DRAFT 

ADVISORY BOARD ON RADIATION AND WORKER HEALTH 

NATIONAL INSTITUTE FOR 

OCCUPATIONAL SAFETY AND HEALTH 

A REVIEW OF NIOSH’S PROGRAM EVALUATION REPORT 

DCAS-PER-043, “INTERNAL DOSIMETRY ORGAN, 

EXTERNAL DOSIMETRY ORGAN, AND IREP MODEL 

SELECTION BY ICD-9 CODE REVISION”

Contract No. 211-2014-58081

SCA-TR-PR2014-0089, Rev. 0 

Prepared by 

U. Hans Behling, PhD, MPH 

SC&A, Inc. 

S. Cohen & Associates 

1608 Spring Hill Road, Suite 400 

Vienna, VA 22182 

August 2014 

Disclaimer 

This document is made available in accordance with the unanimous desire of the Advisory Board on 

Radiation and Worker Health (ABRWH) to maintain all possible openness in its deliberations. However, 

the ABRWH and its contractor, SC&A, caution the reader that at the time of its release, this report is predecisional and has not been reviewed by the Board for factual accuracy or applicability within the 

requirements of 42 CFR 82. This implies that once reviewed by the ABRWH, the Board’s position may 

differ from the report’s conclusions. Thus, the reader should be cautioned that this report is for 

information only and that premature interpretations regarding its conclusions are unwarranted.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

2 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution. 

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82. 

S. COHEN & ASSOCIATES:

Technical Support for the Advisory Board on

Radiation & Worker Health Review of

NIOSH Dose Reconstruction Program

Document No. 

SCA-TR-PR2014-0089

Effective Date: 

Draft – August 18, 2014

A REVIEW OF NIOSH’S PROGRAM

EVALUATION REPORT DCAS-PER-043, 

“INTERNAL DOSIMETRY ORGAN, 

EXTERNAL DOSIMETRY ORGAN, AND 

IREP MODEL SELECTION BY ICD-9 CODE 

REVISION”

Page 2 of 16

Task Manager:

________________________ Date: ___________

U. Hans Behling, PhD, MPH 

Supersedes:

N/A

Project Manager:

________________________ Date: ___________

John Stiver, CHP

Reviewer(s):

 John Stiver

Record of Revisions

Revision 

Number

Effective 

Date Description of Revision

0 (Draft) 08/18/2014 Initial issue
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

3 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

TABLE OF CONTENTS

Abbreviations and Acronyms ..........................................................................................................4

1.0 Statement of Purpose ...........................................................................................................5

2.0 Subtask 1: Identify the Circumstances that Necessitated the Need for 

DCAS-PER-043...................................................................................................................7

3.0 Subtask 2: Assess NIOSH’s Specific Methods for Corrective Action .............................11

4.0 Subtask 3: Evaluate the PER’s Stated Approach for Identifying the Number of 

DRs Requiring Re-evaluation of Dose ..............................................................................13

5.0 Subtask 4: Conduct Audits of a Sample Set of DRs Affected by DCAS-PER-043 .........14

6.0 References..........................................................................................................................15
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

4 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

ABBREVIATIONS AND ACRONYMS

CCL chronic lymphocytic leukemia

CM Clinical Modification

DCAS Division of Compensation Analysis and Support (formerly OCAS)

DHHS (U.S.) Department of Health and Human Services

DOL (U.S.) Department of Labor

DR dose reconstruction

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ICRP International Commission on Radiological Protection

ICD International Classification of Diseases

IMBA Integrated Modules for Bioassay Analysis

IREP Interactive RadioEpidemiological Program

NCHS National Center for Health Statistics

NIOSH National Institute for Occupational Safety and Health

NOS not otherwise specified

OCAS Office of Compensation Analysis and Support (now DCAS)

ORAUT Oak Ridge Associated Universities Team

PEP Program Evaluation Plan

PER Program Evaluation Report

POC probability of causation

SC&A S. Cohen and Associates (SC&A, Inc.)

SEC Special Exposure Cohort

TIB technical information bulletin
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

5 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

1.0 STATEMENT OF PURPOSE

To support dose reconstruction (DR), the National Institute for Occupational Safety and Health 

(NIOSH) and the Oak Ridge Associated Universities Team (ORAUT) have assembled a large 

body of guidance documents, workbooks, computer codes, and tools. In recognition of the fact 

that all of these supporting elements in DR may be subject to revisions, provisions exist for 

evaluating the effect of such programmatic revisions on the outcome of previously completed 

DRs. Such revisions may be prompted by document revisions due to new information, 

misinterpretation of guidance, changes in policy, and/or programmatic improvements.

The process for evaluating potential impacts of programmatic changes on previously completed 

DRs has been proceduralized in OCAS-PR-008, Preparation of Program Evaluation Reports 

and Program Evaluation Plans (OCAS 2006), Revision 2, dated December 6, 2006. This 

procedure describes the format and methodology to be employed in preparing a Program 

Evaluation Report (PER) and a Program Evaluation Plan (PEP).

A PER provides a critical evaluation of the effect(s) that a given issue/programmatic change may 

have on previously completed DRs. This includes a qualitative and quantitative assessment of 

potential impacts. Most important in this assessment is the potential impact(s) on the Probability 

of Causation (POC) of previously completed DRs with POCs of <50%.

During a teleconference by the Advisory Board’s Procedures Subcommittee meeting on April 

16, 2014, SC&A was tasked by the Board to conduct reviews of three PERs. Included among 

the PERs is DCAS-PER-043, Internal Dosimetry Organ, External Dosimetry Organ, and IREP 

Model Selection by ICD-9 Code Revision (DCAS 2013). In conducting a PER review, SC&A is 

committed to perform the following five subtasks, each of which is discussed in this report:

Subtask 1: Assess NIOSH’s evaluation/characterization of the “issue” and its potential impacts 

on DR. Our assessment intends to ensure that the “issue” was fully understood and 

characterized in the PER.

Subtask 2: Assess NIOSH’s specific methods for corrective action. In instances where the PER 

involves a technical issue that is supported by document(s) [e.g., white papers, technical 

information bulletins (TIBs), procedures] that have not yet been subjected to a formal 

SC&A review, Subtask 2 will include a review of the scientific basis and/or sources of 

information to ensure the credibility of the corrective action and its consistency with 

current/consensus science. Conversely, if such technical documentation has been 

formalized and previously subjected to a review by SC&A, Subtask 2 will simply provide 

a brief summary/conclusion of this review process.

Subtask 3: Evaluate the PER’s stated approach for identifying the universe of potentially 

affected DRs, and assess the criteria by which a subset of potentially affected DRs was 

selected for re-evaluation. The second step may have important implications in instances 

where the universe of previously denied DRs is very large and, for reasons of practicality, 

NIOSH’s re-evaluation is confined to a subset of DRs that, based on their scientific 
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

6 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

judgment, have the potential to be significantly affected by the PER. In behalf of 

Subtask 3, SC&A will also evaluate the timeliness for the completion of the PER.

Subtask 4: Conduct audits of DRs affected by the PER under review. Based on information 

contained in Table 1 (and discussed in Section 3.1 below), the number of DRs selected 

for audit for a given PER will vary. (It is assumed that the selection of the DRs and the 

total number of DR audits per PER will be made by the Advisory Board.) 

Subtask 5: Prepare a written report that contains the results of the Subtask 4 DR audit, along 

with our review conclusions. 
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

7 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

2.0 SUBTASK 1: IDENTIFY THE CIRCUMSTANCES THAT 

NECESSITATED THE NEED FOR DCAS-PER-043

Under the Energy Employees Occupational Illness Compensation Program Act of 2000 

(EEOICPA), the organs or tissues for which doses must be estimated are those that are delineated 

by the specified ICD-9 code that is received from the U.S. Department of Labor (DOL). Thus, 

coding of the cancers is conducted by DOL on the basis of ICD-9. The U.S. Department of 

Health and Human Services (DHHS) National Center for Health Statistics (NCHS) has issued a 

related document, International Classification of Diseases, Ninth Edition, Clinical Modification 

(ICD-9-CM; DHHS 2008), which is widely used in the United States. ICD-9-CM is revised on 

an annual basis. While many ICD-9 codes are clear in their intended organ or tissue, additional 

guidance is necessary to identify the appropriate organs or tissues for internal and external dose 

estimation and the Interactive RadioEpidemiological Program (IREP) model to use for the organ 

or tissue.

ORAUT-OTIB-0005, Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, provides guidance on selection of (1) the appropriate International 

Commission on Radiological Protection (ICRP) organ or tissue model to estimate the internal 

dose for specific ICD-9 codes, (2) the appropriate organs or tissues to estimate external dose, and 

(3) the appropriate model in IREP. ORAUT-OTIB-0005 also provides information for selecting 

and assessing likely primary cancers for secondary cancers.

Revision 0 of ORAUT-OTIB-0005 was issued on March 11, 2003. Since that time, changes 

have been introduced that have mandated the following nine revisions to ORAUT-OTIB-0005.

Revision # Issue Date

Revision 0 11/3/2003

Revision 1 11/23/2004

Revision 1 PC-1 3/5/2004

Revision 1 PC-2 5/7/2004

Revision 1 PC-3 10/29/2004

Revision 2 12/2/2005

Revision 2 PC-1 2/10/2006

Revision 3 2/26/2010

Revision 4 4/18/2011

Revision 5 12/20/2012

While some changes in these revisions increased doses, others reduced doses. Since corrective 

actions mandated by DCAS-PER-043 only need to consider those changes that could result in an 

increase in dose (and the POC), our review is restricted to those changes that may increase organ 

doses as summarized below:

 Revision 1 incorporated guidance for the selection of the external organ for a given 

ICD-9 code into ORAUT-OTIB-0005, which was previously contained in OCAS-IG-001. 

This revision did not introduce a change to the estimate of the organ dose.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

8 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

 Revision 1 PC-1 added the bone cancer model as a possible option to ICD-9 code 238.7 

[lymphoproliferative disease, not otherwise specified (NOS)].

 Revision 1 PC-2 changed the designated internal organ for codes 231.8, 235.8, and 235.9 

from lung to “medical review”.

1

 Revision 1 PC-3 introduced two changes, both of which resulted in a decrease in dose 

and are, therefore, not impacted by DCAS-PER-043.

 Revision 2 modified handling adenocarcima of the lower third of the esophagus. The 

revised method required modeling of the esophagus and the stomach to determine which 

is higher.

 Revision 3 changed the internal organ for ICD-9 code 155.1 (malignant neo intrahepatic 

ducts) from gallbladder to liver/gallbladder. The liver is to be used for intrahepatic ducts; 

the gallbladder for gallbladder; and a medical review is required to determine the 

appropriate internal organ for any other specific organ.

 Revision 4 changed internal and external target organs for ICD-9 codes 238.0 (uncert 

behave neoplasm nec/nos) and 239.2 (bone/skin neoplasm nos). The internal target 

organ changed from “medical review” to bone surfaces; and the external target organ 

changed from red bone marrow to bone surface.

 Revision 5 added code 204.1 [chronic lymphocytic leukemia (CLL)] that is briefly 

described in ORAUT-OTIB-0082 and in greater detail in Apostoaei and Trabalka 

(2012). 

SC&A Comments

Based on summary information provided above, only seven of the nine revisions contributed to 

the need for DCAS-PER-043:

 Revision 1 and Revision 1 PC-3 introduced changes that decreased dose and are 

therefore not relevant to DCAS-PER-043.

 Revision 1 PC-1, Revision 1 PC-2, Revision 2, Revision 3, and Revision 4, introduced 

changes that (1) added ICD-9 codes, (2) changed internal and/or external target organs, or 

(3) revised the handling of esophageal cancer of the lower third section. These changes 

all have the potential for increasing dose.

 Revision 5 introduced CLL as a newly recognized radiogenic cancer (ICD-9 code 204.1 

series).

 

1 Due to the complexity of determining the appropriate internal organ for some ICD-9 code cancers, a 

medical review/recommendation by an ORAUT physician is required for determination of internal organ.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

9 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

Pertaining to revisions introduced in ORAUT-OTIB-0005 that necessitated the need for DCASPER-043, Sections 2.0 and 4.2 of OTIB-0005 (Revs. 03, 04, and 05) provide the following 

explanation regarding responsible parties for the assignment of ICD-9 codes and the appropriate 

selection of target organs/tissues for internal and external dose estimates:

 From Section 2.0

Under EEOICPA, the organs or tissues for which doses must be estimated are 

those that are delineated by the specified ICD-9 code that is received from the 

U.S. Department of Labor (DOL). While many ICD-9 codes are clear in their 

intended organ or tissue, additional guidance is necessary to identify the 

appropriate organs or tissues for internal and external dose estimation and the 

IREP model to use for the organ or tissue. This TIB designates the appropriate 

internal dosimetry organ and tissue selection for the various ICD-9 coded 

cancers, the appropriate organs and tissues to estimate external dose, and the 

appropriate IREP model.

Coding of the cancers is conducted by DOL on the basis of ICD-9. The U.S. 

Department of Health and Human Services (DHHS) National Center for Health 

Statistics (NCHS) has issued a related document, International Classification of 

Diseases, Ninth Edition, Clinical Modification (ICD-9-CM; DHHS 2008), which 

is widely used in the United States. ICD-9-CM is revised on an annual basis. . . . 

Although the ICD-9-CM coding provides detail that is not in ICD-9, this has not 

historically been required for assessment under EEOICPA. However, because 

ICD-9-CM is widely used in the United States, DOL might provide some codes 

that did not appear in earlier versions of this TIB. . . . Due to the complexity of 

determining the appropriate organs for lymphatic/hematopoietic cancers, the 

NIOSH Division of Compensation Analysis and Support (previously the Office of 

Compensation Analysis and Support or OCAS) conducted a comprehensive 

review of the state of knowledge regarding the etiology and diagnosis of the 

various lymphomas, leukemias, and multiple myeloma. This TIB incorporates the 

findings from this review as set forth in OCAS-TIB-012, Selection for Internal and 

External Dosimetry Target Organs for Lymphatic/Hematopoietic Cancers 

(NIOSH 2006). [Emphasis added.]

 From Section 4.2

Due to the complexity of determining the appropriate organs and tissues for some 

ICD-9 code cancers, a medical review by an Oak Ridge Associated Universities 

(ORAU) Team physician is required to determine the organs and tissues to use in 

IMBA for those cancers. These cancers have been designated in Table 3-1 as 

“Medical review.” The ORAU Team physician will recommend to the dose 

reconstructor the appropriate organs and tissues for dose estimation purposes.

SC&A concludes that revisions to ORAUT-OTIB-0005 (that necessitated DCAS-PER-043) were

exclusively introduced by parties that are generally not within the scope of SC&A’s review. We 
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

10 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

assume that changes and additions to ICD-9 codes reflect updates/revisions to the International 

Classification of Diseases and ORAUT’s improved understanding of corresponding internal and 

external target organs. 

Therefore, SC&A accepts changes introduced to ORAUT-OTIB-0005, and there are no findings.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

11 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

3.0 SUBTASK 2: ASSESS NIOSH’S SPECIFIC METHODS FOR 

CORRECTIVE ACTION

For corrective action, NIOSH only considered these revisions to ORAUT-OTIB-0005, which 

had the potential to increase the dose/POC of previously completed claims, as summarized 

below:

 Revision 1 PC-1 – NIOSH identified five claims that had been completed prior to this 

revision on March 5, 2004, which added the bone cancer model as a possible option to 

ICD-9 code 238.7. However, subsequent to this revision, all five cases had been returned 

for other reasons and reworked using the bone cancer model as a possible option. 

NIOSH stated that “. . . Therefore, no further action is necessary.”

 Revision 1 PC-2 – Previously completed claims affected by changes introduced in this 

revision were limited to esophageal cancer of the lower third for which stomach cancer 

is an optional consideration. NIOSH identified a total of six cancers of the lower third 

esophagus, of which two were compensated under a Special Exposure Cohort (SEC) and 

four were re-evaluated. None of the four reworked claims resulted in a POC ≥50%.

 Revision 3 – For code 155.1, this revision identified the liver as the appropriate internal 

organ for some cases that may have previously used the gall bladder. Of 23 previously 

completed claims with code 155.1, 8 were compensated under an SEC. Of the 15 claims 

that were re-evaluated, 13 claims remained below a POC of 50%.

 Revision 4 – This revision affected codes 232, 238, and 239.2. For code 232, this 

revision added basal cell carcinoma for consideration when the cell type was not

specified. NIOSH identified a total of 16 previously completed claims with code 232 for 

which the cell type had not been specified. When reworked, all 16 cases resulted in 

POCs less than 50%.

For code 238.0, the internal target organ was changed from medical review to bone 

surface and the external target organ from bone surface to bone marrow. A single claim 

was affected and re-evaluated. It resulted in a POC of <50%.

 Revision 5. The final revision to ORAUT-OTIB-0005 added chronic lymphocytic 

leukemia (CLL) as a radiogenic cancer that was previously not considered under the

EEOICPA. However, this change is being considered an additional cancer rather than a 

revised method for the reconstruction of dose. Since to date, no CLL claims have been 

processed, Revision 5 is not included in the audit of DCAS-PER-043.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

12 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

SC&A Comments, Findings, Observations

SC&A reviewed all revisions stated in DCAS-PER-043 and compared these to statements cited 

in the text and to entries given in Table 3-1 (Selection of Organs, Tissues, and IREP Models for 

Internal and External Dose Reconstruction Based on ICD-9 Code).

SC&A found no discrepancies, and there are no findings.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

13 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

4.0 SUBTASK 3: EVALUATE THE PER’s STATED APPROACH FOR 

IDENTIFYING THE NUMBER OF DRs REQUIRING REEVALUATION OF DOSE

Criteria used to determine the total population of claims that had the potential of being affected 

by DCAS-PER-043 included the following:

(1) Claims were completed prior to the issue date for a specific revision, which had the 

potential of increasing the dose;

(2) Claims with a derived POC of less than 50%; 

(3) Claims that met one or more changes that were identified in a specific revision as given in 

Section 3.0 of DCAS-PER-043 and summarized in Section 2.0 above; and

(4) A number of claims that met criteria #1, #2, and #3, but were excluded for reasons that 

include the following:

– claim had subsequently qualified for inclusion/compensation under an SEC; or

– claim had been returned for other reasons and reworked using the revised applicable 

changes.

In summary, revisions introduced in ORAUT-OTIB-0005 affected a total of 36 previously 

completed claims. Of these, 2 claims resulted in a revised POC greater than 50%; the remaining 

34 claims resulted in POCs of less than 45% and represent the pool of claims from which a 

subset is subject to audit.

SC&A’s Comments/Findings

SC&A was not given access to the primary data used by NIOSH to identify and quantify those 

claims, which met the stated criteria and qualified for a re-evaluation of dose. SC&A is, 

therefore, not able to verify the above-cited number of 36 claims that were subject to dose reevaluation.

Our assessment is, therefore, limited to the methodology/criteria employed by NIOSH to identify 

those claims that are/were potentially impacted by DCAS-PER-043. Based on this restrictive 

assessment, SC&A concludes that the screening criteria used to identify potentially impacted 

claims are scientifically sound.

SC&A has no findings pertaining to the identification of claims that were impacted by 

DCAS-PER-043.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

14 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

5.0 SUBTASK 4: CONDUCT AUDITS OF A SAMPLE SET OF DRs

AFFECTED BY DCAS-PER-043

Selection of DRs

Among the pool of 34 DRs that are subject to audit, SC&A recommends the selection of one 

claim from each of the following revisions and/or ICD-9 codes:

 Revision 2: ICD-9 code 150. This change required the need to consider stomach cancer

(both target organ and cancer model) for esophageal cancer of the lower third portion of 

the esophagus. Select one case from among four affected cases with reworked POC 

of <50%.

 Revision 3: ICD-9 code 155.1. This change specified liver as the appropriate internal 

dose organ for cases that had previously used the gall bladder. Select one case from 15 

affected claims with reworked POCs of <50%.

 Revision 4:

– ICD-9 Code 232 – added basal carcinoma to the considered cancer models for code 

232 when cell type was not specified. Select one claim from 16 reworked claims 

with POC of <50%.

– ICD-9 Code 238 – changed target organs. Select the single claim that was reevaluated and resulted in a POC of <50%.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

15 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

6.0 REFERENCES

42 CFR 82, 2002. Methods for Radiation Dose Reconstruction under the Energy Employees

Occupational Illness Compensation Program Act of 2000; Final Rule, Federal

Register/Vol.67, No. 85/Thursday, May 2, 2002, p. 22314.

Apostoadi, A.I. and J.R. Trabbalka. 2012. Review, Synthesis, and Application of Information on 

the Human Lymphatic System to Radiation Dosimetry for Chronic Lymphocytic Leukemia, Final 

Report. SENES Oak Ridge, Inc., Center for Risk Analysis, Oak Ridge, TN. March 2012.

DCAS 2013. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model Selection 

by ICD-9 Code Revision, Rev. 0, DCAS-PER-043, NIOSH’s Division of Compensation 

Analysis and Support, Cincinnati, Ohio. June 7, 2013.

DHHS (U.S. Department of Health and Human Services), 2008. International Classification of 

Diseases, Ninth Revision, Clinical Modification, Centers for Medicare and Medicaid Services 

and National Center for Health Statistics, Hyattsville, Maryland, October 1, 

http://www.cdc.gov/nchs/about/otheract/icd9/abticd9.htm.

NIOSH (National Institute for Occupational Safety and Health), 2006. Selection for Internal and 

External Dosimetry Target Organs for Lymphatic/Hematopoietic Cancers, OCAS-TIB-012, Rev. 

1, Office of Compensation Analysis and Support, Cincinnati, Ohio, February 10.

OCAS 2006. Preparation of Program Evaluation Reports and Program Evaluation Plans, 

OCAS-PR-008, Revision 2, NIOSH’s Office of Compensation Analysis and Support, 

Cincinnati, Ohio. December 6, 2006.

OCAS-IG-001. 2007. External Dose Reconstruction Implementation Guideline, Rev. 3, 

National Institute for Occupational Safety and Health, Office of Compensation Analysis and 

Support, Cincinnati, Ohio. November 21, 2007.

ORAUT 2003. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 00, ORAUT-OTIB-0005. Oak Ridge Associated Universities 

Team, Cincinnati, Ohio. November 3, 2003.

ORAUT 2004a. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 01, ORAUT-OTIB-0005. Oak Ridge Associated Universities 

Team, Cincinnati, Ohio. January 23, 2004.

ORAUT 2004b. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 01 PC-1, ORAUT-OTIB-0005. Oak Ridge Associated 

Universities Team, Cincinnati, Ohio. March 5, 2004.

ORAUT 2004c. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 01 PC-2, ORAUT-OTIB-0005. Oak Ridge Associated 

Universities Team, Cincinnati, Ohio. May 7, 2004.
Effective Date:

August 18, 2014

Revision No.

0

Document No.

SCA-TR-PR2014-0089

Page No.

16 of 16

NOTICE: This report has been reviewed for Privacy Act information and has been cleared for distribution.

However, this report is pre-decisional and has not been reviewed by the Advisory Board on Radiation and Worker 

Health for factual accuracy or applicability within the requirements of 42 CFR 82.

ORAUT 2004d. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 01 PC-3, ORAUT-OTIB-0005. Oak Ridge Associated 

Universities Team, Cincinnati, Ohio. October 29, 2004.

ORAUT 2005. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 02, ORAUT-OTIB-0005. Oak Ridge Associated Universities 

Team, Cincinnati, Ohio. December 2, 2005.

ORAUT 2006. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 02 PC-1, ORAUT-OTIB-0005. Oak Ridge Associated 

Universities Team, Cincinnati, Ohio. February 10, 2006.

ORAUT 2010. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 03, ORAUT-OTIB-0005. Oak Ridge Associated Universities 

Team, Cincinnati, Ohio. February 26, 2010.

ORAUT 2011. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 04, ORAUT-OTIB-0005. Oak Ridge Associated Universities 

Team, Cincinnati, Ohio. April 18, 2011.

ORAUT 2012a. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model 

Selection by ICD-9 Code, Rev. 05, ORAUT-OTIB-0005. Oak Ridge Associated Universities 

Team, Cincinnati, Ohio. December 20, 2012.

ORAUT 2012b. Dose Reconstruction Method for Chronic Lymphocytic Leukemia, Rev. 01 PC1, ORAUT-OTIB-0082. Oak Ridge Associated Universities Team, Cincinnati, Ohio. December 

20, 2012.