It has been revised in v3.1 to:

6. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos for at least 250 aggregate
work days. This can be determined by existing asbestos exposure presumptions or an
IH assessment.

= Section 14.b regarding mesothelioma. The language included in v3.0 read:

b. Exposure; The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos on a day-by-day basis for
at least 30 aggregate work days. This can be determined by existing asbestos
exposure presumptions or an IH assessment.

It has been revised in v3.1 to:

6. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos for at least 30 aggregate
work days. This can be determined by existing asbestos exposure presumptions or an
IH assessment.

= Section 15.b regarding ovarian cancer. The language included in v3.0 read:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos on a day-by-day basis for
at least 250 aggregate work days. This can be determined by existing asbestos
exposure presumptions or an IH assessment.

It has been revised in v3.1 to:
b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos for at least 250 aggregate
work days. This can be determined by existing asbestos exposure presumptions or an
IH assessment.

* Section 17.b regarding pleural plaques. The language included in v3.0 read:
b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos-on a day-by-day basis for
at least 250 aggregate work days. This can be determined by existing asbestos
exposure presumptions or an IH assessment.

It has been revised in v3.1 to:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos for at least 250 aggregate

5


To calculate the dollar amount of the new impairment award, first subtract the total
coordination amount of $60,000.00 for asbestosis ($50,000.00 calculated at the time of
the prior award + the additional amount of $10,000.00 = $60,000.00) from the new
dollar amount attributable to asbestosis ($76,740.00), which leaves $16,740.00. Add the
new amount attributable to skin cancer ($23,260.00) to this figure for asbestosis, and the
result is $40,000.00 ($23,260.00 + $16,740.00 = $40,000.00).

Finally, from this amount of $40,000.00, subtract the total amount of impairment benefits
previously paid ($16,854.50), and the resulting figure of $23,145.50 is the amount
payable as increased impairment benefits ($40,000.00 - $16,854.50 paid on the prior
award = $23,145.50), with no outstanding surplus.

In any unique or challenging circumstance involving how best to apply SWC
coordination or tort offset to a payable impairment, the CE consults with the NO Policy
Branch,

Chapter 30, Home and Residential Health Care, is reissued to include a new forms process
for making HHC claims and contains new sections outlining the HRHC claims adjudication
process. Also updated are sections pertaining to the emergency authorization of HRHC
claims, and other administrative procedures.

© Section 1. New language introducing an expanded chapter on HRHC.
© Section 2. Definitions provided to explain terms common to the HRHC claim process.

o Sections 3 and 4. New language introducing two HRHC claim forms, a discussion of the
forms process, and an explanation of the claimant’s right to make certain decisions
pertaining to their HRHC needs.

© Sections 5. New guidance to the Medical Benefits Examiner (MBE) regarding the
evaluation of a Letter of Medical Necessity (LMN) for authorization of HRHC.

o Section 6 and 7. New guidance outlining development resources available to the MBE
and new procedural guidance discussing the development steps necessary to support an
authorization for HRHC.

o Section 8, 9 and 10. New procedural guidance explaining the process for issuing
authorizations for medically appropriate HRHC and for issuing recommended decisions
for the denial or reduction of authorized HRHC.

© Section 11. A revised section explaining the process for obtaining an emergency
authorization for HRHC.

o Section 12. Updated instructions to providers regarding documentation required when
billing DEEOIC for HRHC authorized services.

10


It has been revised in v3.1 to:

6. Established CBD Before 1993, Part B. The evidence required to establish a claim
Sor established CBD under Part B of the Act is described under 42 U.S.C. §73841(13).
Whether to use the pre- or post-1993 CBD criteria depends upon the totality of the
medical evidence, including when the employee was tested positive for, diagnosed with,
and/or treated for a chronic respiratory disorder.

If the earliest dated document showing that the employee was tested positive for, treated
Sor, or diagnosed with a chronic respiratory disorder is dated prior to January I, 1993,
the pre-1993 CBD criteria should be used. Evidence of a chronic respiratory disorder
includes records communicating existence of a long term, prolonged pulmonary disease
process. References to acute pulmonary conditions, such as short-term pulmonary
distress associated with temporary viral or bacterial infection do not qualify as a chronic
respiratory disorder. Pulmonary testing performed in occupational or medical settings,
which identify abnormalities, are not appropriate to document a chronic respiratory
disorder, unless interpreted as such by a physician. In situations where it is critical that
the question of whether historical documentation communicates the existence of a
chronic respiratory disorder, the CE is to undertake development to allow for a physician
chosen by the claimant to provide clarification, or when the claimant is unable to provide
such evidence, seek the input of a CMC.

If the earliest dated document showing a chronic respiratory disorder lists a date after
January 1, 1993, the post-1993 CBD criteria should be used. If the employee sought
treatment before 1993, but the medical documentation relating to the treating document
is dated on or after January 1, 1993, the pre-1993 CBD criteria should be used. In this
situation, the medical evidence is to clearly communicate the fact that treatment occurred
prior to 1993.

To establish pre-1993 CBD, the medical documentation is to include at least three of the
following: characteristic chest radiographic [or computed tomography (CT)]
abnormalities; restrictive or obstructive lung physiology testing or diffusing lung
capacity defect; lung pathology consistent with CBD (including the results of an
abnormal mediastinal lymph node biopsy); a clinical course consistent with a chronic
respiratory disorder, or immunologic tests showing beryllium sensitivity (e.g., skin patch
test or beryllium blood test preferred). Once it is established that the employee had

a chronic respiratory disorder prior to 1993, the CE is not limited to the use of medical
reports dated prior to 1993 to meet three of the five criteria.

Ch. 18.12(a)(2) has been edited for clarity. The language included in v3.0 read:
(2) Present for an aggregate of at least 250 work days during the mining of tunnels at

a DOE facility located in Nevada or Alaska for tests or experiments related to an
atomic weapon (Part B claims only).

It has been revised in v3.1 to:

(2) Present for an aggregate of at least 250 work days during the mining of tunnels at
a DOE facility located in Nevada or Alaska for tests or experiments related to an

7


work days. This can be determined by existing asbestos exposure presumptions or an
IH assessment.

¢ Chapter 18, Eligibility Criteria for Non-Cancerous Conditions:

o Ch. 18.6 has been edited for clarity concerning the use of evidence to support a pre-1993
CBD claim. The language included in v3.0 read:

6. Established CBD Before 1993, Part B. The evidence required to establish a claim
Sor established CBD under Part B of the Act is described under 42 U.S.C. §73841(13).
Whether to use the pre- or post-1993 CBD criteria depends upon the totality of the
medical evidence, including when the employee was tested for, diagnosed with, and/or
treated for a chronic respiratory disorder.

If the earliest dated document showing that the employee was either treated for or
diagnosed with a chronic respiratory disorder is dated prior to January 1, 1993, the pre-
1993 CBD criteria should be used. Evidence of a chronic respiratory disorder includes
records communicating existence of a long term, prolonged pulmonary disease process.
References to acute pulmonary conditions, such as short-term pulmonary distress
associated with temporary viral or bacterial infection do not qualify as a chronic
respiratory disorder. Pulmonary testing performed in occupational or medical settings,
which identify abnormalities, are not appropriate to document a chronic respiratory
disorder, unless interpreted as such by a physician. In situations where it is critical that
the question of whether historical documentation communicates the existence of a
chronic respiratory disorder, the CE is to undertake development to allow for a physician
chosen by the claimant to provide clarification, or when the claimant is unable to provide
such evidence, seek the input of a CMC.

If the earliest dated document showing a chronic respiratory disorder lists a date after
January 1, 1993, the post-1993 CBD criteria should be used. If the employee sought
treatment before 1993, but the medical documentation relating to the treating document
is dated on or after January 1, 1993, the pre-1993 CBD criteria should be used. In this
situation, the medical evidence is to clearly communicate the fact that treatment occurred
prior to 1993.

To establish pre-1993 CBD, the medical documentation is to include at least three of the
following: characteristic chest radiographic [or computed tomography (CT)]
abnormalities; restrictive or obstructive lung physiology testing or diffusing lung
capacity defect; lung pathology consistent with CBD (including the results of an
abnormal mediastinal lymph node biopsy); a clinical course consistent with a chronic
respiratory disorder, or immunologic tests showing beryllium sensitivity (e.g., skin patch
test or beryllium blood test preferred).


amount attributable to skin cancer of $23,260.00, subtract the previous award of
$16,854.50, which equals to $6,405.50. The CE adds the dollar amounts for each organ
or body function to determine that the increased impairment award is

$23, 145.50($16, 740.00 + $6,405.50 = $23,145.50) with no outstanding surplus.

In any unique or challenging circumstance involving how best to apply SWC
coordination or tort offset to a payable impairment, the CE consults with the NO Policy
Branch.

It has been revised in v3.1 to:

13. How to Calculate Increased Impairment Award with Tort Offset/SWC

Coordination, For an increased impairment claim involving tort offset and/or SWC
coordination, the calculation must be based on the current impairment rating/award and
not on the net increased impairment award.

For example, John Doe had previously been awarded impairment for asbestosis and skin
cancer for 26%. The current combined impairment rating is 40%, which is comprised of
33% due to asbestosis and 10% due to skin cancer. Using the current impairment rating,
follow the calculation in Section 12c to determine the relative percentage of impairment
for each organ or body function and Section 12d to determine the dollar amount
attributable for each organ or body function. The dollar amount attributable to each
organ or body function must be based on the current impairment award of 40% or
$100,000.00 and not on the net increase of 14% (40% - 26% = 14%) or $35,000.00. As
such, the increased impairment calculation is as follows:

For asbestosis — Multiply 76.74% (the percentage attributable to asbestosis based on the
current impairment rating) by the current impairment award of $100,000.00 to determine
that $76,740.00 is the dollar amount attributable to asbestosis.

For skin cancer — Multiply 23.26% (the percentage of current impairment rating
attributable to skin cancer) by $100,000.00 to determine that $23,260.00 is the dollar
amount attributable to skin cancer.

Since the CE calculates the increased impairment award based on the current
impairment rating and not on the net increase, the total of all SWC coordination/tort
offset for that organ or body function must be subtracted from the current dollar amount
attributable to that organ or body function that is available for SWC coordination/tort

offset.

Example: In the previous impairment decision issued to John Doe, the CE concluded that
a surplus of $1,854.50 remained for asbestosis after coordination of SWC benefits for
asbestosis in the amount of $50,000.00. The total impairment award was $16,854.50
Srom the skin portion of the combined impairment award. Since the previous impairment
decision, the CE concluded that John Doe received an additional SWC coordination for
asbestosis in the amount of $10,000.00 for a total coordination amount of $60,000.00.

9


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 3.1:

EEOICPA TRANSMITTAL NO. 19-02 May 16, 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 3.1 of the Federal (EEOICPA) Procedure
Manual (PM). Version 3.1 (v3.1) replaces Version 3.0 (v3.0), effective the date of publication of
this transmittal.

Following are the content edits that make up Federal (EEOICPA) PM v3.1:
e Chapter 6, Processing Mail:
co Ch. 6.5d was updated for clarity. The language included in v3.0 read:

d. Priority Correspondence. Priority correspondence generally to the request for
information and/or status of a claim from the claimant or an authorized third
party. Consequently, priority correspondence is time sensitive and requires
careful attention in its review and response.

Of the priority correspondence listed in paragraph 2a above, the most are FOIA
requests, Privacy Act requests, and Congressional inquiries. In instances when a
third party makes such a request (other than a FOIA request), a waiver signed by
the claimant or AR must be included.

(1) FOIA Requests. FOIA requests allow third parties to request and gain
access to existing Federal Government information, as outlined under 5
U.S.C. §552. FOIA requests are highly time sensitive and require careful
attention as they involve the disclosure of specific documentation
pertaining to the DEEOIC and/or its claimants. Each DEEOIC Office is
to have a FOIA coordinator to effectively facilitate the identification and
processing of FOIA requests.

Exhibit 6-2 shows a FOIA Process Flow Chart which identifies the steps
to be taken in order to accurately and expeditiously process a FOIA
request received in a DEEOIC office.


o The following Exhibits for Ch. 30 have been updated:

Exhibit 30-1, Form EE-17A: Claim for Home Health Care, Nursing Home, or
Assisted Living Benefits Under the EEOICPA

Exhibit 30-2, Form EE-17B: Physician’s Certification of Medical Necessity Under
the EEOICPA

Exhibit 30-3, Sample Letter to Treating Physician

Exhibit 30-4, DEEOIC Home and Residential Health Care Authorized Billing Codes

Batil ¢ Lepr

Rachel P. Leiton
Director, Division of
Energy Employees Occupational Illness Compensation

11


atomic weapon (Part B claims only). This tunnel work occurred through October
1992, at which time the unilateral moratorium on nuclear weapons testing went
into effect.

e Chapter 21, Impairment Ratings:

o Ch, 21.13 has been revised with updated guidance on calculating increased impairment
awards with tort offset/SWC coordination. The language included in v3.0 read:

13. How to Calculate Increased Impairment Award with Tort Offset/SWC

Coordination, For increased impairment claim involving tort offset and/or SWC
coordination, the calculation must be based on the current impairment rating/award and
not on the net increased impairment award.

For example, John Doe had previously been awarded impairment for asbestosis and skin
cancer for 26%. The current combined impairment rating is 40%, which comprised of
33% due to asbestosis and 10% due to skin cancer. Using the current impairment rating,
follow the calculation in Section 12c to determine the relative percentage of impairment
Sor each organ or body function and Section 12d to determine the dollar amount
attributable for each organ or body function. The dollar amount attributable to each
organ or body function must be based on the current impairment award of 40% or
$100,000.00 and not on the net increase of 14% (40% - 26% = 14%) or $35,000.00. As
such, the increased impairment calculation is as follows:

For asbestosis — Multiply 76.74% (the percentage attributable to asbestosis based on the
current impairment rating) by the current impairment award of $100,000.00 to determine
that $76,740.00 is the dollar amount attributable to asbestosis.

For skin cancer — Multiply 23.26% (the percentage of current impairment rating
attributable to skin cancer) by $100,000.00 to determine that $23,260.00 is the dollar
amount attributable to skin cancer.

Since the CE calculates the increased impairment award based on the current
impairment rating and not on the net increase, any previous award(s) of impairment and
any SWC coordination/tort offset for that organ or body function must be subtracted from
the current impairment award.

Example: In the previous impairment decision issued to John Doe, the CE concluded that
a surplus of $1,854.50 remained for asbestosis after coordination of SWC benefits for
asbestosis in the amount of $50,000.00. The total impairment award was $16,854.50
Srom the skin portion of the combined impairment award. Since the previous impairment
decision, the CE concluded that John Doe received an additional SWC coordination for
asbestosis in the amount of $10,000.00 for a total coordination amount of $60,000.00.

To calculate the new impairment award, subtract the total coordination amount of
$60,000.00 for asbestosis from the new dollar amount attributable to asbestosis
(876,740.00) which equals to $16,740.00 payable for asbestosis. From the new dollar

8


b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos on a day-by-day basis
Sor at least 250 aggregate work days. This can be determined by existing
asbestos exposure presumptions or an IH assessment.

It has been revised in v3.1 to:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos for at least 250 aggregate
work days. This can be determined by existing asbestos exposure presumptions or an
TH assessment.

= Section 10.b regarding laryngeal cancer. The language included in v3.0 read:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos on a day-by-day basis for
at least 250 aggregate work days. This can be determined by existing asbestos
exposure presumptions or an IH assessment.

It has been revised in v3.1 to:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos for at least 250 aggregate
work days. This can be determined by existing asbestos exposure presumptions or an
TH assessment.

= Section 11.b regarding leukemia. The language included in v3.0 read:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to benzene on a day-by-day basis for
at least 250 aggregate work days. This can be determined by an IH assessment.

It has been revised in v3.1 to:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to benzene for at least 250 aggregate
work days. This can be determined by an IH assessment.

® Section 12.b regarding lung cancer. The language included in v3.0 read:

b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to asbestos on a day-by-day basis for
at least 250 aggregate work days. This can be determined by existing asbestos
exposure presumptions or an IH assessment.


the claims process. From that point forward, or until the claimant removes or changes
the representative, the CE or FAB staff person will communicate with the designated
representative and copy them on all written interactions intended for the claimant. The
CE or FAB staff are permitted to communicate with employees of the designated
representative, including legal assistants, administrative staff, paralegals, or other
individuals in the employment of the representative.

e Chapter 15, Establishing Toxic Substance Exposure and Causation:

o Exhibit 15-2, Section 4.4 has been modified to eliminate the need to report ICD codes.
The language included in v3.0 read:

4. Health Effect(s): List the health effect(s) that are under toxic development along
with the diagnosis date and ICD-9 or ICD-10 code as appropriate based on filing date of
the diagnosed condition. Since the employee’s work processes and work duties remain
the same for the identified facility/site and labor category, multiple health effects may be
listed and considered within the same section. The CE will clearly specify in #6 which
toxins are associated with each corresponding health effect.

It has been revised in v3.1 to:

4. Health Effect(s): List the diagnosed condition that has a health effect link
established by application of SEM or the opinion of a qualified physician. Since the
employee ’s work processes and work duties remain the same for the identified facility/site
and labor category, multiple health effects may be listed and considered within the same
section. The CE will clearly specify in #6 which toxins are associated with each
corresponding health effect.

o Exhibit 15-4, has been modified to eliminate references to day-by-day exposure.

= Section 1.b regarding angiosarcoma. The language included in v3.0 read:
b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to polyvinyl chloride on a day-by-day
basis for at least 250 aggregate work days. This can be determined by an IH
assessment.

It has been revised in v3.1 to:
b. Exposure: The employee was employed in a job that would have brought the
employee into contact with significant exposure to polyvinyl chloride for at least 250

aggregate work days. This can be determined by an IH assessment.

*® Section 4.b regarding asbestosis. The language included in v3.0 read:


°

It has been revised in v3.1 to:

d. Priority Correspondence. Priority correspondence generally refers to the request
Sor information and/or status of a claim from the claimant or an authorized third
party. Consequently, priority correspondence is time sensitive and requires
careful attention in its review and response.

Of the priority correspondence listed in paragraph 2a above, the most common
are FOIA requests, Privacy Act requests, and Congressional inquiries. In
instances when a third party makes such a request (other than a FOIA request), a
waiver signed by the claimant or AR must be included.

(1) FOIA Requests. FOIA requests allow third parties to request and gain
access to existing Federal Government information, as outlined under 5
U.S.C. §552. FOIA requests are highly time sensitive and require careful
attention as they involve the disclosure of specific documentation
pertaining to the DEEOIC and/or its claimants. Each DEEOIC Office is to
have a Point of Contact who can effectively identify FOIA requests and
forward them to the DEEOIC National Office’s Branch of Outreach and
Technical Assistance.

Exhibit 6-2 shows a FOIA Process Flow Chart which identifies the steps
to be taken in order to accurately and expeditiously process a FOIA
request received in a DEEOIC office.

Exhibit 6-2, FOIA Process Flow Chart, has been updated

e Chapter 12, Representative Services:

O°

Ch. 12.6 has been updated to clarify communication with an employee of a duly
appointed representative. The language included in v3.0 read:

6. Interaction with Representatives. After a claimant properly appoints a
representative to handle his or her DEEOIC claim, the CE or FAB staff person contacts
the representative by letter (Exhibit 12-3). In the letter, the CE acknowledges the
appointment and describes the extent to which the representative has an active role in
the claims process. From that point forward, or until the claimant removes or changes
the representative, the CE or FAB staff person will communicate with the designated
representative and copy them on all written interactions intended for the claimant.

It has been revised in v3.1 to:

6. Interaction with Representatives. After a claimant properly appoints a
representative to handle his or her DEEOIC claim, the CE or FAB staff person contacts
the representative by letter (Exhibit 12-3). In the letter, the CE acknowledges the
appointment and describes the extent to which the representative has an active role in

2