United States Energy Employees Occupational Illness CompensationProgram:  Adjudication of Radiation-related Cancer Claims Utilizing 

Dose Reconstruction and Probability of Causation ProceduresLarry J. Elliott, Ted Katz, James Neton, and Mary Schubauer-Berigan

U.S. Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway MS: R-45, Cincinnati, Ohio 45226

DISCUSSIONINTRODUCTIONGuidelines for Determining Probability of 

Causation (42CFR Part 81)

• Based on the cancer risk models developed by the National Institutes of Health (NIH).

• Cancer risk models updated by a joint workgroup of the National Cancer Institute and the Centers for Disease Control and Prevention (CDC).

• NIOSH incorporated additional changes with particular importance for claims under EEOICPA.• Risk models for skin cancer• Adjustments to risk models to account 

for unique types of radiation exposure

• Accounts for uncertainty associated with risk.

• Provide the Department of Labor with  systematic objective procedures for handling claims with unusual characteristics.• Primary cancer identification from 

secondary cancers

Overview

• Covers approximately 650,000 nuclear weapons production workers employed by the US Department of Energy and it contractors since the 1940’s.

• U.S. Congress passed the Energy Employees Occupational Illness Compensation Program Act in October 2000.• Purpose of the act was to establish a 

compensation program for:• Cancer• Beryllium Disease• Silicosis

• Benefit• $150,000 (US$)• Medical Coverage

• Department of Labor determines compensation eligibility based on probability that the cancer was “at least as likely as not”  (50% or greater probability) caused by radiation doses incurred in the line of duty.  • Determinations based on upper 99% 

confidence interval (credibility limit) of the probability of causation.

• December 2000, the President of the United States issued Executive Order 13179 assigning several policymaking and technical roles under EEOICPA to the Department of Health and Human Services (DHHS).

• Develop Guidelines for Determining the Probability of Causation (42 CFR Part 81)

• Develop Methods for Radiation Dose Reconstruction (42 CFR Part 82)

Methods for Dose Reconstruction             (42CFR Part 82)

• Based on standard research approaches employed by many epidemiological studies.

• Systematic inclusion of claimant in dose reconstruction process.

• Trade-off of reduced precision for increased processing efficiency.

• Triage approach to husband resources in which increased precision is important and to expedite conclusion of dose reconstructions for claims in which outcome is not affected by increased precision. 

• Accounts for uncertainty and effectiveness factors of radiation dose.

1. Review and Verify Eligibility2. Requests Employment Verification from DOE4. Requests Dose Reconstruction from NIOSH

9.  Calculated Probability of Causation10. Issues recommended Decision11. Renders Final Decision

5. Requests Dose Data from DOE7. Interviews Claimant or Survivor8. Conducts Dose Reconstruction 

3. Verifies Employment6. Provides Radiation Dose Data 

Department of Labor Department of Energy

Department of Health and Human Services - NIOSH