1

U.S. Department of Labor Office of Workers’ Compensation Programs 

Division of Energy Employees Occupational 

Illness Compensation 

Washington, DC 20210

RELEASE – TRANSMISSION OF FEDERAL (EEOICPA) PROCEDURE 

MANUAL VERSION 4.0: 

EEOICPA TRANSMITTAL NO. 20-01 November 14, 2019 

EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) is issuing this 

transmittal to notify staff of the publication of Version 4.01 of the Federal (EEOICPA) Procedure 

Manual (PM). Version 4.0 (v4.0) replaces Version 3.1 (v3.1), effective the date of publication of 

this transmittal.

Following are the content edits that make up Federal (EEOICPA) PM v4.0: 

• Chapter 1 – Definitions

o Ch. 1.2ccc has been edited to correct a citation in compliance with 20 CFR § 30.5. The 

language included in v3.1 read:

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

CFR § 30.5(ff):

It has been edited in v4.0 to:

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

CFR § 30.5(gg):

• Chapter 7 – Case Creation

o Ch. 7.2 has been edited to comply with 20 CFR § 30.100 and 30.101 regarding the 

necessity for a claimant signed claim form. The language included in v3.1 read:

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: 

 1 The contents of this document do not have the force and effect of law and are not meant to bind the public 

in any way.
2

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.

It has been edited in v4.0 to:

2. New Cases. A new case 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. DEEOIC will create a new case upon receipt of a signed written 

communication from the claimant or a person acting on behalf of the claimant (e.g., a 

guardian or duly authorized Power of Attorney). DEEOIC will consider any of the 

following documents a claim 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.

o Ch. 7.5 has been edited to comply with 20 CFR § 30.100 and 30.101 and adds guidance 

regarding processing signed claim forms. The language included in v3.1 read:

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 includes 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 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, 
3

for claim adjudication a signed EE-1 or EE-2 is required. Without a properly completed 

form, the claim is administratively closed.

It has been edited in v4.0 to:

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 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 an unsigned EE-1 or 2, or a claimantsigned 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 submit a signed EE-1 or 2 to allow for 

claim adjudication. 

Case adjudication requires submission of a claimant signed EE-1 or EE-2, so that 

DEEOIC obtains information necessary to process the claim and to ensure that the 

claimant acknowledges his or her responsibilities when submitting a claim. CCC will 

create a claim based on the submission of an unsigned EE-1/2, or words of claim. 

However, it is then the responsibility of the assigned CE to validate that the form is 

signed by either the claimant, or a person with legal authority to act on the claimant’s 

behalf, prior to the issuance of a RD. If, when the case is in posture for the issuance of a 

RD, the CE has not obtained a claim form which has been signed by a claimant, or a 

person with legal authority to act on the claimant’s behalf, the CE is to administratively 

close the claim. The CE mails a notification to the submitter advising of the 

administrative closure and requesting that the claimant submit a signed claim form. 

Upon receipt of a properly signed form, adjudication may resume, and the date of filing 

remains the date the original unsigned claim, or words of claim, was received.

o Ch. 7.9a has been added to provide guidance on resumption of development after 

withdrawal of a claim:

a. To resume development on a withdrawn claim, the claimant must submit a signed 

letter to DEEOIC requesting the resumption of the withdrawn claim or submit a 

new signed EE-1 or EE-2 form for the same illness(es)/death previously under 

adjudication. DEEOIC will resume development by picking up where 

development left off at the time the claimant chose to withdraw. Therefore, if a 
4

recommended decision concerning the claim in question was issued and the case 

forwarded to FAB, but then the claim was administratively closed while the case 

was at FAB due to claim withdrawal, a new recommended decision should not be 

issued.

• Chapter 12 – Representative Services

o Ch. 12.4 has been edited to comply with 20 CFR. § 30.600 regarding obtaining claimant 

signed claim forms. The language included in v3.1 read:

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 EN-20 Payment Form for the claimant.

It has been edited in v4.0 to:

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, 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 
5

appointed AR, 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 for a claimant in initiating 

a claim or sign an EN-20 Payment Form for the claimant.

o Exhibit 12-2, Powers of Attorney Memo for SOL Review has been replaced with an 

updated version.

• Chapter 14 – Establishing Special Exposure Cohort Status

o Ch. 14.7c has been edited to clarify that leukocytosis and thrombocytosis are not a 

diagnosis of cancer. The language included in v3.1 read:

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, spentphase 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.)

It has been edited in v4.0 to:

c. Primary of 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, spentphase 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 blood 

abnormalities and are not to be considered cancer or, specifically, bone cancer. 

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.)

• Chapter 15 – Establishing Toxic Substance Exposure and Causation

o Ch. 15.11d has been edited to provide instructions on how an Industrial Hygienist (IH)

engages directly with a claimant in collecting exposure data for informing a toxic 

substance profile. The language included in v3.1 read:
6

d. IH assessment and opinion. 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. This is reserved for the most complex 

cases and is at the discretion of the IH. The IH role is to anticipate, recognize, 

and evaluate hazardous conditions in occupational environments, and to opine 

based upon his/her specialized knowledge. The IH strives to answer the question 

based upon the information outlined by the CE.

 

(1) IH Memorandum. The IH renders an expert opinion in the form of a 

memorandum that addresses the issue as specifically as possible. The 

IH’s reply addresses the specific question(s) posed by the CE in the IH 

Referral, and employs specialized training to make findings based upon 

the evidence of file and clearly rationalized science.

It has been edited in v4.0 to:

d. IH assessment and opinion. 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. This is reserved for the most complex 

cases and is at the discretion of the IH. The IH role is to anticipate, recognize, 

and evaluate hazardous conditions in occupational environments, and to opine 

based upon his/her specialized knowledge. The IH strives to answer the question 

based upon the information outlined by the CE.

During the evaluation of the CE’s IH referral, DEEOIC IH (federal or 

contractor) staff may determine if it is necessary to obtain clarification from a 

claimant regarding the circumstance of an employee’s work that brought the 

employee into contact with a particular toxic substance. This could include 

clarifying the employee’s specific occupational roles and responsibilities; 

proximity to work processes or particular materials; frequency of activity 

occurrence; knowledge of work with particular materials; or clarifying 

information provided in referral case evidence. Under this circumstance, the IH 

will email the designated federal IH Team Lead advising of the need for clarifying 

information and requesting a telephone call with the claimant. Within the email 

the IH will identify the claim file number, explain the specific information 

requested and the justification for the request. Upon review, the federal IH Team 

Lead will then coordinate with the assigned CE to have a telephone call with the 

claimant and a federal IH staff person to address the request for information. 

Upon completion of the call, in addition to the usual ECS call summary, the CE 

will prepare a Memo to File describing the outcome of additional development, 

including a detailed narrative of any conversation held with the claimant. Once 

complete, the CE will forward the memo to the requesting IH for consideration in 

preparation of the IH referral response. 

(1) IH Memorandum. The IH renders an expert opinion in the form of a 

memorandum that addresses the issue as specifically as possible. The IH’s 
7

reply addresses the specific question(s) posed by the CE in the IH 

Referral. The IH is to employ his or her subject matter expertise to make 

reasonable findings regarding exposure based upon the unique features of 

the case under review. The IH is to consider any information obtained 

from the claimant in a verbal exchange that occurred because the IH 

requested clarification. 

o Exhibit 15-4.3 has been edited to extend the temporal duration for the presumption of 

asbestos exposure for certain labor categories, to remove language requiring high levels 

of asbestos exposure, and to add the labor category of Uranium Miner/Miller. The 

language included in v3.1 read:

3. Asbestos (exposure presumption): The program recognizes that asbestos is a toxic 

material that was present in all Department of Energy (DOE) facility locations. The CE 

may accept the following presumptions regarding asbestos exposure.

a. Asbestos exposure through 1986, specific end date used is December 31, 1986.

(1) The following labor categories are considered to have had significant 

exposure to asbestos at high levels based on their associated job tasks.

• Automotive mechanic; Vehicle mechanic; Vehicle maintenance 

mechanic

• Boilermaker

• Carpenter; Drywaller; Plasterer

• Demolition technician; Laborer

• Electrical mechanic; Electrician; Floor covering worker

• Furnace & saw operator; Furnace builder; Furnace operator; 

Furnace puller; Furnace technician; Furnace tender; Furnace 

unloader

• Glazier; Glass installer; Glazer

• Grinder operator; Mason (concrete grinding); Tool grinder; 

Maintenance mechanic (general grinding); Welder (general grinding); 

Machinist (machine grinding)

• Insulation worker; Insulation trade worker; Insulator

• Ironworker; Ironworker-rigger

• Maintenance mechanic; Electrician; Insulator;

• Mason; Brick & tile mason; Concrete and terrazzo worker; 

Bricklayer, Tilesetter 

• Millwright

• Heavy equipment operator; Operating Engineer

• Painter

• Pipefitter, Plumber steamfitter; Plumber/pipefitter; Plumbing & 

pipefitting mechanic; Plumbing technician, Steamfitter

• Roofer
8

• Sheet metal mechanic; Sheet metal fabricator/installer

• Welder; Welder burner; Welder mechanic

(2) All other labor categories are assumed to have had some level of exposure to 

asbestos. However, that level of exposure is determined by guidance from an IH 

or full IH assessment. The IH will determine if the level of exposure was 

significant (high, moderate, or low) or not significant (incidental-occurring in 

passing only). 

It has been edited in v4.0 to:

3. Asbestos (exposure presumption): The program recognizes that asbestos is a toxic 

material that was present in all Department of Energy (DOE) facility locations. The CE 

may accept the following presumptions regarding asbestos exposure, when applicable to 

the medical condition under adjudication.

a. Asbestos exposure through December 31, 1995.

(1) The CE is to consider the following labor categories to have had significant 

exposure to asbestos based on their job tasks.

• Automotive mechanic; Vehicle Mechanic; Vehicle maintenance mechanic 

• Boilermaker

• Carpenter; Drywall; Plaster

• Demolition technician, Laborer

• Electrical mechanic; Electrician; Floor covering workers

• Furnace & saw operator; Furnace builder; Furnace operator, Furnace 

puller; Furnace technician; Furnace tender; Furnace unloader

• Glazier, Glass installer, Glazer

• Grinder Operator; Mason (concrete grinding); Tool grinder, 

Maintenance mechanic (general grinding); Welder (general grinding); 

Machinist (machine grinding)

• Insulation worker; Insulation trader worker; Insulator

• Ironworker, Ironworker-rigger

• Maintenance mechanic; Electrician; Insulator

• Mason; Brick & tile mason; Concrete and terrazzo worker; Bricklayer; 

Tilesetter

• Millwright

• Heavy equipment operator; Operating Engineer

• Painter

• Pipefitter; Plumber steamfitter; Plumber/pipefitter; Plumbing & 

pipefitting mechanic; Plumbing technician; Steamfitter

• Roofer

• Sheet metal mechanic; Sheet metal fabricator/installer
9

• Welder; Welder burner; Welder mechanic

• Uranium Miner/Miller

b. For employment that does not qualify for the standard in “a.”, the CE will 

assume the employee to have had some level of exposure to asbestos. However, the 

CE is to refer the case to an IH to determine the level, extent, nature and frequency of 

exposure; including whether the exposure was significant (high, moderate, or low) or 

not significant (incidental – occurring in passing only).

• Chapter 16 – Developing and Weighing Medical Evidence

o Ch.16.3a(3) has been edited to correct a citation reference relating to 20 CFR § 30.5. 

The language included in v3.1 read:

(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.

It has been edited in v4.0 to:

(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(ee) of the regulations.

o Ch. 16.5a(1) has been added to add distinction on how DEEOIC is to define a diagnosed 

condition vs. symptom:

(1) Establishment of a diagnosis requires that a physician interpret available clinical 

and diagnostic evidence to identify a disease or disorder. Alternatively, signs and 

symptoms are abnormalities that a physician may use to form a judgment of 

medical diagnosis. A claimed illness filed by a claimant that medical evidence 

establishes as a finding, sign or symptom is not necessarily a diagnosed 

condition. In those instances where unclear evidence exists whether the CE 

should categorize the claimed condition as a medical diagnosis or not, the CE is 

to seek clarification from the claimant’s physician or a CMC. 

o Ch. 16.9a-c has been edited to correct an error in the outline format. The language 

included in v3.1 read:

a. Diagnosis. Clarification and confirmation of diagnosis. 

c. Causation. Assessment of exposure and medical documentation for the purpose of 

rendering an opinion on causation. 
10

c. Impairment. Percentage of permanent impairment to the whole person as a result 

of an accepted illness or illnesses.

It has been corrected in v4.0 to:

a. Diagnosis. Clarification and confirmation of diagnosis. 

b. Causation. Assessment of exposure and medical documentation for the purpose of 

rendering an opinion on causation. 

c. Impairment. Percentage of permanent impairment to the whole person as a result 

of a covered illness or illnesses.

• Chapter 18: Eligibility Criteria for Non-Cancerous Conditions

o Ch. 18.13 has been edited to clarify the appropriate use of SEM in cases of fibrotic lung 

diagnoses. The language included in v3.1 read:

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:

It has been edited in v4.0 to:

13. Pneumoconiosis, Part E. Pneumoconiosis is caused by the deposition of 

particulate matter, such as coal dust, asbestos, and silica in the lungs. Pneumoconiosis is

oftentimes a broad categorization physicians use for various subtypes of pulmonary 

disease. For example, asbestosis is a type of pneumoconiosis, as is silicosis. The CE is 

to treat pneumoconiosis, pulmonary fibrosis and interstitial lung disease as being 

equivalents for purposes of claims adjudication. For SEM searches, the appropriate 

search term for each of these is “pneumoconiosis, other.” It is not appropriate for a CE 

to make assumptions beyond these 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:

• Chapter 22 – Wage-Loss Determinations

o Ch. 22.6a has been updated to comply with guidance found in Ch. 22.12. The language 

included in v3.1 read:
11

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 SSA581 (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 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.

It has been edited in v4.0 to:

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 

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 SSA-581 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 wage-loss, along with medical 

evidence supporting a causal relationship between the covered illness and the 

wage-loss. The form contains an instruction for the claimant to submit Form EN11B (Wage-Loss Benefits Response Form) if he/she is claiming wage-loss, and to 

provide the date (trigger month and year) the employee first experienced wageloss.

• Chapter 23 – Consequential Conditions

o Ch. 23.3 has been edited to comply with 20 CFR § 30.100 and 30.101 regarding the 

necessity of obtaining claimant signed claim forms. The language included in v3.1 read:

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-
12

1/2 is required because it provides notice to the claimant of his or her responsibilities in 

filing for benefits under the Act.

It has been edited in v4.0 to:

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, so 

long as the claimant signs the submission. However, while documents containing written 

words of claim for a consequential condition(s) are acceptable, the CE is to obtain a 

completed and claimant 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 EE1/2 is required, because it provides notice to the claimant of his or her responsibilities in 

filing for benefits under the Act.

• Chapter 25 – FAB Review Process

o Ch. 25.7d(7) has been added to provide guidance on the resumption of development after 

the withdrawal of a claim:

(7) Resumption of FAB review after claim withdrawal. A claimant may choose to 

withdraw a claim prior to the issuance of a final decision. If FAB had scheduled 

a hearing, a withdrawal of the claim will also constitute a withdrawal of the 

request for a hearing. Under this circumstance, should the claimant seek to 

resume adjudication of the claim, a hearing will not occur and instead the FAB 

will undertake a review of the written record at the conclusion of any balance of 

the 60 day period remaining for the claimant to submit evidence for 

consideration. If the claimant did not file an objection prior to a withdrawal of a 

claim, and the claimant later seeks to resume adjudication of the claim, the 

claimant retains their right to object and/or request a hearing for any remaining 

balance of the 60-day period for filing objections that existed prior to the claim 

withdrawal.

• Chapter 26 – FAB Decisions

o EEOICPA Bulletin No. 19-04 has been incorporated by updating the Exhibit 26-2, 

Medical Benefits Letter

• Chapter 28 – Medical Bill Process

o Ch. 28.2b has been updated to clarify the role of the Medical Benefits Examiner (MBE). 

The language included in v3.1 read:

b. Medical Benefits Examiner. The MBE is a specialized CE responsible for 

reviewing, developing, and approving or denying claims for in-home health care.
13

It has been edited in v4.0 to:

b. Medical Benefit or Claims Examiner – CE/MBE staff are responsible for 

reviewing, developing, and deciding whether to authorize the payment of services, 

appliances, supplies, modifications or travel expenses necessary to cure, give 

relief, or reduce the degree or period of illness.

o Ch. 28.2c has been deleted due to the edit added at Ch. 28.2b. Accordingly, the remaining 

section Ch. 28.2 has been renumbered.

o All references throughout Ch. 28 to Claims Examiner (CE) have been changed to 

CE/MBE.

o Ch. 28.13d has been edited to reflect a change in the timeframe allowed for a response to 

a request for reconsideration. The language included in v3.1 read:

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:

It has been edited in v4.0 to:

d. Within 15 days of receiving the request for reconsideration, the MBPU prepares a 

response to the medical provider outlining DEEOIC’s decision to either:

• Chapter 29 – Ancillary Medical Services and Related Expenses

o All references throughout Ch. 29 to CE have been changed to CE/MBE.

o Ch. 29.2d has been modified to provide updated develpoment guidance regarding the 

medical necessity of prescribed ancillary services or equipment; and provide clarity 

regarding the 30 day medical development authorization period, including two 

development letters in 15 day increments. The language included in v3.1 read:

d. Upon receipt of an authorization request, not accompanied by appropriate 

medical evidence, the CE begins development. 

(1) The CE/MBE sends a development letter to the claimant advising that he 

or she has received a request, but without the required supporting 

documentation. The CE/MBE’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/MBE 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 supplies.) The CE/MBE 
14

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.

It has been edited in v4.0 to:

d. Upon receipt of an authorization request, not accompanied by appropriate 

medical evidence, the CE/MBE 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 15 calendar days to provide the evidence. 

If the requested evidence is not received within the 15 day period 

provided, the CE sends a second development letter, providing an 

additional 15 days to receive the requested evidence. 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 

supplies.) The CE updates the correspondence section of ECS to record 

the issuance of the development letter, once mailed.

(2) A CE/MBE may utilize the services of DEEOIC Nurse Consultants in 

assessing the rationale of the prescribing physician in justifying the 

medical necessity of prescribed ancillary services or DME. In any 

instance where a DEEOIC Nurse Consultant identifies a concern with the 

LMN from a claimant’s physician, the CE/MBE must permit the 

claimant’s physician the opportunity to provide clarification. In those 

situations where the claimant’s physician does not provide clarifying 

rationale to address a deficiency in the evidence within 15 days, the 

CE/MBE may refer the matter to a CMC for review. 

o Exhibit 29-1 has been edited to reflect the above change in development periods from 30 

to 15 days.
15

o Exhibit 29-2 has been edited to reflect the above change in development periods from 30 

to 15 days.

o Ch. 29.4b has been modified to provide clear guidance regarding the evidence a 

physician may choose to use in support of a prescription for Oxygen Therapy or DME. 

The language included in v3.1 read:

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.

It has been edited in v4.0 to:

b. Upon receipt of the request for rental or purchase of Oxygen Therapy DME 

and/or Oxygen Medical Supplies, the CE/MBE 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. 

(1) As noted earlier in this chapter, the CE/MBE must obtain a LMN from a 

claimant’s physician that provides a written explanation regarding the 

justification for any prescribed ancillary services or equipment. For 

Oxygen Therapy DME or Oxygen Medical Supplies, the prescribing 

physician must describe the diagnostic or clinical evidence that supports 

the medical necessity for the prescribed care in treating the accepted 

pulmonary condition.

• Chapter 30 – Home and Residential Health Care

o Ch. 30.7b has been updated to provide clarity regarding 30 day development periods, 

including two development letters in 15 day increments. The language included in v3.1 

read:
16

b. Incomplete or defective evidence. If, upon review of the case evidence, the MBE 

finds that any of the basic criteria, above, are missing, or there is a documented 

defect in the medical evidence that conflicts with the care prescribed in the LMN 

the MBE is to initiate development. 

It has been edited in v4.0 to:

b. Incomplete or defective evidence. If, upon review of the case evidence, the MBE 

finds that any of the basic criteria, above, are missing, or there is a documented 

defect in the medical evidence that conflicts with the care prescribed in the LMN 

the MBE is to initiate development. The duration allocated by the MBE for the 

submission of necessary evidence to support a HRHC claim is 30 days. For an 

initial request for evidence, the MBE is to grant a period of 15 days to allow for 

the submission of responsive documentation. If the requested evidence is not 

received within the 15 day period provided, the MBE sends a second development 

letter, providing an additional 15 days to submit the requested documentation.

o Ch. 30.13 has been added to provide guidance to HRHC providers on their role and 

responsibility in providing travel assistance to covered employees receiving home health 

care.

13. Medical Travel Occurring During Authorized Periods of HRHC. DEEOIC 

permits HRHC providers to travel with a claimant to and from medical appointments 

when medically necessary for the treatment or care of an accepted work-related illness. 

DEEOIC considers this type of travel assistance as included within the scope of 

authorized HRHC service hours and not a separate or additional transportation service. 

DEEOIC will reimburse travel mileage to either the HRHC provider or the claimant, 

depending on whose vehicle is used for the travel. Aside from mileage and HRHC 

service hours spent assisting with travel, no other ancillary costs associated with 

conducting travel covered under this section is reimbursable. As with any other billable 

medical service, HRHC providers are to document properly any service time spent 

assisting with medically necessary travel. Travel under this guidance will not require 

pre-approval by a Medical Benefit Examiner for travel under 200 miles round-trip or less 

than three qualifying trips per week. DEEOIC provides guidance relating to extended 

travel authorization in Chapter 29 – Ancillary Medical Services and Related Expenses. 

For HRHC travel with the claimant for more than three trips in a week period, a preauthorization request must be submitted to DEEOIC along with medical justification for 

such travel. 

• Chapter 31 – Tort Action and Election of Remedies

o Ch. 31.5d has been updated to clarify that payments made by asbestos bankruptcy trusts 

trigger the offset provision of § 7385. The language included in v3.1 read:
17

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.

It has been edited in v4.0 to:

d. Asbestos Bankruptcy Trust. A claimant’s settlement with asbestos bankruptcy 

trust is treated like any other tort settlement for the purposes of offset 

determination. The CE obtains copies of all administrative claim forms that have 

been submitted to an asbestos bankruptcy trust to compare the pertinent exposure 

and injuries claimed under the abestosis bankruptcy trust with payable EEOICPA 

benefits for possible tort offset.

o Ch. 31.9 has been modified to delete language regarding paper file jackets. The language 

included in v3.1 read:

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. 

It has been edited in v4.0 to:

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. 

• Chapter 32 – Coordinating State Workers’ Compensation Benefits

o Ch. 32.9 has been modified to delete language regarding paper file jackets. The language 

included in v3.1 read:

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. 

It has been edited in v4.0 to:
9. Calculate Amount to Coordinate. Once the CE receives the documentation which

verifies the amount ofSWC benefits the claimant received/or the same covered illness,

the CE completes the "EEOICPAISWC 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 EEOICP A Part

E benefits to reflect benefits received from a SWC program for a covered illness

compensable under Part E.

• Chapter 3 5 - Overpayment Process

o EEOICPA Bulletin No. 19-05 has been incorporated by updating a mailing address in the

following Exhibits:

■ Exhibit 35-2, Sample Initial Overpayment Notification Letter - Without Fault

■ Exhibit 35-3, Sample Initial Overpayment Notification Letter- At Fault

• Exhibit 35-4, Sample Letter to Non-Claimant Regarding Federal Debt

• Exhibit 35-8, Sample Overpayment Final Decision- Preliminary At Fault

Determination Correct

• Exhibit 35-9, Sample Overpayment final Decision- Without Fault - Waiver Denied

■ Exhibit 35-11, Sample Overpayment ,Final Decision - Waiver Granted (Full or

Partial) Based on Violate Equity and Good Conscience

• Chapter 36 - Debt Liquidation

o EEOICPA Bulletin No. 19-05 has been incorporated by updating a mailing address in the

following Exhibits:

■ Exhibit 36-1, Sample Second Demand Letter

■ Exhibit 36-2, Sample Third and Final Demand Letter

■ Exhibit 36-4, Sample Repayment Agreement

Rachel P. Lei ton 

Director, Division of 

Energy Employees Occupational Illness Compensation 

18