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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 4.1: 

EEOICPA TRANSMITTAL NO. 20-02 March 31, 2020 

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 4.1 of the Federal (EEOICPA) Procedure 

Manual (PM). Version 4.1 (v4.1) replaces Version 4.0 (v4.0), effective the date of publication of 

this transmittal.

Following are the content edits that make up Federal (EEOICPA) PM v4.1: 

• Chapter 2 – The EEOICPA

o Incorporates Bulletin 20-01, which, in part, updated and replaced Chapter 2 – The

EEOICPA.

o Exhibit 2-2 has been edited to update the address of the Final Adjudication Branch in

Washington, D.C.

• Chapter 8 – Case Maintenance

o Ch. 8.7 has been added to Incorporate Bulletin 14-01, National Instant Criminal

Background Check System (NICS) Improvement Amendments Act of 2007 (NIAA).

7. National Instant Criminal Background Check System (NICS) Improvement

Amendments Act of 2007 (NIAA). The NICS is a computerized system designed to help

determine if a person is disqualified from possessing or receiving firearms by conducting

a search of available relevant records. Among its requirements, the NIAA mandates that

federal departments and agencies provide relevant information to the Attorney General

for the NICS. The databases used by the NICS in its searches contain records with

information relevant to the various legal prohibitions against firearm possession and

purchasing under both Federal and State law. There are ten categories of Federal

firearm prohibitions. For each category of prohibition, there are relevant record types

that should be reported to the NICS. During the administration of the EEOICPA, the

DEEOIC takes possession of a variety of claim documentation including some that is

reportable. Records that DEEOIC is obligated to report under the NIAA are those that it

receives during the administration of claims that originate from State or Local agencies.
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a. Under the NIAA, DEEOIC has the potential to have reportable records in 

several of the ten categories of Federal firearm prohibitions. 

(1) Felons.

(a) This includes any person “who has been convicted in any 

court of a crime punishable by imprisonment for a term 

exceeding one year,” (including general court-martial) 

regardless of whether or not that term of imprisonment was 

imposed. 

(b) The term “offense punishable by imprisonment for a 

term exceeding one year” does not include:

(i) any federal or state offenses pertaining to antitrust 

violations, unfair trade practices, restraints of trade 

or other similar offenses relating to the regulation 

of business practices; or

(ii) any state offense classified by the laws of the state 

as a misdemeanor and punishable by a term of 

imprisonment of two years or less. 

(c) What constitutes a conviction is determined in accordance 

with the law of the jurisdiction in which the proceedings 

were held. If a conviction has been expunged or set aside, 

or the person has been pardoned or had his/her civil rights 

restored, it is not considered a conviction unless it was 

provided in the expungement, pardon, or restoration that 

the person may not ship, transport, possess, or receive 

firearms. 

Relevant records defined by DOJ: Judgment and commitment 

orders from the courts – only if the conviction is secured without 

collaborating with a U.S. Attorney’s Office or other DOJ

component. 

Potential DEEOIC specific relevant records: Judgments in state 

court actions, usually received in conjunction with 42 U.S.C. § 

7385i(a) which states that a person convicted of fraud in the 

application for or receipt of benefits under the Energy Employees 

Occupational Illness Compensation Program Act (EEOICPA) or 

any other federal or state workers’ compensation law forfeits any 

entitlement to the EEOICPA benefits for any injury, illness or 

death for which the time of injury was on or before the date of the 

conviction.
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(2) Fugitives from justice.

 (a) This includes any person who has fled from any 

 State to avoid prosecution for a felony or a 

misdemeanor leaves the state to avoid giving 

testimony in any criminal proceeding, or who knows

that misdemeanor or felony charges are pending against

him/her and who leaves the state of prosecution. 

Relevant records defined by DOJ: Misdemeanor and felony 

warrants and charging documents – only if obtained without 

collaborating with a U.S. Attorney’s Office or other DOJ 

component. 

Potential DEEOIC specific relevant records: None anticipated.

(3) Persons unlawfully using or addicted to any controlled substance.

(a) This includes any person who uses a controlled substance 

and has lost the power of self-control with reference to the 

use of the controlled substance or who is a current user of 

a controlled substance in a manner other than as 

prescribed by a licensed physician. 

(b) Unlawful use need only to have occurred recently enough 

to indicate that the individual is actively engaged in such 

conduct, not necessarily at the precise time the person 

seeks to acquire a firearm.

(c) An inference of current use may be drawn from evidence of 

recent use or possession of a controlled substance, or a 

pattern of use or possession that reasonably covers the 

present time (i.e., conviction for use or possession within 

the past year or multiple arrests for possession within the 

past five years if the most recent arrest occurred within the 

past year).

(d) For a current or former member of the Armed Forces, an 

inference of current use may be drawn from recent 

disciplinary or other administrative action based on 

confirmed drug use (i.e., discharged based on drug 

rehabilitation failure).

(e) The term “controlled substance” includes, but is not 

limited to, marijuana, depressants, stimulants, and narcotic 
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drugs, but excludes distilled spirits, wine, malt beverages, 

and tobacco. 

Relevant records defined by DOJ: Drug-related convictions, drugrelated arrests, and disciplinary or other administrative actions in 

the Armed Forces based on confirmed drug use – only if obtained 

without collaborating with a U.S. Attorney’s Office or other DOJ 

component. Therapeutic or medical records that are created in the 

course of treatment in hospitals, medical facilities, or analogous 

contexts that demonstrate drug use or addiction should not be 

submitted. 

Potential DEEOIC specific relevant records: Judgments in state 

court actions, usually received in conjunction with 42 U.S.C. § 

7385i(a).

(4) Persons “adjudicated as a mental defective” or “committed to a 

mental institution”

(a) This includes any person who has been determined by a 

court, board, commission, or other lawful authority as 

being a danger to himself/herself or others, or lacking the 

mental capacity to contract or manage his/her own affairs. 

(b) A mental institution is a facility that provides diagnoses by 

licensed professionals of mental retardation or mental 

illness. 

(c) “Mentally defective” does not include a person:

(i) who has been granted relief from the disability 

through a qualifying federal or state relief from 

disability program as authorized by the NIAA; or

(ii) whose adjudication or commitment was imposed by 

a federal department or agency and: the 

adjudication or commitment has been set aside or 

expunged; the individual has been fully released or 

discharged from all treatment, supervision or 

monitoring; the individual has been found by a 

court, board, commission or other lawful authority 

to no longer suffer from the mental health condition 

that was the basis for the adjudication or 

commitment, or whose adjudication or commitment 

is based on a medical finding of disability, without 

an opportunity for a hearing by a court, board, 
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commission, or other lawful authority and the 

person has not been “adjudicated as a mental 

defective” pursuant to 18 U.S.C. § 922(g)(4).

(d) Formal commitment of a person to a mental institution by a 

court, board, commission or other lawful authority includes 

commitment to a mental institution involuntarily, 

commitment for mental defectiveness or mental illness or 

commitment for other reasons, such as for drug use. It 

does not include a person in a mental institution for 

observation or a voluntary admission to a mental 

institution.

Relevant records defined by DOJ: Judgment and commitment 

orders, sentencing orders, and court or agency records of 

adjudications of an individual’s inability to manage his or her own 

affairs if such adjudication is based on marked subnormal 

intelligence or mental illness, incompetency, or disease (including 

certain agency designations of representative or alternate payees 

for program beneficiaries).

Potential DEEOIC specific relevant records: Court ordered 

guardianship and conservatorship documents received during the 

course of claims adjudication. 

(5) Illegal/unlawful aliens, and aliens admitted on a non-immigrant 

visa.

(a) This includes any person who is illegally or unlawfully in 

the United States or has been admitted to the United States 

under a non-immigrant visa. 

This includes those persons who:

(i) unlawfully entered the United States without

inspection and authorization by an immigrant 

officer and who have not been paroled into the 

United Stated under § 212(d)(5) of the INA; 

(ii) are a non-immigrant and whose authorized period 

of stay has expired or who has violated the terms of 

the non-immigrant category in which he/she was 

admitted; 
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(iii) were paroled under INA § 212(d)(5) whose 

authorized period of parole has expired or whose 

parole status has been terminated, or;

(iv) are under an order of deportation, exclusion or 

removal, or voluntary departure, whether or not 

he/she has left the United States.

(b) Permanent resident aliens and aliens lawfully present in 

this country without a visa are not prohibited. 

Relevant records defined by DOJ: Deportation orders, visa 

applications (including denials), and immigration papers.

 Potential DEEOIC specific relevant records: None anticipated.

 (6) Persons dishonorably discharged from the military.

(a) This includes any person whose separation from the U.S. 

Armed Forces was characterized as a dishonorable 

discharge or a dismissal adjudged by a general courtmartial.

(b) Any person who was separated for any other discharge (for 

example, a bad conduct discharge) or whose dishonorable 

discharge or dismissal has been upgraded under the 

authority of a discharge review board or a board for the 

correction of military records is not prohibited. 

 

Relevant records defined by DOJ: Discharge records, courtmartial records, and disciplinary orders – only if no other federal 

agency would be submitting. 

 Potential DEEOIC specific relevant records: None anticipated. 

(7) Citizen renunciates.

(a) This includes any person who having been a U.S. citizen 

renounced U.S. citizenship either before a diplomatic or 

consular office of the United States in a foreign state 

pursuant to 8 U.S.C. § 1481(a)(5) or before an officer 

designated by the Attorney General when the United States 

is in a state of war pursuant to 8 U.S.C. § 1481(a)(6). 
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(b) Any person whose renunciation of citizenship has been 

reversed as a result of administrative or judicial appeal is 

not prohibited.

Relevant records defined by DOJ: Form DS-4083, Certificates of 

Loss of Nationality.

Potential DEEOIC specific relevant records: None anticipated.

 (8) Persons subject to a domestic violence restraining order.

(a) This includes any person subject to a domestic violence 

restraining order as long as the court order was:

(i) issued after a hearing of which such person 

received actual notice and had an opportunity to 

participate;

(ii) restrains such person from harassing, stalking, or 

threatening his/her intimate partner or his/her child 

with that intimate partner or person, or engaging in 

other conduct that would place the intimate partner 

in reasonable fear of bodily injury to the partner or 

child; and

(iii) includes a finding that such person represents a 

credible threat to the physical safety of the intimate 

partner or child or, by its terms, prohibits the use, 

attempted use or threatened use of physical force 

against the intimate partner or child that would 

reasonably be expected to cause bodily injury. 

(b) The Bureau of Alcohol, Tobacco, Firearms and Explosives 

(ATF) has clarified that an “intimate partner” is defined 

as:

(i) the spouse of the person

(ii) a former spouse of the person

(iii) an individual who is a parent of a child of the 

person

(iv) an individual who cohabits or has cohabited with 

the person.
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Relevant records defined by DOJ: Protective orders.

Potential DEEOIC specific relevant records: Protective orders 

potentially received in conjunction with child support orders.

 (9) Persons convicted of a misdemeanor crime of domestic violence.

(a) This includes any person who meets all of the following 

criteria:

(i) has been convicted of a federal, state, local or tribal 

offense that is a misdemeanor, or in states that do 

not classify offenses as misdemeanors, is an offense 

punishable by imprisonment for a term of one year 

or less or only by a fine;

(ii) the offense has, as an element, the use or attempted 

use of physical force or the threatened use of a 

deadly weapon; and

(iii) the offense was committed by a current or former 

spouse, parent or guardian of the victim, by a 

person with whom the victim shares a child, by a 

person who is cohabitating with or has cohabited 

with the victim as a spouse, parent or guardian, or 

by a person similarly situated to a spouse, parent or 

guardian of the victim. 

(b) If a conviction of a misdemeanor crime of domestic 

violence has been expunged or set aside, or the person has 

been pardoned or had his/her civil rights restored, it is not 

considered a conviction unless it was provided in the 

expungement, pardon, or restoration that the person may 

not ship, transport, possess, or receive firearms (and the 

person is not otherwise lawfully prohibited in the 

jurisdiction in which the proceedings were held).

Relevant records defined by DOJ: Convictions – only if obtained

without collaborating with a U.S. Attorney’s Office or other DOJ 

component.

Potential DEEOIC specific relevant records: Judgments in state 

court actions, usually received in conjunction with 42 U.S.C. § 

7385i(a).

 (10) Persons under indictment.
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(a) This includes any person “who is under indictment for a 

crime punishable by imprisonment for a term exceeding 

one year.”

(b) The ATF has clarified that this includes:

(i) a person under indictment or information in any 

court under which a crime punishable by 

imprisonment for a term exceeding one year may be 

prosecuted, or; 

(ii) a military service member charged with any offense 

punishable by imprisonment for a term exceeding 

one year which has been referred to a general 

court-martial.

Relevant records defined by DOJ: Indictments and information –

only if obtained without collaborating with a U.S. Attorney’s 

Office or other DOJ component. 

Potential DEEOIC relevant records: Indictments in state court 

actions – usually received in conjunction with 42 U.S.C. § 

7385i(a).

b. DEEOIC Responsibilities. All DEEOIC staff is to familiarize themselves 

with the stipulations for reporting records under the NIAA. During the 

course of claim adjudication, should a DEEOIC staff person identify any 

reportable records, he or she is to notify the assigned CE and Supervisory 

CE by email that a potentially reportable document exists in a DEEOIC 

case file. Once notified, it becomes the responsibility of the assigned CE 

to then undertake closer scrutiny of the potentially reportable document to 

ascertain the proper action to be undertaken. 

(1) The CE is to examine the document, informed by the guidance 

provided in this section of the Procedure Manual on the ten 

categories of reportable documents, to make a decision on whether 

the document is sufficient to identify the named individual as a 

potential prohibitor under NIAA. The CE is to prepare a draft 

Memo to File that provides a summary of the matter and explains 

the outcome of their analysis, including justification for action as a 

potentially reportable document under NIAA or closure of the 

matter with no further action necessary. The CE then will forward 

the draft Memo to File for the DD to review. The DD is to review 

the Memo and certify that it represents an accurate finding with 

regard to the CE’s review of the available evidence. If certified, 
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the CE will finalize the Memo to File, and upload it into the OIS 

case file record. 

(2) If the Memo to File, certified by the DD, identifies a potentially 

reportable document, the case file is to be transferred to the 

National Office Policy Branch for further action. 

(3) Once the Policy Branch receives the case file, a Policy Analyst will 

evaluate whether the further action is appropriate. If the assigned 

Policy Analyst concurs with the Memo to File, the case file will be 

transferred to the Office of the Solicitor for evaluation. If the 

Solicitor agrees that the document meets the NICS reporting 

requirement, it will notify the Policy Analyst. The Policy Analyst 

will then update the ECS case record with the completion of the 

NICS indicator, along with a note on the input screen about the 

reportable document, the identified prohibitor and the relevant 

NIAA category. DEEOIC will coordinate the reporting of all cases 

with a positive ECS NICS indicator to the proper DOJ point of 

contact. Once all actions are complete, the Policy Analyst will 

transfer the case file back to the originating district office with a 

brief memo describing the disposition of the NICS evaluation. If 

any future developments occur with regard to the reportable 

document, including changes that warrant removal of a reported 

document, the CE may contact the Policy Branch for guidance. 

• Chapter 10 – Resource Centers

o Ch. 10.2b has been edited to amend guidance to reflect new duties/responsibilities of the 

RC staff as it relates to incoming phone calls. The language in v4.0 read:

b. Claim Status. The RC fields claim status requests to assist claimants with general 

questions not requiring DO or FAB involvement. The RC staff member reviews 

ECS and answers claimant inquiries, memorializing such activities in ECS. 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 ECS and directs the caller to the 

proper CE or FAB HR.

When RC’s receive inquiries from a claimant or AR seeking claim status, they 

refer the claimant to the adjudicatory DO CE or the FAB HR as necessary. When 

referring a claimant or AR to a DO or FAB, the RC provides the claimant/AR 

with the toll-free number to the DO or FAB. All RC Managers have full read only 

access to ECS and OIS in order to better assist claimants with inquiries. Any 

inquiries cannot be addressed by the RC staff/Manager go to the CE or FAB HR, 

as appropriate. 
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It has been updated in v4.1 to:

b. Phone Calls: RC staff will serve as the initial responder for incoming DEEOIC 

phone inquiries, regardless of case location/jurisdiction or request status. RC 

staff members will use all available program resources in responding to inquiries 

in the most efficient and expedient manner possible. 

When RC’s receive phone inquiries from a claimant or AR seeking a status of a 

claim or medical authorization request that requires further review/analysis by 

DEEOIC staff, they are to transfer the call to the appropriate adjudicatory DO 

CE, FAB HR or assigned MBE. Calls transferred in this manner will be 

documented as a pending phone call in ECS until closed by RC or DEEOIC staff. 

In the event that a transferred phone call is not answered by the designated 

DEEOIC staff member, the caller will have the option to either leave a voice mail 

message with the intended call recipient or be returned back to the RC staff 

member who may then annotate ECS with a request for a returned phone call. 

When RC’s receive onsite inquiries from a claimant or AR seeking claim status

that requires further review/analysis by DEEOIC staff, they initiate contact with 

the DO CE, FAB HR or assigned MBE. When referring a claimant or AR to a 

DO, FAB or assigned MBE, the RC will initiate a telephone call with the 

appropriate DEEOIC staff member, requesting assistance to address an incoming 

inquiry received at the RC. If the DEEOIC staff member is not available to take 

the call, an automated record of a pending phone call will be created in ECS.

• Chapter 14 – Establishing Special Exposure Cohort Status

o Exhibit 14-1, List of SEC Designated Classes, has been updated to include Circular 19-

04, pertaining to the most recent SEC class added to the Idaho National Laboratory (INL) 

from January 1, 1963 through February 28, 1970.

• Chapter 15 – Establishing Toxic Substance Exposure and Causation

o Incorporates Bulletin 20-02, which updated Exhibit 15-4: Exposure and Causation 

Presumptions with Development Guidance for Certain Conditions, Section 15 pertaining 

to Non-Hodgkin’s lymphoma. 

• Chapter 17 – Development of Radiogenic Cancer Claims

o Exhibit 17-1, NIOSH Referral Summary Document (NRSD), has been updated to remove 

outdated references to ICD-9 codes.

o Exhibit 17-2, Instructions for Completing the NRSD, has been updated to remove 

outdated references to ICD-9 codes.
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• Chapter 20 – Establishing Survivorship

o Ch. 20.11c has been edited to delete language regarding RD cover letters. The language 

in v4.0 read:

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.

It has been updated in v4.1 to:

c. Individual Addresses. The RD does not include the addresses of the various 

claimants. Instead, an address sheet is prepared for each claimant and a copy of 

the decision is sent to all filing parties.

• Chapter 21 – Impairment Ratings

o Ch. 21.17 has been edited to ensure language conformity with regard to election of 

benefits across multiple chapters. The language in v4.0 read:

17. Issues Involving Survivor Election. If a covered Part E employee dies after 

submitting a Part E claim, but before that claim is paid, and death is caused solely by a 

non-covered 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.

It has been updated in v4.1 to:

17. Issues Involving Survivor Election. If a covered Part E employee dies after 

submitting a Part E claim, but before that claimed payment is received, and if the 

employee’s death was caused solely by a non-covered 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). It is not necessary for the employee to have filed a claim specifically for 

impairment benefits to have the election of benefits option available. As long as the 

employee filed a claim for Part E benefits, the CE presumes that claims for impairment 

and wage-loss were filed. The earlier receipt by the employee of monetary benefits under 

Part E for wage-loss and/or impairment does not negate the availability of this election 

for any subsequent amount of monetary benefits claimed by the survivor up to the 

aggregate maximum amount of compensation payable under Part E.
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• Chapter 22 – Wage-Loss Determinations

o Ch. 22.15b has been edited to ensure language conformity with regard to election of 

benefits across multiple chapters. The language in v4.0 read:

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.

It has been updated in v4.1 to:

b. Survivor Election. If a covered Part E employee dies after filing a Part E claim 

but before the claimed payment is received, and if the employee’s death was 

caused solely by a non-covered illness, the survivor(s) has the option to elect to 

receive the payment that the covered Part E employee would have received, had 

he/she not died prior to payment, rather than survivor benefits. It is not necessary 

for the employee to have filed a claim specifically for wage-loss benefits for the 

election option to be available to the survivor(s). As long as the employee filed a 

claim for Part E benefits, claims for impairment and wage-loss benefits are 

presumed by the CE. The earlier receipt by the employee of monetary benefits 

under Part E for impairment or wage-loss does not negate the availability of this 

election for any subsequent amount of monetary benefits claimed by the survivor.

• Chapter 24 – Recommended Decisions

o Ch. 24.6e has been edited include language regarding RD address sheets. The language 

in v4.0 read:

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. 

It has been updated in v4.1 to:

e. Mailing Addresses. Mailing Addresses. For mailing purposes, the CE is to print 

a separate mailing sheet for each claimant who is to receive a copy of the RD. 

The mailing sheet is to include only the mailing address of the claimant, and when 
14

applicable, his/her authorized representative. The CE is to image each mailing 

sheet in OIS, along with the final version of the RD and accompanying documents 

(as a consolidated document) to record the transmission of the RD to all 

claimants named as a party of the decision. 

o Ch. 24.7 has been edited to remove language regarding RD cover letters and the use of 

two distinctive types of waivers. New language has been inserted regarding guidance on 

the use of RD address sheets and the use of a singular consolidated waiver form. The 

language in v4.0 read:

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. It advises that the accompanying is a recommendation, is not 

a final decision, 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 DO issued a 

recommendation to deny based on written input received from a DEEOIC 

medical health scientist (TOX/IH or HP) or CMC, the CE must attach the 

document(s) for reference.

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 the case evidence, nor 
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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 
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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 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 
17

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.

Within the context of decision analysis, the CE is to maintain a 

claimant-oriented 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 
18

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 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 nonprecedent 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 
19

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 and title 

of the person who prepared the recommendation and the name and 

title of the person who reviewed and certified the decision, when 

applicable. When a decision is certified by a SrCE/Supervisor, this 

means that the reviewer has assessed the overall accuracy and 

readability of the decision to ensure quality.

(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 
20

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.

It has been updated in v4.1 to:

7. Content and Format. A RD is comprised of a written decision and a Notice of 

Recommended Decision provided to a claimant explaining his or her right to challenge 

the recommendation. With the Notice of Recommended Decision, the DEEOIC provides 

a waiver for claimant to complete if they agree with the decision entirely or in part. The 

CE is to attach to the decision any Medical Health Science (HP, IH, TOX or CMC) input 

that provides justification or support for a claim denial. The CE is responsible for 

preparing the RD and all its component parts. The format and content of a RD is as 

follows:

a. Written Decision. The written decision is comprised of an Introduction, a 

Statement of the Case, Explanation of Findings, and Conclusions of Law. 

Exhibit 24-1and Exhibit 24-2 provide sample RDs. 

(1) Notice of Recommended Decision. 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 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;
21

(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 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 
22

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.

Within the context of decision analysis, the CE is to maintain a 

claimant-oriented perspective. This can be defined as decisions 
23

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 

Workers’ 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, 
24

how the average annual wage was compared to future 

calendar years of wage-loss, and any 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 nonprecedent 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. 
25

(6) Signatory Line. The signature line must include the name and title 

of the person who prepared the recommendation and the name and 

title of the person who reviewed and certified the decision, when 

applicable. When a decision is certified by a SrCE/Supervisor, this 

means that the reviewer has assessed the overall accuracy and 

readability of the decision to ensure quality.

(7) Notice of Recommended Decision. 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. The notice also outlines the claimant’s State Workers’ 

Compensation and Tort reporting requirements in the case of 

recommended acceptances. A sample Notice of Recommended 

Decision is included as part of Exhibit 24-4.

(a) Waiver of Rights. A waiver is included within the Notice of 

Recommended Decision and the CE is to list the case ID 

number, name of the employee, name of the claimant, and 

the date of the decision in the upper right hand corner. 

With the completion of the waiver, 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. The claimant may 

waive any objection to the decision in its entirety or in part. 

A claimant has 60 days from the date a CE issues the RD to 

file an objection, and may waive this right at any time.

o A Sample Cover Letter, which was previously found in v4.0 as Exhibit 24-1, has been 

deleted. 

o Accordingly, what was previously Exhibit 24-2: Sample RD, Accept, has been 

renumbered to Exhibit 24-1in v4.1. Additionally, this Exhibit now includes a new field 

in the header for inclusion of a “Date of Issuance.”

o Accordingly, what was previously Exhibit 24-3: Sample RD, Denial, has been 

renumbered to Exhibit 24-2 in v4.1. Additionally, this Exhibit now includes a new field 

in the header for inclusion of a “Date of Issuance.”

o What was previously, in v4.0, Exhibit 24-4: Notice of Recommended Decision and 

Claimant Rights; has been deleted.

o What was previously, in v4.0, Exhibit 24-5, Sample Waiver; has been deleted.

o What was previously, in v4.0, Exhibit 24-6, Sample Bifurcated Waiver, has been deleted. 

o As such, the deleted exhibits listed above have been replaced in v4.1 with a new Exhibit 

24-3, Notice of Recommended Decision.
26

o Ch. 24.10c-d has been edited to clarify the issuance of letter decisions for HHC or DME. 

The language in v4.0 read:

c. Acceptance or denial of medical care or treatment, including home health care. 

d. Acceptance or denial of DME or housing/vehicle modification.

It has been updated in v4.1 to:

c. Acceptance of medical care or treatment, including home health care. 

d. Acceptance of DME or housing/vehicle modification.

• Chapter 25 – FAB Review Process

o Ch. 25.5 has been edited to reflect the use of a singular consolidated waiver form. The 

language in v4.0 read:

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 separate FD adjudicating the objected-to 

portion of the RD after a review of the written record or a hearing, or 
27

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.

It has been updated in v4.1 to:

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. 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. If FAB 

receives a 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.

• Chapter 26 – FAB Decisions

o Ch. 26.3b(4)(a) has been edited to delete an incorrect reference to DEEOIC HP referrals. 

The language in v4.0 read:

(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.

It has been updated in v4.1 to:

(a) Objections to NIOSH Dose Reconstruction Decisions. Detailed procedures for 

assessment of objections to the NIOSH process are found in Chapter 25, FAB 

Review Process.
28

• Chapter 28 – Medical Bill Process

o Incorporates Bulletin 20-01, which, in part, updated and replaced Chapter 28 – Medical 

Bill Process.

o Ch. 28.5 has been edited to clarify the medical records procurement policy. The 

language in v4.0 read:

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.

It has been updated in v4.1 to:

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 request.

• Chapter 29 – Ancillary Medical Services and Related Expenses

o Incorporates Bulletin 20-01, which, in part, updated and replaced Chapter 29 – Ancillary 

Medical Services and Related Expenses.

o New content has been added as Ch., 29.19 to incorporate guidance regarding claims for 

corrective eyewear. The new language at Ch. 29.19 in v4.1 reads:

19. Corrective Eyewear. The MBE may evaluate a claim for reimbursement of 

corrective eyewear, including eyeglasses and contact lenses that serve to accommodate a 

medically necessary effect from an accepted illness. In assessing a claim for corrective 

eyewear, the MBE is to obtain a LMN that convincingly and reasonably establishes the 

medical need for corrective lenses to address the effect of an accepted illness. The MBE 

may authorize eyewear reimbursement for those costs limited to correcting a vision 

deficiency brought about by an accepted illness. The MBE is to exclude from any 

calculation of reimbursement those costs relating to enhancements or other added 

features unrelated to accommodating a medical need, including tinting, polarization, 

colorization etc. Once the MBE provides an initial authorization for the reimbursement 

of eyeglasses, the MBE may authorize replacement with appropriate documentation of a 

change in medical need or other established circumstance such as damage or 

loss. Reimbursement of authorized contact lenses may occur in increments of time 

communicated in the claimant’s LMN or prescription.
29

o New content has been added as Ch., 29.20 to incorporate guidance regarding claims for 

marijuana reimbursement. The new language at Ch. 29.20 in v4.1 reads:

20. Marijuana Reimbursement Policy. All products that contain any amount of 

tetrahydrocannabinol (THC), an active ingredient of marijuana, are considered schedule 

I controlled substances by the U.S. Drug Enforcement Administration and are therefore 

not eligible for payment/reimbursement. State laws authorizing the use of Schedule I 

drugs, such as marijuana, even when characterized as medicine, are contrary to Federal 

Law. The Controlled Substances Act (Title 21 United States Code 801 et al.) designates 

Schedule I drugs as having no currently accepted medical use and there are criminal 

penalties associated with production, distribution, and possession of these drugs.

o Accordingly, content that was previously located in v4.0 at Ch.20.19 (Rehabilitative 

Therapy Services) and Ch. 20.20 (Ancillary Services Or Expense Authorization RD) has 

been moved and renumbered in v4.1 to Ch. 20.21 and Ch. 20.22, respectively.

• Chapter 31 – Tort Action and Election of Remedies

o Ch. 31.3c has been edited to clarify guidance regarding FABs handling of cases in which 

a claimant does not return the completed EN-16. The language in v4.0 read:

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). 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.

It has been updated in v4.1 to:

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). 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 administratively closes the case 

and returns it to the DO. The FAB sends a letter advising the claimant of this 

course of action.

• Chapter 32 – Coordinating State Workers’ Compensation Benefits

o Ch. 32.6c has been edited to clarify guidance regarding FABs handling of cases in which 

a claimant does not return the completed EN-16. The language in v4.0 read:
30

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.

It has been updated in v4.1 to:

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 administratively closes the 

case and returns it to the DO. The FAB sends a letter advising the claimant of 

this course of action.

• Chapter 33 – Compensation Payments

o Ch. 33.3a-c have been updated. The language in v4.0 read:

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. 

b. Retention of Form EN-20.

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.

It has been updated in v4.1 to:
31

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.

b. Retention of Form EN-20.

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) Case ID

Rachel D. Pond

Director, Division of 

Energy Employees Occupational Illness Compensation