are needed to 

streamline the hearing process.

If more than one RD is pending a FD, the HR contacts each objecting claimant 

and advises that all objections, not just those pertaining to the RD that is the 

subject of the hearing request, may be discussed during the hearing. The 

claimant(s) will be encouraged to bring relevant evidence, even if it concerns a 

RD for which a timely objection was not filed. All telephonic contact prior to the 

hearing is documented in ECS. 

(1) Hearing Requests on Multiple RDs Pending a FD. When additional timely 

hearing requests are submitted based on other recommended denials prior 

to the date of the previously scheduled hearing, the HR contacts the 

requesting party to advise that all objections will be considered so that one 

hearing may serve to accept evidence and testimony on several different 

RDs. This process is designed to avoid multiple hearings. 

The HR notes the conversation with the claimant in ECS, confirming that 

the claimant was advised that all outstanding objections will be considered 

at the hearing. The HR updates ECS for each RD and each claimant 

requesting the hearing.

Separate hearing request acknowledgments and hearing notices are not 

required. The HR must be prepared to entertain objections about all RDs 

issued up to the date of the hearing and will take testimony and evidence 

on all outstanding objections. Each RD in question is considered in a 

single FAB decision once the FAB hearing process is concluded. 

(2) Hearing Request on One RD, Request for Review of the Written Record 

on Another. If a claimant has requested a hearing on one outstanding RD 

and a review of the written record on another, the HR allows the claimant 

to present evidence about the objections which are not the subject of the 

hearing, so long as FAB has not issued a FD on the review of the written 

record request. 

[If FAB has issued a FD on the request for review of the written record, 

see paragraph (4) below.] 

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(a) The objections and evidence are considered at the hearing and 

addressed in the post-hearing FAB decision. No review of the 

written record decision is issued. ECS must be updated to reflect a 

Request for a Hearing, rather than a Request for a Review of the 

Written Record.

(b) In cases with multiple claimants when one claimant requests a 

review of the written record and another requests a hearing, no 

decision is issued to either claimant until the hearing process is 

complete. FAB may contact the claimant who requested a review 

of the written record and ask if he or she would like to address 

objections to the RD for which a review of the written record was 

requested at the time of the hearing on the other RD. If he or she 

agrees, the Review of the Written Record is changed to a hearing 

in ECS. If he or she declines, his or her objections will be 

reviewed as part of the hearing decision. Coding in ECS must be 

updated to reflect a Request for a Hearing rather than a Request for 

a Review of the Written Record and a note should be added to ECS 

explaining this action. All claimants, whether they request a 

hearing or not, are served with notice of the hearing and are 

afforded the opportunity to be present at the hearing and 

participate. The request for Review of the Written Record 

objections and the objections discussed at the hearing will be 

addressed in one FD. 

(3) Hearing Request on One RD, No Objection Filed on Another. While 

awaiting a hearing on one RD, the FAB may issue a FD on another RD if 

the 60-day period for objecting has passed without objection from the 

claimant. However, if at the time of a hearing, there is one or more 

pending RDs, the claimant may offer testimony or evidence in response to 

any of the pending decisions, even if outside of the 60-day period in which 

to object. The FAB HR must subsequently address such testimony or 

evidence to determine whether a FD or Remand Order is appropriate. 

 

(4) Hearing Request on One RD, FD Issued on Another. A claimant may 

request a hearing on one RD and a reconsideration of a previously issued 

FD within 30 days of its issuance. 

(a) If a FD has been issued and a hearing is held regarding an 

outstanding RD within the 30 day post-decision reconsideration 

period, the HR reviews any new evidence related to the previously 

issued FD as a request for reconsideration. Reconsideration 

requests cannot be assigned to a FAB representative who has had 

prior involvement with the claim. If the FD was issued by the HR 

present at the hearing, the reconsideration request should be 

assigned to another FAB representative. A decision on the 

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reconsideration should be issued separately from the hearing 

decision. 

(b) If the claimant presents evidence or argument pertaining to a FD at 

the hearing and the hearing date is outside of the 30 day postdecision reconsideration period, the evidence is referred to the DD 

with jurisdiction over the case file for reopening consideration. 

8. Conduct of the Hearing. The hearing is an informal proceeding and the HR is not bound 

by common law or statutory rules of evidence or by technical or formal rules of procedure. 

Generally, the hearing is scheduled to last one hour, but the HR should not specifically limit the 

hearing to one hour and should never tell a claimant that he or she is limited to one hour. Also, 

the HR must bring a tape recorder to the hearing in case a court reporter is not present. The HR 

must ensure that the court reporter is using required back-up recorders.

a. Convening. At the scheduled time and place, the HR will meet with the court 

reporter, the claimant, and any AR. 

(1) If any other individual(s) is in attendance, the HR will request the identity 

of this individual(s) and have the claimant(s) sign a “Waiver of Right to 

Confidentiality” (See Exhibit 25-5) before convening the hearing. The 

claimant(s) sign a separate waiver (see Exhibit 25-6) if he or she requests 

that a member of the media be present. 

(2) If there are multiple claimants present, each is required to sign a waiver of 

confidentiality.

(3) At the start of the hearing, the HR indicates to the court reporter that he or 

she wishes to open the record of the hearing. He or she will note the date 

and time, identify all persons present by name, and enter a brief narrative 

into the record describing the events leading to the hearing, including the 

specific objection(s) raised by the claimant. If no specific objections have 

been raised, the HR should indicate this. 

 

For hearings addressing NIOSH Dose Reconstruction issues, the HR strictly follows the hearing 

script shown as Exhibit 25-7. The HR advises participants that he or she can discuss issues of a 

factual nature about the information provided to NIOSH and the application of methodology (see 

example below), but is not permitted to consider in the FD objections to the methodology 

employed by NIOSH in preparing the dose reconstruction report. 

APPLICATION OF METHODOLOGY

A claimant may present argument to the FAB that NIOSH made an error in the application of 

methodology such as applying the radiation dose estimate methods to his or her individual 

circumstances, or that NIOSH did not address a specific incident discussed in the phone 

interview.

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Another application issue might involve the use of “worst case” approach (which is a NIOSH 

method). The application aspect of this issue might be whether the “worst case” selected was the 

worst case (e.g., there were 20 more people working there that were not monitored and the worst 

case was based only on monitored individuals). 

 

Example of Application of Methodology. The objection alleges that NIOSH did not properly 

consider the “proximity to the source.” The NIOSH exposure matrix considers that the worker 

was one foot away from uranium billets/rods for six hours and one meter away for four hours. 

NIOSH considers this to adequately account for times when the worker would touch the uranium 

rods/billets, since there would also be times when the worker was at a much greater distance. 

This exposure matrix is drawn as the example of highest possible exposure, as no individual 

exposure records are available. The objection indicates that the worker handled the uranium 

metal more often than NIOSH allowed in the exposure matrix. This is a challenge to the 

application of the dose reconstruction methodology and can be addressed as part of the hearing 

process.

METHODOLOGY

20 CFR 30.318(b) provides that the "methodology" NIOSH uses in making radiation dose 

estimates is binding on the FAB. The "methodology" NIOSH uses is the way NIOSH performs 

the dose reconstruction, which is addressed in the statute and 42 CFR Part 82. “Methodology" is 

dictated by sections 7384n(c) and (d) of the statute. For example, those methods must be based 

on the radiation dose received by the employee (or a group of employees performing similar 

work) and the upper 99 percent confidence interval of the probability of causation in the 

radioepidemiological tables published under the Orphan Drug Act. The Act also requires 

NIOSH to consider the type of cancer, past health-related activities (such as smoking), and 

information on the risk of developing a radiation-related cancer from workplace exposure. 

The "methods" of dose reconstruction are set out in 42 CFR Part 82 and include: analyzing 

specific characteristics of the monitoring procedures in a given work setting; identifying events 

or processes that were unmonitored; identifying the types and quantities of radioactive materials 

involved; evaluating production processes and safety procedures; applying certain assumptions 

that err reasonably on the side of overestimating exposures while achieving efficiency; and using 

current models for calculating internal dose published by the International Commission on 

Radiological Protection (ICRP). The NIOSH “efficiency” process of using overestimates and 

underestimates in dose reconstruction is another example of a methodology. It is these 

"methods" that cannot be addressed by FAB. Any questions related to the content of NIOSHIREP software are also related to methodology, whereas questions related to the Department of 

Labor’s probability of causation calculation (which relies on NIOSH-IREP software) can be 

considered. 

Example of Objections to Methodology. The radiation dose to the claimant’s gall bladder was 

calculated using the highest recorded doses from other co-workers at the facility as the basis for 

the claimant’s dose estimate. This was noted in the text of the dose reconstruction report as 

being “the highest reasonably possible radiation dose.” No uncertainty values were assigned to 

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the claimant’s estimate because it was considered that the claimant’s “dose was no higher than 

this estimate.”

b. Testimony and Evidence. The HR will administer an oath to each person giving 

testimony. The HR should make clear at the outset that he or she cannot receive 

testimony from participants who are not under oath. If a witness arrives late, he or 

she must be sworn in before testifying. An attorney must not be sworn in since he 

or she simply presents arguments, objections or evidence but not testimony. 

(1) A court reporter shall record oral testimony and place it into the record. A 

court reporter may use only audio (not video) equipment. Moreover, 

neither the claimant(s), any AR nor anyone else present at the hearing may 

bring audio or video equipment to obtain an independent record of the 

hearing. 

(2) Any evidence or testimony a claimant wishes to enter into the record is 

entered, even if it pertains to a RD that was previously issued and the 60-

day post-decision timeframe to object has expired. The HR will accept all 

testimony and evidence presented at the hearing. 

(3) During the claimant’s testimony, the HR should note any additional 

questions or areas for exploration and make appropriate inquiries. The 

claimant can raise additional objections at this time. The HR should ask 

questions or request the claimant to elaborate so the objections are clearly 

understood. 

(4) Each exhibit is marked separately and identified on the record by name 

and number with a brief description of its content. The HR will state on 

the record that the exhibit is being entered into the evidence of record. 

(5) During the testimony the HR states whether there is a need to interrupt 

testimony and go off the record. When it is time to return on the record, 

the HR indicates this and, once back on record, provides a brief 

description of why it was necessary to go off the record. Time and issues 

discussed off the record should be kept to a minimum. 

The HR is responsible for maintaining order during the hearing. The HR 

should keep testimony on point. Should any of the hearing attendees cause 

a disruption or unreasonable delay in the proceedings, the HR will warn 

the disruptive attendee and terminate the hearing if the warning goes 

unheeded. 

(6) The HR spells unfamiliar words or names to help the court reporter 

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c. Conclusion. When all testimony has been given and all the exhibits marked and 

clarifications made, the HR explains that the record will remain open 30 days 

after the date of the hearing to permit the submission of additional written 

evidence or argument on the issue(s) in question. 

The HR also advises that the claimant will receive a copy of the transcript and 

will have 20 days from the date of mailing to request changes in writing to the 

record. The HR then closes the proceedings by noting the time and date. 

9. Post-Hearing Actions. After the hearing, the HR obtains a copy of the transcript from the 

reporting service. FAB must timely send the claimant a copy of the hearing transcript.

A cover letter accompanies the transcript, reminding the claimant that he or she has 20 days from 

the date of the letter to comment on the accuracy of the transcript in writing. The claimant is also 

advised that the record will remain open 30 days from the hearing date for the submission of 

additional evidence. 

a. Collecting Comments and Additional Evidence. The HR keeps the hearing record 

open for 30 calendar days after the hearing. At his or her discretion, the HR may 

choose to grant the claimant an extension for the submission of new evidence. 

However, the HR may only grant one extension not to exceed another 30 calendar 

days. 

(1) If the claimant submits additional evidence within 30 days after the date of 

the hearing, or comments on the transcript, the HR will enter such 

evidence into the record and weigh it when issuing the decision. 

 

(2) If the claimant does not submit additional evidence within 30 days after 

the date of the hearing, and does not comment on the transcript, the HR 

reaches a decision based on examination of the evidence of record. 

However, the HR must consider all evidence submitted, even if it arrives 

after the 30 day period, prior to issuing a FD. 

b. FD. After examining the documents associated with the hearing, the HR 

independently assesses the evidence, analyzes the conclusions of the RD for 

appropriate application of law, regulations and procedures, and evaluates the 

objections. If a determination can be made without further development, the HR 

issues a FD. 

c. Disposition of Case File. Once the HR issues the FD, the case file is returned to 

the DO that issued the contested decision, unless additional FAB review is needed 

on an outstanding RD. 

10. Receipt of New Claim or New Medical Evidence. If the DO receives new medical 

evidence or a new claim while the case file is at FAB, the DO promptly transfers the documents 

to the FAB office where the case file is located.

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a. New Medical Evidence Received. If FAB has the case file, receives new medical 

evidence, and has not issued the FD, the CE or HR reviews the new medical 

evidence and determines if the evidence pertains to a claimed condition or to a 

new, as-yet-unclaimed condition. 

(1) New Medical Evidence Pertaining to Claimed Condition. If the evidence 

pertains to a previously claimed condition and the RD recommends denial 

of benefits based on insufficient evidence relating to that condition, FAB 

has the discretion to determine if the new evidence, when reasonably 

considered with the totality of the evidence, is likely to support a reversal 

of the RD in favor of the claimant.

(a) If FAB concludes that the new medical evidence of the claimed 

condition supports a reversal of the RD to deny the condition, and 

no further development is needed, FAB reverses the decision in 

favor of the claimant and accepts the claim. 

(b) If FAB concludes that the new medical evidence does not support 

a reversal of the RD to deny, FAB upholds the denial. 

(c) If FAB concludes that the new medical evidence does not support 

a reversal of the RD, but that further development is needed, FAB 

remands the case to the DO.

(2) New Medical Evidence of an Unclaimed Condition. If new evidence is of 

a condition that has not yet been claimed, FAB sends the case to the CE2 

who issues a letter to the claimant addressing receipt of the new evidence 

and explaining the ability to file a new claim form. FAB then proceeds 

with its review of the case and issues the FD on the claimed conditions. 

b. New Claim Filed. If FAB has the case file, receives a new claim from a current 

claimant, and has not issued the FD, the CE or HR reviews the new claim and 

determines if any medical condition is being claimed for the first time. 

If the conditions are determined to be duplicative, FAB acknowledges receipt of 

the new claim in writing and advises that it will not lead to further development as 

no new medical conditions were claimed. However, in certain instances, a 

subsequent claim for a condition such as skin cancer may lead to the need for 

further development. 

In the event the claim is for a condition which has not previously been claimed, 

the FAB transfers the case file to the CE2 to add a new claim or a new medical 

condition to an existing claim and to develop the claim if necessary. If FAB 

receives new medical evidence or a new claim form while the case file is at a DO, 

FAB promptly transfers the documents to the DO where the case file is located. 

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(1) New Condition Claimed, Case in Posture for Denial. If a claim for a new 

medical condition is filed while the case is at FAB for denial of benefits, 

FAB has the discretion to determine if the new claimed condition, when 

considered with the totality of the evidence, is likely to lead to acceptance 

of benefits for the condition presently before FAB. 

(a) If FAB determines that coverage is likely, FAB remands the case 

to the DO without issuing a FD. 

(b) If FAB determines that coverage is not likely, the issue is 

forwarded to the CE2 for development. FAB then issues a FD on 

the matter adjudicated in the RD and notes in the opening of the 

FD that the development of the new claim is pending by the DO. 

(2) New Condition Claimed, Case in Posture for Acceptance. If a claim for a 

new medical condition is filed while the case is at FAB for a review of a 

RD awarding benefits, the case is forwarded to the CE2 to acknowledge 

receipt of the new claim and to advise that the DO will develop the newly 

claimed condition. FAB then proceeds to issue a FD on the conditions 

adjudicated in the RD. 

 

(3) New Claimant. In multi-claimant cases, if a new claim is received while 

the case is at FAB, and the claimant had not previously filed a claim, FAB 

remands the case to the DO for development of the new claim. 

11. One Year Requirement. To prevent undue delays in adjudication, 20 C.F.R. § 30.316(c) 

imposes a one-year limit on the amount of time a RD can be pending at the FAB before it 

automatically becomes a FD. Once the one year time frame has elapsed, there is essentially a 

regulatory/administrative FD. FAB CEs and HRs must ensure that a FD is issued prior to the 

expiration of a one-year deadline. FAB managers ensure that cases are assigned or re-assigned 

so as to prevent the expiration of a one-year deadline. 

a. No Objection or Hearing Request Filed. If the claimant did not object to the RD 

and did not request a hearing, and the RD has been pending at FAB for more than 

one year from the last date on which the claimant was allowed to file an objection 

or request a hearing, the RD becomes final on the one-year anniversary of that 

date. This would be 425 days [60 days to object + 365 days (one year)] after the 

RD date. 

b. Objection or Hearing Request Filed. A RD awaiting either a hearing or a review 

of the written record at the FAB will automatically become a FD on the one-year 

anniversary of the date the objection or request for a hearing was received in the 

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c. DEEOIC Director Reopened the Claim. A RD awaiting a FD following an order 

by the DEEOIC Director reopening the claim for a new FD shall be considered a 

FD on the one-year anniversary of the date of the Director’s reopening order.

d. One-Year Event Occurs. If the one-year time limit has expired, the RD 

automatically becomes a FD, and the case shall be transferred to the FAB-NO for 

review. 

The FAB CE/HR ensures the case file is sent to the FAB-NO to the attention of 

the FAB Operations Specialist. A memo from the district FAB Manager, through 

the FAB Chief, dated and signed by the FAB Chief, to the Director must be 

included with the case file. The FAB Operations Specialist ensures that the case 

file is sent to the NO to the attention of the Office of the Director. The memo 

requests that the regulatory/administrative FD (based on the one-year rule) be 

vacated so a formal FD can be issued. 

Once the case file is received in the NO, an assessment will be undertaken to 

determine whether it is necessary to vacate the regulatory/administrative FD. The 

Director may choose to allow an administratively finalized decision to stand and 

not issue a Director’s Order. However, if a Director’s Order is deemed necessary, 

it will specify whether the case file needs to be returned to FAB for a FD or to the 

DO for a new RD based on the evidence of record. Once the file is received back 

in the FAB or DO, the DO or FAB proceeds as instructed by the Director’s Order. 

 

e. Jurisdiction. Upon expiration of the one-year time period described above, FAB 

has no jurisdiction to remand the case for further development or to take any 

action other than that described above. 

12. CE2 Designated to the FAB. FAB offices are geographically located as noted in section 

3 above. However, since DO adjudicatory functions are sometimes required while a case is at 

FAB, each DO assigns certain CEs to handle DO development and adjudication while the case is 

at FAB. This process eases the burden of file sharing and allows for case files to be maintained 

in one central location while RDs are pending review or FAB is addressing objections by hearing 

or review of the written record and further DO-level development is required. 

 

a. Reporting and Roles. These CEs are called Co-Located Secondary CEs (CE2s) 

because the FAB CE (or HR) is considered the primary CE while the case is in 

FAB’s jurisdiction. This group of CE2s is referred to as the “Co-Located Unit.” 

The Co-Located Unit reports to either the DO or to the Policy Branch. 

b. Assign CE2 Role. To enable the CE2 role, the DD or designee e-mails the Unit 

Chief of the Policy, Regulations and Procedures Unit, with a copy to Energy 

Technical 

Support, requesting the role change. The e-mail contains the name of the CE and 

the reason for the request. The FAB manager to which the CE2 is co-located is 

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also copied on the e-mail, so that FAB is aware of personnel changes that affect 

FAB workflow. 

c. Development Memorandum for Co-Located Unit. A DO CE who prepares a RD 

must be aware of any outstanding claims issues not addressed in the RD and 

requiring further development. If more development is needed concurrent with 

FAB’s review of the case, the CE prepares a memorandum on gold-colored paper 

addressed to the FAB manager from the Senior CE, Supervisor, or DD who is the 

final reviewer of the RD. The subject line should read: “Co-Located FAB 

Development for File No. [file number].” 

The body of the memorandum addresses any outstanding claim issues that require 

development by the Co-Located Unit while the case is being reviewed by the 

FAB. When the RD is reviewed and signed, the memorandum is also reviewed 

and signed. Once this is done, the original memorandum is spindled on top of the 

case file documents. 

d. Receipt of Case by the FAB. The FAB CE or HR reviews any co-located 

development memorandum and notes any further development needed. The FAB 

CE or HR may also become aware of issues during their review.

If DO development is required where no co-located memorandum exists in the 

case file, FAB writes a memo to the CE2 outlining the issues that must be 

developed and sends the file to the co-located unit. The FAB CE or HR must not 

assign any development actions to the CE2 regarding matters before the FAB for 

review. The FAB CE or HR conducts any development necessary about matters 

before the FAB.

e. CE2 and FAB Coordination. The FAB CE or HR and the CE2 should coordinate 

their work to ensure that the file is where it is needed and the work can be 

completed. If both the FAB CE or HR and the CE2 need the actual file, the needs 

of the FAB CE or HR take precedence.

 

f. Development by CE2. When the FAB completes its initial review, the CE2 may 

request the case to determine whether the evidence of file is sufficient to issue a 

RD on an outstanding claim element. The CE2 inputs the appropriate action 

status in ECS. Jurisdiction should remain in the appropriate FAB office and not 

be changed to the DO. 

 

(1) Issuing a RD. Should the record contain enough evidence to support a RD 

on any of the outstanding claim elements, the CE2 issues a RD. The 

Senior or journey level CE in the DO (or DD designee) reviews and signs 

the decision before issuance. Once the decision is reviewed and approved 

by the appropriate individual at the DO, the CE2 returns the case to the 

FAB and reflects the transfer of the case in ECS. It is particularly 

important to issue a RD if the claim element is in posture for acceptance. 

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If additional elements of the claim require development, the CE2 prepares 

a memorandum as outlined below. There is no need to rush to issue a RD 

denying a claim element if alternate elements are being deferred. In such 

a situation, the CE2 should wait until the deferred elements are resolved 

before proceeding with a RD. An exception to this rule is if a hearing date 

has been requested or scheduled. In these cases, the CE2 proceeds with 

any appropriate denial prior to a hearing so that objections to all 

outstanding RDs can be entertained at one time, thus avoiding multiple 

hearings. 

 

(2) Further Development Required. If the DO development does not permit 

the CE2 to issue an additional RD, he or she completes whatever 

development is possible and returns the case to FAB. The CE2 prepares a 

memorandum on gold-colored paper to the DD explaining what 

development actions have been taken and what future actions are required. 

The memorandum is spindled on top of the case file. Throughout the time 

the case is in FAB, the CE2 continues development and issues RDs on 

approved claim elements as the requisite evidence is received and 

evaluated. 

g. RD Returned by Postal Service. If the case file is at the FAB for review of a RD, 

and the Postal Service returns the RD sent to a claimant as undeliverable, the 

assigned FAB CE or HR should quickly ascertain whether a simple mailing 

mistake (e.g. typographical error) occurred that is easily rectified, or whether the 

claimant’s mailing address is no longer valid. If the FAB CE or HR determines 

that the claimant’s mailing address is invalid, he or she transfers the case record to 

a CE2 for development. Once the CE2 receives the transfer; he or she evaluates 

the case evidence to identify any information that could help locate the claimant. 

The CE2 investigation should include making a reasonable effort to obtain new 

information that may assist in identifying the claimant’s valid mailing address. 

For example, the CE2 should request a forwarding address from the Post Office 

closest to the claimant’s last known address. See Exhibit 25-8. 

(1) Correct Address Not Found. If the CE2 cannot obtain the claimant’s 

current address, the CE2 places a memorandum in the file listing the 

actions taken to locate the claimant, and then administratively closes the 

claim until receipt of the claimant’s valid mailing address. 

(2) Correct Address Found, Claimant Did Not Notify DO. In the event the 

CE2 obtains the claimant’s current address, and the claimant did not notify 

the DEEOIC in writing of that change, the CE2 sends the claimant a copy 

of the RD from the file. The CE is to prepare a separate request to the 

claimant asking for written notice of his or her address change (See 

Exhibit 25-9). The letter is to allow 30 days for the claimant to submit 

written confirmation of his or her address change. The CE then files a 

memorandum into the case describing the actions taken regarding the 

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address problem, and transfers the case file back to the FAB. The FAB 

does not issue the FD until receipt of a written confirmation from the 

claimant of the correct mailing address. If the claimant does not submit a 

written confirmation of his or her address change within the 30 days 

requested, the FAB administratively closes the claim.

(3) Correct Address Found, Claimant Notified DO. In the event the CE2 

obtains written confirmation of the claimant’s proper address, and the 

wrong-address problem was not the claimant’s fault, the CE2 coordinates 

with the DO to re-issue the RD to the claimant with a new issuance date. 

In a multiple person claim, the CE must reissue the RD to all claimants, 

with a brief explanation of the matter contained in the RD cover letter. The 

CE2 spindles a memorandum explaining the situation into the case file. 

The CE2 then transfers the case file back to the assigned FAB CE/HR.

(4) Multiple Claimants. If a case has multiple claimants, and the Postal 

Service returns one or more claimants’ RDs because of an incorrect 

address, the CE2 undertakes development individually for each returned 

RD in accordance with the instruction provided above. At the conclusion 

of the CE2’s development, he or she prepares a memorandum for the case 

describing the outcome of development, which could include 

administrative closure for claimants with an invalid address. The CE2 

then returns the case to the FAB. The FAB CE or HR may then proceed 

to issue a FD to all claimants for which a valid and confirmed mailing 

address exists. Claims administratively closed due lack of correct mailing 

address, or failure to return written confirmation of a new address within a 

30 days, are referenced in the FD; however, the effected claimants are not 

party to the decision. The FAB explains in the FD that any shares of 

payable compensation on an administratively closed claim is held in 

abeyance until the claimant provides written confirmation of his or her 

correct mailing address. 

h. FD Returned by Postal Service. If the FAB has issued a FD and the Postal 

Services returns it as undeliverable, the responsible CE or CE2 staff person is to 

ascertain the correct mailing address for the effected claimant. If the assigned 

staff person obtains written confirmation of a new address from the claimant, he 

or she is to mail a copy of the FD to the claimant’s new address. In the event that 

the assigned staff person is unable to obtain a written confirmation of a new 

address, he or she is to refer the claim to the appropriate DO contact to initiate an 

administrative reopening. The assigned DO staffer will draft a Director’s Order 

for the file explaining that the mailing address of the claimant is invalid, attempts 

to obtain a valid address were unsuccessful, and that a reopening is necessary to 

allow for an administrative closure. In a multiple claimant situation, reopening 

and administrative closure will only apply to those claims where the DO cannot 

confirm an address. However, later, if the DO receives written confirmation of a 

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valid address on an administratively closed claim, it may then become necessary 

to reopen the other claims to permit for a reissuance of a unified FD. 

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CHAPTER 26 – FAB DECISIONS

1. Purpose and Scope. The Act and its implementing regulations provide for administrative 

review of all RDs. This Chapter describes the process by which the FAB performs that review 

and issues a FD or Remand Order on claims filed pursuant to the EEOICPA. This chapter also 

describes the FAB process following a claimant’s request for reconsideration of a FD. 

2. FDs. The FAB CE/HR reviews all evidence of record and the RD. Based upon that 

review, the FAB CE/HR issues an independent written decision addressing the appropriateness 

of the RD outcome. A FD of FAB may accept the findings presented in the RD, whether the RD 

awards or denies benefits, or reverse the RD if it denies the claim and the FAB CE/HR 

determines that the claim should be accepted. If FAB disagrees with the outcome of the RD, but 

there is insufficient basis to warrant a reversal, it issues a separate type of decision called a 

Remand Order. Guidance relating to the issuance of Remand Orders comes later in the chapter. 

As part of the content of a FD, the FAB CE/HR makes findings of fact and conclusions of law 

that support his or her position. 

There are several types of FDs:

a. Acceptances. When FAB receives a RD accepting a claim for benefits, the 

assigned CE/HR evaluates the evidence, and the written content of the RD to 

validate that the RD outcome is appropriate given the circumstances of the claim. 

In particular, the assigned FAB CE/HR is to determine whether the conclusion 

described in the RD is based on the proper application of EEOICPA legal, 

regulatory, or procedural standards to the facts of the case. Once the FAB CE/HR 

has determined the RD to accept was decided properly, he or she is to prepare a 

FD listing the findings of fact and conclusions of law that permit the final 

approval of the claim. 

(1) If the DO issued a RD accepting the claim in full and independent review 

by FAB concludes the acceptance is correct, FAB issues the FD awarding 

benefits in full. 

(2) If the DO has issued a RD accepting one or more claim element(s) while 

denying and/or deferring other elements, the FAB issues the FD on the 

accepted portion of the claim as soon as possible to expedite the 

claimant’s receipt of benefits. The FAB does not wait to issue the FD until 

the elements under development at the DO, or under contention due to 

denial, are decided. 

b. Denials. When FAB receives a RD in which the DO denies the claim in full or in 

part, FAB reviews the RD and independently reviews the case to ensure that 

appropriate development has occurred, the case has been adjudicated consistent 

with the law, regulations, policies and procedures and that the assessment of 

evidence has been interpreted reasonably to allow for a negative outcome. 

Provided no technical or procedural errors exist, FAB issues a FD to deny the 

claim.

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If the RD denies one claim element and defers another claim element pending 

further development, the designated CE2 continues to develop the claim element 

that is not before the FAB. 

(1) For non-contested denials, absent any technical or procedural error, the 

FAB issues a FD accepting the RD findings and denying the claim for 

benefits in cases where no timely objection is filed or a waiver is received. 

(2) For contested denials, the FAB considers the timely filed written objection 

by either conducting a hearing, if requested, or a review of the written 

record before a FD is issued, as appropriate. 

c. Decisions Issued in Response to an Objection. After considering a timely filed 

written objection by conducting a hearing that has been requested or, in those 

cases in which no hearing has been requested, by reviewing the written record, 

FAB issues a decision based upon its review of the record, consideration of the 

objections, and any new evidence. The FAB can issue a FD, a remand order 

returning the case file to the DO for further development or some other action, or 

a FD reversing a RD denying benefits.

Remand orders and FD reversals are discussed below and can be issued on both 

contested and non-contested claims. 

(1) A review of the written record (RWR) is performed after a claimant has 

objected to the findings of a RD without requesting an oral hearing. The 

FAB will review the written record, the claimant’s objection, and any 

additional evidence submitted to determine whether the RD findings can 

be adopted, reversed to accept the claim or remanded for further 

development. The FAB CE/HR must review all objections raised in the 

RWR objection letter and respond to each objection clearly and 

comprehensively. Once this review is complete, the FAB issues a decision 

based on its independent review. 

(2) If the FAB conducts a hearing and satisfies all of the requirements of the 

hearing process (see Chapter 25, FAB Review Process), a decision is 

issued. While the HR may entertain objections raised from several RDs at 

the hearing itself, one FAB decision will be issued that addresses each 

contested RD after the resolution of the entire hearing process. 

(3) In the decision following a hearing, the HR outlines the facts of the case, 

lists and comprehensively addresses all of the objection(s)(whether raised 

in the hearing request letter, subsequent letters, hearing testimony, or 

hearing exhibits) and thoroughly discusses the findings and/or conclusions 

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d. Reversal. A reversal is a FD issued when the evidence shows that either the RD 

denied benefits in error or new and compelling evidence warrants overturning a 

RD denial and accepting a claim for benefits. 

If there is evidence in the case that warrants a reversal, the FAB CE/HR reverses 

the decision with approval from the FAB Chief and issues a decision to the 

claimant without delay. If the claimant submits additional evidence, the FAB 

CE/HR reviews such evidence and determines whether it is sufficient to accept 

the case. If it is sufficient, and there are no outstanding development issues (such 

as SWC/Tort information), the FAB CE/HR may reverse the decision 

immediately and accept the case. If the evidence is sufficient to warrant further 

development, FAB remands the case. 

(1) A reversal can be issued when a case is denied in full or in part. In partial 

denials, the FAB may reverse to accept if the portion of the claim denied 

by the RD is found to be in posture for acceptance, a DO error is 

identified, or new evidence is received that warrants a reversal.

(2) A decision reversing the RD is used only where a denial is reversed to 

accept benefits. The FAB may not issue a reversal to deny benefits. The 

rationale for reversals must be clearly stated in the body of the decision 

and forwarded with the case file to the FAB Chief for review and 

approval. A reversal cannot be issued without such approval. 

(3) When considering a reversal, FAB must be mindful of tort offset/SWC 

coordination and determine whether anyone received a settlement that 

might reduce the EEOICPA benefit. 

 

3. Preparation of FDs. As with RDs, multiple FAB decisions are possible on one case. 

Given the requirement that any RD in which the DO decides the eligibility of any one claimant 

to receive benefits must include all claimants’ party to the decision, a FD cannot be issued 

deciding any one claimant’s eligibility to receive benefits without including all claimants with an 

interest in the claim as party to the decision. Accordingly, it is the responsibility of the FAB to 

remand any RD which does not comply with these procedures and instruct the DO to issue a new 

RD to address the eligibility of each party to the claim. This may require the reopening of certain 

claims, except in certain limited circumstances (see Chapter 27 – Reopening Process). 

FAB decisions are plainly written and provide the claimant with a descriptive explanation 

regarding the basis for the outcome. This ensures that the decision-making process is transparent. 

The FAB clearly identifies the Part of the Act under which benefits are awarded or denied so that 

the claimant clearly understands the decision. They include statutory/regulatory language in the 

conclusions of law when outlining the benefits being awarded or denied. 

a. Three Components. The FAB representative must prepare three components 

before issuing a FD (a sample of a complete FD is shown as Exhibit 26-1):

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(1) A cover letter explaining that a FD has been reached. The cover letter 

must clearly identify what is being accepted or denied and under what Part 

of the Act. This letter provides general information about the FD process 

and the administrative review available to the claimant.

(2) The FD. The FD contains a Statement of the Case, Findings of Fact and 

Conclusions of Law.

(3) Certificates of Service certify that each listed claimant and his or her AR

was mailed a copy of the FD and the date it was placed in the U.S. mail. 

A separate certificate of service is created for each claimant, but a 

claimant and his or her AR may appear on the same certificate of service.

An acceptance may include two other components: (1) a medical benefits letter 

explaining entitlement to medical benefits for an accepted condition (Exhibit 26-

2); and/or (2) an Acceptance of Payment form (EN-20), which is required before 

payment can be issued. 

b. Formatting and Content, FD for Acceptances, Contested Decisions, Denials, and 

Reversals. Where a FD is prepared for an acceptance, contested decision, denial 

or reversal, it must contain the following sections in the following sequence: 

(1) Statement of the Case. This section sets out the case history, relevant to 

the issue for determination, up to the point of the issuance of the FD, 

including FAB actions and other pertinent information in a clear, concise 

narrative. No analysis of the facts or law and no citations should appear in 

this section.

(2) Findings of Fact. This section is a recitation of all facts needed to reach 

the conclusions of law and the ultimate decision rendered by the FAB. 

The findings of fact are the most significant findings from the Statement 

of the Case that are needed to support the FD ruling. Each finding is 

numbered sequentially. The findings should draw conclusions from the 

evidence of record, and must not simply recite the statement of the case.

(3) Objections. This section contains a summary of any timely objection 

brought up by the claimant or AR in connection with the RD(s) before 

FAB, as well as FAB’s response to these objections. The summary should 

mention all timely objections in a clear and orderly manner, but the 

summary does not need to be numbered and it may combine similar 

objections. All summarized objections must be responded to, with a 

discussion of FAB’s analysis of the objections in respect to entitlement 

requirements and an explanation of whether the objections have an impact 

on the adjudication of the claim. In most situations, to fully respond to the 

objections, the Objections section will need to make reference to the Act, 

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regulations, or procedures. Therefore, citations are necessary and 

appropriate in this section. 

(a) Objections to NIOSH Dose Reconstruction Decisions. Detailed 

procedures for objections to the NIOSH process and referrals to the 

DEEOIC HP are found in Chapter 25, FAB Review Process. 

(i) Factual objections in FD. If the claimant submits a factual 

objection and the factual findings reported to NIOSH are 

supported by the evidence of record, the FAB CE/HR 

addresses the objections in the FD. No referral to the 

DEEOIC HP is necessary. If the factual findings reported 

to NIOSH do not appear to be supported by the evidence of 

record the FAB CE/HR refers the case to the HP for 

review. If the HP determines that a rework of the dose 

reconstruction is not necessary, the FAB CE/HR addresses 

the objection in the FD by outlining the findings of the HP. 

However, if the HP determines that a rework of the dose 

reconstruction is necessary, the FAB CE/HR remands the 

case to the DO. 

 

(ii) Technical Objections in FD. A technical objection 

involving either methodology or application must be 

referred to the DEEOIC HP. If the DEEOIC HP deems 

none of the technical objections plausible, the FAB CE/HR 

incorporates the findings on these technical issues into the 

FD. 

However, if the DEEOIC HP determines that there is 

substantial factual evidence that NIOSH had not previously 

considered and/or that NIOSH should consider an issue 

relating to application of methodology, he or she notifies 

the FAB CE/HR, who then remands the case, after 

supervisory approval, to the DO with instructions to refer 

the case back to NIOSH. In most cases, NIOSH will 

perform a new dose reconstruction based on circumstances 

of the remand. 

 

(iii) Objections to Methodology in FD. When an objection is 

directed at NIOSH’s methodology, the FAB CE/HR states 

in the decision that the objection cannot be addressed based 

on 20 CFR § 30.318(b) (methodology that NIOSH uses in 

arriving at reasonable estimates of radiation doses is 

binding on the FAB). The FAB CE/HR makes this 

statement only if so advised by the DEEOIC HP. 

Objections related to the content of NIOSH-IREP software 

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are also related to methodology. However, the calculation 

of the probability of causation using the IREP software is 

the responsibility of the DEEOIC; therefore, FAB must 

address these objections in the FD. 

 

(iv) Conclusions of Law. This section contains the statutory 

and regulatory analysis used by the FAB reviewer to 

support his or her decision, referencing the findings of facts 

that support the conclusions of law. This section must be 

well-reasoned and provide appropriate legal citations. It 

should not, however, consist of a list of statutory and 

regulatory references without any explanation. This section 

also discusses any objection raised by the claimant in 

writing or through an oral hearing and includes FAB’s 

response to the objection based on FAB’s analysis of the 

objections and evidence of file. Finally, an overall legal 

conclusion supporting the decision must be reached. The 

conclusions of law must specifically identify whether or not 

benefits are being awarded or denied and under which Part 

of the Act. 

c. Return of FD by Postal Service. Should FAB receive a returned FD, the FAB 

CE/HR will attempt to obtain the new or updated address for the claimant and remail the decision. More details regarding the handling of a returned FD are 

outlined in Chapter 25, FAB Review Process. 

4. Remand Orders. If the FAB determines that the claim(s) addressed in the RD are not in 

posture for FD, 20 C.F.R. § 30.317 gives FAB the authority to return cases to the DO without 

issuing a FD. A Remand Order is a written directive to the DO issued in lieu of a FD. 

 

A Remand Order is written in narrative format to the claimant(s), but does not contain the 

normal sections of a FD (Statement of Case, Findings of Fact, and Conclusions of Law). 

However, where objections have been filed or a hearing has been held, the remand order should 

discuss and respond to the objections raised. 

A Remand Order may instruct the DO to perform further development, address an error or other 

deficiency contained in a RD, address new evidence or a new claim received prior to the 

issuance of the FD, or address a change in the law, regulations, policies or procedures. A 

Remand Order can be warranted at any point during a review of the written record, before or 

after a hearing, or during the review of a RD. 

FAB is to use reasonable discretion when assessing a case for remand. If the RD provides sound 

reasoning and thorough discussion of how it reached its conclusions and does not include 

material factual errors or erroneous application of law, the FAB must respect the DOs 

adjudicatory function. If FAB can make a reasonable determination that the outcome of the case 

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would not be materially affected regardless of further development, FAB should exercise its 

discretion and not issue a Remand Order 

Should the FAB find a technical, procedural, or some other error requiring a remand order, the 

FAB returns the case file to the DO with specific instructions in the remand order as to how to 

proceed further. Remand orders are largely issued in instances where further development is 

required at the DO level. FAB does not issue a remand order where FAB personnel can conduct 

minor development to resolve the issue at hand. 

a. Change in Law, Regulations or Policies. If FAB determines that a RD outcome is 

erroneous in light of a recent change in the law, regulations, or policy, FAB may 

remand the case. When this occurs, the Remand Order is to include specific 

narrative content explaining the basis for returning the case to the DO. For 

example, newly designated SEC class, changes to the DOE facility or AWE 

facility coverage, date or facility changes to the list of residually contaminated 

sites, modified program information on toxic substance or occupational health 

effects data or other regulatory or policy changes that could affect the claim 

outcome. 

 

b. Erroneous Application of Law, Regulations, Policies or Procedures. If FAB 

determines that the recommended determination in the RD resulted from a 

misapplication of the law, regulations, policies or procedures, FAB may remand 

the case. The Remand Order identifies the misapplication of law, regulations, 

policies or procedures and describes how it effects the adjudication of the case. To 

expedite a favorable decision, the FAB CE/HR can reverse the decision without 

issuing a Remand Order, following procedures set forth in subpart 2.d of this 

chapter.

c. Receipt of New Medical Evidence or a New Claim for a Previously Unclaimed 

Illness. If while the case is at FAB, new medical evidence or a new claim for a 

new illness is received that is material to the recommended denial, FAB may 

remand or reverse to accept the claim, as applicable. 

For example, if the RD denies a claim for CBD on the basis of a lack of medical 

evidence and the claimant later submits medical evidence establishing CBD, the 

FAB may remand the claim or reverse the RD if all elements of the adjudicatory 

process are complete.

If a claim for a new illness is received, the case will be remanded for development 

of the newly claimed illness if it will affect the outcome of the issue before the 

FAB. If filing of the new claim will not affect the issue before the FAB, the FAB 

can issue a FD and return the new claim to the DO for further development. If the 

FAB is not immediately ready to issue the FD, then the CE2 should create the 

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new claim and begin development while the case is at FAB. 
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d. Receipt of Other New Evidence. If FAB receives new evidence that was not a 

part of the file when the RD was issued and that is material to the recommended 

determination (such as employment evidence, survivorship evidence, or evidence 

of a SWC/tort suit); FAB may remand the case or reverse the RD if it is 

advantageous to the claimant. The Remand Order will describe the new evidence 

and its possible effect on the adjudication of the case. 

e. Evidence Already in File. If the RD fails to properly address material evidence in 

the file and the failure could have an effect on the adjudication of the claim, FAB 

may remand the case. The Remand Order will describe the evidence and its 

possible effect on the adjudication of the case. If advantageous to the claimant, 

and all adjudicatory issues are complete, FAB may reverse the RD and accept the 

claim.

For example, if evidence in the file sufficiently supports a diagnosis of a claimed 

cancer but the cancer was not included in the dose reconstruction, FAB may 

remand the case for a re-work of the dose reconstruction. 

f. Miscalculation of Tort Offset or SWC Coordination. If FAB determines that the 

RD contains a finding of fact or conclusion of law that is based on a material 

miscalculation of the offset arising from a tort lawsuit or SWC coordination, FAB 

may remand the case. 

(1) If a case is remanded for this reason, FAB includes its calculation 

worksheet in the file and a supplemental explanation of what FAB 

considers the evidentiary basis for its calculation. 

(2) If FAB determines that the miscalculation was relatively minor and was 

not favorable to the claimant, FAB may exercise its discretion and issue a 

FD which corrects the calculation in the claimant’s favor, without a 

remand.

g. Where a case is at FAB for review of one claim element and a remand order is 

issued on another claim element; the designated CE2 addresses the remand order. 

If there are no outstanding issues before FAB, the remand order and case file is 

returned to the DO that issued the RD. FAB may also issue remand orders in part, 

returning one portion of the claim to the DO for further action and issuing a FD 

on other portions of the claim. 

 

h. Format of Remand Order. A Remand Order follows a narrative format and is 

directed to the DO which issued the RD. It includes a brief discussion of the 

claim’s adjudicatory history when pertinent to the matter at hand, the basis for the 

remand, any explanation and supplemental documentation required and an 

explanation of the actions to be undertaken by the DO. A sample Remand Order 

is shown in Exhibit 26-3. 

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 i. Notification and Transfer of File. When a Remand Order is issued, FAB inserts 

 into the case file a copy of the Remand Order, certificate of service, and any 

 supporting calculations or supplementary documentation. FAB sends a copy of 

 the Remand Order, certificate of service, and cover letter to the claimant and the 

 AR, if any. 

(1) The cover letter explains the Remand Order and the DOs responsibility for 

preparing a new RD after further development. Additionally, the cover 

letter advises the claimant to which office the case file is being forwarded, 

and provides the address and telephone number of that office. See Exhibit 

26-3. 

(2) A certificate of service, which certifies the Remand Order was mailed on a 

certain date, is also prepared for each individual recipient, attesting to the 

date the remand order is sent, and is also included in Exhibit 26-3. 

(3) Upon issuance of a Remand Order, FAB transfers the case file to the DO 

 that issued the RD. 

 

j. Challenging a Remand Order. No procedure allows a claimant to directly 

challenge a Remand Order, but each DD has the authority to formally challenge a 

FAB Remand Order with the DEEOIC Director if sufficient cause exists to do so. 

In such instances, the DD prepares a memorandum to the Director of the DEEOIC 

outlining his or her concerns and the case file is transferred to the Office of the 

Director for review.

5. Administrative Closure. If FAB determines that an individual claim requires 

administrative closure, a Remand Order is not necessary. These situations include: 

a. Claimant Withdraws Claim. If a claimant advises the DEEOIC that he or she 

wishes to withdraw the claim, the FAB administratively closes the claim and 

drafts a memo to the file explaining the reason for the closure. Additionally, the 

FAB is to send a letter to the claimant advising him/her of the administrative 

closure. 

b. Claimant Dies. If the claimant dies after the issuance of a RD but prior to 

issuance of the FD, the decedent’s claim is administratively closed by the FAB. 

In the case of a single claimant, the FAB returns the claim to the DO to pursue 

survivor claims. In situations involving multiple claimants, the case is remanded 

to the DO for the issuance of a new RD which reallocates benefits. However, if 

the RD is recommending denial of all claims, the FAB may issue a FD to the 

remaining survivors, denoting the administrative closure of the decedent’s claim. 

c. Claimant Cannot be Located. When a RD is returned by the Postal Service and a 

current address for the claimant cannot be obtained by the Co-Located Unit within 

a reasonable period of time, the FAB administratively closes the claim and returns 

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the case file to the DO. In situations involving multiple claimants, the FAB issues 

a FD to the remaining survivors, denoting the administrative closure of the 

claimant whose address could not be determined, and outlining that the share of 

compensation of the claimant whose claim has been administratively closed will 

be held in abeyance. 

d. SWC/Tort/Fraud Statements (EN-16) Not Obtained. Where signed statements are 

required regarding tort lawsuits, SWC claims and any possible fraud committed in 

connection with an application for or receipt of any federal or state workers’ 

compensation benefit, and the claimant has not submitted such statements within 

30 days of the issuance of the RD, the FAB administratively closes the claim. A 

memo to the file is drafted explaining the reason for the closure, and a letter is 

sent to the claimant advising him/her of the administrative closure.

In instances involving multiple claimants and one or more claimants have not 

submitted the required EN-16, the FAB issues a FD to the claimants who have 

submitted a signed EN-16, denoting the administrative closure of the claimant(s) 

who failed to submit an EN-16. The share of compensation of the claimant(s) 

whose claim(s) has been administratively closed will be held in abeyance.

When a consequential injury is to be accepted, the CE must get a new signed EN16 SWC/Tort/Fraud affidavit from the claimant for that consequential injury.

FAB’s responsibilities in obtaining the appropriate EN-16 forms are described in 

further detail in Chapter 30 - Tort Action and Election of Remedies and Chapter 

31 – Coordinating State Workers’ Compensation Benefits. 

6. Claimant Rights Following the Issuance of FAB FDs. A claimant may seek review of a 

FD by filing a request for reconsideration or by filing a request for reopening of the claim. This 

section discusses requests for reconsideration and provides guidance relating to the initial receipt 

of requests for reopening. 

 

a. Receipt of a Request for Review.

(1) A request for reconsideration will be considered timely if it was filed 

within 30 calendar days of the date of issuance of the FD. Pursuant to 20 

C.F.R. § 30.319(b), the request will be considered to be “filed” on the date 

the claimant mails it to the FAB, as determined by the postmark, or on the 

date the written request is actually received by the DO or FAB, whichever 

is the earliest determinable date. A request for reopening may be filed at 

any time after the FD is issued.

(2) Any correspondence from a claimant or AR which is received in the DO 

or FAB within 30 calendar days after the FD is issued, and which contains 

either an explicit request for reconsideration or language which could be 

reasonably interpreted as intent to disagree with the FD will be considered 

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a timely request for reconsideration. If new evidence is received in the DO 

or FAB within 30 calendar days after the FD issuance, and the new 

evidence relates to an issue which was adjudicated and denied in the FD, 

this new evidence will be considered a timely request for reconsideration. 

If the DO receives the request for reconsideration, it must be sent to FABNO for handling. 

(3) Upon receipt of correspondence or new evidence which constitutes a 

timely filed request for reconsideration, FAB will send a letter to the 

claimant acknowledging receipt of the correspondence or evidence and 

advising that such receipt is considered a timely filed request for 

reconsideration. 

(4) If correspondence received within 30 calendar days of the FD specifically 

requests a reopening instead of reconsideration, it will be handled as a 

reopening request by the DO. If both reconsideration and reopening are 

requested, FAB will process the reconsideration request first and then 

forward the claim to the DO to process the reopening request. 

 

(5) A request for reopening may take several forms: 

(a) Any correspondence or evidence containing or accompanied by a 

specific request for reopening, which is received at any time after 

the issuance of the FD, will be treated as a reopening request. 

(b) If correspondence or evidence is received without a specific 

request for reopening after the deadline for a timely 

reconsideration request, and the FD denied the claim to which the 

correspondence or evidence relates, the evidence is reviewed for 

possible reopening. 

If FAB determines that such correspondence or evidence meets the 

evidentiary requirements set forth in 20 C.F.R. § 30.320(b), the 

FAB-DO district manager or the FAB-NO Branch Chief will 

prepare a memorandum to the EEOICP Director outlining the 

relevant claim history and the nature of the evidence and forward 

the case file to the EEOICP Director for review for possible 

reopening. 

Should the evidentiary requirements not be met, FAB will 

associate the correspondence or evidence with the case file. In 

either case the claimant will not be notified of the actions taken by 

the FAB, because the claimant has not requested a specific action. 

 

(6) Upon receipt of a request for review: 

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(a) Any request for reconsideration, along with the case file, is 

forwarded to FAB and assigned to a FAB CE/HR for review. A 

reconsideration request will not be assigned to a FAB CE/HR who 

issued the FD for the specific claim element being addressed in the 

reconsideration request. 

Additionally, should the claimant specifically request that the 

reconsideration be addressed by a different FAB office, every 

effort should be made to accommodate the claimant.

The FAB CE/HR will screen the case to determine if the 

correspondence constitutes a request for reconsideration and, if so, 

if the request was timely filed.

 

(b) All requests for reopening received in the DO are initially 

reviewed by the DD. If a reopening request is received in FAB, 

the FAB-DO district manager or FAB-NO Branch Chief will 

transfer the request, any supporting evidence, and the case file to 

the DD for review. 

 

(7) Upon receipt of a timely request for reconsideration, the FD in question 

will no longer be deemed “final” until a decision is reached on the 

reconsideration request. Receipt of a request for reopening does not have 

a similar effect and the subject FD remains “final” until such time as the 

EEOICP Director issues an order reopening the claim. 

(8) A reconsideration request does not come with further reconsideration 

rights but only reopening rights or right to file suit in District Court. 

Therefore, if FAB denied a request for reconsideration and the claimant 

subsequently files another request for reconsideration of the same FD, 

FAB will not entertain the subsequent request. A letter explaining to the 

claimant that reconsideration rights attach only once to a FD is signed by 

the FAB chief.

b. Processing an Untimely Request for Reconsideration. 

(1) Any initial reconsideration request which is filed after the above-noted 

deadline is an untimely filed request for reconsideration. 

 

(a) No letter is sent to acknowledge receipt of an untimely request for 

reconsideration. FAB issues a Denial of Request for 

Reconsideration advising the claimant that the request for 

reconsideration was not filed within 30 days of the issuance of the 

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(b) If FAB concludes that any evidence received with an untimely 

request for reconsideration may warrant a reopening, FAB may 

forward the request to the DD of the DO with jurisdiction over the 

claim for review. 

(2) If an untimely filed request for reconsideration is accompanied by a 

specific request for reopening, FAB issues a Denial of Request for 

Reconsideration based on the untimely filing. The FAB CE/HR then 

forwards the reopening request with the case file to the DD of the office 

with jurisdiction over the claim for review for possible reopening. 

 

c. Adjudicating a Timely Request for Reconsideration. Requests for reconsideration 

typically come in a number of different forms. To determine the appropriate 

action to be taken in response to the request, the FAB CE/HR must review the 

request and, if appropriate, any accompanying argument or evidence. 

 (1) If the request for reconsideration simply states 

that the claimant disagrees with the FD and provides no new argument or 

evidence in support of their request, the CE/HR may simply deny the 

request for reconsideration on the grounds that no argument or evidence 

was submitted that would alter the FD. See Exhibit 26-4. 

(2) If the request for reconsideration raises new legal arguments with respect 

to the FD but includes no new evidence, the CE/HR reviews the FD and 

considers the arguments made by the claimant. The reviewer must 

examine the evidence of record and the FD challenged by the claimant. 

See Exhibit 26-5. 

 

(a) If the arguments do not change the outcome of the FD under 

review, the request for reconsideration is denied with appropriate 

and specific response to the arguments made in the request. FAB 

does not make any factual findings. 

(b) If the arguments made in the request for reconsideration support a 

conclusion that there was a misapplication of the law, regulations 

or procedures in the FD, the request for reconsideration may be 

granted, and the case remanded to the DO or a new FD issued by 

the FAB reversing to accept the claim.

(3) If the request for reconsideration includes evidence which is duplicative, 

or essentially duplicates that which is already in the file and was 

previously considered in the FD, the request is denied with an explanation 

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(4) If the request for reconsideration includes new, probative evidence which 

would alter the outcome of the FD, the request for reconsideration is 

granted.

d. Effect of denial or grant of reconsideration on finality.

(1) If the FAB denies the request, the FAB decision which was the subject of 

the request will be considered “final” on the date the request is denied. No 

further requests for reconsideration of that particular FD of the FAB will 

be considered. 

(2) If the FAB grants the request for reconsideration and issues a new FD, that 

decision will become final on the date of its issuance. Accordingly, the 

FAB will consider subsequent requests for reconsideration pertaining to 

that decision. 

(3) If the FAB grants the request for reconsideration and remands the case to 

the DO for further development, the claimant(s) will receive a new RD 

with the full rights that go with a RD and a new FD. 

 

7. Alternative Filing, Part E. If a claimant is denied as an ineligible survivor under Part E, 

he or she has the right to alternatively receive a non-decision determination regarding the 

employee’s claimed illness (es). FAB advises the claimant of this right in the cover letter of the 

FD (see Exhibit 26-6 for a sample cover letter). Additional information regarding Alternative 

Filing can be found in Chapter 20, Establishing Survivorship..

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CHAPTER 27 – REOPENING PROCESS

1. Purpose and Scope. This chapter describes the process by which the Director of the 

DEEOIC reopens claims for benefits under the EEOICPA and vacates decisions of the FAB. 

2. Authority. Under 20 C.F.R. § 30.320, the Director of the DEEOIC has the authority to 

reopen a claim and vacate a FAB decision at any time after the FAB has issued a FD pursuant to 

20 C.F.R. § 30.316. Also, under 20 C.F.R. § 30.320(a), the Director may vacate a FAB Remand 

Order. While any party to a FD may submit a written request for reopening, it may also occur at 

the discretion of the Director of the DEEOIC for administrative reasons, due to procedural error, 

or a change in the law, regulations, agency policy, or any other reason at the sole discretion of 

the Director. If the Director initiates such a review, the NO requests the case file from the 

District or FAB Office for the reopening to be handled locally or delegates the authority for the 

reopening to be handled at a DO through procedural directive. The Director’s decision to reopen 

a claim and vacate a FAB decision is not reviewable.

The Director will delegate reopening authority by issuance of policy directives or other formal 

guidance that explains the extent of reopening authority conferred. In certain circumstances, the 

Director may delegate authority to reopening claims to the Branch Chief of the Policy Branch, 

the Unit Chiefs for the PRPU, and the DDs. For delegated reopening authority granted to the 

DDs, the delegation applies to ADDs when agreed to by a DD. The DEEOIC Director can grant 

reopening authority to other individuals in the program as needed. The Director retains sole 

reopening authority in any instance where he or she has not delegated reopening authority. 

3. Claimant’s Explicit Request for Reopening. The regulations allow a claimant or a 

claimant’s duly AR, at any time after the FAB has issued a FD, to file a written request seeking 

reopening of a FD under the EEOICPA, pursuant to 20 C.F.R. § 30.320(b). The Regulations 

allow that such a request may be filed:

Provided that the claimant also submits new evidence of either covered employment or exposure 

to a toxic substance, or identifies either a change in the PoC guidelines, a change in the dose 

reconstruction methods or an addition of a class of employees to the SEC. 

There is no limit to how many times a claimant may request a reopening. A written request for a 

reopening is to result in a written decision either accepting or denying the reopening. 

a. Timeliness. A claimant may file a request for reopening at any time after the 

FAB issues a FD. The CMR is to associate incoming reopening documentation to 

the case record in the OWCP OIS. Upon review by the responsible staff person in 

the DO or FAB, the reopening is marked as reviewed and indexed clearly as a 

request for reopening. 

b. Initial Review. The responsible staff person who screens the incoming reopening 

request in OIS is to direct the documentation to the DD responsible for the case 

file. 

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Requests for reopening received in the NO FAB (FAB-NO) are reviewed by the 

FAB-NO Branch Chief. The DD or FAB-NO Branch Chief is to conduct an 

initial review of the correspondence to determine whether the request is 

accompanied by new evidence, or other information, which is of a sufficiently 

compelling nature to warrant a reopening. 

c. Referral for Reopening Action. Once initial review of a reopening request is 

completed, the DD or FAB-NO Branch Chief is to determine the responsible 

party for issuing a reopening decision. In many instances, the DD will have 

authority to issue a reopening decision on his or her own authority, as delegated 

by the Director. The FAB-NO Branch Chief, however, does not have the capacity 

to reopen a FD. Accordingly, he or she is to decide the appropriate office to 

which the reopening request is referred for review. The options available to the 

FAB-NO Branch Chief are to refer the matter to a DD with jurisdiction over the 

case or refer it to the DEEOIC Director. Circumstances in which a DD can 

reopen a FD are as follows:

(1) Employment. Newly submitted employment evidence contradicts a FD 

 that the employee did not have covered employment. 

(2) Survivorship. A previously denied survivor submits new evidence to 

document his or her qualifying relationship to the employee. A DD may 

also reopen a FD when a new survivor subsequently files a claim in a 

multiple claimant case and is determined to be eligible. 

(3) SEM. An update occurs to SEM or the claimant presents new factual 

evidence that a previously denied, closed, or unverified toxic substance 

exposure is newly shown to be linked to the claimed illness(es). 

 

(4) PoC. Cases containing a FD based on a PoC of 50% or less are reopened 

by the DD when new evidence is received that warrants a referral to the 

NIOSH resulting in a revised PoC that makes the claim compensable. 

This most commonly occurs with claimant submission of an additional 

cancer claim. In those instances where a new cancer is evaluated by 

NIOSH and does not result in a PoC of 50% or greater, a reopening of the 

prior FD is not necessary. The DD directs his or her staff to proceed with 

any additional development that may be warranted (Part E analysis for 

non-radiogenic toxic substances) or proceed with a recommendation to 

deny the new cancer claim if Part E does not apply.

(5) New Medical Evidence. New medical records or documentation is 

submitted, which clearly establishes a diagnosis of a medical condition or 

the existence of a percentage of permanent partial impairment, previously 

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(6) Change in Law, Regulations or Policies. If the initial review reveals that 

the claimant has identified a change in the law, regulations, or policies 

governing the EEOICPA, the DD determines whether the nature and 

extent of such information satisfies the requirements of 20 C.F.R. § 

30.320, and whether it is sufficient to warrant reopening. 

d. Denial of Request for Reopening. If no evidence is submitted, or if the evidence 

submitted and/or the change in law, regulations, or policies identified by the 

claimant is insufficient to support a reopening, the DD issues a Denial of Request 

for Reopening. 

e. Referral to DEEOIC Director. If the DD or FAB-NO Branch Chief cannot 

determine whether the evidence submitted, and/or the change in law, regulations, 

or policies identified by the claimant, is sufficient to warrant a reopening, or if the 

request presents an issue for which the Director has not delegated reopening 

authority, he or she is to refer the matter to the DEEOIC Director. A DD or the 

FAB-NO Branch Chief is to refer to the Director requests involving uniquely 

complex or potentially sensitive topics. In these instances, the person making the 

referral to the Director prepares a memorandum explaining his or her reasons for 

requesting the Director review the case for reopening. The memorandum is to 

outline the case history, the evidence of record and explain why the new evidence, 

or other information, is material to a potential reopening. It is important that the 

DD or FAB-NO Branch Chief merely identify the issue(s) requiring review. He 

or she is not to advocate for a particular reopening outcome, as that is the 

exclusive purview of the DEEOIC Director. 

4. Claimant’s Non-Specific Correspondence or Evidence. Once FAB issues a FD there may 

arise situations where a claimant submits non-specific correspondence or evidence. Under these 

circumstances, it is difficult to interpret the documentation to determine if the claimant is 

objecting to a particular Conclusion of Law referenced in the FD. To address this problem, it is 

necessary for the staff person responsible for the claim to contact the claimant by telephone to 

ascertain his or her intent to pursue an objection. 

During contact with the claimant, the responsible CE or FAB representative is to notify the 

claimant of his or her options, which may include reconsideration within 30 days of the FD (if 

applicable) or evaluation under the authority granted to the Director to reopen a claim. If the 

claimant provides written or verbal clarification of his or her intention, the CE or FAB 

representative is to input a note in the ECS documenting clearly the information provided. 

Should the CE or FAB representative not reach the claimant by phone within a reasonable period 

(approximately 3 days), and clarification cannot be obtained by telephone, he or she will need to 

evaluate the evidence to determine the appropriate action to be undertaken. 

a. Non-Specific Correspondence or Evidence Received Within 30 Days of a FD. If 

attempts to clarify the intent of the claimant are not successful, and the 30-day 

period granted to request reconsideration has not expired, a DO FAB Manager or 

FAB-NO Branch Chief is to determine if a sufficient basis exists to treat the 

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documentation as a request for reconsideration. A DO FAB Manager or FAB-NO 

Branch Chief can delegate this responsibility to other FAB staff persons. If it is 

determined that the evidence warrants a reconsideration determination, a DO FAB 

Manager or FAB-NO Branch Chief ensures that the matter is referred to the 

proper FAB staff person to record the request as a reconsideration requiring 

action. 

b. Non-Specific Correspondence or Evidence Received After 30 Days of a FD. 

Once the claimant’s option of requesting reconsideration expires, the claimant 

only has the ability to pursue reopening should he or she disagree with a FD. 

With the receipt of non-specific correspondence after the period of 

reconsideration submission expires and efforts to have the claimant clarify his or 

her intent to request reopening are unsuccessful, the staff person in possession of 

the file is to coordinate with the DD with jurisdiction over the case file to 

determine the appropriate course of action. The DD (or his or her delegate) 

reviews the evidence to determine whether there is sufficient basis to warrant a 

reopening, and whether he or she has been delegated authority to reopen based on 

the case circumstance. If the DD or their delegate decides that the evidence 

supports taking reopening actions and possesses the authority to reopen the FD, 

he or she proceeds to review the case for a reopening decision. If the DD does not 

have the requisite authority to reopen the FD, or there is some other complication, 

he or she seeks guidance from the DEEOIC Director. 

c. Non-specific Evidence That Does Not Warrant Reconsideration or Reopening. 

Under any circumstance where incoming correspondence does not support 

reconsideration or reopening, the assigned CE or FAB representative assigned to 

the case is responsible for uploading a memorandum to file in OIS documenting 

the actions taken to review the correspondence that supports taking no action. 

5. Reopening and Vacating a FAB Decision. The DEEOIC Director or an individual acting 

under a delegated authority, reopens a FD by issuing a Director’s Order. 

a. Director’s Order Content. A Director’s Order contains three components. 

 

(1) Cover Letter. The cover letter is addressed to the claimant(s) receiving the 

Director’s Order. It cites the authority by which a FD or Remand Order is 

being vacated, and provides a summary of the issue under review, a clear 

indication of all actions taken under the Order and the reopening 

conclusion. 

(2) Director’s Order. A Director’s Order is the written notice which provides 

narrative explaining the basis for reopening and vacating a FAB decision. 

It is divided into three parts; including: a Background section, which 

discusses the history of the case record leading to the FD under 

contention; a Discussion section, which includes analysis of the evidence 

supporting the decided outcome; and a Conclusion (see Appendix 27-1) 

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The decision narrative is to provide descriptive explanation of the 

rationale supporting the reopening and the basis for vacating a FAB FD or 

Remand. There are many reasons for reopening a FD, including the 

receipt of new evidence, incorrect application of program policy, or 

content errors. In addition to including a written explanation of the 

reason(s) for reopening a FD or Remand, a Director’s Order may provide 

corrective action instruction to a district or FAB office responsible for the 

case record. 

(3) Certificate of Service. This confirms the mailing date of a Director’s 

Order, and lists the name and address of the intended decision recipient. 

A Certificate of Service is completed individually for each claimant (or his 

or her AR) who is party to the Director’s Order. It must be dated on the 

date of decision mailing. 

b. Reopening Multiple Claimant Claims. Under certain situations, the CE or FAB 

representative is to proceed with a reopening referral when a circumstance 

involves a change to a benefit entitlement after the issuance of a FD involving 

multiple claimants. Each individual named in a multiple claimant FD is required 

to be a party to any decision that addresses a benefit entitlement, even if the 

outcome does not necessarily change each claim. The reason for this is to ensure 

each filed claimant receives notification of the distribution of benefits under the 

claim to which he or she is a claimant. It also permits each claimant to contest 

any outcome to which he or she disagrees. Common reasons for reopening a prior 

FD to multiple claimants includes the identification of a new qualifying survivor, 

new evidence documenting that a previously ineligible survivor now qualifies, or 

reallocation of lump-sum compensation that was held in abeyance until the status 

of a non-filing survivor was determined. 

c. District or FAB Offices are Responsible for Complying With Any Guidance or 

Instruction Provided in a Director’s Order. The issuance of a Director’s Order is 

at the discretion of the Director or a delegate. As the decision represents the 

intent of the Director to address a defect in a FD, district or FAB offices are 

required to comply with any guidance or instruction included in a Director’s 

Order. 

6. Reopening and Vacating a FAB Decision Following an Employee’s or Survivor’s Death. 

In cases where an employee or survivor dies following the issuance of a FD and a new survivor 

files a subsequent claim, the CE takes action to administratively close the deceased individual’s 

claim. He or she then initiates action to adjudicate the claims for any additional new survivor(s). 

In some instances, during the adjudication of the claim for a new survivor, the CE may determine 

that a factual finding and/or Conclusion of Law in a previously issued FD (i.e., covered 

employment, survivorship, medical diagnosis, etc.) is not accurate and affects the adjudication of 

the new survivor’s claim. Once FAB incorporates a factual finding and/or Conclusion of Law 

into a FD, a CE cannot undo the decision by administratively closing it. A factual finding and/or 

Conclusion of Law cited in a FD is legally operable until vacated by a Director’s Order issued by 

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the Director or someone with delegated authority to do so. For example, the employee received 

a FD that specified covered dates of employment at facility A; however, with the employee’s 

death, a survivor decision is now needed. Upon review, the CE finds that the employee’s 

employment actually occurred at facility B. Under this circumstance, the CE must obtain a 

reopening of the decision that was issued to the employee to allow for a correct reference to 

covered employment at facility B. The CE is only required to address factual findings and/or 

Conclusions of Law that contradict directly with the evidence necessary to proceed with a new 

decision. It is not necessary for the CE to obtain a Director’s Order when FAB concluded that it 

did not have the necessary evidence needed to arrive at a decision regarding a particular factual 

finding and/or Conclusion of Law. 

In cases where the CE identifies a material factual finding and/or Conclusion of Law in a prior 

FD that is now contradicted based on a new examination of case evidence, he or she is to obtain 

a Director’s Order vacating the FD containing the erroneous factual finding and/or Conclusion of 

Law.

a. When issuing a Director’s Order to correct a factual finding and/or Conclusion of 

Law from a previously issued FD, the Director or DD with authority to reopen the 

claim issues the decision to all the parties named in the vacated FD. In the 

circumstance where all the parties who received the decision are deceased, the 

Director or the DD is to issue the Director’s Order as would normally be the case, 

but annotate that he or she is issuing it to the case file as an administrative 

function. 

7. Denying a Specific Request for Reopening. A Denial of Reopening Request is a written 

decision issued by either the DEEOIC Director or a designated representative. The content of a 

denial is similar to that of a Director’s Order in that it contains a cover letter, decision notice, and 

Certificate of Service. Much like a Director’s Order the decision notice provides a background 

of the case history leading up to the decision under contention, and a discussion of the evidence 

or argument presented in support of a reopening. However, the decision is to provide a detailed 

explanation as to why the evidence presented is insufficient to warrant reopening of a FD or 

Remand Order (Appendix 27-2). The Director or designated representative responds 

comprehensively to each objection presented by a claimant. 

 

a. Issuance of a Denial of Reopening Request is to be Limited to the Individual(s) 

Requesting Review of a FD. 

 

b. Requests to Vacate a FAB Remand Order. The DEEOIC Director is the only 

authority that is permitted to vacate a FAB Remand Order. A reopening review 

of a Remand Order will normally originate from a DD or ADD due to the 

identification of misapplied program policy or a challenge to FAB’s rationale for 

returning a case to the DO. In these scenarios, the DD or ADD is to send his or 

her request for a review of the Remand to the Director. The referral is to include 

a memorandum identifying the specific Remand Order under contention and state 

merely that the DD or ADD wants the Director to review the Remand for 

accuracy. The DD or ADD is not to advocate for any particular outcome, merely 

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that there is a potential deficiency contained in the Remand that the Director 

needs to review. Upon receipt, if the Director agrees with the Remand Order, he 

or she will deny the request to vacate by issuing a memorandum to the requesting 

party. Otherwise, the Director issues a Director’s Order to vacate the Remand 

and return the case file to the proper office for handling. 

8. ECS Implications. All reopening requests, requests to vacate FAB decisions, and 

decisions granting or denying such requests are to be properly documented in ECS pursuant to 

DEEOIC procedures.

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CHAPTER 28 – MEDICAL BILL PROCESS 

1. Purpose and Scope. This chapter describes the roles of the CE, Medical Benefit 

Examiner (MBE), FO, and MS), in the medical bill process. It also outlines the procedures for 

evaluating and approving requests for employees who are in need of medical services, supplies, 

or reimbursement of expenses related to medical care.

2. Roles and Responsibilities. Upon issuance of a final decision approving a specific 

medical condition, the CE, MBE, the BPA, the FO, and the MS must ensure that the medical 

needs of the claimant, as they relate to his or her accepted medical condition, are reasonably 

provided for. 

a. Medical BPA. The use of a contractor for processing medical 

 bills allows the DEEOIC to provide a high level of service to eligible claimants 

 and their providers. Once a claimant has been accepted for a covered condition 

 under the EEOICPA, an eligibility file is automatically generated in ECS and sent 

 to the BPA electronically. 

 (1) When the BPA receives the eligibility file, the BPA sends a medical bill 

 identification card (MBIC) and general information about the medical bill 

 process to the claimant.

 (2) Providers, Claimants and District Office Staff send all medical bills, bill 

 attachments, treatment notes, and requests for claimant reimbursement to 

 the contractor for scanning and keying into their system. 

 (3) The BPA maintains a customer call center, medical staff, and bill 

 resolution units. 

 b. Medical Benefits Examiner. The MBE is a specialized CE responsible for 

 reviewing, developing, and approving or denying claims for in-home health care. 

c. CE. The CE considers for approval services, appliances, supplies, modifications, 

or travel expenses that are recommended or prescribed by a licensed physician, 

and necessary to cure, give relief, or reduce the degree or the period of an illness. 

(Refer to Chapter 29 – Ancillary Medical Services and Related Expenses for 

detailed information on approval of durable medical equipment, oxygen 

therapy/oxygen medical supplies, massage therapy, sun-protective clothing, gym 

memberships, extended medical travel, and other ancillary medical services.)

 (1) The CE considers the level of care prescribed by the treating physician as 

 it relates to the accepted medical condition and the facts of the case. The 

 CE must then make an informed judgment based on the level of care 

 prescribed by the doctor. 

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 patient, as well as those of the family. The DEEOIC will not dictate what 

 option an employee must accept, nor will decisions be made based solely 

 upon cost. The CE must also consider what level of care or services satisfy 

 the patient’s needs.

 (3) The CE is responsible for communicating all decisions (approval/denial) 

 to the requestor. 

 (a) If a request for services or payment originates from the BPA, the 

 FO notifies the CE via email. These requests may come to the CE 

 as a prior authorization request, or may come after submission of a 

 charge to the BPA.

 The CE emails his or her determination to the FO, inputs it into 

 ECS under the correspondence tab and communicates the decision 

 via thread to the BPA. 

 (b) If the request originates from a claimant or provider, the CE 

 immediately sends a copy via facsimile to the FO, and 

 concurrently begins development for approval or denial of the 

 request. The CE communicates all approvals or denials to the 

 requestor as outlined above. 

 d. FO. The FO acts as liaison between the CE and the BPA, serves as coordinator 

 for medical bill issues between the DO and the NO, and maintains a DO record of 

 persons authorized to access the BPA website. The FO does not determine 

 eligibility or authorize payments.

e. District MS. The MS coordinates all requests for both CMC and Non-Contracted 

 Impairment reviews. 

f. CMC. The CMC reviews and evaluates the medical evidence of record and 

 provides medical opinions about various aspects of cases; including interpretation 

 of medical evidence, causation between an illness and occupational toxic 

 substance exposure, and percentage of impairment. 

3. Parameters for Payment. OWCP procedures employ four levels of review in the medical 

bill process, only two of which DEEOIC currently uses. The BPA processes charges for Level 1 

services without CE approval. Any higher level of service (i.e. two, three or four) is treated as a 

Level 4 service in our program and requires that the CE review the proposed procedures or 

service(s), the proposed charges if applicable, and the supporting medical documentation, prior 

to approving or denying the request. 

4. Mailbox for Medical Bill Inquiries. The PRPU of the DEEOIC Policy Branch, located in 

the NO, has created an electronic mailbox (email) for use in resolving medical bill questions. 

Staff must use this mailbox when submitting inquiries concerning medical bills, travel 

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reimbursement, treatment suites, provider outreach, or policy questions regarding medical bill 

processing.

The FO in each respective DO serves as liaison for CEs with questions that require review by the 

MBPU located in the NO.

Use of this mailbox provides for expedited resolution of medical bill issues as they arise, and 

provides a more uniform process for responding to these questions and issues, program wide. 

 

a. When a CE receives an inquiry regarding reimbursement of a medical bill, for an 

 accepted condition, the CE first reviews the bill in the Achieve medical bill 

 inquiry system, and/or the XTCM Image Retrieval system, available at: 

 http://owcp.dol.acs-inc.com/portal/main.do) to verify that the supporting medical 

 documentation is on file. If, after reviewing the supporting documentation in the 

 BPA web portal and in the case file, the CE still has questions related to medical 

 bill processing, travel reimbursement, treatment suites, provider outreach, or a 

 policy question regarding medical bill processing, additional assistance may be 

 requested through the medical bill inquiries mailbox.

 b. The CE prepares an email to the FO. In order to maintain consistency and to 

 provide clarity in the communication process, it is imperative that the CEs 

 provide sufficient information in the email, clearly defining the nature of the 

 question, so that it can routed properly for response. Inquiries to the mailbox 

 must be categorized using the subject headings below, and the subject line of the 

 email must contain one of the following four subject headings: 

 (1) Policy Questions. Questions regarding policy interpretation or 

 implementation are answered by the MBPU.

 (2) Treatment Suites. The treatment suites and ICD-9/10 codes utilized by the 

 DEEOIC are contained within a database, administered by medical 

 professionals within the OWCP. This database compares an ICD-9/10 

 coded diagnosis, and associated services being billed by a provider, with 

 a group (or suite) of acceptable, allowable treatments or services for that 

 accepted condition. The use of treatment suites allows bills to be paid 

 automatically when the treatment being billed is reasonable and customary 

 for the accepted condition. Often, issues arise when a claimant is trying to 

 obtain payment for a consequential illness and the medical bills are being 

 denied because the consequential illness is not being recognized within the 

 treatment suite(s) for the accepted condition. Inquiries of this nature will 

 be directed to the MBPU, for a response. 

 (3) Provider Outreach. Questions from medical providers regarding 

 assistance with enrollment, submission of bill(s), or understanding 

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 DEEOIC’s medical billing process, must be forwarded to the MBPU, who 

 will then coordinate with the RC Manager on these issues. Provider 

 outreach issues must be coordinated through the MBPU. 

 (4) Bill Payment Processing. Questions regarding reimbursement of medical 

 bills must be routed to the MBPU for a response. 

 The body of the email itself must contain the following information (as 

 applicable):

 DO Location;

 CE Name;

 Employee’s Name; 

 DOL File Number(not to be used in the subject line);

 Accepted Condition(s) with ICD-9/10 code(s); 

 Billed Amount(s);

 Date(s) of Service(s)or Travel day(s); 

 Medical Provider Name(s); 

 Type of Service(s) (i.e., Pharmacy, In-Home Health); 

 Question(s) or issue(s) to be resolved. 

c. Upon receipt of an email question, the FO reviews the email and determines 

 whether the issue warrants referral. If the question does warrant such review, the 

 FO forwards the inquiry to the medical bill inquiries mailbox.

 d. The MBPU reviews all submissions submitted to the medical bill inquiries 

 mailbox and it determines the proper course of action. As noted above, the 

 MBPU reviews and answers all policy, treatment suite, and medical provider 

 outreach questions. It also responds to issues related to medical bill payments. 

 Some referrals to the mailbox may have elements related to several topics in the 

 inquiry. In these situations, the Payment Systems Manager (PSM) will coordinate 

 the development of the referral between different subject matter experts to 

 respond. 

e. In the case of a policy or treatment suite issue, the MBPU researches the inquiry 

 and provides an answer to the requesting DO within five business days. If a 

 policy question requires additional research, the PSM will grant an extension. 

 Complex policy issues might require the involvement of the Policy Branch Chief. 

f. The MBPU may refer provider enrollment issues to the RC Manager for 

 development. The RCs serve as the primary point of contact for DEEOIC’s 

 provider enrollment inquiries. The RC Manager has three business days of 

 receipt to attempt to resolve the situation with the provider and report the outcome 

 back to the MBPU. The MBPU will relay the response(s) by email to the 

 requester.

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g. Upon receipt of the MBPRU responses, the FO forwards the response to the 

 appropriate CE via email. The CE is responsible for notifying the employee, 

 claimant, authorized representative and or provider (if applicable), via telephone 

 or in writing, of the appropriate response to the issue at hand. All telephone 

 activity is documented in ECS and a copy of the email response from the MBPU 

 or PSM is added to the case file.

5. Medical Records Procurement. DEEOIC pays costs associated with obtaining medical 

records regardless of whether a claim has been approved for benefits. This reimbursement is 

payable only to a hospital, physician’s office, or other medical facility that charges a fee to 

produce records. The maximum allowable reimbursement is $100 per employee. 

a. Form of Request. The provider provides the CE with the written fee request on 

 official letterhead or billing statement. The request includes the tax identification 

 number of the facility, total amount charged for the record request, and the 

 provider enrollment number. If the provider is not enrolled, the CE forwards an 

 enrollment package to the provider with a letter requesting that the provider 

 enroll, and after completion of the enrollment process, the provider informs the 

 CE of their new provider number. 

 b. Approval of Payment. Upon receipt of the required information, the CE approves 

 the payment of the bill by completing a Form OWCP-1500, sending an approval 

 letter to the requestor, and completing ECS coding as required in DEEOIC 

 procedures. The CE then forwards the completed Form OWCP-1500, approval 

 letter, and invoice to the FO for payment processing. 

6. Treatment Suites. At the core of the medical bill reimbursement process is the use of 

treatment suites. The treatment suites used by the DEEOIC are contained in a database 

maintained by medical professionals within the OWCP. They compare an accepted (ICD-9/10 

coded) diagnosis for which a provider has billed, with acceptable, allowable treatments for that 

condition. The use of treatment suites allows automatic payment of bills, for authorized services, 

when the amount billed is reasonable and customary for an accepted condition. 

7. Eligibility Files. In order for a claimant’s bills to be paid, an eligibility file is generated 

automatically in ECS and sent to the BPA once a condition has been accepted. This eligibility 

file contains the accepted condition for which a claimant is entitled to medical treatment. When 

the accepted condition(s) are coded and billed with the correct ICD-9/10 Code, the volume of 

suspended and denied bills is significantly reduced. Consequently, accurate code selection 

expedites provider reimbursement for all approved medical services rendered to the claimant. 

8. ICD-CM Codes. The International Classification of Diseases, 9th and 10th Revision, and 

Clinical Modification, (referred to simply as ICD-9/10 codes), is a statistical classification and 

coding system used to assign appropriate codes for signs, symptoms, injuries, diseases, and other 

medical conditions. 

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These codes are assigned, based on the claimants’ medical documentation (records), including, 

but not limited to physician notes, diagnostic tests, and surgical reports. ICD-9/10 codes are 

divided into an alphabetic index, which is an alphabetic list of terms and their corresponding 

codes. ICD-9/10 codes are composed of numbers with 3, 4, 5, 6 or 7 digits. Three-digit category 

codes are generally subdivided by adding a fourth, fifth and/or sixth digit to further specify and 

clarify the nature of the disease or medical condition. The CE entering an ICD-9/10 code must 

identify and enter the code that references the disease, illness or medical condition that was 

reported, and should identify the organ(s) or portion of the body affected by the condition. 

In general, three-digit codes identify a category of illness, while codes with fourth digits are 

called subcategory codes, and those with fifth digits are referred to as sub-classifications.

When a specific condition, illness, etc., contains a 5th or 6th digit, the CE uses all available digits 

to identify the condition. In addition to providing further specificity of the anatomical site, the 

4th and 5th digits also provide additional pertinent clinical information related to the 

injury or medical condition. Therefore, when selecting ICD codes, the CE should always use the 

code that most specifically describes the medical condition reported. 

a. Examples of valid 3-character ICD-10-CM codes: 

 (1) I10 Primary Hypertension 

 (2) N19 Renal Failure.

 b. Examples of 4, 5, and 6 character ICD-10-CM codes: 

 (1) J44.9 chronic obstructive pulmonary disease unspecified (requires a 4th 

 digit).

 (2) C34.11 Malignant neoplasm of upper lobe, right bronchus or lung 

 (requires 5th digit). 

 (3) C50.012 Malignant neoplasm of lower-outer quadrant of left female breast 

 (requires a 6th digit).

For all medical conditions with a medical eligibility begin date on or after October 1, 2015, the CE 

will use ICD-10-CM coding in ECS, development, and decisions. If the condition is input into 

ECS after October 1, 2015, ECS will default to entry of an ICD-10 code. However, the system 

will allow entry of an ICD-9 if appropriate. If the condition is determined to be a consequential 

condition and the underlying condition has a filing/eligibility begin date prior to October 1, 2015, 

the ECS system will force the user to enter an ICD-9 code, even though the condition itself was 

filed after October 1, 2015. Ultimately, the medical eligibility begin date is the driving factor on 

whether an ICD-9 or ICD-10 code must be used on a medical condition. If the medical eligibility 

begin date is on or after October 1, 2015, the ICD-10 code is what will be reflected throughout the 

system wherever ICDs are reflected. CEs will also reference ICD-10 in decisions and development 

letters if the filing/eligibility begin date is on or after October 1, 2015. For example, if the medical 

records list a primary diagnosis of renal failure and the status effective date is October 1, 2015, the 

CE enters (N19) as the ICD-10-CM code in the medical condition field and uses this code in the 

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rest of the correspondence throughout the case. 

9. Coding Software. CEs are to utilize Optum, an online tool that helps to identify the 

appropriate ICD-9/10-CM code. These guidelines are to be used as a supplement to the ICD-9/10-

CM Coding books. 

10. Prompt Pay. The Prompt Payment Act requires federal agencies to pay vendors in a 

timely manner. The Act requires assessment of late interest penalties against agencies that pay 

vendors after a payment due date. The DEEOIC has identified three classes of bills that fall 

under the Prompt Pay Act: Reviews by a CMC, Second Opinion/Referee Medical Examinations, 

and Impairment Rating Examinations. These bills must be processed within seven calendar days 

from date of receipt in the District Office. (Refer to Chapter 16 – Developing and Weighing 

Medical Evidence for the specific actions to be taken by the CE and the MS in the processing of 

CMC bills.)

11. Time Limits for Submission of Medical Bills. DEEOIC pays providers and reimburses 

employees promptly for all bills that are properly submitted on an approved form and which are 

submitted in a timely manner. No such bill is paid for expenses incurred if the bill is submitted 

more than one year beyond the end of the calendar year in which the expense was incurred, or 

the service or supply was provided; or, more than one year beyond the end of the calendar year 

in which DEEOIC first accepted the claim, whichever is later.

12. Fee Schedule. For professional medical services, OWCP maintains a schedule of 

maximum allowable fees for procedures performed in a given locality. The schedule consists of: 

a. An assignment of a value to procedures identified by HCPCS/CPT code which 

 represents the relative skill, effort, risk and time required to perform the 

 procedure, as compared to other procedures of the same general class. 

 b. An index based on a relative value scale that considers skill, labor, overhead, 

 malpractice insurance and other related costs.

c. A monetary value assignment (conversion factor) for one unit of value in each of 

 the categories of service.

Generally, bills submitted using HCPCS/CPT codes cannot exceed the fee schedule. If the time, 

effort and skill required to perform a particular procedure varies widely from one occasion to the 

next, DEEOIC may choose not to assign a fee schedule limitation. In these cases, the allowable 

charge is set individually based on consideration of a detailed medical report and other evidence. 

At its discretion, DEEOIC may set fees without regard to schedule limits for specially authorized 

consultant examinations, and for other specially authorized services.

13. Fee Schedule Appeal Process. As part of the medical bill review process, program 

regulations provide for the appeal of fee schedule reductions (charges by a provider that have 

been reduced in accordance with the OWCP fee schedule for that specific service.) In order to 

maintain consistency, record responses, and track fee schedule appeals, the following procedures 

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have been developed to further delineate this process. 

a. When the BPA receives a fee appeal request letter, the BPA stores an electronic 

 copy of the appeal letter in the XTCM Image Retrieval system, linked to the 

 remittance voucher if submitted by the provider, and sends an email to the MBPU 

 for review.

 b. For each fee schedule appeal letter received, the MBPU creates a record, and 

 maintains it in a tracking system (spreadsheet or database) created for this 

 purpose. 

c. The MBPU POC reviews the fee appeal request to determine if the provider has 

 met any of the conditions below which justify a reevaluation of the amount paid. 

 These three conditions, as found in 20 C.F.R. 30.712, are: 

 (1) The service or procedure was incorrectly identified by the original code; 

 or 

 (2) The presence of a severe or concomitant medical condition made 

 treatment especially difficult; or 

 (3) The provider possesses unusual qualifications (i.e. possesses additional 

 qualifications beyond board-certification in a medical specialty, such as 

 professional rank or published articles.) 

 d. Within 30 days of receiving the request for reconsideration, the MBPU prepares a 

 response to the medical provider outlining DEEOIC’s decision to either: 

(1) Approve an additional payment amount: In this instance, the MBPU 

generates a draft letter for DD signature, informing the provider of the 

 approval for additional payment. Where an additional amount is found to 

 be payable based on unusual provider qualifications, the DD determines 

 whether future bills for the same or similar service from that provider 

 should be exempt from the fee schedule. The MBPU also prepares a 

 memorandum for the case file stating the findings and the basis for the 

 approval of the additional amount, or; 

(2) Deny any additional payment: In this instance the MBPU prepares a draft 

letter-decision for DD signature, advising that additional payment is 

 denied, based upon the provider’s inability to establish one of the 

 conditions listed above in Item c(1)(2)(3). Where additional payment is 

 denied, the letter decision must contain a notice of the provider’s right to 

further review, similar to the following:

 If you disagree with this decision, you may, within 30 days of the 

 date of this decision, apply for additional review. The application 

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 may be accompanied by additional evidence and should be 

 addressed to the Regional Director, District _________, Office of 

 Workers’ Compensation Programs, U.S. Department of Labor, 

 [Insert appropriate Regional Office address and Zip Code.]

e. The draft approval or denial letters are prepared by the MBPU, for the signature 

 of the DD whose office has control of the claim file(s) being addressed 

 in the decision(s). The MBPU sends the draft letter (via email) to the DD for 

 review, signature, and mailing. The DD places a copy of the signed letter in the 

 case file and also returns (via email) a scanned copy of the signed letter, to be 

 retained by the PSM.

f. The MBPU continues to track the status of any fee schedule appeal case, and 

 maintains an electronic copy of all correspondence. This includes a copy of the 

 draft letter and a scanned copy of the signed letter mailed by the DD.

g. If a denial is subsequently appealed to the RD, the RD must consult with the PSM 

 to obtain copies of relevant bills and documents, and to discuss the appeal. The 

 PSM also provides the RD with a copy of the denial letter signed by the DD. This 

 can be handled via email.

 h. After consultation with the PSM, the RD prepares a written response to the 

 provider within 60 days of receipt of the request for review. Where additional 

 payment is denied at the regional level, the letter decision from the RD advises 

 the provider that the decision is final and is not subject to further administrative 

 review. The RD forwards a scanned copy of the signed letter decision to the PSM. 

 The PSM also retains that response as part of the appeal record. 

i. The final outcome of each appeal letter is recorded in the MBPU tracking system 

 to indicate:

 (1) Additional payment made. 

 (2) DD Denial letter.

 (3) RD Appeal letter.

 (4) Time limit (30 days) has expired for appeal to RD. 

 (5) The final disposition date for each appeal letter.

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CHAPTER 29 – ANCILLARY MEDICAL SERVICES AND RELATED EXPENSES

1. Purpose and Scope. This chapter includes the procedures that DEEOIC claims staff use 

in evaluating and approving requests for ancillary medical services, DME and supplies, and 

related expenses.

 

2. Requests for Ancillary Medical Services and Related Expenses. This chapter provides further 

guidance relating to the review process for requests pertaining to a wide variety of ancillary services and 

related expenses. A claimant, AR, treating physician, or a provider may request the services and related 

expenses described in this chapter. Requestors are to make their claims by sending them to the DEEOIC 

BPA via fax, mail, or electronic submission. The assigned CE, or FAB staff person, who receive 

requests through OIS, forwards them to the BPA. 

a. The BPA creates an electronic record of the request and initiates a thread 

 to the FO at the district office where the claimant’s case file resides. The 

 thread from the BPA advises the FO of a pending request for authorization 

 of services. For DME or supplies requests, the thread details will include a 

 statement indicating if any requested DME or supplies are subject to the 

 OWCP Medical Fee Schedule.

 b. The requestor must submit a Letter of Medical Necessity (LMN), (or an 

 updated LMN in the event that reauthorization for an additional period of 

 time is being requested). A LMN is the written explanation from the 

 treating physician describing the medical need to assist the claimant in the 

 treatment, care, or relief of their accepted work-related illness(s). To 

 ensure that the physician’s opinion derives from a recent physical 

 assessment of the claimant’s medical status, the physician is to document 

 that a face-to-face visit/evaluation occurred between the claimant and the 

 prescribing physician, within six months prior to the date that the 

 physician orders the service. The LMN must clearly identify the type of 

 ancillary medical service sought, explain why it is medically necessary for 

 the accepted condition, and specify the duration of use. The requestor is to 

 submit any supporting documentation substantiating the medical need for 

 the requested service (i.e.; medical reports, prescriptions, therapy reports, 

 diagnostic reports). 

c. Requests submitted for authorization are to include the following: 

 (1) Claimant information such as name, case file number, date of birth, 

 and telephone number. 

 

 (2) Provider, supplier, or requestor information including name, 

 provider address, provider number, Tax ID number, National 

 Provider Number (NPI), telephone number, and fax number. 

 

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 (3) Prescribing/treating physician contact information including name, 

 address, telephone number, and fax number. 

 

 (4) The billing code(s) such as HCPCS and/or Current Procedural 

 Terminology (CPT), code modifier(s), total cost, begin date, and 

 end date.

 (5) Diagnosis code(s) for the condition(s) for which the item(s) is 

 being prescribed.

 (6) In addition, requests submitted for authorization for DME or 

 oxygen therapy DME and oxygen medical supplies are to include 

 the following: 

 (a) Supporting documentation that provides the need for DME 

 and/or Medical Supplies (i.e.; prescription, narrative LMN, 

 supporting medical documentation). 

 (b) Equipment billing code(s) (HCPCS/CPT), modifier(s), 

 quantity, purchase price and rental price, total cost, begin 

 date, end date, duration of use and frequency. 

 (c) The provider will need to bill with the appropriate billing 

 modifier to receive reimbursement. If the billing modifier is 

 missing or invalid, the BPA will deny the bill.

 (d) Prior to payment being made for purchased equipment, the 

 provider is to submit, along with the bill, proof of a 

 transferred title to the claimant, bill of sale, and/or signed 

 invoice by the claimant indicating receipt of the purchased 

 equipment. 

 d. Upon receipt of an authorization request, not accompanied by appropriate 

 medical evidence, the CE begins development. 

 (1) The CE sends a development letter to the claimant advising that he 

 or she has received a request, but without the required supporting 

 documentation. The CE’s development letter to the claimant must 

 include a clear description of the medical documentation needed to 

 support the request, and grant the claimant 30 calendar days to 

 provide the information. The CE also notifies the claimant that a 

 lack of response or submission of insufficient evidence will result 

 in a denial of the request. (Exhibit 29-1 provides a sample 

 development letter for ancillary medical services. Exhibit 29-2 is a 

 sample development letter for DME / Oxygen therapy and related medical 

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 supplies.) The CE updates the correspondence section of ECS to 

 record the issuance of the development letter, once mailed. 

 (2) If the CE receives the appropriate medical evidence within the 30- 

 day development period, the CE prepares an authorization letter to 

 the claimant (Exhibit 29-3 provides a sample authorization letter 

 for ancillary medical services; Exhibit 29-4 is a sample 

 authorization letter pertaining to DME/Oxygen Therapy and 

 related supplies). 

 (3) In situations where the treating physician does not respond or does 

 not provide clarifying medical rationale to support the request, the 

 CE may refer the matter to a CMC for review. 

e. Communicating the decision to the requestor. Upon completion of all 

 appropriate development steps for the requested services, and upon review 

 of all evidence submitted, the CE communicates a decision to approve or 

 deny such services to the requestor. The CE sends an e-mail to the FO, 

 who prepares and sends a thread to the BPA, authorizing or denying the 

 claimed medical services or related expenses. The CE also creates a 

 correspondence entry in the Correspondence screen of ECS, documenting 

 the decision. 

 d. Communicating the decision to the claimant. When the CE receives a 

 request for authorization, accompanied by appropriate medical evidence, 

 the CE prepares an authorization letter to the claimant, approving the 

 requested services (See Exhibit 29-3 for a Sample Letter for authorizing 

 ancillary medical services or Exhibit 29-4 for a sample letter authorizing 

 DME, Oxygen Therapy and related supplies). The CE sends a copy of the 

 letter to the supplier/vendor designated by the claimant. The approval 

 letter is to include the following information:

 (1) Covered medical condition(s) for which the DME is approved, 

 massage therapy is prescribed, or the condition to be treated with 

 acupuncture. 

 (2) Authorized billing code(s) relevant to the approval. 

 (3) Time period (To and From dates) during which the DME 

 rental/purchase is authorized and/or number of frequency and visits 

 approved for massage therapy and acupuncture therapy (i.e.; two 

 visits per week for eight weeks).

 (4) Statement advising that fees are subject to the OWCP Medical Fee 

 Schedule.

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 (5) Statement advising that if the rental is converted to a purchase, 

 rental expenses incurred and paid will be deducted from the 

 purchase price and only the difference will be reimbursed. 

3. DME. A physician must prescribe all DME, supplies, and custom devices. DME serve a 

medical purpose and can withstand repeated use (e.g.; hospital beds, walkers, and wheel chairs, 

etc.).

a. A CE must review all requests for the rental and/or purchase of DME to 

 determine their medical necessity. Requests for DME rental or purchase 

 require pre-authorization. 

 b. In instances where DME, supplies, and custom devices have a total 

 purchase price greater than $500 and the OWCP Medical Fee Schedule 

 does not apply, the CE is to undertake development with the claimant.

 (1) The claimant must submit two estimates from two different DME 

 suppliers to include the supplier name and supplier contact 

 information. These estimates must be for exactly the same type of 

 DME, and/or supplies. 

 (2) Each potential supplier must submit a signed statement describing 

 the DME, supplies, or unadorned item meeting the treating 

 physician’s specifications, and a breakdown of all costs including 

 delivery and installation, and the current Healthcare Common 

 Procedure Code System (HCPCS) code for each DME, supply 

 and/or item needed. 

c. Where the purchase of DME, supplies or custom devices are less than 

 $500 or when the OWCP medical fee schedule applies, the CE may 

 approve the purchase request, after appropriate medical evidence is 

 received, without obtaining cost estimates. 

 d. The CE reviewing a DME request may consider authorization for rental 

 rather than purchase. In most situations, DME rental is the preferred 

 choice. The CE may authorize the rental of DME for up to six months. 

 

 (1) The CE should review the LMN and the provider-submitted rental 

 proposal to ensure that the DME will satisfy the needs of the 

 claimant as outlined by his or her physician. If the CE determines 

 that the rental meets the medical requirements of the physician, he 

 or she is to grant authorization for DME rental for six months (or 

 less depending on the need of the claimant). The CE mails a letter 

 of authorization to the claimant, along with a copy to the chosen 

 DME provider. Additional details on the DME authorization are 

 provided later in this section. 

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 (2) For each DME rental authorization that may extend beyond the 

 initial authorization period, the CE is to enter a reminder in ECS 

 that reauthorization occurs at a six-month interval. The CE must 

 set the reminder to occur 60 days prior to the expiration date of 

 authorized DME rental. 

f. In certain situations, the CE may authorize the purchase of DME or 

 supplies. When considering the purchase of DME, the CE is to use 

 discretion to ensure that any authorization granted for the purchase of any 

 DME satisfies the medical needs of the claimant. The CE should not 

 authorize a request for DME based on convenience, comfort, or other non- 

 medical reasons. 

 DME purchases can only be approved if the CE is able to obtain such an 

 option from an enrolled provider. 

 (1) Items that should not be rented but considered for purchase include 

 medical/surgical supplies (i.e.; ostomy, incontinence, dialysis, 

 wound care), canes, crutches, and commodes. 

 (2) The CE may evaluate a DME purchase, when the purchase price of 

 such equipment or item is more cost effective than the rental price. 

 For example, if the price of renting a standard wheelchair is more 

 than the cost to purchase it, the CE should approve the purchase of 

 the wheelchair rather than renting it.

 (3) When reauthorizing rentals, the CE must consider whether the cost 

 to purchase the equipment, minus the rental amount paid, is less 

 than the total cost to authorize another six months of rental. If 

 agreeable with the claimant and the DME provider, the CE may 

 authorize the purchase of such equipment. Otherwise, the CE is to 

 continue to review the claim as a DME rental. 

 (a) Situations may arise when the CE previously authorized the 

 rental of a DME, then subsequently receives a request for 

 authorization to purchase that same item. Under these 

 circumstances, it may become necessary to convert the 

 rental to a purchase. If the CE receives a request for a 

 purchase, the rental charges were paid for the same DME 

 with no break in service between the rental period and the 

 approved purchase period and the provider who billed for 

 the rental is the same as the provider now requesting the 

 purchase, the CE must request that the provider deduct the 

 rental charges previously paid from the cost of the item 

 being purchased. DEEOIC reimburses all post-purchase 

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 requests (from a rental) in accordance with the applicable 

 OWCP Medical Fee Schedule amount.

g. Repair/Maintenance Cost. The CE must authorize the cost for 

 modifications and maintenance to DME equipment when evidence is 

 received validating the need for changes/repair/maintenance of previously 

 approved DME. 

 h. Replacement. A new request must be submitted if a claimant requires a 

 replacement of previously purchased equipment approved by DEEOIC for 

 purchase. The CE must approve DME for replacement if the equipment is 

 three years or older, inoperable and beyond repair, or the request 

 demonstrates repair costs that exceed the cost to replace the equipment, 

 and that the equipment is no longer covered by warranty, or if the 

 equipment is lost or stolen. In the event the equipment is stolen, the 

 claimant must furnish a police report documenting the incident. The CE 

 can consult with the NO MBPU for situations involving unique or 

 unusual circumstance. 

i. DME add-ons or Upgrades. DEEIOC will consider approval for DME 

 add-ons or upgrades where the evidence substantiates the medical need for 

 the enhancement. Add-ons and/or upgrades are not approved for the 

 claimant’s convenience or where such enhancements do not significantly 

 improved DME functionality. 

j. Emergency situations. The CE may authorize the rental of DME for a 

 preliminary 30-day period while additional development is undertaken. 

 (1) If medical documentation from the treating physician supports the 

 need for immediate DME authorization, the CE provides approval 

 for 30 days pending additional development. 

 (2) The CE sends a letter to the treating physician (with a copy to the 

 claimant) requesting necessary evidence to substantiate that the 

 DME is medically necessary. This should occur within the 

 preliminary 30-day authorization period. The CE may grant 

 extensions in increments of 30 days, not to exceed a total of six 

 months, while awaiting necessary medical evidence.

 k. When the CE receives a request for authorization of DME and appropriate 

 medical evidence does not accompany the request, the CE begins 

 development. Refer to Section 2(d) for further guidelines to begin 

 development. 

l. When the CE receives a request for authorization of DME, accompanied 

 by appropriate medical evidence, the CE prepares a decision letter to the 

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 claimant authorizing the DME. Refer to Section 2(e-f) for further 

 guidelines in communicating a decision. 

 

4. Oxygen Therapy DME and Oxygen Medical Supplies. This section provides procedural 

guidelines the CE follows when reviewing and authorizing requests for the rental or purchase of 

Oxygen Therapy DME or Oxygen Medical Supplies. 

a. Physicians prescribe Oxygen Therapy DME and Oxygen Medical Supplies 

 to treat patients diagnosed with different forms of pulmonary 

 disease. Some examples of Oxygen Therapy DME and Oxygen Medical 

 Supplies include stationary and portable oxygen concentrators, gaseous 

 and liquid oxygen delivery systems, cannulas, tubing, regulators, etc. 

 (Exhibit 29-5 provides definitions and describes the functions of some of 

 the more commonly prescribed oxygen DME.) The CE reviews requests 

 for the rental and/or purchase of Oxygen Therapy DME and Oxygen 

 Medical Supplies to validate their medical necessity. Refer to Section 2(c) 

 to see what is required for authorization. 

 b. Upon receipt of the request for rental or purchase of Oxygen Therapy 

 DME and/or Oxygen Medical Supplies, the CE evaluates the medical 

 evidence to determine if there is sufficient justification to authorize the 

 request as medically necessary for the treatment or care of an accepted 

 condition. In addition to the guidelines already described in Section 2(g), 

 the claimant must include the following: 

 

 (1) Diagnostic testing that supports the physician’s reasons for 

 prescribing Oxygen Therapy DME or Oxygen Medical Supplies, 

 and identifies clear, objective pulmonary deficits including results 

 from an ABG and/or resting/exercise spirometry test, and/or nocturnal 

 oximetry studies. The results are to identify the conditions under which the 

 test(s)/studies were performed; (i.e.; during exercise, at rest, or during 

 sleep). The test(s) are to be performed by a qualified medical professional, 

 and originate from a qualified source such as a laboratory, diagnostic 

 testing facility, hospital, physician’s office or clinic.

c. Additional Information. If the CE determines the evidence is deficient, for 

 example, the physician has not provided a clear description of the needed 

 Oxygen Therapy DME and/or Oxygen Medical Supplies, or has not 

 provided information on the duration or use of the prescribed equipment, 

 the CE initiates development. Refer to Section 2(b) for guidance on 

 development. 

 

 d. Upon receipt of appropriate evidence establishing the medical necessity 

 for Oxygen Therapy DME and/or Oxygen Medical Supplies, the CE 

 proceeds to assess whether it is appropriate to authorize a short-term 

 rental, continuous rental, or a purchase of the requested DME. 

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 (1) For authorization of equipment rentals, the DEEOIC will 

 reimburse monthly charges for the approved equipment. A rental 

 period for oxygen equipment is one month (30 or 31 days) and is 

 equivalent to one unit of service. When oxygen equipment is 

 purchased, the DEEOIC will reimburse for a one-time charge, not 

 to exceed the total allowable amount as set forth in the OWCP 

 Medical Fee Schedule.

 (2) If the request for oxygen equipment is for a period of 90 days or 

 less, oxygen equipment shall be reimbursed on a monthly rental 

 basis according to the OWCP Medical Fee Schedule. The rental 

 reimbursement amount includes delivery, set-up, education, and 

 training for the claimant, and is not separately reimbursable.

 (3) If the request for oxygen equipment is for a period of less than 30 

 days (partial month), reimbursement occurs on a daily basis. The 

 CE is to authorize units by the number of days that is being 

 requested (e.g.; the request is for dates of service 4/1/2016 – 

 4/20/2016. The maximum number of units authorized is 20). 

 (4) If the request for oxygen equipment is for a period of more than 90 

 days, the CE is to approve continuous rental, up to one year, or 

 purchase of prescribed oxygen equipment if requested by the DME 

 supplier. 

 (5) In emergency or urgent situations (such as the claimant being 

 discharged from the hospital to home with urgent oxygen needs), 

 the CE can authorize up to a 30-day rental period for oxygen 

 equipment, while additional development is undertaken. The CE 

 may grant additional extensions of 30-day increments during 

 development, not to exceed a six month period. 

e. Authorization Limitations. The CE is to adhere to the following 

 restrictions when evaluating claims for Oxygen Therapy DME and/or 

 Oxygen Medical Supplies. 

 (1) Approval for a portable oxygen system (liquid or concentrator) 

 will only be made in combination with a request for a stationary 

 system, or after verification by the CE that the claimant already has 

 a stationary system in the home.

 (2) Approval should not be given for more than one delivery system 

 within a claimant’s home. A claimant is entitled to one stationary 

 and one portable oxygen system during an authorization period 

 unless there are extenuating circumstances justified by medical 

 rationale (LMN).

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 (3) Approval for a mechanical ventilator will be coordinated by the 

 DEEOIC Medical Director. The DO will obtain the properly 

 completed LMN, a copy of the hospital admission history and 

 physical, hospital discharge summary, and a detailed report from 

 the claimant’s treating physician containing diagnosis, prognosis, 

 proposed treatment regime, and the qualified professional(s) who 

 will monitor the claimant and the ventilator. Once the completed 

 information package is obtained, the CE forwards it to the 

 DEEOIC Medical Director for review and consideration. The CE 

 addresses any such requests to the DEEOIC Medical Director, 

 through the DEEOIC Bill Pay Mailbox. Further information 

 regarding this mailbox is discussed in Chapter 10 – Resource Centers. 

f. Upon the approval of either rental or purchase of the prescribed Oxygen 

 Therapy DME and/or Oxygen Medical Supplies, the CE prepares a 

 decision letter to the claimant and the requestor as outlined above in 

 Section 2, e-f, authorizing the equipment and/or supplies. Renewal of an 

 existing authorization requires the claimant to obtain a LMN 

 demonstrating a continuing need for the oxygen therapy DME or oxygen 

 medical supplies. 

g. DEEOIC will reimburse for repair, maintenance, non-routine service, 

 modifications necessary to make the equipment operable, and replacement 

 of medically necessary oxygen equipment that a claimant owns. DEEOIC 

 will not provide separate reimbursement for maintenance and service for 

 DME covered under a manufacturer or supplier warranty agreement unless 

 the charges are excluded from the warranty. Reimbursement for repair, 

 maintenance, non-routine service, or replacement of rented oxygen 

 equipment is included in the monthly payment allowance and is not 

 separately reimbursable.

 h. All repair, maintenance, and non-routine service requests for authorization 

 must include the following: 

 (1) Supporting documentation itemizing each repair/maintenance/non- 

 routine service.

 (2) The request for authorization is to indicate that the equipment is 

 claimant-owned (non-rented) and out of warranty. 

 (3) DEEOIC will not authorize separate travel time or equipment pick- 

 up and/or delivery time. Services are reimbursed according to the 

 OWCP Medical Fee Schedule.

 (4) DEEOIC allows up to two hours of service within a 120-day 

 period. If a CE receives a repair request for more than two hours of 

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 service within a 120-day period, the CE forwards the request and 

 supporting documentation to the NO for review through the 

 DEEOIC bill pay mailbox. The CE is to list details of the 

 documented thread, including the document control number 

 retrieved from the Xerox Transaction Content Management 

 (XTCM) stored image retrieval system and/or attached supporting 

 documentation. 

 (5) The request for authorization is to indicate whether a temporary 

 replacement or “loaner” will be required. If a temporary 

 replacement or loaner is required, DEEOIC will authorize the 

 temporary equipment on a rental basis for up to a one-month 

 period, not to exceed the estimated repair time.

 (a) The temporary replacement request is to include a 

 description of the equipment being dispensed, and is to be 

 the same type of equipment that the claimant uses to treat 

 their illness.

 (b) A new LMN is not required for the repair or temporary 

 equipment as long as the type of equipment and/or the 

 medical necessity is unchanged. DEEOIC will cover the 

 cost for repair up to the OWCP Medical Fee Schedule 

 maximum allowable amount, not to exceed the cost of a 

 replacement.

 (6) A new request must be submitted if a claimant requires a 

 replacement of previously purchased equipment approved by 

 DEEOIC for purchase. The CE must approve DME for 

 replacement if the equipment is three years or older, or it is 

 inoperable and beyond repair, or the request demonstrates repair 

 costs that exceed the cost to replace the equipment, and that the 

 equipment is no longer covered by warranty, or if the equipment is 

 lost or stolen. In the event the equipment is stolen, the claimant 

 must furnish a police report documenting the incident. The CE can 

 consult with the MBPU for situations involving unique or unusual 

 circumstance.

 

i. DME suppliers may not automatically deliver additional oxygen 

 accessories or medical supplies to claimants without a request from the 

 claimant, an order from the treating physician, or a pre-determined 

 schedule that is medically necessary. Accessories and supplies are 

 comprised of, but not limited to, regulators, wheeled carts, stands, battery 

 packs and chargers, cannulas, tubing, oxygen contents, etc. When authorizing 

 contents and content refills: 

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 (1) For the Rental of a Stationary Gaseous System/Liquid: The 

 content refills are included in the rental price. Therefore, contents 

 are not separately reimbursable.

 (2) For the Rental of a Portable Gaseous System/Liquid. The CE can 

 approve contents for the duration of the rental of a portable 

 gaseous system or portable liquid system. One unit of contents is 

 equal to one month’s supply. Therefore, when authorizing contents 

 for the rental period of a portable gaseous system, the CE should 

 only authorize one unit per month. 

 (3) For the Purchase of a Gaseous System/Liquid. Purchased 

 systems do not include contents, thus, when authorizing the 

 purchase of a gaseous system or liquid system the CE authorizes 

 contents for a period of one year. Contents are authorized based on 

 one unit per month (i.e.; 12 units = one year). The claimant must 

 provide an updated LMN that supports the need for continued 

 authorization of additional contents. 

5. Massage Therapy/Acupuncture Treatments. This section provides procedural guidance 

with regard to the review and development process leading up to an authorization or denial of a 

request for Massage Therapy and/or Acupuncture Treatments.

a. The treating physician must prescribe massage therapy and/or acupuncture 

 treatment only for the treatment or care of the claimant’s covered medical 

 condition(s). Along with the signed prescription from the treating 

 physician, the requestor must submit a LMN to reflect that an initial face- 

 to-face visit was held with the claimant. Face-to-face visits are only 

 required for the initial pre-authorization request. The narrative of the LMN 

 should describe the unique physical and therapeutic benefits that the 

 claimant will derive from massage therapy or acupuncture treatment, and 

 specify the frequency and duration of care to be provided in allotments of 

 time (e.g.; twice a week for eight weeks). 

 

 b. When the CE receives a massage therapy and/or acupuncture treatment 

 request unaccompanied by an LMN, the CE begins development. Refer to 

 Section 2(d) for further guidelines to begin development.

c. If the CE receives the appropriate medical evidence within the 30-day 

 development period, the CE prepares a letter to the claimant authorizing 

 massage therapy and/or acupuncture treatment. Refer to Section 2(e-f) for 

 further guidelines in communicating the approval. 

 d. The initial authorization period may be fewer than, but should not exceed 

 eight weeks, and the CE may approve up to two visits per week, for 16 

 visits during the initial authorization period. Each visit is equal to a 

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 maximum of 1.5 hours. Reauthorization, including obtaining updated 

 medical evidence is required for any request for additional massage 

 therapy or acupuncture treatment after the initial eight-week period. The 

 CE may not authorize more than 60 massage therapy and/or acupuncture 

 treatment visits per calendar year.

 

e. If, at the end of the initial eight-week authorization period, the CE receives 

 a new request for additional massage therapy and/or acupuncture 

 treatment, the CE must conduct a new evaluation of the medical necessity 

 for continuation of care. If the request is appropriate (updated medical 

 documentation adequately explains the medical necessity for continuing 

 massage therapy and/or acupuncture treatment), the CE grants 

 authorization for the extension of care within the authorization parameters 

 of no more than two visits per week and a maximum of 60 visits per year. 

f. Massage therapists and/or acupuncture providers, must hold a valid 

massage therapist’s license or certification in the state where services are 

rendered.

g. Massage therapy and/or acupuncture treatment services must be conducted 

 in an appropriate setting (i.e.; medical clinic, medical office) and should 

 be billed daily (i.e.; one date of service per OWCP-1500 line). 

 (1) The service provider must submit medical notes to the DEEOIC’s 

 BPA, along with their bill, describing the particular therapeutic 

 care provided during each visit with the claimant. The notes should 

 describe the effect of the massage therapy, including any specific 

 improvements in functionality or in achieving relief from the 

 symptoms of a compensable illness. The BPA then forwards the 

 medical notes to the DO for review. 

 (2) The OWCP Medical Fee Schedule does not provide a separate 

 allowance for massage therapy and/or acupuncture supplies (i.e.; 

 tables, equipment). The cost of supplies is factored into the fee 

 schedule amount. 

 h. If the CE receives a request for in-home massage therapy and/or 

 acupuncture treatment, the claimant must be homebound in order to 

 receive authorization for such services. Medical evidence from the treating 

 physician must demonstrate that the claimant is medically unable to travel 

 to obtain massage therapy and/or acupuncture treatment. Once the CE 

 receives convincing evidence that the claimant is not able to travel for 

 care, and sufficient documentation exists regarding the medical necessity 

 for care, the CE may authorize in-home massage therapy and/or 

 acupuncture treatment.

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i. Massage therapy and/or acupuncture treatment is not restricted by medical 

 diagnosis or condition, but is not appropriate when prescribed solely for 

 prevention of future injury, recreation (spa therapy), and/or stress 

 reduction. 

6. Chiropractic Services. The CE may authorize chiropractic services limited to treatment 

for correction of spinal subluxation, along with the tests performed or required by a chiropractor 

to diagnose such subluxation. A physician or chiropractor must document a diagnosis of spinal 

subluxation in his or her LMN as demonstrated by an x-ray before a CE can authorize services, 

and the spinal subluxation must be related to an accepted condition. 

7. Pulmonary Rehabilitation. The CE is required to authorize pulmonary rehabilitation 

services when prescribed by the treating physician. The treating physician must submit a LMN 

describing the need for pulmonary rehabilitation and its association to an accepted work-related 

illness. The LMN must specify the type, amount, frequency, and duration of pulmonary 

rehabilitation. The LMN must also include measurable and expected outcomes and estimated 

timetables to achieve these outcomes. Pulmonary rehabilitation must be conducted in an 

outpatient hospital setting or doctor’s office. A CE may authorize pulmonary rehabilitation for a 

period of up to six months. Recertification is required for any period beyond six months. 

Recertification should be completed before the current authorization expires, to allow for care to 

continue uninterrupted. 

8. Hearing Aids. A claimant requesting hearing aid(s) must submit LMN from his or her 

treating physician. The LMN must contain an explanation for obtaining hearing assistance due to 

an accepted work-related hearing loss. Services associated with the assessment, provision or 

fitting of hearing aids must be rendered by a licensed otolaryngologist, otologist, audiologist, or 

hearing aid specialist. Hearing aids are limited to one per ear every three years. The CE must 

authorize needed repairs within the three-year period, if the manufacturer’s warranty has expired. 

 

9. Organ Transplants (including Stem Cell). Organ transplants are a complicated and 

medically challenging treatment option. As a result, a special level of review is required. Once 

the FO alerts the CE to a request for organ transplant, the CE immediately obtains all relevant 

documentation from the treating physician relating to medical necessity of an organ transplant. In 

particular, the CE seeks a LMN describing the justification for the transplant, laboratory and 

diagnostic test results, CT or MRI scan results, and a transplant protocol. Once the CE has 

obtained this information, the CE forwards the information to the MBPU, via the DEEOIC Bill 

Pay Mailbox, requesting review for organ transplant authorization. The MBPU will then forward 

all pertinent information to the DEEOIC Medical Director, who prepares a memorandum 

approving or denying the transplant. The MBPU will then forward the signed memorandum to 

the jurisdictional office responsible for the claim. 

a. With notification of approval, the CE updates ECS Notes with a 

 confirmation of organ transplant authorization. The CE then prepares a 

 letter of authorization to the claimant with a copy to his or her physician. 

 The letter is to provide notification on the organ transplant authorization 

 including: 

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 (1) Covered medical condition(s). 

 (2) Authorized billing code(s) relevant to the approval. 

 (3) Statement advising that organ transplants must be performed at a 

 Center for Medicare and Medicaid Services (CMS) approved 

 facility. 

 (4) Statement advising that fees are subject to the OWCP fee schedule.

 

 (5) Statement advising that an organ donor is not considered an 

 “employee” or “claimant” within the meaning of DEEOIC and is 

 not entitled to compensation for wage-loss or permanent 

 impairment, nor is a donor entitled to benefits for any post- 

 operative complications resulting from the transplant. Only those 

 medical and related expenses of the donor, which are necessary to 

 secure treatment for the employee, are allowable.

 b. In-Patient or Outpatient Setting. Depending upon the transplant center, 

 the condition of the patient, and geographic limitations, transplant 

 procedures may occur on an in-patient or outpatient basis. 

 (1) Autologous transplants may be performed in either an in-patient or 

 outpatient setting, depending upon the transplant center. This type 

 of transplant requires stem cells that have been gathered and 

 stored, coming directly from the patient. 

 (2) Allogenic transplants may also be performed in either an in-patient 

 or out-patient setting. Allogenic transplants require that donor- 

 blood stem cells be drawn, stored, and then transplanted into the 

 patient.

c. Choice of Donors. 

 (1) The first choice of a donor is generally a family member or 

 relative. If the transplant facility approves a related donor, 

 transportation expenses and the cost of required medical 

 procedures for obtaining the organ(s) or blood stem cells are 

 reimbursable. The transplant facility submits bills to the BPA, 

 referencing the employee’s (recipient) SSN, and including the 

 medical documentation/ information pertaining to the donor. 

 Donor travel is reimbursed following the same guidelines 

 established for companion medical travel, and is paid directly to 

 

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 (2) If no suitable match is available through a relative, an unrelated 

 donor search must be authorized. The transplant center coordinates 

 with the National Donor Program for the testing of each potential 

 donor. The transplant center submits bills to the BPA for all such 

 tests and procedures. Unrelated donors are not paid for their 

 donation; the only coverage is for the medical expenses related to 

 the organ donor procedure. These procedures are billed by the 

 transplant facility, the same as with related donors, referencing the 

 covered employee’s SSN on all bills. 

 d. Long-Term Living Expenses. Transplants involve prolonged outpatient 

 procedures requiring the patient to remain within a short distance of the 

 transplant center. If the CE authorizes a transplant procedure and if the 

 claimant requires extended residency near the facility, the CE must 

 authorize lodging, per diem, companion, and other travel-related expenses 

 on a long-term basis. 

10. Mental or Psychiatric Illness Treatment. A CE may accept a mental or psychiatric illness 

under a Part B or Part E claim as a consequential illness to another accepted illness. In these 

situations, the CE must obtain a narrative medical report from a licensed clinical psychologist, 

psychiatrist, or licensed clinical social worker which includes: 

a. Diagnosis (with correct ICD10 code) and the initial date of diagnosis. 

 b. Medical rationale in support of how the mental or psychiatric illness is 

 related to a condition accepted by the DEEOIC under Part B or Part E of 

 the EEOICPA.

 

11. Experimental Treatment. The CE may consider authorizing experimental treatment if the 

accepted condition is life threatening, conventional therapy has been tried to no avail and a 

significant body of data supports the view that the experimental procedure is indeed beneficial. 

 

To request experimental treatment, the treating physician must send the treatment protocol, 

medical rationale, and peer-reviewed documents supporting the treatment to the CE. The CE 

forwards the information to the MBPU via the DEEOIC Bill Pay Mailbox. The MBPU will 

forward all pertinent information to the DEEOIC Medical Director, who prepares a 

memorandum approving or denying the experimental treatment. The MBPU will then forward 

the signed memorandum to the requesting DO. 

Upon receipt of the approval from the DEEOIC Medical Director, the CE sends an email to the 

FO, who prepares and sends a thread to the BPA, authorizing the experimental treatment 

approved by the DEEOIC Medical Director. The CE also documents the approval in the Notes 

section of ECS. The CE sends a copy of the approval letter to the provider designated by the 

claimant to provide the service. The approval letter must contain the following information: 

a. Covered medical condition(s). 

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 b. Authorized billing code(s) relevant to the approval. 

c. Statement advising that fees are subject to the OWCP fee schedule.

12. Sun Protective Clothing. This section describes the procedures a CE follows when 

authorizing a claimant’s request for reimbursement of sun protective clothing. DEEOIC has 

established a maximum $400 limit for sun protective clothing per calendar year. Sun protective 

clothing used for general health or personal reasons is not covered. 

a. Sun protective clothing is clothing specifically designed for sun protection 

 and is produced from a fabric rated for its level of ultraviolet protection. 

 Sun protective clothing is clothing that offers at least 30 or more 

 Ultraviolet-A (UVA) and Ultraviolet-B (UVB) sun protection for 

 claimants with accepted conditions of melanoma, other skin cancer or 

 other significant dermatologic condition. 

 (1) For authorization, the CE obtains the following information: 

 (a) A LMN from the treating physician describing a medical 

 need for sun protective clothing. 

 (b) The claimant must submit a receipt documenting that the 

 clothing was purchased from a sun protective clothing 

 company (i.e.; Solumbra or Coolibar). 

 (2) Once appropriate documentation is received, the CE approves the 

 reimbursement for the sun protective clothing using the OWCP 

 procedure code Clothing Modifications - CLMOD.

13. Vehicle Modifications and Purchases. This section provides clarification with regard to 

the evidence needed to approve vehicle modifications and purchases, and provides procedural 

guidance with regard to the process for review, development, and authorization of such requests. 

a. Criteria for Modifications. Upon receipt of a LMN describing a medical 

 need for vehicle modification, and if the claimant’s medical needs can be 

 met by modifying or adding accessories/equipment to the claimant’s 

 present vehicle, the CE explores that option first, before considering 

 replacement of the existing vehicle. When considering modifications to an 

 existing vehicle, the CE takes into consideration the type of vehicle 

 currently owned, its age, and condition. Modifications must be consistent 

 with the claimant’s pre-injury standard of living and should approximate 

 that standard insofar as practical.

 b. Proposals. If the CE determines that the claimant’s medical needs warrant 

 vehicle modification, the CE advises the claimant in writing to submit a 

 detailed written proposal containing the following information: 

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 (1) The year, make, model, and body style of the vehicle to be 

 modified, as well as current mileage, description of general 

 mechanical condition, and any modifications currently needed or 

 anticipated. The same applies regardless of whether the vehicle to 

 be modified is new or used. 

 (2) Detailed written estimates from two licensed automobile dealers, 

 or custom alteration facilities, itemizing the proposed vehicle 

 modifications necessary to comply with the treating physician’s 

 LMN. Estimates must include a breakdown of all parts, labor, and 

 the respective costs associated with each item. The estimates 

 should also state the amount of time required to perform the 

 modifications.

c. Acceptance by the CE. The CE has the latitude to approve an estimate that 

 the claimant favors, if the estimates are reasonably similar in scope and 

 cost.

 (1) Approval or Denial. Upon review of the evidence, the CE 

 approves or denies the request by sending a letter decision to the 

 claimant advising of the approval, or reason(s) for denial of the 

 request. 

 (2) Additional Information. If the CE determines that additional 

 information is necessary, the CE sends a letter to the claimant 

 requesting the additional documentation that is necessary to 

 continue with the review process. 

 (3) Inadequate response. If the claimant does not respond to the 

 development letter, or does not provide sufficient documentation to 

 support the request, after considering all relevant evidence, the CE 

 issues a letter decision informing the claimant of the authorization 

 denial. 

 d. Vehicle Purchase. If the claimant provides a LMN establishing that 

 modifications to his or her currently owned vehicle are not feasible or 

 practical, and that a substitute vehicle is required for the claimant to 

 operate, the CE reviews the case with a supervisor and the NO FO, and 

 may authorize the purchase of a suitable replacement vehicle. Under these 

 circumstances, credit must be taken for the value of the claimant’s existing 

 vehicle. Purchase options include the following: 

 (1) Purchase of a used vehicle, (similar in quality to the claimant’s 

 existing vehicle), equipped to accommodate the claimant’s 

 disability and transportation needs. 

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 (2) Purchase of a used vehicle that is suitable for modification as 

 described above.

 (3) Purchase of a new vehicle, modified, or suitable for modification, 

 to meet the needs of the claimant, arising from an accepted 

 condition. 

 (4) Whether a new or used vehicle is purchased, it must be a vehicle of 

 comparable value as the vehicle currently owned and operated by 

 the claimant (i.e.; a vehicle in a price range that closely 

 approximates the level of income and/or standard of living of the 

 claimant). For example, if the claimant owns a mid-priced 

 Chevrolet, Ford, Honda or Toyota; purchase of a Cadillac, 

 Lincoln, or Lexus SUV, would not represent a vehicle of 

 comparable value. Once the baseline cost of a comparable quality 

 vehicle has been established, the claimant may (at his or her 

 option) choose to upgrade the baseline model, by adding additional 

 equipment, with the difference in cost being paid for by the 

 claimant.

 (5) After determining the baseline cost of a comparable vehicle, the 

 CE must take credit for (deduct) the wholesale value of the 

 claimant’s existing car when determining the allowance to be paid 

 for a replacement vehicle. The wholesale value of the existing 

 vehicle can be determined through a number of internet websites 

 that make this information available free-of-charge. The CE 

 should advise the claimant of the source of their information, once 

 the wholesale value of the claimant’s current vehicle has been 

 determined.

 (6) Sales Tax. State sales tax should be included in the cost of 

 obtaining a replacement vehicle.

 (7) Equipment that is medically necessary for the accepted 

 condition should be factory-installed whenever possible.

 (8) Maintenance Costs. The CE authorizes necessary maintenance on 

 the specialized equipment in a modified vehicle, whether installed 

 in a new or used vehicle.

 (a) Replacement cost of the specialized equipment, due to 

 normal wear and tear, may be considered as well. Other 

 parts of the vehicle will be maintained at the owner’s 

 expense, even if the vehicle purchase was reimbursed by 

 DEEOIC.

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 (b) Replacement of the vehicle, and all authorized equipment, 

 can be considered if the claimant can establish that the age, 

 mileage, and condition of the vehicle warrant such 

 replacement. Any residual value remaining in the vehicle to 

 be replaced would be applied as a credit toward the cost of 

 a replacement vehicle.

 (9) Proof of Insurance. The claimant bears the cost of obtaining 

 automobile insurance and maintaining current vehicular 

 registration in conformance with the laws of the state within which 

 the claimant resides. Claimants are required to carry 

 comprehensive (fire, theft, vandalism) and collision insurance on 

 any vehicle for which DEEOIC has authorized reimbursement, 

 unless the fair market value of the vehicle and its equipment is less 

 than $2,500. The claimant may select the deductible of the 

 insurance policy but will be responsible for any such deductible 

 should an accident occur. 

 (10) Vehicle No Longer Needed. If the CE obtains information that a 

 vehicle purchased by DEEOIC is no longer needed, the CE will 

 send an email to the DEEOIC Bill Pay Box Mailbox alerting 

 MBPU of the situation. DEEOIC is entitled to recover the fair 

 market value of the purchased vehicle, less any percentage 

 contribution the claimant made to the overall purchase price of the 

 vehicle and its modifications. The MBPU will undertake 

 appropriate action to attempt recovery of any funds collectable 

 through sale of a DEEOIC purchased vehicle no longer needed by 

 a claimant. 

14. Housing Modifications. This section provides clarification with regard to the evidence 

needed to approve housing modifications, and provides procedural guidance with regard to the 

process for review, development, and authorization of housing modifications. The CE considers 

home modification only when deemed medically necessary due to an accepted condition. A CE’s 

responsibility is to grant authorization to modify an existing structure to accommodate the 

claimant’s medical needs. The treating physician must describe in a LMN the particular home 

modifications needed to accommodate the claimant’s work-related illness. 

a. Modifications to Owned Property. Modifications to a house must be 

 consistent with the claimant’s pre-injury standard of living and should 

 approximate that standard insofar as practical, with respect to the quality 

 of construction materials and workmanship. 

 (1) Modifications may include certain additions where warranted. For 

 example, if a ground-floor recreation room is converted to a 

 bedroom, to accommodate a wheelchair-bound individual, and if 

 no ground-floor bathroom facilities exist, then the addition of a 

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 bathroom on the ground floor could be approved. Similarly, if 

 there is no suitable space for conversion of a bedroom on the 

 ground floor, then the addition of a bedroom on the ground floor 

 could be approved, if no other reasonable alternative exists. 

 (2) Modifications may include certain appliances, such as air 

 conditioning or air filtration equipment, if deemed to be medically 

 necessary by the treating physician, and necessary for the relief of 

 accepted medical conditions. For example, if the claimant suffers 

 from respiratory or cardiac conditions that have been accepted, his 

 or her physician may order that the claimant be kept in an air 

 conditioned environment, in which case the expense for these 

 modifications would be allowed. 

 (3) When considering modification requests, the CE should consider 

 whether a portion of a home can be modified, as compared to a 

 whole-house modification. An example of this would be one or 

 two room air conditioning units, versus installing a whole-house 

 air conditioning system.

 (4) Maintenance expenses. The CE approves maintenance expenses 

 for equipment furnished to the claimant, as well as replacement 

 costs, after the normal life expectancy of the appliance. 

 b. Modifications to Non-Owned Property. Any modifications to property not 

 owned by the claimant, and his or her family, are subject to approval by 

 the landlord or owner. This is in addition to the preceding guidelines 

 established for owned property. When presented with a request for 

 modifications to non-owned property, the CE considers the following 

 points: 

 (1) Rental property may be subject to federal Americans with 

 Disabilities Act (ADA), state, or local statutes that mandate 

 barrier-free accessibility for persons with disabilities. The claimant 

 should discuss any change in housing needs with his or her 

 landlord, who may be able to offer modifications or alternative 

 accommodations better suited to the needs of the individual. 

 (2) If the landlord is unable or unwilling to pay for modifications, or 

 offer other suitable accommodations, approval must still be 

 obtained from the landlord prior to making any changes or 

 alternations to the non-owned property. Any such changes must be 

 made at the claimant’s expense, and are subject to review and 

 approval by DEEOIC, prior to any reimbursement. 

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 (3) If the landlord/owner will not permit modifications, or if the costs 

 are excessive, and if suitable housing arrangements are available 

 elsewhere, within the same geographic area, it may be more cost- 

 effective to consider paying relocation expenses rather than paying 

 for modifications at the current location. If changing locations is 

 the most cost-effective alternative, the CE may authorize a subsidy 

 for any increase in rent, if warranted, in addition to the relocation 

 expense. For example, if the claimant lives in an apartment with 

 stairs, and is no longer able to climb stairs due to his or her 

 accepted condition(s), DEEOIC would reimburse the claimant for 

 the most nearly comparable apartment available that offers an 

 elevator and any other accommodations required to fulfill the 

 claimant’s medical needs arising from the claimant’s accepted 

 condition(s). 

 (4) The Government is entitled to reimbursement only for the value of 

 special equipment that can be removed and sold separately, once 

 the claimant no longer needs that equipment. Improvements or 

 modifications, and any increase in property value resulting from 

 such changes, accrue to the benefit of the owner.

c. Proposals. If the CE determines that the claimant is eligible for housing 

 modifications, the CE asks the claimant to submit a detailed written 

 proposal for review and consideration. The CE advises the claimant that 

 the proposed housing modifications should be of a quality and grade 

 consistent with the existing architecture and construction materials, not 

 superior to them. Further, the claimant should be cautioned that structural 

 modifications must not compromise the integrity of the existing structure. 

 Modifications will be no more expensive than necessary to accomplish the 

 required purpose. For example, when remodeling a bathroom, it may be 

 feasible to re-install an existing sink at wheelchair height, for less than the 

 cost of discarding the sink and buying a new one. 

 Conversely, modifications must be in keeping with the standard of the 

 décor of the current or pre-illness accommodations. For example, if the 

 claimant’s dwelling requires that a sink or commode be changed for 

 handicap accessibility, and if it is necessary to tear out and replace tile, 

 then the tile in the entire bathroom or kitchen may have to be replaced 

 with similar quality tile in order to maintain the architectural décor of the 

 room.

 Proposals must include the following information: 

 (1) A medical report detailing the physical limitations for which the 

 requested modifications are necessary. This report should be 

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 prepared by a physician who is a recognized authority in the 

 appropriate medical specialty. 

 (2) An itemization of all modifications proposed. Where substantial 

 modifications are required, the detailed changes should be 

 recommended by a medical or rehabilitation professional familiar 

 with the needs of the disabled. 

 (3) If the claimant lives in a rented or non-owned premise, a written 

 statement from the landlord/owner must be obtained, approving 

 and authorizing the specific plans and proposed modifications. 

 (4) The CE reviews the itemized proposal and determines if the 

 specified modifications are warranted. If the CE identifies 

 technical issues regarding implementation, the CE develops the 

 issue further to identify alternate solutions.

 d. Fees and Bids.

 (1) Reasonable fees may be paid for the medical or rehabilitation 

 professional’s visit to the site, and for the preparation of the 

 detailed report. The same applies to any architectural drawings that 

 are required for significant structural changes.

 (2) No fee will be paid for attorneys or similar representatives engaged 

 by the claimant to assist with the proposal. Any fee charged by an 

 AR remains the claimant’s obligation.

 (3) The claimant must provide two or more bids for the proposed 

 changes from licensed and/or certified contractors. The bids 

 submitted must be for exactly the same modifications so that 

 comparison of the competitive bids can be made. 

 (a) If construction work is required, the bids obtained must be 

 for binding estimates of the cost. No fees will be paid for 

 the bids or estimates.

 (b) If special accessories or devices are required, the CE 

 stipulates that the price quoted by the vendor includes any 

 necessary installation. 

 (4) The CE reviews the bids to determine that the same workmanship 

 and materials are specified in the competitive bids, and normally 

 selects the lowest cost bid, unless there is a sound reason for a 

 higher-cost alternative, such as increased durability. If the CE 

 selects a bid other than the lowest-cost bid, a memorandum to the 

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 file is required, explaining any variance or the justification for 

 accepting a higher bid.

 (5) Additional Information. If the CE determines that additional 

 information is necessary, the CE sends a letter to the claimant 

 requesting additional documentation that is necessary to continue 

 with the review process.

e. Approval and Payment Options. Upon approval of the request, the CE 

 writes a detailed letter decision to the claimant advising of the approval 

 (Exhibit 29-6 provides a sample of the home modification approval letter.) 

 The approval letter is to include guidance to the claimant of the payment 

 options available and requests that the claimant respond in writing, 

 indicating his/her preferred payment option. For payment of home 

 modification, the following is necessary: 

 (1) The claimant submits medical evidence and two proposals for 

 home modifications. Upon review the CE approves the lower cost 

 bid proposal and sends a letter to claimant stating DEEOIC agrees 

 to the approved scope and cost of repairs, and, at the claimant’s 

 request, will make direct payment to the enrolled contractor, once 

 the agreed upon work has been completed. The letter states that 

 upon completion of the agreed-upon work, the claimant must 

 submit a written attestation to DEEOIC stating that the agreed 

 upon work has been completed by the contractor, to the claimant’s 

 satisfaction, and requesting that payment be made to the 

 contractor. The CE sends a courtesy copy of this letter to the 

 contractor.

 (2) Upon receipt of the claimant’s attestation and request to pay the 

 contractor, the CE acknowledges the claimant letter and advises 

 that the enrolled contractor should submit Form OWCP- 1500, 

 along with a final invoice, in order to receive payment of the 

 agreed upon price. The OWCP Code for HOME MODIFICATION 

 - HSMDF is used, when preparing the Form OWCP-1500. 

 (3) In certain situations, the CE may authorize payment of a pre- 

 construction deposit if required by the contractor whose bid has 

 been accepted by the CE. In these situations, the contractor is to 

 specify the total cost for specified home modification, along with 

 the amount of any deposit (up to one-third of the total cost) 

 required to initiate work. With CE approval, the contractor may 

 then submit Form OWCP-1500, to receive partial payment for the 

 deposit amount of the estimated cost. The OWCP code for HOME 

 MODIFICATION - HSMDF is used when preparing the Form 

 OWCP-1500. Upon completion of the work, the claimant must 

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 submit a written attestation to DEEOIC stating that the agreed 

 upon work has been completed by the contractor, to the claimant’s 

 satisfaction, and requesting that final payment be made to the 

 contractor. The contractor submits a separate Form OWCP-1500, 

 requesting payment of the balance of the agreed upon amount. 

 (4) For guidance regarding problems encountered during the course of 

 home modifications, or for other billing questions, (e.g.; billing 

 difficulties, disputes or other irregularities), the CE should contact 

 the NO Policy Branch for assistance.

15. Health Facility Membership and Spa Membership. This section describes procedures 

when a claimant requests authorization for reimbursement of fees to join a commercial health 

club or spa. 

a. Authorization. Membership in a health club or exercise facility, or 

 treatment at a spa, may be authorized when recommended by the treating 

 physician as likely to treat the effects, cure or give relief from a covered 

 illness. All requests for reimbursement of health facility and spa fees 

 require prior authorization from the CE. In all cases where such 

 membership is requested, the CE determines whether the membership is 

 likely to be effective and cost-efficient.

 b. Payment. Whenever a request for payment of health club/spa membership 

 is received, the CE obtains the following information: 

 (1) Information from Physician. The CE obtains the following 

 information from the treating physician:

 (a) A description of the specific therapy and or exercise routine 

 needed to address the effects of the covered illness, 

 including the frequency with which the exercises should be 

 performed.

 (b) The anticipated duration of the recommended regimen (i.e.; 

 weeks, months). 

 (c) An opinion as to the actual/anticipated effectiveness of the 

 regimen, treatment, goals attained/sought, and frequency of 

 examinations to assess the continuing need for the regimen. 

 (d) A description/list of the specific equipment and or facilities 

 needed to safely perform the regimen. 

 (e) The nature and extent of supervision, if any, required for 

 the safety of the claimant while performing the exercises.

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 (f) An opinion stating whether exercise can be performed at 

 home, as part of a home exercise program, or a 

 recommendation as to what kind of public or commercial 

 facility could provide the prescribed exercise routine. 

 (2) Information from Claimant. In addition, the CE obtains the 

 following information from the claimant:

 (a) The full name, address, and distance from the claimant’s 

 home or work location, of any public facilities (no 

 membership required) and those commercial facilities 

 (membership required) able to accommodate the prescribed 

 regimen.

 (b) If applicable, the specific reason(s) membership in a 

 commercial health club/spa is required when public 

 facilities are available, and or where the doctor indicates 

 the regimen can be performed at home. 

 (c) A signed statement from the health club/spa manager 

 stating that the club/spa can fully provide the exercise 

 regimen prescribed by the treating physician, and a 

 breakdown of the fees and charges for various membership 

 options and terms. The statement should describe all 

 facilities, services, and special charges not included in the 

 membership fee.

c. Approval. 

 (1) The CE must write a letter to the claimant advising of the approval. 

 The letter must include the following:

 (a) The date the DO received the request.

 (b) The period of time which the approval will cover. 

 (c) The amount approved (i.e.; monthly or annual fee). 

 (d) The type of membership approved. 

 (e) Two copies of a blank OWCP-957. 

 d. Additional Information. If the CE determines that additional information 

 is necessary, the CE sends a letter to the claimant (with a copy to the 

 treating physician) requesting additional documentation that is necessary 

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 to continue with the review process. In the letter, the CE provides 30 days 

 for receipt of the requested information. 

e. Period of Service. The CE may approve health facility membership for up 

 to twelve months. Recertification is required for any period beyond twelve 

 months. 

16. Medical Alert Systems. This section describes procedures the CE follows when a 

claimant requests authorization for medical alert system.

a. Definition. A medical alert system is an electronic device connected to a 

 telephone line. In an emergency, the system can be activated by either 

 pushing a small button on a pendant or pressing the help button on the 

 console unit. When the device is activated, a person from the 24-hour 

 central monitoring station answers the call, speaks to the claimant via the 

 console unit, assesses the need for help, and takes appropriate action. A 

 medical communication system qualifies as a medical alert system if it 

 includes the following requirements:

 (1) An in-home medical communications transceiver;

 (2) A remote, portable activator (Personal Pendant); 

 (3) A central monitoring station staffed by trained attendants 24 hours 

 a day, seven days a week (optional). 

 b. Authorization. All requests for medical alert systems require prior 

 authorization from the CE. A request for a medical alert system must be 

 documented with a letter of medical necessity from the treating physician, 

 linked to the accepted condition, which includes a statement that the 

 claimant has an acute or chronic condition which can require urgent or 

 emergency care.

 (1) Period of Service. The CE may authorize the medical alert system 

 for up to twelve months at a time. The need for such equipment 

 should be recertified by the prescribing physician prior to the 

 expiration of the authorization period. 

 (2) Billing. Systems that require a one-time connection fee and 

 monthly monitoring fee may be approved, based on the claimant’s 

 needs and the medical justification. The equipment provided is 

 leased and must be returned when no longer needed to avoid 

 further charges. DEEOIC is not responsible for any additional 

 charges incurred for failure to return equipment or failure to timely 

 return the equipment in a timely manner. 

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c. Approval. 

 (1) The CE writes a letter to the claimant advising of the approval. The 

 letter includes the following:

 (a) The date the DO received the request;

 (b) The period of time which the approval will cover; 

 (c) The amount approved. 

 d. Additional Information. If the CE determines that additional information 

 is necessary, the CE sends a letter to the claimant (with a copy to the 

 treating physician) requesting specific documentation that is necessary to 

 continue with the approval process. In the letter, the CE provides 30 days 

 for receipt of the requested information. 

17. Medical Expense Reimbursement for Extended Travel. This section describes 

procedures to be followed for authorizing medical travel requests over 200 miles round-trip, and 

the process for approving claims for reimbursement, regardless of whether the claimant obtained 

prior approval for the trip. 

a. Authorization. DEEOIC requires pre-authorization for reimbursement of 

 transportation, lodging, meals, and incidental expenses incurred when a 

 claimant travels in excess of 200 miles round trip for medical care of an 

 approved condition. DEEOIC’s BPA processes reimbursement claims for 

 claimant travel without pre-authorization when travel is 200 miles or less 

 round trip. (Exhibit 29-7 provides a sample Travel Authorization Letter.) 

 

 b. Processing. DEEOIC’s BPA processes reimbursement claims in 

 accordance with Government Services Administration (GSA) travel guidelines. 

 Per diem rates for overnight stay and mileage reimbursement rates are published 

 on the GSA website, and air fare reimbursement is based on actual ticket cost up 

 to the amount of a refundable coach ticket (Y-Class airfare).

c. Prior Approval. Upon acceptance of a medical condition, the claimant 

 receives a medical benefits package from the DEEOIC that includes 

 instructions on how to submit a written request for prior approval of 

 medical travel when such extended travel (over 200 miles round trip) is 

 required. Despite these instructions, it is not uncommon for claimants to 

 submit their request for reimbursement after a trip has been completed, 

 and without having obtained prior approval. 

 (1) Travel Exceeding 200 Miles. Medical expense reimbursement for 

 travel exceeding 200 miles round trip must be authorized by the 

 CE. Claims that are submitted to DEEOIC’s BPA, for reimbursement of 

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 travel expenses arising from medical travel in excess of 200 miles 

 roundtrip, will not be processed for payment unless authorization has been 

 provided by the DO. 

 d. Requests. Upon receipt of a travel authorization request from the 

 claimant, the CE takes immediate action to ensure that the request meets 

 one basic requirement: that the medical treatment or service is for the 

 claimant’s approved medical condition(s). The medical provider’s 

 enrollment in the DEEOIC program is not a prerequisite to approving 

 medical travel if the claimant chooses to receive medical services from a 

 non-enrolled provider. 

 

 (1) Companion. If the travel request involves authorization for a 

 companion to accompany the claimant, the claimant must provide 

 medical justification from a physician. The justification must be in 

 written form, relating the treatment to the accepted condition and 

 rationalizing the need for the companion. If the doctor confirms 

 that a companion is medically necessary, and provides satisfactory 

 rationale, then the CE may approve companion travel. In the 

 alternative, the CE can authorize the claimant to stay overnight in a 

 hospital or medical facility, and can approve payment for a nurse 

 or home health aide if a companion is not available. The CE must 

 use discretion when authorizing such requests and may approve 

 one of the above alternatives when there is a definite medical need, 

 accompanied by written justification from the physician.

 (2) Mode of Travel. The CE may allow the claimant to specify his or 

 her desired mode of travel. It is the CE’s role to authorize the 

 desired mode of travel for the time period(s) requested. When a 

 request is received from the claimant that does not identify the 

 mode of transportation, the CE contacts the claimant by telephone 

 and assists in determining the desired mode of travel. (RC staff 

 may assist in this process.)

e. Approval. Once the basic requirements for travel over 200 miles are met, 

 as outlined above, the CE prepares and sends the claimant a travel 

 authorization letter following the guidelines below. The CE may approve 

 an individual trip, or any number of trips within a specified date range, all 

 in one letter to the claimant. Once an initial authorization letter has been 

 sent, future visits to the same doctor or facility may be approved by 

 telephone, and confirmed by a follow-up letter.

f. Authorization Letter. The authorization letter delineates the specifics of 

 the trip being authorized, based upon the mode of travel the claimant has 

 selected. In the travel authorization letter, the CE advises the claimant that 

 travel costs are reimbursable only to the extent that the travel is related to 

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 obtaining medical treatment. In the letter, the CE also invites the claimant 

 to contact the nearest RC for assistance prior to or upon completing any 

 trip to complete Form OWCP-957, Request for Reimbursement. 

g. Adjudication. When adjudicating claims submitted after the trip has been 

 completed, but for which prior approval was not obtained, the CE follows 

 the same steps as for pre-authorized trips, to the point of sending an 

 authorization package. At that point the CE sends only the authorization 

 (or denial) letter to the claimant, not an entire authorization package. 

 h. Notifying the BPA. In conjunction with sending the claimant an approval 

 or denial of a travel request, the CE conveys his/her decision to DEEOIC’s 

 BPA via the office’s FO, who is the POC with DEEOIC’s BPA for such 

 issues. The CE prepares an e-mail to the FO, who in turn generates an 

 electronic thread to the BPA. In the e-mail the CE provides the 

 information specified below. The CE must also enter the following 

 information into ECS: 

 (1) Approved dates for a single trip or in the alternative, a date range 

 and number of trips authorized within that time frame.

 (2) Approved mode of transportation. 

 (3) Starting point and destination, (e.g.; claimant address and provider 

 address, city & state at a minimum).

 (4) Authorization for rental car reimbursement, if appropriate. 

 (5) Companion travel if approved. 

 i. Approval Package. The approval package must include the following: 

 (1) Two copies of the detailed authorization letter.

 (2) Two copies of a blank OWCP-957. 

 (3) A prepaid express mail envelope, addressed to DEEOIC’s BPA, 

 for the claimant’s use. 

18. Ancillary Services or Expense Authorization RD. When a CE decides to deny authorization 

for a claimed ancillary service or expense discussed in this chapter, the CE sends a letter decision 

to the claimant. The letter decision is to include a narrative explanation as to why the evidence is 

insufficient to warrant authorization. The CE is to send a copy of the letter decision to the 

provider, if applicable. 

a. The letter decision is to include the following language: 

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 If you disagree with this decision and wish to request a formal decision, 

 please immediately advise this office, in writing, that you wish to have a 

 Recommended Decision issued in this case, providing you with your 

 rights of action. 

 Upon issuance of the denial letter, the CE creates correspondence in ECS 

 documenting the issuance of the decision letter denying the ancillary 

 medical service. 

 b. RD. Should the claimant request a RD regarding denial of an ancillary 

 medical service or related expense, the CE completes the RD process in 

 accordance with existing DEEOIC procedure. In particular, the CE 

 ensures that the narrative content of the Explanation of Finding includes a 

 well-written discussion of the justification for the denial of authorization. 

 The FAB is responsible for independently evaluating the recommendation 

 of the CE, along with the file evidence, and deciding whether to finalize 

 the RD. 

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CHAPTER 30 – HOME AND RESIDENTIAL HEALTH CARE

1. Purpose and Scope. This chapter describes the procedures for evaluating and approving 

requests from claimants who are seeking approval for differing types of Home and Residential 

Health Care (HRHC) services including in-home health care, hospice services, and long-term 

residential care in an assisted living facility or nursing home. This section also provides 

procedural guidance with regard to the process for development and authorization of these 

services. 

During the processing of all HRHC claims the Medical Benefits Examiner (MBE), or other 

designated staff, are responsible for ensuring all documents created during the review process are 

properly scanned into OIS for recordkeeping purposes and that all appropriate case management 

updates to ECS occur.

2. In-Home Health Care Services (HHC). This section provides clarification with regard to 

the evidence needed to authorize HHC, which includes skilled nursing services, and attendant 

services such as home health aides, personal care attendants (PCA), etc. 

a. BPA. All requests for HHC must be submitted to the Division of 

Energy DEEOIC BPA via fax, mail, or electronically, to begin the authorization 

 process. The BPA creates an electronic record of all relevant documents and 

requests, and initiates an electronic message (thread) to the NO, advising of a 

 new, pending HHC request. 

 b. HHC requests are routed, via the BPA, to the Workers’ Compensation Assistant 

 (WCA). The WCA reviews the request and forwards the information to the 

 appropriate MBE for review and adjudication. 

c. Prior Authorization Required. All HHC requests require prior authorization from 

 a MBE, including authorization for initial in-home assessments. 

 d. Requests for an in-home assessment of a patient’s needs, and/or requests for 

 HHC, can be initiated by a claimant, the claimant’s authorized representative, any 

 licensed doctor who is treating the claimant for an accepted condition, or a HHC 

 provider. 

e. Telephone Requests. The MBE must document telephone requests for HHC care 

 in ECS. Moreover, the MBE advises the callers that they must submit their 

 requests, in writing, before the authorization process can begin. 

f. Approving Initial In-Home Assessment Requests. The MBE must approve any 

 request for an initial in-home HHC assessment, upon receipt of a signed 

 prescription by the treating physician. When an initial HHC assessment request is 

 properly documented with a physician’s prescription, the MBE approves the 

 initial request and sends an email to the WCA, who sends a thread to the BPA 

 authorizing the assessment. If the MBE receives a request for an initial HHC 

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 assessment without a physician’s prescription, the MBE sends a letter to the 

 claimant requesting a signed prescription for the initial assessment. In the letter, 

 the MBE advises that the claimant has 30 days within which to submit a signed 

 physician’s request for an initial HHC evaluation. If medical documentation or 

 signed physician’s prescription is not received within 30 days, the MBE denies 

 the request. 

g. LMN. The LMN is a narrative statement of the physician’s opinion regarding the 

 patient’s HHC needs and the medical justification for such services. The treating 

 physician must prepare the LMN based upon a clear understanding of the 

 patient’s medical history (including the accepted work-related illnesses), reported 

 findings from an in-home assessment, face-to-face examination of the claimant, 

 and consideration of other sources of information (such as family members, or 

 prior nursing notes in the case of a reauthorization of services). 

 Upon receipt of a LMN, or a hospital discharge summary specifically prescribing 

 HHC services, the MBE must conduct a complete review of the case file medical 

 evidence to determine if there is sufficient and well-rationalized documentation 

 from the physician, describing the medical reasons for HHC, as they relate to the 

 covered medical condition(s). The necessary information that the treating 

 physician must provide in the form of a signed LMN includes: 

 (1) Medical Rationale. A description of the HHC needs of the patient, as they 

 relate to the patient’s covered medical condition(s), based upon a face-to- 

 face medical examination conducted within the past 60 days. HHC exams 

 must be conducted by the patient’s treating physician, a physician’s 

 assistant, or other medical professional licensed and authorized by state 

 law to conduct such examinations within the physician’s practice, or 

 employed by the physician. This should include a detailed description of, 

 and distinction between the patient’s medical need for skilled nursing care, 

 personal attendant care, and/or any other type of care, while in the home; 

 and, an explanation as to how the requested care is linked to the covered 

 medical condition(s). The physician must describe the findings upon 

 physical examination, and provide a complete list of all medical 

 conditions, including conditions not accepted by DEEOIC. If a claimant 

 has one or more non-covered conditions, medical evidence must 

 demonstrate how the requirement for in-home health care relates 

 specifically to the accepted conditions. The physician should also 

 describe laboratory or other findings that substantiate a causal relationship 

 between the accepted condition(s) and the need for assistance or skilled 

 nursing care in the home. 

 (2) Level of care required. The doctor’s LMN must specify the appropriate 

 type of health care professional who will attend to the patient, i.e., 

 Registered Nurse (RN), Licensed Practical Nurse (LPN), PCA, Certified 

 Nursing Assistant (CNA), or Home Health Aide (HHA). Generally, 

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 approved in-home skilled nursing services (RN/LPN) include services 

 such as: administration of prescription medication, wound dressing 

 changes, administration of intravenous medications, assessment of 

 patient’s medical condition, and communication with treating physician(s) 

 regarding changes in accepted condition(s). Services provided by non- 

 skilled persons such as home health aides or personal care attendants are 

 typically intended for assistance with activities of daily living which often 

 include: mobility within the household, dressing and undressing, toileting, 

 bathing, and meal preparation. 

 (3) Extent of care required (hours, days, weeks, etc.). A written medical 

 narrative must describe the extent of care to be provided in allotments of 

 time, to include the duration of each function or operation, and the number 

 of times per hour/day/week a particular function or operation is to be 

 performed or repeated. The LMN must also state the duration of time for 

 which care is being prescribed in days, weeks, or months. 

 h. Incomplete medical evidence. If, upon review, the MBE finds that the medical 

 evidence is incomplete and/or the file does not contain an appropriate medical 

 rationale to support the type(s) of HHC being prescribed for the patient, the MBE 

 prepares development letters to the prescribing physician (Exhibit 30-1), and the 

 claimant (Exhibit 30-2). 

 (1) Physician Letter. The letter to the treating physician is to include the 

 MBE’s request for a narrative medical report addressing the specific 

 requirements needed to substantiate a clear medical basis for HHC. The 

 letter is also to include a request that the physician estimate the length of 

 time for which the patient will ultimately require HHC services. Lastly, 

 the letter is to reference the fact that DEEOIC cannot process the 

 claimant’s HHC request without this additional information. A response 

 from the physician is requested within 30 days. The MBE also faxes a 

 copy of the request letter to the treating physician’s office.

 (2) Claimant Letter. The MBE’s letter to the claimant acknowledges receipt of 

 a request for authorization of HHC services and advises that further 

 medical evidence is required to process the claimant’s request. 

 Additionally, the claimant letter contains a copy of the development letter 

 to the prescribing physician, which separately describes the medical 

 evidence requested by DEEOIC. The claimant letter is to include an 

 explanation that without the necessary supporting medical evidence, the 

 request for HHC services cannot be authorized. Finally, the MBE is to 

 request that the claimant contact the prescribing physician’s office to make 

 certain that a response to DEEOIC is provided within 30 days. 

 (3) No response after 30 days. If, after 30 days, there is no satisfactory 

 response from the treating physician, or no response from the claimant, the 

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 MBE prepares a second letter to the claimant (accompanied by a copy of 

 the initial letter), advising that no additional information has been received 

 from the treating physician. The MBE advises that an additional period of 

 30 days will be granted for the submission of necessary medical evidence. 

 The MBE further advises in the letter that if the requested information is 

 not received, DEEOIC must deny the claimant’s request for HHC services.

 (4) No response to second request. If the claimant or the physician does not 

 provide a response to the second request for information within the 30-day 

 period allowed, the MBE issues a letter decision to the claimant denying 

 the claim for HHC. The MBE sends an email to the FO, who sends a 

 thread to the BPA advising that the service has been denied. 

i. Claimant Has Final Authority. The claimant, or properly designated AR, has final 

 decision-making authority regarding the amount or type of HHC they want. If a 

 claimant calls and states that he/she does not require HHC, wishes to discontinue 

 care that is currently authorized, or requests a reduction in the amount of care, the 

 MBE takes one of the following actions: 

 (1) Discontinue Care. Should the claimant wish to discontinue care, the MBE 

 requests that the claimant send DEEOIC a signed letter declining HHC 

 services. Upon receipt of any written statement from the claimant stating 

 that HHC services are not being requested, or no longer wanted, the MBE 

 writes a letter to the claimant, with a copy to the treating physician and 

 any designated HHC provider, confirming that the claimant is declining 

 HHC services and thus the matter is closed. Additionally, the MBE sends 

 an email to the WCA, who sends a thread to the BPA advising that HHC 

 services are denied or terminated, with an effective end-date in the event 

 of termination. 

 (2) Modification of Care Currently Authorized. If the claimant contacts 

 DEEOIC and requests a reduction in the amount of care being provided, 

 (e.g.; the claimant only wants a home health aide in the home 8 hours a 

 day, and not 24-hours a day), the MBE instructs the claimant to call 

 his/her prescribing physician and request that the physician prepare a new 

 LMN for DEEOIC. The MBE advises the claimant that DEEOIC cannot 

 modify the amount/type of care being authorized without a LMN from the 

 physician. Upon receipt of any such letter from the physician, the MBE 

 takes appropriate action with regard to evaluating new medical evidence.

j. Evaluating Medical Evidence. Upon receipt of medical evidence pertaining to 

 either a new HHC request, or an existing HHC authorization, the MBE must 

 determine if the evidence is of sufficient probative value to authorize HHC. To 

 determine the probative value of any medical request for HHC, it is critical that 

 the MBE undertake appropriate analysis of the case file documentation pertaining 

 to HHC services before authorizing such care. 

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 (1) The underlying function of the MBE is to ensure that the covered 

 employee receives the necessary medical care for the accepted medical 

 condition(s) and that any such request for care reasonably corresponds 

 with the medical evidence in the case file. If the physician does not 

 provide sufficient detail concerning the claimant’s physical condition, 

 relationship of the prescribed care to the accepted condition(s), or specific 

 medical rationale for HHC, the MBE must prepare and send a letter to the 

 treating physician specifically describing the deficiency in the medical 

 evidence and stating clearly what information is needed. 

 (2) When evaluating the medical evidence, the MBE must base any 

 determination solely on the weight of medical evidence in the case file. 

 While the MBE can request clarification or seek additional information 

 regarding the medical justification for home health care, it is not 

 appropriate to reduce or modify the type or level of care without the 

 support of medical evidence obtained from a physician. 

 (3) Nurse Consultants and Medical Director. DEEOIC employs nurse 

 consultants and a medical director, who are available to both the MBE and 

 CE staff, to assist in the evaluation and analysis of medical evidence. 

 DEEOIC medical staff serve as a technical resource to the district offices 

 in regards to claims-related medical issues and can assist in the 

 determination of appropriate services and procedures that require 

 authorization by DEEOIC. 

 (4) Second Opinion (SECOP) Medical Examinations. Independent physicians, 

 randomly selected by a third-party contractor, perform SECOP 

 examinations. If the MBE deems the medical recommendations of the 

 treating physician are not supported by appropriate medical rationale and 

if attempts by the MBE are unsuccessful in clarifying the HHC needs of 

the claimant via the treating physician, the MBE must immediately 

arrange for a second medical opinion, or a referee medical opinion, 

depending on the circumstances. (Refer to Chapter 16 - Developing And 

Weighing Medical Evidence, for guidance pertaining to the 

SECOP/Referee examination process.) The context of any SECOP or 

referee examination is the medical necessity of HHC for one or more 

distinct six-month periods. 

For SECOP medical examinations required to evaluate HHC renewals, the 

MBE is to extend the existing HHC authorization until a SECOP medical 

examination is completed. Under these circumstances, the MBE takes the 

necessary actions to update the ECS, and notify the WCA (i.e., an update 

to reflect a 30 or 60-day extension of an existing HHC authorization), 

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Upon receipt of the SECOP exam results, the MBE considers the reports 

from both the SECOP doctor and the claimant’s treating doctor and 

determines if one report should be assigned a greater probative value than 

the other. If the MBE determines that the SECOP medical report is of 

lesser or equal weight, the SECOP report cannot be used to overturn the 

opinion of the claimant’s treating doctor. If the MBE determines that the 

two reports are of equal value, the MBE has the option of accepting the 

treating physician’s report, or seeking resolution by obtaining a referee 

medical opinion. 

A determination regarding the weight of medical evidence and a 

conclusion regarding the HHC needs of the claimant must clearly identify 

one or more six-month periods of HHC. Once the period(s) of HHC 

covered by second opinion decision expires, the MBE treats any 

subsequent request for HHC as a new request. 

 k. Emergency Authorizations. In certain emergency circumstances, the MBE may 

 authorize HHC for a preliminary 30-day period while additional development is 

 undertaken. In order to obtain approval for an emergency authorization, the 

 physician or hospital staff contacts DEEOIC’s BPA and advises the BPA that a 

 claimant requires care of an emergency nature (e.g., the claimant is being released 

 from the hospital and requires immediate in-home care). 

The BPA obtains any pertinent medical documentation and assesses the 

emergency nature of the request. A mere discharge following hospitalization is 

not a sufficient basis to authorize emergency HHC. The hospitalization discharge 

documentation must clearly describe the emergent medical need for HHC related 

to an accepted condition. It must also specify the level, extent, and duration of 

HHC required at the emergency level of care. Upon receipt of an emergency 

HHC authorization request, the BPA immediately contacts the WCA, advises the 

nature of the emergency, and provides electronic copies of all documentation 

obtained. The WCA forwards the information to the MBE for review. The BPA 

does not make a decision regarding the request, but simply obtains the pertinent 

documentation and advises of the emergency request.

(1) Upon receipt of supporting medical documentation, the BPA sends the 

 information to the WCA, who sends the information to the MBE for 

review. The MBE must carefully evaluate these situations to ensure the 

medical documentation clearly indicates that the patient’s care and wellbeing are dependent upon HHC services for a DEEOIC accepted medical 

 condition. If the BPA has not already obtained medical documentation to 

 support this need, the MBE requests the attending physician discharge 

 summary and discharge plan stating the level of care needed in the home. 

 If necessary, the MBE may call the hospital or attending physician for 

clarification of the need for emergency care and discuss needed medical 

evidence. 

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 (2) If discharge information from a treating physician supports the need for 

 immediate authorization; the MBE provides an emergency 30-day 

 approval pending additional development. When granting an emergency 

 HHC authorization, and for each 30-day temporary extension (while 

 awaiting medical evidence), the MBE notifies the claimant and provider, 

 in writing, of the initial and subsequent periods of authorization. The MBE 

 sends an email to the WCA advising of any authorizations, and the WCA 

 forwards the information to the BPA in the form of a thread. 

 (3) Upon initial approval of 30-day emergency care, the MBE sends a letter to 

 the treating physician, with a copy to the claimant, requesting the 

 necessary medical evidence to substantiate that the approved level of care 

 is medically necessary to give relief for the accepted medical condition(s). 

 This should occur within the initial 30-day authorization period. The 

 MBE may grant extensions in increments of 30 days, while awaiting the 

 necessary evidence to document that the level of care is medically 

 warranted and necessary. These extensions should generally not exceed a 

 total of 90 days. 

 (4) Some emergency authorization requests may not warrant approval. In 

 some situations, the evidence supplied may not justify the emergency 

 request. After careful review of the evidence supplied, the MBE sends a 

 letter to the claimant, with a faxed copy to the requestor, if other than the 

 claimant. In the letter, the MBE explains the deficiency that exists in the 

 medical evidence necessary to support the request for emergency care. 

 The MBE further advises that a LMN is required, clearly describing the 

 patient’s discharge circumstances that support the need for a specific level 

 of in-home health care. In addition, the MBE sends an email to the WCA, 

 who updates the thread request indicating the emergency authorization 

 request is under development. 

l. Authorization Letters to Claimants. If the MBE determines that the medical 

 evidence, or the emergency request, warrants approval of the HHC being 

 prescribed, authorization may be granted for up to 6 months (up to 90 days for 

 emergency requests). The MBE prepares a letter decision notifying the claimant 

 and the home health care provider of the authorization being approved, and 

 delineating the following information. (See Exhibit 30-3 for a sample 

 authorization letter):

 (1) Covered medical condition(s) for which care is authorized. 

 (2) Level and duration of the type(s) of in-home care to be provided, i.e., RN 

 1 hour per day and Home Health Aide 8 hours per day, 7 days a week for a 

 period of 6 months. 

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 (3) Authorized billing codes relevant to the level and duration of the care 

 authorized (see Exhibit 30-4 for a description of the pertinent codes). 

 (4) Period of authorization with specific start and end dates.

m. Approval Actions by the MBE. Upon sending the authorization letter to the 

 claimant and provider, the MBE completes the authorization process with the 

 following steps: 

 (1) Create Authorization: The MBE sends an email to the WCA, who initiates 

 an electronic thread to the BPA to authorize the specific level(s) of care, 

 billing codes (with units), and time period of the authorization. 

 (2) ECS Reminder. The MBE creates a reminder note to review the HHC 

 authorization 60 days prior to the expiration of the authorized period (or 

 within 30 days of the letter for emergency authorization requests). 

 n. Insufficient Evidence. After appropriate development as outlined above, if the 

 MBE reviews the medical evidence in the file and determines that there is 

 insufficient evidence to warrant authorization of HHC, the MBE sends a detailed 

 letter-decision to the claimant (with a copy to the HHC provider) advising of 

 DEEOIC’s determination. A letter decision is also required any time medical 

 evidence is received that warrants a reduction in the level of HHC services 

 currently being authorized. Letter decisions to either reduce or deny HHC must 

 include a copy of any SECOP or Referee report if that report serves as the basis 

 for the decision to reduce or deny the requested level of care. The narrative 

 content of the letter decisions must clearly explain how the MBE evaluated the 

 medical evidence, and must provide a rationale for his/her determination. Further, 

 all letter decisions must clearly identify the six-month period(s) being addressed 

 by the decision. The letter-decision must include a sentence at the end with 

 language as follows:

 If you disagree with this decision and wish to request a formal decision, please 

 immediately advise this office, in writing, that you wish to have a Recommended 

 Decision issued in this case, providing you with your rights of action. 

 o. Issuing a RD. In the event that the claimant does request a RD, the MBE prepares 

 and issues the decision. 

 p. Receipt of new medical evidence. Upon receipt of new medical evidence during 

 development of a new HHC request, during a currently authorized period of HHC, 

 after an authorized period of HHC has expired, or following a denial of a HHC 

 request, the MBE must review that new evidence to determine if any action is 

 required. New medical evidence could potentially result in one of the following 

 scenarios:

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 (1) Approval of the HHC request currently under consideration, (including 

 six-month reauthorization), or approval of an HHC request previously 

 withdrawn or denied. 

 (2) An increase in the current level of authorized services. In this instance the 

 MBE must terminate the current authorization and begin a new six-month 

 HHC authorization period. 

(3) A reduction in the current level of authorized services, but only if ordered 

by the treating physician who initially prescribed the care, or, based on a 

SECOP medical exam and report. When a decrease in care is warranted, 

the MBE must terminate the existing authorization and begin a new six-

 month authorization period. 

 (4) A denial of the current level of authorized services. (Examples of this 

 would be in cases where HHC was authorized on an interim basis 

 while awaiting results of a SECOP exam, or where a temporary 

 emergency authorization was granted while awaiting additional medical 

 evidence.)

 If the claimant’s treating physician provides new medical evidence supporting a 

 reduction in, or a termination of care, that reduction or termination is 

 communicated to the claimant by letter. There is no need to include language 

 regarding the claimant’s right to request a RD. 

 q. Letters advising of a reduction or termination of services must be copied to the 

 HHC provider and must specifically advise the claimant that the reduction or 

 termination will occur 15 days from the date of the letter. The letter must provide 

 an explanation of any new level of authorized services.

r. No overlapping HHC authorizations. It is important for the MBE to understand 

 that only one six-month HHC authorization period can exist at any given time. 

 Regardless of differing types of service(s) authorized, there can be no overlapping 

 dates. If the medical evidence dictates a change in the care currently authorized, 

 the authorization must be closed, with an end-date, and a new authorization 

 begun. 

 For example: If the claimant was authorized 8 hours a day of skilled nursing and 8 

 hours a day of HHA care, for a six-month period, and if the treating doctor 

 prescribed an increase in the HHA care, to 16 hours a day, the entire authorization 

 would be terminated and a new authorization period would be approved for both 

 the skilled nursing and the increased level of HHA care. 

s. Reauthorization of HHC Services. The following actions are taken by the MBE 

 during the course of an existing authorization: 

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 (1) 60 Days prior to the expiration of a HHC authorization the MBE reviews 

 the case record to determine if new medical evidence exists in support of a 

 reauthorization of services. 

 (2) If new evidence exists (face-to-face medical exam, updated medical 

 report, etc.) supporting a reauthorization of services, the MBE follows the 

 guidance under “p” and re-evaluates the case for consideration of a new 6- 

 month period of care. 

 (3) In the absence of new medical evidence supporting a reauthorization, the 

 MBE sends a letter to the treating physician, with a copy to the claimant. 

 The letter advises of the upcoming expiration date and emphasizes the 

 need for updated medical evidence, if continuing HHC services are 

 necessary.

 (4) Following a request for updated medical information, prior to a six-month 

 reauthorization, if no response is forthcoming, the HHC authorization 

 expires and the MBE takes appropriate action to close the HHC claim. 

 However, if the provider or the claimant submits a request for a 

 continuation of services, the MBE evaluates the request, and any 

 accompanying medical evidence.

3. Attendant Services Provided by Family Members. A claimant’s spouse, or relative, may 

provide authorized attendant care services if properly credentialed. Requirements for licensing, 

certification, or training, vary from state-to-state. There are two ways an individual can qualify 

for reimbursement by DEEOIC as a provider of HHC services:

a. A qualified individual can enroll with DEEOIC (OWCP.dol.acs-inc.com), as a 

 HHC provider and can be authorized for reimbursement for a maximum of 12 

 hours per day. 

 b. The employee’s spouse or relative can be employed by a DEEOIC enrolled 

 medical provider of HHC services. In this instance, licensing, certification and 

 training become the responsibility of the enrolled provider. 

4. Conflict of Interest Policy. DEEOIC has developed a Conflict of Interest Policy regarding 

the role of authorized representatives. (Refer to Chapter 12 – Representative Services.) Conflicts 

of interest can arise when a duly AR has direct financial interests as a result of his or her role, 

aside from the permitted fee enumerated under the EEOICPA. Because the “role” of an AR is so 

important, DEEOIC will consider the AR to have a prohibited “conflict of interest” if that 

individual could directly benefit financially from their client’s EEOICPA claim due to something 

other than the statutorily limited fee for representing a client in connection with his or her 

EEOICPA claim. 

With regard to HHC services, a DEEOIC enrolled provider of medical services will be 

considered to have a prohibited conflict of interest if, in addition to being the client’s authorized 

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representative, they are also being paid by DEEOIC, directly or indirectly, as a provider of 

authorized medical services to that individual. Because there is an obvious conflict of interest in 

these circumstances, DEEOIC will not recognize the enrolled provider as an AR. Under these 

circumstances, DEEOIC will inform the claimant of the need to designate another person as 

authorized representative, who does not have such a conflict. 

5. Hospice Care. This section provides clarification with regard to the evidence needed to 

authorize in-home hospice care services. 

a. Hospice care is generally requested and authorized when a physician has 

 determined that an individual has a terminal illness and has no more than six 

 months to one year of life remaining. When a treating physician determines that 

 in-home hospice care is required for an accepted condition and prescribes these 

 services for a claimant, it remains the role of the claimant’s treating physician to

 determine and prescribe all medical services and care, required by the patient for 

 the accepted condition(s). 

 b. All requests for in-home hospice care require prior authorization from the MBE 

 and must be submitted to DEEOIC’s BPA via fax, mail, or electronically, to begin 

 the authorization process. Upon receipt, the BPA creates an electronic record of 

 the request and generates a thread advising that a new hospice request is pending 

 CE approval. 

6. Extended Care Facilities. This section provides clarification with regard to the evidence 

needed to authorize placement in an extended care facility. When a treating physician determines 

that extended care is required for an accepted condition and provides a LMN to that effect, the 

CE may authorize the services.

a. Care in a nursing home, skilled nursing facility, or an assisted living facility may 

 be authorized when the claimant does not need acute care but does require 

 medical services and assistance with activities of daily living.

 b. All requests for extended care require prior authorization from the MBE and must 

 be submitted to DEEOIC’s BPA via fax, mail, or electronically, to begin the 

 authorization process. The BPA creates an electronic record of all such 

 documents and requests, and initiates a thread to the DO FO, advising of a new 

 and pending request for extended care. The FO forwards the request to the MBE 

 for review and adjudication. 

7. Billing Procedures and Authorization Periods. This section provides guidance with regard 

to billing protocol and authorization periods relevant to all types of ancillary medical services 

(e.g. home health care, hospice care and extended care facilities).

a. Authorization Period. All types of care (with the exception of Assisted Living 

 Facilities) may be authorized for a period not to exceed six months. Assisted 

 living may be authorized for a period not to exceed 12 months. Recertification is 

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 required for each successive six-month, or 12-month period, or part thereof, and 

 should be completed before the current authorization expires, to allow 

 uninterrupted care. The MBE should make every effort to complete recertification 

 before a current authorization expires. 

 b. Billing Procedures. The provider submits Form OWCP-1500, which must be 

 accompanied by supporting documentation (e.g. nursing notes, attendant care 

 notes, and itemization of charges with dates and hours of care). Exhibit 4 lists and 

 describes the various billing codes used by DEEOIC, when approving HHC 

 services.

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CHAPTER 31 – TORT ACTION AND ELECTION OF REMEDIES

1. Purpose and Scope. This chapter describes procedures to determine if a claimant is 

eligible to receive Part B benefits because of a lawsuit filed against a beryllium vendor or AWE 

due to the “election of remedies” provision of the EEOICPA. It also describes procedures for 

offsetting (reducing) EEOICPA benefits if the claimant is eligible to receive EEOICPA benefits 

but received settlement from a lawsuit for injuries resulting from exposure to the same toxic 

substance for which EEOICPA benefits are payable. 

2. Authority. 42 U.S.C. § 7385 requires the offset for certain EEOICPA payments. 42 

U.S.C. § 7385d requires the election of remedies for Part B beryllium vendor and AWE 

employees.

 

3. Signed Response Regarding Lawsuit, SWC Claim and Fraud. Before a claim can be 

accepted under the Act, the claimant must provide a signed response (affidavit) reporting 

whether a lawsuit had been filed for exposure to the same toxic substance for which EEOICPA 

benefits are payable, or whether a SWC claim had been filed for the same medical condition(s), 

or whether the claimant has ever pled guilty to or been convicted of fraud in connection with an 

application for or receipt of any federal or SWC. This signed response must be obtained 

regardless of the information contained on the forms EE-1 or EE-2 related to these three 

questions. 

a. The CE may call the claimant to get an initial verbal response to the three 

questions. If the claimant confirms verbally or submits a signed response that 

he/she has not filed a lawsuit, SWC claim, or pled guilty to or been convicted of 

fraud, the CE may proceed with issuance of the RD. 

Since a signed response from the claimant must be included in the case file before 

issuance of the FD, the CE follows up with a development letter requesting the 

signed response from each claimant before transferring the case to the FAB. The 

development letter must be claim specific and clearly note that by signing the 

written response, the claimant agrees to report any changes to the information 

provided in the response, immediately, to DEEOIC. The CE also advises the 

claimant that failure to submit a signed response will result in administrative 

closure of the claim.

b. If the CE is unable to obtain a verbal response from the claimant or the claimant 

responds affirmatively to any one of the questions, or evidence in the case file 

indicates that a lawsuit, SWC claim or fraud was filed or committed, the CE 

cannot issue a RD without further development and clarification. The CE may 

consider administrative closure of the claim if the claimant is not responsive to 

the development request for clarification but only as a last resort, and after at least 

two development letters. 

c. It is the responsibility of the FAB to obtain this signed response if a RD is issued 

without receipt of the signed response (i.e. the CE only received verbal 

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confirmation). The FAB makes every effort to obtain this signed response 

including calling the claimant and sending a follow up development letter. 

However, if the FAB is unable to obtain the signed response after 30 days from 

the FAB’s follow up development letter, the FAB remands the case to the DO for 

administrative closure of the claim. The FAB sends a letter advising the claimant 

of this course of action. 

d. If the case is with the FAB, and there is evidence in the case file of a lawsuit, a 

SWC claim, or fraud in connection with an application for or receipt of workers’ 

compensation that may impact the claimant’s EEOICPA benefits, further 

development must be undertaken. If the matter could be clarified by a telephone 

call, the FAB takes this action. If the matter requires extensive development, the 

case is to be remanded to the DO for further development. 

e. By signing the written response, the claimant agrees to notify DEEOIC of any 

changes in the information provided in regards to the lawsuit/SWC/fraud 

statement. It is not necessary to request this information again unless there is a 

new exposure or illness (including consequential) being accepted under 

EEOICPA. For instance, if the claimant had submitted a written response for lung 

cancer and is now filing a claim for a consequential condition of bone cancer, a 

new written response regarding the bone cancer is required before this 

consequential condition may be accepted under the Act. 

4. Developing for Lawsuit. If the claimant reports, or the evidence indicates, that a lawsuit 

was filed (regardless of what type, what happened, when it was filed or who filed it), the CE 

develops for verification of the lawsuit and lawsuit payments received. 

a. Contact with Claimant. The CE confirms with the claimant as to whether a 

lawsuit was filed and requests documents related to the lawsuit if one was filed. 

The CE requests copies of any complaint, settlement document, award from a 

judge/jury, and settlement sheet from the legal proceeding. If the claimant states 

that he or she is not legally permitted to disclose the information, it may be 

possible to persuade him or her to do so based on the Privacy Act protections in 

place for claims filed under the EEOICPA.

b. Contact with Attorney/Law Firm. The CE advises the claimant to contact the 

attorney who filed the lawsuit to obtain copies of required documents if the 

claimant does not have them. If the claimant is elderly or he or she is confused as 

to the type of documents that are required, the CE may need to directly contact the 

attorney. If the attorney considers the release on the bottom of Form EE-1 or 

Form EE-2 to be legally insufficient to authorize the release of the required 

document, the CE requests a separate written release from the claimant.

If the attorney is no longer with the law firm, the CE attempts to find out who in 

the law firm inherited the attorney’s clients, or where the records are stored. 

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c. Information from Other Sources. If information is not available from the claimant 

or the law firm, the CE attempts to obtain it from other sources. Some 

information can be obtained from the court where the matter was litigated, such as 

the complaint, judge or jury award (if any), and pertinent court orders. 

d. Initial Development Letter. The CE follows up with a development letter to the 

claimant explaining the need for the lawsuit documents and requesting a response 

within 30 days. The CE requests documents as noted in paragraph 4a. The letter 

indicates that failure to comply with the request may result in an administrative 

closure of the claim. 

 

e. No Response. If there is no response to the initial development letter after 30 

days, the CE sends a second development letter. The second development letter 

informs the claimant that the requested information must be submitted before the 

claim can be fully adjudicated, and the claim will be administratively closed if no 

response is received.

f. Administrative Closure. The CE may administratively close the file after two 

development letters are sent, if no response is received from the claimant and the 

CE is unable to obtain the lawsuit documents from other sources. 

5. Evaluating Lawsuit Documents. Once the CE has obtained the necessary documents 

regarding the lawsuit, he or she must review them to see what impact, if any, the lawsuit will 

have on the claim.

a. Complaint. A complaint is a legal document in which the plaintiff alleges that 

certain events took place involving exposures to toxic substances and that those 

events were the fault of the defendant(s). The complaint asks for certain remedies 

(payment for the resulting medical condition). From the complaint, the CE can 

discern the reason why the plaintiff filed the lawsuit, the identity of the plaintiff, 

the identity of the defendant and the date the lawsuit was filed. 

(1) The CE determines if the alleged exposures raised by the plaintiff were the 

same as the exposures for which EEOICPA benefits are claimed. There 

may be some exposures alleged by the plaintiff in the complaint that are 

not exposures for which EEOICPA benefits can be paid (non-employment 

exposures). 

(2) The CE must thoroughly understand the basis for the lawsuit (e.g., 

whether the plaintiff alleged that he or she was exposed as a worker rather 

than just as an individual who lived in a particular locale). 

(3) The CE also determines the identities of the parties to the lawsuit. To do 

so, the CE may need to inquire whether any later amended complaints 

were also filed.

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b. Settlement Sheet. A settlement sheet is basically a billing document. It lists the 

amounts received from a defendant and attorney fees and other costs that are 

being charged against those amounts. However, there may not be a document 

entitled “Settlement Sheet.” Instead, a CE may receive a document that simply 

lists the name of each defendant and the amount that the defendant paid to settle 

the suit. The CE needs to be able to determine how much the plaintiff/claimant 

actually received. 

When a settlement sheet lists the amount of the “costs” of bringing the lawsuit 

(not the attorney fees that are being charged), the CE must insist on an itemized 

list of costs, if they are not already itemized on the settlement sheet. If the legal 

costs are not itemized, the CE may not deduct the legal costs in calculating the 

amount of offset. 

c. Court Orders. If the lawsuit was not settled, the CE may be provided with an 

order of a judge, or a jury award, that states the amount that the defendant must 

pay to the plaintiff and the reason for payment of that amount. 

d. Bankruptcy. If a claimant receives a settlement in a bankruptcy proceeding, such 

settlement is treated like any other settlement for purposes of the offset. The CE 

requests the settlement sheet from the claimant's attorney, as outlined above. 

6. Election of Remedies, Part B. Depending on the circumstances of the lawsuit and the Part 

B claim, the claimant may no longer be eligible for EEOICPA Part B benefits based on the 

“election of remedies” provision under the Act. The election of remedies provision does not 

apply to Part E benefits. Different scenarios are discussed below:

a. Lawsuit against AWE or Beryllium Vendor. The “election of remedies” 

provision applies only to Part B claimants who have filed a lawsuit against either 

an AWE or a beryllium vendor. To determine if this provision applies to a Part B 

claim involving a lawsuit, the CE must determine if the otherwise eligible 

claimant was the same person who filed the lawsuit, if the lawsuit was against an 

AWE or a beryllium vendor, and if the lawsuit was for employment-related 

exposure to either radiation or beryllium. If the answer to all three of these 

questions is yes, further development is required, based on the date that the 

lawsuit was filed.

b. Lawsuits Filed Before October 30, 2000, Terminated Prior to December 28, 2001. 

For lawsuits in this category, “terminated” means that the lawsuit was concluded 

in any way: the parties settled, after which the suit was dismissed by the judge; 

the claimant won the case; or even that the claimant lost the case (judgment was 

granted for the defendants). This meaning of “terminated” applies to this time 

period only. 

The CE must look for proof that the matter has been resolved, regardless of the 

outcome. If the CE finds that the matter was terminated before December 28, 

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2001, the claimant is not disqualified from receiving any Part B benefits. The CE 

must include a finding in the RD that the lawsuit did not cause the claimant to be 

disqualified.

c. Lawsuits Filed Before October 30, 2000, Still Pending as of December 28, 2001. 

For lawsuits in this category, the CE will need to determine if the claimant 

dismissed all claims in the suit that arose out of the same employment-related 

exposure to either beryllium or radiation that is the basis for the Part B claim by 

December 31, 2003. 

Unlike the situation discussed on paragraph 6b, the suit must be dismissed, rather 

than merely terminated. That means that there must not be a final judgment in the 

suit for either the claimant or the defendant. If the suit was not dismissed by 

December 31, 2003 or if there is a final judgment in the suit, the claimant is not 

entitled to any Part B benefits. 

d. Lawsuits Filed Between October 30, 2000 and December 28, 2001. For lawsuits 

in this category, the claimant will not be eligible to receive Part B benefits, if the 

claimant does not dismiss all claims in the suit that arose out of the same 

employment-related exposure to either beryllium or radiation that is the basis for 

the Part B claim by the later of April 30, 2003, or the date that is 30 months after 

the date the claimant either received a radiation dose reconstruction from NIOSH

or a diagnosis of either beryllium sensitivity or CBD, depending on the 

occupational illness being claimed. 

e. Lawsuits Filed after December 28, 2001. For lawsuits in this category, the 

claimant will not be eligible for Part B benefits if a judgment is entered against 

the claimant (that is, the claimant loses the lawsuit). If the judgment is entered for 

the claimant (the claimant wins the lawsuit), the claimant is eligible for Part B 

benefits. 

If judgment has not been entered against the claimant, the claimant will not be 

eligible to receive Part B benefits, if the claimant does not dismiss all claims in 

the suit that arose out of the same employment-related exposure to either 

beryllium or radiation that is the basis for the Part B claim by the later of April 30, 

2003, or the date that is 30 months after the date the claimant either received a 

radiation dose reconstruction from NIOSH or a diagnosis of either beryllium 

sensitivity or CBD, depending on the occupational illness being claimed. 

7. Tort Offset, Parts B and/or E. If the lawsuit has not adversely affected the claimant’s 

eligibility under Part B due to election of remedies, an offset of the potential Part B and/or E 

award may still be needed. EEOICPA benefits are only offset if the basis for the lawsuit and the 

payable EEOICPA claim are due to injuries from exposure to the same toxic substance. For 

example, if the claimant filed a lawsuit for lung cancer based on exposure to asbestos and the 

Part E claim that is payable is also based on lung cancer due to exposure to asbestos, offset is 

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required. As long as there is one exposure that would be compensable, offset is required even if 

the lawsuit or EEOICPA claim is based on several other different exposures. 

a. Exceptions: There are several exceptions to the offset requirement.

 

(1) If the lawsuit alleges exposure that is clearly outside the time frame and/or 

location of exposure awarded under EEOICPA or if the lawsuit and 

EEOICPA claim are based on exposure to two different toxic substances, 

offset is not required. For example, if the EEOICPA claim is based on 

radiation exposure from 1952 to 1962 but the lawsuit is based on radiation 

exposure beginning in 1965, offset is not required. 

(2) If the lawsuit alleges non employment exposures, offset is not required 

(nor is there an election of remedies requirement). For example, if a 

claimant alleges in a lawsuit that he was exposed to radiation because he 

lived in proximity to a facility that produced radiation, not because he was 

exposed to radiation while working in a covered facility, offset is not 

required. 

(3) If an employee and his or her spouse were both plaintiffs with causes of 

action in a lawsuit they brought together and they both signed releases to 

settle their case, but only the spouse received tort payment and the 

employee was alive at that time, no offset is required. 

8. Pending Tort Settlement Payment. The requirement to offset EEOICPA benefits does not 

apply if the claimant has not received any payments from a lawsuit at the time of the EEOICPA 

payment. The CE does not defer issuing the RD or the FD. The RD or the FD is issued without 

offset since the claimant has not yet received tort payment.

 

However, if the claimant receives tort payment that requires EEOICPA benefits to be offset, at 

any time after issuing the RD or FD, but before the issuance of EEOICPA payment, the 

EEOICPA payment cannot be issued until the following actions are taken. 

a. Tort Payment Pending at the DO. If the tort payment is pending at the time of the 

RD, the CE issues the RD without an offset. However, the CE states in the RD’s 

cover letter that if the claimant receives tort payment after the issuance of the RD, 

but before issuance of the FD, the claim will be remanded by the FAB for offset 

and a new RD.

b. Tort Payment Pending at the FAB. If the tort payment is pending at the time of 

the FD, the FAB HR issues the FD without an offset. However, the HR states in 

the FD’s cover letter that if the claimant receives tort payment after the issuance 

of the FD, but before issuance of the EEOICPA payment, the FD authorizing the 

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c. Tort Payment Pending at the time of EEOICPA Payment. Before issuing 

EEOICPA payment, the CE calls the claimant to verify that tort payment is still 

pending. If the claimant receives tort payment after issuance of the FD, but 

before issuance of the EEOICPA payment, the DO forwards the claim to the NO

for a reopening. 

9. Required Tort Offset. After receipt of all relevant documents, the CE determines whether 

an offset is needed. If so, the CE completes the “EEOICPA Part B/E Benefits Offset Worksheet” 

(Exhibit 31-1).

The Worksheet includes detailed instructions for computing the amounts that the CE uses to 

calculate the amount of any offset. After completing the Worksheet, the CE staples it to the 

inside left cover of the case file jacket. 

a. Complaint. While the complaint must be obtained if the claimant disputes the 

 necessity of the offset, the CE may proceed with the offset without the complaint 

 if the claimant does not dispute that offset is necessary, and the CE has sufficient 

 evidence to fill out the EEOICPA Part B/E Benefits Offset Worksheet. This step 

 occurs after confirming that the election of remedies does not apply. 

 b. EEOICPA Benefits Greater than Offset. If the amount of EEOICPA benefits to 

 which the claimant is currently entitled is more than the offset, the balance due 

 the claimant will be the amount appearing on Line 7b of the 

 Worksheet. This is the amount of EEOICPA benefits that must be referenced in 

 the RD, along with an explanation of how this amount was calculated. 

 

c. EEOICPA Benefits Less than Offset. If the amount of EEOICPA benefits 

 currently payable is less than the offset, the amount of the “surplus” payment still 

 to be offset will appear on Line 7c of the Worksheet. All future EEOICPA 

 benefit payments for the same exposure(s) that formed the basis for the lawsuit 

 are subject to the offset to absorb a surplus. Since additional EEOICPA benefits 

 must first become payable before a surplus payment can be absorbed, no further 

 action to offset the surplus payment is required for a survivor’s Part B claim. 

 (1) If a surplus payment is to be absorbed in an employee’s Part B claim, this 

 must be noted in the RD, along with an explanation that DEEOIC will not 

 pay medical benefits until the surplus is absorbed. 

 (2) If a surplus is to be absorbed in an employee’s Part E claim, this same 

 explanation must appear in the RD, plus an explanation that DEEOIC will 

 also not pay any benefits for wage-loss and/or impairment that may be due 

 in the future until the surplus is absorbed. 

 (3) If a surplus is to be absorbed in a survivor’s Part E claim and further 

 monetary benefits may be payable based on the deceased employee’s 

 calendar years of qualifying wage-loss, this must be noted in the RD, 

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 along with an explanation that DEEOIC will absorb the remaining surplus 

 out of those benefits if and when they become payable. 

 

 d. FAB Award Letter. In situations involving a surplus, the FAB issues an award 

 letter which accompanies the final decision and advises the claimant of the exact 

 amount of the surplus. In the award letter, the FAB representative explains that 

 the surplus will be absorbed out of medical benefits payable under EEOICPA 

 (and lump-sum payments due in the future under Part E). The FAB representative 

 instructs the claimant to submit proof of payment of medical bills to the until 

 notice is received that the surplus has been absorbed, and to advise medical 

 providers to submit proof of payment of medical bills to the DO during this time. 

 

e. ECMS Coding. Upon issuance of the final decision that concludes with a surplus, 

 the FAB reviewer updates ECMS in the condition status field with the “O” 

 (Offset) code for the affected medical condition(s) on the medical condition 

 screen for the employee’s claim. The offset only applies to the employee’s claim, 

 even in the event that the employee died prior to adjudication of the case, and the 

 survivor is entitled to compensation. The “O” code is entered only for the medical 

 condition(s) that derived from the same exposure(s) that formed the basis for the 

 tort claim. During the time in which the “O” code remains in the medical 

 condition status screen, the BPA denies medical bills related to the medical 

 condition coded as “O” and generates explanations of benefits that the bills are 

 not payable due to a surplus. Once the surplus is absorbed, the CE replaces the 

 “O” code with “A” (Accepted) code. 

10. Actions to Absorb Surplus. Each DD appoints a qualified individual to serve as the POC 

to monitor surplus situations for both tort settlements and SWC benefits. Tort settlement and 

SWC benefit surpluses are absorbed until the surplus is exhausted and EEOICPA benefit 

disbursement can commence. The POC tabulates the amounts of proofs of payment, using the 

DEEOIC Offset Tracking Database, until they equal or exceed the surplus amount. 

a. While the surplus is being absorbed, the POC temporarily places the affected case 

 file in a red jacket denoting that a surplus exists. All case file contents are 

 maintained in the red jacket throughout the process of surplus depletion. 

 b. No further payments related to the same toxic exposure(s) that formed the basis 

 for the lawsuit are made on any case file contained in a red jacket until such time 

 the offset has been absorbed. Should an unpaid bill be submitted to the POC 

 during the surplus period, it must be forwarded to the BPA so an explanation of 

 benefits can be generated. 

c. During the time in which the surplus is being monitored for depletion, the POC 

 continually tracks the offset using the DEEOIC Offset Tracking Database, which 

 is accessible through the shared drive. Upon payment of impairment benefits, 

 wage-loss compensation, or proof of payment of medical bills, the POC enters the 

 dollar amount being applied toward the offset into the appropriate field in the 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Chapter 31 – Tort Action and 

Election of Remedies

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 DEEOIC Offset Tracking Database, until such time the surplus has been 

 absorbed. 

 d. While medical benefits are not being paid because of a surplus that is being 

 absorbed, the CE may find it necessary to obtain a second opinion examination, a 

 referee examination, or a medical file review. If so, DEEOIC pays the costs for 

 these directed examinations or reviews and reimburses any reasonable expenses 

 incurred by the employee, including medical travel expenses, without adding to 

 the surplus. Therefore, offset does not apply to any prior approval medical 

 conditions in ECMS, coded with a medical condition type of “PA.” In such 

 situations, the CE enters a comment into ECMS case notes authorizing the BPA 

 to pay all bills related to the directed medical examination or medical file review.

 

 In a case with a surplus, BPA creates a thread for all medical travel refund 

 requests to the POC requesting authority to deny or proceed with payment. 

 Medical travel expenses related to a directed medical examination must be 

 approved for payment and are not subject to offset. 

e. Once the surplus is completely absorbed and EEOICPA benefits may commence, 

 the POC removes the temporary red file jacket and returns the case contents to the 

 original file jacket. Removal of the red file jacket signifies that future benefit 

 payments may be made on the case. Once the surplus is absorbed, the CE also 

 replaces the “O” in the condition status field in ECMS with “A” (Accepted) code. 

 However, cases are not to be deleted from the DEEOIC Offset Tracking Database 

 once the offset has been absorbed. 

f. The POC sends a letter to the claimant that the surplus is absorbed. The letter 

 provides the claimant with the address of the BPA and instructs him or her to 

 submit all future unpaid medical bills to that address for processing. To avoid 

 duplicate payment of medical bills that were applied toward the offset, BPA 

 creates threads for all submitted medical bills with service dates prior to the date 

 that condition status “O” was changed to “A” in ECMS. The CE reviews the 

 threads and advises BPA if the medical bills can be paid by checking the DEEOIC 

 Offset Tracking Database to determine if the medical bills were applied toward 

 the offset. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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CHAPTER 32 – COORDINATING STATE WORKERS’ COMPENSATION BENEFITS

1. Purpose and Scope. This chapter describes procedures for coordinating Part E benefits 

with SWC benefits. “Coordination of benefits” occurs when the compensation payable under 

Part E of the Act is reduced to reflect certain benefits previously received by the claimant under 

a SWC program for the same covered illness. 

2. Authority. 42 U.S.C. § 7385s-11 requires the OWCP to coordinate the Part E award(s) 

with the amount of certain benefits received from a SWC program for the same covered illness, 

after deducting the reasonable costs incurred by the claimant in obtaining those benefits. 

3. SWC Benefits. SWC programs are no fault systems designed to provide injured workers 

or survivor benefits for work-related injuries or illnesses without having to sue their employers. 

SWC benefits may include payments for medical services, vocational services, cash payments to 

the injured worker for wage-loss or reduction in earning capacity, as well as death and funeral 

benefits to the worker’s survivor(s). 

The laws creating these systems differ by state, but the cash benefits (whether for temporary total 

disability, temporary partial disability, permanent total disability, permanent partial disability, or 

death of a worker) are typically a calculated percentage of the injured worker’s weekly earnings 

for a set number of weeks. SWC benefits can be administered directly by a state commission (as 

in Ohio). Another method is to have a state board supervise or adjudicate disputed claims and 

enforce the required payments made by private parties such as employers or insurance 

companies. Payments can be issued in a lump-sum award or settlement, on an ongoing basis 

(weekly or monthly), or a combination of both. 

4. When Coordination is Required. Coordination of Part E benefits (there is no 

coordination of Part B benefits) is required only if the EEOICPA beneficiary received benefits 

through a SWC program for the same covered illness for which that same EEOICPA beneficiary 

is eligible to receive benefits under Part E. This means the CE first determines the 

employee/survivor’s eligibility to receive Part E benefits, then determines who the beneficiary of 

the SWC benefits was before determining whether coordination is required. For example, if the 

employee settles a SWC claim for asbestosis and the accepted covered illness for which the 

employee is entitled to Part E benefits is also asbestosis, coordination of the Part E award is 

required to reflect the amount of SWC benefits the employee has received. 

Similarly, in cases where the employee had filed a Part E claim but died before payment could be 

issued, Part E medical benefits through the date of employee’s death awarded to the survivor 

requires coordination if the employee had received SWC benefits for the same covered illness. 

Coordination of medical benefits is required in this case because the Part E medical benefits 

were based on the employee’s entitlement to Part E benefits and the same employee received 

SWC benefits for the same covered illness. 

However, if the employee or the deceased employee’s estate (considered same as the employee) 

receives SWC benefits for asbestosis and the accepted covered illness for which the survivor is 

entitled to Part E benefits is also asbestosis, the CE will not consider this claim for coordination 

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Compensation Benefits

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(unless that survivor also received some form of SWC benefits for asbestosis, such as death 

benefits). 

5. Exceptions. The following are exceptions to the coordination requirement. Review 

Exhibit 32-1 for additional scenarios and determination as to whether coordination is required. 

 

a. Multiple illnesses. If the claimant receives SWC benefits for a non-covered 

illness, or for both a covered and a non-covered illness arising out of and in the 

course of the same work-related exposure, the CE does not coordinate the Part E 

award. 

For example, if the claimant settles a SWC claim for asbestosis and silicosis 

arising out of the same exposure and the amounts are not apportioned between the 

two illnesses, and the accepted covered illness for which the claimant is entitled to 

Part E benefits is only asbestosis, coordination of the Part E benefits is not 

required. 

b. Covered illness. Because a “covered illness” is an illness resulting from exposure 

to a toxic substance, the same medical condition accepted by DEEOIC and a 

SWC program may not require coordination. For example, if the claimant settles a 

SWC claim for asbestosis in a non-DOE facility and is entitled to Part E benefits 

for asbestosis based on a separate and distinct exposure to asbestos at a DOE 

facility, coordination of the Part E benefits is not required because it is not the 

same covered illness (not resulting from the same toxic exposure). 

c. Waivers. DEEOIC may waive the requirement to coordinate Part E benefits with 

benefits paid under a SWC program, if it is determined that the administrative 

costs and burdens of coordinating Part E benefits in a particular case or class of 

cases justifies the waiver. A waiver is automatically granted if the total amount of 

SWC benefits the claimant received is under $200. 

If a waiver is to be granted, the CE prepares a memo to the file, approved by the 

DD, explaining that the requirement to coordinate the benefits is waived due to 

the dollar amount of the SWC benefits the claimant received.

d. Medical or Vocational Benefits Only Claims. Medical or vocational benefits paid 

by a SWC program do not require any coordination of benefits. 

6. Signed Response Regarding SWC Claim, Lawsuit and Fraud. Before a Part E claim can 

be accepted under the Act, the claimant must provide a signed response (affidavit) reporting 

whether a SWC claim had been filed for the same covered medical condition(s), or whether a 

lawsuit had been filed for the same toxic exposure, or if the claimant has ever pled guilty to or 

been convicted of fraud in connection with an application for or receipt of any federal or SWC. 

This signed response must be obtained regardless of the information on the forms EE-1 or EE-2 

as related to these three questions. 

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Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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a. The CE may call the claimant to get an initial verbal response to the three 

questions. If the claimant confirms verbally or submits a written response that 

he/she has not filed a SWC claim, lawsuit, or pled guilty to or been convicted of 

fraud, the CE may proceed with issuance of the RD. 

Since a signed response from the claimant must be included in the case file before 

issuance of the FD, the CE must follow up with a development letter requesting 

the signed written response from each claimant before transferring the case to the 

FAB. The development letter must be claim specific and clearly note that by 

signing the written response, the claimant agrees to report any changes to the 

information provided in the response, immediately, to DEEOIC. The CE must 

also advise the claimant that failure to submit a signed response will result in 

administrative closure of the claim.

b. If the CE is unable to obtain a verbal response from the claimant or the claimant 

responds affirmatively to any one of the questions, the CE cannot issue a RD 

without further development and clarification. The CE may consider 

administrative closure of the claim if the claimant is not responsive to the 

development request for clarification. This action is taken only as a last resort, 

and after at least two development letters. 

c. It is the responsibility of the FAB to obtain this signed response if a RD is issued 

without receipt of the signed response (i.e. the CE only received verbal 

confirmation). Every effort should be taken by the FAB to obtain this signed 

response including calling the claimant and sending a follow up development 

letter. However, if the FAB is unable to obtain the signed response after 30 days 

from the FAB’s follow up development letter, the FAB remands the case to the 

DO for administrative closure of the claim. 

d. If the case is with the FAB, and there is evidence in the case file of a SWC claim, 

lawsuit, or fraud in connection with an application for or receipt of workers’ 

compensation that may impact the claimant’s EEOICPA benefits, further 

development must be undertaken. If the matter could be clarified by a telephone 

call, the FAB should take this action. If the matter requires extensive 

development, the case is to be remanded to the DO for further development. 

e. By signing the written response, the claimant agrees to notify DEEOIC of any 

changes in the information provided in regards to the SWC/lawsuit/fraud 

statement. It is not necessary to request this information again unless there is a 

new exposure or illness (including consequential) being accepted under 

EEOICPA. For instance, if the claimant has submitted a written response for lung 

cancer and is now filing a claim for a consequential condition of bone cancer, a 

new signed response regarding the bone cancer is required before this 

SUPERSEDED

consequential condition is accepted under the Act. 
Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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7. Verifying SWC Claims. If the claimant reports, or the evidence indicates a SWC was 

filed, the CE verifies the illness and SWC benefits received, but only after the CE determines 

Part E eligibility. 

Once the CE determines that there is qualifying employment, covered illness, and a SWC claim 

for the same illness, the CE sends the claimant a development letter. The development letter 

states that a decision under the EEOICPA cannot be rendered until the claimant provides 

evidence from the state commission, board, payment-issuing agency, or from an attorney who 

settled his or her SWC claim verifying the total amount and type of SWC benefits paid to date. 

a. Benefit Categories. The evidence from the state commission, board, paymentissuing agency or attorney must specify the total amount in benefits the claimant 

received as of the date of the reply, and an itemized account of the total benefits 

paid for each benefit category, such as: medical benefits; disability benefits; 

death benefits; burial/funeral benefits; settlement amount; attorney fees; 

vocational rehabilitation; and the amount of any disability payment issued during 

vocational rehabilitation training.

b. No Response or Insufficient Response. If the claimant does not respond to the 

request or the material submitted is not sufficient to coordinate benefits, the claim 

is administratively closed and the claimant is advised that no additional action 

will be taken until the required documentation is provided. 

In some limited cases, the claimant, the SWC board, commission, paymentissuing agency or attorney may no longer have the SWC records. If the CE 

independently confirms with the SWC board, commission, payment-issuing 

agency or attorney that the SWC record is no longer available, the CE may accept 

a signed affidavit from the claimant attesting to the amount of the SWC benefit. 

As a last resort, this affidavit can be used to determine the amount of 

coordination. 

8. Pending SWC Payment. Coordination of benefits is tied to the dollar value of the SWC 

benefits the claimant received for the same covered illness. Therefore, the requirement to 

coordinate benefits does not apply if the claimant has not received SWC benefits as of the time 

of the Part E payment. 

If payment of SWC benefits for the same covered illness is pending at the time of the Part E 

payment, the CE does not defer issuing the RD or the FD. The RD or the FD is issued without 

coordination since the claimant has not actually received SWC benefits yet.

 

However, if the claimant receives payment on the pending SWC claim at any time after issuing 

the RD or FD, but before the issuance of the Part E payment, the Part E payment cannot be 

issued until the following actions are taken. 

a. SWC Payment Pending, Prior to RD. If the claimant filed a SWC claim for the 

same covered illness, but SWC payment is pending at the time of the RD, the CE 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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issues the RD without any coordination. However, the CE states in the RD’s 

cover letter that if the claimant receives SWC payment after the issuance of the 

RD, but before issuance of the FD, the claim will be remanded by the FAB for 

coordination of benefits and a new RD. 

b. SWC Payment Pending While the Case is at the FAB. If the SWC payment is 

pending while the case is in posture for the FD, the FAB HR issues the FD 

without coordination. However, the HR states in the FD’s cover letter that if the 

claimant receives SWC payment after the issuance of the FD, but before issuance 

of the Part E payment, the FD authorizing the payment will be vacated. 

c. SWC Payment Pending at the Time of EEOICPA Payment. Before issuing the 

Part E payment, the CE calls the claimant to verify that payment of the SWC 

benefits is still pending. If the claimant receives SWC payment after issuance of 

the FD, but before issuance of the Part E payment, the DO forwards the claim to 

the NO for a reopening.

9. Calculate Amount to Coordinate. Once the CE receives the documentation which 

verifies the amount of SWC benefits the claimant received for the same covered illness, the CE 

completes the “EEOICPA/SWC Coordination of Benefits Worksheet” (Exhibit 32-2). This 

Worksheet (and its detailed instructions) is to be used by the CE to make the calculations 

necessary to determine how much to coordinate a claimant’s EEOICPA Part E benefits to reflect 

benefits received from a SWC program for a covered illness compensable under Part E. After 

completing the Worksheet, the CE staples it to the inside of the case file jacket. 

a. Maximum Aggregate Compensation. The amount of monetary compensation 

 provided under Part E (impairment and wage-loss compensation), excluding 

 medical benefits, cannot exceed $250,000. In determining the aggregate 

 compensation, reduction of compensation based on state workers’ compensation 

 coordination or tort offset is not taken into consideration. For example, if the 

 employee is awarded benefits for impairment in the amount of $100,000 but his 

 compensation is reduced because of coordination of SWC benefits to $60,000, 

 the amount of compensation used to determine the maximum aggregate 

 compensation is $100,000. 

 b. Periodic SWC Benefits. Some claimants receive ongoing periodic SWC benefits, 

 such as a worker’s or widow’s annuity that can make calculation of the proper 

 amount of coordination difficult. For cases with such SWC payments, the FAB is 

 to use the same cut-off date for determining the amount of SWC received that was 

 used by the CE at the DO. 

c. Part E Benefits Greater than SWC Benefits. If the amount of EEOICPA Part E 

 benefits (which may consist of lump-sum payments and/or post-filing and 

 ongoing medical benefits) to which the claimant is currently entitled is MORE 

 than the amount of the SWC requiring coordination, the balance due the claimant 

 (i.e., a positive amount) will be listed on Line 7 of the Worksheet. This is the 

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Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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 amount of Part E benefits that must be referenced in the RD, together with an 

 explanation of how this amount was calculated. 

 d. Part E Benefits Less than SWC Benefits: If the amount of Part E benefits is LESS 

 than the amount of the SWC requiring coordination, the amount of the “surplus” 

 (i.e., a negative amount) is listed on Line 7 of the Worksheet. Because a surplus 

 can only be absorbed from EEOICPA Part E benefits due an employee currently 

 or in the future, no further action is required for a survivor claim. 

 If there is a surplus to be absorbed in an employee’s Part E claim, this must be 

 noted in the RD, along with an explanation that OWCP will not pay medical 

 benefits and will apply the amount it would otherwise pay (directly to a medical 

 provider, or to reimburse an employee for ongoing medical treatment) to the 

 remaining surplus until it is absorbed. In addition, the CE explains in the RD that 

 OWCP will not pay any further lump-sum payments for wage-loss and/or 

 impairment due in the future until the surplus is absorbed. 

e. FAB Award Letter. In situations involving a surplus, the FAB issues an award 

 letter to the claimant containing special language. The FAB award letter 

 accompanies the final decision and advises the claimant of the exact amount of 

 the surplus. 

 (1) The FAB explains in the award letter that the surplus will be absorbed out 

 of medical benefits payable and further lump-sum payments due in the 

 future (i.e. wage-loss and impairment) under Part E of the EEOICPA. 

 (2) The award letter further instructs the claimant to submit proof of payment 

 of medical bills to the DO until notice is received from the DO that the 

 surplus has been absorbed. 

 (3) In addition, the award letter instructs the claimant to advise medical 

 providers to submit proof of payment of medical bills to the DO during 

 this time.

10. Actions to Absorb Surplus. Each DD appoints a qualified individual to serve as thePOC

to monitor surplus situations for both tort settlements and SWC benefits. Tort settlement and 

SWC benefit surpluses are absorbed until the surplus is exhausted and EEOICPA benefit 

disbursement can commence. The POC tabulates the amounts of proofs of payment and further 

lump-sum awards for wage-loss and impairment benefits using the DEEOIC Offset Tracking 

Database, which is accessible through the NO Shared Drive, until they equal or exceed the 

surplus amount. 

a. While the surplus is being absorbed, the POC temporarily places the affected case 

 file in a red file jacket denoting that a surplus exists. All case file contents are 

 maintained in the red file jacket throughout the process of surplus depletion. 

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Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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 b. No further payments are made on any case contained in a red file jacket. Should 

 an unpaid bill be submitted to the POC during the surplus period, it must be 

 forwarded to the medical BPA so an explanation of benefits can be generated. 

c. During the time in which the surplus is being monitored for depletion, the POC 

 continually tracks the offset using the DEEOIC Offset Tracking Database until 

 the surplus has been depleted. Proofs of payment amount and further lump-sum 

 awards for wage-loss and impairment benefits will be entered into the appropriate 

 fields in the DEEOIC Offset Tracking Database, until they equal or exceed the 

 surplus amount. 

 d. Once the surplus is completely absorbed and EEOICPA benefits may commence, 

 the POC removes the temporary red file jacket and returns the case contents to the 

 original file jacket. Removal of the red file jacket signifies that future benefits 

 may be provided on the case. Cases are not to be deleted from the DEEOIC Offset 

 Tracking Database. 

 

e. The POC sends a letter advising the claimant that the surplus is absorbed. The 

 letter provides the claimant with the address of the BPA and instructs him or her 

 to submit all future medical bills to that address to review for payment. 

 

f. While medical benefits are not being paid because of a surplus that is being 

 absorbed, the CE may find it necessary to obtain a medical examination, second 

 opinion examination, a referee examination, or a medical file review. If so, 

 DEEOIC will pay the costs for these directed examinations or reviews and will 

 reimburse any reasonable expenses incurred by the employee, including medical 

 travel expenses, without adding to the surplus. Therefore, the coordination of 

 benefits will not apply to any prior approval medical conditions in ECMS, coded 

 with a medical condition type of “PA.” In such situations, the CE enters a 

 comment into ECMS case notes authorizing the BPA to pay all bills related to the 

 directed medical examination or medical file review. 

 

 In a case with a surplus, BPA creates a thread for all medical travel refund 

 requests to the POC requesting authority to deny or proceed with payment. 

 Medical travel expenses related to a directed medical examination must be 

 approved for payment and are not subject to coordination. 

 

11. ECMS Coding. Accurate and prompt ECMS coding is important because on surplus 

cases, the condition status field for the medical condition(s) must be updated to “O” (Offset) on 

the Employee Medical Condition screen to suspend medical bill payment until the surplus is 

absorbed and the “O” code is replaced by “A” (Accepted). During the time in which the “O” 

code remains in the medical condition status screen, the BPA denies medical bills related to the 

medical condition coded as “O” and generates explanations of benefits that the bills are not 

payable due to a surplus. 

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Federal (EEOICPA) Procedure Manual Chapter 32 – Coordinating State Workers’ 

Compensation Benefits

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12. Contact with SWC Office. Due to privacy and disclosure regulations, the CE can not 

disclose any information regarding a claim filed by a claimant to a SWC office unless:

 

a. CE Requires Information from the SWC Office. If the CE requires information 

from a SWC office to process an EEOICPA claim, the CE can disclose to that 

SWC office that the claimant filed for benefits under the EEOICPA.

 

b. The SWC Office Requests Evidence. If a SWC office requests evidence to 

establish that the EEOICPA claimant should not receive benefits from a SWC 

claim, the request should be submitted to the NO for review. The NO will 

provide instructions for responding to the request after reviewing all information.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Chapter 33 – Compensation Payments 

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CHAPTER 33 – COMPENSATION PAYMENTS

1. Purpose and Scope. This chapter describes the policy and procedure for the DEEOIC 

claim staff to process compensation payments, and defines the roles of the various personnel in 

DO and the FAB, with respect to the compensation payment process. At the discretion of the 

DD, the order and manner in which payment documents are routed in OIS, from one individual 

to another, may vary; however, the ECS process cannot. 

2. Responsibilities. When lump-sum compensation is awarded by FD, the FAB CE or HR, 

the DO CE, SrCE or SCE, FO, and DD all ensure that the payment is processed in an accurate 

and timely manner. The payment process begins at the FAB office, and continues at the DO, 

upon return of the completed Form EN-20. Persons in the roles listed above serve to validate the 

accuracy of payment data and enforce security of the payment creation process by conducting 

individual assessments of each lump-sum payment prepared for issuance. 

Throughout this document, the term “routing,” as it is used to describe the movement of the EN20 from one individual to the next, entails assignment of the document in OIS, by means of OIS 

Notification, to the next appropriate role designation. 

3. Processing the EN-20. Upon issuance of a FD awarding compensation, the FAB enters 

the Acceptance of Payment (AOP) amount in ECS. ECS generates the EN-20 (Acceptance of 

Payment Form) and the EE-20 (award letter), which FAB mails to the claimant, along with the 

FD. ECS will automatically assign an AOP sent date to correspond with the issuance date of the 

FD. As part of the electronic document retention process, the appropriate staff person will 

electronically image (a/k/a bronze) the cover letter, FD, and a copy of the EN/EE-20 for viewing 

in OIS. If the claimant requests another EN-20, it is permissible to send a photocopy or 

facsimile to the claimant, for signature, however, it must be returned by mail, bearing an original 

payee signature, with no changes or alterations to the information contained on the original EN20. 

If a claimant or AR inadvertently returns an EN-20 to a RC, or to the CMR in London, KY, staff 

in these facilities will upload the document through the EDP, then mail the original document to 

the appropriate DO via regular mail. 

a. DO Mailroom Handling. The FD cover letter instructs the claimant to return the 

completed EN-20 to the DO that issued the RD. Upon receipt of the completed 

EN-20, mailroom staff date stamps the form (AOP Received Date), in the upper 

right corner, using an ink date stamp, and writes the Case ID in the top, right 

corner. Mailroom staff then scans the completed EN-20, the envelope, and any 

supporting documentation received in the same envelope, into the corresponding 

OIS case record. It will not matter whether the EN-20 has obvious errors or 

omissions; mailroom staff scans any received payment documents into OIS for 

recordkeeping. Once scanned, the mailroom delivers the original EN-20 to the 

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DO.
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b. Retention of Form EN-20. Original EN-20 forms are maintained by the FOs, in a 

secure area of the DO, and are retained for a period of 3 years, then disposed in 

accordance with DOL document retention guidelines. The EN-20 is available for 

inspection by any of the individuals responsible for the creation, certification, 

verification or authorization of the payment, at any time during payment process. 

c. ECS Routing. Once the completed EN-20 is bronzed into the OIS case record, the 

document automatically appears in the OIS Unreviewed Document Tab of the 

ECS-assigned DO or FAB CE, for initial review. 

(1) Accuracy of Payment Data. The CE reviews the signed EN-20, in OIS, 

(or the original document if so desired,) to determine if the form contains 

correct payment data, and that the form has been correctly completed by 

the payee, examining each of the following items: 

(a) File number. 

(b) Payee name.

(c) Payee SSN.

(d) Verification of Account Information: “type account” block is 

checked (“C” for checking, “S” for savings) and the routing and 

account numbers are listed correctly, with no trace-overs, or 

corrections. 

(e) EN-20 is signed and dated. (If the form is signed by an individual 

with POA, refer to the POA process below). 

If the CE, SrCE, FO, or DD wishes to examine the original EN-20, 

because the OIS document is not clear, that individual obtains the original 

document from the DO folder, then returns the original document to the 

DO folder, when finished. 

d. Deficient EN-20. Minor deficiencies in claimant-provided information, other than 

items (a) through (e), above, can often be explained by a memorandum to the case 

file without having to return an EN-20 to the claimant. However, if the CE 

determines that a significant deficiency exists in one of the above-described items, 

the CE/FO prepares a letter to the claimant explaining the EN-20 deficiency and 

the corrective action required for the payment to proceed. In either case, the CE 

bronzes the memorandum, or the claimant letter, to OIS. The CE also annotates 

the OIS description field identifying the EN-20 as defective. When returning a 

defective EN-20 to a payee, a new copy of the EN-20 is to be provided for the 

claimant’s use. If a modification of the original EN-20 is required, due to 

incorrect information provided by the FAB, the DO POC contacts the FAB and 

requests that a corrected EN-20 be mailed to the payee. In this instance, the FAB 

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office is responsible for sending a new EN-20 to the claimant and imaging a copy 

of the corrected EN-20 into OIS. 

(1) Signature by POA. If the EN-20 contains a signature by a POA, either the 

FO, or the CE (at the DD’s discretion) conducts a document review to 

ascertain whether the individual who signed the EN-20 has the legal 

authority to sign on behalf of the payee. To accomplish this, the CE 

identifies and reviews the legal document authorizing an individual as 

POA. If such a document does not exist in the case file, the FO/CE 

undertakes development to obtain this information. Upon receipt of a 

document identifying the designated POA, the FO/CE prepares a cover 

memorandum and sends the memorandum, the EN-20, and the POA 

documents,(via facsimile), to the NO Policy Branch, for referral to the 

SOL. The DO memorandum requests a review of the POA documents to 

determine their legal sufficiency as they pertain to the signing of an EN20. The person preparing the memorandum ensures that it is bronzed into 

OIS. At the time of referral to the Policy Branch, the FO/CE enters a 7-

day “reminder” in ECS.

(2) The Policy Branch fiscal staff acts as the NO POC for any follow-up 

inquiries from the DO. Staff within the Policy Branch are responsible for 

routing POA requests to the SOL for review and response. Upon review, 

the SOL responds directly to the requesting DO, via facsimile. 

(a) If the SOL determines that the POA documentation is deficient for 

any reason, the CE sends a letter to the claimant (with a copy to the 

POA), advising that the SOL has determined the POA documents 

to be unacceptable, and stating the reason why. The CE does not 

send a copy of the Solicitor’s opinion to the claimant. Upon 

notification to the claimant, of a deficient POA, the CE deletes the 

“AOP received date” from ECS.

(b) All documents pertaining to the acceptance or rejection of a POA 

are imaged and stored in OIS, separate from the payment 

documents, and are specifically identified as POA documents.

e. Check Requests. In accordance with Department of Treasury Regulations, 

individuals requesting payment by check can only be approved for such under 

limited circumstances, and upon written request from the payee. 

An exception was granted by Treasury for check requests by law firms that 

receive multiple payments (refer to 3d (6) below), and for payments made to 

foreign addresses (refer to 4e, below).

(1) In the event that a claimant contacts the DO, by letter or telephone call, 

requesting payment by check, the request is routed to the responsible CE. 

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The CE is to inform the payee that compensation payments are delivered 

via EFT, unless the claimant meets one of two exceptions: 

(a) Payment by electronic funds would impose a hardship because of 

the individual’s inability to manage an account at a financial 

institution due to a mental impairment; or,

(b) Payment by electronic funds imposes a hardship because the 

individual lives in a remote geographic location lacking the 

infrastructure to support electronic financial transactions. 

(2) If the claimant states that one of these two exceptions is applicable, the CE 

instructs the claimant to return the signed and completed EN-20 (leaving 

the EFT section blank), to the DO accompanied by a signed letter which: 

(a) Requests payment by check; 

(b) States which of the above two exceptions applies; 

(c) States the mailing address for the check.

(3) Upon receipt of a satisfactory letter, which meets the above criteria, and 

which accompanies a properly executed EN-20 (minus the EFT 

information) the letter and EN-20 are bronzed into OIS, and the EN-20 is 

sent to the FO for review. If approved, the FO notifies the CE, via OIS, 

that the request for payment by check is approved. 

(4) Unsolicited letters from claimants, requesting payment by check, that do

not meet the above exceptions [(items d (1)(a) and (b)], require a 

telephone call to the claimant explaining the limited exceptions to the EFT 

rule. If the claimant states that he/she meets one of the exception criteria, 

the claimant submits a new signed letter, specifically requesting payment 

by check, citing the applicable exception.

(5) If, after the CE has explained the limited exceptions to a claimant and 

upon receipt of a letter deemed deficient or lacking in explanation, the CE 

refers the letter to the Policy Branch and requests that the NO contact the 

payee. 

(6) It is the responsibility of the DD in each DO to prepare procedural 

guidance for the law firms within their jurisdiction that regularly submit 

check requests to DEEOIC. This includes advising the firms as to what 

specific information should be contained in cover letters to be used when 

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f. EFT. If the FO finds that the EN-20 and associated payment documents are 

acceptable for payment processing, the FO sends a notification to the Pay Change 

Assistant (PCA) for continuation of the payment process. If the case is designated 

“Terminal” in ECS, the FO directs the CE to prepare an Expedited Processing 

Payment 

Transaction Form (EPPTF) for use by the NO. If the DO is unable to process the 

payment through ECS, an EPPTF is prepared for use by the NO. The payment 

forms available for use in creating expedited and exception payments, (samples of 

which are found in the Appendix), are as follows: 

(1) Expedited Payments – Expedited Processing PTF (Exhibit 33-1) 

(2) Expedited Payments to third-party account names or alias names – 

Expedited Processing PTF, Third Party Accounts (Exhibit 33-2) 

(3) Exception Payments (Non-ECS Payments) – Exception Processing PTF 

(Exhibit 33-3) 

Further instructions pertaining to exception processing of payments, by the NO, 

appear in section 8, below. 

4. Creating the EFT Payment. 

a. PCA Data Entry: The PCA enters the following items in the ECS payment screen:

(1) AOP received date (i.e., date the EN-20 was date-stamped as received at 

the DO).

(2) Banking Information pertaining to the recipient’s financial institution 

(bank or credit union). 

(a) Bank or Credit Union Name. 

(b) ACH (Federal Reserve Bank) Routing Number. 

(c) Recipient’s account number. 

(d) Type of account: Checking or Savings. (Payments may also be 

made to money market accounts, as long as no third-party routing 

system is involved and the account type can be classified as 

checking or savings.) 

(3) Names listed on EN-20 for all account-holders. [Note: For wire transfer 

(Fed Wire) payments, the Payee Name on the EN-20 must match one of 

the Account Holder names.] 

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b. PCA Verification. Upon PCA submission of the data in ECS, the CE 

automatically receives a “Payment Pending” item in their ECS work queue. 

c. Verification of Federal Reserve Bank Routing Number. The FO (or designated 

alternate) verifies the authenticity of the bank routing number, listed on the EN20, through the Federal Reserve Financial Services website: Search for ACH 

Participants. Once verification of the routing number is complete, the FO 

memorializes the verification in an ECS Note. The Federal Reserve website is 

found at: https://www.frbservices.org/EPaymentsDirectory/agreement.html. 

d. Special Routing Instructions for Expedited Payments (Terminal Claimants). 

When processing EN-20 payment requests, for terminal claimants, it is 

permissible to substitute the bank ACH routing number for a Fed Wire routing 

number to that same bank. The staff person completing this task documents this 

change with a printout of the Treasury Fed Wire webpage, and a memorandum of 

explanation signed by the DD/ADD. These documents become part of the 

payment record in OIS. 

e. International Payments. 

 

(1) Payments to claimants living outside the U.S. can only be made by check; 

however, a claimant living outside the U.S. can open a bank account at a 

U.S. bank and arrange for withdrawal or transfer of funds, once payment 

has been made to that account.

(2) When preparing a check request in ECS, for a mailing address outside the 

U.S., the addressee information (street name and number, building name, 

etc.) is entered on the three address lines provided on the payment screen; 

the City and any special City Code is entered on the “City” line; 5 zeroes 

are entered in the Zip Code field; and “Non-USA State Address” is 

selected from the “State” drop-down menu. The Country Name is typed in 

the “Country” field. 

5. Creating the Check Payment. After review by the FO, check requests are routed directly 

to the CE, who reviews the claimant’s address listed on the EN-20, and verifies this address 

against case file documents, the current address displayed in ECS, and any change of address 

requests in the case record. If the claimant provides a different mailing address on the EN-20, 

from the current address of record, and indicates this is a "Payment Only address," the CE 

contacts the claimant by telephone to determine if the change of address is permanent, or if it is a 

one-time payment-only address. An appropriate call note is added to the ECS record. 

a. Permanent Change. If the payment address provided on the EN-20 represents a 

permanent change of address, the CE instructs the claimant to submit a separate 

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b. Temporary Change. If the payment address is a temporary address for that 

payment only, the CE advises the payee that any permanent change of address 

will be processed upon submission of a separate written and signed request. 

6. Completing the ECS Payment. Once the PCA has verified the accuracy and 

completeness of the information provided on the EN-20, and entered the payment data in ECS, 

the CE receives a “Pending Payment” item in their work queue. The CE verifies the banking 

information (account number, routing number, and account type) by re-entering it in ECS. The 

CE Creates the payment in ECS and routes the payment to a Senior CE for Certification. After 

certification, the payment is routed to an FO for Verification, then to a DD (or an individual with 

DD privileges), for Authorization. As each individual (CE, SrCE, and FO) completes their 

function in ECS, the next designated user automatically receives a pending payment item in their 

ECS work queue. Each individual, who completes their respective payment step in ECS, is 

responsible for examining the payment documents and affirming that the payment amount and 

associated data, recorded on the EN-20, appears correctly on the ECS payment screen. Once the 

DD completes the authorization step, the payment is automatically added to the weekly batch 

payments for that DO and the payment is authorized for issuance by the Department of Treasury. 

7. Entering and Identifying Payments in OIS. Payments completed at both the DO and the 

NO are to be bronzed in OIS and identified as follows: 

a. DO Payments. At the time a payment is Authorized by the DD (or an approved 

person with the DD role), the EN-20, and any associated correspondence or 

memoranda associated with the final EN-20, are to be bronzed and saved as a 

“final payment” documents in OIS. When adding these documents to OIS, they 

are to be labeled with a unique identifier consisting of the letters “PMT” followed 

by the first 4 letters of the payee’s last name, the last 4 numbers of the payee SSN, 

and the Authorization Date as it appears in ECS. For example, the EN-20 for a 

payment to someone named Jones, with a “last 4” of 9876, and an Authorization 

Date of 01/01/2014 would be stored in OIS as follows: 

Category: Forms & Claims

Subject: EN-20 

Description: PMT JONE9876, 01-01-2014 

The purpose of this unique identification is to allow for easy identification of the 

final EN-20 and associated documents used in the creation of the ECS payment. 

8. Expedited and Exception Payments. The NO FO and NO staff with Certifying Officer 

status process expedited (terminal) payments, and other “exception” payments that cannot be 

processed through the normal ECS payment method. For expedited and exception processing of 

payments at the NO, the Expedited Processing, or EPPTF (Exhibit 33-1 & Exhibit 33-3) is 

completed by the DO. For payments where the account-holder name is different from the payee 

name, the CE verifies with the payee that payment is being made to a third-party account name 

and uses the Third-Party PTF (Exhibit 33-2). The third-party EPPTF is also used by the DO to 

account for minor variances between the account holder name and the payee name of record in 

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ECS (a/k/a alias name). Any memorandum of explanation, or record of a telephone call to the 

payee, is printed and becomes a part of the payment record in OIS. Once the DO actions are 

complete, the payment documents are forwarded to the NO for processing, and bronzing, as 

follows: 

a. Expedited Payments are payments involving cases coded “Terminal” in ECS, and 

which require immediate processing by the NO. 

(1) Upon receipt of an ECS payment requiring expedited processing, and 

upon review and confirmation that all ECS payment data has been 

completed correctly, the FO selects “Expedited Payment” on the ECS 

screen and proceeds with Verification of the payment in ECS. 

 

(2) The FO then compiles the payment documents (i.e., EPPTF, EN-20, 

payment memo, etc.) in a PDF document and forwards that document to 

the DD, via email, advising that the expedited payment awaits completion 

in ECS by the NO fiscal staff. 

(3) The DD (or individual with DD role) reviews the payment in ECS, and 

upon verification that all payment data is correct, the DD forwards the 

payment documents to the NO payment team, authorizing completion of 

the expedited payment in ECS. 

(4) Upon completion of the expedited payment, the NO fiscal staff bronzes 

the final payment packet, including the final EPPTF, into OIS, and 

identifies the documents with the unique identifier described in 7a, 

following the same process as the DO. 

b. Exception Payments are payments, such as 2nd Part B payments, and payments 

that exceed the programmatic limits. Because ECS is unable to process these 

payments, they must be forwarded to the NO for completion. The DO staff is to 

process and bronze exception payments as follows: 

(1) Because exception payments are created outside ECS, the DO staff will 

create and circulate an EPPTF, collecting the names and signatures of the 

appropriate ECS user roles required to create a payment (i.e., CE, SrCE, 

FO and DD). Upon completion of the EPPTF, the FO forwards the 

documents (EPPTF, EN-20, and other related documents) to the DO 

mailroom for bronzing into OIS. Upon completion of OIS bronzing, the 

FO sends a notification to the NO Certifying Officers, advising that 

exception payment documents are pending action. 

(2) Upon completion of an exception payment at the NO, the NO fiscal staff 

bronzes the payment packet into OIS, using the unique identifier described 

in 7a, and following the same process as the DO. Once the final payment 

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documents are bronzed into OIS, a notification is sent to the verifying FO 

in the DO.

c. Retention of Documents. Upon completion of any payment, both DO and NO 

staff will retain the original payment documents (excepting the EN-20) in 

accordance with the document retention schedule for OIS documents. (EN-20 

forms will be retained by the FO, for a period of 3 years, as previously specified 

in 3a.) 

9. Deleting Payments and Cancelling Transactions. During the payment process, if a staff 

person discovers a critical issue relating to the sufficiency of the EN-20, or an error in the 

accuracy of ECS payment data, or (in limited circumstances) the EPPTF, that individual stops 

the payment process and undertakes corrective action to rectify the error.

a. Error in EN-20. If the cancellation is due to a deficient EN-20, the CE is notified, 

 via OIS, that corrective action is required. (Return to Item 3c above.) 

b. Data Entry Error from EN-20. If the CE, or any individual above the CE level, 

identifies a data entry error after the payment information has been entered in 

ECS, the payment is returned (via OIS Notification) to the CE, who “Deletes” the 

payment from ECS. “Deleting” the payment removes the AOP received date in 

ECS, and any information on the payment screen. (Note: If there is a pending Part 

B and Part E payment included in the same EN-20, deleting one payment will 

cause both payments to be deleted. If one of the two payments is not in a state 

that can be deleted, then the System will abort and will not allow the deletion. 

Once a payment is created, it must be rejected by the reviewer [SrCE or SCE prior 

to certification, FO prior to verification, or DD prior to authorization] before the 

CE can delete it. Once the payment is deleted the payment process begins anew, 

with the PCA, upon receipt of a corrected EN-20. 

10. Payment Reports. On Thursday of each week, at close-of-business (5:00 PM EST), ECS 

automatically creates an electronic file of all pending, "Authorized" payments created during that 

weekly cycle. The Branch of Automated Systems (BAS) forwards this electronic payment file to 

Treasury for payment the following Thursday. The BAS also stores a copy of this weekly report 

(Benefit Transaction History Report or BTHR) on a shared-access drive, available to the DO 

fiscal staff on the Monday following the close of the payment cycle. Once the weekly payment 

cycle is closed, the FO closes the separate weekly spreadsheet report of all DO payments for that

pay cycle, and reconciles the DO spreadsheet against the BTHR. After reconciliation, each DO

FO prepares an email summary report containing the total of all weekly payments, broken down 

by Part (B or E) and by payment type (EFT or check), authorized during that week's payment 

cycle. Each FO forwards their DO summary report to the NO FO, via email. Upon completion of 

the reconciliation of these three documents (BTHR, DO spreadsheet, and email summary), the 

FO scans and stores the reports in a secure, limited-access payment folder on the DO share-drive, 

labeling them as the DO weekly payment report.

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11. Substitutions Among Staff. If the creator, certifier, verifier, or authorizer is not available 

to perform a particular payment function, alternate persons in these same roles can substitute for 

them. Any CE, SrCE, or SCE can create the payment. Any SrCE or SCE can certify the 

payment as long as that person did not create it. 

In the absence of a FO, either the DD or ADD can verify a payment. However, the same 

individual who verifies a payment cannot authorize that same payment, as no one person can 

perform the function of two different roles for any particular payment. 

If both the DD and ADD will be unavailable to authorize payments on any given date, advance 

notice is sent by one of those individuals, via email, to the Unit Chiefs for Policy, Regulations 

and Procedures, the Policy Branch Chief and the Deputy Director at the NO. The DD/ADD 

advises the name of the person to be designated as Acting DD, and the applicable dates. In 

response, the Policy Branch Chief, a Unit Chief, or the Deputy Director sends an email request to 

Energy Technical Support (ETS), requesting that they assign a temporary DD role to the 

designated individual, thus allowing that individual to authorize ECS payments on the requested 

date(s). ETS notifies the Policy Branch, via email, once the role-change request is processed.

12. Temporary Role Changes for Expedited Payments. For Expedited Payments requiring 

authorization by an individual assigned a temporary DD role in ECS, the FO includes a copy of 

the approval email (Step 11) confirming the temporary role-change approval associated with that 

individual for that date, when forwarding the payment documents to the NO. 

The FO will not accept any expedited payment without the necessary role-change email attached, 

and returns the payment documents to the appropriate party, requesting that a temporary rolechange request be approved by the NO. 

13. Stolen Check Claims. Upon notification that a payee’s compensation check has not been 

received, the CE requests that the payee (or appropriate representative) provide the DO with 

immediate written notification of non-receipt of payment. Upon receipt of such notification, the 

FO forwards that notice to the NO FO, who takes the following actions: 

a. Review payment status in the Treasury Check Information System (TCIS).

b. If Payment Status in TCIS shows as: “Negotiated” (check cashed), the NO FO 

creates a claim in the Treasury system for that payment and selects Option #2 – 

Entitlement After Status. 

c. After 24 hours, the NO FO reviews the payment and confirms that the updated 

status of the payment appears properly in the Treasury TCIS system. Once 

confirmed, the NO FO contacts the claimant and provides the toll-free telephone 

number for the Treasury Stolen Check Department. Upon reporting the claim to 

Treasury, the investigation and disposition of the stolen check claim is entirely 

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d. Treasury will notify the payee of its determination once the investigation is 

complete. If Treasury determines that the stolen check claim is bonafide, Treasury 

will reissue payment to the payee.

14. Processing Payment Cancellations. A "cancelled" payment is a payment, either 

electronic or check, that has been issued by, and then returned to, the Department of Treasury. 

When this occurs, Treasury notifies the DEEOIC via Cancellation Report that a payment has 

been returned to Treasury and credited to the DEEOIC account. In order to maintain an accurate 

and comprehensive accounting of all funds disbursed by the DEEOIC, it is then necessary to 

cancel any returned payment in ECS, as well. 

The ECS payment cancellation process is completed before the compensation payment is 

reissued to the same payee, or before the funds can be awarded to other claimants in the same 

case. Multi-level reviews, concurrence by DEEOIC management and documentation of the 

actions taken by all parties (claimants, financial institutions, and DEEOIC claims staff) are 

essential to safeguarding the integrity and security of the DEEOIC’s financial accounting 

processes.

a. Cancellation Initiated by Treasury. The Treasury Department transmits an 

electronic Cancellation Report to the DEEOIC when EFT payments are rejected 

or returned to Treasury by the payee's bank, or when a check is returned to 

Treasury for any reason. These reports are sent to the DEEOIC NO FO, who then 

notifies the appropriate DO fiscal staff (via OIS and email) of the returned 

payment. The NO FO also has the capability of viewing the status of any payment 

through Treasury’s online TCIS system.

b. Cancellation Initiated by Claimant. Upon notification from a claimant of nonreceipt of payment, the DO takes the following steps:

(1) The CE documents any telephone call or correspondence in ECS regarding 

contact from a claimant who has not received a payment. A printed record 

of all phone calls is bronzed into OIS. 

(2) If notification of non-receipt is by telephone, the CE instructs the claimant 

to provide DEEOIC with a written, signed notice of the non-receipt of 

payment. 

(3) Upon receipt of either a telephone call or letter advising of non-receipt, the 

CE transfers the case file to the FO.

(4) The FO notifies the NO FO, via email, of the non-receipt of funds. 

(5) The NO FO initiates an inquiry in Treasury’s TCIS system, determines the 

status of the payment, and advises the FO of one of the following: 

(a) Check Outstanding (not yet negotiated). 

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(b) Check Cancelled (returned to Treasury).

(c) Check Reconciled in Treasury system. (This indicates the check 

has been negotiated [cashed] by someone, but not necessarily the 

payee.) 

(d) EFT transaction completed.

(e) EFT funds returned to Treasury (Cancelled). 

(6) The NO FO provides the FO with a screenshot of the Treasury payment 

status, via email.

(7) The FO notifies the claimant of the payment status and explains the 

payment cancellation process, if appropriate.

(a) EFT Status. If Treasury shows delivery of the funds to the payee's 

bank, the FO notifies the payee of same. If Treasury shows that the 

EFT payment was returned by the payee's bank, the FO advises the 

payee that the DEEOIC will begin the payment cancellation 

process and, if appropriate, process a new payment. 

(b) Check Status. For checks outstanding in the Treasury payment 

system, upon receipt of the signed notice of non-receipt of 

payment from the payee (or AR), the FO initiates an email to the 

NO FO and requests that a “Stop Pay” order be placed on the 

check. The NO FO initiates a stop pay request, in TCIS, and after 

24 hours, verifies that the cancellation request has been processed. 

Upon confirmation that a stop pay order has been placed on the 

check, the NO FO sends a screenshot confirmation, via email, to 

the FO. 

15. ECS Payment Cancellation Process. Upon receipt of documentation (from the NO FO), 

through OIS, confirming return of a payment to Treasury, (check or EFT), or confirming a valid 

stop pay order on an outstanding check, the FO proceeds with an ECS Payment Cancellation 

request. The steps outlined below ensure that appropriate documentation exists to explain and 

validate the need for cancellation of a payment in ECS.

a. The DO FO conducts inquiries with the payee and the payee’s bank to determine 

why the payment was returned to Treasury. 

b. DO FO prepares a memorandum to the NO, with an explanation as to the reason 

for the returned payment and requests payment cancellation in ECS. The 

memorandum is imaged in OIS, and notification is sent to the NO FO. 

Additionally, the DO FO notifies the NO FO, and the two Policy Branch Unit 

Supervisors, via email, that a Payment Cancellation Request is pending in OIS. 

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c. It is not necessary to transfer the ECS case record to the NO when requesting 

initiation of a payment cancellation by the Director. [ECS allows appropriate NO 

staff to initiate the cancellation action without file transfer.] 

d. Upon receipt of the DO memorandum requesting cancellation, the NO FO 

prepares a Payment Cancellation Memorandum and an ECS Payment 

Cancellation Form (Exhibit 33-4) for review and signature by a Policy Branch 

Unit Chief and the Director or Deputy Director of DEEOIC. 

e. The Director or Deputy Director completes the relevant portion of the ECS 

Payment Cancellation Form, and initiates cancellation of the payment in ECS. 

Upon completion of these actions the payment cancellation documents are 

returned to the NO FO for bronzing of the partially completed cancellation form 

into OIS. 

f. The NO FO notifies the DO FO and the DD that a partially completed ECS 

Payment Cancellation awaits final action by the DD, and that the relevant 

documents are available in OIS.

g. The DD reviews the payment cancellation documents and completes the payment 

cancellation in ECS. If the payment is not being reissued, the DD checks the box 

labeled “Claimant Repayment Not Authorized” when completing the cancellation 

action. Upon completion of the ECS cancellation, the DD signs the ECS Payment 

Cancellation Form and routes the completed form to the appropriate DO

personnel for imaging in OIS. 

16. Post Payment Cancellation Actions. 

a. Reissuing Payment. If the compensation payment is to be reissued, the DD routes 

the case file to the CE, advises that the ECS payment cancellation process is 

complete, and instructs the CE to reissue the payment. 

b. Voided Transactions. If the compensation payment is not being reissued, the FO 

confirms that the “Void Transaction” has been completed in ECS, and verifies 

that the “Claimant Repayment Not Authorized” option has been checked by the 

DD. The case is routed to the DO file room, and/or transferred to “FIL” in ECS, 

on the transfer screen, or, is routed to the CE for survivor development, if 

applicable.

17. Death During Payment Process. If the employee or survivor is alive when the FAB

issues its FD, but that individual dies before the DO processes the payment, the assigned CE, 

FAB CE, or HR shall administratively close the deceased individual’s claim in ECS.

In the event that payment is processed and DEEOIC receives notification that the payee died 

prior to receipt of payment, it is the responsibility of the DO FO, in conjunction with the 

assigned CE, to attempt recovery of the payment. The OWCP Regulations state that under these 

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circumstances, the person who receives the payment shall return it to OWCP. Should the DO 

encounter difficulty in recovering the payment, the DO refers the case to the NO Policy Branch 

to initiate overpayment procedures. 

In either instance, the assigned CE (DO or FAB CE2) administratively closes the deceased 

individual’s claim and undertakes necessary development to identify any individuals potentially 

eligible for redistribution of the payment.

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CHAPTER 34 – POST-AWARD ADMINISTRATION

1. Purpose and Scope. This chapter outlines the actions the CE takes on Part E cases after a 

claim has been approved for benefits. The chapter also describes the procedures used by the NO 

to ensure that payment of medical benefits to covered Part E employees is fully coordinated with 

any SWC benefits received by those employees or their survivors. 

2. Authority. Section 7385s-11(a) requires that compensation to an individual under Part E 

be coordinated with SWC benefits, other than medical benefits and benefits for vocational 

rehabilitation, that the individual has received for the same covered illness. The Director of the 

DEEOIC has been delegated the authority to request information from SWC authorities 

concerning SWC benefits that covered Part E employees receive.

3. CE Responsibilities. The CE sends a Form EE-12 letter, accompanied by Form EN-12 

enclosure, to each covered Part E employee who receives medical benefits under Part E for a 

covered illness. These forms are sent on the one-year anniversary of the latest award of any type 

of Part E benefits, and every year thereafter in which the employee continues to receive medical 

benefits. The employee must complete and return the EN-12 questionnaire within 30 days. 

If the employee does not return the completed form within 30 days, the CE attempts to verify the 

employee’s contact information in the case file. The CE sends another Form EE/EN-12 and 

provides the employee with an additional 30 days in which to respond. If the employee does not 

respond within 30 days, the CE may consider suspending benefits.

Upon receipt of a completed Form EN-12 from an employee, the CE reviews the employee’s 

responses and takes the appropriate action as noted below. 

a. Change of Address. If the employee lists a new address or telephone number, the 

CE notes the new information in the case file. The CE also ensures that the new 

contact information is reflected in ECS.

b. Treatment Concerns. If the employee identifies concerns about the treatment that 

he or she is receiving for a covered illness, the CE acknowledges these concerns 

by letter and advises that they are being referred to the appropriate person for 

further action. 

c. Additional Impairment or Wage-Loss. If the employee indicates that he or she 

wishes to claim additional Part E compensation due to increased permanent 

impairment as a result of an accepted covered illness, or additional compensation 

for another calendar year of qualifying wage-loss, the CE follows established 

procedures for facilitating these claims.

d. SWC. If the employee indicates that he or she has filed for or received SWC 

benefits after the receipt of an award of Part E benefits, the CE ensures that the 

employee provides all the requested information concerning the SWC benefits 

filed for or received. 

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e. Tort Awards or Settlements. If the employee indicates that since receiving an 

award of benefits under Part E, he or she has received a tort award or settlement 

(other than for a claim for SWC) in connection with a lawsuit alleging exposure to 

a toxic substance for which the Part E award was received, the CE ensures that the 

employee provides all the requested information concerning the tort award or 

settlement.

4. NO Responsibilities. At the beginning of each fiscal year, the NO FO sends a Form EN13 information request to each state’s workers’ compensation authority advising of the 

requirement under the EEOICPA that any SWC benefits received by a covered Part E employee 

for an accepted covered illness must be coordinated with Part E benefits received for that same 

illness, and requesting information about workers’ compensation benefits paid to employees who 

have been awarded Part E benefits.

 

Upon receipt from the states, the NO FO must coordinate with each DO FO to reassess any need 

to evaluate a particular claim for coordination with information of payment of SWC benefits. 

a. Initial Requests. Form EE-13 lists employees who worked at DOE facilities in 

the state in question whose claims for compensation under Part E were accepted 

during the 12 months preceding issuance of the Form EE-13. For each employee, 

the list contains the following information: 

(1) Name(s) of the claimant(s); 

(2) Whether the claimant is the employee or the employee’s survivor;

(3) SSN of the employee;

(4) Employee’s accepted medical condition; and 

(5) Date the claimant’s eligibility for Part E benefits began.

For each employee listed, the state agency is asked to provide information about 

any SWC claim(s) that was filed on behalf of the same worker, including the 

name(s) of the claimant(s), whether the claim was accepted, and, if so, the 

medical condition accepted and the effective date of the award. 

b. Subsequent Requests. Form EE-13 also contains a second list of employees for 

whom information has already been requested by a prior Form EE-13. For each 

employee on the second list, the state agency will be asked to indicate whether 

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CHAPTER 35 – OVERPAYMENT PROCESS

1. Purpose and Scope. This chapter describes how the OWCP, through the DEEOIC, 

identifies, evaluates, provides notification of, waives, issues FDs regarding, and recovers 

overpayments under both Parts B and E of the EEOICPA. 

2. Legislative Authority and Directives. The instructions in this part of the PM derive from 

the following regulations and authority: 

a. The EEOICPA at 42 U.S.C. 7385j-2 authorizes the Secretary of Labor to recover 

because of an error of fact or law, except when an incorrect payment has been 

made to an individual who is without fault and the adjustment or recovery would 

defeat the purpose of the EEOICPA or would be against equity and good 

conscience. With respect to recovery, the EEOICPA authorizes DEEOIC (as 

designee of the Secretary of Labor) to recover the overpayment pursuant to 

regulations prescribed by the Secretary.

b. Public Law 89-508 [Federal Claims Collection Act of 1966 (80 Stat. 308), 

 amended by Public Law 900-904 (2000)], assigns the Secretary responsibility for 

 the collection of debts arising from the activities of the DOL. It also provides the 

 authority to compromise, terminate, or suspend collection action on debts not in 

 excess of $100,000 (exclusive of interest, penalties, and administrative costs and 

 after partial payments have been deducted). In such cases, there must be no 

 indication of fraud, and it must appear that: 

(1) The debtor is unable to pay the full amount within a reasonable period of 

time, as verified through credit reports or other financial information;

(2) The Government is unable to collect the debt in full within a reasonable 

time by enforced collection proceedings;

(3) The cost of collecting the debt does not justify the enforced collection of 

the full amount; or 

(4) There is significant doubt concerning the Government’s ability to prove its 

case in court. 

The Department of Labor Manual Series (DLMS) 6, Chapter 1100, Debt 

Management, provides that DOL Agency Heads are delegated the authority to 

compromise, suspend or terminate collection action on debts stemming from 

program activities not in excess of $100,000, and that Agency Heads may redelegate this authority to officials in their agencies with approval of the Chief 

Financial Officer. DLMS6-1111b (1),c (2). 

c. Public Law 97-365 (Debt Collection Act of 1982) amended several statutes, 

including the Federal Claims Collection Act of 1966. The Debt Collection Act 

authorizes Federal agencies to collect certain charges on outstanding debts, to use 

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salary offset or administrative offset to collect claims and to use the services of 

private collection agencies. (Note: The Federal Claims Collection Act of 1966 as 

amended by the Debt Collection Act of 1982 has been codified as 31 USC 900-

904.) 

d. Public Law 104-134 (Debt Collection Improvement Act of 1996) also amended 

several statutes, including the Debt Collection Act of 1982. The Debt Collection 

Improvement Act provides that any non-tax debt or claim owed to the United 

States that has been delinquent for a period of 180 days be turned over to the 

Secretary of the Treasury, who will determine whether to collect or terminate 

collection actions on the debt or claim. 

e. 31 CFR Parts 900-904 (Federal Claims Collection Standards) describes standards 

for the collection and compromise of debts, termination of agency collection, and 

referral of civil claims to the DOJ. In particular, 31 CFR 902.1(b) and 903.1(b) 

provide that the DOJ has the exclusive authority to compromise, suspend or 

terminate claims in excess of $100,000, exclusive of interest, penalties and 

administrative costs. Consequently, even if DEEOIC believes that compromise, 

suspension or termination of recovery of such a debt is appropriate, the matter 

must be referred to the DOJ for determination. 

f. 31 CFR Part 285 includes the provisions for transferring delinquent debts to the 

Department of the Treasury for collection. 

g. In a case involving fraud on the part of the debtor or any other party having an 

interest in the claim, 31 CFR 900.3(a) provides that only DOJ has authority to 

compromise, suspend, or terminate collection action on such claims. 

h. In cases that have been referred to the Office of the Inspector General (OIG) or 

the U.S. Attorney for reasons other than collection of the debt, the Policy Analyst 

(PA) will advise OIG before collection action is initiated in order to evaluate 

whether collection action would jeopardize an ongoing investigation or a legal 

action in progress. 

3. Definition of Overpayment. An overpayment is any amount of compensation paid under 

42 U.S.C. §§ 7384s, 7384t, 7384u, 7385s-2 or 7385s-3 to a recipient that, at the time of payment, 

is paid where no amount is payable or where payment exceeds the correct amount of 

compensation determined by DEEOIC. 

4. Notification of EEOICPA Payment. Upon publication of a FD by the FAB that awards 

lump-sum compensation, designated payees receive notification of the allotted compensation 

payable. The FAB provides reference to payable amounts in the FD, along with sending Form 

EN-20 Acceptance of Payment to each payee specifying the amount of payable lump-sum 

compensation. To process the allocated lump-sum compensation for payment, a payee must 

provide necessary information on the EN-20, including bank routing and account numbers, to 

permit DEEOIC to process a payment. Payee signs and dates the form. Payments processed by 

DEEOIC direct money to a payee’s designated checking or savings account via EFT, or in 

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some unique situations with issuance of a paper check. With EFT or paper check, the deposit of 

payable funds into an account or negotiation of a paper check, is considered due notice of 

payment absent affirmative evidence to the contrary. In the case of any improper payment 

received by either a claimant or other party, including survivors of deceased payees, estates, or 

joint-account holders, the party in receipt of the funds is to notify DEEOIC immediately. 

When the FAB issues a FD accepting a medical condition, it also awards the payment of medical 

bills for that condition. The FAB may also issue a FD that awards only the payment of medical 

bills for an accepted condition. 

5. Recovery of Funds. Upon receipt of information that suggests a payment processed by 

DEEOIC is in error or some other circumstances where the paid claimant is no longer entitled to 

the funds, DO or FAB staff is to bring the matter to the attention of the DO FO. This includes, 

but is not limited to, the incorrect amount paid; death of the employee prior to time of payment; 

or a person who has a joint bank account with a deceased claimant and withdraws EEOICPA 

funds prior to recovery of the funds. Chapter 32 of this PM states that the DO FO will attempt 

recovery of the improperly paid funds. The DO FO will attempt recovery of the funds as 

follows: 

a. Recoupment of EFT payment. 

b. Stop payment of paper check. 

c. Request the person in receipt of the funds to return the money. 

If the DO FO is unsuccessful in recouping the funds, the DO will refer the claim to the NO. 

6. Referral to NO. When a potential overpayment or debt is identified and the DO cannot 

recover the funds, the matter is referred to the DO Chief of Operations (COP) or FAB Manager 

for review. If the COP or FAB manager agrees that a potential overpayment or debt exists, he or 

she is to have a memorandum prepared to the attention of the Branch Chief for the Policy Branch 

describing the circumstances of the matter, including a description of any information relating to 

the overpayment or debt that may be helpful in recovery of the funds. Important details to 

include in the memorandum are the name of the individuals associated with the overpaid funds, 

any efforts taken to recover funds, descriptions of related communications or phone calls, or any 

other information as to the status of the overpayment or debt. Authority to issue overpayment 

decisions rests solely with the Policy Branch. 

7. Identifying Overpayments. Overpayments occur whenever a payee or other party is in 

receipt of lump-sum compensation or payment of medical bills exceeding that for which they are 

entitled, and Treasury or DEEOIC could not recoup the overpaid funds through recovery effort 

as outlined in paragraph 5. Overpayment liability is the responsibility of anyone who is in 

receipt of funds to which they are not entitled under the EEOICPA. 

a. Establishment of an overpayment. Overpayments can occur for a variety of 

reasons. Once FAB issues a FD and a named payee receives lump-sum 

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compensation for a claim, evidence may later arise that requires action to vacate 

the decision through the issuance of a Director’s Order. This can occur to correct 

a deficiency or to respond to new evidence. Once claim adjudication results in 

the publication of a new FD for the same claim, and the new payable lump-sum 

compensation is less then what was previously paid to the payee, DEEOIC has to 

find that an overpayment exists. DEEOIC cannot establish an overpayment until 

the new FD concluding the correct entitlement to a payee is issued. The most 

frequent reasons for overpayments include the following: 

(1) A claimant was paid compensation in error. This might result when the 

FAB issues a FD based on inaccurate or incomplete factual evidence. For 

example, a claimant received compensation, but the DEEOIC later 

discovered that the employee worked at a different location than 

previously established.

(2) The required tort offset or coordination with SWC benefits was either 

improperly applied or never applied. For example, a claimant does not 

notify the DO that he or she received SWC or money from a tort 

settlement. The DEEOIC then awards the claimant compensation without 

coordinating (offsetting) lump-sum compensation properly. 

(3) A lump-sum award requires adjustment because additional eligible 

survivors emerge after payment of compensation. This results in an 

overpayment to the original eligible payee(s). For example, an eligible 

child of a deceased employee is awarded survivor benefits. The DO was 

not aware of additional survivors and awards the survivor the full amount 

of benefits available. Thereafter, another eligible child of the employee 

files a claim. The compensation must now be shared, and the original 

claimant is overpaid. 

(4) A claimant dies after FAB awards compensation, but before receipt of the 

funds. For example, a survivor receives a FD, and DEEOIC issues a 

payment to the survivor’s account. However, several days after the 

deposit, DEEOIC receives information showing that the survivor passed 

away before the payment was processed. As a payee is required by law to 

be alive at time of payment, the paid funds are now considered not due 

and must be returned to DEEOIC. 

8. Review and Initial Notification. The PA reviews the overpayment memorandum from 

the DO or FAB, and all available evidence to verify the existence of an overpayment. The PA 

then calculates the exact amount of the overpayment. 

 

a. Administrative Write-Off. If the amount of the overpaid funds is equal to or less 

than $2,500, the PA does not prepare an initial notice to the claimant. Rather, the 

PA recommends administrative write-off, regardless of the claimant’s fault, since 

the cost of recovery action will exceed the expected recovery amount. The PA 

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prepares a brief memorandum to the Unit Chief describing the reasons for the 

write-off. 

Once the Unit Chief approves an administrative write-off, the PA prepares a 

memorandum to file. Exhibit 35-3 is a sample memorandum to file for this 

process. The PA writes off the overpaid amount without giving notice of the 

overpaid funds to that claimant. Because an overpayment decision is not issued, 

it is not an official overpayment. Therefore, the PA does not enter it into the 

overpayment database or report it on the Treasury Report on Receivables 

(TROR). The PA enters the details of the administrative write-off into the 

administrative write-off spreadsheet located in the Policies and Procedures / 

Overpayments folder in the shared directory. 

b. Determination of Fault. Once an overpayment is established, the PA determines 

whether the claimant bears any fault in the creation of the overpayment. The 

determination of fault depends on the circumstances surrounding the 

overpayment. The claimant must show good faith, and exercise a high degree of 

care in reporting events which may affect entitlement to or the amount of benefits. 

The degree of care may vary with the complexity of circumstances and a 

claimant’s capacity to realize an overpayment has occurred. While this is not an 

exhaustive list, the following can be construed as fault in creating an 

overpayment: 

(1) Claimant made an incorrect statement as to a material fact he or she knew 

or should have known to be incorrect. 

(2) Claimant failed to provide information he or she knew or should have 

known to be material in nature. 

(3) Claimant accepted payment that he or she knew or should have known to 

be incorrect.

c. Initial Notification. Initial notification to the overpaid claimant is required before 

DEEOIC can take any final action to recover an overpayment or adjust benefits. 

The PA prepares and signs a letter informing the claimant of the overpayment and 

the preliminary findings. The Unit Chief reviews the letter prior to its release. 

The initial notification includes the Response to Initial Overpayment Notice form 

and the Overpayment Recovery Questionnaire (Form OWCP-20). Form OWCP20 is available online or via the DEEOIC shared directory. 

The notification letter serves to:

(1) Notify the claimant that an overpayment exists and the exact amount of 

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(2) Provide the result of the preliminary finding of fault. If the PA makes a 

preliminary finding that the claimant was at fault in causing the 

overpayment, the initial notification letter will advise the claimant that 

DEEOIC cannot grant an overpayment waiver if that finding becomes 

final.

(3) Advise the claimant of his or her rights. The claimant has 30 days 

following the date of the overpayment notification letter to invoke rights 

to: 

(a) Request a telephone conference.

(b) Challenge any finding of fault. 

(c) Request waiver of recovery of the overpayment. 

(d) Present written evidence challenging the existence or amount of 

the overpayment. 

The filing date of the claimant’s challenge to the overpayment is 

determined by the postmark date, or the date the request is received in the 

office or RC, whichever is the earliest determinable date. This includes 

the date that the CMR receives a document via the EDP. 

Exhibit 35-1 is a sample initial overpayment notification letter used when the 

claimant is without fault in causing the overpayment. Exhibit 35-2 is a sample 

initial overpayment notification letter used when the claimant is at fault in causing 

the overpayment. If a delinquent debt was referred to Treasury, and Treasury 

obtains a current address upon receipt of a dispute by the claimant, DEEOIC may 

recall the debt from Treasury. The PA will then resend the overpayment 

notification to the claimant.

d. Notification of Federal Debt After Claimant’s Death. In the event that a payment 

is processed and DEEOIC receives notification that the payee died prior to receipt 

of payment, it is the responsibility of the DO FO, in conjunction with the assigned 

CE, to attempt recovery of the payment. The DO will attempt recovery of the 

funds as outlined in paragraph 5 above. If a non-claimant is in receipt of 

EEOICPA compensation and fails to return the money, it is a federal debt and not 

an overpayment. That person must return the money. An example, this situation 

can occur when compensation is deposited into a joint bank account after a 

claimant has died, and the joint account holder withdraws the money. If the DO’s 

attempts to recover the funds are not successful, and the evidence of record 

identifies the joint account holder’s name and address, the DO will transfer the 

case to the NO for further recovery attempts. The PA will send a demand letter 

(without appeal rights) to the person requesting the return of the funds. If the 

person does not respond after 30 days, the PA will send a second and then a third 

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demand letter in 30 day intervals. If the person does not respond within 30 days 

after the third demand letter, the PA will refer the debt to Treasury for collection. 

Exhibit 35-11 is a sample demand letter to a non-claimant. 

9. Telephone Conferences. When requested by the claimant, the PA holds a telephone 

conference within 30 days of the date of the request for the conference. The PA also holds 

telephone conferences in cases where the financial data in the file is not clear or sufficient to 

make a decision about waiver or repayment. 

a. Pre-conference Call. The PA holds a pre-conference call to give the claimant a 

clear explanation of the purpose and process of the conference and the obligations 

of all parties, and to schedule a time for the call. During the call, the PA:

(1) Explains the issues that the PA will address during the conference call 

(i.e., income, expenses, assets, transfer of assets, and liabilities). If a 

preliminary finding of "at fault" was issued, the PA explains how the 

decision was made and its implications, and invites the claimant to provide 

any information that could affect the preliminary determination;

(2) Describes the criteria used to make key decisions in the case (i.e., at fault 

finding, criteria for waiver, interest charges);

(3) Describes the evidence the claimant needs to collect in preparation for the 

conference call;

(4) Gives the claimant a chance to ask questions;

(5) Determines the best time for the conference; and

(6) Prepares the pre-conference checklist that verifies that the conference 

agenda items were discussed. (Exhibit 35-4) 

b. During the Conference Call. The PA:

 (1) Identifies him or herself;

 (2) References the pre-conference call;

 (3) States the purpose of the call;

(4) Advises the claimant that he or she will be taking notes and for that reason 

there will be periodic pauses while he or she is writing;

 

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(6) Obtains the claimant’s acknowledgement that he or she understands what 

the conference issues are and what the conference is about;

(7) Listens carefully to what is being said;

(8) Probes responses that are too general or not credible, or which conflict 

exists with other statements given or the evidence of file;

(9) Takes notes complete enough to capture the necessary information; and 

(10) Confirms the accuracy of the statements recorded by reading them back to 

the participant(s) for confirmation.

c. After the Conference. The PA:

(1) Prepares a neutral Memorandum of Conference without findings, 

describing what transpired during the conference. (See Exhibit 35-5 for a 

sample Memorandum of Conference.) The language of the memorandum 

must be clear and non-technical. A sound Memorandum of Conference 

should: 

(a) Identify and describe the issues that were discussed during the 

conference;

(b) Identify the PA who conducted the conference and who 

participated in the conference;

(c) Describe the position of DEEOIC and the claimant coming into the 

conference;

(d) Describe the explanation provided in the conference that is 

relevant to the issue;

(e) Describe what was said in the conference that is relevant to the 

issue;

(f) Describe the method used to confirm the accuracy of the 

information collected during the conference that is recorded in the 

Memorandum of Conference; and

(g) Describe any agreements reached in the conference.

(2) Sends the Memorandum of Conference to the conference participant(s) for 

review and comments. Exhibit 35-6 is a sample memorandum cover letter 

to the claimant. The PA allows 15 days from the date of the letter and 

memorandum for the claimant to provide comments. After the 15 day 

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period, the PA makes findings on the issues for resolution and documents 

these findings in the final overpayment decision. 

10. Consideration of Overpayment Waiver. When the claimant is not at fault in causing the 

overpayment, DEEOIC may waive recovery of all or part of an overpayment based on whether 

the claimant meets the financial criteria as stated in 10.a or 10.b. For further explanation of a 

partial waiver, see paragraph 10.b(2)(b) Example 2. A determination to waive recovery of 

an overpayment is based on the PA’s review of a fully completed Form OWCP-20 and 

supporting documentation, and additional documentation or argument submitted by the claimant. 

Form OWCP-20 is designed to obtain extensive financial information, including income, 

expenses, and assets. 

The burden of proof rests with the claimant to prove the conditions necessary to grant a waiver. 

The claimant must submit the supporting documentation within the required 30-day time period 

as stated in the initial overpayment notice or cover letter to the Memorandum of Conference. 

However, the claimant may request an extension of time when it is necessary to obtain the 

required documents. If the claimant does not submit the information within the allotted time, the 

PA will prepare an overpayment FD denying the waiver. DEEOIC will not grant a waiver once 

the PA issues an overpayment FD, unless the claimant no longer lives at the address in the 

DEEOIC record, and did not receive the notification of the overpayment. 

There are two types of overpayment waivers under the EEOICPA. The DEEOIC may grant a 

waiver of recovery of the overpayment if the claimant meets the criteria under “recovery would 

defeat the purpose of the EEOICPA” or “recovery would violate equity and good conscience.” If 

the claimant does not meet either criterion, DEEOIC will pursue a return of the funds regardless 

of the fault finding. 

 

a. Recovery Would Defeat the Purpose of the EEOICPA. The DEEOIC will not 

seek recovery of overpaid funds if that recovery would defeat the purpose of the 

EEOICPA. To defeat the purpose of the EEOICPA, the PA must find that the 

claimant requires substantially all current income to meet current ordinary and 

necessary living expenses and that the claimant’s assets do not exceed a specified 

amount as determined by DEEOIC from data furnished by the Bureau of Labor 

Statistics (BLS). 

When a claimant exceeds the limit for either disposable current income or assets, 

a basis exists for establishing a reasonable repayment schedule over a reasonable, 

specified period. It is the claimant’s burden to show otherwise by submitting 

evidence that recovery of the overpayment would cause hardship of a nature 

sufficient to justify waiver.

(1) The PA determines the claimant’s income based upon documents 

submitted. An individual's total income includes any funds which may 

reasonably be considered available for his or her use, regardless of the 

source. A spouse's income will not be considered available to the claimant 

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unless the spouse was living in the household both at the time the 

overpayment was incurred and at the time waiver is considered. Income 

to be considered includes, but is not limited to:

(a) Wages and self-employment income.

(b) Government benefits. 

(c) Regular payments (rent or pension). 

(d) Investment income and alimony or child support payments. 

(2) The PA reviews claimed ordinary living expenses. It is the claimant’s 

burden to show that such expenses are reasonable and necessary. An 

individual is deemed to need substantially all of his or her current income 

to meet current ordinary and necessary living expenses if monthly income 

does not exceed monthly expenses by more than $200. The following can 

be considered as ordinary and necessary living expenses: 

(a) Food, clothing, household and personal hygiene supplies, rent, 

mortgage payments, property taxes, utilities (e.g., electricity, gas, 

fuel, telephone, water), insurance (e.g., auto, life, accident, and 

health), vehicle — one or two allowable, expenses for one or two 

vehicles (e.g., loan payments with the date each will be paid off, 

gas, oil, maintenance), transportation expenses not included under 

vehicle expenses, and creditor payments (e.g., credit card debt or 

other debt made in monthly installments). 

(b) Medical, hospitalization and similar expenses not reimbursed by 

insurance or other sources. 

(c) Church and charitable contributions made on a regular basis. This 

does not include large one-time gifts made after receipt of the 

preliminary notice of the overpayment. 

(d) Miscellaneous expenses (e.g., haircuts, newspapers) not to exceed 

$200 per month. 

If the PA makes a finding that a type of expense is ordinary and necessary, 

it does not necessarily mean that the amount is ordinary and necessary. 

The burden is on the claimant to show that the expenses are reasonable 

and needed for a legitimate purpose. 

If the PA determines that the amount of certain expenses is not ordinary 

and necessary, particularly regarding significant expenses for food, 

clothing, and vehicles, the PA must state in writing the reasons for the 

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finding. The finding must be supported by rationale, which may include 

reference to recognized research data (such as current statistics from BLS) 

that show that the claimant’s expenses exceed the average or range of 

expenses for the general population relevant to the claimant’s 

circumstances.

The PA evaluates only the minimum periodic payment as determined by a 

creditor. Copies of the claimant’s monthly billing for consumer debt will 

verify the minimum amount.

(3) An individual’s assets should not exceed the resource base of $5,500 for 

an individual or $9,200 for an individual with a spouse or one dependent, 

plus $1,100 for each additional dependent, based on information from 

BLS. A spouse's assets will not be considered available to the claimant 

unless the spouse was living in the household both at the time the 

overpayment was incurred and at the time waiver is considered. 

 

(a) Liquid assets may include (but are not limited to) cash, the value of 

stocks, bonds, savings accounts, mutual funds, and certificates of 

deposit. 

(b) Non-liquid assets may include (but are not limited to) the fair 

market value of an owner’s equity in property such as a camper, 

boat, second home and furnishing/supplies, vehicle(s) (i.e., any 

vehicles above the two allowed per immediate family), and 

jewelry.

Assets do not include the value of household furniture (primary 

residence), clothing, one or two vehicles, a home which the person 

maintains as the principal family domicile, or income-producing property, 

if the income from such property has been included in income. 

b. Recovery Would Violate Equity and Good Conscience. If the claimant is not 

entitled to waiver under the “defeat the purpose of the EEOICPA” clause, the PA 

considers the “against equity and good conscience” clause. Even if the claimant 

does not raise the “equity and good conscience” reason in the claim for waiver, 

the PA applies it in his or her analysis nonetheless. 

The PA reviews all pertinent financial information to determine if recovery of the 

overpayment will violate the concept of “equity and good conscience.” This 

clause is divided into two parts, financial hardship and relinquishing a valuable 

right. To demonstrate such a violation it must be established that either:

(1) Recovery will cause the claimant to experience severe financial hardship. 

The PA evaluates financial records and compares income with expenses 

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similar to the review conducted under paragraph 10.a to determine if 

repayment will cause severe financial hardship.

Recovery will be found to be “against equity and good conscience” when 

an individual who was not entitled to benefits would experience severe 

financial hardship in attempting to repay the debt. The criteria to be 

applied in making this determination are the same as those stated above in 

paragraph 10.a. 

(2) The claimant has relinquished a valuable right or changed position for the 

worse. The PA must review pertinent financial and other evidence to 

determine either of the following:

(a) Based chiefly or solely on notification of payment, the claimant 

relinquished a verifiably valuable right and such right cannot be 

regained (e.g., left a job that cannot be regained, sold a business, 

retired, or other major life-changing financial decisions). When a 

claimant gives up a valuable right, his or her current ability to 

repay is not taken into consideration, as the forfeiture of the right is 

in itself the grounds for waiver. 

For example, after being advised of entitlement to compensation, 

the claimant resigned his job and withdrew his contributions to his 

retirement fund, under the assumption that he was entitled to a 

lump-sum award of $150,000. Three years later, it was discovered 

that his award was erroneous. The claimant had lost his retention 

rights, was unable to get his old job back, and could not secure 

other employment. Recovery of any of the overpayment would be 

“against equity and good conscience” in this situation because the 

individual gave up a valuable right. 

(b) A decision was made resulting in a loss that verifiably worsened 

the claimant’s condition, and such decision would not have been 

made but for the receipt of benefits. The claimant must show that if 

required to repay the overpayment, he or she would be in a worse 

position after repayment than would have been the case if the 

benefits had never been received in the first place.

Converting the overpayment into a different form, such as food, 

consumer goods, real estate, etc., from which the claimant derived 

some benefit, is not considered a loss. Converting the overpayment 

into a different form for the benefit of another person, such as a 

child or relative, may be considered as a loss if the claimant retains 

no ownership interest in the proceeds and has no ability to reclaim 

the proceeds. 

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Example 1: A claimant received a lump-sum award. Later the 

entire award is declared to be an overpayment. The claimant 

contends that he has changed his position for the worse, as he used 

the entire award to make a down payment on a larger home. The 

claimant has not met his burden in showing that he changed his 

position for the worse, since he has not established that he suffered 

any loss. He has simply converted the money into a different form. 

Conversion of a liquid asset into real or tangible property does not 

constitute a loss.

Example 2: A claimant is notified that he is entitled to $30,000. 

Upon receipt of the money, the claimant signs an application to 

rent a larger apartment and pays a $2,000 non-refundable deposit. 

He places the remainder of the award in a savings account. Before 

the claimant moves in, he is notified that the entire award is an 

overpayment. As a result, the claimant does not move into the new 

apartment and forfeits the deposit. 

Since the claimant would not have signed an application to rent the 

apartment without the receipt of benefits, it would be inequitable to 

recoup the entire $30,000 overpayment. The claimant clearly 

suffered a $2,000 loss and repayment would put him in a worse 

position than if he had not received the initial award. 

Given that the claimant suffered a $2,000 loss, and not a $30,000 

loss, a partial waiver is a legitimate action is this case. The 

claimant does not have the money to rent a larger apartment and 

had no intention of doing so until he received his award. Thus, the 

claimant relied on DEEOIC’s action and it would be inequitable to 

recover that part of the overpayment. It would not be inequitable 

to recover that part of the overpayment that the claimant deposited 

in the bank. However, if the claimant were faced with additional 

expenditures arising out of the intent to move, those expenses 

would also be deducted from the overpayment. 

Example 3: Suppose a claimant receives a $150,000 award and 

loaned a relative $25,000 to buy a house before he received notice 

of an overpayment. Since the claimant has not suffered a loss, 

equity and good conscience do not require waiving of this $25,000. 

However, it would be inequitable to tell the claimant to recall the 

loan at once (further, the terms may not allow such action), and it 

would be inequitable to count the $25,000 as currently available 

assets. The interest the claimant receives on the loan as well as 

any sum he may receive on the principal should be considered 

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income when determining the claimant’s ability to repay the 

overpayment. 

11. Overpayment Decisions. After weighing all the evidence and considering all the 

circumstances surrounding the overpayment, the PA prepares an overpayment decision. The 

decision outlines his or her findings, and how recovery of the overpayment is to be pursued, as 

outlined in this chapter and Chapter 36 – Debt Liquidation. If the decision does not waive the 

overpayment, the PA signs the decision. Before releasing the decision, the PA sends it to the 

Unit Chief for review and certification for publication. For overpayment decisions that waive 

any part of the overpayment, the Unit Chief signs the overpayment decision. 

a. First Demand Letter. Where the PA finds that an overpayment debt exists 

following the initial notification to the claimant, the overpayment decision serves 

as the first demand letter. The overpayment decision outlines the facts 

surrounding the overpayment, provides a rationale as to why the overpayment is 

recoverable, and informs the claimant of the exact amount owed and the 

collection strategy to be used (i.e., payment in full, monthly payments, or 

collection from future entitlement). 

The decision includes information advising the claimant that he or she has 30 

days from the date of issuance of the overpayment decision to resolve the debt. 

The decision communicates to the claimant that if he or she does not take the 

necessary steps to resolve the debt within the 30 days, it will become a delinquent 

debt, and that DEEOIC will refer delinquent debts to Treasury or DOJ for 

collection. The decision must include the due process requirements outlined by 

Treasury. Exhibit 35-7 and Exhibit 35-8 are samples of overpayment decision 

first demand letters.

b. Waiver Approved. If the PA determines that a waiver is warranted under the 

“defeat the purpose of the EEOICPA” clause, the overpayment decision 

definitively waives the full amount of the overpayment. (See Exhibit 35-9) No 

further action is required on the part of the overpaid claimant. The PA will 

upload the decision in the case file and update the overpayment database. If the 

PA determines that the claimant meets the criteria under the “violate equity and 

good conscience” clause, the overpayment decision will advise the claimant 

regarding whether a full or partial waiver is granted. If a partial waiver is granted, 

the PA will advise the claimant of the collection steps and rights outlined in 11.a 

(See Exhibit 35-10). 

 

12. Overpayment Database. When the PA makes a determination that an overpayment exists 

and sends an initial notice to the claimant, the PA enters the claimant information into the 

overpayment database. The information in the database includes the employee and claimant 

identifying information, overpaid amount, dates of notices, status of the debt, and balance of 

debt. The database is updated whenever the PA completes any action on the debt, records 

payments received and interest added, or refers the debt to Treasury for collection. The PA does 

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not add interest on the debt once it has been referred to Treasury. The overpayment database is 

available to PA staff on the DEEOIC shared directory. 

13. TROR and Debt Collection Activities. DEEOIC collects data on overpayments 

beginning with when the PA issues an initial notice to the overpaid claimant. The assigned PA 

enters overpayment data into the overpayment database. One of the functions of the database is 

assembling overpayment data for preparation of the TROR. The TROR is prepared quarterly 

and is based on the fiscal year (October 1 to September 30.) DEEOIC submits the quarterly 

TROR to OWCP by the seventh day of the month following the end of the fiscal year quarter. 

OWCP collects the data from all OWCP divisions, and sends the report to Treasury. Treasury 

has published an instruction booklet on how to prepare the TROR, which is available online. 

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CHAPTER 36 – DEBT LIQUIDATION

1. Purpose and Scope. The purpose of this chapter is to provide guidance for managing 

debts by collection, compromise and termination. Included are procedures for the assessment of 

charges, collection actions, salary offset, administrative offset, compromise, referral to the 

Department of the Treasury, and termination (write-off) of collection efforts.

2. Responsibilities. The collection and settlement of debts are handled by: 

a. Claims Staff. CEs identify the potential overpayments and initially compute the 

debts. 

b. NO Fiscal POC. NO Fiscal POC employees are authorized to compromise claims 

and to suspend or terminate collection action, subject to the approval of the Chief 

of the Policies, Regulations, and Procedures Unit (PRPU), on claims of $1 to 

$100,000 (exclusive of interest, penalties, and administrative costs). The POC 

also recommends referral of claims of more than $100,000 to the Director of the 

DEEOIC, for such action. 

(1) If there is any indication of fraud on the part of the claimant or any other 

party with an interest in the claim, the POC refers the claim to the Director 

of DEEOIC, who in turn refers the claim to the DOJ. The POC has no 

authority to compromise, suspend or terminate recovery on such claims. 

A case involves fraud if an investigation is ongoing which is likely to lead 

to an indictment, if an indictment is pending, or if there has been a 

conviction in connection with the debt claim. Cases where the DOJ has 

declined to seek an indictment, or the criminal case has been dismissed, or 

an acquittal has occurred are not considered fraud cases.

(2) The POC also takes preliminary and final actions with respect to waiver of 

recovery, establishing and maintaining accounts receivable actions in a 

spreadsheet, pursuing collection of the debt, and monitoring accounts 

receivable to determine if and when referral to the Department of the 

Treasury or termination of collection action may be appropriate. 

c. An overpayment of compensation does not become a "debt" and is not subject to 

recoupment until established due process procedures have been provided and a 

FD on waiver of recovery has been issued. Until that time, the POC may accept 

payment against the overpayment but may not assess any charges, take any action 

to collect from compensation owed, or issue requests for offset by any other 

agency.

3. Recovery. The overpayment decision serves as the first demand letter to a claimant. If 

there is no response from the claimant, or the claimant has responded but failed to agree to a 

reasonable collection strategy as outlined by DEEOIC, the PA generates a second demand letter 

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within 30 days of the issuance of the overpayment decision (see Exhibit 36-1). If the claimant 

does not respond or resolve the overpayment within 30 days of the issuance of the second 

demand letter, a third and final demand letter is sent (see Exhibit 36-2).

a. Means of Recovery. DEEOIC may employ various means of recovery where an 

overpaid claimant has been made aware of the overpayment (via the overpayment 

decision described above) but fails to refund the overpayment within 60 days of 

the issuance of the third and final demand letter.

(1) Where the claimant has failed to refund the overpayment, DEEOIC 

recovers the overpayment by reducing any further lump-sum payments 

due (current and future). 

(2) Should the claimant die prior to repaying the overpayment, DEEOIC shall 

decrease future payments to any eligible survivors with respect to the 

underlying occupational illness or covered illness. 

(3) If no element of fraud on the claimant’s part is present, the PA refers the 

debt to the Department of the Treasury when a recoverable overpayment 

exists and the claimant fails to refund the full amount within 60 days of 

the final demand letter, and DEEOIC is unable to recover from any future 

or current compensation. 

(a) Due to cross-servicing requirements of the Debt Collection 

Improvement Act of 1966, debts that are delinquent for more than 

180 days should be referred to the Department of the Treasury for 

further debt collection action on the agency’s behalf. Agencies 

may also refer debts that have been delinquent for less than 180 

days to the Department of the Treasury to ensure efficient, costeffective debt collection.

(b) If there is sufficient reason to conclude that full or partial 

collection of the debt would be best achieved through litigation, 

the Department of the Treasury referral should include a 

recommendation to forward the debt to the DOJ for litigation [see 

DLMS 6 § 1162(a)]. 

(c) However, no claim should be referred for litigation until 

DEEOIC’s collection efforts and administrative processes are 

completed and the debt remains delinquent and legally 

enforceable. All referrals of this type should have the concurrence 

of the Office of the Solicitor of Labor. 

(d) The overpayment is subject to the provisions of the Federal Claims 

Collection Act of 1966, as amended (31 U.S.C. 3701 et seq.), and 

may be reported to the Internal Revenue Service as income. 

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(4) Where there is an indication of fraud, a false claim being made, or 

misrepresentation on the part of the claimant, the PA refers the debt to the 

DOJ for recovery if no overpayment refund is made in full at the end of 

the recovery process. 

The PA follows the current fraud procedures and promptly refers the claim 

to the Office of Inspector General for investigation. However, a debt 

would not be referred to the DOJ if the debt is less than $2,500, which is 

the minimum amount necessary for referring debts to the DOJ for 

litigation.

4. Assessment of Charges. The Debt Collection Act of 1982 authorizes the assessment of 

interest, administrative costs, and penalties on delinquent debts. 

a. FD. Charges are assessed on any debt where a FD has been issued, beginning on 

the date the claimant was notified that charges may apply to the debt, or the date 

of the FD, whichever is later.

b. Court Order. In cases of court-ordered restitution, the Court Order takes 

precedence over the Debt Collection Act. Unless stipulated in the Court Order, 

charges may not be assessed on the part of the debt corresponding to the 

restitution amount set by the court (see paragraph 16 below). 

c. Interest. Interest is assessed at the rate in effect on the date of the FD (unless the 

claimant has defaulted on a previous agreement). The rate of interest assessed 

shall be the rate of the current value of funds to the United States Treasury as 

published in the Federal Register. The Treasury Current Value of Funds Rate is 

posted on the U.S. Treasury website at: http://www.fms.treas.gov/cvfr/index.html. 

d. Administrative Costs. When a debt is found to be delinquent and is referred to the 

Department of the Treasury for collection, a charge is added to the principal and 

interest as an administrative cost of collection.

5. Waiver of Interest and Other Charges. Interest charges may be waived under three 

circumstances. Waiver of these charges is mandatory under the provisions outlined in the first 

two subparagraphs below, and discretionary under the provisions outlined in the third 

subparagraph. 

a. Full Payment Within 30 Days. If the principal is repaid in full within 30 days of 

the notification (FD) that charges are applicable, then charges are waived. This 

may be extended for one additional 30-day period on a case-by-case basis for 

good cause shown. Acceptable reasons for the 30-day extension include (but are 

not limited to) situations where the claimant needs the additional time to liquidate 

assets or arrange financing to pay the debt, or where the claimant does not receive 

FD in a timely manner (e.g., because of absence from home due to vacation). 

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b. Claimant Without Fault. Where the claimant is without fault in the creation of the 

debt and a repayment agreement has been established, interest charges are waived 

if:

(1) The monthly payment is so small that it does not cover the interest, or 

(2) There is so little left after interest that the debt will not be paid off within 

the lifetime of the claimant as determined by actuarial tables.

The POC determines whether charges are waived under this provision by 

completing the Waiver of Charges Worksheet (Exhibit 36-3).

If the claimant should later default on the repayment agreement, interest 

charges will again apply.

c. Cost of Recovery Exceeds Accrued Charges. If the full amount of the principal is 

paid after charges have accrued, and the additional cost of recovering the charges 

is greater than the amount of the accrued charges, then the DEEOIC may, at its 

discretion, waive the charges.

6. Compromise. Compromise differs from waiver of recovery of an overpayment. Waiver is 

accomplished by formal decision negating the overpayment before it becomes a debt, while 

compromise is an administrative means of disposing of a debt by accepting a partial settlement. 

The claimant has no legal right to settlement or compromise. Also, the claimant need not be 

without fault for compromise to be considered.

a. Compromise to Limit Repayment Period. This method of compromise is 

addressed more fully in paragraph 7 below. 

b. Compromise Due to Legal Issues. A debt may also be compromised if the Office 

of the Solicitor notifies the POC that significant doubt exists as to whether the 

Government could establish its claim in court, and the claimant has offered partial 

repayment. This may occur because of a dispute about the law or facts of the 

case. However, the POC does not make a judgment about legal enforceability 

without the Office of the Solicitor's specific advice after review of the case. (The 

limitations noted in subparagraph c below also apply here.) 

c. Resolution of Debt. Once a compromise letter explaining the reasons for, and 

amount to be compromised, is issued by the NO and the agreed-upon portion of 

the debt has been refunded to DEEOIC, the debt is fully resolved. The POC 

annotates the accounts receivable records to reflect resolution by compromise and 

the amount repaid. 

(1) The POC also sends a letter to the claimant confirming that the debt has 

been discharged. Unless the compromise was for reasons of economic 

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hardship, the POC also advises in this letter that the amount compromised 

will be reported as income to the IRS and may be subject to taxation under 

IRS rules. 

(2) At the end of each year, the NO POC files IRS Form 1099G in cases 

where the debt has been compromised for reasons other than economic 

hardship, and a copy of the form is forwarded to the claimant’s case file. 

7. Compromise to Limit Repayment Period. Compromise of the principal amount owed is 

an established tool for collecting existing overpayments. However, compromise for the 

application of additional charges is different from compromise of principal. Compromise of 

additional charges is mandatory where the repayment period must be limited. Compromise to 

limit the repayment period may be due to hardship, or based on life expectancy. In such cases, a 

specific mathematical formula is used to determine the amount to be compromised. 

Under this policy, the POC considers compromising additional charges in all cases at the time 

the repayment agreement is established, unless charges are waived pursuant to paragraph 5(c) of 

this chapter. If charges are waived under that provision, then compromise will not be considered 

under this policy. 

a. Effect of Charges. If charges cannot be waived and a repayment schedule (either 

initial or re-negotiated) is being established, compromise must be considered in 

cases where the POC has determined that a certain amount is the most the 

claimant can afford to repay. 

 

For example, if the POC determines, by review of detailed financial information, 

that the maximum amount the claimant can afford per installment and the period 

required for repayment of the debt at this rate is extended by more than 35% due 

to the application of the charges, then the amount of the principal must be 

compromised so that the period required for repayment of the debt is not extended 

by more than 35%. 

b. Information Needed. The following information is needed to determine whether 

 compromise of accrued charges and/or principal is required: the amount of the 

principal, the amount of the monthly payment, and the interest rate.

c. General Calculation Rule. Some cases may be eliminated from consideration for 

compromise by applying the following rule: divide the current principal balance 

(plus any accrued charges) by the monthly payment and multiply the result by the 

annual interest rate. 

If the result is less than 5.5%, no compromise is necessary, and the POC so 

indicates on the Compromise of Principal Worksheet (Exhibit 36-4). If the result 

is 5.5 or greater, the POC completes the Compromise of Principal Worksheet in its 

entirety to determine the amount to be compromised. 

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d. Compromise Order. If the principal must be compromised under this provision, 

the principal (before compromise) does not exceed $100,000, and no indication of 

fraud is present, the Chief of the PRPU certifies the Compromise of Principal 

Worksheet and the POC issues a compromise order to the claimant. The 

compromise order, which includes the information outlined below, does not carry 

the right to a hearing. Exhibit 36-5 is a sample compromise order.

If the repayment period is sufficiently reduced by compromising only accrued 

charges, the PRPU Chief certifies the Compromise of Principal Worksheet and the 

POC issues a compromise order to the claimant, regardless of the principal 

amount. The compromise order includes: 

(1) The amount of each component of the debt (with separate amounts 

specified for principal, accrued administrative costs, accrued penalty, and 

accrued interest, as applicable);

(2) The rationale for the determination that the debt cannot be waived; 

(1) The rationale for any determination with respect to fraud (see paragraph 

2b above); 

(2) A brief explanation of the rationale for compromise (the Compromise of 

Principal Worksheet may be incorporated by reference);

(5) The amount to be accepted in full settlement of each component of the 

debt (with separate amounts specified for principal, accrued administrative 

costs, accrued penalty, and accrued interest, as applicable);

(6) The time and manner of payment; and 

(7) A statement that the debt is not compromised or settled until full payment 

of the specified amount has been made. 

e. Principal Over $100,000. If any amount of the principal must be compromised 

under this provision and the principal amount (before compromise) exceeds 

$100,000, the case is referred to the Director of DEEOIC for further action after 

the Chief of the Policies, Regulations and Procedures Unit certifies the 

Compromise of Principal Worksheet.

f. Compromise Not Approved. If neither accrued charges nor principal are 

compromised under this provision, the POC files the Compromise of Principal 

Worksheet in the case file. 

8. Compromise in Consideration of Partial Payment. Regardless of whether it is required 

under the provisions of this chapter, compromise may be further considered as a means of 

disposing of debts where collection would be extremely difficult or expensive. The claimant 

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need not be without fault for compromise to be considered, however, the claimant has no legal 

right to settlement or compromise to dispose of an overpayment. 

a. Proposal. The claimant may propose that DEEOIC be satisfied with partial 

recovery on the debt, or DEEOIC may propose a compromise to the claimant. For 

example, compromise might occur if the claimant reported a liquid asset that 

exceeded the resource base, but was insufficient to cover the debt, and otherwise 

had only enough income to meet expenses. The compromise would provide for 

recovery of the amount available and forgiveness of the remainder. 

However, in judging whether repayment would cause hardship, the POC assesses 

the claimant's income and assets according to the criteria provided in EEOICPA 

PM 3-0800. The claimant should be required to submit a current financial report 

(OWCP-20), if one has not been provided within the previous six months. Also, 

the POC informs the claimant that under certain circumstances the compromised 

portion of the debt will be reported to IRS as income 

b. Repayment Within Reasonable Time. Compromise should be considered if the 

Government cannot collect the full amount because the claimant is unable to pay 

it within a reasonable time, or the claimant refuses to pay the claim in full and the 

Government cannot enforce collection by court action within a reasonable time. In 

determining inability to pay, the OWCP may consider: 

(1) The age and health of the claimant;

(2) Current and potential income; 

(3) Inheritance prospects; 

(4) The possibility that the claimant has concealed or transferred assets to 

avoid recoupment; and 

(5) The availability of assets or income for enforced collection.

If the POC finds that compromise is warranted, he or she prepares a 

memorandum to the file which describes the financial circumstances of the 

claimant, the proposed compromise, and the considerations which led to 

the compromise recommendation. Exhibit 36-6 is a sample compromise 

memorandum. 

c. Limitations. The compromise limitations described earlier in this chapter also 

apply here. If compromise of the debt principal appears warranted but the 

original principal amount is more than $100,000, or where there is an indication 

of fraud (see paragraph 2b above), then the compromise memorandum and the 

case file should be referred to the Director of DEEOIC for further action.

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d. Compromise Order. If compromise appears warranted and the limitations noted 

above do not apply, the POC issues a compromise order which includes the items 

listed in paragraph 4a above. The POC incorporates the information noted in the 

compromise memorandum in the compromise order to explain the basis for the 

compromise to the claimant. The compromise order does not carry the right to a 

hearing. Exhibit 36-5 is a sample compromise order.

e. Contractual Agreement. When a debt is compromised, the United States agrees to 

be satisfied with partial repayment. Even if the claimant's circumstances change, 

such that the reasons for the compromise are no longer valid, OWCP has 

officially forgiven the remainder of the debt and may not press for additional 

repayment unless the claimant defaults on the repayment agreement. Therefore, 

compromise should be undertaken only after the claimant's financial 

circumstances are known.

9. Collection Strategies. Strategies for collection of a debt are generally pursued in the 

following order, as appropriate: 

a. Recovery of Entire Debt. This may occur by reducing any further compensation 

payment due currently or in the future for which there is direct statutory authority 

under 42 U.S.C. 7385j-2. Such recoupment, either in a lump-sum or in 

installments, is addressed in paragraph 9 below. 

b. Voluntary Repayment in Lump-Sum. Such repayments are addressed in paragraph 

10 below. 

c. Voluntary Deduction from Retirement Benefits. Such deductions are made in 

installments from periodic payments.

d. Involuntary Offset of Retirement Benefits. Also, refund of retirement 

 contributions may be pursued. 

e. Voluntary Installment Payments. Payments made directly by the debtor are 

addressed in paragraph 10 below. 

f. Compromise. This action is addressed in paragraph 6 above. Where a debt 

exceeds $100,000, a recommendation is made to forward the debt to the DOJ for 

litigation or for compromising, suspending or terminating debt collection. 

g. Termination or Suspension. These actions, also termed write-offs, are addressed 

in paragraph 13 below. 

10. Recovery from Compensation Entitlement. If further compensation is owed to the 

claimant, the POC recovers the debt from any lump-sum payment due currently or in the future. 

Collection action cannot begin until after the POC issues a final overpayment decision. If a 

sufficiently large lump-sum payment of compensation is due, the debt is recovered in full by a 

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single deduction from compensation owed. The POC sends the claimant a letter explaining the 

recovery method. The POC establishes an accounts receivable on the accounts receivable 

spreadsheet to track the balance due, interest incurred, and/or payments received.

11. Recovery in Cases With No Compensation Entitlement. 

a. Lump-Sum Preferable. Debts are collected in one lump-sum whenever possible. 

If the claimant cannot pay in this manner, payment may be accepted in regular 

installments. The POC determines the size and frequency of the installment 

 payments by the size of the debt and the claimant's ability to repay. 

b. Claimant's Resources. The POC evaluates the claimant's resources for repayment 

as soon as a final overpayment decision is made (see Chapter 35 – Overpayment 

Process) and sets or negotiates an appropriate repayment plan with the claimant.

If detailed information about the claimant's financial status is not already in the 

case file, it should be obtained. This information may include: Form OWCP-20 

Overpayment Recovery Questionnaire; information provided on Forms EE-1 and 

EE-2; information provided by the SSA in response to requests from the 

DEEOIC; and other documents concerning the claimant's financial status.

c. Detailed Financial Information Not Available. If the claimant refuses to submit 

detailed financial information, or has not yet had time to reply to a request for 

such information, the POC may accept voluntary installment payments in an 

amount determined by the claimant, until detailed financial information becomes 

available. 

However, the POC should not enter into a formal agreement with the claimant, 

and should not consider waiver of charges (see paragraph 4) or compromise of 

principal (see paragraphs 5 and 6), unless and until the claimant provides detailed 

financial information and agrees to installment payments in an amount which 

reasonably represents the maximum he or she can afford. 

 

d. Schedule of Payments. If the claimant offers to repay on a set schedule or 

requests a change in a schedule already established, the POC evaluates the 

 proposed repayment plan for reasonableness on the basis of the claimant's 

resources as documented in the case file. The Department of Labor’s regulations 

 concerning debt collection recommend that debt repayment be scheduled to 

 recover the entire amount (including any interest or penalties) in three years, but 

this may not be practical if the claimant does not have appreciable income (29 

 C.F.R 20.33(a)). 

(1) If the repayment plan is not reasonable, the POC asks the claimant, in 

writing, to contact the POC or the Chief, PRPU to discuss an accelerated 

repayment plan. 

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(2) If the repayment plan is reasonable, the POC obtains a signed statement 

from the claimant which specifies the terms of repayment. This statement 

constitutes a legally enforceable agreement. The POC annotates the 

accounts receivable spreadsheet and diaries the next payment.

e. Unreasonably Small Payments. If the claimant unilaterally makes installment 

payments in amounts so small that the debt will never be repaid, or will be repaid 

in an unreasonably long period (such that the claimant will become a "perpetual 

debtor"), and the claimant refuses to increase the payments or submit detailed 

financial information justifying the size of the payments, the POC refers the debt 

to the Department of the Treasury with a recommendation that the debt be 

forwarded to the Justice Department for resolution, if appropriate. 

 

f. No Response to Demand Letters. If no response is received to the demand letters, 

the POC attempts to contact the claimant by telephone. The POC explains who is 

calling and refers to the decision that stated the amount and terms of collection. 

The POC asks what arrangements the claimant would like to make to effect 

repayment.

If the claimant does not suggest a repayment plan, the POC should be prepared, 

based on review of the case file, to propose a weekly or monthly amount. The 

POC ensures that the details of the telephone call are documented in the ECMS 

Telephone Messaging System. When agreement is reached, the POC drafts a 

follow-up letter referring to the telephone call and the terms discussed, and 

requesting the first installment payment.

g. Further Action. If the telephone call is unsuccessful, or if the claimant does not 

begin the agreed-upon payments, the POC evaluates the debt for referral to the 

Department of the Treasury, with a recommendation that it be forwarded to the 

DOJ, if appropriate, for termination of collection action.

12. Referring Debts to Department of Treasury. The Debt Collection Improvement Act of 

1996 provides that any non-tax debt or claim owed to the United States that has been delinquent 

for a period of 180 days be turned over to the Secretary of the Treasury for appropriate action to 

collect or terminate collection actions on the debt or claim. To further this goal, the Department 

of the Treasury has created the Debt Management Services (DMS), a division of the Financial 

Management Services Branch.

DMS provides government-wide debt collection services through the Treasury Offset Program 

(TOP) and Cross-Servicing Program. TOP involves offsets of payments from a variety of 

federal programs and includes offset of income tax refunds. The Cross-Servicing Program 

includes skip trace services, administrative wage garnishment, referral of debts to the DOJ for 

litigation, and referral of debts to private collection agencies.

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The Department of the Treasury oversees all collection activity on all referred debts, and all 

debts more than 180 days delinquent must be referred for either TOP or Cross-Servicing or 

both. All debts related to overpayment of benefits under the EEOICPA are referred for both.

a. Notice to Claimant. At least 60 days prior to referral to the Department of the 

Treasury, the POC sends a letter advising the claimant that referral for collection 

action is possible. The notice includes specific advice that the claimant can:

(1) Inspect and request copies of records about the debt; 

(2) Enter into a mutually agreeable written repayment agreement; and

(3) Request review of the amount of the debt, its past-due status, and whether 

the debt is legally enforceable.

Sample letters shown as Exhibit 36-1 and Exhibit 36-2 include language 

for this purpose, so issuance of either or both at 30-day intervals after the 

debt becomes final provides adequate due process. The Department of the 

Treasury will not accept debts where such notice has not been given. 

b. Referral. When a debt is 180 days delinquent, it is eligible for referral to the 

DMS at Department of the Treasury. If the POC has made no progress in 

collection efforts through recoupment of compensation benefits or voluntary 

repayment actions, the POC refers the debt to the Department of the Treasury. 

The POC ensures that all due process requirements have been met and that the 

debt is appropriate for referral to the Department of the Treasury. The 

Department of the Treasury will not accept debts that are not final, covered by 

bankruptcy, already in private collection, in litigation, or with the DOJ. 

The POC refers the case to the Department of the Treasury using the automated 

Debt Management System on the Department of the Treasury website. The POC 

completes the DMS Agency Profile for each debt referred for servicing. The 

profile information includes: 

(1) Claimant/Debtor’s Social Security number;

(2) Agency Points of Contact; 

(3) The method(s) by which DEEOIC wants the DMS to service their debts 

(refer to TOP, refer to credit bureaus);

(4) Payment agreement parameters (e.g., will interest accrue during payment 

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(5) Whether the administrative fee is added to the debt or charged to 

DEEOIC.

c. Return of Debt. The Department of the Treasury may return a debt to DEEOIC if 

it has been collected in full, found to be uncollectible, or covered by a bankruptcy 

filing, or if compromise has been reached. Returned debts are sent to the POC for 

further action as necessary.

d. Debt and Transaction Tracking. DMS tracks all debts and payments using Fed 

Debt, a debt and debtor based system which allows: 

(1) DMS to better handle joint and several debts; 

(2) A demand letter to be sent to each debtor; 

(3) Users to update debt and/or debtor information; 

(4) Multiple payment agreements for a debt; 

(5) Removal of a debtor/claimant from the debt without closing the entire 

debt; 

(6) Records of transactions, including how payments are applied (i.e., 

administrative fees, penalties, interest and principal); 

(7) Federal agencies to report payments, adjustments and reversals they 

receive in their offices.

The POC has access to the DMS Fed Debt System and uses it to track the status 

 of the debt until it is resolved. 

e. Referral to DOJ. A component of the Department of the Treasury’s Cross Servicing is 

referral of debts in excess of $100,000 to the DOJ for litigating, compromising, 

suspending and terminating collection. The DOJ has the exclusive authority to 

compromise, suspend or terminate collection activity on debts in excess of $100,000, 

unless it decides, in its discretion, to return the debt to the agency for such purposes. 

The POC ensures that all Department of the Treasury referrals for debts in excess of 

$100,000, exclusive of interest, include recommendations to forward the debt to DOJ for 

permission to compromise, suspend or terminate collection action. 

(1) While the DOJ is considering a case, the POC carries the accounts receivable 

record as open and annotates it as referred to DOJ.

(2) When collecting a debt under a DOJ agreement, DEEOIC cannot charge interest 

or send billing notices. 

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(3) The POC cancels the accounts receivable record on a case referred for collection 

when notified by the DOJ that it will not take further action.

13. Termination of Collection Action (Write-off). When the Department of the Treasury 

directs DEEOIC to write off the debt, the POC removes the account from DEEOIC’s receivables. 

a. Potential for Litigation. NO managers periodically review the accounts 

receivable spreadsheets to identify cases in which aggressive collection action has 

 brought no result. Each case is examined to determine whether litigation would 

lead to collection of the debt. 

Cases in which collection is not likely to succeed are terminated. They include 

situations where the claimant appears to have no assets or income which could be 

attached by a court; where the claimant's financial circumstances are such that 

hardship would result from recoupment; or where the Office of the Solicitor or the 

U.S. Attorney’s Office states that DEEOIC has a poor legal case against the 

debtor. 

The POC prepares a memorandum (Exhibit 36-6) regarding termination of 

collection action where collection actions have brought no results. In the 

memorandum, the POC states the nature and amount of the debt, the efforts made 

to collect it, and the financial circumstances of the claimant, explaining why 

termination of collection action is warranted.

If the debt exceeds $100,000, or is between $2500 and $100,000 and there is an 

indication of fraud (see paragraph 2b above), the Chief of the PRPU signs the 

memorandum. Debts of $2500 or less which cannot be collected by administrative 

means, including referral to the Department of the Treasury, must be written off, 

since the Department of the Treasury will not accept them.

b. Suspension of Collection Action. Occasionally a claimant may ask that the debt 

 be forgiven due to financial hardship. The POC may suspend collection action 

 because of financial hardship, but reserves the right to resume collection action in 

 the event of future claims or change in the claimant's circumstances. Exhibit 36-7

shows a sample letter advising a claimant of this action.

c. Termination of Collection Action. When collection action is terminated, the POC 

documents and closes the accounts receivable record. Termination of collection 

action, or the “write-off” of a bad debt, is an administrative action which differs 

from waiver or compromise. Termination of collection action does not forgive 

the debt, since DEEOIC may collect it at a later date. Generally, however, once a 

debt has been written off, collection actions are never resumed. 

At the end of each year, the Department of the Treasury files IRS Form 1099G for 

each case where the debt has been written off for reasons other than economic 

hardship, and a copy of the form is sent to the POC for inclusion in the case file. 

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Once Form 1099G has been filed, the POC documents the accounts receivable 

record accordingly, and DEEOIC may not collect the debt at a later date.

14. Recovery from Deceased Claimant's Estate. If the claimant dies before the debt is 

completely recovered, the POC acts quickly to obtain pertinent information about the estate. 

Prompt action is essential because creditors who have not properly asserted a claim before the 

estate is closed are generally precluded from any recovery. Once the estate has been closed and 

the proceeds distributed, collection action must be terminated. The information to be requested 

and the action to be taken are described in Chapter 35 – Overpayment Process and are the same 

for an established debt as for a newly discovered debt. 

15. Credit Reporting. Under the Debt Collection Act of 1982, claimants whose accounts 

become delinquent are subject to reporting to private credit reporting bureaus. The Department 

of the Treasury refers delinquent DEEOIC debts to one or more credit bureaus based on 

information the POC places in the Department of the Treasury’s Debt Management System. The 

credit bureaus maintain credit information on individuals and provide the information upon 

request to lenders. The POC points out the possibility of credit reporting to individuals who 

refuse to cooperate in the debt collection process. 

If a claimant disputes the information in a credit bureau's file, the Department of the Treasury 

will contact the NO to verify the information. The POC verifies the information and responds 

within seven business days. 

If the Department of the Treasury fails to respond to the credit bureaus within a given time limit 

(generally 30 days), the credit bureau will accept the claimant's version of the facts.

If the information held by the credit bureau was incorrect, the POC notifies the Department of 

the Treasury and corrects the information in the office’s overpayment tracking system. The POC 

also updates the Treasury’s online debt system, so that the error is not repeated in the next 

transmission to the credit bureau. 

16. Court Ordered Restitution in Fraud Cases. When a claimant has been convicted of filing 

a false claim which resulted in an overpayment/debt due the government, the court often orders 

the defendant/claimant to make restitution to the United States as a condition of probation. The 

amount of restitution may or may not be the full amount of the debt owed to OWCP. 

a. "Global Settlement". If the Court Order states that the restitution amount will be 

in full satisfaction of the debt owed the United States (a "Global Settlement"), the 

Court Order takes precedence over the OWCP's administrative debt collection 

process. 

In such cases, if the restitution amount is less than the outstanding debt principal 

balance, the principal balance must be reduced to the restitution amount set by the 

court. Also, interest may not be applied to such debts unless stipulated in the 

Court Order. However, if the probation period ends and the claimant fails to 

make full restitution, the POC pursues collection of the full original debt amount. 

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b. Other Than "Global Settlement". If the Court Order does not represent a "Global 

Settlement," the POC continues to pursue collection of the full amount of the 

debt, taking credit for any restitution amounts received. Unless the Court Order 

stipulates assessment of interest, interest may not be applied to the restitution 

amount and any restitution payments received should be applied directly to the 

debt principal. 

In criminal cases, OWCP is sometimes asked to assist the DOJ in calculating the 

loss to the government in accordance with federal sentencing guidelines. This 

may involve calculating how benefits would have been paid if the claimant had 

fully advised OWCP. The POC processes all such requests. 

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Appendix 1 - Exhibits

Chapter 1 – Definitions

Exhibit 1-1 Abbreviations

Exhibit 1-2 Forms

Chapter 2 – The EEOICPA

 

Exhibit 2-1 Jurisdictional Map

Exhibit 2-2 DEEOIC Office Addresses

Exhibit 2-3 DEEOIC References and Resources

Chapter 6 – Processing Mail

Exhibit 6-1 OIS Subjects and Categories

Exhibit 6-2 FOIA Process Flow Chart

Exhibit 6-3 Data Release Form

Exhibit 6-4 USPS Postmaster Address Request Letter

Chapter 7 – Case Creation

Exhibit 7-1 Sample Acknowledgement Letter

Chapter 10 – Resource Centers

Exhibit 10-1 RC Checklist

Exhibit 10-2 Occupational History Interview

Exhibit 10-3 Interview Confirmation Letter

Chapter 11 – Initial Development

Exhibit 11-1 DOL Letter to DOE FWP

Chapter 12 – Representative Services

Exhibit 12-1 Authorization for Representation/Privacy Act Waiver

Exhibit 12-2 Powers of Attorney Memo for SOL Review

Exhibit 12-3 Notification to Representative

Exhibit 12-4 Notification to Representative of Conflict of Interest

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Chapter 13 – Establishing Covered Employment

Exhibit 13-1 Telephone Contact Information for Inquiries to SSA

Exhibit 13-2 Sample Subcontractor Employment Memo

Chapter 14 – Establishing Special Exposure Cohort Status

Exhibit 14-1 SEC Class Screening Worksheet

Exhibit 14-2 Sample Letter to Claimant Granting Medical Benefits for Unaccepted 

Reverse Consequential Condition (Medical Treatment of Underlying 

Primary Cancer)

Chapter 15 – Establishing Toxic Substance Exposure

Exhibit 15-1 DAR Cover Letter

Exhibit 15-2 DAR Questionnaire

Exhibit 15-3 Establishing Causation for Asbestosis And Hearing Loss

Chapter 16 – Developing and Weighing Medical Evidence

Exhibit 16-1 Sample Questions for Physician

Exhibit 16-2 ICD Codes and Corresponding Procedure Codes

Exhibit 16-3 Sample Letter to Claimant Regarding Second Opinion/Referee 

Physician

Chapter 17 – Development of Radiogenic Cancer Claims

Exhibit 17-1 NIOSH Referral Summary Document (NRSD)

Exhibit 17-2 Instructions for Completing the NRSD

Exhibit 17-3 NIOSH Referral Letter to Claimant

Exhibit 17-4 Examples of Rework Request

Exhibit 17-5 Review of Dose Reconstruction Letter to Claimant

Exhibit 17-6 Primary Cancer Sites 

Exhibit 17-7 Glossary of Cancer Descriptions

Chapter 18 – Eligibility Criteria for Non-Cancerous Conditions

Exhibit 18-1 Matrix for Confirming Sufficient Evidence of Non-Cancerous Covered 

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Chapter 19 – Eligibility Requirements for Certain Uranium Workers

Exhibit 19-1 DOJ Response to Request for Identification of RECA Claim

Exhibit 19-2 Letter to DOJ for RECA Award Confirmation

Exhibit 19-3 Alternate Letter to DOJ for RECA Documentation

Exhibit 19-4 DOJ Response to Request for Identification of Pending RECA Claim

Exhibit 19-5 DOJ Letter Indicating No Claim Filed

Exhibit 19-6 Letter to Claimant Advising of Part B RECA Award Requirement

Exhibit 19-7 Letter to DOJ for Section 4 RECA Claim Status

Chapter 20 – Establishing Survivorship

Exhibit 20-1 Sample Letter to Potential Survivor Advising of Right to File Claim

Exhibit 20-2 Sample Alternative Filing Acknowledgement Letter

Exhibit 20-3 Sample Alternative Filing Determination Letter

Chapter 21 – Impairment Ratings

Exhibit 21-1 Not at MMI Letter

Exhibit 21-2 Not Claiming Impairment Letter 

Exhibit 21-3 Impairment Eligibility Letter to Physician

Exhibit 21-4 Impairment Rating Requirements

Exhibit 21-5 Required Medical Evidence for Specific Conditions 

Exhibit 21-6 Breast Impairment Letter

 

Chapter 22 – Wage-Loss Determinations

Exhibit 22-1 Normal Social Security Retirement Age Table

Exhibit 22-2 Not Claiming Wage-Loss Letter

Exhibit 22-3 Fax Cover Sheet to SSA

Exhibit 22-4 Inquiries to SSA

Chapter 23 – Consequential Conditions

Exhibit 23-1 Sample Listing of Consequential Illnesses 

Exhibit 23-2 Sample Letter Decision

Chapter 24 – Recommended Decisions

Exhibit 24-1 Sample Cover Letter

Exhibit 24-2 Sample Recommended Decision, Accept

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Exhibit 24-3 Sample Recommended Decision, Denial

Exhibit 24-4 Notice of Recommended Decision and Claimant Rights

Exhibit 24-5 Sample Waiver

Exhibit 24-6 Sample Partial Accept/Partial Denial Bifurcated Waiver

Chapter 25 – FAB Review Process

Exhibit 25-1 Sample Acknowledgment Letter, Review of Written Record

Exhibit 25-2 Sample Acknowledgment Letter, Hearing 

Exhibit 25-3 Sample Hearing Notice to Claimant Who Filed an Objection 

Exhibit 25-4 Sample Hearing Notice to Claimant Who Did Not File an Objection 

Exhibit 25-5 Waiver of Rights to Confidentiality 

Exhibit 25-6 Waiver of Rights to Confidentiality (Media) 

Exhibit 25-7 Sample Hearing Script 

Exhibit 25-8 Sample Letter to Postmaster 

Exhibit 25-9 Sample Change of Address Letter

Chapter 26 – FAB Decisions

Exhibit 26-1 Sample Final Decision

Exhibit 26-2 Medical Benefits Letter

Exhibit 26-3 Sample Remand Order

Exhibit 26-4 Sample Denial of Request for Reconsideration (No New Evidence or 

Argument Submitted) 

Exhibit 26-5 Sample Denial of Request for Reconsideration (New Evidence and/or 

New Argument Submitted)

Exhibit 26-6 Sample Cover Letter, Alternative Filing

Chapter 27 – Reopening Process

Exhibit 27-1 Sample Director’s Order to Reopen

Exhibit 27-2 Sample Denial of a Request for Reopening

Chapter 29 – Ancillary Medical Services and Related Expenses

Exhibit 29-1 Sample Ancillary Medical Services Development Letter

Exhibit 29-2 Sample Development Letter (DME/Oxygen Treatment Therapy/Oxygen 

Medical Supplies)

Exhibit 29-3 Sample Ancillary Medical Services Authorization Letter

Exhibit 29-4 Sample Authorization Letter (DME/Oxygen Treatment Therapy/Oxygen 

Medical Supplies)

Exhibit 29-5 Oxygen Delivery Systems

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Exhibit 29-6 Sample Home Modification Letter

Exhibit 29-7 Sample Travel Authorization Letter

Chapter 30 – Home and Residential Health Care

Exhibit 30-1 Sample Medical Development Letter (Physician)

Exhibit 30-2 Sample Medical Development Letter (Claimant)

Exhibit 30-3 Sample Authorization Letter

Exhibit 30-4 Billing Codes

Chapter 31 – Tort Action and Election of Remedies

Exhibit 31-1 Instructions for Completing Offset Worksheet

Chapter 32 – Coordinating State Workers’ Compensation Benefits

Exhibit 32-1 Do Not Coordinate Table

Exhibit 32-2 Instruction for Completing Coordination of SWC Benefits Worksheet 

Chapter 33 – Compensation Payments

Exhibit 33-1 Payment Transaction Form for Expedited Processing (EPPTF)

Exhibit 33-2 Payment Transaction Form for 3rd Party Expedited Payments (EPPTF)

Exhibit 33-3 Payment Transaction Form for Exception Processing

Exhibit 33-4 ECS Payment Cancellation Form 

Chapter 35 – Overpayment Process

Exhibit 35-1 Sample Initial Overpayment Notification Letter - Without Fault

Exhibit 35-2 Sample Initial Overpayment Notification Letter - At Fault

Exhibit 35-3 Sample Memorandum to File for Administrative Write-Off of Debt Equal 

to or Less Than $2,500

Exhibit 35-4 Sample Pre-Conference Call Checklist

Exhibit 35-5 Sample Memorandum of Conference

Exhibit 35-6 Sample Cover Letter to Memorandum of Conference

Exhibit 35-7 Sample Overpayment FD - Preliminary at Fault Determination Correct

Exhibit 35-8 Sample Overpayment FD - Without Fault - Waiver Denied

Exhibit 35-9 Sample Overpayment FD - Waiver Granted-Defeats Purpose of EEOICPA

Exhibit 35-10 Sample Overpayment FD - Waiver Granted (Full or Partial) Based onViolate Equity and Good Conscience

Exhibit 35-11 Sample Letter to Non-Claimant Regarding Federal Debt

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Chapter 36 – Debt Liquidation

Exhibit 36-1 Sample Second Demand Letter

Exhibit 36-2 Sample Third and Final Demand Letter

Exhibit 36-3 Waiver of Charges Worksheet

Exhibit 36-4 Compromise of Principal Worksheet

Exhibit 36-5 Sample Compromise Order

Exhibit 36-6 Sample Compromise Memorandum

Exhibit 36-7 Sample Letter Terminating Collection Actions

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ABBREVIATIONS 

Common abbreviations for EEOICPA terms are as follows: 

AAW Average Annual Wage

AMA Guides American Medical Association’s Guides to the Evaluation of Permanent 

Impairment, 5th Edition

ANRSD Amended NIOSH Referral Summary Document

AWE Atomic Weapons Employer

BAS Branch of Automated Data Processing Systems

BOTA Branch of Outreach and Technical Assistance 

BPA Bill Processing Agent

CBD Chronic Beryllium Disease

CDC Centers for Disease Control

CE Claims Examiner

CIS Carcinoma in situ

CLL

CMC

Chronic Lymphocytic Leukemia

Contract Medical Consultant

CPT Code Current Procedural Terminology

CCRT The Center for Construction Research and Training (formerly The Center 

to Protect Workers’ Rights)

DAR Document Acquisition Request

DD District Director

DEEOIC Division of Energy Employees Occupational Illness Compensation

DME Durable Medical Equipment

DO District Office

DOE Department of Energy

DOJ Department of Justice

DOL Department of Labor

DR Dose Reconstruction

DRGs Diagnostic-Related Groups

ECS

EDP

EEOICP

Energy Compensation System

Energy Document Portal 

Energy Employees Occupational Illness Compensation Program

EEOICPA Energy Employees Occupational Illness Compensation Program Act

FAB Final Adjudication Branch

FD Final Decision

FECA Federal Employees’ Compensation Act

FO Fiscal Officer

FOIA Freedom of Information Act

FY Fiscal Year

GPO Government Printing Office

GPRA Government Performance Results Act

HCPCS Healthcare Common Procedure Coding System

HHS Department of Health and Human Services

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HP Health Physicist

ICD International Classification of Disease

IH Industrial Hygienist

MHSU Medical, Health & Science Unit

MMI Maximum Medical Improvement

NCI National Cancer Institute

NDC number National Drug Code

NIOSH National Institute for Occupational Safety and Health 

NIOSH - IREP NIOSH - Interactive RadioEpidemiological Program 

NO National Office

NRSD NIOSH Referral Summary Document

OIS

OMB

OWCP Imaging System

Office of Management and Budget

OPM Office of Personnel Management

ORISE Oak Ridge Institute for Science and Education

OWCP Office of Workers Compensation Programs

PCA Payee Change Assistant

PEP Program Evaluation Plan

PER Program Evaluation Report

PII Personally Identifiable Information

PM Procedure Manual

POA Power of Attorney

PoC Probability of Causation

PTF Payment Transaction Form

RC Resource Center

RCC Revenue Center Code

RD Recommended Decision

RECA Radiation Exposure Compensation Act 

SEC Special Exposure Cohort

SEM Site Exposure Matrices

SOAF Statement of Accepted Facts

SOL Office of the Solicitor

SSA Social Security Administration

SWC State Workers’ Compensation

TBD Technical Basis Document

TOX

UPRP

Toxicologist

Units of Policy, Regulations and Procedures

WCA Workers’ Compensation Assistant

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FORMS

Below are listed the various forms used within the DEEOIC. 

Form EE-1 Claim for Benefits under EEOICPA 

Form EE-2 Claim for Survivor Benefits under EEOICPA

Form EE-3 Employment History for Claim under EEOICPA

Form EE-4 Employment History Affidavit for Claim under the EEOICPA

Form EE-5 Department of Energy Response to Employment History for Claim under 

the EEOICPA

Form EE-7 Medical Requirements under the EEOICPA

Form EE/EN-8 Racial/Ethnic Identification under EEOICPA

Form EE/EN-9 Smoking History Identification under EEOICPA

Form EE-10 Claim for Additional Wage-Loss and/or Impairment under the EEOICPA

Form EE/EN-11A 

Form EE/EN-11B 

Form EE/EN-12 

Impairment Benefits Response Form 

Wage-Loss Benefits Response Form 

Beneficiary Annual Report Form

Form EE-13/EN-13

Form EE/EN-16 

Request for Information with Respect to State Workers’ Compensation 

Claims

Claimant Report Form

Form EE/EN-20 Acceptance of Payment under the EEOICPA

Form DL 1-520 Request under the Freedom of Information Act

Form ESA-67a Privacy Act Record System Log of Disclosures

Form OWCP-04 Uniform Bill for Medical Expenses

Form OWCP-915 Claim for Medical Reimbursement

Form OWCP-957 Medical Travel Refund Request

Form OWCP-1500 Health Insurance Claim

Form SSA-581 Authorization to Obtain Earnings Data from the SSA

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Jurisdictional Map 

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DEEOIC OFFICE ADDRESSES

National Office - Washington, D.C. 

U.S. Department of Labor, DEEOIC 

200 Constitution Avenue, NW 

Room C-3321 

Washington, DC 20210 

(202)693-0081 (Main) (202)693-1465 (Fax) 

District Office 1 - Jacksonville, Florida 

(Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and 

Tennessee)

U.S. Department of Labor, DEEOIC 

400 West Bay Street, Room 722 

Jacksonville, Florida 32202 

(904)357-4705 (Main) (904)357-4704 (Fax) 

(877)336-4272 (Toll Free) 

District Office 2 - Cleveland, Ohio 

(Connecticut, Delaware, District of Columbia, Illinois, Indiana, Iowa, Maine, Maryland, 

Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, Ohio, 

Pennsylvania, Puerto Rico, Rhode Island, Vermont, the Virgin Islands, Virginia, West Virginia, 

and Wisconsin) 

U.S. Department of Labor, DEEOIC 

1001 Lakeside Avenue, Suite 350 

Cleveland, Ohio 44114 

(216)802-1300 (Main) (216)802-1308 (Fax) 

(888)859-7211 (Toll Free) 

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District Office 3 - Denver, Colorado 

(Arkansas, Colorado, Kansas, Louisiana, Missouri, Montana, Nebraska, North Dakota, 

Oklahoma, South Dakota, Texas, Utah, Wyoming, and all claims from RECA Section 5 

awardees)

U.S. Department of Labor, DEEOIC 

One Denver Federal Center

Building 53, Room B1501 

Denver, Colorado 80225 

(720)264-3060 (Main) (720)264-3099 (Fax) 

(888)805-3389 (Toll Free) 

District Office 4 - Seattle, Washington 

(Alaska, Arizona, California, Idaho, Hawaii, Marshall Islands, Nevada, New Mexico, Oregon, 

and Washington) 

U.S. Department of Labor, DEEOIC 

300 Fifth Avenue, Suite 1050E 

Seattle, Washington 98104 

(206)373-6750 (Main) Fax: (206)224-1216 

(888)805-3401 (Toll Free) 

Final Adjudication Branch – Jacksonville, Florida 

U.S. Department of Labor, DEEOIC 

Final Adjudication Branch 

400 West Bay Street, Suite 431 

Jacksonville, Florida 32202 

(904)366-0397 (Main) (904)357-4785(Fax) 

(877)336-4272 (Toll Free) 

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Final Adjudication Branch – Cleveland, Ohio

U.S. Department of Labor – DEEOIC

Final Adjudication Branch 

1001 Lakeside Avenue, Suite 390 

Cleveland, Ohio 44114 

(216)802-1449 (Main) Fax: (216)802-1390 

(888)859-7211 (Toll Free) 

Final Adjudication Branch – Denver, Colorado 

U.S. Department of Labor, DEEOIC 

Final Adjudication Branch 

One Denver Federal Center

Building 53, Room D2212 

Denver, Colorado 80225 

(720)264-3062 (Main) Fax: (720)264-3218 

(888)805-3389 (Toll Free) 

Final Adjudication Branch – Seattle, Washington

U.S. Department of Labor, DEEOIC 

Final Adjudication Branch 

300 Fifth Avenue, Suite 1050 

Seattle, Washington 98104 

(206)373-6714 (Main) Fax: (206)224-2506 

(888)805-3401 (Toll Free)

Final Adjudication Branch – Washington, D.C. 

U.S. Department of Labor, DEEOIC 

Final Adjudication Branch (FAB - National) 

800 N. Capitol Street, NW, Room 565 

Washington, DC 20211 

(202)218-6800 (Main) Fax: (202)513-6401 

(866)538-8143 (Toll F

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DEEOIC References and Resources

• Energy Employees Occupational Illness Compensation Program Act (EEOICPA) of 

2000, as amended, 42 U.S.C. § 7384 et seq. 

• CFR Parts 1 and 30 (Regulations) – Claims for Compensation Under the Energy 

Employees Occupational Illness Compensation Program Act, issued December 29, 2006. 

• Executive Order 13179, signed December 7, 2000. 

• Federal EEOICPA PM.

• Bulletins, Circulars and Program Memoranda. 

• Guides to the Evaluation of Permanent Impairment, 5th Edition, American Medical 

Association. 

• ICD9/10 coding manuals or online resources. 

• NIOSH Regulations on dose reconstruction and probability of causation (42 CFR Parts 

81 and 82, Guidelines for Determining the Probability of Causation and Methods for 

Radiation Dose 

• Reconstruction Under the Employees Occupational Illness Compensation Program Act of 

2000; Final Rules). 

• The Federal Register publications listing covered facilities.

• User’s Guide for the Interactive RadioEpidemiological Program (NIOSH-IREP).

• Interagency contacts or website links

• Shared Drive maintained by the NO.

• SEM.

• ECS User Guide and procedures 

• OIS User Guide and indexing guidance 

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OIS Subjects and Categories

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FOIA Process Flow Chart

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Data Release Form 

FOR ALL FILE COPY REQUESTS: This form must be completed and placed on the spindle in 

the claim file. 

Employee Name: __________________________________ 

File Number: __________________________________ 

Assigned Claims Examiner: __________________________________ 

Date of Request for File Copy:__________________________________ 

Name of Requestor: __________________________________ 

File Copy to be Sent to: __________________________________ 

Initial Reviewer Name: __________________________________ 

Initial Review Date: __________________________________ 

Final Reviewer Name: __________________________________ 

Final Review Date: __________________________________ 

I have carefully reviewed the documents and/or electronic media being sent pursuant to this 

claimant request for a copy of file documents. To the best of my knowledge these documents 

and/or electronic media do not contain Personally Identifiable Information (PII) of other 

individuals aside from the requestor or any PII that has been redacted. 

_________________________________________ ___________ 

(CE, CE2, FAB, or NO Representative) (Date)

_________________________________________ ___________ 

(Final Reviewer)

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USPS Postmaster Address Request Letter

Postmaster Date: 

City, State, Zip Code-9998 

 

Dear Postmaster:

Address Information Request 

Please furnish this agency with the new address, if available, for the following individual or 

verify whether or not the address given below is one at which mail for this individual is currently 

being delivered. If the following address is a post office box, please furnish the street address as 

recorded on the box-holder’s application form. 

Full Name: Claimant/Authorized Representative

Last Known Address: Number/Street Name

 City, State, Zip Code 

 

I certify that the address information for this individual is required for the performance of this 

agency’s official duties. 

_____________________________________________________________ 

Signature of Agency Official

____________________ 

Title

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 

FOR POST OFFICE USE ONLY

___ Mail is delivered to address given New Address:

___ Not known at address given ________________________ 

___ Moved, left no forwarding address ________________________ 

___ No such address ________________________ 

___ Other: (Specify) ___________ 

________________________________ Box Holder’s Street Address:

________________________________ ____________________________ 

________________________________ ____________________________ 

________________________________ ____________________________ 

USPS Return Address: Postmark/Date Stamp

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As per 39 USC 404...”the USPS does not disclose mailing information except in the following 

limited circumstances; Authorized disclosures include limited circumstances such as the 

following: (a) to other government agencies or bodies: when relevant to a decision concerning 

employment, security clearances, security or suitability investigations, contracts, licenses, grants 

or benefits”...

The correspondence in question fits within the aforementioned parameters and our agency is 

requesting the aforementioned information as formatted in the USPS Administrative Support 

Manual Section 352.44. Please respond to our office via return mail or fax with the 

aforementioned postal patron’s new address/contact information. 

If you have any questions regarding this letter, please call me at XXX-XXX-XXXX

Physical Address: US Department of Labor – DEEOIC

P.O. Box 8306 

London, KY 40742-8306 

Sincerely,

Name

Title

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LETTER OF ACKNOWLEDGEMENT

Date Case ID Number: 

 

Name

Address 

Dear Mr./Ms. Claimant:

We have received your claim under the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA). We have entered your claim into our system and assigned it the 

above Case ID number. You should refer to this number when calling our office and write it on 

the top right corner of any correspondence you submit in support of your claim. 

Your claim has been assigned to a Claims Examiner for review. If additional information is 

required, the Claims Examiner will request it through a separate correspondence. During the 

adjudication of your claim you may be assigned a new Claims Examiner due to unforeseen 

circumstances. In these instances, the new Claims Examiner will review your file and handle 

your claim expeditiously so as to not cause delays. 

Submission of Documents and Claimant Status Web Page: All correspondence are to be 

mailed to our Central Mail Room in London, KY or uploaded electronically through our secure 

internet service called the Energy Document Portal (EDP). Information about these two methods 

of document submission is included in the attached information sheet. We also have an online 

web-based Claimant Status Web Page that makes information available online to claimants. 

Instructions for accessing this website are also included in the attached information sheet. 

To speak with someone directly, our Customer Service Representatives are available to answer 

many of your questions regarding the processing of your claim. Our representatives are 

available Monday through Friday between 8:00 am and 4:30 pm. You may also obtain 

information through your local resource center or by visiting our website at:

http://www.dol.gov/owcp/energy/. I assure you every effort will be made to process your claim in 

a timely manner. If you have any questions, please feel free to contact us, toll free, at 1-888-859-

7211. 

Sincerely, 

District Director

District Office

cc: Authorized Representative Name, Authorized Representative

______________________________________________________________________________ 

If you have a disability (a substantially limiting physical or mental impairment), please contact 

our office for information about the kinds of help available, such as communication 

assistance (alternate formats or sign language interpretation), accommodations and 

modifications.

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Sample Acknowledgment letter

U.S. Department of Labor 

Important Information about your EEOICPA claim

______________________________________________________________________________ 

For Correspondence by Mail

Please write your Case ID Number on the top right hand corner of any correspondence and mail 

to:

Energy Employees Occupational

Illness Compensation Program 

DOL DEEOIC Central Mail Room

P.O. Box 8306 

London, KY 40742-8306 

 

Do not send original documents such as certified copies of birth certificates, pictures, death 

certificates, medical films, or marriage certificates with a raised seal – These documents will 

NOT be returned to you. 

_________________________________________________ 

Energy Document Portal (EDP) 

The Energy Document Portal allows you to electronically submit documents directly to your 

case and will decrease mailing delays. You can access our EDP at https://eclaimant.dol-esa.gov

and you will need the following information: 

• your Case ID as indicated above;

• the Energy Employee’s last name; and

• the last 4 digits of the Energy Employee’s Social Security Number. 

_________________________________________________ 

Online Claimant Status Page 

You may obtain a general status of your claim by visiting our Claimant Status Page website. 

This website allows claimants access to limited claims information from the same electronic 

claims database that is used by DEEOIC claim examiners. Available information includes: 

claimed medical conditions, worksite locations, most recent claim action, payment information, 

and current case location.

The website can be accessed at: 

http://www.dol.gov/owcp/energy/regs/compliance/Claimant_status.htm

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You will be asked to provide 3 pieces of data unique to your individual claim: 

(1) The last four digits of the Employee’s social security number; 

(2) Your full date of birth; and, 

(3) The unique 8-digit claimant identification number. This is for internet access only.

Questions and concerns regarding this website should be directed to this office. 

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RC Checklist Cover Sheet

Date: _______________ 

To:

DOL Jacksonville District Office  Attention: __________________ 

DOL Denver District Office

DOL Cleveland District Office

DOL Seattle District Office

The attached claim forms are submitted with supporting documentation. 

Employee: ________________________ SSN: ________________________ 

Survivor: _________________________ SSN: ________________________ 

Enclosed documents include: 

EE-1/EE-2 Marriage License/Certificate

EE-3 Death Certificate

EE-4 Divorce Decree

Authorization for Representation Power of Attorney Document 

EE-5 (s) Adoption Records 

Claimant Employment Records Social Security Records (brought in by 

claimant)

Occupational History Questionnaire Medical Records/Pathology Report 

Occupational History Thank You 

Letter Other

Birth Certificate Other

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Occupational History Interview

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Interview Confirmation Letter

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April 2017 Appendices

DOL Letter to DOE Former Worker Program

Dear FWP POC Name:

(Survivor/Employee name) has submitted a claim for benefits under the Energy Employees 

Occupational Illness Compensation Program. (Mr./Ms./ name) has claimed that he/she (his 

spouse/Father/Mother Full Name) participated in the {Site Name} Former Worker Screening 

Program.

The Department of Labor is requesting copies of all records you have for (employee name) to 

assist us in the adjudication of the claim.

Attached is the signed EE-3 which authorizes the FWP to release records to the Department of 

Labor.

If you have any questions regarding this request, please contact me directly at (phone number). 

Thank you for your assistance in this matter 

Sincerely,

Claims Examiner

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April 2017 Appendices

Employee:

Case ID: 

AUTHORIZATION FOR REPRESENTATION/PRIVACY ACT WAIVER

To provide that a duly authorized representative serves only the interest of the claimant, DEEOIC will not 

recognize the designation of an authorized representative whom DEEOIC finds is directly benefitting 

financially as a result of his or her affiliation with a claim, aside from the fee authorized by law. 

I,

(Name of Claimant)

(Address of Claimant)

(City, State, Zip of Claimant)

do hereby authorize:

(Name of Representative/Person receiving records)

(Address of Representative/Person receiving records)

(City, State, Zip of Representative/ Person receiving records)

(Phone Number of Representative/Person receiving records)

to (check all that apply):

_______serve as my representative in all matters pertaining to the administrative adjudication of my claim 

under the Energy Employees Occupational Illness Compensation Program Act of 2000 by the Division of 

Energy Employees Occupational Illness Compensation, Office of Workers’ Compensation Programs, U.S. 

Department of Labor. 

_______receive copies of all factual and medical evidence contained in my claim filed under the Energy 

Employees Occupational Illness Compensation Program Act of 2000 from the Division of Energy 

Employees Occupational Illness Compensation, Office of Workers’ Compensation Programs, U.S. 

Department of Labor. 

I declare that the foregoing is true and correct. This authorization is effective on the date it is signed, and is 

effective until specifically revoked by me in writing.

_________________________________ __________________________________ 

 (Signature of Claimant)

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Federal (EEOICPA) Procedure Manual Appendices 

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April 2017 Appendices

Powers of Attorney Memo for SOL Review

MEMORANDUM

DATE: mm/dd/yyyy 

FOR {Name of DEEOIC Counsel}

 Counsel for Energy Employees Compensation, Division of 

 Federal Employees and Energy Workers’ Compensation 

FROM: {Name of requester or designee}

 {Phone Number} 

SUBJECT: {Routine/Terminal} 

 Power of Attorney review for {Employee/Survivor} 

CASE ID: {Assigned Case ID Number} 

PAYEE NAME: {John Doe} 

POA STATE: {Jurisdictional state of origin of POA Example- Idaho} 

Attached for your review is a Power of Attorney (POA) that purports to grant (Name of person 

granted POA) to act on behalf of the above named payee. Review the POA to decide if it is a 

properly executed document. Please forward your response to {designated national office staff 

person/s}, who will upload it into OIS.

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Notification to Representative 

Date: Case ID Number: 

 Employee Name: 

Claimant Name: 

Representative Name

Address 

City, State, Zip Code 

Dear [Representative]:

According to our records, you have been designated as the authorized representative in the above 

case. As the authorized representative, you have the ability to receive correspondence, submit 

additional evidence, argue factual or legal issues and exercise appeal rights pertaining to the 

above claim. The authorized representative does not have signature authority on behalf of the 

claimant on Form EN-20. 

As the authorized representative of [claimant name], any correspondence from the Division of 

Energy Employees Occupational Illness Compensation (DEEOIC) will be directed to you in this 

capacity. If the correspondence indicates a response is warranted or additional information is 

required, it is expected that you will make the necessary arrangements with [claimant name]. 

Representative Fees. A representative may charge the claimant a fee for costs associated with 

his/her activities regarding the Energy Employees Occupational Illness Compensation Program 

Act (EEOICPA). The claimant is solely responsible for paying any fee or other costs associated 

with the actions of a representative. The DEEOIC will not reimburse the claimant, nor is it liable 

for the amount of any fee and other costs relating to an agreement between a claimant and a 

representative. 

Permissible Charges. Under the regulations implementing 42 U.S.C. § 7385g, a representative is 

permitted to charge an appropriate fee for services related to a claim before DEEOIC. The 

maximum allowable percentage of a payment of lump-sum compensation that can be collected as 

a fee is as follows:

(1) 2% for the filing of an initial claim with DEEOIC, provided that the 

representative was retained prior to the filing of the initial claim; plus

(2) 10% of the difference between the lump-sum payment made to the claimant and 

the amount proposed in the recommended decision with respect to objections to a 

recommended decision.

Conflict of Interest Policy. As an authorized representative of a claimant under the EEOICPA, 

you are prohibited from having private, non-representational direct financial interests, other than 

your fee for serving as a representative, in regard to your client’s claim with DEEOIC. Because 

the “role” of an authorized representative is so important, DEEOIC will consider you to have a 

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______________________________________________________________________________ 

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April 2017 (Page 2 of 2) Appendices

conflict of interest if you could directly benefit financially from your client’s EEOICPA claim 

due to something other than your statutorily limited fee for representing your client in 

connection with his or her EEOICPA claim. For example, you will be considered to have a 

conflict of interest if, in addition to being your client’s authorized representative, you are also 

being paid by DEEOIC, directly or indirectly, as a provider of authorized medical services to 

your client. Because there is an obvious conflict of interest that will arise in this sort of situation, 

DEEOIC will not recognize you as an authorized representative should this occur, and will 

inform the claimant of the need to designate another person as his or her authorized 

representative who does not have such a conflict. If you are in a position to directly benefit 

financially from your client’s EEOICPA claim, you are required to notify DEEOIC and 

withdraw as representative. 

Please feel free to contact the District Office or Final Adjudication Branch, if you have any 

questions or concerns. Our telephone number is 000-000-0000. 

Sincerely,

Printed Name

Title

District Office/Final Adjudication Branch

cc: Claimant

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April 2017 Appendices

Notification to Representative of Conflict of Interest

Date: Claimant Name:

Case ID Number: 

Representative Name

Address 

City, State, Zip Code 

Dear [Representative]:

According to our records, you have been designated as the authorized representative in the above 

case. As the authorized representative of the above claimant, you are expected to put your 

client’s interests before your own private, non-representational direct financial interests in all of 

your dealings with the Division of Energy Employees Occupational Illness Compensation 

(DEEOIC). DEEOIC will consider you to have a prohibited “conflict of interest” if you could 

directly benefit financially from your client’s Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA) claim due to something other than your statutorily 

limited fee for representing your client in connection with his or her EEOICPA claim. 

DEEOIC has received information that suggests a conflict of interest exists in this case. 

{Describe the evidence that suggests a conflict of interest. Be sure to include names, dates of 

letters, and all pertinent information to describe the evidence.} 

In light of this evidence, DEEOIC requests that you prepare a signed statement explaining your 

response to the above detailed evidence of a conflict of interest. Please submit your statement 

within 30 days from the date of this letter. Upon review of your statement, in conjunction with 

the evidence of record, DEEOIC will determine whether a conflict of interest exists in the case. 

If it is determined that a conflict of interest does exist, DEEOIC will no longer recognize you as 

the claimant’s authorized representative unless the conflict of interest is eliminated. If you 

acknowledge that a conflict of interest does exist, you may resolve the conflict by either 

submitting a signed resignation as the claimant’s authorized representative, or submitting 

evidence of the relinquishment of the charges, position, job, or duty creating the conflict. 

Please contact the district office at XXX-XX-XXXX if you have any questions or concerns 

regarding this letter. 

Sincerely,

Name

Title

District Office

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April 2017 Appendices

SSA Contact Numbers

SSN Range

(Last 4 digits)

Module 

Number

Help Desk 

Telephone No.

0000-0999 Mod 1 410-966-1247

1000-1999 Mod 2 410-966-5657

2000-3999 Mod 3 410-597-1045

4000-5999 Mod 4 410-966-8512

6000-7999 Mod 5 410-597-1061

8000-9999 Mod 6 410-597-1065

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Sample Subcontractor Employment Memo

Note: In cases of subcontractor employment, the evidence varies greatly between 

employees and facilities, so there is no “one-size fits all.” Sometimes proof of 

employment with SSA in conjunction with a DOE clearance and a job category that could 

only be performed on site (plumber) is sufficient, other times more is needed. What 

follows is an outline that attempts to include most everything, but keep in mind this is just 

a model. As long as the memo delineates the evidence used to support 1) employment 

with a company that had 2) a contract to perform services on site at a DOE facility and 

3) the employee was so employed providing those services on that site during those years, 

then the memo is complete. 

________________________________________________________ 

DATE:

MEMORANDUM TO: FILE

FROM: CE

SUBJECT: Subcontractor Employment 

This is a case involving a claim of subcontractor employment. Mr. Johnson claimed 

subcontractor employment at (name of facility) for the following period(s) of time (list 

period claimed on claim form). He stated that he worked as a (name of trade, job title) 

for the following employers (list the names of the companies for whom he claims to have 

been employed) at (name of facility) doing (identify service on site). Evidence in the file 

regarding employment was submitted, and is summarized below (use only those items for 

which there is corresponding evidence).

DOE provided (and then specify what DOE provided, such as clearance records, 

infirmary records, dose records). List those here with the date of each record and any 

other pertinent information on the record, such as name of employer or location of work. 

 

Example 1: July 10, 1984 report from the BNL health unit reporting that he got 

something in his eyes while welding some pipe in the XX building. 

Example 2: DOE provided a clearance card indicating that Mr. Johnson was 

granted a “Q” clearance on June 10, 1984 to August 30, 1984. The clearance card 

identifies his employer as Smalls Mechanical Contractors, Inc. 

Records from the SSA were also obtained. For the period claimed, they identify the 

following employers during the noted years (list). 

 

Example: 1985 Smalls Mechanical Contractors, Inc.

A review of the CPWR database was conducted and it showed (explain which 

subcontractors show up in database and for what periods of time, for example some case 

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files still have detailed union log sheets, some have news clipping about subcontractors 

linking them to a facility – all this needs to be delineated)

Example: Smalls Mechanical Contractors, Inc. – CPWR BtComp database 

indicates that Smalls was a BNL subcontractor for the period of June 18, 1984 

through August 30, 1985. 

Other documentation submitted included (list anything else submitted in the case that 

bears on the question of whether the employee provided a service on site at the facility 

for a given employer during the years so employed) 

Example: A news clipping from the Tri-Cities Herald shows a photo of a ribboncutting ceremony at Hanford for the construction of XYZ and identifies Smalls 

Mechanical Contractors, Inc. as one of the subcontractors on the project. 

The following affidavits were also submitted (list every single affiant and what they attest 

– OK to summarize...if same affiant attests more than once, that also needs to be noted, 

especially if the attestations are inconsistent with each other).

Example: Paul Smith, work associate and friend, attested that the employee 

worked for Smalls Mechanical Contractors at BNL from June 1984 to August 

1985. The work involved the cryogenics lab and the Isabelle project. 

After reviewing all this documentation, I conclude that Mr. Johnson’s employment for 

(list dates) is a covered DOE subcontractor. For this period, SSA records (or union 

records or whatever evidence is used) demonstrate he worked for (name of company), 

and according to CPWR, there was a subcontract in place between (company) and 

(facility) for (years). Additionally, there was an infirmary record from DOE which 

identifies Mr. Johnson as having been onsite during the period. His co-worker Mr. Smith 

also attested to the period....... 

With regard to the period (dates), I find that the evidence falls short of meeting the 

standard for covered subcontractor employment because....and then give reason – no 

evidence of being onsite, no evidence of contract, dates don’t match up. 

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April 2017 Appendices

SEC Class Screening Worksheet

1) Employee Name:________________________________________________

 

2) Case ID: _____________________________________________________ 

 

3) Is there proof of a diagnosis of specified cancer? Y/N

 

 If yes, list cancer type and diagnosis date: 

___________________________________________________________ 

 

4) Does there appear to be at least 250 workdays of covered employment at the SEC site(s)? 

 Y/N

 

If yes, identify SEC site(s) and employment period(s): 

___________________________________________________________ 

___________________________________________________________ 

 

5) For a claim with a deceased employee, is there an eligible survivor who has filed a claim? 

Y / N

6) If either question 3, 4, or 5 is answered “no,” is there anything in the file to suggest that 

additional development might change the answers to “yes?” Y / N 

If so, what development is needed? 

________________________________________________________________ 

________________________________________________________________ 

________________________________________________________________ 

Action Taken on the ECS Screening Navigation Panel: 

 □ Select “Likely” (#3, #4, and #5 are Yes) 

□ Select “Unlikely” (#6 is No)

□ Select “Development Needed” (#6 is Yes)

 ________________ _____________________________________ 

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Sample Letter to Claimant Granting Medical Benefits for Unaccepted Reverse 

Consequential Condition (Medical Treatment of Underlying Primary Cancer)

[Date]

Case ID: [number] 

 Employee: [name]

[Claimant Name]

[Street Address]

[City, State, Zip]

Dear [name]:

The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) regulation 

at 20 CFR § 30.400(a) states the following with regard to payment of medical bills for an 

unaccepted condition: “In situations where the accepted occupational illness or covered illness is 

a secondary cancer, such treatment may include treatment of the underlying primary cancer when 

it is medically necessary or related to treatment of the secondary cancer.” 

Accordingly, payment for medical treatment of your primary cancer [identify cancer] is covered 

when medically necessary or related to the treatment of your accepted secondary cancer. 

However, payment for medical treatment of your primary cancer under these circumstances does 

not constitute a determination by the Office of Workers’ Compensation Programs that the 

primary cancer is an accepted illness under the EEOICPA.

For reimbursement of medical bills, I have enclosed form OWCP-915 (Claim for Medical 

Reimbursement). Carefully read and follow the instructions on the back of the form to ensure 

reimbursement of those bills.

Where to Send Your Reimbursement Form: 

Send a copy of this authorization letter, the completed itemized Form OWCP-915, and any 

required receipts to our bill processing agent. For your convenience, I have enclosed a preaddressed envelope and an extra copy of this authorization letter. Mail your information to: 

Energy Employees Occupational 

Illness Compensation Program 

P.O. Box 8304 

London, KY 40742-8304 

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If you have any questions, you may contact the district office at [phone number]. 

Sincerely,

[Examiner Name]

Examiner

Enclosure: OWCP-915 (Claim for Medical Reimbursement)

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April 2017 Appendices

DAR Cover Letter

U.S.DEPARTMENT OF LABOR EMPLOYMENT STANDARDS ADMINISTRATION 

 OFFICE OF WORKERS’ COMPENSATION PROGRAMS

 DIVISION OF ENERGY EMPLOYEES’ OCCUPATIONAL 

ILLNESS COMPENSATION

 

(Date)

EMPLOYEE NAME:

CLAIM FILE NUMBER:

(DAR POC Address)

To Whom It May Concern: 

A claim for benefits under the Energy Employees Occupational Illness Compensation Program 

Act (EEOICPA) has been submitted with respect to the employee named above, claiming 

employment at a Department of Energy facility. He or she is claiming that employment for the 

Department of Energy or one of its contractors or subcontractors has contributed to a covered 

illness. Your facility has been identified as having possession of or access to records which may 

identify employment and toxic substance exposure regarding this individual. 

Included as an attachment to this cover letter is a copy of the claimant’s EE-1 or EE-2 Claim for 

Benefits, the EE-3 Employment History and a Document Acquisition Request (DAR) 

Questionnaire. Marked on the attached DAR Questionnaire is the name of the employee, 

employee SSN, employer name and the facility where employment is alleged to have occurred as 

well as selected categories of documentation we hope you have at your facility. 

Please conduct a reasonable search for the requested documentation and provide a copy of those 

records in digital PDF format on a compact disc (CD) if available. You may make as many 

copies of the DAR Questionnaire as necessary. 

Please return the completed DAR Questionnaire, the CD and any hard copy documents to the 

address provided above. If you have received this request in error or if you have any other 

concerns, please feel free to contact me directly at ***-***-  or fax ** *-***-****. 

Sincerely,

Claims Examiner

Attachments:

EE-1/2 Claim for Benefits

EE-3 Employment History

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-2 Back to Top

April 2017 (Page 1 of 3) Appendices

DAR Questionnaire

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-2 Back to Top

April 2017 (Page 2 of 3) Appendices

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-2 Back to Top

April 2017 (Page 3 of 3) Appendices

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-3 Back to Top

April 2017 Appendices

Statement of Accepted Facts (SOAF)

1. Employee Information

a. Name:

b. Case File Number:

c. Date of Birth:

d. Date of Death:

i. If deceased, list Cause(s) of Death from Death Certificate

2. Medical Information 

a. Has an Occupational Health Questionnaire (OHQ) been completed? (Provide date)

b. Diagnosed Condition(s): (Provide date of diagnosis for each, if possible; if diagnosed 

 condition is skin cancer, provide body location) 

c. List any accepted conditions (if applicable). 

d. Other medical information/conditions available for review by referral personnel (if 

appropriate): (Provide dates of Former Worker Protection (FWPP) Interview, authorized 

home health care periods, etc.) 

3. Employment Information - If Relevant - [Provide a detailed description of the employee’s 

verified and covered employment history – include where employee worked, date(s) of 

employment, job title(s), job duty(ies)]. 

4. Occupational Toxic Exposure - If Relevant - (Provide the occupational toxic substance 

exposures encountered by the employee and shown to have a potential health effect to the 

diagnosed condition; provide relevant information on the nature, extent and duration of such 

exposures) 

5. Claim History – If Relevant - (Provide significant events such as date of filing of Part B and/or 

Part E, date submitted to NIOSH for dose reconstruction, Probability of Causation %, date of 

denial/acceptance, date of remanded claim, etc.)

6. Other Information - (Include any other information that may be useful to those conducting the 

referral evaluation)

7. Claims Examiner Information 

a. Submitting District Office:

b. Claims Manager:

c. Unit designation:

d. Telephone Number: 

e. E-mail address:

f. Date of referral:

8. Verification of Review – (Should be signed by District Office Director, or designee, indicating 

that the referral information has been reviewed and meets minimum criteria for submittal)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-4 Back to Top

April 2017 (Page 1 of 3) Appendices

Establishing Causation For Hearing Loss and Asbestosis 

Asbestosis: A Claims Examiner is to accept Part E causation for asbestosis once the following 

three criteria are satisfied.

1. Medical: A medical diagnosis of asbestosis. 

2. Employment: The employee is a covered DOE contractor employee at a covered DOE 

or RECA section 5 facility and in the course of employment was exposed to asbestos 

while at the DOE or RECA section 5 facility.

Asbestos existed at all covered DOE and RECA section 5 facilities. Using the SEM, 

along with an examination of pertinent exposure data maintained in the case, a CE is to 

determine if there is a reasonable basis to conclude that the employee had exposure to 

asbestos. Additionally, the CE should reference EEOICPA Circular 15-05, 

“Occupational Exposure Guidance Relating to Asbestos,” for further guidance on 

asbestos exposure. If there is reason to doubt the employee’s exposure to asbestos 

because of the type of work performed, or other contradictory evidence, he or she is to 

request the following information from the claimant: 

a. Contemporaneous medical evidence discussing the employee’s work 

history and exposure to asbestos at the covered facility. The presence of pleural 

thickening, interstitial fibrosis, neoplasia, or other medical findings characteristic of 

asbestosis also helps establish the relationship between employment and exposure; 

b. Personnel or incident records disclosing exposure to asbestos; or 

c. Persuasive affidavits from other employees, with reason to know, attesting 

to the employee’s asbestos exposure and other evidence such as independent 

studies of the facility or newspaper articles discussing asbestos exposure at the site.

Once the CE has collected all relevant exposure information, and he or she still cannot 

affirmatively conclude the extent or duration of employee’s exposure to asbestos, an 

Industrial Hygiene referral is to occur. 

3. Exposure/Causation: Causation will be presumed when the case file contains evidence 

that the employee was exposed to asbestos for at least 250 aggregate workdays, and there 

was a latency period of at least 10 years between the start of covered DOE or RECA 

section 5 employment and the onset of asbestosis. 

In a claim for an employee that does not meet the requirements of presumed causation because 

the evidence does not establish 250 days of asbestos exposure, or the latency requirement, the 

CE is to undertake development to obtain an opinion on causation from either the claimant’s 

treating physician or a CMC. 

Hearing Loss: Part E causation for hearing loss can be presumed without referral to National 

Office specialists if all three following conditions are satisfied

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-4 Back to Top

April 2017 (Page 2 of 3) Appendices

1. Medical: The file contains a diagnosis of bilateral sensorineural hearing loss 

(conductive hearing loss is not known to be linked to toxic substance exposure). 

2. Employment: The verified covered employment must be within at least one specified 

job category listed below for a period of 10 consecutive years, completed prior to 1990. 

The labor categories are the following: 

• Boilermaker

• Chemical Operator

• Chemist

• Electrician/Electrical Maintenance/Lineman

• Electroplater/Electroplating Technician

• Garage/Auto/Equipment Mechanic 

• Guard/Security Officer/Security Patrol Officer (i.e., firearm cleaning 

activities)

• Instrument Mechanic/ Instrument Technician

• Janitor 

• Laboratory Analyst/Aide 

• Laboratory Technician/Technologist

• Lubricator 

• Machinist

• Maintenance Mechanic

• Millwright

• Operator (most any industrial kind, the test being whether the operator 

position is one in which there is potential for solvent exposure) 

• Painter

• Pipefitter

• Printer/Reproduction clerk 

• Refrigeration Mechanic/HVAC Mechanic

• Sheet Metal Worker

• Utility Operator

3. Exposure: Evidence in the file must not only establish that the employee worked 

within a certain job category listed above, but that the employee was concurrently 

exposed to at least one of the specified organic solvents listed below: 

• Toluene 

• Styrene

• Xylene

• Trichloroethylene 

• Methyl Ethyl Ketone

• Methyl Isobutyl Ketone 

SUPERSEDED

• Ethyl Benzene
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 15-4 Back to Top

April 2017 (Page 3 of 3) Appendices

Hearing loss claims supported by rationalized medical evidence asserting a causative link 

between covered employment and exposure to OTHER solvents not listed in this Exhibit should 

be forwarded to the NO for specialist review. 

Challenges to the DEEOIC Conditions of Acceptance. This policy guidance represent the sole 

evidentiary basis a CE is to use in making a decision concerning whether it is “at least as likely 

as not” that an occupational exposure to a toxic substance was a significant factor in aggravating, 

contributing to or causing a diagnosed bilateral sensorineural hearing loss. Claims filed for 

hearing loss that do not satisfy the conditions for acceptance outlined in this procedure cannot be 

accepted, because these standards represent the only scientific basis for establishing workrelated hearing loss due to exposure to a toxic substance. 

The CE is to undertake routine development (i.e., SEM, SEM mailbox, IH referral, etc.) on any 

hearing loss claim that does not meet the criteria described in this procedure, including 

communicating to the claimant the evidence necessary for a compensable hearing loss claim. As 

part of that development, the CE is to notify the claimant of his or her ability to challenge the 

scientific underpinnings of the DEEOIC hearing loss policy. 

The claimant has the burden of establishing, through the submission of probative scientific 

evidence, that the criteria used by the program do not represent a reasonable consensus drawn 

from the body of available scientific data. If a claimant seeks to argue that the standard by which 

DEEOIC evaluates claims is not based on a correct interpretation of available scientific evidence, 

or that a toxic substance that is not listed as having a health effect of hearing loss exists, he or 

she will need to provide probative epidemiological data to support the claim. Any claimant 

submission of scientific documentation, including journals, periodicals, or other literature 

(including citations to literature) has to relate to the topic of the correlation between hearing loss 

and toxic substance exposure. Scientific evidence that does not relate to or reference hearing loss 

is insufficient. 

With the receipt of compelling scientific data relating to a challenge to the DEEOIC conditions 

of acceptance for hearing loss, the CE is to prepare a referral of the documentation to the Policy 

Branch for examination by a Health Scientist who will respond to whether the evidence warrants 

a change to program policy regarding hearing loss. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 16-1 Back to Top

April 2017 Appendices

Sample Questions For Physician

Questions:

CE: Choose from options below or add your own 

1. Impairment: Refer to PM Ch. 2-1300, Impairment Ratings for questions and instructions 

for CMC’s conducting impairment evaluations. 

2. Impairment: If it is not possible to complete an impairment rating based on the medical 

evidence we provided, please advise us what medical records and/or testing is required to 

complete the rating. 

3. Diagnosis: In your opinion, do the medical records support a diagnosis of a medical 

condition? If so, please provide the first date of diagnosis, diagnosis, and the ICD code. 

4. Causation: If a medical condition was diagnosed, in your opinion is it at least as likely as 

not that exposure to toxic substances during the course of employment at covered facility

was a significant factor in aggravating, contributing to, or causing the employee’s 

medical condition? 

5. Causation: If so, please provide the earliest date of diagnosis(es) and ICD code of the 

condition you believe is related. Please provide the rationale and objective findings to 

support your conclusion that the condition(s) are related to exposure in the workplace.

Claims Examiner Claims Examiner

(Printed Name)

Date

(Signature) (Date)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 16-2 Back to Top

April 2017 Appendices

ICD Codes and Corresponding Procedure Codes

V49.8 File Reviews 

FR001 File Review 

FR002 Supplemental File Review 

FR003 Clarification of Diagnosis, Treatment, Tests 

V49.8 Impairment Ratings

FR004 Impairment Evaluation 

V68.89 Wage-Loss 

WL001 Assessing Ability to Work/Wage-Loss

V68.2 Second Medical Opinions 

SEP02 Second Medical Opinion (includes physical exam and file 

review) 

FR002 Supplemental File Review 

Cancl Appointment Cancellation 

V65.8 Referee Referrals (Physical Exam or Written Exam) 

REFER Physical examination which includes file review 

REF01 File review only 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 16-3 Back to Top

April 2017 (Page 1 of 2) Appendices

Sample Letter to Claimant Regarding Second Opinion/Referee Physician

DEEOIC Case ID: (Case ID # 

Employee Name: (Employee Name)

(Claimant Name)

(Street Address)

(City, State, Zip)

Dear (Mr/Ms Claimant): 

 

This letter is in reference to your claim under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). 

Under our regulations, the Division of Energy Employees Occupational Illness Compensation 

(DEEOIC) has the authority to refer an employee for a physical examination by a second opinion 

physician when it considers such a referral to be reasonably necessary.

Because it considers such a referral to be reasonably necessary for the proper adjudication of 

your claim, DEEOIC has arranged for you to be examined by a second opinion physician. Please 

review the attached letter for the time, date, and location of your scheduled appointment. 

DEEOIC will pay the out-of-pocket costs you incur in connection with the examination or any 

diagnostic testing. Travel costs to attend the examination are reimbursable upon submission of 

Form OWCP-957 (Attached). 

DEEOIC recommends that you call the physician’s office ahead of time to confirm your 

appointment. Providing the physician with your name, case ID #, and contact information, when 

you call, will help ensure that the process works as smoothly as possible. 

Rescheduling the appointment is strongly discouraged and you should only do so in emergencies. 

Altering an appointment schedule can hinder our ability to take substantive action on your claim 

and promptly deliver services to you. If you are unavoidably prevented from keeping your 

appointment, you must immediately call your assigned claims examiner at the district office at 

Your Phone #. DEEOIC will evaluate any request to reschedule your appointment to determine 

whether you have submitted proof of one or more legitimate reasons to change the appointment. 

If you do not attend the scheduled appointment, or cannot establish good cause for your failure to 

appear, DEEOIC will suspend claim adjudication and administratively close your claim. 

Reopening of the claim record will not occur until you agree to and attend a DEEOIC scheduled 

medical examination.

DEEOIC strongly encourages physicians to limit persons in attendance during the actual 

examination to one or two individuals. This would include a family member or designated 

authorized representative, and/or a health care professional, such as a RN/LPN, or CNA/HHA 

who is currently providing care to the patient. Ultimately, it is the examining physician’s 

decision as to who can be present during the examination.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 16-3 Back to Top

April 2017 (Page 2 of 2) Appendices

If you have a disability (a substantially limiting physical or mental impairment), please contact 

our office/claims examiner for information about the kinds of help available, such as 

communication assistance (alternate formats or sign language interpretation), 

accommodations and modifications.

Should someone accompanying you disrupt the scheduled medical examination, DEEOIC will 

reschedule the exam with a different qualified physician. You will not be entitled to have that 

individual accompany you during the subsequent examination unless DEEOIC determines that 

exceptional circumstances exist.

We appreciate your cooperation in this matter. If you have any questions regarding the 

scheduled examination, please contact me at the address listed above or call Your Phone #. 

 

Sincerely,

(YOUR NAME)

Enc: OWCP-957 

 Copy of Authorization Letter 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-1 Back to Top

April 2017 (Page 1 of 3) Appendices

NIOSH Referral Summary Document (NRSD)

Enter a “X” where appropriate

Initial Amendment Supplement

Remarks(if Amendment or Supplement):

1. DOL Case ID Number: 

Case File Contact Information 

2. Energy Employee (EE): 

a. Name (First-Middle-Last-Suffix)

b. Gender (Male or Female)

c. Date of Birth (MM/DD/YYYY)

d. Date of Death (MM/DD/YYYY)

e. Address (Street, City, State, Zip) 

f. Phone Number and Type

3. Survivor(s) (SV) (If applicable, create a table for each): 

a. Name (First-Middle-Last-Suffix)

b. Address (Street, City, State, Zip)

c. Phone Number and Type

d. Relationship to employee

e. Currently eligible survivor (Y/N)

a. Name (First-Middle-Last-Suffix)

b. Address (Street, City, State, Zip)

c. Phone Number and Type

d. Relationship to employee

e. Currently eligible survivor (Y/N)

a. Name (First-Middle-Last-Suffix)

b. Address (Street, City, State, Zip)

c. Phone Number and Type

d. Relationship to employee

e. Currently eligible survivor (Y/N)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-1 Back to Top

April 2017 (Page 2 of 3) Appendices

4. Other Contact(s)(OC)(If applicable, create a table for each): 

a. Name (First-Middle-Last-Suffix)

b. Address (Street, City, State, Zip)

c. Phone Number and Type

d. Relationship to employee

Medical and Employment Information 

5. EE Covered Cancer Information (create a table for each 

cancer): 

a. Primary [ ] or Secondary (metastatic) [ ]

b. Cancer Description/Type

c. Associated ICD-9 Code

d. Associated ICD-10 Code 

e. Date of Cancer Diagnosis 

6. Other Covered Condition: 

a. SEC Cancer Claim, but filing for Non-SEC cancer medical 

benefits [ ]

b. Other claim for benefits scenario [ ] 

c. Explain:

7. Energy Employee Verified Employment History: 

(List all breaks in employment at the DOE or AWE Facility): 

a. Employer / Facility Name

b. Start Date

c. End Date

d. Employment Badge Number

e. Dosimetry Badge No.

f. Job Title 

8. Employment Verification Information Valuable to NIOSH: 

a. DOE could not verify employment

b. Employment Verification based upon Affidavit or Other 

 Credible Evidence.

c. Worked for a contractor/sub-contractor not listed in DOE

 SUPERSEDEDOffice of Worker Advocacy facility online database.
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-1 Back to Top

April 2017 (Page 3 of 3) Appendices

9. Other information relevant to dose reconstruction, if 

required: 

a. If the claim is for 

skin cancer or a 

secondary cancer for 

which skin cancer is a 

likely primary cancer, 

list one or more of the 

following:

American Indian or Alaska Native

Asian, Native Hawaiian, or 

 Pacific Islander

 Black 

 White-Hispanic 

 White-Non-Hispanic 

Not given

b. If the claim is for 

lung cancer or a 

secondary cancer for 

which lung cancer is a 

likely primary cancer, 

select one of the 

following (Note: 

Currently refers to time 

of cancer diagnosis):

Never smoked

 Former smoker 

 Current smoker (? cig/day) 

  <10 cig/day 

  10-19 cig/day 

  20-39 cig/day 

  40+ cig/day 

10. DOL Information: 

a. District Office

b. Claims Examiner Name

c. Claims Examiner Phone Number

d. Claims Examiner e-mail 

address

Reviewed by:

Claims Examiner Date

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-2 Back to Top

April 2017 (Page 1 of 3) Appendices

INSTRUCTIONS FOR COMPLETING THE NRSD

No. Title Description Example

N/A NRSD Type

Enter an “X” next to the type of NRSD that is being submitted. If you select 

Amendment or Supplement enter Remarks (the reason and or data that has 

created the need for an Amendment/Supplement. For an Initial NRSD include all 

sections, unless they will be blank (i.e., other contact if there isn’t one). For an 

Amendment include the employee’s name, DOL case number, NIOSH tracking 

number, the tables that include changed information, and the DOL information 

(including the SrCE or journey level CE signature). For Supplements, include the 

DOL case number, NIOSH tracking number, and employee’s name.

1 DOL Case ID Enter the case ID number 12345

2 Energy Employee (EE) The employee as listed on the EE-1/EE-2.

a Name Enter the Employee’s name as it is listed in 

ECS/Claim Form (First, Middle Initial, Last, Suffix) Fred R. Flintstone, III

b Gender Enter Male or Female as indicated in ECS/Claim 

Form Male, Female

c Date of Birth Enter the date of birth in MM/DD/YYYY format 01/31/1964

d Date of Death If applicable, enter the date of death in 

MM/DD/YYYY format 11/01/2006

e Address

If applicable, enter the full address of the EE (Street, 

City, State, and zip code) 

 

 

• 

710 Bedrock Dr., Aiken, 

SC 26175-0454

f Phone Number and 

Type

If available/applicable, enter the employee’s 10 digit 

phone number. Refer to ECS for the EE-2. Type 

can include home, work, cell, day, evening, vacation 

home, etc. 

865-123-

9870 Home

3 Survivor(s) Data

If applicable, enter the survivor’s data for each survivor that has filed a Claim for 

Benefits, Form EE-2. If not applicable (the employee is living), delete these tables. 

If there are more than 3 survivors, copy and paste one table and add to the 

bottom, be sure to include a space between them.

a Name Enter the Survivor’s name (First, Middle Initial, Last, 

Suffix). Refer to ECS for the EE-2 Betty D. Flintstone

b Address Enter the full address of the survivor (Street, City, 

State, and zip code). Refer to ECS or the EE-2.

710 Bedrock Dr., Aiken, 

SC 26175-0454

c 

Phone Number and 

Type

If available, enter the survivor’s 10 digit phone 

number. Refer to ECS or the EE-2. Type can include 

home, work, cell, day, evening, vacation home, etc.

703-999-

8000 Other

d Relationship to 

Employee

Enter the survivor’s relationship to the employee as 

selected on the EE-2 Spouse, Child, Grandchild

e Currently eligible 

survivor (Yes or No)

Enter Yes or No. Entering “Yes” means the survivor 

has met all the requirements to establish 

survivorship. Also note if the survivor is a “Part E 

Only” survivor (i.e., a non-spousal child). In cases of 

multiple survivors, indicate which survivor would 

prefer to be contacted by entering “Primary Contact” 

in the space provided.

Yes (Part E Only/Nonspousal Child)/Primary 

Contact

4 Other Contact

If applicable, enter the Authorized Representative/Power of Attorney (POA) data. 

If not, delete this table. If there is more than one contact, copy and paste the table 

and add to the bottom, be sure to include a space between them.

a Name Enter the Contact’s name (First, Middle Initial, Last, 

Suffix) Ira M. Lawyer, Jr.

b Address Enter the full address of the survivor (Street, City, 

State, and zip code)

710 Bedrock Dr., Aiken, 

SC 26175-0454

c 

Phone Number and 

Type

If available, enter the survivor’s 10 digit phone 

number. Type can include home, work, cell, day, 

evening, vacation home, etc.

703-999-

8000 Work

Helpful Hint: Adding the +4 zip code may speed up mail delivery by several days (visit 

www.usps.com to find an address’ +4 zip code). 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-2 Back to Top

April 2017 (Page 2 of 3) Appendices

d Relationship to 

employee If known, enter the contact’s relationship to the EE Lawyer

5 EE Covered Cancer 

Information

Enter the EEs verified diagnosed cancer(s). Create a table (copy, cut, paste); for 

each primary cancer or secondary cancer for which there is an unknown primary.

a Primary or Secondary Place an “X” (by clicking) in the box that best 

describes the cancer (Primary or Secondary)

b Cancer Description/Type Enter the cancer description from the 

pathology/operative report, etc.

Chronic myelomonocytic 

leukemia, in remission

c Associated ICD-9 Code Enter the ICD-9 code that best describes the cancer 206.11

d Associated ICD-10 Code Enter the ICD-10 code that best describes the cancer C93.11

e 

Date of Cancer 

Diagnosis

Enter the date of cancer diagnosis from pathology 

report, operative report, death certificate, etc. in 

MM/DD/YYYY format. The entire date is not required 

but preferred. List the month and year if the full date 

is not available. The year of diagnosis is required.

01/10/2001

6 Other Covered Condition If applicable, place and “X” (by clicking) in the box(es).

a 

SEC Cancer Claim, but 

filing for Non-SEC 

cancer medical benefits

Select this box if the claim is an employee claim or a 

survivor claim where the employee filed initially, that 

is being or has been accepted for an SEC cancer; 

and there is a claim for a non-SEC Cancer.

Employee is accepted for 

SEC lung cancer; and 

now is filing for a non-SEC 

skin cancer.

b Other claim for benefits 

scenario

If there is any scenario not “typical” (i.e., non SEC 

cancer/employment) and not covered in 6.a, select 

this box by clicking.

Part B survivor case 

accepted for CBD. Under 

Part E, cannot establish 

death link relating to CBD; 

death certificate lists lung 

cancer as cause of death.

c Explain Provide a detailed/specific explanation for the reason 

box 6.b was selected

For the example above: 

“Survivor already 

compensated under Part 

B, Dose Reconstruction 

will be to establish death 

link for Part E only.”

7 

Energy Employee 

Verified Employment 

History

Complete this section for all verified employment. Any breaks in employment 

seven days or more must be reported separately. Create another table by using 

copy, paste; remember to leave a space between them. It is not necessary to 

verify employment beyond the date of cancer diagnosis for the purposes of 

submitting the NRSD; however, once submitted, continue to complete employment 

verification for toxic exposure and other claimed illnesses. Remember that the 

verified employment may extend beyond the covered employment at a particular 

site. The CE must verify the covered dates for a site by going to the DOE Office of 

Worker Advocacy Covered Facility List 

(http://www.hss.energy.gov/healthsafety/fwsp/advocacy/faclist/findfacility.cfm). 

a Employer/Facility Name Enter the employer and Facility Name Union Carbide/K-25

b Uranium Mine/Mill For RECA Section 5 workers, Enter Name of 

Uranium Mine/Mill 

Climax Uranium Mill, 

Grand Junction, CO

c Start Date Enter the start date in MM/DD/YYYY Format 01/01/1956

d End Date Enter the end date in MM/DD/YYYY Format 12/31/1959

e Employment badge 

number

If available, list the EEs employment badge number 

from the EE-3 or DAR. 10349

f Dosimetry Badge No. If available, list the EEs dosimetry badge number 

from the EE-3, DAR, or ORISE 10949

g Job Title

If available, list the EEs job title (for the specific 

employment period) using information from the EE-3, 

DAR, or ORISE

SUPERSEDED

Pipefitter
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-2 Back to Top

April 2017 (Page 3 of 3) Appendices

INSTRUCTIONS FOR COMPLETING THE NRSD

8 

Employment verification 

information valuable to 

NIOSH

Select these boxes, by clicking, if applicable. 

a DOE could not verify 

employment Select this box if employment wasn’t verified 

b 

Employment verification 

based on affidavit or 

other credible evidence

c 

Worked for a 

contractor/sub-contractor 

not listed

If the employee worked for a 

contractor/subcontractor not listed on the DOE Office 

of Worker Advocacy Covered Facility List, select this 

box.

F.H. McGraw

9 

Other information 

relevant to dose 

reconstruction

For skin cancer and lung cancer cases additional information regarding the 

following must be provided.

a Ethnicity selection

For skin cancers, it is required that the District Office supply NIOSH with the EEs 

race/ethnicity. The method used to gather this information is EE/EN-9. If the 

claimant does not return the questionnaire within 60 days, the case will be 

administratively closed. However, if the CE can obtain the information from the 

EE’s medical information or other credible source (i.e., DAR), the NRSD may be 

completed using that information and forwarded to NIOSH with an explanation of 

where the information was acquired.

b Smoking History

For lung cancer or a secondary cancer with an unknown primary cancer that 

includes lung cancer as a possible primary cancer, the CE must request the EEs 

smoking history using the EE/EN-8. If the claimant does not return the 

questionnaire within 60 days, the case will be administratively closed. However, if 

the CE can obtain the information from the EE’s medical information or other 

credible source (i.e., DAR), the NRSD may be completed using that information 

and forwarded to NIOSH with an explanation of where the information was 

acquired. If the employee is a current smoker (currently refers to time of cancer 

diagnosis), then the CE must select an additional box, which indicates the amount 

(per day) the employee smoked at the time of cancer diagnosis.

10 DOL Information Enter the requested information

a District Office Enter the CE’s District Office Cleveland, Denver, 

Jacksonville, Seattle 

b Claims Examiner Name Enter the CE’s full name John Q. Examiner

c 

Claims Examiner Phone 

No.

Enter the CE’s direct dial phone number (not the toll 

free number) (904)357-4795 x74307

d Claims Examiner e-mail 

address Enter the CE’s DOL e-mail address examiner.john@dol/.gov

Reviewed by

A CE/SrCE must review the NRSD, sign, and date; affirming that to the best of 

her/his ability, they have reviewed the information provided and believe it to be 

accurate and correct.

Note: A complete copy of the case file (including the Part D if available) via CD or other means of electronic 

submission, will be duplicated and sent with the NRSD to NIOSH.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-3 Back to Top

April 2017 (Page 1 of 2) Appendices

NIOSH Referral Letter to Claimant

Dear [Insert Claimant Name]: 

We have received the necessary medical and employment information submitted in support of 

your claim for compensation under the Energy Employees Occupational Illness Compensation

Program Act (EEOICPA). 

The next step in the adjudication of your claim is the dose reconstruction process. The National 

Institute for Occupational Safety and Health (NIOSH), an agency within the Department of 

Health and Human Services, administers this portion of the process. In order for NIOSH to 

proceed with the dose reconstruction, they must have access to your complete case record. 

Therefore, a copy of your case file is being referred to them.

Based on our review of your claim, we will report the following information to NIOSH: 

Medical

• Cancer diagnosis type (nomenclature), [Insert Diagnosis Code(s)] and date of diagnosis 

Employment

• Employer name, facility, and dates of employment (list each individually) 

If you [or the “the employee” when writing to a survivor] had any other primary cancers, in 

addition to what is listed above, it is important that you send written medical records 

documenting an explicit diagnosis of any additional primary cancers, the type of cancer, and the 

date of its first diagnosis. Also, with regard to employment, if you [or “the employee” if writing 

to a survivor] had other covered employment, either before or after the dates shown above, or 

employment at another Department of Energy covered facility, please send us any evidence you 

have that supports this additional employment. Any such medical or employment evidence 

should be sent to your claims examiner at the mailing address provided below. 

Once NIOSH receives your case record, they will send you a letter advising that they have 

received your information. The letter will contain information on dose reconstruction and what 

to expect from NIOSH in regard to your claim. NIOSH has informed us that the process of dose 

reconstruction can be time consuming because it relies on information that must be collected 

from a number of sources. NIOSH’s first priority is to ensure the collected information is valid 

and that the assumptions used to estimate doses are fair, consistent, and well-grounded in the 

best available science.

Once NIOSH completes the dose reconstruction, they will send us the results, and we will apply 

a formula, using the NIOSH data, to determine whether your [or the employee’s] claimed cancer 

is at least as likely as not (a 50% or greater probability) related to the covered employment. We 

will then notify you, in writing, regarding the status of your claim.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-3 Back to Top

April 2017 (Page 2 of 2) Appendices

If you have specific questions regarding the status of the dose reconstruction, you may contact 

the NIOSH office by calling their toll-free number at 1-877-222-7570. Any other questions 

regarding your claim should be addressed to your claims examiner at the mailing address below.

Sincerely,

Claims Examiner

{Insert Central Mailroom Address} 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-4 Back to Top

April 2017 (Page 1 of 3) Appendices

Examples of Rework Request

These examples do not cover all scenarios. Please use your professional judgment in 

conveying the most accurate and pertinent information necessary concerning how the DR 

was performed, and what modifications need to be made. Also, ensure that the appropriate 

ICD code with the condition description is included. 

1. Additional cancer reported to the DO (employment history unchanged):

NIOSH DR for Karen Smith, 111-11-1111, (NIOSH 3450). Ms. Smith was employed at the 

Paducah Gaseous Diffusion Plant for several periods between 09/28/55 to 12/28/79. The DR 

was performed for two cancers: BCC (left preaurical area), diagnosed on 01/28/02; and SCC insitu right ear, diagnosed on 9/17/02. The POC was 38.14%. 

 

Subsequently, the DO received evidence of an additional verified cancer: SCC (right posterior 

inferior pinna), diagnosed on 07/31/03. 

2. Cancers were incorrectly reported in the NRSD (employment history has not changed):

John M. Jones, 222-22-2222, (NIOSH 5678). Mr. Jones was employed at the Nevada Test Site 

from (09/01/65 to 03/3/73) and (11/19/79 to 09/30/87). The DR was performed for two cancers: 

• Prostate cancer, diagnosed on 01/01/98 

• Adenocarcinoma, Barrett’s Esophagus, diagnosed on 11/15/01 

The POC was 36.39%. We reviewed the case file and determined that the prostate diagnosis date 

and the Barrett’s Esophageal cancer were incorrectly reported. The correct cancer information 

follows: 

1. Prostate cancer, diagnosed on 04/08/98 - (diagnosis 4 

 months later than reported) 

2. Adenocarcinoma, lower (distal) esophagus, diagnosed 

 on 11/15/01 

3. Corrections to employment (cancer unchanged)

Mary Smith, 333-33-3333 (NIOSH 91264). Ms. Smith worked at NTS for four periods from the 

1950s to the 1970s. The DR was performed for astrocytoma, diagnosed on 03/19/77. Based on 

the employment used in the DR, the POC was 35.57%. 

The DR used the following NTS employment dates, as reported in the NRSD: 

1. 04/24/57 – 06/24/57 

2. 07/09/60 – 01/18/63 

3. 01/31/63 – 07/19/65 

4. 07/26/55 – 02/01/74

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-4 Back to Top

April 2017 (Page 2 of 3) Appendices

Subsequent to submitting the NRSD report, we received additional employment evidence to 

determine that employment period 4 above, should actually be 07/26/65 - 02/01/74, resulting in 

about 5 years less verified employment than represented in the current DR. 

4. Correction to cancers and employment history: 

Tom Doe, 444-44-4444 (NIOSH 23679). The DO reported that Mr. Doe was employed at the 

Tonopah Test Range and Nevada Test Site (NTS) from 03/27/87 to 01/22/91. The DR was 

performed for esophageal cancer, diagnosed on 03/26/93. The POC was 2.35%. 

We reviewed the case file and found that the cancer and the employment site and dates reported 

in the original NRSD were incorrect. Please replace the originally reported esophageal cancer, 

with the following two cancers: 

• Squamous cell carcinoma of the right piriform fossa, diagnosed on 01/31/90 

• Squamous cell carcinoma of the distal esophagus, diagnosed on 03/25/93 

In addition, Mr. Doe was on leave without pay as of 01/22/90, although his actual termination 

date was 01/22/91. Therefore, the correct employment is: Solely at NTS (no Tonopah 

employment) from 03/27/87 to 01/22/90, one less year than originally reported.

5. Correction to reported cancers, and additional cancer (no changes to employment): 

DR for James Johnson, 555-55-5555 (NIOSH 0432). Mr. Johnson was employed at NTS 

intermittently from 09/07/54 to 12/31/95. The NRSD reported 4 primary cancer sites for dose 

reconstruction: two (2) prostate cancers (right and left lobes), and two (2) BCCs, diagnosed in 

10/97 and 04/99. The resultant POC was 51.05%. 

 

Upon further review of the medical evidence, we determined that the two prostate cancers should 

only be reported as one, as the pathology report for both lobes was reported within the same two 

weeks, and there is no indication that the two lobes are separate primaries. We also determined 

that the 04/99 BCC was a recurrent cancer of the 10/97 BCC and should not be included in the 

DR. In addition, we received additional medical evidence of another verified cancer: SCC 

(scalp), diagnosed on 06/12/96. 

 

Therefore the DR should be performed for the correct cancers as follows: 

1. Prostate, diagnosed on 10/14/84 

2. BCC (rt cheek), diagnosed on 10/23/97 

3. SCC (scalp), diagnosed on 06/12/96. 

6. Deletion of several cancers from a list of multiple cancers (no change in employment):

DR for Pete James, 666-66-6666 (NIOSH 3495). Mr. James was employed at the Pacific 

Northwest National Lab from 08/25/69 to 06/28/87. The DR was performed for eleven (11) 

cancers. The POC was 52.1%.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-4 Back to Top

April 2017 (Page 3 of 3) Appendices

 

Upon further review of the medical evidence in the case file, we determined that only eight (8) of 

the original eleven (11) cancers are verifiable. Below is the list of the 11 initially reported 

cancers; the three (3) erroneous cancers are identified by strikethrough: 

 

1. Seminoma of the R. Testicle, 06/01/77 

2. BCC R. Shoulder, 10/30/97 

3. BCC R. Cheek, 10/30/97 

4. SCC in situ, L. Temple, 02/24/98 

5. SCC in situ, Scalp, 02/24/98 

6. SCC in situ, L. Forearm, 04/24/98 

7. SCC in Situ, L. Dorsal Forearm, 06/23/98 

8. SCC R. Cheek, 11/29/01 

9. BCC L. Chin, 11/29/01 

10. BCC L. Cheek, 02/07/02 

11. SCC in situ, L. Lateral Forearm, 06/30/03 

 

The 8 DOL verified cancers are therefore: 

 

1. Seminoma of the R. Testicle, 06/01/77 

2. BCC R. Cheek, 10/30/97 

3. SCC in situ, L. Temple, 02/24/98 

4. SCC in situ, Scalp, 02/24/98 

5. SCC in Situ, L. Dorsal Forearm, 06/23/98 

6. SCC R. Cheek, 11/29/01 

7. BCC L. Chin, 11/29/01 

8. SCC in situ, L. Lateral Forearm, 06/30/03 

7. Additional verified employment periods (employment in NRSD correct): 

DR for Sam Jones, 777-77-7777 (NIOSH 3254). The DR was performed for liver cancer, 

diagnosed on 09/03/87. The POC was 22%. The DR Coversheet (dated 06/02/05) notes Mr. 

Jones’ Hanford employment as: “06/29/54-07/12/77 (eleven periods of employment).” This is 

correct based on the employment originally reported in the NRSD by the DO. 

 

We have subsequently received evidence of additional verified Hanford employment periods: 

 

1. 01/01/53 to 12/31/53 

2. 08/07/53 to 06/28/54 

3. 01/30/62 to 04/15/62 

4. 01/01/79 to 12/31/79 

5.

SUPERSEDED

 01/01/80 to 12/31/80
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-5 Back to Top

April 2017 Appendices

Review of Dose Reconstruction Letter to Claimant

Dear Claimant Name:

We recently received the results of the dose reconstruction conducted by the National Institute 

for Occupational Safety and Health (NIOSH) in regard to your claim for compensation under the 

Energy Employees Occupational Illness Compensation Program Act. After review of the dose 

reconstruction and the evidence received in support of your claim, it was discovered that [insert 

reason]. 

We determined that your claim must be returned to NIOSH so that they can review and revise 

the dose reconstruction, as appropriate, to include this information. This may not affect the 

outcome of your claim, but the information used in the dose reconstruction must accurately 

reflect what is shown in the evidence received by the district office. Your NIOSH tracking 

number xxxxx will remain the same. Your claim will receive priority consideration by NIOSH.

You will have the opportunity to review the revised dose reconstruction report, and will again be 

required by NIOSH to sign the OCAS-1 to acknowledge your receipt of the revised report and 

initial dose reconstruction results. 

When NIOSH finishes its revised study and sends us the results, we will apply a formula to the 

dose reconstruction to determine whether the cancer(s) was at least as likely as not (50% or 

greater chance) related to the covered employment. We will then notify you in writing regarding 

the status of your claim.

If you have specific questions regarding the status of the dose reconstruction, you may contact 

the NIOSH office by calling toll free at 1-877-222-7570. Any other questions should still be 

addressed to this district office.

Sincerely,

Claims Examiner

District Office Location

cc: NIOSH Public Health Advisor 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-6 Back to Top

April 2017 (Page 1 of 3) Appendices

Primary Cancer Sites

Secondary Cancer Likely Primary Cancers

Lymph nodes of 

head, face and neck 

Malignant neoplasm of base of tongue, Malignant neoplasm of parotid 

gland, Malignant neoplasm of tonsil, unspecified, Malignant neoplasm of 

pharynx, unspecified, Malignant neoplasm of glottis, Malignant neoplasm 

of trachea, Malignant melanoma of lip, Unspecified malignant neoplasm of 

skin of lip, Malignant neoplasm of nipple and areola, unspecified female 

breast, Malignant neoplasm of thyroid gland

Intrathoracic lymph 

nodes 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

trachea, Malignant neoplasm of nipple and areola, unspecified female 

breast

Intra-abdominal 

lymph nodes 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

pylorus, Malignant neoplasm of hepatic flexure, Malignant neoplasm of 

head of pancreas, Malignant neoplasm of trachea, Malignant neoplasm of 

nipple and areola, unspecified female breast, Malignant neoplasm of 

endocervix, Malignant neoplasm of prostate, Malignant neoplasm of

unspecified kidney, except renal pelvis, Follicular lymphoma, unspecified, 

extranodal and solid organ sites

Lymph nodes of 

axilla and upper 

limb 

Malignant neoplasm of trachea, Malignant melanoma of lip, Malignant 

neoplasm of nipple and areola, unspecified female breast

Inguinal and lower 

limb lymph nodes 

Malignant neoplasm of rectosigmoid junction, Malignant neoplasm of 

trachea, Malignant melanoma of lip, Unspecified malignant neoplasm of 

skin of lip, Malignant neoplasm of prepuce

Intrapelvic lymph 

nodes 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of rectosigmoid 

junction, Malignant neoplasm of trachea, Malignant neoplasm of 

endocervix, Malignant neoplasm of corpus uteri, unspecified, Malignant 

neoplasm of prostate, Malignant neoplasm of trigone of bladder

Lymph nodes of 

multiple sites 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

cardia, Malignant neoplasm of hepatic flexure, Malignant neoplasm of 

trachea, Malignant neoplasm of nipple and areola, unspecified female 

breast

Lymph nodes, site 

unspecified 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

cardia, Malignant neoplasm of sigmoid colon, Malignant neoplasm of 

trachea, Malignant melanoma of lip, Malignant neoplasm of nipple and 

areola, unspecified female breast, Malignant neoplasm of prostate

Lung 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of trachea,

Malignant melanoma of lip, Malignant neoplasm of nipple and areola, 

unspecified female breast, Malignant neoplasm of prostate, Malignant 

neoplasm of trigone of bladder, Malignant neoplasm of unspecified kidney, 

except renal pelvis

Mediastinum 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

trachea, Malignant neoplasm of nipple and areola, unspecified female 

breast

Pleura Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

hepatic flexure, Malignant neoplasm of trachea, Malignant neoplasm of 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-6 Back to Top

April 2017 (Page 2 of 3) Appendices

nipple and areola, unspecified female breast, Malignant neoplasm of 

unspecified ovary , Malignant neoplasm of prostate, Malignant neoplasm of 

unspecified kidney, except renal pelvis

Other respiratory 

organs 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

hepatic flexure, Malignant neoplasm of glottis, Malignant neoplasm of 

trachea, Unspecified malignant neoplasm of skin of lip, Malignant 

neoplasm of nipple and areola, unspecified female breast, Malignant 

neoplasm of prostate, Malignant neoplasm of thyroid gland

Small intestine, 

including duodenum 

Malignant neoplasm of duodenum, Malignant neoplasm of hepatic flexure,

Malignant neoplasm of head of pancreas, Malignant neoplasm of trachea,

Malignant neoplasm of connective and soft tissue of head, face and neck,

Malignant melanoma of lip, Malignant neoplasm of nipple and areola, 

unspecified female breast, Malignant neoplasm of unspecified ovary, Malignant neoplasm of unspecified kidney, except renal pelvis

Large intestine and 

rectum 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of rectosigmoid 

junction, Malignant neoplasm of trachea, Malignant neoplasm of nipple and 

areola, unspecified female breast, Malignant neoplasm of unspecified 

ovary, Malignant neoplasm of prostate

Retroperitoneum and 

peritoneum 

Malignant neoplasm of cardia, Malignant neoplasm of hepatic flexure,

Malignant neoplasm of rectosigmoid junction, Malignant neoplasm of head 

of pancreas, Malignant neoplasm of trachea, Malignant neoplasm of 

peripheral nerves of head, face and neck, Malignant neoplasm of nipple and 

areola, unspecified female breast, Malignant neoplasm of corpus uteri, 

unspecified, Malignant neoplasm of unspecified ovary

Liver, specified as 

secondary 

Malignant neoplasm of cardia, Malignant neoplasm of hepatic flexure,

Malignant neoplasm of rectosigmoid junction, Malignant neoplasm of head

of pancreas, Malignant neoplasm of trachea, Malignant neoplasm of nipple 

and areola, unspecified female breast

Other digestive 

organs 

Malignant neoplasm of upper third of esophagus, Malignant neoplasm of 

cardia, Malignant neoplasm of hepatic flexure, Malignant neoplasm of head 

of pancreas, Malignant neoplasm of trachea, Malignant neoplasm of nipple 

and areola, unspecified female breast, Malignant neoplasm of prostate

Kidney 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of trachea,

Malignant neoplasm of nipple and areola, unspecified female breast,

Malignant neoplasm of endocervix, Malignant neoplasm of prostate,

Malignant neoplasm of trigone of bladder, Malignant neoplasm of 

unspecified kidney, except renal pelvis, Follicular lymphoma, unspecified, 

extranodal and solid organ sites

Other urinary 

organs 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of nipple and 

areola, unspecified female breast, Malignant neoplasm of endocervix,

Malignant neoplasm of unspecified ovary, Malignant neoplasm of prostate,

Malignant neoplasm of trigone of bladder, Malignant neoplasm of 

SUPERSEDED

unspecified kidney, except renal pelvis
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-6 Back to Top

April 2017 (Page 3 of 3) Appendices

Skin 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of trachea,

Malignant neoplasm of peripheral nerves of head, face and neck, Malignant 

melanoma of lip, Unspecified malignant neoplasm of skin of lip, Malignant 

neoplasm of nipple and areola, unspecified female breast, Malignant 

neoplasm of unspecified kidney, except renal pelvis

Brain and spinal 

cord 

Malignant neoplasm of trachea, Malignant melanoma of lip, Malignant 

neoplasm of nipple and areola, unspecified female breast

Other parts of 

nervous system 

Malignant neoplasm of trachea, Malignant melanoma of lip, Malignant 

neoplasm of nipple and areola, unspecified female breast, Malignant 

neoplasm of prostate, Follicular lymphoma, unspecified, extranodal and 

solid organ sites

Bone and bone 

marrow 

Malignant neoplasm of trachea, Malignant neoplasm of nipple and areola, 

unspecified female breast, Malignant neoplasm of prostate

Ovary Malignant neoplasm of hepatic flexure, Malignant neoplasm of nipple and 

areola, unspecified female breast, Malignant neoplasm of unspecified ovary

Suprarenal gland Malignant neoplasm of hepatic flexure, Malignant neoplasm of trachea, Malignant neoplasm of nipple and areola, unspecified female breast

Other specified 

sites 

Malignant neoplasm of hepatic flexure, Malignant neoplasm of trachea,

Malignant melanoma of lip, Malignant neoplasm of nipple and areola, 

unspecified female breast, Malignant neoplasm of unspecified ovary,

Malignant neoplasm of prostate, Malignant neoplasm of trigone of bladder

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-7 Back to Top

April 2017 (Page 1 of 2) Appendices

Glossary of Cancer Descriptions

Cancer Description

Malignant neoplasm of lip

Malignant neoplasm of tongue

Malignant neoplasm of major salivary glands

Malignant neoplasm of gum

Malignant neoplasm of floor of mouth

Malignant neoplasm of other and unspecified parts of mouth

Malignant neoplasm of oropharynx

Malignant neoplasm of nasopharynx

Malignant neoplasm of hypopharynx

Malignant neoplasm of other and ill-defined sites within the lip, oral 

cavity, and pharynx

Malignant neoplasm of esophagus

Malignant neoplasm of stomach

Malignant neoplasm of small intestine, including duodenum

Malignant neoplasm of colon

Malignant neoplasm of rectum, rectosigmoid junction, and anus

Malignant neoplasm of liver and intrahepatic bile ducts

Malignant neoplasm of gall bladder and extrahepatic bile ducts

Malignant neoplasm of pancreas

Malignant neoplasm of retroperitoneum and peritoneum

Malignant neoplasm of other and ill-defined sites within the digestive 

organs and peritoneum

Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses

Malignant neoplasm of larynx

Malignant neoplasm of trachea, bronchus and lung

Malignant neoplasm of pleura

Malignant neoplasm of thymus, heart, and mediastinum

Malignant neoplasm of other and ill-defined sites within the 

respiratory system and intrathoracic organs

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 17-7 Back to Top

April 2017 (Page 2 of 2) Appendices

Malignant neoplasm of bone and articular cartilage

Malignant neoplasm of connective and other soft tissue

Malignant melanoma of skin

Other malignant neoplasms of skin

Malignant neoplasm of female breast

Malignant neoplasm of male breast

Malignant neoplasm of uterus, part unspecified

Malignant neoplasm of cervix uteri

Malignant neoplasm of placenta

Malignant neoplasm of body of uterus

Malignant neoplasm of ovary and other uterine adnexa

Malignant neoplasm of other and unspecified female genital organs

Malignant neoplasm of prostate

Malignant neoplasm of testis

Malignant neoplasm of penis and other male genital organs

Malignant neoplasm of urinary bladder

Malignant neoplasm of kidney and other and unspecified urinary organs

Malignant neoplasm of eye

Malignant neoplasm of brain

Malignant neoplasm of other and unspecified parts of nervous system

Malignant neoplasm of thyroid gland

Malignant neoplasm of other endocrine glands and related structures

Malignant neoplasm of other and ill-defined sites

Secondary and unspecified malignant neoplasm of the lymph nodes

Secondary malignant neoplasm of the respiratory and digestive organs

Secondary malignant neoplasm of other tissue and organs

Malignant neoplasm without specification of site

Lymphosarcoma and reticulosarcoma

Hodgkin's disease

Other malignant neoplasms of lymphoid and histiocytic tissue

Multiple myeloma and other immunoproliferative neoplasms

Lymphoid leukemia

Myeloid leukemia

Monocytic leukemia

Other specified leukemia

Leukemia of unspecified cell type 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 1 of 13) Appendices

Matrix for Confirming Sufficient Evidence of Non-Cancerous Covered Illnesses

SILICOSIS, CHRONIC 

 

Criteria Common characteristics for the diagnosis of the medical 

condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* 10 years or more

Medical Evidence for illness and 

diagnostic testing criteria

A written diagnosis of silicosis made by a medical doctor

And

Any one of the following three criteria:

a. A chest radiograph, interpreted by NIOSH certified B reader 

classifying the existence of pneumoconiosis of category 1/0 or 

higher; 

b. Results from a chest x-ray or computer assisted tomography 

(CT) or other imaging technique that are consistent with silicosis; 

or 

• Such as nodules, or fibrosis usually with upper lung 

zone predominance

c. Lung biopsy findings consistent with silicosis

• Such as silicotic nodules.

Additional considerations

for causation If the evidence is insufficient, physician review required.

* The actual latency period for disease development is a function of the duration and intensity of exposure.

*** References utilized include American Thoracic Society consensus statement.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 2 of 13) Appendices

SILICOSIS, ACUTE

 

Criteria Common characteristics for the diagnosis of the medical 

condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Weeks to months

Medical Evidence for illness and 

diagnostic testing criteria

Any one of the following two criteria:

a. A written diagnosis of acute silicosis made by a medical doctor; or

b. Death certificate or other acceptable documentation of death due 

to acute silicosis

And

The medical record contains no other diagnoses, such that would 

otherwise account for the acute sudden severe lung illness, such as 

other infection or ARDS.

Additional considerations 

for causation Physician review required

* The actual latency period for the development is a function of the exposure’s duration and intensity of exposure.

***References utilized include American Thoracic Society consensus statement. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 3 of 13) Appendices

SILICOSIS, ACCELERATED

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* 2-5 years

Medical Evidence for illness and 

diagnostic testing criteria

A written diagnosis of accelerated silicosis made by a medical doctor

And

Any one of the following three criteria:

a. A chest radiograph, interpreted by NIOSH certified B reader classifying 

the existence of pneumoconiosis of category 1/0 or higher; 

b. Results from a chest x-ray or computer assisted tomography (CT) or 

other imaging technique that are consistent with silicosis; or 

• Such as nodules or fibrosis usually with upper lung zone 

predominance 

c. Lung biopsy findings consistent with silicosis

• Such as silicotic nodules.

Additional considerations for 

causation Physician review required

* The actual latency period for the development of this disease is a function of the duration and intensity of exposure. 

*** References utilized include American Thoracic Society consensus statement.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 4 of 13) Appendices

SILICOSIS, COMPLICATED

Criteria Common characteristics for the diagnosis of the medical 

condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Years to decades

Medical Evidence for illness and diagnostic 

testing criteria

A written diagnosis of progressive massive fibrosis (PMF) or 

complicated silicosis made by a medical doctor

And

Results from a chest x-ray or computer assisted tomography 

(CT) or other imaging technique that are consistent with PMF 

• Progression and coalescence of the upper lung zone 

nodules to form masses (conglomerate lesions) 

• When they cause contraction of the lobes, an “angel

wing pattern” can be seen.

Additional considerations 

for causation Physician review required

 

* The actual latency period for the development of this disease is a function of the duration and intensity of exposure.

*** References utilized include American Thoracic Society consensus statement.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 5 of 13) Appendices

PNEUMOCONIOSIS

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Years 

Medical Evidence for illness and 

diagnostic testing criteria

Written evidence of one of the following two criteria:

a. A written diagnosis of pneumoconiosis made by a medical doctor; or

b. Results of breathing tests (PFTs or spirometry) showing a restrictive 

lung pattern FVC < 80% predicted

And

Any one of the following three criteria:

a. A chest radiograph, interpreted by NIOSH certified B reader classifying 

the existence of pneumoconiosis of category 1/0 or higher;

b. Results from a chest x-ray or computer assisted tomography (CT) or 

other imaging technique that are consistent with asbestosis and/or findings 

of pleural plaques or rounded atelectasis; or

c. Lung biopsy findings consistent with pneumoconiosis. 

Additional considerations for 

causation If the evidence is insufficient, physician review required

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 6 of 13) Appendices

MESOTHELIOMA

Criteria Common characteristics for the diagnosis of the medical 

condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* 30-50 years

Medical Evidence for illness and 

diagnostic testing criteria

A written diagnosis of mesothelioma made by a medical doctor

And

Pathology report consistent with mesothelioma from surgical or 

biopsy specimen.

Additional considerations

for causation If the evidence is insufficient, physician review required. 

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure.

*** References utilized include American Thoracic Society consensus statement. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 7 of 13) Appendices

ASBESTOS RELATED DISORDERS

 

Criteria Common characteristics for the diagnosis of the medical 

condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Pleural plaques: 20 or more years

Pleural effusions: 5-30 years

Medical Evidence for illness and 

diagnostic testing criteria

A diagnosis of pleural plaques or pleural effusions made by a medical 

doctor 

And 

Results from a chest x-ray or computer assisted tomography (CT) or 

other imaging technique that are consistent with these disorders

• Pleural plaques 

• Pleural thickening, not associated with an area of prior surgery or 

trauma

• Rounded atelectasis

 

• Bilateral pleural effusions, also called benign asbestos related 

pleural effusion.

Additional considerations 

for causation Physician review required

* The actual latency period for the development of this disease is a function of the duration and intensity of 

exposure.

*** References utilized include American Thoracic Society consensus statement. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 8 of 13) Appendices

LUNG FIBROSIS

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Years 

Medical Evidence for illness and 

diagnostic testing criteria

A written diagnosis of lung fibrosis made by a medical doctor

And

Any one of the following three criteria:

a. Results from a chest x-ray or computer assisted tomography (CT) or 

other imaging technique that are consistent with fibrosis;

• Such as small lung fields or volumes, minimal ground glass 

opacities, and/or bibasilar reticular abnormalities

b. Results of breathing tests (PFTs or spirometry) showing a restrictive 

or mixed pattern; or

• Such as FVC <80% predicted

c. Lung biopsy findings consistent with fibrosis

And

There is no evidence in the medical record that the lung fibrosis is 

present due to another disease process.

Additional considerations for 

causation If the evidence is insufficient, physician review required. 

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 9 of 13) Appendices

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Years 

Medical Evidence for illness and 

diagnostic testing criteria

A written diagnosis of COPD or chronic bronchitis made by a medical 

doctor

• Chronic bronchitis is defined as the presence of chronic 

productive cough for 3 months in each of two successive years 

and other causes of cough have been excluded

And 

Any one of the following four criteria: 

a. Abnormal results from Arterial Blood Gas (ABG) Testing

b. Results from a chest x-ray or other imaging technique that are 

consistent with COPD

• Such as air trapping, flattening of diaphragms, enlarged lung 

fields, interstitial patterns, scarring, or other abnormalities

c. Results of PFTs or spirometry showing an obstructive or mixed pattern

 

• FEV1/FVC< 70% and FEV1<80% predicted. 

d. Results from Bronchoscopy showing obstruction

 

And

The employee has a history of being a never smoker***

And

There is no other lung disease present that would account for the findings.

Additional considerations for 

causation There is currently no medical testing or means to distinguish COPD due 

to any of the above toxic substance exposures and COPD due to other

causes. Physician review is required. 

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure.

***ATS criterion for a never smoker, or non-smoker, is < 20 packs of cigarettes in a lifetime, but this piece of 

information may not be found in most medical records.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 10 of 13) Appendices

KIDNEY DISEASE

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Months or years

Medical Evidence for illness and 

diagnostic testing criteria

Any one of the following two criteria

a. A written diagnosis of kidney disease made by a medical doctor

• Other terms are chronic renal disease, chronic renal failure, 

renal insufficiency

b. The worker required dialysis 

And

The worker does not have high blood pressure or diabetes 

And

The type of kidney disease diagnosed is consistent with one known to 

be caused by the identified toxic substance. 

Additional considerations for 

causation Additional testing may be required to help establish a causal link 

between a toxic substance and a specific kidney disease. This may 

include additional urine testing, such as β 2-microglobulin or retinol 

binding protein and/or biological tests to detect residual evidence of the 

toxic substance in the body. The need for this additional testing should 

be determined by the reviewing physician. 

Physician review is required. 

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 11 of 13) Appendices

ASTHMA, OCCUPATIONAL

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Weeks, months, or years

Medical Evidence for illness 

and diagnostic testing criteria

A written diagnosis of occupational asthma or asthma caused by toxic 

substance made by a medical doctor

And

The diagnosis of asthma was made based on any one of the following criteria

a. Methacholine challenge test results showing a PC20 ≤ 8 mg/ml; 

b. Post-bronchocodialator reversibility of FEV1 ≥ 12% and 200 ml; or

c. Post-bronchocodialator reversibility of FEV1 ≥ 12% , but <20 ml, with 

subsequent improvement in FEV1 ≥ 20% after steroid trial

And

Additional considerations for 

causation

An association between symptoms of asthma and work, including wheeze 

and/or shortness of breath that are better on days away from work, especially 

on holiday or vacation

And

One or more of the following criteria:

a. work-related change in FEV1 or PEF rate; or

b. work-related change in bronchial hyperresponsiveness; or

c. positive response to specific inhalation challenge test (note this is not 

recommended if not already performed).

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18-1 Back to Top

April 2017 (Page 12 of 13) Appendices

NEUROPATHY, TOXIC

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Days, months, or years

Medical Evidence for 

illness and diagnostic 

testing criteria

A written diagnosis of peripheral neuropathy, toxic neuropathy, or neuropathy due 

to a toxic substance 

And

The physician’s diagnosis was made by all three of the following criteria. Note: the 

definition of the classic syndrome will vary among the different toxic substances 

a. Symptoms consistent with the classic syndrome caused by the specific toxic 

substance

• Sensory; 

• Motor; or

• Sensorimotor

b. Signs consistent with the classic syndrome caused by the specific toxic 

substance

• Decreased or abnormal distal sensation

a. Such as stocking-glove numbness, allodynia, and/or 

hyperalgesia

• Decreased or absent distal reflexes

• Distal muscle weakness and/or atrophy

c. Results of electrodiagnostic studies consistent with a neuropathy caused by the 

specific toxic substance

• Should include both needle EMG and nerve conduction studies (NCS).

Additional considerations 

for causation

Electrodiagnostic testing can distinguish some but not all toxic neuropathies from 

those due to other causes. There are many medical causes of peripheral 

neuropathy, especially sensorimotor neuropathies. Physician review required. 

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure.

.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 18.1 Back to Top

April 2017 (Page 13 of 13) Appendices

ENCEPHALOPATHY, CHRONIC TOXIC

 

Criteria Common characteristics for the diagnosis of the medical condition

DOE exposure criteria* DOE Facilities

Specific job titles/ processes 

Applicable dates

Latency* Years

Medical Evidence for 

illness and diagnostic 

testing criteria

A written diagnosis of chronic toxic encephalopathy (or analogus condition) made by a 

medical doctor

And

A formal neuropsychological assessment that included a battery of neurobehavioral 

tests is consistent with the diagnosis.

Appropriate neuroimaging studies (e.g., brain MRI, head CT) have been performed to 

investigate findings consistent with the diagnosis, or suggestive of unrelated causes.

Additional 

considerations for 

causation

Some patterns on the history and neurobehavioral test profile may be more consistent 

with chronic toxic encephalopathy than with unrelated causes (e.g., greater 

decrements in performance vs. verbal IQ). Physician review is required.

* The actual latency period for the development of this disease is a function of the specific causative toxic substance 

as well as the duration and intensity of exposure.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-1 Back to Top

April 2017 Appendices

DOJ Response to Request for Identification of RECA Claim

District Director

U.S. Department of Labor 

EEOICP

1999 Broadway, Suite 1120 

Denver, CO 80202-5711 

RE: John M. Doe, DOL Cl. No. 211-16-0000; DOL Cl. No. 999-99-9999 

Dear [District Director]:

 We have conducted a search of our records and have determined that the claim 

filed on behalf of John M. Doe by his eligible surviving beneficiary, Jane M. Doe, was 

approved for an award under Section 5 of the Radiation Exposure Compensation Act, 42 

U.S.C. § 2210 note (2000), amended by Pub. L. No. 107-273 (2002), on August 1, 2001, 

for the following medical condition: Pulmonary fibrosis, Fibrosis of the Lung, Lung 

Cancer, Cor Pulmonale, Chronic Renal Disease, Silicosis, and Pneumoconiosis, Moderate 

to Sever. Please feel free to contact me with any questions, comments or concerns you 

may have. 

 Very Truly Yours,

 Claudia B. Gangi

 Trial Attorney

Civil Division

 United States Department of Justice

 Ben Franklin Station 

 Washington, D.C. 20044-0146 

SUPERSEDED

 (202) 616-4138
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-2 Back to Top

April 2017 Appendices

Letter to DOJ for RECA Award Confirmation 

U.S. DEPARTMENT OF LABOR Employment Standards Administration

Energy Employees’ Occupational Illness Compensation

1999 Broadway, Suite 1120

Denver, CO 80202-5711

Date:

US DEPARTMENT OF JUSTICE

RECA PROGRAM

1425 NEW YORK AVE. NW, ROOM 3148 

WASHINGTON, DC 20005 [All letters to this address must be grouped together and sent 

via an overnight carrier] 

Re: Employee:

Employee SSN:

Dear:

The U.S. Department of Labor (DOL) has received a claim for benefits under the Energy 

Employees Occupational Illness Compensation Program Act (EEOICPA) regarding the abovereferenced employee. Please see attached EE-1/EE-2 claim form. The claimant seeks benefits as 

a Radiation Exposure Compensation Act (RECA) uranium worker or survivor of a uranium 

worker under the EEOICPA. Accordingly, DOL requests the following information from the 

Department of Justice (DOJ) so that the claim under the EEOICPA may be processed:

 1. Confirmation of entitlement under Section 5 of the RECA; 

2. If an award has not been issued, then advise if a Section 5 RECA claim is 

pending. If pending, please provide DOL with a letter that includes a factual 

statement verifying dates and places of employment covered under Section 5 of 

the RECA and a copy of all employment, medical and identification records in 

DOJ’s possession regarding the employee. If the claim is denied at a later date, 

please provide information under the criteria set out below; 

3. If DOJ denied the Section 5 RECA claim, please provide DOL with all 

employment, medical and identification records in DOJ’s possession regarding 

the employee and a copy of DOJ’s decision in this matter; 

4. If no Section 5 RECA claim has been filed, please provide DOL with a letter 

SUPERSEDED

verifying dates and places of employment covered under Section 5 of the RECA. 
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-2 Back to Top

April 2017 (page 2 of 2) Appendices

DOL appreciates your cooperation so that we may fully adjudicate the above-referenced claim 

for benefits under the EEOICPA. Should you have any questions or concerns, please do not 

hesitate to contact me.

Sincerely, 

Claims Examiner

Enclosures: EE-1 or EE-2

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-3 Back to Top

April 2017 Appendices

Alternate Letter to DOJ for RECA Documentation

U.S. DEPARTMENT OF LABOR Employment Standards Administration

Energy Employees’ Occupational Illness Compensation

1999 Broadway, Suite 1120

Denver, CO 80202-5711

Date:

US DEPARTMENT OF JUSTICE

RECA PROGRAM

1425 NEW YORK AVE. NW, ROOM 3148

WASHINGTON, DC 20005 [All letters to this address must be grouped together and sent 

via an overnight carrier] 

Re: Employee:

Employee SSN:

Dear:

The U.S. Department of Labor (DOL) has received a claim for benefits under the Energy 

Employees Occupational Illness Compensation Program Act (EEOICPA) regarding the abovereferenced employee. Please see attached EE-1/EE-2 claim form. The claimant seeks benefits as 

a Radiation Exposure Compensation Act (RECA) uranium worker under the EEOICPA. 

As the claimant seeks benefits for a medical condition not covered under the RECA, please 

provide DOL with a letter that includes a factual statement verifying dates and places of 

employment covered under Section 5 of the RECA and all employment, medical and 

identification records in DOJ’s possession regarding the employee. Please also include a copy of 

any DOJ decision in this matter if it has not been submitted. 

DOL appreciates your cooperation so that we may fully adjudicate the above-referenced claim 

for benefits under the EEOICPA. Should you have any questions or concerns, please do not 

hesitate to contact me.

Sincerely, 

Claims Examiner

Enclosures: EE-1 or EE-2

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-4 Back to Top

April 2017 Appendices

DOJ Response to Request for Identification of Pending RECA Claim

District Director

U.S. Department of Labor 

EEOICP

1999 Broadway, Suite 1120 

Denver, CO 80202-5711 

RE: John M. Doe, DOL Cl. No. 211-16-0000; DOL Cl. No. 999-99-9999 

Dear [District Director]:

 We have conducted a search of our records and have determined that Jane M. Doe 

filed a claim on behalf of John M. Doe under Section 5 of the Radiation Exposure 

Compensation Act, 42 U.S.C. § 2210 note (2000), amended by Pub. L. No. 107-273 

(2002) (“RECA”), on August 1, 2001. Please note that the RECA claim is still pending. 

Feel free to contact me with any questions, comments or concerns you may have. 

 Very Truly Yours,

 Claudia B. Gangi

 Trial Attorney

 Civil Division

 United States Department of Justice

 Ben Franklin Station 

 Washington, D.C. 20044-0146 

SUPERSEDED

 (202) 616-413
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-5 Back to Top

April 2017 Appendices

DOJ Letter Indicating No Claim Filed

[District Director]

District Director

U.S. Department of Labor 

EEOICP

1999 Broadway 

Suite 1120 

Denver, CO 80202-5711 

RE: John M. Doe, DOL Cl. No. 211-16-0000; DOL Cl. No. 999-99-9999 

Dear [District Director]:

 We have conducted an extensive search of our records and have determined that 

no one has filed a claim on behalf of John M. Doe under Section 5 of the Radiation 

Exposure Compensation Act, 42 U.S.C. § 2210 note (2000), amended by Pub. L. No. 

107-273 (2002). Please feel free to contact me with any questions, comments or concerns 

you may have. 

 Very Truly Yours,

 Claudia B. Gangi

 Trial Attorney

 Civil Division 

 United States Department of Justice

 Ben Franklin Station 

 Washington, D.C. 20044-0146 

 (202) 616-4138 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-6 Back to Top

April 2017 (Page 1 of 2) Appendices

Letter to Claimant Advising of Part B RECA Award Requirement

U.S. DEPARTMENT OF LABOR Employment Standards Administration

Energy Employees’ Occupational Illness Compensation

1999 Broadway, Suite 1120

Denver, CO 80202-5711

1-888-805-3389 (toll-free)

Date:

Claimant Name Uranium Worker: 

Street Address SSN: 

City, State Zip RECA Claim No.: 

Dear Claimant:

We are in receipt of the claim you filed under the Energy Employee Occupational Illness 

Compensation Program Act (EEOICPA). The information you provided on your claim form 

indicates that (uranium worker’s name) was a uranium worker. 

The Denver District Office contacted the Department of Justice on (Date Contacted) to request 

verification that you have been approved for an award under Section 5 of the Radiation Exposure 

Compensation Act (RECA). On (Date Replied), the Department of Justice confirmed that they 

have not received a claim from you under the RECA. 

Uranium workers are not covered under Part B of the EEOICPA unless they have received a 

notice of award from the Department of Justice under Section 5 of RECA. The first step in 

pursuing a claim under Part B of the EEOICPA with the Division of Energy Employees 

Occupational Illness Compensation Program (DEEOICP) is to file a claim with the Department 

of Justice under Section 5 of RECA. 

This letter serves as official notification that you have 60 days from the date of this 

correspondence to file a claim with the Department of Justice under Section 5 of RECA. It is 

your responsibility to provide this office with proof that you have filed with the Department of 

Justice under Section 5 of RECA. 

If you do not file a claim with the Department of Justice or provide proof of filing to the 

DEEOICP within the allotted 60 days, this office will render a decision on your Part B 

EEOICPA claim. Your Part E claim is not dependent on a Section 5 RECA award and is 

presently under development. 

The Department of Justice may be contacted at:

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-6 Back to Top

April 2017 (Page 2 of 2) Appendices

U.S. Department Of Justice

Radiation Exposure Compensation Program 

P.O. Box 146 

Ben Franklin Station

Washington, D.C. 20044-0416 

Or by calling:

1-800-729-7327 

Sincerely, 

Name

Claims Examiner

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 19-7 Back to Top

April 2017 Appendices

Letter to DOJ for Section 4 RECA Claim Status 

U.S. DEPARTMENT OF LABOR Employment Standards Administration

Energy Employees’ Occupational Illness Compensation

1999 Broadway, Suite 1120

Denver, CO 80202-5711

Date:

US DEPARTMENT OF JUSTICE

RECA PROGRAM

1425 NEW YORK AVE. NW, ROOM 3148

WASHINGTON, DC 20005 [All letters to this address must be grouped together and sent 

via an overnight carrier] 

Re: Employee:

Employee SSN:

Dear:

The U.S. Department of Labor (DOL) has received a claim for benefits under the Energy 

Employees Occupational Illness Compensation Program Act (EEOICPA) regarding the abovereferenced employee. Please see the attached EE-1 or EE-2 claim form. The employee (or a 

beneficiary of the employee), has indicated that they are seeking benefits under the Radiation 

Exposure Compensation Act (RECA) section 4. 

To make a determination of eligibility under the EEOICPA, the Department of Labor requires 

information on the status of the RECA section 4 claim. Please provide the following:

• Copy of any RECA section 4 award or denial notice 

• If a RECA section 4 award was granted, but the claimant has elected to reject payment, 

provide DOL with a copy of the Acceptance of Payment form, indicating such election. 

DOL appreciates your assistance. Please mail any correspondence or other documentation to the 

address listed above. Should you have any questions or concerns, please do not hesitate to 

contact me.

Sincerely, 

Name

Claims Examiner

Enclosures: EE-1 or EE-2 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 20-1 Back to Top

April 2017 (Page 1 of 2) Appendices

Sample Letter to Potential Survivor Advising of 

Right to File Claim

Dear Claimant Name:

We have been advised that you may be an eligible survivor of the above-named employee under 

the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA). 

Enclosed is Form EE-2, Claim for Survivor Benefits under EEOICPA. If you wish to be 

included in the claim for survivor benefits under our program, please complete the EE-2 form 

and return it to this office at the address noted above at your earliest convenience.

Once we receive your completed form, your claim will be added to the existing case file. We 

will use the Case ID number referenced above, so please include this Case ID number in any 

future correspondence or telephone inquiries concerning your claim. 

If you have knowledge of other individuals who may also be entitled to claim benefits as a 

survivor of your [enter survivor’s relationship to deceased], please include their contact 

information on the EE-2 form, including name, address, and telephone number (if known). 

For claims under Part B of the EEOICPA, the definition of an “eligible survivor” and the order 

of payment are as follows: 

1. If there is a living spouse (married to the employee for at least one year immediately 

before the death):

a. Spouse receives entire amount; 

b. UNLESS there is at least one child of the employee who is a minor at the time of 

payment and not a child of the spouse – in which case half of the award goes to the 

spouse and the rest is split between all living minor children of the employee. 

2. If there is no living spouse, the award will be given in the following order: 

a. Living children; 

 b. If none of the above, to living parents of the employee;

c. If none of the above, to living grandchildren of the employee;

d. If none of the above, to living grandparents of the employee. 

For claims under Part E of the EEOICPA, the definition of an “eligible survivor” and the order of 

payment are as follows:

1. If there is a living spouse (married to the employee for at least one year immediately 

before the death):

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 20-1 Back to Top

April 2017 (Page 2 of 2) Appendices

a. Spouse receives entire amount; 

b. UNLESS there is at least one living child of the employee at the time of the payment 

who is also a “covered child” under Part E (i.e., under the age of 18 years at the time of 

the employee’s death, or under the age of 23 years and continuously enrolled as a fulltime student since attaining the age of 18 at the time of the employee’s death, or any age 

and incapable of self-support at the time of the employee’s death) and not a child of the 

spouse – in which case half of the award goes to the spouse and the rest is split between 

all “covered children” of the employee living at the time of payment.

2. If there is no living spouse, the award will be split between all “covered children” of the 

employee who are living at the time of payment. 

Although there is no time limit for the filing of a claim for benefits under the EEOICPA, we ask 

that you respond to this request within 30 days from the date of this letter in order to prevent any 

delay in the adjudication and awarding of benefits for this case. 

Also, please note that filing a claim does not guarantee your eligibility for benefits under the 

EEOICPA. Additional investigation will be required to determine if all statutory and regulatory 

requirements have been met before compensation can be awarded.

If you have any questions, please feel free to call or write us at the above address. 

Sincerely,

Claims Examiner 

(City) Office

Enclosure: EE-2, Claim for Survivor Benefits

 EE-3, Employment History 

 EE-7, Medical Requirements

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 20-2 Back to Top

April 2017 Appendices 

Sample Alternative Filing Acknowledgement Letter

Date Employee:

 Case ID:

 

Requester name

Address 

City, State, Zip Code 

Dear Mr./Mrs. Requester:

I am writing concerning the alternative filing request you filed under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA) to receive a determination as to 

whether your [employee relationship to survivor] contracted an illness as a result of exposure 

to a toxic substances while working at [facility]. 

Under the EEOICPA implementing regulations (20 CFR § 30.101(f)), a finding can be made by 

the program acknowledging the hazards faced by a deceased employee who worked in the 

Department of Energy atomic weapons program, even when there are no qualifying survivors 

eligible to receive benefits.

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) will 

investigate the details of your [relationship’s] employment history to determine if he/she

contracted an illness as a result of occupational exposure to a toxic substance while working at a 

DOE facility. You will receive a determination letter outlining the results of this investigation.

You should be aware that the information gathered as a result of this investigation does not 

change your eligibility to receive compensation under the EEOICPA. Additionally, the results 

reported to you cannot be used as evidence that your [relationship’s] illness was caused by 

his/her employment for the purposes of any law suit or workers’ compensation program, 

including the EEOICPA. 

Should you wish to have your case fully investigated and adjudicated, you can choose to file a 

claim at any time. If you file a claim, after gathering and assessing the necessary evidence, you 

would receive a recommended and final decision. You will need to complete and submit a form 

EE-2 (which can be found on DOL’s website at 

http://www.dol.gov/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf, the District Offices, 

or any Resource Center) to begin the adjudication process. 

Sincerely,

Claims Examiner, 

(City) Office

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 20-3 Back to Top

April 2017 Appendices

Sample Alternative Filing Determination Letter

Date Employee:

 Case ID:

 

Requester name

Address 

City, State, Zip Code 

Dear Mr./Mrs. Requester:

I am writing concerning the alternative filing request you filed under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA) to receive a determination as to 

whether your [employee relationship to survivor] contracted an illness as a result of exposure 

to toxic substances while working at [facility]. 

The following determination is intended to provide a measure of closure to you and your family, 

and should serve as recognition of your [employee’s relationship to the claimant]’s 

extraordinary service and sacrifice on behalf of our country. 

 

[Description of the findings] 

Again, this assessment DOES NOT change your eligibility for benefits or establish causation 

under the Act, and is not subject to further agency or judicial review. 

If you so desire, DOL will undertake full adjudication of the facts of this case. You will need to 

complete and submit a form EE-2 (which can be found on DOL’s website at, 

http://www.dol.gov/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf, the District Offices, 

or any Resource Center) to begin the adjudication process. The outcome of a full investigation 

of the circumstances of the claim may not result in a change of your status as an ineligible 

survivor, and upon issuance of a final decision in your case, you still may not be entitled to 

EEOICPA benefits.

Sincerely,

District Director, 

(City) Office

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-1 Back to Top

April 2017 Appendices

Not at MMI Letter

U.S. Department of Labor 

Office of Workers’ Compensation Programs

Division of Energy Employees Occupational 

Illness Compensation

 

Date 

Case ID Number: 

Employee: 

 

Name

Address 

Address 

Dear Mr./Mrs. Last Name: 

I am writing to inform you that we are unable to make a determination on your claim for 

impairment benefits under Part E of the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA).

In order to determine whether you have sustained a permanent impairment, the physician must 

conclude that your accepted condition is well stabilized and unlikely to improve substantially 

with or without medical treatment; this is called maximum medical improvement or MMI. The 

medical evidence shows your condition has not reached this state; therefore, we cannot 

determine your impairment rating at this time.

Your impairment claim will be administratively closed until your condition has reached MMI. 

At that time, please submit your physician’s opinion and we will reopen your impairment claim

and resume development. 

If at any time you would like to discuss this issue further, please do not hesitate to contact our 

office, toll-free, at ( ) . If it is more convenient, you may visit one of our local 

resource centers for additional help. 

Sincerely,

Printed Name

Claims Examiner

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-2 Back to Top

April 2017 Appendices

Not Claiming Impairment Letter

U.S. Department of Labor 

Office of Workers’ Compensation Programs

Division of Energy Employees Occupational 

Illness Compensation

 

Date 

Case ID Number: 

Employee Name: 

 

 

Name

Address 

Address 

Dear Mr./Ms. Last Name: 

This is regarding your claim for benefits under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). On Date of Letter or Phone Call you advised us that 

you do not want to pursue a claim for impairment. 

I would like to thank you for taking the time to consider our request to file for an award. Please 

note that your decision at this time does not relinquish your right to file a claim for impairment in 

the future. Therefore, we will not undertake further development for impairment at this time. 

Should you wish to pursue a claim in the future, please notify us in writing at the address above. 

If you have any questions about your claim or other benefits available under this program, do not 

hesitate to call me, toll-free, at ( ) . If it is more convenient, you may visit one of our 

local resource centers for additional help. 

Sincerely,

Printed Name

Claims Examiner

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-3 Back to Top

April 2017 (Page 1 of 2) Appendices

Impairment Eligibility Letter to Physician

U.S. Department of Labor 

Office of Workers’ Compensation Programs

Division of Energy Employees Occupational 

Illness Compensation

Date 

 CASE ID NUMBER: 

EMPLOYEE: 

Medical Provider

Street Adress

City, State, Zip Code 

Dear Medical Provider;

Our office has determined that the above employee is eligible for an impairment evaluation 

under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) in 

relation to the following accepted illness Insert name AND ICD-9/10 of covered illness. 

Employee name has identified you as his/her choice to perform an impairment evaluation in 

relation to his/her covered illness. The Division of Energy Employees Occupational Illness 

Compensation (DEEOIC) will cover the cost of the impairment evaluation as long as the 

condition has reached a point where further improvement is not expected (Maximum Medical 

Improvement/MMI), or the employee is considered to be in the terminal stages of the illness. The 

evaluation must also be performed within one year of the date DEEOIC receives the completed 

impairment report, and not performed prior to Filing date (the date he/she filed for benefits under 

the EEOICPA). The evaluation must be performed in accordance with the 5th Edition of the 

American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA’s 

Guides), with specific page and table references included in your report. 

Physicians who perform impairment evaluations for the DEEOIC must hold a valid medical 

license and Board certification/eligibility in their field of expertise (e.g., toxicology, pulmonary, 

neurology, occupational medicine, etc.). The physician must also meet at least one of the 

following criteria: 

• is certified by the American Board of Independent Medical Examiners (ABIME) 

• is certified by the American Academy of Disability Evaluating Physicians (AADEP) 

• possesses knowledge and experience in using the AMA’s Guides 

• possesses the requisite professional background and work experience to conduct such 

ratings

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-3 Back to Top

April 2017 (Page 2 of 2) Appendices

When your impairment evaluation has been completed, please submit a letter to establish that 

you meet the criteria listed above. If you do not possess either the ABIME or AADEP 

certification, please submit a statement certifying and explaining your familiarity and years of 

experience in using the AMA’s Guides. 

Physicians may bill impairment evaluation using CPT Code 99455 or 99456 with ICD-9 code 

V70.9. 

Diagnostic services related to impairment evaluations must be billed with the appropriate CPT 

codes. Supporting documentation (e.g. medical reports, evaluation reports, assessment reports 

and diagnostic testing results) must be submitted with the completed Office of Workers’ 

Compensation Program (OWCP) Health Insurance 1500 Form (OWCP 1500). If you need a copy 

of the medical record in our case file to perform the impairment evaluation, please contact me. 

Reimbursement for these services will be in accordance with the OWCP fee schedule. 

Electronic versions of OWCP-1500 and the Provider Enrollment Package are available on-line 

at:

OWCP-1500 – http://www.dol.gov/owcp/dfec/regs/compliance/OWCP-1500.pdf 

Provider Enrollment Package - http://www.dol.gov/owcp/dfec/regs/compliance/OWCP1168.pdf

If you have any questions regarding this letter or impairment ratings in general, please contact 

me directly at (XXX) XXX-XXX.

Thank you for your assistance.

Sincerely,

Examiner name

Claims Examiner

Enclosures: 

Required Medical Evidence for Determining Impairment Rating By Specific ICD-9/10 Codes 

Examiner note: print appropriate section from Impairment Documentation for ICD9 template

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-4 Back to Top

April 2017 (Page 1 of 5 ) Appendices

Impairment Rating Requirements

If you elect to file an impairment claim, you will be required to provide Activities of Daily 

Living (ADL), along with the required medical records dated preferably within the last 12 

months. 

The ADLs must be provided by your Specialist Physician, Family Practitioner or Primary 

Physician in a letter or should be noted in your medical records (for example, History and 

Physical Examination) in order for the impairment rating to be performed. For your 

convenience, please take the attached sample ADL Questionnaire to your treating 

physician for his/her completion. Please remember your medical records and diagnostic 

examinations must include your current treatments and prescribed medications. This 

information should be dated within the last 12 months. However, if you have no additional 

medical records to provide, please inform our office in writing, so that we can proceed with 

your impairment claim.

Since you will not be physically examined by a Contract Medical Consultant (CMC), obtaining 

your current medical records and ADLs or equivalent record from your physician is important in 

determining your rating. The lack of medical information, could potentially affect your 

impairment rating. Below is an example of the ADL information needed from your physician, as 

referenced in the AMA’s Guides, Table 1-2. 

 

Table 1-2 Activities of Daily Living Commonly Measured 

 in Activities of Daily Living (ADL) and 

 Instrumental Activities of Daily Living (IADL) 

Scales

Activity Example

Self-care, personal hygiene Urinating, defecating, 

brushing teeth, combing hair, 

bathing, dressing oneself, 

eating

Communication Writing, typing, seeing, 

hearing, speaking

Physical activity Standing, sitting, reclining, 

walking, climbing stairs

Sensory function Hearing, seeing, tactile 

feeling, tasting, smelling

Nonspecialized hand 

activities

Grasping, lifting, tactile 

discrimination

Travel Riding, driving, flying

Sexual function Orgasm, ejaculation, 

lubrication, erection

Sleep Restful, nocturnal sleep 

SUPERSEDED

pattern
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-4 Back to Top

April 2017 (Page 2 of 5 ) Appendices

Activities of Daily Living Questionnaire Name: 

Case ID #:

Accepted Conditions ICD-9/10 

Code Condition @ MMI1

Rating Scale

(Each criteria is graded in level of dependence)

 1 – Performs independently without reminder or assistance

 2 – Performs with assistance or reminders

 3 – Unable to perform on own, even if assisted

 Yes No

 Yes No

 Yes No

See attached if more than 3 conditions

Is the claimant terminal? YES NO If YES, estimated timeframe: _____________________________________________

Since the employee will not be physically evaluated for impairment by a Department of Labor physician, the 

following information regarding the employee’s Activities of Daily Living (ADL) or equivalent information is required. 

Rate the activity based only on limitations caused or contributed to by the accepted condition(s). Address all items 

using the above rating scale to determine the person’s ability to perform the activity. 

Self-Care / Personal Hygiene Rating Additional comments concerning these activities

Dressing/undressing oneself

Eating

Meal preparation

Taking or managing medicine

Toileting – getting to and on/off toilet

Toileting – keeping self-clean and dry

Toileting – arranging clothes 

Bladder/Bowel control

Brushing teeth

Combing/brushing hair

Bathing

Light housekeeping

Communication Rating Additional comments concerning these activities

Writing

Typing

Seeing

Hearing

Speaking

Physical Activity Rating Additional comments concerning these activities

Standing

Sitting

Reclining

Walking

Climbing Stairs

 

1 Condition has reached maximum medical improvement (MMI) i.e. well-stabilized and unlikely to improve 

with medical treatment or not required if an illness is in a terminal stage.

SUPERSEDED
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______________________________________________________________________________ 

Version 1.0 Exhibit 21-4 Back to Top

April 2017 (Page 3 of 5) Appendices

Sensory Function Rating Additional comments concerning these activities

Hearing

Seeing

Tactile Feeling

Tasting

Smelling

Other: Non-specialized hand activities Rating Additional comments concerning these activities

Grasping

Lifting

Pulling/Pushing

Reaching up, down, out

Tactile Discrimination

Travel Rating Additional comments concerning these activities

Riding

Driving

Flying

Arranging travel for self

Transferring In and Out of: Rating Additional comments concerning these activities

Bed

Tub/Shower

Chair/Sofa

Vehicles

Sexual Function Yes No Additional comments concerning these activities

Orgasm

Ejaculation

Lubrication

Erection

Sleep Yes No Additional comments concerning these activities

Restful

Nocturnal Sleep Pattern

Provide any additional comments to explain what this person can or cannot do in their daily life (if additional 

space is needed, please provide a typed narrative report and attach it to this questionnaire): 

The information listed above is complete and accurate to the best of my knowledge:

Physician’s Printed Name

SUPERSEDED

Physician’s Signature Date
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-4 Back to Top

April 2017 (Page 4 of 5) Appendices

Activities of Daily Living 

Supplementary ADL Specific to: Breast Cancer

Name: 

Case ID#:

Is the patient at MMI for breast cancer and if so what date? MMI Yes No Date: 

1. Was removal of part or all of one or both breast required? If so, describe.

2. Is there resulting lymphedema in the affected arms? If so, describe severity. Is it partially or completely controlled 

with stockings?

3. Is there a resulting decrease of motion in affected extremities? If so, detail range of motion for those joints.

4. Is there any decrease in strength in the upper extremities? If so, describe on a scale of 0-5 with mention of involved 

motor nerves.

5. Is there decreased sensation in the affected extremities? If so, describe with mention of which sensory nerves.

6. Is there any intermittent or continuous pain of the chest wall? If so, describe.

 

 7. Has there been metastasis? If so, describe.

 Additional Comments:

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-4 Back to Top

April 2017 (Page 5 of 5) Appendices

Activities of Daily Living 

Supplementary ADL Specific to: Skin Cancer 

Name: 

Case ID#:

Is the patient at MMI for skin cancer and if so what date? MMI Yes No Date: 

1. Is the claimant limited to sun exposure? If so, describe.

2. Does the claimant have a significant deformity from the skin cancer affecting interpersonal relationships? If so, 

please describe.

3. Does the claimant have a deformity or scarring that limits range of motion of any joints? If so, please state joint and 

indicate range of motion.

4. Does the claimant require use of a prescriptive drug for the treatment of skin cancer, either intermittently or 

continuously? If so, please describe.

5. Does the claimant’s skin cancer limit any ADL other than sun exposure? If so, please describe.

6. Has there been metastasis? If so, please describe.

Additional Comments:

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 1 of 9) Appendices

Required Medical Evidence for Specific Conditions 

► Disorder of the Thyroid gland must have the following reported within the past year before impairment rating can 

take place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area(s) affected

• Any Biopsy information

• Surgical history of site

► Anemia must have the following reported within the past twelve months before impairment rating can take place:

Note from Physician with the following information:

• Current symptoms

• Need for transfusion and the intervals involved

• Current treatment(s) including prescriptions

o Complete Blood Count with differential (CBC with Diff)

► Tremor must have the following reported within the past twelve months before impairment rating can take place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area(s) affected:

o Motor strength

o Coordination

o Dexterity

• Functional Activity pertaining to Activity of Daily Living (ADL):

o Buttoning shirt

o Lacing shoes

o Performing peg tasks

• Current treatment(s)

► Peripheral Neuropathy, Polyneuropathy must have the following reported within the past twelve months before 

impairment rating can take place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the Upper Extremities

o Motor strength

o Coordination

o Dexterity

• Functional Activity pertaining to Activity of Daily Living (ADL): 

o Buttoning shirt

o Lacing shoes

o Performing peg tasks

• Physical exam findings of the Lower Extremity

o Motor strength

o Coordination

• Functional Activity pertaining to Activity of Daily Living (ADL): (Upper extremities)

o Standing (with/without mechanical support and/or assistive device)

o Walking

 With/without assistance

 Ability to start and stop walking

 Limited to level surface

 Difficulty with elevation/stairs

SUPERSEDED
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______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 2 of 9) Appendices

o Loss of stature

o Romberg Sign

• Current treatment(s)

Electromyography (EMG)

► Cataracts must have the following reported within the past year before impairment rating can take place:

Note from Physician with the following information:

Current symptoms

• Physical exam findings

• Current treatment(s)

• Surgical procedure(s)

Visual Acuity testing, corrected

Visual Field testing

► Hearing loss must have the following reported within the past twelve months before impairment rating can take place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area(s) affected

Tympanometry

Speech Discrimination test

Pure Tone Audiogram of both ears

► Chronic Sinusitis must have the following reported within the past twelve months before impairment rating can take 

place:

Note from Physician with the following information:

• Current symptoms including: headaches, balance problems

• Physical exam findings of the area(s) affected

• Current treatment(s) including prescriptions

Sinus CT

► Allergic Rhinitis must have the following reported within the past twelve months before impairment rating can take 

place:

Note from Physician with the following information:

• Current symptoms including headaches, balance problems

• Physical exam findings of the area(s) affected

• Current treatment(s) including prescriptions

► Emphysema, Chronic Obstructive Pulmonary Disease (COPD), Bronchitis, Asbestosis, Chronic Respiratory condition

must have the following reported within the past twelve months before impairment rating can take place:

Note from Physician with the following information

• Current symptoms

• Physical exam findings of the area(s) affected

• Current treatment(s) including prescriptions

Pulmonary Function Test (PFT) with DLCO with pre/post bronchodilator

► Liver Disease must have the following reported within the past twelve months before impairment rating can take 

place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area(s) affected

• Any Biopsy information

• Surgical history of site

• Nutritional Status and/or restriction

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Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 3 of 9) Appendices

• Current treatment(s) including prescriptions

Liver Function Test (LFTs)

► Upper Genitourinary Disease must have the following reported within the past twelve months before impairment 

rating can take place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area(s) affected

• Any Biopsy information

• Surgical history

• Current treatment(s) including prescriptions

• Need for Dialysis and its schedule

• Nutritional Status and/or restrictions

Kidney Function Test (Creatinine Clearance Test)

Serum Creatinine

Urine Analysis

► Bladder Disease must have the following reported within the past twelve months before impairment rating can take 

place:

Note from Physician with the following information:

• Current signs/symptoms (frequency, nocturia, loss of control, urgency, dribbling)

• Physical exam findings of the area(s) affected

• Any Biopsy information

• Surgical history

• Current treatment(s) including prescriptions

► Dermatitis, Skin Rash must have the following reported within the past twelve months before impairment rating can 

take place:

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area in question

• Activities of Daily Living (ADLs)

• Current treatment(s)

• Patch testing information when available

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 4 of 9) Appendices

Cancers

(in alphabetical order) 

All information has to be dated in the past 12 months including the diagnostic tests. 

Bladder Cancer

Note from Physician with the following information:

• Current symptoms to include urinary frequency/nocturia, reflex activity of the bladder

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs)

• Current treatment(s)

Breast Cancer 

Note from Physician with the following information:

• Current symptoms 

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs)

• Current treatment(s)

 

Colon Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Presence of any stomas

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Esophageal Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Presence of any stomas

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Gallbladder Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage, and jaundice

• Presence of any stomas

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Liver Function Tests (LFTs

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 5 of 9) Appendices

Hodgkin’s Lymphoma

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs)

• Current treatment(s)

Complete Blood Count (CBC) with differential

Pathology report if available

Hypo-pharyngeal Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Presence of any stomas

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

Laryngeal Cancer

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings

• Surgical history to the area

• Presence of any stomas

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

Leukemia (includes Acute/Chronic Lymphocytic Leukemia (ALL/CLL) and Acute/Chronic Myelocytic Leukemia 

(AML/CML))

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings including any liver or spleen abnormalities

• Activities of Daily Living (ADLs)

• Current treatment(s)

Complete Blood Count (CBC) with differential

Liver Function Tests (LFTs)

Liver Cancer

Note from Physician with the following information: 

• Current symptoms including nutritional status, weight loss and percentage, presence of 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 6 of 9) Appendices

• jaundice

• Physical exam findings of the area(s) affected including presence of ascites

• Surgical history to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Liver Function Tests (LFTs)

Lung Cancer

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings

• Surgical history to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Pulmonary Function Test (PFT)

Multiple Myeloma

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings including any spleen abnormalities

• Activities of Daily Living (ADLs)

• Current treatment(s)

Complete Blood Count (CBC) with differential

Myelodysplastic Syndrome

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings including any spleen abnormalities

• Activities of Daily Living (ADLs)

• Current treatment(s)

Complete Blood Count (CBC) with differential

Nasal Cancer

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings

• Surgical history to the area

• Presence of any stomas

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

Nasopharyngeal

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Presence of any stomas

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 7 of 9) Appendices

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

Kidney Cancer

See Renal Cancer

Pancreatic Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage, and jaundice

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Liver and Pancreatic Function Tests

Pharyngeal Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Presence of any stomas

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

Polycythemia Vera

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings including any spleen abnormalities

• Activities of Daily Living (ADLs)

• Current treatment(s)

Complete Blood Count (CBC) with differential

Prostate Cancer

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage along with urinary 

control and sexual function after surgery if prostatectomy was performed

• Physical exam findings including pain induced by metastatic lesions

• Activities of Daily Living (ADLs)

• Surgical history to the affected area

• Current treatment(s)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 8 of 9) Appendices

Renal Cancer

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings

• Need for dialysis and schedule

• Kidney transplant

• Surgical history to the affected area

• Presence of any stomas

• Activities of Daily Living (ADLs)

• Current treatment(s)

Kidney Function Test (Creatinine Clearance Test)

Serum Blood Urea Nitrogen (BUN) and Creatinine

Urine Analysis

Skin Cancer

Note from Physician with the following information:

• Current symptoms

• Physical exam findings of the area(s) affected

• Physical exam findings of the area in question

• Activities of Daily Living (ADLs)

• Current treatment(s)

Small Intestinal Cancer (duodenum, jejunum, ileum)

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Presence of any stomas

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

Thyroid Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs)

• Current treatment(s) and presence of other illnesses allowing for only partial hormone replacement

Tongue Cancer

Note from Physician with the following information:

• Current symptoms including weight loss and percentage

• Physical exam findings of the area(s) affected

• Remission status and number of years in remission

• Surgical History to the area

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-5 Back to Top

April 2017 (Page 9 of 9) Appendices

Tracheal Cancer

Note from Physician with the following information:

• Current symptoms including nutritional status, weight loss and percentage

• Physical exam findings

• Surgical history to the area

• Presence of any stomas

• Activities of Daily Living (ADLs) to include any limitation on diet

• Current treatment(s)

• Description of the Voice/Speech detailing: using the Table below

Please complete this task with and without use of assistive device for speech

 Audibility

 Intelligibility

 Functional Efficiency

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 21-6 Back to Top

April 2017 (Page 1 of 2) Appendices

Breast Impairment Letter

U.S. Department of Labor 

Office of Workers’ Compensation Programs

Division of Energy Employees Occupational 

Illness Compensation

 

Date CASE ID#: 

 EMPLOYEE: 

Medical Provider

street address

City, State, zip 

Dear Medical Provider;

 

The above-named employee filed a claim for whole body impairment as a result of breast cancer 

under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). 

 

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) requires 

impairment determinations to be performed in accordance with the 5th Edition of the American 

Medical Association’s Guide to the Evaluation of Permanent Impairment (AMA’s Guides). 

Moreover, to ensure that the employee’s impairment is fully rated, several factors must be 

considered and included in the evaluation report. These factors include: (1) the unilateral or 

bilateral absence of the breast; (2) the loss of function of the upper extremity, including range of 

motion, neurological abnormalities and pain, etc.; (3) skin disfigurement; and (4) other physical 

impairments affecting activities of daily living.

We would greatly appreciate a detailed narrative report from you, based on your examination 

that addresses the following: 

 

1. Has maximum medical improvement been reached? If so, what is the approximate 

date? DEEOIC defines maximum medical improvement as when the claimant’s condition 

is unlikely to improve substantially with or without medical treatment. 

 

2. Is there surgical absence of the breast(s)? Surgical absence of a breast is rated in 

accordance with AMA’s Guides, section 10.9, page 239 and is assigned a maximum of 

5% of the whole person. 

 

3. A description of the surgical site (if any) and mention of infections, ulcerations, grafts 

and any other factors that have affected the size and aspect of the scar and the presence of 

other skin abnormalities. If a rating for skin disfigurement/abnormalities is needed please 

use Chapter 8 in the AMA’s Guides. 

4. The effects of radiation or other therapies on any organ system represented by clinical 

findings and/or tests, as well as the ability to perform activities of daily living. 

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5. Other physical impairments related to the underlying condition including those 

mentioned under number 4 above. These need to be well documented and ratable under 

the AMA’s Guides. 

 

6. Your recommended percentage of impairment including a rationalized opinion as to 

how you arrived at the total impairment. This includes how you arrived at the 

impairment figure, referencing applicable tables and sections of the AMA’s Guides. It is 

important that you respond to each of these questions to ensure that the patient receives 

the maximum percentage of impairment allowed by the AMA’s Guides for his/her workrelated condition. The rating should be performed on the patient’s current level of 

impairment. Please note that the DEEOIC allows for periodic re-evaluations for future 

increases in permanent impairment.

Payment for the impairment evaluation and required diagnostic tests are covered by the 

DEEOIC. Physicians may bill impairment evaluation using CPT Code 99455 or 99456 with 

ICD-9 code V70.9. Diagnostic services related to impairment evaluations must be billed with 

the appropriate CPT codes. Supporting documentation (e.g. medical reports, evaluation reports, 

assessment reports and diagnostic testing results) must be submitted with the completed Office 

of Workers’ Compensation Program (OWCP) Health Insurance 1500 Form (OWCP 1500). 

Reimbursement for these services will be in accordance with the OWCP fee schedule.

If you have any questions or concerns regarding this letter or impairment ratings in general, 

please contact me directly at (XXX) XXX-XXXX. 

 

Thank you for your assistance.

 

Sincerely, 

Examiner Name

Claims Examiner

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April 2017 Appendices

Normal Social Security Retirement Age Table

Normal retirement age is the age at which an employee may receive unreduced Social 

Security retirement benefits. This age varies by date of birth and is set by section 216(1) 

of the Social Security Act, 42 U.S.C. 416(1). In general, persons born during or before 

1937 are eligible for unreduced Old Age, Survivors, and Disability Insurance (OASDI) 

(i.e. Social Security) retirement benefits at age 65. The eligibility age increases in twomonth increments for persons born between 1937 and 1960 until it reaches 67, which is 

the age at which persons born during or after 1960 become eligible for unreduced OASDI 

retirement benefits. 

• The normal retirement age is age 65 for a covered Part E employee born on 1/1/38 or 

earlier. 

• For a covered Part E employee born on 1/2/38 or later, please refer to the chart below 

for the normal retirement age respectively:

 

If the Birth Date is... The Normal Retirement Age is...

1/2/38 thru 1/1/39 65 years and 2 months 

1/2/39 thru 1/1/40 65 years and 4 months

1/2/40 thru 1/1/41 65 years and 6 months 

1/2/41 thru 1/1/42 65 years and 8 months

1/2/42 thru 1/1/43 65 years and 10 months 

1/2/43 thru 1/1/55 66 years 

1/2/55 thru 1/1/56 66 years and 2 months 

1/2/56 thru 1/1/57 66 years and 4 months 

1/2/57 thru 1/1/58 66 years and 6 months 

1/2/58 thru 1/1/59 66 years and 8 months 

1/2/59 thru 1/1/60 66 years and 10 months

1/2/60 and later 67 years 

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April 2017 Appendices

NOT CLAIMING WAGE-LOSS LETTER

Date 

Case ID: 

 Employee Name: 

 

 

Dear Mr./Ms. : 

This is regarding your claim for benefits under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). On Date of Letter or Phone Call you advised us that 

you do not want to pursue a claim for wage-loss.

I would like to thank you for taking the time to consider our request to file for benefits. Please 

note that your decision at this time does not relinquish your right to file a claim for wage-loss in 

the future. Therefore, we will not undertake further development for wage-loss at this time. 

Should you wish to pursue a claim in the future, please notify us in writing at the address above. 

If you have any questions about your claim or other benefits available under this program, do not 

hesitate to call me, toll-free, at ( ) . If it is more convenient, you may visit one of our 

local resource centers for additional help. 

Sincerely,

 

Claims Examiner

SUPERSEDED
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Version 1.0 Exhibit 22-3 Back to Top

April 2017 Appendices

FAX COVER SHEET TO SSA

Department of Labor 

Program – DEEOIC | Job Code - 8015

Primary Fax: 904-359-9294 |Secondary Fax: 904-359-9294

TO:

Social Security Administration

Planning Automation and Training Staff/HSS FROM:

FAX: 410-966-4210 PAGES:

PHONE: (410) 966-6995 || Donald Fair DATE:

RE: Itemized Statement of Earnings (581) Reject

Reject Reference #

CC:

 Urgent  For Review  Please Comment  Please Reply  Please Recycle

Comments: [Your comments here] 

Itemized Statement of Earnings (581) Reject fax

SUPERSEDED
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April 2017 Appendices

INQUIRIES TO SSA

SSN Range

(Last 4 digits)

Module 

Number

Help Desk 

Telephone No.

0000-0999 Mod 1 410-966-1247

1000-1999 Mod 2 410-966-5657

2000-3999 Mod 3 410-597-1045

4000-5999 Mod 4 410-966-8512

6000-7999 Mod 5 410-597-1061

8000-9999 Mod 6 410-597-1065

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April 2017 (Page 1 of 2) Appendices

Sample Listing of Medical Conditions 

with Likely Secondary Disorders

Disorders secondary to Chronic Beryllium Disease (CBD) or its treatment due to steroid use 

(such as Prednisone) 

• Airflow obstruction/wheezing (asthma-like presentation of CBD) 

• Right heart failure, Cor pulmonale 

• Pulmonary hypertension 

• Respiratory infections (Pneumonia, Acute Bronchitis) 

• Spontaneous Pneumothorax 

• Deconditioning secondary to chronic lung disease 

• Joint Aches (this is a symptom) 

• Hyperuricemia, Gout 

• Hypercalcemia/hypercalciuria

• Granulomatous Hepatitis

• Skin Nodules/Ulceration 

• Aggravation of sleep apnea due to hypoxemia of CBD 

• Weight gain

• Elevated blood pressure 

• Elevated Cholesterol and abnormal lipids 

• Liver function abnormalities

• Blood sugar change 

• Diabetes

• Eye/vision problems such as cataracts, glaucoma, and visual acuity changes 

• Gastrointestinal conditions such as gastric reflux or peptic ulcers 

• Psychiatric or psychological conditions such as depression or anxiety 

• Skin problems such as thrush or other fungal infections 

• Metabolic changes such as folic acid depletion

• Decreased immune response leading to infections and viruses

• Decreased bone density leading to osteoporosis/osteopenia 

Disorders secondary to Silicosis 

• Hypoxemia 

• Right heart failure, Cor pulmonale 

• Pulmonary Hypertension 

• Deconditioning secondary to chronic lung disease 

• Progressive Massive Fibrosis

• Silicotuberculosis

Disorders secondary to prednisone treatment 

• Cataracts

• Glaucoma

• Visual acuity changes 

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• Diabetes Mellitus 

• Osteoporosis 

• Osteopenia 

• Gastric reflux

• Peptic ulcers

• Elevated blood pressure 

• Elevated cholesterol

• Abnormal lipid profiles 

• Sleep disorders 

• Weight gain 

• Myopathy, dermal atrophy 

• Increased intracranial pressure

Other disorders 

• Oral thrush and other fungal infections secondary to inhaled steroids, 

immunosuppression 

• Folic acid depletion secondary to Methotrexate

• Infections due to immunosuppression (bacterial and viral) 

• Post-herpetic neuralgia secondary to Herpes Zoster

• Flare due to immunosuppression 

• Tinnitus – this condition is typically synonymous with sensorineural hearing loss. 

Tinnitus can be considered as a separate, stand alone condition or as consequential to 

sensorineural hearing loss.

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Sample Letter Decision

Date: Case ID:

Employee:

 

Name

Address

City, State, Zip Code 

Dear XXXXX:

This letter is in reference to your claim to receive medical benefits to treat your Lymphedema as 

a consequential illness resulting from the treatment for your accepted condition of breast cancer, 

under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). 

Medical evidence includes a letter dated January 1, 2015, in which Dr. John Smith stated that 

you have been diagnosed with breast cancer and had to undergo a radical mastectomy. As such, 

you developed lymphedema as a result of your radical mastectomy. 

Based on Dr. Smith’s statement, the medical evidence is sufficient to establish that your 

lymphedema is a result of treatment for your covered illness, breast cancer and is accepted as a 

covered consequential illness under Parts B and E of the EEOICPA guidelines. Medical benefits 

are approved for the treatment of your lymphedema (ICD-9 Code 457.1) retroactive to July 1, 

2013, the date of filing for your breast cancer. 

Covered medical services are payable in accordance with fee schedules and medical policy of the 

EEOICPA. The policy includes coverage of medical appointments, hospitalizations, appliances, 

supplies and drugs that are prescribed by a qualified physician and approved by the EEOICPA.

When you receive medical treatment you should show this letter to the medical provider you 

wish to designate as your treating physician and any other authorized medical provider who may 

treat you for your covered illnesses. Most physicians, hospitals, durable medical equipment 

providers, and other health care providers will bill the EEOICPA directly so that you will not 

have to pay for medical treatment covered under the Program. To bill directly, providers must be 

enrolled in the program. For information about enrollment and billing procedures, providers may 

contact the Program at the address and telephone number listed at the end of this letter. 

Note: If the EEOICPA pays less than the billed amount (in accordance with the fee schedule), 

you are not responsible for payment of the difference to a provider. Providers (and claimants) 

may submit requests for reconsideration of fee determinations in writing, with accompanying 

documentation to the address supplied at the end of this letter. 

The EEOICPA will reimburse you for the cost of covered services/items that you have 

personally paid, providing that you submit appropriate documentation to the Program’s billing 

address. However, bills and requests for reimbursement must be sent to EEOICPA within one 

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year after the end of the calendar year in which the service or supply was provided, or within a 

year after the end of the calendar year in which the condition was accepted, whichever is later. 

To request reimbursement of medical expenses associated with treatment of your accepted 

illnesses you are required to complete and submit the OWCP-915 form, Claim for Medical 

Reimbursement. You should also complete and submit the OWCP-957, Medical Travel 

Refund Request form with appropriate receipts when seeking reimbursement for travel 

expenses covered under the program. Both OWCP-915 and OWCP-957 forms (copies enclosed 

for convenience) include instructions for when you should complete these forms and the 

documentation required to process your request for reimbursement. 

All requests for reimbursement of covered treatment related expenses including travel are to be 

mailed to:

 Division of Energy Employees Occupational 

Illness Compensation

P.O. Box 8304 

London, KY 40742-8304 

If providers have questions regarding submission or payment of bills, or require any other 

medical bill program assistance, they may contact a representative at toll free 1-XXX-XXXXXXX.

Sincerely,

_______________________ _____________ 

(Name) Date

Claims Examiner

_______________________ ______________ 

(Name) Date

Supervisor 

Enclosures: 

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April 2017 (Page 1 of 2) Appendices

Sample Cover Letter

Dear [NAME]:

Enclosed is the Notice of Recommended Decision of the district office concerning your claim for 

compensation under the Energy Employees Occupational Illness Compensation Program Act 

(EEOICPA or Act). The district office recommends acceptance of your claim for skin cancer 

under both Part B and Part E of the EEOICPA. As such, it is recommended that you be awarded 

$150,000.00 under Part B, as well as medical benefits under Parts B and E of the Act. Please 

note that this is only a RECOMMENDATION; this is not a Final Decision. We caution 

against making financial commitments based on the anticipated receipt of an award. The 

Recommended Decision has been forwarded to the Final Adjudication Branch (FAB) for their 

review and issuance of the Final Decision. 

Please read the Notice of Recommended Decision and Claimant Rights carefully, as it 

recommends an acceptance of some benefits and denial of others. You have several choices. 

Consider your options carefully as your choice will affect your ability to raise objections, as well 

as the steps the FAB takes in issuing a Final Decision. 

(Insert this paragraph when the decision was made using a CMC report) In arriving at this 

decision, the district office received the opinion of a Contract Medical Consultant (CMC) who 

reviewed all the medical records contained in your file and provided an opinion on your case. If 

you would like to review the CMC’s report, you may send your request to: 

U.S. Department of Labor, FAB 

P.O. Box 8306 

London, KY 40742-8306 

The request should indicate that you are requesting the “CMC Report”; include your full name, 

file number, signature, and address to which you want us to send the records.

If you have a disability (a substantially limiting physical or mental impairment), please contact our office/claims 

examiner for information about the kinds of help available, such as communication assistance (alternate formats or 

sign language interpretation), accommodations and modifications. 

State Workers’ Compensation: If you receive or have received any benefit (with the exception 

of medical 

benefits or vocational rehabilitation) from a state workers’ compensation program for any of the 

same conditions being recommended for acceptance in this decision under Part E, you must 

notify the FAB immediately. This includes any benefits received after the issuance of this 

Recommended Decision (remove this paragraph if the decision is a denial or Part B decision). 

Tort Actions: If anyone receives or has received any form of benefit (money, medical benefits, 

etc.) based on a lawsuit claiming that the employee was harmed from the same type of exposure 

(e.g. asbestos, radiation, beryllium, or any other toxic substance) upon which the EEOICPA 

claim is being recommended for acceptance in this decision, the FAB must be notified 

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immediately. This includes any benefits received after the issuance of this Recommended 

Decision (remove this paragraph if the decision is a denial). 

Should you have any questions concerning the recommendation, you may call the FAB, toll free, 

at: (FAB Office telephone number)

Sincerely,

Claims Examiner

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______________________________________________________________________________ 

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Sample Recommended Decision, Accept

EMPLOYEE: [NAME]

CLAIMANT: [NAME]

CASE NUMBER: XXXXXXXX

 

NOTICE OF RECOMMENDED DECISION

This is a Recommended Decision of the district office concerning your claim for benefits under 

the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or Act). 

The district office recommends acceptance of your claim for skin cancer under both Part B and 

Part E of the EEOICPA, and recommends that you be awarded lump-sum compensation under 

Part B of $150,000.00, as well as medical benefits under Parts B and E of the Act. 

STATEMENT OF THE CASE

The evidence of record shows that on June 24, 2006, you filed a claim for benefits under both 

Parts B and E of the EEOICPA, claiming that you had developed skin cancer as a result of your 

employment at a Department of Energy (DOE) facility. A pathology report of November 27, 

2001 provided confirmation of diagnosis with basal cell carcinoma (BCC) of the left arm. 

You claimed that you worked as a scientist at the Savannah River Site (SRS) in Aiken, S.C., 

from September 1, 1974 through April 1, 2004. The DOE was able to verify your employment at 

the SRS with E.I. DuPont from September 1, 1974 until June 1, 1989; and with Westinghouse 

from April 1, 1989 to February 28, 2004. 

In development of your Part B claim, the district office forwarded relevant claim documentation 

to the National Institute for Occupational Safety and Health (NIOSH) for a radiation dose 

reconstruction. NIOSH used this information to estimate your exposure to occupational radiation 

and complete a dose reconstruction report. With the return of the completed dose 

reconstruction, the district office then applied the does estimate in a calculation to determine the 

probability that your cancer was related to exposure to radiation during your employment at the 

SRS. In this case, the probability was calculated to be 57.6%, which exceeds the 50% 

requirement for compensability. 

EXPLANATION OF FINDINGS

The issue for determination in this case is whether you are eligible to receive benefits under Part 

B and Part E for the claimed conditions of skin cancer. 

As outlined above, the district office verified your employment with E.I DuPont and 

Westinghouse, both known DOE contractors at the SRS. Additionally, medical evidence 

submitted in support of your claim established your diagnosis with skin cancer. Accordingly, you 

meet the employment and diagnostic criteria of the EEOICPA.

SUPERSEDED
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In order for your Part B claim to be compensable, it must be established that the claimed skin 

cancer was “at least as likely as not” (a 50% or greater probability) related to occupational 

exposure to radiation. In your case, the district office used the results of a dose reconstruction to 

calculate a probability of causation (PoC) of 57.6. This exceeds the 50% threshold for 

compensability. Accordingly, the district office recommends acceptance of your Part B claim.

 

With regard to your Part E claim, the evidence shows that you worked as a contractor employee 

at the SRS site, a requirement for a compensable Part E claim. In addition, with the finding of a 

compensable Part B occupational illness, the same illness is accepted as work-related under Part 

E. As you have qualifying contractor employment, and the evidence of record establishes that 

you have a qualifying occupational illness, the district office also recommends acceptance of that 

your Part E claim.

Finally, in accordance with EEOICPA regulations, you have submitted Form EN-16, declaring 

that you have neither filed a tort suit nor received any settlement or award from a claim or suit 

related to an exposure for which you are eligible to receive compensation under the Act. You 

also declared that you have neither filed for nor received any state workers’ compensation 

benefits on account of the claimed illness. Lastly, you have declared that you have neither pled 

guilty to nor been convicted on any charges of having committed fraud in connection with an 

application for or receipt of benefits under the Act or any other federal or state workers’ 

compensation law. 

CONCLUSIONS OF LAW

Based on the above, the district office recommends acceptance of your claim for benefits for the 

condition of skin cancer be accepted under both Part B and Part E of the Act. It is recommended 

that you be awarded lump-sum compensation of $150,000.00 under Part B of the EEOICPA, as 

well as medical benefits for this illness under Parts B and Part E, commencing the date of claim 

filing.

Prepared by:

 

_____________________________ ____________ 

(Name of Appropriate Signatory) Date

(Title)

(District Office)

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Sample Recommended Decision, Denial

EMPLOYEE: [NAME]

CLAIMANT: [NAME]

CASE NUMBER: XXXXXXXX

 

NOTICE OF RECOMMENDED DECISION

This is a Recommended Decision concerning your claim for benefits under the Energy 

Employees Occupational Illness Compensation Program Act (EEOICPA or Act). The district 

office recommends a denial of your Part E claim for liver disease.

STATEMENT OF THE CASE

The history of your claim shows that you have filed for and received several final decisions 

regarding medical conditions you claimed as being related to occupational exposure to toxic 

substances. As part of the development of those prior claims, the district office has accepted that 

you worked for a Department of Energy (DOE) contractor at the Lawrence Livermore National 

Laboratory (LLNL). Specifically, you were an administrative assistant between July 18, 1989 

and September 1, 1994. 

Recently, you filed a claim for the condition of liver disease. Along with your claim, you 

submitted a narrative report from your treating physician confirming your diagnosis with 

sarcoidosis of the liver. Additionally, you submitted a printout of toxic substances known to be 

present at LLNL, noting that both trichloroethylene and vinyl chloride were present at LLNL and 

claiming both contributed to the onset of liver disease. 

The DEEOIC evaluated all information available with regard to known links between chemical 

or biological agents and the development of liver sarcoidosis. This included reviewing 

employment, occupational and medical evidence in your case. Moreover, claims staff searched 

the Site Exposure Matrix (SEM) for any information on sarcoidosis. The SEM is an electronic 

repository of known toxic materials at covered DOE facilities, along with information on the 

known health effects of those exposures. None of the research conducted produced any 

compelling evidence to document that you were potentially exposed to any toxic substance, 

including trichloroethylene and vinyl chloride, during your employment, that are linked to 

sarcoidosis. 

To provide you additional opportunity to support your claim, the DEEOIC asked you to supply 

any evidence that might assist with the analysis of your claim. In particular, the district office 

requested you submit evidence to show that, during your employment at LLNL, you were 

exposed to any toxic substance linked to liver disease. No response from you was forthcoming. 

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EXPLANATION OF FINDINGS

As outlined above, the district office finds that you worked at the LLNL as an administrative

assistant between July 18, 1989 and September 1, 1994. 

Medical evidence submitted in support of your latest claim is sufficient to allow the district 

office to find that you have sarcoidosis of the liver, which a physician diagnosed in 2010. 

Accordingly, you meet the employment and diagnostic criteria under Part E of the Act. 

The issue for determination in this case is whether there exists sufficient evidence that 

occupational exposure to a toxic substance was “at least as likely as not” a significant factor that 

caused, contributed to, or aggravated your diagnosed condition of sarcoidosis. A toxic substance 

is defined under the Act as any biological, chemical or radioactive material that has the potential 

to cause illness or death. 

Research of case evidence and all other available resources did not reveal any known scientific 

link between any biological or chemical exposure and the onset of sarcoidosis. Further, case 

records contained no reference or other information linking your liver disease to a specific toxin 

to which you, as an administrative assistant, would have been exposed while working at LLNL. 

With regard to your assertions that trichloroethylene and vinyl chloride are linked to liver 

disease, our research has found no such scientific consensus. As mentioned, you were asked to 

submit probative evidence to support such a link’; however, you did not provide any further 

evidence for the district office evaluate. Moreover, research of records obtained from the DOE, 

including medical or employment records, revealed no evidence of your exposure to either 

trichloroethylene or vinyl chloride or any other hazard that is known to induce liver disease. The 

Site Exposure Matrix (SEM), which provides scientifically scrutinized information on the health 

effects of various toxins encountered at LLNL, also provided no data to show that an 

administrative assistant at LLNL had the potential to encounter any toxic substance in 

performance of their duties that is linked to sarcoidosis. 

Given the lack of information we were able to obtain regarding your claim, you were notified of 

the need for evidence, specifically evidence linking your illness to a toxin you encountered at 

LLNL. These requests also explained that you ultimately bore responsibility for providing the 

evidence necessary to establish your claim. Unfortunately, you provided no response. 

After reviewing all available evidence, there is presently no basis to conclude that occupational 

exposure was “at least as likely as not” a significant factor in aggravating, contributing to or 

causing your diagnosed disease of sarcoidosis. As such, the district office has to recommend that 

your Part E claim for liver disease be denied.

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April 2017 (Page 3 of 3) Appendices

CONCLUSIONS OF LAW

Based on the above, is the district office recommends a denial of your claim for liver disease 

under Part E of the Act. 

Prepared by:

 

_____________________________ ____________ 

(Name of Appropriate Signatory) Date

(Title)

(District Office)

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NOTICE OF RECOMMENDED DECISION AND CLAIMANT RIGHTS

The district office has issued the attached Recommended Decision on your claim under the 

Energy Employees Occupational Illness Compensation Program Act (EEOICPA). This notice 

explains how to file objections to the Recommended Decision. This notice also explains what to 

do if you agree with the Recommended Decision and want the Final Adjudication Branch (FAB) 

to issue a Final Decision before the 60-day period to object has ended. Read the instructions 

contained in this notice carefully. 

IF YOU WISH TO OBJECT TO THE RECOMMENDED DECISION: 

If you disagree with all or part of the Recommended Decision, you MUST file your objections 

within sixty (60) days from the date of the Recommended Decision by writing to the FAB at: 

U.S. Department of Labor, DEEOIC 

P.O. Box 8306 

London, KY 40742-8306 

If you want an informal oral hearing on your objections, at which time you will be given the 

opportunity to present both oral testimony and written evidence in support of your claim, you 

MUST request a hearing when you file your objections. If you have special needs (e.g., 

physical handicap, dates unavailable, driving limitations, etc.) relating to the scheduling 

(time and location) of the hearing, those needs must be identified in your letter to the FAB 

requesting a hearing. In the absence of such a special need request, the FAB scheduler will 

schedule the hearing and you will be notified of the time and place. If you do not include a 

request for a hearing with your objections, the FAB will consider your objections through a 

review of the written record, which will also give you the opportunity to present written evidence 

in support of your claim. If you fail to file any objections to the Recommended Decision within 

the 60-day period, the Recommended Decision may be affirmed by the FAB and your right to 

challenge it will be waived for all purposes.

IF YOU AGREE WITH THE RECOMMENDED DECISION: 

If you agree with the Recommended Decision and wish for it to be affirmed in a Final Decision 

without change, you may waive your right to object on the accompanying waiver form and 

forward it to the FAB at the above address. This action will allow the FAB to issue a Final 

Decision on your claim before the end of the 60-day period for filing objections. If you wish to 

object to only part of the Recommended Decision and waive any objections to the remaining 

parts of the decision, you may do so. In that situation, the FAB may issue a Final Decision 

affirming the parts of the Recommended Decision to which you do not object. 

BE SURE TO PRINT YOUR NAME, FILE NUMBER AND DATE OF THE 

RECOMMENDED DECISION ON ANY CORRESPONDENCE SUBMITTED TO THE 

FAB.

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Please be advised that the Final Decision on your claim may be posted on the agency’s website if 

it contains significant findings of fact or conclusions of law that might be of interest to the 

public. If it is posted, your Final Decision will not contain your file number, nor will it identify 

you or your family members by name.

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April 2017 Appendices

Sample Waiver

 

Case Number: 

 Employee:

 Claimant:

 Date of Decision:

U.S. Department of Labor, DEEOIC 

P.O. Box 8306 

London, KY 40742-8306 

Dear Sir or Madam:

I, _______________________, being fully informed of my right to object to any of the findings 

of fact and/or conclusions of law contained in the Recommended Decision issued on my claim 

for compensation under the Energy Employees Occupational Illness Compensation Program Act, 

do hereby waive those rights. 

_______________________ 

 Signature 

 _______________________ 

 Date

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April 2017 Appendices

Sample Partial Accept/Partial Denial Bifurcated Waiver 

 

Case Number: 

 Employee:

 Claimant:

 Date of Decision:

U.S. Department of Labor, DEEOIC 

Attn: Final Adjudication Branch

P.O. Box 8306 

London, KY 40742-8306 

Dear Sir or Madam: 

(Option 1) 

I, ____________________, being fully informed of my right to object to any of the findings of fact 

and/or conclusions of law contained in the Recommended Decision issued on my claim for 

compensation under the Energy Employees Occupational Illness Compensation Program Act, do 

hereby waive those rights only as those rights pertain to the portion of my claim recommended for 

acceptance. I do, however, reserve my right to object to the findings of fact and/or conclusions of 

law contained in the Recommended Decision that recommend denial of claimed benefits. 

I understand that should I choose to file an objection, I may either attach such objection to this form 

or submit a separate written objection to the address listed above within 60 days of the date of 

issuance of the Recommended Decision. 

_______________________ 

Signature Date

(Option 2)

I, ____________________, being fully informed of my right to object to any of the findings of fact 

and/or conclusions of law contained in the Recommended Decision issued on my claim for 

compensation under the Energy Employees Occupational Illness Compensation Program Act, do 

hereby waive those rights.

_______________________ 

Signature Date

(NOTE ON WAIVER: If you wish to file a waiver of objections, 

please select and sign only one of the above options. Select 

Option 1 to waive your right to object to the portion of your 

claim recommended for acceptance but reserve your right to 

object to the recommended denial of benefits. Select the Option 

2 to waive your rights to object to ALL findings and 

conclusions.) 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 Appendices

SAMPLE ACKNOWLEDGMENT LETTER, REVIEW OF WRITTEN RECORD

Date

Claimant Name and Address 

Employee:

Claimant:

Last 4 Digits of Claim Number:

Dear Claimant Name:

On [date objection letter received], the Final Adjudication Branch (FAB) received a letter of 

objection dated [date of letter] stating you object to the(district office)district office’s 

recommended decision of (date of RD) which recommends denial of your claim for benefits 

under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). 

Your objections, along with the information in the file, will be carefully considered and 

included in our final decision. If you have any additional evidence that you wish to be 

considered, it must be received by the FAB within 20 calendar days of this letter. After that 

date, a review of the written record will be made and a final decision will be issued. Any 

evidence you wish to be considered should be submitted to: 

U.S. Department of Labor 

DEEOICP

Final Adjudication Branch 

P.O. Box XXXX

City, State Zip Code 

If you wish, you may submit such evidence via fax to (xxx) xxx-xxxx. Please ensure that your 

file number shown above is noted on any documentation you send to this office. 

Sincerely,

Hearing Representative

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 25-2 Back to Top

April 2017 Appendices

Sample Acknowledgement Letter, Hearing

Dear Claimant Name:

The Final Adjudication Branch of the Division of Energy Employees Occupational Illness 

Compensation (DEEOIC) has received and docketed your letter dated ________, objecting to the 

recommended decision of the district office dated _________. Your request for a hearing has 

been noted and a hearing will be scheduled. 

Please be advised that your notification of the time, date and location of your hearing will be 

mailed at least 30 days prior to the date set for your hearing. The hearing will be conducted 

within a reasonable distance from your home at a government building or DEEOIC Resource 

Center. The hearing may be conducted with a FAB hearing representative in the hearing room or 

at another location via video teleconferencing. The hearing may also be held via telephone. At 

the hearing, you will be provided the opportunity to present your objections to the recommended 

decision, along with any additional evidence you would like to present. This testimony will be 

made under oath and transcribed by a court reporter for inclusion in your case file. If there is 

more than one claimant involved in this case, each is allowed to participate in the hearing. You 

may designate an attorney or other individual to be present and to represent you at the hearing. 

You are not, however, required to have a representative present at the hearing. 

If you prefer, you may have a hearing by telephone instead of in person. You should request that 

in writing as soon as possible so we can make appropriate arrangements. You may send that 

request by fax to (xxx) xxx-xxxx – ATTN: Hearings Unit. Any additional correspondence 

should be directed to: 

U.S. Department of Labor, EEOICP 

Attn: Final Adjudication Branch

PO Box xxxx 

City, State ZIP

Thank you for your cooperation.

Sincerely,

Hearing Representative

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (page 1 of 4) Appendices

SAMPLE HEARING NOTICE TO CLAIMANT WHO FILED AN OBJECTION

RE: NOTICE OF HEARING

 

Dear Claimant Name: 

A hearing has been scheduled concerning the above referenced claim under the Energy 

Employees Occupational Illness Compensation Program Act of 2000, as amended, 42 U.S.C. § 

7384 et seq. (EEOICPA). The hearing will begin promptly at TIME AM/PM on DAY, DATE at 

the following location: 

 

BUILDING NAME

STREET ADDRESS

CITY, ST ZIP-CODE

(XXX) XXX-XXXX (for directions only) 

Please bring a photo I.D. so that you may be admitted into the building. 

The specific issue to be addressed at the hearing: [If it is a Part E hearing request: The issue to be 

addressed at the hearing is whether you are entitled to compensation and benefits under Part E of 

the EEOICPA. If it is a Part B and Part E hearing request: The issues to be addressed at the 

hearing are whether you are entitled to compensation and benefits under Part B and Part E of the 

EEOICPA.] 

 

You must inform me of any person other than your authorized representative that will be 

attending the hearing with you not later than XXXXXX (1 week prior to the date of the hearing). 

Please be aware that in such circumstances, all claimants who have requested this hearing must 

sign a “WAIVER OF RIGHTS TO CONFIDENTIALITY.” Additionally, I will need to 

determine whether proper room arrangements can be made to accommodate the number of 

people expected to attend the hearing. 

Please be advised that the security requirements of the XXXXXXXX (Federal Building) require 

me to provide a list of all attendees. Anyone not on the list will not be admitted to the building 

and will not be able to attend the hearing. 

The hearing is an informal process, and I am not bound by common law or statutory rules of 

evidence or by technical or formal rules of procedure. During the hearing, you may state your 

arguments and present new written evidence and/or testimony in support of the claim. Oral 

testimony will be made under oath or affirmation and is recorded. The recording of the hearing 

proceedings is then transcribed and placed in the record. You will be provided a copy of the 

hearing transcript. You or anyone else present may not make your own video or audio recording 

of the hearing. 

I determine the conduct of the hearing and may terminate the hearing at any time I determine that 

all relevant evidence has been obtained or because of misbehavior on the part of the claimant 

and/or representative, or any other persons in attendance at or near the place of the hearing.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (page 2 of 4) Appendices

[Add this paragraph if the hearing concerns the POC] Since the issues raised relate to the dose 

reconstruction process, it is important for you to know that the National Institute for 

Occupational Safety and Health (NIOSH) has full authority under the regulations to complete the 

dose reconstruction as prescribed in its rules. The dose reconstruction is used by the Department 

of Labor to determine the probability that the claimed cancer is related to employment at a 

covered facility. During the hearing, I am not authorized to address NIOSH methodology and 

therefore will not be in a position to discuss the way in which NIOSH prepares the dose 

reconstruction. You may present your objections at the hearing, including any evidence or 

information you wish to submit and all arguments, evidence and information will be entered into 

the record. However, I can discuss only issues of a factual nature regarding the information you 

provided to NIOSH, and which that agency used to perform the dose reconstruction. 

I have attached additional information regarding the hearing procedures for your review. If you 

have any questions concerning these procedures, please feel free to contact me at 

(xxx) xxx-xxxx. 

Sincerely,

Hearing Representative

Enclosure

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (page 3 of 4) Appendices

HEARING PROCEDURES

BEFORE THE DATE OF THE HEARING: Before the date of the hearing, please submit any 

additional evidence that you wish me to consider. However, if such evidence is submitted on the 

date of the hearing or within thirty (30) days after the hearing, it will still be carefully considered 

and made part of the record. You must notify me at least one (1) week prior to the date of the 

hearing if persons other than claimants involved with the case, to include any properly appointed 

authorized representatives, will be attending the hearing. Please be aware that in such 

circumstances, all claimants who have requested this hearing must sign a “WAIVER OF 

RIGHTS TO CONFIDENTIALITY.” Additionally, I will need to determine whether proper 

room arrangements can be made to accommodate the number of people expected to attend the 

hearing. 

The hearing is an informal process, and I am not bound by common law or statutory rules of 

evidence or by technical or formal rules of procedure. During the hearing, you may state your 

arguments and present new written evidence and/or testimony in support of the claim. Oral 

testimony will be made under oath or affirmation and is recorded. The recording of the hearing 

proceedings is then transcribed and placed in the record. You will be provided a copy of the 

hearing transcript. You may not make your own video or audio recording of the hearing. 

NO POSTPONEMENT WILL BE GRANTED UNLESS EXTREMELY COMPELLING 

CIRCUMSTANCES EXIST: If you are hospitalized for a reason which is not elective, or where 

the death of your parent, spouse, or child prevents attendance at the hearing, a postponement may 

be granted upon proper documentation. Please contact the Final Adjudication Branch at (XXX) 

XXX-XXXX, if an emergency arises. If a postponement cannot be granted, the request for a 

hearing will automatically convert to a request for a review of the written record. If you do not 

appear at the scheduled time and place, the request for a hearing will automatically convert to a 

request for a review of the written record.

WITHDRAWAL OF REQUEST FOR HEARING: At any time after requesting a hearing, you 

can request a change to review of the written record by making a written request to the Final 

Adjudication Branch. Once such a change is made, no further opportunity for a hearing will be 

provided, and I will review the written record. 

HEARING BY TELEPHONE: If you would like to have a hearing by telephone, please contact 

the Final Adjudication Branch at (XXX) XXX-XXXX. Any testimony presented at the 

telephone hearing will be made under oath or affirmation and the testimony will be recorded by a 

court reporter and made part of the record. Telephone hearings can not be conducted on cell 

phones. 

REPRESENTATION: You may designate a person to represent you to help you prepare 

your case and/or present your case at the hearing. Your representative can be an attorney, 

but he or she need not be. There are rules concerning the maximum fee an attorney can 

charge you. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (page 4 of 4) Appendices

AFTER THE HEARING: I will furnish a transcript of the hearing to you (at no charge) within a 

few weeks after the hearing. You will then have twenty (20) days from the date it is sent to 

submit any comments to me. You will also have thirty (30) days after the hearing is held to 

submit additional evidence or argument, unless an extension is granted. Only one such extension 

may be granted. After the hearing, I will study the record and make findings based on the 

evidence, including testimony taken at the hearing, and issue a written decision.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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SAMPLE HEARING NOTICE TO CLAIMANT WHO DID NOT FILE AN OBJECTION 

Dear Claimant Name:

A hearing has been scheduled concerning the above referenced claim under the Energy 

Employees Occupational Illness Compensation Program Act of 2000, as amended, 42 U.S.C. § 

7384 et seq. (EEOICPA or the Act). The file indicates that you did not file an objection to the 

recommended decision of the district office. However if you wish, you may participate in the 

hearing. The option to participate by telephone is available, but you must let me know 

immediately. The hearing will begin promptly at TIME AM/PM on DAY, DATE at the 

following location: 

 

BUILDING NAME

STREET ADDRESS

CITY, ST ZIP-CODE

(XXX) XXX-XXXX (for directions only) 

Please bring a photo I.D. so that you may be admitted into the building. 

The specific issue to be addressed at the hearing: [If it is a Part E hearing request: The issue to be 

addressed at the hearing is whether you are entitled to compensation and benefits under Part E of 

the EEOICPA. If it is a Part B and Part E hearing request: The issues to be addressed at the 

hearing are whether you are entitled to compensation and benefits under Part B and Part E of the 

EEOICPA.] 

You must notify me at least one (1) week prior to the date of the hearing if persons other than 

claimants involved with the case, and a properly appointed authorized representative, will be 

attending the hearing. Please be aware that in such circumstances, all claimants who have 

requested this hearing must sign a “WAIVER OF RIGHTS TO CONFIDENTIALITY.” 

Additionally, I will need to determine whether proper room arrangements can be made to 

accommodate the number of people expected to attend the hearing. 

Please be advised that the security requirements of the XXXXXXXX (Federal Building) require 

me to provide a list of all attendees. Anyone not on the list will not be admitted to the building 

and will not be able to attend the hearing. 

The hearing is an informal process, and I am not bound by common law or statutory rules of 

evidence or by technical or formal rules of procedure. During the hearing, you may state your 

arguments and present new written evidence and/or testimony in support of the claim. Oral 

testimony will be made under oath or affirmation and is recorded. The recording of the hearing 

proceedings is then transcribed and placed in the record. You will be provided a copy of the 

hearing transcript. You or anyone else present may not make your own video or audio recording 

of the hearing. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (Page 2 of 2) Appendices

I determine the conduct of the hearing and may terminate the hearing at any time I determine that 

all relevant evidence has been obtained or because of misbehavior on the part of the claimant 

and/or representative, or any other persons in attendance at or near the place of the hearing. 

[Add this paragraph if the hearing concerns the POC] Since the issues raised relate to the dose 

reconstruction process, it is important for you to know that the National Institute for 

Occupational Safety and Health (NIOSH) has full authority under the regulations to complete the 

dose reconstruction as prescribed in its rules. The dose reconstruction is used by the Department 

of Labor to determine the probability that the claimed cancer is related to employment at a 

covered facility. During the hearing, I am not authorized to address NIOSH methodology and 

therefore will not be in a position to discuss the way in which NIOSH prepares the dose 

reconstruction. You may present your objections at the hearing, including any evidence or 

information you wish to submit and all arguments, evidence and information will be entered into 

the record. However, I can discuss only issues of a factual nature regarding the information you 

provided to NIOSH, and which that agency used to perform the dose reconstruction. 

I have attached additional information regarding the hearing procedures for your review. If you 

have any questions concerning these procedures, please feel free to contact me at 

(xxx) xxx-xxxx. 

Sincerely,

Hearing Representative

Enclosure 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 25-5 Back to Top

April 2017 Appendices

WAIVER OF RIGHTS TO CONFIDENTIALITY

 

I, ______________________, (File Number ____________), residing at 

____________________________, am aware that persons other than claimants involved in the 

above case or their authorized representative may be present at a hearing convened under the 

Energy Employees Occupational Illness Compensation Program Act (EEOICPA) on 

______________, at _____ AM/PM in _________________, in the State of 

_____________________. 

I have requested the presence of these persons, or accept their presence at this proceeding, and I 

hereby waive any right to confidentiality of records, documents or other materials contained in 

files maintained by the Office of Workers’ Compensation Programs and disclosed during the 

hearing. I further waive any right to privacy under the Privacy Act of 1974 in the disclosure of 

records, documents or other materials related to my claim that may be released during the course 

of the hearing. 

Acknowledged and signed this ______day of ________, 2009. 

____________________________ 

 (signature) 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 Appendices

WAIVER OF RIGHTS TO CONFIDENTIALITY (MEDIA)

 

I, ______________________, (File Number _____________) residing at 

____________________________, am aware that representatives of the print and/or broadcast 

media may be present at a hearing convened under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA) on ______________, at _____ AM/PM in 

_________________, in the State of _____________________. 

I have requested the presence of these persons, or accept their presence at this proceeding, and I 

hereby waive any right to confidentiality of records, documents or other materials contained in 

files maintained by the Office of Workers’ Compensation Programs and disclosed during the 

hearing. I further waive any right to privacy under the Privacy Act of 1974 in the disclosure of 

records, documents or other materials related to my claim that may be released during the course 

of the hearing. 

Acknowledged and signed this ______day of ________, 2009. 

 ____________________________________ 

(signature)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (Page 1 of 2) Appendices

SAMPLE HEARING SCRIPT FOR A HEARING INVOLVING NIOSH DR ISSUES

CONVENING THE HEARING

I. OPENING, AUTHORITY, AND NARRATIVE

We will now open the record. Today is _____________, and it is _________AM/PM. My name 

is ____________ and I have been designated to conduct this hearing and to receive the 

objections of EMPLOYEE/CLAIMANT. (At this point indicate whether or not claimant is 

represented by counsel or other authorized representative). This case is identified under claim 

number xxx-xx-xxxx and carries docket number xxxx-2008. 

This hearing is convened under the Energy Employees Occupational Illness Compensation 

Program Act (I will make future references to it as the Act), and is governed by the provisions of 

Title 20, Section 30.314 of the Code of Federal Regulations. These regulations provide 

claimants with the right to object to a recommended decision of a district office. While this 

hearing is informal and not governed by rules of evidence, I will administer an oath or 

affirmation to every person providing testimony today. I will first review the history of your 

claim as it appears in the written record. You may then present testimony, argument, and any 

additional evidence addressing the merits of your claim. 

On DATE OF FILING, you submitted an EE-(1 or 2)form to the NAME OF LOCATION district 

office claiming benefits under the Act. On your EE-1/2 form, you claimed LIST FORM OF 

CANCER as the claimed condition related to employment under the Act. You also submitted an 

EE-3 form indicating employment at LIST FACILITY, DATES OF EMPLOYMENT AND 

COVERED PERIOD FOR FACILITY. You submitted evidence establishing your employment 

at NAME FACILITY and submitted BRIEFLY OUTLINE MEDICAL EVIDENCE establishing 

a cancer diagnosis.

Since YOUR/THE EMPLOYMENT did not qualify YOU/THE EMPLOYEE for membership in 

the special exposure cohort, the DISTRICT OFFICE forwarded your claim file information to 

the National Institute for Occupational Safety and Health (hereinafter referred to as NIOSH) for 

radiation dose reconstruction. The district office undertook such an action pursuant to the 

instructions set out in the regulations governing the Act. The Act and implementing regulations 

mandate that when a claimant with covered employment establishes a cancer diagnosis, NIOSH 

will prepare a radiation dose reconstruction. The Department of Labor then applies a formula to 

the dose reconstruction in order to determine whether the employee’s cancer is as least as likely 

as not related to the covered employment. 

NIOSH provided a report of the dose reconstruction and DISTRICT OFFICE found that there 

was a % probability that YOUR/THE EMPLOYEE’S cancer was causally related to employment 

under the Act. As such, it was determined that the cancer was not found to be at least as likely as 

not related to employment under the Act. Accordingly, the DISTRICT OFFICE issued its 

recommended decision on DATE OF RD recommending denial of your claim for benefits under 

the Act. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (Page 2 of 2) Appendices

II. STATEMENT OF OBJECTION AND NIOSH DISCLAIMER

On DATE OF OBJECTION, you filed your objection to the recommended decision and 

requested an oral hearing. You have objected specifically that the NIOSH dose reconstruction 

failed to show enough exposure so the DO could find that YOUR/THE EMPLOYEE’S cancer 

was at least as likely as not related to YOUR/THE EMPLOYEE’S employment. 

At this time I would like to say something about the NIOSH dose reconstruction. NIOSH is 

given full authority under the regulations that govern the Act to conduct the dose reconstruction 

used by the Department of Labor to determine the probability that a cancer is related to 

employment. I am, therefore, not in a position to discuss the way in which NIOSH goes about 

preparing the dose reconstruction report. However, I can discuss issues of a factual nature 

regarding the information you provided to NIOSH, and challenges to the application of NIOSH’s 

methodology. I am here to take your objections and enter them into the evidence of record, but I 

am not permitted to consider objections to NIOSH methodology at this time.

III. ADMINISTER OATH AND TAKE EVIDENCE

As stated previously, while the hearing is designated as an informal process, anyone giving 

testimony today is required to do so under Oath. Mr./Ms. Claimant, will you please raise your 

hand? (Administer Oath: “Do you swear/affirm to tell the truth in the testimony you are about to 

give in these proceedings today?” 

Mr/Ms. Claimant, will you please, for the record, state your full name and address, and then 

proceed to give your testimony for the record. 

AT THIS POINT, ALLOW THE CLAIMANT TO GIVE ORAL TESTIMONY AND ENTER 

SUCH DOCUMENTS AS THE CLAIMANT MAY DESIRE INTO THE RECORD AS 

EVIDENCE. IDENTIFY AND MARK EACH AND EVERY EXHIBIT AND NUMBER 

EACH EXHIBIT SEQUENTIALLY. 

IV. CLOSING

Before closing, I will advise Mr./Ms. Claimant of what will transpire from this date forward. 

These proceedings will be transcribed, and a copy of the transcript will be provided to you. I 

will leave the record open for another 30 days for you to submit any additional evidence. You 

also have 20 days from the date of mailing of the transcript to offer any corrections or 

comments on the transcript. Any such additional evidence or comments will be included in the 

record and considered, along with your hearing testimony and all of the evidence already in the 

record, prior to issuance of the final decision. If there is no other testimony to be given in this 

matter, I will close the hearing. It is now _____A.M/P.M. and this hearing is closed.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 (Page 1 of 2) Appendices

SAMPLE LETTER TO POSTMASTER

Postmaster

Any Town, Any State 12345-9998 

 

Dear Postmaster:

Agency Control Number (if applicable):_____________________ 

Date:____________________________________ 

Address Information Request

Please furnish this agency with the new address, if available for the following individual or 

verify whether or not the address given below is one at which mail for this individual is currently 

being delivered. If the following address is a post office box, please furnish the street address as 

recorded on the box-holder’s application form. 

Name: ______________________________________________________________ 

Last Known Address __________________________________________ 

 __________________________________________ 

 __________________________________________ 

I certify that the address information for this individual is required for the performance of this 

agency’s official duties. 

_____________________________________________________________ 

Signature of Agency Official

_____________________________________________________________ 

Title

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 

* * * * * 

FOR POST OFFICE USE ONLY

___ Mail is delivered to address given New Address: 

___ Not known at address given _________________________ 

___ Moved, left no forwarding address _________________________ 

___ No such address _________________________ 

___ Other: (Specify) _______________ 

Box Holder’s Street Address:

________________________________ 

________________________________ 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

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April 2017 (Page 2 of 2) Appendices

USPS Return Address: 

Postmark/Date Stamp

As per 39 USC 404...”the USPS does not disclose mailing information except in the following 

limited circumstances; Authorized disclosures include limited circumstances such as the 

following: (a) to other government agencies or bodies: when relevant to a decision concerning 

employment, security clearances, security or suitability investigations, contracts, licenses, grants 

or benefits”...

 

The correspondence in question fits within the aforementioned parameters and our agency is 

requesting the aforementioned information as formatted in the USPS Administrative Support 

Manual Section 352.44. Please respond to our office via return mail or fax with the 

aforementioned postal patron’s new address/contact information. 

If you have any questions regarding this letter you can call me at my direct number xxx-xxxxxxx. 

Physical Address:

US Department of Labor – DEEOIC

P.O. Box XXXX

City, State Zip

Fax Number: xxx-xxx-xxxx Attn: Co-located unit 

Sincerely,

Claims Examiner

 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

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April 2017 Appendices

SAMPLE CHANGE OF ADDRESS LETTER

Date:___________________ 

 File #: Claim Number

 Employee:____________________ 

 Claimant:_____________________ 

Name of Claimant 

Address (Line 1)

Address (Line 2)

Address (Line 3)

Change of Address

This will notify you of my change of address to the following: 

Name

Address

City/State/Zip

Phone Number

Other Information:

_________________________________ _______________ 

Signature Date

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

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April 2017 (Page 1 of 5) Appendices

SAMPLE FINAL DECISION - ACCEPTANCE

Dear Claimant Name:

Enclosed please a Final Decision on your claim for compensation under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA). The district office recommends 

acceptance of your claim for Burkitt’s lymphoma under both Part B and Part E of the Act. 

I have enclosed the Acceptance of Payment form (EN-20), which is required before the Office of 

Workers’ Compensation Programs can issue payment to you. You must complete the form in 

permanent ink and there can be no cross outs or other marks. Do not use white out or correction 

tape. Any alteration of the form will result in it being rendered unusable for purposes of issuing 

payment. If you make a mistake or need another form, please contact the district office handling 

your claim. You must submit the form with an original signature. Faxes or another copied 

version of the EN-20 is not acceptable. A second copy of the form is attached in case a mistake is 

made. Only one form needs to be returned. Please check with your financial institution before 

returning the form to us to verify the routing number and your account number so that your 

money arrives promptly and to the correct account. 

Please email the completed and signed original EN-20 to: 

U.S. Department of Labor 

DEEOIC, District Office

P.O. Box XXXX 

City, State ZIP

Please be advised that the final decision on your claim may be posted on the agency’s website if 

it contains significant findings of fact or conclusions of law that might be of interest to the 

public. If it is posted, your final decision will not contain your file number, nor will it identify 

you or your family members by name.

Any future correspondence, inquiries, or telephone calls should be directed to the (District 

Office) district office. Thank you for your cooperation. 

Sincerely,

Hearing Representative

Final Adjudication Branch

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 26-1 Back to Top

April 2017 (Page 2 of 5) Appendices

EMPLOYEE: [Name]

CLAIMANT: [Name]

FILE NUMBER: [Number]

DOCKET NUMBER: [Number]

DECISION DATE: [Date]

 

NOTICE OF FINAL DECISION

This decision of the Final Adjudication Branch (FAB) concerns the above claim for benefits 

under the Energy Employees Occupational Illness Compensation Program Act of 2000 

(EEOICPA or the Act), as amended, 42 U.S.C. § 7384 et seq. For the reasons set forth below, 

the claim for benefits under Part B and Part E of the Act for Burkitt’s lymphoma is approved. 

STATEMENT OF THE CASE

On February 6, 2012, the claimant filed a Form EE-1 under the Act. He claimed that he 

developed non-Hodgkin’s lymphoma as a consequence of his employment at multiple 

Department of Energy (DOE) facilities. 

In support of his claim, he submitted a Form EE-3 indicating that he was employed at the 

Hanford Plant in Richland, Washington from 1976 to 1987, and at the Savannah River Site 

(SRS) in Aiken, South Carolina from June 1984 to July 1985. A representative of DOE 

confirmed that he was employed at Hanford by the Bechtel Corporation, a DOE subcontractor, 

from December 6, 1982 to December 30, 1983, by the J.A. Jones Company, a DOE 

subcontractor, from January 27, 1987 to February 28, 1987 and by Kaiser Engineers Hanford, a 

DOE contractor, from April 1, 1987 to May 1, 1987. Also, union dispatch records and 

occupational medicine records provided by the DOE establish that the claimant was employed at 

Hanford by the Bechtel Corporation from June 2, 1977 to April 23, 1978. In addition, radiation 

exposure monitoring records provided by the DOE establish that he was employed at the SRS, a 

DOE facility, by B.F. Shaw Company, a DOE subcontractor, from November 26, 1984 to June 

23, 1985.2

Also in support of his claim, the claimant submitted a hematopathology report, signed by 

Dr. Jonathan Roller, documenting a diagnosis of non-Hodgkin’s lymphoma on November 

1, 2011.

 

2 Hanford is a covered DOE facility from 1942 to the present. The SRS is a covered DOE facility from 1950 to the 

present. See DOE Office of Worker Advocacy Covered Facility List at: 

http://www.hss.doe.gov/healthsafety/fwsp/advocacy/faclist/showfacility.cfm (verified by the FAB on November 21, 

2012).

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

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April 2017 (Page 3 of 5) Appendices

A subsequent oncology visit report from Dr. Thomas Jacobsen, dated February 27, 2012, 

confirms a specific diagnosis of Burkitt’s lymphoma, a form of non-Hodgkin’s lymphoma, based 

on the particular characteristics of the malignant lymphocytes.

On October 9, 2012, the Seattle district office issued a recommended decision to accept the claim 

for Burkitt’s lymphoma under Parts B and E of EEOICPA, finding that the claimant is a member 

of the Special Exposure Cohort (SEC) who was diagnosed with a specified cancer after 

beginning employment at a DOE facility. The district office also recommended that the claimant 

be awarded compensation in the amount of $150,000.00 under Part B, and medical benefits for 

the treatment of Burkitt’s lymphoma retroactive to February 6, 2012 under both Part B and Part 

E of the Act. 

The claimant submitted a Form EN-16, dated October 16, 2012, declaring that he had neither 

filed a tort suit nor received any settlement or award from a claim or suit related to an exposure 

for which he would be eligible to receive compensation under the Act. He also declared that he 

had neither filed for nor received any state workers’ compensation benefits on account of the 

claimed illness. And finally, the claimant declared that he had neither pled guilty to nor been 

convicted on any charges of having committed fraud in connection with an application for or 

receipt of benefits under the Act or any other federal or state workers’ compensation law. 

On October 22, 2012, FAB received the claimant’s written notification indicating that he waived 

all rights to file objections to the findings of fact and conclusions of law in the recommended 

decision. 

Based on an independent review of the evidence of record, FAB hereby makes the following: 

FINDINGS OF FACT

1. On February 6, 2012, the claimant filed a claim for benefits under the Act for nonHodgkin’s lymphoma due to employment at DOE facilities. 

2. The claimant was employed at Hanford, a DOE facility, by the Bechtel Corporation, a 

DOE subcontractor, from June 2, 1977 to April 23, 1978 and December 6, 1982 to 

December 30, 1983, by the J.A. Jones Company, a DOE subcontractor, from January 27, 

1987 to February 28, 1987 and by Kaiser Engineers Hanford, a DOE contractor, from 

April 1, 1987 to May 1, 1987. In addition, he was employed at the SRS, a DOE facility, 

by B.F. Shaw Company, a DOE subcontractor, from November 26, 1984 to June 23, 

1985. 

3. The claimant was diagnosed with Burkitt’s lymphoma, a form of non-Hodgkin’s 

lymphoma, on November 1, 2011. 

4. The claimant has neither filed a tort suit nor received any settlement or award from a 

claim or suit related to an exposure for which he would be eligible to receive 

compensation under the Act. He has neither filed for nor received any state workers’ 

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5. compensation benefits on account of the claimed illness, and he has neither pled guilty to 

nor been convicted on any charges of having committed fraud in connection with an 

application for or receipt of benefits under the Act or any other federal or state workers’ 

compensation law. 

Based on these findings of fact, FAB hereby makes the following: 

CONCLUSIONS OF LAW

If a claimant waives any objections to all or part of the recommended decision, FAB may issue a 

final decision accepting the recommendation of the district office, either in whole or in part. 20 

C.F.R. § 30.316(a) (2012). The claimant waived his right to file objections to the findings of fact 

and conclusions of law in the recommended decision. 

Under Part B of the Act, an individual is a “covered employee with cancer” if that individual is a member of the 

SEC who contracted a specified cancer after beginning employment at a DOE facility. 42 U.S.C. § 7384l(9)(A). 

On August 23, 2012, the Secretary of Health and Human Services designated the following class 

of employees for addition to the SEC in a report to Congress: 

 

All employees of the DOE, its predecessor agencies, and their contractors and 

subcontractors who worked at Hanford in Richland, Washington, from July 1, 1972 

through December 31, 1983, for a number of work days aggregating at least 250 work 

days, occurring either solely under this employment, or in combination with work days 

within the parameters established for one or more other classes of employees in the SEC.

See EEOICPA Circular No. 12-16 (issued September 22, 2012). 

The claimant was employed at Hanford by a DOE subcontractor for a period in excess of 250 

work days between July 1, 1972 and December 31, 1983. Therefore, he is a member of the SEC. 

Also, Burkitt’s lymphoma is a specified cancer, provided the onset of the condition occurred at 

least five years after the initial exposure to radiation during covered employment. 20 C.F.R. § 

30.5(ff)(5)(ii). The claimant began working at Hanford on June 2, 1977, and was diagnosed with 

Burkitt’s lymphoma on November 1, 2011. Therefore, he was diagnosed with a specified cancer 

over 5 years after beginning employment at a DOE facility. 

Accordingly, the claimant is a “covered employee with cancer” under Part B in accordance with 

42 U.S.C. § 7384l(9)(A), and his Burkitt’s lymphoma is an “occupational illness” in accordance 

with 42 U.S.C. § 7384l(15). As such, he is entitled to compensation in the amount of 

$150,000.00 and medical benefits under Part B, retroactive to February 6, 2012; the date of 

filing. 

Further, since the claimant was employed by DOE contractors and subcontractors at covered 

DOE facilities during covered time periods, and given the acceptance of his Part B claim, that 

acceptance is treated for the purposes of Part E of the Act as a determination that he contracted 

his illness through work-related exposure to a toxic substance at a DOE facility. 42 U.S.C. 

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§ 7385s-4(a). As such, the FAB finds that the claimant is also a “covered DOE contractor 

employee” under Part E, and 

his Burkitt’s lymphoma is a “covered illness” under Part E. As a covered DOE contractor, the 

claimant is also entitled to medical benefits for his Burkitt’s lymphoma under Part E. 

In summary, the claim for benefits under Part B and Part E of EEOICPA for Burkitt’s lymphoma 

is approved. The claimant is awarded $150,000.00 under Part B and medical benefits for the 

treatment of Burkitt’s lymphoma, retroactive to February 6, 2012, under Part B and Part E of the 

Act. 

Washington, D.C. 

__________________________ 

Name

Hearing Representative 

Final Adjudication Branch 

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Sample Medical Benefits Letter

DATE

NAME AND ADDRESS

Dear CLAIMANT NAME: 

As a beneficiary under the Energy Employees Occupational Illness Compensation Program 

Act (EEOICPA), you are entitled to medical benefits for treatment of your MEDICAL 

CONDITION (ICD-9 codes: ICD-9 CODES), effective February 29, 2012. Covered 

medical services are payable in accordance with the fee schedules and medical benefits 

policies established under the Energy Employees Occupational Illness Compensation 

Program (EEOICP). Your medical benefits coverage includes payment to medical 

providers for services such as medical appointments, hospitalizations, home health care 

services (see attached Notice Regarding Home Health Services), medical appliances, 

supplies, and drugs that are prescribed by a qualified physician and approved by the 

EEOICP.

Within the next few weeks, you will be receiving additional information regarding your medical 

benefits coverage. This will include a medical benefits identification card, which you will need 

to show to your physician or other enrolled medical provider you chose to treat your covered 

condition. This card will be accompanied by instructions and a phone number to call to activate 

the card. The card will instruct your physician, hospital, durable medical equipment supplier or 

other health care providers to bill the EEOICP directly, so that you will not have to pay for 

medical treatment covered under the program. There are no deductibles for services or 

equipment as long as the services are billed by an EEOICP enrolled medical provider. 

To bill us directly, providers must be enrolled in the Program. For information about enrollment 

and billing, please have your provider contact us at the address and telephone number listed at 

the end of this letter, or give us your provider’s phone number when you call to activate your 

medical benefits identification card. We will call and explain the Program to your provider(s) 

and give them the necessary forms required for submitting bills for reimbursement.

To request reimbursement for out of pocket medical expenses associated with treatment of your 

accepted condition, you must submit the following forms: (OWCP-915 Form, Claim for Medical 

Reimbursement Under the Energy Employees Occupational Illness Compensation Program Act),

and (OWCP-957 Form, Medical Travel Refund Request). Both forms are enclosed for your 

convenience and include instructions for completing these forms and submitting any additional 

required documentation. 

Please mail completed forms to:

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U.S. Department of Labor 

Energy Employees Occupational Illness Compensation Program 

P.O. Box 8304 

London, KY 40742-8304 

If you or your provider(s) have questions regarding submission or payment of bills, or require 

any other medical bill program assistance, contact a representative toll free at 

1-866-272-2682. 

Sincerely,

Hearing Representative

Enclosures: 

OWCP-915 

OWCP-957 

Notice Regarding Home Health Care Services

Note: if the EEOICP pays less than the billed amount (in accordance with the fee schedule), you 

are not responsible for payment of the difference to a provider. Providers and claimants may 

submit requests for reconsideration of fee determinations in writing, with accompanying 

documentation to the address supplied in this letter. 

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Notice Regarding Home Health Services

As a beneficiary under the Energy Employees Occupational Illness Compensation Program Act 

(EEOICPA), you are eligible for those services, appliances, and supplies prescribed or 

recommended by a qualified physician, which are likely to cure, give relief to, or reduce the 

degree or the period of the accepted illness. 

Home health care is one of the many medical benefits you may receive for an accepted illness 

under the EEOICPA. Home health care includes both in-home skilled nursing care, and the 

services of a home health aide to assist you with activities of daily living, related to your 

accepted condition(s). Examples of these daily activities include assistance with mobility around 

the house, dressing, feeding and food preparation, and accompanying you to medical 

appointments. 

It is important for you to be well informed about your EEOICPA benefits as they relate to home 

health care services. This begins with an explanation of the benefits you are entitled to, and the 

information you and your doctor will be asked to provide before home health care can be 

approved. 

• A request for home health care must be submitted to the District Office servicing your 

claim. Your claim number should be clearly noted on any request. There are no 

restrictions on when you can apply for home health care once a work-related illness is 

accepted in your claim; however, services are authorized based upon the presentation of 

medical evidence from your treating physician confirming the need for care due to an 

accepted illness. 

• Written authorization for home health care must be obtained prior to any service provider 

entering your residence to conduct services in connection with the accepted work-related 

illness, except in certain emergency situations. 

• When you initially request home health care, the physician treating you for a workrelated illness accepted in your claim will be asked to supply a written explanation of the 

care you require, called a Plan of Care. This plan of care must explain the need for inhome health care as it relates to the accepted illness (es) in your claim. Your physician is 

to clearly specify the level of care required (skilled nursing care, home health aide, etc.); 

the frequency of care required (i.e., number of hours per day or week for each type of 

care); and the time period for which you will require in-home care. Medical evidence 

presented by a physician who has not personally treated your accepted work-related 

illness, or who is otherwise unfamiliar with your treatment needs, is of reduced probative 

value in assessing home health care requests. 

• Once approval is granted for home health care, you are free to choose from any licensed 

medical provider of the services you require, as long as the provider is enrolled with the 

Division of Energy Employees Occupational Illness Compensation (DEEOIC). 

Moreover, you are free to change providers at any time. The DEEOIC neither endorses 

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nor sponsors any home health care provider, or any other entity providing medical 

services.

• Approval for home health care is granted for up to six-month periods and must be 

renewed with the submission of updated medical information from your treating 

physician. Changes to an approved level of home health care must be requested in 

writing and must be accompanied by medical documentation from your treating 

physician explaining the basis for any alteration in your current plan of care. 

• The DEEOIC may conduct reviews of home health care authorizations using medical 

consultants, field nurses, or other forms of inquiry with your treating physician at any 

given time. 

As with all forms of health care, you play an important role in determining the appropriate level 

of care and the types of services being provided to you. If you have questions regarding home 

health care, direct your concerns to the District Office servicing your claim. 

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SAMPLE REMAND ORDER 

Date

Claimant Name Last 4 Digits of File Number:

Address 

Dear Claimant:

Enclosed please find the Remand Order concerning your claim for compensation under the Energy 

Employees Occupational Illness Compensation Program Act. 

Please note that the remand order is directed to the EEOICP 

district office. Unless you are contacted by that office for additional information, you are not required to 

take any action 

at this time. I regret any inconvenience caused to you by this remand. 

Your file is being returned to: 

U.S. Department of Labor, DEEOIC 

XXXXX District Office

Address 

City, State Zip

Future correspondence, inquiries, or telephone calls may be directed to the district office. Thank you for 

your cooperation.

Sincerely,

Hearing Representative

Final Adjudication Branch

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EMPLOYEE: [Employee’s Name]

CLAIMANT: [Claimant’s Name]

FILE NUMBER: [Last 4 digits of file #]

DOCKET NUMBER: [Docket Number]

DECISION DATE: [Decision Date]

REMAND ORDER

This order of the Final Adjudication Branch (FAB) concerns your claim for benefits under the 

Energy Employees Occupational Illness Compensation Program Act of 2000, as amended 

(EEOICPA or the Act), 42 U.S.C. § 7384 et seq. Your case is remanded to the EEOICP 

district office for consideration of the new medical evidence received that established a cancer 

diagnosis. 

On November 9, 2005, you filed a claim for survivor benefits under the Act, based upon the 

claim that the employee contracted skin cancer, seizures and heart problems while employed at 

the Iowa Ordnance Plant. You submitted no medical evidence to establish that the employee 

was diagnosed with cancer. 

On May 16, 2006, the district office issued a recommended decision concluding that there was 

insufficient evidence to establish an occupational illness under Part B of the Act and that there 

was insufficient evidence to establish a covered illness under Part E of the Act. Therefore, it 

was recommended that your claim for survivor benefits under the Act be denied. On May 30, 

2006, you filed objections to the recommended decision and requested a hearing. 

On August 18, 2006, a hearing was conducted on your objections. At, and subsequent to, the 

hearing, you submitted additional medical evidence. The medical records, specifically a 

pathology report of November 12, 2001, support a finding that the employee was diagnosed with 

basal cell carcinoma, i.e. skin cancer. This new evidence is sufficient to warrant further 

development of the claim. 

Pursuant to 20 C.F.R. § 30.317: “At any time before issuance of its final decision, the FAB may 

return the claim to the district office for further development and/or issuance of a new 

recommended decision without issuing a final decision, whether or not requested to do so by the 

claimant.” Therefore, the May 16, 2006 recommended decision is vacated and the case is being 

returned to the EEOICP district office for further development and issuance of a new 

recommended decision. 

Washington, DC

Hearing Representative

Final Adjudication Branch

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CERTIFICATE OF SERVICE

I hereby certify that on ________, a copy of the Remand Order was sent by regular mail to the 

following: 

 

Claimant Name

Claimant Address 

Hearing Representative

Final Adjudication Branch

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NOTICE OF DENIAL OF REQUEST FOR RECONSIDERATION (NO NEW 

EVIDENCE OR ARGUMENT SUBMITTED) 

This is in response to your letter of January 29, 2011 requesting reconsideration of the January 

12, 2011 Final Decision of the Final Adjudication Branch (FAB). For the reasons set forth 

below, your request for reconsideration is denied. 

The January 12, 2011 Final Decision found that your lung cancer was “not at least as likely as 

not” related to your employment at the Pinellas Plant. It was on this basis that your Part B claim 

was denied under the Energy Employees Occupational Illness Compensation Program Act 

(EEOICPA). Further, the final decision was based on the evidence of file, which included the 

dose reconstruction report, your letters of objection, the hearing transcript and comments you 

submitted regarding the hearing transcript.

As you have not submitted any new argument or evidence which justifies reconsideration of the 

January 12, 2011 final decision, I must deny your request. Accordingly, the decision of the FAB 

denying your Part B claim is final on the date of issuance of this denial of your request for 

reconsideration. 20 C.F.R. § 30.319(c)(2). 

Washington, D.C. 

 

 

Hearing Representative

Final Adjudication Branch

EMPLOYEE: [Employee’s Name]

CLAIMANT: [Claimant’s Name]

FILE NUMBER: [Last 4 digits of file #]

DOCKET NUMBER: [Docket Number]

DECISION DATE: [Decision Date]

SUPERSEDED
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Sample Denial of Reconsideration Request (New Evidence and/or New Argument 

Submitted)

NOTICE OF DENIAL OF REQUEST FOR RECONSIDERATION

This is a response to your request for reconsideration of the July 1, 2011 final decision of the 

Final Adjudication Branch (FAB) under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA or Act) which denied your Part E claim for sleep apnea 

consequential to sarcoidosis. The FAB received your request and determined that it was timely 

filed. 20 C.F.R. § 30.319 (2011). On August 15, 2011, the FAB acknowledged receipt of your 

request for reconsideration. However, the evidence of record shows that, to date, you have not 

submitted any additional evidence.

In your request for reconsideration, you stated, “The opinion of Dr. Smith and the Contract 

Medical Consultant (CMC) conflicted, which would require that the matter be sent to a third 

physician for a referee opinion, and it was an error not to do so.” The Federal (EEOICPA) 

Procedure Manual Chapter 2-0800.13 provides guidance when making a determination as to 

when a claim is to be referred for a referee opinion:

In most instances, careful weighing of the medical evidence should allow for resolution 

of the issues without having to resort to a referee or "impartial" specialist. However, 

where the weight of medical evidence is divided equally between the opinion of the 

treating doctor and that of the second opinion physician, a referee opinion must be 

obtained...a conflict of medical opinion must actually exist as determined by weighing 

the medical evidence. The CE must decide the relative value of opposing opinions in the 

medical record by considering all factors, to include each physician’s specialty and 

qualifications, completeness and comprehensiveness of evaluations and rationale, and 

consistency of opinions. 

The FAB weighed the medical evidence and determined that the conflicting medical opinions 

were not of equal weight. In such cases, a referee specialist examination is not necessary. I have 

reviewed the evidence of record, including the CMC report and the medical evidence you have 

submitted and the opinion of Dr. Smith. I have determined that the report of the CMC is of 

greater weight and probative value because Dr. Smith failed to provide a complete and 

EMPLOYEE: [Employee’s Name]

CLAIMANT: [Claimant’s Name]

FILE NUMBER: [Last 4 digits of file #]

DOCKET NUMBER: [Docket Number]

DECISION DATE: [Decision Date]

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comprehensive medical report. The FAB noted that the district office requested such a report; 

however none was provided. Accordingly, the FAB gave consideration to the relative value of 

the opposing opinions, including considering the rationale and consistency of the respective 

opinions, and determined the CMC’s report should be granted more weight. 

Additionally, in your request for reconsideration you stated, “The treating physician who 

examined and treated the claimant was not given proper weight over a CMC who never saw the 

claimant.” According to the EEOICPA Procedure Manual, in evaluating the merits of medical 

reports, greater value is assigned to a well-rationalized opinion which is based on complete 

factual and medical information over an opinion based on incomplete, subjective or inaccurate 

information. The FAB notes that Dr. Smith stated in his report that he “believed your sleep apnea 

was indirectly related to your lung disease.” Dr. Smith continued, “I do not have any concrete 

evidence to prove this, but it is my opinion.” As such, Dr. Smith’s opinion is not based on 

complete factual and medical information, but is instead subjective. In contrast, the opinion of 

the CMC was found to be well-rationalized, supported by the medical evidence in this case and 

cites recent scientific and medical literature in support of his conclusion. Further, the EEOICPA 

Procedure Manual outlines that the opinion of an expert in the relevant medical field is to be 

granted greater value. Dr. Smith is a general practitioner specializing in geriatric medicine. The 

CMC is an expert in occupational medicine.

 

Your request for reconsideration goes on to object to the handling of your claim by the Hearing 

Representative (HR). You state that the HR “applied the wrong standard of proof by a 

preponderance of evidence instead of the at least as likely as not standard in the Conclusions of 

Law.” The 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. To establish eligibility for a consequential condition under Part 

E, you must prove by preponderance of the evidence that the diagnosed illness, in this case sleep 

apnea, occurred as a result of an accepted illness. This is established by a fully-rationalized 

medical report by a physician which shows the relationship between the claimed consequential 

condition and the accepted illness. The “at least as likely as not” standard cited in your request 

only pertains to causation determinations for primary illnesses, which is not at issue in your 

claim for a consequential illness.

Finally, the request for reconsideration renewed your previous objections to the June 9, 2010 

recommended decision of the Denver district office. These objections were previously 

considered by the FAB and were addressed in the July 1, 2011 final decision. 

The EEOICPA is administered according to the Act itself, 42 U.S.C. § 7384, et seq., the 

associated Code of Federal Regulations, 20 C.F.R. Part 30, Bulletins, Circulars and the Federal 

EEOICPA Procedure Manual. The FAB has thoroughly reviewed your case file and finds that 

your claim has been properly adjudicated according to the Act and its associated regulations, 

policies and procedures. 

The Federal (EEOICPA) Procedure Manual Chapter 2-1800 provides that a timely request for 

reconsideration may be denied if it does not contain sufficient probative evidence or 

substantiated argument that directly contradicts a material finding of fact or conclusion of law set 

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forth in the final decision. You have not submitted a new argument or evidence that directly 

contradicts the conclusions reached in the July 1, 2011 final decision. As such, your request for 

consideration is denied. The denial of your Part E claim for sleep apnea is final on the date of 

issuance of this denial of your request for reconsideration. 20 C.F.R. § 30.319(c). 

Denver, Colorado 

Hearing Representative

Final Adjudication Branch 

 

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SAMPLE COVER LETTER, ALTERNATIVE FILING - DENIAL

Dear Claimant Name:

Enclosed please find the Notice of Final Decision which denies your claim for compensation and 

benefits under the Energy Employees’ Occupational Illness Compensation Program Act 

(EEOICPA). If you disagree with this decision, you may request reconsideration. Such a 

request must be in writing and must be made within 30 days of the date of issuance of this 

decision. It must clearly state the grounds upon which reconsideration is being requested. In 

order to ensure that you receive an independent evaluation of the evidence, your request for 

reconsideration will be reviewed by a different Final Adjudication Branch hearing representative 

than that who issued the final decision. Your request for reconsideration should be sent to: 

 

U.S. Department of Labor 

DEEOIC

Final Adjudication Branch 

Attn: FAB OPS

P. O. Box XXX

CITY, STATE ZIP CODE

If your claim was denied because you have not established covered employment or a covered 

illness and you have new evidence of either covered employment or a covered illness, you may 

request a reopening of your claim. If your claim was denied because a cancer was not causally 

related to work-related exposure to radiation and you can identify either a change in the 

probability of causation guidelines, a change in the dose reconstruction methods or an addition of 

a class of employees to the Special Exposure Cohort, you may also request a reopening of your 

claim. 

These requests to reopen your claim must be in writing and be sent, along with your supporting 

information, to the following address: 

U.S. Department of Labor 

DEEOIC, DISTRICT DIRECTOR

P.O. BOX XXX

CITY, STATE ZIP CODE

While you do not meet the statutory definition of an eligible survivor as set out under Part E of 

the EEOICPA, you may seek an alternative filing review pursuant to 42 U.S.C. § 7385s-4(d). 

You may request such a review by writing to: 

U.S. Department of Labor 

DEEOIC, DISTRICT DIRECTOR

ADDRESS

Alternative filing reviews can also be conducted by the district office upon request. In these 

reviews, the district office will assess a facility where alleged employment and exposure took 

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place and render a determination as to potential causation. Should you wish to receive this type 

of review; the district office will provide you with a determination. Please note, however, that 

such a determination does not change your eligibility for benefits or establish causation under the 

Act, and is not subject to further agency or judicial review. 

Please be advised that the final decision on your claim may be posted on the agency’s website 

if it contains significant findings of fact or conclusions of law that might be of interest to the 

public. If it is posted, your final decision will not contain your file number, nor will it identify 

you or your family members by name.

Except as provided above, all future correspondence, inquiries or telephone calls should be 

directed to the district office. Thank you for your cooperation.

Sincerely,

Hearing Representative

Enc: Notice of Final Decision

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Sample Director’s Order to Reopen

<Date>

Joe C. Claimant 

123 Main Street 

City, State, Zip

Dear Mr. Claimant: 

I am writing in reference to your claim for benefits under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA or the Act). 

On April 6, 2005, the Final Adjudication Branch (FAB) issued a Final Decision denying 

your claim for colon cancer under Part B of the EEOICPA, citing the lack of medical 

evidence to establish that a physician diagnosed you with colon cancer. The FAB issued 

a subsequent Final Decision on June 10, 2006, which finalized the Part E denial of your 

claim because the case file did not contain evidence of your diagnosis with colon cancer. 

The EEOICPA allows for review by the Director of the Division of Energy Employees 

Occupational Illness Compensation (DEEOIC) of decisions issued by the FAB. It is 

solely within the Director’s discretion to review and reopen such claims as necessary. 

The Director has delegated the authority to review and issue determinations for certain 

claims to the District Director having jurisdictional authority over the case.

A recent review of your case reveals that medical evidence received by the Cleveland 

District Office on April 26, 2007 confirms your diagnosis of colon cancer and this new 

evidence is sufficient to warrant reopening your claims under both Part B and Part E. 

Accordingly, the attached Director’s Order vacates the April 6, 2005 and June 10, 2006 

Final Decisions denying your claims for benefits for the condition of colon cancer under 

Part B and Part E, respectively. The attached Director’s Order explains in more detail 

the reasons for this decision. The district office is directed to evaluate the new medical 

evidence in support of your claims, and issue a new Recommended Decision to address 

your eligibility under both Part B and Part E of the Act.

Your case file is being returned to the [district office] of DEEOIC. All future 

correspondence concerning your claim should be directed to:

DOL DEEOIC Central Mail Room Correspondence

P.O. Box 8306 

London, 

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KY 40742-8306
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If you have any questions about the Director’s Order, you may contact the [district office]

at [district office telephone number].

Sincerely,

[Name]

[Title]

DEEOIC

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EMPLOYEE: Joe C. Claimant

CLAIMANT: Joe C. Claimant 

CASE ID: 1234 

DOCKET NUMBER(S): 00000-2003 

 00000000-2006 

DIRECTOR’S ORDER

The Energy Employees Occupational Illness Compensation Program Act (EEOICPA or 

the Act) Regulations at 20 C.F.R. § 30.320 state that a Final Decision, or any other 

decision issued by the Final Adjudication Branch (FAB), may be reopened at any time 

on motion of the Director of the Division of Energy Employees Occupational Illness 

Compensation (DEEOIC). It further states that the case may be reopened without 

regard to whether new evidence or information is presented or obtained, and that the 

decision whether or not to reopen a case is solely within the discretion of the Director of 

the DEEOIC.

For the reasons set forth below, the April 6, 2005 and June 10, 2006 Final Decisions 

denying your claims for benefits for the condition of colon cancer under Part B and Part 

E, respectively, are vacated. The case is returned to the Cleveland District Office to 

proceed as outlined below. 

BACKGROUND

The evidence of record shows that on April 7, 2004, you filed claims for benefits under 

both Part B and Part E of the EEOICPA. You claimed that you developed colon cancer 

as a result of your employment at a Department of Energy (DOE) facility.

Form EE-3, Employment History, includes information describing your work as a 

production worker at the Iowa Army Ammunition Plant (IAAP) in Burlington, Iowa, 

from May 3, 1965 to May 25, 1971. The DOE was able to verify the claimed dates of 

employment at the IAAP. 

With regard to the claimed condition of colon cancer, you did not submit medical 

evidence to establish the diagnosis. As such, the district office issued four letters, 

dating from July of 2004 to December of 2004, requesting that you provide evidence to 

establish your diagnosis with colon cancer, and that the condition resulted from your 

occupational exposure to a toxic substance. However, you provided no further 

evidence.

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Accordingly, on January 28, 2005, the district office issued a Recommended Decision to 

deny your claim for colon cancer under Part B of the EEOICPA; finding insufficient 

evidence to establish that you were diagnosed with colon cancer. The FAB finalized the 

recommendation in a Final Decision of April 6, 2005. 

Subsequently, on May 1, 2006, the district office also issued a Recommended Decision to 

deny your claim for colon cancer under Part E; again citing insufficient evidence that 

you were diagnosed with the claimed illness. After an independent assessment and 

review, on June 10, 2006, the FAB issued a Final Decision finalizing the findings of the 

district office.

In a submission received by the district office on April 26, 2007, you provided a 

pathology report and additional medical records to confirm your diagnosis with colon 

cancer. Accordingly, the district office referred your case file to the Office of the 

Director for review and consideration of reopening claims under both Part B and Part E 

of the Act. 

DISCUSSION

After careful assessment of your case record, I find it necessary to vacate the April 6, 

2005 and June 10, 2006 Final Decisions denying your claims for benefits for the 

condition of colon cancer under Part B and Part E, respectively. Sufficient evidence 

exists to establish your diagnosis with colon cancer. As such, additional development is 

required to determine your eligibility to benefits under both Part B and Part E of the 

EEOICPA.

On April 26, 2007, you submitted new medical evidence in support of your claims for 

colon cancer. This new evidence includes a pathology report dated January 16, 2002, 

confirming your diagnosis with colon cancer. Additionally, various medical reports 

and progress notes, ranging from 2002 to the present, establish your diagnosis and 

treatment for this illness. This new evidence invalidates the basis of the April 6, 2005 

and June 10, 2006 Final Decisions denying your Part B and Part E claims. As such, it is 

necessary to vacate these prior Final Decisions so that the district office may proceed 

with a new examination of your eligibility under Part B and Part E for colon cancer. 

CONCLUSION

The April 6, 2005 and June 10, 2006 Final Decisions, respectively, denying your claim for 

colon cancer under Part B and Part E are vacated. The district office is directed to 

evaluate the new medical evidence in support of your claims and issue a new 

Recommended Decision to encompass your eligibility to benefits for the condition of 

colon cancer under both Part B and Part E of the Act. 

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Should you disagree with the decision, you will be afforded the opportunity to file an 

objection and request an oral hearing or a review of the written record.

Washington, D.C. 

[Name]

[Title]

DEEOIC

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CERTIFICATE OF SERVICE

I hereby certify that on a copy of the Director’s Order was sent by regular 

mail to the following:

Joe C. Claimant 

123 Main Street 

City, State, Zip

[Name]

[Title]

DEEOIC

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Sample Denial of Request for Reopening

<Date>

Jane B. Claimant 

PO Box 12345 

City, State Zip

Dear Ms. Claimant: 

I am writing in reference to your claim for benefits under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA). 

On December 7, 2005, the Final Adjudication Branch (FAB) issued a Final Decision to 

deny your claim for breast cancer under Part B, because the probability of causation 

failed to exceed the 50% threshold for compensability. A subsequent Final Decision of 

October 24, 2006 denied your claim for breast cancer under Part E, finding insufficient 

evidence to establish that this condition was related to exposure to toxic substances. 

The Regulations provide that a claimant may file a written request that the Director of 

the Division of Energy Employees Occupational Illness Compensation (DEEOIC) 

reopen his/her claim. The decision whether or not to reopen a claim under this section 

is solely within the discretion of the Director. 

On December 9, 2008, you requested reopening of your claim for benefits under Parts B 

and E of the EEOICPA. I have reviewed the objections and the evidence on file and I 

find that your case is not in posture for reopening at this time. The attached Denial of 

Reopening Request provides further explanation of why there is insufficient basis to 

warrant reopening. 

Your case file is being returned to the [district office] of DEEOIC. All future 

correspondence concerning your claim should be directed to:

DOL DEEOIC Central Mail Room Correspondence

P.O. Box 8306 

London, KY 40742-8306 

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If you have any questions about this Denial of Reopening Request, you may contact the 

[district office] at [district office telephone number].

Sincerely, 

Director,

Division of Energy Employees

Occupational Illness Compensation

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EMPLOYEE: Jane B. Claimant

CLAIMANT: Jane B. Claimant 

CASE ID: 1234 

DOCKET NUMBER(S): XXXXX-2005 

 XXXXXXXX-2006

 

DENIAL OF REOPENING REQUEST

The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) 

Regulations provide that a claimant may file a written request that the Director of the 

Division of Energy Employees Occupational Illness Compensation (DEEOIC) reopen 

his/her claim. The Regulations state that in order to support the request to reopen, a

claimant must submit evidence of either covered employment or exposure to a toxic 

substance, or identify either a change in the probability of causation guidelines, a 

change in the dose reconstruction methods or an addition of a class of employees to the 

Special Exposure Cohort (SEC). The decision whether or not to reopen a claim under 

this section is solely within the discretion of the Director. 

For the reasons set forth below, the December 9, 2008 reopening request is denied. 

Accordingly, the December 7, 2005 Part B and the October 24, 2006 Part E Final 

Decisions of the Final Adjudication Branch (FAB) remain in effect. The case is returned 

to the Jacksonville District Office. 

BACKGROUND

The evidence of record shows that on January 5, 2005, you filed a claim for benefits 

under the EEOICPA. You claimed that you developed breast cancer as a result of your 

employment at a covered Department of Energy (DOE) facility. 

Form EE-3, Employment History, provides information that describes your 

employment at the Pinellas Plant, located in Largo, FL, from 1975 until 1997. The DOE 

was able to establish your employment with General Electric, a known DOE contractor 

at the Pinellas Plant, from April 3, 1975 to June 10, 1997. With regard to the claimed 

condition, a pathology report of December 3, 2001 established your diagnosis with 

breast cancer. 

In development of your claims for benefits, the assigned Claims Examiner (CE) referred 

your case to the National Institute for Occupational Safety and Health (NIOSH) to 

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prepare a radiation dose reconstruction. The DEEOIC used the information supplied in 

the dose reconstruction report to determine whether your breast cancer is “at least as 

likely as not” related to radiation exposure during your employment at the Pinellas 

Plant. For a claim to be compensable under Part B, the probability of causation (PoC) 

must be 50% or greater. In this case, the dose reconstruction estimates resulted in an 

18.26% probability. 

Accordingly, on August 22, 2005, the CE recommended denial of your claim for benefits 

under Part B, finding that your breast cancer was not “at least as likely as not” caused 

by occupational exposure to radiation. After its independent assessment, the FAB 

Hearing Representative finalized the denial of your claim in a Final Decision of 

December 7, 2005. 

With regard to your claim under Part E, the CE conducted a search of the Site Exposure 

Matrices (SEM). The SEM acts as a repository of information related to toxic substances 

potentially present at covered DOE sites and has information regarding site 

investigations and Haz-Map (Occupational Exposure to Hazardous Agents) to assist in 

evaluating causation. Based on the results of the SEM search and a review of all other 

evidence presented in the case, the CE was unable to find a link between toxic exposure 

and breast cancer.

In addition to the SEM search, the CE requested that you provide additional 

information in support of your claim under Part E. Specifically, by letter dated June 30, 

2006, the CE requested evidence to support a link between your claimed condition and 

exposure to a toxic substance. However, you did not provide any additional evidence 

for consideration. 

As such, on August 15, 2006, the CE issued a Recommended Decision to deny your 

claim for breast cancer under Part E; finding insufficient evidence to establish that the 

claimed condition was “at least as likely as not” caused, contributed to, or aggravated 

as a result of exposure to toxic substances during your employment. By Final Decision 

dated October 24, 2006, a FAB CE finalized the recommendation denying your claim for 

benefits under Part E of the EEOICPA.

You requested a reopening of your claims under both Part B and Part E of the Act by 

fax received in the district office on December 9, 2008. Due to the nature of the request, 

the CE sent your case to the Office of the Director for reopening review. 

DISCUSSION

After a careful assessment of your case record, I have concluded there is insufficient 

evidence to warrant reopening your claim. Your request for reopening cites several 

technical objections challenging NIOSH’s dose reconstruction methodology. 

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Furthermore, you object to the Part E decision by presenting a list of toxic substances, 

along with excerpts of scientific journals referencing human and non-human 

epidemiological studies. 

To determine the probability of whether you sustained cancer in the performance of 

duty, the CE referred your case to NIOSH for radiation dose reconstruction. NIOSH 

reported annual dose estimates from the date of initial radiation exposure during 

covered employment, to the date you first were diagnosed with cancer. A summary 

and explanation of information and methods applied to produce these dose estimates, 

including your involvement through an interview and review of the dose report, are 

documented in the “NIOSH Report of Dose Reconstruction under EEOICPA.” On July 

26, 2005, you signed the OCAS-1, indicating that you reviewed the NIOSH Draft Report 

of Dose Reconstruction and that you agreed that it identified all of the relevant 

information provided to NIOSH. The district office received the final NIOSH Report of 

Dose Reconstruction on August 2, 2005.

In your letter requesting reopening, you raise a number of points of contention with 

regard to your Part B claim. These objections to the Part B decision denying your claim 

are challenges to the dose reconstruction methodology. Methodology used by NIOSH 

in arriving at reasonable estimates of radiation doses received by an employee is 

binding on the DEEOIC. However, for thoroughness, a DEEOIC Health Physicist 

conducted a May 20, 2009 reassessment of your case file along with a re-examination of 

the NIOSH dose reconstruction methodology. After his assessment, he reported that 

the assessment of your occupational radiation dose was factually accurate. He also 

noted that the dose reconstruction derived from an accurate application of dose 

reconstruction science and NIOSH policy. Therefore, the Health Physicist found no 

basis for a rework of the dose reconstruction, and as such, I do not have reason to 

support a reopening of your claim. 

In addition to the Health Physicist review, a DEEOIC Toxicologist reviewed the 

objections with regard to the denial of your claim under Part E. In your request for 

reopening, you presented references pertaining to chemical substances linked to breast 

cancer, but did not provide any treatment records or other medical evidence that 

showed you developed breast cancer as a result of a exposure to an occupational toxin. 

The DEEOIC Toxicologist reviewed the most recent published literature of occupational 

medicine regarding toxic chemical exposure in the workplace and the potential 

development of adverse health effects. She opined that review of the occupational desk 

references used by occupational health physicians and epidemiologists, which were 

peer reviewed by scientists, and the review of individual published studies that have 

investigated breast cancer, did not show a causal link between occupational exposures

described in your letter and the development of breast cancer. Given the opinion of the 

DEEOIC Toxicologist and the lack of any medical evidence showing a link between 

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breast cancer and an occupational toxic substance exposure, I have no basis to reopen

the Part E portion of your claim. 

In summary, I find that the application of the NIOSH dose reconstruction methodology 

was appropriate, and there is no basis to warrant reopening your claim under Part B of 

the Act. Additionally, I find no new evidence to establish a link between toxic 

substance exposure and the claimed illness that necessitates reopening your claim 

under Part E. 

CONCLUSION

Based upon the foregoing discussion, I find there is insufficient basis to warrant 

reopening the December 7, 2005 Part B and the October 24, 2006 Part E Final Decisions 

of the FAB. As such, I have to deny your December 9, 2008 request for reopening. 

However, if you should obtain new and probative evidence that establishes a link 

between toxic substance exposure and your claimed conditions of breast cancer, the 

DEEOIC will reconsider its position. 

Washington, D.C. 

 Director

Division of Energy Employees

Occupational Illness Compensation 

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 CERTIFICATE OF SERVICE

I hereby certify that on a copy of the Denial of Reopening Request was 

sent by regular mail to the following:

Jane B. Claimant 

PO Box 12345 

City, State 67890 

 

Director

Division of Energy Employees

 Occupational Illness Compensation

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Sample Ancillary Medical Services Development Letter

Date:

Claimant: (or Auth Rep/Provider) Case ID:

Street Address Accepted Condition(s):

City, State, Zip

Dear [Enter Claimant or Auth Rep]:

I am writing to you concerning your benefits under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). We have received a request for authorization for the 

[Enter type of ancillary medical service requested]. In order to properly evaluate and respond to 

this request, we need additional information from you. 

Please provide our office with the following information:

(Request only that information that is necessary to process the claim. Feel free to modify the 

following, if necessary.)

o Prescription from your treating physician (should include diagnosis code(s) for the 

condition for which the item(s) is being prescribed).

o Letter of Medical Necessity or other medical documentation (describe the general 

information a LMN is to provide. 

o Claimant information such as name, case file number, date of birth, and telephone 

number.

o Provider or vendor information such as name, provider address, ACS provider number, 

Tax ID number, national provider identification number, telephone number, and fax 

number.

o Treating physician contact information such as name, address, telephone number, and fax 

number.

o DME information such as diagnosis code, HCPCS/CPT, modifier, quantity, purchase 

price, rental price, total cost, begin date, end date, and duration of use. 

You have 30 calendar days to provide the additional information. Your lack of response or 

submission of insufficient evidence will result in a denial of the request.

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In the interest of expediting the approval of your request for [Enter type of Ancillary Medical 

Service], please fax the requested information to the DEEOIC Bill Processing Agent at (800) 

882-6147, within 30 days, or contact me if you have questions regarding this request. 

Thank you for your assistance. 

Sincerely,

[Enter POC CE Name and Signature]

[Enter POC CE Telephone and Fax Numbers]

cc: [Enter as appropriate]

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Sample Development Letter (DME/Oxygen Therapy Equipment/Oxygen Medical Supplies)

Date:

Claimant: (or Auth Rep/Provider) Case ID:

Street Address Accepted Condition(s):

City, State, Zip

Dear [Enter Claimant or Auth Rep]:

I am writing to you concerning your benefits under the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). We have received a request for authorization for the 

[rental/purchase] of a [Enter type of DME, Oxygen Therapy Equipment and/or Oxygen Medical 

Supplies requested]. In order to properly evaluate and respond to this request, we need 

additional information from you. 

Please provide our office with the following information:

(Request only that information that is necessary to process the claim. Feel free to modify the 

following, if necessary.)

o Prescription from your treating physician (should include diagnosis code(s) for the 

condition for which the item(s) is being prescribed).

o Letter of Medical Necessity or other medical documentation (describe the general 

information a LMN is to provide. 

o Claimant information such as name, case file number, date of birth, and telephone 

number. 

o Provider or vendor information such as name, provider address, ACS provider number, 

Tax ID number, national provider identification number, telephone number, and fax 

number.

o Treating physician contact information such as name, address, telephone number, and fax 

number.

o DME information such as diagnosis code, HCPCS/CPT, modifier, quantity, purchase 

price, rental price, total cost, begin date, end date, and duration of use. 

 

o Diagnostic testing that supports the physician’s reasons for prescribing oxygen therapy 

DME or oxygen medical supplies, and identifies clear, objective pulmonary deficits 

including results from an arterial blood gas (ABG) and/or resting/exercise spirometry 

test, and/or nocturnal oximetry studies. The results are to identify the conditions under 

which the test(s)/studies were performed; (i.e.; during exercise, at rest, or during sleep). 

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o The test(s) are to be performed by a qualified medical professional, and originate from a 

qualified source such as a laboratory, diagnostic testing facility, hospital, physician’s 

office or clinic.

Note that add-ons and/or upgrades to Oxygen Therapy Equipment and/or Oxygen Medical 

Supplies will be considered for approval if evidence substantiates a medical need for the 

enhancement. However, add-ons and/or upgrades to Oxygen Therapy Equipment and/or Oxygen 

Medical Supplies are not covered when they are intended primarily for the claimant’s 

convenience and do not significantly enhance functionality. 

You have 30 calendar days to provide the additional information. Your lack of response or 

submission of insufficient evidence will result in a denial of the request. 

In the interest of expediting the approval of your request for [Enter type of DME, Oxygen 

Therapy Equipment and/or Oxygen Medical Supplies], please fax the requested information to 

the DEEOIC Bill Processing Agent at (800) 882-6147, within 30 days, or contact me if you have 

questions regarding this request. 

Thank you for your assistance. 

Sincerely,

[Enter POC CE Name and Signature]

[Enter POC CE Telephone and Fax Numbers]

cc: [Enter as appropriate]

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April 2017 Appendices

SAMPLE ANCILLARY MEDICAL SERVICES AUTHORIZATION LETTER

Date:

Claimant Name (or Auth Rep)

Street Address

City, State, Zip

 Re: Case ID [Enter Case ID Number]

Dear [Enter Claimant or Auth Rep Name]:

This letter is in reference to your claim for benefits under the Energy Employees Occupational 

Illness Compensation Program Act (EEOICPA).

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) recently 

received a request for authorization for [Enter the ancillary medical service] for the following 

covered medical condition(s):

List the covered condition(s):

After a thorough review of your case file, including communication with your treating physician 

(if applicable), the following authorization is granted:

[Enter type of ancillary medical service and billing code(s)] for the period of 

[Enter to and from date] from [Enter vendor name]. 

Note that the DEEOIC requires that the approved vendor noted above be enrolled as a provider 

in our medical bill payment system to be reimbursed. Vendors may call toll free 1-866-272-2682 

for program enrollment information or for answers to payment questions. 

All fees for the ancillary medical service is subject to the OWCP Fee Schedule. 

If you have any questions or concerns regarding this authorization, please call your claims 

examiner at (XXX) XXX-XXXX. 

Sincerely, 

[Enter CE name]

DEEOIC Claims Examiner

cc: [Enter supplier name]

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Sample Authorization Letter (DME/Oxygen Treatment Therapy/Oxygen Medical Supplies)

Date:

Claimant Name (or Auth Rep)

Street Address

City, State, Zip

 Re: Case ID [Enter Case ID Number]

Dear [Enter Claimant or Auth Rep Name]:

This letter is in reference to your claim for benefits under the Energy Employees Occupational 

Illness Compensation Program Act (EEOICPA).

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) recently 

received a request for authorization for the [Enter purchase or rental] of a [Enter the Durable 

Medical and/or Oxygen Therapy Equipment and/or Medical Supplies] for the following covered 

medical condition(s):

List the condition(s)

After a thorough review of your case file, including communication with your treating physician 

(if applicable), the following authorization is granted:

Rental of [Enter type of Durable Medical and/or Oxygen Therapy Equipment 

and/or Medical Supplies and billing code(s) for the period] of [Enter to and 

from date] from [Enter vendor name]. 

If the rental is converted to a purchase, the purchase reimbursement 

price must be less than the paid rental price.

Purchase of [Enter type Durable Medical and/or Oxygen Therapy Equipment 

and/or Medical 

Supplies and billing code(s)] from [Enter vendor name].

Note that the DEEOIC requires that the approved vendor noted above be enrolled as a provider 

in our medical bill payment system to be reimbursed. Vendors may call toll free 1-866-272-2682 

for program enrollment information or for answers to payment questions. 

Reimbursement claims must be submitted with the appropriate modifier to receive payment for 

Durable Medical and/or Oxygen Therapy Equipment and/or Medical Supplies.

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All fees for the rental/purchase of Durable Medical and/or Oxygen Therapy Equipment and/or 

Medical Supplies are subject to the OWCP Fee Schedule. 

Add-ons and/or upgrades to the Durable Medical and/or Oxygen Therapy Equipment and/or 

Medical Supplies are considered for approval if evidence substantiates a medical need for the 

enhancement. However, add-ons and/or upgrades to Durable Medical and/or Oxygen Therapy 

Equipment and/or Medical Supplies are not covered when they are intended primarily for the 

claimant’s convenience and do not significantly enhance the equipment/supplies functionality. 

If you have any questions or concerns regarding this authorization, please call your claims 

examiner at (XXX) XXX-XXXX. 

Sincerely, 

[Enter CE name]

DEEOIC Claims Examiner

cc: [Enter supplier name] 

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April 2017 Appendices

OXYGEN DELIVERY SYSTEMS

GASEOUS OXYGEN SYSTEM – This consists of an oxygen tank with a regulator/flowmeter. 

This is a compressed gas system. A regulator/flowmeter is attached to the tank via an oxygen 

wrench. The flow rate is controlled by adjusting the knob on the regulator/flowmeter. Oxygen 

tanks, no matter how large or small, are all portable. 

OXYGEN CONCENTRATOR – An oxygen concentrator is a device which takes ambient or 

room air and divides the air into oxygen and nitrogen. The nitrogen is discarded and the oxygen 

is stored, concentrated, and delivered to the patient at 90-95% purity. A stationary concentrator 

is most typically utilized inside the patient’s home. A stationary system runs on electricity. A 

stationary system has a regulator/flowmeter built into the device. A stationary system typically 

has a single delivery port and, depending upon the model, can deliver up to 8 liters per minute 

(LPM) of oxygen to the patient. A portable oxygen concentrator is most typically utilized 

outside the patient’s home. A portable system runs on a battery that must be recharged 

periodically. The battery recharger runs on electricity. Typical battery life for a portable oxygen 

concentrator is approximately 4 hours. 

LIQUID OXYGEN SYSTEM – Liquid oxygen systems consist of a stationary unit or reservoir 

which stores a large volume of liquid oxygen and a portable unit which can be refilled from the 

stationary unit. Neither the stationary or portable units require electricity. 

MECHANICAL VENTILATOR – Mechanical ventilation may be defined as a life-support 

system designed to replace or support normal ventilator lung function. Mechanical ventilation 

serves only to provide assistance for breathing and does not cure a disease process. Mechanical 

ventilators require electricity and a skilled professional (M.D., D.O., PA, NP, RN, or RRT) to 

monitor the patient and the ventilator settings.

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Sample Home Modification Letter

[Date] 

[Claimant Name or AR Name]

[Street Address] 

[City, State, Zip]

Employee: 

Case ID: 

[Insert Employee Name]

XXXXX

Dear [Insert Employee or AR Name]:

This letter is in reference to your claim for medical benefits under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA). 

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) recently 

received an authorization request for home modifications related to your accepted medical 

condition(s). 

Along with your request we also received a copy of your letter of medical necessity, prescribing 

[Insert brief description of modifications prescribed by letter of medical necessity]. Additionally, 

we received the two, detailed contractor estimates, describing the scope and cost of the proposed 

modifications.

After a careful review of your request, we have determined that the evidence submitted is 

sufficient to authorize your request for home modification. The request is approved subject to 

the following conditions: 

• The DEEOIC is approving modifications based upon the proposal submitted by: [Insert 

Name and Address of Contractor and Date of Proposal, for the approved bid.] 

• The total approved cost for all work, including materials, labor, profit and overhead is the 

amount of[Insert Approved Dollar Amount] as stated in the proposal. 

• Upon completion of the approved modifications, you must submit a signed letter to 

DEEOIC advising that all of the approved work has been completed, and that the work 

has been completed in a satisfactory manner. Along with your letter you must submit a 

completed OWCP Form 915 (Claim For Medical Reimbursement), a final invoice for the 

charges billed, and proof of payment to the contractor. 

• If you want DEEOIC to pay the contractor directly, it will be necessary for the contractor 

to enroll in our medical bill processing system in order to receive payment. Contractors 

seeking additional enrollment information can call our toll-free number (866-272-2682) 

for answers to billing questions. Once the approved work has been completed, it will be 

necessary for you to write us advising that all work has been completed in a satisfactory

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 manner, and that you are requesting DEEOIC to make payment directly to the contractor, 

for the pre-approved amount. 

• Once DEEOIC has approved a written proposal for medically necessary modifications, 

you have the option of contracting for additional modifications, or for materials and 

appliances that represent an upgrade from the medically necessary standard prescribed. 

You may do so with the understanding that DEEOIC will only reimburse you for the cost 

of medically necessary modifications approved in writing. Reimbursement for the 

approved amount will be made to you upon completion of all work, and upon receipt of 

the following: 

o A letter from you stating that all work, as detailed in the approved modification 

proposal, has been completed to your satisfaction. 

o A final invoice from the contractor itemizing the cost of the completed work.

o Proof of payment to the contractor for an amount no less than the amount 

approved for reimbursement by DEEOIC. 

• The DEEOIC neither endorses nor sponsors any entity providing services to beneficiaries 

of our program. 

If you have any questions or concerns regarding this authorization please call me at [Insert 

Telephone Number].

Sincerely,

[Enter CE Name] 

Claims Examiner

Copy To: Authorized Representative

Copy To: Contractor 

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Sample Travel Authorization Letter

Date:

Claimant Name (or Auth Rep): 

Street Address

City, State, Zip

Dear Claimant Name (or Auth Rep):

This letter is in reference to your request for medical travel authorization under the Energy 

Employees Occupational Illness Compensation Program Act. You (or you and your companion)

are authorized to travel for medical treatment with (Insert name of doctor or medical facility) in 

(City / State). Outlined below are the itemized travel allowances approved for your trip: 

• Dates of Trip: (Insert authorized travel dates)

[Or in the alternative] 

• Multiple Trips Authorized (Insert Authorized travel date range)

• Trip Origin & Destination: (Insert starting City/State and ending points) 

• Authorized mode of travel (Insert approved mode: auto, air, etc.) 

• Meals & Incidental Expenses (M&IE) See below.

• Lodging (single or double occupancy) See below.

• Airfare allowance See below. 

• Mileage allowance for personal vehicle (Insert appropriate mileage rate or N/A)

• Companion approved to travel: (Insert name of companion or N/A] 

• Rental car reimbursement Indicate “YES” or N/A]

Companion Travel: If you have been authorized a companion to accompany you on this trip, 

you will be reimbursed at twice the daily M&IE rate and lodging will be based upon doubleoccupancy, unless otherwise approved. If travel is by commercial airline, then the companion 

airfare will be reimbursed as well. The expenses for your companion will be paid to you, not to 

the companion, or any other party.

Travel Changes: We understand your travel may not happen as originally planned. If you 

encounter a change in your travel plans (such as an extended stay) that may result in additional 

expenses, please contact me or the DEEOIC Resource Center identified below at your earliest 

convenience to let us know the specific changes. We will be glad to assist you with any 

adjustments to your authorization so you won’t encounter any delays in your reimbursement. 

How to File for Travel Reimbursement: Reimbursement requests must be submitted using the 

enclosed Form OWCP-957. Only travel costs that are directly related to obtaining medical 

treatment for your accepted condition(s) will be reimbursed. Receipts are required for all 

lodging, airfare, rental car (if authorized), and gasoline purchases (for approved rental car only). 

Any other expenses under $75.00 do not require receipts. The OWCP-957 form includes an 

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instruction sheet; however, I would like to provide you with some additional information to help 

you with your reimbursement request: 

M&IE: Itemization of expenses and submission of receipts is not required for meals and 

incidental expenses (MIE). The MIE expenses are reimbursed as a fixed-rate, daily 

allowance, regardless of what you actually spend, and are determined by the Government 

Services Administration (GSA) published rate for the geographic location of your stay on 

any given day. 

By GSA rule, reimbursement for the first and last days of travel is 75% of the daily fixedrate for MIE.

Lodging: Daily lodging rates are also based on applicable GSA rates for the location of 

your stay and may change due to seasonal fluctuations so be sure to check the current 

rates. State and local lodging taxes are not included in the daily lodging rate and will be 

reimbursed separately. All receipts must be submitted.

Rental Car: When a rental car has been approved, reimbursement will be based upon an 

economy-sized vehicle, unless otherwise approved. Gasoline 

purchases for the rental car are reimbursable. All receipts must be submitted.

Airfare: Airfare reimbursement will be based upon the actual cost incurred, but not to 

exceed the cost of a refundable coach or economy class fare (Y-Class airfare). All 

receipts must be submitted.

GSA Rates: The daily allowances for MIE and lodging are determined by GSA, for 

specific cities and geographic areas around the country, and they vary by region. These 

rates are revised occasionally by GSA. For more information on these GSA-published 

rates, please visit the GSA Website at: www.gsa.gov ; or contact your nearest resource 

center for assistance.

Where to Send Your Reimbursement Forms: Send a copy of this authorization letter, along 

with your itemized Form OWCP-957, along with any required receipts, to our bill processing 

agent. For your convenience, I have enclosed a pre-paid envelope and an extra copy of this 

authorization letter. Please send your information to: 

(Insert Name and Address of the DEEOIC Bill Processing Agent)

Where to go for Help: For assistance in completing your travel reimbursement form, or in 

determining applicable MIE and lodging rates, or if you need other assistance related to this 

travel authorization or reimbursement process, please contact your nearest DEEOIC Resource 

Center, or call me. Below is the address of your nearest Resource Center. 

Insert complete RC address 

Telephone Number

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Additional information and forms are also available on our website at: 

https://www.dol.gov/owcp/energy/. Please have a safe trip and let me know if you have any other 

concerns that are not addressed in this letter. I can be reached, toll free, at: (Insert toll free 

number). 

Sincerely,

Claims Examiner

Enc: OWCP-957 (2 blank forms) 

Prepaid envelope addressed to bill processing agent 

Copy of Authorization Letter (2 copies) 

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SAMPLE MEDICAL DEVELOPMENT LETER (PHYSICIAN)

Physician Name Patient Name:

Street Address

City, State Zip

Patient Date of Birth:

DEEOIC Case ID:

Dear Dr. _________: 

This letter is in reference to your patient, ____________, who has been awarded medical benefits 

under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), for 

the following accepted, work-related conditions: [Insert Medical Conditions.] 

Non-covered conditions which are noted in your patient’s records, and for which benefits are not 

provided, [Insert non-covered conditions.]

You recently wrote to the Division of Energy Employees Occupational Illness Compensation 

(DEEOIC) on [Insert Date of Physician Letter], prescribing the following home health care 

services:

• [Insert description of services prescribed by the doctor]

WHAT DEEOIC IS REQUESTING FROM YOU:

DEEOIC can only authorize home health care services deemed medically necessary for the 

accepted medical conditions listed above. After a review of your narrative letter and your 

patient’s medical records, we are seeking clarification from you regarding the medical necessity 

for the home health care services you have prescribed, as they relate to your patient’s accepted 

condition(s). If home health care is medically necessary for the treatment of these conditions, we 

require a narrative letter, describing in detail the specific medical, and/or ancillary services 

required by your patient, and an explanation as to how these services are causally related to the 

DEEOIC accepted conditions. Medical evidence should include findings upon physical exam (a 

face-to-face exam conducted within the past 60 days is required), laboratory and other test 

results, and any other supporting documentation related to your examination and findings. 

Your narrative letter must clearly differentiate between skilled nursing services and non-skilled 

home health services, and provide specifics as to the frequency and duration of the care your 

patient requires, i.e.; number of hours a day, days a week, and the time period for which these 

services are needed. Skilled and non-skilled services should be separately delineated as follows:

(a) Skilled Nursing Care: A description of the specific medical services to be performed by a 

licensed professional such as a RN/LPN including the frequency that each of these services is to 

be performed in a 24-hour period (or in a calendar week, if the frequency is less than once a 

day), and the period of time for which you are prescribing these services. 

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(b) Non-Skilled Home Health Services: Services of a general nature - - assistance with 

activities of daily living - - such as bathing, personal hygiene, feeding, and assistance with 

ambulation, are generally performed by home health aides (HHA), personal care attendants 

(PCA), or certified nursing assistants (CNA). The need for non-skilled services must be 

separately described, along with the number of hours each day, or week, for which you are 

prescribing care.

Thank you for your assistance in providing this requested information. Please respond within 30 

days to the address on the letterhead. 

The DEEOIC does not endorse or sponsor any home health care provider. Any nursing 

assessment or other documentation presented from a home health provider is the product of that 

provider and should be evaluated carefully in conjunction with your knowledge of the patient’s 

physical findings and medical history. 

Physicians may bill DEEOIC for report preparation using CPT Code 99080, in addition to billing 

for customary medical services (e.g., office visits, diagnostic testing, laboratory services, etc.) 

provided during the physical examination as long as they relate to an accepted condition. 

Supporting documentation (e.g., medical reports, evaluation reports, assessment reports, progress 

report/notes, clinical notes and diagnostic testing results) must be submitted with the completed

OWCP-1500 to DEEOIC’s bill processing agent. Reimbursement for services will be in 

accordance with the OWCP fee schedule.

To receive payment for services, you must be enrolled as a DEEOIC provider. For more 

information on how to become an enrolled provider, please contact the DEEOIC bill processing 

agent at 1-866-272-2682 or at http://owcpstaff.dol.acs-inc.com. DEEOIC requires that providers 

meet basic qualifications, which includes maintaining appropriate licensure, to be enrolled. If 

you have any questions regarding this request, please contact me at 1-888-XXX-XXXX.

Sincerely,

 

[Insert Name]

Claims Examiner

cc: [Insert Patient Name]

Attachments: [Individually describe any medical records or other documents attached]

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SAMPLE MEDICAL DEVELOPMENT LETTER (CLAIMANT)

(Date)

Employee Name

Employee Address

City, State Zip

Employee: 

Case ID: 

Dear (Insert Employee Name):

We recently received a claim requesting that home health care services be provided to you under 

the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). You have 

previously been awarded medical benefits, which may include home health care services, for the 

following work-related conditions: [Insert Accepted Medical Conditions] 

After a careful review of your claim, we have determined that additional medical evidence is 

needed in order to evaluate your request. We have written to your doctor requesting the 

additional information that we require. A copy of our letter is attached. 

Please contact your doctor’s office to confirm that they received our request, and that a response 

will be provided. If you believe that our request should be directed to a doctor other than the one 

identified in this attached letter, please contact me right away.

Ultimately, it is your responsibility to make certain that we receive the medical information 

needed in support of your request. We are asking that you and your physician provide us with a 

response within the next 30 days. 

If you have any questions, or need to contact me regarding this letter, please call me at 1-888-

XXX-XXXX.

Sincerely,

(Insert Name) 

Claims Examiner

Encl. Letter to Physician

______________________________________________________________________________________

If you have a disability (a substantially limited physical or mental impairment); please contact our office/claims 

examiner for information about the kinds of help available, such as communication assistance (alternate formats or 

sign language interpretation), accommodations and modifications.

SUPERSEDED
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SAMPLE AUTHORIZATION LETTER

Date:

Claimant Name (or Authorized Representative) 

Street Address

City, State, ZIP 

Re: Claim Number (Insert Claim Number)

Dear :( Insert Claimant or Authorized Representative Name):

This letter is in reference to your claim for compensation under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA). 

We recently received a request for authorization of in-home medical care for the 

following covered medical conditions: 

Pulmonary Fibrosis

Silicosis

Chronic Obstructive Pulmonary Disease (COPD)

After a thorough review of your case file including communication with your treating 

physician [if applicable] the following authorization is granted for the period of 

December 4, 2006 through June 4, 2007: 

Registered Nurse [Billing Codes T1030 (per diem) and S9123 (hourly)] to 

administer medication and conduct physical evaluation 1 hour per day, every 5 

days.

Home Health Aid or equivalent [Billing Codes S5126 (per diem) and S9122 

(hourly)], 16 hours per day, seven days per week, to assist with ambulating, 

bathing, general personal hygiene, food preparation and feeding, and oxygen 

canister replacement.

You are free to select any licensed provider willing to perform the authorized services; 

however, the DEEOIC requires that the provider be enrolled in our medical bill payment 

system. Providers may call toll free 1-866-272-2682 for program enrollment information 

or for answers to payment questions.

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If you have any questions or concerns regarding this authorization please call your claims 

examiner at (XXX) XXX-XXXX.

Sincerely,

(Insert CE Name)

Claims Examiner

cc: Provider

______________________________________________________________________________________

If you have a disability (a substantially limited physical or mental impairment); please contact our 

office/claims examiner for information about the kinds of help available, such as communication assistance 

(alternate formats or sign language interpretation), accommodations and modifications

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Billing Codes

T1001: Nursing Assessment/Initial Evaluation: A physician’s written report and a Claims 

Examiner’s prior authorization is required before the in-home assessment is conducted. 

Typically only one (1) in-home initial evaluation is authorized for a claimant. Once an 

authorization is approved by the DEEOIC, an assessment can be performed. 

 

T1017: Targeted Case Management (15 minutes = 1 Unit): This service requires prior 

authorization from the DEEOIC Claims Examiner for a Registered Nurse to perform targeted 

case management. This is limited to the clinical impact of a claimant’s accepted work-related 

condition on his/her current medical status. The skill level of a Registered Nurse is required for 

this targeted case management activity. The Claims Examiner’s authorization will specify the 

number of hours authorized for a case management visit. Each unit of a T1017 code is equal to 

15 minutes; therefore, if a nurse case manager is at the claimant’s home for an assessment for 

one hour, the proper number of units to bill for this T1017 code is 4 units. 

 

T1019: Personal Care Attendant (PCA) (15 Minutes = 1 Unit): This service requires prior 

authorization from the Claims Examiner. Attendant services are non-skilled services routinely 

provided in an in-home setting. These services assist claimants with activities of daily living (i.e. 

bathing, feeding, dressing, etc.) Attendant services must be provided by a home health aide, 

licensed practical nurse, or similarly trained individual. A family member who is also a trained 

personal care attendant can only be approved for up to 12 hours of care per day. 

An attendant can only be approved for care if there is sufficient medical rationale from a 

physician stipulating the specific need for personal care services related to the accepted work 

related condition that requires an attendant.

Each unit of a T1019 code is equal to 15 minutes; therefore, if an attendant provides services for 

one hour, the proper number of units to bill for this T1019 code is 4 units. Under no 

circumstances should this code be authorized for more than 7 hours and 45 minutes (31 units) of 

care per day.

T1020: Personal Care Services (PCA) Per Diem (8 hrs.): This service requires prior 

authorization from the DEEOIC Claims Examiner. Attendant services are non-skilled services 

routinely provided in an in-home setting. These services assist claimants with activities of daily 

living (i.e. bathing, feeding, dressing, etc.) Attendant services must be provided by a home 

health aide, licensed practical nurse, or similarly trained individual. A family member who is 

also a trained personal care attendant can only be approved for up to 12 hours of care per day. 

An attendant can only be approved for care if there is sufficient medical rationale from a 

physician stipulating the specific need for personal care services related to the accepted work 

related condition that requires an attendant. 

12-hour care: For personal care services approved for 12 hour care, the bill must be submitted 

with one unit of a T1020 code, which covers the 8-hour period of provided services, and 16 units 

T1019 which cover the 4-hour period of provided services. 

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Under no circumstance should a per diem code be used for less than 8 hours of care. 

T1030: Nursing Care, in-home, by Registered Nurse (RN), Per Diem (8 Hours): This 

service requires prior authorization from the DEEIOC Claims Examiner for a Registered Nurse 

to perform in home health care (per 8 hour shift). An RN can only be approved for ongoing care 

if there is sufficient medical rationale from a physician stipulating the specific medical services 

related to the accepted work-related condition that require an RN for an 8 hour shift(s). 

24-hour care: If this code is approved for 24 hour care, the bill must be submitted with 3 units 

of a T1030 code which covers the 24 hour period of provided services, regardless of the number 

of RNs assigned. For example, if two nurses are utilized for two 12 hour shifts, the bill must 

reflect three units of the authorized T1030 code. 

Under no circumstances should a per diem code be used for less than 8 hours of care. 

T1031: Nursing Care, in-home, by Licensed Practical Nurse (LPN) Per Diem (8 Hours): 

This service requires prior authorization from the DEEOIC Claims Examiner for a Licensed 

Practical Nurse to perform in-home health care (per 8 hour shift). An LPN can only be approved 

for ongoing care if there is sufficient medical rationale from a physician stipulating the specific 

medical services related to the accepted work-related condition that require an LPN for an 8 hour 

shift(s).

24-hour care: If this CPT code is approved for 24 hour care, the bill must be submitted with 3 

units of a T1031 code which covers the 24 hour period of provided services, regardless of the 

number of LPNs assigned. For example, if two nurses are utilized for two 12 hour shifts, the bill 

must reflect three units of the authorized T1031 code. 

Under no circumstances should a per diem code be used for less than 8 hours of care. 

S5126: Attendant: Home Health Aide (HHA), Certified Nurse Assistant (CNA), Per Diem 

(8 Hours): This service requires prior authorization from the DEEIOC Claims Examiner. A 

HHA/CNA can only be authorized for care if there is sufficient medical rationale from a 

physician documenting the medical necessity of the service for the accepted work-related 

condition. If a HHA/CNA is authorized and a RN/LPN is utilized, bills should be submitted with 

the S5126 code. 

24-hour care: If this CPT code is approved for 24 hour care and the care is provided, the bill 

must be submitted for 3 units which cover the 24 hour period of provided services, regardless of 

the number of HHA/CNAs assigned. For example, if two HHA/CNAs are utilized for two 12 

hour shifts, the service provided still covers the authorized three 8 hour shifts and the bill should 

reflect 3 units of the authorized S5126 code. 

Under no circumstances should a per diem code be used for less than 8 hours of care

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S9122: Home Health Aide (HHA) or Certified Nurse Assistant (CNA) Hourly Code (less 

than 8 hour care): This service requires prior authorization from the DEEOIC Claims 

Examiner for a HHA or CNA to perform in home health care (per hour code only). A HHA or 

CNA can be approved if there is sufficient medical rationale from a physician stipulating the 

specific medical services related to the accepted work-related condition that requires a HHA or 

CNA. Under no circumstances should an hourly code be authorized for more than 7 hours (units) 

of care per day.

S9123: Nursing Care in-home Registered Nurse (RN) Hourly Code (less than 8 hour care): 

This service requires prior authorization from the DEEOIC Claims Examiner for a RN to 

perform in home care (per hour code only). A RN can only be approved for ongoing care if there 

is sufficient medical rationale from a physician stipulating the specific medical services related 

to the accepted work-related condition that requires a RN. Under no circumstances should an 

hourly code be authorized for more than 7 hours (units) of care per day.

S9124: Nursing Care in-home License Practical Nurse (LPN) Hourly Rate (less than 8 

hour care): This service requires prior authorization from the Claims Examiner for a LPN to 

perform in home care (per hour code only). A LPN can only be approved for ongoing care if 

there is sufficient medical rationale from a physician stipulating the specific medical services 

related to the accepted work-related condition that requires a LPN. Under no circumstances 

should an hourly code be authorized for more than 7 hours (units) of care per day. 

S9126: Hospice Care, in the home, Per Diem (8 Hour Shifts): This service requires prior 

authorization from the DEEOIC Claims Examiner. Hospice care is generally requested and 

authorized when an employee is determined to be terminally ill. 

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INSTRUCTIONS FOR COMPLETING OFFSET WORKSHEET

READ BEFORE THE WORKSHEET IS COMPLETED: Lump-sum payments 

and/or medical benefits to be awarded for an accepted condition are only “offset” or reduced to 

reflect the amount of any settlement or final judgment payment for injuries due to exposure to 

the same toxic substance for which EEOICPA payments are payable. If the payment was for 

injuries due solely to exposure to some other toxic substance, no offset of EEOICPA benefits is 

required. For example, a Part B award for lung cancer due to exposure to radiation is NOT offset 

to reflect a settlement or final judgment payment in a suit that only alleges exposure to asbestos 

fibers. Also, if the tort complaint alleges exposure that is clearly outside the time frame and/or 

location of exposure awarded under EEOICPA, offset is not required. As long as there is one 

exposure that would be compensable, offset is required even if the tort suit or EEOICPA claim 

has several other different exposures. In order to determine whether offset will be necessary, the 

CE must examine the complaint to see what alleged exposure is identified as causing the alleged 

injuries.

 

The CE does not have to fill out the Worksheet if the employee or his/her survivor(s) has had 

their workers’ compensation benefits, or a RECA section 4 or 5 award, or a prior award of 

EEOICPA Part B/E benefits offset to reflect the full amount of a settlement or final judgment 

payment. However, if the reduction of those prior benefits was not enough to fully offset the 

payment, leaving a surplus payment still requiring an offset, enter the dollar amount of the 

surplus payment on Line 6c and complete the remainder of the Worksheet. The CE does not 

have to complete the entire Worksheet if he or she is only offsetting a claimant’s current Part 

B/E lump-sum award or future medical benefits to reflect a surplus payment.

 

Step 1 – Putting a Value on a Settlement or Final Judgment. 

 

Settlements or final judgments can include both an initial cash payment and future payments. 

The “value” of future payments is their present value, not the sum of the future payments (which 

will always be more than the present value of the future payments). If the future payments are 

made through an annuity, the CE may accept the purchase price of the annuity as the present 

value of the future payments. Do not attempt to put a value on a future payment that is 

contingent upon an event that has not yet taken place, such as the diagnosis of another medical 

condition. This particular type of future payment cannot be valued and is not to be included in 

the amount listed on Line 1 of the Worksheet. However, if the event in question has occurred by 

the time a later award under Part E becomes payable, any payment for that event must be added 

to the amount entered on Line 1, and the Worksheet must be completed again. Any payment for 

the aggravation, by medical malpractice, of illnesses caused by the same exposure for which 

EEOICPA benefits are payable is an amount that must be reported to OWCP and included in the 

amount listed on Line 1. 

 

In some rare cases, a complaint alleging injuries due to exposure to a toxic substance may 

contain causes of action for unrelated damages to either personal property or real property of the 

plaintiff(s). If this occurs, and the payment listed on Line 1 includes an amount for damages to 

personal or real property, enter this amount on Line 1a. If there is a question about whether or 

not the complaint contains a cause of action of this sort, contact the National Office.

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Since EEOICPA benefits are not offset to reflect the amount of any payment for medical 

treatment provided BEFORE the date an employee files a claim, enter the amount of the payment 

listed on Line 1 that is explicitly designated as being for this medical treatment on Line 1b, even 

if the payment was made directly to the provider. Also, if a malpractice payment is included in 

the amount on Line 1, and it only constitutes a reimbursement for medical treatment provided 

before the employee filed a claim, include the malpractice payment in the amount listed on Line 

1b and complete the remainder of the Worksheet. If a malpractice payment constitutes anything 

other than a reimbursement for medical treatment provided to the employee before he/she filed a 

claim for EEOICPA benefits, do not complete the Worksheet and refer the case to the National 

Office. 

 

Some law suits, such as those related to exposure to asbestos, may involve multiple defendants 

making multiple payments over time. EEOICPA benefits currently payable will be reduced to 

reflect the total of only those settlement or final judgment payments received. Payments 

received at a later date may be offset from any future EEOICPA award of lump-sum benefits or 

payment of medical benefits, at which time another Worksheet must be completed, listing on 

Line 1 the total of the payments received since the completion of the prior Worksheet (also add 

any prior unabsorbed surplus from any earlier offset of benefits to the amount in Line 6c). 

 

Step 2 – Single Recoveries vs. Joint Recoveries. 

 

A payment on a final judgment or settlement is a joint recovery only if it was paid to multiple 

parties. Joint recoveries are “allocated” or split up between multiple parties at either Step 3 or 4 

of the Worksheet. If only one party received the amounts on Lines 1a, 1b and 1c of the 

Worksheet, AND THAT PARTY WAS THE EMPLOYEE OR ANOTHER PERSON 

WITHOUT THEIR OWN CAUSE OF ACTION IN THE COMPLAINT, fill in the remainder of 

the Worksheet. It is rare that a payment will be made to a person who does not have their own 

cause of action in the complaint. However, if an unmarried employee files suit and then dies, a 

court may appoint another person to take charge of the suit. While this person will not have their 

own cause of action, he will be the proxy for the deceased employee. 

If someone other than these two specific parties received the entire payment, and the employee 

was alive at the time it was paid, no offset is needed and the Worksheet does not need to be 

completed. For example, if an employee and his or her spouse were both plaintiffs with causes 

of action in a case they brought together and they both signed releases to settle their case, but 

only the spouse received a payment and the employee was alive at that time, no offset is 

required. 

 

Step 3 – Judge/Jury Allocation of Joint Recoveries. 

 

If a judge or jury specifies how to allocate a joint recovery between multiple parties, the CE 

MUST use that allocation to fill in the blanks in Step 3, as appropriate. In these situations, the 

CE must obtain a copy of either the judge’s order or the jury’s verdict making the allocation.

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Step 4 – All Other Allocations for Living/Deceased Employees. 

 

In all other situations involving a joint recovery, the CE will automatically allocate 75% of the 

amount on Line 1c to the employee and the remaining 25% to the other parties to the litigation if 

the employee was alive at the time the payment was made, then enters this amount on Line 4a of 

the Worksheet. If the employee died before a payment was made, the CE automatically allocates 

50% of the amount on Line 1c for the employee’s occupational illness/covered illness, and enters 

this amount on Line 4b. 

 

If the claimant wants to allocate less than the standard percentages to the recovery of the 

employee (which will reduce the amount by which the EEOICPA award must be offset), the 

claimant must submit evidence and legal argument to the CE that shows that a lower percentage 

is appropriate. This evidence MUST show that: 

 

A. State law in the relevant state provides a cause of action for loss of consortium (tort claim 

based on deprivation of a spousal or parental relationship due to injuries) or wrongful death for 

the family member to whom the recovery is attributed, and

 

B. A cause of action for loss of consortium or wrongful death was actually asserted by that 

family member, either in the same action or in separate actions.

 

To make these required showings, the claimant must submit a copy of the complaint filed on 

behalf of the spouse and/or children, and citations to appropriate state case law or statutes. If the 

CE determines that the evidence as noted above support allocating a lower percentage to the 

employee, the CE circles “Y” at Line 4c and enters the lower percentage for the employee in the 

appropriate blank in Line 4d. Using this percentage, the CE calculates the new allocation for the 

employee and enters this amount on Line 4d. Any situations where this matter is unclear should 

be referred to the National Office for guidance.

 

In the event there are multiple payments over time constituting joint recoveries by an employee 

and other plaintiffs, and the employee dies after receiving at least one payment (but before all of 

the payments are made), the CE calculates the amount of the offset of an EEOICPA award by 

using two Worksheets. Using two Worksheets enables the CE to allocate the appropriate 

percentage of the joint recoveries to the employee. The CE completes one Worksheet for 

payments received prior to the employee’s death (entering that amount on Line 1), and another 

Worksheet for payments received after the employee’s death. 

 

Step 5 – Allowable Deductions from a Payment. 

 

Costs that may be listed on Line 5a of the Worksheet are reasonable out-of-pocket costs and 

expenses involved in bringing a lawsuit, but do not include fees paid to co-counsel or normal 

office expenses like secretary or paralegal services or in-house record copying costs. Before the 

CE may approve the deduction of any costs, the costs MUST be itemized so the CE may evaluate 

the nature of each individual cost to ensure that it is allowable. Costs that are allowable could 

include filing fees, travel expenses, record copy services, witness fees, court reporter costs for 

transcripts of hearings and depositions, postage, and long distance telephone calls. Once the 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 31-1 Back to Top

April 2017 (Page 4 of 5) Appendices

allowable costs have been identified and the sum of those costs are listed on Line 5a, the CE 

must divide these costs by the amount of the gross payment listed on Line 1 of the Worksheet to 

determine the percentage of the payment that is represented by the allowable costs, rounded up to 

the next highest tenth. For example, 26.121% is rounded up to 26.2%. Once this rounded 

percentage is calculated, the CE must multiply it by the amount listed on Line 1c (if the only 

party paid was the employee or another person without their own cause of action), or the amount 

listed on Line 3a, 4a, 4b or 4d (if multiple parties were paid) to calculate the amount of costs to 

deduct. The CE then enters the result on Line 5b. 

 

Attorney fees submitted for consideration should be entered on Line 5c of the Worksheet. Using 

the same basic calculation method used for costs, the CE should divide Line 5c by Line 1 to 

determine the percentage of the gross payment that is represented by the attorney fees, rounded 

up to the next highest tenth. For example, 26.121% is rounded up to 26.2%. Enter the rounded 

percentage in the space provided after Line 5c. In general, any fee that exceeds 40% will be 

considered unreasonable. To determine the amount of allowable attorney fees to be deducted, 

the CE must multiply the amount listed on Line 1c (if the only party paid was the employee or 

another person without their own cause of action), or the amount listed on Line 3a, 4a, 4b or 4d 

(if multiple parties were paid), by the LOWER of the attorney fees percentage that was entered 

in the space after Line 5c or 40%, and enter the result on Line 5d. If the attorney fee percentage 

exceeds 40%, the CE should inform the claimant and allow an opportunity to establish that an 

attorney fee in excess of 40% is reasonable.

 

The circumstances which should be taken into account in determining the reasonableness of both 

attorney fees and costs of suit include prevailing local fees, cases of similar complexity and the 

amount of the gross settlement or final judgment at issue. CE determinations in these areas are 

made for the sole purpose of administering § 7385 of EEOICPA and do not have any effect on a 

fee agreement between an attorney and client or any other matter not involving the application of 

the Act.

 

Sometimes after an attorney receives a settlement or final judgment payment, but before the 

attorney distributes that payment to his or her clients, the attorney has to pay out a portion of the 

payment to satisfy the lien of a state workers’ compensation system or an insurer for amounts 

paid by the system or insurer for the employee’s medical condition. When this has occurred, the 

CE enters the amount of the payment that was made to satisfy the lien on Line 5e of the 

Worksheet. 

 

Step 6 – Calculating the Amount of the Offset. 

 

To calculate the amount by which EEOICPA benefits must be offset, the CE subtracts Line 5b 

from Line 1c, 3a, 4a, 4b or 4d, as appropriate, and enters the result on Line 6a. The CE then 

subtracts Line 5d from Line 6a, and enters the result on Line 6b. Finally, the CE subtracts the 

amount on Line 5e (if any) from Line 6b, and enters the result on Line 6c. This last amount is 

the amo

SUPERSEDED

unt by which the claimant’s Part B or E award must be offset. 
Federal (EEOICPA) Procedure Manual Appendices 

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April 2017 (Page 5 of 5) Appendices

Step 7 – Amount of Part B/E Benefits Due or Surplus Payment. 

 

At Step 7 of the Worksheet, the CE determines either the net amount of EEOICPA benefits due 

the claimant, or the amount of the surplus payment remaining that must still be absorbed from 

either future Part E lump-sum payments, or future medical benefits under either Part B or Part E. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 32-1 Back to Top

April 2017 Appendices

DO NOT COORDINATE

Multiple illnesses arising out of same incident accepted under 

SWC, only one of those accepted as covered illness under Part E 

of EEOICPA – do not coordinate any Part E benefits

SWC paid only medical benefits, no monetary benefits – do not 

coordinate any Part E benefits

SWC paid only vocational rehabilitation benefits, no monetary 

benefits – do not coordinate any Part E benefits

Illness accepted under Part B, accepting same illness under Part 

E for causation only (no monetary) for the condition accepted 

under Part B only – do not coordinate Part E medical benefits 

(but coordinate impairment and wage-loss benefits). 

SUPERSEDED
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April 2017 (Page 1 of 2) Appendices

Instructions for Completing Coordination of SWC Benefits Worksheet 

Determining the amount of SWC received. Enter the gross dollar amount of SWC the claimant 

received as of the date of the recommended decision on Line 1, less any amounts previously 

coordinated with prior Part E payments. SWC received by someone other than the claimant is 

not used to coordinate the claimant’s Part E benefits and must not be included in the amount 

entered on Line 1. For example, SWC received by a worker who is now deceased is not used to 

coordinate Part E benefits payable to that worker’s survivor(s). If the amount on Line 1 includes 

SWC that was received for a medical condition other than the covered illness(es) accepted by

DEEOIC in the claim, DO NOT COMPLETE THE WORKSHEET.

If the amount entered on Line 1 does not include medical and/or vocational rehabilitation 

benefits, the CE circles “NO” at Step 2 and skips Step 3. However, if the amount on Line 1 does 

include medical and/or vocational rehabilitation benefits, the CE circles “YES” at Step 2 and 

performs the calculations listed at Step 3. On Line 3a, the CE enters the amount of medical 

benefits paid to both the employee and any providers. On Line3b, the CE enters the total amount 

of vocational rehabilitation expenses paid to both the employee and any providers. These 

amounts are added at Line 3c, and this total is subtracted from the amount listed on Line 1, 

leaving the “net” SWC listed on Line 3d. 

Costs of suit that may be listed on Line 4a of the Worksheet are reasonable out-of-pocket costs 

and expenses involved in bringing a SWC lawsuit, but do not include any fees paid to co-counsel 

or normal office expenses like secretarial or paralegal services or in-house record copying costs. 

To be deductible from the amount of SWC received by the claimant, the costs MUST be 

itemized so each individual cost may be evaluated by the CE to ensure that it is allowable and 

authentic. Costs that are routinely allowable are filing fees, travel expenses, record copy 

services, witness fees, postage, court reporter costs for transcripts of hearings and depositions, 

and long distance telephone calls. Once the costs percentage has been calculated (round this 

figure to the nearest HIGHER one-tenth percentage point) and entered on Line 4b, the CE 

multiplies that percentage by the amount listed on Line 1, or the amount listed on Line 3d if 

“YES” was circled at Step 2, and enters this amount on Line 4c. Attorney fees supported by bills 

or other appropriate documentation are entered on Line 4d of the Worksheet. In general, 

attorney fees that exceed 40% of the SWC amount entered on Line 1 will be considered 

unreasonable. If the fees percentage (round this figure to the nearest HIGHER one-tenth 

percentage point also) entered on Line 4e is greater than 40%, the CE must inform the claimant 

of this matter and provide him or her an opportunity to show (to the CE’s satisfaction) that the 

attorney fees paid were reasonable. If the claimant is unable to do so, the CE uses 40% to 

calculate the amount entered on Line 4f. 

To determine the amount of SWC requiring coordination, the CE subtracts the amount entered 

on Line 4g from the SWC entered on Line 1, or the “net” SWC entered on Line 3d if Step 3 of 

the Worksheet was used, and enters the result on Line 5. The amount entered on Line 5 is the 

amount of SWC to be used to coordinate the claimant’s current Part E benefits. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

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Version 1.0 Exhibit 33-4 Back to Top

April 2017 Appendices

Coordinating the Part E benefits. To perform the required coordination of Part E benefits, the 

CE enters the amount of Part E benefits that are currently payable to the claimant on Line 6 of 

the Worksheet, and subtracts the amount of SWC entered on Line 5 of the Worksheet from the 

amount entered on Line 6. The result of this coordination is entered on Line 7. If Line 5 is 

LESS than Line 6, the amount on Line 7 is the compensation payable to the claimant under Part 

E of EEOICPA, reduced to reflect the benefits previously received under a SWC program. This 

is also the amount of Part E compensation that must be referenced in the recommended decision. 

If Line 5 is MORE than Line 6, the amount on Line 7 will be a negative number that represents 

the amount of the “surplus” of SWC that must be absorbed from any future Part E benefits 

payable to the claimant. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 33-4 Back to Top

April 2017 Appendices

Payment Transaction Form for Expedited Processing (EPPTF)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 33-4 Back to Top

April 2017 Appendices

Payment Transaction Form for 3rd Party Expedited Payments (EPPTF)

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 33-4 Back to Top

April 2017 Appendices

Payment Transaction Form for Exception Processing 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 33-4 Back to Top

April 2017 Appendices

ECS Payment Cancellation Form 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-1 Back to Top

April 2017 (Page 1 of 5) Appendices

Sample Initial Overpayment Notification Letter - Without Fault 

Employee: 

 EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant Name

Address 

 

Dear [Claimant Name]:

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has made a 

preliminary finding that you have been overpaid benefits in the amount of [$ ]. The 

overpayment occurred because: 

[Describe reason]

DEEOIC has also made a preliminary finding that you are without fault in creating the 

overpayment. If you disagree with the fact or the amount of the overpayment, you have a right to 

submit new evidence. 

When a claimant is without fault in creating an overpayment, the law states that DEEOIC may 

not recover the overpayment if the recovery would defeat the purpose of the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA), or the recovery would be against 

equity and good conscience.

To defeat the purpose of the EEOICPA, it must be found that the claimant requires substantially 

all current income to meet current ordinary and necessary living expenses and the claimant assets 

do not exceed a specified amount as determined by DEEOIC from data furnished by the Bureau 

of Labor Statistics.

It would be against equity and good conscience to recover an overpayment when:

1. A claimant would suffer severe financial hardship in trying to repay the debt; or 

2. A claimant, acting on incorrect information from DEEOIC, gives up a verifiably 

valuable right or changes his or her position for the worse, such as leaving a job which he 

or she cannot regain; or 

3. A claimant, acting on incorrect information from DEEOIC, spends or commits funds 

in ways which he or she otherwise would not have done, and suffers a financial loss as a 

SUPERSEDED

result.
Federal (EEOICPA) Procedure Manual Appendices 

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Version 1.0 Exhibit 35-1 Back to Top

April 2017 (Page 2 of 5) Appendices

ACTIONS YOU MAY TAKE

If you believe that you should receive a waiver instead of repaying the overpayment, you may 

take any one of the following actions within 30 days of the date of this letter:

1. Request a telephone conference with the DEEOIC National Office; or

2. Request that the DEEOIC National Office issue a final decision based on the written 

evidence of record.

The DEEOIC staff will address the following issues during the telephone conference or in 

writing:

a. How the overpayment occurred and the amount; 

b. Discuss the criteria for a waiver on collecting the overpayment. 

INFORMATION NEEDED TO WAIVE RECOVERY OF THE OVERPAYMENT

If you are seeking a waiver of recovery (whether you choose a phone conference or not) you 

should send the following to DEEOIC: 

1. A detailed explanation of your reasons for seeking waiver; 

2. A fully-completed Overpayment Recovery Questionnaire (Form OWCP-20) 

(copy enclosed); and

3. Supporting documents, to include copies of income tax returns, bank account 

statements, bills and canceled checks, pay slips, and other records to support income and 

expenses shown on Form OWCP-20. Do not send originals as they will not be returned. 

This information will help us decide whether or not you meet the criteria to waive recovery of 

the overpayment. If waiver is not granted, the information will be used to decide how to collect 

the overpayment. We will not try to collect the overpayment until we reach a final decision on 

your request for waiver.

Also please note that under 20 CFR 30.518, we will deny waiver if you fail to furnish the 

information requested on the enclosed Form OWCP-20 (or other information we need to address 

a request for waiver) within 30 days. We will not consider any further request for waiver until 

the requested information is furnished. Once an overpayment final decision letter is issued, a 

waiver of recovery of the overp

SUPERSEDED

ayment is no longer an option.
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-1 Back to Top

April 2017 (Page 3 of 5) Appendices

CONTACTING DEEOIC

If you wish to have a telephone conference, please so state on the attached Response to Initial 

Overpayment Notice, and send it to the DOL DEEOIC Central Mail Room address noted below 

the National Office within 30 days. You must also submit a detailed explanation of your reasons 

for seeking waiver, a fully-completed and signed Form OWCP-20, and supporting documents 

along with your request. We will then contact you to arrange a convenient time for the 

conference, allowing enough time for you to prepare. If we do not receive a reply from you 

within 30 days of the date of this letter, we will issue a final decision based on the information 

currently on file. Please note that without the required financial information, a waiver of 

recovery of the overpayment cannot be granted. 

If you wish to have a decision made based on the written evidence only, please so state on the 

attached form and send it to the DOL DEEOIC Central Mail Room within 30 days. (We may still 

contact you to arrange a telephone conference if the written evidence is not sufficient to make a 

decision.) 

A request for either a conference or a decision on the written evidence, along with any 

supporting evidence or arguments, should be sent to the following address: 

DOL DEEOIC Central Mail Room

PO Box 8306 

London, KY 40742-8306 

If you agree with the findings of this decision, and you wish to make payment at this time, please 

send a check to the address shown below. Make the check payable to the “U.S. Department of 

Labor, OWCP”, notate the case ID, and indicate that it is for an overpayment. 

US DEPARTMENT OF LABOR

DEEOIC

PO Box 77247 

Washington, DC 20013-7247 

If we do not receive a reply from you within 30 days of the date of this letter, a final decision 

will be issued based on the evidence of record. 

If you have any questions about this letter, you may contact me at { } or 202-693-0081. 

Sincerely,

{PA name}

Policy Unit

DEEOIC

Enclosures: Overpayment Recovery Questionnaire (Form OWCP-20) 

 Response to Initial Overpayment Notice 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-1 Back to Top

April 2017 (Page 4 of 5) Appendices

Notice to Customers Making Payment by Check 

When you provide a check as payment, you authorize us either to use information from your 

check to make a one-time electronic fund transfer from your account or to process the payment 

as a check transaction. When we use information from your check to make an electronic fund 

transfer, funds may be withdrawn from your account as soon as the same day we receive your 

payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting 

and collecting the information from your check, and explaining the purposes and routine uses which will be 

made of your check information, is available on internet site at: https://www.pccotc.gov/pccotc/index.htm , or 

call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a 

decision not to do so may require you to make payment by some other method.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-1 Back to Top

April 2017 (Page 5 of 5) Appendices

RESPONSE TO INITIAL OVERPAYMENT NOTICE

EMPLOYEE: 

EEOICPA CASE ID: 

CLAIMANT: 

EEOICPA CLAIM ID: 

____ I request a telephone conference with the National Office on the issue of possible waiver 

of recovery of this overpayment. My supporting financial documents are enclosed. 

 ____ I request that the National Office make a decision based on the written evidence on the 

issue of possible waiver of recovery of this overpayment. My supporting financial documents are 

enclosed. 

Signature: _____________________________ Date: _________________ 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-2 Back to Top

April 2017 (Page 1 of 5) Appendices

SAMPLE INITIAL OVERPAYMENT NOTIFICATION LETTER - AT FAULT

 Employee: 

EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant Name

Address 

 

Dear [Claimant Name]:

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has made a 

preliminary finding that you have been overpaid benefits in the amount of [$ ]. The 

overpayment occurred because: 

[Describe reason]

DEEOIC has also made a preliminary finding that you were at fault in this matter for the 

following reason(s): 

[Describe reason]

This letter is not a final decision. You have the right to submit evidence or arguments which you 

believe will affect these preliminary findings if:

1. You disagree that the overpayment occurred;

2. You disagree with the amount of the overpayment; 

3. You believe that the overpayment occurred through no fault of your own; or 

4. You believe that the overpayment occurred through no fault of your own and that 

DEEOIC should waive recovery of the overpayment. 

ACTIONS YOU MAY TAKE

You may take any one of the following actions within 30 days of the date of this letter: 

1. Request a telephone conference with the DEEOIC National Office; or

2. Request that the DEEOIC National Office issue a final decision based on the 

written evidence of record. 

The following issues will be addressed during the telephone conference or in writing:

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-2 Back to Top

April 2017 (Page 2 of 5) Appendices

a. How the overpayment occurred and the amount; 

b. Discuss the criteria for a waiver on collecting the overpayment. 

INFORMATION NEEDED TO WAIVE RECOVERY OF THE OVERPAYMENT

A waiver of recovery of an overpayment can only be granted when the claimant is without fault 

in causing it. When the claimant is without fault, the law states that DEEOIC may not recover 

the overpayment if the recovery would defeat the purpose of the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA), or the recovery would be against 

equity and good conscience.

To defeat the purpose of the EEOICPA, it must be found that the claimant requires substantially 

all current income to meet current ordinary and necessary living expenses and the claimant’s 

assets do not exceed a specified amount as determined by DEEOIC from data furnished by the 

Bureau of Labor Statistics.

It would be against equity and good conscience to recover an overpayment when: 

1. A claimant would suffer severe financial hardship in trying to repay the debt; 

2. A claimant, acting on incorrect information from DEEOIC, gives up a valuable 

right, such as leaving a job which he or she cannot regain; or 

3. A claimant, acting on incorrect information from DEEOIC, spends or commits 

funds in ways which he or she otherwise would not have done, and suffers a financial 

loss as a result.

DEEOIC may overturn the preliminary finding of at fault based on new evidence or arguments 

you submit. This action may make it possible for DEEOIC to waive recovery of the 

overpayment. Therefore, you should complete the enclosed Overpayment Recovery 

Questionnaire (Form OWCP-20) and submit it to this office at the DOL DEEOIC Central Mail 

Room address. You should attach supporting documents to Form OWCP-20, including copies of 

income tax returns, bank account statements, bills and canceled checks, pay slips, and any other 

records which support the income and expenses listed. Do not send originals as they will not be 

returned. 

If the preliminary finding is overturned, this information will help us determine whether or not 

you meet the criteria to waive recovery of the overpayment. If the preliminary finding is upheld 

or waiver is not granted, the information will be used to decide how to collect the overpayment. 

Please note that if we make a final decision that you were at fault in creating an overpayment, we 

cannot waive recovery of the overpayment. However, we will not try to collect the overpayment 

until we reach a final decision on your request for waiver.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-2 Back to Top

April 2017 (Page 3 of 5) Appendices

Also, please note that under 20 CFR 30.518, we will deny a waiver if you fail to furnish the 

information requested on the enclosed Form OWCP-20 (or other information we need to address 

a request for waiver) within 30 days. We will not consider any further request for waiver until 

the requested information is furnished. Once an overpayment final decision letter is issued, a 

waiver of recovery of the overpayment is no longer an option. 

CONTACTING DEEOIC

If you wish to have a telephone conference, please so state on the attached Response to Initial 

Overpayment Notice, and send it to the DOL DEEOIC Central Mail Room address noted below 

within 30 days. You must also submit a detailed explanation of your reasons for requesting a 

waiver, a fully-completed and signed Form OWCP-20, and supporting documents. We will then 

contact you to arrange a convenient time for the conference, allowing enough time for you to 

prepare. If we do not receive a reply from you within 30 days of the date of this letter, we will 

issue a final decision based on the information currently on file. Please note that without the 

required financial information, a waiver of recovery of the overpayment cannot be granted. 

If you wish to have a decision made based on the written evidence only, please so state on the 

attached form and send it to this office at the DOL DEEOIC Central Mail Room address within 

30 days. (We may still contact you to arrange a telephone conference if the written evidence is 

not complete enough to make a decision.) 

A request for either a conference or a decision on the written evidence, along with any 

supporting evidence or arguments, should be sent to the following address: 

DOL DEEOIC Central Mail Room

PO Box 8306 

London, KY 40742-8306 

If you do not disagree with findings of this decision, and wish to make payment at this time, 

please send a check or money order to the address shown below. Make it payable to the “U.S. 

Department of Labor, OWCP”, notate the case ID, and indicate that it is for an overpayment. 

U.S. Department of Labor 

DEEOIC

PO Box 77247 

Washington, DC 20013-7247 

If we do not receive a reply from you within 30 days of the date of this letter, we will issue a 

final decision based on the evidence of record. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-2 Back to Top

April 2017 (Page 4 of 5) Appendices

If you have any questions about this letter, you may contact me at { } or 202-693-0081. 

Sincerely,

{PA name}

Policy Unit

DEEOIC 

Enclosure: Form OWCP-20 

 Response to Initial Overpayment Notice 

Notice to Customers Making Payment by Check 

When you provide a check as payment, you authorize us either to use information from your 

check to make a one-time electronic fund transfer from your account or to process the payment 

as a check transaction. When we use information from your check to make an electronic fund 

transfer, funds may be withdrawn from your account as soon as the same day we receive your 

payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting 

and collecting the information from your check, and explaining the purposes and routine uses which will be 

made of your check information, is available on internet site at: https://www.pccotc.gov/pccotc/index.htm , or 

call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a 

decision not to do so may require you to make payment by some other method.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-2 Back to Top

April 2017 (Page 5 of 5) Appendices

RESPONSE TO INITIAL OVERPAYMENT NOTICE

EMPLOYEE: 

EEOICPA CASE ID: 

CLAIMANT: 

EEOICPA CLAIM ID: 

____ I request a telephone conference with the DEEOIC National Office on the issues of fault 

and possible waiver of recovery of this overpayment. My supporting financial documents are 

enclosed.

____ I request that the DEEOIC National Office make a decision based on the written 

evidence on the issues of fault and possible waiver of recovery of this overpayment. My 

supporting financial documents are enclosed. 

Signature: ______________________________ Date: ________________ 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-3 Back to Top

April 2017 Appendices

SAMPLE MEMORANDUM TO FILE FOR ADMINISTRATIVE WRITE-OFF OF DEBT 

EQUAL TO OR LESS THAN $2500 

MEMORANDUM 

DATE: 

TO: {Name], Unit Chief, PRPU 

FROM: {Name], Policy Analyst

SUBJECT: Employee:

 Claimant: 

 DEEOIC CASE ID: 

 ADMINISTRATIVE WRITE-OFF OF DEBT EQUAL TO OR 

LESS THAN $2,500 

The Federal Claims Collection Standards (FCCS), 4 CFR Section 103.4, state that a claim may 

be compromised if the cost of collection would not justify enforcing the collection of the full 

claim. Section 104.3I states, that collection action may be terminated when it is likely that the 

cost of further collection action will exceed the amount likely to be recovered. In a decision 

issued on September 29, 1986, the Comptroller General elaborated on 4 CFR by concluding that 

these standards extend to the collection of debts from federal employees, and that agencies may 

establish “minimum debt amounts” and realistic “points of diminishing returns” in their debt 

collection activities. The term “minimum debt amounts” refers to the designation of categorical 

thresholds beneath which collection action need not be initiated because the amount of the debts 

in that class are so small in relation to the costs of attempting collection efforts. “Diminishing 

returns” refers to an agency’s designation of thresholds beneath which the agency will 

discontinue collection efforts already initiated when it appears that the costs of additional 

collection actions would exceed the amounts likely to be recovered. The Comptroller General 

instructed further that agencies may, on a case-by-case basis, take the anticipated costs of 

required administrative hearings into consideration when determining whether to compromise or 

terminate collection action. 

The National Office has considered the case and has noted that the following applied: [Describe 

how debt occurred.] 

RECOMMENDATION: Based upon the above, I find that the following action is appropriate: 

[Explain why it’s feasible to terminate debt collection activities.]

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-4 Back to Top

April 2017 Appendices

SAMPLE PRE-CONFERENCE CALL CHECKLIST

Name of person to be called: ___________________________________ 

Telephone Number: ______________________ 

 (Area code, number) 

Person to be called is: _____Claimant ___Attorney/Representative

Agenda items: Item Completed Comments

1. Explain purpose of pre-conference call _____________ _________ 

2. Explain purpose of conference 

 and topics to be discussed; i.e., 

fault determination and/or waiver ______________ _________ 

3. Describe info person will need at ______________ _________ 

 conference

4. Confirm person’s ability to obtain info ______________ _________ 

5. Explain “at fault” finding, if applicable ______________ _________ 

6. Explain criteria for “waiver” ______________ _________ 

7. Explain “interest” charges ______________ _________ 

8. Indicate conference is limited to 

overpayment issues ______________ _________ 

9. Confirm person’s understanding ______________ _________ 

 of conference

10. Ask if person has questions ______________ _________ 

11. Conference scheduled for: 

 Date_______________________ Time______________ 

 

12. Other items (specify) 

______________________________________________________________________________

______________________________________________________________________________ 

13. Pre-conference call made by ________________Date____________ 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-5 Back to Top

April 2017 (Page 1 of 3) Appendices

SAMPLE MEMORANDUM OF CONFERENCE

MEMORANDUM OF CONFERENCE

DATE:

NAME OF EMPLOYEE: 

 

NAME OF CLAIMANT: 

CASE ID: 

 

CONFERENCE DATE: 

 

PARTICIPANTS: { Name } , Claimant 

 { Name } , Policy Analyst, DEEOIC 

PREPARED BY: {Analyst’s name} 

This memorandum summarizes the telephone conference held to discuss the {$ } overpayment 

in the claim filed by {Claimant’s name} under Part {B and/or E} of the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA or Act). 

PURPOSE OF TELEPHONE CONFERENCE: 

In response to an overpayment notice, {Claimant’s name} requested a telephone conference to 

discuss the findings pertaining to the overpayment in {his / her} claim, including a request for 

waiver of recovery of the overpayment. 

BACKGROUND: 

{Describe the background of the claim and how the overpayment was determined.}

When an overpayment occurs in a claim, the DEEOIC is required to take the appropriate action 

to recover the overpaid benefits. The DEEOIC sent {Claimant’s name} a notice informing 

{him / her} of the overpayment. The notice also informed {him / her} of the preliminary 

finding that {he / she} was {insert fault finding} in causing the overpayment. {If at fault, 

insert why this finding was made.}

 

In response to the notice, {Claimant’s name} requested a telephone conference and requested a 

waiver of recovery. {Claimant’s name} submitted an Overpayment Recovery Questionnaire 

and {

SUPERSEDED

insert documentation submitted}. 
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-5 Back to Top

April 2017 (Page 2 of 3) Appendices

PRE-CONFERENCE CALL:

On {date}, {Analyst’s name} telephoned {Claimant’s name} to schedule a telephone 

conference. {Claimant’s name} was informed that the purpose of the conference was to give 

{him / her} the opportunity to discuss the criteria for granting a waiver of recovery of the 

overpayment. The telephone conference was scheduled for {date}. 

OVERPAYMENT TELEPHONE CONFERENCE: 

The telephone conference was held on {date} with {Analyst’s name}, who advised 

{Claimant’s name} that the purpose of the conference was to give {him / her} the opportunity 

to provide information to support the request for a waiver of recovery of the overpayment. 

{Insert in detail what claimant stated during the conference}

{Analyst’s name} explained the criteria for granting a waiver of recovery of the overpayment. 

A waiver can be granted if a claimant is not at fault in causing the overpayment, and that it 

would be a financial hardship and defeat the purpose of the EEOICPA, or it would be against 

equity and good conscience if required to repay the money. 

{If waiver request is based on financial hardship, list type and amount of income, expenses, 

and assets.} 

{Claimant’s name} stated that the monthly income, expenses, and assets include the following: 

Monthly Income:

{Identify each income source} $

Monthly Expenses: 

{Identify each monthly expense} $

 

Countable Assets: 

(Identify each countable asset $

 and value) 

-OR- 

{If waiver request is based on against equity and good conscience, describe the basis for 

that request and documentation submitted to support it.}

{Analyst’s name} informed {Claimant’s name} that if a waiver is granted based on “against 

equity and good conscious,” financial information is not taken into consideration. Therefore, 

{his / her} complete financial information was not being requested at this time.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-5 Back to Top

April 2017 (Page 3 of 3) Appendices

CONCLUSION: 

{Analyst’s name} informed {Claimant’s name} that {he / she} would prepare and send a 

memorandum summarizing the telephone conference. If {he / she} had any comments regarding 

the memorandum, {he / she} should send the comments in writing to {Analyst’s name}. The 

information in the case file will be reviewed, and a final decision regarding the overpayment will 

be sent to {him / her}. {Claimant’s name} stated that {he / she} did not have any further 

statements, and the telephone conference was concluded.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-6 Back to Top

April 2017 Appendices

SAMPLE COVER LETTER TO MEMORANDUM OF CONFERENCE

 Employee: 

EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant Name

Address 

 

Dear {Claimant Name}:

This letter is in reference to the telephone conference held on {date}. You requested the 

conference to discuss the overpayment in your claim under Part {B and/or E} of the Energy 

Employees Occupational Illness Compensation Program Act (EEOICPA or Act). 

A memorandum summarizing the telephone conference is attached for your review. The 

memorandum does not include any findings in this matter. If you do not disagree with anything 

in the memorandum, you do not have to send a response. If you find that the memorandum does 

not accurately report what you stated during the conference, please provide me with your reasons 

for disagreeing in writing within fifteen (15) days of the date of this letter. 

{Insert a request for additional documentation, if needed. Additional documentation is to 

be submitted within 30 days.}

Send your response to the following address: 

DOL DEEOIC Central Mail Room

PO Box 8306 

London, KY 40742-8306 

All information regarding the overpayment will be reviewed, and an overpayment final decision 

will be sent to you. If you have any questions regarding this matter, you may contact me at 

{phone number}.

Sincerely,

{PA name}

Policy Unit

DEEOIC

Attachment

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-7 Back to Top

April 2017 (Page 1 of 2) Appendices

SAMPLE OVERPAYMENT FINAL DECISION – PRELIMINARY AT FAULT 

DETERMINATION CORRECT

 Employee: 

EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant Name

Address 

 

Dear {Claimant Name}:

This is the final decision in reference to the overpayment of benefits in the amount of {$ } in 

your {Part B and/or E} claim under the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA or Act). 

{Provide explanation of how overpayment occurred.}

{Provide explanation of how the overpayment final decision was determined.}

Based on the review of the evidence of record, DEEOIC finds that you did not provide sufficient 

evidence to reverse the preliminary overpayment determination. Accordingly, the final 

determination in this case is that you were at fault in causing the overpayment, and that you must 

return the {$ }. 

In addition, as of the date of this decision, interest on this debt began accruing at the current U.S. 

Department of Treasury note rate of { %} annually. If you wish to repay the overpayment at 

this time and avoid the payment of interest, please send your full payment immediately. You 

may also request to enter into a repayment agreement to make monthly installment payments. If 

we do not receive your payment or request to enter into a repayment agreement within 30 days of 

the date of this letter, this will be a delinquent debt. 

It is important to note that delinquent debts will be referred to the Department of the Treasury for 

recovery. This referral is authorized under the Debt Collection Act, which also authorizes the 

assessment of interest, administrative costs, and penalties on delinquent debts. Various measures 

may be utilized to collect the debt, including administrative wage garnishment, offset of 

payments from federal programs such as income tax refunds, and referral of debts to private 

collection agencies and credit bureaus. The information that will be provided to a credit bureau 

includes your name, address, social security number, the amount, status, and history of the debt, 

and the program under which the debt arose (Energy Employees Occupational Illness 

Compensation Program). 

Certain rights are provided to you with respect to the referral of your debt to the Department of 

Treasury or credit bureaus. If you think that the determination regarding the debt is in error, you 

may request further information as noted below, and send your request to: DOL DEEOIC 

Central Mail Room, PO Box 8306, London, KY 40742-8306.

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-7 Back to Top

April 2017 (Page 2 of 2) Appendices

• You may request copies of your records about this debt. 

• You may request a review of our determination about the amount of your debt, its past-due 

status, and its legal enforceability. To exercise this right, you must state your request in 

writing, state your reason(s) for challenging our determinations, and sign your statement. If 

you believe that any information of record concerning your debt is not accurate, timely, 

relevant, or complete, you must provide information or documentation to support your belief. 

To pay the overpayment in full, you should send your payment in the amount of {$ } within 

30 days. Make your check or money order payable to “U.S. Dept. of Labor, OWCP/DEEOIC.” 

Please notate the case ID on the check or money order and indicate that it is for an overpayment 

refund. Send the payment to: US Department of Labor, DEEOIC, PO Box 77247, Washington, 

DC 20013. 

If you cannot repay the full amount at this time and would like to enter into a written repayment 

agreement, you should contact this office to make arrangements for installment payments. The 

Overpayment Recovery Questionnaire and supporting financial documentation will be used in 

setting up the repayment agreement. 

If you have any questions about this letter or wish to set up an installment repayment plan, you 

may contact me at {phone number} or 202-693-0081. 

Sincerely,

{PA name} 

Policy Unit

DEEOIC

Notice to Customers Making Payment by Check 

When you provide a check as payment, you authorize us either to use information from your 

check to make a one-time electronic fund transfer from your account or to process the payment 

as a check transaction. When we use information from your check to make an electronic fund 

transfer, funds may be withdrawn from your account as soon as the same day we receive your 

payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting 

and collecting the information from your check, and explaining the purposes and routine uses which will be 

made of your check information, is available on internet site at: https://www.pccotc.gov/pccotc/index.htm , or 

call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a 

decision not to do so may require you to make payment

SUPERSEDED

by some other method. 
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-8 Back to Top

April 2017 (Page 1 of 4) Appendices

SAMPLE OVERPAYMENT FINAL DECISION – WITHOUT FAULT - WAIVER 

DENIED

 Employee: 

EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant’s Name

Address 

 

Dear {Claimant Name}: 

This is the final decision in reference to the overpayment of benefits in the amount of {$ } in 

your {Part B and/or E} claim under the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA or Act). After a thorough review of the financial information 

submitted, it has been determined that you do not meet the criteria for a waiver of the 

overpayment recovery. 

{Provide explanation of how overpayment occurred.} 

{Provide explanation of how the overpayment final decision was determined. If applicable, 

include a statement if the preliminary at fault finding was reversed.}

In response to an overpayment notice sent to you on {date}, you completed an Overpayment 

Recovery Questionnaire (OWCP-20) and requested a waiver of recovery of the overpayment. To 

support your request, you submitted the required financial information pertaining to your 

income, expenses, and assets. This determination is based on the financial documentation that 

you provided. 

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.a states that an overpayment 

waiver may be granted if recovery would defeat the purpose of the EEOICPA. This means that it 

must be found that the claimant requires substantially all current income to meet current ordinary 

and necessary living expenses. To meet this criterion, the monthly income must not exceed 

monthly expenses by more than $200. In addition, the claimant’s countable assets must not 

exceed an amount as determined by data obtained from the Bureau of Labor Statistics (BLS). 

The countable asset limit is $5,500 for an individual and $9,200 for an individual and spouse, 

plus $1,100 for each dependent. 

The information you provided shows that your household consists of you, {include spouse and 

number of children, if any}. The monthly household income is approximately {$ }. The 

monthly expenses that you submitted are approximately {$ }, and include {list type of 

expenses}. Based on this information, {state whether monthly income exceeds monthly 

expenses by more than $200 or it does not exceed monthly expenses by more than $200.

SUPERSEDED

} 
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-8 Back to Top

April 2017 (Page 2 of 4) Appendices

With regard to your assets, your home and up to two motor vehicles are excluded from your 

countable assets. The information you submitted show that your countable assets include the 

following: 

{List assets and value} $ 

Total Countable Assets $ 

The asset amount allowed for your household is {$ }. The known value of your countable 

assets is {$ }. {State whether assets are under or over the countable asset limit to qualify 

for a waiver.}

{State why claimant does not meet waiver criteria}

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.b states that an overpayment 

waiver may also be granted if recovery of the overpayment would violate equity and good 

conscience. The following is the criteria to qualify for a waiver under this clause:

 

1. A claimant would suffer severe financial hardship in trying to repay the debt; 

2. A claimant, acting on incorrect information from DEEOIC, gives up a verifiably valuable 

right or changes his or her position for the worse, such as leaving a job which he or she cannot 

regain; or 

3. A claimant, acting on incorrect information from DEEOIC, spends or commits funds in 

ways which he or she otherwise would not have done, and suffers a financial loss as a result. 

I advised you of this clause and explained the criteria for a waiver. However, you did not 

provide any information to indicate that you would meet the waiver criteria. 

The DEEOIC Policy Unit has reviewed the documentation submitted in support of your request 

for a waiver of recovery of the overpayment. The final determination with regard to the 

overpayment in your claim is that you do not meet the criteria for a waiver to be granted. 

Accordingly, you must return the overpaid compensation of {$ }. 

In addition, as of the date of this decision, interest on this debt began accruing at the current U.S. 

Department of Treasury note rate of { %} annually. If you wish to repay the overpayment at 

this time and avoid the payment of interest, please send your full payment immediately. You 

may also request to enter into a repayment agreement to make monthly installment payments. If 

we do not receive your payment or request to enter into a repayment agreement within 30 days of 

the date of this letter, this wi

SUPERSEDED

ll be a delinquent debt. 
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-8 Back to Top

April 2017 (Page 3 of 4) Appendices

It is important to note that delinquent debts will be referred to the U.S. Department of Treasury 

for recovery. This referral is authorized under the Debt Collection Act, which also authorizes the 

assessment of interest, administrative costs, and penalties on delinquent debts. Various measures 

may be utilized to collect the debt, including administrative wage garnishment, offset of 

payments from federal programs such as income tax refunds, and referral of debts to private 

collection agencies and credit bureaus. The information that will be provided to a credit bureau 

includes your name, address, social security number, the amount, status, history of the debt, and 

the program under which the debt arose (Energy Employees Occupational Illness Compensation 

Program).

Certain rights are provided to you with respect to the referral of your debt to the Department of 

Treasury or credit bureaus. If you think that the determination regarding the debt is in error, you 

may request further information as noted below, and send your request to: DOL DEEOIC 

Central Mail Room, PO Box 8306, London, KY 40742-8306. 

• You may request copies of your records about this debt. 

• You may request a review of our determination about the amount of your debt, its past-due 

status, and its legal enforceability. To exercise this right, you must state your request in 

writing, state your reason(s) for challenging our determinations, and sign your statement. If 

you believe that any information of record concerning your debt is not accurate, timely, 

relevant, or complete, you must provide information or documentation to support your belief. 

To pay the overpayment in full, send your payment in the amount of {$ } within 30 days of 

the date of this letter. Make your check or money order payable to “U.S. Dept. of Labor, 

OWCP/DEEOIC”. Please notate the case ID number on the check or money order and indicate 

that it is for an overpayment refund. Send the payment to: US Department of Labor, DEEOIC, 

PO Box 77247, Washington, DC 20013. 

If you cannot repay the full amount at this time and would like to enter into a written repayment 

agreement, you should contact this office to make arrangements for installment payments. The 

Overpayment Recovery Questionnaire and supporting financial documentation will be used in 

setting up the repayment agreement.

If you have any questions about this letter or wish to set up an installment repayment plan, please 

contact me at {phone number} or 202-693-0081. 

Sincerely,

{PA name}

Policy Unit

DEEOIC

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-8 Back to Top

April 2017 (Page 4 of 4) Appendices

Notice to Customers Making Payment by Check 

When you provide a check as payment, you authorize us either to use information from your 

check to make a one-time electronic fund transfer from your account or to process the payment 

as a check transaction. When we use information from your check to make an electronic fund 

transfer, funds may be withdrawn from your account as soon as the same day we receive your 

payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting 

and collecting the information from your check, and explaining the purposes and routine uses which will be 

made of your check information, is available on internet site at: https://www.pccotc.gov/pccotc/index.htm , or 

call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a 

decision not to do so may require you to make payment by some other method. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-9 Back to Top

April 2017 (Page 1 of 2) Appendices

SAMPLE OVERPAYMENT FINAL DECISION – WAIVER GRANTED BASED ON 

DEFEAT PURPOSE OF EEOICPA

 Employee: 

EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant Name

Address 

 

Dear {Claimant Name}:

This is the final decision in reference to the overpayment of benefits in the amount of {$ } in 

your {Part B and/or E} claim under the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA or Act). A full waiver recovery of the overpayment in your claim is 

hereby granted.

{Provide explanation of how overpayment occurred.}

On {date}, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) 

sent you a letter informing you of the overpayment, with a finding that you were without fault in 

creating the overpayment. The letter also informed you that when a without fault finding is 

made, the overpaid claimant is still required to repay that money, but may request a waiver under 

certain financial circumstances. You requested a waiver of recovery of the overpayment.

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.a states that an overpayment 

waiver may be granted if recovery would defeat the purpose of the EEOICPA. This means that it 

must be found that the claimant requires substantially all current income to meet current ordinary 

and necessary living expenses. To meet this criterion, the monthly income must not exceed 

monthly expenses by more than $200. In addition, the claimant’s countable assets must not 

exceed an amount as determined by data obtained from the Bureau of Labor Statistics (BLS). 

The countable asset limit is $5,500 for an individual and $9,200 for an individual and spouse, 

plus $1,100 for each dependent. 

To support your waiver request, you submitted the required financial information. 

{Describe documents submitted and financial information}

The information you provided shows that your household consists of you, {include spouse and 

number of children, if any}. The monthly household income is approximately {$ }. The 

monthly expenses are approximately {$ }. Based on this information, your expenses are 

within the limits of being reasonable and necessary, and your monthly income does not exceed 

your monthly expenses by more than $200. Your countable assets of {$ } do not exceed the 

resource limit of {$ } based on the limit for your household. As such, your financial 

documents show that you meet the criteria for a waiver of recovery of the overpayment based on 

“recovery would defeat the purpose of the EEOICPA.”

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-9 Back to Top

April 2017 (Page 1 of 2) Appendices

Accordingly, the DEEOIC grants a waiver of recovery of the {$ } overpayment in the Part {B 

and/or E} claim filed by {Claimant’s name}. This matter is closed and no further action will 

be taken. If you have any questions about this letter, you may contact this office at {Analyst’s 

phone number} or 202-693-0081. 

Sincerely,

{Name} 

Unit Chief for Policy, 

Regulations and Procedures 

DEEOIC

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-10 Back to Top

April 2017 (Page 1 of 3) Appendices

SAMPLE OVERPAYMENT FINAL DECISION - WAIVER GRANTED (FULL OR 

PARTIAL) BASED ON VIOLATE EQUITY AND GOOD CONSCIENCE

 Employee: 

EEOICPA Case ID: 

EEOICPA Claim ID: 

Claimant Name

Address 

Dear {Claimant Name}:

This is the final decision in reference to the overpayment of benefits in the amount of {$ } in 

your {Part B and/or E} claim under the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA or Act). A {full or partial} waiver recovery of the overpayment in 

your claim is hereby granted.

{Provide explanation of how overpayment occurred.}

On {date}, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) 

sent you a letter informing you of the overpayment, with a finding that you were without fault in 

creating the overpayment. The letter also informed you that when a without fault finding is 

made, the overpaid claimant is still required to repay that money, but may request a waiver under 

certain financial circumstances. You requested a waiver of recovery of the overpayment.

The EEOICPA Federal Procedure Manual at Chapter 3-0800.10.b states that an overpayment 

waiver may be granted if recovery would violate equity and good conscience. This means that 

(1) recovery will cause the claimant to suffer severe financial hardship and meets the required 

criteria, or (2) the claimant has relinquished a valuable right or changed position for the worse. 

To support your waiver request, you stated that {insert claimant’s reason for requesting a 

waiver}, and submitted the required documentation. 

{Describe documents submitted that meet the criteria 

for the waiver}

The DEEOIC has reviewed the documents and statements provided, and finds that you meet the 

criteria for a waiver. Accordingly, the DEEOIC grants a {full or partial} waiver of recovery of 

the overpayment in the amount of {$ } in the Part {B and/or E} claim filed by {Claimant’s 

name}. 

{If full waiver is granted insert the following 

SUPERSEDED

closing paragraph} 
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-10 Back to Top

April 2017 (Page 2 of 3) Appendices

This matter is closed and no further action will be taken. If you have any questions about this 

letter, you may contact this office at {Analyst’s phone number} or 202-693-0081. 

Sincerely,

{Name} 

Unit Chief for Policy, 

Regulations and Procedures 

DEEOIC

– or – 

{If partial waiver granted, explain further collection actions to be taken and rights as noted 

below, and include Notice for check payment.}

You must return the remaining overpaid compensation of {$ }. As of the date of this decision, 

interest on this debt began accruing at the current U.S. Treasury note rate of { %} annually. If 

you wish to repay the overpayment at this time and avoid the payment of interest, please send 

your full payment immediately. If you cannot pay the full amount at this time, you may also 

request to enter into a repayment agreement to make monthly installment payments.

This debt will become delinquent if your payment is not received or you do not request to enter 

into a repayment agreement within 30 days of the date of this letter. It is important to note that 

delinquent debts will be referred to the U.S. Department of Treasury for recovery. This referral 

is authorized under the Debt Collection Act, which also authorizes the assessment of interest, 

administrative costs, and penalties on delinquent debts. Treasury may utilize various measures 

to collect the debt, including administrative wage garnishment, offset of payments from federal 

programs such as income tax refunds, and referral of debts to private collection agencies and the 

credit bureaus. The information that will be provided to a credit bureau includes your name, 

address, social security number, the amount, status, history of the debt, and the program under 

which the debt arose (Energy Employees Occupational Illness Compensation Program). 

Certain rights are provided to you with respect to the referral of your debt to Treasury or to credit 

bureaus. If you think that the determination regarding the debt is in error, you may request 

further information as noted below. Send your request to this office at DOL DEEOIC Central 

Mail Room, PO Box 8306, London, KY 40742-8306. 

• You may request copies of your records about this debt. 

• You may request a review of our determination about the amount of your debt, its pastdue status, and its legal enforceability. To exercise this right, you must state your request 

in writing, state your reason(s) for challenging our determinations, and sign your 

statement. If you believe that any information of record concerning your debt is not 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-10 Back to Top

April 2017 (Page 3 of 3) Appendices

accurate, timely, relevant, or complete, you must provide information or documentation 

to support your belief. 

To pay the overpayment in full, send your payment in the amount of {$ } within 30 days of 

the date of this letter. Make your check or money order payable to “U.S. Dept. of Labor, 

OWCP/DEEOIC”, notate the case ID, and indicate that it is for an overpayment. Send the 

payment to: 

US DEPARTMENT OF LABOR

DEEOIC

P.O. Box 77247 

Washington, DC 20013 

If you wish to set up a repayment agreement or have any questions about this letter, please 

contact this office at {Analyst’s phone number} or 202-693-0081. 

Sincerely,

{Name} 

Unit Chief for Policy, 

Regulations and Procedures 

DEEOIC

Notice to Customers Making Payment by Check 

When you provide a check as payment, you authorize us either to use information from your 

check to make a one-time electronic fund transfer from your account or to process the payment 

as a check transaction. When we use information from your check to make an electronic fund 

transfer, funds may be withdrawn from your account as soon as the same day we receive your 

payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting 

and collecting the information from your check, and explaining the purposes and routine uses which will be 

made of your check information, is available on internet site at: https://www.pccotc.gov/pccotc/index.htm , or 

call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a 

decision not to do so may require you to make payment by some other method. 

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

______________________________________________________________________________ 

Version 1.0 Exhibit 35-11 Back to Top

April 2017 (Page 1 of 2) Appendices

SAMPLE LETTER TO NON-CLAIMANT REGARDING FEDERAL DEBT

 Employee: 

EEOICPA Case ID: 

Name

Address 

Dear :

This letter concerns the claim filed by {Claimant’s name}, under Part {B and/or E} of the 

Energy Employees Occupational Illness Compensation Program Act (EEOICPA). 

A compensation payment in the amount of {$ } was paid to {Claimant’s name} on {date} 

by way of direct deposit into a joint bank account held by {Claimant’s name} and you at the 

{name of bank}. Subsequent to the payment, the district office became aware that {Claimant’s 

name} died on {date of death}, which is prior to the date of payment. Under the EEOICPA, a 

person is only eligible for benefits if that person is alive at time of payment. Since {Claimant’s 

name} died prior to the payment, the compensation should have been returned. 

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) contacted the 

{name of bank} requesting that the {$ } be returned to the U.S. Treasury. However, the 

bank stated that you had withdrawn the money and closed the account. 

You must return the full amount of the compensation. To resolve this matter, please send a 

check or money order made payable to the U.S. Dept. of Labor, OWCP/DEEOIC. Please notate 

the EEOICPA case ID on the check and indicate that it is a return of benefits. Send the payment 

to: 

U.S. Dept. of Labor 

DEEOIC

P.O. Box 77247 

Washington, DC 20013 

If we do not receive payment within 30 days, this will be considered a delinquent debt. You 

should be aware that the DEEOIC will refer delinquent debts to the U.S. Department of the 

Treasury for collection. The Department of Treasury may recover this debt by administrative 

wage garnishment, offset from any federal payments that may be due you, and/or referral to 

private collection agencies. An administrative cost will be assessed to help defray the expense of 

this referral. Furthermore, information about the status and delinquency of your debt will be 

subject to credit reporting. 

Interest began accruing as of the date of this letter at the current U.S. Treasury note rate of { 

%} annually. If you wish to repay the entire amount of the debt at this time, and thus avoid the 

payment of interest, please submit your full payment immediately

SUPERSEDED
Federal (EEOICPA) Procedure Manual Appendices 

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Thank you for your prompt attention to this matter. If you have any questions about this letter, 

please feel free to contact this office at {Analyst’s phone number}. 

Sincerely,

{PA name}

Policy Unit

DEEOIC

Notice to Customers Making Payment by Check 

When you provide a check as payment, you authorize us either to use information from your 

check to make a one-time electronic fund transfer from your account or to process the payment 

as a check transaction. When we use information from your check to make an electronic fund 

transfer, funds may be withdrawn from your account as soon as the same day we receive your 

payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting 

and collecting the information from your check, and explaining the purposes and routine uses which will be 

made of your check information, is available on internet site at: https://www.pccotc.gov/pccotc/index.htm , or 

call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check information is voluntary, but a 

decision not to do so may require you to make payment by some other method. 

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SAMPLE SECOND DEMAND LETTER

Dear [Claimant Name]: 

This letter is in further reference to your debt in the amount of [$], which resulted from the 

overpayment of benefits in your case. A copy of our overpayment decision and first demand for 

payment, dated [insert date] is enclosed. We have not received payment from you or any 

indication that you intend to cooperate in this matter. 

If we do not receive payment, or some indication that you intend to make payment, within 30 

days of the date of this letter, we may add administrative charges for sending any additional 

demands for payment. 

If your debt remains delinquent, we will refer it to the Department of the Treasury for collection. 

We will assess an additional administrative cost to help defray the expense of this referral. 

Information about the status and delinquency of your debt is reportable to credit bureaus. 

• You may inspect and request copies of your records about this debt; 

• You may contact us to enter into a mutually agreeable written repayment agreement; and

• You may request a review of our determinations about the amount of your debt, its pastdue status, and its legal enforceability. To exercise this right, you must state your request 

in writing, state your reason(s) for challenging our determinations, and sign your 

statement. If you believe that any information of record concerning your debt is not 

accurate, timely, relevant, or complete, you must provide information or documentation 

to support your belief. 

You are expected to reply within 30 days. Make your check payable to the U.S. Department of 

Labor, OWCP, and include your EEOICPA file number on the check. Send payment to: 

U.S. Dept. of Labor 

DEEOIC

P.O. Box 77247 

Washington, DC 20013

If you wish to enter into a written repayment agreement, contact me immediately at [insert 

telephone number]. 

. 

Sincerely,

Unit Chief for Policies, 

Regulations and Procedures 

DEEOIC

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April 2017 Page 1 of 2 Appendices

Enclosure: 

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April 2017 Page 2 of 2 Appendices

Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize us either to use information from your check to make a onetime electronic fund transfer from your account or to process the payment as a check transaction. When we use 

information from your check to make an electronic fund transfer, funds may be withdrawn from your account as 

soon as the same day we receive your payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and collecting the information

from your check, and explaining the purposes and routine uses which will be made of your check information, is available on internet 

site at: https://www.pccotc.gov/pccotc/index.htm , or call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check 

information is voluntary, but a decision not to do so may require you to make payment by some other method. 

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April 2017 Page 1 of 2 Appendices

SAMPLE THIRD AND FINAL DEMAND LETTER

Dear [Claimant Name]: 

This letter is in further reference to your debt in the amount of [$], which resulted from the 

overpayment of benefits in your case. 

Because 30 days have passed and we have not received payment or an indication that you intend 

to repay this money, your debt is now considered to be delinquent. Interest will therefore be 

assessed at the rate which applied when you received your first notice of indebtedness, or [$]. 

We may add penalty charges of 6% per year for any portion of the debt remaining delinquent for 

more than 90 days and administrative charges. 

We may refer the debt to a credit bureau and to the Department of the Treasury for 

administrative offset if payment is not made within 60 days of the date of this letter. Information 

which will be given to a credit bureau is limited to your name, address and social security 

number; the amount, status and history of the debt; and the program under which the debt arose, 

that is, the Energy Employees Occupational Illness Compensation Program. 

Once your debt has been referred to the Department of the Treasury, administrative charges will 

be added to the current principal amount. These charges, which are computed as a percentage of 

the debt, reflect our collection cost. They are authorized by the Debt Collection Improvement 

Act of 1996 (Public Law 104-134). This referral will therefore result in a large increase in the 

size of your debt. 

You may avoid these outcomes by sending a check in the amount stated above. Make your check 

payable to U.S. Department of Labor, OWCP, and include your EEOICPA file number on the 

check. Send it to: 

U.S. Dept. of Labor 

DEEOIC

P.O. Box 77247 

Washington, DC 20013

As you have been advised previously, you have certain rights with respect to referral of your 

debt to the Department of the Treasury or to credit bureaus: 

 You may inspect and request copies of your records about this debt; 

 You may contact us to enter into a mutually agreeable written repayment agreement; and

 You may request a review of our determinations about the amount of your debt, its past-due 

status, and its legal enforceability. To exercise this right, you must state your request in 

writing, state your reason(s) for challenging our determinations, and sign your statement. If 

you believe that any information of record concerning your debt is not accurate, timely, 

relevant, or complete, you must provide information or documentation to support your belief

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If you wish to enter into a written repayment agreement, contact me immediately at [insert 

telephone number]. 

Sincerely,

Unit Chief for Policies, 

Regulations and Procedures 

DEEOIC

Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize us either to use information from your check to make a onetime electronic fund transfer from your account or to process the payment as a check transaction. When we use 

information from your check to make an electronic fund transfer, funds may be withdrawn from your account as 

soon as the same day we receive your payment. 

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and collecting the information 

from your check, and explaining the purposes and routine uses which will be made of your check information, is available on internet 

site at: https://www.pccotc.gov/pccotc/index.htm , or call toll free at 1-866-945-7920 to obtain a copy by mail. Furnishing the check 

information is voluntary, but a decision not to do so may require you to make payment by some other method. 

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April 2017 Page 1 of 3 Appendices

WAIVER OF CHARGES WORKSHEET

File Number: 123456789 

1. Current principal balance $_________ 

2. Accrued charges

a.) accrued Administrative charges $_________ 

b.) accrued penalty $_________ 

c.) accrued interest $_________ 

Total (Item 2a + Item 2b + Item 2c) $_________ 

3. Interest rate (express as percent; i.e. 5% not .05) 

Monthly interest rate (annual rate/12) _________% 

4. Monthly payment $_________ 

5. Monthly interest (Item 1 x Item 3) $_________ 

If Item 5>= Item 4, then charges are waived. Stop here

 If Item 5< Item 4, go on to Item 6 

6. Period to repay full amount of debt (months) 

 a) Period to repay accrued charges________ mos. 

Item 2/Item 4- (Item 1 x Item 3) 

b) Period to repay principal ________ mos. 

Total (Item 6a + Item 6b) ________ mos. 

7. Debtor’s life expectancy (see page 2 of this exhibit; multiply that figure by 12 to convert 

years to months). 

IF ITEM 7 IS LESS THAN ITEM 6, then all charges must be waived. 

IF ITEM 7 IS GREATER THAN OR EQUAL TO ITEM 6, then charges cannot be 

waived.

Consider whether the accrued charges and/or principal must be compromised by 

completing the Compromise of Principal Worksheet. 

Calculations performed by: _______________ Date: _________ 

Certified by: ____________________________ Date: _________ 

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April 2017 Page 2 of 3 Appendices

Life Table 6.3 Expectation of Life at Single Years of Age, by Race and Sex. United States, 

1999. Found in “National Vital Statistics Reports, April 21, 2001, Volume 50, Number 6, page 2 

(Table A and 7-12, Tables 1-3), published by the Department of Health and Human Services, 

Center for Disease Control and Prevention, National Center for Health Statistics, National Vital 

System.

Age

All Races

Both Sexes Male Female

30 48.2 45.7 50.5

31 47.3 44.8 49.8

32 46.3 43.9 48.6

33 45.4 42.9 47.6

34 44.4 42.0 46.7

35 43.5 41.1 45.7

36 42.6 40.2 44.8

37 41.6 39.2 43.8

38 40.7 38.3 42.9

39 39.8 37.4 41.9

40 38.8 36.5 41.0

41 37.9 35.6 40.0

42 37 34.7 39.1

43 36.1 33.8 38.2

44 35.2 32.9 37.2

45 34.3 32.0 36.3

46 33.4 31.1 35.4

47 32.5 30.3 34.4

48 31.6 29.4 33.5

49 30.7 28.5 32.6

50 29.8 27.7 31.7

51 28.1 26.8 30.8

52 28.1 26.0 29.9

53 27.2 25.2 29.0

54 26.4 24.4 28.2

55 25.5 23.6 27.3

56 24.7 22.7 26.4

57 23.9 21.9 25.6

58 23.1 21.2 24.7

59 22.3 20.4 23.9

60 21.5 19.6 23.1

61 20.7 19.9 22.3

62 20.0 18.9 21.5

63 19.2 18.2 20.7

64 18.9 17.5 19.9

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65 17.7 16.1 19.1

66 17.4 16.1 18.4

67 16.3 15.4 17.6

68 15.6 14.7 16.9

69 15 13.5 16.1

70 14.3 12.8 15.4

71 13.7 12.3 14.7

72 13.0 11.7 14.1

73 12.4 11.1 13.4

74 11.8 10.6 12.7

75 11.2 10.0 12.1

76 10.7 9.6 11.5

77 10.1 9.0 10.8

78 9.6 8.5 10.2

79 9.0 8.0 9.7

80 8.5 7.5 9.1

81 8.0 7.1 8.6

82 7.5 6.7 8.0

83 7.1 6.3 7.5

84 6.7 5.9 7.1

85 6.3 5.5 6.6

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COMPROMISE OF PRINCIPAL WORKSHEET

File Number: 123456789 

1. Current principal balance $________ 

2. Accrued charges

a.) accrued Administrative charges $________ 

b.) accrued penalty $________ 

c.) accrued interest $________ 

Total (Item 2a + Item 2b + Item 2c) $________ 

3. Interest rate (express as percent; i.e. 5% not .05) 

a.) Annual Interest rate ________% 

 b.) Monthly interest rate (annual rate/12) ________% 

4. Monthly payment $________ 

5. To determine if this is a candidate for compromise apply the following rule:

Divide the current principal balance (plus any accrued charges) by the monthly payment; and 

multiply the result by the annual interest rate.

_________ + _________ / _________ x ____________ = _________ 

Item 1 Item 2 Item 4 Item 3a

If the result is less than 5.5, no compromise is necessary. If the result is 5.5 or greater complete 

the balance of the worksheet to determine the amount, if any, to be compromised. 

6. First month interest (Item 1 x Item 3b/100) $_________ 

7. Period within which debt must be repaid (months) 

(Item 1/Item 4 x 1.35) __________ 

If Item 6 is >/= to Item 4, then all accrued charges are compromised; skip Item 8 through 10, 

and go to Item 11 to determine the amount of principal to be compromised. Otherwise, continue 

with Item 8.

8. Period to repay full amount of debt (months) 

a.) Period to repay accrued charges ________ mos. 

 (Item 2/Item 4) – (Item 1 x Item 3) 

 b.) Period to repay principal ________ mos. 

Total (Item 8a + Item 8b) ________ mos. 

If Item 8b is </= to Item 7, no principal need be compromised. Skip to Item 12. 

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If Item 8b is > Item 7, the amount of the principal must be compromised. Continue to the next 

item.

9. Maximum amount of accrued charges to be compromised.

(Item 8 – Item 7/Item 8a) x Item 2 _________ 

If no number is generated here, then there are no accrued charges to be compromised. Proceed 

to the next item.

10. Apportionment of compromise

 a.) Item 9 or Item 2, whichever is less 

 b.) Admin Charges (Item 2a or Item 10a, whichever is less) 

c.) Balance (Item 10a – Item 10b) 

 d.) Penalty (Item 2b or Item 10c, whichever is less) 

e.) Balance (Item 10c – Item 10d) 

f.) Interest (Item 2c or Item 10e, whichever is less)

11. Amount of principal after compromise $___________ 

If this amount is more than the original principal, then there is no compromise of principal. 

12. New debt balances. (If Item 10 was skipped then consider item 10a thru 10e as zero) 

a.) Accrued admin charges (Item 2a – Item 9b) 

 b.) Accrued penalty (Item 2b – Item 10d) 

c.) Accrued interest (item 2c – Item 10f) 

d.) Principal Balance (Item 11; or, if Item 11 was skipped, use Item 1) 

Calculations performed by: __________________ Date:________ 

Certified by: _______________________________ Date:________ 

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SAMPLE COMPROMISE ORDER

1. An overpayment of compensation was found in the above referenced case in the amount of 

{insert amount}. 

It has been determined that the claimant does not have the present or prospective ability to pay 

the full amount of the claim within a reasonable period of time. It has been further determined 

that there is no indication of fraud, the filing of a false claim, or misrepresentation on the part of 

the claimant or on the part of any other party having an interest in the claim. 

(Adjust wording of paragraph 2 to fit circumstances.)

2. On {insert date} DEEOIC advised the claimant that he was found (with/without) fault in the 

matter of the overpayment and was notified of the grounds for consideration of waiver and of his 

rights in the matter. The claimant applied for waiver, and on {insert date} a final determination 

was made that claimant was with fault in the matter and was not entitled to consideration of 

waiver.

3. Based on the information outlined above, it is hereby determined that full settlement of the 

claim for recovery of the overpayment shall be accepted in the amount of {insert amount}, 

which does not exceed $100,000 exclusive of interest and penalties, to be paid in the following 

manner and time:

{Describe payment terms} 

4. The claim for overpayment shall not be considered settled until full payment of {insert 

amount} has been made within the time and in the manner specified above. The failure to make 

such payment shall result in the reinstatement of the full amount of the overpayment, less any 

amounts paid prior to default. 

Given by me this day of 

Unit Chief for Policies, 

Regulations and Procedures 

DEEOIC

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SAMPLE COMPROMISE MEMORANDUM 

MEMORANDUM TO FILE:

The claimant in the attached case is indebted to DEEOIC in the amount of {insert amount}. 

The indebtedness arose because the Office accepted a claim for {insert} condition which was 

later rescinded by decision dated {insert date}. The claimant was fully advised of his rights in 

the matter of the overpayment but did not request a review of the documents or a telephone 

conference. The decision regarding the overpayment was made final by letter decision dated 

{insert date}. 

The claimant has agreed that a certificate in the amount of {insert amount} be paid in partial 

settlement of the debt and he proposed that we accept this in full settlement. The claimant 

submitted financial reports showing that his income is derived solely from a pension under the 

Civil Service Retirement Act and Social Security benefits. Also, the claimant has submitted 

documentation of his expenses which, according to the calculations in the file, consume virtually 

all of his income. There is no indication of fraud in this case. 

Since it appears extremely unlikely that the debt can be recouped in a reasonable period of time, 

either voluntarily or through legal proceedings, given the claimant's age, health, and financial 

circumstances, I recommend that this proposal for settlement be accepted and that an order be 

issued compromising the remainder of the debt upon receipt of {insert amount}. 

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SAMPLE LETTER TERMINATING COLLECTION ACTIONS

Dear CLAIMANT NAME:

This is in further reference to your debt to the United States in the amount of {insert amount}, 

and your letter to us of {insert date}. 

I have reviewed the issues raised in your letter, and the information concerning your financial 

situation which you have provided. I have determined that collection action on your debt will be 

terminated indefinitely and that no further action will be taken by this office, unless we are 

notified that your circumstances have changed.

I have taken this action because it has been found that your financial circumstances are such that 

recovery would cause hardship. In the event that we receive evidence of substantial income or 

assets which would support collection, we reserve the right to take further action to recover the 

money due. 

Sincerely,

Unit Chief for Policies, 

Regulations and Procedures 

DEEOIC

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April 2017 

Appendix 2 – Catalogue of Content Edits 

• Version 1.0 consolidates the PM into one document, changing the outline formatting and

numbering sequence of chapters. Version 1.0 contains no substantive changes to existing 

program procedure.

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